Chagas disease deaths detected among garbage codes registered in mortality statistics in Brazil: a study from the buRden of ChAgas dISEase in the contemporary world (RAISE) project.

OBJECTIVES: The objective of this study was to identify Brazil's most critical garbage codes (GCs) reclassified to Chagas disease (ChD) in mortality data and their proportions. We also estimated the potential impact of misclassification on the number of deaths attributed to ChD. STUDY DESIGN: Population-based descriptive study. METHODS: We used the Mortality Information System (SIM; in Portuguese) data before and after routine GC investigation in 2015-2019 to evaluate ChD deaths detected among them. We identified priority GCs, which contributed more than 0.1 % to the percentage of total ChD deaths registered. Spearman's correlation was used to evaluate the association between the reclassification of priority GCs and ChD prevalence. Then, we applied the GC correction factors to estimate the number of deaths attributed to ChD. RESULTS: 22,154 deaths were reported as ChD in the study period. Among them, 1004 deaths originally listed as priority GCs were deaths reclassified to ChD after an investigation in the SIM final database. Unspecific cardiomyopathy (10.2 %), unspecific heart diseases (4.7 %), and heart failure (2.8 %) were GCs with the highest proportions of reclassification to ChD in Brazil. Higher ChD prevalence at the state level was associated with a higher proportion of GC deaths reclassified as ChD. When applying correction factors identified after investigation, we estimated an increase of 26.4 % in registered ChD deaths, mostly in states with higher endemicity. CONCLUSIONS: GCs might conceal deaths due to ChD, particularly in Brazil's states with higher endemicity. The approach suggested in this study may offer an alternative method for estimating ChD-related deaths in endemic countries.

Estimation of genetic parameters for weight and length gains in tambaqui (Colossoma macropomum).

The goal of this study was to determine the genetic parameters for growth traits in tambaqui (Colossoma macropomum) fish of similar age and weight. The data set included monthly measurements of body weight and length from120 fish for a year (1,440 measurements). The study found that weight gain had a heritability estimate of 0.01, while length gain had a heritability estimate of 0.27. There was a high positive correlation (0.84) between weight and length gains. The genetic variance and heritability of body weight decreased with age. This study suggests that breeding programs should select for body weight and weight gain to promote genetic gain in tambaqui. Selecting younger animals can also help reduce costs while still achieving genetic gains.

Mortality by road transport injury in Brazilian municipalities between 2000 and 2018.

OBJECTIVES: This study aimed to investigate patterns of mortality by road transport injury (RTI) in Brazilian municipalities, focused on deaths of motorcyclists, between 2000 and 2018, and their relation with population size and economic status. STUDY DESIGN: This was an ecological epidemiological study with a descriptive and analytical nature. METHODS: The age-standardized RTI mortality rates were calculated for the Brazilian municipalities, referring to the 3-year periods of 2000/2002 (T1), 2009/2011 (T2), and 2016/2018 (T3). The rates were stratified according to macroregion and population size and were compared in terms of percentage variation from one 3-year period to another. The Moran Global and Local indices were used in the spatial point-pattern analysis of the rates. To verify the association with the gross domestic product (GDP) per capita, the Spearman correlation coefficient was applied. RESULTS: A decline in RTI mortality rates was found between 2000 and 2018, with the most significant declines observed in municipalities from the South and Southeast regions of Brazil. However, increases were observed among motorcyclists. Clusters of municipalities were detected, which presented high mortality rates among the motorcyclists in the Northeast region and in some states of the North and Midwest regions. The mortality rates showed a negative correlation with the GDP per capita of the Brazilian municipalities. CONCLUSIONS: Although there were decreases in RTI mortality rates between 1990 and 2018, there was a significant increase in deaths among motorcyclists, especially in the Northeast, North, and Midwest regions of the country. Such differences can be explained by unequal growth in the size of the motorcycle fleet in those regions, by less law enforcement capability, and by the implementation of educational actions.

Antioxidant, anti-inflammatory and anti-obesity effects of onion and its by-products in high-fat fed rodents: a systematic review.

The effects of onion and its by-products on metabolic changes induced by excessive consumption of a high fat diet have been the focus of many studies. The aim of this study was to systematically review the effects of onion and its by-products antioxidant, anti-inflammatory and anti-obesity in rats exposed to a high-fat diet. Five databases were used: Pubmed, EMBASE, Science Direct, Web of science and Scopus until June 2020 updated December 1, 2022. Research of the articles was carried out by two reviewers, searching and selecting studies after an initial reading of the titles and abstracts. In total, 2,448 papers were found and, after assessing against the inclusion and exclusion criteria, 18 papers were selected for this review. The findings of this review show the beneficial effects of onion and its by-products on inflammatory parameters, obesity, cardiovascular disease, thermogenesis and hepatic alterations generally associated with the consumption of a high-fat diet.

Clinical standards for the assessment, management and rehabilitation of post-TB lung disease.

BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR).METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement).RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR.CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.

The electronic nose as a rule-out test for tuberculosis in an indigenous population.

INTRODUCTION: To end the tuberculosis (TB) epidemic, efficient diagnostic tools are needed. In a previous calibration study, a portable 'point of care' electronic nose device (AeonoseTM ) proved to be a promising tool in a hospital setting. We evaluated this technology to detect TB in an indigenous population in Paraguay. METHODS: A total of 131 participants were enrolled. eNose results were compared with anamnesis, physical examinations, chest radiography and mycobacterial cultures in individuals with signs and symptoms compatible with TB. The eNose analysis was performed in two stages: first, the training with a combination of a previous study population plus 47 participants from the new cohort (total n = 153), and second, the 'blind prediction' of 84 participants. RESULTS: 21% of all participants (n = 131) showed symptoms and/or chest radiography abnormalities suspicious of TB. No sputum samples resulted culture positive for Mycobacterium tuberculosis complex. Only one patient had a positive smell print analysis. In the training model, the specificity was 92% (95% confidence interval (CI): 85%-96%) and the negative predictive value (NPV) was 95%. In the blind prediction model, the specificity and the NPV were 99% (95% CI: 93%-99%) and 100%, respectively. Although the sensitivity and positive predictive value of the eNose could not be assessed in this cohort due to the small sample size, no active TB cases were found during a one year of follow-up period. CONCLUSION: The eNose showed promising specificity and negative predictive value and might therefore be developed as a rule-out test for TB in vulnerable populations.

Synthesis, biological activity, and four-dimensional quantitative structure-activity analysis of 2-arylidene indan-1,3-dione derivatives tested against Daphnia magna.

A series of 18 2-arylidene indan-1,3-dione derivatives was synthesized and tested against Daphnia magna to assess the environmental toxicity of these compounds. Aiming to investigate the toxicity mechanism for this series of compounds, a four-dimensional quantitative structure-activity analysis (4D-QSAR) was performed through the partial least square regression (PLS). The best PLS model was built with two factors and the selected field descriptors, of Coulomb (C) and Lennard-Jones (L) nature, describing 77.43% of variance and presenting the following statistics: r 2 = 0.89; SEC = 0.30; Q 2 = 0.81; SEV = 0.36. According to the literature, the bioactivity of α,ß-unsaturated ketones, a functionality present in the series of compounds under investigation, is related to the conjugated double bond with the carbonyl group. The presence of a positive Coulomb descriptor nearby the carbonyl moieties, obtained as a result of the regression model, indicates that these polar groups are also related to the toxicity on D. magna. From the PLS regression model, the toxicity EC50-48 h values increases with the positive Coulomb descriptor and diminishes with the negative Lennard-Jones descriptors. It could be concluded that the presence of small polar groups in the aromatic ring of the arylidene moiety tends to increase the toxicity, while bulkier apolar substituents lead to a decrease of the toxicity.

Clinical outcomes and trans-syndesmotic screw frequency after posterior malleolar fracture osteosynthesis.

AIM: This study aimed to evaluate the clinical outcomes and the trans-syndesmotic screw frequency after trimalleolar ankle fractures with a posterior malleolus fracture involving <25% of the articular surface. MATERIAL AND METHODS: Retrospective comparative study. Patients with trimalleolar ankle fracture who underwent surgery between January 2011 and January 2018 were identified within the departments' fracture database. General demographics, treatment details, and fracture specific details (CT-scans) were assessed. Patients were grouped per the posterior malleolus fragment treatment: osteosynthesis (group 1) and non-osteosynthesis (group 2). RESULTS: 64 patients, 58.6 ± 17.8 years (range: 23-75), 68.8% female were eligible and follow up time was 43.1 ± 22.2 (range 24-96) months. The mean size of the posterior malleolus fragment was 14.7 ± 5.3% (range: 5-24). Posterior malleolus fragment treatment distribution: osteosynthesis (group 1) 31.2% and non- osteosynthesis (group 2) 68.8%. Group 1 showed significantly better clinical outcomes (p<0.05), AOOS (93.9 ± 5.79 (range: 73-99), AOFAS (91.5 ± 6.22 (range: 72-100) and VAS (0.8 ± 1.22 (range: 0-5) compared to Group 2, AOOS (84.25±8.34 (range: 63-100); AOFAS (84.75±8.05 (range: 58-100) and VAS (1.7 ± 1.38 (range: 0-6). Osteosynthesis of the posterior malleolus fragment significantly reduced the frequency of trans-syndesmotic screw (0%) compared to non-osteosynthesis posterior malleolus fragment (15.9%) (p < 0.05). The EQ-5D score was better in group 1 (1.08±0.27 (range: 1-2.2) compared to group 2 (1.27 ± 0.27 (range: 1-2.4) but with no statistical significance (p> 0.15). CONCLUSION: Posterior malleolus fragments (<25% of the articular surface) have significantly better clinical outcomes and significant decrease in trans-syndesmotic screw need following osteosynthesis.

Paro cardiaco tras embolia gaseosa cerebral. Caso clínico / Cardiac arrest after a cerebral gas embolism. Case report

El embolismo gaseoso arterial cerebral es un episodio grave y frecuentemente iatrogénico fatal, asociado a procedimientos invasivos. Se trata de una causa posible de paro cardiaco, y el diagnóstico es difícil. Reportamos un caso de paro cardiaco tras una embolia gaseosa en arteria cerebral, en un varón de 63 años sometido a biopsia por aspiración transtorácica con aguja ecoguiada por TAC, que fue exitosamente tratado con oxigenoterapia hiperbárica

Cerebral arterial gas embolism is a serious and often iatrogenic fatal event associated with invasive procedures. It is a possible cause of a cardiac arrest and the diagnosis is challenging. We report a case of a cardiac arrest after a cerebral arterial gas embolism, in a 63-year-old male subjected to a Computed Tomography-guided Transthoracic Needle Aspiration Biopsy, which was successfully managed with hyperbaric oxygen therapy

The multifaceted role of mobile technologies as a strategy to combat COVID-19 pandemic.

The coronavirus 2019 (COVID-19) outbreak in China rapidly spread throughout the world, becoming a threatening pandemic with unprecedented consequences. Mobile technologies have led to a revolution in health and their applicability in the context of COVID-19 is promising. In this commentary, we provide an overview of the role that mobile technologies play in the COVID-19 pandemic context and discuss the main issues associated. Four main domains stood out: health communication, prevention, support and research. Strengthening local surveillance systems, geographic contact tracing, support for clinical practice and data collection of real-time longitudinal data at the population level are some of the main advantages of the applications reported so far. The potential conflict to data privacy urges for discussion on their use in a responsible manner. Along with fair regulation and close monitoring of data collection and process, data anonymisation must be a standard and personal data must be deleted after its usage. Preparation is key for effective containment of a public health crisis and learning lessons on the role of mobile technologies is useful for future challenges in global health. It is noteworthy that their use must be driven by an equitable and inclusive orientation, and mostly integrated into an articulated policy to respond to the crisis.

Pontine Myelinolysis Caused by Hypovolemic Hypernatremia.

Introduction. Central pontine myelinolysis is characterized by the occurrence of acute demyelinating lesions of cells in the pons secondary to abrupt oscillations of serum osmolarity. Its exact incidence is not well defined, but studies show a prevalence of 0.25 to 0.5% in the general population, 2.5% in the intensive care unit, and up to 10% in patients with risk factors, such as chronic liver disease and hepatic transplantation, alcoholism, malnutrition, diuretic therapy, electrolyte imbalance, hypoglycemia, and hyperglycemia. Case Report. A 70-year-old white female with extranodal diffuse large B-cell non-Hodgkin's lymphoma (extensive mass on the left anterior chest wall), stage IVA, developed pontine myelinolysis secondary to hypovolemic acute hypernatremia, which occurred due to diarrhea caused by chemotherapy (rituximab, cyclophosphamide, doxorubicin, and vincristine). Discussion. Pontine myelinolysis occurs most often due to the rapid correction of chronic hyponatremia. But here, we describe a case of the disease secondary to the occurrence of hypovolemic acute hypernatremia in a patient with a hematological malignancy under treatment, who was on chronic treatment with thiazide diuretics and who presented with other electrolyte disturbances as risk factors for the development of pontine myelinolysis.

Intralesional injection of triamcinolone hexacetonide as an alternative treatment for central giant cell lesions: a prospective study.

The aim of this prospective study was to report on the response to treatment of central giant cell lesions (CGCL) with intralesional corticosteroid injections. Consecutive cases of CGCL were treated with a biweekly intralesional injection of 20mg/ml triamcinolone hexacetonide diluted in an anaesthetic solution of 2% lidocaine/epinephrine 1:200 000 at the proportion 1:1. All patients were monitored using cone beam computed tomography. Eleven patients were treated; their ages ranged from 15-34 (mean 22 years); and eight lesions were in the mandible, and three in the maxilla. Three cases were diagnosed as non-aggressive, and eight as aggressive. Six cases presented good results (four aggressive and two non-aggressive); three cases presented a moderate response (two aggressive and one non-aggressive); and two had a poor response to treatment (both aggressive). In four cases with a good response, osteoplasty was done. In all cases with a moderate response, the remaining lesion was curetted. Cases with a poor response were submitted to either curettage or denosumab injections. Corticotherapy, as main or neoadjuvant therapy, may be an option for treatment of CGCL.

Cardiac arrest after a cerebral gas embolism. Case report. / Paro cardiaco tras embolia gaseosa cerebral. Caso clínico.

Cerebral arterial gas embolism is a serious and often iatrogenic fatal event associated with invasive procedures. It is a possible cause of a cardiac arrest and the diagnosis is challenging. We report a case of a cardiac arrest after a cerebral arterial gas embolism, in a 63-year-old male subjected to a Computed Tomography-guided Transthoracic Needle Aspiration Biopsy, which was successfully managed with hyperbaric oxygen therapy.

Mandibular incisive canal-related prevalence, morphometric parameters, and implant placement implications: a multicenter study of 847 CBCT scans.

BACKGROUND: This study evaluated the epidemiological and morphological features of the mandibular incisive canal (MIC) using cone beam computed tomography (CBCT) in a significant sample of subjects in Brazil. MATERIAL AND METHODS: This retrospective, multicenter study assessed 847 CBCT scans performed at four oral imaging centers. The sample comprised CBCT images acquired from dentate individuals who presented at least from tooth 35 to tooth 45 in the anterior mandible region. Data regarding patient sex and age, and MIC linear measurements (length and diameter in mm), anatomical distances (to the alveolar, buccal and lingual cortexes, inferior border of the mandible, and adjacent teeth apexes), and location were obtained. RESULTS: The MIC was more prevalent in women (76.3% [p<0.001]) between the fourth and sixth decades of life (p<0.001). It was present bilaterally (p<0.001) and exhibited a mean length of 7.7 mm (standard deviation [SD]=3.7 mm). Spearman correlation and logistic regression analysis revealed collinearity between age and linear measurements (p<0.05). The mean distances varied from the initial to the final portion of the MIC, respectively, in relation to the buccal cortex (mean=2.6 mm, SD=1.27; mean=3.96 mm; SD=1.43), to lingual cortex (mean=5.13 mm; SD=1.7; mean=4.61 mm, SD = 1.65), and to the inferior mandibular border (mean = 9.32 mm, SD=1.92; mean=8.76 mm, SD=2.07 mm). The difference in the proximity of the MIC to the apex of the inferior lateral incisor was statistically significant (p<0.05). CONCLUSIONS: Results of this study revealed a high prevalence of MIC with a bilateral pattern in women who were between the fourth and sixth decades of life. Both the distance between the MIC and the lingual cortex of the mandibular alveolar bone, and the diameter of the MIC, decreased as its trajectory assumed a more anterior position.

Local inhomogeneous state in multiferroic SmCrO3.

Rare-earth orthochromites with distorted perovskite structure (e.g. RCrO3, R = Sm, Gd) have been under strong debate with respect to the origin of their ferroelectric order. Of particular interest is the question of whether such orthochromites are, in fact, magnetically driven improper ferroelectrics, as many rare-earth manganites or orthoferrites. Here we show, by studying at the atomic scale the rare-earth SmCrO3 system that a distortion of the Sm local environment emerges within the paramagnetic phase, near room temperature. Our Electric Field Gradient measurements combined with first-principles calculations show that the emergent phase cannot be simply ascribed to the Pna21 structure as reported for GdCrO3 or SmCrO3. Instead a local inhomogeneous state, where regular non-polar and polar distorted environments coexist, develops at low temperatures.

Preparation of Long-Lived, Non-Autoionizing Circular Rydberg States of Strontium.

Alkaline earth Rydberg atoms are very promising tools for quantum technologies. Their highly excited outer electron provides them with the remarkable properties of Rydberg atoms and, notably, with a huge coupling to external fields or to other Rydberg atoms while the ionic core retains an optically active electron. However, low angular-momentum Rydberg states suffer almost immediate autoionization when the core is excited. Here, we demonstrate that strontium circular Rydberg atoms with a core excited in a 4D metastable level are impervious to autoionization over more than a few millisecond time scale. This makes it possible to trap and laser-cool Rydberg atoms. Moreover, we observe singlet to triplet transitions due to the core optical manipulations, opening the way to a microwave to optical quantum interface.

Role of inflammation, oxidative stress, and autonomic nervous system activation during the development of right and left cardiac remodeling in experimental pulmonary arterial hypertension.

This study investigated the impact of experimental pulmonary arterial hypertension (PAH) progression by evaluating morphometric and functional parameters, oxidative stress, autonomic nervous system (ANS) activation, and inflammation in the right (RV) and left (LV) ventricles. Male rats were first divided into two groups: monocrotaline (MCT) and control. The MCT group received a single MCT injection (60 mg/kg, intraperitoneal), while control received saline. The MCT and control groups were further divided into four cohorts based on how long they were observed: 1, 2, 3, and 4 weeks. Animals were submitted to echocardiographic and hemodynamic analysis. RV and LV were used for morphometric, biochemical, and histological measurements. Autonomic modulation was evaluated by cardiac spectral analysis, considering two components: low frequency (LF) and high frequency (HF). Lung and liver weight was used for morphometric analysis. MCT induced 100% mortality at 4 weeks. In the RV, disease progression led to mild inflammation and enhanced reactive oxygen species (ROS) in week 1, followed by moderate inflammation, ROS production, and hypertrophy in week 2. By week 3, there was moderate inflammation, oxidative stress, and ANS imbalance, with development of right heart dysfunction. LV biochemical changes and inflammation were observed at week 3. The initial changes appeared to be related to inflammation and ROS, and the later ones to inflammation, oxidative stress, and ANS imbalance in MCT animals. This study reinforces the severity of the disease in the RV, the late effects in the LV, and the role of ANS imbalance in the development of heart dysfunction.

Higher values of triglycerides:HDL-cholesterol ratio hallmark disease severity in children and adolescents with sickle cell anemia.

Dyslipidemia has been described in sickle cell anemia (SCA) but its association with increased disease severity is unknown. Here, we examined 55 children and adolescents with SCA as well as 41 healthy controls to test the association between the lipid profiles in peripheral blood and markers of hemolysis, inflammation, endothelial function, and SCA-related clinical outcomes. SCA patients exhibited lower levels of total cholesterol (P<0.001), low-density lipoprotein cholesterol (LDL-c) (P<0.001), and high-density lipoprotein cholesterol (HDL-c) (P<0.001), while displaying higher triglyceride (TG) levels and TG/HDL-c ratio values (P<0.001). TG/HDL-c values were positively correlated with lactate dehydrogenase (P=0.047), leukocyte count (P=0.006), and blood flow velocity in the right (P=0.02) and left (P=0.05) cerebral artery, while being negatively correlated with hemoglobin levels (P<0.04). Acute chest syndrome (ACS) and vaso-occlusive events (VOE) were more frequent in SCA patients exhibiting higher TG/HDL-c values (odds ratio: 3.77, P=0.027). Multivariate logistic regression analysis confirmed independent associations between elevated TG/HDL-c values and SCA. Thus, children and adolescents with SCA exhibited a lipid profile associated with hemolysis and inflammatory parameters, with increased risk of ACS and VOE. TG/HDL-c is a potential biomarker of severity of disease.

Bactérias zoonóticas isoladas de Passeriformes silvestres recuperados do tráfico de animais no estado do Ceará/Brasil / Zoonotic bacteria isolated from wild Passeriformes recovered from animal trafficking in the State of Ceará/Brazil

A ordem dos Passeriformes é uma das mais pressionadas pelas ações antrópicas, especialmente as relativas ao tráfico de animais, que, devido às más condições de manejo e higiênico-sanitárias, favorecem a infecção dos espécimes por patógenos virulentos e zoonóticos, como cepas de Escherichia coli e Salmonella spp., cujo isolamento em suabes cloacais, bem como a análise dos genes de virulência das cepas de E. coli foram objetivos do estudo. Para isso, 120 Passeriformes silvestres nativos, recebidos pelo Cetas/CE, foram avaliados individualmente. As cepas isoladas foram submetidas a teste de disco difusão para determinação da sensibilidade aos antimicrobianos. Em etapa posterior, foi realizada PCR para a detecção de oito genes de virulência dos principais patotipos diarreiogênicos de E. coli. Quanto aos resultados, nenhuma cepa de Salmonella spp. foi isolada, no entanto a ocorrência de E. coli foi de 40,8%. Foi observada elevada resistência, principalmente aos antimicrobianos tetraciclina, ampicilina e sulfazotrim, ocorrendo multirresistência em 42,8% das cepas. Pela análise molecular, foram diagnosticados quatro entre os nove genes pesquisados, com a identificação de EPEC típicas, EPEC atípicas, ETEC, EHEC e EAEC. Os resultados apontam para a importância de Passeriformes como possíveis disseminadores de zoonoses.(AU)

The order Passeriformes is one of the most pressured by anthropic actions, especially those related to animal trafficking. Due to poor sanitary and hygienic conditions, the infection of the specimens is favored by virulent and zoonotic pathogens such as strains of Escherichia coli and Salmonella spp., whose isolation in cloacal swabs as well as the analysis of the virulence genes of E. coli strains were the objectives of the study. For this, 120 native wild Passeriformes, received by CETAS/CE were individually evaluated. The isolated strains were submitted to diffusion disc test to determine sensitivity to antimicrobials. In a later stage, PCR was performed for the detection of eight virulence genes from the main E. coli diarrhoeagenic pathogens. Regarding the results, no strain of Salmonella spp. was isolated; however, the occurrence of E. coli was 40.8%. High resistance was observed, mainly to the antimicrobials Tetracycline, Ampicillin and Sulfazotrim, with multi-resistance in 42.8% of the strains. By molecular analysis, four of the nine genes were diagnosed, identifying typical EPEC, atypical EPEC, ETEC, EHEC and EAEC. The results point to the importance of Passeriformes as possible disseminators of zoonoses.(AU)