Trichoptera Life Stages Present Distinct Responses to Environmental Conditions in Amazonian Streams.

Biological communities have their biodiversity patterns affected by environmental, spatial, and biogeographic factors that vary from taxa to taxa, and often between life stages. This is especially true when there are differences in the habitat the species use in each of them. Individuals of the insect order Trichoptera are mostly aquatic in their larval stage and terrestrial in their adult stage, which may result in different behaviors and environmental requirements. Our goal was to evaluate the congruence between the larval and adult stages of Trichoptera in Amazonian streams regarding their abundance, richness, and assemblage composition. Additionally, we tried to identify the main environmental factors related to each life stage. For this, larvae and adults of Trichoptera were sampled in the same sites at 12 streams in the Caxiuanã National Forest, Pará state, Brazil. Adult assemblages had greater richness of genera and abundance of individuals than the larval ones, and there was no congruence in the genera composition between these life stages. Our results also showed that different environmental variables structured Trichoptera larvae and adults. Since the sampling of larvae and adults proved to be complementary in the studied streams, we advise that Trichoptera diversity surveys consider both life stages of these organisms.

Eventos adversos pós-vacina contra o papilomavírus humano em adolescentes: revisão sistemática da literatura / Adverse events following human papillomavirus vaccine in adolescents: systematic review of the literature / Eventos adversos tras la vacuna contra el virus del papiloma humano en adolescentes: revisión sistemática de la literatura

Objetivo: O objetivo desse estudo foi investigar a ocorrência de Eventos Supostamente Atribuídos a Vacinação e/ou Imunização associados à vacina Papilomavírus Humano entre adolescentes de ambos os sexos. Métodos:Trata-se de uma revisão sistemática, realizada segundo os preceitos do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados: Inicialmente, foram identificados 11.016 artigos e, após a remoção de duplicidades, restaram 6.824. Destes, 59 foram selecionados para leitura na íntegra. Ao final, nove estudos compuseram a amostra. Os resultados indicam que a maioria dos Eventos Supostamente Atribuídos a Vacinação e/ou Imunização foram leves e moderados, prevalecendo eventos no local da injeção, como a dor e edema. Os Eventos Supostamente Atribuídos a Vacinação e/ou Imunização sistêmicos mais frequentes foram a febre, cefaleia, fadiga e tontura. Conclusão: A vacina contra o Papilomavírus Humano para os adolescentes é segura, reforçando-se sua importância como estratégia para diminuir as taxas de incidência dos cânceres associados ao Papilomavírus Humano.

Objective: The objective of this study was to investigate the occurrence of Events Supposedly Attributable to Vaccination and/or Immunization associated with the Human Papillomavirus vaccine among adolescents of both sexes. Methods: This is a systematic review carried out according to the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Initially, 11,016 articles were identified, of which 6,824 remained after removing duplicates, and 59 of these were selected for full reading. The sample comprised nine studies. The results indicate that most Events Supposedly Attributable to Vaccination and/or Immunization were mild and moderate, and events at the injection site, such as pain and edema, prevailed. The most common systemic Events Supposedly Attributable to Vaccination and/or Immunization were fever, headache, fatigue and dizziness. Conclusion: The Human Papillomavirus vaccine for adolescents is safe, reinforcing its importance as a strategy to reduce the incidence rates of Human Papillomavirus associated cancers

Objetivo: El objetivo de este estudio fue investigar la ocurrencia de Eventos Supuestamente Atribuibles a la Vacunación o Inmunización asociados a la Vacuna contra el Virus del Papiloma Humano entre adolescentes de ambos sexos. Métodos: Se trata de una revisión sistemática realizada según la declaración Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados:Se identificaron 11.016 artículos y, tras eliminar duplicados, quedaron 6.824. De ellos, 59 fueron seleccionados para lectura completa. La muestra estuvo compuesta por nueve estudios. Los resultados indican que la mayoría de los Eventos Supuestamente Atribuibles a la Vacunación o Inmunización fueron leves y moderados, prevaleciendo los eventos en el lugar de la inyección, como dolor y edema. Los Eventos Supuestamente Atribuibles a la Vacunación o Inmunización sistémicos más comunes fueron fiebre, dolor de cabeza, fatiga y mareos. Conclusión: La vacuna contra el Virus del Papiloma Humano para adolescentes es segura, lo que refuerza su importancia como estrategia para reducir las tasas de incidencia de cánceres asociados al Virus del Papiloma Humano.

Effect of seasonality on the leaf phenology and physiology of Byrsonima species (Malpighiaceae)

Introduction: Defined seasonality in savanna species can stimulate physiological responses that maximize photosynthetic metabolism and productivity. However, those physiological responses are also linked to the phenological status of the whole plant, including leaf phenophases. Objective: To study how physiological traits influence phenophase timing among congeneric and co-occurring savanna species. Methods: We evaluated the leaf phenology and physiological traits of populations of Byrsonima intermedia, B. coccolobifolia, and B. verbascifolia. Physiological measurements were performed at the onset of the dry and rainy seasons and again late in the season. Results: B. intermedia and B. coccolobifolia were classified as brevideciduous and B. verbascifolia as evergreen. The maximum quantum yield for B. intermedia and B. coccolobifolia were lowest during the dry season. At the onset of the dry period, the highest chloroplastidic pigment levels were observed, which decreased as the season advanced, total chlorophyll/carotenoid ratios were lowest, and carotenoid contents were highest. We detected low starch content values at the start of the rainy season, coinciding with the resumption of plant growth. Two months into this season, the leaves were at their peak structural and functional maturity, with high water-soluble polysaccharide values and photosynthetic rates, and were storing large amounts of starch. Conclusions: Physiological and leaf phenological strategies of the Byrsonima species were related to drought resistance and acclimatization to the seasonality of savanna water resources. The oscillations of the parameters quantified during the year indicated a strong relationship with water seasonality and with the phenological status of the leaves.

Introducción: La marcada estacionalidad en las especies de sabana puede estimular respuestas fisiológicas que maximicen el metabolismo fotosintético y la productividad. Sin embargo, esas respuestas fisiológicas están vinculadas al estado fenológico de toda la planta, incluidas las fenofases de las hojas. Objetivo: Estudiar cómo los rasgos fisiológicos influyen en el tiempo de la fenofase entre especies de sabana congenéricas y concurrentes. Métodos: Evaluamos la fenología y características fisiológicas de poblaciones de Byrsonima intermedia, B. coccolobifolia y B. verbascifolia. Las mediciones fisiológicas se realizaron al inicio de la estación seca y lluviosa, y de nuevo al final de la estación. Resultados: B. intermedia y B. coccolobifolia se clasificaron como brevicaducifolias y B. verbascifolia como perennifolias. El rendimiento cuántico máximo para B. intermedia y B. coccolobifolia fueron más bajos durante la época seca. Al inicio del período seco, se observaron niveles de pigmentos cloroplastídicos más altos, aunque los niveles de clorofila disminuyeron a medida que avanzaba la estación seca, las proporciones clorofila/carotenoides totales fueron más bajas y los contenidos de carotenoides más altos. Detectamos valores bajos de contenido de almidón al inicio de la época lluviosa, que coincide con la reanudación del crecimiento de la planta. A dos meses de esta época, las hojas estaban en su máxima madurez estructural y funcional, con altos valores de polisacáridos solubles en agua y tasas fotosintéticas, y almacenaban grandes cantidades de almidón. Conclusiones: Las estrategias fisiológicas y fenológicas de las hojas de las especies de Byrsonima estaban relacionadas con la resistencia a la sequía y la aclimatación a la estacionalidad de los recursos hídricos de la sabana. Las oscilaciones de los parámetros cuantificados durante el año indicaron una fuerte relación con la estacionalidad hídrica y con los estados fenológicos de las hojas.

Repercussions of SARS-CoV-2 infection and the pandemic on birth routes: a cross-sectional study.

OBJECTIVE: To assess the repercussions of SARS-CoV-2 infection (suspected or confirmed) and the context of the pandemic on the birth route and humanized assistance during childbirth. METHOD: Cross-sectional epidemiological study, nested within a cohort and comparative with the research "Birth in Belo Horizonte: Survey on Childbirth and Delivery".The medical records of three reference maternity hospitals in Belo Horizonte were assessed, with a final sample of 1,682 pregnant women, in the months of May, June and July 2020. A descriptive analysis was carried out, with absolute and relative frequency, and a comparative one, with a Pearson's chi-square test. RESULTS: It was observed that 2.02% of pregnant women were infected with SARS-CoV-2.Before the pandemic, out of a total of 390 pregnant women, 74.10% gave birth vaginally.During a pandemic, among infected women, 51.61% gave birth via cesarean section and 48,39% via vaginal delivery;among uninfected, 26.99% cesarean sections and 73.01% vaginaldeliveries. CONCLUSION: There was an increase in the percentage of cesarean sections and a possible influence of the pandemic on the rates of indication of cesarean sections at the time of admission to the maternity ward.

Epidemiology of monkeypox notifications in the state of Minas Gerais, Brazil.

OBJECTIVES: to describe the epidemiological profile of suspected, confirmed, and probable cases of monkeypox in the state of Minas Gerais, Brazil. METHODS: a descriptive, retrospective study of reported suspected, confirmed, and probable cases of monkeypox infection in the state of Minas Gerais, Brazil. The study period was from the first notification, on June 11, to September 7, 2022. RESULTS: a total of 759 suspected, confirmed, and probable cases of monkeypox infection were reported, with 35.44% suspected, 53.75% confirmed, and 10.81% probable cases, respectively. As for the coexisting diseases within confirmed cases, 38.79% were related to people living with human immunodeficiency virus, and 13.74% had some active sexually transmitted infection. Regarding the evolution of confirmed cases, 47.43% were cured. CONCLUSIONS: the results contribute to greater knowledge and control of the infection by allowing better disease management and care offered in health services.

Comparison of different methods of obtaining the rapid shallow breathing index.

OBJECTIVE: To compare the Rapid Shallow Breathing Index (RSBI) obtained by the ventilometer and from mechanical ventilation parameters. METHODS: Randomized crossover trial, including 33 intubated patients, on mechanical ventilation for at least 24 hours, undergoing spontaneous breathing test. Patients were submitted to the measurement of RSBI by four methods: disconnected from the ventilator through the ventilometer; in Pressure Support Ventilation (PSV) mode at a pressure of 7.ßcm H2O; in Continuous Positive Airway Pressure (CPAP) mode at a pressure of 5.ßcmH2O with flow trigger; in CPAP mode at a pressure of 5.ßcmH2O with pressure trigger. RESULTS: No significant difference was detected between the RSBI obtained by the ventilometer and in the CPAP mode with flow and pressure triggers, however, in the PSV mode, the values were lower than in the other measurements (p.ß<.ß0.001). By selecting patients from the sample with higher RSBI (... 80 cycles.min-1.L-1), the value of the index obtained by the ventilometer was higher than that obtained in the three options of ventilation methods. CONCLUSION: The RSBI obtained in the CPAP mode at a pressure of 5.ßcmH2O, in both triggers types, did not differ from that measured by the ventilometer; it is, therefore, an alternative when obtaining it from mechanical ventilation parameters is necessary. However, in the presence of borderline values, the RSBI measured by ventilometer is recommended, as in this method the values are significantly higher than in the three ventilation modalities investigated.

An updated distribution list of Leptophlebiidae Banks, 1900 (Ephemeroptera: Insecta) for Piauí state / Uma lista de distribuição atualizada de Leptophlebiidae Banks, 1900 (Ephemeroptera: Insecta) para o estado do Piauí

Abstract Leptophlebiidae is the second most diverse family within Ephemeroptera, with species distributed across various States in Brazil, but with gaps in distribution records in others. Currently, nine species of Leptophlebiidae are recorded for the state of Piauí. Based on this information gap, the objective of this study was to present an updated species list of the family Leptophlebiidae new occurrence records and distributional sites for the state of Piauí, Brazil. By analyzing 447 specimens, we have significantly expanded our knowledge about the distribution of Leptophlebiidae species in the state of Piauí, increasing the recorded species from nine to 17. We have also added new occurrence records for six species and, for the first time, documented the presence of four genera. It is important to highlight that there is still an extensive area within the Cerrado and Brazilian semiarid regions where the occurrence of Ephemeroptera is unknown, confirming that the diversity in this area is underestimated and that knowledge of Ephemeroptera species and their distributions can expand with increased sampling efforts in the coming years, reducing the Linnean and Wallacean shortfall regarding this group. Our results also demonstrate the urgent need for inventories in the southern part of the state of Piauí, particularly in the sub-basins of the middle and upper Parnaíba river, which are considered suitable for monoculture expansion in Brazil.

Resumo Leptophlebiidae é a segunda família mais diversa de Ephemeroptera, com espécies distribuídas em vários estados do Brasil, mas com lacunas no registro de distribuição em outros. Por exemplo, no estado do Piauí tem registrado apenas nove espécies de Leptophlebiidae. Baseada nessa lacuna de informação, o objetivo deste estudo foi apresentar uma lista atualizada de espécies da família Leptophlebiidae, novos registros de ocorrência e sítios de distribuição para o estado do Piauí, Brasil. Ao analisar 447 exemplares, ampliamos significativamente nosso conhecimento sobre a distribuição das espécies de Leptophlebiidae no estado do Piauí, aumentando o número de espécies registradas de nove para 17. Também adicionamos novos registros de ocorrência para seis espécies e, pela primeira vez, documentamos a presença de quatro gêneros. Destacamos que ainda existe uma extensa área do Cerrado e semiárido brasileiro que se desconhece a ocorrência de Ephemeroptera, confirmando que a diversidade nessa área é subestimada e que o conhecimento sobre as espécies de Ephemeroptera e suas distribuições podem se expandir com o aumento do esforço amostral nos próximos anos, diminuindo as lacunas Lineana e Wallaceana sobre esse grupo. Nossos resultados também demonstram a necessidade emergencial de inventários no sul do Estado do Piauí, principalmente nas sub-bacias do médio e alto rio Parnaíba que é considerado adequado para a expansão da monocultura no Brasil.

Evaluation on the information about absolute and relative indications of cesarean sections available on popular websites / Avaliação das informações sobre indicações absolutas e relativas de cesarianas disponíveis em sites populares

Abstract Objectives: to evaluate the reliability of information available on popular websites, in other words, websites aimed lay pregnant women, about absolute and relative indications for cesarean sections. Methods: this was a descriptive/comparative study based on the popular websites most likely to be visited by lay pregnant women and that contained information about indications for absolute and relative cesarean sections. Cohen's Kappa index of agreement was used to analyze the reliability degree on the indications for cesarean sections presented on the websites and the scientific evidence. Results: there was a higher prevalence (62.63%) of information on the indications for cesarean sections that did not mention whether the indication was absolute or relative, and of these indications, 40.74% were not indications for cesarean sections. Low agreement was also observed among websites and the scientific evidence when the website mentioned the indication for cesarean section was absolute or relative. Conclusion: this study showed that the reliability of the information on absolute and relative indications for cesarean sections available in popular websites is questionable.

Resumo Objetivos: avaliar a confiabilidade das informações disponíveis em sites populares, ou seja, sites voltados para gestantes leigas, sobre indicações absolutas e relativas de cesarianas. Métodos: estudo descritivo/comparativo, baseado nos sites populares mais prováveis de serem visitados por gestantes leigas e que traziam informações sobre as indicações de cesarianas absolutas e relativas. Para analisar o grau de confiabilidade das indicações de cesarianas apresentadas pelos sites e a evidência cientifica, foi realizado o índice de concordância de Kappa de Cohen. Resultados: houve maior prevalência (62,63%) de informações de indicações de cesarianas que não mencionavam se a indicação apresentada era absoluta ou relativa, sendo que destas, 40,74% não eram indicações de cesarianas. Observou-se, concordância baixa entre os sites e a evidência cientifica quando o site mencionava que a indicação de cesariana era absoluta ou relativa. Conclusão: este estudo demonstrou que a confiabilidade das informações acerca das indicações absolutas e relativas de cesarianas disponíveis em sites populares é questionável

Epidemiology of monkeypox notifications in the state of Minas Gerais, Brazil / Epidemiología de las notificaciones de viruela del mono en el estado de Minas Gerais, Brasil / Epidemiologia das notificações de monkeypox no estado de Minas Gerais, Brasil

ABSTRACT Objectives: to describe the epidemiological profile of suspected, confirmed, and probable cases of monkeypox in the state of Minas Gerais, Brazil. Methods: a descriptive, retrospective study of reported suspected, confirmed, and probable cases of monkeypox infection in the state of Minas Gerais, Brazil. The study period was from the first notification, on June 11, to September 7, 2022. Results: a total of 759 suspected, confirmed, and probable cases of monkeypox infection were reported, with 35.44% suspected, 53.75% confirmed, and 10.81% probable cases, respectively. As for the coexisting diseases within confirmed cases, 38.79% were related to people living with human immunodeficiency virus, and 13.74% had some active sexually transmitted infection. Regarding the evolution of confirmed cases, 47.43% were cured. Conclusions: the results contribute to greater knowledge and control of the infection by allowing better disease management and care offered in health services.

RESUMEN Objetivos: describir perfil epidemiológico de casos sospechosos, confirmados y probables por viruela símica en Minas Gerais, Brasil. Métodos: estudio descriptivo, retrospectivo, con casos notificados sospechosos, confirmados y probables de infección por viruela símica en el estado de Minas Gerais, Brasil. El período del estudio fue desde la primera notificación, en 11 de junio, hasta 7 de septiembre de 2022. Resultados: fueron notificados 759 casos sospechosos, confirmados y probables de infección por viruela símica, siendo, respectivamente, 35,44% sospechosos, 53,75% confirmados y 10,81% probables. Cuanto a las enfermedades coexistentes en los casos confirmados, 38,79% referidos a personas viviendo con virus de la inmunodeficiencia humana, y 13,74% poseían alguna infección sexualmente transmisible activa. Sobre la evolución de casos confirmados, 47,43% evolucionaron para la cura. Conclusiones: los resultados contribuyen para mayor conocimiento y control de la infección, auxiliando en la mejor gestión de la enfermedad y cuidado ofrecidos en los servicios de salud.

RESUMO Objetivos: descrever o perfil epidemiológico dos casos suspeitos, confirmados e prováveis por monkeypox no estado de Minas Gerais, Brasil. Métodos: estudo descritivo, retrospectivo, com os casos notificados suspeitos, confirmados e prováveis de infecção pelo monkeypox no estado de Minas Gerais, Brasil. O período do estudo foi desde a primeira notificação, em 11 de junho, até 7 de setembro de 2022. Resultados: foram notificados 759 casos suspeitos, confirmados e prováveis de infecção pelo monkeypox, sendo, respectivamente, 35,44% suspeitos, 53,75% confirmados e 10,81% prováveis. Quanto às doenças coexistentes nos casos confirmados, 38,79% referiam-se a pessoas vivendo com vírus da imunodeficiência humana, e 13,74% possuíam alguma infecção sexualmente transmissível ativa. Sobre a evolução dos casos confirmados, 47,43% evoluíram para a cura. Conclusões: os resultados contribuem para maior conhecimento e controle da infecção, de modo a auxiliar no melhor gerenciamento da doença e cuidado ofertados nos serviços de saúde.

Repercussions of SARS-CoV-2 infection and the pandemic on birth routes: a cross-sectional study / Repercusiones de la infección por SARS-CoV-2y la pandemia en las vías de nacimiento: un estudio transversal / Repercussões da infecção por SARS-CoV-2 e da pandemia nas vias de nascimento: estudo transversal

ABSTRACT Objective: To assess the repercussions of SARS-CoV-2 infection (suspected or confirmed) and the context of the pandemic on the birth route and humanized assistance during childbirth. Method: Cross-sectional epidemiological study, nested within a cohort and comparative with the research "Birth in Belo Horizonte: Survey on Childbirth and Delivery".The medical records of three reference maternity hospitals in Belo Horizonte were assessed, with a final sample of 1,682 pregnant women, in the months of May, June and July 2020. A descriptive analysis was carried out, with absolute and relative frequency, and a comparative one, with a Pearson's chi-square test. Results: It was observed that 2.02% of pregnant women were infected with SARS-CoV-2.Before the pandemic, out of a total of 390 pregnant women, 74.10% gave birth vaginally.During a pandemic, among infected women, 51.61% gave birth via cesarean section and 48,39% via vaginal delivery;among uninfected, 26.99% cesarean sections and 73.01% vaginaldeliveries. Conclusion: There was an increase in the percentage of cesarean sections and a possible influence of the pandemic on the rates of indication of cesarean sections at the time of admission to the maternity ward.

RESUMEN Objetivo: Evaluar las repercusiones de la infección por SARS-CoV-2 (sospechosa o confirmada) y el contexto de la pandemia en la vía del parto y la asistencia humanizada durante el parto. Método: Estudio epidemiológico transversal, anidado en una cohorte y comparativo con la investigación "Nacimiento en Belo Horizonte: Encuesta sobre Parto y Parto".Se enviaron los prontuarios de tres maternidades de referencia en Belo Horizonte, con una muestra final de 1.682 gestantes, en los meses de mayo, junio y julio de 2020. Se realizó un análisis descriptivo, con frecuencia absoluta y relativa, y comparativo. uno, con una prueba de Chi, cuadrado de Pearson. Resultados: Tenga en cuenta que el 2,02% de las mujeres embarazadas estaban infectadas con SARS-CoV-2.Antes de la pandemia, en un total de 390 gestantes, el 74,10% daba a luz por vía vaginal.Durante una pandemia, entre las mujeres infectadas, el 51,61% dio a luz por cesárea y el 48,39% por parto vaginal;en las no infectadas, 26,99% cesáreas y 73,01% vaginales. Conclusión: Hubo un aumento en el porcentaje de cesáreas y una posible influencia de la pandemia en las tasas de indicación de cesáreas al momento del ingreso a la sala de maternidad.

RESUMO Objetivo: Avaliar as repercussões da infecção por SARS-CoV-2 (suspeita ou confirmada) e do contexto da pandemia na via de nascimento e na assistência humanizada ao parto. Método: Estudo epidemiológico transversal, aninhado a uma coorte e comparativo com a pesquisa "Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento". Avaliou-se prontuários de três maternidades-referência em Belo Horizonte, com amostra final de 1.682 parturientes, nos meses de maio, junho e julho de 2020. Realizou-se análise descritiva, com frequência absoluta e relativa, e comparativa, com teste Qui-quadrado de Pearson. Resultados: Observou-se que, 2,02% das gestantes estavam infectadas por SARS-CoV-2. Antes da pandemia, em um total de 390 gestantes, 74,10% pariram via vaginal. Durante a pandemia, nas mulheres infectadas, 51,61% pariram pela via cesariana e 48,39% pela vaginal; nas não infectadas, 26,99% cesarianas e 73,01% vaginais. Conclusão: Observou-se aumento percentual de cesarianas e possível influência da pandemia nas taxas de indicação de cesarianas no momento da admissão na maternidade.

Comparison of different methods of obtaining the rapid shallow breathing index

Abstract Objective: To compare the Rapid Shallow Breathing Index (RSBI) obtained by the ventilometer and from mechanical ventilation parameters. Methods: Randomized crossover trial, including 33 intubated patients, on mechanical ventilation for at least 24 hours, undergoing spontaneous breathing test. Patients were submitted to the measurement of RSBI by four methods: disconnected from the ventilator through the ventilometer; in Pressure Support Ventilation (PSV) mode at a pressure of 7 cm H2O; in Continuous Positive Airway Pressure (CPAP) mode at a pressure of 5 cmH2O with flow trigger; in CPAP mode at a pressure of 5 cmH2O with pressure trigger. Results: No significant difference was detected between the RSBI obtained by the ventilometer and in the CPAP mode with flow and pressure triggers, however, in the PSV mode, the values were lower than in the other measurements (p < 0.001). By selecting patients from the sample with higher RSBI (≥ 80 cycles.min−1.L−1), the value of the index obtained by the ventilometer was higher than that obtained in the three options of ventilation methods. Conclusion: The RSBI obtained in the CPAP mode at a pressure of 5 cmH2O, in both triggers types, did not differ from that measured by the ventilometer; it is, therefore, an alternative when obtaining it from mechanical ventilation parameters is necessary. However, in the presence of borderline values, the RSBI measured by ventilometer is recommended, as in this method the values are significantly higher than in the three ventilation modalities investigated.

Cardiovascular Autonomic Responses to Aerobic, Resistance and Combined Exercises in Resistance Hypertensive Patients.

Here, we report the acute effects of aerobic (AER), resistance (RES), and combined (COM) exercises on blood pressure, central blood pressure and augmentation index, hemodynamic parameters, and autonomic modulation of resistant (RH) and nonresistant hypertensive (NON-RH) subjects. Twenty participants (10 RH and 10 NON-RH) performed three exercise sessions (i.e., AER, RES, and COM) and a control session. Hemodynamic (Finometer®, Beatscope), office blood pressure (BP), and autonomic variables (accessed through spectral analysis of the pulse-to-pulse BP signal, in the time and frequency domain-Fast Fourrier Transform) were assessed before (T0), one-hour (T1), and twenty-four (T2) hours after each experimental session. There were no changes in office BP, pulse wave behavior, and hemodynamic parameters after (T0 and T1) exercise sessions. However, AER and COM exercises significantly reduced sympathetic modulation in RH patients. It is worth mentioning that more significant changes in sympathetic modulation were observed after AER as compared to COM exercise. These findings suggest that office blood pressure, arterial stiffness, and hemodynamic parameters returned to baseline levels in the first hour and remained stable in the 24 hours after the all-exercise sessions. Notably, our findings bring new light to the effects of exercise on RH, indicating that RH patients show different autonomic responses to exercise compared to NON-RH patients. This trial is registered with trial registration number NCT02987452.

Avaliação das informações sobre covid-19 disponíveis em sites populares e direcionadas às gestantes / Evaluación de la información sobre covid-19 disponible en sitios web populares dirigidos a mujeres embarazadas / Assessment of information on covid-19 available on popular websites aimed at pregnant women

RESUMO Objetivo: avaliar se as informações sobre a COVID-19 direcionadas às mulheres gestantes, disponíveis em sites populares, estão de acordo com as recomendações do Ministério da Saúde. Métodos: estudo descritivo/comparativo, realizado em sites populares mais acessados por mulheres leigas. Foi elaborado um checklist com informações relevantes sobre COVID-19 e gestação, com base nas recomendações do Ministério da Saúde e da literatura. O checklist apresentava os tópicos: pré-natal; gestante com suspeita ou diagnóstico de COVID-19; aleitamento materno; recomendações quanto à via de parto e interrupção da gestação; orientações para trabalho de parto e parto; orientações para cuidado no pós-parto; agentes farmacológicos, outros tratamentos e monitoramento da infecção por COVID-19; gestantes profissionais ou não da área da saúde; e risco de infecção por transmissão vertical e no pós-parto. Resultados: após aplicação do checklist, 210 sites foram selecionados para análise do seu conteúdo na íntegra. Observou-se que nenhum deles apresentou o conteúdo elencado de acordo com as evidências sobre gestação, parto/nascimento, pós-parto e COVID- 19 disponíveis até o presente momento. As informações mais negligenciadas sobre COVID-19 e gestação estavam no conjunto de informações sobre "Agentes farmacológicos, outros tratamentos e monitoramento da infecção COVID-19". As informações sobre o "pré-natal" foram as que mais apresentaram informações corretas nos sites analisados. Conclusão: os sites trouxeram informações importantes para as mulheres gestantes e puérperas; contudo, muitas vezes, essas informações estavam incompletas. Espera-se que as evidências deste estudo possam contribuir para o aprimoramento da educação em saúde, de modo a indicar novas possibilidades de comunicação com base em fontes confiáveis.

RESUMEN Objetivo: evaluar si la información sobre la COVID-19 dirigida a las mujeres embarazadas disponible en los sitios web populares se ajusta a las recomendaciones del Ministerio de Salud. Métodos: estudio descriptivo/comparativo, realizado con los sitios populares a los que más acceden las mujeres laicas. Se elaboró una checklist con información relevante sobre la COVID-19 y el embarazo, basándose en las recomendaciones del Ministerio de Salud y en la bibliografía. La checklist presentó los temas: cuidados prenatales, mujeres embarazadas con sospecha o diagnóstico de COVID-19, lactancia materna, recomendaciones para la vía del parto y la interrupción del embarazo, directrices para el trabajo de parto y el parto, directrices para la atención posparto, agentes farmacológicos, otros tratamientos y seguimiento de la infección por COVID-19, mujeres embarazadas o no en el área de la salud y riesgo de infección por transmisión vertical y posparto. Resultados: después de aplicar la checklist, se seleccionaron 210 sitios para el análisis completo de su contenido. Se observó que ninguno de ellos presentó el contenido listado de acuerdo con la evidencia sobre embarazo, parto/nacimiento, posparto y COVID-19 disponible hasta la fecha. La información más descuidada sobre COVID-19 y embarazo fue en el conjunto de información sobre "Agentes farmacológicos, otros tratamientos y seguimiento de la infección por COVID-19". La información sobre "Prenatal" fue la que presentó la información más correcta sobre los sitios analizados. Conclusión: los sitios aportaron información importante para las mujeres embarazadas y posparto, sin embargo, a menudo estaban incompletos. Se espera que la evidencia de este estudio pueda contribuir a la mejora de la educación para la salud, con el fin de indicar nuevas posibilidades de comunicación basadas en fuentes confiables.

ABSTRACT Objective: to assess whether information about COVID-19 aimed at pregnant women, available on popular websites, is in accordance with the recommendations of the Ministry of Health. Methods: descriptive/comparative study, carried out on popular websites most accessed by lay women. A checklist was prepared with relevant information about COVID-19 and pregnancy, based on the recommendations of the Ministry of Health and the literature. The checklist presented the topics: prenatal care; pregnant woman with suspected or diagnosed COVID-19; breastfeeding; recommendations regarding the mode of delivery and termination of pregnancy; guidelines for labor and delivery; guidelines for postpartum care; pharmacological agents, other treatments, and monitoring of COVID-19 infection; professional or non-professional pregnant women in the health area; and risk of infection by vertical and postpartum transmission. Results: after applying the checklist, 210 websites were selected for full content analysis. It was observed that none of them presented the content listed according to the evidence on pregnancy, delivery/birth, postpartum and COVID-19 available to date. The most neglected information about COVID-19 and pregnancy was in the information set on "Pharmacological agents, other treatments and monitoring of COVID-19 infection". Information about "prenatal care" was the one that most presented correct information on the analyzed websites. Conclusion: the websites provided important information for pregnant and postpartum women; however, this information was often incomplete. It is hoped that the evidence from this study can contribute to the improvement of health education, in order to indicate new possibilities of communication based on reliable sources.

Response of aquatic insects to an environmental gradient in Amazonian streams.

The increasing land use in the Amazon region has resulted in the widespread substitution of forest areas with pasture and bauxite mining. These land uses reduce the forest cover of streams and modify their characteristics, reducing the diversity of aquatic insect assemblages. In the present study, we aimed to identify the threshold of the assemblages of the larvae of insects of the orders Ephemeroptera, Plecoptera, and Trichoptera (collectively known as EPT), and adults of the order Odonata, along an environmental gradient of land use and land cover (LULC). We sampled 30 streams along an environmental gradient determined by the proportion of forest, pasture, and bauxite mining observed within the catchment of each stream. We identified 12 taxa associated with forest (nine positively and three negatively) and four negatively associated with pasture. However, no taxa were associated explicitly with the bauxite mining gradient. As forest is converted to pasture, the abundance and frequency of occurrence of the taxa sensitive to pasture are reduced, reflecting their environmental sensitivity and their potential as sentinels of preserved streams. The identification of the thresholds of the EPT and odonates taxa allowed us to determine which of these organisms are positively or negatively associated with the environmental gradient of LULC in Amazonian streams. We hope that the results of the present study can be applied in future biomonitoring programs, particularly for monitoring the response of aquatic insects to the degradation of streams.

Reliability of information available on popular websites about vaccination of pregnant women.

OBJECTIVE: To analyze the reliability of information available on popular websites about vaccination of pregnant women according to the recommendations of the Brazilian Ministry of Health. METHOD: Descriptive and comparative study. For data collection, a checklist composed of information on recommended, contraindicated, and indicated vaccines in special situations during pregnancy, according to the Ministry of Health, was elaborated. RESULTS: None of the analyzed websites presented all the recommended information. Contraindications, most common adverse events, simultaneous administration of vaccines, information on the DT vaccine, and recommended vaccines in special situations were presented by a minority of websites. CONCLUSION: Information available on websites about the vaccination of pregnant women is not always based on the recommendations and misinformation may interfere with the acceptance of this practice. The importance of the professionals of the multidisciplinary team as information mediators, particularly the nurse, is emphasized, as is the need for regulating the production and dissemination of information on the internet.

Adverse events following immunization in pregnant women from Minas Gerais.

OBJECTIVE: To analyze the distribution of adverse events following immunization (AEFI) in pregnant women in the state of Minas Gerais, between 2015 and 2019. METHODS: This is an epidemiological, descriptive study conducted with AEFI data from 2015 to 2019, recorded in the Adverse Events Surveillance Information System, in the state of Minas Gerais (MG), Brazil. A total of 670 AEFI were analyzed in pregnant women. The estimates were presented in proportions, according to the year of occurrence, health macro-region of Minas Gerais and immunobiological administered. RESULTS: The year in which there were the most records was 2017 (36.8%). Among the 14 macro-regions, the ones with the lowest and highest number of records were the Vale do Jequitinhonha (0.5%) and Center (31.8%), respectively. The vaccines contraindicated during pregnancy represented 27.6% of the total notifications. The total of 69.5% of the cases were considered immunization errors. In 75.9% of the records, the variable of medical care was ignored, and in 73.7% of the cases no information on the evolution was presented. CONCLUSION: This study shows the need for continuing education for the multidisciplinary team, in order to reduce cases of AEFI and ensure the adequate completion of notifications by health professionals.

Effects of Anti-TNF alpha Therapy on Blood Pressure in Resistant Hypertensive Subjects: A Randomized, Double-Blind, Placebo-Controlled Pilot Study. / Efeitos da Terapia com Anti-TNF alfa na Pressão Arterial em Pacientes com Hipertensão Resistente: Um Estudo Piloto Randomizado, Duplo-Cego e Controlado por Placebo.

BACKGROUND: The cytokine tumor necrosis factor-alpha (TNF-α) is elevated in resistant hypertension (RH), but the effects of a TNF-α inhibitor in this population is unknown. OBJECTIVE: The aim of this trial was to evaluate whether a single dose of infliximab controlled by placebo acutely reduces blood pressure (BP) in RH subjects. METHODS: A double-blind, placebo-controlled, crossover trial was conducted, and randomized RH subjects received either infliximab or placebo. The primary endpoint was the change in mean BP levels relative to the baseline immediately after the infusion obtained by continuously beat-to-beat non-invasive hemodynamic assessment. Secondary endpoints included changes in office, ambulatory and central BP measurements; endothelial function; and inflammatory biomarkers after 7 days. The level of significance accepted was alpha=0.05. RESULTS: Ten RH subjects were enrolled. The primary endpoint analysis showed an acute decrease in mean BP values (mean of differences ± standard deviation = -6.3 ± 7.2 mmHg, p=0.02) from baseline, after the application of infliximab compared with placebo. Diastolic BP levels (-4.9 ± 5.5 mmHg, p=0.02), but not systolic BP levels (-9.4 ± 19.7 mmHg, p=0.16), lowered after infliximab infusion. No further significant differences were identified in either the other hemodynamic parameters or in secondary endpoints, except for TNF-α levels, which increased continuously after infliximab infusion. No adverse events were reported during the protocol. CONCLUSIONS: A single-dose of infliximab decreased the mean and diastolic BP levels immediately after its infusion, when compared to the placebo in RH. The anti-TNF-α therapy was found to be safe and well-tolerated. The results of this proof-of-concept are hypothesis-generating and need to be further investigated. (Arq Bras Cardiol. 2021; 116(3):443-451).

FUNDAMENTO: A citocina fator de necrose tumoral alfa (TNF-α) é elevada na hipertensão resistente (HAR), mas os efeitos dos inibidores de TNF-α nessa população ainda são desconhecidos. OBJETIVOS: O objetivo deste estudo foi avaliar se uma única dose de infliximabe controlada por placebo reduz a pressão arterial (PA) de forma aguda em pacientes com HAR. MÉTODOS: Realizamos um estudo cruzado, randomizado, duplo-cego e controlado por placebo em que pacientes com HAR receberam infliximabe ou placebo. O desfecho primário foi a alteração dos níveis de PA média em relação ao basal imediatamente após a infusão, obtida por avaliação hemodinâmica não invasiva contínua, batimento a batimento. Os desfechos secundários incluíram alterações em medidas de PA central, ambulatorial e em consultório, na função endotelial, e nos biomarcadores inflamatórios após 7 dias. O nível de significância aceito foi alfa=0,05. RESULTADOS: Foram incluídos dez portadores de HAR. O resultado do desfecho primário demonstrou uma redução aguda dos níveis de PA média (média das diferenças ± desvio padrão = -6,3 ± 7,2 mmHg, p=0,02) em relação ao basal, após o uso de infliximabe, em comparação com o placebo. Os níveis de PA diastólica (-4,9 ± 5,5 mmHg, p=0,02), mas não os níveis de PA sistólica (-9,4 ± 19,7 mmHg, p=0,16), reduziram após a infusão de infliximabe. Não foram identificadas diferenças significativas nos demais parâmetros hemodinâmicos, nem nos resultados dos desfechos secundários, com exceção dos níveis de TNF-α, que aumentaram continuamente após o uso de infliximabe. Não foram relatados eventos adversos durante o protocolo. CONCLUSÕES: Uma dose única de infliximabe reduziu os níveis de PA média e diastólica imediatamente após sua infusão, em comparação com placebo em HAR. A terapia com anti-TNF-α foi considerada segura e bem tolerada. Os resultados desse estudo prova de conceito são geradores de hipótese e precisam ser investigados em maior detalhe. (Arq Bras Cardiol. 2021; 116(3):443-451).

Efeitos da Terapia com Anti-TNF alfa na Pressão Arterial em Pacientes com Hipertensão Resistente: Um Estudo Piloto Randomizado, Duplo-Cego e Controlado por Placebo / Effects of Anti-TNF alpha Therapy on Blood Pressure in Resistant Hypertensive Subjects: A Randomized, Double-Blind, Placebo-Controlled Pilot Study

Resumo Fundamento: A citocina fator de necrose tumoral alfa (TNF-α) é elevada na hipertensão resistente (HAR), mas os efeitos dos inibidores de TNF-α nessa população ainda são desconhecidos. Objetivos: O objetivo deste estudo foi avaliar se uma única dose de infliximabe controlada por placebo reduz a pressão arterial (PA) de forma aguda em pacientes com HAR. Métodos: Realizamos um estudo cruzado, randomizado, duplo-cego e controlado por placebo em que pacientes com HAR receberam infliximabe ou placebo. O desfecho primário foi a alteração dos níveis de PA média em relação ao basal imediatamente após a infusão, obtida por avaliação hemodinâmica não invasiva contínua, batimento a batimento. Os desfechos secundários incluíram alterações em medidas de PA central, ambulatorial e em consultório, na função endotelial, e nos biomarcadores inflamatórios após 7 dias. O nível de significância aceito foi alfa=0,05. Resultados: Foram incluídos dez portadores de HAR. O resultado do desfecho primário demonstrou uma redução aguda dos níveis de PA média (média das diferenças ± desvio padrão = -6,3 ± 7,2 mmHg, p=0,02) em relação ao basal, após o uso de infliximabe, em comparação com o placebo. Os níveis de PA diastólica (-4,9 ± 5,5 mmHg, p=0,02), mas não os níveis de PA sistólica (-9,4 ± 19,7 mmHg, p=0,16), reduziram após a infusão de infliximabe. Não foram identificadas diferenças significativas nos demais parâmetros hemodinâmicos, nem nos resultados dos desfechos secundários, com exceção dos níveis de TNF-α, que aumentaram continuamente após o uso de infliximabe. Não foram relatados eventos adversos durante o protocolo. Conclusões: Uma dose única de infliximabe reduziu os níveis de PA média e diastólica imediatamente após sua infusão, em comparação com placebo em HAR. A terapia com anti-TNF-α foi considerada segura e bem tolerada. Os resultados desse estudo prova de conceito são geradores de hipótese e precisam ser investigados em maior detalhe. (Arq Bras Cardiol. 2021; 116(3):443-451)

Abstract Background: The cytokine tumor necrosis factor-alpha (TNF-α) is elevated in resistant hypertension (RH), but the effects of a TNF-α inhibitor in this population is unknown. Objective: The aim of this trial was to evaluate whether a single dose of infliximab controlled by placebo acutely reduces blood pressure (BP) in RH subjects. Methods: A double-blind, placebo-controlled, crossover trial was conducted, and randomized RH subjects received either infliximab or placebo. The primary endpoint was the change in mean BP levels relative to the baseline immediately after the infusion obtained by continuously beat-to-beat non-invasive hemodynamic assessment. Secondary endpoints included changes in office, ambulatory and central BP measurements; endothelial function; and inflammatory biomarkers after 7 days. The level of significance accepted was alpha=0.05. Results: Ten RH subjects were enrolled. The primary endpoint analysis showed an acute decrease in mean BP values (mean of differences ± standard deviation = -6.3 ± 7.2 mmHg, p=0.02) from baseline, after the application of infliximab compared with placebo. Diastolic BP levels (-4.9 ± 5.5 mmHg, p=0.02), but not systolic BP levels (-9.4 ± 19.7 mmHg, p=0.16), lowered after infliximab infusion. No further significant differences were identified in either the other hemodynamic parameters or in secondary endpoints, except for TNF-α levels, which increased continuously after infliximab infusion. No adverse events were reported during the protocol. Conclusions: A single-dose of infliximab decreased the mean and diastolic BP levels immediately after its infusion, when compared to the placebo in RH. The anti-TNF-α therapy was found to be safe and well-tolerated. The results of this proof-of-concept are hypothesis-generating and need to be further investigated. (Arq Bras Cardiol. 2021; 116(3):443-451)

Factors associated with tetanus vaccination in pregnant women living in Minas Gerais State, Brazil: A cross-sectional study.

Background: Immunization in pregnant women is essential to help controlling and avoiding preventable diseases. Aim: Analyzing some factors associated with non-vaccination against tetanus in pregnant women who gave birth in maternity hospitals in Belo Horizonte City, Minas Gerais State, Brazil. Methods: Cross-sectional study carried out with database deriving from the research titled "Born in Belo Horizonte: Survey on childbirth", which was developed in public and private hospitals. Sample was calculated by taking into consideration the total number of births recorded in each investigated maternity hospital - the final sample comprised 481 mothers. Descriptive population statistics were used for data analysis purposes, whereas Poisson regression model was used to estimate factors associated with non-vaccination against tetanus during pregnancy. Results: The prevalence of puerperal women subjected to at least 2 doses of tetanus vaccine reached 59.2%. Adjusted analyses have shown that not living with a partner has increased by 1.58 times the prevalence of women who did not take tetanus vaccine, on average; that the prevalence of women who were not vaccinated has decreased by 0.65 times after each prenatal consultation, on average; that prenatal consultations with nurses have reduced by 0.52 times the prevalence of women who did not take the tetanus vaccine, on average. Conclusion: Almost half of puerperal women were not vaccinated against tetanus during pregnancy. It is essential identifying specific groups to help implementing and expanding preventive actions, such as immunization for pregnant women. Despite advances in public health policies, authorities still face challenges to expand vaccination coverage in the investigated state, as well as to strengthen the national immunization program to help increasing tetanus vaccination rates among pregnant women.

Combined Aerobic and Resistance Exercises Evokes Longer Reductions on Ambulatory Blood Pressure in Resistant Hypertension: A Randomized Crossover Trial.

AIM: The present study compared the acute effects of aerobic (AER), resistance (RES), and combined (COM) exercises on blood pressure (BP) levels in people with resistant hypertension (RH) and nonresistant hypertension (NON-RH). METHODS: Twenty patients (10 RH and 10 NON-RH) were recruited and randomly performed three exercise sessions and a control session. Ambulatory BP was monitored over 24 hours after each experimental session. RESULTS: Significant reductions on ambulatory BP were found in people with RH after AER, RES, and COM sessions. Notably, ambulatory BP was reduced during awake-time and night-time periods after COM. On the other hand, the effects of AER were more prominent during awake periods, while RES caused greater reductions during the night-time period. In NON-RH, only RES acutely reduced systolic BP, while diastolic BP was reduced after all exercise sessions. However, the longest postexercise ambulatory hypotension was observed after AER (~11 h) in comparison to RES (~8 h) and COM (~4 h) exercises. CONCLUSION: Findings of the present study indicate that AER, RES, and COM exercises elicit systolic and diastolic postexercise ambulatory hypotension in RH patients. Notably, longer hypotension periods were observed after COM exercise. In addition, NON-RH and RH people showed different changes on BP after exercise sessions, suggesting that postexercise hypotension is influenced by the pathophysiological bases of hypertension.