Search

In light of the concept of scenic truth, this paper discusses the influences of the Stanislavski method in the early experiments of the Arena Theatre of São Paulo, and also shows traces of the Russian master’s principles in the Poetics of the Oppressed of Augusto Boal. The primary objective of the article is to encourage the construction of Forum Theatre, which uses physical rigor and Stanislavski’s psychological breakdown as points of departure. This work can be developed as the actor’s internal logic during the phase that precedes the creative process, before the intervention of audiences, and within professional staging of Forum Theatre with more long lasting results.

Human Immunodeficiency Virus (HIV), Human T Lymphotropic Virus (HTLV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) coinfection may lead to disease progression or worsen its clinical presentation. Viral coinfections screening during blood donation is critical. To identify risk factors for coinfection among blood donors, we assessed the blood donations at the Fundação de Hematologia e Hemoterapia da Bahia, from 2008 to 2017. We compared serological/molecular evidence of single infection versus two or more viral blood-borne infections-BBI). A multivariable logistic regression model was performed to evaluate independent associations between characteristics of donors with single infection and multiple infection using "non-infection" category as reference. Among 777,446 collected blood donations, 27 358 (3.5%) were reactive, most (n = 26 677, 97.6%) for a single infection and 681 (2.4%) for coinfection. The most frequent coinfections were HBV-HIV (30.6%), HBV-HCV (30.4%), and HBV-HTLV (24.4%). Male sex, lower education, being single, and being a first-time donor were independently associated with both single and coinfections. Nevertheless, the adjusted odds for risk factors of coinfections were much higher than those for single infection. Donors with single and coinfection for BBI shared identical risks, but they were significantly higher for coinfection. Preventive strategies addressing the identified risks can decrease transmission of viral BBI by blood transfusion., (© 2025 Wiley Periodicals LLC.)

Background: Traumatic dental injuries (TDIs) in early childhood exert a negative impact on the quality of life of children and their families. However, there is no evidence from cohort studies on which to base prevention strategies at the beginning of life, when children are entirely dependent upon supervision. The aim of the present study was to estimate the incidence of TDI in the first year of life and explore risk factors in a birth cohort followed up in three major cities in different regions of Brazil., Methods: A birth cohort study was conducted with children in the cities of Porto Alegre, Salvador, and Manaus. Socioeconomic, demographic, and anthropometric characteristics were collected at baseline. Behavioral characteristics were collected when the children were six and 12 months of age. After the first year of life, clinical examinations were performed by trained, calibrated dentists for the assessment of TDI (Andreasen's criteria). Poisson regression models were used to estimate associations between the independent variables and TDI, with the calculation of crude and adjusted relative risk (RR) and respective 95% confidence intervals (CI)., Results: The incidence of TDI in the first year of life (range: 12 to 16 months) was 18.1% (95% CI: 13.6-22.6%). The multivariable analysis revealed a significantly greater risk of TDI in children from non-nuclear families (RR = 1.83; 95% CI: 1.11-3.00) as well as those whose mothers had a higher level of schooling (RR = 2.42; 95% CI: 1.04-5.63) and when tooth eruption began up to six months of age (RR = 2.30; 95% CI: 1.34-3.95). Being the first-born child was a protective factor (RR = 0.48; 95% CI: 0.27-0.87) for the occurrence of the outcome., Conclusion: The high incidence of TDI in the first year of life indicates the need for primary prevention strategies with an emphasis on active supervision in the first months of life. Risk factors associated with TDI related to the family, mother and child suggest pathways for the planning of such strategies., Competing Interests: Declarations. Ethics approval and consent to participate: This study was performed in line with the principles of the Declaration of Helsinki and approved by the Human Research Ethics Committee of Universidade Federal de Ciências da Saúde de Porto Alegre (No. 88214918.3.0000.5345) and was registered with clinicaltrials.gov (nº NCT03841123). All parents signed a statement of informed consent after receiving clarifications regarding the intervention and all phases of the data collection process. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objectives: This study aimed to define handgrip strength (HGS) cutoff points to predict 1-year mortality in adult patients with liver cirrhosis., Methods: This is an analysis of cohort databases from four reference centers in Brazil. Inpatients or outpatients with cirrhosis and aged ≥18 years were included. The best cutoff values of HGS (highest value from three attempts with the non-dominant hand) for predicting 1-year mortality, stratified by sex and age, were established based on the sensitivity and specificity analyses. Adjusted Cox regression models were used to test the predictive value of low HGS., Results: The study included 724 patients with cirrhosis, with a median age of 57.0 years (IQR: 50.0-63.0), 66.4% (n = 481) male. Most patients had alcoholic cirrhosis (n = 281; 38.8%), 400 (55.3%) were classified as Child-Pugh B or C, and 134 (18.5%) patients died after 1-year. The HGS cutoffs were ≤33 kgf and ≤12 kgf for men and women aged <60 years, respectively, and ≤22 kgf and ≤10 kgf for older men and women, respectively (sensitivity: 70.9%; specificity: 61.2%). Low HGS was associated with a 2.5-fold increase in the risk of 1-year mortality., Conclusion: These cutoff points could be used to identify patients with a higher mortality risk., Competing Interests: Competing interests: The authors declare no competing interests. Ethical approval: The study was performed in accordance with the Declaration of Helsinki and was approved by the ethics committees from the following institutions: Universidade Federal de Minas Gerais, Universidade Federal da Bahia, Universidade Estadual Paulista, and Universidade Federal do Rio Grande do Sul., (© 2025. The Author(s), under exclusive licence to Springer Nature Limited.)

There are insufficient predictors of progression to tuberculosis among contacts. A case-control study within RePORT-Brazil matched 20 QuantiFERON-positive progressors and 40 non-progressors by sex, age, and exposure duration. Twenty-nine cytokines were measured by Luminex in QuantiFERON-TB Gold Plus supernatants collected at baseline and evaluated using machine learning for tuberculosis prediction. The same markers were evaluated in 8 QuantiFERON positive progressors and 12 non-progressors from India. IL-8, IL-10, and CCL3 levels predicted incident tuberculosis (AUC: 0.75) in two years with sensitivity and specificity higher than 80%, in both cohorts. This signature predicted tuberculosis progression in close contacts meeting WHO goals., (© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Patient-reported outcomes (PROs) facilitate communication between patients and providers, enhancing patient-centered care. We report PROs for virologically suppressed people living with HIV-1 who switched to dolutegravir/lamivudine (DTG/3TC) or continued their 3- or 4-drug current antiretroviral regimen (CAR) in the phase 3 SALSA study. Secondary endpoints included change from baseline in HIV Treatment Satisfaction Questionnaire (status version; HIVTSQs) and HIV Symptom Distress Module (HIV-SDM) at Weeks 4, 24, and 48. A post hoc analysis assessed change in HIVTSQs and HIV-SDM by age (≥ 50 and < 50 years). Higher HIVTSQs scores represent greater treatment satisfaction (range, 0-60); lower HIV-SDM scores indicate less symptom bother (range, 0-80). Participants in the DTG/3TC (n = 246) and CAR (n = 247) groups reported comparable baseline HIVTSQs total scores (mean [SD], 55.2 [6.5] and 55.8 [5.5], respectively). Beginning at Week 4, mean HIVTSQs scores in the DTG/3TC group further increased vs. CAR and were sustained through Week 48. Baseline mean (SD) HIV-SDM symptom bother scores were comparable between the DTG/3TC (9.0 [9.9]) and CAR (7.9 [9.3]) groups. Small improvements in HIV-SDM scores favoring DTG/3TC were observed at Weeks 4 and 24 and sustained through Week 48 (though not significant between groups). Participants aged ≥ 50 and < 50 years who switched to DTG/3TC reported higher satisfaction and less symptom distress vs. CAR; these results were generally comparable between age groups. Participants who switched to DTG/3TC reported rapid and sustained improvements in treatment satisfaction compared with those who continued CAR, reinforcing the benefits of DTG/3TC beyond virologic suppression (NCT04021290; registration date, 7/11/2019)., Competing Interests: Declarations. Ethical Approval: This study was designed in agreement with the International Conference on Harmonization Good Clinical Practice and adhered to the principles of the Declaration of Helsinki. Study documents were reviewed and approved by national, regional, or investigational center ethics committees or institutional review boards. Consent to Participate: Written informed consent was obtained before participant screening. Consent to Publish: Not applicable. Competing Interests: PK has received grants from Gilead, Merck, Theratechnologies, and ViiV Healthcare/GSK (paid to institution); has received consulting fees from and participated in data safety monitoring/advisory boards for Gilead, Merck, and ViiV Healthcare/GSK; and holds stock/stock options in Gilead, GSK, Johnson & Johnson, Merck, Moderna, and Pfizer. AEC has received grants from Gilead, GSK, MSD, and ViiV Healthcare (paid to institution); speaker fees from MSD; travel/meeting support from Gilead and ViiV Healthcare; and has participated in advisory boards for MSD, Theratechnologies, and ViiV Healthcare. CJ-O has received consulting fees from GSK and ViiV Healthcare; honoraria from AbbVie, CCO, Gilead, GSK, Janssen-Cilag, and ViiV Healthcare; payment for expert testimony from GSK and ViiV Healthcare; travel/meeting support from CCO, Gilead, GSK, Janssen-Cilag, MSD, and ViiV Healthcare; has participated in data safety monitoring/advisory boards for Gilead, GSK, Janssen-Cilag, MSD, and ViiV Healthcare; and holds a leadership role with BAGNAE. MGD has received grants and honoraria from and participated in data safety monitoring/advisory boards for AbbVie, Gilead, Janssen, MSD, and ViiV Healthcare; has received meeting/travel support from Gilead and Janssen; and has received equipment/materials from Gilead. SDG has no competing interests. CB has received research grants from GSK and Pfizer and received speaker fees from and participated in advisory boards for Gilead, GSK, and Merck. LH has received honoraria and meeting/travel support from Gilead, MSD, and ViiV Healthcare. P-LL has no competing interests. JO, AO, BW, BJ, LAE, DF, MK, and JP are employees of GSK or ViiV Healthcare and may own stock in GSK., (© 2024. The Author(s).)

Land use change threatens global biodiversity and compromises ecosystem functions, including pollination and food production. Reduced taxonomic α-diversity is often reported under land use change, yet the impacts could be different at larger spatial scales (i.e., γ-diversity), either due to reduced β-diversity amplifying diversity loss or increased β-diversity dampening diversity loss. Additionally, studies often focus on taxonomic diversity, while other important biodiversity components, including phylogenetic diversity, can exhibit differential responses. Here, we evaluated how agricultural and urban land use alters the taxonomic and phylogenetic α-, β-, and γ-diversity of an important pollinator taxon-bees. Using a multicontinental dataset of 3117 bee assemblages from 157 studies, we found that taxonomic α-diversity was reduced by 16%-18% in both agricultural and urban habitats relative to natural habitats. Phylogenetic α-diversity was decreased by 11%-12% in agricultural and urban habitats. Compared with natural habitats, taxonomic and phylogenetic β-diversity increased by 11% and 6% in urban habitats, respectively, but exhibited no systematic change in agricultural habitats. We detected a 22% decline in taxonomic γ-diversity and a 17% decline in phylogenetic γ-diversity in agricultural habitats, but γ-diversity of urban habitats was not significantly different from natural habitats. These findings highlight the threat of agricultural expansions to large-scale bee diversity due to systematic γ-diversity decline. In addition, while both urbanization and agriculture lead to consistent declines in α-diversity, their impacts on β- or γ-diversity vary, highlighting the need to study the effects of land use change at multiple scales., (© 2025 John Wiley & Sons Ltd.)

We report herein the case of a 41-year-old man operated on for a small inferior parietal lobule ganglioglioma with a sleep-awake-sleep protocol and language mapping to avoid major speech disorders. Postoperatively, however, writing disturbance was characterized by persistent graphemic errors that lasted for about 8 months. The topic is discussed in light of recent literature, exploring the possible relationship between writing difficulties and disconnections produced by a combination of resecting supramarginal gyrus components and interrupting arcuate fasciculus fibers. Awake mapping of eloquent structures is typically done using direct brain stimulation to maximize the extent of the resection while minimizing permanent neurological deficits. However, most intraoperative language tests focus on language skills such as oral and reading skills. Therefore, the detection of dysgraphia requires a high degree of attention from the surgical team and direct examination intra-and perioperatively. To this end, employing an intraoperative writing test during awake surgery may be considered. Advances in this field may aid in increasing the accuracy during parenchymal dissections, influencing the extent of the resection, improving the patient's functional prognosis and long-term quality of life., Competing Interests: Conflict of Interest Statement. The authors have no conflicts of interest to declare., (© 2025. The Author(s).)

Blanchetia heterotricha is a species popularly used for its medicinal properties. However, few scientific records report the investigation of its chemical composition and biological activity. Herein, a metabolomics and multivariate statistical analysis approach was used to assess the chemical composition, antioxidant, and antimicrobial activity of B. heterotricha essential oil (BHEO) and fixed extracts (nonvolatile). Thirty-six metabolites were identified in the essential oil by gas chromatography-mass spectrometry (GC-MS), whereas 59 metabolites were identified in the fixed extracts by high-performance liquid chromatography coupled with high-resolution mass spectrometry (HPLC-HRMS). The essential oil and fixed extracts showed varying degrees of antioxidant and antimicrobial activities. The antioxidant activity varied from 7.27 ± 0.95 µg mL -1 for the root methanolic extract to 513.25 ± 7.77 µg mL -1 for the seed hexane extract. Extracts obtained with ethyl acetate showed the most promising antimicrobial activity, followed by extracts obtained with methanol and hexane. Multivariate statistical analysis allowed the identification of possible contributors to the observed activities within the extracts. This is the first study to assess the antimicrobial activity in any Blanchetia species. The combination of metabolomics and multivariate statistical analysis was a powerful tool to identify bioactive compounds, highlighting the potential of BHEO and fixed extracts as sources of metabolites with antioxidant and antimicrobial properties., (© 2024 Wiley‐VHCA AG, Zurich, Switzerland.)

Background: Tuberculosis vaccine trials using disease as the primary endpoint are large, time consuming, and expensive. An earlier immunological measure of the protection against disease would accelerate tuberculosis vaccine development. We aimed to assess whether the effectiveness of the Bacillus Calmette-Guérin (BCG) vaccine for prevention of Mycobacterium tuberculosis infection was consistent with that for prevention of tuberculosis disease., Methods: We conducted an individual participant data (IPD) meta-analysis on experimental and observational longitudinal studies before April 6, 2018, identified through systematic reviews, known to us through expert knowledge in the field, reporting on BCG vaccination status, M tuberculosis infection test (QuantiFERON IFN-γ release assay [IGRA] and tuberculin skin test [TST]), and tuberculosis incidence. Cohort studies were included only for countries with a mandatory neonatal BCG vaccination policy. Exclusion criteria were previous or current tuberculosis disease, HIV infection, tuberculosis preventive treatment usage, and for household contacts, a positive baseline IGRA or TST test and young children aged 0-2 years; for randomised controlled trials, TST results within 2 years after random assignation were excluded. We contacted the investigators of the identified studies to provide IPD. We compared the protective efficacy of the BCG vaccine against M tuberculosis infection with that against tuberculosis disease using mixed-effects, multivariable proportional hazards modelling, by study type, M tuberculosis infection test (IGRA and TST), cutoff for defining test positivity, age, sex, and latitude., Findings: We identified 79 studies eligible for full screening and of these, IPD datasets from 14 studies were included in our analysis: 11 household contact studies (29 147 participants), two adolescent cohort studies (11 368 participants), and one randomised controlled trial (2963 participants). Among 28 188 participants we found no protection by the BCG vaccine against TST conversion regardless of cutoff in any type of study. Among 1491 household contacts, but not among 5644 adolescents, the BCG vaccine protected against QuantiFERON conversion at the primary cutoff of 0·7 IU/mL or more with the adjusted hazard ratio (0·65, 95% CI 0·51-0·82) being consistent with that for protection against disease (0·68, 0·18-2·59). Protection against QuantiFERON conversion at cutoff of 0·35 IU/mL or more (0·64, 0·51-0·81) was similar., Interpretation: Protection from the BCG vaccination against M tuberculosis infection, measured as QuantiFERON conversion, is inconsistent across different groups. Among groups with recent household exposure, QuantiFERON conversion is consistent with protection against disease and could be evaluated as a proxy for disease in tuberculosis vaccine trials. We found that TST lacks value for prevention in phase 2b proof-of-concept trials., Funding: Bill & Melinda Gates Foundation., Competing Interests: Declaration of interests PTP is currently employed by IAVI but was employed at the KNCV Tuberculosis Foundation at the time of the research. RGW is funded by the Wellcome Trust (218261/Z/19/Z), National Institutes of Health (1R01AI147321-01, G-202303-69963, and R-202309-71190), The European & Developing Countries Clinical Trials Partnership (EDCTP; RIA208D-2505B), UK Medical Research Council (CCF17-7779 via SET Bloomsbury), Economic and Social Research Council (ES/P008011/1), Bill & Melinda Gates Foundation (INV-004737, INV-035506), and WHO (2020/985800-0). ASR is supported by the UK Foreign, Commonwealth and Development Office (Leaving No-one Behind Transforming Gendered Pathways to Health for Tuberculosis). FGJC has grants from EDCTP (RIA2018D-2509, RIA2018D-2511, and RIA2020I-3305). ACC is a senior investigator from the Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil. NEA is funded by the US Department of Defense (HU 001-17-2-0023, HU001-19-2-0125, and HU 0001-20-2-007) for unrelated BCG research. MB has grants from EDCTP (HORIZON-JU-GH-EDCTP3-2022-01, RIA2017T-2019, and RIA2018CO-2515) the ANRS Emerging Infectious Diseases (ANRS0405s), the Initiative (23SANIC208), and the INSERM. JAV is currently a federal employee with the National Center for Emerging and Zoonotic Infectious Diseases, Division of High Consequence Pathogens and Pathology, at the Centers for Disease Control and Prevention (CDC). All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The mechanisms that mediate immune protection in individuals with subclinical (SC) or asymptomatic infection with Leishmania braziliensis are largely unknown. Neutrophils (polymorphonuclear leukocytes [PMNs]) have been implicated in progressive symptomatic cutaneous leishmaniasis (CL), but their potential participation in maintenance of subclinical infection is unexplored. The aim of this study was to compare the phenotypic and functional profiles of PMNs in individuals with SC infection versus patients with symptomatic CL due to L braziliensis., Methods: Subjects were recruited in the endemic region of Corte de Pedra, Bahia, Brazil. Surface markers to define activation status were characterized by flow cytometry. Functional responses of PMNs including phagocytic capacity, production of oxidative species, and oxidative killing of intracellular parasites were studied in vitro., Results: PMNs from individuals with SC infection displayed a more activated phenotype and greater ability to control the infection than PMNs from patients with CL. In contrast, PMNs from patients with CL exhibited higher expression of HLA-DR and higher production of oxidative species than PMNs from subjects with SC infection., Conclusions: PMNs from individuals with SC infection can control the infection more efficiently than PMNs from patients with CL, despite the lower production of oxidants. Our observations suggest that L braziliensis may evade microbicidal mechanisms of PMNs from patients with CL, contributing to parasite dissemination and the establishment of disease., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Anthropogenic landscape modification may lead to the proliferation of a few species and the loss of many. Here we investigate mechanisms and functional consequences of this winner-loser replacement in six human-modified Amazonian and Atlantic Forest regions in Brazil using a causal inference framework. Combining floristic and functional trait data for 1,207 tree species across 271 forest plots, we find that forest loss consistently caused an increased dominance of low-density woods and small seeds dispersed by endozoochory (winner traits) and the loss of distinctive traits, such as extremely dense woods and large seeds dispersed by synzoochory (loser traits). Effects on leaf traits and maximum tree height were rare or inconsistent. The independent causal effects of landscape configuration were rare, but local degradation remained important in multivariate trait-disturbance relationships and exceeded the effects of forest loss in one Amazonian region. Our findings highlight that tropical forest loss and local degradation drive predictable functional changes to remaining tree assemblages and that certain traits are consistently associated with winners and losers across different regional contexts., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Context: There is growing evidence that insufficient dietary intake is associated with sarcopenia., Objective: In this systematic review and meta-analysis, the energy and nutrient intakes by people with and without sarcopenia were compared using only the European Working Group on Sarcopenia in Older People 2010 (EWGSOP1) and 2019 (EWGSOP2) consensus diagnostic criteria., Data Sources: Only observational studies that compared energy and nutrient intake from food alone by individuals with and without sarcopenia were included. Studies were searched in the following databases: Embase, PubMed, Scopus, Web of Science, Lilacs, Ovid, and Scopus. The review followed the PRISMA checklist and submitted the protocol to PROSPERO., Data Extraction: Data were extracted by 2 authors independently. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale., Data Analysis: A total of 8648 articles were identified and 12 were selected. Among individuals with sarcopenia, lower intakes of energy and some nutrients, mainly with antioxidant properties, were observed compared with those without sarcopenia. Meta-analyses showed that individuals with sarcopenia consume fewer calories/day than individuals without sarcopenia (n = 10 studies; standardized mean difference (SMD) -0.15; 95% confidence interval: -0.29, -0.01) diagnosed by EWGSOP1 and EWGSOP2. Individuals with sarcopenia consume less omega-3, folate, magnesium, phosphorus, selenium, zinc, and vitamins C, D, and E when compared with those without sarcopenia., Conclusion: The results of the present study suggest that insufficient intake of energy and nutrients with antioxidant potential may be associated with sarcopenia., Systematic Review Registration: PROSPERO registration no. CRD 42020195698., (© The Author(s) 2023. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

There are few cerebrotendineous xanthomatosis (CTX) case series and observational studies including a significant number of Latin American patients. We describe a multicenter Brazilian cohort of patients with CTX highlighting their clinical phenotype, recurrent variants and assessing possible genotype-phenotype correlations. We analyzed data from all patients with clinical and molecular or biochemical diagnosis of CTX regularly followed at six genetics reference centers in Brazil between March 2020 and August 2023. We evaluated 38 CTX patients from 26 families, originating from 4 different geographical regions in Brazil. Genetic analysis identified 13 variants in the CYP27A1 gene within our population, including 3 variants that had not been previously described. The most frequent initial symptom of CTX in Brazil was cataract (27%), followed by xanthomas (24%), chronic diarrhea (13.5%), and developmental delay (13.5%). We observed that the median age at loss of ambulation correlates with the age of onset of neurological symptoms, with an average interval of 10 years (interquartile range 6.9 to 11 years). This study represents the largest CTX case series ever reported in South America. We describe phenotypic characteristics and report three new pathogenic or likely pathogenic variants., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Platelet concentrates undergo progressive changes during storage, such as a decrease in pH. Additionally, pH and lactate production showed the strongest correlation with platelet survival in posttransfusion viability studies. pH measurement is a straightforward method for evaluating the quality control of blood components in blood bank practice. Our aim was to compare three pH assessment methods for canine platelet concentrates. The pH values of the canine platelet concentrates were assessed on the first day of storage using a calibrated pH meter, a portable gas analyzer and pH-indicator strips. The results from the pH meter and portable gas analyzer measurements were similar. The pH indicator strips presented higher average values compared to the other more reliable methods evaluated, which could result in the use of inadequate blood components. In conclusion, it is recommended to implement pH measurements using a pH meter for quality control in veterinary blood banks., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

A new species of Characidium shared by adjacent tributaries of the upper portions of the Tapajós and Xingu river basins is described. Characidium varii, new species, can be distinguished from the congeners by having distinctly speckled pattern of colouration, including dark blotches on cheek and ventral surface of head, by having conspicuous dark marks on fins, along with a single row of dentary teeth, isthmus completely covered by scales, 14 circumpeduncular scales, and swimbladder reduced. Molecular data reinforce the validation of the new species. The distribution of C. varii supports the hypothesis of the existence of a faunistic mixing between Tapajós and Xingu river basins, corresponding to the region of the Serra do Cachimbo and surrounding areas, previously proposed in the literature., (© 2024 Fisheries Society of the British Isles.)

Habitat loss can lead to biotic homogenization (decrease in β diversity) or differentiation (increase in β diversity) of biological communities. However, it is unclear which of these ecological processes predominates in human-modified landscapes. We used data on vertebrates, invertebrates, and plants to quantify β diversity based on species occurrence and abundance among communities in 1367 landscapes with varying amounts of habitat (<30%, 30-60%, or >60% of forest cover) throughout the Brazilian Atlantic Forest. Decreases in habitat amount below 30% led to increased compositional similarity of vertebrate and invertebrate communities, which may indicate a process of biotic homogenization throughout the Brazilian Atlantic Forest. No pattern was detected in plant communities. We found that habitat loss was associated with a deterministic increase in faunal community similarity, which is consistent with a selected subset of species being capable of thriving in human-modified landscapes. The lack of pattern found in plants was consistent with known variation between taxa in community responses to habitat amount. Brazilian legislation requiring the preservation of 20% of Atlantic Forest native vegetation may be insufficient to prevent the biotic homogenization of faunal communities. Our results highlight the importance of preserving large amounts of habitat, providing source areas for the recolonization of deforested landscapes, and avoiding large-scale impacts of homogenization of the Brazilian Atlantic Forest., (© 2024 Society for Conservation Biology.)

Background: While COVID-19 vaccination has been shown to reduce the risk of severe illness, its impact on the occurrence of persistent symptoms in patients with mild Omicron infection remains uncertain. Our objective was to investigate whether COVID-19 vaccination reduces the occurrence of persistent COVID-19-related symptoms 3 months after mild Omicron infection., Methods: Multicenter prospective cohort study was conducted in Brazil between January 2022 and June 2023 when Omicron was predominant. Participants ≥ 18 years seeking outpatient care for symptomatic SARS-CoV-2 infection were enrolled. Complete vaccination included individuals who received the full primary series and any booster dose, while incomplete vaccination included those with incomplete primary series or no vaccination. The primary outcome was any persistent symptoms at 3 months. Secondary outcomes were organ system-specific persistent symptoms and the EQ-5D-3L utility score. All outcomes were assessed by means of structured telephone interviews 3 months after enrollment., Results: 1,067 patients were enrolled (median age, 39 years), of which 914 (871 completely vaccinated and 43 unvaccinated or incompletely vaccinated). Among the vaccinated participants the median time since the last vaccine dose was 145 (interquartile range, 106-251) days. A total of 388/1067 (36.9 %) had a prior infection at the time of study entry . The occurrence of overall persistent COVID-19-related symptoms at 3 months was 41.6 % (n = 362) among completely vaccinated and 44.2 % (n = 19) among unvaccinated or incompletely vaccinated patients (adjusted risk ratio [aRR], 0.87; 95 % confidence interval [CI], 0.61-1.23; p  = 0.43). Complete vaccination was associated with lower occurrence of mental health symptoms (aRR, 0.44; 95 % CI, 0.24-0.81; p  = 0.01). No differences were found in the occurrence of persistent symptoms in other specific domains, nor in EQ-5D-3L utility scores., Conclusions: This study was not able to identify a statistically significant protection of complete COVID-19 vaccination against any overall persistent symptoms at 3 months. Nevertheless, complete vaccination was associated with a lower occurrence of persistent mental health symptoms., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors MMR, FLS, GT, MMDS, DS, RRMS, RFCS, ESR, GPE, GSR, DM, JMBS, APM, CRI, GNS, JMN, HJMF, CVPS, ASS, CMD, CMS, JVP and IFS work at Hospital Moinhos de Vento, which received a research grant from the Brazilian Ministry of Health for the conduction of this study. RGR and MF had received research grants from the Brazilian Ministry of Health, Pfizer and MSD. All other authors declare that they have no conflict of interest. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

A gluten-free diet is the only treatment for patients with coeliac disease, who report dissatisfaction with the availability and variety of products, especially bread and pasta. The aim was to compare availability, cost, nutritional composition and ingredients of gluten-free and conventional bread and pasta products. Census of breads and pastas available in online commerce belonging to the third largest supermarket chain in southern Brazil. Information was collected at supermarket's and brand's websites. One hundred and fourteen products were analysed ( n  = 37 breads and n  = 77 pastas): 32.4% ( n  = 12) gluten-free breads and 18.2% ( n  = 14) gluten-free pastas. Both gluten-free breads and pastas were significantly more expensive when compared to gluten-containing breads and pastas. Gluten-free breads have higher fat content, gluten-free pastas have higher content of sodium and ingredients. Gluten-free breads and pastas are less available, more expensive and have lower nutritional value compared to conventional versions.

Background: Training primary care doctors and nurses to use Practical Approach to Care Kit (PACK) improved management of asthma and chronic obstructive pulmonary disease (COPD) in a previous randomised trial. The present study examined the training effects including a second year of follow-up with expanded coverage of repeated training sessions., Methods: Using a stepped-wedge cluster randomised trial design, 48 clinics were randomly allocated either to sequence A: (1) no intervention, (2) no intervention, (3) intervention or sequence B: (1) no intervention, (2) intervention, (3) intervention, during three 12-month periods. Primary outcomes were change in treatment and spirometry ordering. Effects of any exposure to the training, and of exposure to the first and second years of training, were estimated with mixed effect logistic regression models., Results: Any exposure to training was associated with increased changes in treatment (OR adjusted for calendar time (OR) 1.29, 95% CI 1.02 to 1.64) and more spirometry ordering (OR 1.55, (95% CI 1.22 to 1.97)) in asthma patients, and with more spirometry ordering (OR 1.50 (95% CI 1.15 to 1.96)) in patients with COPD. Change in asthma treatment was more likely during the first and second year of exposure to training compared with no exposure (ORs 1.43 (95% CI 1.09 to 1.87); 1.91 (95% CI 1.21 to 3.02)), respectively. Spirometry was more likely during the first and second year of exposure in asthma patients (ORs 1.76 (95% CI 1.34 to 2.30); 2.05 (95% CI 1.32 to 3.19)) and in patients with COPD (ORs 1.57 (95% CI 1.18 to 2.10)); 1.71 (95% CI 1.08 to 2.70))., Conclusion: Extended follow-up suggested that PACK training continued to be effective in improving chronic respiratory care and that effective intervention delivery was sustainable for 2 years., Trial Registration Number: NCT02786030., Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare that CW, LRF, DG-P, LFA, RVC and EDB are employees of the KTU. RZ and MPdA are employees of the City Health Department, Florianópolis, Brazil. JZ was an employee of the City Health Department, Florianópolis, Brazil during the initial agreement and adaptation of PACK in Florianópolis. AAC reports grants, personal fees and non-financial support from GSK, personal fees and non-financial support from AstraZeneca, personal fees and non-financial support from Boehringer Ingelheim, personal fees and non-financial support from MEDA, personal fees and non-financial support from Novartis, personal fees and non-financial support from EUROFARMA, personal fees and non-financial support from CHIESI, personal fees and non-financial support from Boston Scientific, outside the submitted work. EDB reports grants to institution for clinical trials from Novartis, Boehringer Ingelheim, Merck, Takeda, GlaxoSmithKline, Hoffmann La Roche, Actelion, Chiesi, Sanofi-Aventis, Cephalon, TEVA and AstraZeneca and personal fees from ICON, Novartis, Cipla, Vectura, Cipla, Menarini, ALK, ICON, Sanofi Regeneron, Boehringer Ingelheim and AstraZeneca, outside the submitted work, and is a Member of Global Initiative for Asthma Board and Science Committee. RS reports grants for clinical trials, personal, institution fees and non-financial support from AstraZeneca, and personal fees and non-financial support from Novartis, Boehringer Ingelheim, CHIESI and EUROFARMA. Between 2015 and 2020, the KTU and BMJ were engaged in a non-profit strategic partnership to provide continuous evidence updates for PACK, expand PACK-related supported services to countries and organisations as requested, and where appropriate license PACK content. The KTU and BMJ co-funded core positions, including a PACK Global Development Director, and received no profits from the partnership. PACK receives no funding from the pharmaceutical industry. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The COVID-19, triggered by the SARS-CoV-2 virus, has varied clinical manifestations, ranging from mild cases to severe forms such as fatal pneumonia and acute respiratory distress syndrome (ARDS). Disease severity is influenced by an exacerbated immune response, characterized by high pro-inflammatory cytokine levels. Inhibition of AKT can potentially suppress pathological inflammation, cytokine storm and platelet activation associated with COVID-19. In this study, we aimed to investigate the rs2494746 and rs1130214 variants in the AKT1 gene associated with severe COVID-19 outcomes., Methods: Peripheral blood samples and sociodemographic data from 508 individuals with COVID-19, measuring plasma cytokine concentrations using ELISA and genotyped the AKT1 variants., Results: The rs2494746-C allele was associated with severity, ICU admission, and death from COVID-19. The C allele at rs1130214 was linked to increased TNF and D-dimer levels. Moreover, both variants exhibited an increased cumulative risk of disease severity, ICU admission, and mortality caused by COVID-19. In the predictive analysis, the rs2494746 obtained an accuracy of 71%, suggesting a high probability of the test determining the severity of the disease., Discussion: Our findings contribute to understanding the influence of the AKT1 gene variants on the immunological damage in individuals infected with SARS-CoV-2., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 de Almeida, Tosta, Pena, Silva, Reis-Goes, Silva, Cruz, Silva, de Araújo, Rodrigues, Oliveira, Figueiredo, Vaz, Montaño-Castellón, Santana, Torres, Beltrão, Carneiro, Campos, Brites, Fortuna, Figueiredo, Trindade, Ramos and Costa.)

Background: The "Serra da Concórdia" is part of the Atlantic Forest phytogeographical domain in the Brazilian state of Rio de Janeiro and it has a predominant phytophysiognomy of Semideciduous Seasonal Forest. This region underwent intense habitat loss and fragmentation during the 19 th century, due to coffee plantations and later pastures. With the decline of these activities, the areas were abandoned, triggering secondary succession. In 2002, the "Parque Estadual da Serra da Concórdia" was established in this region to preserve the remaining forest fragments. The updated list of vascular plants recorded in this protected area, published in the "Catálogo de Plantas das Unidades de Conservação do Brasil", is presented here, along with information on richness, endemism, and conservation status., New Information: The "Parque Estadual da Serra da Concórdia" houses 231 vascular plant species, of which 90% are angiosperms, 10% ferns and lycophytes, and 27% endemic to the Atlantic Forest. Ten species are threatened with extinction, three are categorized as Endangered, and seven as Vulnerable. Although there have been expeditions in the "Parque Estadual da Serra da Concórdia", they have been limited, resulting in a low number of records and the species richness for a protected area. This is notable considering the 2,130 Brazilian native vascular plant species recorded in the semideciduous seasonal forest of Rio de Janeiro. Our data indicates that floristic inventories of Brazilian protected areas could help highlight gaps in flora knowledge and support the proposal of effective conservation actions., (Lara Serpa Jaegge Deccache, Claudine Massi Mynssen, Claudio Nicoletti de Fraga, Eduardo Pinheiro Fernandez, Elsie Franklin Guimarães, Elton John de Lírio, Fabiana Luiza Ranzato Filardi, Fernanda Ribeiro de Mello Fraga, Fernanda Saleme, Gustavo Hiroaki Shimizu, Haroldo Cavalcante de Lima, Helen Ayumi Ogasawara, Hemily Oliveira Marques, Isabela Maciel Waga, Isabella Cristina de Castro Silva, Jenifer de Carvalho Lopes, Leonardo Biral, Lucas Vieira Lima, Maria Liris Barbosa, Mario Gomes, Massimo Giuseppe Bovini, Miriam Kaehler, Nádia Roque, Otávio Luis Marques da Silva, Pedro Luís Rodrigues de Moraes, Rodrigo Lopes Borges, Ronaldo Marquete, Thuane Bochorny, Thiago Fernandes, Marcio Verdi.)

Competing Interests: We declare no competing interests.

Objective: This study aimed to review the current body of literature on underexplored areas of photobiomodulation (PBM) for preventing and/or treating oral adverse events. Background: Recent studies suggest that PBM may offer potential benefits in managing cancer-related toxicities other than oral mucositis. Nevertheless, further research to establish conclusive evidence is still missing. Methods: A panel of specialists conducted a narrative review to evaluate the evidence on PBM therapy for oral mucositis, xerostomia, dysgeusia, dysphagia, and trismus/fibrosis. Each topic was reviewed by two specialists who discussed treatment rationale, summarized current evidence, evaluated risk/benefit ratio, and identified future research directions. Results: The current evidence suggests promising outcomes in nonroutine uses of PBM for xerostomia, dysgeusia, odynophagia, oral mucositis (extraoral PBM and the pediatric population), and trismus/fibrosis. However, the primary studies are often small and may have biases that require further evaluation, particularly regarding treatment safety. Conclusion: Despite the overall positive impression of PBM therapy for oral adverse events of cancer treatment, robust evidence from large multicentered studies is necessary to support its widespread clinical use.

Long COVID is characterized by persistent that extends symptoms beyond established timeframes. Its varied presentation across different populations and healthcare systems poses significant challenges in understanding its clinical manifestations and implications. In this study, we present a novel application of text mining technique to automatically extract unstructured data from a long COVID survey conducted at a prominent university hospital in São Paulo, Brazil. Our phonetic text clustering (PTC) method enables the exploration of unstructured Electronic Healthcare Records (EHR) data to unify different written forms of similar terms into a single phonemic representation. We used n-gram text analysis to detect compound words and negated terms in Portuguese-BR, focusing on medical conditions and symptoms related to long COVID. By leveraging text mining, we aim to contribute to a deeper understanding of this chronic condition and its implications for healthcare systems globally. The model developed in this study has the potential for scalability and applicability in other healthcare settings, thereby supporting broader research efforts and informing clinical decision-making for long COVID patients., (© 2024. The Author(s).)

Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Muscle loss is one of the phenotypic criteria of malnutrition, is highly prevalent in patients with cirrhosis, and is associated with adverse outcomes. Mid-arm muscle circumference (MAMC) estimates the skeletal muscle mass and is especially helpful in cases of fluid overload. This study aimed to propose MAMC cutoff points for patients with cirrhosis and demonstrate its association with 1-year mortality., Methods: This is an analysis of cohort databases from five reference centers in Brazil that included inpatients and outpatients with cirrhosis aged ≥18 y. The nutritional variables obtained were the MAMC (n = 1075) and the subjective global assessment (n = 629). We established the MAMC cutoff points stratified by sex based on the subjective global assessment as a reference standard for malnutrition diagnosis, considering the sensitivity, specificity, and Youden index. An adjusted Cox regression model was used to test the association of MAMC cutoff points and 1-year mortality., Results: We included 1075 patients with cirrhosis, with a mean age of 54.8 ± 11.3 y; 70.4% (n = 757) male. Most patients had alcoholic cirrhosis (47.1%, n = 506) and were classified as Child-Pugh B (44.7%, n = 480). The MAMC cutoff points for moderate and severe depletion were ≤21.5 cm and ≤24.2 cm; ≤20.9 cm and ≤22.9 cm for women and men, respectively. According to these cutoff points, 13.8% (n = 148) and 35.1% (n = 377) of the patients had moderate or severe MAMC depletion, respectively. The 1-year mortality rate was 17.3% (n = 186). In the multivariate analysis adjusted for sex, age, MELD-Na, and Child-Pugh scores, a severe depletion in MAMC was an independent increased risk factor for 1-year mortality (HR: 1.71, 95% CI: 1.24-2.35, P < 0.001). Each increase of 1 cm in MAMC values was associated with an 11% reduction in 1-year mortality risk (HR: 0.89, 95% CI: 0.85-0.94, P < 0.001)., Conclusions: Low MAMC classified according to the new cutoff points predicts mortality risk in patients with cirrhosis and could be used in clinical practice., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The reasons that lead some individuals living with the Human T Lymphotropic Virus 1 (HTLV-1) to develop HAM/TSP are still unclear. To better understand the viral genetic factors that may be associated with the development of HAM/TSP, this study aims to evaluate the impact of HTLV-1 genome mutations on the development of this disease through a systematic review. This review followed the PRISMA guidelines and was registered in the PROSPERO database. The search for articles was performed in PMC, PubMed, Lilacs, SciELO, and Embase databases using the following search descriptors: HTLV-1, HAM/TSP, mutation, polymorphism, genetic variation, and sequenc*. From the 1,929 articles found in the search, 20 were selected according to the pre-defined inclusion and exclusion criteria. A total of 619 HAM/TSP cases were compared with 555 AC controls. The mutations possibly related to the disease progression were detected in hbz (R119Q), tax (A7959V), ORF-I (R88K, P86S, S69G, P45L, L40F, C39R, CR9Y), and gp46 (V247I, N93D, S72G) genetic regions. The data collected and analyzed here indicate that mutations in the HTLV-1 genome could play an important role in the chronic inflammatory state and may be related to the development of HAM/TSP., (© 2024 Wiley Periodicals LLC.)

Introduction: Catatonia, documented since the 19th century, remains a significant challenge in terms of recognition and treatment. Over the last two decades, ketamine has brought new perspectives to psychiatry, sparking widespread interest. Concurrently, catatonia has attracted heightened scientific attention. Preliminary evidence suggests the therapeutic potential of ketamine for catatonia., Methods: We systematically searched Medline/PubMed, Embase, PsycINFO, Lilacs, and Cochrane Library databases, as well as Google Scholar, for studies with ketamine or its enantiomers as intervention for catatonia, with no restrictions to underlying diagnosis, date, language, or study design., Results: Twenty articles were included, encompassing a total of 25 catatonic patients receiving ketamine or esketamine. Predominantly female (61.9 %), with a mean age of 44.4 years, patients mostly exhibited manifestations compatible with the retarded subtype of catatonia. Mood disorders were the most prevalent underlying diagnoses. Ketamine was primarily administered intravenously over a 40-minute period and in multiple-dosing schemes. Mean response and remission rates of catatonic manifestations for the whole sample were 80 % and 44 %, respectively, with no reports of worsening catatonic features or psychotic symptoms. Only one patient discontinued treatment due to intolerable dissociative effects., Conclusion: Challenging the conventional contraindication of ketamine in psychotic disorders, current evidence highlights its potential efficacy, particularly in treating catatonia. Pending further research, we advocate reevaluating this contraindication, as it may offer a promising therapeutic option, especially for challenging cases. Preliminary evidence suggests potentially greater benefits for catatonic patients with underlying mood disorders compared to primary psychotic disorders., Competing Interests: Declaration of competing interest LCQ reports consulting fees from Allergan, Abbot, Janssen Pharmaceutical and Lundbeck, and research fees from Janssen Pharmaceutical. ALTL has received consulting fees from Hoffmann–La Roche, Genentech, Janssen Pharmaceutical, Daiichi Sankyo, Cristalia Produtos Químicos e Farmacêuticos, Pfizer, Mantecorp Indústria Química e Farmacêutica, Libbs Farmacêutica, FQM Farma, and Sanofi-Aventis over the last 24 months and has received research fees from Janssen Pharmaceutical, Eli Lilly, Novartis, Biophytis, Celltrion, Azidus, H. Lundbeck A/S, Servier Laboratories, Hoffman-La Roche, FQM Farma, and Forum Pharmaceuticals. AG has been a consultant and/or advisor to or has received honoraria from Aché, Daiichi Sankyo, Torrent, Bayer, Cristália, and Janssen. We declare no other conflicts of interest concerning the publication of this article., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Parenting a child on the autism spectrum presents particular challenges that can lead to increased stress, anxiety, and depression among family members. Therefore, we aimed to investigate the prevalence of mental disorders in first-degree relatives of individuals on the autism spectrum. This article adheres to the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines, including studies indexed in PubMed/Medline, Embase, PsycINFO, Biblioteca Virtual em Saúde (BVS), and SciELO. Nineteen articles met eligibility criteria for the systematic review. Using a random-effects model (N = 93,876), we found a pooled prevalence of affective disorders of 13% in mothers of people on the autism spectrum (95% CI 7-21%; I 2  = 99%, p < 0.01). Additionally, another random-effects model pointed out that first-degree relatives of people on the autism spectrum (N = 93,263) were more likely to present affective disorders than relatives of people with neurotypical development (N = 152,455) (pooled OR: 2.17; 95% CI 1.81-2.61). Careful assessment for mental disorders in parents and siblings of individuals on the autism spectrum is crucial to ensure appropriate treatment for these family members. This approach can also contribute to optimizing care for the individuals on the autism spectrum., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

In terrestrial forested ecosystems, fungi may interact with trees in at least three distinct ways: (i) associated with roots as symbionts; (ii) as pathogens in roots, trunks, leaves, flowers, and fruits; or (iii) decomposing dead tree tissues on soil or even on dead tissues in living trees. Distinguishing the latter two nutrition modes is rather difficult in Hymenochaetaceae (Basidiomycota) species. Herein, we have used an integrative approach of comparative genomics, stable isotopes, host tree association, and bioclimatic data to investigate the lifestyle ecology of the scarcely known neotropical genus Phellinotus , focusing on the unique species Phellinotus piptadeniae . This species is strongly associated with living Piptadenia gonoacantha (Fabaceae) trees in the Atlantic Forest domain on a relatively high precipitation gradient. Phylogenomics resolved P. piptadeniae in a clade that also includes both plant pathogens and typical wood saprotrophs. Furthermore, both genome-predicted Carbohydrate-Active Enzymes (CAZy) and stable isotopes (δ 13 C and δ 15 N) revealed a rather flexible lifestyle for the species. Altogether, our findings suggest that P. piptadeniae has been undergoing a pathotrophic specialization in a particular tree species while maintaining all the metabolic repertoire of a wood saprothroph., Importance: This is the first genomic description for Phellinotus piptadeniae . This basidiomycete is found across a broad range of climates and ecosystems in South America, including regions threatened by extensive agriculture. This fungus is also relevant considering its pathotrophic-saprotrophic association with Piptadenia goanocantha , which we began to understand with these new results that locate this species among biotrophic and necrotrophic fungi., Competing Interests: The authors declare no conflict of interest.

Objectives: Encephalitis is a severe neurological syndrome for which herpesvirus and enteroviruses are the most common etiological agents. Arboviruses, a wildly diverse group of pathogens, are also critical epidemiological agents associated with encephalitis. In Brazil, little is known about the causative agents of encephalitis., Methods: We conducted a hospital surveillance for encephalitis between 2020 and 2022. Molecular (RT-PCR and qPCR) and serological (virus-specific IgM and viral antigens) techniques were performed in cerebrospinal fluid and serum samples obtained from study participants., Results: In the 43 participants evaluated, the etiologic agent or the presence of IgM was detected in 16 (37.2%). Nine (20.9%) cases were positive for chikungunya virus (CHIKV), three (7.0%) for dengue virus, two (4.7%) for human adenovirus, one (2.3%) for varicella-zoster virus, and one (2.3%) for enterovirus. Whole-genome sequencing revealed that the CHIKV identified belongs to the East/Central/South African lineage., Conclusion: Herein, CHIKV is a common pathogen identified in encephalitis cases. Our results reinforce previous evidence that chikungunya represents a significant cause of encephalitis during CHIKV outbreaks and epidemics and add to existing information on the epidemiology of encephalitis in Brazil., Competing Interests: Declarations of competing interest The authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Therapeutic anticoagulation showed inconsistent results in hospitalized patients with COVID-19 and selection of the best patients to use this strategy still a challenge balancing the risk of thrombotic and hemorrhagic outcomes. The present post-hoc analysis of the ACTION trial evaluated the variables independently associated with both bleeding events (major bleeding or clinically relevant non-major bleeding) and the composite outcomes thrombotic events (venous thromboembolism, myocardial infarction, stroke, systemic embolism, or major adverse limb events). Variables were assessed one by one with independent logistic regressions and final models were chosen based on Akaike information criteria. The model for bleeding events showed an area under the curve of 0.63 (95% confidence interval [CI] 0.53 to 0.73), while the model for thrombotic events had an area under the curve of 0.72 (95% CI 0.65 to 0.79). Non-invasive respiratory support was associated with thrombotic but not bleeding events, while invasive ventilation was associated with both outcomes (Odds Ratio of 7.03 [95 CI% 1.95 to 25.18] for thrombotic and 3.14 [95% CI 1.11 to 8.84] for bleeding events). Beyond respiratory support, creatinine level (Odds Ratio [OR] 1.01 95% CI 1.00 to 1.02 for every 1.0 mg/dL) and history of coronary disease (OR 3.67; 95% CI 1.32 to 10.29) were also independently associated to the risk of thrombotic events. Non-invasive respiratory support, history of coronary disease, and creatinine level may help to identify hospitalized COVID-19 patients at higher risk of thrombotic complications.ClinicalTrials.gov: NCT04394377., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Infectious disease (ID) cohorts are key to advancing public health surveillance, public policies, and pandemic responses. Unfortunately, ID cohorts often lack funding to store and share clinical-epidemiological (CE) data and high-dimensional laboratory (HDL) data long term, which is evident when the link between these data elements is not kept up to date. This becomes particularly apparent when smaller cohorts fail to successfully address the initial scientific objectives due to limited case numbers, which also limits the potential to pool these studies to monitor long-term cross-disease interactions within and across populations. CE data from 9 arbovirus (arthropod-borne viruses) cohorts in Latin America were retrospectively harmonized using the Maelstrom Research methodology and standardized to Clinical Data Interchange Standards Consortium (CDISC). We created a harmonized and standardized meta-cohort that contains CE and HDL data from 9 arbovirus studies from Latin America. To facilitate advancements in cross-population inference and reuse of cohort data, the Reconciliation of Cohort Data for Infectious Diseases (ReCoDID) Consortium harmonized and standardized CE and HDL from 9 arbovirus cohorts into 1 meta-cohort. Interested parties will be able to access data dictionaries that include information on variables across the data sets via Bio Studies. After consultation with each cohort, linked harmonized and curated human cohort data (CE and HDL) will be made accessible through the European Genome-phenome Archive platform to data users after their requests are evaluated by the ReCoDID Data Access Committee. This meta-cohort can facilitate various joint research projects (eg, on immunological interactions between sequential flavivirus infections and for the evaluation of potential biomarkers for severe arboviral disease)., (©Gustavo Gómez, Heather Hufstedler, Carlos Montenegro Morales, Yannik Roell, Anyela Lozano-Parra, Adriana Tami, Tereza Magalhaes, Ernesto T A Marques, Angel Balmaseda, Guilherme Calvet, Eva Harris, Patricia Brasil, Victor Herrera, Luis Villar, Lauren Maxwell, Thomas Jaenisch, ReCoDID Arbovirus harmonization study group. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 23.07.2024.)

Background: The Costa das Algas Environmental Protection Area (EPA) and the Santa Cruz Wildlife Refuge (WR), located in the Espírito Santo Continental Shelf, Brazil, are outstanding marine protected areas due to their high biodiversity, particularly of macroalgae. Together, these two relatively small protected areas (1,150 and 177 km 2 , respectively) harbour about a quarter of all macroalgal species recorded in Brazil.The checklist presented herein updates the algal flora of these two protected areas with data obtained until 2019. Two hundred and sixty-five macroalgal taxa were recorded, most of which with vouchers. Checklists based on the collections of each protected area were published on: "Catálogo de Plantas das Unidades de Conservação do Brasil" (https://catalogo-ucs-brasil.jbrj.gov.br/)., New Information: Besides specimens collected between 2018 and 2019, the algal flora presented herein includes previous records from different Brazilian herbaria (e.g., SP, SPF, ALCB). Herbaria records may include species that do not occur in intertidal reefs (e.g., Laminaria ). Overall, 249 macroalgal taxa and one marine angiosperm were recorded in the Costa das Algas EPA (87 new records) and 136 macroalgal taxa and one marine angiosperm in the Santa Cruz WR (46 new records). All taxa are native to Brazil and nine are endemic to Brazil. Our results provide a taxonomic foundation to support management, long-term monitoring and conservation in these protected areas., (Claudia S Karez, Ricardo G Bahia, José M C Nunes, Gabriel N Santos, Rodrigo L Moura, Paulo S Salomon, Clarice C M Ribeiro, Carolina C Silva, Pedro Cardial, Gabriella A Leal, Manoela B Lyra, Leonardo T Salgado.)

Background: Adherence to anti-tuberculosis treatment (ATT) in Brazil remains a challenge in achieving the goals set by the World Health Organization (WHO). Patients who are lost to follow-up during treatment pose a significant public health problem. This study aimed to investigate the factors associated with unfavorable ATT outcomes among those undergoing retreatment in Brazil., Methods: We conducted an observational study of patients aged ≥18 years with tuberculosis (TB) reported to the Brazilian National Notifiable Disease Information System between 2015 and 2022. Clinical and epidemiologic variables were compared between the study groups (new cases and retreatment). Regression models identified variables associated with unfavorable outcomes., Results: Among 743 823 reported TB cases in the study period, 555 632 cases were eligible, consisting of 462 061 new cases and 93 571 undergoing retreatments (44 642 recurrent and 48 929 retreatments after loss to follow-up [RLTFU]). RLTFU (odds ratio [OR], 3.96 [95% confidence interval {CI}, 3.83-4.1]) was a significant risk factor for any type of unfavorable ATT. Furthermore, RLTFU (OR, 4.93 [95% CI, 4.76-5.11]) was the main risk factor for subsequent LTFU. For death, aside from advanced age, living with HIV (OR, 6.28 [95% CI, 6.03-6.54]) was the top risk factor., Conclusions: Retreatment is a substantial risk factor for unfavorable ATT outcomes, especially after LTFU. The rates of treatment success in RLTFU are distant from the WHO End TB Strategy targets throughout Brazil. These findings underscore the need for targeted interventions to improve treatment adherence and outcomes in persons who experience RLTFU., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Objectives: This study aimed to estimate the disease burden of BSIs caused by gram-negative bacteria (GNB-BSIs) in a Brazilian hospital from 2015 to 2019, measured in disability-adjusted life-years (DALYs)., Methods: A retrospective cohort study of adult patients with GNB-BSI was conducted from April 01, 2015 to March 31, 2019. This study was carried out in a 356-bed private hospital with a 68-bed medical intensive care unit located in Salvador, Brazil. Demographic and clinical data were collected through a review of medical records. DALYs were estimated using Monte Carlo Simulations, using life tables for Brazilians estimated for 2020 and the Global Burden of Diseases 2010 (GBD 2010)., Results: A total of 519 GNB-BSI episodes in 498 individuals were identified. The mean age was 59.92 ± 17.97 years, with 61.1% being male. The most common bacterial infections were Klebsiella pneumoniae and Escherichia coli (66.5%), whereas carbapenem-resistant gram-negative bacteria (CR-GNB) accounted for 32.7% of cases. The highest overall DALYs were observed in 2018 (752, 95% confidence interval [CI]: 520-1021 with Brazilian Life Tables and 782, 95% CI: 540-1062 with GBD 2010). Infections due to CR-GNB had the highest DALYs, particularly, in 2017, reaching 7050 (95% CI: 3200-12,150 with Brazilian Life Tables and 7350, 95% CI: 3350-12,700 with GBD 2010) DALYs per 1000 patient days and an estimated mortality rate of 40% per 1000 patient days., Conclusions: The persistently high DALYs associated with CR-GNB raise alarming concerns, potentially leading to over 300 deaths per 1000 patient days in the coming years. These findings underscore the urgency of addressing GNB-BSI as a significant public health issue in Brazil. These results are expected to provide helpful information for public health policymakers to prioritize interventions for infections due to antibiotic-resistant bacteria., Competing Interests: The authors have no competing interests to declare., (© 2024 The Author(s).)

Background: Women living with HIV/AIDS (WLHA) have an increased prevalence of high-risk HPV infection (HR-HPV) and cervical intraepithelial neoplasia (CIN) and a greater risk of cervical cancer despite access to a new generation of antiretroviral therapy. The aim of this study is to evaluate the concentrations of different cytokines involved in the local immune response in WLHA, which is fundamental for understanding the pathogenesis of HPV-related cancer in this population., Methods: IL-1β, IL-2, IL-4, IL-6, IL-10, IFN-γ, TNF-α, IP-10, GM-CSF, and MIP-1α were investigated in the cervicovaginal lavage (CVL) of 106 WLHA attending at Hospital Universitario Professor Edgard Santos in Salvador, Bahia, Brazil, during the period December 2019 to April 2023 by Luminex ® . All participants were also tested for Chlamydia trachomatis and Neisseria gonorrhoeae and underwent colposcopy, Pap smear, and Nugent score. HIV plasma viral load (VL) and CD4 cell count were performed for all WLHA., Results: In this study, 22.6% (24/106) of WLHA were infected with HR-HPV. A higher proportion of patients with HR-HPV (66.7%) had detectable levels of IL-10 than those negative ones (40.2%, p = 0.02). More premenopausal women had either IL-6 (51.4%) or IP-10 (58.3%) than those in menopausal status (26.5% for IL-6 and 32.4% for IP-10, p = 0.013 and p = 0.011, respectively). Vaginosis was negatively associated with detection of IP-10 (24.2% vs. 61.4%, p < 0.001) and INF-γ (39.4% vs. 68.6%, p = 0.005). A positive association was detected for IL-1β (66.7 vs. 37.1%, p = 0.005) and IL-10 (63.6% vs. 37.1%, p = 0.01). VL and CD4 were not associated with the studied cytokines., Conclusion: We demonstrated a positive association between IL-10 and HPV infection in CVL, suggesting the predominance of the Th2 response in HIV/HPV co-infected patients. However, further studies with longer follow-up will be needed to evaluate the association of IL-10 with HPV infection, CIN, and cervical cancer in WLHA., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Schindler, Netto, Deminco, Figueiredo, de Andrade, Alves and Brites.)

Importance: Menopausal hormone therapy (HT) includes a wide variety of hormonal compounds, and its effect on blood pressure is still uncertain., Objective: The aim of this study was to assess evidence regarding the effect of HT on blood pressure in postmenopausal women and its association with arterial hypertension., Evidence Review: This systematic review and meta-analysis included randomized clinical trials and prospective observational studies. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and the incidence of hypertension were assessed. All stages were independently performed by two reviewers. For blood pressure outcome, standardized mean differences (SMD) and 95% confidence intervals (95% CI) were calculated as effect measures. Heterogeneity was assessed using the I2 statistic. The results are presented based on the HT type. The incidence of hypertension was compared using descriptive analyses., Findings: Eleven studies were included with 81,041 women evaluated, of which 29,812 used HT. The meta-analysis, conducted with 8 studies and 1,718 women, showed an increase in SBP with the use of oral conjugated equine estrogens plus progestogen (SMD = 0.60 mm Hg, 95% CI = 0.19 to 1.01). However, oral or transdermal use of estradiol plus progestogen (SMD = -2.00 mm Hg, 95% CI = -7.26 to 3.27), estradiol alone, and tibolone did not show any significant effect. No significant effect on DBP was observed for any formulation. Women who used oral estrogen plus progestogen had a higher risk of incident hypertension than those who never used it., Conclusions and Relevance: The effect of HT on blood pressure is influenced by the formulation used, especially the type of estrogen. The combined formulations of conjugated equine estrogens plus progestogen increased SBP and the risk of hypertension, which was not observed among estradiol plus progestogen, estradiol alone, and tibolone users., Competing Interests: Financial disclosure/conflicts of interest: None reported., (Copyright © 2024 by The Menopause Society.)

Asthma has striking disparities across ancestral groups, but the molecular underpinning of these differences is poorly understood and minimally studied. A goal of the Consortium on Asthma among African-ancestry Populations in the Americas (CAAPA) is to understand multi-omic signatures of asthma focusing on populations of African ancestry. RNASeq and DNA methylation data are generated from nasal epithelium including cases (current asthma, N = 253) and controls (never-asthma, N = 283) from 7 different geographic sites to identify differentially expressed genes (DEGs) and gene networks. We identify 389 DEGs; the top DEG, FN1, was downregulated in cases (q = 3.26 × 10 -9 ) and encodes fibronectin which plays a role in wound healing. The top three gene expression modules implicate networks related to immune response (CEACAM5; p = 9.62 × 10 -16 and CPA3; p = 2.39 × 10 -14 ) and wound healing (FN1; p = 7.63 × 10 -9 ). Multi-omic analysis identifies FKBP5, a co-chaperone of glucocorticoid receptor signaling known to be involved in drug response in asthma, where the association between nasal epithelium gene expression is likely regulated by methylation and is associated with increased use of inhaled corticosteroids. This work reveals molecular dysregulation on three axes - increased Th2 inflammation, decreased capacity for wound healing, and impaired drug response - that may play a critical role in asthma within the African Diaspora., (© 2024. The Author(s).)

Background: Identifying patients at increased risk of loss to follow-up (LTFU) is key to developing strategies to optimize the clinical management of tuberculosis (TB). The use of national registry data in prediction models may be a useful tool to inform healthcare workers about risk of LTFU. Here we developed a score to predict the risk of LTFU during anti-TB treatment (ATT) in a nationwide cohort of cases using clinical data reported to the Brazilian Notifiable Disease Information System (SINAN)., Methods: We performed a retrospective study of all TB cases reported to SINAN between 2015 and 2022; excluding children (< 18 years-old), vulnerable groups or drug-resistant TB. For the score, data before treatment initiation were used. We trained and internally validated three different prediction scoring systems, based on Logistic Regression, Random Forest, and Light Gradient Boosting. Before applying our models we splitted our data into training (~ 80% data) and test (~ 20%) sets, and then compared the model metrics using the test data set., Results: Of the 243,726 cases included, 41,373 experienced LTFU whereas 202,353 were successfully treated. The groups were different with regards to several clinical and sociodemographic characteristics. The directly observed treatment (DOT) was unbalanced between the groups with lower prevalence in those who were LTFU. Three models were developed to predict LTFU using 8 features (prior TB, drug use, age, sex, HIV infection and schooling level) with different score composition approaches. Those prediction scoring systems exhibited an area under the curve (AUC) ranging between 0.71 and 0.72. The Light Gradient Boosting technique resulted in the best prediction performance, weighting specificity and sensitivity. A user-friendly web calculator app was developed ( https://tbprediction.herokuapp.com/ ) to facilitate implementation., Conclusions: Our nationwide risk score predicts the risk of LTFU during ATT in Brazilian adults prior to treatment commencement utilizing schooling level, sex, age, prior TB status, and substance use (drug, alcohol, and/or tobacco). This is a potential tool to assist in decision-making strategies to guide resource allocation, DOT indications, and improve TB treatment adherence., (© 2024. The Author(s).)

Introduction: In Brazil, approximately 5% are born with a congenital disorder, potentially fatal without surgery. This study aims to evaluate the relationship between gastrointestinal congenital malformation (GICM) mortality, health indicators, and socioeconomic factors in Brazil., Methods: GICM admissions (Q39-Q45) between 2012 and 2019 were collected using national databases. Patient demographics, socioeconomic factors, clinical management, outcomes, and the healthcare workforce density were also accounted for. Pediatric Surgical Workforce density and the number of neonatal intensive care units in a region were extracted from national datasets and combined to create a clinical index termed ' NeoSurg'. Socioeconomic variables were combined to create a socioeconomic index termed ' SocEcon'. Simple linear regression was used to investigate if the temporal changes of both indexes were significant. The correlation between mortality and the different indicators in Brazil was evaluated using Pearson's correlation coefficient., Results: Over 8 years, Brazil recorded 12804 GICM admissions. The Southeast led with 6147 cases, followed by the Northeast (2660), South (1727), North (1427), and Midwest (843). The North and Northeast reported the highest mortality, lowest NeoSurg, and SocEcon Index rates. Nevertheless, mortality rates declined across regions from 7.7% (2012) to 3.9% (2019), a 51.7% drop. The North and Midwest experienced the most substantial reductions, at 63% and 75%, respectively. Mortality significantly correlated with the indexes in nearly all regions ( p <0.05)., Conclusion: Our study highlights the correlation between social determinants of health and GICM mortality in Brazil, using two novel indexes in the pediatric population. These findings provide an opportunity to rethink and discuss new indicators that could enhance our understanding of our country and could lead to the development of necessary solutions to tackle existing challenges in Brazil and globally., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Leptospirosis is a zoonosis caused by pathogenic species of bacteria belonging to the genus Leptospira. Most studies infer the epidemiological patterns of a single serogroup or aggregate all serogroups to estimate overall seropositivity, thus not exploring the risks of exposure to distinct serogroups. The present study aims to delineate the demographic, socioeconomic and environmental factors associated with seropositivity of Leptospira serogroup Icterohaemorraghiae and serogroup Cynopteri in an urban high transmission setting for leptospirosis in Brazil., Methods/principal Findings: We performed a cross-sectional serological study in five informal urban communities in the city of Salvador, Brazil. During the years 2018, 2020 2021, we recruited 2.808 residents and collected blood samples for serological analysis using microagglutination assays. We used a fixed-effect multinomial logistic regression model to identify risk factors associated with seropositivity for each serogroup. Seropositivity to Cynopteri increased with each year of age (OR 1.03; 95% CI 1.01-1.06) and was higher in those living in houses with unplastered walls (exposed brick) (OR 1.68; 95% CI 1.09-2.59) and where cats were present near the household (OR 2.00; 95% CI 1.03-3.88). Seropositivity to Icterohaemorrhagiae also increased with each year of age (OR 1.02; 95% CI 1.01-1.03) and was higher in males (OR 1.51; 95% CI 1.09-2.10), in those with work-related exposures (OR 1.71; 95% CI 1.10-2.66) or who had contact with sewage (OR 1.42; 95% CI 1.00-2.03). Spatial analysis showed differences in distribution of seropositivity to serogroups Icterohaemorrhagiae and Cynopteri within the five districts where study communities were situated., Conclusions/significance: Our data suggest distinct epidemiological patterns associated with the Icterohaemorrhagiae and Cynopteri serogroups in the urban environment at high risk for leptospirosis and with differences in spatial niches. We emphasize the need for studies that accurately identify the different pathogenic serogroups that circulate and infect residents of low-income areas., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 de Oliveira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The chemical composition of Pachira aquatica crude extracts flowers, leaves, and seeds was obtained by UHPLC-ESI/qTOF and GC/MS. The antiproliferative activity was evaluated against the human tumour cell lines AGS (gastric), CaCo-2 (colorectal), MCF-7 (breast), and NCI-H460 (lung). The anti-inflammatory and cellular antioxidant activities were also studied. Flavonoids, phenolic acids, coumarins, and saturated fatty acids were identified in the samples. The concentration of extracts responsible for inhibiting 50% of nitric oxide production ranged from (149 to > 400 µg mL -1 ). Antiproliferative activity against the tumour cell lines was: AGS (GI 50 175 to > 400 µg mL -1 ), Caco-2 (GI 50 215 to > 400 µg mL -1 ), MCF7 (GI 50 232 to > 400 µg mL -1 ) and NCI-H460 (GI 50 208 to > 400 µg mL -1 ). Cellular antioxidant activity remained between 73% to > 2000%. The selectivity index (SI) ranged from 1.00 to 2.78, indicating low antiproliferative activity.

Background: In most cases, Zika virus (ZIKV) causes a self-limited acute illness in adults, characterized by mild clinical symptoms that resolve within a few days. Immune responses, both innate and adaptive, play a central role in controlling and eliminating virus-infected cells during the early stages of infection., Aim: To test the hypothesis that circulating T cells exhibit phenotypic and functional activation characteristics during the viremic phase of ZIKV infection., Methods: A comprehensive analysis using mass cytometry was performed on peripheral blood mononuclear cells obtained from patients with acute ZIKV infection (as confirmed by RT-PCR) and compared with that from healthy donors (HD). The frequency of IFN-γ-producing T cells in response to peptide pools covering immunogenic regions of structural and nonstructural ZIKV proteins was quantified using an ELISpot assay., Results: Circulating CD4+ and CD8+ T lymphocytes from ZIKV-infected patients expressed higher levels of IFN-γ and pSTAT-5, as well as cell surface markers associated with proliferation (Ki-67), activation ((HLA-DR, CD38) or exhaustion (PD1 and CTLA-4), compared to those from HD. Activation of CD4+ and CD8+ memory T cell subsets, including Transitional Memory T Cells (TTM), Effector Memory T cells (TEM), and Effector Memory T cells Re-expressing CD45RA (TEMRA), was prominent among CD4+ T cell subset of ZIKV-infected patients and was associated with increased levels of IFN-γ, pSTAT-5, Ki-67, CTLA-4, and PD1, as compared to HD. Additionally, approximately 30% of ZIKV-infected patients exhibited a T cell response primarily directed against the ZIKV NS5 protein., Conclusion: Circulating T lymphocytes spontaneously produce IFN-γ and express elevated levels of pSTAT-5 during the early phase of ZIKV infection whereas recognition of ZIKV antigen results in the generation of virus-specific IFN-γ-producing T cells., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Samri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)