INTERNACIONALIZAÇÃO DAS EMPRESAS DE BIOTECNOLOGIA EM BELO HORIZONTE – MG, BRASIL

A internacionalização das empresas integrantes do Arranjo Produtivo Local de Biotecnologia da Região Metropolitana de Belo Horizonte (APL Biotec) é avaliada a partir de um diagnóstico realizado no ano de 2007. A pesquisa propõe identificar estágios de internacionalização e delinear ações de capacitação e promoção comercial externa. A metodologia utilizada foi a realização de entrevistas para levantamento de dados situacionais, com aplicação de questionário semi-estruturado aos proprietários e gerentes de 16 empresas entre as 21 integrantes do APL Biotec. Ressalta-se como resultado da pesquisa a capacidade das empresas de ser uma born global pela posse de certificações e registros internacionais e a participação constante em eventos internacionais como forma de promoção comercial. São apontadas ações alternativas para maximizar a competitividade do setor, buscando a melhoria da sua posição no mercado internacional e promovendo sinergia para que as empresas enfrentem os desafios do mercado global

MECANISMO DE DIFUSÃO-OSMOSE EM SISTEMAS VEGETAIS SOB INFLUÊNCIAS DE CAMPOS MAGNÉTICOS ESTACIONÁRIOS DE NEODÍMIO

In order to explain the operating mechanisms of electromagnetic influences on plant development and the facts found in the literature, this article has the general objective of studying such influences and the mechanism acting in this phenomenon, in order to describe it as a possible scientific solution. The quali-quantitative methodology, defined by main experimentation that will evaluate the water and nutrient transport mechanism, namely: observation of water absorption by seeds of 3 species, lettuce, tomato and melon, divided into two groups, control and experimental. The latter being under the influence of permanent bar magnets of Neodymium, magnetic induction, performing collections of Total Dissolved Solids (TDS), from TDS Meter V1.0 sensors, compatible with Arduino software, in time intervals of 2 hours. The results obtained corroborate what is described in the literature, demonstrating an intensified decrease in the amount of water and also solutes in the experimental groups, compared to the controls, so that the seeds under magnetic influences absorbed all the water and nutrients in a shorter time than the same under natural conditions, which is plausible in relation to the intensification of plant metabolism resulting from electromagnetic influences, and the identification of a possible synergistic mechanism of Diffusion-Osmosis.Para explicar os mecanismos operantes das influências eletromagnéticas sobre o desenvolvimento vegetal, o presente artigo tem por objetivo investigar as influências e mecanismos atuantes neste fenômeno, a fim de descrever o processo difusivo com e sem presença de campo magnético sobre as amostras. A metodologia utilizada é de cunho quali-quantitativo, definida por experimentação principal que avaliará o mecanismo de transporte de água e nutrientes, à saber: observação da absorção de água por sementes de 3 espécies, alface, tomate e melão, divididas em dois grupos, controle e experimental. Sendo que este último estava sob a influência de imãs permanentes de Neodímio em barra, de indução magnética, realizando coletas de Sólidos Totais Dissolvidos, a partir de sensores TDS Meter V1.0, compatíveis com o software Arduino, em intervalos de tempo de 2 h. Os resultados obtidos corroboram com o que é descrito na literatura, demonstrando a diminuição intensificada da quantidade de água e também solutos nos grupos experimentais, em comparação aos controles, de modo que as sementes sob influências magnéticas absorveram toda a água e nutrientes em menor tempo do que as mesmas em condições naturais, o que é plausível em relação a intensificação no metabolismo vegetal oriundo das influências eletromagnéticas, e a identificação de um possível mecanismo sinérgico de Difusão-Osmose. Palavras-chave: eletromagnetismo; termodinâmica; metabolismo vegetal; canais iônicos.   Diffusion-osmosis mechanism in plant systems under influences of neodymium stationary magnetic fields   ABSTRACT: To explain the operating mechanisms of electromagnetic influences on plant development and the facts found in the literature, this article aims to investigate the influences and mechanisms acting on the specific mechanisms, to describe the diffusive process with and without the presence of magnetic field on the samples. The methodology used is a quality-quantitative methodology, defined by main experimentation that will evaluate the water and nutrient transport mechanism: observation of water absorption by seeds of 3 species, lettuce, tomato and melon, divided into two groups, control and experimental. The latter is under the influence of permanent bar magnets of Neodymium, magnetic induction, performing collections of Total Dissolved Solids (TDS), from TDS Meter V1.0 sensors, compatible with Arduino software, in time intervals of 2 hours. The results obtained corroborate what is described in the literature, demonstrating an intensified decrease in the amount of water and solutes in the experimental groups, compared to the controls, so that the seeds under magnetic influences absorbed all the water and nutrients in a shorter time than the same under natural conditions, which is plausible in relation to the intensification of plant metabolism resulting from electromagnetic influences, and the identification of a possible synergistic mechanism of Diffusion-Osmosis. Keywords: electromagnetism; thermodynamics; plant metabolism; ionic channels

TELE-critical Care verSus usual Care On ICU PErformance (TELESCOPE): protocol for a cluster-randomised clinical trial on adult general ICUs in Brazil

Introduction Daily multidisciplinary rounds (DMRs) consist of systematic patient-centred discussions aiming to establish joint therapeutic goals for the next 24 hours of intensive care unit (ICU) care. The aim of the present study protocol is to evaluate whether an intervention consisting of guided DMRs, supported by a remote specialist and audit/feedback on care performance will reduce ICU length of stay compared with a control group.Methods and analysis A multicentre, controlled, cluster-randomised superiority trial including 30 ICUs in Brazil (15 intervention and 15 control), from August 2019 to June 2021. In a parallel assignment, ICUs are randomised to a complex-intervention composed by daily rounds carried out through Tele-ICU by a remote ICU physician; development of local quality indicators dashboards coupled with monthly meetings with local leadership; and dissemination of evidence-based clinical protocols versus usual care. Primary outcome is ICU length of stay. Secondary outcomes include classification of the unit according to the profiles defined by the standardised resource use and the standardised mortality rate, hospital mortality, incidence of healthcare-associated infections, ventilator-free days at 28 days, patient-days receiving oral or enteral feeding, patient-days under light sedation or alert and calm, rate of patients under normoxaemia. All adult patients admitted after the beginning of the study in each participant ICU will be enrolled. Inclusion criteria (clusters): public Brazilian ICUs with a minimum of 8 ICU beds interested/committed to participating in the study. Exclusion criteria (clusters): units with fully established DMRs by an intensivist, specialised or step-down units.Ethics and dissemination The study protocol was approved by the institutional review board (IRB) of the coordinator centre, and by IRBs of each enrolled hospital/ICU. Statistical analysis protocol is being prepared for submission before the end of patient’s enrolment. Results will be disseminated through conferences, peer-reviewed journals and to each participating unit.Trial registration number NCT03920501; Pre-results

Smoking worsens the prognosis of mild abnormalities in cervical cytology

To examine the effect of smoking on the incidence of low- and high-grade cervical intraepithelial neoplasia (CIN) in women with a baseline Pap smear of atypical squamous cells (ASC) or a low-grade squamous intraepithelial lesion (LSIL). Objective. To examine the effect of smoking on the incidence of low‐ and high‐grade cervical intraepithelial neoplasia (CIN) in women with a baseline Pap smear of atypical squamous cells (ASC) or a low‐grade squamous intraepithelial lesion (LSIL). Design. Prospective study in which a cohort of women with normal colposcopy and ASC/LSIL at baseline were followed at 6‐month intervals of up to 36 months. Women were grouped in post‐hoc analysis according to their smoking behavior: never (or past) smokers and current smokers. Setting. This report was based on data from the Latin American Screening Study, conducted in São Paulo, Campinas, Porto Alegre (Brazil) and Buenos Aires (Argentina). Population. A subset of 150 women derived from a cohort of 1,011 women. Methods. Multivariate Cox analysis and Kaplan–Meier curves were used. Main outcome measures. Low‐ and high‐grade CIN during follow‐up. Results. The only factor related to an increased risk of developing CIN was the positive high‐risk (hr) HPV status (hazard ratio (HR) = 3.42; 95% CI: 1.11–9.43). A total of 21 cases of incident CIN were detected during follow‐up. Of these, 11 appeared in the group of 67 smokers and 10 among the 83 non‐smoker women (log‐rank, p = 0.33). Smoking status was not associated with the risk of developing CIN (HR = 0.73; 95% CI: 0.40–1.33). However, when restricting the analysis to high‐grade CIN only (11 cases), the probability of developing the disease was significantly higher among smokers (p = 0.04). Conclusions. Smoking contributes additional risk for developing high‐grade CIN in women with ASC or LSIL cytology but normal colposcopy.LAMS (Latin American Screening) study, entitled: Improving health systems towards equality‐based control of cervical cancer in Latin America, and supported by the Inco‐Dev Program of the European Commission (Project No. ICA4‐CT‐2001‐10013). The contribution of Digene Inc. (USA

Performance characteristics of Pap test, VIA, VILI, HR-HPV testing, cervicography, and colposcopy in diagnosis of significant cervical pathology

We sought to evaluate the performance of diagnostic tools to establish an affordable setting for early detection of cervical cancer in developing countries. We compared the performance of different screening tests and their feasibility in a cohort of over 12,000 women: conventional Pap smear, liquid-based cytology, visual inspection with acetic acid (VIA), visual inspection with Iodine solution (VILI), cervicography, screening colposcopy, and high-risk human papillomavirus (HPV) testing (HR-HPV) collected by physician and by self-sampling. HR-HPV assay collected by the physician has the highest sensitivity (80 %), but high unnecessary referrals to colposcopy (15.1 %). HR-HPV test in self-sampling had a markedly lower (57.1 %) sensitivity. VIA, VILI, and cervicography had a poor sensitivity (47.4, 55, and 28.6 %, respectively). Colposcopy presented with sensitivity of 100 % in detecting CIN2+, but the lowest specificity (66.9 %). Co-testing with VIA and VILI Pap test increased the sensitivity of stand-alone Pap test from 71.6 to 87.1 % and 71.6 to 95 %, respectively, but with high number of unnecessary colposcopies. Co-testing with HR-HPV importantly increased the sensitivity of Pap test (to 86 %), but with high number of unnecessary colposcopies (17.5 %). Molecular tests adjunct to Pap test seems a realistic option to improve the detection of high-grade lesions in population-based screening programs.European Commission, INCO-DEV Programme (contract# ICA4-CT-2001-10013). The generous contribution of DIGENE Corporation (USA) donating the HCII tests at our disposal is gratefully acknowledged

Statistical analysis of a cluster-randomized clinical trial on adult general intensive care units in Brazil:TELE-critical care verSus usual Care On ICU PErformance (TELESCOPE) trial

OBJECTIVE: The TELE-critical Care verSus usual Care On ICU PErformance (TELESCOPE) trial aims to assess whether a complex telemedicine intervention in intensive care units, which focuses on daily multidisciplinary rounds performed by remote intensivists, will reduce intensive care unit length of stay compared to usual care. METHODS: The TELESCOPE trial is a national, multicenter, controlled, open label, cluster randomized trial. The study tests the effectiveness of daily multidisciplinary rounds conducted by an intensivist through telemedicine in Brazilian intensive care units. The protocol was approved by the local Research Ethics Committee of the coordinating study center and by the local Research Ethics Committee from each of the 30 intensive care units, following Brazilian legislation. The trial is registered with ClinicalTrials. gov (NCT03920501). The primary outcome is intensive care unit length of stay, which will be analyzed accounting for the baseline period and cluster structure of the data and adjusted by prespecified covariates. Secondary exploratory outcomes included intensive care unit performance classification, in-hospital mortality, incidence of nosocomial infections, ventilator-free days at 28 days, rate of patients receiving oral or enteral feeding, rate of patients under light sedation or alert and calm, and rate of patients under normoxemia. CONCLUSION: According to the trial’s best practice, we report our statistical analysis prior to locking the database and beginning analyses. We anticipate that this reporting practice will prevent analysis bias and improve the interpretation of the reported results. ClinicalTrials.gov registration: NCT0392050

TELE-critical Care verSus usual Care on ICU PErformance (TELESCOPE): Protocol for a cluster-randomised clinical trial on adult general ICUs in Brazil

Introduction Daily multidisciplinary rounds (DMRs) consist of systematic patient-centred discussions aiming to establish joint therapeutic goals for the next 24 hours of intensive care unit (ICU) care. The aim of the present study protocol is to evaluate whether an intervention consisting of guided DMRs, supported by a remote specialist and audit/feedback on care performance will reduce ICU length of stay compared with a control group. Methods and analysis A multicentre, controlled, cluster-randomised superiority trial including 30 ICUs in Brazil (15 intervention and 15 control), from August 2019 to June 2021. In a parallel assignment, ICUs are randomised to a complex-intervention composed by daily rounds carried out through Tele-ICU by a remote ICU physician; development of local quality indicators dashboards coupled with monthly meetings with local leadership; and dissemination of evidence-based clinical protocols versus usual care. Primary outcome is ICU length of stay. Secondary outcomes include classification of the unit according to the profiles defined by the standardised resource use and the standardised mortality rate, hospital mortality, incidence of healthcare-associated infections, ventilator-free days at 28 days, patient-days receiving oral or enteral feeding, patient-days under light sedation or alert and calm, rate of patients under normoxaemia. All adult patients admitted after the beginning of the study in each participant ICU will be enrolled. Inclusion criteria (clusters): public Brazilian ICUs with a minimum of 8 ICU beds interested/committed to participating in the study. Exclusion criteria (clusters): units with fully established DMRs by an intensivist, specialised or step-down units. Ethics and dissemination The study protocol was approved by the institutional review board (IRB) of the coordinator centre, and by IRBs of each enrolled hospital/ICU. Statistical analysis protocol is being prepared for submission before the end of patient's enrolment. Results will be disseminated through conferences, peer-reviewed journals and to each participating unit. Trial registration number NCT03920501; Pre-results

Azithromycin in addition to standard of care versus standard of care alone in the treatment of patients admitted to the hospital with severe COVID-19 in Brazil (COALITION II):a randomised clinical trial

Background: The efficacy and safety of azithromycin in the treatment of COVID-19 remain uncertain. We assessed whether adding azithromycin to standard of care, which included hydroxychloroquine, would improve clinical outcomes of patients admitted to the hospital with severe COVID-19. Methods: We did an open-label, randomised clinical trial at 57 centres in Brazil. We enrolled patients admitted to hospital with suspected or confirmed COVID-19 and at least one additional severity criteria as follows: use of oxygen supplementation of more than 4 L/min flow; use of high-flow nasal cannula; use of non-invasive mechanical ventilation; or use of invasive mechanical ventilation. Patients were randomly assigned (1:1) to azithromycin (500 mg via oral, nasogastric, or intravenous administration once daily for 10 days) plus standard of care or to standard of care without macrolides. All patients received hydroxychloroquine (400 mg twice daily for 10 days) because that was part of standard of care treatment in Brazil for patients with severe COVID-19. The primary outcome, assessed by an independent adjudication committee masked to treatment allocation, was clinical status at day 15 after randomisation, assessed by a six-point ordinal scale, with levels ranging from 1 to 6 and higher scores indicating a worse condition (with odds ratio [OR] greater than 1·00 favouring the control group). The primary outcome was assessed in all patients in the intention-to-treat (ITT) population who had severe acute respiratory syndrome coronavirus 2 infection confirmed by molecular or serological testing before randomisation (ie, modified ITT [mITT] population). Safety was assessed in all patients according to which treatment they received, regardless of original group assignment. This trial was registered at ClinicalTrials.gov, NCT04321278. Findings: 447 patients were enrolled from March 28 to May 19, 2020. COVID-19 was confirmed in 397 patients who constituted the mITT population, of whom 214 were assigned to the azithromycin group and 183 to the control group. In the mITT population, the primary endpoint was not significantly different between the azithromycin and control groups (OR 1·36 [95% CI 0·94–1·97], p=0·11). Rates of adverse events, including clinically relevant ventricular arrhythmias, resuscitated cardiac arrest, acute kidney failure, and corrected QT interval prolongation, were not significantly different between groups. Interpretation: In patients with severe COVID-19, adding azithromycin to standard of care treatment (which included hydroxychloroquine) did not improve clinical outcomes. Our findings do not support the routine use of azithromycin in combination with hydroxychloroquine in patients with severe COVID-19. Funding: COALITION COVID-19 Brazil and EMS