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[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 Silvestre de Sousa, Andréa Silvestre de Sousa 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 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

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Publication date: 2022-10-11

Abstract: En Pt

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;

https://doi.org/10.1590/SciELOPreprints.4820

[SciELO Preprints] - Transition of care for post-Covid-19 patients: sociodemographic and clinical profile and associated factors
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Arrais, Diego Joao de Lima Costa, Maria Fernanda Baeta Neves Alonso da Cunha, Carlos Leonardo Figueiredo da Gomes, Mateus Cunha Riegel, Fernando Parente, Andressa Tavares Rodrigues, Diego Pereira Aben-Athar, Cintia Yolette Urbano Pauxis Ramos, Aline Maria Cruz Sousa, Fabianne

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Publication date: 2022-06-03

Abstract: En Pt Es

Objective: to identify the sociodemographic and clinical characteristics and factors associated with the transition of care for patients recovered from Covid-19. Method: a cross-sectional study with a quantitative approach carried out with 49 patients and/or caregivers who were discharged home from a university hospital. Three instruments were used, the sociodemographic questionnaire, the clinical questionnaire, and the Carenbsp;Transitions Measure instrument to assess the transition of care. The analysis was performed using SPSS software, applying the Mann-Whitney test, adopting a significance level of p  0,005. Results: of the 49 participants, they were male (59.2%) with a mean age of 50 years, with more than 10 years of schooling. The main symptoms of Covid-19 were dyspnea (79.6%) followed by fatigue (75.5%) and fever (69.4%). The most prevalent comorbidity was systemic arterial hypertension (32.7%). There was a significant association between the transition of care and comorbidities (Diabetes mellitus, Obesity and Cancer) (p0,005). Conclusion and implications for practice: Covid-19 coping practices were successful, reflecting the transition from high care. However, the need to implement public policies after hospital discharge in a pandemic context is highlighted.nbsp;

Objetivo: identificar as características sociodemográficas, clínicas e fatores associados à transição do cuidado de pacientes recuperados de Covid-19. Método: estudo transversal com abordagem quantitativa realizado com 49 pacientes e/ou cuidadores que receberam alta hospitalar para o domicílio em um hospital universitário. Utilizou-se três instrumentos, o questionário sociodemográfico, o clínico e o instrumento Care Transitions Measure para avaliar a transição do cuidado. A análise foi realizada por meio do software SPSS, aplicado o Teste de Mann-Whitney adotado nível de significância p  0,005. Resultados: dos 49 participantes, eram do sexo masculino (59,2%) com média de idade de 50 anos apresentando escolaridade acima de 10 anos de estudo. Os principais sintomas da Covid-19 foram dispneia (79,6%) seguidos de fadiga (75,5%) e febre (69,4%). A comorbidade mais prevalente foi a Hipertensão arterial sistêmica (32,7%). Houve associação significativa entre a transição do cuidado com as comorbidades (Diabetes mellitus, Obesidade e Câncer) (p0,005). Conclusão e implicações para a prática: as práticas de enfrentamento a Covid-19 foram bem-sucedidas refletindo na transição do cuidado alta. Contudo ressalta-se a necessidade de implementação de políticas públicas após alta hospitalar em contexto pandêmico.nbsp;

Objetivo: identificar las características sociodemográficas, clínicas y factores asociados a la transición de la atención a pacientes recuperados de Covid-19. Método: estudio transversal con abordaje cuantitativo realizado con 49 pacientes y/o cuidadores que fueron dados de alta de un hospital universitario. Se utilizaron tres instrumentos, el cuestionario sociodemográfico, el cuestionario clínico y el instrumento Care Transitions Measure para evaluar la transición del cuidado. El análisis se realizó mediante el software SPSS, aplicando la prueba de Mann-Whitney, adoptando un nivel de significancia de p  0,005. Resultados: de los 49 participantes, eran del sexo masculino (59,2%) con una edad media de 50 años, con más de 10 años de escolaridad. Los principales síntomas de la Covid-19 fueron disnea (79,6 %) seguida de fatiga (75,5 %) y fiebre (69,4 %). La comorbilidad más prevalente fue la hipertensión arterial sistémica (32,7%). Hubo asociación significativa entre la transición de cuidados y las comorbilidades (Diabetes mellitus, Obesidad y Cáncer) (p0,005). Conclusión e implicaciones para la práctica: las prácticas de afrontamiento de Covid-19 fueron exitosas, lo que refleja la transición desde la alta atención. Sin embargo, se destaca la necesidad de implementar políticas públicas tras el alta hospitalaria en contexto de pandemia.

https://doi.org/10.1590/SciELOPreprints.4216

[SciELO Preprints] - Transitional care of post-COVID-19 patients: from hospital discharge to home
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Sousa, Fabianne Arrais, Diego João de Lima Costa, Maria Fernanda Baeta Neves Alonso da Riegel, Fernando Cunha, Carlos Leonardo Figueiredo da Parente, Andressa Tavares Aben-Athar, Cintia Yolette Urbano Pauxis Ramos, Aline Maria Cruz

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Publication date: 2022-05-23

Abstract: En Pt Es

Objective: To assess the quality of the care transition of post-COVID-19 patients who were discharged from the hospital service to their home. Method: Quantitative, cross-sectional, descriptive and analytical study carried out in a university hospital in Northern Brazil, from May to December 2021. The sample consisted of 49 participants. Data collection took place through a sociodemographic questionnaire and the Care Transitions Measure (CTM-15) translated and validated into Portuguese. Results: The mean score for the transition of care was 87.4 (±16.1). Factor 1 (Self-Management Training) had an average score of 82.6 (± 14.8), Factor 2 (Understanding of Medication) 86.6 (± 15.0), Factor 3 (Respected Preferences) 82.0 ( ± 16.7) and Factor 4 (Care Plan) 81.2 (± 18.2). Conclusion: The quality of the care transition perceived by the patient recovered from COVID-19, or by their caregivers, in the process of hospital discharge to home, was considered high, evidencing the involvement of the multidisciplinary team in the preparation and guidelines for the follow-up of care. at home, reducing the rates of readmissions and post-discharge complications.

Objetivo: Avaliar a qualidade da transição do cuidado de pacientes pós-COVID-19 que tiveram alta do serviço hospitalar para o domicílio. Método: Estudo quantitativo, do tipo transversal, descritivo e analítico realizado em um hospital universitário no Norte do Brasil, de maio a dezembro de 2021. A amostra foi composta por 49 participantes. A coleta de dados ocorreu por meio de um questionário sociodemográfico e do instrumento de avaliação da transição de cuidados, o Care Transitions Measure (CTM-15) traduzido e validado para o português. Resultados: A pontuação média para a transição do cuidado foi de 87,4 (±16,1). O Fator 1 (Treinamento de Autogestão) obteve uma pontuação média de 82,6 (± 14,8), Fator 2 (Entendimento da Medicação) 86,6 (± 15,0), Fator 3 (Preferências Respeitadas) 82,0 (± 16,7) e Fator 4 (Plano de Cuidados) 81,2 (±18,2). Conclusão: A qualidade da transição do cuidado percebida pelo paciente recuperado de COVID-19, ou por seus cuidadores, no processo de alta hospitalar para o domicílio, foi considerada alta, evidenciando o envolvimento da equipe multiprofissional no preparo e orientações para o seguimento dos cuidados no domicílio, reduzindo as taxas de re-internações e complicações pós alta hospitalar.

Objetivo: Evaluar la calidad de la transición asistencial de los pacientes post-COVID-19 que fueron dados de alta del servicio hospitalario a su domicilio. Método: Estudio cuantitativo, transversal, descriptivo y analítico realizado en un hospital universitario del Norte de Brasil, de mayo a diciembre de 2021. La muestra estuvo compuesta por 49 participantes. La recolección de datos ocurrió a través de un cuestionario sociodemográfico y la Medida de Transiciones de Atención (CTM-15) traducida y validada para el portugués. Resultados: La puntuación media para la transición de cuidados fue de 87,4 (±16,1). El Factor 1 (Entrenamiento de Automanejo) tuvo un puntaje promedio de 82.6 (± 14.8), el Factor 2 (Comprensión de Medicamentos) 86.6 (± 15.0), el Factor 3 (Preferencias Respetadas) 82.0 (± 16.7) y el Factor 4 (Plan de Cuidados) 81,2 (± 18,2). Conclusión: La calidad de la transición asistencial percibida por el paciente recuperado de COVID-19, o por sus cuidadores, en el proceso de alta hospitalaria a domicilio, fue considerada alta, evidenciando el involucramiento del equipo multidisciplinario en la elaboración y orientaciones para el seguimiento de la atención. en casa, reduciendo las tasas de reingresos y complicaciones posteriores al alta.

https://doi.org/10.1590/SciELOPreprints.4152

Evaluation of Strongyloides stercoralis infection in patients with HTLV-1
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Pereira Vieira Barreto, Nilo Manoel

; Brito Farias, Marina Morena

; de Lima Oliveira, Cíntia

; Almeida Costa Araujo, Weslei

; Rios Grassi, Maria Fernanda

; Nascimento de Souza, Joelma

; Soares Jacobina, Beatriz

; Aquino Teixeira, Márcia Cristina

; Galvão-Castro, Bernardo

; Matos Soares, Neci

Biomédica

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mar 2022, Volume 42 N. 1 Pages 31 - 40

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Introducción. Los individuos infectados por el virus linfotrópico T humano tipo 1 (HTLV-1) pueden presentar formas graves y diseminadas de infestación por Strongyloides stercoralis con poca mejoría terapéutica. Objetivo. Investigar la infestación por S. stercoralis y la seroprevalencia de IgG anti-S. stercoralis en individuos infectados por HTLV-1 atendidos en el Centro de Referencia para HTLV-1 (CHTLV), en Salvador, Bahía, Brasil. Materiales y métodos. Se hizo un estudio transversal con 178 individuos infectados por HTLV-1 atendidos en el centro especializado de HTLV entre enero de 2014 y diciembre de 2018. El diagnóstico parasitológico de S. stercoralis se hizo mediante los métodos de Hoffman, Pons y Janer, cultivo en placa de agar y Baermann-Morais. Para la detección de IgG anti-S. stercoralis, se utilizó una prueba casera de inmunoabsorción ligada a enzimas (ELISA). La infección por HTLV-1 se diagnosticó usando un ELISA comercial y se confirmó mediante Western blot. Resultados. La frecuencia de infestación por S. stercoralis fue del 3,4 % (6/178). Además, los individuos infestados por S. stercoralis provenientes de la zona rural (50,0 %; 3/6) también mostraron hiperinfestación por S. stercoralis (>3.000 larvas/gramo de heces). La frecuencia de anticuerpos IgG anti-S. stercoralis fue del 20,8 % (37/178). Conclusiones. Las personas infectadas por HTLV-1 que viven en condiciones sanitarias precarias son más propensas a desarrollar formas graves de infestación por S. stercoralis. Teniendo en cuenta la gran vulnerabilidad y el resultado desfavorable de la infección en estos individuos, se debe considerar el diagnóstico serológico de S. stercoralis para administrar el tratamiento.

Abstract Introduction: Individuals infected with the human T-lymphotropic virus type 1 (HTLV-1) may present severe and disseminated forms of Strongyloides stercoralis infection with low therapeutic response. Objective: To investigate the S. stercoralis infection and the seroprevalence of IgG anti-S. stercoralis antibodies in individuals infected with HTLV-1 attending the Reference Center for HTLV-1 (CHTLV) in Salvador, Bahia, Brazil. Materials and methods: We conducted a cross-sectional study in 178 HTLV-1-infected individuals treated at the HTLV specialized center between January, 2014, and December, 2018. The parasitological diagnosis of S. stercoralis was performed using the Hoffman, Pons and Janer, agar plate culture, and Baermann-Morais methods. The IgG anti-S. stercoralis detection was performed using an in house enzyme-linked immunosorbent assay (ELISA). The HTLV-1 infection was diagnosed using a commercial ELISA and confirmed by Western blot. Results: The frequency of S. stercoralis infection was 3.4% (6/178). Individuals infected with S. stercoralis from rural areas (50.0%; 3/6) also showed S. stercoralis hyperinfection (>3,000 larvae/ gram of feces). The frequency of circulating anti-S. stercoralis IgG antibodies was 20.8% (37/178). Conclusions: HTLV-1-infected people living in precarious sanitary conditions are more prone to develop severe forms of S. stercoralis infection. Considering the high susceptibility and unfavorable outcome of the infection in these individuals, the serological diagnosis for S. stercoralis should be considered when providing treatment.

https://doi.org/10.7705/biomedica.5888

Quality of sleep and musculoskeletal pain in adolescents: observational study
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Batista, Jéssica Fernanda de Oliveira Lima

; Alencar, Thais Costa de

; Tolêdo, Janaína Maria Gomes Fonsêca

; Mota, Kelly Rodrigues

; Santos Júnior, Valdeci Elias dos

; Heimer, Mônica Vilela

BrJP

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mar 2022, Volume 5 N. 1 Pages 20 - 25

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT BACKGROUND AND OBJECTIVES: Musculoskeletal pain (MSP) is related to psychogenic factors and quality of sleep, showing that this triad is a biopsychosocial process. The aim of this study was to analyze an association between poor sleep quality and MSP in adolescents. METHODS: This study has an observational, cross-sectional character, in which 545 adolescents, aged between 11 and 15 years, were analyzed. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), the presence of MSP using the Nordic Musculoskeletal Questionnaire (NMQ), temporomandibular disorder using the Axis II of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and excessive daytime sleepiness using the Epworth Sleepiness Scale (ESS). Pearson Chi-square or Fishers Exact test were used to assess the association between two categorical variables. RESULTS: The prevalence of poor sleep quality, sleep disorders, MSP and excessive daytime sleepiness were, respectively, 66.8, 9.5, 87.5 and 30.5%. An association was observed between the quality of sleep and the number of hours of sleep per night [OR = 1.49; (1.01 to 2.21)], and between sleep disorders and MSP in the upper back [OR=1.9; (1.0 to 3.3)], and the wrists and hands [OR=2.8; (1.4 to 5.7)]. However, there was no association between sleep quality and MSP [OR=1.29; (0.76 to 2.17)]. CONCLUSION: An association was found between sleep disorders and MSP, as well as between the number of hours slept per night and quality of sleep.

RESUMO JUSTIFICATIVA E OBJETIVOS: As dores musculoesqueléticas (DME) possuem relação com fatores psicogênicos e qualidade de sono, evidenciando que essa tríade se refere a um processo biopsicossocial. O objetivo deste estudo foi analisar a associação entre má qualidade de sono e DME em adolescentes. MÉTODOS: Realizou-se estudo observacional, com delineamento transversal, no qual foram analisados 545 adolescentes, na faixa etária entre 11 e 15 anos. A qualidade do sono foi avaliada através do Índice de Qualidade do Sono de Pittsburgh (PSQI), a presença de DME pelo Questionário Nórdico de Sintomas Osteomusculares (QNSO), disfunções temporomandibulares pelo Eixo II dos Critérios Diagnósticos de Pesquisa em Disfunção Temporomandibular (RDC/TMD) e a sonolência diurna excessiva através da Escala de Sonolência de Epworth (ESE). Para avaliar associação entre duas variáveis categóricas, foi utilizado o teste Qui-quadrado de Pearson ou o teste Exato de Fisher. RESULTADOS: A prevalência da má qualidade do sono, distúrbios do sono, DME e sonolência diurna excessiva foram 66,8, 9,5, 87,5 e 30,5%, respectivamente. Observou-se associação entre qualidade do sono e quantidade de horas de sono por noite [OR=1,49; (1,01 a 2,21)], e entre distúrbios do sono e DME na parte superior das costas [OR=1,9; (1,0 a 3,3)] e nos punhos e mãos [OR=2,8; (1,4 a 5,7)]. No entanto, não foi verificada associação entre qualidade do sono e DME [OR=1,29; (0,76 a 2,17)]. CONCLUSÃO: Foi verificada associação entre distúrbios de sono e DME, bem como entre qualidade do sono e quantidade de horas dormidas por noite.

https://doi.org/10.5935/2595-0118.20220010

Quality of sleep and musculoskeletal pain in adolescents: observational study
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Batista, Jéssica Fernanda de Oliveira Lima

; Alencar, Thais Costa de

; Tolêdo, Janaína Maria Gomes Fonsêca

; Mota, Kelly Rodrigues

; Santos Júnior, Valdeci Elias dos

; Heimer, Mônica Vilela

BrJP

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2022, N. ahead

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

https://doi.org/10.5935/2595-0118.20220010

Coxsackievirus A6 strains causing an outbreak of hand-foot-and-mouth disease in Northeastern Brazil in 2018
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Luchs, Adriana

; Azevedo, Lais Sampaio de

; Souza, Ellen Viana de

; Medeiros, Roberta Salzone

; Souza, Yasmin França Viana Pires de

; Teixeira, Dalane Loudal Florentino

; Carneiro, Thiago Franco de Oliveira

; Alencar, Gabriela Maria Fernandes de

; Morais, Fernanda Lúcia de Sousa Leite

; Pinto, Diana de Fátima Alves

; Okay, Thelma Suely

; Yamamoto, Lidia

; Morais, Vanessa dos Santos

; Araújo, Emerson Luiz Lima

; Leal, Elcio

; Costa, Antonio Charlys da

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e16

Abstract: En | Text: En | PDF: En

ABSTRACT Hand-foot-and-mouth disease (HFMD) is a highly contagious viral disease commonly associated to Enteroviruses (EV). During 2018, Brazil faced massive HFMD outbreaks spread across the country. This study aimed to characterize the EV responsible for the HFMD outbreak that occurred in Paraiba State, Brazilian Northeastern region, in 2018, followed by a phylogenetic analysis to detail information on its genetic diversity. A total of 49 serum samples (one from each patient) collected from children ≤ 15 years old, clinically diagnosed with HFMD were tested for EV using conventional RT-PCR and RT-qPCR. EV infection was confirmed in 71.4% (35/49) of samples. The mean and median ages were 1.83 years and one year old, respectively. Twenty-two EV-positive samples were successfully sequenced and classified as EV-A species; 13 samples were also identified with the CV-A6 genotype. The phylogenetic analysis (VP1 region) of three samples revealed that the detected CV-A6 strains belonged to sub-lineage D3. The CV-A6 strains detected here clustered with strains from South America, Europe and West Asia strains that were also involved in HFMD cases during the 2017-2018 seasons, in addition to the previously detected Brazilian CV-A6 strains from 2012 to 2017, suggesting a global co-circulation of a set of different CV-A6 strains introduced in the country at different times. The growing circulation of the emerging CV-A6 associated with HFMD, together with the detection of more severe cases worldwide, suggests the need for a more intense surveillance system of HFMD in Brazil. In addition, this investigation was performed exclusively on serum samples, and the analysis of whole blood samples should be considered and could have shown advantages when employed in the diagnosis of enteroviral HFMD outbreaks.

https://doi.org/10.1590/s1678-9946202264016

The Brazilian congresses of epidemiology
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Barata, Rita Barradas

; Costa, Maria Fernanda Furtado Lima e

; Goldbaum, Moisés

Revista Brasileira de Epidemiologia

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2022, Volume 25 elocation e220008

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT: This paper deals with the first ten epidemiology conferences held by ABRASCO between 1990 and 2017. Objective: To provide historical records of these events, highlighting the context in which they were conceived, the chosen themes and their role in the national and international epidemiological landscape, the venues, and the presidents of the different editions. Methods: Data were extracted from printed and electronic proceedings, with some data gaps that could not be filled. Results: The numbers and characteristics of different activities are also presented, with emphasis on conferences and roundtables, lectures, panels and debates, and the collaboration of the academic and professional community for coordinated communications and posters outlining a wide range of themes and approaches. This paper keeps record of most of the activities carried out. Conclusions: The authors are aware that the record presented is a pale picture of the real meaning of these meetings in which the development of epidemiology was being built, in an articulation between scholars and health services and as a cooperation between national researchers and our companions and friends who work in foreign institutions all around the world.

RESUMO: O artigo trata dos primeiros dez congressos de epidemiologia realizados pela Associação Brasileira de Saúde Coletiva, entre 1990 e 2017. Objetivo: O objetivo do artigo é prover um registro histórico desses eventos destacando o contexto no qual eles foram concebidos, os temas adotados e seu sentido quanto ao panorama nacional e internacional da disciplina, as sedes e os presidentes das diferentes edições. Métodos: Os dados foram extraídos dos anais impressos ou eletrônicos dos congressos, havendo alguns lapsos nos dados que não puderam ser preenchidos. Resultados: São também apresentados os números e as características das diferentes atividades, com destaque para conferências e mesas-redondas, palestra, painéis e debates e para a colaboração da comunidade acadêmica e profissional para comunicações coordenadas e pôsteres, traçando um amplo painel de temas e abordagens. O artigo registra a maioria das atividades desenvolvidas. Conclusão: Os autores têm consciência de que o registro apresentado é uma pálida imagem do real significado desses encontros, nos quais o desenvolvimento da epidemiologia foi sendo construída na articulação entre a academia e os serviços de saúde e na cooperação entre pesquisadores nacionais e nossos colegas e amigos que atuam em instituições estrangeiras em diferentes partes do mundo.

https://doi.org/10.1590/1980-549720220008

The Brazilian congresses of epidemiology
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Barata, Rita Barradas

; Costa, Maria Fernanda Furtado Lima e

; Goldbaum, Moisés

Revista Brasileira de Epidemiologia

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2022, Volume 25 elocation e220008

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1980-549720220008

10.

SARS-CoV-2 and rhinovirus infections: are there differences in clinical presentation, laboratory abnormalities, and outcomes in the pediatric population?
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Pereira, Maria Fernanda Bádue

; Suguita, Priscila

; Litvinov, Nadia

; Farhat, Sylvia Costa Lima

; Paula, Camila Sanson Yoshino de

; Lázari, Carolina dos Santos

; Bedê, Pedro Vale

; Framil, Juliana Valeria de Souza

; Bueno, Catarina

; Branas, Priscila Cristina Abduch Adas

; Guimarães, Irina Monteiro da Costa

; Leite, Marcia Marques

; Navega, Ana Carolina Barsaglini

; Nanbu, Danilo Yamamoto

; Schvartsman, Claudio

; Pinho, João Renato Rebello

; Silva, Clovis Artur Almeida

; Marques, Heloisa Helena de Sousa

; Eisencraft, Adriana Pasmanik

; Rossi Jr, Alfio

; Delgado, Artur Figueiredo

; Leal, Gabriela Nunes

; Gibelli, Maria Augusta Cicaroni

; Palmeira, Patricia

; Sakita, Neusa Keico

; Santos, Emilly Henrique dos

; Rocha, Mussya Cisotto

; Kanunfre, Kelly Aparecida

; Okay, Thelma Suely

; Carneiro-Sampaio, Magda

; Carvalho, Werther Brunow de

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e34

Abstract: En | Text: En | PDF: En

ABSTRACT This study aims to assess COVID-19 and other respiratory viruses in pediatric patients. Between April 17 and September 30, 2020, we collected 1,566 respiratory samples from 1,044 symptomatic patients who were younger than 18 years old to assess SARS-CoV-2 infection. Of these, 919 were analyzed for other respiratory pathogens (ORP). Patients with laboratory-confirmed COVID-19 or ORP were included. We evaluated 76 pediatric COVID-19 infections and 157 other respiratory virus infections. Rhinovirus occurred in 132/157 (84%). COVID-19 patients who were significantly older, had more fevers, headaches and pneumonia than those with ORP. The median white blood cell count was lower in patients with SARS-CoV-2 than in those with ORP (6,470 versus 8,170; p=0.02). COVID-19 patients had significantly worse symptoms than those with ORP.

https://doi.org/10.1590/s1678-9946202264034

11.

Technical performance of a lateral flow immunoassay for detection of anti-SARS-CoV-2 IgG in the outpatient follow-up of non-severe cases and at different times after vaccination: comparison with enzyme and chemiluminescent immunoassays
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Barreira, Gabriel Acca

; Santos, Emilly Henrique dos

; Pereira, Maria Fernanda Bádue

; Rodrigues, Karen Alessandra

; Rocha, Mussya Cisotto

; Kanunfre, Kelly Aparecida

; Marques, Heloisa Helena de Sousa

; Okay, Thelma Suely

; Eisencraft, Adriana Pasmanik

; Rossi Junior, Alfio

; Fante, Alice Lima

; Cora, Aline Pivetta

; Costa Reis, Amelia Gorete A. de

; Ferrer, Ana Paula Scoleze

; Andrade, Anarella Penha Meirelles de

; Watanabe, Andreia

; Gonçalves, Angelina Maria Freire

; Waetge, Aurora Rosaria Pagliara

; Silva, Camila Altenfelder

; Ceneviva, Carina

; Lazari, Carolina dos Santos

; Abellan, Deipara Monteiro

; Sabino, Ester Cerdeira

; Bianchini, Fabíola Roberta Marim

; Alcantara, Flávio Ferraz de Paes

; Ramos, Gabriel Frizzo

; Leal, Gabriela Nunes

; Rodriguez, Isadora Souza

; Pinho, João Renato Rebello

; Carneiro, Jorge David Avaizoglou

; Paz, Jose Albino

; Ferreira, Juliana Carvalho

; Ferranti, Juliana Ferreira

; Ferreira, Juliana de Oliveira Achili

; Framil, Juliana Valéria de Souza

; Silva, Katia Regina da

; Bastos, Karina Lucio de Medeiros

; Galleti, Karine Vusberg

; Cristofani, Lilian Maria

; Suzuki, Lisa

; Campos, Lucia Maria Arruda

; Perondi, Maria Beatriz de Moliterno

; Diniz, Maria de Fatima Rodrigues

; Fonseca, Maria Fernanda Mota

; Cordon, Mariana Nutti de Almeida

; Pissolato, Mariana

; Peres, Marina Silva

; Garanito, Marlene Pereira

; Imamura, Marta

; Dorna, Mayra de Barros

; Luglio, Michele

; Aikawa, Nadia Emi

; Degaspare, Natalia Viu

; Sakita, Neusa Keico

; Udsen, Nicole Lee

; Scudeller, Paula Gobi

; Gaiolla, Paula Vieira de Vincenzi

; Severini, Rafael da Silva Giannasi

; Rodrigues, Regina Maria

; Toma, Ricardo Katsuya

; Paula, Ricardo Iunis Citrangulo de

; Palmeira, Patricia

; Forsait, Silvana

; Farhat, Sylvia Costa Lima

; Sakano, Tânia Miyuki Shimoda

; Koch, Vera Hermina Kalika

; Cobello Junior, Vilson

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e49

Abstract: En | Text: En | PDF: En

ABSTRACT This study assessed the technical performance of a rapid lateral flow immunochromatographic assay (LFIA) for the detection of anti-SARS-CoV-2 IgG and compared LFIA results with chemiluminescent immunoassay (CLIA) results and an in-house enzyme immunoassay (EIA). To this end, a total of 216 whole blood or serum samples from three groups were analyzed: the first group was composed of 68 true negative cases corresponding to blood bank donors, healthy young volunteers, and eight pediatric patients diagnosed with other coronavirus infections. The serum samples from these participants were obtained and stored in a pre-COVID-19 period, thus they were not expected to have COVID-19. In the second group of true positive cases, we chose to replace natural cases of COVID-19 by 96 participants who were expected to have produced anti-SARS-CoV-2 IgG antibodies 30-60 days after the vaccine booster dose. The serum samples were collected on the same day that LFIA were tested either by EIA or CLIA. The third study group was composed of 52 participants (12 adults and 40 children) who did or did not have anti-SARS-CoV-2 IgG antibodies due to specific clinical scenarios. The 12 adults had been vaccinated more than seven months before LFIA testing, and the 40 children had non-severe COVID-19 diagnosed using RT-PCR during the acute phase of infection. They were referred for outpatient follow-up and during this period the serum samples were collected and tested by CLIA and LFIA. All tests were performed by the same healthcare operator and there was no variation of LFIA results when tests were performed on finger prick whole blood or serum samples, so that results were grouped for analysis. LFIA’s sensitivity in detecting anti-SARS-CoV-2 IgG antibodies was 90%, specificity 97.6%, efficiency 93%, PPV 98.3%, NPV 86.6%, and likelihood ratio for a positive or a negative result were 37.5 and 0.01 respectively. There was a good agreement (Kappa index of 0.677) between LFIA results and serological (EIA or CLIA) results. In conclusion, LFIA analyzed in this study showed a good technical performance and agreement with reference serological assays (EIA or CLIA), therefore it can be recommended for use in the outpatient follow-up of non-severe cases of COVID-19 and to assess anti-SARS-CoV-2 IgG antibody production induced by vaccination and the antibodies decrease over time. However, LFIAs should be confirmed by using reference serological assays whenever possible.

https://doi.org/10.1590/s1678-9946202264049

12.

O Coração de Pacientes Pediátricos com COVID-19: Novos Insights a Partir de um Estudo Ecocardiográfico Sistemático em um Hospital Terciário no Brasil
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Diniz, Maria de Fátima Rodrigues

; Cardoso, Maira Freire

; Sawamura, Karen Saori Shiraishi

; Menezes, Carolina Rocha Brito

; Lianza, Alessandro Cavalcanti

; Pereira, Maria Fernanda Badue

; Litvinov, Nadia

; Ferranti, Juliana Ferreira

; Forsait, Silvana

; Watanabe, Andreia

; Farhat, Sylvia Costa Lima

; Aikawa, Nadia Emi

; Campos, Lucia Maria Arruda

; Delgado, Artur Figueiredo

; Carneiro-Sampaio, Magda

; Carvalho, Werther Brunow de

; Silva, Clovis Artur

; Leal, Gabriela Nunes

Arquivos Brasileiros de Cardiologia

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nov 2021, Volume 117 N. 5 Pages 954 - 964

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background COVID-19 pandemic represents a huge burden to the health system in the world. Although pediatric COVID-19 patients have been relatively spared compared with adults, recent reports showed an increasing number of critically ill patients with multisystemic inflammatory syndrome in children (MIS-c), with marked cardiovascular impairment. Nevertheless, little is known about the relationship between cardiac abnormalities and inflammatory and coagulation biomarkers. Objectives to investigate echocardiographic abnormalities in pediatric patients with COVID-19 admitted to tertiary hospital. Methods this was a retrospective longitudinal study, based on the review of medical records and echocardiograms of patients (0-19 years) admitted to a tertiary hospital between March 30 and June 30, 2020. For statistical analysis, the significance level was set at 5% (p < 0.05). Results Forty-eight patients were enrolled, 73% with preexisting diseases, 20 (41.7%) with MIS-c. Median age was 7.5 (0-18.6) years; 27 (56.2%) were male. Median duration of hospitalization was 15.4 (2-92) days and seven (14.6%) patients died. A total of 70 echocardiograms were performed; 66.7% patients were scanned only once and 33.3% multiple times. Twenty-three (48%) patients showed echocardiographic abnormalities: eight (16.6%) left ventricle (LV) systolic dysfunction, six (12.5%) right ventricle (RV) systolic dysfunction and 12 (25%) coronary dilatation (Z-score>+2.5). Echocardiographic abnormalities were significantly associated with MIS-c, admission to the pediatric intensive care unit, multiple organ dysfunction, ventilatory/vasoactive support, and death (p<0.05). Significantly higher d-dimer (ng/mL) levels were detected in patients with LV dysfunction [16733(4157-115668) vs. 2406.5(190-95040)], RV dysfunction [25769(3422-115668) vs. 2803.5(190-95040)] and coronary artery dilation [9652.5(921-115668) vs. 2724(190- 95040)] (p<0.05). Conclusion Echocardiographic abnormalities in COVID-19 pediatric patients were frequent and associated with worse clinical outcomes. Exacerbation of the inflammation and coagulation pathways may play an important role in cardiovascular injury in those patients.

Resumo Fundamento A pandemia da COVID-19 representa uma enorme carga para o sistema de saúde do mundo. Apesar de pacientes pediátricos terem sido relativamente poupados em comparação a adultos, estudos recentes mostraram um número crescente de pacientes críticos com Síndrome Inflamatória Multisistêmica Pediátrica (SIM-P) com disfunção cardiovascular importante. No entanto, pouco se conhece a respeito da relação entre anormalidades cardíacas e biomarcadores inflamatórios e de coagulação. Objetivos Investigar anormalidades ecocardiográficas em pacientes pediátricos com COVID-19 admitidos em um hospital terciário. Métodos Este foi um estudo longitudinal retrospectivo, baseado na revisão de prontuários médicos e ecocardiogramas de pacientes (0-19 anos) admitidos em um hospital terciário entre 30 de março e 30 de junho de 2020. Para a análise estatística, o nível de significância foi estabelecido em 5% (p<0,05). Resultados Foram incluídos 48 pacientes, 73% com doenças pré-existentes, 20 (41,7%) com SIM-P. A idade mediana foi 7,5 (0-18,6) anos; 27 (56,2%) eram do sexo masculino. A duração mediana de internação foi 15,4 (2-92) dias e sete (14,6%) pacientes morreram. Um total de 70 ecocardiografias foram realizadas, 66,7% submeteram-se ao exame somente uma vez, e 33,3% várias vezes. Vinte e três (48%) pacientes apresentaram anormalidades no ecocardiograma: oito (16.6%) disfunção sistólica do ventrículo esquerdo, seis (12.5%) disfunção sistólica do ventrículo direito, e 12 (25%) dilatação da artéria coronária (Z-score>+2,5). Anormalidades ecocardiográficas foram significativamente associadas com SIM-P, admissão na unidade de terapia intensiva pediátrica, suporte ventilatório/vasoativo, e morte ( p <0,05). Níveis significativamente mais altos de d-dímero (ng/mL) foram detectados em pacientes com disfunção ventricular esquerda [16733(4157-115668) vs. 2406.5(190-95040)], disfunção ventricular direita [25769(3422-115668) vs. 2803.5(190-95040)] e dilatação da artéria coronária [9652.5(921-115668) vs. 2724(190- 95040)] (p<0,05). Conclusão Anormalidades ecocardiográficas eram frequentes nos pacientes pediátricos com COVID-19 e associadas com piores desfechos clínicos. Exacerbação das vias de inflamação e coagulação pode exercer um importante papel na lesão cardiovascular nesses pacientes.

https://doi.org/10.36660/abc.20200920

13.

Soroprevalência e fatores associados a infecções crônicas entre idosos residentes na comunidade
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Peixoto, Sérgio Viana

; Torres, Karen Cecília Lima

; Teixeira-Carvalho, Andréa

; Martins-Filho, Olindo Assis

; Lima-Costa, Maria Fernanda

Ciência & Saúde Coletiva

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oct 2021, Volume 26 Suppl. 3 Pages 5109 - 5121

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Chronic infections can contribute to the aging process, but this issue is less studied in Latin America. The aim was to assess the prevalence and factors associated with cytomegalovirus (CMV), Herpes Simplex 1 (HSV-1), Chlamydia pneumoniae and Helicobacter pylori among the elderly. A total of 1,320 individuals participated from the baseline of the Elderly Cohort of Bambuí. IgG antibodies against infections and explanatory variables (sociodemographic factors, health behaviors and health conditions) were evaluated. Poisson regression models with robust variance were used. Seroprevalence rates were 99.4% for CMV, 96.7% for HSV-1, 56% for C. pneumoniae and 70.5% for H. pylori. Elderly men, women, smokers, diabetics, the disabled and those with high levels of IL-6 had a higher prevalence of CMV. HSV-1 was less frequent among women. The prevalence of C. pneumoniae was higher at ages >75 and among diabetics; it was lower among women and individuals with less schooling. H. pylori was less frequent among women and those with detectable levels of IL-1β, but more common among smokers. The findings show a high prevalence of chronic infection and a different epidemiologic profile for each pathogen, making it possible to detect groups that are vulnerable to these infections.

Resumo Infecções crônicas podem contribuir com o processo de envelhecimento, mas isso ainda é pouco explorado na América Latina. O objetivo foi avaliar a prevalência e os fatores associados ao citomegalovírus (CMV), Herpes simples 1 (HSV-1), Chlamydia pneumoniae e Helicobacter pylori entre idosos. Participaram 1.320 indivíduos da linha de base da Coorte de Idosos de Bambuí. Foram avaliados anticorpos (IgG) para as infecções e variáveis exploratórias (sociodemográficas, comportamentos em saúde e condições de saúde). Utilizaram-se modelos de regressão de Poisson com variância robusta. A prevalência foi de 99,4% para CMV, 96,7% para HSV-1, 56,0% para C. pneumoniae e 70,5% para H. pylori. Os mais velhos, mulheres, fumantes, diabéticos, incapazes e com maiores níveis de IL-6 tinham maior prevalência de CMV. HSV-1 foi menos frequente entre as mulheres. Infecção por C. pneumoniae foi maior entre os mais velhos e diabéticos; e menor entre mulheres e os menos escolarizados. H. pylori foi menos frequente entre as mulheres e naqueles com maiores níveis de IL-1β, mas mais comuns entre os fumantes. Os achados mostram elevada prevalência de infecções crônicas e diferentes perfis epidemiológicos para cada patógeno, permitindo a detecção de grupos vulneráveis a essas infecções.

https://doi.org/10.1590/1413-812320212611.3.37062019

14.

Soroprevalência e fatores associados a infecções crônicas entre idosos residentes na comunidade
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Peixoto, Sérgio Viana

; Torres, Karen Cecília Lima

; Teixeira-Carvalho, Andréa

; Martins-Filho, Olindo Assis

; Lima-Costa, Maria Fernanda

Ciência & Saúde Coletiva

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oct 2021, Volume 26 Suppl. 3 Pages 5109 - 5121

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1413-812320212611.3.37062019

15.

Prevalence of Errors and Number of Retakes in Panoramic Radiography: Influence of Professional Training and Patient Characteristics
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Costa, Eliana Dantas

; Cral, Wilson Gustavo

; Murad, Fernanda Pinto

; Oliveira, Matheus Lima

; Ambrosano, Glaucia Maria Bovi

; Freitas, Deborah Queiroz

International journal of odontostomatology

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sep 2021, Volume 15 N. 3 Pages 719 - 726

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT: Panoramic radiography has clinical importance in several dental specialties. The objective of this study was to evaluate the influence of professionals’ experience and patient characteristics (age group and dental absence) in the prevalence of errors and the number of retakes in the panoramic radiography.771 panoramic radiographs were evaluated and classified according to the group of patients (children, dentulous adults, total edentulous adults, and anterior edentulous adults) and professionals who performed the technique (novice and experienced). The association between frequency and type of error, group of patients, professionals’ experience, and number of retakes was performed by the Chi-square and Fisher’s exact test (a=0.05). There was no significant association between the frequency of errors or retakes of the radiograph s and the professionals’ experience or patients’ characteristics (p<0.05). The errors “turned head” and “tongue not against the palate,” “chin tipped low”, “chin not resting on the support,” “patient movement during exposure,” and “lead apron artifact” showed significantly higher frequency of retake (p<0.05). The most frequent type of error was due to the failure to position the tongue against the palate for all patients and both groups of professionals. The frequency of errors in the panoramic radiography occurs regardless of the professionals’ experience, and age and dental absence of the patients. Error occurs mainly due to the lack of patient collaboration, and the examination is rarely repeated by the professionals.

RESUMEN: La radiografía panorámica es de importancia clínica en varias especialidades dentales. El objetivo de este estudio fue evaluar la experiencia de los profesionales y las características de los pacientes (grupo etario y ausencia dentaria) en la prevalencia de errores y el número de repeticiones en la radiografía panorámica.771 radiografías panorámicas fueron evaluadas y clasificadas según la grupo de pacientes (niños, adultos desdentados, adultos desdentados totales y adultos desdentados anteriores) y profesionales que realizaron la técnica (novatos y experimentados). La asociación entre frecuencia y tipo de error, grupo de pacientes, experiencia de los profesionales y número de repeticiones se realizó mediante la prueba de Chicuadrado y exacta de Fisher (a = 0,05). No hubo asociación significativa entre la frecuencia de errores o repetición de las radiografías y la experiencia de los profesionales o las características de los pacientes (p <0,05). Los errores "cabeza girada" y "lengua no contra el paladar", "mentón inclinado hacia abajo", "mentón no apoyado en el soporte", "movimiento del paciente durante la exposición" y "artefacto del delantal de plomo" mostraron una frecuencia de repetición significativamente mayor (p < 0,05). El error más frecuente se debió a la falta de posicionamiento de la lengua contra el paladar para todos los pacientes y en ambos grupos de profesionales. La frecuencia de errores en la radiografía panorámica ocurre independientemente de la experiencia de los profesionales, edad y ausencia dentaria del pacientes. El error se produce principalmente por la falta de colaboración del paciente, y los profesionales rara vez repiten el examen.

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Glossary and search help

You can enrich your search in a very simple way. Use the search indexes combined with the connectors (AND or OR) and specify more your search.

For example, if you want to search for articles about
cases of dengue in Brasil in 2015, use:
ti:dengue and publication_year:2015 and aff_country:Brasil

See below the complete list of search indexes that can be used:

Index code	Element
ti	article title
au	author
kw	article keywords
subject	subject (title words, abstract and keywords)
ab	abstract
ta	journal short title (e.g. Cad. Saúde Pública)
journal_title	journal full title (e.g. Cadernos de Saúde Pública)
la	publication language code (e.g. pt - Portuguese, es - Spanish)
type	document type
pid	publication identifier
publication_year	publication year of publication
sponsor	sponsor
aff_country	country code of the author's affiliation
aff_institution	author affiliation institution
volume	article volume
issue	article issue
elocation	elocation
doi	DOI number
issn	journal ISSN
in	SciELO colection code (e.g. scl - Brasil, col - Colômbia)
use_license	article usage license code

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