Abstract Background Heart rate (HR) has shown prognostic value in patients with heart failure with reduced ejection fraction (HFrEF) and sinus rhythm. However, the method of measurement is debated in the literature. Objectives To compare HR on Holter with 3 resting electrocardiograms (ECG1, ECG2, and ECG3) in patients with HFrEF and sinus rhythm. Methods This was a cross-sectional study with 135 patients with heart failure with ejection fraction ≤ 40% and sinus rhythm. HR was assessed by ECG and Holter. Analyses included intraclass correlation coefficient (ICC), robust regression, root mean squared error, Bland-Altman, and area under the receiver operating characteristic (ROC) curve. A significance level of 0.05 and Bonferroni-Holm adjustment were adopted to minimize type I errors. Results The median [interquartile range] age and ejection fraction were 65 years [16] and 30% [11], respectively. The ICC of the 3 ECGs was 0.922 (95% confidence interval: 0.892; 0.942). The robust regression coefficients for ECG1 and ECG3 were 0.20 (95% confidence interval: 0.12; 0.29) and 0.21 (95% confidence interval: 0.06; 0.36). The robust R2 was 0.711 (95% confidence interval: 0.628; 0.76). In the Bland-Altman agreement analysis, the limits of agreement were −17.0 (95% confidence interval: −19.0; −15.0) and 32.0 (95% confidence interval: 30.0; 34.0). The area under the ROC curve was 0.896 (95% confidence interval: 0.865; 0.923). Conclusion The HR on ECG showed high agreement with the HR on Holter, validating its clinical use in patients with HFrEF and sinus rhythm. However, agreement was suboptimal in one third of patients with HR below 70 bpm on ECG; thus, 24-hour Holter monitoring should be considered in this context. (HR (HFrEF rhythm However literature ECG1, (ECG1 ECG2 crosssectional cross sectional 13 40 ICC, , (ICC) error BlandAltman, BlandAltman Bland Altman, Altman (ROC 005 0 05 0.0 BonferroniHolm Bonferroni Holm errors interquartile range 6 16 [16 30 11, 11 [11] respectively 0922 922 0.92 95% 95 (95 interval 0.892 0892 892 0.942. 0942 0.942 . 942 0.942) 020 20 0.2 0.12 012 12 0.29 029 29 021 21 0.06 006 06 0.36. 036 0.36 36 0.36) R 0711 711 0.71 0.628 0628 628 0.76. 076 0.76 76 0.76) analysis 170 17 −17. −19.0 190 19 −15.0 150 15 320 32 32. 30.0 300 34.0. 340 34.0 34 34.0) 0896 896 0.89 0.865 0865 865 0.923. 0923 0.923 923 0.923) 7 thus 24hour hour 24 context (ECG 1 4 (ICC 00 0. [1 [11 092 92 0.9 9 (9 089 89 094 0.94 94 02 2 0.1 01 03 0.3 071 71 0.7 0.62 062 62 07 −17 −19. −15. 30. 34. 0.8 0.86 086 86 [ 09 ( 08 8 0.6 −1 −19 −15 −

Resumo Fundamento A frequência cardíaca (FC) na insuficiência cardíaca com fração de ejeção reduzida (ICFEr) e ritmo sinusal apresenta valor prognóstico. Entretanto, o método de mensuração é debatido na literatura. Objetivos Comparar em pacientes com ICFEr e ritmo sinusal a FC no Holter com três eletrocardiogramas de repouso: ECG1, ECG2 e ECG3. Metodologia Estudo transversal com 135 pacientes portadores de insuficiência cardíaca com fração de ejeção ≤ 40% e ritmo sinusal. A FC foi avaliada por ECG e Holter. Análises incluíram o coeficiente de correlação intraclasse (CCI), regressão robusta, raiz do erro quadrático médio, Bland-Altman e a área sobre a curva ROC. Adotou-se nível de significância de 0,05 e o ajuste de Bonferroni-Holm para minimizar erros tipo I. Resultados As medianas [intervalo interquartil] de idade e fração de ejeção foram de 65 anos [16] e 30% [11], respectivamente. O CCI dos 3 ECG foi de 0,922 (intervalo de confiança de 95%: 0,892; 0,942). Os coeficientes de regressão robusta para ECG1 e ECG3 foram 0,20 (intervalo de confiança de 95%: 0,12; 0,29) e 0,21 (intervalo de confiança de 95%: 0,06; 0,36). O R2 robusto foi de 0,711 (intervalo de confiança de 95%: 0,628; 0,76). Na análise de concordância de Bland-Altman, os limites de concordância foram de −17,0 (intervalo de confiança de 95%: −19,0; −15,0) e 32,0 (intervalo de confiança de 95%: 30,0; 34,0). A área sob a curva ROC foi de 0,896 (intervalo de confiança de 95%: 0,865; 0,923). Conclusão A FC do ECG mostrou alta concordância com a FC do Holter, validando seu uso clínico em pacientes com ICFEr e ritmo sinusal. Contudo, a concordância foi subótima em um terço dos pacientes com FC inferior a 70 bpm pelo ECG, devendo ser considerada a realização de Holter neste contexto. (FC (ICFEr prognóstico Entretanto literatura repouso 13 40 CCI, , (CCI) médio BlandAltman Bland Altman Adotouse Adotou se 005 0 05 0,0 BonferroniHolm Bonferroni Holm I intervalo interquartil 6 16 [16 30 11, 11 [11] respectivamente 0922 922 0,92 95% 95 0,892 0892 892 0,942. 0942 0,942 . 942 0,942) 020 20 0,2 0,12 012 12 0,29 029 29 021 21 0,06 006 06 0,36. 036 0,36 36 0,36) R 0711 711 0,71 0,628 0628 628 0,76. 076 0,76 76 0,76) BlandAltman, Altman, 170 17 −17, −19,0 190 19 −15,0 150 15 320 32 32, 30,0 300 34,0. 340 34,0 34 34,0) 0896 896 0,89 0,865 0865 865 0,923. 0923 0,923 923 0,923) Contudo 7 contexto 1 4 (CCI 00 0, [1 [11 092 92 0,9 9 089 89 094 0,94 94 02 2 0,1 01 03 0,3 071 71 0,7 0,62 062 62 07 −17 −19, −15, 30, 34, 0,8 0,86 086 86 [ 09 08 8 0,6 −1 −19 −15 −

ABSTRACT Soil salinization negatively affects the growth and yield of economically valuable crops such as soybeans. New technologies are being developed to minimize the damage caused by saline stress and improve crop performance. Therefore, the use of biostimulants in agriculture may offer an alternative method to mitigate the deleterious effects of salinity. Extracts of the seaweed, Ascophyllum nodosum and humic substances (fulvic acids) are commonly used. Therefore, this study aimed to evaluate the action of a biostimulant composed of A. nodosum seaweed extract and fulvic acid applied at different phenological stages on the biometric, biochemical, and physiological parameters of soybeans (Glycine max) subjected to irrigation with saline water. The experimental design used was completely randomized in a 3 × 2 + 2 factorial scheme, referring to three applications of the biostimulant at different soybean phenological stages: V3, V3R1, and V3R1R4, two levels of electrical conductivity of irrigation water (ECw): 0.5 (S0) and 5.0 dS m-1 (S1), two additional controls, one with a positive control (PC) and the other with a negative control (NC). The experiment had five replicates with one plant per plot. The results of this study suggest that the application of the biostimulant can mitigate the harmful effects of salt stress in soybeans. The results obtained with V3R1 application in the parameters stem diameter, leaf area, shoot dry mass, electrolyte leakage, and chlorophyll b represent greater efficiency in mitigating the harmful effects of salinity in soybean cultivation. performance Therefore acids A biometric biochemical Glycine max scheme V3 V VR R V3R1R4 VRR ECw (ECw) 05 0 5 0. S0 S (S0 50 5. m1 m 1 m- S1, S1 , (S1) controls PC (PC NC. NC . (NC) plot V3R diameter area mass leakage cultivation V3R1R (ECw (S (S1 (NC

RESUMO Processo de salinização do solo afeta negativamente o crescimento e o rendimento de culturas economicamente valiosas, como a soja. Com o objetivo de minimizar os danos causados pelo estresse salino e melhorar o desempenho das culturas, novas tecnologias estão sendo desenvolvidas. Neste contexto, o uso de bioestimulantes na agricultura pode oferecer uma alternativa para mitigar os efeitos deletérios da salinidade. O extrato da alga Ascophyllum nodosum e substâncias húmicas (ácidos fúlvicos) são comumente empregados. Portanto, o estudo teve como objetivo avaliar a ação de um bioestimulante composto pelo extrato da alga marinha A. nodosum e ácidos fúlvicos aplicados em diferentes estádios fenológicos sobre parâmetros biométricos, bioquímicos e fisiológicos da soja (Glycine max) submetida à irrigação com água salina. O delineamento experimental utilizado foi inteiramente casualizado em esquema fatorial 3 x 2 + 2, referente a três aplicações do bioestimulante em diferentes estádios fenológicos da soja: V3, V3R1 e V3R1R4, dois níveis de condutividade elétrica da água de irrigação (CEa): 0,5 (S0) e 5,0 dS m-1 (S1), dois controles adicionais, um com controle positivo (PC) e outro com controle negativo (NC). O experimento contou com cinco repetições e uma planta por parcela. Os resultados deste estudo sugerem que a aplicação do bioestimulante pode ser uma alternativa na mitigação dos efeitos nocivos do estresse salino em soja. Os resultados foram obtidos com a aplicação V3R1 nos parâmetros diâmetro do caule, área foliar, massa seca da parte aérea, extravasamento de eletrólitos e clorofila b representam maior eficiência na mitigação dos efeitos nocivos da salinidade no cultivo da soja. valiosas desenvolvidas contexto empregados Portanto A biométricos Glycine max salina V3 V VR R V3R V3R1R4 VRR CEa (CEa) 05 0 5 0, S0 S (S0 50 5, m1 m 1 m- S1, S1 , (S1) adicionais PC (PC NC. NC . (NC) parcela caule foliar aérea V3R1R (CEa (S (S1 (NC

ABSTRACT: The use of resistant wheat cultivars is a fundamental strategy to minimize the damages caused by blast, a disease caused by the fungus Pyricularia oryzae Triticum (PoT). The objetive of this stydy was to (a) evaluate the reaction to blast of Brazilian wheat cultivars and (b) determine whether there is correlation between severity of symptoms on wheat spikes and “sporulation rate of PoT conidia per gram of wheat spike rachis” (Rscon). Plants of 16 wheat cultivars were grown in greenhouse until flowering (Zadoks stage 65), when their spikes were inoculated with a suspension formed by mixing the conidia of three PoT isolates. The evaluated variables were blast severity on spikes at 5, 7 and 11 days after inoculation (dai) and Rscon. Rachis were evaluated individually to determine the Rscon. Correlation analyzes were carried out between blast severity means on spikes of cultivars at 5, 7 and 11 dai and Rscon. The cultivars TBIO Mestre, TBIO Aton, ORS 1401, ORS 1403, ORS Destak, ORS Feroz, and CD 116 stood out for being classified in the statistical groups with the highest resistance to blast for the four variables considered in the study. The correlation between blast severity on spikes at 5, 7 and 11 dai and Rscon is at most moderate. ABSTRACT PoT. . (PoT) (a b (b sporulation rachis (Rscon) 1 Zadoks 65, 65 , 65) isolates 5 (dai Mestre Aton 1401 1403 Destak Feroz study moderate (PoT (Rscon 6 140 14

RESUMO: A utilização de cultivares de trigo resistentes é estratégia fundamental para minimizar danos causados pela brusone, doença causada pelo fungo Pyricularia oryzae Triticum (PoT). O objetivo do estudo foi avaliar (a) a reação à brusone de cultivares brasileiras de trigo e (b) verificar a correlação entre a severidade dos sintomas na espiga e a “taxa de esporulação de conídios de PoT por g de ráquis de espigas de trigo” (Txcon). Plantas de 16 cultivares de trigo foram conduzidas em casa-de-vegetação até o florescimento (estádio 65 da escala de Zadoks), quando as espigas das mesmas foram submetidas à inoculação com uma suspensão formada pela mistura de conídios de três isolados de PoT. As variáveis avaliadas foram a severidade de brusone nas espigas aos cinco, sete e 11 dias após a inoculação (dai) e a Txcon. A Txcon foi determinada de forma individualizada para os ráquis. Foram realizadas análises de correlação entre as médias de severidade de brusone nas espigas das cultivares aos cinco, sete e 11 dai e a Txcon. As cultivares TBIO Mestre, TBIO Aton, ORS 1401, ORS 1403, ORS Destak, ORS Feroz e CD 116 se destacaram por terem sido classificadas nos grupos estatísticos de maior resistência à brusone para as quatro variáveis consideradas no estudo. A correlação entre a severidade de brusone nas espigas aos cinco, sete e 11 dai e Txcon é, no máximo, moderada. RESUMO . (PoT) (a b (b taxa (Txcon) 1 casadevegetação casa vegetação estádio 6 Zadoks, Zadoks , Zadoks) cinco (dai Mestre Aton 1401 1403 Destak máximo moderada (PoT (Txcon 140 14

RESUMEN Introducción: Las pérdidas cognitivas se encuentran entre los eventos más prevalentes en la población anciana y pueden causar déficits funcionales. Entre las alternativas de prevención y tratamiento no farmacológico disponibles, el aumento de los niveles de condición física funcional se presenta como una estrategia importante que sugiere mejoras en la función física y cognitiva de los ancianos, desencadenada por la práctica de ejercicios. Objetivo: Determinar el poder predictivo de los indicadores de aptitud funcional y establecer sus puntos de corte como discriminadores del deterioro cognitivo en adultos mayores. Métodos: La muestra estuvo compuesta por 310 ancianos que respondieron un cuestionario que comprendía información sociodemográfica, hábitos de vida, hospitalización en los últimos 12 meses, presencia de comorbilidad y el Mini-Examen del Estado Mental. La condición física funcional se evaluó utilizando la fuerza de agarre manual (FAM) y las pruebas de sentarse y levantarse de una silla. Para identificar predictores de deterioro cognitivo, se adoptó el análisis de curvas Receiver Operating Characteristic (ROC), con intervalo de confianza del 95% (IC95%). Posteriormente se identificaron los puntos de corte con sus respectivas sensibilidades y especificidades. Los análisis se realizaron respetando el nivel de significancia del 5%. Resultados: Se observó que algunos indicadores de aptitud funcional mostraron un Área Bajo la Curva (ABC) significativa, y la prueba de sentarse y pararse (ABC=0,72; 95%IC: 0,64-0,77) mostró los mejores resultados. Los mejores puntos de corte para el test FAM y el sit-and-stand test fueron 18,8 kgf y 8 repeticiones, respectivamente. Conclusión: Los resultados del presente estudio permiten concluir que el test sit-to-stand es moderadamente eficiente para discriminar la presencia de deterioro cognitivo en adultos mayores. Nivel de Evidencia III; Estudio Transversal. Introducción funcionales disponibles ejercicios Objetivo mayores Métodos 31 sociodemográfica vida 1 meses MiniExamen Mini Examen Mental (FAM silla ROC, ROC , (ROC) 95 IC95%. IC95 IC IC95% . (IC95%) especificidades 5 5% Resultados ABC (ABC significativa ABC=0,72 ABC072 0 72 (ABC=0,72 95%IC 95IC 0,640,77 064077 0,64 0,77 64 77 0,64-0,77 sitandstand sit and stand 188 18 18, repeticiones respectivamente Conclusión sittostand to III Transversal 3 (ROC 9 IC9 (IC95% ABC=0,7 ABC07 7 (ABC=0,7 640 0,640,7 06407 064 0,6 077 0,7 6 0,64-0,7 (IC95 ABC=0, ABC0 (ABC=0, 0,640, 0640 06 0, 07 0,64-0, (IC9 ABC=0 (ABC=0 0,640 0,64-0 (IC ABC= (ABC= 0,64-

ABSTRACT Introduction: Cognitive losses are among the most prevalent events in the elderly population and can cause functional deficits. Among the available non-drug prevention and treatment alternatives, the increase in functional fitness levels is presented as an important strategy suggesting improvements in the physical and cognitive function of the elderly triggered by exercise. Objective: To determine the predictive power of functional fitness indicators and establish their cutoff points as discriminators of cognitive impairment in the elderly. Methods: The sample comprised 310 elderly people who answered a questionnaire comprising sociodemographic information, lifestyle habits, hospitalization in the last 12 months, presence of comorbidity, and the Mini-Mental State Examination. Functional fitness was assessed using the Hand Grip Strength (HGS) and sitting and rising from a chair tests. To identify predictors of cognitive impairment, analysis of Receiver Operating Characteristic (ROC) curves was adopted, with a confidence interval of 95% (95%CI). Subsequently, the cut-off points with their respective sensitivities and specificities were identified. The analyses were performed respecting the significance level of 5%. Results: It was observed that some functional fitness indicators showed significant Area Under the Curve (AUC), and the sit-and-stand test (AUC=0.72; 95%CI: 0.64-0.77) showed the best results. The best cut-off points for the HGS and sit-and-stand tests were 18,8 kgf and eight repetitions, respectively. Conclusion: The results of the present study allow us to conclude that the sit-to-stand test is moderately efficient in discriminating the presence of cognitive impairment in the elderly. Level of Evidence III; Study Cross-sectional. Introduction deficits nondrug non drug alternatives exercise Objective Methods 31 information habits 1 months comorbidity MiniMental Mini Mental Examination (HGS ROC (ROC adopted 95 95%CI. 95CI CI 95%CI . (95%CI) Subsequently cut off identified 5 5% Results AUC, AUC , (AUC) sitandstand sit stand AUC=0.72 AUC072 0 72 (AUC=0.72 0.640.77 064077 0.64 0.77 64 77 0.64-0.77 188 18 8 18, repetitions respectively Conclusion sittostand III Crosssectional. Crosssectional Cross sectional. sectional Cross-sectional 3 9 (95%CI (AUC AUC=0.7 AUC07 7 (AUC=0.7 640 0.640.7 06407 064 0.6 077 0.7 6 0.64-0.7 AUC=0. AUC0 (AUC=0. 0.640. 0640 06 0. 07 0.64-0. AUC=0 (AUC=0 0.640 0.64-0 AUC= (AUC= 0.64-

RESUMO Introdução: As perdas cognitivas estão entre os eventos mais prevalentes na população idosa, podendo causar déficits funcionais. Dentre as alternativas de prevenção e tratamento não medicamentosos disponíveis, o aumento dos níveis de aptidão funcional apresenta-se como uma estratégia importante sugerindo melhorias na função física e na função cognitiva de idosos, desencadeadas através da prática de exercícios. Objetivo: Determinar o poder preditivo dos indicadores de aptidão funcional e estabelecer seus pontos de corte como discriminadores do comprometimento cognitivo em idosos. Métodos: A amostra compreendeu 310 idosos que responderam a um questionário composto por informações sociodemográficas, hábitos de vida, hospitalização nos últimos 12 meses, presença de comorbidade e o Mini-Exame do Estado Mental. A aptidão funcional foi avaliada por meio dos testes de Força de Preensão Manual (FPM) e o de sentar e levantar da cadeira. Para identificação dos preditores do comprometimento cognitivo, foi adotada a análise das curvas Receiver Operating Characteristic (ROC), com intervalo de confiança de 95% (IC95%). Posteriormente, identificaram-se os pontos de corte com as respectivas sensibilidades e especificidades. As análises foram efetuadas respeitando-se o nível de significância de 5%. Resultados: Observou-se que alguns indicadores de aptidão funcional apresentaram Área Sob a Curva (ASC) significativas, sendo que o teste de sentar e levantar da cadeira (ASC=0,72; IC95%= 0,64-0,77) apresentou os melhores resultados. Os melhores pontos de corte para o teste de FPM e o teste de sentar e levantar da cadeira foram de 18,8 kgf e 8 repetições respectivamente. Conclusão: Os resultados do presente estudo permitem concluir que o teste de sentar e levantar da cadeira apresenta moderada eficiência para discriminar a presença de comprometimento cognitivo em idosos. Nível de Evidência III; Estudo Transversal. Introdução idosa funcionais disponíveis apresentase se exercícios Objetivo Métodos 31 sociodemográficas vida 1 meses MiniExame Mini Exame Mental (FPM ROC, ROC , (ROC) 95 IC95%. IC95 IC IC95% . (IC95%) Posteriormente identificaramse identificaram especificidades respeitandose respeitando 5 5% Resultados Observouse Observou ASC (ASC significativas ASC=0,72 ASC072 0 72 (ASC=0,72 0,640,77 064077 0,64 0,77 64 77 0,64-0,77 188 18 18, respectivamente Conclusão III Transversal 3 (ROC 9 IC9 (IC95% ASC=0,7 ASC07 7 (ASC=0,7 640 0,640,7 06407 064 0,6 077 0,7 6 0,64-0,7 (IC95 ASC=0, ASC0 (ASC=0, 0,640, 0640 06 0, 07 0,64-0, (IC9 ASC=0 (ASC=0 0,640 0,64-0 (IC ASC= (ASC= 0,64-

Abstract This study evaluated the productive and reproductive performances of Santa Inês sheep and their Dorper crossbreeds during the lactation period amidst the dry season in the semi-arid region of Paraíba, Brazil. Conducted at the experimental goat farm of the State University of Paraíba (UEPB), Campus IV, Catolé do Rocha, the investigation included a cohort of 24 ewes (12 Santa Inês and 12 Dorper crossbreeds [comprising 87.5% Dorper and 12.5% Santa Inês]) and 30 lambs (10 males and 20 females). Observations were recorded from birth and continued at 30-day intervals up to 90 days. Using a two-way ANOVA with a 2 x 2 factorial design (two genetic groups and two sexes), the study monitored both ewes and lambs. The animals adhered to traditional regional management, grazing in paddocks by day and secured in shelters by dusk. The study found that both Santa Inês and Dorper crossbred ewes produced similar quantities of milk (P=0.8310) for the first 60 days of lactation. There was no discernible effect of the ewes’ genetic backgrounds on their live weights, body condition scores at lambing, throughout the subsequent 30, 60, and 90 days of lactation, or on the overall productive efficiency and total weight of weaned lambs per ewe. In contrast, Dorper lambs demonstrated a higher weaning weight (P=0.0349) and greater weight gain (P=0.0403). The study also noted that the sex of the lambs did not notably influence their performance within the first 90 days of suckling. semiarid semi arid Brazil UEPB, UEPB , (UEPB) IV Rocha (1 1 comprising 875 87 5 87.5 125 12.5 Inês] 3 10 females. females . females) 30day 9 twoway way sexes, sexes sexes) management dusk P=0.8310 P08310 P 0 8310 (P=0.8310 6 weights lambing ewe contrast P=0.0349 P00349 0349 (P=0.0349 P=0.0403. P00403 P=0.0403 0403 (P=0.0403) suckling (UEPB ( 8 87. 12. P=0.831 P0831 831 (P=0.831 P=0.034 P0034 034 (P=0.034 P0040 P=0.040 040 (P=0.0403 P=0.83 P083 83 (P=0.83 P=0.03 P003 03 (P=0.03 P004 P=0.04 04 (P=0.040 P=0.8 P08 (P=0.8 P=0.0 P00 (P=0.0 (P=0.04 P=0. P0 (P=0. P=0 (P=0 P= (P= (P

Resumo Objetivou-se avaliar o desempenho produtivo e reprodutivo de ovinos da raça Santa Inês e mestiços da raça Dorper criados em sistema tradicional de produção durante a fase de amamentação na época seca do ano no semiárido paraibano. O experimento foi conduzido no Setor de Caprinovinocultura da Universidade Estadual da Paraíba/UEPB/Campus-IV, Catolé do Rocha/PB. Foram utilizadas 24 ovelhas multíparas, sendo 12 da raça Santa Inês e 12 mestiças da raça Dorper (87,5% Dorper + 12,5% Santa Inês) paridas com 30 ovinos jovens, sendo 10 machos e 20 fêmeas. O período experimental se iniciou no momento do parto e os dados foram coletados ao nascimento, aos 30, 60 e 90 dias de idade. Foi utilizada análise de variância para as ovelhas e para os cordeiros esquema fatorial 2 x 2 (dois grupos genéticos e dois sexos). Os cordeiros permaneceram com suas mães em piquetes durante o dia e à noite no aprisco, manejo tradicional da região. As ovelhas Santa Inês e mestiças Dorper produziram quantidades de leite semelhantes (P=0,8310) até os 60 dias de lactação. O grupo genético das ovelhas não influenciou os pesos vivos e escore de corporal ao parto, 30, 60 e 90 dias de lactação, como também a eficiência produtiva e peso total de crias desmamadas por ovelha. Os cordeiros e cordeiras Dorper apresentaram maiores pesos vivos (P=0,0349) e ganhos de peso (P=0,0403), por outro lado, o sexo dos ovinos jovens não influenciou o desempenho até os 90 dias de amamentação. Objetivouse Objetivou paraibano Paraíba/UEPB/CampusIV, ParaíbaUEPBCampusIV Paraíba/UEPB/Campus IV, Paraíba UEPB Campus IV Paraíba/UEPB/Campus-IV RochaPB Rocha PB Rocha/PB multíparas 1 87,5% 875 87 5 (87,5 125 12,5 3 fêmeas nascimento 6 9 idade sexos. sexos . sexos) aprisco região P=0,8310 P08310 P 0 8310 (P=0,8310 lactação ovelha P=0,0349 P00349 0349 (P=0,0349 P=0,0403, P00403 P=0,0403 , 0403 (P=0,0403) lado CampusIV Paraíba/UEPB/CampusIV ParaíbaUEPBCampus 87,5 8 (87, 12, P=0,831 P0831 831 (P=0,831 P=0,034 P0034 034 (P=0,034 P0040 P=0,040 040 (P=0,0403 87, (87 P=0,83 P083 83 (P=0,83 P=0,03 P003 03 (P=0,03 P004 P=0,04 04 (P=0,040 (8 P=0,8 P08 (P=0,8 P=0,0 P00 (P=0,0 (P=0,04 ( P=0, P0 (P=0, P=0 (P=0 P= (P= (P

ABSTRACT Objective: To examine the physical function and respiratory muscle strength of patients - who recovered from critical COVID-19 – after intensive care unit discharge to the ward on Days one (D1) and seven (D7), and to investigate variables associated with functional impairment. Methods: This was a prospective cohort study of adult patients with COVID-19 who needed invasive mechanical ventilation, non-invasive ventilation or high-flow nasal cannula and were discharged from the intensive care unit to the ward. Participants were submitted to Medical Research Council sum-score, handgrip strength, maximal inspiratory pressure, maximal expiratory pressure, and short physical performance battery tests. Participants were grouped into two groups according to their need for invasive ventilation: the Invasive Mechanical Ventilation Group (IMV Group) and the Non-Invasive Mechanical Ventilation Group (Non-IMV Group). Results: Patients in the IMV Group (n = 31) were younger and had higher Sequential Organ Failure Assessment scores than those in the Non-IMV Group (n = 33). The short physical performance battery scores (range 0 - 12) on D1 and D7 were 6.1 ± 4.3 and 7.3 ± 3.8, respectively for the Non-Invasive Mechanical Ventilation Group, and 1.3 ± 2.5 and 2.6 ± 3.7, respectively for the IMV Group. The prevalence of intensive care unit-acquired weakness on D7 was 13% for the Non-IMV Group and 72% for the IMV Group. The maximal inspiratory pressure, maximal expiratory pressure, and handgrip strength increased on D7 in both groups, but the maximal expiratory pressure and handgrip strength were still weak. Only maximal inspiratory pressure was recovered (i.e., > 80% of the predicted value) in the Non-IMV Group. Female sex, and the need and duration of invasive mechanical were independently and negatively associated with the short physical performance battery score and handgrip strength. Conclusion: Patients who recovered from critical COVID-19 and who received invasive mechanical ventilation presented greater disability than those who were not invasively ventilated. However, they both showed marginal functional improvement during early recovery, regardless of the need for invasive mechanical ventilation. This might highlight the severity of disability caused by SARS-CoV-2. Objective COVID19 COVID 19 COVID-1 D (D1 D7, , (D7) impairment Methods noninvasive non highflow high flow sumscore, sumscore sum score, sum-score tests NonInvasive Non NonIMV . Results n 31 33. 33 33) range 12 61 6 1 6. 43 4 3 4. 73 7 7. 38 8 3.8 13 1. 25 2 5 2. 26 37 3.7 unitacquired acquired 72 weak i.e., ie i e (i.e. 80 value sex Conclusion ventilated However recovery SARSCoV2. SARSCoV2 SARSCoV SARS CoV SARS-CoV-2 COVID1 COVID- (D (D7 3. i.e. (i.e SARS-CoV- i.e SARS-CoV

RESUMO Objetivo: Examinar a função física e a força muscular respiratória de pacientes que se recuperaram da COVID-19 grave após a alta da unidade de terapia intensiva para a enfermaria nos Dias 1 e 7 e investigar as variáveis associadas ao comprometimento funcional. Métodos: Trata-se de estudo de coorte prospectivo de pacientes adultos com COVID-19 que necessitaram de ventilação mecânica invasiva, ventilação mecânica não invasiva ou cânula nasal de alto fluxo e tiveram alta da unidade de terapia intensiva para a enfermaria. Os participantes foram submetidos aos testes Medical Research Council sum-score, força de preensão manual, pressão inspiratória máxima, pressão expiratória máxima e short physical performance battery. Os participantes foram agrupados em dois grupos conforme a necessidade de ventilação mecânica invasiva: o Grupo Ventilação Mecânica Invasiva (Grupo VMI) e o Grupo Não Ventilação Mecânica Invasiva (Grupo Não VMI). Resultados: Os pacientes do Grupo VMI (n = 31) eram mais jovens e tinham pontuações do Sequential Organ Failure Assessment mais altas do que os do Grupo VMI (n = 33). As pontuações do short physical performance battery (intervalo de zero a 12) nos Dias 1 e 7 foram 6,1 ± 4,3 e 7,3 ± 3,8, respectivamente para o Grupo Não VMI, e 1,3 ± 2,5 e 2,6 ± 3,7, respectivamente para o Grupo VMI. A prevalência de fraqueza adquirida na unidade de terapia intensiva no Dia 7 foi de 13% para o Grupo Não VMI e de 72% para o Grupo VMI. A pressão inspiratória máxima, a pressão expiratória máxima e a força de preensão manual aumentaram no Dia 7 em ambos os grupos, porém a pressão expiratória máxima e a força de preensão manual ainda eram fracas. Apenas a pressão inspiratória máxima foi recuperada (ou seja, > 80% do valor previsto) no Grupo Não VMI. As variáveis sexo feminino, e necessidade e duração da ventilação mecânica invasiva foram associadas de forma independente e negativa à pontuação do short physical performance battery e à força de preensão manual. Conclusão: Os pacientes que se recuperaram da COVID-19 grave e receberam ventilação mecânica invasiva apresentaram maior incapacidade do que aqueles que não foram ventilados invasivamente. No entanto, os dois grupos de pacientes apresentaram melhora funcional marginal durante a fase inicial de recuperação, independentemente da necessidade de ventilação mecânica invasiva. Esse resultado pode evidenciar a gravidade da incapacidade causada pelo SARS-CoV-2. Objetivo COVID19 COVID 19 COVID-1 Métodos Tratase Trata sumscore, sumscore sum score, score sum-score . Resultados n 31 33. 33 33) intervalo 12 61 6 6, 43 4 3 4, 73 7, 38 8 3,8 13 1, 25 2 5 2, 26 37 3,7 72 fracas seja 80 previsto feminino Conclusão invasivamente entanto recuperação SARSCoV2. SARSCoV2 SARSCoV SARS CoV 2. SARS-CoV-2 COVID1 COVID- 3, SARS-CoV- SARS-CoV

Abstract Mucopolysaccharidosis type IIIB (MPS IIIB) is caused by deficiency of alpha-N-acetylglucosaminidase, leading to storage of heparan sulphate. The disease is characterized by intellectual disability and hyperactivity, among other neurological and somatic features. Here we studied retrospective data from a total of 19 MPS IIIB patients from Brazil, aiming to evaluate disease progression. Mean age at diagnosis was 7.2 years. Speech delay was one of the first symptoms to be identified, around 2-3 years of age. Behavioral alterations include hyperactivity and aggressiveness, starting around age four. By the end of the first decade, patients lost acquired abilities such as speech and ability to walk. Furthermore, as disease progresses, respiratory, cardiovascular and joint abnormalities were found in more than 50% of the patients, along with organomegaly. Most common cause of death was respiratory problems. The disease progression was characterized in multiple systems, and hopefully these data will help the design of appropriate clinical trials and clinical management guidelines. alphaNacetylglucosaminidase, alphaNacetylglucosaminidase alpha N acetylglucosaminidase, acetylglucosaminidase alpha-N-acetylglucosaminidase sulphate features 1 Brazil 72 7 2 7. identified 23 3 2- aggressiveness four decade walk Furthermore progresses 50 organomegaly problems systems guidelines 5

Abstract Introduction: Metabolic syndrome (MS) and obesity are risk factors for cardiovascular diseases (CVD). However, the development of cardiovascular pathologies in obese individuals without MS is being investigated. Objective: To investigate whether there are similar electrocardiographic (ECG) and echocardiographic changes in individuals with obesity with and without MS. Methodology: A retrospective, descriptive cross-sectional study was carried out with obese patients at a university hospital in Belém, Pará, Brazil. Anthropometric, laboratory, ECG and echocardiographic data were evaluated in both populations. The chi-square test was used to describe the relationship between variables among groups; hypothesis tests with p < 0.05 were considered statistically significant values. Results: The study evaluated 100 individuals with obesity, 60 of whom had MS. The average age was 54 years, and the female sex was prevalent. Systolic blood pressure, HDL, and waist circumference were altered in both groups. Systemic arterial hypertension and low HDL demonstrated 4.27 times and 3.32 times greater likelihood of presenting changes in the ECG and echocardiogram for both groups. On the ECG, diffuse changes in ventricular repolarization were observed in both groups. On echocardiography, left ventricular diastolic dysfunction and left ventricular hypertrophy were present in both populations studied. Conclusion: Obese individuals without MS present a similar risk, requiring adequate attention to their cardiac health. Introduction (MS CVD. CVD . (CVD) However investigated Objective (ECG Methodology retrospective crosssectional cross sectional Belém Pará Brazil Anthropometric laboratory chisquare chi square groups 005 0 05 0.0 values Results 10 6 5 years prevalent pressure 427 4 27 4.2 332 3 32 3.3 echocardiography studied Conclusion health (CVD 00 0. 1 42 2 4. 33 3.

Abstract The adnexa fetal tissues are sources of mesenchymal stromal cells (MSCs) due to their noninvasive harvest, with all biological material discarded most of the time. MSCs are a promise regarding to their plasticity, self-renewal, differentiation potentials, immunomodulatory and anti-inflammatory properties, which have made clinical stem cell therapy a reality. The present study aimed to characterize and evaluate the immunomodulation ability of bovine mesenchymal cells collected from bovine amniotic fluid (bAFMSCs) isolated and subjected to sixth consecutive culture passages in vitro. The multilineage properties of the bAFMSCs collections confirmed the ability to undergo adipogenic, chondrogenic and osteogenic differentiation. The mesenchymal gene transcription CD106, CD73, CD29, CD90 and CD166 were detected in bAFMSCs, whereas CD34 and CD45 were not detected. Regarding cytokine mRNA expression, IL2, IL6, INFα, INFβ, INFγ, TNFα and TNFβ were downregulated, while IL10 was highly regulated in all studied passages. The present study demonstrated the immunological properties and multipotency of in vitro bAFMSCs collections, and thus, they can be tested in cattle pathological treatments or multiplication by nuclear transfer cloning. (MSCs harvest time plasticity selfrenewal, selfrenewal self renewal, renewal self-renewal potentials antiinflammatory anti inflammatory reality (bAFMSCs adipogenic CD106 CD CD73 CD29 CD9 CD16 CD3 CD4 expression IL2 IL IL6 INFα INFβ INFγ downregulated IL1 thus cloning CD10 CD7 CD2 CD1

Abstract Aging has a direct impact on balance due to changes in sensory and motor response, sarcopenia, reduced muscle strength and range of motion that occur in the elderly. In this context, strength training (ST) programs are seen as a valuable strategy to minimize the deleterious effect of aging on strength production and balance in this population. The purpose of the study was to evaluate the effect of 12 weeks of progressive intensity ST on static balance variables in the elderly. The study included 23 elderly with an average age of 65±8.61 years, of both sexes, who performed a twelve-week strength training program, with a frequency of three times a week and with progressive intensity (60 - 85% of 1-RM). Balance was assessed before and after the intervention period, through stabilometric assessment on a force plate. After the intervention, there was a reduction in the anteroposterior amplitude (p=0.01), in the anteroposterior velocity (p=0.01) and in the total displaced area (p=0.04). It is concluded that the strength training can be used as a key tool to minimize the deleterious effect of aging on the maintenance of static balance. response sarcopenia context (ST population 1 2 65861 65 8 61 65±8.6 years sexes twelveweek twelve program 60 (6 85 1RM. 1RM RM . 1-RM) period plate p=0.01, p001 p p=0.01 , 0 01 (p=0.01 p=0.04. p004 p=0.04 04 (p=0.04) 6586 6 65±8. ( 1-RM p00 p=0.0 (p=0.0 (p=0.04 658 65±8 p0 p=0. (p=0. 65± p=0 (p=0 p= (p= (p

Resumo O envelhecimento tem impacto direto no equilíbrio devido a alterações da resposta sensorial e motora, sarcopenia e redução da força muscular e da amplitude de movimento que ocorre nos idosos. Nesse contexto, programas de treinamento de força (TF) são vistos como valiosa estratégia para minimizar o efeito deletério do envelhecimento na produção de força e no equilíbrio dessa população. O objetivo do estudo foi avaliar o efeito de 12 semanas de TF com intensidade progressiva sobre as variáveis de equilíbrio estático em idosos. Participaram do estudo 23 idosos com idade média de 65±8,61 anos, de ambos os sexos, que realizaram um programa de TF de doze semanas, com frequência de três vezes por semana e com intensidade progressiva (60 - 85% de 1-RM). O equilíbrio foi avaliado antes e após o período de intervenção, por meio de avaliação estabilométrica em plataforma de força. Após a intervenção houve redução na amplitude anteroposterior (p=0,01), na velocidade anteroposterior (p=0,01) e na área total deslocada (p= 0,04). Conclui-se que o treinamento de força pode ser utilizado como ferramenta chave para minimizar o efeito deletério do envelhecimento na manutenção do equilíbrio estático. motora contexto (TF população 1 2 65861 65 8 61 65±8,6 anos sexos 60 (6 85 1RM. 1RM RM . 1-RM) p=0,01, p001 p p=0,01 , 0 01 (p=0,01 p= (p 0,04. 004 0,04 04 0,04) Concluise Conclui se 6586 6 65±8, ( 1-RM p00 p=0,0 (p=0,0 00 0,0 658 65±8 p0 p=0, (p=0, 0, 65± p=0 (p=0

Abstract The objective of the present study was to investigate the frequency of oral leukoplakia and oral erythroplakia among young patients from three Brazilian reference centers in Oral and Maxillofacial Pathology. A retrospective study was carried out from 2011 to 2021 on 861 patients diagnosed with oral leukoplakia and oral erythroplakia. Demographic and clinicopathological data were evaluated. Fisher’s exact test was used to evaluate the association among sex, age, anatomical location, and histopathological diagnosis. A total of 83 (9.64%) cases involved young patients (aged <40 years). Among these, biopsy records were included in 31 (37.34%) cases, all of which received a clinical diagnosis of oral leukoplakia. Seventeen (54.84%) patients were female, mostly in their fourth decade of life (n = 22/70.97%), and their mean age at diagnosis was 32.61(± 5.21) years. Among informed cases, seven (22.58%) patients were smokers. The lateral border of the tongue (n = 9/29.03%) was the most affected site. In 13 (41.94%) cases, oral leukoplakias showed a homogeneous appearance. The mean size of the lesions was 1.47 cm (0.2–3.0 cm) and the mean time of disease progression was 64.37 (± 65.90) months. The histopathological analysis showed that 11 cases (35.48%) exhibited some degree of epithelial dysplasia. Acanthosis and/or hyperkeratosis were observed in 20 cases (64.52%). No significant associations were observed between sex and anatomical location, age and anatomical location, nor between sex and histological diagnosis (p > 0.05). Oral leukoplakia and oral erythroplakia are uncommon diseases in young patients. In this population, oral leukoplakia shows a slight predilection for women aged between 30 and 39 years. Pathology 201 202 86 evaluated Fishers Fisher s location 8 9.64% 964 9 64 (9.64% 40 <4 years . years) these 3 37.34% 3734 37 34 (37.34% 54.84% 5484 54 84 (54.84% female n 22/70.97%, 227097 22/70.97% , 22 70 97 22/70.97%) 32.61± 3261 32.61 ± 32 61 32.61( 5.21 521 5 21 22.58% 2258 58 (22.58% smokers 9/29.03% 92903 29 03 site 1 41.94% 4194 41 94 (41.94% appearance 147 47 1.4 0.2–3.0 0230 0 2 (0.2–3. 6437 64.3 ( 65.90 6590 65 90 months 35.48% 3548 35 48 (35.48% dysplasia andor or 64.52%. 6452 64.52% 52 (64.52%) p 0.05. 005 0.05 05 0.05) population 9.64 96 6 (9.64 4 < 37.34 373 (37.34 54.84 548 (54.84 22709 22/70.97 7 326 32.6 5.2 22.58 225 (22.58 9/29.03 9290 41.94 419 (41.94 14 1. 0.2–3. 023 (0.2–3 643 64. 65.9 659 35.48 354 (35.48 645 64.52 (64.52% 00 0.0 9.6 (9.6 37.3 (37.3 54.8 (54.8 2270 22/70.9 32. 5. 22.5 (22.5 9/29.0 929 41.9 (41.9 0.2–3 02 (0.2– 65. 35.4 (35.4 64.5 (64.52 0. 9. (9. 37. (37. 54. (54. 227 22/70. 22. (22. 9/29. 92 41. (41. 0.2– (0.2 35. (35. (64.5 (9 (37 (54 22/70 (22 9/29 (41 0.2 (0. (35 (64. (3 (5 22/7 (2 9/2 (4 (0 (64 22/ 9/ (6

Abstract This study aimed to calculate the temperature and humidity indexes (THIs) derived from extremely high air temperatures during the months of December 2021, January, and February 2022 in Rio Grande do Sul. The main goal was to characterize and regionalize potential impacts on dairy production. We used hourly measurements of temperature and relative humidity from 28 meteorological stations of the INMET/SIMAGRO/SEAPI network. These data cover ten ecoclimatic regions of the state. THI and Estimated Milk Loss (EML) were calculated, with the daily number of hours classified under each THI category during the trimester by municipality and region. The effects of region and month on THI and EML were evaluated through analysis of variance at a 5% significance level. Differences between means were compared using the Tukey HSD test (P<0.05). The probability of each daily hour having a THI in thermal discomfort (THI>70) was determined through analysis of variance for binomial variables by region, with the observed effect of time (P<0.05), and means were compared using the non-parametric Bonferroni test at 5%. To group these data, we applied the ScottKnott test. The Baixo Vale do Uruguai stood out in the trimester with the highest THI values, indicating thermal discomfort. Conversely, no heat stress was indicated in the Serra do Nordeste. In all regions, the most frequent daily classification of thermal discomfort ranged from attention to alert, with January being particularly significant. The highest EML estimates for most of the eight production levels were recorded in January. High estimates of productivity loss occurred in cows with higher milk production potential. THIs (THIs 2021 202 Sul 2 INMETSIMAGROSEAPI INMET SIMAGRO SEAPI network state (EML calculated 5 level P<0.05. P005 P P<0.05 . 0 05 (P<0.05) THI>70 THI70 70 (THI>70 P<0.05, , nonparametric non parametric values Conversely Nordeste alert significant 20 P00 P<0.0 (P<0.05 THI>7 THI7 7 (THI>7 P0 P<0. (P<0.0 THI> (THI> P<0 (P<0. (THI P< (P<0 (P< (P

Resumo O objetivo do estudo foi calcular o índice de temperatura e umidade (ITU), devido às temperaturas do ar extremamente elevadas durante os meses de dezembro 2021, janeiro e fevereiro 2022 no Rio Grande do Sul, para fins de caracterização e regionalização dos possíveis impactos na produção leiteira. Empregaram-se dados horários de temperatura e umidade relativa do ar de 28 estações meteorológicas da rede INMET/SIMAGRO/SEAPI, de dez regiões ecoclimáticas do Estado, calculando-se ITU e Perda Estimada de Leite (DPL), contabilizando-se número diário de horas em cada classificação do ITU, durante trimestre por município e região. Avaliou-se efeito da região e mês no ITU e DPL, pela análise de variância a 5% de significância. Detectadas diferenças entre médias, compararam-se pelo teste Tukey HSD (P<0,05). Verificou-se probabilidade de cada hora diária apresentar ITU em desconforto térmico (ITU>70), através da análise de variância para variáveis binomiais, por região; observado efeito de horário (P<0,05), médias foram comparadas pelo teste não paramétrico Bonferroni a 5%. Para agrupamento destas, usou-se o teste Scott-Knott. O Baixo Vale do Uruguai se destacou no trimestre com maiores valores do ITU, desconforto térmico, enquanto na Serra do Nordeste, não indicaram estresse calórico. Em todas as regiões, a classificação de desconforto térmico mais frequente, diariamente, foi de atenção até alerta, destacando-se o mês de janeiro. Maiores estimativas de DPL, para grande parte dos oito níveis de produção, registraram-se em janeiro. Elevadas estimativas de perda de produtividade, ocorreram em vacas com maior potencial de produção de leite. , (ITU) 2021 202 Sul leiteira Empregaramse Empregaram 2 INMETSIMAGROSEAPI INMET SIMAGRO SEAPI INMET/SIMAGRO/SEAPI Estado calculandose calculando DPL (DPL) contabilizandose contabilizando Avaliouse Avaliou 5 significância compararamse compararam P<0,05. P005 P P<0,05 . 0 05 (P<0,05) Verificouse Verificou ITU>70, ITU70 ITU>70 70 (ITU>70) binomiais P<0,05, destas usouse usou ScottKnott. ScottKnott Scott Knott. Knott Scott-Knott Nordeste calórico frequente diariamente alerta destacandose destacando registraramse registraram produtividade leite (ITU 20 (DPL P00 P<0,0 (P<0,05 ITU7 ITU>7 7 (ITU>70 P0 P<0, (P<0,0 ITU> (ITU>7 P<0 (P<0, (ITU> P< (P<0 (P< (P

Abstract This study aimed to assess the influence of streptozotocin (STZ)-induced diabetes on the nociceptive behavior evoked by the injection of hypertonic saline (HS) into the masseter muscle of rats. Forty male rats were equally divided into four groups: a) isotonic saline control, which received 0.9% isotonic saline (IS), (Ctrl-IS); b) hypertonic saline control, which received 5% HS (Ctrl-HS); c) STZ-induced diabetic, which received IS, (STZ-IS); d) STZ-induced diabetic, which received HS (STZ-HS). Experimental diabetes was induced by a single intraperitoneal injection of STZ at dose of 60 mg/kg dissolved in 0.1 M citrate buffer, and 100 μL of HS or IS were injected into the left masseter to measure the nociceptive behavior. Later on, muscle RNA was extracted to measure the relative expression of the following cytokines: cyclooxygenase-2 (COX-2), tumor necrosis factor (TNF-α), and interleukins (IL)-1β, -2, -6, and -10. One-way analysis of variance (ANOVA) was applied to the data (p < 0.050). We observed a main effect of group on the nociceptive response (ANOVA: F = 11.60, p < 0.001), where the Ctrl-HS group presented the highest response (p < 0.001). However, nociceptive response was similar among the Ctrl-IS, STZ-IS, and STZ-HS group (p > 0.050). In addition, the highest relative gene expression of TNF-α and IL-6 was found in the masseter of control rats following experimental muscle pain (p < 0.050). In conclusion, the loss of somatosensory function can be observed in deep orofacial tissues of STZ-induced diabetic rats. STZinduced (HS groups 09 0 9 0.9 , (IS) CtrlIS Ctrl (Ctrl-IS) b 5 CtrlHS (Ctrl-HS) c STZIS (STZ-IS) d STZHS. STZHS . (STZ-HS) 6 mgkg mg kg 01 1 0. buffer 10 cytokines cyclooxygenase2 cyclooxygenase 2 cyclooxygenase- COX2, COX2 COX (COX-2) TNFα, TNFα TNF α (TNF-α) IL1β, IL1β ILβ IL 1β, 1β β (IL)-1β 2, -2 6, -6 10. -10 Oneway One way ANOVA (ANOVA 0.050. 0050 0.050 050 0.050) 1160 11 11.60 0.001, 0001 0.001 001 0.001) 0.001. However CtrlIS, Ctrl-IS STZIS, STZ-IS addition IL6 IL- conclusion (IS (Ctrl-IS (Ctrl-HS (STZ-IS (STZ-HS (COX-2 (TNF-α - -1 005 0.05 05 116 11.6 000 0.00 00 (COX- 0.0 11. (COX

Abstract Objective In this systematic review (SR), the authors aimed to identify the possible impact of the social restriction imposed by the Coronavirus Disease-19 (COVID-19) pandemic on children/adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Data sources This SR was registered on PROSPERO CRD42021255569. Eligible articles were selected from PubMed, Embase, and LILACS, according to the following characteristics: ADHD patients < 18 years old, exposed to the COVID-19 pandemic, and the outcomes, medications, relationships, sleep, media use, remote learning, and comorbidities such as depression/sadness, inattention, anxiety, and irritability/aggressiveness. Newcastle-Ottawa Scale (NOS) for cohort, cross-sectional and case-control studies was used to assess methodological quality and the risk of bias. Summary of findings Of the 222 articles identified, 27 were included, with information on 7,235 patients. Most studies (n = 22) were cross-sectional and received a mean NOS 4.63/10 followed by longitudinal (n = 4) with 3.75/8 points and case-control (n = 1), with 3/9 points. The pandemic affected patients’ access to treatment, behavior, and sleep. Difficulties in remote learning and increased use of social media were described, as well as significant and positive changes in relationships with family and peers. Conclusion Although the studies were heterogeneous, they indicated that the pandemic-related issues experienced by patients with ADHD were mostly manifested affecting their behavior and sleep patterns. SR, , (SR) Disease19 Disease 19 Disease-1 COVID19 COVID (COVID-19 childrenadolescents children adolescents ADHD. . (ADHD) CRD42021255569 CRD PubMed Embase LILACS characteristics 1 old COVID-1 outcomes medications depressionsadness depression sadness depression/sadness inattention anxiety irritabilityaggressiveness irritability aggressiveness irritability/aggressiveness NewcastleOttawa Newcastle Ottawa (NOS cohort crosssectional cross sectional casecontrol case control bias 22 identified 2 included 7235 7 235 7,23 n 46310 4 63 10 4.63/1 3758 3 75 8 3.75/ 1, 1) 39 9 3/ treatment described peers heterogeneous pandemicrelated related patterns (SR Disease1 Disease- COVID1 (COVID-1 (ADHD CRD4202125556 COVID- 723 23 7,2 4631 6 4.63/ 375 3.75 (COVID- CRD420212555 72 7, 463 4.63 37 3.7 (COVID CRD42021255 46 4.6 3. CRD4202125 4. CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

RESUMEN Objetivos: comprender las experiencias de angustia moral de los enfermeros relacionadas con la sobrecarga de trabajo durante la pandemia de COVID-19 en Brasil. Métodos: investigación cualitativa, cuya recolección de datos ocurrió a través de entrevistas individuales con 19 enfermeros que actuaron en la primera línea de COVID-19 en servicios de salud de la región Sudeste de Brasil. Los datos fueron analizados mediante análisis de contenido temático. Resultados: la sobrecarga de trabajo resultó ser una poderosa fuente de experiencias de sufrimiento moral por exceso de jornada durante la vacunación, doble jornada laboral, relaciones conflictivas por presiones de los directivos y la población y agotamiento físico y mental, lo que impidió al enfermero actuar según su criterio. Consideraciones Finales: la sobrecarga de trabajo de las enfermeras se refleja en la calidad de la atención al paciente e impide que las enfermeras actúen de acuerdo con sus principios morales, generando sufrimiento moral en las enfermeras. Objetivos COVID19 COVID COVID-1 Brasil Métodos cualitativa 1 temático Resultados vacunación laboral mental criterio Finales morales COVID1 COVID-

ABSTRACT Objectives: to understand nurses’ experiences of moral distress related to work overload during the COVID-19 pandemic in Brazil. Methods: qualitative research, whose data collection occurred through individual interviews with 19 nurses who worked on the front line of COVID-19 in health services in southeastern Brazil. Data were analyzed using thematic content analysis. Results: work overload proved to be a powerful source of experiences of moral distress due to excessive working hours during vaccination, double working hours, a troubled relationship due to pressure from managers and the population and physical and mental exhaustion, which prevented nurses from act according to their judgment. Final Considerations: nurses’ work overload reflects on quality patient care and prevents nurses from acting in accordance with their moral principles, generating moral distress in nurses. Objectives COVID19 COVID COVID-1 Brazil Methods research 1 analysis Results vaccination exhaustion judgment Considerations principles COVID1 COVID-

RESUMO Objetivos: compreender vivências de sofrimento moral de enfermeiros relacionadas à sobrecarga de trabalho durante a pandemia de COVID-19 no Brasil. Métodos: pesquisa qualitativa, cuja coleta de dados ocorreu através de entrevistas individuais com 19 enfermeiros que atuaram na linha de frente da COVID-19 em serviços de saúde da região Sudeste do Brasil. Os dados foram analisados mediante análise temática de conteúdo. Resultados: a sobrecarga de trabalho mostrou-se potente fonte para vivências de sofrimento moral devido à jornada de trabalho excessiva na vacinação, à dupla jornada de trabalho, à relação conturbada por pressão de gestores e população e ao esgotamento físico e mental, os quais impediam o enfermeiro de agir conforme o seu julgamento. Considerações Finais: a sobrecarga de trabalho dos enfermeiros reflete na assistência de qualidade ao paciente, e impede que os enfermeiros atuem conforme os seus princípios morais, gerando sofrimento moral nos enfermeiros. Objetivos COVID19 COVID COVID-1 Brasil Métodos qualitativa 1 conteúdo Resultados mostrouse mostrou se vacinação mental julgamento Finais paciente morais COVID1 COVID-