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BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality and long-term functional impairment. Data on clinical management and functional outcomes from developing countries are scarce. We aimed to define patient profiles and clinical practices and evaluate long-term outcomes after SAH in a middle-income country. METHODS: This was a prospective study including consecutive adult patients admitted with SAH to two reference centers in Brazil from January 2016 to February 2020. The primary outcome was functional status at 6 months using the modified Rankin Scale. Mixed multivariable analysis was performed to determine the relationship between clinical variables and functional outcomes. RESULTS: From 471patients analyzed, the median time from symptom onset to arrival at a study center was 4 days (interquartile range 0-9). Median age was 55 years (interquartile range 46-62) and 353 (75%) patients were women. A total of 426 patients (90%) were transferred from nonspecialized general hospitals, initial computed tomography revealed thick hemorrhage in 73% of patients (modified Fisher score of 3 or 4), and 136 (29%) had poor clinical grade (World Federation of Neurological Surgeons score of 4 or 5). A total of 312 (66%) patients underwent surgical clipping, and 119 (25%) underwent endovascular coiling. Only 34 patients (7%) underwent withdrawal or withholding of life-sustaining therapy during their hospital stay, and in-hospital mortality was 24%. A total of 187 (40%) patients had an unfavorable long-term functional outcome (modified Rankin Scale score of 4 to 6). Factors associated with unfavorable outcome were age (adjusted odds ratio [OR] 1.05, 95% confidence interval [CI] 1.03-1.08), hypertension (adjusted OR 1.81, 95% CI 1.04-3.16), poor clinical grade (adjusted OR 4.92, 95% CI 2.85-8.48), external ventricular drain (adjusted OR 3.8, 95% CI 2.31-6.24), postoperative deterioration (adjusted OR 2.33, 95% CI 1.32-4.13), cerebral infarction (adjusted OR 3.16, 95% CI 1.81-5.52), rebleeding (adjusted OR 2.95, 95% CI 1.13-7.69), and sepsis (adjusted OR 2.68, 95% CI 1.42-5.05). CONCLUSIONS: Our study demonstrated that SAH management in a middle-income country diverges significantly from published cohorts and current guidelines, despite comparable clinical profiles on presentation and admission to high-volume referral centers. Earlier aneurysm occlusion and increased use of endovascular therapy could potentially reduce modifiable in-hospital complications and improve functional outcomes in Brazil.

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RESUMO O objetivo deste artigo foi analisar as concepções de mães e filhos em relação à autonomia de jovens com Síndrome de Down. Nesse sentido, participaram deste estudo 20 mães e 20 jovens com Síndrome de Down. Foi realizado um estudo qualitativo, por meio de entrevistas semiestruturadas, que foram gravadas, transcritas e posteriormente analisadas. Os resultados do estudo mostraram que a perspectiva das mães com relação à autonomia diz respeito à realização das atividades cotidianas em casa, mas, ao sair desse ambiente, eles demonstram medo, não permitindo que os filhos ampliem essa autonomia para outros ambientes. Com relação ao jovem com Síndrome de Down, é possível perceber que, mesmo não entendendo a sua condição genética e o que venha a ser de fato autonomia, eles demonstram o desejo de terem uma vida como qualquer outro jovem, que estuda, namora, trabalha, sai de casa sozinho. Assim sendo, é preciso a implementação de programas voltados à capacitação de profissionais, família e jovens com SD no auxílio à autonomia.

ABSTRACT The objective of this article was to analyze the conceptions of mothers and children in relation to the autonomy of young people with Down Syndrome. In this sense, 20 mothers and 20 young people with Down Syndrome participated in this study. A qualitative study was carried out through semi-structured interviews, which were recorded, transcribed and subsequently analyzed. The results of the study showed that the perspective of mothers regarding autonomy concerns carrying out daily activities at home, but when leaving this environment, they show fear, not allowing their children to extend this autonomy to other environments. With regard to young people with Down Syndrome, it is possible to notice that even though they do not understand their genetic condition and what autonomy actually means, they demonstrate the desire to have a life like any other young person, who studies, dates, works, leaves home alone. Thus, it is necessary to implement programs aimed at training professionals, families and young people with DS in helping autonomy.

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The genus Rickettsia belongs to the Proteobacteria phylum and these bacteria infect animals and humans causing a range of diseases worldwide. The genus is divided into 4 groups and despite the public health threat and the knowledge accumulated so far, the mandatory intracellular bacteria behaviour and limitation for in vitro culture makes it difficult to create new vaccines and drug targets to these bacteria. In an attempt to overcome these limitations, pan-genomic approaches has used 47 genomes of the genus Rickettsia, in order to describe species similarities and genomics islands. Moreover, we conducted reverse vaccinology and docking analysis aiming the identification of proteins that have great potential to become vaccine and drug targets. We found out that the bacteria of the four Rickettsia groups have a high similarity with each other, with about 90 to 100% of identity. A pathogenicity island and a resistance island were predicted. In addition, 8 proteins were also predicted as strong candidates for vaccine and 9 as candidates for drug targets. The prediction of the proteins leads us to believe in a possibility of prospecting potential drugs or creating a polyvalent vaccine, which could reach most strains of this large group of bacteria.Communicated by Ramaswamy H. Sarma.

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Pertussis is a highly contagious respiratory disease caused by Bordetella pertussis, a Gram-negative bacterium described over a century ago. Despite broad vaccine coverage and treatment options, the disease is remerging as a public health problem especially in infants and older children. Recent data indicate re-emergence of the disease is related to bacterial resistance to immune defences and decreased vaccine effectiveness, which obviously suggests the need of new effective vaccines and drugs. In an attempt to contribute with solutions to this great challenge, bioinformatics tools were used to genetically comprehend the species of these bacteria and predict new vaccines and drug targets. In fact, approaches were used to analysis genomic plasticity, gene synteny and species similarities between the 20 genomes of Bordetella pertussis already available. Furthermore, it was conducted reverse vaccinology and docking analysis to identify proteins with potential to become vaccine and drug targets, respectively. The analyses showed the 20 genomes belongs to a homogeneous group that has preserved most of the genes over time. Besides that, were found genomics islands and good proteins to be candidates for vaccine and drugs. Taken together, these results suggests new possibilities that may be useful to develop new vaccines and drugs that will help the prevention and treatment strategies of pertussis disease caused by these Bordetella strains. Communicated by Ramaswamy H. Sarma.

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This study evaluated the effects of sustained deficit irrigation (SDI) on fruit yield and fruit water quality of dwarf green coconut trees. The experiment was carried out in a commercial orchard located in Camocim, Ceará, Brazil. Four years old coconut trees were irrigated during 29 months, using micro-sprinklers, at irrigation depths equivalent to 55%, 77%, 100% and 131% of crop evapotranspiration (ETc). Green coconut fruits were harvested six months after flower aperture and evaluated for number of fruits per plant, volume of coconut water per fruit and total soluble solids of the coconut water. SDI reduced coconut fruit yield, fruit water volume and coconut water yield. Conversely, SDI increased total soluble solids of the coconut water and irrigation water productivity in terms of fruits and coconut water. Deficit irrigation showed no economic advantage over full irrigation due to the small reduction in irrigation costs compared to the substantial reduction in gross revenue.

Este estudo teve como objetivo avaliar os efeitos da irrigação com déficit sustentado (SDI) sobre a produção e a qualidade da água de frutos do coqueiro Anão Verde. O experimento foi realizado em um pomar comercial localizado em Camocim, Ceará, Brasil. Plantas com quatro anos de idade foram irrigadas por microaspersão, durante 29 meses, com lâminas de irrigação equivalentes a 55%, 77%, 100% e 131% da evapotranspiração da cultura (ETc). Os frutos foram colhidos seis meses após a abertura das flores e avaliados quanto ao número de frutos por planta, volume de água de coco por fruto e sólidos solúveis totais da água de coco. A SDI reduziu a produtividade de frutos, o volume de água do fruto e a produção de água de coco por planta. Por outro lado, a SDI aumentou os sólidos solúveis totais da água de coco e a produtividade da água de irrigação em termos de frutas e água de coco. A SDI não apresentou vantagem econômica sobre a irrigação plena devido à pequena redução nos custos de irrigação em comparação à redução substancial da receita bruta.

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BACKGROUND: Lactobacillus crispatus is the dominant species in the vaginal microbiota associated with health and considered a homeostasis biomarker. Interestingly, some strains are even used as probiotics. However, the genetic mechanisms of L. crispatus involved in the control of the vaginal microbiome and protection against bacterial vaginosis (BV) are not entirely known. To further investigate these mechanisms, we sequenced and characterized the first four L. crispatus genomes from vaginal samples from Brazilian women and used genome-wide association study (GWAS) and comparative analyses to identify genetic mechanisms involved in healthy or BV conditions and selective pressures acting in the vaginal microbiome. METHODS: The four genomes were sequenced, assembled using ten different strategies and automatically annotated. The functional characterization was performed by bioinformatics tools comparing with known probiotic strains. Moreover, it was selected one representative strain (L. crispatus CRI4) for in vitro detection of phages by electron microscopy. Evolutionary analysis, including phylogeny, GWAS and positive selection were performed using 46 public genomes strains representing health and BV conditions. RESULTS: Genes involved in probiotic effects such as lactic acid production, hydrogen peroxide, bacteriocins, and adhesin were identified. Three hemolysins and putrescine production were predicted, although these features are also present in other probiotic strains. The four genomes presented no plasmids, but 14 known families insertion sequences and several prophages were detected. However, none of the mobile genetic elements contained antimicrobial resistance genes. The genomes harbor a CRISPR-Cas subtype II-A system that is probably inactivated due to fragmentation of the genes csn2 and cas9. No genomic feature was associated with a health condition, perhaps due to its multifactorial characteristic. Five genes were identified as under positive selection, but the selective pressure remains to be discovered. In conclusion, the Brazilian strains investigated in this study present potential protective properties, although in vitro and in vivo studies are required to confirm their efficacy and safety to be considered for human use.

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Objetivo: discutir sobre o impacto do déficit de investimentos para o tratamento da Doença de Chagas no Brasil. Método: trata-se de uma revisão narrativa da literatura realizada nas seguintes bases de dados: SCIELO, LILACS, BIREME e MEDLINE. A amostra final foi composta por 27 artigos científicos publicados entre o período de 2000 a 2020. Resultados: o Brasil é um dos países com maior prevalência de pacientes portadores da doença, porém pouco se avançou em pesquisas nessa área, de modo a repercutir em um baixo incentivo e investimento dos governantes e da indústria farmacêutica para a Doença de Chagas, tendo em vista a doença ser de progressão lenta e o diagnóstico e o tratamento serem tardios. Conclusão: fica evidente a falta de investimento e políticas públicas que possibilitem o diagnóstico e o tratamento precoce da doença tendo como conseqüência um déficit na qualidade de vida dos pacientes.(AU)

Objective: to discuss the impact of the investment deficit for the treatment of Chagas Disease in Brazil. Method: This is a narrative review of the literature conducted in the following databases: SCIELO, LILACS, BIREME and MEDLINE. The final sample consisted of 27 scientific articles published between 2000 and 2020. Results: Brazil is one of the countries with the highest prevalence of patients with the disease, but little progress has been made in research in this area, so as to have a low incentive and investment from governments and the pharmaceutical industry for Chagas Disease, in view of the disease being of slow progression and the diagnosis and treatment are late. Conclusion: it is evident the lack of investment and public policies that make possible the diagnosis and early treatment of the disease with the consequence of a deficit in the quality of life of the patients.(AU)

Objetivo: discutir el impacto del déficit de inversión para el tratamiento de la enfermedad de Chagas en Brasil. Método: se trata de una revisión narrativa de la literatura realizada en las siguientes bases de datos: SCIELO, LILACS, BIREME y MEDLINE. La muestra final consistió en 27 artículos científicos publicados entre 2000 y 2020. Resultados: el Brasil es uno de los países con mayor prevalencia de pacientes con la enfermedad, pero se ha avanzado poco en la investigación en esta área, para tener un bajo incentivo e inversión de los gobiernos y de la industria farmacéutica para la enfermedad de Chagas, considerando que la enfermedad es de progresión lenta y el diagnóstico y tratamiento son tardíos. Conclusión: es evidente la falta de inversión y de políticas públicas que permitan el diagnóstico y tratamiento precoz de la enfermedad con el consiguiente déficit en la calidad de vida de los pacientes.(AU)

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Objective: to analyze the work overload and its consequences in the caregiver of fragile elderly. Method: it is a descriptive, exploratory study, based on an integrative review, performed in the online databases of the Virtual Health Library: LILACS and SCIELO. The study sample consisted of 14 articles published between 2009 and 2019. A form was used as a data collection tool. Results: the studies emphasize the biopsychosocial burden of labor fatigue, forged in a repetitive daily routine, often for years, with overload of activity in their daily lives, dealing not only with an overload in activities, but also a threat to their health. Conclusion: the care of the family caregiver requires special attention in order to prevent aggravation to his or her health, and the care of dependent elderly people is stressful and entails risk to the physical and mental health of the caregiver.(AU)

Objetivo: analizar la sobrecarga de trabajo y sus consecuencias en el cuidador de ancianos frágiles. Método: Se trata de un estudio descriptivo y exploratorio, basado en una revisión integradora, realizada en las bases de datos online de la Biblioteca Virtual de Salud: LILACS y SCIELO. La muestra del estudio consistió en 14 artículos publicados entre 2009 y 2019. Se utilizó un formulario como herramienta de recogida de datos. Resultados: los estudios destacan la carga biopsicosocial de la fatiga laboral, forjada en una rutina diaria repetitiva, a menudo durante años, con sobrecarga de actividad en su vida cotidiana, enfrentándose no sólo a una sobrecarga en las actividades, sino también a una amenaza para su salud. Conclusión: el cuidado del cuidador familiar requiere una atención especial con el fin de prevenir el agravamiento de su salud, y el cuidado de las personas mayores dependientes es estresante y conlleva un riesgo para la salud física y mental del cuidador. (AU)

Objetivo: analisar a sobrecarga de trabalho e suas conseqüências no cuidador de idosos frágeis. Método: trata-se de um estudo descritivo, exploratório, com base em uma revisão integrativa, realizada nas bases de dados online da Biblioteca Virtual de Saúde, sendo elas: LILACS e SCIELO. A amostra do estudo foi constituída por 14 artigos publicados entre 2009 e 2019. Utilizou-se um formulário como instrumento de coleta de dados. Resultados: os estudos enfatizam o ônus biopsicossocial decorrente do desgastante laboral, forjada numa repetitiva rotina diária incessante, muitas vezes durante anos, com sobrecarga de atividade no seu cotidiano, tratando não só de uma sobrecarga nas atividades, mas também de uma ameaça a sua saúde. Conclusão: a assistência do cuidador familiar requer uma atenção especial tendo em vista a prevenção de agravos a sua saúde, sendo que os cuidados com idosos dependentes são desgastantes e implica risco a saúde física e mental do cuidador. (AU)

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Background: Convalescent plasma is a potential therapeutic option for critically ill patients with coronavirus disease 19 (COVID-19), yet its efficacy remains to be determined. The aim was to investigate the effects of convalescent plasma (CP) in critically ill patients with COVID-19. Methods: This was a single-center prospective observational study conducted in Rio de Janeiro, Brazil, from March 17th to May 30th, with final follow-up on June 30th. We included 113 laboratory-confirmed COVID-19 patients with respiratory failure. Primary outcomes were time to clinical improvement and survival within 28 days. Secondary outcomes included behavior of biomarkers and viral loads. Kaplan-Meier analyses and Cox proportional-hazards regression using propensity score with inverse-probability weighing were performed. Results: 41 patients received CP and 72 received standard of care (SOC). Median age was 61 years (IQR 48-68), disease duration was 10 days (IQR 6-13), and 86% were mechanically ventilated. At least 29 out of 41CP-recipients had baseline IgG titers ≥ 1:1,080. Clinical improvement within 28 days occurred in 19 (46%) CP-treated patients, as compared to 23 (32%) in the SOC group [adjusted hazard ratio (aHR) 0.91 (0.49-1.69)]. There was no significant change in 28-day mortality (CP 49% vs. SOC 56%; aHR 0.90 [0.52-1.57]). Biomarker assessment revealed reduced inflammatory activity and increased lymphocyte count after CP. Conclusions: In this study, CP was not associated with clinical improvement or increase in 28-day survival. However, our study may have been underpowered and included patients with high IgG titers and life-threatening disease. Clinical Trial Registration: The study protocol was retrospectively registered at the Brazilian Registry of Clinical Trials (ReBEC) with the identification RBR-4vm3yy (http://www.ensaiosclinicos.gov.br).