Characterization of variables related to high stability of raw cow milk.

This research paper analyzes the stability of raw cow milk in the alcohol test and seeks to understand to know the factors that influence milk stability and the occurrence of unstable non-acid milk. Milk samples were collected from the cooling tanks of rural farmers in the state of Paraná twice in summer and twice in winter. The farms were classified according to the production system: pasture with supplementation and feedlot. The following variables were analyzed: stability in the alcohol test, titratable acidity, ionized calcium concentration (iCa), chemical composition of milk, somatic cell count and standard plate count. The results showed that milk stability was greater in winter vs. summer, when the milk contained higher iCa, and in the feedlot vs. pasture system. The Pearson Correlation between variables (ethanol stability, milk composition, iCa, cooling tank temperature, milk volume, number of milking, number of cows milked, fat/protein ratio, distance and travel time) were analyzed. Stability was negatively correlated with iCa concentration and positively with lactose content. Logistic regression of the risk of unstable non-acid milk at 72% alcohol (UNAM72) showed that only iCa and lactose were determinants, while evaluation of the same risk at 78% alcohol revealed iCa, titratable acidity, lactose and milk urea nitrogen as risk factors. Under the dairy farming conditions of Paraná state, the frequency of UNAM72 was low (12.16%) and was higher in summer and in pasture systems with supplementation. In conclusion, in dairy herds bred with high technological level, with adequate nutritional and health management, the frequency of UNAM is low and is related to nutritional management abnd, perhaps, heat stress, factors that alter iCa and lactose levels.

Treatment of a severely compromised endodontically treated tooth with a 2-piece premanufactured glass-fiber post: A clinical report.

A 2-piece premanufactured glass-fiber post-and-core for a child with a severely compromised endodontically treated tooth to restore dental form, function, and esthetics, is described. A shorter chair time than for the conventional options was needed, and the post provided an adequate biomechanical response with a reduced intracanal cement thickness.

Instruments to Assess Evidence-Based Practice Among Health Care Professionals: A Systematic Review.

BACKGROUND: The use of measurement instruments to assess the use of Evidence-Based Practice by health professionals has been frequently reported in studies. AIMS: This systematic review aimed to summarize, describe, and evaluate the measurement properties of the instruments that evaluate the use of Evidence-Based Practice in health professionals. METHODS: The search was carried out in four databases considering three groups of search terms: evidence-based practice, evaluation, and measurement proprieties. Studies were included that described the use of instruments to assess Evidence-Based Practice in health professionals, with the full-text publication, which analyzed the measurement properties, in English. The methodological quality of the studies was evaluated using COnsensus-based Standards for the selection of health Measurement INstruments. RESULTS: In total, 6,429 were found and only 92 were eligible for data analysis. Forty new instruments were identified most were developed for nursing and physical therapist. The investigators performed at least 1 type of validity test on 73% of the instruments. Reliability was tested at 90%, through internal consistency. Responsiveness was tested on less than half of the instruments (30%). Most of the instruments identified are reliable and valid to measure evidence-based practice in health professionals. CONCLUSION: Although the Fresno Test remains the most complete instrument, and adequate for use. The COnsensus-based Standards for the selection of health Measurement INstruments checklist classified 7 (seven) instruments as suitable for the target audience.

Cross-Cultural Adaptation and Validation of the European Portuguese Dysphagia Handicap Index.

The Dysphagia Handicap Index (DHI) is a valid Health-related Quality of Life (HRQoL) 25-item questionnaire assessing the physical, functional, and emotional aspects of patients with oropharyngeal dysphagia (OD), of heterogeneous etiologies. The purpose of this study is to translate and validate the European Portuguese-DHI (EP-DHI). This is a prospective study that was carried out at Centro Hospitalar Universitário do Porto (CHUPorto). The generated EP-DHI was administered to 132 patients with OD and 112 healthy control subjects. 132 patients undergoing fiberoptic endoscopic examination of swallowing (FEES). 15 patients were contacted by phone, 2 or 3 weeks later after the first interview to repeat the questionnaire. The validity of concurrent criteria was evaluated by comparing the results of the EP-DHI score with the score attributed to the pathological findings found in FEES and, consequently, Functional Oral Intake Scale (FOIS). The internal consistency of EP-DHI was successful: Cronbach's alpha coefficient for total EP-DHI was 0.874. The test-retest reliability for the total and the three EP-DHI subscales obtained a Pearson's correlation coefficient ranged from 0.990 to 0.712. This study demonstrates that EP-DHI is a valid tool for self-assessment of the handicapping effect of dysphagia on physical, functional, and emotional aspects of patient's quality of life, among an European Portuguese sample.

Cordoma Sacral: Relato de uma Rara Neoplasia Maligna / Sacral Chordoma: Report of a Rare Malignant Neoplasm / Cordoma Sacral: Relato de uma Rara Neoplasia Maligna

Introdução: O cordoma é um tipo de sarcoma cuja malignidade óssea primária se origina da notocorda e se localiza no eixo espinhal entre o clivus e o sacro. A primeira descrição dessa patologia foi em 1857. Na epidemiologia da doença, são mais afetados pacientes entre 40 e 60 anos, sendo o principal sítio de acometimento a região sacrococcígea. O quadro clínico é variável conforme o local acometido com sintomas geralmente inespecíficos, gerando atrasos no diagnóstico feito por biópsia. Entre as opções de tratamento, o principal método é a ressecção cirúrgica com margens, que pode ser associada à radioterapia ou à radiocirurgia quando necessário; os sítios de metástases mais comuns são pulmões, ossos, fígado e linfonodos locais. Relato do caso: Paciente, sexo feminino, 62 anos, iniciou com quadro de dor em região coccígea com piora ao sentar-se e surgimento de lesão nodular com crescimento progressivo recebendo diagnóstico de cordoma, após biópsia da lesão, depois de três anos. Em razão da lesão extensa, optou-se inicialmente por tratamento com quimio e radioterapia para citorredução. Pela pouca responsividade, foi submetida ao tratamento de sacralectomia com sucesso, porém apresentou como complicação deiscência de ferida operatória e necessidade de reabordagem, desde então sem recorrência no seguimento clínico. Conclusão: Assim, evidencia-se a necessidade de novas pesquisas sobre o cordoma, um tumor raro e de baixa responsividade aos tratamentos não cirúrgicos, visando a melhorar a terapêutica quimioterápica dessa neoplasia potencialmente deformante.

Introduction: Chordoma is a type of sarcoma, a primary bone malignancy that originates from the notochord and is located on the spinal axis between the clivus and the sacrum. The first description of this pathology occurred in 1857. Patients between 40 and 60 years old are the most affected according to the disease's epidemiology, the main site involved is the sacral/coccygeal region. The clinical condition is variable depending on the site affected, with generally nonspecific symptoms, delaying the diagnosis made by biopsy. Among the treatment options, surgical resection with margins is currently the main method, and may be associated with radiotherapy or radiosurgery when necessary; the most common metastatic sites are lungs, bones, liver and local lymph nodes. Case report: A 62-year-old female patient had pain in the coccygeal region, worsening while sitting and the appearance of a nodular lesion with progressive growth, diagnosed as a chordoma three years later, after biopsy of the lesion. Due to the extensive lesion, initially she was submitted to chemotherapy and radiotherapy for cytoreduction, but because of the poor response, she was successfully submitted to sacralectomy, however, dehiscence of the surgical wound was detected, and the patient underwent a new approach; since then, no recurrence in the clinical follow-up. Conclusion: Apparently, it is clear the necessity for further investigations on chordoma, a rare tumor with poor response to non-surgical treatments, in order to improve the chemotherapy for this potentially deforming neoplasm.

Introducción: El cordoma es un tipo de sarcoma, una malignidad ósea primaria que se origina en la notocorda y se localiza en el eje espinal entre el clivus y el sacro. La primera descripción de esta patología fue en 1857. En la epidemiología de la enfermedad, los pacientes entre 40 y 60 años son los más afectados, siendo el principal sitio de afectación la región sacrocoxígea. El cuadro clínico es variable según el sitio afectado, con síntomas generalmente inespecíficos, lo que provoca retrasos en el diagnóstico realizado mediante biopsia. Entre las opciones de tratamiento, la resección quirúrgica con márgenes es actualmente el principal método, pudiendo asociarse a radioterapia o radiocirugía cuando sea necesario; los sitios más comunes de metástasis son los pulmones, los huesos, el hígado y los ganglios linfáticos locales. Informe del caso: Paciente, sexo femenino, de 62 años inició con dolor en la región coccígea, empeorando al sentarse y aparición de una lesión nodular con crecimiento progresivo, recibiendo diagnóstico de cordoma, luego de biopsia de la lesión, después de tres años. Debido a la extensión de la lesión optó inicialmente por tratamiento con quimio y radioterapia para citorreducción, por la poca reactividad fue sometida con éxito al tratamiento de sacralectomía, pero presentó como complicación dehiscencia de la herida quirúrgica y necesidad de reabordaje. Desde entonces sin recurrencia en el seguimiento clínico. Conclusión: Por lo tanto, es evidente la necesidad de seguir investigando sobre el cordoma, un tumor poco frecuente con escasa respuesta a los tratamientos no quirúrgicos, con el fin de mejorar la terapia de quimioterapia para esa neoplasia potencialmente deformante.

Prevalence of intestinal parasitic infections versus knowledge, attitudes and practices of male residents in Brazilian urban slums: a cross-sectional study.

Intestinal parasitic infections (IPIs) are neglected diseases caused by helminths and protozoa, with the relationships between parasite, host and environment having the potential to produce high morbidity and incapacity to work and mortality in vulnerable areas. This study assessed the prevalence of IPIs concerning socio-environmental conditions and analyzed the knowledge, attitudes and practices related to these diseases among men living in the slums of Rio de Janeiro city, Rio de Janeiro State, Brazil. A cross-sectional study was conducted in an agglomeration of urban slums between 2018 and 2019, with men aged between 20 and 59 years. A socioeconomic status questionnaire and an IPIs knowledge, attitudes and practices questionnaire (KAPQ) were applied. Coproparasitological diagnoses (n=454) were performed using four methods and samples of water for household consumption (n=392) were subjected to microbiological and physicochemical analysis. A total of 624 participants were enrolled. About 40% of the households had "water unsuitable for consumption". Only one Major Area, MA 3 was not statistically significant for IPIs (AOR=0.75; 95% CI: 0.30-1.88; p=0.55). The overall prevalence of IPIs was 23.8%. Endolimax nana (n=65, 14.3%) and hookworm (n=8, 1.7%) were the most frequently identified parasites. The analysis of the frequency of responses to the KAPQ has shown that men reported to seeking medical care if they were suspicious of IPIs, and around 35% would self-medicate. The results have shown the need to adopt integrated health education practices targeting male residents in urban slums to qualify the care with water for human consumption and promote self-care about IPIs. The household can be considered strategic for Primary Health Care activities for men.

Condições socioeconômicas e impactos da pandemia da Covid-19 na região da Sub-Bacia do Canal do Cunha, Rio de Janeiro / Socioeconomic conditions and impacts of the COVID-19 pandemic in the Canal do Cunha Sub-Basin region, Rio de Janeiro municipality

RESUMO O Município do Rio de Janeiro (MRJ) estava entre as cidades com altas taxas de mortalidade ao longo da pandemia de Covid-19. Neste estudo, analisamos as taxas de incidência, de mortalidade e letalidade por Covid-19 nas áreas com predominância de Aglomerados Subnormais (ASN). Foram considerados todos os 36 bairros da Sub-Bacia do Canal do Cunha (SBCC) associadas às características demográficas, socioeconômicas e epidemiológicas, com estatística espacial de Moran. A taxa de incidência nos bairros da SBCC foi de 621,5/10.000 habitantes. Complexo do Alemão, Mangueira, e Maré tiveram maiores proporções de casos e mortes. A menor incidência (33,6/10.000 habitantes) e mortalidade (8,3/10.000 habitantes), mas com maior taxa de letalidade (24,7%) foi registrada no Complexo do Alemão. Foi observado correlação negativa entre a taxa de mortalidade e a proporção de habitantes nos bairros com ASN (rho= -0,433; p=0,023). Na estatística espacial, houve correlação inversa para a incidência da Covid-19 (índice Moran, -0,155863; p=0,02). Conclui-se que incidência e mortalidade nas áreas de ASN estão significativamente relacionadas com as estruturas sociodemográficas, demandando o reforço dos sistemas de vigilância e de controle da Covid-19 em territórios de favelas. As recomendações não farmacológicas e a Atenção Primária à Saúde em favelas desempenham relevante papel na redução da transmissão, mortalidade e iniquidades em saúde.

ABSTRACT Along COVID-19 pandemics, Rio de Janeiro (MRJ) has figured among the Brazilian cities with the highest mortality rates. In this study, we explored COVID-19 incidence and mortality in areas with a predominance of subnormal population clusters (SNC) in MRJ. We analyzed 36 neighborhoods of Canal do Cunha Sub-basin (CCSB) and the associations between demographic, socioeconomic, and epidemiological features, and the cumulative incidence, mortality, and lethality rates, and Moran's spatial statistics were performed. The incidence rate in CCSB neighborhoods was 621.5/10,000 inhabitants. Complexo do Alemão, Mangueira, and Maré had the highest proportions of cases and deaths. And the lowest incidence (33.6/10,000 inhabitants), mortality (8.3/10,000 inhabitants), but with the highest lethality rate (24.7%) was recorded in Complexo do Alemão. There was a negative correlation between mortality and the proportion of inhabitants in neighborhoods with ASN (rho= -0.433; p=0.023). In spatial statistics, there was an inverse correlation for the incidence (Moran index, -0.155863; p=0.02). It is concluded that incidence and mortality in SNC areas are significantly related to their sociodemographic structures, highlighting the need to strengthen the surveillance and control systems of COVID-19 in slums territories. Non-pharmacological recommendations and suitable Primary Health Care in slums areas play a relevant role in reducing viral transmission, mortality, and health inequities.

Oncological Surgery During the COVID-19 Pandemic: Effectiveness of Preoperative Screening and Factors Associated with Postoperative SARS-CoV-2 Infection.

BACKGROUND: Routine preoperative screening of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with reverse transcriptase-polymerase chain reaction (RT-PCR) may reduce in-hospital SARS-CoV-2 transmission. METHODS: This was a prospective, observational, cohort study. The endpoints were the incidence of asymptomatic patients with positive preoperative RT-PCR results and the incidence and factors associated with postoperative SARS-CoV-2 infection in patients with cancer referred for elective surgery. Patients with elective surgery between May and October 2020 were included. RT-PCR of nasopharyngeal swabs was performed preoperatively for all patients. Postoperative SARS-CoV-2 infection was assessed within 30 postoperative days. RESULTS: A total of 1636 preoperative screening RT-PCR tests were performed. Of these, 102 (6.2%) cases were positive, and 1,298 surgical procedures were analyzed. The postoperative SARS-CoV-2 infection rate was 0.9%. The length of stay (odds ratio [OR] 1.08; 95% confidence interval [CI] 1.04-1.11; p < 0.001), surgical time (OR 1.004; 95% CI 1.001-1.008; p = 0.023), intensive care unit admission (OR 7.7; 95% CI 2.03-29.28; p = 0.003), and hospital readmissions (OR 9.56; 95% CI 2.50-36.56; p = 0.001) were associated with postoperative coronavirus disease (COVID-19). Using unadjusted and adjusted logistic regression, length of stay (OR 1.08; 95% CI 1.04-1.11; p < 0.001), and readmission (OR 9.02; 95% CI 2.30-35.48; p = 0.002) were independent factors of postoperative COVID-19. CONCLUSIONS: Screening patients preoperatively may reduce in-hospital SARS-CoV-2 transmission. Length of stay and readmission were independently correlated with postoperative COVID-19.

Papel do strain no diagnóstico precoce da cardiomiopatia diabética / Role of strain in the early diagnosis of diabetic cardiomyopathy

Fundamento: A ecocardiografia avançada com utilização de strain miocárdico bi e tridimensional propõe identificar a disfunção sistólica subclínica em diversas condições clínicas. No diabetes mellitus, seu papel é de grande interesse para diagnóstico precoce de cardiomiopatia diabética. Contudo, há grande heterogeneidade nos artigos publicados. Objetivo: Realizar uma revisão sistemática, para avaliar o papel atual da avaliação com strain nos pacientes com diabetes mellitus. Métodos: Após revisão sistemática em cinco bancos de dados, 19 estudos que utilizaram strain bidimensional e oito estudos que utilizaram strain tridimensional foram incluídos. Resultados:Na avaliação por strain bidimensional, a amostra totalizou 1.774 indivíduos com diabetes mellitus, com idade média de 57,1 anos e mediana de 55 anos, com equilíbrio em relação ao sexo dos participantes (47,5% do sexo feminino). Nos estudos que utilizaram strain tridimensional, foram incluídos 488 indivíduos com diabetes, com idade média de 55,7 anos e mediana de 63 anos, também com equilíbrio entre o sexo dos pacientes (51% do sexo feminino). O strain global longitudinal foi o marcador de deformação miocárdica que mais frequentemente conseguiu demonstrar diferença entre grupos com indivíduos diabéticos e controles. Conclusão: O strain miocárdico por speckle tracking bi e tridimensional permite identificar disfunção sistólica subclínica em pacientes diabéticos, o que se torna mais marcante nos pacientes com mais fatores de risco associados e com remodelamento ventricular.(AU)

Background: Advanced echocardiography using two- and three-dimensional myocardial strain proposes to identify subclinical systolic dysfunction in different clinical conditions. Strain assessment plays an important role in the early diagnosis of diabetic cardiomyopathy in diabetes mellitus (DM). However, the findings of published articles are heterogeneous. Here we conducted a systematic review to analyze the current role of strain assessment in patients with DM. Methods: This systematic review of five databases identified 19 studies that used twodimensional strain and 8 studies that used three-dimensional strain. Results: The studies of two-dimensional strain included 1,774 DM patients (mean age, 57.1 years; median age, 55 years; 47.5% women), while those of three-dimensional strain included 488 DM patients (mean age, 55.7 years; median age, 63 years; 51% women). Global longitudinal strain was the myocardial deformation marker that differed most frequently between the DM and control groups. Conclusion: Myocardial strain imaging by two- and three-dimensional speckle tracking echocardiography allows the identification of subclinical systolic dysfunction in DM patients, and differences become more marked when associated with risk factors and ventricular remodeling.(AU)

Prevalence of intestinal parasitic infections versus knowledge, attitudes and practices of male residents in Brazilian urban slums: a cross-sectional study

ABSTRACT Intestinal parasitic infections (IPIs) are neglected diseases caused by helminths and protozoa, with the relationships between parasite, host and environment having the potential to produce high morbidity and incapacity to work and mortality in vulnerable areas. This study assessed the prevalence of IPIs concerning socio-environmental conditions and analyzed the knowledge, attitudes and practices related to these diseases among men living in the slums of Rio de Janeiro city, Rio de Janeiro State, Brazil. A cross-sectional study was conducted in an agglomeration of urban slums between 2018 and 2019, with men aged between 20 and 59 years. A socioeconomic status questionnaire and an IPIs knowledge, attitudes and practices questionnaire (KAPQ) were applied. Coproparasitological diagnoses (n=454) were performed using four methods and samples of water for household consumption (n=392) were subjected to microbiological and physicochemical analysis. A total of 624 participants were enrolled. About 40% of the households had "water unsuitable for consumption". Only one Major Area, MA 3 was not statistically significant for IPIs (AOR=0.75; 95% CI: 0.30-1.88; p=0.55). The overall prevalence of IPIs was 23.8%. Endolimax nana (n=65, 14.3%) and hookworm (n=8, 1.7%) were the most frequently identified parasites. The analysis of the frequency of responses to the KAPQ has shown that men reported to seeking medical care if they were suspicious of IPIs, and around 35% would self-medicate. The results have shown the need to adopt integrated health education practices targeting male residents in urban slums to qualify the care with water for human consumption and promote self-care about IPIs. The household can be considered strategic for Primary Health Care activities for men.

Concessão privatista do saneamento e a incidência da Covid-19 em favelas do Rio de Janeiro / Privatizing sanitation concessions and the incidence of COVID-19 in slums in Rio de Janeiro

RESUMO O objetivo foi avaliar a relação espacial dos indicadores de saneamento (acesso à água e ao esgoto), considerando a modelagem da concessão da Companhia Estadual de Águas e Esgotos do Rio de Janeiro (Cedae), e a sua possível relação com a incidência da Covid-19, nos bairros com e sem áreas de favelas. Os dados de casos confirmados da Covid-19 analisados foram obtidos no Painel Saúde do Rio de Janeiro. Foi considerado o fracionamento do município em quatro blocos regionais. Nos 163 bairros da cidade, a taxa de incidência média foi de 9,78 casos/1.000 hab. Os bairros com as menores taxa de incidência foram aqueles com predominância de aglomerados subnormais (favelas), baixa renda per capita e cobertura de saneamento, sugerindo maior lacuna de testagem e subnotificação de casos. Reduzir a inequidade e o racismo estrutural deveria ser prioritário. A sindemia da Covid-19 contribuiu fortemente para perdas socioeconômicas e de saúde pública significativas. Em um cenário de reconstrução, é imprescindível retomar o compromisso para com os Objetivos de Desenvolvimento Sustentável da Agenda 2030 das Nações Unidas.

ABSTRACT This assessment aimed to evaluate the putative spatial relationship between sanitation indicators (access to water and sewage) considering the Rio de Janeiro State Water and Sewage Company (CEDAE) parameters and the COVID-19 incidence among districts with and without slum areas. The data of confirmed COVID-19 cases analyzed were obtained from the Rio de Janeiro Health Panel. We considered the division of the municipality into four regional blocks. The mean COVID-19 incidence was 9.78 cases/1,000 inhabitants in the 163 city districts. The lowest COVID-19 incidence rate was most reported in slum regions, with lower per capita income and sanitation coverage, suggesting a significant gap in testing and case underreporting. Reducing inequality and structural racism should be a priority. The COVID-19 syndemic strongly contributed to significant socioeconomic and public health losses. Our commitment to the Sustainable Development Goals of the 2030 agenda of the United Nations is pivotal in a backdrop of reconstruction.

Suffering experiences of people with cancer undergoing chemotherapy: A meta-ethnographic study.

This meta-ethnography had the objectives of identifying, evaluating, and summarizing the findings of qualitative studies regarding the suffering experiences of people undergoing chemotherapy, as well as developing an explanatory conceptual structure regarding what affects these experiences. A systematic literature review was carried out, covering the past 10 years, in the following databases: CINAHL, Embase, Medline, LILACS and Scopus. By using meta-ethnographic synthesis methods, the following themes were found: the pain of loss; evaluating, measuring, and neutralizing the threat; and social contours of suffering. The experience of living with cancer and undergoing chemotherapy was synthesized into a theoretical-explanatory model with a structure that resembles barbed-wire loops. The model expresses people's suffering experiences as marked by the feeling of loss, restraint of emotions, and resilience. While transcendent movements broke the cycle of suffering, resilience emerged as a learning experience that made patients more resistant to the pain of loss. The results indicated a complex and diverse set of factors that influence suffering, which confirmed that experiences are individual, comprehensive, and continuously reinterpreted.

Demographic, socioeconomic and epidemiological aspects of COVID-19 in the Cunha Canal Sub-Basin Region, Rio de Janeiro / Aspectos demográficos, socioeconômicos e epidemiológicos da COVID-19 na Região da Sub-Bacia do Canal do Cunha, Rio de Janeiro

The objective of this study was to analyze the COVID-19 incidence of and mortality in a population from a territorial area with a predominance of neighborhoods with slum areas (subnormal settlements), and its relationship with contextual variables. We analyzed 36 neighborhoods of the Canal do Cunha Sub-basin that presented 30,008 deaths by COVID-19 until February 5, 2021. Cumulative incidence, cumulative mortality, and cumulative lethality rates were considered as dependent variables. Contextual variables included patient neighborhood; proportion of ASN by neighborhoods, percentage of black and brown people, age group; income ratio, and sanitation indices. The variables were analyzed descriptively, bivariately by Spearman correlation, and Moran's spatial statistics were performed. The Complexo do Alemão, Mangueira, and Maré neighborhoods had the highest proportions of cases and deaths from COVI-19. The percentage of infection in the 20 to 29, 30 to 39, and 40 to 49 age groups were 13.6%, 21.5%, and 20.1%, respectively. In the 70 to 79 age group was 7.3% of the total COVID-19 cases, and 26.7% deaths and 34.2% lethality rate. When added the records of black and brown people with those without records for color/race there was significant positive moderate correlation between the cumulative incidence rate and mortality rate (rho = 0.383; p=0.048 and rho= 0.3176; p= 0.0106). The global and local Moran's spatial statistical evaluation allowed to verify intermediate and medium priority areas that need to strengthen the surveillance and control system of COVID-19. The epidemiological situation of an area with a high percentage of slum areas showed that mortality by COVID-19 in black and brown people is related to demographic aspects and that there is low notification of cases and deaths attributed to COVID-19 in residents of areas with slums.

Objetivo desse estudo foi analisar a incidência e mortalidade por COVID-19 em população de área territorial com predominância de bairros com áreas de favelas (aglomerados subnormais), e sua relação com variáveis contextuais. Foram analisados 36 bairros da Sub-bacia do Canal do Cunha que apresentaram 30.008 óbitos por COVID-19 até o dia 05 de fevereiro de 2021. Considerou-se como variáveis dependentes as taxas de incidência acumulada, mortalidade acumulada e letalidade acumulada. Entre as variáveis contextuais, foram incluídas bairro do paciente; proporção de ASN por bairros, percentual de pretos e pardos, faixa etária; razão de renda, e índices de saneamento. As variáveis foram analisadas de forma descritiva, bivariada pela correlação de Spearman e utilizado a estatística espacial de Moran. Os bairros Complexo do Alemão, Mangueira e Maré foram que apresentaram as maiores proporções de casos e óbitos por COVI-19. O percentual de infecção nas faixas de 20 a 29 anos, 30 a 39 anos e 40 a 49 anos foram de 13,6%, 21.5% e 20,1%, respectivamente. Na faixa etária entre 70 e 79 anos foi 7,3% do total de casos de COVID-19, e 26,7%  de óbitos e 34,2% taxa de letalidade. Quando somado os registros de pessoas pretas e parda com os sem registro para cor/raça houve correlação moderada positiva significativa entre a taxa de incidência acumulada e a taxa de mortalidade  (rho = 0,383; p=0,048 e rho= 0,3176; p=0,0106). A avaliação estatística espacial global e local de Moran permitiu verificar áreas de prioridade intermediárias e médias que necessitam reforçar o sistema de vigilância e controle da COVID-19. A situação epidemiológica de área com grande percentual de áreas favelas mostrou que a mortalidade por COVID-19 em pessoas pretas e pardas está relacionada a aspectos demográficos e que ocorre baixa notificação de casos e de óbitos atribuídas ao COVID-19 em moradores de áreas com favelas.

Events linked to Geosmin and 2-methylisoborneol (2-MIB) in a Water Supply Source in the State of Rio de Janeiro, Brazil: a case study / Eventos atrelados a Geosmina e 2-metilisoborneol (2-MIB) em Manancial de Abastecimento do Estado do Rio de Janeiro, Brasil: estudo de caso

Tastes and odors in tap water are problems faced by water companies all over the world, with complaints from consumers especially during the summer when cyanobacterial blooms occur that produce compounds such as geosmin and 2-methylisoborneol (2-MIB).  We analyzed data on the intensity of taste and odor, and total concentration of the substances geosmin and 2-MIB, present in drinking water and raw water collected by the sanitation company that supplies the metropolitan region of the state of RJ/Brazil, during water crises in the year 2020, and in the new event of 2021, despite the previous warnings made by experts. Statistical and correlation analysis of the public data, and metagenomic analysis of the raw water captured from the Guandu basin in the year 2020 were performed. Organoleptic data allowed us to signal the presence of these compounds in drinking water, the values of the intensity of taste were more times above the MPV of the Brazilian legislation, with the average of the data for 2020 being 37.5 and in the following year this average was 5 times lower, indicating that the measures to remove the compounds were more effective, but did not eliminate the problem. For the year 2020 there was a linear correlation of 0.97 between the taste organoleptic standard and the total concentration of the compounds. The metagenomic data of the raw water of the year 2020, related to the genes mtf, mic and glys indicated that the substance responsible for the taste and odor was 2-MIB, since the read rate for it was higher, both in the first visit and only in the second visit, when there was still perception of intensity of taste and odor. Modifications in the surveillance system of the quality of the water taken and consumed need to be adopted to circumvent the problems of cyanobacterial proliferation in the Guandu basin, since conditions favorable to blooms will occur as long as the sanitation problems in this watershed are not solved.

Gostos e odores na água da torneira são problemas enfrentados por empresas produtoras de água em todo o mundo, com reclamações dos consumidores principalmente durante o verão, quando ocorrerem florações de cianobactérias produtoras dos compostos como geosmina e o 2-metilisoborneol (2-MIB).  Foram analisados dados de intensidade do gosto e do odor, e concentração total das substâncias geosmina e 2-MIB, presente na água  potável e na água bruta captada pela empresa de saneamento, que abastece a região metropolitana do estado do RJ/Brazil,  durante  crises hídricas do ano 2020, e no novo evento de 2021, a despeito dos alertas prévios feitos por especialistas. Foram realizadas análises estatísticas e de correlação dos dados públicos, e analise metagenômica da água bruta captada no manancial da Bacia do Guandu, no ano de 2020. Dados organolépticos permitiram sinalizar a presença desses compostos na água de consumo, os valores da intensidade do gosto estiveram maior número de vezes acima do VMP da legislação brasileira, sendo a  média dos dados de 2020 de 37,5 e no ano seguinte esta média foi 5 vezes menor, indicando que as medidas para retirar dos compostos foram mais eficazes, mas não eliminaram o problema. Para o ano de 2020 houve correlação linear de 0,97 entre o padrão organoléptico gosto e a concentração total dos compostos. Os dados metagenômicos da água bruta do ano 2020, relacionados com os genes mtf, mic e glys indicaram que a substância responsável pelo gosto e odor foi o 2-MIB, visto o índice de reads para ele ter sido maior, tanto na primeira visita e único na segunda, quando ainda havia percepção de intensidade de gosto e odor. Modificações no sistema de vigilância da qualidade da água captada e de consumo precisam ser adotadas para contornar os problemas de proliferação de cianobactérias na bacia do Guandu, pois condições favoráveis às florações irão acontecer enquanto não forem resolvidos os problemas de saneamento dessa bacia hidrográfica.

Aspectos demográficos, socioeconômicos e epidemiológicos da COVID-19 na Região da Sub-Bacia do Canal do Cunha, Rio de Janeiro / Demographic, socioeconomic and epidemiological aspects of COVID-19 in theCunha Canal Sub-Basin Region, Rio de Janeiro

Objetivo desse estudo foi analisar a incidência e mortalidade por COVID-19 em população de área territorial com predominância de bairros com áreas de favelas (aglomerados subnormais), e sua relação com variáveis contextuais. Foram analisados 36 bairros da Sub-bacia do Canal do Cunha que apresentaram 30.008 óbitos por COVID-19 até o dia 05 de fevereiro de 2021. Considerou-se como variáveis dependentes as taxas de incidência acumulada, mortalidade acumulada e letalidade acumulada. Entre as variáveis contextuais, foram incluídas bairro do paciente; proporção de ASN por bairros, percentual de pretos e pardos, faixa etária; razão de renda, e índices de saneamento. As variáveis foram analisadas de forma descritiva, bivariada pela correlação de Spearmane utilizadoa estatística espacial de Moran. Os bairros Complexo do Alemão, Mangueira e Maré foram que apresentaram as maiores proporções de casos e óbitos por COVI-19. O percentual de infecção nas faixas de 20 a 29 anos, 30 a 39 anos e 40 a 49 anos foram de 13,6%, 21.5% e 20,1%, respectivamente. Na faixa etária entre 70 e 79 anos foi 7,3% do total de casos de COVID-19, e 26,7% de óbitos e 34,2% taxa de letalidade. Quando somado os registros de pessoas pretas e parda com os sem registro para cor/raça houve correlaçãomoderada positiva significativa entre a taxa de incidência acumulada e a taxa de mortalidade (rho = 0,383; p=0,048 e rho= 0,3176; p=0,0106). A avaliação estatística espacial global e local de Moran permitiu verificar áreas de prioridade intermediárias e médias que necessitam reforçar o sistema de vigilância e controle da COVID-19. A situação epidemiológica de área com grande percentual de áreas favelas mostrou que a mortalidade por COVID-19 em pessoas pretas e pardas está relacionada a aspectos demográficos e que ocorre baixa notificação de casos e de óbitos atribuídas ao COVID-19 em moradores de áreas com favelas.

Wastewater-Based Epidemiology (WBE) and Viral Detection in Polluted Surface Water: A Valuable Tool for COVID-19 Surveillance-A Brief Review.

SARS-CoV-2 is the causative agent of the current COVID-19 pandemic. Disease clinical manifestations range from asymptomatic to severe multiple organ damage. SARS-CoV-2 uses ACE2 as a cellular receptor, which is abundantly expressed in the small intestine, allowing viral replication in the gastrointestinal tract. Viral RNA has been detected in the stool of COVID-19 patients and viable viruses had been isolated in some of these samples. Thus, a putative role of SARS-CoV-2 fecal-oral transmission has been argued. SARS-CoV-2 is shed in human excreta and further disposed in the sewerage or in the environment, in poor basic sanitation settings. Wastewater-based epidemiology (WBE) is a valuable population level approach for monitoring viral pathogens and has been successfully used in different contexts. This review summarizes the current global experience on SARS-CoV-2 WBE in distinct continents and viral detection in polluted surface water. The advantages and concerns of this strategy for SARS-CoV-2 surveillance are discussed. Outcomes suggest that WBE is a valuable early warning alert and a helpful complementary surveillance tool to subside public health response, to tailor containment and mitigation measures and to determine target populations for testing. In poor sanitation settings, contaminated rivers could be alternatively used as a source for environmental surveillance.

Água de reúso: uma alternativa sustentável para o Brasil / Water reuse: a sustainable alternative for Brazil

RESUMO As motivações para a busca de soluções e alternativas que podem diminuir o estresse hídrico são evidentemente importantes. Mesmo que renováveis, os recursos hídricos de qualidade e potabilidade são escassos. Como alternativa, o reúso pode ajudar a diminuir o uso de águas potáveis para atividades que não necessitam de potabilidade. Este trabalho teve como objetivo realizar uma revisão da literatura sobre água de reúso a partir da definição de alternativa sustentável e racional para o uso da água. Realizou-se um levantamento bibliográfico do período de julho a dezembro de 2017 nas bases de dados Medical Literature Analysis and Retrievel System Online (MedLine), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Embase e Institute for Scientific Information (ISI). Com a revisão bibliográfica foi possível identificar que o tema "reúso" vem sendo debatido para a gestão, a padronização e os riscos associados à utilização. No Brasil, não há uma legislação a nível nacional que regule o uso e determine os padrões de qualidade da água de reúso. No entanto, nas quatro regiões brasileiras foi observado que há sete estados com legislações e normas sobre o tema. Legislações internacionais apresentam uma relação abrangente de parâmetros que podem ser utilizados no debate para a legislação brasileira. Trabalhos produzidos pela comunidade acadêmica fundamentam os riscos sobre esse tipo de água. Publicações científicas sobre água de reúso devem ser estimuladas, assim como legislações mais detalhadas descrevendo os tipos de água de reúso, assim como os padrões de riscos relacionados.

ABSTRACT The motivations for seeking solutions and alternatives that can reduce water stress is clearly important. Even though renewable, water resources of quality and potability are scarce. As an alternative, reuse can help reduce the use of drinking water for activities that do not require drinking. The objective was to carry out a review of the literature on reuse water based on the definition of a sustainable and rational alternative for water use. A bibliographical survey was carried out from July to December 2017 in the MedLine, Lilacs, Embase, and ISI databases. The bibliographic review showed that the reused topic has been discussed with notes to the management, standardization, and risks associated with its use. There is no national Brazilian legislation that regulates the use and quality standards of reuse water. However, in the four Brazilian regions, the literature points to only seven Brazilian states with legislation and norms on the subject. International legislations present a comprehensive list of parameters that can be used in the discussion of Brazilian national legislation. Works have been produced by the academic community, basing the risks of this type of water. Scientific publications on reuse water should be encouraged, as well as more detailed legislation describing the types of reuse water and related risk patterns.

Suffering among patients with cancer undergoing neurotoxic chemotherapy: a phenomenological approach / Sufrimiento de pacientes con cáncer en quimioterapia neurotóxica: un abordaje fenomenológico / Sofrimento de pacientes com câncer em quimioterapia neurotóxica: uma abordagem fenomenológica

ABSTRACT Objective: reveal experiences of cancer patients undergoing neurotoxic chemotherapy. Method: phenomenology-based, qualitative study, carried out with nine adult patients in antineoplastic neurotoxic treatment, interviewed in June and July 2018. The testimonies were analyzed using an empirical comprehensive model. Results: the following categories were delineated: nerves on edge: perception of limitations caused by neuropathic pain induced by chemotherapy; chemotherapy drains me of energy; the suffering of starting again; the suffering of enduring it; alone in a desert, I heard the cry of my silence; chemotherapy: an infusion of hope; and there is no suffering on earth that heaven cannot heal. Conclusion: the study presented various meanings of suffering that emerge from experiences with neurotoxic treatment and found that many dimensions of suffering interpenetrate, making it impossible to disassociate them.

RESUMEN Objetivo: revelar experiencias de pacientes con cáncer que se sometieron a terapia con quimioterápicos neurotóxicos. Método: Estudio cualitativo fundamentado en la fenomenología, realizado con nueve pacientes adultos tratados con antineoplásicos neurotóxicos, entrevistados entre junio y julio de 2018. Los testimonios fueron analizados según el modelo empírico-comprensivo. Resultados: se determinaron las categorías: Con los nervios a flor de piel -percepción de limitaciones provocadas por el dolor neuropático inducido por la quimioterapia-, La quimioterapia que acaba con mi energía; El sufrimiento de recomenzar; El sufrimiento de soportar; Solo, en un desierto, oí el grito de mi silencio; Quimioterapia -una infusión de esperanza-; y No hay sufrimiento en la tierra que el cielo no pueda curar. Conclusión: el estudio presentó varios significados de sufrimiento que surgen de la experiencia con el tratamiento neurotóxico, manifestando que muchas de las dimensiones del sufrimiento se entrecruzan, siendo imposible disociarlas.

RESUMO Objetivo: desvelar experiências de pacientes com câncer que se submeteram à terapia com quimioterápicos neurotóxicos. Método: estudo qualitativo, fundamentado na fenomenologia, realizado com nove pacientes adultos em tratamento com antineoplásicos neurotóxicos, entrevistados em junho e julho de 2018. Os depoimentos foram analisados segundo o modelo empírico-compreensivo. Resultados: foram reveladas as categorias: com os nervos à flor da pele - percepção das limitações provocadas pela dor neuropática induzida pela quimioterapia; a quimioterapia que acaba com a minha energia; o sofrimento de recomeçar; o sofrimento de suportar; sozinho, em um deserto, ouvi o grito do meu silêncio; quimioterapia - uma infusão de esperança; e, não há sofrimentos na terra que o céu não possa curar. Conclusão: o estudo apresentou vários significados de sofrimento que emergem da experiência com o tratamento neurotóxico, relatando que muitas das dimensões do sofrimento interpenetram-se, sendo impossível dissociá-las.