Landscape of Invasive Fusariosis in Pediatric Cancer Patients: Results of a Multicenter Observational Study From Latin America.

Invasive fusariosis (IF) is a life-threatening opportunistic infection that affects vulnerable hosts. We conducted a multicenter and multinational retrospective study to characterize the natural history and clinical management of IF in pediatric cancer patients. We selected patients <18 years old who were sequentially hospitalized in 10 Latin American medical centers with a diagnosis of IF between 2002 and 2021. Data were collected using an electronic case report form complemented by a dictionary of terms. We assessed mortality rates at 30, 60, and 90 days. We collected data from 60 episodes of IF (median age, 9.8 years) that were mostly documented in patients with hematologic cancer (70%). Other risk conditions found were lymphopenia (80%), neutropenia (76.7%), and corticosteroid exposure (63.3%). IF was disseminated in 55.6% of patients. Skin lesions was present in 58.3% of our patients, followed by pulmonary involvement in 55%, sinusitis in 21.7%, bone/joint involvement in 6.7% and 1 case each of endocarditis and brain abscess. Positive blood and skin biopsy cultures were detected in 60% and 48.3% of cases, respectively. Fusarium solani complex was the most commonly identified agent (66.6%). The majority of patients received monotherapy within the first 72 hours (71.6%), either with voriconazole or amphotericin B formulation. The mortality rates at 30, 60, and 90 days were 35%, 41.6%, and 45%, respectively. An important factor affecting mortality rates appears to be disseminated disease. The high percentage of patients with fungal involvement in multiple organs and systems highlights the need for extensive workup for additional sites of infection in severely immunocompromised children.

Comparing the current short-term cancer incidence prediction models in Brazil with state-of-the-art time-series models.

The World Health Organization has highlighted that cancer was the second-highest cause of death in 2019. This research aims to present the current forecasting techniques found in the literature, applied to predict time-series cancer incidence and then, compare these results with the current methodology adopted by the Instituto Nacional do Câncer (INCA) in Brazil. A set of univariate time-series approaches is proposed to aid decision-makers in monitoring and organizing cancer prevention and control actions. Additionally, this can guide oncological research towards more accurate estimates that align with the expected demand. Forecasting techniques were applied to real data from seven types of cancer in a Brazilian district. Each method was evaluated by comparing its fit with real data using the root mean square error, and we also assessed the quality of noise to identify biased models. Notably, three methods proposed in this research have never been applied to cancer prediction before. The data were collected from the INCA website, and the forecast methods were implemented using the R language. Conducting a literature review, it was possible to draw comparisons previous works worldwide to illustrate that cancer prediction is often focused on breast and lung cancers, typically utilizing a limited number of time-series models to find the best fit for each case. Additionally, in comparison to the current method applied in Brazil, it has been shown that employing more generalized forecast techniques can provide more reliable predictions. By evaluating the noise in the current method, this research shown that the existing prediction model is biased toward two of the studied cancers Comparing error results between the mentioned approaches and the current technique, it has been shown that the current method applied by INCA underperforms in six out of seven types of cancer tested. Moreover, this research identified that the current method can produce a biased prediction for two of the seven cancers evaluated. Therefore, it is suggested that the methods evaluated in this work should be integrated into the INCA cancer forecast methodology to provide reliable predictions for Brazilian healthcare professionals, decision-makers, and oncological researchers.

The Impact of Highly Weathered Oil from the Most Extensive Oil Spill in Tropical Oceans (Brazil) on the Microbiome of the Coral Mussismilia harttii.

In 2019, the largest oil spill ever recorded in tropical oceans in terms of extent occurred in Brazil. The oil from the spill was collected directly from the environment and used in an exposure experiment with the endangered reef-building coral Mussismilia harttii. The treatments of the experiment were control (without oil), 1% oil, 2.5% oil, and direct contact of coral with oil. The most abundant hydrocarbon in the seawater of the experiment was phenatrene, which is toxic to corals. However, overall, the concentration of PAHs was not very high. The analysis of the maximum photosynthetic capacity of Symbiodiniaceae dinoflagellates showed a small impact of oil on corals, mainly on the contact treatment. However, coral microbiomes were affected in all oil treatments, with the contact treatment showing the most pronounced impact. A greater number and abundance of stress-indicating and potentially pathogenic bacteria were found in all oil treatments. Finally, this highly weathered oil that had lain in the ocean for a long time was carrying potentially coral-pathogenic bacteria within the Vibrionaceae family and was able to transmit some of these bacteria to corals. Bacteria within Vibrionaceae are the main causes of disease in different species of corals and other marine organisms.

Biomineralization biomarkers to assess microplastics toxic effects in the freshwater snail Pomacea canaliculata.

Microplastics (MPs) pollution has increased the number of reports on the toxic effects on biota, especially aquatic organisms. Recently, studies highlighted changes in ion transport and concentration, especially Ca2+, in organisms exposed to MPs. For calcifying organisms, such as mollusks, Ca2+ homeostasis is critical for their shells construction. We investigated the effects of polyethylene (PE) MPs at 20 µg/L on biomineralization biomarkers (Ca2+ATPase, carbonic anhydrase, hemolymph [Ca2+], and shell regeneration) of the freshwater gastropod Pomacea canaliculata. Two experimental sets were performed: (1) animals in physiological condition and (2) animals with their shells excised. The results of the first set showed that within 24 h, the hemolymph [Ca2+] decreased, and the Ca2+ATPase activity increased in the mantle edge. For carbonic anhydrase (CA), the activity decreased in the gland and increased in the mantle. By 72 h, the hemolymph [Ca2+] had not changed, whereas both enzymes had increased in both tissues. In the second set, the hemolymph [Ca2+] increased after 72 h, whereas Ca2+ATPase activity decreased in both tissues. For AC, the opposite results were observed. At 120 h, calcium pumping was still reduced and CA values increased in the digestive gland. Additionally, MPs exposure increased the capacity of the gastropods to recover their shells. Based on this, our work provides novel data associating PE microplastic exposures (at 20 µg/L) and their potential to stimulate biomineralization enzymes of P. canaliculata, as well as increase shell regeneration in excised animal; a good prerogative for further investigations on both subjects that still lacks of more robust evidence.

Consequences of prenatal exposure to contaminants in elasmobranchs: Biochemical outcomes during the embryonic development of Pseudobatos horkelii.

Coastal elasmobranchs are vulnerable to chemicals mostly due to their k-strategic life history characteristics and high trophic positions. Embryos might be particularly exposed through the maternal offloading of contaminants, possibly leading to disruptions during critical developmental phases. Yet, knowledge on biochemical outcomes of prenatal exposure in elasmobranchs is notably limited. Therefore, we aimed to investigate the effects of prenatal exposure to contaminants in embryos of the critically endangered Brazilian guitarfish, Pseudobatos horkelii. Polybrominated diphenyl ethers (PBDEs), polycyclic aromatic hydrocarbons (PAHs), pharmaceuticals and personal care products, and metals were determined in embryos. Additionally, glutathione S-transferase activity (GST), glutathione (GSH), and metallothionein levels (MT) were analyzed. Finally, lipid peroxidation levels (LPO) and protein carbonyl groups (PCO) were assessed. Embryonic exposure depended on yolk consumption, which was conspicuous in earlier development. We observed a dilution effect of contaminants levels, potentially related to biotransformation of these compounds throughout the embryonic development. Nevertheless, GST was not correlated to contaminant concentrations. The multivariate relationship between antioxidant components (GSH and GST) and LPO and PCO was negative, suggesting the lack of efficient defense of these biomarkers in early development, leading to oxidative damage. In this context, our results indicate that prenatal exposure to contaminants might impact the redox status in embryos of P. horkelii, leading to oxidative damage. Furthermore, metal concentrations influenced MT levels, suggesting this as a potential detoxification pathway in this species.

Investigação sobre Atenção Primária durante a pandemia em territórios vulneráveis de Campinas, São Paulo e Rio de Janeiro, Brasil / Research on Primary Care during the pandemic in vulnerable territories of Campinas, São Paulo and Rio de Janeiro, Brazil

Resumo A pandemia de COVID-19 encontrou no Brasil um campo propício para sua propagação. A falta de coordenação de ações do governo federal, em conjunto com uma Atenção Primária à Saúde (APS) já fragilizada trouxe consequências para trabalhadores e usuários. O objetivo é analisar a gestão e o processo de trabalho na APS no enfrentamento à pandemia da COVID-19 em 3 municípios, considerando o processo histórico de sua constituição, a relação com o SUS e a APS e o ativismo social em territórios vulneráveis, a partir da percepção de usuários e trabalhadores. Foi realizada busca bibliográfica, observação participante e 97 entrevistas em profundidade com trabalhadores e usuários da APS. Os resultados foram organizados em 4 eixos: Implantação e gestão da APS nos municípios; Processo de trabalho na APS; Percepção dos trabalhadores e usuários em relação à APS e o SUS; Territórios, coletivos organizados e ativismo social. Os trabalhadores enfrentaram um ambiente de medo, sobrecarga e mudanças no processo de trabalho, o que não os impediu de resistir e reinventar suas práticas. Os usuários conviveram com barreiras de acesso e dificuldades no cumprimento de medidas sanitárias, mas foram encontradas experiências de coletivos organizados que surgiram como forma de enfrentamento à pandemia.

Abstract The COVID-19 pandemic found favourable conditions to spread in Brazil. A lack of coordinated action by the federal government, together with already weak Primary Health Care (PHC) had consequences for workers and users. This study examined PHC management and work process in response the COVID-19 pandemic in three municipalities, in view of the history of how PHC was set up, its relationship with the national public health system (SUS), and PHC and social activism in vulnerable territories, from the perceptions of users and workers. The study included a literature search, participant observation and 97 in-depth interviews of PHC workers and users. The results were organised into four areas: PHC implementation and management in the municipalities; the PHC work process; workers' and users' perceptions of PHC and the SUS; and territories, organised groups and social activism. Workers faced an environment of fear, overwork and changes in their work process, none of which prevented them from persisting and reinventing their practice. Users encountered barriers to access and difficulties in complying with public health measures, but the study found experiences of organised groups that emerged as means of coping with the pandemic.

Coletivos organizados, ativismo social e narrativas da pandemia em territórios vulneráveis na cidade do Rio de Janeiro, Brasil / Organised groups, social activism and narratives of the pandemic in vulnerable territories in the city of Rio de Janeiro, Brazil

Resumo A pandemia de COVID-19 no Brasil atingiu níveis alarmantes. Na cidade do Rio de Janeiro, ela encontrou um cenário de desmonte da Atenção Primária à Saúde (APS) em meio à uma crise política, o que teve grande impacto nos territórios de maior vulnerabilidade. O objetivo desse estudo é analisar de que forma as favelas e equipes da APS organizaram-se para desenvolver ações comunitárias, ocupando espaços deixados pela falta de outras políticas públicas. Os resultados fazem parte da pesquisa qualitativa multicêntrica "Estratégias de abordagem dos aspectos subjetivos e sociais na Atenção Primária no contexto da pandemia", onde foram analisados documentos orientadores públicos e 36 entrevistas em profundidade com trabalhadores e usuários da APS, organizadas em grades interpretativas. Como resultado, observou-se que houve iniciativas cogestoras dos trabalhadores e usuários da APS, a partir do surgimento de coletivos organizados e ativismo social, para o enfrentamento da pandemia, independente das normativas da Secretaria Municipal de Saúde e demais instâncias governamentais. A APS se apresentou como único equipamento público nos territórios de alta vulnerabilidade, onde a violência armada esteve presente mesmo durante a pandemia.

Abstract The COVID-19 pandemic has reached alarming levels in Brazil. In Rio de Janeiro city, it arrived in a scenario in which Primary Health Care (PHC) was being dismantled in the midst of a political crisis, which had major impact on the most vulnerable territories. This study examined how favelas and PHC teams organised community-based action and occupy the vacuum left by the lack of public policies. The results form part of the multi-centre qualitative study "Strategies for approaching subjective and social aspects of Primary Care in the pandemic context", using public guidance documents and 36 in-depth interviews of PHC workers and users, which were categorised into interpretive grids. Co-management initiatives by PHC workers and users were found to have arisen out of organised groups and social activism, to face the pandemic, independently of regulations from the Municipal Health Department and other government bodies. PHC figured as the only public facility in highly vulnerable territories, where armed violence was ongoing even during the pandemic.

Allelopathy of Ricinus communis and light spectrum variation decrease emergence and growth of Cyperus rotundus

Weeds negatively influence agricultural production. However, those losses depend on weed specie, its time of emergence, and period of interference on agricultural crops. Synthetic herbicides are commonly used to control these plants species; however, they may cause damage to the environment, human beings and animals health, and this problem justify the need to develop alternative bioherbicides. To evaluate the allelopathic potential of Ricinus communis (Castor bean) and light spectrum variation on the emergence and growth of Cyperus rotundus L., a trial was carried out in a protected environment with 15% of brightness reduction at the Center for Agricultural and Environmental Sciences at the Paraíba State University. Four aqueous extract concentrations of R. communis leaves were tested (0, 5, 10, and 15%) and four light spectrums variations (white, purple, blue, and red lights). Variables such as emergence, length, dry matter accumulation and growth rates of shoots and root of C. rotundus seedlings were assessed. Data were analyzed by normality test, analysis of variance, polynomial regression, and averages test. Soot and root emergence, length, and dry matter accumulation of C. rotundus seedlings were reduced due to the allelopathy caused by R. communis aqueous extract leaves (15% concentration) and under purple or red light spectrum radiation.

Uso de la pasta CDZ en dientes temporarios necrosados con una técnica mínimamente invasiva / Use of CDZ paste in necrotic primary teeth with a minimally invasive technique

Introducción: El tratamiento de los canales radiculares de molares temporales con pulpas infectadas ha sido ampliamente descrito y motivo de discusión por muchos años, no existiendo aún un consenso en cuanto al material de obturación. La pasta CTZ (cloranfenicol, tetraciclina y óxido de zinc más eugenol) acompañada de la Técnica de Endodoncia No Instrumentada ha mostrado una alta efectividad clínica y radiográfica para el tratamiento de molares temporales con compromiso pulpar. Se ha propuesto el reemplazo del componente Tetraciclina por Doxiciclina de la formulación, por las implicancias de un posible amelo-génesis imperfecta y la coloración en la corona de dicho componente. Objetivo. Evaluar la efectividad clínica de la pasta CDZ en el tratamiento endodóntico de dientes primarios necrosados con una técnica mínimamente invasiva. Metodología. Estudio de intervención en el que se incluyeron pacientes que presentaban dientes temporales con indicación de terapia pulpar y en quienes se utilizó la pasta CDZ. El éxito del tratamiento se midió por la desaparición de la sintomatología. Resultados. Se incluyeron en el estudio 76 pacientes entre 2 a 9 años. La eficacia del tratamiento con CDZ fue del 97,6% en 125 dientes. Conclusiones. Los hallazgos son comparables a los estudios que utilizaron el CTZ. Debido a las características biológicas del material, su bajo costo, fácil manipulación y excelentes resultados clínicos, se considera una opción en la terapia pulpar en dientes temporales, como una alternativa en el uso de programas de salud pública.

Introduction: Treatment of root canals of primary molars with infected pulps has been widely described and has been the subject of discussion for many years, and there is still no consensus regarding the filling material. The CTZ paste (chloramphenicol, tetracycline and zinc oxide plus eugenol) accompanied by the Non-Instrumented Endodontic Technique has shown high clinical and radiographic effectiveness for the treatment of primary molars with pulp involvement. The replacement of the Tetracycline component by Doxycycline of the formulation has been proposed, due to the implications of a possible amelogenesis imperfecta and the coloration in the crown of said component. Goal. To evaluate the clinical effectiveness of CDZ paste in the endodontic treatment of necrotic primary teeth with a minimally invasive technique. Methodology: Intervention study in which patients with temporary teeth with an indication for pulp therapy and in whom CDZ paste was used were included. Treatment success was measured by the disappearance of symptoms. Results. 76 patients between 2 and 9 years old were included in the study. The efficacy of CDZ treatment was 97.6% in 125 teeth. Conclusions: The findings are comparable to studies using CTZ. Due to the biological characteristics of the material, its low cost, easy handling and excellent clinical results, it is considered an option in pulp therapy in primary teeth, as an alternative in the use of public health programs.

Diversity and Efficiency of Rhizobia from a Revegetated Area and Hotspot-Phytophysiognomies Affected by Iron Mining as Indicators of Rehabilitation and Biotechnological Potential.

This study aimed to evaluate the resilience of phytophysiognomies under influence of iron mining by assessing the occurrence, diversity, and symbiotic efficiency of native communities of nitrogen-fixing bacteria that nodulate leguminous plants (rhizobia) in soils of an area revegetated with grass after iron mining activities and in the phytophysiognomies in adjacent areas (Canga, Atlantic Forest, Cerrado, and Eucalyptus-planted forest). Experiments for capturing rhizobia through two species of promiscuous plants, siratro (Macroptilium atropurpureum) and cowpea (Vigna unguiculata), were conducted in a greenhouse. The rhizobial strains isolated were characterized phenotypically, genetically (16S rRNA sequencing and BOX-PCR fingerprinting), and regard symbiotic efficiency of biological nitrogen fixation (BNF) compared to mineral nitrogen and reference strains. Cowpea captured a higher density of rhizobia than siratro did. However, most of the strains captured by siratro had greater symbiotic efficiency. The revegetated area proved to be the community most efficient in N2 fixation and was also the most diverse, whereas Canga was the least diverse. For the two trap species, the predominant genus captured in the revegetated area and in the phytophysiognomies was Bradyrhizobium. The greater symbiotic efficiency and the high genetic diversity of the rhizobial community in the revegetated area indicate the effectiveness of the soil rehabilitation process. The revegetated area and the phytophysiognomies proved to harbor strains with high biotechnological potential. Results indicate that the high functional redundancy of this group of bacteria contributes to the resilience of these phytophysiognomies and the revegetated area.

As Ouvidorias do SUS e a Rede Brasileira de Escolas de Saúde Pública: uma experiência inédita / SUS Ombudsman offices and the Brazilian Public Health School Network: a novel experience

RESUMO Este relato de experiência teve como objetivo analisar o processo de formação de ouvidores do Sistema Único de Saúde (SUS), uma parceria entre a Escola Nacional de Saúde Pública Sergio Arouca (Ensp/ Fiocruz), a Rede Brasileira de Escola de Saúde Pública (RedEscola) e a Secretaria de Gestão Estratégica e Participativa do SUS (SGEP/MS). Considerada pioneira, a formação foi desenvolvida dentro da lógica de construção participativa, envolvendo atores municipais, estaduais e nacionais das Ouvidorias do SUS, instituições/escolas de saúde pública estaduais, Conselho Nacional de Secretarias Municipais de Saúde (Conasems) e Secretaria Técnica e Executiva da RedEscola, em uma articulação de governança consertada que resultou na formação de 451 ouvidores.

ABSTRACT This experience report aimed to analyze the vocational education of ombudsmen in the Unified Health System (SUS). This project was a partnership between the Sergio Arouca National School of Public Health (ENSP/FIOCRUZ), the Brazilian Network of Public Health Schools (RedEscola), and the SUS Strategic and Participatory Management Secretary (SGEP/MS). Considered pioneering, the vocational education was developed within the logic of a participatory process which involved municipal, state and national actors from SUS Ombudsman offices, state public health institutions/schools, the National Council of Municipal Health Secretaries (CONASEMS), and the RedEscola's Technical and Executive Secretary in a consensual governance articulation resulting in the qualification of 451 ombudsmen.

Effect of alkaline and deep eutectic solvents pretreatments on the recovery of lignin with antioxidant activity from grape stalks.

Grape stalks are lignocellulosic residues that can be valorized through the extraction of lignin - an underutilized biopolymer with high potential. Two lignin extraction methods, alkaline and deep eutectic solvents (DES), were studied, and experimental designs were carried out to obtain the best extraction conditions. The defined parameters for alkaline extraction allowed the recovery of ~48 % of lignin with low purity that was further improved with an autohydrolysis pretreatment (~79 % purity; ~32 % yield). Optimum parameters of DES method rendered high purity lignin (~90 %) without the need of a pretreatment and with a better yield (50.2 % (±2.3)) than the alkaline method. Both lignin fractions presented high antioxidant activities, being close to the antioxidant capacity of BHT for DPPH scavenging. Structural analysis proved the presence of lignin in both alkaline and DES samples with similar morphology. Overall, DES method was more efficient in the extraction of lignin from grape stalks besides its greener and sustainable nature. This work uses DES to extract lignin from this biomass while comparing it with a commonly classical method, proving that grape stalks can be used to extract lignin with a sustainable and efficient method rendering a final ingredient with value-added properties.

Effect of squalane-based emulsion on polyphenols skin penetration: Ex vivo skin study.

Polyphenols have gained attractiveness as ingredients in cosmetic formulations as result of their ability to delay the aging process. However, different factors limit their use, including low solubility and poor skin permeability. In this sense, this study describes the potential of squalane to increase the polyphenols ex vivo skin penetration, incorporated into a water-in-oil emulsion. Polyphenols skin permeation followed the Fick's first law and, p-coumaric acid, vitexin, schaftoside and ferulic acid had the higher permeability coefficients (Kp = 6.0-8.0 × 10-3 cm-2 h-1). Addition of squalane to phenolic compounds decreased the permeability coefficients (Kp = 4.1-5.9 × 10-3 cm-2 h-1), indicating that squalane increased the retention of polyphenols in the skin. Gentisic acid, ferulic acid, and p-coumaric acid were the only compounds permeating from water-in-oil emulsion, in the first 8 h of study and, according Krosmeyer-Peppas model, its n value was > 1 indicating a high transport resistance from the formulation and throughout the skin. Results suggest squalane as an efficient vehicle to increase the dermal availability increasing phenolic compounds physiological functions, by enhancing the skin retention time where they should exert antiaging effect.

Combined physiological and behavioral approaches as tools to evaluate environmental risk assessment of the water accommodated-fraction of diesel oil.

There is an increasing concern related to the toxic effects of the soluble portion of diesel oil on aquatic ecosystems and the organisms living in them. In this context, the aim of this study was to analyze the effects of diesel water accommodated-fraction (WAF) on behavioral and biochemical responses of mussels Perna perna. Animals were exposed to 5 and 20% of WAF for 96 h. Prior to the beginning of the experiments, Hall effect sensors and magnets were attached to the valves of the mussels. Valve gaping behavior was continuously recorded for 12 h of exposure and tissues (gills and digestive gland) were separated after 96 h of exposure. Overall, both behavior and biochemical biomarkers were altered due to WAF exposure. Animals exposed to WAF reduced the average amplitude of the valves and the fraction of time opened, and presented greater transition frequency, demonstrating avoidance behavior over the 12 h period. Furthermore, the biochemical biomarkers (GSH, GST, SOD and CAT) were altered following the 96 h of exposure to WAF. Considering the results presented, this study demonstrates the toxic potential of WAF in both shorter and longer exposure periods.

Pequi oil (Caryocar brasilense Cambess.) nanoemulsion alters cell proliferation and damages key organelles in triple-negative breast cancer cells in vitro.

Pequi oil is extracted from the fruit of a Brazilian native plant (Caryocar brasiliense Camb) that contains some molecules with anticancer potential. Due to its hydrophobic property, the administration of pequi oil associated with nanoemulsion systems represents a successful strategy to improve oil bioavailability. Breast cancer is the most frequent type of cancer among women and conventional therapies used are frequently associated with several side effects. Thus, the aim of this study was to investigate the effects of pequi oil-based nanoemulsion (PeNE) on triple-negative breast cancer cells (4T1), in vitro. PeNE presented a dose- and time-dependent cytotoxic effect with lower IC50 than free pequi oil after 48 h of exposure (p < 0.001). At 180 µg/mL, PeNE demonstrated numerous cell alterations, when compared to free pequi oil, such as morphological alterations, reduction in cell proliferation and total cell number, damage to plasmatic membrane, induction of lysosomal membrane permeability and depolarization of mitochondrial membrane, alteration of intracellular ROS production and calcium level, and increase in phosphatidylserine exposure. Taken together, the results suggest an interesting induction of cell death mechanisms involving a combined action of factors that impair nucleus, mitochondria, lysosome, and ER function. In addition, more pronounced effects were observed in cells treated by PeNE at 180 µg/mL when compared to free pequi oil, thereby reinforcing the advantages of using nanometric platforms. These promising results highlight the use of PeNE as a potential complementary therapeutic approach to be employed along with conventional treatments against breast cancer in the future.

Comparison of Outcomes in Immediate Implant-Based Breast Reconstruction: Acellular Dermal Matrix versus Inferior Dermal Flap.

Background Implant-based breast reconstruction has evolved tremendously in the last decades, mainly due to the development of new products and techniques that make the procedure safer and more reliable. The purpose of this study was to compare the outcomes in immediate one-stage breast reconstruction between acellular dermal matrix (ADM) and inferior dermal flap (IDF). Methods We conducted a retrospective comparative study of patients submitted to immediate breast reconstructions with an anatomical implant and ADM or IDF in a single center between 2016 and 2018. Outcomes evaluated included major complications, early complications, reinterventions, readmissions, and reconstruction failure. Simple descriptive statistics and univariate analysis were performed. Results A total of 118 breast reconstructions (85 patients) were included in the analysis. Patients in the IDF group had a higher body mass index (median = 27.0) than patients in the ADM group (median = 24). There were no statistically significant differences among both groups regarding immediate major complication, early complications, readmissions, and reinterventions. Conclusion There are no significant differences in complications between the ADM and IDF approach to immediate implant breast reconstruction. In patients with higher body mass index and large, ptotic breasts, we recommend an immediate implant reconstruction with IDF.

Association of Anti-β 1 and Anti-M2 Antibodies with Autonomic Nervous System Modulation in Patients with Chronic Chagas Cardiomyopathy

Abstract Background: Different immune mechanisms of myocardial damage involved in the pathophysiology of Chagas disease coexist with high titers of autoantibodies induced by T. cruzi . There are few studies in the literature about the adaptive role of anti-β1 and anti-M2 antibodies in chronic Chagas cardiomyopathy (CCC). Objectives: To evaluate the association between anti-β1 and anti-M2 antibodies with heart rate variability (HRV) parameters on 24h Holter monitoring and the rate-pressure product (RPP) on cardiopulmonary exercise testing (CPET). Methods: Anti-β1 and anti-M2 antibody titers were measured by enzyme-linked immunosorbent assay (ELISA) in 64 patients affected by CCC. Analysis of HRV was performed through the time-domain indices NNs, mean NN, SDNN, SDANN, SDNN index, NNNs, RMSSD, and pNN50. Spearman's correlation coefficient was used to assess the association between antibody titers and numerical variables. The Mann-Whitney test was used for comparison between two groups. Multiple linear regression was used to identify independent variables capable of explaining anti-β1 and anti-M2 antibody titers at the 5% significance level. Results: On 24h Holter, during the period of greatest parasympathetic activation (2:00-6:00 a.m.), an inverse association was found between anti-β1 titers and SDNN (rs=-0.13, p =0.041, n=43), as well as a direct association between anti-M2 titers and SDANN ( r s=0.317, p =0.039, n=43). Regarding CPET variables, anti-β1 titers were directly associated with RPP (rs=0.371, p =0.005, n=56). The subgroup of patients with a normal chronotropic response showed higher anti-β1 titers than the subgroup with an impaired response (p=0.023). RPP was an independent explanatory variable for anti-β1 titers, although with a low coefficient of determination (R2=0.147). Conclusion: The findings of this study suggest that, in patients with CCC, anti-β1 and anti-M2 antibodies may affect HRV parameters. RPP was directly associated with higher anti-β1 titers.

Challenging case of Whipple's disease: The contribution of radiology.

Whipple's disease is a rare chronic infectious disease, caused by Tropheryma whipplei. The disease can be challenging to diagnose due to the variable clinical manifestations and the nonspecific laboratory and imaging findings. We report the case of a 75-year-old man, complaining of weight loss and arthralgias with an insidious onset. A thoracic, abdominal and pelvic CT was performed, demonstrating features suggestive of Whipple's disease. Although not specific, the imaging findings of fatty attenuation mesenteric and retroperitoneal enlarged lymph nodes are a common finding in Whipple's disease. Esophagogastroduodenoscopy with duodenal biopsy confirmed the diagnosis through PCR analysis.

Health condition of Chelonia mydas from a foraging area affected by the tailings of a collapsed dam in southeast Brazil.

In 2015, the failure of the Fundão dam caused the release of 43 million m3 of tailings into the Doce River Basin, in southeast Brazil. It was considered the largest environmental disaster of the world mining industry. The tailings, composed mostly of heavy metals, caused massive destruction of the Doce River ecosystem endangering the organisms that live in the coastal zone where the mud reached the ocean. Among the exposed species are the sea turtles that use the region for food. The aim of this study was to evaluate the effect of contaminants on the health status of juvenile green sea turtles that feed in a coastal area exposed to ore mud (Santa Cruz) and to compare them with animals from an area not directly affected (Coroa Vermelha). A physical examination was performed to determine the health status. Blood samples were analyzed for hematological and biochemical parameters, and metal concentrations (As, Cd, Cr, Cu, Fe, Hg, Mn, Pb, and Zn). Santa Cruz sea turtles had more ectoparasites and a higher incidence of fibropapillomatosis. Statistically significant differences between sites were found for levels of calcium, phosphorus, glucose, protein, albumin, globulin, cholesterol, triglycerides, urea, CPK, ALT, and AST. The count of leukocytes, thrombocytes, and heterophils, as well as the concentrations of As and Cu were higher in Santa Cruz turtles. Together the results show a worse nutritional status and a greater degree of liver and kidney damage in animals affected by the tailings. The health status may indicate a physiological deficit that can affect their immune system and behavior, which is supported by the higher fibropapillomatosis tumor score and ectoparasite load in these animals. These results support the need for long-term monitoring of the exposed area to quantify the direct and indirect influence of the heavy metals levels on sea turtles and how this reflects the environmental health.

Imaging Tips to Recognize Primary Breast Angiosarcoma.

Teaching Point: Primary breast angiosarcoma should be in the differential of a breast mass with rapid growth. It typically appears intensely vascularized and non-calcified, predominantly hyperechoic, and hyperintense on T2-weighted MRI.