ABSTRACT The increase in inflammatory markers associated with persistent chronic fibrosing myocarditis, a characteristic of chronic Chagas disease, can result in a reduction in inspiratory muscle strength (IMS) in Chagas cardiomyopathy (CC). However, literature in this field is still scarce. This review aimed to map and summarize the evidence regarding IMS in patients with CC. The inclusion criteria included reports with adult participants with a CC diagnosis, with or without heart failure (HF). The core concept examined was the maximum inspiratory pressure evaluated in the untrained and trained groups in the pre-training period. The context was open, including but not limited to hospitals and health centers. Two authors independently identified eligible studies and extracted the data. Descriptive synthesis was used as the primary strategy for analyzing the results. Nine studies (five clinical trials, three cross-sectional, and one cohort) were included. The CC classification differed among the studies, with no mention of HF in five and no CC staging specification in six. IMS was assessed using a manovacuometer, and only six studies analyzed and interpreted the data concerning the predicted values. The CC population with HF appeared to have impaired IMS. All studies involved only Brazilian volunteers. In conclusion, randomized clinical trials evaluating IMS and the effects of inspiratory muscle training need to be conducted to better understand the prevalence and risk of inspiratory muscle weakness in the CC population, as well as the effects of training. Such studies should be conducted at different stages of CC in different populations and countries.

Abstract Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.

Abstract INTRODUCTION We aimed to describe the sociodemographic, epidemiological, and clinical characteristics of patients with chronic Chagas disease (CD) at an infectious disease referral center. Changes in patient profiles over time were also evaluated. METHODS This retrospective study included patients with CD from November 1986-December 2019. All patients underwent an evaluation protocol that included sociodemographic profile; epidemiological history; anamnesis; and physical, cardiologic, and digestive examinations. Trend differences for each 5-year period from 1986 to 2019 were tested using a nonparametric trend test for continuous and generalized linear models with binomial distribution for categorical variables. RESULTS A total of 2,168 patients (52.2% women) were included, with a mean age of 47.8 years old. White patients with low levels of education predominated. The reported transmission mode was vectorial in 90.2% of cases. The majority came from areas with a high prevalence (52.2%) and morbidity (67.8%) of CD. The most common clinical presentation was the indeterminate form (44.9%). The number of patients referred gradually decreased and the age at admission increased during the study period, as did the patients’ levels of education. CONCLUSIONS The clinical profile of CD is characterized by a predominance of the indeterminate form of the disease. Regarding the patients who were followed up at the referral center, there was a progressive increase in the mean age and a concomitant decrease in the number of new patients. This reflects the successful control of vector and transfusion transmission in Brazil as well as the aging population of patients with CD.

Resumo Cryptosporidium é um protozoário com uma grande variedade de hospedeiros, incluindo os seres humanos. No entanto, poucas espécies têm sido descritas em aves (Cryptosporidium meleagridis, C. baileyi, C. galli e C. avium). O objetivo do presente estudo foi investigar a ocorrência de Cryptosporidium spp. em fezes de pombas-de-bando (Zenaida auriculata), e realizar a caracterização molecular dos isolados. Um total de 196 animais de ambos os sexos foram capturados, eutanasiados e o conteúdo intestinal recolhido para extração de DNA. Após a extração, realizou-se uma nested-PCR (nPCR), que amplifica um fragmento do gene 18S rRNA do Cryptosporidium spp.. Os fragmentos obtidos foram purificados e encaminhados para sequenciamento. Os resultados da n-PCR revelaram 30 animais (15.3%) positivos para Cryptosporidium spp.. Quanto ao sexo dos animais não foram observadas diferenças estatísticas significativas (p > 0.05). Somente 15 de 30 amostras positivas foram sequenciadas com sucesso e as espécies determinadas, das quais, 13 (86.7%) e 2 (13.3%) foram C. meleagridis e C. galli, respectivamente. Esse é o primeiro estudo com caracterização molecular de Cryptosporidium de fezes de pombas-de-bando (Z. auriculata), e propõe serem esses animais potenciais fonte de infecção de C. meleagridis para humanos.

Abstract Cryptosporidium is a protozoan parasite with a wide range of hosts, including humans. However, only a few Cryptosporidium species have been described in birds (C. meleagridis, C. baileyi, C. galli and C. avium). The aim of this study was to investigate the occurrence of Cryptosporidium spp. in feces of eared doves (Zenaida auriculata), followed by molecular characterization of the parasite. A total of 196 animals of both sexes were trap-captured; the animals were culled and the intestinal contents were collected for DNA extraction. After extraction, a nested-PCR (nPCR), which amplifies a fragment of the 18S rRNA gene of Cryptosporidium spp., was performed. The amplicons obtained were purified and sequenced. PCR analysis revealed that 30 animals (15.3%) were positive for Cryptosporidium spp. There was no significant sex-dependent enrichment of Cryptosporidium occurrence (p > 0.05). Only 15 out of the 30 positive samples were successfully sequenced and their species determined, of which, 13 (86.7%) and 2 (13.3%) were C. meleagridis and C. galli, respectively. Herein, we present for the first time a molecular characterization of Cryptosporidium from feces of eared doves (Z. auriculata) and propose that these birds are a potential source of C. meleagridis infection in humans.

Resumen Estructuras compuestas con capas elásticas y núcleo viscoelástico han sido usadas como tratamiento amortiguador pasivo para reducir las amplitudes de vibraciones. En el proyecto de este tipo de técnica de amortiguación, muchos aspectos deben ser considerados, desde este modelaje computacional hasta ensayos en laboratorio. En este artículo, un abordaje basado en los modelos Golla-Hughes-McTavish (GHM) y Anelastic Displacement Field (ADF) son presentados y aplicados al modelaje de materiales viscoelásticos. Con el fin de evaluar los resultados numéricos se realizó un programa experimental. En este sentido, a partir de las propiedades dinámicas de un material viscoelástico, son evaluados el comportamiento de estructuras sándwich a través de modelos numéricos, enseñándonos las ventajas y desventajas de estas metodologías.

Abstract Composite structures with elastic layers and viscoelastic core have been used as a passive damping treatment applied to reduce vibration amplitudes. In the design phase of this type of damping technique, many aspects ranging from computer modeling to laboratory tests should be considered. Due to the frequency dependency of mechanical properties on these materials, time domain based models for viscoelastic materials are not as numerous as frequency domain based methods. Usually, time domain methods introduce extra dissipation coordinates or internal variables as Golla-Hughes-McTavish (GHM) method and also Anelastic Displacement Field (ADF) method. In this paper, these methods are evaluated by comparing their results to the ones obtained by means of theoretical analysis. Processing time are also evaluated highlighting advantages and disadvantages of these methodologies. Finally, these two-time domain methods are applied to a real structure, pointing out the facilities and difficulties to simulate an actual situation.

Abstract Viscoelastic materials can dissipate a large amount of energy when subjected to cyclic shear deformations, but they have low bearing capacity. Therefore they are often employed as a damping layer in sandwich structures. These sandwich structures present a high damping ratio and simple application. In order to design sandwich structures, many aspects ranging from computer modeling to laboratory testing should be considered. In this study, a test set of experiments were performed and results are compared with a numerical GHM (Golla, Hughes and Mc Tavish method) based model, in order to establish a method to support viscoelastic sandwich beam design. In this way, starting from the dynamic properties of a viscoelastic material, a numerical model is used to evaluate the behavior of these structures. Comparisons with uncontrolled structures are also presented, showing the dissipative characteristics of this passive control.

A avaliação pulmonar através do ultrassom é um tema de crescente interesse na avaliação de pacientes críticos, muitas vezes aplicado por não radiologistas. Como essa técnica baseia-se no fato de que todas as agressões agudas reduzem a aeração pulmonar, o ultrassom pulmonar pode fornecer informações complementares ao exame físico e à impressão clínica, com a principal vantagem de ser realizado à beira do leito. O objetivo dessa revisão foi avaliar as aplicações clínicas do ultrassom pulmonar, através da pesquisa das bases de dados PubMed e Biblioteca Virtual em Saúde dos seguintes termos, em português e em inglês: ultrassom, pulmão e cuidados críticos. Além dos artigos mais relevantes, estendeu-se a busca a livros especializados. Dados da literatura mostram que o ultrassom pulmonar é útil na interpretação de infiltrados pulmonares, tendo boa acurácia na identificação de consolidações e de síndrome intersticial. Além disso, ultrassom pulmonar tem sido amplamente utilizado na avaliação e abordagem de derrames pleurais, assim como na identificação de pneumotórax. Essa técnica pode também ser útil na avaliação imediata de pacientes com dispneia ou insuficiência respiratória aguda. Outras aplicações descritas são a monitorização da resposta ao tratamento e o aumento da segurança na realização de procedimentos invasivos. Embora ainda haja a necessidade de uma padronização dos critérios de treinamento e certificação, esse é um método rápido, barato e amplamente disponível, e a incorporação dessa nova tecnologia deve tornar-se progressivamente maior no cuidado de doentes críticos.

The evaluation of critically ill patients using lung ultrasound, even if performed by nonspecialists, has recently garnered greater interest. Because lung ultrasound is based on the fact that every acute illness reduces lung aeration, it can provide information that complements the physical examination and clinical impression, the main advantage being that it is a bedside tool. The objective of this review was to evaluate the clinical applications of lung ultrasound by searching the PubMed and the Brazilian Virtual Library of Health databases. We used the following search terms (in Portuguese and English): ultrasound; lung; and critical care. In addition to the most relevant articles, we also reviewed specialized textbooks. The data show that lung ultrasound is useful in the differential diagnosis of pulmonary infiltrates, having good accuracy in identifying consolidations and interstitial syndrome. In addition, lung ultrasound has been widely used in the evaluation and treatment of pleural effusions, as well as in the identification of pneumothorax. This technique can also be useful in the immediate evaluation of patients with dyspnea or acute respiratory failure. Other described applications include monitoring treatment response and increasing the safety of invasive procedures. Although specific criteria regarding training and certification are still lacking, lung ultrasound is a fast, inexpensive, and widely available tool. This technique should progressively come to be more widely incorporated into the care of critically ill patients.

OBJETIVO: O presente estudo teve como objetivo comparar a qualidade da dieta de indivíduos expostos e não expostos a um programa de reeducação alimentar. MÉTODOS: Foi realizado estudo transversal, envolvendo 100 indivíduos, com idade média de 40,7, DP=12,4 anos e índice de massa corporal médio de 27,4, DP=4,7kg/m². Foram avaliados dois grupos: um grupo com 54 indivíduos expostos a um programa de reeducação alimentar por 18 meses (grupo E) e um grupo composto por 46 indivíduos sem orientação nutricional prévia nos últimos 6 meses (grupo-controle). Ambos os grupos foram submetidos a avaliação antropométrica (peso, estatura, índice de massa corporal e circunferência da cintura) e do consumo alimentar (dois recordatórios alimentares de 24 horas). A análise dietética foi realizada no software Avanutri®, e a qualidade da dieta foi estimada pelo Índice de Alimentação Saudável adaptado para a população brasileira. RESULTADOS: A pontuação no Índice de Alimentação Saudável, adaptado para a população brasileira, foi maior no grupo E do que no grupo-controle (M=97,0, DP= 6,2 vs M=84,2, DP=15,2; p<0,001). Em relação às categorias de classificação desse índice, os grupos diferiram quanto ao percentual de indivíduos com dieta de boa qualidade (29,6% dos indivíduos do grupo E vs 17,4% dos indivíduos do grupo-controle) e de má qualidade (0% no grupo E vs 10,9% no grupo-controle). Os indivíduos expostos ao programa de reeducação alimentar apre-sentaram maior pontuação para vegetais, frutas, laticínios, colesterol e variedade, assim como menor pontuação para óleos e açúcares, em comparação ao grupo-controle. CONCLUSÃO: Indivíduos expostos ao programa de reeducação alimentar apresentaram dieta com melhor qualidade do que indivíduos sem acompanhamento nutricional prévio. Tais achados reforçam a importância da educação nutricional na promoção da alimentação saudável.

OBJECTIVE: The present study compared the diet quality of individuals exposed or not to a nutrition education program. METHODS: This cross-sectional study compared the diets of 54 individuals exposed to a nutrition education program for 18 months (varied between 2 and 169 months) (group E) to those of 46 individuals who did not receive nutritional counseling in the last six months (group NE). All participants underwent anthropometric (weight, height, body mass index, waist circumference) and dietary assessments (two 24-hour recalls). Nutrient intakes were calculated by the Avanutri software® and diet quality was estimated by the Healthy Eating Index adapted for the Brazilian population (IASad). RESULTS: A total of 100 individuals with a mean age of 40.7, SD=12.4 years and mean body mass index of 27.4, SD=4.7kg/m² were studied. The two groups did not differ significantly in terms of age and BMI. Group E had a higher IASad score than group NE (97.0, SD=6.2 vs 84.2, SD=15.2, p<0.001). Regarding IASad classification categories, the percentages of individuals consuming a good-quality diet in the two groups differed significantly (29.6% in group E vs 17.4% in group NE) as did the percentages of those consuming a poor-quality diet (0% in group E versus 10.9% in group NE, p=0.014). Group E scored higher than group NE for vegetables, fruits, dairy, cholesterol and diet variety and lower than group NE for oils and sugars. CONCLUSION: Individuals exposed to a nutrition education program had a better-quality diet than individuals not exposed to nutritional counseling. These findings reinforce the importance of nutrition education for the promotion of healthy food habits.