Reproductive Activity of Socorro Island Merino Ewes and Their Crosses with Pelibuey under Heat Stress Conditions.

An experiment was carried out to evaluate the effect of spring and autumn seasons on the reproductive activity of Merino Socorro Island ewes and their crosses with Pelibuey under heat stress (HS) conditions in the tropics. All ewes (n = 80) were randomly assigned to one of two breeds during the first and second periods, respectively: (1) Twenty Socorro Island Merino ewes (SIM) and (2) 20 Pelibuey Crossbred ewes (PBC). Animals were fed the same diet and given water ad libitum. All statistical analyses were performed using SAS statistical software 9.12 procedures. In both seasons, a mean of more than 80 U of maximum THI was obtained, while in spring and autumn, the minimum THI exceeded 30 and 40 U, respectively. All animals were in oestrus and ovulated in both seasons. The frequency of animals in spring during the first 48 h of oestrus expression was greater (p < 0.05) than 48-55 h but similar (p > 0.05) than 55-65 h; in autumn during the first 48 h and 48-55 h were similar (p > 0.05), but different (p < 0.05) than 55-65 h. The duration of oestrus expression was longer in the spring than in the autumn (p < 0.05). The frequency of animals was higher (p < 0.05) in SIM than in PBC ewes during the first oestrus cycle (1-17 d) and was also higher (p < 0.05) in PBC than in SIM ewes during the second oestrus cycle (18-35 d). The SIM ewes produced more (p < 0.05) progesterone (P4) than the PBC ewes. During the sampling days of the oestrus cycle, more P4 was created in autumn than in spring (p < 0.05). Both breeds showed severe HS. In the future, ewes treated under assisted reproductive programs in the tropics may improve reproductive efficiency.

Impact of Spin-Entropy on the Thermoelectric Properties of a 2D Magnet.

Heat-to-charge conversion efficiency of thermoelectric materials is closely linked to the entropy per charge carrier. Thus, magnetic materials are promising building blocks for highly efficient energy harvesters as their carrier entropy is boosted by a spin degree of freedom. In this work, we investigate how this spin-entropy impacts heat-to-charge conversion in the A-type antiferromagnet CrSBr. We perform simultaneous measurements of electrical conductance and thermocurrent while changing magnetic order using the temperature and magnetic field as tuning parameters. We find a strong enhancement of the thermoelectric power factor at around the Néel temperature. We further reveal that the power factor at low temperatures can be increased by up to 600% upon applying a magnetic field. Our results demonstrate that the thermoelectric properties of 2D magnets can be optimized by exploiting the sizable impact of spin-entropy and confirm thermoelectric measurements as a sensitive tool to investigate subtle magnetic phase transitions in low-dimensional magnets.

Immunoprecipitation of RNA-DNA hybrid interacting proteins in Trypanosoma brucei reveals conserved and novel activities, including in the control of surface antigen expression needed for immune evasion by antigenic variation.

RNA-DNA hybrids are epigenetic features of genomes that provide a diverse and growing range of activities. Understanding of these functions has been informed by characterising the proteins that interact with the hybrids, but all such analyses have so far focused on mammals, meaning it is unclear if a similar spectrum of RNA-DNA hybrid interactors is found in other eukaryotes. The African trypanosome is a single-cell eukaryotic parasite of the Discoba grouping and displays substantial divergence in several aspects of core biology from its mammalian host. Here, we show that DNA-RNA hybrid immunoprecipitation coupled with mass spectrometry recovers 602 putative interactors in T. brucei mammal- and insect-infective cells, some providing activities also found in mammals and some lineage-specific. We demonstrate that loss of three factors, two putative helicases and a RAD51 paralogue, alters T. brucei nuclear RNA-DNA hybrid and DNA damage levels. Moreover, loss of each factor affects the operation of the parasite immune survival mechanism of antigenic variation. Thus, our work reveals the broad range of activities contributed by RNA-DNA hybrids to T. brucei biology, including new functions in host immune evasion as well as activities likely fundamental to eukaryotic genome function.

OpenCare5G: O-RAN in Private Network for Digital Health Applications.

Digital Health is a new way for medicine to work together with computer engineering and ICT to carry out tests and obtain reliable information about the health status of citizens in the most remote places in Brazil in near-real time, applying new technologies and digital tools in the process. InovaHC is the technological innovation core of the Clinics Hospital of the Faculty of Medicine of the University of São Paulo (HCFMUSP). It is the first national medical institution to seek new opportunities offered by 5G technology and test its application in the first private network for Digital Health in the largest hospital complex in Latin America through the OpenCare5G Project. This project uses an Open RAN concept and network disaggregation with lower costs than the traditional concept used by the telecommunications industry. The technological project connected to the 5G network was divided into two phases for proof-of-concept testing: the first with an initial focus on carrying out examinations with portable ultrasound equipment in different locations at HCFMUSP, and the second focusing on carrying out remote examinations with health professionals in other states of Brazil, who will be working in remote areas in other states with little or no ICT infrastructure together with a doctor analyzing exams in real time at HCFMUSP in São Paulo. The objective of the project is to evaluate the connectivity and capacity of the 5G private network in these the proof-of-concept tests for transmitting the volume of data from remote exams with higher speed and lower latency. We are in the first phase of the proof of concept testing to achieve the expected success. This project is a catalyst for innovation in health, connecting resources and entrepreneurs to generate solutions for the innovation ecosystem of organizations. It is coordinated by Deloitte with the participation of the Escola Politécnica da USP (The School of Engineering-University of São Paulo), Airspan, Itaú Bank, Siemens Healthineers, NEC, Telecom Infra Projet, ABDI and IDB. The use of 5G Open RAN technology in public health is concluded to be of extreme social, economic, and fundamental importance for HCFMUSP, citizens, and the development of health research to promote great positive impacts ranging from attracting investment in the country to improving the quality of patient care.

Randomized trial of the efficacy of trial-based cognitive therapy for obsessive-compulsive disorder: preliminary findings.

INTRODUCTION: Obsessive-compulsive disorder (OCD) is the fourth most prevalent mental disorder and is a disabling condition. OCD is associated with anatomical and functional changes in the brain, in addition to dysfunctional cognitions. The treatments of choice are selective serotonin reuptake inhibitors, cognitive-behavioral therapy (CBT), and exposure and response prevention (ERP). Trial-based cognitive therapy (TBCT) is a recent and empirically validated psychotherapy with a focus on restructuring dysfunctional negative core beliefs (CBs). The objective of this study was to evaluate the efficacy of TBCT relative to ERP for treatment of OCD. METHOD: A randomized, single-blind clinical trial was conducted, randomizing 26 patients for individual treatment with TBCT (n = 12) or ERP (n = 14). The groups were evaluated at baseline, at the end of 3 months (12 sessions), and at 3, 6, and 12-month follow-ups. RESULTS: Both approaches reduced the severity of symptoms with large effect sizes. These results were maintained at the 12-month follow-up assessment. CONCLUSION: TBCT may be a valid and promising treatment for this disorder.

Randomized trial of the efficacy of trial-based cognitive therapy for obsessive-compulsive disorder: preliminary findings

Abstract Introduction Obsessive-compulsive disorder (OCD) is the fourth most prevalent mental disorder and is a disabling condition. OCD is associated with anatomical and functional changes in the brain, in addition to dysfunctional cognitions. The treatments of choice are selective serotonin reuptake inhibitors, cognitive-behavioral therapy (CBT), and exposure and response prevention (ERP). Trial-based cognitive therapy (TBCT) is a recent and empirically validated psychotherapy with a focus on restructuring dysfunctional negative core beliefs (CBs). The objective of this study was to evaluate the efficacy of TBCT relative to ERP for treatment of OCD. Methods A randomized, single-blind clinical trial was conducted, randomizing 26 patients for individual treatment with TBCT (n = 12) or ERP (n = 14). The groups were evaluated at baseline, at the end of 3 months (12 sessions), and at 3, 6, and 12-month follow-ups. Results Both approaches reduced the severity of symptoms with large effect sizes. These results were maintained at the 12-month follow-up assessment. Conclusion TBCT may be a valid and promising treatment for this disorder.

Tratamiento de la rinitis alérgica en época de pandemia. Documento de consenso de sociedades médicas de América Latina y el Caribe / Treatment of allergic rhinitis in pandemic times. Consensus statement from medical societies of Latin America and the Caribbean

La rinitis alérgica ha ido en aumento en los países latinoamericanos, dando lugar a una creciente población de pacientes que necesitan tratamiento médico para esta afección respiratoria. Su similitud con la COVID-19 en cuanto a síntomas y la posibilidad de concurrencia con esta, hacen que la rinitis alérgica sea de particular interés para los sistemas de salud. Los países de América Latina y el Caribe han sido particularmente vulnerables por múltiples desafíos, entre estos, las altas tasas de pobreza, el acceso limitado a la atención médica y las limitaciones en la prestación de servicios básicos de salud, así como la ausencia de guías de tratamiento para la rinitis alérgica en situación de pandemia. Con el objetivo de proporcionar orientación esencial para los equipos multidisciplinarios de América Latina y el Caribe con respecto a la evaluación y el tratamiento de la rinitis alérgica durante la pandemia de COVID-19, se revisó literatura científica publicada sobre tratamiento de la rinitis alérgica y COVID-19, y se consideró la opinión de profesionales líderes de sociedades científicas de la región. Se analizaron las diferentes medidas para evitar contagios, y las diferentes estrategias de tratamiento con énfasis en la terapia intranasal y el tratamiento con vacunas contra la alergia. Se formuló una declaración de posicionamiento con la intención de mantener la continuidad del servicio médico en el contexto de una pandemia y minimizar la propagación, infección y complicación asociada con el coronavirus tipo 2 del síndrome respiratorio agudo severo en pacientes con seguimiento o comenzando tratamiento para la rinitis alérgica(AU)

Allergic rhinitis has been increasing in Latin American countries, leading to a growing population of patients who need medical treatment for this respiratory condition. Its similarity to COVID-19 in terms of symptoms and the possibility of concurrence with it, make allergic rhinitis of particular interest to health systems. The countries of Latin America and the Caribbean have been particularly vulnerable due to multiple challenges, including high poverty rates, limited access to medical care and limitations in the provision of basic health services, as well as the absence of guidelines of treatment for allergic rhinitis in a pandemic situation. With the aim of to provide essential management for multidisciplinary teams in Latin America and the Caribbean regarding the evaluation and treatment of allergic rhinitis during the COVID-19 pandemic, published scientific literature on the treatment of allergic rhinitis and COVID-19 was reviewed, and the opinion of leading professionals from scientific societies in the region was considered. The different measures to avoid infections and the different treatment strategies were analyzed, with an emphasis on intranasal therapy and treatment with allergy vaccines. A position statement was formulated with the intention of maintaining continuity of medical service in the context of a pandemic and minimizing the spread, infection and complication associated with severe acute respiratory syndrome coronavirus 2 in patients undergoing or starting treatment for allergic rhinitis(AU)

Effect of Bauhinia monandra Kurz Leaf Preparations on Embryonic Stages and Adult Snails of Biomphalaria glabrata (Say, 1818), Schistosoma mansoni Cercariae and Toxicity in Artemia salina.

Biomphalaria glabrata snails constitute the main vector of schistosomiasis in Brazil, and Bauhinia monandra Kurz, the leaves of which contain BmoLL lectin with biocidal action, is a plant widely found on continents in which the disease is endemic. This work describes the composition of B. monandra preparations and the effect on embryos and adult snails, their reproduction parameters and hemocytes. We also describe the results of a comet assay after B. glabrata exposure to sublethal concentrations of the preparations. Additionally, the effects of the preparations on S. mansoni cercariae and environmental monitoring with Artemia salina are described. In the chemical evaluation, cinnamic, flavonoid and saponin derivatives were detected in the two preparations assessed, namely the saline extract and the fraction. Both preparations were toxic to embryos in the blastula, gastrula, trochophore, veliger and hippo stages (LC50 of 0.042 and 0.0478; 0.0417 and 0.0419; 0.0897 and 0.1582; 0.3734 and 0.0974; 0.397 and 0.0970 mg/mL, respectively) and to adult snails (LC50 of 6.6 and 0.87 mg/mL, respectively), which were reproductively affected with decreased egg deposition. In blood cell analysis, characteristic cells for apoptosis, micronucleus and binucleation were detected, while for comet analysis, different degrees of nuclear damage were detected. The fraction was able to cause total mortality of the cercariae and did not present environmental toxicity. Therefore, B. monandra preparations are promising in combating schistosomiasis since they can control both the intermediate host and eliminate the infectious agent, besides being safe to the environment.

A Novel Approach to Multi-Provider Network Slice Selector for 5G and Future Communication Systems.

The Network Slice Selection Function (NSSF) in heterogeneous technology environments is a complex problem, which still does not have a fully acceptable solution. Thus, the implementation of new network selection strategies represents an important issue in development, mainly due to the growing demand for applications and scenarios involving 5G and future networks. This work presents an integrated solution for the NSSF problem, called the Network Slice Selection Function Decision-Aid Framework (NSSF DAF), which consists of a distributed solution in which a part is executed on the user's equipment (for example, smartphones, Unmanned Aerial Vehicles, IoT brokers) functioning as a transparent service, and another at the Edge of the operator or service provider. It requires a low consumption of computing resources from mobile devices and offers complete independence from the network operator. For this purpose, protocols and software tools are used to classify slices, employing the following four multicriteria methods to aid decision making: VIKOR (Visekriterijumska Optimizacija i Kompromisno Resenje), COPRAS (Complex Proportional Assessment), TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) and Promethee II (Preference Ranking Organization Method for Enrichment Evaluations). The general objective is to verify the similarity among these methods and applications to the slice classification and selection process, considering a specific scenario in the framework. It also uses machine learning through the K-means clustering algorithm, adopting a hybrid solution in the implementation and operation of the NSSF service in multi-domain slicing environments of heterogeneous mobile networks. Testbeds were conducted to validate the proposed framework, mapping the adequate quality of service requirements. The results indicate a real possibility of offering a complete solution to the NSSF problem that can be implemented in Edge, in Core, or even in the 5G Radio Base Station itself, without the incremental computational cost of the end user's equipment, allowing for an adequate quality of experience.

Improvement of Ruminal Neutral Detergent Fiber Degradability by Obtaining and Using Exogenous Fibrolytic Enzymes from White-Rot Fungi.

The present review examines the factors and variables that should be considered to obtain, design, and evaluate EFEs that might enhance ruminal NDF degradability. Different combinations of words were introduced in Google Scholar, then scientific articles were examined and included if the reported factors and variables addressed the objective of this review. One-hundred-and-sixteen articles were included. The fungal strains and culture media used to grow white-rot fungi induced the production of specific isoforms of cellulases and xylanases; therefore, EFE products for ruminant feed applications should be obtained in cultures that include the high-fibrous forages used in the diets of those animals. Additionally, the temperature, pH, osmolarity conditions, and EFE synergisms and interactions with ruminal microbiota and endogenous fibrolytic enzymes should be considered. More consistent results have been observed in studies that correlate the cellulase-to-xylanase ratio with ruminant productive behavior. EFE protection (immobilization) allows researchers to obtain enzymatic products that may act under ruminal pH and temperature conditions. It is possible to generate multi-enzyme cocktails that act at different times, re-associate enzymes, and simulate natural protective structures such as cellulosomes. Some EFEs could consistently improve ruminal NDF degradability if we consider fungal cultures and ruminal environmental conditions variables, and include biotechnological tools that might be useful to design novel enzymatic products.

Toxic, cytotoxic and genotoxic effect of saline extract and fraction of Parkia pendula seeds in the developmental stages of Biomphalaria glabrata (Say 1818 - intermediate host) and cercaricide activity against the infectious agent of schistosomiasis.

This study describes for the first time the effect of saline extract and Parkia pendula seed fraction on Biomphalaria glabrata adult embryos and molluscs well as the reproductive parameters (fecundity and fertility) and survival, in addition to cytotoxicity and genotoxicity through the profile of blood cells after exposure to sublethal concentrations. Furthermore, we analyzed the action of both preparations against the cercariae of Schistosoma mansoni and their environmental safety using the bioindicator Artemia salina. The saline extract and fraction showed toxic effects for embryos (CL90 of 464.25, 479.62, 731.28, 643.28, 408.43 and 250.94, 318.03, 406.12, 635.64, 1.145 mg/mL, for blastula, gastrula, trocophore, veliger and hippo stage respectively), adult snails after 24 h of exposure (CL90 of 9.50 and 10.92 mg/mL, respectively) with increased mortality after 7 days of observation and significant decrease (p <0.05; p < 0.01 and p < 0.001) in egg mass deposition. At sublethal concentrations, an increase in quantitative and morphological changes in hemocytes was observed, and in the genotoxicity/comet assay analysis, varying degrees of nuclear damage were detected. In addition, the saline extract showed changes in the motility of the cercariae, while the fraction howed toxicity from a concentration of 1.0 mg/mL. The saline extract showed toxicity to A. salina at the highest concentrations (3.0, 4.0 and 5.0 mg/mL), while the fraction did not show ecotoxicity. Thus, the saline extract and fraction was promising in combating schistosomiasis by eliminating the intermediate host and causing alterations and/or mortality to the infectious agent.

Características epidemiológicas de los pacientes ingresados por COVID-19 en el Hospital Pediátrico Cerro (2021)

Introducción: La infección por SARS-CoV-2 en la población pediátrica mostró en el año 2021 un aumento en la morbilidad de la pandemia. Se elevó el número de pacientes por lo que fue necesario la apertura de hospitales idóneos. Objetivo: Caracterizar desde el aspecto epidemiológico a los pacientes atendidos en el Hospital Pediátrico Cerro con diagnóstico de COVID-19. Métodos: Estudio observacional, descriptivo transversal sobre las características epidemiológicas de los pacientes ingresados, entre el 3 de abril y 7 de octubre de 2021. El universo fue de 2699 pacientes menores de 18 años con diagnóstico confirmado por el test de reacción en cadena de polimerasa. Las variables analizadas fueron: grupos de edad, sexo, procedencia según municipio y territorio, mes e ingreso en sala de terapia, características sintomáticas y evolución. Los resultados se expresaron en valores absolutos y relativos y se estimó el odd ratio con su intervalo de confianza de 95 %, (p<0,05). Resultados: Predominó el grupo de edades entre 5-10 años (31,83 %), el sexo masculino (50,46 %) y los pacientes procedentes del municipio Cerro (12,41 %). Desde abril hasta junio hubo un rango promedio de 300 casos mensuales con aumento desde julio hasta septiembre y disminución en octubre. Los pacientes sintomáticos alcanzaron 76,0 % y en terapia intensiva se internaron 1,66 %. Conclusiones: El grupo de edad escolar sintomático alcanzó la mayor frecuencia, con un número superior de casos desde julio hasta septiembre sobre todo en los municipios Cerro y Arroyo Naranjo. Se registraron pocos ingresos en terapia intensiva por presentar la mayoría una evolución favorable.

Introduction: SARS-CoV-2 infection in the pediatric population showed an increase in the morbidity of the pandemic in 2021. The number of patients also increased, so it was necessary to open suitable hospitals. Objective: To characterize from the epidemiological aspect the patients treated at Cerro Pediatric Hospital with a diagnosis of COVID-19. Methods: Observational, descriptive cross-sectional study on the epidemiological characteristics of admitted patients, between April 3 and October 7, 2021. The universe consisted of 2699 patients under 18 years of age with a diagnosis confirmed by the polymerase chain reaction test. The variables analyzed were: age groups, sex, origin according to municipality and territory, month and admission to the therapy room, symptomatic characteristics and evolution. The results were expressed in absolute and relative values and the odd ratio was estimated with its 95% confidence interval (p<0.05). Results: The age group between 5-10 years (31.83 %), the male sex (50.46 %) and patients from Cerro municipality (12.41 %) predominated. From April to June there was an average range of 300 monthly cases with an increase from July to September and a decrease in October. Symptomatic patients reached 76.0 % and 1.66 % were hospitalized in intensive care. Conclusions: The symptomatic school age group reached the highest frequency, with a higher number of cases from July to September, especially in the municipalities of Cerro and Arroyo Naranjo. There were few admissions to intensive care because most of them showed a favorable evolution.

Discovering of Genomic Variations Associated to Growth Traits by GWAS in Braunvieh Cattle.

A genome-wide association study (GWAS) was performed to elucidate genetic architecture of growth traits in Braunvieh cattle. Methods: The study included 300 genotyped animals by the GeneSeek® Genomic Profiler Bovine LDv.4 panel; after quality control, 22,734 SNP and 276 animals were maintained in the analysis. The examined phenotypic data considered birth (BW), weaning (WW), and yearling weights. The association analysis was performed using the principal components method via the egscore function of the GenABEL version 1.8-0 package in the R environment. The marker rs133262280 located in BTA 22 was associated with BW, and two SNPs were associated with WW, rs43668789 (BTA 11) and rs136155567 (BTA 27). New QTL associated with these liveweight traits and four positional and functional candidate genes potentially involved in variations of the analyzed traits were identified. The most important genes in these genomic regions were MCM2 (minichromosome maintenance complex component 2), TPRA1 (transmembrane protein adipocyte associated 1), GALM (galactose mutarotase), and NRG1 (neuregulin 1), related to embryonic cleavage, bone and tissue growth, cell adhesion, and organic development. This study is the first to present a GWAS conducted in Braunvieh cattle in Mexico providing evidence for genetic architecture of assessed growth traits. Further specific analysis of found associated genes and regions will clarify its contribution to the genetic basis of growth-related traits.

Transitional Care Management from Emergency Services to Communities: An Action Research Study.

In recent years, nurses have developed projects in the area of hospital to community transition. The objective of the present study was to analyze the transitional care offered to elderly people after they used emergency services and were discharged to return to the community. The action research method was chosen. The participants were nurses, elderly people 70 years old or older, and their caregivers. The study was carried out from October 2018 to August 2019. The data were collected by means of semi-structured interviews with the nurses, analysis of medical records, participatory observation, phone calls to the elderly people and caregivers, and team meetings. The qualitative data were submitted to Bardin's content analysis. Statistical treatment was carried out by applying SPSS version 23.0. The institution's research ethics committee approved the research. Only 31.4% of the sample experienced care continuity after discharge, and the rate of readmission to emergency services during the first 30 days after discharge was 33.4%. The referral letters lacked data on information provided to patients or caregivers, and nurses mentioned difficulties in communication between care levels, as well as obstacles to teamwork; they also mentioned that the lack of health policies and clinical rules to formalize transitional care between the hospital and the community perpetuated non-coordination of care between the two contexts. The low level of literacy of patients and their relatives are mentioned as a cause for not understanding the information regarding seeking primary health care services and handing the discharge letter. It was concluded that there is an urgent need to mobilize health teams toward action in the patients' process of returning home, and this factor must be taken into account in care planning.

Single-Arm, Multicenter Phase I/II Clinical Trial for the Treatment of Envenomings by Massive Africanized Honey Bee Stings Using the Unique Apilic Antivenom.

We evaluated the safety, optimal dose, and preliminary effectiveness of a new-approach Africanized honeybee (Apis mellifera) Antivenom (AAV) in a phase I/II, multicenter, non-randomized, single-arm clinical trial involving 20 participants with multiple stings. Participants received 2 to 10 vials of AAV depending on the number of stings they suffered, or a predefined adjuvant, symptomatic, and complementary treatment. The primary safety endpoint was the occurrence of early adverse reactions within the first 24 h of treatment. Preliminary efficacy based on clinical evolution, including laboratory findings, was assessed at baseline and at various time points over the four following weeks. ELISA assays and mass spectrometry were used to estimate venom pharmacokinetics before, during, and after treatment. Twenty adult participants, i.e., 13 (65%) men and 7 (35%) women, with a median age of 44 years and a mean body surface area of 1.92 m2 (median = 1.93 m2) were recruited. The number of stings ranged from 7 to > 2,000, with a median of 52.5. Symptoms of envenoming were classified as mild, moderate, or severe in 80% (16), 15% (3), and 5% (1) of patients, respectively; patients with mild, moderate, or severe envenoming received 2, 6, and 10 vials of AAV as per the protocol. None of the patients had late reactions (serum sickness) within 30 d of treatment. There was no discontinuation of the protocol due to adverse events, and there were no serious adverse events. One patient had a moderate adverse event, transient itchy skin, and erythroderma. All participants completed the intravenous antivenom infusion within 2 h, and there was no loss to follow-up after discharge. ELISA assays showed venom (melittin and PLA2) concentrations varying between 0.25 and 1.479 ng/mL prior to treatment. Venom levels decreased in all patients during the hospitalization period. Surprisingly, in nine cases (45%), despite clinical recovery and the absence of symptoms, venom levels increased again during outpatient care 10 d after discharge. Mass spectrometry showed melittin in eight participants, 30 d after treatment. Considering the promising safety results for this investigational product in the treatment of massive Africanized honeybee attack, and its efficacy, reflected in the clinical improvements and corresponding immediate decrease in blood venom levels, the AAV has shown to be safe for human use. Clinical Trial Registration: UTN: U1111-1160-7011, identifier [RBR-3fthf8].

A relação entre hipertensão arterial, ansiedade e estresse: uma revisão integrativa da literatura / La relación entre hipertensión arterial, ansiedad y estrés: una revisión bibliográfica integrativa / The relationship of high blood pressure, anxiety and stress: an integrative literature review

RESUMO. Este estudo teve por objetivo realizar uma revisão integrativa de literatura para verificar o que os estudos têm abordado sobre a relação entre estresse e ansiedade em pessoas hipertensas. Para tanto, o levantamento dos estudos foi realizado nas bases PsycINFO, Portal da Capes, Scielo e Medline BVS-PSI, utilizando os descritores 'hipertensão arterial' and 'estresse' and 'ansiedade', e seus correspondentes na língua inglesa 'arterial hypertension' and 'stress' and 'anxiety' e espanhola 'hipertensión' and 'estrés' and 'ansiedad', considerando os últimos seis anos (2013 a 2018). Foram selecionados 14 estudos. Os resultados foram agrupados em três categorias: a) o impacto causado pelo diagnóstico de doenças crônicas não transmissíveis, b) fatores psicológicos associados à hipertensão arterial e c) relação saúde física versus saúde mental: uma questão também de método. Os resultados mostraram que ansiedade e estresse, além da depressão podem apresentar-se como aspectos moduladores da hipertensão arterial. Portanto, considera-se necessária a desmistificação da lógica cartesiana entre mente e corpo, para que sejam efetivadas ações de cuidado integral dos sujeitos e de promoção à saúde. Espera-se que os resultados obtidos reafirmem a importância de considerar os aspectos psicológicos e emocionais nas doenças crônicas e que estudos futuros com diferentes delineamentos sejam desenvolvidos na área da psicologia.

RESUMEN. Este estudio tuvo como objetivo realizar una revisión bibliográfica integradora para verificar lo que los estudios han abordado sobre la relación entre estrés y ansiedad en personas hipertensas. Para ello, el levantamiento de los estudios fue realizado en las bases PsycINFO, Portal da Capes, Scielo y Medline BVS-PSI, utilizando los descriptores 'hipertensión arterial' y 'estrés' y 'ansiedad', y sus correspondientes en la lengua inglesa 'arterial hipertension' y 'ansiedad' y 'ansiedad', considerando los últimos seis años (2013 a 2018). Se seleccionaron 14 estudios. Los resultados fueron agrupados en tres categorías: a) el impacto causado por el diagnóstico de enfermedades crónicas no transmisibles, b) factores psicológicos asociados a la hipertensión arterial y c) Relación entre salud física y mental: una cuestión también de método. Los resultados mostraron que la ansiedad y el estrés, además de la depresión pueden presentarse como aspectos moduladores de la arterial hipertension. Por lo tanto, se considera necesaria la desmistificación de la lógica cartesiana entre mente y cuerpo, para que se efectúen acciones de cuidado integral de los sujetos y de promoción a la salud. Se espera que los resultados obtenidos reafirmen la importancia de considerar los aspectos psicológicos y emocionales en las enfermedades crónicas, y que estudios futuros con diferentes delineamientos se desarrollen en las demas áreas de salud, ademas del área médica.

ABSTRACT The objective of this study was to conduct an integrative literature review to verify which studies addressed the relationship between stress and anxiety in hypertensive patients. To do so, the study was carried out at the bases PsycINFO, Portal da Capes, Scielo and Medline BVS-PSI, using the descriptors 'arterial hypertension' and 'stress' and 'anxiety', and their correspondents in the English language 'arterial hypertension' and 'stress' and 'anxiety' and Spanish 'hypertension' and 'anxiety', considering the last six years (2013 to 2018). The results were grouped into three categories: a) The impact caused by the diagnosis of chronic non communicable diseases, b) Psychological factors associated with arterial hypertension and c) Deconstructing the dichotomy: physical health vs. mental health. The search resulted in the inclusion of 14 empirical studies. The results showed that anxiety and stress, in addition to depression, may present as modulatory aspects of arterial hypertension. Therefore, it is considered necessary the demystification of the cartesian logic between mind and body, so that actions of integral care of the subjects and promotion of health are carried out. It is hoped that the results obtained reaffirm the importance of considering the psychological and emotional aspects in chronic diseases, and that future studies with different designs be developed in the other areas of health, besides the medical area.

Single-arm, multicenter phase I/II clinical trial for the treatment of envenomings by massive africanized honey bee stings using the unique apilic antivenom

We evaluated the safety, optimal dose, and preliminary effectiveness of a new-approach Africanized honeybee (Apis mellifera) Antivenom (AAV) in a phase I/II, multicenter, non-randomized, single-arm clinical trial involving 20 participants with multiple stings. Participants received 2 to 10 vials of AAV depending on the number of stings they suffered, or a predefined adjuvant, symptomatic, and complementary treatment. The primary safety endpoint was the occurrence of early adverse reactions within the first 24 h of treatment. Preliminary efficacy based on clinical evolution, including laboratory findings, was assessed at baseline and at various time points over the four following weeks. ELISA assays and mass spectrometry were used to estimate venom pharmacokinetics before, during, and after treatment. Twenty adult participants, i.e., 13 (65%) men and 7 (35%) women, with a median age of 44 years and a mean body surface area of 1.92 m2 (median = 1.93 m2) were recruited. The number of stings ranged from 7 to > 2,000, with a median of 52.5. Symptoms of envenoming were classified as mild, moderate, or severe in 80% (16), 15% (3), and 5% (1) of patients, respectively; patients with mild, moderate, or severe envenoming received 2, 6, and 10 vials of AAV as per the protocol. None of the patients had late reactions (serum sickness) within 30 d of treatment. There was no discontinuation of the protocol due to adverse events, and there were no serious adverse events. One patient had a moderate adverse event, transient itchy skin, and erythroderma. All participants completed the intravenous antivenom infusion within 2 h, and there was no loss to follow-up after discharge. ELISA assays showed venom (melittin and PLA2) concentrations varying between 0.25 and 1.479 ng/mL prior to treatment. Venom levels decreased in all patients during the hospitalization period. Surprisingly, in nine cases (45%), despite clinical recovery and the absence of symptoms, venom levels increased again during outpatient care 10 d after discharge. Mass spectrometry showed melittin in eight participants, 30 d after treatment. Considering the promising safety results for this investigational product in the treatment of massive Africanized honeybee attack, and its efficacy, reflected in the clinical improvements and corresponding immediate decrease in blood venom levels, the AAV has shown to be safe for human use. Clinical Trial Registration: UTN: U1111-1160-7011, identifier [RBR-3fthf8].

Risk of venous thromboembolism in users of contraception and menopausal hormone therapy during the COVID-19 pandemic.

OBJECTIVES: The outbreak of coronavirus disease (COVID-19) is a public health emergency of international concern. Inflammatory changes are part of COVID-19 pathophysiology and this might generate a higher thromboembolic risk in patients using combined hormonal contraception and menopausal hormone therapy. We aimed to discuss the main aspects related to this issue and propose management strategies for women affected by COVID-19. METHODS: This narrative review collected information from several articles published since the beginning of the outbreak of the new coronavirus disease about the pathophysiology, stage of the disease, the occurrence of thrombotic events, and the risk of thromboembolism in users of contraception and hormonal therapy. RESULTS: This article consolidates clinical parameters about the risk of venous thromboembolism in users of contraception and menopausal hormone therapy emphasizing the probable increase of that risk in women with suspected or confirmed COVID-19 and bringing safer recommendations. CONCLUSIONS: In this scenario, apart from the fundamental orientations of preventive measures, like social isolation and hygiene, it is important that all female health professionals have knowledge of the new rules and adopt safety measures, especially on the prescription of hormonal therapy and contraception.

Fatores associados à presença de Candida spp. em amostras de fluido vaginal de mulheres residentes em comunidades quilombolas / Factors associated with the presence of Candida spp. in vaginal fluid samples from women living in quilombola settlements

RESUMO: Objetivo: Investigar a frequência e fatores associados à detecção de Candida spp. em fluido vaginal de mulheres residentes em uma comunidade quilombola. Materiais e Método: Um estudo transversal foi conduzido com 177 mulheres residentes em uma comunidade quilombola no Nordeste do Brasil. Foram coletados dados sociodemográficos, hábitos de vida, saúde geral e saúde reprodutiva. O material coletado na região do colo do útero foi submetido a exame citopatológico. Amostras de fluido vaginal foram coletadas para a análise microbiológica. Os testes Qui-quadrado, exato de Fisher e modelos de Re-gressão Logística foram utilizados na análise estatística. Resultados: Foi detectado Candida spp. em 28,9% das amostras. A espécie mais frequente nos casos positivos foi a Candida albicans (49%), seguida da Candida krusei (39,2%). Após o ajustamento, observou-se que mulheres com idade igual ou maior que 50 anos apresentaram maior chance da detecção de Candida spp. no fluido vaginal (OR ajustada = 3,46; IC95% = 1,68-7,12), enquanto as mulheres com queixa de corrimento vaginal apresentaram uma chance menor de detecção de Candida spp. (OR ajustada = 0,29; IC95% = 0,11-0,78). Conclusão: Os achados sugerem uma elevada detecção de Candida spp. no fluido vaginal entre mulheres residentes em comunidades quilombolas, o que sinaliza a necessidade do planejamento de medidas para prevenção e rastreamento de caso de candidíase vulvovaginal neste grupo populacional. Além disso, a presença de Candida spp. foi mais elevada em mulheres a partir da quinta década de vida, menor nas mulheres com queixas de corrimento vaginal. (AU)

ABSTRACT: Objective: Investigate the frequency and factors associated with the detection of Candida spp. in vaginal fluid from women living in a quilombola settlement. Materials and Method: A cross-sectional study was conducted with 177 women living in a quilombola settlement in Northeast, Brazil. Socio-demographic data, living habits, general health, and reproductive health were collected. The material collected in the region of the cervix was submitted to cytopathological examination. Vaginal fluid samples were collected for microbiological analysis. Chi-square test, exact Fisher's test, and logistic regression models were used for the statistical analysis. Results: Candida spp. was detected in 28.9% of the samples. The most frequent species in positive cases were Candida albicans (49%), followed by Candida krusei (39.2%). After adjustment, it was observed that women aged over 50 years had a higher chance of detecting Candida spp. in vaginal fluid (OR adjusted = 3.46; 95% CI = 1.68-7.12), while women complaining of vaginal discharge had a lower chance of detecting Candida spp. (OR adjust-ed = 0.29; 95% 95% CI= 0.11-0.78). Conclusion: The findings suggest a high detection of Candida spp. in vaginal fluid among women living in quilombola settlements, which indicates the need for planning measures for prevention and track the cases of vulvovaginal candidiasis in this population group. Besides, the presence of Candida spp. was higher in women from the fifth decade of life, lower in women with complaints of vaginal discharge. (AU)