Results Of Minimally Invasive Vats Thymectomy In Miastenia Gravis Patients Compared With More Invasive Approaches - 10-Year Experience In A Single Center.

INTRODUCTION: Myasthenia gravis (MG) is an autoimmune, neurologic disease that causes a wide range of symptoms. While the transsternal, transcervical and thoracotomy approaches are accepted as effective, there is still debate regarding the VATS approach. MATERIALS AND METHODS: We analyzed our center's surgical experience with thymectomy for myasthenia gravis, comparing the results of patients operated on using VATS and more invasive approaches, over a period of 10 years. A search of the department's surgical database for myasthenia gravis cases between January 2010 and January 2021, revealed a total of 40 cases. Twenty-four patients were included in the final analysis and were distributed into two groups: the VATS procedure group (group A) and the open procedure group (group B). The latter included sternotomy, thoracotomy, transcervical and hemiclamshell approaches. Only radical thymectomies were included. The established outcomes were clinical improvement defined as asymptomatic remission, reduction, or discontinuation of the medication necessary to achieve optimal symptom control. RESULTS: The median follow-up time was 27 months (ranging from 4 to 75 months). Videothoracoscopy radical thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement (reduced symptoms or decreased medication) was observed in 8 cases (66.6%). No change in clinical outcome was noted in 1 patient (8.3%). None of the patients reported worsening symptoms. Open thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement was noted in 6 cases (50%). No change in clinical outcome was observed in 3 patients (25%) whereas 2 of them (16.7%) experienced slightly better symptom control but with a significant increase in medication. One patient (8.3%) described the clinical results as without any significant change. None of the patients reported worsening symptoms. CONCLUSION: The videotoracoscopic approach in the treatment of myasthenia gravis is non-inferior compared to the open approach and effective in a long-term follow-up, offering all the additional benefits of less invasive surgery.

Hesperidin from Orange Peel as a Promising Skincare Bioactive: An Overview.

The pursuit for better skin health, driven by collective and individual perceptions, has led to the demand for sustainable skincare products. Environmental factors and lifestyle choices can accelerate skin aging, causing issues like inflammation, wrinkles, elasticity loss, hyperpigmentation, and dryness. The skincare industry is innovating to meet consumers' requests for cleaner and natural options. Simultaneously, environmental issues concerning waste generation have been leading to sustainable strategies based on the circular economy. A noteworthy solution consists of citrus by-product valorization, as such by-products can be used as a source of bioactive molecules. Citrus processing, particularly, generates substantial waste amounts (around 50% of the whole fruit), causing unprecedented environmental burdens. Hesperidin, a flavonoid abundant in orange peels, is considered to hold immense potential for clean skin health product applications due to its antioxidant, anti-inflammatory, and anticarcinogenic properties. This review explores hesperidin extraction and purification methodologies as well as key skincare application areas: (i) antiaging and skin barrier enhancement, (ii) UV radiation-induced damage, (iii) hyperpigmentation and depigmentation conditions, (iv) wound healing, and (v) skin cancer and other cutaneous diseases. This work's novelty lies in the comprehensive coverage of hesperidin's promising skincare applications while also demonstrating its potential as a sustainable ingredient from a circular economy approach.

Clinical and Acoustic Alterations of Swallowing in Children Exposed to Zika Virus during Pregnancy in a Cohort in Amazonas, Brazil: A Case Series Study.

Oropharyngeal dysphagia (OD) is a swallowing disorder that involves difficulty in safely passing the food bolus from the oral cavity to the stomach. OD is a common problem in children with congenital Zika virus syndrome (CZS). In this case series, we describe the clinical and acoustic alterations of swallowing in children exposed to the Zika virus during pregnancy in a cohort from Amazonas, Brazil. From July 2019 to January 2020, 22 children were evaluated, 6 with microcephaly and 16 without microcephaly. The mean age among the participants was 35 months (±4.6 months). All children with microcephaly had alterations in oral motricity, mainly in the lips and cheeks. Other alterations were in vocal quality, hard palate, and soft palate. Half of the children with microcephaly showed changes in cervical auscultation during breast milk swallowing. In children without microcephaly, the most frequently observed alteration was in lip motricity, but alterations in auscultation during the swallowing of breast milk were not observed. Regarding swallowing food of a liquid and pasty consistency, the most frequent alterations were incomplete verbal closure, increased oral transit time, inadequacy in capturing the spoon, anterior labial leakage, and increased oral transit time. Although these events are more frequent in microcephalic children, they can also be seen in non-microcephalic children, which points to the need for an indistinct evaluation of children exposed in utero to ZIKV.

PLANTdataHUB: a collaborative platform for continuous FAIR data sharing in plant research.

In modern reproducible, hypothesis-driven plant research, scientists are increasingly relying on research data management (RDM) services and infrastructures to streamline the processes of collecting, processing, sharing, and archiving research data. FAIR (i.e., findable, accessible, interoperable, and reusable) research data play a pivotal role in enabling the integration of interdisciplinary knowledge and facilitating the comparison and synthesis of a wide range of analytical findings. The PLANTdataHUB offers a solution that realizes RDM of scientific (meta)data as evolving collections of files in a directory - yielding FAIR digital objects called ARCs - with tools that enable scientists to plan, communicate, collaborate, publish, and reuse data on the same platform while gaining continuous quality control insights. The centralized platform is scalable from personal use to global communities and provides advanced federation capabilities for institutions that prefer to host their own satellite instances. This approach borrows many concepts from software development and adapts them to fit the challenges of the field of modern plant science undergoing digital transformation. The PLANTdataHUB supports researchers in each stage of a scientific project with adaptable continuous quality control insights, from the early planning phase to data publication. The central live instance of PLANTdataHUB is accessible at (https://git.nfdi4plants.org), and it will continue to evolve as a community-driven and dynamic resource that serves the needs of contemporary plant science.

Climate and fertility amid a public health crisis.

One line of enquiry in demographic research assesses whether climate affects fertility. We extend this literature by examining the ramifications of climate conditions on fertility over a period of public health crisis in a highly unequal, urban middle-income country. We use monthly data for Brazil's 5,564 municipalities and apply spatial fixed-effects models to account for unobserved municipal heterogeneity and spatial dependence. Findings suggest that increases in temperature and precipitation are associated with declines in births. We also show that changes in response to climate conditions became greater during the Zika epidemic, particularly in urban areas. Combined, findings highlight the value of understanding the intersections between climate and fertility across geographic boundaries and during this public health crisis. Epidemics have become more important in people's lives with the recurring emergence of novel infectious disease threats, such as Zika and Covid-19.

BNT162b2 mRNA COVID-19 against symptomatic Omicron infection following a mass vaccination campaign in southern Brazil: A prospective test-negative design study.

BACKGROUND: Evidence regarding effectiveness of BNT162b2 mRNA COVID-19 vaccine against Omicron in Latin America is limited. We estimated BNT162b2 effectiveness against symptomatic COVID-19 in Brazil when Omicron was predominant. METHODS: This prospective test-negative, case-control study was conducted in Toledo, Brazil, following a mass COVID-19 vaccination with BNT162b2. Patients were included if they were aged ≥12 years, sought care for acute respiratory symptoms in the public health system between November 3, 2021 and June 20, 2022, and were tested for SARS-CoV-2 using RT-PCR. In the primary analysis, we determined the effectiveness of two doses of BNT162b2 against symptomatic COVID-19. RESULTS: A total of 4,574 were enrolled; of these, 1,758 patients (586 cases and 1,172 controls) were included in the primary analysis. Mean age was 27.7 years, 53.8 % were women, and 90.1 % had a Charlson comorbidity index of zero. Omicron accounted for >97 % of all identified SARS-CoV-2 variants, with BA.1 and BA.2 accounting for 84.3 % and 12.6 %, respectively. Overall adjusted estimate of two-dose vaccine effectiveness against symptomatic COVID-19 was 46.7 % (95 %CI, 19.9 %-64.6 %) after a median time between the second dose and the beginning of COVID-19 symptoms of 94 days (IQR, 60-139 days). Effectiveness waned from 77.7 % at 7-29 days after receipt of a second dose to <30 % (non-significant) after ≥120 days. CONCLUSION: In a relatively young and healthy Brazilian population, two doses of BNT162b2 provided protection against symptomatic Omicron infection. However, this protection waned significantly over time, underscoring the need for boosting with variant-adapted vaccines in this population prior to waves of disease activity. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov number, NCT05052307 (https://clinicaltrials.gov/ct2/show/NCT05052307).

Predicting congenital syphilis cases: A performance evaluation of different machine learning models.

BACKGROUND: Communicable diseases represent a huge economic burden for healthcare systems and for society. Sexually transmitted infections (STIs) are a concerning issue, especially in developing and underdeveloped countries, in which environmental factors and other determinants of health play a role in contributing to its fast spread. In light of this situation, machine learning techniques have been explored to assess the incidence of syphilis and contribute to the epidemiological surveillance in this scenario. OBJECTIVE: The main goal of this work is to evaluate the performance of different machine learning models on predicting undesirable outcomes of congenital syphilis in order to assist resources allocation and optimize the healthcare actions, especially in a constrained health environment. METHOD: We use clinical and sociodemographic data from pregnant women that were assisted by a social program in Pernambuco, Brazil, named Mãe Coruja Pernambucana Program (PMCP). Based on a rigorous methodology, we propose six experiments using three feature selection techniques to select the most relevant attributes, pre-process and clean the data, apply hyperparameter optimization to tune the machine learning models, and train and test models to have a fair evaluation and discussion. RESULTS: The AdaBoost-BODS-Expert model, an Adaptive Boosting (AdaBoost) model that used attributes selected by health experts, presented the best results in terms of evaluation metrics and acceptance by health experts from PMCP. By using this model, the results are more reliable and allows adoption on a daily usage to classify possible outcomes of congenital syphilis using clinical and sociodemographic data.

Trabalho Docente no Contexto da Expansão Universitária / Teaching Work in the Context of University Expansion / Trabajo Docente en el Contexto de la Expansión Universitaria

As reformas neoliberais promoveram transformações no ensino superior. Nesse contexto, diversas instituições aderiram ao Programa de Apoio a Planos de Reestruturação e Expansão das Universidades Federais (REUNI). Isto, contudo, se deu sem as contrapartidas necessárias. O propósito da investigação, assim, foi compreender os impedimentos ao poder de agir de docentes que atuavam em um campus estruturado a partir do REUNI. Adotou-se o referencial da Clínica da Atividade. Participaram do estudo três docentes, duas mulheres e um homem, que atuavam em cursos de graduação e pós-graduação. Em uma perspectiva histórico-desenvolvimentista, foram realizadas entrevistas a partir de imagens que representavam elementos do contexto laboral. Utilizou-se análise construtivo-interpretativa. Dentre os resultados, viu-se intensificação do trabalho promovida pela atuação em cursos de pós-graduação e por atividades invisibilizadas; desprofissionalização associada ao desempenho de atividades alheias ao fazer docente; estrutura física inadequada; carga de trabalho elevada; pressões para o cumprimento de prazos; uso do espaço doméstico para o trabalho; e invasão do tempo livre. Os achados podem nortear ações de promoção da saúde docente e dar balizas para a discussão sobre as melhorias dos contextos de trabalho.

Neoliberal reforms promoted transformations in higher education. In this context, several institutions joined the Support Program for Restructuring and Expansion Plans of Federal Universities (REUNI). This happened without the necessary counterparts. The purpose of the investigation was to understand the impediments to the power to act of professors who worked in a campus structured from the REUNI. The reference of the Clinic of Activity was adopted. Three professors participated in the study, two women and one man, who worked in undergraduate and graduate courses. From a historical-developmental perspective, interviews were carried out based on images that represented elements of the work context. Constructive-interpretative analysis was used. Among the results, it was seen the intensification of work promoted by the performance in postgraduate courses and by invisible activities; de professionalization associated with the performance of activities outside the teaching profession; inadequate physical structure; high workload; pressure to meet deadlines; use of domestic space for work and invasion of free time. The findings can guide actions to promote teachers' health and provide guidelines for the discussion on improvements in work contexts.

Las reformas neoliberales impulsaron transformaciones en la educación superior. En ese contexto, varias instituciones se adhirieron al Programa de Apoyo a los Planes de Reestructuración y Expansión de las Universidades Federales (REUNI). Esto sucedió sin las contrapartes necesarias. La investigación tuvo como objetivo comprender los impedimentos al poder de actuar de los profesores que actuaban en un campus estructurado a partir de lo REUNI. Se adoptó la referencia de la Clínica de la Actividad. Participaron del estudio tres profesores, dos mujeres y un hombre, que actuaban en cursos de pregrado y posgrado. Desde una perspectiva histórica e de desarrollo, se realizaron entrevistas a partir de imágenes que representaban elementos del contexto de trabajo. Se utilizó el análisis constructivo-interpretativo. Entre los resultados, se vio la intensificación del trabajo promovida por la actuación en cursos de posgrado y por actividades invisibles; desprofesionalización asociada al desempeño de actividades ajenas a la docencia; estructura física inadecuada; alta carga de trabajo; presión para cumplir los plazos; uso del espacio doméstico para el trabajo e invasión del tiempo libre. Los hallazgos pueden orientar acciones para promover la salud de los docentes y proporcionar pautas para la discusión sobre mejoras en los contextos de trabajo.

Potential of Atlantic Codfish (Gadus morhua) Skin Collagen for Skincare Biomaterials.

Collagen is the major structural protein in extracellular matrix present in connective tissues, including skin, being considered a promising material for skin regeneration. Marine organisms have been attracting interest amongst the industry as an alternative collagen source. In the present work, Atlantic codfish skin collagen was analyzed, to evaluate its potential for skincare. The collagen was extracted from two different skin batches (food industry by-product) using acetic acid (ASColl), confirming the method reproducibility since no significant yield differences were observed. The extracts characterization confirmed a profile compatible with type I collagen, without significant differences between batches or with bovine skin collagen (a reference material in biomedicine). Thermal analyses suggested ASColl's native structure loss at 25 °C, and an inferior thermal stability to bovine skin collagen. No cytotoxicity was found for ASColl up to 10 mg/mL in keratinocytes (HaCaT cells). ASColl was used to develop membranes, which revealed smooth surfaces without significative morphological or biodegradability differences between batches. Their water absorption capacity and water contact angle indicated a hydrophilic feature. The metabolic activity and proliferation of HaCaT were improved by the membranes. Hence, ASColl membranes exhibited attractive characteristics to be applied in the biomedical and cosmeceutical field envisaging skincare.

Tuberculosis preventive treatment in children and adolescents: an observational study of secondary data.

OBJECTIVE: To analyze the effectiveness, safety, outcomes, and associated factors of tuberculosis preventive treatment (TPT) in children and adolescents in Paraná, southern Brazil. METHOD: This was an observational cohort study with a retrospective collection of secondary data from the TPT information systems of the state of Paraná from 2009 to 2016, and tuberculosis in Brazil from 2009 to 2018. RESULTS: In total, 1,397 people were included. In 95.4% of the individuals, the indication for TPT was a history of patient-index contact with pulmonary tuberculosis. Isoniazid was used in 99.9% of the cases with TPT, and 87.7% completed the treatment. The TPT protection was 98.7%. Among the 18 people who had TB, 14 (77.8%) became ill after the second year of treatment, and four (22.2%) in the first two years (p < 0.001). Adverse events were reported in 3.3% of cases, most of them were gastrointestinal and medication was discontinued in only 2 (0.1%) patients. No risk factors associated with the illness were observed. CONCLUSIONS: The authors observed a low rate of illness in pragmatics routine conditions in TPT for children and adolescents, especially within the first two years after the end of treatment, with good tolerability and a good percentage of adherence to the treatment. TPT should be encouraged to achieve the goals of the End TB Strategy of the World Health Organization as an essential strategy to reduce the incidence rate of the disease, but studies with new schemes must continue to be carried out in real-life scenarios.

Growth Velocity and Nutritional Status in Children Exposed to Zika Virus during Pregnancy from Amazonas Cohort, Brazil.

The high incidence of Zika virus (ZIKV) infection in the period of 2015-2016 in Brazil may have affected linear height growth velocity (GV) in children exposed in utero to ZIKV. This study describes the growth velocity and nutritional status based on the World Organization (WHO) standards of children exposed to ZIKV during pregnancy and followed up in a tertiary unit, a reference for tropical and infectious diseases in the Amazon. Seventy-one children born between March 2016 and June 2018 were monitored for anthropometric indices: z-score for body mass index (BMI/A); weight (W/A); height (H/A) and head circumference (HC/A); and growth velocity. The mean age at the last assessment was 21.1 months (SD ± 8.93). Four children had congenital microcephaly and severe neurological impairment. The other 67 were non-microcephalic children (60 normocephalic and 7 macrocephalic); of these; 24.2% (16 children) had neurological alterations, and 28.8% (19 children) had altered neuropsychomotor development. Seventeen (24.2%) children had inadequate GV (low growth velocity). The frequencies of low growth among microcephalic and non-microcephalic patients are 25% (1 of 4 children) and 23.9% (16 of 67 children); respectively. Most children had normal BMI/A values during follow-up. Microcephalic patients showed low H/A and HC/A throughout the follow-up, with a significant reduction in the HC/A z-score. Non-microcephalic individuals are within the regular ranges for H/A; HC/A; and W/A, except for the H/A score for boys. This study showed low growth velocity in children with and without microcephaly, highlighting the need for continuous evaluation of all children born to mothers exposed to ZIKV during pregnancy.

Can the Content of Social Networks Explain Epidemic Outbreaks?

People share and seek information online that reflects a variety of social phenomena, including concerns about health conditions. We analyze how the contents of social networks provide real-time information to monitor and anticipate policies aimed at controlling or mitigating public health outbreaks. In November 2020, we collected tweets on the COVID-19 pandemic with content ranging from safety measures, vaccination, health, to politics. We then tested different specifications of spatial econometrics models to relate the frequency of selected keywords with administrative data on COVID-19 cases and deaths. Our results highlight how mentions of selected keywords can significantly explain future COVID-19 cases and deaths in one locality. We discuss two main mechanisms potentially explaining the links we find between Twitter contents and COVID-19 diffusion: risk perception and health behavior.

Extralobar Pulmonary Sequestration.

Male, 71 year-old, asymptomatic, former smoker and previous history of lung tuberculosis. Referred to outpatient clinic due to left lower lobe consolidation diagnosed on non-contrasted CT scan, with increased uptake on PET-CT. Then, a contrast-enhanced CT scan revealed extralobar pulmonary sequestration with venous drainage to the left azygos vein (Blue arrow) and a double branch arterial supply from the thoracic aorta (Red arrow).

Description of a specialized outpatient clinic as a reference center for children and adolescents living with HIV/AIDS in southern Brazil / Descrição de um ambulatório especializado referência em crianças e adolescentes vivendo com HIV/AIDS no sul do Brasil

Introduction: Children living with HIV/AIDS require specialized care. Objective: To describe clinical and epidemiological characteristics of patients living with HIV/AIDS. Methods: Observational, descriptive study using medical records data of patients with HIV/AIDS under 14 years of age. Approved by the institution's Ethics Committee under number 1,432,517. Results: 60 cases were included; the median follow-up duration was 6.8 years; 50.0% were male; 88.3% were white; 75.0% were from the capital and metropolitan region. Prenatal records were available for 51 cases, but only 44.6% received antiretroviral therapy (ART) during pregnancy (mean duration of 3.3 months). HIV diagnosis was based on clinical symptoms in 28.3% of the cases, occurring in similar proportions for both childhood common infections and opportunistic infections. According to the CDC clinical classification (1994), at the start of follow-up, 56.6% of patients had moderate or severe symptoms, which would be reduced to only 18.3% upon reclassification at the last visit (p=0.016). Initially, 41.7% showed evidence of immunosuppression, compared to 19.9% at the time of the study (p=0.5). Only 6.6% remained asymptomatic. A decrease in the average number of hospitalizations was observed during follow-up. Conclusion: Among the cases diagnosed based on clinical symptoms, half were attributed to common childhood infections and lacked immunosuppression

Introdução: Crianças que vivem com o vírus da imunodeficiência humana ­ HIV/AIDS requerem atendimento especializado. Objetivo: Descrever características clínicas e epidemiológicas de pacientes que vivem com HIV/AIDS. Métodos: Estudo observacional, descritivo, com dados de prontuários de pacientes com HIV/AIDS de até 14 anos de idade incompletos, aprovado pelo Comitê de Ética em Pesquisa da instituição sob o número 1.432.517. Resultados: Foram incluídos 60 casos. A mediana de acompanhamento foi de 6,8 anos; 50,0% eram do sexo masculino; 88,3% brancos; 75,0% naturais da capital e região metropolitana. Em 51 prontuários havia descrição de pré-natal, porém apenas 44,6% fizeram uso de terapia antirretroviral (TARV) na gestação (tempo médio de 3,3 meses). Em 28,3% o HIV foi pesquisado por sintomas clínicos, que ocorreram em proporções similares tanto por infecções habituais da infância como por oportunistas. De acordo com a classificação clínica dos Centers for Disease Control and Prevention ­ CDC (1994), ao início do acompanhamento, 56,6% dos pacientes apresentavam sintomas moderados ou graves e, na última consulta, se fossem reclassificados, seriam apenas 18,3% (p=0,016). Incialmente, 41,7% apresentavam evidência de imunossupressão, comparativamente aos 19,9% na ocasião do estudo (p=0,5). Apenas 6,6% permaneceram assintomáticos. Com o acompanhamento, verificou-se diminuição na média do número de hospitalizações. Conclusão: Dos casos que apresentaram seu diagnóstico por sintomas clínicos, metade foi por infecções habituais da infância e sem imunossupressão

Fever in a Patient with a Central Venous Catheter Colonized by Pandoraea pnomenusa.

Pandoraea species are a newly described genus of multidrug-resistant, non-fermentative Gram-negative bacilli, mainly isolated from sputum samples of cystic fibrosis patients. In immunocompromised patients or with high antibiotic selective pressure, these pathogens are generally opportunistic and invasive. Although Pandoraea spp. are rare, the true incidence of these infections may be underestimated due to difficulties in microbial identification by phenotypic methods. We present the case of a 51-year-old woman, with new-onset fever after a prolonged hospitalization and multiple courses of antibiotics. Mass spectrometry assays identified Pandoraea pnomenusa in the blood cultures taken from the central venous catheter and in the catheter tip. Fever cessation after catheter removal suggests a catheter-related bloodstream infection. To the best of our knowledge, this is the first isolation of a Pandoraea spp. in Portugal, which should raise awareness to the emergence of these opportunistic and multidrug-resistant microorganisms, and the importance of its prompt identification.

O género Pandoraea é constituído por bacilos Gram-negativo não fermentadores multirresistentes, maioritariamente isolados em amostras respiratórias de doentes com fibrose quística. No entanto, em doentes imunodeprimidos e/ou sujeitos a elevada pressão antibiótica, podem ser agentes invasivos e oportunistas. Apesar de estas infeções serem raras, a incidência pode estar subestimada por dificuldades na sua identificação por métodos fenotípicos. Apresentamos um caso clínico de uma mulher de 51 anos, com febre de novo após um internamento complexo e múltiplos ciclos de antibioterapia. Nas hemoculturas colhidas do cateter venoso central e na ponta do cateter foi identificada, por espectrometria de massa, uma Pandoraea pnomenusa. A resolução da febre após retirada do cateter sugere uma bacteriemia associada a cateter. Tanto quanto é do nosso conhecimento, este é o primeiro caso reportado de Pandoraea spp. em Portugal, pondo em evidência a necessidade de se estar alerta para a emergência de agentes de infeção multirresistentes, bem como a necessidade da sua identificação precoce.

Intensificação laboral e gênero profissional de professoras da educação infantil / Intensification of labor and professional gender of female teachers of early childhood education

As reformas neoliberais levaram à intensificação do trabalho, dada a exigência de maiores e melhores resultados em contextos laborais cujas condições eram insuficientes para realizá-lo. Este artigo visa compreender, a partir do referencial teórico da Clínica da Atividade, a relação entre intensificação do trabalho docente e gênero profissional. Trata-se de um estudo de caso derivado de uma intervenção com seis professoras da Educação Infantil que utilizou o método de instrução ao sósia. Os registros de áudio produzidos ao longo das instruções ao sósia foram transcritos e submetidos à análise construtivo-interpretativa. O número de alunos por sala, fator inerente à organização do trabalho, mostrou-se promotor dessa intensificação, uma vez que exigia mais dos profissionais, sem a contrapartida necessária das condições de trabalho. Nesse cenário, ocorreu a construção coletiva do que era chamado de "domínio de sala", norma de proceder não oficializada relativa às habilidades necessárias à atuação docente para lidar com a intensificação laboral. Desenvolveu-se, assim, uma cultura profissional que orientou a ação das docentes, de modo a viabilizar a atividade e preservar o poder de agir

Neoliberal reforms have led to the intensification of work, given the demand for greater and better results in labor contexts whose conditions were insufficient to realize it. This article aims to understand based on the theoretical framework of the Clinic of Activity the relationship between intensification of the teaching work and professional genre. This is a case study derived from an intervention with six children's education teachers that used the method of instruction to the look-alike. The audio recordings produced during the instruction to the look-alike were transcribed and submitted to constructive-interpretative analysis. The number of students per classroom, a factor inherent to the work organization, proved to be a promoter of this intensification, since it demanded more from professionals, without the necessary counterpart of working conditions. In this scenario there was a collective construction of what was called "classroom mastery," an unofficial rule of thumb related to the necessary skills for teaching to deal with work intensification. Thus, a professional culture was developed that guided the teachers' action to make the activity viable and preserve the power to act

Tuberculosis preventive treatment in children and adolescents: an observational study of secondary data

Abstract Objective To analyze the effectiveness, safety, outcomes, and associated factors of tuberculosis preventive treatment (TPT) in children and adolescents in Paraná, southern Brazil. Method This was an observational cohort study with a retrospective collection of secondary data from the TPT information systems of the state of Paraná from 2009 to 2016, and tuberculosis in Brazil from 2009 to 2018. Results In total, 1,397 people were included. In 95.4% of the individuals, the indication for TPT was a history of patient-index contact with pulmonary tuberculosis. Isoniazid was used in 99.9% of the cases with TPT, and 87.7% completed the treatment. The TPT protection was 98.7%. Among the 18 people who had TB, 14 (77.8%) became ill after the second year of treatment, and four (22.2%) in the first two years (p < 0.001). Adverse events were reported in 3.3% of cases, most of them were gastrointestinal and medication was discontinued in only 2 (0.1%) patients. No risk factors associated with the illness were observed. Conclusions The authors observed a low rate of illness in pragmatics routine conditions in TPT for children and adolescents, especially within the first two years after the end of treatment, with good tolerability and a good percentage of adherence to the treatment. TPT should be encouraged to achieve the goals of the End TB Strategy of the World Health Organization as an essential strategy to reduce the incidence rate of the disease, but studies with new schemes must continue to be carried out in real-life scenarios.

Would Zika virus Infection in Pregnancy Be a Sentence of Poor Neurological Prognosis for Exposed Children? Neurodevelopmental Outcomes in a Cohort from Brazilian Amazon.

Infections with Flavivirus in pregnant women are not associated with vertical transmission. However, in 2015, severe cases of congenital infection were reported during the Zika virus outbreak in Brazil. More subtle infections in children born to mothers with ZIKV still remain uncertain and the spectrum of this new congenital syndrome is still under construction. This study describes outcomes regarding neurodevelopment and neurological examination in the first years of life, of a cohort of 77 children born to pregnant women with ZIKV infection in Manaus, Brazil, from 2017 to 2020. In the group of normocephalic children (92.2%), most showed satisfactory performance in neuropsychomotor development, with a delay in 29.6% and changes in neurological examination in 27.1%, with two children showing muscle-strength deficits. All microcephalic children (5.2%) evolved with severe neuropsychomotor-development delay, spastic tetraparesis, and alterations in the imaging exam. In this cohort, 10.5% of the children had macrocephaly at birth, but only 2.6% remained in this classification. Although microcephaly has been considered as the main marker of congenital-Zika-virus syndrome in previous studies, its absence does not exclude the possibility of the syndrome. This highlights the importance of clinical follow-up, regardless of the classification of head circumference at birth.