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.

MiRNA-30d and miR-770-5p as potential clinical risk predictors of Vasoplegic Syndrome in Patients undergoing on-pump coronary artery bypass grafting.

The aims of this study were to perform pre-surgery miRNA profiling of patients who develop Vasoplegic syndrome (VS) after coronary artery bypass grafting (CABG) and identify those miRNAs that could be used as VS prognostic tools and biomarkers. The levels of 754 microRNAs (miRNAs) were measured in whole blood samples from a cohort of patients collected right before the coronary artery bypass grafting (CABG) surgery. We compared the miRNA levels of those who developed VS (VASO group) with those who did not (NONVASO group) after surgery. Six miRNAs (hsa-miR-548c-3p, -199b-5p, -383-5p -571 -183-3p, -30d-5p) were increased and two (hsa-1236-3p, and hsa-miR770-5p) were decreased in blood of VASO compared to NONVASO groups. Receiver Operating Characteristic (ROC) curve analysis revealed that a combination of the miRNAs, hsa-miR-30d-5p and hsa-miR-770-5p can be used as VS predictors (AUC = 0.9615, p < 0.0001). The computational and functional analyses were performed to gain insights into the potential role of these dysregulated miRNAs in VS and have identified the "Apelin Liver Signaling Pathway" as the canonical pathway containing the most target genes regulated by these miRNAs. The expression of the combined miRNAs hsa-miR-30d and hsa-miR-770-5p allowed the ability to distinguish between patients who could and could not develop VS, representing a potential predictive biomarker of VS.

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.

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.

Survey on the recognition, attitudes, and experience of horse owners during episodes of equine colic in Rio Grande do Norte, Brazil.

Horse owners are crucial in recognizing colic because they are responsible for identifying the signs of colic and deciding whether to seek veterinary intervention. Common reasons for delayed response to clinical issues include lack of understanding or knowledge of the subject and difficulty in recognizing subtle clinical signs of abdominal pain. Examining horse owners' basic knowledge of colic, their motivations, obstacles in seeking veterinary care, and their responses to the various clinical symptoms manifested during colic will identify current knowledge gaps and decision-making barriers. This study aimed to examine the experiences, recognition, and attitudes of horse owners during an episode of equine colic in Rio Grande do Norte, Brazil. A cross-sectional study was conducted using questionnaires in Rio Grande do Norte, Brazil. The sample consisted of horse owners, competitors of any equestrian modality (provided that they were responsible for a horse at the time of the application of the questionnaire), or individuals who had previously owned a horse. There were differences related to the recognition and attitudes adopted towards colic in horses compared to the studies performed in other countries. The overall results of this study highlight the need for educational campaigns for horse owners to fill knowledge gaps about colic and the need for a clearer picture of colic, including what it is, the predisposing factors, and the range of symptoms. Additionally, this knowledge will equip horse owners to appropriately respond to these symptoms.

Os proprietários de equinos são essenciais no reconhecimento das cólicas, pois geralmente são os principais responsáveis por identificar os sinais e decidir procurar a intervenção veterinária. Os motivos comuns para a resposta tardia a um problema clínico são a falta de compreensão ou conhecimento do assunto, bem como a dificuldade em reconhecer sinais clínicos sutis de dor abdominal. Investigar o conhecimento básico de cólicas dos proprietários de cavalos, suas motivações, obstáculos para a busca de atendimento veterinário e suas respostas aos diferentes sinais clínicos manifestados durante os episódios de cólica é essencial para identificar lacunas no conhecimento atual e barreiras à tomada de decisão. Este estudo teve como objetivo levantar a experiência, reconhecimento e atitudes de proprietários de equinos durante episódios de cólica equina no estado do Rio Grande do Norte, Brasil. Foi realizado um estudo transversal, por meio de questionário, com proprietários de cavalos do estado do Rio Grande do Norte, Brasil. A amostra foi composta por proprietários de cavalos, competidores de qualquer modalidade equestre (desde que fossem responsáveis por um cavalo no momento da aplicação do questionário) ou que possuíam cavalo. Existem diferenças quanto ao reconhecimento e atitudes adotadas em relação à cólica equina em relação aos países onde esse tipo de pesquisa foi realizado. A constatação abrangente deste estudo foi a necessidade de campanhas educativas para proprietários de cavalos sobre cólicas a partir das lacunas de conhecimento, e são a necessidade de clareza de informações sobre cólicas para os proprietários, incluindo o que é cólica, fatores predisponentes, qual a gama de diferentes sinais que podem ser exibido e como responder a esses sinais.

Impact of a Multimodal Analgesia Protocol in an Intensive Care Unit: A Pre-post Cohort Study.

Introduction  Opioids are the mainstay of pain management in critically ill patients. However, recent attention to their adverse effects in the intensive care unit (ICU) has led to the use of strategies that aim to reduce these side effects. Among these strategies, there are multimodal analgesia protocols, which prioritize pain management and employ a combination of different analgesics to spare excessive doses of opioids and sedatives in continuous infusion. Objective The objective of this study is to evaluate the impact of a multimodal analgesia protocol on clinical outcomes and consumption of sedatives and analgesics in two intensive care units. Methods  We conducted a single-center, quasi-experimental, retrospective, and prospective cohort study comparing clinical outcomes and consumption of sedatives and analgesics before and after the implementation of a multimodal pain management protocol in critically ill adult patients. We included 465 patients in 2017 (pre-intervention group) and 1508 between 2018 and 2020 (post-intervention group). Results In the analysis of the primary outcome, there was a significant reduction in mortality between 2017 and 2020 (27.7% - 21.7%, p=0.0134). There was no statistical difference in mechanical ventilation time or concerning the infection rate. Patients who received the multimodal analgesia protocol had a decrease of 24% regarding mean fentanyl intake and a progressive reduction in morphine milligram equivalents (MME) (8.4% - 19%). There was an increasing trend in the use of adjuvant analgesics and morphine in preemptive and therapeutic analgesia. Conclusion The implementation of a multimodal pain control protocol significantly reduced morbidity and mortality and the use of opioids in the ICU.

Proposal of a New Specific Test to Assess the Aerobic Performance in Judo.

Purpose: Judo is an intermittent sport, dependent on anaerobic metabolism as well as aerobic metabolism to generate energy during a match; however, there are few reliable tests to measure specific aerobic performance in judo. Thus, the present study aimed to propose a new specific and indirect method to assess the aerobic performance in judo athletes; it determined the inter-rater and test-retest reliability of this new protocol and correlated the new protocol with a valid laboratory test. Method: The participants included 15 men, athletes of judo (age average: 21.59 ± 4.60 years, weight: 80.71 ± 15.93 kg and height: 173.2 ± 6.84 cm). The participants performed three tests: the first test was a graded exercise test (GXT) and the second and third tests were the Judo Aerobic Test (JAT). Results: The test presented high test-retest and inter-rater reliability, the intraclass correlation coefficients (ICC) ranking of 0.68-0.96, the correlation values ranging from .77 to .96, and no statistical differences between means in test and retest (p > .05). The standard error of measurement and the coefficient of variation between raters presented lower than 10%, indicating reproducibility. Moderate and strong correlations were found between JAT and GXT variables. Conclusion: We concluded that the test presents excellent inter-rater and test-retest reliability and a moderate correlation with GXT.

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.

Computer-assisted Parkinson's disease diagnosis using fuzzy optimum- path forest and Restricted Boltzmann Machines.

Parkinson's disease (PD) is a progressive neurodegenerative illness associated with motor skill disorders, affecting thousands of people, mainly elderly, worldwide. Since its symptoms are not clear and commonly confused with other diseases, providing early diagnosis is a challenging task for traditional methods. In this context, computer-aided assistance is an alternative method for a fast and automatic diagnosis, accelerating the treatment and alleviating an excessive effort from professionals. Moreover, the most recent studies proposing a solution to this problem lack in computational efficiency, prediction power, reliability among other factors. Therefore, this work proposes a Fuzzy Optimum Path Forest for automated PD identification, which is based on fuzzy logic and graph-based framework theory. Experiments consider a dataset composed of features extracted from hand-drawn images using Restricted Boltzmann Machines, and results are compared with baseline models such as Support Vector Machines, KNN, and the standard OPF classifier. Results show that the proposed model outperforms the baselines in most cases, suggesting the Fuzzy OPF as a viable alternative to deal with PD detection problems.

Guapiaçu virus, a new insect-specific flavivirus isolated from two species of Aedes mosquitoes from Brazil.

Classical insect-flaviviruses (cISFVs) and dual host-related insect-specific flavivirus (dISFV) are within the major group of insect-specific flavivirus. Remarkably dISFV are evolutionarily related to some of the pathogenic flavivirus, such as Zika and dengue viruses. The Evolutionary relatedness of dISFV to flavivirus allowed us to investigate the evolutionary principle of host adaptation. Additionally, dISFV can be used for the development of flavivirus vaccines and to explore underlying principles of mammalian pathogenicity. Here we describe the genetic characterization of a novel putative dISFV, termed Guapiaçu virus (GUAPV). Distinct strains of GUAPV were isolated from pools of Aedes terrens and Aedes scapularis mosquitoes. Additionally, we also detected viral GUAPV RNA in a plasma sample of an individual febrile from the Amazon region (North of Brazil). Although GUAPV did not replicate in tested mammalian cells, 3'UTR secondary structures duplication and codon usage index were similar to pathogenic flavivirus.

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.

Detection of Zika and dengue viruses in wild-caught mosquitoes collected during field surveillance in an environmental protection area in São Paulo, Brazil.

Species of the genus Flavivirus are widespread in Brazil and are a major public health concern. The country's largest city, São Paulo, is in a highly urbanized area with a few forest fragments which are commonly used for recreation. These can be considered to present a potential risk of flavivirus transmission to humans as they are home simultaneously to vertebrate hosts and mosquitoes that are potential flavivirus vectors. The aim of this study was to conduct flavivirus surveillance in field-collected mosquitoes in the Capivari-Monos Environmental Protection Area (EPA) and identify the flavivirus species by sequence analysis in flavivirus IFA-positive pools. Monthly mosquito collections were carried out from March 2016 to April 2017 with CO2-baited CDC light traps. Specimens were identified morphologically and grouped in pools of up to 10 individuals according to their taxonomic category. A total of 260 pools of non-engorged females were inoculated into C6/36 cell culture, and the cell suspensions were analyzed by indirect immunofluorescence assay (IFA) after the incubation period. IFA-positive pools were tested by qRT-PCR with genus-specific primers targeting the flavivirus NS5 gene to confirm IFA-positive results and sequenced to identify the species. Anopheles cruzii (19.5%) and Wyeomyia confusa (15.3%) were the most frequent vector species collected. IFA was positive for flaviviruses in 2.3% (6/260) of the sample pools. This was confirmed by qRT-PCR in five pools (83.3%). All five flavivirus-positive pools were successfully sequenced and the species identified. DENV serotype 2 (DENV-2) was detected in Culex spp. and Culex vaxus pools, while ZIKV was identified in An. cruzii, Limatus durhamii and Wy. confusa pools. To the best of our knowledge, detection of flavivirus species of medical importance has never previously been reported in these species of wild-caught mosquitoes. The finding of DENV-2 and ZIKV circulating in wild mosquitoes suggests the existence of an enzootic cycle in the area. In-depth studies of DENV-2 and ZIKV, including investigation of mosquito infection, vector competence and infection in sylvatic hosts, are needed to shed light on the transmission dynamics of these important viruses and the potential risk of future outbreaks of DENV-2 and ZIKV infections in the region.

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.

Genomic evidence of yellow fever virus in Aedes scapularis, southeastern Brazil, 2016.

The southeastern region of Brazil has recently experienced the largest yellow fever disease outbreak in decades. Since July 2016 epizootic events were reported in São Paulo state's north region, where 787 Culicidae were captured as part of public health surveillance efforts and tested using real-time quantitative PCR. One Aedes scapularis pool collected in November 2016 in an agriculture area in Urupês city tested positive for YFV-RNA. Using a validated multiplex PCR approach we were able to recover a complete virus genome sequence from this pool. Phylogenetic analysis of the novel strain and publicly available data indicates that the belongs to the South American genotype 1 clade circulating in Sao Paulo state and is basal to the recent outbreak clade in southeast Brazil. Our findings highlight the need of additional studies, including vector competence studies, to disentangle the role of Aedes scapularis in yellow fever transmission in the Americas.

Using the ICF framework to evaluate the effects of environmental factors on physical disability among people with diabetes mellitus.

Objective: This study aimed to analyze the influence of environmental factors on the ICF activity-participation outcome, controlling for body function and personal factor dimensions of 75 diabetes patients. Method: Outcome measures included questionnaires on musculoskeletal pain (Nordic Questionnaire), physical and environment domains of World Health Organization Quality of Life version BRIEF (WHOQOL-brief) and clinical and personal data. Multiple linear regression with hierarchical entry of variables was used. Results: An assessment of WHOQOL-brief revealed a score of 66.6 (SD = 17.3) to physical domain and 58.8 (DP = 12.1) to environment domain. The factors associated with physical domain were lower limb pain, number of comorbidities, and environment barriers. The highest environmental barriers were financial constraints, availability of health services, deficiency of self-management, and inadequate family and social support. The final model explained 44.0% (F[12.02], p < 0.001) of variability of the physical domain. Conclusions: We confirmed the functional consequences of diabetes mellitus to be complex and multifactorial. An approach that considers the interaction between individual and environmental attributes is necessary due to the disabling nature of this health condition.

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.

Delayed diaphragmatic hernia after open trauma with unusual content: Case report.

INTRODUCTION: Post-traumatic diaphragmatic hernias are not commonly diagnosed immediately after the initial trauma. There is a greater prevalence of left hernias due to the fragility or injury in diaphragm muscle and the lack of solid and fixed structures on the left side. PRESENTATION OF CASE: A male patient, 30 years old, he was admitted to the emergency department presenting diffuse abdominal pain, vomiting, dyspnea, pain in the left hemithorax with worsening during forced inspiration. After performing X-ray and computed tomography (CT), the presence of organs in the abdominal cavity outside the usual position was evidenced and with discrete deviation. Immediate surgery was performed with posterolateral thoracic access through the sixth left intercostal space combined with left subcostal access. Initially, it was found jejunum, ileum and left colonic flexure and accessory spleen filling the hernial sac. DISCUSSION: This report is the first case to report two accessory spleens in manual reduction of herniation between thoracic and abdominal cavities after trauma and percutaneous perforation. The splenectomy performed in both organs occurred due to their advanced ischemia that was due to reduced vascularity. CONCLUSION: The presence of the reported accessory spleen inside the thoracic cavity is only a possible variation within the possibilities in cases of diaphragmatic hernias, which does not modify the surgical procedure in a relevant way.

A new interpretation of the mechanism of wormlike micelle formation involving a cationic surfactant and salicylate.

HYPOTHESIS: When tetradecyltrimethylammonium bromide, TTAB, is added to aqueous solution of sodium salicylate, NaSal, the threading of the aromatic anion into the micellar palisade leads to the formation of wormlike micelles. Based on the calorimetric titration of NaSal with TTAB, and on the lifetime of fluorescence of salicylate, we propose that the aggregation of the two components directly leads to the formation of wormlike micelles, without any pre-aggregation. EXPERIMENTS: By using an isothermal titration calorimeter, aliquots of TTAB were added to a dilute solution of NaSal. The energy involved in each addition was then integrated and the variation of enthalpy was determined. In the same range of concentrations and molar ratios, the surface tensiometry and time-resolved emission spectroscopy experiments were performed. FINDINGS: A very characteristic calorimetric signal associated with wormlike micelle formation was obtained, being the enthalpy variation of this process, ΔWLMH2980 < 0. When 1.2 mmol L-1 of NaSal is titrated with 11.0 mmol L-1 of TTAB at 298.15 K, ΔfH2980 = -10.31 kJ per mol of injectant. By adding TTAB to NaSal solution, two fluorescence lifetimes of salicylate were observed solely after wormlike micelle being formed. The correspondent lifetime values of 4.0 ns and 7.2 ns are respectively associated with the free and associated species of salicylate. The new results demonstrated that wormlike micelles are the first aggregate formed when TTAB is added to salicylate. This aspect is relevant for understanding the mechanism of wormlike micelles formation.