Reemergence of Dengue Virus Serotype 3, Brazil, 2023.

We characterized 3 autochthonous dengue virus serotype 3 cases and 1 imported case from 2 states in the North and South Regions of Brazil, 15 years after Brazil's last outbreak involving this serotype. We also identified a new Asian lineage recently introduced into the Americas, raising concerns about future outbreaks.

Do Orofacial Clefts Impair Breastfeeding and Increase the Prevalence of Anemia?

OBJECTIVE: This study aimed to correlate the prevalence of iron deficiency anemia and breastfeeding with orofacial clefts in children. DESIGN: Data on the participant profile, presence and type of the cleft lip and/or palate (CL/P), and records on anemia and breastfeeding were collected from patients' charts, and submitted to statistical analysis by χ2 test (p < .05; software SPSS 23.0). RESULTS: Two-hundred and ten files were divided according to: CL/P presence (cleft group; n = 132) or absence (control group; n = 78). Group CL/P was subdivided according to the type of cleft: CL/P-I (cleft lip; n = 35); CL/P-II (cleft lip and palate; n = 45); CL/P-III (cleft palate; n = 43); and CL/P-IV (rare orofacial clefts; n = 9). Group CL/P had significantly more records on anemia (p = .016) and fewer records on breastfeeding (P<.01) than controls. More records on anemia occurred in CL/P-II (p = .004) and CL/P-IV (p = .006) than the control group. The comparison among the orofacial cleft types regarding the anemia records showed no statistically significant differences (p = .123). Group CL/P-I had more records on breastfeeding than the other cleft types (p < .01). CONCLUSIONS: Thus, it is suggested that the breastfeeding process is more complex, and the history of anemia is more frequent, in children with cleft lip and palate or rare orofacial clefts than in children without clefts.

A preliminary comparison between the effects of red and infrared laser irradiation on viability and proliferation of SHED.

The aim of this preliminary study was to compare the effects of different energy densities from red and infrared low-level laser (LLL) on viability and proliferation of stem cells from human exfoliated deciduous teeth (SHED). SHED were irradiated with red laser (R) or infrared laser (IR) set with the following dosimetry: 1.2 J/cm2 (0.05 J), 2.5 J/cm2 (0.1 J), 5.0 J/cm2 (0.2 J), and 7.5 J/cm2 (0.3 J). Positive (C+) and negative (C-) control groups comprised non-irradiated cells. Data were analyzed by two-way ANOVA followed by Tukey's test (P < 0.05). At 24- and 48-h period, group R5.0 showed significantly higher cell viability rates than R1.2 and R2.5. At 48 h, R2.5 also revealed lower proliferation than R5.0. Comparing to the C+ group, R2.5 exhibited lower viability at 72 h, and proliferation at 24 and 48 h. Groups R1.2, IR1.2, and IR5.0 were less viable at 24 h, while R1.2, IR2.5, and IR5.0 revealed lower proliferative capacity at 48 h. Overall, our results showed that LLL can favor viability and proliferation of SHED, especially when cells receive red laser irradiation at 5.0 J/cm2. Therefore, according to this preliminary investigation, 5 J/cm2 applied by red LLL induced high rates of cell viability and proliferation, while the same irradiation dose using infrared laser led to negative effects. LLL irradiation with 1.2 and 2.5 J/cm2 was deleterious to metabolic activity and proliferation of SHED regardless of the type of laser. Further studies are necessary to gain in-depth knowledge about the effects of different wavelengths of LLL on SHED viability and proliferation.

Laser treatment contributes to maintain membrane integrity in stem cells from human exfoliated deciduous teeth (shed) under nutritional deficit.

This study aimed to analyze the effects of laser irradiation on the membrane integrity and viability of stem cells from human exfoliated deciduous teeth (SHED) that were kept in serum starvation. Nutritional deficit was used to mimic the cellular stress conditions of SHED isolation for regenerative dental approaches, where laser therapy could be beneficial. SHED were cultured under serum starvation (MEMα + 1%FBS) for 1 or 24 h pre-irradiation (protocols A and B, respectively). Then, cells received low-level laser therapy (LLLT; 660 nm) at 2.5 J/cm2 (0.10 W; groups I and V), 5.0 J/cm2 (0.20 W; groups II and VI), 7.5 J/cm2 (0.30 W; groups III and VII), or remained non-irradiated (groups IV and VIII). During irradiation, cells were maintained in 1% FBS (groups I-IV) or 10% FBS (normal culture conditions; groups V-VIII). Membrane integrity was evaluated by quantifying lactate dehydrogenase (LDH) release (immediately after irradiation), and cell viability was assessed by the MTT assay (24, 48, and 72 h post-irradiation). Serum starvation did not alter LDH release by non-irradiated SHED, while LDH release decreased significantly in groups irradiated in 1% FBS (I and III), but not in groups irradiated in 10% FBS (V-VII), regardless the pre-irradiation conditions (protocols A/B). Cell viability was significantly higher 24 h after irradiation, in most protocol A groups. In contrast, cell viability remained mostly unaltered in protocol B groups. LLLT contributed to maintain membrane integrity in SHED subjected to nutritional deficit before and during irradiation with 0.10 or 0.30 W. Short serum starvation before irradiation improved SHED viability at 24 h post-irradiation.

Bell's palsy treated with photobiomodulation in an adolescent: Rare case report and review of the published literature.

BACKGROUND: Bell's palsy represents a peripheral unilateral facial nerve paralysis, being an acute, idiopathic disorder, which can affect children and adolescents. Some therapeutic approaches have been proposed including facial exercises, biofeedback, photobiomodulation, electrotherapy, massage, and thermotherapy. The present report documents a rare case of Bell's palsy in an adolescent successfully treated with a new protocol of photobiomodulation, consisting of a short-term treatment. CASE REPORT: A 13-year-old girl presented absence of facial movement on the right side when smiling, inability to close the right eye and to raise the right eyebrow, intense painful symptoms on the right side of the face, difficult in chewing and talking, and sialorrhea. She was diagnosed with an idiopathic facial paralysis or Bell's palsy associated with right masseter myalgia, and treated with three sessions of photobiomodulation using infrared laser, 100 mW output power, 100 J/cm2 of energy density, 28 seconds per point, applied at the origin and insertion of the right superficial masseter muscle. The patient presented complete regression of paralysis, improvement of speech and chewing, and absence of muscular pain. CONCLUSION: Photobiomodulation was effective to treat Bell's palsy in a pediatric patient, being a true noninvasive approach and with no side effects, although there is still no established definitive protocol.

The Computational Fluid Dynamics Rupture Challenge 2013--Phase II: Variability of Hemodynamic Simulations in Two Intracranial Aneurysms.

With the increased availability of computational resources, the past decade has seen a rise in the use of computational fluid dynamics (CFD) for medical applications. There has been an increase in the application of CFD to attempt to predict the rupture of intracranial aneurysms, however, while many hemodynamic parameters can be obtained from these computations, to date, no consistent methodology for the prediction of the rupture has been identified. One particular challenge to CFD is that many factors contribute to its accuracy; the mesh resolution and spatial/temporal discretization can alone contribute to a variation in accuracy. This failure to identify the importance of these factors and identify a methodology for the prediction of ruptures has limited the acceptance of CFD among physicians for rupture prediction. The International CFD Rupture Challenge 2013 seeks to comment on the sensitivity of these various CFD assumptions to predict the rupture by undertaking a comparison of the rupture and blood-flow predictions from a wide range of independent participants utilizing a range of CFD approaches. Twenty-six groups from 15 countries took part in the challenge. Participants were provided with surface models of two intracranial aneurysms and asked to carry out the corresponding hemodynamics simulations, free to choose their own mesh, solver, and temporal discretization. They were requested to submit velocity and pressure predictions along the centerline and on specified planes. The first phase of the challenge, described in a separate paper, was aimed at predicting which of the two aneurysms had previously ruptured and where the rupture site was located. The second phase, described in this paper, aims to assess the variability of the solutions and the sensitivity to the modeling assumptions. Participants were free to choose boundary conditions in the first phase, whereas they were prescribed in the second phase but all other CFD modeling parameters were not prescribed. In order to compare the computational results of one representative group with experimental results, steady-flow measurements using particle image velocimetry (PIV) were carried out in a silicone model of one of the provided aneurysms. Approximately 80% of the participating groups generated similar results. Both velocity and pressure computations were in good agreement with each other for cycle-averaged and peak-systolic predictions. Most apparent "outliers" (results that stand out of the collective) were observed to have underestimated velocity levels compared to the majority of solutions, but nevertheless identified comparable flow structures. In only two cases, the results deviate by over 35% from the mean solution of all the participants. Results of steady CFD simulations of the representative group and PIV experiments were in good agreement. The study demonstrated that while a range of numerical schemes, mesh resolution, and solvers was used, similar flow predictions were observed in the majority of cases. To further validate the computational results, it is suggested that time-dependent measurements should be conducted in the future. However, it is recognized that this study does not include the biological aspects of the aneurysm, which needs to be considered to be able to more precisely identify the specific rupture risk of an intracranial aneurysm.

Human outbreaks of a novel reassortant Oropouche virus in the Brazilian Amazon region.

The Brazilian western Amazon is experiencing its largest laboratory-confirmed Oropouche virus (OROV) outbreak, with more than 6,300 reported cases between 2022 and 2024. Here, we sequenced and analyzed 382 OROV genomes from human samples collected in Amazonas, Acre, Rondônia, and Roraima states, between August 2022 and February 2024, to uncover the origin and genetic evolution of OROV in the current outbreak. Genomic analyses revealed that the upsurge of OROV cases in the Brazilian Amazon coincides with spread of a novel reassortant lineage containing the M segment of viruses detected in the eastern Amazon region (2009-2018) and the L and S segments of viruses detected in Peru, Colombia, and Ecuador (2008-2021). The novel reassortant likely emerged in the Amazonas state between 2010 and 2014 and spread through long-range dispersion events during the second half of the 2010s. Phylodynamics reconstructions showed that the current OROV spread was mainly driven by short-range (< 2 km) movements consistent with the flight range of vectors. Nevertheless, a substantial proportion (22%) of long-range (> 10 km) OROV migrations were also detected, consistent with viral dispersion by humans. Our data provides a view of the unprecedented spread and evolution of OROV in Brazilian western Amazon region.

The continuous increase in the number of systemic lupus erythematosus cases in Brazil in the COVID-19 era.

This study aims to reevaluate and compare the data from the Brazilian Unified Health System (SUS) on the number of diagnoses of systemic lupus erythematosus (SLE) in the pre-pandemic period with those in the pandemic period, as well as to compare the first year (2020) of the COVID-19 pandemic in Brazil with the last year (2021), to update the data, and to verify whether SLE disease control measures were effective in 2021. There was a consistent and significant increase in the incidence of SLE cases all over Brazil between the first and second pandemic years and between the pre-pandemic triennium and the second pandemic year. Therefore, it is inescapable to have larger clinical studies with different populations to better understand the relationship between these two conditions and find measures to improve the control of this disease.

Clinical outcomes of dental implants in head and neck cancer patients: An overview.

OBJECTIVE: The aim of this study was to evaluate the clinical outcomes of dental implants (DIs) in patients with head and neck cancer (HNC) treated with radiotherapy (RT), isolated chemotherapy, or bone modifying agents (BMAs). STUDY DESIGN: This study was registered in the Prospective Register of Systematic Reviews (CRD42018102772); conducted via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; and based on PubMed, Scopus, Embase, Cochrane Library, Web of Science, and gray literature searches. The selection of studies was performed in 2 phases by 2 independent reviewers. The risk of bias (RoB) was assessed by the Measurement Tool to Assess the Methodological Quality of Systematic Reviews 2. RESULTS: Twenty systematic reviews were included in the qualitative analysis. The majority scored as having high RoB (n = 11). Primary DIs placement in the mandible of patients with HNC subjected to RT doses <50 Gy was associated with better survival rates. CONCLUSIONS: The placements of DIs could be considered safe in patients with HNC in sites of alveolar bone that received RT (≤5000 Gy); however, no conclusions could be made in patients with cancer managed by chemotherapy or BMAs. Due to the heterogeneity of studies included, the recommendation for DIs placement in patients with cancer should be carefully considered. Future better controlled randomized clinical trials are required to provide enhanced clinical guidelines for best patient care.

COVID-19 Pandemic Causes Increased Clinic Visits with Diagnosis of Tegumentary Leishmaniasis in Brazil in 2020.

Coronavirus disease 2019 (COVID-19) protocols has reduced primary and secondary health care for other diseases, such as leishmaniasis, a parasitic, endemic, chronic and persistent disease in Brazil. To ascertain this, we compared the number of leishmaniasis cases diagnosed before and after the COVID-19 pandemic. In 5 regions of Brazil, there was an increase in the mean number of leishmaniasis clinic visits from 2020 pandemic period (over 57%) compared with 2017-2019 years. Interestingly, this increase was due to tegumentary leishmaniasis (TL) while visceral leishmaniasis consultations decreased considerably. The increase in clinic visits with a diagnosis of TL in all regions of Brazil during the pandemic period in 2020, shows that the epidemiological surveillance of neglected tropical diseases cannot slowdown in the country. Expanding information can minimize the negative impacts of COVID-19 on health promotion, prevention and monitoring of the most prevalent neglected diseases.

Cancer diagnosis in Brazil in the COVID-19 era.

The comprehensive care and treatment for cancer patients in Brazil, regulated by the National Cancer Prevention and Control Policy, is provided by Brazilian Unified Healthcare System (SUS) in certified health institution. Due the COVID-19 pandemic, several restrictive measures have been implemented by the State federation's governments, and cancer diagnosis reference centers were also impacted by these measures. Thus, this study aimed to compare SUS-oriented cancer diagnosis in Brazil before and during the pandemic so far. The average number of cancer diagnoses has dropped considerably in all Brazilian Regions since the pandemic period started. The number of new cancer cases has plunged in all regions, ranged from -24.3% in the North to -42.7% in Northeast region. The overall Brazilian average deficit reached 35.5%, corresponding to about 15,000 undiagnosed cases of cancer monthly. The pandemic period has dramatically reduced the diagnosis of new cases of cancer in Brazil, since consultations in public health services were compromised by restrictive measures. Therefore, effective measures must be urgently put in action in order to minimize the damage, and consequently, the negative health impacts caused by the COVID-19 pandemic in the care of cancer patients.

Impact of the coronavirus disease 2019 on the diagnoses of Hansen's disease in Brazil.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has limited the access of patients with Hansen's disease (HD) to care due to changes in routine health services. METHODS: To ascertain this, we compared the number of HD cases diagnosed before and after the COVID-19 pandemic. RESULTS: The decrease in HD cases in Brazil reached 18,223 (-48.4%), corresponding to an average reduction of 1,518 cases per month during the COVID-19 pandemic. CONCLUSION: Therefore, effective measures should be implemented to minimize the damage and the consequent negative health impact of COVID-19 on the care of HD patients.

Increased number of Herpes Zoster cases in Brazil related to the COVID-19 pandemic.

Coronavirus 2019 (COVID-19), caused by the pathogen SARS-CoV-2, was declared a pandemic in March 2020. Recently, studies have discussed reports of patients infected with COVID-19 associated with vesicular manifestations of Herpes Zoster. The objective of this study was to compare the data from the Unified Health System (SUS) on the number of diagnoses of Herpes Zoster from March to August from 2017 to 2019, with the same period in 2020, in the five Brazilian regions (North, Northeast, Southeast, South, and Midwest). The data were extracted from the public database (DATASUS) of Brazil's Ministry of Health. The data showed an increase in the number of Herpes Zoster diagnoses over the years and the negative impact from the COVID-19 disease, revealing an average increase corresponding to an extra 10.7 cases per million inhabitants during the pandemic in all Brazilian Regions. Therefore, although the association between HZ and COVID-19 is not well established, we observed in this study an increase in HZ cases during the COVID -19 pandemic, which suggests a correlation between these diseases.

Resumption of brazilian oral medicine health care during the second period of the COVID-19 pandemic

Aim: This present study aims to compare the data from the Brazilian Unified Health System on the number of clinical consultations of Oral Medicine from the first 6 months (March-August 2020) of the COVID-19 pandemic in Brazil with the last 6 months (September-February 2020/2021) to update the data, verify the measures' effectiveness to return clinical activities in the following months. Methods: perform a literature review of recent articles that report the impact of the COVID-19 pandemic on Oral Medicine. Results: There was an increase in the number of Oral Medicine clinical consultations in the second half of the pandemic throughout Brazil (+64.2%), representing over 9,235 appointments in this period. Conclusion: measures for the return of health assistance and the practice of Telemedicine proved to be effective after the second period of the pandemic. Even so, strengthening security measures against the coronavirus is essential to ward off a new wave since the Omicron variant emerged in the country and, consequently, possible new lockdowns that might affect healthcare in Brazil

Revaluation of the COVID-19 pandemic impact on the epidemiology of syphilis in Brazil

Introduction: Due to the coronavirus 2019 disease (COVID-19) pandemic, health systems worldwide have suffered interferences, with the interruption of sexual health clinics, limitation of ambulatory consults, prevention, diagnosis, and treatment of several diseases, especially syphilis, altering their epidemiology.Objective: To investigate the impact of the pandemic on syphilis diagnosis in Brazil, the main goal of this study was to update and reevaluate data from the Brazilian Unified Health System on the number of syphilis cases reported in all five Brazilian geographic regions and verify the response of the Brazilian health care to the COVID-19 pandemic. Methods: The data were retrieved from the National Disease Notification System and the Department of Chronic Conditions Diseases and Sexually Transmitted Infections and represent syphilis diagnosis in Brazil, from March to December 2017 to 2019, 2020, and 2021. Results: The increase in the number of syphilis cases was minor compared to 2020, keeping the Southeast region as the most impacted (+146.1%) and an increase of 22,633 cases throughout Brazil (+54.3%). Conclusion:Syphilis disease control measures were ineffective in 2021 as the drop in the number of cases was irrelevant compared to the years before the pandemic. The association between the increase in syphilis cases in Brazil and the COVID-19 pandemic should be further investigated to assist in decision-making processes and in the programming of health actions in addition to finding measures to raise the control of this disease.

Introdução: Em consequência da pandemia de COVID-19, os sistemas de saúde em todo o mundo sofreram interferências, com interrupção de clínicas de saúde sexual, limitação de consultas ambulatoriais, de prevenção, diagnóstico e tratamento de diversas doenças, principalmente a sífilis, alterando sua epidemiologia. Objetivo: Para investigar o impacto da pandemia no diagnóstico da sífilis no Brasil, o objetivo principal do presente estudo foi atualizar e reavaliar os dados do Sistema Único de Saúde sobre o número de casos de sífilis notificados nas cinco regiões geográficas brasileiras e verificar a resposta da atenção básica à saúde brasileira diante da pandemia de COVID-19. Métodos: Os dados foram retirados do Sistema Nacional de Notificação de Agravos e do Departamento de Doenças Crônicas e Infecções Sexualmente Transmissíveis e representam o diagnóstico de sífilis no Brasil, de março a dezembro de 2017 a 2019, 2020 e 2021. Resultados: O aumento no número de casos de sífilis foi menor em relação a 2020, mantendo-se a Região Sudeste como a mais impactada (+146,1%) e havendo aumento de 22.633 casos em todo o Brasil (+54,3%). Conclusão: As medidas de controle da sífilis foram ineficazes em 2021, pois a queda no número de casos foi irrelevante em comparação aos anos anteriores à pandemia. A associação entre o aumento dos casos de sífilis no Brasil e a pandemia de COVID-19 deve ser mais bem investigada para auxiliar nos processos de tomada de decisão e na programação das ações de saúde, além de se encontrarem medidas para elevar o controle desta doença.

The continuous increase in the number of systemic lupus erythematosus cases in Brazil in the COVID-19 era

Abstract This study aims to reevaluate and compare the data from the Brazilian Unified Health System (SUS) on the number of diagnoses of systemic lupus erythematosus (SLE) in the pre-pandemic period with those in the pandemic period, as well as to compare the first year (2020) of the COVID-19 pandemic in Brazil with the last year (2021), to update the data, and to verify whether SLE disease control measures were effective in 2021. There was a consistent and significant increase in the incidence of SLE cases all over Brazil between the first and second pandemic years and between the pre-pandemic triennium and the second pandemic year. Therefore, it is inescapable to have larger clinical studies with different populations to better understand the relationship between these two conditions and find measures to improve the control of this disease.