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We assessed the diversity of triatomines, the rates of natural infection, and the discrete typing units (DTUs) of Trypanosoma cruzi isolated from them in two municipalities in the state of Sergipe, Brazil. Active searches for triatomines were conducted in the peridomicily and wild enviroments of 10 villages within the two municipalities. Triatomines were taxonomically identified and their feces were extracted using the abdominal compression method. Parasite detection was performed using optical microscopy. For Trypanosoma cruzi genotyping via PCR-FFLB, 151 samples of the subspecies Triatoma brasiliensis macromelasoma and Triatoma brasiliensis were isolated from both municipalities. In total, 505 triatomines were collected, with Triatoma brasiliensis macromelasoma being the most frequent species (58.81 %). Triatoma b. brasiliensis was the only species in both peridomestic and wild environments. Regarding the other species, T. pseudomaculata was found only in the peridomestic environment; and T. b. macromelasoma and Psammolestes tertius were found in the wild environment. Three Discrete Typing Units were identified: TcI (87.51 %) detected in T. b. brasiliensis and T. b. macromelasoma, TcI+TcIII (10.41 %) in T. b. macromelasoma, and TcI+Trypanosoma rangeli (2.08 %) in T. b. macromelasoma. It is concluded that T. b. macromelasoma is the species collected most frequently in the studied region and the one that presents the highest rates of natural infection, highlighting its epidemiological importance for the vectorial transmission of Chagas disease in Sergipe.

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The giant African land snail Achatina fulica is known to be the intermediate host of a number of nematode species that are prejudicial to human and veterinary health, being also an agricultural and urban pest. The present study investigated the presence of nematodes in A. fulica and other terrestrial mollusks in 24 municipalities of Sergipe State, northeastern of Brazil, in the dry and rainy seasons. In 2019 and 2020, the specimens were collected in standard 20 m × 10 m plots (10 min/01 collector), while in 2021, they were collected by convenience sampling. The nematode species were identified based on sequencing of the mitochondrial Cytochrome C Oxidase Subunit I (COI) gene and the ribosomal nuclear Internal Transcribed Spacer (ITS 2). Specimens of A. fulica infected with Angiostrongylus cantonensis, a nematode that causes eosinophilic meningitis (EM) in humans and animals, were collected in four municipalities. Two nematodes of veterinary importance were also identified, Aelurostrongylus abstrusus and Cruzia tentaculata in seven municipalities. This is the first record of Cruzia tentaculata in Sergipe. Free-living nematodes were also found in 18 municipalities. One of these species - Caenorhabditis briggsae - was identified in the municipality of Itabaiana. Specimens of other mollusks species were also collected. Only one of these mollusks, C. fasciata from Japaratuba, was found infected with free-living nematodes. A. fulica showed greater positivity for nematodes in the dry season, especially in the regions of Lower São Francisco River, Greater Aracaju and South Central Sergipe. The probability of infection increased when mollusks were larger and more recurrent in plots. Given that A. cantonensis is the etiological agent of EM and was found associated to A. fulica in four municipalities, it will be important to implement programs of continuous monitoring of the mollusk's fauna, combined with educational programs that provide information necessary to control A. fulica.

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OBJECTIVE: Development and evaluation of a mobile application for remote monitoring and guidance of pediatric patients diagnosed with cleft lip and/or palate (CL ± P) and their caregivers. DESIGN: This is a pilot cross-sectional, applied, and quantitative study. SETTING: The study was conducted in two tertiary care treatment centers in Brazil. PARTICIPANTS: The participants included 20 caregivers and infants undergoing treatment with nasoalveolar molding (NAM) for CL ± P. INTERVENTIONS: The intervention involved using the TeleCleft mobile application for remote monitoring and guidance of caregivers and infants during NAM treatment. MAIN OUTCOME MEASURE(S): The main outcome measures included usability and satisfaction of users with the TeleCleft application. RESULTS: The results showed high usability and satisfaction ratings among users of the TeleCleft application. Most participants found remote monitoring to be effective and expressed positive opinions about its convenience and usefulness. CONCLUSION: TeleCleft could be a viable tool for remote monitoring and guidance, reducing the need for patients and caregivers to travel to treatment centers, which could potentially alleviate the burden of care faced by families during the journey of CL ± P treatment.

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INTRODUCTION: Neuromyelitis optica spectrum disorders (NMOSD) and MOG-associated disease (MOGAD) are an increasingly recognized group of demyelinating disorders of the central nervous system. Previous studies suggest that prognosis is predicted by older age at onset, number of relapses, the severity of the first attack and autoantibody status. OBJECTIVE: To study prognostic factors associated with disability progression and additional relapses in the 3-year follow-up of a national NMOSD/MOGAD cohort. RESULTS: Out of 180 of the initial Portuguese cohort, data on 82 patients was available at the end of the follow-up period (2019-2022). Two patients died. Twenty (24.4%) patients had one or more attack in this period (25 attacks in total), mostly transverse myelitis (TM) (56.0%) or optic neuritis (32.0%). MOGAD was significantly associated with a monophasic disease course (p = 0.03), with milder attacks (p = 0.01), while AQP4 + NMOSD was associated with relapses (p = 0.03). The most common treatment modalities were azathioprine (38.8%) and rituximab (18.8%). AQP4 + NMOSD more frequently required chronic immunosuppressive treatment, particularly rituximab (p = 0.01). Eighteen (22.5%) had an EDSS ≥6 at the end of the follow-up. AQP4 + NMOSD (p < 0.01) and the occurrence of transverse myelitis (TM) during disease (p = 0.04) correlated with an EDSS≥6 at the end of the follow-up period. MOGAD was significantly associated with an EDSS<6 (p < 0.01), and MOG+ cases that reached an EDSS>6 were significantly older (64.0 ± 2.8 versus 31.0 ± 17.1, p = 0.017). A bivariate logistic regression model including the serostatus and TM attacks during disease history successfully predicted 72.2% of patients that progressed to an EDSS≥6. CONCLUSION: This study highlights that myelitis predict increased disability (EDSS≥6) in NMOSD/MOGAG and AQP4 positivity is associated with increased disability.

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PURPOSE: In this study, 143 lutjanid fishes representing four different species from the Northeast coast off Brazil were analyzed for parasites. The aim of the present study is to provide a detailed redescription of R. (I.) vicentei, collected from lutjanid fishes in Brazil, including the first observation of the species using scanning electron microscopy (SEM). METHODS: Nematodes found clarified in a crescent glycerin series, were photographed and measured (in mm), and some specimens destined for SEM. The Illustrations were made using an optical microscope with a drawing tube. RESULTS: Nematodes found were identified as Raphidascaris (Ichthyascaris) vicentei, infecting 6.29% of the examined fish. Detailed morphological analysis revealed the following characteristics observed for the first time in this species: labial papillae, narrow lateral alae and the detailed structure of male spicules. These contributions help filling the gaps in the literature and expand the knowledge of this parasite morphology. CONCLUSIONS: The presence of R. (I.) vicentei in four lutjanid species may indicates low host specificity, highlighting its adaptability to different hosts. Furthermore, new host records are given. This research provides the most comprehensive morphological description of R. (I.) vicentei to date, generating crucial insights for a better understanding of the parasitic biodiversity off the Brazilian Northeastern coast of Brazil, as well as establishing foundation for future investigations on the ecology and impacts of these parasites in fish populations from this region.

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INTRODUCTION: Cerebral venous thrombosis (CVT) is a rare but potentially fatal disease in pediatric age with an important morbimortality. In adults several factors have been associated with worse outcomes, however there are still few studies in children. This study aims to identify risk factors associated with clinical manifestations and long-term sequelae in pediatric CVT. METHODS: Retrospective analysis of pediatric inpatients admitted to a tertiary-care hospital due to CVT between 2008 and 2020. RESULTS: Fifty-four children were included, 56% male, median age of 6.5 years (9 months-17.3 years). Permanent risk factors were identified in 13 patients (malignancy, 8; hematologic condition, 5) and transient risk factors in 47, including head and neck infections (57%) and head trauma (15%). Multiple venous sinuses involvement was present in 65% and the deep venous system was affected in four patients. Seventeen percent had intracranial hemorrhage and 9% cerebral infarction. Sixty-four percent of patients with multiple venous sinuses involvement presented with severe clinical manifestations: impaired consciousness, intracranial hypertension, acute symptomatic seizures or focal deficits. Regarding long-term prognosis, six patients had major sequelae: epilepsy (n = 3), sensory motor deficits (n = 2), and cognitive impairment (n = 3). Permanent risk factors were associated with severe clinical manifestations (p = 0.043). Cerebral infarction and intracranial hemorrhage were associated with major sequelae (p = 0.006 and p = 0.03, respectively, adjusted for age and sex). CONCLUSION: Permanent risk factors, involvement of multiple venous sinuses, intracranial hemorrhage, and cerebral infarction, were related to worse prognosis. Detection and early management of risk factors may limit CVT extension and reduce its morbimortality.

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Abstract Wildlife roadkill surveys in Brazil often focus on birds, as they are one of the main groups affected by road accidents. In addition roadkill, anthropogenic litter also contributes to a significant number of bird fatalities every year. The present study aimed to investigate the stomach contents and possible contamination by inorganic material of birds killed on a federal highway that crosses the Serra de Itabaiana National Park in the state of Sergipe, Brazil. Monitoring and data collection were carried out from January to June 2022, with a motorcycle at an average speed of 60 km/h. The collected animals were transported to the Institute of Technology and Research, located at the Tiradentes University, Sergipe, Brazil, and a plastic material was identified. The plastic material found was subjected to Fourier Transform Infrared Spectroscopy (FTIR), which showed a similar wavenumber to a polymer in the polypropylene chain, very common in plastic packaging. The presence of plastics and metals in the intestinal contents of Caracara plancus and Crotophaga ani is noteworthy, as they have a greater tendency to ingest plastics due to their generalist diet. Plastic contamination in Progne chalybea and Nyctidromus albicollis probably occurred through bioaccumulation, from the consumption of insects contaminated by microplastics.

Resumo As pesquisas sobre atropelamentos de animais silvestres no Brasil geralmente se concentram nas aves, pois elas são um dos principais grupos afetados por acidentes rodoviários. Além dos atropelamentos, o lixo antropogênico também contribui para um número significativo de mortes de aves todos os anos. O presente estudo teve como objetivo investigar o conteúdo estomacal e possível contaminação por material inorgânico de aves atropeladas em uma rodovia federal que atravessa o Parque Nacional da Serra de Itabaiana, no estado de Sergipe, Brasil. O monitoramento e a coleta de dados foram realizados no período de janeiro a junho de 2022, com uma motocicleta a uma velocidade média de 60 km/h. Os animais coletados foram transportados para o Instituto de Tecnologia e Pesquisa situado na Universidade Tiradentes, Sergipe, Brasil, onde foi identificado um material plástico. O material plástico encontrado foi submetido à espectroscopia no infravermelho com transformada de Fourier (FTIR), que mostrou número de onda semelhante a um polímero da cadeia do polipropileno, muito comum em embalagens plásticas. Chama a atenção a presença de plásticos e metais no conteúdo intestinal de Caracara plancus e Crotophaga ani, pois apresentam maior tendência à ingestão de plásticos devido à dieta generalista. A contaminação plástica em Progne chalybea e Nyctidromus albicollis provavelmente ocorreu por bioacumulação, a partir do consumo de insetos contaminados por microplásticos.

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Monogeneans are a diverse group of flatworms, being ectoparasites of marine and freshwater fish, with great morphological and ecological variety. Analyzes of monogenetics in fish with great habitat diversity such as snappers are scarce in the literature, which already emphasizes the need for an update in this regard. The presente study found, morphologically characterized and mapped the geographic distribution and in known hosts the species Microcotyloides incisa and Microcotyloides impudicus, describing the first occurrence of these monogeneans for South America and in new hosts. The survey of hosts in the literature shows that M. incisa seems to have a greater Affinity with congener species of Lutjanidae and fish from other families, which may indicate a preference or specificity for fish of this family because they are congeners of their host type. The introduction of these parasites into South American waters may have occurred due to the migratory behavior of snappers, which are well distributed along the Mexican coast, where the parasites are usually reported. Here, we also bring the first occurrence of M. incisa for Lutjanus analis and Lutjanus jocu and M. impudicus for Ocyurus chrysurus and Lutjanus synagris, helping in the mapping and distribution of these monogenetic species in the Americas.

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Anti-Hu antibodies are associated with autoimmune syndromes, mainly limbic encephalitis, encephalomyelitis, and painful sensory polyneuropathy (Denny-Brown). We report the case of a 15-year-old boy presenting with epilepsia partialis continua (EPC) found to have a right middle frontal gyrus brain lesion without atrophy or contralateral involvement. After partial resection, neuropathology revealed neuronal loss, reactive gliosis and astrocytosis, and perivascular mononuclear inflammatory infiltrate and features of neuronophagia resembling Rasmussen encephalitis. Suboptimal response to antiseizure drugs and surgery prompted further workup with identification of positive serum anti-Hu antibodies and a mediastinal seminoma. The patient was treated with immunotherapy including steroids, IV immunoglobulin, azathioprine, rituximab, plasmapheresis, and mediastinal lesion resection. However, he continued to experience EPC and psychomotor impairment along with left hemiparesis and dysarthria. Given clinical progression with failure to respond to immunotherapy and antiseizure polytherapy, hemispherotomy was attempted and seizure freedom achieved. A review of the literature found only 16 cases of neurologic presentations associated with anti-Hu antibodies in children, confirming the rarity of EPC in these cases. Thus, this report provides a new observation of germ cell mediastinal tumor associated with anti-Hu antibodies in children, broadening the spectrum of anti-Hu-associated neurologic disorders in children and highlighting the importance of considering antineuronal antibody testing in children presenting with EPC and brain lesions suggestive of Rasmussen encephalitis.

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Physician-Patient communication (PPC) has been linked to patient adjustment outcomes. However, conflicting results have been reported and previous systematic reviews showed some methodological weaknesses. It has also been suggested that PPC is related to physicians' own adjustment outcomes. This systematic review aims to explore and synthesize the associations between PPC and both patient and physician adjustment outcomes. A systematic search was conducted primarily in five databases and 11.488 non-duplicated articles were identified. Forty-five studies met the eligibility criteria and data extraction was performed for sample characteristics, PPC measurement, adjustment outcomes under examination and main outcomes. The observed results showed that the majority of the included studies were cross-sectional, assessed PPC by proxy-report and reported an overall positive association with patients' adjustment outcomes. None of the studies examined the association between PPC and physicians' adjustment outcomes. Thirty-three studies were meta-analyzed and showed a positive and significant association between PPC and patients' adjustment outcomes (r = .16). Due to the small number of studies included in the meta-analysis, the heterogeneity was high. Subgroup analysis could not identify sources for heterogeneity. Research on the associations between PPC and physicians' own adjustment outcomes is warranted. Future studies should be rigorous in defining clear PPC definitions, directionality of communication processes, and study design.

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Epileptic encephalopathy with spike-wave activation in sleep (EE-SWAS) and developmental EE-SWAS (DEE-SWAS) are characterized by variable combinations of cognitive, language, behavioral, and/or motor regression associated with continuous or near-continuous diffuse spike-and-wave complexes during sleep. Glutamate ionotropic receptor NMDA type subunit 2A (GRIN2A) variants have been associated with EE-SWAS. It encodes the most relevant GluN2 subunit of the N-methyl-D-aspartate receptor (NMDAR). Sulthiame reduces NMDAR-mediated neuronal excitability and has been progressively used as monotherapy in self-limited epilepsy with centrotemporal spikes (SeLECTS) or as add-ontherapy in EE-SWAS/DEE-SWAS. A five-year-old female, with family history of epilepsy, was initially diagnosed with SeLECTS and medicated with valproic acid (VPA). One year later, she presented a focal to bilateral tonic-clonic seizure during sleep and learning difficulty. The electroencephalogram revealed continuous spike-and-wave during sleep leading to the diagnosis of EE-SWAS. Prednisolone was effective, but there was repeated recurrence after its discontinuation and associated adverse effects. As an alternative, sulthiame was added to VPA. Four years later, she remains clinically stable. Genetic testing revealed a GRIN2A missense variant, C.3228C>A (p.Asn1076Lys). Sulthiame appeared effective in this recurrent EE-SWAS child, who presented a GRIN2A missense variant with possible NMDAR gain-of-function and adverse effects of corticosteroids. Functional studies​​​​​​​ of GRIN2A variants might become a future tool for individualized therapies.

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OBJETIVO: explorar sistematicamente a literatura quanto aos cuidados de enfermagem prestados aos idosos internados com delirium, em unidades de terapia intensiva, sejam eles para prevenção, sejam eles para manejo do delirium. MÉTODO: protocolo de revisão de escopo, estruturado pelas recomendações do Manual do Instituto Joanna Briggs, utilizando as seguintes bases de dados: PubMed via MEDLINE, Scopus, Embase, Web of Science e Google Scholar. A bibliografia encontrada será organizada através do gerenciador EndNote. Após a exclusão dos estudos duplicados, as citações serão transferidas para o software Rayyan. Em seguida, será iniciada a triagem das referências por dois pesquisadores independentes. O processo da seleção de estudos será exibido no fluxograma adaptado do Checklist PRISMA-ScR. Os dados serão extraídos dos estudos através de uma planilha desenvolvida no programa Microsoft Excel pelos próprios autores, avaliando e interpretando as informações de acordo com o objetivo proposto. Os dados serão organizados em tabelas, quadros e fluxogramas, com discussão narrativa.

OBJECTIVE: to systematically explore the literature regarding the nursing care provided to the older adult hospitalized with delirium in intensive care units for the prevention or management of delirium. METHOD: scoping review protocol, structured by the recommendations of the Joanna Briggs Institute manual, utilizing the following database: MEDLINE via PubMed, Scopus, Embase, Web of Science, and Google Scholar. We will organize the citations found through the EndNote manager. After the exclusion of duplicated studies, we will transfer the citations to the Rayyan software. Afterward, two independent researchers will begin the screening of titles / abstracts. We will present the selection process of studies in the Checklist PRISMA-ScR adopted flowchart. The authors will extract the data of the studies through a spreadsheet developed in the Microsoft Excel, evaluating and interpreting the information according to the objective of the study. We will organize the data in charts, tables, and flowcharts with a narrative discussion.

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OBJETIVO: Mapear as tecnologias educacionais utilizadas pelo enfermeiro no cuidado ao idoso em hemodiálise. MÉTODO: Trata-se de um protocolo de revisão de escopo desenvolvido com base nas recomendações do Manual do Instituto Joanna Briggs e registrado na Open Science Framework: https://osf.io/9qfge. A busca pelos artigos será realizada nas bases de dados Medline/PubMed, Scopus, Web of Science, Embase, LILACS, BDENF, CINAHL e Google Scholar. Serão considerados elegíveis os estudos que respondam à pergunta de pesquisa "Quais são as tecnologias educacionais utilizadas pelo enfermeiro ao idoso em hemodiálise?". Dois revisores atuarão de maneira independente para promover a seleção dos artigos. O software Rayyan será utilizado como ferramenta para auxiliar no arquivamento dos documentos. As listas de referências dos artigos selecionados também serão consultadas. Caso haja divergências entre os revisores, um terceiro revisor fará a apreciação para resolver as discordâncias. Para a síntese e extração dos dados, os autores utilizarão um formulário previamente elaborado. A apresentação dos resultados será feita por meio de quadros, fluxogramas, resumo e discussão narrativa.

OBJECTIVE: To identify the educational technologies used by nurses in the care of the elderly on hemodialysis. METHOD: This is a scoping review protocol developed based on the recommendations of the Joanna Briggs Institute Manual and registered with the Open Science Framework: https://osf.io/9qfge. Articles will be searched in Medline/PubMed, Scopus, Web of Science, Embase, LILACS, BDENF, CINAHL, and Google Scholar databases. Studies that answer the research question, "What educational technologies are used by nurses working with the elderly in hemodialysis?" will be considered eligible. Two reviewers will work independently to select articles. Rayyan software will be used as a tool to assist in document archiving. The reference lists of the selected articles will also be consulted. A third reviewer will assess the disagreement in case of disagreement between the reviewers. For data synthesis and extraction, the authors will use a pre-designed form. The results will be presented in tables, flowcharts, summaries, and narrative discussions.

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LAY ABSTRACT: Motor stereotypies are one of the most frequent features in children with a diagnosis of autism spectrum disorder. They may disrupt children's functioning and development and be a potential source of stress for families. Several factors, including sex, age, cognitive ability, and severity of autism spectrum disorder, may influence the presence and intensity of stereotypies. The present study aimed to identify the prevalence of motor stereotypies in a group of children with autism spectrum disorder. In addition, it sought to investigate whether sex, age, cognitive ability, verbal language, neurological comorbidities, and severity of autism spectrum disorder were associated with an increased probability and higher number, duration, and variability of stereotypies. A total of 134 participants aged 2.3-17.6 years underwent a clinical protocol with standardized video-recorded sessions. Stereotypies were identified and classified by two independent evaluators. The prevalence of stereotypies was 56.7%, and a total of 1198 motor stereotypies were captured. Children who were younger, nonverbal, and had higher severity of autism spectrum disorder had an increased probability of presenting stereotypies. Being nonverbal or having higher severity of autism spectrum disorder was also associated with presenting a higher number of stereotypies. Children with developmental delay, intellectual disability, or epilepsy displayed longer stereotypies, and children with developmental delay or intellectual disability additionally presented more diverse stereotypies. As part of the study, the authors present a clinical classification model, a glossary, and video samples of motor stereotypies. The findings of this study suggest that children who are younger, nonverbal, have lower cognitive ability, and have higher severity of autism spectrum disorder may have a higher burden of stereotypies. Earlier intervention and monitoring of these children have the potential to improve their long-term outcomes.

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OBJECTIVE: To explore a wide range of factors associated with complete mental health (i.e., positive mental health - the presence of flourishing, and the absence of mental illness - depressive and anxious symptoms) among Portuguese pregnant women, during the COVID-19 pandemic. DESIGN: Quantitative cross-sectional study. SETTING: Data were collected through an online survey placed on social media websites targeting pregnant Portuguese adult women between October 2020 and April 2021. PARTICIPANTS: The sample comprised 207 pregnant women. RESULTS: A multivariate logistic regression model showed that higher levels of self-compassion and higher engagement in mindful self-care practices increased the likelihood of reporting complete mental health during pregnancy. CONCLUSIONS: Promoting self-compassion and mindful self-care may be particularly important in pregnant women, as these psychological factors appear to contribute to complete mental health during COVID-19 pandemic. IMPLICATIONS FOR PRACTICE: The COVID-19 pandemic represented a demanding period for pregnant women. Our findings highlight that targeting the promotion of self-compassion and mindful self-care practices during stressful periods could significantly contribute to their overall mental health.

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Some sand fly species are the vectors responsible for the transmission of Leishmania spp. (Kinetoplastida: Trypanosomatidae), the etiological agent of leishmaniasis, and in the state of Sergipe, the two main forms of the disease (visceral and cutaneous) are recorded. Few works show information about the species that form the Phlebotominae fauna in Sergipe. This study aimed to update and determine how they are distributed throughout the state. The study used data from surveys about phlebotomines in Sergipe, from the Program of Surveillance and Control of Visceral Leishmaniasis, carried out by the Central Public Health Laboratory of Sergipe, from 2008 to 2018, along with review and original data from 2022. The commentary on this information was developed with focus on the species that can be vectors for the disease. Sergipe has, up to now, 27 registered species of phlebotomines from 12 genera, 15 of them are of sanitary relevance. Twenty two of these species are in the mesoregion East, 19 in the Agreste, and 11 in the Sertão of Sergipe. The species with the greatest distribution was Evandromyia lenti (Mangabeira, 1938), present in 74.6% of the municipalities of Sergipe, followed by Lutzomyia longipalpis (Lutz & Neiva, 1912), the main vector of the etiological agent of visceral leishmaniasis in Brazil, present in 68% of the municipalities studied. This study expands the number and distribution of species recorded in the state. This information can contribute to disease containment plans and support health education actions aimed at the control of leishmaniasis in Sergipe.

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