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 Reasoning: A 62-Year-Old Woman With Transient Vision Loss.

Transient visual loss (TVL) is a common complaint in the emergency department, with numerous possible etiologies. Prompt evaluation and management of TVL can potentially prevent progression to permanent visual loss. In this case, a 62-year-old woman presented with acute, painless, unilateral TVL. Two weeks before presentation, the patient reported bitemporal headaches and paresthesia of the distal extremities. A review of systems revealed chronic fatigue, cough, diffuse arthralgias, and decreased appetite for the previous 6 months. This case highlights the diagnostic approach to patients with TVL. Some common and rare causes associated with this clinical manifestation are briefly reviewed.

A De Novo HECW2 Variant in a Patient with Acetazolamide-Responsive Episodic Ataxia.

To the best of our knowledge, this is the first case to address episodic ataxia (EA) as a possible phenotypic feature of HECW2-related disorder. This single case study describes a 26-year-old female born at term with mild intellectual disability, neonatal hypotonia, and a history of febrile seizures who presented with paroxysmal events since the age of 2. These episodes include frequent falls due to imbalance, dilated pupils, vertigo, diaphoresis, nausea, vomiting, and nystagmus. Brain imaging was normal. A prolonged electroencephalogram (EEG) revealed interictal epileptiform discharges but failed to capture her clinical events. For several years, she was treated for presumed focal seizures with preserved awareness and trialed on adequate dosing of several antiepileptic medications without improvement. After 25 years, given the more prolonged nature of her episodes and the mild interictal cerebellar signs, empiric treatment with acetazolamide was initiated for a presumed diagnosis of EA. Acetazolamide treatment led to a dramatic reduction in event frequency and severity. The initial EA genetic panel was negative. Clinical exome sequence analysis revealed a novel pathogenic de novo missense variant in the HECW2 gene [c.3829 T > C;(p.Tyr1277His)], located in the HECT domain. HECW2 variants are associated with neurodevelopmental delay, hypotonia, and epilepsy. This study expands the genetic and clinical spectrum of HECW2-related disorder and adds EA to the phenotypic spectrum in affected individuals.

Trees of the cerrado in the Clube Caça e Pesca Itororó, Uberlândia, Minas Gerais State, Brazil / As árvores no Clube Caça e Pesca Itororó, Uberlândia, Estado de Minas Gerais, Brasil

We present a floristic survey of the trees in the stricto sensu cerrado remnant. In total, 63 species belonging to 46 genera of 26 families were registered. The most represented were Fabaceae (16 spp.) and Vochysiaceae (six spp.) Bowdichia virgilioides Kunth was considered near threatened, e Caryocar brasiliense Cambess. is protected by a state law. Of the registered trees, 19% are endemic to the biome (12 spp.). We present a list of species, identification key and an assessment of the conservation status and endemism of the species found. Due to its "cerrado" representative florist composition, and in order to ensure the conservation of this important genetic heritage, this cerrado remnant should urgently became a protected area again.

O presente estudo apresenta levantamento florístico das árvores do remanescente de cerrado. No total foram registradas 63 espécies pertencentes a 46 gêneros de 26 famílias. As mais representadas foram Fabaceae (16 spp.) e Vochysiaceae (seis spp.). Bowdichia virgilioides Kunth é considerada como quase ameaçada, e Caryocar brasiliense Cambess. é protegida pela legislação estadual. Das árvores amostradas 19% são endêmicas ao bioma (12 spp.).  Apresentamos uma lista das espécies, chave de identificação e uma avaliação do status de conservação e endemismos das espécies encontradas. Devido a sua composição florística representativa do cerrado e a fim de garantir a conservação desse importante patrimônio genético, esse remanescente deve urgentemente a ser uma área protegida.

The effects of resistance exercise on obstructive sleep apnea severity and body water content in older adults: A randomized controlled trial.

OBJECTIVES/BACKGROUND: The prevalence of obstructive sleep apnea (OSA) in people over 70 years can reach up to 95%. Aerobic or combined exercise programs have been shown to impact positively on OSA severity. Resistance training changes leg fluid retention. We hypothesized that through this mechanism it may have an impact on the OSA severity in older adults. PATIENTS/METHODS: We evaluated changes in the respiratory event index (REI) of older adults with moderate-severe obstructive sleep apnea in a randomized, masked, controlled, parallel group trial. Participants between the age of 65 and 80 years with REI between 20 and 50 events/hour were assigned randomly to 12 weeks of resistance training or healthy life-style recommendations. Change in REI was the primary outcome. Muscle thickness, maximum strength, and physical function were secondary outcomes and body mass index (BMI) and body water content were assessed as mediators. RESULTS: Twenty-three subjects were included, 57% men, aged 71 ± 5 years, randomized to training (n = 12) and control intervention (n = 11). The baseline REI in the training and control groups were 30 ± 7/h and 29 ± 9/h; at follow-up, the delta REI were -3.6/hour (95% confidence interval -0.7 to -5.4) and 6.7/hour (5.2-8.6), respectively, with significant time × group interaction that remained significant after adjusting the generalized estimating equations model for delta BMI and delta body water content. CONCLUSIONS: Twelve weeks of resistance training in older adults significantly changed the respiratory event index and was well tolerated. Changes in body water content were slight but cannot be dismissed as contributing to REI reduction.

Chronic testicular pain cured by low-dose pramipexole: is there an association with restless legs syndrome?

Restless legs syndrome (RLS) is characterized by an urge to move the legs, predominantly at night. About one quarter of the patients with RLS report painful symptoms in the legs. In this case report, the patient presented at the sleep clinic with a chief complaint of insomnia and the classical symptoms of RLS. He also mentioned a chronic testicular pain (CTP). For over a year, the patient had undergone urologic investigation and empiric treatments, with only mild improvement of the testicular pain. After 3 months of therapy with pramipexole, the RLS symptoms and the CTP were no longer present. Finding an etiology for CTP can be challenging and many cases are diagnosed as idiopathic. RLS may be a forgotten and unidentified etiology for CTP in typical urological care. Considering the high prevalence of RLS and CTP, it is relevant to clarify the possible association. CITATION: Tedesco Silva LM, Lenz MCS, Martinez D. Chronic testicular pain cured by low-dose pramipexole: Is there an association with restless legs syndrome? J Clin Sleep Med. 2022;18(5):1467-1469.

Multisite non-invasive brain stimulation in Parkinson's disease: A scoping review.

BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder, characterized by cardinal motor symptoms in addition to cognitive impairment. New insights concerning multisite non-invasive brain stimulation effects have been gained, which can now be used to develop innovative treatment approaches. OBJECTIVE: Map the researchs involving multisite non-invasive brain stimulation in PD, synthesize the available evidence and discuss future directions. METHODS: The databases PubMed, PsycINFO, CINAHL, LILACS and The Cochrane Library were searched from inception until April 2020, without restrictions on the date of publication or the language in which it was published. The reviewers worked in pairs and sequentially evaluated the titles, abstracts and then the full text of all publications identified as potentially relevant. RESULTS: Twelve articles met the inclusion criteria. The target brain regions included mainly the combination of a motor and a frontal area, such as stimulation of the primary motor córtex associated with the dorsolateral prefrontal cortex. Most of the trials showed that this modality was only more effective for the motor component, or for the cognitive and/or non-motor, separately. CONCLUSIONS: Despite the results being encouraging for the use of the multisite aproach, the indication for PD management should be carried out with caution and deserves scientific deepening.

Effects of Hydroxychloroquine on endOthelial function in eLDerly with sleep apnea (HOLD): study protocol for a randomized clinical trial.

BACKGROUND: Sleep apnea and coronary artery disease are prevalent and relevant diseases. The mechanism by which sleep apnea leads to coronary artery disease remains unclear. Intermittent hypoxia, caused by sleep apnea, leads to inflammation and consequent endothelial dysfunction. Endothelial dysfunction precedes the development of atherosclerotic disease and the occurrence of cardiovascular events. Agents that potentially act to improve endothelial function can help prevent cardiovascular events. Patients using immunomodulators due to rheumatic diseases have a lower prevalence of cardiovascular diseases. However, the potential cardioprotective effect of these drugs in patients without autoimmune diseases is not clear. Hydroxychloroquine (HCQ) is an immunomodulator used to treat rheumatoid arthritis and systemic lupus erythematosus. In addition to its anti-inflammatory properties, HCQ reduces cholesterol and blood glucose levels and has antithrombotic effects. The drug is inexpensive and widely available. Adverse effects of HCQ are rare and occur more frequently with high doses. OBJECTIVE: In this randomized clinical trial, the effect of HCQ treatment on endothelial function will be tested in seniors with sleep apnea. METHODS: We will recruit participants over the age of 65 and with moderate-severe sleep apnea from an ongoing cohort. We chose to use this sample already evaluated for sleep apnea for reasons of convenience, but also because the elderly with sleep apnea are vulnerable to heart disease. Endothelial function will be assessed by examining flow-mediated dilation of the brachial artery, the gold standard method, considered an independent predictor of cardiovascular events in the general population and by peripheral arterial tonometry, the most recent and most easily obtained method. Hydroxychloroquine will be used at a dose of 400 mg/daily for 8 weeks. DISCUSSION: Our study aims to obtain evidence, albeit preliminary, of the efficacy of hydroxychloroquine in improving endothelial function and reducing cardiovascular risk markers. If the improvement occurs, we plan to design a randomized multicenter clinical trial to confirm the findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT04161339 . Registered on November 2019.

Epidemiology of chronic back pain among adults and elderly from Southern Brazil: a cross-sectional study.

BACKGROUND: Chronic back pain (CBP) can negatively affect one's quality of life and health condition, posing significant social and economic burdens. OBJECTIVES: (1) To determine the prevalence of CBP and analyze associated factors in adult and elderly individuals in a municipality in southern Brazil; (2) to verify who sought medical attention or missed work because of back pain; and (3) to estimate the impact of CBP on selected health outcomes. METHODS: This was a population-based cross-sectional study conducted with individuals aged 18 years and older. CBP was defined as "pain for three consecutive months in the cervical, thoracic, or lumbar regions in the last year." Demographic, socioeconomic, behavioral, and physical and mental health information was collected. The impact of CBP was assessed by the etiological fraction method. RESULTS: The prevalence of CBP was 20.7% (95% CI: 18.3, 23.0) among the 1300 study participants. The factors associated with CBP were women, elderly, smokers, obesity, and sleeping fewer hours per night, as well as those with higher mental stress levels, history of fracture, arthritis/rheumatism, and work-related musculoskeletal disorder/repetitive strain injury. One-third of those with CBP missed work (31%) and 68% visited the physician over a 12-month period. All health outcomes analyzed (poor or very poor sleep quality, regular or poor health perception, worsened quality of life, depressive symptoms, perceived sadness) were significantly associated with CBP. CONCLUSION: One in five adults or elderly reported having CBP over the previous 12 months. This condition was associated with poorer health perception, poorer quality of life, and depressive symptoms.

Polymyxin for treatment of ventilator-associated pneumonia in a setting of high carbapenem resistance.

OBJECTIVES: To analyse the use of polymyxins for the treatment of ventilator-associated pneumonia (VAP) at a teaching hospital where carbapenem-resistant gram-negative bacteria are endemic. PATIENTS AND METHODS: This was a historical cohort study of patients receiving polymyxins to treat VAP in ICUs at a public university hospital in southern Brazil between January 1, 2017 and January 31, 2018. RESULTS: During the study period, 179 cases of VAP were treated with polymyxins. Of the 179 patients, 158 (88.3%) were classified as having chronic critical illness. Death occurred in 145 cases (81.0%). Multivariate analysis showed that the factors independently associated with mortality were the presence of comorbidities (P<0.001) and the SOFA score of the day of polymyxin prescription (P<0.001). Being a burn patient was a protective factor for mortality (P<0.001). Analysis of the 14-day survival probability showed that mortality was higher among the patients who had sepsis or septic shock at the time of polymyxin prescription (P = 0.028 and P<0.001, respectively). Acinetobacter baumannii was identified as the etiological agent of VAP in 121 cases (67.6%). In our cohort, polymyxin consumption and the incidence density of VAP were quite high. CONCLUSIONS: In our study, comprised primarily of chronically critically ill patients, there was a high prevalence of VAP caused by multidrug-resistant bacteria, consistent with healthcare-associated infections in low- and middle-income countries. Presence of comorbidities and the SOFA score at the time of polymyxin prescription were predictors of mortality in this cohort. Despite aggressive antimicrobial treatment, mortality was high, stressing the need for antibiotic stewardship.

The effects of two abundant ant species on soil nutrients and seedling recruitment in Brazilian Atlantic Forest

ABSTRACT Ants can influence soil fertility and the spatial distribution of seeds, with possible effects on seedling recruitment. The ant species Pachycondyla striata Fr. Smith, 1858 and Odontomachus chelifer (Latreille, 1802) co-occur in many forest areas in the Neotropics. We assessed soil fertility and seed bank structure in soil samples close and distant (control) from ant nests in forest fragments. We also assessed the richness and abundance of seedlings on nests and control sites. In soil samples from ant nests, the concentration of phosphorus and potassium were respectively 55.6% and 36% higher than in control sites. Aluminium was 11-15% lower in soil samples from ant nests. In the greenhouse, soils from ant nests had higher plant abundance and species richness, but the same species composition in comparison with control sites. Although more plants emerged from soil samples of O. chelifer nests, in the field, the density and richness of seedlings were similar for the two ant species studied. Seedlings in the nest sites were, on average, 1.8 times more abundant and 1.6 times richer in species than in control sites. Our results showed that ant species can play a key role in seedling recruitment in forest fragments, where other animals with equivalent and positive effects, such as mammals, are missing.

The effect of caffeine supplementation on exercise performance evaluated by a novel animal model

Introduction: Caffeinated drinks are used for improve performance. Animal models represent investigational strategy that circumvents most of the drawbacks of research in humans, including motivational factors and the placebo effect. No animal model that could test whether different forms of administering caffeine affect exercise propensity was found in the literature. Methods: An animal model of grouped voluntary exercise was tested. Two-month-old male C57/bl mice were housed in a cage fitted with one running wheel and a monitoring system. Six animals per cage were introduced individually. To assess the sensitivity of the model, the effect of different caffeinated drinks was observed in mice exercising ad libitum. During 2 days, the mice received: 1) pure anhydrous caffeine 0.125 mg/mL (PC), 2) cola drink (CC), and 3) caffeine-taurine-glucuronolactone drink (CTG), intercalating wash-out periods of 2 days, receiving pure water. Results: The distance run during the periods of water ingestion was significantly lower than during the periods of stimulant drinks ingestion: PC (5.6 ± 1.3 km; p = 0.02), of CC ingestion (7.6 ± 0.6 km; p = 0.001), and of CTG ingestion (8.3 ± 1.6 km; p = 0.009). The performances when ingesting the three caffeinated drinks do not follow a dose-response curve. Conclusions: The model described here was able to measure the effect of caffeine intake on voluntary exercise of mice. The sensitivity of the model to the effect of caffeine needs to be further validated. The action of each component of the drinks on exercise performance needs to be clarified in future research. The present model is adequate for such investigation (AU)

Atuação fonoaudiológica na síndrome da apnéia e hipopnéia obstrutiva do sono: relato de caso / Speech therapy in the obstructive sleep apnea-hypopnea syndrome: case report

OBJETIVO: verificar a contribuição da Fonoaudiologia no tratamento de uma paciente com a síndrome da apnéia e hipopnéia obstrutiva do sono. MÉTODOS: relato de caso de um paciente do sexo feminino, de sessenta anos de idade, com a síndrome da apnéia e hipopnéia do sono, de grau grave, que se submeteu ao atendimento fonoaudiológico para melhora do quadro de apnéia/hipopnéia, ronco e cansaço diurno. Foram realizadas avaliação clínica de motricidade orofacial e polissonografia antes e após a fonoterapia. Com base na avaliação clínica foi elaborado um plano terapêutico que buscou propiciar à paciente relaxamento cervical e da musculatura supra-hióidea, melhora na aeração nasal, adequação do posicionamento e força de língua, fortalecimento dos músculos do palato mole e sua mobilidade, aumento de força da musculatura mastigatória, treino da mastigação bilateral alternada e abaixamento do osso hióide. RESULTADOS: após 12 sessões de terapia fonoaudiológica, com duração de 40 minutos cada, pôde-se observar diminuição da tensão cervical, relaxamento da musculatura supra-hióidea, adequação do posicionamento do osso hióide, língua normotensa com dorso rebaixado, palato mole com mobilidade normal e mastigação adequada. A paciente relatou importante melhora no cansaço diurno. O resultado da segunda polissonografia indicou diminuição de 44 para 3 eventos por hora de apnéia e hipopnéia durante o sono, tendo o quadro passado do nível grave a um índice de distúrbio respiratório baixo não mais caracterizando doença apnéica do sono. CONCLUSÃO: a fonoterapia foi eficaz para o tratamento deste caso de síndrome da apnéia e hipopnéia do sono.

Purpose: to check the contribution of speech therapy in the treatment of a patient with obstructive sleep apnea-hypopnea syndrome. METHODS: case description of a sixty-year old, female patient with severe obstructive sleep apnea-hypopnea syndrome that underwent speech therapy treatment for improvement of the apnea/ hypopnea condition, snoring, and day fatigue. Clinical evaluation of orofacial myology and a polysomnography were performed before and after speech therapy. Based on the clinical evaluation, a therapeutic plan was elaborated to provide the patient with cervical relaxation and relaxation of the suprahyoid muscles, for improvement in nasal aeration, tongue strength and position, strengthening of the soft palate muscles and their mobility, as well as the mastication muscles. Alternate bilateral mastication training and lowering of the hyoid bone were included. RESULTS: after twelve-forty-minute sessions of speech therapy, a decrease of cervical tension and relaxation of the suprahyoid muscles were observed. The position of the hyoid bone had been adjusted as well as tongue normotension with the dorsal lowered. The soft palate had normal mobility with adequate mastication. The patient reported important improvement in day fatigue. The result of the second polysomnography indicated a decrease from 44 to 3 events per hour of apnea and hypopnea during sleep, lowering the severe level to an index of breathing disturbance which no longer characterized the disease as sleep apnea. CONCLUSION: speech therapy was effective in the treatment for this case of obstructive sleep apnea-hypopnea syndrome.