Dental biofilm of symptomatic COVID-19 patients harbours SARS-CoV-2.

AIMS: SARS-CoV-2 RNA has been recovered from different sites in the human body, including the mouth. The present study aimed to investigate the presence of SARS-CoV-2 RNA in the dental biofilm of symptomatic patients who tested positive in nasopharyngeal and oropharyngeal (NASO/ORO) samples. MATERIALS & METHODS: An observational clinical study of individuals with flu-like symptoms was conducted between July and September 2020. Dental biofilm (BIO) samples were collected and analysed using real-time quantitative polymerase chain reaction (RT-qPCR) to determine the virus's presence. RESULTS: Seventy participants (40 ± 9.8 years of age, 71.4% female) tested positive for SARS-CoV-2 RNA in NASO/ORO samples and were included in the study. Among them, 13 tested positive in BIO samples (18.6%; 95% CI: [9.5, 27.7]). The median and interquartile range of cycle quantification (Cq) for NASO/ORO and BIO samples were 15.9 [6.9] and 35.9 [4.0] (p = .001), respectively. BIO-positive participants showed a higher virus load in NASO/ORO samples (p = .012) than those testing negative (Cq = 20.4 [6.1]). CONCLUSIONS: Dental biofilms from symptomatic COVID-19 patients harbour SARS-CoV-2 RNA and might be a potential reservoir with an essential role in COVID-19 transmission.

Malnutrition and its associated factors: a cross-sectional study with children under 2 years in a suburban area in Angola.

BACKGROUND: The prevalence of child malnutrition in Angola is still very high, and little is known about its associated factors. The aim of this study was to identify these factors in children under 2 years in a suburban area of the country's capital city. METHODS: We used data from a cross-sectional population-based study conducted in 2010. The outcomes studied were stunting and underweight. Multivariable analysis was conducted; prevalence ratios were estimated by Poisson regression with robust variance using a hierarchical model. RESULTS: Of the children studied (N = 749), 232 [32.0% (95% CI: 28.7-35.5%)] were stunted and 109 [15.1% (95% CI: 12.6-17.9%)] were underweight. In multivariable analysis, occurrence of diarrhea (PR 1.39 [95% CI: 1.07-1.87]) and the death of other children in the household (PR 1.52 [95% CI: 1.01-2,29]) were associated with stunting and underweight, respectively. In the model composed only of distal and intermediate factors, the primary caregiver not being the mother increased the prevalence of stunting by 42% (PR 1.42 [95% CI: 1.10-1.84], and a mother's working outside the house while not being self-employed was associated with its reduced prevalence (PR 0.55 [95% CI: 0.34-0.89]). In the intermediate model, each additional month of delay in the onset of prenatal care increased the relative prevalence of underweight by 20% (PR 1.20 [95% CI: 1.03-1.40]). CONCLUSIONS: Despite the high prevalence rates of stunting and underweight, relatively few risk factors were identified for these conditions, suggesting that collective exposures are likely to play a major role in causing malnutrition in Angola. The individual factors identified can be useful for the development of strategies to deal with this public health problem.

Pedagogical training profile of basic health sciences faculty in biomedical and related fields at Brazilian public and private higher education institutions.

Historically, Brazilian higher education teachers' pedagogical training has not been a concern. Even today, a graduate degree is the main requirement to be a faculty member. However, a set of competencies is necessary to teach: pedagogical competency, political competency, and knowledge of specific content. Most graduate training covers only knowledge of specific content. Therefore, this work aimed to outline the profile of basic health sciences faculty members teaching in biomedical and related fields regarding their undergraduate and graduate training, as well as the initial and continued pedagogical training in Brazilian public and private higher education institutions (HEIs). An electronic questionnaire was sent to these professionals, and a total of 763 responses were analyzed (66.4% from public and 33.6% from private HEIs). Compared with private HEI faculty, faculty from public HEIs were more experienced in teaching, and more time had passed since they finished their graduate training. On the other hand, faculty from private HEIs had a more intense undergraduate teaching workload than faculty from public HEIs. Additionally, faculty from private HEIs attended more extensive and more frequent pedagogical training activities (PTAs). Both groups expressed that activities closely related to their classroom practice and recognition for good pedagogical performance were incentives for their participation in PTAs. In conclusion, differences between the faculty from public and private HEIs may be due to the characteristics of HEIs themselves. Hypothetically, private HEIs focus on teaching, which may explain why faculty from these institutions seek improvement in this area, whereas public HEIs focus on research.

Performance of the Gail and Tyrer-Cuzick breast cancer risk assessment models in women screened in a primary care setting with the FHS-7 questionnaire.

Breast cancer (BC) risk assessment models base their estimations on different aspects of a woman's personal and familial history. The Gail and Tyrer-Cuzick models are the most commonly used, and BC risks assigned by them vary considerably especially concerning familial history. In this study, our aim was to compare the Gail and Tyrer-Cuzick models after initial screening for familial history of cancer in primary care using the FHS-7 questionnaire. We compared 846 unrelated women with at least one positive answer to any of the seven FHS-7 questions (positive group) and 892 unrelated women that answered negatively (negative group). Concordance between BC risk estimates was compared by Bland-Altman graphics. Mean BC risk estimates were higher using the Tyrer-Cuzick Model in women from the positive group, while women from the negative group had higher BC risk estimates using the Gail model. With increasing estimates, discordance also increased, mainly in the FHS-7 positive group. Our results show that in women with a familial history of cancer, the Gail model underestimates risk and the Tyrer-Cuzick seems to be more appropriate. FHS-7 can be a useful tool for the identification of women with higher breast cancer risks in the primary care setting.

Genetic Background of ß-Lactamases in Enterobacteriaceae Isolates from Environmental Samples.

The prevalence of ß-lactamase-producing Enterobacteriaceae has increased worldwide. Although antibiotic-resistant bacteria are usually associated with hospitals, there are a growing number of reports of resistant bacteria in other environments. Concern about resistant microorganisms outside the hospital setting highlights the need to investigate mechanisms of antibiotic resistance in isolates collected from the environment. The present study evaluated the resistance mechanism to ß-lactam antibiotics in 40 isolates from hospital sewage and surface water from the Dilúvio Stream, Porto Alegre City, Southern Brazil. The multiplex PCR technique was used to detect several resistance genes of ß-lactamases: extended-spectrum ß-lactamases (ESBLs), carbapenemases, and ß-lactamase AmpC. After genes, detection amplicons were sequenced to confirm their identification. The clonal relationship was established by DNA macrorestriction using the XbaI enzyme, followed by pulsed-field gel electrophoresis (PFGE). The results indicated that resistance genes were present in 85% of the isolates. The most prevalent genes encoded narrow-spectrum ß-lactamase, such as TEM-1 and SHV-1 with 70% of the strains, followed by carbapenemase KPC and GES (45%), ESBL types SHV-5 and CTX-M-8 (27.5%), and AmpC (ACT-1/MIR-1) (2.5%). Twelve isolates contained only one resistance gene, 14 contained two, and eight isolates had three resistance genes. PFGE indicated a clonal relationship among K. pneumoniae isolates. It was not possible to establish a clonal relationship between Enterobacter sp. isolates. The results highlight the potential of these resistance genes to spread in the polluted environment and to present a health risk to communities. This report is the first description of these resistance genes present in environmental samples other than a hospital in the city of Porto Alegre/RS.

Lack of association between rrl and erm(41) mutations and clarithromycin resistance in Mycobacterium abscessus complex.

BACKGROUND: Mycobacterium abscessus complex (MABC) includes species with high resistance rates among mycobacterial pathogens. In fact, MABC infections may not respond to clarithromycin treatment, which has historically been very effective against MABC infection. Molecular markers have been proposed to detect both acquired (rrl polymorphisms) and inducible (erm(41) polymorphisms) clarithromycin resistance in MABC isolates. OBJECTIVES: This study aimed to evaluate the susceptibility profile and molecular markers of clarithromycin resistance in MABC. METHODS: The clarithromycin susceptibility profile was determined by broth microdilution with reads on days 3, 5, 7 and 14. Mutations in the rrl and erm(41) genes were evaluated by polymerase chain reaction (PCR) using specific primers, followed by sequencing. FINDINGS: A total of 14 M. abscessus subsp. abscessus isolates and 28 M. abscessus subsp. massiliense isolates were evaluated, and clarithromycin resistance was observed in all isolates for up to three days of incubation. None of the 42 isolates exhibited a point mutation in the rrl gene, while all the isolates had a T28 polymorphism in the erm(41) gene. Moreover, all 28 M. abscessus subsp. massiliense isolates had a deletion in the erm(41) gene. MAIN CONCLUSIONS: While all the MABC isolates exhibited acquired clarithromycin resistance, no isolates exhibited a point mutation in the rrl gene in this study. The M. abscessus subsp. massiliense isolates demonstrated clarithromycin resistance, which is an uncommon phenotype. The molecular data for the rrl and erm(41) genes were not consistent with the phenotypic test results of clarithromycin susceptibility, indicating a lack of correlation between molecular clarithromycin resistance markers for both acquired and inducible resistance.

Detection of tuberculosis drug resistance: a comparison by Mycobacterium tuberculosis MLPA assay versus Genotype®MTBDRplus.

BACKGROUND: To cope with the emergence of multidrug-resistant tuberculosis (MDR-TB), new molecular methods that can routinely be used to screen for a wide range of drug resistance related genetic markers in the Mycobacterium tuberculosis genome are urgently needed. OBJECTIVE: To evaluate the performance of multiplex ligaton-dependent probe amplification (MLPA) against Genotype® MTBDRplus to detect resistance to isoniazid (INHr) and rifampicin (RIFr). METHOD: 96 culture isolates characterised for identification, drug susceptibility testing (DST) and sequencing of rpoB, katG, and inhA genes were evaluated by the MLPA and Genotype®MTBDRplus assays. RESULTS: With sequencing as a reference standard, sensitivity (SE) to detect INHr was 92.8% and 85.7%, and specificity (SP) was 100% and 97.5%, for MLPA and Genotype®MTBDRplus, respectively. In relation to RIFr, SE was 87.5% and 100%, and SP was 100% and 98.8%, respectively. Kappa value was identical between Genotype®MTBDRplus and MLPA compared with the standard DST and sequencing for detection of INHr [0.83 (0.75-0.91)] and RIFr [0.93 (0.88-0.98)]. CONCLUSION: Compared to Genotype®MTBDRplus, MLPA showed similar sensitivity to detect INH and RIF resistance. The results obtained by the MLPA and Genotype®MTBDRplus assays indicate that both molecular tests can be used for the rapid detection of drug-resistant TB with high accuracy. MLPA has the added value of providing information on the circulating M. tuberculosis lineages.

Multidrug-resistant nontuberculous mycobacteria isolated from cystic fibrosis patients.

Worldwide, nontuberculous mycobacteria (NTM) have become emergent pathogens of pulmonary infections in cystic fibrosis (CF) patients, with an estimated prevalence ranging from 5 to 20%. This work investigated the presence of NTM in sputum samples of 129 CF patients (2 to 18 years old) submitted to longitudinal clinical supervision at a regional reference center in Rio de Janeiro, Brazil. From June 2009 to March 2012, 36 NTM isolates recovered from 10 (7.75%) out of 129 children were obtained. Molecular identification of NTM was performed by using PCR restriction analysis targeting the hsp65 gene (PRA-hsp65) and sequencing of the rpoB gene, and susceptibility tests were performed that followed Clinical and Laboratory Standards Institute recommendations. For evaluating the genotypic diversity, pulsed-field gel electrophoresis (PFGE) and/or enterobacterial repetitive intergenic consensus sequence PCR (ERIC-PCR) was performed. The species identified were Mycobacterium abscessus subsp. bolletii (n = 24), M. abscessus subsp. abscessus (n = 6), Mycobacterium fortuitum (n = 3), Mycobacterium marseillense (n = 2), and Mycobacterium timonense (n = 1). Most of the isolates presented resistance to five or more of the antimicrobials tested. Typing profiles were mainly patient specific. The PFGE profiles indicated the presence of two clonal groups for M. abscessus subsp. abscessus and five clonal groups for M. abscesssus subsp. bolletii, with just one clone detected in two patients. Given the observed multidrug resistance patterns and the possibility of transmission between patients, we suggest the implementation of continuous and routine investigation of NTM infection or colonization in CF patients, including countries with a high burden of tuberculosis disease.

Evaluation of respiratory syncytial virus group A and B genotypes among nosocomial and community-acquired pediatric infections in Southern Brazil.

BACKGROUND: Respiratory syncytial virus (RSV) is the main cause of lower respiratory tract illness in children worldwide. Molecular analyses show two distinct RSV groups (A and B) that comprise different genotypes. This variability contributes to the capacity of RSV to cause yearly outbreaks. These RSV genotypes circulate within the community and within hospital wards. RSV is currently the leading cause of nosocomial respiratory tract infections in pediatric populations. The aim of this study was to evaluate the G protein gene diversity of RSV amplicons. METHODS: Nasopharyngeal aspirate samples were collected from children with nosocomial or community-acquired infections. Sixty-three RSV samples (21 nosocomial and 42 community-acquired) were evaluated and classified as RSV-A or RSV-B by real-time PCR. Sequencing of the second variable region of the G protein gene was performed to establish RSV phylogenetics. RESULTS: We observed co-circulation of RSV-A and RSV-B, with RSV-A as the predominant group. All nosocomial and community-acquired RSV-A samples were from the same phylogenetic group, comprising the NA1 genotype, and all RSV-B samples (nosocomial and community-acquired) were of the BA4 genotype. Therefore, in both RSV groups (nosocomial and community-acquired), the isolates belonged to only one genotype in circulation. CONCLUSIONS: This is the first study to describe circulation of the NA1 RSV genotype in Brazil. Furthermore, this study showed that the BA4 genotype remains in circulation. Deciphering worldwide RSV genetic variability will aid vaccine design and development.

Investigation of anti-Leptospira spp. antibodies and leptospiruria in cats attended to a veterinary teaching hospital in southern Brazil.

Leptospirosis is a bacterial zoonosis that affects both humans and animals worldwide. Currently, it is known that cats may be susceptible to infection. This study aims to investigate the presence of anti-Leptospira spp. antibodies and leptospiruria in cats, using Microscopic Agglutination Test (MAT) and Real-time Polymerase Chain Reaction (PCR) techniques, respectively. A total of 76 cats, undergoing comprehensive anamnesis, general physical examination, and complementary exams were included in the investigation. Among the 76 cats tested, 9.2% (7/76) exhibited the presence of anti-Leptospira spp. antibodies, while Leptospira spp. DNA was detected in at 1.3% (1/76) of the evaluated urine samples. No significant associations were observed between the serological and molecular diagnostic results and the assessed variables, including clinical data and laboratory results of cats testing positive. This study provides insight into the occurrence of Leptospira spp. infection and leptospiruria in cats treated at a veterinary teaching hospital in southern Brazil.

Performance of the GenoType MTBDRplus assay directly on sputum specimens from Brazilian patients with tuberculosis treatment failure or relapse.

Rapid identification of drug resistance in clinical isolates of Mycobacterium tuberculosis is important in determining treatment for tuberculosis. The aim of this work was evaluate the performance of the GenoType MDRTBplus assay directly on sputum of patients who had treatment failure or relapse in a routine outpatient setting in southern Brazil.

Adjunctive treatment with lodenafil carbonate for erectile dysfunction in outpatients with schizophrenia and spectrum: a randomized, double-blind, crossover, placebo-controlled trial.

INTRODUCTION.: Evidence is accumulating to support the presence of erectile dysfunction in patients with schizophrenia. This dysregulation may be amenable to therapeutic intervention to improve adherence and quality of life of patients who suffer from schizophrenia and schizoaffective disorders. AIM.: We aimed to evaluate the use of adjunctive medication lodenafil for the treatment of erectile dysfunction in outpatients with schizophrenia and spectrum. METHODS.: The design was a randomized, double-blind, crossover, placebo-controlled trial with lodenafil and it was carried at the Schizophrenia Outpatients Program. MAIN OUTCOME MEASURES.: The measures used to assess sexual dysfunction were Arizona Sexual Experiences Scale (ASEX) and International Index of Erectile Function (IIEF). The Positive and Negative Syndrome Scale (PANSS) and the Quality of Life Scale (QLS) were also used. The measures included the levels of prolactin, estradiol, luteinizing hormone, sex hormone-binding globulin, free testosterone, and total testosterone at baseline and end point. Lodenafil and placebo pills were used by the patients for 16 weeks. RESULTS.: Fifty male outpatients fulfilled the criteria and 94% of the participants completed the study. Lodenafil and placebo produced improvement in ASEX, IIEF scale, PANSS, and QLS, and there was no statistical difference between lodenafil and placebo groups in all sexual domains in the results of PANSS and QLS and in the results of hormone levels. CONCLUSION.: These results indicate that both lodenafil and placebo were effective in the treatment of erectile dysfunction for schizophrenia. Placebo effect is very important in patients with schizophrenia and this study showed the importance of discussing sexuality and trying to treat these patients. Further studies designed to test treatments of erectile dysfunction in patients who suffer from schizophrenia are necessary.

A telemedicine strategy to reduce waiting lists and time to specialist care: A retrospective cohort study.

INTRODUCTION: The demand for specialty care is rising worldwide. In the state of Rio Grande do Sul, Brazil, more than 150,000 people were waiting for specialist consultations in 2013. A telemedicine programme (RegulaSUS) developed referral protocols, audited waitlisted cases, authorised/prioritised referrals by risk and discuss deferred cases primary-care physician. This study assesses the effectiveness of RegulaSUS. METHODS: A retrospective cohort analysis with contemporaneous controls was performed from June 2014 to June 2016. Six medical specialties included in RegulaSUS (50,185 patients) were compared to 50,124 control patients waitlisted according to the usual routine (scheduled for specialty consultation at the next available date). The groups were matched (1:1) by semester and year of waitlisting and by the specialty demand-to-supply ratio. Primary outcomes were referral-to-consultation time and number of waitlisted patients. RESULTS: The mean referral-to-consultation time was 584.8 days in the intervention group and 607.0 days in controls (p<0.001). For specialties regulated by RegulaSUS, the mean referral-to-consultation time was 237.6 days for higher-risk patients. At the end of the observation, 26,708 control patients had been unlisted compared to 31,050 patients in the intervention group (reduction of 53.5% vs. 61.9%, respectively; p<0.001). The number of cancelled referrals was lower in the control group (n=14,403; 28.7%) than in the intervention group (n=16,387; 32.7%; p<0.001). DISCUSSION: Telemedicine support for primary care effectively decreased the time to specialty consultation, reduced the number of waitlisted patients and allowed sicker patients to reach a specialist faster.

Does preappointment gabapentin affect neurological examination findings? A prospective, randomized and blinded study in healthy cats.

OBJECTIVES: The aim of this study was to evaluate the influence of a preappointment oral dose of gabapentin on the neurological examination of cats. METHODS: A prospective, randomized and blinded clinical trial was conducted in 35 client-owned healthy cats. Cats were scheduled for two appointments and randomly assigned to receive either a placebo or a 100 mg gabapentin capsule prior to the second veterinary visit. A neurological examination was performed during each visit, and the results were compared between groups. Normal/abnormal response rates for each test were based on the number of cats that allowed the test to be performed. RESULTS: Gabapentin was administered to 17 cats. Gait and postural reactions were significantly affected in the gabapentin group. Comparing the gabapentin with the placebo groups, proprioceptive ataxia was identified in 4/17 (23.5%) vs 0/18 cats (P = 0.0288); paw placement deficits were seen in 10/11 (90.9%) vs 1/4 (25%) cats; table tactile placement deficits were identified in 13/17 (76.5%) vs 0/18 cats (P <0.0001); hopping deficits were seen in 5/17 (29.4%) vs 0/16 cats (P = 0.0185); and abnormalities on wheelbarrowing and extensor postural thrust were reported in 5/17 (29.4%) vs 0/18 cats (P = 0.0129). These results had no correlation with age or dose/kg received. No significant difference was noted in the assessment of level and content of consciousness, posture, cranial nerves and spinal nerves. No significant differences were noted in test compliance or examination duration. CONCLUSIONS AND RELEVANCE: Gabapentin significantly altered gait analyses and postural reactions in this group of healthy cats. The administration of gabapentin could lead to false-positive results and, possibly, an incorrect identification of neurological lesions. In contrast, gabapentin did not impair the assessment of cranial nerves and spinal reflexes, which can be assessed in patients receiving the drug.

Strategies for the treatment of antipsychotic-induced sexual dysfunction and/or hyperprolactinemia among patients of the schizophrenia spectrum: a review.

There is limited evidence for the management of sexual dysfunction and/or hyperprolactinemia resulting from use of antipsychotics in patients with schizophrenia and spectrum. The aim of this study was to review and describe the strategies for the treatment of antipsychotic-induced sexual dysfunctions and/or hyperprolactinemia. The research was carried out through Medline/PubMed, Cochrane, Lilacs, Embase, and PsycINFO, and it included open labels or randomized clinical trials. The authors found 31 studies: 25 open-label noncontrolled studies and 6 randomized controlled clinical trials. The randomized, double-blind controlled studies that were conducted with adjunctive treatment that showed improvement of sexual dysfunction and/or decrease of prolactin levels were sildenafil and aripiprazole. The medication selegiline and cyproheptadine did not improve sexual function. The switch to quetiapine was demonstrated in 2 randomized controlled studies: 1 showed improvement in the primary outcome and the other did not. This reviewed data have suggested that further well-designed randomized controlled trials are needed to provide evidence for the effects of different strategies to manage sexual dysfunction and/or hyperprolactinaemia resulting from antipsychotics. These trials are necessary in order to have a better compliance and reduce the distress among patients with schizophrenia.

Evaluation of music therapy to reduce stress in hospitalized cats.

OBJECTIVES: This study aimed to evaluate the use of two different types of music - cat-specific music and classical music - compared with no music, to reduce stress in cats during hospitalization. METHODS: Thirty-five hospitalized cats were randomly divided into three groups and each group received a different stimulus - cat-specific music, classical music or no music (control) - throughout their hospitalization. Respiratory rate, salivary cortisol and social interaction were documented. A blinded researcher performed the Cat Stress Score (CSS) during the video analysis of recordings at five specific times over 31 h of hospitalization. RESULTS: There was no difference in the mean CSS between cats listening to cat-specific music, classical music and control throughout the five evaluations. Cat-specific music had a higher percentage of positive social interactions than the other groups on the first evaluation (P <0.05). The average respiratory rate was significantly lower in the classical music group vs control on the fourth evaluation (P <0.05). Although statistically insignificant, the average respiratory rate decreased only in the classical music group during the five evaluations. Cortisol quantification did not seem to follow the CSS results. However, owing to the low and unrepresentative number of samples, it was not possible to perform statistical analysis on these results or a group sample comparison. CONCLUSIONS AND RELEVANCE: Both cat-specific music and classical music seem to have some benefit to hospitalized cats. The salivary cortisol analysis was not adequate nor useful to measure stress in hospitalized cats in our study.

Impact of dentists and equipment in the performing dental imaging examinations: a longitudinal analysis.

In this study, we aimed to identify factors associated with performing dental imaging examinations in public health services. Brazilian data at the municipal level (n = 5,564) in two time periods, P0 (2005-2007) and P1 (2014-2016), were collated from health information systems. The increase in the municipal rates of intraoral and extraoral radiographic imaging procedures was the outcome. Changes in the use of clinical procedures and the rates of dentists and equipment were the main predictors. Multiple logistic regression analysis was performed to estimate the adjusted odds ratio (OR). Approximately 35.3% of the Brazilian municipalities increased the dental radiography equipment rate, 9.9% increased the fan-beam computed tomography (CT) equipment rate, and 5.9% increased the magnetic resonance imaging (MRI) equipment rate. In addition, 31.8% increased the periapical/interproximal radiography rate, 10.5% increased the CT rate, and 4.4% increased the MRI rate. Increases in the dental radiography, CT, and MRI rates were associated with higher chances of periapical/interproximal images (OR = 1.90, p < 0.01), face and neck images (OR =1 5.3, p < 0.01), and MR images (OR = 18.1, p < 0.01), respectively. Municipalities that increased the rates of endodontists increased the rates of periapical/interproximal (OR = 2.50, p < 0.01) and occlusal (OR = 1.60, p < 0.01) imaging procedures, and those that increased the rates of radiologists also increased the rates of occlusal (OR = 2.00, p < 0.01) and panoramic (OR = 1.70, p < 0.01) imaging procedures. The implementation of a secondary dental care center, Centro de Especialidades Odontológicas (CEO) was associated with an increase in the chances of performing periapical/interproximal and panoramic radiographic procedures in 1.5 and occlusal radiographic examinations in 2.0. The rates of dentists, equipment, specialized dental centers, and specific dental procedures were associated with the increased use of imaging procedures in dentistry in the Brazilian public health system.

[Congenital anomalies from the perspective of social determinants of health]. / Anomalias congênitas na perspectiva dos determinantes sociais da saúde.

The objective of this study was to analyze factors associated with cases of congenital anomalies from the perspective of social determinants of health in the State of Rio Grande do Sul, Brazil. This is a case-control study with all the pairs of mothers and liveborn infants from 2012 to 2015 in the state, based on the total number of liveborn infants with congenital anomalies (5,250) and a random sample of 21,000 without congenital anomalies, according to data on the live birth certificates. The statistical analyses included chi-square tests and logistic regression models with SPSS. The Dahlgren & Whitehead model was used as the basis for grouping and discussing the variables. In the multivariate model, all the variables that were significantly associated with the outcome were in the sense of increasing the odds of births with congenital anomalies: black women had 20% higher odds than white women (OR = 1.20; p-value = 0.013); age over 40 years increased the odds by 97% when compared to women 18 to 29 years of age; women with less than four years of schooling showed 50% higher odds when compared to women with 12 or more years of schooling (OR = 1.50; p-value = 0.001); women with no prenatal visits had 97% higher odds than women with seven or more prenatal visits (OR = 1.97; p-value = 0.001); and prior history of miscarriages/stillbirths increased the odds by 17% (OR = 1.17; p-value = 0.001). The results raise the issue of racial and social inequalities, related to health inequities.

O objetivo deste estudo foi analisar os fatores associados aos casos de anomalias congênitas na perspectiva dos determinantes sociais da saúde no Estado do Rio Grande do Sul, Brasil. Trata-se de um estudo do tipo caso-controle, com todas as duplas de mães e nascidos vivos no período de 2012 a 2015 no estado, sendo considerado o total de nascidos vivos com anomalia congênita (5.250), e realizada amostragem aleatória de 21 mil sem anomalia congênita, conforme as informações das Declarações de Nascidos Vivos. Para análise estatística, foram realizados testes qui-quadrado e modelos de regressão logística com o SPSS. O modelo de Dahlgren & Whitehead foi utilizado como base para agrupamento e discussão das variáveis. No modelo multivariado, todas variáveis que se mostraram associadas significativamente com o desfecho foram no sentido de aumentar a chance de nascimentos com anomalia congênita: as mulheres pretas tiveram 20% mais chance, comparadas às brancas (OR = 1,20; valor de p = 0,013); ter mais de 40 anos aumentou em 97% a chance, quando comparadas às de 18 a 29 anos; as mulheres com menos de quatro anos de estudo apresentaram 50% mais chance, comparadas às mulheres com 12 anos ou mais de estudo (OR = 1,50; valor de p = 0,001); as mulheres que não realizaram nenhuma consulta de pré-natal tiveram 97% mais chance, comparadas às mulheres que realizaram sete ou mais consultas (OR = 1,97; valor de p = 0,001); e a ocorrência de abortos/perdas fetais aumentou em 17% a chance, em relação a nunca ter tido abortos/perdas fetais prévios (OR = 1,17; valor de p = 0,001). Os resultados trazem à discussão as desigualdades raciais e sociais, relacionando-as às iniquidades em saúde.

El objetivo de este estudio fue analizar los factores asociados con los casos de anomalías congénitas desde la perspectiva de los determinantes sociales en salud del estado de Rio Grande do Sul, Brasil. Se trata de un estudio de tipo caso-control, con todas las parejas de madres y nacidos vivos en el período de 2012 a 2015 en el estado, considerando el total de nacidos vivos con anomalía congénita (5.250), y realizando una muestra aleatoria con 21.000 sin anomalía congénita, conforme la información de las Declaraciones de Nacidos Vivos. Para el análisis estadístico, se realizaron tests chi-cuadrado y modelos de regresión logística mediante el SPSS. El modelo de Dahlgren & Whitehead se utilizó como base para el agrupamiento y discusión de las variables. En el modelo multivariado, todas las variables que se mostraron asociadas significativamente con el resultado fueron en el sentido de aumentar la oportunidad de nacimientos con anomalía congénita: las mujeres negras tuvieron un 20% más de oportunidad, comparadas con las blancas (OR = 1,20; valor de p = 0,013); tener más de 40 años aumentó en un 97% la oportunidad, cuando se comparan con las de 18 a 29 años; las mujeres con menos de cuatro años de estudio presentaron un 50% más de oportunidades, comparadas con las mujeres con 12 años o más de estudio (OR = 1,50; valor de p = 0,001); las mujeres que no realizaron ninguna consulta prenatal tuvieron 97% más oportunidades, comparadas con las mujeres que realizaron siete o más consultas (OR = 1,97; valor de p = 0,001); y la ocurrencia de abortos/pérdidas fetales aumentó en un 17% la oportunidad, en relación a nunca haber sufrido abortos/pérdidas fetales previas (OR = 1,17; valor de p = 0,001). Los resultados plantean la discusión de las desigualdades raciales y sociales, relacionándolas con las inequidades en salud.

SARS-CoV-2 RNA in dental biofilms: Supragingival and subgingival findings from inpatients in a COVID-19 intensive care unit.

BACKGROUND: Saliva, salivary glands, gingival crevicular fluid, and supragingival biofilms may harbor SARS-CoV-2 RNA. This observational study aimed to investigate the presence and load of SARS-CoV-2 RNA in supragingival, and subgingival biofilms obtained from intensive care unit (ICU) patients. METHODS: A convenience sample, composed of 52 COVID-19+ participants (48.6 ± 14.8 years, 26.9% females), were evaluated for pre-existing comorbidities, number of teeth, and periodontal data [visible plaque (VPI), bleeding on probing (BOP), periodontal probing depth (PPD), and attachment loss (AL)]. Supragingival and subgingival samples (SubDeep: four sites with the deepest PPD; SubRemain: remaining shallower sites) were analyzed by RT-qPCR with corresponding cycle quantification (Cq). Statistical analyses considered the individual (P = 5%). RESULTS: Twenty-six participants tested positive for dental biofilms (Biofilm+) with 96.2% of them being positive for subgingival samples. Pre-existing comorbidities, number of teeth examined, VPI, PPD, AL, and BOP were similar between Biofilm+ and Biofilm-. SubDeep PPD (3.72 ± 0.86), AL (4.34 ± 1.33), and % of BOP (66.0 ± 31.1) values were significantly greater compared to SubRemain values (2.84 ± 0.48, 3.37 ± 0.34, and 20.4 ± 24.1, respectively). Biofilm+ Cqs showed no association with the periodontal condition. Cqs from Nasopharynx/Oropharynx (Naso/Oro; n = 36) were similar between Biofilm+ and Biofilm- participants. Length of time since ICU intake, last Naso/Oro RT-qPCR readings, onset of COVID-19 symptoms, and biofilm samplings were greater for Biofilm-. CONCLUSIONS: ICU patients harbored SARS-CoV-2 RNA in supragingival and subgingival biofilms, irrespective of the periodontal condition, and systemic viral load. The high number of positive patients highlights the need to better understand this habit to provide adequate oral care.

Evaluation of the effects of gabapentin on the physiologic and echocardiographic variables of healthy cats: a prospective, randomized and blinded study.

OBJECTIVES: The aim of this study was to evaluate, using echocardiography, the effects of oral administration of a single dose of gabapentin on the physiologic variables (heart rate [HR], respiratory rate [RR] and systolic blood pressure [SBP]) and systolic and diastolic cardiac function of healthy cats. METHODS: This was a prospective, randomized and blinded study with 40 healthy cats aged between 6 months and 2 years. The cats' health status was assessed on the first appointment (T1) when they underwent a physical examination, complete blood count, biochemical profile, assessment of physiologic variables and echocardiogram. The echocardiogram was used to measure the left ventricle's (LV) internal diameter during systole and diastole, isovolumic relaxation time, transmitral flow, E-wave deceleration time and HR. The cats were randomly divided into two groups: (1) a treatment group with 20 cats that received a single oral dose of gabapentin (100 mg/cat); and (2) a control group with 20 cats that received a single oral dose of placebo. All variables of the physiologic and echocardiographic variables were re-evaluated 1-3 weeks after T1 (T2), 90 mins after medication or placebo administration. RESULTS: There was no difference in the physiologic variables evaluated in both groups. The proportion of cats in the treatment group that had their ventricular filling waves fused on T1 but did not have them fused on T2 was significantly higher (45%) compared with cats in the control group (15%; P = 0.0384). CONCLUSIONS AND RELEVANCE: There was no difference between the groups in regard to SBP, HR, RR and echocardiographic variables. Gabapentin improved evaluation of diastolic function on echocardiogram because it reduced the fusion of ventricular filling waves during the evaluation of the diastolic function of the LV. Gabapentin did not cause adverse effects on the cardiovascular hemodynamics of young healthy cats.