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1.
Common mental disorders in Brazilian adolescents: association with school characteristics, consumption of ultra-processed foods and waist-to-height ratio
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Gratão, Lucia Helena Almeida
; Silva, Thales Philipe Rodrigues da
; Rocha, Luana Lara
; Jardim, Mariana Zogbi
; Oliveira, Tatiana Resende Prado Rangel de
; Cunha, Cristiane de Freitas
; Mendes, Larissa Loures
.
Resumo: Metade de todos os problemas de saúde mental diagnosticados na idade adulta têm seu início antes ou durante a adolescência, especialmente os transtornos mentais comuns (TMC). Desta maneira, é importante estudar os fatores associados a estes transtornos. Este estudo objetiva investigar a associação entre características escolares, consumo de alimentos ultraprocessados e razão cintura/estatura com a presença de TMC em adolescentes brasileiros. Trata-se de um estudo transversal de base escolar que analisou dados de 71.553 adolescentes brasileiros de 12-17 anos. A prevalência de TMC nesses adolescentes foi de 17,1% (ponto de corte 5 para o Questionário de Saúde Geral - GHQ-12). As associações foram estimadas por meio de modelos logísticos multiníveis, tendo como variável dependente a presença de TMC. O modelo final, ajustado para variáveis individuais não modificáveis, variáveis individuais modificáveis e características familiares, identificou uma associação positiva entre dependência administrativa privada (OR = 1,1; IC95%: 1,07-1,14), presença de propaganda de alimentos ultraprocessados (OR = 1,13; IC95%: 1,09-1,17), segundo a quarto quartis de consumo de alimentos ultraprocessados e razão cintura/estatura (OR = 2,26; IC95%: 2,03-2,52). Este estudo demonstrou que a dependência administrativa privada da escola, a presença de propagandas de alimentos ultraprocessados, o consumo de alimentos ultraprocessados e o aumento da razão cintura/estatura são fatores de risco para TMC em adolescentes brasileiros.
Abstract: Half of all mental health problems diagnosed in adulthood have their onset before or during adolescence, especially common mental disorders (CMD). Thus, it is relevant to study the factors associated with these disorders. This study aimed to investigate the association of school characteristics, consumption of ultra-processed foods, and waist-to-height ratio with the presence of CMD in Brazilian adolescents. This is a school-based, cross-sectional study that analyzed data from 71,553 Brazilian adolescents aged 12-17 years. The prevalence of CMD in these adolescents was 17.1% (cut-off point 5 for the General Health Questionnaire-12). Associations were estimated using multilevel logistic models, with the presence of CMD as the dependent variable. The final model, adjusted for non-modifiable individual variables, modifiable individual variables and family characteristics, identified a positive association between private-funded schools (OR = 1.10; 95%CI: 1.07-1.14), advertisements for ultra-processed foods (OR = 1.13; 95%CI: 1.09-1.17), the second to fourth quartiles of ultra-processed food intake and waist-to-height ratio (OR = 2.26; 95%CI: 2.03-2.52). This study demonstrated that the private-funded schools , the presence of ultra-processed food advertisements, the consumption of ultra-processed food, and an increased waist-to-height ratio are risk factors for CMD in Brazilian adolescents.
Resumen: La mitad de todos los problemas de salud mental diagnosticados en la edad adulta empiezan antes o durante la adolescencia, sobre todo los trastornos mentales comunes (TMC). Así, es importante estudiar los factores asociados a estos trastornos. El objetivo de este estudio es investigar la asociación entre las características escolares, el consumo de alimentos ultraprocesados y la proporción cintura/estatura y la presencia de TMC en adolescentes brasileños. Se trata de un estudio transversal de base escolar que analizó datos de 71.553 adolescentes brasileños de 12 a 17 años. La prevalencia de TMC en estos adolescentes fue del 17,1% (punto de corte 5 para el Cuestionario General de Salud - GHQ-12). Se estimaron las asociaciones a través de modelos logísticos multinivel, con la presencia de TMC como variable dependiente. El modelo final, ajustado para variables individuales no modificables, variables individuales modificables y características familiares, identificó una asociación positiva entre la dependencia administrativa privada (OR = 1,10; IC95%: 1,07-1,14), la presencia de publicidad de alimentos ultraprocesados (OR = 1,13; IC95%: 1,09-1,17), segundo al cuarto cuartil de consumo de alimentos ultraprocesados y la proporción cintura/estatura (OR = 2,26; IC95%: 2,03-2,52). Este estudio demostró que la dependencia administrativa privada de la escuela, la presencia de publicidades de alimentos ultraprocesados, el consumo de alimentos ultraprocesados y el aumento de la proporción cintura/estatura son factores de riesgo para trastornos mentales comunes en adolescentes brasileños.
2.
Common mental disorders in Brazilian adolescents: association with school characteristics, consumption of ultra-processed foods and waist-to-height ratio adolescents characteristics ultraprocessed ultra processed waisttoheight waist to height
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Gratão, Lucia Helena Almeida
; Silva, Thales Philipe Rodrigues da
; Rocha, Luana Lara
; Jardim, Mariana Zogbi
; Oliveira, Tatiana Resende Prado Rangel de
; Cunha, Cristiane de Freitas
; Mendes, Larissa Loures
.
Resumo: Metade de todos os problemas de saúde mental diagnosticados na idade adulta têm seu início antes ou durante a adolescência, especialmente os transtornos mentais comuns (TMC). Desta maneira, é importante estudar os fatores associados a estes transtornos. Este estudo objetiva investigar a associação entre características escolares, consumo de alimentos ultraprocessados e razão cintura/estatura com a presença de TMC em adolescentes brasileiros. Trata-se de um estudo transversal de base escolar que analisou dados de 71.553 adolescentes brasileiros de 12-17 anos. A prevalência de TMC nesses adolescentes foi de 17,1% (ponto de corte 5 para o Questionário de Saúde Geral - GHQ-12). As associações foram estimadas por meio de modelos logísticos multiníveis, tendo como variável dependente a presença de TMC. O modelo final, ajustado para variáveis individuais não modificáveis, variáveis individuais modificáveis e características familiares, identificou uma associação positiva entre dependência administrativa privada (OR = 1,1; IC95%: 1,07-1,14), presença de propaganda de alimentos ultraprocessados (OR = 1,13; IC95%: 1,09-1,17), segundo a quarto quartis de consumo de alimentos ultraprocessados e razão cintura/estatura (OR = 2,26; IC95%: 2,03-2,52). Este estudo demonstrou que a dependência administrativa privada da escola, a presença de propagandas de alimentos ultraprocessados, o consumo de alimentos ultraprocessados e o aumento da razão cintura/estatura são fatores de risco para TMC em adolescentes brasileiros. Resumo adolescência . (TMC) maneira escolares cinturaestatura cintura estatura Tratase Trata se 71553 71 553 71.55 1217 12 17 12-1 anos 171 1 17,1 ponto GHQ12. GHQ12 GHQ GHQ-12) multiníveis final familiares OR 1,1 11 IC95% IC95 IC 1,071,14, 107114 1,07 1,14 , 07 14 1,07-1,14) 1,13 113 13 1,091,17, 109117 1,09 1,17 09 1,09-1,17) 2,26 226 2 26 2,032,52. 203252 2,03 2,52 03 52 2,03-2,52) escola (TMC 7155 7 55 71.5 121 12- 17, GHQ1 GHQ-12 1, IC9 071 1,071,14 10711 107 1,0 114 0 1,07-1,14 091 1,091,17 10911 109 117 1,09-1,17 2,2 22 032 2,032,52 20325 203 2,0 252 2,5 2,03-2,52 715 71. GHQ-1 1,071,1 1071 10 1,07-1,1 1,091,1 1091 1,09-1,1 2, 2,032,5 2032 20 25 2,03-2,5 GHQ- 1,071, 1,07-1, 1,091, 1,09-1, 2,032, 2,03-2, 1,071 1,07-1 1,091 1,09-1 2,032 2,03-2 1,07- 1,09- 2,03-
Abstract: Half of all mental health problems diagnosed in adulthood have their onset before or during adolescence, especially common mental disorders (CMD). Thus, it is relevant to study the factors associated with these disorders. This study aimed to investigate the association of school characteristics, consumption of ultra-processed foods, and waist-to-height ratio with the presence of CMD in Brazilian adolescents. This is a school-based, cross-sectional study that analyzed data from 71,553 Brazilian adolescents aged 12-17 years. The prevalence of CMD in these adolescents was 17.1% (cut-off point 5 for the General Health Questionnaire-12). Associations were estimated using multilevel logistic models, with the presence of CMD as the dependent variable. The final model, adjusted for non-modifiable individual variables, modifiable individual variables and family characteristics, identified a positive association between private-funded schools (OR = 1.10; 95%CI: 1.07-1.14), advertisements for ultra-processed foods (OR = 1.13; 95%CI: 1.09-1.17), the second to fourth quartiles of ultra-processed food intake and waist-to-height ratio (OR = 2.26; 95%CI: 2.03-2.52). This study demonstrated that the private-funded schools , the presence of ultra-processed food advertisements, the consumption of ultra-processed food, and an increased waist-to-height ratio are risk factors for CMD in Brazilian adolescents. Abstract adolescence CMD. . (CMD) Thus characteristics ultraprocessed ultra processed waisttoheight waist height schoolbased, schoolbased based, based school-based crosssectional cross sectional 71553 71 553 71,55 1217 12 17 12-1 years 171 1 17.1 cutoff cut off Questionnaire12. Questionnaire12 Questionnaire Questionnaire-12) models variable model nonmodifiable non privatefunded private funded OR 1.10 110 10 95%CI 95CI CI 95 1.071.14, 107114 1.07 1.14 07 14 1.07-1.14) 1.13 113 13 1.091.17, 109117 1.09 1.17 09 1.09-1.17) 2.26 226 2 26 2.032.52. 203252 2.03 2.52 03 52 2.03-2.52) (CMD 7155 7 55 71,5 121 12- 17. Questionnaire1 Questionnaire-12 1.1 11 9 071 1.071.14 10711 107 1.0 114 0 1.07-1.14 091 1.091.17 10911 109 117 1.09-1.17 2.2 22 032 2.032.52 20325 203 2.0 252 2.5 2.03-2.52 715 71, Questionnaire-1 1. 1.071.1 1071 1.07-1.1 1.091.1 1091 1.09-1.1 2. 2.032.5 2032 20 25 2.03-2.5 Questionnaire- 1.071. 1.07-1. 1.091. 1.09-1. 2.032. 2.03-2. 1.071 1.07-1 1.091 1.09-1 2.032 2.03-2 1.07- 1.09- 2.03-
Resumen: La mitad de todos los problemas de salud mental diagnosticados en la edad adulta empiezan antes o durante la adolescencia, sobre todo los trastornos mentales comunes (TMC). Así, es importante estudiar los factores asociados a estos trastornos. El objetivo de este estudio es investigar la asociación entre las características escolares, el consumo de alimentos ultraprocesados y la proporción cintura/estatura y la presencia de TMC en adolescentes brasileños. Se trata de un estudio transversal de base escolar que analizó datos de 71.553 adolescentes brasileños de 12 a 17 años. La prevalencia de TMC en estos adolescentes fue del 17,1% (punto de corte 5 para el Cuestionario General de Salud - GHQ-12). Se estimaron las asociaciones a través de modelos logísticos multinivel, con la presencia de TMC como variable dependiente. El modelo final, ajustado para variables individuales no modificables, variables individuales modificables y características familiares, identificó una asociación positiva entre la dependencia administrativa privada (OR = 1,10; IC95%: 1,07-1,14), la presencia de publicidad de alimentos ultraprocesados (OR = 1,13; IC95%: 1,09-1,17), segundo al cuarto cuartil de consumo de alimentos ultraprocesados y la proporción cintura/estatura (OR = 2,26; IC95%: 2,03-2,52). Este estudio demostró que la dependencia administrativa privada de la escuela, la presencia de publicidades de alimentos ultraprocesados, el consumo de alimentos ultraprocesados y el aumento de la proporción cintura/estatura son factores de riesgo para trastornos mentales comunes en adolescentes brasileños. Resumen adolescencia TMC. . (TMC) Así escolares cinturaestatura cintura estatura 71553 71 553 71.55 1 años 171 17,1 punto GHQ12. GHQ12 GHQ GHQ-12) multinivel dependiente final familiares OR 1,10 110 10 IC95% IC95 IC 1,071,14, 107114 1,07 1,14 , 07 14 1,07-1,14) 1,13 113 13 1,091,17, 109117 1,09 1,17 09 1,09-1,17) 2,26 226 2 26 2,032,52. 203252 2,03 2,52 03 52 2,03-2,52) escuela (TMC 7155 7 55 71.5 17, GHQ1 GHQ-12 1,1 11 IC9 071 1,071,14 10711 107 1,0 114 0 1,07-1,14 091 1,091,17 10911 109 117 1,09-1,17 2,2 22 032 2,032,52 20325 203 2,0 252 2,5 2,03-2,52 715 71. GHQ-1 1, 1,071,1 1071 1,07-1,1 1,091,1 1091 1,09-1,1 2, 2,032,5 2032 20 25 2,03-2,5 GHQ- 1,071, 1,07-1, 1,091, 1,09-1, 2,032, 2,03-2, 1,071 1,07-1 1,091 1,09-1 2,032 2,03-2 1,07- 1,09- 2,03-
3.
Mortality, hospitalizations, and persistence of symptoms in the outpatient setting of the first COVID-19 wave in Brazil: results of SARS-Brazil cohort study Mortality hospitalizations COVID19 COVID 19 COVID-1 Brazil SARSBrazil SARS COVID1 1 COVID-
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Fonseca, Henrique Andrade Rodrigues
; Pereira, Adriano Jose
; Nawa, Ricardo Kenji
; Sant’Anna, Viviane Aparecida Rodrigues
; Almeida, Tatiana Ferreira de
; Guimarães, Hélio Penna
; Tognon, Alexandre Pereira
; Marques, Lucas Miranda
; Silva, Lucas Santana Coelho da
; Bittencourt, Rafaela de Souza
; Gomes, Camila Pachêco
; Martins, Priscila de Aquino
; Oliveira, Aryadne Lyrio de
; Milan, Eveline Pipolo
; Dall’Orto, Frederico Toledo Campos
; Hoffman Filho, Conrado Roberto
; Almeida, Guacyra
; Hohmann, Fábio Barlem
; Moia, Diogo Duarte Fagundes
; Piano, Luciana Pereira Almeida
; Machado, Felipe Pinheiro
; Soares, Ronaldo Vicente Pereira
; Damiani, Lucas Petri
; Assis, Silvia Regina Lamas
; Amaro Junior, Edson
; Rizzo, Luiz Vicente
; Berwanger, Otávio
.
ABSTRACT Objective To evaluate deaths, hospitalizations, and persistence of symptoms in patients with COVID-19 after infection in an outpatient setting during the first COVID-19 wave in Brazil. Methods This prospective cohort was between April 2020 and February 2021. Hospitalized or non-hospitalized COVID-19 patients until five days after symptom onset were included. The outcomes measured were incidence of death, hospitalization, and persistence of more than two symptoms 60 days after discharge. Results Out of 1,198 patients enrolled in the study, 66.7% were hospitalized. A total of 289 patients died (1 [0.3%] non-hospitalized and 288 [36%] hospitalized). At 60 days, patients non-hospitalized during admission had more persistent symptoms (16.2%) compared to hospitalized (37.1%). The COVID-19 severity variables associated with the persistence of two or more symptoms were increased age (OR= 1.03; p=0.015), respiratory rate at hospital admission (OR= 1.11; p=0.005), length of hospital stay of more than 60 days (OR= 12.24; p=0.026), and need for intensive care unit admission (OR= 2.04; p=0.038). Conclusion COVID-19 survivors who were older, tachypneic at admission, had a hospital length of stay >60 days, and were admitted to the intensive care unit had more persistent symptoms than patients who did not require hospitalization in the early COVID-19 waves. ClinicalTrials.gov Identifier: NCT04479488. deaths hospitalizations COVID19 COVID 19 COVID-1 Brazil 202 2021 nonhospitalized non included death 6 discharge 1198 1 198 1,19 study 667 66 7 66.7 28 ( 0.3% 03 0 3 [0.3% 36% 36 [36% . hospitalized) 16.2% 162 16 2 (16.2% 37.1%. 371 37.1% 37 (37.1%) OR= OR (OR 1.03 103 p=0.015, p0015 p p=0.015 , 015 p=0.015) 1.11 111 11 p=0.005, p0005 p=0.005 005 p=0.005) 12.24 1224 12 24 p=0.026, p0026 p=0.026 026 p=0.026) 2.04 204 04 p=0.038. p0038 p=0.038 038 p=0.038) older >6 waves ClinicalTrialsgov ClinicalTrials gov Identifier NCT04479488 NCT COVID1 COVID- 20 119 1,1 66. 0.3 [0.3 [36 16.2 (16.2 37.1 (37.1% 1.0 10 p001 p=0.01 01 1.1 p000 p=0.00 00 12.2 122 p002 p=0.02 02 2.0 p003 p=0.03 > NCT0447948 1, 0. [0. [3 16. (16. 37. (37.1 1. p00 p=0.0 12. 2. NCT044794 [0 [ (16 (37. p0 p=0. NCT04479 (37 p=0 NCT0447 (3 p= NCT044 NCT04 NCT0
4.
The association between multiple cardiovascular risk factors and overweight in Brazilian adolescents: an analysis based on the grade of membership adolescents
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Silva, Thales Philipe Rodrigues da
; Matozinhos, Fernanda Penido
; Guedes, Gilvan Ramalho
; Gratão, Lucia Helena Almeida
; Silva, Ariene do Carmo
; Vilela, Luisa Arantes
; Oliveira, Tatiana Resende Prado Rangel de
; Grillo, Cristiane de Freitas Cunha
; Mendes, Larissa Loures
.
Resumo O objetivo desta pesquisa é analisar a coexistência de comportamentos de risco modificáveis para doenças cardiovasculares (DCV) em adolescentes de 12 a 17 anos residentes no Brasil e sua influência no excesso de peso. Estudo epidemiológico nacional, transversal, de base escolar, com foco em estimar a prevalência de fatores de risco cardiovascular e síndrome metabólica em adolescentes de 12 a 17 anos matriculados em escolas públicas e privadas de municípios brasileiros que somam mais de 100 mil habitantes. O grade of membership foi utilizado para identificar a coexistência de fatores de risco entre os adolescentes. A amostra analítica foi composta por 71.552 adolescentes. De acordo com os dois perfis gerados, os adolescentes classificados no Perfil 2 mostraram comportamentos como fumar, consumo de álcool e dieta rica em alimentos ultraprocessados ≥ 80% da porcentagem do valor calórico total. Além disso, adolescentes com perfil de risco para DCV mostraram maior probabilidade de apresentar excesso de peso. O estudo encontrou coexistência de fatores de risco para DCV em adolescentes brasileiros, com destaque para tabagismo e consumo de bebidas alcoólicas. Além disso, demonstra associação entre fatores de risco para DCV e desfechos de saúde, como o excesso de peso. (DCV 1 peso nacional transversal escolar 10 habitantes 71552 71 552 71.55 gerados fumar 80 total disso alcoólicas saúde 7155 7 55 71.5 8 715 5 71.
Abstract The aim of the current research is to analyze the coexistence of modifiable risk behaviors for cardiovascular disease (CVD) in 12-to-17-year-old adolescents living in Brazil and their influence on overweight. National, cross-sectional, school-based epidemiological study focused on estimating the prevalence of cardiovascular risk factors and metabolic syndrome in 12 to 17 year old adolescents enrolled in public and private schools in Brazilian counties accounting for more than 100 thousand inhabitants. The grade of membership method was used to identify the coexistence of risk factors among adolescents. The analytical sample comprised 71,552 adolescents. According to the two herein generated profiles, adolescents classified under Profile 2 have shown behaviors such as smoking, alcohol consumption and diet rich in Ultra-processed food intake ≥ 80% of the percentage of total caloric value. In addition, adolescents presenting CVD risk profile have shown increased likelihood of being overweight. The study has found coexistence of risk factors for CVD in Brazilian adolescents, with emphasis on tobacco smoking and alcoholic beverage intake. In addition, it heads towards the analysis of the association between CVD risk factors and health outcomes, such as overweight. (CVD 12to17yearold toyearold overweight National crosssectional, crosssectional cross sectional, sectional cross-sectional schoolbased school based 1 10 inhabitants 71552 71 552 71,55 profiles Ultraprocessed Ultra processed 80 value addition outcomes yearold 7155 7 55 71,5 8 715 5 71,
5.
The association between multiple cardiovascular risk factors and overweight in Brazilian adolescents: an analysis based on the grade of membership
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Silva, Thales Philipe Rodrigues da
; Matozinhos, Fernanda Penido
; Guedes, Gilvan Ramalho
; Gratão, Lucia Helena Almeida
; Silva, Ariene do Carmo
; Vilela, Luisa Arantes
; Oliveira, Tatiana Resende Prado Rangel de
; Grillo, Cristiane de Freitas Cunha
; Mendes, Larissa Loures
.
Resumo O objetivo desta pesquisa é analisar a coexistência de comportamentos de risco modificáveis para doenças cardiovasculares (DCV) em adolescentes de 12 a 17 anos residentes no Brasil e sua influência no excesso de peso. Estudo epidemiológico nacional, transversal, de base escolar, com foco em estimar a prevalência de fatores de risco cardiovascular e síndrome metabólica em adolescentes de 12 a 17 anos matriculados em escolas públicas e privadas de municípios brasileiros que somam mais de 100 mil habitantes. O grade of membership foi utilizado para identificar a coexistência de fatores de risco entre os adolescentes. A amostra analítica foi composta por 71.552 adolescentes. De acordo com os dois perfis gerados, os adolescentes classificados no Perfil 2 mostraram comportamentos como fumar, consumo de álcool e dieta rica em alimentos ultraprocessados ≥ 80% da porcentagem do valor calórico total. Além disso, adolescentes com perfil de risco para DCV mostraram maior probabilidade de apresentar excesso de peso. O estudo encontrou coexistência de fatores de risco para DCV em adolescentes brasileiros, com destaque para tabagismo e consumo de bebidas alcoólicas. Além disso, demonstra associação entre fatores de risco para DCV e desfechos de saúde, como o excesso de peso.
Abstract The aim of the current research is to analyze the coexistence of modifiable risk behaviors for cardiovascular disease (CVD) in 12-to-17-year-old adolescents living in Brazil and their influence on overweight. National, cross-sectional, school-based epidemiological study focused on estimating the prevalence of cardiovascular risk factors and metabolic syndrome in 12 to 17 year old adolescents enrolled in public and private schools in Brazilian counties accounting for more than 100 thousand inhabitants. The grade of membership method was used to identify the coexistence of risk factors among adolescents. The analytical sample comprised 71,552 adolescents. According to the two herein generated profiles, adolescents classified under Profile 2 have shown behaviors such as smoking, alcohol consumption and diet rich in Ultra-processed food intake ≥ 80% of the percentage of total caloric value. In addition, adolescents presenting CVD risk profile have shown increased likelihood of being overweight. The study has found coexistence of risk factors for CVD in Brazilian adolescents, with emphasis on tobacco smoking and alcoholic beverage intake. In addition, it heads towards the analysis of the association between CVD risk factors and health outcomes, such as overweight.
6.
Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil
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LOUREDO, Brendo Vinicius Rodrigues
; CURADO, Maria Paula
; PENAFORT, Paulo Victor Mendes
; DE ARRUDA, José Alcides Almeida
; ABREU, Lucas Guimarães
; MESQUITA, Ricardo Alves
; PINTO-JÚNIOR, Décio dos Santos
; ABRAHÃO, Aline Corrêa
; ANDRADE, Bruno Augusto Benevenuto de
; AGOSTINI, Michelle
; MORAES, Renata Mendonça
; ANBINDER, Ana Lia
; DOURADO, Pedro Henrique Silva
; SANTOS, Teresa Cristina Ribeiro Bartholomeu dos
; PIRES, Fábio Ramoa
; BORDIGNON, Natalia Cristina Trentin
; GONDAK, Rogério Oliveira
; DE OLIVEIRA, Marcia Gaiger
; CARRARD, Vinicius Coelho
; MARTINS, Manoela Domingues
; SOUSA-NETO, Sebastião Silvério
; ARANTES, Diego Antônio Costa
; MENDONÇA, Elismauro Francisco
; CIESLAK-SANCHES, Silvia Roberta
; ANTUNES, Daniella Moraes
; AMARAL-SILVA, Gleyson Kleber do
; MANIERI, Patricia Rubia
; RAMALHO, Luciana Maria Pedreira
; DOS SANTOS, Jean Nunes
; LEONEL, Augusto César Leal da Silva
; PEREZ, Danyel Elias da Cruz
; VERHEUL, Hannah Carmem Carlos Ribeiro Silva
; BARROSO, Keila Martha Amorim
; RODRIGUES, Flávia Luiza Santos
; GONZAGA, Amanda Katarinny Goes
; FERNANDES, Romana Renery
; DE SOUZA, Lélia Batista
; SOUZA, Lucas Lacerda de
; PONTES, Flávia Sirotheau Corrêa
; PONTES, Hélder Antônio Rebelo
; SILVA, Caroline Alfaia
; CÂMARA, Jeconias
; LIBÓRIO-KIMURA, Tatiana Nayara
; SANTOS-SILVA, Alan Roger
; LOPES, Márcio Ajudarte
; ALMEIDA, Oslei Paes de
; ROMAÑACH, Mário José
; VARGAS, Pablo Agustin
.
Abstract This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients’ histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil’s Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System. (OMPLs SCC. . (SCC) crosssectional cross sectional North, North (North Northeast CentralWest, CentralWest Central West, West Central-West South. South South) 201 120010 120 010 120,01 20102019, 20102019 , (2010-2019) 69 6 9 6.9 8,321 8321 8 321 (8,32 0.8%, 08 0 (0.8% 95 cases, 4.9%, 49 4 (4.9% 5971 5 971 5,97 1.2%, 12 1 2 (1.2% 1399 399 1,39 Brazils s 64.5%, 645 64.5% 64 (64.5%) located men years level consumption group nonCaucasian non formercurrent former users Institute 99 9.9 Therefore System (SCC 20 12001 01 120,0 2010201 (2010-2019 6. 8,32 832 32 (8,3 0.8% (0.8 4.9% (4.9 597 97 5,9 1.2% (1.2 139 39 1,3 64.5 (64.5% 9. 1200 120, 201020 (2010-201 8,3 83 3 (8, 0.8 (0. 4.9 (4. 59 5, 1.2 (1. 13 1, 64. (64.5 20102 (2010-20 8, (8 0. (0 4. (4 1. (1 (64. (2010-2 ( (64 (2010- (6 (2010 (201 (20 (2
7.
Chikungunya virus infection in the southernmost state of Brazil was characterised by self-limited transmission (2017-2019) and a larger 2021 outbreak selflimited self limited 20172019 2017 2019 (2017-2019 202 2017201 201 (2017-201 20 201720 (2017-20 2 20172 (2017-2 (2017- (2017 (201 (20 (2 (
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Gregianini, Tatiana Schäffer
; Salvato, Richard Steiner
; Barcellos, Regina Bones
; Godinho, Fernanda Marques
; Ruivo, Amanda Pellenz
; de Melo, Viviane Horn
; Schroder, Júlio Augusto
; Martiny, Fernanda Letícia
; Möllmann, Erica Bortoli
; Favreto, Cátia
; Baethgen, Ludmila Fiorenzano
; Ferreira, Vithoria Pompermaier
; de Lima, Lívia Eidt
; Piazza, Cláudia Fasolo
; Machado, Taís Raquel Marcon
; Becker, Irina Marieta
; Ramos, Raquel Rocha
; Frölich, Guilherme Carey
; Rossetti, Alana Fraga
; Almeida, Lucas da Cunha
; Rodrigues, Tahiana Machado Antunes
; Bragança, Isabella Tabelli
; Campos, Aline Alves Scarpellini
; Manzoni, Verônica Baú
; Machado, Lais Ceschini
; da Silva, Luisa Maria Inácio
; de Oliveira, André Luiz Sá
; Paiva, Marcelo Henrique Santos
; Nunes, Zenaida Marion Alves
; de Almeida, Paula Rodrigues
; Demoliner, Meriane
; Gularte, Juliana Schons
; da Silva, Mariana Soares
; Filippi, Micheli
; Pereira, Vyctoria Malayhka de Abreu Góes
; Spilki, Fernando Rosado
; da Veiga, Ana Beatriz Gorini
; Wallau, Gabriel Luz
.
BACKGROUND Chikungunya is a mosquito-borne virus that has been causing large outbreaks in the Americas since 2014. In Brazil, Asian-Caribbean (AC) and East-Central-South-African (ECSA) genotypes have been detected and lead to large outbreaks in several Brazilian states. In Rio Grande do Sul (RS), the southernmost state of Brazil, the first cases were reported in 2016. OBJECTIVES AND METHODS We employed genome sequencing and epidemiological investigation to characterise the Chikungunya fever (CHIKF) burden in RS between 2017-2021. FINDINGS We detected an increasing CHIKF burden linked to travel associated introductions and communitary transmission of distinct lineages of the ECSA genotype during this period. MAIN CONCLUSIONS Until 2020, CHIKV introductions were most travel associated and transmission was limited. Then, in 2021, the largest outbreak occurred in the state associated with the introduction of a new ECSA lineage. CHIKV outbreaks are likely to occur in the near future due to abundant competent vectors and a susceptible population, exposing more than 11 million inhabitants to an increasing infection risk. mosquitoborne mosquito borne 2014 Brazil AsianCaribbean Asian Caribbean AC (AC EastCentralSouthAfrican East Central South African (ECSA states RS, , (RS) 2016 (CHIKF 20172021. 20172021 2017 2021. 2021 2017-2021 period 2020 limited Then lineage population 1 risk 201 (RS 2017202 202 2017-202 20 201720 2017-20 2 20172 2017-2 2017-
8.
Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023 202 20 2
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Marin-Neto, José Antonio
; Rassi Jr, Anis
; Oliveira, Gláucia Maria Moraes
; Correia, Luís Claudio Lemos
; Ramos Júnior, Alberto Novaes
; Luquetti, Alejandro Ostermayer
; Hasslocher-Moreno, Alejandro Marcel
; Sousa, Andréa Silvestre de
; Paola, Angelo Amato Vincenzo de
; Sousa, Antônio Carlos Sobral
; Ribeiro, Antonio Luiz Pinho
; Correia Filho, Dalmo
; Souza, Dilma do Socorro Moraes de
; Cunha-Neto, Edecio
; Ramires, Felix Jose Alvarez
; Bacal, Fernando
; Nunes, Maria do Carmo Pereira
; Martinelli Filho, Martino
; Scanavacca, Maurício Ibrahim
; Saraiva, Roberto Magalhães
; Oliveira Júnior, Wilson Alves de
; Lorga-Filho, Adalberto Menezes
; Guimarães, Adriana de Jesus Benevides de Almeida
; Braga, Adriana Lopes Latado
; Oliveira, Adriana Sarmento de
; Sarabanda, Alvaro Valentim Lima
; Pinto, Ana Yecê das Neves
; Carmo, Andre Assis Lopes do
; Schmidt, Andre
; Costa, Andréa Rodrigues da
; Ianni, Barbara Maria
; Markman Filho, Brivaldo
; Rochitte, Carlos Eduardo
; Macêdo, Carolina Thé
; Mady, Charles
; Chevillard, Christophe
; Virgens, Cláudio Marcelo Bittencourt das
; Castro, Cleudson Nery de
; Britto, Constança Felicia De Paoli de Carvalho
; Pisani, Cristiano
; Rassi, Daniela do Carmo
; Sobral Filho, Dário Celestino
; Almeida, Dirceu Rodrigues de
; Bocchi, Edimar Alcides
; Mesquita, Evandro Tinoco
; Mendes, Fernanda de Souza Nogueira Sardinha
; Gondim, Francisca Tatiana Pereira
; Silva, Gilberto Marcelo Sperandio da
; Peixoto, Giselle de Lima
; Lima, Gustavo Glotz de
; Veloso, Henrique Horta
; Moreira, Henrique Turin
; Lopes, Hugo Bellotti
; Pinto, Ibraim Masciarelli Francisco
; Ferreira, João Marcos Bemfica Barbosa
; Nunes, João Paulo Silva
; Barreto-Filho, José Augusto Soares
; Saraiva, José Francisco Kerr
; Lannes-Vieira, Joseli
; Oliveira, Joselina Luzia Menezes
; Armaganijan, Luciana Vidal
; Martins, Luiz Cláudio
; Sangenis, Luiz Henrique Conde
; Barbosa, Marco Paulo Tomaz
; Almeida-Santos, Marcos Antonio
; Simões, Marcos Vinicius
; Yasuda, Maria Aparecida Shikanai
; Moreira, Maria da Consolação Vieira
; Higuchi, Maria de Lourdes
; Monteiro, Maria Rita de Cassia Costa
; Mediano, Mauro Felippe Felix
; Lima, Mayara Maia
; Oliveira, Maykon Tavares de
; Romano, Minna Moreira Dias
; Araujo, Nadjar Nitz Silva Lociks de
; Medeiros, Paulo de Tarso Jorge
; Alves, Renato Vieira
; Teixeira, Ricardo Alkmim
; Pedrosa, Roberto Coury
; Aras Junior, Roque
; Torres, Rosalia Morais
; Povoa, Rui Manoel dos Santos
; Rassi, Sergio Gabriel
; Alves, Silvia Marinho Martins
; Tavares, Suelene Brito do Nascimento
; Palmeira, Swamy Lima
; Silva Júnior, Telêmaco Luiz da
; Rodrigues, Thiago da Rocha
; Madrini Junior, Vagner
; Brant, Veruska Maia da Costa
; Dutra, Walderez Ornelas
; Dias, João Carlos Pinto
.
9.
IMPACTO-MR: um estudo brasileiro de plataforma nacional para avaliar infecções e multirresistência em unidades de terapia intensiva IMPACTOMR IMPACTO MR IMPACTO-MR
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Tomazini, Bruno M
; Nassar Jr, Antonio Paulo
; Lisboa, Thiago Costa
; Azevedo, Luciano César Pontes de
; Veiga, Viviane Cordeiro
; Catarino, Daniela Ghidetti Mangas
; Fogazzi, Debora Vacaro
; Arns, Beatriz
; Piastrelli, Filipe Teixeira
; Dietrich, Camila
; Negrelli, Karina Leal
; Jesuíno, Isabella de Andrade
; Reis, Luiz Fernando Lima
; Mattos, Renata Rodrigues de
; Pinheiro, Carla Cristina Gomes
; Luz, Mariane Nascimento
; Spadoni, Clayse Carla da Silva
; Moro, Elisângela Emilene
; Bueno, Flávia Regina
; Sampaio, Camila Santana Justo Cintra
; Silva, Débora Patrício
; Baldassare, Franca Pellison
; Silva, Ana Cecilia Alcantara
; Veiga, Thabata
; Barbante, Leticia
; Lambauer, Marianne
; Campos, Viviane Bezerra
; Santos, Elton
; Santos, Renato Hideo Nakawaga
; Laranjeiras, Ligia Nasi
; Valeis, Nanci
; Santucci, Eliana
; Miranda, Tamiris Abait
; Patrocínio, Ana Cristina Lagoeiro do
; Carvalho, Andréa de
; Sousa, Eduvirgens Maria Couto de
; Sousa, Ancelmo Honorato Ferraz de
; Malheiro, Daniel Tavares
; Bezerra, Isabella Lott
; Rodrigues, Mirian Batista
; Malicia, Julliana Chicuta
; Silva, Sabrina Souza da
; Gimenes, Bruna dos Passos
; Sesin, Guilhermo Prates
; Zavascki, Alexandre Prehn
; Sganzerla, Daniel
; Medeiros, Gregory Saraiva
; Santos, Rosa da Rosa Minho dos
; Silva, Fernanda Kelly Romeiro
; Cheno, Maysa Yukari
; Abrahão, Carolinne Ferreira
; Oliveira Junior, Haliton Alves de
; Rocha, Leonardo Lima
; Nunes Neto, Pedro Aniceto
; Pereira, Valéria Chagas
; Paciência, Luis Eduardo Miranda
; Bueno, Elaine Silva
; Caser, Eliana Bernadete
; Ribeiro, Larissa Zuqui
; Fernandes, Caio Cesar Ferreira
; Garcia, Juliana Mazzei
; Silva, Vanildes de Fátima Fernandes
; Santos, Alisson Junior dos
; Machado, Flávia Ribeiro
; Souza, Maria Aparecida de
; Ferronato, Bianca Ramos
; Urbano, Hugo Corrêa de Andrade
; Moreira, Danielle Conceição Aparecida
; Souza-Dantas, Vicente Cés de
; Duarte, Diego Meireles
; Coelho, Juliana
; Figueiredo, Rodrigo Cruvinel
; Foreque, Fernanda
; Romano, Thiago Gomes
; Cubos, Daniel
; Spirale, Vladimir Miguel
; Nogueira, Roberta Schiavon
; Maia, Israel Silva
; Zandonai, Cassio Luis
; Lovato, Wilson José
; Cerantola, Rodrigo Barbosa
; Toledo, Tatiana Gozzi Pancev
; Tomba, Pablo Oscar
; Almeida, Joyce Ramos de
; Sanches, Luciana Coelho
; Pierini, Leticia
; Cunha, Mariana
; Sousa, Michelle Tereza
; Azevedo, Bruna
; Dal-Pizzol, Felipe
; Damasio, Danusa de Castro
; Bainy, Marina Peres
; Beduhn, Dagoberta Alves Vieira
; Jatobá, Joana D’Arc Vila Nova
; Moura, Maria Tereza Farias de
; Rego, Leila Rezegue de Moraes
; Silva, Adria Vanessa da
; Oliveira, Luana Pontes
; Sodré Filho, Eliene Sá
; Santos, Silvana Soares dos
; Neves, Itallo de Lima
; Leão, Vanessa Cristina de Aquino
; Paes, João Lucidio Lobato
; Silva, Marielle Cristina Mendes
; Oliveira, Cláudio Dornas de
; Santiago, Raquel Caldeira Brant
; Paranhos, Jorge Luiz da Rocha
; Wiermann, Iany Grinezia da Silva
; Pedroso, Durval Ferreira Fonseca
; Sawada, Priscilla Yoshiko
; Prestes, Rejane Martins
; Nascimento, Glícia Cardoso
; Grion, Cintia Magalhães Carvalho
; Carrilho, Claudia Maria Dantas de Maio
; Dantas, Roberta Lacerda Almeida de Miranda
; Silva, Eliane Pereira
; Silva, Antônio Carlos da
; Oliveira, Sheila Mara Bezerra de
; Golin, Nicole Alberti
; Tregnago, Rogerio
; Lima, Valéria Paes
; Silva, Kamilla Grasielle Nunes da
; Boschi, Emerson
; Buffon, Viviane
; Machado, André Sant’Ana
; Capeletti, Leticia
; Foernges, Rafael Botelho
; Carvalho, Andréia Schubert de
; Oliveira Junior, Lúcio Couto de
; Oliveira, Daniela Cunha de
; Silva, Everton Macêdo
; Ribeiro, Julival
; Pereira, Francielle Constantino
; Salgado, Fernanda Borges
; Deutschendorf, Caroline
; Silva, Cristofer Farias da
; Gobatto, Andre Luiz Nunes
; Oliveira, Carolaine Bomfim de
; Dracoulakis, Marianna Deway Andrade
; Alvaia, Natália Oliveira Santos
; Souza, Roberta Machado de
; Araújo, Larissa Liz Cardoso de
; Melo, Rodrigo Morel Vieira de
; Passos, Luiz Carlos Santana
; Vidal, Claudia Fernanda de Lacerda
; Rodrigues, Fernanda Lopes de Albuquerque
; Kurtz, Pedro
; Shinotsuka, Cássia Righy
; Tavares, Maria Brandão
; Santana, Igor das Virgens
; Gavinho, Luciana Macedo da Silva
; Nascimento, Alaís Brito
; Pereira, Adriano J
; Cavalcanti, Alexandre Biasi
.
RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos. Objetivo IMPACTOMR, IMPACTOMR IMPACTO MR, MR saúde Métodos Resultados System demográficos comorbidades funcional secundários laboratoriais outros 201 2020 33983 33 983 33.98 5 principal Conclusão multicêntricos 20 202 3398 3 98 33.9 2 339 9 33.
ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials. Objective IMPACTOMR, IMPACTOMR IMPACTO MR, MR careassociated associated multidrugresistant multidrug resistant bacteria Methods selection collection objectives Results System status scores diagnoses laboratory stay others 201 2020 33983 33 983 33,98 5 Conclusion trials 20 202 3398 3 98 33,9 2 339 9 33,
10.
[SciELO Preprints] - Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy
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Marin-Neto, José Antonio
Rassi Jr., Anis
Moraes Oliveira, Gláucia M.
Lemos Correia, Luís Claudio
Novaes Ramos Jr., Alberto
Hasslocher-Moreno, Alejandro Marcel
Luquetti Ostermayer, Alejandro
Sousa, Andréa Silvestre de
Amato Vincenzo de Paola, Angelo
Sobral de Sousa, Antonio Carlos
Pinho Ribeiro, Antonio Luiz
Correia Filho, Dalmo
Moraes de Souza, Dilma do Socorro
Cunha-Neto, Edecio
J. A. Ramires, Felix
Bacal, Fernando
Pereira Nunes, Maria do Carmo
Martinelli Filho, Martino
Ibrahim Scanavacca, Maurício
Magalhães Saraiva, Roberto
Alves de Oliveira Júnior, Wilson
M. Lorga-Filho, Adalberto
de Jesus Benevides de Almeida Guimarães, Adriana
Lopes Latado Braga, Adriana
Sarmento de Oliveira, Adriana
V. L. Sarabanda, Alvaro
Yecê das Neves Pinto, Ana
Assis Lopes do Carmo, André
Schmidt, André
Costa, Andréa Rodrigues da
Ianni, Barbara Maria
Markman Filho, Brivaldo
Eduardo Rochitte, Carlos
Thé Macedo, Carolina
Mady, Charles
Chevillard, Christophe
Bittencourt das Virgens, Cláudio Marcelo
Nery de Castro, Cleudson
De Paoli de Carvalho Britto, Constança Felícia
Pisani, Cristiano
do Carmo Rassi, Daniela
C. Sobral Filho, Dario
Rodrigues Almeida, Dirceu
A. Bocchi, Edimar
T. Mesquita, Evandro
de Souza Nogueira Sardinha Mendes, Fernanda
Pereira, Francisca Tatiana
Sperandio da Silva, Gilberto Marcelo
de Lima Peixoto, Giselle
Glotz de Lima, Gustavo
H. Veloso, Henrique
Turin Moreira, Henrique
Bellotti Lopes, Hugo
Masciarelli Francisco Pinto, Ibraim
Pinto Dias, João Carlos
Bemfica, João Marcos
Silva-Nunes, João Paulo
Soares Barreto-Filho, José Augusto
Kerr Saraiva, José Francisco
Lannes-Vieira, Joseli
Menezes Oliveira, Joselina Luzia
V. Armaganijan, Luciana
Martins, Luiz Cláudio
C. Sangenis, Luiz Henrique
Barbosa, Marco Paulo
Almeida-Santos, Marcos Antônio
Simões, Marcos Vinicius
Shikanai-Yasuda, Maria Aparecida
Vieira Moreira, Maria da Consolação
Higuchi, Maria de Lourdes
Costa Monteiro, Maria Rita de Cássia
Felix Mediano, Mauro Felippe
Maia Lima, Mayara
T. Oliveira, Maykon
Moreira Dias Romano , Minna
Nitz, Nadjar
de Tarso Jorge Medeiros, Paulo
Vieira Alves, Renato
Alkmim Teixeira, Ricardo
Coury Pedrosa, Roberto
Aras, Roque
Morais Torres, Rosália
dos Santos Povoa, Rui Manoel
Rassi, Sérgio Gabriel
Salles Xavier, Sérgio
Marinho Martins Alves , Silvia
B. N. Tavares, Suelene
Lima Palmeira, Swamy
da Silva Junior, Telêmaco Luiz
da Rocha Rodrigues, Thiago
Madrini Junior, Vagner
Maia da Costa , Veruska
Dutra, Walderez
This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.nbsp;
Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.
nbsp;
Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.nbsp;
The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.nbsp;
The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.nbsp; nbsp;nbsp;
Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.
Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou.
A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica.
Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas.
A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica.
A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.nbsp;nbsp;nbsp;
Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.nbsp;
11.
Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS
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Freitas, Flavio Geraldo Rezende de
; Hammond, Naomi
; Li, Yang
; Azevedo, Luciano Cesar Pontes de
; Cavalcanti, Alexandre Biasi
; Taniguchi, Leandro
; Gobatto, André
; Japiassú, André Miguel
; Bafi, Antonio Tonete
; Mazza, Bruno Franco
; Noritomi, Danilo Teixeira
; Dal-Pizzol, Felipe
; Bozza, Fernando
; Salluh, Jorge Ibrahin Figueira
; Westphal, Glauco Adrieno
; Soares, Márcio
; Assunção, Murillo Santucci César de
; Lisboa, Thiago
; Lobo, Suzana Margarete Ajeje
; Barbosa, Achilles Rohlfs
; Ventura, Adriana Fonseca
; Souza, Ailson Faria de
; Silva, Alexandre Francisco
; Toledo, Alexandre
; Reis, Aline
; Cembranel, Allan
; Rea Neto, Alvaro
; Gut, Ana Lúcia
; Justo, Ana Patricia Pierre
; Santos, Ana Paula
; Albuquerque, André Campos D. de
; Scazufka, André
; Rodrigues, Antonio Babo
; Fernandino, Bruno Bonaccorsi
; Silva, Bruno Goncalves
; Vidal, Bruno Sarno
; Pinheiro, Bruno Valle
; Pinto, Bruno Vilela Costa
; Feijo, Carlos Augusto Ramos
; Abreu Filho, Carlos de
; Bosso, Carlos Eduardo da Costa Nunes
; Moreira, Carlos Eduardo Nassif
; Ramos, Carlos Henrique Ferreira
; Tavares, Carmen
; Arantes, Cidamaiá
; Grion, Cintia
; Mendes, Ciro Leite
; Kmohan, Claudio
; Piras, Claudio
; Castro, Cristine Pilati Pileggi
; Lins, Cyntia
; Beraldo, Daniel
; Fontes, Daniel
; Boni, Daniela
; Castiglioni, Débora
; Paisani, Denise de Moraes
; Pedroso, Durval Ferreira Fonseca
; Mattos, Ederson Roberto
; Brito Sobrinho, Edgar de
; Troncoso, Edgar M. V.
; Rodrigues Filho, Edison Moraes
; Nogueira, Eduardo Enrico Ferrari
; Ferreira, Eduardo Leme
; Pacheco, Eduardo Souza
; Jodar, Euzebio
; Ferreira, Evandro L. A.
; Araujo, Fabiana Fernandes de
; Trevisol, Fabiana Schuelter
; Amorim, Fábio Ferreira
; Giannini, Fabio Poianas
; Santos, Fabrício Primitivo Matos
; Buarque, Fátima
; Lima, Felipe Gallego
; Costa, Fernando Antonio Alvares da
; Sad, Fernando Cesar dos Anjos
; Aranha, Fernando G.
; Ganem, Fernando
; Callil, Flavio
; Costa Filho, Francisco Flávio
; Dall´Arto, Frederico Toledo Campo
; Moreno, Geovani
; Friedman, Gilberto
; Moralez, Giulliana Martines
; Silva, Guilherme Abdalla da
; Costa, Guilherme
; Cavalcanti, Guilherme Silva
; Cavalcanti, Guilherme Silva
; Betônico, Gustavo Navarro
; Betônico, Gustavo Navarro
; Reis, Hélder
; Araujo, Helia Beatriz N.
; Hortiz Júnior, Helio Anjos
; Guimaraes, Helio Penna
; Urbano, Hugo
; Maia, Israel
; Santiago Filho, Ivan Lopes
; Farhat Júnior, Jamil
; Alvarez, Janu Rangel
; Passos, Joel Tavares
; Paranhos, Jorge Eduardo da Rocha
; Marques, José Aurelio
; Moreira Filho, José Gonçalves
; Andrade, Jose Neto
; Sobrinho, José Onofre de C
; Bezerra, Jose Terceiro de Paiva
; Alves, Juliana Apolônio
; Ferreira, Juliana
; Gomes, Jussara
; Sato, Karina Midori
; Gerent, Karine
; Teixeira, Kathia Margarida Costa
; Conde, Katia Aparecida Pessoa
; Martins, Laércia Ferreira
; Figueirêdo, Lanese
; Rezegue, Leila
; Tcherniacovsk, Leonardo
; Ferraz, Leone Oliveira
; Cavalcante, Liane
; Rabelo, Ligia
; Miilher, Lilian
; Garcia, Lisiane
; Tannous, Luana
; Hajjar, Ludhmila Abrahão
; Paciência, Luís Eduardo Miranda
; Cruz Neto, Luiz Monteiro da
; Bley, Macia Valeria
; Sousa, Marcelo Ferreira
; Puga, Marcelo Lourencini
; Romano, Marcelo Luz Pereira
; Nobrega, Marciano
; Arbex, Marcio
; Rodrigues, Márcio Leite
; Guerreiro, Márcio Osório
; Rocha, Marcone
; Alves, Maria Angela Pangoni
; Alves, Maria Angela Pangoni
; Rosa, Maria Doroti
; Dias, Mariza D’Agostino
; Martins, Miquéias
; Oliveira, Mirella de
; Moretti, Miriane Melo Silveira
; Matsui, Mirna
; Messender, Octavio
; Santarém, Orlando Luís de Andrade
; Silveira, Patricio Júnior Henrique da
; Vassallo, Paula Frizera
; Antoniazzi, Paulo
; Gottardo, Paulo César
; Correia, Paulo
; Ferreira, Paulo
; Torres, Paulo
; Silva, Pedro Gabrile M. de Barros e
; Foernges, Rafael
; Gomes, Rafael
; Moraes, Rafael
; Nonato filho, Raimundo
; Borba, Renato Luis
; Gomes, Renato V
; Cordioli, Ricardo
; Lima, Ricardo
; López, Ricardo Pérez
; Gargioni, Ricardo Rath de Oliveira
; Rosenblat, Richard
; Souza, Roberta Machado de
; Almeida, Roberto
; Narciso, Roberto Camargo
; Marco, Roberto
; waltrick, Roberto
; Biondi, Rodrigo
; Figueiredo, Rodrigo
; Dutra, Rodrigo Santana
; Batista, Roseane
; Felipe, Rouge
; Franco, Rubens Sergio da Silva
; Houly, Sandra
; Faria, Sara Socorro
; Pinto, Sergio Felix
; Luzzi, Sergio
; Sant’ana, Sergio
; Fernandes, Sergio Sonego
; Yamada, Sérgio
; Zajac, Sérgio
; Vaz, Sidiner Mesquita
; Bezerra, Silvia Aparecida Bezerra
; Farhat, Tatiana Bueno Tardivo
; Santos, Thiago Martins
; Smith, Tiago
; Silva, Ulysses V. A.
; Damasceno, Valnei Bento
; Nobre, Vandack
; Dantas, Vicente Cés de Souza
; Irineu, Vivian Menezes
; Bogado, Viviane
; Nedel, Wagner
; Campos Filho, Walther
; Dantas, Weidson
; Viana, William
; Oliveira Filho, Wilson de
; Delgadinho, Wilson Martins
; Finfer, Simon
; Machado, Flavia Ribeiro
.
RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.
Abstract Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
https://doi.org/10.5935/0103-507x.20210028
273 downloads
12.
COVID-19 diagnosis by RT-qPCR in alternative specimens
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Gonçalves, Cássia Cristina Alves
; Barroso, Shana Priscila Coutinho
; Herlinger, Alice Laschuk
; Galliez, Rafael de Mello
; de Almeida, Tailah Bernardo
; Boullosa, Lidia Theodoro
; Nascimento, Erica Ramos dos Santos
; de Almeida, Jessica M
; da Costa, Raissa Mirella dos Santos Cunha
; da Paixão, Tatiana Monteiro
; Couceiro, José Nelson dos Santos Silva
; Frauches, Thiago Silva
; de Souza Jr, Wilson Rodrigues
; Costa, Andréa Ribeiro
; Faffe, Débora Souza
; Leitão, Isabela de Carvalho
; da Silva, Bianca Ortiz
; de Lira, Guilherme Sant’Anna
; de Almeida, Isabela Labarba Carvalho
; Ferreira Jr, Orlando da Costa
; Castiñeiras, Terezinha Marta Pereira Pinto
; Mariani, Diana
; Tanuri, Amilcar
.
BACKGROUND The high demand for adequate material for the gold standard reverse transcription real-time polymerase chain reaction (RT-qPCR)-based diagnosis imposed by the Coronavirus disease 2019 (COVID-19) pandemic, combined with the inherent contamination risks for healthcare workers during nasopharyngeal swab (NP) sample collection and the discomfort it causes patients, brought the need to identify alternative specimens suitable for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVES The aim of this work was to compare saliva and gingival fluid swabs to NP swabs as specimens for RT-qPCR-based SARS-CoV-2 diagnosis. METHODS We compared gingival fluid swabs (n = 158) and saliva (n = 207) to the rayon-tipped NP swabs obtained from mild-symptomatic and asymptomatic subjects as specimens for RT-qPCR for SARS-CoV-2 detection. FINDINGS When compared to NP swabs, gingival fluid swabs had a concordance rate of 15.4% among positive samples, zero among inconclusive, and 100% among negative ones. For saliva samples, the concordance rate was 67.6% among positive samples, 42.9% among inconclusive, and 96.8% among negative ones. However, the concordance rate between saliva and NP swabs was higher (96.9%) within samples with lower cycle threshold (Ct) values (Ct > 10 ≤ 25). MAIN CONCLUSIONS Our data suggests that whereas gingival fluid swabs are not substitutes for NP swabs, saliva might be considered whenever NP swabs are not available or recommended.
https://doi.org/10.1590/0074-02760210085
205 downloads
13.
O ensino da prática médica no internato em tempo de pandemia: aprendizados e impactos emocionais
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Andrade, Maria Denise Fernandes Carvalho de
; Coelho, Mayara Rocha
; Bachur, Tatiana Paschoalette Rodrigues
; Bezerra, João Ernesto Moura Sobreira
; Almeida, Maria Irismar de
; Branco, Layza Mendes Castelo
.
Resumo: Introdução: Diante da pandemia ocasionada pelo vírus Sars-CoV-2, diversos profissionais da saúde depararam-se com novos desafios. Estudantes internos de Medicina também se encontram imersos nesse cenário e foram afetados no desempenho de seus papéis. Consiste este trabalho na observação dos aspectos físicos e psíquicos dos estudantes de Medicina que estão no período do internato nessa conjuntura. Objetivo: Desse modo, objetivou-se identificar os aprendizados e os impactos emocionais que os internos estão vivenciando no início de suas inserções no Sistema Único de Saúde diante da pandemia. Método: Para tanto, realizou-se uma análise qualitativa das narrativas de 37 internos de Medicina da Universidade Estadual do Ceará (23 do sexo masculino e 14 do sexo feminino), com média de idade de 25,5 anos, que responderam a um questionário eletrônico que lhes fora enviado como estratégia para auxiliar a coordenação do curso a organizar o internato no contexto pandêmico. Resultado: A relação dos internos com preceptores de Medicina foi destacada como causadora de sofrimento psíquico e carente de aprendizado antes e durante a pandemia. Observou-se a presença constante de sentimentos ambivalentes. Muitos dos internos de Medicina desejavam ajudar reconhecendo a importância de sua contribuição neste momento complexo da saúde no país. Todavia, alguns se sentiam inseguros com a situação crítica decorrente da pandemia, com receios acerca da segurança pessoal e familiar dos internos. Uma das razões pontuada foi a escassez de equipamentos de proteção individual (EPI). Conclusão: Vários internos ressaltaram o interesse em continuar o internato, e, por isso, é fundamental que os EPI estejam disponíveis para uso dos alunos. Diante do contexto de pandemia ou não, é imprescindível que o relacionamento entre preceptores e internos seja mais pedagógico e proporcione aprendizado aos estudantes. A apresentação desta experiência pode servir como recurso para a compreensão de cenários semelhantes, auxiliando a iluminar as relações do internato de Medicina que precisam passar por melhorias contínuas, quer em tempos de pandemia ou não, para favorecer a busca contínua por uma formação acadêmica de qualidade.
Abstract: Introduction: The pandemic caused by the Sars-CoV-2 virus has generated new challenges for numerous health professionals. Clerkship students are also immersed in this scenario and have been affected in the performance of their duties. This work consists of observing the physical and psychological aspects of medical students currently in their clerkship. Objective: Thus, the objective was to identify the learning and emotional impacts that clerkship students are experiencing in their initial placements in the Unified Health System against the backdrop of the pandemic. Method: A qualitative analysis of the accounts given by 37 medical interns at the Universidade Estadual do Ceará (23 men and 14 women; mean age 25.5 years old) was conducted. They answered an electronic questionnaire applied by the course coordination as a strategy to assist in the organization of the clerkship program during the pandemic. Results: The relationship between the clerkship students and medical preceptors was highlighted as causing psychological distress and lack of learning before and during the pandemic. There was a constant presence of ambivalent feelings. Many clerkship students wanted to help, recognizing that they could make an important contribution during this health crisis in the country. However, some felt insecure about the critical situation resulting from the pandemic and feared for the safety of the clerkship students and their respective families. One of the cited reasons was the scarcity of personal protective equipment (PPE). Conclusions: Several clerkship students highlighted the interest in continuing the clerkship program and that is why it is essential that PPE is available for students to use. Whether in the grips of a pandemic or not, it is essential that the relationship between preceptors and clerkship students is more pedagogical and provides learning to students. The presentation of this experience can serve as a resource for the understanding of similar scenarios, helping to shed light on the medical intern’s relationships that need to undergo continuous improvements, whether during a pandemic or not, to support the ongoing quest for an academic education of quality.
https://doi.org/10.1590/1981-5271v45.4-20200218
36 downloads
14.
Saúde bucal de adolescentes rurais quilombolas e não quilombolas: um estudo dos hábitos de higiene e fatores associados
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Silva, Etna Kaliane Pereira da
; Santos, Patrícia Reis dos
; Chequer, Tatiana Praxedes Rodrigues
; Melo, Camila Moreira de Almeida
; Santana, Katiuscy Carneiro
; Amorim, Maise Mendonça
; Medeiros, Danielle Souto de
.
Resumo Este estudo avaliou os hábitos de higiene bucal e sua associação com fatores socioculturais, ambientais e relacionados à utilização de serviços odontológicos entre adolescentes rurais quilombolas e não quilombolas do interior da Bahia. Foi um estudo transversal realizado em 2015. Estimaram-se prevalências e razões de prevalências para os desfechos e foi conduzida análise múltipla por regressão de Poisson com variância robusta. Foram entrevistados 390 adolescentes, 42,8% quilombolas. Escovação dentária insatisfatória e não uso do fio dental foram encontrados em 33,3% e 46,7% dos adolescentes, respectivamente. Mostraram aumentar a escovação dentária insatisfatória: sexo masculino (RP = 1,45), não morar com ambos os pais (RP = 1,45), menor hábito de lavar as mãos (RP = 1,72) e pior autoavaliação da saúde bucal (RP = 1,38). Com o não uso de fio dental, mostraram-se associados: nível econômico E (RP = 1,54), maior idade (RP = 0,91) menor hábito de lavar as mãos (RP = 1,53) e pior autoavaliação da saúde bucal (RP = 1,33). Distintos fatores associados foram observados entre quilombolas e não quilombolas. Ressalta-se a necessidade de se considerar as especificidades das populações para a promoção da saúde bucal dos adolescentes e a importância da intersetorialidade entre educação e saúde e a atenção às famílias.
Abstract This study evaluated oral hygiene habits and their association with sociocultural, environmental factors and factors related to the use of dental services among Quilombola and non-Quilombola rural adolescents from inland Bahia. Thiswas a cross-sectional study conducted in 2015. Prevalence and prevalence ratios were estimated for the outcomes and multiple Poisson regression analysis with robust variance was performed. We interviewed 390 adolescents, of which 42.8% were Quilombola. Poor tooth brushing and non-flossing were found in 33.3% and 46.7% of adolescents, respectively. Poor tooth brushing was increased by male gender (PR = 1.45), not living with both parents (PR = 1.45), lower hand hygiene habit (PR = 1.72) and worse oral health self-assessment (PR = 1.38). Non-flossing was associated with economic level E (PR = 1.54), older age (PR = 0.91), lower hand hygiene habit (PR = 1.53) and worse oral health self-assessment (PR = 1.33). Different associated factors were observed between Quilombola and non-Quilombola. It is necessary to consider the specificities of the populations for the promotion of adolescent oral health and the importance of the intersectoriality between education and health and care to families.
https://doi.org/10.1590/1413-81232018239.02532018
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15.
Analysis of the immunological biomarker profile during acute Zika virus infection reveals the overexpression of CXCL10, a chemokine linked to neuronal damage
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Naveca, Felipe Gomes
; Pontes, Gemilson Soares
; Chang, Aileen Yu-hen
; Silva, George Allan Villarouco da
; Nascimento, Valdinete Alves do
; Monteiro, Dana Cristina da Silva
; Silva, Marineide Souza da
; Abdalla, Lígia Fernandes
; Santos, João Hugo Abdalla
; Almeida, Tatiana Amaral Pires de
; Mejía, Matilde del Carmen Contreras
; Mesquita, Tirza Gabrielle Ramos de
; Encarnação, Helia Valeria de Souza
; Gomes, Matheus de Souza
; Amaral, Laurence Rodrigues
; Campi-Azevedo, Ana Carolina
; Coelho-dos-Reis, Jordana Graziela
; Antonelli, Lis Ribeiro do Vale
; Teixeira-Carvalho, Andréa
; Martins-Filho, Olindo Assis
; Ramasawmy, Rajendranath
.
BACKGROUND Infection with Zika virus (ZIKV) manifests in a broad spectrum of disease ranging from mild illness to severe neurological complications and little is known about Zika immunopathogenesis. OBJECTIVES To define the immunologic biomarkers that correlate with acute ZIKV infection. METHODS We characterized the levels of circulating cytokines, chemokines, and growth factors in 54 infected patients of both genders at five different time points after symptom onset using microbeads multiplex immunoassay; comparison to 100 age-matched controls was performed for statistical analysis and data mining. FINDINGS ZIKV-infected patients present a striking systemic inflammatory response with high levels of pro-inflammatory mediators. Despite the strong inflammatory pattern, IL-1Ra and IL-4 are also induced during the acute infection. Interestingly, the inflammatory cytokines IL-1β, IL-13, IL-17, TNF-α, and IFN-γ; chemokines CXCL8, CCL2, CCL5; and the growth factor G-CSF, displayed a bimodal distribution accompanying viremia. While this is the first manuscript to document bimodal distributions of viremia in ZIKV infection, this has been documented in other viral infections, with a primary viremia peak during mild systemic disease and a secondary peak associated with distribution of the virus to organs and tissues. MAIN CONCLUSIONS Biomarker network analysis demonstrated distinct dynamics in concurrence with the bimodal viremia profiles at different time points during ZIKV infection. Such a robust cytokine and chemokine response has been associated with blood-brain barrier permeability and neuroinvasiveness in other flaviviral infections. High-dimensional data analysis further identified CXCL10, a chemokine involved in foetal neuron apoptosis and Guillain-Barré syndrome, as the most promising biomarker of acute ZIKV infection for potential clinical application.
https://doi.org/10.1590/0074-02760170542
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