We excluded patients aged less than 18 years; those that had acquired hearing aid for less than 6 weeks, and patients with severe comprehension and expression limitation. The results showed that patients were considerably satisfied with the use of aids. There was lower satisfaction level with the negative factor subscale of SADL (Satisfaction with Amplification in Daily Life), especially in relation to telephone using. The factors that were associated with satisfaction were linked to the person and, mainly, to auditory rehabilitation. The data showed that, beyond the selection of the most technically appropriate hearing aid, it is highly important to follow auditory rehabilitation programs including home trials, guidance and counseling so that patients can have realistic expectations.The objective of the present study was to investigate satisfaction levels with hearing aids in daily life of Army Health System users, in addition to associated factors. Adults and seniors from 3 Satisfaction is the measurement of auditory rehabilitation outcome that represents the most comprehensive combination of factors required to define final outcomes, given that the variable of interest represents the point of view of the patient and it is not related only with performance of hearing aid , depending exclusively on people's perceptions and attitudes .Since it involves judgments that reflect personal and subjective circumstances about expectations, needs and desires they do not allow objective measurements . This type of measurement of result is used to conduct surveys about effectiveness of treatment, serves as a basis for development of clinical practice guidelines and directs planning to compare, improve and standardize health care .Despite technological advance of modern acoustic amplification systems, satisfaction of users is still a challenge to most audiologists and high rates of use cessation is still a problem for health services. In the United States, the rate of dissatisfied users of hearing aids has already reached 47%, out of which approximately 18% end up giving up auditory rehabilitation . In Brazil, these data are still unknown.Hearing loss is one of the most devastating sensorial deficits because it impairs communication and leads to emotional, social and occupational sequelae. Hearing deterioration is normally a factor that announces the beginning of aging .About 90% of the people aged over 80 years present hearing loss. As an expected consequence of the aging population, the number of candidates to wear a hearing aid will increase in upcoming years .In the services provided by the Military Medical Services of Porto Alegre, the Health Care Fund of the Army has high annual expenditure with acquisition of hearing aids to be prescribed its users. The cost of providing hearing aids to users, the importance of the success of aural rehabilitation in the life of subjects who have hearing loss and complexity of adapting acoustic amplification were motivations for the investigation of the result of aural rehabilitation.Monitoring satisfaction levels is something important to assess clinical procedures, ensure the purposes of quality of services because satisfaction reflects the reality of health care results. Upon identifying the factors that contribute to satisfaction and upon trying to confirm these attributes in the involved processes, we reach the potential to have more effective results in healthcare services .The purpose of the present study was to investigate the level of satisfaction with hearing aids in the daily life of users of Military Medical Services of Porto Alegre and to check associated factors.We conducted a transversal study with 201 users of hearing aids acquired by the Health Care Fund of the Army (FUSEX), between years 1998 and 2003. The patients that acquired the hearing aids at that time but did not effectively use them , did not join the study because the variable of interest that is part of the satisfaction rate depends on the point of view of the patient about systematic use of amplification  . We exclThe satisfaction rate with use of hearing aids in daily life was conducted using the questionnaire Satisfaction With Amplification in Daily Life – SADL, developed by Cox and Alexander (1999), with a sample of 257 subjects, mean age of 72 years, originated from an American medical center of the veterans, a community center for speech and hearing and a private clinic of hearing. SADL was validated by the authors in 2001. The instrument was prepared to assess satisfaction of people with the use of hearing aids, quantifying it by a four subscale score: Positive Effects , Services and Costs , Negative Factors , and Personal Image  . The mean score of subscales, which are domains of satisfaction, results in the Overall Satisfaction score. The questions were answered with a 7-point scale of equal interval, corresponding to a categorical scale, from not at all to highly satisfied. For 11 questions, highly satisfied indicated complete satisfaction and was scored 7, whereas not at all indicated complete dissatisfaction and was scored 1. For the other 4 questions, the score was inverted, meaning that highly meant highly dissatisfied and not at all meant completely satisfied and scored 7.To check whether possible factors were associated with satisfaction with use of hearing aids we also applied a questionnaire about the fitting process including the following subscales: Guidance Test, Hearing Center, Handling, Benefits, Limitations and Strategies of Communication. In addition, demographical and audiometric data were presented. The use of SADL in this population was anticipated with two independent translations to Portuguese, pre-tested with users of hearing aids from FUSEX, reviewed by the researcher concerning appropriateness of translation to the population, tested again with the modifications  in users of hearing aids from FUSEX and hearing centers, submitted to opinion by specialists in the area, then sent for back-translation made by English native speaker, and tested with the final version in users of hearing aids of the center.Patients were contacted by telephone and invited to come to the medical center. The questionnaire was self-applied to ensure the private nature that enhances validity of responses. Clarifications and guidance about the study and the questionnaire were provided by military layperson trained to do it. The total time required to answer the questionnaire was about 40 minutes. The main difficulty of very old patients was visual limitation to read the questions, and in some cases they used a magnifying glass or projection of questions on a large screen.We conducted logistic regression and included the variables that presented statistically significance of at least 0.05 in bivariate analysis.As to ethics, we used the informed consent term, signed in two copies based on the Regulating Guidelines and Rules for Healthcare Studies (Resolution nº 196/96). Project nº 2003125 was approved by the Ethics Research Committee, Federal University of Rio Grande do Sul (UFRGS). The authorization of the Military Healthcare Unit to conduct the study was published in the Internal Newsletter nº 074, dated May 9, 2003, of Military Medical Unit of Porto Alegre.The studied population was evenly distributed between female (49.3%) and male (51.7%) gender and educational level: 30.3% had completed elementary school, 32.3% had completed high school, and 37.3% had completed college education. There was predominance of race: 95% of the patients were Caucasians. As to military status, 73.1% of the main holders were officers and 51.2% of them were the actual patients. Mean age was 72 years. Most patients (60.2%) had family income below or equal to 6 minimum wages .Table 1BUpon checking validity of the translated questionnaire, we compared the overall satisfaction score of a categorical scale of simple items . We found strong correspondence of values, with mean of 5.05 for score of overall satisfaction of SADL and 5.16 for score of categorical scale of simple items. The values of percentiles were also quite close .Table 2CRegarding validity of questionnaire, upon comparing satisfaction with hearing aids in daily life between North-American standard  and the present study, we detected similar results, with slightly better response among Brazilian subjects. Percentiles 20 and 80 were equivalent with small difference in subscale of negative factors. In both studies of subscale, what showed less satisfaction were the negative factors. A qualitative analysis in both populations showed SADL overall score in which subjects were considerably satisfied .Figure 2In the present study, mean scores of SADL and the respective correspondence of categorical scale were: overall score 5.05 (min. 2.5 and max. 7.0) –considerably satisfied; positive effects 4.99 (min. 1.2 and max. 7.0) –considerably satisfied; services and costs 4.94 (min. 2.0 and max. 7.0) –considerably satisfied; negative factors 4.5 (min. 1.0 and max. 7.0) –a little satisfied to considerably satisfied; and personal image 5.78 (min. 2.3 and max. 7.0) –very satisfied . NegativUpon analyzing factors associated with satisfaction with the use of hearing aids, it was defined high satisfaction as high score, referring to superior quartile, with cut-off point at 5.7 in the overall satisfaction scale SADL.People-related factors that presented association with satisfaction in use of hearing aids were: absence of auditory disorders, absence of purely bilateral sensorineural components, and perception of good health.Among the 25% patients with highest satisfaction score, there were 2.71 (CI 95%: 1.27 – 5.78) more chances of them being satisfied when they reported absence of hearing disorders (tinnitus and intolerance to loud sounds), 2.95 (CI 95%: 1.39 – 6.25) more chances of being satisfied when they did not have purely bilateral sensorineural loss; and 2.75 (CI 95%: 1.30 – 5.82) more chances of being satisfied when they reported perception of good health .Table 3PFactors related to the process of auditory rehabilitation that presented association with satisfaction in the use of hearing aid were: having participated in the Auditory Rehabilitation Program and having received instructions on use and handling of hearing aids.Among the 25% of patients with highest satisfaction rates, there were 2.88 (CI 95%: 1.37 – 6.04) more chances of them being satisfied when they had participated in the rehabilitation program, and 3.78 (CI 95%: 1.74 – 8.26) more chances of being satisfied when they had been instructed about the use and handling of hearing aids, regardless of having participated at the program .Table 4PResults of overall score and subscales were equivalent to those of the original study , reaching the same configuration in percentiles and in scales of higher or lower satisfaction levels.The mean of SADL overall score showed that patients were considerably satisfied, but there was less satisfaction in relation to negative factors of hearing aids performance, especially telephone use, similarly to the population studied by Cox and Alexander (1999). The low score in negative factor subscale because of poor telephone use performance has already been reported in the literature as one of the main explanations for low satisfaction rates . Northern (2000) has also reported in his studies that even though patients were satisfied, they had reported low improvement rate in telephone use. Telephone use is an auditory situation in which technological limitations of hearing aids are clearly evidenced. For this reason, guidance on use and handling of hearing aids should be reinforced by training telephone use and counseling should emphasize that difficulties are inevitable, so that the patients do not raise their expectations and end up being disappointed.The other score that was highlighted was the personal image subscale, showing that normally patients did not associate use of hearing aids with image of disability. It is probably a response to the influence of human rights in the society. For the past decades, non-governmental associations and agencies have communicated the principles of equality and non-discrimination all over the world, and many have already included that in their Constitution. Thus, disabilities, among which hearing impairment, are more naturally seen and specific rights are assured to holders, trying to guarantee social insertion and reduction of prejudice. Hearing impaired subjects, as part of this society, have also changed their vision on their own hearing loss, which facilitates the acceptance of limitations without having the perception that they prevent normal functional life.As to people-related factors, patients with fewer complaints of hearing loss (intolerance to loud noise and tinnitus) who did not have bilateral sensorineural loss had better results with hearing aids. Henderson et al. (1998) stated that even when wearing a hearing aid, patients with sensorineural loss and correlated symptoms (tinnitus and auditory recruitment) still have difficulty to understand acoustic information, especially speech sounds in noisy or reverberating environments. Non-ideal performance with hearing aids in these cases reflects in auditory processing disorders. Garstecki and Erler (1998) noticed that patients with sound intolerance would have deficit in their skills to benefit from the use of hearing aids. This finding is in accordance with the pathophysiological characteristics of hearing loss, since as previously demonstrated, if patients have sensorineural hearing loss, intolerance to loud sounds and tinnitus they are less benefited by acoustic amplification, and so it is expected that they would be less satisfied with the results obtained with hearing aids. It reinforces the importance of taking into account type of hearing loss and the presence of auditory damage in prescribing the characteristics of the hearing aids and guidance.Another factor associated with high satisfaction level whose temporality was not reached in this study was the perception patients have of good general health status. To Crow et al. (2002), health status is a determining factor in satisfaction of patients seen by healthcare centers. Garstecki and Erler (1998) noticed better results in hearing aids use in patients that presented better health status. People in better general health status tend to be more active and consequently better prepared to face new situations, such as hearing aids fitting, that is, more prone to be satisfied. Conversely, satisfaction would reduce difficulty in communication and higher opportunities for socialization, reducing stress and allowing better general functional status. As we do not know which variable has more influence, we should at least be more attentive to general and psychosocial health aspects of patients when planning and conducting the auditory rehabilitation process.As to factors related to process of auditory rehabilitation, this study showed that patients presented higher levels of satisfaction when they had participated in the Auditory Rehabilitation Program. In summary, the program developed by our center starts with assessment of global profile of the candidate to hearing aid fitting for planning the right focus on rehabilitation. The results of the audiological tests are explained to the patient and next we suggest that the patient should participate in one or more sessions on the topics: hearing loss and its implications, possibilities and limitations of the results of hearing aids use, and information about hearing aids. The patient that decides to continue in the process will take tests with different brands of hearing aids from vendors, followed by home trial period with the chosen model. Home trial, which is the result of the partnership between our center and hearing aids companies, provides free trial period of intra-aural hearing aids when this type of amplification system is prescribed. During the home trial period, the patient participates in counseling sessions, guidance and training on use and handling of hearing aids and communication strategies. If the patient acquired the hearing aids and does not require immediate follow up, he/she will be followed up within 3 months. If the hearing aid fitting is confirmed, we ask the patient to come back after one year or whenever needed.If not properly adapted, we investigate the difficulties and provide new strategies, maintaining follow-up sessions up to complete fitting. It is important that the patient feels our support and that there is good interaction with the audiologist. Russo and Almeida (1995) emphasized that only by implementing a global rehabilitation program that supports adult hearing impaired people and their family members to deal with disadvantages and inabilities resultant from the deficit, in which the hearing aids are perceived as an integral part of the problem, there will be effective support to prevent social isolation and to reengage the patients in the world of verbal communication.One of the main difficulties that hearing aid users have after acquisition is to turn occasional use into effective use. Therefore, professional intervention is longitudinal. No matter how well fitting has been made, following up the patients only at the acquisition moment is not enough. However, even though the literature in general advocates auditory rehabilitation programs, there are still no studies addressing their effectiveness. Moreover, data on rehabilitation programs should be carefully compared given that our program was developed by the researcher for her own use in daily clinical practice.Data from previous studies together with these data suggest that guidance has a key role in satisfying hearing aids users. In the studied patients, counseling was made at the rehabilitation program and in the services provided by the hearing aid centers. For this reason, guidance was analyzed not only as part of the program, but also independently, finding a positive correlation with satisfaction, especially if related with generating realistic expectations. Many authors considered it a determining factor in hearing aid satisfaction, having close relation with perceptions about product performance . Even though, too high expectations of patients may result in disappointment and dissatisfaction . Since expectations are a factor necessarily perceived before hearing aid fitting, one important resource to reach satisfaction is to provide guidance for patients to be aware of limitations of the process. Moreover, we should let them know that they need persistence and patience to overcome the barriers of auditory rehabilitation and that with realistic expectations they will be ready to face them and reach a successful and satisfying fitting experience. Education is one more tool to make patients aware of their new condition, empowering them to become active, confident and independent agents to use and handle the hearing aids. Stika and Ross (2002) found that inappropriate guidance is a cause of dissatisfaction, and Sweetow (1999) and Russo and Silveira (2001) considered that a well-structured guidance and counseling program is essential to reach satisfaction.Data showed that in addition to selecting the most technically appropriate hearing aid that has enough technology for each case, it is essential to reach high levels of satisfaction with hearing aids fitting with the implementation of an aural rehabilitation program. Findings suggest that such programs should count on home trial period and detailed instructions and guidance, aiming at transforming the patient into an active agent of the process, with knowledge and realistic expectations.It is especially important to consider that public health services that provide hearing aids should realize that high cost with technological sophistication is not the only solution to prevent waste of cessation of use: support and educational programs are efficient allies.The present study was conducted in a military center, whose environment is peculiar and the satisfaction profile has the specificities of the corporation. Thus, new research studies should be conducted to investigate the level of satisfaction of users of hearing aids in other populations to confirm these factors as key to satisfaction level of hearing aid users, as well as to clarify the effectiveness of auditory rehabilitation programs and the efficiency of different models.


Spodoptera frugiperda, the key invasive pest of maize, is a serious concern due to its biology and the current global restriction on applying synthetic pesticides. Entomopathogenic fungi are considered to be a potential biological control strategy. The pathogenicity of 12 isolates of Beauveria bassiana in the immature stages and feeding efficacy of S. frugiperda were evaluated. The B. bassiana isolates QB-3.45, QB-3.46 and QB-3.428 caused the highest egg mortality rates of 87.3, 82.7 and 79.3%, respectively, when applied at a concentration of 1 × 108 conidia/mL and measured at 7 days post-treatment. Neonate mortality rates of 45.6 to 53.6% were observed with the same isolates. The B. bassiana isolates caused significant cumulative mortality rates ranging from 71.3 to 93.3% at 14 days post-treatment and reduced larval feeding efficacy from 69.4 to 77.8% at 48 h post-treatment. This study supports using the effective B. bassiana isolates as a biological control agent against S. frugiperda. The significant mortality of the eggs and neonatal larvae and the reduction in the feeding efficacy of the second instar larvae of the S. frugiperda that were treated with isolates of B. bassiana supports the application of entomopathogenic fungi as a biocontrol agent for the effective control of the S. frugiperda population.The control of  Maize is one of the primary crops producing commercial cereal commodities worldwide, second to rice and wheat . In addiSpodoptera frugiperda, JE Smith, 1797, (Lepidoptera: Noctuid) is one of the most destructive, invasive pests with more than 350 host-plant species due to its polyphagous nature; however, it prefers to feed on maize. FAW is native to the Americas [Fall armyworm (FAW), Americas ,7. MaizeAmericas ,9, whichAmericas . FAW larAmericas ,12.FAW is considered an A1 quarantine invasive pest in Africa . In 2019The fall armyworm was first detected in Africa and it then expanded throughout the world to locations such as Nepal, Indonesia, and Swaziland ,20,21. FMost maize growers in Indonesia prefer using pesticides to control this invasive pest in order to avoid the yield losses of maize to FAW . The conMetarhizium anisopliae, Beauveria bassiana and Bacillus thuringiensis are the most effective biocontrol agents among the active biopesticide products that have been registered by the United States Environmental Protection Agency as of 2016 [B. bassiana, which can be effectively transmitted and produces a variety of toxin-causing infections in the host [B. bassiana was first isolated from silkworm cadavers by Agostino Bassi in the 19th century and it has since infected more than 200 species of insects belong to different orders [Biocontrol agents, such as entomopathogenic fungi, have prominent virulence factors and are rapidly emerging as prime substitutes for synthetic insecticides . Metarhi of 2016 . The mosthe host ,53. B. bt orders .Beauveria bassiana is competitive with synthetic insecticides against forest and farm insect pests in China [B. bassiana were screened in order to evaluate their pathogenicity against the S. frugiperda adult in Nairobi, Kenya [B. bassiana resulted in affecting the larval development of S. frugiperda in Eldoret, Kenya [S. frugiperda in Mexico [B. bassiana proved to be effective for the management of S. frugiperda in Thailand [B. bassiana isolates are considered to be a sound biocontrol agent for the management of FAW [in China . Six isoi, Kenya . Tomato t, Kenya . Entomopn Mexico ,59. The Thailand . B. basst of FAW ,62.Beauveria, from which several bio-insecticides have been derived and used in Indonesia [B. bassiana isolates were used in the present study, originating from different hosts and already tested for their virulence against Solenopsis invicta Buren, one of the most important pests in China [B. bassiana was indicated to be an entomopathogen in many insects’ orders; lepidopteran pests in particular have been effectively controlled by this fungus [Among the identified species of fungi, the most utilized are in the genus ndonesia . Entomopndonesia . Twelve in China . B. basss fungus . Three ds fungus . ConsequEntomopathogenic fungi (EPF) are environmentally friendly and could replace synthetic insecticides. However, one negative impact of the EPFs is that they kill or infect the insect much more slowly than a synthetic insecticide due to their different modes of action depending on which insect continuously feeds on the crop. The different life stages of any insect do not respond to any pathogenic stress in the same way. So, it is very normal to test EPF on various life stages in order to understand which life stage is most susceptible or to find the stage that is the most resistant to the said fungal isolate. This method is able to inform the users of the most appropriate stage of the insect to target for effective biological control programs. Our previous study has concluded that the eggs are the most susceptible stage for targeting as compared to the other life stages of FAW ,62. It hB. bassiana were proved to be pathogenic against S. invicta in 2018 [B. bassiana against the immature stages  and the feeding efficacy of FAW. Therefore, the present study aims to investigate the bioassay of isolates of B. bassiana for the management of FAW.These isolates of  in 2018  but afteThe FAW eggs were established using a collection of larvae that were found on maize crops from Guangdong province, China, during the maize growing season. The collected larvae were cultured on an artificial diet  and the B. bassiana was evaluated against the immature stages and the feeding efficacy of FAW. B. bassiana isolates that were obtained from the IZ-GDAS’s laboratory were cultured on potato dextrose agar (PDA) and maintained at 25 ± 2 °C in the dark. The tested isolates of B. bassiana were previously identified by Li et al. [B. bassiana. The information regarding the B. bassiana isolates is available in  were obtained from the adult cylindrical cages. A batch of 50 eggs was separated with a light microscope using a camel hairbrush. Then, 10 mL of the spore suspension at each concentration was sprayed on a set of 50 eggs using manual atomized spray bottles (20 mL). A sterilized paper towel was used at the bottom of the Petri plate for the absorption of the extra spore suspension. The control was treated with distilled water containing 0.05% Tween-80. The batch of treated eggs was air-dried for 1 h under a laminar hood. The eggs (hatched and non-hatched) were recorded at 7 days post-treatment.B. bassiana were fed fresh maize leaves in a rectangular plastic box (28 × 17 × 18 cm3) that was lined with moist filter paper, incubated at 25 ± 2 °C and monitored daily. The maize was grown under lab conditions in order to ensure that the maize leaves were fresh and insecticide-free.The FAW neonatal larvae that emerged from the eggs that were treated with the isolates of The mortality of the neonatal larvae that were treated with the isolates was further recorded daily for 7 days post-emergence. The bioassays were laid out according to a completely randomized design with three replications for each treatment. Mycosis was assessed for the dead cadavers by following the approach of Aktuse et al. . The dea3). A group of 30 second instar larvae of FAW was shifted into the box containing the maize leaves. Each group of 30 larvae represented one replicate and three replications were used for each treatment with a completely randomized design. Each group of second instar larvae in each plastic box was provided with fresh maize leaves that had been treated with 10 mL of 1 × 106, 107 or 108 conidia/mL using a spray tower. Each concentration was sprayed on every second instar larva to ensure that none escaped from the fungal spore suspension by hiding beneath the leaves’ surfaces. The control larvae were treated with distilled water (0.05% Tween-80). The treated larvae were incubated at 25 ± 2 °C and fresh maize leaves were provided daily. The larval mortality rate was recorded daily for 7 days. A mycosis test was conducted in order to confirm that the mortality of the larvae was due to a fungal infection, as described above.Fresh maize leaves were placed individually in a perforated rectangular plastic box  [3). The control was treated with distilled water containing 0.05% Tween-80. The maize leaves that were provided to the group of second instar larvae as an insect diet were weighed before and after being treated. The feeding efficacy percentage was measured by calculating the total weight of the fresh maize leaves, in grams, that were provided to the larvae divided by the total weight of the leaves that were not fed on by the larvae, multiplied by 100 [A group of 15 second instar stages of FAW was treated with 10 mL of 1 × 10 (20 mL) . Fresh md by 100 . The feeB. bassiana were screened for their ability to cause the mortality of the pupae of FAW. The pupae of the FAW were treated with 10 mL of 1 × 106, 1 × 107, or 1 × 108 conidia/mL using manual atomizer sprayer bottles (20 mL). The FAW pupae were placed in a perforated rectangular plastic box (28 × 17 × 18 cm3). Each group of 10 pupae represented one replicate and three replications were used for each treatment. The control was treated with a solution of distilled water containing 0.05% Tween-80. The pupal mortality rate was recorded for 15 days [The isolates of  15 days . A pupa ® version 8.1  were used to perform for the data analysis and to calculate the homogeneous letters, respectively.The mortality data for all of the stages were analyzed using Abbott’s formula  and the B. bassiana induced egg mortality rates of 30.0 and 28.7%, respectively, followed by the QB-3.46, LNSE-22 and QB-3.436 isolates, which caused 25.3, 24.0 and 20.7% FAW egg mortality when applied at a concentration of 1 × 106 conidia/mL and measured at 7 days post-treatment . . However, the QB-3.436 and LNSE-22 isolates caused egg mortality rates of 40.0 and 35.3% . However, the XJWLMQ-32 and SPLE-24 isolates of B. bassiana caused 39.3 and 30.7% egg mortality, respectively, 7 days post-treatment . . QB-3.45nd 35.3% . The QB-reatment .B. bassiana were the least significant and induced additional mortality rates of 14.9 and 13.4% when applied at a concentration of 1 × 106 conidia/mL  against the neonatal larvae of FAW and measured at 7 days post-treatment   (The results indicated that the effects of the QB-3.428 and QB-3.46 isolates of reatment . The QB-< 0.000) . The QB-< 0.000) . FurtherB. bassiana induced cumulative mortality rates of 39.3, 36.7 and 35.3% against eggs and neonates, respectively, followed by the QB-3.436 and LNSE-22 isolates’ mortality rate of 31.3% at a concentration of 1 × 106 conidia/mL and measured at 14 days post-treatment . However, ≤16.7% cumulative mortality was observed for the other tested isolates . Furthermore, the rest of the other isolates of B. bassiana caused ≤26.0% cumulative mortality rates . Furthermore, 50.0 and 44.7% cumulative mortality rates were observed with the ZGNKY-01 and SPLE-24 isolates of B. bassiana . The QB-3.428, QB-3.46 and QB-3.436 isolates of B. bassiana caused 13.4% to 14.9% mortality rates of larvae of FAW that were treated with 1 × 107 conidia/mL . The QB-3.45 and QB-3.45 isolates of B. bassiana caused larval mortality of 25.6 and 20.0% and the QB-3.428 and QB-3.436 isolates caused 17.8 and 14.4% larval mortality of FAW when applied at a concentration of 1 × 108 conidia/mL   .B. bassiana significantly reduced the feeding efficacies of the second instar larvae of FAW by 56.9 and 54.2%, respectively, followed by QB-3.428 and QB-3.436, which reduced the feeding efficacy to 48.6 and 43.1% when applied at a concentration of 1 × 106 conidia/mL and measured at 48 h post-treatment . The QB-3.45 and QB-3.46 isolates of B. bassiana reduced the feeding efficacy to 65.3 and 61.1%, respectively, followed by QB-3.428 (58.3%), in second instar larvae when applied at a concentration of 1 × 107 conidia/mL . The QB-3.45 and QB-3.46 isolates of B. bassiana reduced the feeding efficacy rates to 77.8 and 72.2%, respectively, followed by QB-3.428 (69.4%), against the second instar FAW larvae . The QB-3.436 and LNSE-22 isolates of B. bassiana moderately reduced the feeding efficacy to 54.2 and 51.4%, respectively, against the second instar larva of FAW  (The results showed that the isolates of > 0.000) .2, 286 = 280.34; p > 0.000), the treatments , the life stages , and the interaction  on the mortality of FAW  of FAW. These isolates also showed effectiveness in reducing the feeding efficacy of the treated larvae. In the present study, the QB-3.45, QB-3.46 and QB-3.428 isolates of B. bassiana proved to be the most effective for the management of the FAW population. Therefore, these isolates perhaps provide bases for the development of commercial biological insecticides. Further research is needed to find the main toxins that affect the virulence factors of the entomopathogenic fungal isolates.The


One of the main implications of hearing impairment is the difficulty in perceiving speech sounds, especially in noisy environments. Thus, the frequency-modulated system is considered an important educational tool for children with hearing impairment because it improves speech perception in acoustically-unfavorable environments, such as in the classroom. The assessment of speech perception in noise is included in the verification protocol of this device.To verify the effectiveness of the phrases in noise test Brazil in children with hearing impairment using an frequency-modulated system.p < 0.05) was adopted.This was a cross-sectional cohort study. The sample included 40 children, aged 4 years to 11 years and 11 months old, divided into 4 groups: (1) 10 normal hearing children; (2) 13 children with hearing aids and frequency-modulated system; (3) 12 children using cochlear implant and fitted with the frequency-modulated system; and (4) 5 children diagnosed with auditory neuropathy spectrum disorder, fitted with hearing aids and/or cochlear implant and with the frequency-modulated system. The phrases in noise test Brazil was used to evaluate speech perception in noise under the conditions with and without the frequency-modulated system. For the statistical analysis of the data, a significance level of 5% (There was a significant difference between the groups when they were evaluated with the frequency-modulated system. The test was also validated through concurrent and convergent validation measures. Phrases in noise test Brazil is a viable option for monitoring auditory performance in noise in different groups of children with hearing impairmen.Phrases in noise test Brazil was effective in assessing speech perception in noise and may contribute to the improvement of the indication, fitting and follow-up protocols for the frequency-modulated system use. One of the main implications of hearing impairment (HI) is the difficulty in perceiving speech sounds.Sistema Único de Saúde).3Currently, the technology embedded in Hearing Aids (HAs) and cochlear implant (CI) speech processors and bone conduction hearing aids allows access to speech perception, modifying and enhancing oral language acquisition with the help of speech therapy. In Brazil, these devices can be acquired in accredited Hearing Health Services, following criteria published by the Brazilian Unified Health System .Thus, the FM system is considered an important educational tool for children with HI,The American Academy of Audiology has developed a best practice guideDue to the scarcity of speech perception in noise tests for young children, the Phrases in Noise Test (PINT) was developed for children with CI,Therefore, this study addresses the validation process of the PINT BrazilThis is a cross-sectional study carried out at the Speech-Language Pathology Clinic of Faculdade de Odontologia de Bauru, Universidade de São Paulo (FOB/USP) and the Hearing Health Division of the Craniofacial Anomalies Rehabilitation Hospital, Universidade de São Paulo (HRAC/USP), after approval by the Research Ethics Committee  n. 17699713.9.0000.5417, CAAE n. 56422116.8.3001.5441 and CAAE n. 62481816.2.0000.541), from May 2014 to August 2016. All participants were instructed on the research objectives and invited to sign the Informed Consent Form with their guardians. All participants were instructed regarding the study objectives and invited to sign the Free and Informed Consent form with their parents/guardians.The following inclusion criteria were established: (a) Having a diagnosis: (1) normal hearing children for the control group, (2) children with moderate to severe sensorineural HI, fitted with HA, (3) children with severe to profound sensorineural HI, users of CI and (4) children diagnosed with ANSD, fitted with HA and/or CI; (b) users of the FM system; c) Aged 4 years up to 11 years and 11 months; d) being enrolled in elementary school.Thus, the convenience sample consisted of 40 children, aged 4 years up to 11 years and 11 months of age, regularly enrolled in the FOB/USP and HRAC/USP hearing health services. The sample was divided into four groups, as follows: (1) 10 normal hearing children; (2) 13 children fitted with HAs and FM system; (3) 12 children using CI and users of the FM system; and (4) 5 children with ANSD, fitted with HAs and/or CI and users of the FM system.The speech perception in noise test was performed in an acoustically treated booth. A two-channel audiometer, model Astera AS by Madsen, and a two-speaker amplification system were used to present speech and noise stimuli in a free field, with an incidence angle at 0° (zero degree) azimuth and 180° (one hundred and eighty degrees) azimuth respectively, aiming to simulate the classroom environment.The participants were seated in a chair in the middle of the booth, one meter away from each speaker. The FM system was placed at a distance of approximately 22 cm below the speaker that presented the speech stimulus. The test environment is described in The Phrases in Noise Test (PINT) BrazilThe test consists of 10 simple-order sentences referring to body parts (closed-set auditory recognition). Six test lists were created in the Brazilian Portuguese version, and each sentence is repeated twice per list in a pseudorandomized way. The test begins with a Signal/Noise ratio (SNR) of +15 dB SNR and the SNR decreases to −12 dB SNR; the test continues with a −12 dB SNR that progressively increases to +15 dB SNR. The speech signal is presented at a fixed intensity of 60 dB and the noise intensity varyies in an adaptive manner.The noise in the PINT BrazilBefore the PINT Brazil was appliedThe list presentation was performed in the following situations: (a) Only with the hearing device (HA or CI) and then; (b) With the hearing device paired with the FM System, in random order of presentation using the Latin square design.The answers were noted on the response form  and the The test is interrupted when the child obtains three consecutive correct answers at the rising intensity of the answer form.t-test and intergroup comparisons by t-test for independent groups. A significance level of 5% (p < 0.05) was used for all tests.The data were submitted to the Kolmogorov-Smirnov normality criterion. Intragroup comparisons were performed by paired The ANOVA hypothesis test was performed to calculate the sample size. The parameters considered for the test were the difference (Δ) between the situations WITH and WITHOUT the FM system after grouping of the four levels, which resulted in a mean difference of 2.65 and a standard deviation of 2.84. Considering a test power (K) of 80%, a chance of Type II error (β) of 20% and a significance level (α) of 5%, the estimated sample size comprised 27 participants.The box-plot graph  shows thAccording to the literature, individuals with hearing loss of cochlear origin show greater difficulty in speech perception in noisy environments and need +15 dB to +20 dB for the SNR to be favorable for speech perception.p < 0.05) can be observed when comparing the situations with and without the FM System in the group of children using PSAD, CI and with ANSD, consistent with the consensus in the literature that the FM System promotes the improvement of speech perception in noise.20Statistically significant differences  between the two tests.For convergent validation, where two measures need to be similar to each other,Therefore, the PINT BrazilThe PINT Brazil10.13039/501100002322Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001, Conselho Nacional de Desenvolvimento Científico e Tecnológico , Fundação de Amparo à Pesquisa do Estado de São Paulo  and the Unified Scholarship Program of Universidade de São Paulo.This study received support from The authors declare no conflicts of interest.


Hearing loss is a sensory deprivation, which can brings several consequences, among them: language development delay, emotional and social problems, and school difficulties. In such settings, we stress the role of nursing professional, who can expand their knowledge about children's hearing health, all the way from pre-natal care.To check the knowledge of nursing professional after the educational actions on pediatric hearing.A quasi-experimental design with time-series outline. We had 82 nursing professional participating  working in a university hospital between March and September of 2011. All of the interviewees answered a semi-structured questionnaire before and after the educational actions.We observed a significant change in the knowledge of the nursing professionals after the educational activity in most of the variables; such as: ideal age to perform the newborn hearing screening; ideal age to diagnose hearing loss; ideal age to start intervention against hearing loss and risk indicators for hearing loss.It is believed that the methodology used in educational activities, based on problems found in professional practice, education may have contributed greatly to increase knowledge about hearing health, especially concerning neonates and infants. Hearing is characterized as a fundamental condition for oral language development. Therefore, it is closely related to human communicaitonHearing health promotion is the first step of a Children Auditory Health Program (CAHP) which must be started already in pre-natal care. One important stage in these programs is the Neonatal Hearing Screening (NHS), which allows for the detection of possible auditory changes in neonates and infantsIn these settings, we highlight nursing professionals, who may act as multipliers of knowledge on children auditory healthPaulo Freire's methodology proposes the conceptualization of educational actions from its practiceSince there is a need for greater disclosure about children auditory health and be able to work with the theme, based on Paulo Freire's problematic, this study aimed at checking the knowledge of nursing professionals after educational programs on children auditory health.This is a quasi-experimental study with a temporal-series outline. We had 82 nursing professionals  participating from a university hospital, who worked in the puericulture, pediatrics, neonatal intensive care wards, maternity and obstetric center, between March and September of 2011. The inclusion criterion to participate in the study was to be present in at least three of the meetings proposed for the educational initiatives.- in this stage, the Nursing Professionals answered a semi-structured questionnaire; (2) Educational Programs - Based on the information collected in the questionnaire, we developed themes approached in the educational actions based on the precepts of Paulo Freire's methodology, which core is associated with the problematic as a starting pointData collection was carried out at three moments: (1) Initial questionnaire deployment Statistical Package for the Social Sciences (SPSS) software, version 13.0. In data analysis we calculated the percentage frequencies for the variables studied and we built the contingency tables of interest. In order to assess the numerous factors studied, we used the Chi-square test for independence. On the tables in which the Chi-square test assumptions were not met, we used the Fisher's exact test. To assess the professionals' levels of knowledge before and after the educational programs, we used the Chi-square test for homogeneity; and we used the Chi-square test for proportion in comparing the percentages of simple frequency distributions. In all the conclusions we considered a significance level of p ≤ 0.05. This study was approved by the Ethics in Research Committee, under protocol number 0130.0.172.000-10.The data was entered in a database, in the Among the nursing professionals who participated in this study (n = 82), 80 were females and two were males, with ages between 21 and 63 years (mean of 41.6 years). As far as education is concerned, 52.4% (n = 43) had higher education, with graduation time and professional carrier time of less than 20 years - 58.5% (n = 48) and 56.1% (n = 46), respectively. Most nursing professionals  stated they did not receive information concerning auditory health during their professional training.We stress that: (a) 35.4% (n = 29) worked as a nurse, (b) 26.8% (n = 22) of the nursing professionals worked in the Neonatal Intensive Care Unit (NICU) and (c) 97.6% (n = 80) worked only in a public hospital .Table 1DWe can observe a change in the knowledge of nursing professionals after the educational program in different variables. In regards of the knowledge of nursing professionals as to the need to assess the hearing of neonates and infants with/without a hearing loss risk indicator (HLRI) and as to the knowledge about which hospitals of the region do the NHS , we noticed that there had been no significant change after the educational program. It was not possible to do the significance statistical test for the analysis of the knowledge of the nurses on the need to assess the hearing of neonates and infants with HLRI, since they all reported that it was relevant to investigate the hearing of this population, before and after the educational initiative .Table 2NMost nursing professionals reported that the first month of life is ideal to do the NHS, before  and after  the educational program .Table 3KOn Concerning the conduct of such professional regarding neonates and infants under risk for hearing loss, there was a difference on the answers regarding: the need to refer neonates and infants to NHS of 28.0% (n = 23) to35.4% (n = 29); refer to a specialist: from 20.7% (n = 17) to 14.6% (n = 12); not knowing what to do  to educate the parents concerning NHS .The attitudes and influence of nursing professionals on a given population is impressiveThis study's sample was made up mainly of females. This is a profession's trait which reflects socio-historical aspectsAlthough 52.4% of the participants in this study had higher education - 64.6% worked in middle-level roles - as nursing technicians or assistants. It is common for nursing professionals to start their professional lives in middle level programs, even with the possibility of moving on to higher educationThus, children auditory health themes must be added to the training of nurses, as we consider the attitudes and influence of nursing professionals on the people they work withDespite the fact that all nursing professionals who work with pregnant women, parturients, neonates and infants need knowledge on children auditory healthhabitué profession in other types of neonatal screenings, fostering the increase in coverage and the number of examsAmong the relevant aspects associated with children hearing health, we know that UNHS is recommended since 1994As to the ideal age to perform the audiological diagnosis and the ideal age to start intervention, we noticed that, in the beginning, the interviewees did not know when the ideal time for intervention was. This lack of knowledge may lead to a late diagnosis of hearing loss and, consequently, late intervention. Thus, there is no question about the need for information. Even before the educational programs most of the interviewees reported knowing about the consequences of hearing loss.It is estimated that neonatal hearing loss prevalence is approximately 1 to 6:1,000 births, being higher than in newborns coming from the NICUKnowledge on the type and degree of hearing loss is also convenient in order to associate such factors to the etiology of hearing loss and its consequences. Although this knowledge is specific for the professionals who work with hearing, this aspect enables healthcare professionals to have a different look on children who bear certain etiologies associated with hearing loss with specific levels and types. As a result, the expectation is to minimize the losses in oral language developmentThe lack of information on children hearing health during the education of nursing professionals and the separation between teaching and practice may corroborate the lack of knowledge about HLRIOther risk indicators that may impact health are socioeconomic and demographics. Since the definition of health is broadNHS involves TOAE and/or BAEPAt the end of this study, all the professionals who participated in the program could properly educate the families, strengthening the multidisciplinary work, and making it so that all the recommended stages for identification and intervention in the first months of life are complied withThis study may guide on the creation of continuing educational programs among healthcare professional concerning the auditory health of neonates and infants, aiming at intervention, started as soon as possible, thus minimizing the consequences of hearing loss on the individual's life and that of his/her family and the State.In time, we suggest a future study with the redeployment of the questionnaire, six months after the end of the educational programs to check the knowledge acquired and added to practice. The setting up of a Family Counseling service may also be an interesting initiative, providing information and education, supported by hearing and speech therapists, since they are the healthcare professionals able to act in these full efforts to identify hearing loss as soon as possible.Educational programs on the hearing health of neonates and infants have significantly changed the knowledge of nursing professionals. The methodology utilized in the educational programs, based on problematizing daily life, may contribute to the increase of knowledge on the theme.


Functional near-infrared spectroscopy (fNIRS) studies have demonstrated associations between hearing outcomes after cochlear implantation and plastic brain changes. However, inconsistent results make it difficult to draw conclusions. A major problem is that many variables need to be controlled. To gain further understanding, a careful preparation and planning of such a functional neuroimaging task is key.Using fNIRS, our main objective is to develop a well-controlled audiovisual speech comprehension task to study brain activation in individuals with normal hearing and hearing impairment (including cochlear implant users). The task should be deductible from clinically established tests, induce maximal cortical activation, use optimal coverage of relevant brain regions, and be reproducible by other research groups.The protocol will consist of a 5-minute resting state and 2 stimulation periods that are 12 minutes each. During the stimulation periods, 13-second video recordings of the clinically established Oldenburg Sentence Test (OLSA) will be presented. Stimuli will be presented in 4 different modalities: (1) speech in quiet, (2) speech in noise, (3) visual only , and (4) audiovisual speech. Each stimulus type will be repeated 10 times in a counterbalanced block design. Interactive question windows will monitor speech comprehension during the task. After the measurement, we will perform a 3D scan to digitize optode positions and verify the covered anatomical locations.This paper reports the study protocol. Enrollment for the study started in August 2021. We expect to publish our first results by the end of 2022.The proposed audiovisual speech comprehension task will help elucidate neural correlates to speech understanding. The comprehensive study will have the potential to provide additional information beyond the conventional clinical standards about the underlying plastic brain changes of a hearing-impaired person. It will facilitate more precise indication criteria for cochlear implantation and better planning of rehabilitation.DERR1-10.2196/38407 Disabling hearing loss is a major communication and health problem that affects over 6% of the overall population and over 50% of adults above the age of 65. For adults, deafness leads to social isolation, unemployment, and reliance on social services. This problem will increase with demographic change. It is estimated that by 2050, 10% of the global population will be living with disabling hearing loss ,4, improIn the absence of auditory input, the sensory deprivation induces reallocation of cortical areas . This leads to functional reorganization within the auditory and auditory-related brain cortex, with new functions being assigned to these brain regions . As an eWe use functional imaging to study these described plastic brain changes. However, in CI recipients, there are important considerations to make. Despite the efforts of CI manufacturers to allow structural magnetic resonance imaging (MRI) with a surgically implanted device, the technique has limitations. The outer speech processor cannot be worn during MRI scanning and thus cannot be used to assess evoked auditory responses associated with functional MRI. Furthermore, the implanted magnet and electrode array of the CI cause imaging artifacts in MRI and stimulation artifacts in electroencephalography (EEG) -20.Functional near-infrared spectroscopy (fNIRS), on the other hand, is ideal for this patient population . The tecPrevious fNIRS studies with implanted adults showed evidence of cortical reorganization. However, when comparing study findings, there are contradictory results. For example, some studies suggest that strong activation of the auditory cortex during lipreading tasks is a negative predictor of speech understanding with the implant ,23. OtheAccording to a recent review on fNIRS measurements in CI patients, at the current stage, it is difficult to draw a general conclusion about the potential positive or negative effects of cortical reorganization. Instead, methodological aspects must first be clarified . The effThe aim of our study protocol is to develop a well-controlled and reproducible fNIRS task to evaluate brain activation in response to speech comprehension in individuals with normal hearing, those with hearing impairments, and CI users. Our hypothesis is that through such a task, we can identify cortical networks that are clearly correlated to hearing performance with the implant. Identified brain activation patterns may later be used preoperatively as biomarkers of speech understanding with the implant.Using fNIRS, our main objective is to develop an audiovisual speech comprehension task to measure functional brain activity regarding speech understanding. The task should comply with the following criteria: it should (1) be deducible from clinically established hearing tests; (2) induce maximal cortical activation ; (3) align with the international 10-10 system of electrode placement, using optimally spaced optode positions with maximal coverage over the responsible brain regions. Short separation channels should allow noise reduction; (4) be time-efficient  be suitable for normal hearing, hearing impaired, and cochlear implant users; and (6) be reproducible by other research groups.We will correlate the fNIRS recordings with (1) data from patients’ history, (2) clinically validated questionnaires, and (3) performance during the fNIRS measurements .This research project is a prospective single-center study and will be conducted at the Department of Otolaryngology, Head and Neck Surgery at the Bern University Hospital, Inselspital, Bern, Switzerland.The protocol was designed in accordance with the ethical principles of the Declaration of Helsinki. The study setup was approved by the local ethical committee (reference number 2020-02978) and fulfils all the patient data regulations of Switzerland.All study participants must (1) be at least 18 years old, (2) be native German speakers, and (3) have preferably light and thin hair ,30. PartThe ear through which the acoustic stimulation will be presented needs to be implanted for at least 1 year. This will ensure that hearing rehabilitation after implantation is completed.Participants will be allocated to one of 3 groups: (1) normal hearing “control” cohort, (2) CI users with good speech understanding (“overperformer”), or (3) CI users with poor speech understanding (“underperformer”). CI users with moderate speech perception  will not be recruited because we want to investigate the functional mechanisms specifically for good and poor outcomes. Pilot measurements were performed on 10 participants to estimate an appropriate sample size. We compared the median relative change in the concentration of oxygenated hemoglobin in the auditory cortex. After acoustic stimulation (speech in quiet), an increase of 1.315 (SD 1.275) µMolar*cm was measured, while during the resting state, the value fluctuated close to 0. A power analysis to test a 2-sided hypothesis at 95% significance and 80% power showed that we need at least 15 participants with normal hearing to detect auditory activations. In addition, we considered previous findings from auditory fNIRS studies ,28,31,32Recruitment will be done through the CI center of our department. Potential study candidates will be screened based on their medical records and will be subsequently informed verbally or in writing about the study procedure. Candidates who are willing to participate and able to complete all tests required for the study will be asked to sign an informed consent form.Potential study candidates will be invited to an enrollment session. First, we will hand out the information sheet and answer any questions the candidates may have. To assess full eligibility, the candidates will have to fill in questionnaires and perform additional hearing tests before data collection. Bilateral CI users will be asked to turn off and remove the audio processor of the worse hearing ear to limit acoustic stimulation exclusively to the better ear. The worse hearing ear will be covered using an ear plug. The full enrollment session will take a maximum of 30 minutes.Questions on medical history will target the candidates’ handedness (Edinburgh Handedness Inventory) and the presence of diseases, which are among the exclusion criteria -35. AddiThe audiometric measurements and the fNIRS recordings will take place in an acoustic chamber (6 m × 4 m × 2 m) with a separate ventilation system and electromagnetic shielding. The broadband reverberation time is ~200 ms.In normal hearing participants, we will assess pure tone air-conduction hearing thresholds with a clinical audiometer . The findings must confirm that participants have no hidden or undetected hearing loss . For CI In all participants, we will measure the word recognition score for Freiburg monosyllabic word lists at a sound pressure level (SPL) of 65 dB . AdditioDuring fNIRS recording, each study participant will sit in a comfortable chair with an armrest, headrest, and lumbar support . A desk The stimulation protocol will be controlled by a custom-written script (Python 3.8.8) using Tkinter and python-vlc libraries. The script will send triggers via the serial interface to a trigger-box , which converts the signals to transistor-transistor Logic (TTL) levels. The TTL-encoded signals will then be received by the fNIRS machine .Participants will interact with the control laptop using the buttons of a mouse . The pointing function of the mouse will be disabled to ensure that participants control the experiment only by clicking and rolling. During the fNIRS measurement, the participants will be able to press an alarm button  positioned in a reachable distance on the table.We will select the regions of interest (ROIs) for the placement of the optodes considering previous studies. We expect responses related to audiovisual speech comprehension in the auditory and visual cortex, more specifically in the following ROIs: superior temporal gyrus (STG), primary visual cortex (V1), and visual association cortex (V2) ,31,46-50The montage will consist of 16 sources and 16 detectors placed on the surface of the skull according to the international 10-10 system of electrode placement A 54]. T. T54]. TThe optode holder cap will be assembled using the manufacturer's components  and custom 3D printed parts (colored optode markers and stabilizers for different head sizes). The parts will be designed in a solid modelling software  and printed using a 3D printer .At the end of the experiment, we will digitize the position of all optodes with a depth sensing camera  connected to an iPad . The depth sensing camera will be set up for optimized scanning of dark objects with low ambient infrared light. The infrared exposure time, gain, and depth resolution will be set to the highest available settings so that the colored optode markers can be easily identified on the 3D scan.During fNIRS recordings, we will instruct the participants to concentrate on the screen, follow the instructions, and reduce head movements. If the participants feel uncomfortable, an emergency button in front of them will be made available to stop the experiment. We will give all instructions both verbally and in writing. Before the recordings, the participants will conduct a short familiarization session with 4 example stimulations. Once the participant confirms that the task is understood, we will start the definitive recording. The functional recordings will begin with a 5-minute resting state period A. We wilAs stimulus material, we will use a video version of the female OLSA test ,58. A siA single stimulation block will contain 4 different stimuli, presented in one of the following modalities in a counterbalanced order B: (1) spAt random points, participants will be asked to answer questions to ensure attention and monitor speech comprehension during the test. The questions will be displayed in the nonstimulus epoch, for which the nonstimulus interval will be shortened to 10 seconds. The questions will ask to repeat the correct name or number of the last sentence from 4 possible answers. For example, if the sentence is “Nina gives 12 red flowers,” the question is either ”How many red flowers?“ or ”Who gives 12 red flowers?“ To answer the question, the participant will have to select 1 of 4 choices: 2 randomly selected numbers/names from the OLSA sentence matrix (wrong answers), an option if the respondent is not sure of the answer (skipped answer), and the correct answer. For the previous question, a possible combination could be (1) ”Britta,” (2) “Nina,” (3) “Peter,” and (4) “I cannot decide.” The participant will select an option with the roller on the computer mouse and confirm the answer with a double click. In the previous example, the participant must select the second option (”Nina“). The questions and the answers will be randomly generated, and the position of the question within the blocks will also be randomly chosen.The shortened nonstimulus interval of 10 seconds prior to the question window will allow us to evaluate the fNIRS responses. Therefore, the interleaved questions will not harm the overall effectiveness of the measurement. After the question is answered, the regular 20-25 second relaxation time will be applied to ensure that the brain responses return to baseline. Overall, 2 questions per modality will be asked, resulting in 8 questions throughout the entire fNIRS measurement.Following the breaks, before the first stimulation, there will be a stimulus-free interval of 20 seconds. This will ensure homogeneity of responses, meaning that all stimuli are perceived under similar circumstances. Overall, 10 blocks will be presented, resulting in 10 responses per stimulation modality, and the total fNIRS measurement time will be around 45 minutes. At the beginning of every event , a trigger will be sent from the control computer to the fNIRS machine through the trigger-box and stored as an extra channel in the fNIRS raw data.Following 5 stimulation blocks, we will ask every participant to rate their listening effort to the different stimuli, their rating of fatigue and their level of mind-wandering A 60-64]-6460-64]All written source documents will be completed in a neat, legible manner to ensure accurate interpretation of data. For each participant, a case report form (CRF) will be maintained, including the participant number. In CRFs and other project-specific documents, participants are only identified by a unique participant number. fNIRS measurements will be stored in a closed research environment . The secure web application is running on a local server maintained and backed up by the University of Bern. All documents related to the study, including the CRFs will be considered as source data, and these will be stored at the measurement site in accordance with relevant standards.Data preprocessing will be performed in MATLAB (MathWorks) using the Homer2 (v2.3)  and NIRSA further correction step will be performed to reduce noise based on the principle that the concentration changes of oxygenated and deoxygenated hemoglobin should be negatively correlated .We will perform the postprocessing of the scans with a 3D mesh processing tool (MeshLab) and custom-written scripts (MathWorks) .We will manually select the coordinates of the optodes and anatomical landmarks with MeshLab on the obtained 3D scans. The list of coordinates will then be exported and projected into Montreal Neurological Institute (MNI) space. The MNI coordinates will be displayed on the preoperative MRI scan of every CI-user participant, and the exact source of measured hemodynamic activation will be determined. Additionally, the mean and the standard deviation of optode coordinates will be calculated and reported as quality measure for optode fittings ,76.t=24 seconds relative to the stimulus onset. The epochs will be baseline-corrected by subtracting the mean of the signal between t =−5 seconds and t=0 seconds. Using the Glover canonical hemodynamic response function [Data analysis will be performed in Python using the MNE-Toolbox  and MNE-function  a designfunction ,81. Aftefunction . The datThe answers from the questionnaires will be digitized, and correlation analysis will be performed to reveal relations between the measured brain activation patterns and the evaluated questionnaires. Additionally, further behavioral data will be obtained from the triggers, such as reaction time to questions across the measurement as a measure of fatigue or response accuracy for each stimulation type as a measure of speech understanding.The enrollment for the study described in this protocol started in August 2021. The first results are expected at the end of 2022.The postoperative adaptive or maladaptive effect of existing cross-modal reorganization in CI candidates is a complex question. The available studies show contradictory findings. A recent review states that it is important to discuss the methodological aspects of such functional neuroimaging examinations ,46,47,50First, the test should be deducible from clinically established hearing tests. We used the video version of a widely used clinical test (Oldenburg Sentence Test) . FunctioSecond, the task should induce maximal cortical activation . We use an optimized counterbalanced block design. The duration of 1 stimulus will be 13 seconds, and the interstimulus break will be between 20 and 25 seconds, comparable to hemodynamic responses ,59. Our Third, it should be in alignment with the international 10-10 system of electrode placement, using optimally spaced optode positions with maximal coverage over the responsible brain regions. Short separation channels should allow noise reduction. Our optode placement covers the following brain regions: superior temporal gyrus (STG), primary visual cortex (V1), visual association cortex (V2), left inferior frontal gyrus (LIFG), middle temporal gyrus (MTG), and middle frontal gyrus (MFG). This allows us to study not only audiovisual activations but also speech perception in noise, the effects of fatigue, and activity related to higher-order cortical processing. Many other studies have not had the opportunity to cover such a wide range of cortical regions, mostly due to hardware limitations -25,50. WAdditionally, we use a multidistance channel setup. The optodes of the regular channels are ~30 mm apart from each other. Additional short channels with a 15-mm interoptode distance over the auditory and visual cortex provide extracerebral information to remove confounding systemic signals. It is recommended to use a systemic physiology controlled fNIRS approach, although this has rarely been applied in previous studies .Fourth, it should be time efficient to avoid fatigue due to experiment duration. The longest task the participants will be required to complete will last 12 minutes, and the total measurement time will be around 45 minutes. Regular breaks will be provided, and the total duration of the experiment is expected to be around 120-150 minutes.Fifth, it should be suitable for participants with normal hearing, hearing impairments, and those using CIs. The audio material is presented through a loudspeaker, so the task is suitable for people with normal hearing as well as for hearing aid and CI users. Alternatively, an insert earphone or a direct CI audio input simulation would be feasible. However, these 2 approaches have the disadvantage that the 3 aforementioned groups cannot not be stimulated identically. Our optode placement was chosen to allow for easy attachment of the implant coil.Sixth, it should be reproducible by other research groups. The audiovisual version of the OLSA was published in 2021 and is now accessible . MoreoveIn summary, the proposed audiovisual speech comprehension task will help us understand neural correlates to speech understanding. In the first stage, we will perform these measurements postoperatively to better understand the corresponding neuronal networks with an activated implant. In the subsequent stage, we will perform the measurements pre- and postoperatively to make prognostic calculations. The comprehensive study will have the potential to provide additional prognostic information beyond the conventional clinical standards regarding the underlying plastic brain changes of a person with hearing impairment. Our study will facilitate more precise indication criteria for cochlear implantation and a better planning of rehabilitation.


Objective: This paper assesses the relationship between demographics, health parameters, and functional limitations among older adults in Korea, including limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).Methods: We analyzed data from the Korean Longitudinal Study of Aging survey in 2020 and included only participants aged 65 and older. Multinomial logistic regression models were conducted to evaluate the factors that predicted functional limitations.Results: The prevalence of at least one ADL and IADL limitations were 6.14% (severe 1.94% and moderate 4.20%) and 15.49% (severe 3.11% and moderate 12.38%), respectively. People aged 85 and older had high rates of severe disability with 7.37% for ADLs and 12.06% for IADLs. High rates also occurred among people with low education, underweight, physical inactivity, depression, and three or more chronic diseases.Conclusion: Factors associated with functional limitations were age, educational status, body mass index, physical activity, depression, and chronic diseases. To prevent and improve functional limitations in the older populations, active and applicable interventions should be considered for modifiable factors such as physical activity, depression, and abnormal weight. The concept of aging in place, living independently or with some assistance from the community, has been well-acknowledged and promoted by the Korean government for people aged 65 years and older (older adults), including older adults with dementia , and it The most common indicators of functional limitations in older adults are changes in the ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs) . ADLs arSeveral studies found that the progression of disability in older adults differed by sociodemographic and health-related parameters such as age, sex, education status, living arrangement, physical activity, and body mass index (BMI) –16. The Our purposes in this study are to show the prevalence of ADL/IADL disability levels the distribution of ADL/IADL disability level according to age group by sex, and to determine the relating factors of the ADL/IADL disability levels according to demographics and health parameters in older Korean adults.In this study, the data from the Korean Longitudinal Study of Aging survey in 2020 (KLOSA 2020)  were appFollowing the KLOSA 2020 survey, the ADL scale considered seven indicators: 1) dressing, 2) washing face, hair, and brushing teeth, 3) bathing or showering, 4) eating food that has been prepared, 5) getting in/out of bed, 6) toileting, and 7) managing bladder/bowel . For eacThe IADL scale contained ten instrumental activities: 1) grooming, 2) household chores, 3) preparing meals, 4) laundry, 5) going out a short distance, 6) using public transportation, 7) shopping, 8) managing money, 9) making or taking a phone call, and 10) taking medicine at the right dose and time. The IADL index had a total of 10 possible scores, calculated based on the sum of scores from ten indicators. With the same meaning as ADL disability, an IADL disability was also defined with three levels: “none,” “moderate,” and “severe,” corresponding to participants scoring 0, 1-9, and 10 on the IADL index, respectively. This classification of ADL disability and IADL disability into different levels is similar to that of previous studies [2; normal, 18.5–23 kg/m2; overweight, 23–25 kg/m2; and obesity, >25 kg/m2, based on the Asia-Pacific classification of BMI [The covariates were taken from the KLOSA 2020 data and included demographic factors of sex , age , living arrangement , and educational status ; and health parameters of BMI , physicp-values for differences across ADL/IADL disability levels.The data were analyzed by using R software version 4.1.3. Bivariate statistics was used to identify participant characteristics and estimate differences in ADL/IADL disability levels for research purposes. The prevalence of ADL/IADL disability levels was specified. The Chi-square test  was usedp-values less than 0.05 in the two-sided Wald test were considered statistically significant. An OR represented a relative risk ratio for the change of the dependent variable in a particular category (relative to the reference category) associated with a one-level change in the respective predictor [Multinomial logistic regression models  were useredictor .We analyzed 4,337 participants aged 65 and older, and 2,509 (57.85%) of them were female. People aged 65–74 accounted for the highest proportion (47.06%), whereas those aged 85 and older made up only 13.77% of the study population. People with an elementary school or lower education accounted for the highest proportion (approximately 50%), whereas those with a college degree or higher accounted for a relatively small proportion (8.72%). Up to 24.9% of participants reported being obese whereas only 3.76% of them were underweight. More than 60% of participants responded did not exercise at least once a week, and 4.45% of those living in a depressive state. Those with at least one chronic disease accounted for about 81%; three or more chronic diseases accounted for 26.59%. The proportion of people with at least one ADL limitation was 6.14%, of which severe disability was 1.94%. For the IADL limitation, these numbers were 15.49% and 3.11%, respectively. The demographic and health parameter characteristics of the participants are shown in The prevalence of ADL/IADL disability among older adults is shown in The distributions of ADL/IADL disability levels by age and sex are visualized in p-values in the Goodness-of-fit test (around 2.2 × 10−16) indicated that the models were appropriate and consistent.The results of multinomial logistic regression analyses are shown in As shown in People with severe functional limitations often experience particular difficulties with daily activities, which place a burden on the healthcare system –16. TherThis study analyzed the prevalence of functional limitations in older Korean adults. For the entire population discussed in this study, the proportion of people who reported at least one ADL limitation was 6.14%, of which severe ADL disability was 1.94%. These numbers for IADL disability were 15.49% and 3.11%, respectively. The ADL/IADL disability increased significantly with age. For people aged 85 years or older, approximately 21.6% reported at least one ADL limitation, and 44.6% reported at least one IADL limitation. The results are similar to those of a survey of older adults residing in the community in Korea ; those rThe average human lifespan in Korea has been increasing in recent years, and the number of older adults increased significantly. Around 16% of the Korean population was age 65 or older in 2020, according to the South Korea Age structure . Among tIn this study, we verified that advanced age, low education, being underweight, physical inactivity, and chronic diseases were factors strongly associated with functional limitations in older adults. These findings were consistent with those of previous studies , 7, 11. We found that the prevalence of ADL/IADL disability was higher in underweight individuals than in normal-weight individuals, while it was lower in groups with overweight and obesity. This finding differs from the studies from Korea in that BMI did not significantly affect the prevalence of ADL/IADL disability in Korean older adults , 19. PreThe rates of severe ADL/IADL disability were exceptionally high in physically inactive individuals (a 9.85-fold increase for ADL and a 6.10-fold increase for IADL as shown in this study) compared with physically active individuals. A previous study reported a high prevalence of ADL (OR = 15.23) and IADL (OR = 4.98) disability in older adults without physical activity . LimitatChronic disease has been consistently reported as a risk factor for disability, and it may lead to disability due to limitations on physical and social activities , 38. TheWe also found that factors such as age, physical activity, depression, and chronic diseases influenced the risk for severe disability much more strongly than that for moderate disability at both ADL and IADL while there was almost no more difference in the influence of BMI on risk for severe as well as moderate disability. With the factor of educational status, the risk of ADL disability was significantly higher than that of IADL disability at both severe and moderate levels. This finding is interesting and has not been shown in previous studies related to older adults in Korea. This can be explained by the nature of limitations. ADL disability involves basic activities of daily living while the IADL disability includes more complex activities, so the prevalence of IADL disability was often higher than that of ADL disability and it is often more evident in the later stages of the disability .This study had some limitations. First, several parameters, such as the place of residence and income, were not included in this study to avoid the presence of missing data. Second, as this was a secondary data analysis study, we were unable to include the variables known as significantly associated factors  as in previous studies. Third, our study was based on cross-sectional data and did not include time-varying trends in ADL/IADL disability. It is necessary to confirm the causal relationship between the associated factors according to the level of ADL/IADL disability in a future longitudinal study. Despite several limitations, our findings have importance in formulating social policies and improving the healthcare system to properly accommodate the development of physical disabilities among older people in Korea. In particular, active policy support and intervention approaches for severe disability groups will be needed.In summary, this study specified the risk factors associated with ADL/IADL disability among older adults in Korea using bivariate analyses and multinomial logistic regression analyses of KLOSA data. Significantly, severe ADL/IADL disability tended to be closely associated with age, educational status, BMI, physical activity, depression status, and chronic diseases. In particular, modifiable factors were identified as major related factors of ADL/IADL disability, and it is necessary to prevent the occurrence of disability in the older population by improving modifiable factors through active intervention.


Cordyceps militaris has long been used in Eastern medicine for alleviating fatigue and as an immunostimulant. The present study aimed to determine the content of biologically active substances (bioelements and organic compounds), the total phenolic content, and the antioxidant activity of fruiting bodies , mycelia, and two food supplements. The results show that substrate composition and cultivation method had an influence on the properties of mushroom materials. An important aspect of the study is the estimation of the content of bioactive substances present after extraction into digestive juices in the artificial gastrointestinal tract model, which can allow for determining the amount of these substances that is potentially bioavailable for the human body. The best results for cordycepin (81.4 mg/100 g d.w.) and lovastatin (53.6 mg/100 g d.w.) were achieved for commercially available food supplements. Furthermore, after digestion in artificial intestinal juice, the highest amount of cordycepin was determined in the fruiting bodies from commercially obtained (25.9 mg/100 g d.w.) and self-cultivated mushroom (25.8 mg/100 g d.w.). In conclusion, the mycelium and fruiting bodies of C. militaris are ideal food supplements and pharmaceutical agents and can serve as a good source of prohealth substances potentially bioavailable for humans. Cordyceps spp. belonging to the Ascomycota group (family Cordycipitaceae) have long been used in Asian ethnomedicine as a natural agent for reducing tiredness and stimulating the immune system of the human body ..C. militC. militaris samples in the artificial gastric juice may suggest less effective absorption of bioelements and organic compounds from these materials into the human organism as the absorption takes place mainly in the intestines in humans.The direction of the arms shown in C. militaris can be a potential dietary and therapeutic material and a source of supplementation for the human body. Due to the possibility of optimizing the cultivation of fruiting bodies and obtaining mycelium with increased content of health-promoting substances, further research should be performed to obtain material for the production of therapeutics in the future.The analysis of bioelements and organic compounds in the present study shows, for the first time, not only the content but also the bioavailability of substances that are important for human health. Each of the analyzed materials—both from own cultivation and commercial cultivation—contained a slightly different amount of substances, but all the materials were found to be a valuable source of cordycepin, ergothioneine, as well as indole compounds, lovastatin, and bioelements. The contained active ingredients have shown numerous biological activities in many studies, such as antioxidant, antitumor, immunostimulant, ergogenic, and anti-inflammatory activity. In the case of cordycepin, the best potentially bioavailable source was both self-cultivated and commercially available fruiting bodies. In conclusion, it should be emphasized that not only food supplements but also mycelium from in vitro cultures and fruiting bodies of


Background and Objectives: Discussion is open about the relationship between diabetes (DM) and hearing loss (HL). There is a lot of evidence in the literature suggesting a causal link between these conditions, beyond being considered simple comorbidities. The difficulty in identifying populations free from confounding factors makes it difficult to reach definitive conclusions on the pathophysiological mechanisms at play. Nonetheless, there is numerous evidence that demonstrates how the population affected by DM is more affected by sensorineural HL (SNHL) and exhibit a higher prevalence of idiopathic sudden sensorineural HL (ISSNHL). Materials and Methods: Articles reporting potentially relevant information were reviewed, and the most significant results are discussed in this article. Starting from the possible mechanisms relating to auditory impairment in the diabetic condition, this article summarizes the studies on auditory evaluation in subjects with DM1 and DM2 and addresses the relationship between DM and ISSNHL. Results: DM is considered a risk factor for SNHL, although some studies have reported no relationship when the associations were adjusted for age, gender, and hypertension. Macro and microvascular insults that cause decreased blood flow, oxygen exchange, and ion transport are major complications of hypertension and DM and can have a direct effect on the sensory and support cells of the cochlea. Conclusions: Given the difficulty of carrying out studies on populations without confounding factors, new laboratory studies are strongly required to clarify which specific physiopathological mechanisms underlie the diabetic damage caused to the hearing organs and how pharmacological management may contribute to counteracting the pathophysiological effects of the diabetic condition on the auditory system. There is growing attention paid to the relationship between diabetes and inner ear structures. ,23,24,25This study was principally designed to review the most recent evidence related to DM and auditory system impairment. In October 2022, a literature search was performed using the following string on PubMed:  AND . Only articles published in the English language were considered. The abstracts and titles obtained were screened independently by two of the authors (F.M.G. and P.V.), who subsequently discussed disagreements of citation inclusion. The articles reporting potentially relevant information were read in full. The files were then revised, and the most significant results were discussed in this article.The cochlea is the mammalian organ of hearing. It is a coiled, fluid-filled tube that is composed of three compartments known as the scala vestibuli, scala media, and scala tympani which run along its length . Corti’sAlthough several theories have been proposed , the exact underlying mechanisms responsible for diabetes-induced damage to the auditory system remain uncertain. Many studies performed on animal or human models tried to investigate the alterations occurring in cochlear substructures after a prolonged diabetic state . Smith eDM1 is mainly due to a lack of insulin caused by the destruction of pancreatic β-cells by an autoimmune process. DM1 differs from type 2 in etiology, pathogenesis, clinical features, and predisposition to complications. DM1 appears at earlier ages than DM2, and therefore, its complications are already present in young adulthood. In recent years, two systematic reviews with meta-analyses investigated the audiological modifications in subjects affected by DM1. In 2017, Teng et al., tried to establish the effective relationship between the presence of DM1 and auditory dysfunction. Fifteen studies were included, and the authors observed a significant relationship between the presence of DM1 and an increased risk for developing mild and subclinical hearing impairment . LikewisAkinpelu et al., included 18 studies in a meta-analysis about the possible association between DM2 and hearing alterations. The authors concluded that DM2 patients have significantly higher incidence of mild HL when compared with controls. DM2 patients had poorer hearing at all frequencies, with greater impairment at 6 and 8 kHz. Interestingly, these patients had a threefold delay in ABR wave V latency, generated from the inferior colliculus that is the principal brainstem nucleus of the auditory pathway. These data also suggest retrocochlear involvement. Moreover, the incidence of HL was higher for older diabetics. Control patients also showed an increase in the incidence of HL with increasing age; however, the increase was greater among the diabetic group . Some ren = 94, 23.3%) usually presented with severe HL and required longer hospitalization than subjects with normal glucose levels. The DM patients had a higher initial hearing threshold, more hypertension, and less frequent hearing recovery than those without diabetes. However, when age, sex, and initial hearing level were adjusted by propensity score matching, the DM patients and matched controls yielded similar treatment results [Only a few studies investigated the possible connections between diabetes and ISSNHL, which is defined as a sudden onset of unilateral sensorineural HL of 30 dB or more over at least three contiguous audiometric frequencies ,56,57. W results .DM is also considered a risk factor for SNHL, although some studies have reported no relationship when the associations were adjusted for age, gender, and hypertension. Macro and microvascular insults that cause decreased blood flow, alterations in oxygen exchange, and ion transport are major complications of hypertension and DM and can have a direct effect on the sensory and support cells of the cochlea. A balanced diet and healthy lifestyle can prevent the progression of DM and SNHL; if necessary, vasodilators can be used to improve nerve blood flow.A large majority of published reports investigating hearing impairment in DM confirm the presence of a mild HL for high frequencies, suggesting that the most damaged inner ear structures are those placed on the cochlear basal turn that seems to be a “fragile” inner ear portion, potentially affected by different pathological events. In fact, other audiological conditions also represent important confounding factors during the clinical evaluation of diabetic HL. The first consideration must be age-related hearing loss (ARHL), which often starts with worsening high-frequency sound perception. Furthermore, noise-induced hearing loss (NIHL) is another condition that leads to selective damage in high-frequency sound transduction.For this reason, new laboratory studies are strongly required to clarify which are the specific physiopathological mechanisms that promote diabetic damage towards the hearing organs. These studies should also try to define if the auditory diabetic damage shares the same molecular mechanisms as those that are associated with the aging process and chronic noise exposure. Clarifying whether these mechanisms have common pathways can help identify shared therapeutic approaches.Furthermore, as regards future clinical trials, it would be necessary to standardize a series of hearing tests with the aim of homogeneously examining the diabetic patients’ auditory pathway, as is already performed during oculistic and nephrological evaluations. Our review clarified how some tests can be used as a screening procedure to identify hearing impairments that have already engendered clinical consequences, such as pure-tone and speech audiometry. Meanwhile, other, more sophisticated hearing tests may be useful for detecting subclinical cochlear damage. Well-designed longitudinal studies are also strongly recommended to investigate if the progression of auditory alterations differs on the basis of diabetes status/duration, as well as to ascertain if different pharmacological management may contribute to counteracting the pathophysiological impact of the diabetic condition on the auditory system.HL can strongly compromise the quality of life in diabetic subjects, and the inclusion of hearing evaluation in the American Diabetes Association recommended comprehensive medical assessment would be useful. Interventions aimed at controlling factors that may cause morphological and functional changes in the cochlea are critical in managing diabetic hearing damage.Individuals with DM are at increased risk of hearing impairment, although this particular population may frequently have confounding comorbidities. Since the severity, course, and consequences of hearing damage can be influenced by the medical treatment of DM and by the medical and rehabilitative management of HL, we believe it is important to include a detailed assessment of the hearing threshold in the diagnostic work-up of diabetic patients.Interventions aimed at controlling factors that may cause morphological and functional changes in the cochlea are critical in managing diabetic hearing damage.


Mucormycosis is a severe invasive fungal disease. During the coronavirus disease 2019 (COVID-19) pandemic, outbreaks have been reported worldwide, but epidemiological studies are still scarce in Brazil.  We conducted a time-series cohort hospitalization study (2010-2021) in southeastern Brazil.P < 0.05) involvement of patients older than 40 years (84%), white patients (78%), rhinocerebral site (63%), and São Paulo State residents (84%).  There were 311 cases (85 during the pandemic), with significant ( Mucormycosis hospitalizations were highly prevalent. Further studies are needed to assess the burden of COVID-19 on mucormycosis in Brazil. Rhizopus spp, Mucor spp, and Rhizomucor spp,--Mucormycosis is a severe and lethal fungal disease. Urgent surgical intervention and antifungal therapy are lifesavingSistema de Informações Hospitalares (SIH) [Brazilian Hospital Information System] and selected patients with the 10th International Classification of Diseases (ICD): B46.0-B46.9 in at least one of the diagnosis fields provided through the hospital admission authorization (AIH) from 2010 to 2021. To compare the two periods, 2010-2019 and 2020-2021, we created a time-series graph , age group (< 40 years and > 40 years), skin color , state of residence , anatomical site , bed occupation , days of hospitalization, intensive care unit (ICU) admission, emergency hospitalization, onco-hematological and transplant disease, and discharge or death outcome. For geographical visualization . Rhinocerebral mucormycosis was more frequent in the second period, and the pulmonary clinical form was less frequent. During the pandemic period, patients over 40 years of age (P = 0.038) and whites (P = 0.020) were significantly more prevalent. Lethality, need for ICU admission, and days of hospital stay were similar between the two periods.There was a statistically significant difference in the proportional distribution of cases between the different types of anatomical sites considered  compared with the literature (39.2-45.7%)Mucormycosis is an emerging invasive fungal infection in the COVID-19 era. Our study has identified a recent increase in the occurrence of mucormycosis in southeastern Brazil. The alert from ANVISA may have played a role in improving diagnosis. Further studies are needed to assess the impact of COVID-19 on mucormycosis occurrence in Brazil.