Towards the elimination of dog-mediated rabies: development and application of an evidence-based management tool.

BACKGROUND: International organizations advocate for the elimination of dog-mediated rabies, but there is only limited guidance on interpreting surveillance data for managing elimination programmes. With the regional programme in Latin America approaching elimination of dog-mediated rabies, we aimed to develop a tool to evaluate the programme's performance and generate locally-tailored rabies control programme management guidance to overcome remaining obstacles. METHODS: We developed and validated a robust algorithm to classify progress towards rabies elimination within sub-national administrative units, which we applied to surveillance data from Brazil and Mexico. The method combines criteria that are easy to understand, including logistic regression analysis of case detection time series, assessment of rabies virus variants, and of incursion risk. Subjecting the algorithm to robustness testing, we further employed simulated data sub-sampled at differing levels of case detection to assess the algorithm's performance and sensitivity to surveillance quality. RESULTS: Our tool demonstrated clear epidemiological transitions in Mexico and Brazil: most states progressed rapidly towards elimination, but a few regressed due to incursions and control lapses. In 2015, dog-mediated rabies continued to circulate in the poorest states, with foci remaining in only 1 of 32 states in Mexico, and 2 of 27 in Brazil, posing incursion risks to the wider region. The classification tool was robust in determining epidemiological status irrespective of most levels of surveillance quality. In endemic settings, surveillance would need to detect less than 2.5% of all circulating cases to result in misclassification, whereas in settings where incursions become the main source of cases the threshold detection level for correct classification should not be less than 5%. CONCLUSION: Our tool provides guidance on how to progress effectively towards elimination targets and tailor strategies to local epidemiological situations, while revealing insights into rabies dynamics. Post-campaign assessments of dog vaccination coverage in endemic states, and enhanced surveillance to verify and maintain freedom in states threatened by incursions were identified as priorities to catalyze progress towards elimination. Our finding suggests genomic surveillance should become increasingly valuable during the endgame for discriminating circulating variants and pinpointing sources of incursions.

New species of Elateridae (Coleoptera) from Madre de Dios, Peru, with new taxonomic changes and distribution records / Especies nuevas de Elateridae (Coleoptera) de Madre de Dios, Perú, con nuevos cambios taxonómicos y registros de distribución

The Elateridae fauna of Peru is updated with species new to science, new country records and new taxonomic combinations from the Madre de Dios region. Ten species representing eight genera are described as new: Conoderus wachiperi new species (Agrypninae, Oophorini) Cosmesus aca new species (Elaterinae, Pomachilini), Dipropus amarakaeri new species and Dipropus losamigos new species (Elaterinae, Ampedini, Dicrepidiina), Esthesopus machiguenga new species (Cardiophorinae), Glyphonyx peruanus new species (Elaterinae, Adrastini), Lissomus carmen new species (Lissominae), Paradonus kosnipata new species (Negastriinae), and Pomachilius qusqu new species and Pomachilius wayqecha new species (Elaterinae, Pomachilini). Aeolus platynotus Candèze is changed to Conoderus platynotus (Candèze) new combination and Aeolus ticuna Johnson is changed to Conoderus ticuna (Johnson) new combination (Agrypninae, Oophorini); and Crigmus brunnipilis (Candèze) is changed to Probothrium brunnipilis (Candèze) new combination (Elaterinae, Elaterini). Twenty-seven (27) species, the genera Glyphonyx Candèze and Paradonus Stibick, the tribe Adrastini, and the subfamily Negastriinae are added to the Peru faunal list. There are now 201 species representing 48 genera and 9 subfamilies recorded from Peru.

La fauna Elateridae del Perú se actualiza con especies nuevas para la ciencia, nuevos registros de países y nuevas combinacion es taxonómicas de la región de Madre de Dios. Diez especies que representan ocho géneros se describen como nuevas: Conoderus wachiperi nueva especie, Cosmesus aca nueva especie, Dipropus amarakaeri nueva especies, Dipropus losamigos, nueva especie, Esthesopus machiguenga nueva especie, Glyphonyx peruanus nueva especie, Lissomus carmen nueva especie, Paradonus kosnipata nueva especie, Pomachilius qusqu nueva especie, Pomachilius wayqecha nueva especie. Aeolus ticuna Johnson se cambia a Conoderus ticuna (Johnson) nueva combinación, Aeolus platynotus Candèze se cambia a Conoderus platynotus (Candèze) nueva combinación, y Crigmus brunnipilis (Candèze) se cambia a Probothrium brunnipilis (Candèze). Veintisiete (27) especies, los géneros Glyphonyx Candèze y Paradonus Stibick, la tribu Adrastini y la subfamilia Negastriinae se agregan a la lista de fauna de Perú. Ahora hay 201 especies que representan 48 géneros y 9 subfamilias se registran en el Perú.

Defining Outcomes for ß-cell Replacement Therapy in the Treatment of Diabetes: A Consensus Report on the Igls Criteria From the IPITA/EPITA Opinion Leaders Workshop.

ß-cell replacement therapy, available currently as pancreas or islet transplantation, has developed without a clear definition of graft functional and clinical outcomes. The International Pancreas and Islet Transplant Association and European Pancreas and Islet Transplantation Association held a workshop to develop consensus for an International Pancreas and Islet Transplant Association and European Pancreas and Islet Transplant Association Statement on the definition of function and failure of current and future forms of ß-cell replacement therapy. There was consensus that ß-cell replacement therapy could be considered as a treatment for ß-cell failure, regardless of etiology and without requiring undetectable C-peptide, accompanied by glycemic instability with either problematic hypoglycemia or hyperglycemia. Glycemic control should be assessed at a minimum by glycated hemoglobin (HbA1c) and the occurrence of severe hypoglycemia. Optimal ß-cell graft function is defined by near-normal glycemic control (HbA1c ≤6.5% [48 mmol/mol]) without severe hypoglycemia or requirement for insulin or other antihyperglycemic therapy, and with an increase over pretransplant measurement of C-peptide. Good ß-cell graft function requires HbA1c less than 7.0% (53 mmol/mol) without severe hypoglycemia and with a significant (>50%) reduction in insulin requirements and restoration of clinically significant C-peptide production. Marginal ß-cell graft function is defined by failure to achieve HbA1c less than 7.0% (53 mmol/mol), the occurrence of any severe hypoglycemia, or less than 50% reduction in insulin requirements when there is restoration of clinically significant C-peptide production documented by improvement in hypoglycemia awareness/severity, or glycemic variability/lability. A failed ß-cell graft is defined by the absence of any evidence for clinically significant C-peptide production. Optimal and good function are considered successful clinical outcomes.

A New Species of Dodecacius Schwarz (Coleoptera: Elateridae) from Madre de Dios, Peru

Dodecacius Schwarz is reviewed, it includes two species known only from the eastern lower slopes of the Andes and adjacent Amazonia in southeastern Peru. Dodecacius paititi new species is described. Dodecacius testaceus Schwarz is treated as a new synonym of D. nigricollis Schwarz.

El género Dodecacius Schwarz es revisado, incluye dos especies conocidas solamente de las laderas orientales bajas de los Andes y la Amazonia adyacente en el sureste de Perú. Se describe la nueva especie Dodecacius paititi y Dodecacius testaceus Schwarz es considerado como un nuevo sinónimo de D. nigricollis Schwarz.

First record of the beetle family Throscidae (Insecta: Coleoptera), a new species of Aulonothroscus Horn, and new species records to the fauna of Peru / Primer registro de la familia de escarabajos Throscidae (Insecta: Coleoptera), una nueva especie de Aulonothroscus Horn y tres nuevos registros de especies para la fauna de Perú

The beetle family Throscidae is documented from Peru for the first time, based on specimens collected in the regions of Cajamarca, Junín, Loreto and Madre de Dios. Aulonothroscus tambopata new species is described from Madre de Dios. Also, three additional species of Aulonothroscus are reported from Peru for the first time - A. alvarengai Cobos new country record, A. freudi Cobos new country record, and A. oculatissimus Cobos new country record. A key separating these four species is given. This report is part of the "Beetles of Peru" project.

Se documenta por primera vez la familia de escarabajos Throscidae para el Perú, a partir de ejemplares recolectados en las regiones de Cajamarca, Junín, Loreto y Madre de Dios. Aulonothroscus tambopata sp. nov. se describe a partir de ejemplares recolectados en Madre de Dios. Igualmente, se reporta por primera vez para el Perú tres especies adicionales del género Aulonothroscus - A. alvarengai Cobos registro nuevo del país, A. freudi Cobos registro nuevo del país, A. oculatissimus Cobos registro nuevo del país y se presenta una clave que separa las cuatro especies. Este artículo forma parte del proyecto "Escarabajos del Perú.

Demography of the giant otter (Pteronura brasiliensis) in Manu National Park, south-eastern Peru: implications for conservation.

The giant otter (Pteronura brasiliensis) is an endangered semi-aquatic carnivore of South America. We present findings on the demography of a population inhabiting the floodplain of Manu National Park, south-eastern Peru, arising from 14 annual dry season censuses over a 16 year period. The breeding system of territorial groups, including only a single breeding female with non-reproductive adult 'helpers', resulted in a low intrinsic rate of increase (0.03) and a slow recovery from decades of hunting for the pelt trade. This is explained by a combination of factors: (1) physiological traits such as late age at first reproduction and long generation time, (2) a high degree of reproductive skew, (3) small litters produced only once a year, and (4) a 50% mortality between den emergence and age of dispersal, as well as high mortality amongst dispersers (especially males). Female and male giant otters show similar traits with respect to average reproductive life-spans (female 5.4 yrs., male 5.2 yrs.) and average cub productivity (female 6.9, male 6.7 cubs per lifetime); the longest reproductive life spans were 11 and 13 years respectively. Individual reproductive success varied substantially and depended mainly on the duration of dominance tenure in the territory. When breeding females died, the reproductive position in the group was usually occupied by sisters or daughters (n = 11), with immigrant male partners. Male philopatry was not observed. The vulnerability of the Manu giant otter population to anthropogenic disturbance emphasises the importance of effective protection of core lake habitats in particular. Riverine forests are the most endangered ecosystem in the Department of Madre de Dios due to the concentration of gold mining, logging and agricultural activities in floodplains, highlighting the need for a giant otter habitat conservation corridor along the Madre de Dios River.

The variability of blood pressure due to small changes of hematocrit.

The hematocrit (Hct) of awake hamsters was lowered to 90% of baseline by isovolemic hemodilution using hamster plasma to determine the acute effect of small changes in Hct and blood viscosity on systemic hemodynamics. Mean arterial blood pressure increased, reaching a maximum of about 10% above baseline (8.6 +/- 5.5 mmHg) when Hct decreased 8.4 +/- 1.9% (P < 0.005). Cardiac output increased continuously with hemodilution. These conditions were reached at approximately 60 min after exchange transfusion and remained stationary for 1 h. Peripheral vascular resistance was approximately constant up to a decrease of Hct of about 10% and then fell continuously with lowering Hct. Vascular hindrance or vascular resistance independent of blood viscosity increased by about 20% and remained at this level up to an Hct decrease of 20%, indicating that the vasculature constricted with the lowered Hct. The results for the initial 2-h period are opposite but continuous with previous findings with small increases in Hct. In conclusion, limited acute anemic conditions increase mean arterial blood pressure during the initial period of 2 h, an effect that is quantitatively similar but opposite to the acute increase of Hct during the same period.

Severe complications of a "Brazilian" bikini wax.

A 20-year-old Australian woman with poorly controlled type 1 diabetes presented with life-threatening Streptococcus pyogenes and Herpes simplex infection of her external genitalia following a routine perineal "Brazilian" bikini wax. Extensive pubic hair removal is now common among young adults in Australia and elsewhere. However, the infectious risks of these practices, particularly among immunosuppressed individuals, are often underappreciated.

Toxic clonidine ingestion in children.

OBJECTIVES: We performed a prospective case series to seek dosage or clinical parameters to better identify patients who need direct medical evaluation. STUDY DESIGN: All clonidine ingestions in children younger than 12 years of age reported to 6 poison centers were followed for a minimum of 24 hours. Exclusion criterion was polydrug ingestion. RESULTS: The study included 113 patients, of whom 63 were male. Mean age was 3.8 years (+/-2.4 SD). Clinical effects were common, but severe adverse effects occurred in <10% of patients. The dose ingested was reported for 90 patients (80%); 61 (68%) children ingested <0.3 mg and none had coma, respiratory depression, or hypotension. The lowest dose ingested by history with coma and respiratory depression was 0.3 mg (0.015 mg/kg). Prior clonidine therapy did not affect outcome. Onset of full clinical effects in all cases was complete within 4 hours of ingestion. CONCLUSIONS: We recommend direct medical evaluation for (1) all children 4 years of age and younger with unintentional clonidine ingestion of >or=0.1 mg, (2) ingestion of >0.2 mg in children 5 to 8 years of age, and (3) ingestion of >or=0.4 mg in children older than 8 years of age. Observation for 4 hours may be sufficient to detect patients who will develop severe effects.