Diagnostic Accuracy of Morning Salivary Cortisol in the Assessment of the Hypothalamic-Pituitary-Adrenal Axis Recovery after Prolonged Corticosteroid Therapy in Children.

INTRODUCTION: Assessment of the hypothalamic-pituitary-adrenal (HPA) axis is necessary after prolonged glucocorticoid therapy withdrawal. Salivary cortisol reflects 65% of the free circulating cortisol fraction. Saliva collection is non-invasive and child friendly. OBJECTIVE: We aimed to evaluate the diagnostic accuracy of morning salivary cortisol (mSAF) to determine HPA recovery after prolonged corticosteroid therapy in children. METHODS: We conducted a prospective, validation study in 171 paediatric patients (mean ± SD age: 13.0 ± 4.4 years) who received glucocorticoids for >4 weeks (median and interquartile range: 11 [7-14] months) and were referred for therapy withdrawal. Serum and saliva samples were collected between 8 and 9 a.m. on the same day. Cortisol was measured by an electrochemiluminescence immunoassay (ECLIA) 48 h after cessation of glucocorticoid therapy. Serum cortisol ≥193 nmol/L was used as the reference cut-off value for HPA recovery after glucocorticoid withdrawal and mSAF as the index test. RESULTS: The cut-off concentration obtained by ROC for mSAF was ≥5.0 nmol/L. True positive and true negative results were observed in 85/171 and 40/171 children, respectively. The false-positive rate was low (3/171, 1.7%); however, false-negative results were observed in 43/171 (25%) children. The main ROC results (95% CI) were area under curve: 0.98 (0.96-0.99), sensitivity: 0.66 (0.57-0.75), specificity: 0.93 (0.81-0.99), positive predictive value: 0.97 (0.90-0.99), negative predictive value: 0.48 (0.37-0.59), LR+: 9.5, and diagnostic accuracy: 73.1%. CONCLUSION: The present study supports that mSAF ≥5.0 nmol/L by ECLIA is a non-invasive biomarker for the assessment of HPA recovery after prolonged glucocorticoid therapy in paediatric patients, with a positive predictive value of 97%. This proposed cut-off should be further validated using gold standard techniques for steroid quantification such as liquid chromatography-tandem mass spectrometry.

Yellow Fever Virus Maintained by Sabethes Mosquitoes during the Dry Season in Cerrado, a Semiarid Region of Brazil, in 2021.

In recent decades, waves of yellow fever virus (YFV) from the Amazon Rainforest have spread and caused outbreaks in other regions of Brazil, including the Cerrado, a savannah-like biome through which YFV usually moves before arriving at the Atlantic Forest. To identify the vectors involved in the maintenance of the virus in semiarid environments, an entomological survey was conducted after confirmation of yellow fever (YF) epizootics at the peak of the dry season in the Cerrado areas of the state of Minas Gerais. In total, 917 mosquitoes from 13 taxa were collected and tested for the presence of YFV. Interestingly, mosquitoes of the Sabethes genus represented 95% of the diurnal captured specimens, displaying a peak of biting activity never previously recorded, between 4:30 and 5:30 p.m. Molecular analysis identified three YFV-positive pools, two from Sabethes chloropterus-from which near-complete genomes were generated-and one from Sa. albiprivus, whose low viral load prevented sequencing. Sa. chloropterus was considered the primary vector due to the high number of copies of YFV RNA and the high relative abundance detected. Its bionomic characteristics allow its survival in dry places and dry time periods. For the first time in Brazil, Sa. albiprivus was found to be naturally infected with YFV and may have played a role as a secondary vector. Despite its high relative abundance, fewer copies of viral RNA were found, as well as a lower Minimum Infection Rate (MIR). Genomic and phylogeographic analysis showed that the virus clustered in the sub-lineage YFVPA-MG, which circulated in Pará in 2017 and then spread into other regions of the country. The results reported here contribute to the understanding of the epidemiology and mechanisms of YFV dispersion and maintenance, especially in adverse weather conditions. The intense viral circulation, even outside the seasonal period, increases the importance of surveillance and YFV vaccination to protect human populations in affected areas.

Cross-sectional spatial and epidemiological analysis of canine visceral leishmaniasis cases in the triple border region, Brazil, Argentina and Paraguay, between 2015 and 2020.

Visceral Leishmaniasis is one of the most important vector-borne zoonoses in the world. In 2013, the first autochthonous canine case of the disease in the state of Paraná, southern region of Brazil, was reported in Foz do Iguaçu, on the triple border between Brazil, Argentina and Paraguay. In 2015, the first human case was related. Once the endemic was confirmed, the Zoonoses Control Center (ZCC), an agency of the Municipal Health Department, started actions to implement the Human Visceral Leishmaniasis (HVL) Surveillance and Control Program (VLSCP), of the Ministry of Health. Between 2015 and 2020, 12,205 dog samples were analyzed for the diagnosis of the disease. A prevalence of 37.94% (4,630 samples) was found: 2016 had the highest prevalence, with 46.25%, and the year with the lowest prevalence was 2020, with 25.98%. Possible risk factors for dogs were analyzed, and the results obtained were: whether the request for the exam was performed by the ZCC was a significant protective factor, with a lower prevalence (37.5%) than dogs coming from private clinics (OR = 0.89, p-value = 0.016). Males were significantly more infected than females, with 41.1% and 35.7% positivity, respectively (OR = 1.24, p < 0.0001). Companion dogs and mixed breed dogs were significantly less affected than the other groups tested (OR = 0.44, p < 0.001; OR = 0.79, p = 0.012, respectively). The dogs' dark coat color was a significant risk factor with respect to the other color categories. Short and medium coat sizes were significantly considered risk factors, with 41.3% and 31.3% positivity. Long-haired dogs had only 22.7% positivity. In univariate analyses, giant, large and medium dogs were significantly more affected than small dogs. Dogs up to four years of age were significantly less affected than those in other age groups. There was a coincidence of human and canine cases in the spatial distribution. However, according to the literature, a higher incidence would be expected in humans, due to the high prevalence found in dogs. Therefore, further studies should be carried out to understand the dynamics of the disease in this region.

Fast surveillance response reveals the introduction of a new yellow fever virus sub-lineage in 2021, in Minas Gerais, Brazil.

BACKGROUND: In Brazil, the yellow fever virus (YFV) is maintained in a sylvatic cycle involving wild mosquitoes and non-human primates (NHPs). The virus is endemic to the Amazon region; however, waves of epidemic expansion reaching other Brazilian states sporadically occur, eventually causing spillovers to humans. OBJECTIVES: To report a surveillance effort that led to the first confirmation of YFV in NHPs in the state of Minas Gerais (MG), Southeast region, in 2021. METHODS: A surveillance network was created, encompassing the technology of smartphone applications and coordinated actions of several research institutions and health services to monitor and investigate NHP epizootics. FINDINGS: When alerts were spread through the network, samples from NHPs were collected and YFV infection confirmed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and genome sequencing at an interval of only 10 days. Near-complete genomes were generated using the Nanopore MinION sequencer. Phylogenetic analysis indicated that viral genomes were related to the South American genotype I, clustering with a genome detected in the Amazon region (state of Pará) in 2017, named YFVPA/MG sub-lineage. Fast YFV confirmation potentialised vaccination campaigns. MAIN CONCLUSIONS: A new YFV introduction was detected in MG 6 years after the beginning of the major outbreak reported in the state (2015-2018). The YFV strain was not related to the sub-lineages previously reported in MG. No human cases have been reported, suggesting the importance of coordinated surveillance of NHPs using available technologies and supporting laboratories to ensure a quick response and implementation of contingency measures to avoid YFV spillover to humans.

[Antimicrobial stewardship program during the COVID-19 pandemic]. / Programa de optimización del uso de antimicrobianos durante la pandemia de COVID-19.

In spite of the low frequency of COVID-19 associated bacterial coinfections, the rate of empiric antibiotic use varies between 70% and 90%. The primary objective of this study was to evaluate the impact of an antimicrobial stewardship program (ASP) on COVID-19 patients. The study design was an interrupted time series, assessing prevalence of antibiotic use, adequacy of treatment and antimicrobial consumption in adult patients hospitalized with COVID before the COVID-ASP implementation in June 2020, and on three subsequent periods (P2 in August 2020, P3 in October 2020 and P4 in June 2021). One hundred and one patients were included. Moderate and severe disease was more frequent in P2, P3, and P4 periods (p < 0.001). After the implementation we observed a significant reduction on ATM use (61% vs. 41% vs. 31.1% vs. 8.1%, p < 0.001), and macrolid combination therapy (17.3% vs. 19.2% vs. 10.8% vs. 1.4%, p = 0.03), and an increase of adequate use (37.5% vs. 46.9% vs. 69.9% vs. 66.6%, p = 0.039). Antimicrobial consumption by period in days of therapy (DOT)/1000 patient-day was 347.9 vs. 272.8 vs. 134.29 vs. 43.6 (p <0.001). We did not find any difference in intensive care unit transfer or mortality. COVID-ASP implementation was an effective strategy to reduce antimicrobial consumption and optimize antibiotic indications without affecting morbidity or mortality.

A pesar de la baja frecuencia de coinfecciones bacterianas asociadas al COVID-19, la tasa de uso de antibióticos (ATB) empíricos varía entre 70 y 90%. El objetivo primario del estudio fue evaluar el impacto de la implementación de un programa de optimización de antimicrobianos en pacientes con COVID-19 (PROA-COVID). Se realizó un estudio prospectivo de serie de tiempo interrumpida. Se evaluó la prevalencia, adecuación y consumo de ATB en adultos internados con COVID previo a la implementación del PROA-COVID (P1, junio 2020) y en tres períodos posteriores (P2 en agosto 2020, P3 en octubre 2020 y P4 en junio 2021). Se incluyeron 301 pacientes. Las formas clínicas moderadas-graves fueron más frecuentes en los P2, 3 y 4 (p < 0.001). La implementación del programa mostró una disminución significativa del uso de ATB (61% vs. 41% vs. 31.1% vs. 8.1%, p < 0.001), de la indicación de tratamiento combinado con macrólidos (17.3% vs. 19.2% vs. 10.8% vs. 1.4%, p = 0.03) y aumento del uso adecuado (37.5% vs. 46.9% vs. 69.9% vs. 66.6%, p = 0.039). El consumo de ATB en DDT (días de tratamiento) totales/1000 días paciente fue: 347.9 vs. 272.8 vs. 134.3 vs. 43.6 (p < 0.001). No hubo diferencias significativas en el pase a unidades de cuidados críticos ni en la mortalidad. La implementación del PROA-COVID fue una estrategia efectiva para reducir el uso de antibióticos y optimizar sus indicaciones sin impacto en la morbimortalidad.

Programa de optimización del uso de antimicrobianos durante la pandemia de COVID-19 / Antimicrobial stewardship program during the COVID-19 pandemic

Resumen A pesar de la baja frecuencia de coinfecciones bacterianas asociadas al COVID-19, la tasa de uso de antibióticos (ATB) empíricos varía entre 70 y 90%. El objetivo primario del estudio fue evaluar el impacto de la implementación de un programa de optimización de antimicrobianos en pacientes con COVID-19 (PROA-COVID). Se realizó un estudio prospectivo de serie de tiempo interrumpida. Se evaluó la prevalencia, adecuación y consumo de ATB en adultos internados con COVID previo a la implementación del PROA-COVID (P1, junio 2020) y en tres períodos posteriores (P2 en agosto 2020, P3 en octubre 2020 y P4 en junio 2021). Se incluyeron 301 pacientes. Las formas clínicas moderadas-graves fueron más frecuentes en los P2, 3 y 4 (p < 0.001). La implementación del programa mostró una disminución significativa del uso de ATB (61% vs. 41% vs. 31.1% vs. 8.1%, p < 0.001), de la indicación de tratamiento combinado con macrólidos (17.3% vs. 19.2% vs. 10.8% vs. 1.4%, p = 0.03) y aumento del uso adecuado (37.5% vs. 46.9% vs. 69.9% vs. 66.6%, p = 0.039). El consumo de ATB en DDT (días de tratamiento) totales/1000 días paciente fue: 347.9 vs. 272.8 vs. 134.3 vs. 43.6 (p < 0.001). No hubo diferencias significativas en el pase a unidades de cuidados críticos ni en la mortalidad. La implementación del PROA-COVID fue una estrategia efectiva para reducir el uso de antibióticos y optimizar sus indicaciones sin impacto en la morbimortalidad.

Abstract In spite of the low frequency of COVID-19 associated bacterial coinfections, the rate of empiric an tibiotic use varies between 70% and 90%. The primary objective of this study was to evaluate the impact of an antimicrobial stewardship program (ASP) on COVID-19 patients. The study design was an interrupted time series, assessing prevalence of antibiotic use, adequacy of treatment and antimicrobial consumption in adult patients hospitalized with COVID before the COVID-ASP implementation in June 2020, and on three subsequent periods (P2 in August 2020, P3 in October 2020 and P4 in June 2021). One hundred and one patients were included. Moderate and severe disease was more frequent in P2, P3, and P4 periods (p < 0.001). After the implementation we observed a significant reduction on ATM use (61% vs. 41% vs. 31.1% vs. 8.1%, p < 0.001), and macrolid combination therapy (17.3% vs. 19.2% vs. 10.8% vs. 1.4%, p = 0.03), and an increase of adequate use (37.5% vs. 46.9% vs. 69.9% vs. 66.6%, p = 0.039). Antimicrobial consumption by period in days of therapy (DOT)/1000 patient-day was 347.9 vs. 272.8 vs. 134.29 vs. 43.6 (p<0.001). We did not find any difference in intensive care unit transfer or mortality. COVID-ASP implementation was an effective strategy to reduce antimicrobial consump tion and optimize antibiotic indications without affecting morbidity or mortality.

Parasitic infections, hematological and biochemical parameters suggest appropriate health status of wild coati populations in anthropic Atlantic Forest remnants.

Coatis are hosts of a great diversity of parasites, that due to anthropic pressures in forest fragments, like changes in landscapes and ecosystems, can influence the dynamics and physiological responses to those parasite infections, affecting the animal's health and fitness. This is the first study about health parameters and parasitic infections of wild coati (Nasua nasua) populations in the Atlantic Forest (Pernambuco Center of Endemism). The following hypotheses were evaluated: (i) infections and co-infections by gastrointestinal parasites and ectoparasites can generate changes in the health parameters of coatis such as the body condition score (BCS), packed cell volume (PCV), leukogram, and serum protein profile; (ii) biological aspects (sex and age) or fragment they inhabit, can influence changes in the health parameters (BCS, PCV, leukogram and serum protein profile). Were studied 55 free-living coatis in three anthropized forest remnants in the Metropolitan Region of Recife. After chemical containment, the animals were submitted to physical examination and collection of biological samples (blood, feces, and ectoparasites). On the physical examination, 23.6% of coatis had a low BCS and 5.4% were overweighted. Amblyomma spp. ticks were found in 83.6% of the animals of all studied remnants, A. sculptumAmblyomma sculptum in 12.7% and A. ovale in 1.8%. Regarding gastrointestinal parasites, Ancylostoma sp. was the most prevalent (80.4%) and most animals (66.7%) had co-infection with Ancylostoma sp. and Capillaria sp., Strongyloides sp., Acanthocephala, Cestoda, and Coccidia. The 76.5% of the coatis presented co-infections with Ancylostoma spp. + Amblyomma spp. Principal coordinates analyses (PCoA) scores of health parameters were used as dependent variables and fragment, sex, age, Ancylostoma sp. infection, gastrointestinal parasites co-infection, Amblyomma spp. infestation and co-infection of Ancylostoma sp. + Amblyomma spp. as a predictor variable in the linear models. Parasites did not influence the PCV of the individuals, but a decrease was evident in adult animals. Variations in protein profile, neutrophils, and lymphocytes, without leaving the normal range for the species, but WBC were predicted by age group, and infections by Ancylostoma or Amblyomma spp., but not their co-infections. The free-living coati populations of the anthropized remnants in the Atlantic Forest of northeastern Brazil proved to be healthy and seem to be adapted to face the challenges of anthropization and parasitic infections.

Presence and potential distribution of malaria-infected New World primates of Costa Rica.

BACKGROUND: In South and Central America, Plasmodium malariae/Plasmodium brasilianum, Plasmodium vivax, Plasmodium simium, and Plasmodium falciparum has been reported in New World primates (NWP). Specifically in Costa Rica, the presence of monkeys positive to P. malariae/P brasilianum has been identified in both captivity and in the wild. The aim of the present study was to determine the presence of P. brasilianum, P. falciparum, and P. vivax, and the potential distribution of these parasites-infecting NWP from Costa Rica. METHODS: The locations with PCR (Polymerase Chain Reaction) positive results and bioclimatic predictors were used to construct ecological niche models based on a modelling environment that uses the Maxent algorithm, named kuenm, capable to manage diverse settings to better estimate the potential distributions and uncertainty indices of the potential distribution. RESULTS: PCR analysis for the Plasmodium presence was conducted in 384 samples of four primates (Howler monkey [n = 130], White-face monkey [n = 132], Squirrel monkey [n = 50], and red spider monkey [n = 72]), from across Costa Rica. Three Plasmodium species were detected in all primate species (P. falciparum, P. malariae/P. brasilianum, and P. vivax). Overall, the infection prevalence was 8.9%, but each Plasmodium species ranged 2.1-3.4%. The niche model approach showed that the Pacific and the Atlantic coastal regions of Costa Rica presented suitable climatic conditions for parasite infections. However, the central pacific coast has a more trustable prediction for malaria in primates. CONCLUSIONS: The results indicate that the regions with higher suitability for Plasmodium transmission in NWP coincide with regions where most human cases have been reported. These regions were also previously identified as areas with high suitability for vector species, suggesting that enzootic and epizootic cycles occur.

Fast surveillance response reveals the introduction of a new yellow fever virus sub-lineage in 2021, in Minas Gerais, Brazil

BACKGROUND In Brazil, the yellow fever virus (YFV) is maintained in a sylvatic cycle involving wild mosquitoes and non-human primates (NHPs). The virus is endemic to the Amazon region; however, waves of epidemic expansion reaching other Brazilian states sporadically occur, eventually causing spillovers to humans. OBJECTIVES To report a surveillance effort that led to the first confirmation of YFV in NHPs in the state of Minas Gerais (MG), Southeast region, in 2021. METHODS A surveillance network was created, encompassing the technology of smartphone applications and coordinated actions of several research institutions and health services to monitor and investigate NHP epizootics. FINDINGS When alerts were spread through the network, samples from NHPs were collected and YFV infection confirmed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and genome sequencing at an interval of only 10 days. Near-complete genomes were generated using the Nanopore MinION sequencer. Phylogenetic analysis indicated that viral genomes were related to the South American genotype I, clustering with a genome detected in the Amazon region (state of Pará) in 2017, named YFVPA/MG sub-lineage. Fast YFV confirmation potentialised vaccination campaigns. MAIN CONCLUSIONS A new YFV introduction was detected in MG 6 years after the beginning of the major outbreak reported in the state (2015-2018). The YFV strain was not related to the sub-lineages previously reported in MG. No human cases have been reported, suggesting the importance of coordinated surveillance of NHPs using available technologies and supporting laboratories to ensure a quick response and implementation of contingency measures to avoid YFV spillover to humans.

Real-Time Genomic Surveillance during the 2021 Re-Emergence of the Yellow Fever Virus in Rio Grande do Sul State, Brazil.

The 2021 re-emergence of yellow fever in non-human primates in the state of Rio Grande do Sul (RS), southernmost Brazil, resulted in the death of many howler monkeys (genus Alouatta) and led the state to declare a Public Health Emergency of State Importance, despite no human cases reported. In this study, near-complete genomes of yellow fever virus (YFV) recovered from the outbreak were sequenced and examined aiming at a better understanding of the phylogenetic relationships and the spatio-temporal dynamics of the virus distribution. Our results suggest that the most likely sequence of events involved the reintroduction of YFV from the state of São Paulo to RS through the states of Paraná and Santa Catarina, by the end of 2020. These findings reinforce the role of genomic surveillance in determining the pathways of distribution of the virus and in providing references for the implementation of preventive measures for populations in high risk areas.

Hematology and Serum Biochemistry Values of Healthy Free-Ranging Panamanian White-Faced Capuchins (Cebus imitator) in Costa Rica.

We describe the hematology and serum biochemistry values for 26 free-ranging Panamanian white-faced capuchins (Cebus imitator) in Costa Rica. Howell-Jolly bodies and microfilariae were observed in some animals. This baseline information is a tool for health assessment and species conservation.

Evaluación de la implementación de un Programa de Uso Optimizado de Antimicrobianos en la pandemia de COVID-19 / Evaluation of an antimicrobial stewardship program implementation during the global outbreak of coronavirus desease (COVID-19)

Introducción: No obstante la baja frecuencia de infecciones bacterianas asociadas al COVID-19, la prevalencia del uso de antibióticos empíricos es de 70 a 90%. El objetivo primario del estudio fue evaluar el impacto de la implementación de un programa de optimización de antimicrobianos dirigido a pacientes con COVID-19 (PROA-COVID).Material y métodos: Estudio antes y después, retrospectivo, descriptivo y analítico. Se evaluó prevalencia y adecuación del uso de antibióticos antes y después de implementación del PROA-COVID en pacientes internados. Se estimó consumo mensual de antibióticos en DDD/100 pacientes-día y costos por uso inadecuado.Resultados: Se incluyeron 153 pacientes, 75 antes y 78 después de la intervención, sin diferencias significativas en las características poblacionales entre ambos períodos. Las formas clínicas moderadas-severas fueron más frecuentes postintervención (p=0,03). La implementación mostró una disminución significativa en prevalencia de uso (64% vs 41%, p=0,004), con aumento de uso adecuado (37,5% vs. 46,8%, p=NS). La indicación innecesaria fue mayor antes del PROA (80% vs 50%, p=0,03) y la duración del tratamiento postintervención (13,3% vs. 43,7%%, p=0,02). La implementación redujo el consumo de betalactámicos + IBL y azitromicina.No se observaron diferencias significativas en mortalidad, frecuencia de pase a UCC ni uso de antibioticoterapia combinada con macrólidos entre ambos períodos ajustando por severidad. Conclusiones: La implementación del PROA-COVID fue una estrategia efectiva para reducir el uso de antibióticos y optimizar sus indicaciones, lo que destaca la importancia de su aplicación rápida y oportuna.

ntroduction: Despite the low frequency of Covid-19-associated bacterial infections, empirical antibacterial treatment is as high as 70 to 90%. The primary goal of this study was to determine the impact of the implementation of an antimicrobial stewardship program to target Covid-19 patients (ASP-COVID).Materials and methods: Retrospective, descriptive, and analytic pre and post intervention study. Prevalence and adequacy of antibacterial treatment in hospitalized patients prior and after ASP-COVID implementation were assessed. Monthly antibiotic consumption in DDD/100 patients-day and costs related with inadequate usage were estimated. Results: One hundred and fifty three patients, 75 prior and 78 after ASP-COVID implementation, were included. No significant difference in population characteristics between both periods was observed. Moderate and severe clinical presentations were more frequent after the intervention (p=0,03). ASP implementation showed a significant reduction of antimicrobial treatment (64% vs 41%, p=0,004), with an increment of adequate usage (37,5% vs 46,8%, p=NS). Unnecessary usage was higher prior to ASP (80% vs 50%, p =0,03) and length of treatment post intervention (13,3% vs 43,7%%, p=0,02). Program implementation decreased beta lactam antibiotics + IBL and azithromycin consumption. After adjusting for severity, no significant difference was found in mortality, incidence of ICU admission nor combined antibacterial therapy with macrolides between both periods.Conclusions: ASP-COVID implementation was an effective strategy in reducing antimicrobial usage and in optimizing antibacterial treatment indications, highlighting the importance of its rapid and timely application.

Detection of antibodies against flavivirus over time in wild non-human primates from the lowlands of Costa Rica.

Two-hundred-nine free ranging non-human primates from 31 locations throughout Costa Rica were captured and released between 1993 and 2012, and blood samples, sera or plasma were collected, to detect antigens and antibodies, and so assess the distribution of active and passive flavivirus infections over time. A competitive enzyme-linked immunoassay for the detection of antibodies was used to determine the distribution of past flavivirus infections over time, while Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) was used to detect active West Nile Virus (WNV) and Dengue virus (DENV) infections. The first serological evidence of flavivirus in these animals was determined in 1993, at the same time when DENV re-emerged in humans from Costa Rica. An increase in the number of seropositive wild monkeys to flavivirus was determined over time in the country (11.3% seropositivity in 1993-1996, 20.7% in 2001-2008, and finally 52.9% in 2010-2012). Furthermore, the presence of DENV2 was detected in samples from four howler monkeys collected in 2001-2002, whereas DENV2, DENV3, and DENV4 were found in samples from four white-faced monkeys, and WNV in three howler monkeys living in the Pacific coast of Costa Rica during 2010-2012. The habitat where the positive PCR individuals lived were characterized as fragmented forests, having temperatures ranging from 26°C to 28°C, altitudes below 250 meters above sea level, high precipitation during 7 to 9 months (1500-4000 mm), and a marked dry season of 3 to 5 months. All these animals were living near mangroves; however, they did not show clinical signs of illness at the time of sampling. Results obtained show that the number of seropositive wild non-human primates to flavivirus were increasing during time in the country, longitudinal studies are needed to investigate their role as sentinels of these viruses and to determine if flavivirus infections can affect these species.

Subcutaneous fat distribution in small for gestational age newborns.

We assessed the anthropometric characteristics of symmetric (SGA-S) and asymmetric (SGA-A) term newborns and describe their subcutaneous fat differences. We assessed perinatal data, maternal characteristics and anthropometric variables (including skinfold thicknesses) in 139 small for gestational age (SGA) term infants, classified as symmetric and asymmetric according to their ponderal index (using the 10(th) percentile as the cut-off criterion). Despite an overall small body size and lower amounts of subcutaneous fat than the reference population, SGA-S term newborns showed a proportionate body fat distribution and SGA-A were thinner and had a lower percentage of central subcutaneous fat than SGA-S. These findings, resulting from intrauterine growth restriction, could be associated with different early and later postnatal outcomes among SGA groups.

Effects of smoking during pregnancy on the optic nerve neurodevelopment.

BACKGROUND: Tobacco smoking during pregnancy alters neurodevelopment. Optical coherence tomography (OCT) provides precise measurements of the retinal nerve fiber layer (RNFL), which forms part of the central nervous system. AIMS: To assess using the OCT how smoking during pregnancy would affect optic nerve development as detected in human offspring. STUDY DESIGN: Visual examination and OCT were performed on a group of children (n=70; 4.15-13.50 years of age), classified as being exposed or not to maternal smoking during gestational period. The association between smoking during pregnancy and RNFL thickness was assessed by a linear regression analysis adjusted for possible confounding factors. RESULTS: Although visual outcomes did not differ between groups, a significant decrease in the RNFL thickness was found in the group of infants exposed to smoke (105.3 vs 95.6; p=0.002), even when adjusting for gestational age, birth weight or gender. CONCLUSIONS: OCT measurements show that intrautero exposure to tobacco smoke interferes with the development of the optic nerve.