Impact of the COVID-19 pandemic on people with epilepsy: Findings from the Brazilian arm of the COV-E study.

The COVID-19 pandemic has had an unprecedented impact on people and healthcare services. The disruption to chronic illnesses, such as epilepsy, may relate to several factors ranging from direct infection to secondary effects from healthcare reorganization and social distancing measures. OBJECTIVES: As part of the COVID-19 and Epilepsy (COV-E) global study, we ascertained the effects of COVID-19 on people with epilepsy in Brazil, based on their perspectives and those of their caregivers. We also evaluated the impact of COVID-19 on the care delivered to people with epilepsy by healthcare workers. METHODS: We designed separate online surveys for people with epilepsy and their caregivers. A further survey for healthcare workers contained additional assessments of changes to working patterns, productivity, and concerns for those with epilepsy under their care. The Brazilian arm of COV-E initially collected data from May to November 2020 during the country's first wave. We also examined national data to identify the Brazilian states with the highest COVID-19 incidence and related mortality. Lastly, we applied this geographic grouping to our data to explore whether local disease burden played a direct role in difficulties faced by people with epilepsy. RESULTS: Two hundred and forty-one people returned the survey, 20% were individuals with epilepsy (n = 48); 22% were caregivers (n = 53), and 58% were healthcare workers (n = 140). Just under half (43%) of people with epilepsy reported health changes during the pandemic, including worsening seizure control, with specific issues related to stress and impaired mental health. Of respondents prescribed antiseizure medication, 11% reported difficulty taking medication on time due to problems acquiring prescriptions and delayed or canceled medical appointments. Only a small proportion of respondents reported discussing significant epilepsy-related risks in the previous 12 months. Analysis of national COVID-19 data showed a higher disease burden in the states of Sao Paulo and Rio de Janeiro compared to Brazil as a whole. There were, however, no geographic differences observed in survey responses despite variability in the incidence of COVID-19. CONCLUSION: Our findings suggest that Brazilians with epilepsy have been adversely affected by COVID-19 by factors beyond infection or mortality. Mental health issues and the importance of optimal communication are critical during these difficult times. Healthcare services need to find nuanced approaches and learn from shared international experiences to provide optimal care for people with epilepsy as the direct burden of COVID-19 improves in some countries. In contrast, others face resurgent waves of the pandemic.

Thermal Variation During Osteotomy With Different Dental Implant Drills: A Standardized Study in Bovine Ribs.

INTRODUCTION: This study evaluated thermal variation (heat generation) by dental drills of similar geometries, made from different materials, during performance of 450 standardized osteotomies in bovine ribs to simulate implant site preparations. MATERIALS AND METHODS: Each of the 3 groups-steel with a diamond-like carbon coating (SG), experimentally surface-treated steel (EG), and aluminum-toughened zirconium ceramic (ZG)-included 3 drills, distributed across 6 subgroups. An implant motor provided torque, rotation, and irrigation for 50% of subgroups. RESULTS: In preparations drilled to 5 mm under irrigation, the number of osteotomies, material, and diameter did not influence thermal variation (ΔT); when drilling to 13 mm, the greatest ΔT occurred in EG (2.8°C). When drilling to 5 mm without irrigation, drill material influenced mean temperature; when drilling to 13 mm without irrigation, the greatest ΔT (5.5°C) occurred in EG. The highest temperature was observed in SG (79.6°C). CONCLUSION: After 50 uses, the greatest ΔT occurred in EG and the ∅3.0-mm drill exhibited the highest mean and peak temperatures. Temperatures were influenced by irrigation, number of uses, depth, drill diameter, geometry, and material; however, mean values were within physiological limits.

Thermal change in a resin block during motorized and manual implant placement.

STATEMENT OF PROBLEM: Several studies have demonstrated the harmful role of heat generation during implant site drilling in subsequent bone healing. However, heat generation during implant placement should also be carefully considered. PURPOSE: The purpose of this in vitro study was to evaluate thermal change in a resin block during motorized and manual implant placement with and without saline irrigation. MATERIAL AND METHODS: Thermocouple probes were placed in resin blocks to measure the thermal change during forty 3.75x15-mm self-tapping cylindrical screw implant placements as follows: MtI group, 10 motorized implant placements with external saline irrigation; MtNI group, 10 motorized implant placements without irrigation; MI group, 10 manual implant placements with external saline irrigation; MNI group, 10 manual implant placements without irrigation. The temperature values were recorded with a data acquisition system with a 20-channel multiplexer module connected to a personal computer. The normality of data distribution was assessed with the Shapiro-Wilk test and the homogeneity of variances with the Levene test. The mean temperatures of the groups was assessed with the 3-way ANOVA test followed by the Tukey HSD test for normal distribution and the Games-Howell test for non-normal distribution (α=.05). RESULTS: The rate of temperature rise in the resin blocks was 1.1°C to 7.3°C. The highest mean temperature was present in the group for manual implant placement without irrigation (26.2 ±1.1°C), and the lowest thermal change was in the motorized implant placement group with external saline irrigation (23.6 ±1.0°C). CONCLUSIONS: The thermal change in resin blocks during motorized implant placement was lower than manual implant placement, especially with external saline irrigation.

Morphological and ultrastructural changes in fungal agents after LASER application.

BACKGROUND: Onychomycosis is a fungal nail infection of difficult treatment due to the fungal survival capacity and reduced number of effective therapies. The present study aimed to isolate fungal agents that cause onychomycosis in immunocompetent patients and evaluate how LASER treatments affect the growth and ultrastructure of isolates. METHODS: In total, 21 patients with positive direct microscopic examination (DME) for onychomycosis had nail samples collected for cultivation and phenotypic identification of microorganisms. From these patients, 12 underwent LASER treatment, divided in Group 1 (n = 5) treated with Nd: YAG 1,064 nm, and Group 2 (n = 7) treated with Nd: YAG 1,064 nm + Er: YAG 2,940 nm + topical isoconazole. Transmission Electron Microscopy (TEM) was performed to evaluate ultrastructural changes after treatment. RESULTS: DME, cultivation, and phenotypic identification showed that the most identified fungus was Trichophyton rubrum spp. After LASER therapy, sample cultivation showed alterations in the fungal morphology with reduction of hyphae, conidia, and reproductive structures. Alterations in fungal cell wall structure, cytoplasm density, and organelles were observed by TEM. CONCLUSION: LASER irradiation causes changes in the fungal cells, especially in the number of hyphae and the presence of conidia. In addition, it affects fungal growth and reproduction capacity, which interferes with their infection ability and virulence.

Identification of the Radiative Parameters-Albedo and Optical Thickness-Of the Juncus maritimus Fiber.

The present work aims to characterize the radiative thermal properties albedo and optical thickness of Juncus maritimus fibers using a FTIR spectrometer. Measurements of normal/directional transmittance and normal and hemispherical reflectance are performed. The numerical determination of the radiative properties is conducted through the computational treatment of the Radiative Transfer Equation (RTE) using the Discrete Ordinate Method (DOM), together with the inverse method, which is done through Gauss linearization. As it is a non-linear system, iterative calculations are necessary, which demand a significant computational cost, and, to optimize this problem, the Neumann method is used for the numerical determination of the parameters. These radiative properties are useful to quantify the radiative effective conductivity.

COVID-19 in a Portuguese whole blood donor population.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), leading to pneumonia and acute respiratory distress syndrome. The COVID-19 pandemic had a major impact on the stock of blood banks worldwide. This study aims to assess the prevalence of COVID-19 in a population of whole blood donors and analyze the possible association between blood group and susceptibility to the disease and the impact of adopting preventive measures against SARS-CoV-2 infection. Material and methods: This retrospective study included all whole blood donors from a Portuguese hospital between July and September 2021. A self-assessment questionnaire was used to collect data on COVID-19 infection, vaccination, and preventive measures. Statistical analysis was performed using Chi-square and Mann-Whitney U tests. Results: The prevalence of COVID-19 in the donor population was 11.96% (n = 97), with only 2 cases of serious illness requiring hospitalization. No association was found between blood group and disease susceptibility. Older men were less likely to adopt preventive measures. The vaccination rate was high, with 84.26% of donors having received at least one dose of the vaccine. Seven donors declined COVID-19 vaccination. Preventive measures did not differ based on COVID-19 infection status or vaccination. Discussion: Although there was a higher frequency of COVID-19 in group A donors, the blood group was not associated with susceptibility to infection. The donor population consisted of young individuals without comorbidities, showing a COVID-19 prevalence like the general population and few severe cases. The high vaccination rate and adoption of preventive measures likely contributed to these findings.

Post-thaw quality of ram sperm frozen with different concentrations of low-density lipoproteins associated with non-enzymatic antioxidants.

The cryopreservation reduces ram sperm quality, decreasing the pregnancy rate of ewes inseminated with thawed sperm. Hence, we aimed to improve the post-thaw quality of ram sperm replacing egg yolk on Tris-Glucose extender with different concentrations of LDL (2 or 8%), associated with the addition of 10 mM non-enzymatic antioxidants (ascorbic acid, hydroxytoluene butylate, ascorbyl palmitate, and trehalose). Semen samples were collected from six rams, split into different treatments, and frozen. After thawing, kinematic (CASA), structural (propidium iodide and carboxyfluorescein diacetate) and functional (hypoosmotic test) sperm membrane integrity was assessed. Total motility, VCL, and LIN were also assessed in thawed samples during 3 h of incubation (38 °C). The results showed that hydroxytoluene butylate at 10 mM in Tris-Glucose extender with 8% LDL improved velocity parameters immediately post-thaw compared with Tris-Glucose egg yolk extender, as well as prevented the reduction of total motility and VCL after incubation. There was no benefit of adding ascorbic acid and trehalose. Moreover, for the first time, it was shown the motility impairment promoted by ascorbyl palmitate to ram sperm.

A peculiar case of onychomycosis caused by Cladosporium halotolerans.

A 49-year-old patient with changes in the nails of the hallux for 10 years was diagnosed with onychomycosis. The identity of the causative agent was confirmed as Cladosporium halotolerans from the Cladosporium sphaerospermum species complex using molecular techniques. MALDI-TOF identified the agent as C. sphaerospermum complex species. Overall, species such as onychomycosis agents should attract special attention to avoid mistakes in the identification process while considering a probable contaminant as responsible for the disease. These species deserve attention since there are rare descriptions of them as causes of onychomycosis. It is important to recognize them as causes of disease and not just as a probable contaminant.

Rosuvastatin slows the development of diastolic dysfunction in calcific aortic stenosis.

BACKGROUND AND AIM OF THE STUDY: The study aims were to test the effect of rosuvastatin on the progression of left ventricular (LV) diastolic function in patients with aortic stenosis (AS), and to evaluate the use of beta-natriuretic-peptide (BNP) as a marker of diastolic dysfunction in this condition. METHODS: Sixty-one hypercholesterolemic, consecutive new referrals with moderate AS were administered rosuvastatin (Crestor) 20 mg/day for 18 months, while a further 60 subjects with normal cholesterol levels remained untreated. The LV diastolic function was determined using conventional Doppler echocardiography, tissue Doppler imaging (TDI); BNP plasma levels were monitored when subjects entered the study and then assessed prospectively at six-month intervals until the study end. RESULTS: After an 18-month (mean 73 +/- 24 weeks) period of treatment with rosuvastatin (Tx group), patients showed a significantly better diastolic function than untreated subjects (uTx group), as indicated by an isovolumic relaxation time (IVRT) (Tx 102.0 +/- 42.8 versus 97.2 +/- 19.1; p < 0.001; uTx 99.7 +/- 21.7 versus 95.2 +/- 21.8 ms; p = 0.032), E/A ratio (Tx 1.0 +/- 0.6 versus 0.9 +/- 0.3, p = 0.52; uTx 1.2 +/- 0.40 versus 0.9 +/- 0.30 versus, p = 0.006), and E/E' ratio (Tx 11.4 +/- 1.5 versus 11.4 +/- 1.8, p = 0.19; uTx 15.4 +/- 1.2 versus 12.3 +/- 1.5, p < 0.001). Similarly, at study end, plasma levels of BNP were significantly lower in the Tx group than in the uTx group [median (1st-3rd quartiles): 37.0 pg/ml (20.1-65.2 pg/ml) versus 57.1 pg/ml (46.9-98.2 pg/ml); p = 0.017]. CONCLUSION: The results of this prospective follow up study of asymptomatic patients showed that rosuvastatin treatment delays the progression of diastolic dysfunction in moderate AS when assessed using hemodynamic echocardiographic parameters or by the release of plasma physiological markers. Hence, the benefits of statin treatment in AS, which are known to affect the valve endothelium, also extend to changes affecting myocardial function itself.

Valvular lesions in patients with systemic lupus erythematosus and antiphospholipid syndrome: an old disease but a persistent challenge.

Valvular heart disease is common in systemic lupus erythematosus (SLE) and antiphospholipid syndrome. Immunologic insult plays a fundamental role in its pathogenesis but data on the role of antiphospholipid antibodies have been inconsistent, particularly regarding SLE-associated valvular lesions. Although timely diagnosis is essential to prevent progression of valvular lesions, treatment remains a challenge because of the lack of large systematic studies. This article reviews and summarizes recent information relating to valvular damage in these two autoimmune diseases, and highlights some important questions that need to be answered.

Natriuretic peptides in aortic stenosis.

Aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries. Diagnosis, risk stratification and monitoring are usually based on clinical and echocardiographic parameters. Complementary methods are needed to improve management and outcome, particularly in patients with severe asymptomatic AS, whose management remains controversial. Natriuretic peptides (NPs) have established value as biomarkers in heart failure, coronary heart disease and pulmonary hypertension. This review discusses the usefulness and prognostic value of natriuretic peptides in AS. B-type natriuretic peptide (BNP) and its prohormone (NT-proBNP) correlate with disease severity, development of symptoms and prognosis, but before they can be routinely used in clinical practice, additional prospective studies are needed.

Discriminating Aging Cognitive Decline Spectrum Using PET and Magnetic Resonance Image Features.

BACKGROUND: The population aging increased the prevalence of brain diseases, like Alzheimer's disease (AD). Early identification of individuals with higher odds of cognitive decline is essential to maintain quality of life. Imaging evaluation of individuals at risk of cognitive decline includes biomarkers extracted from brain positron emission tomography (PET) and structural magnetic resonance imaging (MRI). OBJECTIVE: We propose investigating ensemble models to classify groups in the aging cognitive decline spectrum by combining features extracted from single imaging modalities and combinations of imaging modalities (FDG+AMY+MRI, and a PET ensemble). METHODS: We group imaging data of 131 individuals into four classes related to the individuals' cognitive assessment in baseline and follow-up: stable cognitive non-impaired; individuals converting to mild cognitive impairment (MCI) syndrome; stable MCI; and Alzheimer's clinical syndrome. We assess the performance of four algorithms using leave-one-out cross-validation: decision tree classifier, random forest (RF), light gradient boosting machine (LGBM), and categorical boosting (CAT). The performance analysis of models is evaluated using balanced accuracy before and after using Shapley Additive exPlanations with recursive feature elimination (SHAP-RFECV) method. RESULTS: Our results show that feature selection with CAT or RF algorithms have the best overall performance in discriminating early cognitive decline spectrum mainly using MRI imaging features. CONCLUSION: Use of CAT or RF algorithms with SHAP-RFECV shows good discrimination of early stages of aging cognitive decline, mainly using MRI image features. Further work is required to analyze the impact of selected brain regions and their correlation with cognitive decline spectrum.

A new model for classification of medical CT images using CNN: a COVID-19 case study.

SARS-CoV-2 is the causative agent of COVID-19 and leaves characteristic impressions on chest Computed Tomography (CT) images in infected patients and this analysis is performed by radiologists through visual reading of lung images, and failures may occur. In this article, we propose a classification model, called Wavelet Convolutional Neural Network (WCNN) that aims to improve the differentiation of images of patients with COVID-19 from images of patients with other lung infections. The WCNN model was based on a Convolutional Neural Network (CNN) and wavelet transform. The model proposes a new input layer added to the neural network, which was called Wave layer. The hyperparameters values were defined by ablation tests. WCNN was applied to chest CT images to images from two internal and one external repositories. For all repositories, the average results of Accuracy (ACC), Sensitivity (Sen) and Specificity (Sp) were calculated. Subsequently, the average results of the repositories were consolidated, and the final values were ACC = 0.9819, Sen = 0.9783 and Sp = 0.98. The WCNN model uses a new Wave input layer, which standardizes the network input, without using data augmentation, resizing and segmentation techniques, maintaining the integrity of the tomographic image analysis. Thus, applications developed based on WCNN have the potential to assist radiologists with a second opinion in the analysis.1.

Effect of hydroxymethylglutaryl coenzyme-a reductase inhibitors on the long-term progression of rheumatic mitral valve disease.

BACKGROUND: At present, no medical therapy is known to affect the progression of rheumatic mitral stenosis (MS). We sought to assess the effect of statin treatment on long-term progression of MS in a large population. METHODS AND RESULTS: From our 20-year database, we identified all patients with rheumatic MS with > or =2 echocardiographies > or =1 year apart. Exclusion criteria were previous intervention on the mitral valve, more than moderate aortic regurgitation, or symptoms at first examination. The study sample included 315 patients (mean age, 61+/-12 years; 224 women); 35 patients (11.1%) were treated with statins, and 280 (88.9%) were not. Mean follow-up period was 6.1+/-4.0 years (range, 1 to 20). The rate of decrease in mitral valve area was significantly lower in the statin group compared with the untreated group (0.027+/-0.056 versus 0.067+/-0.082 cm(2)/y; P=0.005). The annualized change in mean transmitral gradient was lower in statin-treated patients (0.20+/-0.59 versus 0.58+/-0.96 mm Hg/y; P=0.023). The prevalence of fast MS progression (annual change in mitral valve area >0.08 cm(2)) was significantly lower in the statin group (P=0.008). An increase in systolic pulmonary artery pressure of >10 mm Hg was found in 17% of patients in the statin group versus 40% of untreated patients (P=0.045). CONCLUSIONS: Our study shows a significantly slower progression of rheumatic MS in patients treated with statins. These findings could have an important impact in the early medical therapy of patients with rheumatic heart disease.

Analysis of variability and reproducibility of echocardiography measurements in valvular aortic valve stenosis.

BACKGROUND: Doppler echocardiography is the most frequent method for detecting and evaluating the severity of valvular aortic stenosis. The aim of this study was to assess the variability and reproducibility of echocardiographic parameters including aortic valve area (AVA), peak aortic jet velocity (V(max)), velocity ratio (V(LVOT)/V(max)), peak gradient (G(max)) and mean gradient (G(mean)) in aortic stenosis (AS) patients. METHODS: Doppler echocardiograms were obtained from 150 randomly selected patients (56.7% male; mean age 73 +/- 9 years) with asymptomatic moderate aortic valve stenosis. The echocardiographic measurements were performed by two independent level III (expert) blinded observers. To assess intra-observer variability, we evaluated parameters of AS progression at two different times (mean of two weeks after the first examination). RESULTS: For intra-observer variability (observer 1), the variation and reproducibility coefficients were, respectively, 1.88% and 0.16 m/s for V(max), 2.08% and 0.14 for V(LVOT)/V(max) 2.05% and 0.18 cm2 for AVA, 3.89% and 5.18 mmHg for G(max) and 7.87% and 6.30 mmHg for G(mean). For inter-observer variability, the variation and reproducibility coefficients were, respectively, 2.00% and 0.14 m/s for V(max), 2.91% and 0.14 for V(LVOT)/V(max), 7.67% and 0.16 cm2 for AVA, 8.53% and 7.06 mmHg for G(mean) and 3.90% and 5.58 mmHg for G(max). Both intra- and inter-observer studies showed excellent intraclass correlation coefficients (ICC) for all echocardiographic parameters (ICC ranged from 0.943 to 0.990 for intra-observer variability and from 0.955 to 0.992 for interobserver variability). CONCLUSION: Doppler echocardiographic measurements of AVA, V(max), G(max) and G(mean) are highly reproducible when performed by expert observers. Of all echocardiographic parameters, V(max) and V(LVOT)/V(max) showed the best variability and reproducibility, and thus constitute reliable tools for clinical and research purposes in aortic stenosis diagnosis and follow-up.

Explainable Machine Learning for COVID-19 Pneumonia Classification With Texture-Based Features Extraction in Chest Radiography.

Both reverse transcription-PCR (RT-PCR) and chest X-rays are used for the diagnosis of the coronavirus disease-2019 (COVID-19). However, COVID-19 pneumonia does not have a defined set of radiological findings. Our work aims to investigate radiomic features and classification models to differentiate chest X-ray images of COVID-19-based pneumonia and other types of lung patterns. The goal is to provide grounds for understanding the distinctive COVID-19 radiographic texture features using supervised ensemble machine learning methods based on trees through the interpretable Shapley Additive Explanations (SHAP) approach. We use 2,611 COVID-19 chest X-ray images and 2,611 non-COVID-19 chest X-rays. After segmenting the lung in three zones and laterally, a histogram normalization is applied, and radiomic features are extracted. SHAP recursive feature elimination with cross-validation is used to select features. Hyperparameter optimization of XGBoost and Random Forest ensemble tree models is applied using random search. The best classification model was XGBoost, with an accuracy of 0.82 and a sensitivity of 0.82. The explainable model showed the importance of the middle left and superior right lung zones in classifying COVID-19 pneumonia from other lung patterns.

European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease).

Mitral and tricuspid are increasingly prevalent. Doppler echocardiography not only detects the presence of regurgitation but also permits to understand mechanisms of regurgitation, quantification of its severity and repercussions. The present document aims to provide standards for the assessment of mitral and tricuspid regurgitation.

European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease).

Valvular regurgitation represents an important cause of cardiovascular morbidity and mortality. Echocardiography has become the primary non-invasive imaging method for the evaluation of valvular regurgitation. The echocardiographic assessment of valvular regurgitation should integrate quantification of the regurgitation, assessment of the valve anatomy, and function as well as the consequences of valvular disease on cardiac chambers. In clinical practice, the management of patients with valvular regurgitation thus largely integrates the results of echocardiography. It is crucial to provide standards that aim at establishing a baseline list of measurements to be performed when assessing regurgitation.

[Bicuspid aortic valve and aortic disease: past, present and future]. / Válvula aórtica bicúspide e aortopatia: o passado, o presente e o futuro [121].

Bicuspid Aortic Valve is the most common cardiac congenital abnormality occurring in 1% to 2% of the general population. The acquired bicuspid valve has been considered by some authors to be a rheumatic disease consequence. Meanwhile, some recent experimental studies where atrioventricular valves have been studied for the presence of rheumatic stigmata have excluded this hypothesis. There are some theories that can explain the genesis of this disease but actually Bicuspid Aortic Valve is often considered a benign lesion early in life, but its valvular and vascular complications result in considerable morbidity and mortality later in life. Beside beta-blockers, there are some drugs that are being study and may be used in a nearly future for slower disease progression, although the definitive treatment still is the cardiac valve replacement surgery.