HIV, malnutrition, and noncommunicable disease epidemics among tuberculosis-affected households in east and southern Africa: A cross-sectional analysis of the ERASE-TB cohort.

BACKGROUND: As a result of shared social and structural risk factors, people in households affected by tuberculosis may have an increased risk of chronic conditions; at the same time, tuberculosis screening may be an opportunity for interventions. We sought to describe the prevalence of HIV, nutritional disorders, and noncommunicable diseases (NCDs) among members of tuberculosis-affected households in 3 African countries. METHODS AND FINDINGS: A part of a multicountry cohort study, we screened for tuberculosis, HIV, nutritional disorders (underweight, anaemia, overweight/obesity), and NCDs (diabetes, hypertension, and chronic lung disease) among members of tuberculosis-affected households aged ≥10 years in Mozambique, Tanzania, and Zimbabwe. We describe the prevalence of these conditions, their co-occurence within individuals (multimorbidity) and household-level clustering. Of 2,109 household contacts recruited, 92% (n = 1,958, from 786 households) had complete data and were included in the analysis. Sixty-two percent were female, median age was 27 years, and 0.7% (n = 14) were diagnosed with co-prevalent tuberculosis. Six percent of household members (n = 120) had previous tuberculosis, 15% (n = 294) were living with HIV, 10% (n = 194) had chronic lung disease, and 18% (n = 347) were anaemic. Nine percent of adults (n = 127) had diabetes by HbA1c criteria, 32% (n = 439) had hypertension. By body mass index criteria, 18% household members (n = 341) were underweight while 29% (n = 549) were overweight or obese. Almost half the household members (n = 658) had at least 1 modifiable tuberculosis risk factor. Sixty-one percent of adults (n = 822) had at least 1 chronic condition, one in 4 had multimorbidity. While most people with HIV knew their status and were on treatment, people with NCDs were usually undiagnosed and untreated. Limitations of this study include use of point-of-care HbA1c for definition of diabetes and definition of hypertension based on single-day measurements. CONCLUSIONS: Households affected by tuberculosis also face multiple other health challenges. Integrated approaches to tuberculosis screening may represent an opportunity for identification and treatment, including prioritisation of individuals at highest risk for tuberculosis to receive preventive therapy.

Generalized anxiety disorder in Brazilian undergraduate dental students during the COVID-19 pandemic: A cross-sectional study.

OBJECTIVE: Explore the prevalence of generalized anxiety disorder (GAD) and associated factors in undergraduate dental students during the first wave of the COVID-19 pandemic in Brazil. MATERIALS AND METHODS: Cross-sectional study. A semi-structured questionnaire addressing the variables of interest was shared with dental students between July 8 and 27 2020. The outcome was determined using the seven-item generalized anxiety disorder (GAD-7) scale. A 'positive' diagnosis was defined as a total of ≥10 points on the scale. Statistical analysis involved descriptive, bivariate and multivariate analyses, with the significance level set at 5%. RESULTS: Among the 1050 students evaluated, 53.8% had a positive diagnosis for GAD. The multivariate analysis revealed that the prevalence of symptoms was higher among individuals who resided with more than three people, those enrolled at teaching institutions that suspended all clinical and laboratory activities, those who did not have an adequate home situation to maintain distance learning, those who had been diagnosed with COVID-19, those who felt anxious about having to see patients with a suspicion or diagnosis of COVID-19 and those who preferred to interrupt in-person academic activities until the population is vaccinated for the COVID-19 virus. CONCLUSION: The prevalence of GAD was high. Aspects related to the composition and organization of the home, the suspension of academic activities, a history of COVID-19 contamination, feelings of anxiety in providing dental care to patients with symptoms/suspected of COVID-19 infection and the preference to interrupt in-person academic activities until the population is vaccinated for COVID-19 were factors predisposing the students to anxiety during the first wave of the pandemic.

The Efficacy of Fosfomycin as Antibiotic Prophylaxis for Transrectal Prostate Biopsy and Impact on Lower Urinary Tract Symptom After Biopsy: A Prospective Study.

OBJECTIVE: Due to fluoroquinolone resistances worldwide, valid alternatives for anti- biotic prophylaxis for transrectal ultrasound-guided prostate biopsy are needed, thus, we aimed to evaluate the efficacy, safety, and tolerability of prophylactic fosfomycin versus other oral prolonged antibiotic regimens, in preventing complications after transrectal ultrasound-guided prostate biopsy. METHODS: In this prospective study, patients submitted to transrectal ultrasound- guided prostate biopsy were divided into 2 groups according to the prophylactic antibiotic scheme performed: "short" (2 fosfomycin doses) versus "long" (antibiotic ≥ 8 days). One week and 1 month after transrectal ultrasound-guided prostate biopsy, we assessed complications' occurrence (lower urinary tract symptoms, fever, sepsis, hemorrhage) and adverse drug reactions. RESULTS: We included 244 patients (fosfomycin n=178, "long" antibiotic n=66). The only significant difference between groups was higher lower urinary tract symptom incidence 1 month after transrectal ultrasound-guided prostate biopsy in fosfomy- cin patients (16.85% vs. 6.06%, P=.031). However, after 1 week, lower urinary tract symptoms were tendentially frequenter on "long" antibiotic group (31.81% vs. 25.84%, P = .059). Infectious and hemorrhagic complications rate, adverse drug reactions, and recurrence to health services were similar between groups, and significantly decreased between the first week and first month. CONCLUSION: Antibiotic prophylaxis seems to impact lower urinary tract symptoms after transrectal ultrasound-guided prostate biopsy. Fosfomycin may provide slightly better outcome on the immediate period, while "long" antibiotic courses lead to significantly less lower urinary tract symptoms 1 month post-transrectal ultrasound-guided pros- tate biopsy, perhaps by preventing incipient prostatitis phenomena. Future directed studies should clarify these findings. Still, it seems feasible to ally fosfomycin advan- tages with noninferior safety, efficacy, and tolerability, allowing to reserve "long" regimens to other contexts. This is especially relevant in centers where transperineal biopsies are still not possible.

Long-term impacts of an urban sanitation intervention on enteric pathogens in children in Maputo city, Mozambique: study protocol for a cross-sectional follow-up to the Maputo Sanitation (MapSan) trial 5 years postintervention.

INTRODUCTION: We previously assessed the effect of an onsite sanitation intervention in informal neighbourhoods of urban Maputo, Mozambique on enteric pathogen detection in children after 2 years of follow-up (Maputo Sanitation (MapSan) trial, ClinicalTrials.gov: NCT02362932). We found significant reductions in Shigella and Trichuris prevalence but only among children born after the intervention was delivered. In this study, we assess the health impacts of the sanitation intervention after 5 years among children born into study households postintervention. METHODS AND ANALYSIS: We are conducting a cross-sectional household study of enteric pathogen detection in child stool and the environment at compounds (household clusters sharing sanitation and outdoor living space) that received the pour-flush toilet and septic tank intervention at least 5 years prior or meet the original criteria for trial control sites. We are enrolling at least 400 children (ages 29 days to 60 months) in each treatment arm. Our primary outcome is the prevalence of 22 bacterial, protozoan, and soil transmitted helminth enteric pathogens in child stool using the pooled prevalence ratio across the outcome set to assess the overall intervention effect. Secondary outcomes include the individual pathogen detection prevalence and gene copy density of 27 enteric pathogens (including viruses); mean height-for-age, weight-for-age, and weight-for-height z-scores; prevalence of stunting, underweight, and wasting; and the 7-day period prevalence of caregiver-reported diarrhoea. All analyses are adjusted for prespecified covariates and examined for effect measure modification by age. Environmental samples from study households and the public domain are assessed for pathogens and faecal indicators to explore environmental exposures and monitor disease transmission. ETHICS AND DISSEMINATION: Study protocols have been reviewed and approved by human subjects review boards at the Ministry of Health, Republic of Mozambique and the University of North Carolina at Chapel Hill. Deidentified study data will be deposited at https://osf.io/e7pvk/. TRIAL REGISTRATION NUMBER: ISRCTN86084138.

Vineyard Pruning Extracts as Natural Antioxidants for Biodiesel Stability: Experimental Tests and Preliminary Life Cycle Assessment.

The control of the oxidative stability of biodiesel and blends of biodiesel with diesel is one of the major concerns of the biofuel industry. The oxidative degradation of biodiesel can be accelerated by several factors, and this is most critical in the so-called second generation biodiesel, which is produced from low-cost raw materials with lower environmental impacts. The addition of antioxidants is imperative to ensure the oxidative stability of biodiesel, and these are considered products of high commercial value. The antioxidants currently available on the market are from synthetic origin, so the existence/availability of alternative antioxidants of natural origin (less dependent on fossil sources) at a competitive price presents itself as a strong business opportunity. This work describes and characterizes a sustainable alternative to synthetic antioxidants used in the biodiesel market developed from extracts of vineyard pruning waste (VPW), which are naturally rich in phenolic compounds with antioxidant properties. A hydrothermal extraction process was applied as a more efficient and sustainable technology than the conventional one with the potential of the extracts as antioxidant additives in biodiesel evaluated in Rancitech equipment. The VPW extract showed comparable antioxidant activity as the commercial antioxidant butylated hydroxytoluene (BHT) typically used in biodiesel. The stability of the biodiesel is dependent from the amount of the extract added. Further, for the first time, the assessment of the environmental impacts of using natural extracts to control the oxidative stability of biodiesel in the production process is also discussed as a key factor of the process environmental sustainability.

Long-term impacts of an urban sanitation intervention on enteric pathogens in children in Maputo city, Mozambique: study protocol for a cross-sectional follow-up to the Maputo Sanitation (MapSan) trial 5 years postintervention

Introduction We previously assessed the effect of an onsite sanitation intervention in informal neighbourhoods of urban Maputo, Mozambique on enteric pathogen detection in children after 2 years of follow-up (Maputo Sanitation (MapSan) trial, ClinicalTrials.gov: NCT02362932). We found significant reductions in Shigella and Trichuris prevalence but only among children born after the intervention was delivered. In this study, we assess the health impacts of the sanitation intervention after 5 years among children born into study households postintervention. Methods and analysis We are conducting a crosssectional household study of enteric pathogen detection in child stool and the environment at compounds (household clusters sharing sanitation and outdoor living space) that received the pour-flush toilet and septic tank intervention at least 5 years prior or meet the original criteria for trial control sites. We are enrolling at least 400 children (ages 29 days to 60 months) in each treatment arm. Our primary outcome is the prevalence of 22 bacterial, protozoan, and soil transmitted helminth enteric pathogens in child stool using the pooled prevalence ratio across the outcome set to assess the overall intervention effect. Secondary outcomes include the individual pathogen detection prevalence and gene copy density of 27 enteric pathogens (including viruses); mean height-for-age, weight-for-age, and weight-for-height z-scores; prevalence of stunting, underweight, and wasting; and the 7-day period prevalence of caregiver-reported diarrhoea. All analyses are adjusted for prespecified covariates and examined for effect measure modification by age. Environmental samples from study households and the public domain are assessed for pathogens and faecal indicators to explore environmental exposures and monitor disease transmission.

Occurrence of Multidrug-Resistant Bacteria Resulting from the Selective Pressure of Antibiotics: A Comprehensive Analysis of ESBL K. pneumoniae and MRSP Isolated in a Dog with Rhinorrhea.

Because of public health concerns, much greater scrutiny is now placed on antibiotic use in pets, especially for antimicrobial agents that have human analogs. Therefore, this study aimed to characterize the phenotypic and genotypic profiles of multidrug-resistant bacteria isolated from nasal swabs samples taken from a one-year-old male Serra da Estrela dog with rhinorrhea that was treated with amikacin. An extended-spectrum ß-lactamases (ESBL) Klebsiella pneumoniae was isolated in the first sample taken from the left nasal cavity of the dog. Seven days later, methicillin-resistant (MRSP) Staphylococcus pseudintermedius was also isolated. Nevertheless, no alterations to the therapeutic protocol were performed. Once the inhibitory action of the antibiotic disappeared, the competitive advantage of the amikacin-resistant MRSP was lost, and only commensal flora was observed on both nasal cavities. The genotypic profile of extended-spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae revealed the same characteristics and close relation to other strains, mainly from Estonia, Slovakia and Romania. Regarding MRSP isolates, although resistance to aminoglycosides was present in the first MRSP, the second isolate carried aac(6')-aph(2″), which enhanced its resistance to amikacin. However, the veterinary action was focused on the treatment of the primary agent (ESBL K. pneumoniae), and the antibiotic applied was according to its phenotypic profile, which may have led to the resolution of the infectious process. Therefore, this study highlights the importance of targeted therapy, proper clinical practice and laboratory-hospital communication to safeguard animal, human and environmental health.

Ultra-processed food consumption and dental caries in adolescents from the 2004 Pelotas Birth Cohort study.

OBJECTIVE: To investigate the relationship between ultra-processed food (UPF) consumption and dental caries in adolescents. METHODS: Data from 996 adolescents aged 12-13 years who participated in an oral health sub-study of the 2004 Pelotas Birth Cohort in southern Brazil were analysed. The main exposure was daily UPF consumption at age 10-11 years, measured by a food frequency questionnaire containing 24 UPF items defined based on the NOVA system. UPF consumption was calculated in frequency, grams and calories, in general and for six types of food (biscuits, savoury snacks and sugar-sweetened cereals; ultra-processed meats and fats; sweets; fast food and instant noodles; soft drinks and artificially flavoured drinks; and sweetened milk and powdered chocolate). The outcome was dental caries, measured according to the decayed, missing and filled indexes (DMFS and dmfs) at age 12-13 years. Poisson regression models were used to analyse the association between UPF consumption and dental caries, adjusting for socioeconomic and demographic variables, dental visits and oral hygiene. RESULTS: Overall, the daily UPF consumption in frequency, grams and calories was associated with caries. The findings were consistent for UPF consumption for all six food groups. The higher the UPF consumption, the higher the probability of having caries in adolescence. The associations between ultra-processed meats and fats, and fast food and instant noodles intake with dental caries alert to the cariogenic potential of such UPF foods. CONCLUSION: Ultra-processed food consumption was associated with greater caries burdens in young adolescents. The findings reinforce the need for interventions and public policies to reduce UPF consumption in adolescence.

Enhanced neuronal differentiation by dynamic piezoelectric stimulation.

Electroactive smart materials play an important role for tissue regenerative applications. Poly(vinylidene fluoride) (PVDF) is a specific subtype of piezoelectric electroactive material that generates electrical potential upon mechanical stimulation. This work focuses on the application of piezoelectric PVDF films for neural differentiation. Human neural precursor cells (hNPCs) are cultured on piezoelectric poled and non-poled ß-PVDF films with or without a pre-coating step of poly-d-lysine and laminin (PDL/L). Subsequently, hNPCs differentiation into the neuronal lineage is assessed (MAP2+ and DCX+ ) under static or dynamic (piezoelectric stimulation) culture conditions. The results demonstrate that poled and coated ß-PVDF films induce neuronal differentiation under static culture conditions which is further enhanced with mechanical stimulation. In silico calculations of the electrostatic potential of different domains of laminin, highlight the high polarity of those domains, which shows a clear preference to interact with the varying surface electric field of the piezoelectric material under mechanical stimulation. These interactions might explain the higher neuronal differentiation induced by poled ß-PVDF films pre-coated with PDL/L under dynamic conditions. Our results suggest that electromechanical stimuli, such as the ones induced by piezoelectric ß-PVDF films, are suitable to promote neuronal differentiation and hold great promise for the development of neuroregenerative therapies.

COVID-19 pandemic and impact on dental education: perception of Brazilian dental students

Aim: The aim of the present study is to assess the perception of undergraduate students on the impact of the COVID-19 pandemic on Brazilian dental education. Methods: This crosssectional study was conducted using an online questionnaire hosted in Google Forms platform and publicized on Instagram® and Facebook®. The questionnaire was available between July 8-27, 2020. Absolute and relative frequencies were obtained for variables of interest using Pearson's chi-squared and considering 95% confidence intervals. Prevalence of learning resource variables according to self-reported skin color, educational institution, and Brazilian region were presented using equiplots. Results: A total of 1,050 undergraduate dental students answered the questionnaire. Most students reported being in full-distance learning mode. Among the undergraduate students, 65.4% reported perceiving a very high impact in dental education, and 16.6% of students reported not being able to follow distance learning. In addition, 14% reported not having a personal laptop or desktop to study with, with this condition being more prevalent among non-white than white individuals. Conclusion: We conclude that Brazilian dental students perceived a high impact of COVID-19 on dental education, as well as one-sixth of the students reported not having adequate resources to continue with distance learning. It is important that different policies are developed at the institutional and governmental levels to reduce the impact of the pandemic on dental education

Ultra-processed food consumption and dental caries in children and adolescents: a systematic review and meta-analysis.

This study summarised the association between ultra-processed food (UPF) consumption and dental caries in children and adolescents through a systematic review and meta-analysis. The search of PubMed, Cochrane, Web of Science and Scopus databases using the 'PECOS' strategy retrieved 1462 eligible articles. Only studies with humans aged ≤ 19 years; that assessed groups of any UPF or specific UPF items; that measured dental caries as the decayed, filled and missing surfaces or teeth indexes, based on the WHO criteria; cross-sectional, case-control, cohort and all types of interventions that examined the adjusted association between UPF consumption and dental caries were included. All studies received qualitative evaluation. Meta-analysis using random-effects models combined multivariable-adjusted OR for case-control and cross-sectional studies and risk ratio (RR) for longitudinal studies of the highest v. lowest category of UPF consumption. Forty-two studies were included in the qualitative synthesis and twenty-seven in the meta-analysis. The pooled RR was 1·71 (95 % CI 1·31, 2·24), and the pooled OR was 1·55 (95 % CI 1·37, 1·75). The highest OR was found among participants who had dental caries prevalence >70 % (OR = 3·67, 95 % CI 2·16, 6·23). Better evidence quality was found among cohort studies that evaluated children <6 years old. The findings suggest that higher UPF consumption is associated with greater dental caries in children and adolescents. Public health efforts to reduce UPF consumption are needed to improve the oral health of children and adolescents.

Factors associated with the reduction of dental care in Primary Health Care in Brazil after the emergence of COVID-19: a cross-sectional study, 2020. / Fatores associados à redução de atendimentos odontológicos na Atenção Primária à Saúde no Brasil, com o surgimento da COVID-19: estudo transversal, 2020.

OBJECTIVE: To analyze factors associated with the reduction of dental care in Primary Health Care, during the COVID-19 pandemic in Brazil. METHODS: This was a cross-sectional study conducted with dentists in primary healthcare centers (PHCCs). The reduction of dental care was the outcome, and the exposure variables were sociodemographic data, availability of personal protective equipment (PPE) and measures adopted by PHCCs during the pandemic. Poisson regression was performed to determine the prevalence ratio and 95% confidence interval (95%CI). RESULTS: Of the total of 958 participants, 62.6% reported a reduction of over 50% in dental visits after the beginning of the pandemic. Adoption of biosafety protocols (PR = 1.04; 95%CI 1.01;1.07), availability of PPE recommended by new protocols (PR = 0.94; 95%CI 0.89;0.99) and adoption of tele-screening (PR = 0.90; 95%CI 0.85;0.96) were associated with the reduction. CONCLUSION: The availability of new types of PPE and implementation of tele-screening in PHCCs seem to have minimized the reduction of dental care after the beginning of the pandemic.

Factors associated with the reduction of dental care appointments in Primary Health Care in Brazil with the emergence of COVID-19: cross-sectional study, 2020 / Factores asociados a la reducción de la atención odontológica en Atención Primaria de Salud en Brasil con la aparición de COVID-19: estudio transversal, 2020 / Fatores associados à redução de atendimentos odontológicos na Atenção Primária à Saúde no Brasil, com o surgimento da COVID-19: estudo transversal, 2020

Objective: To analyze the associated factors of reductions for dental visits performed in Primary Health Care (PHC) in Brazil during COVID-19 pandemic. Methods: Crosssectional study with PHC dentists. The outcome was a reduction in dental care appointments and that the exposure variables included sociodemographic factors, aspects about personal protective clothing and equipment (PPE) and measures adopted by the Basic Health Unit (UBS) in Brazil after the appearance of COVID. Poisson regression was performed, used to determine the prevalence ratio and 95% confidence interval. Results: Reduction in visits above 50% after the onset of the pandemic was reported by 62.6% of 958 participating. Biosafety protocols (PR=1.04 ­ 95%CI 1.01;1.07), PPE suggested by the protocols (PR=0.94 ­ 95%CI 0.89;0.99), and telescreening (PR=0.90 ­ 95%CI 0.85;0.96) were factors associated with this reduction. Conclusion: The availability of the new PPE and the implementation of telescreening at UBS seem to have minimized the reduction in dental care after the onset of the pandemic

Objetivo: Analizar factores asociados a la reducción de consultas odontológicas en Atención Primaria de Salud (APS) en Brasil durante COVID-19. Métodos: Estudio transversal con dentistas de APS. El hecho investigado fue reducción de consultas odontológicas y las variables de exposición incluyeron factores sociodemográficos, aspectos de los equipos de protección personal (EPI) y las medidas adoptadas por la Unidad Básica de Salud (UBS) tras la aparición del COVID. Regresión de Poisson utilizada para determinar la razón de prevalencia y el intervalo de confianza del 95%. Resultados: El 62,6% de los 958 participantes informó una reducción en la asistencia superior al 50% después del inicio de la pandemia. La adopción de protocolos (RP=1,04 ­ IC95% 1,01;1,07), disponibilidad de EPI recomendado por los nuevos protocolos (RP=0,94 ­ IC95% 0,89;0,99) y la adopción de televaluación (RP=0,90 ­ IC95% 0,85;0,96) fueron factores que se asoció con esta reducción. Conclusión: La disponibilidad del nuevo EPP y la implementación de la teleprotección en UBS parecen haber minimizado la reducción en la atención dental después del inicio de la pandemia.

Objetivo: Analisar fatores associados à redução de atendimentos odontológicos na Atenção Primária à Saúde, durante pandemia de COVID-19 no Brasil. Métodos: Estudo transversal, com cirurgiões-dentistas das unidades básicas de saúde (UBS). O desfecho foi a redução dos atendimentos odontológicos, e as variáveis de exposição, dados sociodemográficos, disponibilidade de equipamentos de proteção individual (EPIs) e medidas adotadas pela UBS na pandemia. Realizou-se regressão de Poisson para determinar razão de prevalências e intervalo de confiança de 95%. Resultados: A redução de atendimentos acima de 50% após o início da pandemia foi relatada por 62,6% dos 958 participantes. Adoção de protocolos de biossegurança (RP=1,04 ­ IC95% 1,01;1,07), disponibilidade de EPI preconizados por novos protocolos (RP=0,94 ­ IC95% 0,89;0,99) e adoção da teletriagem (RP=0,90 ­ IC95% 0,85;0,96) estiveram associados à redução. Conclusão: A disponibilização dos novos EPIs e a implementação da teletriagem nas UBS parecem ter minimizado a redução dos atendimentos odontológicos após o início da pandemia.

Knowledge About Biosafety Measures in Clinical Setting During the COVID-19 Pandemic: A Cross-Sectional Study With Brazilian Dental Students.

OBJECTIVE: The aim of this study is to evaluate the knowledge of Brazilian dental students about biosafety measures that should be adopted in the clinical setting during the coronavirus disease (COVID-19) pandemic. METHODS: A cross-sectional study with 1050 dental students was conducted. A semi-structured questionnaire was shared with students. Mean knowledge score on biosafety guidelines during the COVID-19 pandemic was the outcome, with a maximum of 8 scores. Explanatory variables included sociodemographic and educational characteristics, aspects related to biosafety education, actions adopted by the dental schools during the pandemic, and sources of biosafety information. Multivariate linear regression analyses were performed. RESULTS: Mean knowledge score was 5.19 (1.28). Female students (ß = 0.346; 95% CI: 0.154-0.539), those enrolled in the intermediate (ß = 0.525; 95% CI: 0.167-0.883) or final (ß = 0.569; 95% CI: 0.200-0.937) stage of course, and those who had already received theoretical-practical training in biosafety (ß = 0.464; 95% CI: 0.063-0.866) presented higher mean knowledge scores. Students who did not receive guidance on aerosol control measures before the pandemic (ß = -0.324; 95% CI: -0.519 to -0.130) had the lowest score. CONCLUSION: Students presented a medium level of knowledge about dental biosafety measures concerning the COVID-19 pandemic. Sociodemographic characteristics and those related to the institutional profile of the participants, and access to orientation and training in biosafety, may influence their knowledge.

Recovery of SARS-CoV-2 from large volumes of raw wastewater is enhanced with the inuvai R180 system.

Wastewater-based epidemiology (WBE) for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is a powerful tool to complement syndromic surveillance. Although detection of SARS-CoV-2 in raw wastewater may be prompted with good recoveries during periods of high community prevalence, in the early stages of population outbreaks concentration procedures are required to overcome low viral concentrations. Several methods have become available for the recovery of SARS-CoV-2 from raw wastewater, generally involving filtration. However, these methods are limited to small sample volumes, possibly missing the early stages of virus circulation, and restrained applicability across different water matrices. The aim of this study was thus to evaluate the performance of three methods enabling the concentration of SARS-CoV-2 from large volumes of wastewater: i) hollow fiber filtration using the inuvai R180, with an enhanced elution protocol and polyethylene glycol (PEG) precipitation; ii) PEG precipitation; and iii) skimmed milk flocculation. The performance of the three approaches was evaluated in wastewater from multiple wastewater treatment plants (WWTP) with distinct singularities, according to: i) effective volume; ii) percentage of recovery; iii) extraction efficiency; iv) inhibitory effect; and v) the limits of detection and quantification. The inuvai R180 system had the best performance, with detection of spiked control across all samples, with average recovery percentages of 68% for porcine epidemic diarrhea virus (PEDV), with low variability. Mean recoveries for PEG precipitation and skimmed milk flocculation were 9% and 14%, respectively. The inuvai R180 enables the scalability of volumes without negative impact on the costs, time for analysis, and recovery/inhibition. Moreover, hollow fiber ultrafilters favor the concentration of different microbial taxonomic groups. Such combined features make this technology attractive for usage in environmental waters monitoring.

Fatores associados à redução de atendimentos odontológicos na Atenção Primária à Saúde no Brasil, com o surgimento da COVID-19: estudo transversal, 2020 / Factores asociados a la reducción de la atención odontológica en Atención Primaria de Salud en Brasil con la aparición de COVID-19: estudio transversal, 2020 / Factors associated with the reduction of dental care in Primary Health Care in Brazil after the emergence of COVID-19: a cross-sectional study, 2020

Objetivo: Analisar fatores associados à redução de atendimentos odontológicos na Atenção Primária à Saúde, durante pandemia de COVID-19 no Brasil. Métodos: Estudo transversal, com cirurgiões-dentistas das unidades básicas de saúde (UBS). O desfecho foi a redução dos atendimentos odontológicos, e as variáveis de exposição, dados sociodemográficos, disponibilidade de equipamentos de proteção individual (EPIs) e medidas adotadas pela UBS na pandemia. Realizou-se regressão de Poisson para determinar razão de prevalências e intervalo de confiança de 95% (IC95%). Resultados: A redução de atendimentos acima de 50% após o início da pandemia foi relatada por 62,6% dos 958 participantes. Adoção de protocolos de biossegurança (RP = 1,04; IC95% 1,01;1,07), disponibilidade de EPIs preconizados por novos protocolos (RP = 0,94; IC95% 0,89;0,99) e adoção da teletriagem (RP = 0,90; IC95% 0,85;0,96) estiveram associados à redução. Conclusão: A disponibilização dos novos EPIs e a implementação da teletriagem nas UBS parecem ter minimizado a redução dos atendimentos odontológicos após o início da pandemia.

Objetivo: Analizar factores asociados a la reducción de consultas odontológicas en Atención Primaria de Salud en Brasil durante el COVID-19. Métodos: Estudio transversal con cirujanos dentistas de las Unidades Básicas de Salud (UBS). El hecho investigado fue la reducción de consultas odontológicas y las variables de exposición incluyeron factores sociodemográficos, aspectos de los equipos de protección personal (EPPs) y las medidas adoptadas por la UBS tras la aparición del COVID. La regresión de Poisson se utilizó para determinar la razón de prevalencia y el intervalo de confianza del 95% (IC95%). Resultados: El 62,6% de los 958 participantes informó una reducción en la asistencia superior al 50% después del inicio de la pandemia. La adopción de protocolos (RP = 1,04; IC95% 1,01;1,07), disponibilidad de EPPs recomendados por los nuevos protocolos (RP = 0,94; IC95% 0,89;0,99) y la adopción de teletriaje (RP = 0,90; IC95% 0,85;0,96) fueron factores que se asociaron con esta reducción. Conclusión: La disponibilidad del nuevo EPP y la implementación de la teleprotección en las UBS parecen haber minimizado la reducción en la atención bucal después del inicio de la pandemia.

Objective: To analyze factors associated with the reduction of dental care in Primary Health Care, during the COVID-19 pandemic in Brazil. Methods: This was a cross-sectional study conducted with dentists in primary healthcare centers (PHCCs). The reduction of dental care was the outcome, and the exposure variables were sociodemographic data, availability of personal protective equipment (PPE) and measures adopted by PHCCs during the pandemic. Poisson regression was performed to determine the prevalence ratio and 95% confidence interval (95%CI). Results: Of the total of 958 participants, 62.6% reported a reduction of over 50% in dental visits after the beginning of the pandemic. Adoption of biosafety protocols (PR = 1.04; 95%CI 1.01;1.07), availability of PPE recommended by new protocols (PR = 0.94; 95%CI 0.89;0.99) and adoption of tele-screening (PR = 0.90; 95%CI 0.85;0.96) were associated with the reduction. Conclusion: The availability of new types of PPE and implementation of tele-screening in PHCCs seem to have minimized the reduction of dental care after the beginning of the pandemic.

Systemic infection following intravesical therapy with BCG.

Immunotherapy with BCG is an effective and widely used treatment for non-muscle-invasive bladder cancer. BCG sepsis is a rare but life-threatening and frequently not a straightforward complication of this treatment; in cases with a high index of suspicion, anti-bacillary treatment should not wait for laboratory confirmation and be instituted immediately. We report a severe case of BCG sepsis, in which timely diagnosis and initiation of antituberculosis agents enabled a full recovery.

Archaeological and Chemical Investigation on Mortars and Bricks from a Necropolis in Braga, Northwest of Portugal.

This investigation intends to study and characterize the mortars and bricks from walls and floors used in the funerary nucleus of the archaeological site of Dr. Gonçalo Sampaio Street (Braga, Portugal), associated with the Via XVII necropolis of the Bracara Augusta Roman city. The diversity of the funeral structures and their exceptional state of conservation make this sector of the necropolis an unprecedented case and a reference site in the archaeology of Braga, a determinant for its conservation and musealization. Nineteen mortars samples were analysed by X-ray Fluorescence. The results showed clear chemical composition differences among coating and floor mortars (CFM), masonry mortars (MM) and bricks (B) groups of samples. The chemical affinity between CFM from the V to IV centuries, CFM from the IV to V centuries, MM from brick walls (IV-V centuries), MM from stone walls (V-VII centuries) and B from the IV to V centuries samples were confirmed by statistical analyses. Their composition was distinctly related to the use of different raw materials, according to their chronological context; in mortars, according to their function in the structures; and in some samples, from contamination.

Methodological Characteristics, Physiological and Physical Effects, and Future Directions for Combined Training in Soccer: A Systematic Review.

Combined training (CT) may combine strength and endurance training within a given time period, but it can also encompass additional protocols consisting of velocity, balance, or mobility as part of the same intervention. These combined approaches have become more common in soccer. This systematic review was conducted to (1) characterize the training protocols used in CT studies in soccer, (2) summarize the main physiological and physical effects of CT on soccer players, and (3) provide future directions for research. Methods: A systematic review of Cochrane Library, PubMed, Scopus, SPORTDiscus, and Web of Science databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PICOS were defined as follows: P (soccer players of any age or sex); I (CT combining strength and endurance or sprinting or balance or mobility training); C (the control group (whenever applicable), with or without comparative interventions in addition to usual soccer training); O (acute and/or chronic responses: biochemical, physiological and physical); S (must have at least two groups, either randomized or non-randomized). The database search initially identified 79 titles. From those, eight articles were deemed eligible for the systematic review. Three studies analyzed acute responses to concurrent training, while the remaining five analyzed adaptations to CT. In those tested for acute responses, physiological (hormonal) and physical (strength and power external load, internal load) parameters were observed. Adaptations were mainly focused on physical parameters (strength and power, sprints, jumps, repeated sprint ability, aerobic, change-of-direction), with relatively little focus on physiological parameters (muscle architecture). Short-term responses to CT can affect hormonal responses of testosterone after resistance training with internal and external load. In turn, these responses' effects on strength and power have produced mixed results, as have adaptations. Specifically, strength and hypertrophy are affected to a lesser extent than speed/power movements. Nevertheless, it is preferable to perform CT before endurance exercises since it is a limiting factor for interference. Volume, intensity, rest between sessions, and athletes' fitness levels and nutrition dictate the degree of interference.

Anxiety symptoms and alcohol abuse during the COVID-19 pandemic: A cross-sectional study with Brazilian dental undergraduate students.

AIM: The aim of this study is to assess whether anxiety symptoms are associated with alcohol abuse in Brazilian undergraduate dental students during the COVID-19 pandemic. METHOD: A cross-sectional study was conducted. A semi-structured questionnaire addressing the variables of interest was hosted on Google Forms and shared with dental undergraduate students from all Brazilian regions between July 8 and 27, 2020. Alcohol abuse was measured using the Cut down, Annoyed, Guilty, Eye opener (CAGE) questionnaire score of ≥2. All participants responded to the seven-item Generalized Anxiety Disorder Scale (GAD-7). Hierarchical logistic regression was also conducted. RESULTS: Among the 1050 students evaluated, 18.7% (n = 196) had a positive screening for alcohol abuse during the pandemic. The prevalence of mild (GAD-7 = 5-9), moderate (GAD-7 = 10-14), and severe (GAD-7 ≥15) anxiety among students were 31.3%, 29.6%, and 24.2%, respectively. The final hierarchical logistic regression model showed that during the COVID-19 pandemic, anxiety levels predict the likelihood of alcohol abuse among students with moderate (OR 10.05 [95% IC: 4.12-24.52]) or severe (OR 15.82 [95% IC: 6.46-38.73]) anxiety, especially for male students (moderate anxiety: OR 17.06 [95% CI: 8.36-34.78]; severe anxiety: OR 28.38 [95% CI: 8.62-38.24]). CONCLUSION: The prevalence of alcohol abuse and moderate or severe anxiety in Brazilian undergraduate dental students during the COVID-19 pandemic was high. Male students may be more sensitive to the presence of anxiety symptoms in this period, thus contributing to higher levels of alcohol consumption, in comparison to female students. Intervention strategies that promote the adoption of healthier lifestyles can enable the effective management of anxiety symptoms during the pandemic and thus, hold the potential to reduce exacerbated alcohol intake in this population.