The response to COVID-19 in Argentina, Brazil, and Mexico: challenges to national coordination of health policies.

The article analyzes the fight against COVID-19 in three Latin American countries: Argentina, Brazil, and Mexico. A multiple case study was carried out in a comparative perspective, based on a bibliographic review, documentary analysis, and secondary data, considering characteristics of the countries and the health system, evolution of COVID-19, national governance, containment and mitigation measures, health systems response, constraints, positive aspects and limits of responses. The three countries had distinct health systems but were marked by insufficient funding and inequalities when hit by the pandemic and recorded high-COVID-19 mortality. Structural, institutional, and political factors influenced national responses. In Argentina, national leadership and intergovernmental political agreements favored the initial adoption of centralized control measures, which were not sustained. In Brazil, there were limits in national coordination and leadership related to the President's denialism and federative, political, and expert conflicts, despite a universal health system with intergovernmental commissions and participatory councils, which were little used during the pandemic. In Mexico, structural difficulties were associated with the Federal Government's initial reluctance to adopt restrictive measures, limits on testing, and relative slowness in immunization. In conclusion, facing health emergencies requires strengthening public health systems associated with federative, intersectoral, and civil society coordination mechanisms and effective global solidarity mechanisms.

Anti-Staphy Peptides Rationally Designed from Cry10Aa Bacterial Protein.

Bacterial infections pose a significant threat to human health, constituting a major challenge for healthcare systems. Antibiotic resistance is particularly concerning in the context of treating staphylococcal infections. In addressing this challenge, antimicrobial peptides (AMPs), characterized by their hydrophobic and cationic properties, unique mechanism of action, and remarkable bactericidal and immunomodulatory capabilities, emerge as promising alternatives to conventional antibiotics for tackling bacterial multidrug resistance. This study focuses on the Cry10Aa protein as a template for generating AMPs due to its membrane-penetrating ability. Leveraging the Joker algorithm, six peptide variants were derived from α-helix 3 of Cry10Aa, known for its interaction with lipid bilayers. In vitro, antimicrobial assays determined the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) required for inhibiting the growth of Staphylococcus aureus, Escherichia coli, Acinetobacter baummanii, Enterobacter cloacae, Enterococcus facallis, Klebsiella pneumonia, and Pseudomonas aeruginosa. Time-kill kinetics were performed using the parental peptide AMPCry10Aa, as well as AMPCry10Aa_1 and AMPCry10Aa_5, against E. coli ATCC, S. aureus 111 and S. aureus ATCC strains showing that AMPCry10Aa_1 and AMPCry10Aa_5 peptides can completely reduce the initial bacterial load with less than 2 h of incubation. AMPCry10Aa_1 and AMPCry 10Aa_5 present stability in human serum and activity maintenance up to 37 °C. Cytotoxicity assays, conducted using the MTT method, revealed that all of the tested peptides exhibited cell viability >50% (IC50). The study also encompassed evaluations of the structure and physical-chemical properties. The three-dimensional structures of AMPCry10Aa and AMPCry10Aa_5 were determined through nuclear magnetic resonance (NMR) spectroscopy, indicating the adoption of α-helical segments. Electron paramagnetic resonance (EPR) spectroscopy elucidated the mechanism of action, demonstrating that AMPCry10Aa_5 enters the outer membranes of E. coli and S. aureus, causing substantial increases in lipid fluidity, while AMPCry10Aa slightly increases lipid fluidity in E. coli. In conclusion, the results obtained underscore the potential of Cry10Aa as a source for developing antimicrobial peptides as alternatives to conventional antibiotics, offering a promising avenue in the battle against antibiotic resistance.

Custo Direto do Tratamento do Acidente Vascular Cerebral Isquêmico na Perspectiva de um Hospital Público Terciário (Direct Cost of Treating Ischemic Stroke From the Perspective of a Tertiary Public Hospital).

OBJECTIVES: To measure the direct cost of treating acute ischemic stroke (IS) from the perspective of a public hospital in Brazil (HCFMB) and compare it with the reimbursement by the Unified Health System (SUS), through the Procedure Table Management System, Medicines, Orthoses/Prostheses and Special Materials of the Unified Health System (SIGTAP). METHODS: We performed a micro-costing study; four scenarios were evaluated: standard (1); alteplase (2); alteplase and mechanical thrombectomy (3); mechanical thrombectomy (4). Based on the number of patients hospitalized for ischemic stroke in 2019, hospital cost, and SUS billing were calculated for each scenario. Hospital costs were adjusted for inflation using CCEMG-EPPI-Centre Cost Converter. RESULTS: In 2019, 258 patients were hospitalized due to IS, 89.5% in scenario 1, 8% in scenario 2, 1.5% in scenario 3, 1% in scenario 4. From the hospital's perspective, the cost per patient was estimated at R$7780.13, R$15 741.23, R$28 988.49, R$25 739.79, for scenarios 1, 2, 3 and 4, respectively. The reimbursement by SIGTAP was estimated at R$3079.87, R$5417.21, R$10 901.92, R$10 286.28, respectively. If thrombectomy had been included in the SIGTAP, the last two values would be R$25 393.34 and R$24 248.89. CONCLUSIONS: The hospital cost of treating acute IS in 2019 was estimated at R$2 295 209, the SUS reimbursement at R$889 391.54. With the inclusion of thrombectomy at SIGTAP, this reimbursement would be R$975 282.44, and the loss in the cost of HCFMB per patient in relation to reimbursement by the SUS is greater in scenarios without this procedure.

Can species guilds act as hubs for energy transfer in macrophyte meadows of Amazonian floodplain lakes?

Aquatic macrophytes are the main autochthonous component of primary production in the Amazon Basin. Floating meadows of these plants support habitats with highly diverse animal communities. Fishes inhabiting these habitats have been assumed to use a broad range of food items and compose a particular food web. We employed carbon (δ13C) and nitrogen (δ15N) stable isotope analysis to draw the trophic structure of these habitats and to trace the energy flow by its trophic levels. Fishes and other animals from 18 independent macrophyte meadows of a floodplain lake of the Solimões River (Amazonia, Brazil) were analyzed. The food web of macrophyte meadows consists of four trophic levels above autotrophic sources. In general, primary consumers exhibited a broader range of food sources than the upper trophic levels. Some fish species depended on a large number of food sources and at the same time are consumed by several predators. The energy transfer from one trophic level to the next was then mainly accomplished by these species concentrating a high-energy flux and acting as hubs in the food web. The broad range of δ13C values observed indicates that the organisms living in the macrophyte meadows utilize a great diversity of autotrophic sources.

Challenges in adapting a stroke unit in a middle-income country: warning about costs and underfunding to achieve the Brazilian Ministry of Health's benchmark.

Background: Since the implementation of the stroke care line in Brazil, the relationship (adequacy) of costs spent during hospitalization with the Brazilian Ministry of Health indicators for a stroke unit have not yet been analyzed. Aims: This study aimed to assess the adequacy of a comprehensive stroke center for key performance indicators and analyze the costs involved in hospitalization. We verified the association between stroke severity at admission and care costs during hospitalization. Methods: A retrospective medical chart review of 451 patients was performed using semiautomatic electronic data from a single comprehensive stroke center in Brazil between July 2018 and January 2020. Clinical and resource utilization data were collected, and the mean acute treatment cost per person was calculated. The Kruskal-Wallis test with Dunn's post-test was used to compare the total costs between stroke types and reperfusion therapies. A robust linear regression test was used to verify the association between stroke severity at hospital admission and the total hospitalization costs. Good adequacy rates were observed for several indicators. Results: Data from 451 patients were analyzed. The stroke unit had good adaptation to key performance indicators, but some critical points needed revision and improvement to adapt to the requirements of the Ministry of Health. The average total cost of the patient's stay was the USD 2,637.3, with the daily hospitalization, procedure, operating room, and materials/medication costs equating to USD 2,011.1, USD 220.7, USD 234.1, and USD 98.8, respectively. There was a positive association between the total cost and length of hospital stay (p < 0.001). Conclusion: The stroke unit complied with most of the main performance indicators proposed by the Brazilian Ministry of Health. Underfunding of the costs involved in the hospitalization of patients was verified, and high costs were associated with the length of stay, stroke severity, and mechanical thrombectomy.

To what extent does frailty mediate the association between age and the outcomes of brain reperfusion following acute ischemic stroke?

Objective: We evaluated the extent to which frailty mediated the association between age, poor functional outcomes, and mortality after acute ischemic stroke when patients were treated with brain reperfusion (thrombolytic therapy and/or thrombectomy). Materials and methods: This retrospective cohort study included patients diagnosed with ischemic stroke who had undergone intravenous cerebral reperfusion therapy and/or mechanical thrombectomy. We created a mediation model by analyzing the direct natural effect of an mRS score > 2 and death on age-mediated frailty according to the Frailty Index. Results: We enrolled 292 patients with acute ischemic stroke who underwent brain reperfusion. Their mean age was 67.7 ± 13.1 years. Ninety days after the stroke ictus, 54 (18.5%) participants died, and 83 (28.4%) lived with moderate to severe disability (2 < mRS < 6). In the mediation analysis of the composite outcome of disability (mRS score > 2) or death, frailty accounted for 28% of the total effect of age. The models used to test for the interaction between age and frailty did not show statistically significant interactions for either outcome, and the addition of the interaction did not significantly change the direct or indirect effects, nor did it improve model fit. Conclusion: Frailty mediated almost one-third of the effect of age on the composite outcome of disability or death after acute ischemic stroke.

Long-term preservation of established fibroblast lines from six-banded armadillos (Euphractus sexcintus, Linnaeus, 1758) by extended passage and cryopreservation.

Establishing new somatic cell cultures has raised significant attention as an effective and convenient way to preserve genetic samples for different applications. Although many lines have been established in model animals, none derived from six-banded armadillo species is currently available. We report the successful isolation and characterization of fibroblasts from six-banded armadillos, evaluating the cell quality after extended culture and cryopreservation. Initially, we collected ear skin from five captive adult individuals and identified fibroblast lines by morphology, karyotyping, and immunophenotyping assays. The isolated fibroblasts were evaluated after several passages (fourth, seventh, and tenth passages) and cryopreservation by slow freezing. Cell morphology, viability, metabolism, proliferative activity, mitochondrial membrane potential, and apoptosis levels were analyzed. The skin explants had great adhesion, and cell outgrowth could be seen after 3-6 d. The cells were verified as fibroblasts at the fourth passage by vimentin expression and normal karyotype (2n = 58). The viability remained high (> 87%) and constant from the fourth to the tenth passage (p > 0.05). The passages did not change the cell morphology and metabolic and growth rates. Moreover, cryopreservation did not affect most evaluated parameters; post-thawed cells maintained their viability, growth, metabolism, and apoptosis levels. Nevertheless, cryopreservation increased mitochondrial membrane permeability and cell population doubling time compared to non-cryopreserved cells (p < 0.05). In summary, viable fibroblasts can be obtained from six-banded armadillo skin while conserving their quality as the number of passages increases and featuring few changes after cryopreservation.

Deciphering the structure and mechanism of action of computer-designed mastoparan peptides.

Mastoparans are cationic peptides with multifunctional pharmacological properties. Mastoparan-R1 and mastoparan-R4 were computationally designed based on native mastoparan-L from wasps and have improved therapeutic potential for the control of bacterial infections. Here, we evaluated whether these peptides maintain their activity against Escherichia coli strains under a range of salt concentrations. We found that mastoparan-R1 and mastoparan-R4 preserved their activity under the conditions tested, including having antibacterial activities at physiological salt concentrations. The overall structure of the peptides was investigated using circular dichroism spectroscopy in a range of solvents. No significant changes in secondary structure were observed (random coil in aqueous solutions and α-helix in hydrophobic and anionic environments). The three-dimensional structures of mastoparan-R1 and mastoparan-R4 were elucidated through nuclear magnetic resonance spectroscopy, revealing amphipathic α-helical segments for Leu3-Ile13 (mastoparan-R1) and Leu3-Ile14 (mastoparan-R4). Possible membrane-association mechanisms for mastoparan-R1 and mastoparan-R4 were investigated through surface plasmon resonance and leakage studies with synthetic POPC and POPC/POPG (4:1) lipid bilayers. Mastoparan-L had the highest affinity for both membrane systems, whereas the two analogs had weaker association, but improved selectivity for lysing anionic membranes. This finding was also supported by molecular dynamics simulations, in which mastoparan-R1 and mastoparan-R4 were found to have greater interactions with bacteria-like membranes compared with model mammalian membranes. Despite having a few differences in their functional and structural profiles, the mastoparan-R1 analog stood out with the highest activity, greater bacteriostatic potential, and selectivity for lysing anionic membranes. This study reinforces the potential of mastoparan-R1 as a drug candidate.

A saúde na região do Médio Solimões no estado do Amazonas: a centralidade de Tefé / Health in the Middle Solimões region, state of Amazonas: the centrality of Tefé

RESUMO Em um cenário de várzea amazônica com fluxos fluviais, o estudo analisa a articulação da Atenção Básica com a Atenção Especializada, buscando discutir as condições políticas e geográficas que impactam na conformação da rede assistencial em uma região de saúde na Amazônia Ocidental. Adotouse uma combinação de estratégias metodológicas: levantamento de indicadores de morbidade e da rede de saúde, mapeamento dos trajetos intermunicipais, levantamento de despesas em Ações e Serviços Públicos de Saúde e entrevistas com gestores. O município de Tefé concentra serviços bancários, poder judiciário, educacional, órgãos de controle e segurança que lhe conferem uma centralidade de funções. Contudo, a saúde não considera os fluxos existentes no território para definição de quais municípios têm Tefé como referência. A defasagem dos dados nos sistemas de informação em saúde, aliada a ausência do ente estadual no planejamento regional de saúde, apoio para provimento de profissionais especializados, pagamento de insumos e organização do fluxo de referência-contrarreferência na rede têm sido desafios para planejar integralidade da atenção na região, sobrecarregando o município-polo. Apesar do aumento progressivo de despesas em saúde nos municípios analisados, a oferta de serviço para além da Atenção Básica permanece sendo um desafio para o Sistema Único de Saúde (SUS) na Amazônia.

ABSTRACT In an Amazonian floodplain scenario with river flows, the study analyzes the articulation of Primary Care with Specialized Care, seeking to discuss the political and geographical conditions that impact on the formation of the care network in a health region in the Western Amazon. A combination of methodological strategies was adopted: survey of morbidity indicators and the health network, mapping of intercity routes, survey of expenses in Public Health Actions and Services and interviews with managers. Tefé concentrates banking services, judiciary branch, education and security bodies that give it a centrality of functions. However, health does not consider existing flows in the territory to define which municipalities have Tefé as a health reference. Outdated data in the health information systems, combined with the absence of the state government in the regional health planning, support to provide specialized professionals, payment for supplies and the organization of referral-counter-referral flow in the network have been challenges for integrality of the attention in the region, overloading the hub municipality. Despite the progressive increase in health expenses in the analyzed municipalities, the provision of services beyond Primary Care remains a challenge for the Unified Health System (SUS) in the Amazon.

The response to COVID-19 in Argentina, Brazil, and Mexico: challenges to national coordination of health policies / La respuesta al COVID-19 en Argentina, Brasil y México: los desafíos a la coordinación federativa de las políticas de salud / A resposta à COVID-19 na Argentina, no Brasil e no México: desafios à coordenação federativa das políticas de saúde

Abstract: The article analyzes the fight against COVID-19 in three Latin American countries: Argentina, Brazil, and Mexico. A multiple case study was carried out in a comparative perspective, based on a bibliographic review, documentary analysis, and secondary data, considering characteristics of the countries and the health system, evolution of COVID-19, national governance, containment and mitigation measures, health systems response, constraints, positive aspects and limits of responses. The three countries had distinct health systems but were marked by insufficient funding and inequalities when hit by the pandemic and recorded high-COVID-19 mortality. Structural, institutional, and political factors influenced national responses. In Argentina, national leadership and intergovernmental political agreements favored the initial adoption of centralized control measures, which were not sustained. In Brazil, there were limits in national coordination and leadership related to the President's denialism and federative, political, and expert conflicts, despite a universal health system with intergovernmental commissions and participatory councils, which were little used during the pandemic. In Mexico, structural difficulties were associated with the Federal Government's initial reluctance to adopt restrictive measures, limits on testing, and relative slowness in immunization. In conclusion, facing health emergencies requires strengthening public health systems associated with federative, intersectoral, and civil society coordination mechanisms and effective global solidarity mechanisms.

Resumen: El artículo analiza la lucha contra el COVID-19 en tres federaciones latinoamericanas: Argentina, Brasil y México. Se realizó un estudio de casos múltiple en perspectiva comparada, basado en revisión bibliográfica, análisis documental y de datos secundarios, teniendo en cuenta: las características de los países y del sistema de salud, la evolución del COVID-19, la gobernanza nacional, las medidas de contención y mitigación, la respuesta de los sistemas de salud, los factores condicionantes, los aspectos positivos y los límites de las respuestas. Los tres países tenían sistemas de salud diferentes, pero marcados por financiación insuficiente y desigualdades, cuando afectados por la pandemia, y registraron una alta mortalidad por COVID-19. Las respuestas nacionales se influyeron por factores condicionantes estructurales, institucionales y políticos. En Argentina, el liderazgo nacional y los acuerdos políticos intergubernamentales favorecieron la adopción inicial de medidas de control centralizadas, que no se sustentaron. En Brasil, hubo límites en la coordinación y liderazgo nacional, relacionados con el negacionismo del presidente y los conflictos federativos, políticos y con expertos, a pesar de existir un sistema de salud universal que tiene comisiones intergubernamentales y consejos participativos, poco utilizados en la pandemia. En México, las dificultades estructurales se asociaron con la renuencia inicial del gobierno nacional en adoptar medidas restrictivas, límites en las pruebas y relativa lentitud en la vacunación. Se concluye que para enfrentar emergencias sanitarias hay que fortalecer los sistemas públicos de salud asociados con mecanismos de coordinación federativa, intersectorial y con la sociedad civil, así como mecanismos efectivos de solidaridad global.

Resumo: Este artigo analisa o enfrentamento da COVID-19 em três federações latino-americanas: Argentina, Brasil e México. Realizou-se um estudo de casos múltiplos em perspectiva comparada, baseado em revisão bibliográfica, análise documental e de dados secundários, considerando: características dos países e do sistema de saúde, evolução da COVID-19, governança nacional, medidas de contenção e mitigação, resposta dos sistemas de saúde, condicionantes, aspectos positivos e limites das respostas. Os três países apresentavam sistemas de saúde distintos, porém marcados por financiamento insuficiente e desigualdades quando atingidos pela pandemia, e registraram alta mortalidade por COVID-19. As respostas nacionais foram influenciadas por condicionantes estruturais, institucionais e políticos. Na Argentina, a liderança nacional e acordos políticos intergovernamentais favoreceram a adoção inicial de medidas centralizadas de controle, que não se sustentaram. No Brasil, houve limites na coordenação e liderança nacional, relacionadas ao negacionismo do presidente e a conflitos federativos, políticos e com especialistas, apesar da existência de um sistema de saúde universal que têm comissões intergovernamentais e conselhos participativos, pouco acionados na pandemia. No México, dificuldades estruturais se associaram à relutância inicial do governo nacional em adotar medidas restritivas, limites na testagem e relativa lentidão na vacinação. Conclui-se que o enfrentamento de emergências sanitárias requer o fortalecimento dos sistemas públicos de saúde associados a mecanismos de coordenação federativa, intersetorial e com a sociedade civil, bem como mecanismos efetivos de solidariedade global.

FishDNAIDs: DNA barcoding as a tool in the development and validation in silico and in vitro of detection systems to four species of Characiformes of commercial importance in the Brazilian Amazon.

BACKGROUND: The COI mitochondrial gene has been chosen as the "DNA barcode in animals" and the large quantity of genetic information in public databanks gives solid support for the use of DNA barcoding as a promising tool for the development of a specific molecular detection system. METHODS AND RESULTS: The present study aimed to develop a Specific Molecular Detection System (SMDS: FishDNAIDs) (primers and probe sets) for the following four target species: Prochilodus nigricans, Potamorhina altamazonica, Psectrogaster rutiloides and Triportheus angulatus, in qPCR assays. In silico and in vitro tests (using gDNA) were performed to test these sets. The database generated contained the cytochrome c oxidase subunit I (COI) nucleotide sequence for 183 specimens of Characiformes, distributed in 34 species representing eight families. In silico, primers designed for the target species amplified different species from the same genus, except for P. rutiloides, which amplified only the target species. In the in vitro test, using the SYBRGreentm and TaqMan® fluorescence systems, both sets detected the respective target species (P. nigricans, P. altamazonica, P. rutiloides and T. angulatus). In the qPCR assays using SYBRGreentm, species considered to be related were also detected, in addition to the target species, with the exception of P. amazonica and P. essequibensis (correlated to P. rutiloides). All target species were detected in the qPCR assays using the TaqMan® system; however, with the SMDS PALT, the target species P. altamazonica was detected with low CT values (22.21 ± 0.17) as well as the correlates of P. latior and P. pristigaster, though with high CT values (23.51 ± 0.19 and 30.21 ± 0.95). This assay uniquely identifies known adult tissue samples from all four species. CONCLUSIONS: The primers and probe sets developed can act as powerful tools for detecting the target Characiformes species.

Covid-19 Fiocruz Observatory - an analysis of the evolution of the pandemic from February 2020 to April 2022. / Observatório Covid-19 Fiocruz - uma análise da evolução da pandemia de fevereiro de 2020 a abril de 2022.

The COVID-19 pandemic had a significant impact on the living and working conditions of the entire population of Brazil, having a different and more intense effect on groups considered to be vulnerable. The objective of this article is to present an overview of the evolution of the pandemic in the country according to the bulletins of the Covid-19 Fiocruz Observatory in the period between the declarations of the beginning and end of the Public Health Emergency of National Concern (ESPIN, in Portuguese), February 2020 to April 2022. Several of the indicators adopted in the 69 bulletins published for the analysis of the pandemic were used, such as cases and deaths due to SARIs and COVID-19, age groups, % of occupancy of ICU beds, and vaccination, among others. The evolution analysis was organized between years and phases of the pandemic, seeking to highlight what characterized each moment. The closing statement of ESPIN in Brazil coincides with the discussions on the transition from a pandemic to an endemic scenario, without this representing the elimination of the virus, infections, and disease, posing the challenges of advances in vaccination processes in Brazil and around the world, as well as living with scenarios that may require the adoption of temporary protection measures in epidemic periods and periods of greater risk for vulnerable groups.

A pandemia de COVID-19 teve um imenso impacto nas condições de vida e trabalho de toda a população do país, impactando de modo diferenciado e mais intenso os grupos considerados vulneráveis. O objetivo deste artigo é apresentar um panorama da evolução da pandemia no país segundo os boletins do Observatório Covid-19 Fiocruz, no período entre as declarações de início e de encerramento da Emergência em Saúde Pública de Importância Nacional (ESPIN), fevereiro de 2020 a abril de 2022. Foram utilizados diversos dos indicadores adotados nos 69 boletins publicados para a análise da pandemia, como casos e óbitos por SRAGs e COVID-19, grupos etários, taxas de ocupação de leitos UTI e vacinação, entre outros. A análise da evolução foi organizada entre anos e fases da pandemia, procurando destacar o que caracterizou cada momento. A declaração de encerramento da ESPIN no Brasil coincide com as discussões acerca da transição de pandemia para a endemia, sem que isso represente a eliminação do vírus, das infecções e da doença, colocando-se os desafios de avanços nos processos de vacinação no Brasil e no mundo e da convivência com cenários que poderão exigir a adoção de medidas de proteção temporárias em períodos epidêmicos e de maior risco para grupos vulneráveis.

Observatório Covid-19 Fiocruz - uma análise da evolução da pandemia de fevereiro de 2020 a abril de 2022 / Covid-19 Fiocruz Observatory - an analysis of the evolution of the pandemic from February 2020 to April 2022

Resumo A pandemia de COVID-19 teve um imenso impacto nas condições de vida e trabalho de toda a população do país, impactando de modo diferenciado e mais intenso os grupos considerados vulneráveis. O objetivo deste artigo é apresentar um panorama da evolução da pandemia no país segundo os boletins do Observatório Covid-19 Fiocruz, no período entre as declarações de início e de encerramento da Emergência em Saúde Pública de Importância Nacional (ESPIN), fevereiro de 2020 a abril de 2022. Foram utilizados diversos dos indicadores adotados nos 69 boletins publicados para a análise da pandemia, como casos e óbitos por SRAGs e COVID-19, grupos etários, taxas de ocupação de leitos UTI e vacinação, entre outros. A análise da evolução foi organizada entre anos e fases da pandemia, procurando destacar o que caracterizou cada momento. A declaração de encerramento da ESPIN no Brasil coincide com as discussões acerca da transição de pandemia para a endemia, sem que isso represente a eliminação do vírus, das infecções e da doença, colocando-se os desafios de avanços nos processos de vacinação no Brasil e no mundo e da convivência com cenários que poderão exigir a adoção de medidas de proteção temporárias em períodos epidêmicos e de maior risco para grupos vulneráveis.

Abstract The COVID-19 pandemic had a significant impact on the living and working conditions of the entire population of Brazil, having a different and more intense effect on groups considered to be vulnerable. The objective of this article is to present an overview of the evolution of the pandemic in the country according to the bulletins of the Covid-19 Fiocruz Observatory in the period between the declarations of the beginning and end of the Public Health Emergency of National Concern (ESPIN, in Portuguese), February 2020 to April 2022. Several of the indicators adopted in the 69 bulletins published for the analysis of the pandemic were used, such as cases and deaths due to SARIs and COVID-19, age groups, % of occupancy of ICU beds, and vaccination, among others. The evolution analysis was organized between years and phases of the pandemic, seeking to highlight what characterized each moment. The closing statement of ESPIN in Brazil coincides with the discussions on the transition from a pandemic to an endemic scenario, without this representing the elimination of the virus, infections, and disease, posing the challenges of advances in vaccination processes in Brazil and around the world, as well as living with scenarios that may require the adoption of temporary protection measures in epidemic periods and periods of greater risk for vulnerable groups.

Neurofibromatosis type 1, fibromuscular dysplasia, and ischemic stroke: an association lost in time? A case report.

Neurofibromatosis Type 1 (NF1) is a rare cause of ischemic stroke (IS) in the general population. We report a case of a young patient with NF1 in whom IS was caused by fibromuscular dysplasia. An angiographic study demonstrated occlusion in the right internal carotid artery (ICA), just after its origin, and the left ICA, just before the intracranial portion, and brain magnetic resonance imaging showed the limits of an area of brain infarction in the right frontoparietal region. Despite these concomitant neuroimaging findings, this association is rare, and it is difficult to establish the contribution to the outcome made by each of these diseases, which treatment is the best to implement, or what prognosis is.

A neurofibromatose tipo 1 (NF1) é uma causa rara de acidente vascular cerebral isquêmico (AVCi) na população geral. Neste estudo, relatamos o caso de um paciente jovem com AVCi, com diagnóstico de NF1 associada a displasia fibromuscular. O estudo angiográfico demonstrou oclusão da carótida interna direita, logo após sua origem, e esquerda, antes da porção intracraniana. A ressonância magnética do encéfalo mostrou delimitação de um infarto na região frontoparietal direita. Apesar desses achados concomitantes na neuroimagem, essa associação é rara, sendo difícil de estabelecer a contribuição de cada uma dessas doenças no desfecho, tampouco qual o melhor tratamento a ser implementado e qual o prognóstico.

World federation of interventional and therapeutic neuroradiology (WFITN) federation assembly neurointerventional surgery safety checklist.

Over the last 10 years, there has been a rise in neurointerventional case complexity, device variety and physician distractions. Even among experienced physicians, this trend challenges our memory and concentration, making it more difficult to remember safety principles and their implications. Checklists are regarded by some as a redundant exercise that wastes time, or as an attack on physician autonomy. However, given the increasing case and disease complexity along with the number of distractions, it is even more important now to have a compelling reminder of safety principles that preserve habits that are susceptible to being overlooked because they seem mundane. Most hospitals have mandated a pre-procedure neurointerventional time-out checklist, but often it ends up being done in a cursory fashion for the primary purpose of 'checking off boxes'. There may be value in iterating the checklist to further emphasize safety and communication. The Federation Assembly of the World Federation of Interventional and Therapeutic Neuroradiology (WFITN) decided to construct a checklist for neurointerventional cases based on a review of the literature and insights from an expert panel.

Role of choledochotomy after mechanical lithotripsy-related adverse event in endoscopic retrograde cholangiopancreatography.

In case of rupture of the mechanical lithotripter's traction wires during an ERCP, we suggest performing a choledochotomy to remove the stone, and remove the closed Dormia basket through the mouth.

Uncertainties regarding the natural mortality of fish can increase due global climate change.

The increase in temperature resulting from global climate change can directly affect the survival of fish and therefore population parameters such as natural mortality (M). The estimation of this parameter and the understanding of the uncertainties in its estimates are enormous challenges for studies that evaluate fish stocks. In addition, the effects of increases in temperature may be associated with life strategies. Therefore, the fuzzy set theory was used to evaluate the effects of temperature increase on the natural mortality of fish, considering different life strategies. The model showed that the increase in temperature increased the uncertainties in M estimates for all species, regardless of the life strategy. However, opportunistic species present greater uncertainties in estimates of M compared to equilibrium species. The patterns found in uncertainties of M associated with species groupings by life strategies can be used in holistic approaches for the assessment and management of recently exploited fisheries resources or for those with limited biological data.

Tracking excess of maternal deaths associated with COVID-19 in Brazil: a nationwide analysis.

BACKGROUND: The COVID-19 pandemic brought a new challenge to maternal mortality in Brazil. Throughout 2020, Brazil registered 549 maternal deaths, mainly in second and third-trimester pregnant women. The objective of this study was to estimate the excess maternal deaths in Brazil caused directly and indirectly by Covid-19 in the year 2020. In addition, we sought to identify clinical, social and health care factors associated with the direct maternal deaths caused by Covid-19. METHODS: We performed nationwide analyses based on data from the Mortality Information System (SIM) for general and maternal deaths and the Influenza Epidemiological Surveillance System (SIVEP-Influenza) for estimates of female and maternal deaths due to COVID-19. Two distinct techniques were adopted. First, we describe maternal deaths directly caused by covid-19 and compare them with the historical series of deaths from covid-19 among women of childbearing age (15 to 49 years). Next, we estimated the total excess maternal mortality. Then, we calculated odds ratios for symptoms, comorbidities, social determination proxies and hospital care aspects between COVID-19 maternal deaths and deaths of women of childbearing age who were not pregnant or no maternal deaths. We chose women of childbearing age (15 to 49 years) as a reference because sex and age introduce differentials in the risk of COVID-19 death. RESULTS: Most maternal deaths occurred during pregnancy compared to postpartum deaths month by month in 2020 (µ = 59.8%, SD = 14.3%). The excess maternal mortality in 2020 in Brazil was 1.40 (95% CI 1.35-1.46). Even considering excess mortality due to COVID-19 for the childbearing age female population (MMR 1.14; 95% CI 1.13-1.15), maternal mortality exceeded the expected number. The odds of being a black woman, living in a rural area and being hospitalized outside the residence municipality among maternal deaths were 44, 61 and 28% higher than the control group. Odds of hospitalization (OR 4.37; 95% CI 3.39-5.37), ICU admission (OR 1.73; 95% CI 1.50-1.98) and invasive ventilatory support use (OR 1.64; CI 95% 1.42-1.86) among maternal deaths were higher than in the control group. CONCLUSIONS: There was excess maternal mortality in 2020 in Brazil. Even with adjustment for the expected excess mortality from Covid-19 in women of childbearing age, the number of maternal deaths exceeds expectations, suggesting that there were deaths among pregnant and postpartum women indirectly caused by the pandemic, compromising access to prenatal care., adequate childbirth and puerperium.