Resumo Introdução: O Programa Nacional de Alimentação Escolar (PNAE) destaca-se por ser um dos maiores programas do mundo de alimentação escolar, contemplando o Direito Humano à Alimentação Adequada a estudantes brasileiros. Entretanto, alguns estudos têm observado baixa aceitabilidade e adesão à alimentação escolar. Objetivo: Analisar a percepção de merendeiras e escolares acerca da aceitabilidade e adesão à alimentação escolar. Metodologia: Pesquisa qualitativa realizada através de grupos focais com merendeiras de três escolas e escolares do sexto ao nono ano de escola pública de Sumidouro, Rio de Janeiro, Brasil. Os grupos focais foram realizados utilizando-se roteiros semiestruturados e gravados em áudio e vídeo, posteriormente transcritos e analisados por Análise de Conteúdo. Resultados: Foram identificados seis temas: autoconhecimento, adesão, aceitabilidade, preparo e distribuição da alimentação escolar, cardápio e ambiente. Conclusão: O emprego de esforços na melhoria da infraestrutura e aspecto do ambiente alimentar, com a aquisição de utensílios adequados, alteração no modelo de serviço de distribuição e no modo de preparo das refeições, resultando em cardápios variados, são estratégias que podem contribuir para melhorar a adesão e aceitabilidade à alimentação escolar. Essas mudanças favorecem a promoção de saúde no espaço escolar, com foco em políticas públicas saudáveis.

Abstract Introduction: National School Feeding Program (PNAE) stands out for being one of the largest school feeding programs in the world, contemplating the Human Right to Adequate Food for Brazilian students. However, some research works have observed low acceptability and adherence to school meals. Objective: To analyze the perception of school lunch ladies and students about acceptability and adherence to school meals. Methodology: Qualitative research carried out through focus groups with lunch ladies from three schools and students from the sixth to the ninth grade of a public school in Sumidouro, Rio de Janeiro state, Brazil. The focus groups were carried out using semi-structured scripts and recorded in audio and video, later transcribed and analyzed by Content Analysis. Results: Six themes were identified: self-knowledge, adherence, acceptability, preparation and distribution of school meals, menu and environment. Conclusion: The use of efforts to improve the infrastructure and aspect of the food environment, with the acquisition of adequate utensils, change in the distribution service model and in the way of preparing meals, resulting in varied menus, are strategies that can contribute to improve adherence and acceptability to school meals. These changes favor the promotion of health in the school environment, focusing on healthy public policies.

Abstract Background: There is controversy regarding the factors that determine a greater risk of severity and complications from COVID-19 in people living with HIV (PLHIV). Likewise, there are limited data on the impact of SARS-CoV-2 vaccination on hospitalization in this population. Aims: To describe clinical characteristics and outcome of COVID-19 in PLHIV; To assess risk factors for hospitalization; To evaluate the impact of vaccination on hospitalization. Methods: Multicenter, prospective, observational study (September 2020 to June 2022). Clinical and immunovirological variables, antiretroviral treatment (ART), SARS-CoV-2 vaccination, and hospitalization in PLHIV with COVID-19 were recorded. Univariate and multivariate analyzes were performed examining factors associated with hospitalization using two models: first model (without vaccination) and second model (vaccination, minimum one dose). Results: 1,201 PLHIV were included. The median age was 45 years. 65.3% were men; 38.7% presented comorbidities. 92.8% received ART and 83.1% presented undetectable viral load (VL). The median CD4+ T-cell count was 600/mm3. 95.7% presented symptoms. The rates of hospitalization, ICU admission, oxygen requirement, and death were 17.8 %, 2.8%, 10.7% and 1.39%, respectively. According to the multivariate analysis for the first model, age > 60 years and comorbidities were associated with a higher risk of hospitalization, while female sex and CD4+ > 500/mm3 had a protective effect. In the second model, only the comorbidities were associated with a higher risk of hospitalization, while vaccination and CD4+ > 500/mm3 reduced it. Conclusions: in PLHIV, comorbidities were associated with a higher hospitalization rate, while having elevated CD4+ T-cell counts and being vaccinated had a protective effect. ART and VL had no impact in any model, while age and sex only had an influence when vaccination was not considered.

Resumen Introducción: Existe controversia con respecto a los factores que determinan un mayor riesgo de gravedad y complicaciones por COVID-19 en personas que viven con VIH (PVVIH). Asimismo, hay datos limitados sobre el impacto de la vacunación contra SARS-CoV-2 en la hospitalización en esta población. Objetivos: Describir las características clínicas y evolutivas de COVID-19 en PVVIH; Evaluar factores de riesgo para hospitalización; Evaluar el impacto de la vacunación en la hospitalización. Pacientes y Métodos: Estudio observacional, prospectivo, multicéntrico (septiembre de 2020 a junio de 2022). Se registraron variables clínicas, inmunovirológicas, tratamiento antirretroviral (TARV), vacunación contra SARS-CoV-2 y hospitalización en PVVIH con COVID-19. Se realizaron análisis uni y multivariados examinando factores asociados a hospitalización utilizando dos modelos: primer modelo (sin vacunación) y segundo modelo (vacunación, mínimo una dosis). Resultados: Se incluyeron 1.201 PVVIH. La mediana de edad fue 45 años. El 65,3% fueron hombres; el 38,7% presentó comorbilidades. Recibía TARV el 92,8% y presentó carga viral (CV) indetectable el 83,1%. La mediana de linfocitos T CD4+ fue de 600 céls/mm3. El 95,7% presentó síntomas. Las tasas de hospitalización, ingreso a UCI, requerimiento de oxígeno y muerte fueron 17,8%, 2,8%, 10,7% y 1,39%, respectivamente. De acuerdo con el análisis multivariado para el primer modelo, la edad > 60 años y las comorbilidades se asociaron a mayor riesgo de hospitalización, mientras que el sexo femenino y un recuento de linfocitos T CD4+ > 500 céls/mm3 tuvieron un efecto protector. En el segundo modelo sólo las comorbilidades se relacionaron con un mayor riesgo de hospitalización mientras que la vacunación y células CD4+ > 500 céls/mm3 la redujeron. Conclusiones: En PVVIH las comorbilidades se asociaron con mayor tasa de hospitalización, mientras que tener linfocitos T CD4+ elevados y estar vacunado tuvieron un efecto protector. El TARV y la CV no tuvieron impacto en modelo alguno mientras que la edad y el sexo solo influyeron cuando no se consideró la vacunación.

Abstract A nine-year-old girl with obesity and subclinical hypothyroidism presented with pain in the right thigh with inability to bear weight and associated lameness. These complaints had been present for one month but had recently worsened. There was no history of trauma, fever, or recent infections. On objective examination, she presented with pain on mobilization of the right thigh that worsened with hip rotation and flexion. Bilateral hip radiographs were obtained and showed right-sided femoral offset between the epiphysis and the neck. These findings were consistent with the diagnosis of slipped capital femoral epiphysis. The patient was managed with in situ fixation and prophylactic fixation of the contralateral hip, with gradual improvement.

Resumo Uma pré-adolescente de nove anos de idade com obesidade e hipotiroidismo subclínico foi observada no Serviço de Urgência por queixas álgicas na coxa direita com um mês de evolução, sem história de trauma, febre ou intercorrências infeciosas. Ao exame físico, apresentava dor à mobilização da anca direita, sobretudo com rotaçãos e flexão máxima. Foi realizada uma radiografia bilateral da anca, que revelou um deslizamento da epífise proximal do fémur direito em relação ao colo. Estes achados foram consistentes com o diagnóstico dea epifisiólise femoral proximal. A doente foi tratada com fixação in situ e fixação profilática da anca contralateral, com melhoria progressiva.

Resumen: Tras cuatro meses luchando contra la pandemia, la ciudad de São Paulo, Brasil, empezó una fase de flexibilización de las medidas de alejamiento social en julio de 2020. A la vez, hubo una reducción en la tasa de alejamiento social y en el número de casos, muertes y ocupación de camas en los hospitales. Se desarrolló un modelo de simulación multiagente para entender la dinámica de la pandemia en la ciudad de São Paulo. Diferente de lo esperado, los resultados contradictorios del modelo reflejaron la realidad de la ciudad. Sostenemos que se puede atribuir este fenómeno a las burbujas locales de protección que surgieron durante la ausencia de redes de contagio. Estas burbujas redujeron la tasa de transmisión del virus, reduciendo de forma corta y temporal la curva epidémica -pero se manifestaron como un equilibrio inestable. Nuestra hipótesis se alinea con la dinámica de la propagación del virus observada hasta el momento, sin la necesidad de suposiciones ad hoc sobre umbrales de inmunidad colectiva natural o heterogeneidad de la tasa de transmisión de la población, lo que puede provocar previsiones equivocadas. Nuestro modelo se proyectó para ser fácil de usar y no necesita ningún conocimiento científico o de programación para generar resultados sobre la transmisión del virus en un determinado local. Además, como insumo para iniciar nuestro modelo de simulación, desarrollamos el Índice de Protección contra la COVID-19 como una alternativa al Índice de Desarrollo Humano, que mide la vulnerabilidad de un determinado territorio al coronavirus e incluye características del sistema de salud y del desarrollo socioeconómico, además de la infraestructura de la ciudad de São Paulo.

Abstract: After four months of fighting the pandemic, the city of São Paulo, Brazil, entered a phase of relaxed social distancing measures in July 2020. Simultaneously, there was a decline in the social distancing rate and a reduction in the number of cases, fatalities, and hospital bed occupancy. To understand the pandemic dynamics in the city of São Paulo, we developed a multi-agent simulation model. Surprisingly, the counter-intuitive results of the model followed the city’s reality. We argue that this phenomenon could be attributed to local bubbles of protection that emerged in the absence of contagion networks. These bubbles reduced the transmission rate of the virus, causing short and temporary reductions in the epidemic curve - but manifested as an unstable equilibrium. Our hypothesis aligns with the virus spread dynamics observed thus far, without the need for ad hoc assumptions regarding the natural thresholds of collective immunity or the heterogeneity of the population’s transmission rate, which may lead to erroneous predictions. Our model was designed to be user-friendly and does not require any scientific or programming expertise to generate outcomes on virus transmission in a given location. Furthermore, as an input to start our simulation model, we developed the COVID-19 Protection Index as an alternative to the Human Development Index, which measures a given territory vulnerability to the coronavirus and includes characteristics of the health system and socioeconomic development, as well as the infrastructure of the city of São Paulo.

Resumo: Após quatro meses lutando contra a pandemia, a cidade de São Paulo, Brasil, entrou em uma fase de flexibilização das medidas de distanciamento social em julho de 2020. Simultaneamente, houve queda na taxa de distanciamento social e redução no número de casos, mortes e ocupação de leitos hospitalares. Um modelo de simulação multiagente foi desenvolvido para entender a dinâmica da pandemia na cidade de São Paulo. Ao contrário do esperado, os resultados contraintuitivos do modelo acompanharam a realidade da cidade. Argumentamos que este fenômeno pode ser atribuído às bolhas locais de proteção que surgiram na ausência de redes de contágio. Estas bolhas reduziram a taxa de transmissão do vírus, causando reduções curtas e temporárias na curva epidêmica - mas se manifestaram como um equilíbrio instável. Nossa hipótese está alinhada com a dinâmica da propagação do vírus observada até o momento, sem a necessidade de suposições ad hoc sobre limiares de imunidade coletiva natural ou heterogeneidade da taxa de transmissão da população, o que pode levar a previsões errôneas. Nosso modelo foi projetado para ser fácil de usar e não requer nenhum conhecimento científico ou de programação para gerar resultados sobre a transmissão do vírus em um determinado local. Além disso, como insumo para iniciar nosso modelo de simulação, desenvolvemos o Índice de Proteção contra a COVID-19 como alternativa ao Índice de Desenvolvimento Humano, que mede a vulnerabilidade de um determinado território ao coronavírus e inclui características do sistema de saúde e do desenvolvimento socioeconômico, além da infraestrutura da cidade de São Paulo.

BACKGROUND In 2022, an outbreak of mpox that started in European countries spread worldwide through human-to-human transmission. Cases have been mostly mild, but severe clinical presentations have been reported. In these cases, tecovirimat has been the drug of choice to treat patients with aggravated disease. OBJECTIVES Here we investigated the tecovirimat susceptibility of 18 clinical isolates of monkeypox virus (MPXV) obtained from different regions of Brazil. METHODS Different concentrations of tecovirimat were added to cell monolayers infected with each MPXV isolate. After 72 hours, cells were fixed and stained for plaque visualization, counting, and measurement. The ortholog of F13L gene from each MPXV isolate was polymerase chain reaction (PCR)-amplified, sequenced, and the predicted protein sequences were analyzed. FINDINGS The eighteen MPXV isolates generated plaques of different sizes. Although all isolates were highly sensitive to the drug, two showed different response curves and IC50 values. However, the target protein of tecovirimat, F13 (VP37), was 100% conserved in all MPXV isolates and therefore does not explain the difference in sensitivity. MAIN CONCLUSIONS Our results support screening different MPXV isolates for tecovirimat susceptibility as an important tool to better use of the restricted number of tecovirimat doses available in low-income countries to treat patients with mpox.

ABSTRACT Objective: To analyze the social representations of nursing students about transsexuality and the health demands of transsexual people. Methods: Qualitative, descriptive research with undergraduate nursing students from a public university in Rio de Janeiro/Brazil. The data came from a semi-structured interview and lexical analysis using Alceste 2012 software. Results: Transsexuality was represented as a transgression, with the transsexual person being objectified as unnatural because they do not identify with their biological sex. Hormone therapy and sex reassignment surgeries were understood as the main demands, being anchored in a pathologizing and medicalizing health sphere. However, the theme is not addressed during graduation, generating unpreparedness for professional life. Final considerations: The need to update the academic curriculum, as well as the way of thinking about the care of transsexual people, is essential and urgent for an integral and equitable care.

RESUMEN Objetivo: Analizar las representaciones sociales de estudiantes de enfermería sobre la transexualidad y las demandas de salud de las personas transexuales. Métodos: Investigación cualitativa, descriptiva con estudiantes de graduación en enfermería de una universidad pública de Río de Janeiro/Brasil. Los datos provinieron de una entrevista semiestructurada y análisis léxico utilizando el software Alceste 2012. Resultados: La transexualidad fue representada como una transgresión, siendo objetivada la persona transexual como antinatural porque no se identifica con su sexo biológico. La terapia hormonal y las cirugías de reasignación de sexo fueron entendidas como las principales demandas, ancladas en un ámbito patologizante. ymedicalizando la salud. Sin embargo, el tema no es abordado durante la graduación, generando despreparación para la vida profesional. Consideraciones finales: La necesidad de actualizar el currículo académico, así como la forma de pensar la atención a las personas transexuales, es fundamental y urgente para una atención integral y equitativa.

RESUMO Objetivo: Analisar as representações sociais dos graduandos de enfermagem acerca da transexualidade e as demandas de saúde das pessoas transexuais. Métodos: Pesquisa qualitativa, descritiva, com 28 graduandos em enfermagem de uma universidade pública do Rio de Janeiro/Brasil. Realizou-se uma entrevista semiestruturada, no período de novembro de 2017 a março de 2018, e análise tipo lexical com auxílio do software Alceste 2012. Resultados: A transexualidade foi representada como uma transgressão, sendo a pessoa transexual objetivada como antinatural por não se identificar com seu sexo biológico. Terapia hormonal e cirurgias de redesignação sexual foram entendidas como as principais demandas, sendo ancoradas numa esfera patologizante e medicalizadora da saúde. A temática não é abordada durante a graduação, gerando despreparo para vida profissional. Considerações finais: Faz-se necessário ampliar as discussões sobre gênero na academia, tendo como propósito a transposição do imperativo da heteronormatividade, para que futuros enfermeiros estejam aparelhados para fornecer um cuidado integral e equânime.

SUMMARY OBJECTIVE: The aim of this study was to carry out a systematic review of the literature with meta-analysis to evaluate the effect of using oral contraceptive and hormone replacement therapy as a protective factor in the formation of intracranial aneurysms and subarachnoid hemorrhage. METHODS: This is a systematic review of the literature with meta-analysis, using PubMed and Embase as databases and the PRISMA method. Case-control and cohort studies published until December 2022 were included in this review. RESULTS: Four studies were included in this review; three of which were eligible for meta-analysis. Regarding the use of oral contraceptive and the development of subarachnoid hemorrhage, there was a lower risk of aneurysm rupture with an odds ratio 0.65 (confidence interval 0.5–0.85). In the analysis of patients using hormone replacement therapy and developing subarachnoid hemorrhage, there was also a lower risk of aneurysm rupture with an OR 0.54 (CI 0.39–0.74). Only one article analyzed the formation of intracranial aneurysm and the use of hormone replacement therapy and oral contraceptive, and there was a protective effect with the use of these medications. oral contraceptive: OR 2.1 (CI 1.2–3.8) and hormone replacement therapy: OR 3.1 (CI 1.5–6.2). CONCLUSION: The use of hormone replacement therapy and oral contraceptive has a protective effect in intracranial aneurysm rupture and formation.

Abstract: After four months of fighting the pandemic, the city of São Paulo, Brazil, entered a phase of relaxed social distancing measures in July 2020. Simultaneously, there was a decline in the social distancing rate and a reduction in the number of cases, fatalities, and hospital bed occupancy. To understand the pandemic dynamics in the city of São Paulo, we developed a multi-agent simulation model. Surprisingly, the counter-intuitive results of the model followed the city’s reality. We argue that this phenomenon could be attributed to local bubbles of protection that emerged in the absence of contagion networks. These bubbles reduced the transmission rate of the virus, causing short and temporary reductions in the epidemic curve - but manifested as an unstable equilibrium. Our hypothesis aligns with the virus spread dynamics observed thus far, without the need for ad hoc assumptions regarding the natural thresholds of collective immunity or the heterogeneity of the population’s transmission rate, which may lead to erroneous predictions. Our model was designed to be user-friendly and does not require any scientific or programming expertise to generate outcomes on virus transmission in a given location. Furthermore, as an input to start our simulation model, we developed the COVID-19 Protection Index as an alternative to the Human Development Index, which measures a given territory vulnerability to the coronavirus and includes characteristics of the health system and socioeconomic development, as well as the infrastructure of the city of São Paulo.

Resumen: Tras cuatro meses luchando contra la pandemia, la ciudad de São Paulo, Brasil, empezó una fase de flexibilización de las medidas de alejamiento social en julio de 2020. A la vez, hubo una reducción en la tasa de alejamiento social y en el número de casos, muertes y ocupación de camas en los hospitales. Se desarrolló un modelo de simulación multiagente para entender la dinámica de la pandemia en la ciudad de São Paulo. Diferente de lo esperado, los resultados contradictorios del modelo reflejaron la realidad de la ciudad. Sostenemos que se puede atribuir este fenómeno a las burbujas locales de protección que surgieron durante la ausencia de redes de contagio. Estas burbujas redujeron la tasa de transmisión del virus, reduciendo de forma corta y temporal la curva epidémica -pero se manifestaron como un equilibrio inestable. Nuestra hipótesis se alinea con la dinámica de la propagación del virus observada hasta el momento, sin la necesidad de suposiciones ad hoc sobre umbrales de inmunidad colectiva natural o heterogeneidad de la tasa de transmisión de la población, lo que puede provocar previsiones equivocadas. Nuestro modelo se proyectó para ser fácil de usar y no necesita ningún conocimiento científico o de programación para generar resultados sobre la transmisión del virus en un determinado local. Además, como insumo para iniciar nuestro modelo de simulación, desarrollamos el Índice de Protección contra la COVID-19 como una alternativa al Índice de Desarrollo Humano, que mide la vulnerabilidad de un determinado territorio al coronavirus e incluye características del sistema de salud y del desarrollo socioeconómico, además de la infraestructura de la ciudad de São Paulo.

Resumo: Após quatro meses lutando contra a pandemia, a cidade de São Paulo, Brasil, entrou em uma fase de flexibilização das medidas de distanciamento social em julho de 2020. Simultaneamente, houve queda na taxa de distanciamento social e redução no número de casos, mortes e ocupação de leitos hospitalares. Um modelo de simulação multiagente foi desenvolvido para entender a dinâmica da pandemia na cidade de São Paulo. Ao contrário do esperado, os resultados contraintuitivos do modelo acompanharam a realidade da cidade. Argumentamos que este fenômeno pode ser atribuído às bolhas locais de proteção que surgiram na ausência de redes de contágio. Estas bolhas reduziram a taxa de transmissão do vírus, causando reduções curtas e temporárias na curva epidêmica - mas se manifestaram como um equilíbrio instável. Nossa hipótese está alinhada com a dinâmica da propagação do vírus observada até o momento, sem a necessidade de suposições ad hoc sobre limiares de imunidade coletiva natural ou heterogeneidade da taxa de transmissão da população, o que pode levar a previsões errôneas. Nosso modelo foi projetado para ser fácil de usar e não requer nenhum conhecimento científico ou de programação para gerar resultados sobre a transmissão do vírus em um determinado local. Além disso, como insumo para iniciar nosso modelo de simulação, desenvolvemos o Índice de Proteção contra a COVID-19 como alternativa ao Índice de Desenvolvimento Humano, que mede a vulnerabilidade de um determinado território ao coronavírus e inclui características do sistema de saúde e do desenvolvimento socioeconômico, além da infraestrutura da cidade de São Paulo.

Resumen: El cultivo del ñame es de alta importancia para la seguridad alimentaria de las familias rurales en la región Caribe de Colombia. Uno de los principales problemas tecnológicos que enfrentan los pequeños productores es la baja calidad y disponibilidad de la semilla para las siembras. El presente trabajo se realizó con el objeto de evaluar la tecnología de producción de minitubérculos en plántulas de ñame generadas a partir de esquejes, mediante inducción con rizobacterias. Para ello, inicialmente se evaluó in vitro la capacidad de producción de fitohormonas de tres rizobacterias, identificadas con los códigos DCR11 (Azotobacter vinelandii), DSC21 (Brevibacillus laterosporus) y DSC1 (Bacillus licheniformis), y una vez comprobada su capacidad, se estableció un experimento bajo condiciones de casa de malla para inducir, con las rizobacterias, la producción de minitubérculos en las plántulas de ñame, bajo tres niveles de sombreamiento. Se utilizó un diseño experimental completamente al azar con arreglo en parcelas subdivididas y tres repeticiones, en donde la parcela principal correspondió a los niveles de sobreamiento (0, 65 y 80%), las subparcelas a las tres rizobacterias (DCR11 A. vinelandii, DSC1 B. licheniformis, DSC21 B. laterosporus) y las sub-subparcelas a las dosis del inóculo (0, 2, 4 y 6 mL pl-1). Los resultados in vitro demostraron el potencial de las rizobacterias para producir citoquinas y auxinas. En casa de malla se logró evidenciar la capacidad de producción de minitubérculos por parte de las plántulas de ñame, en donde las rizobacterias DSC1 B. licheniformis y DSC21 B. laterosporus mostraron mayor capacidad de inducción. A partir de los resultados se demostró la viabilidad de producción de minitubérculos en plántulas de ñame bajo condiciones de casa de malla mediante inducción con rizobacterias, por lo que se recomendó su validación a nivel semicomercial como estrategia para la producción masiva de minitubérculos de ñame, como alternativa para la siembra de cultivos comerciales.

Summary: Yam cultivation is of high importance for the food security of rural families in the Caribbean region of Colombia. One of the main technological problems faced by small yam producers is the low quality and availability of seed for planting. The present work was carried out to evaluate the technology of minitubers production in yam seedlings generated from cuttings, by induction with rhizobacteria. For this purpose, the phytohormone production capacity of three rhizobacteria, identified with the codes DCR11 (Azotobacter vinelandii), DSC21 (Brevibacillus laterosporus), and DSC1 (Bacillus licheniformis), was initially evaluated in vitro, and once their capacity was verified, an experiment was established under mesh house conditions to induce, with rhizobacteria, the production of mini-tubers in yam seedlings under three levels of shading. A completely randomized experimental design with subdivided plots and three replications was used, where the main plot corresponded to the shade levels (0, 65 and 80%), the subplots to the rhizobacteria (DCR11 A. vinelandii, DSC1 B. licheniformis, DSC21 B. laterosporus), and the sub-subplots at the inoculum doses (0, 2, 4 and 6 mL pl-1). The in vitro results demonstrated the potential of rhizobacteria to produce cytokines and auxins. In mesh house, the capacity of yam seedlings to produce mini-tubers was demonstrated, where the rhizobacteria DSC1 B. licheniformis and DSC21 B. laterosporus showed greater induction capacity. The results demonstrated the feasibility of minitubers production in yam seedlings under mesh house conditions by induction with rhizobacteria, and therefore, its validation at a semi-commercial level is recommended as a strategy for mass production of yam minitubers, as an alternative for the planting of commercial crops.

Abstract Introduction: The COVID-19 pandemic represented a major threat to global health. The special circumstances and changes to everyday life due to the worldwide measures had a strong impact, particularly in childhood and adolescent obesity. We aimed to evaluate the impact on the treatment of obesity and on the expression of comorbidities during the first lockdown. Methods: Retrospective cohort study of overweight and obese children/adolescents (6-18 years), followed at reference outpatient clinic, since 2018. Anthropometric and biochemical parameters were evaluated. Results: We studied 71 children/adolescents (52.1% female) with a median age of 10 years. 87.3 % were obese and a family history of obesity was positive in 51.4%. After home confinement, a significant increase was observed regarding body mass index (p<0.001) and there was worsening of insulin levels (p<0.001), homeostasis model assessment for insulin resistance (p=0.005), and aspartate aminotransferase (p<0.001), but not reaching pathologic levels. Therefore, there was no significant worsening of comorbidities after the lockdown. Conclusion: During the COVID-19 pandemic, there was a worsening in the magnitude of obesity. However, there was no significant repercussions on its comorbidity, which does not allow to exclude any long-term consequences.

Resumo Introdução: A pandemia COVID-19 é uma grande ameaça à saúde a nível global. As circunstâncias especiais e as mudanças na vida quotidiana devido às medidas instituídas tiveram um forte impacto, em particular na obesidade durante a infância e adolescência. Neste estudo, pretendemos avaliar durante o primeiro confinamento, o impacto no tratamento da obesidade e na expressão das suas comorbilidades. Métodos Estudo retrospetivo de crianças/adolescentes com excesso de peso e obesidade (6-18 anos), seguidos em consulta externa de referência, desde 2018. Foram avaliados parâmetros antropométricos e bioquímicos. Resultados: O estudo foi realizado em 71 crianças/adolescentes (52,1% do sexo feminino) com mediana de idades de 10 anos. 87,3 % eram obesos e com história familiar de obesidade em 51,4%. Após o confinamento, observou-se um aumento significativo no que diz respeito ao índice de massa corporal (p<0,001) e agravamento dos níveis de insulina (p<0,001), do índice de resistência à insulina (p=0,005) e da aminotransferase aspartato (p<0,001), mas não em nível patológico. Portanto, não existiu agravamento significativo das comorbidades após o confinamento. Conclusão Durante o confinamento relacionado com a COVID-19 existiu um agravamento na magnitude da obesidade. No entanto, não existiram repercussões significativas nas suas comorbilidades, o que não permite excluir consequências a longo prazo.

Resumen Introducción. La infección respiratoria aguda en niños tiene una alta carga de enfermedad. La detección de múltiples microorganismos a través de pruebas moleculares en hisopados nasales podría cambiar el paradigma de patógeno único causal de enfermedad respiratoria en niños y ser de utilidad en la práctica clínica. Objetivo. Caracterizar los patógenos identificados mediante la técnica de reacción en cadena de polimerasa multiplex en tiempo real (RT-PCR) en hisopado nasal, así como las variables clínicas y los resultados de laboratorio en niños <5 años diagnosticados con infección respiratoria aguda baja (IRAB) y hospitalizados en Bogotá D.C., Colombia. Materiales y métodos. Estudio transversal realizado en 81 niños hospitalizados entre septiembre de 2019 y marzo de 2020 en la clínica Cafam y en quienes se hizo hisopado nasal para realizar la identificación microbiològica mediante la prueba RT-PCR multiplex Allplex. Las correlaciones entre el número de patógenos y los niveles de células del hemograma y el nivel de proteína C reactiva se determinaron mediante el coeficiente de correlación de Spearman. Resultados. La edad promedio fue 17.23 meses (±14.44), 54.32% fueron varones y 51.85%, lactantes menores. Se identificaron 149 microorganismos (60.40% virus) en 63 niños (77.78%). Hubo infección mixta en el 48.15% y coinfección en 11.11% de los niños. Respecto a los hallazgos clínicos, la dificultad respiratoria, la obstrucción de la vía respiratoria alta, la tos, la fiebre y la faringitis fueron más comunes en los casos de infección mixta (32.97%), ausencia de microorganismo (16.00%), coinfección (64.40%), infección mixta (29.78%) y ausencia de microorganismo (22.00%), respectivamente. Se observó una correlación negativa entre el número de leucocitos y neutrófilos y el número de microorganismos detectados en preescolares (r=-0.46; p=0.058 y r=-0.51; p=0.033) y una positiva entre el recuento de monocitos y el número de microorganismos detectados (r=0.53; p =0.0096). Conclusión. La prueba RT-PCR multiplex permitió identificar microorganismos en la mayoría de niños, así como casos de infección mixta y coinfección en más de la mitad de la muestra. Además, los hallazgos clínicos fueron altamente heterogéneos entre los niños según el resultado de la prueba.

Abstract Introduction: Acute respiratory infection in children has a high burden of disease. Detection of multiple micro -organisms through molecular testing of nasopharyngeal swab samples could change the paradigm of a single pathogen being the cause of respiratory disease in children and prove its usefulness in clinical practice. Objective: To characterize the pathogens identified in nasopharyngeal swab samples by means of multiplex realtime polymerase chain reaction (RT-PCR), as well as clinical variables and laboratory findings in children <5 years diagnosed with acute lower respiratory tract infection (ALRTI) and hospitalized in Bogotá D.C., Colombia. Materials and methods: Cross-sectional study conducted in 81 children hospitalized between September 2019 and March 2020 at the Clínica Cafam and in whom nasopharyngeal swab samples were collected for microbiological identification using the Allplex™ multiplex RT-PCR assay. Correlations between the number of pathogens and blood cells and C-reactive protein levels were determined by Spearman's rank correlation coefficient. Results: Patients' mean age was 17.23 months (±14.44), 54.32% were males, and 51.85% were young infants. A total of 149 microorganisms (60.40% viruses) were identified in 63 children (77.78%). Mixed infection and coinfection were reported in 48.15% and 11.11% of children, respectively. Regarding clinical findings, shortness of breath, upper airway obstruction, cough, fever and pharyngitis were the most common clinical signs and/or symptoms in patients with mixed infection (32.97%), coinfection (64.40%), mixed infection (29.78%), and absence of microorganism (22.00%), respectively. A negative correlation was observed between the number of leukocytes and the number of neutrophils and the number of microorganisms detected in the preschoolers group (r=-0.46; p =0.058 and r=-0.51; p =0.033, respectively). Furthermore, a positive correlation was found between monocyte count and the number of microorganisms detected (r=0.53; p =0.0096). Conclusion: Multiplex RT-PCR assay allowed the identification of microorganisms in most children, as well as cases of mixed infection and coinfection in more than half of the sample. In addition, clinical findings in these children were highly heterogeneous as per the assay result..

Abstract Background: The spread of SARS-CoV-2 required widespread lockdown to mitigate the pandemic. Argentine authorities imposed preventive social isolation for 234 days (March 20th to November 9th 2020). This measure led to major changes in the population's lifestyle. Aim: To examine the influence of COVID-19 lockdown measures on the metabolic profile of HIV-infected patients in Argentina. Methods: Retrospective cohort study of 10,239 HIV-infected patients under follow up in a private clinic for HIV care. Adult patients with ongoing antiretroviral therapy (ART) and a baseline determination of blood glucose, total cholesterol, HDL-cholesterol and triglycerides done before lockdown (BL: second semester of 2019) and a second determination during lockdown (DL: May 2020) were included. Patients with recent changes in ART that may have metabolic impact, those starting lipid/glucose lowering agents and pregnant women were excluded. Categorical variables were compared using the χ2 test or Fisher's exact test, and continuous variables using the t-test or the Mann-Whitney test. A two-tailed value of p < 0.05 was considered significant. Results: 540 individuals were included, median of age was 47 years and 74.6% were male. Median body mass index was 26.1 and 94.6% had low cardiovascular risk. There was a significant increase in the percentage of patients that met criteria for hyperglycemia (BL 4.8% and DL 8.5%, p < 0.001). We also observed significant (p < 0.001) increase in median (IQR) BL vs DL values in LDL-cholesterol [109 (90-128) vs 118 (97-139) mg/dL]; and triglycerides [120 (87-172) vs. 132 mg/dL (96-184)]. The proportion of patients with hyper-LDL cholesterolemia according to individual cardiovascular risk increased from 12.6 to 17.2% (p = 0.04). Conclusion: Our results suggest that quarantine, at least in its initial phases, may have a negative impact on the metabolic profile of this population.

Resumen Introducción: Para mitigar la propagación del SARS-CoV-2 se requirió de un confinamiento generalizado. Las autoridades argentinas impusieron aislamiento social preventivo durante 234 días (20 de marzo al 9 de noviembre de 2020), modificando el estilo de vida de la población. Objetivos: Examinar la influencia de las medidas de bloqueo en el perfil metabólico de pacientes infectados por VIH en Argentina. Pacientes y Métodos: Estudio de cohorte retrospectivo de 10.239 pacientes en seguimiento en una clínica de atención privada de personas con infección por VIH. Se incluyeron pacientes adultos con terapia antirretroviral (TARV) en curso que tuvieran una determinación de glucemia, colesterol total, colesterol HDL y trigliceridemia antes de la cuarentena (Pre-C: segundo semestre 2019) y una segunda determinación durante la misma (Intra-C: mayo 2020). Se excluyeron los pacientes con cambios en la TARV con impacto metabólico, los que iniciaron o suspendieron hipolipemiantes o hipoglucemiantes y mujeres embarazadas. Las variables categóricas se compararon mediante la prueba de la χ2 o la prueba exacta de Fisher y las continuas mediante la prueba t o la prueba de Mann-Whitney según correspondiera. Se consideró significativo un valor de p a dos colas < 0,05. Resultados: Se incluyeron 540 individuos. La mediana de edad fue de 47 años y 74,6% fueron de sexo masculino. La mediana de índice de masa corporal fue 26,1 y 94,6% tenían bajo riesgo cardiovascular. Hubo un aumento significativo en el porcentaje de pacientes con hiperglucemia (Pre-C 5,2% vs Intra-C 8,5%, p 0,04), hipertrigliceridemia (Pre-C 33,9% vs Intra-C 40,7%, p 0,02) e hipercolesterolemia LDL (Pre-C 12,6% vs Intra-C 17,2%, p 0,04). Conclusión: Nuestros resultados sugieren que la cuarentena, al menos en sus fases iniciales, puede tener un impacto negativo en el perfil metabólico de esta población.

RESUMO Os programas de rastreamento de câncer de pulmão (RCP) estão aumentando em todo o mundo. Achados incidentais (AI) no RCP são achados de TC de baixa dose sem relação com o propósito principal de identificar câncer de pulmão. A maioria dos AI no RCP é benigna e clinicamente insignificante, mas os AI estão sendo cada vez mais reconhecidos, e alguns requerem encaminhamento urgente para investigação diagnóstica adicional. Outros achados são esperados e conhecidos como comorbidades relacionadas ao tabagismo, tais como DPOC, doença cardiovascular, enfisema e doença pulmonar intersticial, e seu diagnóstico pode ter um impacto significativo no prognóstico do paciente. O propósito deste ensaio pictórico é ilustrar os AI mais comuns no RCP, organizados por órgão/sistema. Discutiremos a literatura atual a respeito de AI no RCP, com foco em sua prevalência, comunicação apropriada e desencadeamento de procedimentos clínicos.

ABSTRACT Lung cancer screening (LCS) programs are increasing worldwide. Incidental findings (IFs) on LCS are defined as low-dose CT findings unrelated to the primary purpose of identifying lung cancer. Most IFs on LCS are benign and clinically insignificant but are being increasingly recognized, and some require urgent referral for further diagnostic workup. Other findings are expected and are known as smoking-related comorbidities, including COPD, cardiovascular disease, emphysema, and interstitial lung disease, and their diagnosis can have a significant impact on patient prognosis. The purpose of this pictorial essay is to illustrate the most common IFs on LCS, organized by organ. We will discuss the current literature on IFs on LCS, focusing on their prevalence, appropriate communication, and triggering of clinical pathway systems.

ABSTRACT Hand-foot-and-mouth disease (HFMD) is a highly contagious viral disease commonly associated to Enteroviruses (EV). During 2018, Brazil faced massive HFMD outbreaks spread across the country. This study aimed to characterize the EV responsible for the HFMD outbreak that occurred in Paraiba State, Brazilian Northeastern region, in 2018, followed by a phylogenetic analysis to detail information on its genetic diversity. A total of 49 serum samples (one from each patient) collected from children ≤ 15 years old, clinically diagnosed with HFMD were tested for EV using conventional RT-PCR and RT-qPCR. EV infection was confirmed in 71.4% (35/49) of samples. The mean and median ages were 1.83 years and one year old, respectively. Twenty-two EV-positive samples were successfully sequenced and classified as EV-A species; 13 samples were also identified with the CV-A6 genotype. The phylogenetic analysis (VP1 region) of three samples revealed that the detected CV-A6 strains belonged to sub-lineage D3. The CV-A6 strains detected here clustered with strains from South America, Europe and West Asia strains that were also involved in HFMD cases during the 2017-2018 seasons, in addition to the previously detected Brazilian CV-A6 strains from 2012 to 2017, suggesting a global co-circulation of a set of different CV-A6 strains introduced in the country at different times. The growing circulation of the emerging CV-A6 associated with HFMD, together with the detection of more severe cases worldwide, suggests the need for a more intense surveillance system of HFMD in Brazil. In addition, this investigation was performed exclusively on serum samples, and the analysis of whole blood samples should be considered and could have shown advantages when employed in the diagnosis of enteroviral HFMD outbreaks.

RESUMO Muitos sistemas de saúde têm utilizado a angiotomografia coronariana (ATC) como exame de primeira linha para pacientes com doença cardíaca isquêmica em diversos países. O crescente número de exames de ATC tem levado a um aumento significativo do número de relatos de achados extracardíacos incidentais, principalmente no tórax. Nódulos pulmonares são os achados incidentais mais comuns nas imagens de ATC, pois há uma substancial sobreposição de fatores de risco entre a população que busca a exclusão de doença cardíaca isquêmica e aqueles em risco de desenvolver câncer de pulmão (por exemplo, idade avançada e tabagismo). No entanto, a maioria dos achados incidentais é clinicamente insignificante e seu seguimento ativo pode ter um custo proibitivo e submeter o paciente a exames desnecessários e potencialmente prejudiciais. Além disso, há pouco consenso sobre quando relatar ou ativamente excluir esses achados e como manejá-los, ou seja, quando acionar um alerta ou imediatamente encaminhar o paciente para um pneumologista, um cirurgião torácico ou uma equipe multidisciplinar. Este ensaio pictórico discute a literatura atual sobre esse tópico e é ilustrado com uma revisão de imagens de ATC. Também propomos uma lista de verificação organizada por órgão e sistema, recomendando ações para a conscientização de pneumologistas, cirurgiões torácicos, cardiologistas e radiologistas sobre os achados incidentais mais significativos e acionáveis nas imagens de ATC.

ABSTRACT Many health systems have been using coronary CT angiography (CCTA) as a first-line examination for ischaemic heart disease patients in various countries. The rising number of CCTA examinations has led to a significant increase in the number of reported incidental extracardiac findings, mainly in the chest. Pulmonary nodules are the most common incidental findings on CCTA scans, as there is a substantial overlap of risk factors between the population seeking to exclude ischaemic heart disease and those at risk of developing lung cancer (i.e., advanced age and smoking habits). However, most incidental findings are clinically insignificant and actively pursuing them could be cost-prohibitive and submit the patient to unnecessary and potentially harmful examinations. Furthermore, there is little consensus regarding when to report or actively exclude these findings and how to manage them, that is, when to trigger an alert or to immediately refer the patient to a pulmonologist, a thoracic surgeon or a multidisciplinary team. This pictorial essay discusses the current literature on this topic and is illustrated with a review of CCTA scans. We also propose a checklist organised by organ and system, recommending actions to raise awareness of pulmonologists, thoracic surgeons, cardiologists and radiologists regarding the most significant and actionable incidental findings on CCTA scans.