INTRODUCTION: Serum creatinine is a marker highly used to evaluate renal function, but it has limitations to evaluate elderly people, since it varies according to muscle reserve, inflammation status and diet. Over the years, muscle reserve tends to decrease, which makes the elderly more predisposed to the development of sarcopenia and the current guidelines for assessing glomerular filtration rate do not provide formulas that fit these limitations in the elderly population. OBJECTIVE: The present study aimed to evaluate whether there is an association between sarcopenia and glomerular filtration rate estimated from serum creatinine. MATERIALS AND METHODS: This was a cross-sectional study to be conducted in participants selected by convenience, in which socioeconomic, demographic, clinical, anthropometric and sarcopenia data were collected. Anthropometric evaluation included BMI, waist and calf circumferences, and bioimpedance analyses. Sarcopenia was evaluated according to the criteria proposed by the European Working Group on Sarcopenia in Older People – EWGSOP (2019). The statistical analysis used Student's t-test, chi-square test, simple linear regressions and adjusted for sex and age, all in IBM SPSS software version 21, adopting an alpha value of 5%. RESULTS: The study included 65 elderly participants with chronic kidney disease (CKD), 29 women (44.6%) and 36 men (55.4%), with 55.4% of individuals who declared themselves brown. Of the individuals evaluated, according to the GFR estimated from the formula proposed by BIS1, 87.7% were between stages 3 of Chronic Kidney Disease and 33.84% of all participants were at risk of sarcopenia. CONCLUSION: The work is still ongoing.

Responsible for protein synthesis, bile production, glucose balance, micronutrient storage, cholesterol production, detoxification and metabolism of some hormones, among others, the liver plays an extremely important role in the body's homeostasis. Constant aggression to the liver by alcohol, viral hepatitis, metabolic and autoimmune diseases can lead to irreversible damage, with impaired liver function. The natural history of chronic liver disease is characterized by a long asymptomatic (silent) or compensated phase (VUILLELESSARD; RODRIGUES; BERZIGOTTI, 2021), which can progress to clinical decompensation, a phase characterized by the systemic manifestation of liver damage. One of the main consequences of advanced chronic liver disease (ACHD) is portal hypertension, which is responsible for the main complications in clinical decompensation that manifests itself with ascites, hepatic encephalopathy and digestive hemorrhage due to rupture of esophagogastric varices. After the first episode of decompensation, the disease progresses more quickly, increasing morbidity and mortality, and the patient should be evaluated for the possibility of liver transplantation (LTx). The transition from compensated cirrhosis to decompensated cirrhosis occurs at a rate of 5 to 7% per year (D'AMICO; GARCIA-TSAO; PAGLIARO, 2006). The progression of decompensated disease can be further accelerated by the development of other complications such as rebleeding, acute kidney injury, with or without the features of hepatorenal syndrome, hepatopulmonary syndrome, portopulmonary hypertension, cirrhotic cardiomyopathy, and bacterial infections. 2018).

The association between circadian rhythm, perineural invasion, and pancreatic
adenocarcinoma is a topic of growing interest in medical and scientific research. Pancreatic
adenocarcinoma is an aggressive form of cancer that originates from the mucus-producing
cells in the pancreas. These cells are located in the pancreatic ducts and play an important role
in digestion. Perineural invasion is a process in which cancer cells penetrate the nerves
surrounding the pancreas. This can occur when neoplastic cells spread beyond the primary
tumor, affecting adjacent nerve structures. Several studies have shown that disruption of the
circadian rhythm can promote tumor growth, perineural invasion, and metastasis in patients
with pancreatic adenocarcinoma. It is believed that the dysregulation of genes involved in the
circadian rhythm, such as the PER2 gene, may contribute to disease progression. Additionally,
changes in sleep patterns, night shift work, and exposure to artificial light at night have been
associated with an increased risk of developing this type of cancer. The present study aims to
understand the interaction between circadian rhythm and perineural invasion in the context of
pancreatic adenocarcinoma. For this purpose, scRNA (single-cell RNA) and spatial
transcriptome data will be used to analyze the molecular and spatial characteristics of cancer
cells, nerve cells, and the surrounding environment. A systematic review of pancreatic
adenocarcinoma studies was conducted using the Gene Expression Omnibus (GEO-NCBI)
database, from which studies were selected to identify the inflammatory processes associated
with the injury. These studies were analyzed using a pipeline developed in the R programming
language to standardize the processing of single-cell RNA sequencing and spatial
transcriptome gene expression data. The pipeline allows for downloading data from GEO,
quality control analysis, normalization, identification and removal of potential outliers,
summarization of gene expression data, gene annotation, identification of cells present in the
samples, and analysis of differentially expressed genes (DEGs). The processed scRNA-seq
data and annotation tables were downloaded from the GEO database. The dataset consisted of
180,000 cells corresponding to 36 patients with brain metastasis. Untreated samples were
specified and investigated to eliminate unnecessary factors. Separately, the cell count matrices
of the selected samples were introduced into R (4.1.0) and analyzed for cellular composition,
cell-cell interaction, and spatial transcriptome. The data were analyzed using specific
packages in R software, demonstrating that there are gene expression patterns in the different
analyzed samples. Our observations expand the notion by identifying that proliferative and
inflammatory processes coexist as opposing main cellular states and suggest that immune
escape and proliferation act as combined events. The present study identifies neoplastic,
stromal, and immune cell types in different types of pancreatic adenocarcinoma and presents
hypotheses to understand the interaction between intrinsic characteristics of tumor cells and
host environment characteristics in human metastasis.

INTRODUCTION: Liver transplantation (HTT) is the treatment of choice for cases
acute or chronic end-stage liver disease, provided that the benefits of
treatment outweigh the risks inherent in the procedure. While the patient is on the list
Waiting, the team should focus on the management of the underlying disease and complications, to
that is in adequate conditions at the time of TxH. In these individuals it is observed
a metabolic change in the primary fuel from glucose to fatty acids and
proteins, combined with a reduction in protein synthesis which also contributes to the
muscle depletion and installation of sarcopenia. Also seen in patients with liver disease, the
frailty manifests as loss of muscle function, beyond dimensions
psychological and social, being amenable to reversal when properly diagnosed.
The presence of these nutritional extremes is directly related to the inflammatory process
related to the underlying mechanism of disease, which is intrinsically linked to stress
oxidative. OBJECTIVE: To identify how nutritional status, frailty and sarcopenia
are associated with the presence of inflammation and oxidative stress in candidates for
liver transplantation. MATERIALS AND METHODS: This is a cross-sectional study,
whose data collection, in progress, began in October 2022, after approval by the
Research Ethics Committee of the Federal University of Alagoas, with a forecast of
end in August 2023, at the pre and post liver transplant outpatient clinic of the Hospital
University Professor Alberto Antunes. Screening tools and
nutritional assessment for cirrhotic RFH-NPT and RFH-GA, screening for
sarcopenia as recommended by the EWGSOP2 and frailty through the

Liver Fragility. For the comparison of frequencies, the chi-
square or Fischer's exact test with Bonferroni fit. Logistic regression

binary was calculated between the nutritional risk identified by RFH-NPT and CHILD (A
vs BC), adjusted for sex, age, and etilogy of liver disease. Data were expressed
as a 95% confidence interval (CI) and odds ratio (OR). Were
Results with a p-value < 0.05 were considered significant. FINDINGS
PRELIMINARIES: To date, the sample has consisted of 37 patients,
70.3% (n=26) were male and 29.7% (n=11) were female. Ages
ranged from 18 to 70 years, with a mean age of 46.24±15.17 years.

INTRODUCTION: Systemic Lupus Erytheamus is a chronic, immunomediated inflammatory disease, where the loss of immune regulation and the presence of autoantibodies result in multiple organ involvement. Lupus patients have increased cardiovascular risk compared to healthy people of the same sex and age. Existing methods of cardiovascular risk screening are not sufficient for patients with Systemic Lupus Erytheamus. OBJECTIVES: To evaluate metabolomic biomarkers that may be predictors and aid for cardiovascular risk assessment in this population. MATERIALS AND METHODS: Observational study and cross-sectional cohort. The sample was selected by convenience, composed of patients with SLE by the Rheumatology outpatient clinic of the Professor Alberto Antunes Hospital, a tertiary hospital in a northeastern capital. Patients of both sexes over the age of 18 years were included and signed the Free Consent and Informed Consent Form (Informed Consent). For the comparative analysis, the sample of patients control by convenience was also selected, composed of people of both sexes aged over 18 years who did not have autoimmune disease. These control patients also signed the Free Consent and Informed Consent Term (TCLE). Blood examination was collected at the Laboratory of the Professor Alberto Antunes University Hospital and a sample was sent to the Chemistry Laboratory of the Federal University of Alagoas for metabolomics evaluation. Subsequently, a statistical comparison of patients with Lupus and controls will be performed.

INTRODUCTION: Systemic lupus erithematosus (SLE) is an autoimmune condition of multisystem character associated with significant morbidity and mortality rates. Physical inactivity is highly prevalent in individuals with SLE. The phenotypic expression of an individual’s circadian rhythm or circadian preference is closely related to biological variables, and as a result it might influence the level of physical activity and clinical conditions in a population. OBJECTIVES: This study aimed at determining levels of physical activity and their associations with circadian preferences and clinical parameters in systemic lupus erythematosus. MATERIALS AND METHODS: SLE patients according to ACR’s criteria for diagnosis were included in this research. Physical inactivity was assessed through IPAQ short form. Circadian preference was assessed via MEQ. Disease activity and damage were assessed through modified SLEDAI-2K and SLICC. Data was analysed statiscally considering p < 0,05

INTRODUCTION: Chronic kidney disease (CKD) negatively affects muscle health
with consequent increase in frailty. Especially in patients undergoing
hemodialysis (HD), peculiar factors of the pathology and the dialysis process favor the
decline in nutritional status, greater fragility and risk of falls and fractures in these
patients, negatively impacting quality of life and contributing to a worse
prognosis. OBJECTIVES: To investigate the association of muscle strength and muscle mass
reduced in patients with CKD on HD and their impact as a risk factor for
hospitalizations, cardiovascular events, and mortality. MATERIAL AND METHODS:
This is a prospective cohort, carried out with 300 patients between 18 and 80 years of age, in
Chronic HD. Muscle strength was measured by handgrip strength (HGS) and
muscle mass by the equation estimating the corrected arm muscle area (AMBc).
Patients were classified as reduced HGS as HGS<26kg for men and
<16kg for women. Those were classified with muscle depletion by AMBc
who presented values ≤15th percentile according to sex and age group. The patients were
followed for a minimum period of 9 months to observe the incidence of
clinical outcomes investigated. For analysis of the association between reduced HGS and AMBc
and clinical outcomes, the Kaplan-Meier survival curve and the logrank test were used. A multivariate analysis was also performed using the regression model of
Cox proportional hazards presented as hazard ratio (RR) at intervals of
95% confidence (95% CI) and considered significant when p<0.05.
RESULTS: Reduced FMF was significantly associated with Mass Index
Body (BMI) and type of vascular access (p=<0.05). The reduced AMBc was also
associated with BMI (p=0.015), in addition to longer HD time (p<0.001). According to analysis
of regression, it was evidenced that HGS and reduced AMBc presented themselves as factors
of significant risk for the incidence of hospitalizations (p<0.001) and events
cardiovascular (p=0.025). The reduced AMBc is still strongly associated with
increased relative risk for mortality (p=0.020). CONCLUSION: Patients with
CKD on HD that showed reduced muscle strength and muscle mass measured by
HGS and AMBc have a higher risk for the incidence of hospitalizations, events
cardiovascular and mortality when compared to patients with HGS and AMBc
Normal.

Leprosy is caused by Mycobacterium leprae, an alcohol-acid bacillus
(ADR) with a predilection for skin and peripheral nerve cells. When
in contact with the body, this bacillus can cause neurological dermato lesions and,
therefore, physical, functional and psychological impairments. The high
incidence of infection is related to ecological factors. From this perspective, studies
make important advances in the conception of the natural history of
diseases, as they contribute to the understanding of the dynamics of
transmission of various pathologies, especially infectious diseases, such as
leprosy. This research is part of the larger project "Susceptibility factors to
leprosy in Alagoas: epidemiological, genetic and immuno-inflammatory aspects" and
its primary objective is to analyze the sand-time epidemiological dynamics of
leprosy in the state of Alagoas in the period 2010-2019 and identify factors of
associated susceptibility and underreporting. To this do so, this retrospective study
quantitative ecological nature involved confirmed cases of leprosy in the
years from 2010 to 2019 that have obtained adequate records since the recognition of
diagnostic form of the disease and the type of patient's entry into health services until the
reported cases, which counted 4739 cases. These were obtained in the
from October 2021 to February 2022 in the Injury Information System
(SINAN) of the State Secretariat of Alagoas. Based on the
Database of the Department of Informatics of the Brazilian Unified Health System
(DATASUS). The analysis is being structured in five stages (descriptive, temporal,
risk factors and underreporting) with the elaboration of tables, figures and graphs.
Through temporal analysis, it was possible to infer that new cases of leprosy in
population showed a decreasing trend (PCA/AAPC = - 3.0).
However, for new cases of the population under 15 years of age, the disease
presented a stationary trend which points out that the elimination of it in the
state is more illusory than real. In addition, despite the
physical disability in the diagnosis has a decreasing tendency, the indicator of
2 of physical disability in the diagnosis is stationary. This given alert to
a possibility of late diagnosis of the disease in the state of Alagoas. Still, it is worth
point out that the indicator of degree of physical disability in healing that assesses the quality of
attention and follow-up of new cases diagnosed until the completeness of the
treatment- has a decreasing trend, which points to a fragility in the
leprosy patients in the state. Still at this core, the indicator of
grade 2 of physical disability in healing has a steady pattern. It is expected that
this research is able to guide the identification of areas with greater vulnerability
in Alagoas, as well as the definition of priority areas for tackling the
leprosy. It is intended to produce and implement mechanisms to combat
pathology and its complications.

Violence against women is a serious global public health problem, particularly in Brazil there
are high and increasing cases of domestic aggression against women especially after the Covid
Pandemic 19, from childhood to adulthood, this violence causes a series of physical changes
and mental disorders that favor ideation and consequent suicide attempts. It is necessary to
study the predisposing factors and symptoms more related to these attempts so that objective
actions aimed at the impediment are taken and effected. Most suicide attempts are not even
attended in health services and it is estimated that before the consumption of lethal fact a
person performs previous attempts, in women the attempts are more frequent and this is
justified by the use of less lethal methods, while men use more invasive and destructive
methods, attempts can be prevented if well addressed, for this, in-depth data on factors
involved are needed since the majority is not at least notified, a record that according to
Ordinance No. 204 of the Ministry of Health should be done within 24 hours. This study seeks
to understand and relate suicide attempts involving patients treated at the largest public
emergency hospital in the state of Alagoas with domestic violence. Patients over 18 years of
age treated in the emergency department with admission due to self-inflicted injury by suicide
attempt will be interviewed, first a sociodemographic questionnaire and psychological pain
scale, later the WAST scale validated for screening for domestic violence in women, patients
who acentire will be followed at the University Hospital with psychiatric and psychological
care, in addition, they will be monitored through teleservices performed by researchers
weekly, every two weeks, monthly and quarterly. Between March and July 2022, 4 women
were approached (50% of the total sample), all did not have a partner, all have children (2 to 3
children) per woman and all have incomplete elementary school, 85% non-white, half inactive
work, family income ranged from 400 to 2400 methods used were burn and injury by misplate,
the mean age was 43.25 ranging from 24 to 60 years, one reported prior planning; the
Psychological Pain scale showed a high degree of suffering indicated by high scores 44.75,
higher than the general 43.85 [±8.68]. The data reveal the difficulties of screening, prevention
and treatment of these women since none remained in the study, and it is not possible to
apply the WAST questionnaire and subsequent follow-up.

Leishmaniasis is anthropozoonosis caused by protozoa of the genus Leishmania
sp. and transmitted by vectors, mainly affect less-favored populations, where the
access, medical care and drug therapy are limited, causing serious
public health problems. For these reasons too,
and are endemic in several countries. Clinical forms are varied, from
simple skin lesions that may spontaneously disappear into the visceral form,
affecting several organs, and may lead the individual to death. In Brazil, for all
forms of leishmaniasis, first-line treatment is pentavalent antimonials
Sb(V), currently the available antimonials are N-methyl-glucamina antimoniate
(Glucantime) and sodium sybogluconate (Pentostan) for all forms of leishmaniasis,
the first-line treatment are pentavalent antimonial Sb(V), currently the
antimonial scans are N-methyl-glucamina antimoniate (Glucantime) and
sodium sybogluconate (Pentostan), in addition to other second-choice drugs, however,
cause a number of side effects and resistance on the part of patients. In view of this, the
bioprospecting of natural products is an excellent alternative for
production of new antiparasitium drugs, especially bioactive compounds of
microorganisms, including bacterial ones. To this end, the present study aims to
investigate the leishmanicide activity of extracts of microorganisms isolated from the biome
Caatinga. To this do so, five bacterial isolates obtained from liquen samples were
nutrient broth for seven days at 25 °C for biomass production. The
intracellular pigmented metabolites were extracted with methanol and ethyl acetate,
the extractive solutions obtained were dried in a vacuum desiccator.
Subsequently, the cytotoxic activity against macrophages of the J774 scan was evaluated. A1
using the MTT method. The anti-promastigote activity of
Leishmania amazonensis and Leishmania chagasi, after cultivation of the parasite with the products
Natural. It was found that the extracts did not present cytotoxic effect for macrophages.

Phenylketonuria or PKU is an ininate error of amino acid metabolism caused by the mutation of the gene encoding the liver enzyme phenylalanine hydroxylase. This enzymatic defect, related to autosomal recessive inheritance, leads to the accumulation of phenylalanine and its metabolic in the bloodstream and tissues that may imply neurotoxicity and cause irreversible cognitive and neurological damage, including mental retardation, when not diagnosed and treated early. Dietotherapy is the basis of the treatment of this aminoacidopathy and consists of a restrictive diet associated with the use of metabolic formula throughout life. This cross-sectional and observational study has, to date, a sample of 27 participants in follow-up to the Reference Service in Neonatal Screening (SRTN) of the State of Alagoas and aims to analyze the epidemiological profile and clinical situation of alagoan phenylketonurics. The variables surveyed were collected during a face-to-face interview through a questionnaire prepared by the executing researcher followed by physical examination and review of medical records. For the crossing between categorical variables, the chi-square test and fisher's exact test were used when necessary. The differences were considered statistically significant for p < than 5%. Preliminary results reveal that, of the 27 patients, 14 (51.83%) are children under 11 years of age, 70.40% male and 74.10% from the interior of Alagoas. All are single and only 3/27 have some paid activity. Only 29.60% have a family income above 2 minimum wages and 33% receive disease assistance because they have clinical complications and/or cognitive impairment. More than 80% reported clinical complications and 66.70% are classified as mild PKU. Adequate metabolic control was observed in only 22.20% of the study participants. Statistically significant associations were observed between the use of metabolic formula and the presence of clinical complications (p = 0.03) and between cognitive impairment associated with receiving social benefit p < 0.001. The shortage through the state program of acquisition and distribution of these formulas is considered by 74.10% the main factor that impairs the treatment and continuity of treatment. Finally, most alagoan phenylketonurics, although screened and assisted by SRTN/AL, suffer sequelae, avoidable, related to treatment conditions and have compromised health conditions.

Background: Oral clefts are complex and frequent congenital anomalies. The frequency of dysmorphic signs associated varies from 3% to 63%. The presence of dysmorphic features may change the status from non-syndromic OC (NSOC) to syndromic OC. The diagnosis established through genetic assessment allows treatment planning accordingly to the patient needs and genetic counseling. Treatment is longitudinal and multidisciplinary throughout the health system levels. Timely primary surgery (cheiloplasty and palatoplasty) is essential for successful rehabilitation. A network of 30 craniofacial hospitals accredited by the the Ministry of Health (CFAH) provides specialized treatment in Brazil. However, throughout the country, non-CFAH also operate to the supply-demand disequilibrium. Aim: To investigate the access of patients with NSOC to genetic assessment and surgery in CFAH and non-CFAH. Methods: Quantitative, retrospective, observational, multicenter study with patients with FONS, followed-up from 2008 until 2019 in two CFAH and two non-CFAH members of Brazil's Craniofacial Project. Data was collected during outpatient visits using the CranFlow platform that feeds the Brazilian Database on Craniofacial Anomalies (BDCA). Genetic assessment and cheiloplasty performed after 12 months-old and palatoplasty after 18 months-old were classified as delayed. Odds ratio (OR), Chi-square and Fisher's exact tests were used for statistics with a p-value of 0,05 for significance.  Results: Information on 840 patients with NOC feeded the BDCA after genetic assessment. The CFAH and non-CFAH patient rate was 2:1, with the majority attending hospitals in the Northeast of Brazil. Age ranged from 1 day to 61 years-old (4±8) with a predominance of children up to 12 months old. Most lived outside the city where the hospital is located, had low-income families and parents with low education. Cleft lip and palate (CLP) occurred in 54.1%, cleft lip (CL) in 25.4%, and cleft palate (CP) in 20.5% of cases. CLP predominated in males and CP in females (p<0.00); unilateral over bilateral clefts (p<0.00), and left-sided over right-sided clefts (p<0.00). The first genetic assessment was performed before completing 12 months-age in 53.1% of the sample. When comparing patients who had timely genetic assessment with late assessment, there was an increased odds of patients in the delayed group experiencing the following barriers: attending a Non-CFAH (OR=1.8; p<0.000), living outside the hospital's location (OR=1.40; p=0.032) and having illiterate mother (OR=11.72; p<0.000) and father (OR= 3.67; p<0.000). Due to the lack of information on the status of surgical treatment in the BDCA, 331 (39.4%) patients were excluded from this analysis. Among the remaining 509, 261 (51.3%) have had surgical delay, 170 had been timely repaired and 78 were into the time-window for surgery. Summing up there were 431 patients timely-repaired, late repaired and late non-repaired for whom 666 surgeries were needed. However, 418 surgeries were overdue, 219 of which were palatoplasties. When comparing patients who had timely surgery with late surgery, there was an increased odds of patients in the delayed group experiencing the following barriers: attending a Non-CFAH (OR=2.7; p<0.000) from the Northeast (OR=3.93; p<0.000), being in a low-income family (OR=2.32; p=0.005), and having parents with low education (mother: OR=15.11; p<0.000; father: OR=3.53; p=0.001). There was a statistically significant increased odds of patients who needed palatoplasty compared to those who needed cheiloplasty (OR=1.8; p<0.000). Conclusion: Clinical-genetics characteristics of the sample corroborate the literature on the epidemiology of NSOC around the world. Overall, half of the patients included in this study had a delay in genetic assessment and/or surgical rehabilitation. Differences were found in the access of patients with NSOC to genetic assessment and surgery, with a greater disadvantage for those followed at NCFH and needing palatoplasty. Patients with NSOC experienced many barriers to access genetic assessment and surgery through the Brazilian Unified Health System. These results highlight and strengthen the need to establish a transversal health policy, having the CFAH as a reference network able to address the unmet health needs of this population.

Introduction: Congenital Adrenal Hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD) is an inborn error of autosomal recessive metabolism. The clinical form depends on the 21OH residual enzymatic activity. The classic salt-wasting form (CL-PS) causes homeostatic imbalance, leading to death in the neonatal period if not identified and treated in time. HAC-21OHD was incorporated into the National Neonatal Screening Program (PNTN) in Brazil in 2012 and implemented in the Brazilian Unified Health System of Alagoas (SUS-AL) in 2016 and the screened patients are referred to a multidisciplinary team at the reference service of neonatal screening (Serviço de Referência em Triagem Neonatal – SRTN), linked to the Santa Monica Maternity Hospital of the Health Sciences State University of Alagoas (SRTN/MESM/UNCISAL). Before the PNTN, since 2008, CAH patients from SUS-AL have been followed up at the Clinical Genetics Service of the Professor Alberto Antunes University Hospital of the Federal University of Alagoas (SGC/HUPAA/UFAL). Both services are a reference in the care of patients with HAC-21OHD in SUS-AL. Objective: To describe the clinical-molecular profile of HAC-21OHD in SUS-AL, based on the composition of a unique database. Methods: Patients treated from 03/2008 to 02/2022 in both services, with HAC-21OHD clinical and laboratory diagnosis, were included. Data were collected from medical files and molecular reports of CYP21A2 gene analysis. Case series descriptive analysis was performed, with frequency distribution and measures of central tendency and dispersion. Results: The unique database consisted of 45 patients distributed in 40 families, most from the interior of AL (71,1%), and 17,5% reported consanguinity. The age at the 1st consultation ranged from 7 days to 43 years old and 68,2% had genital ambiguity. The CL-PS form was the most frequent, with the c.290-13A/C>G variant being the most prevalent, followed by p.Ser170Lisfs*125. Four patients died from adrenal crisis, one of them, screened by the PNTN, died before the results were published. Conclusion: The data presented here are in accordance with the literature, where the CL-PS form is more frequent, with a higher prevalence of the c.290-13A/C>G variant. However, the high frequency of the p.Ser170Lisfs*125 variant, considered rare, provides evidence of a possible founder effect. The need for decentralization of services to the interior of the state is evident. Deaths from the adrenal crisis have substantially reduced, but there is still a need to improve the flow of service. The recognition of these characteristics is important both at the individual and at the collective level, supporting the construction of specific health policies for these patients.

INTRODUCTION: Chronic Kidney Disease (CKD) is sustained damage to the renal parenchyma causing deterioration and progressive loss of kidney function that may progress to the end stage. Some studies have shown beneficial results for the practice of physical exercise in the treatment adjunct to various pathologies, especially for metabolic diseases such as obesity, dyslipidemia and diabetes mellitus; and for cardiovascular diseases and Systemic Arterial Hypertension, pathologies that are bases or metabolic alterations associated with the development of CKD. Such benefits can also be observed in aspects of quality of life, especially those focused on emotional, psychosocial and general perception of well-being. OBJECTIVE: To evaluate the level of physical activity, quality of life and nutritional profile; associate and correlate the levels of physical activity, nutritional profile and quality of life level with ckD stages of patients undergoing conservative treatment for Chronic Kidney Disease in a high complexity hospital in a capital of northeastern Brazil. MATERIALS AND METHODS: Observational study and cross-sectional study. The sample was selected by convenience, formed by all patients with CKD assisted by nephrology outpatient clinics (CIN-HUPAA). Patients of both sexes were studied; over 18 years of age; signed the Free Consent and Informed Consent Form (TCLE). The analysis variables were: socioeconomic and outpatient data; nutritional profile data (Body Mass Index, Waist Circumference and Fat Percentage); level of physical activity (from the application of the International Physical Activity Questionnaire, IPAQ-Short Version); quality of life (from the World Health of Quality of Live (WHOQOL-Bref)). All analyses were performed with the aid of software R, with the jasp statistical package version 0.13.1, adopting a confidence level of 95% (p<0.05). The Shapiro-Wilk Test was used to verify the normality of the data. For the association between the variables, the Mann Whitney was used; as well as the R-Spearman correlation was used for the monotonic variables (continuous or ordinal) of the variables QOL, NAF and BMI and GFR. The size of the effect based on D-Cohen's Standardt having as reference 0-0.2 for irrelevant effect; 0.3-0.5 for small effect; 0.6-0.8 average effect; above 0.9 wide effect. Significance levels were considered p= <0.05 and confidence interval at 95%. RESULTS: Fifty-two patients with a mean age of 60.3 years ± 9.11 years participated in the study. Within the social profile and general health aspects were patients 53.84% women, 88.46% mixed color, 63.49% resident in Maceió, 42.3% single, 34.61% with incomplete elementary school, 57.69% with Diabetes Mellitus Type 2, 76.92% with Systemic Arterial Hypertension, 13.47% with dyslipidemia; 86.53% non-smokers and 78.84% non-smokers. Nutritional Profile: 76.73±5.31Kg; 38.46% were obese and 61.53% eutrophic or overweight; 82.69% with elvados DC standards; 15.34±5.02 %G (eutrophic). Level of physical activity: 38% are insufficiently active and 29% sedentary, a sample with low levels of physical activity. Quality of Life level: lower scores in satisfaction with health (2.98± 0.83) and environment (2.75± 0.38); better scores in the psychological domain (3.80± 0.53) and Social Relations (3.58± 0.58), but the sample presents regular levels of perception with quality of life. Only health satisfaction (p=0.043) and BMI (p=0.034) showed a significant difference in the association between ckd stages of patients with levels of physical activity, nutritional profile and quality of life level. The correlation was negative of the CKD stage only with the social relations dimension (0.084) of the quality of life level, but the other variables showed positive correlations. CONCLUSIONS: The subjects presented low levels of physical activity, but these levels did not change in association with ckD stages, but the higher the CKD stage, the lower the levels of physical activity practices recommended by the WHO. Regarding the perception of quality of life, the patients evaluated presented low levels, especially in the context of health satisfaction. The subjects undergoing conservative treatment with GFR < 59ml min revealed lower scores, even though the associations between the groups did not present significant differences. The greatest impact on the stages in the correlation was observed in social relations.

The phenomenon of carcinogenesis is a complex process that occurs through multiple genetic events that alter the normal functions of oncogenes and tumor suppressor genes. Studies have shown that Schwann cells participate in the tumor microenvironment, producing several factors that benefit cancer cells. During this process, Schwann cells are undifferentiated and aid the process of cancer cell proliferation. These cells then migrate to the region near the tumor tissue and aid the development of the neoplastic cell. In this context, the aim of this study was to evaluate the influence of Schwann cells on prostate cancer. We performed a bioinformatics view and observed that the "neuroactive connecting-receptor interaction" was positively regulated in prostate cancer. The "p53 signaling pathway" is active, since CCNE1, CDKN2A and PERP are increased. specific miRNAs inactivate the pathway of "guidance of axons", aiming at the ROBO2 and SLIT2 genes. Both genes are also associated with inhibition of schwann cell migration. In addition, GFAP and GAP43 are overexpressed, leading to dedifferentiation of Schwann cells. Both Schwann and neoplastic cells are stimulated via phosphorylation cascade to proliferate and migrate. The results show that schwann cell dedifferentiation and proliferation are induced by neoplastic tissue; consequently, Schwann cells produce different factors that will participate in various tumor progression processes. These processes may also be involved in tumor invasion in perineural tissue in prostate neoplasia.

Context. Being born in Brazil is a challenge. In 2019, approximately 24,000 neonatal deaths
were registered in the country. There are almost three deaths per hour in the country, something worrisome and that
needs attention. Health professionals have several tools to assist in
prediction of this outcome. However, such tools are mostly based on
in-hospital aspects, focused on the points of intensive care, and based on
data from developed countries. Goal. Develop a neonatal death prediction score
using data present in the declarations of live birth and death of the State of Alagoas
between 2016 and 2020. Methods. This is a case-control study, which
involved newborns whose death occurred between birth and 27 full days of life
(case) and surviving newborns at the same period (control). Data collection was
held at the Health Surveillance Superintendence of the Health Department of the State of
between December 2020 and February 2021. The sample size
based on the absolute number of neonatal deaths between 2016 and 2020. The variable
dependent was neonatal death. The independent variables corresponded to the
present in the DAndd. The statistical analysis included descriptive analysis of the data, as well as
bivariate and multivariate analysis, in addition to sensitivity, specificity and
construction of the ROC curve. Findings. There were 1,338 neonatal deaths between 2016 and
2020 in Alagoas. The weight < 2500 g obtained an adjusted OR of 7.52 (5.86 – 9.74); the presence
congenital malformation 28.15 (16.73 - 47.36); gestational age < 37 weeks 6.06 (4.72
– 7.78), APGAR < 7 in the 5th minute 61.61 (38.01 - 99.88) and prenatal care with < 7 consultations 1.29
(1.04 – 1.59). The VK-10 score, whose best cut-off point found was greater than or equal to five,
obtained an AUC of 89.6%, in addition to a sensitivity of 72.28%, a specificity of
95.61%, a positive likelihood ratio of 16.46 and a likelihood ratio
negative of 0.28. Conclusion. The VK-10 score is shown as a proposal to be valued,
once it presented a high AUC. Moreover, because it has a reason for likelihood
positive high, a score above five points should be valued, that is, when there is a
higher chance of death.

INTRODUCTION: Diabetic nephropathy is the main complication that leads diabetic patients to hemodialysis. At this time of pandemic by COVID 19, patients with diabetes, especially the obese diabetics, are part of the risk group that can evolve with the most severe presentation of the disease. In obese individuals with diabetes and patients with chronic kidney disease, the inflammatory process occurs in an exacerbated manner with the uncontrolled elevation of inflammatory cytokines and may have an unfavorable outcome. The sarcopenia present in these patients also appears as a complicating factor during the pandemic period, with repercussions still uncertain in this scenario. OBJECTIVE: To investigate the risk of sarcopenia and inflammatory response in diabetic patients with chronic kidney disease, underconservative treatment during the COVID pandemic 19. MATERIALS AND METHODS: The dissertation presents two products. Product 1 is a review article "Metabolic pathways and hyperinflammation in covid 19 in chronic renal diabetic obese patients and their post-infection physical rehabilitation", published in the Journal of Development ISSN: 2525-8761, DOI: https://doi.org/10.34117/bjdv7n7-167. The second product refers to a cross-sectional study, observational, and the sample was calculated from 40 diabetic patients undergoing conservative treatment for Chronic Kidney Disease (CKD), with < 60mL/min/1.73m² (GFR calculated with ckd-EPI formula) of both sexes, assisted by the Integrated Nephrology Center of the Professor Alberto Antunes University Hospital (HUPAA) during the COVID pandemic 19. The collection was carried out from January to July 2021. The study was done in two stages, the first being retrospective observational by collecting data from medical records, including socioeconomic, anthropometric (weight and height) and biochemical data (blood count, urea, creatinine, albumin, fasting glycemia, lipidogram, C-reactive protein, ferritin, uric acid, sodium, potassium, calcium, phosphorus, PTH and 25-hydroxy-vitamin D). The second part was the collection of blood samples for the evaluation of inflammatory cytokines (IL-1β, IL-6, IL-8, TGF-β) and screening of sarcopenia by applying the SARC-F<® questionnaire. RESULTS: Forty-one patients (63.8% elderly and 36.1% adults) were evaluated, and a high percentage of obesity was observed (mean BMI 30.4Kg/m², with SD 6.541, p 0.001), with 39.02% of obese individuals and the presence of a decreased glomerular filtration rate (mean GFR of 38.2mL/min/1.73m², with SD 14.68, p 0.039). Of this population, 36 people answered the SARC-F questionnaire to assess the risk of sarcopenia and we found 38.9% of signs suggestive of sarcopenia, which indicates to continue with the investigation later and greater attention to care. The variables related to personal and health data were analyzed regarding the association with nutritional status and no statistical significance was found. Personal and health data when associated with nutritional status did not differ, however, the risk of sarcopenia was associated with the fasting glucose value (p 0.017) with low association effect. The correlation analysis using spearman rho coefficient, performed between nutritional status and nonlinear variables, found a positive relationship between obesity and glomerular filtration rate, fasting glycemia and glycated hemoglobin. Inflammatory markers will be analyzed at a later stage. CONCLUSION: The studied population represents patients with advanced stage of diabetic chronic kidney disease and the obesity rate appears high in this sample. This fact may be related to the presence of sarcpenic obesity, considering the data of the SARC-F. In addition, the positive correlations between obesity and GFR, fasting glycemia and glycated hemoglobin reflect the metabolic repercussions to which this nutritional profile is associated, according to the literature.

INTRODUCTION: Diabetic nephropathy is the main cause that leads diabetic patients to hemodialysis. At this time of pandemic by COVID 19, infection caused by the new coronavirus (SARS- CoV-2), patients with diabetes, especially the obese, are part of the risk group that can evolve with the most severe presentation of the disease. In this group of patients, obese with diabetes and patients with chronic kidney disease, the inflammatory process occurs in an exacerbated manner with the uncontrolled elevation of inflammatory cytokines and may have a fatal outcome. The sarcopenia present in these diabetic, obese and oral patients also appears as a complicating factor of COVID 19, with repercussions still uncertain in the post-infection scenario. OBJECTIVE: To investigate the inflammatory response and sarcopenia after covid-19 infection in participants with chronic kidney disease and overweight/obesity, diabetics, undergoing hemodialysis. MATERIALS AND METHODS: The sample consisted of 32 diabetic patients on hemodialysis (sample calculation from the data of diabetics on dialysis according to a Brazilian survey conducted by the Brazilian Society of Nephrology - SBN, in 2017), of both sexes, assisted by the Integrated Nephrology Center of the University Hospital Professor Alberto Antunes (HUPAA), Hospital Veredas and UNIRIM. The participants were divided into two groups; A: Those with confirmed Infection by Sars-COV-2 and B: Those who did not have Sars-COV-2 infection. Demographic and laboratory data were collected. RESULTS: Group A (mean + standard deviation): n = 12 Age 60.33 + 8.03 years; BMI 31.19+1.89 Kg/m2; Dialysis time 865+689 days; Hematocrit 33.32 +4.84; Hemoglobin 10.72+1.43; Urea 148.82+31.18; Creatinine 8.53+3.04; Ca 8.35+0.49; P 5.89+1.30; Albumin 3.74+0.51; Globulins 2.96+0.52; Ferritin 229+185; PTH 460.55+350.01. Group B is described as well (mean + standard deviation): n = 30; Age 65.55 + 9 years; BMI 30.95+3.24 Kg/m2; Dialysis time 1175+768 days; Hematocrit 33.17 +4.22; Hemoglobin 11.03+1.37; Urea 139+43.91; Creatinine 7.69+2.56; Ca 8.64+0.98; P 5.1+1.82; Albumin 3.79+0.61; Globulins 3.59+1.39; Ferritin 253+197; PTH 207.76+258.31. CONCLUSION: We have not found so far a difference between the markers studied in the groups studied. More analysis is required for effective completion.

INTRODUCTION: According to estimates, about 13% of children and adolescents in Brazil have some psychopathy and that only 37.5% of them receive some therapeutic intervention over 5 years. The gap between prevalence and access to specialized treatment demonstrates that some factors may interfere with the coverage and efficacy of mental health care for this population. The main barriers of access faced by family members involve both personal factors (financial situation, abdication of social commitments and physical and emotional exhaustion required in care) and factors related to deficiencies in the care network, such as: disarticulation in services, lack of investments, specialized professionals and procrastination in diagnosis. The sequence of the itinerary tends to be adjusted according to the particularities of the users and is usually preceded by care in the Basic Health Units (UBS), Emergency Care Units (UPA) and psychiatric hospitals, involving a diversity of professionals until the arrival at the Psychosocial Care Center for Children and Adolescents. Regarding the specialized network, Alagoas has only one CAPSi unit, a reference in the care of children and adolescents aged 5 to 18 years, with some serious mental disorder. OBJECTIVE: To analyze the path taken by family members or caregivers for mental health treatment of children and adolescents treated in a MACEIÓ CAPSi; identify the motivations for seeking treatment, trying to understand the difficulties and strategies used in this process and describe the factors related to treatment abandonment. MATERIALS AND METHODS: This is an exploratory, descriptive and qualitative study, based on the theoretical and methodological precepts of therapeutic itineraries. The sample consisted of 29 participants, divided with the following organization: 20 responsible for children or adolescents with mental disorders in care at CAPSi and 9 guardians who abandoned treatment between 2019 and 2020. The sampling was performed for convenience, taking into account the scheduling of consultations for psychiatrists performed at CAPSi, during the months of May and June 2021. In the case of dropouts, a search was carried out in the archive of inactive medical records, from which the first 9 that fit the described period were selected, and in which it was possible to contact through the telephone number informed. Data collection was performed through semi-structured interviews, composed of open questions elaborated by the researchers. The data produced by the interviews were worked in the qualitative typology, with the help of atlas ti software version 9, following the theoretical-methodological approach of thematic content analysis proposed by Minayo, in its three phases of analysis: Pre-Analysis, Exploration of the material and Treatment of the results obtained and interpretation. RESULTS: Considering the demographic profile of the participants, 75% showed the maternal figure, in the age group of 41 to 50 years, as the main responsible for the child or adolescent in the treatment in capsi. The predominance of family income of a minimum wage, low schooling and non-exercise of paid activity comprised the characteristic factors of a population in social vulnerability. Among users, higher frequency was observed in males, aged between 11 and 13 years, with length of stay in CAPSi up to two years. The predominant diagnostic groups were F70-79 (Mental retardation), F 84 (Global Child Development Disorders) and F 91 (Conduct Disorders). The results of the interviews were organized into three themes: Motivation to seek help; Paths traveled / difficulties until arrival at CAPSI and Reasons for withdrawal from treatment. Among the interviewees, what motivated the search for help were changes in the child's behavior, such as hyperactivity, heteroaggressiveness and introspection, perceived mainly by the mother, between 2 and 4 years. The therapeutic itinerary was described as a long and exhausting stage, in which family members moved between several establishments in the primary care of the SUS, complementary units of mental health services, as well as professionals from the private network. The average number of professionals accessed was 6 and the average time spent until referral and arrival at CAPSi was 4 years. Lack and/or long wait for vacancy, dissatisfaction with therapies, refusal to accept the diagnosis, stigma and maternal burden were the most cited difficulties in the pilgrimage for specialized treatment. The CAPSi in general was well evaluated by users, mainly by trained professionals, family reception and availability of medications, but insatisfações were recorded in the says res

Introduction: Central venous catheters (CVCs) for hemodialysis (HD) can be short-term catheters (STC) or tunneled catheters (TC). Bacteremia and dysfunction are complications that can impact morbidity and mortality. We decided tocompare the rates of bacteremia and dysfunction between STC and TC and the survival of patient survival 90 days after catheter insertion. Methods: Retrospective cohort to evaluate CVCs inserted between January 2011 and December 2020 in a tertiary hospital. CVCs in patients with end-stage chronic kidney disease were included. Patients with acute kidney injury, CVC that lasted less than three HD sessions, and patients who died within one week after insertion were excluded. Bacteremia and dysfunction rates, bacteremia-free survival, and dysfunction-free survival were investigated. Multivariate analysis was performed using a Cox proportional hazards regression model for patient survival at 90 days. Results: A total of 670 catheters were analyzed in 287 patients, which were 422 STC (63%) and 248 TC (37%). The rates of confirmed bacteremia per 1,000 catheter-days were 1.19 for STC and 0.20 for TC (p < 0.0001). The rates of confirmed or suspected bacteremia were 2.27 and 0.37 per 1,000 catheter-days for STC and TC, respectively (p < 0.0001). The dysfunction rates were 3.96 and 0.86 for STC and TC, respectively (p < 0.0001). Patient survival at 90 days was higher in the TC group compared to the STC group (96.8% vs 89.1%; p < 0.0001). Age in years (HR 1.033: 95% CI 1.009-1.057), albumin in g/dl (HR 0.278: 95% CI 0.154-0.505) and use of STC (HR 2.807: 95% CI 1.048-7.521) were the variables that influenced mortality 90 days after insertion. Conclusion: We found lower rates of bacteremia and dysfunction for TC, in addition to demonstrating that the use of STC influences patient mortality.

INTRODUCTION: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune
disease involving multiple organs. Prevalence of work disability (WD) respectively
within 5 years after diagnosis ranges from 15% to 40%, increasing to 36% and 51% at
10 and 15 years. Several risk factors for work dysfunction have been reported in several
SLE patients, including sociodemographic, environmental and disease-related issues.
Although several studies have public consequences for productivity in SLE, none has
evaluated the Brazilian targets. OBJECTIVES: To determine the prevalence and risk
factors associated with WD in patients with SLE. METHOD: cross-sectional study
carried out at the SLE Outpatient Clinic of the Rheumatology Service of the University
Hospital of Alagoas, Brazil. The sampling was non-probabilistic for convenience,
consisting of 110 patients in outpatient care. Data collection was based on the
application of the Sociodemographic and Occupational Questionnaire, ABEP&#39;s Brazilian
Economic Classification Criteria, MAT (Measurement of Adherence to Treatment), SF-
12 (The 12-item Short Form Survey), SLICC (The Systemic Lupus International
Collaborating Clinics/ American College of Rheumatology – Damage Index), SLEDAI
(The Systemic Lupus Erythematosus Disease Activity Index), in its 2K modified
version, and analysis of medical records. As for the statistical analysis, the Shapiro-
Wilk test evaluated the normality of the distribution of continuous variables, which
were compared using the Mann-Whitney test. Chi-square, Chi-square with continuity
correction or Fisher&#39;s exact tests were performed to compare categorical variables. The
association between sociodemographic, occupational and clinical factors with work
disability was assessed using logistic regression. RESULTS: The sample consisted of
98.1% female participants, with a median age of 38.5 (IQR 18) years, 78.1% non-
Caucasians, with more than 10 years of schooling in 62.7% of participants, with 74.5%
of the sample framed in social vulnerability status, with an average income of up to
R$1,100.00, equivalent to US$212.76. As for occupational profile, 83.6% were inactive
at the time of the research, while 64.55% had an active current income and 47.2%
received social security benefit due to a temporary or permanent poor health condition.
75.4% came to work in jobs that required high physical demand life habits. As for life
habits, 3.6% of the participants said they were alcoholics, 1.8% said they were smokers,
24.5% said they practiced regular physical exercise. The prevalence of WD due to SLE
in our sample was 76.3%. In the univariate analysis, the significant predictors of labor
dysfunction were older age, less than 10 years of education, married marital status,
occupational position with high physical demand and not practing physical exercise. In
the multivariate analysis, an association was found between WD and less than 10 years
of education (p=0.028). Clinical characteristics were not significant predictors of work-
related dysfunction. Participants with less than 10 years of education were 5.33 times
more likely to have work disability. CONCLUSION: More than half of the sample
(76.3% of the participants) presented loss of productivity at work. Less than 10 years of
education was a predictor of work disability in this population.

Acute myeloid leukemia (AML) and acute lymphoid leukemia (ALL), neoplasms of the hematopoietic system, are hematological malignancies that affect adults and children, with great involvement in the latter. Analyzing these mutations allows for greater knowledge about drug resistance, complications arising from treatment, relapses and chances of cure - resulting in a better prognosis. Thus, the objective of this study was to analyze the gene expression, which is related to the therapeutic prognosis, in patients with acute myeloid and lymphoid leukemia. This is an observational, cross-sectional analytical study carried out in the pediatric oncology ward of Hospital Veredas with children, aged between 0 and 19 years old, diagnosed with leukemia. Previously, a patent was built aiming at the identification of genes related to prognosis, with regard to survival and recurrence of acute myeloid leukemias. Analysis for lymphoid subtype is ongoing. Subsequently, the evaluation of the biological material will allow the identification of the profile of the research participants. The S1PR4, PBX4, FAM171A1, RARRES2, HPGD, CD1C and PAM genes were identified in the pediatric patient group for both disease severity and negative association with AML survival. The FAM171A1, RARRES2 and PAM genes were identified in the analysis for chemoresistance. The sample, so far, consists of 13 patients, with a mean age of 7.83 years old (standard deviation of ± 7.7 years old), with 7 children (53.84%) being male. The mean time between the first symptoms and diagnosis was 55 days - the shortest and longest time, respectively: 7 and 180 days. The initial signs and symptoms, with the highest recurrence, that led to the search for a diagnosis were: pain in the lower limbs (30.76%) and pallor (23.07%). As for the type of leukemia, 10 (76.92%) patients were diagnosed with ALL, with type B being more prevalent (69.23%). No child had CNS infiltration, according to chart analysis. Spinal cord relapse was confirmed in 3 (23.07%) patients, who were on new anticancer treatment, with 2 (66.66%) of them waiting on the list for BMT. It is concluded that the knowledge of gene expression, in the sample obtained, will make it possible to present prognoses, resulting in possible improvements in the making of therapeutic decisions, regarding the treatment of pediatric leukemias.

Introduction: Tumorigenesis is affected by clock genes. Changes in the expression of clock genes can increase cancer susceptibility through the effects on biological mechanisms that regulate DNA damage and repair, energy metabolism, cell growth and death in neoplastic tissues (NIRVANI et al, 2018; GERY, 2010). Objective: to analyze the association of circadian rhythm, type 2 diabetes and cancer. Methodology: The study is a meta-analysis performed on type 2 diabetes, genes related to circadian rhythm and transcriptome data associated with breast, bladder, liver, pancreas, colon and rectum cancer using the integration of gene expression profiles with biomolecular in genome scale networks in diabetes samples, the databases searched were Pubmed and TCGA. The descriptors circadian rhythm, type 2 diabetes and cancer in English were used with Boolean operators and or or. Results: several common genes deregulate in diabetes mellitus and cancer. KLF10, NTKR3, IGF1, USP2, EZH2 were both down-regulated in samples of type 2 diabetes and cancer, while ARNTL2 AND AGRP were up-regulated. It appears that changes in mRNA are contributing to phenotypic changes in type 2 diabetes, resulting in phenotypic changes associated with malignant transformation. Taking these genes to perform a survival analysis, we found only the IGF1, USP2 and ARNTL2 genes associated with patient results. While negative regulation of IGF1 and USP2 had a negative impact, positive regulation of ARNTL2 was associated with poor survival in BLCA and BRCA cancer samples. Conclusion: our data stimulate efforts in new studies to achieve experimental and clinical validation on these biomolecule

home and that for the reduction of deaths

early fetal and neonatal diseases, the indicators of perinatal mortality are stable,

despite the significant reduction in infant mortality observed
since the early 2000s. The occurrence of fetal deaths and
early neonatal deaths are closely related to the
quality of prenatal, intrapartum and postpartum care offered
pregnant women, so that the investigation of the factors associated with
these deaths will underpin public policy adaptations
able to reduce the occurrence of perinatal outcomes
Unwanted. we intend to identify sociodemographic factors,
maternal and care-related mothers associated with perinatal mortality in

a population of pregnant women, puerperated women and neonates admitted to
a maternity school in northeastern Brazil, between June
2015 to May 2016 and generate data that collaborates with the
planning of maternal and child care. a study was carried out
prospective cohort approach. The subjects were pregnant
admitted to the Santa Monica Maternity School, located in the
municipality of Maceió, State of Alagoas (Northeastern Brazil),
between June 2015 and May 2016. Having as factors of
exposure to sociodemographic, obstetric,
care delays and maternal near miss, the data were
collected through interviews and medical records. Measures of
frequency were generated through the Epi Info 3.5.1.A
bivariate analysis was performed at Open Epi to calculate the
risk association considering the significance level of
5%. Subsequently, the variables with p&lt;0.02 were included in the
multivariate analysis, through multiple logistic regression
stepwise, from a Hierarchical Theoretical Model having as
variable dependent on perinatal mortality. They joined
perinatal mortality to be held in perinatal mortality.
prenatal care in a number of less than six, the non-
the presence of congenital malformations, the presence of
management criteria for maternal near miss and the first delay
Care. In our study, we can infer that the factors
determinants of perinatal mortality were associated with the quality of
in maternal health care offered, from the care

to the intra-hospital level required a restructuring of the
and qualification of maternal and child care in a system that is more
regionalized and paid-up.

Obesity is one of the most prevalent metabolic disorders of the 21st century. Its growing epidemic generates important consequences in public and individual health such as: diabetes, cardiovascular complications, cancer, asthma, sleep disorders, liver dysfunction, renal dysfunction and infertility (MANNA and JAIN, 2015).

Its etiology is complex and multifactorial, resulting from the interaction of genetic, environmental, emotional and lifestyle factors. Decreased physical activity and increased consumption of high caloric density foods are determining factors (abeso guideline, 2016). In humans, several other reward and emotional factors play a role in food intake, in addition to hunger (guideline of the endo Society 2014).

The disease not associated with genetic syndromes has polygenic inheritance, and the environment plays a fundamental role in genetically susceptible individuals (abeso guideline, 2016). Lifelong dietary patterns play a strong role in the development of chronic diseases, including diabetes and hypertension, the main risk factors for end-stage kidney disease (STD) (CAMARA et. al, 2017)

By 2025, an estimated 2.3 billion adults around the world are overweight, of which 700 million are diagnosed with obesity (WHO website). In Brazil, there was an increase of 67.8% in the years 2006 to 2018, representing a prevalence of 19.8% in the latter. Currently in the country, 20.7% of women and 18.7% of men are obese (ABESO website).

To define it, the WHO uses body mass index (BMI), body weight measurement adjusted for height, weight (kg)/height(m2). Calculation of simple interpretation and better correlation with other estimates of adiposity, besides eliminating the need for height/weight tables for specific genera. It is based on the observation that body weight is proportional to square dwell in adults with preserved anatomical composition (BRAY et al., 2018)

Studies with human and animal models show an association between obesity and end-stage renal disease, even after adjustments for systemic arterial hypertension and diabetes mellitus (MUNUSAMY et al., 2015). Around 50% of patients with type 2 diabetes mellitus will develop CKD, with obesity accounting for a 23% increase in risk. In addition, it is a risk factor for nephrolithiasis and renal neoplasia, influencing prognosis and associating with worse outcomes (TAHERGORABI, Z. et al., 2016).

The kidney and adipose tissue of the obese individual secrete pro-inflammatory cytokines, such as angiotensin II and leptin, among other adipocytokines with effects on doucytes, mesangial and tubular cells, which also express insulin and leptin receptors, crucial for maintaining cellular permoseletivity. The larger the adipose tissue, the greater the circulation of these substances and the inflammatory syndrome concomitant with obesity is related, among other alterations, to the appearance of glomerulosclerosis and tubulointerstitial atrophy. (COWARD and FORNONI, 2015).

In addition, excess weight is commonly accompanied by other components of metabolic syndrome and insulin resistance, which synergistically can induce the onset of kidney injury or exacerbate pre-existing pathologies. Most of these are possibly compensatory responses to the systemic increase in energy demand (TSUBOI et al., 2017). Its association with the rate of progression of chronic kidney disease (CKD) is related to many factors such as hyperfiltration, glomerular hypertension and hyperactivation of the anintho-angiotensin-aldosterone system (AAR) (BOUQUEGNEAU, 2015).

The condition called obesity-related glomerulopathy is characterized by glomerulomegaly, progressive glomerulosclerosis, and declining renal function. The rate of progression to end-stage renal disease (ESD) is slow and once renal damage is established, the disease progresses with the development of proteinuria. The marked difference in the prevalence of obesity compared to the prevalence of kidney disease demonstrates that obesity alone is not a sufficient risk factor for kidney disease. There are other factors that increase individual susceptibility to the disease. (TSUBOI et al., 2017).

Unsustained weight loss during treatment and recurrence of the disease is often observed, leading to the progression of target organ damage in many of these patients. Research efforts have focused not only on the factors that regulate energy balance, but also on the mechanisms of target organ injury; these are given from physical compression of the organ by excess weight to various pathological pathways (CHAD and HALL, 2016).

According to population estimates, there are currently 850 million people with kidney disease worldwide, resulting from various etiologies. Its chronic form causes at least 2.4 million deaths annually; in Brazil, around ten million people have the disease. 

Systemic lupus erythesus (SLE) is one of the most prevalent autoimmune rheumatologic diseases in the population, especially affecting young adults of economically active age.

The disease is characterized by the presence of multiple autoantibodies, compromising different organs and systems (FREIRE; SOUTO; CICONELLI, 2011). Individuals of all ethnic groups may be affected, being more common in black individuals. The disease predominantly affects women, with a rate ranging from 4 to 13 women for each man (PETRI, 2002).

The manifestations of the disease are heterogeneous, ranging from laboratory abnormalities detectable to inflammation and multiple organ failure (ARRIENS et al., 2017).

General constitutional symptoms such as asthena, fever and weight loss are common in SLE (HOCHBERGt al., 2016). Edermatological lesions are very frequent and polymorphous, involving skin, vessels and mucous membranes. Cutaneous vasculitis occurs in about 20-30% of patients and can cause nail damage, ulcerations, and gangrene of digital extremities. Joint involvement is common, preferably compromising metacarphalangeal, proximal interphalangeal, knees and wrists, usually symmetrically. Cardiovascular involvement is characterized mainly by a pancarditis.

There is evidence of clinical renal impairment in 50% of patients. In renal involvement by SLE can occur in several compartments including tubules, interstice, vessels and glomeruli, the latter being the most related to the symptomology in general presented by patients (MARKOWITZ; D'AGATI, 2009). Glomerular disease in SLE may present varying classes of severity with risk of death in some cases. Renal biopsy is the standard procedure used to assess the degree of activity and chronicity related to glomerulopathy. However, in some cases for technical and/or clinical reasons (e.g. increased risk of bleeding) this is not performed using in these cases of treatment based on clinical and laboratory markers already well established for evaluation of renal function such as serum creatinine and creatinine clearance in addition to the 24-hour urine protein dosage to conduct therapy (HOCHBERG et al., 2016; KLUMB et al., 2015). Thus, the evaluation of inflammatory biomarkers that may be related to the degrees of disease activity may be of great importance in the diagnostic and therapeutic arsenal aimed at the patient.

The Coronavirus 19 pandemic (SARS-CoV-2) has brought great advances in research in medical areas worldwide, with a growing search for more appropriate diagnostic methods, effective treatments and preventive methods, such as vaccination, for example. The precise diagnosis of COVID-19 infection is made by laboratory examination known as RCT-PCR, which analyzes the presence of the virus in the nasal and oral cavities. Computed tomography of the chest has been assisting in the early diagnosis of pulmonary alterations resulting from COVID-19 and collaborates with the multidisciplinary team in the evaluation of the severity of the patient, favoring a more adequate conduction for each situation. Main objective is to correlate the main clinical, laboratory and imaging alterations in Computed Tomography in patients confirmed by SARS-COV-2 infection. One of the private hospitals in the state of Alagoas has a registry of 3456 patients confirmed for infection with COVID-19 through RT-PCR between March and December 2020, of these only 1568 have ct scans in the imaging database. Of these 1568, 430 patients were randomly selected and respecting the monthly proportionality of cases, but 40 were excluded by age (06), incomplete laboratory data (32) and for having imaging exams (tomography) unavailable (02), totaling a sample of 390 patients. Of the 390 patients analyzed, 194 were male and 196 female and the mean age of the sample studied was 49.8 years (between 18 and 95 years). The symptoms presented at the time of medical consultation were dry cough (66.9%), fever (58.9%), dyspnea (45.6%), headache (45.1%), myalgia (36.4%), odinofagia (34.8%), asthenaism (31 anosmia (28.9%), ageusia (27.1%), runny nose (23.5%), diarrhea (21.0%), chest pain (13.5%), dizziness (5.1%), abdominal pain (3.8%), productive cough (2.0%), conjunctivitis (1.5%) and rash (1.0%). In conclusion, SARSCOV-2 infection has been increasingly studied for a better understanding of its behavior in the body, in order to promote better care to the population with reduced mortality.

INTRODUCTION: One of the points considered most important for the success of a treatment is adherence to the prescribed therapy. The World Health Organization (WHO) points out that patients with chronic diseases are potential candidates for inadequate follow-up of the proposed drug therapy, which hampers the achievement of the desired results, putting in doubt, for example, its efficacy. In the group of chronic diseases is Systemic Lupus Erythematosus (SLE), which also corresponds to an inflammatory, multisystemic, immune-mediated disease. Low adherence to SLE can lead to disease activity, causing organic damage, increasing the number and length of hospital stays, reducing the quality of life of this patient, culminating in a high risk of morbidity and mortality, work and school absenteeism, generating a great impact psychosocial and economic aspects of patients and their social environment. OBJECTIVES: To verify the prevalence of Adherence to Drug Therapy (TMJ) among patients with Systemic Lupus Erythematosus (SLE) and the factors associated with it. MATERIAL/METHOD: exploratory, descriptive, cross-sectional study, carried out at the SLE Clinic of the Rheumatology Service of Hospital Universitário de Alagoas, Brazil. The sampling method used was non-probabilistic for convenience and the sample consisted of 116 patients in outpatient care. Data collection took place through the application of the Sociodemographic Questionnaire, the Brazilian Economic Classification Criterion of ABEP, MAT (Treatment Adherence Measure), SF-12, SLICC, SLEDAI and analysis of medical records. Descriptive and inferential statistical analysis was performed. RESULTS: Demographic and social data showed that 64.7% of the sample declared themselves brown, with a mean age of 36.5 (± 11.30), with the majority being female (95.7%). Regarding the sample's schooling, 50.9% had completed high school; the income of 46.6% of the sample being approximately up to a minimum wage. Regarding the treatment regimen, 58.6% of the sample had polymedication. The prevalence of adherence was 55.2%. The statistical tests used in this study showed an association between the variable adherence and time since diagnosis (p <0.033), headache (p <0.014), physical exercise (p <0.005) and difficulty following the treatment (taking medication and / or performing exams and / or going to consultations) (p <0.000). CONCLUSION: The study data indicated that adherence to drug therapy in SLE is a complex and multifactorial phenomenon. The identification and analysis of the factors that can lead to non-adherence to drug therapy, can allow the development of health actions aimed at reducing barriers in treatment, as well as care costs and, mainly, promoting better perspective and quality of life for the patient.

Introduction Patients with Acute Renal Injury (AKI) have a higher risk of death and development of chronic kidney disease (CKD). It is essential to evaluate the glomerular filtration rate (GFR) in patients who had AKI, especially in the elderly population. There are still few studies that have evaluated GFR according to the severity of AKI. Objective: To analyze the effect of AKI in reducing the glomerular filtration rate in the elderly after 1 year in a tertiary hospital. Methodology: This study is a retrospective cohort conducted in a tertiary hospital. We collected data from patients with acute kidney injury aged 65 years or over who were evaluated by the nephrology service from January 1, 2012 to December 31, 2018. Only those who had at least one serum creatinine dosage after one year of aki development were included. GFR was calculated by ckd-epi formula in ml/min/1.73m2. Patients diagnosed with stage 5 chronic kidney disease (gFR estimated less than 15 ml/min/1.73m2), renal transplant recipients and those who died during hospitalization were excluded. All data were collected through the review of electronic medical records. We analyzed the mean GFR in time zero (T0) and 360 days (T1). Results: A total of 125 patients were included. We observed that the mean GFR of patients between 65 and 80 years in T0 was 60.5 ± 22.11 and in T1 of 46.6 ± 24.5 (reduction of 13.92, p<0.0001) and in patients >80 years in T0 it was 55.6 ± 22.1 and in T1 37.2 ± 20.5 (reduction of 18.3, p<0.00001). Patients with AKIN 1 had a mean reduction in GFR of 10.7 (p=0.002), AKIN 2 of 15.6 (p<0.001) and AKIN 3 of 22.3 (p< 0.00001) between T0 and T1. Patients who had GFR>60 ml/min/1.73m2 had a mean reduction in GFR of 25.02 (p<0.00001) and those with GFR< 60 ml/min/1.73m2 of 7.8 (p=0.0008). patients in >80 years and those who achieved AKIN 3. In our analysis, the reduction of GFR was more pronounced in those patients with GFR >60 ml/min/1.73m2.

Worldwide, there has been an increase in the prevalence of overweight and obesity. According to 2019 IBGE data, 1.6% of the adult population had weight loss, 60.3% were overweight, with a prevalence of obesity in 25.9%. Several studies evaluate the effects of maternal nutritional status on gestational complications and unfavorable outcomes for maternal and newborns, but few studies address this assessment in the context of high-risk pregnancies. In addition to the clinical status, the quality of life of the pregnant woman could be impacted during the gestational period, since it is a time of many changes. Objective: to evaluate the nutritional status of high-risk pregnant women attended at the Professor Alberto Antunes University Hospital and its relationship with the occurrence of gestational complications, outcomes for the newborn and quality of life of pregnant women. Results: the prevalence of underweight in the sample studied was 5.66%, overweight was 73.58%, 33.96% overweight and 39.62% obese. The percentage of pregnant women with insufficient weight gain was 20.75% and excessive gain was 49.06%. There was a higher prevalence of complications related to hypertensive syndrome in obese patients and higher occurrence of infectious complications and prematurity in those with low weight. The weight of the NB at birth showed a difference between the groups, with a mean lower weight in the groups of low weight and eutrophy, while the mean higher weight occurred in the obese group. There were no differences in quality of life scores in relation to nutritional status. Conclusion: The high prevalence of obesity in high-risk pregnant women and the association between maternal nutritional status and the occurrence of conditions that interfere with maternal and newborn perinatal outcomes highlights the importance of measures aimed at improving the nutritional status of women prior to pregnancy and during prenatal follow-up.