The characterisation of the craniofacial morphology of infants born with Zika virus:Innovative approach for public health surveillance and broad clinical applications

Background: This study was carried out in response to the Zika virus epidemic which constituted a public health emergency and to the 2019 WHO calling for strengthened surveillance for the early detection of related microcephaly. The main aim of the study was to phenotype the craniofacial morphology of microcephaly using novel approach and new measurements, relate the characteristics to brain abnormalities in Zika infected infants in Brazil to improve clinical surveillance. Methods: We captured 3D images of the face and the cranial vault of 44 Zika infected infants and matched healthy controls using 3D camera. The CT scans of the brain of the infected infants were analysed. The Principal Component Analysis (PCA) was applied to characterise the craniofacial morphology. In addition to the head circumference (HC), we introduced a new measurement, head height (HH) to measure the cranial vault. The level of brain abnormality present in the CT scans was assessed, the severity of parenchymal volume loss and ventriculomegaly was quantified. Findings: The PCA identified a significant difference (p <0.001) between the cranial vaults and the face of the Zika infants and that of the controls. Spearman's rank-order correlation coefficients show that the head height (HH) has a strong correlation (0.87 in Zika infants; 0.82 in Controls) with the morphology of the cranial vaults which are higher than the correlation with the routinely used head circumference (HC). Also, the head height (HH) has a moderate negative correlation (-0.48) with the brain abnormalities of parenchymal volume loss. Interpretation: We discovered that head height (HH), the most sensitive and discriminatory measure of the severity of cranial deformity which should be used for clinical surveillance of Zika syndrome, evaluation of other craniofacial syndromes and assessment of various treatment modalities

Idade, tabagismo, hipertensão arterial, altura e sexo feminino são determinantes de envelhecimento vascular avaliados pela segunda derivada da fotopletismografia digital

OBJETIVO: Avaliar os fatores de risco cardiovascular (RCV) determinantes dos índices de função arterial obtidos pela segunda derivada da fotopletismografia digital (SDPTG) em uma população de funcionários de uma instituição de ensino privado da cidade de São Paulo. MÉTODOS: Foram obtidos dados antropométricos e clínicos, medidas de pressão arterial (PA) com aparelho automático Microlife em 238 indivíduos de 23 a 72 anos (média 40,1 ± 9), 105 mulheres / 133 homens. A SDPTG foi registrada automaticamente pelo dispositivo Dynapulse, com o sensor localizado no 2º dígito da mão direita; da SDPTG obtivemos ondas a, b, c e d na sístole e e na diástole, e foram calculados as relações b/a, d/a e o índice de envelhecimento vascular (AGI) = [(b-c-d-e)/a], respectivamente, marcadores de distensibilidade arterial, intensidade das ondas de reflexão e envelhecimento vascular. A idade vascular (IVS) foi estimada a partir de dados comparativos do AGI obtido e valores de uma população normal. Os indivíduos foram considerados com índices vasculares piores, se tivessem valores superiores à média mais o desvio padrão. Hipertensão arterial (HA) foi definida como PA>140x90mmHg ao exame ou referida pelo paciente. RESULTADOS: Na análise de regressão logística, a possibilidade de AGI elevado relacionou-se positiva e independentemente com idade > 50anos (Odds Ratio-OR = 17,24), tabagismo (O.R. = 3,82) e sexo feminino (O.R. = 6,05); menor relação b/a com idade > 50 anos (O.R. = 6,37), enquanto a relação d/a relacionou-se com sexo feminino (O.R. = 3,90). A maior IVS relaciona-se à idade (OR = 8,85), sexo feminino (OR= 4,0) e HAS (OR = 2,42). A análise multivariada mostrou que altura se relaciona com AGI (Mean Square – MS = 0,701) e D/A (MS = 0,279), enquanto que este último parâmetro também é influenciado pela PA diastólica (MS = 0,168) e PA média. CONCLUSÕES: Os índices vasculares obtidos pela SDPTG têm influência dos principais fatores de RCV e outros fatores a serem considerados em sua análise. A distensibilidade arterial (b/a) é relacionada à idade enquanto a intensidade da reflexão das ondas de pulso (d/a) tem influência do sexo feminino, altura e PA. O envelhecimento vascular sofre influências da HA, do tabagismo, idade e altura.Objectives: To evaluate the cardiovascular risk (CR) determinants of the arterial function indices obtained by the second derivative photopletysmogram (SDPTG) in a agent population from a private teaching institution of São Paulo. Methods: antropometric and clinical data, arterial pressure (AP) by na automatic device Microlife were obtained from 238 individuals from 28 to 72 years (mean 40,1 ± 9), 105 women / 133 men. The SDPTG was automatically registered by the Dynapulse device through its sensor placed on the 2nd finger of the right hand; from SDPTG were obtained the a, b, c and e waves during the systole and the e wave during diastole and were calculated the b/a, d/a and the aging index (AGI) = [(b-c-d-e)/a], respectively, markers of arterial distensibility, wave reflection intensity and vascular aging. The vascular age (IVS) was estimated from comparison of the AGI data obtained and values of a normal population. The individuals were considered as worse vascular indices if their analysed values were higher than mean plus standard deviation. Arterial hypertension (AH) was defined as AP > 140x90mmHg at the examination or referred by the patient. Results: at the logistic regression, the possibility of high AGI was positively and independently related to age > 50 years (Odds Ratio-OR = 17,24), tabagism (O.R. = 3,82) and feminine sex (O.R. = 6,05); low b/a relation with age> 50 years (O.R. = 6,37), while high d/a was related to feminine sex (O.R. = 3,90). Higher IVS was related to age (OR = 8,85), feminine sex (OR = 4,0), and AH (OR = 2,42). At multivariate analysis, height was related to AGI (Mean Square – MS = 0,701) and D/A (MS = 0,279), while this last parameter was also influenced by diastolic AP (MS = 0,168) and mean AP. Conclusions: the vascular indices obtained by SDPTG are influenced by main CR and other factors to be considered at their analysis. The arterial distensibility (b/a) is related to age, while the intensity of pulse wave reflection to feminine Sex, height and AP. Vascular aging is influenced by AH, tabagism and height

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). the majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryBrazilian Diabetes SocietyFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Estado Rio de Janeiro, Unit Diabet, BR-20551030 Rio de Janeiro, BrazilBaurus Diabet Assoc, São Paulo, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilFed Univ Hosp Porto Alegre, Porto Alegre, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilSanta Casa Misericordia, Belo Horizonte, MG, BrazilSanta Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilHosp Geral de Bonsucesso, Rio de Janeiro, BrazilHosp Univ Clementino Fraga Filho IPPMG, Rio de Janeiro, BrazilUniv Hosp São Paulo, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, São Paulo, BrazilUniv São Paulo, Inst Crianca, Hosp Clin, São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, BrazilAmbulatorio Fac Estadual Med Sao Jose Rio Preto, Ribeirao Preto, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilClin Endocrinol Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Estadual Londrina, Londrina, BrazilUniv Fed Parana, Hosp Clin, Porto Alegre, RS, BrazilInst Crianca Com Diabet Rio Grande Sul, Rio Grande Do Sul, RS, BrazilGrp Hosp Conceicao, Inst Crianca Com Diabet, Porto Alegre, RS, BrazilHosp Univ Santa Catarina, Florianopolis, SC, BrazilInst Diabet Endocrinol Joinville, Joinville, BrazilHosp Reg Taguatinga, Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilCtr Diabet & Endocrinol Estado Bahia, Goiania, Go, BrazilUniv Fed Maranhao, Sao Luis, BrazilCtr Integrado Diabet & Hipertensao Ceara, Fortaleza, Ceara, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Univ Alcides Carneiro, Campina Grande, BrazilHosp Univ Joao de Barros Barreto, Belem, Para, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, São Paulo, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilWeb of Scienc

Paulo Freire in memes: caricatures of a divided country

Estamos vivendo tempos de polarização de nossa sociedade e, em meio a ela, a figura de Paulo Freire tem sido central em diferentes embates. A intenção deste texto é compreender como a publicização de memes em redes sociais tem contribuído para a construção de uma narrativa de descrédito do patrono da educação brasileira. A fim de alcançar esse objetivo, foram selecionados memes sobre Paulo Freire compartilhados pelo Movimento Escola Sem Partido em seu perfil nas redes sociais. Tais dados foram analisados à luz da teoria do dialogismo do Círculo de Bakhtin (Bakhtin, 2010; 2015; 2017; Volóchinov, 2017), e ao pensamento do próprio Freire (1967; 1987; 1992; 1996). Os resultados apontam para o uso intencional de termos pejorativos e de baixo calão na produção de tais textos, que têm potencial para causar excitabilidade e adesão de um público contrário a ideias progressistas. Nessa arena, vozes antagônicas aparecem de modo acanhado nos comentários e apontam a necessidade de buscar formas de resistência por meio não apenas de leituras críticas, mas também de engajamento com os processos de construção discursiva a fim de compreender como diferentes ideologias são construídas na linguagem.   Palavras-chave: Paulo Freire; Escola Sem Partido; Círculo de Bakhtin. We are facing difficult times, in which we find society polarized and, in this arena, the figure of Paulo Freire being central to many different and contradictory discussions. In this context, the intention of this paper is to understand how the propagation of memes in social networks may have contributed to the construction of a narrative of discredit of the patron of Brazilian education. In order to achieve this goal, memes about Paulo Freire shared by the School without Borders Movement were collected from its Facebook page. The data was analyzed in the light of the theory of dialogism (Bakhtin’s Circle – Bakhtin, 2010; 2015; 2017; Volóchinov, 2017) and against our readings or Freire´s work. The results of our analysis point to the use of pejorative terms and lack of ethical commitment, which potentially cause over excitability and adherence of an audience against progressive ideas. In this arena, antagonistic voices appear narrowly and illustrate the need to seek other forms of resistance

Variability in the clinical distributions of Candida species and the emergence of azole-resistant non-Candida albicans species in public hospitals in the Midwest region of Brazil

Abstract INTRODUCTION Incidence and antifungal susceptibility of Candida spp. from two teaching public hospitals are described. METHODS The minimum inhibitory concentrations of fluconazole, voriconazole, itraconazole, and amphotericin B were determined using Clinical Laboratory Standard Institute broth microdilution and genomic differentiation using PCR. RESULTS Of 221 Candida isolates, 50.2% were obtained from intensive care unit patients; 71.5% were recovered from urine and 9.1% from bloodstream samples. Candida parapsilosis sensu stricto was the most common candidemia agent. CONCLUSIONS We observed variations in Candida species distribution in hospitals in the same geographic region and documented the emergence of non-C. albicans species resistant to azoles