ABSTRACT Inactivated COVID-19 vaccines data in immunocompromised individuals are scarce. This trial assessed the immunogenicity of two CoronaVac doses and additional BNT162b2 mRNA vaccine doses in immunocompromised (IC) and immunocompetent (H) individuals. Adults with solid organ transplant (SOT), hematopoietic stem cell transplant, cancer, inborn immunity errors or rheumatic diseases were included in the IC group. Immunocompetent adults were used as control group for comparison. Participants received two CoronaVac doses within a 28-day interval. IC received two additional BNT162b2 doses and H received a third BNT162b2 dose (booster). Blood samples were collected at baseline, 28 days after each dose, pre-booster and at the trial end. We used three serological tests to detect antibodies to SARS-CoV-2 nucleocapsid (N), trimeric spike (S), and receptor binding domain (RBD). Outcomes included seroconversion rates (SCR), geometric mean titers (GMT) and GMT ratio (GMTR). A total of 241 IC and 100 H adults participated in the study. After two CoronaVac doses, IC had lower SCR than H: anti-N, 33.3% vs 79%; anti-S, 33.8% vs 86%, and anti-RBD, 48.5% vs 85%, respectively. IC also showed lower GMT than H: anti-N, 2.3 vs 15.1; anti-S, 58.8 vs 213.2 BAU/mL; and anti-RBD, 22.4 vs 168.0 U/mL, respectively. After the 3rd and 4th BNT162b2 doses, IC had significant anti-S and anti-RBD seroconversion, but still lower than H after the 3rd dose. After boosting, GMT increased in IC, but remained lower than in the H group. CoronaVac two-dose schedule immunogenicity was lower in IC than in H. BNT162b2 heterologous booster enhanced immune response in both groups. COVID19 COVID 19 COVID-1 scarce BNTb BNT b BNT162b (IC (H SOT, SOT , (SOT) cancer comparison 28day day interval booster. . (booster) baseline 2 prebooster pre end SARSCoV2 SARSCoV SARS CoV SARS-CoV- N, N (N) S, S (S) RBD. RBD (RBD) SCR, (SCR) (GMT GMTR. GMTR (GMTR) 24 10 study antiN, antiN anti anti-N 333 33 3 33.3 79% 79 antiS, antiS 338 8 33.8 86 86% antiRBD, antiRBD RBD, 485 48 5 48.5 85 85% respectively 23 2. 15.1 151 15 1 588 58 58. 2132 213 213. BAU/mL BAUmL BAU mL 224 22 4 22. 1680 168 0 168. UmL U U/mL rd th boosting twodose groups COVID1 COVID- (SOT (booster SARS-CoV (N (S (RBD (SCR (GMTR 33. 7 48. 15. 21 16

ABSTRACT Objective: To describe caregivers’ perception of tracheostomized children about the challenges in discharge to their homes in the Amazonian context. Method: A descriptive, qualitative study was conducted with 16 caregivers of tracheostomized children who experienced dehospitalization in a children’s hospital in Rio Branco - Acre - Brazil. Saturation-defined sampling, data collected with a semi-structured script from August to December 2021, submitted to Bardin Content Analysis. Results: the analysis resulted in four categories: (1) feelings experienced with the use of the tracheal device; (2) routine tracheostomy care that caregivers consider important; (3) questions and reports about tracheal aspiration; and (4) conduct in the face of complications in children using tracheostomy. Final remarks: the fear of learning the tracheal aspiration technique and of being discharged from the hospital reinforces the need for early and continuous education for caregivers, focusing on routine and emergency care for tracheostomized children. Objective context Method descriptive 1 childrens s Brazil Saturationdefined Saturation defined sampling semistructured semi structured 2021 Analysis Results categories (1 device 2 (2 important 3 (3 4 (4 remarks 202 ( 20

RESUMEN Objetivo: describir la percepción de los cuidadores de niños traqueostomizados sobre los desafíos del alta domiciliaria en el contexto amazónico. Material y método: estudio descriptivo, cualitativo, realizado con 16 cuidadores de niños traqueostomizados que pasaron por la experiencia de des-hospitalización en un Hospital Infantil de Rio Branco - Acre - Brasil. Muestreo definido por saturación, datos recogidos mediante guion semiestructurado de agosto a diciembre de 2021, sometidos al Análisis de Contenido de Bardin. Resultados: el análisis dio lugar a cuatro categorías: (1) sentimientos experimentados con el uso del dispositivo traqueal; (2) cuidados rutinarios con la traqueostomía que los cuidadores consideran importantes; (3) dudas e informes sobre la aspiración traqueal; y (4) comportamiento en caso de complicaciones en niños que utilizan una traqueostomía. Consideraciones finales: el miedo a aprender la técnica de aspiración traqueal y a recibir el alta hospitalaria refuerza la necesidad de una formación precoz y continuada de los cuidadores, centrada en los cuidados rutinarios y de urgencia de los niños traqueostomizados. Objetivo amazónico método descriptivo cualitativo 1 deshospitalización des hospitalización Brasil saturación 2021 Bardin Resultados categorías (1 2 (2 importantes 3 (3 4 (4 finales 202 ( 20

RESUMO Objetivo: descrever a percepção dos cuidadores de crianças traqueostomizadas sobre os desafios no processo de alta para o domicílio no contexto amazônico. Método: estudo descritivo, qualitativo, realizado com 16 cuidadores de crianças traqueostomizadas que vivenciaram a desospitalização, em um Hospital Infantil de Rio Branco - Acre - Brasil. Amostragem definida por saturação, dados coletados com roteiro semiestruturado de agosto a dezembro de 2021, submetidos à Análise de Conteúdo de Bardin. Resultados: a análise resultou em quatro categorias: (1) sentimentos vivenciados com o uso do dispositivo traqueal; (2) cuidados rotineiros com a traqueostomia que os cuidadores julgam importantes; (3) dúvidas e relatos sobre a aspiração traqueal; e (4) condutas diante de intercorrências nas crianças em uso de traqueostomia. Considerações finais: o temor em aprender a técnica de aspiração traqueal e da alta hospitalar reforça a necessidade de educação precoce e contínua dos cuidadores, com foco no atendimento de rotina e de emergência para as crianças traqueostomizadas. Objetivo amazônico Método descritivo qualitativo 1 desospitalização Brasil saturação 2021 Bardin Resultados categorias (1 2 (2 importantes 3 (3 4 (4 finais 202 ( 20

Structure-based virtual screening (SBVS) is an important approach that makes the first stages of drug development and repurposing processes faster and more efficient. Advances in experimental techniques and in silico computational modeling have contributed significantly to the characterization of diverse biological targets. Combined with the rapidly growing number of chemical compounds available in virtual databases, these advances enable the effective application of SBVS for prioritization of putative bioactive compounds to treat a wide range of pathologies. Techniques such as molecular docking, along with the utilization of pharmacophore models, are commonly employed for screening large databases of compounds, providing a solid foundation for employing SBVS in drug development pipelines. This review comprehensively analyzes recent advancements and strategies employed in the field of SBVS and explores methodologies for validation, limitations, and challenges associated with this approach. Through a series of case studies across different therapeutic targets, we demonstrate SBVS’s versatility and efficacy in identifying potential therapeutic agents. However, challenges remain, and understanding these is crucial for maximizing SBVS’s potential. We address these challenges, offering insights into the current limitations and future prospects of SBVS in drug development. Structurebased Structure based (SBVS efficient targets pathologies docking models pipelines validation SBVSs s agents However remain

ABSTRACT Objective: To evaluate the risk factors for healthcare-related infections during the COVID-19 pandemic in intensive care units, to investigate the impact of COVID-19 on Central Line-Associated Bloodstream Infection, Catheter-Associated Urinary Tract Infection, and ventilator-associated pneumonia, and to describe healthcare-associated infections in the waves of the COVID-19 pandemic. Methods: This nested case-control study was conducted in a 137-bed adult medical/surgical intensive care unit at a private hospital in São Paulo, Brazil, between January 11, 2019, and May 21, 2022. Case patients were identified using the Nosocomial Infection Control Committee database and control patients were identified using the intensive care unit's EPIMED system. For the analysis of risk factors, the chi-square test, multiple logistic regression model, and Kaplan-Meier method were used to identify independent risk factors, considering p<0.05. Results: The Case Group consisted of 189 healthcare-associated infections, including ventilator-associated pneumonia (61.4%), Central Line-Associated Bloodstream Infection (30.1%), Catheter-Associated Urinary Tract Infection (8.5%), and the Control Group consisted of 6,834 patients. The independent risk factors were COVID-19 infection (OR=2.84, 95%CI=1.92–4.23, p<0.01), length of stay in intensive care greater than 14 days (OR=3.15, 95%CI=1.95–5.14, p<0.01), length of hospital stay greater than 30 days (OR=3.64, 95%CI=2.44–5.51, p<0.01), and patients who were in the third wave (OR=1.72, 95%CI=1.05–2.91, p=0.04). Ventilator-associated pneumonia was the only healthcare-related infection for which COVID-19 infection was an independent risk factor (OR=3.32, 95%CI=1.92–5.94, p<0.01). Conclusion: COVID-19 and length of hospital stay were independent risk factors for healthcare-associated infections, and only ventilator-associated pneumonia was affected by the COVID-19 pandemic. Objective healthcarerelated healthcare related COVID19 COVID 19 COVID-1 units LineAssociated Line Associated CatheterAssociated Catheter ventilatorassociated ventilator associated healthcareassociated Methods casecontrol case 137bed bed 137 medicalsurgical medical surgical Paulo Brazil 11 2019 21 2022 s system chisquare chi square test model KaplanMeier Kaplan Meier p005 p 0 05 p<0.05 Results 18 61.4%, 614 61.4% , 61 4 (61.4%) 30.1%, 301 30.1% 1 (30.1%) 8.5%, 85 8.5% 8 5 (8.5%) 6834 6 834 6,83 OR=2.84, OR284 OR 2 84 (OR=2.84 95CI192423 CI 95 92 23 95%CI=1.92–4.23 p<0.01, p001 p<0.01 01 p<0.01) OR=3.15, OR315 3 15 (OR=3.15 95CI195514 95%CI=1.95–5.14 OR=3.64, OR364 64 (OR=3.64 95CI244551 44 51 95%CI=2.44–5.51 OR=1.72, OR172 72 (OR=1.72 95CI105291 91 95%CI=1.05–2.91 p=0.04. p004 p=0.04 . 04 p=0.04) Ventilatorassociated Ventilator OR=3.32, OR332 32 (OR=3.32 95CI192594 94 95%CI=1.92–5.94 p<0.01. Conclusion COVID1 COVID- 13 201 202 p00 p<0.0 61.4 (61.4% 30.1 (30.1% 8.5 (8.5% 683 83 6,8 OR=2.84 OR28 (OR=2.8 95CI19242 9 95%CI=1.92–4.2 OR=3.15 OR31 (OR=3.1 95CI19551 95%CI=1.95–5.1 OR=3.64 OR36 (OR=3.6 95CI24455 95%CI=2.44–5.5 OR=1.72 OR17 7 (OR=1.7 95CI10529 95%CI=1.05–2.9 p=0.0 OR=3.32 OR33 (OR=3.3 95CI19259 95%CI=1.92–5.9 20 p0 p<0. 61. (61.4 30. (30.1 8. (8.5 68 6, OR=2.8 OR2 (OR=2. 95CI1924 95%CI=1.92–4. OR=3.1 OR3 (OR=3. 95CI1955 95%CI=1.95–5. OR=3.6 95CI2445 95%CI=2.44–5. OR=1.7 OR1 (OR=1. 95CI1052 95%CI=1.05–2. p=0. OR=3.3 95CI1925 95%CI=1.92–5. p<0 (61. (30. (8. OR=2. (OR=2 95CI192 95%CI=1.92–4 OR=3. (OR=3 95CI195 95%CI=1.95–5 95CI244 95%CI=2.44–5 OR=1. (OR=1 95CI105 95%CI=1.05–2 p=0 95%CI=1.92–5 p< (61 (30 (8 OR=2 (OR= 95CI19 95%CI=1.92– OR=3 95%CI=1.95– 95CI24 95%CI=2.44– OR=1 95CI10 95%CI=1.05– p= (6 (3 ( OR= (OR 95CI1 95%CI=1.92 95%CI=1.95 95CI2 95%CI=2.44 95%CI=1.05 95CI 95%CI=1.9 95%CI=2.4 95%CI=1.0 95%CI=1. 95%CI=2. 95%CI=1 95%CI=2 95%CI= 95%CI

ABSTRACT Objective: To estimate the prevalence and factors associated with hepatitis A, B, and C in transgender women and travestis's networks, in 5 regions of Brazil. Methods: This cross-sectional study includedtransgender women and travestis in five Brazilian capitals (Campo Grande, Manaus, Porto Alegre, Salvador, and São Paulo), between December/2019 and July/2021. All samples were subjected to detection of serological markers of hepatitis virus A (HAV), B (HBV), and C (HCV) infections through rapid tests and chemiluminescent microparticle immunoassays. Positive samples in the screening tests were submitted to detect HBV DNA and HCV-RNA by real-time PCR and genotyped by Sanger sequencing. Results: Analysis of 1,317 samples showed network prevalence rates of 69.1%, 25.1%, and 1.5% for HAV, HBV, and HCV exposure, respectively. A high susceptibility rate to HBV infection (35.7%) and low prevalence of vaccine response markers (40%) were also observed. Age greater than 26 years, self-declared black/brown skin color, having only primary education, history of incarceration, and use of a condom in the last sexual intercourse with a casual partner were associated with total anti-HAV. Exposure to HBV was associated with age greater than 26 years, self-declared black/brown, history of being a sex worker, and incarceration. Age > 37 years, history of sexual abuse, and frequent alcohol consumption were associated with hepatitis C infection. Conclusion: The highest prevalence of HAV in this population was found in the North and Northeast regions, and the prevalence found was higher than that in the general population, suggesting greater vulnerability. The prevalence of HCV infection in our study was similar to that observed in the general population. Objective travestiss s networks Brazil Methods crosssectional cross sectional Campo Grande Manaus Alegre Salvador Paulo, Paulo , Paulo) December2019 December 2019 December/201 July2021 July 2021 July/2021 (HAV) (HBV) (HCV immunoassays HCVRNA RNA realtime real time sequencing Results 1317 1 317 1,31 691 69 69.1% 251 25 25.1% 15 1.5 exposure respectively 35.7% 357 35 7 (35.7% 40% 40 (40% 2 years selfdeclared self declared blackbrown black brown color education incarceration antiHAV. antiHAV anti HAV. anti-HAV worker 3 abuse Conclusion vulnerability December201 201 December/20 July202 202 July/202 (HAV (HBV 131 31 1,3 6 69.1 25.1 1. 35.7 (35.7 4 (40 December20 20 December/2 July20 July/20 13 1, 69. 25. 35. (35. (4 December2 December/ July2 July/2 (35 ( July/ (3

RESUMO Objetivo: Estimar as prevalências e fatores associados com as hepatites A, B e C em mulheres trans e travestis em cinco regiões do Brasil. Métodos: Estudo transversal com mulheres trans e travestis em cinco capitais brasileiras (Campo Grande, Manaus, Porto Alegre, Salvador e São Paulo), entre dezembro/2019 e julho/2021. As amostras foram submetidas à detecção de marcadores das infecções pelos vírus das hepatites A (HAV), B (HBV) e C (HCV), utilizando-se testes rápidos e quimioluminescência. Amostras positivas foram submetidas à detecção de HBV-DNA e HCV-RNA por PCR em tempo real e genotipadas por sequenciamento de Sanger. Resultados: As análises de 1.317 amostras indicaram taxas de prevalências nas mulheres trans e travestis recrutadas de 69,1%, 24,4% e 1,5% para exposição ao HAV, HBV e HCV, respectivamente. Elevada taxa de suscetibilidade ao HBV (35,7%) e baixa prevalência do marcador vacinal (40,0%) foram observadas. Mostraram-se associadas à presença de anti-HAV: idade maior que 26 anos, autodeclarar-se preta-parda, ter apenas educação básica, história de encarceramento e uso de preservativo na última relação sexual com parceiro casual. Quanto à exposição ao HBV, foi associada a idade maior que 26 anos, cor da pele preto-parda, ter sido profissional do sexo e história de encarceramento. Idade maior de 37 anos, história de abuso sexual e consumo frequente de álcool foram associadas ao HCV. Conclusão: As maiores prevalências de HAV nessa população encontram-se nas regiões Norte e Nordeste. Com relação ao HBV, a prevalência encontrada foi superior à encontrada na população geral, sugerindo maior vulnerabilidade. A prevalência do HCV foi semelhante à encontrada na população geral. Objetivo Brasil Métodos Campo Grande Manaus Alegre Paulo, Paulo , Paulo) dezembro2019 dezembro 2019 dezembro/201 julho2021 julho 2021 julho/2021 (HAV) (HBV (HCV) utilizandose utilizando se quimioluminescência HBVDNA DNA HCVRNA RNA Sanger Resultados 1317 1 317 1.31 691 69 69,1% 244 24 4 24,4 15 5 1,5 respectivamente 35,7% 357 35 7 (35,7% 40,0% 400 40 0 (40,0% observadas Mostraramse Mostraram antiHAV anti anti-HAV 2 anos autodeclararse autodeclarar pretaparda, pretaparda preta parda, parda preta-parda básica casual pretoparda, pretoparda preto preto-parda 3 Conclusão encontramse encontram Nordeste geral vulnerabilidade dezembro201 201 dezembro/20 julho202 202 julho/202 (HAV (HCV 131 31 1.3 6 69,1 24, 1, 35,7 (35,7 40,0 (40,0 dezembro20 20 dezembro/2 julho20 julho/20 13 1. 69, 35, (35, 40, (40, dezembro2 dezembro/ julho2 julho/2 (35 (40 julho/ (3 (4 (

ABSTRACT Objectives: to understand nurses’ experiences in caring for people with mental health problems hospitalized due to clinical comorbidities in non-psychiatric Inpatient Units. Methods: qualitative study, guided by Alfred Schutz’s social phenomenology. Sixteen phenomenological interviews were conducted. The content was analyzed and discussed based on the literature, through the composition of three categories of analysis. Results: three categories emerged in the study: Challenges in care faced by nurses; Fragmented care action; and Ideal care. The disarticulation of the clinic was revealed, as described by nurses, showing care as an action far removed from the comprehensiveness of a person. Nurses’ performance is guided predominantly by biomedical reference, disregarding appreciation of subjectivity. Final Considerations: it was observed that nurses attribute the responsibility for patient care to factors external to their life-world, when, in fact, these aspects should be components that help them in comprehensive care construction. Objectives nonpsychiatric non psychiatric Units Methods study Schutzs Schutz s phenomenology conducted literature analysis Results revealed person Nurses reference subjectivity Considerations lifeworld, lifeworld life world, world life-world when fact construction

RESUMEN Objetivos: comprender las experiencias de enfermeros en el cuidado de personas con sufrimiento psicológico internadas por comorbilidades clínicas en Unidades de Internación no psiquiátricas. Métodos: estudio cualitativo, guiado por la fenomenología social de Alfred Schutz. Se realizaron 16 entrevistas fenomenológicas. El contenido fue analizado y discutido con base en la literatura, a través de la composición de tres categorías de análisis. Resultados: emergieron tres categorías en el estudio: Desafíos de cuidado enfrentados por los enfermeros; La acción fragmentada del cuidado; y Atención óptima. Se reveló la desarticulación de la clínica, descrita por los enfermeros, destacando el cuidado como una acción alejada de la plenitud de la persona. Las acciones de los enfermeros son guiadas predominantemente por el marco biomédico, desconsiderando la apreciación de la subjetividad. Consideraciones Finales: se observó que los enfermeros atribuyen la responsabilidad por el cuidado del paciente a factores externos a su mundo de vida, cuando, en realidad, esos aspectos deben ser componentes que les ayuden a construir un cuidado integral. Objetivos psiquiátricas Métodos cualitativo Schutz 1 fenomenológicas literatura análisis Resultados óptima clínica persona biomédico subjetividad Finales vida cuando realidad integral

RESUMO Objetivos: compreender as experiências dos enfermeiros no cuidado da pessoa em sofrimento psíquico hospitalizada por comorbidades clínicas em Unidades de Internação não psiquiátricas. Métodos: estudo qualitativo, orientado pela fenomenologia social de Alfred Schutz. Realizaram-se 16 entrevistas fenomenológicas. O conteúdo foi analisado e discutido com base na literatura, por meio da composição de três categorias de análise. Resultados: surgiram três categorias no estudo: Desafios no cuidado enfrentados pelos enfermeiros; A ação fragmentada do cuidado; e O cuidado ideal. Desvelou-se a desarticulação da clínica, conforme descrito pelos enfermeiros, evidenciando o cuidado como uma ação afastada da integralidade da pessoa. A atuação dos enfermeiros é guiada predominantemente pelo referencial biomédico, desconsiderando a valorização da subjetividade. Considerações Finais: observou-se que o enfermeiro atribui a responsabilidade do cuidado do paciente a fatores externos ao seu mundo vida, quando, na verdade, esses aspectos deveriam ser componentes que o auxiliassem na construção de um cuidado integral. Objetivos psiquiátricas Métodos qualitativo Schutz Realizaramse Realizaram se 1 fenomenológicas literatura análise Resultados ideal Desvelouse Desvelou clínica biomédico subjetividade Finais observouse observou vida quando verdade integral

ABSTRACT Introduction: Elitism in medical education is a historical phenomenon. Beginning at the European universities of the Middle Ages, the teaching of medicine became a monopoly of the elite, excluding less privileged social groups. In Brazil, the elitization of medical knowledge occurred with the arrival of the royal family in 1808, reinforcing the role of doctors as protagonists of health, while popular healing practices were devalued. In the US, Abraham Flexner influenced medical teaching worldwide with an elitist model based on biomedical logic. Objectives: The objective is to understand the factors that reproduced the elitist context in medical teaching, investigate how these aspects influence the exclusion of certain social groups in the medical environment and point out ways to discuss and tackle the problem. Methods: This is an integrative literature review of 14 articles selected from 182, published between 2012 and 2022, and filtered from the PubMed, Scielo, Lilacs, Web of Science and Scopus databases. Results and Discussion: There are similarities among those in the privileged group in medicine, characterised by being white, heterosexual and cisgender men of favourable socioeconomic status, compared to the systematically marginalized group of women belonging to ethnic minorities, low socio-economic class and/or part of the LGBTQIA+ community. This coincidence has historical and economic bases that reflect a larger structure, which distributes privileges based on the criteria of race, gender, social class and sexual orientation. Among the historical processes that have reproduced this pattern, the colonization process of countries such as Brazil is cited, marked by the exploitation, erasure and imposition of a medical culture and science guided by a European standard; racism and chauvinism that as ideologies, remain criteria for the distribution of privileges in class society and cisheteronormativity, which also excludes bodies and sexual orientations and the production of health care knowledge and practices. Conclusion: Critical epistemologies such as those found in the intersectional thinking of black feminism and in Aníbal Quijano and Audre Lorde’s coloniality of the power are presented as ways to break this norm, giving rise to questions of its roots for the organization of collective struggles and forms of production of knowledge that meet the interests of historically oppressed groups. Introduction phenomenon Ages elite 1808 devalued US logic Objectives problem Methods 1 182 201 2022 PubMed Scielo Lilacs databases Discussion white status minorities socio andor or LGBTQIA community structure race gender orientation pattern cited exploitation standard ideologies cisheteronormativity Conclusion Lordes Lorde s norm 180 18 20 202 2

RESUMO Introdução: O elitismo no ensino da medicina é um fenômeno histórico. Desde as universidades europeias da Idade Média, o ensino da medicina tornou-se um monopólio da elite. No Brasil, a elitização do conhecimento médico ocorreu com a vinda da família real em 1808, reforçando o papel dos médicos como protagonistas da saúde, enquanto práticas curativas populares foram desvalorizadas. Nos Estados Unidos, Abraham Flexner influenciou o ensino médico mundial com um modelo elitizado baseado na lógica biomédica. Objetivo: Este estudo teve como objetivos compreender os fatores que reproduzem o contexto elitista no ensino da medicina, investigar como esses aspectos influenciam a exclusão de determinados grupos sociais no meio médico e apontar caminhos para a discussão e o enfrentamento do problema. Método: Trata-se de uma revisão integrativa de literatura realizada a partir de 14 artigos selecionados entre 182, publicados no período de 2012 a 2022 e filtrados das bases de dados PubMed, SciELO, Lilacs, Web of Science e Scopus. Resultado: Percebem-se semelhanças entre o grupo privilegiado na medicina, formado por homens, brancos, heterossexuais e cisgênero, de condição socioeconômica favorável, em comparação ao grupo sistematicamente marginalizado de mulheres pertencentes a minorias étnico-raciais, de baixa classe socioeconômica e/ou parte da população LGBTQIA+. Essa coincidência tem bases históricas e econômicas que refletem uma estrutura maior, que distribui privilégios partindo dos critérios de raça, gênero, classe social e orientação sexual. Entre os processos históricos que reproduzem esse padrão, cita-se o processo de colonização de países como o Brasil, marcado pela exploração, pelo apagamento e pela imposição de uma cultura e ciência médica balizada por um padrão europeu; o racismo e machismo que, como ideologias, continuam sendo critérios para a distribuição de privilégios na sociedade de classes; e a heterocisnormatividade, que também atua excluindo corpos e orientações sexuais e produção de conhecimentos e práticas de cuidado em saúde. Conclusão: Epistemologias críticas como as presentes no pensamento interseccional do feminismo negro e na colonialidade do poder de Aníbal Quijano e Audre Lorde apresentam-se como caminhos à ruptura dessa norma, propiciando o questionamento de suas raízes para a organização de lutas coletivas e formas de produção de conhecimento que venham ao encontro dos interesses dos grupos historicamente oprimidos. Introdução histórico Média tornouse tornou se elite Brasil 1808 saúde desvalorizadas Unidos biomédica Objetivo problema Método Tratase Trata 1 182 201 202 PubMed SciELO Lilacs Scopus Resultado Percebemse Percebem homens brancos cisgênero favorável étnicoraciais, étnicoraciais étnico raciais, raciais étnico-raciais eou ou LGBTQIA LGBTQIA+ maior raça gênero sexual citase cita exploração europeu ideologias classes heterocisnormatividade Conclusão apresentamse apresentam norma oprimidos 180 18 20 2

Abstract Background In general, patients are referred for rheumatological evaluation due to isolated laboratory abnormalities, especially antinuclear antibody (ANA) positivity, with the risk of more severe patients remaining on the waiting list for longer than desired. The aim of this study was to analyze the demographic, clinical, and laboratory information of patients referred to a specialized rheumatological care unit because of positive antinuclear antibody. Methods This is a retrospective study of 99 out of 1670 patients seen by the same rheumatologist between 01/01/2011 and 01/01/2019. Patients whose referrals were exclusively due to the ANA test result and the specialist’s final diagnosis being “abnormal finding of serum immunological test” (ICD-10 R769) were included. Sociodemographic, clinical, and laboratory information were extracted from the consulting rheumatologist’s chart. Descriptive statistics were used for data analysis. Results A total of 99 patients were included, most of whom were female (84.8%) with a median age of 49 years. At the moment of specialist’s appointment, 97 patients (97.9%) repeated the ANA test, and 77 patients remained positive. Of these, only 35 (35.35%) were in a high titer range (greater than or equal to 1:320). Complete blood count for cytopenia’s investigation was not performed in a high percentage of patients (22.2%), as well as urinalysis (31.3%). In addition, more than 70% of patients score 0 to 1 classification criteria for Systemic Lupus Erythematosus, according to SLE - ACR 1987 (American College of Rheumatology) and SLICC 2012 (Systemic Lupus International Collaborating Clinics). Conclusions Most patients are still referred for specialized evaluation due to the misinterpretation of laboratory tests that were inappropriately requested in patients without clinical evidence of autoimmune rheumatic disease. general abnormalities (ANA positivity desired demographic 9 167 01012011 01 2011 01/01/201 01012019 2019 01/01/2019 specialists specialist s abnormal ICD10 ICD 10 (ICD-1 R769 R included Sociodemographic rheumatologists chart analysis 84.8% 848 84 8 (84.8% 4 years appointment 97.9% 979 (97.9% 7 these 3 35.35% 3535 (35.35% greater 1320. 1320 320 . 1:320) cytopenias cytopenia 22.2%, 222 22.2% , 22 2 (22.2%) 31.3%. 313 31.3% 31 (31.3%) addition 70 Erythematosus 198 American Rheumatology 201 Clinics. Clinics Clinics) disease 16 0101201 01/01/20 ICD1 (ICD- R76 84.8 (84.8 97.9 (97.9 35.35 353 (35.35 132 32 1:320 22.2 (22.2% 31.3 (31.3% 19 20 010120 01/01/2 (ICD R7 84. (84. 97. (97. 35.3 (35.3 13 1:32 22. (22.2 31. (31.3 01012 01/01/ (84 (97 35. (35. 1:3 (22. (31. 0101 01/01 (8 (9 (35 1: (22 (31 010 01/0 ( (3 (2 01/

Abstract Background Systemic sclerosis (SSc) is a rare chronic autoimmune disease with heterogeneous manifestations. In the last decade, several clinical trials have been conducted to evaluate new treatment options for SSc. The purpose of this work is to update the recommendations of the Brazilian Society of Rheumatology in light of the new evidence available for the pharmacological management of SSc. Methods A systematic review including randomized clinical trials (RCTs) for predefined questions that were elaborated according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) strategy was conducted. The rating of the available evidence was performed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. To become a recommendation, at least 75% agreement of the voting panel was needed. Results Six recommendations were elaborated regarding the pharmacological treatment of Raynaud’s phenomenon, the treatment (healing) and prevention of digital ulcers, skin involvement, interstitial lung disease (ILD) and gastrointestinal involvement in SSc patients based on results available from RCTs. New drugs, such as rituximab, were included as therapeutic options for skin involvement, and rituximab, tocilizumab and nintedanib were included as therapeutic options for ILD. Recommendations for the pharmacological treatment of scleroderma renal crisis and musculoskeletal involvement were elaborated based on the expert opinion of the voting panel, as no placebo-controlled RCTs were found. Conclusion These guidelines updated and incorporated new treatment options for the management of SSc based on evidence from the literature and expert opinion regarding SSc, providing support for decision-making in clinical practice. (SSc manifestations decade (RCTs PatientPopulation Patient Population Patient/Population Intervention Comparison PICO (PICO Assessment GRADE (GRADE methodology recommendation 75 needed Raynauds Raynaud s phenomenon healing (healing ulcers ILD (ILD drugs rituximab placebocontrolled placebo controlled found decisionmaking decision making practice 7

Abstract The pathogenic nature of infections caused by Candida spp. underscores the necessity for novel therapeutic agents. Extracts of Schinopsis brasilienses Engl are \ a promising source of agents with antifungal effects. This study aimed to assess the antifungal potential of the leaf extract of S. brasilienses. The antifungal activity was evaluated by determining the minimum inhibitory concentrations and fungicide concentrations (MIC and MFC). The antibiofilm potential was assessed by counting colony-forming units/mL. The study examined the inhibition kinetics of fungal growth and potential synergism between gallic acid or the extract and nystatin using the Checkerboard method. Cytotoxicity was evaluated through the MTT assay. The extract exhibited antifungal effect against all tested strains, with MIC and MFC ranging from 31.25–250 μg/mL. Gallic acid, the main isolated compound, displayed a MIC of 2000 μg/mL. The extract of S. brasilienses at 31.25 μg/mL inhibited the formation of biofilm by C. albicans and significantly reduced the mass of mature biofilm after 24 and 48 h (p < 0. 05). At a concentration of 125 μg/mL, the extract demonstrated significant inhibition of fungal growth after 6 hours. The combination of gallic acid or extract with nystatin did not exhibit synergistic or antagonistic effect. Furthermore, the extract did not induce cytotoxicity to a human cell line. The extract of S. brasiliensis demonstrates antifungal activity against Candida, generally exhibiting fungicidal action and capacity to inhibit biofilm formation as well as reduce mature biofilms. Additionally, the extract showed low cytotoxicity to human cells. spp effects S MFC. . MFC) colonyforming colony forming unitsmL units mL units/mL method assay strains 3125250 31 25 250 31.25–25 μgmL μg compound 200 3125 31.2 C 2 4 p 0 05. 05 05) 12 hours Furthermore line biofilms Additionally cells 312525 3 31.25–2 20 312 31. 1 31252 31.25–

ABSTRACT This is a theoretical study aimed at reflecting on the contribution of the concept of family myth to nursing care for children in psychological distress. It is methodologically structured around three topics: the importance of the family in caring for children; the perspective of family-centered nursing care for children in psychological distress; and the contribution of the understanding of family myth to nursing care for children in psychological distress. The following dialectic is considered: the family, considered by current literature to be a harmonious unit, also triggers family conflicts that can be the cause of psychological suffering. The concept of family myth emerges as a possible theoretical anchor for nursing care for children in psychological distress, as it allows nurses to consider the signifiers that mark the child’s psychological structure and construct their symptoms. Uncovering the place that the family assigns to the child enables nurses to help them construct and elaborate their own place as a subject in their subjectivity. distress topics familycentered centered unit suffering childs s symptoms subjectivity

RESUMEN Se trata de un estudio teórico dirigido a reflexionar sobre la contribución del concepto de mito familiar a los cuidados de enfermería a niños con sufrimiento psicológico. Metodológicamente se estructura en torno a tres temas: la importancia de la familia en el cuidado de los niños; la perspectiva de los cuidados de enfermería centrados en la familia para niños con sufrimiento psicológico; y la contribución de la comprensión del mito familiar a los cuidados de enfermería a niños con sufrimiento psicológico. Se plantea la dialéctica: la familia, considerada por la literatura actual como una unidad armoniosa, también desencadena conflictos familiares que pueden ser causa de sufrimiento psicológico. El concepto de mito familiar emerge como anclaje teórico para los cuidados de enfermería a los niños en malestar psicológico, ya que permite a las enfermeras considerar los significantes que marcan la estructura psicológica del niño y construyen sus síntomas. Desvelar el lugar que la familia asigna al niño permite a las enfermeras ayudarle a construir y elaborar su propio lugar como sujeto en su subjetividad. psicológico temas dialéctica armoniosa síntomas subjetividad

RESUMO Trata-se de um estudo teórico com o objetivo de refletir sobre a contribuição do conceito de mito familiar para o cuidado de enfermagem à criança em sofrimento psíquico, sendo metodologicamente estruturado em três tópicos: importância da família no cuidado de crianças; perspectiva do cuidado de enfermagem centrado na família de crianças em sofrimento psíquico; e contribuição do entendimento de mito familiar para o cuidado de enfermagem à criança em sofrimento psíquico. Considera-se a dialética: a família, tida pela literatura atual como unidade harmônica, também desencadeia conflitos familiares que podem ser a causa de sofrimentos psíquicos. O conceito de mito familiar surge como possibilidade de ancoragem teórica ao cuidado de enfermagem à criança em sofrimento psíquico ao permitir que o enfermeiro considere os significantes que marcam a estruturação psíquica da criança e constroem seu sintoma. Desvendar o lugar que a família destina à criança viabiliza ao enfermeiro auxiliá-la a construir e elaborar um local próprio enquanto sujeito em sua subjetividade. Tratase Trata se tópicos Considerase Considera dialética harmônica psíquicos sintoma auxiliála auxiliá la subjetividade

ABSTRACT Purpose To compare the acoustic measurements of Cepstral Peak Prominence Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) of children with normal and altered voices, to relationship with auditory-perceptual judgment (APJ) and to establish cut-off points. Methods Vocal recordings of the sustained vowel and number counting tasks of 185 children were selected from a database and submitted to acoustic analysis with extraction of CPPS and AVQI measurements, and to APJ. The APJ was performed individually for each task, classified as normal or altered, and for the tasks together defining whether the child would pass or fail in a situation of vocal screening. Results Children with altered APJ and who failed the screening had lower CPPS values and higher AVQI values, than those with normal APJ and who passed the screening. The APJ of the sustained vowel task was related to CPPS and AVQI, and APJ of the number counting task was related only to AVQI and CPPS numbers. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the vowel CPPS, 7.62 for the CPPS numbers and 2.01 for the AVQI. Conclusion Children with altered voices, have higher AVQI values and lower CPPS values, when detected in children with voices within the normal range. The acoustic measurements were related to the auditory perceptual judgment of vocal quality in the sustained vowel task, however, the number counting task was related only to the AVQI and CPPS. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the CPPS vowel, 7.62 for the CPPS numbers and 2.01 for the AVQI. The three measures were similar in identifying voices without deviation and dysphonic voices. (CPPS (AVQI auditoryperceptual (APJ cutoff cut off 18 1407 14 07 14.0 762 7 62 7.6 201 2 01 2.0 range however 1 140 0 14. 76 6 7. 20 2.

RESUMO Objetivo Comparar as medidas acústicas de Cepstral Peak Prominence Smoothed (CPPS) e Acoustic Voice Quality Index (AVQI) de crianças com vozes normais e alteradas, relacionar com o julgamento perceptivo-auditivo (JPA) da voz e estabelecer pontos de corte. Método Gravações vocais das tarefas de vogal sustentada e contagem de números de 185 crianças foram selecionadas em um banco de dados e submetidas a análise acústica com extração das medidas de CPPS e AVQI, e ao JPA. O JPA foi realizado individualmente para cada tarefa e as amostras foram classificadas posteriormente como normal ou alterada, e para as tarefas em conjunto definindo-se se a criança passaria ou falharia em uma situação de triagem vocal. Resultados Crianças com JPA alterado e que falharam na triagem apresentaram valores menores de CPPS e maiores de AVQI, do que as com JPA normal e que passaram na triagem. O JPA da tarefa de vogal sustentada se relacionou ao CPPS e AVQI, e da tarefa de contagem de números relacionou-se apenas ao AVQI e CPPS números. Os pontos de corte que diferenciam crianças com e sem desvio vocal são 14,07 para o CPPS vogal, 7,62 para o CPPS números e 2,01 para o AVQI. Conclusão Crianças com JPA alterado apresentaram maiores valores de AVQI e menores valores de CPPs. O JPA da tarefa de vogal previu todas as medidas acústicas, porém, de contagem previu apenas as medidas extraídas dela. As três medidas foram semelhantes na identificação de vozes sem desvio e vozes disfônicas. (CPPS (AVQI alteradas perceptivoauditivo perceptivo auditivo (JPA 18 alterada definindose definindo relacionouse 1407 14 07 14,0 762 7 62 7,6 201 2 01 2,0 CPPs porém dela disfônicas 1 140 0 14, 76 6 7, 20 2,

Abstract The Paranaguá Estuarine Complex (PEC) is one of Brazil's largest southwest Atlantic estuarine systems, possessing a rich microalgae diversity that remains to be fully explored. Therefore, due to the increasing interest in the microalgae biotechnological potential, this study isolated and identified diatoms found in the PEC. The diatoms were purified and analyzed with light and scanning electron microscopy for morphological identification, while DNA sequences were used for molecular identification. Although a diatoms rich diversity was obtained, only a few were viable after the cultivation period. The two best-selected strains were identified as belonging to two genera, Nitzschia and Navicula. The rbcL region was found to be the most informative for species identification. Morphological and molecular analyses allowed for the identification of species Nitzschia inconspicua and Navicula pseudoantonii, which was understood as the first report of N. pseudoantonii in the American continent. PEC (PEC Brazils Brazil s systems explored Therefore potential obtained period bestselected best selected genera N continent

RESUMO OBJETIVO Avaliar a prevalência e os fatores associados à ocorrência de quedas em idosos. MÉTODOS Estudo transversal com amostra representativa de 1.451 idosos residentes na zona urbana de Pelotas, RS, em 2014. Foi realizada análise descritiva dos dados e apresentada a prevalência de quedas no último ano. A análise de fatores demográficos, socioeconômicos, comportamentais e de saúde associados ao desfecho foi realizada por meio de regressão de Poisson com ajuste para variância robusta conforme modelo hierárquico. As variáveis foram ajustadas entre si dentro de cada nível e para as de nível superior. Aquelas com p ≤ 0,20 foram mantidas no modelo para controle de confusão e aquelas com p < 0,05 foram consideradas associadas ao desfecho. RESULTADOS A prevalência de quedas em idosos no último ano foi de 28,1% (IC95% 25,9–30,5), e a maioria ocorreu na própria residência do idoso. Entre os idosos que sofreram queda, 51,5% (IC95% 46,6–56,4) tiveram uma única queda e 12,1% (IC95% 8,9–15,3) tiveram fratura como consequência, sendo a de membros inferiores a mais relatada. A prevalência de quedas foi maior em mulheres, idosos com idade avançada, de menor renda e escolaridade, com incapacidade funcional para atividades instrumentais e portadores de enfermidades como diabetes, doença cardíaca e artrite. CONCLUSÕES A ocorrência de quedas atingiu quase um terço dos idosos, e a prevalência foi mais elevada em segmentos específicos da população em questão. Cerca de 12% dos idosos que caíram, fraturaram algum osso. Os fatores associados à ocorrência de quedas identificados neste estudo poderão nortear medidas que visem sua prevenção na população de idosos.

ABSTRACT OBJECTIVE Evaluate the prevalence and the factors associated with the occurrence of falls among older adults. METHODS A cross-sectional study with a representative sample of 1,451 elderly residents in the urban area of Pelotas, RS, in 2014. A descriptive analysis of the data was performed and the prevalence of falls in the last year was presented. The analysis of demographic, socioeconomic, behavioral and health factors associated with the outcome was performed using Poisson regression with adjustment for robust variance according to the hierarchical model. The variables were adjusted to each other within each level and for the higher level. Those with p ≤ 0.20 were maintained in the model for confounding control and those with p < 0.05 were considered to be associated with the outcome. RESULTS The prevalence of falls among older adults in the last year was 28.1% (95%CI 25.9–30.5), and most occurred in the person’s own residence. Among the older adults who fell, 51.5% (95%CI 46.6–56.4) had a single fall and 12.1% (95%CI 8.9–15.3) had a fracture as a consequence, usually in the lower limbs. The prevalence of falls was higher in women, adults of advanced age, with lower income and schooling level, with functional incapacity for instrumental activities, and patients with diseases such as diabetes, heart disease, and arthritis. CONCLUSIONS The occurrence of falls reached almost a third of the older adults, and the prevalence was higher in specific segments of the population in question. About 12% of the older adults who fell fractured some bone. The factors associated with the occurrence of falls identified in this study may guide measures aimed at prevention in the older adult population.

A retrospective study on the prevalence of hepatitis E virus (HEV) infection was conducted in selected populations in Rio de Janeiro, Brazil. A total of 1,115 subjects were tested including 146 patients with acute Non-A Non-B Non-C (NANBNC) viral hepatitis, 65 hemodialysis patients, 93 blood donors, 102 intravenous drug users (IVDUs), 304 pregnant women, 145 individuals living in the rural area and 260 individuals living in the urban area. In order to characterize a favorable epidemiological set for enterically transmitted infection in the studied populations we also evaluated the prevalence of anti-HAV IgG (hepatitis A virus) antibodies. Specific antibodies to HEV (anti-HEV IgG) were detected by a commercial EIA and specific antibodies to HAV (anti-HAV IgG) were detected using a competitive "in house" EIA. We found a high prevalence of anti-HAV IgG in these populations, that could indicate some risk for infections transmitted via the fecal-oral route. The anti-HEV IgG prevalence among the different groups were: 2.1% in patients with acute NANBNC viral hepatitis, 6.2% in hemodialysis patients, 4.3% in blood donors, 11.8% in IVDUs, 1% in pregnant women, and 2.1% in individuals form the rural area. Among individuals living in the urban area we did not find a single positive serum sample. Our results demonstrated the presence of anti-HEV IgG in almost all studied populations; however, further studies are necessary to establish the real situation of HEV epidemiology in Rio de Janeiro, Brazil.