São Paulo City Research Articles

Abstract 2264: Co-infection with Epstein-Barr virus impacts oral HPV persistence

Abstract Rates of oropharyngeal cancer (OPC) associated with human papillomavirus (HPV) infection are increasing in men. The obligate precursor to OPC is a persistent infection with an oncogenic HPV type that is unable to be cleared via natural immunity alone. However, the factors that influence HPV persistence at the oral cavity are unknown. It is plausible that long-term infection with other pathogens at the same anatomic site indicates an overall inability to clear an oral infection. Epstein-Barr virus (EBV) is a saliva-transmitted gamma herpesvirus that infects 90% of the population by adulthood and replicates in the epithelial cells of the oropharynx. This study aimed to investigate whether oral EBV shedding, a marker of active viral replication, could serve as a biomarker for persistent, oncogenic oral HPV infection in men. Men with an HPV16 or 18 oral infection present at the baseline visit of the HPV Infection in Men (HIM) Study were included (n=63). Briefly, men from Tampa, FL, U.S.; Cuernavaca, Mexico; and Sao Paolo, Brazil were followed every 6 months for a median of 4.1 years. Men completed a risk factor questionnaire and provided an oral gargle sample at each visit. For this study, the baseline, 6-month, and 12-month oral specimens were HPV genotyped using the SPF10 PCR-DEIA-LiPA25 system. Presence of EBV was evaluated in the baseline specimen using PCR to amplify and quantify the EBV DNA on the Rotor-Gene Q MDx instrument. Men with the same oral HPV type present at the 6-month and 12-month visit were categorized as 6-month and 12-month oral HPV persistent, respectively. The association between EBV and persistent HPV infection was investigated using a logistic regression model adjusted for age, country, and smoking. Among 63 men with oral HPV 16/18 infection at baseline, 44 HPV infections did not persist, 19 persisted to at least 6-months and 11 persisted to at least 12 months. Among the total sample, 32 also had EBV detected in the oral gargle at baseline. Among men who did not have a persistent HPV infection, 21 (47.7%) had EBV detected at baseline while 11 (57.9%) men with an HPV infection that persisted at least 6 months had detectable EBV at baseline; and 9 (81.8%) of the men who persisted to 12 months had EBV detected. Mean EBV viral load was highest among men who persisted to at least 12 months (5.0 log copies/ml) and was significantly higher than men who did not persist (2.5 log copies/ml; p=0.047). Detection of oral EBV at baseline was significantly associated with elevated risk of ≥12-month oral HPV 16/18 persistence (aOR: 9.90; 95% CI: 1.38-70.96), but not ≥6-month HPV 16/18 persistence (aOR: 1.62; 95% CI: 0.52-5.06).These data support the hypothesis that EBV reactivation may be a biomarker of poor immune control leading to increased risk of oral HPV persistence. The use of a biomarker that identifies men whose HPV infection may persist would be a useful tool to allow for screening and early detection of OPC. Citation Format: Brittney L. Dickey, Anna R. Giuliano, Bradley Sirak, Martha Abrahamsen, Eduardo Lazcano-Ponce, Luisa L. Villa, Anna E. Coghill. Co-infection with Epstein-Barr virus impacts oral HPV persistence [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 2264.

Educational Nursing Interventions in Post-COVID-19 Heart Transplantation: An Experience Report

Abstract:Introduction: COVID-19 infection can lead to fulminant myocarditis, making the pretransplant process shorter and more rapidly progressing. Objective: To report the case of a patient who after COVID-19 infection evolved to heart transplantation, as well as the educational nursing interventions performed in this process. Methods: This is a case reportapproved by the Research Ethics Committee, under protocol no. 52318721.7.0000. 5462, described according to the CARE guidelines, and a systematization of nursing care for an adult who, upon contracting COVID-19 in June 2020, evolved within six months to myocarditis, heart failure, and transplantation, in a cardiology hospital in the city of São Paulo (SP). Results: A young male adult presented with mild symptoms of COVID-19 and progressed with worsening systemic symptoms, failure to withdraw vasoactive drugs, and implantation of an intra-aortic balloon device with outcome to heart transplantation. The reported case showed the evolution of this young patient, with no history of cardiovascular disease, evolving to heart transplantation, differently from what is reported in the literature about transplant patients who acquired COVID-19. The evolution of the disease required systematized nursing care and educational interventions, the focus of this study to obtain health education outcomes. Conclusion: The patient, with a nursing diagnosis of improved knowledge disposition, through the intervention of improved health education, obtained knowledge of heart failure control and had heart transplantation as the outcome, with in-hospital adherence to therapy, and should be monitored after discharge.

Principle of progressive autonomy, participation, and recognition of agency. Substantive citizenship in the transition from childhood to adolescence

It is necessary to talk about children's and adolescents' education for citizenship beyond the vindication of spaces for citizen action. It is necessary to incorporate the principle of progressive autonomy highlighted by the Convention on the Rights of the Child of 1989 in terms of 'evolving capacities', from the knowledge of their rights and their exercise. This article aims to analyse the concept of substantive citizenship of children and adolescents based on their right to participation and from the recognition of their agency, as well as the promotion of and respect for the principle of progressive autonomy. Based on a participatory narrative research with a socio-critical perspective, 23 discussion groups were carried out with 210 young people between 15 and 19 years old in five Iberoamerican cities: Barcelona, Buenos Aires, Mexico City, Madrid and Sao Paolo. From the content analysis of their contributions, three dimensions emerge: to know oneself as a subject of rights from the knowledge of these rights, the importance of intergenerational relations in recognising progressive autonomy, and the incidence of age in the development of their autonomy. As conclusions, it should be noted that young people in the five cities know their rights and recognise that family, school and social networks favour their recognition as subjects of rights and responsibilities. It also reveals that age is a limiting element and a fundamental factor for the development of substantive citizenship.

The silver jubilee of the Nitric Oxide journal: From 1997 to 2021

Based on the Scopus record, Nitric Oxide journal (NOJ) has completed 25 years of publications. On March 8, 2022, the publication data was retrieved from the Scopus database and analyzed on VOSviewer and R-Studio (Bibliometrix R package/Biblioshiny). NOJ has published 1928 research documents majorly comprising of articles (1611/83.56%) and reviews (210/10.89%). The total citations and h-index were 56291 & 97, respectively. The per year (from 1997 to 2022) publications and citations are presented in this study. We tried to highlight some of the influential researchers, institutes, and countries. In all publications, 7450 authors have contributed with a collaboration index of 0.241. For all authors, we provided descriptive details about their total number of publications (NoP), total citations (TC), h-index, g-index, m-index, citations per paper (CPP), citation per year (CPY), HG Sqrt and Q2Index. Based on each indicator, we highlighted the top five scientists. The research publications (over time) of the top ten authors are also described. Furthermore, the collaboration network of authors is graphically presented. We also provided descriptive details about the most productive institutes. The highest number of documents are published by the University of Sao Paolo (n = 78), Brazil, while in-country sections, USA has the highest number of publications (n = 553) with 21739 citations and 69 h-index. In the same vein, for each era (five years) details about the top five countries are provided. In all publications (n = 1794), 34 European, 3 North American, 13 Asian, 10 South American, 5 Middle East, 8 African and 2 Asia Pacific countries have contributed. Numerical details about the collaboration links of all countries and the per-era contributions of the top ten countries are also provided. Based on the co-words analysis the per era research focus is graphically presented. Descriptive details about the major trends in publication in each era are also provided. We also manually analyzed 160 words that appeared more than thirty thousand (n = 30,000) times and tried to provide a broader overview of research publications. Based on Scopus record, the NOJ ranking is yearly improving and presently (2021–2022) it holds 14th and 17th positions in clinical biochemistry and physiology. The success could be attributed to all researchers, institutes, editors-in-chief, reviewers, editorial board & entire management.

Hepatitis B Virus Infection among Japanese Immigrants and Descendants: The Need to Strengthen Preventive and Control Measures.

This cross-sectional study aimed to investigate the prevalence and risk factors of Hepatitis B virus infection among Japanese immigrants and their descendants from São Paulo (SP), and to verify the occurrence of occult hepatitis B and coinfection with HCV, Delta, and HTLV. All samples (n = 2.127) were tested for HBV serological markers by electrochemiluminescence. HBsAg and/or total anti-HBc positive samples were tested for HBV DNA by real-time PCR, and genotyped by sequencing using the Sanger methodology. The prevalence rate of HBV exposure was 13.4% (CI 95%: 11.9–14.9%), and 22 (1.1%) were HBsAg positive. A high rate of susceptibility to HBV infection was found (67.4%; CI 95%: 65.4–69.4%). In contrast, only 19.2% (CI 95%: 17.6–20.9%) presented a serological profile analogous to that elicited by Hepatitis B vaccination. HBV isolates (n = 8) were classified as genotypes HBV/B1 (62.5%), HBV/C2 (12.5%), HBV/F1b (12.5%), and HBV/A1 (12.5%). Hepatitis B vaccination strategies and educational measures to control this infection should be considered.

Association Between Dietary Patterns and Bullying Among Adolescents in Sao Paulo-Brazil.

Previous studies have assessed the association between food consumption and bullying perpetration, but most of them have not broadly assessed food consumption, neither the distinction between forms of bullying. The aim of the study was to evaluate the association between dietary patterns with bullying roles and its different types of bullying perpetration among adolescents. Data on a representative sample of ninth-grade students (N = 2,163; mean age = 14.8 years) taken from Sao Paulo Project for the social development of children and adolescents (SP-PROSO) were used. The independent variables were healthy and unhealthy dietary patterns obtained by exploratory factor analysis. The dependent variables were bullying role (victim-only, bully-only, bully-victim) and bullying perpetration (any type, social exclusion, psychological/verbal aggression, physical aggression, property destruction, sexual harassment). Multinomial and logistic regression models were performed for the total sample and stratified by sex (only for association with sexual harassment), adjusting for covariates. Adolescents who engaged in a healthy dietary pattern were less likely to be bullies (RR 0.67 [0.49, 0.92]), while adolescents with an unhealthy dietary pattern were more likely to be bully-victims (RR 1.29 [1.12, 1.48]). Unhealthy dietary pattern was associated with any type of bullying perpetration (OR 1.24 [1.12, 1.38]), mainly with sexual harassment and physical aggression. Boys who had an unhealthy dietary pattern were more likely to sexually harass another adolescent (OR 2.10 [1.20, 3.66]). In conclusion, adolescents who had a healthy dietary pattern were less likely to perpetrate bullying. Unhealthy dietary pattern was associated with bullying perpetration, especially with sexual harassment by boys.

Efficacy of alternative herbicides to glyphosate in the weed control in glyphosate and sulfonylurea-tolerant soybean

It is believed that ALS inhibitor herbicides in combination with ACCase inhibitors can be used as an alternative to glyphosate in weed control in RR2/STS soybeans. In the present study, the efficacy of ALS inhibitor herbicides, in combination with haloxyfop, is evaluated in the control of weeds for post-emergence application (V4) of RR/STS soybeans. The experiment is carried out in the 2017/18 season in Piracicaba, São Paulo (SP), Brazil. The cultivar BMX Garra RR2/STS is used, and the treatments were composed by the application of ALS inhibitor herbicides in association with haloxyfop. The experimental design was a randomized block with four replications. Were evaluated control and dry mass of weeds, symptoms of injury in soybean plants and yield. The data were submitted to analysis of variance and the means of the treatments were compared by the Tukey test. Visual symptoms of injury were observed in soybean plants, mainly for the application of nicosulfuron and nicosulfuron + cloransulam. Soybean yield was higher in all herbicide treatments compared to the control without weeding. Associations between ALS inhibitor herbicides and haloxyfop applied post-emergence (V4) of soybean cultivar BMX Garra RR2/STS were effective in weed control.

The bias in estimating accessibility inequalities using gravity-based metrics

Accessibility measures have been extensively used to explore the outcomes of the spatial distribution of transport, jobs, and population groups in cities. Despite its wide use, identifying the population groups that most benefit from accessibility is not straightforward and different metrics might result in different conclusions. The present work aims to analyze the potential bias of using gravity-based measures based on revealed mobilities to identify job accessibility inequalities. By looking at two large and very different regions, the municipality of São Paulo (SP) and the Greater London Area (GLA), we argue that distance decay functions built from current trip behaviors should be carefully used in evaluations of accessibility inequalities because it may underestimate disparities between socio-occupational groups and also result in a misleading interpretation of impedance factors. Two distinct approaches were implemented to support those claims. We first estimate group-specific distance decay functions, considering only travel time. Secondly, we consider both travel time and travel cost relative to income to estimate zone-specific and city-specific distance decay functions for each one of the study areas. The population of both cases studies was stratified according to the NS-SEC standard to select the highest and the lowest socio-occupational groups and to explore job accessibility inequalities. It was found that higher-level and lower-level socio-occupational groups of SP and GLA present striking differences in terms of travel times and relative travel costs, with SP being more unequal. By applying the distance decay function of the lowest level socio-occupational group to the calculations of the job accessibility of the highest level group, and by adding travel cost to the analysis, we highlight inconsistencies between gravity-based accessibility calculations and theory, as trips taken by different groups can be mistakenly associated with willingness to travel. From a policy perspective, our findings emphasize that accessibility inequalities in large urban centers, especially in the Global South, can be underestimated if revealed mobilities are considered to represent the willingness to travel and by not taking into account the relative cost of travel.

Post-varicella arterial ischemic stroke in children and neurocognitive performance: a 4-year follow-up study.

ABSTRACTObjective To analyze data from children who were previously healthy and presented with post-varicella arterial ischemic stroke upon arrival when admitted to the emergency room, with focus on the clinical/laboratory aspects, and neurocognitive performance after four-year follow-up.Methods Seven children presenting with arterial ischemic stroke after varicella were evaluated at pediatric emergency services in the city of São Paulo (SP), Brazil. Ischemic stroke was determined by magnetic resonance imaging/magnetic resonance angiography in a topography compatible with the areas supplied by the middle cerebral or internal carotid arteries. IgG-class antibodies against varicella zoster virus and varicella-zoster virus DNA by polymerase chain reaction in cerebrospinal fluid were tested. Patients with prothrombotic conditions were excluded. The Pediatric Stroke Outcome Measure was applied upon admission and 4-years after the stroke.Results All patients (age range: 1.3 to 4 years) included presented chickenpox 5.1 (±3.5) months before. All patients had analysis of anti-varicella-zoster-virus-IgG in cerebrospinal fluid, but only three (43%) had a positive result. Of the patients 43% had no vascular lesions identified in magnetic resonance angiography. All patients showed improvement in their sequela scores. After 4 years, five patients displayed good evolution in the Pediatric Stroke Outcome Measure, and only one patient presented with a score of 2 in the sensorimotor and cognition areas. No recurrence of arterial ischemic stroke was observed.Conclusion We reinforced the non-progressive course of post-varicella arterial ischemic stroke after 4-year follow-up. The presence of varicella-zoster-virus-DNA detected by polymerase chain reaction, and/or intrathecal IgG antibody against varicella zoster virus, and angiopathy location in magnetic resonance angiography were not determining for the diagnosis. Invasive tests, with low sensitivity, should be well considered in the diagnosis of post-varicella arterial ischemic stroke.

Optimization of water allocation networks in highly engineered basins: The case of Guandu River basin, Rio de Janeiro State, Brazil

During the last decades, metropolitan areas with a large population and economic size have mushroomed, modifying the urban geography and natural environment. Along with the rising of megacities, highly engineered basins have been created, providing resource security regarding water and energy. The coastal Guandu River basin in Brazil represents an artificial basin that has been heavily intervened for decades. The basin receives almost ∼80% of the water by transfers from the Paraiba do Sul River Basin System and has an associated hydroelectric complex that generates power for the national network. It is the primary source of water and energy for the Rio de Janeiro Metropolitan Area, home to ∼13 million people. Recently, water availability for this region has been jeopardized by drought conditions due to changing rainfall patterns and competition for water resources with other users such as Sao Paolo Metropolitan Area. This study focuses on the development of an optimization framework (WANAB model) for water resources management at the macroscopic level in the Guandu Basin to guarantee economic viability and water resources sustainability. The model incorporates parameters and equations for hydrological, and engineered water and hydropower processes to determine the optimal water allocation network. Also, a multi-criteria analysis is proposed to evaluate the water availability considering different scenarios. The results show that through optimization, it is possible to have a water availability of up to ∼24 m3/s in the Guandu River basin by integrating elements such as water storage systems, grey and blackwater treatment plants with capacities up to ∼39 m3/s and ∼9 m3/s, respectively. The results show that it is possible to reach a water availability of 21 m3/s in the scenario, considering the reduction of water transfers from outside the basin due to climate change. However, the major impact is observed in the hydropower generation, decreasing from ∼2270 GWh/y to ∼1950 GWh/y. The WANAB model represents a decision-making and policy tool for optimizing water allocation networks and may be adapted for other highly engineered basins.

Factors associated with multidrug-resistant bacteria in healthcare-associated infections: a pediatric intensive care unit case-control study.

ABSTRACTObjective To investigate the prevalence of factors related to healthcare-associated infections, caused by multidrug-resistant bacteria, in a pediatric intensive care unit.Methods A retrospective case-control study conducted from January 1, 2007 to December 31, 2018, in São Paulo (SP), Brazil. The study was carried out at the pediatric intensive care unit of a high-complexity, tertiary care general hospital. The study included patients aged 1 month to 19 years, admitted to the pediatric intensive care unit, diagnosed as healthcare-associated infections.Results There was significant evidence of infection by multidrug-resistant bacteria associated with immunosuppressed patients (p<0.001), in whom the likelihood of multidrug-resistant bacteria infection was estimated to be nine-fold higher than among non-immunosuppressed patients (OR 8.97; 95%CI 2.69-29.94). In the analysis of multiple logistic regression model, we observed that immunosuppressed patients had an 8.5-fold higher chance of multidrug-resistant bacteria infection when compared to non-immunosuppressed patients (OR 8.48; 95%CI 2.54-28.35; p=0.001). There is evidence of association between the Case Group and presence of Gram-positive (p=0.007), coagulase-negative Staphylococcus (p<0.001), and Gram-negative (p=0.041) microorganisms.Conclusion The immunocompromised-state variable is a factor related to healthcare-associated infections caused by multidrug-resistant bacteria, and the Case Group presented higher proportions of Gram-positive microorganisms and coagulase-negative Staphylococcus.

Towards imaging criteria that best differentiate MS from NMOSD and MOGAD: Large multi-ethnic population and different clinical scenarios

BackgroundThe “1/3″ brain magnetic resonance imaging (MRI) criteria including 1) a lesion adjacent to the lateral ventricle and in the inferior temporal lobe, or 2) a juxtacortical lesion, or 3) a Dawson finger-type lesion were shown to distinguish multiple sclerosis (MS) from antibody-mediated conditions. In this large multicentre study, we aimed to assess how the criteria perform 1) in different onset phenotypes, 2) distinct ethnic groups, 3) when the absence of myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease (MOGAD)-typical fluffy infratentorial (FIT) lesions and longitudinally extensive transverse myelitis (LETM) lesions are added as features (“2/4″ and 3/5″ criteria, respectively). Methods577 patients with MS (n = 332), aquaporin-4 antibody (AQP4-Ab) neuromyelitis optica spectrum disorder (NMOSD) (n = 196) and MOGAD (n = 49) were recruited from 6 international centres (Buenos Aires, Sao Paolo, Maracaibo, Goyang, Oxford and Milan). Imaging scans were obtained at disease onset or relapse. ResultsAdding the absence of FIT lesions increased the specificity of the “1/3″ criteria vs. AQP4-Ab NMOSD from 84.7% to 87.2% and vs. MOGAD from 85.7% to 93.9% without compromising their sensitivity (86%). In particular, for those presenting with brain/brainstem attacks “2/4″ had significantly higher specificity than “1/3″ (85% vs. 80% against AQP4-Ab NMOSD, 88.9% vs. 72.2% against MOGAD). Positive predictive values of the “1/3″ criteria for MS were lowest for Asian patients (84.8 vs. 99.1% for White) but were significantly increased by adding further criteria (94.1% for “3/5″). ConclusionThe “1/3″ criteria perform well in discriminating MS from NMOSD and MOGAD regardless of ethnic background and clinical scenario. Adding the absence of FIT lesions increases the specificity in those presenting with brain/brainstem symptoms.

Social isolation: main dermatosis and the impact of stress during the COVID-19 pandemic.

ABSTRACTObjective To analyze the pattern of triggering and exacerbation of dermatological diseases between March and July 2020 and to compare this pattern to the corresponding period of 2019.Methods This was a quantitative, descriptive, comparative and documentary study that was carried out through the retrospective analysis of medical records (March to July 2019 and 2020) of individuals assisted at a private dermatology practice service located in the southern area of the city of São Paulo (SP).Results We evaluated 992 medical consultations in 2019 and 1,176 in 2020. In 2020, we observed a significant increase in cases of telogen effluvium (276%), psoriasis (1,400%), atopic dermatitis (178%), seborrheic dermatitis (200%), herpes zoster (1,200%) and vitiligo (433%). All diseases had stress as a possible initial trigger. In addition, fragile nail syndrome and contact dermatitis, pathologies associated with behavioral measures, also had an important increase in the prevalence (6,400% and 5,500%, respectively). However, the number of aesthetic procedures decreased by approximately 54% during the pandemic period.Conclusion During the pandemic period, the pattern of incidence of dermatoses had changed compared with the previous year. An emphasis was observed on diseases triggered by a psychological component, as well as those pathologies that have behavioral measures as the main cause. For this reason, the impacts of COVID-19 is greater than only among those infected.

Circulation of Chikungunya virus East-Central-South African genotype during the 2020–21 outbreak in São Paulo State, Brazil

Chikungunya virus (CHIKV), a mosquito-borne alphavirus, has traditionally circulated in Africa and Asia, causing human febrile illness accompanied by severe, chronic joint pain. The Asian and East-Central-South African (ECSA) genotypes were introduced in Brazil in 2014, in Bahia State and Northeast region. CHIKV virus rapidly spread, causing epidemics in urban areas, and the ECSA genotype was detected also in other regions. In the last five years, more than 700,000 cases of Chikungunya fever were reported in Brazil. Nevertheless, there is limited information about the genomic epidemiology of CHIKV from surveillance studies. In São Paulo (SP), the most populous Brazilian state, until 2015 only imported cases were identified. In 2020–21, an outbreak was detected in the coastal region of SP, accounting for 98% of confirmations in SP. To better understand the disease dynamics in SP, we generated 53 nearcomplete genomes of CHIKV isolates from Baixada Santista, obtained from clinical samples. Our results demonstrate that SP-CHIKV clade belongs to a distinct clade from those previously found in Brazil, supporting the local circulation of a specific lineage in the period. None of the SP-CHIKV carry the substitutions A226V (E1 protein) and L210Q (E2 protein) associated with increased transmission in Aedes albopictus mosquitoes. The results confirm that the ECSA lineage continues to spread across the country and reinforce that genomic data can provide information about virus genetic diversity and transmission dynamics, assisting the establishment of a more effective surveillance framework.

Cecidomyiidae (Diptera) in the State of Santa Catarina, Brazil

The first checklist of gall midges (Diptera: Cecidomyiidae) in the state of Santa Catarina (SC) is organized based on literature review. Species distribution, discussion regarding endemism, and a list of host plants in the state are provided for the first time. We compare the composition of cecidomyiid species with other states of Brazil. Twenty-three species of gall midges occur in SC, all gall-inducers. They are distributed in 14 genera, being Lopesia Rübsaamen, 1908 and Bruggmannia Tavares, 1906 the best represented. The most speciose genera of Cecidomyiidae in SC are among the most speciose in Brazil, so this result matches the Brazilian pattern. Cecidomyiids are associated with 18 host plant species distributed in 12 families. Although SC comprises a low percentage of the Brazilian fauna of Cecidomyiidae (8.7%), two species are known only from the state. The Sorensen`s index showed that the fauna of SC and São Paulo (SP) are the most similar to each other. The similarity of gall-inducing insects can be related to the host plant composition and phytogeographic domain.

Telementored ultrasonography: a narrative review.

Teleradiology consists of electronic transmission of radiological images from one location to another, including between countries, for interpretation and/or consultation. It is one of the most successful applications of telemedicine. Combining this methodology with ultrasound (called telesonography) can accelerate the process of making diagnoses. Despite this rationale, the quality of the evidence about the effectiveness and accuracy of teleradiology remains unknown. To review the literature on the evidence that exists regarding use of telemedicine for ultrasound in situations of synchronous transmission. Narrative review conducted within the evidence-based health program at a federal university in São Paulo (SP), Brazil. A search of the literature was carried out in April 2020, in the online databases MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS, for original publications in all languages. The reference lists of the studies included and the main reviews on the subject were also evaluated. We included ten studies that assessed procedures performed by different healthcare professionals, always with a doctor experienced in ultrasound as a distant mentor. Among these, only one study assessed disease diagnoses in relation to real patients. Despite the promising position of telesonography within telemedicine, no studies with reasonable methodological quality have yet been conducted to demonstrate its effectiveness.

In search of disambiguation: development of eye drop bottle sleeves to aid in identification and survey among possible users. A cross-sectional study.

Considerable numbers of individuals present low vision, blindness, illiteracy and other conditions that could possibly impair their identification of medications, such as eye drops. Through helping these individuals to identify their eye drops, they can achieve greater autonomy. Misidentification can be avoided through use of multisensory sleeves that can be adapted to most eye drop bottles. Correct use of eye drops is important for preventing progression of diseases like glaucoma that could potentially lead to blindness. To develop bottle sleeves to aid in identification of eye drops and then interview a group of possible users to evaluate the acceptance of the solution. Cross-sectional survey performed at an ophthalmological clinic in São Paulo (SP), Brazil. We describe the development of multisensory sleeves to assist in identification of eye drops. To assess the acceptance of this solution, we interviewed 18 patients who were currently using three or more types of eye drops. We developed four prototypes for eye drop bottle sleeves and conducted an acceptance test on them. Most of the patients who answered the survey about the sleeves were elderly. Most (95%) reported believing that the sleeves would help reduce the risk of mixing up eye drops with other medications that also dispense drops. They also believed that these would increase their autonomy in using eye drops. The solution presented was well accepted and may help increase safety in using eye drops through preventing misidentification.

Indications for accurate and appropriate use of personal protective equipment for healthcare professionals. A systematic review.

The speed of the spread of coronavirus disease 2019 (COVID-19) has put enormous pressure on hospitals and other healthcare facilities. This, together with blockages in several countries, has hindered the availability and accessibility of the necessary personal protective equipment (PPE). To identify, systematically evaluate and summarize the available scientific evidence on the efficacy, safety, safe use and reuse of PPE for healthcare professionals, for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Systematic review of studies analyzing products for disinfecting and enabling reuse of PPE for coronavirus within the evidence-based health program of a federal university in São Paulo (SP), Brazil. A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science and LILACS databases, for articles published up to November 30, 2020. Ten studies were selected. These analyzed the use of N95, surgical and cotton masks, face shields, flexible enclosures with plastic covers or polycarbonate intubation boxes and plastic curtains; and also PPE disinfection using several substances. Combined use of a face shield with a N95 mask proved to be superior to other associations for protecting healthcare workers. Some products are useful for disinfecting PPE, such as 70% ethanol, 0.1% sodium hypochlorite and a mixture of quaternary ammonium and H2O2, and hydrogen peroxide. Ultraviolet light and dry heat at 70 °C can be used to decontaminate N95 masks. DOI: 10.17605/OSF.IO/4V5FD at the OPENSCIENCE Framework.

Molecular Detection of Tick-Borne Agents in Cats from Southeastern and Northern Brazil

Even though the epidemiology of tick-borne agents (TBA) in dogs has been extensively investigated around the world, the occurrence, vectors involved, and molecular identity of these agents in cats remains elusive in many regions. Among TBA, Ehrlichia, Anaplasma, Babesia, Cytauxzoon, and Hepatozoon are responsible for diseases with non-specific clinical signs in cats, making essential the use of molecular techniques for accurate diagnosis and proper treatment. The present work aimed to investigate the occurrence and molecular identity of tick-borne agents (Ehrlichia, Anaplasma, Babesia/Theileria, Cytauxzoon, and Hepatozoon) in cats from southeastern (states of São Paulo (SP) and Minas Gerais (MG)) and northern (state of Rondônia (RO)) Brazil. For this purpose, 390 blood samples were collected from domiciled cats in MG (n = 155), SP (n = 151), and RO(n = 84) states, submitted to DNA extraction and PCR assays for Ehrlichia spp. (dsb gene), Anaplasma spp. (rrs gene), piroplasmids (18S rRNA gene), and Hepatozoon spp. (18S rRNA gene), sequencing, and phylogenetic inferences. The overall positivity for Anaplasma spp., Ehrlichia spp., Babesia/Theileria spp., Cytauxzoon spp., and Hepatozoon spp. were 7.4% (12.3% (MG) and 6.6% (SP)), 2% (4.5% (MG) and 0.6% (SP)), 0.7% (0.6% (MG), 0.6% (SP) and 1.2% (RO)), 27.2% (41.9% (MG), 24.5% (SP) and 4.8% (RO), and 0%, respectively. The phylogenetic analysis grouped the obtained sequences with ‘Candidatus Anaplasma amazonensis’, A. platys, B. vogeli, and Cytauxzoon sp. previously detected in wild felids from Brazil. qPCR specific for E. canis based on the dsb gene confirmed the molecular identity of the detected ehrlichial agent. The present study expanded the list and geographical distribution of hemoparasites in cats. ‘Candidatus Anaplasma amazonensis’, recently detected in sloths from northern Brazil, was described for the first time in cats. This is the first report of piroplasmids infecting cats in northern Brazil. Coinfection by Cytauxzoon and other TBA (Ehrlichia, Anaplasma, and B. vogeli) reported in the present study raises the need for veterinary practitioners’ awareness of cats parasitized by multiple TBA.

Health promotion to people with disabilities: case report from two University extension projects

Developing Health Promotion programs and interventions for people with disabilities during undergraduate health courses represents a relevant strategy to ensure comprehensive, equitable and universal care. Objective: to describe and reflect on two Brazilian experiences focused on promoting the health of people with physical disabilities within the scope of university extension. Method: this is the report of experiences derived from the “Praia Sem Barreiras” Project in Recife (PE) and the “Remo Meu Rumo” Project in São Paulo (SP), Brazil. Results: both activities are interdisciplinary, interprofessional and intersectoral. They focus on relationships between Higher Education Institutions and articulate community partnerships focusing on well-being, self-care and physical activity and leisure. Final Considerations: it is evident that the performance of undergraduate health students and professors excelled in the use of public spaces in the city as a powerful strategy for social inclusion, collaborative learning and the exercise of citizenship. However, it is necessary to broaden the discussion on developing Health Promotion skills to prepare the health sector workforce with greater sensitivity to the needs of people with disabilities or reduced mobility.