Prevalence of oral cleft in Campos dos Goytacazes-RJ, 1999-2004

The purpose of the present study was to determine the prevalence of oral clefts in the city of Campos dos Goytacazes-RJ/Brazil, in children born from January 01, 1999 to December 31, 2004. Age group, cleft type, sex and race of the child were considered, as well as the marital status, education and origin of the child's mother at the time of birth. In this manner, the records of patients enrolled in reference services for treatment of craniofacial anomalies in the cities of Campos dos Goytacazes (RJ), Rio de Janeiro (RJ) and in Bauru (SP) were reviewed with the purpose of selecting those whose birth and/or residence was in the city of Campos dos Goytacazes, within the target period. After the initial selection, a search in the ISLB was conducted to define the universe of the study, which was: finding the children who were born alive between 1999 and 2004 whose mothers were living in Campos dos Goytacazes. In this period, using as a reference the mother's residence, the number of children born in the city was of 46,707, of which 63 had cleft lip with or without cleft palate, representing a prevalence of 1.35 cases in every 1,000 live births. The analysis of the data revealed that 55.6% of the patients were male; the most common type of cleft was isolated cleft palate and cleft lip and palate (34.9%); 61.3% of the cases were white children but the percentage of cases within each race did not differ statistically in relation to the distribution of births in the population; most of the mothers were single or married with little education.O objetivo deste estudo foi determinar a prevalência de fissuras labiopalatais no município de Campos dos Goytacazes-RJ, Brasil, em crianças nascidas entre 01/01/1999 e 31/12/2004. Foram considerados a faixa etária, tipo de fissura, sexo e raça da criança, além do estado civil, grau de escolaridade e procedência da mãe do portador na época do parto. Deste modo, foram verificados os prontuários de pacientes inscritos em serviços de referência em tratamento de anomalias craniofaciais, com o objetivo de selecionar os nascidos e/ou domiciliados no município de Campos dos Goytacazes. Após seleção inicial, foi realizada busca no Sistema de Informações sobre Nascidos Vivos (SINASC), definindo o universo do estudo, a saber: nascidos vivos entre 1999 e 2004, cujas mães eram residentes em Campos dos Goytacazes. Neste período, o número de nascidos no município, por residência da mãe, foi de 46.707, dos quais 63 possuíam algum tipo de fissura labiopalatal, representando uma prevalência de 1,35 casos por 1000 nascidos vivos. A análise dos dados revelou que 55,6% dos pacientes eram do sexo masculino. Os tipos de fissuras mais encontrados foram o de lábio e palato e o de palato isolado (34,9% cada). Embora a raça branca tenha representado 61,3% dos indivíduos estudados, o percentual de casos por raça não diferiu estatisticamente em relação à distribuição de nascidos na população. Com relação à mãe do portador, a maior parte das mães era solteira ou casada, possuindo como característica o baixo grau de escolaridade.10911

Panorama global da anquiloglossia em recém-nascidos: uma análise bibliométrica

This study aims to understand the global panorama of ankyloglossia in newborns by means of a bibliometric analysis of scientific productions up to January 2023. A search was conducted with the terms "Newborn", "Ankyloglossia" and their synonyms in the Pubmed, Embase, Cochrane, Virtual Health Library, Web of Science and Scopus platforms. After removing duplicates and applying the eligibility criteria, 431 studies were included and imported into the VOSviwer software. The most cited keywords were "Surgery" (198) and "Breastfeeding" (151). Among the 49 countries surveyed, the United States published the most on the subject (107). The most relevant study in the studied portfolio was "Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad" by Ballard and collaborators. The journal "Pediatrics" obtained the highest number of citations (608) and year 2019 recorded the most articles about ankyloglossia in newborns (44). The findings of this study show that the topic linked to oral brakes has sparked a growing interest in the scientific community, and show the concern in unveiling the real impact of ankyloglossia on the infant's breastfeeding, as well as the need to seek a consensus in diagnosis regarding surgical indication.Este trabalho buscou mapear o panorama global da anquiloglossia em recém-nascidos por meio da análise bibliométrica de produções científicas até janeiro de 2023. Para obtenção dos estudos, foi realizada uma busca avançada com os termos “Newborn”, “Ankyloglossia” e seus sinônimos nas plataformas Pubmed, Embase, Cochrane, Biblioteca Virtual de Saúde, Web of Science e Scopus. Os resultados foram importados para o gerenciador de referência Zotero. Após a remoção das duplicatas e aplicação dos critérios de elegibilidade, 431 estudos foram incluídos na análise e importados para o software VOSviwer versão 16.18. As palavras-chave mais citadas na pesquisa foram “Cirurgia” (198) e “Aleitamento” (151), que também apresentaram forte ligação entre si. Dentre os 49 países pesquisados, os Estados Unidos, o Reino Unido e a Austrália foram os que mais publicaram sobre o assunto, com 107, 44 e 28, respectivamente. O estudo mais relevante no portfólio estudado foi escrito por Ballard e colaboradores sob o título “Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad”. A revista “Pediatrics” obteve o maior número de citações (608) e ano de 2019 registrou a maior quantidade de artigos sobre a anquiloglossia em recém-nascidos (44). Os achados deste estudo demonstram que a temática ligada aos freios orais tem despertado um interesse crescente na comunidade científica e evidenciam a preocupação em desvendar o impacto real da anquiloglossia na amamentação do bebê, assim como a necessidade de buscar um consenso no diagnóstico em relação à indicação cirúrgica

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

Mayaro fever in an HIV-infected patient suspected of having Chikungunya fever

Abstract Arboviruses impose a serious threat to public health services. We report a case of a patient returning from a work trip to the Amazon basin with myalgia, arthralgia, fever, and headache. During this travel, the patient visited riverside communities. Both dengue and Chikungunya fevers were first suspected, tested for, and excluded. Mayaro fever was then confirmed by reverse transcription polymerase chain reaction followed by next-generation sequencing and phylogenetic reconstruction. The increased awareness of physicians and consequent detection of Mayaro virus in this case was only possible due a previous surveillance program with specific health personnel training about these neglected arboviruses

Land Use and Management Effects on Sustainable Sugarcane-Derived Bioenergy

Bioenergy is an important and feasible option for mitigating global warming and climate change. However, large-scale land-use change (LUC) to expand bioenergy crops, such as sugarcane, raises concerns about the potential negative environmental and socioeconomic side effects. Such effects are context-specific, and depending on the LUC scenario and management practices, several co-benefits can be attained. We reviewed the literature and discussed how LUC and best management practices affect key components of sustainability (e.g., soil health, soil carbon (C) sequestration, greenhouse gas emissions (GHG) emissions, nutrient cycling, water quality, among others) of sugarcane-derived bioenergy production in Brazil. Sugarcane expansion has occurred predominantly over pasture areas, although converting croplands could be also an environmentally feasible option. The land transition from low-productivity pastures to sugarcane cultivation seems to be a sustainable pathway to increase bioenergy production. This LUC scenario enhances soil health and soil C sequestration over time, although soil compaction, biodiversity loss, and erosion are still challenging. Besides, adopting best management practices, such as conservation tillage, sustainable crop residue management, rational fertilization, and recycling by-products, has been fundamental to ensuring sustainable bioenergy production. Public policies and well-designed legal frameworks and regulations, such as the Forest Code and the RenovaBio legislations in Brazil, are necessary to make bioenergy production compatible with rational land use and protection. Lastly, our analysis provided insights into sugarcane expansion over a small proportion (1%) of pasture areas in Latin American and Caribbean (LAC) and sub-Saharan African (SSA) countries, which may result in a substantial impact on global bioenergy supply. We concluded that sugarcane-derived bioenergy is a sustainable option to tackle climate change while provisioning other key ecosystem services and promoting socioeconomic development

Mayaro fever in an HIV-infected patient suspected of having Chikungunya fever

Abstract Arboviruses impose a serious threat to public health services. We report a case of a patient returning from a work trip to the Amazon basin with myalgia, arthralgia, fever, and headache. During this travel, the patient visited riverside communities. Both dengue and Chikungunya fevers were first suspected, tested for, and excluded. Mayaro fever was then confirmed by reverse transcription polymerase chain reaction followed by next-generation sequencing and phylogenetic reconstruction. The increased awareness of physicians and consequent detection of Mayaro virus in this case was only possible due a previous surveillance program with specific health personnel training about these neglected arboviruses