Availability of Genetic Tests in Public Health Services in Brazil: Data from the Brazilian Rare Diseases Network.

INTRODUCTION: The Brazilian Policy for Comprehensive Care for People with Rare Diseases (BPCCPRD) was published in 2014, accrediting several reference centers and incorporating many genetic tests for the diagnosis of rare diseases (RDs). The Brazilian Network of Rare Diseases (RARAS) comprises more than 40 institutions that offer diagnosis and treatment for RDs in Brazil. This network includes Reference Services for Rare Diseases (RDRS), Reference Services for Newborn Screening (NSRS), and University Hospitals distributed in all Brazilian regions. OBJECTIVE: The aim of the study was to map the availability and distribution of the BPCCPRD diagnostic procedures in the Brazilian Unified Health System through RARAS. METHOD: Data were collected through a questionnaire on the Research Electronic Data Capture platform, with 22 questions regarding the availability of procedures. Thirty-seven coordinators from RARAS participating centers received the questionnaire link for participation by email from August/2020 to March/2021. All participating institutions ethically approved this project. RESULTS: Of the 37 institutions, 23 (62.16%) offered cytogenetic tests, 20 (54.05%) offered molecular procedures, and 22 (59.46%) offered inborn errors of metabolism diagnostic tests. The Southern blot analysis, enzyme assays on cultured tissue and urinary organic acid tests had the highest outsourcing rate. On the other hand, the procedures most frequently performed on-site were bone marrow karyotype and long-term cultured karyotype. It was observed that 10 of the 37 centers (27%) did not provide access to investigated procedures (on-site or outsourced). The North and Midwest regions stood out in terms of the unavailability of such techniques in at least 40% of the evaluated institutions. DISCUSSION AND CONCLUSION: This study reveals large discrepancies in the supply of diagnostic procedures in the Brazilian territory. Moreover, there is a broad collaboration between services through the outsourcing of multiple diagnostic techniques to address this issue. Finally, this work corroborates the importance of mapping services for the diagnosis and treatment of individuals with RDs to propose actions for the better supply and distribution of these procedures.

Flexural strength, surface roughness, micro-CT analysis, and microbiological adhesion of a 3D-printed temporary crown material.

OBJECTIVE: To evaluate the thermocycling effect of 3D-printed resins on flexural strength, surface roughness, microbiological adhesion, and porosity. MATERIALS AND METHODS: 150 bars (8 × 2 × 2 mm) and 100 blocks (8 × 8 × 2 mm) were made and divided into 5 groups, according to two factors: "material" (AR: acrylic resin, CR: composite resin, BIS: bis-acryl resin, CAD: CAD/CAM resin, and PRINT: 3D-printed resin) and "aging" (non-aged and aged - TC). Half of them were subjected to thermocycling (10,000 cycles). The bars were subjected to mini-flexural strength (σ) test (1 mm/min). All the blocks were subjected to roughness analysis (Ra/Rq/Rz). The non-aged blocks were subjected to porosity analysis (micro-CT; n = 5) and fungal adherence (n = 10). Data were statistically analyzed (one-way ANOVA, two-way ANOVA; Tukey's test, α = 0.05). RESULTS: For σ, "material" and "aging" factors were statistically significant (p < 0.0001). The BIS (118.23 ± 16.26A) presented a higher σ and the PRINT group (49.87 ± 7.55E) had the lowest mean σ. All groups showed a decrease in σ after TC, except for PRINT. The CRTC showed the lowest Weibull modulus. The AR showed higher roughness than BIS. Porosity revealed that the AR (1.369%) and BIS (6.339%) presented the highest porosity, and the CAD (0.002%) had the lowest porosity. Cell adhesion was significantly different between the CR (6.81) and CAD (6.37). CONCLUSION: Thermocycling reduced the flexural strength of most provisional materials, except for 3D-printed resin. However, it did not influence the surface roughness. The CR showed higher microbiological adherence than CAD group. The BIS group reached the highest porosity while the CAD group had the lowest values. CLINICAL RELEVANCE: 3D-printed resins are promising materials for clinical applications because they have good mechanical properties and low fungal adhesion.

Temporomandibular disorders and the use of traditional and laser acupuncture: a systematic review.

OBJECTIVE: To evaluate current studies to establish and compare the efficacy of traditional and laser acupuncture in reducing the signs and symptoms of temporomandibular disorders (TMD). METHODS: PubMed, Cochrane, Scopus, and Web of Science databases were searched. Clinical, controlled, and randomized trials written in English and having used traditional or laser acupuncture as therapy for TMD and RDC/TMD or DC/TMD as a diagnostic criterion for TMD were included. RESULTS: Six studies that evaluated the intensity of pain and the level of mouth opening of the patients submitted to acupuncture were selected, and all showed improvement. However, similar results were also observed in the groups treated with occlusal splint and placebo acupuncture. Only one study evaluated laser acupuncture and showed a higher proportion of patients with remission of symptoms in the experimental group. CONCLUSION: The traditional acupuncture seems to relieve the signs and symptoms of TMD, as well as laser acupuncture when associated with occlusal splint. However, more rigorous and high-quality clinical trials are needed.

Bond strength, degree of conversion, and microorganism adhesion using different bracket-to-enamel bonding protocols.

PURPOSE: This study aimed to evaluate the effect of bonding protocols and the type of orthodontic resin on the adhesion of microorganisms, degree of conversion (DC), and shear bond strength (SBS) of metallic brackets to enamel. METHODS: A total of 60 bovine incisors were prepared and randomly divided into 6 groups (n = 10): "bonding protocol" (A: phosphoric acid; AXT: A+Transbond™ XT primer adhesive [all Transbond™ products from 3M Unitek, Monrovia, CA, USA]; and SE: Transbond™ Plus Self Etching Primer) and "orthodontic resin" (XT: Transbond™ XT adhesive paste and CC: Transbond™ Plus Color Change). After bonding, the samples were subjected to thermocycling (5000 cycles) and to the SBS test. Bond failures were classified according to the adhesive remnant index (ARI). Next, 60 enamel blocks were sterilized in ethylene oxide in order to perform the CFU (Streptococcus mutans) assay in vitro to analyze the colony forming units (CFU/mL). Then, 60 discs of each orthodontic resin were made to measure the DC. The SBS (MPa), CFU/mL, and DC (%) data were statistically analyzed by two-way analysis of variance and Tukey's test (5%) was performed for the DC. RESULTS: CFU and SBS revealed no significance for all factors (P > 0.05). Tukey's test showed that A_XT (acid+Transbond™ XT adhesive paste) presented the highest DC (70.38% ± 10.5), while AXT_XT (acid+Transbond™ XT primer adhesive+Transbond™ XT adhesive paste) showed the lowest (23.47% ± 10.4). An ARI score of 2 was more frequent for the CC resin and an ARI score of 4 for the XT resin. CONCLUSION: The CC resin does not reduce adhesion of S. mutans around orthodontic brackets and the bonding protocol did not influence the SBS, although the SE and A_XT groups contributed to a better DC.

Epidemiology of rare diseases in Brazil: protocol of the Brazilian Rare Diseases Network (RARAS-BRDN).

The Brazilian Policy of Comprehensive Care for People with Rare Diseases (BPCCPRD) was established by the Ministry of Health to reduce morbidity and mortality and improve the quality of life of people with rare diseases (RD). Several laboratory tests, most using molecular genetic technologies, have been incorporated by the Brazilian Public Health System, and 18 specialised centres have so far been established at university hospitals (UH) in the capitals of the Southern, Southeastern and Northeastern regions. However, whether the available human and technological resources in these services are appropriate and sufficient to achieve the goals of care established by the BPCCPRD is unknown. Despite great advances in diagnosis, especially due to new technologies and the recent structuring of clinical assessment of RD in Brazil, epidemiological data are lacking and when available, restricted to specific disorders. This position paper summarises the performance of a nationally representative survey on epidemiology, clinical status, and diagnostic and therapeutic resources employed for individuals with genetic and non-genetic RD in Brazil. The Brazilian Rare Disease Network (BRDN) is under development, comprising 40 institutions, including 18 UH, 17 Rare Diseases Reference Services and five Newborn Screening Reference Services. A retrospective study will be initially conducted, followed by a prospective study. The data collection instrument will use a standard protocol with sociodemographic data and clinical and diagnostic aspects according to international ontology. This great collaborative network is the first initiative of a large epidemiological data collection of RD in Latin America, and the results will increase the knowledge of RD in Brazil and help health managers to improve national public policy on RD in Brazil.

COVID-19 BR: A web portal for COVID-19 information in Brazil.

Brazil is a large developing country that requires attention to regionalized behaviors regarding the dissemination of COVID-19. To deal with this complexity, the COVID-19 Brazil observatory was developed. The Portal aims to monitor and analyze data from different sources. Therefore, with a detailed audit, we centralized this information on the evolution of the disease, allowing for territorial and temporal monitoring. The daily publication of numbers about COVID-19 allowed anyone to follow the current scenario in several Brazilian cities. With about 1,7 million accesses, the Portal offers clarity and an easy understanding of the pandemic data in the country.

Effect of finishing/polishing techniques and aging on topography, C. albicans adherence, and flexural strength of ultra-translucent zirconia: an in situ study.

OBJECTIVE: To investigate the influence of different finishing/polishing techniques and in situ aging on the flexural strength (σ), surface roughness, and Candida albicans adherence of 5 mol% yttria-stabilized zirconia (ultratranslucent zirconia). MATERIALS AND METHODS: A total of 120 zirconia bars (Prettau Anterior, Zirkonzahn) with dimensions of 8 × 2 × 0.5 mm were divided into 8 groups (n = 15) according to two factors: "in situ aging" (non-aged and aged (A)) and "finishing/polishing" (control (C), diamond rubber polishing (R), coarse grit diamond bur abrasion (B), and coarse grit diamond bur abrasion + diamond rubber polishing (BR)). Half of the samples from each group were subjected to a 60-day in situ aging by fixing the bars into cavities prepared in the posterior region of the base of complete or partial dentures of 15 patients. The samples were then subjected to the mini flexural (σ) test (1 mm/min). A total of 40 zirconia blocks (5 × 5 × 2 mm) were prepared and subjected to roughness (Ra) analyses and fungal adherence and complementary analyses (X-ray diffraction (XRD) and scanning electron microscopy (SEM)). The data of mean σ (MPa) and roughness Ra (µm) were statistically analyzed by two-way and one-way ANOVA, respectively, and Tukey's test. The Weibull analysis was performed for σ data. The fungal adhesion (Log CFU/mL) data were analyzed by Kruskal-Wallis tests. RESULTS: For flexural resistance, the "finishing/polishing" factor was statistically significant (P = 0.0001); however, the "in situ aging" factor (P = 0.4458) was not significant. The non-aged (507.3 ± 115.7 MPa) and aged (487.6 ± 118.4 MPa) rubber polishing groups exhibited higher mean σ than the other techniques. The non-aged (260.2 ± 43.3 MPa) and aged (270.1 ± 48.8 MPa) bur abrasion groups presented lower σ. The coarse-grit diamond bur abrasion group (1.82 ± 0.61 µm) presented the highest roughness value (P = 0.001). Cell adhesion was not different among groups (P = 0.053). Group B presented the most irregular surface and the highest roughness Ra of 0.61 m. CONCLUSIONS: The finishing of ultratranslucent zirconia might be preferably done with a diamond rubber polisher. Moreover, the protocols used did not interfere with Candida albicans adhesion. CLINICAL RELEVANCE: Coarse-grit diamond burs might be avoided for finishing ultratranslucent monolithic zirconia, which might be preferably performed with a diamond rubber polisher.

Management of cognitive impairment in bipolar disorder: a systematic review of randomized controlled trials.

Cognitive impairment is common in bipolar disorder and is emerging as a therapeutic target to enhance quality of life and function. A systematic search was conducted on PubMed, PsycInfo, Cochrane, clinicaltrials.gov, and Embase databases for blinded or open-label randomized controlled trials evaluating the pro-cognitive effects of pharmacological, neurostimulation, or psychological interventions for bipolar disorder. Twenty-two trials were identified, evaluating a total of 16 different pro-cognitive interventions. The methodological quality of the identified trials were assessed using the Cochrane Risk of Bias tool. Currently, no intervention (i.e., pharmacologic, neurostimulation, cognitive remediation) has demonstrated robust and independent pro-cognitive effects in adults with bipolar disorder. Findings are preliminary and methodological limitations limit the interpretation of results. Methodological considerations including, but not limited to, the enrichment with populations with pre-treatment cognitive impairment, as well as the inclusion of individuals who are in remission are encouraged. Future trials may also consider targeting interventions to specific cognitive subgroups and the use of biomarkers of cognitive function.

Mapping, Infrastructure, and Data Analysis for the Brazilian Network of Rare Diseases: Protocol for the RARASnet Observational Cohort Study.

BACKGROUND: A rare disease is a medical condition with low prevalence in the general population, but these can collectively affect up to 10% of the population. Thus, rare diseases have a significant impact on the health care system, and health professionals must be familiar with their diagnosis, management, and treatment. OBJECTIVE: This paper aims to provide health indicators regarding the rare diseases in Brazil and to create a network of reference centers with health professionals from different regions of the country. RARASnet proposes to map, analyze, and communicate all the data regarding the infrastructure of the centers and the patients' progress or needs. The focus of the proposed study is to provide all the technical infrastructure and analysis, following the World Health Organization and the Brazilian Ministry of Health guidelines. METHODS: To build this digitized system, we will provide a security framework to assure the privacy and protection of each patient when collecting data. Systems development life cycle methodologies will also be applied to align software development, infrastructure operation, and quality assurance. After data collection of all information designed by the specialists, the computational analysis, modeling, and results will be communicated in scientific research papers and a digital health observatory. RESULTS: The project has several activities, and it is in an initial stage. Initially, a survey was given to all health care centers to understand the technical aspects of each network member, such as the existence of computers, technical support staff, and digitized systems. In this survey, we detected that 59% (23/39) of participating health units have electronic medical records, while 41% (16/39) have paper records. Therefore, we will have different strategies to access the data from each center in the data collection phase. Later, we will standardize and analyze the clinical and epidemiological data and use these data to develop a national network for monitoring rare diseases and a digital health observatory to make the information available. The project had its financing approved in December 2019. Retrospective data collection started in October 2020, and we expect to finish in January 2021. During the third quarter of 2020, we enrolled 40 health institutions from all regions of Brazil. CONCLUSIONS: The nature of rare disease diagnosis is complex and diverse, and many problems will be faced in the evolution of the project. However, decisions based on data analysis are the best option for the improvement of the rare disease network in Brazil. The creation of RARASnet, along with all the digitized infrastructure, can improve the accessibility of information and standardization of rare diseases in the country. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24826.

The acute antisuicidal effects of single-dose intravenous ketamine and intranasal esketamine in individuals with major depression and bipolar disorders: A systematic review and meta-analysis.

The efficacy of ketamine in reducing suicidal ideation (SI) has been previously reported. We aimed to evaluate acute anti-SI effects of single-dose ketamine in different formulations/routes of administration by pooling results from randomized controlled trials (RCTs). A systematic search was conducted on Cochrane, Embase, Medline, and PubMed from inception to July 1st, 2020. Studies were selected based on pre-determined eligibility criteria. Effect sizes of different formulations/routes at various time points were computed using random-effects models. With data from nine eligible RCTs (n = 197), the pooled effect size for anti-SI effects at the 24-h time point was 1.035 (N = 6, CI: 0.793 to 1.277, p < 0.001) for intravenous (IV) racemic ketamine and 1.309 (N = 1, CI: 0.857 to 1.761, p < 0.001) for intranasal (IN) esketamine. An additional five RCTs were available for qualitative analysis. RCTs were identified for oral/sublingual ketamine for depression, however, none of these trials reported anti-SI effects preventing quantitative analysis for these routes of delivery. No RCTs for intramuscular (IM) ketamine were identified. The findings suggest that single-dose IV ketamine/IN esketamine is associated with robust reductions in suicidal thoughts at 2-h, 4-h, and 24-h post-intervention. In addition, future studies on IM/oral/sublingual ketamine and comparative studies are warranted to evaluate the anti-SI efficacy of distinct formulations and routes of administration.

Brazil: the emerging epicenter of COVID-19 pandemic.

INTRODUCTION: Five months after the first confirmed case of COVID-19 in Brazil, the country has the second highest number of cases in the world. Without any scientifically proven drug or vaccine available combined with COVID-19's high transmissivity, slowing down the spread of the infection is a challenge. In an attempt to save the economy, the Brazilian government is slowly beginning to allow non-essential services to reopen for in-person customers. METHODS: In this study, we analyze, based on data analysis and statistics, how other countries evolve and under which conditions they decided to resume normal activity. In addition, due to the heterogeneity of Brazil, we explore Brazilian data of COVID-19 from the State Health Secretaries to evaluate the situation of the pandemic within the states. RESULTS: Results show that while other countries have flattened their curves and present low numbers of active cases, Brazil continues to see an increase in COVID-19 patients. Furthermore, a number of important states are easing restrictions despite a high percentage of confirmed cases. CONCLUSIONS: All analyses show that Brazil is not ready for reopening, and the premature easing of restrictions may increase the number of COVID-19-related deaths and cause the collapse of the public health system.

The effect of intravenous, intranasal, and oral ketamine in mood disorders: A meta-analysis.

BACKGROUND: Ketamine is established as a rapid and effective treatment in adults with treatment-resistant depression (TRD). The availability of different formulations and routes of delivery invites the need for evaluating relative effect sizes. METHODS: Effect size with respect to depression symptom reduction for each formulation and route of delivery was compared at discrete time-points (i.e., 24 h, 2-6 days, 7-20 days, 21-28 days) in adults with TRD. A random-effects meta-analysis was conducted to evaluate the effect size across intravenous, intranasal and oral routes of administration. Analysis was also conducted evaluating the effect size of racemic ketamine to esketamine. RESULTS: The pooled effect size for intranasal ketamine/esketamine at 24 h was g = 1.247 (n = 5, 95% CI: 0.591-1.903, p < 0.01). At 2-6 days, the pooled effect size for intravenous ketamine/esketamine was g = 0.949 (n = 14, 95% CI: -0.308-2.206, p = 0.139). At 7-20 days, intranasal ketamine had a pooled effect size of g = 1.018 (n = 4, 95% CI: 0.499-1.538, p < 0.01). At 21-28 days, oral ketamine had a pooled effect size of g = 0.633 (n = 2, 95% CI: 0.368-0.898, p < 0.01). LIMITATIONS: Additional comparative studies are needed with regards to the efficacy of different formulations and routes of delivery. CONCLUSIONS: The short-term efficacy of intravenous and intranasal ketamine/esketamine for adults with TRD was established. Interpreting the efficacy of oral ketamine was limited by the need for studies with larger samples across independent sites. No conclusions regarding comparative efficacy of the disparate formulations and routes of delivery can be derived from this analysis. Direct comparative studies are needed to further inform treatment options for TRD.

The effectiveness of repeated intravenous ketamine on depressive symptoms, suicidal ideation and functional disability in adults with major depressive disorder and bipolar disorder: Results from the Canadian Rapid Treatment Center of Excellence.

BACKGROUND: The effectiveness, tolerability, and safety of intravenous (IV) ketamine in adults with treatment resistant depression (TRD) receiving care in real-word settings is insufficiently characterized. Herein, results from a naturalistic, retrospective study are presented from a Canadian outpatient IV ketamine clinic. METHODS: Adults (N = 213; Mage = 45) with Major Depressive Disorder or Bipolar Disorder, with a minimum of Stage 2 antidepressant resistance, received IV ketamine at a community-based multi-disciplinary clinic. The primary outcome measure was change from baseline to post-infusion 4 on the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR16; n = 190). Secondary measures included QIDS-SR16-measured response and remission rates, changes from baseline to endpoint in Generalized Anxiety Disorder-7 Scale (GAD-7; n = 188) and the Sheehan Disability Scale (SDS; n = 168). RESULTS: Significant improvement in total depressive symptoms severity (p < 0.0001) was observed after four infusions of IV ketamine 0.5-0.75 mg/kg. Moreover, the response rate (QIDS-SR16 total score change ≥ 50%) was 27% and remission (QIDS-SR16 total score ≤5) rate was 13%. Patients receiving IV ketamine exhibited anxiolytic effects (p < 0.0001,), improved overall psychosocial function (p < 0.0001), and reduced suicidal ideation (p < 0.0001). Compared to the baseline infusion, dissociation severity significantly reduced in subsequent infusions. LIMITATIONS: This was a naturalistic, retrospective study, without a control group. CONCLUSIONS: IV ketamine was safe, well-tolerated, and effective at improving depressive, anxiety, and functional impairment symptoms in a well-characterized cohort of adults with TRD.

Effect of finishing/polishing techniques and low temperature degradation on the surface topography, phase transformation and flexural strength of ultra-translucent ZrO2 ceramic.

OBJECTIVE: To investigate the effect of different surface finishing and polishing regimes and low temperature degradation on flexural strength, phase transformation and surface topography of ultra-translucent ZrO2 ceramic. METHODS: 300 (n=15/group) of conventional zirconia (Z: Ice Zirkon Transluzent) and ultra-translucent zirconia (UT: Prettau Anterior) bar-specimens were made and divided according to the "Finishing/Polishing" - (C - Control, B - diamond rubber polishers, P - adjusting with burs, PB - adjusting with burs+diamond polishers, PG - adjusting with burs+glaze), "Low temperature Degradation (LTD)" (with or without a treatment at 127°C, 1.7bar/24h). Then, a 3-point mini flexural test was performed in a universal testing machine (1mm/min, 500kgf load cell). SEM, EDS, XDR, AFM, optical profilometry and Weibull analysis were performed. Data were analyzed by 3-way ANOVA and Tukey's post-test (5%). RESULTS: Groups ZPBD (1670±253MPa), ZBD (1664±217MPa), and ZB (1655±3678MPa) showed significantly higher flexural strength than the UTPG group (372±56MPa). The Weibull modulus was significantly higher for the ZPD group compared to the UB, UCD, UPD and UPBD, while UTB, UTCD and UTPD had the lowest value. Monoclinic phases were observed only in the conventional zirconia groups and were more evident after LTD. Diamond rubber polishers presented less roughness for both zirconias. SIGNIFICANCE: The use of diamond rubber polishers is the most suitable finishing/polishing method for zirconia ceramic restorations and that final glazing reduces the fracture resistance of these materials.

Effects of 2 Types of Resistance Training Models on Obese Adolescents' Body Composition, Cardiometabolic Risk, and Physical Fitness.

Magnani Branco, BH, Carvalho, IZ, Garcia de Oliveira, H, Fanhani, AP, Machado dos Santos, MC, Pestillo de Oliveira, L, Macente, SB, and Nelson, NJ. Effects of 2 types of resistance training models on obese adolescents' body composition, cardiometabolic risk, and physical fitness. J Strength Cond Res 34(9): 2672-2682, 2020-The main objective of this study was to investigate the effects of 2 types of resistance training (RT) models in conjunction with interdisciplinary interventions by other health professionals to reduce the body fat and cardiometabolic risk of obese adolescents while improving their general health-related physical fitness. The 12-week analyses involved 18 male adolescents who were split into 2 groups (weight lifting: n = 9 and functional: n = 9), with equalization according to the primary muscle group (whenever possible), the effort:pause ratio, and intensity. The results showed reductions in fat mass and body fat, as well as in waist and hip circumferences (p < 0.05) after the intervention period. However, no significant differences were observed in terms of the body mass, body mass index, neck circumference, systolic and diastolic blood pressures, and for lean mass (p > 0.05) after the respective period. Maximal isometric strength, abdominal strength resistance, flexibility, and maximal oxygen consumption all produced significant increases after the interventions (p < 0.05). There were reductions in low-density lipoproteins and triglyceride levels after the intervention period (p < 0.05). For fasting glycemia, high-density lipoproteins, and alanine aminotransferase, no differences were observed (p > 0.05). In addition, no differences were observed in rating of perceived recovery, internal training load, or caloric intake (p > 0.05). With the results presented, it is concluded that both RT methods were effective at reducing both fat mass and body fat, thus improving health-related physical fitness components and decreasing cardiometabolic risk.

Brazil: the emerging epicenter of COVID-19 pandemic

Abstract INTRODUCTION Five months after the first confirmed case of COVID-19 in Brazil, the country has the second highest number of cases in the world. Without any scientifically proven drug or vaccine available combined with COVID-19's high transmissivity, slowing down the spread of the infection is a challenge. In an attempt to save the economy, the Brazilian government is slowly beginning to allow non-essential services to reopen for in-person customers. METHODS: In this study, we analyze, based on data analysis and statistics, how other countries evolve and under which conditions they decided to resume normal activity. In addition, due to the heterogeneity of Brazil, we explore Brazilian data of COVID-19 from the State Health Secretaries to evaluate the situation of the pandemic within the states. RESULTS: Results show that while other countries have flattened their curves and present low numbers of active cases, Brazil continues to see an increase in COVID-19 patients. Furthermore, a number of important states are easing restrictions despite a high percentage of confirmed cases. CONCLUSIONS: All analyses show that Brazil is not ready for reopening, and the premature easing of restrictions may increase the number of COVID-19-related deaths and cause the collapse of the public health system.

Effects of the Order of Physical Exercises on Body Composition, Physical Fitness, and Cardiometabolic Risk in Adolescents Participating in an Interdisciplinary Program Focusing on the Treatment of Obesity.

The main objective of this study was to investigate the effects of the order of physical exercises on body composition, physical fitness, and cardiometabolic risk in adolescents participating in an interdisciplinary program focusing on the treatment of obesity. The final 12-week analyses involved 33 female adolescents who were split into two groups of concurrent training (CT): resistance plus aerobic training and aerobic plus resistance training, with equalization performed in all physical exercises. The only difference between the two groups was the order in which the exercises were performed. The results showed reductions in fat mass, body fat, and waist circumference, as well as increases in musculoskeletal mass and resting metabolic rate (p < 0.05) following the multiprofessional intervention period. However, no significant differences were observed in regard to body mass, body mass index, neck circumference, or arm circumference (p > 0.05). Maximal isometric strength and maximal oxygen consumption showed significant increases after the intervention period (p < 0.05). There were reductions in insulin, HOMA-IR, total cholesterol, triglycerides, and low-density lipoproteins (p < 0.05), and an interaction within the resistance plus aerobic training group showed lower values for triglycerides when compared to itself (p = 0.002). No difference was found in fasting glycemia for either group (p > 0.05). It is worth noting that the equalization training variables presented no differences between the two groups (p > 0.05). Based on these results, both CT methods were found to be effective in promoting health parameters in overweight and obese female adolescents, and triglyceride values decreased more in the resistance plus aerobic group. Future studies with larger samples and feeding control should be conducted to confirm or refute our findings.

Influência de diferentes técnicas de acabamento e polimento na resistência à flexão de zirconia ultratranslucida após envelhecimento in situ / Influence of different finishing and polishing techniques on the flexural strength of ultratranslucent zirconia after in situ aging

Objetivo: Investigar o efeito de técnicas de acabamento/polimento, da espessura e do envelhecimento in situ na resistência à flexão, topografia superficial e adesão celular de uma zircônia ultratranslúcida. Metodologia: Duzentas e quarenta barras de zircônia (UT: Prettau Anterior/Ultratranslúcida, Zirkonzahn, Gais, Itália) foram cortadas, lixadas e sinterizadas, sendo metade (120) nas dimensões finais de 8 x 2 x 1mm e as demais nas dimensões de 8 x 2 x 0,5mm. As barras foram divididas em 16 grupos (n=15) de acordo com três fatores: "envelhecimento in situ" (E: com e sem), "espessura"(1: 1 mm ou 05: 0,5mm) e "Acabamento e Polimento" (C: Controle; B:borrachas DhPro, Paraná Brasil; P: Asperização com pontas diamantadas KG Sorensen 4135; PB: Asperização com pontas diamantadas + Pontas de borrachas ). Para os grupos experimentais submetidos ao envelhecimento in situ, foram selecionados 15 pacientes (comitê de ética - 3.133.187), as amostras foram incluídas nas próteses totais provisórias dos pacientes, que utilizaram as próteses com as barras durante 60 dias. As barras foram submetidas ao ensaio de mini flexão de três pontos (1mm/min, 100 kgf). Duas amostras de cada grupo foram preparadas para as análises topográficas em Microscopia Eletrônica de Varredura (MEV), Difração de raios X (DRX), Microscopia de Força Atômica (AFM) e rugosidade superficial. Para o ensaio de adesão celular, seis blocos de zircônia ultra translúcida (2,5 x 2,5 mm), de cada grupo, foram contaminadas com C. albicans (ATCC 90028) para contagem da unidade formadora de colônia (UFC/mL). Os dados do ensaio de mini flexão (MPa) foram analisados por meio de ANOVA (3 fatores) e Tukey (5%); e os dados do ensaio de adesão celular pelo teste Kruskal Wallis (5%). Resultados: ANOVA (3 fatores) revelou que apenas o fator "Acabamento e Polimento" foi estatisticamente significativo para a resistência à mini flexão (p=0,0001). O desgaste apenas com broca diamantada produziu valores de resistência à mini flexão (variando de 257,1 a 292,9MPa) estatisticamente inferiores em relação aos grupos polidos apenas com discos de borracha (variando de 449,8 a 513,5 MPa), para todas as condições experimentais. No que diz respeito à adesão celular, o teste de Kruskal wallis não revelou diferenças significativas entre os grupos experimentais (p=0,053), apesar da rugosidade ter sido estatisticamente significante por meio do ANOVA (p = 0,001) e diferente entre todos os grupos. Conclusão: O ajuste de peças monolíticas de zircônia ultratranslúcida deve ser realizado idealmente com discos de borracha de poliuretano impregnadas com diamantes. Para a adesão celular, os protocolos de acabamento e polimento não interferem na adesão fúngica, apenas na rugosidade superficial, sendo as amostras polidas com borrachas as de maior lisura (AU).

Introduction: The aim of this study was to investigate the influence of different protocols of finishing and polishing, thickness, and aging in situ on flexural strength and cell adhesion of ultratranslucent zirconia. Methodology: 240 zirconia bars (UT: Prettau Anterior/Ultratranslucent, zirkonzahn, Gais, Italy) were cut, polished and sintered, presenting final dimensions of 1,0 x 2 x 8mm, and 0,5 x 2 x 8mm. The bars were divided among 16 groups (n=15) in accordance to three factors "in situ aging"­ 2 levels (With and Withouth "E"), "thickness" ­ 2 levels (1- 1 mm or 05- 0,5mm) and "Finishing and Polishing" ­ 4 levels (CControl, B- Rubber polishing; P- grinding with burs; PB- grinding with burs + polishing). To the experimental groups submitted to in situ aging, 15 patients were selected (ethics commitee - 3.133.187), the samples were included on the temporary prothesis, and the patients used the prothesis with the bars during 60 days. The bars were submitted to mini flexure three points test (1mm/min, load cell 100 kgf). Two samples of each group were prepared to the topographical analysis on Scanning Electron Microscopy (SEM), X-ray Diffraction (XRD), Atomic Force Microscopy (AFM), and surface roughness. For the cell adhesion assay, six blocks of ultratranslucent zirconia (2.5 x 2.5 mm), of each group were contaminated with the C. albicans (ATCC 90028) for counting the colony forming units (CFU / mL). Results: The mechanical test results were analyzed using ANOVA (3 factors) and Tukey (5%); and the cell adhesion assay data by the Kruskal Wallis test (5%. Results: ANOVA (3 factors) revealed that only the "Finishing and Polishing" factor was statistically significant for mini-flexure strength (p = 0.0001). The finishing and polishing with rubber polishers produced mini-flexure resistance values (varying from 257,1 to 292,9 Mpa) statistically lower in relation to the groups polished only with rubber discs (varying from 449,8 to 513,5 Mpa) to all experimental conditions. Concerning to cell adhesion, Kruskal wallis test did not reveal any significant differences between the experimental groups (p=0,053), despite of the fact that, the surface roughness presented itself statistically significant through ANOVA (p = 0,001) and difference between all groups. Conclusion: The adjustment of ultratranslucent zirconia monolithic should preferably be performed with rubber polishers impregnated with polyurethan. Concerning to cell adhesion, the protocols of finishing and polishing do not interfer at fungal adhesion, only on surface roughness, when the samples are polished with the smoothest rubbers (AU).

Proposal of a normative table for body fat percentages of Brazilian young adults through bioimpedanciometry.

Identification of the body fat (BF) percentage allows health professionals to detect healthy or risky patterns in a population. However, no studies have elaborated BF cutoff points using the bioelectrical impedance method in young Brazilian adults. Thus, the objective of the present study was to elaborate normative tables for BF in Brazilian men and women (sedentary and physically active) between 18 and 39 years of age. A total of 3,111 adults (958 men and 2,153 women) were evaluated using bioimpedance measurements with the InBody 520 device. The data were distributed normally and divided into percentiles (P3, P10, P25, P50, P75, P90, and P97). The following values were observed: for men: P3=8.9%-12.5%; P10=12.6%-17.5%; P25=17.6%-25.3%; P50=25.4%-35.1%; P75=35.2%-43.0%; P90=43.1%-49.4% and P97=49.5%; for women: P3=18.7%-23.1%; P10=23.2%-28.7%; P25=28.8%-35.7%; P50=35.8%-42.9%; P75=43.0%-49.1%; P90=49.2%-52.1% and P97≥52.2%. These percentiles can be used to classify the adiposity of sedentary and physically active individuals evaluated by bioimpedanciometry.

Cuidado no parto e nascimento: percepção de puérperas / Atención en el parto y nacimiento: percepción de puérperas / Care during labor and birth: mothers' perception

Objetivo descrever o cuidado oferecido à mulher durante o trabalho de parto e parto na percepção de puérperas. Métodos pesquisa com abordagem qualitativa, desenvolvida em um hospital da região norte do Estado do Ceará, com 14 puérperas. A análise explorou o conteúdo a luz das boas práticas de atenção ao parto e nascimento, preconizados pela Política Nacional de Humanização. Resultados os discursos das puérperas revelaram a necessidade de tornar o ambiente mais acolhedor e o atendimento humanizado durante o parto, contemplando à escuta dos seus problemas e dúvidas; satisfação com uso de métodos não farmacológicos utilizados para alívio da dor e com os cuidados oferecidos durante o parto. Conclusão revelou-se o quanto o envolvimento humano e a busca por uma atenção qualificada às puérperas nas maternidades têm contribuído significativamente para a qualidade destas ações.

Objetivo describir la atención prestada a la mujer durante el trabajo de parto y parto en la percepción de puérperas. Métodos investigación cualitativa, desarrollada en un hospital en la región norte del Estado de Ceará, con 14 madres. El análisis exploró el contenido a la luz de las mejores prácticas de la atención durante el parto y el nacimiento, recomendado por la Política Nacional de Humanización. Resultados los discursos de las puérperas revelaron la necesidad de hacer el ambiente más acogedor y la atención humanizada del parto, contemplando escucha a sus problemas y preocupaciones; satisfacción con el uso de métodos no farmacológicos utilizados para alivio del dolor y el cuidado dado durante el parto. Conclusión demostró lo mucho que la intervención humana y la búsqueda de una asistencia calificada a las madres en las salas de maternidad han contribuido significativamente a la calidad de estas acciones.

Objective to describe the care provided to women during labor and delivery in their perception. Methods study with qualitative approach, developed in a hospital in the northern region of the state of Ceará, with 14 mothers. The analysis explored the content in the light of good care practices during labor and birth, recommended by the National Humanization Policy. Results the mothers' speeches revealed the need to make the environment more welcoming and the care more humanized during childbirth, contemplating listening to their problems and their concerns; satisfaction with the use of non-pharmacological methods used for pain relief and with the care given during labor. Conclusion it was revealed how much human involvement and the search for a qualified assistance to mothers in maternity wards have contributed significantly to the quality of these actions.