Variations in National Surveillance Reporting for Mpox Virus : A Comparative Analysis in 32 Countries

Objectives: Case Reporting and Surveillance (CRS) are crucial to combat the global spread of the Monkeypox virus (Mpox). To support CRS, the World Health Organization (WHO) has released standardized case definitions for suspected, probable, confirmed, and discarded cases. However, these definitions are often subject to localized adaptations by countries leading to heterogeneity in the collected data. Herein, we compared the differences in Mpox case definitions in 32 countries that collectively reported 96% of the global Mpox caseload. Methods: We extracted information regarding Mpox case definitions issued by the competent authorities in 32 included countries for suspected, probable, confirmed, and discarded cases. All data was gathered from online public sources. Results: For confirmed cases, 18 countries (56%) followed WHO guidelines and tested for Mpox using species specific PCR and/or sequencing. For probable and suspected cases, seven and eight countries, respectively were found to have not released definitions in their national documentations. Furthermore, none of the countries completely matched WHO’s criteria for probable and suspected cases. Overlapping amalgamations of the criteria were frequently noticed. Regarding discarded cases, only 13 countries (41%) reported definitions, with only two countries (6%) having definition consistent with WHO guidelines. For case reporting, 12 countries (38%) were found to report both probable and confirmed cases, in line with WHO requirements. Conclusions: The heterogeneity in case definitions and reporting highlights the pressing need for homogenization in implementation of these guidelines. Homogenization would drastically improve data quality and aid data-scientists, epidemiologists, clinicians etc., to better understand and model the true disease burden in the society, followed by formulation and implementation of targeted interventions to curb the virus spread.publishersversionPeer reviewe

DO ENSINO MÉDIO AO ENSINO MÉDICO: UM RELATO DE EXPERIÊNCIA DE ACOLHIMENTO AOS CALOUROS

RESUMO  INTRODUÇÃO: Os acadêmicos de medicina sofrem com muita ansiedade ao entrarem na faculdade, e isso se deve principalmente a mudança no ciclo de vida e à adaptação a uma realidade ainda desconhecida. O evento “Passei, e agora?” foi criado com o intuito de acolher e auxiliar esses novos estudantes a se ajustarem a uma nova rotina, por meio da apresentação de temas desde materiais usados na faculdade até saúde mental. O objetivo deste relato é descrever a organização e a importância do evento. RELATO: A reunião, realizada em agosto de 2021 de forma híbrida, contou com 24 inscrições por um formulário que continha um pré-teste. Foram apresentados, por meio de slides, temas particulares da faculdade, como materiais, ligas acadêmicas, estágios, projetos de extensão e pesquisa, e habilidades a serem desenvolvidas, como planejamento, gestão de tempo, produtividade, saúde mental e sono. Posteriormente, foi aplicado um formulário pós-teste, a fim de avaliar a apresentação e impacto da reunião. DISCUSSÃO: O estudante de medicina atinge seu maior nível de ansiedade no 1° semestre, quando tem de lidar com a adaptação a uma nova realidade e o encontro de novas preocupações. Nesse contexto, o “Passei, e agora?” auxilia os estudantes a lidar com o início do curso, afinal, nesse período salienta-se a relevância da saúde mental. Apesar dos elogios e iniciativa dos estudantes presentes, a forma híbrida limitou a participação daqueles que assistiam de forma online, por estarem no primeiro período, não foi possível mensurar o impacto a longo prazo. CONCLUSÃO: Evidenciou-se a importância do evento que, trazendo auxilio e conforto aos novos estudantes de medicina, contribui para o processo de adaptação à vida acadêmica universitária. Assim, pretende-se continuar com a realização deste, inserindo dinâmicas integrativas entre os presentes. ABSTRACT INTRODUCTION: Medical students suffer from a lot of anxiety when they get into college, this is mainly due to the change in the life cycle and the adaptation to a still unknown reality. The event "Passei, e agora?" intends to welcome and help these new students to adjust to a new routine, through the presentation of topics ranging from materials used in college to mental health. The purpose of this report is to describe the organization and importance of the event. EXPERIENCE REPORT: The meeting, held in August 2021 in a hybrid way, had 24 registrations through a form that contained a pre-test. Particular college topics were presented by slides, such as materials, academic leagues, internships, extension and research projects, and skills to be developed, such as planning, time management, productivity, mental health and sleep. Subsequently, a post-test form was applied in order to measure the presentation and impact of the meeting. DISCUSSION: Medical students reach their highest level of anxiety in the 1st semester, when they have to deal with adapting to a new reality and dealing with new concerns. In this context, "Passei, e agora?" helps students to deal with the beginning of the course, after all, in this period, the importance of mental health is highlighted. Despite the compliments and initiative of the students that were present, the hybrid form limited the participation of those who watched it online, in addition to the fact that they were still in their first year, making it hard to measure the long-term impact. CONCLUSION: The importance of the event, which brings help and comfort to the new medical students, is evident, as it contributes to the process of adaptation to the university academic life. Thus, it is intended to continue with its realization, inserting integrative dynamics among those present

Efeitos da estimulação tatil-cinestésica e vestibular no recém-nascido de baixo peso e avaliação da melhor técnica: uma revisão sistemática e metanálise / Effects of tactile-kinesthetic and vestibular stimulation in low weight newborns and evaluation of best technique: a systematic review and meta-analysis

Durante anos a prematuridade tem se tornado um grande desafio dentro das Unidades de Terapia Intensiva Neonatal (UTIN), pois afeta o desenvolvimento e crescimento dos recém-nascidos (RN) decorrendo de deficiências que começariam a assumir funções normais para sua idade. A estimulação precoce tem como objetivo, devolver ao RN, seu desenvolvimento perfeito ou chegar o mais próximo da normalidade, utilizando condutas especificas, pois logo após o nascimento o cérebro apresenta uma intensa neuroplasticidade. A estimulação tátil-cinestésica proporciona ao RNPTBP, ganho de peso diário e redução do tempo de internação, pois para o recém-nascido a estimulação tátil nos seus primeiros dias de vida é maior do que qualquer outro estímulo sensorial. O objetivo do presente trabalho, foi analisar os efeitos da técnica de estimulação tátil-cinestésica com os efeitos da estimulação vestibular no recém-nascido pré-termo de baixo peso, para fazer uma comparação sobre qual será a melhor para ser aplicada no RNPTBP dentro da UTIN. Este estudo foi realizado de acordo com as recomendações dos relatórios de análises sistemáticas e metanálises (Preferred Reporting Items for Systematic Reviews and Meta- analyses PRISMA). Foram realizadas buscas nas seguintes bases de dados: LiLASC, SCOPUS, PUBMED, PEDro, MEDLINE, Web of Science; Cochrane Libary e Google Scholar. Os períodos abrangidos da pesquisa foram a partir do ano de 2.015 até o ano de 2020. Com base nas análises realizadas neste presente estudo é incontestável que a assistência à neonatos devem ser realizada de forma criteriosa e atenta as necessidades individuais de cada um, pois se essa assistência for prestada de forma inadequada, omissa, e deficiente ao recém-nascido, principalmente em condição prematura e de baixo peso, devido ao seu alto grau de vulnerabilidade, poderá acarretar sérias consequências em seu desenvolvimento que influenciará, por toda a sua vida

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

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 <= 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

Alterações ósseas no desenvolvimento da acondroplastia

Introduction: Achondroplasia, the most common type of dwarfism, is a bone dysplasia that affects 1 in every 15000 to 40000 live births, characterized by a mutation in the fibroblast growth factor gene (FGFR3). This paper aims to highlight the bone changes present in achondroplasia and the possible radiological findings. Methods: Narrative literature review conducted from April to June 2019, selecting 41 articles from the Scielo, Virtual Health Library (VHL) and Pubmed databases. Five books were also consulted. Results: Numerous bone changes were found in achondroplastic individuals. The following were observed in the skull: decreased diameter of the foramen magnum, disproportion between viscerocranium and neurocranium, crowded dentition, mandibular prognathism, depressed nasal bridge, prominent frontal bone and central hypoplasia of the face. In the spine, the vertebral pedicles are shorter, vertebral canal stenosis, lumbar kyphosis, hyperlordosis, and scoliosis occur. The pelvis presents small and depressed ischial spines, rounded iliac ends, a square-shaped iliac fossa, and a horizontal acetabular roof. The sacrum is narrow and horizontal. In the limbs, rhizomelic shortening and bony prominences stand out. Fibular overgrowth occurs, with anterior tibial angulation, inability to everse the foot, and genu varum. In the upper limb, the radial head is flattened, limiting movement of the elbow. The hands are trident shaped, with short proximal phalanges and metacarpal deformities. The rib cage is small but broad, with short ribs and broadened anterior extremities. Discussion: The modifications mentioned corroborate the clinical and radiological findings in the diagnosis by ultrasonography from the twentieth gestational week and by radiography after birth. Conclusion: Of the changes described, those of the skull, spine, pelvis, limbs and chest stand out. There is still a need for more complete studies on the subject.Introdução: A acondroplasia, o tipo mais comum de nanismo, é uma displasia óssea que afeta 1 para cada 15000 a 40000 nascidos vivos, caracterizada por uma mutação no gene do fator de crescimento de fibroblastos (FGFR3). Esse trabalho tem como objetivo evidenciar as alterações ósseas presentes na acondroplasia e os possíveis achados radiológicos. Métodos: Revisão narrativa de literatura realizada de abril a junho de 2019, selecionando 41 artigos das bases de dados Scielo, Biblioteca Virtual de Saúde (BVS) e Pubmed. Também foram consultados 5 livros. Resultados: Inúmeras alterações ósseas foram encontradas nos indivíduos acondroplásicos. Foram observados no crânio: diminuição do diâmetro do forame magno, desproporção entre viscerocrânio e neurocrânio, dentição apinhada, prognatismo mandibular, ponte nasal deprimida, osso frontal proeminente e hipoplasia central da face. Na coluna, os pedículos vertebrais são mais curtos, ocorre estenose do canal vertebral, cifose lombar, hiperlordose e escoliose. A pelve apresenta espinhas isquiáticas pequenas e deprimidas, extremidades do ílio arredondadas, fossa ilíaca em formato quadrado e teto acetabular horizontal. O sacro é estreito e horizontalizado. Nos membros, destaca-se o encurtamento rizomélico e as proeminências dos acidentes ósseos. Ocorre supercrescimento fibular, com angulação anterior tibial, incapacidade de eversão do pé e Genu Varum. No membro superior, a cabeça radial é achatada, limitando a movimentação do cotovelo. As mãos são em tridente, com falanges proximais curtas e deformidades metacarpais. A caixa torácica é pequena, porém ampla, com costelas curtas, de extremidades anteriores alargadas. Discussão: As modificações mencionadas corroboram os achados clínicos e radiológicos no diagnóstico por meio de ultrassonografias a partir da vigésima semana gestacional e por radiografias após o nascimento. Conclusão: Das alterações descritas, destacam-se as do crânio, coluna vertebral, pelve, membros e tórax. Ainda há a necessidade de estudos mais completos sobre o tema

Data_Sheet_1_Variations in national surveillance reporting for Mpox virus: A comparative analysis in 32 countries.docx

ObjectivesCase Reporting and Surveillance (CRS) are crucial to combat the global spread of the Monkeypox virus (Mpox). To support CRS, the World Health Organization (WHO) has released standardized case definitions for suspected, probable, confirmed, and discarded cases. However, these definitions are often subject to localized adaptations by countries leading to heterogeneity in the collected data. Herein, we compared the differences in Mpox case definitions in 32 countries that collectively reported 96% of the global Mpox caseload.MethodsWe extracted information regarding Mpox case definitions issued by the competent authorities in 32 included countries for suspected, probable, confirmed, and discarded cases. All data were gathered from online public sources.ResultsFor confirmed cases, 18 countries (56%) followed WHO guidelines and tested for Mpox using species specific PCR and/or sequencing. For probable and suspected cases, seven and eight countries, respectively were found to have not released definitions in their national documentations. Furthermore, none of the countries completely matched WHO’s criteria for probable and suspected cases. Overlapping amalgamations of the criteria were frequently noticed. Regarding discarded cases, only 13 countries (41%) reported definitions, with only two countries (6%) having definition consistent with WHO guidelines. For case reporting, 12 countries (38%) were found to report both probable and confirmed cases, in line with WHO requirements.ConclusionThe heterogeneity in case definitions and reporting highlights the pressing need for homogenization in implementation of these guidelines. Homogenization would drastically improve data quality and aid data-scientists, epidemiologists, and clinicians to better understand and model the true disease burden in the society, followed by formulation and implementation of targeted interventions to curb the virus spread.</p