Ketamine-dexmedetomidine combination for sedation in pediatric major surgery in a low-income country.

Anorectal malformations are one of the most frequent congenital malformations treated by pediatric surgeons. In low-income countries, the surgical and anesthetic management of children in need of these procedures can be challenging. Limited oxygen supply, lack of equipment, especially pediatric, and intensive care units make the use of regional anesthesia appealing. We present a series of four cases of anorectal malformations corrections in Guinea Bissau, in children up to 13 months of age, under regional anesthesia and sedation with ketodex, a mixture of ketamine and dexmedetomidine (in a proportion of 1 mg to 1 µg). No child developed respiratory depression requiring airway intervention or supplemental oxygen, or had hemodynamic instability.

Genomic Surveillance of Yellow Fever Virus Epizootic in São Paulo, Brazil, 2016 - 2018.

São Paulo, a densely inhabited state in southeast Brazil that contains the fourth most populated city in the world, recently experienced its largest yellow fever virus (YFV) outbreak in decades. YFV does not normally circulate extensively in São Paulo, so most people were unvaccinated when the outbreak began. Surveillance in non-human primates (NHPs) is important for determining the magnitude and geographic extent of an epizootic, thereby helping to evaluate the risk of YFV spillover to humans. Data from infected NHPs can give more accurate insights into YFV spread than when using data from human cases alone. To contextualise human cases, identify epizootic foci and uncover the rate and direction of YFV spread in São Paulo, we generated and analysed virus genomic data and epizootic case data from NHPs in São Paulo. We report the occurrence of three spatiotemporally distinct phases of the outbreak in São Paulo prior to February 2018. We generated 51 new virus genomes from YFV positive cases identified in 23 different municipalities in São Paulo, mostly sampled from NHPs between October 2016 and January 2018. Although we observe substantial heterogeneity in lineage dispersal velocities between phylogenetic branches, continuous phylogeographic analyses of generated YFV genomes suggest that YFV lineages spread in São Paulo at a mean rate of approximately 1km per day during all phases of the outbreak. Viral lineages from the first epizootic phase in northern São Paulo subsequently dispersed towards the south of the state to cause the second and third epizootic phases there. This alters our understanding of how YFV was introduced into the densely populated south of São Paulo state. Our results shed light on the sylvatic transmission of YFV in highly fragmented forested regions in São Paulo state and highlight the importance of continued surveillance of zoonotic pathogens in sentinel species.

Differential Yellow Fever Susceptibility in New World Nonhuman Primates, Comparison with Humans, and Implications for Surveillance.

A major outbreak of yellow fever (YF) occurred in Brazil during 2016-2018. Epizootics in New World nonhuman primates are sentinel events for YF virus circulation. However, genus-specific susceptibilities and suitability for YF surveillance remain poorly understood. We obtained and compared epidemiologic, histopathologic, immunohistochemical, and molecular results from 93 human and 1,752 primate cases submitted during the recent YF outbreak in Brazil (2017), with the support of the Brazilian National YF Surveillance Program. We detected heterogeneous YF-associated profiles among the various genera of primates we analyzed. Alouatta primates were the most reliable sentinel; Sapajus and Callicebus primates had higher viral loads but lower proportional mortality rates. Callithrix primates were the least sensitive, showing lower viral loads, lower proportional mortality rates, and no demonstrable YF virus antigen or extensive lesions in liver, despite detectable viral RNA. These differences in susceptibility, viral load, and mortality rates should be considered in strategic surveillance of epizootics and control measures for YF.

Improving Seismic Inversion Robustness via Deformed Jackson Gaussian.

The seismic data inversion from observations contaminated by spurious measures (outliers) remains a significant challenge for the industrial and scientific communities. This difficulty is due to slow processing work to mitigate the influence of the outliers. In this work, we introduce a robust formulation to mitigate the influence of spurious measurements in the seismic inversion process. In this regard, we put forth an outlier-resistant seismic inversion methodology for model estimation based on the deformed Jackson Gaussian distribution. To demonstrate the effectiveness of our proposal, we investigated a classic geophysical data-inverse problem in three different scenarios: (i) in the first one, we analyzed the sensitivity of the seismic inversion to incorrect seismic sources; (ii) in the second one, we considered a dataset polluted by Gaussian errors with different noise intensities; and (iii) in the last one we considered a dataset contaminated by many outliers. The results reveal that the deformed Jackson Gaussian outperforms the classical approach, which is based on the standard Gaussian distribution.

Probing the Formation of Wormlike Micelles Formed by Cationic Surfactant with Chlorobenzoate Derivatives.

The energy released when tetradecyltrimethylammonium bromide (C14TAB) is combined with different derivatives of chlorobenzoates in an isothermal titration calorimeter (ITC) allows a direct evaluation of the spontaneity of the threading of the aromatic anions into the micellar palisade. The comparison between the enthalpimetric curves with the ones for viscosity of the solutions, hydrodynamic radii of the aggregates (dynamic light scattering experiments), and the fraction of aromatic anions incorporated (diffusion-ordered spectroscopy experiments) allows the establishment of the variations of enthalpy with formation, growth, and decrease of the wormlike micelles (WLMs). The formation of WLMs with C14TAB is very favored (very exothermic) for titrations of chlorobenzoate derivatives which present the chlorine atom in positions 3 or 4 of the aromatic ring. However, the aggregation is highly unfavorable if chlorine is at position 2 of chlorobenzoate. According to the results, the high potential of the ITC to determine critical concentrations and the energies associated with the aggregation of a cationic surfactant and aromatic anions for the formation of WLMs was demonstrated.

Mini-trampoline enhances cardiovascular responses during a stationary running exergame in adults.

A new class of video game called exergame (EXG) has been used to promote physical activity and cardiovascular fitness, but EXGs are not as efficient as traditional aerobic exercises. However, auxiliary tools, such as the mini trampoline (MT), may enhance the physiological responses obtained by the EXG. The aim of this study was to compare the metabolic and cardiovascular responses of a stationary running EXG with and without an MT. Nineteen healthy males performed a treadmill test for the determination of VO2max and HRmax. In sequence, the VO2, HR, and METs were measured during the Free Run, a Nintendo Wii's stationary running EXG, according to two distinct protocols. One protocol used the traditional EXG (EXG-PT), and the other protocol used an MT during the EXG (MT-PT). The normalized data were analyzed by statistical software SPSS 20.0 using a t-test and ANOVA for repeated measures (p < 0.05). The results supported that stationary running EXG performed on an MT showed an increased intensity, in all variables analyzed, when compared with the traditional EXG. Furthermore, the MT-PT was classified as a vigorous-intensity exercise and EXG-PT as a moderate to vigorous intensity exercise. In conclusion, these findings support that the MT is a feasible auxiliary tool to enhance physiologic responses during a stationary running EXG.

Probable transfusion-transmitted Zika virus in Brazil.

BACKGROUND: Zika virus (ZIKV) is an emerging arthropod-borne flavivirus transmitted by Aedes mosquitoes. Recent commentaries regarding ZIKV routes of transmission describe a potential transmission by transfusion. Herein, we report a probable case of transfusion-transmitted ZIKV infection through a platelet transfusion that was detected from postdonation information. CASE REPORT: A blood donor made a voluntary telephone report to the blood donor facility 3 days after donation and informed the facility of a febrile illness (fever, malaise, and headaches). Due to the ongoing dengue epidemic, the initial clinical investigation included dengue among other possible diagnoses. The serology and molecular laboratory results excluded dengue infection. However, stored samples from the donation were positive for ZIKV on reverse transcription-polymerase chain reaction (RT-PCR) analysis. A retrospective investigation demonstrated that the platelet concentrate, which was part of a pool, had been transfused after a liver transplantation. A physician had evaluated the patient 4 days after surgery. Laboratory investigation showed enzyme-linked immunosorbent assay results that were negative for dengue immunoglobulin M antibodies; however, the results were positive for hemagglutination inhibition antibodies against flavivirus. ZIKV RT-PCR and virus isolation analyses in cell cultures from recipient serum were both positive. The sequencing confirmed ZIKV in the donor and patient samples. Ten partial nucleotide sequences from the ZIKV strain that were detected in the donor were aligned and compared with the ZIKV genome detected in the recipient, revealing a 99.8% homology between the two strains. CONCLUSIONS: This is a case of probable transmission of ZIKV through blood transfusion. The patient had been transfused with the blood product from an infected donor, most likely in the incubation period after ZIKV infection but prior to clinical disease onset. This report emphasizes the importance of postdonation information and recipient investigations during outbreaks of potentially blood-borne infections.

Influence of repeated bouts of eccentric exercise on high-intensity aerobic performance.

[Purpose] It is believed that eccentric high-intensity exercise can decrease performance in subsequent exercise. However, with repetition, the deleterious effects can be minimized. Thus, this study evaluated the influence of repeated bouts of eccentric exercise on subsequent high-intensity aerobic performance. [Subjects and Methods] Seven healthy and sedentary male volunteers were recruited. a) Visit 1: determination of maximum oxygen uptake (VO2max) and speed associated with maximum oxygen uptake (vVO2max) in incremental treadmill testing; b) Visit 2: run to exhaustion at vVO2max (Tlim control); c) Visit 3: 10 sets of 10 depth jumps, followed by a run to exhaustion at vVO2max (Tlim 1); d) Visit 4: after 6 weeks without any physical training, the volunteers carried out the same procedures as on the third visit (Tlim 2). Data were analyzed using one-way analysis of variance (ANOVA) with the post-hoc Tukey test. [Results] Significant differences were found between Tlim control and Tlim 1 (283.4 ± 47.7 s vs. 125.2 ± 64.1 s, respectively), these were not different from Tlim 2. [Conclusion] Eccentric exercise showed deleterious effects on subsequent high-intensity aerobic performance. These effects were minimized after the exercise protocol was repeated 6 weeks after the first event.

Could the bone mineral density (T-score) be correlated with the Raman spectral features of keratin from women's nails and be used to predict osteoporosis?

Osteoporosis is a disease with great importance in current public health due to the associated risk of fracture; therefore, a rapid and accurate diagnosis becomes increasingly important. Recent literature has described a possible relationship between the changes in the organic phase of bone and the changes in nail keratin measured through Raman spectroscopy, aiming at the development of a standard for measuring bone quality and fracture risk both rapid and accurately. This work evaluated the correlation between the bone mineral density (BMD) scores of women with and without osteoporotic disease with the changes in the Raman spectra of the nail keratin, by assessing the intensity of the peak at 510 cm(-1) (S-S bridge) and the scores of principal component analysis (PCA), correlated with the values of BMD measured at the lumbar and hip. Raman spectra of ex vivo fingernails of 213 women were obtained by means of a dispersive Raman spectrometer (830 nm, 300 mW, in the spectral range between 400 and 1,800 cm(-1)). Peak intensities at ∼510 cm(-1) (assigned to the keratin S-S bridge) were measured, and the scores of first principal component loading vectors were calculated. Results showed no differences in the mean Raman spectra of nails of groups with and without osteoporosis. No correlation was found between the BMD scores and both the intensities of the 510 cm(-1) peak and the scores of the first four principal component vectors. Results suggest that BMD and fracture risk could not be assessed by the nail keratin features.

Effects of feedback on activation of the quadriceps during weight-bearing tasks of the Wii.

[Purpose] This investigation evaluated the effect of real-time feedback on electrical activation of the quadriceps during 3 weight-bearing tasks of the Wii Fit Plus(®). [Subjects] Thirty male healthy volunteers were recruited. [Methods] Activation of the vastus medialis, vastus lateralis, and rectus femoris muscles was recorded during virtual lunge, single leg extension, and single leg reach exercises. Each exercise was performed twice in 3 randomized experimental conditions (with visual feedback, with auditory feedback, and with no feedback). The normalized electromyographic data (using maximum voluntary isometric contraction) were analyzed using repeated measures analysis of variance and Tukey's test. [Results] No significant difference was found in the muscles among the feedback conditions during the 3 exercises. However, the variation in the muscle activity of the vastus medialis and vastus lateralis (18.23-29.20% of maximum voluntary isometric contraction) was higher (47-62%) than that in the rectus femoris (7.35-12.98% of maximum voluntary isometric contraction). [Conclusion] Real-time feedback did not alter quadriceps activation during the Wii tasks. Additionally, these games showed electromyographic activation levels similar to those for the same tasks outside the virtual environment. The Wii weight-bearing tasks could therefore constitute a physical activity program but without the additional benefit of feedback.

Acute cardiovascular responses while playing virtual games simulated by Nintendo Wii(®).

[Purpose] This investigation evaluated the acute cardiovascular responses that occur while playing virtual games (aerobic and balance) emulated by Nintendo Wii(®). [Subjects] Nineteen healthy male volunteers were recruited. [Methods] The ergospirometric variables of maximum oxygen consumption, metabolic equivalents, and heart rate were obtained during the aerobic (Obstacle Course, Hula Hoop, and Free Run) and balance (Soccer Heading, Penguin Slide, and Table Tilt) games of Wii Fit Plus(®) software. To access and analyze the ergospirometric information, a VO2000 analyzer was used. Normalized data (using maximum oxygen consumption and heart rate) were analyzed using repeated measures analysis of variance and Scheffe's test. [Results] Significant differences were found among the balance and aerobic games in all variables analyzed. In addition, the Wii exercises performed were considered to be of light (balance games) and moderate (aerobic games) intensity in accordance with American College Sports Medicine exercise stratification. [Conclusion] Physical activity in a virtual environment emulated by Nintendo Wii(®) can change acute cardiovascular responses, primarily when Wii aerobic games are performed. These results support the use of the Nintendo Wii(®) in physical activity programs.

Cardiovascular effects of Zumba(®) performed in a virtual environment using XBOX Kinect.

[Purpose] This study evaluated the acute cardiovascular responses during a session of Zumba(®) Fitness in a virtual reality environment. [Subjects] Eighteen healthy volunteers were recruited. [Methods] The following cardiovascular variables: heart rate, systolic blood pressure, diastolic blood pressure, and double product were assessed before and after the practice of virtual Zumba(®), which was performed as a continuous sequence of five choreographed movements lasting for 22 min. The game Zumba Fitness Core(®), with the Kinect-based virtual reality system for the XBOX 360, was used to create the virtual environment. Comparisons were made among mean delta values (delta=post-Zumba(®) minus pre-Zumba(®) values) for systolic and diastolic blood pressure, heart rate, and double product using Student's t-test for paired samples. [Results] After a single session, a significant increase was noted in all the analyzed parameters (Systolic blood pressure=18%; Diastolic blood pressure=13%; Heart rate=67%; and Double product=97%). [Conclusion] The results support the feasibility of the use of Zumba Fitness Core(®) with the Kinect-based virtual reality system for the XBOX 360 in physical activity programs and further favor its indication for this purpose.

Humoral immune response to Shiga Toxin 2 (Stx2) among Brazilian urban children with hemolytic uremic syndrome and healthy controls.

BACKGROUND: Shiga toxin (Stx)-producing Escherichia coli (STEC) infection is associated with hemolytic uremic syndrome (HUS), the main cause of acute renal failure in early childhood. Stx is essential in the pathogenesis of HUS, which has been mostly related to Stx2-producing isolates. Very limited data exist on the immune response to STEC in the Brazilian population. In this study, the prevalence of immunoglobulin G (IgG) antibodies to Stx2 was investigated in sera of children diagnosed with HUS and of healthy children in the city of São Paulo, Brazil. METHODS: IgG-antibody reactivity to Stx2 was determined by immunoblotting (WB) and enzyme-linked immunosorbent assay (ELISA) in sera from 13 children with HUS aged 8 months to 6 years and 54 healthy urban children aged 5 months to 7 years. RESULTS: A positive immune response to the A and B subunits of Stx2 was observed in 46.1% HUS patients and in 16.6% healthy individuals by WB. All HUS patients and 62.9% healthy children showed IgG antibodies to the Stx2 A subunit. The frequency of antibodies to both subunits or only to the A subunit of Stx2 was significantly higher in HUS patients than controls (p<0.05). Also, the mean OD value obtained by ELISA was higher in that group. Considering children's age, the frequency of reactivity to either the A subunit or both subunits of Stx2 was considerably higher in HUS children up to three years old compared to controls in the same age range. Moreover, in almost 37% of healthy children, no immune response to Stx2 was detected independently of the child's age. CONCLUSIONS: The seroepidemiolgy of anti-Stx2 antibodies was described for the first time in healthy children and children with HUS in Brazil. The percentage of individuals showing antibodies against Stx2 was higher among HUS patients than controls, and in spite of the low number of notified HUS cases, STEC strains are circulating in our settings. In addition, the results obtained also corroborated previous data on the increased sensitivity and specificity of WB compared to toxin-based enzyme immunoassays.

Raman spectroscopy detection of molecular changes associated with two experimental models of osteoarthritis in rats.

The aim of the present study was to evaluate the feasibility of applying Raman spectroscopy in probing the molecular changes in terms of collagen deposition and tissue remodeling associated with two well-established experimental models of osteoarthritis (OA) in knee of rats. In order to evaluate alterations in the articular surface area, the menisci-covered tibial region was assessed into three groups as follows: control (joint preserved) and two models of experimental knee OA: collagenase-induced model (n = 8) and treadmill exercise-induced model (n = 8). Each group was examined for molecular changes using spectral parameters related to cartilage, subchondral bone, and bone tissues. A significant increase of Raman ratios related to mineralization and tissue remodeling was found (p < 0.05), suggesting that both models were successful for inducing OA in rats. The significantly lower phenylalanine content and higher crystallinity in the treadmill exercise-induced model of OA than collagenase-induced model of OA (p < 0.05) indicated that the OA pathogenesis was model-dependent. Thus, this work suggests that the Raman spectroscopy technique has potential for the diagnosis and detection of cartilage damage and monitoring of subchondral bone and bone in OA pathogenesis at the molecular level.

Low-level light-emitting diode therapy increases mRNA expressions of IL-10 and type I and III collagens on Achilles tendinitis in rats.

The present study investigated the effects of low-level light-emitting diode (LED) therapy (880 ± 10 nm) on interleukin (IL)-10 and type I and III collagen in an experimental model of Achilles tendinitis. Thirty male Wistar rats were separated into six groups (n = 5), three groups in the experimental period of 7 days, control group, tendinitis-induced group, and LED therapy group, and three groups in the experimental period of 14 days, tendinitis group, LED therapy group, and LED group with the therapy starting at the 7th day after tendinitis induction (LEDT delay). Tendinitis was induced in the right Achilles tendon using an intratendinous injection of 100 µL of collagenase. The LED parameters were: optical power of 22 mW, spot area size of 0.5 cm(2), and irradiation time of 170 s, corresponding to 7.5 J/cm(2) of energy density. The therapy was initiated 12 h after the tendinitis induction, with a 48-h interval between irradiations. The IL-10 and type I and III collagen mRNA expression were evaluated by real-time polymerase chain reaction at the 7th and 14th days after tendinitis induction. The results showed that LED irradiation increased IL-10 (p < 0.001) in treated group on 7-day experimental period and increased type I and III collagen mRNA expression in both treated groups of 7- and 14-day experimental periods (p < 0.05), except by type I collagen mRNA expression in LEDT delay group. LED (880 nm) was effective in increasing mRNA expression of IL-10 and type I and III collagen. Therefore, LED therapy may have potentially therapeutic effects on Achilles tendon injuries.

Health risk assessment and quality reference values of potentially toxic elements in soils of the Southwestern Amazonas State - Brazil.

The geochemical processes involved in the Amazon soils formation are not totally understood because its geological and pedological features were formed during different geological events and different times. The Southwestern region of Amazonas State is an example of a region where the soils were developed from rocks formed by sedimentary processes and, nowadays, the soils continue receiving seasonal inputs from the Andes sediments. Data on geochemical patterns of this region are scarce, and there is no information about the possible effects of the natural or unnatural enrichment of potentially toxic elements (PTEs). Thus, this study represents the first research into the geochemical patterns of PTEs in soils of Southwestern Amazonas State. Further, we carried out a human health risk assessment and a proposal for Quality Reference Values (QRV) for thirteen PTEs (As, Ba, Cd, Co, Cr, Cu, Mn, Ni, Pb, Ti, V, Zn and Zr). Our findings showed that the PTEs contents in soil samples collected in the lowland areas are strongly influenced by sediments inputs, while samples localized in the highland areas are weakly influenced by sediments inputs and present depletion of PTEs. Barium, Cr, Cu, Ni and Pb were the PTEs most influenced by sediment's deposition. The soil contamination assessment showed the existence of enrichment of the potentially toxic elements in soil samples, which may be a consequence of the natural inputs of the Andean sediments. Furthermore, Co and Cr exceed the safety zone for carcinogenic risk assessment, which indicates the need to monitor these elements and their possible effects on the health of the population in this region.

Effects of low-level laser therapy (LLLT) on bone repair in rats: optical densitometry analysis.

The aim of this study was to evaluate the process of bone repair in rats submitted to low-level laser therapy using optical densitometry. A total of 45 rats which underwent femoral osteotomy were randomly distributed into three groups: control (group I) and laser-treated groups using wavelengths in the red (λ, 660-690 nm) and in the infrared (λ, 790-830 nm) spectra (group II and group III, respectively). The animals (five per group) were killed after 7, 14, and 21 days and the femurs were removed for optical densitometry analysis. Optical density showed a significant increase in the degree of mineralization (gray level) in both groups treated with the laser after 7 days. After 14 days, only the group treated with laser therapy in the infrared spectrum showed higher bone density. No differences were observed between groups after 21 days. Such results suggest the positive effect of low-level laser therapy in bone repair is time- and wavelength-dependent. In addition, our results have confirmed that optical densitometry technique can measure bone mineralization status.

Low-level laser therapy combined with platelet-rich plasma on the healing calcaneal tendon: a histological study in a rat model.

The objective of this study was to investigate the effects of low-level laser therapy (LLLT) treatment alone (λ = 660 nm and λ = 830 nm) or associated with platelet-rich plasma (PRP). We used 54 male rats divided into six groups, with nine animals each: group 1, partial tenotomy; group 2 (GII), PRP; group 3 (GIII): λ660 nm; group 4 (GIV), λ830 nm; group 5 (GV), PRP + λ660 nm; and group 6 (GVI), PRP + λ830 nm. The protocol used was power density 0.35 W/cm(2), energy 0.2 J, energy density 7.0 J/cm(2), time 20 s per irradiated point, and number of points 3. Animals in groups GII, GV, and GVI received treatment with PRP, consisting of a single dose of 0.2 mL directly into the surgical site, on top of the tenotomy. Animals were killed on the 13th day post-tenotomy and their tendons were surgically removed for a quantitative analysis using polarization microscopy. The percentages of collagen fibers of types I and III were expressed as mean ± SD. Higher values of collagen fibers type I were obtained for groups GV and GVI when compared with all other groups (p < 0.05), whereas groups GIII and GIV showed no significant difference between them (p > 0.05). For collagen type III, a significant difference was observed between GII and all other groups (p < 0.5), but no significant difference was found between GIII and GIV and between GV and GVI. Results showed that the deposition of collagen type I was higher when treatment with PRP and LLLT was combined, suggesting a faster regeneration of the tendon.

Serological evidence of arenavirus circulation in wild rodents from central-west, southeast, and south regions of Brazil, 2002-2006.

Viral hemorrhagic fevers caused by arenaviruses are severe zoonotic diseases. In reservoirs, the presence of antibodies may indicate viral circulation in a population of a specific region, and these data can be used as an indicator for further investigations by molecular techniques. The present study aimed to detect the presence of arenavirus antibodies in wild rodents captured from 1998 to 2008 during epidemiological surveillance activities. A retrospective analysis of 2243 wild rodent blood samples using a broad cross-reactive in-house developed enzyme-linked immunosorbent assay (ELISA) revealed a 0.44% (10/2243) positive rate in wild rodents, which included Necromys lasiurus (6/1012), Calomys callosus (2/94), and Akodon sp. (2/273) species. These rodents were captured between 2002 to 2006 in Campo Alegre de Goiás/GO, Bodoquena/MS, Nuporanga/SP, and Mogi das Cruzes/SP. Our findings suggest the sylvatic circulation of arenavirus among wild rodents in the southeast region of Brazil. However, future virological and molecular studies are necessary to confirm the viral presence in these regions.