BACKGROUND AND PURPOSE:Arthrogryposis is among the malformations of congenital Zika syndrome. Similar to the brain, there might exist a spectrum of spinal cord abnormalities. The purpose of this study was to explore and describe in detail the MR imaging features found in the spinal cords, nerve roots, and brains of children with congenital Zika syndrome with and without arthrogryposis.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been caused the greatest pandemic of our century. Many of the deaths related to it are due to a systemic inflammatory response, which has been called ‘cytokine storm’. Objectives We developed a comprehensive review of the pathophysiology mechanisms of COVID-19 and of the rationale for drugs and therapeutics that have been tested in clinical trials. Methods A narrative review of the literature was conducted using PubMed, SciELO, Bireme, Google Scholar and ClinicalTrials. Results SARS-CoV-2 has evolutive mechanisms that made it spread all around the globe, as a higher latency period and a lesser lethality than other coronaviruses. SARS-CoV-2 causes a delay in the innate immune response and it disarranges the immune system leading to an overwhelming inflammatory reaction (the ‘cytokine storm’). In this scenario, high levels of interleukins (IL), notably IL-6 and IL-1, create a positive feedback of chemokines and immune responses, and powers pulmonary and systemic tissue damage, leading to capillary leakage and SARS, the main cause of death in patients with COVID-19. On 17 July 2020, there were 1450 entries on ClinicalTrials.gov of ongoing studies on COVID-19. The mechanisms of the main therapeutic approaches were comprehensively reviewed throughout the text. Therapies focus on blocking viral entry (remdesivir, umifenovir, among others) and blocking of immune system for cytokine storm control (IL-1 and IL-6 inhibitors, glucocorticoids, convalescent plasma, among others). Conclusions Understanding of action mechanisms of SARS-CoV-2 enables us to direct efforts on effective therapeutic targets. This comprehensive review helps to interpret the clinical results of the several trials ongoing.

Background Psychological distress is common among medical trainees. This study aimed to assess the frequency of depression, anxiety and burnout among physician residents and their association with both individual and residency program-related factors. Methods This was a cross-sectional study applying an online survey in a national-wide sample of medical residents from Brazil. Depression, anxiety, burnout and diurnal somnolence were assessed with validated tools (Patient Health Questionnaire-4, 2 items version of Maslach Burnout Inventory, and Epworth Sleepiness Scale). Socio-demographic and residency program-related factors were measured with internally validated instruments. We performed multivariate binary logistic regression analysis for each of the main outcomes. Results Screening for depression, anxiety and burnout was positive respectively in 46.9%, 56.6% and 37.0% of our sample (n = 1,419). Depression was independently related to female sex, longer duty hours, absence of day off, poor learning perception, poor feeling about the residency program, overall occurrence of psychological abuse, anxiety, diurnal somnolence and burnout (AUROC = .859 [95%CI = .840-.878], p < .001). Anxiety was independently associated with female sex, higher age and duty hours, work-personal life conflicts, few classroom activities, providing assistance without supervision, depression and diurnal somnolence (837 [.816-.857], p < .001). Burnout was related to lower age and leisure time, male sex, longer duty hours, absence of day off, provision of care without supervision, choice of the wrong specialty, poor learning, psychological abuse, depression and diurnal somnolence (.780 [.753-.806], p < .001). Conclusion Frequency of psychological distress in residency training is high and related to both individuals and environmental factors, namely high workloads, occurrence of psychological abuse, poor faculty supervision, poor learning experience and work-personal life conflicts.

No abstract

Background Although a common complaint and related to factors frequently present in medical residency such as psychological distress, depression, and anxiety, headache is an issue poorly explored among medical residents. Methods This was a cross‐sectional study enrolling medical residents from all geographic regions of Brazil. We applied an online structured survey with demographic and residency program‐related questions, as well as validated tools to assess burnout, diurnal somnolence, anxiety, depression, and migraine. Results The link to the survey received 1989 clicks, of which 1421 individuals completed the questionnaire (71.4% of all clicks). The prevalence of at least 1 headache attack in the last 3 months was 1236/1419 (87.1%); migraine occurred in 400/1419 (28.2%). Frequent headache attacks (headaches occurring daily or often) were associated with female sex (OR = 1.80 [95%CI = 1.36‐2.37]), substantial weight gain (1.93 [1.38‐2.70]), migraine (5.49 [4.16‐7.24]), anxiety (1.45 [1.06‐1.98]), depression (1.98 [1.47‐2.67]), emotional exhaustion domain of burnout (1.49 [1.09‐2.04]), and diurnal somnolence symptoms (1.32 [1.00‐1.76]). Headaches with functional impact were associated with female sex (1.39 [1.10‐1.74]), clinical training areas (1.32 [1.06‐1.65]), anxiety (1.74 [1.38‐2.21]), an unsatisfactory work‐life balance (1.57 [1.17‐2.09]), the emotional exhaustion component of burnout (1.49 [1.14‐1.94]), and an unsatisfactory subjective learning curve (1.30 [1.02‐1.67]). Migraine was associated with female sex (3.10 [2.34‐4.13]), anxiety (2.53 [1.94‐3.31]), more than 60 hours duty‐hours in residency (1.66 [1.29‐2.15]), psychological abuse from patients (1.42 [1.06‐1.90]) and a clinical training area (1.34 [1.04‐1.73]). Conclusion Headaches among medical residents are frequent and are related not only to depression, anxiety, burnout, and diurnal somnolence, but also to aspects closely related to residency training such as the occurrence of mistreatment, longer duty‐hours, a poor work‐life balance, and an unsatisfactory learning curve.

A man, 26years-old, presented fever, mental confusion and a progressively worsening headache 6days prior to admission. The CSF study was suggestive of meningoencephalitis, the PCR study revealed presence of HSV-1 and ZIKV, while other immunology tests were negative. ZIKV was also identified in serum. The MRI showed temporal lobe hyper-intensity in FLAIR-weight sequence with areas of contrast enhancement and the electroencephalogram showed slow wave activity in such region. Patient was treated with acyclovir and supportive measures and had good clinical outcome at evaluation after 6 months. Neurological spectrum of ZIKV manifestations is wide, but meningoencephalitis is not frequent. Co-infection HSV-1 plus ZIKV was not yet related in humans, but there is increased cellular damage caused by association of ZIKV and herpes virus family infection. ZIKV may facilitate infection or recrudescence by other viruses or cause concurrently neuronal injury by direct or indirect mechanisms. We suggest that clinicians attempt new manifestations related to ZIKV and include this agent in differential diagnosis of neurological diseases even when other agents were identified.

No abstract

Introdução: A transmissão SARS-CoV-2 de humano para humano pode ocorrer e o risco de propagação no ar durante os procedimentos odontológicos geradores de aerossóis permanece uma preocupação. Acredita-se que um enxaguatório bucal antimicrobiano pré-operacional reduza o número de micróbios orais. No entanto, a eficácia do enxaguatório bucal pré-procedimento na redução do número de microrganismos disseminados por meio do aerossol gerado por procedimentos odontológicos ainda não está clara. Objetivo: avaliar através de uma revisão de literatura o uso de enxaguantes bucais na redução da carga viral do SARS-CoV-2. Materiais e Método: O levantamento literário para esta pesquisa foi realizado no período de dezembro de 2019 a 10 de agosto de 2020 nas bases de dados Scielo e Medline/PubMed. Na estratégia de busca, foram utilizadas as palavras “SARS-CoV-2”, “2019-nCoV”, “COVID-19”, “Dentistry”, “Odontologia”, “Odontología”, “Mouthwashes”, “Antissépticos Bucais” e “Antisépticos Bucales”.  Resultados: Uma busca sistematizada foi realizada, foram encontrados 661 artigos, após a realização da leitura criteriosa dos artigos completos foram selecionados 42 artigos. 88% dos estudos indicavam o uso de Peróxido de hidrogênio a 1%, 76% indicavam Povidine 0,2% e apenas 19% o uso da Clorexidina a 0,12%. Conclusão: Os estudos presentes na literatura apresentam divergências nas indicações e porcentagens dos enxaguantes indicados. Os protocolos clínicos devem ser avaliados para reduzir o risco de transmissão e proteger pacientes e profissionais.Descritores: Infecções por Coronavírus; Betacoronavirus; Odontologia; Antissépticos Bucais.ReferênciasGe ZY, Yang LM, Xia JJ, Fu XH, Zhang YZ. Possible aerosol transmission of COVID-19 and special precautions in dentistry. J Zhejiang Univ Sci B. 2020;21(5):361-68. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):9.Fallahi HR, Keyhan SO, Zandian D, Kim SG, Cheshmi B. Being a front-line dentist during the Covid-19 pandemic: a literature review. Maxillofac Plast Reconstr Surg. 2020;42(1):12.Yoon JG, Yoon J, Song JY, Yoon SY, Lim CS, Seong H, et al. Clinical Significance of a High SARS-CoV-2 Viral Load in the Saliva. J Korean Med Sci. 2020;35(20):e195.Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J. 2020;32(4):181-86.Amato A, Caggiano M, Amato M, Moccia G, Capunzo M, De Caro F. Infection Control in Dental Practice During the COVID-19 Pandemic. Int J Environ Res Public Health. 2020;17(13):4769.Amorim, LM, Maske TT, Ferreira SH, Santos RB, Feldens CA, Kramer PF. New Post-COVID-19 Biosafety Protocols in Pediatric Dentistry. Pesqui Bras Odontopediatria Clín. Integr. 2020;  20(Suppl 1): e0117.Araya-Salas,C. Consideraciones para la Atención de Urgencia Odontológica y Medidas Preventivas para COVID-19 (SARS-CoV 2). Int. J. Odontostomat. 2020;14(3):268-70.Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care. J Endod. 2020;46(5):584-95.Bahramian H, Gharib B, Baghalian A. COVID-19 Considerations in Pediatric Dentistry. JDR Clin Trans Res. 2020:2380084420941503.Bajaj N, Granwehr BP, Hanna EY, Chambers MS. Salivary detection of SARS-CoV-2 (COVID-19) and implications for oral health-care providers. Head Neck. 2020;42(7):1543-47.Barabari P, Moharamzadeh K. Novel Coronavirus (COVID-19) and Dentistry-A Comprehensive Review of Literature. Dent J (Basel). 2020;8(2):53.Barca I, Cordaro R, Kallaverja E, Ferragina F, Cristofaro MG. Management in oral and maxillofacial surgery during the COVID-19 pandemic: Our experience. Br J Oral Maxillofac Surg. 2020;58(6):687-91.Bhanushali P, Katge F, Deshpande S, Chimata VK, Shetty S, Pradhan D. COVID-19: Changing Trends and Its Impact on Future of Dentistry. Int J Dent. 2020;2020:8817424.Cabrera-Tasayco FDP, Rivera-Carhuavilca JM, Atoche-Socola KJ, Pena-Soto C, Arriola-Guillen LE. Biosafety measures at the dental office after the appearance of COVID-19: A systematic review. Disaster Med Public Health Prep. 2020:1-16. Carrouel F, Conte MP, Fisher J, et al. COVID-19: A Recommendation to Examine the Effect of Mouthrinses with beta-Cyclodextrin Combined with Citrox in Preventing Infection and Progression. J Clin Med. 2020;9(4):1126.Chen W, Wang Q, Li YQ, Yu HL, Xia YY, Zhang ML, et al. [Early containment strategies and core measures for prevention and control of novel coronavirus pneumonia in China]. Zhonghua Yu Fang Yi Xue Za Zhi. 2020;54(3):239-44.Duruk G, Gumusboga ZS, Colak C. Investigation of Turkish dentists' clinical attitudes and behaviors towards the COVID-19 pandemic: a survey study. Braz Oral Res. 2020;34:e054.Baghizadeh Fini M. What dentists need to know about COVID-19. Oral Oncol. 2020;105:104741.Guiñez-Coelho, M. Impacto del COVID-19 (SARS-CoV-2) a Nivel Mundial, Implicancias y Medidas Preventivas en la Práctica Dental y sus Consecuencias Psicológicas en los Pacientes. Int. J. Odontostomat. 2020;14(3):271-78.Guo Y, Jing Y, Wang Y, To A, Du S, Wang L,et al. Control of SARS-CoV-2 transmission in orthodontic practice. Am J Orthod Dentofacial Orthop. 2020;S0889-5406(20):30307-3.Gurzawska-Comis K, Becker K, Brunello G, Gurzawska A, Schwarz F. Recommendations for Dental Care during COVID-19 Pandemic. J Clin Med. 2020;9(6):1833.Ilyas N, Agel M, Mitchell J, Sood S. COVID-19 pandemic: the first wave - an audit and guidance for paediatric dentistry. Br Dent J. 2020; 228(12):927-3.Jamal M, Shah M, Almarzooqi SH, Aber H, Khawaja S, El Abed, et al. Overview of transnational recommendations for COVID-19 transmission control in dental care settings. Oral Dis. 2020.10.1111/odi.13431.Jotz GP, Voegels RL, Bento RF. Otorhinolaryngologists and Coronavirus Disease 2019 (COVID-19). Int. Arch. Otorhinolaryngol. 2020;24(2):125-28.Kerawala C, Riva F. Aerosol-generating procedures in head and neck surgery - can we improve practice after COVID-19? Br J Oral Maxillofac Surg. 2020;58(6):704-7.Koutras S, Govender S, Wood NH, Motloba PD. COVID-19 pandemic and the dental practice. S. Afr. dent. j. 2020;75(3):119-25. Lo Giudice R. The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) in Dentistry. Management of Biological Risk in Dental Practice. Int J Environ Res Public Health. 2020;17(9):3067.Long RH, Ward TD, Pruett ME, Coleman JF, Plaisance MC, Jr. Modifications of emergency dental clinic protocols to combat COVID-19 transmission. Spec Care Dentist. 2020;40(3):219-26.Martins-Chaves RR, Gomes CC, Gomez RS. Immunocompromised patients and coronavirus disease 2019: a review and recommendations for dental health care. Braz Oral Res. 2020;34:e048.Naqvi K, Mubeen SM, Ali Shah SM. Challenges in providing oral and dental health services in COVID-19 pandemic. J Pak Med Assoc. 2020;70(Suppl 3)(5):S113-17.Passarelli PC, Rella E, Manicone PF, Garcia-Godoy F, D'Addona A. The impact of the COVID-19 infection in dentistry. Exp Biol Med (Maywood). 2020;245(11):940-44.Patil S, Moafa IH, Bhandi S, Jafer MA, Khan SS, Khan S,et al. Dental care and personal protective measures for dentists and non-dental health care workers. Dis Mon. 2020;101056.Peditto M, Scapellato S, Marciano A, Costa P, Oteri G. Dentistry during the COVID-19 Epidemic: An Italian Workflow for the Management of Dental Practice. Int J Environ Res Public Health. 2020;17(9):3325.Romero MR. Guía de buenas prácticas en Odontología para Uruguay durante la pandemia Covid-19. Odontoestomatología. 2020;22, 22(Supl 1):25-37.Sales PH, Sales PL, Da Hora Sales ML. COVID-2019. How to decrease the risk of infection in dental practice? Minerva Stomatol. 2020; 10.23736/S0026-4970.20.04372-1.Sarfaraz S, Shabbir J, Mudasser MA, Khurshid Z, Al-Quraini AAA,Abbasi MS, et al. Knowledge and Attitude of Dental Practitioners Related to Disinfection during the COVID-19 Pandemic. Healthcare (Basel). 2020;8(3):E232.Sigua-Rodríguez EA, Bernal-Pérez JL, Lanata-Flores AG, Sánchez-Romero C, Rodríguez-Chessa J, Haidar ZS, et al. COVID-19 y la Odontología: una revisión de las recomendaciones y perspectivas para latinoamérica. Int J Odontostomat. 2020;14(3):299-309.Siles-Garcia AA, Alzamora-Cepeda AG, Atoche-Socola KJ, Pena-Soto C, Arriola-Guillen LE. Biosafety for dental patients during dentistry care after COVID-19: A review of the literature. Disaster Med Public Health Prep. 2020:1-17.Turkistani KA. Precautions and recommendations for orthodontic settings during the COVID-19 outbreak: A review. Am J Orthod Dentofacial Orthop. 2020;158(2):175-81.Volgenant CMC, Persoon IF, de Ruijter RAG, de Soet JJH. Infection control in dental health care during and after the SARS-CoV-2 outbreak. Oral Dis. 2020;10.1111/odi.13408.Wu KY, Wu DT, Nguyen TT, Tran SD. COVID-19's impact on private practice and academic dentistry in North America. Oral Dis. 2020;10.1111/odi.13444.Zimmermann M, Nkenke E. Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic. J Craniomaxillofac Surg. 2020;48(5):521-26.Xu H, Zhong L, Deng J, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12(1):8.Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-73.Meng L, Hua F, Bian Z. Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine. J Dent Res. 2020;99(5):481-87.Eggers M, Koburger-Janssen T, Eickmann M, Zorn J. In vitro bactericidal and virucidal efficacy of povidone-iodine gargle/mouthwash against respiratory and oral tract pathogens. Infect Dis Ther. 2018;7(2):249-59.Lin L, Li TS. [Interpretation of "Guidelines for the Diagnosis and Treatment of Novel Coronavirus (2019-nCoV) Infection by the National Health Commission (Trial Version 5)"]. Zhonghua Yi Xue Za Zhi. 2020;100(0):E001.Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect. 2020;104(3):246-51.Martinez Lamas L, Diz Dios P, Perez Rodriguez MT, Pérez VDC, Alvargonzales JJC, Domínguez AML, et al. Is povidone iodine mouthwash effective against SARS-CoV-2? First in vivo tests. Oral Dis. 2020;10.1111/odi.13526.Marui VC, Souto MLS, Rovai ES, Romito GA, Chambrone L, Pannuti CM. Efficacy of preprocedural mouthrinses in the reduction of microorganisms in aerosol: A systematic review. J Am Dent Assoc. 2019;150(12):1015-26.e1.