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BACKGROUND: In April 2022, after a year of COVID-19 vaccination, there were large differences in coverage between urban and rural areas in Guatemala. To address barriers in rural communities, the "Health on Wheels" (HoW) strategy was implemented. The strategy deployed mobile brigades with a dedicated team of health workers and a culturally sensitive health promotion plan in selected communities in 15 districts in Alta Verapaz, a health area with low COVID-19 vaccination uptake and a high-level of COVID-19 vaccine hesitancy. This study evaluates the impact of the HoW strategy. METHODS: We measured the relative increase in COVID-19 doses administered prior and during the HoW implementation period in the 190 intervened communities and compared to 188 communities without the intervention. Communities were grouped by health district and the impact analyses were stratified by number of COVID-19 vaccine dose (1st, 2nd, and 3rd doses) and history of vaccine hesitancy. RESULTS: The increase in 1st, 2nd, and 3rd dose-COVID-19 vaccination coverage between before and during HoW implementation was 2.4, 2.2 and 2.6 times higher in intervened communities (20 %, 21 % and 37 % increase in 1st, 2nd and 3rd dose, respectively) than in non-intervened communities (8 %, 10 % and 14 % increase in 1st, 2nd and 3rd dose respectively). For the 1st dose, increase in dose administration was 2.9 times higher in intervened communities (n = 24) with hesitancy (24 % increase) compared to non-intervened communities (n = 188) without hesitancy (8 % increase). CONCLUSION: The deployment of mobile brigades with a dedicated team of vaccinators and culturally sensitive health promotion through the HoW strategy successfully accelerated the increase in COVID-19 vaccination coverage in rural communities in Guatemala.

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Introduction: Family members of patients admitted to an Intensive Care Unit present high uncertainty level due to not knowing what is happening and to not having clear details about the related events; therefore, interventions are required to allow modulating those levels. Objective: To evaluate the effect of an educational Nursing intervention compared to conventional care on the uncertainty of family members of patients hospitalized in an ICU. Materials and methods: An experimental study with a sample comprised by 132 relatives of patients admitted to an ICU, randomly distributed in four Solomon groups (33 in each group). The Nursing intervention based on the concepts of the Uncertainty in Illness Theory was applied to both experimental groups and devised under the Whittemore and Grey parameters with three moments: assessment; education about the relative's hospitalization in the ICU; and accompaniment. This was done with pre-assessments for two groups and post-assessments for the four groups, using the PPUS-FM Uncertainty Scale. The data were analyzed by means of descriptive statistics and respective non-parametric analyses. The study took into account the ethical principles in research. Results: The family members in the experimental groups presented a lower final uncertainty level when compared to the control groups, with a difference of 73.04 points and a p-value of 0.001. Discussion: Standardized interventions and under a theoretical model allow reducing uncertainty in relatives of patients in ICUs. Conclusions: The Nursing intervention based on the Uncertainty theory allows reducing uncertainty in relatives of patients hospitalized in an Intensive Care Unit.

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Breast cancer is the second most common diagnosed type of cancer in women. Chronic neuropathic pain after mastectomy occurs frequently and is a serious health problem. In our previous single-center, prospective, randomized controlled clinical study, we demonstrated that the combination of serratus anterior plane block (SAM) and pectoral nerve block type I (PECS I) with general anesthesia reduced acute postoperative pain. The present report describes a prospective follow-up study of this published study to investigate the development of chronic neuropathic pain 12 months after mastectomy by comparing the use of general anesthesia alone and general anesthesia with SAM + PECS I. Additionally, the use of analgesic medication, quality of life, depressive symptoms, and possible correlations between plasma levels of interleukin (IL)-1 beta, IL-6, and IL-10 collected before and 24 h after surgery as predictors of pain and depression were evaluated. The results showed that the use of SAM + PECS I with general anesthesia reduced numbness, hypoesthesia to touch, the incidence of patients with chronic pain in other body regions and depressive symptoms, however, did not significantly reduce the incidence of chronic neuropathic pain after mastectomy. Additionally, there was no difference in the consumption of analgesic medication and quality of life. Furthermore, no correlation was observed between IL-1 beta, IL-6, and IL-10 levels and pain and depression. The combination of general anesthesia with SAM + PECS I reduced the occurrence of specific neuropathic pain descriptors and depressive symptoms. These results could promote the use of SAM + PECS I blocks for the prevention of specific neuropathic pain symptoms after mastectomy.Registration of clinical trial: The Research Ethics Board of the Hospital Sirio-Libanes/Brazil approved the study (CAAE 48721715.0.0000.5461). This study is registered at Registro Brasileiro de Ensaios Clinicos (ReBEC), and ClinicalTrials.gov, Identifier: NCT02647385.

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Background: The Maranhão State harbours great fish diversity, but some areas are still undersampled or little known, such as the Munim River Basin in the northeast of the State. This lack of knowledge is critical when considering anthropogenic impacts on riverine systems especially in the face of major habitat destruction. These pressing threats mean that a comprehensive understanding of diversity is critical and fish checklists extremely relevant. Therefore, the present study provides a checklist of the fish species found in the Munim River Basin, Maranhão State, north-eastern Brazil, based on collected specimens. New information: A total of 123 species were recorded for the Munim River Basin, with only two non-native species, Oreochromisniloticus and Colossomamacropomum, showing that the fish assemblage has relatively high ecological integrity. In addition, 29 species could not be identified at the species level, indicating the presence of species that are probably new to science in the Basin. A predominance of species belonging to the fish orders Characiformes and Siluriformes, with Characidae being recovered as the most species-rich family (21 species) agrees with the general pattern for river basins in the Neotropical Region. The total fish diversity was estimated by extensive fieldwork, including several sampling gears, carried out in different seasons (dry and rainy) and exploring different environments with both daily and nocturnal sampling, from the Basin's source to its mouth. A total of 84 sites were sampled between 2010 and 2022, resulting in 12 years of fieldwork. Fish assemblages were distinct in the Estuary and Upper river basin sections and more similar in the Lower and Middle sections indicating environmental filtering processes. Species were weakly nested across basin sections, but unique species were found in each section (per Simpsons Index). High variability of species richness in the Middle river basin section is likely due to microhabitat heterogeneity supporting specialist fish communities.

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A cardiomiopatia arritmogênica do ventrículo direito é uma desordem hereditária caracterizada pela substituição fibrogordurosa do músculo cardíaco. O manejo clínico busca reduzir os riscos de morte súbita e melhorar a qualidade de vida, aliviando os sintomas arrítmicos e de insuficiência cardíaca. O ecocardiograma é o exame inicial para a investigação da cardiomiopatia arritmogênica do ventrículo direito, podendo apresentar dilatação das câmaras direitas e disfunção sistólica do ventrículo direito. Este relato chama atenção por envolver o diagnóstico de cardiomiopatia arritmogênica do ventrículo direito em paciente atleta. Mulher, 47 anos, maratonista, sem história familiar de morte súbita cardíaca, deu entrada na emergência com palpitação associada à pré-síncope. O eletrocardiograma da admissão mostrava taquicardia ventricular. O ecocardiograma revelou aumento de câmaras cardíacas direitas e disfunção sistólica do ventrículo direito. O cateterismo cardíaco não evidenciou doença coronária obstrutiva. A paciente foi orientada acerca da necessidade de suspensão de atividades físicas, porém, 3 meses depois, foi readmitida com instabilidade hemodinâmica por nova taquicardia ventricular, tendo sido cardiovertida. Realizou ressonância cardíaca, que evidenciou áreas de discinesia e formação de microaneurismas em ventrículo direito. Foi diagnosticada com cardiomiopatia arritmogênica do ventrículo direito, tendo sido com cardioversor desfibrilador implantável, amiodarona e betabloqueador. A diferenciação entre a cardiomiopatia arritmogênica do ventrículo direito e o coração do atleta representa um desafio, devido à sobreposição de alterações estruturais que coexistem nessas entidades, daí a importância da análise integrada de fatores clínicos, eletrocardiográficos e morfofuncionais.(AU)

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This work is focused on characterizing and understanding the aboveground biomass of Caatinga in a semiarid region in northeastern Brazil. The quantification of Caatinga biomass is limited by the small number of field plots, which are inadequate for addressing the biome's extreme heterogeneity. Satellite-derived biomass products can address spatial and temporal changes but they have not been validated for seasonally dry tropical forests. Here we combine a compilation of published field phytosociological observations with a new 30m spatial resolution satellite biomass product. Both data were significantly correlated, satellite estimates consistently captured the wide variability of the biomass across the different physiognomies (2-272 Mg/ha). Based on the satellite product we show that in year 2000 about 50 percent of the region had very low biomass (<2 Mg/ha) and that the majority of the biomass (86%) is concentrated in only 27% of the area. Our work confirm other estimates of biomass 39 Mg/ha (9-61 Mg/ha) and carbon 0.79 PgC. The satellite products together with ground based estimates has the potential to improve forest management in Caatinga and other seasonally dry tropical forests through improved approximation of spatial variability, how they relate to climate, and support numerical modeling experiments in semiarid regions.

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Ovarian tumours in mares represent 2.5% to 6% of the most frequent neoplasms found in the equine species, with a higher chance of benignity. This study aims to describe a case of two different tumours found in the same ovary of a mare that presented clinical signs of suppressed oestrous cycle during 5 years. After unilateral ovariectomy, the ovary was sent to the histopathology examination which determined a mixed tumour of granulosa cell and leiomyosarcoma. After treatment, the mare returned to oestrus and got pregnant in the next season.

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A endometrite persistente é uma das principais causas de subfertilidade nas éguas, interferindo negativamente na reprodução equina. Muitas vezes, a endometrite ocorre como consequência de uma falha nos mecanismos de defesa uterina, gerando problemas na eliminação de antígenos e produtos inflamatórios presentes no ambiente uterino. A ozonioterapia é uma das terapias existentes para o tratamento desta doença, e seu uso tem aumentado em medicina veterinária. O presente estudo avaliou oito éguas em período cíclico, com endometrite persistente. Um tratamento com ozônio intrauterino persistiu por dois dias. A partir dos dados obtidos no presente estudo, a terapia com ozônio parece ser uma técnica efetiva e promissora na reprodução equina, atuando de maneira efetiva em infecções bacterianas uterinas e condições inflamatórias.

Persistent endometritis is one of the major causes of subfertility in mares, negatively interfering with equine reproduction. Many times, endometritis occurs as consequence of a failure in the uterine defense mechanisms, generating problems in the elimination of antigens and inflammatory products present in the uterine environment. Ozone therapy is one of the existing therapies for the treatment of this disease, and its use has increased in veterinary medicine. The present study evaluated eight cycling mares, with persistent endometritis. An intrauterine ozone treatment for two days was chosen. From the data obtained in the present study, ozone therapy appear to be an effective and promising technique in equine reproduction, acting effectively in uterine bacterial infections and inflammatory conditions.

La endometritis persistente es una de las causas principales de la subfertilidad en las yeguas, interfiriendo negativamente con la reproducción equina. Muchas veces, la endometritis ocurre como consecuencia de un fracaso en los mecanismos de defensa uterinos, generando problemas en la eliminación de antígenos y productos inflamatorios presentes en el mediouterino. La ozonoterapia es una de las terapias existentes para el tratamiento de esta enfermedad, y su uso ha aumentado en la medicina veterinaria. El presente estudio evaluó ocho yeguas con el cicloestral normal, con endometritis persistente. Un tratamiento intrauterino con ozono por dos días fue elegido. A partir de los datos obtenidos en el presente estudio, la ozonoterapia parece ser una técnica efectiva y prometedora en la reproducción equina, actuando eficazmente en las infecciones bacterianas uterinas y en las condiciones inflamatorias.

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A endometrite persistente é uma das principais causas de subfertilidade nas éguas, interferindo negativamente na reprodução equina. Muitas vezes, a endometrite ocorre como consequência de uma falha nos mecanismos de defesa uterina, gerando problemas na eliminação de antígenos e produtos inflamatórios presentes no ambiente uterino. A ozonioterapia é uma das terapias existentes para o tratamento desta doença, e seu uso tem aumentado em medicina veterinária. O presente estudo avaliou oito éguas em período cíclico, com endometrite persistente. Um tratamento com ozônio intrauterino persistiu por dois dias. A partir dos dados obtidos no presente estudo, a terapia com ozônio parece ser uma técnica efetiva e promissora na reprodução equina, atuando de maneira efetiva em infecções bacterianas uterinas e condições inflamatórias.(AU)

Persistent endometritis is one of the major causes of subfertility in mares, negatively interfering with equine reproduction. Many times, endometritis occurs as consequence of a failure in the uterine defense mechanisms, generating problems in the elimination of antigens and inflammatory products present in the uterine environment. Ozone therapy is one of the existing therapies for the treatment of this disease, and its use has increased in veterinary medicine. The present study evaluated eight cycling mares, with persistent endometritis. An intrauterine ozone treatment for two days was chosen. From the data obtained in the present study, ozone therapy appear to be an effective and promising technique in equine reproduction, acting effectively in uterine bacterial infections and inflammatory conditions.(AU)

La endometritis persistente es una de las causas principales de la subfertilidad en las yeguas, interfiriendo negativamente con la reproducción equina. Muchas veces, la endometritis ocurre como consecuencia de un fracaso en los mecanismos de defensa uterinos, generando problemas en la eliminación de antígenos y productos inflamatorios presentes en el mediouterino. La ozonoterapia es una de las terapias existentes para el tratamiento de esta enfermedad, y su uso ha aumentado en la medicina veterinaria. El presente estudio evaluó ocho yeguas con el cicloestral normal, con endometritis persistente. Un tratamiento intrauterino con ozono por dos días fue elegido. A partir de los datos obtenidos en el presente estudio, la ozonoterapia parece ser una técnica efectiva y prometedora en la reproducción equina, actuando eficazmente en las infecciones bacterianas uterinas y en las condiciones inflamatorias.(AU)

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