Use of point-of-care ultrasound to assess the severity of scorpion stings in hospitalized patients.

INTRODUCTION: Scorpionism is a public health problem, especially in tropical regions. In Brazil, the prevalence of envenomation by scorpions is high, and the average national lethality is around 0.16 percent. The Tityus serrulatus scorpion is the primary species of medical importance. However, objective tools to predict and define the severity of these envenomations are lacking. MATERIALS AND METHODS: This was an observational study conducted among patients aged 0-19 years with scorpionism. Patients were admitted to a reference hospital between December 2020 and May 2022. Point-of-care ultrasound was performed within 24 hours of the scorpion sting. RESULTS: Forty-nine patients were included, with a median age of 3.6 (interquartile range 2.3-5.3) years and a predominance of females (51 percent). Fifteen patients (30.6 percent) presented major life-threatening signs, 32 (65.3 percent) minor systemic manifestations, and two (4.1 percent) only local manifestations. Left ventricular dysfunction was identified in 13 patients (26.5 percent). Ten patients (20.4 percent) presented pattern B (visualization of three or more B lines in the evaluated quadrant) in at least one lung window. The sensitivity and specificity of cardiac and pulmonary ultrasound to identify the most severely ill patients were 86 percent and 94 percent, respectively. DISCUSSION: The changes found on point-of-care ultrasound were associated with life-threatening signs. All patients with class III envenomation were referred to the intensive care unit, showing the importance of early identification of this subgroup. The main limitations were the small sample size and the fact that admission to intensive care was not based on systematic criteria. CONCLUSIONS: Point-of-care ultrasound is able to identify early signs of pulmonary congestion and heart failure in scorpionism. It can be useful for the objective selection of patients who are at a higher risk of complications and death and who require intensive support; it may also be valuable for periodic reassessments. Point-of-care ultrasound is a valuable tool for identifying and monitoring severe cases of scorpionism.

Reduction of hospital length of stay through the implementation of SAFER patient flow bundle and Red2Green days tool: a pre-post study.

BACKGROUND: In 2018, the National Health System released the 'Guide to reducing long hospital stays' to stimulate improvement and decrease length of stay (LOS) in England hospitals. The SAFER patient flow bundle and Red2Green tool were described as strategies to be implemented in inpatient wards to reduce discharge delays. OBJECTIVE: To verify if implementing the SAFER patient flow bundle and Red2Green days tool is associated with LOS reduction in the internal medicine unit (IMU) wards of a university hospital in Brazil. METHODS: In this pre post study, we compared the LOS of patients discharged from the IMU wards in 2019, during the implementation of the SAFER bundle and Red2Green tool, to the LOS of patients discharged in the same period in 2018. The Diagnosis-Related Group Brazil algorithm compared groups according to complexity and resource requirements. In-hospital mortality, readmission rates, the number of hospital acquired conditions and the number and causes of inappropriate hospital days were also evaluated. RESULTS: Two hundred and eight internal medicine patients were discharged in 2018, and 252 were discharged in 2019. The median hospital LOS was significantly lower during the intervention period (14.2 days (IQR, 8-23) vs 19 days (IQR, 12-32); p<0.001). In-hospital mortality, 30-day mortality, readmission in 30 days and the number of hospital acquired conditions were the same between groups. Of the 3350 patient days analysed, 1482 (44.2%) were classified as green and 1868 (55.8%) as red. The lack of senior review was the most frequent cause of a red day (42.4%). CONCLUSION: The SAFER patient flow bundle and Red2Green days tool implementation were associated with a significant decrease in hospital LOS in a university hospital IMU ward. There is a considerable improvement opportunity for hospital LOS reduction by changing the multidisciplinary team's attitude during patient hospitalisation using these strategies.

Compartmentalized Regulation of Pulmonary and Systemic Inflammation in Critical COVID-19 Patients.

Critical COVID-19 has been associated with altered patterns of cytokines. Distinct inflammatory processes in systemic and pulmonary sites have been reported, but studies comparing these two sites are still scarce. We aimed to evaluate the profile of pulmonary and systemic cytokines and chemokines in critically ill COVID-19 patients. Levels of cytokines and chemokines were measured in plasma samples and minibronchoalveolar lavage of critical COVID-19 patients within 48 h and 5-8 days after intubation. Distinct inflammatory processes were observed in the lungs and blood, which were regulated separately. Survivor patients showed higher lung cytokine levels including IFN-γ, IL-2, IL-4, G-CSF, and CCL4, while nonsurvivors displayed higher levels in the blood, which included IL-6, CXCL8, CXCL10, CCL2, and CCL4. Furthermore, our findings indicate that high TNF and CXCL8 levels in the mini-BAL were associated with better lung oxygen exchange capacity, whereas high levels of IFN-γ in plasma were associated with worse lung function, as measured using the PaO2/FiO2 ratio. These results suggest that a robust and localized inflammatory response in the lungs is protective and associated with survival, whereas a systemic inflammatory response is detrimental and associated with mortality in critical COVID-19.

Morphofunctional analysis of fibroblast-like synoviocytes in human rheumatoid arthritis and mouse collagen-induced arthritis.

BACKGROUND: Fibroblast-like synoviocytes (FLS) play a prominent role in rheumatoid synovitis and degradation of the extracellular matrix through the production of inflammatory cytokines and metalloproteinases (MMPs). Since animal models are frequently used for elucidating the disease mechanism and therapeutic development, it is relevant to study the ultrastructural characteristics and functional responses in human and mouse FLS. The objective of the study was to analyze ultrastructural characteristics, Interleukin-6 (IL-6) and Metalloproteinase-3 (MMP-3) production and the activation of intracellular pathways in Fibroblast like synoviocytes (FLS) cultures obtained from patients with rheumatoid arthritis (RA) and from mice with collagen-induced arthritis (CIA). METHODS: FLSs were obtained from RA patients (RA-FLSs) (n = 8) and mice with CIA (CIA-FLSs) (n = 4). Morphology was assessed by transmission and scanning electron microscopy. IL-6 and MMP-3 production was measured by ELISA, and activation of intracellular signaling pathways (NF-κB and MAPK: p-ERK1/2, p-P38 and p-JNK) was measured by Western blotting in cultures of RA-FLSs and CIA-FLSs stimulated with tumor necrosis factor-alpha (TNF-α) and IL-1ß. RESULTS: RA-FLS and CIA-FLS cultures exhibited rich cytoplasm, rough endoplasmic reticula and prominent and well-developed Golgi complexes. Transmission electron microscopy demonstrated the presence of lamellar bodies, which are cytoplasmic structures related to surfactant production, in FLSs from both sources. Increased levels of pinocytosis and numbers of pinocytotic vesicles were observed in RA-FLSs (p < 0.05). Basal production of MMP-3 and IL-6 was present in RA-FLSs and CIA-FLSs. Regarding the production of MMP-3 and IL-6 and the activation of signaling pathways, the present study demonstrated a lower response to IL-1ß by CIA-FLSs than by RA-FLSs. CONCLUSION: This study provides a comprehensive understanding of the biology of RA-FLS and CIA-FLS. The differences and similarities in ultrastructural morphology and important inflammatory cytokines shown, contribute to future in vitro studies using RA-FLS and CIA-FLS, in addition, they indicate that the adoption of CIA-FLS for studies should take careful and be well designed, since they do not completely resemble human diseases.

Dysfunctional phenotype of systemic and pulmonary regulatory T cells associate with lethal COVID-19 cases.

Severe cases of COVID-19 present hyperinflammatory condition that can be fatal. Little is known about the role of regulatory responses in SARS-CoV-2 infection. In this study, we evaluated the phenotype of regulatory T cells in the blood (peripheral blood mononuclear cell) and the lungs (broncho-alveolar) of adult patients with severe COVID-19 under invasive mechanical ventilation. Our results show important dynamic variation on Treg cells phenotype during COVID-19 with changes in number and functional parameters from the day of intubation (Day 1 of intensive care unit admission) to Day 7. We observed that compared with surviving patients, non-survivors presented lower numbers of Treg cells in the blood. In addition, lung Tregs of non-survivors also displayed higher PD1 and lower FOXP3 expressions suggesting dysfunctional phenotype. Further signs of Treg dysregulation were observed in non-survivors such as limited production of IL-10 in the lungs and higher production of IL-17A in the blood and in the lungs, which were associated with increased PD1 expression. These findings were also associated with lower pulmonary levels of Treg-stimulating factors like TNF and IL-2. Tregs in the blood and lungs are profoundly dysfunctional in non-surviving COVID-19 patients.

Social skills training with a tabletop role-playing game, before and during the pandemic of 2020: in-person and online group sessions.

Background: The area of social skills is broad, in theory and in practice. For social skills training, various clinical practices have been applied in group sessions, as have motivational resources such as role-playing games (RPGs). In recent years, the need arose to assess the clinical impact of the pandemic. The objective of this study was to determine the impact that the pandemic has had on in-person and online social skills training. Methods: We evaluated six subjects with autism spectrum disorder, with or without another, similar disorder, each of whom attended a total of 12 two-hour RPG sessions over a 12-month period. The original (Portuguese-language) version of the Social Skills Inventory for Adolescents was applied at three different time points (pre-, mid-, and post-intervention). Results: After six in-person tabletop RPG sessions, there was an increase in the mean frequency scores and a decrease in the mean difficulty scores. However, during the pandemic, the remaining six sessions were conducted online and the effect was the opposite. Conclusion: Our data indicate that there is a need for further studies assessing social skills training in online contexts.

Análise da qualidade de vida de professores de educação física escolar / Analysis of quality of life of school physical education teachers / Análisis de la calidad de vida del profesorado escolar de educación física

RESUMO O objetivo do presente estudo foi verificar o índice de qualidade de vida (QV) de professores de educação física de uma rede pública municipal de ensino no estado do Rio de Janeiro através do questionário Whoqol-breef. Foram avaliados 31 professores de um total de 65 professores de educação física da rede, estratificados pelo sexo e tempo de trabalho (2-8 anos, 9-15 anos, >15 anos). Os resultados A média geral do escore de QV indicou que a qualidade de vida dos professores necessita de mais atenção e melhorias, principalmente nos domínios das relações sociais, condições ambientais e estresse. Conclui-se que os índices reduzidos de satisfação e cuidados com a QV denota necessidade de repensar as políticas públicas de saúde do trabalhador e as características do trabalho docente.

ABSTRACT The objective of the present study was to verify the quality of life (QL) index of physical education teachers from a municipal public teaching network in the state of Rio de Janeiro through the Whoqol-breef questionnaire. Thirty-one teachers from a total of 65 physical education teachers in the network were evaluated, stratified by gender and length of service (2-8 years, 9-15 years, >15 years). The results The general average of the QL score indicated that the teachers' quality of life needs more attention and improvements, mainly in the domains of social relations, environmental conditions and stress. It is concluded that the reduced rates of satisfaction and care with QoL denotes the need to rethink public policies on workers' health and the characteristics of teaching work.

RESUMEN El objetivo del presente estudio fue verificar el índice de calidad de vida (CV) de profesores de educación física de una red pública municipal de enseñanza en el estado de Río de Janeiro a través del cuestionario Whoqol-breef. Se evaluaron 31 docentes de un total de 65 docentes de educación física de la red, estratificados por género y antigüedad (2-8 años, 9-15 años, >15 años). Los resultados El promedio general de la puntuación de la CV indicó que la calidad de vida de los profesores necesita más atención y mejoras, principalmente en los dominios de relaciones sociales, condiciones ambientales y estrés. Se concluye que los reducidos índices de satisfacción y cuidado con la CV denotan la necesidad de repensar las políticas públicas sobre salud de los trabajadores y las características del trabajo docente.

Morphofunctional analysis of fibroblast-like synoviocytes in human rheumatoid arthritis and mouse collagen-induced arthritis

Abstract Background Fibroblast-like synoviocytes (FLS) play a prominent role in rheumatoid synovitis and degradation of the extracellular matrix through the production of inflammatory cytokines and metalloproteinases (MMPs). Since animal models are frequently used for elucidating the disease mechanism and therapeutic development, it is relevant to study the ultrastructural characteristics and functional responses in human and mouse FLS. The objective of the study was to analyze ultrastructural characteristics, Interleukin-6 (IL-6) and Metalloproteinase-3 (MMP-3) production and the activation of intracellular pathways in Fibroblast like synoviocytes (FLS) cultures obtained from patients with rheumatoid arthritis (RA) and from mice with collagen-induced arthritis (CIA). Methods FLSs were obtained from RA patients (RA-FLSs) (n = 8) and mice with CIA (CIA-FLSs) (n = 4). Morphology was assessed by transmission and scanning electron microscopy. IL-6 and MMP-3 production was measured by ELISA, and activation of intracellular signaling pathways (NF-κB and MAPK: p-ERK1/2, p-P38 and p-JNK) was measured by Western blotting in cultures of RA-FLSs and CIA-FLSs stimulated with tumor necrosis factor-alpha (TNF-α) and IL-1β. Results RA-FLS and CIA-FLS cultures exhibited rich cytoplasm, rough endoplasmic reticula and prominent and well- developed Golgi complexes. Transmission electron microscopy demonstrated the presence of lamellar bodies, which are cytoplasmic structures related to surfactant production, in FLSs from both sources. Increased levels of pinocytosis and numbers of pinocytotic vesicles were observed in RA-FLSs (p < 0.05). Basal production of MMP-3 and IL-6 was present in RA-FLSs and CIA-FLSs. Regarding the production of MMP-3 and IL-6 and the activation of signaling pathways, the present study demonstrated a lower response to IL-1β by CIA-FLSs than by RA-FLSs. Conclusion This study provides a comprehensive understanding of the biology of RA-FLS and CIA-FLS. The differences and similarities in ultrastructural morphology and important inflammatory cytokines shown, contribute to future in vitro studies using RA-FLS and CIA-FLS, in addition, they indicate that the adoption of CIA-FLS for studies should take careful and be well designed, since they do not completely resemble human diseases.

Psychometric Evaluation of the Cardiology Certification Exam of the Brazilian Society of Cardiology. / Avaliação Psicométrica da Prova de Título de Especialista em Cardiologia da Sociedade Brasileira de Cardiologia.

BACKGROUND: The Cardiology Certification Exam is issued annually by the Brazilian Cardiology Society and set and applied by the Judging Committee for the Cardiologist Title (CJTEC). The psychometric analysis of the exam items using the Item Response Theory (IRT) may provide robust data that can help in the continuous improvement of this instrument. OBJECTIVES: To evaluate the psychometric properties of the 2019 Cardiology Certification Exam in relation to the IR parameters. METHODS: This was an observational study, with psychometric analysis of the 120 questions of the exam taken by 1,120 candidates for the title of Cardiologist in 2019. RESULTS: The IRT analysis revealed that 32.2% of the items had a "high" or "very high" discriminating power, 49.2% were categorized as "easy" or "very easy", and 41.5% showed a high probability of a correct guessing. Sixty-nine deficient items in terms of the IRT parameters were identified, which were then considered poorly effective in evaluating the candidate's ability. CONCLUSIONS: The psychometric analysis of the 2019 Cardiology Certification Exam by the IRT revealed a high percentage of easy questions, with nearly two thirds of the items with a high probability of correct guessing. These data may serve as a basis for a series of discussions and proposals for the elaboration of future certificate exams in Cardiology.

FUNDAMENTO: A Sociedade Brasileira de Cardiologia promove anualmente a prova para obtenção do título de especialista em Cardiologia, sendo a Comissão Julgadora do Título de Especialista em Cardiologia responsável pela sua organização e aplicação. A análise psicométrica dos itens de uma prova, por meio da Teoria de Resposta ao Item (TRI) pode fornecer informações robustas e contribuir para o aprimoramento contínuo dessa avaliação. OBJETIVOS: Avaliar as propriedades psicométricas da prova do Título de Especialista em Cardiologia no ano de 2019, em relação aos parâmetros da TRI. MÉTODOS: Estudo observacional, com a análise psicométrica das 120 questões da prova realizada por 1120 (mil cento e vinte) candidatos para a obtenção do título de especialista em Cardiologia, no ano de 2019. RESULTADOS: A análise da prova pela TRI mostrou 32,2% dos itens com poder de discriminação "alto" ou "muito alto", 49,2% dos itens categorizados como "fácil" ou "muito fácil" e 41,5% apresentavam alta probabilidade de acerto ao acaso . Foram identificados 69 itens com problemas em relação aos parâmetros da TRI e, portanto, com baixo poder de avaliar a proficiência do candidato. CONCLUSÕES: A análise psicométrica da prova de título de Especialista em Cardiologia pela TRI demonstrou um alto percentual de questões fáceis, com cerca de dois terços dos itens com alta probabilidade de acerto ao acaso. Esses dados poderão desencadear uma série de discussões e propostas para a construção das futuras provas em cardiologia.

Avaliação Psicométrica da Prova de Título de Especialista em Cardiologia da Sociedade Brasileira de Cardiologia / Psychometric Evaluation of the Cardiology Certification Exam of the Brazilian Society of Cardiology

Resumo Fundamento A Sociedade Brasileira de Cardiologia promove anualmente a prova para obtenção do título de especialista em Cardiologia, sendo a Comissão Julgadora do Título de Especialista em Cardiologia responsável pela sua organização e aplicação. A análise psicométrica dos itens de uma prova, por meio da Teoria de Resposta ao Item (TRI) pode fornecer informações robustas e contribuir para o aprimoramento contínuo dessa avaliação. Objetivos Avaliar as propriedades psicométricas da prova do Título de Especialista em Cardiologia no ano de 2019, em relação aos parâmetros da TRI. Métodos Estudo observacional, com a análise psicométrica das 120 questões da prova realizada por 1120 (mil cento e vinte) candidatos para a obtenção do título de especialista em Cardiologia, no ano de 2019. Resultados A análise da prova pela TRI mostrou 32,2% dos itens com poder de discriminação "alto" ou "muito alto", 49,2% dos itens categorizados como "fácil" ou "muito fácil" e 41,5% apresentavam alta probabilidade de acerto ao acaso . Foram identificados 69 itens com problemas em relação aos parâmetros da TRI e, portanto, com baixo poder de avaliar a proficiência do candidato. Conclusões A análise psicométrica da prova de título de Especialista em Cardiologia pela TRI demonstrou um alto percentual de questões fáceis, com cerca de dois terços dos itens com alta probabilidade de acerto ao acaso. Esses dados poderão desencadear uma série de discussões e propostas para a construção das futuras provas em cardiologia.

Abstract Background The Cardiology Certification Exam is issued annually by the Brazilian Cardiology Society and set and applied by the Judging Committee for the Cardiologist Title (CJTEC). The psychometric analysis of the exam items using the Item Response Theory (IRT) may provide robust data that can help in the continuous improvement of this instrument. Objectives To evaluate the psychometric properties of the 2019 Cardiology Certification Exam in relation to the IR parameters. Methods This was an observational study, with psychometric analysis of the 120 questions of the exam taken by 1,120 candidates for the title of Cardiologist in 2019. Results The IRT analysis revealed that 32.2% of the items had a "high" or "very high" discriminating power, 49.2% were categorized as "easy" or "very easy", and 41.5% showed a high probability of a correct guessing. Sixty-nine deficient items in terms of the IRT parameters were identified, which were then considered poorly effective in evaluating the candidate's ability. Conclusions The psychometric analysis of the 2019 Cardiology Certification Exam by the IRT revealed a high percentage of easy questions, with nearly two thirds of the items with a high probability of correct guessing. These data may serve as a basis for a series of discussions and proposals for the elaboration of future certificate exams in Cardiology.

Mast cell-T cell axis alters development of colitis-dependent and colitis-independent colorectal tumours: potential for therapeutically targeting via mast cell inhibition.

BACKGROUND: Colorectal cancer (CRC) has a high mortality rate and can develop in either colitis-dependent (colitis-associated (CA)-CRC) or colitis-independent (sporadic (s)CRC) manner. There has been a significant debate about whether mast cells (MCs) promote or inhibit the development of CRC. Herein we investigated MC activity throughout the multistepped development of CRC in both human patients and animal models. METHODS: We analyzed human patient matched samples of healthy colon vs CRC tissue alongside conducting a The Cancer Genome Atlas-based immunogenomic analysis and multiple experiments employing genetically engineered mouse (GEM) models. RESULTS: Analyzing human CRC samples revealed that MCs can be active or inactive in this disease. An activated MC population decreased the number of tumor-residing CD8 T cells. In mice, MC deficiency decreased the development of CA-CRC lesions, while it increased the density of tumor-based CD8 infiltration. Furthermore, co-culture experiments revealed that tumor-primed MCs promote apoptosis in CRC cells. In MC-deficient mice, we found that MCs inhibited the development of sCRC lesions. Further exploration of this with several GEM models confirmed that different immune responses alter and are altered by MC activity, which directly alters colon tumorigenesis. Since rescuing MC activity with bone marrow transplantation in MC-deficient mice or pharmacologically inhibiting MC effects impacts the development of sCRC lesions, we explored its therapeutic potential against CRC. MC activity promoted CRC cell engraftment by inhibiting CD8+ cell infiltration in tumors, pharmacologically blocking it inhibits the ability of allograft tumors to develop. This therapeutic strategy potentiated the cytotoxic activity of fluorouracil chemotherapy. CONCLUSION: Therefore, we suggest that MCs have a dual role throughout CRC development and are potential druggable targets against this disease.

Targeting the Annexin A1-FPR2/ALX pathway for host-directed therapy in dengue disease.

Host immune responses contribute to dengue's pathogenesis and severity, yet the possibility that failure in endogenous inflammation resolution pathways could characterise the disease has not been contemplated. The pro-resolving protein Annexin A1 (AnxA1) is known to counterbalance overexuberant inflammation and mast cell (MC) activation. We hypothesised that inadequate AnxA1 engagement underlies the cytokine storm and vascular pathologies associated with dengue disease. Levels of AnxA1 were examined in the plasma of dengue patients and infected mice. Immunocompetent, interferon (alpha and beta) receptor one knockout (KO), AnxA1 KO, and formyl peptide receptor 2 (FPR2) KO mice were infected with dengue virus (DENV) and treated with the AnxA1 mimetic peptide Ac2-26 for analysis. In addition, the effect of Ac2-26 on DENV-induced MC degranulation was assessed in vitro and in vivo. We observed that circulating levels of AnxA1 were reduced in dengue patients and DENV-infected mice. Whilst the absence of AnxA1 or its receptor FPR2 aggravated illness in infected mice, treatment with AnxA1 agonistic peptide attenuated disease manifestationsatteanuated the symptoms of the disease. Both clinical outcomes were attributed to modulation of DENV-mediated viral load-independent MC degranulation. We have thereby identified that altered levels of the pro-resolving mediator AnxA1 are of pathological relevance in DENV infection, suggesting FPR2/ALX agonists as a therapeutic target for dengue disease.

Narrative review about kip's execution on the low bar of uneven bars / Revisão narrativa sobre a execução do kip na barra baixa das paralelas assimétricas

O kip é uma habilidade fundamental amplamente utilizada nas rotinas de treinamento da ginástica artística. No entanto, faltam materiais didáticos que auxiliem o processo de ensino-aprendizagem dos alunos e dos professores iniciantes. OBJETIVO: Apresentar uma análise biomecânica qualitativa do kippe realizado na barra inferior das paralelas assimétricas. MÉTODOS: Esta foi uma revisão narrativa baseada no Google Acadêmico. Os termos utilizados para a busca dos materiais foram kippe e biomecânica, em Português e Inglês, considerando estudos experimentais e não experimentais. RESULTADOS: A literatura aponta diferentes termos para designar este mesmo movimento. Os movimentos articulares predominantes são extensão e flexão, o que justifica a maioria dos textos abordar a análise do plano sagital. O kippe tem seis instantes e três fases de movimento, Glide, Pike e Pull Up. A literatura mostra pequenas diferenças na execução em cada uma dessas fases. No entanto, alguns erros comuns de execução são apontados com algum consenso como deslizar muito curto, não alcançar o pike, abaixar as pernas muito rápido após o pike e flexionar os cotovelos na tentativa de encerrar o movimento. CONCLUSÃO: Há um número reduzido de estudos que integram a avaliação biomecânica ao processo ensino-aprendizagem na ginástica, bem como no contexto do esporte de alto rendimento. Demonstramos que essa abordagem qualitativa pode ser útil para o processo de ensino-aprendizagem desse exercício específico. A decomposição do movimento em fases permite estabelecer prioridades com base nas forças e fraquezas apresentadas pelos atletas / alunos, otimizando assim as intervenções para melhorar o seu desempenho. (AU)

Kip is a fundamental skill widely used in artistic gymnastics trai-ning routines. However, there is a lack of didactic material that helps students' tea-ching-learning process and beginning teachers. OBJECTIVE: To present a qualitative biomechanical analysis of the kippe performed on the lower bar of the asymmetric parallel bars. METHODS: This was an narrative review based on Google Scholar. The terms used to search for materials were kippe and biomechanics, in Portuguese and English, considering experimental and nonexperimental studies. RESULTS: The lite-rature points out different terms to designate this same movement. The predominant articular movements are extension and flexion, which justifies the majority of the texts to approach the sagittal plane analysis. The kippe has six instants and three phases of movement, Glide, Pike, and Pull Up. The literature show small differences in executi-on in each of these phases. However, some common execution errors are pointed out with consensus as glide too short, do no reach the pike, lower the legs too fast after the pike, and flexing the elbows in an attempt to end the movement. CONCLUSION: The-re is a low number of studies that integrate biomechanical assessment with the tea-ching-learning process in gymnastics, as well as in the context of high-performance sport. We have demonstrated that this qualitative approach might be useful to the tea-ching-learning process of this specific exercise. The decomposition of the movement in critical phases allows establishing priorities based on the strengths and weaknesses exhibited by the athletes/students, thereby optimizing the interventions to improve their performance. (AU)

Transient Alterations in Streamwater Quality Induced by Pollution Incidents: Interim Losses Calculations and Compensation Alternatives Based on Habitat Equivalency Analysis.

Pollution incidents cause transient water quality alterations during the passage of contaminants' plume along watercourses, with plume passage period and contaminants' concentrations modelled by advection-dispersion equations. Despite being transient, water quality alterations can impose many impacts on the streamwater ecosystem services. This study proposes two frameworks based on Habitat Equivalency Analysis to be applied during assessments of streamwaters' pollution incidents and respective compensation panoramas: (1) Streamwater interim loss framework, to calculate interim loss debits caused by transient alterations in the streamwater quality; (2) Total credit framework, to calculate streamwater credits generated by improvements in selected watercourse's streamwater quality, produced by wastewater treatment plants in this study. The amount of credits calculated in the selected watercourses assists in the proposal of suitable compensatory remediation projects to offset interim losses. Frameworks' calculations are founded on IVA, a water quality index for protection of aquatic life and aquatic communities. Frameworks' calculations depend on three parameters: IVA, watercourses fluxes and the present value multiplier. The frameworks were calculated in ΔIVAxL, unit defined by multiplying sensed alterations in streamwater quality (as ΔIVA) and streamwater flux, in liters (L). The frameworks were applied to two major streamwater pollution incidents in Brazil, caused by the dam collapses of Mariana and Brumadinho, suggesting suitable compensatory remediations' projects for the respective streamwater interim losses. Depending on the selected project, Brumadinho compensation period varied from 2 to 5 years, with estimated costs in the 2020 Int.$ 5.7-18.7M range; Mariana compensation period varied from 8 to 20 years, with estimated costs in the 2020 Int.$ 16.7-58.1M range. Based on Brumadinho compensatory remediation projects, an average water pollution environmental damage value per interim loss was calculated, 1.17E-4 2020 Int.$/ΔIVAxL, which might be useful in comparing streamwater pollution evaluations around the world.

Performance of High Mobility Protein Group 1 and Interleukin-6 as Predictors of Outcomes Resulting from Variceal Bleeding in Patients with Advanced Chronic Liver Disease.

Variceal bleeding is a serious complication in cirrhotic patients and is related to increased expression of inflammatory mediators that accentuate circulatory dysfunction. The study aims to evaluate the performance of high mobility protein group 1 (HMG1) and interleukin-6 (IL-6) as predictors of acute kidney injury (AKI), infection and death in these patients. Fifty patients who were diagnosed with advanced chronic liver disease with variceal bleeding were included. The mean age was 52.8 ± 10.8 years, and 33 (66%) were male. Twenty-one (42%) patients were classified as Child-Pugh C, 21 (42%) Child-Pugh B and 8 (16%) Child-Pugh A. The mean HMG1 serum level was 2872.36 pg/mL ± 2491.94, and the median IL-6 serum level was 47.26 pg/mL (0-1102.4). In AKI, the serum level of HMG1 that performed best on the ROC curve was 3317.9 pg/mL. The IL-6 serum level was not associated with AKI. HMG1 and IL-6 cut-off values that better predicted infection were 3317.9 pg/mL and 72.9 pg/mL, and for mortality, the values were 2668 pg/mL and 84.5 pg/mL, respectively. In multivariate analysis, the variables that were associated with AKI and infection outcomes were model for end-stage liver disease and HMG1. Infections were related to the risk of death. Clinical and laboratory variables related to the outcomes were identified. Serum levels of HMG1 were associated with AKI and infection and had good performance in the ROC curve. IL-6 levels were not maintained in logistic regression outcomes but had good performance in infection and death outcomes. Such data will be useful for comparisons and possible future validations.

Emergency medicine in Brazil: historical perspective, current status, and future challenges.

BACKGROUND: Emergency medicine (EM) in Brazil has achieved critical steps toward its development in the last decades including its official recognition as a specialty in 2016. In this article, we worked in collaboration with the Brazilian Association of Emergency Medicine (ABRAMEDE) to describe three main aspects of EM in Brazil: (1) brief historical perspective; (2) current status; and (3) future challenges. MAIN TEXT: In Brazil, the first EM residency program was created in 1996. Only 20 years later, the specialty was officially recognized by national regulatory bodies. Prior to recognition, there were only 2 residency programs. Since then, 52 new programs were initiated. Brazil has now 54 residency programs in 16 of the 27 federative units. As of December 2020, 192 physicians have been board certified as emergency physicians in Brazil. The shortage of formal EM-trained physicians is still significant and at this point it is not feasible to have all Brazilian emergency care units and EDs staffed only with formally trained emergency physicians. Three future challenges were identified including the recognition of EM specialists in the house of Medicine, the need of creating a reliable training curriculum despite highly heterogeneous emergency care practice across the country, and the importance of fostering the development of academic EM as a way to build a strong research agenda and therefore increase the knowledge about the epidemiology and organization of emergency care. CONCLUSION: Although EM in Brazil has accomplished key steps toward its development, there are several obstacles before it becomes a solid medical specialty. Its continuous development will depend on special attention to key challenges involving recognition, reliability, and research.

Lung Ultrasound Can Predict the Clinical Course and Severity of COVID-19 Disease.

Coronavirus disease 2019 (COVID-19) compromises the lung in large numbers of people. The development of minimally invasive methods to determine the severity of pulmonary extension is desired. This study aimed to describe the characteristics of sequential lung ultrasound and to test the prognostic usefulness of this exam in a group of patients admitted to the hospital with COVID-19. We prospectively evaluated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to our hospital between April and August 2020. Bedside lung ultrasound exams were performed at three time points: at inclusion in the study, after 48 h and on the seventh day of follow-up. Lung ultrasound scores were quantified according to the aeration loss in each of eight zones scanned. Sixty-six participants were included: 42 (63.6%) in the intensive care unit and 24 (36.3%) in the ward. Lung ultrasound scores were higher in participants admitted to the intensive care unit than in those admitted to the ward at the time of inclusion (16 [13-17] vs. 10 [4-14], p < 0.001), after 48 h (15.5 [13-17] vs. 12.5 [8.2-14.7], p = 0.001) and on the seventh day (16 [14-17] vs. 7 [4.5-13.7], p < 0.001) respectively. Lung ultrasound score measured at the time of inclusion in the study was independently associated with the need for admission to the intensive care unit (odds ratio = 1.480; 95% confidence interval, 1.093-2.004; p = 0.011) adjusted by the Sequential Organ Failure Assessment score.

Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers.

OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.