Perfil epidemiológico das malformações congênitas do sistema nervoso central no estado do Pará, Brasil / Epidemiological profile of congenital malformations of the central nervous system in the state of Pará, Brazil

Objetivo: Descrever as características epidemiológicas das malformações congênitas do sistema nervoso central no estado do Pará, Brasil, no quinquênio 2014 a 2018. Metodologia: Trata-se de um estudo descritivo, do tipo corte transversal, baseado em dados secundários coletados do banco de dados do Sistema de Informações de Nascidos Vivos (SINASC). Resultados: No período analisado ocorreram 705.344 nascimentos, 613 eram de recém-nascidos com malformação do sistema nervoso central. A incidência foi de 0.8 casos/1.000 nascidos vivos. As características epidemiológicas que obtiveram maior prevalência foram: mães com idade entre 20 a 24 anos (31,6%); com 8 a 11 anos de escolaridade (56,46%); que realizaram 7 ou mais consultas pré-natais (38,13%); parto cesáreo (69,4%); cor/raça preta (64,32%); recém-nascidos do sexo feminino (53,4%); com idade gestacional entre 37 a 41 semanas (62,8%); e peso ao nascer entre 3000 a 3999g (33,4%). Conclusão: Através do estudo foi possível caracterizar o panorama epidemiológico das malformações congênitas do sistema nervoso central no estado do Pará, essas informações são indispensáveis para o planejamento de politicas públicas apropriadas e direcionadas a saúde materno-infantil, tendo como objetivo a prevenção e o controle

Sentimentos e percepções que as ações extensionistas do projeto Periferia dos Sonhos acarretam em seus integrantes

Desde 1995, são desenvolvidas atividades de ensino, extensão e pesquisa com graduandos e pós?graduandos da Escola Paulista de Enfermagem da Universidade Federal de São Paulo (Unifesp) junto à população adulta e idosa em situação de rua24 na cidade de São Paulo.O ensino e a extensão até o ano de 2009 estavam previstos no currículo do Curso de Enfermagem com o objetivo de propiciar aos estudantes o desenvolvimento de ações de educação e comunicação em saúde, bem como prestar assistência de enfermagem para esta população. No período entre 1995 e 2006 esta experiência ocorreu junto a um Centro de Convivência por meio do projeto curricular de extensão “Saúde do povo em situação de rua”, envolvendo as disciplinas curriculares: Assistência Transdisciplinar em Comunidade, Enfermagem Gerontológica e Geriátrica, Enfermagem em Saúde Mental. As pesquisas, por sua vez, respondiam às exigências dos programas de iniciação científica e da pós?graduação estrito senso, vinculada ao Programa de Pós?Graduação em Enfermagem da Unifesp.A partir de 2009, dado a estruturação político?pedagógica do currículo de graduação em Enfermagem, os equipamentos sociais destinados ao cuidado às pessoas em situação de rua deixam de ser campo de estágio para os graduandos, por outro lado, a extensão e a pesquisa se aproximam, passando a ser desenvolvidas de forma indissociável. <br /

Sentimentos e percepções que as ações extensionistas do projeto Periferia dos Sonhos acarretam em seus integrantes

Desde 1995, são desenvolvidas atividades de ensino, extensão e pesquisa com graduandos e pós?graduandos da Escola Paulista de Enfermagem da Universidade Federal de São Paulo (Unifesp) junto à população adulta e idosa em situação de rua24 na cidade de São Paulo.O ensino e a extensão até o ano de 2009 estavam previstos no currículo do Curso de Enfermagem com o objetivo de propiciar aos estudantes o desenvolvimento de ações de educação e comunicação em saúde, bem como prestar assistência de enfermagem para esta população. No período entre 1995 e 2006 esta experiência ocorreu junto a um Centro de Convivência por meio do projeto curricular de extensão “Saúde do povo em situação de rua”, envolvendo as disciplinas curriculares: Assistência Transdisciplinar em Comunidade, Enfermagem Gerontológica e Geriátrica, Enfermagem em Saúde Mental. As pesquisas, por sua vez, respondiam às exigências dos programas de iniciação científica e da pós?graduação estrito senso, vinculada ao Programa de Pós?Graduação em Enfermagem da Unifesp.A partir de 2009, dado a estruturação político?pedagógica do currículo de graduação em Enfermagem, os equipamentos sociais destinados ao cuidado às pessoas em situação de rua deixam de ser campo de estágio para os graduandos, por outro lado, a extensão e a pesquisa se aproximam, passando a ser desenvolvidas de forma indissociável

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Educomunicação e suas áreas de intervenção: Novos paradigmas para o diálogo intercultural

oai:omp.abpeducom.org.br:publicationFormat/1O material aqui divulgado representa, em essência, a contribuição do VII Encontro Brasileiro de Educomunicação ao V Global MIL Week, da UNESCO, ocorrido na ECA/USP, entre 3&nbsp;e 5 de novembro de 2016. Estamos diante de um conjunto de 104 papers executivos, com uma média de entre 7 e 10 páginas, cada um. Com este rico e abundante material, chegamos ao sétimo e-book publicado pela ABPEducom, em seus seis primeiros anos de existência. A especificidade desta obra é a de trazer as “Áreas de Intervenção” do campo da Educomunicação, colocando-as a serviço de uma meta essencial ao agir educomunicativo: o diálogo intercultural, trabalhado na linha do tema geral do evento internacional: Media and Information Literacy: New Paradigms for Intercultural Dialogue

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Pharmacological contribution of early-lifetime exposure of mice to 1,2-naphthoquinone (1,2-NQ) to increase pulmonary susceptibility of allergic response at a late stage of life.

Este estudo consistiu em avaliar comparativamente se camundongos neonatos e adultos, quando expostos ao poluente 1,2-NQ exibiriam susceptibilidade aumentada à inflamação alérgica (ovalbumina; OVA). Camundongos adultos ou neonatos foram expostos à 1,2-NQ ou veículo (15 min por três dias). Os camundongos adultos, após 24 h, ou neonatos, após 59 dias, foram sensibilizados/desafiados com OVA e os parâmetros funcionais e inflamatórios foram avaliados 24 h após. Em animais expostos a 1,2-NQ na fase neonatal, o desafio alérgico na idade adulta causou potente influxo de leucócitos no pulmão, sangue periférico e maturação eosinofílica na medula óssea, mas não afetou a hiperresponsividade brônquica. Isto foi consistente com maior biossíntese de citocinas Th2 e apresentação de CD11c esplênica. Em animais adultos, a 1,2-NQ não amplificou a inflamação alérgica. Conclui-se que, a exposição de camundongos neonatos à 1,2-NQ aumentou a susceptibilidade destes à inflamação alérgica na idade adulta via maior apresentação de CD11c esplênica e da biossíntese de citocinas Th2.We have comparatively investigated whether exposure of neonates and adults mice to 1,2-NQ increases their susceptibility to allergic inflammation evoked by ovalbumin (OVA). Adults or neonate mice were nebulized with 1,2-NQ or corresponding vehicle. Following 24 h or eight weeks, adult or neonate mice were sensitized and challenged with OVA and the functional and inflammatory parameters were evaluated 24 h later. The allergic challenge in mice exposed to 1,2-NQ as neonates caused a potent influx of leukocytes in bronchoalveolar lavage, peripheral blood and increased eosinophil maturation in the bone marrow, without affecting Penh response. This was correlated with increased presentation of splenic CD11c and biosynthesis of Th2 cytokines in the lung. Adult mice exposure to 1,2-NQ failed to significantly increase OVA-induced allergic responses. Exposure to 1,2-NQ during neonatal period is critical to enhance susceptibility of asthma at a later stage of life, and that increased expression of splenic CD11c and inflammatory mediators contribute to this effect