Publications by authors named "Eduardo Oliveira"

336 Publications

Influence of Homogenization in the Physicochemical Quality of Human Milk and Fat Retention in Gastric Tubes.

J Hum Lact 2021 Jul 26:8903344211031456. Epub 2021 Jul 26.

Departamento de Tecnologia de Alimentos, Universidade Federal de Viçosa (UFV), Viçosa, MG, Brasil.

Background: The retention of human milk nutrients in gastric tubes used to feed premature infants is a challenge to be overcome.

Research Aims: To evaluate (1) the performance of six homogenizers (mixing processor, piston valve, ultrasonic bath, ultraturrax, stirring mixer, and ultrasound probe) for the fat retention reduction in gastric tubes; (2) the influence of the best homogenization conditions on the fatty acid and protein profiles of human milk; and (3) the cost/benefit ratio for the inclusion of homogenization as a new step in human milk processing.

Methods: The influence of different levels and times of homogenization on reducing fat retention of human milk in probes was evaluated in this comparative prospective cross-sectional study. After homogenization, human milk flowed through a gavage and infusion pump apparatus used for feeding. Fat content was quantified before and after feeding. The techniques that reduced fat globule sizes and/or promoted a lower percentage of fat holding were evaluated for efficiency, variations in the fatty acid and protein profiles, and energy density and operating costs.

Results: Homogenization led to a reduction in fat retention in feeding probes. The mixer processor and the ultrasound probe reduced fat retention by 99.23% (SD = 0.07) and 99.95% (SD = 0.02), respectively, and did not negatively influence fatty acid and protein profiles. The mixer processor demonstrated low energy density and low cost for human milk processing.

Conclusion: Homogenization promoted reduced fat retention in the feed probe and could help maintain fat nutrients of human milk during enteral feeding.
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http://dx.doi.org/10.1177/08903344211031456DOI Listing
July 2021

A Calcifying Odontogenic Cyst Associated with Compound Odontoma Mimicking a Tooth Germ.

Case Rep Dent 2021 28;2021:9991772. Epub 2021 Jun 28.

Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

Calcifying odontogenic cyst (COC) is a rare cyst that affects mainly the anterior region of the jaws. Generally, it appears as a unilocular radiolucent lesion containing peripheral foci of calcification, but with radiographic variations depending on the type of presentation. Here, we report an atypical case of COC associated with odontoma, initially diagnosed as a tooth germ, in the posterior region of the mandible of a 10-year-old male patient. Interestingly, the radiographic aspect appeared as a unilocular radiolucent lesion without peripheral foci of calcification in the edentulous region, having its size increased after traction of the impacted tooth adjacent to that area. Thus, the case presented in this study is aimed at calling dentists' attention to its developmental changes and related pathologies.
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http://dx.doi.org/10.1155/2021/9991772DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257329PMC
June 2021

The Use of a PEG/Ascorbate Booster Following Standard Bowel Preparation Improves Visualization for Capsule Endoscopy in a Randomized, Controlled Study.

Turk J Gastroenterol 2021 05;32(5):437-442

Instituto Cuf Porto/ManopH Gastroenterology Clinic.

Background/aims: The increasing use of capsule endoscopy (CE) to examine the gastrointestinal tract highlights the need to establish intestinal preparations that ensure optimal visualization while maximizing patient adherence. Thus, we assessed whether bowel preparation involving dietary restriction and a booster regimen produces adequate CE visualization in a real-world clinical setting.

Methods: We conducted a randomized, double-blind, prospective study of CE procedures at 2 tertiary-care centers. Patients were allocated to 3 groups: group 1 followed a clear liquid diet and fasting-based bowel preparation for the exploration (n = 55); group 2 followed the same procedure as group 1 and then ingested 1 L of a polyethylene glycol (PEG)/ascorbic acid booster solution when the capsule reached the small intestine (n = 55); and group 3 followed the same procedure but ingesting only 0.5 L of the booster solution (n = 56). The quality of visualization and the average gastric, orocecal and small-bowel transit times were evaluated.

Results: A total of 166 patients participated in the study. Significantly higher quality of visualization (Park score) was obtained in group 3 (2.28 ± 0.59) than in group 1 (1.84 ± 0.54, P < .001), while there were no significant differences in the average gastric (range: 36.58- 48.32 min, P = .277), orocecal (range: 322.58-289.45 min, P = .072), and small-bowel transit time (range: 280.71-249.95 min, P = .286) between the 3 groups.

Conclusions: Following a clear liquid diet and fasting-based bowel preparation for CE exploration, administering a booster solution of PEG/ascorbic acid after the capsule had reached the small intestine improves mucosal visualization and cleansing without affecting capsule transit times.
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http://dx.doi.org/10.5152/tjg.2021.20279DOI Listing
May 2021

Comparative Study of Clinical and Ultrasound Parameters for Defining a Difficult Airway in Patients with Obesity.

Obes Surg 2021 Jul 5. Epub 2021 Jul 5.

São Domingos Hospital, São Luís, Brazil.

Introduction: Patients with obesity have anatomical changes due to increased adipose tissue that negatively affect airway accessibility, making it difficult to establish an advanced airway through orotracheal intubation. This article aims to evaluate the correlation of clinical and sonographic parameters as predictors of difficult airway management (DAM) in patients with obesity and to establish the predictive value of the skin-epiglottis distance as an indicator of a probable DAM.

Methods: This is an observational, prospective study of 100 patients with obesity who underwent bariatric surgery over a 12-month period. The patients were categorized into the easy airway and the difficult airway groups, according to the Cormack-Lehane classification in the laryngoscopy evaluation, and the clinical and sonographic variables collected were statistically evaluated to obtain the relation with the presence of DAM, according to the Cormack-Lehane classification.

Results: The mouth opening (p = 0.010) and the skin-epiglottis distance (p = 0.019) were statistically significant when comparing the easy airway and the difficult airway groups of the Cormack-Lehane classification. The predictive value of the skin-epiglottis distance for difficult airway assessment was 29.3 mm. The neck circumference (p = 0.225), the Mallampati index (p = 0.260), and the other clinical variables showed no statistical relevance when compared in isolation with the Cormack-Lehane groups.

Conclusion: The ultrasound method as a predictor of difficult intubation is promising in anesthetic practice when used according to standardized measurements evaluation and cutoff values.
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http://dx.doi.org/10.1007/s11695-021-05528-1DOI Listing
July 2021

Active immunization against GnRH as an alternative therapeutic approach for the management of Bos indicus oocyte donors diagnosed with chronic cystic ovarian disease.

Theriogenology 2021 Jun 18;172:133-141. Epub 2021 Jun 18.

Universidade José do Rosário Vellano, Alfenas, MG, 37130-000, Brazil; Embrapa Gado de Leite, Juiz de Fora, MG, 36038-330, Brazil.

The aim of this study was to evaluate the effect of active immunization against GnRH in Nelore (Bos indicus) cows repeatedly used as oocyte donors that developed chronic cystic ovarian disease (COD). In the first experiment, ovarian and uterine features were first compared between COD cows (n = 15) and healthy cows (n = 22, cycling control group) from the same breed and herd. Cows with COD had a greater number of large (P < 0.0001) and medium follicles (P < 0.01) but lesser small follicles (P < 0.05) than cycling controls. Mucometra was diagnosed in 73.3% of COD cows, but in none of the controls. No difference in average thickness of the endometrium was detected between groups; however, endometrial thickness and mucometra score were negatively correlated (R = -0.73, P = 0.0029) in COD cows. In the second experiment, COD cows were randomly allocated into two experimental groups, which received two 1.0 mL SC injections of either an anti-GnRH vaccine (COD immunized group, n = 8) or saline (COD control group, n = 7), given 28 days apart. Cows were examined weekly by transrectal ultrasonography during nine consecutive weeks after the first injection to evaluate the number and distribution of follicles among size classes, endometrial thickness, and presence of clinical mucometra. Vaccination against GnRH resulted in a progressive suppression of follicle growth and a reduction in the average size of the largest follicle, as well as in the number of large follicles (P < 0.01) in COD immunized cows compared with COD controls from week 7 onwards. Conversely, the number of small follicles in the COD immunized group increased after week 5 and was greater (P = 0.0023) than controls on week 9. Endometrial thickness and mucometra score were not affected (P > 0.05) by immunization against GnRH. In the third experiment, the COD immunized cows with effective suppression of follicle growth four weeks after the 2nd injection (n = 6) were submitted to three consecutive ovum pick-up (OPU) sessions (weeks 10, 11, and 12) for in vitro embryo production (IVEP). Cumulus-oocyte complexes (COC) collected from slaughterhouse ovaries were used as controls for IVEP. COD cows with produced 25.0 ± 3.8 COC per OPU session with no apparent detrimental effect of anti-GnRH vaccine on oocyte developmental potential in vitro, i.e., we observed similar cleavage rate (P = 0.5914) and greater blastocyst rate (P = 0.0177) in immunized cows compared with COC from slaughterhouse controls. Finally, in the fourth experiment wave emergence and follicular dynamics after follicle ablation were compared between COD immunized cows with effective suppression of follicle growth and a subset (n = 6) of the cycling, control group. No follicles grew beyond 4 mm diameter after follicle ablation in the COD immunized group, whereas a normal follicular wave emergence occurred in cycling controls. Antral follicle count was similar between cycling controls and COD immunized groups at 24 h and 96 h post-follicle ablation (P > 0.05), but greater in cycling controls at 48 h and 72 h post-follicle ablation (P < 0.05). In summary, our results suggest that active immunization against GnRH is effective to induce the regression of follicular cysts as well as increase the number of small follicles growing on the ovaries, in oocyte donors diagnosed with chronic COD, with no apparent negative effect on oocyte developmental potential in vitro.
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http://dx.doi.org/10.1016/j.theriogenology.2021.06.014DOI Listing
June 2021

Salivary molecules of bone remodeling and tissue repair after head and neck radiotherapy.

Braz Oral Res 2021 16;35:e079. Epub 2021 Jun 16.

Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil.

Head and neck radiotherapy causes quantitative and qualitative changes in saliva. The objective of this case-control study was to evaluate the salivary biomarkers associated with bone remodeling and tissue repair in patients submitted to radiotherapy for head and neck cancer treatment, compared with non-irradiated individuals. Total unstimulated saliva was collected for ELISA assay analysis of receptor activator for nuclear factor κ B (RANK) and its ligand (RANK-L), osteoprotegerin, matrix metalloproteinase-9/ tissue inhibitor of metalloproteinase-2, vascular endothelial growth factor, and epidermal growth factor. Statistics were performed, and revealed that salivary RANK (p = 0.0304), RANK-L (p = 0.0005), matrix metalloproteinase-9/ tissue inhibitor of metalloproteinase-2 (p = 0.0067), vascular endothelial growth factor (p = 0.0060), and epidermal growth factor (p < 0.0001) were reduced in patients, compared with the control group. Osteoprotegerin did not differ between the groups (p = 0.3765). Salivary biomarkers did not differ according to radiotherapy completion time (p > 0.05). In conclusion, the lower output of the salivary molecules - essential for bone remodeling and tissue repair - may disrupt tissue homeostasis and play a role in the pathogenesis of the radiotherapy-induced deleterious effects in the oral cavity.
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http://dx.doi.org/10.1590/1807-3107bor-2021.vol35.0079DOI Listing
June 2021

The Role of Growth Hormone in Chronic Kidney Disease.

Semin Nephrol 2021 Mar;41(2):144-155

Division of Pediatric Nephrology, Rady Children's Hospital, University of California, San Diego, La Jolla, CA. Electronic address:

Growth hormone (GH) has become a critical therapy for treating growth delay and failure in pediatric chronic kidney disease. Recombinant human GH treatment is safe and significantly improves height and height velocity in these growing patients and improved growth outcomes are associated with decreased morbidity and mortality as well as improved quality of life. However, the utility of recombinant human GH in adults with chronic kidney disease and end-stage renal disease for optimization of body habitus and reducing frailty remains uncertain. Semin Nephrol 41:x-xx © 2021 Elsevier Inc. All rights reserved.
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http://dx.doi.org/10.1016/j.semnephrol.2021.03.009DOI Listing
March 2021

Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database.

Lancet Child Adolesc Health 2021 Aug 11;5(8):559-568. Epub 2021 Jun 11.

Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil; Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA.

Background: COVID-19 is usually less severe and has lower case fatality in children than in adults. We aimed to characterise the clinical features of children and adolescents hospitalised with laboratory-confirmed SARS-CoV-2 infection and to evaluate the risk factors for COVID-19-related death in this population.

Methods: We did an analysis of all patients younger than 20 years who had quantitative RT-PCR-confirmed COVID-19 and were registered in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe, a nationwide surveillance database of patients admitted to hospital with severe acute respiratory disease in Brazil), between Feb 16, 2020, and Jan 9, 2021. The primary outcome was time to recovery (discharge) or in-hospital death, evaluated by competing risks analysis using the cumulative incidence function.

Findings: Of the 82 055 patients younger than 20 years reported to SIVEP-Gripe during the study period, 11 613 (14·2%) had available data showing laboratory-confirmed SARS-CoV-2 infection and were included in the sample. Among these patients, 886 (7·6%) died in hospital (at a median 6 days [IQR 3-15] after hospital admission), 10 041 (86·5%) patients were discharged from the hospital, 369 (3·2%) were in hospital at the time of analysis, and 317 (2·7%) were missing information on outcome. The estimated probability of death was 4·8% during the first 10 days after hospital admission, 6·7% during the first 20 days, and 8·1% at the end of follow-up. Probability of discharge was 54·1% during the first 10 days, 78·4% during the first 20 days, and 92·0% at the end of follow-up. Our competing risks multivariate survival analysis showed that risk of death was increased in infants younger than 2 years (hazard ratio 2·36 [95% CI 1·94-2·88]) or adolescents aged 12-19 years (2·23 [1·84-2·71]) relative to children aged 2-11 years; those of Indigenous ethnicity (3·36 [2·15-5·24]) relative to those of White ethnicity; those living in the Northeast region (2·06 [1·68-2·52]) or North region (1·55 [1·22-1·98]) relative to those in the Southeast region; and those with one (2·96 [2·52-3·47]), two (4·96 [3·80-6·48]), or three or more (7·28 [4·56-11·6]) pre-existing medical conditions relative to those with none.

Interpretation: Death from COVID-19 was associated with age, Indigenous ethnicity, poor geopolitical region, and pre-existing medical conditions. Disparities in health care, poverty, and comorbidities can contribute to magnifying the burden of COVID-19 in more vulnerable and socioeconomically disadvantaged children and adolescents in Brazil.

Funding: National Council for Scientific and Technological Development, Research Support Foundation of Minas Gerais.
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http://dx.doi.org/10.1016/S2352-4642(21)00134-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192298PMC
August 2021

Evaluation of Urinary Tract Dilation Classification System for Prediction of Long-Term Outcomes in Isolated Antenatal Hydronephrosis: A Cohort Study.

J Urol 2021 Jun 8:101097JU0000000000001899. Epub 2021 Jun 8.

Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology of Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.

Purpose: The aim of this study was to evaluate the performance of the new classification of urinary tract dilatation (UTD) to predict long-term clinical outcomes in infants with isolated antenatal hydronephrosis (ANH).

Materials And Methods: Between 1989 and 2019, 447 infants diagnosed with isolated severe ANH and were prospectively followed. The main predictive variable for the analysis was the new UTD classification system. The events of interest were surgical interventions, urinary tract infections, chronic kidney disease stage II or higher, hypertension and proteinuria. The primary end-point was time until the occurrence of a composite event of renal injury, including proteinuria, hypertension and chronic kidney disease.

Results: Among 447 infants with ANH included in the analysis, 255 (57%) had UTD P1, 93 (20.8%) UTD P2 and 99 (22.2%) UTD P3. Median followup time was 9 years (IQR 7-12 years). Of 447 patients included in the analysis, 11 (2.5%) had hypertension, 13 (2.9%) exhibited persistent mild proteinuria, 14 (3%) developed chronic kidney disease Stage 2 and 26 (5.8%) had the composite outcome of renal injury. By survival analysis, the UTD system predicted accurately all events of interest. According to the Kaplan-Meier survival analysis, the probability of renal injury at 20 years of age was estimated at about 0%, 14% and 56% for patients assigned to UTD P1, UTD P2 and UTD P3, respectively (p <0.001).

Conclusions: Our findings provide insights that the new UTD classification has a good performance for discriminating not only mid-term, but also long-term clinical outcomes, including renal injury.
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http://dx.doi.org/10.1097/JU.0000000000001899DOI Listing
June 2021

Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause urethral discharge.

Rev Soc Bras Med Trop 2021 17;54(suppl 1):e2020633. Epub 2021 May 17.

Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil.

This article approaches infections that cause urethral discharge. This theme is part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020. These guidelines were prepared based on scientific evidence and validated in discussions with experts. Urethritis can cause severe and even irreversible health damage when not properly treated, or when the microorganism develops antimicrobial resistance. It is noteworthy that the high levels of antimicrobial resistance grown by pathogens that cause urethritis comprises a global emergency in public health. This article presents epidemiological and clinical aspects, recommendations on diagnostic and treatment, and strategies for surveillance, prevention, and control actions for infections that cause urethral discharge, to contribute to managers' and health professionals' care qualification. Associated factors with urethritis are: young age, low socioeconomic level, multiple partnerships or new sexual partnership, history of STI, irregular use of condoms, and lack of access to adequate diagnosis and treatment.
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http://dx.doi.org/10.1590/0037-8682-633-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8210486PMC
May 2021

Brazilian Protocol for Sexually Transmitted Infections, 2020: sexually transmitted enteric infections.

Rev Soc Bras Med Trop 2021 17;54(suppl 1):e2020598. Epub 2021 May 17.

Universidade Federal do Pará, Belém, PA, Brasil.

The sexually transmitted enteric infections topic is one of the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects of these infections and guidance for service managers on their programmatic and operational management. The aim is to assist health professionals with screening, diagnosis, and treatment of people with sexually transmitted enteric infections and their sexual partners, in addition to supporting strategies for their surveillance, prevention, and control. The incidence of anorectal sexually transmitted infections has increased over the last years, mainly due to the increase in the practice of unprotected receptive anal sexual intercourse.
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http://dx.doi.org/10.1590/0037-8682-598-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8210495PMC
May 2021

Homogenised and pasteurised human milk: lipid profile and effect as a supplement in the enteral diet of Wistar rats.

Br J Nutr 2021 Apr 27:1-11. Epub 2021 Apr 27.

Departamento de Tecnologia de Alimentos, Universidade Federal de Viçosa (UFV), Av. P.H. Rolfs, s/n, 36570-900 Viçosa, MG, Brasil.

The retention of human milk (HM) fat in nasogastric probes of infusion pumps can be observed during the feed of infants unable to suck at the mother's breast. The lack of homogenisation of HM could contribute to the fat holding. Therefore, the present study evaluated (i) the influence of homogenisation on milk fat retaining in infant feeding probes and (ii) the in vivo effect of the homogenisation on lipid absorption by Wistar rats. The animals were fed with HM treated following two processing conditions, that is, pasteurised and homogenised-pasteurised. The animals were randomly subdivided into four experimental groups: water-fed (control), pasteurised milk, homogenised-pasteurised milk and pasteurised-skimmed milk. The results of food consumption, mass body gain, corporate metrics and plasma blood levels of total cholesterol did not show any difference (P < 0·05) among the three types of HM used in the experiments. The liver, intestine and intra-abdominal adipose tissue of the four groups of animals presented normal and healthy histology. The composition of fatty acids in the brain tissue of animals fed with homogenised HM increased when compared with the groups fed with non-homogenised HM. These values were 11·08 % higher for arachidonic acids, 6·59 % for DAH and 47·92 % for nervous acids. The ingestion of homogenised HM promoted higher absorption of milk nutrients. Therefore, the addition of the homogenisation stage in HM processing could be an alternative to reduce fat retention in probes and to improve the lipids' absorption in the body.
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http://dx.doi.org/10.1017/S0007114521001380DOI Listing
April 2021

Aqueous solutions of glycolic, propionic, or lactic acid in substitution of acetic acid to prepare chitosan dispersions: a study based on rheological and physicochemical properties.

J Food Sci Technol 2021 May 12;58(5):1797-1807. Epub 2020 Aug 12.

Departamento de Tecnologia de Alimentos, Universidade Federal de Viçosa (UFV), Av. Peter Henry Rolfs, s/n, Campus Universitário, Viçosa, MG 36570-000 Brazil.

Chitosan (CH) is a biopolymer derived from chitin, which is the second most abundant polysaccharide in nature, after cellulose. Their functional groups -NH and -OH can form intermolecular interactions with water and other molecules, enabling a variety of applications for CH. -NH groups become protonated in acidic solutions, causing an increase in electrostatic repulsion between CH chains, which facilitates their dispersion in aqueous media. Aqueous solutions of acetic acid and/or acetates buffers have been used to disperse CH, but may not be adequate for technological applications, espeacially because of the strong flavor this acid confers to formulations. In this study, 0.125; 0.250; 0.500; 0.750 and 1.000 g (100 g) CH dispersions were prepared in acidic aqueous media (50 mmol L), not only with acetic (AA), but also with glycolic (GA), propionic (PA), or lactic (LA), acid aiming to evaluate the effects of biopolymer concentration and type of organic acid on: electrical conductivity, pH, density and rheological characteristics of dispersions. Moreover, ζ potential values of CH chains dispersed in these acidic aqueous media were assessed. pH, density and consistency index were influenced by the biopolymer concentration, but not by the acid type. At a given biopolymer concentration, ζ potential signs (+) and values suggested that electrostatic interactions between CH chains and counter-anions occurred, regardless of the type of the organic acid. Thus, at least from a physicochemical point of view, GA, PA or LA showed to be suitable to replace AA when preparing dispersions containing from 0.125 to 1.000 g (100 g) CH for technological purposes, such as thickening or stabilizer in formulated food products.
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http://dx.doi.org/10.1007/s13197-020-04691-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021676PMC
May 2021

A prospective, multicentre, cohort study to assess the incidence of dengue illness in households from selected communities in Brazil (2014-2018).

Int J Infect Dis 2021 Apr 21;108:443-453. Epub 2021 Apr 21.

Instituto de Tecnologia em Imunobiológicos Bio-Manguinhos/Fiocruz, Avenida Brasil 4.365, Manguinhos, Rio de Janeiro - RJ, 21.040-900, Brazil.

Objectives: To estimate the incidence of dengue infection across geographically distinct areas of Brazil.

Methods: This prospective, household-based, cohort study enrolled participants in five areas and followed them up for up to 4 years (2014-2018). Dengue seroprevalence was assessed at each scheduled visit. Suspected dengue cases were identified through enhanced passive and active surveillance. Acute symptomatic dengue infection was confirmed through reverse-transcriptase quantitative polymerase chain reaction in combination with an antigenic assay (non-structural protein 1) and serology.

Results: Among 3300 participants enrolled, baseline seroprevalence was 76.2%, although only 23.3% of participants reported a history of dengue. Of 1284 suspected symptomatic dengue cases detected, 50 (3.9%) were laboratory-confirmed. Based on 8166.5 person-years (PY) of follow-up, the incidence of laboratory-confirmed symptomatic infection (primary endpoint) was 6.1 per 1000 PY (95% confidence interval [CI]: 4.5, 8.1). Incidence varied substantially in different years (1.8-7.4 per 1000 PY). The incidence of inapparent primary dengue infection was substantially higher: 41.7 per 1000 PY (95% CI: 31.1, 54.6).

Conclusions: Our findings, highlighting that the incidence of dengue infection is underestimated in Brazil, will inform the design and implementation of future dengue vaccine trials.

Clinical Trial Registration: NCT01751139.
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http://dx.doi.org/10.1016/j.ijid.2021.04.062DOI Listing
April 2021

Combined spinal-epidural anesthesia for abdominoplasty and liposuction in Limb-Girdle Muscular Dystrophy: case report.

Braz J Anesthesiol 2021 May-Jun;71(3):299-301. Epub 2021 Apr 3.

Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil. Electronic address:

We report the anesthetic management with combined spinal-epidural in a patient with limb-girdle muscular dystrophy type 2A, submitted to abdominoplasty and liposuction. The patient had onset of symptoms at 8 years old, diagnosed by muscular biopsy, presenting muscle weakness in the scapular and pelvic girdles, with reduced mobility. We performed monitorization with noninvasive blood pressure, oximeter, thermometer, and electrocardiogram. In the postoperative period, she showed no clinical signs of rhabdomyolysis, myotonia, or adverse effects, maintaining hemodynamic stability. The anesthesia technique allowed spontaneous ventilation, monitoring of clinical parameters close to physiological conditions and used smaller doses of medication, reducing related risks.
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http://dx.doi.org/10.1016/j.bjane.2021.02.046DOI Listing
April 2021

ICU outcomes and survival in patients with severe COVID-19 in the largest health care system in central Florida.

PLoS One 2021 25;16(3):e0249038. Epub 2021 Mar 25.

AdventHealth Orlando Central Florida Division, Orlando, Florida, United States of America.

Background: Observational studies have consistently described poor clinical outcomes and increased ICU mortality in patients with severe coronavirus disease 2019 (COVID-19) who require mechanical ventilation (MV). Our study describes the clinical characteristics and outcomes of patients with severe COVID-19 admitted to ICU in the largest health care system in the state of Florida, United States.

Methods: Retrospective cohort study of patients admitted to ICU due to severe COVID-19 in AdventHealth health system in Orlando, Florida from March 11th until May 18th, 2020. Patients were characterized based on demographics, baseline comorbidities, severity of illness, medical management including experimental therapies, laboratory markers and ventilator parameters. Major clinical outcomes analyzed at the end of the study period were: hospital and ICU length of stay, MV-related mortality and overall hospital mortality of ICU patients.

Results: Out of total of 1283 patients with COVID-19, 131 (10.2%) met criteria for ICU admission (median age: 61 years [interquartile range (IQR), 49.5-71.5]; 35.1% female). Common comorbidities were hypertension (84; 64.1%), and diabetes (54; 41.2%). Of the 131 ICU patients, 109 (83.2%) required MV and 9 (6.9%) received ECMO. Lower positive end expiratory pressure (PEEP) were observed in survivors [9.2 (7.7-10.4)] vs non-survivors [10 (9.1-12.9] p = 0.004]. Compared to non-survivors, survivors had a longer MV length of stay (LOS) [14 (IQR 8-22) vs 8.5 (IQR 5-10.8) p< 0.001], Hospital LOS [21 (IQR 13-31) vs 10 (7-1) p< 0.001] and ICU LOS [14 (IQR 7-24) vs 9.5 (IQR 6-11), p < 0.001]. The overall hospital mortality and MV-related mortality were 19.8% and 23.8% respectively. After exclusion of hospitalized patients, the hospital and MV-related mortality rates were 21.6% and 26.5% respectively.

Conclusions: Our study demonstrates an important improvement in mortality of patients with severe COVID-19 who required ICU admission and MV in comparison to previous observational reports and emphasizes the importance of standard of care measures in the management of COVID-19.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249038PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993561PMC
April 2021

[Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause urethral discharge].

Epidemiol Serv Saude 2021 15;30(spe1):e2020633. Epub 2021 Mar 15.

Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil.

This article approach infections that cause urethral discharge, theme which is part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020. These guidelines were prepared based on scientific evidence and validated in discussions with experts. When urethritis is not treated correctly, or when the microorganism develops antimicrobial resistance, it can cause serious and even irreversible health damage. It is noteworthy that the high levels of antimicrobial resistance developed by pathogens that causes urethritis comprises a global emergency in public health. This article presents epidemiological and clinical aspects, recommendations on diagnostic and treatment, and strategies for surveillance, prevention and control actions of infections that cause urethral discharge, with the purpose of contributing with managers and health professionals to care qualification.
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http://dx.doi.org/10.1590/S1679-4974202100009.esp1DOI Listing
March 2021

[Brazilian Protocol for Sexually Transmitted Infections 2020: sexually transmitted enteric infections].

Epidemiol Serv Saude 2021 15;30(spe1):e2020598. Epub 2021 Mar 15.

Universidade Federal do Pará, Belém, PA, Brasil.

The topic of sexually transmitted enteric infections is one of the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects related to these infections, as well as guidance for service managers on their programmatic and operational management. The aim is to assist health professionals with screening, diagnosis and treatment of people with sexually transmitted enteric infections and their sexual partners, in addition to supporting strategies for their surveillance, prevention and control.
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http://dx.doi.org/10.1590/S1679-4974202100012.esp1DOI Listing
March 2021

Edentulism-free life expectancy among older Brazilian adults: SABE study, 2006-2016.

Gerodontology 2021 Feb 9. Epub 2021 Feb 9.

René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil.

Aim: To assess edentulism-free life expectancy (EFLE) and the related inequalities by sex and schooling among older Brazilian adults from 2006 to 2016.

Background: Tooth loss is related to shortened longevity and unhealthy life expectancy in old age.

Materials And Methods: The outcome of the study was EFLE, assessed by age, sex and schooling. EFLE was estimated using the Sullivan method, considering the years and proportion of remaining life and the prevalence of edentulism-assessed in the Health, Well-being, and Aging cohort study, as well as the official mortality data for adults aged 60 years or older living in São Paulo, Brazil.

Results: EFLE increased from 10.9 (95% CI: 10.4-11.5) to 13.8 (95% CI: 13.2-14.5) years, considering data from 2006 to 2016, among 60-year-old individuals. In relative terms, these individuals expected to live 50.7% (95% CI: 48.1-53.2) of their remaining life free of edentulism in 2006, while this expectation was 62.8% (95% CI: 60.0-65.6) in 2016. Within both years, women and the less educated had lower EFLE than men and the higher educated.

Conclusion: EFLE increased from 2006 to 2016. However, inequalities concerning sex and education remained significant, thereby highlighting the need to continuously address inequalities in tooth loss throughout life to contribute to a healthy ageing.
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http://dx.doi.org/10.1111/ger.12541DOI Listing
February 2021

Optimization of airflow and aeration cycles in a new structured bed reactor configuration for carbon and nitrogen removal.

Environ Technol 2021 Mar 4:1-13. Epub 2021 Mar 4.

Institute of Science and Technology, Federal University of Alfenas (UNIFAL-MG), Poços de Caldas, Brazil.

The Structured Bed Reactor with Recirculation and Intermittent Aeration (SBRRIA) is a reactor configuration that presents high efficiency of organic matter and nitrogen removal, besides low sludge production. However, operational parameters, as the recirculation rate, aeration time, and airflow, are not fully established. A bench-scale structured bed reactor with intermittent aeration was fed with synthetic effluent simulating the characteristics of sanitary sewage. The reactor was operated for 280 days with an operational hydraulic retention time (HRT) of 10 h. The reactor was operated without effluent recirculation for the first time since this approach was not yet reported, and was named Structured Bed Reactor with Intermittent Aeration (SBRIA). The COD removal was higher than 81% for all operational conditions, and the total nitrogen removal ranged from 10 to 80%. The highest efficiencies were obtained with an aeration time of 1 h 45 min (total cycle of 3 h) and an airflow rate of 4.5 L.min. Different nitrification and denitrification behaviours were observed, resulting in nitrification efficiencies over 90% when the reactor was submitted to higher aeration times and denitrification efficiencies above 90% when the reactor was submitted to low aeration times. The airflow ranges tested in this study affected the nitrification and the total nitrogen efficiencies. Even without effluent recirculation, the temporal profile showed that there were no peaks in the concentration of the nitrogen forms in the reactor effluent, saving electrical energy up to 75% due to pumping.
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http://dx.doi.org/10.1080/09593330.2021.1887370DOI Listing
March 2021

Life expectancy with poor health-related quality of life among Brazilian older adults.

Arch Gerontol Geriatr 2021 May-Jun;94:104346. Epub 2021 Jan 16.

René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Av. Augusto de Lima, 1715, Barro Preto, Belo Horizonte, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.archger.2021.104346DOI Listing
May 2021

Cancer diagnosis in Brazil in the COVID-19 era.

Semin Oncol 2021 Jan 7. Epub 2021 Jan 7.

Primary Care Postgraduate Program, State University of Montes Claros Unimontes, Minas Gerais, Brazil; Center for Rehabilitation of Craniofacial Anomalies, University of Alfenas, Minas Gerais, Brazil.

The comprehensive care and treatment for cancer patients in Brazil, regulated by the National Cancer Prevention and Control Policy, is provided by Brazilian Unified Healthcare System (SUS) in certified health institution. Due the COVID-19 pandemic, several restrictive measures have been implemented by the State federation's governments, and cancer diagnosis reference centers were also impacted by these measures. Thus, this study aimed to compare SUS-oriented cancer diagnosis in Brazil before and during the pandemic so far. The average number of cancer diagnoses has dropped considerably in all Brazilian Regions since the pandemic period started. The number of new cancer cases has plunged in all regions, ranged from -24.3% in the North to -42.7% in Northeast region. The overall Brazilian average deficit reached 35.5%, corresponding to about 15,000 undiagnosed cases of cancer monthly. The pandemic period has dramatically reduced the diagnosis of new cases of cancer in Brazil, since consultations in public health services were compromised by restrictive measures. Therefore, effective measures must be urgently put in action in order to minimize the damage, and consequently, the negative health impacts caused by the COVID-19 pandemic in the care of cancer patients.
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http://dx.doi.org/10.1053/j.seminoncol.2020.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789866PMC
January 2021

Mixed starch/chitosan hydrogels: elastic properties as modelled through simulated annealing algorithm and their ability to strongly reduce yellow sunset (INS 110) release.

Carbohydr Polym 2021 Mar 16;255:117526. Epub 2020 Dec 16.

Departamento de Tecnologia de Alimentos, Universidade Federal de Viçosa (UFV), Av. Peter Henry Rolfs, s/n, Campus Universitário, 36570-000, Viçosa, MG, Brazil. Electronic address:

Biopolymers mixtures appear as a strategy to improve sensorial/technological characteristics of gel-like products. Thus, self-sustaining starch (S100/C0) hydrogels were prepared with a partial replacement of the gelling agent by 5.0 % (S95/C5), 7.5 % (S92.5/C7.5), or 10.0 % chitosan (S90/C10), and containing yellow sunset (INS 110). Major visual changes or significant differences on L*a*b* parameters were not observed for starch/chitosan hydrogels. Creep-recovery data was modeled using the simulated annealing algorithm, and relative recovery results showed an increase for S95/C5 (82.6 %), when compared to S100/C0 (72.9 %). After 312 h, chitosan strongly reduced the INS 110 release from hydrogels to an ethanolic solution (3.1∙10 and 4.1∙10 g/100 mL for S95/C5 and S100/C0, respectively) or to a sucrose solution (1.1∙10 and 6.5∙10 g/100 mL for S95/C5 and S100/C0, respectively). Such results highlighted that chitosan not only presented a techno-functionality on starch hydrogels by improving their elasticity but also by hindering the release of yellow sunset.
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http://dx.doi.org/10.1016/j.carbpol.2020.117526DOI Listing
March 2021

Sampling effort and the drivers of plant species richness in the Brazilian coastal regions.

Oecologia 2021 Jan 3;195(1):163-171. Epub 2021 Jan 3.

Evolution and Conservation of Biodiversity (INCT-EECBio), National Institute of Science and Technology Ecology, Goiânia, Goiás, Brazil.

The causes of the gradients in species richness remain contentious because of multiple competing hypotheses, significant knowledge gaps, and regional effects of environmental and historical factors on species pools. Coastal zones are subject to particular sets of environmental constraints, thus identifying the drivers of species richness therein should shed light on the regional gradients of species diversity. Here, we investigate the geographic patterns and drivers of plant diversity across coastal regions while allowing for pervasive sampling deficiencies. Based on 142708 records of flowering plant occurrences, we mapped species richness and estimated the level of knowledge across the coastal zone of Brazil. Based on inventory completeness, we used linear regression models to test the predictive power of environmental variables that represent different environmental hypotheses. Few cells (25%) were well-surveyed, reflecting little knowledge about the distribution and diversity of flowering plants on the highly-populated Brazilian coast. Still, we found support for the habitat heterogeneity hypothesis as the best explanation of the variation in species richness of flowering plants in this region. Soil properties and water constraints are also important factors. Although our work emphasises the paucity of information on plant diversity in tropical and human-dominated areas, we show that knowledge limitations should not curb our capability of addressing hypotheses about species diversity.
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http://dx.doi.org/10.1007/s00442-020-04805-7DOI Listing
January 2021

BRAF p.V600E status in epithelial areas of ameloblastoma with different histological aspects: Implications to the clinical practice.

J Oral Pathol Med 2021 May 18;50(5):478-484. Epub 2021 Jan 18.

Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

Background: BRAF p.V600E is reported in up to 80% of ameloblastomas. Despite the high frequency, the presence of this mutation in different histopathological areas of the tumour has not been investigated. This information has an important role in the use of BRAF p.V600E assessment as an auxiliary tool in the differential diagnosis between unicystic ameloblastoma and other odontogenic cystic lesions, especially when only incisional biopsies are available. Therefore, the purpose of the present study was to investigate BRAF p.V600E heterogeneity in unicystic ameloblastoma.

Methods: Five cases of ameloblastoma and two dentigerous cysts were analysed. The regions exhibiting different microscopic characteristics were selected from each ameloblastoma case and manually dissected. TaqMan allele-specific qPCR or Sanger sequencing was performed to determine BRAF p.V600E status.

Results: We screened the mutation in a small cohort of UA and no molecular heterogeneity was found. Four cases of ameloblastoma (80%) exhibited BRAF p.V600E in all different areas evaluated. One case did not harbour the mutation in any microscopic region analysed. The BRAF mutation was absent in the dentigerous cysts.

Conclusion: Ameloblastomas appear to exhibit a homogeneous profile regarding the BRAF p.V600E no matter what histological feature is observed under light microscopy, suggesting that this molecular test may contribute to establish the correct diagnosis in cases microscopically resembling other odontogenic lesions.
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http://dx.doi.org/10.1111/jop.13155DOI Listing
May 2021

Castor cake as organic fertilizer to control gastrointestinal nematodes in pasture-raised sheep.

Rev Bras Parasitol Vet 2020 4;29(4):e021420. Epub 2020 Dec 4.

Empresa Brasileira de Pesquisa Agropecuária - Embrapa Caprinos e Ovinos, Sobral, CE, Brasil.

Gastrointestinal parasitism is one of the factors that discourages farmers from raising small ruminants in cultivated pastures. To validate a soil treatment strategy to control the free-living stages of gastrointestinal nematodes (GIN), castor cake (CC) was used as a fertilizer on a pasture where sheep grazed on guinea grass under continuous stocking. On day zero, the pasture was divided into three paddocks, contaminated by GIN and treated, respectively, with CC divided into two applications (2CC1/2), CC in a single application (CC1) and organic compost in a single application (control). On day 21, eight GIN-free sheep were placed in each paddock. On day 58, significant differences (P<0.05) were observed: reduction of up to 66.10% in larvae.g-1 of dry mass in pastures fertilized with CC, decrease of up to 60.72% in infection rates among the animals in the groups treated with CC, higher average daily weight gain (over 185 g.day-1) and packed cell volume (over 26%) in the groups treated with CC, when compared to the control (128 g.day-1; 20.9%). In view of the results, the use of CC, mainly CC1, as a fertilizer for guinea grass pastures, under continuous stocking, proved to be promising, with 63.41% effectiveness in controlling worm infestations.
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http://dx.doi.org/10.1590/S1984-29612020103DOI Listing
January 2021

Blastocoel fluid removal and melatonin supplementation in the culture medium improve the viability of vitrified bovine embryos.

Theriogenology 2021 Jan 4;160:134-141. Epub 2020 Nov 4.

Center for Studies and Research in Animal Reproductive Biology, College of Veterinary and Animal Science, Federal University of Goiás, Rodovia Goiânia - Nova Veneza, km 8, Campus Samambaia, CEP 74690-900, Goiânia, Goiás, Brazil. Electronic address:

In this study, we investigated the effects of melatonin supplementation in the culture medium and blastocoel fluid removal (BFR) before vitrification on the quality and viability of in vitro-derived bovine embryos. After fertilization, presumptive zygotes were assigned to one of the following treatments: control, in vitro standard culture (IVC) medium; IVC + M10, IVC medium supplemented 10 M melatonin; or IVC + M10 BFR, IVC medium supplemented with 10 M melatonin plus BFR on day 7 (D7) of culture. D7 blastocysts were vitrified by the Cryotop method and, after 5 mo of storage, were warmed and incubated for an additional 72 h. The re-expansion rate was evaluated after 2 and 24 h, and the hatching rate was evaluated after 24, 48, and 72 h. At 72 h, the total number of cells (TNC); number of apoptotic cells (NAC); and expression of genes related to oxidative stress (HSPA5), cell metabolism (SLC2A3), cell repair (MSH6), placentation (KRT8 and PLAC8), and implantation (FOSL1) were assessed in the blastocysts. Less than 30% of the control blastocysts re-expanded until 2 h, whereas more than 85% of the IVC + M10 and IVC + M10 BFR blastocysts re-expanded (P < 0.05). The hatching rate of IVC + M10 BFR blastocysts increased at all time points (P < 0.05), reaching 66.8% at 72 h of incubation. The TNC was similar among treatments (P > 0.05), regardless of vitrification/warming and re-cultivation. The NAC:TNC was smaller for melatonin-treated blastocysts (P < 0.05). BFR increased HSPA5 (P = 0.0118) expression and did not affect SLC2A3, MSH6, KRT8, and FOSL1 expression (P > 0.05). In conclusion, melatonin (10 M) supplementation in the culture medium and BFR on D7 of culture increased the hatching rate 24, 48, and 72 h after warming of the vitrified embryos, indicating an improvement in cryotolerance.
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http://dx.doi.org/10.1016/j.theriogenology.2020.10.028DOI Listing
January 2021
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