The American Academy of Dermatology's "Good Skin Knowledge" program enhances children and adolescents' confidence regarding dermatologic knowledge.

The American Academy of Dermatology (AAD) has resources meant to be used by children. Herein, we discuss the Good Skin Knowledge (GSK) curriculum, which was created to educate youth aged 8-13 about common dermatologic conditions to promote healthy skin habits, build self-confidence, and encourage careers in science and medicine. To assess participants' confidence regarding understanding and retention of GSK materials, the authors developed a pre- and post-training survey consisting of 10 questions. Results of our survey demonstrate a significant improvement in participants confidence regarding knowledge of skin function and care with at least two thirds of youth surveyed indicating understanding across all areas, with the largest gains centered around knowledge of the three skin layers, knowing what a dermatologist does, and appreciating the causes of acne.

Density and behavior of capybara (Hydrochoerus hydrochaeris) ticks (Acari: Ixodidae) Amblyomma sculptum and Amblyomma dubitatum with notes on Rickettsia bellii infection: Assessing human exposure risk.

In several urban and peri­urban areas of Brazil, populations of Amblyomma sculptum and Amblyomma dubitatum ticks are maintained by capybaras (Hydrochoerus hydrochaeris). In some of these areas, this host and these tick species are associated with Brazilian spotted fever (BSF), a lethal human disease caused by the bacterium Rickettsia rickettsii. In this work, we evaluated the risk of human exposure to these tick species using four collection techniques to discern host-seeking behavior. The study was carried out in 10 urban sites inhabited by capybaras in Uberlândia, a BSF-free municipality in southeastern Brazil. Ticks were collected in areas of 400 m2 at each site and at three seasons. Within the same municipality, the distance and speed of A. sculptum nymphs moving towards the CO2 traps were evaluated. In a sample of ticks Rickettsia DNA was investigated. During the study period, 52,953 ticks were collected. Among these, 83.4 % were A. sculptum (1,523 adults, 10,545 nymphs and 32,104 larvae) and 16.6 % were A. dubitatum (464 adults, 2,153 nymphs and 6,164 larvae). An average annual questing tick density of 4.4/m² was observed, with the highest density recorded at one site in autumn (31.8/m²) and the lowest in summer at another site (0.03/m²). The visual search yielded the highest proportion of A. sculptum larvae, constituting 47 % of the total and 63.6 % of all A. sculptum larvae. In contrast, CO2 traps collected a greater proportion of nymphs and adults of A. sculptum ticks. In the case of A. dubitatum, the CO2 trap was the most efficient technique with 57.7 % of captures of this species, especially of nymphs (94.5 % of captures) and adults (97.8 % of captures). Ticks' ambush height on vegetation (9 to 77 cm), observed by visual search 30 times, yielded a total of 20,771 ticks. Of these, 28 (93 %) were A. sculptum ticks, with only two (7 %) identified as A. dubitatum ticks. Among A. sculptum ticks, the nymph was the most attracted stage to humans and larva in the case of A. dubitatum. Amblyomma sculptum adults and nymphs were significantly more attracted to humans than those of A. dubitatum, but A. dubitatum larvae were significantly more attracted than the same stage of A. sculptum. The maximum distance and speed of horizontal displacement for A. sculptum nymphs were five meters and 2.0 m/h, respectively. The only species of Rickettsia detected in ticks, exclusively in A. dubitatum, was R. bellii. Importantly, it was observed that the higher the proportion of A. sculptum in the community of ticks, the lower the rate of infection of A. dubitatum by R. bellii. In conclusion, host-seeking behavior differed between the two tick species, as well as between stages of the same species. A greater restriction of A. dubitatum ticks to the soil was observed, while larvae and nymphs of A. sculptum dispersed higher in the vegetation. The behavior presented by A. sculptum provides greater opportunities for contact with the hosts, while A. dubitatum depends more on an active search for a host, the hunter behavior. Taken together, these observations show that a human being crossing an area infested with A. sculptum and A. dubitatum ticks will have almost exclusive contact with A. sculptum larvae and/or nymphs. Humans in a stationary position (sitting, lying or immobile) are exposed to both tick species, but they are more attractive to adults and mainly nymphs of A. sculptum compared to the corresponding stages of the tick A. dubitatum. The negative effect of A. sculptum on A. dubitatum infection by R. bellii deserves further studies.

Survey of Rickettsia spp. in ticks (Acari: Ixodidae) infesting opossums (Didelphis albiventris) and capybaras (Hydrochoerus hydrochaeris) from an urban park in southeastern Brazil.

Ticks are hematophagous arthropods and, during feeding, may transmit pathogens to vertebrate hosts, including humans. This study aimed to investigate the presence of Rickettsia spp. in ticks collected between 2010 and 2013 from free-ranging capybaras (Hydrochoerus hydrochaeris) and opossums (Didelphis albiventris) that inhabit Sabiá Park in Uberlândia, Brazil. Overall, 1,860 ticks were collected: 1,272 (68.4%) from capybaras (487 of the species Amblyomma sculptum, 475 adults and 12 nymphs; 778 Amblyomma dubitatum, 727 adults and 51 nymphs; and seven larva clusters of the genus Amblyomma); and 588 (31.6%) from opossums (21 A. sculptum, one adult and 20 nymphs; 79 A. dubitatum, all nymphs; 15 Ixodes loricatus, 12 adults and three nymphs; 457 Amblyomma sp. larva clusters; 15 Ixodes sp. larva clusters; and one Argasidae larva cluster). Out of 201 DNA samples tested for the presence of Rickettsia spp. DNA using polymerase chain reaction (PCR) 12 showed amplification of a gtlA gene segment that was specific to Rickettsia bellii, a bacterium non-pathogenic to humans. As there has been a report showing serological evidence of infections caused by Rickettsia species of the spotted fever group (SFG) in capybaras and opossums in the park, including Rickettsia rickettsii, the etiological agent of Brazilian spotted fever, and considering the presence of A. sculptum ticks, which are aggressive to humans, as well as these vertebrate hosts, which are amplifiers of R. rickettsii, it is important to monitor the presence of SFG rickettsiae in the Sabiá Park, which is visited daily by thousands of people.

Clinical characteristics of probands with obsessive-compulsive disorder from simplex and multiplex families.

Genetic and non-genetic factors contribute to obsessive-compulsive disorder (OCD), with strong evidence of familial clustering. Genomic studies in psychiatry have used the concepts of families that are "simplex" (one affected) versus "multiplex" (multiple affected). Our study compares demographic and clinical data from OCD probands in simplex and multiplex families to uncover potential differences. We analyzed 994 OCD probands (501 multiplex, 493 simplex) from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC). Clinicians administered the Structured Clinical Interview for DSM-IV (SCID-IV) to diagnose, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to assess severity, and Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) to assess symptom dimensionality. Demographics, clinical history, and family data were collected. Compared to simplex probands, multiplex probands had earlier onset, higher sexual/religious and hoarding dimensions severity, increased comorbidity with other obsessive-compulsive-related disorders (OCRD), and higher family history of psychiatric disorders. These comparisons provide the first insights into demographic and clinical differences between Latin American simplex and multiplex families with OCD. Distinct clinical patterns may suggest diverse genetic and environmental influences. Further research is needed to clarify these differences, which have implications for symptom monitoring and management.

Rickettsia communities and their relationship with tick species within and around the national park of Iguaçu, Brazil.

We report Rickettsia species from 2,334 ticks collected from environment (1,939 ticks) and animals (395 ticks) in the largest inland fragment of the Atlantic rainforest of southern Brazil and its fragments. Additionally, the DNA infection rates of Amblyomma ovale tick populations in the Neotropics with Rickettsia bellii and Rickettsia parkeri strain Atlantic rainforest were calculated using data from scientific publications, and their correlation was evaluated. From 11 tick species Rickettsia DNA was detected in seven (Amblyomma brasiliense, Amblyomma coelebs, Amblyomma incisum, Amblyomma longirostre, A. ovale, Haemaphysalis juxtakochi, Ixodes fuscipes) and was not detected in four species (Amblyomma dubitatum, Ixodes loricatus, Rhipicephalus microplus and Rhipicephalus sanguineus sensu lato). DNA of five Rickettsia species was detected (R. bellii, Rickettsia amblyommatis, Rickettsia rhipicephali, Rickettsia felis and Rickettsia sp. Aragaoi). To determine the prevalence of Rickettsia DNA positivity according to vector species, ticks were processed individually or in pools of 2-10 individuals (samples). The most prevalent Rickettsia species was R. bellii, found in 112 samples, followed by R. amblyommatis, R. rhipicephali, R. felis and Rickettsia sp. Aragaoi, found in 16, five, two and one sample, respectively. Rickettsia bellii DNA was found in five tick species with the highest infection rate in A. ovale and A. brasiliense. Absence of R. parkeri strain Atlantic rainforest in A. ovale ticks was an unexpected result. Furthermore, a negative correlation was identified between the infection rates (DNA) of R. bellii and/or R. parkeri strain Atlantic rainforest within A. ovale tick populations in the Neotropics. Putting together current knowledge, it can be proposed that, within natural settings, the diversity of rickettsiae and ticks creates a buffering effect on the overgrowth of rickettsiae and episodes of bacteremia in the hosts.

The GABAergic system in Alzheimer's disease: a systematic review with meta-analysis.

The γ-aminobutyric acid (GABA)ergic system is the primary inhibitory neurotransmission system in the mammalian brain. Its dysregulation has been shown in multiple brain conditions, but in Alzheimer's disease (AD) studies have provided contradictory results. Here, we conducted a systematic review with meta-analysis to investigate whether the GABAergic system is altered in AD patients compared to healthy controls (HC), following the PRISMA 2020 Statement. We searched PubMed and Web of Science from database inception to March 18th, 2023 for studies reporting GABA, glutamate decarboxylase (GAD) 65/67, GABAA, GABAB, and GABAC receptors, GABA transporters (GAT) 1-3 and vesicular GAT in the brain, and GABA levels in the cerebrospinal fluid (CSF) and blood. Heterogeneity was estimated using the I2 index, and the risk of bias was assessed with an adapted questionnaire from the Joanna Briggs Institute Critical Appraisal Tools. The search identified 3631 articles, and 48 met the final inclusion criteria (518 HC, mean age 72.2, and 603 AD patients, mean age 75.6). Random-effects meta-analysis [standardized mean difference (SMD)] revealed that AD patients presented lower GABA levels in the brain (SMD = -0.48 [95% CI = -0.7, -0.27], adjusted p value (adj. p) < 0.001) and in the CSF (-0.41 [-0.72, -0.09], adj. p = 0.042), but not in the blood (-0.63 [-1.35, 0.1], adj. p = 0.176). In addition, GAD65/67 (-0.67 [-1.15, -0.2], adj. p = 0.006), GABAA receptor (-0.51 [-0.7, -0.33], adj. p < 0.001), and GABA transporters (-0.51 [-0.92, -0.09], adj. p = 0.016) were lower in the AD brain. Here, we showed a global reduction of GABAergic system components in the brain and lower GABA levels in the CSF of AD patients. Our findings suggest the GABAergic system is vulnerable to AD pathology and should be considered a potential target for developing pharmacological strategies and novel AD biomarkers.

Effect of modeling liquids on resin composite roughness and color parameters after staining and toothbrushing.

This study evaluated surface roughness, color stability, whitening index, and opacity of different types of modeling liquids for resin composite coating after exposure to staining and toothbrushing. Disc-shaped resin composite (Vittra APS, FGM) specimens were fabricated and divided into four groups (n = 10 each): control group, Composite Wetting resin (Ultradent Products), Adper Scotchbond Multipurpose adhesive (3M ESPE), and Adper Universal adhesive (3M ESPE). Surface roughness (Ra) was measured using a rugosimeter, while color stability (∆E00), whitening index (WI), and opacity (%) were measured using a spectrophotometer. Assessments were made at four time points: after polishing (baseline, T1), after immersion in red wine for 24 h (T2), and after 5,000 (T3) and 10,000 (T4) cycles of toothbrushing. Scanning electron microscopy images were captured to analyze the scratches created. The data were statistically analyzed by two-way repeated-measures analysis of variance and Tukey's honestly significant difference tests (α = .05). Modeling with the Wetting resin resulted in higher surface roughness (p < 0.05) and low color stability, which were attributable to porosities. Higher color change values were observed in the control group after staining. Both adhesives showed the lowest mean ΔE00 values (p < 0.005). WI decreased after staining, except with the use of the Universal adhesive (p < 0.005). The lowest opacity values were observed at baseline for all groups (p < 0.005). The Universal and Scotchbond adhesives had lower surface roughness, better color stability, higher WI, and the lowest opacity values after staining with red wine and toothbrushing.

"A gente é descartado e invisível": processo de trabalho, fome e insegurança alimentar em entregadores de comida de Curitiba / "We are discarded and unseen": working process, hunger and food insecurity among food delivery Workers in Curitiba

O cenário que antecedeu a pandemia de covid19 já apresentava situações de fome e insegurança alimentar e nutricional crescentes no Brasil e no mundo, resultantes da alta de preços dos alimentos básicos, a diminuição de investimentos em programas de segurança alimentar e nutricional. Apesar de reconhecidos avanços e bons resultados na redução da insegurança alimentar e nutricional, e no aumento da renda e do poder de compra por meio de políticas públicas, grupos marginalizados e desprovidos de direitos já vinham enfrentando dificuldades no acesso a uma alimentação saudável e adequada. Dentre entres grupos destacam-se trabalhadores informais, tais como os entregadores de aplicativo, cuja luta em sido reconhecida no Brasil pelo dilema de "trabalhar com fome entregando comida". Mudanças no mundo do trabalho, oriundas das reformas da previdência e trabalhista, agravadas pela persistência da crise econômica entre trabalhadores informais e pela pandemia, estão aprofundando situações de fome e IAN entre trabalhadores informais, a despeito da oferta de serviços de educação, saúde e renda. De forma geral, este trabalho pretende entender como as condições de trabalho de entregadores de comida influenciam situações de segurança alimentar nutricional, fome, saúde, qualidade de vida e engajamento político. Trata-se de uma pesquisa social realizada por meio de quatro etapas: testagem do instrumento, incursões ao primeiro campo para familiarização com o cenário e os atores, segunda etapa de incursões nos points, de acordo com a proposta de saturação de dados, bem como a complementação com observação de grupos de redes sociais. Após análise qualitativa, por meio de núcleos de sentido e de estatística descritiva bivariada, os resultados apontam que há um impacto negativo sobre entregadores negros e entregadores de aplicativo com mais intensidade, constituído por um balanço desfavorável que combina ausência de qualquer aspecto fixo do processo de trabalho (alimentação, água, banheiros, abrigos, local para descanso), relação de desconfiança com clientes, empregadores e restaurantes, risco de acidentes, proteção em caso de acidentes e contaminação por covid-19, ausência de conhecimento do funcionamento das plataformas, dificuldade de acesso a políticas públicas, sentimentos de invisibilidade, abandono, desvalorização social, culminando em perda da identidade de trabalho e ausência do senso de luta política coletiva. Já o entendimento das práticas alimentares no trabalho e no domicílio dos entregadores de comida a partir da complexidade das suas condições de trabalho distintas, do quesito cor e da renda dos entregadores mostrou como a precarização, informalização e plataformização violam o direito humano à alimentação adequada destes grupos. Tal encadeamento de causalidades permitiu vislumbrar as situações de fome vividas durante o processo de trabalho, e como este processo influencia a insegurança alimentar em nível domiciliar. Pode-se concluir que o processo de trabalho de entregadores de aplicativo, principalmente quando são negros e cicloentregadores, frequentemente leva a situações de fome no trabalho, predispondo a diferentes níveis de insegurança alimentar e nutricional no domicílio.

Before covid19, worlwide and brazilian scenario already presented situations of hunger and growing food and nutritional insecurity, resulting from the high prices of basic foods, decrease in public investments in food and nutrition security programs. Despite recognized advances and good results in reducing food and nutritional insecurity, and increasing income and purchasing power through public policies, marginalized and deprived groups were already facing difficulties in accessing healthy and adequate food. Among these vulnerable groups, informal workers, such as app deliverers, have been recognized in Brazil by their struggle to "deliver food and work with hunger dilema". Changes in the world of work, arising from the pension and labor reforms, aggravated by the persistence of the economic crisis among informal workers and the pandemic, are deepening situations of hunger and IAN among informal workers, despite the provision of education, health and income. This work aims to understand how food delivery workers' working conditions influence nutritional food security, hunger, health, quality of life and political engagement. This is a social research carried out through four stages: testing of the instrument, incursions into the first field to familiarize with the scenario and the actors, a second stage of incursions into the remaining points, according to the data saturation proposal, as well as the observational practice of social media groups´s interactions. After qualitative analysis, through meaning cores, and quantitative, through bivariate statistics, the results indicate the existance of a more intense and negative impact on black delivery drivers and app deliverers, caractherized by an unfavorable balance that combines absence of any fixed aspect of the working conditions (food, water, bathrooms, shelters, place for rest), relationship of mistrust with customers, employers and restaurants, risk of accidents, protection in case of accidents and contamination by covid-19, lack of knowledge of the functioning of the platforms, difficulty of access to public policies, feelings of invisibility, abandonment, social devaluation, culminating in the loss of work identity and absence of the sense of collective political struggle. Through exploratory work, the understanding of the eating practices at work and at home of food delivery drivers based on the complexity of their different working conditions, color and income of delivery drivers showed how precariousness, informalization and platformization violate the human right to adequate food of these groups. This chain of causalities allowed us to glimpse the situations of hunger experienced during the work process, and how this process influences food insecurity at the household level. All these drawbacks and lack of positive perspective meet the government-companies-platforms´ abandonment and abuse, keeping them as society's outsiders, therefore helping to produce political restraints and disengagement, aside from far right opinions.

Effect of modeling liquids on resin composite roughness and color parameters after staining and toothbrushing

Abstract This study evaluated surface roughness, color stability, whitening index, and opacity of different types of modeling liquids for resin composite coating after exposure to staining and toothbrushing. Disc-shaped resin composite (Vittra APS, FGM) specimens were fabricated and divided into four groups (n = 10 each): control group, Composite Wetting resin (Ultradent Products), Adper Scotchbond Multipurpose adhesive (3M ESPE), and Adper Universal adhesive (3M ESPE). Surface roughness (Ra) was measured using a rugosimeter, while color stability (∆E00), whitening index (WI), and opacity (%) were measured using a spectrophotometer. Assessments were made at four time points: after polishing (baseline, T1), after immersion in red wine for 24 h (T2), and after 5,000 (T3) and 10,000 (T4) cycles of toothbrushing. Scanning electron microscopy images were captured to analyze the scratches created. The data were statistically analyzed by two-way repeated-measures analysis of variance and Tukey's honestly significant difference tests (α = .05). Modeling with the Wetting resin resulted in higher surface roughness (p < 0.05) and low color stability, which were attributable to porosities. Higher color change values were observed in the control group after staining. Both adhesives showed the lowest mean ΔE00 values (p < 0.005). WI decreased after staining, except with the use of the Universal adhesive (p < 0.005). The lowest opacity values were observed at baseline for all groups (p < 0.005). The Universal and Scotchbond adhesives had lower surface roughness, better color stability, higher WI, and the lowest opacity values after staining with red wine and toothbrushing.

Cardiometabolic multimorbidity is common among patients with psoriasis and is associated with poorer outcomes compared to those without comorbidity.

BACKGROUND: Associations between cardiometabolic multimorbidity and response to therapy in psoriasis are unknown. OBJECTIVE: Determine the associations of multimorbidity with response to biologic treatment in psoriasis patients. METHODS: CorEvitas Psoriasis Registry participants who initiated biologic therapy and had 6-month follow-up were stratified by 0, 1, 2+ comorbidities (diabetes, hypertension, hyperlipidemia). Adjusted odds ratios (95% CIs) were calculated overall and separately by biologic class (TNFi, IL-17i, IL-12/23i + IL-23i), to assess the likelihood of achieving response for the 1 and 2+ groups vs. 0. RESULTS: Of 2,923 patients, 49.5%, 24.7% and 25.8% reported 0, 1 and 2+ comorbidities, respectively. Overall, likelihood of PASI75 was 18% (OR = 0.82; 95%CI: 0.67, 1.00) and 23% (OR = 0.77; 95%CI: 0.63, 0.96) lower in those with 1 and 2+ comorbidities, respectively, vs. 0. In those who initiated IL-17i, odds of PASI75 and PAS90 were 34% (OR = 0.66; 95%CI: 0.48-0.91) and 35% (OR = 0.65; 95%CI: 0.47-0.91) lower in the 2+ multimorbidity cohort. No significant associations were found among users of TNFi or IL-12/23i + IL-23i groups in the multimorbidity group. LIMITATIONS: Patients may not be representative of all psoriasis patients. CONCLUSION: Multimorbidity in psoriasis may decrease the likelihood of achieving treatment response to biologic therapy and should be considered when discussing treatment expectations with patients.

Incidence of hemoglobinopathies and spatialization of newborns with sickle cell trait in Mato Grosso do Sul, Brazil.

OBJECTIVE: To evaluate the incidence of variant hemoglobins of newborn samples from the Neonatal Screening Center in the state of Mato Grosso do Sul, Brazil, and to analyze the distribution and spatial autocorrelation of newborns with sickle cell trait. METHODS: Samples from 35,858 newborns screened by the Neonatal Screening Center. The samples with inconclusive diagnosis were submitted to electrophoretic, chromatographic, cytological and molecular analyses. The spatial distribution analysis of newborns with sickle cell trait was performed by spatial autocorrelation. RESULTS: A total of 919 newborns showed an abnormal hemoglobin profile; in that, ten genotypes had significant clinical impacts identified. Among the asymptomatic newborns, the sickle cell trait was the most frequent (incidence of 1.885 cases/100 newborns). The highest incidence rates were registered in the municipalities of Terenos, Figueirão, Corguinho and Selvíria. There was positive spatial autocorrelation between the proportion of declared individuals of black race/color and the incidence of newborns with sickle cell trait. CONCLUSION: The early diagnosis by neonatal screening and laboratory tests was very important to identify abnormal hemoglobin profiles and guide the spatial autocorrelation analysis of sickle cell trait newborns in Mato Grosso do Sul, serving as a support to anticipate health measures aimed to discuss efficient therapeutic behaviors and effective planning of municipalities with the greatest need for care, monitoring and orientations for affected families.

Comparing scapular morphology of Amblyomma sculptum and Amblyomma dubitatum nymphs allows a fast and practical differential diagnosis of ticks in highly infested areas with dominance of these two species.

Rickettsia rickettsii infection causes the highest human fatality rate among all Rickettsia species of the world and is endemic in Southeast Brazil. In this part of the country most human spotted fever cases are related to unnaturally high populations of ticks, usually a mix of two species, Amblyomma dubitatum Neumann and Amblyomma sculptum Berlese and their local host, capybara (Hydrochoerus hydrochaeris). At the same time, an increase in the number of SF notifications as well as its urbanization was observed, and a better characterization of disease epidemiology is mandatory for control measures and to halt its expansion. It was recently noticed in southeast Brazil that SF endemic areas were characterized by overgrowth populations of A. sculptum and decreased populations of A. dubitatum. Hence, characterization of areas with potential to endemicity, eco-epidemiological studies and control measures may rely on the evaluation of A. sculptum/A. dubitatum rate. However, in potentially endemic scenarios, discriminating the two tick species, particularly the nymphs considered the main vector stage, is a challenge in face of several hundreds to thousands of ticks that should be examined for quantitative studies. We herein present additional morphological features to an existing identification key for Amblyomma nymphs that considerably diminishes the labor to distinguish nymphs of these two tick species. Specifically, the oval-shaped scutum of A. dubitatum and a conspicuous scapula of A. sculptum are prominent discriminating features.

Novel genotypes of Hepatozoon spp. in small mammals, Brazil.

BACKGROUND: Small mammals (rodents and marsupials) have been poorly explored for the occurrence of apicomplexan (genus Hepatozoon and genera of the order Piroplasmorida) and Anaplasmataceae agents in Brazil. Thus, this study investigated the occurrence of Hepatozoon spp., Piroplasmorida, and Anaplasmataceae agents in small mammals in seven forest fragments in Brazil. METHODS: During 2015-2018, small mammals were captured in six forest fragments in the State of São Paulo (Cerrado and Atlantic Forest biomes) and one fragment in the State of Mato Grosso do Sul (Pantanal biome). Mammal blood, liver, spleen, and lung samples were tested molecularly for the presence of DNA of Hepatozoon, Piroplasmorida, and Anaplasmataceae agents. RESULTS: A total of 524 mammals were captured, comprising seven species of marsupials, 14 rodents, two carnivores, and one Cingulata. Four novel haplotypes (1, 2, 3, 4) of Hepatozoon spp. were detected in small mammals from different biomes. In São Paulo state, haplotype 1 was detected in rodents from Cerrado and a transition area of Cerrado and Atlantic Forest biomes, whereas haplotype 2 was detected in rodents from the Atlantic Forest biome. On the other hand, haplotypes 3 and 4 were restricted to rodents and marsupials, respectively, from the Pantanal biome of Mato Grosso do Sul. No host species shared more than one haplotype. Despite these distinct geographical and host associations, our phylogenetic analyses indicated that the four Hepatozoon haplotypes belonged to the same clade that contained nearly all haplotypes previously reported on rodents and marsupials, in addition to several reptile-associated haplotypes from different parts of the world. No mammal samples yielded detectable DNA of Piroplasmorida agents. On the other hand, the Anaplasmataceae-targeted polymerase chain reaction (PCR) assay amplified a sequence 100% identical to the Wolbachia pipientis endosymbiont of the rodent filarid Litomosoides galizai. CONCLUSIONS: We report a variety of Hepatozoon haplotypes associated with small mammals in three Brazilian biomes: Cerrado, Atlantic Forest, and Pantanal. Through phylogenetic analyses, the Hepatozoon agents grouped in the rodent-marsupial-reptile large clade of Hepatozoon spp. from the world. The detection of a W. pipientis associated with the rodent filarid L. galizai indicates that the rodent was infected by filarial nematodes.

Comorbid obesity and history of diabetes are independently associated with poorer treatment response to biologics at 6 months: A prospective analysis in Corrona Psoriasis Registry.

BACKGROUND: Psoriasis is associated with comorbid systemic metabolic disease. OBJECTIVE: To assess possible associations of comorbid obesity, history of diabetes, hypertension, and hyperlipidemia with response to biologic treatment at 6 months among patients in CorEvitas' Psoriasis Registry. METHODS: Participants included 2924 patients initiating biologic therapy (tumour necrosis factor inhibitors [TNFi], interleukin [IL]-17i, IL-12/23i, or IL-23i) with baseline and 6-month follow-up visits available. Logistic regressions resulted in adjusted odd ratios (OR) and 95% confidence intervals (CI) for achievement of response in select outcomes for those with obesity and history of diabetes, hypertension, and hyperlipidemia relative to those without each. RESULTS: Overall, obesity reduced by 25% to 30% odds of achieving PASI75 (OR, 0.75; 95% CI, 0.64-0.88) and PASI90 (OR, 0.70; 95% CI, 0.59-0.81). History of diabetes reduced odds of achieving PASI75 by 31% (OR, 0.69; 95% CI, 0.56-0.85) and PASI90 by 21% (OR, 0.79; 95% CI, 0.63-0.98). Obesity was associated with lower response to TNFi and IL-17i classes. Independent of obesity, diabetes was associated with poorer outcomes when on IL-17i therapy and hypertension, to a lesser extent, when on the TNFi class. No significant associations were found in the hyperlipidemia group. LIMITATIONS: The study assessed only short-term effectiveness and small sample sizes limited the power to detect differences. CONCLUSION: Assessment of comorbid disease burden is important for improved likelihoods of achieving treatment response with biologics.

Incidence of hemoglobinopathies and spatialization of newborns with sickle cell trait in Mato Grosso do Sul, Brazil

ABSTRACT Objective To evaluate the incidence of variant hemoglobins of newborn samples from the Neonatal Screening Center in the state of Mato Grosso do Sul, Brazil, and to analyze the distribution and spatial autocorrelation of newborns with sickle cell trait. Methods Samples from 35,858 newborns screened by the Neonatal Screening Center. The samples with inconclusive diagnosis were submitted to electrophoretic, chromatographic, cytological and molecular analyses. The spatial distribution analysis of newborns with sickle cell trait was performed by spatial autocorrelation. Results A total of 919 newborns showed an abnormal hemoglobin profile; in that, ten genotypes had significant clinical impacts identified. Among the asymptomatic newborns, the sickle cell trait was the most frequent (incidence of 1.885 cases/100 newborns). The highest incidence rates were registered in the municipalities of Terenos, Figueirão, Corguinho and Selvíria. There was positive spatial autocorrelation between the proportion of declared individuals of black race/color and the incidence of newborns with sickle cell trait. Conclusion The early diagnosis by neonatal screening and laboratory tests was very important to identify abnormal hemoglobin profiles and guide the spatial autocorrelation analysis of sickle cell trait newborns in Mato Grosso do Sul, serving as a support to anticipate health measures aimed to discuss efficient therapeutic behaviors and effective planning of municipalities with the greatest need for care, monitoring and orientations for affected families.

Autonomía y tutela en el ambiente escolar / Autonomia e tutela no ambiente escolar / Autonomy and tutelage in the school environment

O tema da autonomia está presente desde os primórdios da educação. Na sociedade atual, a autonomia estudantil nas práticas escolares pode determinar a participação política e social dos jovens. O presente estudo busca problematizar autonomia e tutela na educação formal a partir de revisão integrativa da literatura científica. A proposta implica contextualizar os referidos conceitos, traçando um cenário histórico a partir do qual se delineiam as práticas educativas que tangem autonomia e tutela. O trabalho inclui a análise de onze artigos científicos publicados na base de dados Portal Periódicos Capes entre os anos 2000 e 2019. Os resultados apontam para três eixos: a construção dos conceitos de autonomia e tutela a partir de uma trajetória histórica e filosófica; a análise crítica da sociedade a partir de orientações políticas; e, por fim, a relação entre o caráter político de autonomia e tutela e as práticas educacionais que emergem do cotidiano escolar.

El tema de la autonomía está presente desde los primordios de la educación. En la sociedad actual, la autonomía estudiantil en las prácticas escolares puede determinar la participación política y social de los jóvenes. En el presente estudio se busca problematizar autonomía y tutela en la educación formal a partir de revisión integrativa de la literatura científica. La propuesta implica contextualizar los referidos conceptos, trazando un escenario histórico desde el cual se delinean las prácticas educativas acerca de la autonomía y tutela. En el estudio se incluye el análisis de once artículos científicos publicados en la base de datos Portal Periódicos Capes entre los años 2000 y 2019. Los resultados apuntan a tres ejes: la construcción de los conceptos de autonomía y tutela a partir de una trayectoria histórica y filosófica; el análisis crítico de la sociedad a partir de orientaciones políticas; y, por fin, la relación entre el carácter político de autonomía y tutela y las prácticas educacionales que emergen del cotidiano escolar.

The theme of autonomy has been present since the beginnings of education. In today's society, student's autonomy in school practices can determine the political and social participation of young people. This study seeks to problematize autonomy and tutelage in formal education from an integrative review of scientific literature. The proposal implies contextualizing these concepts, tracing a historical scenario from which educational practices that relate to autonomy and tutelage are delineated. The work includes the analysis of eleven scientific articles published in the Portal Periódicos Capes database between 2000 and 2019. The results point to three axes: the construction of the concepts of autonomy and tutelage from a historical and philosophical trajectory; critical analysis of society based on political guidelines; and, finally, the relationship between the political character of autonomy and tutelage and the educational practices that emerge from everyday school life.

Autopsia y certificados médicos de defunción en fallecidos relacionados con la COVID-19

RESUMEN Introducción: La pandemia de la COVID-19 ha sido la mayor del siglo actual y motivo de numerosos trabajos científicos. En Cuba se ha constituido el Grupo Temporal de Anatomía Patológica para estudiar las autopsias de los fallecidos por la COVID-19 (más de 400). Los certificados médicos de defunción, documentos de inestimable valor, en Cuba se reparan de acuerdo a los resultados de las autopsias, para elevar su calidad. Objetivos: Evaluar los resultados de las autopsias con diagnósticos de COVID-19, comparadas con los certificados médicos de defunción. Métodos: Se evaluaron los diagnósticos de causas de muerte de 65 autopsias del año 2020 con sus certificados médicos de defunción. Los diagnósticos fueron procesados en el Sistema Automatizado de Registro y Control de Anatomía Patológica. Se analizaron las causas directas de muerte, causas básicas de muerte, causas de muerte intermedias y causas de muerte contribuyentes. Se definió la coincidencia total de ambos diagnósticos, coincidencia parcial, no coincidencia o discrepancia diagnóstica y datos insuficientes. Resultados: Las discrepancias diagnósticas de causa básica y directa de muerte son 46,2 % y 60,0 % del total de casos y 19,4 % y 64,5 % cuando la COVID-19 fue causa básica de muerte. Las elevadas cifras de discrepancias diagnósticas, se corresponden con las reportadas en estudios previos, tanto en diagnósticos clínicos como en los certificados médicos de defunción. Conclusiones: Existe elevadas cifras de discrepancias diagnósticas en los resultados de las autopsias con diagnósticos de COVID-19, comparadas con los certificados médicos de defunción.

ABSTRACT Introduction: The COVID-19 pandemic has been the largest in the current century and the reason for numerous scientific works. In Cuba, the Temporary Group of Pathological Anatomy has been established to study the autopsies of those who died from COVID-19 (more than 400). The medical death certificates, documents of inestimable value, in Cuba are repaired according to the results of the autopsies, to raise their quality. Objectives: To evaluate the results of autopsies with COVID-19 diagnoses, compared to medical death certificates. Methods: The diagnoses of causes of death of 65 autopsies of the year 2020 were evaluated with their medical death certificates. The diagnoses were processed in the Automated System for the Registration and Control of Pathology. Direct causes of death, basic causes of death, intermediate causes of death, and contributing causes of death were analyzed. The total agreement of both diagnoses was defined, partial agreement, diagnostic mismatch or discrepancy, and insufficient data. Results: Diagnostic discrepancies of basic and direct cause of death are 46.2 % and 60.0 % of all cases and 19.4 % and 64.5 % when COVID-19 was basic cause of death. The high figures for diagnostic discrepancies correspond to those reported in previous studies, both in clinical diagnoses and in medical death certificates. Conclusions: There are high numbers of diagnostic discrepancies compared with the results of autopsies with COVID-19 diagnoses, compared to medical death certificates.

Unilateral Distribution of Lichen Planus Pigmentosus-Inversus Unresponsive to Clobetasol and Hydroquinone.

Lichen planus pigmentosus-inversus (LPP-inversus) is a rare, pigmented variant of lichen planus of unknown etiology. This skin condition typically affects the intertriginous and flexural regions of the body bilaterally. We report an unusual case presentation with unilateral distribution of LPP-inversus in a woman originally from Nepal. The lesions developed rapidly over a three-month period and were recalcitrant to therapy with topical clobetasol and hydroquinone.

Small mammals, ticks and rickettsiae in natural and human-modified landscapes: Diversity and occurrence of Brazilian spotted fever in Brazil.

We studied communities of small mammals and their ticks in endemic (E) and non-endemic (NE) areas for Brazilian spotted fever (BSF), aiming to infer if diversity parameters of parasites and hosts could be related to occurrence and prevalence of rickettsial infection, especially Rickettsia rickettsii. We compared E and NE areas in human-modified landscapes (HMLs) and natural areas (BIO) with no report of BSF cases. Composition and equitability were important components of diversity explaining differences among areas. The marsupial Didelphis albiventris was dominant in HMLs, but not in natural areas, and this opossum was the main host for the tick Amblyomma sculptum, principal vector of R. rickettsii, especially in E areas. Communities of ticks were dominated by A. sculptum, followed by Amblyomma dubitatum in E areas. In NE areas, this dominance was inverted, with more A. dubitatum than A. sculptum infesting small mammals, but the numbers of ticks were much lower than in E areas. Composition and abundance of ticks in natural areas were very dissimilar from HMLs, with the lowest tick burdens. Didelphis albiventris in E areas presented higher seroprevalence and endpoint titres against R. rickettsii than in other areas. At least three Rickettsia species, non-pathogenic to humans, were detected in natural areas (Rickettsia bellii, Rickettsia amblyommatis and 'Candidatus Rickettsia andeanae'), and only one non-pathogenic species in HMLs (R. bellii). Our results suggest that higher diversity of ticks, hosts and rickettsiae could be relevant factors in buffering the effect in BSF occurrence. Particularly for D. albiventris, its importance has to be quantified in further studies considering the epidemiological scenario of BSF.