Managing carbon waste in a decarbonized industry: Assessing the potential of concrete mixing storage.

The effort towards a greener future will entail a shift to more environmentally friendly alternatives of many human activities. Within this context, the path towards a decarbonized society in general, and industrial decarbonization in particular, will require using low carbon solutions and/or capturing carbon emissions at the source. This flux of captured carbon will then require management and one option is to store it in concrete. The incorporation of the captured CO2 can be done during the mixing and/or curing. While the latter is more efficient and effective in terms of the amount of CO2 incorporated, it is limited to concrete in elements that are compatible with chamber curing. In practice, this would be restricted to the concrete pre-fabrication industry and, most probably, only to small size elements. Despite the lower performance, incorporation of CO2 into concrete during the mixing stage is a relatively universal alternative. The present research effort reveals that the latter solution is beneficial from an environmental point of view, with an estimated yearly carbon storage of 23 million tonnes worldwide against emissions of 2.5 million tonnes to do it.

Exposure to and infection by Leishmania infantum among domestic dogs in an area of the Cerrado biome, Maranhão, Brazil.

Visceral Leishmaniasis is a serious public health problem and dogs are considered to be the main source of infection in urban areas. In Brazil, this disease is present in all regions, but with high concentration of cases in the Northeast, and the state of Maranhão is considered to be an endemic region. The aim of this study was to conduct an epidemiological, spatial, molecular and serological survey on Leishmania infantum among domestic dogs in the municipality of Belágua, Maranhão. Blood samples were collected from dogs and questionnaires were applied to their owners to obtain epidemiological data and risk factors relating to this zoonosis in the region. The coordinates of the dogs' homes were obtained to produce a disease risk map. Serological diagnoses were made using the indirect immunofluorescence reaction (IFAT) and the dual-path platform chromatographic immunoassay test (DPP®) (Bio-Manguinhos/FIOCRUZ, Brazil). A molecular investigation was undertaken using the polymerase chain reaction (PCR). Georeferencing was performed using the global positioning system (GPS) and cases of canine visceral leishmaniasis in the municipality were spatially represented and analyzed using QGIS version 3.16.6 (QGIS Development Team, 2021). A total of 205 blood samples were collected, of which 122 (59.51%) were seroreactive for L. infantum through IFAT, while the DPP test showed 84 reactive samples (40.97%). IFAT and DPP detected 16 positive animals simultaneously. One sample that was seroreactive through IFAT was also positive through PCR. In the clinical evaluation, it was observed that among the seropositive dogs, 112 (91.80%) were symptomatic and 10 (8.20%) were asymptomatic. In the spatial analysis, the Kernel density estimator enabled determination of the place at greatest risk of occurrence of the disease. The areas with the highest concentrations of cases were in districts with large quantities of precarious housing and lack of basic sanitation. This was the first report on the occurrence of L. infantum among dogs in the municipality of Belágua. The results show that canine visceral leishmaniasis is well dispersed in this municipality, thus putting at risk the human population.

Hypothyroidism: A Peculiar Presentation.

Hypothyroidism constitutes a prevalent pathology, with up to 80% of afflicted individuals displaying associated muscular symptoms. However, these symptoms rarely appear as the first or only manifestation of hypothyroidism. We report the case of a previously healthy 21-year-old man, diagnosed with hypothyroid myopathy after experiencing intense myalgias and cramps, which were relieved by oral administration of levothyroxine. This case demonstrates the significance of considering thyroid-related conditions when patients present muscular symptoms as these can represent the only or initial indicator of hypothyroidism. Timely thyroxine supplementation leads to the gradual resolution of most neuromuscular symptoms.

Litomosoides brasiliensis (Nematoda: Onchocercidae) infecting chiropterans in the Legal Amazon region, Brazil.

Chiropterans play an important role in the maintenance of the environmental balance, since they are pollinators, seed dispersers and predators. They contribute to transmission and spreading of microorganisms such as helminths, fungi, protozoa, bacteria and virus. The aim of the present study was to investigate natural filariid infection among bats in the Legal Amazon region, Brazil, by means of parasitological and molecular analyses. Blood samples were collected from 82 bats for blood smears and for DNA extraction via the polymerase chain reaction (PCR) assay. Microfilariae were observed in blood smears from Carollia perspicillata (2), Artibeus lituratus (1), Artibeus fimbriatus (2), Dermanura gnoma (2) and Glossophaga soricina (1). Five positive samples were detected through the PCR assay and four of these were also positive in blood smears. From genome sequencing and comparative analysis with sequences deposited in GenBank, one sample showed 99.31% similarity to the species Litomosoides brasiliensis. The present study expands the geographical distribution of L. brasiliensis, to include the state of Maranhão as an area of occurrence of this species and includes D. gnoma and A. fimbriatus as hosts in Brazil.

Parametric Study towards Optimization of a Short Duration Carbonation Process of Recycled Cement Paste.

The recycling process of concrete originates a byproduct, cement paste powder (CPP), which is a material composed mainly of hydrated cement. This cementitious material has demonstrated promising results when applied as a binder in new concrete batches, provided it has been subjected to a previous carbonation process. One of the obstacles to the industrial application of this strategy is the long duration of the typical carbonation process, which requires from 3 to 28 days. Recently, the authors have developed a short two-hour carbonation process and thoroughly analysed it over its entire extension. In this paper, a parametric analysis of the carbonation process is performed towards CO2 uptake maximization, aiming to increase the feasibility of its short duration. CO2 uptake is evaluated using the ignition by furnace method and thermogravimetric analysis. Among the parameters considered, the initial water content and the CPP thickness present the highest impact on CO2 uptake. The investigation of different CO2 concentrations inside the carbonation chamber showed that the maximum CO2 uptake does not occur for the highest concentration value. Moreover, a minimum resident time for the forced carbonation of CPP in industrial contexts is presented, and is found to be highly dependent on the CO2 concentration. The particle size and purity degree of CPP revealed a limited influence on the CO2 uptake achieved. Additionally, this paper provides further insight into the mechanisms involved in the carbonation of mature cement paste while increasing the feasibility of our recently proposed short duration carbonation process.

Valorisation of Recycled Cement Paste: Feasibility of a Short-Duration Carbonation Process.

Cement paste powder (CPP) is a by-product of the recycling process of concrete with an elevated carbonation capability and potential to be recycled as a binding material in new concrete batches. The application of a carbonation treatment to CPP improves this potential even more, besides the evident gains in terms of CO2 net balance. However, the long duration usually adopted in this treatment, from 3 to 28 days, hampers the industrial viability of the process. We studied the feasibility of a short-duration carbonation process, with a duration of two hours, carrying out a comprehensive characterization of the material throughout the process. The test was performed on CPP with an average initial water content of 16.9%, exposed to a CO2 concentration of 80%. The results demonstrate two main carbonation rates: a rapid growth rate in the first 18 minutes of the process, involving all the calcium-bearing compounds in CPP, and a slow growth rate afterwards, where only C-S-H contributes to the carbonation reaction. During the 2 h carbonation process, the main CPP compounds, calcium silicate hydrate (C-S-H) and calcium hydroxide (CH), reached different carbonation degrees, 31% and 94%, with, however, close CO2 uptake values, 8% and 11%, respectively. Nevertheless, the total CO2 uptake for this process (≈19%) attained values not distant from the values usually obtained in a carbonation of 12 days or more (19-25%). Hence, these findings highlight the blocking role of C-S-H in the carbonation process, indicating that longer carbonation periods are only going to be useful if an effective carbonation of this compound is accomplished. In the present scenario, where CH is the main contributor to the reaction, the reduction in the process duration is feasible.

Feedback of Antibiotic Prescribing in Primary Care (FAPPC) trial: results of a real-world cluster randomized controlled trial in Scotland, UK.

OBJECTIVES: To evaluate the effect of general practice-level prescribing feedback on antibiotic prescribing in a real-world pragmatic cluster randomized controlled trial. METHODS: Three hundred and forty general practices in four territorial Health Boards in NHS Scotland were randomized in Quarter 1, 2016 to receive four quarterly antibiotic-prescribing feedback reports or not, from Quarter 2, 2016 to Quarter 1, 2017. Reports included different clinical topics, benchmarking against national and health board rates, and behavioural messaging with improvement actions. The primary outcome was total antibiotic prescribing rate. There were 16 secondary prescribing outcomes and 5 hospital admission outcomes (potential adverse effects of reduced prescribing). The main evaluation timepoint was 1 year after the final report (Quarter 1, 2018), with an additional evaluation in the quarter after the final report (Quarter 2, 2017). Routine administrative NHS data were used to generate the feedback reports and analyse the effects. RESULTS: Total antibiotic prescribing rates were lower at the main evaluation timepoint in both intervention (1.83 versus baseline 1.93 prescriptions/1000 patients/day) and control (1.90 versus baseline 1.98) practices, with no evidence of intervention effect [adjusted rate ratio (ARR) 0.98 (95% CI 0.94-1.02; P = 0.35)]. At the additional timepoint, adjusted total antibiotic prescribing rates were 1.67 and 1.73 prescriptions/1000 patients/day, with evidence of a small intervention effect, ARR 0.99 (0.98-1.00; P = 0.03). CONCLUSIONS: This well-designed, practice-level antibiotic-prescribing feedback had limited evidence of additional effects in the context of decreasing antibiotic prescribing and an established national stewardship programme.

Chiropterans as a potential hosts of Leishmania spp. in endemic areas for leishmaniasis in northeastern Brazil.

The species of the genus Leishmania are protozoa that are widely distributed from Asia to the Americas, affecting humans and wild and domestic animals. Little is known about infection by Leishmania in bats in the state of Maranhão, Brazil. The objective of this study was to investigate the presence of Leishmania in bats in Maranhão. Blood samples were collected from bat species for parasitological diagnosis. Samples of spleen and liver were collected for molecular analysis. All the blood cultures were negative. In two blood smears, organisms similar to amastigotes of Leishmania sp. were detected. Of the 116 samples, two spleen samples were positive and showed similarity to Leishmania infantum. Therefore, further studies are needed to elucidate whether bats take part in the epidemiological chain of leishmaniasis.

Associations between declining antibiotic use in primary care in Scotland and hospitalization with infection and patient satisfaction: longitudinal population study.

BACKGROUND: Reducing antibiotic use is central to antimicrobial stewardship, but may have unintended consequences. OBJECTIVES: To examine associations between size of decline in antibiotic prescriptions in general practices and (i) rate of hospitalization for infection and (ii) patient satisfaction. METHODS: Routine data analysis for all general practices in Scotland, quarter one 2012 (Q1 2012) to quarter one 2018 (Q1 2018). Practices were grouped into quartiles of rate of change in prescribing and changes in rates of hospitalization were compared across groups. For satisfaction analysis, associations between practice-level patient satisfaction in 2017-18 (Scottish Health and Care Experience Survey) and prior change in antibiotic prescription were examined. RESULTS: Antibiotic prescriptions overall fell from 194.1 prescriptions/1000 patients in Q1 2012 to 165.3 in Q1 2018 (14.9% reduction). The first quartile of practices had a non-significant increase in prescriptions [change per quarter = 0.22 (95% CI -0.42 to 0.86) prescriptions/1000 patients], compared with large reductions in the other three groups, largest in quartile four: -2.95 (95% CI -3.66 to -2.24) prescriptions/1000 patients/quarter (29.7% reduction overall). In all quartiles, hospitalizations with infection increased. The increase was smallest in quartile four (the biggest reduction in prescriptions) and highest in quartile one (no significant change in prescriptions): 2.18 (95% CI 1.18 to 3.19) versus 3.68 (95% CI 2.64 to 4.73) admissions/100 000 patients/quarter, respectively [difference = - 1.50 (95% CI -2.91 to -0.10)]. There was no statistically significant association between change in antibiotic prescriptions and patient satisfaction. CONCLUSIONS: Very large reductions in antibiotic prescriptions in Scottish general practices have not been associated with increases in hospitalization with infection or changes in patient satisfaction.

Seroprevalence and detection of Trypanosoma cruzi in dogs living in a non-endemic area for Chagas disease in the legal Amazon region, Brazil.

Trypanosoma cruzi, the etiological agent for Chagas disease, is widely distributed in the Americas. Its hosts are humans and wild and domestic mammals, and its vectors are triatomine insects. Studies have indicated that domestic dogs are sentinel animals in the epidemiology of Chagas disease in endemic regions, including states in the Legal Amazon region of Brazil. In São Luís, the capital of Maranhão, a non-endemic state, the existence of a domestic cycle involving domestic rats has been proven, along with a wild cycle maintained by didelphids. However, no studies on T. cruzi infection in domestic animals in this locality have been conducted. The aim of this study was to investigate occurrence of T. cruzi in dogs living in the Itaqui Bacanga district of São Luís, Maranhão, by means of serological and molecular tests. Blood samples were obtained from 330 dogs and structured epidemiological questionnaires were applied to their keepers. These samples were used in the indirect immunofluorescent antibody test (IFAT), enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). Fisher's exact test was used for statistical calculations with the aim of identifying risk factors. Out of the 330 animals, 105 (31.8%) were reactive in IFAT, 46 (13.0%) in ELISA and 20 (6.0%) in both serological tests. The results were not significant (p > 0.05) when submitted to statistical analysis for the studied variables. From PCR, 58 samples (17.5%) were found to be positive and, of these, one (0.3%) showed similarity to T. cruzi after sequencing. These data demonstrate that dogs were exposed to and infected by T. cruzi. Thus, they can be considered sentinel animals for Chagas disease in the locality studied, which signals that there is a need for epidemiological surveillance actions.

Parasitoses intestinais e fatores de risco associados em crianças em um município do Nordeste Brasileiro / Intestinal parasites and risk factors associated f in children in a Brazilian Northeast municipality

Introdução: os parasitos gastrintestinais são causas de morbidade em crianças, podendo determinar quadros de anemia e diarréria. Podem estar associados as condições socioeconômicas, de saneamento básico e práticas de higiene. Objetivo: o objetivo desta investigação foi identificar as parasitoses intestinais e os fatores de risco associados em crianças menores de 12 anos cadastradas em duas Unidades Básicas de Saúde do município de Caxias, estado do Maranhão. Metodologia: neste estudo transversal 422 exames coproparasitológicos pela técnica de Hoffman, Pons e Janner foram realizados. Para comparar as proporções utilizou-se o teste Qui-quadrado ou teste exato de Fisher. Empregou-se análises univariadas e multivariadas por regressão logística para avaliar a associação entre a infecção por enteroparasitos e os fatores de risco. Resultados: a frequência de parasitos intestinais foi 49,05%, sendo predominante o Ascaris lumbricoides (68,18%) e a Entamoeba sp. (65,38%). Conforme a análise estatística, ingerir água sem tratamento domiciliar e não lavar as mãos antes das refeições podem ser considerados como fatores de risco para as enteropatias parasitárias. Conclusão: ressalta-se a necessidade de implementar políticas públicas que visem reduzir as altas taxas destes parasitos, e que contribuam para melhorar a qualidade de vida dessa população.

Introduction: intestinal parasites are cause of morbidity in children and can determine anemia and diarrhea. It can be associated to social economical conditions, basic sanitation and hygiene. Objective: the objective of this research was to identify tne intestinal parasitosis and the risk factors associated in children less than 12 years old registered in two Basic Health Units in Caxias municipality, state of Maranhão. Metodology: in this cross-sectional study 422 fecal exams were performed by the technique of Hoffman, Pons and Janner in 422 children. To compare the proportions, the chi-square test or Fisher's exact test was used. Univariate and multivariate analyzes were used by logistic regression to evaluate the association between enteroparasite infection and risk factors. Results: the frequency of intestinal parasites was 49.05%, being predominant Ascaris lumbricoides (68.8%) and Entamoeba sp. (65.38%). According to statistical analysis, drinking water without home treatment and not washing hands before meals, can be considered as risk factors for parasitic enteropathies. Conclusion: It's necessary to implement public policies aimed at reducing the high rates of intestinal parasites, which contributes to improve the quality of life of this population.

Field and classroom initiatives for portable sequence-based monitoring of dengue virus in Brazil.

Brazil experienced a large dengue virus (DENV) epidemic in 2019, highlighting a continuous struggle with effective control and public health preparedness. Using Oxford Nanopore sequencing, we led field and classroom initiatives for the monitoring of DENV in Brazil, generating 227 novel genome sequences of DENV1-2 from 85 municipalities (2015-2019). This equated to an over 50% increase in the number of DENV genomes from Brazil available in public databases. Using both phylogenetic and epidemiological models we retrospectively reconstructed the recent transmission history of DENV1-2. Phylogenetic analysis revealed complex patterns of transmission, with both lineage co-circulation and replacement. We identified two lineages within the DENV2 BR-4 clade, for which we estimated the effective reproduction number and pattern of seasonality. Overall, the surveillance outputs and training initiative described here serve as a proof-of-concept for the utility of real-time portable sequencing for research and local capacity building in the genomic surveillance of emerging viruses.

"Everything Is Gonna Be Alright with Me": The Role of Self-Compassion, Affect, and Coping in Negative Emotional Symptoms during Coronavirus Quarantine.

Self-compassion has been associated with less distress, particularly when people face stressful and negative events. This study analyzed the mediation role of coping and affect in the relation between self-compassion and negative emotional symptoms during the quarantine decreed by Portuguese Health Authorities in the first phase of the coronavirus outbreak. A total of 428 Portuguese adults (75% women; Mage = 40.8, SD = 11.6) completed an online survey comprised by the Self-Compassion Scale (predictor); Short Version of Depression, Anxiety and Stress Scale (outcomes); The Positive and Negative Affect Schedule; and Brief-COPE. These instruments were adapted to COVID 19's epidemic. Parallel mediation analyses demonstrated that self-compassionate participants were at less risk of suffering from symptoms of depression, anxiety, and stress during the quarantine. Plus, the relation between self-compassion and depressive, anxious, and stress symptoms were mediated by negative affect and dysfunctional coping style, but only for symptoms of depression. The findings support coping strategies and affect as links between self-compassion and distress but also the importance of separately analyzing the role of self-compassion, negative affect, and coping on symptoms of anxiety, depression, and stress. Low self-compassion might increase negative affect, maintaining stress responses to face demanding events during the COVID-19 epidemic. Results were discussed in the context of the pandemic outbreak.

Retrospective and new records of ticks (Acari: Argasidae, Ixodidae) from the state of Maranhão, an Amazon-Cerrado transition area of Brazil.

The Brazilian state of Maranhão is located in a transition area of the Amazon and Cerrado biomes, where there is a rich fauna of vertebrates. This study aimed to update the list of the ticks occurring in Maranhão, through a compilation of literature records and examination of three tick collections, plus the addition of unpublished collections of ticks from road-killed animals during recent years. Our results indicate that the tick fauna of Maranhão includes 26 species: seven in the family Argasidae (Antricola guglielmonei, Argas miniatus, Ornithodoros cavernicolous, Ornithodoros hasei, Ornithodoros mimon, Ornithodoros rietcorreai and Ornithodoros rudis); and 19 in the family Ixodidae (Amblyomma auricularium-provisional, Amblyomma cajennense sensu stricto, Amblyomma calcaratum, Amblyomma dissimile, Amblyomma geayi, Amblyomma longirostre, Amblyomma naponense, Amblyomma nodosum, Amblyomma oblongoguttatum, Amblyomma ovale, Amblyomma parvum, Amblyomma rotundatum, Amblyomma sculptum, Amblyomma triste, Dermacentor nitens, Ixodes luciae, Haemaphysalis juxtakochi, Rhipicephalus microplus, and Rhipicephalus sanguineus sensu lato). Eleven of the above species are reported for the first time in Maranhão. We consider previous reports of Ornithodoros talaje and Amblyomma pseudoconcolor in Maranhão as misidentification with O. hasei and A. auricularium, respectively. Until 1958, only 11 tick species were reported in Maranhão, with no additional reports until 2009. During 2010-2019, 15 additional species were reported. We also highlight the importance of ticks for public and veterinary health in Maranhão.

Yellow fever epizootics in non-human primates, Southeast and Northeast Brazil (2017 and 2018).

BACKGROUND: Yellow fever (YF) is a severe, infectious, but non-communicable arboviral hemorrhagic disease. In the last decades, yellow fever virus (YFV) infections have been prevalent in endemic areas in Brazil, affecting human and non-human primate (NHP) populations. Monitoring of NHP infection started in 1999, and reports of epizootic diseases are considered important indicators of viral transmission, particularly in relation to the sylvatic cycle. This study presents the monitoring of YFV by real-time RT-PCR and the epidemiological findings related to the deaths of NHPs in the south-eastern states and in the north-eastern state of Bahia, during the outbreak of YF in Brazil during 2017 and 2018. METHODS: A total of 4198 samples from 2099 NHPs from south-eastern and north-eastern Brazilian states were analyzed by real-time reverse transcription polymerase chain reaction (rtRT-PCR). RESULTS: A total of 4198 samples from 2099 NHPs from south-eastern and north-eastern Brazilian states were collected between 2017 and 2018. The samples were subjected to molecular diagnostics for YFV detection using real-time reverse transcription polymerase chain reaction (rtRT-PCR) techniques. Epizootics were coincident with human YF cases. Furthermore, our results showed that the YF frequency was higher among marmosets (Callithrix sp.) than in previous reports. Viremia in species of the genus Alouatta and Callithrix differed greatly. DISCUSSION: Our results indicate a need for further investigation of the role of Callithrix spp. in the transmission cycles of YFV in Brazil. In particular, YFV transmission was observed in a region where viral circulation has not been recorded for decades and thus vaccination has not been previously recommended. CONCLUSIONS: This highlights the need to straighten epizootic surveillance and evaluate the extent of vaccination programmes in Brazil in previously considered "YFV-free" areas of the country.

Renal Injury in DENV-4 Fatal Cases: Viremia, Immune Response and Cytokine Profile.

Dengue virus (DENV) infections may result in asymptomatic cases or evolve into a severe disease, which involves multiple organ failure. Renal involvement in dengue can be potentially related to an increased mortality. Aiming to better understand the role of DENV in renal injury observed in human fatal cases, post-mortem investigations were performed in four DENV-4 renal autopsies during dengue epidemics in Brazil. Tissues were submitted to histopathology, immunohistochemistry, viral quantification, and characterization of cytokines and inflammatory mediators. Probably due the high viral load, several lesions were observed in the renal tissue, such as diffuse mononuclear infiltration around the glomerulus in the cortical region and in the medullary vessels, hyalinosis arteriolar, lymphocytic infiltrate, increased capsular fibrosis, proximal convoluted tubule (PCT) damage, edema, PCT debris formation, and thickening of the basal vessel membrane. These changes were associated with DENV-4 infection, as confirmed by the presence of DENV-specific NS3 protein, indicative of viral replication. The exacerbated presence of mononuclear cells at several renal tissue sites culminated in the secretion of proinflammatory cytokines and chemokines. Moreover, it can be suggested that the renal tissue injury observed here may have been due to the combination of both high viral load and exacerbated host immune response.

Cryoprotectants synergy improve zebrafish sperm cryopreservation and offspring skeletogenesis.

The synergy obtained by the combination of cryoprotectants is a successful strategy that can be beneficial on the optimization of zebrafish sperm cryopreservation. Recently, a protocol was established for this species using an electric ultrafreezer (-150 °C) performing cooling rate (-66 °C/min) and storage within one step. The ultimate objective of sperm cryopreservation is to generate healthy offspring. Therefore, the objective of this study was to select the most adequate cryoprotectant combination, for the previously established protocol, that generate high quality offspring with normal skeletogenesis. Among the permeating cryoprotectant concentrations studied 12.5% and 15% of N,N-dimethylformamide (DMF) yielded high post-thaw sperm quality and hatching rates. For these two concentrations, the presence of bovine serum albumin (10 mg/mL), egg yolk (10%), glycine (30 mM) and bicine (50 mM) was evaluated for post-thaw sperm motility, viability, in vitro fertilization success and offspring skeletal development (30 days post fertilization). Higher concentration of permeating cryoprotectant (15%) decreased the incidence of deformed arches and severe skeletal malformations, which suggests higher capacity to protect the cell against cold stress and DNA damage. Extender containing 15% DMF with Ctrl, Bicine and egg yolk were the non-permeating cryoprotectants with higher post-thaw quality. The use of these compounds results in a reduction in vertebral fusions, compressions and severity of skeletal malformations in the offspring. Therefore, these extender compositions are beneficial for the quality of zebrafish offspring sired by cryopreserved sperm with -66 °C/min freezing rate. To the best of our knowledge, this is the first report on skeletal development of the offspring sired by cryopreserved sperm performed with different freezing media compositions in zebrafish.

Diagnosis and epidemiology of Leishmania infantum in domestic cats in an endemic area of the Amazon region, Brazil.

Visceral leishmaniasis is a zoonotic disease caused by Leishmania infantum for which dogs are the main reservoir. In South America, presence of this disease is expanding along with increasing dispersion of its principal vector, the sand-fly Lutzomyia longipalpis. Feline leishmaniasis is an emerging disease in domestic cats, but epidemiological studies in endemic areas of the Amazon region of Brazil are scarce and the role of cats as reservoirs of L. infantum has been debated. The aim of this study was to investigate L. infantum infection in cats living in the Amazon biome region, using serological and molecular methods. A total of 105 cats were subjected to clinical examination and blood samples were taken for immunofluorescent-antibody (IFAT) serological evaluation, to determine anti-Leishmania antibody titers. Conventional PCR and Sanger's sequencing targeting L. infantum chitinase and Leishmania species ribosomal internal transcribed spacer (ITS-1) encoding genes were performed on conjunctival swabs from these cats. Seropositivity was detected in 32 animals (30.48%), thus confirming that contact between these cats and the parasite was occurring. PCR followed by amplicon sequencing showed that three samples (2.86%) were positive for a chitinase gene and six (5.71%) were positive for the ITS-1 gene. Parasite-positive diagnoses presented a statistically significant association with free access to the streets (p = 0.0111), cohabitation with dogs affected previously by VL (p = 0.0006) and absence of backyard cleaning and garbage collection (p = 0.00003). These results emphasize that cats should be included in epidemiological surveys of leishmaniasis, especially in endemic areas, if not as the reservoir host (unproven), at least as a "sentinel host" that is useful for revealing situations of endemic circulation of L. infantum. Moreover, in these areas, feline leishmaniasis needs to be considered in the differential diagnosis among domestic cats presenting alopecia, rarefied hair, lacerations and ulcerative dermatitis.

Factors predicting the severity of dengue in patients with warning signs in Rio de Janeiro, Brazil (1986-2012).

BACKGROUND: Since 1981, >12 million cases of dengue have been reported in Brazil. Early prediction of severe dengue with no warning signs is crucial to avoid progression to severe dengue. Here we aimed to identify early markers of dengue severity and characterize dengue infection in patients in Rio de Janeiro. METHODS: We evaluated early severity markers, serotypes, infection status, number of days of illness and viral loads associated with dengue fever in patients from Rio de Janeiro, Brazil through an observational retrospective study (1986-2012). We compared dengue without warning signs and dengue with warning signs/severe dengue (DWWS/SD). Infection status was classified by enzyme-linked immunosorbent assay and viraemia was quantified by quantitative real-time reverse transcription polymerase chain reaction. RESULTS: The presence of DWWS/ SD was significantly associated with younger age; patients 13-19 y of age had a significantly greater chance of presenting warning signs. Dengue virus type 3 (DENV3) was more likely to induce DWWS/SD, which was more frequent on days 4-5 of illness. CONCLUSIONS: DENV3, 4-5 d of illness and 13-19 y of age were early biomarkers of dengue severity. To our knowledge, this was the first study to analyse the characteristics of dengue severity in the state of Rio de Janeiro over 27 y of epidemics since the introduction of DENV.