Exclusive use of absorbable suture threads in cleft lip and palate

INTRODUCTION: The treatment of orofacial clefts comprises steps that may result in considerable psychological trauma for patients and their caregivers. The use of absorbable sutures may help to eliminate these uncomfortable situations. However, the exclusive use of this synthetic material is still not preferred by surgeons, particularly in the muscle planes. METHODS: Data from patients who underwent surgery at the University Hospital of the Federal University of Rio de Janeiro from 2007 to 2014 were used. The patients underwent correction of cleft lip or palate, using only absorbable sutures (poliglecaprone 25 - Monocryl® or polyglactin 910 - Vicryl Rapide®) in all suture planes (mucosa, muscle, skin). RESULTS: We found 360 patients who met the inclusion criteria for this study. We did not observe differences in terms of the local appearance of the wounds during the suture absorption process. The incidence of dehiscence or fistula cases was below 1%, and there were no complications regarding the objectives of the study. In the long term, the scars did not differ from those obtained with non-absorbable sutures used in other types of surgeries. CONCLUSIONS: The exclusive use of absorbable sutures was shown to be an efficient and safe option. These resulted in good quality scars and adequate tensile strength (even in muscle planes), and we did not observe complications related to the absorption process of the material used

Identification of priority areas for surveillance of cutaneous leishmaniasis using spatial analysis approaches in Southeastern Brazil.

BACKGROUND: Cutaneous leishmaniasis (CL) is an important public health problem in Brazil and in several tropical regions of the world. In the Americas, Brazil is the country with the highest number of registered cases. In Brazil, the state of Minas Gerais has the highest number of cases in the southeastern region. In the present study, we used spatial analysis in the State of Minas Gerais to identify municipalities of priority during a nine-year period (2007-2015), which might be used to guide surveillance and control measures. METHODS: An ecological study with spatial analysis of autochthonous cases of CL was performed in the state of Minas Gerais between 2007 and 2015. We calculated incidence rates, used Empirical Bayesian smoothing for each municipality, and divided the analyses into three-year intervals. In order to analyze the existence of spatial autocorrelation, and to define priority areas, Moran's Global Index and Local Indicators of Spatial Association (LISA) were used. RESULTS: The mean incidence rate for the entire state was 6.1/100,000 inhabitants. For Minas Gerais, analysis of CL cases over time revealed a successive increase of indicated mesoregions with high priority municipalities. Eight of the designated mesoregions contained municipalities classified as high priority areas in any of the three evaluated trienniums, and four mesoregions had high priority municipalities throughout the entire investigation. CONCLUSIONS: Within the southeastern region of Brazil, Minas Gerais State stands out, with highest CL incidence rates. Using spatial analysis, we identified an increasing numbers of cases in the municipalities classified as high priority areas in different mesoregions of the state. This information might be of value to direct surveillance and control measures against CL and to understand the dynamics of the expansion of CL in Minas Gerais. Similar approaches might be used to map CL in other regions throughout Brazil, or in any other country, where national notification and control programs exist

Notas sobre la fauna de flebótomos (Diptera: Psychodidae) en una región de Brasil

The family Psychodidae has a cosmopolitan distribution with members that occur in many habitats, mainly in humid environments, and is most diverse in the tropics. Subfamilies Sycoracinae and Phlebotominae have females with hematophagous habits and the latter studied more due to medical and veterinary interest, since it includes species that can transmit diseases to animals and humans. The knowledge about the sand fly fauna in a region is extremely important for adequate monitoring and control measures for leishmaniasis. Thus, the objective of this study was to characterize Psychodidae fauna in relation to richness, abundance and molecular identification of Leishmania spp. in sand flies in southern Santa Catarina, Brazil. The ollections were carried out between 2015 and 2016 in three cities in Santa Catarina, Brazil. Samples were taken near feeding places for domestic animals, urban forest and peridomicile areas. The insects were identified and female sand flies were submitted to molecular analysis to detect the presence of Leishmania spp.. A total of 4,200 insects were collected, 4,193 from the Sycoracinae subfamily and 7 Phlebotominae from the Nyssomyia neivai and Pintomyia fisheri species. Of the studied municipalities, sandflies were registered in Tubarão and Imaruí and the most frequent habitat was the peridomicile areas. No samples were positive for Leishmania spp. In conclusion, the work highlights the presence of two species of sandflies, which were recorded for the first time in southern Santa Catarina.A família Psychodidae possui distribuição cosmopolita com membros que ocorrem em diversos habitats, principalmente em ambientes úmidos, sendo mais diversa nos trópicos. As subfamílias Sycoracinae e Phlebotominae apresentam fêmeas com hábitos hematófagos, sendo esta última estudada mais por interesse médico e veterinário, pois inclui espécies que podem transmitir doenças para animais e humanos. O conhecimento da fauna de flebotomíneos em uma região é de extrema importância para o adequado monitoramento e controle da leishmaniose. Assim, o objetivo deste estudo foi caracterizar a fauna de Psychodidae em relação à riqueza, abundância e identificação molecular de Leishmania spp. em flebotomíneos no sul de Santa Catarina, Brasil. As coletas foram feitas entre 2015 a 2016 em três cidades catarinenses. As amostras foram coletadas próximo a locais de alimentação de animais domésticos, floresta urbana e áreas de peridomicílio. Os insetos foram identificados e flebotomíneos fêmeas foram submetidos a análises moleculares para detecção de Leishmania spp. Foram coletados 4.200 insetos, sendo 4.193 espécimes da subfamília Sycoracinae e 7 Phlebotominae das espécies Nyssomyia neivai e Pintomyia fisheri. Dos municípios estudados, os flebotomíneos foram registrados em Tubarão e Imaruí e o habitat mais frequente foram as áreas de peridomicílio. Nenhuma amostra foi positiva para Leishmania spp. Em conclusão, o trabalho destaca a presença de duas espécies de flebotomíneos, que foram registradas pela primeira vez no sul de Santa Catarina.La familia Psychodidae tiene una distribución cosmopolita con miembros que se encuentran en diferentes hábitats, principalmente en ambientes húmedos, siendo más diversos en los trópicos. Las subfamilias Sycoracinae y Phlebotominae tienen hembras con hábitos hematófagos, siendo esta última más estudiada por interés médico y veterinario, ya que incluye especies que pueden transmitir enfermedades a animales y humanos. El conocimiento de la fauna de flebótomos en una región es extremadamente importante para el seguimiento y control adecuados de la leishmaniasis. Así, el objetivo de este estudio fue caracterizar la fauna de Psychodidae en relación a la riqueza, abundancia e identificación molecular de Leishmania spp. en flebótomos en el sur de Santa Catarina, Brasil. Las recolecciones se realizaron entre 2015 y 2016 en tres ciudades de Santa Catarina. Las muestras se recolectaron cerca de sitios de alimentación de animales domésticos, bosques urbanos y áreas de peridomicilo. Se identificaron insectos y se sometieron a análisis moleculares hembras de flebótomos para detectar Leishmania spp. Se recolectaron un total de 4.200 insectos, 4.193 de la subfamilia Sycoracinae y 7 Phlebotominae de las especies Nyssomyia neivai y Pintomyia fisheri. De los municipios estudiados, se registraron flebótomos en Tubarão e Imaruí y el hábitat más frecuente fue el peridomicilio. Ninguna muestra fue positiva para Leishmania spp. En conclusión, el trabajo destaca la presencia de dos especies de flebótomos, que se registraron por primera vez en el sur de Santa Catarina

Effects of Gender, Sterilization, and Environment on the Spatial Distribution of Free-Roaming Dogs: An Intervention Study in an Urban Setting.

Information concerning the factors affecting the circulation and distribution of free-roaming dogs is crucial in developing control actions and limiting the spread of zoonoses. The present study analyzes the influence of gender, sterilization, and environment on the spatial distribution of free-roaming dogs in urban settings. Animals were captured/recaptured in seven consecutive morning sampling efforts conducted at 2-monthly intervals in control and intervention areas in a medium-size town in southeastern Brazil. Capture locations were georeferenced and captured animals were microchipped before being released at their original capture sites. Dogs captured in the intervention area were subjected additionally to surgical sterilization prior to release. Home range (HR) areas were calculated by applying the minimum convex polygon method to dogs that had been captured at least three times. Land coverage zones were determined from satellite images and overlaid on maps of the study areas along with the locations of 22 commercial food outlets. HR areas showed a global mean of 448 m2 and a median of 28 m2, values that were smaller than those reported previously for dogs in rural regions. The median HR of females (64.m2) was higher than that of males (15 m2), while median HRs of animals in the control and intervention areas were similar (27 and 28.5 m2, respectively). Variability of HR was high, although animals with small HRs predominated. Free-roaming dogs grouped primarily in urbanized and transitional regions, and their spatial distribution was positively correlated with locations of commercial food outlets. While sterilization did not influence HR size, the search for food was a key factor in determining mobility and spatial aggregation of free-roaming dogs. Our findings are pertinent in understanding the ecology of free-roaming dogs in urban environments and will be applicable to strategies aimed at promoting animal welfare and preventing the dissemination of zoonoses

Spatiotemporal dynamics and risk estimates of COVID-19 epidemic in Minas Gerais State: analysis of an expanding process

COVID-19 is an infectious disease caused by the recently discovered coronavirus SARS-Cov-2. The disease became pandemic affecting many countries globally, including Brazil. Considering the expansion process and particularities during the initial stages of the epidemic, we aimed to analyze the spatial and spatiotemporal patterns of COVID-19 occurrence and to identify priority risk areas in Minas Gerais State, Southeast Brazil. An ecological study was performed considering all data from human cases of COVID-19 confirmed from the epidemiological week (EW) 11 (March 08, 2020) to EW 26 (June 27, 2020). Crude and smoothed incidence rates were used to analyze the distribution of disease patterns based on global and local indicators of spatial association and space-time risk assessment. Positive spatial autocorrelation and spatial dependence were found. Our results suggest that the metropolitan region of the State capital Belo Horizonte (MRBH) and Vale do Rio Doce mesoregions, as major epidemic foci in the beginning of the expansion process, have had important influence on the dispersion of SARS-CoV-2 in Minas Gerais State. Triangulo Mineiro/Alto Paranaiba region presented the highest risk of infection. In addition, six statistically significant spatiotemporal clusters were identified in the State, three at high risk and three at low risk. Our findings contribute to a greater understanding of the space-time disease dynamic and discuss strategies for identification of priority areas for COVID-19 surveillance and control

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Spatial and spatiotemporal patterns of human visceral leishmaniasis in an endemic southeastern area in countryside Brazil.

Visceral leishmaniasis (VL) has shown endemic pattern and epidemic episodes in urban and rural areas, however, there are still gaps in knowledge with regards to disease transmission. This study aimed to analyze the spatiotemporal dispersion of VL cases in the municipality of Araçuaí, Minas Gerais. A study of confirmed VL cases was conducted considering the endemic and epidemic periods between 2012 and 2017. The incidence rate was calculated, and for spatial analysis, the kernel map, directional distribution ellipse, and space-time scanning techniques were used. The correlations between VL cases and exposure variables (precipitation, humidity, and temperature) were calculated. The mean incidence of VL in the endemic period was 18.5 (95% confidence interval (CI) 5.9-32.5) and 44.4 in the epidemic period (95%CI, 12.0-28.6) by 100,000 inhabitants. The relative risk for the epidemic period was 2.4 (95% CI 1.4-4.1) when compared to the endemic period. A higher incidence of the disease was observed in rural areas of the municipality. Kernel mapping analysis revealed hotspots in the urban area of the municipality. The directional distribution ellipse encompasses the urban perimeter and part of the rural area of the municipality, expanding eastward during the epidemic period. Spatial analysis revealed a high-risk cluster for VL in rural areas. A positive correlation was observed between VL cases and temperature during the endemic period. Spatial analysis allowed us to outline the epidemiological scenario of human VL cases. These findings may be useful in case surveillance and in the work of health professionals and managers in Brazil

Temporal patterns, spatial risks, and characteristics of tegumentary leishmaniasis in Brazil in the first twenty years of the 21st Century.

BackgroundTegumentary leishmaniasis (TL) is a significant public health issue in Brazil. The present ecological study describes the clinical and epidemiological characteristics of TL cases reported in the country, and analyzes the spatial and temporal patterns of the incidences and risks of occurrence across the five geopolitical regions and 27 federative units.Methodology/principal findingsData regarding new cases of TL notified between 2001 and 2020 were obtained from the Information System for Notifiable Diseases of the Brazilian Ministry of Health. Joinpoint and spatial and temporal generalized additive models were used to establish trends in the evolution of TL during the target period. The incidence rate for the entire period was 226.41 cases/100,000 inhabitants. All regions of Brazil showed trends of decreasing incidence rates, albeit with fluctuations at specific times, with the exception of the Southeast where rates have increased since 2014, most particularly in Minas Gerais state. The disease was concentrated predominantly in the North region, with Acre state leading the incidence rank in the whole country, followed by Mato Grosso (Midwest), Maranhão and Bahia (Northeast) states. The spatial distribution of the risk of TL occurrence in relation to the annual averages was relatively stable throughout the period. The cutaneous form of TL was predominant and cases most frequently occurred in rural areas and among men of working age. The ages of individuals contracting TL tended to increase during the time series. Finally, the proportion of confirmations by laboratory tests was lower in the Northeast.Conclusion/significanceTL shows a declining trend in Brazil, but its widespread occurrence and the presence of areas with increasing incidence rates demonstrate the persistent relevance of this disease and the need for constant monitoring. Our findings reinforce the importance of temporal and spatial tools in epidemiologic surveillance routines and are valuable for targeting preventive and control actions