Maternal depression and child development at 3 years of age: a longitudinal study in a Brazilian child development promotion program.

BACKGROUND: We tested the hypothesis that children of non-depressed mothers perform better in a developmental test at 3 years than children of depressed mothers. METHOD: Longitudinal analysis from a trial to assess the impact of a child development promotion program in 30 Brazilian municipalities. Mothers and children were appraised at first-year post-partum, 1 and 3 years after enrollment. Child development was assessed through the Ages and Stages Questionnaire (ASQ3) and maternal depression through the Edinburgh Postnatal Depression Scale (EPDS). Crude and adjusted beta coefficients were obtained by linear regression before and after multiple imputation. RESULTS: In total, 2098 mother/child dyads were included and 8.2% of the mothers had persistent depressive symptoms. There was a decrease in ASQ3 as the number of follow-ups with EPDS ≥ 10 increased (p for trend <0.001). In adjusted analysis, the direction of the association persisted but lost statistical significance. After multiple imputation, children from mothers with EPDS ≥ 10 in three follow-ups presented a decrease of about 14 points in ASQ3 (adjusted beta coefficient = -13.79; -22.59 to -5.00) (p for trend = 0.001). CONCLUSIONS: Identification of women at increased risk of depression should be among the primary health care sector priorities in maternal and child health in Brazil. IMPACT: In our population study, almost one in every ten women presented persistent depression symptoms across the first 3 years postpartum. In adjusted analysis there was a detrimental impact of persistent maternal depression on child development at 3 years of age. The persistent exposure to maternal depression across early childhood negatively influences children's development. Considering its prevalence, identification of women at increased risk of depression should be among the primary health care sector priorities in maternal and child health in Brazil.

What Is the Contribution of Community Programs to the Physical Activity of Women? A Study Based on Public Open Spaces in Brazil.

Community programs can facilitate the access of vulnerable subgroups to physical activity (PA). This study analyzed the relationship between sociodemographic characteristics, health conditions, public open spaces (POS) usage, and women's PA. The 155 participants were assiduous in taking part in PA classes in POS in São José dos Pinhais, Brazil. The accelerometer-based PA measures identified four outcomes: (1) daily light-intensity PA (LPA), (2) daily moderate-to-vigorous intensity PA (MVPA), (3) LPA in POS, and (4) MVPA in POS. Linear regression, and the Durbin-Watson and Mann-Whitney U tests were used for data analysis in STATA software. The main results showed that the weekly frequency (ß: 10.9, p < 0.01) and intensity of the main activity in the POS (ß: 22.4, p < 0.05) were related to daily MVPA. Economic level and length of stay in the POS were positively related to the LPA performed (p < 0.05). Weekly frequency (ß: 2.4, p < 0.01), length of stay (ß: 11.0, p < 0.01), and intensity of PA practiced in the POS (ß: 5.9, p < 0.05) showed a positive relationship with MVPA in the POS. In conclusion, there was a positive relationship between some analyzed variables and PA of different intensities, especially the consistent relationship between weekly frequency of POS usage and MVPA. Participation in structured PA classes in a community program can contribute to an increase of 47 min of daily MVPA.

Association of the Practice of Physical Activity and Dietary Pattern with Psychological Distress before and during COVID-19 in Brazilian Adults.

To verify the association between the practice of physical activity and dietary patterns and psychological distress before and during the lockdown due to COVID-19, a cross-sectional study was performed with 2000 Brazilians (mean [M] = 35.78 years; standard deviation [SD] = 11.20; 59.6% women) recruited through convenience sampling via digital media. Participants completed an electronic questionnaire containing sociodemographic and clinical information, nutritional patterns, physical activity, and psychological distress. Data were analyzed using descriptive statistics and multinomial regression. Before the COVID-19 lockdown, the chance of women presenting very high stress, in relation to men, was six times higher (OR = 6.32; 95% CI 4.20-9.51), a behavior that remained similar during the lockdown (OR = 6.63; 95% CI 4.40-10.00). Before the lockdown, insufficient physical activity doubled the chance of having very high stress in relation to those who engaged in physical activities six to seven times a week (OR = 2.11; 95% CI 1.10-4.02). However, during the lockdown, this probability was higher, from twice to 10 times the chance (OR = 10.19; 95% CI 4.85-21.41). Not exercising alone (OR = 2.18; 95% CI 1.52-3.11) and a decreasing physical activity frequency (OR = 2.28; 95% CI 1.40-3.71) were also associated with very high stress during the lockdown. Additionally, the consumption of smaller amounts of food showed an inverse association with very high stress (OR = 0.28; 95% CI 0.18-0.43). The maintenance of physical activity and an adequate eating frequency are measures that should be considered to cope with higher levels of anxiety and depression.

Amitriptyline efficacy in decreasing implant-induced foreign body reaction.

Beyond its actions on the nervous system, amitriptyline (AM) has been shown to lower inflammatory, angiogenic, and fibrogenic markers in a few pathological conditions in human and in experimental animal models. However, its effects on foreign body reaction (FBR), a complex adverse healing process, after biomedical material implantation are not known. We have evaluated the effects of AM on the angiogenic and fibrogenic components on a model of implant-induced FBR. Sponge disks were implanted subcutaneously in C57BL/6 mice, that were treated daily with oral administration of AM (5 mg/kg) for seven consecutive days in two protocols: treatment was started on the day of surgery and the implants were removed on the seventh day after implantation and treatment started 7 days after implantation and the implants removed 14 after implantation. None of the angiogenic (vessels, Vascular endothelial growth factor (VEGF), and interleukin-1ß (IL-1ß) or fibrogenic parameters (collagen, TGF-ß, and fibrous capsule) and giant cell numbers analyzed were attenuated by AM in 7-day-old implants. However, AM was able to downregulate angiogenesis and FBR in 14-day-old implants. The effects of AM described here expands its range of actions as a potential agent capable of attenuating fibroproliferative processes that may impair functionality of implantable devices.

Course of depression during the first 2 years postpartum among Brazilian women enrolled in a conditional cash transfer program.

BACKGROUND: Women living in low- and middle-income countries are more exposed to known risk factors for depression occurrence and persistency over time. AIM: Our aim was to investigate the course of depression in the first 2 years postpartum among Brazilian women enrolled in a cash transfer program. METHOD: Longitudinal analysis of baseline (T0; mean 3.7 months postpartum) and first follow-up data (T1; mean 18.6 months postpartum) from a trial to assess the impact of a child development promotion program in 30 municipalities from six Brazilian states. The program does not include any interventions against maternal depression. The Edinburgh Postnatal Depression Scale (EPDS) at cutoff ⩾10 was applied. Women were categorized into four groups based on EPDS at T0 and T1: absence of depression, persistence, discontinuity, or emergence pattern. Adjusted Poisson regressions were run using a multilevel hierarchical model. RESULTS: Two thousand eight hundred sixty-three women were assessed. Prevalence of depression was 26.4% [24.8, 28.1] at T0 and 24.4% [22.8, 26.0] at T1. Persistence, discontinuation, and emergence were found in 14.1% [11.3, 17.6%], 12.8% [11.4, 14.3%], and 10.2% [8.0, 13.0], respectively. In adjusted analyses, the persistence pattern was directly associated with parity and inversely associated with schooling of the woman and of the child's father. Living with husband/partner and support from the child's father and family members during pregnancy were protective against persistence. The discontinuity and the emergence patterns were not associated with any of the exposure variables. CONCLUSIONS: Depressive symptoms were highly prevalent during the first 2 years postpartum. About half of the women with depression at T1 were persistent cases that could have been detected earlier. Screening for maternal depression should be an essential component in every encounter of women with health professionals in primary health care settings.

Understanding and controlling asthma in Latin America: A review of recent research informed by the SCAALA programme.

Asthma is an important health concern in Latin America (LA) where it is associated with variable prevalence and disease burden between countries. High prevalence and morbidity have been observed in some regions, particularly marginalized urban populations. Research over the past 10 years from LA has shown that childhood disease is primarily non-atopic. The attenuation of atopy may be explained by enhanced immune regulation induced by intense exposures to environmental factors such as childhood infections and poor environmental conditions of the urban poor. Non-atopic symptoms are associated with environmental and lifestyle factors including poor living conditions, respiratory infections, psychosocial stress, obesity, and a diet of highly processed foods. Ancestry (particularly African) and genetic factors increase asthma risk, and some of these factors may be specific to LA settings. Asthma in LA tends to be poorly controlled and depends on access to health care and medications. There is a need to improve management and access to medication through primary health care. Future research should consider the heterogeneity of asthma to identify relevant endotypes and underlying causes. The outcome of such research will need to focus on implementable strategies relevant to populations living in resource-poor settings where the disease burden is greatest.

Oral formulation of Wnt inhibitor complex reduces inflammation and fibrosis in intraperitoneal implants in vivo.

The use of implantable biomaterials to replace physiological and anatomical functions has been widely investigated in the clinic. However, the selection of biomaterials is crucial for long-term function, and the implantation of certain biomaterials can cause inflammatory and fibrotic processes, triggering a foreign body reaction that leads to loss of function and consequent need for removal. Specifically, the Wnt signaling pathway controls the healing process of the human body, and its dysregulation can result in inflammation and fibrosis, such as in peritoneal fibrosis. Here, we assessed the effects of daily oral administration of a Wnt pathway inhibitor complex (CD:LGK974) to reduce the inflammatory, fibrotic, and angiogenic processes caused by intraperitoneal implants. CD:LGK974 significantly reduced the infiltration of immune cells and release of inflammatory cytokines in the implant region compared to the control groups. Furthermore, CD:LGK974 inhibited collagen deposition and reduced the expression of pro-fibrotic α-SMA and TGF-ß1, confirming fibrosis reduction. Finally, the CD:LGK974 complex decreased VEGF levels and both the number and area of blood vessels formed, suggesting decreased angiogenesis. This work introduces a potential new application of the Wnt inhibitor complex to reduce peritoneal fibrosis and the rejection of implants at the intraperitoneal site, possibly allowing for longer-term functionality of existing clinical biomaterials.

Evaluation of Candida rugosa Lipase Immobilized on Magnetic Nanoparticles in Enzymatic/Chemical Hydroesterification for Biodiesel Production.

This study aimed to (i) prepare functionalized maghemite nanoparticles for immobilization of Candida rugosa lipase (CRL) by covalent binding, (ii) evaluate the application of the immobilized derivative in the hydrolysis of waste cooking oil (WCO) to fatty acids, and (iii) assess the potential of the hydrolyzed material for biodiesel production by hydroesterification. Maghemite (γFe2O3) obtained by precipitation of Fe3Cl2 with NH4OH served as an efficient support for covalent immobilization of CRL. Fourier-transform infrared spectroscopy and hydrolytic activity analysis indicated that CRL was covalently immobilized on the surface of the maghemite support. The derivative showed an activity of 166.62 ± 8 U g-1 in WCO hydrolysis at 40 °C and pH 6. Scanning electron microscopy revealed that, after lipase immobilization, nanoparticles became more dispersed, which is advantageous for biocatalysis reactions, as it increases the contact area with the substrate. WCO hydrolysis afforded 96 ± 0.2 wt% free fatty acids. In the second step, free fatty acids were subjected to chemical esterification with sulfuric acid, affording 94.4 ± 0.02 wt% fatty acid methyl esters (biodiesel). The findings of this study contribute to the field of biotechnology and may promote the development of enzymatic technologies for the synthesis of products of economic and social interest.

Autonomous Environment Disinfection Based on Dynamic UV-C Irradiation Map.

The COVID-19 pandemic has become a worldwide concern and has motivated the entire scientific community to join efforts to fight it. Studies have shown that SARS-CoV-2 remains viable onsurfaces for days, increasing the chances of human infection. Environmental disinfection is thus an important action to prevent the transmission of the virus. Despite the valuable contribution of the research community to the field of UV-C disinfection by robots, there still lacks a disinfection system that is fully autonomous and computes its trajectory in real-time and in unknown environments. To meet this need, we propose an autonomous UV-C disinfection strategy for indoor environments based on a dynamic Irradiation Map that indicates the amount of energy applied in each region. Our method was tested in different scenarios and compared with other disinfection strategies. Experiments show that our approach delivers better results, especially when targeting high ideal UV-C doses.

The Salvador Primary Care Longitudinal Study of Child Development (CohortDICa) Following the Zika Epidemic: Study Protocol.

This article describes the Salvador Primary Care Longitudinal Study of Child Development (CohortDICa). The exposed group was defined by confirmation of Congenital Zika Syndrome (CZS) diagnosed through computed tomography, magnetic resonance or transfontanellar ultrasound. A random selection of the 169 exposed children led to a subgroup of 120 children who were paired with children from the Live Birth Information System, according to birthdate, residence in the same street or neighborhood, and gestational age, resulting in 115 subjects in the non-exposed group. Following recruitment and before the participants completed 42 months, three measures were applied to assess cognitive, motor, and language performance, corresponding to three home visits. Social characteristics of the families and children, and the neurocognitive development of the children will be compared across the CZS exposed group (n = 147), the typical children with no exposure to CZS (n = 115) and the STORCH exposed group (Syphilis, Toxoplasma gondii, Rubella, Cytomegalovirus, and Herpes simplex) (n = 20). Primary Health Care (PHC) should include long-term care strategies for the care of children and family members, and might benefit from the research, teaching, and extension activities provided in this study. In the face of the consequences of the Zika virus epidemic, an opportunity arose to intervene in the integrated care of child development within PHC, including, on an equal basis, typical children and those with delays or disabilities in the first six years of life.

Catalytic Transformation of Triglycerides to Biodiesel with SiO2-SO3H and Quaternary Ammonium Salts in Toluene or DMSO.

SiO2-SO3H, with a surface area of 115 m2·g-1, pore volumes of 0.38 cm3·g-1 and 1.32 mmol H+/g, was used as a transesterification catalyst. Triglycerides of waste cooking oil reacted with methanol in refluxing toluene to yield mixtures of diglycerides, monoglycerides and fatty acid methyl esters (FAMEs) in the presence of 20% (w/w) catalyst/oil using the hydrophilic sulfonated silica (SiO2-SO3H) catalyst alone or with the addition of 10% (w/w) co-catalyst/oil [(Bun4N)(BF4) or Aliquat 336]. The addition of the ammonium salts to the catalyst lead to a decrease in the amounts of diglycerides in the products, but the concentrations of monoglycerides increased. Mixtures of (Bun4N)(BF4)/catalyst were superior to catalyst alone or Aliquat 336/catalyst for promoting the production of mixtures with high concentrations of FAMEs. The same experiments were repeated using DMSO as the solvent. The use of the more polar solvent resulted in excellent conversion of the triglycerides to FAME esters with all three-catalyst media. A simplified mechanism is presented to account for the experimental results.

Asthmatic Symptoms in Children and Adolescents: the Role of Maternal Experiences of Racial Discrimination.

Emerging evidence suggests that vicarious racial experiences of discrimination may negatively influence child health. Few studies have focus on childhood asthma symptoms and potential moderators of such relationship. METHODS: We used two population-based cross-sectional studies from the Social Change Allergy and Asthma in Latin America project in Salvador, Brazil. A total of 1003 children and mothers interviewed in 2006 were included, of whom 873 were reached again in 2013. Vicarious racial discrimination was assessed in mothers by applying the Experiences of Discrimination scale. Data on wheeze and environmental exposures were collected with standardized questionnaires. Levels of allergen-specific IgE were measured to identify atopy. Generalized estimating equations were used to estimate the association between maternal discrimination and wheezing and asthma phenotypes. Interaction terms were evaluated to identify whether mothers' mental health and family social support modified such associations. RESULTS: Children whose mothers reported racial discrimination had greater odds of have asthma symptoms (OR 1.75; 95% CI 1.15-2.67) and non-atopic asthma (OR 1.92; 95% CI 1.09-3.40). When we considered effect modification by social support, we found a higher ORs when the level of social support was lower (OR 2.43; 95% IC 1.19-4.97) than when the level of social support was higher (OR 1.12; CI 0.64-1.96). CONCLUSION: Maternal discrimination was associated with asthma symptoms and with non-atopic phenotype among their children. Enjoying wider social support network appears to buffer the effect on asthmatic symptoms. Intervention on childhood asthma needs to incorporate strategies that target the family.

Anatomy of the Middle Meningeal Artery

Introduction The middle meningeal artery (MMA) is an important artery in neurosurgery. As the largest branch of the maxillary artery, it provides nutrition to the meninges and to the frontal and parietal regions. Diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (TAVF), Moya-Moya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine, and meningioma,may be related to the MMA. The aim of the present study is to describe the anatomy of the MMA and to correlate it with brain diseases. Methods A literature review was performed using the PubMed, Scielo, Scientific Direct, Ebsco, LILACS, TripDataBase and Cochrane databases, with the following descriptors: neurosurgery, neuroanatomy, meninges and blood supply. Discussion The MMA is embedded in a cranial groove, and traumatic or iatrogenic factors can result in MMA-associated pseudoaneurysms or arteriovenous fistulas (AVFs). In hemodynamic stress, true aneurysms can develop. Arteriovenous fistulas, pseudoaneurysms, and true aneurysms can be effectively treated by endovascular or surgical removal. In MMD, the MMA plays a role in the development and in the improvement of collateral circulation. Finally, in cases of CSDH, when standard surgery and drainage fail, MMA embolization can constitute a great alternative. Conclusion The MMA is a relevant structure for the understanding of neurosurgical diseases. In conclusion, every neurosurgeon must know the anatomy of the MMA sufficiently to correlate it with the diagnosed pathology, thus obtaining treatment effectiveness and preventing brain lesion.

Medicines for the new coronavirus in the view of Classical Systemic Homeopathy.

INTRODUCTION: According to the World Health Organization, the coronavirus disease 2019 (COVID-19) has 48.896.564 reported cases and 1.236.995 deaths worldwide on November 5, 2020. Despite great efforts, there is no treatment of COVID-19 up to nowadays. Therefore, it is essential to search for therapeutic alternatives to COVID-19, such as Integrative Medicine, especially Homeopathy, which was used with excellent results in the great epidemics. AIM: This study aims to describe the coronavirus Pandemic from the perspective of Classical Systemic Homeopathy and to identify the homeopathic medicine (medicines genius) that has its sphere of action in most of the symptoms involved in this pandemic. METHODS: Articles published in indexed journals and websites of medical institutions, books of homeopathic materia medica, scientific journals, and government publications were reviewed. RESULTS: A total of 39 references were selected and enclosed 20 articles indexed on COVID-19, 08 references of systemic conditions, 11 articles indexed of homeopathy, 06 classic homeopathy books. After the study, the homeopathic medicine Cinchona officinalis (China officinalis) was proposed, according to pathogenesis (experimental pathophysiological study in humans) described in the materia medica books consulted, for the relief of symptoms. Its sphere of action in most of the symptoms involved in this pandemic. Moreover, acute homeopathic medicines were determined to act in the relief of symptoms of the various phases of the manifestations of the disease. CONCLUSION: Data contributes to use in homeopathic interventions during the COVID-19 epidemic as a health promotion and treatment strategy that can be used as an adjunct to all sanitary and therapeutic measures recommended by health authorities.

Frequency of physical activity and stress levels among Brazilian adults during social distancing due to the coronavirus (COVID-19): cross-sectional study

ABSTRACT BACKGROUND: The COVID-19 pandemic may be having many psychological impacts on people, at both an individual and a community level. OBJECTIVE: To ascertain the relationship between the weekly frequency of physical activity and levels of stress among Brazilian adults during social distancing due to the coronavirus (COVID-19), and the interaction of sex in this association. DESIGN AND SETTING: Cross-sectional study with a descriptive approach conducted at a public university in Curitiba (PR), Brazil. METHODS: 2,000 Brazilian adults (average age 36.4 years; 59.6% women) were recruited according to convenience through digital media. They filled out a questionnaire in electronic format that asked for sociodemographic information, health data, food consumption data, weekly frequency of physical activity and stress levels on the 10-item Kessler psychological distress scale. Descriptive statistics and regression analyses were used to evaluate the data. RESULTS: Associations were observed for the following correlations: male sex * no physical activity (odds ratio (OR): 4.35; 95% confidence interval (CI): 1.14-16.67); female sex * physical activity 4 or 5 times a week (OR: 7.86; 95% CI: 2.28-27.05); female sex * physical activity 3 times a week (OR: 7.32; 95% CI: 2.09-25.58); female sex * physical activity 1 or 2 times a week (OR: 14.57; 95% CI: 4.28-49.57); and female sex * no physical activity (OR: 24.17; 95% CI: 7.21-80.97). CONCLUSION: The lower the weekly frequency of physical activity during the period of social distancing was, the greater the chances of having stress levels were, especially for women.

Expression of matrix metalloproteinases 2 and 9 in replanted teeth with external root resorption: A cross-sectional study.

OBJECTIVE: To evaluate matrix metalloproteinase (MMP) expression in replanted permanent teeth with external root resorption (ERR). DESIGN: The present cross-sectional study included 42 patients with replanted permanent teeth, presenting with progressive forms of ERR, and referred for extraction according to the rehabilitation treatment plan or due to root fractures. The control group consisted of 12 healthy premolars, from 5 patients with good periodontal health and no radiographic evidence of root resorption, referred for extraction for orthodontic reasons. Root fragments were processed soon after extraction, and the supernatant was collected to measure matrix metalloproteinase 2/tissue inhibitor of metalloproteinase 2 (MMP-2/TIMP-2) and matrix metalloproteinase 9/tissue inhibitor of metalloproteinases 2 (MMP-9/TIMP-2) complexes through a double-ligand enzyme-linked immunosorbent assay (ELISA). RESULTS: Case groups with external inflammatory root resorption (EIRR) or external replacement root resorption (ERRR) showed significantly higher levels of MMP-2/TIMP-2 and MMP-9/TIMP-2 complexes than the control group. Additionally, comparisons between the case groups demonstrated that the MMP-2/TIMP-2 complex also had significantly higher levels in the ERRR group (p < 0.001). CONCLUSIONS: Our results suggest that MMP-2 and MMP-9 participate in the pathobiology of both types of ERR. In addition, the higher levels of MMP-2/TIMP-2 complex in the ERRR group support common modulation mechanisms with physiological bone turnover.

Frequency of physical activity and stress levels among Brazilian adults during social distancing due to the coronavirus (COVID-19): cross-sectional study.

BACKGROUND: The COVID-19 pandemic may be having many psychological impacts on people, at both an individual and a community level. OBJECTIVE: To ascertain the relationship between the weekly frequency of physical activity and levels of stress among Brazilian adults during social distancing due to the coronavirus (COVID-19), and the interaction of sex in this association. DESIGN AND SETTING: Cross-sectional study with a descriptive approach conducted at a public university in Curitiba (PR), Brazil. METHODS: 2,000 Brazilian adults (average age 36.4 years; 59.6% women) were recruited according to convenience through digital media. They filled out a questionnaire in electronic format that asked for sociodemographic information, health data, food consumption data, weekly frequency of physical activity and stress levels on the 10-item Kessler psychological distress scale. Descriptive statistics and regression analyses were used to evaluate the data. RESULTS: Associations were observed for the following correlations: male sex * no physical activity (odds ratio (OR): 4.35; 95% confidence interval (CI): 1.14-16.67); female sex * physical activity 4 or 5 times a week (OR: 7.86; 95% CI: 2.28-27.05); female sex * physical activity 3 times a week (OR: 7.32; 95% CI: 2.09-25.58); female sex * physical activity 1 or 2 times a week (OR: 14.57; 95% CI: 4.28-49.57); and female sex * no physical activity (OR: 24.17; 95% CI: 7.21-80.97). CONCLUSION: The lower the weekly frequency of physical activity during the period of social distancing was, the greater the chances of having stress levels were, especially for women.

Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers.

BACKGROUND: There is growing concern about individuals reported to suffer repeat COVID-19 disease episodes, these in a small number of cases characterised as de novo infections with distinct sequences, indicative of insufficient protective immunity even in the short term. METHODS: Observational case series and case-control studies reporting 33 cases of recurrent, symptomatic, qRT-PCR positive COVID-19. Recurrent disease was defined as symptomatic recurrence after symptom-free clinical recovery, with release from isolation >14 days from the beginning of symptoms confirmed by qRT-PCR. The case control study-design compared this group of patients with a control group of 62 patients randomly selected from the same COVID-19 database. RESULTS: Of 33 recurrent COVID-19 patients, 26 were female and 30 were HCW. Mean time to recurrence was 50.5 days which was associated with being a HCW (OR 36.4 (p <0.0001)), and blood type A (OR 4.8 (p = 0.002)). SARS-CoV-2 antibodies were signifcantly lower in recurrent patients after initial COVID-19  (2.4 ±â€¯0.610; p<0.0001) and after recurrence (6.4 ±â€¯11.34; p = 0.007).  Virus genome sequencing identified reinfection by a different isolate in one patient. CONCLUSIONS: This is the first detailed case series showing COVID-19 recurrence with qRT-PCR positivity. For one individual detection of phylogenetically distinct genomic sequences in the first and second episodes confirmed bona fide renfection, but in most cases the data do not formally distinguish between reinfection and re-emergence of a chronic infection reservoir. These episodes were significantly associated with reduced Ab response during initial disease and argue the need for ongoing vigilance without an assumption of protection after a first episode.

Pulp healing in immature replanted permanent teeth: A competing risk analysis.

BACKGROUND/AIM: Tooth displacement during avulsion causes total rupture of the pulp's neurovascular supply. Revascularization and pulp healing may occur in immature teeth, which gives rise to the recommendation that root canal treatment may not be required. The aim of this study was to evaluate the prognostic factors for the pulp's response after replantation of young permanent teeth. METHODS: Records from 117 patients with 133 replanted permanent immature teeth were reviewed, and pulp outcomes were classified as healing (hard tissue deposition on the dentinal walls followed by narrowing of the pulp lumen or ingrowth of bone-like tissue inside the pulp canal) or non-healing (pulp necrosis with infection). The effect of clinical and demographic co-variates on the hazards of both outcomes was assessed performing a competing risk model. RESULTS: Pulp necrosis with infection was diagnosed in 78.2% of the teeth, and healing was observed in 12.8% of the teeth. A total of 12 teeth (9.0%) were censored due to prophylactic removal of the pulp or severe external root resorption caused by eruption of adjacent canines. The cs-Cox model demonstrated that the hazards of pulp healing increased in teeth with extra-alveolar periods <15 min (csHR: 7.83, 95% CI 1.76-34.80, p = .01), while the hazards of pulp necrosis with infection decreased (csHR: 0.31, 95% CI: 0.10-0.92, p = .04). Teeth replanted with Moorrees' stages 4 and 5 of root development had higher hazards of pulp necrosis with infection than teeth with stage 2 of root development (csHR: 2.23, 95% CI 1.11-4.50, p = .03; csHR: 2.89, 95% CI: 1.40-5.95; p = .01). CONCLUSIONS: Pulp healing rarely occurred after replantation of young permanent teeth being associated with short extra-alveolar periods <15 min. Early stages of root development decreased the hazards of pulp necrosis with infection.

Post-partum depression: a cross-sectional study of women enrolled in a conditional cash transfer program in 30 Brazilian cities.

OBJECTIVE: Investigate factors associated with symptoms of postpartum depression in mothers from families in social vulnerability. METHODS: Information was used from the baseline of a randomized trial to assess a child development program that enrolled 3,242 children < 12 months of age from beneficiary families of the Bolsa Família Program residing in 30 municipalities (counties) in six states of Brazil. The Edinburgh Postnatal Depression Scale (EPDS) was applied to the mothers, and depression was defined as score ≥10. Information on the mother (schooling, age, parity, marital status, skin color, smoking, number of prenatal appointments, and planning of the pregnancy), family (paternal schooling, household crowding, support from the child's father and the family during the pregnancy, and number of children under 7 years living in the household), and infant (sex, gestational age, birthweight, Apgar score, and child's age at the time of the interview) was collected. Prevalence rates for depressive symptoms were calculated with crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI), using hierarchical logistic regression, in a multilevel model. RESULTS: The analysis included 3,174 mothers with information on EPDS. The interviews were conducted on average 7.9 months (standard deviation= 2.9) after childbirth. Overall prevalence of depressive symptoms was 26.5% (25.0-28.1%). In the adjusted analysis, higher parity was associated with higher odds of postpartum depression (p <0.001). Women with ≥3 previous deliveries showed an odds 84% higher of presenting depressive symptoms (OR= 1.84; 1.43-2.35) than primiparae. Higher maternal and paternal schooling, presence of husband or partner, and having received support from the child's father and the family during the pregnancy were protective factors against postpartum depression. CONCLUSION: The study showed high prevalence of postpartum depressive symptoms. Promotion of parental education, alongside with the promotion of support to the woman during pregnancy by the child's father and by the family, as well as family planning leading to birth spacing are measures that may help to prevent postpartum depressive symptoms.