Estimating mortality and disability in Peru before the COVID-19 pandemic: a systematic analysis from the Global Burden of the Disease Study 2019.

Background: Estimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru's healthcare system performance. Methods: Using estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region. Results: The Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8-70.3) to 80.3 (77.2-83.2) years. This increase was driven by the decline in under-5 mortality (-80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5-10.1) and reached 7.5 million (6.1-9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region. Conclusion: In the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.

Metabolic Consequences of the Water We Drink: A Study Based on Field Evidence and Animal Model Experimentation.

The effect of the chronic consumption of water contaminated with residual concentrations of DDT's metabolites (DDD-dichlorodiphenyldichloroethane and DDE-dichlorodiphenyldichloroethylene) found in the environment were evaluated on the biometric, hematological and antioxidant system parameters of the hepatic, muscular, renal and nervous tissues of Wistar rats. The results showed that the studied concentrations (0.002 mg.L-1 of DDD plus 0.005 mg.L-1 of DDE) could not cause significant changes in the hematological parameters. However, the tissues showed significant alteration in the activity of the antioxidant system represented by the increase in the activity of the enzymes gluthathione S-transferases in the liver, superoxide dismutase in the kidney, gluthathione peroxidase in the brain, and several changes in enzymatic activity in muscle (SOD, GPx and LPO). The enzymes alanine aminotransaminase (ALT) and aspartate aminotransaminase (AST) were also evaluated for the amino acids' metabolism in the liver, with ALT showing a significant increase in the exposed animals. In the integrative analysis of biomarkers (Permanova and PCOA), the studied concentrations showed possible metabolic changes and damage to cellular structures evidenced by increased oxidative stress and body weight gain among the treated animals. This study highlights the need for further studies on the impact of banned pesticides still present in soils that may induce adverse effects in organisms that may prevail in future generations and the environment.

Earthworm communities in long-term no-tillage systems and secondary forest fragments in Paraná, Southern Brazil.

The area destined for agricultural production in Paraná state in Brazil is ~6 million hectares, of which 79% are under no-tillage systems (NTS) that can positively affect earthworm populations. Furthermore, earthworm abundance and richness can be valuable soil quality. This study assessed earthworm communities in long-term no-tillage sites (NTS) and nearby secondary Atlantic Forest (SF) fragments. Sampling was performed in June 2018 and May 2019 using the quantitative Tropical Soil Biology and Fertility handsorting method (ISO-TSBF), complemented by qualitative sampling in three municipalities: Faxinal, Mauá da Serra and Palmeira, in NTS and SF. Eleven earthworm species, belonging to five families (Benhamiidae, Glossoscolecidae, Megascolecidae, Ocnerodrilidae, and Rhinodrilidae) were found along with seven native species (Glossoscolex sp.22, Glossoscolex sp.23, Fimoscolex sp.21, Fimoscolex sp.24, Fimoscolex sp.42, Andiorrhinus duseni and Urobenus brasiliensis) and four exotic or cosmopolitan species (Dichogaster gracilis, Amynthas gracilis, Metaphire californica and Pontoscolex corethrurus). The cosmopolitan P. corethrurus dominated Faxinal and Mauá da Serra, while in Palmeira Fimoscolex and Glossoscolex were the most abundant. Six species belonging to Glossoscolex and Fimoscolex were new to science and must be described. Overall, 239 individuals were found. In 2018 126 individuals were found (76 in NTS and 50 in SF) and in 2019, only 112 individuals were found (45 in NTS and 67 in SF). The highest earthworm abundance was in Faxinal (123 individuals), with 76 individuals in NTS and 47 in SF. In Mauá da Serra the same pattern was observed (SF>NTS), while in Palmeira in overall, fewer individuals (38) were collected (24 in NTS and 14 in SF). The NTS at Faxinal and SF Mauá da Serra in 2019 had only/more exotic/cosmopolitan species, while at the other dates and sites >50% of the specimens sampled were native species. Overall, forests had more native species than exotics: in 2018, natives represented > 75% of all specimens, but in 2019 both Faxinal and Mauá da Serra had more exotic species (> 65%), while at Palmeira, they represented 50% of the individuals. Earthworm total biomass for forest sites was higher in Faxinal (3.2 g) and NTS in Mauá da Serra (1.7 g) in 2019. Overall, the total biomass was higher in SF sites than NTS. Using a classification available for earthworm populations in no-tillage systems, all three sites were considered to have poor quality in terms of abundance (ind m-2), while for species richness, they were considered to have moderate (Faxinal and Mauá da Serra) and good quality (Palmeira).

Pesticides in a case study on no-tillage farming systems and surrounding forest patches in Brazil.

With the growing global concern on pesticide management, the relationship between its environmental recalcitrance, food security and human health has never been more relevant. Pesticides residues are known to cause significant environmental contamination. Here, we present a case study on long-term no-tillage farming systems in Brazil, where Glyphosate (GLY) has been applied for more than 35 years. GLY and its main breakdown product, aminomethylphosphonic acid (AMPA) were determined in topsoil (0-10 cm) samples from no-tillage fields and nearby subtropical secondary forests by high-performance liquid chromatography coupled with a fluorescence detector. In addition, the presence of carbamates, organochlorines, organophosphates and triazines were also screened for. GLY and AMPA were present in all soil samples, reaching values higher than those described for soils so far in the literature. A significant decrease for AMPA was observed only between the secondary forest and the farm's middle slope for site B. GLY and AMPA were observed respectively at peak concentrations of 66.38 and 26.03 mg/kg soil. GLY was strongly associated with forest soil properties, while AMPA associated more with no-tillage soil properties. Soil texture was a significant factor contributing to discrimination of the results as clay and sand contents affect GLY and AMPA retention in soils. This was the first study to report DDT and metabolites in consolidated no-tillage soils in Brazil (a pesticide fully banned since 2009). Based on human risk assessment conducted herein and the potential risk of GLY to local soil communities, this study offers a baseline for future studies on potential adverse effects on soil biota, and mechanistic studies.

Effect of Polysaccharide Sources on the Physicochemical Properties of Bromelain-Chitosan Nanoparticles.

Bromelain, a set of proteolytic enzymes potential pharmaceutical applications, was encapsulated in chitosan nanoparticles to enhance enzyme stability, and the effect of different chitosan sources was evaluated. Chitosan types (i.e., low molecular weight chitosan, chitosan oligosaccharide lactate, and chitosan from shrimp shells) produced nanoparticles with different physicochemical properties, however in all cases, particle size and zeta potential decreased, and polydispersity index increased after bromelain addition. Bromelain encapsulation was higher than 84% and 79% for protein content and enzymatic activity, respectively, with low molecular weight chitosan presenting the highest encapsulation efficiency. Nanoparticle suspension was also tested for accelerated stability and rheological behavior. For the chitosan-bromelain nanoparticles, an instability index below 0.3 was recorded and, in general, the loading of bromelain in chitosan nanoparticles decreased the cohesiveness of the final suspension.

Evaluation of the Influence of Process Parameters on the Properties of Resveratrol-Loaded NLC Using 22 Full Factorial Design.

Resveratrol (RSV) is a natural antioxidant commonly found in grapes, berries, and nuts that has shown promising results in the treatment of a variety of degenerative and age-related diseases. Despite the proven beneficial results on reduction of reactive oxidant species (ROS) and on inflammatory process, RSV shows various limitations including low long-term stability, aqueous solubility, and bioavailability, restricting its applications in the medical-pharmaceutical area. To overcome these limitations, it has been applied in pharmaceutical formulations as nanostructured lipid carriers (NLC). Thus, the present study focuses on the optimization of the production process of NLC. NLC was produced by high shear homogenization (HSH) and ultrasound method (US) using Compritol® ATO C888 as solid lipid and Miglyol 812® as liquid lipid. In order to obtain an optimized formulation, we used a 22 full factorial design with triplicate of central point investigating the effects of the production process parameters; shear intensity and homogenization time, on the mean particle size (PS) and polydispersity index (PDI). Instability index, encapsulation efficiency, and production yield were also evaluated. As the PS and PDI values obtained with 6 min of shear at 19,000 rpm and 10 min of shear and 24,000 rpm were similar, the instability index (<0.1) was also used to select the optimal parameters. Based on the results of the experimental design and instability index, it was concluded that the shear rate of 19,000 rpm and the shear time of 6 min are the optimal parameters for RSV-loaded NLC production. Factorial design contributed therefore to optimize the variables of the NLC production process from a small number of experiments.

Further definition on the multiple partner choice arena: a potential animal model for the study of premature ejaculation.

INTRODUCTION: The multiple partner choice arena (MPCA) is an experimental setup in which male rats display a significant shortening of ejaculation latency, which is the main characteristic of premature ejaculation (PE) in men. Thus, the MPCA is a potential animal model for PE. AIM: In this study, we further analyze whether the features of the MPCA satisfy the validity criteria for it to be considered an animal model as well as the possible participation of the serotoninergic system in the faster ejaculation exhibited by male rats in the MPCA. METHODS: In Experiment 1, male rats were tested in a standard arena to assess their sexual behavior, then were assessed 1 week later in the MPCA. Another group was first tested in the MPCA, then in a standard arena. In Experiment 2, male rats divided into two groups were treated daily with WAY-100635 (5-HT(1A) antagonist) or vehicle for 15 days. In each group, half of the subjects were tested in a standard arena and half were tested in the MPCA on days 1, 8, and 15 of treatment. MAIN OUTCOME MEASURES: Number of intromissions and intromission and ejaculation latencies were the main outcome measures. RESULTS: In Experiment 1, males tested in the MPCA ejaculated significantly faster, regardless of the order in which they were evaluated in both arenas. In Experiment 2, the administration of WAY-100635 increased intromission and ejaculation latencies, and the number of intromissions in the MPCA. CONCLUSIONS: The results obtained in the MPCA support its use as an animal model for PE evaluation.

Síndrome de Brown-Séquard por hérnia discal cervical a duplo nível: caso clínico e revisão da literatura / Brown-Séquard syndrome by double level cervical disc herniation: case report and review of the literature / Síndrome de Brown-Séquard por hernia discal cervical en nivel doble: caso clínico y revisión de la literatura

Descrição do caso clínico de um paciente com síndrome de Brown-Séquard por hérnia de disco cervical em duplo nível, 40 anos, do sexo masculino, sem história de patologia prévia da coluna cervical; teve início insidioso de paresia nos membros direitos, associada à diminuição da sensibilidade dolorosa e térmica do hemicorpo esquerdo, após mergulho que ocasionou trauma indireto da coluna cervical. A RM da coluna cervical mostrou hérnias discais paramedianas direitas nos níveis C4-C5 e C5-C6 com compressão da metade direita do cordão medular e hiperintensidade em T2. Foi realizada descompressão por via anterior e artrodese dos níveis afetados. O paciente recuperou-se parcialmente dos déficits neurológicos, após um longo programa de reabilitação funcional. O tratamento cirúrgico e um programa de reabilitação precoce são da maior importância para a recuperação neurológica de paciente com síndrome de Brown-Séquard por hérnia de disco cervical.

This article presents a case in which Brown-Séquard syndrome resulted from a double level cervical disc herniation. A 40-year-old man without previous history of cervical pathology, presented with insidious right arm and leg paresis associated with associated with decreased pain and thermal sensitivity in the left hemibody after diving which caused indirect trauma of the cervical spine. Magnetic resonance imaging of the cervical spine showed double level disc herniation in C4-C5 and C5-6 with compression of the right half of spinal cord and hyperintensity in T2-weighted images. After a complete decompression of neural structures, a double level interbody fusion was performed. There was partial recovery of neurological status after a long period of physical therapy. Early surgical intervention and prompt rehabilitation are paramount to achieve neurological recovery in patients with Brown-Séquard syndrome resulting from a cervical disc herniation.

Descripción del caso clínico de un paciente con síndrome de Brown-Séquard por hernia de disco cervical en nivel doble, 40 años, del sexo masculino, sin historial de patología previa de la columna cervical; tuvo inicio insidioso de paresia en los miembros derechos, vinculada con la disminución de la sensibilidad dolorosa y térmica del hemicuerpo izquierdo, después de zambullida que ocasionó traumatismo indirecto de la columna vertebral. La RM de la columna cervical mostró hernias discales paramedianas derechas, en los niveles C4-C5 y C5-C6, con compresión de la mitad derecha del cordón medular e hiperintensidad en T2. Se realizó descompresión por vía anterior y artrodesis de los niveles afectados. El paciente se recuperó, parcialmente, de los déficits neurológicos, después de un programa prolongado de rehabilitación funcional. El tratamiento quirúrgico y un programa de rehabilitación precoz son de máxima importancia para la recuperación neurológica del paciente con síndrome de Brown-Séquard por hernia de disco cervical.

The mild stress of chronic prenatal injections may have additive effects on drugs administered during pregnancy to alter brain sexual differentiation.

OBJECTIVE: In order to clarify the effect of the prenatal (PN) treatment of the drug 1,4,6-androstatriene-3,17-dione (ATD) which blocks the conversion of testosterone into estradiol on male sexual behavior of the rats offsprings, from the effect of the mild stress induced by the PN administration of the Propylene glycol (PG), the vehicle used to dissolve ATD. METHODS: Pregnant Wistar rats were divided into three groups. The CON group did not receive any kind of treatment. The other two groups (PG and ATD) were injected i.p. during gestation (days 11-22) with 0 and 5 mg of ATD, dissolved in 0.1 ml of PG, respectively, doses reported by other authors. Sexual performance of the male pups was analyzed three months later in four successive tests. RESULTS: In the first sexual test of these naive rats, the percentage of males mounting, intromitting, ejaculating and the ejaculation frequency of the ATD group decreased significantly in comparison with the CON group. Also in the first and 4th tests, mounting, intromission and ejaculation latencies, as in the post-ejaculatory refractory period, ATD group, was significantly longer in comparison with the CON group. PG males showed a male sexual behavior (MSB) similar to that observed in the ATD group, but the differences did not reach statistical significance when they were compared with the CON group. CONCLUSION: We considered that the PN stress induced by the daily administration of PG and ATD, results in a slower execution of the MSB in both groups and avoid distinguish the effect of the ATD. Then chronic PN injections, as a route of administration, could act as mild stressor and may have additive effects on drugs affecting brain sexual differentiation.

Monoaminergic and cholinergic stimulation of masculine sexual behavior in neonatally demasculinized male rats.

Sexual behavior during adulthood largely depends upon hormonal events that take place around birth. Administration of the antiestrogen Tamoxifen (Tx) to males immediately after birth induces a marked decrease of masculine sexual behavior during adulthood. On the other hand, it is well known that masculine sexual behavior can be stimulated by the administration of drugs acting specifically on the monoaminergic or the cholinergic systems. This study was performed to analyze if masculine sexual behavior can be pharmacologically stimulated in adult male rats neonatally demasculinized by the administration of Tx. Neonatal administration of Tx induced clear impairments of masculine sexual behavior during adulthood. Administration of oxotremorine (OXO), 8-OH-DPAT (8-hydroxy-2(di-n-propylaminotetraline)), yohimbine (YH), and apomorphine (APO), drugs that normally elicit a stimulation of masculine sexual behavior were unable to fully restore it in demasculinized males. Only slight improvements of some behavioral parameters were observed with 8-OH-DPAT and YH. OXO seems to induce a worsening of sexual behavior impairments. Results obtained with APO were not significantly different from saline controls. Data suggest that neonatal treatment with Tx induces permanent impairments of the neural circuitry regulating masculine sexual behavior not only limited to morphological changes but also functional alterations of the neurotransmitter systems.

Masculine sexual behavior features in the Flinders sensitive and resistant line rats.

The Flinders sensitive (FSL) and resistant (FRL) lines of rats have been selectively bred for their differences in cholinergic sensitivity. The FSL rats display hypersensitive responses to agonists of muscarinic receptors. In addition, the FSL rats display behavioral alterations that support the notion that this strain could be useful as an animal model of depression. These abnormalities include increase in rapid eye movement sleep, decrease of saccharin consumption after stress, and reduced exploratory behavior in a novel open field. On the other hand, sexual behavior is a pleasure-seeking behavior that should be altered in a mood disorder characterized by anhedonia. In the present study, spontaneous masculine sexual behavior features were analyzed, both during 30-min tests as well as during a satiety test. Results showed that, compared to outbred Sprague-Dawley (SD) rats, both the FSL and the FRL rats displayed some behavioral impairment, like a marked decrease of the ejaculatory frequency. During the satiety tests, both the FSL and the FRL rats became exhausted sooner than their SD controls. In addition to considering the present results in terms of alterations in specific neurotransmitter systems, endogamy is proposed as a possible source of the behavioral alterations.