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Objective: Emergency contraception (EC) is an effective and safe method for preventing unplanned pregnancy after unprotected sexual intercourse among adolescents but is infrequently prescribed by pediatricians. Because of the scarcity of data on the discomfort with EC prescription among physicians in Brazil, this study aimed to identify associated factors with discomfort with EC prescription among pediatricians in the state of Amazonas. Methods: A web-based, cross-sectional study including sociodemographic data, knowledge, attitudes, and discomfort with EC prescription was used. Multivariate logistic regression and artificial intelligence methods such as decision tree and random forest analysis were used to identify factors associated with discomfort with EC prescriptions. Results: Among 151 physicians who responded to the survey, 53.0% were uncomfortable with prescribing EC, whereas only 33.1% had already prescribed it. Inexperience was significantly associated with discomfort with EC prescription (odds ratio 4.47, 95% confidence interval 1.71–11.66). Previous EC prescription was protective against discomfort with EC prescription in the three models. Conclusions: EC is still infrequently prescribed by pediatricians because of inexperience and misconceptions. Training these professionals needs to be implemented as part of public health policies to reduce unplanned adolescent pregnancy.

We assessed the effectiveness of lyophilised banked human milk (HM) as a fortifier to feed very-low-birth-weight infants (VLBWI). This study aimed to evaluate the safety and tolerability of HM with HM lyophilisate as an additive compared with the standard additive (cows’ milk protein). In this phase I double-blind randomised controlled clinical trial, set in the intensive and intermediate care units of a tertiary hospital, forty VLBWI were enrolled and allocated into two groups: HM plus HM lyophilisate (LioNeo) or HM plus commercial additive (HMCA). The inclusion criteria were preterm infants, birth weight 750–1500 g, small or adequate for gestational age, exclusively receiving donor HM, volume ≥ 100 ml/kg per d and haemodynamically stable. Participants were followed up for 21 consecutive days. The primary outcome measures were necrotising enterocolitis (NEC), late-onset sepsis (LOS), death, gastrointestinal (GI) bleeding or perforation, diarrhoea, regurgitation, vomiting and abdominal distension. The LioNeo and HMCA groups had similar weights at baseline. The regression models showed no differences between the groups in terms of the primary outcomes. Diarrhoea, GI perforation, NEC and LOS were absent in the LioNeo group (one LOS and one NEC in the HMCA group). Multiple regression analysis with the total volume of milk as a covariate did not show significant differences. The lyophilisation of donor HM was considered safe and tolerable for use in stable haemodynamically VLBWI.

O processo educativo vivenciado por estudantes e professores deve ser focado na aquisição de conhecimento, habilidades e atitudes relevantes para compreensão dos fenômenos da vida e sua aplicação na prática profissional, exigindo a participação ativa e efetiva dos muitos envolvidos: estudantes, professores, gestores acadêmicos e outros atores importantes. Ainda que essa máxima faça parte dos discursos dos cursos da área da saúde, ressalta-se, neste trabalho, o valor fundamental do planejamento para uma ação educacional de qualidade. A adoção de instrumentos pedagógicos próprios para este fim pode favorecer uma melhor reflexão, desenvolvimento e comunicação do percurso de formação dos estudantes. Na Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), o instrumento utilizado é conhecido como Plano de Ensino e Aprendizagem, o PEA. Neste relato de experiência, apresenta-se o seu contexto de implementação, as discussões envolvendo a comunidade acadêmica, as ações formativas para torná-lo um recurso vivo e potente para o fazer docente, elementos estes que fortaleceram o ensino nos cursos de graduação da FMRP. Ao longo deste artigo, o leitor conhecerá as partes que compõem o PEA, orientações sobre como elaborá-lo, exemplos produzidos por professores e um conjunto de rubricas e critérios que contribuem para nortear o planejamento no contexto da docência nas profissões da saúde.

Background The emergence and re-emergence of infectious diseases are a cause for worldwide concern. The introduction of Zika and Chikungunya diseases in the Americas has exposed unforeseen medical and logistical challenges for public health systems. Moreover, the lack of preventive measures and vaccination against known and emerging mosquito-transmitted pathogens, and the occurrence of unanticipated clinical complications, has had an enormous social and economic impact on the affected populations. In this study, we aimed to measure the seroprevalence of endemic and emerging viral pathogens in military personnel stationed in Manaus, Amazonas state. Methods We measured the seropositivity of antibodies against 19 endemic and emerging viruses in a healthy military personnel group using a hemagglutination inhibition assay (HIA). Results Overall, DENV positivity was 60.4%, and 30.9% of the individuals reacted against ZIKV. Also, 46.6%, 54.7%, 51.3% and 48.7% individuals reacted against West Nile virus (WNV), Saint Louis encephalitis virus (SLEV), Ilheus virus (ILHV) and Rocio virus (ROCV), respectively. Individuals with high DENV HIA titer reacted more frequently with ZIKV or WNV compared to those with low HIA titers. Observed cross-reactivity between Flaviviruses varied depending on the virus serogroup. Additionally, 0.6% and 0.3% individuals were seropositive for Oropouche virus (OROV) and Catu virus (CATUV) from the family Peribunyaviridae, respectively. All samples were negative for Eastern Equine Encephalitis virus (EEEV), Western Equine Encephalomyelitis virus (WEEV), Mayaro virus (MAYV), Mucambo virus (MUCV) and CHIKV from the family Togaviridae. Conclusions A high proportion of individuals in our high-risk population (~ 60%) lacked antibodies against major endemic and emerging viruses, which makes them susceptible for further infections. Military personnel serving in the Amazon region could serve as sentinels to strengthen global infectious disease surveillance, particularly in remote areas. Graphical abstract

Additional file 1: Table S1. Socio-demographic features of the study population.

Additional file 5: Figure S1. Distribution of dengue, Zika and Chikungunya virus cases in Brazil between 2014 and 2018. Hot spot detection maps were plotted using publicly available data for dengue (a and b), Zika (c and d) and Chikungunya (e and f) virus incidences between 2014 and 2018 (Ministry of Health Brazil, https://www.saude.gov.br/boletins-epidemiologicos ). Please note the differences in the incidence rate scales for each virus. North region: Acre: AC, Amapá: AP, Amazonas: AM, Pará: PA, Rondônia: RO, Roraima: RR, Tocantins: TO; Northeast region: Alagoas: AL, Bahia: BA, Ceará: CE, Maranhão: MA, Paraíba: PB, Pernambuco: PE, Piauí: PI, Rio Grande do Norte: RN, Sergipe: SE; Midwest region: Goiás: GO, Mato Grosso: MT, Mato Grosso do Sul: MS, Distrito Federal (Federal District): DF; Southeast region: Espírito Santo: ES, Minas Gerais: MG, Rio de Janeiro: RJ, São Paulo: SP; South region: Paraná: PR, Rio Grande do Sul: RS, Santa Catarina: SC.

Additional file 2: Table S2. Prevalence of antibodies against principal human arboviruses.

Objetivo: Descrever a adesão ao autocuidado em idosos com diabetes mellitus tipo 2. Métodos: Estudo de revisão integrativa, com abordagem qualitativa. A pesquisa bibliográfica foi concretizada em bases de dados, cientificamente válidas, por meio da Biblioteca Virtual em Saúde (BVS), selecionando artigos através dos Descritores em Saúde (DeCS): Diabetes Mellitus; Idosos; Autocuidado, publicados entre os anos de 2015 à 2020, considerando os critérios de elegibilidade e inelegibilidade. Resultados: Foram encontrados 527 artigos na Scielo, 99 na Medline e 3.248 na Lilacs, totalizando 3.874 achados, destes 20 artigos atenderam os critérios elencados para os resultados. A literatura demonstra riqueza quanto aos estudos voltados ao autocuidado, mas existe repetição dos assuntos elencados nos estudos, não tendo um fator que conduza de forma conclusiva a melhora de tal problemática. Considerações finais: Analisar o entendimento dos idosos através das literaturas, e do que tem sido feito para uma promoção de saúde mais efetiva mostrou-se essencial para que fosse possível reconhecer as contribuições dessa estratégia para a melhoria do autocuidado em idosos com diabetes.

OBJETIVO: Avaliar se a aprotinina em altas doses hemostáticas pode reduzir o processo inflamatório após circulação extracorpórea (CEC) em crianças. MÉTODOS: Estudo prospectivo randomizado em crianças de 30 dias a 4 anos de idade, submetidas à correção de cardiopatia congênita acianogênica, com CEC e divididas em dois grupos, um denominado Controle (n=9) e o outro, Aprotinina (n=10). Neste, o fármaco foi administrado antes e durante a CEC. A resposta inflamatória sistêmica e disfunções hemostática e multiorgânicas foram analisadas por marcadores clínicos e bioquímicos. Foram consideradas significantes as diferenças com POBJECTIVE: To assess if the hemostatic high-dose aprotinin is able to reduce the inflammatory process after cardiopulmonary bypass (CPB) in children. METHODS: A prospective randomized study was performed on children aged 30 days to 4 years who underwent correction of acyanogenic congenital heart disease with CPB and were divided into two groups: Control (n=9) and Aprotinin (n=10). In the Aprotinin Group the drug was administered before and during CPB and the systemic inflammatory response and hemostatic and multiorgan dysfunctions were assessed through clinical and biochemical markers. Differences were considered to be significant when P

OBJETIVO: Avaliar se o uso de aprotinina em altas doses hemostáticas pode influenciar as funções miocárdicas, renais e metabólicas em crianças operadas com circulação extracorpórea (CEC). MÉTODOS: Estudo prospectivo randomizado em crianças de 30 dias a 4 anos de idade, submetidas à correção de cardiopatia congênita acianogênica, com CEC e divididas em dois grupos, um denominado Controle (n=9) e o outro, Aprotinina (n=10). Neste, a droga foi administrada antes e durante a CEC. As disfunções miocárdicas e multiorgânicas foram analisadas por marcadores clínicos e bioquímicos. Foram consideradas significantes as diferenças com POBJECTIVE: To evaluate if the use of hemostatic high-dose aprotinin seems influence to myocardial, renal and metabolic functions in children submitted to surgical correction with extracorporeal circulation (ECC). Material and Methods A prospective randomized study was conducted on children aged 30 days to 4 years submitted to correction of acyanogenic congenital heart disease with ECC and divided into two groups: Control (n=9) and Aprotinin (n=10). In the Aprotinin Group the drug was administered before and during ECC and the myocardial and multiorgan dysfunctions were analyzed on the basis of clinical and biochemical markers. Differences were considered to be significant when P

OBJETIVO: Avaliação dos efeitos hemostáticos e plaquetários em crianças submetidas a correção de cardiopatias congênitas acianogênicas com circulação extracorpórea que receberam aprotinina. MÉTODOS: Estudo prospectivo randomizado em crianças de 30 dias a 4 anos de idade, submetidas a correção de cardiopatia congênita acianogênica, com circulação extracorpórea (CEC) e divididas em dois grupos, um denominado Controle (n=9) e o outro, Aprotinina (n=10). Neste, a droga foi administrada antes e durante a CEC. A disfunção hemostática foi analisada por marcadores clínicos e bioquímicos. Foram consideradas significantes as diferenças com POBJECTIVE: Evaluation of the hemostatic and platelets effects in children with acyanogenic congenital heart disease undergone on-pump surgery who received aprotinin. METHODS: A prospective randomized study was performed on children aged 30 days to 4 years who had undergone correction of acyanogenic congenital heart disease using cardiopulmonary bypass (CPB) and were divided into two groups: Control (n=9) and Aprotinin (n=10). In the Aprotinin Group the drug was administered before and during CPB and the hemostatic dysfunction was analyzed by clinical and biochemical markers. Differences were considered to be significant when P

Brazil has reported more than 1,600 cases of hantavirus cardiopulmonary syndrome (HPS) since 1993, with a 39% rate of reported fatalities. Using a recombinant nucleocapsid protein ofAraraquaravirus, we performed ELISA to detect IgG antibodies against hantavirus in human sera. The aim of this study was to analyze hantavirus antibody levels in inhabitants from a tropical area (Amazon region) in Rondônia state and a subtropical (Atlantic Rain Forest) region in São Paulo state, Brazil. A total of 1,310 serum samples were obtained between 2003 and 2008 and tested by IgG-ELISA, and 82 samples (6.2%), of which 62 were from the tropical area (5.8%) and 20 from the subtropical area (8.3%), tested positive. Higher levels of hantavirus antibody were observed in inhabitants of the populous subtropical areas compared with those from the tropical areas in Brazil.

Neste trabalho foi feito uma investigação sorológica em moradores na região amazônica e moradores rurais do sudeste brasileiro, através do teste de inibição da hemaglutinação (HI) para a cepa vacinal da Febre Amarela mais 17 sorotipos diferentes de arbovírus, sendo quatro do gênero Alphavirus (ALP), nove do gênero Flavivirus (FLA) e cinco do gênero Orthobunyavirus (ORT), para verificar qual desses vírus estão circulando nessas regiões. Os resultados do HI foram divididos em quatro áreas: na cidade Machadinho dOeste (Rondônia) (N=285) tivemos para ALP=50 (17,54%), FLA=270 (94,74%), ORT=58 (20,35%) e negativos (NEG)=12 (4,20%). Nas pessoas que moram ao longo do Rio Machado (Rondônia) (N=343) tivemos ALP=99 (28,86%), FLA=229 (66,76%), ORT=41 (11,95%) e NEG=93 (27,10%). Na cidade Teodoro Sampaio (São Paulo) (N=78) tivemos FLA=55 (70,51%) e NEG=23 (29,5%). Na cidade Jacupiranga (São Paulo) (N=149) tivemos ALP=7 (4,7%), FLA=50 (33,56%), ORT=20 (13,42%) e NEG=84 (56,4%). Concluímos que os resultados obtidos sugerem a circulação desses vírus nas regiões estudadas. In this work we performed a serological investigation in residents of Amazon region and country people who lives in Southeastern of Brazil, by hemagglutination inhibition (HI) for Yellow fever vaccine and 17 different serotype of arboviruses: four from the genus Alphavirus (ALP), nine from the genus Flavivirus (FLA), and five from the genus Orthobunyavirus (ORT), to try to ascertain which of these arboviruses are circulating in these areas. The results of HI were divided into four areas: In Machadinho dOeste city (Rondônia) (N=285) we had to ALP=50 (17,54%), FLA=270 (94,74%), ORT=58 (20,35%) and negatives (NEG)=12 (4,20%). In people who live along the Machado River (Rondônia) (N=343) we had to ALP=99 (28,86%), FLA=229 (66,76%), ORT=41 (11,95%) and NEG=93 (27,10%). In Teodoro Sampaio City (São Paulo) (N=78) we had to FLA=55 (70,51%) and NEG=23 (29,5%). In Jacupiranga City (São Paulo) (N=149) we had to ALP=7 (4,70%), FLA=50 (33,56%), ORT=20 (13,42%) and NEG=84 (56,4%). In conclusion, the obtained data suggest the circulation of these viruses in these regions.

To evaluate if the hemostatic high-dose aprotinin seems to reduce the inflammatory process after extracorporeal circulation (ECC) in children.A prospective randomized study was conducted on children aged 30 days to 4 years submitted to correction of acyanogenic congenital heart disease with ECC and divided into two groups: Control (n=9) and Aprotinin (n=10). In the Aprotinin Group the drug was administered before and during ECC and the systemic inflammatory response and hemostatic and multiorgan dysfunctions were analyzed on the basis of clinical and biochemical markers. Differences were considered to be significant when P0.05.The groups were similar regarding demographic and intraoperative variables, except for a greater hemodilution in the Aprotinin Group. The drug had no benefit regarding time of mechanical pulmonary ventilation, permanence in the postoperative ICU and length ofIn this series, hemostatic high-dose aprotinin did not minimize the clinical manifestations or serum markers of the inflammatory systemic response.

To evaluate if the use of hemostatic high-dose aprotinin seems influence to myocardial, renal and metabolic functions in children submitted to surgical correction with extracorporeal circulation (ECC). Material and Methods A prospective randomized study was conducted on children aged 30 days to 4 years submitted to correction of acyanogenic congenital heart disease with ECC and divided into two groups: Control (n=9) and Aprotinin (n=10). In the Aprotinin Group the drug was administered before and during ECC and the myocardial and multiorgan dysfunctions were analyzed on the basis of clinical and biochemical markers. Differences were considered to be significant when P0.05.The groups were similar regarding demographic and intraoperative variables, except for a greater hemodilution in the Aprotinin Group. The drug had no benefit regarding time of mechanical pulmonary ventilation, permanence in the pediatric postoperative intensive care unit (ICU) and length of hospitalization, or regarding the use of inotropic drugs and renal function. The partial arterial oxygen pressure/inspired oxygen fraction ratio (PaO2/FiO2) was significantly reduced 24h after surgery in the Control Group. Blood loss was similar for both groups. Cardiac troponin I (cTnI), creatine kinase MB fraction (CKMB), serum glutamic-oxaloacetic transaminase (SGOT) and the aminoterminal fraction of natriuretic peptide type B (NT-proBNP) did not differ significantly between groups. Post-ECC blood lactate concentration and metabolic acidosis was more intense in the Aprotinin Group. There were no complications with the use of aprotinin.High-dose aprotinin did not significant influence in serum markers troponin I, NT-proBNP and renal function, but did associated with hemodilution, blood lactate concentration and metabolic acidosis more intense.

Evaluation of the hemostatic and platelets effects in children with acyanogenic congenital heart disease undergone on-pump surgery who received aprotinin.A prospective randomized study was performed on children aged 30 days to 4 years who had undergone correction of acyanogenic congenital heart disease using cardiopulmonary bypass (CPB) and were divided into two groups: Control (n=9) and Aprotinin (n=10). In the Aprotinin Group the drug was administered before and during CPB and the hemostatic dysfunction was analyzed by clinical and biochemical markers. Differences were considered to be significant when P0.05.The groups were similar regarding demographic and intraoperative variables, except for a greater hemodilution in the Aprotinin Group. The drug presented no benefit regarding time of mechanical pulmonary ventilation, stay in the postoperative intensive care unit and hospital, or regarding the use of inotropic drugs and renal function. Platelet concentration was preserved with the use of Aprotinin, whereas thrombocytopenia occurred in the Control Group since the initiation of CPB. Blood loss was similar for both groups. There were no complications with the use of Aprotinin.Aprotinin quantitatively preserved the blood platelets in children with acyanogenic congenital heart disease.

Objectives: to determine the prevalence of pulmonary hemorrhage in newborns and evaluate the associated risk factors and outcomes. Methods: this was a retrospective case-control study involving 67 newborns who met the criteria for pulmonary hemorrhage. A control was selected for each case: the next-born child of the same gender, similar weight (± 200 g) and gestational age (± 1 week), with no previous pulmonary hemorrhage and no malformation diagnosis. Factors previous to pulmonary hemorrhage onset, as well as aspects associated to the condition, were assessed. Results: the prevalence was 6.7 for 1,000 live births, and the rates observed were: 8% among newborns < 1,500 g, and 11% among newborns < 1,000 g. Intubation in the delivery room (OR = 7.16), SNAPPE II (OR = 2.97), surfactant use (OR = 3.7), and blood components used previously to pulmonary hemorrhage onset (OR = 5.91) were associated with pulmonary hemorrhage. In the multivariate logistic regression model, only intubation in delivery room and previous use of blood components maintained the association. Children with pulmonary hemorrhage had higher mortality (OR = 7.24). Among the survivors, the length of stay (p ≤ 0.01) and mechanical ventilation time were longer (OR = 25.6), and oxygen use at 36 weeks of corrected age was higher (OR = 7.67). Conclusions: pulmonary hemorrhage is more prevalent in premature newborns, and is associated with intubation in the delivery room and previous use of blood components, leading to high mortality and worse clinical evolution.