Abstract Introduction: Cardiovascular disease is an important cause of death among patients with chronic kidney disease (CKD). Valve calcification is a predictor of cardiovascular mortality and coronary artery disease. Objective: To assess heart valve disease frequency, associated factors, and progression in CKD patients. Methods: We conducted a retrospective study on 291 CKD patients at Hospital das Clínicas de Pernambuco. Inclusion criteria were age ≥ 18 with CKD and valve disease, while those on conservative management or with missing data were excluded. Clinical and laboratory variables were compared, and patients were categorized by dialysis duration (<5 years; 5–10 years; >10 years). Statistical tests, including chi-square, Fisher’s exact, ANOVA, and Kruskal-Wallis, were employed as needed. Simple and multivariate binary regression models were used to analyze valve disease associations with dialysis duration. Significance was defined as p < 0.05. Results: Mitral valve disease was present in 82.5% (240) of patients, followed by aortic valve disease (65.6%; 86). Over time, 106 (36.4%) patients developed valve disease. No significant association was found between aortic, pulmonary, mitral, or tricuspid valve disease and dialysis duration. Secondary hyperparathyroidism was the sole statistically significant factor for mitral valve disease in the regression model (OR 2.59 [95% CI: 1.09–6.18]; p = 0.031). Conclusion: CKD patients on renal replacement therapy exhibit a high frequency of valve disease, particularly mitral and aortic valve disease. However, no link was established between dialysis duration and valve disease occurrence or progression.

Resumo Introdução: Doenças cardiovasculares são uma causa significativa de morte em pacientes com Doença Renal Crônica (DRC). A calcificação valvar é preditor de mortalidade cardiovascular e doença arterial coronariana. Objetivo: Avaliar a frequência, fatores associados e progressão de valvopatias em pacientes com DRC. Métodos: Coorte retrospectiva com 291 pacientes ambulatoriais no Hospital das Clínicas de Pernambuco. Inclusão: ≥18 anos com DRC e valvopatia; exclusão: tratamento conservador ou dados incompletos. Variáveis clínicas e laboratoriais foram comparadas e categorizadas por tempo de terapia dialítica (TTD): <5 anos, 5–10 anos, >10 anos. Foram aplicados os testes Qui-quadrado, exato de Fisher, ANOVA, Kruskal-Wallis. Associação entre valvopatia e TTD foi avaliada por regressão binária. Significância foi definida como p < 0,05. Resultados: A valvopatia mitral foi encontrada em 82,5% (240) dos casos, seguida da aórtica (65,6%; 86). Houve progressão da doença valvar em 106 (36,4%) pacientes. Não houve associação entre valvopatias aórtica, pulmonar, mitral ou tricúspide e TTD. Hiperparatireoidismo secundário foi a única variável explicativa significativa na regressão para valvopatia mitral (OR 2,59 [IC95%: 1,09–6,18]; p = 0,031). Conclusão: Encontramos alta frequência de valvopatias, especialmente mitral e aórtica, aem pacientes com DRC. Não houve associação entre TTD e valvopatia.

Abstract Objective COVID-19 is associated with an elevated risk of thromboembolism and excess mortality. Difficulties with best anticoagulation practices and their implementation motivated the current analysis of COVID-19 patients who developed Venous Thromboembolism (VTE). Method This is a post-hoc analysis of a COVID-19 cohort, described in an economic study already published. The authors analyzed a subset of patients with confirmed VTE. We described the characteristics of the cohort, such as demographics, clinical status, and laboratory results. We tested differences amid two subgroups of patients, those with VTE or not, with the competitive risk Fine and Gray model. Results Out of 3186 adult patients with COVID-19, 245 (7.7%) were diagnosed with VTE, 174 (5.4%) of them during admission to the hospital. Four (2.3% of these 174) did not receive prophylactic anticoagulation and 19 (11%) discontinued anticoagulation for at least 3 days, resulting in 170 analyzed. During the first week of hospitalization, the laboratory most altered results were C-reactive protein and D-dimer. Patients with VTE were more critical, had a higher mortality rate, worse SOFA score, and, on average, 50% longer hospital stay. Conclusion Proven VTE incidence in this severe COVID-19 cohort was 7.7%, despite 87% of them complying completely with VTE prophylaxis. The clinician must be aware of the diagnosis of VTE in COVID-19, even in patients receiving proper prophylaxis.

ABSTRACT The membrane bioreactor process has been consolidated in recent years as an alternative to traditional methods for the treatment of effluents from the paper production industry. Recently, the introduction of support material in these reactors has contributed to the improvement of their performance, in view of the greater biological activity that occurs as a result of the development of biofilms. Thus, the presence of adhered biomass gives the membrane bioreactor an additional capacity to withstand shock loads, as well as contributing to the biodegradation of potentially toxic and recalcitrant compounds such as lignin derivatives. Thus, the present work aimed to evaluate the performance of a sequencing batch moving bed membrane bioreactor and applied to the treatment of real low-load effluent from paper production. The reactor was evaluated for its performance in removing soluble chemical oxygen demand, total phenol, true color, aromatic (UV254mn) and lignin (UV280mn) compounds. At the same time, the reactor was evaluated in terms of the membrane clogging process, by monitoring the transmembrane pressure, the concentration of extracellular polymeric substances and soluble microbial products. Under the conditions tested, the sequencing batch moving bed membrane bioreactor achieved an average removal efficiency of 89; 39; 38; 57; and 73% for CODs, UV254nm, UV280nm, true color and total phenols, respectively. Regarding membrane clogging, the variables UV254nm, UV280nm and total phenols were directly correlated with the increase in transmembrane pressure (TMP).

RESUMO O processo de biorreator com membranas tem se consolidado nos últimos anos como uma alternativa aos métodos tradicionais para o tratamento de efluentes da indústria de produção de papel. Recentemente, a introdução de material suporte nesses reatores tem contribuído para a melhoria de seu desempenho, tendo em vista a maior atividade biológica que se verifica em decorrência do desenvolvimento de biofilme. Assim, a presença da biomassa aderida confere uma capacidade adicional ao biorreator com membranas em suportar choques de cargas, bem como pode contribuir para a biodegradação de compostos potencialmente tóxicos e recalcitrantes como derivados da lignina. Desse modo, o presente trabalho teve como objetivo avaliar o desempenho de um biorreator à membrana de leito móvel operado em batelada sequencial e aplicado ao tratamento de efluente real de baixa carga oriundo da produção de papel. O reator foi avaliado quanto ao seu desempenho na remoção de demanda química de oxigênio solúvel, fenol total, cor verdadeira, compostos aromáticos (UV254nm) e lignínicos (UV280nm). Paralelamente, o reator foi avaliado quanto ao processo de colmatação das membranas, por meio do monitoramento da pressão transmembrana, da concentração de substâncias poliméricas extracelulares e produtos microbianos solúveis). Nas condições testadas, o biorreator à membrana de leito móvel operado em batelada sequencial atingiu eficiência média de remoção de 89% para demanda química de oxigênio solúvel, 39% para UV254nm, 38% para UV280nm, 57% para cor verdadeira e 73% para fenóis totais. Em relação à colmatação das membranas, as variáveis UV254nm, UV280nm e fenóis totais correlacionaram-se diretamente com o aumento da pressão transmembrana (PTM).

RESUMO O objetivo foi avaliar a divergência genética entre acessos de espécies silvestres e híbridos interespecíficos F1 de tomateiro. Caracterizou-se seis acessos silvestres (Solanum pimpinellifolium ‘AF 26970’, S. galapagense ‘LA-1401’, S. peruvianum ‘AF 19684’, S. habrochaites var. hirsutum ‘PI-127826’, S. habrochaites var. glabratum ‘PI-134417’ e S. pennellii ‘LA-716’), a cultivar comercial Redenção e os respectivos híbridos interespecíficos F1: ‘Redenção’ x ‘AF 26970’, ‘Redenção’ x ‘LA-1401’, ‘Redenção’ x ‘AF 19684’, ‘Redenção’ x ‘PI-127826’, ‘Redenção’ x ‘PI-134417’ e ‘Redenção’ x ‘LA-716’. Foram avaliados 35 caracteres quantitativos, sendo 29 morfoagronômicos e seis fisiológicos. Realizou-se análises de componentes principais (ACP). Utilizou-se os métodos de otimização de Tocher, baseado na distância de Mahalanobis e a dispersão gráfica das variáveis canônicas, que seguiram a mesma tendência de agrupamento dos genótipos, formando três grupos distintos. As ACP permitiram observar algumas divergências genéticas não observadas pelos demais métodos. Ocorreu alta divergência entre os acessos das espécies e híbridos interespecíficos. A cultivar Redenção teve a maior dissimilaridade genética e os híbridos interespecíficos de S. lycopersicum com acessos silvestres, apresentaram maior similaridade morfoagronômica e fisiológica com os genitores silvestres.

ABSTRACT The objective of this study was to evaluate the genetic divergence among accessions of wild tomato species and interspecific F1 hybrids. Six wild accessions were characterized (Solanum pimpinellifolium ‘AF 26970’, S. galapagense ‘LA-1401’, S. peruvianum ‘AF 19684’, S. habrochaites var. hirsutum ‘PI-127826’, S. habrochaites var. glabratum ‘PI-134417’, and S. pennellii ‘LA-716’), the commercial cultivar Redenção, and the respective interspecific F1 hybrids: ‘Redenção’ x ‘AF 26970’, ‘Redenção’ x ‘LA-1401’, ‘Redenção’ x ‘AF 19684’, ‘Redenção’ x ‘PI-127826’, ‘Redenção’ x ‘PI-134417’, and ‘Redenção’ x ‘LA-716’. Thirty-five quantitative traits were evaluated, encompassing 29 morphoagronomic and six physiological characteristics. Principal component analysis (PCA) was performed. Tocher’s optimization method was used based on the Mahalanobis distance and the graphic dispersion of canonical variables, which followed the same trend of genotype clustering, forming three distinct groups. The PCA indicated some genetic divergences not shown by the other methods. A high divergence was observed among the species accessions and interspecific hybrids. The cultivar Redenção had the greatest genetic dissimilarity, and the interspecific hybrids of S. lycopersicum with wild accessions showed the greatest morphoagronomic and physiological similarity with the wild parents.

ABSTRACT Irrigated rice cultivation is an important source of greenhouse gas emissions. Among the main greenhouse gases, there are carbon dioxide, methane, and nitrous oxide, with the emission of each gas varying according to the management of the crop, cultivar and irrigation management. In this context, the present study aimed to quantify the partial global warming potential (pGWP) measured by CH4 and N2O emissions in conventional and hybrid cultivars under two irrigation management, as well as the relation with grain yield (pGWP/Y). For this, a field experiment was conducted during the 2016/17 and 2017/18 crop seasons, with an experimental design of randomized blocks in a factorial arrangement (2×4), with four replications using water and rice cultivars. The water was managed through permanent and intermittent irrigation, with one conventional cultivar (IRGA 424 RI) and three hybrid cultivars (XP 113, Titan CL and Lexus CL). The pGWP can be reduced by up to 18% depending on the cultivar used and 11.8% through the adoption of intermittent irrigation management. More than 90% of the pGWP is due to methane emission, and the management actions of the rice crop should be directed towards the mitigation of this gas. In relation to the pGWP/Y index, the cultivar XP 113 had presented the best results.

Abstract An adequate amount of soil organic matter is considered essential for long-term sustainable agriculture, ensuring good productivity. Therefore, the present study quantified carbon and nitrogen stocks and microbiological activity in soil of three different areas: Forest-pasture System, Pasture System and preserved Caatinga - used as a reference of the experiment - located in a semi-arid region, in Watershed of Pajeú River, state of Pernambuco, Brazil. Eight trenches were opened in each system to collect soil samples at depths of 0 - 10, 20 - 30 and 50 - 60 cm, for chemical and microbiological analysis. In general, attributes of soil showed better results of land use in the following order: preserved Caatinga - Forest-pasture System - Pasture System.

Resumo: Introdução: Os processos formativos na educação médica possuem fatores estressores e possíveis desencadeadores de transtornos mentais. Objetivo: Este estudo teve como objetivo determinar a prevalência e os fatores associados aos sinais e sintomas de ansiedade e depressão nos estudantes de Medicina durante o distanciamento social devido à pandemia pela Covid-19. Método: Realizou-se um estudo de corte transversal entre maio a junho de 2020, com estudantes de Medicina das instituições de ensino superior do estado de Pernambuco, no Brasil. Elaborou-se um questionário on-line por meio do Google Forms contendo características sociodemográficas e clínicas, e a Escala Hospitalar de Ansiedade e Depressão (EHAD). Para análise estatística, realizou-se análise multivariada, e calcularam-se a razão de risco (RR) e o intervalo de confiança de 95% (IC95%), considerando o coeficiente de significância p < 0,05. Resultado: As variáveis associadas ao maior risco de sinais e sintomas de ansiedade foram sexo feminino, diminuir/aumentar o hábito de fumar, aumentar/não alterar o consumo de medicamentos, diminuir/não praticar lazer, não preparação da universidade para o ensino a distância (EAD), ter EAD antes da pandemia e diminuição do rendimento escolar comparado aos períodos anteriores. Quanto à depressão, observaram-se os seguintes fatores: maior risco para aumentar/não alterar o uso de medicamentos, diminuir a prática de lazer, universidade não ter se preparado para o EAD, diminuição do rendimento escolar e cor de pele parda. Conclusão: Identificaram-se diferentes fatores relacionados aos sinais e sintomas de ansiedade e depressão no período de distanciamento social causado pela pandemia da Covid-19.

Abstract: Introduction: Medical training involves stressors and possible triggers of mental disorders. Objective: Our study aims to determine the prevalence and factors associated with signs and symptoms of anxiety and depression in medical students during social distancing measures imposed due to the COVID-19 pandemic. Method: A cross-sectional study was conducted between May and June 2020 among medical students from higher education institutions in Pernambuco state, Brazil. An online questionnaire was created using Google Forms containing sociodemographic and clinical characteristics and the Hospital Anxiety and Depression Scale (EHAD). For statistical analysis, multivariate analysis was performed and the risk ratio (RR) and its 95% confidence interval (95%CI) were calculated, considering the significance coefficient (p) <0.05. Result: The variables associated with a higher risk of anxiety signs and symptoms were female gender, decreasing/increasing smoking habit, increasing/not changing drug consumption, decreasing/not practicing leisure, lack of preparation by the university for distance learning, distance learning in place before the pandemic and decline in academic performance compared to previous periods. As for depression, there was a greater risk of increasing/not changing the use of medications, decreasing leisure time, university not being prepared for distance learning, declining academic performance and brown skin colour. Conclusion: Different factors related to the signs and symptoms of anxiety and depression were identified in the period of social distancing resulting from the COVID-19 pandemic.

RESUMO RACIONAL: O tumor sólido pseudopapilar do pâncreas tem sido relatado na literatura com mais frequência nas últimas duas décadas. A cirurgia continua sendo o tratamento indicado, sendo o fígado o local mais frequente de metástases. OBJETIVOS: Apresentar a opção de tratamento cirúrgico de paciente feminino, 18 anos, com lesão sólida no corpo e cauda do pâncreas associada a lesões metastáticas em ambos os lobos hepáticos. MÉTODOS: Dois procedimentos cirúrgicos foram agendados. No primeiro procedimento foi realizada pancreatectomia corpo-caudal com esplenectomia, associada à ressecção de 3 lesões do lobo esquerdo do fígado. A hepatectomia direita foi realizada seis meses após, evoluindo sem complicações. RESULTADOS: O paciente continua sem queixas clínicas no último retorno, e a ressonância magnética do abdomem realizada 28 meses após o segundo procedimento não mostra lesões hepáticas ou na cavidade abdominal. CONCLUSÕES: O conhecimento do comportamento biológico dos tumores, a evolução e os riscos de recidiva, permitem a indicação de técnicas cirúrgicas mais racionais e que melhor beneficiam os pacientes.

ABSTRACT BACKGROUND: Solid pseudopapillary tumor of the pancreas has been frequently reported in the past two decades. Surgery remains the treatment of choice, with the liver being the most frequent site of metastases. AIMS: The study aimed to present an option of surgical treatment for an 18-year-old female patient with a solid lesion in the body and tail of the pancreas associated with metastatic lesions in both hepatic lobes. METHODS: Two surgical procedures were scheduled. In the first procedure, body-caudal pancreatectomy with splenectomy was performed, associated with the resection of three lesions of the liver's left lobe. A right hepatectomy was performed 6 months later, progressing without complications. RESULTS: The patient continues without clinical complaints on the last return, and abdominal magnetic resonance performed 28 months after the second procedure does not show liver or abdominal cavity lesions. CONCLUSIONS: The knowledge on the biological behavior of tumors, evolution, and recurrence risks allows the indication of more rational surgical techniques that best benefit patients.

RESUMO Conhecer o comportamento geomorfológico de bacias hidrográficas é fundamental para a elaboração de políticas públicas de conservação dos recursos naturais, para subsidiar a ocupação humana de forma que os processos erosivos sejam minimizados. Considerando-se as escassas informações sobre a bacia hidrográfica do Rio das Balsas, no sul do estado do Maranhão, este estudo teve como objetivos realizar o diagnóstico físico e apresentar as áreas suscetíveis à erosão por meio de classificação qualitativa. Para tanto, utilizaram-se informações das bases de dados da Agência Nacional de Águas, Companhia de Pesquisa de Recursos Minerais e United States Geological Survey (modelo digital de elevação, hidrografia, solos e geologia). Por rotinas de geoprocessamento, foram delimitadas a bacia e as sub-bacias e obtidos os dados para o cálculo dos índices morfométricos. Além disso, foi feita a reclassificação das áreas suscetíveis a erosão, baseada no curve number, método que avalia o potencial de escoamento superficial por tipo de solo e respectivo uso. A reclassificação em quatro classes de suscetibilidade possibilitou elaborar o mapa de áreas suscetíveis à erosão. As características morfogenéticas encontradas na área mostram que são necessárias ações de manejo adequado, já que alguns tipos de solos combinados com 45% de declividade (44% da área) são as áreas mais vulneráveis aos processos erosivos. Com isso, conclui-se que o planejamento do uso e ocupação da bacia são extremamente importantes para que as características físicas da região não interfiram de maneira negativa no futuro da sua expansão, no que concerne tanto às atividades agrícolas quanto às urbanas.

Abstract Knowledge of the geomorphological behavior of watersheds is fundamental for the elaboration of public policies for the conservation of natural resources, to subsidize human occupation in a way that minimizes erosion processes. Considering the lack of information about the Balsas river basin, located in the south of the state of Maranhão, Brazil, this study aimed to make a physical diagnosis and indicate areas susceptible to erosion through qualitative classification. To that end, it drew on information from National Water Agency (ANA), the Geological Survey of Brazil (CPRM) and the United States Geological Survey (USGS) databases (digital elevation model, hydrography, soils and geology). Through geoprocessing routines, the basin and sub-basins were mapped and data was obtained for the calculation of morphometric indices. In addition, the areas susceptible to erosion were reclassified based on the curve number method, which assesses surface runoff potential by soil type and use. Reclassification into four susceptibility classes made it possible to map erosion susceptible areas. The morphogenetic characteristics found in the area show the need for appropriate management actions, since some types of soils, combined with 45% slope (about 44% of the area), are the most vulnerable to erosive processes. The conclusion reached was that planning of the use and occupation of the basin is extremely important to prevent the physical characteristics of the basin interfering negatively in the future of the region, as its agricultural as well as urban activities expand.

Resumo Objetivos: determinar a frequência e os fatores associados aos sinais e sintomas de estresse, ansiedade e depressão grave/extremos em pacientes diabéticos durante a pandemia pela COVID-19. Métodos: realizou-se estudo de corte transversal em abril/maio de 2020 que incluiu 162 indivíduos com diabetes mellitus e maiores de 18 anos. Aplicou-se um questionário online divulgado nas mídias sociais, sendo composto por características biológicas, sociodemográ-ficas, clínicas e a Escala de Estresse, Ansiedade e Depressão (DASS-21). Para análise estatística foi aplicado modelo de regressão logística multivariado com nível de significância de 5%. Resultados: encontrou-se frequência de 37,7%, 43,3% e 45,1% para qualquer sinal e sintoma de estresse, ansiedade e depressão, respectivamente. Os fatores associados a sinais e sintomas psíquicos graves/extremos foram: não ter religião (estresse, ansiedade e depressão); estar na graduação (estresse e ansiedade);antecedente de ansiedade e/ou depressão (ansiedade e depressão); não realizar ou ter diminuído exercícios físicos, iniciado, aumentado ou mantido medicações para dormir (estresse); história de contato com caso suspeito da COVID-19; ausência ou diminuição de lazer (ansiedade) e sexo feminino, ausência de companheiro, diminuição da renda familiar e do trabalho ou estudo (depressão). Conclusão: a frequência de transtornos psíquicos foi maior que a descrita na literatura em pacientes diabéticos, sendo associada a fatores biológicos, sociodemográficos, clínicos e aspectos relacionados à COVID-19 durante a pandemia.

Abstract Objectives: to determine the frequency and factors associated with severe / extreme signs and symptoms of stress, anxiety and depression in diabetic patients during the COVID-19 pandemic. Methods: cross-sectional study conducted in April /May 2020, which included 162 individuals with diabetes mellitus and over 18 years old. An online questionnaire was applied on social networks, composed of biological, sociodemographic, clinical characteristics and the Stress, Anxiety and Depression Scale (DASS-21). For statistical analysis, a multivariate logistic regression model was applied with a 5% significance level. Results: frequency of 37.7%, 43.3% and 45.1% were found for some symptom of stress, anxiety and depression, respectively. The factors associated with sign and symptoms of severe / extreme psychic disorders were: not having religion (stress, anxiety and depression); be at graduation (stress and anxiety); history of anxiety and depression (anxiety and depression); not practicing or decreasing physical exercises and starting, increased or continue taking sleeping medications (stress); history of contact with a suspected case of COVID-19, absence or decreased leisure (anxiety); female gender, absence of a partner, decreased family income and work or study (depression). Conclusion: the frequency of psychological disorders was higher than described in the literature on diabetic patients, being associated with biological, sociodemographic, clinical factors and aspects related to COVID-19 during the pandemic

ABSTRACT OBJECTIVE To estimate the prevalence of clinical signs and symptoms of severe/extreme stress, anxiety, and depression, as well as their associated factors, among Brazilians during social distancing. METHODS This is a cross-sectional study conducted in April/May 2020 with 3,200 Brazilians over 18 years old. Respondents’ sociodemographic and clinical data were collected using an online questionnaire, which also included the 21-item Depression, Anxiety and Stress Scale (DASS-21) to assess emotional symptoms. Unadjusted and adjusted prevalence ratios and their respective 95% confidence intervals were estimated using Poisson regression models with robust variance. RESULTS Our results show the prevalence of severe/extreme stress was 21.5%, anxiety 19.4%, and depression 21.5%. In the final model, sociodemographic, clinical, and Covid-19-related factors were associated with severe/extreme stress, anxiety, and depression in Brazilians during social distancing due to the Covid-19 pandemic. We found the main factors associated with severe/extreme depression to be young women, brown, single, not religious, sedentary, presenting reduced leisure activities, history of anxiety and depression, increased medication use, and Covid-19 symptoms. CONCLUSION This study may help develop and systematically plan measures aimed to prevent, early identify, and properly manage clinical signs and symptoms of stress, anxiety, and depression during the Covid-19 pandemic.

ABSTRACT OBJECTIVE To estimate the prevalence of clinical signs and symptoms of severe/extreme stress, anxiety, and depression, as well as their associated factors, among Brazilians during social distancing. METHODS This is a cross-sectional study conducted in April/May 2020 with 3,200 Brazilians over 18 years old. Respondents’ sociodemographic and clinical data were collected using an online questionnaire, which also included the 21-item Depression, Anxiety and Stress Scale (DASS-21) to assess emotional symptoms. Unadjusted and adjusted prevalence ratios and their respective 95% confidence intervals were estimated using Poisson regression models with robust variance. RESULTS Our results show the prevalence of severe/extreme stress was 21.5%, anxiety 19.4%, and depression 21.5%. In the final model, sociodemographic, clinical, and Covid-19-related factors were associated with severe/extreme stress, anxiety, and depression in Brazilians during social distancing due to the Covid-19 pandemic. We found the main factors associated with severe/extreme depression to be young women, brown, single, not religious, sedentary, presenting reduced leisure activities, history of anxiety and depression, increased medication use, and Covid-19 symptoms. CONCLUSION This study may help develop and systematically plan measures aimed to prevent, early identify, and properly manage clinical signs and symptoms of stress, anxiety, and depression during the Covid-19 pandemic.