Segurança e Eficácia da Vacina Qdenga® (TAK-003) em Crianças de Até 12 anos: Uma Revisão Sistemática

Introduction: Dengue, a viral disease transmitted by the Aedes aegypti mosquito. poses a significant challenge to public health, especially in Brazil, where epidemics occur. The Qdenga vaccine (TAK-003) emerges as a promising intervention, considering its safety and potential efficacy. Objective: Analyze the safety and efficacy of the TAK-003 vaccine in children up to twelve years old. Method: A systematic intervention review was conducted, based on the PICO question "What is the Safety and Efficacy of the Qdenga®️ Vaccine (TAK-003) in Children Up to 12 Years Old?". Texts were searched in five different databases (Scielo, U.S. National Institutes of Health's National Library of Medicine (NIH/NLM - PubMed), Biblioteca Virtual em Saúde (BVS), Sistema Regional de Información en línea para Revistas Científicas de América Latina, el Caribe, España y Portugal (LatinDex), and ScienceDirect), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to maximize methodological quality. Results: Studies consistently demonstrated the efficacy and safety of the Qdenga vaccine in preventing dengue infection in children. Analysis of clinical outcomes indicated good overall efficacy and minimal incidence of serious adverse events related to the vaccine. Conclusion: Based on the results, it is essential to make the Qdenga vaccine available for children, given its proven efficacy and safety. The urgency of accelerating vaccination is emphasized, given children's vulnerability to dengue and the potential negative impact on public health and associated costs.Introdução: A dengue, uma doença viral transmitida pelo mosquito Aedes aegypti, representa um desafio significativo para a saúde pública, especialmente no Brasil, onde ocorre uma epidemia. A vacina Qdenga (TAK-003) surge como uma promissora intervenção, considerando sua segurança e eficácia potencial. Objetivo: Analisar a segurança e eficácia do imunizante TAK-03 em crianças de até doze anos Método: Uma revisão sistemática de intervenção foi conduzida, tendo como base a pergunta PICO “Qual a Segurança e Eficácia da Vacina Qdenga®️ (TAK-003) em Crianças de Até 12 anos?”. A busca dos textos foi efetuada em cinco bases de dados distintas (Scielo, U.S. National Institutes of Health's National Library of Medicine (NIH/NLM - PubMed), Biblioteca Virtual em Saúde (BVS), Sistema Regional de Información en línea para Revistas Científicas de América Latina, el Caribe, España y Portugal (LatinDex) e ScienceDirect.), e seguiu as diretrizes da Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) para maximizar a qualidade metodológica.  Resultados: Os estudos demonstraram consistentemente a eficácia e segurança da vacina Qdenga em prevenir a infecção por dengue em crianças. A análise dos desfechos clínicos indicou uma boa eficácia geral e uma incidência mínima de eventos adversos graves relacionados à vacina. Conclusão: Com base nos resultados, é essencial disponibilizar a vacina Qdenga para crianças, dada sua eficácia e segurança comprovadas. A urgência de uma aceleração na vacinação é destacada, dada a vulnerabilidade das crianças à dengue e o potencial impacto negativo na saúde pública e nos custos associados à doença

ACUPUNTURA NA PROFILAXIA DA ENXAQUECA SEM AURA COMPARADA COM A TERAPIA FARMACOLÓGICA: UMA REVISÃO SISTEMÁTICA

Migraine without aura is a primary painful disorder characterized by pulsating, unilateral, and recurrent headaches. Pharmacological therapy is the first option for crisis relief; however, about 40% of patients require prophylactic therapy. In this context, acupuncture emerges as it has shown to be very effective in controlling painful conditions. To analyze the effectiveness of acupuncture prophylaxis compared to pharmacological therapies in migraine without aura. A Systematic Literature Review was conducted. Articles were selected from various databases using English Health Sciences Descriptors associated with the boolean operator "AND", "Acupuncture", and "Migraine Without Aura". Eligibility criteria included Randomized Clinical Trials in English, Spanish, and Portuguese with full-text availability, resulting in a final sample of five articles. Most studies agree that initially prophylactic acupuncture therapy showed superiority in reducing frequency, pain, symptomatic medication use, and improving patients' quality of life. However, after six months, there was no significant difference between the acupuncture and pharmacological therapy groups in the analyzed clinical outcomes. Acupuncture is valid as an alternative prophylactic therapy to pharmacological therapies, having shown short-term superiority in all selected outcomes with low risk of bias in the analyzed articles. However, it is important to note the scarcity of studies related to the topic, recommending greater effort from the scientific community in research and testing regarding integrative practice in migraine without aura prophylaxis.La migraña sin aura es un trastorno primario doloroso caracterizado por cefaleas pulsátiles, unilaterales y recurrentes. La terapia farmacológica es la primera opción para el alivio de las crisis; sin embargo, alrededor del 40% de los pacientes requieren terapia profiláctica. En este contexto, la acupuntura surge como una opción, ya que ha demostrado ser muy efectiva en el control de condiciones dolorosas. Se realizó una Revisión Sistemática de la Literatura para analizar la efectividad de la profilaxis con acupuntura en comparación con las terapias farmacológicas en la migraña sin aura. Se seleccionaron artículos de varias bases de datos utilizando Descriptores en Ciencias de la Salud en inglés asociados con el operador booleano "AND", "Acupuncture", y "Migraine Without Aura". Los criterios de elegibilidad incluyeron Ensayos Clínicos Aleatorizados en inglés, español y portugués con disponibilidad de texto completo, resultando en una muestra final de cinco artículos. La mayoría de los estudios coinciden en que la terapia profiláctica con acupuntura mostró inicialmente superioridad en la reducción de la frecuencia, el dolor, el uso de medicación sintomática y la mejora de la calidad de vida de los pacientes. Sin embargo, después de seis meses, no hubo una diferencia significativa entre los grupos de acupuntura y terapia farmacológica en los resultados clínicos analizados. La acupuntura es válida como una terapia profiláctica alternativa a las terapias farmacológicas, habiendo mostrado superioridad a corto plazo en todos los resultados seleccionados con bajo riesgo de sesgo en los artículos analizados. Sin embargo, es importante señalar la escasez de estudios relacionados con el tema, recomendándose un mayor esfuerzo de la comunidad científica en la investigación y pruebas sobre la práctica integrativa en la profilaxis de la migraña sin aura.Introdução: A enxaqueca sem aura é um distúrbio doloroso primário, de caráter pulsante, unilateral e recorrente. A terapia farmacológica é a primeira opção para o alívio das crises, porém, cerca de 40% dos pacientes necessitam de terapia profilática. Nesse contexto surge a acupuntura, que já se mostrou muito eficaz no controle de quadros dolorosos. Objetivo: Analisar a efetividade da profilaxia com acupuntura em relação às terapias farmacológicas na enxaqueca sem aura. Método: Foi realizada uma Revisão Sistemática da Literatura. A partir dos descritores encontrados no Descritores em Ciências da Saúde em inglês, associados ao operador booleano “AND”: “Acupuncture” e “Migraine Without Aura”, foram selecionados artigos das seguintes bases de dados: Medical Literature Analysis and Retrieval System Online, National Library of Medicine, Scientific Electronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde e Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. Como critérios de elegibilidade foram escolhidos estudos caracterizados como Ensaios Clínicos Randomizados em inglês, espanhol e português com disponibilidade de texto completo, resultando em uma amostra final de cinco artigos. Resultados: A maioria dos estudos concordam que inicialmente a terapia profilática com acupuntura se mostrou superior na diminuição da frequência, da dor, no uso de medicamentos sintomáticos e na melhoria da qualidade de vida dos pacientes. Porém, após seis meses, não houve diferença significativa entre os grupos em uso de acupuntura e em uso de terapias farmacológicas nos desfechos clínicos analisados. Conclusão: A acupuntura é válida como terapia profilática alternativa às terapias farmacológicas, tendo se mostrado superior a curto prazo em todos os desfechos selecionados, com baixo risco de viés nos artigos analisados. Porém, é importante ressaltar a escassez de estudos relacionados ao tema, recomendando-se um maior esforço da comunidade científica na pesquisa e nos testes com relação à prática integrativa na profilaxia da Enxaqueca sem aura

Third brazilian consensus for autoantIbodies screening in HEp-2 Cells : historical perspectve, quality control and clinical associatons

O III Consenso Brasileiro para Pesquisa de Autoanticorpos em Células HEp-2 (FAN) objetivou discutir estratégias para controlar a qualidade do ensaio, promover a atualização das associações clínicas dos diversos padrões e avaliar as difculdades de implantação do II Consenso ocorrido no ano de 2002. Métodos: Nos dias 13 e 14 de abril de 2007 participaram do encontro em Goiânia pesquisadores e especialistas de diversos centros universitários e laboratórios clínicos de diferentes regiões do Brasil, com o propósito de discutir e aprovar as recomendações que visam a melhores padronização, interpretação e utilização do ensaio pelos clínicos. Foram convidados como ouvintes representantes comerciais de diferentes empresas produtoras de insumos para realização do teste de FAN. Resultados e conclusão: Dada a heterogeneidade de microscópios e reagentes disponíveis no mercado, o III Consenso enfatizou a necessidade do controle de qualidade em ensaios de imunofuorescência indireta. Foram também feitas algumas adequações na terminologia utilizada para classifcar os diferentes padrões. Finalmente, foi realizada uma atualização das associações clínicas com fnalidade de facilitar cada vez mais o melhor uso do ensaio pelos clínicos. _________________________________________________________________________________ ABSTRACTThe Third Brazilian Consensus for Autoantibodies Screening in HEp-2 Cells (ANA) had as purpose the evaluation of diffculties in the accomplishment of the 2nd Consensus recommendations that took place in the year of 2002, the discussion of strategies for quality control of the assay and the discussion of an update of the clinical associations of the several immunofuorescent patterns. Methods: Several ANA experts from university centers and private laboratories in different areas in Brazil joined the workshop in Goiânia on 2007 April 13 and 14 with the purpose of discussing and approving the recommendations for standardization, interpretation and use of the test by physicians. Commercial representatives of different ANA slide brands were also invited as listeners to the workshop. Results and conclusion: The 3rd ANA Consensus emphasized the need for quality control in indirect immunofuorescent assays since there is a considerable heterogeneity of available microscopes and reagents. It also promoted adaptations in the previously approved terminology used to classify the different patterns and fnally updated the clinical associations of the several patterns with the purpose of providing guidance for interpretation of the assay by clinical pathologists and assistant physicians

Third Brazilian consensus for autoantibodies screening in HEp-2 cells (ANA) : recommendations for standardization of autoantibodies screening trial in HEp-2 cells, quality control and clinical associations

Objetivo: O 3º Consenso Brasileiro para pesquisa de autoanticorpos em Células HEp-2 (FAN) teve como propósito avaliar as dificuldades de implantação do 2º Consenso ocorrido no ano de 2002, discutir estratégias para controlar a qualidade do ensaio e promover a atualização das associações clínicas dos diversos padrões. Métodos: Participaram do encontro em Goiânia nos dias 13 e 14 de abril de 2008 pesquisadores e especialistas de diversos centros universitários e laboratórios clínicos de diferentes regiões do Brasil, com o propósito de discutir e aprovar as recomendações que visam à melhor padronização, interpretação e utilização do ensaio pelos clínicos. Representantes comerciais de diferentes empresas produtoras de insumos para realização do teste de FAN foram convidados como ouvintes. Resultados e Conclusões: O 3º Consenso enfatizou a necessidade do controle de qualidade em imunofluorescência dada a heterogeneidade de microscópios e reagentes disponíveis no mercado, promoveu adequações na terminologia utilizada para classificar os diferentes padrões e, finalmente, atualizou as associações clínicas com finalidade de facilitar cada vez mais o melhor uso do ensaio pelos clínicos. ________________________________________________________________________________ ABSTRACTObjective: The Third Brazilian Consensus for autoantibodies Screening in HEp-2 cells had as purpose the evaluation of difficulties in the accomplishment of the 2nd Consensus recommendations that took place in the year of 2002, the discussion of strategies for quality control of the assay and the promotion of an update of the clinical associations of the several immunofluorescent patterns. Methods: Several ANA experts from university centers and private laboratories in different areas in Brazil joined the workshop in Goiânia on 2008 April 13 and 14 with the purpose of discussing and approving the recommendations for standardization, interpretation and use of the test by physicians. Commercial representatives of different ANA slide brands were also invited as listeners to the workshop. Results and Conclusions: The 3rd Consensus emphasized the need for quality control in indirect immunofluorescent since there is a considerable heterogeneity of available microscopes and reagents. It also promoted adaptations in the previously approved terminology used to classify the different patterns and finally updated the clinical associations of the several patterns with the purpose of providing guidance for interpretation of the assay by clinical pathologists and assistant physicians

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

Abstract Background Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. Methods This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Results The median age of the model-derivation cohort was 59 (IQR 47–70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918–0.939) and validation (temporal AUROC 0.927, 95% CI 0.911–0.941; geographic AUROC 0.819, 95% CI 0.792–0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). Conclusions The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data