COVID-19 : nothing is normal in this pandemic

Funding: This work was partially support by CEAUL (funded by FCT – Fundação para a Ciência e a Tecnologia, Portugal, through the project UIDB/00006/2020).This manuscript brings attention to inaccurate epidemiological concepts that emerged during the COVID-19 pandemic. In social media and scientific journals, some wrong references were given to a "normal epidemic curve" and also to a "log-normal curve/distribution". For many years, textbooks and courses of reputable institutions and scientific journals have disseminated misleading concepts. For example, calling histogram to plots of epidemic curves or using epidemic data to introduce the concept of a Gaussian distribution, ignoring its temporal indexing. Although an epidemic curve may look like a Gaussian curve and be eventually modelled by a Gauss function, it is not a normal distribution or a log-normal, as some authors claim. A pandemic produces highly-complex data and to tackle it effectively statistical and mathematical modelling need to go beyond the "one-size-fits-all solution". Classical textbooks need to be updated since pandemics happen and epidemiology needs to provide reliable information to policy recommendations and actions.Publisher PDFPeer reviewe

Saúde bucal, práticas de higiene bucal e ocorrência de câncer da cavidade oral

OBJECTIVE: To assess the association between oral health and hygiene practices and oral cancer. METHODS: Hospital-based case-control study in the metropolitan area of São Paulo, southeastern Brazil, from 1998 to 2002. A total 309 patients with squamous cell carcinoma of the mouth and the pharynx and 468 controls matched by sex and age were included in the study. Cases were recruited in seven reference hospitals and controls were selected in five out of the seven participating hospitals. Detailed information on smoking, alcohol consumption, schooling, oral health status and hygiene practices were obtained through interviews. Odds ratios (OR) and 95% confidence intervals (95% CI), adjusted by sex, age, schooling, smoking, alcohol consumption as well as the variables oral health status and hygiene practices were estimated using unconditional logistic regression analyses. RESULTS: The use of complete dental prosthesis was not associated with oral cancer but regular gum bleeding showed a strong association (OR 3.1; 95% CI 1.2-7.9). Those who never attended a dental visit were more likely to have oral cancer (OR 2.5; 95% CI 1.3-4.8). Daily mouthwash use showed a stronger association to pharynx (OR 4.7; 95% CI 1.8-12.5) than mouth cancer (OR 3.2; 95% CI 1.6-6.3). CONCLUSIONS: Gum bleeding, no dental care, and daily mouthwash use were factors associated with oral cancer regardless of tobacco and alcohol consumption.OBJETIVO: Avaliar a associação entre saúde e higiene bucal na ocorrência de câncer oral. MÉTODOS: Estudo caso-controle de base hospitalar, realizado entre 1998 e 2002 na área metropolitana de São Paulo, SP. Foram incluídos 309 pacientes com carcinoma epidermóide de boca e orofaringe e 468 controles, pareados com os casos por sexo e idade. Os casos foram levantados em sete hospitais que concentram a assistência médica a pacientes com a doença e os controles rastreados em cinco hospitais gerais dentre os sete. Informações pormenorizadas sobre tabagismo, consumo de álcool, escolaridade, saúde bucal e práticas de higiene bucal foram obtidas por entrevista. Por meio de análise de regressão logística não condicional foram calculados odds ratios (OR) e intervalos com 95% de confiança (IC 95%), ajustados por sexo, idade, nível educacional, tabagismo e consumo de álcool, bem como para as demais variáveis de saúde e higiene bucal. RESULTADOS: Uso de prótese bucal total não se associou a câncer oral, mas sangramento gengival freqüente apresentou alta associação (OR=3,1; IC 95%: 1,2;7,9). Nunca ter consultado dentista mostrou associação com câncer oral (OR=2,5; IC 95%: 1,3;4,8). Uso diário de enxaguatórios bucais apresentou associação mais intensa com tumores de faringe (OR=4,7; IC 95%: 1,8;12,5) do que com tumores de boca (OR=3,2; IC 95%: 1,6;6,3). CONCLUSÕES: Sangramento gengival, ausência de consultas com dentistas e uso regular de enxaguatórios bucais foram fatores associados com câncer oral, independentemente de tabagismo e consumo de bebidas alcoólicas.European Commission ContractFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Oral health, hygiene practices and oral cancer

OBJECTIVE: To assess the association between oral health and hygiene practices and oral cancer. METHODS: Hospital-based case-control study in the metropolitan area of São Paulo, southeastern Brazil, from 1998 to 2002. A total 309 patients with squamous cell carcinoma of the mouth and the pharynx and 468 controls matched by sex and age were included in the study. Cases were recruited in seven reference hospitals and controls were selected in five out of the seven participating hospitals. Detailed information on smoking, alcohol consumption, schooling, oral health status and hygiene practices were obtained through interviews. Odds ratios (OR) and 95% confidence intervals (95% CI), adjusted by sex, age, schooling, smoking, alcohol consumption as well as the variables oral health status and hygiene practices were estimated using unconditional logistic regression analyses. RESULTS: The use of complete dental prosthesis was not associated with oral cancer but regular gum bleeding showed a strong association (OR 3.1; 95% CI 1.2-7.9). Those who never attended a dental visit were more likely to have oral cancer (OR 2.5; 95% CI 1.3-4.8). Daily mouthwash use showed a stronger association to pharynx (OR 4.7; 95% CI 1.8-12.5) than mouth cancer (OR 3.2; 95% CI 1.6-6.3). CONCLUSIONS: Gum bleeding, no dental care, and daily mouthwash use were factors associated with oral cancer regardless of tobacco and alcohol consumption.OBJETIVO: Avaliar a associação entre saúde e higiene bucal na ocorrência de câncer oral. MÉTODOS: Estudo caso-controle de base hospitalar, realizado entre 1998 e 2002 na área metropolitana de São Paulo, SP. Foram incluídos 309 pacientes com carcinoma epidermóide de boca e orofaringe e 468 controles, pareados com os casos por sexo e idade. Os casos foram levantados em sete hospitais que concentram a assistência médica a pacientes com a doença e os controles rastreados em cinco hospitais gerais dentre os sete. Informações pormenorizadas sobre tabagismo, consumo de álcool, escolaridade, saúde bucal e práticas de higiene bucal foram obtidas por entrevista. Por meio de análise de regressão logística não condicional foram calculados odds ratios (OR) e intervalos com 95% de confiança (IC 95%), ajustados por sexo, idade, nível educacional, tabagismo e consumo de álcool, bem como para as demais variáveis de saúde e higiene bucal. RESULTADOS: Uso de prótese bucal total não se associou a câncer oral, mas sangramento gengival freqüente apresentou alta associação (OR=3,1; IC 95%: 1,2;7,9). Nunca ter consultado dentista mostrou associação com câncer oral (OR=2,5; IC 95%: 1,3;4,8). Uso diário de enxaguatórios bucais apresentou associação mais intensa com tumores de faringe (OR=4,7; IC 95%: 1,8;12,5) do que com tumores de boca (OR=3,2; IC 95%: 1,6;6,3). CONCLUSÕES: Sangramento gengival, ausência de consultas com dentistas e uso regular de enxaguatórios bucais foram fatores associados com câncer oral, independentemente de tabagismo e consumo de bebidas alcoólicas

O impacto do diagnóstico citológico de atipiasi indeterminadas no sistema público de saúde

As alterações citológicas de significado indeterminado representam uma importante limitação diagnóstica nos programas de escrutíneo de lesões cérvico-vaginais. A introdução de métodos biomoleculares, como o sistema de captura híbrida para detecção de HPV de alto risco contribui para a otimização da conduta clínica dessas pacientes, indicando colposcopia com precisão. Objetivo: avaliar o significado de lesões de significado indeterminado com relação à infecção pelo HPV, com o uso do teste de DNA para HPV com o método da captura de híbridos II. Métodos: foram estudadas amostras de 236 casos consecutivos examinados no laboratório da DIGENE-BRASIL, de pacientes com diagnóstico citológico prévio de ASCUS. As amostras foram submetidas ao teste de captura híbrida para identificação de DNA-HPV de alto e baixo riscos. Resultados: dos 236 casos analisados, 183 (77,5%) foram negativos para o teste de captura híbrida, seis (2,6%) foram positivos para HPV de baixo risco e 47 (19,9%) foram positivos para HPV de alto risco. Conclusão : as amostras positivas para HPV de baixo risco representam uma pequena e não- onsiderável minoria de casos, provavelmente, transientes. Cerca de 20% dos casos foram positivos para HPV de alto risco e deverão ser encaminhados à colposcopia e biopsia, se necessário. Esses casos representam um grande potencial de progressão para lesões cervicais.In order to optimize the morphological analysis of the cases with uncertain diagnosis, we critically analyzed the cases with Atypia of Squamous Cells of Undertemined Significance (ASCUS) in cytological samples of uterine cervix collected in conventional smears (CS) and liquidbased preparations (LBC) an to correlate the findings with Hybrid Capture II (HC2) assay and biopsy. Objective: to evaluate the meanig of undetermined cytological atypia in relation to HPV infection detected by hybrid capture II test. Methods: 97 cases taken from women examined at Perola Byignton Hospital, São Paulo, Brazil, during the year of 2002. The conventional smears were taken previously than LBC. The residual sample was placed in liquid-medium and LBC preparation with DNA-Citoliq system was performed. If at least one of the paired samples were classified as ASCUS, the pair was submitted to a guided revision in order to evaluate the type of alteration taken in account to categorized ASCUS. Results: from 97 cases studied, 14 were categorized as ASCUS by the two methods simultaneously. The others had different classification under or hyper estimated. Six cases diagnosed as squamous intraepithelial lesion (SIL) by CS were ASCUS by LBC; in contrary, 19 ASCUS by CS were SIL by LBC. Eleven ASCUS by CS were diagnosed as negative by LBC, but CS categorized 47 LBC ASCUS as negative. From the morphological parameters nuclear enlargement and coarse chromatin were regarded as ASCUS. From 68 ASCUS by LBC, 36 were HC2 positive for high risk HPV (hr-HPV) : ten of them with biopsy proven lesion. From 42 CS ASCUS, 23 were hr-HPV positive, but only 7 with histological lesion. Conclusion: our results reinforced the hypothesis that ASCUS is poorly reproducible by morphological examination by CS or LBC preparations. To add HC2 as adjunct method to ASCUS cytology can improve the routine diagnosed of the uncertain atypies

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

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