Untargeted Metabolomic to Access Chemical Differences Induced by Dual Endophyte Cultures Isolated from Euphorbia Umbellata.

Endophytic fungi live asymptomatically inside vegetal tissues, and such uncommon habitat contributes to their exceptional chemical diversity. Isolating natural products from endophytic fungi could fail due to silent biosynthetic gene clusters under ordinary in vitro culture conditions, and co-culturing has been assayed to trigger their metabolism. We carried out single and dual cultures with 13 endophyte strains isolated from Euphorbia umbellata leaves. Multivariate statistics applied to untargeted metabolomics compared the chemical profiles of all endophyte cultures. PCA analysis guided the selection of the Aspergillus pseudonomiae J1 - Porogramme brasiliensis J9 dual culture for its most significant chemical differentiation: Five compounds were putatively annotated in the J1-J9 culture according to UHPLC-HRMS data, kojic acid, haliclonol and its diastereoisomer, caffeic acid, and 2-(3,4-dihydroxyphenyl)acetaldehyde. Analysis by PLS-DA using VIP score showed that kojic acid displayed the most significative importance in discriminating single and dual J1-J9 cultures.

Motivational drivers for health professionals in a large quality improvement collaborative project in Brazil: a qualitative study.

BACKGROUND: The success of collaborative quality improvement (QI) projects in healthcare depends on the context and engagement of health teams; however, the factors that modulate teams' motivation to participate in these projects are still unclear. The objective of the current study was to explore the barriers to and facilitators of motivation; the perspective was health professionals in a large project aiming to implement evidence-based infection prevention practices in intensive care units of Brazilian hospitals. METHODS: This qualitative study was based on content analysis of semistructured in-depth interviews held with health professionals who participated in a collaborative QI project named "Improving patient safety on a large scale in Brazil". In accordance with the principle of saturation, we selected a final sample of 12 hospitals located throughout the five regions of Brazil that have implemented QI; then, we conducted videoconference interviews with 28 health professionals from those hospitals. We encoded the interview data with NVivo software, and the interrelations among the data were assessed with the COM-B model. RESULTS: The key barriers identified were belief that improvement increases workload, lack of knowledge about quality improvement, resistance to change, minimal involvement of physicians, lack of supplies, lack support from senior managers and work overload. The primary driver of motivation was tangible outcomes, as evidenced by a decrease in infections. Additionally, factors such as the active participation of senior managers, teamwork, learning in practice and understanding the reason for changes played significant roles in fostering motivation. CONCLUSION: The motivation of health professionals to participate in collaborative QI projects is driven by a variety of barriers and facilitators. The interactions between the senior manager, quality improvement teams, and healthcare professionals generate attitudes that modulate motivation. Thus, these aspects should be considered during the implementation of such projects. Future research could explore the cost-effectiveness of motivational approaches.

Twenty-first-century demographic and social inequalities of heat-related deaths in Brazilian urban areas.

Population exposure to heat waves (HWs) is increasing worldwide due to climate change, significantly affecting society, including public health. Despite its significant vulnerabilities and limited adaptation resources to rising temperatures, South America, particularly Brazil, lacks research on the health impacts of temperature extremes, especially on the role played by socioeconomic factors in the risk of heat-related illness. Here, we present a comprehensive analysis of the effects of HWs on mortality rates in the 14 most populous urban areas, comprising approximately 35% of the country's population. Excess mortality during HWs was estimated through the observed-to-expected ratio (O/E) for total deaths during the events identified. Moreover, the interplay of intersectionality and vulnerability to heat considering demographics and socioeconomic heterogeneities, using gender, age, race, and educational level as proxies, as well as the leading causes of heat-related excess death, were assessed. A significant increase in the frequency was observed from the 1970s (0-3 HWs year-1) to the 2010s (3-11 HWs year-1), with higher tendencies in the northern, northeastern, and central-western regions. Over the 2000-2018 period, 48,075 (40,448-55,279) excessive deaths were attributed to the growing number of HWs (>20 times the number of landslides-related deaths for the same period). Nevertheless, our event-based surveillance analysis did not detect the HW-mortality nexus, reinforcing that extreme heat events are a neglected disaster in Brazil. Among the leading causes of death, diseases of the circulatory and respiratory systems and neoplasms were the most frequent. Critical regional differences were observed, which can be linked to the sharp North-South inequalities in terms of socioeconomic and health indicators, such as life expectancy. Higher heat-related excess mortality was observed for low-educational level people, blacks and browns, older adults, and females. Such findings highlight that the strengthening of primary health care combined with reducing socioeconomic, racial, and gender inequalities represents a crucial step to reducing heat-related deaths.

Biotransformation of progesterone by endophytic fungal cells immobilized on electrospun nanofibrous membrane.

Biotransformation of steroids by fungi has been raised as a successful, eco-friendly, and cost-effective biotechnological alternative for chemical derivatization. Endophytic fungi live inside vegetal tissues without causing damage to the host plant, making available unique enzymes that carry out uncommon reactions. Moreover, using nanofibrous membranes as support for immobilizing fungal cells is a powerful strategy to improve their performance by enabling the combined action of adsorption and transformation processes, along with increasing the stability of the fungal cell. In the present study, we report the use of polyacrylonitrile nanofibrous membrane (PAN NFM) produced by electrospinning as supporting material for immobilizing the endophytic fungus Penicillium citrinum H7 aiming the biotransformation of progesterone. The PAN@H7 NFM displayed a high progesterone transformation efficiency (above 90%). The investigation of the biotransformation pathway of progesterone allowed the putative structural characterization of its main fungal metabolite by GC-MS analysis. The oxidative potential of P. citrinum H7 was selective for the C-17 position of the steroidal nucleus.

A scoping review about LGBTQIAP+ people in oral health research.

Oral health personnel must acknowledge the health needs of sexual and gender minorities. They should consult scientific literature to deepen their knowledge about sexuality, gender identity, general and oral health status, and treatment disparities among LGBTQIA+ people. The aim of this scoping review was to portray the development and current stage of internationally indexed literature approaching the oral health of this population. In this study, the search strategy used consisted of combinations of subject descriptors (MeSH terms), in two concept blocks: LGBTQIAP+ people and oral health. Global literature was searched through Medline (PUBMED), Web of Science, Embase, Lilacs, and Scopus electronic databases, with no language or date restrictions. Records were selected and evaluated by two independent reviewers, under the supervision of three senior reviewers and the inclusion criteria resulted in 189 eligible papers. Since the first study was published in 1974, numbers increased over the decades, reaching 67 (35.4%) in 2010-2019. The most frequently studied populations were North American (42.9%) and European (19.0%) and the most frequent language of publication was English (99.0%). There were 38 open access papers (20.1%). Medical (57.7%) and dental journals (20.1%) predominated. Cross-sectional studies were found more frequently (65.1%), followed by the cohort type (11.1%). Oral manifestation of STI (58.7%) was the topic most frequently addressed. The search for literature approaching the oral health of LGBTQIAP+ people showed evidence of the need to encourage research reported in papers made easily available, with more robust scientific evidence, and on a broader scope of topics, including oral health needs and treatment, and planning of oral health services.

Effect of shading on the physiological and reproductive parameters in Nelore cows.

This study aimed to evaluate the physiological and reproductive parameters of Nelore cows under various microclimatic conditions. The experiment was performed in Central Brazil, which has a tropical climate with dry winters and rainy summers. The experimental groups were divided into an area with shading (5.8 trees/ha; n = 42) and an area with little shading (0.4 trees/ha; n = 42). The physiological (heart rate, respiratory rate, rectal temperature, surface body temperature, and vaginal temperature) and reproductive (estrus detection, conception rate, and rate of pregnancy loss) parameters were then assessed. The rectal temperature (p = 0.002); surface body temperature on the flanks, forehead, and shoulder (p < 0.001); and vaginal temperature (p < 0.001) of cows in the group with shading were significantly lower than those of cows in the group without shading. Estrus was higher (p = 0.08) in the shaded group; however, no effect was observed on conception and pregnancy loss rates. In conclusion, shading (5.8 trees/ha) provided better thermal comfort for Nelore animals in the tropical climatic region. However, this did not affect their performance after fixed-time artificial insemination.

National School Feeding Program (PNAE): A Public Policy That Promotes a Learning Framework and a More Sustainable Food System in Rio Grande do Sul, Brazil.

Food systems drive change, which can accelerate the process of ending hunger, improving diets and protecting the environment. This is the attribution given to the Brazilian National School Feeding Program (Programa Nacional de Alimentação Escolar-PNAE), which was created to supply 15% of the food needs of millions of children in Brazilian schools. Therefore, the purpose of this article was to create a framework to analyze learnings in the PNAE that contribute to the development of a sustainable food system in the state of Rio Grande do Sul, Brazil. For this, a qualitative descriptive survey with abductive logic was chosen through a study of multiple cases and semistructured interviews as its strategy. It was noticed that individuals tended to group themselves in accordance with their learning level. A group in which instrumental learning was prevailing would tend to strictly follow the rules. Groups that already had communicative learning would be more proactive and look for improvements. However, when they would reach emancipatory learning, they would become more willing to disrupt initiatives to create new perspectives to solve problems. From that, decisions became political, and the more organized the groups became, the more power they had to allow their ideas to prevail.

Semen quality of Nellore and Angus bulls classified by fertility indices and relations with field fertility in fixed-time artificial insemination.

Despite being the most important form of biotechnology in animal reproduction, artificial insemination was used in about 23% of Brazilian bovine herds in 2021. This is due to the variability of results caused by varying bull fertility and body condition of the cows. This study aimed to correlate the fertility indices of bulls with qualitative attributes of the semen. Semen samples from 28 bulls (Nellore and Angus) were used to evaluate postthaw sperm morphology and kinetics using conventional analysis, image-based flow cytometry (IBFC) and computer-assisted semen analysis (CASA). The fertility index was effective in separating bulls into 4 different fertility classes (P < 0.001), and fertility rates in timed artificial insemination (TAI) remained constant between the cows' fertility categories (P < 0.001) and in the different grades of female body condition (P < 0.005). After partial least squares regression (PLS) analysis, four models were proposed with different variables. The coefficients of determination for the conventional analysis, CASA, and IBCFC models were 0.154, 0.380, and 0.259, respectively. The composite model, including select IBFC and CASA parameters, showed a greater R2 (0.481) with progressive motility, average speed (VAP, µm/s), membrane integrity, and mitochondrial potential, showing a positive effect. Linear speed (VSL, µm/s) and acrosomal integrity had a negative effect on bull fertility indices. Bulls classified by the fertility index attained dispersed pregnancy rates in different cow body condition score (BCS) classes, and the sperm quality pattern was consistent with this classification. In conclusion, this novel composite model including CASA and IBFC parameters improves the prediction of bull fertility used in TAI.

Assessment of clinical characteristics and viral load in individuals infected by Delta and Omicron variants of SARS-CoV-2.

In late 2021, a new variant of SARS-CoV-2 called Omicron emerged, replacing Delta worldwide. Although it has been associated with a lower risk of hospitalization and severe forms of COVID-19, there is little evidence of its relationship with specific symptoms and viral load. The aim of this study was to verify the relationship between Delta and Omicron variants of concern, viral load, and the occurrence of symptoms in individuals with COVID-19. Nasopharyngeal swab samples were collected and sequenced from patients with COVID-19 from the Northeast Region of Brazil between August 2021 and March 2022. The results showed a gradual replacement of the Delta variant by the Omicron variant during the study period. A total of 316 samples (157 Delta and 159 Omicron) were included. There was a higher prevalence of symptoms in Delta-infected individuals, such as coryza, olfactory and taste disturbances, headache, and myalgia. There was no association between viral load and the variants analyzed. The results reported here contribute to the understanding of the symptoms associated with the Delta and Omicron variants in individuals affected by COVID-19.

Endophytic fungus from Handroanthus impetiginosus immobilized on electrospun nanofibrous membrane for bioremoval of bisphenol A.

The current industrial and human activities scenario has accelerated the widespread use of endocrine-disrupting compounds (EDCs), which can be found in everyday products, including plastic containers, bottles, toys, cosmetics, etc., but can pose a severe risk to human health and the environment. In this regard, fungal bioremediation appears as a green and cost-effective approach to removing pollutants from water resources. Besides, immobilizing fungal cells onto nanofibrous membranes appears as an innovative strategy to improve remediation performance by allowing the adsorption and degradation to occur simultaneously. Herein, we developed a novel nanostructured bioremediation platform based on polyacrylonitrile nanofibrous membrane (PAN NFM) as supporting material for immobilizing an endophytic fungus to remove bisphenol A (BPA), a typical EDC. The endophytic strain was isolated from Handroanthus impetiginosus leaves and identified as Phanerochaete sp. H2 by molecular methods. The successful assembly of fungus onto the PAN NFM surface was confirmed by scanning electron microscopy (SEM). Compared with free fungus cells, the PAN@H2 NFM displayed a high BPA removal efficiency (above 85%) at an initial concentration of 5 ppm, suggesting synergistic removal by simultaneous adsorption and biotransformation. Moreover, the biotransformation pathway was investigated, and the chemical structures of fungal metabolites of BPA were identified by ultra-high performance liquid chromatography - high-resolution mass (UHPLC-HRMS) analysis. In general, our results suggest that by combining the advantages of enzymatic activity and nanofibrous structure, the novel platform has the potential to be applied in the bioremediation of varied EDCs or even other pollutants found in water resources.

Autophagy signaling in hypertrophied muscles of diabetic and control rats.

Autophagy plays a vital role in cell homeostasis by eliminating nonfunctional components and promoting cell survival. Here, we examined the levels of autophagy signaling proteins after 7 days of overload hypertrophy in the extensor digitorum longus (EDL) and soleus muscles of control and diabetic rats. We compared control and 3-day streptozotocin-induced diabetic rats, an experimental model for type 1 diabetes mellitus (T1DM). EDL muscles showed increased levels of basal autophagy signaling proteins. The diabetic state did not affect the extent of overload-induced hypertrophy or the levels of autophagy signaling proteins (p-ULK1, Beclin-1, Atg5, Atg12-5, Atg7, Atg3, LC3-I and II, and p62) in either muscle. The p-ULK-1, Beclin-1, and p62 protein expression levels were higher in the EDL muscle than in the soleus before the hypertrophic stimulus. On the contrary, the soleus muscle exhibited increased autophagic signaling after overload-induced hypertrophy, with increases in Beclin-1, Atg5, Atg12-5, Atg7, Atg3, and LC3-I expression in the control and diabetic groups, in addition to p-ULK-1 in the control groups. After hypertrophy, Beclin-1 and Atg5 levels increased in the EDL muscle of both groups, while p-ULK1 and LC3-I increased in the control group. In conclusion, the baseline EDL muscle exhibited higher autophagy than the soleus muscle. Although TDM1 promotes skeletal muscle mass loss and strength reduction, it did not significantly alter the extent of overload-induced hypertrophy and autophagy signaling proteins in EDL and soleus muscles, with the two groups exhibiting different patterns of autophagy activation.

Cryopreservation of jaguar (Panthera onca) sperm cells using different cryoprotectants and different thawing temperatures.

The cryopreservation of jaguar semen must be improved to produce high-quality biobanking doses. Until now, the rare studies of semen freezing in the species have only evaluated glycerol, always with a significant reduction in sperm quality in thawed semen. The purpose of this study was to assess the efficacy of three cryoprotectants, dimethylsulfoxide (DMSO), glycerol (GLY), and methanol (MET), in the cryopreservation of jaguar semen in an LDL-based extender, as well as the effect of thawing temperature on dosage quality. Five mature males with a history of reproduction were used. On the males, an infrared thermal image (IRT) was captured, the spicules and testes were analyzed, and the CASA system was used to evaluate the quality of fresh and thawed sperm. The superficial IRT was 4.6 ± 1.2 °C cooler than the anal sphincter, and the semen measured between 27.3 and 28.7 °C shortly after exiting the urethra. The total motility of fresh sperm was 55.3 ± 22.6%, and progressive motility was 36.3 ± 18%. The total motility of thawed sperm was 5.28 ± 2.51%, 4.49 ± %2.49, and 0.51 ± 0.62% for DMSO, GLY, and MET, respectively. DMSO and GLY performed better than MET, and there was no difference in thawing temperature (37°C 30 s vs. 50°C 12 s). All animals exhibit a considerable level of morphological changes in sperm. Low amounts of total and progressive motility were found in the thawed sperm. Males with a high level of sperm morphological changes were found to be fertile, but the lone male with normospermia was infertile. Thus, we contest the applicability of the commonly used morphological classification for bovines to felid species.

Impact of quercetin, carnosine, and ozone in the cryopreservation on Nellore (Bos indicus) semen.

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.

Occult hepatitis C infection identified in injection drug users with direct antiviral agents therapy and spontaneous resolution of hepatitis C virus infection.

BACKGROUND: Occult hepatitis C infection (OCI) is characterized by the detection of hepatitis C virus (HCV) RNA in hepatocytes and in peripheral blood mononuclear cells (PBMCs) without detection in serum. We aimed to evaluate OCI in drug and no drug users who achieved sustained virological response (SVR) after therapy with direct-acting antivirals (DAAs) and with HCV spontaneous resolution. METHODS: Twenty-four patients in the AVP group (who achieved a SVR after DAAs therapy), 13 in the NAVP group (with HCV spontaneous resolution) and 7 HCV-RNA positive patients (CPP, control positive group) were included in the study. HCV/OCI-RNA was screened in serum and PBMCs samples of the patients by ddPCR for OCI patients' identification. Plasma and red blood cells (RBCs) samples of the patients were also evaluated for HCV/OCI-RNA detection by ddPCR. RESULTS: OCI was presented in injection drug users (IDUs) in the AVP (20.8%) and NAVP (23.1%) groups by ddPCR with a higher statistically significant percentage detected in RBCs samples of the patients in the AVP group comparatively to NAVP (p<0.01) and CPP (p < 0.05) groups. CONCLUSION: OCI was identified in IDUs patients of the AVP and NAVP groups by ddPCR. These results suggest that OCI patients in the AVP group might not be entirely cured, and that OCI patients in the NAVP group were not identified at clinical evaluation time when just serum samples were analysed. A higher percentage of HCV/OCI-RNA was detected in RBCs samples. Overall results recommends that HCV/OCI identification in patients with DAAs therapy and spontaneous resolution of HCV infection should be studied more accurately in future and in larger patient groups if possible. Additionally, suggest also PBMCs and RBCs samples as predictors for HCV/OCI diagnosis and management.

Prevalence of childhood obesity in Brazil: a systematic review.

The present study aimed to analyze the prevalence of childhood obesity in Brazil and compare it between boys and girls. This systematic review was conducted and reported according to the guidelines outlined in the PRISMA statement. A systematic search of electronic databases, including PubMed, LILACS, and SciELO, was performed in November 2021. Studies that met the following criteria were included: (i) original quantitative studies regardless of their design; (ii) childhood obesity was clearly defined; (iii) prevalence of childhood obesity was reported or it was possible to extract from tables or figures in the text; and (iv) eligible population included children under 12 years of age. A total of 112 articles were included in the systematic review. The prevalence of childhood obesity in Brazil was of 12.2%, being 10.8% in girls and 12.3% in boys. In addition, wide heterogeneity in the childhood obesity prevalence was observed between the states, since it was 2.6% in Pará, while it was 15.8% in Rondônia. Thus, the importance of urgently implementing measures to prevent and treat childhood obesity should be emphasized aiming to reduce obese children and adolescents and future health problems in adult life resulting from this cardiovascular risk factor.

Biotransformation of hydroxychloroquine to evaluate the cytotoxicity of its metabolites and mimic mammalian metabolism.

Hydroxychloroquine (HCQ) displays attractive anti-inflammatory and antiviral effects. Because of that, such a drug made part of some clinical trials for combating Sars-CoV-2 during the COVID-19 pandemic. The present study aimed to conduct the biotransformation of HCQ by filamentous fungi reported as microbial models of mammalian drug metabolism to evaluate its cytotoxic after metabolization. Cunninghamella echinulata var. elegans ATCC 8688a could efficiently biotransform HCQ into one main metabolite identified as the new 4-(1,2,3,4-tetrahydroquinolin-4-ylamino)pentan-1-ol (HCQ-M). The microbial transformation occurred through N-dealkylation, 7-chloro-elimination, and reduction of the two conjugated double-bond from the quinoline system of HCQ. The cytotoxic profiles of HCQ and its metabolite were evaluated using CCD-1059Sk cells (human fibroblasts) through sulforhodamine B, trypan blue, and Live/Dead assays. Both HCQ and HCQ-M displayed cytotoxic activities in human fibroblasts, but HCQ-M was significantly more toxic than HCQ. The reported findings should be considered for further clinical studies of HCQ and will be important for guidance in achieving new derivatives from it.

Competências percebidas na condução de rodas de conversas para a promoção da saúde: relato de experiência / Perceived skills in conducting conversation circles for health promotion: experience report

O estudo discute as competências envolvidas na condução de rodas de conversas. Trata-se de um relato analítico e reflexivo desenvolvido a partir das experiências dos estudantes da disciplina de Promoção da Saúde de um programa de Mestrado Profissional em Saúde da Família, Mato Grosso do Sul, Brasil. As experiências foram registradas no formato de relatórios de experiências e enfatizaram o uso de rodas de conversas em Unidades de Saúde da Família. A partir do corpus documental, foram levantados o público- alvo, temáticas/objetivos e quatro competências aplicadas para o desenvolvimento das rodas de conversa, a saber: aprender a conhecer, aprender a fazer, aprender a conviver, e aprender a ser. Observou-se que o público-alvo e as temáticas desenvolvidas nas rodas de conversas foram relacionados a situação epidemiológica do território. Ainda, foi identificado que a técnica é frequentemente baseada no referencial teórico de Paulo Freire, com etapas sistematizadas. As competências de saber conhecer e saber fazer foram desafiantes. As competências saber conviver e ser destacaram- se positivamente nas experiências descritas. Por fim, as experiências revelaram que há competências que precisam ser aprimoradas para a condução de rodas de conversas, com vistas a alcançar o seu potencial transformador.

A scoping review about LGBTQIAP+ people in oral health research

Abstract Oral health personnel must acknowledge the health needs of sexual and gender minorities. They should consult scientific literature to deepen their knowledge about sexuality, gender identity, general and oral health status, and treatment disparities among LGBTQIA+ people. The aim of this scoping review was to portray the development and current stage of internationally indexed literature approaching the oral health of this population. In this study, the search strategy used consisted of combinations of subject descriptors (MeSH terms), in two concept blocks: LGBTQIAP+ people and oral health. Global literature was searched through Medline (PUBMED), Web of Science, Embase, Lilacs, and Scopus electronic databases, with no language or date restrictions. Records were selected and evaluated by two independent reviewers, under the supervision of three senior reviewers and the inclusion criteria resulted in 189 eligible papers. Since the first study was published in 1974, numbers increased over the decades, reaching 67 (35.4%) in 2010-2019. The most frequently studied populations were North American (42.9%) and European (19.0%) and the most frequent language of publication was English (99.0%). There were 38 open access papers (20.1%). Medical (57.7%) and dental journals (20.1%) predominated. Cross-sectional studies were found more frequently (65.1%), followed by the cohort type (11.1%). Oral manifestation of STI (58.7%) was the topic most frequently addressed. The search for literature approaching the oral health of LGBTQIAP+ people showed evidence of the need to encourage research reported in papers made easily available, with more robust scientific evidence, and on a broader scope of topics, including oral health needs and treatment, and planning of oral health services.

IMPACTO-MR: um estudo brasileiro de plataforma nacional para avaliar infecções e multirresistência em unidades de terapia intensiva / IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units

RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.

ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

Assistência a pacientes com doenças imunoalérgicas no Sistema Único de Saúde brasileiro ­ Carta de São Paulo / Treating patients with allergic diseases in the Brazilian Unified Health System ­ Letter from São Paulo

O Sistema Único de Saúde (SUS) abrange todos os níveis de atenção à saúde e garante acesso integral, universal e gratuito para toda a população brasileira. As transições demográfica e epidemiológica observadas nas últimas décadas trouxeram um cenário de maior prevalência das doenças imunoalérgicas. Nesse contexto, a implementação de políticas de saúde voltadas à assistência à saúde dessa população tornou-se um desafio. Com o objetivo de discutir a atenção à saúde dos pacientes com doenças alérgicas e imunológicas no Brasil, a Associação Brasileira de Alergia e Imunologia (ASBAI) realizou em 26 de agosto de 2022, na cidade de São Paulo, o Fórum sobre a Assistência a Pacientes com Doenças Imunoalérgicas no SUS. O evento foi estruturado no formato de painéis e contou com a participação de membros da ASBAI e representantes da gestão pública federal, do Ministério Público, de sociedade de pacientes e profissionais de saúde de diversos serviços com experiência em programas e projetos bem sucedidos na assistência a pacientes com doenças imunoalérgicas. Após a discussão, concluiu-se que ainda existem muitas necessidades não atendidas em relação à atenção à saúde da população com doenças alérgicas e imunológicas no Brasil. A ASBAI tem trabalhado no sentido de contribuir para organizar, implantar e manter a assistência a estes pacientes no âmbito do SUS.

The Brazilian Unified Health System covers all levels of health care and guarantees full, universal and free access for the entire population. The demographic and epidemiological transitions observed in recent decades have led to a higher prevalence of allergic diseases. In this context, implementing health policies to benefit these patients has become a challenge. To discuss health care for patients with allergic and immunological diseases in Brazil, the Brazilian Association of Allergy and Immunology (ASBAI) held a forum in São Paulo on August 26, 2022 called "Treating Patients with Allergic Diseases in the Unified Health System". The event's panels included members of ASBAI, representatives of the federal government, the attorney general's office, patients, and health professionals from various services with experience in successful programs for patients with allergic diseases. It was concluded that there are still many unmet health care needs for Brazilians with allergic and immunological diseases. ASBAI is contributing to the organization, implementation, and maintenance of care for these patients within the scope of the Unified Health System.