Estado De Research Articles

Combined artificial intelligence and radiologist model for predicting rectal cancer treatment response from magnetic resonance imaging: an external validation study.

To evaluate an MRI-based radiomic texture classifier alone and combined with radiologist qualitative assessment in predicting pathological complete response (pCR) using restaging MRI with internal training and external validation. Consecutive patients with locally advanced rectal cancer (LARC) who underwent neoadjuvant therapy followed by total mesorectal excision from March 2012 to February 2016 (Memorial Sloan Kettering Cancer Center/internal dataset, n = 114, 41% female, median age = 55) and July 2014 to October 2015 (Instituto do Câncer do Estado de São Paulo/external dataset, n = 50, 52% female, median age = 64.5) were retrospectively included. Two radiologists (R1, senior; R2, junior) independently evaluated restaging MRI, classifying patients (radiological complete response vs radiological partial response). Model A (n = 33 texture features), model B (n = 91 features including texture, shape, and edge features), and two combination models (model A + B + R1, model A + B + R2) were constructed. Pathology served as the reference standard for neoadjuvant treatment response. Comparison of the classifiers' AUCs on the external set was done using DeLong's test. Models A and B had similar discriminative ability (P = 0.3; Model B AUC = 83%, 95% CI 70%-97%). Combined models increased inter-reader agreement compared with radiologist-only interpretation (κ = 0.82, 95% CI 0.70-0.89 vs k = 0.25, 95% CI 0.11-0.61). The combined model slightly increased junior radiologist specificity, positive predictive value, and negative predictive values (93% vs 90%, 57% vs 50%, and 91% vs 90%, respectively). We developed and externally validated a combined model using radiomics and radiologist qualitative assessment, which improved inter-reader agreement and slightly increased the diagnostic performance of the junior radiologist in predicting pCR after neoadjuvant treatment in patients with LARC.

Abstract 1491: Investigation of differentially expressed miRNAs in patients with gastric adenocarcinoma

Abstract Gastric cancer (GC) is one of the most common cancers and one of the leading causes of cancer related death worldwide. Although the treatment of GC patients has improved during the last decades, thanks to advancements in surgery, radiotherapy and chemotherapy, the long-term survival rates of patients with GC remains around 20%. In addition, late diagnosis usually occurs due to the absence of symptoms or the presence of non-specific symptoms in early stages of the disease. Thus, the continuous study of new strategies for early diagnosis and identification of novel therapeutic approaches is of great interest, to reduce the need for mutilating surgeries and morbid adjuvant therapies. Next-generation sequencing technologies unveiled new roles and functions of RNAs, particularly, non-coding RNAs. Among the most studied molecules, microRNAs (miRNAs) have been reported to play important roles in different physiological and pathological processes, including cancer. Therefore, the goals of this project are (1) to determine the miRNA profile of patients with GC using tumor tissue samples using next-generation sequencing; and (2) to validate the expression profile of differentially expressed (DE) miRNAs in serum from patients with GC. To identify DE microRNAs between GC tissues and gastric tissues from individuals without cancer, 24 samples (17 cancer and 7 controls) were sequenced using the Ion Torrent PGM (Thermo Fisher Scientific) sequencing equipment. Preliminary results indicate that there are 54 DE miRNAs among the 269 known human miRNAs identified, where 44 were upregulated, while 10 were downregulated in samples from GC patients when compared to samples from individuals without cancer. As expected, Over-Representation Analysis (ORA) revealed that the disease most frequently associated with these DE miRNAs is the digestive system neoplasm. Moreover, Gene Set Enrichment Analysis (GSEA) showed that neoplasm metastasis is the phenotype most associated with this subset of DE miRNAs, indicating that these miRNAs possibly contribute to cell invasion and migration in gastric tumors. To confirm these findings, further experiments are now being performed, such as validation of the DE miRNAs by qRT-PCR in tissue and serum of GC samples, as well as functional studies. Thereby, the identification of a circulating signature of miRNAs will allow a better understanding of physiopathology of gastric carcinogenesis and the identification of possible biomarkers, which may help in early diagnosis, prognosis, and development of novel anticancer therapies.Funding: MACS, Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) grant # 2016/25562-0; MACS, Conselho Nacional de Pesquisa (CNPq) grant # 2018/301127-2; MACS, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) 23038051640/2009-01; BTRK, Postdoctoral Fellowship, FAPESP 2019/20592-6; CAP, CAPES Doctoral Fellowship 88882.430351/2019-01. Citation Format: Bruno Takao Real Karia, Camila Albuquerque Pinto, Leonardo Caires, Yeda Beatriz Louredo dos Santos, Fernanda Wisnieski, Carolina Gigek, Marilia de Arruda Cardoso Smith. Investigation of differentially expressed miRNAs in patients with gastric adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1491.

Agroecological production experiences in four agricultural regions of Mexico

Objective: To analyze experiences with various activities and practices carried out in different agroecologicalregions of Mexico, involving diverse crops, but excluding the use of chemicals.Design/Methodology/Approach: Surveys were conducted in four agricultural regions of Mexico (Texcoco,Estado de México; Vicente Guerrero, Tlaxcala; Michoacan; and Tetela del Volcán, Morelos); they tackled abroad description, background, inputs, and agroecological practices, in order to enable a descriptive analysis.Results: Out of all the agroecological units, 60% are ejidos and 40% are small private properties. Producersare between 25 and 68 years old. Plots range from 0.50 to 20 ha. The main crops are corn (Zea mays ssp. mays)and avocado (Persea americana Mill.). Forty-five percent of the crops are rainfed and 36% are irrigated/rainfed.Half of the producers perform crop rotation, while 40% prefers crop association. After 15 years of experience,the number of producers who did not use chemical herbicides increased from 59% to 95%. Crop nutrition isbased on such elements as compost (27%) and manure (23%). Fifty percent of the producers manage pests anddiseases through agroecological practices. Sixty-eight-point-two percent receive technical advice, while 77.3%are familiar with the decree to phase out the use of glyphosate.Study Limitations/Implications: Currently, 13.6% of producers are still transitioning and continue toperform chemical control of pests and diseases, as well as chemical fertilization.Findings/Conclusions: It is indeed possible to produce crops and obtain healthy food while caring forbiodiversity, making use of environmental-friendly local resources, and achieving soil conservation.

Isolation of bacteria from pulque with probiotic potential

Objective: To isolate bacteria from pulque with probiotic potential for animal feed. Design/Methodology/Approximation: Samples were taken from pulque in the municipalities Tlatlauquitepec, Puebla; Otumba and Tequexquináhuac, Estado de México. For the samples, pH, moisture, ash, and protein were determined. The bacteria colonies were isolated and identified morphologically. Gram dyeing and the catalase test were conducted in pre-selected strains from colonies. In the end, strains with probiotic potential, resistance to pH, biliary salts and antimicrobial activity were identified. Results: For pH, moisture, ash, and protein in pulque samples from Tlatlauquitepec, the results were 3.3, 96.17%, 5.98% and 0.352 g 100 mL-1; from Otumba, 3.25, 97.67% and 0.1763 g 100 mL-1; and from Tequexquináhuac, 2.25, 97.55%, 4.65% and 0.1765 g 100 mL-1. Six different strains were isolated (C2, C3 and C4 in Tequexquináhuac; C5 and C6 in Otumba; and C1 in Tlatlauquitepec). It was found that strain C1 could grow in a pH of 3.0 with survival of 84 % and 73% in biliary salts. Study Limitations/Implications: Bacteria from pulque present probiotic characteristics that can be used for animal feed. Findings/Conclusions: Strain C1 grew in pH of 3.0 and showed high percentage of survival, which is why it can be used as probiotic in animal feed.

Real world evidence in involuntary psychiatric hospitalizations: 64,685 cases.

Objective:We explored hospitalization patterns and the clinical and individual characteristics of a large cohort of patients who underwent involuntary psychiatric hospitalization in Brazil (n=64,685).Methods:Data were collected from the District Attorney's Office of the State of São Paulo (Ministério Público do Estado de São Paulo) on all involuntary psychiatric hospitalizations in the city of São Paulo between January 2003 and February 2020. The annual involuntary psychiatric hospitalization rate was calculated and descriptive statistics of the characteristics were produced.Results:Involuntary psychiatric hospitalizations increased from 5.8 to 25.5 per 100,000 population, with an eight-folder increase in the first 10-year period (2003-2013). The majority of admissions were to public institutions (86.6%), involved a psychotic disorder in the primary diagnosis (26.1%), involved more than one diagnosis (83.7%), and lasted less than 7 days (52.4%). The majority of the patients were aged 18 to 39 years and were single, and readmission was relatively common (13%). Although the reason for admission was missing in many reports (44%), the risk of harm to self or others was the most common (68.5%).Conclusion:This is one of the largest cohorts of involuntary psychiatric hospitalization records ever explored. These findings build upon existing international evidence about involuntary psychiatric hospitalizations and show recent trends in admission rates in the largest city in Brazil.

Virtual education in universities

The Universidad Autónoma del Estado de México, with the commitment to incorporate information and communications technology, established the Distance Education Department in the 1990s. However, some academic institutions to date does not have a specific coordination of Distance Education, the School of Architecture and Design is no exception. This has been overwhelmed by the change in face-to-face education because of the pandemic COVID-19 to virtual education. Therefore, the need arises to set up strategies for the implementation of virtual and distance education in the School of Architecture and Design of the UAEM, which will be serves as a reference in other academic institutions of the University, based on the Law of the Universidad Autónoma del Estado de México and its Estatuto Universitario. To achieve this, a qualitative method with a descriptive design has been implemented, through a scientific literature review; including a historical framework, legal framework, contextual framework was determined; supported by the case study method; In addition, a procedure was defined to confirm the existence of the research problem. The results revealed the need for the FAD to develop a strategic planning adapted to the needs of virtual education. Finally, the most important elements of the proposal will be presented, based on a virtual education office that contributes to the current and future dynamics.

The Spanish flu epidemic in the press: health and education in the cities of Rio de Janeiro and São Paulo (Brazil) in the years 1918–1919

ABSTRACT This article aims to map the news and debates that circulated in the press in the context of the outbreak of the Spanish flu in the cities of Rio de Janeiro and São Paulo (Brazil) in the years 1918–1919. We are interested in reflecting on the criticisms and alternatives glimpsed regarding education and care for the population. In Brazil, the Spanish flu was officially declared in October 1918, triggering debates and discussions about the spread, contagion, morbidity, prophylaxis, prevention, and treatment of the disease. Studies were produced by academic and scientific institutions mobilising campaigns and press advertisements. In the cities of Rio de Janeiro and São Paulo, measures were taken to prevent the spread of the disease, with emphasis on the closing of schools, factories, theatres, and cinemas, as well as the promotion of campaigns on hygienic and prophylactic means to be observed by the population. The suspension of classes occurred through a protocol decision by the public health authorities, in many cases transforming school buildings into hospitals. The documentary sources used in the preparation of the article are printed materials available in the Digital Library of the National Library and the newspaper O Estado de São Paulo, in which we highlight notices, news, and advertisements, especially between 1918 and 1919, as well as reports, books, and medical-scientific magazines.

Inequity in inequity: Disproportional mortality risk in patients with cancer with COVID-19 in Brazil - a call to action

Inequity in inequity: Disproportional mortality risk in patients with cancer with COVID-19 in Brazil - a call to action

Association of sarcopenia and oxygen uptake efficiency slope in male patients with heart failure: The skeletal muscle hypothesis in practice

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background Sarcopenia, a generalized loss of muscle mass and function, is a common comorbidity in patients with heart failure (HF). The skeletal muscle, through afferent nerve pathways, modulates the respiratory response during physical efforts. However, whether ventilatory behavior is affected by the presence of sarcopenia is still unknown. Purpose To evaluate the impact of sarcopenia in ventilatory parameters of patients with HF. Methods We enrolled 169 male patients with stable chronic HF with left ventricular ejection fraction <40% (LVEF). Muscle strength was measured by handgrip dynamometer. Body composition was measured with dual-energy X-ray absorptiometry (DXA). Appendicular skeletal muscle (ASM) was comprised by lean muscle mass of both arms and legs. Sarcopenia was defined by handgrip strength and ASM/height2 lower than 27 kg and 7.0 kg/m2, respectively. Ventilation (VE), oxygen consumption (VO2), and carbon dioxide output (VCO2) were evaluated using breath-by-breath measurements during a cardiopulmonary exercise test performed on a cycle ergometer. Oxygen uptake efficiency slope (OUES) was calculated from data taken at exercise peak. Results Sarcopenia was identified in 29 patients (17.2%). Patients with sarcopenia had lower body mass index (BMI; 21.2±2.4 vs. 26.5±3.8 kg/m2, p<0.0001) with higher C-reactive protein [CRP; 12.4 (2.8-22.4) vs. 2.4 (1.0-6.3) mg/L, p<0.001] and brain natriuretic peptide [BNP; 949 (446-1722) vs. 374 (127-885) pg/mL, p<0.001] compared to patients without sarcopenia, respectively. At the first ventilatory threshold, VE/VO2 (36.9±5.9 vs. 32.7±6.5, p=0.003) and VE/VCO2 (39.8±7.2 vs. 35.3±6.9, p=0.004) were higher in sarcopenic patients compared to those without sarcopenia. At the exercise peak, comparing to patients without sarcopenia, sarcopenic patients had lower OUES (1,186±295 vs. 1,634±564, p<0.001), absolute VO2 (0.93±0.25 vs. 1.43±0.47 L/min, p<0.0001), relative VO2 (16.2±5.0 vs. 19.5±6.5 ml/kg/min, p=0.011), and VE (47.3±10.1 vs. 63.0±18.2 L/min, p<0.001), while VE/VCO2 (42.9±8.9 vs. 38.7±8.4, p=0.025) was increased and VE/VO2 (49.6±11.5 vs. 45.1±10.8, p=0.066) showed a tendency to be higher. OUES was positively correlated with total lean body mass (r=0.38; p<0.0001), ASM/height2 (r=0.36; p<0.0001), and handgrip strength (r=0.31; p<0.001). In a multivariate logistic regression model using OUES as the dependent variable, ASM/height2 (OR, 1.466; 95% CI, 1.003–2.141; p=0.048), haemoglobin (OR, 0.346; 95% CI, 0.135–0.886; p=0.027), and creatinine (OR, 0.391; 95% CI, 0.166–0.918; p=0.031) were independently associated with OUES adjusted by age, BMI, LVEF, BNP, CRP, and beta-blocker use. Conclusion Our results suggest that sarcopenia, possibly by reducing thoracic skeletal muscle mass or inefficiently modulating ventilation through afferent pathways, is related to impaired ventilatory response during exercise in patients with HF.

Suicide Prevention: Signs and Safety Planning

Patient Education| 2021 Teen Suicide, Mood Disorder, and Depression Connected Content Translation: Suicidio, trastorno del estado de ánimo y depresión en los adolescentes Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Teen Suicide, Mood Disorder, and Depression. Pediatric Patient Education 2021; 10.1542/peo_document097 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Topics: depressive disorders, misconceptions, mood disorder, suicide, sleep, death, feelings, suicidal behavior, self-mutilation by cutting Thousands of teens commit suicide each year in the United States. In fact, suicide is the second leading cause of death for 15- to 24-year-olds. Suicide does not just happen. Studies show that at least 90% of teens who kill themselves have some type of ­mental health problem, such as depression, anxiety, drug or alcohol abuse, or a behavior problem. They may also have problems at school or with friends or family, or a combination of all these things. Some teens may have been victims of sexual or physical abuse, or bullied via social media. Others may struggle with issues related to gender and sexual identity. Usually they have had problems for some time. Most teens do not spend a long time planning to kill themselves. They may have thought about it but only decide to do it after an event... © 2017 American Academy of Pediatrics. All rights reserved. You do not currently have access to this content.

Microbial biomass and earthworms as indicators of soil quality under contrasting management practices in small-scale dairy systems

Objetive: To determine soil quality under two contrasting agricultural management practices, based on microbial biomass and earthworm density, as compared to untilled control soils in two seasons (dry and wet), in different production units of small-scale milk production systems. Methodology: The work was conducted in ten production units in the municipality of Aculco, Estado de México, Mexico. We analyzed physical, chemical, and biological soil indicators (microbial biomass and earthworm density). We conducted an ANOVA with a 3 x 2 factorial arrangement (three systems [maize, grassland, and control] and two seasons [dry and wet]). Results: Values for all quality indicators in maize-cultivated soils were low, but increased in the wet season. Parameters in pasture-cultivated soils were similar to control soils. Implications: These results determine the conditions of the soils used in milk production systems. Conclusions: Some of the parameters assessed can be used as indicators of soil degradation and to strengthen other indicators which lead to an improved assessment of these systems’ sustainability

SOGI-PLL aprimorado por algoritmo de Fourier de um ciclo e controle de estados finitos

Este trabalho apresenta um método para estimar o ângulo de fase da tensão da rede baseado em um conjunto finito de ângulos - na condição de problemas de qualidade da energia elétrica em sistemas de distribuição de baixa tensão, como afundamentos de tensão simétricos e assimétricos, desequilíbrios, distorções harmônicas e variações de frequência - para sistemas monofásicos. O método é composto pelo filtro de Fourier de um ciclo (OCF) em conjunto com a técnica de posições finitas (FPS), e é chamado de PLL (Phase-Locked Loop) com Filtro de Fourier de Um Ciclo com Controle de Estados Finitos (OCF-FPS-PLL). O OCF-FPS-PLL usa um procedimento de decomposição do vetor de tensão síncrono no quadro αβ estacionário da estrutura SOGI. O desempenho deste procedimento é aprimorado por meio do filtro de Fourier de um ciclo (OCF). A tensão extraída desse filtro é então tratada por um algoritmo que é implementado por um conjunto de posições finitas (FPS) para estimar o ângulo de fase. Além disso, a estrutura SOGI utilizando o PLL no quadro de referência síncrono (SRF-PLL), a estrutura SOGI utilizando o filtro de média móvel (MAF) e a estrutura SOGI usando o filtro de Fourier de um ciclo (OCF), ambos também utilizando o PLL no quadro de referência síncrono, são comparadas. Os resultados obtidos em uma bancada experimental validam o método proposto. A principal contribuição deste trabalho é a não utilização de controladores Proporcional+Integral (PI) por PLLs para estimar o ângulo de fase da rede.

Status epilepticus: review on diagnosis, monitoring and treatment.

Status epilepticus (SE) is a frequent neurological emergency associated with high morbidity and mortality. According to the new ILAE 2015 definition, SE results either from the failure of the mechanisms responsible for seizure termination or initiation, leading to abnormally prolonged seizures. The definition has different time points for convulsive, focal and absence SE. Time is brain. There are changes in synaptic receptors leading to a more proconvulsant state and increased risk of brain lesion and sequelae with long duration. Management of SE must include three pillars: stop seizures, stabilize patients to avoid secondary lesions and treat underlying causes. Convulsive SE is defined after 5 minutes and is a major emergency. Benzodiazepines are the initial treatment, and should be given fast and an adequate dose. Phenytoin/fosphenytoin, levetiracetam and valproic acid are evidence choices for second line treatment. If SE persists, anesthetic drugs are probably the best option for third line treatment, despite lack of evidence. Midazolam is usually the best initial choice and barbiturates should be considered for refractory cases. Nonconvulsive status epilepticus has a similar initial approach, with benzodiazepines and second line intravenous (IV) agents, but after that, aggressiveness should be balanced considering risk of lesion due to seizures and medical complications caused by aggressive treatment. Usually, the best approach is the use of sequential IV antiepileptic drugs (oral/tube are options if IV options are not available). EEG monitoring is crucial for diagnosis of nonconvulsive SE, after initial control of convulsive SE and treatment control. Institutional protocols are advised to improve care.

ARGUMENTATIVE TECHNIQUES

The article analyses, from the perspective of the dialogical theory-analysis of the discourse of the Bakhtin Circle, and the theory of argumentation of Chaim Pelremam, the opinion articles “Legalizing drugs” by federal deputy Jean Wyllys, published in the magazine Carta Capital and “Legalization of drugs” by Dom Odílo P. Scherer, cardinal-archbishop, published in the newspaper O Estado de São Paulo. The objective is to work on the opinion article genre, given that it has a strong argumentative nature, to analyze the aforementioned theories in order to enrich the theoretical debate on argumentative resources. We chose the topic Legalization of drugs because it is a controversial topic that involves several segments and social institutions in its discussion. In order to do so, the dialogic relationships established between the two authors as well as with other social institutions are analyzed, as well as the argumentative techniques used by both to support their points of view, based on the qualitative and interpretive approach of bibliographic research. It appears that the authors dialogue both with each other and with other voices, such as the Supreme Court of Argentina and the church, whether disagreeing or agreeing, in order to affirm their ideological positions when discussing the legalization of drugs. In our conclusive considerations, we highlight the responsive character of the statements, in which an article is constituted as a response to previous positions, while they are opposed, and we also highlight the presence, in both analyzed articles, of Pelremam’s argumentative techniques that were both the arguments based on the structure of the real and the arguments that found the structure of the real.

Nuevo registro estatal de Skalistes lugubris (Dohrn, 1862) (Dermaptera: Forficulidae) para México

The earwig Skalistes lugubris (Dohrn, 1862) is reported for the first time within the Estado de México, Mexico. The taxonomic importance structures and allometry of the male cerci are illustrated.

Peasant strategies for the use and conservation of native corn in Juchitepec, Estado de México

Objective: To determine the evolution that native corn has had in the municipality of Juchitepec, as well as to describe and analyze the strategies that peasants families are currently implementing for its use and conservation. Design/methodology/approach: A survey was carried out with 20 peasants in the municipality of Juchitepec, chosen from a random sample obtained from the register of the Producción para el Bienestar program. Additionally, a series of semi-structured interviews were conducted with key informants, in order to identify the most important issues around corn in the region. Results: An elderly population was found (=61), but with some young people working decisively in its production units. Seventy-five percent own less than 6 ha, mostly communal land property. Eighty-nine percent of the farmers interviewed continue to grow native corn. They achieve this by adapting their practices and knowledge to the soil and climate conditions of their plots, modifying, for example, the sowing date, the variety or species cultivated, and the place of cultivation. Seventeen percent grow hybrid corn. Two native varieties have recently been introduced as a strategy to obtain greater profitability: ancho and cacahuacintle. Some practices are being modified based on the equipment and the economic resources available, such as the “de dos” labor that only 50% of the farmers carry out. Eighty percent do not have agricultural equipment. The use of chemical fertilizers and herbicides is widespread. The sale of corn husks is an economically important activity. Peasants frequently exchange seeds, usually with other members of their own community. The Ozumba market represents a vitally important marketing channel for native corn. The guaranteed prices established in 2019 were low for this type of corn. Peasants are not formally organized for corn cultivation. Sixty-five percent consider themselves peasants. Study limitations/implications: The study of local agrarian systems with a focus on peasant strategies should contemplate acting under different circumstances, preferably in several work cycles, to better understand their adaptability. Findings/conclusions: Native corn survives in the region, preserved in a socio-productive system based on peasant knowledges, strategies and socio-technical practices that enable its reproduction and recreation. Peasant strategies for the cultivation and use of these corns strengthen their conservation.

Safety and immunogenicity of CoronaVac in people living with HIV: a prospective cohort study

BackgroundPeople living with HIV might have a poor or delayed response to vaccines, mainly when CD4 cell counts are low, and data concerning COVID-19 vaccines in this population are scarce. This prospective cohort study assessed the safety and immunogenicity of the inactivated SARS-CoV-2 vaccine CoronaVac in people with HIV compared with people with no known immunosuppression.MethodsIn this prospective cohort study, adults (aged ≥18 years) living with HIV who were regularly followed up at the University of Sao Paulo HIV/AIDS outpatient clinic in Sao Paulo, Brazil, were included in the study. Eligibility for people with HIV was independent of antiretroviral use, HIV viral load, or CD4 cell count. Adults with no known immunosuppression with CoronaVac vaccination history were included as a control group. CoronaVac was given intramuscularly in a two-dose regimen, 28 days apart. Blood was collected before vaccine administration and 6 weeks after the second dose (day 69). Immunogenicity was assessed at baseline (day 0), before second vaccine (day 28), and 6 weeks after second vaccine dose (day 69) through SARS-CoV-2 IgG titre and seroconversion, neutralising antibody (NAb) positivity and percentage activity, and factor increase in IgG geometric mean titres (FI-GMT). We investigated whether HIV status and CD4 count (<500 or ≥500 cells per μL) were associated with CoronaVac immunogenicity by use of multivariable models adjusted for age and sex.FindingsBetween Feb 9, 2021, and March 4, 2021, 776 participants were recruited. Of 511 participants included, 215 (42%) were people with HIV and 296 (58%) were people with no known immunosuppression. At 6 weeks after the second vaccine dose (day 69), 185 (91%) of 204 participants with HIV and 265 (97%) of 274 participants with no known immunosuppression had seroconversion (p=0·0055). 143 (71%) of 202 participants with HIV were NAb positive compared with 229 (84%) of 274 participants with no known immunosuppression (p=0·0008). Median IgG titres were 48·7 AU/mL (IQR 26·6–88·2) in people with HIV compared with 75·2 AU/mL (50·3–112·0) in people with no known immunosuppression (p<0·0001); and median NAb activity was 46·2% (26·9–69·7) compared with 60·8% (39·8–79·9; p<0·0001). In people with HIV who had CD4 counts less than 500 cells per μL seroconversion rates, NAb positivity, and NAb activity were lower than in those with CD4 counts of at least 500 cells per μL. In multivariable models for seroconversion, NAb positivity, IgG concentration, and NAb activity after a complete two-dose regimen, adjusted for age and sex, people with HIV who had CD4 counts of at least 500 cells per μL and people with no known immunosuppression had higher immunogenicity than did people with HIV with CD4 counts less than 500 cells per μL. No serious adverse reactions were reported during the study.InterpretationImmunogenicity following CoronaVac in people with HIV seems strong but reduced compared with people with no known immunosuppression. Our findings highlight the need for strategies to improve vaccine immunogenicity in people with HIV.FundingFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), and B3—Bolsa de Valores do Brasil.

Treatment of severe COVID-19 patients with either low- or high-volume of convalescent plasma versus standard of care: A multicenter Bayesian randomized open-label clinical trial (COOP-COVID-19-MCTI)

BackgroundAdministration of convalescent plasma may serve as an adjunct to supportive treatment to prevent COVID-19 progression and death. We aimed to evaluate the efficacy and safety of 2 volumes of intravenous convalescent plasma (CP) with high antibody titers for the treatment of severe cases of COVID-19.MethodsWe conducted a Bayesian, randomized, open-label, multicenter, controlled clinical trial in 7 Brazilian hospitals. Adults admitted to hospital with positive RT-PCR for SARS-CoV2, within 10 days of the symptom onset, were eligible. Patients were randomly assigned (1:1:1) to receive standard of care (SoC) alone, or in combination with 200 mL (150–300 mL) of CP (Low-volume), or 400 mL (300–600 mL) of CP (High-volume); infusion had to be performed within 24 h of randomization. Randomization was centralized, stratified by center. The primary outcome was the time until clinical improvement up to day 28, measured by the WHO ten-point scale, assessed in the intention-to-treat population. Interim and terminal analyses were performed in a Bayesian framework. Trial registered at ClinicalTrials.gov: NCT04415086.FindingsBetween June 2, 2020, and November 18, 2020, 129 patients were enrolled and randomly assigned to SoC (n = 42), Low-volume (n = 43) or High-volume (n = 44) CP. Donors presented a median titer of neutralizing antibodies of 1:320 (interquartile range, 1:160 to 1:1088). No evidence of any benefit of convalescent plasma was observed, with Bayesian estimate of 28-day clinical improvement of 72.7% (95%CI, 58.8 to 84.7) in the SoC versus 64.1% (95%ci, 53.8 to 73.7) in the pooled experimental groups (mean difference of -8.7%, 95%CI, -24.6 to 8.2). There was one case of cutaneous mild allergic reaction related to plasma transfusion and one case of suspected transfusion-related acute lung injury but deemed not to be related to convalescent plasma infusion.InterpretationIn this prospective, randomized trial of adult hospitalized patients with severe COVID-19, convalescent plasma was not associated with clinical benefits.FundingBrazilian Ministry of Science, Technology and Innovation, Fundação de Amparo à Pesquisa do Estado de São Paulo.

Defending democracy or amplifying populism? Journalistic coverage, Twitter, and users’ engagement in Bolsonaro’s Brazil

The article examines how mainstream news organizations in Brazil have tweeted about Jair Bolsonaro, investigating to what extent they may (voluntarily or not) amplify the visibility of populist leaders. We also scrutinize the levels of audience engagement with posts mentioning the President. Our empirical design comprises a content analysis of 128,096 tweets published throughout 2019 by Folha de S. Paulo, O Estado de S. Paulo, and O Globo. The results reveal that such newspapers focused on controversies and negative issues involving Bolsonaro, while posts addressing public policies did not achieve high visibility or engagement. The article also discusses to what degree the newspapers may be taking advantage of users' preferences for content with populist features to reinforce their watchdog role and boost audience ratings. Our findings also contribute to understanding how populist leaders and media organizations can build a mutually beneficial relationship, even though they publicly claim to oppose each other. Finally, the paper suggests new hypotheses to be explored, such as the argument that quality papers may be loosening the division between news and opinion when using social media to satisfy audience niches in polarized environments.

Psycho-emotional factors in health personnel during COVID-19 pandemic

The COVID-19 pandemic has caused a worldwide emotional health crisis, which has affected front-line health personnel in care of patients with COVID-19; under this condition, they are at risk of developing psychological disorders, compromising their personal integrity and their work performance. Assessing their mental health will allow the identification of vulnerable health personnel for their care and planning actions for diagnosis, prevention and care of mental health. The objective was to identify psycho-emotional factors in health personnel in the face of the COVID-19 pandemic. Through an analytical cross-sectional study in 1166 health professionals from the Instituto de Salud del Estado de México (ISEM) evaluating anxiety, depression, burnout, resilience and fear of COVID-19, through a digital questionnaire. Our results show that apparently the majority of health professionals were mentally prepared to receive the pandemic; It is important to emphasize that the studied health personnel received training months before the first case was presented in the country, which allowed a window of preparation to identify risks. It is necessary to propose possible alternative solutions such as support and help networks for better mental health.