Premature birth and COVID-19: an integrative review/ Nascimento prematuro e COVID-19: uma revisão integrativa

OBJECTIVE: To review the current scientific evidence of premature birth related to coronavirus disease 2019 (Covid-19).METHODS: An integrative review was carried out by three independent researchers, based on the literature available in the MEDLINE (via PubMed) and LILACS databases, using the descriptors "coronavirus infections" and "premature birth". This research included case reports or case series published until 26th February 2021, in English or Portuguese. After reading the articles in their entirety, those specifically related to premature birth in pregnant women positive for Covid-19 were selected. Initially, a total of 21 articles were found, 19 were analyzed in full-text and 13 were finally selected for this study. RESULTS: The rate of prematurity was not reflected at the expense of spontaneous premature birth, since these were relatively low, with a cesarean section percentage higher than 80%. Most reports describe the termination of pregnancy by cesarean section due to maternal-fetal hemodynamic instability. It is known that Covid-19 can cause serious maternal or perinatal outcomes; however, it is suggested that the indication of the delivery route be individualized and the importance of quality prenatal care is emphasized.CONCLUSION: Covid-19 prematurity seems to be elevated by the increased number of preterm births due to cesarean sections possibly to improve maternal and neonatal clinical status. However, more studies are needed to prove the hypothesis of spontaneous premature labor caused directly by SARS-CoV-2

Effectiveness of individualized counseling on the duration of exclusive breastfeeding: study protocol for a multicenter, randomized, parallel, and open clinical trial.

BACKGROUND: Despite the benefits of breastfeeding, early weaning is a reality, so less than 50% of children worldwide and in Brazil are on exclusive breastfeeding in the sixth month of life. A strategy to counteract this scenario is breastfeeding counseling. This study aims to verify the effectiveness of individualized counseling by nurses trained in breastfeeding counseling, on the duration of exclusive breastfeeding, compared to standard care. METHODS: Multicenter, randomized, parallel, and open clinical trial, with primiparous women aged over 18 years, hospitalized in rooming-in wards at participating centers and hemodynamically stable, aware, and oriented, who had a single-fetus pregnancy and gave birth, regardless of the type of delivery, with live child, gestational age of 37 to 42 weeks and birth weight greater than 2500 g. The women will be initially approached in rooming-in wards and, upon consent to participate in the study, will be allocated through randomization by blocks composed of eight participants in two groups: intervention and control. The randomization lists will be organized by a central without involvement with the study, which will manage the allocation groups and be prepared in the Randon® program. Women allocated to the intervention group will receive breastfeeding counseling by trained nurses, and those in the control group will receive standard care at the center participating in the study. DISCUSSION: The results can contribute to breastfeeding by evidencing possible exclusivity and duration of the counseling trained nurses provide. TRIAL REGISTRATION: REBEC RBR-4w9v5rq (UTN: U1111-1284-3559) ( https://ensaiosclinicos.gov.br/rg/RBR-4w9v5rq ). Posted on March 20, 2023

Efeito do tempo de intubação nos desfechos de mortalidade em pacientes com Covid – 19: uma revisão bibliográfica narrative / The effect of intubation time on mortality outcomes in patients with Covid-19: a narrative literature review

A COVID-19 é uma novo vírus altamente infecciosos e letal cujos desdobramentos no sistema de saúde, nos índices de infecção e mortalidade e até na economia têm sido severos. Embora várias diretrizes internacionais recomendem a intubação precoce em relação à tardia de pacientes com COVID-19, este assunto ainda é controverso. O objetivo do presente estudo foi investigar o efeito de tempo de intubação em resultados clínicos de pacientes criticamente enfermos com COVID-19 por meio da realização de uma revisão bibliográfica. As buscas foram realizadas na plataforma indexadora Pubmed selecionando artigos publicados entre 2019 e 2021 e houveram 2,784 artigos encontrados na plataforma indexadora. As seleções dos artigos foram realizadas pela leitura primária por título e resumo e depois por leitura completa, totalizando 7 artigos incluídos para a extração de dados e síntese dos resultados. 5 estudos não encontram correlação significativa entre o tempo de intubação e a taxa de mortalidade, não havendo melhores ou piores prognósticos e desfechos diante de uma intubação precoce ou tardia 1 estudo encontra maior taxa de mortalidade entre o grupo de pacientes intubados e outro encontra maior taxa de mortalidade entre os pacientes intubados tardiamente. O desfecho da presente revisão aponta que a estratégia de intubação precoce não está atrelada a melhores desfechos clínicos nem a uma menor taxa de óbitos em consequência da COVID-19. Entretanto, este se trata de um tema ainda emergente e com teorias muito distintas e inconclusivas, mostrando a necessidade de maiores e melhores publicações sobre o problema

Reuma.pt/vasculitis - the Portuguese vasculitis registry

BACKGROUND: The vasculitides are a group of rare diseases with different manifestations and outcomes. New therapeutic options have led to the need for long-term registries. The Rheumatic Diseases Portuguese Register, Reuma.pt, is a web-based electronic clinical record, created in 2008, which currently includes specific modules for 12 diseases and > 20,000 patients registered from 79 rheumatology centres. On October 2014, a dedicated module for vasculitis was created as part of the European Vasculitis Society collaborative network, enabling prospective collection and central storage of encrypted data from patients with this condition. All Portuguese rheumatology centres were invited to participate. Data regarding demographics, diagnosis, classification criteria, assessment tools, and treatment were collected. We aim to describe the structure of Reuma.pt/vasculitis and characterize the patients registered since its development. RESULTS: A total of 687 patients, with 1945 visits, from 13 centres were registered; mean age was 53.4 ± 19.3 years at last visit and 68.7% were females. The most common diagnoses were Behçet's disease (BD) (42.5%) and giant cell arteritis (GCA) (17.8%). Patients with BD met the International Study Group criteria and the International Criteria for BD in 85.3 and 97.2% of cases, respectively. Within the most common small- and medium-vessel vasculitides registered, median [interquartile range] Birmingham Vasculitis Activity Score (BVAS) at first visit was highest in patients with ANCA-associated vasculitis (AAV) (17.0 [12.0]); there were no differences in the proportion of patients with AAV or polyarteritis nodosa who relapsed (BVAS≥1) or had a major relapse (≥1 major BVAS item) during prospective assessment (p = 1.00, p = 0.479). Biologic treatment was prescribed in 0.8% of patients with GCA, 26.7% of patients with AAV, and 7.6% of patients with BD. There were 34 (4.9%) deaths reported. CONCLUSIONS: Reuma.pt/vasculitis is a bespoke web-based registry adapted for routine care of patients with this form of rare and complex diseases, allowing an efficient data-repository at a national level with the potential to link with other international databases. It facilitates research, trials recruitment, service planning and benchmarking.publishersversionpublishe

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

Tree community dynamics in a semideciduous forest fires under recurrent

Made available in DSpace on 2014-07-29T16:21:15Z (GMT). No. of bitstreams: 1 Dissertacao Karine Peixoto.pdf: 442940 bytes, checksum: 48c053e39f9bd13d7c629c7894cfce37 (MD5) Previous issue date: 2010-03-05The effects of fire on tree mortality can change the floristic and structure of forest depending on intensity, frequencies and duration of burnt. Besides should play a fundamental role in vegetation dynamics. Areas of semideciduous forest subject to different frequencies of fire were monitored: 0.9 ha burned in 2007 (Q1) and 0.9 ha in 2005 and 2007 (Q2). The dynamics was based the average interval of 2.03 years between T1 (outubro/2006-maio/2007) and T2 (March/2009), including individuals with PAP ≥ 15 cm. Diversity (H ) and species richness (estimated by Jackknife) were higher in Q2, both at T1 and T2. The decrease on tree density between surveys was significant for Q1 and Q2. The proportion of deaths was higher in Q1. With exception of change (based number of individuals) that was higher in Q1, there were no differences in the dynamic parameters between Q1 and Q2 considering both the number of individuals and basal area. The increase of diversity in Q2 may be partially explained by the hypothesis of intermediate disturbance. On the other hand, despite the recruitment and mortality did not differ between Q1 and Q2, the high turnover rates independent of fire frequency suggests future changes in forest if the fire continuing frequent in the area.Os efeitos do fogo sobre a mortalidade de árvores podem alterar a composição e estrutura da vegetação, dependendo da intensidade, freqüência e duração das queimadas. Nós monitoramos áreas de floresta sujeitas à diferentes freqüências de fogo: 0,9 ha queimaram em 2007 (Q1) e 0,9 ha em 2005 e 2007 (Q2). A dinâmica foi referente ao intervalo médio de 2,03 anos entre T1 (outubro/2006-maio/2007) e T2 (março/2009), considerando indivíduos com PAP ≥ 15 cm. A diversidade (H ) e riqueza de espécies (estimada por Jackknife) foram maiores em Q2, nos dois levantamentos (T1e T2). Ocorreu a diminuição na densidade em Q1 e Q2. No entanto, a proporção de indivíduos que morreram foi maior em Q1. Os parâmetros da dinâmica baseados no número de indivíduos e na área basal não diferiram entre Q1 e Q2, exceto mudança (por número de indivíduos) que foi maior em Q1. O aumento na diversidade na área sujeita a maior freqüência de queimadas pode ser explicada pela hipótese de distúrbio intermediário. Por outro lado, apesar da mortalidade e recrutamento não terem diferido entre Q1 e Q2, as altas taxas de mudanças, independentes da freqüência, do fogo sugerem futuras mudanças florísticas e estruturais na floresta caso as queimadas continuem ocorrendo na área

Fogo e dinâmica da comunidade lenhosa em cerrado sentido restrito, Barra do Garças, Mato Grosso

Estudos sobre a dinâmica e estrutura da vegetação lenhosa após incêndios naturais ocorridos no Parque Estadual da Serra Azul mostram que as queimadas afetam a sobrevivência e o crescimento das plantas sendo o impacto dependente da intensidade, frequência e duração dos incêndios. Dez parcelas (20 × 50 m) queimaram em 2002 e 2007 (Área 1) e outras 10 (Área 2) queimaram em 2002, 2005 e 2007. Em janeiro de 2009, a Área 1 apresentou menor mortalidade (2,0%) e maior recrutamento (3,7%) que a Área 2 (4,3% e 0,05% respectivamente). A mortalidade decresceu com o aumento das classes de diâmetro. O tamanho médio (altura e diâmetro) dos indivíduos decresceu na Área 2. O padrão de rebrotas após o fogo foi relacionado ao tamanho dos indivíduos. As rebrotas ocorreram na base dos indivíduos pertencentes às menores classes de tamanho e na copa daqueles pertencentes às maiores classes de tamanho. Os estimadores Jacknife e Chao 2 indicaram redução da riqueza na Área 2 submetida a maior freqüência de queimadas. A longevidade das árvores adultas e a persistência de indivíduos menores através das rebrotas podem determinar a manutenção da comunidade lenhosa no cerrado se os intervalos entre queimadas não forem inferiores a cinco anos