Safety and Efficacy of Trichloroacetic Acid Peels in the Treatment of Melasma: A Split-face, Randomized, Prospective Trial in Latin American Women.

Background: There is controversy on the efficacy and safety of chemical peels used to treat Hispanic women with melasma. Studies evaluating superficial peels for melasma are limited due to lack of controls, blinding or objective assessment tools, poor inclusion of darker phototypes, and small sample number. Objectives: We sought to evaluate the safety and efficacy of trichloroacetic acid (TCA) peels when added to hydroquinone and tretinoin in the treatment of melasma in Hispanic women. Methods: A single blinded, prospective, split-face trial of superficial TCA peels was performed on Hispanic women with melasma. Topical hydroquinone and tretinoin were used on both sides. A total of four monthly peels were performed on one side. The relative reduction of melasma severity was evaluated using narrowband reflectance spectrophotometry (NRS), Modified Melasma Area and Severity Index (mMASI), and Global Melasma Severity Assessment (GMSA). Adverse events were monitored. Results: Thirty-three patients completed the study. Pigment intensity was reduced on both sides based on all measures. A greater improvement of mMASI and GMSA was achieved on the peeled side. Limitations: Limitations include the single-center study design with one blinded investigator. Conclusion: Based on our results, TCA peels appear to be safe and effective in augmenting treatment response on melasma patients with phototypes III and IV treated with hydroquinone and tretinoin.

Medication Use Among Pregnant Women With SARS-CoV-2 Infection and Risk of Hospitalization-A Study in Two Brazilian Hospitals.

There is limited evidence about the use of medications among pregnant women with COVID-19, as well as risk factors for hospitalization due to COVID-19 in pregnancy. We aimed to describe the use of medications among SARS-CoV-2-positive pregnant women at the time around infection and identify predictors for hospitalization due to COVID-19 in two hospitals in Brazil. This is a hospital record-based study among pregnant women with positive SARS-CoV-2 tests between March 2020 and August 2022 from two Brazilian hospitals. Characteristics of sociodemographic, obstetrical, and COVID-19 symptoms were extracted retrospectively. The prevalence use of medications was based on self-reported use, and this was administered at the hospital. Logistic regression was used to estimate predictors of hospitalization due to COVID-19. There were 278 pregnant women included in the study, of which 41 (14.7%) required hospitalization due to COVID-19. The remaining 237 (85.3%) had mild symptoms or were asymptomatic. Most of the women had the infection in the third trimester (n = 149; 53.6%). The most prevalent medications used across all trimesters were analgesics (2.4% to 20.0%), antibacterials (15.0% to 23.1%), and corticosteroids (7.2% to 10.4%). Pre- or gestational hypertensive disorder (odds ratio (OR) 4.94, 95% confidence interval (CI) 1.65, 14.87) and having at least one dose of vaccine against SARS-CoV-2 (OR 0.13, 95% CI 0.04, 0.39) were associated with hospitalization due to COVID-19. Analgesics, antibacterials, and corticosteroids were the most frequently used medications among pregnant women with COVID-19. Women with hypertensive disorders have almost a five-fold increased risk of hospitalization due to COVID-19. Vaccination was the strongest protective factor for severe COVID-19. The COVID-19 vaccination among pregnant women should be promoted, and pregnant women diagnosed with COVID-19 who have hypertensive disorders should be closely monitored.

Nano copper in the diet of laying quails: productive performance, metabolism, and tissue concentration.

The study evaluated the use of nano copper in semi-purified diets for laying quails and its effect on performance, metabolic state, and bioavailability. A total of 160 (180-days-old) quails were distributed in a completely randomized design, in a 3x3+1 factorial. The copper sources used were copper sulfate, copper oxide, and nano copper oxide, at levels of 200, 400, and 800 ppm each, totaling nine treatments plus a negative control (with no copper inclusion). The following variables were determined: weight gain, feed intake, egg production, egg weight, hemoglobin, hematocrit, Cu in the tissues and Cu bioavailability. Data were subjected to analysis of variance at 5% probability. The effect of sources and levels, as well as the interaction between the factors were evaluated. When interaction was observed, the effect of sources was evaluated separately by the Tukey's test and the effect of levels by regression, both at 5% probability. Copper nano oxide can be used at up to 800 ppm in the diet of laying quails without altering the productive performance, and with higher bioavailability than conventional copper oxide. Hemoglobin increases with the inclusion of 200 and 400 ppm of nano copper oxide and the hematocrit with 400 ppm.

Relatedness dynamics and sex-biased dispersal in a seasonal cycle of corn mice from intensively managed agroecosystems.

The sex-biased dispersal and kinship dynamics are important factors shaping the spatial distribution of individuals and are key parameters affecting a variety of ecological and evolutionary processes. Here, we studied the spatial distribution of related individuals within a population of corn mice Calomys musculinus in a seasonal cycle to infer dispersal patterns. The sampling was carried out from spring 2005 to winter 2006 in field borders of intensively managed agroecosystems. Genotyping data from 346 individuals with 9 microsatellites showed spatial genetic structure was weak for males, but not for females. The results indicate a complex spatial kinship dynamic of related females across all seasons. Which, contrary to our expectations, dispersal distances decrease with the increase of the population abundance. Meanwhile, male dispersal distances were greater when population abundance increased and thus the availability of active females. Males disperse greater distances to mate and sire offspring with distant females as a possible inbreeding avoidance mechanism. This study shows that C. musculinus is capable of much greater scattering distances than previously reported and that dispersal occurs fluidly and without barriers across the agroecosystem. The indirect benefit of dispersal on individual fitness could be related to relaxing the competition in the natal area and increasing the mating rate. Our study highlights the value of combining genetic relatedness, fieldwork observations, and behavioral data to estimate dispersal at a fine geographical scale.

Lipid profile and reproductive performance of female offspring of SWISS mouse females supplemented with resveratrol or canjiqueira (Byrsonima cydoniifolia A Juss) during gestation.

This study aimed to resveratrol supplementation (at 5 or 10 mg/kg) and a hydroethanolic extract of canjiqueira fruits (150 mg/kg) on female SWISS mice. Total cholesterol, high-density lipoprotein (HDL), triglyceride levels, gestation rates, and embryonic implantation rates in their female Offspring was evaluated. In conclusion, the consumption of canjiqueira fruit extract altered the lipid profile of their female offspring, and did not impact their reproductive performance. Supplementing female SWISS mice with 10 mg/kg of resveratrol increased total cholesterol, triglycerides, and HDL levels, thereby enhancing the reproductive efficiency of their offspring.

Facial fat necrosis after autologous fat transfer possibly associated with SARS-CoV-2 vaccine.

A 52-year-old female patient developed facial fat necrosis presenting with cutaneous induration three weeks after minimal access cranial suspension (MACS) lift with autologous fat grafting from the abdomen. Given that the patient received the Moderna SARS-CoV-2 vaccine one week after surgery, we hypothesize that the former predisposed her to tissue ischemia leading to fat necrosis. Histological findings after biopsy were consistent with fat necrosis, which included marked dermal fibrosis with areas of focal fat necrosis, lipophages, multinucleated giant cells, and siderophages. It is our hope that documenting this rare development in literature may serve as encouragement for adverse effect reporting after the SARS-CoV-2 vaccine administration and may boost inspection and monitoring of other health consequences by regulating agencies.

Deficiencia del transportador de glucosa tipo 1: aspectos clínicos, diagnóstico y terapéutica / Glucose transporter type 1 deficiency syndrome: clinical aspects, diagnosis, and treatment

El síndrome de deficiencia del transportador de glucosa tipo 1 es una enfermedad de causa genética, que involucra el gen SLC2A1. En general, se presenta durante los primeros años de vida con retraso en la adquisición de pautas madurativas, epilepsia farmacorresistente y desórdenes del movimiento. La clínica y la disminución de glucosa en líquido cefalorraquídeo permiten sospechar el diagnóstico, el cual debe ser confirmado mediante el estudio molecular del gen SLC2A1. Debido a que se trata de una enfermedad poco frecuente y de expresión clínica variable, el diagnóstico precoz suele representar un desafío para los equipos de salud. Este es importante, ya que la implementación de la terapia cetogénica logra controlar las manifestaciones clínicas y mejora el pronóstico a largo plazo. Presentamos una revisión sobre el déficit del transportador de glucosa tipo 1, que abarca sus características clínicas, bioquímicas, moleculares y terapéuticas.

Glucose transporter type 1 deficiency with a typical onset is a genetic disorder associated with the SLC2A1 gene. Usually appears during the first years of life with severe developmental delay, drugresistant epilepsy, and movement disorders. Diagnosis is suspected based on clinical manifestations and a low glucose level in cerebrospinal fluid, and should be confirmed by the molecular genetic study of the SLC2A1 gene. As it is a rare disease with variable clinical expression, early diagnosis is often challenging for the healthcare team. Nevertheless, this is important because early implementation of ketogenic therapy will lead to control of the clinical manifestations and a better long-term prognosis. Here we review the glucose transporter type 1 deficiency syndrome focusing on its clinical, biochemical, molecular, and therapeutic characteristics.

Glucose transporter type 1 deficiency syndrome: clinical aspects, diagnosis, and treatment. / Deficiencia del transportador de glucosa tipo 1: aspectos clínicos, diagnóstico y terapéutica.

Glucose transporter type 1 deficiency with a typical onset is a genetic disorder associated with the SLC2A1 gene. Usually appears during the first years of life with severe developmental delay, drugresistant epilepsy, and movement disorders. Diagnosis is suspected based on clinical manifestations and a low glucose level in cerebrospinal fluid,and should be confirmed by the molecular genetic study of the SLC2A1 gene. As it is a rare disease with variable clinical expression, early diagnosis is often challenging for the healthcare team. Nevertheless, this is important because early implementation of ketogenic therapy will lead to control of the clinical manifestations and a better long-term prognosis. Here we review the glucose transporter type 1 deficiency syndrome focusing on its clinical, biochemical, molecular, and therapeutic characteristics.

El síndrome de deficiencia del transportador de glucosa tipo 1 es una enfermedad de causa genética, que involucra el gen SLC2A1. En general, se presenta durante los primeros años de vida con retraso en la adquisición de pautas madurativas, epilepsia farmacorresistente y desórdenes del movimiento. La clínica y la disminución de glucosa en líquido cefalorraquídeo permiten sospechar el diagnóstico, el cual debe ser confirmado mediante el estudio molecular del gen SLC2A1. Debido a que se trata de una enfermedad poco frecuente y de expresión clínica variable, el diagnóstico precoz suele representar un desafío para los equipos de salud. Este es importante, ya que la implementación de la terapia cetogénica logra controlar las manifestaciones clínicas y mejora el pronóstico a largo plazo. Presentamos una revisión sobre el déficit del transportador de glucosa tipo 1, que abarca sus características clínicas, bioquímicas, moleculares y terapéuticas.

Clinical and genetic study of developmental and epileptic encephalopathy in Argentinean pediatric patients.

INTRODUCTION: The aim of this study was to extend our knowledge of the genetic background of Argentinean pediatric patients with developmental and epileptic encephalopathy (DEE) applying a next generation sequencing (NGS) panel. METHODS: Thirty one patients with DEE were studied, including these phenotypes: Dravet syndrome (n:7), Dravet like syndrome (n:3), West syndrome (WS) (n:6), WS that evolved to Lennox-Gastaut syndrome (LGS) (n:4), epilepsy of infancy with migrating focal seizures (n:2), continuous spikes and waves during slow sleep evolving to LGS (n:1), LGS (n:1), myoclonic status in non-progressive encephalopathy (n:1), myoclonic atonic epilepsy (n:1), epileptic encephalopathy with multifocal spikes (n:1) and unclassified epileptic encephalopathy (n:4). Fifty-two genes frequently associated with DEE were studied by NGS in genomic DNA from peripheral blood. RESULTS: Relevant variants were detected in 12 cases; 6 novel pathogenic or likely pathogenic variants, 6 previously reported as pathogenic and 1 variant of unknown significance. Single-nucleotide heterozygous variants were identified in the SCN1A (5), GABRG2 (1), STXBP1 (2) genes, a mosaic variant in SCN2A (1) and a homozygous variant in SCN1B (1). Additionally, a heterozygous deletion involving the SCN1A, SCN2A and SCN3A genes (1), and the most frequent triplet repeat expansion in the ARX gene (1) were detected. DISCUSSION: Genetic diagnosis was made in 39% of patients. We emphasize the importance of considering mosaic variants, copy number variants and hereditary forms when designing and interpreting molecular studies, to optimize diagnosis and management of patients. Approximately 42% of the detected variants were novel, expanding the knowledge of the molecular basis of DEEs in Latin-American patients.

Introducción: El objetivo del estudio fue ampliar el conocimiento de las bases moleculares de las encefalopatías epilépticas y del desarrollo (EED) en pacientes pediátricos argentinos aplicando un panel de secuenciación de nueva generación (NGS). Métodos: Se analizaron 31 pacientes con los fenotipos clínicos de síndrome de Dravet (n:7), síndrome símil Dravet (n:3), síndrome de West (SW) (n:6), SW que evoluciona a síndrome de Lennox Gastaut (SLG)(N:4), epilepsia de la infancia con crisis focales migratorias (n:2), actividad de punta onda continua durante el sueño que evolucionan a SLG (n:1), SLG (n:1), encefalopatía no progresiva con estatus mioclónico (n:1), epilepsia mioclónica atónica (n:1), encefalopatía epiléptica con espigas multifocales (n:1) y encefalopatía epiléptica indeterminada (n:4). Se estudiaron los 52 genes más frecuentemente asociados a EED a través de NGS, en ADN extraído de sangre periférica. Resultados: Se identificaron variantes relevantes en 12 casos, de las cuales 5 fueron nuevas y 6 previamente reportadas como patogénicas o posiblemente patogénicas, mientras que una variante fue clasificada como de significado incierto. Variantes heterocigotas, de nucleótido único, se identificaron en los genes SCN1A (5), GABRG2 (1), STXBP1 (2), una variante en mosaico en SCN2A (1) y otra homocigota en SCN1B (1). Además, se detectó una deleción que involucra a los genes SCN1A, SCN2A y SCN3A (1) y la expansión de repeticiones de tripletes más frecuente en el gen ARX (1). Discusión: Se alcanzó el diagnóstico molecular en el 39% de los pacientes. Remarcamos la importancia de considerar variantes en mosaico, variantes en el número de copias y formas heredadas al momento de diseñar e interpretar los estudios moleculares, de tal forma de optimizar el diagnóstico y seguimiento de los pacientes con EED. Cabe destacar, que el 42% de las variantes detectadas fueron nuevas, ampliando nuestro conocimiento sobre las bases moleculares de las EED en población latino americana.

Clinical and genetic study of developmental and epileptic encephalopathy in argentinean pediatric patients / Estudio clínico y genético de encefalopatía epiléptica y del desarrollo en pacientes pediátricos argentinos

Abstract Introduction: The aim of this study was to extend our knowledge of the genetic background of Argentinean pediatric patients with developmental and epileptic encephalopathy (DEE) applying a next generation sequencing (NGS) panel. Methods: Thirty one patients with DEE were studied, including these phenotypes: Dravet syndrome (n:7), Dravet like syndrome (n:3), West syndrome (WS) (n:6), WS that evolved to Lennox-Gastaut syndrome (LGS) (n:4), epilepsy of infancy with migrating focal seizures (n:2), continuous spikes and waves during slow sleep evolving to LGS (n:1), LGS (n:1), myoclonic status in non-progressive encephalopathy (n:1), myoclonic atonic epilepsy (n:1), epileptic encephalopathy with multifocal spikes (n:1) and unclassified epileptic encephalopathy (n:4). Fifty-two genes frequently associated with DEE were studied by NGS in genomic DNA from peripheral blood. Results: Relevant variants were detected in 12 cases; 6 novel pathogenic or likely pathogenic variants, 6 previously reported as pathogenic and 1 variant of unknown sig nificance. Single-nucleotide heterozygous variants were identified in the SCN1A (5), GABRG2 (1), STXBP1 (2) genes, a mosaic variant in SCN2A (1) and a homozygous variant in SCN1B (1). Additionally, a heterozygous deletion involving the SCN1A, SCN2A and SCN3A genes (1), and the most frequent triplet repeat expansion in the ARX gene (1) were detected. Discussion: Genetic diagnosis was made in 39% of patients. We emphasize the importance of considering mosaic variants, copy number variants and hereditary forms when designing and interpreting molecular studies, to optimize diagnosis and management of patients. Approximately 42% of the de tected variants were novel, expanding the knowledge of the molecular basis of DEEs in Latin-American patients.

Resumen Introducción: El objetivo del estudio fue ampliar el conocimiento de las bases moleculares de las encefalopatías epilépticas y del desarrollo (EED) en pacientes pediátricos argentinos aplicando un panel de secuenciación de nueva generación (NGS). Métodos: Se analizaron 31 pacientes con los fenotipos clínicos de síndrome de Dra vet (n:7), síndrome símil Dravet (n:3), síndrome de West (SW) (n:6), SW que evoluciona a síndrome de Lennox Gastaut (SLG)(N:4), epilepsia de la infancia con crisis focales migratorias (n:2), actividad de punta onda continua durante el sueño que evolucionan a SLG (n:1), SLG (n:1), encefalopatía no progresiva con estatus mioclónico (n:1), epilepsia mioclónica atónica (n:1), encefalopatía epiléptica con espigas multifocales (n:1) y encefalopatía epiléptica indeterminada (n:4). Se estudiaron los 52 genes más frecuentemente asociados a EED a través de NGS, en ADN extraído de sangre periférica. Resultados: Se identificaron variantes relevantes en 12 casos, de las cuales 5 fueron nuevas y 6 previamente reportadas como patogénicas o posiblemente patogénicas, mien tras que una variante fue clasificada como de significado incierto. Variantes heterocigotas, de nucleótido único, se identificaron en los genes SCN1A (5), GABRG2 (1), STXBP1 (2), una variante en mosaico en SCN2A (1) y otra homocigota en SCN1B (1). Además, se detectó una deleción que involucra a los genes SCN1A, SCN2A y SCN3A (1) y la expansión de repeticiones de tripletes más frecuente en el gen ARX (1). Discusión: Se alcanzó el diagnóstico molecular en el 39% de los pacientes. Remarcamos la importancia de considerar variantes en mosaico, variantes en el número de copias y formas heredadas al momento de diseñar e interpretar los estudios moleculares, de tal forma de optimizar el diagnóstico y seguimiento de los pacientes con EED. Cabe destacar, que el 42% de las variantes detectadas fueron nuevas, ampliando nuestro conocimiento sobre las bases mole culares de las EED en población latino americana.

Survey of off-label prescribing in a university paediatric outpatient in Brazil.

Ours is a cross-sectional, descriptive, retrospective study evaluating the extent of off-label prescribing for patients attending a university paediatric outpatient department in Goiás, Brazil. 391 patients were treated in the outpatient, and 668 medicines were prescribed. Of these, 70.4% followed the terms of the marketing authorization; 0.3% were unlicenced, and 11% were off-label. Dose was the main factor in off-label prescribing. Infants (0-2 years) received 37.8% of the off-label prescriptions. Vitamins and drugs for the treatment of respiratory diseases were the most prevalent culprits. Of the total prescriptions, 23 different drugs were defined as off-label. Salbutamol was the most prescribed (41.9%). Owing to practical and legal difficulties in carrying out clinical trials, medicines are inadequately studied in children; cooperation between industry, regulatory authorities, and healthcare professionals is required to improve treatment safety. Our results may help guide clinical researcher on off-label prescripting in future trials.

A 9-Year-Old Patient with Recurrent Fever, Urticarial Rash and Demyelinating Brain Lesions: NLRP3-Autoinflammatory Disease in Ecuador.

Autoinflammatory diseases (AIDs) are a relatively new family disorders defined approximately 20 years ago. AIDs are caused by defect(s) or dysregulation of the innate immune system, characterized by recurrent or continuous inflammation and lack of a primary pathogenic role for the adaptive immune system. One AID, NLRP3-associated autoinflammatory disease (NLRP3-AID), involves a clinical presentation since the neonatal period or childhood, with multiple inflammatory recurrent symptoms that appear throughout the patient´s life. We present the first case of NLRP3-AID in Ecuador. The patient presented recurrent fever since 6 months of age associated with urticarial rash, arthralgias, and abdominal pain; recently, he had a seizure at 7 years of age. Brain MRI revealed demyelinating lesions, and genetic testing uncovered a de novo mutation in the NLRP3 gene. The patient had a good clinical response to treatment with canakinumab.

[Measurable residual disease by rearrangements of immunoglobulins and T-lymphocyte receptors]. / Enfermedad residual medible mediante reordenamientos de inmunoglobulinas y receptores de linfocitos-T.

Acute leukemias are the most common neoplasm in pediatric patients. Currently, 80% of children with diagnosis of acute lymphoblastic leukemia (ALL) are cured with conventional chemotherapy, but 20% of them will have a recurrence of the disease. Measurable Residual Disease (MRD) has been described as an important prognostic factor that allows evaluating the response of patients to treatment. One of the most sensitive techniques to study MRD is the quantification of immunoglobulins (Ig) and T-lymphocyte receptors (TCR) genes rearrangements. The aims of this study were to describe the detected Ig/TCR rearrangements, to evaluate the prognostic impact of MRD in our population of children with ALL and to compare the MRD values by Ig/TCR with those obtained by multiparametric flow cytometry (MFC). A total of 455 patients were studied. In 96% of the cases, it was possible to characterize at least one Ig/TCR rearrangement. The total number of Ig/TCR rearrangements detected was 1550. MRD was successfully applied in 89% of the cases. The combined positive MRD values at day 33 and 78 of treatment allow the identification of high-risk patients in cases previously stratified by MRD using flow cytometry at day 15. The comparison between MRD determination by Ig/TCR rearrangements and FC showed excellent correlation. The present work constitutes a study of MRD by Ig/TCR carried out in a very significant number of patients consecutively diagnosed, treated within a homogeneous protocol and with excellent clinical follow-up.

Las leucemias agudas constituyen la neoplasia más frecuente en pacientes pediátricos. Actualmente, el 80% de los niños con leucemia linfoblástica aguda (LLA) logran curarse con quimioterapia convencional pero el 20% de los mismos presentarán una reaparición de la enfermedad. La enfermedad residual medible (ERM) ha sido descripta como un importante factor pronóstico, que permite evaluar la respuesta de los pacientes al tratamiento. Una de las técnicas más sensibles par a estudiar ERM es la cuantificación de reordenamientos génicos de inmunoglobulinas (Ig) y receptores de linfocitos-T (TCR). Los objetivos del presente trabajo fueron describir los reordenamientos detectados de Ig/TCR, evaluar el efecto de la ERM en la supervivencia de niños con LLA y comparar la ERM por Ig/TCR con la cuantificada mediante citometría de flujo multiparamétrica (CFM). Del total de 455 pacientes estudiados, en el 96% fue posible caracterizar al menos un reordenamiento de Ig/TCR. El total de reordenamientos clonales detectados fue de 1550. La ERM pudo ser estudiada en forma exitosa en el 89% de los casos. El valor de ERM positiva combinada al día 33 y 78 de tratamiento, permitió identificar pacientes de alto riesgo, entre los previamente estratificados por la ERM mediante CFM al día 15. La comparación entre la determinación de ERM mediante reordenamientos Ig/TCR y CFM mostró una excelente correlación. El presente trabajo constituye un estudio de ERM mediante Ig/TCR realizado en un número muy significativo de pacientes diagnosticados en forma consecutiva, tratados en el marco de un protocolo homogéneo y con excelente seguimiento clínico.

Mercury in birds (aquatic and scavenger) from the Western Amazon.

In the Amazon rainforest, methylmercury (MeHg) is easily biomagnified and bio-accumulated in the aquatic food chain. This unique biome has been studied for occupational and environmental issues related to human health and contamination through fish consumption; however, wildlife studies have not yet addressed fish-eating birds. Different species of birds categorized by foraging strategies and life-stages were studied in the Madeira River Basin (Western Amazon rainforest). Feather and tissue (muscle, liver, kidneys, lungs, heart, brain, and blood) samples were collected opportunistically from six bird species feeding on fish and aquatic fauna and a scavenger (a saprophagous species) during the low-water season (July 2017). All collected samples were analyzed for total Hg (THg); methyl-Hg (MeHg) was determined only in feathers. The mean THg concentrations in feathers (dw) were as follows: Ardea cocoi (4.05 µg g-1, n = 51) > Egretta thulla (3.94 µg g-1, n = 5) > Ardea alba (3.80 µg g-1, n = 61) > Anhinga anhinga (3.69 µg g-1, n = 8) > Nannopterum brasilianus (3.07 µg g-1, n = 10). The scavenger Coragyps atratus showed mean THg in feathers (9.93 µg g-1, n = 30) to be significantly higher than in fish-eating birds. Across species, THg levels in feathers correlated significantly with THgmuscle (p = 0.022) and THgbrain (p = 0.002). THg concentrations varied in tissues (feather > liver > kidneys > lungs > heart > muscle > blood > brain). The Hgbrain:Hgfeather, Hgbrain:Hgmuscle, and Hgbrain:Hgblood ratios were 0.031, 0.503 and 0.516, respectively. The mean [MeHg:THg] ratio in feathers from aquatic birds varied between species from 14 to 74% with a mean of 38%. Scavenger birds that forage in the terrestrial Amazonian environments concentrate more THg than species that forage in the aquatic environment. None of the aquatic species showed THg concentration in internal organs that were above threshold for risk of Hg toxicity; additionally, they are not listed in the categories of threat by the International Union for Conservation of Nature (IUCN).

Enfermedad residual medible mediante reordenamientos de inmunoglobulinas y receptores de linfocitos-T / Measurable residual disease by rearrangements of immunoglobulins and T-lymphocyte receptors

Resumen Las leucemias agudas constituyen la neoplasia más frecuente en pacientes pediátricos. Actualmente, el 80% de los niños con leucemia linfoblástica aguda (LLA) logran curarse con quimioterapia con vencional pero el 20% de los mismos presentarán una reaparición de la enfermedad. La enfermedad residual medible (ERM) ha sido descripta como un importante factor pronóstico, que permite evaluar la respuesta de los pacientes al tratamiento. Una de las técnicas más sensibles par a estudiar ERM es la cuantificación de reordena mientos génicos de inmunoglobulinas (Ig) y receptores de linfocitos-T (TCR). Los objetivos del presente trabajo fueron describir los reordenamientos detectados de Ig/TCR, evaluar el efecto de la ERM en la supervivencia de niños con LLA y comparar la ERM por Ig/TCR con la cuantificada mediante citometría de flujo multiparamétrica (CFM). Del total de 455 pacientes estudiados, en el 96% fue posible caracterizar al menos un reordenamiento de Ig/TCR. El total de reordenamientos clonales detectados fue de 1550. La ERM pudo ser estudiada en forma exitosa en el 89% de los casos. El valor de ERM positiva combinada al día 33 y 78 de tratamiento, permitió identificar pacientes de alto riesgo, entre los previamente estratificados por la ERM mediante CFM al día 15. La comparación entre la determinación de ERM mediante reordenamientos Ig/TCR y CFM mostró una excelente correlación. El presente trabajo constituye un estudio de ERM mediante Ig/TCR realizado en un número muy significativo de pacientes diagnosticados en forma consecutiva, tratados en el marco de un protocolo homogéneo y con excelente seguimiento clínico.

Abstract Acute leukemias are the most common neoplasm in pediatric patients. Currently, 80% of children with diagnosis of acute lymphoblastic leukemia (ALL) are cured with conventional chemotherapy, but 20% of them will have a recurrence of the disease. Measurable Residual Disease (MRD) has been described as an important prognostic factor that allows evaluating the response of patients to treatment. One of the most sensitive techniques to study MRD is the quantification of immunoglobulins (Ig) and T-lymphocyte receptors (TCR) genes rearrangements. The aims of this study were to describe the detected Ig/TCR rearrangements, to evaluate the prognostic impact of MRD in our population of children with ALL and to compare the MRD values by Ig/TCR with those obtained by multiparametric flow cytometry (MFC). A total of 455 patients were studied. In 96% of the cases, it was possible to characterize at least one Ig/TCR rearrangement. The total number of Ig/TCR rear rangements detected was 1550. MRD was successfully applied in 89% of the cases. The combined positive MRD values at day 33 and 78 of treatment allow the identification of high-risk patients in cases previously stratified by MRD using flow cytometry at day 15. The comparison between MRD determination by Ig/TCR rearrangements and FC showed excellent correlation. The present work constitutes a study of MRD by Ig/TCR carried out in a very significant number of patients consecutively diagnosed, treated within a homogeneous protocol and with excellent clinical follow-up.

Mercury in blood, hair, and feces from subsistence fish-eating riverines of the Madeira River Basin (Western Amazon).

BACKGROUND: The Madeira River (Amazon Basin) has been impacted by activities related to artisanal and small-scale gold mining (ASGM), deforestation and burning (for timber, agriculture, and hydroelectric dam projects). All these activities contribute to environmental mercury (Hg) release and cycling into the Amazon ecosystem and thus to changing lifestyles. METHOD: We assessed exposure to total and MeHg in two small riverine communities of the Madeira River (Amazon): Lago Puruzinho (LP, n = 26 families) and São Sebastião do Tapurú (SST, n = 31 families). Samples of human hair (n = 137), blood (n = 39), and feces (n = 41) were collected from adults and children (0-15 years of age). RESULTS: In women of childbearing age from LP village, the mean blood total-Hg (THg) (45.54 ±â€¯24.76 µg.L-1) and MeHg (10.79 ±â€¯4.36 µg.L-1) concentrations were significantly (p = 0.0024; p < 0.0001, respectively) higher than in women from SST village (THg: 25.32 ±â€¯16.75 µg.L-1; MeHg: 2.32 ±â€¯1.56 µg.L-1) village; the trend in hair-Hg persisted but was statistically significant (p < 0.0145) only for THg (LP, 11.34 ±â€¯5.03 µg. g-1; SST, 7.97 ±â€¯3.51 µg. g-1). In women, the median hair:blood ratio of total Hg was 269. In children, the mean hair THg concentrations were 6.07 ±â€¯3.60 µg. g-1 and 6.47 ±â€¯4.16 µg. g-1 in LP and SST; thus, not significantly different (p = 0.8006). There was a significant association (p < 0.001) between hair-Hg concentrations of mothers and their respective children. The excretion of Hg in feces of women (0.52 µg. g-1 dw) was not significantly different from children (0.49 µg. g-1 dw). The only statistically significant correlation between Hg in feces and in hair was found in children, (n = 16, rs = 0.38, p = 0.005). Significant relationship was seen between the levels of THg in blood and hair of women from LP and SST. Based on hair-Hg concentrations, fish consumption rate ranged from 94.5 to 212.3 g.day-1. CONCLUSION: Women and children excrete THg in feces in comparable concentrations. However, the mean fish consumption rate and blood MeHg are higher in the most remote villagers. Mother`s hair-Hg concentration is a good predictor of children's hair-Hg.

Preretinal hemorrhage preventing subretinal involvement in multilayer macular hemorrhages: coincidence or plausible relationship?

BACKGROUND: To report four cases with interesting anatomical presentations of multilayer macular hemorrhages with preretinal hemorrhage possibly preventing subretinal involvement of the macular area. CASES PRESENTATION: Observational study of four patients presenting with macular hemorrhages. RESULTS: Four patients with multilayer macular hemorrhage due to different causes, presented with a halo-shaped submacular hemorrhage coincident with the preretinal hemorrhage borders. After resolution, in all cases, the macular area underneath the preretinal hemorrhage was found to be spared. CONCLUSION: We hypothesized that an extensive preretinal hemorrhage can exert a mechanical force pushing the subretinal hemorrhage towards the periphery, consequently protecting the macular area.

Three new species of Urocleidoides (Monogenoidea: Dactylogyridae) parasitizing characiforms (Actinopterygii: Characiformes) in Tocantins River, states of Tocantins and Maranhão, and new record for U. triangulus in Guandu River, state of Rio de Janeiro, Brazil

Three new species of Urocleidoides Mizelle & Price, 1964 are described from the gills of characiform fishes in the Tocantins River and its tributaries. Urocleidoides boulengerellae sp. nov. is described from Boulengerella cuvieri (Spix & Agassiz, 1829) and differs from all its congeners by the dorsal bar with a long posteromedial projection; male copulatory organ with 2-3 counterclockwise rings and a base with a flange; an accessory piece comprising a robust Y-shaped unit and a sheath-like unit; and a highly sclerotized vaginal canal. Urocleidoides paratriangulus sp. nov., described from Psectrogaster amazonica Eigenmann & Eigenmann, 1889, Cyphocharax gouldingi Vari, 1992, Caenotropus labyrinthicus (Kner, 1858) and Mylesinus paucisquamatus Jégu & Santos, 1988, is most similar to Urocleidoides triangulus (Suriano, 1981) Rossin & Timi, 2016 based on the shape of the anchors and bars but differs from U. triangulus in the morphology of the projection of the dorsal bar, the number of rings of male copulatory organ, and by the smaller size of members of hook pairs 1 and 5 compared with those of the remaining pairs. Urocleidoides tocantinensis sp. nov. is easily distinguished from all other species of the genus by the morphology of the vagina, which present a vaginal vestibule with a membranous cap. Urocleidoides triangulus is reported from its type host in the Guandu River, state of Rio de Janeiro. The present study increases the number of Urocleidoides species to 37 recognized species that fit all the generic characters.(AU)

Three new species of Urocleidoides (Monogenoidea: Dactylogyridae) parasitizing characiforms (Actinopterygii: Characiformes) in Tocantins River, states of Tocantins and Maranhão, and new record for U. triangulus in Guandu River, state of Rio de Janeiro, Brazil

Three new species of Urocleidoides Mizelle & Price, 1964 are described from the gills of characiform fishes in the Tocantins River and its tributaries. Urocleidoides boulengerellae sp. nov. is described from Boulengerella cuvieri (Spix & Agassiz, 1829) and differs from all its congeners by the dorsal bar with a long posteromedial projection; male copulatory organ with 2-3 counterclockwise rings and a base with a flange; an accessory piece comprising a robust Y-shaped unit and a sheath-like unit; and a highly sclerotized vaginal canal. Urocleidoides paratriangulus sp. nov., described from Psectrogaster amazonica Eigenmann & Eigenmann, 1889, Cyphocharax gouldingi Vari, 1992, Caenotropus labyrinthicus (Kner, 1858) and Mylesinus paucisquamatus Jégu & Santos, 1988, is most similar to Urocleidoides triangulus (Suriano, 1981) Rossin & Timi, 2016 based on the shape of the anchors and bars but differs from U. triangulus in the morphology of the projection of the dorsal bar, the number of rings of male copulatory organ, and by the smaller size of members of hook pairs 1 and 5 compared with those of the remaining pairs. Urocleidoides tocantinensis sp. nov. is easily distinguished from all other species of the genus by the morphology of the vagina, which present a vaginal vestibule with a membranous cap. Urocleidoides triangulus is reported from its type host in the Guandu River, state of Rio de Janeiro. The present study increases the number of Urocleidoides species to 37 recognized species that fit all the generic characters.

Three new species of Urocleidoides (Monogenoidea: Dactylogyridae) parasitizing characiforms (Actinopterygii: Characiformes) in Tocantins River, states of Tocantins and Maranhão, and new record for U. triangulus in Guandu River, state of Rio de Janeiro, Brazil

ABSTRACT Three new species of Urocleidoides Mizelle & Price, 1964 are described from the gills of characiform fishes in the Tocantins River and its tributaries. Urocleidoides boulengerellae sp. nov. is described from Boulengerella cuvieri (Spix & Agassiz, 1829) and differs from all its congeners by the dorsal bar with a long posteromedial projection; male copulatory organ with 2-3 counterclockwise rings and a base with a flange; an accessory piece comprising a robust Y-shaped unit and a sheath-like unit; and a highly sclerotized vaginal canal. Urocleidoides paratriangulus sp. nov., described from Psectrogaster amazonica Eigenmann & Eigenmann, 1889, Cyphocharax gouldingi Vari, 1992, Caenotropus labyrinthicus (Kner, 1858) and Mylesinus paucisquamatus Jégu & Santos, 1988, is most similar to Urocleidoides triangulus (Suriano, 1981) Rossin & Timi, 2016 based on the shape of the anchors and bars but differs from U. triangulus in the morphology of the projection of the dorsal bar, the number of rings of male copulatory organ, and by the smaller size of members of hook pairs 1 and 5 compared with those of the remaining pairs. Urocleidoides tocantinensis sp. nov. is easily distinguished from all other species of the genus by the morphology of the vagina, which present a vaginal vestibule with a membranous cap. Urocleidoides triangulus is reported from its type host in the Guandu River, state of Rio de Janeiro. The present study increases the number of Urocleidoides species to 37 recognized species that fit all the generic characters.