Evidence that hematophagous triatomine bugs may eat plants in the wild.

Blood feeding is a secondary adaptation in hematophagous bugs. Many proteins are secreted in the saliva that are devoted to coping with the host's defense and to process the blood meal. Digestive enzymes that are no longer required for a blood meal would be expected to be eventually lost. Yet, in many strictly hematophagous arthropods, α-amylase genes, which encode the enzymes that digest starch from plants, are still present and transcribed, including in the kissing bug Rhodnius prolixus (Hemiptera, Reduviidae) and its related species, which transmit the Chagas disease. We hypothesized that retaining α-amylase could be advantageous if the bugs occasionally consume plant tissues. We first checked that the α-amylase protein of Rhodnius robustus retains normal amylolytic activity. Then we surveyed hundreds of gut DNA extracts from the sylvatic R. robustus to detect traces of plants. We found plant DNA in 8% of the samples, mainly identified as Attalea palm trees, where R. robustus are usually found. We suggest that although of secondary importance in the blood-sucking bugs, α-amylase may be needed during occasional plant feeding and thus has been retained.

Comprehensive quality assurance for intracranial radiosurgery treatments using a postal system / Garantía de calidad para tratamientos de radiocirugía intracranial usando un sistema postal

Radiosurgery is a high-precision technique for delivering, in most cases, a single highly conformal dose to a stereotactically localized target. It can be indicated for small intracranial injury treatment, using either multiple sources of 60Co (γ rays) or high energy photon beams produced by linear accelerators. In order to minimize the impact of inaccurate localization of the target or dose delivery, a rigorous Quality Assurance (QA) program must be enforced, which should include an independent auditing system. This work proposes a simple and reliable postal QA phantom to be used as an independent evaluation. In it two important parameters were verified such as, the dosimetric precision of the planning system, by comparing the absorbed doses measured in the target volume using different dosimeters (ionization chamber, films, thermoluminescent dosimeters and L-alanine dosimeters) all calibrated against a small volume ion chamber. The exact positioning of the target volume was localized using air spaces and small steel spheres to find the appropriate target coordinates. The head phantom and the instruction sheets were extensively tested and sent by mail to selected institutions. The overall results were very encouraging and suggest that the proposed phantom may be used as a postal system as part of an independent QA tool in radiosurgery.

La radiocirugía es una técnica de alta precisión para administrar, en la mayoría de los casos, una sola dosis altamente conformada en un objetivo localizado estereotípicamente. Puede estar indicado para el tratamiento de pequeñas lesiones intracraneales, utilizando múltiples fuentes de 60Co (rayos γ) o haces de fotones de alta energía producidos por aceleradores lineales. Con el fin de minimizar el impacto de la ubicación inexacta de la administración de la meta o de la dosis, se debe aplicar un riguroso programa de control de calidad (QA), que debe incluir un sistema de auditoría independiente. Este documento propone un fantoma postal de control de calidad simple y fiable que se utilizará como evaluación independiente. Se verificó dos parámetros importantes, como la precisión dosimétrica del sistema de planificación, comparando las dosis absorbidas medidas en el volumen objetivo mediante diferentes dosis (cámara de ionización, películas, dosímetros Termoluminiscentes y dosímetros de L-alanina) todos calibrados con una pequeña cámara de iones de volumen. El posicionamiento exacto del volumen objetivo se localizó utilizando espacios aéreos y pequeñas esferas de acero para encontrar las coordenadas de destino adecuadas. El fantoma principal y las hojas de instrucciones fueron ampliamente probados y enviados por correo a instituciones seleccionadas. Los resultados generales fueron muy alentadores y sugieren que el fantoma propuesto puede utilizarse como sistema postal como parte de una herramienta independiente de control de calidad en radiocirugía.

Do the new triatomine species pose new challenges or strategies for monitoring Chagas disease? An overview from 1979-2021

Chagas disease persists as one of the most important, and yet most neglected, diseases in the world, and several changes in its epidemiological aspects have been recorded since its discovery. Currently, some of the most relevant changes are related to: (i) the reduction in the incidence of the endemic due to the control of the most important vectors, Triatoma infestans and Rhodnius prolixus, in many countries; (ii) the migration of human populations spreading cases of the disease throughout the world, from endemic to non-endemic areas, transforming Chagas disease into a global threat; and (iii) new acute cases and deaths caused by oral transmission, especially in the north of Brazil. Despite the reduction in the number of cases, new challenges need to be responded to, including monitoring and control activities aiming to prevent house infestation by the secondary vectors from occurring. In 1979, Lent & Wygodzinsky(1) published the most complete review of the subfamily Triatominae, encompassing 111 recognised species in the taxon. Forty-two years later, 46 new species and one subspecies have been described or revalidated. Here we summarise the new species and contextualise them regarding their ecology, epidemiologic importance, and the obstacles they pose to the control of Chagas disease around the world.

Vascular access: the impact of ultrasonography / Acesso vascular: o impacto da ultrassonografia

ABSTRACT Vascular punctures are often necessary in critically ill patients. They are secure, but not free of complications. Ultrasonography enhances safety of the procedure by decreasing puncture attempts, complications and costs. This study reviews important publications and the puncture technique using ultrasound, bringing part of the experience of the intensive care unit of the Hospital Israelita Albert Einstein, São Paulo (SP), Brazil, and discussing issues that should be considered in future studies.

RESUMO Punções vasculares são muitas vezes necessárias em pacientes gravemente enfermos. São seguras, mas não isentas de complicações. A ultrassonografia associada à técnica de punção gera diminuição do número de tentativas, de complicações e de custos. O presente artigo revisou importantes publicações sobre o tema, bem como técnicas de punções, trazendo parte da experiência do centro de terapia intensiva de adultos do Hospital Israelita Albert Einstein, em São Paulo (SP) e discutindo tópicos que devem ser melhor explorados em estudos futuros.

Cerebral Aneurysm in Takayasu's Arteritis: A Case Report and Review of the Literature

Cerebral aneurysms are rarely observed in patients with Takaysu's arteritis. To our knowledge, this report presents the first case described in Brazil. Hemodynamic stress caused by obstructions of the cervical vessels developes cerebral aneurysms in these patients and they have higher rates of multiple and posterior circulation aneurysms than general population. In the majority of cases, microsurgical treatment is indicated mainly due to changes in the cervical vessels that preclude an endovascular approach.

Aneurismas cerebrais são raramente observados em pacientes com arterite de Takayasu. Este é o primeiro caso desta associação descrito no Brasil. O estresse hemodinâmico causado pelas obstruções vasculares cervicais desenvolve os aneurismas cerebrais nestes pacientes e eles apresentam maiores taxas de aneurismas múltiplos e de acometimento da circulação cerebral posterior. Na maioria dos casos, o tratamento microcirúrgico está indicado pois as alterações anatômicas dos vasos cervicais dificultam a abordagem endovascular.

Redução da mortalidade em pacientes queimados / Reduction of mortality in burned patients. A multifactorial approach

Classicamente, a infecção é atribuída como a principal causa de morte em queimaduras. Entretanto, outros parâmetros estão também intimamente relacionados à mortalidade. A superfície corporal queimada (SCQ), a profundidade da queimadura, idade avançada, a inalação de fumaça, o regime da reposição hídrica, a temporalidade dos procedimentos cirúrgicos, bem como o uso racional de antimicrobianos exemplificam os principais parâmetros. Este artigo tem o objetivo de discutir brevemente este conjunto de fatores causais relacionados à redução da mortalidade no paciente queimado.

Classically, the infection is attributed as a major cause of death in burns. However, other parameters are also closely related to mortality. The burnedbody surface area (BSA), the depth of the burn, advanced age, smokeinhalation, the regime of fluid replacement, the temporality of surgicalprocedures as well as the rational use of antimicrobial exemplify the mainparameters. This article aims to briefly discuss this set of causal factors relatedto the reduction of mortality in burned patients.

Utilização da tomografia computadorizada para o diagnóstico da articulação temporomandibular / Use of CT for diagnosing temporomandibular joint

A tomografia computadorizada desempenha um papel importante no diagnóstico de anomalias e condições patológicas da ATM, permitindo a visualização completa da região articular, fornecendo um diagnóstico mais preciso. Para avaliação das imagens tomográficas é necessário que o profissional tenha o conhecimento da anatomia seccional da região articular, para que o mesmo reconheça as alterações estruturais. Assim, foi exposto e descrito neste trabalho as características tomográficas de normalidade, alterações morfológicas e condições patológicas mais encontradas na região da articulação temporomandibular. Sendo a tomografia computadorizada um exame de imagem superior aos métodos convencionais de imagem para ATM, pois permite uma visualização tridimensional adequada e apurada de todos os detalhes ósseos sem a limitação das sobreposições, fornecendo o tamanho e formato real das estruturas anatômicas, alterações morfológicas e condições patológicas.

The computed tomography plays an important role in the diagnosis of anomalies and pathological conditions of the TMJ, providing a complete visualization of joint region, providing a more accurate diagnosis. For evaluation of the images is necessary to the professional the knowledge of sectional anatomy of the joint region, so he can recognize the structural changes. Therefore, it was explained and described in this study the characteristics of normal CT, morphological and pathological conditions commonly found in the region of the temporomandibular joint. The Computed tomography is an imaging exam superior than the conventional imaging exam for TMJ, because it allows an adequate and accurate three-dimensional visualization of all details of the bone, without the limitation of overlap, providing the real size and shape of the anatomical structures, morphological changes and pathological conditions.

Biology of Triatoma carcavalloi Jurberg, Rocha & Lent, 1998 under laboratory conditions

Introduction Triatoma carcavalloi is a wild species that is found in sympatry with Triatoma rubrovaria and Triatoma circummaculata, which are vectors of Trypanosoma cruzi currently found in rural areas of Rio Grande do Sul, Brazil. Methods Fertility was assessed and to determine the incubation period, the eggs were observed until hatching. The first meal was offered to 1st stage nymphs. The intermolt period was also determined. The number of blood meals was quantified at each nymphal stage and the resistance to fasting as the period between ecdysis and death. Mortality was assessed and longevity was determined by recording the time that elapsed from molting to the adult stage and until death. The developmental cycle was assessed by recording the length in days of each stage from molting to adult hood. Results The average incubation period was 22.7 days. The average first meal occurred 3.1 days after hatching. The 5th stage nymph to adult intermolting period was the longest at 193.4 days. The average number of feedings during nymphal development was 13.4. The resistance to fasting assay indicated that the 3rd, 4th and 5th stage nymphs presented higher resistance than did adults. The highest mortality rate was observed in the 3rd stage nymphs (22.2%). The average length of adult survival was 25.6 weeks, and the average total life cycle lasted 503.4 days. Conclusions This study is the first report on the biology of T. carcavalloi that fed on mice. The presented findings expand the bionomic knowledge of these species. .

Incêndio no centro cirúrgico / Fire in the surgical center / Incendio en el quirófano

JUSTIFICATIVA E OBJETIVOS: A existência de um ambiente rico em oxigênio, material combustível em abundância e a utilização de aparelhos capazes de fornecerem ignição transformam a sala cirúrgica em um ambiente de risco para a ocorrência de incêndios. Apesar de rara, trata-se de uma complicação potencialmente grave e na maioria das vezes evitável. Relatamos um caso de incêndio no campo cirúrgico durante uma cirurgia de blefaroplastia em que foi suplementado oxigênio por meio de cateter nasal. RELATO DO CASO: Paciente de 52 anos, sexo feminino, sem comorbidades, admitida para realização de blefaroplastia bilateral. Após monitorização e venóclise, procedeu-se à sedação endovenosa com oferta de oxigênio suplementar por meio de cateter tipo óculos, com fluxo de 4 L.min-1, seguida de anestesia local das pálpebras. Durante o ato cirúrgico, a utilização do bisturi elétrico ocasionou combustão dos campos cirúrgicos e queimaduras na face da paciente. CONCLUSÕES: O anestesiologista desempenha papel fundamental na prevenção de incêndio na sala cirúrgica, reconhecendo possíveis fontes de ignição e administrando de forma racional o oxigênio, principalmente com sistemas abertos. O primeiro passo para a prevenção deve ser a lembrança constante da possibilidade de incêndio.

BACKGROUND AND OBJECTIVES: There are several factors in operating rooms that increase the risk of fire. Besides being an oxygen-enriched environment, it contains combustible materials and equipment with available ignition sources. Although fires in operating rooms are a relatively rare event, the consequences are potentially serious and mostly avoidable. We present a case report of a fire occurring in the surgical drape during a blepharoplasty in which oxygen was supplemented by nasal catheter. CASE REPORT: Female patient, 52-years old, without comorbidities, admitted to hospital for a bilateral blepharoplasty. After monitoring and venoclysis, the patient underwent intravenous sedation and additional oxygen given via spectacle-type catheter at a flow rate of 4 L.min-1, followed by local anesthesia in the eyelids. During surgery, the use of electric scalpel provoked combustion in the surgical drapes and burns on the patient's face. CONCLUSIONS: Anesthesiologists play an important role preventing fire in operating rooms, as they can recognize possible ignition sources and rationally administer the oxygen, especially in open systems. The first step toward prevention is to be constantly aware of potential fire.

JUSTIFICATIVA Y OBJETIVOS: La existencia de un ambiente rico en oxígeno, material combustible en abundancia, y la utilización de aparatos capaces de realizar la ignición, transforma el quirófano en un ambiente de riesgo para el conato de incendios. A pesar de ser una complicación rara, es potencialmente grave y en la mayoría de los casos se puede evitar. Relatamos aquí un caso de incendio en el ambiente quirúrgico durante una cirugía de blefaroplastia en que fue suministrado oxígeno por medio de un catéter nasal. RELATO DEL CASO: Paciente de 52 años, del sexo femenino, sin comorbilidades, admitido para la realización de blefaroplastia bilateral. Posteriormente a la monitorización y a la venoclisis, se procedió a la sedación endovenosa con oferta de oxígeno suplementario por medio de un catéter tipo gafas con flujo de 4 L.min-1, seguida de anestesia local en los párpados. Durante la operación, la utilización del bisturí eléctrico creó una combustión de los campos quirúrgicos produciendo quemaduras en la cara de la paciente. CONCLUSIONES: El anestesiólogo desempeña un rol fundamental en la prevención del incendio en el quirófano, reconociendo posibles fuentes de ignición y administrando de forma racional el oxígeno, principalmente con sistemas abiertos. El primer paso para su prevención es estar siempre alertas sobre la posibilidad de que se pueda producir un incendio.