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BACKGROUND: This study evaluated the long-term effects of percutaneous intervention in children and adolescents with transplant renal artery stenosis (TRAS). METHODS: Twenty patients had significant stenosis (>50%) and underwent percutaneous transluminal angioplasty (PTA/stenting) (TRAS group-intervention); 14 TNS (non-significant group -control) patients did not have significant stenosis (≤50%) and were treated clinically. The combined primary endpoints were death from all causes and late graft failure. The secondary endpoints were serum creatinine (SCr), systolic blood pressure (SBP), and diastolic blood pressure (DBP). RESULTS: No statistically significant difference was found between TRAS-Intervention(N = 20) and TNS groups-Control (N = 14) for these clinical parameters: deaths, 1 (5.0%) vs. 0 (0.0%) (p = 1.000) and graft loss, 4 (20.0%) vs. 2 (14.3%) (p = 1.000). For the secondary endpoints, after 1 month and 1 year the values of SCr, SBP, and DBP were similar between the two groups but not statistically significant. DISCUSSION: In the TRAS group (intervention), the stent implantation was beneficial for treating refractory hypertension and reducing blood pressure (BP) in children and adolescents. Despite the outcomes being similar in the two groups, it can be inferred that the patients in the TRAS group (intervention) would have had a worse outcome without the percutaneous intervention. CONCLUSION: TRAS treatment with stenting can be considered for children and adolescents. Because the sample in the present study comprised of only a specific population, further studies are needed for generalization. TRIAL REGISTRATION: The trial was registered at clinictrials.gov with trial registration number NCT04225338.

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Acute myocardial infarction (AMI) is the main cause of morbidity and mortality worldwide and is characterized by severe and fatal arrhythmias induced by cardiac ischemia/reperfusion (CIR). However, the molecular mechanisms involved in these arrhythmias are still little understood. To investigate the cardioprotective role of the cardiac Ca2+/cAMP/adenosine signaling pathway in AMI, L-type Ca2+ channels (LTCC) were blocked with either nifedipine (NIF) or verapamil (VER), with or without A1-adenosine (ADO), receptors (A1R), antagonist (DPCPX), or cAMP efflux blocker probenecid (PROB), and the incidence of ventricular arrhythmias (VA), atrioventricular block (AVB), and lethality (LET) induced by CIR in rats was evaluated. VA, AVB and LET incidences were evaluated by ECG analysis and compared between control (CIR group) and intravenously treated 5 min before CIR with NIF 1, 10, and 30 mg/kg and VER 1 mg/kg in the presence or absence of PROB 100 mg/kg or DPCPX 100 µg/kg. The serum levels of cardiac injury biomarkers total creatine kinase (CK) and CK-MB were quantified. Both NIF and VER treatment were able to attenuate cardiac arrhythmias caused by CIR; however, these antiarrhythmic effects were abolished by pretreatment with PROB and DPCPX. The total serum CK and CK-MB were similar in all groups. These results indicate that the pharmacological modulation of Ca2+/cAMP/ADO in cardiac cells by means of attenuation of Ca2+ influx via LTCC and the activation of A1R by endogenous ADO could be a promising therapeutic strategy to reduce the incidence of severe and fatal arrhythmias caused by AMI in humans.

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Northeast Brazil is a region with great international tourist potential. Among the states that make up this region, Paraíba stands out due to the presence of vulnerable groups and factors that contribute to adverse outcomes of COVID-19. Therefore, the aim of this study was to analyze the epidemiological data on the incidence, mortality, and case fatality of COVID-19 in Paraíba. An ecological, population-based study was performed, with data extracted from the Brazilian Ministry of Health database. All cases and deaths from COVID-19 from March 2020 to December 2022 were included. The time series was built by applying the Prais-Winsten regression model, and the daily percent change was calculated to analyze the trends. The highest case fatality of the entire period was in April 2020 (7.8%), but in March 2021, the state broke the dismal record of 1248 deaths and the highest mortality rate (30.5 deaths per 100,000 inhabitants). Stationary mortality and case fatality were better in 2022; however, in February 2022, the mortality rate was at levels similar to the same month of the previous year. These results illustrate that COVID-19 is evolving and needs to be constantly monitored.

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OBJECTIVE: This study aims to investigate the ability of the six-minute walk distance (6MWD) as a prognostic marker for midterm clinical outcomes three months after coronary artery bypass grafting (CABG), to identify possible predictors of fall in 6MWD in the early postoperative period, and to establish the percentage fall in early postoperative 6MWD, considering the preoperative baseline as 100%. METHODS: A prospective cohort of patients undergoing elective CABG were included. The percentage fall in 6MWD was assessed by the difference between preoperative and postoperative day (POD) five. Clinical outcomes were evaluated three months after hospital discharge. RESULTS: There was a significant decrease in 6MWD on POD5 compared with preoperative baseline values (percentage fall of 32.5±16.5%, P<0.0001). Linear regression analysis showed an independent association of the percentage fall of 6MWD with cardiopulmonary bypass (CPB) and preoperative inspiratory muscle strength. Receiver operating characteristic curve analysis revealed that the best cutoff value of percentage fall in 6MWD to predict poorer clinical outcomes at three months was 34.6% (area under the curve = 0.82, sensitivity = 78.95%, specificity = 76.19%, P=0.0001). CONCLUSION: This study indicates that a cutoff value of 34.6% in percentage fall of 6MWD on POD5 was able to predict poorer clinical outcomes at three months of follow-up after CABG. Use of CPB and preoperative inspiratory muscle strength were independent predictors of percentage fall of 6MWD in the postoperative period. These findings further support the clinical application of 6MWD and propose an inpatient preventive strategy to guide clinical management over time.

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Abstract Objective Advances in medicine have increased the life expectancy of pediatric patients with chronic illnesses, and challenges with the guided transition of adolescents and young adults from pediatric clinics to adult clinics have grown. The aim of this study was to better understand readiness and factors related to this transition process in Brazil. Method In this cross-sectional study of 308 patients aged from 16 to 21 years under follow-up in pediatric specialties, the degree of readiness for transition was assessed using the Transition Readiness Assessment Questionnaire (TRAQ) and its domains. Associations with demographic data, clinical data, socio-economic level, medication adherence, family functionality, and parental satisfaction with health care were evaluated. Results The median TRAQ score was 3.7 (3.2 - 4.2). Better readiness was associated with female patients, socio-economic class A-B, current active employment, higher level of education, not failing any school year, attending medical appointments alone, functional family, and a good knowledge of disease and medications. A low correlation was observed between TRAQ and age. TRAQ presented good internal consistency (alpha-Cronbach 0.86). In the multiple linear regression, TRAQ score showed a significant association with female gender, advanced age, socio-economic class A-B, better knowledge of disease and medications, and independence to attend appointments alone. Conclusion TRAQ instrument can guide healthcare professionals to identify specific areas of approach, in order to support adolescents with chronic disease to set goals for their own personal development and improve their readiness to enter into the adult healthcare system. In this study, some factors were related to better TRAQ scores.

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Introduction: COVID-19 unfolded differently in Pará and Rio Grande do Sul, Brazil, owing to distinct socioeconomic contexts. From 2020 to 2022, both states implemented diverse measures against the virus SARS-CoV-2, including vaccination and variant monitoring, tailored to their specific challenges. Understanding regional impacts on COVID-19 indicators is crucial for designing effective control strategies. Objective: to analyze the incidence, mortality, and lethality of COVID-19 in Pará and Rio Grande do Sul and the trends of these indicators from 2020 to 2022. Methods: ecological study with time series from public and official data available in the Health Secretariat of Pará and Rio Grande do Sul, including all cases and deaths by COVID-19 from February 2020 to December 2022. Lethality, mortality, and incidence rates were calculated. Prais-Winsten regression analysis was used, and trends were classified as stationary, increasing, or decreasing. Significant differences were considered when the p-value is <0.05. Results: when examining the lethality rates between the states of Para and Rio Grande do Sul, an observable trend emerged during the analyzed period. It became evident that the total lethality rate consistently remained higher in Para. Noteworthy peaks in lethality were mainly observed during the months of April 2020, May 2020, and March 2021. The incidence rates showed increasing trends during 2020, both in Pará with a daily percentage change (DPC) of 1.69% (p <0.05) and in Rio Grande do Sul with a DPC of 1.70% (p<0.05). In 2021, the incidence was decreasing (p <0.05) in both states, with a DPC of 0.60% in Pará and 0.64% in Rio Grande do Sul and continued this trend in Pará in 2022 (DPC of -0.50% p <0.05), becoming stationary in Rio Grande do Sul, with a non-significant p-value (p> 0.05).Conclusion: the positive impact of the vaccination program is reflected in the evolution of the pandemic. During the study period Rio Grande do Sul and Para exhibited a stationary incidence trend, emphasizing the need for continued monitoring of cases and morbidity across various age and demographic groups.

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Introduction: Down syndrome is the most common genetic cause of intellectual disability, and the use of augmented reality can be improving the cognitive, motor, and literacy skills of this population Objective: to compare statistical differences in learning between individuals with Down syndrome and individuals with typical development using augmented reality games.Methods: we compared the reaction time before and after the virtual reality tasks, in addition to the performance in these tasks, which consisted of correctly identifying numbers and letters in 46 people with Down syndrome and 46 controls with typical development.Results: our results indicate that the total points for the typical development group were higher (M = 13.0 and 11.9) when compared to the Down syndrome group (M = 6.6 and 4.6) for letters of the alphabet and numbers, respectively. Furthermore, the results indicated that participants in both groups were more accurate in identifying alphabetic symbols when compared to numerical symbols, and both groups were sensitive to the number of symbols presented in each phase. The down syndrome group had a lower performance when compared to the typical development group.Conclusion: despite the need for further studies, our results support the outcome that there is clinical utility of an intervention based on virtual reality tasks for people with Down syndrome. In conclusion, the use of this technology to improve the reaction time of this population is considered useful

Introdução: a síndrome de Down é uma das principais doenças genéticas que causam deficiência intelectual, e o uso da realidade aumentada pode aumentar as habilidades cognitivas, motoras e de aprendizado dessa população. Objetivo: comparar diferenças estatísticas na aprendizagem entre indivíduos com síndrome de Down e indivíduos com desenvolvimento típico usando jogos de realidade aumentada.Métodos: comparamos o tempo de reação antes e depois das tarefas de realidade virtual, além do desempenho nessas tarefas, que consistiam em identificar corretamente números e letras em 46 pessoas com síndrome de Down e 46 controles com desenvolvimento típico.Resultados: nossos resultados indicam que o total de pontos para o grupo de desenvolvimento típico foi maior (M = 13,0 e 11,9) quando comparado ao grupo com síndrome de Down (M = 6,6 e 4,6) para letras do alfabeto e números, respectivamente. Além disso, os resultados indicaram que os participantes de ambos os grupos foram mais precisos na identificação de símbolos alfabéticos quando comparados aos símbolos numéricos, e ambos os grupos foram sensíveis ao número de símbolos apresentados em cada fase. O grupo com síndrome de Down teve desempenho inferior quando comparado ao grupo de desenvolvimento típico.Conclusão: apesar da necessidade de mais estudos, nossos resultados suportam a utilidade clínica de uma intervenção baseada em tarefas de realidade virtual para pessoas com síndrome de Down. Em conclusão, considera-se útil o uso dessa tecnologia para melhorar o tempo de reação dessa população

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OBJECTIVE: Advances in medicine have increased the life expectancy of pediatric patients with chronic illnesses, and challenges with the guided transition of adolescents and young adults from pediatric clinics to adult clinics have grown. The aim of this study was to better understand readiness and factors related to this transition process in Brazil. METHOD: In this cross-sectional study of 308 patients aged from 16 to 21 years under follow-up in pediatric specialties, the degree of readiness for transition was assessed using the Transition Readiness Assessment Questionnaire (TRAQ) and its domains. Associations with demographic data, clinical data, socio-economic level, medication adherence, family functionality, and parental satisfaction with health care were evaluated. RESULTS: The median TRAQ score was 3.7 (3.2 - 4.2). Better readiness was associated with female patients, socio-economic class A-B, current active employment, higher level of education, not failing any school year, attending medical appointments alone, functional family, and a good knowledge of disease and medications. A low correlation was observed between TRAQ and age. TRAQ presented good internal consistency (alpha-Cronbach 0.86). In the multiple linear regression, TRAQ score showed a significant association with female gender, advanced age, socio-economic class A-B, better knowledge of disease and medications, and independence to attend appointments alone. CONCLUSION: TRAQ instrument can guide healthcare professionals to identify specific areas of approach, in order to support adolescents with chronic disease to set goals for their own personal development and improve their readiness to enter into the adult healthcare system. In this study, some factors were related to better TRAQ scores.

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ABSTRACT Objective: This study aims to investigate the ability of the six-minute walk distance (6MWD) as a prognostic marker for midterm clinical outcomes three months after coronary artery bypass grafting (CABG), to identify possible predictors of fall in 6MWD in the early postoperative period, and to establish the percentage fall in early postoperative 6MWD, considering the preoperative baseline as 100%. Methods: A prospective cohort of patients undergoing elective CABG were included. The percentage fall in 6MWD was assessed by the difference between preoperative and postoperative day (POD) five. Clinical outcomes were evaluated three months after hospital discharge. Results: There was a significant decrease in 6MWD on POD5 compared with preoperative baseline values (percentage fall of 32.5±16.5%, P<0.0001). Linear regression analysis showed an independent association of the percentage fall of 6MWD with cardiopulmonary bypass (CPB) and preoperative inspiratory muscle strength. Receiver operating characteristic curve analysis revealed that the best cutoff value of percentage fall in 6MWD to predict poorer clinical outcomes at three months was 34.6% (area under the curve = 0.82, sensitivity = 78.95%, specificity = 76.19%, P=0.0001). Conclusion: This study indicates that a cutoff value of 34.6% in percentage fall of 6MWD on POD5 was able to predict poorer clinical outcomes at three months of follow-up after CABG. Use of CPB and preoperative inspiratory muscle strength were independent predictors of percentage fall of 6MWD in the postoperative period. These findings further support the clinical application of 6MWD and propose an inpatient preventive strategy to guide clinical management over time.

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Este artigo propõe-se a apresentar aspectos essenciais das análises construídas a partir de uma pesquisa teórica que teve o objetivo de analisar as contribuições que a Pedagogia Histórico-crítica e a Psicologia Histórico-cultural apresentam em relação às potencialidades e possibilidades de que o ensino escolar e a atividade de ensino do professor promovam o desenvolvimento da atenção voluntária dos estudantes. Dessa forma, assumiu-se como objeto de estudo o desenvolvimento dessa função psicológica em sua dimensão cultural. As análises buscaram mostrar, nas produções da Psicologia Histórico-cultural e da Pedagogia Histórico-crítica, elementos acerca do desenvolvimento da atenção que possam auxiliar na concretização do objetivo apresentado por esta investigação, destacando a necessidade de considerar o materialismo histórico-dialético como perspectiva teórico-metodológica orientadora das teorias analisadas e também das análises propostas por este trabalho. O material empírico da investigação consistiu em artigos, teses e livros que discorrem sobre o desenvolvimento da atenção e o papel do ensino para tal desenvolvimento. Como síntese das dimensões essenciais identificadas por meio da análise das obras destaca-se a necessidade de compreender que o desenvolvimento das funções psicológicas humanas não se esgota em um processo de maturação biológica, mas articula e submete esta dimensão aos aspectos culturais, históricos e sociais do desenvolvimento humano, sendo que a adoção da Psicologia Histórico-cultural, como perspectiva teórico-metodológica para a organização do ensino e da atividade docente, mostra ser uma importante ferramenta para o enfrentamento da lógica medicalizante. (AU)

This article proposes to present essential aspects of the analyzes constructed from a theoretical research that had the objective of analyzing the contributions that Historical-Critical Pedagogy and Historical-Cultural Psychology present in relation to the potentialities and possibilities that the school education and the teaching activity promote the development of voluntary attention of the students. Thus, the development of this psychological function in its cultural dimension was assumed as the object of study. The analyzes sought to highlight elements of the development of attention in the productions of Historical-Cultural Psychology and of Historical-Critical Pedagogy that may assist in the achievement of the objective presented by this research, highlighting the need to consider historical-dialectical materialism as a theoretical perspective -methodological guide of the theories analyzed. The empirical material of the research consisted of articles, theses and books that discuss the development of attention and the role of teaching for such development. As a synthesis of the essential dimensions identified through the analysis of the works it is necessary to understand that the development of human psychological functions is not exclusively in a process of biological maturation, but rather it articulates and submits this dimension to the cultural, historical and social aspects of human development. The adoption of Historical-Cultural Psychology as a theoretical-methodological perspective for the organization of teaching and teaching activity, proves to be an important tool for confronting the medical logic. (AU)

Este artículo presenta los aspectos esenciales de las discusiones realizadas a partir de una investigación teórica que tuvo el objetivo de analizar las contribuciones que la Pedagogía Histórico-Crítica y la Psicología Histórico-Cultural direccionan a la enseñanza escolar y la actividad del profesor en la promoción del desarrollo de la atención voluntaria de los estudiantes. Así, se asumió como objeto de estudio el desarrollo de esa función psicológica en su dimensión cultural. Los análisis buscaron evidenciar, en las producciones de la Psicología Histórico-Cultural y de la Pedagogía HistóricoCrítica, elementos acerca del desarrollo de la atención que puedan auxiliar en la concreción del objetivo presentado por esta investigación, destacando la necesidad de considerar el materialismo histórico-dialéctico como perspectiva teórica-metodológica orientadora de las teorías analizadas y también de los análisis propuestos por este trabajo. El material empírico de la investigación consistió en artículos, tesis y libros que discurren sobre el desarrollo de la atención y el papel de la enseñanza para eso proceso. Como síntesis de las dimensiones esenciales identificadas por medio del análisis de las obras se destaca la necesidad de comprender que el desarrollo de las funciones psicológicas humanas no se agota en un proceso de maduración biológica sino que articula y somete esta dimensión a los aspectos culturales, históricos y sociales del desarrollo humano, siendo que la adopción de la Psicología Histórico-Cultural, como perspectiva teóricometodológica para la organización de la enseñanza y la actividad docente, demuestra ser una importante herramienta para el enfrentamiento de la lógica de la medicalización de la educació. (AU)

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ABSTRACT Background: Stroke is a serious complication of sickle cell anemia (SCA). The transcranial Doppler (TCD) is the risk-screening tool for ischemic strokes. The objective of the study was to describe the clinical progression of children with SCA who presented with high risk for stroke by TCD or relevant changes by magnetic resonance angiography (MRA) and underwent the regular transfusion program (RTP) and/or hydroxyurea (HU) treatment between 2007 and 2018. Method: This was a neonatal retrospective/prospective cohort study with children born between 1999 and 2014 with the homozygotic form (HbSS) or Sβ0-thalassemia who underwent TCD at least once. Results: Of the 718 children screened during this period, 675 had HbSS and 43 Sβ0-thalassemia. In 54 children (7.5%), all with HbSS, a high-risk TCD (n = 45) or, when the TCD was inconclusive, an MRA with cerebral vasculopathy (n = 9) was used for detection. Of these, 51 started the RTP and the families of three refused treatment. Of the 43 children with a highrisk TCD who initiated the RTP, 29 (67.4%) reverted to low risk. In 18 of them (62%), HU was started at the maximum tolerated dose (MTD) before transfusion discontinuation. None of these 29 patients had a stroke. Eight children (18.6%) maintained a high-risk TCD, even using the RTP/HU and two had a stroke. Conclusions: The TCD was confirmed as a viable tool for tracking patients with a risk for stroke. The RTP was effective in preventing the primary event. New strategies are necessary to prevent stroke using HU and new drugs, in addition to bone marrow transplantation.

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BACKGROUND: Sickle cell anemia is a disease that develops episodes of acute pain and multiple organ dysfunction that can affect the growth hormone/insulin-like growth factor 1 (GH/IGF-1) axis. The severity of sickle cell anemia is influenced by modifying factors, such as levels of fetal hemoglobin (HbF), the co-inheritance of alphathalassemia, or treatment with hydroxyurea. METHODS: This cross-sectional study in children with sickle cell anemia evaluated bone age (BA), adult height prediction (AHP) using BA, a target height (TH) calculated as the mean SDS of the parents, and laboratory parameters. Children were grouped according to serum levels of HbF, co-inheritance of alpha-thalassemia, and hydroxyurea therapy.. RESULTS: The mean age of the 39 children was 8.2 ± 2.2 years old. The average height was -0.75 ± 0.30 SDS, and 10.3% (4/39) had short stature. Adjusted levels of IGF-1 or IGFBP- 3 were significantly higher in children with sickle cell anemia on hydroxyurea treatment, in children with HbF levels >10%, and in those without alpha-thalassemia. Using SDS, the growth potential of children with sickle cell anemia in relation to their parents calculated by the difference between AHP and TH as well as the difference between children's height and their TH, were lower in children with co-inheritance of alphathalassemia. CONCLUSION: The study showed an association between modifying factors and the GH/IGF-1 axis in children with sickle cell anemia. Additionally, the co-inheritance of alpha-thalassemia was associated with decreased height in these children when adjusted for their parents' height.

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BACKGROUND: Stroke is a serious complication of sickle cell anemia (SCA). The transcranial Doppler (TCD) is the risk-screening tool for ischemic strokes. The objective of the study was to describe the clinical progression of children with SCA who presented with high risk for stroke by TCD or relevant changes by magnetic resonance angiography (MRA) and underwent the regular transfusion program (RTP) and/or hydroxyurea (HU) treatment between 2007 and 2018. METHOD: This was a neonatal retrospective/prospective cohort study with children born between 1999 and 2014 with the homozygotic form (HbSS) or Sß0-thalassemia who underwent TCD at least once. RESULTS: Of the 718 children screened during this period, 675 had HbSS and 43 Sß0-thalassemia. In 54 children (7.5%), all with HbSS, a high-risk TCD (n = 45) or, when the TCD was inconclusive, an MRA with cerebral vasculopathy (n = 9) was used for detection. Of these, 51 started the RTP and the families of three refused treatment. Of the 43 children with a high-risk TCD who initiated the RTP, 29 (67.4%) reverted to low risk. In 18 of them (62%), HU was started at the maximum tolerated dose (MTD) before transfusion discontinuation. None of these 29 patients had a stroke. Eight children (18.6%) maintained a high-risk TCD, even using the RTP/HU and two had a stroke. CONCLUSIONS: The TCD was confirmed as a viable tool for tracking patients with a risk for stroke. The RTP was effective in preventing the primary event. New strategies are necessary to prevent stroke using HU and new drugs, in addition to bone marrow transplantation.

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A Superintendência da Escola de Saúde de Goiás (SESG) coordena e gere a educação permanente e continuada em saúde, no âmbito do SUS e este e-book tem como objetivo de apresentar a configuração da "Nova Escola de Saúde de Goiás", abrangendo educação permanente em saúde, educação à distância, qualificação dos trabalhadores do SUS para organização e fortalecimento dos processos de trabalho, divulgação científica no estado de Goiás, programa de pesquisa para o SUS (PPSUS), democratização, solidariedade, metodologias ativas, tecnologias educacionais e estratégias de ensino e aprendizagem.

The Superintendence of the School of Health of Goiás (SESG) coordinates and manages permanent and continuous education in health, within the scope of the SUS and this e-book aims to present the configuration of the "New School of Health of Goiás", covering education permanent education in health, distance education, qualification of SUS workers to organize and strengthen work processes, scientific dissemination in the state of Goiás, research program for SUS (PPSUS), democratization, solidarity, active methodologies, educational technologies and strategies of teaching and learning

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