Incursion of Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Virus, Brazil, 2023.

We report 4 highly pathogenic avian influenza A(H5N1) clade 2.3.4.4.b viruses in samples collected during June 2023 from Royal terns and Cabot's terns in Brazil. Phylodynamic analysis revealed viral movement from Peru to Brazil, indicating a concerning spread of this clade along the Atlantic Americas migratory bird flyway.

Insight into the role of copper-based materials against the coronaviruses MHV-3, a model for SARS-CoV-2, during the COVID-19 pandemic.

Coating high-touch surfaces with inorganic agents, such as metals, appears to be a promising long-term disinfection strategy. However, there is a lack of studies exploring the effectiveness of copper-based products against viruses. In this study, we evaluated the cytotoxicity and virucidal effectiveness of products and materials containing copper against mouse hepatitis virus (MHV-3), a surrogate model for SARS-CoV-2. The results demonstrate that pure CuO and Cu possess activity against the enveloped virus at very low concentrations, ranging from 0.001 to 0.1% (w/v). A greater virucidal efficacy of CuO was found for nanoparticles, which showed activity even against viruses that are more resistant to disinfection such as feline calicivirus (FCV). Most of the evaluated products, with concentrations of Cu or CuO between 0.003 and 15% (w/v), were effective against MHV-3. Cryomicroscopy images of an MHV-3 sample exposed to a CuO-containing surface showed extensive damage to the viral capsid, presumably due to the direct or indirect action of copper ions.

Severe maternal morbidity: a case-control study in Maranhao, Brazil.

BACKGROUND: Maternal mortality and morbidity are among the top public health priorities in Brazil, being quite high, especially among the most disadvantage women. A case control study was developed to identify risk factors for severe maternal morbidity in Sao Luis, one of the poorest Brazilian State Capitals. METHODS: The case-control study was carried out between 01/03/2009 and 28/02/2010 in two public high-risk maternities facilities and in two intensive care units (ICUs) for referral of obstetric cases. All cases hospitalized due to complications during gestation period, childbirth or up to 42 days of puerperium and who fulfilled any of Mantel's and/or Waterstone's criteria were identified. Two controls per case were randomly selected among patients of the same clinics discharged for other reasons. Data were obtained through a structured interview as well as from medical charts and prenatal cards and included sociodemographic variables, clinical and obstetric histories, behavioral factors and exposure to stress factors during pregnancy, pre-natal assistance and obstetric complication and childbirth care. RESULTS: In the final model of the unconditional logistic regression analysis, being older than 35 years (OR=3.11; 95% CI:1.53-6.31), previous hypertension (OR=2.52; 95% CI:1.09-5.80), history of abortion (OR=1.61; 95% CI:0.97-2.68), 4-5 pre-natal consultations (OR=1.78; 95% CI:1.05-3.01) and 1-3 pre-natal consultations (OR=1.89; 95% CI:1.03-3.49) were independently associated with severe maternal morbidity. CONCLUSIONS: The results corroborate the importance of reproductive healthcare, of identifying a high-risk pregnancy and of a qualified and complete prenatal care to prevent severe morbid events.

Coding-Complete Genome Sequence of Murine Hepatitis Virus Strain 3 from Brazil.

Murine hepatitis virus (MHV) strain 3, one of the most important inducers of viral hepatitis, has been extensively studied as an organism to gain a better understanding of coronavirus biology and pathogenesis. Only one sequence is currently available. Another representative isolate has now been sequenced and added to the arsenal of MHV-3 variants.

Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study.

OBJECTIVES: Data on cardiac arrest survivors from developing countries are scarce. This study investigated clinical characteristics associated with in-hospital mortality in resuscitated patients following cardiac arrest in Brazil. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Ninety-two general ICUs from 55 hospitals in Brazil between 2014 and 2015. PATIENTS: Adult patients with cardiac arrest admitted to the ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed 2,296 patients (53% men; median 67 yr (interquartile range, 54-79 yr]). Eight-hundred patients (35%) had a primary admission diagnosis of cardiac arrest suggesting an out-of-hospital cardiac arrest; the remainder occurred after admission, comprising an in-hospital cardiac arrest cohort. Overall, in-hospital mortality was 83%, with only 6% undergoing withholding/withdrawal-of-life support. Random-effects multivariable Cox regression was used to assess associations with survival. After adjusting for age, sex, and severity scores, mortality was associated with shock (adjusted odds ratio, 1.25 [95% CI, 1.11-1.39]; p < 0.001), temperature dysregulation (adjusted odds ratio for normothermia, 0.85 [95% CI, 0.76-0.95]; p = 0.007), increased lactate levels above 4 mmol/L (adjusted odds ratio, 1.33 [95% CI, 1.1-1.6; p = 0.009), and surgical or cardiac cases (adjusted odds ratio, 0.72 [95% CI, 0.6-0.86]; p = 0.002). In addition, survival was better in patients with probable out-of-hospital cardiac arrest, unless ICU admission was delayed (adjusted odds ratio for interaction, 1.63 [95% CI, 1.21-2.21]; p = 004). CONCLUSIONS: In a large multicenter cardiac arrest cohort from Brazil, we found a high mortality rate and infrequent withholding/withdrawal of life support. We also identified patient profiles associated with worse survival, such as those with shock/hypoperfusion and arrest secondary to nonsurgical admission diagnoses. Our findings unveil opportunities to improve postarrest care in developing countries, such as prompt ICU admission, expansion of the use of targeted temperature management, and implementation of shock reversal strategies (i.e., early coronary angiography), according to modern guidelines recommendations.

Elderly patients with cancer admitted to intensive care unit: A multicenter study in a middle-income country.

BACKGROUND: Very elderly critically ill patients (ie, those older than 75 or 80 years) are an increasing population in intensive care units. However, patients with cancer have encompassed only a minority in epidemiological studies of very old critically-ill patients. We aimed to describe clinical characteristics and identify factors associated with hospital mortality in a cohort of patients aged 80 or older with cancer admitted to intensive care units (ICUs). METHODS: This was a retrospective cohort study in 94 ICUs in Brazil. We included patients aged 80 years or older with active cancer who had an unplanned admission. We performed a mixed effect logistic regression model to identify variables independently associated with hospital mortality. RESULTS: Of 4604 included patients, 1807 (39.2%) died in hospital. Solid metastatic (OR = 2.46; CI 95%, 2.01-3.00), hematological cancer (OR = 2.32; CI 95%, 1.75-3.09), moderate/severe performance status impairment (OR = 1.59; CI 95%, 1.33-1.90) and use of vasopressors (OR = 4.74; CI 95%, 3.88-5.79), mechanical ventilation (OR = 1.54; CI 95%, 1.25-1.89) and renal replacement (OR = 1.81; CI 95%, 1.29-2.55) therapy were independently associated with increased hospital mortality. Emergency surgical admissions were associated with lower mortality compared to medical admissions (OR = 0.71; CI 95%, 0.52-0.96). CONCLUSIONS: Hospital mortality rate in very elderly critically ill patients with cancer with unplanned ICU admissions are lower than expected a priori. Cancer characteristics, performance status impairment and acute organ dysfunctions are associated with increased mortality.

Green tea extract outperforms metformin in lipid profile and glycaemic control in overweight women: A double-blind, placebo-controlled, randomized trial.

BACKGROUND & AIMS: Both green tea and metformin are used as adjuvants to treat and prevent complications associated with obesity; however, studies comparing their action and interaction in non-diabetic overweight women have not been reported. Thus, the current study evaluated the effects of green tea extract and metformin, both individually and in combination, on type 2 diabetes risk factors in non-diabetic overweight women. METHODS: A total of 120 overweight women were randomly assigned in a double-blind manner to 1 of 4 groups, as follows: control (n = 29; 1 g of cellulose), green tea (n = 32; 1 g of dry green tea extract), metformin (n = 28; 1 g of metformin), and green tea + metformin (n = 31; 1 g of dry green tea extract + 1 g of metformin). Each group took the indicated capsules daily for 12 weeks. Anthropometric measurements, body composition, and fasting blood samples were evaluated. RESULTS: Although no significant interactions were observed in glycaemic control (p = 0.07), green tea in the absence of metformin reduced fasting glucose (-4.428 ± 2.00; p = 0.031), but when combined the lowering effect was nullified. In contrast, metformin increased HbA1c concentration (0.048 ± 0.189%; p = 0.017) and also reduced body weight (-1.318 ± 0.366 kg; p = 0.034) and LM (lean mass) (-1.249 ± 0.310; p = 0.009). Regarding lipid parameters, green tea significantly reduced total cholesterol and LDL-c. CONCLUSIONS: Green tea was superior to metformin in improving glycaemic control and lipid profile in non-diabetic overweight women and, therefore, green tea extract is a promising alternative for reducing type 2 diabetes risk in overweight women.

Quality in intensive care units: proposal of an assessment instrument.

BACKGROUND: There is an increasing need for standardized instruments for quality assessment that are able to reflect the actual conditions of the intensive care practices, especially in low and middle-income countries. The aim of this article is to describe the preparation of an instrument for quality assessment of adult intensive care services adapted to the actual conditions of intensive care in a middle-income country and comprising indicators validated in the literature. METHODS: The study consisted of five steps: (1) a literature survey; (2) a discussion with specialists by consensus method; (3) a pilot field test; (4) a description of indicators; and (5) an elaboration of the final version of the instrument. Each generated indicator was attributed a score ("out of standard" = 0; "below standard" = 1; "standard" = 2) that allowed calculation of the total score for each service assessed. RESULTS: A total of 62 indicators were constructed, distributed as follows: 38 structure indicators (physical structure: 4; human resources: 14; continued education and training: 2; protocols and routines: 12; material resources: 6); 17 process indicators (safety: 7; work: 10); and seven outcome indicators. The maximum possible total score was 124. CONCLUSIONS: Possible future applications of the instrument for the assessment of intensive care units that was constructed in the present study include benchmarking, multicenter studies, self-assessment of intensive care units, and evaluation of changes resulting from interventions.

Das provas operatórias à construção de estruturas cognitivas: um estudo de caso em psicopedagogia / From operational tests to the cognitive structures construction: A case study in Psychopedagogy

O artigo apresenta um estudo de caso com foco nas provas operatórias de Jean Piaget utilizadas numa avaliação psicopedagógica com uma criança de 9 anos. A análise das provas operatórias apontou que ela apresentava um ritmo de desenvolvimento do raciocínio mais lento do que a média. Apresentamos, então, propostas de intervenção psicopedagógica, que tiveram por base as teorias de Jean Piaget e de Vygotsky, visando contribuir no processo de desenvolvimento do pensamento lógico de sujeitos que apresentam dificuldades para aprender, como é o caso do sujeito avaliado.

This paper presents a case study focused in the operational tests of Jean Piaget used in a psychopedagogical evaluation of a 9-years-old child. The analysis of the operational tests showed that the young boy exhibited a slower reasoning rhythm compared to the average. Therefore, we presented psychopedagogical intervention proposals, which were based on Jean Piaget and Vygotsky theories, aiming to contribute to the development process of the reasoning logical of individuals who exhibit learning disabilities, as occurs to the person evaluated in this study.

Karyotype diversity and the origin of grapefruit.

Grapefruit is a group of citrus of recent origin, probably resulting from a cross between pummelo and sweet-orange. Aiming to investigate this putative origin and the genetic variability among grapefruit cultivars, the karyotype of six grapefruits, two pummelos, and one tangelo cultivar (grapefruit x tangerine) were analyzed using sequential CMA/DAPI double staining and FISH with rDNA probes. The karyotypes of grapefruit 'Duncan' and 'Foster' differ from those of 'Flame', 'Henderson', 'Marsh' and 'Rio Red'. The former have two chromosomes with a single CMA(+) band in both terminal regions (C type chromosome) and six chromosomes with only one CMA(+) terminal band (D type), whereas the latter have three C and five D type chromosomes. All accessions investigated exhibited two chromosomes with 5S rDNA but a variable number of 45S rDNA. The two former grapefruits displayed four 45S rDNA sites, whereas the remaining grapefruit cultivars had five. The two pummelos showed identical karyotypes, homozygous for CMA(+) bands and their four rDNA sites. From each pummelo chromosome pair one chromosome seems to be present in grapefruit karyotypes. The different grapefruit karyotypes might result from independent crosses between pummelos of different karyotypic constitution and sweet-oranges. The chromosome markers found in the tangelo 'Orlando' and the position of their two 45S rDNA confirm the grapefruit 'Duncan' and the tangerine 'Dancy' as their parents.