RESUMEN

The Hass cultivar is one of the most cultivated and distributed avocado varieties throughout the world, having high productivity, nutritional quality, market acceptance and adaptation to different climatic zones (Dreher and Davenport 2013). Anthracnose affects avocado production in tropical and subtropical regions, causing economic losses, especially post-harvest (Fuentes-Aragón et al. 2020). Correct identification of Colletotrichum species causing anthracnose is essential, as different species vary in important phenotypes such as virulence and sensitivity to fungicides (Chen et al. 2016). Twelve samples from batches of avocados with anthracnose were collected in Minas Gerais State, Brazil, in September 2023. The observed symptoms were brown to black depressed circular spots, ranging from a few millimeters to 3 cm in diameter on the epicarp of the fruits, covered in center by mucilaginous layers of pathogen sporulation. Isolation was performed directly from the spore masses and monoconidial isolates were cultured in PDA at 25°C for 7 days for morphological characterization and preserved in sterile water at 4°C. One of the morphotypes commonly recovered from lesions, represented by isolate UCBV 362 (Culture Collection COAD 3843), formed fast-growing colonies having white aerial mycelium and intense salmon-colored sporulation. The cylindrical conidia were 13 to 17.5 µm long and 4.5 to 7 µm wide (average 14.5 x 5.7 µm, N=100), produced on conidiophores dispersed in the aerial mycelium or aggregated on melanized conidiomata formed on the agar. The partial sequence of the second largest subunit of the RNA polymerase II gene (RPB2) from isolate UCBV 362 (GenBank: PQ034617, 1116 nt) showed 99% of coverage and 99.37% of nucleotide identity with the RPB2 sequence of the ex-epitype strain of Colletotrichum nymphaeae ICMP 17918 (=CBS 515.78) (GenBank: JN985506). In a Maximum Likelihood phylogenetic tree composed with RBP2 sequences from reference strains of the Colletotrichum acutatum species complex, the isolate UCBV 362 formed a highly supported clade with the ex-epitype and other reference strains of Colletotrichum nymphaeae, occupying the Clade 2 of the species complex together with C. scovillae and C. simmondsii (Damm et al. 2012). This result shows the reliability of RPB2 for phylogeny and species delimitation within Colletotrichum. To confirm pathogenicity, 10-mm discs from a 7-day-old colony were inoculated at 3 different points on healthy-looking avocado fruits and incubated at 28°C. Uninoculated fruits served as controls. The first symptoms appeared 5 days after inoculation and were similar to those observed in the original samples, while the fruits in the control group remained asymptomatic. The pathogen was reisolated from the lesions and identified morphologically, fulfilling Koch's postulates. Colletotrichum nymphaeae has been associated with avocado anthracnose in Mexico (Fuentes-Aragón et al. 2020). In Brazil, a study based on molecular phylogeny identified Colletotrichum siamense and C. karsti as etiological agents of this disease (Soares et al. 2021). This report expands the range of species that cause avocado anthracnose in Brazil and provides etiological information for the implementation and monitoring of control methods, especially chemical control.

RESUMEN

OBJECTIVE: To provide a comprehensive overview of the epidemiologic characteristics, outcomes, and risk factors of COVID-19-related deaths in children and adolescents in Brazil. STUDY DESIGN: We conducted a population-based, retrospective cohort study that included all patients aged <18 years with laboratory-confirmed, symptomatic SARS-CoV-2 infection as registered in official Brazilian national surveillance systems for COVID-19 between February 2020 and February 2023. The primary outcome was COVID-19-related deaths. Odds ratios (ORs) of risk factors associated with death were estimated using multivariable logistic regression. RESULTS: Over a 3-year period, 2 855 704 pediatric patients with symptomatic SARS-CoV-2 infection were registered in Brazil. Of these, 59 179 (2.1%) were hospitalized, 13 844 (0.48%) were admitted to the intensive care unit, and 4943 (0.17%) received mechanical ventilation. A total of 4740 (0.17%) patients had fatal outcomes. The case fatality rate increased to 7.9% among patients who required hospitalization; 2102 (44.3%) patients who died did not receive advanced critical support. Notably, 2 (65%, 95% CI 58-71) or 3 doses (86%, 95% CI 81-89) of the vaccine provided strong protection against death. The following adjusted covariates were significantly associated with increased odds of death: age (0-4 and 11-17 years), ethnicity (Brown and Indigenous), region (Northeast or North), dyspnea, nosocomial infection, and comorbidities. Conversely, living in the South or Central-West regions, admission in the later period of the pandemic, and receiving a vaccine were all associated with protection against death. CONCLUSIONS: Our findings suggest that a complex interplay between individual factors and social inequities has shaped the impact of COVID-19 on Brazilian children and adolescents.

RESUMEN

Tropical regions have provided new insights into how ecological communities are assembled. In dry coastal communities, water stress has been hypothesized to determine plant assembly structure by favoring preadapted lineages from neighboring ecosystems, consistent with functional clustering. However, it is unclear whether this hypothesis is sufficient to explain how coastal communities in tropical ecosystems are assembled. Here, we test whether water stress or other factors drive community assembly in woody plant communities across the coastal zone of Brazil, a tropical ecosystem. We characterized functional and phylogenetic structures of these communities and determined the underlying environmental factors (e.g., water stress, historical climate stability, edaphic constraints, and habitat heterogeneity) that drive their community assembly. Assemblages of coastal woody species show geographically varied patterns, including stochastic arrangements, clustering, and overdispersion of species relative to their traits and phylogenetic relatedness. Topographic complexity, water vapor pressure, and soil nutrient availability best explained the gradient in the functional structure. Water deficit, water vapor pressure, and soil organic carbon were the best predictors of variation in phylogenetic structure. Our results support the water-stress conservatism hypothesis on functional and phylogenetic structure, as well as the effect of habitat heterogeneity on functional structure and edaphic constraints on functional and phylogenetic structure. These effects are associated with increased phenotypic and phylogenetic divergence of woody plant assemblages, which is likely mediated by abiotic filtering and niche opportunities, suggesting a complex pattern of ecological assembly.

RESUMEN

OBJECTIVE: The objective of this study was to describe a series of peripheral T-cell lymphoma, not otherwise specified (PTCL NOS) affecting the oral cavity and to review the available literature. STUDY DESIGN: Cases diagnosed as PTCL-NOS affecting the oral cavity were retrospectively retrieved from pathology files. Original hematoxylin and eosin-stained slides and immunohistochemical reactions were reviewed for microscopic confirmation. The presence of Epstein-Barr virus (EBV) was investigated by in situ hybridization. Clinical and follow-up data were retrieved from patients' pathology and medical files. RESULTS: A total of 5 cases were obtained with a mean age of 51.8 years old, 3 male patients and 2 female patients. Three cases affected the palate and 2 cases affected the gingiva, whereas 1 case affected the maxillary bone. Tumors presented as destructive, infiltrative, and painful lesions causing swelling, ulceration, and tissue necrosis. All cases exhibited CD3 expression. GATA3 was expressed in 3 cases. Four patients were deceased of the disease during follow-up. CONCLUSIONS: PTCL NOS affecting the oral cavity is rare and usually present as a very aggressive disease, associated with a poor prognosis and dismal outcome. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

RESUMEN

COVID-19, a respiratory illness with a global impact on millions, has recently been linked to manifestations affecting various bodily systems, including the oral cavity. Studies highlight oral issues, like ulcers, blisters, and white patches, alongside olfactory and gustatory dysfunction, influencing an individual's quality of life. In this context, our study aimed to assess the frequency of oral lesions, olfactory and gustatory disorders, and xerostomia resulting from COVID-19. An observational study was conducted with 414 patients to evaluate the frequency of oral symptoms resulting from COVID-19. Patients were diagnosed with mild symptoms and evaluated through clinical examination of the oral cavity and a questionnaire to assess functional alterations. The findings showed that 139 out of 414 patients presented clinical manifestations, with oral lesions being the most prevalent (19.1%), followed by gustatory disorders (18.1%), xerostomia (14.2%), and olfactory dysfunction (14%). The most prevalent oral lesions were ulcerations (n = 51), candidiasis (n = 8), and erythema or red plaques (n = 7). Unfortunately, 50 (12.1%) patients died during this study. Therefore, oral lesions, olfactory and gustatory dysfunctions, and xerostomia are common symptoms associated with COVID-19.

RESUMEN

The Verbal Autopsy (VA) is a questionnaire about the circumstances surrounding a death. It was widely used in Brazil to assist in postmortem diagnoses and investigate excess mortality during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to determine the accuracy of investigating acute respiratory distress syndrome (ARDS) using VA. This is a cross-sectional study with prospective data collected from January 2020 to August 2021 at the Death Verification Service of Sao Luis city, Brazil. VA was performed for suspected COVID-19 deaths, and one day of the week was randomly chosen to collect samples from patients without suspected COVID-19. Two swabs were collected after death and subjected to reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 detection. Of the 250 cases included, the VA questionnaire identified COVID-19-related ARDS in 67.2% (52.98% were positive for COVID-19). The sensitivity of the VA questionnaire was 0.53 (0.45-0.61), the specificity was 0.75 (0.64-0.84), the positive predictive value was 0.81 (0.72-0.88), and the negative predictive value was 0.44 (0.36-0.53). The VA had a lower-than-expected accuracy for detecting COVID-19 deaths; however, because it is an easily accessible and cost-effective tool, it can be combined with more accurate methods to improve its performance.

Asunto(s)

Autopsia , COVID-19 , Humanos , COVID-19/mortalidad , COVID-19/diagnóstico , Estudios Transversales , Masculino , Femenino , Brasil/epidemiología , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto , Sensibilidad y Especificidad , Anciano , SARS-CoV-2 , Estudios Prospectivos , Adulto Joven , Síndrome de Dificultad Respiratoria/mortalidad , Síndrome de Dificultad Respiratoria/diagnóstico , Causas de Muerte , Adolescente

RESUMEN

INTRODUCTION: Current evidence suggests the potential heightened vulnerability of smokers to severe coronavirus disease (COVID-19) outcomes. AIMS: This study aimed to analyze the clinical outcomes and mortality related to tobacco use in a cohort of hospitalized Brazilian COVID-19 patients. METHODS: This retrospective cohort study analyzed adults hospitalized for COVID-19 in Brazil using the SIVEP-Gripe database (official data reported by public and private healthcare facilities for monitoring severe acute respiratory syndrome cases in Brazil). The inclusion criteria were patients over 18 years of age with a positive RT-qPCR test for SARS-CoV-2. The analysis focused on in-hospital mortality, considering smoking as an exposure variable, and included covariates such as age, gender, and comorbidities. Smoking history was collected from the self-reported field in the database. Statistical analyses included descriptive statistics, crude Odds Ratios, and multivariable binary logistic regression. RESULTS: This study included 2,124,285 COVID-19 patients, among whom 44,774 (2.1 %) were smokers. The average age of the smokers was higher than that of the never-smokers (65.3 years vs. 59.7 years). The clinical outcomes revealed that smokers had higher rates of intensive care unit admission (51.6 % vs. 37.2 % for never-smokers), invasive ventilatory support (31.5 % vs. 20.2 % for never-smokers), and higher mortality (42.7 % vs. 31.8 % for never smokers). In the multivariable analysis, smokers demonstrated a heightened risk of death (aOR 1.23; 95 % CI 1.19-1.25). CONCLUSIONS: This large populational-based cohort study confirms the current evidence and underscore the critical importance of recognizing smoking as a substantial risk factor for adverse outcomes in COVID-19 patients.

Asunto(s)

COVID-19 , Mortalidad Hospitalaria , Fumar , Humanos , COVID-19/mortalidad , Brasil/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Adulto , Fumar/epidemiología , Estudios de Cohortes , SARS-CoV-2 , Factores de Riesgo , Hospitalización/estadística & datos numéricos , Comorbilidad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Respiración Artificial/estadística & datos numéricos

RESUMEN

BACKGROUND: The outbreak of the COVID-19 pandemic has had a profound impact on the circulation of seasonal respiratory viruses. This study aimed to compare the outcomes of SARS-CoV-2 and seasonal viruses in adults hospitalized with severe acute respiratory infection during the COVID-19 pandemic. METHODS: This population-based cohort study included patients aged >18 years hospitalized for severe acute respiratory infection in Brazil between February 2020 and February 2023. The primary outcome was in-hospital mortality. A competing risk analysis was used to account for competing events. RESULTS: In total, 2 159 171 patients were included in the study. SARS-CoV-2 was the predominant virus (98.7%). Among patients testing positive, the cumulative incidence of in-hospital mortality was 33.1% for SARS-CoV-2, 31.5% for adenovirus, 21.0% for respiratory syncytial virus, 18.7% for influenza, and 18.6% for other viruses. SARS-CoV-2 accounted for 99.3% of the deaths. Older age, male sex, comorbidities, hospitalization in the northern region, and oxygen saturation <95% were the common risk factors for death among all viruses. CONCLUSIONS: In this large cohort study, individuals infected with SARS-CoV-2 or adenovirus had the highest risk of mortality. Irrespective of the virus type, older age, male sex, comorbidities, hospitalization in vulnerable regions, and low oxygen saturation were associated with an increased risk of fatality.

Asunto(s)

COVID-19 , Mortalidad Hospitalaria , Hospitalización , SARS-CoV-2 , Humanos , COVID-19/mortalidad , COVID-19/epidemiología , Brasil/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Hospitalización/estadística & datos numéricos , Anciano , Adulto , Estudios de Cohortes , Estaciones del Año , Factores de Riesgo , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Infecciones del Sistema Respiratorio/mortalidad , Comorbilidad , Anciano de 80 o más Años , Adulto Joven , Gripe Humana/epidemiología , Gripe Humana/mortalidad , Gripe Humana/virología

RESUMEN

OBJECTIVE: To describe the clinical outcomes and risk factors of death related to mental disorders in a cohort of Brazilian hospitalized patients with COVID-19. METHODS: This retrospective cohort study utilized the Brazilian database SIVEP-Gripe to analyze patients aged ≥18 years who had been hospitalized with COVID-19 between 2020 and 2022. The exposure of interest were mental disorders (anxiety, depression, schizophrenia, and bipolar disorder), identified through self-reported fields. The primary outcome was in-hospital mortality. Covariates included demographic and clinical features. Descriptive statistics, t-tests, chi-square tests, and binary logistic regression were used to analyze the data. RESULTS: A cohort of 2,124,285 patients was included in the analysis, with 23,246 individuals (1.1%) having self-reported mental disorders. Among these mental disorders, depression was the most prevalent (52.3%). The mortality rate of the patients with mental disorders was 30.8%. Analysis of risk factors for mortality revealed that age, gender, region, dyspnea, low oxygen saturation, and comorbidities were associated with an increased risk of death. Patients with schizophrenia had a higher mortality risk (aOR:1.68;95%CI:1.54-1.81). CONCLUSIONS: Patients diagnosed with schizophrenia have a greater likelihood of COVID-19- related death than those without mental health conditions. These findings underscore the significant effect of serious mental disorders on COVID-19 mortality.

RESUMEN

The interactions between plants, beneficial bacteria and their environment are profoundly shaped by various environmental factors, including light, temperature, water availability, and soil quality. Despite efforts to elucidate the molecular mechanisms involved in the association between plants and beneficial bacteria, like Plant Growth-Promoting Bacteria (PGPB), with many studies focusing on the transcriptional reprogramming in the plant, there is no report on the modulation of genetic controls from both plant and associated bacteria standpoints, in response to environment. The main goal of this study was to investigate the relationship between plant-bacteria-environment signaling, using as a model maize plants inoculated with H. seropedicae ZAE94 and cultivated with different doses of N (0.3 and 3 mM). For this purpose, we performed rRNA-depleted RNA-seq to determine the global gene expression of both maize roots and associated H. seropedicae ZAE94. Our results revealed a differential modulation of maize nitrogen metabolism, phytohormone and cell wall responses when associated with H. seropedicae ZAE94 at different N concentrations. In parallel, a modulation of the bacterial metabolism could be observed, by regulating genes involved in transport, secretion system, cell mobility, oxidoreductases, and chemotaxis, when bacteria were associated with maize roots and cultivated at different doses of N. The molecular and phenotypic data of maize plantlets suggested that different doses of N fertilization differentially regulated the beneficial effects of bacterial inoculation, as higher doses (3 mM) favored shoot elongation and lower doses (0.3 mM) favored increase in plant biomass. Our results provide a valuable integrated overview of differentially expressed genes in both maize and associated H. seropedicae ZAE94 in response to different N availability, revealing new insights into pathways involved in grass-PGPB associations.

RESUMEN

The concentration of atmospheric CO2 and temperature are pivotal components of ecosystem productivity, carbon balance, and food security. In this study, we investigated the impacts of a warmer climate (+2 °C above ambient temperature) and an atmosphere enriched with CO2 (600 ppm) on gas exchange, antioxidant enzymatic system, growth, nutritive value, and digestibility of a well-watered, managed pasture of Megathyrsus maximus, a tropical C4 forage grass, under field conditions. Elevated [CO2] (eC) improved photosynthesis and reduced stomatal conductance, resulting in increased water use efficiency and plant C content. Under eC, stem biomass production increased without a corresponding increase in leaf biomass, leading to a smaller leaf/stem ratio. Additionally, eC had negative impacts on forage nutritive value and digestibility. Elevated temperature (eT) increased photosynthetic gains, as well as stem and leaf biomass production. However, it reduced P and K concentration, forage nutritive value, and digestibility. Under the combined conditions of eC and eT (eCeT), eT completely offset the effects of eC on the leaf/stem ratio. However, eT intensified the effects of eC on photosynthesis, leaf C concentration, biomass accumulation, and nutritive value. This resulted in a forage with 12% more acid detergent fiber content and 28% more lignin. Additionally, there was a decrease of 19% in crude protein leading to a 15% decrease in forage digestibility. These changes could potentially affect animal feeding efficiency and feedback climate change, as ruminants may experience an amplification in methane emissions. Our results highlight the critical significance of conducting multifactorial field studies when evaluating plant responses to climate change variables.

Asunto(s)

Dióxido de Carbono , Ecosistema , Animales , Dióxido de Carbono/metabolismo , Agua/metabolismo , Atmósfera , Fotosíntesis , Poaceae/metabolismo , Hojas de la Planta/metabolismo , Valor Nutritivo

RESUMEN

Introduction: Women living with HIV/AIDS have a higher frequency of anogenital neoplasms resulting from human papillomavirus (HPV) infection. The World Health Organization recommends that cervical cancer screening uses molecular tests that amplify viral genetic material, such as HPV-DNA. In addition to collection by health professionals, self-collection of vaginal samples is a useful tool for expanding access to testing. Objective: To describe the results of the pilot study that evaluated the acceptability of self-collection of vaginal samples and the applicability of offering HPV-DNA tests with self-collection of vaginal samples for women living with HIV/AIDS in Brazil. Methods: Descriptive cross-sectional study involving women living with HIV/AIDS treated in eight HIV-specialty healthcare facilities distributed in all regions of the country from May 2021 to May 2022 and a central laboratory. Vaginal self-collection was offered, and participants were interviewed about sociodemographic data and impressions of self-collection. Results: In total, 1,919 women living with HIV/AIDS with an average age of 45 years participated in the study. Some type of HPV was detected in 66% (1,267) of cases. The majority (71.9%) said they preferred self-collection to sample collection by health care professionals. Only 53.8% of participants underwent cytology at the appropriate frequency, as recommended by the protocol. Conclusion: The results may support the implementation of molecular biology tests to detect HPV in women living with HIV/AIDS, including the possibility of vaginal self-collection, promoting increased access to cervical cancer screening. (AU)

---

Introdução: Mulheres vivendo com HIV/AIDS possuem maior frequência de neoplasias anogenitais decorrentes da infecção pelo papilomavírus humano (HPV). A Organização Mundial da Saúde recomenda que o rastreio de câncer do colo do útero seja utilizado por testes moleculares que amplificam o material genético viral, como o HPV-DNA. Além da coleta por profissionais da saúde, a autocoleta de amostras vaginais consiste em uma ferramenta útil para ampliação do acesso à testagem. Objetivo: Descrever os resultados do estudo piloto que avaliou a aceitabilidade da autocoleta de amostra vaginal e aplicabilidade da oferta de testes HPV-DNA com autocoleta de amostras vaginais para mulheres vivendo com HIV/AIDS no Brasil. Métodos: Estudo transversal descritivo envolvendo mulheres vivendo com HIV/AIDS atendidas em oito serviços ambulatoriais distribuídos em todas as regiões do país no período de maio/2021 a maio/2022 e um laboratório central. Realizou-se a oferta de autocoleta vaginal e uma entrevista com as participantes sobre dados sociodemográficos e impressões da autocoleta. Resultados: No total, 1.919 mulheres vivendo com HIV/AIDS com média de 45 anos participaram do estudo. Houve detecção de algum tipo de HPV em 66% (1.267) dos casos. A maioria (71,9%) afirmou preferir a autocoleta à coleta de amostras por profissionais da saúde. Apenas 53,8% das participantes realizaram citologia na periodicidade adequada, conforme recomendação do protocolo. Conclusão:Os resultados poderão apoiar a implementação dos testes de biologia molecular para detecção de HPV em mulheres vivendo com HIV/AIDS, incluindo a possibilidade de autocoleta vaginal, promovendo a ampliação do acesso ao rastreamento de câncer do colo do útero. (AU)

Asunto(s)

Humanos , Femenino , Pruebas Serológicas , Seropositividad para VIH , Sobrevivientes de VIH a Largo Plazo , Calidad de la Atención de Salud , Neoplasias del Cuello Uterino , Tamizaje Masivo , Papillomaviridae

RESUMEN

BACKGROUND: In hematologic cancers, including leukemia, cells depend on amino acids for rapid growth. Anti-metabolites that prevent their synthesis or promote their degradation are considered potential cancer treatment agents. Amino acid deprivation triggers proliferation inhibition, autophagy, and programmed cell death. L-lysine, an essential amino acid, is required for tumor growth and has been investigated for its potential as a target for cancer treatment. L-lysine α-oxidase, a flavoenzyme that degrades L-lysine, has been studied for its ability to induce apoptosis and prevent cancer cell proliferation. In this study, we describe the use of L-lysine α-oxidase (LO) from the filamentous fungus Trichoderma harzianum for cancer treatment. RESULTS: The study identified and characterized a novel LO from T. harzianum and demonstrated that the recombinant protein (rLO) has potent and selective cytotoxic effects on leukemic cells by triggering the apoptotic cascade through mitochondrial dysfunction. CONCLUSIONS: The results support future translational studies using the recombinant LO as a potential drug for the treatment of leukemia.

Asunto(s)

Hypocreales , Leucemia , Neoplasias , Trichoderma , Humanos , Lisina , Apoptosis , Leucemia/tratamiento farmacológico , Necrosis

RESUMEN

BACKGROUND AND OBJECTIVES: Understanding how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interacts with other respiratory viruses is crucial for developing effective public health strategies in the postpandemic era. This study aimed to compare the outcomes of SARS-CoV-2 and seasonal viruses in children and adolescents hospitalized with severe acute respiratory infection (SARI). METHODS: This population-based, retrospective cohort study included children and adolescents hospitalized with SARI from February 2020 to February 2023 in Brazil. The main exposure of interest was viral etiology. The primary outcome was in-hospital mortality. Competing risk analysis was used to account for time dependency and competing events. RESULTS: A total of 235 829 patients had available results of the viral tests, with SARS-CoV-2 predominance. According to the competing-risk survival analysis, the estimated probability of a fatal outcome at 30 days of hospitalization according to the viral strain was 6.5%, 3.4%, 2.9%, 2.3%, 2.1%, and 1.8%, for SARS-CoV-2, coinfection, adenovirus, influenza, other viruses, and respiratory syncytial virus, respectively. Individuals with a positive test for SARS-CoV-2 had hazard of death 3 times higher than subjects with a negative test (hazard ratio, 3.3; 95% confidence interval, 3.1-3.5). After adjustment by the competing-risk multivariable analysis, admission in Northeast and North regions, oxygen saturation <95%, and the presence of comorbidities were risk factors for death in all viral strains. CONCLUSIONS: SARS-CoV-2 infection had the highest hazard of in-hospital mortality in this pediatric cohort hospitalized with SARI. Regardless of viral etiology, the presence of underlying medical conditions was a risk factor for death.

Asunto(s)

COVID-19 , Gripe Humana , Virus , Adolescente , Humanos , Niño , SARS-CoV-2 , Brasil/epidemiología , Estudios Retrospectivos , Estaciones del Año

Asunto(s)

Lordosis

RESUMEN

RESUMO OBJETIVO: Avaliar se adolescentes de minorias sexuais que iniciaram a profilaxia pré-exposição sexual (PrEP) em organizações comunitárias (OC) apresentam maior vulnerabilidade social e ao HIV em comparação com adolescentes em PrEP de um serviço de saúde convencional. Além disso, avaliar se esses adolescentes tiveram um acesso mais oportuno à profilaxia. MÉTODOS: Estudo demonstrativo da efetividade de PrEP, realizado na cidade de São Paulo, em duas OC, localizadas no centro (OC-centro) e na periferia (OC-periferia), e em um serviço convencional de testagem para o HIV (CTA-centro). Foram elegíveis para PrEP, entre 2020 e 2022, adolescentes homens cisgêneros que fazem sexo com homens (aHSH), travestis, mulheres transexuais e pessoas transfemininas (aTTrans), de 15 a 19 anos, HIV-negativos e com práticas de maior risco para o HIV. Indicadores de acesso oportuno e de vulnerabilidades dos adolescentes iniciando PrEP nas OC foram analisados, tendo por referência o CTA-centro e empregando regressão logística multinomial. RESULTADOS: 608 adolescentes iniciaram PrEP nas OC e CTA-Centro. Adolescentes das OC estiveram associados a um menor tempo de início de PrEP (1-7 dias; OC-periferia: ORa = 2,91; IC95% 1,22-6,92; OC-centro: ORa = 1,91; IC95% 1,10-3,31); e a um menor IDH de moradia (OC-centro: ORa = 0,97; IC95% 0,94-1,00; OC-periferia: ORa = 0,82; IC95% 0,78-0,86). Na OC-periferia houve aumento na chance de os adolescentes serem mais jovens (ORa = 3,06; IC95% 1,63-5,75) e morarem mais próximos ao serviço (ORa = 0,82; IC95% 0,78-0,86, média 7,8 km). Enquanto adolescentes da OC-centro estiveram associados ao maior conhecimento prévio de PrEP (ORa = 2,01; IC95% 1,10-3,91) e a alta percepção de risco (ORa = 2,02; IC95% 1,18-3,44). Não estiveram associadas aos adolescentes das OC as práticas sexuais de maior risco e as situações de vulnerabilidade ao HIV. CONCLUSÕES: A oferta de PrEP nas OC facilitou o acesso de adolescentes vulnerabilizados e pode contribuir para reduzir inequidades.

---

ABSTRACT OBJECTIVE: To evaluate whether adolescents from sexual minorities who initiated pre-exposure prophylaxis (PrEP) in community-based organizations (COs) are more socially and HIV-vulnerable compared with their counterparts from a conventional health service. In addition, to evaluate whether these adolescents had more timely access to prophylaxis METHODS: A PrEP demonstration study was conducted in the city of São Paulo in two COs, located in the center (CO-center) and the outskirts (CO-outskirts), and a conventional HIV testing service (CTA-center). Between 2020 and 2022, cisgender male adolescents who have sex with men (aMSM), transgender and gender diverse adolescents (aTTrans) aged 15 to 19 years, HIV-negative, with higher-risk practices for HIV were eligible for PrEP. Indicators of timely access and vulnerabilities of adolescents initiating PrEP in COs were analyzed using CTA-center as a reference and multinomial logistic regression. RESULTS: 608 adolescents initiated PrEP in COs and CTA-center. Adolescents from COs were associated with a shorter time to PrEP initiation (1-7 days; CO-outskirts: ORa = 2.91; 95%CI 1.22-6.92; CO-center: ORa = 1.91; 95%CI 1.10-3.31); and a lower housing Human Development Index (HDI) (CO-center: ORa = 0.97; 95%CI 0.94-1.00; CO-outskirts: ORa = 0.82; 95%CI 0.78-0.86). In CO-outskirts, there was an increased chance of adolescents being younger (ORa = 3.06; 95%CI 1.63-5.75) and living closer to the service (ORa = 0.82; 95%CI 0.78-0.86, mean 7.8 km). While adolescents from the CO-center were associated with greater prior knowledge of PrEP (ORa = 2.01; 95%CI 1.10-3.91) and high-risk perception (ORa = 2.02; 95%CI 1.18-3.44), adolescents from the COs were not associated with higher-risk sexual practices and situations of vulnerability to HIV. CONCLUSION: The provision of PrEP in the COs facilitated access for vulnerable adolescents and may contribute to reducing inequities.

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , VIH , Ensayo Clínico , Organización Comunitaria , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Brasil

RESUMEN

RESUMO OBJETIVO: Analisar os impactos dos sistemas de opressão intersectados no continuum do cuidado de profilaxia pré-exposição sexual (CCPrEP) entre gays, bissexuais e outros homens que fazem sexo com homens (aGBHSH) e como estes são identificados e tratados por profissionais de saúde (PS), visando o cuidado à saúde sexual e prevenção do HIV. MÉTODOS: Estudo de investigação qualitativa integrado a uma pesquisa de coorte com aGBHSH e mulheres transexuais e travestis (aMTrT) em uso de PrEP. Foram analisados dados produzidos na cidade de São Paulo, integrando 16 entrevistas com aGBHSH e oito com PS. O referencial teórico metodológico se orientou pela categorização interativa de análise temática com enquadramento interseccional. RESULTADOS: Os conhecimentos sobre PrEP dos aGBHSH são afetados pelos efeitos negativos dos sistemas de opressão, sobretudo entre adolescentes negros que adquirem conhecimento de forma menos técnica quando comparados aos brancos. A maioria dos profissionais enxerga as opressões e as suas consequências, e confere protagonismo ao racismo, mas poucos articulam os diferentes marcadores sociais que potencializam barreiras para o sucesso do CCPrEP. CONCLUSÕES: As opressões sociais impactam o sucesso do CCPrEP de diferentes maneiras. Os PS são centrais para mitigação e não propagação dessas experiências negativas dentro do serviço de saúde e no acesso, uso e adesão à PrEP.

---

ABSTRACT OBJECTIVE: To analyze the impact of intersecting systems of oppression on the continuum of PrEP care among adolescent gays, bisexuals, and other men who have sex with men (aGBMSM), and to examine how health professionals (HP) identify and address these challenges to provide sexual health care and HIV prevention. METHODS: This qualitative exploratory study was part of a cohort research project involving aGBMSM, travesties, and transgender women (aTrTW) using PrEP. Data analyzed consisted of 16 interviews with aGBMSM and eight with health professionals (HPs) in São Paulo study site. The methodological and theoretical framework for the interactive categorization of thematic analysis was based on an intersectional approach. RESULTS: The knowledge of aGBMSM about PrEP was influenced by the adverse effects of systems of oppression, particularly among Black adolescents, who acquired knowledge in a less technical manner compared to White adolescents. Most professionals recognized oppression and its impact on the PrEP care continuum (PrEPCC), especially noting the presence of racism. However, few articulated how different social markers compound barriers to the success of the PrEPCC. CONCLUSION: Social oppression affects the success of the PrEP care continuum (PrEPCC) in multiple ways. Health professionals (HPs) play a crucial role in mitigating and not perpetuating these negative experiences within health services, as well as in PrEP access, use, and adherence.

Asunto(s)

Humanos , Masculino , Infecciones por VIH/prevención & control , Adolescente , Personal de Salud , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Marco Interseccional , Brasil

RESUMEN

ABSTRACT The Verbal Autopsy (VA) is a questionnaire about the circumstances surrounding a death. It was widely used in Brazil to assist in postmortem diagnoses and investigate excess mortality during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to determine the accuracy of investigating acute respiratory distress syndrome (ARDS) using VA. This is a cross-sectional study with prospective data collected from January 2020 to August 2021 at the Death Verification Service of Sao Luis city, Brazil. VA was performed for suspected COVID-19 deaths, and one day of the week was randomly chosen to collect samples from patients without suspected COVID-19. Two swabs were collected after death and subjected to reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 detection. Of the 250 cases included, the VA questionnaire identified COVID-19-related ARDS in 67.2% (52.98% were positive for COVID-19). The sensitivity of the VA questionnaire was 0.53 (0.45-0.61), the specificity was 0.75 (0.64-0.84), the positive predictive value was 0.81 (0.72-0.88), and the negative predictive value was 0.44 (0.36-0.53). The VA had a lower-than-expected accuracy for detecting COVID-19 deaths; however, because it is an easily accessible and cost-effective tool, it can be combined with more accurate methods to improve its performance.

RESUMEN

Abstract Introduction: Brazilian scientific production has shown substantial growth and achieved international visibility. However, in general, the participation of women in scientific activities remains limited. Objective: This study aimed to evaluate the indicators of scientific productivity of women fellows of the Council for Scientific and Technological Development (CNPq) in the field of Medicine. Method: This cross-sectional study was conducted on 541 (211 women, 39%) researchers registered as recipients of CNPq research productivity (PQ) scholarships in Medicine according to a list provided in December 2022. Results: There was a predominance of male researchers (n=330; 61%). In both the male and female groups, most researchers were at level 2, with 62.5% women and 47.2% men (p=0.018). All 211 female PQ scholars were distributed among 37 different institutions and published 34,969 papers in scientific journals, averaging 165.7 articles per researcher. In the last five years of the study period (from 2018 to 2022), 9,679 papers were published. Over their careers, the 211 researchers supervised 5,440 undergraduate research students, 4,144 master's degree students, and 2,923 PhD candidates. There was a significant difference between the scholarship levels for the development of human resources in undergraduate research (p=0.040), master's degree (p=0.027), and PhD. (p<0.001). Conclusion: There are still less women participating in CNPq medical research than men. However, we observed a substantial participation of women in all the assessed items, including technical and scientific production and the human resources training.

---

Resumo Introdução: A produção científica brasileira apresentou crescimento substancial e visibilidade internacional. Contudo, em geral, a participação das mulheres em atividades científicas ainda é limitada. Objetivo: Este estudo objetivou avaliar os indicadores de produtividade científica de mulheres bolsistas do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) na área de medicina. Método: Foi realizado estudo transversal com 541 (211 mulheres, 39%) pesquisadores cadastrados como bolsistas de produtividade em medicina do CNPq conforme lista disponibilizada em dezembro de 2022. Resultado: Houve predomínio de pesquisadores do sexo masculino (n = 330; 61%). Em ambos os grupos, masculino e feminino, a maioria dos investigadores encontra-se no nível 2, sendo 62,5% mulheres e 47,2% homens (p = 0,018). Todos os 211 pesquisadores foram distribuídos em 37 instituições diferentes e publicaram 34.969 artigos em revistas científicas, com média de 165,7 artigos por pesquisador. De 2018 a 2022, foram publicados 9.679 artigos. Ao longo de suas carreiras, os 211 pesquisadores orientaram 5.440 alunos de iniciação científica, 4.144 alunos de mestrado e 2.923 alunos de doutorado. Houve diferença significativa entre os níveis de bolsas quanto ao desenvolvimento de recursos humanos em iniciação científica (p = 0,040), mestrado (p = 0,027) e doutorado (p < 0,001). Conclusão: Ainda há menor participação de mulheres do que de homens entre os pesquisadores médicos do CNPq. Contudo, foi possível observar participação substancial das mulheres em todos os quesitos avaliados, incluindo a produção técnica e científica e a formação de recursos humanos.