Spatiotemporal Evolution of the Yellow Fever Epidemic in Southeast Brazil from 2016 to 2019.

Background: Yellow fever (YF) is a zoonotic disease transmitted by mosquitoes among humans and nonhuman primates. Although urban YF is eradicated, the sylvatic YF has reemerged in some areas of Brazil in the twenty-first century. From 2016 to 2019, a sylvatic YF epidemic occurred in Southeast Brazil, where it had been eradicated in the 1940s. Methods: This study's objective was to describe the epidemic in the states of the Southeast region, based on descriptive, cluster, and mobility analyses. Results: Both the descriptive and cluster analyses showed that the YF cases spread from the state of Minas Gerais southward, causing peaks in cases during the summer months. None of the state capitals was included in the clusters, but the connectivity between the municipalities in Greater Metropolitan São Paulo highlighted potential paths of spread. Despite differences in sociodemographic profiles between the Southeast and North of Brazil (the latter region considered endemic), the epidemiological profile was similar, except for patients' occupation, which was not related to rural work in the Southeast. Conclusion: The results contributed to our understanding of the paths by which YF spread across Southeast Brazil and the epidemiological profile in an area that had gone decades without autochthonous cases.

Obstructive sleep apnea screening in different age groups: performance of the Berlin, STOP-Bang questionnaires and Epworth Sleepiness Scale.

OBJECTIVE: To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. METHODS: Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18-39, 40-59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders-third edition. Performance was assessed using 2×2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. RESULTS: We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. CONCLUSION: In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. LEVEL OF EVIDENCE ACCORDING THE GUIDE FOR AUTHORS: level 2.

Spatio-Temporal Cluster Detection of Dengue, Chikungunya, and Zika Viruses' Infection in Rio de Janeiro State from 2010 to 2019.

Dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) virus infections are widespread throughout the Rio de Janeiro state. The co-circulation of these emergent arboviruses constitutes a serious public health problem, resulting in outbreaks that can spatially and temporally overlap. Environmental conditions favor the presence, maintenance, and expansion of Aedes aegypti, the primary vector of these urban arboviruses. This study assessed the detection of clusters of urban arboviruses in the Rio de Janeiro state from 2010 to 2019. Notified cases of dengue, chikungunya, and Zika were grouped by year according to the onset of symptoms and their municipality of residence. The study period recorded the highest number of dengue epidemics in the state along with the simultaneous circulation of chikungunya and Zika viruses. The analyzes showed that the central municipalities of the metropolitan regions were associated with higher risk areas. Central municipalities in metropolitan regions were the first most likely clusters for dengue and Zika, and the second most likely cluster for chikungunya. Furthermore, the northwest and north regions were comprised clusters with the highest relative risk for the three arboviruses, underscoring the impact of these arboviruses in less densely populated regions of Brazil. The identification of high-risk areas over time highlights the need for effective control measures, targeted prevention and control interventions for these urban arboviral diseases.

Obstructive sleep apnea screening in different age groups: performance of the Berlin, STOP-Bang questionnaires and Epworth Sleepiness Scale

Abstract Objective To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. Methods Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18-39, 40-59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders—third edition. Performance was assessed using 2 × 2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. Results We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. Conclusion In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. Level of evidence according the guide for authors: level 2.

Strength training improves insulin resistance and differently affects mitochondria in skeletal muscle and visceral adipose tissue in high-fat fed mice.

AIMS: Strength training (ST) improves insulin resistance and glucose tolerance by yet unknown mechanisms. The aims of this study were to investigate the effects of ST on mitochondrial adaptation in skeletal muscle and adipose tissue, on heat shock protein 72 (Hsp72) in skeletal muscle, and on visceral adipocyte size in mice with high-fat diet (HFD)-induced insulin resistance. MATERIALS AND METHODS: Male Balb/c mice were divided into sedentary control-chow (C-chow), strength trained-chow (ST-chow), sedentary control-HFD (C-HFD) and strength trained-HFD (ST-HFD). Diet was provided for 12 weeks, while ladder climbing ST was performed for the final six weeks of the study at a frequency of three days per week. KEY FINDINGS: Strength training led to increased strength, muscular endurance, and skeletal muscle hypertrophy. Compared to the C-HFD group, mice in the ST-HFD group decreased their whole-body insulin resistance, improved their glucose tolerance, and had higher activation of the insulin pathway in skeletal muscle. ST increased citrate synthase (CS) activity in skeletal muscle, but this increase was blunted in ST-HFD. Conversely, HFD reduced adipose tissue CS activity regardless of training status. Hsp72 content was reduced in C-HFD, but returned to control levels in ST-HFD. Finally, reduced epididymal adipocyte size was observed in ST-HFD. SIGNIFICANCE: These results suggest that the improvement in insulin resistance induced by ST is related to mitochondrial adaptation in skeletal muscle, but not in adipose tissue. Moreover, this improvement might be related to increased skeletal muscle Hsp72 and reduced epididymal adipocyte size.

Live and frozen Artemia nauplii for catfish Lophiosilurus alexandri (Steindachner, 1876) larvae in different salinities.

The objective of the study was to verify the combination of live and frozen Artemia nauplii, in different salinized water, and its influence in growth and survival of the catfish Lophiosilurus alexandri (Steindachner, 1876) larvae. Larvae were exposed to a combination of two feeds and two different salinities: live Artemia nauplii + 0‰ salinity in the water; live Artemia nauplii + 2‰ salinity in the water; frozen Artemia nauplii + 0‰ salinity in the water; and frozen Artemia nauplii + 2‰ salinity in the water. The experiment was conducted in a randomized design, in a 2 × 2 factorial scheme, 5 replicates, during 15 days. The larvae final weight, weight gain, food conversion, standard and total length, biomass, survival, body width, intestinal quotient, Fulton's condition factor, and water quality were evaluated. The use of Artemia nauplii and 2 ppm salinized water for L. alexandri larviculture proved to be adequate providing greater growth. This was due to Artemia nauplii being kept alive and attractive for the cultivation of larvae in salinized water, even though salt was a stress factor. Already, the frozen Artemia nauplii was a viable food but should be used preferably in times of lack of live nauplii and without salinization of the water.

Comparative larval ontogeny of two fish species (Characiformes and Siluriformes) endemic to the São Francisco River in Brazil.

The aim of the present study was to perform comparative histological analyses of the ontogenetic development of two fish species endemic to the São Francisco River in Brazil: Prochilodus argenteus and Lophiosilurus alexandri. Histological analyses were performed every 24 h from the moment of hatching until 14 days post-hatching (dph) for the observation of larval development and until 39 dph for the observation of gonadal development. Whole larvae were fixed in Bouin's solution and the histological slides were stained with haematoxylin-eosin. Lophiosilurus alexandri larvae had a larger body size compared with P. argenteus larvae since hatching. Lophiosilurus alexandri larvae had mouth opening and pigmentation of the eyes upon hatching, whereas these events were observed at 1 dph in P. argenteus larvae. The visualisation and the inflation of the swim bladder occurred at 1 and 3 dph, respectively, in the P. argenteus, whereas these events occurred at 2 and 8 dph, respectively, in L. alexandri. Yolk granules were absorbed at 4 dph in P. argenteus and the 10 dph in L. alexandri. At 7 dph, the digestive tube was more differentiated in L. alexandri than P. argenteus and at 14 dph, the digestive system of both species had features of their eating habits: broad stomach and short intestine in L. alexandri, typical of carnivorous habits; stomach with a mechanical function and long intestine in P. argenteus, typical of detritivorous habits. The epithelial lining tissue, formed by a single layer of cells in the newly hatched larvae (0 dph), differentiated throughout the study, exhibiting scales in P. argenteus and numerous club cells in the middle epithelial region of L. alexandri at 39 dph. Undifferentiated gonads with somatic cells and primordial germ cells were observed at 39 dph, with caudal-cranial migration since 1 dph in both species. The anatomic changes during the ontogeny of P. argenteus and L. alexandri larvae are directly associated with the evolutionary history of each species, which explains their feeding habits, behaviour and distribution in the environment: Prochilodus argenteus is detritivorous and actively swims in the water column, whereas L. alexandri is carnivorous and inhabits bottom regions. At 39 dph neither species exhibited sexual differentiation.

Plant species diversity in a Neotropical wetland: patterns of similarity, effects of distance, and altitude

ABSTRACT The Brazilian Pantanal is an extensive wetland with heterogeneous habitats, primarily due to the river-floodplain system and plants with differential adaptations and reproductive strategies. Factors such as altitude, distance among plant formations, and flood pulse must be considered to better understand its diversity. Aiming to assess the influence of biogeographic patterns in this system, we analyzed the floristic composition of six areas along the Paraguay River, including residual relieves, verifying the pattern of similarity, and effects of distance and altitude. We recorded 356 species in 87 families, mostly perennial (75%), and some annuals (15%) and pluriannuals (5%). Herbaceous plants were the most represented (48%), followed by arboreal (23%), shrubby (15%) and epiphytic (14%) habits, only 12% being endemic to Brazil. The studied areas showed low floristic similarity, but higher resemblance of species between neighboring areas, and no relation with altitude. The upper Paraguay River is diverse, with high spatial variability of species, predominantly perennial. The river-floodplain connectivity may be a determinant factor in species richness and occurrence of endemic species.

Plant species diversity in a Neotropical wetland: patterns of similarity, effects of distance, and altitude.

The Brazilian Pantanal is an extensive wetland with heterogeneous habitats, primarily due to the river-floodplain system and plants with differential adaptations and reproductive strategies. Factors such as altitude, distance among plant formations, and flood pulse must be considered to better understand its diversity. Aiming to assess the influence of biogeographic patterns in this system, we analyzed the floristic composition of six areas along the Paraguay River, including residual relieves, verifying the pattern of similarity, and effects of distance and altitude. We recorded 356 species in 87 families, mostly perennial (75%), and some annuals (15%) and pluriannuals (5%). Herbaceous plants were the most represented (48%), followed by arboreal (23%), shrubby (15%) and epiphytic (14%) habits, only 12% being endemic to Brazil. The studied areas showed low floristic similarity, but higher resemblance of species between neighboring areas, and no relation with altitude. The upper Paraguay River is diverse, with high spatial variability of species, predominantly perennial. The river-floodplain connectivity may be a determinant factor in species richness and occurrence of endemic species.

Clinical variables determining the success of adenotonsillectomy in children with Down syndrome.

OBJECTIVES: To evaluate the evolution of polysomnographic parameters of children with Down syndrome and obstructive sleep apnea syndrome submitted to adenotonsillectomy and the interaction of comorbidities on therapeutic outcome. METHODS: Ninety patients with Down syndrome and habitual snoring were identified between 2005 and 2015 in a Pediatric Otorhinolaryngology Clinic. Parent's complaints were evaluated by the test of equality of two proportions. Wilcoxon test was used to examine pre- and post-operative polysomnographic differences. Mann-Whitney test evaluated the influence of comorbidities. A p < 0.05 was considered significant. RESULTS: A total of 27 patients met the inclusion criteria (55.6% patients were males; mean (SD) age were 6.7 (3.6) years (range, 1.5-16 years). Significant improvement of parent's complaints (p < 0.001), arousal index (p = 0.045), and minimum oxygen saturation were observed post-adenotonsillectomy (p = 0.034). Adenotonsillectomy was able to resolve obstructive sleep apnea syndrome in 29.6% of children with Down syndrome. Nineteen patients (70.4%) remained with obstructive sleep apnea syndrome and 44.4% showed a reduction of at least 50% of obstructive apnea-hypopnea index. Central apnea index post-adenotonsillectomy was worse in patients with heart disease (p = 0.022). Sleep efficiency (p = 0.031), N1 sleep stage (p = 0.001), apnea-hypopnea index (p = 0.023), and central apnea index (p = 0.008) were worse after surgery in patients with hypothyroidism. Patients with severe OSAS showed significant improvement in polysomnographic parameters after surgery. CONCLUSION: Although adenotonsillectomy improved symptoms and objective sleep data in children with Down syndrome, it was not able to resolve obstructive sleep apnea syndrome in most patients. Congenital heart diseases and hypothyroidism may affect the outcome.

Relação entre controle e tratamento medicamentoso de pacientes atendidos pelo programa de hipertensão arterial em uma unidade primária do rio de janeiro / Relationship between Control and Drug Therapy among Patients Followed by the Arterial Hypertension Program in a Primary Care Unit of Rio de Janeiro

O estudo pretendeu avaliar o controle da hipertensãoarterial sistêmica em pacientes de uma unidade de saúdebásica do Município do Rio de Janeiro, acompanhadospor um grupo de médicos, enfermeiros e nutricionistas,em esquema de rodízio; e aqueles assistidos apenas pormédicos, durante 5 anos, e verificar a relação com a gravidadeda doença e o tratamento medicamentoso realizado.Os participantes foram selecionados aleatoriamente paracada grupo após a confirmação do diagnóstico com duasaferições da pressão arterial (PA) superiores ao limite propostopelo Programa Nacional de Controle da HipertensãoArterial - pressão arterial sistólica (PAS) ?140 mmHg e/ou pressão arterial diastólica (PAD) ? 90mmHg. Foramestudados os seguintes dados: sexo, idade, escolaridade,PA inicial, PA final e medicamentos utilizados, após cincoanos de acompanhamento. Os grupos eram homogêneose comparáveis quanto à idade (p=0,20), à escolaridade(p=0,17), ao sexo (p=0,89), à PAS inicial (p=0,23) e à PADinicial (p=0,11). Na admissão, predominaram pacientescom hipertensão controlada e com hipertensão moderadano grupo A (atendimento médico isolado); enquanto nogrupo B (atendimento em rodízio de profissionais) concentravam-se os pacientes com hipertensão leve e severa.Em ambos os grupos, havia predomínio do uso de doisou mais medicamentos, não havendo diferença significativanas frequências de distribuição (p=0,37). Embora emambos os grupos a queda da PA tenha sido significativa(p< 0,0001), houve maior redução da PAS (p=0,004) e daPAD (p=0,0007) no grupo B do que no grupo A. Emborahouvesse, na admissão, mais pacientes com HAS controladano grupo A (26,7%) em relação ao grupo B (8,65%), ao finaldo estudo, o controle da HAS foi maior no grupo B (45%)do que no grupo A (30%) (p=0,05). A abordagem adotadano grupo B foi capaz de induzir um melhor controle daHAS e esse fato não pôde ser atribuído à menor gravidadedos pacientes ou ao maior número de drogas utilizadas.

Shear bond strength of resin composite to enamel treated with Er: YAG laser and phosphoric acid

The purpose of this work was to evaluate the shear bond strength of resin composite to enamel treated with Er:YAGlaser. It was used 33 human third molars. After the dental crowns cutting, the mesial and distal surfaces were embeddedperpendicularly to the PVC cylinders long axis. Enamel was ground and the samples were randomly divided into 6 groups:G1- phosphoric acid (control), G2- Er:YAG laser (60mJ/10Hz), G3- Er:YAG (100mJ/10Hz), G4- Er:YAG (60mJ/10Hz+ acid), G5- Er:YAG (100mJ/ 10Hz + acid), G6- Er:YAG (80mJ/2Hz). In all groups, Single Bond was used and resincomposite cylinders (Z100) were prepared. The samples were stored in distilled water at 37oC for 24 hours and submittedto shearing test. G1 presented bond strength values significantly higher than G2, G3 and G6. The groups irradiated onlywith Er:YAG laser, in different intensities and frequencies, were equivalent as for the bond strength values. The groupstreated with laser + acid presented strength values statistically equal to those of the control group. The enamel treatmentwith phosphoric acid, or its association with laser, is important to obtain good bond. The use of Er: YAG laser alone isnot recommended, considering the conditions tested in this study.

Objetivou-se avaliar a resistência adesiva da resina composta ao esmalte condicionado com Er:YAG laser, através do teste de cisalhamento. Foram utilizados 33 terceiros molares humanos. Após o seccionamento das coroas dentárias, as faces mesial e distal foram incluídas perpendiculares ao longo eixo de cilindros de PVC. O esmalte foi planificado com lixa 600 e os espécimes aleatoriamente divididos em 6 grupos: G1- ácido fosfórico (controle), G2- Er:YAG laser(60mJ/10Hz), G3- Er:YAG (100mJ/10Hz), G4- Er:YAG (60mJ/10Hz + ácido), G5- Er:YAG (100mJ/ 10Hz + ácido), G6-Er:YAG (80mJ/2Hz). Em todos os grupos, o sistema adesivo Single Bond foi aplicado e os cilindros de resina composta (Z100) confeccionados. Os espécimes foram armazenados em água destilada a 37°C por 24h e submetidos ao teste de cisalhamento. O G1 apresentou valores de resistência adesiva significantemente superiores aos grupos G2, G3 e G6.Os grupos irradiados apenas com Er: YAG laser, nas diferentes intensidades e freqüências, equivaleram-se quanto aos valores de resistência adesiva. Os grupos tratados com laser + ácido apresentaram valores de resistência estatisticamente iguais ao grupo controle. O tratamento do esmalte com ácido fosfórico, ou a sua associação com laser, é importante para a obtenção de uma boa adesão. A utilização somente do Er: YAG laser não é recomendada, considerando-se as condições testadas neste estudo.

Hidroterapia, pompage e alongamento no tratamento de fibromialgia: relato de caso / Hidrotherapy, pompage and stretching as a psysicaltherapy treatment in people with fibromyalgi: case's relate

A Fibromialgia é uma síndrome de dor crônica caracterizada pela presença de dor difusa em músculos, tendões e ossos, sem evidência de componente inflamatório, além de possuir etiologia e fisiopatologia desconhecidas. O achado mais característico é a presença de "Tender Points" que são extremamente dolorosos à palpação. São escassas as informações a respeito de tratamentos eficazes no controle da sintomatologia da fibromialgia. O objetivo deste estudo foi avaliar os efeitos da hidroterapia associada a pompages e alongamentos gerais no tratamento de uma paciente portadora de fibromialgia. A voluntária foi selecionada de forma aleatória e submetida a uma avaliação fisioterapêutica realizada na Clínica de Fisioterapia da UNIARA onde dados sobre a história da patologia apresentada foram colhidos. Além disso, a paciente foi submetida a avaliações: 1) postural e de flexibilidade muscular; 2) positividade de "Tender Points"; 3) sensação dolorosa e qualidade do sono, por meio da aplicação de escalas análogas visuais. O tratamento consistiu de alongamentos gerais, pompages e hidroterapia em sessões de uma hora, totalizando 10 sessões de tratamento. Foi observado, no presente estudo, que o tratamento proposto trouxe benefícios à paciente, mostrando como resultado a melhora da qualidade do sono, diminuição da positividade dos "Tender Points" (queda de 55 por cento), melhora da flexibilidade muscular, da postura e do bem-estar geral da paciente

“Inlay”/“Onlay” semidireta de resina composta: uma alternativa às técnicas indiretas / Composite semi-direct inlays and onlays: an alternative to indirect techniques

A técnica restauradora semidireta com resina composta é hoje uma alternativa para a reconstrução de dentes posteriores com grande destruição coronária. O artigo relata um caso de “onlay” no primeiro molar superior (dente 16) de um paciente jovem de boa higiene oral. A restauração é realizada pelo cirurgião-dentista com resina composta em seu próprio consultório. O material de escolha foi a resina composta Filtek P60 (3M ESPE), e a cimentação foi realizada com cimento resinoso EnForce (Dentsply).