The fuzzy system ensembles entomological, epidemiological, demographic and environmental data to unravel the dengue transmission risk in an endemic city.

BACKGROUND: The effectiveness of dengue control interventions depends on an effective integrated surveillance system that involves analysis of multiple variables associated with the natural history and transmission dynamics of this arbovirus. Entomological indicators associated with other biotic and abiotic parameters can assertively characterize the spatiotemporal trends related to dengue transmission risk. However, the unpredictability of the non-linear nature of the data, as well as the uncertainty and subjectivity inherent in biological data are often neglected in conventional models. METHODS: As an alternative for analyzing dengue-related data, we devised a fuzzy-logic approach to test ensembles of these indicators across categories, which align with the concept of degrees of truth to characterize the success of dengue transmission by Aedes aegypti mosquitoes in an endemic city in Brazil. We used locally gathered entomological, demographic, environmental and epidemiological data as input sources using freely available data on digital platforms. The outcome variable, risk of transmission, was aggregated into three categories: low, medium, and high. Spatial data was georeferenced and the defuzzified values were interpolated to create a map, translating our findings to local public health managers and decision-makers to direct further vector control interventions. RESULTS: The classification of low, medium, and high transmission risk areas followed a seasonal trend expected for dengue occurrence in the region. The fuzzy approach captured the 2020 outbreak, when only 14.06% of the areas were classified as low risk. The classification of transmission risk based on the fuzzy system revealed effective in predicting an increase in dengue transmission, since more than 75% of high-risk areas had an increase in dengue incidence within the following 15 days. CONCLUSIONS: Our study demonstrated the ability of fuzzy logic to characterize the city's spatiotemporal heterogeneity in relation to areas at high risk of dengue transmission, suggesting it can be considered as part of an integrated surveillance system to support timely decision-making.

Spatial distribution and population dynamics of free-roaming (stray and semi-domiciled) dogs in a major Brazilian city.

Introduction: Although estimate models have been proposed to determine free-roaming (both stray and semi-domiciled) dog populations, to date, no study has focused on the three major border areas of Brazil. Therefore, the present study assessed the free-roaming dog population of Foz do Iguaçu, a major far-west Brazilian city located in a three-border area (Brazil, Argentina, and Paraguay), which is considered among the top five Brazilian tourist destinations. Methods: Capture-release sampling was performed in three phases with a 6-month interval and 10-day duration of each phase, totaling 18 months, between 2018 and 2019. Results: A total of 1,273 dogs were estimated in the first [95% confidence interval (CI), 468-2,078 dogs], 904 in the second (95%CI, 452-1,355 dogs), and 1,564 in the third (95%CI, 521-2,607 dogs) capture phases in this area, suggesting a population density of 18.4 dogs/km2 (6.1-30.6 dogs/km2, 95% CI). Of all free-roaming dogs, 452/1,125 (40.2%) were stray with no confirmed ownership or household, whereas 672/1,125 (59.8%) had a known origin, among which 625/1,125 (55.6%) were semi-domiciled with ownership or a household, 36/1,125 (3.2%) were neighborhood dogs with maintainers, and 11/1,125 (1.0%) were owned by recycling material collectors and homeless individuals. The majority of the 1,125 dogs (862/1,125; 76.6%) had an ideal body condition score. The high outdoor access of owned dogs is likely caused by cultural behavior. However, because 533/1,125 (47.4%) of the free-roaming dogs presented with clinical abnormalities, irresponsible ownership may have negatively impacted dog health and welfare. Discussion: This study was the first to establish the density of free-roaming dogs, the ratio of stray and semi-domiciled dogs, and their dynamics over time in Foz do Iguaçu. The findings may serve as a warning for the high level of dog outdoor access and irresponsible guardianship, which may negatively affect animal health and welfare, leading to diseases, accidents, trauma, and animal cruelty.

Fatores associados a lesões perineais em partos vaginais: análise multinível / Factors associated with perineal injuries in vaginal deliveries: multilevel analysis / Factores asociados con lesiones perineales en parto vaginal: análisis multinivel

Objetivo: Estimar a prevalência de lesão perineal e seus fatores associados em casa de parto, controlando-se o contexto de cidade de origem da parturiente. Métodos: Estudo transversal retrospectivo realizado com parturientes no Centro de Parto Normal de São Sebastião, Distrito Federal. Os dados de práticas obstétricas foram obtidos por meio de registros em prontuários físicos (n=400) coletados entre junho e setembro de 2016. Considerou-se como variável dependente 'lesão perineal', e independentes os registros de lacerações de primeiro, segundo e terceiro graus. Para o processo de análise de regressão logística multinível considerou-se dois níveis, I ­ variáveis individuais e II ­ contextual 'cidade de origem'. Resultados: A prevalência de lesão perineal foi 72,8% (IC 96% 6,85-77,2) nas mulheres assistidas. Permaneceram associadas positivamente à lesão perineal as variáveis independentes, anos de estudo <8 anos, primiparidade e uso de ocitocina intraparto. Conclusão: A alta prevalência de lesão perineal e seus fatores associados encontrados na população estudada reforçam a importância da atuação de enfermeiras obstétricas nestes dispositivos de atenção à saúde da mulher, visando a redução destes agravos. (AU)

Objective: To estimate the prevalence of perineal injury and its associated factors in the delivery home, controlling the mother's city of origin. Methods: Retrospective cross-sectional study carried out with parturients at the Normal Childbirth Center of São Sebastião, Distrito Federal. Data on obstetric practices were obtained through records in physical records (n=400) collected between June and September 2016. The dependent variable was 'perineal injury', and records of first, second and third lacerations were considered independent. degree. For the multilevel logistic regression analysis process, two levels were considered, I ­ individual variables and II ­ contextual 'city of origin'. Results: The prevalence of perineal injury was 72.8% (CI 96% 6.85-77.2) in women assisted. The independent variables, years of education <8 years, primiparity and use of intrapartum oxytocin remained positively associated with perineal injury. Conclusion: The high prevalence of perineal injury and its associated factors found in the studied population reinforce the importance of the role of obstetric nurses in these women's health care devices, aiming at reducing these injuries. (AU)

Objetivo: Estimar la prevalencia de lesión perineal y sus factores asociados en el hogar de parto, controlando la ciudad de origen de la madre. Métodos: Estudio transversal retrospectivo realizado con parturientas en el Centro de Parto Normal de São Sebastião, Distrito Federal. Los datos sobre prácticas obstétricas se obtuvieron a través de registros en registros físicos (n=400) recolectados entre junio y septiembre de 2016. La variable dependiente fue 'lesión perineal', y los registros de primer, segundo y tercer grado se consideraron independientes. Para el proceso de análisis de regresión logística multinivel, se consideraron dos niveles, I - variables individuales y II - contextual 'ciudad de origen'. Resultados: La prevalencia de lesión perineal fue 72,8% (IC 96% 6,85-77,2) en mujeres asistidas. Las variables independientes, años de educación <8 años, primiparidad y uso de oxitocina intraparto permanecieron asociadas positivamente con la lesión perineal. Conclusión: La alta prevalencia de lesión perineal y sus factores asociados encontrados en la población estudiada refuerzan la importancia del papel de las enfermeras obstétricas en los dispositivos de atención de salud de estas mujeres, con el objetivo de reducir estas lesiones. (AU)

Optimising the surveillance of Aedes aegypti in Brazil by selecting smaller representative areas within an endemic city.

OBJECTIVES: Arboviruses, such as dengue (DENV), zika (ZIKV), and chikungunya (CHIKV), constitute a growing urban public health threat. Focusing on Aedes aegypti mosquitoes, their primary vectors, is crucial for mitigation. While traditional immature-stage mosquito surveillance has limitations, capturing adult mosquitoes through traps yields more accurate data on disease transmission. However, deploying traps presents logistical and financial challenges, demonstrating effective temporal predictions but lacking spatial accuracy. Our goal is to identify smaller representative areas within cities to enhance the early warning system for DENV outbreaks. METHODS: We created Sentinel Geographic Units (SGUs), smaller areas of 1 km2 within each stratum, larger areas, with the aim of aligning the Trap Positivity Index (TPI) and Adult Density Index (ADI) with their respective strata. We conducted a two-step evaluation of SGUs. First, we examined the equivalence of TPI and ADI between SGUs and strata from January 2017 to July 2022. Second, we assessed the ability of SGU's TPI and ADI to predict DENV outbreaks in comparison to Foz do Iguaçu's Early-Warning System, which forecasts outbreaks up to 4 weeks ahead. Spatial and temporal analyses were carried out, including data interpolation and model selection based on Akaike information criteria (AIC). RESULTS: Entomological indicators produced in small SGUs can effectively replace larger sentinel areas to access dengue outbreaks. Based on historical data, the best predictive capability is achieved 2 weeks after infestation verification. Implementing the SGU strategy with more frequent sampling can provide more precise space-time estimates and enhance dengue control. CONCLUSIONS: The implementation of SGUs offers an efficient way to monitor mosquito populations, reducing the need for extensive resources. This approach has the potential to improve dengue transmission management and enhance the public health response in endemic cities.

Factors associated with the quality of life of women undergoing radiotherapy.

OBJECTIVE: To evaluate the skin characteristics and quality of life of patients with breast cancer undergoing radiotherapy. METHOD: Cross-sectional study conducted with 60 women. The classification scales of skin changes resulting from exposure to ionizing radiation (RTOG) and the validated versions in Portuguese of those that classified skin types (Fitzpatrick), symptoms (RISRAS) and quality of life (DLQI) were applied. in the period between December 2021 and October 2022. For data analysis, Fisher's Exact Test, Chi-Square and Asymptotic General Independence Test were used. RESULTS: 100% of patients had skin irritation. As the treatment progressed and the radiodermatitis appeared or worsened, there was a tendency for the intensity of signs and symptoms to increase, such as: sensitivity, discomfort or pain, itching, burning and heat, dry and wet desquamation, which may have impacted the quality of life and reflected in other aspects, such as: shopping activities or outings (p=0.0020), social activities or leisure activities (p=0.0420). CONCLUSION: Radiodermatitis is a common condition that affects women with breast cancer undergoing radiotherapy, skin characteristics and quality of life of patients affected during this treatment.

Factors associated with the quality of life of women undergoing radiotherapy / Factores asociados a la calidad de vida de mujeres en radioterapia / Fatores associados à qualidade de vida de mulheres submetidas à radioterapia

ABSTRACT Objective: To evaluate the skin characteristics and quality of life of patients with breast cancer undergoing radiotherapy. Method: Cross-sectional study conducted with 60 women. The classification scales of skin changes resulting from exposure to ionizing radiation (RTOG) and the validated versions in Portuguese of those that classified skin types (Fitzpatrick), symptoms (RISRAS) and quality of life (DLQI) were applied. in the period between December 2021 and October 2022. For data analysis, Fisher's Exact Test, Chi-Square and Asymptotic General Independence Test were used. Results: 100% of patients had skin irritation. As the treatment progressed and the radiodermatitis appeared or worsened, there was a tendency for the intensity of signs and symptoms to increase, such as: sensitivity, discomfort or pain, itching, burning and heat, dry and wet desquamation, which may have impacted the quality of life and reflected in other aspects, such as: shopping activities or outings (p=0.0020), social activities or leisure activities (p=0.0420). Conclusion: Radiodermatitis is a common condition that affects women with breast cancer undergoing radiotherapy, skin characteristics and quality of life of patients affected during this treatment.

RESUMEN Objetivo: Evaluar las características de la piel y la calidad de vida de pacientes con cáncer de mama en tratamiento con radioterapia. Método: Estudio transversal con 60 mujeres. Se aplicaron la escala de clasificación de alteraciones cutáneas por exposición a radiaciones ionizantes (RTOG) y las versiones validadas en portugués de las que clasificaban tipos de piel (Fitzpatrick), síntomas (RISRAS) y calidad de vida (DLQI) en el período comprendido entre diciembre 2021 y octubre de 2022. Para el análisis de los datos se utilizaron el Test Exacto de Fisher, Chi-Cuadrado y el Test de Independencia General Asintótica. Resultados: El 100% de los pacientes evaluados sobre la piel. A medida que avanzaba el tratamiento y aparecía o empeoraba la radiodermatitis, hubo tendencia a aumentar la intensidad de los signos y síntomas, tales como: sensibilidad, malestar o dolor, visualización, ardor y calor, descamación seca y húmeda, que pudieron haber tenido una impacto en la calidad de vida y reflejado en otros aspectos, como: actividades de compra o salidas (p=0,0020), actividades sociales o de ocio (p=0,0420). Conclusión: La radiodermatitis es una afección común que afecta a mujeres con cáncer de mama, sometidas a radioterapia, las características de la piel y la calidad de vida de las pacientes afectadas durante este tratamiento.

RESUMO Objetivo: Avaliar as características da pele e a qualidade de vida de pacientes com câncer de mama submetidas à radioterapia. Método: Estudo transversal com 60 mulheres. Foram aplicadas as escalas de classificação das alterações cutâneas decorrentes da exposição à radiação ionizante (RTOG) e as versões validadas em português das que classificaram os tipos de pele (Fitzpatrick), os sintomas (RISRAS) e a qualidade de vida (DLQI), no período entre dezembro de 2021 e outubro de 2022. Para a análise de dados, foram utilizados os Testes Exato de Fisher, Qui-Quadrado e Teste de Independência Geral Assintótica. Resultados: 100% das pacientes apresentaram irritação na pele. À medida que o tratamento avançou e que a radiodermatite surgiu ou se agravou, houve maior tendência de intensidade de sinais e sintomas, como: sensibilidade, desconforto ou dor, coceira, queimação e calor, descamação seca e úmida, o que pode ter impactado na qualidade de vida e refletido em outros aspectos, como: atividades de compras ou passeios (p=0,0020), programação social ou atividade de lazer (p=0,0420). Conclusão: A radiodermatite é uma condição comum que afeta as mulheres com câncer de mama submetidas à radioterapia, as características da pele e a qualidade de vida das pacientes são afetadas durante esse tratamento.

SARS-CoV-2 Reinfection Cases in a Household-Based Prospective Cohort in Rio de Janeiro.

This was a household-based prospective cohort study conducted in Rio de Janeiro, in which people with laboratory-confirmed coronavirus disease 2019 (COVID-19) and their household contacts were followed from April 2020 through June 2022. Ninety-eight reinfections were identified, with 71 (72.5%) confirmed by genomic analyses and lineage definition in both infections. During the pre-Omicron period, 1 dose of any COVID-19 vaccine was associated with a reduced risk of reinfection, but during the Omicron period not even booster vaccines had this effect. Most reinfections were asymptomatic or milder in comparison with primary infections, a justification for continuing active surveillance to detect infections in vaccinated individuals. Our findings demonstrated that vaccination may not prevent infection or reinfection with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). Therefore we highlight the need to continuously update the antigenic target of SARS CoV-2 vaccines and administer booster doses to the population regularly, a strategy well established in the development of vaccines for influenza immunization programs.

Herbicide and Cytogenotoxic Activity of Inclusion Complexes of Psidium gaudichaudianum Leaf Essential Oil and ß-Caryophyllene on 2-Hydroxypropyl-ß-cyclodextrin.

The present investigation aimed to develop inclusion complexes (ICs) from Psidium gaudichaudianum (GAU) essential oil (EO) and its major compound ß-caryophyllene (ß-CAR), and to evaluate their herbicidal (against Lolium multiflorum and Bidens pilosa) and cytogenotoxic (on Lactuca sativa) activities. The ICs were obtained using 2-hydroxypropyl-ß-cyclodextrin (HPßCD) and they were prepared to avoid or reduce the volatility and degradation of GAU EO and ß-CAR. The ICs obtained showed a complexation efficiency of 91.5 and 83.9% for GAU EO and ß-CAR, respectively. The IC of GAU EO at a concentration of 3000 µg mL-1 displayed a significant effect against weed species B. pilosa and L. multiflorum. However, the ß-CAR IC at a concentration of 3000 µg mL-1 was effective only on L. multiflorum. In addition, the cytogenotoxic activity evaluation revealed that there was a reduction in the mitotic index and an increase in chromosomal abnormalities. The produced ICs were able to protect the EO and ß-CAR from volatility and degradation, with a high thermal stability, and they also enabled the solubilization of the EO and ß-CAR in water without the addition of an organic solvent. Therefore, it is possible to indicate the obtained products as potential candidates for commercial exploration since the ICs allow the complexed EO to exhibit a more stable chemical constitution than pure EO under storage conditions.

The impact of the distance traveled between residence and gestational trophoblastic neoplasia reference center and clinical outcomes in Brazilian women.

OBJECTIVE: To relate the distance traveled from the patient's residence to the gestational trophoblastic neoplasia (GTN) reference center (RC) and the occurrence of unfavorable clinical outcomes, as well as to estimate the possible association between this distance and the risk of metastatic disease at presentation, the need for multiagent chemotherapy to achieve remission and loss to follow-up before remission. STUDY DESIGN: Retrospective historical cohort study of patients with GTN followed at 8 Brazilian GTN-RC, from January 1st, 2000 - December 31st, 2017. RESULTS: Evaluating 1055 cases of GTN, and using a receiver operating characteristic curve, we found a distance of 56 km (km) from the residence to the GTN-RC (sensitivity = 0.57, specificity = 0.61) best predicted the occurrence of at least one of the following outcomes: occurrence of metastatic disease, need for multiagent chemotherapy to achieve remission, or loss to follow-up during chemotherapy. Multivariate logistic regression adjusted by age, ethnicity, marital status and the reference center location showed that when the distance between residence and GTN-RC was ≥56 km, there was an increase in the occurrence of metastatic disease (relative risk - RR:3.27; 95%CI:2.20-4.85), need for multiagent chemotherapy (RR:1.36; 95%CI:1.05-1.76), loss to follow-up during chemotherapy (RR:4.52; 95CI:1.93-10.63), occurrence of chemoresistance (RR:4.61; 95%CI:3.07-6.93), relapse (RR:10.27; 95%CI:3.08-34.28) and death due to GTN (RR:3.62; 95%CI:1.51-8.67). CONCLUSIONS: The distance between the patient's residence and the GTN-RC is a risk factor for unfavorable outcomes, including death from this disease. It is crucial to guarantee these patients get prompt access to the GTN-RC and receive follow-up support.

SARS-CoV-2 intra-host diversity, antibody response, and disease severity after reinfection by the variant of concern Gamma in Brazil.

The rapid spread of the SARS-CoV-2 Variant of Concern (VOC) Gamma in Amazonas during early 2021 fueled a second large COVID-19 epidemic wave and raised concern about the potential role of reinfections. Very few cases of reinfection associated with the VOC Gamma have been reported to date, and their potential impact on clinical, immunological, and virological parameters remains largely unexplored. Here we describe 25 cases of SARS-CoV-2 reinfection in Brazil. SARS-CoV-2 genomic analysis confirmed that individuals were primo-infected with distinct viral lineages between March and December 2020 (B.1.1, B.1.1.28, B.1.1.33, B.1.195, and P.2) and reinfected with the VOC Gamma between 3 to 12 months after primo-infection. We found a similar mean cycle threshold (Ct) value and limited intra-host viral diversity in both primo-infection and reinfection samples. Sera of 14 patients tested 10-75 days after reinfection displayed detectable neutralizing antibodies (NAb) titers against SARS-CoV-2 variants that circulated before (B.1.*), during (Gamma), and after (Delta and Omicron) the second epidemic wave in Brazil. All individuals had milder or no symptoms after reinfection, and none required hospitalization. These findings demonstrate that individuals reinfected with the VOC Gamma may display relatively high RNA viral loads at the upper respiratory tract after reinfection, thus contributing to onward viral transmissions. Despite this, our study points to a low overall risk of severe Gamma reinfections, supporting that the abrupt increase in hospital admissions and deaths observed in Amazonas and other Brazilian states during the Gamma wave was mostly driven by primary infections. Our findings also indicate that most individuals analyzed developed a high anti-SARS-CoV-2 NAb response after reinfection that may provide some protection against reinfection or disease by different SARS-CoV-2 variants.

The impact of low back pain and disability on frailty levels in older women: longitudinal data from the BACE-Brazil cohort.

METHODS: This is a longitudinal observational study with a convenience subsample from the international Back Complaints in the Elders (BACE)-Brazil. Frailty was assessed by researchers at baseline, 6 and 12 months according to the Frailty Phenotype. Pain was assessed using a Numerical Pain Scale (NPS). Disability was assessed using the Roland Morris Disability Questionnaire. RESULTS: A total of 155 older women (70.4 ± 5.4 years) participated. Follow-up for 6 and 12 months in this study was associated with a change of older women to worse frailty levels (OR = 2.83, 95% CI 1.98-4.67; p < 0.01). A significant association was observed between greater pain intensity and the transition of the older women through the frailty levels (ß = - 0.73; p < 0.01) when inserting the pain variable at baseline of the statistical model. Older women who reported greater pain intensity worsened their frailty level. The same happened when the disability variable was inserted in the model (ß = - 0.74; p < 0.01). The criteria proposed by Fried et al. were able to identify frailty throughout the follow-up and no prevalence of any item. CONCLUSIONS: In older women, relevant factors such as pain and disability are closely linked to the frailty phenomenon. Thus, the frailty syndrome must be assessed, monitored and treated in relation to the individualities of older adults, as those with back pain and greater disabilities are more susceptible to frailty.

As dificuldades na amamentação de recém-nascidos: análise quanto à via de parto / Difficulties in newborn breastfeeding: analysis regarding the delivery route

A amamentação é uma prática recomendada pela Organização Mundial de Saúde devido aos seus inúmeros benefícios para mãe e recém-nascido, porém seu estabelecimento e manutenção vêm sendo um grande desafio nos dias atuais. Objetivo: Identificar comportamentos indicativos de dificuldades maternas e neonatais relacionadas à amamentação considerando a via de parto. Casuística e Métodos: A amostra foi composta por 240 binômios mãe-bebê, por amostragem aleatória simples e os dados obtidos através da aplicação do instrumento de observação e avaliação da mamada, proposto pelo Fundo das Nações Unidas para Infância (Unicef), com realização de entrevista semiestruturada e coleta de dados complementares por análise documental de prontuários. Estes foram analisados pelo programa SPSS versão 3.5 por meio do teste X2, exato de Fisher e aplicada a correção de Yates quando cabível, sendo os resultados estatisticamente significativos quando p<0,05. Resultados: Constatou-se no estudo uma elevada prevalência de participantes com comportamentos indicativos de dificuldades, sendo "posição" e "sucção" os mais prevalentes. Foram encontradas, ainda, significativas associações entre parto normal e comportamentos favoráveis à amamentação relacionados ao aspecto "resposta", assim como entre cesárea e comportamentos favoráveis relacionados à "posição". Conclusão: Foi possível identificar comportamentos sugestivos de dificuldades durante a amamentação, auxiliando a população, oportunizando reflexões e fornecendo subsídios para profissionais da saúde no incentivo e promoção do aleitamento materno

Breastfeeding is a practice recommended by the World Health Organization due to its numerous benefits for mother and newborn, but its establishment and maintenance have been a major challenge nowadays. Objective: To identify behaviors that indicate maternal and neonatal difficulties related to breastfeeding, considering the mode of delivery. Casuistry and Methods: The sample consisted of 240 mother-baby binomials, by simple random sampling and the data obtained through the application of the instrument of observation and evaluation of breastfeeding, proposed by the United Nations Children's Fund (Unicef), with the performance of semi-structured interview and collection of complementary data through document analysis of medical records. These were analyzed using the SPSS version 3.5 program using Fisher's exact X2 test and Yates correction was applied when applicable, with statistically significant results when p<0.05. Results: The study found a high prevalence of participants with behaviors indicative of difficulties, with "position" and "sucking" being the most prevalent. Significant associations were also found between vaginal delivery and favorable breastfeeding behaviors related to the "response" aspect, as well as between cesarean sections and favorable behaviors related to "position". Conclusion: It was possible to identify behaviors that suggest difficulties during breastfeeding, helping the population, providing opportunities for reflection and providing subsidies for health professionals in encouraging and promoting breastfeeding

Fatores clínicos e obstétricos de óbitos fetais em uma maternidade de alto risco / Clinical and obstetric factors of fetal death in a high-risk maternity

Objetivo: Caracterizar os fatores clínicos e obstétricos de mulheres que tiveram diagnóstico de óbito fetal em uma maternidade escola de alto risco. Metodologia: estudo de abordagem quantitativa, de corte transversal e caráter descritivo exploratório. Foram incluídos 354 prontuários de mulheres admitidas com diagnóstico e óbito fetal entre janeiro de 2018 a janeiro de 2022. Analisou-se os dados a partir da distribuição de frequências absolutas e relativas (%). Resultados: A idade média das participantes foi de 26 anos. A maioria era primípara sem perdas fetais prévias. Hipóxia Fetal Intraútero foi a causa de óbito mais frequente (17,8%). Conclusão: O óbito fetal intraútero ainda é um diagnóstico que requer mais visibilidade por parte do sistema de saúde. Foi constatada a deficiência dos registros em prontuário de dados importantes, ressaltando a necessidade de promover treinamento e capacitação para os profissionais que realizam assistência

Objective: To characterize the clinical and obstetric factors of women who were diagnosed with fetal death in a high-risk maternity hospital. Methodology: cross-sectional, analytical and retrospective study, carried out in a high-risk maternity hospital in the Central Region of Goiás. A total of 354 medical records of women admitted with a diagnosis and fetal death between January 2018 and January 2022 were included. Data were analyzed based on the distribution of absolute and relative frequencies (%). Results: The average age of the participants was 26 years old. Most were primiparous without previous fetal losses. Intrauterine Fetal Hypoxia was the most frequent cause of death (17.8%). Conclusion: Intrauterine fetal death is still a diagnosis that requires more visibility from the health system. It was verified the deficiency of records in medical records of important data, emphasizing the need to promote training and qualification for professionals who perform assistance

Desfechos obstétricos em parto de adolescentes: estudo transversal / Obstetric outcomes in adolescents birth: cross-sectionalstudy

A gravidez na adolescência é um problema de saúde pública mundial e apresenta maior risco de morbimortalidade materna e neonatal. Objetivo: analisar os desfechos maternos em adolescentes de risco habitual e alto risco gestacional. Método: Trata-se de um estudo transversal realizado com adolescentes com idade entre 10 a 19 anos. A amostra utilizada no estudo foi de 220 adolescentes. Foram utilizados como testes estatísticos o X² e, quando necessário, o teste exato de Fisher ou Mid-P. Foi considerado o valor de p<0,05. Resultados: Observou-se que as adolescentes de risco habitual apresentaram gestação não desejada (p=0,033) e lacerações perineais durante o parto vaginal (p<0,001) e as de alto risco tiveram alterações da gestação (p<0,001), episiotomia (p= 0,038) no parto e internações em Unidade de Terapia Intensiva (UTI) (p=0,015). Conclusão: As adolescentes de alto risco gestacional necessitam de uma atenção especializada durante o ciclo gravídico-puerperal, para prevenir alterações gestacionais, quadros clínicos graves, internação em UTI e desfechos neonatais adversos, com intuito de melhorar a qualidade de vida perinatal

Teenage pregnancy is a global public health problem and presents a higherrisk of maternal and neonatal morbidity and mortality. This study aims to analyze the maternal outcomes in adolescents of usual riskand high gestational risk. Methods: This is a crosssectional study, carried out with adolescents aged 10to 19 years. The sample used in the study consisted of 220 adolescents. X² were used asstatistical tests, when necessary, Fisher's exact test or Mid-P was used. Ap value <0.05 wasconsidered. Results:it was observed that the usual risk adolescents had unwantedpregnancies (p= 0.033) and perineal lacerations during vaginal delivery (p<0.001) and thehigh risk ones had changesin pregnancy (p<0.001), episiotomy was performed (p= 0.038)and admitted to theIntensive Care Unit (ICU) (p= 0.015). Conclusions: Adolescentsat high gestational risk need specialized care during the pregnancy-puerperal cycle, to prevent gestational changes, severe clinical conditions, ICU admission and adverse neonatal outcomes, withthe aim of improving perinatal quality of life

Relação entre iniquidade racial e violência obstétrica no parto / Relation between racial inequality and obstetric violence in childbirth

A iniquidade racial é a desigualdade em oportunidades e condições de vida que acontece em decorrência da etnia de uma pessoa. Indivíduos pretos, pardos e indígenas são modelos de povos que resistem aos desafios subsequentes dos processos históricos de segregação. Objetivo: Verificar a influência dos aspectos raciais na prática de violência obstétrica na atenção ao parto e nascimento. Métodos: Trata-se de um estudo com abordagem quantitativa, de corte transversal, com coleta de dados prospectiva, realizado em uma maternidade pública na cidade de Goiânia, Goiás. Resultados: Pode-se determinar um cuidado menos satisfatórios para as mulheres negras quando comparado com as brancas para a maioria dos indicadores avaliados neste estudo. Mulheres pretas e pardas têm maior chance de sofrerem manobra de Kristeller, amniotomia precoce, privação alimentar no trabalho de parto, clampeamento imediato do cordão umbilical e menor chance de contato pele a pele e de ser ofertado métodos não farmacológicos para o alívio da dor. Conclusão: O fator raça/cor influencia no tratamento em que as mulheres recebem dentro do estabelecimento de saúde.

Racial inequity is inequality in opportunities and living conditions that occurs as a result of a person's ethnicity. Black, brown and indigenous individuals are models of peoples who resist the subsequent challenges of historical processes of segregation. Objective: To verify the influence of racial aspects in the practice of obstetric violence in labor and birth care. Methods: This is a cross-sectional study with a quantitative approach, with prospective data collection, carried out in a public maternity hospital in the city of Goiânia, Goiás. Results: Less satisfactory care can be determined for black women when compared to white women for most of the indicators evaluated in this study. Black and brown women are more likely to undergo the Kristeller maneuver, early amniotomy, food deprivation during labor, immediate clamping of the umbilical cord and less chance of skin-to-skin contact and being offered non-pharmacological methods for pain relief. Conclusion: The race/color factor alone influences the treatment that women receive within the health establishment.

Entomo-virological surveillance followed by serological active survey of symptomatic individuals is helpful to identify hotspots of early arbovirus transmission.

Arboviruses transmitted by Aedes aegypti in urban environments have spread rapidly worldwide, causing great impacts on public health. The development of reliable and timely alert signals is among the most important steps in designing accurate surveillance systems for vector-borne diseases. In July and September 2017, we conducted a pilot study to improve an existing integrated surveillance system by using entomo-virological surveillance to prioritize areas to conduct active searches for individuals with arbovirus infection symptoms. Foz do Iguaçu City has a permanent entomo-virological surveillance system with approximately 3,500 traps to capture Aedes sp. in the adult stage. The Aedes aegypti females are captured alive and human samples are submitted to RT-qPCR (real-time qPCR) screening for DENV, ZIKV, and CHIKV diagnosis. Of the 55 Ae. aegypti mosquitoes tested in July 2017, seven (12.7%) were considered positive for DENV-2 and three (5.4%) for CHIKV. In September, we tested a sample of 54 mosquitoes, and 15 (27.7%) were considered infected by DENV-2. We created 25 circumferences with 150-m radius each to perform an active survey to identify symptomatic householders. In July, we selected one circumference, and five (35.7%) patients were positive for DENV, whereas two (14.3%) for CHIKV. In September, we selected four circumferences, and, from the 21 individuals sampled, nine (42.8%) were positive for DENV-2. A statistical model with a binomial response was used to estimate the number of cases in areas without active surveys, i.e., 20 circumferences. We estimated an additional 83 symptomatic patients (95% CI: 45-145) to be found in active searches, with 38 (95% CI: 18-72) of them confirming arbovirus infection. Arbovirus detection and serotyping in mosquitoes, but also in symptomatic individuals during active surveys, can provide an alert signal of early arbovirus transmission.

Triazole-functionalized hydrochar-stabilized Pd nanocatalyst for ullmann coupling.

Biomass valorization is essential, particularly in emerging countries. Here, hydrochar from arabica coffee straw was functionalized with a triazole group (HD-TRz) for use as a support of palladium nanoparticles (PdNPs-HD-TRz) applied in the Ullmann coupling reaction for the first time. It provided remarkably excellent selectivities, conversions at a temperature as low as 45 °C and catalyst recyclability, surpassing previous literature performances. Hydrochar was obtained by one-pot reaction via hydrothermal synthesis, using NaOH solution as activating agent and functionalized with a 1,3-triazole group by CuAAC "click" reaction. The PdNPs were prepared via reduction of hydrochar-bound Pd(II) using NaBH4. Hydrochar functionalization was monitored by infrared spectroscopy, and X-ray diffraction (XRD) allowed to observe carbon and palladium planes in hydrochar and PdNPs HD-TRz structures. The PdNPs presented a spherical shape with 2.1 ± 0.1 nm size, homogeneously distributed in the carbon coverslips. The HD-TRz-supported PdNPs were used as a catalyst in the Ullmann reaction of iodobenzene, using ethanol as solvent with 100% of conversion and 91% selectivity at 45 °C. The material was reused, presenting 100% of conversion and selectivities of 92, 84 and 73% for the 1st, 2nd and 3rd cycle, respectively. The scope of the reaction was expanded to other molecules showing the potential of this and other triazole-hydrochar-supported nanocatalysts.

Emergence and Spread of the SARS-CoV-2 Variant of Concern Delta across Different Brazilian Regions.

The SARS-CoV-2 variant of concern (VOC) Delta was first detected in India in October 2020. The first imported cases of the Delta variant in Brazil were identified in April 2021 in the southern region, followed by more cases in different regions during the following months. By early September 2021, Delta was already the dominant variant in the southeastern (87%), southern (73%), and northeastern (52%) Brazilian regions. This study aimed to understand the spatiotemporal dissemination dynamics of Delta in Brazil. To this end, we employed a combination of maximum likelihood (ML) and Bayesian methods to reconstruct the evolutionary relationship of 2,264 VOC Delta complete genomes (482 from this study) recovered across 21 of the 27 Brazilian federal units. Our phylogeographic analyses identified three major transmission clusters of Delta in Brazil. The clade BR-I (n = 1,560) arose in Rio de Janeiro in late April 2021 and was the major cluster behind the dissemination of the VOC Delta in the southeastern, northeastern, northern, and central-western regions. The AY.101 lineage (n = 207) that arose in the Paraná state in late April 2021 and aggregated the largest fraction of sampled genomes from the southern region. Lastly, the AY.46.3 lineage emerged in Brazil in the São Paulo state in early June 2021 and remained mostly restricted to this state. In the rapid turnover of viral variants characteristic of the SARS-CoV-2 pandemic, Brazilian regions seem to occupy different stages of an increasing prevalence of the VOC Delta in their epidemic profiles. This process demands continuous genomic and epidemiological surveillance toward identifying and mitigating new introductions, limiting their dissemination, and preventing the establishment of more significant outbreaks in a population already heavily affected by the COVID-19 pandemic. IMPORTANCE Amid the SARS-CoV-2 continuously changing epidemic profile, this study details the space-time dynamics of the emergence of the Delta lineage across Brazilian territories, pointing out its multiple introductions in the country and its most prevalent sublineages. Some of these sublineages have their emergence, alongside their genomic composition and geographic distribution, detailed here for the first time. A special focus is given to the emergence process of Delta outside the country's south and southeast regions, the most populated and subjects of most published SARS-CoV-2 studies in Brazil. In summary, the study allows a better comprehension of the evolution process of a SARS-CoV-2 lineage that would be associated with a significant recrudescence of the pandemic in Brazil.

Evaluation of pulse wave velocity and central systolic blood pressure in children and adolescents with chronic kidney disease.

OBJECTIVE: Investigate pulse wave velocity and central systolic blood pressure among pediatric population with chronic kidney disease. METHODS: In this cross-sectional study, 57 patients (61.4% male) aged 6.2 to 17.5 years old, 44 with nondialysis chronic kidney disease and 13 on chronic dialysis, were included in the analysis. The pulse wave velocity and the central systolic blood pressure were measured with an oscillometric device with an inbuilt ARC SolverⓇ algorithm and were compared with previously established percentiles. RESULTS: The prevalence of elevated pulse wave velocity was 21.1% (95%Cl: 11.4-33.9) and elevated central systolic blood pressure was 28.1% (95%CI: 17.0-41.5). According to the generalized linear model, there was a higher risk of elevated pulse wave velocity in patients undergoing chronic dialysis treatment than nondialysis chronic kidney disease patients (adjPR=4.24, 95%CI: 1.97-9.13, p=<0.001). Hypertensive patients (stage 2) had a higher risk of elevated pulse wave velocity than normotensive ones (adjPR=2.70, 95%CI: 1.05-6.95, p=0.040), as did patients younger than 12 years than the older patients (adjPR=2.95, 95%CI: 1.05-8.40, p=0.041). Hypertensive patients had a higher risk of elevated central systolic blood pressure than normotensives (adjPR=3.29, 95%Cl: 1.36-7.94), as did patients undergoing chronic dialysis treatment when comparing to nondialysis chronic kidney disease patients (adjPR=2.08, 95%Cl: 1.07-4.02). CONCLUSION: Younger age, dialysis, and hypertension in children are independently associated with higher pulse wave velocity. Hypertension and dialysis are independently associated with higher central systolic blood pressure.

Citywide Integrated Aedes aegypti Mosquito Surveillance as Early Warning System for Arbovirus Transmission, Brazil.

Arbovirus epidemiology lacks efficient and timely surveillance systems with accurate outbreak alert signals. We devised a citywide integrated surveillance system combining entomologic, epidemiologic, and entomo-virologic data gathered during 2017-2020 in Foz do Iguaçu, Brazil. We installed 3,476 adult mosquito traps across the city and inspected traps every 2 months. We compared 5 entomologic indices: traditional house and Breteau indices for larval surveys and trap positivity, adult density, and mosquitoes per inhabitant indices for adult trapping. We screened for dengue, Zika, and chikungunya viruses in live adult Aedes aegypti mosquitoes collected from traps. Indices based on adult mosquito sampling had higher outbreak predictive values than larval indices, and we were able to build choropleth maps of infestation levels <36 h after each round of trap inspection. Locating naturally infected vectors provides a timely support tool for local public health managers to prioritize areas for intervention response to prevent virus outbreaks.