Assessment of wing geometric morphometrics of urban Culex quinquefasciatus (Diptera: Culicidae) populations.

Culex quinquefasciatus is a cosmopolitan species distributed throughout tropical and subtropical areas of the world. The species is of great epidemiological importance as it is responsible for vectoring the causative agent of lymphatic filariasis and several arboviruses, including West Nile virus. Wing geometric morphometrics has been widely used to assess phenotypic variations in mosquito species. Here, we hypothesize that Cx. quinquefasciatus populations in urban parks in the city of São Paulo, Brazil, have been subjected to anthropogenic selective pressures that are responsible for driving their ecology and behavior. Mosquitoes were collected by CDC traps in five municipal parks in the city of São Paulo. Eighteen anatomical landmark coordinates on each female right wing were digitized. Canonical variate analysis, wireframe graphs, cross-validated reclassification tests and the neighbor-joining method were used to assess phenotypical dissimilarity in wing shape between populations. Centroid size was calculated to assess differences in wing size between populations, which can result from different environmental conditions during immature mosquito development. Moderately heterogeneous wing shape and wing size patterns were found in the populations analyzed, indicating that selective pressures in the urban environment are affecting the wing patterns of Cx. quinquefasciatus populations in the city of São Paulo, Brazil.

Interaction predictors of self-perception menstrual symptoms and influence of the menstrual cycle on physical performance of physically active women.

OBJECTIVE: To analyze the physical performance, self-perception menstrual symptoms, of physically active eumenorrheic women with endogenous ovarian cycle in two phases of the menstrual cycle. METHODS: Twenty-six women participated in the study (age 25.8 ± 3.9 years; height 1.64 ± 0.58 m; mass 64 ± 12.32 kg; menarche 11.69 ± 1.28 years). Assessments were performed in two phases of the menstrual cycle (MC), Early-Follicular Phase (FP) and Mid-Luteal Phase (LP), performance was assessed through total time to exhaustion (TTE), complete stages (CE), and final speed (FE), through a graded exercise test (GXT). Information on the participants' menstrual symptoms and their perceptions of the influence of MC on their performance were also collected. Data normality was assessed using the Shapiro-Wilk test. Paired analyses were conducted (t test or Wilcoxon) to examine the responses between the menstrual phases. The interaction analysis of symptom predictors was performed by multiple linear regression, with a significance level of p ≤ 0.05. RESULTS: There was no significant difference in physical performance between the phases during the GXT in TTE (mean difference 8.50; 95% CI - 11.99 to 42; p = 0.36). During FP, women with heavy flow had shorter performance in the GXT (t = - 2.5; p = 0.01), demonstrating an r2 = 0.32. In LP, for the women who reported not having the perception of the influence of the menstrual cycle on exercise, the total test time was longer (t = 2.55; p = 0.01), with an r2 = 0.45. CONCLUSION: There was no difference in physical performance between FP and LP. However, menstrual flow intensity and perception of cycle interference demonstrated a decrease in TTE.

Dual Wavelength Photoplethysmography Framework for Heart Rate Calculation.

The quality of heart rate (HR) measurements extracted from human photoplethysmography (PPG) signals are known to deteriorate under appreciable human motion. Auxiliary signals, such as accelerometer readings, are usually employed to detect and suppress motion artifacts. A 2019 study by Yifan Zhang and his coinvestigatorsused the noise components extracted from an infrared PPG signal to denoise a green PPG signal from which HR was extracted. Until now, this approach was only tested on "micro-motion" such as finger tapping. In this study, we extend this technique to allow accurate calculation of HR under high-intensity full-body repetitive "macro-motion". Our Dual Wavelength (DWL) framework was tested on PPG data collected from 14 human participants while running on a treadmill. The DWL method showed the following attributes: (1) it performed well under high-intensity full-body repetitive "macro-motion", exhibiting high accuracy in the presence of motion artifacts (as compared to the leading accelerometer-dependent HR calculation techniques TROIKA and JOSS); (2) it used only PPG signals; auxiliary signals such as accelerometer signals were not needed; and (3) it was computationally efficient, hence implementable in wearable devices. DWL yielded a Mean Absolute Error (MAE) of 1.22|0.57 BPM, Mean Absolute Error Percentage (MAEP) of 0.95|0.38%, and performance index (PI) (which is the frequency, in percent, of obtaining an HR estimate that is within ±5 BPM of the HR ground truth) of 95.88|4.9%. Moreover, DWL yielded a short computation period of 3.0|0.3 s to process a 360-second-long run.

Incorporation of antimicrobial agents into dental materials obtained by additive manufacturing: A literature review.

Background: This review aimed to identify antimicrobial agents incorporated into dental materials obtained through additive manufacturing and their efficacy. Methods: Protocol registration was performed in Open Science Framework (osf.io/sp3xa/) and an electronic search was carried out in the databases PubMed, Science Direct, Embase, Lilacs, and Scopus, up to February 2022, combining the terms ("additive manufacturing" OR "3D printing") AND (antimicrobial). Eligibility criteria included: experimental studies that incorporated 3D printing material with an antimicrobial agent for dental application; that evaluated antimicrobial activity; articles published in peer-reviewed journals and in English. Results: The database search resulted in 1139 references. The manual selection was carried out in 851 studies. Twenty-five articles were selected for full-text reading, of which 8 were included in this review. Polymers were the dental materials most often modified with antimicrobial agents for 3D printing, followed by metal alloy. The antimicrobials used were mainly nanoparticles, metal particles, antifungals, monomers containing quaternary ammonium salt, and antiseptics such as chlorhexidine. Conclusion: The addition of the antimicrobial agents in polymers and alloy for additive manufacturing showed promising efficacy against Candida spp., Gram-positive and Gram-negative bacteria.

Relationship between vertical stratification and feeding habits of mosquito (Diptera: Culicidae) assemblages collected in conservation units in the green belt of the city of São Paulo, Brazil.

São Paulo is one of the largest cities in the world and has several characteristics that favor a diversity of urban and wild mosquitoes. Little is known about how variations in mosquito diversity and feeding preferences for different hosts in different vegetation strata can influence the risk of pathogen transmission to humans. We investigated vertical stratification of mosquitoes and its relationship with vertebrate hosts in environments with different degrees of conservation in two conservation units in the city of São Paulo. Adult mosquitoes were collected using CDC traps, aspiration and Shannon traps. After morphological identification, host blood in engorged females was analyzed by PCR with a vertebrate-specific primer set based on mitochondrial cytochrome b DNA of vertebrates commonly found in the two conservation units. Although a higher abundance of the species Anopheles cruzii and Culex nigripalpus was found in the canopy, blood not only from birds but also from humans and rodents was identified in these mosquitoes. In one of the units, Wyeomyia confusa and Limatus durhamii were found occupying mainly niches at ground level while Culex vaxus was frequently found in the canopy. Haemagogus leucocelaenus, the main vector of yellow fever, was found in low abundance at all collection points, particularly in the canopy. Species richness and composition tended to vary little between canopy and ground level in the same environment, but the abundance between canopy and ground level varied more depending on the species analyzed, the most abundant and frequent species exhibiting a predilection for the canopy. Even those mosquito species observed more frequently in the canopy did not show an association with hosts found in this stratum as most of the blood identified in these species was from humans, suggesting opportunist feeding behavior, i.e., feeding on the most readily available host in the environment. The two most common species in the study, An. cruzii and Cx. nigripalpus, may be able to act as bridge vectors for pathogens to circulate between the forest canopy and ground level.

Health-related quality of life associated with diabetic retinopathy in patients at a public primary care service in southern Brazil.

OBJECTIVE: This study aimed to establish the utility values of different health states associated with diabetic retinopathy in a Brazilian sample to provide input to model-based economic evaluations. METHODS: This cross-sectional study was performed in a sample of patients with type 2 diabetes mellitus (T2D) who underwent teleophthalmology screening at a primary care service from 2014 to 2016. Five diabetic retinopathy health states were defined: absent, non-sight-threatening, sight-threatening, and bilateral blindness. Utility values were estimated using the Brazilian EuroQol five dimensions (EQ-5D) tariffs. Descriptive statistics were calculated. Analysis of covariance was performed to adjust the utility values for potential confounders. RESULTS: The study included 206 patients. The mean (± standard deviation [SD]) utility value was 0.765 ± 0.19 (95% confidence interval [CI], 0.740-0.790). The adjusted mean utility value was 0.748 (95% CI, 0.698-0.798) in patients without diabetic retinopathy, 0.752 (95% CI, 0.679-0.825) in those with non-sight-threatening state, 0.628 (95% CI, 0.521-0.736) in those with sight-threatening state, and 0.355 (95% CI, 0.105-0.606) in those with bilateral blindness. A significant utility decrement was found between patients without diabetic retinopathy and those with a sight-threatening health state (0.748 vs. 0.628, respectively, p = 0.04). CONCLUSION: The findings suggest that a later diabetic retinopathy health state is associated with a decrement in utility value compared with the absence of retinopathy in patients with T2D. The results may be useful as preliminary input to model-based economic evaluations. Further research is needed to investigate the impact of diabetic retinopathy on health-related quality of life in a sample more representative of the Brazilian population.

Correlation between skin temperature in the lower limbs and biochemical marker, performance data, and clinical recovery scales.

The aim of this study was to evaluate the correlation between tools commonly used in the detection of physiological changes, such as clinical complaints, a biochemical marker of muscle injury, and performance data during official matches, with infrared thermography, which has been commonly used in the possible tracking of musculoskeletal injuries in athletes. Twenty-two athletes from a professional soccer club (age 27.7 ± 3.93 years; BMI 24.35 ± 1.80 kg/cm2) were followed during the season of a national championship, totaling 19 matches with an interval of 7 days between matches. At each match, the athletes used a Global Positioning System (GPS) device to collect performance data. Forty-eight hours after each match, every athlete's perception of recovery, fatigue, and pain was documented. Blood was collected for creatine kinase (CK) analysis, and infrared thermography was applied. Only athletes who presented pain above 4 in either limb were included for thermographic analysis. Each thermographic image was divided into 14 regions of interest. For statistical analysis, we included only the images that showed differences ≥ 1° C. Data normality was verified by the Kolmogorov-Smirnov test with Dallal-Wilkinson-Lilliefors correction. We used the Pearson correlation coefficient to verify the correlation between infrared thermography and the biochemical marker, performance data, and clinical recovery scales. No correlation was observed between mean skin temperature and blood CK levels, pain level, perception of recovery, and fatigue perception (r <0.2, p>0.05). Thus, infrared thermography did not correlate with CK level, pain, fatigue perception, or recovery, nor with performance variables within the field.

Acute application of photobiomodulation does not bring important gains for the muscular performance and functionality of diabetic individuals.

Photobiomodulation therapy (PBMT) has been used to improve the physical performance of individuals with advanced age; however, there are no studies in the literature that support the application of light-emitting diode (LED) therapy for the muscular performance of individuals with diabetes mellitus who show a decline in functionality. The aim of the study was to analyze the acute effects of PBMT on strength and functional performance in type 2 diabetic individuals. Sixty-three volunteers were recruited and randomized into five groups: control (C), sham (S), red LED (R), infrared LED (IR), and red LED + infrared LED (R + IR). On the first day, the volunteers were evaluated using the time up and go (TUG), the 6-min walk test (6MWT), and isokinetic dynamometer of the ankle. In the following 3 days, groups R, IR, R + IR, and S returned for application of PBMT bilaterally, with 180 J of energy on each leg. On the fifth day, a reassessment was performed. There was no statistical difference between groups for the variables of the isokinetic dynamometer, TUG, and 6MWT. Analysis of the size of the clinical effect for the isokinetic variables showed that there was no pattern among the effects observed. There is a moderate effect in favor of R, IR, and R + IR in relation to C for the TUG and a moderate effect of R + IR in relation to C for the 6MWT. The PBMT applied for a short period does not bring important gains for the muscular performance and functionality of diabetic individuals.

Comparing apples to oranges? Minimizing typological biases to better classify healthcare systems globally.

The present study explores the role of typologies as an analytical device in understanding both the theoretical and empirical manifestations of healthcare systems globally. In a first step, we explore the relative benefits and limits of different classificatory logics - inductive vs. deductive - before conducting a review of scholarship on healthcare system classifications. We argue that, in order to capture the role of global actors (international organizations, donor countries etc.) in low-to-upper-middle income economies, classificatory systems must account for potential territorial shifts across the dimensions of financing, service provision and regulation defining all healthcare systems. In its absence, comparative research involving countries of significantly different levels of economic development becomes obfuscated. In an effort to redress this gap in the literature, we lay out how state, societal, market and global actors feature across different dimensions of healthcare systems, putting forth a deductively derived and actor-centered typology.

Measurement of Physical Parameters and Development of a Light Emitting Diodes Device for Therapeutic Use.

INTRODUCTION: Effectiveness of light-emitting diode (LED) in biological tissue is due to the correct application of physical parameters. However, most studies found do not provide complete information on the physical characteristics of the diodes. It is necessary to carefully evaluate the diode parameters so that the results of research with this feature can be reproduced. The objective of this study was to develop a light-emitting device using LED, with proper measurements for application in clinical research. It was used 267 LEDs, powered with 12-V voltage and fixed on a plate of ethylene-vinyl acetate (25 × 42 cm), equidistant at 1.0 cm. For the calculation of red and infrared irradiation, a spectrometer was used, and the data were processed in routines implemented in the OriginPro 8.5.0 SR1 Software. The irradiance was determined by the integration of the spectral irradiation in the LED emission region. The red LED has a wavelength of 620 ± 10 nm, a power density of 52.86 mW/cm2, power of 6.6 mW, and total power of 1.76 W on the device. The infrared LED has a wavelength of 940 ± 10 nm, power density 33.7 mW/cm2, power of 6 mW, and total power of 1.6 W on the device. The LED characterization enables the generation and application of energy with greater precision and reproducibility. Besides, it is a light source, a device capable of framing large areas, reducing the time and cost of the application in different clinical conditions related to neuromuscular performance or rehabilitation.

Photobiomodulation by light emitting diode applied sequentially does not alter performance in cycling athletes.

Analyze the effects of sequential application of photobiomodulation therapy (PBMT) at different wavelengths on the performance of cycling athletes. Cyclists (48 male, mean age 33.77 years) underwent a performance evaluation through an incremental test, VO2max, blood lactate analysis, perception of effort, infrared thermography, and isokinetic evaluations. Photobiomodulation (180 J) with infrared (IR 940 ± 10 nm), red (RED 620 ± 10 nm), mixed Red, and IR (RED/IR 620 + 940 nm) or Sham (disabled device) intervention occurred on three consecutive days and was applied to the quadriceps femoris bilaterally. Reevaluations were performed 24 h after the last application, with 1 week of follow-up. A significance level of 5% was adopted, and the effect size (ES) was calculated by Cohen's d. Results: There were no significant differences in the analyzed variables under any experimental condition (p > 0.005), but a moderate effect size was observed for torque peak at 60°/s on left lower limb (LLL) (ES = 0.67), average power at 60°/s of the right lower limb (RLL) (0.73), and LLL (ES = 0.65) and a considerable effect size in torque peak at 60°/s of the RLL (ES = 0.98) in the IR/RED group compared with sham 24 h after the last application. Moreover, a large effect size was observed for total time to exhaustion (ES = 1.98) and for VO2max (ES = 6.96), and a moderate effect size was seen for anaerobic threshold (ES = 0.62) in the IR/RED group compared with sham. Photobiomodulation, when not associated with training, was not able to produce a cumulative effect on the performance of cycling athletes. However, the association of two wavelengths seems to be better for increased performance. ClinicalTrials.gov Identifier: NCT03225976.

Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System.

OBJECTIVE: To perform a cost-utility analysis of diabetic retinopathy (DR) screening strategies from the perspective of the Brazilian Public Healthcare System. METHODS: A model-based economic evaluation was performed to estimate the incremental costs per quality-adjusted life-year (QALY) gained between three DR screening strategies: (1) the opportunistic ophthalmology referral-based (usual practice), (2) the systematic ophthalmology referral-based, and (3) the systematic teleophthalmology-based. The target population included individuals with type 2 diabetes (T2D) aged 40 years, without retinopathy, followed over a 40-year time horizon. A Markov model was developed with five health states and a 1-year cycle. Model parameters were based on literature and country databases. One-way and probabilistic sensitivity analyses were performed to assess model parameters' uncertainty. WHO willingness-to-pay (WHO-WTP) thresholds were used as reference (i.e. one and three times the Brazilian per capita Gross Domestic Product of R$32747 in 2018). RESULTS: Compared to usual practice, the systematic teleophthalmology-based screening was associated with an incremental cost of R$21445/QALY gained ($9792/QALY gained). The systematic ophthalmology referral-based screening was more expensive (incremental costs = R$4) and less effective (incremental QALY = -0.012) compared to the systematic teleophthalmology-based screening. The probability of systematic teleophthalmology-based screening being cost-effective compared to usual practice was 0.46 and 0.67 at the minimum and the maximum WHO-WTP thresholds, respectively. CONCLUSION: Systematic teleophthalmology-based DR screening for the Brazilian population with T2D would be considered very cost effective compared to the opportunistic ophthalmology referral-based screening according to the WHO-WTP threshold. However, there is still a considerable amount of uncertainty around the results.

Retention of ancestral polymorphism in Culex nigripalpus (Diptera: Culicidae) from São Paulo, Brazil.

Culex nigripalpus Theobald (Diptera: Culicidae) is a native species of Brazil that is well adapted to urban environments and found extensively in the city of São Paulo, Brazil. As a native species, it has been present in this region since long before the foundation of the city, but over time Cx. nigripalpus populations have been affected by man-made changes to the environment. We hypothesize that the populations analyzed in this study constituted a large Cx. nigripalpus population that separated into smaller populations as a result of increased levels of urbanization in the city, and that such high levels of urbanization would result in a genetic homogenization effect. We therefore investigated the microgeographic genetic structure and microevolutionary processes in Cx. nigripalpus populations from seven different locations in the city of São Paulo using a set of six microsatellite primers originally developed for Culex quinquefasciatus and Culex pipiens. Our results indicate that Cx. nigripalpus did not benefit from urbanization and is currently under selective pressures caused by anthropogenic changes and that populations from areas with higher levels of urbanization exhibited similar genetic patterns and low levels of polymorphism, contrasting with the more sylvatic SHA population. These findings are likely to contribute to a better understanding of how anthropogenic selective pressures are driving population genetics and, to some extent, the dynamics of Cx. nigripalpus populations. They should also help elucidate the effects that urbanization processes have on the ecology and behavior of these mosquito populations.

Location of Reference Electrode Does Not Interfere on Electromyographic Parameters in the Domains of Time and Frequency.

There is currently little information on the positioning of reference electrode (RE). It is generally accepted that it must be positioned on electrically neutral tissues, such as tendons or bony prominences. The objective of this study is to analyze the characteristics of the electromyographic signal (EMG) for different positions of RE as well as at different levels of muscle contraction. Signals from the brachial biceps and triceps were recorded from 18 healthy women (BMI: 21.20 kg/m2 ± 1.72; mean age: 21.94 ± 1.98 years old) during 100 and 50% maximum flexion voluntary isometric contractions, as well as at rest. For each situation, the RE was randomly positioned in 4 different locations: a) homolateral acromion; b) homolateral brachial biceps; c) styloid process of the contralateral ulna; and d) lateral malleolus of the contralateral ankle. For statistical analysis, Shapiro-Wilk and Kruskal-Wallis tests were used, followed by Dunn's post-hoc test, at a significance level of 5% (p < 0.05). RMS, normalized RMS, PSD, median frequency and levels of energy at 60 Hz, 120 Hz and 180 Hz were assessed for the different sites of RE. The results show that the positioning of the RE on the four experimental locations did not change important features of the electromyographic signals in the time and frequency domains, for the three levels of isometric contractions studied. Such findings compel us to re-think the current trend regarding the RE position followed by the great majority of the researches in areas such as physical therapy.

Microsatellite Markers Transferability in Culex nigripalpus (Diptera: Culicidae).

Microsatellite loci specifically designed and optimized for secondary vectors and neglected species of mosquitoes are lacking. Cross-species transferability of microsatellite loci between close taxa has been used as a reliable option, being successfully done for Aedes taeniorhynchus Wiedemann (Diptera: Culicidae), Triatoma sordida Stål (Hemiptera: Reduviidae), and Aedes fluviatilis Lutz (Diptera: Culicidae). Nonetheless, prior to the utilization of transferred microsatellites, they must be assessed for their performance and reliability on the target species. Therefore, the goal of this study was to transfer and validate SSR primers previously developed for the Culex pipiens complex to Culex (Culex) nigripalpus Theobald (Diptera: Culicidae). Culex nigripalpus were collected in seven different locations throughout the city of São Paulo using CDC traps baited with dry ice between 2011 and 2013, yielding a total of 223 specimens. Six SSR primers were successfully transferred to Cx. nigripalpus yielding satisfactory results for allele richness, ranging from 5 to 12 alleles per locus. The expected heterozygosity values were higher than the observed heterozygosity (P < 0.05) for the loci CxqCTG10, CxqGT51, and Cxpq59. Linkage disequilibrium results were statistically significant only for the comparison between the loci CxqCA115 and CxqCTG10, and the estimation for the probability of null alleles was also low, ranging from 0 to 0.052. These results substantially validate the SSRs transference to Cx. nigripalpus as well as their subsequent use in microevolution studies comprising this species.

Microgeographic Population Structuring of Culex quinquefasciatus (Diptera: Culicidae) From São Paulo, Brazil.

The continuing worldwide increase in urbanization can potentially have a major impact on the epidemiology of vector-borne diseases, as anthropogenic changes to the environment are known to favor a few species of mosquitoes that can thrive in urban environments. Culex quinquefasciatus Say (Diptera: Culicidae) is found extensively in urban habitats, where it lives in degraded, polluted areas and is often the only species of mosquito capable to surviving under such conditions. Traditional mosquito control strategies no longer have the desired effect due to the several factors such as insecticide resistance, abundance of breeding sites, lack of proper sewage and sanitation, and absence of natural predator, leading Cx. quinquefasciatus populations to increase its numbers in cities. In this study, five Cx. quinquefasciatus populations were analyzed using 12 microsatellite markers to investigate whether the dynamics of these populations are being modulated by urbanization and how they are structured in the city of São Paulo, Brazil. Our results indicate that only one of the study populations (the population from Anhanguera Park) exhibited evidence of expansion. The populations from Ibirapuera Park and Piqueri Park, the most urbanized regions of the areas studied, did not show signs of expansion. A better understanding of the mechanisms involved in the dispersal of Cx. quinquefasciatus and its colonization of new areas, as well as the species' demographic patterns and how these are associated with urbanization, particularly in areas undergoing a rural-to-urban transformation, such as Anhanguera Park, is of great importance for mosquito control.

Wing variation in Culex nigripalpus (Diptera: Culicidae) in urban parks.

BACKGROUND: Culex nigripalpus has a wide geographical distribution and is found in North and South America. Females are considered primary vectors for several arboviruses, including Saint Louis encephalitis virus, Venezuelan equine encephalitis virus and Eastern equine encephalitis virus, as well as a potential vector of West Nile virus. In view of the epidemiological importance of this mosquito and its high abundance, this study sought to investigate wing variation in Cx. nigripalpus populations from urban parks in the city of São Paulo, Brazil. METHODS: Female mosquitoes were collected in seven urban parks in the city of São Paulo between 2011 and 2013. Eighteen landmark coordinates from the right wing of each female mosquito were digitized, and the dissimilarities between populations were assessed by canonical variate analysis and cross-validated reclassification and by constructing a Neighbor-Joining (NJ) tree based on Mahalanobis distances. The centroid size was calculated to determine mean wing size in each population. RESULTS: Canonical variate analysis based on fixed landmarks of the wing revealed a pattern of segregation between urban and sylvatic Cx. nigripalpus, a similar result to that revealed by the NJ tree topology, in which the population from Shangrilá Park segregated into a distinct branch separate from the other more urban populations. CONCLUSION: Environmental heterogeneity may be affecting the wing shape variation of Cx. nigripalpus populations.

Changing patterns in leptospirosis: a three-decade study in Brazil.

BACKGROUND: This study was conducted to investigate changes in the clinical pattern of leptospirosis over time, analyzing its clinical and laboratory presentations in a metropolitan city of Brazil. METHOD: This was a retrospective study including all patients with leptospirosis admitted to tertiary care hospitals in Fortaleza in the northeast of Brazil, between 1985 and 2015. Patients were divided into three groups according to the year of hospital admission: group I for the years 1985-1995, group II for 1996-2005, and group III for 2006-2015. Demographic, clinical, and laboratory data were compared between the groups. RESULTS: A total of 507 patients were included. Their mean age was 37.3±15.9years and 82.4% were male. The mean time between symptom onset and admission was 7±4 days. There was a linear decrease in the levels of serum urea (190.1±92.7, 135±79.5, and 95.6±73.3mg/dl, respectively, p <0.0001) and creatinine (5.8±2.9, 3.8±2.6, and 3.0±2.5mg/dl, respectively, p <0.0001) in each decade, while levels of hemoglobin (10.31±1.9, 10.8±2.0, and 11.5±2.1g/dl, respectively, p <0.0001) and platelets (57.900±52.650, 80.130±68.836, and 107.101±99.699×109/l, respectively, p<0.0001) increased. There was a tendency towards a linear decrease in mortality (22%, 14%, and 11.6%, respectively, p=0.060). CONCLUSIONS: Leptospirosis showed significant changes over time in this region. The main changes point to a decrease in disease severity and complications, such as acute kidney injury. Mortality has decreased, being close to 11%.

Morphometric Wing Characters as a Tool for Mosquito Identification.

Mosquitoes are responsible for the transmission of important infectious diseases, causing millions of deaths every year and endangering approximately 3 billion people around the world. As such, precise identification of mosquito species is crucial for an understanding of epidemiological patterns of disease transmission. Currently, the most common method of mosquito identification relies on morphological taxonomic keys, which do not always distinguish cryptic species. However, wing geometric morphometrics is a promising tool for the identification of vector mosquitoes, sibling and cryptic species included. This study therefore sought to accurately identify mosquito species from the three most epidemiologically important mosquito genera using wing morphometrics. Twelve mosquito species from three epidemiologically important genera (Aedes, Anopheles and Culex) were collected and identified by taxonomic keys. Next, the right wing of each adult female mosquito was removed and photographed, and the coordinates of eighteen digitized landmarks at the intersections of wing veins were collected. The allometric influence was assessed, and canonical variate analysis and thin-plate splines were used for species identification. Cross-validated reclassification tests were performed for each individual, and a Neighbor Joining tree was constructed to illustrate species segregation patterns. The analyses were carried out and the graphs plotted with TpsUtil 1.29, TpsRelw 1.39, MorphoJ 1.02 and Past 2.17c. Canonical variate analysis for Aedes, Anopheles and Culex genera showed three clear clusters in morphospace, correctly distinguishing the three mosquito genera, and pairwise cross-validated reclassification resulted in at least 99% accuracy; subgenera were also identified correctly with a mean accuracy of 96%, and in 88 of the 132 possible comparisons, species were identified with 100% accuracy after the data was subjected to reclassification. Our results showed that Aedes, Culex and Anopheles were correctly distinguished by wing shape. For the lower hierarchical levels (subgenera and species), wing geometric morphometrics was also efficient, resulting in high reclassification scores.

Species Composition and Ecological Aspects of Immature Mosquitoes (Diptera: Culicidae) in Bromeliads in Urban Parks in the City of São Paulo, Brazil.

BACKGROUND: Bromeliads can be epiphytic, terrestrial or saxicolous and use strategies to allow water to be retained in their leaf axils, where various arthropods can be found. These include mosquitoes, whose larvae are the most abundant and commonly found organisms in the leaf axils. The objective of this study was to look for immature forms of mosquitoes (the larval and pupal stages) in bromeliads in municipal parks in São Paulo and to discuss the ecological and epidemiological importance of these insects. METHODS: From October 2010 to July 2013, immature mosquitoes were collected from bromeliads in 65 municipal parks in the city of São Paulo, Brazil, using suction samplers. The immature forms were maintained until adult forms emerged, and these were then identified morphologically. RESULTS: Two thousand forty-two immature-stage specimens belonging to the genera Aedes, Culex, Trichoprosopon, Toxorhynchites, Limatus and Wyeomyia were found in bromeliads in 15 of the 65 parks visited. Aedes albopictus was the most abundant species (660 specimens collected), followed by Culex quinquefasciatus (548 specimens) and Cx. (Microculex) imitator (444). The taxa with the most widespread distribution were Ae. aegypti and Toxorhynchites spp, followed by Ae. albopictus and Cx. quinquefasciatus. CONCLUSION: Bromeliads in urban parks are refuges for populations of native species of Culicidae and breeding sites for exotic species that are generally of epidemiological interest. Hence, administrators and surveillance and mosquito-control agencies must constantly monitor these microenvironments as the presence of these species endangers the health of park users and employees as well as people living near the parks.