Chagas disease deaths detected among garbage codes registered in mortality statistics in Brazil: a study from the buRden of ChAgas dISEase in the contemporary world (RAISE) project.

OBJECTIVES: The objective of this study was to identify Brazil's most critical garbage codes (GCs) reclassified to Chagas disease (ChD) in mortality data and their proportions. We also estimated the potential impact of misclassification on the number of deaths attributed to ChD. STUDY DESIGN: Population-based descriptive study. METHODS: We used the Mortality Information System (SIM; in Portuguese) data before and after routine GC investigation in 2015-2019 to evaluate ChD deaths detected among them. We identified priority GCs, which contributed more than 0.1 % to the percentage of total ChD deaths registered. Spearman's correlation was used to evaluate the association between the reclassification of priority GCs and ChD prevalence. Then, we applied the GC correction factors to estimate the number of deaths attributed to ChD. RESULTS: 22,154 deaths were reported as ChD in the study period. Among them, 1004 deaths originally listed as priority GCs were deaths reclassified to ChD after an investigation in the SIM final database. Unspecific cardiomyopathy (10.2 %), unspecific heart diseases (4.7 %), and heart failure (2.8 %) were GCs with the highest proportions of reclassification to ChD in Brazil. Higher ChD prevalence at the state level was associated with a higher proportion of GC deaths reclassified as ChD. When applying correction factors identified after investigation, we estimated an increase of 26.4 % in registered ChD deaths, mostly in states with higher endemicity. CONCLUSIONS: GCs might conceal deaths due to ChD, particularly in Brazil's states with higher endemicity. The approach suggested in this study may offer an alternative method for estimating ChD-related deaths in endemic countries.

Mortality differences and inequalities within and between 'protected characteristics' groups, in a Scottish Cohort 1991-2009.

BACKGROUND: Little is known about the interaction between socio-economic status and 'protected characteristics' in Scotland. This study aimed to examine whether differences in mortality were moderated by interactions with social class or deprivation. The practical value was to pinpoint population groups for priority action on health inequality reduction and health improvement rather than a sole focus on the most deprived socioeconomic groups. METHODS: We used data from the Scottish Longitudinal Study which captures a 5.3 % sample of Scotland and links the censuses of 1991, 2001 and 2011. Hazard ratios for mortality were estimated for those protected characteristics with sufficient deaths using Cox proportional hazards models and through the calculation of European age-standardised mortality rates. Inequality was measured by calculating the Relative Index of Inequality (RII). RESULTS: The Asian population had a polarised distribution across deprivation deciles and was more likely to be in social class I and II. Those reporting disablement were more likely to live in deprived areas, as were those raised Roman Catholic, whilst those raised as Church of Scotland or as 'other Christian' were less likely to. Those aged 35-54 years were the least likely to live in deprived areas and were most likely to be in social class I and II. Males had higher mortality than females, and disabled people had higher mortality than non-disabled people, across all deprivation deciles and social classes. Asian males and females had generally lower mortality hazards than majority ethnic ('White') males and females although the estimates for Asian males and females were imprecise in some social classes and deprivation deciles. Males and females who reported their raised religion as Roman Catholic or reported 'No religion' had generally higher mortality than other groups, although the estimates for 'Other religion' and 'Other Christian' were less precise.Using both the area deprivation and social class distributions for the whole population, relative mortality inequalities were usually greater amongst those who did not report being disabled, Asians and females aged 35-44 years, males by age, and people aged <75 years. The RIIs for the raised religious groups were generally similar or too imprecise to comment on differences. CONCLUSIONS: Mortality in Scotland is higher in the majority population, disabled people, males, those reporting being raised as Roman Catholics or with 'no religion' and lower in Asians, females and other religious groups. Relative inequalities in mortality were lower in disabled than nondisabled people, the majority population, females, and greatest in young adults. From the perspective of intersectionality theory, our results clearly demonstrate the importance of representing multiple identities in research on health inequalities.

Structure-activity relationships for abiotic thiol reactivity and aquatic toxicity of halo-substituted carbonyl compounds.

Using abiotic thiol reactivity (EC50) and Tetrahymena pyriformis toxicity (IGC50) data for a group of halo-substituted ketones, esters and amides (i.e. SN2 electrophiles) and related compounds a series of structure-activity relationships are illustrated. Only the alpha-halo-carbonyl-containing compounds are observed to be thiol reactive with the order I > Br > Cl > F. Further comparisons disclose alpha-halo-carbonyl compounds to be more reactive than non-alpha-halo-carbonyl compounds; in addition, the reactivity is reduced when the number of C atoms between the carbonyl and halogen is greater than one. Comparing reactivity among alpha-halo-carbonyl-containing compounds with different beta-alkyl groups shows the greater the size of the beta-alkyl group the lesser the reactivity. A comparison of reactivity data for 2-bromoacetyl-containing compounds of differing dimensions reveals little difference in reactivity. Regression analysis demonstrates a linear relationship between toxicity and thiol reactivity: log (IGC(50)(-1)) = 0.848 log (EC(50)(-1)) + 1.40; n=19, s=0.250, r2=0.926, r2(pred)=0.905, F=199, Pr > F=0.0001.

Hemolytic disease of the fetus: a comparison of the Queenan and extended Liley methods.

OBJECTIVE: To compare the clinical utility of the Liley and Queenan methods to monitor the severity of fetal hemolytic disease. METHODS: Amniotic fluid bilirubin was measured in specimens from 73 women sensitized to red blood cell antigens. Chloroform-extracted amniotic fluid was evaluated spectrophotometrically for bilirubin content by using the change-from-expected value of the optical density at 450 nm. Values in the four Queenan zones were compared with those of the four zones of the Liley graph (middle zone subdivided). Clinical utility and accuracy of the two methods were compared. RESULTS: Treatment was based on interpretation of bilirubin values plotted on the Liley graph. Hydrops fetalis was not observed. The highest value for each patient was significantly more likely to be plotted in the highest zone using the Queenan method (23 of 73 compared with eight of 73 patients; P < .001). Overestimation of risk occurred with greater frequency when using the Queenan method (13 of 67 compared with seven of 67 patients; P = .031). Overestimation of risk by the Queenan method also was more likely at or before 28 weeks' gestation (10 of 49 compared with four of 49 patients; P = .031). In nine cases (13%), the Queenan graph and method would have prompted unnecessary or premature umbilical vein sampling that was withheld using the Liley graph. CONCLUSION: The performance of the linearly extended Liley graph was superior to that of the Queenan graph, because the Queenan method frequently overestimated risk.

Adrenal cortex carcinomas with distant metastases in beef cattle at slaughter.

Ten cases of adrenal cortex carcinomas with distant metastases were collected as subclinical lesions at slaughter of approximately 14,000 adult cattle. The primary lesion in the adrenal gland and the distant metastases, to either the lung or liver, were characterized by light microscopy and immunohistochemistry. Carcinomas were usually detected by noting metastases in the lungs as polypoid, soft, red or red and yellow masses. All adrenal tumours were unilateral and none were seen in bulls. In six of 10 carcinomas there was gross evidence of invasion of the vena cava via the adrenal vein. Normal bovine adrenal cortex labelled positively with S100, calretinin, α inhibin and melan-A; however, adenomas and seven of 10 carcinomas were labelled best by melan-A and α inhibin. Three carcinomas, grossly identical to the other seven, had numerous calcific granules and a slightly different microscopical appearance. In addition to melan-A and α-inhibin, these variant carcinomas labelled with S100. This variant may be derived from a different layer of the adrenal cortex. Because of the similarity of the bovine and human adrenal cortices, cultures of spontaneously arising bovine adrenal tumours may be a useful resource for study of human neoplasia.

The Lettuce infectious yellows virus (LIYV)-encoded P26 is associated with plasmalemma deposits within LIYV-infected cells.

Cytological, immunological, and mutagenesis approaches were used to identify the viral factors associated with the formation of plasmalemma deposits (PLDs) in whole plants and protoplasts infected by Lettuce infectious yellows virus (LIYV). Transmission electron microscopy and immunogold labeling using polyclonal antibodies to four of the five LIYV RNA 2-encoded large proteins, capsid protein (CP), minor capsid protein (CPm), HSP70 homolog (HSP70h), and P59, showed specific labeling of LIYV virions or virion aggregates around the vesiculated membranous inclusions, but not PLDs in LIYV-infected Nicotiana benthamiana, Nicotiana clevelandii, Lactuca sativa, and Chenopodium murale plants, and Nicotiana tabacum protoplasts. In contrast, antibodies to the RNA 2-encoded P26 showed specific labeling of PLDs but not virions in both LIYV-infected plants and protoplasts. Virion-like particles (VLPs) were seen in protoplasts infected by all LIYV RNA 2 mutants except for the CP (major capsid protein) mutant. PLDs were more difficult to find in protoplasts, but were seen in protoplasts infected by the CP and CPm mutants, but not in protoplasts infected by the P26, HSP70h, or P59 mutants. Interestingly, although the CPm mutant showed VLPs and PLDs, the PLDs did not show associated virions/virion-like particles as was always observed for PLDs seen in protoplasts infected by wild-type LIYV. Immunoblot analyses performed on purified LIYV virions showed that P26 was not detected with purified virions, but was detected in the cell wall, 1000 g and 30,000 g pellet fractions of LIYV-infected plants. These data suggest that P26 is associated with the LIYV-induced PLDs, and in contrast to the other RNA 2-encoded large proteins, P26 is not a virion protein.

The effects of deinstitutionalization on adults with learning disabilities.

We compared a group of people with learning disabilities who have been deinstitutionalized with a control group remaining in an institution on measures of adaptive and maladaptive behaviour, community living skills, social skills, and quality of life. In general, there was no change over 30 months for the control group. Changes for the experimental group were either not seen or were generally modest in scale, and tended to occur within 6 months of moving, the measures staying relatively stable thereafter. Implications for detailed examination of the effects of deinstitutionalization were discussed.

Amniotic fluid bilirubin and fetal hemolytic disease.

Six different methods for assessing amniotic fluid bilirubin were compared in 111 samples from 37 patients. When the Liley methods were compared, the chloroform extraction and 5% correction methods resulted in 20% and 4% reductions, respectively, in the mean change in optical density at 450 nm when compared with the uncorrected mean (0.086 +/- 0.06 [p less than 0.05] and 0.104 +/- 0.07 [p, not significant] vs 0.108 +/- 0.08). This reduction was observed in spite of significant visual blood contamination being rarely noted. The predictions based on amniotic fluid analysis were compared with the first fetal or neonatal hematocrit. The chloroform-extracted change in optical density at 450 nm accurately predicted fetal status in all patients, whereas lesser degrees of accuracy were observed with other methods. Hydrops fetalis did not occur during the observation period, and fetuses needing transfusion (n = 5) or early delivery (n = 10) were indicated correctly. The chloroform extraction change in optical density at 450 nm accurately predicts fetal status, and its use should continue.