Bacterial load in cerebrospinal fluid predicts unfavourable outcome in pneumococcal meningitis: a prospective nationwide cohort study.

OBJECTIVES: The objective of this study was to determine the role of cerebrospinal fluid (CSF) bacterial load in adults with pneumococcal meningitis. METHODS: We quantified bacterial load in CSF samples from the diagnostic lumbar puncture of adults with community-acquired pneumococcal meningitis. We also measured CSF concentrations of complement component 5a (C5a), and determined associations between bacterial load, clinical characteristics, C5a and unfavourable outcome (Glasgow Outcome Scale score <5). RESULTS: Bacterial load was quantified in 152 CSF samples. Median age of these patients was 61 years (interquartile range [IQR] 51-68), and 69 of 152 (45%) were female. Median CSF bacterial load was 1.6 × 104 DNA copies/mL (IQR 3.4 × 103-1.2 × 105), and did not correlate with CSF white cell count nor with CSF protein concentrations. Median CSF C5a concentration was 35.8 mg/L (IQR 15.9-105.6), and was moderately correlated with CSF bacterial loads (Spearman's rho = 0.42; p < 0001). High bacterial loads were associated with development of complications, such as circulatory shock (OR per logarithmic increase: 2.4, 95% CI: 2.0-2.9; p < 0.001) and cerebrovascular complications [OR: 1.9, 95% CI: 1.6-2.3; p < 0.001]). High bacterial loads were also associated with unfavourable outcome (OR: 2.8, 95% CI: 2.4-3.3; p < 0.001) and death (OR: 3.1, 95% CI: 2.6-3.8; p < 0.001). In a multivariable regression model including age, immunocompromised state, extrameningeal infection focus, admission Glasgow Coma Scale score and CSF C5a concentration, CSF bacterial load remained an independent predictor of unfavourable outcome (adjusted OR: 2.5, 95% CI: 1.6-3.9; p < 0.001). DISCUSSION: High CSF bacterial load predicts the development of complications and unfavourable outcome in adults with pneumococcal meningitis.

Melanoacanthoma, Plasma Cell Cheilitis and Langerhans Cell Hyperplasia on the Lower Lip: An Unusual Association and Immunohistochemical Analysis.

Oral melanoacanthoma is an uncommon reactive lesion, characterized by basal and prickle cell keratinocyte proliferation surrounded by pigment-laden dendritic melanocytes. Plasma cell cheilitis (PCC) is an inflammatory disorder of unknown aetiology, microscopically presenting a dense plasma cell infiltrate. Most PCC cases affect the lower lip. Langerhans cell hyperplasia (LCHyp), a non-neoplastic counterpart of the LC proliferations, has been reported in association with chronic inflammatory skin diseases. Here, we present an unusual association of melanoacanthoma, PCC and LCHyp on the lower lip in a 59-old-year male, expanding the clinicopathological spectrum of these uncommon lesions. The dendritic melanocytes were highlighted by Fontana-Masson stain and HMB-45, whereas S100, CD1a and CD207 evidenced numerous LCs. MUM1/IRF4, EMA, and CD138 highlighted sheets of polyclonal plasma cells, with an IgG4+/IgG+ ratio of 24%. FTA-ABS test for syphilis was negative.

Effect of physical therapy interventions on spatiotemporal gait parameters in children with cerebral palsy: a systematic review.

AIM: To investigate the effect of physical therapy interventions on spatiotemporal gait parameters in children with cerebral palsy. METHODS: Six databases were searched: PubMed, Embase, Web of Science, Science Direct, Lilacs, and Scopus. Two independent reviewers worked on primary study selection based on titles, abstracts, and full text reading. We included randomized controlled trials investigating the role of therapeutic interventions on gait kinematics in children with cerebral palsy. The independent reviewers extracted information about study population, intervention type, main outcomes, and methodological quality according to PEDro Scale. The body of evidence was synthesized through GRADE. RESULTS: Twenty-six studies were found addressing the following treatment categories: functional electrical stimulation, transcranial stimulation, gait training, muscular strengthening, vibratory platform training, and serial casting. A moderate level of evidence was identified for vibratory platform training, gait training, transcranial stimulation (positive effect), and isolated muscle strengthening (negative effect) in relation to gait velocity. Electrical stimulation showed a moderate level of evidence regarding stride length. The evidence for other outcomes was of low or very low quality. CONCLUSION: Vibratory platform, gait training, electrical stimulation, and transcranial stimulation were effective to improve spatiotemporal gait parameters, especially velocity in children with cerebral palsy.Implication for rehabilitationImprovement and maintenance of gait of children with cerebral palsy is a great challenge to rehabilitation professionalsVibratory platform, gait training, electrical stimulation, and transcranial stimulation improve gait parameters.Isolated strength training was not effective to improve gait parameters in Cerebral Palsy.Long-term effect of most techniques on gait parameters until unclear.

Functional near-infrared spectroscopy to assess sensorimotor cortical activity during hand squeezing and ankle dorsiflexion in individuals with and without bilateral and unilateral cerebral palsy.

Significance: Our study is the first comparison of brain activation patterns during motor tasks across unilateral cerebral palsy (UCP), bilateral cerebral palsy (BCP), and typical development (TD) to elucidate neural mechanisms and inform rehabilitation strategies. Aim: Cortical activation patterns were compared for distal upper and lower extremity tasks in UCP, BCP, and TD using functional near-infrared spectroscopy (fNIRS) and related to functional severity. Approach: Individuals with UCP ( n = 10 , 18.8 ± 6.8 years ), BCP ( n = 14 , 17.5 ± 9.6 years ), and TD ( n = 16 , 17.3 ± 9.1 years ) participated in this cross-sectional cohort study. The fNIRS was used to noninvasively monitor the hemodynamic response to task-related cortical activation. The block design involved repetitive nondominant hand squeezing and ankle dorsiflexion. Results: Individuals with UCP demonstrated the highest levels of activation for the squeeze task ( UCP > BCP q = 0.049 ; BCP > TD q < 0.001 ; and UCP > TD q = 0.001 ) and more activity in the ipsilateral versus contralateral hemisphere. Individuals with BCP showed the highest levels of cortical activation in the dorsiflexion task ( BCP > UCP q < 0.001 ; BCP > TD ). Conclusions: Grouping by CP subtype and manual function or mobility level demonstrated significant differences from TD, even for individuals with the mildest forms of CP. Hemispheric activation patterns showed hypothesized but nonsignificant trends.

High Genotypic Diversity, Putative New Types and Intra-Genotype Variants of Bovine Papillomavirus in Northeast Brazil.

Bovine papillomavirus (BPV) can cause damage to the epithelial and mucosal tissue and currently presents 28 known types. Not all BPV types are associated with the development of cancer in cattle. Studies have shown that variants of human papillomavirus types can present different pathogenic profiles. However, despite the similarity, it is not yet known whether variants of BPV types can also present varying degrees of pathogenicity. Thus, the aim of this study was to evaluate the genetic variability of BPV types and variants isolated in Northeastern Brazil. Samples were obtained from animals with papillomatous lesions. BPV DNA was detected by the amplification of the L1 gene and genotyping was performed by sequencing. Mutations were analyzed in a phylogenetic, structural and functional context. In total, 52 positive samples were obtained and 11 different BPV types were identified in the samples. Ten putative new BPV types were also identified. In addition, several non-synonymous mutations were identified and predicted to alter protein stability, having an impact on immune evasion. The study demonstrated a high genetic diversity of BPV in the region with a large number of mutations identified, serving as a basis for more efficient control measures to be adopted for bovine papillomatosis.

Lifestyle behaviors among undergraduate nursing students: A latent class analysis.

This is a cross-sectional study whose objective was to identify clustering of lifestyle behaviors among undergraduate nursing students to inform health promotion efforts and improve health outcomes later in life. All 353 undergraduate nursing students from the School of Nursing in a public university, Bahia, Brazil were invited to participate. The inclusion and exclusion criteria were according to the major project. Participants must be enrolled and attending the 1st to 10th semester, with a minimum age of 18 years. Participants were excluded if they had any physical disabilities that limited the collection of anthropometric measures or were completing an internship off-campus. A total of 286 undergraduate nursing students met the criteria and completed the survey. The questionnaires included standardized measures for demographic, academic, and lifestyle behaviors (e.g., tobacco use, alcohol use, physical activity level, sedentary behavior, and fruits and vegetables consumed). Latent class analysis was performed to identify any clustering of lifestyle behaviors. Descriptive analyses indicated that 3.1% of the students were smokers, 23.1% consumed alcohol, 34.3% were inactive, 85.0% were sedentary, and 80.8% did not consume recommended amounts of fruits and vegetables. Latent class analysis produced four distinct subtypes of health risk: (a) low-health risk (33.57%); (b) moderate-health risk (27.97%); (c) high-health risk (19.58%); and (d) very high-health risk (18.88%). Approximately 38.5% of students were in the very high or high-risk classes. The proportion of students with very high and high-health risks emphasizes the importance of health promotion programs for university nursing students.

Dual-task effects in children with neuromotor dysfunction: a systematic review.

INTRODUCTION: Based on the assumption that motor actions result from the interaction between cognitive, perceptual, mechanical and neurological mechanisms, neuromotor dysfunctions are expected to impair central coordination processes required to perform dual-tasks. The aim of the present work was to systematically review the literature concerning the effects of dual-task in the activities performed by children with neuromotor dysfunctions. EVIDENCE ACQUISITION: A tailored search strategy in relevant databases was conducted by two independent reviewers in August 2018 seeking for online articles published in English evaluating dual-task (motor-motor, cognitive-cognitive or cognitive-motor) effects on activities in subjects with neuromotor dysfunctions younger than 18 years. The following data were extracted: category of dual-task paradigm (motor-motor; cognitive-cognitive; cognitive-motor), primary and secondary tasks, study methods, methodological quality of the studies, and research gaps in the literature. EVIDENCE SYNTHESIS: We identified 13 full-text reports that fulfilled the predefined inclusion and exclusion criteria. CONCLUSIONS: There are a few high-quality studies addressing dual-task effects on activities performed by children with neuromotor dysfunctions. These children show greater susceptibility to dual-task costs than typical ones. There is a lack of studies addressing children with CP and Down Syndrome, which are highly prevalent and commonly seen in clinical settings. Thus, dual-task effects in children with neuromotor dysfunctions remain a wide research field, with need for further studies to fill in the existing gaps.

Effects of quantitative feed restriction and sex on carcass traits, meat quality and meat lipid profile of Morada Nova lambs.

BACKGROUND: An experiment was conducted to evaluate the effects of feed restriction (FR) and sex on the quantitative and qualitative carcass traits of Morada Nova lambs. Thirty-five animals with an initial body weight of 14.5 ± 0.89 kg and age of 120 d were used in a completely randomized study with a 3 × 3 factorial scheme consisting of three sexes (11 entire males, 12 castrated males and 12 females) and three levels of feeding (ad libitum - AL and 30% and 60% FR). RESULTS: Entire males presented greater hot and cold carcass weights (P < 0.05), followed by castrated males and females. However, the hot carcass yield was higher for females and castrated males than for entire males. Luminosity values were influenced (P < 0.05) by sex, with entire males presenting higher values than castrated males and females. Females showed higher (P < 0.05) concentrations of linoleic acid and arachidonic acid in the meat of the longissimus thoracis muscle. The meat of animals submitted to AL intake and 30% FR showed similar (P > 0.05) concentrations, and the concentrations of palmitic acid, palmitoleic acid, stearic acid, oleic acid and conjugated linoleic acid were higher (P < 0.05) than those of animals with 60% FR. The meat of females had a higher ω6/ω3 ratio and lower h/H ratio, and females had greater levels of feeding. The meat of animals on the 60% FR diet had a greater ω6/ω3 ratio, lower h/H ratio and lower concentration of desirable fatty acids in addition to a greater atherogenicity index (AI) and thrombogenicity index (TI). CONCLUSION: Lambs of different sexes had carcasses with different quantitative traits without total influence on the chemical and physical meat characteristics. The lipid profile of the meat was less favorable to consumer health when the animals were female or submitted to 60% feed restriction.

Supplementation with Cashew Nut and Cottonseed Meal to Modify Fatty Acid Content in Lamb Meat.

This study evaluates the effect of cashew nut meal (CNM), whole cottonseed (WCS), and calcium salts of long-chain fatty acids (Ca-LCFA) on the fatty acid profiles of meat from hair lambs. Thirty-five 60-d-old, male, noncastrated Santa Ines lambs with an initial average body weight of 13.00 ± 1.80 kg were used in a randomized complete-block design with 7 blocks and 5 treatments. The experimental treatments consisted of a control diet (CON) without supplemental lipids and 4 test diets with different lipid supplements that were selected according to the degree of protection from ruminal hydrogenation and their polyunsaturated fatty acid richness. The tests diets included the following modifications: supplementation with WCS, supplementation with CNM, supplementation with both cottonseed and CNM (CSCNM), and supplementation with Ca-LCFA. The C18:1n9c content was highest in the meat of the animals fed the CNM diet (42.00%). The meat from lambs fed the WCS and Ca-LCFA diets had higher C18:0 contents (25.23 and 22.80%, respectively). The C16:1 content was higher in the meat from the animals fed the CNM and CON diets (1.54 and 1.49%, respectively). C18:2c9t11 concentration was higher in the meat from the animals fed the Ca-LCFA and CNM diets. The estimated enzyme activity of Δ9-desaturase C18 was highest in the muscles of the lambs fed the CON, CNM, and CSCNM diets. The use of cashew nuts in the diet resulted in an increase in the C18:2c9t11 content of the lamb meat, which improved the nutritional characteristics of the fat.

Secretory expression of Porcine Circovirus Type 2 capsid protein in Pichia pastoris.

Porcine circovirus type 2 (PCV2) is associated with postweaning multisystemic wasting syndrome (PMWS). The PCV2 capsid (Cap) protein is a leading antigen candidate for vaccine and serological diagnostic testing, due to its immunogenic properties. In this study, the codon-optimized PCV2 Cap gene was cloned into a pPICZαA vector for secretory expression in the methylotrophic yeast Pichia pastoris after methanol induction. The screening of recombinant yeasts was followed by detection of the recombinant Cap (rCap) protein by Western blot, using sera from pigs naturally infected with PCV2. The rCap secreted protein was used without prior purification as a coating antigen in the ELISA test, with high discrimination between PCV2-positive and negative sera. These results reveal a high confidence in the specific immunoreactivity of the secreted antigen and show the antigenicity of the recombinant protein. The feasibility of the P. pastoris expression system for the production of PCV2 Cap as secreted protein and its apparent bioactivity, suggests there are good prospects for the use of this antigen in the investigation of PCV2 infections and testing for vaccine purposes.

Efficient and reliable characterization of the corticospinal system using transcranial magnetic stimulation.

PURPOSE: The purpose of this study is to develop a method to reliably characterize multiple features of the corticospinal system in a more efficient manner than typically done in transcranial magnetic stimulation studies. METHODS: Forty transcranial magnetic stimulation pulses of varying intensity were given over the first dorsal interosseous motor hot spot in 10 healthy adults. The first dorsal interosseous motor-evoked potential size was recorded during rest and activation to create recruitment curves. The Boltzmann sigmoidal function was fit to the data, and parameters relating to maximal motor-evoked potential size, curve slope, and stimulus intensity leading to half-maximal motor-evoked potential size were computed from the curve fit. RESULTS: Good to excellent test-retest reliability was found for all corticospinal parameters at rest and during activation with 40 transcranial magnetic stimulation pulses. CONCLUSIONS: Through the use of curve fitting, important features of the corticospinal system can be determined with fewer stimuli than typically used for the same information. Determining the recruitment curve provides a basis to understand the state of the corticospinal system and select subject-specific parameters for transcranial magnetic stimulation testing quickly and without unnecessary exposure to magnetic stimulation. This method can be useful in individuals who have difficulty in maintaining stillness, including children and patients with motor disorders.

Mucoadhesive propolis gel for prevention of radiation-induced oral mucositis.

The objective of this phase II study was to determine the effectiveness of a mucoadhesive propolis gel in the prevention of radiation-induced oral mucositis. Twenty-four patients who were selected to undergo radiation therapy for oral cancer were included in this open-label trial. They were advised to use a mucoadhesive gel containing propolis 5,0% w/v three times a day starting one day before the course of radiation therapy and concluding after 2 weeks of radiation therapy. A weekly follow-up for evaluation of food intake, pain and grading of mucositis was performed. In order to confirm the absence of Candida-related mucositis in patients who developed mucositis, it was performed exfoliative cytology of buccal mucosa, palate and tongue and the material for Candifast(®) Candida species identification. At the end of the study was made the compliance of patients, quality, appreciation and acceptance of product evaluation. Twenty patients did not develop mucositis, two patients developed grade 1 mucositis and two patients developed grade 2 mucositis. None of the patients discontinued food intake and no pain was observed during the study. Candidosis was not detected in any patient. Mucoadhesive propolis gel could be considered as a potential topical medication for preventing radiation-induced oral mucositis. However, comparative phase III study with larger number of patients should be done for confirmation of the efficacy of the product.

Mycoplasma agalactiae in semen and milk of goat from Pernambuco state, Brazil / Mycoplasma agalactiae em sêmen e leite de caprinos do estado de Pernambuco

In goat and sheep flocks, mycoplasmosis is a disease that may cause severe economical losses associated with polyarthritis, mastitis, agalactia, conjunctivitis, pneumonia and reproductive failure. The latter may involve repeat breeding, granular vulvovaginitis, infertility and abortions. The aim of the present study was to assess the occurrence of Mycoplasma agalactiae (Ma) in semen and milk samples from naturally infected goat in the semiarid region from Pernambuco State, Northeast from Brazil. Thirty-nine semen samples and 81 milk samples were submitted to DNA extraction using a commercially available kit and following the manufacturer's instructions. The polymerase chain reaction (PCR) was then performed in accordance with protocols described in the literature. The results of the present study revealed the presence of Ma in the DNA of 17.9% (7/39) of the semen samples and 3.7% (3/81) of the milk samples. The results obtained in the present study confirm the elimination of the DNA of Ma in the semen and milk samples. The presence of this agent in goat flocks is considered very risky in terms of reproductive disorders and contagious agalactia outbreaks in the Northeast region of Brazil.

Em caprinos e ovinos as micoplasmoses causam sérias perdas econômicas associadas com poliartrites, mastites, agalaxia, conjuntivite, pneumonias e falhas reprodutivas. Esta última pode envolver repetição de cio, vulvovaginite granular, infertilidade e abortos. O objetivo desse estudo foi verificar a ocorrência de Mycoplasma agalactiae (Ma) em sêmen e leite de caprinos naturalmente infectados procedentes de regiões semiáridas do Estado de Pernambuco, Nordeste do Brasil. Foram usadas 39 amostras de sêmen e 81 de leite, as quais foram submetidas à extração do DNA genômico usando um kit comercial, seguindo as instruções do fabricante. A reação da PCR foi realizada de acordo com protocolo previamente descrito na literatura. Os resultados revelaram a presença de DNA de Ma nas amostras de sêmen com uma frequência de 17,9% (7/39) e no leite a frequência encontrada foi de 3,7% (3/81). Os resultados obtidos no presente estudo confirmam a eliminação de DNA de Ma nas amostras de sêmen e leite analisadas. A presença deste agente nos rebanhos caprinos pode ser considerada um risco para doenças reprodutivas e surtos de agalaxia contagiosa na região Nordeste do Brasil.

Desenvolvimento e avaliação de um teste ELISA indireto para o diagnóstico sorológico do mormo em equídeos / Standardization and evaluation of an indirect ELISA for the serological diagnosis of glanders in horses

O mormo é uma enfermidade infecto-contagiosa de caráter agudo ou crônico que acomete principalmente os equídeos, causando enormes prejuízos na cadeia produtiva do cavalo. Para controlar a enfermidade o Ministério da Agricultura, Pecuária e Abastecimento (MAPA) instituiu medidas sanitárias obrigatórias em todo território nacional que incluem o diagnóstico oficial pela fixação do complemento (FC), maleinização e sacrifício dos animais positivos. Os kits atuais utilizados no diagnóstico da doença são importados, dificultando e encarecendo sua aplicação na rotina. Objetivou-se com este estudo padronizar um teste de ELISA indireto utilizando o extrato protéico de Burkholderia mallei isolada a partir de equídeo portador no estado de Pernambuco. As amostras foram cultivadas em ágar sangue 10%, incubada por 48h a 37°C; posteriormente caracterizou-se fenotípica e genotipicamente uma das colônias isoladas, e em seguida a cultivou em BHI para enriquecimento; logo após, esta foi repicada para o meio Dor-set Henley o qual foi incubado a 37ºC sob 60rpm por oito semanas. Para padronização do teste utilizou-se o Conjugado Proteína G Peroxidase Sigma na diluição de 1:90.000, com soros diluídos em 1:100 e o antígeno em 1:400. Utilizou-se 60 soros como controle negativo testados frente à FC para determinação do ponto de corte o qual ficou em 0,042nm. Feitas as padronizações, foram testadas 300 amostras, onde 99% (297) foram concordantes com os resultados obtidos na FC. Ao final, o ensaio apresentou 100% de sensibilidade e 98,2% de especificidade com valores preditivo positivo e negativo de 97,7% e 100%, respectivamente. O teste de concordância kappa foi 0,98 e a repetibilidade intra e interplaca ficaram em 8,8 e 10,3%, respectivamente. Diante dos resultados obtidos durante os ensaios, conclui-se que o teste de ELISA indireto pode ser utilizado como uma ferramenta de diagnóstico eficiente. Entretanto, mais ensaios devem ser realizados visando consolidar a confiabilidade do referido teste.

Glanders is an infectious-contagious disease of acute or chronic character which principally affects horses, causing enormous losses in the productive chain of this animal. To control the disease, the Ministry of Agriculture, Husbandry and Supply instituted mandatory sanitation measures in the entire national territory which include an official diagnosis through the complement fixation (CF) test, maleinization and sacrifice of the animals that are positive. Nowadays the kits used for the diagnosis of the disease are imported, making their routine application difficult and more expensive. The objective of this study was to standardize an indirect ELISA test, using the proteic extract of Burkholderia mallei isolated from a carrier horse in the state of Pernambuco. The samples were cultivated in 10% blood agar and incubated for 48h at 37°C; later, one of the isolated colonies was characterized phenotypically and genotypically and immediately cultivated in brain heart infusion (BHI) for enrichment; then it was peaked (repicada) for the Dor-set Henley medium which was incubated at 37ºC under 60rpm for eight weeks. To standardize the test the Protein G Peroxidase Sigma Conjugate was used in the dilution of 1:90.000, with serums diluted in 1:100 and the antigen in 1:400. Sixty serums were used as negative controls, tested before the CF to determine the cutting point which was 0.042nm. After establishing the standardization, 300 samples were tested, of which 99% (297) were in agreement with the results obtained in the CF. At the end, of assay presented 100% sensibility and 98.2% specificity, with predictive (preditivo) positive and negative values of 97.7% and 100% respectively. The Kappa concordance test was 0.98 and the intra and interplac repeatability were 8.8% and 10.3% respectively. From the results obtained, it is possible to affirm that the indirect ELISA test can be used as an efficient diagnosis tool. However, more essays must be carried out to consolidate the reliability of this test.

Oxidative stress modulates DNA methylation during melanocyte anchorage blockade associated with malignant transformation.

Both oxidative/nitrosative stress and alterations in DNA methylation are observed during carcinogenesis of different tumor types, but no clear correlation between these events has been demonstrated until now. Melanoma cell lines were previously established after submitting the nontumorigenicmelanocyte lineage, melan-a, to cycles of anchorage blockade. In this work, increased intracellular oxidative species and nitric oxide levels, as well as alterations in the DNA methylation, were observed after melan-a detachment, which were also associated with a decrease in intracellular homocysteine (Hcy), an element in the methionine (universal methyl donor) cycle. This alteration was accompanied by increase in glutathione (GSH) levels and methylated DNA content. Furthermore, a significant increase in dnmt1 and 3b expression was identified along melan-a anchorage blockade. L(G)-Nitro-L-arginine methyl esther (L-NAME), known as a nitric oxide synthase (NOS) inhibitor, and N-acetyl-L-cysteine (NAC) prevented the increase in global DNA methylation, as well as the increase in dnmt1 and 3b expression, observed during melan-a detachment. Interestingly, both L-NAME and NAC did not inhibit nitric oxide (NO) production in these cells, but abrogated superoxide anion production during anchorage blockade. In conclusion, oxidative stress observed during melanocyte anchorage blockade seems to modulate DNA methylation levels and may directly contribute to the acquisition of an anoikis-resistant phenotype through an epigenetic mechanism.