Has COVID-19 lowered physical activity practice while boosting online searches for professional exercise information?

COVID-19 is an infectious and contagious disease, caused by the SARS-CoV-2 virus. Due to the rapid spreading of the virus and its lethal consequences, the WHO declared a pandemic. One of the main strategies to treat and prevent the spreading was the stay home safe, a social isolation situation that was accompanied by the closing of fitness gyms, city parks and facilities proper to exercise. This context promoted an increase in home fitness programs and in the search for information online regarding exercise and health. So, the objective of this study was to understand the effects of the pandemic on physical activity behavior and online information search regarding exercise programs. Data collection was through a google forms questionnaire, all procedures were approved by the University ethics committee and we collected data from 1065 participants. Our results showed that the participants main behavior was maintained, 80.7% of our sample were active before the pandemic and only 9.7% of this group stopped being active. On the other hand we registered 7% of participants that started exercise after the pandemic installation. Information about exercise was searched outside social media by 49.6% of the participants with 32.5% using social media. 56.1% would look only for professional advice, interestingly 11.4% of the participants were active without any kind of advice. We concluded that Covid-19 pandemic installation affected negatively the population physical activity behavior and increased awareness about the importance of exercise as a health strategy

Anestesia geral em parto cesárea e as repercussões neonatais: revisão integrativa

Quando o parto natural não pode ocorrer, a cesariana é a indicação obstétrica a ser realizada. O uso de raquianestesia (RA) é a técnica mais empregada nesses casos, porém, a anestesia geral (AG) também pode ser uma indicação, principalmente em situações em que haja maior urgência na retirada do feto. O uso dessa última técnica, pode gerar riscos para a mãe, como falhas na intubação e piores índices neonatais. Avaliar como o uso de anestesia geral repercute nos índices neonatais imediatos e no desenvolvimento neuropsicomotor da criança. Trata-se de uma revisão integrativa na base de dados PUBMED utilizando os descritores “CESAREAN AND GENERAL ANESTHESIA AND NEONATAL’’ para artigos publicados entre 2018 e 2023. O uso de AG está associado a uma necessidade 14,3% maior de VPP e o APGAR < 7 no 5º minuto é 4,2% maior quando ocorre esse uso. Além disso, a AG está envolvida com a indicação de ventilação mecânica e internações em Unidade de Terapia Intensiva Neonatal (UTIN). Comparativamente, a morbidade neonatal foi de 16,1% no grupo com RA e 30% no grupo AG e a oxigenação do tecido cerebral neonatal na transição imediata no nascimento é semelhante em cesarianas com uso de AG e RA. A longo prazo, o uso de anestesia geral em partos cesáreos não está relacionado ao atraso neurológico até os dois anos de idade. A AG está relacionada a complicações neonatais imediatas após o parto como a necessidade de ventilação de pressão positiva (VPP), maior necessidade do uso de oxigênio, maior número de casos de ventilação mecânica e diminuição do APGAR. Porém, a longo prazo o uso parece não interferir no desenvolvimento direto da criança

COMPLICAÇÕES CARDIOVASCULARES DA DOENÇA DE KAWASAKI: REVISÃO INTEGRATIVA

Kawasaki Disease corresponds to a primary vasculitis that mainly affects preschool children, with a slight predominance of males and Asian ethnicity. It is the main vasculitis in developed countries and the 2nd in underdeveloped countries. The diagnosis is essentially clinical, characterized by the presence of fever lasting 5 days or more, associated with conjunctivitis, cervical lymphadenopathy, mucositis, changes in the extremities and rash. Treatment is essentially carried out with immunoglobulin and AAS. Diagnosis and treatment must be carried out effectively and in an ideal time in order to reduce the chance of progression to the main complication of the pathology: coronary artery aneurysm.A Doença de Kawasaki corresponde a uma vasculite primária que afeta, principalmente, crianças em idade pré-escolar, com leve predominância do sexo masculino e etnia asiática. É a principal vasculite em países desenvolvidos e a 2ª em países subdesenvolvidos. O diagnóstico é essencialmente clínico, caracterizado pela presença de febre com duração igual ou superior a 5 dias, associada a conjuntivite, linfadenopatia cervical, mucosite, alterações em extremidades e exantema. O tratamento é realizado essencialmente com imunoglobulina e AAS. O diagnóstico e o tratamento devem ser realizados de forma eficaz e em tempo ideal com o intuito de diminui a chance de evolução para principal complicação da patologia: aneurisma de artéria coronariana

CIRURGIA MINIMAMENTE INVASIVA VERSUS PROCEDIMENTOS CONVENCIONAIS: UMA ANÁLISE COMPARATIVA

Objective: This article aims to explore the dichotomy between minimally invasive surgery (MIS) and conventional procedures (PC), analyzing the technological advances and clinical challenges inherent to both approaches. Results: CMI, with its reduced access and innovative technologies, has transformed surgical practice, challenging conventional procedures, which often involve more extensive incisions and prolonged recovery. The evolution of refined instrumentation such as endoscopes and surgical robotics has improved the accuracy of CMI, although challenges such as the learning curve and cost considerations persist. Methodology: The search included several academic databases such as PubMed, Scopus, Scielo, VHL and Web of Science, using specific terms such as "Minimally Invasive Surgery", "Conventional Procedures" and other related terms. Boolean operators were used to optimize the search. The inclusion criteria ensured relevance, covering studies that directly compared clinical results between Minimally Invasive Surgery and conventional procedures. We excluded studies with heterogeneous samples or without pertinent information. Conclusion: The search for a comprehensive understanding of the advantages and limitations of both approaches is constant, encouraging critical reflection on the future of surgery in search of better results for patients.Objetivo: Este artigo tem como objetivo explorar a dicotomia entre cirurgia minimamente invasiva (CMI) e procedimentos convencionais (PC), analisando os avanços tecnológicos e desafios clínicos inerentes a ambas as abordagens. Resultados: A CMI, com seu acesso reduzido e tecnologias inovadoras, transformou a prática cirúrgica, desafiando os procedimentos convencionais, que frequentemente envolve incisões mais extensas e recuperação prolongada. A evolução de instrumentações refinadas, como endoscópios e robótica cirúrgica, aprimorou a precisão da CMI, embora desafios como a curva de aprendizado e considerações de custo persistam. Metodologia: A busca incluiu diversas bases acadêmicas como PubMed, Scopus, Scielo, BVS e Web of Science, usando termos específicos como "Cirurgia Minimamente Invasiva", "Procedimentos Convencionais" e outros relacionados. Operadores booleanos foram empregados para otimizar a busca. Os critérios de inclusão garantiram relevância, abrangendo estudos que compararam diretamente resultados clínicos entre Cirurgia Minimamente Invasiva e procedimentos convencionais. Excluímos estudos com amostras heterogêneas ou sem informações pertinentes. Conclusão: A busca por uma compreensão abrangente das vantagens e limitações de ambas as abordagens é constante, incentivando uma reflexão crítica sobre o futuro da cirurgia em busca de melhores resultados para os pacientes

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030