ABSTRACT In Brazil, the COVID-19 burden was substantial, and risk factors associated with higher in-hospital mortality rates have been extensively studied. However, information on short-term all-cause mortality and the factors associated with death in patients who survived the hospitalization period of acute SARS-CoV-2 infection is limited. We analyzed the six-month post-hospitalization mortality rate and possible risk factors of COVID-19 patients in a single center in Brazil. This is a retrospective cohort study focused on a six-month follow-up. The exclusion criteria were death during hospitalization, transference to another hospital, and age under 18. We collected data from the charts of all hospitalized patients from March 2020 to December 2020 with a positive RT-PCR test for SARS-CoV-2, resulting in a sample size of 106 patients. The main outcome was death after hospitalization, whereas comorbidities and demographics were evaluated as risk factors. The crude post-hospitalization death rate was 16%. The first 30 days of follow-up had the highest mortality rate. In a Cox regression model for post-hospitalization mortality, previous chronic kidney disease (HR, 4.06, 95%CI 1.46 – 11.30) and longer hospital stay (HR 1.01, 95%CI 1.00 – 1.02) were the only factors statistically associated with death. In conclusion, a high six-month all-cause mortality was observed. Within the six-month follow-up, a higher risk of death was observed for patients who had prior CKD and longer hospital stay. These findings highlight the importance of more intensive medical surveillance during this period. Brazil COVID19 COVID 19 COVID-1 substantial inhospital studied However shortterm short term allcause cause SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- limited sixmonth six month posthospitalization post followup. followup follow up. up 18 202 RTPCR RT PCR SARSCoV2, 2, 10 16 16% 3 HR, HR 406 4 06 4.06 95CI CI 95 146 1 46 1.4 11.30 1130 11 101 01 1.01 100 00 1.0 1.02 102 02 conclusion followup, up, COVID1 COVID- SARS-CoV 20 40 0 4.0 9 14 1. 11.3 113 4. 11.

Abstract Brazilian Red Propolis is a resinous material produced by Apis mellifera bees through the collection of the exudates of Dalbergia ecastaphyllum , rich in flavonoids, and Symphonia globulifera and Clusia species, which are rich in polyprenylated benzophenones. More than 200 compounds, including flavonoids and polyprenylated benzophenones have been found in Brazilian red propolis. The objective of the present study was to evaluate the chemical composition and antiviral activity of an ethanolic extract of red propolis from Alagoas, Brazil, against Herpes Simplex Virus (HSV-1). In the HPLC-PDA-ESI-MS/MS analysis were detected flavanones, isoflavones, chalcones, pterocarpans and polyprenylated benzophenones. The measurement of antiviral activity of red propolis extract was performed by DNA quantification through quantitative real-time PCR assay and negative staining Electron Microscopy. The pretreatment, post-treatment, and virucide assays using ethanolic extract of red propolis with concentration of 8, 12, 24, 48, or 96 µ g/mL, indicated an inhibition of the viral binding and viral entry into cells as well as the replication of HSV-1. In the electron microscopy imaging was observed the disruption of the viral membrane in the HSV-1 treated with red propolis, when compared with HSV-1 that was treated with phosphate buffered saline alone, indicating that ethanolic extract from red propolis can act directly on the viral envelope, through lipid membrane degradation and/or directly blocking the enriched proteins on the viral surface. species 20 compounds Alagoas Brazil HSV1. HSV1 HSV 1 . (HSV-1) HPLCPDAESIMS/MS HPLCPDAESIMSMS HPLC PDA ESI MS/MS MS flavanones isoflavones chalcones realtime real time Microscopy pretreatment posttreatment, posttreatment post treatment, treatment post-treatment 8 12 24 48 9 gmL g mL g/mL 1. HSV- alone envelope andor surface 2 (HSV-1 HPLCPDAESIMS MSMS 4 (HSV- (HSV

ABSTRACT Objective To evaluate deaths, hospitalizations, and persistence of symptoms in patients with COVID-19 after infection in an outpatient setting during the first COVID-19 wave in Brazil. Methods This prospective cohort was between April 2020 and February 2021. Hospitalized or non-hospitalized COVID-19 patients until five days after symptom onset were included. The outcomes measured were incidence of death, hospitalization, and persistence of more than two symptoms 60 days after discharge. Results Out of 1,198 patients enrolled in the study, 66.7% were hospitalized. A total of 289 patients died (1 [0.3%] non-hospitalized and 288 [36%] hospitalized). At 60 days, patients non-hospitalized during admission had more persistent symptoms (16.2%) compared to hospitalized (37.1%). The COVID-19 severity variables associated with the persistence of two or more symptoms were increased age (OR= 1.03; p=0.015), respiratory rate at hospital admission (OR= 1.11; p=0.005), length of hospital stay of more than 60 days (OR= 12.24; p=0.026), and need for intensive care unit admission (OR= 2.04; p=0.038). Conclusion COVID-19 survivors who were older, tachypneic at admission, had a hospital length of stay >60 days, and were admitted to the intensive care unit had more persistent symptoms than patients who did not require hospitalization in the early COVID-19 waves. ClinicalTrials.gov Identifier: NCT04479488. deaths hospitalizations COVID19 COVID 19 COVID-1 Brazil 202 2021 nonhospitalized non included death 6 discharge 1198 1 198 1,19 study 667 66 7 66.7 28 ( 0.3% 03 0 3 [0.3% 36% 36 [36% . hospitalized) 16.2% 162 16 2 (16.2% 37.1%. 371 37.1% 37 (37.1%) OR= OR (OR 1.03 103 p=0.015, p0015 p p=0.015 , 015 p=0.015) 1.11 111 11 p=0.005, p0005 p=0.005 005 p=0.005) 12.24 1224 12 24 p=0.026, p0026 p=0.026 026 p=0.026) 2.04 204 04 p=0.038. p0038 p=0.038 038 p=0.038) older >6 waves ClinicalTrialsgov ClinicalTrials gov Identifier NCT04479488 NCT COVID1 COVID- 20 119 1,1 66. 0.3 [0.3 [36 16.2 (16.2 37.1 (37.1% 1.0 10 p001 p=0.01 01 1.1 p000 p=0.00 00 12.2 122 p002 p=0.02 02 2.0 p003 p=0.03 > NCT0447948 1, 0. [0. [3 16. (16. 37. (37.1 1. p00 p=0.0 12. 2. NCT044794 [0 [ (16 (37. p0 p=0. NCT04479 (37 p=0 NCT0447 (3 p= NCT044 NCT04 NCT0

ABSTRACT Background: This study aimed to identify COVID-19 cases among people living with HIV (PLWH) in Brazil in 2020, describe their clinical, sociodemographic, and epidemiological profiles, and evaluate the factors associated with disease severity. Methods: This cross-sectional study used secondary data obtained from the Brazilian healthcare system. Probabilistic and deterministic data linkage methods were used to identify coinfected patients. Descriptive statistical analysis was conducted, and factors associated with severe cases were evaluated using Pearson's chi-squared test, Student's t-test, and logistic regression. Results: In 2020, 36,746 coinfections were identified, making it one of the largest coinfection databases described worldwide. In total, 4,502 (12.25%) patients had severe cases and 32,244 (87.75%) had non-severe cases. The covariates age (OR=1.05; 95% CI: 1.05-1.06), nonwhite ethnicity (OR=1.68; 95% CI: 1.56-1.81), history of AIDS diagnosis (OR=1.17; 95% CI: 1.08-1.28), recent HIV diagnosis (OR=5.47; 95% CI: 4.25-7.02), absence of antiretroviral therapy (OR=1.70; 95% CI: 1.57-1.84), CD4+ < 200 (OR=6.41; 95% CI: 5.09-8.08), detectable HIV viral load (OR=2.61; 95% CI: 2.21-3.05), ≥ 1 comorbidity (OR=4.09; 95% CI: 3.79-4.41), and ≥ 4 symptoms were associated with increased severity. Conclusions: Multiple factors were linked to severe COVID-19, including uncontrolled HIV infection, age > 50 years, comorbidities, and racial disparities. This study reinforces the importance of maintaining public policies focused on early HIV diagnosis, access and adherence to treatment, especially for minority ethnic groups, and focusing on premature aging in PLWH. Background COVID19 COVID 19 COVID-1 PLWH (PLWH 2020 clinical sociodemographic profiles severity Methods crosssectional cross sectional system conducted Pearsons Pearson s chisquared chi squared test Students Student ttest, ttest t t-test regression Results 36746 36 746 36,74 identified worldwide total 4502 502 4,50 12.25% 1225 12 25 (12.25% 32244 32 244 32,24 87.75% 8775 87 75 (87.75% nonsevere non OR=1.05 OR105 OR 05 (OR=1.05 95 CI 1.051.06, 105106 1.05 1.06 , 06 1.05-1.06) OR=1.68 OR168 68 (OR=1.68 1.561.81, 156181 1.56 1.81 56 81 1.56-1.81) OR=1.17 OR117 17 (OR=1.17 1.081.28, 108128 1.08 1.28 08 28 1.08-1.28) OR=5.47 OR547 5 47 (OR=5.47 4.257.02, 425702 4.25 7.02 7 02 4.25-7.02) OR=1.70 OR170 70 (OR=1.70 1.571.84, 157184 1.57 1.84 57 84 1.57-1.84) CD4 CD 20 OR=6.41 OR641 6 41 (OR=6.41 5.098.08, 509808 5.09 8.08 09 8 5.09-8.08) OR=2.61 OR261 2 61 (OR=2.61 2.213.05, 221305 2.21 3.05 21 3 2.21-3.05) OR=4.09 OR409 (OR=4.09 3.794.41, 379441 3.79 4.41 79 3.79-4.41) Conclusions COVID19, 19, infection years comorbidities disparities treatment groups COVID1 COVID- 202 3674 74 36,7 450 4,5 12.25 122 (12.25 3224 24 32,2 87.75 877 (87.75 OR=1.0 OR10 0 (OR=1.0 9 051 1.051.06 10510 105 1.0 106 1.05-1.06 OR=1.6 OR16 (OR=1.6 561 1.561.81 15618 156 1.5 181 1.8 1.56-1.81 OR=1.1 OR11 (OR=1.1 081 1.081.28 10812 108 128 1.2 1.08-1.28 OR=5.4 OR54 (OR=5.4 257 4.257.02 42570 425 4.2 702 7.0 4.25-7.02 OR=1.7 OR17 (OR=1.7 571 1.571.84 15718 157 184 1.57-1.84 OR=6.4 OR64 (OR=6.4 098 5.098.08 50980 509 5.0 808 8.0 5.09-8.08 OR=2.6 OR26 (OR=2.6 213 2.213.05 22130 221 2.2 305 3.0 2.21-3.05 OR=4.0 OR40 (OR=4.0 794 3.794.41 37944 379 3.7 441 4.4 3.79-4.41 367 36, 45 4, 12.2 (12.2 322 32, 87.7 (87.7 OR=1. OR1 (OR=1. 1.051.0 1051 10 1. 1.05-1.0 1.561.8 1561 15 18 1.56-1.8 1.081.2 1081 1.08-1.2 OR=5. OR5 (OR=5. 4.257.0 4257 42 4. 7. 4.25-7.0 1.571.8 1571 1.57-1.8 OR=6. OR6 (OR=6. 5.098.0 5098 5. 80 8. 5.09-8.0 OR=2. OR2 (OR=2. 2.213.0 2213 22 2. 30 3. 2.21-3.0 OR=4. OR4 (OR=4. 3.794.4 3794 37 44 3.79-4.4 12. (12. 87. (87. OR=1 (OR=1 1.051. 1.05-1. 1.561. 1.56-1. 1.081. 1.08-1. OR=5 (OR=5 4.257. 4.25-7. 1.571. 1.57-1. OR=6 (OR=6 5.098. 5.09-8. OR=2 (OR=2 2.213. 2.21-3. OR=4 (OR=4 3.794. 3.79-4. (12 (87 OR= (OR= 1.051 1.05-1 1.561 1.56-1 1.081 1.08-1 4.257 4.25-7 1.571 1.57-1 5.098 5.09-8 2.213 2.21-3 3.794 3.79-4 (1 (8 (OR 1.05- 1.56- 1.08- 4.25- 1.57- 5.09- 2.21- 3.79- (

ABSTRACT The objective of this study is to present the protocol of a cluster randomized clinical trial to be conducted through the TeleICU project - Qualification of Intensive Care by Telemedicine. The study will consist of a cluster randomized clinical trial, open label, in pediatric intensive care units, with an allocation ratio of 1:1, to compare the intervention group (support of Telemedicine for patients admitted to the pediatric intensive care unit) with a control group (pediatric intensive care unit usual care). The study proposed to select 16 pediatric intensive care units, including 100 participants per site, with a total of 1,600 participants. The intervention group will receive telerounds from Monday to Friday and will have specialists and continuing education activities available. The primary outcome measure will be the length of stay in the pediatric intensive care unit, defined as the difference between the date of discharge of the participant and the date of admission to the intensive care unit. The secondary outcomes will be mortality rate, invasive mechanical ventilation-free days, days using antibiotics, days using vasoactive drugs and days using sedoanalgesia. This study will be conducted in accordance with Resolution 466/12 of the National Health Council, with approval by the Research Ethics Committee of the institutions involved. The present study has the potential to reproduce studies on Telemedicine in intensive care and may make important contributions to care in intensive care units in Brazil and other settings. If Telemedicine shows positive clinical care results compared to conventional treatment, more pediatric patients may benefit. ClinicalTrials.gov registry: NCT05260710

RESUMO O objetivo deste estudo será apresentar o protocolo de um ensaio clínico randomizado em cluster a ser realizado por meio do projeto TeleUTI - Qualificação da Assistência em Terapia Intensiva por Telemedicina. O estudo consistirá em um ensaio clínico randomizado por cluster, open label, em unidades de terapia intensiva pediátricas, com proporção de alocação de 1:1, com o intuito de comparar o grupo de intervenção (apoio da telemedicina para os pacientes internados na unidade de terapia intensiva pediátrica) com um grupo controle (cuidados habituais da unidade de terapia intensiva pediátrica). O estudo se propõe a selecionar 16 unidades de terapia intensiva pediátricas, incluindo 100 participantes por local, com o total de 1.600 participantes. O grupo intervenção receberá telerounds de segunda-feira a sexta-feira e terá à disposição especialistas e atividades de educação continuada. O desfecho primário a ser avaliado será o tempo de permanência nas unidades de terapia intensiva pediátricas, definido pela diferença entre a data de alta do participante com a data de admissão na unidade de terapia intensiva. Os desfechos secundários serão: taxa de mortalidade; dias livres de ventilação mecânica, dias de uso de antibióticos, dias de uso de drogas vasoativas e dias de uso de sedoanalgesia. Este estudo será conduzido em conformidade com a resolução 466/12 do Conselho Nacional de Saúde, com aprovação pelo Comitê de Ética em Pesquisa das instituições hospitalares envolvidas. O trabalho tem o potencial de reproduzir estudos sobre Telemedicina em cuidados intensivos, podendo trazer contribuições importantes ao atendimento em unidades de terapia intensiva no Brasil e em outras realidades. Se a Telemedicina mostrar resultados clínicos assistenciais positivos em relação ao tratamento convencional, mais pacientes pediátricos poderão ser beneficiados. Registro ClinicalTrials.gov: NCT05260710

ABSTRACT BACKGROUND: Liver transplantation represents the best therapeutic modality in end-stage chronic liver disease, severe acute hepatitis, and selected cases of liver tumors. AIMS: To describe a double retransplant in a male patient diagnosed with Crohn's disease and complicated with primary sclerosing cholangitis, severe portal hypertension, and cholangiocarcinoma diagnosed in the transplanted liver. METHODS: A 48-year-old male patient diagnosed with Crohn's disease 25 years ago, complicated with primary sclerosing cholangitis and severe portal hypertension. He underwent a liver transplantation in 2018 due to secondary biliary cirrhosis. In 2021, a primary sclerosing cholangitis recurrence was diagnosed and a liver retransplantation was indicated. Recipient's hepatectomy was very difficult by reason of complex portal vein thrombosis requiring extensive thromboendovenectomy. Intraoperative ultrasound with liver doppler evaluation was performed. Two suspicious nodules were incidentally diagnosed in the donor's liver and immediately removed for anatomopathological evaluation. RESULTS: After pathological confirmation of carcinoma, probable cholangiocarcinoma, at frozen section, the patient was re-listed as national priority and a new liver transplantation was performed within 24 hours. The patient was discharged after 2 weeks. CONCLUSIONS: The screening for neoplasms in donated organs should be part of our strict daily diagnostic arsenal. Moreover, we argue that, for the benefit of an adequate diagnosis and the feasibility of a safer procedure, the adoption of imaging tests routine for the liver donor is essential, allowing a reduction of the costs and some potential risks of liver transplant procedure.

RESUMO RACIONAL: O transplante de fígado representa a melhor modalidade terapêutica na doença hepática crônica terminal, hepatite aguda grave e casos selecionados de tumores hepáticos. OBJETIVOS: Descrever um retransplante duplo em paciente do sexo masculino, diagnosticado com doença de Crohn e complicado com colangite esclerosante primária, hipertensão portal grave e colangiocarcinoma diagnosticado no fígado transplantado. MÉTODOS: Paciente do sexo masculino, 48 anos, diagnosticado com doença de Crohn há 25 anos e complicado com colangite esclerosante primária e hipertensão portal grave. Foi submetido a um transplante de fígado em 2018 devido a cirrose biliar secundária. Em 2021, foi diagnosticada recidiva de colangite esclerosante primária e indicado retransplante hepático. A hepatectomia do receptor foi de alta complexidade devido à trombose complexa da veia porta, exigindo extensa tromboendovenectomia. Foi realizada ultrassonografia intraoperatória com doppler hepático. Dois nódulos suspeitos foram diagnosticados incidentalmente no fígado do doador e imediatamente removidos para avaliação anatomopatológica. RESULTADOS: Após confirmação patológica de carcinoma, provável colangiocarcinoma, pela congelação, o paciente foi relistado como prioridade nacional, e novo transplante hepático foi realizado em 24 horas. O paciente teve alta após 2 semanas. CONCLUSÕES: O rastreamento de neoplasias em órgãos doados deve fazer parte de nosso estrito arsenal diagnóstico diário. Além disso, defendemos que, em benefício de um diagnóstico correto e da viabilidade de um procedimento mais seguro, a adoção de uma rotina de exames de imagem é essencial em doadores hepáticos, permitindo a redução dos custos e alguns riscos potenciais do procedimento de transplante hepático.

Resumen Objetivo Caracterizar el perfil clínico-epidemiológico de los casos por síndrome inflamatorio multisistémico pediátrico asociado temporalmente a la COVID-19 (SIM-PedS) e identificar factores asociados a los óbitos por SIM-PedS en Brasil, 2020. Métodos Estudio transversal basado en datos del monitoreo nacional de la SIM-PedS, Brasil, 2020. Se utilizó regresión logística para estimar razones de probabilidades brutas y ajustadas (OR, odds ratio). Resultados Los casos (n=652) presentaron edad mediana de 5 años, 57,1% eran hombres, 52,0% de raza/color pardo y 6,4% falleció. La probabilidad de muerte fue significativamente mayor entre aquellos con saturación de O2<95% (ORa=4,35 – IC95%1,69;11,20) y resultado alterado de urea (ORa=5,18 – IC95% 1,91;14,04); menor en ausencia de manchas rojas como erupción (ORa=0,23 – IC95% 0,09;0,62), con uso de anticoagulantes (ORa=0,32 – IC95% 0,12;0,89) e inmunoglobulinas (ORa=0,38 – IC95%0,15;1,01). Conclusión La letalidad fue mayor entre casos que presentaron saturación de O2<95% y urea alterada, y menor entre aquellos con manchas rojas, que usaron inmunoglobulinas y anticoagulantes.

Resumo Objetivo Caracterizar o perfil clínico-epidemiológico da síndrome inflamatória multissistêmica pediátrica temporalmente associada à COVID-19 (SIM-P) e identificar fatores associados aos óbitos de SIM-P no Brasil, 2020. Métodos Estudo seccional, utilizando dados do monitoramento nacional da SIM-P. Empregou-se regressão logística para estimar razões de chances (OR, odds ratios ) brutas e ajustadas. Resultados Os casos (n=652) apresentaram mediana de idade de 5 anos; 57,1% eram do sexo masculino e 52,0% de raça/cor da pele parda; 6,4% evoluíram a óbito. A chance de óbito foi significativamente maior nos que apresentaram saturação de O2<95% (ORa=4,35 – IC95% 1,69;11,20) e resultado alterado de ureia (ORa=5,18 – IC95% 1,91;14,04); e menor na ausência de manchas vermelhas pelo corpo (ORa=0,23 – IC95% 0,09;0,62), com uso de anticoagulantes (ORa=0,32 – IC95% 0,12;0,89) e imunoglobulinas (ORa=0,38 – IC95% 0,15;1,01). Conclusão A letalidade foi maior entre casos que apresentaram saturação de O2<95% e ureia alterada; e menor nos que apresentaram manchas vermelhas, usaram imunoglobulinas e anticoagulantes.

Abstract Objective To characterize the clinical-epidemiological profile of multisystem inflammatory syndrome in children temporally associated with COVID-19 (MIS-C), and to identify factors associated with MIS-C deaths in Brazil, 2020. Methods This was a cross-sectional study, using national MIS-C monitoring data. Logistical regression was performed to estimate crude and adjusted odds ratios (OR). Results Median case (n=652) age was 5 years, 57.1% were male, 52.0% were of brown race/skin color and 6.4% died. Likelihood of death was greater among those who presented O2 saturation <95% (ORa=4.35 – 95%CI 1.69;11.20) and altered urea results (ORa=5.18 – 95%CI 1.91;14.04); likelihood of death was lower when red skin blotches were not present (ORa=0.23 – 95%CI 0.09;0.62), when anticoagulants were used (ORa=0.32 – 95%CI 0.12;0.89) and when immunoglobulins were used (ORa=0.38 – 95%CI 0.15;1.01). Conclusion Fatality ratios were higher among cases that presented O2 saturation <95% and altered urea results. Fatality ratios were lower among those with red skin blotches, and those who used immunoglobulins and anticoagulants.

RESUMO Objetivo: Analisar a distribuição dos serviços de saúde de atenção às hepatites virais e os casos notificados de hepatites virais segundo as regiões de saúde dos estados do Norte do Brasil. Método: Trata-se de pesquisa avaliativa, descritiva e quantitativa considerando os serviços de atenção e casos notificados de hepatites virais na região Norte do Brasil. Foram coletados dados do Cadastro Nacional de Estabelecimentos de Saúde e do Sistema de Informação de Agravos e Notificação. Utilizou-se estatística descritiva e georreferenciamento por meio de software para visualizar a distribuição espacial dos serviços e os casos notificados. Resultados: Os serviços são distribuídos de maneira diferenciada; testes rápidos apresentam-se capilarizados nos estados; demais exames para confirmar o diagnóstico e o tratamento são realizados em algumas regiões de saúde, com maior agrupamento de serviços nas capitais e suas cercanias. Verificam-se casos notificados de maneira pulverizada nas regiões, com áreas de maior concentração próximas aos serviços. Conclusão: A disponibilidade de serviços pode favorecer o acesso e a adoção de medidas de prevenção, diagnóstico e monitoramento de casos. Entretanto, peculiaridades organizacionais do sistema e serviços de saúde evidenciam fragilidades que repercutem no acesso e na integralidade da atenção às hepatites virais.

ABSTRACT Objective: To analyze the distribution of health care services for viral hepatitis and reported cases of viral hepatitis according to the health regions of Northern Brazil. Method: It is an evaluative, descriptive and quantitative research considering viral hepatitis care services and reported cases in the Northern region of Brazil, using data collected from the National Registry of Health Establishments and the Notifiable Diseases Information System. Descriptive statistics and georeferencing, through software, were used to demonstrate the spatial distribution of services and reported cases. Results: Viral hepatitis health services are distributed in a differentiated way; rapid tests are capillaries in the states; confirmatory tests and treatment are performed in some health regions, with a greater grouping of services in the capitals and their surroundings. Cases were reported across all regions, with areas of higher concentration near services. Conclusion: The availability of services can favor access to prevention, diagnosis and monitoring of cases. However, organizational peculiarities of the health system and services highlight fragilities that have repercussions on the access and entirety of viral hepatitis care.

El metabolismo humano produce calor en las actividades laborales. El cuerpo humano funciona como un sistema termodinámico que mantiene constante la temperatura corporal. El uso de equipo de protección personal (EPP) dificulta la disipación del calor generado y el mantenimiento de la temperatura corporal a un nivel cómodo. Este estudio analizó la interferencia del EPP agrícola en el confort térmico de los trabajadores. Este estudio realizó mediciones de la frecuencia cardiaca y la temperatura corporal de los trabajadores que utilizan EPP durante el proceso de pulverización de pplaguicidas. Este estudio también hizo evaluaciones subjetivas de la sensación térmica de los trabajadores a través de un cuestionario. Los resultados demostraron: (i) la insuficiencia de proyectos de EPP agrícola, ya que han tenido un impacto negativo en el proceso de termorregulación corporal y (ii) la existencia de importantes diferencias individuales entre los operadores controlados, que pueden estar relacionadas con las estrategias operativas diferentes entre los operadores. Este estudio mostró que hay una fuerte correlación entre la evaluación subjetiva de la sensación térmica y la temperatura corporal.

Human metabolism produces heat during labor activities. The human body works as a thermodynamic system maintaining a steady body temperature. The use of Personal Protective Equipment (PPE) jeopardizes the heat dissipation, making difficult to keep ain body temperature at a comfortable level. This study analyzed the interference of PPE in workers' thermal comfort. This study made measurements of heart rate and body temperature of workers using PPE during the process of spraying pesticides. This study also made subjective evaluations of thermal sensation of workers through a questionnaire. The results demonstrated: (i) the inadequacy of PPE projects because they indicated a negative impact on body thermoregulation process and (ii) the existence of significant individual differences between the monitored workers, which may be related to different operating modes. This study showed that there is a strong correlation between the subjective evaluation of the thermal sensation by workers and body temperature measured.

O metabolismo humano produz calor devido ao esforço físico nas atividades laborais. O corpo humano funciona como sistema termodinâmico que mantem a temperatura corporal constante. A utilização de Equipamento de Proteção Individual (EPI) dificulta a dissipação do calor gerado e a manutenção da temperatura corporal num nível confortável. Este estudo analisou a interferência dos EPI no conforto térmico dos trabalhadores rurais através de medições das frequências cardíacas e das temperaturas corporais dos trabalhadores durante a pulverização de agrotóxicos. Também foram feitas avaliações da sensação térmica dos trabalhadores através de um questionário. Os resultados encontrados demonstraram: (i) a inadequação dos EPI agrícolas, devido apresentarem uma interferência negativa no processo de termorregulação corporal e (ii) a existência de diferenças individuais significativas entre os trabalhadores monitorados. Este estudo mostrou, ainda que há uma correlação forte entre a avaliação da sensação térmica dos trabalhadores e da temperatura corporal medida.

Métabolisme humain produit de la chaleur dans les activités de travail. Le corps humain fonctionne comme un système thermodynamique. L'utilisation de l'équipement de protection individuelle (EPI) empêche la dissipation de la chaleur générée. Cette étude a analysé l'interférence du EPI agricole dans le confort thermique des travailleurs. Cette étude a effectué des mesures de la fréquence cardiaque et la température corporelle des travailleurs utilisant EPI pendant le processus de pulvérisation de pesticides. Cette étude a également fait des évaluations subjectives de la sensation thermique des travailleurs par le biais d'un questionnaire. Les résultats ont démontré: (i) l'insuffisance des projets d'EPI agricoles parce qu'ils ont eu une interférence négative dans le processus de thermorégulation du corps et (ii) l'existence d'importantes différences individuelles entre les opérateurs contrôlés. Cette étude a montré qu'il existe une forte corrélation entre l'évaluation subjective de la sensation thermique et la température corporelle mesurée.

Abstract Sialolithiasis is one of the most common diseases of salivary glands. Sialoliths mainly develop in the submandibular gland with few cases described in the parotid and sublingual glands. They are more common in adults between the third and fourth decades of life, and can affect the elderly and rarely children and adolescents. In most cases, they are located in the ducts, but parenchymal location is unusual. Clinical signs of sialolithiasis are well known; however, they may appear in atypical sites, making it difficult to locate and diagnose them precisely. In these cases, the use of complementary imaging examinations, such as computerized tomography, is critical to delimit the lesion and determine the treatment plan. Therefore, the description of this clinical case of a parotid sialolith, with atypical location, in a 17-year-old patient, that was surgically removed by extraoral access after determining its correct location by using computerized tomography imaging is relevant and important.

Resumen La sialolitiasis es una de las enfermedades más frecuentes de las glándulas salivales. Los sialolitos pueden formarse en la glándula submandibular, y son pocos los casos que se describen en las glándulas parótida y sublingual. Son más comunes en los adultos entre la tercera y la cuarta décadas de la vida, y pueden darse en los ancianos y, excepcionalmente, en los niños y adolescentes. En la mayor parte de los casos, se encuentran en los conductos, y la localización parenquimatosa es poco habitual. Los signos clínicos de la sialolitiasis son bien conocidos; sin embargo, pueden aparecer en localizaciones atípicas, lo cual dificulta su localización y diagnóstico precisos. En tales casos, el uso de técnicas de imagen complementarias, como la tomografía computarizada es crucial para delimitar la lesión y determinar el plan de tratamiento. Así pues, la descripción de este caso clínico de un sialolito parotídeo con una localización atípica, en un paciente de 17 años, que se extrajo con un abordaje extraoral tras determinar su localización exacta mediante tomografía computarizada tiene interés e importancia.

RESUMO: Objetivos: Vacinas representam um importante avanço para melhorar a saúde de uma população. O registro adequado dos dados vacinais é um fator crítico para a programação da distribuição de vacinas. Este estudo investiga os registros de uma vacina aplicada à população, de acordo com dados coletados nas salas de vacinação e dados obtidos a partir de uma plataforma governamental de Internet. Métodos: O número mensal total de doses aplicadas da vacina contra difteria, tétano e coqueluche (isolada ou combinada à vacina contra Haemophilus influenzae tipo b) de uma cidade de médio porte da Região Sudeste do Brasil foi coletado no período de Janeiro/2006 a Dezembro/2010, de duas fontes: a nível Local (diretamente de salas de vacinação, o "padrão ouro") e a nível Federal (a partir de uma plataforma governamental de Internet). Os dados dessas fontes foram comparados utilizando estatística descritiva e a Percentagem de erro. Resultados: Os valores dos dados disponibilizados pela plataforma governamental diferem daqueles obtidos nas salas de vacinação, com uma Percentagem de erro compreendida no intervalo [-0,48; 0,39]. Valores concordantes foram observados somente em um dentre os sessenta meses analisados (1,66%). Conclusões: Detectou-se uma frequente e acentuada diferença entre o número de doses aplicadas da vacina observada relativamente às duas fontes de dados da pesquisa.

ABSTRACT: Objectives: Vaccines represent an important advancement for improving the general health of a population. The effective recording of vaccine data is a factor for the definition of its supply chain. This study investigated vaccine data recording relatively to data collected from vaccination rooms and data obtained from a government-developed Internet platform. Methods: The monthly recorded total number of diphtheria and tetanus toxoids and pertussis vaccine (alone or in combination with the Haemophilus influenzae type b conjugate vaccine) doses administered in a medium-sized city of the Southeast region of Brazil was collected for the period January/2006 through December/2010 from two sources: City level (directly from vaccination rooms, the study "gold standard"), and Federal level (from an Internet platform developed by the country government). Data from these sources were compared using descriptive statistics and the Percentage error. Results: The data values made available by the Internet platform differed from those obtained from the vaccination rooms, with a Percentage error relatively to the actual values in the range [-0.48; 0.39]. Concordant values were observed only in one among the sixty analyzed months (1.66%). Conclusions: A frequent and large difference between the number of diphtheria and tetanus toxoids and pertussis vaccine doses administered in the two levels was detected.

RESUMO OBJETIVO Avaliar o impacto da implantação de leitos de longa permanência para pacientes de baixa complexidade e alta dependência em hospitais de pequeno porte sobre o desempenho de hospital terciário de referência em emergência. MÉTODOS Para este estudo longitudinal, foram identificados hospitais em três municípios no departamento regional de saúde coberto pela instância terciária e que forneciam 10 leitos de longa permanência cada. Os pacientes foram transferidos para os hospitais desses municípios com base em protocolo específico. Obteve-se o desfecho dos pacientes transferidos por acompanhamento diário. Fatores de confusão foram ajustados por regressão logística e semiparamétrica de Cox. RESULTADOS Entre 1 de setembro de 2013 e 30 de setembro de 2014, foram transferidos 97 pacientes, sendo 72,1% homens, com idade média de 60,5 anos (DP = 1,9), para os quais foram realizadas 108 transferências. Desses pacientes, 41,7% evoluíram ao óbito, 33,3% receberam alta, 15,7% retornaram à instância terciária, e apenas 9,3% permaneceram internados até o final do período analisado. Foi calculado o índice de comorbidade de Charlson – 0 (n = 28 [25,9%]), 1 (n = 31 [56,5%]) e ≥ 2 (n = 19 [17,5%]) – a única variável que aumentou a chance de óbito ou retorno ao hospital terciário (Razão de Chances = 2,4; IC95% 1,3;4,4). O tempo de permanência nos leitos de longa permanência foi de 4.253 pacientes-dia, que representariam 607 vagas no hospital terciário, considerando-se a média de internação de sete dias. O hospital terciário aumentou o número de vagas em 50,0% para terapia intensiva, 66,0% para neurologia e 9,3% para as vagas totais. A permanência dos pacientes nos leitos de longa permanência limitou-se em grande parte aos primeiros 30 (50,0%) e 60 (75,0%) dias. CONCLUSÕES A implantação de leitos de longa permanência teve impacto no aumento de vagas novas oferecidas pela instância terciária tanto gerais como para áreas de estrangulamento do sistema, como a Neurologia e Terapia Intensiva. O índice de comorbidade de Charlson está associado à chance de o paciente evoluir ao óbito ou retornar para a instância terciária, mesmo quando ajustado por possíveis fatores de confusão.

ABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.

O objetivo deste artigo é avaliar a imagem corporal de adolescentes de cidades rurais e suas relações com o estado nutricional, sexo e período da adolescência. Estudo transversal com adolescentes de ambos os sexos. A imagem corporal foi avaliada pelo Body Shape Questionnaire (BSQ) e pela Escala de Silhuetas para Adolescentes (ESA). O peso e a estatura foram aferidos para o cálculo do índice de massa corporal. O período da adolescência foi classificado de acordo com a idade. Foram realizadas análises estatísticas descritivas e inferenciais. A amostra foi composta por 445 adolescentes (190 meninos e 255 meninas) com idade média de 16,44 anos. Maior risco de insatisfação corporal foi encontrado entre os participantes com sobrepeso e obesidade (BSQ: OR = 3,359 p < 0,001; ESA: OR = 1,572 p = 0,387) e sexo feminino (BSQ: OR = 3,694 p < 0,001; ESA: OR = 0,922, p = 0,840). Os participantes nos períodos intermediário e final da adolescência apresentaram menores riscos de insatisfação quando comparados àqueles no período inicial. A insatisfação corporal relacionou-se com sobrepeso, com sexo feminino e com período inicial da adolescência. Pesquisas de intervenção são necessárias para controlar os fatores que influenciam a insatisfação corporal excessiva dos adolescentes.

The scope of this article is to evaluate the body image of adolescents from rural cities and its relationship with nutritional status, sex and the adolescent phase. Adolescents of both sexes participated in the cross-sectional study. Body image was evaluated through the Body Shape Questionnaire (BSQ) and the Figure Rating Scale (FRS) for adolescents. Weight and height were measured for the evaluation of body mass index (BMI). Stages of adolescence were classified by age. Descriptive and inferential statistical analyses were conducted. Four hundred and forty-five adolescents (190 boys and 255 girls), with a mean age of 16.44 comprised the sample. Higher risk of body dissatisfaction was found among overweight and obese participants (BSQ: OR = 3.359 p < 0.001; ESA: OR = 1.572 p = 0.387) and the female sex (BSQ: OR = 3.694 p < 0.001; ESA: OR = 0.922, p = 0.840). Participants from the intermediary and final stages of adolescence revealed a lesser risk of dissatisfaction compared to those from the initial phase. Body dissatisfaction was related to overweight and obesity, to the female sex and to the initial period of adolescence. Intervention research is required to control the factors that influence excessive adolescent body dissatisfaction.

Antecedentes: el uso eficiente de forraje de buena calidad es una de las muchas maneras de mejorar la productividad animal y por lo tanto reducir el costo de la alimentación del ganado lechero. Entre la variedad de estudios que permiten mejorar el valor nutritivo del forraje, los estudios histológicos se destacan, porque permiten tanto la comparación de especies o cultivares y el seguimiento del envejecimiento de los tejidos con la madurez de la planta. Objetivo: el presente trabajo tuvo como objetivo caracterizar la morfología del tallo de los clones de Pennisetum (Itambé IV-46, I-Itambé 1.20, Itambé I-1.4, Milheto x Buaçu/112-23.4, Cuba- 116-29.3, el CAC-262-12.102, Roxo de Botucatu x CAC-282-18.29, Taiwán-146-2.6, Itambé I-1.5, Pusa Napier o 419-76 x Buaçu/122-11.2, Taiwan-146-2.03, Taiwán-146-2.85, Itambé II-2.46 , Pusa Napier 419-76 x Cuba-116-12.3 y Napier Pusa o 412-76 x Buaçu/122-8.22) en tres estratos (basal, medio y apical) y tres tallos de la planta con los cortes histológicos. Métodos: el material se recogió en una zona ya establecida en la Estación Experimental de São Bento do Una en el Instituto Agronómico de Pernambuco. Los materiales se distribuyeron en un diseño factorial completamente al azar de 15 x 3 x 3 (14 clones y un híbrido, tres capas de la madre y los tallos de tres). Las muestras fueron recolectadas durante la estación seca comenzando en agosto de 2008. Resultados: hubo diferencias significativas (p<0,05) entre los clones evaluados, y los valores promedio de las células lignificadas en la región de la corteza variaron desde 2,21 hasta 4,21 para los clones Taiwán-146-2.6 y Roxo de Botucatu X CAC-282-18.29, sin embargo, esto no fue diferente de los otros clones en la región medular. El clon Itambé II-2.46 mostró el mayor valor absoluto en el porcentaje de floema en la región de la corteza (2,32%) y un alto valor, con diferencias significativas, en la región medular (1,59%) en comparación con los otros clones. Conclusión: los valores más altos de celulosa en las regiones media y apical de los tallos estudiados representa un beneficio para los animales de pastoreo.

Background: the efficient use of good quality forage represents one of many ways to improve animal productivity and, consequently, reduce the feed costs of dairy farming. Between the wide variety of studies aiming to improve the nutritional value of forage, histological studies, allow for both the comparison of species or cultivars and the monitoring of tissue aging within the plant. Objective: the present work aimed to characterize the stem morphology of Pennisetum clones (Itambé IV-46, Itambé I-1.20, Itambé I-1.4, Milheto x Buaçu/112-23.4, Cuba-116-29.3, CAC-262-12.102, Roxo of Botucatu x CAC-282-18.29, Taiwan-146-2.6, Itambé I-1.5, Pusa Napier or 419-76 x Buaçu/122-11.2, Taiwan-146-2.03, Taiwan-146-2.85, Itambé II-2.46, Pusa Napier or 419-76 x Cuba-116-12.3 and Pusa Napier or 412-76 x Buaçu/122-8.22) into three strata (basal, medium and apical) and three tillers of the plant using histological sections. Methods: the material was collected in a previously established area at the Experimental Station of São Bento do Una at the Agronomic Institute of Pernambuco. The materials were distributed in a completely randomized 15 x 3 x 3 factorial design (14 clones and one hybrid, three layers of stem and three tillers). The samples were collected during the dry season beginning in August 2008. Results: there were significant differences (p<0.05) among the clones evaluated, and the average values for the lignified cells in the cortex region ranged from 2.21 to 4.21 for the Taiwan-146-2.6 and Roxo of Botucatu x CAC-282-18.29 clones; however, this was not different from the other clones in the medullary region. The Itambé II-2.46 clone showed the highest absolute value in the percentage of phloem in the cortex region (2.32%) and a high value, with significant differences, in the medullary region (1.59%) compared to the other clones. Conclusion: the highest values of cellulose in the medium and apical regions of the studied stems represent a benefit to grazing animals.

Antecedentes: o uso eficiente de forragem de boa qualidade representa uma das muitas maneiras de melhorar a produtividade animal e, consequentemente, reduzir os custos de alimentação da pecuária leiteira. Entre a variedade de estudos com o objetivo de melhorar o valor nutritivo da forragem, os estudos histológicos destacam-se, o que permite tanto a comparação de espécies ou cultivares e acompanhamento do envelhecimento dos tecidos com a maturidade da planta. Objetivo: o presente trabalho teve como objetivo caracterizar a morfologia do caule de Pennisetum clones (IV-46 Itambé, Itambé I-1.20, Itambé I-1.4, Milheto x Buaçu/112-23.4, Cuba-116-29.3, CAC-262-12,102, Roxo de Botucatu x CAC-282-18,29, Taiwan-146-2.6, Itambé I-1.5, Pusa Napier ou 419-76 x Buaçu/122-11.2, Taiwan-146-2.03, Taiwan-146-2.85, Itambé II-2,46 , Pusa Napier ou 419-76 x Cuba-116-12.3 e Pusa Napier ou 412-76 x Buaçu/122-8.22) em três estratos (basal, média e apical) e três perfilhos da planta, utilizando cortes histológicos. Métodos: o material foi coletado em uma área já estabelecida na Estação Experimental de São Bento do Una, no Instituto Agronômico de Pernambuco). Os materiais foram distribuídos em um inteiramente casualizado 15 x 3 x fatorial 3 (14 clones e um híbrido, três camadas de tronco e três perfilhos). As amostras foram coletadas durante a estação seca início em agosto de 2008. Resultados: houve diferenças significativas (p<0,05) entre os clones avaliados, e os valores médios para as células lignificadas na região do córtex variou 2,21-4,21 para o Taiwan-146-2,6 e Roxo de Botucatu X CAC-282-18,29 clones, no entanto, isto não era diferente dos outros clones da região medular. O clone II-Itambé 2,46 apresentaram o maior valor absoluto da percentagem de floema na região córtex (2,32%) e um valor elevado, com diferenças significativas, na região medular (1,59%) em comparação com os outros clones. Conclusão: os valores mais elevados de celulose nas regiões média e apical das hastes estudadas contribuir para características positivas para animais em pastejo.