While relatively new, fetal surgery has become an indispensable part of the field of Obstetrics as it allows potentially life-threatening conditions to be corrected in utero. Imaging modalities such as ultrasound, magnetic resonance imaging, and computer tomography have become staples in fetal imaging, as they allow for comprehensive analysis of the fetal anatomy. Uses of these modalities can range from chromosomal diagnosis to surgical planning. Scientific development has not only allowed for visualization in the three-dimensional plane, but the implementation of virtual reality technology is also now a possibility. It is our belief that integrating virtual reality technology will help overcome hurdles currently faced by fetal surgeons including candidate selection and clearly observing fetal anatomy. Training opportunities are also probably, as surgeons and residents can use models created during these virtual reality experiences to study and prepare for complications that may arise during surgical intervention. This article is protected by copyright. All rights reserved.

Objective: a) to verify whether body composition and physical fitness should be analyzed by chronological age and/or maturity stage in young Brazilian soccer players and b) to propose reference values for the evaluation of body composition and physical fitness by maturity stage in elite soccer players. Methods: A descriptive-correlational study was carried out in 206 young Brazilian soccer players (11-16years old). The sample selection was non-probabilistic by convenience. Weight and standing height were evaluated. Body composition (BC) was assessed by dual X-ray absorptiometry (DXA). BC indicators [(percent fat (%F), Fat-free mass (FFM), Fat mass (FM) and Bone mass (BM)] were extracted. For physical fitness (PF), we applied the Flexibility (cm) sit and reach tests, explosive strength tests [Counter Movement Jump CMJ (cm) and horizontal jump HJ (cm)], speed [Speed 10, 20, 30 and 40m (seconds)] and Yo-Yo endurance level I test. Percentiles were constructed for BC and PF using the LMS method [L (Lambda; skewness), M (Mu; median) and S (Sigma; coefficient of variation)]. Results: The explanatory power between chronological age (CA) with BC was: FM (R2 = 0.03%), FFM (R 2 = 0.66%) and BM (R 2 = 0.62%), while between maturity status (MS) with BC were: FM (R 2 = 0.04%), FFM (R 2 = 0.71%) and BM (R 2 = 0.66). The explanatory power between the CA with the physical fitness tests ranged from: (R 2 = 0.22-0.62%). While between MS with physical fitness the values ranged from: (R 2 = 0.23-0.64%). Percentiles per MS (P3, P5, P10, P15, P25, P50, P75, P85, P90, P95 and P97) were proposed for both BC and PF. Conclusion: The results of the study have shown that the evaluation of BC and PF of young soccer players should be performed by controlling for MS rather than for CA. The inclusion of a non-invasive method to control MS by means of percentiles during puberty may contribute to the development of retention and exclusion of young soccer players, thus, they may have a better chance of achieving sporting success.

Congenital heart disease (CHD) is the leading cause of death from malformations in the first year of life and carries a significant burden to the family when the diagnosis is made in the prenatal period. We recognize the significance of family counseling following a fetal CHD diagnosis. However, we have observed that most research focuses on assessing the emotional state of family members rather than examining the counseling process itself. The objective of this study was to identify and summarize the findings in the literature on family counseling in cases of diagnosis of CHD during pregnancy, demonstrating gaps and suggesting future research on this topic. Eight databases were searched to review the literature on family counseling in cases of CHD diagnosis during pregnancy. A systematic search was conducted from September to October 2022. The descriptors were "congenital heart disease", "fetal heart", and "family counseling". The inclusion criteria were studies on counseling family members who received a diagnosis of CHD in the fetus (family counseling was defined as any health professional who advises mothers and fathers on the diagnosis of CHD during the gestational period), how the news is expressed to family members (including an explanation of CHD and questions about management and prognosis), empirical and qualitative studies, quantitative studies, no publication deadline, and any language. Out of the initial search of 3719 reports, 21 articles were included. Most were cross-sectional (11) and qualitative (9) studies, and all were from developed countries. The findings in the literature address the difficulties in effectively conducting family counseling, the strengths of family counseling to be effective, opportunities to generate effective counseling, and the main challenges in family counseling.

AbstractBackgroundThe city of São Caetano do Sul, Brazil, established a web-based platform to provide primary care to suspected COVID-19 patients, integrating clinical and demographic data and sample metadata. Here we describe lineage-specific spatiotemporal dynamics of infections, clinical symptoms, and disease severity during the first year of the epidemic.MethodsWe selected and sequenced 879 PCR+ swab samples (8% of all reported cases), obtaining a spatially and temporally representative set of sequences. Daily lineage-specific prevalence was estimating using a moving-window approach, allowing inference of cumulative cases and symptom probability stratified by lineage using integrated data from the platform.ResultsMost infections were caused by B.1.1.28 (41.3%), followed by Gamma (31.7%), Zeta (9.6%) and B1.1.33 (9.0%). Gamma and Zeta were associated with larger prevalence of dyspnoea (respectively 81.3% and 78.5%) and persistent fever (84.7% and 61.1%) compared to B.1.1.28 and B.1.1.33. Ageusia, anosmia, and coryza were respectively 18.9%, 20.3% and 17.8% less commonly caused by Gamma, while altered mental status was 108.9% more common in Zeta. Case incidence was spatially heterogeneous and larger in poorer and younger districts.DiscussionOur study demonstrates that Gamma was associated with more severe disease, emphasising the role of its increased disease severity in the heightened mortality levels in Brazil.

Abstract Objectives: To assess how systematic reviews of interventions in dentistry report the certainty of evidence using the Grading of Recommendations, Assessment, Development, Evaluation approach (GRADE). Methods: A search on MEDLINE/PubMed database from September 2019 to September 2020 was performed. We included systematic reviews of intervention in dentistry using the GRADE approach to assess the certainty of the evidence. Data was narratively synthesized and summarized using relative frequencies. Results: From 449 retrieved systematic reviews of interventions in dentistry, 23.6% used the GRADE approach and were finally included. Among these, 92.5% used the approach as recommended by the GRADE developers. Regarding the GRADE individual components, 73.6% of studies reported how the risk of bias, 61.3% inconsistency, 16% indirectness, 41.5% imprecision, and 48.1% publication bias domains were assessed. Overall, 41.5% of reviews clearly stated the main outcome assessed and, from these, 6.8% reported high, 38.6% moderate, 25% low, and 29.5% very low certainty of the evidence. For the remaining reviews (50.9%), the main outcome was not possible to be identified, and in 7.5% the judgement about the certainty of evidence found was not adequately reported. Finally, 59.4% of systematic reviews used the certainty of evidence assessment to support their conclusion. Conclusions: Only around one in four systematic reviewsof interventions in dentistry identified in this study have used the GRADE approach to assess the certainty of evidence. In most of those reviews that applied it, GRADE was correctly applied. In more than half, the certainty of the evidence was judged to be low or very low.

To investigate the association between occupation and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections within a Brazilian municipality. In this test-negative study, cases and controls were randomly selected among individuals aged 18-65 years that were registered in a primary health care program in São Caetano do Sul, Brazil. Those who had collected samples for RT-PCR testing between April 2020 and May 2021 were randomly selected to compose the case (positive for SARS-CoV-2) and control (negative for SARS-CoV-2) groups, frequency-matched by sex, age group, and month of sample collection. Complementary data were collected through phone interviews. We estimated the residual effect of occupation on SARS-CoV-2 infection using multiple conditional logistic regression models incrementally adjusted for confounding variables. 1724 cases and 1741 controls who reported being at work at the time of RT-PCR collection were included. Cases were mainly females (52.9%), Whites/Asians (73.3%), and unvaccinated against COVID-19 (46.6%). Compared to other university-level professionals, the highest odds of having COVID-19 were found for workers in police and protective services (odds ratio [OR] 2.21; 95% confidence interval [CI] 1.27-3.84), healthcare and caregiving (OR 1.90; 95% CI 1.34-2.68), and food retail and production (OR 1.88; 95% CI = 1.14-3.11), after adjustment for age, sex, education, means of transport, household crowding, and COVID-19 vaccination. Occupation played an important role in SARS-CoV-2 infection. Food retail and production, health care and caregiving, and police and protective services showed the highest odds of SARS-CoV-2 infection.

Background: In June 2009, the World Health Organization (WHO) raised the global alert level for the A(H1N1)pdm09 influenza pandemic and at that time sustained transmission in Brazil was established. It was urgent to carry out studies that evaluated possible risk factors for death from Influenza A(H1N1) to improve case management strategies to reduce the lethality of the disease. This study aimed to identify risk factors for death from Influenza A(H1N1), including the effectiveness of the vaccine against influenza A(H1N1) concerning mortality. Methods: A case-control of incident cases of influenza A(H1N1) reported in the Epidemiological Information Systems of the states of São Paulo, Paraná, Pará, Amazonas, and Rio Grande do Sul was conducted. Results: 305 participants were included, 70 of them cases and 235 controls, distributed as follows: Amazonas – 9 cases/10 controls, Pará – 22 cases/77 controls, São Paulo – 19 cases/49 controls, Paraná – 10 cases/54 controls, Rio Grande do Sul – 10 cases/45 controls. These participants had a mean age of 30 years, with 33 years among cases and 25 years among controls. There was a predominance of females both among cases and controls. Biological (age), pre-existing diseases (congestive heart failure, respiratory disease, and diabetes mellitus), and care factors (ICU admission) associated with death from Influenza A(H1N1) were identified. Conclusion: The risk factors identified in this investigation allowed subsidizing the elaboration of clinical conducts, but also indicate important aspects for facing “new” influenza epidemics that are likely to occur in our country.