Epidemiological study of paediatric traumatic brain injury in Brazil.

Background: Traumatic brain injury (TBI) has a high economic and social impact on the family dynamics, particularly among children. High-quality and comprehensive epidemiological studies about TBI in this population are limited worldwide, specifically in Latin America. Therefore, this study aimed to elucidate the epidemiology of TBI among children in Brazil and its effects on the public health system. Methods: This epidemiological (cohort) retrospective study collected data from the Brazilian healthcare database between 1992 and 2021. Results: The mean annual volume of hospital admission (HA) due to TBI in Brazil was 29,017. Moreover, the incidence of TBI in the paediatric population was 45.35 admissions per 100,000 inhabitants/year. Furthermore, approximately 941 paediatric hospital deaths per year were caused by TBI, with an in-hospital lethality rate of 3.21%. The average annual financial transfer for TBI was 12,376,628 USD, and the mean cost per admission was 417 USD. In addition, the mean length of hospital stay was 4.2 days. Notably, the length of stay in the hospital was longer among males, Afro-Brazilians patients and individuals aged 15-19 years. Conclusion: Paediatric TBI is an important public health issue worldwide with high social and economic costs. The incidence of paediatric TBI in Brazil is similar to that in developing countries. Moreover, male predominance (2.3:1) was observed in relation paediatric TBI. Notably, during the pandemic, the incidence of paediatric HA has decreased. To the best of our knowledge, this is the first epidemiological study that specifically evaluates paediatric TBI in Latin America.

Smartphone-Based Screening for Cardiovascular Diseases: A Trend?

Abstract Cardiovascular diseases are the leading cause of death in the world. People living in vulnerable and poor places such as slums, rural areas and remote locations have difficulty in accessing medical care and diagnostic tests. In addition, given the COVID-19 pandemic, we are witnessing an increase in the use of telemedicine and non-invasive tools for monitoring vital signs. These questions motivate us to write this point of view and to describe some of the main innovations used for non-invasive screening of heart diseases. Smartphones are widely used by the population and are perfect tools for screening cardiovascular diseases. They are equipped with camera, flashlight, microphone, processor, and internet connection, which allow optical, electrical, and acoustic analysis of cardiovascular phenomena. Thus, when using signal processing and artificial intelligence approaches, smartphones may have predictive power for cardiovascular diseases. Here we present different smartphone approaches to analyze signals obtained from various methods including photoplethysmography, phonocardiograph, and electrocardiography to estimate heart rate, blood pressure, oxygen saturation (SpO2), heart murmurs and electrical conduction. Our objective is to present innovations in non-invasive diagnostics using the smartphone and to reflect on these trending approaches. These could help to improve health access and the screening of cardiovascular diseases for millions of people, particularly those living in needy areas.

Remote and non-invasive monitoring of patients with COVID-19 by smartphone / Monitoramento remoto e não invasivo de pacientes com COVID-19 pelo smartphone

The pandemic caused by the new coronavirus (SARS-COV-2) has led to more than two million deaths in the world by March 2021. The worldwide call to reduce transmission is enormous. Recently, there has been a rapid growth of telemedicine and the use of mobile health (mHealth) in the context of the COVID-19 pandemic. Smartphone accessories such as a flashlight, camera, microphone, and microprocessor can measure different clinical parameters such as oxygen saturation, blood pressure, heart rate, breathing rate, fever, pulmonary auscultation, and even voice analysis. All these parameters are of great clinical importance when evaluating suspected patients of COVID-19 or monitoring infected patients admitted in various hospitals or in-home isolation. In remote medical care, the results of these parameters can be sent to a call center or a health unit for interpretation by a qualified health professional. Thus, the patient can receive orientations or be immediately referred for in-patient care. The application of machine learning and other artificial intelligence strategies assume a central role in signal processing and are gaining much space in the medical field. In this work, we present different approaches for evaluating clinical parameters that are valuable in the case of COVID-19 and we hope that soon all these parameters can be measured by a single smartphone application, facilitating remote clinical assessments.

A pandemia causada pelo novo coronavírus (SARS-COV-2) foi a responsável por mais de dois milhões de mortes no mundo até março de 2021. O apelo mundial para reduzir a transmissão é enorme. Recentemente, houve um rápido crescimento do uso de telemedicina e saúde móvel (mHealth) no contexto da pandemia causada pela doença COVID-19. Os acessórios dos smartphones, como lanterna, câmera, microfone, bem como o microprocessador podem analisar diferentes parâmetros clínicos, tais como, a saturação de oxigênio, pressão arterial, frequência cardíaca, frequência respiratória, febre, ausculta pulmonar e até mesmo análise da voz. Todos esses parâmetros são de grande importância clínica na avaliação de pacientes suspeitos de COVID-19 ou no monitoramento de pacientes infectados que estão no hospital ou em isolamento domiciliar. No atendimento médico remoto, os resultados desses parâmetros podem ser enviados a uma central de atendimento ou à unidade de saúde para que o resultado seja interpretado por profissional de saúde qualificado. Assim, o paciente pode receber orientações ou ser encaminhado imediatamente para internação. A aplicação de aprendizado de máquina e outras estratégias de inteligência artificial assumem um papel central no processamento de sinais e vêm ganhando muito espaço na área médica. Neste trabalho, apresentamos diferentes abordagens para avaliação de parâmetros clínicos valiosos no caso do COVID-19 e esperamos que em breve todos esses parâmetros possam ser mensurados em um único aplicativo para smartphone, facilitando avaliações clínicas à distância.

Fragilidade na formação dos profissionais de saúde quanto à Língua Brasileira de Sinais: reflexo na atenção à saúde dos surdos / Fragility in the training of health professionals regarding the Brazilian Sign Language: a reflection on the health care of the deaf

RESUMO Objetivos Identificar como é a formação de profissionais da saúde quanto à Língua Brasileira de Sinais (Libras). Métodos Trata-se de estudo descritivo e transversal, desenvolvido com dados secundários, coletados no banco de dados eletrônico do Ministério da Educação. Foram analisados a grade curricular e o projeto pedagógico de todos os cursos de graduação na área da saúde em Instituições de Ensino Superior (IES) brasileiras, procurando-se identificar e caracterizar a disciplina de Libras. Resultados Foram localizados 5317 cursos e, destes, 2293 (43,1%) ofereciam disciplina de Libras, sendo 16,7% como disciplina obrigatória e a maioria (83,3%) como optativa. Em relação ao período ofertado, não houve um padrão, variando desde o primeiro até o décimo. Quanto à carga horária destinada à disciplina, dentre os 2077 cursos que disponibilizavam essa informação, 11,1% ofertavam a disciplina com carga horária de até 20 horas, 49,4% com carga horária entre 21 e 40 horas, 29,9% entre 41 e 60 horas, 9,1% entre 61 e 80 horas. Apenas 0,5% dos cursos destinavam mais que 80 horas para o ensino de Libras. Em média, os cursos de graduação em IES públicas (N=217) dedicavam 53,1 horas ao ensino de Libras, enquanto os cursos de IES privadas (N=1860) dedicavam 45,8 horas. Conclusão Há evidências de fragilidade na formação dos profissionais de saúde quanto ao ensino da Libras, o que reflete diretamente no atendimento integral dos surdos.

ABSTRACT Purpose To identify how Brazilian Sign Language (Libras) training is being conducted in undergraduate health care courses at Higher Education Institutions. Methods This is a descriptive and cross-sectional study, developed using secondary data taken from the Ministry of Education electronic database. The curriculum and pedagogical design of all undergraduate health care courses at Brazilian Higher Education Institutions (HEIs) were analyzed, aiming to identify and characterize the Libras discipline. Results 5317 courses were found and, from these, 2293 (43.1%) offered Libras, 16.7% as mandatory and the majority (83.3%) as optional. Regarding the period offered, there was no pattern, ranging from the first to the tenth. Regarding the workload for the discipline, among the 2077 courses that provided this information, 11.1% offered the discipline with a workload of up to 20 hours, 49.4% with a workload between 21 and 40 hours, 29.9% between 41 and 60 hours, and 9.1% between 61 and 80 hours. Only 0.5% of the courses devoted more than 80 hours to teaching Libras. On average, undergraduate courses in public HEIs (N = 217) devoted 53.1 hours to teaching Libras, while private HEI courses (N = 1860) dedicated 45.8 hours. Conclusion There is evidence of weakness in training programs for health professionals regarding teaching Libras, which directly reflects in comprehensive care for the deaf.

Teratogens: a public health issue - a Brazilian overview

Abstract Congenital anomalies are already the second cause of infant mortality in Brazil, as in many other middle-income countries in Latin America. Birth defects are a result of both genetic and environmental factors, but a multifactorial etiology has been more frequently observed. Here, we address the environmental causes of birth defects - or teratogens - as a public health issue and present their mechanisms of action, categories and their respective maternal-fetal deleterious effects. We also present a survey from 2008 to 2013 of Brazilian cases involving congenital anomalies (annual average of 20,205), fetal deaths (annual average of 1,530), infant hospitalizations (annual average of 82,452), number of deaths of hospitalized infants (annual average of 2,175), and the average cost of hospitalizations (annual cost of $7,758). Moreover, we report on Brazilian cases of teratogenesis due to the recent Zika virus infection, and to the use of misoprostol, thalidomide, alcohol and illicit drugs. Special attention has been given to the Zika virus infection, now proven to be responsible for the microcephaly outbreak in Brazil, with 8,039 cases under investigation (from October 2015 to June 2016). From those cases, 1,616 were confirmed and 324 deaths occurred due to microcephaly complications or alterations on the central nervous system. Congenital anomalies impact life quality and raise costs in specialized care, justifying the classification of teratogens as a public health issue.

Teratogens: a public health issue - a Brazilian overview.

Congenital anomalies are already the second cause of infant mortality in Brazil, as in many other middle-income countries in Latin America. Birth defects are a result of both genetic and environmental factors, but a multifactorial etiology has been more frequently observed. Here, we address the environmental causes of birth defects - or teratogens - as a public health issue and present their mechanisms of action, categories and their respective maternal-fetal deleterious effects. We also present a survey from 2008 to 2013 of Brazilian cases involving congenital anomalies (annual average of 20,205), fetal deaths (annual average of 1,530), infant hospitalizations (annual average of 82,452), number of deaths of hospitalized infants (annual average of 2,175), and the average cost of hospitalizations (annual cost of $7,758). Moreover, we report on Brazilian cases of teratogenesis due to the recent Zika virus infection, and to the use of misoprostol, thalidomide, alcohol and illicit drugs. Special attention has been given to the Zika virus infection, now proven to be responsible for the microcephaly outbreak in Brazil, with 8,039 cases under investigation (from October 2015 to June 2016). From those cases, 1,616 were confirmed and 324 deaths occurred due to microcephaly complications or alterations on the central nervous system. Congenital anomalies impact life quality and raise costs in specialized care, justifying the classification of teratogens as a public health issue.

Technical aspects and challenges of colorimetric detection with microfluidic paper-based analytical devices (µPADs) - A review.

Paper-based devices are a leading alternative among the main analytical tools for point-of-care testing, due to their portability, low-cost, and ease-of-use. Colorimetric readouts are the most common method of detection in these microfluidic devices, enabling qualitative, semi-quantitative and fully quantitative analysis of multiple analytes. There is a multitude of ways to obtain a colorimetric output in such devices, including nanoparticles, dyes, redox and pH indicators, and each has unique drawbacks and benefits. There are also multiple variables that impact the analysis of colorimetric reactions in microfluidic paper-based systems, including color homogeneity, image capture methods, and the data handling itself. Here, we present a critical review of recent developments and challenges of colorimetric detection on microfluidic paper-based analytical devices (µPADs), and present thoughts and insights towards future perspectives in the area to improve the use of colorimetric readouts in conjunction with µPADs.

Improving Sample Distribution Homogeneity in Three-Dimensional Microfluidic Paper-Based Analytical Devices by Rational Device Design.

Paper-based devices are a portable, user-friendly, and affordable technology that is one of the best analytical tools for inexpensive diagnostic devices. Three-dimensional microfluidic paper-based analytical devices (3D-µPADs) are an evolution of single layer devices and they permit effective sample dispersion, individual layer treatment, and multiplex analytical assays. Here, we present the rational design of a wax-printed 3D-µPAD that enables more homogeneous permeation of fluids along the cellulose matrix than other existing designs in the literature. Moreover, we show the importance of the rational design of channels on these devices using glucose oxidase, peroxidase, and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) reactions. We present an alternative method for layer stacking using a magnetic apparatus, which facilitates fluidic dispersion and improves the reproducibility of tests performed on 3D-µPADs. We also provide the optimized designs for printing, facilitating further studies using 3D-µPADs.

Development and statistical assessment of a paper-based immunoassay for detection of tumor markers.

Paper-based assays are an attractive low-cost option for clinical chemistry testing, due to characteristics such as short time of analysis, low consumption of samples and reagents, and high portability of assays. However, little attention has been given to the evaluation of the performance of these simple tests, which should include the use of a statistical approach to define the choice of best cut-off value for the test. The choice of the cut-off value impacts on the sensitivity and specificity of the bioassay. Here, we developed a paper-based immunoassay for the detection of the carcinoembryonic antigen (CEA) and performed a statistical assessment to establish the assay's cut-off value using the Youden's J index (68.28 A.U.), what allowed for a gain in sensibility (0.86) and specificity (1.0). We also discuss about the importance of defining a gray zone as a safety margin for test (±12% over the cut-off value), eliminating all false positives and false negatives outcomes and avoiding misleading results. The test accuracy was calculated as the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, presenting a value of 0.97, what classifies this test as highly accurate. We propose here a low-cost method capable of detecting carcinoembryonic antigen (CEA) in human serum samples, highlighting the importance of statistical tools to evaluate a new low-cost diagnostic method.

Paper-Based Microfluidics Immunoassay for Detection of Canine Distemper Virus

ABSTRACT Paper-based devices present low-cost and are versatile, making them very attractive for clinical analysis. To manufacture those devices wax patterns are printed on paper surface and upon heating the wax permeates through the entire thickness of the paper, creating hydrophobic barriers that delimit test areas. Antibodies produced in rabbits against canine distemper virus (CDV) were physically adsorbed on the surface of gold nanoparticles (AuNPs) and incubated with CDV viral antigens, forming the immunocomplex. Anti-CDV antibodies were immobilized into the microchannels by physical adsorption, forming the test region. The test solution containing conjugated AuNPs was applied at the bottom of the microchannel and it was eluted with a phosphate buffer solution 0.01 M pH 7.4. When the solution containing the AuNPs reached the test zone the recognition of antigens contained on the immunocomplex occurred with the consequent development of a red line, which represents a positive outcome for the test. This method demonstrated the success of physical immobilization of antibodies on AuNPs and the physical immobilization of antibodies on cellulose's surface. This colorimetric assay brings simplicity and versatility to clinical analyses, presenting potential for CDV diagnosis.

Recombinant drugs-on-a-chip: The usage of capillary electrophoresis and trends in miniaturized systems - A review.

We present here a critical review covering conventional analytical tools of recombinant drug analysis and discuss their evolution towards miniaturized systems foreseeing a possible unique recombinant drug-on-a-chip device. Recombinant protein drugs and/or pro-drug analysis require sensitive and reproducible analytical techniques for quality control to ensure safety and efficacy of drugs according to regulatory agencies. The versatility of miniaturized systems combined with their low-cost could become a major trend in recombinant drugs and bioprocess analysis. Miniaturized systems are capable of performing conventional analytical and proteomic tasks, allowing for interfaces with other powerful techniques, such as mass spectrometry. Microdevices can be applied during the different stages of recombinant drug processing, such as gene isolation, DNA amplification, cell culture, protein expression, protein separation, and analysis. In addition, organs-on-chips have appeared as a viable alternative to testing biodrug pharmacokinetics and pharmacodynamics, demonstrating the capabilities of the miniaturized systems. The integration of individual established microfluidic operations and analytical tools in a single device is a challenge to be overcome to achieve a unique recombinant drug-on-a-chip device.