Pulmonary arteriovenous malformations in Rendu-Osler-Weber syndrome.

Rendu-Osler-Weber syndrome, also known as hereditary hemorrhagic telangiectasia, is an autosomal dominant hereditary disorder. It is characterized by presence of multiple arteriovenous malformations (AVMs) and telangiectasias. This article reports two cases of patients with Rendu-Osler-Weber syndrome who had pulmonary AVMs and underwent successful endovascular treatment. A brief review of the literature shows that up to 50% of patients with the syndrome have pulmonary AVMs and there is usually a positive family history in these patients. These pulmonary AVMs are multiple in 30% of cases and are associated with the most severe disease complications. Most patients are asymptomatic, even in the presence of AVMs with right-left shunts. When these shunts exceed 25% of the total blood volume, dyspnea, cyanosis, digital clubbing, and extracardiac murmurs may occur. Endovascular treatment is safe and offers control of complications from hereditary hemorrhagic telangiectasia and is currently the treatment of choice for these lesions.

Comparative Effectiveness of Coronavirus Vaccine in Preventing Breakthrough Infections among Vaccinated Persons Infected with Delta and Alpha Variants.

We developed a case-case study to compare mRNA vaccine effectiveness against Delta versus Alpha coronavirus variants. We used data on 2,097 case-patients with PCR-positive severe acute respiratory syndrome coronavirus 2 infections reported in Portugal during May-July 2021. We estimated the odds of vaccine breakthrough infection in Delta-infected versus Alpha-infected patients by using conditional logistic regression adjusted for age group and sex and matched by the week of diagnosis. We compared reverse-transcription PCR cycle threshold values by vaccination status and variant as an indirect measure of viral load. We found significantly higher odds of vaccine breakthrough infection in Delta-infected patients than in Alpha-infected patients (odds ratio 1.96 [95% CI 1.22-3.14]), suggesting lower effectiveness of the mRNA vaccines in preventing infection with the Delta variant. We estimated lower mean cycle threshold values for the Delta cases (mean difference -2.10 [95% CI -2.74 to -1.47]), suggesting higher infectiousness than the Alpha variant.

Impact of a Hemoglobin Trigger Communication Tool on Perioperative Transfusion in Cardiac Surgery.

OBJECTIVES: Blood transfusion represents an important and potentially modifiable risk in the daily practice of cardiac surgery. The risk profile and increasing cost of transfusion led us to study the effect of different maneuvers, interventions, or surgical techniques to minimize transfusion while maintaining patient safety. This study compares postoperative outcomes before and after incorporating a verbal hemoglobin (Hb) trigger during the surgical timeout in which the surgeon and anesthesiologist preemptively agree on a threshold for packed red blood cell (PRBC) administration in the perioperative period. METHODS: The authors performed a chart review of patients who underwent cardiac surgery from July 2013 through June 2014 at our institution. Patients who underwent surgery from July 2013 through December 2013 served as the pre-Hb trigger group, and patients who underwent surgery from January 2014 through June 2014 served as the post-Hb trigger group. Information collected included patient demographics, type of cardiac surgery, preoperative Hb, Hb trigger, and intraoperative and postoperative variables. The primary outcome was the incidence of PRBC transfusions. Secondary outcomes included the incidence of frozen plasma (FP) transfusion, mechanical ventilation beyond postoperative day 1, and 30-day mortality. RESULTS: The study included 191 patients, with 84 in the pre-Hb trigger group and 107 in the post-Hb trigger group. Intraoperative PRBC transfusions did not decrease in the posttrigger group compared with the pretrigger group (pretrigger 51.4% vs posttrigger 52.4%, P = 1.0); however, intraoperative FP administration was lower in the posttrigger group (65.4% vs 50.0%, P = 0.038). Postoperative mechanical ventilation beyond postoperative day 1 also was significantly lower in the posttrigger group compared with the pretrigger group (27.1% vs 14.3%, P = 0.035). CONCLUSIONS: Implementation of a verbal Hb trigger during the surgical timeout was associated with a reduction in FP administration and duration of mechanical ventilation, but not a decrease in PRBC transfusion and mortality.

Analysis of Pre-Driver and Last-Stage Power-Ground-Induced Jitter at Different PVT Corners.

This paper presents the study of power/ground (P/G) supply-induced jitter (PGSIJ) on a cascaded inverter output buffer. The PGSIJ analysis covers the IO buffer transient simulation under P/G supply voltage variation at three process, voltage, and temperature (PVT) corners defined at different working temperatures and distinct P/G DC supply voltages at the pre-driver (i.e., VDD/VSS) and last stage (i.e., VDDQ/VSSQ). Firstly, the induced jitter contributions by the pre-driver, as well as the last, stage are compared and studied. Secondly, the shared and decoupled P/G supply topologies are investigated. The outcomes of these simulation analyses with respect to worst case jitter corners are determined, while highlighting the importance of modeling the pre-driver circuit behavior to include the induced jitter in the input-output buffer information specification (IBIS)-like model. Accordingly, the measured PGSIJ depends on the corners to be analyzed and, therefore, the designer needs to explore the worst-case corner for the driver's technology node and the most supply voltage noise affecting the jitter output for signal and power integrity (SiPI) simulations. Finally, the jitter transfer function sensitivity to the amplitude and frequency/phase variations of the separate and combined impacts of the pre-driver and last stage are explored, while discussing the superposition of the power supply induced jitter (PSIJ) induced by both the driver's IO stages under small signal and large signal supply voltage variations. The linear superposition of the separate PSIJ effects by the pre-driver and last stage depends on the amplitude of the variation of the supply voltage that can drive the transistor to their nonlinear working regions.

A Quality Improvement Project to Decrease Perioperative and Periprocedural Corneal Abrasions.

PURPOSE: We assessed our institution's rate of perioperative and periprocedural corneal abrasions (CAs) and implemented a quality improvement project to improve our detection of CAs and decrease their incidence by at least 25% over 12 months. DESIGN: Retrospective review before and after initiation of a quality improvement project at a single tertiary care institution METHODS: We retrospectively reviewed surgical and procedural patients requiring any type of anesthesia care over three 1-year time periods (2014-2015, 2016-2017, and 2017-2018). Using an electronic pharmacy-based query to identify patients who received proparacaine eye drops in the recovery room, we were able to estimate our incidence of CA during these time periods. We implemented a best practice plan to standardize CA prevention, diagnosis, and treatment after determining our baseline incidence of CA. FINDINGS: Our baseline incidence rate of perioperative and periprocedural CAs was 0.22% (43/19,790 anesthetics) in the 2014-2015 time period. In the 2016-2017 and 2017-2018 time periods, the incidence rate was reduced to 0.09% (21/23,652 anesthetics) and 0.1% (23/23,825 anesthetics), respectively. The use of a standardized CA prevention, diagnosis, and treatment plan reduced the relative risk of CAs by 59% in 2016-2017 (P < .001) and 56% in 2017-2018 (P = .001) compared to baseline, with an absolute reduction of 13% and 12% over those time periods. CONCLUSION: Our data suggests that the adoption of a simple, standardized perioperative and periprocedural CA prevention, diagnosis, and treatment plan can result in sustained reductions in the occurrence of perioperative CAs.

Superficial femoral vein transposition as a solution for hemodialysis vascular access.

The significant growth in the number of individuals dependent on hemodialysis for renal replacement therapy and unrestricted use of short and long-term catheters have challenged vascular surgeons in search of solutions for patients whose options for access via the upper limbs have been exhausted and for the increasing rates of central venous stenosis in these patients. When access via the upper limbs is impossible, exceptional techniques can be used and the lower limbs offer feasible alternative vascular access sites for hemodialysis. This article reports a case of superficial femoral vein transposition to make a loop arteriovenous fistula in a patient with no possibility of access via the upper limbs and presents a literature review on this technique that remains little used.

Macular microhole and foveal red spot syndrome: a critical review of the literature.

PURPOSE: The purpose of this article is to review the literature on nomenclature, natural history, clinical features, diagnosis, management, and prognosis of both macular microhole (MMH) and foveal red spot syndrome (FRS). METHODS: A PubMed primary literature search (February 1, 2020) utilizing the terms macular microhole, foveal red spot syndrome, and outer retinal hole was conducted. All chosen articles were case reports or case series. Articles qualified for inclusion if they documented symptoms, imaging findings, or followed patients longitudinally. RESULTS: A total of 14 studies from 1988 to 2019 that evaluated either MMH, FRS, or both were included in the review. No comparative study between the two defects was found. Studies often used the terms FRS and MMH interchangeably to reference both partial- and full-thickness lesions of the macula. Spectral-domain optical coherence tomography (SD-OCT) was most frequently able to identify these lesions and revealed an absence of all neural retinal layers from the inner limiting membrane (ILM) to the retinal pigment epithelium (RPE) in the full-thickness lesions while the partial-thickness lesions most often involved the photoreceptor layer (PRL) and less frequently the external limiting membrane (ELM). OCT revealed that vitreomacular traction (VMT) was involved in the natural history of both FRS and MMH for a significant subset of patients. CONCLUSION: The terms MMH and FRS have been used interchangeably in the literature. Advances in OCT have revealed that MMHs and FRSs are distinct but sometimes overlapping entities. We suggest that MMH and FRS are similar entities defined as one or more sharply defined lesions in the fovea of the eye < 150 µm in size. MMHs are a full-thickness defect of the entire neuroretina at the center of the foveola while FRSs are partial-thickness lesions. Current literature suggests that there may be subtle differences in the pathogenesis, clinical features, and diagnosis between MMH and FRS; however, prognosis and management for both are favorable. Lastly, we suggest that the terms outer lamellar macular microholes and full-thickness macular microholes may be the more appropriate terminologies to refer to FRS and MMH, respectively.

Neural-Network Based Modeling of I/O Buffer Predriver under Power/Ground Supply Voltage Variations.

This paper presents a neural-network based nonlinear behavioral modelling of I/O buffer that accounts for timing distortion introduced by nonlinear switching behavior of the predriver electrical circuit under power and ground supply voltage (PGSV) variations. Model structure and I/O device characterization along with extraction procedure were described. The last stage of the I/O buffer is modelled as nonlinear current-voltage (I-V) and capacitance voltage (C-V) functions capturing the nonlinear dynamic impedances of the pull-up and pull-down transistors. The mathematical model structure of the predriver was derived from the analysis of the large-signal electrical circuit switching behavior. Accordingly, a generic and surrogate multilayer neural network (NN) structure was considered in this work. Timing series data which reflects the nonlinear switching behavior of the multistage predriver's circuit PGSV variations, were used to train the NN model. The proposed model was implemented in the time-domain solver and validated against the reference transistor level (TL) model and the state-of-the-art input-output buffer information specification (IBIS) behavioral model under different scenarios. The analysis of jitter was performed using the eye diagrams plotted at different metrics values.

Genetic and chemical control of coffee rust (Hemileia vastatrix Berk et Br.): impacts on coffee (Coffea arabica L.) quality.

BACKGROUND: The occurrence of diseases can alter coffee (Coffea arabica L.) metabolism, causing changes in the composition of coffee beans and beverage quality. However, little is known about which aspects of coffee quality are actually altered by rust (Hemileia vastatrix Berk et Br.) and by its main control methods. The effect of chemical and genetic methods for the control of coffee rust on the quality of coffee beans and beverage was investigated. RESULTS: Both genetic and chemical control reduce the damage caused by the disease in the composition of coffee beans. Genotypes with resistant ancestry, even with resistance breakdown, respond better to chemical control. The combination of genetic and chemical control favors an increase in the sugar content in the beans. CONCLUSIONS: Despite the fact that both genetic and chemical control are effective in reducing disease damage regarding the chemical composition of beans, the quality potential of Timor Hybrid genotypes associated with the cancellation of rust expression through the joint action of genetic and chemical control favors the composition of beans and, consequently, the quantitative assessment of sensory attributes, adding value to the final product. © 2020 Society of Chemical Industry.

[Closure of Persisting Full Thickness Macular Holes by Subretinal Fluid Application: Technical Approach and Surgical Considerations]. / Verschluss von persistierenden Makulalöchern durch subretinale Flüssigkeitsapplikation: technisches Vorgehen und chirurgische Überlegungen.

INTRODUCTION: Firm adhesions between the retina and adjacent retinal pigment epithelium (RPE) may prevent the closure of macular holes (MH) after chromovitrectomy. Controlled application of subretinal (SR) fluid with BSS may release these adhesions leading to closure of the retracted retina in large and or refractory macular holes. METHODS: For a standardized procedure, it is recommended to exclude residues of epiretinal membranes on the retinal surface preoperatively at OCT or intraoperatively by means of vital dyes. Intraoperatively, a perfluorocarbon (PFO) bubble is placed above the MH and lowers the infusion bottle of 20 mmHg. Subsequently, SR-fluid blebs are applied in the upper, temporal and inferior quadrants with a subretinal 41-gauge cannula. After removing decalin bubble, the SR-detachment is enlarged toward the foveal center. This is essential to achieve a complete detachment of the outer macular edges from the RPE. The MH can be closed by a temporary gas endotamponade. RESULTS: With a standardized procedure, the operation can be carried out safely and with minimal effort. Additional measures, such as care for bubble-free SR-fluid sands or machine assistance, were added. In a pilot study, experienced VR surgeons performed the SR-fluid application safely and without complications. The preoperative diameter of the MH was 1150 µm (651 - 2350 µm). The secondary closure rate for our PMH was 80.9%. CONCLUSION: SR-adhesions seem to have a previously unnoticed component in persistent macular holes. An SR-fluid application can be carried out quickly, safely and with minimal material effort. The initial results show a high secondary closure rate.

An improved drop casting electrochemical strategy for furosemide quantification in natural waters exploiting chemically reduced graphene oxide on glassy carbon electrodes.

This work exploits the applicability of a chemically reduced graphene oxide (CRGO) modification on the electrochemical response of a glassy carbon electrode (GCE) for the first-time sensitive determination of furosemide in natural waters. The batch injection analysis (BIA) is proposed as an analytical method, where CRGO-GCE is coupled to a BIA cell for amperometric measurements. Acetate buffer (0.1 µmol L-1, pH 5.2) was used as the background electrolyte. The modification provided an increase in sensitivity (0.024 µA/µmol L-1), low limit of detection (0.7 µmol L-1), RSD (< 4%), and broad linear range (1-600 µmol L-1). Recovery tests performed in two different concentration ranges resulted in values between 89 and 99%. Recovery tests were performed and compared with high-performance liquid chromatography (HPLC) with UV-Vis detection using Student's t test at a 95% significance level, and no significant differences were found, confirming the accuracy of the method. The developed method is proven faster (169 h-1) compared with the HPLC analysis (5 h-1), also comparable with other flow procedures hereby described, offering a low-cost strategy suitable to quantify an emerging pharmaceutical pollutant. Graphical abstract.

Hypopharyngeal packing during adenotonsillectomy by cold dissection in children: a randomized controlled trial.

PURPOSE: Nausea and vomiting occur in up to 70% of children after adenotonsillectomy, ingested blood during procedure being one of the reasons for emesis. Hypopharyngeal packing (HP) is a common practice among otolaryngologists to prevent blood from being swallowed, but studies in nasal surgeries in adults failed to show efficacy of this technique in reducing postoperative nausea and vomiting (PONV). There are no studies evaluating the effect of HP in adenotonsillectomy in children. The aim of this study is to evaluate the efficacy HP during adenotonsillectomy in children in the prevention of PONV. METHODS: This is a randomized, double-blinded, controlled trial. Children aged 4-16 years, scheduled for adenotonsillectomy due to sleep-disordered breathing were enrolled in Hospital da Criança Santo Antônio (Brazil). 192 participants were screened, while 129 were enrolled and completed follow-up for primary outcome. Patients were randomized in a consecutive manner to receive HP or not during adenotonsillectomy. PONV occurrence was assessed in the first 24 h after surgery in HP and control group and relative risk with 95% confidence interval was calculated. RESULTS: There were 129 patients randomized, 64 in the HP and 65 in the control group. Female were 40.3% and mean ± SD age was 7.3 ± 2.9. Baseline characteristics and surgery variables were distributed similarly between the groups. Incidence of PONV was 20.3% in the HP and 23.1% in the control group. The relative risk for PONV was 0.88 (95% CI 0.46-1.70). CONCLUSION: Our results suggest that there is no benefit of HP during adenotonsillectomy in children for the prevention of PONV. TRIAL REGISTRATION: Brazilian Register of Randomized Trials (REBEC) identifier: RBR-3zjn27; Universal Trial Number U1111-1197-7461.

Application of glycerol as carbon source for continuous drinking water denitrification using microorganism from natural biomass.

The contamination of water resources by nitrate is a global problem. Indeed, traditional treatment technologies are not able to remove this ion from water. Alternatively, biological denitrification is a useful technique for natural water nitrate removal. This study aimed to evaluate the use of glycerol as a carbon source for drinking water nitrate removal via denitrification in a reactor using microorganisms from natural biomass. The experiment was carried out in a continuous fixed bed reactor using immobilised microorganisms from the vegetal Phyllostachys aurea. The tests were started in batch mode to provide cells growth and further immobilisation on the support. Then, the treatment experiments were accomplished in an up-flow continuous reactor. Ethanol was used as the primary carbon source, and it was gradually replaced by glycerol. The C:N (carbon to nitrogen) ratio and the hydraulic residence time (HRT) were evaluated. It was possible to remove 98.14% of nitrate using a C:N ratio and HRT of 3:1 and 1.51 days, respectively. The results have demonstrated that glycerol is a potential carbon source for denitrification in a continuous reactor using immobilised cells from natural biomass.

La2O3 Nanoparticles: Study of Uptake and Distribution in Pfaffia glomerata (Spreng.) Pedersen by LA-ICP-MS and µ-XRF.

The production and use of nanoparticles (NPs) in different fields increased in the last years. However, some NPs have toxicological properties, making these materials potential emerging pollutants. Therefore, it is important to investigate the uptake, transformation, translocation, and deposition of NPs in plants. In this work, laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) and micro X-ray fluorescence (µ-XRF) were used to investigate the uptake and translocation of La2O3 NPs to stem and leaves of Pfaffia glomerata (Spreng.) Pedersen after in vitro cultivation of plants in the presence of 400 mg L-1 of La2O3 NPs. By using LA-ICP-MS and µ-XRF, image of the spatial distribution of La in the leaves was obtained, where higher concentration of La was observed in the main veins. Differences in the signal profile of La in leaves of plants cultivated in the presence of bulk La2O3 (b-La2O3) and La2O3 NPs were observed. Sharp peaks of La indicated that NPs were transported to the stems and leaves of plants treated with La2O3 NPs. Both LA-ICP-MS and µ-XRF techniques have shown to be useful for detecting NPs in plants, but LA-ICP-MS is more sensitive than µ-XRF and allowed better detection and visualization of La distribution in the whole leaf.

A new dye based on anthocyanins from the acai fruit (Euterpe oleracea) for chromovitrectomy in humans: clinical trial results.

PURPOSE: To test the applicability of the acai dye at a 25% concentration for identifying the posterior hyaloids and internal limiting membranes (ILMs) during pars plana vitrectomy (PPV) in human eyes with macular holes (MHs). METHODS: This study included 25 patients with chronic idiopathic MHs. The exclusion criteria included glaucoma, previous significant ocular conditions, and previous ocular surgeries except uncomplicated cataract. Ten surgeons performed 23-gauge four-port PPV, phacoemulsification, posterior hyaloid detachment, ILM peeling guided by dye staining, and perfluoropropane injection. The patients remained prone for 5 days postoperatively. The patients were evaluated postoperatively after 1, 30, and 180 days. The surgeons completed a questionnaire regarding the dye's staining abilities. RESULTS: The posterior hyaloids and ILMs stained purple in all eyes. The final best-corrected visual acuity improved significantly (p < 0.001) from preoperatively (1.37 ± 0.29) to 180 days postoperatively (1.05 ± 0.43). The MHs closed in 76% of eyes. CONCLUSION: The acai dye at a 25% concentration identified posterior hyaloids and ILMs during PPVs in humans. Dye toxicity was unlikely.

INTRAVITREAL ZIV-AFLIBERCEPT FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: 52-Week Results.

PURPOSE: To evaluate the 52-week safety and efficacy of intravitreal ziv-aflibercept in patients with neovascular age-related macular degeneration. METHODS: All patients received three monthly intravitreal injections of 0.05 mL of ziv-aflibercept (1.25 mg) followed by a pro re nata regimen. The best-corrected visual acuity and spectral domain optical coherence tomography were obtained at baseline and monthly. Full-field and multifocal electroretinograms were obtained at baseline and 4, 13, 26, and 52 weeks. For some full-field electroretinography parameters, we calculated the differences between baseline and 52 weeks and then compared those differences between treated and untreated fellow eyes. RESULTS: Fifteen patients were included and 14 completed the 52-week follow-up. The mean best-corrected visual acuity improved from 0.95 ± 0.41 (20/200) at baseline to 0.75 ± 0.51 (20/125) logarithm of the minimum angle of resolution at 52 weeks (P = 0.0066). The baseline central retinal thickness decreased from 478.21 ± 153.48 µm to 304.43 ± 98.59 µm (P = 0.0004) at 52 weeks. Full-field electroretinography parameters used to assess retinal toxicity after intravitreal injections (rod response and oscillatory potentials) remained unchanged during follow-up. The average multifocal electroretinography macular response in 5° showed increased N1-P1 amplitude and decreased P1 implicit time (P < 0.05). One patient presented with intraocular inflammation after the seventh intravitreal procedure. CONCLUSION: The results suggested that intravitreal ziv-aflibercept might be safe and effective for treating neovascular age-related macular degeneration. More patients and a longer follow-up are needed to confirm the long-term outcomes of intravitreal ziv-aflibercept.

Unravelling the genetic differentiation among varieties of the Neotropical savanna tree Hancornia speciosa Gomes.

Background and Aims: Spatial distribution of species genetic diversity is often driven by geographical distance (isolation by distance) or environmental conditions (isolation by environment), especially under climate change scenarios such as Quaternary glaciations. Here, we used coalescent analyses coupled with ecological niche modelling (ENM), spatially explicit quantile regression analyses and the multiple matrix regression with randomization (MMRR) approach to unravel the patterns of genetic differentiation in the widely distributed Neotropical savanna tree, Hancornia speciosa (Apocynaceae). Due to its high morphological differentiation, the species was originally classified into six botanical varieties by Monachino, and has recently been recognized as only two varieties by Flora do Brasil 2020. Thus, H. speciosa is a good biological model for learning about evolution of phenotypic plasticity under genetic and ecological effects, and predicting their responses to changing environmental conditions. Methods: We sampled 28 populations (777 individuals) of Monachino's four varieties of H. speciosa and used seven microsatellite loci to genotype them. Key Results: Bayesian clustering showed five distinct genetic groups (K = 5) with high admixture among Monachino's varieties, mainly among populations in the central area of the species geographical range. Genetic differentiation among Monachino's varieties was lower than the genetic differentiation among populations within varieties, with higher within-population inbreeding. A high historical connectivity among populations of the central Cerrado shown by coalescent analyses may explain the high admixture among varieties. In addition, areas of higher climatic suitability also presented higher genetic diversity in such a way that the wide historical refugium across central Brazil might have promoted the long-term connectivity among populations. Yet, FST was significantly related to geographic distances, but not to environmental distances, and coalescent analyses and ENM predicted a demographical scenario of quasi-stability through time. Conclusions: Our findings show that demographical history and isolation by distance, but not isolation by environment, drove genetic differentiation of populations. Finally, the genetic clusters do not support the two recently recognized botanical varieties of H. speciosa, but partially support Monachino's classification at least for the four sampled varieties, similar to morphological variation.

Advanced Technical Considerations for Implanting the t-Branch Off-the-Shelf Multibranched Stent-Graft to Treat Thoracoabdominal Aneurysms.

PURPOSE: To demonstrate different techniques and device modifications that can expand the anatomic suitability of the off-the-shelf multibranched t-Branch for treatment of thoracoabdominal aortic aneurysm. TECHNIQUE: The t-Branch device is not customized for specific patient anatomy, and the most frequent limitations to its use are an inadequate sealing zone and renal artery anatomy. Experience with this device has prompted the development of several techniques that can be employed to maximize the suitability of this stent-graft. Advice is offered on modification of the device to minimize the risk of paraplegia or better match patient anatomy. Maneuvers are explained to ease delivery through tortuous anatomy or existing stent-grafts, catheterize visceral target vessels, select a bridging stent, reduce ischemia time in the limbs, and alter the configuration of the branches. CONCLUSION: Employing adjunctive maneuvers can increase the anatomic suitability of the t-Branch; in our experience, these techniques have increased the applicability to more than 80% of all elective and urgent thoracoabdominal aortic aneurysm cases.

Leishmania (Viannia) braziliensis isolated from the saliva of patients in a cutaneous leishmaniasis-endemic area of northeastern Brazil.

Several studies have described the use of non-invasive collection methods, mostly based on the detection of parasite DNA, for diagnosis. However, no Leishmania specimens have been isolated from saliva. Here, we report the first isolation of Leishmania braziliensis from the saliva of humans with cutaneous leishmaniasis but without lesions on their mucosa. The isolates were obtained from salivary fluid inoculated in hamsters and were tested by multilocus enzyme electrophoresis. Seven samples from 43 patients suspected of having the disease were identified for in vivo culture. These findings suggest that saliva is a clinical sample that allows the isolation of Leishmania sp.