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[SciELO Preprints] - Guidelines on the Diagnosis and Treatment of Hypertrophic Cardiomyopathy – 2024
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Fernandes, Fabio Simões, Marcus V. Correia, Edileide de Barros Marcondes-Braga, Fabiana G. Coelho-Filho, Otavio Rizzi Mesquita, Cláudio Tinoco Mathias-Junior, Wilson Rochitte, Carlos Eduardo Ramires, Felix José Alvarez Alves, Silvia Marinho Martins Montera, Marcelo Westerlund Lopes, Renato Delascio Oliveira-Junior, Mucio Tavares Scolari, Fernando L. Avila, Walkiria Samuel Canesin, Manoel Fernandes Bacal, Fernando Bocchi, Edimar Alcides Moura, Lídia Ana Zytynski Saad, Eduardo Benchimol Scanavacca, Mauricio I. Valdigem, Bruno Pereira Cano , Manuel Nicolas Abizaid , Alexandre Ribeiro, Henrique Barbosa Lemos-Neto, Pedro Alves Ribeiro, Gustavo Calado de Aguiar Jatene, Fabio Biscegli Dias, Ricardo Ribeiro Beck-da-Silva, Luis Rohde, Luis Eduardo P. Bittencourt, Marcelo Imbroinise Pereira, Alexandre Krieger, José Eduardo Villacorta, Humberto Martins, Wolney de Andrade Figueiredo-Neto, José Albuquerque de Cardoso , Juliano Novaes Pastore, Carlos Alberto Jatene, Ieda Biscegli Tanaka, Ana Cristina Sayuri Hotta, Viviane Tiemi Romano, Minna Moreira Dias Albuquerque, Denilson Campos de Mourilhe-Rocha, Ricardo Hajjar, Ludhmila Abrahão Brito, Fabio Sandoli de Caramelli , Bruno Calderaro, Daniela Farsky, Pedro Silvio Colafranceschi , Alexandre Siciliano Pinto, Ibraim Masciarelli Vieira , Marcelo Luiz Campos Danzmann, Luiz Claudio Barberato , Silvio Henrique Mady, Charles Martinelli-Filho, Martino Torbey , Ana Flavia Malheiros Schwartzmann, Pedro Vellosa Macedo, Ariane Vieira Scarlatelli Ferreira , Silvia Moreira Ayub Schmidt, Andre Melo , Marcelo Dantas Tavares de Lima-Filho, Moysés Oliveira Sposito, Andrei C. Brito, Flavio de Souza Biolo, Andreia Madrini-Junior, Vagner Rizk, Stéphanie Itala Mesquita, Evandro Tinoco

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Publication date: 2024-04-08

Abstract: Pt Es En

A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura > 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (> 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE.   Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI).

La miocardiopatía hipertrófica (MCH) es una forma de enfermedad cardíaca de origen genético, caracterizada por el engrosamiento de las paredes ventriculares. El diagnóstico requiere la detección mediante métodos de imagen (Ecocardiograma o Resonancia Magnética Cardíaca) que muestren algún segmento de la pared ventricular izquierda con un grosor > 15 mm, sin otra causa probable. El análisis genético permite identificar mutaciones en genes que codifican diferentes estructuras del sarcómero responsables del desarrollo de la MCH en aproximadamente el 60% de los casos, lo que permite el tamizaje de familiares y el asesoramiento genético, como parte importante del manejo de pacientes y familiares. Varios conceptos sobre la MCH han sido revisados recientemente, incluida su prevalencia de 1 entre 250 individuos, por lo tanto, no es una enfermedad rara, sino subdiagnosticada. La gran mayoría de los pacientes son asintomáticos. En los casos sintomáticos, la obstrucción del tracto de salida ventricular izquierdo (TSVI) es el trastorno principal responsable de los síntomas, y su presencia debe investigarse en todos los casos. En aquellos en los que el ecocardiograma en reposo o la maniobra de Valsalva no detecta un gradiente intraventricular significativo (> 30 mmHg), deben someterse a ecocardiografía de esfuerzo para detectar la obstrucción del TSVI. Los pacientes con síntomas limitantes y obstrucción grave del TSVI, refractarios al uso de betabloqueantes y verapamilo, deben recibir terapias de reducción septal o usar nuevos medicamentos inhibidores de la miosina cardíaca. Finalmente, los pacientes adecuadamente identificados con un riesgo aumentado de muerte súbita pueden recibir medidas profilácticas con el implante de un cardioversor-desfibrilador implantable (CDI).

Hypertrophic cardiomyopathy (HCM) is a form of genetically caused heart muscle disease, characterized by the thickening of the ventricular walls. Diagnosis requires detection through imaging methods (Echocardiogram or Cardiac Magnetic Resonance) showing any segment of the left ventricular wall with a thickness > 15 mm, without any other probable cause. Genetic analysis allows the identification of mutations in genes encoding different structures of the sarcomere responsible for the development of HCM in about 60% of cases, enabling screening of family members and genetic counseling, as an important part of patient and family management. Several concepts about HCM have recently been reviewed, including its prevalence of 1 in 250 individuals, hence not a rare but rather underdiagnosed disease. The vast majority of patients are asymptomatic. In symptomatic cases, obstruction of the left ventricular outflow tract (LVOT) is the primary disorder responsible for symptoms, and its presence should be investigated in all cases. In those where resting echocardiogram or Valsalva maneuver does not detect significant intraventricular gradient (> 30 mmHg), they should undergo stress echocardiography to detect LVOT obstruction. Patients with limiting symptoms and severe LVOT obstruction, refractory to beta-blockers and verapamil, should receive septal reduction therapies or use new drugs inhibiting cardiac myosin. Finally, appropriately identified patients at increased risk of sudden death may receive prophylactic measure with implantable cardioverter-defibrillator (ICD) implantation.

https://doi.org/10.1590/SciELOPreprints.8394

Occurrence of avian reovirus and picobirnavirus in wild birds from an environmental protection area in the Brazilian Amazon
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PEREIRA, Diego

; SOUTO, Lizandra Caroline dos Santos

; GUERRA, Sylvia de Fátima dos Santos

; PENHA-JÚNIOR, Edvaldo Tavares da

; LOBO, Patrícia dos Santos

; SOARES, Luana da Silva

; PINHEIRO, Helder Henrique Costa

; CHAGAS, Elaine Hellen Nunes

; GUIMARÃES, Ricardo José de Paula Souza e

; RAMOS, Bruna Alves

; CHAGAS, Liliane Leal das

; FREITAS, Maria Nazaré Oliveira

; FURTADO, Erilene Cristina da Silva

; RODRIGUES, Jéssica Cecília Pinheiro

; CASSEB, Alexandre do Rosário

; MARTINS, Lívia Caricio

; MASCARENHAS, Joana D’Arc Pereira

Acta Amazonica

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2024, Volume 54 N. 1 elocation e54hs23012

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

ABSTRACT Wild birds have great prominence in the transmission of diseases to humans, mainly due to their ease of access to human populations, raising concerns about the potential impact of that proximity on public health. The present study reports ARV and PBV occurrence in wild birds from an environmental protection area in the Amazon biome, in Pará state, Brazil. We obtained 155 fecal specimens from 47 species of wild birds for RNA extraction, ARV and PBV detection utilizing molecular methods, nucleotide sequencing, and phylogenetic analysis. ARV prevalence was 0.6% (1/155), being positive in an individual of Myrmotherula longipennis, and PBV prevalence was 1.29% (2/155), affecting two individuals of Guira guira. The PBV strains were assigned to genogroup I based on phylogenetic analysis, and they shared a strong phylogenetic link with strains isolated from different geographic locations. The ARV strain was more closely related to strains that had previously circulated in the same region. The presence of ARV and PBV in this habitat suggests that infection cycles of these agents occur naturally in the wild ecosystem, potentially triggering transmission events between bird species and humans. This is the first study on ARV detection in wild birds in Brazil and the first report on the occurrence of PBV in wild Guira guira. Additional studies are required to determine the epidemiology, origin, evolution, and emergence of new potentially pathogenic viruses in the Amazon.

RESUMO As aves silvestres têm grande destaque na transmissão de doenças ao homem, principalmente pela facilidade de acesso à população humana, levantando preocupações sobre o potencial impacto dessa proximidade no contexto da saúde pública. O presente estudo relata a ocorrência de ARV e PBV em aves silvestres de uma área de proteção ambiental no bioma Amazônico. Obtivemos 155 espécimes fecais de 47 espécies de aves silvestres, que foram submetidos a extração de RNA, detecção de ARV e PBV por técnicas moleculares, sequenciamento nucleotídico e análise filogenética. A prevalência de infecção por ARV foi 0,6% (1/155), sendo positivo em um indivíduo de Myrmotherula longipennis, e a prevalência de PBV foi 1,29% (2/155), afetando dois insdivíduos de Guira guira. A análise filogenética agrupou as cepas de PBV no genogrupo I, mostrando intensa relação filogenética com cepas isoladas de outras regiões geográficas. A cepa de ARV esteve mais relacionada filogeneticamente a cepas previamente circulantes na mesma região. Este é o primeiro estudo sobre detecção de ARV em aves silvestres no Brasil e o primeiro relato sobre a ocorrência de PBV em Guira guira. A circulação de ARV e PBV nesse ambiente demonstra que os ciclos desses agentes estão ocorrendo de forma natural no ecossistema silvestre, o que pode desencadear possíveis eventos de transmissão entre as espécies aviárias e humanos. Estudos adicionais são necessários para determinar a epidemiologia, origem, evolução e surgimento de novos vírus potencialmente patogênicos na Amazônia.

https://doi.org/10.1590/1809-4392202300120

Steps of cryopreservation of coffee seeds: physiological responses and antioxidant systems
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Souza, Ana Cristina de

; Costa, Marina Chagas

; Figueiredo, Madeleine Alves de

; Pereira, Cristiane Carvalho

; Coelho, Stefânia Vilas Boas

; Vilela, Ana Luiza Oliveira

; Pereira, Diego de Souza

; Rosa, Sttela Dellyzete Veiga Franco da

Ciência Rural

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2024, Volume 54 N. 2 elocation e20220480

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

ABSTRACT: The cryopreservation of plant germplasm at ultralow temperatures is an alternative technique for the long-term storage of seeds of the genus Coffea sp. However, for this technique to be successful, cell integrity must be maintained at all stages of the process on the basis of scientific research. The present study investigated validated cryopreservation protocols for Coffea arabica L. seeds and evaluate the effects on the physiological and biochemical characteristics of the seeds at each stage of the process. Seeds were dried on silica gel or with saturated saline solution, precooled or not in a biofreezer, immersed in nitrogen, and reheated in a water bath. After each of these steps, the physiological and biochemical quality of the seeds was determined. Pre-cooling is a step that can be dispensed with in the cryopreservation of Coffea arabica seeds, direct immersion in liquid nitrogen being more indicated. Coffea arabica L. seeds tolerate cryopreservation after rapid drying in silica gel up to water contents of 17 or 20% (wb), with greater survival at 17%. The enzyme activities of catalase, polyphenol oxidase and peroxidase are indicators of the quality of C. arabica L. seeds subjected to cryopreservation.

RESUMO: A criopreservação de germoplasma vegetal em temperaturas ultrabaixas é uma alternativa para o armazenamento em longo prazo de sementes do gênero Coffea sp. Entretanto, para que essa técnica apresente sucesso, a realização de pesquisas que garantam a manutenção da integridade celular em todas as etapas do processo é de fundamental importância. O objetivo com o presente trabalho foi investigar protocolos de criopreservação validados para sementes de Coffea arabica L., avaliando separadamente, os efeitos sobre as características fisiológicas e bioquímicas das sementes, em cada etapa do processo. As sementes foram secadas em sílica gel ou em solução salina saturada, submetidas ou não ao pré-resfriamento em biocongelador, em seguida imersas no nitrogênio e reaquecidas em banho-maria. Após cada uma dessas etapas, a qualidade fisiológica e bioquímica das sementes foi determinada. O pré-resfriamento é uma etapa que pode ser dispensada na criopreservação de sementes de Coffea arabica, sendo mais indicada a imersão direta em nitrogênio líquido. Sementes de Coffea arabica L. toleram a criopreservação após secagem rápida em sílica gel até teores de água de 17 ou 20% (wb), com maior sobrevivência a 17%. A atividade das enzimas catalase, polifenoloxidase e peroxidase são indicadoras da qualidade de sementes de Coffea arabica L. submetidas à criopreservação.

https://doi.org/10.1590/0103-8478cr20220480

Leprosy prevalence spatial distribution and trend in a health region in Northeast Brazil, 2008-2017: an ecological study
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Oliveira, Rayanne Alves de

; Sousa, Paloma Maria Pereira de

; Silva, Janiel Conceição da

; Santos, Lívia Fernanda Siqueira

; Santos, Floriacy Stabnow

; Pascoal, Lívia Maia

; Costa, Ana Cristina Pereira de Jesus

; Santos, Leonardo Hunaldo dos

; Santos Neto, Marcelino

Epidemiologia e Serviços de Saúde

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2023, Volume 32 N. 2 elocation e2023522

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

Resumo Objetivo: analisar a distribuição espacial e a tendência da hanseníase em municípios de uma regional de saúde de um estado no Nordeste brasileiro. Métodos: estudo ecológico e de séries temporais, sobre a notificação compulsória dos municípios integrantes da Unidade Gestora Regional de Saúde de Imperatriz, Maranhão, Brasil, entre 2008 e 2017; foram determinadas as prevalências e a média para o período; realizou-se a análise espacial de área e os mapas foram gerados pelo aplicativo ArcGis 10.5; na análise de tendência, utilizou-se a regressão de Prais-Winsten. Resultado: foram identificados 4.029 casos da doença e as médias de prevalência variaram de 2,0 a 11,5 casos/10 mil habitantes/ano, com tendência descendente; Governador Edson Lobão apresentou a maior prevalência, 11,5 casos/10 mil hab., e Lajeado Novo a menor, 2,0 casos/10 mil hab. Conclusão: a distribuição espacial dos casos de hanseníase foi heterogênea nos municípios estudados e a tendência da prevalência, decrescente.

Resumen Objetivo: analisar la distribución espacial y la tendencia de la lepra en una región sanitaria de un estado del Nordeste brasileño. Métodos: estudio ecológico y de serie temporal, con notificación obligatoria de los municipios de la Unidad de Gestión Regional de Salud de Imperatriz-MA, entre 2008-2017. Se determinaron la prevalencia y la media del período y se realizó un análisis del espacio de área, los mapas se generaron en ArcGis 10.5. Para el análisis de tendencia se utilizaron regresiones de Prais-Winsten. Resultado: se identificaron 4.029 casos y las prevalencias promedio oscilaron entre 2,0 y 11,5 casos/10.000 habitantes-año, con tendencia al descenso. Governador Edson Lobão presentó la mayor prevalencia 11,5 casos/10.000 habitantes y Lajeado Novo la menor prevalencia 2,0 casos/10.000 habitantes. Conclusión: la distribución espacial de los casos de lepra fue heterogénea en los municipios y la tendencia de prevalencia decreciente.

Abstract Objective: to analyse the spatial distribution and trend of leprosy in municipalities of a health region in a Northeast Brazilian state. Methods: this was an ecological time-series study based on compulsory notification of leprosy cases by the municipalities covered by the Imperatriz-MA Regional Health Management Unit, between 2008 and 2017; prevalence and mean prevalence for the period were calculated; spatial analysis of the area was carried out and maps were generated using ArcGis 10.5. Prais-Winsten regression was used for trend analysis. Result: 4,029 cases of the disease were identified, and average prevalence ranged from 2.0 to 11.5 cases/10,000 inhabitants-year. The overall trend was downward. Governador Edson Lobão had the highest prevalence, 11.5 cases/10,000 inhabitants, and Lajeado Novo had the lowest prevalence, 2.0 cases/10,000 inhabitants. Conclusion: spatial distribution of leprosy cases was heterogeneous in the municipalities studied and prevalence had a falling trend.

https://doi.org/10.1590/s2237-96222023000200021

Impact of quercetin, carnosine, and ozone in the cryopreservation on Nellore (Bos indicus) semen
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Reis, Willian Vaniel Alves dos

; Pereira, Raiza Rocha

; Vieira Junior, Mozarth

; Cunha, Cibele Cristina Tavares da

; Acácio, Bianca Rodrigues

; Macedo, Gustavo Guerino

; Costa-e-Silva, Eliane Vianna da

; Sampaio, Breno Fernandes Barreto

Animal Reproduction

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2023, Volume 20 N. 1 elocation e20220048

Abstract: En | Text: En | PDF: En

Abstract The objective of this study was to reduce the effects of cryoinjury caused in bovine semen by cryopreservation. Ejaculates were collected from Nellore bulls and subjected to freezing in C (control), ozone (15, 30, and 60 µg mL-1 of ozone), quercetin (25, 50, and 100 µg mL-1 of quercetin), and carnosine groups (100, 200, and 300 ng mL-1 of carnosine). Samples were evaluated post-thaw (M0) and post-rapid thermoresistance test (M30) for sperm kinetics (total motility, progressive motility, curvilinear speed, linearity and amplitude of lateral head displacement) and cell structure viability (plasma membrane integrity, acrosomal integrity, mitochondrial potential, membrane fluidity, and lipid peroxidation). There were no differences (P > 0.05) between the control, quercetin, and carnosine-treated groups for the parameters evaluated at M0 and M30. In turn, supplementation with ozone resulted in lower values for sperm kinetics (P < 0.05) and lower mitochondrial potential at M30 (P < 0.05). Quercetin and carnosine at the concentrations used did not promote significant gains in frozen semen, nor did they demonstrate cytotoxicity. We expected to obtain positive results with the use of ozone. Nonetheless, the addition was harmful to the parameters of sperm kinetics, and its effect was not observed as a possible pro-antioxidant. We believe that the fact that the gas did not harm the sperm structure opens avenues for tests with lower dosages, since, by reducing its concentration, we could minimize the damage to sperm kinetics.

https://doi.org/10.1590/1984-3143-ar2022-0048

Favorable Safety Experience of Local Dental Anesthesia in ICD Recipients with Cardiac Channelopathies
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Oliveira, Ana Carolina Guimarães

; Neves, Itamara Lucia Itagiba

; Sacilotto, Luciana

; Olivetti, Natália Quintella Sangiorgi

; Bueno, Savia Christina Pereira

; Pessente, Gabrielle D’Arezzo

; Santos-Paul, Marcela Alves dos

; Montano, Tânia Cristina Pedroso

; Carvalho, Cíntia Maria Alencar de

; Grupi, Cesar José

; Barbosa, Sílvio Alves

; Pastore, Carlos Alberto

; Samesima, Nelson

; Wu, Tan Chen

; Hachul, Denise Tessariol

; Scanavacca, Maurício Ibrahim

; Neves, Ricardo Simões

; Darrieux, Francisco Carlos da Costa

International Journal of Cardiovascular Sciences

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2023, Volume 36 elocation e20200312

Abstract: En | Text: En | PDF: En

Abstract Background Dental anesthetic management in implantable cardioverter defibrillator (ICD) recipients with cardiac channelopathies (CCh) can be challenging due to the potential risk of life-threatening arrhythmias and appropriate ICD therapies during procedural time. Objectives The present study assessed the hypothesis that the use of local dental anesthesia with 2% lidocaine with 1:100,000 epinephrine or without a vasoconstrictor can be safe in selected ICD and CCh patients, not resulting in life-threatening events (LTE). Methods Restorative dental treatment under local dental anesthesia was made in two sessions, with a wash-out period of 7 days (cross-over trial), conducting with a 28h - Holter monitoring, and 12-lead electrocardiography, digital sphygmomanometry, and anxiety scale assessments in 3 time periods. Statistical analysis carried out the paired Student’s t test and the Wilcoxon signed-rank test. In all cases, a significance level of 5% was adopted. All patients were in stable condition with no recent events before dental care. Results Twenty-four consecutive procedures were performed in 12 patients (9 women, 3 men) with CCh and ICD: 7 (58.3%) had long QT syndrome (LQTS), 4 (33.3%) Brugada syndrome (BrS), and 1 (8.3%) Catecholaminergic polymorphic ventricular tachycardia (CPVT). Holter analysis showed no increased heart rate (HR) or sustained arrhythmias. Blood pressure (BP), electrocardiographic changes and anxiety measurement showed no statistically significant differences. No LTE occurred during dental treatment, regardless of the type of anesthesia. Conclusion Lidocaine administration, with or without epinephrine, can be safely used in selected CCh-ICD patients without LTE. These preliminary findings need to be confirmed in a larger population with ICD and CCh.

https://doi.org/10.36660/ijcs.20200312

Nurses’ Work Methods Assessment Scale: a study of content validation
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Ventura-Silva, João Miguel Almeida

; Silva Martins, Maria Manuela Ferreira Pereira da

; Trindade, Letícia de Lima

; Faria, Ana da Conceição Alves

; Barros, Sónia Cristina da Costa

; Melo, Ricardo Manuel da Costa

; Forte, Elaine Cristina Novatzki

; Ribeiro, Olga Maria Pimenta Lopes

Revista Brasileira de Enfermagem

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2023, Volume 76 N. 2 elocation e20220396

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

ABSTRACT Objective: To develop and validate the content of the Nurses’ Work Methods Assessment Scale. Methods: Methodological study conducted between January and February 2022, based on the Quality Standards for Nursing Care and Imogene King’s framework. A literature review was previously undertaken to design the scale. The content validation was carried out by 23 experts. Results: The initial version consisted of 40 items organized in four work methods identified in the literature. In the first dimension, from ten items, seven were considered, and one was reformulated. Seven of the initial ten items were considered in the second version. The third dimension consisted of seven items. In the fourth dimension, three items were reformulated, and three were excluded, leaving seven items. The final version ended with 28 items, whose Content Validity Index ranged between 0.83 and 1. Conclusions: The involvement of experts has become pivotal in the development and validation of the items, providing confidence to the continuity of psychometric procedures.

RESUMEN Objetivo: Construir y validar contenido de Escala de Evaluación de Métodos de Trabajo de Enfermeros. Métodos: Estudio metodológico realizado entre enero y febrero de 2022, basado en Estándares de Calidad de Atención de Enfermeríay referencial de Imogene King. Para construcción de Escala, realizado previamente revisión de literatura. La validez de contenido contó con 23 peritos. Resultados: La versión inicial contenía 40 items, organizados en cuatro métodos de trabajo identificados en la literatura. La primera dimensión, de diez items, fueron considerados siete y uno fue reformulado. La segunda, de diez iniciales, fueron considerados siete. La tercera dimensión constituída por siete ítems. La cuarta dimensión, reformulados tres y excluidos tres, quedando siete. La versión final quedó con 28 items, cuyo Índice de Validez de Contenido osciló entre 0,83 y 1. Conclusiones: Recorrer a peritos volvió fundamental en la construcción y validez de los items, confiriendo seguridad a continuidad de procedimientos psicométricos.

RESUMO Objetivo: Construir e validar o conteúdo da Escala de Avaliação dos Métodos de Trabalho dos Enfermeiros. Métodos: Estudo metodológico realizado entre janeiro e fevereiro de 2022, baseado nos Padrões de Qualidade dos Cuidados de Enfermagem e no referencial de Imogene King. Para construção da Escala, realizou-se previamente revisão de literatura. A validação de conteúdo contou com 23 peritos. Resultados: A versão inicial continha 40 itens, organizados nos quatro métodos de trabalho identificados na literatura. Na primeira dimensão, dos dez itens, foram considerados sete e um foi reformulado. Na segunda, dos dez iniciais, foram considerados sete. A terceira dimensão constituiu-se por sete itens. Na quarta dimensão, reformularam-se três e excluíram-se três, ficando sete. A versão final ficou com 28 itens, cujo Índice de Validade de Conteúdo oscilou entre 0,83 e 1. Conclusões: Recorrer aos peritos tornou-se fundamental na construção e validação dos itens, conferindo segurança à continuidade dos procedimentos psicométricos.

https://doi.org/10.1590/0034-7167-2022-0396

Expression of TIGIT, PD-1 and HLA-DR/CD38 markers on CD8-T cells of children and adolescents infected with HIV and uninfected controls
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Pereira-Manfro, Wânia Ferraz

; Silva, Giselle Pereira da

; Costa, Priscilla Ramos

; Costa, Dayane Alves

; Ferreira, Bianca da Silva

; Barreto, Daniela Mena

; Frota, Ana Cristina Cisne

; Hofer, Cristina Barroso

; Kallas, Esper Georges

; Milagres, Lucimar Gonçalves

Revista do Instituto de Medicina Tropical de São Paulo

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2023, Volume 65 elocation e14

Abstract: En | Text: En | PDF: En

ABSTRACT Immune exhaustion and senescence are scarcely studied in HIV-pediatric patients. We studied the circulatory CD8 T cells activation/exhaustion and senescent phenotype of children and adolescents vertically infected with HIV or uninfected controls based on the expression of human leukocyte antigen (HLA-DR), CD38, T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif (ITIM) domain (TIGIT), programmed death 1 (PD-1) and CD57 by flow cytometry, during approximately one year. Eleven HIV-infected (HI) and nine HIV-uninfected (HU) children/adolescents who received two doses or one dose of meningococcal C conjugate vaccine (MenC), respectively, were involved in this study. Blood samples were collected before the immunization (T0), 1–2 months after the first dose (T1), and 1–2 months after the second dose (T2), which was administered approximately one year after the first one. HI patients not receiving combined antiretroviral therapy (cART) showed a higher frequency of CD8 T cells TIGIT+, PD-1+ or CD57+, as well as a higher frequency of CD8 T cells co-expressing CD38/HLA-DR/TIGIT or CD38/HLA-DR/PD-1 when compared to HI treated or HU individuals, at all times that they were assessed. CD8 T cells co-expressing CD38/DR/TIGIT were inversely correlated with the CD4/CD8 ratio but positively associated with viral load. The co-expression of CD38/DR/TIGIT or CD38/DR/PD-1 on CD8 T cells was also inversely associated with the CD4 T cells expressing co-stimulatory molecules CD127/CD28. The results showed a higher expression of exhaustion/senescence markers on CD8 T cells of untreated HI children/adolescents and its correlations with viral load.

https://doi.org/10.1590/s1678-9946202365014

Surgical counting: design of implementation and maintenance of a standardized evidence-based procedure
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Gomes, Eduardo Tavares

; Albuquerque, Érica Larissa Marinho Souto de

; Pereira, Adélia Cristina Monteiro

; Püschel, Vilanice Alves de Araujo

Revista Brasileira de Enfermagem

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2023, Volume 76 N. 1 elocation e20220144

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

ABSTRACT Objectives: to report the implementation and maintenance of an evidence-based Standard Operating Procedure for surgical counting performed at a teaching hospital. Methods: a report of a project to implement evidence for surgical counting, carried out at a university hospital in December 2017, and the subsequent cycles for better performance of the implemented organizational document and maintenance of better results until March 2022. Results: the report is divided into implementation project presentation and four other cycles after implementation, related to maintenance of improvements. It was possible to prepare a Standard Operating Procedure for Surgical Count, train the nursing team, carry out educational intervention for surgical teams. Final Considerations: there was an improvement in complying with the standardized procedure at the first moment and worsening in the period related to the pandemic. New efforts began again, including a self-instructive online course combined with first-time strategies.

RESUMEN Objetivos: relatar la implementación y mantenimiento de un Procedimiento Operativo Estandarizado basado en evidencia para el conteo quirúrgico realizado en un hospital universitario. Métodos: este es un informe de un proyecto de implementación de evidencias para el conteo quirúrgico, realizado en un hospital universitario, iniciado en diciembre de 2017, y los ciclos posteriores para un mejor desempeño del documento organizacional implementado y mantenimiento de mejores resultados hasta marzo de 2022. Resultados: el informe se divide en una presentación del proyecto de implementación de evidencias y otros cuatro ciclos posteriores a la implementación, relacionados con el mantenimiento de las mejoras. Se logró elaborar el documento Procedimiento Operativo Estándar para el Recuento Quirúrgico en el hospital, capacitar al equipo de enfermería, realizar intervención educativa para los equipos quirúrgicos. Consideraciones Finales: hubo una mejora en la adherencia al procedimiento estandarizado en el primer momento y un empeoramiento en el período relacionado con la pandemia. Los nuevos esfuerzos comenzaron nuevamente incluyendo un curso en línea autoinstructivo combinado con estrategias para la primera vez.

RESUMO Objetivos: relatar a implementação e manutenção de um Procedimento Operacional Padronizado baseado em evidências, para contagem cirúrgica, realizado em hospital universitário. Métodos: trata-se de relato de um projeto de implementação de evidências para contagem cirúrgica, realizado em um hospital universitário, iniciado em dezembro de 2017, e os ciclos subsequentes para melhor desempenho do documento organizacional implementado e manutenção de melhores resultados até março de 2022. Resultados: o relato está dividido em uma apresentação do projeto de implementação de evidências e mais quatro outros ciclos após a implementação, relacionados à manutenção das melhorias. Foi possível elaborar o documento Procedimento Operacional Padrão para a Contagem Cirúrgica no hospital, treinar a equipe de enfermagem, realizar intervenção educativa para as equipes cirúrgicas. Considerações Finais: houve melhora na adesão ao procedimento padronizado no primeiro momento e piora no período relacionado à pandemia. Novos esforços recomeçaram incluindo curso online autoinstrutivo aliado às estratégias do primeiro momento.

https://doi.org/10.1590/0034-7167-2022-0144

10.

Lesão Miocárdica e Prognóstico em Pacientes Hospitalizados com COVID-19 no Brasil: Resultados do Registro Nacional de COVID-19
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Barbosa, Hannah Cardoso

; Martins, Maria Auxiliadora Parreiras

; Jesus, Jordana Cristina de

; Meira, Karina Cardoso

; Passaglia, Luiz Guilherme

; Sacioto, Manuela Furtado

; Bezerra, Adriana Falangola Benjamin

; Schwarzbold, Alexandre Vargas

; Maurílio, Amanda de Oliveira

; Farace, Barbara Lopes

; Silva, Carla Thais Cândida Alves da

; Cimini, Christiane Corrêa Rodrigues

; Silveira, Daniel Vitorio

; Carazai, Daniela do Reis

; Ponce, Daniela

; Costa, Emanuel Victor Alves

; Manenti, Euler Roberto Fernandes

; Cenci, Evelin Paola de Almeida

; Bartolazzi, Frederico

; Madeira, Glícia Cristina de Castro

; Nascimento, Guilherme Fagundes

; Velloso, Isabela Vasconcellos Pires

; Batista, Joanna d’Arc Lyra

; Morais, Júlia Drumond Parreiras de

; Carvalho, Juliana da Silva Nogueira

; Ruschel, Karen Brasil

; Martins, Karina Paula Medeiros Prado

; Zandoná, Liege Barella

; Menezes, Luanna Silva Monteiro

; Kopittke, Luciane

; Castro, Luís César de

; Nasi, Luiz Antônio

; Floriani, Maiara Anschau

; Souza, Maíra Dias

; Carneiro, Marcelo

; Bicalho, Maria Aparecida Camargos

; Lima, Maria Clara Pontello Barbosa

; Godoy, Mariana Frizzo de

; Guimarães-Júnior, Milton Henriques

; Mendes, Paulo Mascarenhas

; Delfino-Pereira, Polianna

; Ribeiro, Raquel Jaqueline Eder

; Finger, Renan Goulart

; Menezes, Rochele Mosmann

; Francisco, Saionara Cristina

; Araújo, Silvia Ferreira

; Oliveira, Talita Fischer

; Oliveira, Thainara Conceição de

; Polanczyk, Carisi Anne

; Marcolino, Milena Soriano

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 2 elocation e20220151

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

Abstract Background Cardiovascular complications of COVID-19 are important aspects of the disease’s pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. Objectives To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. Methods This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. Results Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. Conclusion Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

Resumo Fundamento As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. Objetivos Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. Métodos Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. Resultados Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. Conclusão Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

https://doi.org/10.36660/abc.20220151

11.

In vitro susceptibility of eighteen clinical isolates of human monkeypox virus to tecovirimat
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Nunes, Desiree dos Santos

; Higa, Luiza M

; Oliveira, Régis Linhares

; da Costa, Lendel Correia

; Bomfim, Larissa Maciel

; Gonçalves, Cássia Cristina Alves

; Mariani, Diana

; Hruby, Dennis E

; Voloch, Carolina Moreira

; Castiñeiras, Terezinha Marta Pereira Pinto

; Tanuri, Amilcar

; Damaso, Clarissa R

Memórias do Instituto Oswaldo Cruz

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2023, Volume 118 elocation e230056

Abstract: En | Text: En | PDF: En

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.

https://doi.org/10.1590/0074-02760230056

12.

The internationalization of Higher Education of Brazil in the Education area (1998-2020)
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Pontes Junior, Jose Airton de Freitas

; Abreu, Mariana Cristina Alves de

; Pereira Neto, Francisco Edmar

Ensaio: Avaliação e Políticas Públicas em Educação

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2023, Volume 31 N. 120 elocation e0233781

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

Abstract The study aims to analyze the Internationalization of Higher Education in Brazil through Capes scholarships in the Education area to study abroad between 1998 and 2020. The number of scholarships granted by Capes and available in Geocapes was used and the data were analyzed through descriptive statistics via SPSS 20.0 software. The results show the increase in the number of institutions and scholarship holders abroad over the years, mainly in the Global North countries, as well as its decline after Science Without Borders program. It is questionable whether Brazil’s current role is to seek to join large research networks or be a protagonist in the development of highly qualified human resources training and research. It is emphasized that the former does not exclude the latter, although the former seems to be much more emphasized, at least in the Brazilian context.

Resumen El estudio tiene como objetivo analizar la Internacionalización de la Educación Superior en Brasil a través de las becas Capes en el área de Educación para estudiar en el extranjero entre 1998 y 2020. Se utilizó el número de becas otorgadas por Capes y disponibles en Geocapes y los datos fueron analizados a través de estadística descriptiva vía SPSS software 20.0. Los resultados muestran el aumento del número de instituciones y becarios en el exterior a lo largo de los años, principalmente en los países del Norte Global, así como su declive tras el programa Ciencia Sin Fronteras. Es cuestionable si el papel actual de Brasil es buscar integrar grandes redes de investigación o ser protagonista en el desarrollo de formación e investigación de recursos humanos altamente calificados. Se destaca que lo primero no excluye a lo segundo, aunque lo primero parece estar mucho más enfatizado, al menos en el contexto brasileño.

Resumo O estudo visa a analisar a Internacionalização da Educação Superior do Brasil por meio da distribuição de bolsas da Capes para o exterior, na área de Educação, no período entre 1998 e2020. Foi utilizado o número de bolsas concedidas pela Capes disponíveis no Geocapes e osdados foram analisados por meio de estatística descritiva via software SPSS 20.0. Osresultados evidenciam o crescimento do número de instituições e de bolsistas no exterior, aolongo dos anos pesquisados, principalmente, nos países do Norte Global, e declínio pós-Ciências Sem Fronteiras. É de se questionar se o papel atual do Brasil é buscar aderir-se agrandes redes de pesquisa, ou buscar ser protagonista no desenvolvimento de formação derecursos humanos de alta qualificação e de pesquisas. Enfatiza-se que um não exclui o outro,mas que, no caso brasileiro, nos parece, é demasiado o primeiro.

https://doi.org/10.1590/s0104-40362023003103781

13.

Análise do conflito do uso e cobertura do solo do município de Areia – PB em relação à legislação florestal
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Pereira, Felipy Rafael Marinho

; Machado, Célia Cristina Clemente

; Andrade, Leonaldo Alves de

Ciência Florestal

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2023, Volume 33 N. 1 elocation e36950

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

ABSTRACT The overexploitation of natural resources will drastically affect the quality of life in the coming decades. In Brazil, evidence reveals that many anthropic actions, besides exploiting natural resources in a disorderly manner, are at odds with the legislation with regard to Permanent Preservation Areas (PPAs). Thus, the objective of this work was to delimit the PPAs and to produce a land use and land cover map of Areia municipality, Paraíba state, in order to investigate the existence of use conflicts in these preservation areas. The mapping of land use and land cover was carried out by interpreting an image from the PlanetScope satellite, with a spatial resolution of 3.125 m. Its accuracy was measured by identifying a set of sample locations and applying the Kappa and Tau indices. The PPAs areas around springs and the drainage network were delimited. The results obtained using the Kappa and Tau indices were 0.79 and 0.82, respectively. The main class of land use and land cover diagnosed in the municipality was pasture, with 59.5%. From field observation, this extensive pasture area is largely degraded, underutilized or in a state of neglect. The proportion of land use and land cover classes in Areia mirrors what occurs in many other places in Brazil. It is suggested, therefore, to incorporate these underutilized areas into the demand for expansion of agricultural production frontiers, without the need to modify preserved areas. It was also observed that around 70% of the delimited PPA have inadequate use or coverage, taking into account the restrictions of use to which they are subject by environmental legislation. Finally, it is recommended that public managers search for the environmental adequacy of PPAs through the creation of public policies that promote the maintenance of water resources and the environmental adequacy of rural properties of the municipality through payment for environmental services or other incentive and awareness instruments.

RESUMO A superexploração dos recursos naturais afetará drasticamente a qualidade de vida nas próximas décadas. No Brasil, evidências revelam que muitas ações antrópicas, além de explorarem os recursos naturais de forma desordenada, estão em desacordo com a legislação no que se refere às Áreas de Preservação Permanente (APPs). Dessa forma, o objetivo deste trabalho foi delimitar as APPs e mapear as classes de uso e cobertura da terra presentes no município de Areia, estado da Paraíba, averiguando a existência de conflitos de uso nessas áreas de preservação. O mapeamento de uso e cobertura da terra foi realizado pela interpretação de uma imagem do satélite PlanetScope, com resolução espacial de 3,125 m. A acurácia foi aferida através da identificação de um conjunto de locais amostrais e da aplicação dos índices Kappa e Tau. Delimitaram-se as áreas de APP ao redor de nascentes e da rede de drenagem. Os resultados obtidos com a utilização dos índices Kappa e Tau foram de 0,79 e 0,82, respectivamente. A principal classe de uso e cobertura da terra diagnosticada no município foi a pastagem, com 59,5%. Pela observação de campo, essa extensa área de pasto está, em boa parte, degradada, subutilizada ou em estado de abandono. A proporção de classes de uso e cobertura da Terra em Areia é espelho do que ocorre em muitos outros locais no Brasil. Sugere-se, portanto, que essas áreas subutilizadas sejam incorporadas à demanda de expansão das fronteiras de produção agrícola e agropecuária, sem necessitar modificar áreas preservadas. Também se observou que cerca de 70% das áreas de APPs delimitadas têm uso ou cobertura inadequado, tendo em consideração as restrições de uso a que estão sujeitas pela legislação ambiental. Por fim, recomenda-se aos gestores públicos a adequação ambiental das APPs através da criação de políticas públicas que promovam a manutenção dos recursos hídricos e a adequação ambiental dos imóveis rurais no município através de pagamento por serviços ambientais ou outros instrumentos de incentivo e sensibilização.

https://doi.org/10.5902/1980509836950

14.

COVID-19 outcomes in people living with HIV: Peering through the waves
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Sales, Thaís Lorenna Souza

; Souza-Silva, Maíra Viana Rego

; Delfino-Pereira, Polianna

; Neves, João Victor Baroni

; Sacioto, Manuela Furtado

; Assis, Vivian Costa Morais de

; Duani, Helena

; Oliveira, Neimy Ramos de

; Sampaio, Natália da Cunha Severino

; Ramos, Lucas Emanuel Ferreira

; Schwarzbold, Alexandre Vargas

; Jorge, Alzira de Oliveira

; Scotton, Ana Luiza Bahia Alves

; Castro, Bruno Mateus de

; Silva, Carla Thais Cândida Alves da

; Ramos, Carolina Marques

; Anschau, Fernando

; Botoni, Fernando Antonio

; Grizende, Genna Maira Santos

; Nascimento, Guilherme Fagundes

; Ruschel, Karen Brasil

; Menezes, Luanna Silva Monteiro

; Castro, Luís César de

; Nasi, Luiz Antônio

; Carneiro, Marcelo

; Godoy, Mariana Frizzo de

; Nogueira, Matheus Carvalho Alves

; Guimarães Júnior, Milton Henriques

; Ziegelmann, Patricia Klarmann

; Almeida, Rafaela Charão de

; Francisco, Saionara Cristina

; Silveira Neto, Sidney Teodoro

; Araújo, Silvia Ferreira

; Avelino-Silva, Thiago Junqueira

; Aliberti, Márlon Juliano Romero

; Pires, Magda Carvalho

; Silva, Eduardo Sérgio da

; Marcolino, Milena Soriano

Clinics

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2023, Volume 78 elocation 100223

Abstract: En | Text: En | PDF: En

Abstract Objective To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group.

https://doi.org/10.1016/j.clinsp.2023.100223

15.

Leprosy prevalence spatial distribution and trend in a health region in Northeast Brazil, 2008-2017: an ecological study
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Oliveira, Rayanne Alves de

; Sousa, Paloma Maria Pereira de

; Silva, Janiel Conceição da

; Santos, Lívia Fernanda Siqueira

; Santos, Floriacy Stabnow

; Pascoal, Lívia Maia

; Costa, Ana Cristina Pereira de Jesus

; Santos, Leonardo Hunaldo dos

; Santos Neto, Marcelino

Epidemiologia e Serviços de Saúde

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2023, Volume 32 N. 2 elocation e2023522

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

https://doi.org/10.1590/s2237-96222023000200021

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