Pulmonary inflammation and viral replication define distinct clinical outcomes in fatal cases of COVID-19.

COVID-19 has affected more than half a billion people worldwide, with more than 6.3 million deaths, but the pathophysiological mechanisms involved in lethal cases and the host determinants that determine the different clinical outcomes are still unclear. In this study, we assessed lung autopsies of 47 COVID-19 patients and examined the inflammatory profiles, viral loads, and inflammasome activation. Additionally, we correlated these factors with the patient's clinical and histopathological conditions. Robust inflammasome activation was detected in the lungs of lethal cases of SARS-CoV-2. Experiments conducted on transgenic mice expressing hACE2 and infected with SARS-CoV-2 showed that Nlrp3-/- mice were protected from disease development and lethality compared to Nlrp3+/+ littermate mice, supporting the involvement of this inflammasome in disease exacerbation. An analysis of gene expression allowed for the classification of COVID-19 patients into two different clusters. Cluster 1 died with higher viral loads and exhibited a reduced inflammatory profile than Cluster 2. Illness time, mechanical ventilation time, pulmonary fibrosis, respiratory functions, histopathological status, thrombosis, viral loads, and inflammasome activation significantly differed between the two clusters. Our data demonstrated two distinct profiles in lethal cases of COVID-19, thus indicating that the balance of viral replication and inflammasome-mediated pulmonary inflammation led to different clinical outcomes. We provide important information to understand clinical variations in severe COVID-19, a process that is critical for decisions between immune-mediated or antiviral-mediated therapies for the treatment of critical cases of COVID-19.

Coxiella co-opts the Glutathione Peroxidase 4 to protect the host cell from oxidative stress-induced cell death.

The causative agent of human Q fever, Coxiella burnetii, is highly adapted to infect alveolar macrophages by inhibiting a range of host responses to infection. Despite the clinical and biological importance of this pathogen, the challenges related to genetic manipulation of both C. burnetii and macrophages have limited our knowledge of the mechanisms by which C. burnetii subverts macrophages functions. Here, we used the related bacterium Legionella pneumophila to perform a comprehensive screen of C. burnetii effectors that interfere with innate immune responses and host death using the greater wax moth Galleria mellonella and mouse bone marrow-derived macrophages. We identified MceF (Mitochondrial Coxiella effector protein F), a C. burnetii effector protein that localizes to mitochondria and contributes to host cell survival. MceF was shown to enhance mitochondrial function, delay membrane damage, and decrease mitochondrial ROS production induced by rotenone. Mechanistically, MceF recruits the host antioxidant protein Glutathione Peroxidase 4 (GPX4) to the mitochondria. The protective functions of MceF were absent in primary macrophages lacking GPX4, while overexpression of MceF in human cells protected against oxidative stress-induced cell death. C. burnetii lacking MceF was replication competent in mammalian cells but induced higher mortality in G. mellonella, indicating that MceF modulates the host response to infection. This study reveals an important C. burnetii strategy to subvert macrophage cell death and host immunity and demonstrates that modulation of the host antioxidant system is a viable strategy to promote the success of intracellular bacteria.

H2B.V demarcates divergent strand-switch regions, some tDNA loci, and genome compartments in Trypanosoma cruzi and affects parasite differentiation and host cell invasion.

Histone variants play a crucial role in chromatin structure organization and gene expression. Trypanosomatids have an unusual H2B variant (H2B.V) that is known to dimerize with the variant H2A.Z generating unstable nucleosomes. Previously, we found that H2B.V protein is enriched in tissue-derived trypomastigote (TCT) life forms, a nonreplicative stage of Trypanosoma cruzi, suggesting that this variant may contribute to the differences in chromatin structure and global transcription rates observed among parasite life forms. Here, we performed the first genome-wide profiling of histone localization in T. cruzi using epimastigotes and TCT life forms, and we found that H2B.V was preferentially located at the edges of divergent transcriptional strand switch regions, which encompass putative transcriptional start regions; at some tDNA loci; and between the conserved and disrupted genome compartments, mainly at trans-sialidase, mucin and MASP genes. Remarkably, the chromatin of TCT forms was depleted of H2B.V-enriched peaks in comparison to epimastigote forms. Interactome assays indicated that H2B.V associated specifically with H2A.Z, bromodomain factor 2, nucleolar proteins and a histone chaperone, among others. Parasites expressing reduced H2B.V levels were associated with higher rates of parasite differentiation and mammalian cell infectivity. Taken together, H2B.V demarcates critical genomic regions and associates with regulatory chromatin proteins, suggesting a scenario wherein local chromatin structures associated with parasite differentiation and invasion are regulated during the parasite life cycle.

The Impact of miR-155-5p on Myotube Differentiation: Elucidating Molecular Targets in Skeletal Muscle Disorders.

MicroRNAs are small regulatory molecules that control gene expression. An emerging property of muscle miRNAs is the cooperative regulation of transcriptional and epitranscriptional events controlling muscle phenotype. miR-155 has been related to muscular dystrophy and muscle cell atrophy. However, the function of miR-155 and its molecular targets in muscular dystrophies remain poorly understood. Through in silico and in vitro approaches, we identify distinct transcriptional profiles induced by miR-155-5p in muscle cells. The treated myotubes changed the expression of 359 genes (166 upregulated and 193 downregulated). We reanalyzed muscle transcriptomic data from dystrophin-deficient patients and detected overlap with gene expression patterns in miR-155-treated myotubes. Our analysis indicated that miR-155 regulates a set of transcripts, including Aldh1l, Nek2, Bub1b, Ramp3, Slc16a4, Plce1, Dync1i1, and Nr1h3. Enrichment analysis demonstrates 20 targets involved in metabolism, cell cycle regulation, muscle cell maintenance, and the immune system. Moreover, digital cytometry confirmed a significant increase in M2 macrophages, indicating miR-155's effects on immune response in dystrophic muscles. We highlight a critical miR-155 associated with disease-related pathways in skeletal muscle disorders.

CASP4/11 Contributes to NLRP3 Activation and COVID-19 Exacerbation.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection triggers activation of the NLRP3 inflammasome, which promotes inflammation and aggravates severe COVID-19. Here, we report that SARS-CoV-2 induces upregulation and activation of human caspase-4/CASP4 (mouse caspase-11/CASP11), and this process contributes to NLRP3 activation. In vivo infections performed in transgenic hACE2 humanized mice, deficient or sufficient for Casp11, indicate that hACE2 Casp11-/- mice were protected from disease development, with the increased pulmonary parenchymal area, reduced clinical score of the disease, and reduced mortality. Assessing human samples from fatal cases of COVID-19, we found that CASP4 was expressed in patient lungs and correlated with the expression of inflammasome components and inflammatory mediators, including CASP1, IL1B, IL18, and IL6. Collectively, our data establish that CASP4/11 promotes NLRP3 activation and disease pathology, revealing a possible target for therapeutic interventions for COVID-19.

Quantitative risk assessment of the presence of fumonisin in corn produced in different regions of Brazil: Influence of climatic conditions.

In this study, the probability of occurrence of fumonisins in corn in the states of greatest production in Brazil was determined. The data were analyzed through quantitative risk analysis using the Monte Carlo simulation. The results indicated that there is a strong correlation between fumonisins contamination levels and the geographical region due to the influence of climatic characteristics, with temperature having the main influence. The Southern states presented higher risks of occurrence and concentration levels of fumonisins in corn due to the temperate climate with lower average temperature and higher relative humidity and precipitation indices. Cultivation in the best season indicates a significant reduction in the production of fumonisins when this period was evaluated, with average concentration levels up to 42% lower. The generated data are important for regulatory agencies and the agricultural sector, which needs to be aware that the chance of success in grain production depends on efficient planning of the growing season, mainly concerning the climatic conditions to which it is subject to minimize the risks.

Phytate-phosphorus and phytase on performance, bone characteristics, tissue and serum mineral concentration on broilers.

Male broiler chickens (384), Cobb 500, were housed in metabolic cages to assess the efficacy of phytase in diets with low and high phytate-phosphorus on the performance, bone physical characteristics, tissue and serum mineral deposits. Birds were distributed in four treatments with a 2 x 2 factorial arrangement in a completely randomized block design. Experimental diets based on maize-soybean meal were T1 - diet low phytate-phosphorus; T2 - diet low phytate-phosphorus and phytase (500 FTU/kg); T3 - diet high phytate-phosphorus; T4 - diet high phytate-phosphorus and phytase (500 FTU/kg). Feed intake, body weight, weight gain and feed conversion ratio were assessed. Two left tibias per experimental unit were analyzed for physical characteristics and mineral concentration; a section of skinless breast muscle and blood were collected to measure the concentration of calcium, phosphorus and sodium. Results showed interaction between bone stiffness and serum calcium. The inclusion of phytase in diets with low and high phytate-phosphorus did not alter performance, bone resistance and flexibility, mineral deposits in the tibia and breast muscle, but increased bone stiffness after 22 days of age. It also provided a higher serum calcium rate in broilers fed diets with low phytate-phosphorus up to 32 days of age.

Thirty-six-month follow-up of cervical composite restorations placed with an MDP-free universal adhesive system using different adhesive protocols: a randomized clinical trial.

OBJECTIVES: To evaluate the influence of different application strategies on the clinical behavior of an MDP-free universal adhesive placed in non-carious cervical lesions (NCCLs) over the course of 36 months. MATERIALS AND METHODS: Thirty-one patients participated in this study (N = 31). One hundred twenty-four restorations were assigned to four groups: We used the self-etch strategy on groups with (SE-et) and without (SET) selective enamel etching, and the etch-and-rinse strategy on groups with dry (ER-D) and moist (ER-M) dentin. After applying the MDP-free universal adhesive (Xeno Select universal adhesive, Dentsply Sirona), cavities were filled using EvoluX composite resin (Dentsply Sirona). The restorations were evaluated at baseline and after 36 months according to World Dental Federation (FDI) and US Public Health Service (USPHS) criteria. Friedman's repeated-measures analysis of variance rank (α = 0.05) was used for statistical analysis. RESULTS: We evaluated the 31 patients after 36 months. Forty-two restorations were lost (ER-D = 5, ER-M = 7, SE-et = 14, SET = 16). The 36-month retention/fracture rates (95% confidence interval) were 83.9% for ER-D, 77.4% for ER-M, 54.9% for SE-et, and 48.4% for SET. ER strategy showed better retention rate than SE strategy (p < 0.05). Thirty-four restorations (ER-D = 6, ER-M = 10, SE-et = 10, SET = 8) showed marginal staining per FDI criteria and 15 restorations (ER-D = 1, ER-M = 2, SE-et = 6, SET = 6) showed marginal staining per USPHS criteria. No restorations showed postoperative sensitivity or recurrence of caries. CONCLUSION: The retention rate of Xeno Select universal adhesive was poor, mainly in the self-etch strategy. TRIAL REGISTRATION: REBEC clinical registry under protocol RBR-4wh4sh. CLINICAL RELEVANCE: MDP-free universal adhesive behavior depends on the bonding strategy used.

Treatment with Noripurum EV® is effective and safe in pediatric patients with inflammatory bowel disease and iron deficiency anemia.

OBJECTIVES: To evaluate the therapeutic response and adverse effects of Noripurum EV® in children and adolescents with inflammatory bowel disease (IBD) and iron deficiency anemia. MATERIALS AND METHODS: Cohort study involving patients with Crohn's disease (CD) and ulcerative colitis (UC) who received treatment for iron deficiency anemia with Noripurum EV®. Anemia was defined according to WHO 2011 criteria. Iron deficiency anemia was established when ferritin <30µg/l and transferrin saturation <16%. Iron deficiency anemia and anemia of chronic disease were established when ferritin was between 30 and 100µg/l and transferrin saturation <16%. The total dose of Noripurum EV® was estimated by the Ganzoni formula and divided into weekly administrations. When there was an increase in hemoglobin (Hb) by a minimum of 2g/dl and or when Hb reached the target determined by WHO, treatment was considered a therapeutic success. RESULTS: Noripurum EV® was administered to 16 patients (9.3% of total patients with IBD). Ten (65.5%) were male, the mean (SD) age was 11.3(4.6) years old, 75%(12/16) had CD and 25%(4/16) had UC. All patients presented an increase in Hb (p < .001) at a mean (SD) of 2.8(1.3)g/dl, after median and interquartile range(IQR) of 4.5(3.0-6.0) weeks that iron infusions were completed. It was found that the proportion of patients that achieved therapeutic success (68.8%) was statistically higher (p = .031) than those who did not (31.2%). No adverse events were reported. CONCLUSION: Noripurum EV® in pediatric patients with IBD and iron deficiency anemia was effective and safe, making it an appropriate option for the clinical management of these patients.

Celiac Disease in Brazilian First-degree Relatives: The Odds Are Five Times Greater for HLA DQ2 Homozygous.

First-degree relatives (FDRs) of 47 outpatients with celiac disease (CD) answered a questionnaire about symptoms related to CD and were investigated for human leukocyte antigen (HLA)-DQ2, DQB102 homozygosis, and DQ8 alleles. Genetically susceptible individuals were tested for antitransglutaminase antibody immunoglobulin A. Seropositive FDR underwent small bowel biopsies.From 114 FDR, 74.5% (n = 85) were positive for DQ2, DQ8, or both haplotypes. Homozygosity of DQB102 was found in 11.4% (n = 13) individuals. Three FDR were previously diagnosed with CD. Among the genetically susceptible individuals, 67.1% had at least 1 symptom related to CD. Seropositivity was 8/82 (9.8%), and 4/8 biopsies were compatible with CD. Therefore, the total number of FDR with CD was 6.1% (7/114), 95% confidence interval (1.71, 10.49). Three out of 7 FDR with CD were HLA DQB102 homozygous. The odds of being CD is 5 times, 95% confidence interval (0.99, 26.23), greater for HLA DQ B102 homozygous in FDR.

Selection of indigenous lactic acid bacteria presenting anti-listerial activity, and their role in reducing the maturation period and assuring the safety of traditional Brazilian cheeses.

Artisanal raw milk cheeses are highly appreciated dairy products in Brazil and ensuring their microbiological safety has been a great need. This study reports the isolation and characterization of lactic acid bacteria (LAB) strains with anti-listerial activity, and their effects on Listeria monocytogenes during refrigerated shelf-life of soft Minas cheese and ripening of semi-hard Minas cheese. LAB strains (n = 891) isolated from Minas artisanal cheeses (n = 244) were assessed for anti-listerial activity by deferred antagonism assay at 37 °C and 7 °C. The treatments comprised the production of soft or semi-hard Minas cheeses using raw or pasteurized milk, and including the addition of selected LAB only [Lactobacillus brevis 2-392, Lactobacillus plantarum 1-399 and 4 Enterococcus faecalis (1-37, 2-49, 2-388 and 1-400)], L. monocytogenes only, selected LAB co-inoculated with L. monocytogenes, or without any added cultures. At 37 °C, 48.1% of LAB isolates showed anti-listerial capacity and 77.5% maintained activity at 7 °C. Selected LAB strains presented a bacteriostatic effect on L. monocytogenes in soft cheese. L. monocytogenes was inactivated during the ripening of semi-hard cheeses by the mix of LAB added. Times to attain a 4 log-reduction of L. monocytogenes were 15 and 21 days for semi-hard cheeses produced with raw and pasteurized milk, respectively. LAB with anti-listerial activity isolated from artisanal Minas cheeses can comprise an additional barrier to L. monocytogenes growth during the refrigerated storage of soft cheese and help shorten the ripening period of semi-hard cheeses aged at ambient temperature.

Effect of a dentifrice containing nanohydroxyapatite on the roughness, color, lightness, and brightness of dental enamel subjected to a demineralization challenge.

The dental profession is still pursuing the most effective way to treat white-spot lesions in order to produce a sound and esthetically pleasing enamel surface. The aim of the present research was to evaluate in vitro the effects of a dentifrice with nanohydroxyapatite (nano-HAp) on the roughness, color, lightness, and brightness (gloss) of bovine enamel subjected to pH cycling. Twelve enamel discs prepared from bovine incisors were divided into 2 experimental groups: dentifrice with sodium fluoride (Colgate Total 12 Clean Mint) and dentifrice with nanoHAp (Megasonex). For 14 days, the specimens were subjected to 30 cycles of simulated brushing twice a day as well as to a pH cycling model (6 hours of demineralization and 18 hours of remineralization daily). The roughness, color, lightness, and brightness of all specimens were evaluated at baseline (immediately after specimen preparation) and after 7 and 14 days of treatment. A Tukey test demonstrated that there were no statistically significant differences in the effects of the dentifrices on any parameter after 7 days (P > 0.05). After 14 days, however, there was a statistically significant increase in mean roughness in the group brushed with fluoride dentifrice (P < 0.05). Thus, the nanoHAp containing dentifrice promoted less superficial roughness after 14 days, but both dentifrices were similar in relation to color variation, lightness, and brightness.

An analysis of the influence of sex hormones on Balb/c mice infected with Plasmodium berghei.

Sex steroids can determine several responses in the clinical evolution of malaria. Seventy Balb-c mice were randomly distributed into 7 groups (10 mice per group): G1 to G6 corresponding to castrated females, castrated females that received estradiol cypionate, uncastrated females, castrated males, castrated males that received intramuscular testosterone decanoate and uncastrated males infected with Plasmodium berghei, and G7, the control group. The mice were evaluated with regard to survival, parasitemia, temperature, body weight, hemoglobin level (anemia) and splenic index. Castrated infected females had lower rates of survival. In the castrated male, the administration of testosterone had a negative influence on survival. There was a progressive increase in parasitemia without repercussions for survival. Castration had a significant influence on weight gain in females. Weight loss was observed in all mice, except those in groups G2 and G5, although this bore no direct relation to parasitemia. A significant and progressive decline in temperature and hemoglobin levels occurred in mice over the course of their infection, which differed from the G7 group. The weight of the spleen in relation to total body weight did not differ among the groups of infected mice, but was significantly higher than it was for the control group.

Staphylococcus aureus and the oxacillin sensitivity profile in hospitalized people with HIV/AIDS.

OBJECTIVE: Analyze nasal colonization by oxacillin-sensitive and oxacillin-resistant Staphylococcus aureus in people with HIV/AIDS (PWHA) at days 1 and7 of hospitalization. METHOD: A prospective observational study conducted in a hospital in the countryside of the state of São Paulo. Nasal swab samples were collected and analyzed through microbiological identification, at days 1 and 7 of hospitalization of PWHA, between August 2011 and January 2014. Data were analyzed via IBM SPSS(r), version 20.0. RESULTS: Nasal secretion samples were collected from 187 (50.1%) PWHA at days 1 and 7 of hospitalization. Of these, Staphylococcus aureus was identified in 64 (34.2%) PWHA. CONCLUSION: At day 1 of hospitalization, 27 PWHA were identified with Staphylococcus aureus; 27 PWHA presented colonization by Staphylococcus aureus at days 1 and 7, and 10 PWHA only at day 7. Of 64 PWHA colonized by Staphylococcus aureus, the susceptibility profile of isolated Staphylococcus aureus was oxacillin-resistant in 25 PWHA. OBJETIVO: Analisar a colonização nasal por Staphylococcus aureus sensíveis e resistentes à oxacilina de pessoas vivendo com HIV/aids (PVHA) no primeiro e no sétimo dia de internação hospitalar. MÉTODO: Estudo prospectivo observacional realizado em um hospital do interior paulista. Foram coletadas e analisadas, por meio de identificação microbiológica, amostras de swab nasal no primeiro e no sétimo dia de internação hospitalar de PVHA, no período de agosto/2011 e janeiro/2014. A análise dos dados foi realizada por meio do IBM SPSS(r), versão 20.0. RESULTADOS: Em 187 (50,1%) PVHA foram coletadas amostras de secreção nasal no primeiro e sétimo dia de internação. Destas, em 64 (34,2%) foi identificado Staphylococcus aureus. CONCLUSÃO: No primeiro dia de internação observou-se 27 PVHA colonizadas por Staphylococcus aureus; em 27 PVHA houve a persistência da colonização por Staphylococcus aureus no primeiro e no sétimo dia; em 10 PVHA, somente no sétimo dia. Das 64 PVHA colonizadas por Staphylococcus aureus, em 25 o perfil de suscetibilidade do Staphylococcus aureus isolado foi resistente à oxacilina.

Diagnosis of metabolic syndrome in nursing professionals: An accuracy study.

Metabolic Syndrome (MetS) represents a group of cardiovascular risk factors. This article aims to evaluate the accuracy of the tools of MetS diagnosis in Nursing professionals from Primary Health Care (PHC) in Bahia, Brazil. A cross-sectional study with a random sample selected according to essential health information for the diagnostic of MetS. For MetS diagnostic, we used EGIR, NCEP-ATPIII, AACE, IDF, Barbosa et al. (2006), and IDF/AHA/NHLBI (defined as gold standard) definition. Sensitivity, specificity, predictive values, and likelihood ratio were estimated for each diagnostic tool and compared with the gold standard. Kappa statistic was used to determine the agreement between the diagnostic methods. One thousand one hundred and eleven nursing professionals were included in this study. Sensitivity varied from 15% to 95.1%, and specificity varied between 99.5% and 100%. IDF and Barbosa et al. (2006) definitions were more sensitive (95.1% and 92.8%, respectively), and EGIR, NCEP, ATP III, and IDF showed 100% specificity. IDF and Barbosa et al. (2006) use suitable metabolic syndrome identification and confirmation criteria. The highest agreement was found in the definition of the IDF, Barbosa et al. (2006) and the NCEP ATP III. Defining metabolic syndrome with a higher diagnostic accuracy could contribute to the screening and the early identification of nursing professionals with cardiovascular disease risk factors, which provide opportunities for appropriate prevention and treatment.

Can composite packaging and selective enamel etching affect the clinical behavior of bulk-fill composite resin in posterior restorations? 24-month results of a randomized clinical trial.

OBJECTIVES: This is a double-blind, split-mouth, randomized clinical study that aims to evaluate the influence of bulk-fill composite packaging presented in syringes (BSy) and capsules (BCa), and the effect of selective enamel etching (SEE) on the clinical performance of class I and II bulk-fill resin composite restorations after 24 months. METHODOLOGY: A total of 295 class I or class II restorations were performed on 70 patients. One universal adhesive was applied in all restorations. SEE was used in 148 restorations and self-etching mode (SET) in 147 restorations. After the adhesive application, cavities were restored with Filtek Bulk-fill Posterior Restorative in syringes (BSy), Filtek One Bulk-fill in capsules (BCa), or Filtek Supreme Ultra in syringes with the incremental technique (In). All restorations were evaluated using the FDI criteria after one week and after six, 12, and 24 months. Kaplan-Meier survival analysis and Pearson's Chi-square test were used (α=0.05) for statistical analysis. RESULTS: After 24 months, 62 patients were evaluated and four restorations were lost due to fracture (one for SEEBSy, two for SEEIn, and one for SETIn). No significant differences in the fracture and retention rate were found between groups (p>0.05). SEE showed significantly fewer marginal adaptation defects than SET (p<0.05). BCa and BSy groups showed fewer marginal discrepancies compared to In (p<0.05). Restorations performed with BCa showed less color mismatch than BSy or In (p<0.05). CONCLUSION: Although all restorations exhibited satisfactory clinical performance after 24 months of clinical service, the clinical behavior of class I and II restorations' improved when performed with a bulk-fill composite in capsules, mainly when associated with a universal adhesive applied with SEE.

Alterations in deglutition in children with congenital Zika virus syndrome.

PURPOSE: To characterize swallowing in children with congenital Zika virus syndrome in comparison to typical children. METHODS: This cross-sectional study enrolled 45 children diagnosed with congenital Zika virus syndrome and 45 others with typical development. Swallowing was evaluated through clinical feeding evaluations Protocolo de Avaliação Clínica da Disfagia Pediátrica and using acoustic swallowing parameters (Doppler sonar). RESULTS: The mean age of children with congenital Zika virus syndrome was 26.69 ± 4.46 months and the mean head circumference was 29.20 ± 1.98 cm. Moderate/severe oropharyngeal dysphagia was found in 32(71.1%) of the children with congenital Zika virus syndrome. Significant differences were found between the groups on clinical evaluation: Children with congenital Zika virus syndrome presented insufficient lip closure 42(93.3%) and altered tonus of the tongue 35(77.8%) and cheeks 34(75.6%). In the children in the comparison group, only 6(13.3%) presented insufficient lip closure and 1(2.2%) had inadequate tongue posture. Changes during swallowing with liquid and spoonable food were not observed in the comparison group. When liquid/food was offered, affected children presented difficulties in sipping movements 14(77.8%) and lip/spoon contact 35(75%). The presence of residual food in the oral cavity after swallowing 38(86.4%) and clinical signs indicative of laryngotracheal penetration/aspiration, such as coughing, gagging and/or labored breathing, were also notable. No differences were found between the groups with regard to the acoustic parameters evaluated instrumentally. CONCLUSION: Children with congenital Zika virus syndrome present alterations in the oral phase of swallowing, as well as clinical signs indicative of pharyngeal phase impairment.