Accuracy of geometric morphometrics for age estimation using frontal face photographs of children and adolescents: A promising method for forensic practice.

Age estimation is crucial in legal and humanitarian contexts. Forensic professionals may use various procedures to estimate age, including dental analysis, bone density tests, evaluation of physical characteristics including facial bone structure and development, and image-based methods. Although images are often the only material available, visual observation of photographic material is an imprecise method in age estimation, which can compromise judicial decision-making. Analyzing 4000 photographs from the Brazilian Federal Police database, representing four age groups (6, 10, 14, and 18 years), the study employed automated analysis by marking 28 photogrammetric points. Data were used to establish facial patterns by age and sex using the facial geometric morphometrics method. Performance was assessed through a Multinomial Logistic Regression model, evaluating accuracy, sensitivity, and specificity across the categorical age groups. Analyses were conducted using R software, with a 5 % significance level. The study found that facial geometric morphometrics achieved an overall accuracy of 69.3 % in age discrimination, with higher accuracy in males (74.7 %) compared to females (65.8 %) (p < 0.001). The method excelled at predicting the age of 6-year-olds with 87.3 % sensitivity and 95.6 % specificity but had lower performance at 14 years. It showed greater accuracy in distinguishing age groups with larger age gaps, achieving up to 99.5 % accuracy between certain groups, and was particularly effective in differentiating ages of 6 and 10 years in females and 10, 14, and 18 years in males. The facial geometric morphometrics emerges as a promising approach for age estimation among children and adolescents in forensic settings.

Asthma as a risk factor and allergic rhinitis as a protective factor for COVID-19 severity: a case-control study.

PURPOSE: The COVID-19 pandemic has resulted in significant global morbidity and mortality. The disease presents a broad clinical spectrum, significantly influenced by underlying comorbidities. While certain conditions are known to exacerbate COVID-19 outcomes, the role of chronic inflammatory airway diseases such as asthma and rhinitis in influencing disease severity remains controversial. This study investigates the association between asthma and allergic rhinitis and the severity of COVID-19 outcomes in a specific geographical region prior to widespread vaccine deployment. METHODS: We conducted a case-control study with unvaccinated adult patients who had laboratory-confirmed COVID-19 by polymerase chain reaction (PCR). Cases were defined as severe or critical COVID-19 patients requiring intensive care unit (ICU) admission, and controls were non-severe patients without signs of viral pneumonia or hypoxia. We utilized the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire to assess the presence of asthma and allergic rhinitis. The association between these chronic inflammatory airway diseases and the severity of COVID-19 was evaluated using multivariate logistic regression analysis. RESULTS: A total of 122 patients were analyzed, with 61 in each group. The presence of asthma (9 patients) was associated with an increased likelihood of severe COVID-19 (OR = 13.0; 95% CI 1.27-133.74), while rhinitis (39 patients) was associated with a protective effect against severe outcomes (OR = 0.36; 95% CI 0.13-0.99). No significant association was found between the frequency of asthmatic episodes or the severity of rhinitis and the severity of COVID-19 outcomes. CONCLUSION: This study underscores the divergent effects of chronic inflammatory airway diseases on COVID-19 severity, with asthma associated with a higher likelihood of severe outcomes and rhinitis potentially offering protective effects. These findings enhance our understanding of the complex interactions between respiratory allergies and COVID-19, emphasizing the importance of targeted clinical management and public health strategies.

Demographic evolution and natural increase projection of the Yanomami indigenous population in Brazil.

The Yanomami population, residing in Brazil's largest indigenous reserve in the Amazon Rainforest, face significant health challenges exacerbated by external threats such as infectious diseases, malnutrition, and mercury contamination from illegal mining. These issues, coupled with inadequate healthcare provision, have led to an alarming increase in mortality rates and potentially threaten the long-term survival of the Yanomami community. This ecological study utilized demographic data from the Special Secretariat of Indigenous Health to explore the demographic evolution and natural increase of the Yanomami Indigenous population in Brazil from 2003 to 2022. Employing population pyramids, crude rates of natural increase, the Mann-Kendall test for trend analysis, and linear regression modeling, the study analyzed vital statistics to forecast demographic trends, with analysis conducted using the R statistical software. Our findings showed a substantial growth of the Yanomami population, yet with a decreasing natural increase rate (τ = -0.33; p = 0.047), suggesting a shift toward population stagnation or decline within the next century. These results call for urgent, coordinated actions to address the complex demographic trends and health challenges faced by Yanomami Indigenous people, ensuring their demographic sustainability and the preservation of their traditional ways of life amidst ongoing environmental and health crises.

Emerging Challenges of Mpox Transmission: An In-depth Scoping Review and Evidence Mapping on Breastfeeding Practices in South America.

BACKGROUND: In 2022, a marked escalation in Monkeypox (Mpox) cases was observed in nonendemic regions, notably South America, despite the virus being traditionally endemic to Central and West Africa. This unexpected shift necessitated a deeper exploration of the novel transmission dynamics, including breastfeeding, given the emerging evidence of potential horizontal and vertical Mpox transmission during mother-infant interactions. RESEARCH AIM: The study aimed to critically evaluate existing evidence on potential horizontal and vertical Mpox transmission related to breastfeeding and to assess guidelines in South American countries regarding Mpox prevention during breastfeeding. METHODS: A scoping review and evidence mapping were conducted, adhering to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guideline. Data extraction involved identifying primary studies evaluating breastfeeding as a transmission route. Additionally, official documents from South American Health Ministries detailing guidelines or policies on breastfeeding in the context of maternal Mpox infection were reviewed. RESULTS: Three out of 215 studies were found relevant; 2 were case reports, and 1 was a laboratory study. Available evidence suggests that contamination could likely occur horizontally through skin-to-skin contact. Six South American countries had issued guidelines on breastfeeding during Mpox infection, but the guidance varied and was not consistent across the region. CONCLUSIONS: The study emphasizes the need for clear and consistent guidelines on breastfeeding during Mpox outbreaks, particularly in South America. Collaborative strategies and regular research updates will be essential in addressing the ongoing public health challenge.

Demographic, socioeconomic, and health structure factors associated with the use of HIV pre-exposure prophylaxis in Brazil: A nationwide ecological study.

Aims: To assess the cumulative rate of HIV Pre-Exposure Prophylaxis (PrEP) users in Brazil since its 2018 implementation and to analyze the association between PrEP usage and state-level structural factors. Methods: A nationwide ecological study from 2018 to 2022 was conducted, examining the 5-year cumulative rate of PrEP users in relation to demographic, socioeconomic, and healthcare infrastructure variables. Multiple linear regression analysis identified significant predictors of PrEP utilization. Results: Between 2018 and 2022, 124,796 individuals used PrEP, with a cumulative rate of 61.5 per 100,000 population. The highest usage was in Minas Gerais, São Paulo, and Santa Catarina, while the lowest was in Distrito Federal, Maranhão, and Alagoas. Regression analysis showed that higher PrEP usage was associated with lower population density, a younger median age, a lower male to female ratio, and reduced social vulnerability. Additionally, PrEP usage was positively associated with the density of medical doctors and the number of dispensing units. Conclusions: The study reveals significant regional disparities in PrEP usage across Brazil, influenced by socioeconomic and healthcare factors. It highlights the need for targeted public health strategies to enhance PrEP access and uptake, especially in socially vulnerable regions.

Chronotropic incompetence is associated with reduced aerobic conditioning and sedentary behavior in patients with post-acute COVID-19 syndrome.

Post-acute COVID-19 syndrome, or long COVID, presents with persistent symptoms, including cough, dyspnea, and fatigue, extending beyond one month after SARS-CoV-2 infection. Cardiac complications such as chest pain and arrhythmias have raised concerns, with chronotropic incompetence (CI), an inadequate heart rate increase during exercise, emerging as a significant condition contributing to diminished exercise tolerance and quality of life. This study estimated the prevalence of CI and explored its association with aerobic capacity and physical activity levels in long COVID patients. A cross-sectional study was conducted at a private hospital in Sergipe, Brazil, involving 93 patients over 18 years old with persistent post-COVID-19 symptoms after confirmed SARS-CoV-2 infections. Exclusion criteria included beta-blocker use, inadequate respiratory exchange ratio, and inability to complete cardiopulmonary exercise testing (CPET). Clinical histories, CPET results, and chronotropic index calculation were used to identify CI, with logistic regression analyzing associated factors. Of the participants (mean age 45 years; average duration since COVID-19 diagnosis 120 days), 20.4% were diagnosed with CI. Logistic regression identified a strong association between CI and sedentary behavior (OR 11.80; 95% CI 2.54 to 54.78; p=0.001). Patients with CI showed lower predicted peak heart rates and maximal oxygen uptake. The prevalence of CI among long COVID patients in this study was approximately 20%, associated with decreased aerobic capacity and increased sedentary behavior. These findings highlight the need for timely diagnosis and therapeutic interventions, including cardiopulmonary rehabilitation, to enhance the quality of life in post-COVID patients with CI. The study's cross-sectional design and its specific context have limited causality inference and generalizability, underscoring the importance of further research in diverse settings.

Long-Term Impact of Left Bundle Branch Block on Cardiopulmonary Exercise Test Variables and Left Ventricular Systolic Function: A Two-Stage Observational Study.

INTRODUCTION: Left bundle branch block (LBBB) disrupts the electrical activation of the left ventricle, potentially impairing its systolic function, leading to LBBB-induced cardiomyopathy. This study examined cardiopulmonary exercise test (CPET) variables in patients with and without LBBB and assessed the longitudinal development of left ventricular ejection fraction (LVEF). METHOD: An observational, comparative clinical study was executed in two stages at a private hospital in Brazil. The sample consisted of 27 individuals: 11 with LBBB and 16 without LBBB, all with preserved LVEF (>50%) and without confirmed ischemia. CPET variables were assessed, and after 4 years, participants had a transthoracic echocardiogram for LVEF re-evaluation. Groups were compared using the t test or the χ2 test. Multivariate analysis of covariance determined effect magnitude. RESULTS: Patients with LBBB demonstrated significant differences in CPET variables, particularly in predicted peak V˙O2, predicted peak PO2, V˙E/V˙CO2 slope, and T ½ V˙O2. They also exhibited a more significant decline in LVEF over a 4-year span compared to the patients without LBBB. Although initial preservation of LVEF, changes in contractile patterns due to LBBB interfered with its systolic function, suggesting early ventricular dysfunction indicated by a reduction in LVEF and an increase in the V˙E/V˙CO2 slope. Despite differences in cardiopulmonary function and changes in LVEF over time between patients with and without LBBB, the effect size was considered mild to moderate. CONCLUSIONS: LBBB patients with initially preserved LVEF displayed reduced exercise tolerance and a decrease in LVEF over time, emphasizing the need for vigilant monitoring and early intervention in these patients.