Delays in obstetric care increase the risk of neonatal near-miss morbidity events and death: a case-control study.

BACKGROUND: To evaluate the association between delays in obstetric care and neonatal near-miss mortality events and death in a public maternity referral center. METHODS: This case-control study enrolled 142 neonates, meeting the near-miss criteria of 5-min Apgar < 7, weight < 1500 g, gestational age < 32 weeks, and use of mechanical ventilation or congenital malformation, as well as 284 controls (without the near-miss criteria), at a ratio of 1:2. After follow-up, the following outcomes were reclassified: survival of the neonatal period without the near-miss criteria (true "controls"), "near-miss," and "neonatal death." Maternal sociodemographic characteristics, prenatal care, and pregnancy resolution were evaluated. Pearson's chi-square and Fisher's exact tests were used. Simple logistic regression was performed to determine the association between the three delay factors with near-miss outcomes and/or neonatal death. The variables that had maintained values of p < 0.05 were subjected to multinomial logistic regression. RESULTS: Comparisons revealed the following associations: for controls and near-miss events, delayed access to health services due to a lack of specialized services (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8-5.1) and inappropriate conduct with the patient (OR, 12.1; 95% CI, 1.3-108.7); for controls and death, absent or inadequate prenatal care (OR, 3.3; 95% CI, 1.6-7.1) and delayed access to health services due to a lack of specialized services (OR, 2.5; 95% CI, 1.1-5.6); and for near-miss events and death, absent or inadequate prenatal care (OR, 2.2; 95% CI, 1.0-5.0). Logistic regression for the combined outcome (near-miss plus neonatal deaths) revealed absent or inadequate prenatal care (OR, 1.9; 95% CI, 1.2-2.8), lack of specialized services (OR, 2.8; 95% CI, 1.7-4.5), and improper conduct with the patient (OR, 10.6; 95% CI, 1.2-91.8). CONCLUSIONS: The delays in obstetric care associated with the presence of near-miss and/or neonatal death included absent or inadequate prenatal care, delayed access to health services due to a lack of specialized services, and inappropriate conduct with the patient.

Environmental monitoring of SARS-CoV-2 in the metropolitan area of Porto Alegre, Rio Grande do Sul (RS), Brazil.

Since starts the coronavirus disease 2019 (COVID-19) pandemic identified the presence of genomic fragments of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in various environmental matrices: domestic sewage, surface waters, and contaminated freshwater. Environmental monitoring of SARS-CoV-2 is a tool for evaluating trend curves over the months, compared to several clinical cases of the disease. The objective of this study was to monitor the SARS-CoV-2 in environmental samples collected in different sites in a metropolitan area of Porto Alegre, Southern Brazil. During 10 months from 2020 to 2021, 300 samples were collected weekly and biweekly from nine points located in 3 cities: one point from a wastewater treatment plant (WWTP) in São Leopoldo (fortnightly collection), two points in Dilúvio Stream in Porto Alegre (fortnightly collection), two points in Pampa and Luiz Rau Streams (weekly collection), and two points in public fountains (fortnightly collection) in Novo Hamburgo. After collection, samples were concentrated by ultracentrifugation, and viral nucleic acids were extracted using MagMax® Core Nucleic Acid Purifications kits and submitted to RT-qPCR, using E, N1, and N2 gene targets of SARS-CoV-2. Only 7% (3/41) samples from public fountains were positive, with a mean viral load (VL) of SARS-CoV-2 RNA of 5.02 × 101 gc/l (2.41~8.59 × 101 gc/l), while the streams had average VL of 7.43 × 105 gc/l (Pampa), 7.06 × 105 gc/l (Luiz Rau), 2.01 × 105 gc/l (Dilúvio), and 4.46 × 105 cg/l (WWTP). The results showed varying levels of viral presence in different sample types, with a demonstrated correlation between environmental viral load and clinical COVID-19 cases. These findings contribute to understanding virus persistence and transmission pathways in the environment. Continuous monitoring, especially in less developed regions, is crucial for early detection of vaccine resistance, new variants, and potential COVID-19 resurgence.

Microbial interactions and nitrogen removal performance in an intermittently rotating biological contactor treating mature landfill leachate.

Developing efficient landfill leachate treatment is still necessary to reduce environmental risks. However, nitrogen removal in biological treatment systems is often poor or costly. Studying biofilms in anoxic/aerobic zones of rotating biological contactors (RBC) can elucidate how microbial interactions confer resistance to shock loads and toxic substances in leachate treatment. This study assessed the nitritation-anammox performance in an intermittent-rotating bench-scale RBC treating mature leachate (diluted). Despite the leachate toxicity, the system achieved nitritation with an efficiency of up to 34 % under DO values between 0.8 and 1.8 mg.L-1. The highest average ammoniacal nitrogen removal was 45.3 % with 10 h of HRT. The 16S rRNA sequencing confirmed the presence of Nitrosonomas, Aquamicrobium, Gemmata, and Plantomyces. The coexistence of these bacteria corroborated the selective pressure exerted by leachate in the community structure. The microbial interactions found here highlight the potential application of RBC to remove nitrogen in landfill leachate treatment.

Nutritional interventions in children and adolescents with cerebral palsy: systematic review.

OBJECTIVE: To systematically review the literature in search of the most suitable and effective nutritional interventions and indications for the nutritional treatment of children and adolescents with cerebral palsy (CP). DATA SOURCE: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were selected from seven databases (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde - Lilacs, Embase, United States National Library of Medicine - PubMed, Scientific Electronic Library Online - SciELO, Scopus, and Web of Science). Studies from a pediatric group (0 to 18 years old) diagnosed with CP were included and the search strategy included the descriptors: "children" OR "childhood" AND "nutritional therapy" OR "nutritional intervention" OR "nutrition" OR "nutritional support" OR "diet" AND "cerebral palsy" OR "cerebral injury". Methodological quality was assessed using the checklist for cross-sectional analytical studies, the Newcastle-Ottawa scale or the Cochrane Collaboration tool for clinical trials. DATA SYNTHESIS: Fifteen studies (n=658) published from 1990 to 2020 met the inclusion criteria. All of them had a low risk of bias. The data showed that children and adolescents with CP have worse nutritional status than those normally developed. Those who received hypercaloric and hyperprotein nutritional supplementation benefited from its use. Studies indicate that enteral nutrition should be considered when nutritional needs are not met by the oral diet, especially in cases where oral motor functions are impaired. In addition, there was a direct relationship between the consistency of food, the level of motor function and nutritional status. CONCLUSIONS: Children and adolescents with CP have a greater risk of malnutrition. The use of nutritional supplementation may help with weight gain. In addition, enteral nutrition and modification of food texture have been used to improve the nutritional status of this group.

Sampling strategies for wastewater surveillance: Evaluating the variability of SARS-COV-2 RNA concentration in composite and grab samples.

The shedding of SARS-CoV-2 RNA titers by infected individuals, even asymptomatic and oligosymptomatic ones, allows the use of wastewater monitoring to track the COVID-19 spread in a community. This approach is interesting especially for emerging countries with limited clinical testing capabilities. However, there are still important methodological aspects that need validation so that wastewater monitoring data become more representative and useful for public health. This study evaluated the between-day and within-day variability of SARS-CoV-2 RNA concentrations in 24-hour composite and grab samples from three different sampling points, including two wastewater treatment plants (WTTP) and a sewer manhole. In the between-day evaluation (17 weeks of monitoring), a good agreement between the SARS-CoV-2 RNA concentration of each sampling method was observed. There were no significant differences between the mean concentrations of the grab and composite samples (p-value > 0.05), considering N1 and N2 gene assays. The strong relationship between composite and grab samples was proven by correlation coefficients: Pearson's r of 0.83 and Spearman's rho of 0.78 (p-value < 0.05). In within-day evaluation, 24-hour cycles were analyzed and low variability in hourly viral concentrations was observed for three sampling points. The coefficient of variation (CV) values ranged from 3.0% to 11.5%. Overall, 24-hour profiles showed that viral RNA concentrations had less variability and greater agreement with the mean values between 8 a.m. and 10 a.m, the recommended time for grab sampling. Therefore, this study provides important information on wastewater sampling techniques for COVID-19 surveillance. Wastewater monitoring information will only be useful to public health and decision-makers if we ensure data quality through best practices.

First case of SARS-CoV-2 RNA detection in municipal solid waste leachate from Brazil.

This work presents the first case of SARS-CoV-2 RNA detection in leachate collected from a transfer station in the city of São Paulo, Brazil. After calibration of the viral detection method already used for wastewater samples with a pilot leachate sample and virus fragments in laboratory, twelve polyethylene glycol concentrated leachates samples were tested by RT-qPCR. The results confirmed the presence of N1 gene in 9 of the 12 analyzed samples between epidemiological weeks 33 and 38 of the year 2021 (08/15/2021 to 09/19/2021). The occurrence of the N2 gene was only observed in 5 of the 12 samples. The concentration values for N1 and N2 genes varied between 3.1 and 4.6 log10.GC·L-1, which are values close to those measured in sanitary wastewater. This method showed to be a promising procedure to verify the presence of viral RNA in municipal solid waste leachate, being especially useful where there is no treatment system and sanitation infrastructure, which makes the conventional wastewater surveillance unfeasible.

Wastewater-based epidemiology: A Brazilian SARS-COV-2 surveillance experience.

Since 2020, developed countries have rapidly shared both publicly and academically relevant wastewater surveillance information. Data on SARS-CoV-2 circulation is pivotal for guiding public health policies and improving the COVID-19 pandemic response. Conversely, low- and middle-income countries, such as Latin America and the Caribbean, showed timid activities in the Wastewater-Based Epidemiology (WBE) context. In these countries, isolated groups perform viral wastewater monitoring, and the data are unevenly shared or accessible to health agencies and the scientific community. This manuscript aims to highlight the relevance of a multiparty effort involving research, public health, and governmental agencies to support usage of WBE methodology to its full potential during the COVID-19 pandemic as part of a joint One Health surveillance approach. Thus, in this study, we explored the results obtained from wastewater surveillance in different regions of Brazil as a part of the COVID-19 Wastewater Monitoring Network ANA (National Water Agency), MCTI (Ministry of Science, Technology, and Innovations) and MS (Ministry of Health). Over the epidemiological weeks of 2021 and early 2022, viral RNA concentrations in wastewater followed epidemiological trends and variations. The highest viral loads in wastewater samples were detected during the second Brazilian wave of COVID-19. Corroborating international reports, our experience demonstrated usefulness of the WBE approach in viral surveillance. Wastewater surveillance allows hotspot identification, and therefore, early public health interventions. In addition, this methodology allows tracking of asymptomatic and oligosymptomatic individuals, who are generally underreported, especially in emerging countries with limited clinical testing capacity. Therefore, WBE undoubtedly contributes to improving public health responses in the context of this pandemic, as well as other sanitary emergencies.

Spatiotemporal variability of solid waste on sandy beaches with different access restrictions.

Intense human use and high construction density in coastal areas are stressors to sandy beaches. Pollution by marine debris is a major problem on beaches worldwide. This study pioneered an assessment of marine debris characterization over time on beaches with different levels of access. In two periods and seasons, marine debris was sampled on nine sandy beaches of Rio de Janeiro, grouped by levels of access. The general marine debris density has decreased over time, accompanied by an improvement in public cleaning mechanisms. The most important predictor for the majority of marine debris items is related to accessibility; beaches with restricted access showed a reduction in the abundance of most items. High marine debris densities, even on beaches with restricted access, showed that all evaluated beaches can be sinks for marine debris circulating in marine waters. Beach cleaning strategy improvements will be inefficient unless integrated marine debris management is implemented.

Long-term monitoring of SARS-COV-2 RNA in wastewater in Brazil: A more responsive and economical approach.

SARS-CoV-2, the novel Coronavirus, was first detected in Wuhan, China, in December 2019, and has since spread rapidly, causing millions of deaths worldwide. As in most countries of the world, in Brazil, the consequences of the COVID-19 pandemic have been catastrophic. Several studies have reported the fecal shedding of SARS-CoV-2 RNA titers from infected symptomatic and asymptomatic individuals. Therefore, the quantification of SARS-CoV-2 in wastewater can be used to track the virus spread in a population. In this study, samples of untreated wastewater were collected for 44 weeks at five sampling sites in the ABC Region (São Paulo, Brazil), in order to evaluate the SARS-CoV-2 occurrence in the sewerage system. SARS-CoV-2 RNA titers were detected throughout the period, and the concentration ranged from 2.7 to 7.7 log10 genome copies.L-1, with peaks in the last weeks of monitoring. Furthermore, we observed a positive correlation between the viral load in wastewater and the epidemiological/clinical data, with the former preceding the latter by approximately two weeks. The COVID-19 prevalence for each sampling site was estimated via Monte-Carlo simulation using the wastewater viral load. The mean predicted prevalence ranged 0.05 to 0.38%, slightly higher than reported (0.016 ± 0.005%) in the ABC Region for the same period. These results highlight the viability of the wastewater surveillance for COVID-19 infection monitoring in the largest urban agglomeration in South America. This approach can be especially useful for health agencies and public decision-makers in predicting SARS-CoV-2 outbreaks, as well as in local tracing of infection clusters.

Intermittent rotation as an innovative strategy for achieving nitritation in rotating biological contactors.

The nitritation step is essential when the anammox process is focused, and alternative technologies to achieve partial nitritation-anammox are required. Rotating Biological Contactors (RBCs) are a promising and cost-effective technology, allowing the development of aerobic and anoxic zones in the biofilm, coupled to low energy consumption. This study evaluated nitritation in a RBC with two discs rotation strategies: continuous and intermittent. Continuous rotation resulted in high dissolved oxygen (DO) concentrations and was not favorable for achieving stable nitritation. However, intermittent rotation, coupled with a nitrogen load of 1000 g N·m-3·d-1 and a HRT of 12 h, decreased DO by 77.8% and resulted in nitritation efficiencies of 45.3%. FISH analyses suggested that simultaneous partial nitritation/anammox (PN/A) could also be favored. These results indicated that intermittent rotation may be a core strategy for producing an anammox-suitable effluent or even to promote PN/A in RBCs, upgrading their applicability for wastewater treatment.

Late umbilical cord clamping does not increase rates of jaundice and the need for phototherapy in pregnancies at normal risk.

Objective: To verify the relationship between the time of clamping of the umbilical cord and the development of neonatal jaundice, the dosage of bilirubin and the need for phototherapy. Methods: Cross-sectional, retrospective study with 398 parturients at normal risk (single term gestation, no complications during gestation or delivery, birth weight between 2500 and 4499 g). The population was divided into three groups regarding the time of cord clamping: <1 min(117, 29.4%), between 1 and 3 min(228, 57.3%) and >3 min(53, 13.3%). Sociodemographic, clinical and obstetric characteristics, birth and delivery data, and maternal and perinatal outcomes were evaluated. Pearson's chi-square test, Fisher's exact test and the Kruskal-Wallis test were used for comparison between the groups. Statistical significance was considered p < .05. Results: The groups were similar in the development of jaundice (p = .370), bilirubin dosage (p = .342) and need for phototherapy (p = .515). Late clamping was more prevalent in vaginal deliveries when compared to cesarean sections (1-3 min: 64 versus 21.4%, >3 min: 16.6 versus 1%) (p < .001). There was no difference in other maternal or perinatal variables. Conclusion: The clamping time of the umbilical cord showed no association with jaundice, bilirubin dosage, or phototherapy needs in neonates at normal risk. The adoption of late clamping was more prevalent in vaginal deliveries.

Nutritional interventions in children and adolescents with cerebral palsy: systematic review / Intervenções nutricionais em crianças e adolescentes com paralisia cerebral: revisão sistemática

ABSTRACT Objective: To systematically review the literature in search of the most suitable and effective nutritional interventions and indications for the nutritional treatment of children and adolescents with cerebral palsy (CP). Data source: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were selected from seven databases (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde — Lilacs, Embase, United States National Library of Medicine — PubMed, Scientific Electronic Library Online — SciELO, Scopus, and Web of Science). Studies from a pediatric group (0 to 18 years old) diagnosed with CP were included and the search strategy included the descriptors: "children" OR "childhood" AND "nutritional therapy" OR "nutritional intervention" OR "nutrition" OR "nutritional support" OR "diet" AND "cerebral palsy" OR "cerebral injury". Methodological quality was assessed using the checklist for cross-sectional analytical studies, the Newcastle-Ottawa scale or the Cochrane Collaboration tool for clinical trials. Data synthesis: Fifteen studies (n=658) published from 1990 to 2020 met the inclusion criteria. All of them had a low risk of bias. The data showed that children and adolescents with CP have worse nutritional status than those normally developed. Those who received hypercaloric and hyperprotein nutritional supplementation benefited from its use. Studies indicate that enteral nutrition should be considered when nutritional needs are not met by the oral diet, especially in cases where oral motor functions are impaired. In addition, there was a direct relationship between the consistency of food, the level of motor function and nutritional status. Conclusions: Children and adolescents with CP have a greater risk of malnutrition. The use of nutritional supplementation may help with weight gain. In addition, enteral nutrition and modification of food texture have been used to improve the nutritional status of this group.

RESUMO Objetivo: Revisar sistematicamente a literatura em busca das intervenções e indicações nutricionais mais adequadas e eficazes para o tratamento nutricional de crianças e adolescentes com paralisia cerebral (PC). Fontes de dados: Esta revisão foi conduzida de acordo com as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses — PRISMA. Os artigos foram selecionados em sete bases de dados (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde — Lilacs, Embase, United States National Library of Medicine — PubMed, Scientific Electronic Library Online — SciELO, Scopus, and Web of Science). Foram incluídos estudos de um grupo pediátrico (zero a 18 anos) com diagnóstico de PC e a estratégia de busca incluiu os descritores: "children" OR "childhood" AND "nutritional therapy" OR "nutritional intervention" OR "nutrition" OR "nutritional support" OR "diet" AND "cerebral palsy" OR "cerebral injury". A qualidade metodológica foi avaliada utilizando a lista de verificação para estudos transversais analíticos, escala Newcastle-Ottawa ou ferramenta da Cochrane Collaboration, para ensaios clínicos. Síntese dos dados: Quinze estudos (n=658) publicados de 1990 a 2020 preencheram os critérios de inclusão. Todos tiveram baixo risco de viés. Os dados mostraram que crianças e adolescentes com PC apresentam pior estado nutricional do que os normalmente desenvolvidos. Aqueles que receberam suplementação nutricional hipercalórica e hiperproteica beneficiaram-se de seu uso. Estudos demonstram que a nutrição enteral deve ser considerada quando as necessidades nutricionais não são supridas pela dieta oral, principalmente nos casos em que as funções oromotoras estão prejudicadas. Além disso, houve relação direta entre a consistência dos alimentos, o nível de função motora e o estado nutricional. Conclusões: Crianças e adolescentes com PC têm maior risco de desnutrição. O uso de suplementação nutricional pode auxiliar no ganho de peso desses pacientes. Além disso, a nutrição enteral e a modificação da textura dos alimentos têm sido artifícios utilizados para a melhora do estado nutricional neste grupo.

Fast start-up of the single-stage nitrogen removal using anammox and partial nitritation (SNAP) from conventional activated sludge in a membrane-aerated biofilm reactor.

The single-stage nitrogen removal using anammox and partial nitritation (SNAP) is a promising alternative for low-cost ammonium removal from wastewaters. This study aimed to evaluate the anammox biomass enrichment and SNAP process start-up in a laboratory-scale membrane-aerated biofilm reactor (MABR) at nitrogen loading rates of 50 g N.m-3.d-1 (period 1) and 100 g N.m-3.d-1 (period 2). Anammox activity was observed after 48 days, and the SNAP process was stable after 80 days. In period 1, the average total nitrogen (TN) removal was 78 ±â€¯6%, and the maximum removal was 84%. In period 2, the average TN removal was 61 ±â€¯5%, and the maximum was 69%. Higher dissolved oxygen levels may have caused imbalances in the microbial community in period 2, decreasing the reactor performance. These results demonstrated the potential of the MABR for the fast implementation of the single-stage partial nitritation and anammox processes.

Neck circumference and its association with anthropometric, clinical, and biochemical parameters in patients with chronic kidney disease on hemodialysis / Circunferência do pescoço e sua associação com parâmetros antropométricos, clínicos e bioquímicos em pacientes com doença renal crônica em hemodiálise

ABSTRACT Objective: To investigate the association between neck circumference and anthropometric, clinical, and biochemical parameters in chronic kidney failure patients on hemodialysis. Methods: This is a cross-sectional study with patients with chronic kidney disease undergoing hemodialysis in Western Bahia. For the data collection, anthropometric measures were taken and clinical and biochemical data were gathered from the patient records and employing a structured questionnaire. A multiple linear regression was applied to evaluate the relationship between neck circumference and the anthropometric, clinical, and biochemical parameters. Results: A total of 119 patients were evaluated, of which 63.03% were men and 57.98% were aged between 35 and 59 years old. The mean neck circumference of the patients was 36.2±3.8 cm. A negative association was found between neck circumference and the female sex (p<0.001), while waist circumference (p<0.001), the body adiposity index (p=0.002), and pre-dialysis serum urea concentration (p=0.006) were positively associated with neck circumference. Conclusion: Neck circumference is inversely associated with the female sex and positively associated with a high waist circumference, body adiposity index, and serum urea concentration in patients with chronic kidney disease on hemodialysis.

RESUMO Objetivo: Investigar a associação entre circunferência do pescoço e parâmetros antropométricos, clínicos e bioquímicos em pacientes renais crônico sem hemodiálise. Métodos: Trata-se de um estudo transversal com pacientes com doença renal crônica em hemodiálise no Oeste da Bahia. Para a coleta de dados foram aferidas medidas antropométricas e dados clínicos e bioquímicos foram coletados dos prontuários dos pacientes e por meio de um questionário estruturado. A análise de regressão linear múltipla foi aplicada para avaliar a relação entre a circunferência do pescoço e os parâmetros antropométricos, clínicos e bioquímicos. Resultados: Foram avaliados 119 pacientes, sendo 63,03% homens e 57,98% com idade entre 35 e 59 anos. A média da circunferência do pescoço dos pacientes foi de 36,2±3,8 cm. Foi encontrada associação negativa entre a circunferência do pescoço e sexo feminino (p<0,001), enquanto a circunferência da cintura (p<0,001), o índice de adiposidade corporal (p=0,002) e a concentração sérica de ureia pré-diálise (p=0,006) foram positivamente associados à circunferência do pescoço. Conclusão: A circunferência do pescoço está inversamente associada ao sexo feminino e positivamente associada a uma circunferência abdominal elevada, índice de adiposidade corporal e concentração sérica de ureia em pacientes com doença renal crônica em hemodiálise.

Nutritional interventions in children and adolescents with cerebral palsy: systematic review / Intervenções nutricionais em crianças e adolescentes com paralisia cerebral: revisão sistemática

ABSTRACT Objective: To systematically review the literature in search of the most suitable and effective nutritional interventions and indications for the nutritional treatment of children and adolescents with cerebral palsy (CP). Data source: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were selected from seven databases (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde — Lilacs, Embase, United States National Library of Medicine — PubMed, Scientific Electronic Library Online — SciELO, Scopus, and Web of Science). Studies from a pediatric group (0 to 18 years old) diagnosed with CP were included and the search strategy included the descriptors: "children" OR "childhood" AND "nutritional therapy" OR "nutritional intervention" OR "nutrition" OR "nutritional support" OR "diet" AND "cerebral palsy" OR "cerebral injury". Methodological quality was assessed using the checklist for cross-sectional analytical studies, the Newcastle-Ottawa scale or the Cochrane Collaboration tool for clinical trials. Data synthesis: Fifteen studies (n=658) published from 1990 to 2020 met the inclusion criteria. All of them had a low risk of bias. The data showed that children and adolescents with CP have worse nutritional status than those normally developed. Those who received hypercaloric and hyperprotein nutritional supplementation benefited from its use. Studies indicate that enteral nutrition should be considered when nutritional needs are not met by the oral diet, especially in cases where oral motor functions are impaired. In addition, there was a direct relationship between the consistency of food, the level of motor function and nutritional status. Conclusions: Children and adolescents with CP have a greater risk of malnutrition. The use of nutritional supplementation may help with weight gain. In addition, enteral nutrition and modification of food texture have been used to improve the nutritional status of this group.

RESUMO Objetivo: Revisar sistematicamente a literatura em busca das intervenções e indicações nutricionais mais adequadas e eficazes para o tratamento nutricional de crianças e adolescentes com paralisia cerebral (PC). Fontes de dados: Esta revisão foi conduzida de acordo com as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses — PRISMA. Os artigos foram selecionados em sete bases de dados (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde — Lilacs, Embase, United States National Library of Medicine — PubMed, Scientific Electronic Library Online — SciELO, Scopus, and Web of Science). Foram incluídos estudos de um grupo pediátrico (zero a 18 anos) com diagnóstico de PC e a estratégia de busca incluiu os descritores: "children" OR "childhood" AND "nutritional therapy" OR "nutritional intervention" OR "nutrition" OR "nutritional support" OR "diet" AND "cerebral palsy" OR "cerebral injury". A qualidade metodológica foi avaliada utilizando a lista de verificação para estudos transversais analíticos, escala Newcastle-Ottawa ou ferramenta da Cochrane Collaboration, para ensaios clínicos. Síntese dos dados: Quinze estudos (n=658) publicados de 1990 a 2020 preencheram os critérios de inclusão. Todos tiveram baixo risco de viés. Os dados mostraram que crianças e adolescentes com PC apresentam pior estado nutricional do que os normalmente desenvolvidos. Aqueles que receberam suplementação nutricional hipercalórica e hiperproteica beneficiaram-se de seu uso. Estudos demonstram que a nutrição enteral deve ser considerada quando as necessidades nutricionais não são supridas pela dieta oral, principalmente nos casos em que as funções oromotoras estão prejudicadas. Além disso, houve relação direta entre a consistência dos alimentos, o nível de função motora e o estado nutricional. Conclusões: Crianças e adolescentes com PC têm maior risco de desnutrição. O uso de suplementação nutricional pode auxiliar no ganho de peso desses pacientes. Além disso, a nutrição enteral e a modificação da textura dos alimentos têm sido artifícios utilizados para a melhora do estado nutricional neste grupo.

Padronização de método de concentração e extração de ácidos nucleicos em amostras de esgoto sanitário: uma ferramenta de baixo custo para ser utilizada na vigilância epidemiológica de SARS-CoV-2 / Standardization of the method of concentration and extraction of nucleic acids in wastewater samples: a low-cost tool to be used in epidemiological surveillance of SARS-CoV-2

RESUMO A vigilância da qualidade dos esgotos sanitários pode representar uma ferramenta complementar para monitoramento de doenças infecciosas e prevenção de surtos epidêmicos, especialmente quando a capacidade para testes clínicos é limitada. Dessa maneira, o presente estudo descreve o detalhamento técnico de um método de baixo custo para a concentração e extração de ácidos nucleicos de amostras de esgoto sanitário como etapa prévia para a detecção de vírus e outros agentes patogênicos. Para validar a metodologia proposta, após as etapas de concentração e extração, analisaram-se a presença do ácido ribonucleico do SARS-CoV-2 (COVID-19) nas amostras, por meio de reação em cadeia da polimerase em tempo real. O ácido ribonucleico do vírus foi detectado em 80% das amostras de esgoto sanitário analisadas, comprovando o êxito do procedimento metodológico adotado. A detecção precoce de um patógeno associado ao trabalho de equipes multidisciplinares possibilita a prática da vigilância epidemiológica, que auxilia na tomada de decisões na Saúde Única — união indissociável entre a saúde animal, humana e ambiental.

ABSTRACT Sewage quality surveillance can represent a complementary tool for monitoring infectious diseases and preventing epidemic outbreaks, especially when the capacity for clinical testing is limited. Thus, the present study describes the technical details of a low-cost method for concentrating and extracting nucleic acids from sewage samples, as a preliminary step for the detection of viruses and other pathogens. To validate the proposed methodology, after the concentration and extraction steps, the presence of the SARS coronavirus-2 (COVID-19) in the samples was analyzed using real-time polymerase chain reaction. The virus' ribonucleic acid was detected in 80% of the sewage samples analyzed, proving the success of the methodological procedure adopted. The early detection of a pathogen associated with the work of multidisciplinary teams allows the practice of epidemiological surveillance, which assists in making decisions about One Health — an inseparable union between animal, human, and environmental health.

Factors associated with neonatal near miss and death in public referral maternity hospitals / Fatores associados ao near miss e óbito neonatais em maternidade pública de referência

Abstract Objectives: to evaluate factors associated with neonatal near miss and death in reference hospitals. Methods: this case-control study included 364 cases and 728 controls among 4,929 births. Cases were identified by Apgar < 7 at 5 minutes, weight < 1500 g, gestational age <32 weeks, mechanical ventilation or congenital malformation. After follow-up, outcomes were reclassified into: true controls, near miss and neonatal death. Hierarchically, variables with a p-value < 0.20 were included in the multiple logistic regression. Results: the neonatal near miss rate was 54.1 per 1,000 live births, and the near-miss-to-death ratio was 2.75. Between the control and near miss groups, the predictor variables were neonatal intensive care admission [OR = 35.6 (16.7 - 75.9)] and central venous access [OR= 74.8 (29.4 - 190.4)]. Between the control and death groups, neonatal intensive care admission [OR = 100.4 (18.8 - 537.0)] and central venous access [OR = 12.7 (3.7 - 43.2)] were significant. Between the near miss and death groups, only Apgar < 7 at 5 minutes [OR = 4.1 (1.6 - 10.6)] and vasoactive drug use [OR = 42.2 (17.1 - 104.5)] were significant. Conclusion: factors associated with a greater chance of near miss and/or neonatal death were: Apgar score <7 at 5 minutes, neonatal intensive care confinement, having central venous access, and use of vasoactive drugs.

Resumo Objetivos: avaliar fatores associados à morbidade "near miss" e óbito neonatal em maternidade pública de referência. Métodos: estudo caso-controle com 4,929 nascimentos encontrou 364 casos e 728 controles. Os casos foram identificados pelos critérios: Apgar< 7 no 5° minuto, peso <1500g, idade gestacional < 32 semanas, ventilação mecânica ou malformação congênita. Reclassificou-sequanto aos desfechos: sobrevivência ao período neonatal sem critérios de near miss ("controles" verdadeiros), "near miss" e "óbito neonatal". Hierarquicamente, as variáveis com p< 0,20 foram incluídas na regressão logística múltipla. Resultados: a taxa de near miss neonatal foi 54,1 por mil nascidos vivos, a razão de near miss e óbito foi 2,75. As variáveis preditoras, entre controles e near miss foi internamento em terapia intensiva neonatal: OR 35,6 (16,7 - 75,9) e acesso venoso central: OR= 74,8 (29,4 -190,4); entre controles e óbito internamento em terapia intensiva neonatal: OR=100,4 (18,8 - 537,0)e acesso venoso central: OR 12,7 (3,7 - 43,2); entre near miss e óbito Apgar no 5°minuto < 7: OR= 4,1 (1,6 - 10,6) e uso de drogas vasoativas: OR= 42,2 (17,1 - 104,5). Conclusão: fatores associados à ocorrência de near miss e/ou óbito neonatal foram: Apgar < 7 no 5° minuto, internamento em terapia intensiva neonatal, acesso venoso central e drogas vasoativas.