SUMMARY BACKGROUND: Cerebrovascular accident (or stroke) and ischemic heart disease are the the major causes of death in the world. It is estimated that about 85% of strokes are ischemic in origin. Reperfusion therapy in the acute phase of ischemic stroke with a recombinant human tissue plasminogen activator is effective, but some factors influence the success of this treatment. OBJECTIVE: The aim of this study was to evaluate clinical aspects and possible determinants for reperfusion after venous thrombolysis. METHODS: This is a retrospective, cross-sectional, observational study based on a review of hospital records of inpatients diagnosed with ischemic stroke treated with intravenous thrombolysis, the main outcome being reperfusion or not. RESULTS: Data from this study revealed a predominance of females in the group of reperfused patients and males in the non-reperfused group, both maintaining moderate severity on the National Institutes of Health Stroke Scale and admission without statistical significance (p>0.18). In addition, the mean admission severity score was 13.2 for the group of reperfused patients and 14.2 for those not reperfused, and the mean ejection fraction of both groups was within normal functionality, with a mean of 0.50 for reperfused patients and 0.62 for non-reperfused patients. CONCLUSION: We found an association between successful venous chemical thrombolysis reperfusion and lower mortality in patients with acute stroke.

ABSTRACT Background: Excessive weight gain is a current concern among People Living with HIV (PLHIV) starting ART. Objectives: To evaluate the weight gain after 48-weeks of ART in naive patients, according with baseline CD4 count. Methods: PLHIV starting 3TC + TDF + DTG with at least 48-weeks of follow up in two AIDS referral centers were stratified by baseline CD4 count (lower or higher than 200 cells/mm3). Data on CD4 count, HIV viral load, weight/Body Mass Index (BMI), lipids and glucose levels were collected at baseline, 24 and 48 weeks of treatment. For analysis purpose, patients were categorized according to their BMI progression. Results: A total of 270 patients were included in the study. Mean CD4 count were 78.3 ± 61.7 and 536.7 ± 273 cells/mm3 for low and high CD4 count groups, respectively (p < 0.001). Baseline BMI was significantly lower in low CD4 group (21.7 vs. 23.6 Kg/m2, p < 0.001). Patients in low CD4 group gained more weight than those in high CD4 group (11.2 ± 8.5 kg vs. 2.2 ± 4.2 Kg, p = 0.004). Overall weight gain was higher in women, regardless group (13.1 ± 7.9 Kg vs. 1.4 ± 3.6 Kg for women and men, respectively, p < 0.001). The proportion of overweight/obesity significantly increased in low CD4 group. Viral suppression rate was high for both groups. At week 48 the overall proportion of overweight/obesity was like that reported for the Brazilian population. Conclusions: Weight gain in the present study indicates a “return to health” phenomenon. Excessive weight gain was more frequent in women.

ABSTRACT Introduction: COVID-19 can trigger different clinical presentations in distinct population groups, some of which are considered at higher risk of SARS-CoV-2 infection. Little is known about the susceptibility of certain populations to the infection. Objectives: We aimed to determine the prevalence of COVID-19 among People Living With HIV/AIDS (PLWH) attending a tertiary public hospital in Salvador, Brazil, patients with active pulmonary tuberculosis and Hospital's Healthcare Workers (HCW), and to compare their SARS-CoV-2 antibody levels. Methods: In this observational study we included 2294 participants from June 9, 2020 to August 10, 2021. IgG SARS-CoV-2 antibodies from all participants (275 PLWH, 42 with active tuberculosis and 1977 healthcare workers) were measured. Prevalence of COVID-19 and antibodies indexes were compared across groups. Results: We detected a higher prevalence of COVID-19 in patients with active tuberculosis (42.9%) than in PLWH (22.5%) or HCW (11.7%). Previously vaccinated participants with a COVID-19 history had median higher IgG antibody indexes (8.2; IQR: 5.5–10) than those vaccinated who did not have COVID-19 until the time of this study (4.1; IQR: 1.6–6.2, p < 0.001). Conclusion: Prevalence of previous SARS-CoV-2 infection was higher among tuberculosis patients than that found in HCW and PLWH, but antibodies levels were similar across groups.

ABSTRACT Objectives: The objective of the present study was to evaluate a possible association between personality factors (PF) and the health-related quality of life (HRQoL) of type 1 diabetes (T1D) patients. This allows for the investigation of obstacles related to treatment type and the presence of complications in HRQoL. Materials and methods: This cross-sectional study enrolled 78 patients aged 13-67 years from two diabetes clinics. PF was evaluated using the validated questionnaire Inventory of the Five Great Personality Factors. HRQoL was determined using the Brazilian Problem Areas in Diabetes Scale (B-PAID) questionnaire. The chi-square test, Fisher's exact test, and Welch's modified two-sample t-test were used to establish relationships. Results: In this sample of 46 women and 32 men with T1D and mean A1C of 8%-9%, we observed great suffering in 58.97% and that HRQoL was worse in women. “Openness” was the most prevalent PF and “extroversion” the least prevalent. “Neuroticism” facilitated a tendency to tolerate suffering. Conclusion: T1D patients’ personalities influence their treatment. The PF “neuroticism” is potentially related to better HRQoL. Brazilian T1D patients indicated great suffering in their HRQoL, which may be characteristic across the country. Women experienced worse HRQoL, which is in line with world literature. However, the limited sample size in this study warrant further research to test the hypotheses.

RESUMO JUSTIFICATIVA E OBJETIVOS: Dores musculoesqueléticas estão entre as condições mais incapacitantes, agravando quadros de multimorbidade. Dificuldades no tratamento da dor e multimorbidade ressaltam a importância do estudo dessas populações. O objetivo deste estudo foi determinar a frequência de dor musculoesquelética e multimorbidade, principais queixas em pacientes admitidos em serviço de fisioterapia. MÉTODOS: Este é um estudo observacional de corte transversal. Pacientes com 50 anos ou mais foram avaliados através do Inventário Breve de Dor, Questionário de Incapacidade de Roland Morris para dor em geral, formulário de dados sociodemográficos e clínicos e teste timed-up-and-go. Foram realizadas análises descritivas através da distribuição de números absolutos e proporções para as variáveis categóricas. RESULTADOS: A amostra foi composta por 62 pacientes com 2 ou mais regiões dolorosas, 88,7% mulheres com mediana de idade de 67 anos [IQR 62-72], 81% com índice de massa corpórea acima da normalidade, 71% hipertensos e 97% com multimorbidade. A mediana de regiões dolorosas foi de 7 [IQR 4-8], sendo as mais prevalentes lombar e joelhos (87%); 66% dos pacientes descrevem dor intensa e mediana da duração da dor de 7,5 anos [IQR 3-15]. O alto número de regiões dolorosas teve maior interferência (p<0,05) na vida dos indivíduos e foi associado ao sexo feminino (p=0,04) e a ocorrência de queda no último ano (p<0,003). CONCLUSÃO: A população descrita é majoritariamente composta por mulheres hipertensas, com sobrepeso, multimorbidade, dor crônica e alto número de regiões dolorosas, interferindo nos componentes de afetividade e atividades da vida. Faz-se necessário contínuo estudo da dor musculoesquelética crônica, difusa e multimorbidade, buscando melhores intervenções para estes pacientes.

ABSTRACT BACKGROUND AND OBJECTIVES: Musculoskeletal pain is among the most disabling conditions, aggravating multimorbidity scenarios. Difficulties in the treatment of pain and multimorbidity highlight the importance of the study of these populations. The objective of this study was to determine the frequency of musculoskeletal pain and multimorbidity, the main complaints in patients admitted to physiotherapy services. METHODS: This is a cross-sectional observational study. Patients 50 years or older were evaluated using the Brief Pain Inventory, Roland Morris Disability Questionnaire for general pain, sociodemographic and clinical data form, and timed-up-and-go test. Descriptive analyses were performed through the distribution of absolute numbers and proportions for categorical variables. RESULTS: The sample consisted of 62 patients with 2 or more painful regions, 88.7% women with a median age of 67 years [IQR 62-72], 81% with body mass index above normal, 71% hypertensive and 97% with multimorbidity. The median of painful regions was 7 [IQR 4-8], the most prevalent being low back and knees (87%); 66% of patients describe severe pain, and median pain duration of 7.5 years [IQR 3-15]. The high number of painful regions had greater interference (p<0.05) in the lives of individuals and was associated with females (p=0.04) and the occurrence of a fall in the last year (p<0.003). CONCLUSION: The described population is mostly composed of hypertensive, overweight women with multimorbidity, chronic pain and a high number of painful regions, interfering in activities and in the affective components of life. A continuous study of chronic, diffuse musculoskeletal pain and multimorbidity is necessary, seeking better interventions for these patients.

RESUMO Objetivo Avaliar a associação entre adesão ao tratamento e mortalidade em pacientes com doença pulmonar obstrutiva crônica (DPOC) tratados no Sistema Único de Saúde (SUS). Métodos Este é um estudo de coorte de pacientes com DPOC moderada a grave acompanhados em um programa público de gerenciamento de doença (PGD) baseado no cuidado farmacêutico. Todos os indivíduos que foram a óbito um ano após o início da coorte foram pareados por idade com aqueles que permaneceram vivos ao final do período da coorte. A adesão ao tratamento foi medida através dos registros de dispensação de medicamentos. Os pacientes que receberam pelo menos 90% das doses prescritas foram considerados aderentes ao tratamento. Resultados Dos 333 pacientes (52,8%, idade ≥ 65 anos: 67,9% do sexo masculino), 67,3% aderiram ao tratamento (taxa de adesão = 87,2%). A mortalidade foi associada à não adesão (p = 0,04), presença de sintomas (mMRC ≥ 2) e uso de tratamento para DPOC. Os óbitos foram associados à não adesão, presença de sintomas e hospitalização prévia. Após ajuste, pacientes não aderentes ao tratamento foram quase duas vezes mais propensos a ir a óbito em comparação àqueles aderentes (hazard ratio = 1,86; [IC95%, 1,16-2,98], p = 0,01). Conclusão A não adesão ao tratamento foi associada à maior mortalidade entre pacientes com DPOC de moderada a grave tratados no SUS. Estratégias de monitoramento e otimização da adesão devem ser fomentadas a fim de reduzir a mortalidade relacionada à DPOC.

ABSTRACT Objective To evaluate the association between adherence to treatment and mortality among Chronic Obstructive Pulmonary Disease (COPD) patients treated in the Brazilian public health system. Methods This is cohort study of moderate-to-severe COPD patients monitored in a public pharmaceutical care-based Disease Management Program (DMP). All subjects who died one year after the beginning of the cohort were age-matched with those who remained alive at the end of the cohort period. Treatment adherence was measured through pharmacy records. Patients who received at least 90% of the prescribed doses were considered adherent to treatment. Results Of the 333 patients (52.8% age ≥ 65 years, 67.9% male), 67.3% were adherent to treatment (adherence rate, 87.2%). Mortality was associated with lack of adherence (p = 0.04), presence of symptoms (mMRC ≥ 2) and COPD treatment use. The death was associated with non-adherence, presence of symptoms and previous hospitalization. After adjustment, non-adherent patients to treatment were almost twice times likely to die compared to those adherents (Hazard Ratio (HR) 1.86; CI 1.16-2.98, p = 0.01). Conclusion Non-adherence to treatment was associated with higher mortality among moderate-to-severe COPD patients treated in the Brazilian public health system. Strategies to monitor and optimize adherence should be strengthened to reduce COPD-related mortality.

Resumo O presente artigo oferece uma perspectiva sobre o turismo no Brasil, analisando os principais desdobramentos com foco no período de 2000-2019. Trata-se de um artigo de opinião com reflexões de acadêmicos do turismo brasileiro. Os tópicos relacionados ao turismo, cobertos neste artigo, incluem economia, política e planejamento, marketing, transporte, meio ambiente, gastronomia, hospitalidade, lazer, entre outros. Como principal conclusão, considera-se que o Brasil não conseguiu se posicionar como destino de renome internacional, já que desde a década de 1990 os esforços para apoiar o desenvolvimento do turismo regional obtiveram sucesso apenas moderado. As crises econômicas, a instabilidade política, a violência e a corrupção foram entraves que afetaram consideravelmente o setor de turismo. A falta de uma abordagem coordenada entre os vários níveis de governo, a escassez de dados de turismo e uma campanha de marketing supra-governamental de longo prazo, entre outros fatores, fizeram com que o país perdesse várias oportunidades importantes na década de 2010 para se estabelecer como um dos principais destinos turísticos no mercado global.

Abstract This article provides a perspective on tourism in Brazil, analyzing the main developments focusing on the period 2000-2019. This opinion paper provides a reflection made by academics with expertise in tourism in Brazil. Tourism-related topics covered in this paper include economics, politics and planning, marketing, transportation, environment, gastronomy, hospitality, leisure, among others. As the main conclusion, it is argued that Brazil has not managed to position itself as an internationally renowned destination. The efforts in the 1990s to support the development of regional tourism have had only moderate success. Economic crises, political instability, violence and corruption were obstacles that considerably affected the tourism sector. The lack of a coordinated approach between the various levels of government, the shortage of tourism data and a long-term supra-governmental marketing campaign, among other factors, meant that the country missed several opportunities in the 2010s to become established as one of the top tourist destinations in the global market.

Resumen El artículo ofrece una perspectiva del turismo en Brasil, analizando los principales desarrollos con un enfoque en el período 2000-2019. Es un artículo de opinión con reflexiones de investigadores del turismo brasileño. Los temas relacionados con el turismo que se tratan en este artículo incluyen economía, política y planificación, marketing, transporte, medio ambiente, gastronomía, hostelería, ocio, entre otros. Como conclusión principal, se considera que Brasil no ha logrado posicionarse como un destino de renombre internacional, ya que desde la década de los noventa los esfuerzos para apoyar el desarrollo del turismo regional solo han tenido un éxito moderado. Las crisis económicas, la inestabilidad política, la violencia y la corrupción fueron obstáculos que afectaron considerablemente al sector turístico. La falta de un enfoque coordinado entre los distintos niveles de gobierno, la escasez de datos turísticos y una campaña de marketing supra gubernamental a largo plazo, entre otros factores, hicieron que el país perdiera varias oportunidades importantes en la década de 2010 para establecerse como uno de los principales destinos turísticos del mercado mundial.

ABSTRACT Introduction: The present study aims to investigate the prevalence of lower tract urinary symptoms (LUTS) and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents and their association in a community setting using validated scoring instruments. Materials and Methods: A cross-sectional study was carried out from February 2015 to December 2019, during which the parents or guardians of 431 children and adolescents from 5 to 13 years of age, attending a general pediatric outpatient clinic were interviewed. Results: The prevalence of ADHD symptoms and LUTS were 19.9% and 17.9%, respectively. Of the 82 children and adolescents with ADHD, 28% (23) had LUTS (OR 2.31, 95% CI 1.28 to 3.75, p=0.008). Mean total DVSS score in children in the group of children presenting ADHD symptom was significantly higher than those without ADHD symptom (10.2±4.85 vs. 4.9±2.95, p=0.002). Urgency prevailed among LUTS as the most frequent symptom reported by patients with ADHD symptoms (p=0.004). Analyzing all subscales of the DVSS, the items “When your child wants to pee, can't he wait? “Your child holds the pee by crossing his legs, crouching or dancing?” were higher in those with ADHD symptoms (p=0.01 and 0.02, respectively). Functional constipation was present in 36.4% of children with LUTS and 20.7% without LUTS (OR 4.3 95% CI 1-5.3 p=0.001). Conclusion: Children and adolescents with ADHD symptoms are 2.3 times more likely to have LUTS. The combined type of ADHD was the most prevalent among them.

ABSTRACT Introduction: Nocturnal enuresis is a highly incident chronic disorder that generates countless problems to the child and their parents. Bed-wetting has significant negative impacts on self-esteem and the performance of children. The aim of the current study is to assess the quality of life of enuretic children, as well as its association to sex and age. Patients and Methods: Thirty-nine enuretic children (23 boys) and 49 healthy children (27 boys) without any history of previous treatment for enuresis or voiding dysfunction were included. Age ranged between 6 and 11 years old. The “AUQEI” questionnaire was applied in a private environment to all children by the same researcher (psychologist) to evaluate quality of life. Results: Enuretic children displayed loss in quality of life when compared to non-enuretic (35.9% of enuretic x 16.3% of non-enuretic, p=0.035). They were mostly affected in their daily activities (p=0.02). No significant differences were found in the association of sex and gender with quality of life. These results suggest that, children with nocturnal enuresis have 2.87 times more chances of having loss in quality of life compared to non-enuretic. Conclusions: Enuresis has a great impact in quality of life of children. This impact is not related to the age or sex of the child.

ABSTRACT Purpose To evaluate capsules formed by microtextured silicone implants with and without Parietex® mesh coverage histologically. Methods Sixty Wistar rats were divided in two groups (meshed and unmeshed). Each group was, then, divided into two subgroups for evaluation at 30 and 90 days. Capsules were analyzed based on hematoxylin and eosin (HE) and picrosirius staining. Results The number of fibroblasts, neutrophils and macrophages was similar among all subgroups. There was a higher lymphocyte reaction in the 30-day meshed group (p = 0.003). Giant cell reaction, granulation tissue and neoangiogenesis were similar among the subgroups. Synovial metaplasia was milder at 90-day in the unmeshed (p = 0.002) and meshed group (p < 0.001). Capsular thickness was significantly greater in the meshed samples (30-day p < 0.001 and 90-day p < 0.001). There was a similar amount of collagen types I and III in both groups. Conclusions The mesh-covered implants produced capsules similar to the microtextured ones when analyzing inflammatory variables. Synovial metaplasia was milder at 90 than at 30 days, and the capsular thickness was significantly greater in the meshed group. A similar amount of collagen types I and III was observed. Due to these characteristics, the mesh coverage did not seem to significantly affect the local inflammatory activity.

ABSTRACT Background: Over-the-counter use of ivermectin amongst other drugs as SARS-CoV-2 treatment has been increasingly common, despite the lack of evidence on its clinical efficacy. Objective: To evaluate the effect of ivermectin use on production of antibodies against SARS-CoV-2 in health care workers (HCW) diagnosed with COVID-19 and of Th1/Th2 cytokines by stimulated peripheral blood mononuclear cells of the same cohort (PBMCs). Methods: This cross-sectional study evaluated seroconversion and neutralizing antibodies production in HCW at Complexo Hospitalar Universitário Professor Edgard Santos (Salvador, Brazil), diagnosed with COVID-19 from May to July, 2020, as well as in vitro production of antibody against SARS-CoV-2 and Th1/Th2 cytokines. Analyses were performed between December 2020 and February 2021. Participants were stratified according to the use of ivermectin (≤ 1 dose vs. multiple doses) for treatment of COVID-19. Results: 45 HCW were included (62% women). Mean age was 39 years, and disease severity was similar across groups. Neutralizing antibodies were detected less frequently in multiple doses (70%) vs. ≤ 1 dose (97%) groups, p = 0.02). PBMCs of patients in multiple doses group also were less likely to produce antibodies against SARS-CoV-2 following in vitro stimulation with purified spike protein in comparison with patients in ≤ 1 dose group (p < 0.001). PBMC’s production of Th1/Th2 cytokines levels was similar across groups. Abdominal pain (15% vs 46%, p = 0.04), diarrhea (21% vs. 55%, p = 0.05) and taste perversion (0% vs. 18%, p = 0.05) were more frequently reported by participants that used multiple doses of ivermectin. Conclusions: Although there was no evidence for differential disease severity upon ivermectin use for treatment of COVID-19 it was associated with more gastro-intestinal side-effects and impairment of anti-SARS-CoV2 antibodies production, in a dose dependent manner. This potentially impacts the effectiveness of immune response and the risk of reinfection and warrants additional studies for clarifying the mechanisms and consequences of such immunomodulatory effects.

ABSTRACT The outbreak of the new coronavirus (SARS-CoV-2) causing the coronavirus disease (COVID-19) has spread globally. As of June 18, 2020, a high maternal mortality rate due to SARS-CoV-2 infections was identified in Brazil, representing most of the world cases at that time. An observational, cross-sectional study was performed with pregnant women admitted in two maternity hospitals located in Salvador/Bahia and their newborns, from May 24th up to July 17th of 2020. Among 329 pregnant women enrolled at hospital admission, a high prevalence (n=28; 8.5%) of pregnant women with COVID-19 was observed, as well as a high proportion of asymptomatic cases (n=19; 67.9%). Two newborns had detectable SARS-CoV-2 but evolved without abnormalities. This data highlight the importance of identifying pregnant women with COVID-19 for proper isolation measures to prevent in-hospital transmission.

Abstract Tuberous sclerosis complex (TSC) is an autosomal dominant cancer predisposition disorder caused by heterozygous mutations in TSC1 or TSC2 genes and characterized by mTORC1 hyperactivation. TSC-associated tumors develop after loss of heterozygosity mutations and their treatment involves the use of mTORC1 inhibitors. We aimed to evaluate cellular processes regulated by mTORC1 in TSC cells with different mutations before tumor development. Flow cytometry analyses were performed to evaluate cell viability, cell cycle and autophagy in non-tumor primary TSC cells with different heterozygous mutations and in control cells without TSC mutations, before and after treatment with rapamycin (mTORC1 inhibitor). We did not observe differences in cell viability and cell cycle between the cell groups. However, autophagy was reduced in mutated cells. After rapamycin treatment, mutated cells showed a significant increase in the autophagy process (p=0.039). We did not observe differences between cells with distinct TSC mutations. Our main finding is the alteration of autophagy in non-tumor TSC cells. Previous studies in literature found autophagy alterations in tumor TSC cells or knock-out animal models. We showed that autophagy could be an important mechanism that leads to TSC tumor formation in the haploinsufficiency state. This result could guide future studies in this field.

ABSTRACT Background: COVID-19 pandemic caused increased workload and stress for health professionals involved in the care of such patients. We aimed to describe the health-related quality of life, and burnout in frontline physicians diagnosed with anxiety during the COVID-19 pandemic. Methods: This was a cross-sectional study conducted during the first-wave phase of COVID19, from September to October 2020. Questionnaires were sent electronically to 450 physicians from State of Bahia, assessing symptoms of anxiety, health-related quality of life (HRQOL) and burnout syndrome. For the categorical variables, the Pearson’s chi-square test was used and difference between means was compare using the Mann-Whitney test. was Groups with and without anxiety symptoms were compared using prevalence ratios (PR). Pearson’s correlation measured the correlation between WHOQOL-BREF and MBI (Maslach Burnout Inventory) domains. The Fisher r-to-z transformation was used to assess the significance of the difference between two correlation coefficients. The significance level was <0.05. Results: Out of the 450 physicians, 223 (49,6%) completely answered the questionnaire and 38 (17%) showed symptoms of anxiety. Physicians with anxiety had higher scores in emotional exhaustion (EE) (38.31 ± 8.59 vs 25.31±0.87; p = 0.0001) and depersonalization (DP) (9.0 ± 5.6 vs 5.9 ± 5.3; p = 0.001) domains, and lower scores in personal accomplishment (PA) (32.1 ± 8.2 vs 36.3 ± 7.6; p = 0.004), than those without anxiety. All correlations between WHOQOL-BREF domains and MBI in physicians without anxiety were significant (p = 0.01). Conclusion: Physicians with anxiety showed more emotional exhaustion, less personal accomplishment, and lower quality of life. All domains of WHOQOL BREF were correlated with all MBI domains among physicians without anxiety. Differences in correlation according to anxiety were remarkable in psychological HOQOL BREF domain and emotional exhaustion and depersonalization MBI domains. The effect of anxiety leading to poorer levels of perceived health needs to be further investigated.