SARS-CoV-2 Delta variant of concern in Brazil - multiple introductions, communitary transmission, and early signs of local evolution

The dissemination of the Delta VOC in Brazil is still unclear, despite the frequent reports of isolated cases from different Brazilian states. In this report we characterize the dissemination of the Delta VOC in Brazil and where the introductions of this lineage fall within the global Delta phylogeny. We also examined the mutational profile of the largest clade within the Brazilian Delta VOCs, with a focus on samples which were obtained in the State of Sao Paulo, and especially in the city of Sao Paulo, the largest metropolis of South America, and a national and international transportation hub.

COVID-19 Bimodal Clinical and Pathological Phenotypes

BackgroundPatients with coronavirus disease-2019 (COVID-19) present varying clinical complications. Different viral load and host response related to genetic and immune background are probably the reasons for these differences. We aimed to sought clinical and pathological correlation that justifies the different clinical outcomes among COVID-19 autopsies cases. MethodsMinimally invasive autopsy was performed on forty-seven confirmed COVID-19 patients from May-July, 2020. Electronic medical record of all patients was collected and a comprehensive histopathological evaluation was performed. Immunohistochemistry, immunofluorescence, special stain, western blotting and post-mortem real-time reverse transcriptase polymerase chain reaction on fresh lung tissue were performed. ResultsWe show that 5/47 (10,6%) patients present a progressive decline in oxygenation index for acute respiratory distress syndrome (PaO2/FiO2 ratio), low compliance levels, interstitial fibrosis, high -SMA+ cells/protein expression, high collagens I/III deposition and NETs(P<0.05), named as fibrotic phenotype (N=5). Conversely, 10/47 (21,2%) patients demonstrated progressive increase in PaO2/FiO2 ratio, high pulmonary compliance levels, preserved elastic framework, increase thrombus formation and high platelets and D-dimer levels at admission (P<0.05), named as thrombotic phenotype. While 32/47 (68,1%) had a mixed phenotypes between both ones. ConclusionsWe believe that categorization of patients based on these two phenotypes can be used to develop prognostic tools and potential therapies since the PaO2/FiO2 ratio variation and D-dimer levels correlate with the underlying fibrotic or thrombotic pathologic process, respectively; which may indicate possible clinical outcome of the patient.

Physicians’ circularity in health regions in Brazil / Circularidade dos médicos nas regiões de saúde no Brasil

Objectives: to characterize the medical circularity in Brazil and to discuss the case in the North and South Barretos regions, São Paulo. Methods: a cross-sectional study using secondary data from the national registrations and a case study of physician’s sample in the North-Barretos and South-Barretos regions. Results: in the health regions in Brazil, on an average, 45% of the physicians in activities circulate in more than one region. The Capitals of the States have more stable physicians while more than 50% of the medical workforce work in other regions. The professionals with the greatest tendency to move from one work place to another are those who work in surgical specialties in services to uphold the diagnostic and therapy. Conclusions: there is a high circulation of physicians among the regions, with distinct characteristics between geographical and health regions. In case of Barretos area, the professionals move from one workplace to another according to their professional association and specialized practice.

Objetivos: caracterizar a circularidade médica no Brasil e a discutir o caso das regiões Norte-Barretos e Sul-Barretos, São Paulo. Métodos: estudo transversal com uso de dados secundários de cadastros nacionais e estudo de caso de uma amostra de médicos nas regiões Norte-Barretos e Sul-Barretos. Resultados: em média, nas regiões de saúde do Brasil, 45% dos médicos em atividades circulam em mais de uma região. As capitais dos estados têm médicos mais estáveis, enquanto que mais de 50% da força de trabalho médica atua em outras regiões. Os profissionais com maior tendência de mudança são aqueles que trabalham em especialidades cirúrgicas em serviços para apoiar o diagnóstico e a terapia. Resultados: em média, nas regiões de saúde do Brasil, 45% dos médicos em atividades circulam em mais de uma região. As capitais dos estados têm médicos mais estáveis, enquanto que mais de 50% da força de trabalho médica atua em outras regiões. Os profissionais com maior tendência de mudança são aqueles que trabalham em especialidades cirúrgicas em serviços para apoiar o diagnóstico e a terapia. Conclusões: há uma alta circulação de médicos entre as regiões, com características distintas entre regiões geográficas e regiões de saúde. No caso de Barretos, os profissionais se movimentam em função de sua associação profissional e de especialidades praticadas.

Physicians' circularity in health regions in Brazil / Circularidade dos médicos nas regiões de saúde no Brasil

Abstract Objectives: to characterize the medical circularity in Brazil and to discuss the case in the North and South Barretos regions, São Paulo. Methods: a cross-sectional study using secondary data from the national registrations and a case study of physician's sample in the North-Barretos and South-Barretos regions. Results: in the health regions in Brazil, on an average, 45% of the physicians in activities circulate in more than one region. The Capitals of the States have more stable physicians while more than 50% of the medical workforce work in other regions. The professionals with the greatest tendency to move from one work place to another are those who work in surgical specialties in services to uphold the diagnostic and therapy. Conclusions: there is a high circulation of physicians among the regions, with distinct characteristics between geographical and health regions. In case of Barretos area, the professionals move from one workplace to another according to their professional association and specialized practice.

Resumo Objetivos: caracterizar a circularidade médica no Brasil e a discutir o caso das regiões Norte-Barretos e Sul-Barretos, São Paulo. Métodos: estudo transversal com uso de dados secundários de cadastros nacionais e estudo de caso de uma amostra de médicos nas regiões Norte-Barretos e Sul-Barretos. Resultados: em média, nas regiões de saúde do Brasil, 45% dos médicos em atividades circulam em mais de uma região. As capitais dos estados têm médicos mais estáveis, enquanto que mais de 50% da força de trabalho médica atua em outras regiões. Os profissionais com maior tendência de mudança são aqueles que trabalham em especialidades cirúrgicas em serviços para apoiar o diagnóstico e a terapia. Conclusões: há uma alta circulação de médicos entre as regiões, com características distintas entre regiões geográficas e regiões de saúde. No caso de Barretos, os profissionais se movimentam em função de sua associação profissional e de especialidades praticadas.

Arthrocentesis procedure: using this therapeutic maneuver for TMJ closed lock management.

Temporomandibular joint (TMJ) disorder is a term that encompasses a number of overlapping conditions, such as closed lock. Closed lock of the TMJ is considered a consequence of a nonreducing deformed disc acting as an obstacle to the sliding condylar head that usually causes a decrease in the maximum mouth opening and acute pain. The management of the TMJ is still controversial. Thus, arthrocentesis of the TMJ is a valuable modification of the traditional method of arthroscopic lavage, which consists of washing the joint in order to remove chemical inflammatory mediators and intra-articular adhesions, changing intra-articular pressure. TMJ disorder has always presented as a therapeutic challenge to maxillofacial surgeons. Therefore, this paper aimed to describe a clinical report of a closed lock of the left TMJ in a 19-year-old female subject who was successfully treated by arthrocentesis procedure.

Osteonecrose dos maxilares relacionada ao uso de bisfosfonatos orais: relato de caso / Oral bisphosphonate-related osteonecrosis of the jaws: a case report

Os bisfosfonatos são uma classe de medicamentos caracterizados como potentes inibidores da reabsorção óssea conduzida por osteoclastos e têm sido empregados para o tratamento de diversas entidades patológicas que atingem o tecido ósseo, como osteoporose e metástases ósseas de tumores malignos. Porém, vem aumentando o número de publicações em relação a um efeito colateral destas drogas: a osteonecrose dos maxilares relacionada aos bisfosfonatos (OMARB). Este trabalho relata o caso de uma paciente que fazia uso de alendronato por via oral, por um período de aproximadamente dez anos, para tratamento de osteoporose. Na evolução do caso, verificou-seexposição óssea em região de palato duro e corpo de mandíbula, associada a quadro de dor. Foi conduzida uma revisão da literatura pertinente e o manejo da condição é discutido.

Bisphosphonates are a class of drugs characterized by being potent inhibitors of osteoclast-driven bone resorption, and are currently used for treatment of various conditions such as osteoporosis and metastatic lesions in bone. There has been an increase in reports of a serious side effect of these drugs, the bisphosphonate-related osteonecrosis ofthe jaws (BRONJ). We report on the case of a female patient who had been in use of oral alendronate for over 10 years due to osteoporosis. She presented to our outpatient clinics with painful exposure of bone intra-orally (hard palate and mandibular body). In this work, the pertinent literature is reviewed and the management of the condition is discussed.

Necrotizing sialometaplasia in a patient who is HIV positive: a case report.

Necrotizing sialometaplasia (NS) is a self-limiting, benign, inflammatory disease of the minor salivary glands of the hard palate. The main significance of the NS lesion lies in the fact that it may be mistaken for mucoepidermoid or squamous cell carcinoma. A case report is presented of a patient with NS who was HIV positive; the lesion was located in the minor salivary glands of the hard palate. Clinically, the lesion presented as a deep ulcer with slightly elevated irregular borders and a necrotic base in the hard palate. Histologically, the tissue was characterized by squamous metaplasia of ducts and acini, lobular coagulation necrosis, and pseudoepitheliomatous hyperplasia of the overlying epithelium. The lesion disappeared completely after 2 weeks.

Cleidocranial dysplasia associated with the dentigerous cyst: review of the literature and report of the clinical case / Displasia cleidocraniana associada a cisto dentígero: revisão da literatura e relato de caso clínico

Cleidocranial dysplasia is a developmental anomaly of the skeleton and teeth. It can be inherited as an autosomal dominant characteristic with high penetrance and variable expressivity. It occurs with equal frequency in both genders and races. The clinical appearance of cleidocranial dysplasia is pathognomonic. The stature is mildly to moderately shortened, with neck appearing long and narrow and the shoulders markedly drooped. Maxillary hypoplasia gives the mandible a relatively prognathic appearance, although some patients may show variable mandibular prognathism due to increased length of the mandible in conjunction with short cranial base. The head and neck features are very variable. Herein, we are described one cleidocranial dysplasia case, in an 84 year female patient, with the dentigerous cyst, which she were not kwon the diagnosis of the her congenital syndrome.

A displasia cleidocraniana é uma alteração de desenvolvimento do esqueleto e dos dentes. É uma desordem autossômica dominante com alta penetrância e expressibilidade variada. Ocorre em igual frequência em ambos os gêneros e raças. Suas características clínicas são patognomônicas. Apresenta estatura baixa a moderada, com aparência do pescoço longo e os ombros caídos. Hipoplasia da maxila gera um aparente prognatismo. As características clinicas em cabeça e pescoço são muito variadas. Este relato descreve um caso de uma paciente de 84 anos com displasia cleidocraniana associada a cisto dentígero a qual não sabia ser portadora de tal síndrome congênita.