High-resolution computed tomography findings in young infants with cystic fibrosis detected by newborn screening

OBJECTIVE: High-resolution computed tomography (HRCT) allows the early detection of pathological changes in the lung structure, and reproducible scoring systems can be used to quantify chest computed tomography (CT) findings in patients with cystic fibrosis (CF). The aim of the study was to describe early HRCT findings according to a validated scoring system in infants with CF diagnosed by newborn screening (NBS). METHODS: This cross-sectional study included infants with CF diagnosed by NBS who were born between January 2013 and January 2017 and who underwent HRCT scanning within the first year after diagnosis when they were clinically stable. The CT scans were evaluated using the modified Bhalla score. RESULTS: Thirty-two subjects underwent HRCT scanning. The mean total-modified Bhalla score was 3.6±2.1, and 93.8% of the scans were abnormal. Pseudomonas aeruginosa airway colonization was associated with increased modified Bhalla score values. Bronchial wall thickening was the most common feature (90.6%), followed by bronchial collapse/consolidation (59.4%), mosaic attenuation/perfusion (50%), bronchiectasis (37.5%) and mucus plugging (15.6%). Bronchial wall thickening was diffuse in most of the patients. CONCLUSION: A substantial proportion of infants diagnosed with CF after detection by NBS already showed evidence of lung disease. P. aeruginosa colonization was associated with increased Bhalla scores, highlighting the importance of this CF pathogen in early structural lung disease. The presence of bronchial wall thickening at such a young age may reflect the presence of airway inflammatory processes. The detection and quantification of structural abnormalities with the modified Bhalla score may aid in the identification of lung disease before it is clinically apparent

Comparison of the worldwide transmissible Pseudomonas aeruginosa with isolates from brazilian cystic fibrosis patients

Cross-infection with Pseudomonas aeruginosa among cystic fibrosis (CF) patients is a rare occurrence. However, the emergence of transmissible strains has been reported between unrelated individuals. We analyzed the genetic relationship among P. aeruginosa isolates from Brazilian CF patients and transmissible clones which are worldwide spread. The data does not indicate the presence of closely related variant clones

Cariostáticos na prática odontopediátrica: importância e indicações de uso no contexto da pandemia da COVID-19 / Cariostatics in pediatric dental practice: importance and indications of use in the context of COVID-19 pandemic

Objetivo: Caracterizar a importância e as indicações do uso dos cariostáticos na prática odontopediátrica em tempos de pandemia da COVID-19. Materiais e métodos: Foi realizada busca online por meio das bases de dados PubMed e Cochrane. A consulta foi restrita aos anos de 2010 a 2020. Os descritores e seus sinônimos foram selecionados por meio de consultas no DeCS (Descritores em Ciências da Saúde) e MeSH (Cabeçalhos de Assunto Médico): "cariostatic agents", “dental caries”, "pediatric dentistry" e "coronavirus infections". Foi aplicada uma escala de qualidade aos estudos clínicos randomizados. Resultados: A amostra final consistiu em 17 artigos, dos quais 12 foram Ensaios Clínicos Randomizados e 5 artigos de Revisão Sistemática, todos estes publicados entre 2012 e 2019. Através da aplicação da escala de qualidade metodológica aos Ensaios Clínicos Randomizados, observou-se que dos 12 estudos, quatro artigos obtiveram 5 pontos, que corresponde ao score máximo e nove estudos alcançaram o score 4, indicando serem estudos de alta qualidade. Conclusão: Conclui-se que o uso do diamino fluoreto de prata em altas concentrações mostrou-se efetivo no controle de lesões ativas de cárie. Seu uso corrobora as normas atuais de biossegurança em consultório odontológico durante a pandemia da COVID-19 através de produção reduzida de aerossol, mínima intervenção e bom tempo clínico, mostrando-se, portanto, como uma ótima opção para tratamentos conservadores e efetivos no cenário atual de saúde. 

Avaliação histopatológica da toxicidade da formalina em Arapaima gigas (Arapaimidae), o peixe gigante da Amazônia

O presente estudo teve como objetivo determinar a concentração letal e efeitos estruturais e ultraestruturais causados pela exposição a formalina em juvenis de Arapaima gigas. Noventa peixes (60,1±2,5g e 20,2±0,9cm) foram expostos a 0, 22, 44, 66, 88 e 110mg L-1, para determinar a concentração letal (CL50-96h) de formalina que foi 36,4mg L-1. Os efeitos subletais foram avaliados por análises histopatológicas das brânquias e avaliação das alterações comportamentais e sinais clínicos. A CL50 de formalina para 24, 48 e 72horas foi de 88,3, 64,7 e 56,8; respectivamente. Sinais clínicos e alterações comportamentais encontradas foram: natação errática, letargia, aglomeração de peixes na superfície da água, perda de equilíbrio hidrodinâmico, espasmos e confronto agonísticos, observados apenas nas concentrações de 88 e 110mg L-1. O índice de alteração histológica (IAH) mostrou que as concentrações de 66, 88 e 100mg L-1 apresentaram diferenças significativas (p < 0,05) em relação aos controles, indicando a ocorrência de danos moderados nas brânquias dos peixes expostos a formalina. Os valores médios de alteração (VMA) para as concentrações 22, 44, 66, 88 e 110mg L-1 foram 1,14, 1,29, 1,51, 1,53 e 1,60; respectivamente, e as diferenças na composição desse índice foram observados apenas na exposição com 110mg L-1 de formalina. Foi possível concluir que concentrações subletais de formalina (22,0mg L-1) não comprometem a saúde de juvenis de A. gigas. Concentrações de formalina acima da CL50-96h podem ser usadas cuidadosamente para banho de curto tempo, uma vez que o VMA para todas as concentrações testadas indicou apenas lesões localizadas que não comprometem a funcionalidade das brânquias dos peixes expostos. © 2018 Colegio Brasileiro de Patologia Animal.This study aimed to determine the lethal concentration and the structural and ultra-structural effects caused by the formalin exposure on juveniles of Arapaima gigas. Ninety fish (60.1± 2.5g and 20.2±0.9cm) were exposed to 0, 22, 44, 66, 88 and 110mg L-1 in order to determine the lethal concentration (LC50-96h) that was 36.4mg L-1 of formalin. Sublethal effects were evaluated using histopathological analysis on the gills and assessment of behavioral alterations and clinical signs. The LC50 of formalin for 24, 48 and 72h was 88.3, 64.7 and 56.8mg L-1 respectively. Clinical signs and behavioral changes were found: erratic swimming, lethargy, crowding on the water surface, loss of hydrodynamic equilibrium, spasms and agonistic confrontation, which were observed only at 88 and 110mg L-1. The histological alteration index (HAI) showed that 66, 88 and 100mg L-1 presented significant difference (p < 0.05) in relation to unexposed fish, indicating that moderate damage to the gills of fish exposed to formalin had occurred. The mean values of alteration (MVA) for 22, 44, 66, 88 and 110mg L-1 were 1.14, 1.29, 1.51, 1.53 and 1.60 respectively, and differences in this index were only observed with 110 mgL-1 of formalin. It is therefore possible to conclude that sublethal concentrations of formalin (22.0mg L-1) did not compromise the health of juveniles of A. gigas. Finally, concentrations greater than to LC50-96h may be carefully used for short-term exposure, since the MVA for all concentrations tested only indicated localized lesions that did not compromise gills functionality of exposed fish. © 2018 Colegio Brasileiro de Patologia Animal

Multidrug-Resistant Nontuberculous Mycobacteria Isolated from Cystic Fibrosis Patients

Worldwide, nontuberculous mycobacteria (NTM) have become emergent pathogens of pulmonary infections in cystic fibrosis (CF) patients, with an estimated prevalence ranging from 5 to 20%. This work investigated the presence of NTM in sputum samples of 129 CF patients (2 to 18 years old) submitted to longitudinal clinical supervision at a regional reference center in Rio de Janeiro, Brazil. From June 2009 to March 2012, 36 NTM isolates recovered from 10 (7.75%) out of 129 children were obtained. Molecular identification of NTM was performed by using PCR restriction analysis targeting the hsp65 gene (PRA-hsp65) and sequencing of the rpoB gene, and susceptibility tests were performed that followed Clinical and Laboratory Standards Institute recommendations. for evaluating the genotypic diversity, pulsed-field gel electrophoresis (PFGE) and/or enterobacterial repetitive intergenic consensus sequence PCR (ERIC-PCR) was performed. the species identified were Mycobacterium abscessus subsp. bolletii (n = 24), M. abscessus subsp. abscessus (n = 6), Mycobacterium fortuitum (n = 3), Mycobacterium marseillense (n = 2), and Mycobacterium timonense (n = 1). Most of the isolates presented resistance to five or more of the antimicrobials tested. Typing profiles were mainly patient specific. the PFGE profiles indicated the presence of two clonal groups for M. abscessus subsp. abscessus and five clonal groups for M. abscesssus subsp. bolletii, with just one clone detected in two patients. Given the observed multidrug resistance patterns and the possibility of transmission between patients, we suggest the implementation of continuous and routine investigation of NTM infection or colonization in CF patients, including countries with a high burden of tuberculosis disease.Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)PDTIS-FIOCRUZUniv Fed Rio de Janeiro, Programa Posgrad Clin Med, Hosp Univ Clementino Fraga Filho, Rio de Janeiro, BrazilUniv Fed Rio Grande do Sul, Programa Posgrad Ciencias Med, Porto Alegre, RS, BrazilUniv Fed Rio de Janeiro, Fac Ciencias Med, Dept Microbiol Imunol & Parasitol, Rio de Janeiro, BrazilInst Fernandes Figueira Fiocruz, Rio de Janeiro, BrazilUniv Estado Rio de Janeiro, Hosp Univ Pedro Ernesto, Rio de Janeiro, BrazilUniv Fed Rio de Janeiro, Inst Microbiol, BR-21941 Rio de Janeiro, BrazilFundacao Oswaldo Cruz, Inst Pesquisa Evandro Chagas, Rio de Janeiro, BrazilInst Doencas Torax, Rio de Janeiro, BrazilJohns Hopkins Univ, Baltimore, MD USAUniversidade Federal de São Paulo, Escola Paulista Med, Dept Microbiol Imunol & Parasitol, São Paulo, BrazilUniv Fed Fluminense, Inst Biomed, Niteroi, RJ, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Microbiol Imunol & Parasitol, São Paulo, BrazilFAPERJ: 103.225/2011FAPERJ: 103.287/2011FAPERJ: 110.272/2010FAPERJ: 110.761/2010FAPERJ: 111.497/2008CNPq: 476536/2012-0CNPq: 473444/2010-0CNPq: 567037/2008-8Web of Scienc

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