Detecting space-time clusters of COVID-19 in Brazil: mortality, inequality, socioeconomic vulnerability, and the relative risk of the disease in Brazilian municipalities.

The first case of COVID-19 in South America occurred in Brazil on February 25, 2020. By July 20, 2020, there were 2,118,646 confirmed cases and 80,120 confirmed deaths. To assist with the development of preventive measures and targeted interventions to combat the pandemic in Brazil, we present a geographic study to detect "active" and "emerging" space-time clusters of COVID-19. We document the relationship between relative risk of COVID-19 and mortality, inequality, socioeconomic vulnerability variables. We used the prospective space-time scan statistic to detect daily COVID-19 clusters and examine the relative risk between February 25-June 7, 2020, and February 25-July 20, 2020, in 5570 Brazilian municipalities. We apply a Generalized Linear Model (GLM) to assess whether mortality rate, GINI index, and social inequality are predictors for the relative risk of each cluster. We detected 7 "active" clusters in the first time period, being one in the north, two in the northeast, two in the southeast, one in the south, and one in the capital of Brazil. In the second period, we found 9 clusters with RR > 1 located in all Brazilian regions. The results obtained through the GLM showed that there is a significant positive correlation between the predictor variables in relation to the relative risk of COVID-19. Given the presence of spatial autocorrelation in the GLM residuals, a spatial lag model was conducted that revealed that spatial effects, and both GINI index and mortality rate were strong predictors in the increase in COVID-19 relative risk in Brazil. Our research can be utilized to improve COVID-19 response and planning in all Brazilian states. The results from this study are particularly salient to public health, as they can guide targeted intervention measures, lowering the magnitude and spread of COVID-19. They can also improve resource allocation such as tests and vaccines (when available) by informing key public health officials about the highest risk areas of COVID-19.

Nanostructured materials based on mesoporous silica and mesoporous silica/apatite as osteogenic growth peptide carriers.

The aim of this work was the preparation of inorganic mesoporous materials from silica, calcium phosphate and a nonionic surfactant and to evaluate the incorporation and release of different concentrations of osteogenic growth peptide (OGP) for application in bone regeneration. The adsorption and release of the labeled peptide with 5,6-carboxyfluorescein (OGP-CF) from the mesoporous matrix was monitored by fluorescence spectroscopy. The specific surface area was 880 and 484 m(2) g(-1) for pure silica (SiO) and silica/apatite (SiCaP), respectively; the area influenced the percentage of incorporation of the peptide. The release of OGP-CF from the materials in simulated body fluid (SBF) was dependent on the composition of the particles, the amount of incorporated peptide and the degradation of the material. The release of 50% of the peptide content occurred at around 4 and 30 h for SiCaP and SiO, respectively. In conclusion, the materials based on SiO and SiCaP showed in vitro bioactivity and degradation; thus, these materials should be considered as alternative biomaterials for bone regeneration.

Alterations in serum lipid profile patterns in oral lichen planus: a cross-sectional study.

BACKGROUND: Oral lichen planus (OLP) is a chronic inflammatory disorder. Recently, a case-control study found that lichen planus was associated with dyslipidemia in a large series of patients. However, no data were presented about lipid values in patients and controls. OBJECTIVES: The aim of this study was to investigate the hypothetical association between OLP and dyslipidemia. MATERIALS AND METHODS: The study included a total of 400 patients (200 with OLP and 200 controls with other oral diseases) and investigated the prevalence of dyslipidemia. The variables analyzed were age, sex, tobacco and alcohol consumption, clinical form of OLP and lipid profiles. RESULTS: A 54% prevalence of dyslipidemia was found (58% among the OLP group and 50% in the control group). Statistically significant differences in high-density lipoprotein were found between OLP patients and the control group (p = 0.003). A logistic regression model for presence/absence of cardiovascular risk (Castelli's atherogenic index of ≥ 5.1 for men and ≥ 4.5 for women) found statistically significant differences for sex and tobacco consumption. CONCLUSIONS: The study found a higher atherogenic index amongst OLP patients.

Non-leachable highly luminescent ordered mesoporous SiO2 spherical particles.

Ordered mesoporous highly luminescent SiO2 particles have been synthesized by spray pyrolysis from solutions containing tetraethylorthosilicate (TEOS) and either cetyltrimethylammonium bromide (CTAB) or the block copolymer Pluronic F-68 as structure-directing agents. Rhodamine B (RhB)-containing samples were prepared by using a simple wet impregnation method followed by the growing of a second silica shell in order to prevent leaching of the dye. The obtained materials were characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), powder x-ray diffraction (XRD), ultraviolet-visible spectroscopy (UV-vis) and photoluminescence (PL). Powders with polydisperse spherical grains were obtained displaying an ordered hexagonal array of mesochannels. Luminescence results reveal that RhB molecules have been successfully encapsulated into the channels of mesoporous particles as monomeric species and that a well-defined silica coating hindered dye leaching.

Preconcentration and determination of Cu(II) in a fresh water sample using modified silica gel as a solid-phase extraction adsorbent.

A method was developed to attach 4-amino-2-mercaptopyrimidine (AMP) onto silica gel surface and to determine trace metals. The surface functionalization reaction was performed with a silylant agent, chloropropyltrimethoxysilane (Si-CPTS), and the product, Si-AMP, was characterized by FT-IR and elemental analysis to evaluate the surface modification. The functionalized silica was applied in the sorption of Cu(II) ions from an aqueous medium. The series of adsorption isotherms were adjusted to a modified Langmuir equation and the maximum number of moles of adsorbed copper was 0.447 mmol g(-1). The modified material was placed in a preconcentration system, where it reached an approximately 20-fold enrichment factor using 5mg of Si-AMP. The proposed method was applied in the preconcentration and determination of Cu(II) in a fresh water sample from the Paraná river and was validated through a comparative analysis of a standard reference material (1643e).

[Continuity of medical care. Evaluation of a collaborative program between hospital and Primary Care]. / Continuidad asistencial. Evaluación de un programa de colaboración entre Atención Hospitalaria y Atención Primaria.

The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike.

Continuidad asistencial. Evaluación de un programa de colaboración entre Atención Hospitalaria y Atención Primaria / Continuity of medical care. Evaluation of a collaborative program between hospital and Primary Care

Los pacientes atendidos en nuestro sistema sanitario tienen cada vez más edad y mayor prevalencia de enfermedades crónicas. Estas características de salud han condicionado que entre las expectativas de mayor relevancia de los pacientes, se indiquen la accesibilidad al sistema y la continuidad en los cuidados. La colaboración entre los distintos niveles asistenciales ha sido una herramienta reconocida que facilita la consecución de estas expectativas, provocando cambios en la organización del trabajo. Nuestro hospital ha desarrollado un modelo de atención sanitaria que ­en su orientación al enfermo­ facilita la colaboración entre los distintos niveles asistenciales, consiguiendo un grado de satisfacción de los profesionales elevado. En este trabajo se describe detalladamente parte del modelo, mostrando los elementos que lo caracterizan, indicando algunos parámetros de la evaluación de resultados y revisando la situación de los modelos de continuidad asistencial publicados. En resumen, consideramos que este sistema asistencial está dotado de elementos de gestión que permiten atender las expectativas de los usuarios, aportando beneficios para el paciente, el profesional y el sistema sanitario (AU)

The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike (AU)

Newborn hearing screening project using transient evoked otoacoustic emissions: Western Sicily experience.

OBJECTIVE: To study the incidence of congenital sensorineural hearing loss in all newborns introducing a screen test with a protocol no expensive, with a good "screen sensitivity" that could let an earlier identification of hearing impairment beginning early intervention by 2 months of age and increasing the probability of having language development within the normal range of development. METHODS: The study was conducted in Sciacca hospital from the beginning of 2003 to our days and was carried out with transient evoked otoacoustic emission using the criteria for PASS or RETEST and considering eventual prenatal and perinatal risk factors. All the newborns were divided into four groups each one with its personal secondary step program. RESULTS: In the years 2003-2004 the number of the newborns in Sciacca hospital was: 538 for 2003, 653 for 2004 with a total of 1191; all these infants were divided in three groups: resident in Sciacca, resident in the Sciacca borderlands and resident out of the district of Sciacca. The coverage (percentage of the target population who undergo the screen) was of 90% in the 2003 (483 newborns) and of 90% in the 2004 (585 newborns) with two cases of congenital sensorineural hearing loss identified. The incidence of sensorineural hearing loss, in the District of Sciacca, was estimated to be 2.07/1000 in 2003 and 1.70/1000 in 2004. CONCLUSIONS: The higher incidence of sensorineural hearing loss in our study is due to a high prevalence of consanguineous marriage in Sicily that was shown to be linked with hearing impairment. The "sensitivity value" was 95% at the first step but became 99% after the second step with a few number of false positive (0.74%). All the infants with a diagnosis of sensorineural hearing loss began a rehabilitation program before the age of 5 months and they have a good speech development and speech intelligibility.

[Dyspneic bronchopathy and asthma: hospital admission between 1979 and 1994]. / Broncopatia dispneizzante e asma: l'andamento dei ricoveri dal 1979 al 1994.

4,618 children, hospital admitted between 1979 and 1994 for wheezy bronchitis or asthma, have been investigated. the patients were distributed in two groups, according to mean age of 19 months or 8 year. An increasing incidence of asthma, an earlier onset or respiratory symptoms, more frequent hospitalisation in children aging less than 2 years, in recent years were observed. In elder children however, less frequent hospitalisation occurred.

[Transesophageal echocardiographic evaluation of tricuspid endocarditis from implanted pacemaker: description of two cases]. / Valutazione con ecocardiografia transesofagea dell'endocardite tricuspidale da impianto di pacemaker: descrizione di due casi.

Two cases of tricuspid valve endocarditis due to staphylococcus epidermidis have been examined in patients with permanent transvenous pacemaker. While transthoracic echocardiography was unable to detect any tricuspidal abnormalities, large vegetations located on the tricuspidal leaflets and the electrocatheter were detected by transesophageal echocardiography. Both cases required surgical removal of the electrostimulation system and valve toilet.

[Alcohol consumption and coronary disease in men]. / Consumo di alcol e malattia coronarica nell'uomo.

It has been recently suggested by many epidemiological studies, and emphasized by a nonspecialistic press, that a moderate alcohol intake may exert a protective role in coronary heart diseases. In our study, by means of a questionnaire, the consumption of alcohol in 100 male patients, less than 70 years old, affected by myocardial infarction and/ or angina pectoris, has been evaluated during a period before and after the admission to our Coronary Care Unit. On the basis of their alcohol intake, patients were divided into five categories: abstainers (8%), daily intake lower than one drink (7%), between one and two drinks (8%) between three and four drinks (46%) and equal or higher than five drinks (31%). In the light of these results, we suggested that, in our region (a country area in the north-east of Italy), there are higher levels of ethanol intake compared to those reported by other authors, that these parameters are only slightly modified by the occurrence of coronary heart diseases and that alcohol consumption, although low and moderate, must be therefore emphasized with extreme caution.

Atypical electromechanical dissociation in a patient with recurrent pulmonary embolism.

A 47-year-old man experienced recurrent pulmonary embolism resistant to aggressive medical and surgical prophylaxis. Although paraneoplastic hypercoagulability was suspected, no endoscopic or radiologic signs of malignancy were detected. Death was the result of electromechanical dissociation, which was attributed to right ventricular outflow obstruction. At autopsy, anaplastic lung carcinoma was found in the left basal segment with superimposed pulmonary infarction. A huge pedunculated thrombus was attached to the left ventricular apex and extended into the ascending aorta, obstructing the left ventricular outflow. To our knowledge, this is the first case of electromechanical dissociation due to left ventricular thrombus in a patient with pulmonary embolism. Radiologic and echocardiographic evaluation of such patients should take into account possible masking of the underlying neoplasm by embolic or hemorrhagic phenomena, or both, and the presence of left-sided cardiac thombi, which may cause catastrophic events.

[Colchicine in the treatment of idiopathic recurrent pericarditis. Report of a case]. / La colchicina nel trattamento della pericardite idiopatica recidivante. Descrizione di un caso clinico.

Treatment of recurrence, which is one of the major complications of pericarditis, is often difficult. After three recurrences of idiopathic acute pericarditis, over a period of four months, despite therapy with acetylsalicylic acid, indomethacin and methilprednisolone, a patient, 37 years old, responded favorably to colchine treatment. No recurrences, no side effects were observed, after a prolonged low dose treatment. Our report suggests, therefore, that colchinine may be beneficial in acute attacks of idiopathic pericarditis and may be useful in avoiding recurrent episodes of pericarditis.