An integrated yeast-based process for cis,cis-muconic acid production.

Cis,cis-muconic acid (CCM) is a promising polymer building block. CCM can be made by whole-cell bioconversion of lignin hydrolysates or de novo biosynthesis from sugar feedstocks using engineered microorganisms. At present, however, there is no established process for large-scale CCM production. In this study, we developed an integrated process for manufacturing CCM from glucose by yeast fermentation. We systematically engineered the CCM-producing Saccharomyces cerevisiae strain by rewiring the shikimate pathway flux and enhancing phosphoenolpyruvate supply. The engineered strain ST10209 accumulated less biomass but produced 1.4 g/L CCM (70 mg CCM per g glucose) in microplate assay, 71% more than the previously engineered strain ST8943. The strain ST10209 produced 22.5 g/L CCM in a 2 L fermenter with a productivity of 0.19 g/L/h, compared to 0.14 g/L/h achieved by ST8943 in our previous report under the same fermentation conditions. The fermentation process was demonstrated at pilot scale in 10 and 50 L steel tanks. In 10 L fermenter, ST10209 produced 20.8 g/L CCM with a CCM yield of 0.1 g/g glucose and a productivity of 0.21 g/L/h, representing the highest to-date CCM yield and productivity. We developed a CCM recovery and purification process by treating the fermentation broth with activated carbon at low pH and low temperature, achieving an overall CCM recovery yield of 66.3% and 95.4% purity. In summary, we report an integrated CCM production process employing engineered S. cerevisiae yeast.

Investigating illegal activities that affect biodiversity: the case of wildlife consumption in the Brazilian Amazon.

The illegal use of natural resources, manifested in activities like illegal logging, poaching, and illegal wildlife trade, poses a global threat to biodiversity. Addressing them will require an understanding of the magnitude of and factors influencing these activities. However, assessing such behaviors is challenging because of their illegal nature, making participants less willing to admit engaging in them. We compared how indirect (randomized response technique) and direct questioning techniques performed when assessing non-sensitive (fish consumption, used as negative control) and sensitive (illegal consumption of wild animals) behaviors across an urban gradient (small towns, large towns, and the large city of Manaus) in the Brazilian Amazon. We conducted 1,366 surveys of randomly selected households to assess the magnitude of consumption of meat from wild animals (i.e., wild meat) and its socioeconomic drivers, which included years the head of household lived in urban areas, age of the head of household, household size, presence of children, and poverty. The indirect method revealed higher rates of wildlife consumption in larger towns than did the direct method. Results for small towns were similar between the two methods. The indirect method also revealed socioeconomic factors influencing wild meat consumption that were not detected with direct methods. For instance, the indirect method showed that wild meat consumption increased with age of the head of household, and decreased with poverty and years the head of household lived in urban areas. Simultaneously, when responding to direct questioning, households with characteristics associated with higher wild meat consumption, as estimated from indirect questioning, tended to underreport consumption to a larger degree than households with lower wild meat consumption. Results for fish consumption, used as negative control, were similar for both methods. Our findings suggest that people edit their answers to varying degrees when responding to direct questioning, potentially biasing conclusions, and indirect methods can improve researchers' ability to identify patterns of illegal activities when the sensitivity of such activities varies across spatial (e.g., urban gradient) or social (e.g., as a function of age) contexts. This work is broadly applicable to other geographical regions and disciplines that deal with sensitive human behaviors.

Impacts of rural to urban migration, urbanization, and generational change on consumption of wild animals in the Amazon.

For the first time in history, more people live in urban areas than in rural areas. This trend is likely to continue, driven largely by rural-to-urban migration. We investigated how rural-to-urban migration, urbanization, and generational change affect the consumption of wild animals. We used chelonian (tortoises and freshwater turtles), one of the most hunted taxa in the Amazon, as a model. We surveyed 1356 households and 2776 school children across 10 urban areas of the Brazilian Amazon (6 small towns, 3 large towns, and Manaus, the largest city in the Amazon Basin) with a randomized response technique and anonymous questionnaires. Urban demand for wild meat (i.e., meat from wild animals) was alarmingly high. Approximately 1.7 million turtles and tortoises were consumed in urban areas of Amazonas during 2018. Consumption rates declined as size of the urban area increased and were greater for adults than children. Furthermore, the longer rural-to-urban migrants lived in urban areas, the lower their consumption rates. These results suggest that wild meat consumption is a rural-related tradition that decreases as urbanization increases and over time after people move to urban areas. However, it is unclear whether the observed decline will be fast enough to conserve hunted species, or whether children's consumption rate will remain the same as they become adults. Thus, conservation actions in urban areas are still needed. Current conservation efforts in the Amazon do not address urban demand for wildlife and may be insufficient to ensure the survival of traded species in the face of urbanization and human population growth. Our results suggest that conservation interventions must target the urban demand for wildlife, especially by focusing on young people and recent rural to urban migrants. Article impact statement: Amazon urbanite consumption of wildlife is high but decreases with urbanization, over time for rural to urban migrants, and between generations. Impactos de la Migración del Campo a la Ciudad, la Urbanización y del Cambio Generacional sobre el Consumo de Animales Silvestres en el Amazonas.

Por primera vez en la historia, la población urbana es mayor que la rural. Es muy probable que esta tendencia continúe debido a la migración del campo a la ciudad. Investigamos el efecto de la migración del campo a la ciudad, la urbanización y el cambio generacional sobre el consumo de animales silvestres. Utilizamos como modelo a los quelonios (tortugas acuáticas y terrestres), uno de los taxa más cazados en el Amazonas. Aplicamos encuestas en 1,356 casas y a 2,776 niños en edad escolar en 10 áreas urbanas de la Amazonía brasileña (6 poblados pequeños, 3 poblados grandes y Manaos, la mayor ciudad en la Cuenca del Amazonas) mediante una técnica de respuesta aleatoria y cuestionarios anónimos. La demanda urbana de carne silvestre (i.e., carne de animales silvestres) fue alarmantemente alta. Aproximadamente 1.7 millones de tortugas acuáticas y terrestres fueron consumidas en áreas urbanas del Amazonas durante 2018. Las tasas de consumo declinaron a medida que incrementó la superficie urbana y fueron mayores en adultos que en niños. Más aun, entre más tiempo viviendo en áreas urbanas, las tasas de consumo fueron menores en los migrantes del campo a la ciudad. Estos resultados sugieren que el consumo de carne silvestre es una tradición rural que disminuye a medida que aumenta la urbanización y el tiempo desde que los habitantes se mueven a la ciudad. Sin embargo, no es claro si la declinación observada será lo suficientemente rápida para conservar a las especies cazadas, o si la tasa de consumo de los niños permanecerá igual cuando sean adultos. Por lo tanto, aun se requieren acciones de conservación en áreas urbanas. Los actuales esfuerzos de conservación en el Amazonas no abordan la demanda urbana de carne de monte y pueden ser insuficientes para asegurar la supervivencia de especies comercializadas ante la urbanización y el crecimiento de la población humana. Nuestros resultados sugieren que las intervenciones de conservación deben atender la demanda de fauna silvestre, con énfasis en los jóvenes y los migrantes recientes.

Influenza-like illness in an urban community of Salvador, Brazil: incidence, seasonality and risk factors.

BACKGROUND: Our understanding of the epidemiology of influenza is limited in tropical regions, which in turn has hampered identifying optimal region-specific policy to diminish disease burden. Influenza-like illness (ILI) is a clinical diagnosis that can be used as a surrogate for influenza. This study aimed to define the incidence and seasonality of ILI and to assess its association with climatic variables and school calendar in an urban community in the tropical region of Salvador, Brazil. METHODS: Between 2009 and 2013, we conducted enhanced community-based surveillance for acute febrile illnesses (AFI) among patients ≥ 5 years of age in a slum community emergency unit in Salvador, Brazil. ILI was defined as a measured temperature of ≥ 37.8 °C or reported fever in a patient with cough or sore throat for ≤ 7 days, and negative test results for dengue and leptospirosis. Seasonality was analyzed with a harmonic regression model. Negative binomial regression models were used to correlate ILI incidence with rainfall, temperature, relative humidity and the number of days per month that schools were in session while controlling for seasonality. RESULTS: There were 2,651 (45.6% of 5,817 AFI patients) ILI cases with a mean annual incidence of 60 cases/1,000 population (95% CI 58-62). Risk of ILI was highest among 5-9 year olds with an annual incidence of 105 cases/1,000 population in 2009. ILI had a clear seasonal pattern with peaks between the 35-40th week of the year. ILI peaks were higher and earlier in 5-9 year olds compared with > 19 year olds. No association was seen between ILI and precipitation, relative humidity or temperature. There was a significant association between the incidence of ILI in children 5-9 years of age and number of scheduled school days per month. CONCLUSIONS: We identified a significant burden of ILI with distinct seasonality in the Brazilian tropics and highest rates among young school-age children. Seasonal peaks of ILI in children 5-9 years of age were positively associated with the number of school days, indicating that children may play a role in the timing of seasonal influenza transmission.

Biological activity of ruthenium nitrosyl complexes.

Nitric oxide plays an important role in various biological processes, such as neurotransmission, blood pressure control, immunological responses, and antioxidant action. The control of its local concentration, which is crucial for obtaining the desired effect, can be achieved with exogenous NO-carriers. Coordination compounds, in particular ruthenium(III) and (II) amines, are good NO-captors and -deliverers. The chemical and photochemical properties of several ruthenium amine complexes as NO-carriers in vitro and in vivo have been reviewed. These nitrosyl complexes can stimulate mice hippocampus slices, promote the lowering of blood pressure in several in vitro and in vivo models, and control Trypanosoma cruzi and Leishmania major infections, and they are also effective against tumor cells in different models of cancer. These complexes can be activated chemically or photochemically, and the observed biological effects can be attributed to the presence of NO in the compound. Their efficiencies are explained on the basis of the [Ru(II)NO(+)](3+)/[Ru(II)NO(0)](2+) reduction potential, the specific rate constant for NO liberation from the [RuNO](2+) moiety, and the quantum yield of NO release.

Brazilian Horses from Bahia State Are Highly Infected with Sarcocystis bertrami.

The protozoan Sarcocystis bertrami (syn. Sarcocystis fayeri) infects horses and has dogs as definitive hosts. Herein we aimed to detect S. bertrami in Brazilian horses destined for human consumption and to determine the frequency of infection in the examined animals. Muscle fragments from 51 horses were collected in a slaughterhouse in Bahia State during three different seasons of the year. Samples from six tissues from each animal were prepared for macroscopic and microscopic evaluation, using tissue grinding, squash and histology. Sarcocystis sp. was observed in 100% of the examined horses. Selected samples were processed for transmission electron microscopy (TEM). Species identification was confirmed using a PCR targeted to the mitochondrial cytochrome c oxidase subunit 1 gene (cox1). Histological examination revealed sarcocysts with variable sizes and shapes, and dispersed within the muscle fibers. When observed by TEM, the sarcocyst wall was wavy and covered by an electrodense layer. The villar protrusions were digitiform and bent. To our knowledge, this study is the first morphological and molecular confirmation of S. bertrami in horses in Brazil and South America.

Traditional Uses, Phytochemistry, and Bioactivities of Mesosphaerum suaveolens (L.) Kuntze.

Mesosphaerum suaveolens (L.) Kuntze is a species widely used traditionally in the treatment of ailments, such as stomach pain, hemorrhoids, cough, verminosis, ulcer, liver disease, fever, influenza, nasal congestion, and inflammation. This review aims to provide a survey of available information on seven international electronic databases (Google Scholar, Medline, ResearchGate, Web of Science, Scopus, Science Direct, and PubMed) about botanical aspects, traditional uses, phytochemistry, and biological activities of M. suaveolens. Mesosphaerum suaveolens is a tropical America native species, but it can be found in several parts of the world as a ruderal plant. The species is the most studied species of the genus Lamiaceae due its phytochemical aspect, especially regarding the chemical composition of its essential oil. Besides the essential oils, M. suaveolens is a source of numerous secondary compounds such as triterpenes, diterpenes, and phenolic compounds, which are related to its biological activities, such as allelopathic, antibacterial, antifungal, insecticidal, and larvicidal activities as described in the literature.

Epidemiological profile of leprosy in the state of Mato Grosso: descriptive study.

OBJECTIVE: To analyze the prevalence of leprosy cases using as parameters the number of diagnosed cases, age group, sex, clinical form of the disease, degree of physical disability, affected nerves, and therapeutic methods. METHODS: This was a descriptive study. Data were collected in the Information System for Notifiable Diseases (Sistema de Informações de Agravos de Notificação) from 2014 to 2017 in the state of Mato Grosso (MT), Brazil. RESULTS: In the studied period, 11,388 cases were notified in the state, with a higher prevalence in the year 2017. Most cases were diagnosed in individuals older than 15 years with a slight predominance of men. During diagnosis, there was prevalence of zero degree of physical disability and among individuals with affected nerves, mostly had less than five nerves affected. CONCLUSION: Analyzing the prevalence and epidemiological profile of leprosy cases in the state of Mato Grosso (MT) turns to be essential for coping with the disease, as it helps in its management and treatment, with an emphasis on multidisciplinary approach for the recovery of existing cases and prevention of new cases, especially at hyperendemic states.

Syncope in Patients with Cardiac Pacemakers.

INTRODUCTION: It is challenging to diagnose syncope in patients with pacemakers. Because these patients have increased morbidity and mortality risks, they require immediate attention to determine the causes in order to provide appropriate treatment. This study aimed to investigate the causes and predictive factors of syncope as well as the methods used to diagnose syncope in cardiac pacemaker patients. METHODS: Patients with pacemakers implanted owing to sinus node disease or atrioventricular block were evaluated with standardized questionnaires, endocavitary electrograms, and other tests based on the suspected causes of syncope. Mann- Whitney U tests were used to analyze continuous variables and Chi-squared or Fisher's exact tests were used for categorical variables. Logistic regression was used for multivariate analyses. Statistical significance was P<0.05. RESULTS: The study included 95 patients with pacemakers: 47 experienced syncope in the last 12 months and 48 did not. Of the 100 documented episodes of syncope, 48.9% were vasovagal syncopes, 17% had cardiac-related causes, 10.6% had unknown causes, and 8.5% had pacemaker failure. The multivariate analysis showed that a New York Heart Association (NYHA) Functional Class II was a significant factor for developing syncope (P<0.01). CONCLUSION: While the most common type of syncope in pacemaker patients was neurally mediated, it is important to perform detailed evaluations in this population as the causes of syncope can be life-threatening. The best diagnostic methods were stored electrogram analysis and the tilt table test. NYHA Functional Class II patients were found to have a higher risk for syncope.

Influence of body size, topography, food availability and tree-fall gaps on space use by yellow-footed tortoises (Chelonoidis denticulatus) in Central Amazonia.

Habitat selection and extension of the area used by a given species may vary during different phases of its life and are often determined by the distribution and availability of resources throughout the landscape, such as food, breeding sites, and shelters. In this study, we assessed the influence of body size on the areas used by 21 individuals of the yellow-footed tortoises (Chelonoidis denticulatus) from January to June 2017 in a dense rain forest area in Central Amazonia. We also investigated whether individuals selected different ranges of terrain slope, elevation, areas with high food availability, or areas with treefall gaps that could be used for shelter or thermoregulation. We monitored tortoise movements using thread-bobbins, and sampled terrain characteristics, availability of potential food resources and forest gaps along the routes used by the tortoises. We also measured the same variables in plots distributed systematically throughout the study area to evaluate resource availability. Tortoises used an average area of 1.56 ha (SD = 1.51, min = 0.03, max = 6.44). The size of the area used was positively associated with the individual body size, but did not vary between sexes. Small individuals selected higher and flatter areas where the availability of fallen flowers was higher, whereas the area used by larger individuals did not differ from the natural availability of topographic traits and food in the region. Although tortoises did not select areas according to availability of tree-fall gaps, most larger tortoises were found sheltered under fallen trees (85%). Conversely, small individuals were mainly found hidden under litter (66%). Body size determined the patterns of landscape use by tortoises; larger individuals were mainly generalists, but small individuals occupied high and flat areas. The yellow-footed tortoise is endangered by hunting, illegal collection for the pet trade, habitat destruction and effects of climate change. Size-related differences in habitat selection should be taken into account in species-distribution models for the identification of suitable areas for reintroduction and the development of management plans in protected areas.

Sarcocystis falcatula-like derived from opossum in Northeastern Brazil: In vitro propagation in avian cells, molecular characterization and bioassay in birds.

Most reported isolates of Sarcocystis spp. derived from Brazilian opossums (Didelphis sp.) have genetic characteristics distinct from the known species of Sarcocystis, but behave similarly as Sarcocystis falcatula, as they are infective to budgerigars. In previous studies, these Brazilian isolates, classified as Sarcocystis falcatula-like, were originated from South and Southeast regions of Brazil. In the current work, we aimed to culture and to perform multilocus sequence analysis of Sarcocystis sp. derived from a Brazilian opossum (D. aurita/D. marsupialis) that inhabited the city of Salvador, Bahia, in the Northeast of Brazil. The parasite was isolated in Vero cells, referred here as Sarco-BA1, and propagated in avian cells (DF-1). Molecular analysis of Sarco-BA1 revealed that the nucleotide sequence of the internal transcribed spacer 1 (ITS1) of the rDNA was identical to all isolates (n = 19) of Sarcocystis spp. reported in two studies from South and Southeast regions of the country. Two budgerigars were inoculated with 10 and 1000 sporocysts of Sarco-BA1, respectively, and developed acute sarcocystosis, showing that the parasite behaves like S. falcatula. It was interesting to observe that Sarco-BA1 had almost identical ITS1 and SAG sequences to all 16 isolates of S. falcatula-like recently described in Magellanic penguins (Spheniscus magellanicus) rescued on the coast of Espírito Santo state, Brazil. Our results suggest that Sarco-BA1 and S. falcatula-like may represent a single species of Sarcocystis. Propagation of the parasite in a permanent avian cell line significantly improved the yield of merozoites in cell culture. To our knowledge, this is the first molecular study and in vitro isolation of S. falcatula-like derived from Northeastern Brazil. Studies are under way to determine the infectivity of Sarco-BA1 to other animal species, as well as to investigate serological cross-reactivity among Sarco-BA1, S. neurona and related species.

Accuracy of the SD BIOLINE Dengue Duo for rapid point-of-care diagnosis of dengue.

BACKGROUND: Rapid diagnosis tests (RDTs) are easy to carry out, provide fast results, and could potentially guide medical treatment decisions. We investigated the performance of a commercially available RDT, which simultaneously detects the non-structural 1 (NS1) dengue virus (DENV) antigen, and IgM and IgG DENV antibodies, using representative serum samples from individuals in a dengue endemic area in Salvador, Brazil. METHODOLOGY/PRINCIPAL FINDINGS: We evaluated the accuracy of the SD BIOLINE Dengue Duo RDT (Abbott, Santa Clara, USA; former Alere Inc, Waltham, USA) in a random collection of sera. Samples included acute-phase sera from 246 laboratory-confirmed dengue cases and 108 non-dengue febrile patients enrolled in a surveillance study for dengue detection, 73 healthy controls living in the same surveillance community, and 73 blood donors. RDT accuracy was blindly assessed based on the combined results for the NS1 and the IgM test components. The RDT sensitivity was 46.8% (38.6% for the NS1 component and 13.8% for the IgM component). Sensitivity was greater for samples obtained from patients with secondary DENV infections (49.8%) compared to primary infections (31.1%) (P: 0.02) and was also influenced by the result in the confirmatory dengue diagnostic test, ranging from 39.7% for samples of cases confirmed by IgM-ELISA seroconversion between paired samples to 90.4% for samples of cases confirmed by a positive NS1-ELISA. The RDT specificity was 94.4% for non-dengue febrile patients, 87.7% for the community healthy controls, and 95.9% for the blood donors. CONCLUSIONS/SIGNIFICANCE: The SD BIOLINE Dengue Duo RDT showed good specificities, but low sensitivity, suggesting that it may be more useful to rule in than to rule out a dengue diagnosis in dengue endemic regions.

Epidemiological profile of leprosy in the state of Mato Grosso: descriptive study / Perfil epidemiológico da hanseníase no estado de Mato Grosso: estudo descritivo

ABSTRACT Objective To analyze the prevalence of leprosy cases using as parameters the number of diagnosed cases, age group, sex, clinical form of the disease, degree of physical disability, affected nerves, and therapeutic methods. Methods This was a descriptive study. Data were collected in the Information System for Notifiable Diseases (Sistema de Informações de Agravos de Notificação) from 2014 to 2017 in the state of Mato Grosso (MT), Brazil. Results In the studied period, 11,388 cases were notified in the state, with a higher prevalence in the year 2017. Most cases were diagnosed in individuals older than 15 years with a slight predominance of men. During diagnosis, there was prevalence of zero degree of physical disability and among individuals with affected nerves, mostly had less than five nerves affected. Conclusion Analyzing the prevalence and epidemiological profile of leprosy cases in the state of Mato Grosso (MT) turns to be essential for coping with the disease, as it helps in its management and treatment, with an emphasis on multidisciplinary approach for the recovery of existing cases and prevention of new cases, especially at hyperendemic states.

RESUMO Objetivo Analisar a prevalência de casos de hanseníase, tendo como parâmetros número de casos diagnosticados, faixa etária, sexo, forma clínica da doença, grau de incapacidade física, nervos acometidos e esquema terapêutico. Métodos Trata-se de estudo descritivo. Os dados foram coletados no Sistema de Informações de Agravos de Notificação, referentes ao período de 2014 a 2017 e relativos ao estado do Mato Grosso (MT), Brasil. Resultados No período em estudo notificaram-se 11.388 casos no estado, com maior prevalência no ano de 2017. A maior parte dos casos diagnosticados foi em indivíduos com mais de 15 anos, com discreto predomínio no sexo masculino. Prevaleceu o grau zero de incapacidade física durante o diagnóstico e menos de cinco nervos em cada indivíduo, naqueles com nervos afetado. Conclusão A análise da prevalência e do perfil epidemiológico de casos da hanseníase no estado de Mato Grosso (MT) torna-se essencial para o enfrentamento da doença, pois auxilia no manejo e no tratamento, com ênfase no trabalho multiprofissional para recuperação dos casos já existentes e na prevenção de novos casos, especialmente em estados hiperendêmicos.

Functional Class in Children with Idiopathic Dilated Cardiomyopathy. A pilot Study.

BACKGROUND: Idiopathic dilated cardiomyopathy (IDCM), most common cardiac cause of pediatric deaths, mortality descriptor: a low left ventricular ejection fraction (LVEF) and low functional capacity (FC). FC is never self reported by children. OBJECTIVE: The aims of this study were (i) To evaluate whether functional classifications according to the children, parents and medical staff were associated. (iv) To evaluate whether there was correlation between VO2 max and Weber's classification. METHOD: Prepubertal children with IDCM and HF (by previous IDCM and preserved LVEF) were selected, evaluated and compared. All children were assessed by testing, CPET and functional class classification. RESULTS: Chi-square test showed association between a CFm and CFp (1, n = 31) = 20.6; p = 0.002. There was no significant association between CFp and CFc (1, n = 31) = 6.7; p = 0.4. CFm and CFc were not associated as well (1, n = 31) = 1.7; p = 0.8. Weber's classification was associated to CFm (1, n = 19) = 11.8; p = 0.003, to CFp (1, n = 19) = 20.4; p = 0.0001and CFc (1, n = 19) = 6.4; p = 0.04). CONCLUSION: Drawing were helpful for children's self NYHA classification, which were associated to Weber's stratification.

Storm drains as larval development and adult resting sites for Aedes aegypti and Aedes albopictus in Salvador, Brazil.

BACKGROUND: Dengue (DENV), Chikungunya (CHIKV), Zika (ZIKV), as well as yellow fever (YFV) viruses are transmitted to humans by Aedes spp. females. In Salvador, the largest urban center in north-eastern Brazil, the four DENV types have been circulating, and more recently, CHIKV and ZIKV have also become common. We studied the role of storm drains as Aedes larval development and adult resting sites in four neighbourhoods of Salvador, representing different socioeconomic, infrastructure and topographic conditions. RESULTS: A sample of 122 storm drains in the four study sites were surveyed twice during a 4-month period in 2015; in 49.0 % of the visits, the storm drains contained water. Adults and immatures of Aedes aegypti were captured in two of the four sites, and adults and immatures of Aedes albopictus were captured in one of these two sites. A total of 468 specimens were collected: 148 Ae. aegypti (38 adults and 110 immatures), 79 Ae. albopictus (48 adults and 31 immatures), and 241 non-Aedes (mainly Culex spp.) mosquitoes (42 adults and 199 immatures). The presence of adults or immatures of Ae. aegypti in storm drains was independently associated with the presence of non-Aedes mosquitoes and with rainfall of ≤ 50 mm during the preceding week. CONCLUSIONS: We found that in Salvador, one of the epicentres of the 2015 ZIKV outbreak, storm drains often accumulate water and serve as larval development sites and adult resting areas for both Ae. aegypti and Ae. albopictus. Vector control campaigns usually overlook storm drains, as most of the effort to prevent Ae. agypti reproduction is directed towards containers in the domicile environment. While further studies are needed to determine the added contribution of storm drains for the maintenance of Aedes spp. populations, we advocate that vector control programs incorporate actions directed at storm drains, including regular inspections and use of larvicides, and that human and capital resources are mobilized to modify storm drains, so that they do not serves as larval development sites for Aedes (and other) mosquitoes.

Syncope in patients with cardiac pacemakers

Abstract Introduction: It is challenging to diagnose syncope in patients with pacemakers. Because these patients have increased morbidity and mortality risks, they require immediate attention to determine the causes in order to provide appropriate treatment. This study aimed to investigate the causes and predictive factors of syncope as well as the methods used to diagnose syncope in cardiac pacemaker patients. Methods: Patients with pacemakers implanted owing to sinus node disease or atrioventricular block were evaluated with standardized questionnaires, endocavitary electrograms, and other tests based on the suspected causes of syncope. Mann-Whitney U tests were used to analyze continuous variables and Chi-squared or Fisher's exact tests were used for categorical variables. Logistic regression was used for multivariate analyses. Statistical significance was P<0.05. Results: The study included 95 patients with pacemakers: 47 experienced syncope in the last 12 months and 48 did not. Of the 100 documented episodes of syncope, 48.9% were vasovagal syncopes, 17% had cardiac-related causes, 10.6% had unknown causes, and 8.5% had pacemaker failure. The multivariate analysis showed that a New York Heart Association (NYHA) Functional Class II was a significant factor for developing syncope (P<0.01). Conclusion: While the most common type of syncope in pacemaker patients was neurally mediated, it is important to perform detailed evaluations in this population as the causes of syncope can be life-threatening. The best diagnostic methods were stored electrogram analysis and the tilt table test. NYHA Functional Class II patients were found to have a higher risk for syncope.

Fatores que interferem na duração do aleitamento materno de crianças na Região Metropolitana do Cariri cearense / Factors that interfere in the duration of breastfeeding of children in the Metropolitan Region of Cariri, Ceará

Introdução: O Aleitamento Materno Exclusivo (AME) é uma prática alimentar fundamental para a promoção da saúde materno-infantil. Porém, os índices para o AME no Brasil ainda se encontram abaixo do recomendado pela Organização Mundial da Saúde. Objetivo: Analisar os fatores que interferem na duração do aleitamento materno de crianças situadas na Região Metropolitana do Cariri cearense. Método: Estudo transversal descritivo, com abordagem quantitativa, realizado na Região Metropolitana do Cariri cearense. A amostra foi composta por 177 crianças entre seis e 23 meses de idade. Os dados foram coletados por meio de questionários, contendo informações a respeito das condições socioeconômicas e demográficas da família e da saúde infantil. As análises estatísticas foram realizadas com o software Statistical Package for the Social Sciences, procedendo-se a análise descritiva dos dados e aplicação do teste Qui-Quadrado. Razões de Chance (RC), intervalo de confiança de 95% (IC95%) e respectivos valores de p foram calculados pela regressão logística multinominal. Resultados: O tempo médio para o AME foi de 4,33 (±1,98) meses. Somente 38,9% das crianças avaliadas foram amamentadas, exclusivamente, até os seis meses de vida. Na análise de regressão logística multivariada verificou-se maior chance de tempo de AME adequado nas famílias com <1/4 salário mínimo (RC: 2,270 IC95% 1,104 - 4,666, p= 0,026). Conclusão: O AME, nos municípios avaliados, ainda é insatisfatório de acordo com as recomendações preconizadas pelas entidades de saúde. A baixa renda per capita foi o fator determinante para uma adequada prática do AME na vida dos lactentes. (AU)

Introduction: Exclusive Breastfeeding (EBF) is a fundamental dietary practice for the promotion of maternal and child health. Unfortunately, the rates for EBF in Brazil are still below that recommended by the World Health Organization. Objective: To analyze the factors that interfere in the duration of breastfeeding of children living in the metropolitan region of Cariri, Ceará. Method: Descriptive cross-sectional study, with a quantitative approach, carried out in the Metropolitan Region of Cariri, Ceará. The sample consisted of 177 children between 6 and 23 months of age. The data were collected through questionnaires containing information about the socioeconomic and demographic conditions of the family and child health. Statistical analyses were performed using the software Statistical Package for the Social Sciences, proceeding to the data descriptive analysis, application of the Chi-Square test, Odds Ratios (OR), 95% Confidence Interval (95% CI) and respective values of p were calculated by multinomial logistic regression. Results: The mean EBF length was 4.33 (± 1.98) months, only 38.9% of the evaluated children were exclusively breastfed until 6 months of life. In the multivariate logistic regression analysis, a greater chance of adequate EBF length was verified in families with <1/4 minimum wage (OR: 2.270 95% CI 1.104 - 4.666, p = 0.026). Conclusion: EBF in the municipalities evaluated is still unsatisfactory according to the recommendations recommended by health entities. Low per capita income was the determining factor for the proper practice of EBF in the lives of infants. (AU)

Exercise training improves ambulatory blood pressure but not arterial stiffness in heart transplant recipients.

BACKGROUND: Hypertension is the most prevalent comorbidity after heart transplantation (HT). Exercise training (ET) is widely recommended as a key non-pharmacologic intervention for the prevention and management of hypertension, but its effects on ambulatory blood pressure (ABP) and some mechanisms involved in the pathophysiology of hypertension have not been studied in this population. The primary purpose of this study was to investigate the effects of ET on ABP and arterial stiffness of HT recipients. METHODS: 40 HT patients, randomized to ET (n = 31) or a control group (n = 9) underwent a maximal graded exercise test, 24-hour ABP monitoring, and carotid-femoral pulse wave velocity (PWV) assessment before the intervention and at a 12-week follow-up assessment. The ET program was performed thrice-weekly and consisted primarily of endurance exercise (40 minutes) at ~70% of maximum oxygen uptake (Vo2MAX). RESULTS: The ET group had reduced 24-hour (4.0 ± 1.4 mm Hg, p < 0.01) and daytime (4.8 ± 1.6 mm Hg, p < 0.01) systolic ABP, and 24-hour (7.0 ± 1.4 mm Hg, p < 0.001) daytime (7.5 ± 1.6 mm Hg, p < 0.001) and nighttime (5.9 ± 1.5 mm Hg, p < 0.001) diastolic ABP after the intervention. The ET group also had improved Vo2MAX (9.7% ± 2.6%, p < 0.001) after the intervention. However, PWV did not change after ET. No variable was changed in the control group after the intervention. CONCLUSIONS: The 12-week ET program was effective for reducing ABP but not PWV in heart transplant recipients. This result suggests that endurance ET may be a tool to counteract hypertension in this high-risk population.

Antitubercular activity of Ru (II) isoniazid complexes.

Despite the resistance developed by the Mycobacterium tuberculosis (MTb) strains, isoniazid (INH) has been recognized as one of the best drug for treatment of Tuberculosis (Tb). The coordination of INH to ruthenium metal centers was investigated as a strategy to enhance the activity of this drug against the sensitive and resistant strains of MTb. The complexes trans-[Ru(NH3)4(L)(INH)](2+) (L=SO2 or NH3) were isolated and their chemical and antituberculosis properties studied. The minimal inhibitory concentration (MIC) data show that [Ru(NH3)5(INH)](2+) was active in both resistant and sensitive strains, whereas free INH (non-coordinated) showed to be active only against the sensitive strain. The coordination of INH to the metal center in both [Ru(NH3)5(INH)](2+) and trans-[Ru(NH3)4(SO2)(INH)](2+) complexes led to a shift in the INH oxidation potential to less positive values compared to free INH. Despite, the ease of oxidation of INH did not lead to an increase in the in vitro INH activity against MTb, it might have provided sensitivity toward resistant strains. Furthermore, ruthenium complexes with chemical structures analogous to those described above were synthesized using the oxidation products of INH as ligands (namely, isonicotinic acid and isonicotinamide). These last compounds were not active against any strains of MTb. Moreover, according to DFT calculations the formation of the acyl radical, a proposed intermediate in the INH oxidation, is favored in the [Ru(NH3)5(INH)](2+) complex by 50.7kcalmol(-1) with respect to the free INH. This result suggests that the stabilization of the acyl radical promoted by the metal center would be a more important feature than the oxidation potential of the INH for the antituberculosis activity against resistant strains.