Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

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Human ␣3 chain, a noncollagenous domain of type IV collagen [␣3(IV)NC1], inhibits angiogenesis and tumor growth. These biologic functions are partly attributed to the binding of ␣3(IV)NC1 to ␣V␤3 and ␣3␤1 integrins. ␣3(IV)NC1 binds ␣V␤3 integrin, leading to translation inhibition by inhibiting focal adhesion kinase/phosphatidylinositol 3-kinase/Akt/ mTOR/4E-BP1 pathways. In the present study, we evaluated the role of ␣3␤1 and ␣V␤3 integrins in tube formation and regulation of cyclooxygenase-2 (COX-2) on ␣3(IV)NC1 stimulation. We found that although both integrins were required for the inhibition of tube formation by ␣3(IV)NC1 in endothelial cells, only ␣3␤1 integrin was sufficient to regulate COX-2 in hypoxic endothelial cells. We show that binding of ␣3(IV)NC1 to ␣3␤1 integrin leads to inhibition of COX-2-mediated pro-angiogenic factors, vascular endothelial growth factor, and basic fibroblast growth factor by regulating IB␣/NFB axis, and is independent of ␣V␤3 integrin. Furthermore, ␤3 integrin-null endothelial cells, when treated with ␣3(IV)NC1, inhibited hypoxia-mediated COX-2 expression, whereas COX-2 inhibition was not observed in ␣3 integrin-null endothelial cells, indicating that regulation of COX-2 by ␣3(IV)NC1 is mediated by integrin ␣3␤1. Our in vitro and in vivo findings demonstrate that ␣3␤1 integrin is critical for ␣3(IV)NC1-mediated inhibition of COX-2-dependent angiogenic signaling and inhibition of tumor progression.

Effective reepithelialization after injury is essential for correct wound healing. The upregulation of keratinocyte α3β1 integrin during reepithelialization suggests that this adhesion molecule is involved in wound healing; however, its precise role in this process is unknown. We have shown here that retarded reepithelialization in Itga3 -/-mouse skin wounds is due predominantly to repressed TGF-β1-mediated responses. Specifically, expression of the inhibitor of TGF-β1-signaling Smad7 was elevated in Itga3 -/-keratinocytes. Indeed, in vivo blockade of Smad7 increased the rate of reepithelialization in Itga3 -/-and WT wounds to similar levels. Our data therefore indicate that the function of α3β1 integrin as a mediator of keratinocyte migration is not essential for reepithelialization but suggest instead that α3β1 integrin has a major new in vivo role as an inhibitor of Smad7 during wound healing. Moreover, our study may identify a previously undocumented function for Smad7 as a regulator of reepithelialization in vivo and implicates Smad7 as a potential novel target for the treatment of cutaneous wounds.

Health literacy, a more complex concept than knowledge, is a required capacity to obtain, understand, integrate and act on health information [1], in order to enhance individual and community health, which is defined by different levels, according to the autonomy and personal capacitation in decision making [2]. Medium levels of Health literacy in an adolescent population were found in a study conducted in 2013/2014, being higher in sexual and reproductive health and lower in substance use. It was also noticed that the higher levels of health literacy were in the area adolescents refer to have receipt more health information. The health literacy competence with higher scores was communication skills, and the lower scores were in the capacity to analyze factors that influence health. Higher levels were also found in younger teenagers, but in a higher school level, confirming the importance of health education in these age and development stage. Adolescents seek more information in health professionals and parents, being friends more valued as a source information in older adolescents, which enhance the importance of peer education mainly in older adolescents [3]. As a set of competences based on knowledge, health literacy should be developed through education interventions, encompassing the cultural and social context of individuals, since the society, culture and education system where the individual is inserted can define the way the development and enforcement of the health literacy competences [4]. The valued sources of information should be taken into account, as well as needs of information in some topics referred by adolescents in an efficient health education. Schizophrenia is a serious and chronic mental illness which has a profound effect on the health and well-being related with the well-known nature of psychotic symptoms. The exercise has the potential to improve the life of people with schizophrenia improving physical health and alleviating psychiatric symptoms. However, most people with schizophrenia remains sedentary and lack of access to exercise programs are barriers to achieve health benefits. The aim of this study is to evaluate the effect of exercise on I) the type of intervention in mental health, II) in salivary levels of alpha-amylase and cortisol and serum levels of S100B and BDNF, and on III) the quality of life and selfperception of the physical domain of people with schizophrenia. The sample consisted of 31 females in long-term institutions in the Casa de Saúde Rainha Santa Isabel, with age between 25 and 63, and with diagnosis of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Physical fitness was assessed by the six-minute walk distance test (6MWD). Biological variables were determined by ELISA (Enzyme-Linked Immunosorbent Assay). Psychological variables were assessed using SF-36, PSPP-SCV, RSES and SWLS tests. Walking exercise has a positive impact on physical fitness (6MWD -p = 0.001) and physical components of the psychological test...

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Background: The number of elderly patients being admitted with aneurysmal subarachnoid haemorrhage (SAH) has been increasing. Treatment of the aneurysm may be offset by the higher rate of surgical or endovascular complications. Aim: To study the clinical condition at onset, complications during clinical course, treatment and outcome in a consecutive series of elderly patients. Methods: Patients who were >75 years at the onset of SAH were selected from the databases of two hospitals. Data on clinical condition at onset (poor condition defined as World Federation of Neurological Surgeons (WFNS) Scale IV and V), clinical course, treatment and outcome were extracted. Univariate and multivariate regression analyses were carried out to identify predictors for in-hospital death and poor outcome, defined as death or dependency. Results: The data of 170 patients were retrieved, of whom 25 (15%) patients were independent at discharge; none of these patients had been admitted in a poor condition. Poor clinical condition on admission (odds ratio (OR) 7.9; 95% confidence interval (CI) 3.7 to 17) and recurrent haemorrhage (OR 7.5; 95% CI 2.5 to 23) were the strongest predictors for in-hospital death. Recurrent haemorrhage was the strongest predictor for poor outcome in the subset of patients who were admitted in good clinical condition. In all, 10 of 47 (21%) patients were independent at discharge after neurosurgical clipping (n = 34) or endovascular coiling (n = 13). Conclusion: Elderly patients with SAH have a poor prognosis. The effect of the initial haemorrhage is the most common reason for poor outcome. For patients who are admitted in good clinical condition, the most important complication leading to poor outcome is recurrent haemorrhage. Treatment of the aneurysm in patients >75 years is feasible, may improve the outcome and should be strongly considered in patients who are admitted in a good condition.

Resumen. La historia del archipiélago de Azores, desde el descubrimiento y colonización en la primera mitad del siglo XV hasta ahora, está marcada por los impactos sociales y económicos producidos por los terremotos, principalmente los de alta intensidad. La información compilada nos lleva a concluir que en este periodo 33 terremotos han afectado las islas de Azores con una intensidad igual o superior a VII, causando unas 6.300 muertes y la destrucción generalizada en algunas Islas del Archipiélago, principalmente en S. Miguel, Terceira, Graciosa, Faial, S. Jorge y Pico. La acomodación de los movimientos diferenciales que se producen debido al límite entre las placas eurasiática (EA), africana (AF) y norteamericana (NA) y también al volcanismo que ocurre en la región, son los principales responsables de la intensa actividad sísmica que ocurre en este archipiélago. Este trabajo revisa los temas científicos de los terremotos conocidos que han interferido severamente con la vida del pueblo azoreano a lo largo de su historia, a esos terremotos llamamos grandes terremotos. Palabras clave: Terremotos de Azores; Sismotectónica de Azores; Mecanismo focal de los terremotos de Azores.[en] Large earthquakes in the Azores Abstract. The history of the Azores archipelago, from its discovery and settlement in the first half of the 15th century through the present, is marked by the social and economic impacts produced by earthquakes, mainly the high-intensity ones. Information that has been compiled leads to the conclusion that in this period, 33 earthquakes with intensity equal to or greater than VII have affected the Azores, which caused approximately 6,300 deaths and widespread destruction on some islands of the archipelago, principally S. Miguel, Terceira, Graciosa, Faial, S. Jorge and Pico Islands. The accommodation of strain resulting from the dynamics of the Azores triple junction (ATJ) plate boundary and volcanism, which also occurs in the region, are the main factors responsible for the intense seismic activity in this archipelago. This work reviews the scientific issues of the known earthquakes that have severely interfered with the lives of the Azorean people throughout their history, which we call large earthquakes. Key words: Azores earthquakes; historical earthquakes; seismotectonics of Azores; focal mechanisms.