Chest X-ray evaluation using machine learning to support the early diagnosis of pulmonary TB.

TB is a public health problem, and its diagnosis can be challenging. Among imaging methods, chest X-ray (CXR) is the leading choice for assessing pulmonary TB (PTB). Recent advancements in the field of artificial intelligence have stimulated studies evaluating the performance of machine learning (ML) for medical diagnosis. This study validated a new original Brazilian tool, the XmarTB, applied to CXR images to support the early diagnosis of PTB.An ML model was trained on 3,800 normal images, 3,800 abnormal CXRs without PTB and 1,376 with PTB manifestations from the publicly available TBX11K database.The binary classification can distinguish between normal and abnormal CXR with a sensitivity of 99.4% and specificity of 99.4%. The XmarTB tool had a sensitivity of 98.1% and a specificity of 99.7% in detecting TB cases among CXRs with abnormal CXRs; sensitivity was 96.7% and specificity 98.7% in detecting TB cases among all samples.This diagnostic tool can accurately and automatically detect abnormal CXRs and satisfactorily differentiate PTB from other pulmonary diseases. This tool holds significant promise in aiding the proactive detection of TB cases, providing rapid and accurate support for early diagnosis..

COVID-19 impedimetric biosensor based on polypyrrole nanotubes, nickel hydroxide and VHH antibody fragment: specific, sensitive, and rapid viral detection in saliva samples.

SARS-CoV-2 rapid spread required urgent, accurate, and prompt diagnosis to control the virus dissemination and pandemic management. Several sensors were developed using different biorecognition elements to obtain high specificity and sensitivity. However, the task to achieve these parameters in combination with fast detection, simplicity, and portability to identify the biorecognition element even in low concentration remains a challenge. Therefore, we developed an electrochemical biosensor based on polypyrrole nanotubes coupled via Ni(OH)2 ligation to an engineered antigen-binding fragment of heavy chain-only antibodies (VHH) termed Sb#15. Herein we report Sb#15-His6 expression, purification, and characterization of its interaction with the receptor-binding domain (RBD) of SARS-CoV-2 in addition to the construction and validation of a biosensor. The recombinant Sb#15 is correctly folded and interacts with the RBD with a dissociation constant (KD) of 27.1 ± 6.4 nmol/L. The biosensing platform was developed using polypyrrole nanotubes and Ni(OH)2, which can properly orientate the immobilization of Sb#15-His6 at the electrode surface through His-tag interaction for the sensitive SARS-CoV-2 antigen detection. The quantification limit was determined as 0.01 pg/mL using recombinant RBD, which was expressively lower than commercial monoclonal antibodies. In pre-characterized saliva, both Omicron and Delta SARS-CoV-2 were accurately detected only in positive samples, meeting all the requirements recommended by the World Health Organization for in vitro diagnostics. A low sample volume of saliva is needed to perform the detection, providing results within 15 min without further sample preparations. In summary, a new perspective allying recombinant VHHs with biosensor development and real sample detection was explored, addressing the need for accurate, rapid, and sensitive biosensors.

Medium and large-sized mammals of a private protected wetland in the Cerrado-Amazon biological corridor, Brazil / Mamíferos de médio e grande porte em uma área alagável protegida no corredor biológico Cerrado-Amazônia, Brasil

Abstract Brazil is the world's richest country in biodiversity, including mammal species. In the Brazilian Cerrado biome, mammalian diversity is vast, with about 251 species, 32 of them are endemic and 22 listed as threatened species. In this work, we investigated species diversity of medium- and large-sized mammals in the private protected area RPPN Pontal do Jaburu (RPPN-PJ) and its surroundings, which is a flooded area located in an important biological corridor in the Cerrado-Amazon ecotone zone, a priority area for biodiversity conservation in Brazil. We used camera-trapping, active search (night and day), and track survey during dry season (Apr - Aug 2016). We recorded 29 mammal species, being the Carnivora order the most representative with 11 species. Regarding threat status, 35.7% of the recorded species were listed as threatened in Brazil and 32.1% worldwide. We highlight the high relative frequency of threatened species records such as Tapirus terrestris, Panthera onca, Blastocerus dichotomus, Pteronura brasiliensis, Priodontes maximus, and other, as well as the presence of the newly described aquatic mammal species Inia araguaiaensis. We stress the importance of RPPN-PJ and its surroundings for mammal conservation, which include complex habitats (wetlands) located in an important ecotone zone.

Resumo O Brasil é o país mais rico em biodiversidade no mundo, incluindo espécies de mamíferos. No bioma Cerrado, a diversidade de mamíferos é enorme, com cerca de 251 espécies, sendo 32 delas endêmicas e 22 listadas como ameaçadas de extinção. Neste estudo, investigamos a diversidade de espécies de mamíferos de médio e grande porte da RPPN Pontal do Jaburu (RPPN-PJ) e seu entorno, que é uma floresta de inundação localizada em um importante corredor biológico na zona de ecótono Cerrado-Amazonia, uma área prioritária para conservação da biodiversidade no Brasil. Os dados foram coletados por armadilhas fotográficas, busca ativa (noturna e diurna) e identificação de pegadas durante a estação seca (abril - agosto de 2016). Registramos um grande número de espécies de mamíferos (n = 29), sendo a ordem carnívora a mais representativa com 11 espécies. Com relação ao status de ameaça, 34,5% das espécies registradas foram listadas como ameaçadas na lista vermelha do Brasil e 20,7% na lista vermelha da IUCN. Destacamos a alta frequência relativa de registros de espécies ameaçadas como Tapirus terrestris, Panthera onca, Blastocerus dichotomus, Pteronura brasiliensis, Priodontes maximus, bem como a presença da recém descrita espécie de mamífero aquático Inia araguaiaensis. Nós discutimos a importância da RPPN-PJ e seus arredores para a conservação de espécies de mamíferos, onde inclui habitats complexos (áreas de inundação) localizados em uma importante zona de ecótono.. Os resultados reforçam a relevância desta área para a conservação de mamíferos.

Medium and large-sized mammals of a private protected wetland in the Cerrado-Amazon biological corridor, Brazil / Mamíferos de médio e grande porte em uma área alagável protegida no corredor biológico Cerrado-Amazônia, Brasil

Brazil is the world’s richest country in biodiversity, including mammal species. In the Brazilian Cerrado biome, mammalian diversity is vast, with about 251 species, 32 of them are endemic and 22 listed as threatened species. In this work, we investigated species diversity of medium- and large-sized mammals in the private protected area RPPN Pontal do Jaburu (RPPN-PJ) and its surroundings, which is a flooded area located in an important biological corridor in the Cerrado-Amazon ecotone zone, a priority area for biodiversity conservation in Brazil. We used camera-trapping, active search (night and day), and track survey during dry season (Apr – Aug 2016). We recorded 29 mammal species, being the Carnivora order the most representative with 11 species. Regarding threat status, 35.7% of the recorded species were listed as threatened in Brazil and 32.1% worldwide. We highlight the high relative frequency of threatened species records such as Tapirus terrestris, Panthera onca, Blastocerus dichotomus, Pteronura brasiliensis, Priodontes maximus, and other, as well as the presence of the newly described aquatic mammal species Inia araguaiaensis. We stress the importance of RPPN-PJ and its surroundings for mammal conservation, which include complex habitats (wetlands) located in an important ecotone zone.

O Brasil é o país mais rico em biodiversidade no mundo, incluindo espécies de mamíferos. No bioma Cerrado, a diversidade de mamíferos é enorme, com cerca de 251 espécies, sendo 32 delas endêmicas e 22 listadas como ameaçadas de extinção. Neste estudo, investigamos a diversidade de espécies de mamíferos de médio e grande porte da RPPN Pontal do Jaburu (RPPN-PJ) e seu entorno, que é uma floresta de inundação localizada em um importante corredor biológico na zona de ecótono Cerrado-Amazonia, uma área prioritária para conservação da biodiversidade no Brasil. Os dados foram coletados por armadilhas fotográficas, busca ativa (noturna e diurna) e identificação de pegadas durante a estação seca (abril - agosto de 2016). Registramos um grande número de espécies de mamíferos (n = 29), sendo a ordem carnívora a mais representativa com 11 espécies. Com relação ao status de ameaça, 34,5% das espécies registradas foram listadas como ameaçadas na lista vermelha do Brasil e 20,7% na lista vermelha da IUCN. Destacamos a alta frequência relativa de registros de espécies ameaçadas como Tapirus terrestris, Panthera onca, Blastocerus dichotomus, Pteronura brasiliensis, Priodontes maximus, bem como a presença da recém descrita espécie de mamífero aquático Inia araguaiaensis. Nós discutimos a importância da RPPN-PJ e seus arredores para a conservação de espécies de mamíferos, onde inclui habitats complexos (áreas de inundação) localizados em uma importante zona de ecótono. Os resultados reforçam a relevância desta área para a conservação de mamíferos.

Medium and large-sized mammals of a private protected wetland in the Cerrado-Amazon biological corridor, Brazil

Abstract Brazil is the world's richest country in biodiversity, including mammal species. In the Brazilian Cerrado biome, mammalian diversity is vast, with about 251 species, 32 of them are endemic and 22 listed as threatened species. In this work, we investigated species diversity of medium- and large-sized mammals in the private protected area RPPN Pontal do Jaburu (RPPN-PJ) and its surroundings, which is a flooded area located in an important biological corridor in the Cerrado-Amazon ecotone zone, a priority area for biodiversity conservation in Brazil. We used camera-trapping, active search (night and day), and track survey during dry season (Apr Aug 2016). We recorded 29 mammal species, being the Carnivora order the most representative with 11 species. Regarding threat status, 35.7% of the recorded species were listed as threatened in Brazil and 32.1% worldwide. We highlight the high relative frequency of threatened species records such as Tapirus terrestris, Panthera onca, Blastocerus dichotomus, Pteronura brasiliensis, Priodontes maximus, and other, as well as the presence of the newly described aquatic mammal species Inia araguaiaensis. We stress the importance of RPPN-PJ and its surroundings for mammal conservation, which include complex habitats (wetlands) located in an important ecotone zone.

Resumo O Brasil é o país mais rico em biodiversidade no mundo, incluindo espécies de mamíferos. No bioma Cerrado, a diversidade de mamíferos é enorme, com cerca de 251 espécies, sendo 32 delas endêmicas e 22 listadas como ameaçadas de extinção. Neste estudo, investigamos a diversidade de espécies de mamíferos de médio e grande porte da RPPN Pontal do Jaburu (RPPN-PJ) e seu entorno, que é uma floresta de inundação localizada em um importante corredor biológico na zona de ecótono Cerrado-Amazonia, uma área prioritária para conservação da biodiversidade no Brasil. Os dados foram coletados por armadilhas fotográficas, busca ativa (noturna e diurna) e identificação de pegadas durante a estação seca (abril - agosto de 2016). Registramos um grande número de espécies de mamíferos (n = 29), sendo a ordem carnívora a mais representativa com 11 espécies. Com relação ao status de ameaça, 34,5% das espécies registradas foram listadas como ameaçadas na lista vermelha do Brasil e 20,7% na lista vermelha da IUCN. Destacamos a alta frequência relativa de registros de espécies ameaçadas como Tapirus terrestris, Panthera onca, Blastocerus dichotomus, Pteronura brasiliensis, Priodontes maximus, bem como a presença da recém descrita espécie de mamífero aquático Inia araguaiaensis. Nós discutimos a importância da RPPN-PJ e seus arredores para a conservação de espécies de mamíferos, onde inclui habitats complexos (áreas de inundação) localizados em uma importante zona de ecótono.. Os resultados reforçam a relevância desta área para a conservação de mamíferos.

Mefenoxam and pyraclostrobin: toxicity and in vitro inhibitory activity against Pythium insidiosum.

The objective of this study is to verify in vitro susceptibility of Pythium insidiosum against the agricultural fungicides mefenoxam and pyraclostrobin and evaluate the toxicity of both compounds. Twenty-one P. insidiosum isolates were tested against mefenoxam and pyraclostrobin using the broth microdilution method. Minimum inhibitory and oomicidal concentrations for both compounds were established. Additionally, scanning electron microscopy was performed on P. insidiosum hyphae treated with the sublethal concentration of each fungicide. The toxicity of the compounds was evaluated in vivo Caenorhabditis elegans model. The concentration to inhibit 100% of P. insidiosum growth ranged from 0·625 to 10 µg ml-1 for mefenoxam and from 0·019 to 5 µg ml-1 for pyraclostrobin. The SEM analysis revealed changes on the surface of the hyphae treated with the fungicides, suggesting possible damage caused by these compounds. There was no evidence of toxicity in vivo models. Mefenoxam and pyraclostrobin did not show toxicity at the doses evaluated and have inhibitory effects on the pathogenic oomycete P. insidiosum. However, further evaluations of their pharmacokinetics and toxicity in different animal species and possible pharmacological interactions are necessary to infer a possible use in the clinical management of pythiosis.

Toxic effects of thallium acetate by acute exposure to the nematode C. elegans.

BACKGROUND: Thallium (Tl) is a toxic metalloid and an emerging pollutant due to electronic devices and dispersal nearby base-metal mining. Therefore, Tl poses a threat to human health and especially the long-term impact on younger individuals exposed is still unknown. This study aimed to evaluate the toxic effects of thallium acetate in C. elegans in early larval stages, considering physiological and behavioral endpoints, as well as the Tl absorption and bioaccumulation. METHODS: Caenorhabditis elegans (C. elegans) was exposed to Thallium acetate (50, 100, 150, 200, 250, 500, and 1000 µM) in the L1 larval stage, with the purpose to observe the toxic effects invoked until adulthood. Transgenic worms strains were transported GFP, reporters to DAF-16 and were used to verify the antioxidant response. ICP-MS quantified total Tl+ concentration to evidence Tl uptake and bioaccumulation. RESULTS: Thallium acetate caused a significant reduction in the number of living worms (p < 0.0001 in 100-1000 µM), a delay in larval development (p < 0.01; p < 0.001 and p < 0.0001 in 100-1000 µM) through the larval stages, and egg production in the worm's uterus was reduced. Thallium acetate also induced behavioral changes. Additionally, thallium acetate activated antioxidant pathway responses in C. elegans by translocating the DAF-16 transcription factor and activation of SOD-3::GFP expression. The Tl+ quantification in worms showed its absorption in the L1 larval stage and bioaccumulation in the body after development. CONCLUSIONS: Thallium acetate reduced survival, delayed development, caused behavioral changes, induced responses inherent to oxidative stress, and serious damage to the worm's reproduction. In addition, C. elegans absorbed and bioaccumulated Tl+. Together, our results highlight the impacts of Tl+ exposure in the early stages of life, even for a short period.

Medium and large-sized mammals of a private protected wetland in the Cerrado-Amazon biological corridor, Brazil.

Brazil is the world's richest country in biodiversity, including mammal species. In the Brazilian Cerrado biome, mammalian diversity is vast, with about 251 species, 32 of them are endemic and 22 listed as threatened species. In this work, we investigated species diversity of medium- and large-sized mammals in the private protected area RPPN Pontal do Jaburu (RPPN-PJ) and its surroundings, which is a flooded area located in an important biological corridor in the Cerrado-Amazon ecotone zone, a priority area for biodiversity conservation in Brazil. We used camera-trapping, active search (night and day), and track survey during dry season (Apr - Aug 2016). We recorded 29 mammal species, being the Carnivora order the most representative with 11 species. Regarding threat status, 35.7% of the recorded species were listed as threatened in Brazil and 32.1% worldwide. We highlight the high relative frequency of threatened species records such as Tapirus terrestris, Panthera onca, Blastocerus dichotomus, Pteronura brasiliensis, Priodontes maximus, and other, as well as the presence of the newly described aquatic mammal species Inia araguaiaensis. We stress the importance of RPPN-PJ and its surroundings for mammal conservation, which include complex habitats (wetlands) located in an important ecotone zone.

Thiobarbituric acid reactive substances in dogs with spontaneous hypercortisolism.

Thiobarbituric acid reactive substances (TBARS) are laboratory markers of oxidative stress, which can be used to evaluate the lipid peroxidation that characterizes cell membrane damage caused by excess free radicals. This prospective study aimed to assess TBARS as a parameter of lipid peroxidation in dogs with spontaneous hypercortisolism (HC) at the time of diagnosis, and after trilostane treatment. Furthermore, it aimed to investigate the correlations between TBARS levels, and laboratory and cardiovascular parameters. Sixteen dogs with HC were evaluated at 3 different time points: At diagnosis (T0), 6 mo after treatment (T1), and 12 mo after trilostane treatment (T2). A control group (n = 20) of dogs with a demographic profile similar to the HC group, but considered healthy was selected and evaluated. There was a significant difference (P < 0.001) in TBARS levels between the HC group at diagnosis (4.38 ± 1.16 nmoles MDA/mg protein) and the control group (2.15 ± 0.45 nmoles MDA/mg protein). Dogs in the HC group exhibited a significant reduction (P < 0.001) in TBARS levels after treatment. There was no significant difference in TBARS levels between the control group and the HC group at T1 and T2 evaluation. TBARS positively correlated with left atrial dimensions and hematocrit. The study demonstrates that lipid peroxidation is increased in canine HC and suggests that control of the disease is beneficial to normalize the state of oxidative stress.

Does the etching strategy influence the bonding of universal adhesive systems to primary teeth? A systematic review and meta-analysis of in vitro studies.

PURPOSE: To assess through a systematic review and meta-analysis of in vitro studies, the influence of the etching strategy (etch-and-rinse versus self-etch) of universal adhesive systems on bonding to primary teeth. METHODS: A systematic search was carried out in PubMed, Web of Science and Scopus. In vitro studies that compared the bond strength of the etching strategies of universal adhesives to primary teeth were included. Pooled-effect estimates were derived from a random-effects model by comparing the standardized mean difference between the etching strategies (α < 0.05). The risk of bias and heterogeneity between studies were also assessed (Cochrane and I2 tests). RESULTS: Seven studies were included in the review and six in the meta-analyses. For dentin, the immediate bond strength was not influenced by the etching strategy regardless of sound (Z = 0.72, p = 0.47) or caries-affected (Z = 1.27, p = 0.21) substrate, nor after aging (Z = 0.24, p = 0.81). It was not possible to perform a meta-analysis for the enamel substrate. Most studies have a medium risk of bias. CONCLUSIONS: This systematic review and meta-analysis of in vitro studies provides evidence that universal adhesives can be used in both etching strategies in primary dentin. The evidence is currently insufficient about whether selective acid etching of primary enamel is necessary when universal adhesive systems are used.

Oxidative stress is involved in LLLT mechanism of action on skin healing in rats.

The skin injury healing process involves the main phases of homoeostasis, inflammation, proliferation, and remodeling. The present study aimed to analyze the effects of low-level laser therapy (LLLT) on hematological dynamics, oxidative stress markers, and its relation with tissue healing following skin injury. Wistar rats were divided into control, sham, skin injury, and skin injury LLLT. The biochemical and morphological analyses were performed in the inflammatory (1 and 3 days) and regenerative phases (7, 14, and 21 days) following injury. The skin injury was performed in the dorsal region, between the intrascapular lines, using a surgical punch. LLLT (Al-Ga-In-P, λ=660 nm, energy density of 20 J/cm2, 30 mW power, and a time of 40 s) was applied at the area immediately after injury and on every following day according to the experimental subgroups. LLLT maintained hematocrit and hemoglobin levels until the 3rd day of treatment. Surprisingly, LLLT increased total leukocytes levels compared to control until the 3rd day. The effects of LLLT on mitochondrial activity were demonstrated by the significant increase in MTT levels in both inflammatory and regenerative phases (from the 1st to the 7th day), but only when associated with skin injury. The results indicated that LLLT modulated the inflammatory response intensity and accelerated skin tissue healing by a mechanism that involved oxidative damage reduction mostly at early stages of skin healing (inflammatory phase).

Robertsonian rearrangements in Neotropical Meliponini karyotype evolution (Hymenoptera: Apidae: Meliponini).

Genome changes, evidenced through karyotype or nuclear genome size data, can result in reproductive isolation, diversification and speciation. The aim of this study was to understand how changes in the karyotype such as chromosome number and nuclear genome size accompanied the evolution of neotropical stingless bees, and to discuss these data in a phylogenetic context focusing on the karyotype evolution of this clade. We sampled 38 species representing the three Neotropical Meliponini groups; 35 for karyotype analyses and 16 for 1C value measurement. The chromosome number varied from 2n = 16 to 2n = 34, with distinct karyotypic formulae and the presence of a few polymorphisms, such as B chromosomes in one species and arm size differences between homologous chromosomes in two species. The mean 1C value varied from 0.31 pg to 0.92 pg. We associated empirical data on chromosome number and mean 1C value to highlight the importance of Robertsonian fusion rearrangements, leading to a decrease in chromosome number during the Neotropical Meliponini evolution. These data also allowed us to infer the independent heterochromatin amplification in several genera. Although less frequent, Melipona species with 2n = 22 represent evidence of Robertsonian fissions. We also pointed out the importance of chromosomal rearrangements that did not alter chromosome number, such as inversions and heterochromatin amplification.

Oxidative stress is involved in LLLT mechanism of action on skin healing in rats

The skin injury healing process involves the main phases of homoeostasis, inflammation, proliferation, and remodeling. The present study aimed to analyze the effects of low-level laser therapy (LLLT) on hematological dynamics, oxidative stress markers, and its relation with tissue healing following skin injury. Wistar rats were divided into control, sham, skin injury, and skin injury LLLT. The biochemical and morphological analyses were performed in the inflammatory (1 and 3 days) and regenerative phases (7, 14, and 21 days) following injury. The skin injury was performed in the dorsal region, between the intrascapular lines, using a surgical punch. LLLT (Al-Ga-In-P, λ=660 nm, energy density of 20 J/cm2, 30 mW power, and a time of 40 s) was applied at the area immediately after injury and on every following day according to the experimental subgroups. LLLT maintained hematocrit and hemoglobin levels until the 3rd day of treatment. Surprisingly, LLLT increased total leukocytes levels compared to control until the 3rd day. The effects of LLLT on mitochondrial activity were demonstrated by the significant increase in MTT levels in both inflammatory and regenerative phases (from the 1st to the 7th day), but only when associated with skin injury. The results indicated that LLLT modulated the inflammatory response intensity and accelerated skin tissue healing by a mechanism that involved oxidative damage reduction mostly at early stages of skin healing (inflammatory phase).

Combined use of chemical and biological compounds to control hookworm.

The aim of this study was to evaluate the combined use of different chemical (albendazole, ivermectin, glycerine and Vaseline) and biological (Monacrosporium thaumasium) compounds in the control of Ancylostoma caninum. Infective larvae of A. caninum were obtained from coprocultures of positive faeces from naturally infected dogs. We used 1% ivermectin, 1% albendazole, 100% glycerine, 100% Vaseline and an isolate of the nematophagous fungus M. thaumasium (NF34), alone or in combinations. Next, an experimental test was set up with 16 groups in microtubes, with a 24-h interaction. The groups (G1 to G15) that contained any chemical or biological compound (NF34) and/or their combined use (chemical + biological) showed a difference in relation to the control group, except G5 - Vaseline 100% without combinations. It was concluded that, even on an experimental basis, the combined use of anthelmintic drugs with biological control was efficient; however, more studies must be carried out in order to elucidate the synergistic action between chemical and biological compounds to be used in the effective control of hookworms in the future.

Reduction of visual acuity decreases capacity to evaluate radiographic image quality.

INTRODUCTION: To determine the impact of reduced visual acuity on the evaluation of a test object and appendicular radiographs. METHODS: Visual acuity was reduced by two different magnitudes using simulation glasses and compared to normal vision (no glasses). During phase one phantom images were produced for the purpose of counting objects by 13 observers and on phase 2 image appraisal of anatomical structures was performed on anonymized radiographic images by 7 observers. The monitors were calibrated (SMPTE RP133 test pattern) and the room lighting was maintained at 7 ± 1 lux. Image display and data on grading were managed using ViewDEX (v.2.0) and the area under the visual grading characteristic (AUCVGC) was calculated using VGC Analyzer (v1.0.2). Inferential statistics were calculated using SPSS. RESULTS: For the evaluation of appendicular radiographs the total interpretation time was longer when visual acuity was reduced with 2 pairs of simulation glasses (15.4 versus 8.9 min). Visual grading analysis showed that observers can lose the ability to detect anatomical and contrast differences when they have a simulated visual acuity reduction, being more challenging to differentiate low contrast details. No simulation glasses, compared to 1 pair gives an AUCVGC of 0.302 (0.280, 0.333), that decreases to 0.197 (0.175, 0.223) when using 2 pairs of glasses. CONCLUSIONS: Reduced visual acuity has a significant negative impact on the evaluation of test objects and clinical images. Further work is required to test the impact of reduced visual acuity on visual search, technical evaluation of a wider range of images as well as pathology detection/characterization performance. IMPLICATIONS FOR PRACTICE: It seems that visual performance needs to be considered to reduce the risks associated with incomplete or incorrect diagnosis. If employers or professional bodies were to introduce regular eye tests into health screening it may reduce the risk of misinterpretation as a result of poor vision.

Birth order is associated with caries development in young children: a register-based cohort study.

BACKGROUND: Birth order has been shown to affect the health of the child; less is known, however, about how birth order affects caries development in children. Thus, the present study investigated the association between birth order and dental caries development in young children. METHODS: This retrospective registry-based cohort study included all children born in 2000-2003 who were residing in Stockholm County, Sweden, at age 3 years (n = 83,147). The study followed the cohort until subjects reached 7 years of age. Children with registry data on dental examinations and sociodemographic characteristics at ages 3- and 7 years constituted the final study cohort (n = 65,259). The outcome variable was "caries increment from age 3- to 7 years" (Δdeft > 0) and the key exposure, "birth order", was divided into five groups. A forward stepwise logistic binary regression was done for the multivariate analysis with adjustments for sociodemographic factors. RESULTS: At age 3 years, 94% had no fillings or manifest caries lesions. During the study period, 22.5% (n = 14,711) developed dental caries. The final logistic regression analysis found a statistically significant positive association between birth order and caries increment. Further, excess risk increased with higher birth order; with the mother's first-born child as reference, risk for the second-born child was OR 1.17, 95% CI = 1.12-1.23; for the third-born child, OR 1.47, 95% CI = 1.38-1.56; for the fourth-born child, OR 1.69, 95% CI = 1.52-1.88; and for the fifth-born or higher birth-order child, OR 1.84, 95% CI = 1.58-2.14. CONCLUSIONS: These findings show that birth order influences caries development in siblings, suggesting that birth order can be regarded as a predictor for caries development in young children. This factor may be helpful in assessing caries risk in preschool children and should be considered in caries prevention work in young children with older siblings.

Impact of frailty on hospital adverse outcomes in elderly admitted with acute coronary syndrome

BACKGROUND: Frailty represents a complex clinical syndrome of decreased physiological reserve and increased vulnerability to stressors. Little is known regarding interaction between frailty status and outcomes in patients with acute coronary syndrome. Our study aims to assess the prevalence of frailty and its impact on in-hospital adverse outcomes of patients aged ≥ 75 years admitted for acute coronary syndromes. METHODS: In this retrospective, single centre, observational study were included patients aged ≥ 75 years admitted for acute coronary syndromes between January 2011 and December 2015. Frailty was assessed using the Fried criteria. The primary endpoint was all-cause in-hospital mortality. Secondary endpoints included the occurrence of re-infarction, stroke and major bleeding. RESULTS: Of the 502 patients included, 126 were classified as frail. These patients were older (mean age 78±5.5 vs. 76.2±5.5 years; p = 0.020), more often male (68.3%) and had a higher risk profile according to GRACE (151.4±18.8 vs. 132.1±16.8; p < 0.001), TIMI (4.3±1 vs. 3.1±1; p < 0.001) and CRUSADE (34.6±9.4 vs. 25.8±9.5; p < 0.001) scores at admission. All-cause in-hospital mortality was significantly more frequent in frail patients (11.9% vs. 5.6%; p < 0.001), as well as re-infarction (7.4% vs. 4.8%; p < 0.001), stroke (8.7% vs. 0.5%; p = 0.002) and major bleeding (7.9% vs. 1.6%; p = 0.002). On multivariate analysis, frailty remained independently associated with the primary endpoint (OR 5.63, [2.05-10.35]; p < 0.001). CONCLUSION: Frailty, identified by Fried criteria, is frequent in elderly patients with acute coronary syndromes, and it is an independent prognostic predictor for in-hospital mortality

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