Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital.

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

The influence of lactation on BMD measurements and TBS: a 12-month follow-up study.

Although lactation is associated with transient bone loss and body weight changes, the unchanged TBS could highlight a limited effectiveness in detecting dynamic bone properties in the first year postpartum. PURPOSE: To evaluate trabecular bone score (TBS) and bone mineral density (BMD) in postpartum women. METHODS: This was a 12-month prospective cohort study with 40 lactating postpartum women and 44 non-pregnant women. The inclusion criteria were as follows: aged between 18 and 35 years old, an uncomplicated term (≥37 weeks) pregnancy with a single fetus, and no intention of becoming pregnant within 12 months. BMD measurements, including spine, hip, forearm and whole body, were performed by DXA at four different time points after delivery: (1) 1st month, (2) 3rd-4th month, (3) 6th-9th month, and (4) ≥ 12th month postpartum. RESULTS: BMD measurements showed a statistically significant decrease at spine (1.134 vs. 1.088 g/cm2, p < 0.01), femoral neck (0.988 vs. 0.946 g/cm2, p < 0.01), total femur (0.971 vs. 0.933 g/cm2, p < 0.01), and whole body (1.132 vs. 1.119 g/cm2, p = 0.03) at the 2nd assessment (peak of lactation). There was early spinal recovery after the 3rd assessment with complete recovery in all skeletal sites. Although it has had significant weight loss (67.3 vs. 63.2 kg, p < 0.01) and body mass index reduction (25.2 vs. 23.4, p < 0.01), there was significant increment of spine BMD (1.134 vs. 1.165 g/cm2, p < 0.01) after 12-month follow-up. The TBS did not change over time. CONCLUSIONS: Although lactation is associated with transient bone loss and body weight changes, the unchanged TBS could highlight a limited effectiveness in detecting dynamic bone properties in the first year postpartum.

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

Improvement of pure sensory mononeuritis multiplex and IgG1 deficiency with sitagliptin plus Vitamin D3.

INTRODUCTION: Mononeuritis multiplex (MM) is an unusual form of peripheral neuropathy involving at least two noncontiguous peripheral nerve trunks. The pure sensory form of MM occurs rarely. Immunoglobulin (Ig)G subclass deficiency is a clinically and genetically heterogeneous disorder. Up to 50% of adults with selective subnormal IgG1 levels or selective IgG1 deficiency have a concomitant autoimmune disorder. Herein, we report the case of a patient with MM and selective IgG1 deficiency who showed remarkable clinical improvement after 2-year combination therapy with the DPP-4 inhibitor sitagliptin plus vitamin D3. CASE REPORT: A 49-year-old man developed numbness in right hand and forearm. After 6 months, the patient developed left forefoot numbness. Approximately 8 years later, the patient started to develop numbness also in the right forefoot, along with symptoms of evening fatigue and occasional orthostatic hypotension. The patient also reported recurrent candidiasis in glans and intergluteal areas since adolescence. Electromyoneurography of lower and upper limbs revealed the presence of multiple mononeuropathies. Protein electrophoresis showed hypogammaglobulinemia and low serum IgG1 levels. Sural nerve biopsy showed the presence of perineuritis. The patient was diagnosed with MM due to perineuritis probably secondary to IgG1 deficiency. We, then, proposed combination therapy with sitagliptin and vitamin D3 in the attempt to achieve immunomodulation. At the last follow-up visit (2 years), the patient showed persistent clinical improvement, increase in IgG1 levels and normalization of protein electrophoresis. CONCLUSIONS: To the best of our knowledge, this is the first case showing a remarkable clinical improvement of MM and selective IgG1 deficiency achieved through a combination therapy with sitagliptin and vitamin D3.

Phlebotomines (Diptera: Psychodidae) and Mosquitoes (Diptera: Culicidae) Surrounding an Environmental Protection Zone in the Metropolitan Region of Natal: Use of Light-Emitting Diode (LED) Bulbs in Entomological Surveillance.

Entomological surveillance is very important for parasite and arbovirus vector control programs. Light traps with incandescent bulbs are used to attract insects and analyze the factors that contribute to the occurrence of species surrounding an environmental protection zone. Phlebotomine and mosquito abundance and their diversity were analyzed. Captures occurred monthly using six CDC light traps with two incandescent bulbs, two blue and two red LED lights. A total of 2211 phlebotomines of seven species and 4486 mosquitoes belonging to 20 taxa were captured. Different phlebotomine and mosquito species were found in the forest and peridomestic environments, with a predominance of the sand fly Evandromyia walkeri (Newstead) and the mosquito Coquillettidia venezuelensis (Theobald). There was a significant difference in the abundance of sand flies captured with the three bulbs tested, the blue bulb being the most efficient. The Shannon-Wiener diversity index showed that the trap equipped with a red LED light obtained a higher value than that of the blue LED and incandescent bulb. Analyses showed that the potential vectors and non-vectors of the two groups circulate between the forest and the peridomestic environment, suggesting an adaptation process of species to the altered environment. An incandescent light bulb can be substituted by an LED bulb, without compromising the sensitivity of the method. A blue LED is indicated for the abundant capture of mosquitoes and sand flies, while a red LED obtains a better result in terms of species diversity per capture.

Low-trauma ankle fractures in Brazil: secular trends in patients over 50 years old from 2004 to 2013.

PURPOSE: The most common sites of low-energy trauma fractures are the femur, vertebra, humerus, and forearm. Ankle fractures have significant morbidity and high costs for surgical procedure. Forearm fractures are common nonvertebral fractures. Forearm fractures are classified as fragility fractures and predictive for fractures at other sites, although do not allow osteoporosis diagnosis. It is controversial whether ankle fractures are osteoporosis fractures. METHODS: Retrospective observational study, with secular trend analysis, in patients over 50 years old admitted in the Brazilian Public Health System, from 2004 to 2013. We collected hospitalization data according to the ICD-10 for low-trauma ankle and forearm fractures. Fracture rate was calculated according to gender, age, and geographic region, performed linear regression analysis, and estimated fracture rates for 2030. Comparison of ankle and forearm rates was also performed, grouping them in 3-year block. ANOVA test was used to compare each block. RESULTS: Ankle fracture rate was 21.39 fractures per 100,000 inhabitants, 23.98 in females and 18.49 in males. Fracture rates were higher in the South and Southeast regions. In absolute numbers, although ankle fracture rate increased with age, there was a significant decrease in the population over 80 years old. Data showed stabilization in ankle fractures from 2004 to 2013, in women and men. In 3-year block analysis, men had higher ankle fracture rates than forearm. However, in women, forearm rates were higher than ankle. CONCLUSION: Our data suggest that ankle fractures in men would be considered as a sentinel fracture with a similar clinical impact of forearm fracture.

Influence of adjacent teeth restored with metal posts in the detection of simulated internal root resorption using CBCT.

AIM: To assess the influence of artefacts generated by metal posts on the detection of simulated internal root resorption (IRR) in adjacent teeth using cone-beam computed tomography (CBCT) and to verify the impact of metal artefact reduction (MAR) on these cases. METHODOLOGY: CBCT images of 14 premolar teeth were acquired before and after IRR simulation using chemical and mechanical procedures, in an OP300 Maxio unit, with and without MAR. Each tooth was placed in the socket of a human mandible and scanned under three different conditions: (i) without adjacent teeth - control group; (ii) distal adjacent tooth restored with metal post; and (iii) with both adjacent teeth restored with metal post. Five oral radiologists scored the IRR detection using a 5-point scale. Diagnostic values were obtained for the tested groups and compared using two-way analysis of variance (α = 0.05). RESULTS: The presence of a single adjacent tooth restored with metal post did not significantly influence the diagnostic values for IRR detection (P > 0.05). The presence of both adjacent teeth with metal posts, without MAR application, was associated with a significantly lower area under the ROC curve (Az) compared to the control (P = 0.0182). In this case, the application of MAR increased Az, leading to nonsignificant differences from the control group and the group with one adjacent restored tooth (P > 0.05). Sensitivity decreased significantly when two adjacent restored teeth were present, regardless of MAR application (P = 0.0379). Specificity was not affected by the conditions tested (P > 0.05). CONCLUSION: CBCT detection of IRR was impaired by artefacts only when both adjacent teeth restored with metal posts were present. In such cases, activation of MAR improved the performance on this diagnostic task.

Spatial-temporal genome damaging in the blue crab Cardisoma guanhumi as ecological indicators for monitoring tropical estuaries.

In this study, to better our understanding of the current state of conservation of Cardisoma guanhumi and its habitats, we evaluated the potential spatio-temporal genomic damage of this species across five estuaries in Brazil. The experiment was performed over two consecutive years, and the sampling was performed in the winter and summer seasons. Two genetic tests - micronucleus test and comet assay - were used to quantify the DNA damage. Unlike in the summers and in the winter of 2013, in the winter of 2012 a significant increase was noted in the frequency of micronucleated cells and genomic damage index. The occurrence of genomic damage coincided with the arrival of the harsh winter of 2012 as the water sourced from the coastal rivers significantly affected the estuarine species under study. Our results confirmed that this species was resilient to the atypical climatic conditions, which facilitated the generation of excessive waste.

How does women's bone health recover after lactation? A systematic review and meta-analysis.

This is a systematic review aiming to evaluate the recovery of bone mass after lactation-related loss. Bone loss is transitory with recovery depending on the return of menstruation and weaning, and several compensatory homeostatic mechanisms are involved to minimize any significant damage to the maternal skeleton. Lactation has been associated with significant temporary bone loss, especially during the exclusive breastfeeding period. In the bone recovery phase, there is wide methodological heterogeneity among clinical trials, including follow-up timing, methods and sites of bone measurements, and body composition changes. The purpose of this study is to perform a systematic review and meta-analysis aiming to evaluate the recovery rate of bone mass after lactation-related loss, including the PubMed, Web of Science, and Scopus databases, with no publication date restrictions. The following MeSH terms were used: "bone diseases," "bone resorption," "bone density," "osteoporosis," "calcium," "postpartum period," "weaning," "breast feeding," and "lactation." The inclusion criteria were as follows: prospective human studies in women of reproductive age and bone measurements with two assessments in the postpartum period at least: the first one within the first weeks of lactation and another one 12 months after delivery, 3 months following the return of menses or 3 months postweaning. This research was recorded on the Prospero database (CRD42018096586Bone). A total of 9455 studies were found and 32 papers met the inclusion criteria. The follow-up period ranged from one to 3.6 years postpartum. Lactation was associated with transient bone loss, with a strong tendency to recover in all the sites studied, depending on the return of menstruation and weaning. Small deficits in the microarchitecture of the peripheral skeleton may be present, especially in women with prolonged breastfeeding, but with no deficit regarding the hip geometry was found. Women with a successive gestation after prolonged lactation and women who had breastfed when adolescents had no significant bone loss. Bone loss related to lactation is transitory, and several compensatory homeostatic mechanisms are involved to minimize any significant damage to the maternal skeleton.

Calcicole behaviour of Callisthene fasciculata Mart., an Al-accumulating species from the Brazilian Cerrado.

Most aluminium (Al)-accumulating species are found on soils with high Al saturation and low Ca availability (Ca poor). Callisthene fasciculata Mart. (Vochysiaceae), however, is an Al-accumulating tree restricted to Ca-rich soils with low Al saturation in the Brazilian Cerrado savanna. Here we tested its calcicole behaviour, and the possible role of organic acids in detoxification of Al during the early stages of plant development. We assessed growth, dry mass, nutrients, Al and organic acids in seedlings grown for 50 days on two contrasting Cerrado soils; one with high Ca concentrations and low Al saturation and the other with low Ca availability and high Al saturation. Relative to plants on Ca-rich soil, plants on Ca-poor soil had necrotic spots and bronzing of leaves. Roots and shoots contained reduced concentrations of P and Cu, but higher concentrations of Fe, Al and citrate. Despite lower concentrations in the soil, Ca and Mg increased in shoots. Shoot concentrations of oxalate were also higher. We confirmed C. fasciculata as an Al-accumulating species with calcicole behaviour. The increased concentrations of organic acids in plants with higher Al accumulation suggest that high availability of soluble Al does not prevent occurrence of this species on soils with high Al saturation. Instead, the absence of C. fasciculata from Ca-poor soils is probably due to imbalances in tissue Fe, Cu and Zn imposed by this soil type.

Violência contra a mulher: a percepção dos graduandos de enfermagem / Violence against women: how nursing students perceive it

Objetivo: conhecer as percepções dos graduandos em Enfermagem sobre violência contra a mulher. Métodos: estudo qualitativo realizado com 16 graduandos em Enfermagem entre abril e junho de 2016. Dados coletados por entrevista e realizada a análise de conteúdo. Resultados: foram determinadas como categorias: entendimento sobre violência de gênero, abordagem da violência de gênero na formação dos graduandos, percepção sobre a atuação do enfermeiro na atenção às mulheres em situação de violência e considerações sobre o atendimento ideal à mulher em situação de violência. Considerações finais: a violência e a desigualdade de gênero são percebidas pelos acadêmicos. O papel do enfermeiro é destacado nas habilidades de comunicação e acolhimento. Os graduandos não se identificam como parte da equipe de saúde que receberá a mulher em situação de violência e percebem o tema no currículo da graduação. Estudos semelhantes contribuirão com a discussão sobre a violência contra a mulher.

Objective: to learn how nursing graduate students perceive violence against women. Methods: qualitative analysis carried out with 16 nursing students from April to June 2016. Data were collected in interviews and content was analyzed. Results: four categories were discerned: overall understanding about gender-related violence; approach towards gender-related violence during student’s graduation; perception about nurse’s role when assisting violated women; considerations about the best approach to take when assisting violated women. Final considerations: gender-related violence is noticed by students, as much as gender inequality. Nurse’s highlighted role is the ability to communicate and to foster patient care. Undergraduate students do not identify as active part of health care team. However, they identify the theme in the University’s undergraduation syllabus. Similar researches can contribute to discuss violence against women.

Effects of partial replacement of soybean meal with other protein sources in diets of lactating cows.

The protein nutrition of dairy cows is of great importance because of its direct influence on milk production, reproductive efficiency, and feeding cost. Eight first-lactation Holstein cows were randomly assigned to two contemporary 4 × 4 Latin squares in a 2 × 2 factorial design to evaluate the effects of replacing soybean meal with yeast-derived microbial protein (YMP) as a protein source (0% or 1.5% of dry matter (DM)) and its combination with slow-release urea (SRU; 0% or 0.75% of DM) on DM intake and milk production and composition, as well as blood parameters and nitrogen balance. Each experimental period lasted 28 days, with 21 days of adaptation and 7 days of data collection. The diets were formulated to attend the nutritional recommendations of the National Research Council and consisted of 49% forage (47% corn silage and 2% Tifton hay) and 51% concentrate, with 16.8% CP and 1.6 Mcal net energy for lactation/kg DM. For diets without YMP, the inclusion of SRU decreased DM intake, milk production as well as N intake and balance, but did not affect efficiency of production, milk composition or most of blood parameters. On the contrary, for diets with YMP, DM intake and milk production were increased by inclusion of SRU, while minor effects were observed for milk efficiency and composition, blood parameters as well as N intake, excretion and balance. When diets with SRU were compared, the inclusion of YMP increased DM intake, 4% fat-corrected milk, and N intake and balance (P<0.05), with no differences in milk production (kg/day), milk energy, efficiency of milk production or most of the blood parameters. For diets without SRU, YMP inclusion decreased DM intake, milk production, milk energy, N intake, fecal N and N balance (P<0.05), with no effects on milk efficiency and composition, or most of blood parameters. In conclusion, the use of YMP, SRU or both as partial substitutes of soybean meal in the diet of lactating cows has no negative effects on productivity parameters.

Increased rate of osteoporosis, low lean mass, and fragility fractures in COPD patients: association with disease severity.

A very high rate of osteoporosis, fractures, and low lean mass was observed in patients with chronic obstructive pulmonary disease (COPD). Disease severity was associated with bone and muscle adverse outcomes, while age ≥ 63.5 years old, low lean mass, higher iPTH, and a T-score below - 2.5 were all associated with higher risk of fracture. INTRODUCTION: Osteoporosis is frequently neglected in patients with COPD. We aimed at evaluating the rate of osteoporosis, fractures, and low lean mass in patients with COPD. METHODS: Ninety-nine patients with COPD (53 women, 64.5 ± 9.6 years old, and 46 men, 65.9 ± 8.0 years old) underwent bone densitometry (DXA) with body composition analyses. Healthy individuals (N = 57) not exposed to tobacco matched by sex, age, and body mass index (BMI) were used as controls. Spirometry, routine laboratory workout, and conventional thoracolumbar radiography surveying for vertebral deformities were performed in all patients. RESULTS: Osteoporosis was found in 40.4% of the COPD patients against only 13.0% of the healthy controls (p = 0.001). Vertebral fractures were seen in 24.4% of the men and 22.0% of the women with COPD. Disease severity (GOLD 3 and 4) was significantly associated with higher risk of vitamin D deficiency (p = 0.032), lower BMD (both men and women at all sites), higher frequency of osteoporosis (in women at all sites), lower skeletal mass index, and higher rate of low lean mass (in both men and women) than healthy controls and COPD patients with milder disease (GOLD 1 and 2). Age was a main predictor of vertebral fractures (OR = 1.164 (1.078-9.297); p < 0.001), while high plasma iPTH (OR = 1.045 (1.005-1.088); p = 0.029) and low ALM (OR = 0.99965 (0.99933-0.99997); p = 0.031) were predictors of non-vertebral fractures. CONCLUSION: Highly prevalent in COPD, osteoporosis and low lean mass were associated with FEV1% < 50%. Age, low lean mass, high iPTH, and low bone mass were all significantly associated with fractures in COPD patients.

GILP family: a stress-responsive group of plant proteins containing a LITAF motif.

Lipopolysaccharide-induced tumor necrosis factor-α (LITAF) is a membrane protein that is highly dependent on correct location to exert transcription factor activity and protein quality control. In humans, LITAF, PIG7 (p53-inducible gene 7), and SIMPLE (small integral membrane protein of the lysosome/late endosome) refer to the same gene, which acts as a tumor suppressor. Several studies have shown that the transcription factor activity and nuclear translocation of LITAF protein are critical for the induction of several immune cells via classical pathways. In plants, LITAF protein corresponds to the plasma membrane protein AtGILP (Arabidopsis thaliana GSH-induced LITAF domain protein). The conservation of LITAF proteins across species and their putative role is still unclear. In this study, we investigate the LITAF-containing proteins, which we call GILP proteins, in Viridiplantae. We identified a total of 59 genes in 46 species, whose gene copies range from one to three. Phylogenetic analysis showed that multiple copies were originated via block duplication posteriorly to monocot and eudicot separation. Analysis of the LITAF domain of GILP proteins allowed the identification of a putative domain signature in Viridiplantae, containing a CXXCX41HXCPXC motif. The subcellular location for the majority of GILP proteins was predicted to be in the plasma membrane, based on a transmembrane domain positioned within the LITAF domain. In silico analysis showed that the GILP genes are neither tissue-specific nor ubiquitously expressed, being responsive to stress conditions. Finally, investigation of the GILP protein network resulted in the identification of genes whose families are known to be involved with biotic and/or abiotic stress responses. Together, the expression modulation of GILP genes associated with their plasma membrane location suggests that they could act in the signaling of biotic/abiotic stress response in plants.

Pollination of Campomanesia phaea (Myrtaceae) by night-active bees: a new nocturnal pollination system mediated by floral scent.

Bees are the most important diurnal pollinators of angiosperms. In several groups of bees a nocturnal/crepuscular habit developed, yet little is known about their role in pollination and whether some plants are adapted specifically to these bees. We used a multidisciplinary approach to investigate the reproductive biology and to understand the role of nocturnal/crepuscular bees in pollination of Campomanesia phaea (Myrtaceae), popularly named cambuci. We studied the floral biology and breeding system of C. phaea. We collected the floral visitors and tested the pollinators' effectiveness. We also determined the floral scents released at night and during daytime, and studied behavioural responses of crepuscular/nocturnal bees towards these scents. The flowers of cambuci were self-incompatible and had pollen as the only resource for flower visitors. Anthesis lasted around 14 h, beginning at 04:30 h at night. The flowers released 14 volatile compounds, mainly aliphatic and aromatic compounds. We collected 52 species of floral visitors, mainly bees. Nocturnal and crepuscular bees (four species) were among the most frequent species and the only effective pollinators. In field bioassays performed at night, nocturnal/crepuscular bees were attracted by a synthetic scent blend consisting of the six most abundant compounds. This study describes the first scent-mediated pollination system between a plant and its nocturnal bee pollinators. Further, C. phaea has several floral traits that do not allow classification into other nocturnal pollination syndromes (e.g. pollinator attraction already before sunrise, with pollen as the only reward), instead it is a plant specifically adapted to nocturnal bees.

Blood pressure measurement in hemodialysis: The importance of the measurement technique.

Systemic arterial hypertension contributes to the high cardiovascular morbidity in hemodialysis (HD) patients, but the accuracy of blood pressure (BP) measurement in this population has not been well studied. To evaluate the agreement between BP measurement using the routine measurement technique (usual method) and the technique recommended by the VII Joint (standard method). This cross-sectional study enrolled 124 patients in a single center who had undergone dialysis for more than three months and were 18 years of age or older. The BP was verified at the start of dialysis by the nursing team (usual method) and by the researchers (standard method). The agreement between the systolic and diastolic BP (SBP and DBP) measurements was tested by the Bland-Altman analysis. A difference in BP measurement higher than ±5 mm Hg was considered clinically significant. The studied group had a mean age of 53.2 years. The average difference between routine and standard BP measurement was -6 mm Hg for SBP (limits of agreement: -40.1-28 mm Hg; P <0.001) and -5.6 mm Hg for DBP (limits of agreement: -33.1-21.8 mm Hg; P <0.001). A clinically significant difference in BP measured by both methods was observed in 69.4% of the patients for SBP and in 61.3% for DBP. The disagreement between the results of different BP measurement methods in HD patients was significant and the BP was underestimated using the usual BP method. BP measurement standardization should be encouraged to avoid errors in diagnosis and therapy.

Defensive behaviors and prosencephalic neurogenesis in pigeons (Columba livia) are affected by environmental enrichment in adulthood.

Neurogenesis in the adult brain appears to be phylogenetically conserved across the animal kingdom. In pigeons and other adult non-oscine birds, immature neurons are observed in several prosencephalic areas, suggesting that neurogenesis may participate in the control of different behaviors. The mechanisms controlling neurogenesis and its relevance to defensive behaviors in non-oscine birds remain elusive. Herein, the contribution of the environment to behavior and neurogenesis of pigeons was investigated. Adult pigeons (Columba livia, n = 6/group), housed in standard (SE) or enriched environment (EE) for 42 days, were exposed to an unfamiliar environment (UE) followed by presentation to a novel object (NO). Video recordings of UE+NO tests were analyzed and scored for latency, duration and frequency of angular head movements, peeping, grooming, immobility and locomotion. Twenty-four hours later, pigeons were submitted to the tonic immobility test (TI) and number of trials for TI and TI duration were scored, followed by euthanasia 2 h later. Brains were immunohistochemically processed to reveal doublecortin (DCX), a marker for newborn neurons. Compared to those housed in SE, the pigeons housed in EE responded to a NO with more immobility. In addition, the pigeons housed in EE presented longer TI, more DCX-immunoreactive (DCX-ir) cells in the hippocampus and fewer DCX-ir cells in the lateral striatum than those housed in SE. There was no correlation between the number of DCX-ir cells and the scores of immobility in behavioral tests. Together, these data suggest that enrichment favored behavioral inhibition and neurogenesis in the adult pigeons through different, parallel mechanisms.

Bone mineral density reduction in adolescents with systemic erythematosus lupus: association with lack of vitamin D supplementation.

The aim of this study is to evaluate body composition and the bone mineral density in female adolescents with juvenile systemic lupus erythematosus. Body composition (BC) and bone mineral density (BMD) were evaluated in an observational cohort study with 35 postmenarcheal adolescent females. The variables studied were as follows: current and cumulative corticosteroid dose, intake of supplements containing calcium and vitamin D, 24-h proteinuria, body mass index (BMI), and height for age (Z-score). BC was assessed using dual-energy X-ray absorptiometry (DXA) at two time points (median interval of 1.2 years). The fat mass index (FMI = fat mass in kilograms divided by the height in meters squared) and lean mass index (LMI = lean mass in kilograms divided by the height in meters squared) were calculated based on the DXA results. BMD was classified according to the International Society of Clinical Densitometry (low BMD for chronological age < -2.0 standard deviations). .The mean age of the subjects was 15.4 ± 1.8 years. Of patients, 54.3 % were normal weight, 22.8 % were overweight, 22.8 % were obese, and 8.6 % had short stature. Low BMD for chronological age was observed in 42.8 % of patients, and 60 % were not taking vitamin D. There was no significant difference between the two time points with respect to FMI, LMI, or body mass index Z-score (ZBMI); however, BMD has decreased significantly (p = 0.011). There was an association between not taking a vitamin D supplement and decreased BMD (p = 0.027). Almost half of the patients had altered nutritional status. The BMD decrease in adolescents with juvenile systemic lupus erythematosus (JSLE) was associated with the lack of vitamin D supplementation, highlighting the importance of well-defined vitamin D supplementation protocols.