SITUAÇÃO EPIDEMIOLÓGICA DA HANSENÍASE EM GOIÂNIA, GOIÁS

Resumo O Brasil é a segunda nação com maior número de casos absolutos de hanseníase no mundo. O país possui várias regiões hiperdêmicas para hanseníase, inclusive a cidade de Goiânia. Neste contexto, o presente estudo objetivou caracterizar a situação epidemiológica da hanseníase em Goiânia, analisando a ocorrência da doença no período de 2006 a 2015. Os resultados deste estudo mostraram uma tendência de queda, estatisticamente significativa na incidência da doença em Goiânia no período analisado. Porem ainda é altíssimo o quantitativo de notificações de pacientes com formas mais graves e disseminadas da doença. Estes resultados mostram que apesar da relativa estabilização no número de casos de hanseníase, o diagnóstico da doença ainda continua sendo realizado de forma tardia, o que ainda determina um grande número de pacientes com deformidades e deficiências permanentes. Uma maior precocidade no diagnóstico da doença só será atingindo com um melhor treinamento e capacitação dos profissionais de saúde no manejo dos pacientes com hanseníase. Palavras-Chave: Mal de Hansen. Mycobecterium leprae. Incidência

APLICABILIDADES DO BARU (DIPTERYX ALATA VOGEL) NA SAÚDE HUMANA: REVISÃO DE LITERATURA

Dipteryx alata Vogel, o baru, é uma espécie do Cerrado que possui papel relevante para a alimentação humana e animal, bem como para uso fitoterápico. Diferentes partes dessa planta podem ser utilizadas com diversos fins. Essa espécie tem sofrido efeitos deletérios devido à intensa ocupação agrícola vivenciada no Cerrado, sobretudo, porque há irrisórias áreas de conservação com a presença de D. alata. O objetivo deste trabalho é salientar os potenciais de utilização do baru para a saúde humana. Os bancos de dados consultados para esta revisão foram: Periódico Capes, Pubmed, Lilacs e Scielo. As amêndoas do baru são sementes comestíveis, quando submetidas à prévia torrefação e nelas são encontrados os ácidos graxos insaturados linolênico, oléico, gadoleico, fítico e erúcico. O ácido linoléico extraído da amêndoa do baru pode ser convertido em ácido araquidônico e eicosanoides que são metabolizados em substâncias pró-inflamatórias e estimuladoras de agregação plaquetária. Porém outros ácidos graxos insaturados encontrados no baru têm demonstrado ação anti-inflamatória no sistema cardiovascular, auxiliando na diminuição das concentrações de colesterol sanguíneo. Também apresenta papel anti-inflamatório relevante na prevenção do envelhecimento cutâneo e na proteção tecidual ao estresse oxidativo

Early epilepsy in children with Zika-related microcephaly in a cohort in Recife, Brazil: Characteristics, electroencephalographic findings, and treatment response.

OBJECTIVE: To estimate the incidence of epilepsy in children with Zika-related microcephaly in the first 24 months of life; to characterize the associated clinical and electrographic findings; and to summarize the treatment responses. METHODS: We followed a cohort of children, born during the 2015-2016 Zika virus (ZIKV) epidemic in Brazil, with congenital microcephaly and evidence of congenital ZIKV infection on neuroimaging and/or laboratory testing. Neurological assessments were performed at ≤3, 6, 12, 15, 18, 21, and 24 months of life. Serial electroencephalograms were performed over the first 24 months. RESULTS: We evaluated 91 children, of whom 48 were female. In this study sample, the cumulative incidence of epilepsy was 71.4% in the first 24 months, and the main type of seizure was infantile spasms (83.1%). The highest incidence of seizures occurred between 3 and 9 months of age, and the risk remained high until 15 months of age. The incidence of infantile spasms peaked between 4 and 7 months and was followed by an increased incidence of focal epilepsy cases after 12 months of age. Neuroimaging results were available for all children, and 100% were abnormal. Cortical abnormalities were identified in 78.4% of the 74 children evaluated by computed tomography and 100% of the 53 children evaluated by magnetic resonance imaging. Overall, only 46.1% of the 65 children with epilepsy responded to treatment. The most commonly used medication was sodium valproate with or without benzodiazepines, levetiracetam, phenobarbital, and vigabatrin. SIGNIFICANCE: Zika-related microcephaly was associated with high risk of early epilepsy. Seizures typically began after the third month of life, usually as infantile spasms, with atypical electroencephalographic abnormalities. The seizure control rate was low. The onset of seizures in the second year was less frequent and, when it occurred, presented as focal epilepsy

Characteristics of children of the Microcephaly Epidemic Research Group Pediatric Cohort who developed postnatal microcephaly.

The number of studies published on postnatal microcephaly in children with Congenital Zika Syndrome is small, clinical presentations vary and aspects of the evolution of these children remain unclarified. The present case series examined clinical characteristics and assessed the growth velocity of the head circumference, weight and height Z-scores in 23 children who developed postnatal microcephaly during follow-up in the Microcephaly Epidemic Research Group Pediatric Cohort. To estimate the change in the head circumference, weight and height Z-scores over time and compare the mean difference between sexes, we used multilevel mixed-effects linear regressions with child-specific random effects. Among these children, 60.9% (n = 14/23) presented with craniofacial disproportion, 60.9% (n = 14/23) with strabismus, 47.8% (n = 11/23) with early onset seizures, 47.8% (n = 11/23) with dysphagia and 43.5% (n = 10/23) with arthrogryposis. Of the 82.7% (n = 19/23) children who underwent neuroimaging, 78.9% (n = 15/19) presented with alterations in the central nervous system. Monthly growth velocity, expressed in Z-scores, of the head circumference was - 0.098 (95% CI % - 0.117 to - 0.080), of weight was: - 0.010 (95%-CI - 0.033 to 0.014) and of height was: - 0.023 (95%-CI - 0.046 to 0.0001). Postnatal microcephaly occurred mainly in children who had already presented with signs of severe brain damage at birth; there was variability in weight and height development, with no set pattern

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

Comparison of Oropharyngeal Dysphagia in Brazilian Children with Prenatal Exposure to Zika Virus, With and Without Microcephaly.

Severe brain damage associated with Zika-related microcephaly (ZRM) have been reported to result in oropharyngeal dysphagia (OPD); however, it is unknown if OPD presents in children with prenatal Zika virus (ZIKV) exposure but only mild or undetectable abnormalities. The aims of this study were: to compare the frequency and characteristics of OPD in children with ZRM and in children without microcephaly born to mothers who tested polymerase chain reaction positive (PCR+) for ZIKV during pregnancy; and to investigate the concordance of caregiver reports of OPD with the diagnosis from the clinical swallowing assessment (CSA). Between Mar/2017 and May/2018, we evaluated 116 children (n = 58 with microcephaly, n = 58 children without microcephaly born to ZIKV PCR + mothers) participating in the Microcephaly Epidemic Research Group (MERG) cohort of children born during the 2015-2016 ZIKV epidemic in Pernambuco, Brazil. To assess OPD we used: a CSA; a clinical assessment of the stomatognathic system; and a questionnaire administered to caregivers. The frequency of OPD was markedly higher in children with ZRM (79.3%) than in the exposed but normocephalic group (8.6%). The children with microcephaly also presented more frequently with anatomic and functional abnormalities in the stomatognathic system. There was a high degree of agreement between the caregiver reports of OPD and the CSA (κ = 0.92). In conclusion, our findings confirm that OPD is a feature of Congenital Zika Syndrome that primarily occurs in children with microcephaly and provide support for policies in which children are referred for rehabilitation with an OPD diagnosis based on caregiver report

The Microcephaly Epidemic Research Group Paediatric Cohort (MERG-PC): A Cohort Profile.

This cohort profile aims to describe the ongoing follow-up of children in the Microcephaly Epidemic Research Group Paediatric Cohort (MERG-PC). The profile details the context and aims of the study, study population, methodology including assessments, and key results and publications to date. The children that make up MERG-PC were born in Recife or within 120 km of the city, in Pernambuco/Brazil, the epicentre of the microcephaly epidemic. MERG-PC includes children from four groups recruited at different stages of the ZIKV microcephaly epidemic in Pernambuco, i.e., the Outpatient Group (OG/n = 195), the Microcephaly Case-Control Study (MCCS/n = 80), the MERG Pregnant Women Cohort (MERG-PWC/n = 336), and the Control Group (CG/n = 100). We developed a comprehensive array of clinical, laboratory, and imaging assessments that were undertaken by a 'task force' of clinical specialists in a single day at 3, 6, 12, 18 months of age, and annually from 24 months. Children from MCCS and CG had their baseline assessment at birth and children from the other groups, at the first evaluation by the task force. The baseline cohort includes 711 children born between February 2015 and February 2019. Children's characteristics at baseline, excluding CG, were as follows: 32.6% (184/565) had microcephaly, 47% (263/559) had at least one physical abnormality, 29.5% (160/543) had at least one neurological abnormality, and 46.2% (257/556) had at least one ophthalmological abnormality. This ongoing cohort has contributed to the understanding of the congenital Zika syndrome (CZS) spectrum. The cohort has provided descriptions of paediatric neurodevelopment and early epilepsy, including EEG patterns and treatment response, and information on the frequency and characteristics of oropharyngeal dysphagia; cryptorchidism and its surgical findings; endocrine dysfunction; and adenoid hypertrophy in children with Zika-related microcephaly. The study protocols and questionnaires were shared across Brazilian states to enable harmonization across the different studies investigating microcephaly and CZS, providing the opportunity for the Zika Brazilian Cohorts Consortium to be formed, uniting all the ZIKV clinical cohorts in Brazil

Zika-related adverse outcomes in a cohort of pregnant women with rash in Pernambuco, Brazil.

BACKGROUND: While Zika virus (ZIKV) is now widely recognized as a teratogen, the frequency and full spectrum of adverse outcomes of congenital ZIKV infection remains incompletely understood. METHODS: Participants in the MERG cohort of pregnant women with rash, recruited from the surveillance system from December/2015-June/2017. Exposure definition was based on a combination of longitudinal data from molecular, serologic (IgM and IgG3) and plaque reduction neutralization tests for ZIKV. Children were evaluated by a team of clinical specialists and by transfontanelle ultrasound and were classified as having microcephaly and/or other signs/symptoms consistent with congenital Zika syndrome (CZS). Risks of adverse outcomes were quantified according to the relative evidence of a ZIKV infection in pregnancy. FINDINGS: 376 women had confirmed and suspected exposure to ZIKV. Among evaluable children born to these mothers, 20% presented with an adverse outcome compatible with exposure to ZIKV during pregnancy. The absolute risk of microcephaly was 2.9% (11/376), of calcifications and/or ventriculomegaly was 7.2% (13/180), of additional neurologic alterations was 5.3% (13/245), of ophthalmologic abnormalities was 7% (15/214), and of dysphagia was 1.8% (4/226). Less than 1% of the children experienced abnormalities across all of the domains simultaneously. Interpretation: Although approximately one-fifth of children with confirmed and suspected exposure to ZIKV in pregnancy presented with at least one abnormality compatible with CZS, the manifestations presented more frequently in isolation than in combination. Due to the rare nature of some outcomes and the possibility of later manifestations, large scale individual participant data meta-analysis and the long-term evaluation of children are imperative to identify the full spectrum of this syndrome and to plan actions to reduce damages

Prevalence of pulp and periapical diagnoses in endodontic postgraduate clinics

Antecedentes: Las enfermedades pulpares y periapicales son las patologías que con más frecuencia ocasionan una consulta por urgencia en odontología, y son las historias clínicas las que permiten el registro de la condición de salud con la que acude el paciente, siendo posible con ésta información elaborar estudios de prevalencia que permiten analizar la situación de salud y realizar una vigilancia epidemiológica. Actualmente existe poca información relacionada con la prevalencia de patologías pulpares y periapicales, por lo que el interés en este tema con más estudios permite abarcar aspectos etiológicos, de distribución de las patologías en más sectores, e incluso abordar en la evaluación de servicios, programas y tecnologías de atención a la salud oral. Objetivos: Identificar la prevalencia de diagnósticos pulpares y periapicales según los registros de los anexos de endodoncia de las historias clínicas de los pacientes atendidos en la clínica del Posgrado de Endodoncia de la Pontificia Universidad Javeriana.Materiales y métodos: Estudio observacional, descriptivo de corte transversal, basado en el análisis de 1446 anexos de endodoncia de pacientes que asistieron a la clínica del Posgrado en el periodo 2019-2022, registrados en el software Smile. Resultados: El mayor número de anexos pertenecieron al año 2019, prevaleciendo el género femenino(61.8%); los diagnósticos más frecuentes fueron diente previamente tratado (42.22%), y tejido apical normal (53.81%), siendo los molares superiores (18,60%), seguidos de los incisivos superiores(18,46%) los tipos de dientes más afectados. Conclusiones: La prevalencia de las patologías pulpares y periapicales se centra en diente previamente tratado, y tejido apical normal, prevaleciendo en género el sexo femenino, y en tipo de dientes los molares superiores e incisivos superiores, información recolectada en su mayoría en el periodo 2019; por lo que en el análisis de los estudios realizados previamente se puede concluir que la prevalencia de las patologías pulpares y periapicales varía con la del presente estudio, y según las revisiones observadas la epidemiología en endodoncia no se estudia con frecuencia para establecer diferencias.Background: Pulpal and periapical diseases are the pathologies that most frequently cause an emergency dental consultation, and it ́s the medical record that allows the registry of the patient's health condition with which attends, making possible with this information to elaborate prevalence studies that allow the analysis of the health situation and to carry out epidemiological surveillance. Currently there is limited information related to the prevalence of pulpal and periapical pathologies, so the interest in this subject with more studies allows to cover etiological aspects, distribution of pathologies in more sectors, and even to address in the evaluation of services, programs and technologies for oral health care. Purpose: To identify the prevalence of pulp and periapical diagnoses according to the records of endodontic ́s annexes in the clinical histories of patients attended at the Postgraduate Endodontics Clinic of the Pontifical Xaverian University. Methods: An observational, descriptive, cross-sectional study, based on the analysis of 1446 endodontic annexes of patients who attended the Postgraduate clinic, submitted in the Smile software. Results: The largest number of annexes belonged to the year 2019, prevailing the female gender(61.8%), for the most frequent diagnoses the previously treated tooth (42.22%), and normal apical tissue (53.81%) prevailed, and the most affected tooth types were the upper molars (18.60%), followed by upper incisors (18.46%). Conclusions: The prevalence of pulpal and periapical pathologies center on previously treated tooth and normal apical tissue, prevailing in gender the female sex, and in type of teeth the upper molars and upper incisors, information which was mostly collected in the period 2019; so in the analysis of previously conducted studies it can be concluded that the prevalence of pulpal and periapical pathologies varies, along with the observed reviews the epidemiology in endodontics which is not frequently studied to establish differences.Especialista en EndodonciaEspecializació

Impacto de desastres naturais no sistema de saúde do Brasil / Impact of natural disasters on Brazil’s health system

Desastres naturais são resultado de cadeias de eventos que culminam em danos à todo o  ecossistema; deste modo a extensão e intensidade dos os impactos depende da vulnerabilidade da região afetada. No Brasil, é possível observar o acontecimento de diversos desastres naturais, como de barragens, enxurradas, secas, acidentes radioativos; a biossegurança e manejo de rejeitos decorrentes são imprescindíveis na correta conduta pertinente. Desta forma, o objetivo do estudo foi abordar as implicações em saúde, físicas, psicológicas e de abastecimento em áreas afetados por desastres, a fim de elucidar o potencial risco para comunidade local. Considerando que as populações atingidas, necessitam de muita atenção quanto às necessidades de água, alimentos, medicamentos, condições adequadas sanitárias e, sobretudo psicológicas, a gestão ocupa papel importante na tentativa de reparar e dar suporte aos reflexos diante dos desastres.