A telemedicine network for remote paediatric cardiology services in north-east Brazil.

PROBLEM: Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. APPROACH: In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries. LOCAL SETTING: Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children. RELEVANT CHANGES: From 2012 to 2014, 73,751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P < 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality. LESSONS LEARNT: Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently.

Very low-calorie ketogenic diet in the treatment of adaptive thermogenesis: A case report.

OBJECTIVES: The management of the phenomenon of adaptive thermogenesis poses a challenge to the successful treatment of overweight/obesity with a nutritional intervention that minimizes the loss of muscle mass, with little cognitive restraint use and disorganization of eating behavior. On the other hand, it creates a significant calorie deficit for the reduction of body fat. The aim of this case report was to discuss the effects of a very low-calorie ketogenic diet in a woman with obesity and low resting metabolic rate. CASE DESCRIPTION: A 36-y-old white woman with a history of obesity and bulimia nervosa who has had difficulty losing and maintaining weight despite numerous dietary and pharmacologic treatments. RESULTS: There was a loss of 12 kg in 115 d, reaching 13.4 kg, with 11.4 kg of fat mass (FM). The resting metabolic rate showed an increase of 79% in relation to the initial rate, reaching normal levels for the predictive equations and maintaining this level in the first-year follow-up. Additionally, improvement of metabolic laboratory parameters and eating behavior traits were described. CONCLUSIONS: In this specific case of bulimia nervosa resulting in hypometabolism (low resting metabolic rate/fat-free mass) and obesity, the very low-calorie ketogenic diet intervention has demonstrated a possibility of weight loss with little cognitive restraint use, thereby increasing resting metabolic rate in the short and medium terms, ultimately promoting a negative energy balance. In relation to the numeric results, it seems positive; however, more research is necessary to evaluate the effects on the overall relationship with food and its long-term repercussions.

In vivo measurement of the average refractive index of the human crystalline lens using optical coherence tomography.

We present a method for measuring the average group refractive index of the human crystalline lens in vivo using an optical coherence tomography (OCT) system which, allows full-length biometry of the eye. A series of OCT images of the eye including the anterior segment and retina were recorded during accommodation. Optical lengths of the anterior chamber, lens, and vitreous were measured dynamically along the central axis on the OCT images. The group refractive index of the crystalline lens along the central axis was determined using linear regression analysis of the intraocular optical length measurements. Measurements were acquired on three subjects of age 21, 24, and 35 years. The average group refractive index for the three subjects was, respectively, n=1.41, 1.43, and 1.39 at 835 nm.

Effects of surface hydration state and application method on the bond strength of self-etching adhesives to cut enamel.

PURPOSE: To evaluate the effect of surface hydration state and application method on the microtensile bond strength of one-step self-etching adhesives systems to cut enamel. MATERIALS AND METHODS: One hundred ninety-five bovine teeth were used. The enamel on the buccal side was flattened with 600-grit SiC paper. For the control group, 15 teeth received Adper Single Bond 2, applied according to manufacturer's recommendations. The other specimens were divided into three groups according to the adhesive system used: Futura Bond M (FM; Voco), Clearfil S3 Bond (CS; Kuraray), and Optibond All in One (OA; Kerr). For each group, two hydration states were tested: D: blown dry with air; W: the excess of water was removed with absorbent paper. Two application methods were tested: P (passive): the adhesive was simply left on the surface; A (active): the adhesive was rubbed with an applicator point. A coat of Grandio composite resin (Voco) was applied on the surface. The teeth were sectioned to obtain enamel-resin sticks (1 x 1 mm), which underwent microtensile bond testing. The data in MPa were submitted to a three-way ANOVA and Tukey's test (α = 5%). RESULTS: The ANOVA showed significant differences for application method and the type of adhesive, but not for hydration state. For the application method, the results of Tukey's test were: P: 31.46 (± 7.09)a; A: 34.04 (± 7.19)b. For the type of adhesive, the results were: OA: 31.29 (± 7.05)a; CS: 32.28 (± 7.14)a; FM: 34.68 (± 7.17)b; different lower-case letters indicate statistically significant differences. CONCLUSION: Active application improved the bond strength to cut enamel. The adhesive Futurabond M showed the highest bond strength to cut enamel.

Amazonian Guarana- and Açai-Conjugated Extracts Improve Scratched Fibroblast Healing and Eisenia fetida Surgical Tail Amputation by Modulating Oxidative Metabolism.

Background: Previous studies have suggested that guarana (Paullinia cupana) and açai (Euterpe oleracea) have antioxidant, anti-inflammatory, and proliferative properties, indicating their potential therapeutic action in wound healing. We produced a conjugated guarana-açai (GA) extract and tested its healing action on earthworms (Eisenia fetida) subjected to tail amputation by surgical incision. Methods: Extract from roasted guarana seeds and fresh açai seed berries was produced. The antioxidant and genoprotective capacity of GA extract was tested. The concentration with the most remarkable healing potential was used in subsequent tests. The last three posterior segments of the clitellate earthworm tail reared under standardized conditions were surgically amputated. Next, topical PBS or GA extract was applied to the surgical wound. The rate of cell migration and tissue regeneration at the local wound site was histologically evaluated after the procedure. Expression of the SOX4 gene that acts in epithelial-to-mesenchymal transition was determined by RT-qPCR. Results: Sixteen bioactive molecules, including some previously described substances, were identified. All tested concentrations exhibited antioxidant and genoprotective effects. The GA extract accelerated the healing processes as observed through macroscopic and histological analyses and increased expression of SOX4. Conclusion: The GA extract has a potential role in the healing of surgically induced wounds.

Automated instrument designed to determine visual photosensitivity thresholds.

The Ocular Photosensitivity Analyzer (OPA), a new automated instrument to quantify the visual photosensitivity thresholds (VPT) in healthy and light sensitive subjects, is described. The OPA generates light stimuli of varying intensities utilizing unequal ascending and descending steps to yield the VPT. The performance of the OPA was evaluated in healthy subjects, as well as light sensitive subjects with achromatopsia or traumatic brain injury (TBI). VPT in healthy, achromatopsia, and TBI subjects were 3.2 ± 0.6 log lux, 0.5 ± 0.5 log lux, and 0.4 ± 0.6 log lux, respectively. Light sensitive subjects manifested significantly lower VPT compared to healthy subjects. Longitudinal analysis revealed that the OPA reliably measured VPT in healthy subjects.

Assessment of eye length changes in accommodation using dynamic extended-depth OCT.

It has been suggested that accommodation induces increases in axial eye length which could contribute to the development of myopia. However, it is debated whether changes in eye length occur during accommodation as the degree of change varies widely across literature. In this study, an extended-depth optical coherence tomography (OCT) system that provides dynamic whole eye biometry was utilized to assess changes in lens thickness (LT) and axial eye length (AEL) in young subjects responding to step disaccommodation stimuli of amplitude 2D, 4D, and 6D. The decrease in lens thickness with disaccommodation was strongly correlated with stimulus amplitude. No statistically significant changes in AEL during accommodation were observed.

Hydrocephalus and arthrogryposis in an immunocompetent mouse model of ZIKA teratogeny: A developmental study.

The teratogenic mechanisms triggered by ZIKV are still obscure due to the lack of a suitable animal model. Here we present a mouse model of developmental disruption induced by ZIKV hematogenic infection. The model utilizes immunocompetent animals from wild-type FVB/NJ and C57BL/6J strains, providing a better analogy to the human condition than approaches involving immunodeficient, genetically modified animals, or direct ZIKV injection into the brain. When injected via the jugular vein into the blood of pregnant females harboring conceptuses from early gastrulation to organogenesis stages, akin to the human second and fifth week of pregnancy, ZIKV infects maternal tissues, placentas and embryos/fetuses. Early exposure to ZIKV at developmental day 5 (second week in humans) produced complex manifestations of anterior and posterior dysraphia and hydrocephalus, as well as severe malformations and delayed development in 10.5 days post-coitum (dpc) embryos. Exposure to the virus at 7.5-9.5 dpc induces intra-amniotic hemorrhage, widespread edema, and vascular rarefaction, often prominent in the cephalic region. At these stages, most affected embryos/fetuses displayed gross malformations and/or intrauterine growth restriction (IUGR), rather than isolated microcephaly. Disrupted conceptuses failed to achieve normal developmental landmarks and died in utero. Importantly, this is the only model so far to display dysraphia and hydrocephalus, the harbinger of microcephaly in humans, as well as arthrogryposis, a set of abnormal joint postures observed in the human setting. Late exposure to ZIKV at 12.5 dpc failed to produce noticeable malformations. We have thus characterized a developmental window of opportunity for ZIKV-induced teratogenesis encompassing early gastrulation, neurulation and early organogenesis stages. This should not, however, be interpreted as evidence for any safe developmental windows for ZIKV exposure. Late developmental abnormalities correlated with damage to the placenta, particularly to the labyrinthine layer, suggesting that circulatory changes are integral to the altered phenotypes.

Quantification of the ciliary muscle and crystalline lens interaction during accommodation with synchronous OCT imaging.

Two SD-OCT systems and a dual channel accommodation target were combined and precisely synchronized to simultaneously image the anterior segment and the ciliary muscle during dynamic accommodation. The imaging system simultaneously generates two synchronized OCT image sequences of the anterior segment and ciliary muscle with an imaging speed of 13 frames per second. The system was used to acquire OCT image sequences of a non-presbyopic and a pre-presbyopic subject accommodating in response to step changes in vergence. The image sequences were processed to extract dynamic morphological data from the crystalline lens and the ciliary muscle. The synchronization between the OCT systems allowed the precise correlation of anatomical changes occurring in the crystalline lens and ciliary muscle at identical time points during accommodation. To describe the dynamic interaction between the crystalline lens and ciliary muscle, we introduce accommodation state diagrams that display the relation between anatomical changes occurring in the accommodating crystalline lens and ciliary muscle.

The floating forest: traditional knowledge and use of matupá vegetation islands by riverine peoples of the central Amazon.

Matupás are floating vegetation islands found in floodplain lakes of the central Brazilian Amazon. They form initially from the agglomeration of aquatic vegetation, and through time can accumulate a substrate of organic matter sufficient to grow forest patches of several hectares in area and up to 12 m in height. There is little published information on matupás despite their singular characteristics and importance to local fauna and people. In this study we document the traditional ecological knowledge of riverine populations who live near and interact with matupás. We expected that their knowledge, acquired through long term observations and use in different stages of the matupá life cycle, could help clarify various aspects about the ecology and natural history of these islands that field biologists may not have had the opportunity to observe. Research was carried out in five riverine communities of the Amanã Sustainable Development Reserve (Brazil). Semi-structured interviews were conducted with 45 inhabitants in order to register local understandings of how matupás are formed, biotic/abiotic factors related to their occurrence, the plants and animals that occur on them, their ecological relevance, and local uses. Local people elucidated several little-known aspects about matupá ecology, especially regarding the importance of seasonal dynamics of high/low water for matupás formation and the relevance of these islands for fish populations. Soil from matupás is especially fertile and is frequently gathered for use in vegetable gardens. In some cases, crops are planted directly onto matupás, representing an incipient agricultural experiment that was previously undocumented in the Amazon. Matupás are also considered a strategic habitat for fishing, mainly for arapaima (Arapaima gigas). The systematic study of traditional ecological knowledge proved to be an important tool for understanding this little-known Amazonian landscape.

Calculation of ophthalmic viscoelastic device-induced focus shift during femtosecond laser-assisted cataract surgery.

PURPOSE: To assess if a change in refractive index of the anterior chamber during femtosecond laser-assisted cataract surgery can affect the laser beam focus position. METHODS: The index of refraction and chromatic dispersion of six ophthalmic viscoelastic devices (OVDs) was measured with an Abbe refractometer. Using the Gullstrand eye model, the index values were used to predict the error in the depth of a femtosecond laser cut when the anterior chamber is filled with OVD. Two sources of error produced by the change in refractive index were evaluated: the error in anterior capsule position measured with optical coherence tomography biometry and the shift in femtosecond laser beam focus depth. RESULTS: The refractive indices of the OVDs measured ranged from 1.335 to 1.341 in the visible light (at 587 nm). The error in depth measurement of the refilled anterior chamber ranged from -5 to +7 µm. The OVD produced a shift of the femtosecond laser focus ranging from -1 to +6 µm. Replacement of the aqueous humor with OVDs with the densest compound produced a predicted error in cut depth of 13 µm anterior to the expected cut. CONCLUSIONS: Our calculations show that the change in refractive index due to anterior chamber refilling does not sufficiently shift the laser beam focus position to cause the incomplete capsulotomies reported during femtosecond laser-assisted cataract surgery.

Calculation of crystalline lens power using a modification of the Bennett method.

We present a method for measuring lens power from extended depth OCT biometry, corneal topography, and refraction using an improvement on the Bennett method. A reduced eye model was used to derive a formula for lens power in terms of ocular distances, corneal power, and objective spherical equivalent refraction. An error analysis shows that the formula predicts relaxed lens power with a theoretical accuracy of ± 0.5 D for refractive error ranging from -10 D to + 10 D. The formula was used to calculate lens power in 16 eyes of 8 human subjects. Mean lens power was 24.3 D ± 1.7 D.

Evaluation of the substantivity of chlorhexidine in association with sodium fluoride in vitro.

The efficacy of the fluoride-chlorhexidine association in the prevention of gingivitis and caries has been advocated for a number of years. The objective of the association of these therapeutic agents is a synergistic action. The aim of the present study was to determine the substantivity of chlorhexidine associated or not to sodium fluoride at different intervals of time, in vitro. Bovine enamel surfaces were treated with 0.12% chlorhexidine gluconate (Periogard--Colgate) or 0.05% sodium fluoride with 0.12% chlorhexidine (Duplak--Dentsply) solutions for one minute. Fragments were placed in distilled water and samples were collected at intervals of 5, 30 and 360 minutes and analyzed by spectrophotometry in the visible ultraviolet region. Substantivity was evaluated by the measurement of chlorhexidine desorption from the treated slabs. The mean values obtained were statistically analyzed by Student's t-test. The results showed that the concentration of chlorhexidine decreased when it was used in association with sodium fluoride. The difference between the groups was statistically significant (p < 0.05). These in vitro results suggest that the association between sodium fluoride and chlorhexidine in the studied concentrations appears to have no beneficial effect because of the decrease in the substantivity of chlorhexidine.

Imaging and full-length biometry of the eye during accommodation using spectral domain OCT with an optical switch.

An optical switch was implemented in the reference arm of an extended depth SD-OCT system to sequentially acquire OCT images at different depths into the eye ranging from the cornea to the retina. A custom-made accommodation module was coupled with the delivery of the OCT system to provide controlled step stimuli of accommodation and disaccommodation that preserve ocular alignment. The changes in the lens shape were imaged and ocular distances were dynamically measured during accommodation and disaccommodation. The system is capable of dynamic in vivo imaging of the entire anterior segment and eye-length measurement during accommodation in real-time.

Effects of urea on the cattle tick Rhipicephalus (Boophilus) microplus (Acari: Ixodidae).

This study aimed at evaluating the effects of urea on Rhipicephalus (Boophilus) microplus. The experiment was divided into two stages. In Stage I, Brachiaria brizantha was placed into 30 pots, each with an area of 18 cm(2).These were divided into three groups of ten pots each: G1 non-treated control group, G2 treated with 15 g of urea per pot and G3 treated with 15 g of urea+10% of ammonium sulphate. Three engorged female ticks were placed in each pot and then 1.8l of water were added. In the second stage, a control group was maintained without the addition of urea and another group was treated with urea, each group comprising ten Mombaça grass (Panicum maximum cv. Mombaça) beds. On day zero, 12 engorged females were placed in each grass bed where were then fertilized with 60 g of urea per bed, only in the grass beds of the treated group. On the 27th day, the grass was cut in beds 1-5 in both groups and beds 1-5 in the treated group were fertilized a second time. On the 40th day, pieces of white flannel measuring 1.60 m × 1.00 m were spread over the grass to check for larvae presence. In stage I, observations conducted 24h after contact with urea showed a 100% death rate among the engorged females in G2; in group 3, only one engorged female still remained alive. In stage II, the counting of larvae reported 85.97% (P<0.0001) fewer parasites in the treated group compared to the control group.

Possible acquired resistance of dogs successively infested by Amblyomma cajennense (Fabricius, 1787) (Acari: Ixodidae) nymphs.

The present study aimed to evaluate the occurrence of immune resistance in dogs successively infested with Amblyomma cajennense nymphs. Five animals were submitted to four consecutive infestations with A. cajennense nymphs, at fourteen-day intervals. For each infestation, 50 nymphs were used per animal and data on the parasitic and non-parasitic periods were recorded. The average recovering rate of engorged nymphs in the successive infestations were 52.0, 29.2, 9.6 and 12.8%, respectively, with a significant reduction (p<0.05) of this parameter from the second infestation onwards. The modal drop-off day of engorged nymphs was Day 4 of parasitism in all infestations. The average mortality rates of nymphs seen on the first, second, third and fourth infestations were 3.6, 3.2, 2.0 and 2.8%, respectively, with no significant differences among them (p<0.05). In addition, no significant differences were seen among the ecdysis rates for specimens recovered from successive parasitic challenges. The study results suggest that the acquired resistance of infested dogs had a negative effect on recovery rate of A. cajennense nymphs; however, it did not affect the other biological parameters evaluated.

[Control of Anocentor nitens (Neumann, 1897) (Acari: Ixodidae) on equines]. / Controle de Anocentor nitens (Neumann, 1897) (Acari: Ixodidae) em equinos.

This trial evaluated control practices of Anocentor nitens on equines, using spraying devices and application of acaricide paste formulation in the auricular pavilion and nasal diverticulum. The study was carried out from October 2003 to March of 2008 and the evaluations had been divided in the following stages: Phase 1--out/03 mar/04 and Phases 2, 3, 4 and 5, respectively, correspondents to the month's periods until março/08. It was used score of 0 to 3 to classify infestation levels. From abr/04 to mar/06 was implanted a schedule of acaricide sprayings every seven days and divided in two series. The first one beginning in April 2004 and the second beginning in July, both using six sprayings treatments with pyrethroid chemical base--cypermethrin 0,015%, plus topical treatments applied monthly in the auricular pavilions (powder acaricide). From abril/06 to março/08 was carried out similar schedule treatments, each two months, using an experimental acaricide paste in the auricular pavilion and nasal diverticulum. Phases 2 and 3 did not showed reduction of the parasitic loads of A. nitens compared to the control period. Whereas in Phases 4 and 5 registered significant reduction compared control period and also with the results of Phases 2 and 3, characterizing the effectiveness of the treatment with the acaricide paste formulation. Results demonstrated of A. nitens populations present in the nasal diverticulum are important in the maintenance of the infestations on equines, and necessary attention to this anatomical structure when controlling ticks.

[Effect of the urea fertilization in pasture on Rhipicephalus (Boophilus) microplus (Acari: Ixodidae)]. / Efeito da adubação com uréia em pastagem, sobre Rhipicephalus(Boophilus) microplus (Acari: Ixodidae).

The objective of this study was to verify the effect of the urea fertilization in pasture on Rhipicephalus (Boophilus) microplus population in free living stage. Two groups had been made, a control group and a urea treatment group, each group with 10 lots of Mombaça grass (Panicum maximum cv. Mombaça). In day zero had been placed 12 engorged tick females in each lot and made fertilization with urea in the dosage of 60 g in the lots of the treat group. In 27th day the grass was cutted out in 1 to 5 lots of both groups and fertilized with urea in the lots of 1 to 5 in the treat group. In 40th day was released a white flannel 1.60 x 1.00 m length on each lot to verify the presence of larvae. The results presented a difference of 85.97% (P < 0.0001) between the treat group and the control group.