Main differences between two highly effective lipid-lowering therapies in subclasses of lipoproteins in patients with acute myocardial infarction.

BACKGROUND: Large observational studies have shown that small, dense LDL subfractions are related to atherosclerotic cardiovascular disease. This study assessed the effects of two highly effective lipid-lowering therapies in the atherogenic subclasses of lipoproteins in subjects with ST-segment elevation myocardial infarction (STEMI). METHODS: Patients of both sexes admitted with their first myocardial infarction and submitted to pharmacoinvasive strategy (N = 101) were included and randomized using a central computerized system to receive a daily dose of simvastatin 40 mg plus ezetimibe 10 mg or rosuvastatin 20 mg for 30 days. Intermediate-density lipoprotein (IDL) and low-density lipoprotein (LDL) subfractions were analysed by polyacrylamide gel electrophoresis (Lipoprint System) on the first (D1) and 30th days (D30) of lipid-lowering therapy. Changes in LDL and IDL subfractions between D1 and D30 were compared between the lipid-lowering therapies (Mann-Whitney U test). RESULTS: The classic lipid profile was similar in both therapy arms at D1 and D30. At D30, the achievement of lipid goals was comparable between lipid-lowering therapies. Cholesterol content in atherogenic subclasses of LDL (p = 0.043) and IDL (p = 0.047) decreased more efficiently with simvastatin plus ezetimibe than with rosuvastatin. CONCLUSIONS: Lipid-lowering therapy with simvastatin plus ezetimibe was associated with a better pattern of lipoprotein subfractions than rosuvastatin monotherapy. This finding was noted despite similar effects in the classic lipid profile and may contribute to residual cardiovascular risk. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02428374, registered on 28/09/2014.

Esthetic elastomeric ligatures: Quantification of bacterial endotoxin in vitro and in vivo.

INTRODUCTION: The objective of this study was to evaluate in vitro and in vivo bacterial endotoxin (LPS) adhesion in polyurethane and silicone esthetic elastomeric orthodontic ligatures. The null hypotheses tested were: (1) there is no LPS adhesion in esthetic elastomeric orthodontic ligatures; and (2) there is no difference in the LPS adhesion between different brands of these ligatures. METHODS: For the in vitro study, 4 types of esthetic elastomeric ligatures were used (Sani-Ties and Sili-Ties [Dentsply GAC, Islandia, NY;] and Mini Single Case Ligature Stick and Synergy low-friction ligatures [Rocky Mountain Orthodontics, Denver, Colo]), contaminated or not with endotoxin solution. Replicas of twisted wire and cast stainless steel ligatures were used as control. For the in vivo study, 10 male and 10 female patients, aged 15-30 years, received the same 4 types of ligatures, 1 of each inserted in the maxillary and mandibular canines, randomly. Twenty-one days later, the ligatures were removed, and endotoxin quantification was performed using the Limulus amebocyte lysate test. Data were analyzed (α = 0.05) using the Kruskal-Wallis test and Dunn's posttest or analysis of variance and Tukey's posttest. RESULTS: GAC silicone group had the lowest median contamination (1.15 endotoxin units/mL; P <0.0001) in vitro. In the in vivo study, the GAC silicone group had the lowest mean contamination (0.577 endotoxin units/mL; P <0.001). In both studies, the other groups did not present a significant difference when compared with each other (P >0.05). CONCLUSIONS: LPS exhibited an affinity for all the tested polyurethane and silicone elastomeric ligatures. GAC silicone ligatures presented with lower amounts of LPS attached to their surfaces. Thus, both null hypotheses were rejected.

Overburden soil and marine dredging sludge utilization for production of new composites as highly efficient environmental management.

The main objectives of this study were to develop new composites only from industrial wastes: overburden soil (40-60 wt%), dredging sludge from marine port sediments (20-40%) and lime production waste as a binder (15-30%). The axial resistance strength of the developed materials, on the 365th day, was 18.9 MPa and the values of apparent density and dilatation coefficient ranged from 2.69 to 3.14 g/cm³ and from 0.14 to 1.56%, respectively. Water absorption values after 90 days of cure varied between 8.9 and 15.1% and water resistance coefficient reached 1.17. They can be used for the production of construction materials such as tiles, bricks, and blocks, as road base and airfield runways, dam cores, industrial and municipal waste dumps bases, building foundations. The studies of the developed material, by the methods of XRD, AAS, SEM, EDS, DTA - DTG, tomographic mapping of the chemical elements and isotopic composition (LAMMA), demonstrated the synthesis of new formations, mainly amorphous, with small inclusions of crystalline structures. Results of leaching and solubility tests by the AAS method showed the full ecological compatibility of the developed materials with the environmental standards of Brazil.

Consumers' perceptions toward 3 different fermented dairy products: Insights from focus groups, word association, and projective mapping.

Yogurts, fermented milk beverages, and fermented milks have great similarity and are widely accepted by Brazilian population, but the factors that influence their choice and consumption are unknown. In this sense, the present study aimed to identify the main aspects involved in consumers' perception of 3 different products, comparing the findings by using the 2 fast qualitative methods, word association and projective mapping, and a standard method, focus group. The tasks were performed by different participants through graphic stimuli (word association and projective mapping) and focus interviews (focus group). Results showed that all the 3 methodologies identified numerous intrinsic and extrinsic factors that influence the consumer choices regarding fermented dairy products. Major dimensions were closely related to the sensory aspects, emotional factors, perception of benefits, and composition, among others. It is noteworthy that the stimuli related to fermented milk beverages evoked rejecting responses, possibly due to the dissociation between information and consumers' expectation. Although minor differences were observed between the number and type of dimensions that were obtained, similar conclusions can be drawn from all 3 sensory methods, which shows the relevance of qualitative and projective methods for investigation of consumers' perception. These findings can help dairy companies to provide subsidies and guidelines for the reformulation of their products, marketing strategies, and improvement in the communication between producers and consumers from different fermented dairy products.

The effects of the use of customized silicone digital orthoses on pre-ulcerative lesions and plantar pressure during walking in people with diabetic neuropathy: A study protocol for a randomized controlled trial.

Background: People with diabetes and diabetic peripheral neuropathy (DPN) often develop calluses due to toe misalignment and increased plantar pressure. Untreated, these issues can progress into ulcers, making early intervention crucial. This trial protocol aims to evaluate the efficacy and safety of customized silicone digital orthoses in preventing ulcers, pre-ulcerative lesions, and peak pressure during gait in people with DPN. Methods: In this superiority randomized controlled parallel trial with single-blind assessment, 60 participants will be allocated to the control group (CG) or the intervention group (IG). The CG will receive specialized nurse-administered foot care, including callus removal, nail care guidance, and self-care education. The IG will receive the same care plus a customized silicone orthosis for toe realignment for 6 months. Assessments will occur at baseline and 3 and 6 months for the primary outcomes (pre-ulcerative lesions and ulcer incidence) and secondary outcomes (pressure distribution, foot function and health, quality of life, safety, and comfort). Two-way ANOVAs (p < .05) will assess group, time, and group by time effects following an intention-to-treat approach. Conclusion: Although recommended for foot ulcer prevention, custom silicone orthosis adoption remains limited due to the low certainty of evidence. This trial seeks to provide more consistent evidence for the use of toe orthoses in preventing callus and ulcer formation for individuals with DPN. Trial registry: ClinicalTrials.gov (NCT05683106) "Effects of Customized Silicone Digital Orthoses in People with Diabetic Neuropathy" (registered on December 20, 2022).

Diet as an epigenetic factor in inflammatory bowel disease.

Inflammatory bowel disease (IBD) has as a main characteristic the exacerbation of the immune system against enterocytes, compromising the individual's intestinal microbiota. This inflammatory cascade causes several nutritional deficiencies, which further compromise immunological functioning and, as a result, worsen the prognosis. This vicious cycle can be interrupted as the patient's dietary pattern meets their needs according to their clinical condition, acting directly on the inflammatory process of IBD through the interaction of food, intestinal microbiota, and epigenome. Specific nutritional intervention for IBD has a crucial role in preventing and managing disease activity. This review addresses epigenetic modifications through dietary compounds as a mechanism for modulating the intestinal microbiota of patients with IBD.

Role of the phase angle in the prognosis of the cirrhotic patient: 15 years of follow-up.

BACKGROUND: In 2019, cirrhosis accounted for 2.4% of global deaths. The projection for 2030 is an increase in this index. In recent years, hospitalization costs have escalated by 36% for compensated cirrhosis and 24% for decompensated cirrhosis. Therefore, it is necessary to identify a tool capable of predicting the mortality of these patients according to their clinical condition and consequently extending their survival time. Different studies have shown that the phase angle (PA) can be a feasible method in clinical practice, with the potential to guide assertive patient management in the therapeutic of chronic liver disease. AIM: To evaluate the prognostic role of PA in cirrhotic patients over a 15-year follow-up period. METHODS: Retrospective cohort study with 129 cirrhotic patients of both sexes over 18 years old. Diagnosis of cirrhosis by liver biopsy. The first year of data collection was 2007, and data regarding outcomes was collected in 2023. Data were gathered from medical records, such as esophageal varices (EV), EV bleeding, ascites, spontaneous bacterial peritonitis (SBP), encephalopathy, laboratory findings and PA. The cut-off value for the PA was 5.4°, a value described in 2012 by Fernandes et al for 129 patients evaluated in this study and the cut-off points for the Brazilian population presented in percentiles (P), as described by Mattiello et al. The mortality was assessed using the PA percentile through Kaplan-Meier curves and multivariate binary logistic regression models. RESULTS: Patients were divided into two groups according to the PA 5.4th (PA > 5.4°, n = 40; PA ≤ 5.4°, n = 89) PA percentile (< P50, n = 56; ≥ P50 n = 73). The percentile classification was more accurate in identifying long-term deaths than the 5.4º PA. Patients with < P50 had a higher number of relevant complications such as ascites, SBP, liver encephalopathy and HCC. PA is strongly correlated with serum albumin (P < 0.001), International Normalized Ratio (P = 0.01), total bilirubin (P = 0.02) and direct bilirubin (P = 0.003). PA is correlated with survival time (P < 0.001) and length of stay (P = 0.02). Logistic regression analysis shows that an increase of 1° in PA enlarges the cirrhotic patient's chance of survival by 17.7%. CONCLUSION: PA is a good predictor of morbidity and mortality for cirrhotic patients. The PA by percentile showed greater sensitivity in predicting mortality compared to the cut-off point of 5.4º.

Placental Development and Physiological Changes in Pregnant Ewes in Silvopastoral and Open Pasture Systems during the Summer.

This study aimed to analyze the reproductive and physiological changes in ewes subjected to heat stress during pregnancy at UTFPR-Brazil. Twenty-four pregnant crossbred ewes were kept in a silvopastoral system (SP) or an open pasture system (OP) throughout the final trimester of pregnancy. Both systems were stressful, but the SP system had lower air temperature than the OP system (26.0 ± 0.38 and 26.9 ± 0.41 °C, respectively; p = 0.0288). Moreover, the radiant thermal load of the two groups presented a difference of 34 Wm-2 (p = 0.0288), and the grass temperature was also lower in the SP system compared to that in the OP system (23.4 ± 0.37 and 25.6 ± 0.44 °C, respectively; p = 0.0043). The respiratory and heart rates of animals from the OP group were higher than those from the SP group (p < 0.001), but no difference was observed in the mobilization of white blood cells (p = 0.4777), and the neutrophil count was only affected by time (p < 0.0001). As regards placental biometry, placentas in twin pregnancies had a greater membrane area (p = 0.0223), but no differences between the systems were observed in placental weight (p = 0.1522) and the number of cotyledons (p = 0.5457). We concluded that the type of rearing system used affects the thermal comfort of pregnant ewes, and that an SP system can offer more amenable microclimatic conditions, which result in greater comfort for the ewes.

Relationship between phase angle, steatosis, and liver fibrosis in patients coinfected with human immunodeficiency virus/hepatitis C virus.

BACKGROUND: Malnutrition, lipodystrophy, and dyslipidemia are prevalent characteristics in patients with human immunodeficiency virus (HIV) infection with or without previous treatment. Such a clinical condition can lead to the hypothesis of the presence of hepatic steatosis with possible progression to fibrosis and the risk of hepatocellular carcinoma. Notably, a low phase angle (PA), evaluated by bioelectrical impedance analysis (BIA), is an independent prognostic marker of clinical progression and survival in HIV-infected patients. AIM: To evaluate the relationship between PA and body composition with steatosis and hepatic fibrosis in HIV/hepatitis C virus (HCV)-coinfected patients. METHODS: A retrospective observational study by convenience sampling of coinfected HIV/HCV patients, in which all patients underwent transient elastography (Fibroscan) and BIA evaluation. Student's t test was used for group comparisons, and Spearman's or Pearson's correlation test was used when appropriate. The significance level was set at 5%, and analyses were performed using SPSS version 21.0. RESULTS: Forty-three patients who received antiretroviral therapy met the inclusion criteria, and 23 (53.5%) were under treatment with protease inhibitors (PIs). There was no difference in PA between those who used PIs and those who did not (P = 0.635). There was no correlation between fibrosis grade and PA (P = 0.355) or lean mass (P = 0.378). There was a significant inverse correlation between the controlled attenuation parameter (CAP) and lean mass (P = 0.378), positive correlation between PA and lean mass (P = 0.378), and negative correlation between PA and fatty mass (P = 0.378), although the CAP and PA were not correlated. When evaluated by sex, no significant correlations were found. CONCLUSION: PA determines the muscle function of HIV/HCV-coinfected patients, and the CAP values reinforce the association with lean mass, suggesting that patients require early nutritional interventions.

VITAMIN B12 AND HOMOCYSTEINE LEVELS IN PATIENTS WITH NAFLD: A SYSTEMATIC REVIEW AND METANALYSIS.

BACKGROUND: The vitamin B12 absorption can be affected in patients with nonalcoholic fatty liver disease (NAFLD), and low serum vitamin B12 levels has been related to the high homocysteine (HCY) levels and to the degree of NAFLD. OBJECTIVE: To carry out a systematic review and metanalysis of serum vitamin B12 and HCY levels in patients with NAFLD. METHODS: Original studies including serum vitamin B12 and HCY levels in humans with NAFLD were included. The searches were performed in four databases. RESULTS: 159 studies were identified, and after excluding the duplicates and non-eligible titles, eight original articles were included. Six out of eight showed higher B12 levels in NAFLD patients (404.9±136.2 pg/mL in relation to controls 353.91±117.3 pg/mL). Seven of the eight studies also showed higher HCY levels in NAFLD patients (14.2±3.44 umol/L in relation to controls 11.05±3.6 umol/L). The results for serum vitamin B12 and HCY levels were submitted to metanalysis, showing no difference in the vitamin B12 levels between patients with NAFLD and controls. However, the levels of Hcy were higher in NAFLD patients than in controls. CONCLUSION: There was no relashionship between the vitamin B12 levels and NAFLD. The levels of HCY were significantly higher in patients with NAFLD, suggesting this could be a potential marker for liver damage.

Bilateral Traumatic Testicular Dislocation.

Traumatic testis dislocation is an uncommon condition and usually occurs after direct impact on the scrotum. We present an uncommon case of bilateral testicular dislocation caused by an automotive accident, which is the most frequently associated cause described in literature today. Although the fact that diagnosis can be made either by physical examination or with the use of basic exams such as Doppler ultrasound, it is not uncommon for cases to go undetected and diagnosed late. In this case, there was a late diagnosis, almost one year after the motorcycle accident. Despite this, studies describe preservation of spermatogenesis even after delayed surgical correction. The treatment can be made by manual reduction, but most of the cases need surgical correction. Therefore, it is always necessary to perform the complete physical examination of the polytrauma patient on the first medical exam, in order to avoid the risk of fertility loss, endocrine dysfunction, and future malignancy.

Educação permanente em saúde sobre estomias intestinais com enfermeiros de São Bento do Sul (SC): relato de experiência / Permanent health education on intestinal ostomy with nurses from São Bento do Sul (SC): Experience report / Educación permanente en salud sobre estomales intestinales con enfermeros de São Bento do Sul (SC): Informe de experiencia

Introdução:No Brasil a pessoa estomizadaé contemplada com diretrizes e políticas públicas, além de ser entendida como uma deficiência, sendo necessário assim um cuidado integral, exigindo do profissional que presta a assistência e/ou orientação educação permanente. Objetivo:Relatar uma experiência sobre cuidados de enfermagem com estomias intestinais aos enfermeiros atuantes na Secretaria Municipal de São Bento do Sul/Santa Catarina Metodologia: Trata-se deum estudo descritivo qualitativo do tipo relato de experiência, que se deu através de capacitação realizada em Junho de 2022, com os enfermeiros que atuam na secretaria municipal de saúde de São Bento do Sul, o qual conta com 44 enfermeiros atuantes em 21 unidades básicas de saúde , com a temática cuidados de enfermagem com estomia de eliminação', tendo o mesmo sido ministrado por enfermeira estomaterapeuta no formato presencial com discussão teórica e prática.Resultados e discussão: O Ministério da Saúde vem incentivando práticas formativas aos profissionais inseridos nos serviços, amparadasna Política Nacional de Educação Permanente. Uma vez que a formação de enfermeiros no Brasil é generalista, os cursos e capacitação se tornam uma ferramenta fundamental para uma atuação reflexiva. Dos 44 enfermeiros atuantes no município, participaram do treinamento 21 (47,72%), atendendo ao critério de ao menos um profissional por UBS, podendo este ser um multiplicador de conhecimento, estratégia importante da educação permanente em saúde. Ao final do curso, foram desenvolvidos fluxos de atendimento com os participantes, buscando a descentralização do cuidado para as unidades básicas de cada enfermeiro, favorecendo a criação de vínculo dos pacientes com a equipe. Conclusões:Umprofissional orientado e seguro em sua prática implica diretamente na segurança do paciente, nesse sentido a realização de atividades como cursos, capacitações e eventos, principalmente quando se trata de pacientes estomizados se tornam importantes ferramentas de aprimoramento profissional (AU).

Introduction:In Brazil, people with a stoma are covered by guidelines and public policies, in addition to being understood as a disability, thus requiring comprehensive care, requiring permanent education from the professional who provides assistance and/or guidance. Objective:To report an experience on nursing care with intestinal ostomies to nurses working at the Municipal Secretariat of São Bento do Sul/Santa Catarina. Methodology:This is a qualitative descriptive study of the experience report type, which took place through training carried out in June 2022, with nurses who work at the municipal health department of São Bento do Sul, which has 44 nurses working in 21 basic health units, with the theme of nursing care with elimination stoma', with the same being taught by a stoma therapy nurse in a face-to-face format with theoretical and practical discussion. Results and discussion:The Ministry of Health has been encouraging training practices for professionals working in services, supported by the National Permanent Education Policy. Since the training of nurses in Brazil is generalist, courses and training become a fundamental tool for reflective action. Of the 44 nurses working in the city, 21 (47.72%) participated in the training, meeting the criteria of at least one professional per UBS, which could be a knowledge multiplier, an important strategy for continuing health education. At the end of the course, care flows were developed with the participants, seeking to decentralize care to each nurse's basic units, favoring the creation of a bond between patients and the team.Conclusion: A professional who is oriented and confident in his practice directly implies patient safety, in this sense, carrying out activities such as courses, training and events, especially when dealing with stoma patients, become important tools for professional improvement (AU).

Introducción:En Brasil, las personas ostomizadasestán cubiertas por directrices y políticas públicas, y entendidas como una discapacidad, por lo que requieren atención integral y profesionales que brinden asistencia y/o orientación en educación continua. Objetivo:Relatar la experiencia como enfermerostrabajando en la Secretaría Municipal de São Bento do Sul/Santa Catarina en la atención de ostomías intestinales. Metodología:Estudio cualitativo descriptivo, del tipo relato de experiencia, realizado a través de una capacitación realizada en junio de 2022, con cuarenta y cuatro enfermeros que actúan en la Secretaría Municipal de Salud de São Bento do Sul, con el tema "Asistencia de enfermería a la eliminación del estoma". Impartido por una enfermera estomatóloga en formato presencial con discusión teórica y práctica. Resultados y discusión:El Ministerio de Salud viene incentivando prácticas de formación de profesionales que actúan en los servicios, apoyados en la Política Nacional de Educación Permanente. Dado que la formación de enfermeros en Brasil es generalista, los cursos y capacitaciones se convierten en una herramienta fundamental para la acción reflexiva. De los 44 enfermeros que actúan en la ciudad, 21 (47,72%) participaron de la capacitación, cumpliendo con el criterio de al menos un profesionalpor UBS, lo que podría ser un multiplicador de conocimientos, una estrategia importante para la educación continua en salud. Al final del curso, se desarrollaron flujos de atención con los participantes, buscando descentralizar la atención hacia las unidades básicas de cada enfermero, favoreciendo la creación de vínculo entre los pacientes y el equipo. Conclusiones:Un profesional orientado y confiado en su práctica implica directamente la seguridad del paciente, en este sentido, la realización de actividades como cursos, capacitaciones y eventos, especialmente cuando se trata de pacientes estomáticos se convierten en importantes herramientas de superación profesional (AU).

Consumer-based product characterization using Pivot Profile, Projective Mapping and Check-all-that-apply (CATA): A comparative case with Greek yogurt samples.

Product characterization has been a primary concern for the food industry, and methodologies based on consumers' perceptions have become popular and widely used by industries to replace classical methods. Although there are several studies on other methods, the potential of reference-based one such as Pivot Profile is still little explored. Therefore, the aims of this study were to characterize Greek yogurt samples according to consumers' perceptions using three different methodologies: Pivot Profile (PP), Check-all-that-apply (CATA), and Projective Mapping (PM), and to assess which method is easier for consumers to describe products. The rapid methodologies assessed were equally effective in characterizing the different samples; however, some drawbacks evidenced in the study can help in targeting and choosing the best method to perform the sensory characterization. Pivot Profile showed some advantages, bypassing some limitations presented by the other methods. In addition, its experimental versatility also allows for broad applications evidencing the PP technique as a promising tool for routine use. Some implications of using it were also discussed. We suggest the supplemental use of Multidimensional Alignment (MDA) as it shows more accurately the correlations between attributes and samples, especially in the case of PP data.

Vitamina B12 e homocisteína em pacientes com DHGNA: revisão sistemática e metanálise / Vitamin b12 and homocysteine levels in patients with nafld: a systematic review and metanalysis

ABSTRACT BACKGROUND: The vitamin B12 absorption can be affected in patients with nonalcoholic fatty liver disease (NAFLD), and low serum vitamin B12 levels has been related to the high homocysteine (HCY) levels and to the degree of NAFLD. OBJECTIVE: To carry out a systematic review and metanalysis of serum vitamin B12 and HCY levels in patients with NAFLD. METHODS: Original studies including serum vitamin B12 and HCY levels in humans with NAFLD were included. The searches were performed in four databases. RESULTS: 159 studies were identified, and after excluding the duplicates and non-eligible titles, eight original articles were included. Six out of eight showed higher B12 levels in NAFLD patients (404.9±136.2 pg/mL in relation to controls 353.91±117.3 pg/mL). Seven of the eight studies also showed higher HCY levels in NAFLD patients (14.2±3.44 umol/L in relation to controls 11.05±3.6 umol/L). The results for serum vitamin B12 and HCY levels were submitted to metanalysis, showing no difference in the vitamin B12 levels between patients with NAFLD and controls. However, the levels of Hcy were higher in NAFLD patients than in controls. CONCLUSION: There was no relashionship between the vitamin B12 levels and NAFLD. The levels of HCY were significantly higher in patients with NAFLD, suggesting this could be a potential marker for liver damage.

RESUMO CONTEXTO: A absorção de vitamina B12 pode ser afetada em pacientes com doença hepática gordurosa não alcoólica (DHGNA), e baixos níveis séricos de vitamina B12 têm sido relacionados a níveis elevados de homocisteína (HCI) ao grau de DHGNA. OBJETIVO: Realizar revisão sistemática e metanálise dos níveis séricos de vitamina B12 e de HCI em pacientes com DHGNA. MÉTODOS: Estudos originais que incluíssem avaliação dos níveis séricos de vitamina B12 e de HCI em humanos com DHGNA foram incluídos. As buscas foram realizadas em quatro bases de dados. RESULTADOS: Foram identificados 159 estudos e, após exclusão das duplicatas e dos não elegíveis, oito artigos originais foram incluídos. Seis dos oito artigos apresentaram níveis mais elevados de vitamina B12 nos pacientes com DHGNA (404,9±136,2 pg/mL) em relação aos controles (353,91±117,3 pg/mL). Sete dos oito estudos determinaram os níveis de HCI, estando aumentados em pacientes com DHGNA (14,2±3,44 umol/L) em relação aos controles (11,05±3,6 umol/L). Os resultados dos níveis séricos de vitamina B12 e HCI foram submetidos à metanálise, mostrando que não há diferença nos níveis de vitamina B12 entre os pacientes com DHGNA e os controles. No entanto, os níveis de HCI foram maiores nos pacientes com DHGNA do que nos controles. CONCLUSÃO: Não houve relação entre DHGNA e nível sérico de vitamina B12. Os níveis de HCI foram significativamente maiores em pacientes com DHGNA, sugerindo que esse poderia ser um potencial marcador de lesão hepática.

Novel Babesia and Hepatozoon agents infecting non-volant small mammals in the Brazilian Pantanal, with the first record of the tick Ornithodoros guaporensis in Brazil.

Taking into account the diversity of small terrestrial mammals of the Pantanal, the present study aimed to verify the occurrence of infection by Ehrlichia spp., Anaplasma spp., Rickettsia spp., Hepatozoon spp., Babesia spp. and parasitism by ticks in non-volant small mammals collected in the Brazilian Pantanal. Samples of blood, liver and spleen were collected from 64 captured animals, 22 marsupials and 42 rodents. Pathogen detection was performed by the use of genus-specific Polymerase Chain Reaction (PCR) assays. Ticks collected from the animals consisted of Amblyomma sculptum and Amblyomma triste nymphs, and Ornithodoros guaporensis larvae. None of the vertebrate samples (blood, liver, or spleen) yielded detectable DNA of Rickettsia spp. or Ehrlichia spp. The blood of the rodent Hylaeamys megacephalus yielded an Anaplasma sp. genotype (partial 16S rRNA gene) 99% similar to multiple Anaplasma spp. genotypes around the world. The blood of three rodents of the species Calomys callosus were positive for a novel Hepatozoon sp. agent, phylogenetically related (18S rDNA gene) to distinct Hepatozoon genotypes that have been detected in rodents from different parts of the world. One marsupial (Monodelphis domestica) and three rodents (Thrichomys pachyurus) were positive to novel piroplasmid genotypes, phylogenetically (18S rDNA gene) related to Theileria bicornis, Cytauxzoon manul, and Cytauxzoon felis. The present study provides the first molecular detection of Hepatozoon sp. and piroplasmids in small mammals in Brazil. Additionally, we expanded the distribution of O. guaporensis to Brazil, since this tick species was previously known to occur only in Bolivia.

Rickettsial infection in ticks from wild birds from Cerrado and the Pantanal region of Mato Grosso, midwestern Brazil.

The involvement of different species of ticks and wild animals, such as birds, play an important role in the epidemiology of tick-borne diseases. Birds may serve as reservoirs for some tick-borne diseases, and may carry and spread hematophagous ectoparasites mechanically. This study aimed to show the diversity of ticks on birds and molecular detection of rickettsial infection in ticks from Pantanal and Cerrado, two similar Brazilian biomes characterized by hydrological seasons. During two years, August 2012 to May 2014, ticks were collected from birds and from the environment in total of 14 visits for collecting samples, distributed in all hydrological seasons. A total of 674 birds were captured representing 113 species from 26 families. In total, 71 birds were parasitized (10.5%), and 155 ticks of the following 7 tick species (in decreasing order of prevalence) were identified: Amblyomma longirostre Koch, Amblyomma nodosum Neumann, Amblyomma cajennense Fabricius sensu lato (s.l.), Amblyomma calcaratum Neumann, Ornithodoros mimon Kohls, Clifford & Jones, Amblyomma ovale Koch, and Amblyomma triste Koch. Among free-living ticks collected in the environment, A. cajennense s.l. was the most common. This is the first occurrence of O. mimon on birds, and of A. triste on Passeriformes in Brazil. Molecular analyses revealed that 6 A. longirostre ticks were infected by 'Candidatus Rickettsia amblyommii', whereas 1 A. nodosum was infected by a Rickettsia parkeri-like agent, previously reported as Rickettsia sp. strain NOD. Spotted fever group (SFG) agents were, for the first time, reported in ticks from birds captured in Pantanal biome, and the potential involvement of these agents as human pathogens should be considered in further studies.