TENDÊNCIA DA COVID-19 NO ESTADO DO TOCANTINS: EPIDEMIOLOGIA E ANÁLISE DA DOENÇA ATÉ A SEMANA 35

Objetivo: Descrever a tendência da Covid-19 no estado do Tocantins e o perfil de casos até a semana epidemiológica 35. Métodos: Trata-se de um estudo ecológico do tipo série temporal com base de dados secundários sobre Covid-19 no estado do Tocantins no período de 15 de março a 29 de agosto (semanas epidemiológicas 12 a 35) de 2020. Resultados: A taxa de incidência por Covid-19 apresentou maior crescimento na variação percentual semanal entre as semanas epidemiológicas 12 a 21 (WPC: 91,6; IC: 64,0 a 124,0) na tendência 1. A taxa de mortalidade teve aumento significativo de 73% entre a semana epidemiológica 12 a 20 (WPC: 70,0; IC: 34,0 a 122,5). No período total, a taxa de incidência teve um aumento significativo de 35,3% e a taxa de mortalidade de 19,5%. A ocorrências de casos foi predominante em faixas etárias mais jovens e a mortalidade foi maior nas faixas etárias mais avançadas. As mulheres foram mais diagnosticadas com a Covid-19 e os óbitos foram em maior proporção em homens. Na análise da distribuição espacial de casos confirmados e óbitos, observou-se o registro de mais de mil casos nos municípios de maior densidade populacional e suas áreas metropolitanas. Os registros de óbitos apresentam distribuição similar. Conclusão: Apesar de recomendações governamentais e de autoridades de saúde para o isolamento social e contenção da transmissão da Covid-19, a taxa de incidência e mortalidade pela doença no estado do Tocantins manteve uma curva crescente até a semana epidemiológica 33, contrapondo-se aos demais estados da federação. Aspectos como empecilhos na adesão ao isolamento social, faixa etária, situação de vulnerabilidade, comorbidades e rede hospitalar menor precisam ser levados em conta para a realidade epidemiológica que o estado se encontra. Ressalta-se, que novos estudos serão necessários para monitorar o comportamento da Covid-19 no estado do Tocantins a longo prazo

Tratamento das lesões dentárias traumáticas: perspectivas atuais¹ / Treatment of traumatic dental injuries: current perspectives

 As lesões dentárias traumáticas de dentes permanentes apresentam alta prevalência em crianças e adolescentes. As fraturas mais comuns são as envolvendo tecidos duros e luxações, apresentando uma etiologia multifatorial. É de extrema importância que o cirurgião dentista realize anamnese, exame clínico e radiográfico, para que consiga realizar um diagnóstico adequado e consequentemente um plano de tratamento para um resultado mais favorável, estando sempre atento as mudanças nas diretrizes e condutas. Dessa maneira, o presente estudo teve como objetivo apresentar as novas diretrizes acerca do atendimento de emergência de traumatismos dentários do International Association of Dental Traumatology. Nesse contexto, pode-se concluir que as diretrizes da IADT estão atualizadas e direcionam o dentista para o melhor atendimento possível dos casos de traumatismos dentários

Strategies for the planning of sustainable mobility: An exploratory study in Brazil

O crescimento acelerado da população nas cidades brasileiras, aliado à falta de um planejamento urbano adequado, tem o problema da mobilidade urbana como uma de suas consequências mais aparentes. O artigo aborda os impactos da expansão urbana na mobilidade para o município de São José dos Campos/SP. A falta de integração entre os diferentes modais e os impactos causados no transporte urbano no cenário municipal são os principais pontos que motivam este estudo. Assim, o objetivo do trabalho foi compreender e estruturar esta situação problemática e propor ações estratégicas, com vistas à promoção da mobilidade urbana sustentável naquele município. Para isto, será adotada uma abordagem multimetodológica que consistirá na combinação dos Mapas Cognitivos com o SCA (Strategic Choice Approach), apoiado pela utilização da matriz GUT (Gravidade/Urgência/Tendência). Como resultado foi possível definir um pacote de compromissos de decisões e ações estratégicas, que visem melhorar a infraestrutura de transporte atual e preparar o município para futuras atualizações, já considerando a multimodalidade como alternativa.The accelerated population growth in Brazilian cities, together with the lack of adequate urban planning, has the problem of urban mobility as one of its most apparent consequences. The article discusses the impacts of urban expansion on mobility for the city of São José dos Campos / SP. The lack of integration between the different modalities and the impacts caused in urban transport in the municipal scenario are the main points that motivate this study. Thus, the objective of the work is to understand and to structure this problematic situation and to propose strategic actions, in order to promote sustainable urban mobility in that city. For this, a multi-method approach is adopted, which consists of a combination of Cognitive Maps with the Strategic Choice Approach (SCA), supported by the use of the GUT (Severity / Urgency / Trend) matrix. As a result, it was possible to define a package of commitments for strategic decisions and actions, which has for its purpose to improve the current transportation infrastructure and to prepare the city for future upgrades, considering multimodality as an alternative

TÉCNICAS EMPREENDIDAS PARA DIFUSÃO DA PRÁTICA BASEADA EM EVIDÊNCIAS ENTRE ENFERMEIROS HOSPITALARES

RESUMO O objetivo deste estudo foi relatar uma experiência sobre a difusão da prática baseada em evidências entre enfermeiros gerentes de um hospital público de ensino do Triângulo Mineiro. Trata-se de um projeto de pesquisa que tem a extensão universitária como uma de suas interfaces. Foi implementado pelo setor responsável por assessorar o desenvolvimento de pesquisas desse hospital em parceira com o curso de graduação de Enfermagem da universidade correspondente. As técnicas foram empreendidas durante o desenvolvimento de cinco oficinas motivacionais à prática baseada em evidências, realizadas entre agosto e setembro/2016, por perspectiva hermenêutico-dialética, e os gerentes de enfermagem das unidades assistenciais de internação compuseram o grupo focal. A organização das oficinas conduziu-se por: constituição do grupo condutor; mobilização do grupo de interesse e desenvolvimento do trabalho nas oficinas em si. Foi aplicado questionário estruturado para caracterização do grupo focal. Os participantes apresentaram média de idade de 35,1 anos, maioria de mulheres (95%), todos com pós-graduação. As técnicas empreendidas envolveram desde estratégias discursivas até expressões artísticas para aquecimento e desenvolvimento da tarefa grupal, de forma a auxiliarem a operatividade do grupo, a construção coletiva do conhecimento e ajudar os enfermeiros gerentes a identificar oportunidades no cotidiano para aprimorar processos ou resultados clínicos mediante a incorporação de evidências científicas qualificadas. O nível de preparo do grupo condutor para mediação e características intrínsecas ao grupo focal como a consciência do valor das pesquisas para qualificar a assistência foram fatores facilitadores para o desenvolvimento das oficinas e o sucesso no empreendimento das técnicas

Energy metabolism: gluconeogenesis and oxidative phosphorylation

Most animal cells are able to meet their energy needs from the oxidation of various types of compounds: sugars, fatty acids, amino acids, but some tissues and cells of our body depend exclusively on glucose and the brain is the largest consumer of all. That is why the body has mechanisms in order to keep glucose levels stable. As it decreases, the degradation of hepatic glycogen occurs, which maintains the appropriate levels of blood glucose allowing its capture continues by those tissues, even in times of absence of food intake. But this reserve is limited, so another metabolic pathway is triggered for glucose production, which occurs in the kidneys and liver and is called gluconeogenesis, which means the synthesis of glucose from non-glucose compounds such as amino acids, lactate, and glycerol. Most stages of glycolysis use the same enzymes as glycolysis, but it makes the opposite sense and differs in three stages or also called deviations: the first is the conversion of pyruvate to oxaloacetate and oxaloacetate to phosphoenolpyruvate. The second deviation is the conversion of fructose 1,6 biphosphate to fructose 6 phosphate and the third and last deviation is the conversion of glucose 6 phosphate to glucose

Anti-inflammatory foods: human food patterns, bioactive principles and mechanisms of action

With the increase in life expectancy accompanied by the gradual decrease in the birth rate as well as the greater income distribution associated with the quantitative increase in the minimum wage above inflation and the increase in its purchasing power, today the Brazilian population shows a moment exactly opposite to that found in the last century both in epidemiological terms and in the nutritional pattern. Brazil is currently experiencing the same pattern of mortality as developed countries: the majority of chronic non-communicable diseases are the main cause of death associated with an established model of obesity and sedentarism. These factors incline the scientific community and health professionals to turn their efforts to find food solutions that ease this epidemiological picture and it is in this context that anti-inflammatory foods have gained prominence. The following describes the main compounds that fit this magnitude of effect and their mechanisms of action

Nutritional physical examination: historical, methodological and applied approach

The historical interest in the use of physical evaluation skills in clinical settings gained new notoriety at the end of the 20th century with evidence that patients in intensive care units experienced increased morbidity and mortality related to poor nutritional status before and/or during their admission. This awareness of the adverse effects of malnutrition led to the need for screening and evaluation tools to identify nutritional risk. no clinical finding of EFN should be considered a diagnosis per se. It is academic, scientific and clinical consensus that its results should be interpreted as suggestive, being crucial to consider the other methods of clinical evaluation of the patient\u27s nutritional status for the correct global nutritional diagnosis. However, the systematic and periodic repetition of the test may help to follow the evolution of the individual\u27s nutritional status, especially in the long term. In summary, although it requires specialized training and continuous practice of the evaluator and/or the team – in addition to requiring complementary nutritional information – the physical nutritional examination can still be considered an effective adjuvant method in the clinical evaluation of the patient’s nutritional status

High anti-SARS-CoV-2 antibody seroconversion rates before the second wave in Manaus, Brazil, and the protective effect of social behaviour measures: results from the prospective DETECTCoV-19 cohort

Background: The city of Manaus, Brazil, has seen two collapses of the health system due to the COVID-19 pandemic. We report anti-SARS-CoV-2 nucleocapsid IgG antibody seroconversion rates and associated risk factors in Manaus residents before the second wave of the epidemic in Brazil. Methods: A convenience sample of adult (aged ≥18 years) residents of Manaus was recruited through online and university website advertising into the DETECTCoV-19 study cohort. The current analysis of seroconversion included a subgroup of DETECTCoV-19 participants who had at least two serum sample collections separated by at least 4 weeks between Aug 19 and Oct 2, 2020 (visit 1), and Oct 19 and Nov 27, 2020 (visit 2). Those who reported (or had no data on) having a COVID-19 diagnosis before visit 1, and who were positive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at visit 1 were excluded. Using an in-house ELISA, the reactivity index (RI; calculated as the optical density ratio of the sample to the negative control) for serum anti-SARS-CoV-2 nucleocapsid IgG antibodies was measured at both visits. We calculated the incidence of seroconversion (defined as RI values ≤1·5 at visit 1 and ≥1·5 at visit 2, and a ratio >2 between the visit 2 and visit 1 RI values) during the study period, as well as incidence rate ratios (IRRs) through cluster-corrected and adjusted Poisson regression models to analyse associations between seroconversion and variables related to sociodemographic characteristics, health access, comorbidities, COVID-19 exposure, protective behaviours, and symptoms. Findings: 2496 DETECTCoV-19 cohort participants returned for a follow-up visit between Oct 19 and Nov 27, 2020, of whom 204 reported having COVID-19 before the first visit and 24 had no data regarding previous disease status. 559 participants were seropositive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at baseline. Of the remaining 1709 participants who were seronegative at baseline, 71 did not meet the criteria for seroconversion and were excluded from the analyses. Among the remaining 1638 participants who were seronegative at baseline, 214 showed seroconversion at visit 2. The seroconversion incidence was 13·06% (95% CI 11·52–14·79) overall and 6·78% (5·61–8·10) for symptomatic seroconversion, over a median follow-up period of 57 days (IQR 54–61). 48·1% of seroconversion events were estimated to be asymptomatic. The sample had higher proportions of affluent and higher-educated people than those reported for the Manaus city population. In the fully adjusted and corrected model, risk factors for seroconversion before visit 2 were having a COVID-19 case in the household (IRR 1·49 [95% CI 1·21–1·83]), not wearing a mask during contact with a person with COVID-19 (1·25 [1·09–1·45]), relaxation of physical distancing (1·31 [1·05–1·64]), and having flu-like symptoms (1·79 [1·23–2·59]) or a COVID-19 diagnosis (3·57 [2·27–5·63]) between the first and second visits, whereas working remotely was associated with lower incidence (0·74 [0·56–0·97]). Interpretation: An intense infection transmission period preceded the second wave of COVID-19 in Manaus. Several modifiable behaviours increased the risk of seroconversion, including non-compliance with non-pharmaceutical interventions measures such as not wearing a mask during contact, relaxation of protective measures, and non-remote working. Increased testing in high-transmission areas is needed to provide timely information about ongoing transmission and aid appropriate implementation of transmission mitigation measures. Funding: Ministry of Education, Brazil; Fundação de Amparo à Pesquisa do Estado do Amazonas; Pan American Health Organization (PAHO)/WHO.World Health OrganizationRevisión por pare

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio