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ABSTRACT Objective: To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made. Conclusion: New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.

RESUMO Objetivo: Atualizar as recomendações para embasar as decisões para o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. Métodos: A elaboração desta diretriz foi feita por especialistas, incluindo representantes do Ministério da Saúde e metodologistas. O método utilizado para o desenvolvimento rápido de diretrizes baseou-se na adoção e/ou adaptação de diretrizes internacionais existentes (GRADE ADOLOPMENT) e contou com o apoio da plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. Resultados: Chegaram-se a 21 recomendações, incluindo recomendações fortes quanto ao uso de corticosteroides em pacientes em uso de oxigênio suplementar e recomendações condicionais para o uso de tocilizumabe e baricitinibe, em pacientes com oxigênio suplementar ou ventilação não invasiva, e de anticoagulantes, para prevenção de tromboembolismo. Devido à suspensão da autorização de uso, não foi possível fazer recomendações para o tratamento com casirivimabe + imdevimabe. Foram feitas recomendações fortes contra o uso de azitromicina em pacientes sem suspeita de infecção bacteriana, hidroxicloroquina, plasma convalescente, colchicina e lopinavir + ritonavir, além de recomendações condicionais contra o uso de ivermectina e rendesivir. Conclusão: Foram criadas novas recomendações para o tratamento de pacientes hospitalizados com COVID-19, como as recomendações de tocilizumabe e baricitinibe. Ainda são recomendados corticosteroides e profilaxia contra tromboembolismo, esta em caráter condicional. Vários medicamentos foram considerados ineficazes e não devem ser usados, no intuito de proporcionar o melhor tratamento segundo os princípios da medicina baseada em evidências e promover a economia de recursos.

https://doi.org/10.5935/2965-2774.20230136-en

IMMEDIATE EFFECT OF AN ORTHOSTATIC DEVICE IN AMPUTEES WHO PRACTICE PHYSICAL ACTIVITY
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Alves, Gabriella Coelho Vieira de Melo

; Hotta, Gisele Harumi

; Aguiar, Débora Pinheiro

; Oliveira, Liana Praça

; Leopoldino, Marie Aquino Melo de

; Fortes, Jefferson Pacheco Amaral

; Oliveira, Francisco Carlos de Mattos Brito

; Santos Júnior, Francisco Fleury Uchoa

Revista Brasileira de Medicina do Esporte

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2023, Volume 29 elocation e2021_0304

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

RESUMO Introdução: A amputação de membros inferiores afeta em sua maioria adultos jovens economicamente ativos, o que ocasiona grande impacto socioeconômico devido ao comprometimento da capacidade laboral, socialização e qualidade de vida. Desta forma, as utilizações de dispositivos ortostáticos possibilitariam a reinserção do indivíduo no ambiente de trabalho. Objetivo: Avaliar o efeito imediato da utilização de um dispositivo de elevação postural nos parâmetros fisiológicos e nos níveis da pressão plantar de amputados praticantes de atividade física. Métodos: Foram coletados os dados sociodemográficos e a percepção da qualidade do sono de 14 adultos de ambos os sexos com amputações de membro inferior que praticam atividade física. Os participantes foram colocados em um equipamento de elevação postural durante 90 minutos com monitorização dos parâmetros fisiológicos como pressão arterial, frequência cardíaca, saturação e sistema nervoso autônomo, além dos níveis da pressão plantar. Os dados também foram coletados durante a recuperação (15 e 30 minutos depois do uso do dispositivo). A análise dos dados foi realizada pela ANOVA two-way ou modelo de efeitos mistos com teste de comparações múltiplas de Sidak, p < 0,05. Resultados: Para todos os parâmetros cardiovasculares (p > 0,05) analisados, nível de ativação sistema nervoso autônomo (p > 0,05) e pressão plantar (p > 0,05) não foram observadas diferenças ao longo do uso do dispositivo ortostático em todos os períodos avaliados. Conclusão: A utilização do equipamento de elevação postural por 90 minutos não gera como efeito imediato, alterações nos parâmetros fisiológicos e no controle postural de amputados praticantes de atividade física. Nível de evidência II; Estudos terapêuticos: investigação dos resultados dos tratamentos Declaração de relevância clínica.

ABSTRACT Introduction: Lower limb amputation affects mainly economically active young adults, causing great socio-economic impact due to impaired work capacity, socialization, and quality of life. Thus, the use of orthostatic devices could make reintegration of the individual back into the work environment possible. Objective: To evaluate the immediate effect of using a postural elevation device on physiological parameters and plantar pressure levels in amputees who practice physical activity. Methods: Sociodemographic and perceived sleep quality data were collected from 14 adults of both sexes with lower limb amputations, who practice physical activity. The participants were placed in postural elevation equipment for a period of 90 minutes with monitoring of physiological parameters such as blood pressure, heart rate, and oxygen saturation. Parameters related to the autonomic nervous system and plantar pressure levels were also evaluated. Data were also collected during recovery at 15- and 30-minute intervals after using the device. Data analysis was performed using two-way ANOVA or a mixed-effects model with Sidak's multiple comparisons test. Results: For all cardiovascular parameters (p>0.05) analyzed, the activation level of the autonomic nervous system (p>0.05), and plantar pressure (p>0.05), no evidence of differences was observed during use of the orthostatic device in all evaluated periods. Conclusion: The use of postural elevation equipment for 90 minutes does not generate, as an immediate effect, changes in physiological parameters and postural control in amputees who practice physical activity. Level of evidence II; Therapeutic studies – investigation of treatment results. Clinical relevance statement .

RESUMEN Introducción: La amputación de miembros inferiores afecta mayoritariamente a jóvenes adultos económicamente activos, lo que provoca un gran impacto socioeconómico debido al compromiso de la capacidad laboral, la socialización y la calidad de vida. Así, el uso de dispositivos ortostáticos permitiría la reinserción del individuo en el entorno laboral. Objetivo: Evaluar el efecto inmediato del uso de un dispositivo de elevación postural en los parámetros fisiológicos y en los niveles de presión plantar de amputados que practican actividad física. Métodos: Se recogieron datos sociodemográficos y la percepción de la calidad del sueño de 14 adultos de ambos sexos con amputaciones de miembros inferiores, practicantes de actividad física. Los participantes fueron colocados en equipos de elevación postural durante 90 minutos con monitoreo de parámetros fisiológicos como presión arterial, frecuencia cardíaca, saturación y sistema nervioso autónomo, además de los niveles de presión plantar. También se recopilaron datos durante la recuperación a intervalos de 15 y 30 minutos después de usar el dispositivo. El análisis de datos se realizó mediante ANOVA two-way o un modelo de efectos mixtos con la prueba de comparaciones múltiples de Sidak, p < 0,05. Resultados: Para todos los parámetros cardiovasculares (p> 0,05) analizados, el nivel de activación del sistema nervioso autónomo (p> 0,05) y la presión plantar (p> 0,05), no se observaron diferencias a lo largo del uso del dispositivo ortostático en todos los períodos evaluados. Conclusión: El uso del equipo de elevación postural durante 90 minutos no genera, como efecto inmediato, cambios en los parámetros fisiológicos y en el control postural de los amputados que practican actividades físicas. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados de los tratamientos. Declaración de relevancia clínica .

https://doi.org/10.1590/1517-8692202329012021_0304

Recovery of Bradyrhizobium cells and effects on the physiological quality of soybean seeds sown in dry soil
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Pinto, Débora Bueno Bernardo

; Ferreira, Eduara

; Henning, Fernando Augusto

; Amaral, Higo Forlan

; Hungria, Mariangela

; Nogueira, Marco Antonio

Journal of Seed Science

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2023, Volume 45 elocation e202345001

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract: Farmers sometimes sow soybean (Glycine max (L.) Merrill) in dry soil in the expectation of rain in the short time. However, the forecast may not confirm, letting the inoculated seeds in the dry soil indefinitely. We assessed the survival of inoculated Bradyrhizobium and physiological quality of soybean seeds sown in dry soil. In the first experiment, irrigation was applied with 2 h, 1, 4, 11, 18, or 21 days after sowing; in the second experiment, sowing was carried out 2 h, 1, 5, 12, 14, or 20 days before irrigation. Each time represented a treatment in a completely randomized design. Bradyrhizobium cells dropped from ~8-9 × 104 colony forming units per seed soon after inoculation to -60% at 2 h after sowing in dry soil, and decreased to close to zero with time in both experiments. Although there was no effect on germination (59% and 81% in the first and second experiments, respectively), the exposure to dry soil reduced the emergence speed index from 19.5 (2 h) to 12.0 (21 days) in the first experiment and from 37.8 (2 h) to 13.8 (21 days) in the second. In the first experiment, the number of abnormal seedlings increased from 7% (2 h) to 24% (21 days); in the second, cotyledons showed cracks, which increased from 1% (2 h) to ~50% (≥ 5 days). Sowing in dry soil negatively affects not only the inoculated Bradyrhizobium, but also the physiological quality of soybean seeds.

Resumo: Em alguns casos os agricultores semeiam a soja (Glycine max (L.) Merrill) no solo seco, na espera de ocorrência de chuvas no curto prazo. Entretanto, a previsão pode não se confirmar, fazendo com que as sementes inoculadas permaneçam no solo seco indefinidamente. Avaliou-se a sobrevivência de Bradyrhizobium e o efeito sobre a qualidade fisiológica de sementes de soja inoculadas e semeadas em solo seco. No primeiro experimento, a irrigação foi aplicada com 2 h, 1, 4, 11, 18 ou 21 dias após a semeadura; no segundo experimento, a semeadura ocorreu 2 h, 1, 5, 12, 14 ou 20 dias antes da irrigação. Cada tempo representou um tratamento em delineamento inteiramente casualizado. A recuperação de Bradyrhizobium caiu de ~8-9 × 104 unidades formadoras de colônias por semente logo após a inoculação para -60% 2 h após a semeadura em solo seco, e tendeu a zero com o tempo, em ambos experimentos. Apesar de não afetar a germinação (59% e 81% nos no primeiro e no segundo experimento, respectivamente), a exposição ao solo seco diminuiu o índice de velocidade de emergência de 19,5 (2 h) para 12,0 (21 dias) no primeiro e de 37,8 (2 h) para 13,8 (21 dias) no segundo. No primeiro experimento, o número de plântulas anormais aumentou de 7% (2 h) para 24% (21 dias); no segundo, os cotilédones apresentaram trincas, que aumentaram de 1% (2 h) para ~ 50% (≥ 5 dias). A semeadura em solo seco prejudica não apenas o Bradyrhizobium inoculado, mas também a qualidade fisiológica das sementes de soja.

https://doi.org/10.1590/2317-1545v45259694

RELIABILITY OF THE ISOMETRIC DYNAMOMETER IN CONTROL, PARAPLEGIC, AND AMPUTEE INDIVIDUALS
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FORTES, JEFFERSON PACHECO AMARAL

; HOTTA, GISELE HARUMI

; AGUIAR, DÉBORA PINHEIRO

; OLIVEIRA, VICTOR BRUNO SOARES DE

; OLIVEIRA, FRANCISCO CARLOS DE MATTOS BRITO

; SANTOS-JÚNIOR, FRANCISCO FLEURY UCHOA

Acta Ortopédica Brasileira

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2023, Volume 31 N. 1 elocation e255829

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Objective: To determine the Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), Minimum Detectable Change (MDC), and the Minimum Clinically Important Difference (MCID) of the isometric measurements of muscle strength of trunk extension and of flexion and knee extension at maximum contraction in healthy, paraplegic, and amputee individuals, by using an isometric dynamometer with a belt for stabilization. Methods: An observational cross-sectional study was carried out to assess the reliability of a portable isometric dynamometer in the trunk extension and flexion and knee extension movements of each group. Results: In all measurements, ICC ranged from 0.66 to 0.99, SEM from 0.11 to 3.73 kgf, and MDC from 0.30 to 10.3 kgf. The MCID of the movements ranged from 3.1 to 4.9 kgf in the amputee group and from 2.2 to 3.66 kgf in the paraplegic group. Conclusion: The manual dynamometer demonstrated good intra-examiner reliability, presenting moderate and excellent ICC results. Thus, this device is a reliable resource to measure muscle strength in amputees and paraplegics. Level of Evidence II, Cross-Sectional Study.

RESUMO Objetivo: Determinar o coeficiente de correlação intraclasse (CCI), o erro padrão da medida (EPM), a mínima mudança detectável (MMD) e a mínima mudança clinicamente importante (MMCI) das medidas isométricas de força muscular da extensão de tronco e da flexão e extensão de joelho em contração máxima de indivíduos saudáveis, paraplégicos e amputados, usando um dinamômetro isométrico com cinto para estabilização. Métodos: Foi realizado um estudo observacional transversal para avaliar a confiabilidade de um dinamômetro portátil isométrico nos movimentos de extensão de tronco e de flexão e extensão de joelho de cada grupo Resultados: Em todas as medidas o CCI apresentou uma variação de 0,66 a 0,99, o EPM de 0,11 a 3,73 kgf e a MMD de 0,30 a 10,3 kgf. A MMCI dos movimentos variou de 3,1 a 4,9 kgf no grupo de amputados e de 2,2 a 3,66 kgf no grupo de paraplégicos. Conclusão: O dinamômetro manual demonstrou boa confiabilidade intraexaminador, com variação de CCI de moderada à excelente, apresentando-se como um recurso confiável para mensurar força muscular de amputados e paraplégicos. Nível de Evidência II, Estudo Observacional Transversal.

https://doi.org/10.1590/1413-785220233101e255829

Development and validation of the Brazilian Version of Lay Persons’ Social Judgements about Cleft-lip Scale (B-LSojCleft-S)
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Maia, Ana Carolina Del-Sarto Azevedo

; Grimaldi, Débora Evelyn do Amaral

; Jural, Lucas Alves

; Lima, Stefanni Olga Aguiar Sales

; Magno, Marcela Baraúna

; Maia, Lucianne Cople

; Pithon, Matheus Melo

; Prado, Fabio Ornellas

Brazilian Oral Research

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2023, Volume 37 elocation e086

Abstract: En | Text: En | PDF: En

Abstract The aim of this study was to develop and analyze the psychometric properties of the Brazilian Version of Lay Person's Social Judgement about Cleft-lip Scale (B-LSojCleft-S). A standardized photograph of a 16-year-old girl was manipulated by using photo editing software, to simulate different cleft-lip situations. The cleft-free image was used as a control. The researchers structured an initial questionnaire that was evaluated by experts and a sample of the target population to evaluate the construct. After analysis by the researchers, a final version of the B-LSojCleft-S containing 14 items was generated. Each answer was awarded score from 1 to 3 points, yielding a total score of 14 to 42 points. Higher scores represented better social judgements. The B-LSojCleft-S was applied online to 103 test participants and 73 retest participants with an interval of 20 days between application. Aspects of acceptability, discriminant property, internal consistency, reliability and construct validity were evaluated. Construct validity was assessed using the Friedman test (p < 0.05). Reliability was determined using an intraclass correlation coefficient > 0.70, and internal consistency using Cronbach's alpha > 0.81. The B-LSojCleft-S showed high acceptability, strong discriminant property, excellent internal consistency and reliability, but had a floor and ceiling effect. The instrument reached valid and reliable scores and had acceptable psychometric properties to evaluate the social judgments of lay persons about different cleft lip situations in a Brazilian population.

https://doi.org/10.1590/1807-3107bor-2023.vol37.0086

NOVAS POSSIBILIDADES HISTÓRICAS PARA A DEMOCRACIA E PARA A EDUCAÇÃO PÚBLICA
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Leher, Roberto

; Pino, Ivany Rodrigues

; Zuin, Antônio Alvaro Soares

; Almeida, Luana Costa

; Silveira, Adriana Aparecida Dragone

; Dalbosco, Claudio Almir

; Moraes, Carmen Sylvia Vidigal

; Mazza, Débora

; Amaral, Nelson Cardoso

; Souza, Sandra Maria Zákia Lian

; Almeida, Ana Maria Fonseca de

; Ferretti, Celso João

; Sisto, Vicente

; Goergen, Pedro

; Ximenes, Salomão

; Lima, Licínio Carlos Viana da Silva

; Trevisan, Anderson Ricardo

; Rambla, Xavier

Educação & Sociedade

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2023, Volume 44 elocation e271371

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.1590/es.271371

Cross-sectional assessment of mild cognitive impairment in pre-dialysis chronic kidney disease and its association with inflammation and changes seen on MRI: what the eyes cannot see
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Pires, Leopoldo Antônio

; Almeida, Ana Laura Maciel de

; Paraízo, Marilise de Andrade

; Corrêa, José Otávio do Amaral

; Dias, Débora dos Santos

; Fernandes, Neimar da Silva

; Ezequiel, Danielle Guedes Andrade

; Paula, Rogério Baumgratz de

; Fernandes, Natália Maria da Silva

Brazilian Journal of Nephrology

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sep 2022, Volume 44 N. 3 Pages 336 - 348

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução: O comprometimento cognitivo leve (CCL) é prevalente e subdiagnosticado na doença renal crônica (DRC), condição com a qual compartilha fatores fisiopatológicos como a inflamação crônica. Objetivo: Avaliar a associação do CCL na DRC estágios 1 a 5, com marcadores inflamatórios e alterações de exames de imagem por ressonância magnética (RM). Pacientes e métodos: Estudo transversal em pacientes adultos, com DRC pré-dialítica. CCL foi avaliado pelo Montreal Cognitive Assessment (MoCA) e a taxa de filtração glomerular estimada (TFGe), pela equação do CKD-EPI. Dados sociodemográficos e clínicos foram coletados nos prontuários médicos. Dosadas citocinas IL-4, IL-6, IL-17, o TNF-α e PCR-us. A RM do encéfalo foi realizada em aparelho de 1,5 Tesla, sem contraste. Realizada análise descritiva seguida por comparação de pontuações do MoCA anormais versus normais entre todas as variáveis estudadas. A regressão linear foi realizada usando MoCA como uma variável dependente, ajustada para fatores de confusão. Resultados: De 111 pacientes convidados, oitenta completaram a avaliação neuropsicológica, 56 realizaram RM, tendo sido incluídos no estudo. A média de idade foi de 56,3 ± 8,3 anos e 51,8% (n = 29) apresentavam MoCA alterado. Quando comparado ao grupo MoCA normal, o grupo MoCA alterado apresentou níveis mais elevados de IL-6 e IL-17. Não houve correlação entre MoCA alterado com TFGe nem com anormalidades na RM. Nos modelos ajustados, a IL-6 foi preditor independente do MoCA alterado Conclusão: O CCL avaliado pelo MoCA foi prevalente em pacientes com DRC pré-dialítica, associou-se com inflamação e não apresentou correlação com alterações da RM.

Abstract Introduction: Mild cognitive impairment (MCI) is a prevalent and underdiagnosed condition in chronic kidney disease (CKD), that shares common pathophysiological factors such as chronic inflammation. Objective: To evaluate the association of MCI in CKD stages 1-5 using inflammatory markers and changes by magnetic resonance imaging (MRI). Patients and Methods: Cross-sectional study in adult patients with pre-dialysis CKD. MCI was assessed by the Montreal Cognitive Assessment (MoCA) and the estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration equation. Sociodemographic and clinical data were collected from medical records. The cytokines IL-4, IL-6, IL-17, TNF-α and hs-CRP were determined. Brain MRI was performed in a 1.5 Tesla device, without paramagnetic contrast. A descriptive analysis followed by a comparison of abnormal versus normal MoCA scores among all studied variables. A linear regression analysis was performed using MoCA as a dependent variable, adjusted for confounding factors. Results: Of 111 invited patients, eighty completed the neuropsychological assessment and 56 underwent MRI, and were included in the study. Mean age was 56.3 ± 8.3 years and 51.8% (n = 29) had altered MoCA. When compared to the group with normal MoCA, the group with altered MoCA had higher levels of IL-6 and IL-17. There was no correlation between altered MoCA with eGFR or with MRI abnormalities. Conclusão: MCI assessed by MoCA was prevalent in patients with pre-dialysis CKD, it was associated with inflammation and showed no correlation with MRI changes.

https://doi.org/10.1590/2175-8239-jbn-2021-0194

Effective recommendations towards healthy routines to preserve mental health during the COVID-19 pandemic
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Pilz, Luísa K.

; Couto Pereira, Natividade S.

; Francisco, Ana Paula

; Carissimi, Alicia

; Constantino, Débora B.

; Caus, Letícia B.

; Abreu, Ana Carolina O.

; Amando, Guilherme R.

; Bonatto, Fernanda S.

; Carvalho, Paula V.V.

; Cipolla-Neto, José

; Harb, Ana

; Lazzarotto, Gabriela

; Marafiga, Joseane Righes

; Minuzzi, Luciano

; Montagner, Francisco

; Nishino, Fernanda A.

; Oliveira, Melissa A.B.

; dos Santos, Bruno G.T.

; Steibel, Eduardo G.

; Tavares, Patrice S.

; Tonon, André C.

; Xavier, Nicóli B.

; Zanona, Querusche Klippel

; Amaral, Fernanda G.

; Calcagnotto, Maria Elisa

; Frey, Benicio N.

; Hidalgo, Maria Paz

; Idiart, Marco

; Russomano, Thais

Brazilian Journal of Psychiatry

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apr 2022, Volume 44 N. 2 Pages 136 - 146

Abstract: En | Text: En | PDF: En

Objective: To assess the adherence to a set of evidence-based recommendations to support mental health during the coronavirus disease 2019 (COVID-19) pandemic and its association with depressive and anxiety symptoms. Methods: A team of health workers and researchers prepared the recommendations, formatted into three volumes (1: COVID-19 prevention; 2: Healthy habits; 3: Biological clock and sleep). Participants were randomized to receive only Volume 1 (control), Volumes 1 and 2, Volumes 1 and 3, or all volumes. We used a convenience sample of Portuguese-speaking participants over age 18 years. An online survey consisting of sociodemographic and behavioral questionnaires and mental health instruments (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 [GAD-7]) was administered. At 14 and 28 days later, participants were invited to complete follow-up surveys, which also included questions regarding adherence to the recommendations. A total of 409 participants completed the study – mostly young adult women holding university degrees. Results: The set of recommendations contained in Volumes 2 and 3 was effective in protecting mental health, as suggested by significant associations of adherence with PHQ-9 and GAD-7 scores (reflecting anxiety and depression symptoms, respectively). Conclusion: The recommendations developed in this study could be useful to prevent negative mental health effects in the context of the pandemic and beyond.

https://doi.org/10.1590/1516-4446-2021-2109

Diretrizes Brasileiras para o tratamento farmacológico de pacientes hospitalizados com COVID-19: Diretriz conjunta da Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia e Sociedade Brasileira de Reumatologia
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Falavigna, Maicon

; Stein, Cinara

; Amaral, José Luiz Gomes do

; Azevedo, Luciano Cesar Pontes de

; Belli, Karlyse Claudino

; Colpani, Verônica

; Cunha, Clóvis Arns da

; Dal-Pizzol, Felipe

; Dias, Maria Beatriz Souza

; Ferreira, Juliana Carvalho

; Freitas, Ana Paula da Rocha

; Gräf, Débora Dalmas

; Guimarães, Hélio Penna

; Lobo, Suzana Margareth Ajeje

; Monteiro, José Tadeu

; Nunes, Michelle Silva

; Oliveira, Maura Salaroli de

; Prado, Clementina Corah Lucas

; Santos, Vania Cristina Canuto

; Silva, Rosemeri Maurici da

; Sobreira, Marcone Lima

; Veiga, Viviane Cordeiro

; Vidal, Ávila Teixeira

; Xavier, Ricardo Machado

; Zavascki, Alexandre Prehn

; Machado, Flávia Ribeiro

; Carvalho, Carlos Roberto Ribeiro de

Revista Brasileira de Terapia Intensiva

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mar 2022, Volume 34 N. 1 Pages 1 - 12

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivos: Há diversas terapias sendo utilizadas ou propostas para a COVID-19, muitas carecendo de apropriada avaliação de efetividade e segurança. O propósito deste documento é elaborar recomendações para subsidiar decisões sobre o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. Métodos: Um grupo de 27 membros, formado por especialistas, representantes do Ministério da Saúde e metodologistas, integra essa diretriz. Foi utilizado o método de elaboração de diretrizes rápidas, tomando por base a adoção e/ou a adaptação de recomendações a partir de diretrizes internacionais existentes (GRADE ADOLOPMENT), apoiadas pela plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. Resultados: Foram geradas 16 recomendações. Entre elas, estão recomendações fortes para o uso de corticosteroides em pacientes em uso de oxigênio suplementar, para o uso de anticoagulantes em doses de profilaxia para tromboembolismo e para não uso de antibacterianos nos pacientes sem suspeita de infecção bacteriana. Não foi possível fazer uma recomendação quanto à utilização do tocilizumabe em pacientes hospitalizados com COVID-19 em uso de oxigênio, pelas incertezas na disponibilidade e de acesso ao medicamento. Foi feita recomendação para não usar azitromicina, casirivimabe + imdevimabe, cloroquina, colchicina, hidroxicloroquina, ivermectina, lopinavir/ ritonavir, plasma convalescente e rendesivir. Conclusão: Até o momento, poucas terapias se provaram efetivas no tratamento do paciente hospitalizado com COVID-19, sendo recomendados apenas corticosteroides e profilaxia para tromboembolismo. Diversos medicamentos foram considerados ineficazes, devendo ser descartados, de forma a oferecer o melhor tratamento pelos princípios da medicina baseada em evidências e promover economia de recursos não eficazes.

ABSTRACT Objective: Several therapies are being used or proposed for COVID-19, and many lack appropriate evaluations of their effectiveness and safety. The purpose of this document is to develop recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: A group of 27 experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Sixteen recommendations were generated. They include strong recommendations for the use of corticosteroids in patients using supplemental oxygen, the use of anticoagulants at prophylactic doses to prevent thromboembolism and the nonuse of antibiotics in patients without suspected bacterial infection. It was not possible to make a recommendation regarding the use of tocilizumab in patients hospitalized with COVID-19 using oxygen due to uncertainties regarding the availability of and access to the drug. Strong recommendations against the use of hydroxychloroquine, convalescent plasma, colchicine, lopinavir + ritonavir and antibiotics in patients without suspected bacterial infection and also conditional recommendations against the use of casirivimab + imdevimab, ivermectin and rendesivir were made. Conclusion: To date, few therapies have proven effective in the treatment of hospitalized patients with COVID-19, and only corticosteroids and prophylaxis for thromboembolism are recommended. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and promote economical resource use.

https://doi.org/10.5935/0103-507x.20220001-pt

10.

Self-perceived neighborhood factors and OHRQoL among adolescents: a population-based study in southern Brazil
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DALLA NORA, Ângela

; KNORST, Jéssica Klöckner

; COMIM, Letícia Donato

; RACKI, Débora Nunes de Oliveira

; ALVES, Luana Severo

; ZENKNER, Júlio Eduardo do Amaral

Brazilian Oral Research

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2022, Volume 36 elocation e003

Abstract: En | Text: En | PDF: En

Abstract This study aimed to assess the relationship between self-perceived neighborhood factors and oral health-related quality of life (OHRQoL) among adolescents from southern Brazil. A representative sample of 15-19-year-old students from Santa Maria, Brazil, was included. The Oral Health Impact Profile (OHIP-14) was used to assess the OHRQoL. Self-perceived neighborhood factors were assessed through a structured questionnaire and included characteristics of the neighborhood where the adolescents lived, such as the presence of paved streets, tap water, community social networks, and availability of dental services and the Family Health Strategy (FHS). In addition, socioeconomic, behavioral, and clinical variables (dental caries and malocclusion) were also evaluated. Multilevel Poisson regression analysis with a hierarchical approach was used to assess the association between predictors and OHIP-14. The rate ratio (RR) and 95% confidence intervals (CIs) were estimated. A total of 1,197 adolescents were included in this study (participation rate: 72.3%). The mean OHIP-14 score was 8.4 (standard error = 0.2), ranging from 0 to 49. Living in residences with unpaved streets (RR = 1.11, 95%CI:1.06−1.17), no tap water (RR = 1.11, 95%CI: 1.02−1.20), absence of the FHS services (RR = 1.15, 95%CI: 1.09−1.20), and the availability of dental services (RR = 1.08, 95%CI: 1.03−1.14) were associated with higher OHIP-14 scores, indicating a poorer OHRQoL. In addition, lower socioeconomic status, visiting the dentist for curative reasons, lower frequency of brushing teeth, and higher sugar consumption were also associated with higher OHIP-14 scores. In conclusion, self-perceived neighborhood characteristics were associated with OHRQoL in adolescents. Adolescents who perceived their neighborhood as deprived had poorer OHRQoL.

https://doi.org/10.1590/1807-3107bor-2022.vol36.0003

11.

Selection for grain size and sieve yield in F3 common bean genotypes using linear mixed models
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Amaral, Erisson Lubacheski do

; Woyann, Leomar Guilherme

; Baretta, Douglas Rodrigo

; Gobatto, Débora Regiane

; Paula, Giovanni Silva de

; Kafer, João Matheus

; Amaral, José Eduardo Lubacheski do

; Finatto, Taciane

Acta Scientiarum. Agronomy

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2022, Volume 44 elocation e52953

Abstract: En | Text: En | PDF: En

ABSTRACT. Grain size is an essential trait in common bean breeding as it determines the acceptance of a new cultivar by producers, consumers, and the industry. The objectives of this study were to identify the ideal traits for selecting common bean lines in the F3 generation to obtain an adequate sieve yield and to identify the best lines for sieve yield by applying early generation selection. Two trials were conducted in two locations during the 2016/2017 crop season. These trials were composed of 300 F3 populations and two parents (used as checks). The experimental design used was an augmented block design without repetition for the treatments (lineages). After harvest, the grain yield, yield components, and sieve yield (SY) were evaluated. In conclusion, selection in the F3 generation can be performed for sieve yield, considering the traits SY12+13, SY14, and relative grain yield, as they present the highest values of heritability and greatest correlation between genotype and performance in the evaluated environments. Additionally, the lines selected to continue in the breeding program are composed of the 15 best lineages for traits SY12+13, SY14, and relative grain yield. Preference should be given to lines that excel in more than one of these traits.

https://doi.org/10.4025/actasciagron.v44i1.52953

12.

The health-related quality of life in patients with post-COVID-19 after hospitalization: a systematic review
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Figueiredo, Eduardo Augusto Barbosa

; Silva, Whesley Tanor

; Tsopanoglou, Sabrina Pinheiro

; Vitorino, Débora Fernandes de Melo

; Oliveira, Luciano Fonseca Lemos de

; Silva, Keity Lamary Souza

; Luz, Hiago Daniel Herédia

; Ávila, Matheus Ribeiro

; Oliveira, Lucas Fróis Fernandes de

; Lacerda, Ana Cristina Rodrigues

; Mendonça, Vanessa Amaral

; Lima, Vanessa Pereira

; Mediano, Mauro Felippe Felix

; Figueiredo, Pedro Henrique Scheidt

; Rocha, Manoel Otávio Costa

; Costa, Henrique Silveira

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0741-2021

Abstract: En | Text: En | PDF: En

ABSTRACT Symptoms in post-COVID-19 patients who require hospitalization can persist for months, significantly affecting their health-related quality of life (HRQoL). Thus, the present study aimed to discuss the main findings regarding HRQoL in post-COVID-19 patients who required hospitalization. An electronic search was performed in the MEDLINE, EMBASE, CINAHL, Web of Science, LILACS, and Scopus databases, without date and language restrictions, until July 2021. Twenty-four articles were included in the analysis. It seems that HRQoL partially improved soon after hospital discharge, although the negative impact on HRQoL may persist for months. The physical and mental aspects are affected because patients report pain, discomfort, anxiety, and depression. The HRQoL of COVID-19 infected patients was worse than that of uninfected patients. Additionally, HRQoL seemed worse in patients admitted to the intensive care unit than in those who remained in the ward. Improvements in HRQoL after hospital discharge are independent of imaging improvement, and there seems to be no association between HRQoL after hospital discharge and disease severity on hospital admission. Many factors have been identified as determinants of HRQoL, with women and advanced age being the most related to worse HRQOL, followed by the duration of invasive mechanical ventilation and the need for intensive care. Other factors included the presence and number of comorbidities, lower forced vital capacity, high body mass index, smoking history, undergraduate education, and unemployment. In conclusion, these findings may aid in clinical management and should be considered in the aftercare of patients.

https://doi.org/10.1590/0037-8682-0741-2021

13.

Association between the city region and traumatic dental injuries among adolescents from Santa Maria, South Brazil
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COMIM, Letícia Donato

; DALLA NORA, Ângela

; KNORST, Jessica Klöckner

; RACKI, Débora Nunes de Oliveira

; ZENKNER, Júlio Eduardo do Amaral

; ALVES, Luana Severo

Brazilian Oral Research

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2022, Volume 36 elocation e114

Abstract: En | Text: En | PDF: En

Abstract This study investigated the association between the city region and traumatic dental injury (TDI) among adolescents from Santa Maria, Rio Grande do Sul, Brazil. A population-based cross-sectional survey was conducted from March to November 2018, which included a representative sample of adolescents (15-19-year-old) attending public and private high schools. A questionnaire on sociodemographic information was sent to the parents/legal guardians of the selected adolescents. TDI in the upper and lower permanent incisors and canines was recorded based on the O’Brien classification. Environmental variables (sociodemographic and structural characteristics of the neighborhoods) were obtained from official publications. Multilevel Poisson regression models were used, and prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. A total of 1,146 adolescents participated in this study. The overall prevalence of TDI was 17.3%, mild trauma was 12.7%, and severe trauma was 5.8%. Adolescents living in the southern region had a prevalence of TDI of 25.3%, compared with 13.6% in the northern region. After adjusting for important cofactors, adolescents living in the southern region were more likely to have TDI than their counterparts in the northern region (PR, 1.91; 95%CI: 1.18-3.11; p = 0.009). Analyzing the number of environmental risk indicators in different regions, the southern region presented a higher mean and median than all other regions. In conclusion, living in the southern region was associated with a higher prevalence and severity of TDI among adolescents from Santa Maria, southern Brazil. Our findings suggest the role of the environment in the epidemiology of TDI.

https://doi.org/10.1590/1807-3107bor-2022.vol36.0114

14.

Processamento auditivo temporal em indivíduos expostos à prática musical instrumental
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Ryn Junior, Flavio Van

; Lüders, Débora

; Casali, Raquel Leme

; Amaral, Maria Isabel Ramos do

CoDAS

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2022, Volume 34 N. 6 elocation e20210256

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo Investigar a influência da prática musical instrumental nas habilidades auditivas temporais e nos resultados de potenciais corticais relacionados a eventos auditivos (P300) em um grupo de jovens músicos em comparação com indivíduos sem experiência prática musical. Método Trata-se de um estudo prospectivo, observacional, analítico e transversal. Participaram 34 indivíduos entre 18 a 30 anos, de ambos os sexos, divididos em dois grupos: Grupo I (GI), composto por indivíduos músicos (n=16) e Grupo II (GII), composto por indivíduos não músicos (n=18). Todos os participantes realizaram avaliação comportamental do processamento auditivo temporal, composta pelos testes de Padrão de Duração (TPD), Padrão de Frequência (TPF), Random Gap Detection (RGDT) e avaliação eletrofisiológica - Potencial Evocado Auditivo de Longa Latência (PEALL) - P300. O GI respondeu também a um questionário específico para caracterização da prática musical. Resultados Foram observadas diferenças estatisticamente significantes com desempenho superior do GI em relação ao GII em todos os testes comportamentais aplicados (p<0,001*). Não foram encontradas diferenças significantes entre os grupos com relação aos parâmetros de latência e amplitude analisados a partir da obtenção do PEALL-300 (p>0,05). Conclusão Os achados demonstraram influência positiva da prática musical em relação ao aprimoramento de habilidades auditivas de ordenação e resolução temporal. Todos os participantes apresentaram adequado funcionamento cortical do sistema nervoso auditivo central, sem diferenças significantes entre músicos e não músicos nos parâmetros de amplitude e latência do P300.

ABSTRACT Purpose To investigate the influence of musical instrument practice on temporal auditory abilities and on the results of cortical potentials related to auditory events (P300) in a group of young musicians compared to individuals without experience in musical practice. Methods This is a prospective cross-sectional observational study. In total, 34 individuals between 18 and 30 years old, of both sexes, took part and were divided in two groups: Group I (GI), composed of musicians (n=16), and Group II (GII), composed of non-musicians (n=18). All participants underwent behavioral evaluation of temporal auditory processing, composed of Duration Pattern Sequence Test (DPS), Pitch Pattern Sequence Test (PPS), Random Gap Detection Test (RGDT) and electrophysiological evaluation – Long Latency Auditory Evoked Potential – P300. GI also answered a specific questionnaire to characterize musical practice. Results We observed statistically significant differences with superior performance of GI compared with GII in all behavioral tests (p<0.001*). The groups’ performance was similar regarding the latency and amplitude parameters analyzed from LLAEP-300 data (p>0.05). Conclusion The findings show a positive influence of musical practice toward the improvement of auditory abilities of temporal ordering and resolution. All participants presented adequate cortical functioning of the central auditory nervous system, without significant differences between musicians and non-musicians when considering P300 amplitude and latency.

https://doi.org/10.1590/2317-1782/20212021256pt

15.

REFORMA DO ENSINO MÉDIO: A INSTITUCIONALIZAÇÃO DO APARTHEID SOCIAL NA EDUCAÇÃO
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Moraes, Carmen Sylvia Vidigal

; Ferretti, Celso João

; Pino, Ivany Rodrigues

; Leher, Roberto

; Almeida, Luana Costa

; Ximenes, Salomão Barros

; Dalbosco, Claudio Almir

; Souza, Sandra Maria Zákia Lian

; Zuin, Antônio Alvaro Soares

; Silveira, Adriana Aparecida Dragone

; Almeida, Ana Maria Fonseca de

; Trevisan, Anderson Ricardo

; Mazza, Débora

; Lima, Licínio Carlos Viana da Silva

; Amaral, Nelson Cardoso

; Goergen, Pedro

; Rambla, Xavier

; Sisto, Vicente

Educação & Sociedade

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2022, Volume 43 elocation e261875

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.1590/es.261875

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