Clinical-Epidemiological Profile of COVID-19 Patients Admitted during Three Waves of the Pandemic in a Tertiary Care Center, in Belém, Pará, Amazon Region of Brazil.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease with a broad clinical spectrum, which may result in hospitalization in healthcare units, intensive care, and progression to death. This study aimed to describe and compare the clinical and epidemiological profile of COVID-19 during the three waves of the disease, in patients admitted to a public hospital in the city of Belém, Pará, in the Amazon region of Brazil. METHODS: This descriptive, observational, and cross-sectional study was population-based on individuals who were hospitalized with a diagnosis of COVID-19, confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR), and who were interviewed and monitored at the public hospital, from February 2020 to April 2022. RESULTS: The prevalence was male patients, older than 60 years. The most frequent symptoms were dyspnea, cough, and fever. Systemic arterial hypertension was the most prevalent comorbidity followed by diabetes mellitus. Less than 15% of patients were vaccinated. The nasal oxygen cannula was the most used oxygen therapy interface followed by the non-rebreathing reservoir mask. Invasive mechanical ventilation predominated and the median time of invasive mechanical ventilation ranged from 2 to 6 days among waves. As for the hospital outcome, transfers prevailed, followed by deaths and discharges. CONCLUSION: The presence of comorbidities, advanced age, and male sex were important factors in the severity and need for hospitalization of these patients, and the implementation of the vaccination policy was an essential factor in reducing the number of hospital admissions.

High Prevalence of Syphilis among Young Pregnant Women in the Brazilian Amazon: A Cross-Sectional Study Based on Clinical Records in a Public Health Reference Unit in the City of Belém.

BACKGROUND: Syphilis remains a significant global public health concern, and one of its consequences in pregnant women is the potential occurrence of congenital syphilis due to Treponema pallidum infection. This study determined the prevalence of syphilis among pregnant women undergoing prenatal care in a neighborhood on the outskirts of the city of Belém, Brazilian Amazon. METHODS: This cross-sectional study used data from clinical records of 611 pregnant women who underwent prenatal care at a public health unit in 2019 and 2020. The reagent result for VDRL was used as an indicator of syphilis. Odds Ratio and chi-square tests were used to evaluate the association of information from pregnant women with syphilis. RESULTS: The overall prevalence of syphilis was 5.2 % (32/611; 95 % CI: 3.5-7.0 %). Age under 23 years was identified as a risk factor for syphilis. CONCLUSIONS: The prevalence of syphilis among pregnant women in the outskirts of Belém is high, especially among younger women. There is an urgent need to intensify innovative sexual and reproductive health education initiatives and emphasize the importance of consistent practice of preventive measures against syphilis and other STIs in the Amazon region, especially in the young population.

Exposure to Treponema pallidum among Female Sex Workers: A Retrospective Study Conducted in the State of Pará, Brazilian Amazon.

BACKGROUND: Syphilis remains a significant global public health issue, and female sex workers (FSWs) are highly vulnerable to the etiological agent of this disease. This study aimed to describe the prevalence of exposure to Treponema pallidum, as well as the vulnerability factors among FSWs in the state of Pará, Brazilian Amazon. METHODS: A cross-sectional, retrospective study involving 360 FSWs from five cities in Pará was conducted from 2005 to 2007. Blood samples were collected for treponemal and non-treponemal testing, and epidemiological information was obtained through interviews. RESULTS: The exposure rate to T. pallidum was 37.7% (136/360), and the majority of FSWs had serological results indicating past exposure (21.1%). Among the FSWs exposed to T. pallidum, most of them were single, aged 23 to 42 years old, had less than 8 years of schooling, and had a family income of between 1 and 3 minimum wages. They reported using condoms during sexual intercourse and had no history of sexually transmitted infection (STI). Furthermore, many of the FSWs exposed to T. pallidum reported having more than 20 sexual partners per month, and had partners from other Brazilian states, but not from other countries. An age over 42 years and a reduced level of education were factors associated with exposure to T. pallidum. Finally, a high rate of exposure to T. pallidum among FSWs in the Brazilian state of Pará (from 2005 to 2007) was detected. In later years, epidemiological studies conducted with FSWs recorded that this rate remained high. Measures to control, treat, and prevent syphilis among FSWs were necessary between 2005 and 2007, and they are still imperative today. Actions related to educational programs and STI control, treatment, and prevention measures contained in Brazilian policies aimed at women's health have not changed the vulnerability scenario of FSWs regarding their exposure to T. pallidum, even after 16 years, and must be reviewed and adapted to the conditions of the Brazilian Amazon.

Long-term oxygen therapy to reduce length of hospital stay in COVID-19.

OBJECTIVE: The aim of this study was to evaluate the efficacy of long-term oxygen therapy as a strategy to reduce hospitalization time in patients affected by COVID-19. METHODS: Between April and December 2021, COVID-19 patients with stable clinical conditions needing supplementary oxygen therapy during hospitalization were oriented to have hospital discharge with long-term oxygen therapy and reassessment after 15 days. RESULTS: A total of 62 patients were evaluated and, 15 days after discharge, 69% of patients had suspended long-term oxygen therapy, with no difference between the groups admitted to the intensive care unit or the ward (p=0.319). Among the individuals who needed to maintain long-term oxygen therapy, in addition to worse P/F ratio (265±57 vs. 345±51; p<0.001) and lower partial pressure of oxygen (55±12 vs. 72±11 mmHg; p<0.001), were those more obese (37±8 vs. 30±6 kg/m2; p=0.032), needed more time for invasive mechanical ventilation (46±27 vs. 20±16 days; p=0.029), had greater persistence of symptoms (p<0.001), and shorter time between the onset of symptoms and the need for hospitalization (7 [2-9] vs. 10 [6-12] days; p=0.039). CONCLUSION: Long-term oxygen therapy is an effective strategy for reducing hospitalization time in COVID-19 patients, regardless of gravity. Additionally, more obese patients with persistence of respiratory symptoms, faster disease evolution, and more days of invasive mechanical ventilation needed to maintain the long-term oxygen therapy longer.

Analysis of Heart Rate Variability in Newborns Dogs with Different Types of Delivery during the First 35 Days of Life.

The present study aimed to evaluate the influence of the autonomic nervous system on cardiovascular function during the first 35 days of life in different types of delivery, using heart rate variability (HRV) indices. Thirty newborns were equally divided into two groups based on delivery type: eutocic delivery (EG) and emergency cesarean section (CG). Electrocardiographic evaluation was performed at birth (T0), 24 h postpartum (T1), and at 7, 14, 21, 28, and 35 days of life (T2 to T6). Physical parameters, neonatal reflexes, and Apgar scores were recorded. Over 35 days, the values of the time domain indices were higher in the GE group and increased with age. In the frequency domain, the low frequency (LF) index was higher in the CG, and the opposite occurred for the high frequency (HF) index. Since the CG presented lower HRV than the EG, it was shown that the type of delivery should be considered for the assessment of autonomic nervous system activity in neonates. Thus, as predictive factors of vitality, HRV and Apgar scores can help in the face of neonatal depression, demonstrating that delivery by emergency cesarean section can predispose newborns to delays in the autonomic influence on the heart.

Long-term oxygen therapy to reduce length of hospital stay in COVID-19

SUMMARY OBJECTIVE: The aim of this study was to evaluate the efficacy of long-term oxygen therapy as a strategy to reduce hospitalization time in patients affected by COVID-19. METHODS: Between April and December 2021, COVID-19 patients with stable clinical conditions needing supplementary oxygen therapy during hospitalization were oriented to have hospital discharge with long-term oxygen therapy and reassessment after 15 days. RESULTS: A total of 62 patients were evaluated and, 15 days after discharge, 69% of patients had suspended long-term oxygen therapy, with no difference between the groups admitted to the intensive care unit or the ward (p=0.319). Among the individuals who needed to maintain long-term oxygen therapy, in addition to worse P/F ratio (265±57 vs. 345±51; p<0.001) and lower partial pressure of oxygen (55±12 vs. 72±11 mmHg; p<0.001), were those more obese (37±8 vs. 30±6 kg/m2; p=0.032), needed more time for invasive mechanical ventilation (46±27 vs. 20±16 days; p=0.029), had greater persistence of symptoms (p<0.001), and shorter time between the onset of symptoms and the need for hospitalization (7 [2-9] vs. 10 [6-12] days; p=0.039). CONCLUSION: Long-term oxygen therapy is an effective strategy for reducing hospitalization time in COVID-19 patients, regardless of gravity. Additionally, more obese patients with persistence of respiratory symptoms, faster disease evolution, and more days of invasive mechanical ventilation needed to maintain the long-term oxygen therapy longer.

Exposure to Treponema pallidum Infection among Adolescent and Young Adult Women in Roraima, Amazon Region of Brazil.

BACKGROUND: Syphilis is a chronic infectious disease, and its prevalence has been described since the 15th century. Because of the high prevalence of this infection in Brazil, this study aimed to evaluate the prevalence of syphilis and its associated factors among adolescent and young women living in the city of Boa Vista, Roraima, Brazil. METHODS: The present study was cross-sectional, descriptive, analytical and quantitative. It involved 200 young and adolescent women. Laboratory tests were performed to diagnose syphilis, and a sociodemographic and epidemiological questionnaire was employed. RESULTS: In the studied sample, 10 women had a positive result for syphilis, characterizing a prevalence of 5% for infection with Treponema pallidum. There was a statistically significant association between a monthly family income of less than 1 minimum wage and syphilis (p = 0.0449) and between illicit drug use and syphilis (p = 0.0234). CONCLUSIONS: These results indicate the need for public health interventions, action plans, and the implementation of risk reduction strategies focused on this population.

Digital Assessment of the Knowledge, Attitudes and Preparedness of Dentists towards Providing Dental Treatment to People Living with HIV in Northern Brazil.

People living with HIV (PLWH) continue to face stigma and discrimination during dental treatment in Brazil. This study aimed to describe the sociodemographic, educational and professional characteristics of dentists working in the Northern Brazilian region and to identify the level of knowledge of these health professionals in relation to the care and management of PLWH using a digital form. METHODS: This cross-sectional study was population-based among dentists and was conducted between July and December 2021. A total of 396 dentists were invited using the "snowball" sampling technique and received an anonymous digital form (Google® Forms platform) composed of four blocks of dichotomous and multiple-choice questions. After signing the informed consent form, dentists were divided into seven groups according to the amount of time that had passed (in years) since they had completed their bachelor's degree in dentistry. A total of 25 questions referring to sociodemographic, educational and professional factors and knowledge about the dental care of PLWH were asked, and all data were presented as descriptive percentages and then analyzed using the Kappa test. RESULTS: The average age was 31.9 years, and the states of Pará and Amazonas presented better knowledge about the dental care of PLWH. Dental prostheses (62/381-16.3%), orthodontics (57/381-15%) and periodontics (56/381-14.7%) were the most cited dental specialties, and demographic, professional and epidemiological characteristics showed a statistically significant difference regarding knowledge (<0.0001). CONCLUSIONS: The knowledge of dentists in Northern Brazil is partially high, although there is some lack of knowledge about the dental care of PLWH.

Efficacy of BREATHOX® Device Inhalation on Acute Symptoms Associated with COVID-19 (BREATH Study): A Randomized Pilot Clinical Trial.

(1) Background: A high concentration of sodium chloride on in vitro cell culture leads to reduced SARS-CoV-2 replication. Therefore, our aim was to evaluate the effects of inhaling hypertonic NaCl particles (BREATHOX®) on the duration of COVID-19-induced acute symptoms. (2) Methods: A prospective, open label, randomized, standard of care-controlled group (SOC) pilot trial compared inhaled oral and nasal administered BREATHOX® (2.0 mg NaCl, particles size between 1-10 µm), with five or ten inhalations per day for ten days. The primary endpoint was the time to resolve COVID-19-related symptoms. Safety outcomes included adverse clinical and laboratory events. (3) Results: A total of 101 individuals were screened and 98 were randomly assigned to BREATHOX® ten sessions per day (Group 1; 33 patients), BREATHOX® five sessions per day (Group 2; 32 patients), or SOC (33 patients), and followed up for 28 days. There was an association with cough frequency after 10 days BREATHOX® compared to SOC [Group 1: hazard ratio (HR) 2.01, 95% confidence interval (CI) 1.06-3.81; Group 2: HR 2.17, 95% CI 1.17-4.04]. No differences between the groups for the reported symptoms' resolution time were seen after 28 days. After combining both BREATHOX® groups, the period to cough resolution 10 days after randomization was significantly lower than in SOC (HR 2.10, 95% CI 1.20-3.67). An adverse event occurred in 30% of Group 1, 36% of Group 2, and 9% in SOC individuals. One patient from SOC had a serious adverse event. Nasal burning, sore or itchy nose, and dry mouth were considered related to BREATHOX® use and resolved after stopping inhalations. (4) Conclusion: BREATHOX® inhalation is safe and may be effective in reducing the duration of COVID-19-induced coughing.

Seroprevalence of Dermatophagoides farinae-specific IgE in dogs with atopic dermatitis in São Paulo, Brazil.

Canine atopic dermatitis (CAD) is a chronic, inflammatory, and pruritic disease of the skin resulting from the loss of the epidermal barrier, sensitization, and exacerbated production of IgE antibodies mainly directed against environmental allergens, especially to house dust mites. To select specific allergen immunotherapies with high efficacy, there are necessary studies with house dust mite allergens to improve both serological and intradermal tests. Therefore, the objective of this study was to evaluate the seroprevalence of IgE against Der f 2, Zen 1, and crude Dermatophagoides farinae allergens in dogs with AD in the State of São Paulo, Brazil. The sera of 85 dogs with clinically confirmed atopic dermatitis from the State of São Paulo (Brazil) was collected. In addition, an indirect ELISA test was conducted to detect allergen-specific serum IgE. IgE seropositivity was observed in 97.5% of the dogs for Der f 2, 95.0% for Zen 1, and 92.5% for the crude mite allergens. Due to this high prevalence of IgE specific to these allergens, we suggest that Der f 2 and Zen 1 can be considered major allergens for dogs in the State of São Paulo.

First study demonstrating speckle tracking echocardiography has prognostic value in patients with idiopathic inflammatory myopathies.

To measure left ventricular (LV) global longitudinal strain (GLS) using speckle tracking echocardiography in idiopathic inflammatory myopathy (IIM) patients and to determine whether the LV GLS predicts outcomes in those patients. Prospective study consisted of a cross-sectional phase with 61 IIM patients and 32 individuals without IIM and longitudinal phase, in which patients were divided into two subgroups: 26 with reduced LV GLS and 35 with normal LV GLS; patients were followed for a mean of 25 months, and the occurrence of cardiovascular events and criteria for IIM activity were compared. The mean LV GLS (18.5 ± 2.9% vs. 21.6 ± 2.5%; p < 0.001) and right ventricle free wall strain (21.9 ± 6.1% vs. 27.5 ± 4.7%; p < 0.001) were lower in patients than in controls. The mean N-terminal pro B-type natriuretic peptide level was higher in patients than in controls. There were no differences regarding other cardiac involvement. Anti-Jo1 antibody was associated with general electrocardiographic abnormality and LV diastolic dysfunction. The subgroup with reduced GLS progressed with higher mean creatine phosphokinase, myositis disease activity assessment visual analogue scales, the physician's and patient's visual analogue scales, the health assessment questionnaire, and a higher proportion of relapses than the subgroup with normal GLS. There was no difference between the subgroups regarding cardiovascular events. The LV GLS appears to be useful for evaluating patients with IIM. Abnormal values are associated with more frequent relapses and increased disease activity during follow-up.

Long-term prevalence follow-up (1967-2022) of HTLV-2 among vulnerable indigenous populations in the Amazon region of Brazil.

Introduction: Human T-lymphotropic virus 2 (HTLV-2) has been described for more than 30 years as an endemic infection in Brazilian indigenous populations, with its occurrence varying by age and sex, maintained mainly by sexual intercourse and mother-to-child transmission, favoring intrafamilial aggregation. Methods: The epidemiological scenario of HTLV-2 infection has been described among communities of the Amazon region of Brazil (ARB), with the number of retrospective positive blood samples increasing for more than 50 years. Results: Five publications were selected that showed the presence of HTLV-2 in 24 of 41 communities; the prevalence of infection was described among 5,429 individuals at five points in time. Among the Kayapó villages, the prevalence rates were described according to age and sex and reached up to 41.2%. Three communities (Asurini, Araweté, and Kaapor) were kept virus free for 27 to 38 years of surveillance. Low, medium and high prevalence levels of infection were defined, and two pockets of high endemicity were shown in the state of Pará, pointing to the Kikretum and Kubenkokrê Kayapó villages as the epicenter of HTLV-2 in the ARB. Discussion: The prevalence rates over the years have shown a decline among the Kayapó (from 37.8 to 18.4%) and an apparent change to a higher prevalence among females, but not during the first decade of life, usually associated with transmission from mother to child. Sociocultural and behavioral aspects, as well as public health policies directed toward sexually transmitted infections, might have positively influenced the decline in HTLV-2 infections.

Association of D-Dimer, C-Reactive Protein, and Ferritin with COVID-19 Severity in Pregnant Women: Important Findings of a Cross-Sectional Study in Northern Brazil.

BACKGROUND: The COVID-19 pandemic has had a great impact on pregnant women due to the broad clinical spectrum of the disease. The present study investigated the profile of three biomarkers during hospital admission of pregnant women-D-dimer, C-reactive protein (CRP), and ferritin-and their correlation with the severity and outcome of COVID-19. METHODS: The cross-sectional study included 226 pregnant women hospitalized in the city of Belém, Pará, Northern Brazil, from April 2020 to July 2021. Epidemiological and laboratory data were obtained from medical records, and all pregnant women underwent RT-PCR molecular testing for the detection of SARS-CoV-2. RESULTS: In total, 121 (53.5%) were positive and 105 (46.5%) were negative for SARS-CoV-2 using RT-PCR. Most pregnant women (49.5%) with COVID-19 were between 26 and 34 years old, were residing in the interior of the state of Pará (51.2%), and were in the third gestational trimester (71.9%). In addition, 71.1% of them were admitted to the ward and 28.9% were admitted to the intensive care unit (ICU), with 90.9% surviving COVID-19. The concentrations of D-dimer (p = 0.0122) and ferritin (p ≤ 0.0001) were significantly higher among pregnant women with COVID-19, especially among those hospitalized in the ICU. CONCLUSION: Ferritin and D-dimer seem to serve as important biomarkers for the prognosis of COVID-19 in pregnant women, which was not observed for CRP.

CBCT Assessment of Gubernacular Canals on Permanent Tooth Eruption in Down's Syndrome.

BACKGROUND: The gubernacular canal (GC) is an important dental structure that enables the alveolar bone ridge cohesion of permanent teeth, although GC absence may indicate a dental eruption that might be associated with certain syndromes such as Down's syndrome. This study aims to correlate the eruptive delay of permanent teeth in individuals with Down's syndrome (Ds) and the gubernacular canal (GC) through cone-beam computed tomography (CBCT). METHODS AND RESULTS: This cross-sectional study was conducted between January and July 2022 with a total of 31 individuals (G1 = 16 nonsyndromic and G2 = 15 Down's syndrome) who went through imaging evaluation using CBCT with the following acquisition parameters: tube voltage of 95 kVp, tube current of 7 mA, exposure time of 5.9 s and voxel sizes and field of view 0.15 mm and 0.30 mm, respectively. The imaging evaluation was to assess whether all teeth analyzed had the presence of GC and/or teeth eruption disturbance, with a descriptive statistical analysis of relative frequencies and quantitative variables as well as the p-value (p < 0.005) by G Test. RESULTS: A total of 618 teeth among 31 individuals were analyzed, 475 (76.8%) GC were detected by CBCT in 23/31 patients and of these, 6 belonged to G2. G2 had a decreased GC detection rate (n = 180-37.9%) and the most common tooth with GC detected was the mandibular 1st molar (21 GC/25 teeth-84%) and the absence of GC was most frequently observed in impacted and delayed/unerupted teeth of Ds individuals. CONCLUSION: We concluded that GC absence was higher among Ds individuals, explaining the increased rates of unerupted or impacted teeth in Ds individuals.

CCR5∆32 and SDF1 3'A: Gene Variants, Expression and Influence on Biological Markers for the Clinical Progression to AIDS among HIV-1 Virus Controllers in a Mixed Population of the Amazon Region of Brazil.

CCR5Δ32 and SDF1-3'A polymorphisms were investigated in a cohort of viremia controllers, without the use of therapy, along with their influence on CD4+ T lymphocytes (TLs), CD8+ TLs, and plasma viral load (VL). The samples were analyzed from 32 HIV-1-infected individuals classified as viremia controllers 1 and 2 and viremia non-controllers, from both sexes, mostly heterosexuals, paired with 300 individuals from a control group. CCR5∆32 polymorphism was identified by PCR amplification of a fragment of 189 bp for the wild-type allele and 157 bp for the allele with the ∆32 deletion. SDF1-3'A polymorphism was identified by PCR, followed by enzymatic digestion (restriction fragment length polymorphism) with the Msp I enzyme. The relative quantification of gene expression was performed by real-time PCR. The distribution of allele and genotype frequencies did not show significant differences between the groups. The gene expression of CCR5 and SDF1 was not different between the profiles of AIDS progression. There was no significant correlation between the progression markers (CD4+ TL/CD8+ TL and VL) and the CCR5∆32 polymorphism carrier status. The 3'A allele variant was associated with a marked loss of CD4+ TLs and a higher plasma VL. Neither CCR5∆32 nor SDF1-3'A was associated with viremia control or the controlling phenotype.

Clinical Evaluation of Bilateral Multiple Gingival Recession Treatment with Autogenous Connective Tissue Graft Associated with Low-Level Laser Therapy.

BACKGROUND: Gingival recession (GR) is described as an apical displacement of the gingival margin in relation to the cementoenamel junction, exposing the root surface to the oral cavity environment. This study aimed to evaluate the clinical results of a bilateral root coverage (RC) of GR associated with an autogenous connective tissue graft (aCTG) alone or combined with low-level laser therapy (aCTG + LLLT). METHODS: This cross-sectional, split-mouth, double-blind, clinical pilot study featured three individuals who attended a periodontics post-graduate program with the main complaint of GR and dental hypersensitivity (DHS). Of these, only one patient met the inclusion criteria and the parameters evaluated were: DHS, the keratinized tissue's thickness and width clinical attachment level (CAL), probing on depth (PD), and bilateral GR based on Cairo RT I. The patient was evaluated by a first clinical evaluator and the treatment was randomly divided into two groups, G1: aCTG only (control group, n = 3 teeth per side) and G2: aCTG + LLLT (test group, n = 3 teeth per side). LLLT used a diode laser (660 nm) with a dose of 3 J/cm2 per point and 4 s per point was applied in four different periods, preoperatively; transoperatively and immediately postoperatively, the application was performed in three points (eight applications) on alternate days for 7 days and a 90-day follow-up was performed for clinical evaluations of the periodontal parameters and the collected data were analyzed by Kruskal-Wallis and Dunn tests. RESULTS: the RC mean percentage was <95% in both groups after 90 days. Comparing treatment sides, G1 (n = 3/3, 100%) had a higher prevalence of RC than G2 had (n = 3/3, 95%). DHS significantly decreased after 90 days in both groups. Both groups showed an improvement in the other periodontal parameters evaluated during the short-term follow-up; mainly, PD had a statistically significant (p ˂ 0.05) increase after 90 days and a CAL decrease during this period; KTW and KTT also had a significant increase in both groups (p ˂ 0.05). CONCLUSIONS: the results indicated that aCTG + LLLT might have an additional benefit to GR root coverage within the evaluated time and this section also includes the within-study limitations.

Digital Form for Assessing Dentistry Undergraduates Regarding Periodontal Disease Associated with Cardiovascular Diseases.

Background: Throughout recent years, periodontal disease (PD) has been linked to innumerable medical systemic conditions, such as cardiovascular disease (CVD). This association could negatively impact oral health, so the knowledge of dentists who have graduated must follow modern dentistry in order to promote oral health, mainly in systemically compromised patients. Therefore, the present study aimed to determine and evaluate the knowledge level of dentistry undergraduate students (DUS) regarding the correct periodontal treatment and management of cardiac patients with PD. Methods: This cross-sectional and populational-based study was conducted between March and June 2022 in northern Brazil. A total of 153 DUS received an anonymous digital form (Google Forms Platform) using a non-probabilistic "snowball" sampling technique. The digital form was composed of four blocks of dichotomous and multiple-choice questions. After signing the informed consent term, DUS were divided into three groups according to their period/semester in dentistry graduation during the study time (G1: 1st period/semester; G2: 5th period/semester and G3: 10th period/semester). A total of 25 questions referring to demographic, educational and knowledge data about the dental and periodontal care of cardiac patients with PD were asked, and all data were presented as descriptive percentages and then analyzed using the Kappa test. Results: From a total of 153 (100%) DUS, the sample was mostly composed of 104 (68%) female participants, with an average age of 21.1 years. Regarding basic knowledge, the majority of answers were no, with G1 being higher than G2 and G3. Regarding clinical questions, 1247 (58.3%) answers were no. Additionally, regarding fundamental clinical questions 1, 2, 3, 7, 9, 11, 13 and 14, the majority of G1, G2 and G3 answered no, demonstrating a major lack of knowledge. Conclusions: In our study, DUS demonstrated a low knowledge level of the dental and periodontal care of cardiac patients with PD and its bi-directional link. Thus, according to our results, an improvement in dentistry educational programs regarding periodontal medicine must be implemented.

Advancing understanding of land-atmosphere interactions by breaking discipline and scale barriers.

Vegetation and atmosphere processes are coupled through a myriad of interactions linking plant transpiration, carbon dioxide assimilation, turbulent transport of moisture, heat and atmospheric constituents, aerosol formation, moist convection, and precipitation. Advances in our understanding are hampered by discipline barriers and challenges in understanding the role of small spatiotemporal scales. In this perspective, we propose to study the atmosphere-ecosystem interaction as a continuum by integrating leaf to regional scales (multiscale) and integrating biochemical and physical processes (multiprocesses). The challenges ahead are (1) How do clouds and canopies affect the transferring and in-canopy penetration of radiation, thereby impacting photosynthesis and biogenic chemical transformations? (2) How is the radiative energy spatially distributed and converted into turbulent fluxes of heat, moisture, carbon, and reactive compounds? (3) How do local (leaf-canopy-clouds, 1 m to kilometers) biochemical and physical processes interact with regional meteorology and atmospheric composition (kilometers to 100 km)? (4) How can we integrate the feedbacks between cloud radiative effects and plant physiology to reduce uncertainties in our climate projections driven by regional warming and enhanced carbon dioxide levels? Our methodology integrates fine-scale explicit simulations with new observational techniques to determine the role of unresolved small-scale spatiotemporal processes in weather and climate models.