Factors that can influence the survival rates of coral snakes (Micrurus corallinus) for antivenom production.

Envenoming and deaths resulting from snakebites are a particularly important public health problem in rural tropical areas of Africa, Asia, Latin America, and New Guinea. In 2015, The Lancet highlighted snake-bite envenoming as a neglected tropical disease and urged the world to increase antivenom production. In Brazil, around 20,000 snakebites occur per year affecting mostly agricultural workers and children, of which 1% is caused by coral snakes (Micrurus sp.). Although human envenoming by coral snakes is relatively rare due to their semifossorial habits and nonaggressive behavior, they are always considered severe due to the neurotoxic, myotoxic, hemorrhagic, and cardiovascular actions of their venom, which is highly toxic when compared to the venom of other Brazilian venomous snakes as Bothrops sp. (pit vipers), Crotalus sp. (rattlesnakes), and Lachesis sp. (bushmasters). The production of antivenom serum is an important public health issue worldwide and the maintenance of venomous snakes in captivity essential to obtain high-quality venom. Though more than 30 species of Brazilian coral snakes exist, the specific antivenom serum produced with the venom of two species, Micrurus corallinus and M. frontalis, is able to neutralize the accidents caused by the genus in general. M. corallinus is considered a difficult species to maintain in captivity and concerned about this difficulty the Laboratory of Herpetology (LH) at Instituto Butantan, over the last 10 yr, has given special attention to its maintenance in captivity. In more than 20 yr of maintenance, LH has made some changes to improve Micrurus captive husbandry and welfare. The objective of this study was to verify the factors influencing the survival rates of coral snakes in captivity through data generated from 289 M. corallinus from the LH snake facility in the last 10 yr. We observed that survival rates increased significantly with the improvement of nutritional adequacy that included freezing food items before offering them to coral snakes, as well as the development of a new pasty diet to force-feed anorexic animals. Another important factor responsible for increasing life expectancy was the shift of the cage's substrate from Sphagnum to bark in 2010, aiding in the eradication of Blister Disease, which used to be responsible for the death of several coral snakes in previous years.

Fine needle aspiration biopsy of thyroid nodule smaller than 1.0 cm: accuracy of TIRADS classification system in more than 1000 nodules.

OBJECTIVE: To identify whether or not the same ultrasound features can be applied and should be considered to support the decision as to which subcentimeter nodules should be biopsied with fine needle aspiration (FNAB). METHODS: Single-institution, IRB approved, retrospective study conducted from 2008 to 2016 that evaluated 1094 thyroid nodules smaller than 1.0 cm that were classified according to TIRADS and submitted for FNAB. RESULTS: The value of FNAB of thyroid nodules smaller than 1.0 cm were assessed and correlated with the sonographic criteria by comparing the obtained results with the cytological findings in 1094 thyroid nodules. In the analysis considering all nodules, the proportion of malignancies among nodules with TIRADS 2 is 0.91% and for TIRADS 3 is 2.87%. Among those classified as 4A, 12.26%; with 4B classification, 34.43%; with 4C classification, 66.6%; and among those with 5 classifications, 85.7%. CONCLUSION: In conclusion, the TIRADS classification system, based on the sonographic features reported herein, may help detect which nodules should be investigated for potential malignancies. Advances in knowledge: Few reports compare the efficacy of ultrasound-FNAB for thyroid nodules smaller than 1.0 cm in diameter. The findings of malignancy in this subgroup of nodules may help in the clinical follow-up of which patients should be submitted to an early imaging evaluation or intervention.

Diabetes education program with emphasis on physical exercise in subjects with type 2 diabetes: a community-based quasi-experimental study.

BACKGROUND: Diabetes mellitus (DM) requires permanent multidisciplinary treatment. This study investigated the effects of an educational program with emphasis on physical exercise on biological health markers of subjects with type 2 DM (T2DM). METHODS: This was a quasi-experimental study with subjects who attended a diabetes education program over one year. At the beginning, middle and end of the annual cycle, glycated hemoglobin (HbA1c), lipid profile and anthropometry were measured. The program offered two hours of educational and exercise interventions twice a week. Before and after each session capillary blood glucose (BG) was measured. Statistical analysis used Pearson's χ2, paired t, ANOVA-RM and MANOVA tests to compare results with significance levels set at P<0.05. RESULTS: Data of 103 subjects (73% women) were analyzed. Mean age was 64.1±10.8 years and 23% of participants were on insulin therapy. As an acute effect mean BG decreased significantly (P<0.001) from 157.5±61.5 mg/dL to 128.5±47.5 mg/dL after the intervention sessions, also resulting in increased prevalence of normoglycemic BG (from 44.0% to 68.6%). Chronic effects of participation in the program could be perceived through significant reduction (P<0.05) from beginning to end of the study of mean BG (from 144.8±5.0 mg/dL to 135.3±3.1 mg/dL), HbA1c (from 7.3±1.3% to 7.1±1.0%) and triglycerides (from 177.9±121.3 mg/dL to 150.5±130.9 mg/dL). There were no significant changes in anthropometric variables. CONCLUSIONS: A diabetes education program with emphasis on supervised physical exercise improved triglycerides and glycemic control in subjects with T2DM.

Tenofovir monotherapy for hepatitis B after 1 year does not produce renal dysfunction, but is associated with hyperparathyroidism not related to vitamin D.

INTRODUCTION: Viral hepatitis B (VHB) represents a major public health problem. Studies from HIV multidrug patients have associated the use of tenofovir disoproxil fumarate (TDF) with renal dysfunction and phosphate wasting. OBJECTIVE: The aim of this study was to examine the effect of year-long TDF monotherapy on renal function in VHB patients. PATIENTS AND METHODS: We evaluated adult patients diagnosed with VHB before treatment initiation (T0), and after 3 and 12 months (T3 and T12) of TDF initiation. Estimated glomerular filtration rate (eGFR) was estimated by serum cystatin C and creatinine. In addition, urinary electrolytes and tubular biomarkers (cystatin C, ß2-microglobulin and neutrophil gelatinase-associated lipocalin) were analyzed, as well as parathyroid hormone (PTH) and 25(OH)vitamin D levels. RESULTS: After 1 year, 32 patients completed the study, 22 (68.7%) men and 12 (37.5%) Whites, mean age 44.1±12.0 years. We found that serum electrolytes were similar at baseline and 3 or 12 months after initiation of TDF monotherapy. In addition, urinary fractional excretions of electrolytes as well as proteinuria, albuminuria, urinary ß2-microglobulin, and urinary cystatin C showed no significant differences across the treatment timeline. There were also no statistical differences in the eGFR. There was a statistically significant increase in the PTH (Friedman's test, P=0.012), but the 25(OH)vitamin D levels were in the normal range in the beginning and did not change at the follow-up. Moreover, there was no correlation between the initial levels of vitamin D and the corresponding increases in the PTH values. CONCLUSION: If used as monotherapy in hepatitis B patients for a 12-month period, TDF is not associated with changes in either eGFR or a panel of urinary biomarkers. Serum and urinary electrolytes also remained unchanged. Of note, a significant increase in the PTH was found, although not related to the 25(OH)vitamin D initial status.