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Postoperative infectious complications are extremely important to surgeons and the entire medical care team. Among these complications, surgical site infection (SSI) appears to be one of the earliest and most prevalent events and is considered an inherent complication of surgical procedures. In oncological patients submitted to resections of digestive system tumors, there is a confluence of several risk factors for SSI, making it necessary to establish measures to maximize the control of this condition to provide a better prognosis for these patients. Some risk factors for SSI are the manipulation of structures hosting the highest density of pathogenic microorganisms, such as the colon, the patient's performance status, the patient's nutritional status, the use of chemotherapy and/or radiotherapy, and the surgical procedure itself, which tends to last longer and be more complex than surgeries for benign conditions of the digestive system. Therefore, this review sought to provide a qualitative analysis and a summary of the literature regarding the SSI of postoperative tumor patients who underwent surgical resection and were well-structured postoperatively, to provide objective data on this problem, and alert about the well-structured needs of individualized pre-, peri-, and post-protocols to avoid the development of these events.

Objective  To analyze the epidemiological data of orthopedic injuries in beach tennis players. Methods  We conducted a cross-sectional study, through a questionnaire, with 185 beach tennis players during tournaments and training sessions in two cities. The questionnaire comprised anthropometric data, as well as data on length of time practicing the sport and reported orthopedic injuries. Results  We excluded 25 of the 185 interviewees. Of the 160 players studied, 51.9% were male and 48.1%, female. The average age was of 40.4 years, the average height was of 1.73 m, the average weight was of 75.6 kg, and the average body mass index (BMI) was of 25.2 kg/m 2 . Orthopedic injuries were reported by 48.8% of the participants, 30.0% in the lower limbs, 11.3% in the spine, and 25.0% in the upper limbs, with an incidence of 0.82 per one thousand hours of practice. Correlating the incidence of injuries with age, weight, height, and BMI, we only found relevance between the higher average age in patients with lower- and upper-limb injuries. Players who had no previous experience with other racket sports had fewer injuries. Other parameters, such as gender, use of the two-handed backhand , dominant side, participation in competitions, and practice of other sports did not show statistically significant differences. Conclusion  Orthopedic injuries were found in almost half of the beach tennis players, primarily in the lower limbs. Age, experience with other racket sports, category, hours of training per week, and length of time playing the sport influenced the incidence of orthopedic injuries., Competing Interests: Conflito de Interesses Os autores não têm conflito de interesses a declarar., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ( https://creativecommons.org/licenses/by/4.0/ ).)

Raphanus sativus L. is a potential source of raw material for biodiesel fuel due to the high oil content in its grains. In Brazil, this species is cultivated in the low rainfall off-season, which limits the productivity of the crop. The present study investigated the effects of water restriction on the physiological and biochemical responses, production components, and oil quality of R. sativus at different development stages. The treatments consisted of 100% water replacement (control), 66%, and 33% of field capacity during the phenological stages of vegetative growth, flowering, and grain filling. We evaluated characteristics of water relations, gas exchange, chlorophyll a fluorescence, chloroplast pigment, proline, and sugar content. The production components and chemical properties of the oil were also determined at the end of the harvest cycle. Drought tolerance of R. sativus was found to be mediated primarily during the vegetative growth stage by changes in photosynthetic metabolism, stability of photochemical efficiency, increased proline concentrations, and maintenance of tissue hydration. Grain filling was most sensitive to water limitation and showed a reduction in yield and oil content. However, the chemical composition of the oil was not altered by the water deficit. Our data suggest that R. sativus is a drought-tolerant species.

The Totiviridae family of viruses has a unique genome consisting of double-stranded RNA with two open reading frames that encode the capsid protein (Cap) and the RNA-dependent RNA polymerase (RdRpol). Most virions in this family are isometric in shape, approximately 40 nm in diameter, and lack an envelope. There are five genera within this family, including Totivirus , Victorivirus , Giardiavirus , Leishmaniavirus , and Trichomonasvirus . While Totivirus and Victorivirus primarily infect fungi, Giardiavirus , Leishmaniavirus , and Trichomonasvirus infect diverse hosts, including protists, insects, and vertebrates. Recently, new totivirus-like species have been discovered in fish and plant hosts, and through metagenomic analysis, a novel totivirus-like virus (named Tianjin totivirus) has been isolated from bat guano. Interestingly, Tianjin totivirus causes cytopathic effects in insect cells but cannot grow in mammalian cells, suggesting that it infects insects consumed by insectivorous bats. In this study, we used next-generation sequencing and identified totivirus-like viruses in liver tissue from Molossus molossus bats in the Amazon region of Brazil. Comparative phylogenetic analysis based on the RNA-dependent RNA polymerase region revealed that the viruses identified in Molossus bats belong to two distinct phylogenetic clades, possibly comprising different genera within the Totiviridae family. Notably, the mean similarity between the Tianjin totivirus and the totiviruses identified in Molossus bats is less than 18%. These findings suggest that the diversity of totiviruses in bats is more extensive than previously recognized and highlight the potential for bats to serve as reservoirs for novel toti-like viruses.

Purpose: This systematic review and meta-analysis aimed to compare outcomes between stapled ileal pouch-anal anastomosis (IPAA) and hand-sewn IPAA with mucosectomy in cases of ulcerative colitis and familial adenomatous polyposis., Methods: This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines 2020 and AMSTAR 2 (Assessing the methodological quality of systematic reviews) guidelines. We included randomized clinical trials (RCTs) and controlled clinical trials (CCTs). Subgroup analysis was performed according to the indication for surgery., Results: The bibliographic research yielded 31 trials: 3 RCTs, 5 prospective clinical trials, and 24 CCTs including 8872 patients: 4871 patients in the stapled group and 4038 in the hand-sewn group. Regarding postoperative outcomes, the stapled group had a lower rate of anastomotic stricture, small bowel obstruction, and ileal pouch failure. There were no differences between the 2 groups in terms of operative time, anastomotic leak, pelvic sepsis, pouchitis, or hospital stay. For functional outcomes, the stapled group was associated with greater outcomes in terms of seepage per day and by night, pad use, night incontinence, resting pressure, and squeeze pressure. There were no differences in stool Frequency per 24h, stool frequency at night, antidiarrheal medication, sexual impotence, or length of the high-pressure zone. There was no difference between the 2 groups in terms of dysplasia and neoplasia., Conclusions: Compared to hand-sewn anastomosis, stapled ileoanal anastomosis leads to a large reduction in anastomotic stricture, small bowel obstruction, ileal pouch failure, seepage by day and night, pad use, and night incontinence. This may ensure a higher resting pressure and squeeze pressure in manometry evaluation., Protocol Registration: The protocol was registered at PROSPERO under CRD 42022379880., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The present work aimed to characterize and compare the catalytic properties of amylases from Cunninghamella echinulata and Rhizopus microsporus. The highest production of amylase by C. echinulata, 234.94 U g-1 of dry substrate (or 23.49 U mL-1), was obtained using wheat bran as a substrate, with 50-55% initial moisture and kept at 28 °C for 48 h. The highest production of amylases by R. microsporus, 224.85 U g-1 of dry substrate (or 22.48 U mL-1), was obtained cultivating wheat bran with 65% initial moisture at 45 °C for 24 h. The optimal activity of the amylases was observed at pH 5.0 at 60 °C for C. echinulata enzymes and at pH 4.5 at 65 °C for R. microsporus. The amylases produced by C. echinulata were stable at pH 4.0-8.0, while the R. microsporus enzymes were stable at pH 4.0-10.0. The amylases produced by C. echinulata remained stable for 1 h at 50 °C and the R. microsporus amylases maintained catalytic activity for 1 h at 55 °C. The enzymatic extracts of both fungi hydrolyzed starches from different plant sources and showed potential for liquefaction of starch, however the amylolytic complex of C. echinulata exhibited greater saccharifying potential.

Objective: to investigate the factors that exert an influence on health literacy in patients with coronary artery disease., Methods: a crosssectional study, including 122 patients with coronary diseases (60.7% male; 62.07 ± 8.8 years old). Health literacy and specific knowledge about the disease were evaluated through interviews with the participants by means of the Short Test of Functional Health Literacy in Adults and the Short version of the coronary artery disease education questionnaire. The data were described by means of central tendency measures and frequencies. The factors that exert an influence on health literacy were determined by means of a linear regression model. The significance level adopted was 5%. The study was approved by the Research Ethics Committee., Results: age and arterial hypertension presented an inverse and significant relationship with health literacy. On the other hand, higher schooling levels and having a job were associated with better scores in the health literacy instrument. Specific knowledge about the disease did not exert any influence on health literacy. The variables included in the regression model explained 55.3% of inadequate literacy., Conclusion: this study, knowledge about the disease exerts no influence on health literacy: however, the professionals should consider the sociodemographic and clinical factors to plan the interventions.

Brazil is a great source of arbovirus diversity, mainly in the Amazon region. However, other biomes, especially the Atlantic Forest, may also be a hotspot for emerging viruses, including Bunyaviruses (Negarnaviricota: Bunyavirales). For instance, Vale do Ribeira, located in the Southeastern region, has been widely studied for virus surveillance, where Flavivirus, Alphavirus and Bunyaviruses were isolated during the last decades, including Bruconha virus (BRCV), a member of Orthobunyavirus genus Group C, in 1976. Recently, a new isolate of BRCV named Span321532 was obtained from an adult sentinel mouse placed in Iguape city in 2011, and a full-length genome was generated with nucleotide differences ranging between 1.5%, 5.3% and 5% (L, M and S segments, respectively) from the prototype isolated 35 years earlier. In addition, each segment placed BRCV into different clusters, showing the high variety within Bunyavirales. Although no evidence for reassortants was detected, this finding reiterates the need for new surveillance and genomic studies in the area considering the high mutation rates of arbovirus, and also to identify the hosts capable of supporting the continuous circulation of Orthobunyavirus.

Biorefineries integrate processes for the sustainable conversion of biomass into chemicals, materials, and bioenergy so that resources are optimized and effluents are minimized. Despite the vast potential of lignocellulosic biorefineries, their success depends heavily on effective, economically viable, and sustainable biomass fractionation. Although efficient, organosolv pretreatment still faces challenges that must be overcome for its widespread utilization, mainly related to solvent type and recycling, robustness regarding biomass type and integration of hemicellulose recovery and use. This review shows the recent advances and state-of-the-art of organosolv pretreatment, discussing the advances, such as the use of biobased solvents, whilst also shedding light on the perspectives of using the streams - cellulose, hemicellulose, and lignin - to produce biofuels and products of high added value. In addition, it presents an overview of the existing industrial implementations of organosolv processes and, lastly, shows the main scientific and industrial challenges and opportunities for this process., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sarita Candida Rabelo reports financial support was provided by São Paulo Research Foundation – FAPESP. Aline Carvalho da Costa reports financial support was provided by São Paulo Research Foundation – FAPESP. Eupidio Scopel reports financial support was provided by São Paulo Research Foundation – FAPESP. Luiz Henrique Cardoso reports financial support was provided by Coordination for the Improvement of Higher Education Personnel – CAPES., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the volar cortical angle (VCA), the variation in lateral and intermediate columns, the shape and pattern of the watershed line (WL) of the distal radius and its correlation with locking volar plates available., Methods: 27 human cadaveric radial bones of the Department of Morphology and nine locking volar plates of six different companies were analyzed. VCA were measured from lateral and intermediate columns and their corresponding values on plates, as well as comparing the relief of radius and plates. In the WL analysis, we compared the standard format found on the radius and its equivalent on plates and divided into four types: biconvex, convex, ulnar convex and plan., Results: VCA varied between columns of the distal radius extremity. The mean in the lateral column was 153.40 degrees and 146.06 degrees in the intermediate. Four of nine plates showed no variation in volar angulation. From 27 distal radius, 13 showed convex pattern and 12 had biconvex, whereas most plates (seven of the nine analyzed) were biconvex drawing., Conclusion: Radial bone anatomy was variable. The intermediate column was, on average, steeper than lateral column. Synthes®-2 plate presented the closest design to the anatomy of the distal end of the radial bone, followed by Newclip®-2 plate. Level of Evidence II, Anatomic and Descriptive Study., Competing Interests: All authors declare no potential conflict of interest related to this article.

Background: Despite their worldwide occurrence, the distribution and role of insect-specific flaviviruses (ISFs) remain unclear., Methods: We evaluated the presence of ISFs in mosquitoes collected in São Paulo, Brazil, using reverse transcription and semi-nested polymerase chain reaction (PCR). Some of the positive samples were subjected to nanopore sequencing., Results: Twelve mosquito pools (2.8%) tested positive for flavivirus infection. Nanopore sequencing was successfully performed on six samples. Phylogenetic analysis grouped these sequences into genotype 2 of Culex flavivirus (CxFV)., Conclusions: The identification of CxFV genotype 2 at new locations in São Paulo highlights the importance of understanding the role of ISFs in mosquito vector competence.

Background: Laparoscopic pancreatectomy is currently a widely used approach for benign and malignant lesions of the pancreas., Aims: This study aimed to describe how to perform a laparoscopic distal pancreatectomy using The Clockwise Technique., Methods: An 18-year-old female patient presented with a well-defined tumor in the pancreatic body with 4 cm in diameter that suggested a diagnosis of solid pseudopapillary tumor (Frantz's tumor). The patient was recommended for laparoscopic distal pancreatectomy by using The Clockwise Technique., Results: The clockwise, caudal-to-cephalic approach appears to have other significant technical advantages that facilitate the performance of the procedure., Conclusions: A laparoscopic distal pancreatectomy performed using The Clockwise Technique provides satisfactory outcomes.

Putative replication-associated protein (REP) and capsid-like (CAP) proteins are encoded by circular single-stranded DNA viruses (CRESS DNA), which have been found in samples from most eukaryotic groups. However, the details of these viruses' life cycles and their significance in diseases have yet to be established. We presented and analyzed two full-length CRESS DNA genomes acquired from two children diagnosed with acute gastroenteritis (GI) in the northeast state of Tocantins, Brazil, using next-generation sequencing and a virus-like filtration approach. Both sequences (named SmaCV3BR08 and SmaCV3BR291) are closely similar to a prior CRESS DNA sequence discovered in the feces of a new world monkey ( Alouatta caraya ) from the United States in 2009 and termed Howler monkey-associated porprismacovirus 1 (Genbank ID: NC 026317). According to our comparative study, these porprismacovirus genomes deviate by 10% at the nucleotide level. For comparative reasons, the divergence between our sequences (SmaCV3BR08 and SmaCV3BR291) and a porprismacovirus recently identified in a human fecal sample from Peru is 37%. These data suggest that there is a great diversity of porprismacoviruses in South America, perhaps more than two species. In addition, the finding of closely related sequences of porprismacoviruses in humans and native monkeys highlights the zoonotic potential of these viruses.

Hand-foot-and-mouth disease (HFMD) is a highly contagious viral disease commonly associated to Enteroviruses (EV). During 2018, Brazil faced massive HFMD outbreaks spread across the country. This study aimed to characterize the EV responsible for the HFMD outbreak that occurred in Paraiba State, Brazilian Northeastern region, in 2018, followed by a phylogenetic analysis to detail information on its genetic diversity. A total of 49 serum samples (one from each patient) collected from children ≤ 15 years old, clinically diagnosed with HFMD were tested for EV using conventional RT-PCR and RT-qPCR. EV infection was confirmed in 71.4% (35/49) of samples. The mean and median ages were 1.83 years and one year old, respectively. Twenty-two EV-positive samples were successfully sequenced and classified as EV-A species; 13 samples were also identified with the CV-A6 genotype. The phylogenetic analysis (VP1 region) of three samples revealed that the detected CV-A6 strains belonged to sub-lineage D3. The CV-A6 strains detected here clustered with strains from South America, Europe and West Asia strains that were also involved in HFMD cases during the 2017-2018 seasons, in addition to the previously detected Brazilian CV-A6 strains from 2012 to 2017, suggesting a global co-circulation of a set of different CV-A6 strains introduced in the country at different times. The growing circulation of the emerging CV-A6 associated with HFMD, together with the detection of more severe cases worldwide, suggests the need for a more intense surveillance system of HFMD in Brazil. In addition, this investigation was performed exclusively on serum samples, and the analysis of whole blood samples should be considered and could have shown advantages when employed in the diagnosis of enteroviral HFMD outbreaks.

Objective  To evaluate elbow flexion in children with obstetric brachial plexus paralysis submitted to Oberlin transfer. Methods  Retrospective study with 11 patients affected by paralysis due to labor who did not present spontaneous recovery from elbow flexion until 12 months of life, operated between 2010 and 2018. Results  The children were operated between 5 and 12 months of life, with a mean of 7.9 months, and the mean follow-up time was 133.2 months, ranging from 37 to 238 months. Six patients (54.5%) presented a degree of muscle strength ≥ 3, measured by the strength scale of the Medical Research Council (MRC) and, according to the active movement scale (AMS), 5 patients obtained a score of ≥ 5. A negative correlation was identified between the AMS and the Narakas classification (r = -0.509), as well as between the strength scale (MRC) and the Narakas classification (r = -0.495). A strong positive correlation was observed (r = 0.935) between the AMS and the MRC demonstrating that the higher the score on the movement scale, the higher the score on the muscle strength scale. Conclusion  The Oberlin surgery is a possible option for recovery of elbow flexion in children with neonatal plexopathy, demonstrating, however, very heterogeneous results, even in the long-term follow-up., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective  The incidence of traumatic brachial plexus injuries has been increasing considerably in Brazil, mainly due to the increase in the number of motorcycle accidents. The aim of the present study is to evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) in the diagnosis of brachial plexus avulsion lesions, comparing it with the findings of physical and intraoperative examination. Methods  A total of 16 patients with brachial plexus injury were prospectively evaluated and treated at the hand surgery outpatient clinic from our service. All patients underwent MRI of the brachial plexus, and the findings were inserted on a table, as well as the physical examination data, and part of the patients had the plexus evaluated intraoperatively. Results  In the present study, the accuracy of MRI in the identification of root avulsion was 100%, with 100% sensitivity and specificity when comparing imaging with surgical findings. Conclusion Magnetic resonance imaging showed high sensitivity and specificity, confirmed by intraoperative findings, which allows considering this test as the gold standard in the diagnosis of avulsion in traumatic brachial plexus injuries., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Squash mosaic virus (SqMV) is a phytovirus that infects great diversity of plants worldwide. In Brazil, the SqMV has been identified in the states of Ceará, Maranhão, Piauí, Rio Grande do Norte, and Tocantins. The presence of non-pathogenic viruses in animals, such as phytoviruses, may not be completely risk-free. Similarities in gene repertories between these viruses and viruses that affect animal species have been reported. The present study describes the fully sequenced genomes of SqMV found in human feces, collected in Tocantins, and analyzes the viral profile by metagenomics in the context of diarrhea symptomatology. The complete SqMV genome was obtained in 39 of 253 analyzed samples (15.5%); 97.4% of them belonged to children under 5 years old. There was no evidence that the observed symptoms were related to the presence of SqMV. Of the different virus species detected in these fecal samples, at least 4 (rotavirus, sapovirus, norovirus, parechovirus) are widely known to cause gastrointestinal symptoms. The presence of SqMV nucleic acid in fecal samples is likely due to recent dietary consumption and it is not evidence of viral replication in the human intestinal cells. Identifying the presence of SqMV in human feces and characterization of its genome is a relevant precursor to determining whether and how plant viruses interact with host cells or microorganisms in the human gastrointestinal tract.

Introduction: This study estimated the seroprevalence and risk factors of Chagas disease (CD) in a population of the Quixeré municipality, Ceará., Methods: We conducted serological methods to detect the Trypanosoma cruzi infection. The other variables were evaluated by a standardized questionnaire., Results: The estimated prevalence of CD was 3.7%. Male sex, age >40 years, being farmers, low education level, origin from rural areas, and being born in Quixeré were significantly associated with infection., Conclusion: CD persists in this rural population of Northeast Brazil. Poverty, low education, and limited information regarding CD are critical issues that need to be addressed.

Introduction: Infection of the surgical site is the common complication, with significant rates of morbidity and mortality, representing a considerable economic problem for the health system., Objective: To carry out a narrative review of the literature on surgical site infection and the principles of antibiotic prophylaxis to update the knowledge of its use in surgery., Method: Medline, Ovid, Google Scholar, National Library of Medicine (PubMed), Cochrane and SciELO were used for the research. The keywords used were "anti-bacterial agents"; "antibioticoprophylaxis" AND "surgical wound infection". The inclusion criteria were articles of recent publication, with full texts available and performed in humans., Result: A total of 29 articles were evaluated and selected according to the eligibility criteria., Conclusion: Infection of the surgical site is the most common postoperative complication. The key point of its prevention is the combination of several interventions that aim to reduce risk factors, such as: compliance with the new guidelines of the Center for Disease Control and Prevention; the principles of the use of prophylactic antibiotics; factors and risk index of the surgical site; administration time; duration and dosage of antibiotics. These data are available in this article.

Background: Mortality after emergency surgery in randomized controlled trials. The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity., Aim: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment., Method: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion., Results: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion., Conclusion: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.

Surveillance of Rotavirus A (RVA) throughout the national territory is important to establish a more complete epidemiological-molecular scenario of this virus circulation in Brazil. The aim of the present study was to investigate the genetic diversity of RVA strains circulating in Tocantins State (Northern Brazil) during six years of post-vaccination follow-up (2010-2016). A total of 248 stool samples were screened by next generation sequencing and 107 (43.1%) nearly full length RVA genome sequences were obtained; one sample was co-infected with two RVA strains (G2/G8P[4]). Six G and P genotypes combinations were detected: G12P[8] strains (78.6%), as well as the G3P[8] (9.3%) and G1P[8] (0.9%) were associated with a Wa-like genogroup backbone. All G2P[4] (5.6%) and G8P[4] (2.8%) strains, including the mixed G2/G8P[4] infection (0.9%) showed the DS-1-like genetic background. The two G12P[4] strains (1.9%) were associated with distinct genetic backbones: Wa-like and DS-1-like. The phylogenetic analysis revealed the circulation of lineages G1-I, G2-IV, G3-III, G8-I and G12-III, and P[4]-V and P[8]-III of the VP7 and VP4 genes, respectively. Conserved clustering pattern and low genetic diversity were observed regarding VP1-VP3 and VP6, as well as NSP1-5 segments. We identified the same RVA circulation pattern reported in other Brazilian regions in the period of 2010-2016, suggesting that rural and low-income areas may not have a different RVA genotypic distribution compared to other parts of the country. The unique presentation of whole-genome data of RVA strains detected in the Tocantins State provides a baseline for monitoring variations in the genetic composition of RVA in this area.

Background: Chagas disease (CD) is considered a public health problem in Latin America. The northeastern region, especially the state of Ceará, still represents a major concern in terms of the risk of transmission of CD., Objective: To estimate the prevalence of T. cruzi in blood donors from the state of Ceará., Methods: This is a retrospective descriptive study that was performed in the period from 2010 to 2015 from data recorded in the computerized system of the Hematology and Hemotherapy Center of Ceará (HEMOCE in Portuguese)., Results: Of the 763,731 potential blood donors, 14,159 were serologically ineligible; 1,982 (0.33%) were serologically ineligible due to positive / inconclusive diagnosis for CD. A total of 425 individuals came to the HEMOCE to repeat the test, with 28.2% (120/425) declared ineligible for donations due to CD., Conclusion: No significant reduction of positive / inconclusive serology was observed in the period between 2010 and 2015, but a reduction was observed when compared to 1996/1997 in the state. The determination of the prevalence of CD in blood banks may be relevant as an indicator of the risk of CD transmission through blood transfusions in a given region. New serological tests for triage with better accuracy in screening are needed, in an attempt to reduce the unnecessary disposal of blood bags, reduce costs for the Brazilian Unified Health System, and diminish insecurity for the patient and family members. (Arq Bras Cardiol. 2020; 115(6):1082-1091).

Human Adenovirus species C (HAdV-C) is the most common etiologic agent of respiratory disease. In the present study, we characterized the nearly full-length genome of one potential new HAdV-C recombinant strain constituted by Penton and Fiber proteins belonging to type 89 and a chimeric Hexon protein of types 1 and 89. By using viral metagenomics techniques, we screened out, in the states of Tocantins and Pará, Northern and North regions of Brazil, from 2010 to 2016, 251 fecal samples of children between 0.5 to 2.5 years old. These children were presenting acute diarrhea not associated with common pathogens (i.e., rotavirus, norovirus). We identified two HAdV-C strains in two distinct patients. Phylogenetic analysis performed using all complete genomes available at GenBank database indicated that one strain (HAdV-C BR-245) belonged to type 1. The phylogenetic analysis also indicated that the second strain (HAdV-C BR-211) was located at the base of the clade formed by the newly HAdV-C strains type 89. Recombination analysis revealed that strain HAdV-C BR-211 is a chimera in which the variable regions of Hexon gene combined HAdV-C1 and HAdV-C89 sequences. Therefore, HAdV-C BR-211 strain possesses a genomic backbone of type HAdV-C89 and a unique insertion of HAdV-C1 in the Hexon sequence. Recombination may play an important driving force in HAdV-C diversity and evolution. Studies employing complete genomic sequencing on circulating HAdV-C strains in Brazil are needed to understand the clinical significance of the presented data.

Aedes aegypti is associated with epidemic diseases in Brazil, such as urban yellow fever, dengue, and more recently, chikungunya and Zika viruses infections. More information about Ae. aegypti infestation is fundamental to virological surveillance in order to ensure the effectiveness of control measures in use. Thus, the present study aims to identify and compare infestation and infectivity of Ae. aegypti females in Macapa city, Amapa State (Amazon region), Brazil, between the epidemiological weeks 2017/02 and 2018/20. A total number of 303 Ae. aegypti females were collected at 21 fixed collection points, 171 at the 10 collection points in the Marabaixo neighborhood and 132 at the 11 collection points in the Central neighborhood. Among the collected samples, only two were positive for dengue virus, with a 2.08% (2/96 pools) infectivity rate for Marabaixo. The difference between the medians of Ae. aegypti females captured in Central and Marabaixo sites was not statistically significant. The findings indicate similar mosquito infestation levels between the neighborhoods, and a low-level of mosquito infectivity, although dengue virus was found only in Marabaixo. Virological surveillance of Ae. aegypti was important to identify sites of infection and determine possible routes of transmission to enable health surveillance teams to adopt preventive strategies where infected mosquitoes are present and act faster.

Diarrhea remains one of the most common causes of deaths in children. Although many studies have investigated the prevalence of enteric pathogens around the globe some diarrheal episodes remain unexplained. It is possible that some yet-unidentified viral agents could be related to these cases of gastroenteritis. By using viral metagenomics techniques, we screened 251 fecal samples of children between 0.5 to 2.5-year-old with acute diarrhea not associated with common pathogens. These children live in rural areas and have different levels of contact with animals such as pigs, cows and bats. Here we report a complete genome of one mammalian orthoreovirus (MRV) type 3, denoted TO-151/BR, detected in a female child in the state of Tocantins (north of Brazil). Brazilian TO-151/BR strain was classified as MRV-3 based on S1 phylogeny and was closely related to porcine Asian strains. Phylogenetic analyses showed that other segments were more similar to MRV-3s of different geographic locations and hosts, including human and bats, highlighting genome reassortment and lack of host-specific barriers. This is the first report of MRV-3 in South America and a hypothesis of a silent long-term circulation of this virus in Brazil has been raised.

We characterized the 24 nearly full-length genomes of human parechoviruses (PeV) from children in the north of Brazil. The initial phylogenetic analysis indicated that 17 strains belonged to genotype 1, 5 to genotype 4, and 1 to genotype 17. A more detailed analysis revealed a high frequency of recombinant strains (58%): A total of 14 of our PeV-As were chimeric, with four distinct recombination patterns identified. Five strains were composed of genotypes 1 and 5 (Rec1/5); five strains shared a complex mosaic pattern formed by genotypes 4, 5, and 17 (Rec4/17/5); two strains were composed of genotypes 1 and 17 (Rec1/17); and two strains were composed of genotype 1 and an undetermined strain (Rec1/und). Coalescent analysis based on the Vp1 gene, which is free of recombination, indicated that the recombinant strains most likely arose in this region approximately 30 years ago. They are present in high frequencies and are circulating in different small and isolated cities in the state of Tocantins. Further studies will be needed to establish whether the detected recombinant strains have been replacing parental strains or if they are co-circulating in distinct frequencies in Tocantins.

Human sapoviruses (HSaV) are considered important causative agents of acute gastroenteritis in humans worldwide. However, knowledge of the genetic characteristics of the whole genome of HSaV in Brazil is limited. Here we report the complete genome sequences of six HSaVs GI.2 and two GI.3 strains obtained from children with acute gastroenteritis in the Northern region of Brazil. Next generation sequencing was used to obtain the full genome and molecular characterization of the genome was performed. Phylogenetic analysis of the genome was also performed. Only one complete HSaV GI.2 genome characterization in the country precedes that of the present study. This is the first complete genome sequence of genotype GI.3 in Brazil. The data obtained in this investigation can contribute to the augmentation of the database on the molecular diversity of HSaVs strains circulating in Brazil, and to the improvement of current typing protocols.

Classical insect-specific flaviviruses (cISFs) have been widely detected in different countries in the last decades. Here, we characterize the near full-length genomes of two cISFs detected in mosquitoes collected in the city of Macapá, state of Amapá, Amazon region of Brazil. A total of 105 pools of female mosquitos were analyzed by next-generation sequencing (NGS). Comparative genomics and phylogenetic analysis identified three strains of cell fusing agent virus (CFAV) and two of Culex flavivirus (CxFV). All sequences were obtained from pools of Culex sp., except for one sequence of CFAV detected in a pool of Aedes aegypti. Both CxFV strains are phylogenetically related to a strain isolated in 2012 in the Southeast region of Brazil. The CFAV strains are the first of this species to be identified in Brazil and one of them is highly divergent from other strains of CFAV that have been detected worldwide. In conclusion, CFAV and CxFV, circulate in mosquitoes in Brazil. One strain of CFAV is highly divergent from others previously described, suggesting that a novel strain of CFAV is present in this region., Competing Interests: The authors declare no conflict of interest.

Introduction: The transmission of Chagas disease (CD) through blood transfusion, organ transplantation, and oral transmission has gained greater visibility as a result of intensified vector control activities in endemic regions and to control CD in non-endemic regions. In Brazil, Ceará is one of the states that perform the most organ transplants. Therefore, the objective of this study was to assess the prevalence of Trypanosoma cruzi infection in organ donor candidates., Methods: A retrospective analysis was performed on data from potential organ donors at the Center of Transplantation of the State of Ceará from 2010 - 2015., Results: Data from a total of 2,822 potential donors were obtained, of which 1,038 were effective donors and 1,784 were excluded, likely due to lack of family authorization or medical contraindication. The prevalence of T. cruzi infection among these potential donors was 1.3% (n = 29). The majority of infected donors were males aged 41 - 60 years, residing in the interior of the state. Interestingly, 72.4% (n = 21) had positive or inconclusive serology for additional infections, such as cytomegalovirus, hepatitis B and C, and toxoplasmosis. Probability analysis revealed that stroke was the most common cause of death among potential donors with CD., Conclusions: There was a high prevalence of CD and other coinfections among potential solid organ donors in Ceará, and statistical tests have shown that these individuals are at increased risk of stroke when compared to potential non-reactive donors. This work highlights the importance of screening DC infection in potential donors.

In 2005, a pharmaceutical care service was created in the State of Ceará to provide pharmacotherapeutic follow-up for individuals infected with Trypanosoma cruzi (Chagas Disease). After 10 years of operation, an evaluation was conducted to assess the degree of satisfaction of patients treated under the service. This prospective study used a questionnaire comprising the following sections: socioeconomic data; infrastructure, facilities and operations; pharmaceutical care; and importance of the service. Seventy patients of both sexes and over 18 years of age were interviewed between August 2014 and May 2015. As for infrastructure, location and operation, the average grades show a high level of patient satisfaction. Regarding pharmaceutical care, most patients reported being satisfied and considered "being well treated" to be the most important aspect during treatment. In addition, all patients (100%) rated the service as very important and would recommend it to other individuals. Overall, the study showed a high level of patient satisfaction with the service. There is, however, still much to work to be done on this service in order to promote greater access and qualified care to fully achieve a humanized model focused on patient needs.

Introduction: Chagas disease remains a public health problem in the rural and urban areas of 19 countries in the Americas., Methods: The aim of the present study was to investigate the Trypanosoma cruzi infection rate of triatomines collected from both intra- and peridomiciliary areas in eleven municipalities of Southeastern Ceará, Brazil, from 2009 to 2015., Results: A total of 32,364 triatomine specimens, including nymphs and adults, were collected, and 31,736 (98.06%) of these were examined. More nymphs were collected than adults, and the greatest number of triatomines (n = 8,548) was collected in 2010, for which the infection rate was 1.3%, with the highest rate of infections observed for specimens from Quixere. The species collected during the study were identified as Triatoma pseudomaculata, Triatoma brasiliensis, Panstrongylus megistus, Panstrongylus lutzi, and Rhodnius nasutus, with T. pseudomaculata being the most abundant (n = 19,962)., Conclusions: These results verify the presence of triatomines in both intra- and peridomiciliary areas, thereby ensuring persistence of the pathogen and consequently, the disease, as the presence of infected vectors in households is an important risk factor. According to these findings, the Chagas Disease Control Program should intensify its efforts in order to prevent the spread of the disease.

Objective: The objective of this study was to present a proposal tomographic classification for intra-articular distal radius fractures., Methods: This descriptive study was based on observing tomographic images from 74 patients with distal radius fractures. The cases were grouped by similarity according to the presence of several parameters which determine fracture complexity; the results of the descriptive analysis were transcribed as tomographic classification., Results: The proposal tomographic classification for intra-articular distal radius fractures comprised three major groups and nine sub-groups, which are organized by increasing severity according to the presence of spacing between articular fragments, angulation, loss of radial height, cortical depression, and associated dislocation., Conclusion: This proposal tomographic classification for intra-articular distal radius fractures can help professionals indicate therapeutic options. Level of Evidence IV; Case series., Competing Interests: All authors declare no potential conflict of interest related to this article.

Objective: To evaluate the arc of forearm pronosupination of patients with sequelae of birth paralysis and correlate with these variables., Methods: 32 children aged between 4 and 14 years with total or partial lesions of the brachial plexus were evaluated; measurements of pronation and supination, active and passive, were made, both on the injured side and the unaffected side., Results: A statistically significant difference was observed between the injured side and the normal side, but there was no difference between the groups regarding age or type of injury., Conclusion: The age and type of injury did not impact on the limitation of the forearm pronosupination in children with sequelae of birth paralysis.

Objectives: Development of new tools for rapid and accurate diagnosis of tuberculosis (TB) is considered a strategy for controlling the disease. The recombinant CMX fusion protein is composed of immunodominant epitopes of the Ag85C (Rv0129c), MPT51 (Rv3803c) and the entire HspX (Rv2031c) proteins from Mycobacterium tuberculosis H37Rv (Mtb). The aim of this study was to evaluate the applicability of a test using the CMX protein in individuals suspected of TB., Methods: Indirect ELISA was used to measure serum anti-CMX IgM and IgG in individuals with pulmonary TB., Results: Patients with pulmonary TB had higher titers of IgM (OD = 0.502 ± 0.281) than healthy controls (OD = 0.200 ± 0.125). The cutoff for IgM-ELISA was determined using ROC curve analyzes (AUC = 0.868) with a sensitivity of 80.1% and a specificity of 78.2%. Patients with pulmonary TB also had higher titers of IgG (OD = 0.525 ± 0.391) than healthy controls (OD = 0.215 ± 0.077). The cutoff for IgG-ELISA was determined using ROC curve analyzes (AUC = 0.864) with a sensitivity of 81.7% and a specificity of 74.7%., Conclusion: The results suggest that the recombinant protein CMX can be used in a serological test to complement the screening of individuals suspected of having active pulmonary TB.

Introduction: Benznidazole (BNZ) is a drug available for the etiological treatment of Chagas disease. However, this drug is toxic and has a limited effectiveness on the chronic phase of this disease, often leading to poor treatment adherence., Methods:: This is a descriptive and exploratory study conducted at the Pharmaceutical Care Service for Chagas disease patients of the Federal University of Ceará. Drug-related problems (DRPs) and pharmaceutical interventions (PIs) were classified according to the Second Consensus of Granada., Results:: The average age of patients with Chagas disease was 62 years, with the majority residing in the Ceará countryside (86.7%), and having low education levels (63.3% with elementary school education). Regarding family income, most patients belonged to a household that earned ≤1-2 times the minimum wage per month. Approximately 73% of these patients complied with the BNZ treatment, and nearly 7% underwent therapy interruption after medical evaluation. A total of 189 DRPs were identified, of which 51.9% (n=98) were classified as potential, and 48.1% (n=91) as actual. The most frequent DRPs were related to safety (qualitative safety; n=70; 37%), necessity (non-adherence; n=52; 27.5%), and effectiveness (qualitative effectiveness/non-optimal drug selection; n=45; 23.8%). Among the 216 PIs conducted, the majority were related to patient education (n=168; 77.8%) and pharmacological strategy (n=42; 19.4%)., Conclusions:: This study indicates the need for pharmacotherapeutic monitoring in patients with Chagas because of the high number of therapeutic interventions, DRPs (approximately 3 DRPs/patient), BNZ adherence, and polypharmacy.

The aim of this work was to study cocktail supplementation for sugar cane bagasse hydrolysis, where the enzymes were provided from both commercial source and microorganism cultivation (Trichoderma reesei and genetically modified Escherichia coli), followed by purification. Experimental simplex lattice mixture design was performed to optimize the enzymatic proportion. The response was evaluated through hydrolysis microassays validated here. The optimized enzyme mixture, comprised of T. reesei fraction (80%), endoglucanase (10%) and β-glucosidase (10%), converted, theoretically, 72% of cellulose present in hydrothermally pretreated bagasse, whereas commercial Celluclast 1.5L converts 49.11%±0.49. Thus, a rational enzyme mixture designed by using synergism concept and statistical analysis was capable of improving biomass saccharification., (Copyright © 2015 Elsevier Ltd. All rights reserved.)