Obstetric simulation for undergraduate medical education: how to improve students' self-confidence and expectation according to gender.

OBJECTIVE: The aim of this study was to evaluate the effects of obstetric simulation training on undergraduate medical students to improve their self-confidence. METHODS: Fifth-year undergraduate medical students were invited to a 2-week course of simulation in obstetrics during their clerkship. The sessions included were as follows: (1) care for the second and third periods of childbirth, (2) partograph analysis and pelvimetry, (3) premature rupture of membranes at term, and (4) diagnosis and management of third-trimester bleeding. Before the first session and at the end of the training period, a questionnaire about self-confidence in obstetric procedures and skills was applied. RESULTS: A total of 115 medical students were included, of whom 60 (52.2%) were male and 55 (47.8%) were female. Comparing initial and final scores, the median results of the subscales "comprehension and preparation" (18 vs. 22, p<0.001), "knowledge of procedures" (14 vs. 20, p<0.001), and "expectation" (22 vs. 23, p<0.01) were significantly higher at the end of the training period in all items of the questionnaire than in the beginning. Differences were found based on the students' gender, i.e., female students had a significantly higher sum of scores than the male students in the initial subscale for "expectation" (median, 24 vs. 22, p<0.001) and "interest" (median, 23 vs. 21, p=0.032), and a higher sum of scores in the subscale for "expectation" (median, 23 vs. 21, p=0.010) in the final questionnaire. CONCLUSION: Obstetric simulation enhances the improvement of students' self-confidence in understanding both the physiology of childbirth and the obstetric care procedures. Further studies are needed to understand the influence of gender on obstetric care.

Obstetric simulation for undergraduate medical education: how to improve students' self-confidence and expectation according to gender

SUMMARY OBJECTIVE: The aim of this study was to evaluate the effects of obstetric simulation training on undergraduate medical students to improve their self-confidence. METHODS: Fifth-year undergraduate medical students were invited to a 2-week course of simulation in obstetrics during their clerkship. The sessions included were as follows: (1) care for the second and third periods of childbirth, (2) partograph analysis and pelvimetry, (3) premature rupture of membranes at term, and (4) diagnosis and management of third-trimester bleeding. Before the first session and at the end of the training period, a questionnaire about self-confidence in obstetric procedures and skills was applied. RESULTS: A total of 115 medical students were included, of whom 60 (52.2%) were male and 55 (47.8%) were female. Comparing initial and final scores, the median results of the subscales "comprehension and preparation" (18 vs. 22, p<0.001), "knowledge of procedures" (14 vs. 20, p<0.001), and "expectation" (22 vs. 23, p<0.01) were significantly higher at the end of the training period in all items of the questionnaire than in the beginning. Differences were found based on the students' gender, i.e., female students had a significantly higher sum of scores than the male students in the initial subscale for "expectation" (median, 24 vs. 22, p<0.001) and "interest" (median, 23 vs. 21, p=0.032), and a higher sum of scores in the subscale for "expectation" (median, 23 vs. 21, p=0.010) in the final questionnaire. CONCLUSION: Obstetric simulation enhances the improvement of students' self-confidence in understanding both the physiology of childbirth and the obstetric care procedures. Further studies are needed to understand the influence of gender on obstetric care.

Association between perceived stress and health-risk behaviours in workers.

Individuals who experience stress can engage in health-risk behaviours that may decrease work performance. The aim of this study was to determine perceived stress levels in Brazilian workers and verify whether perceived stress was associated with health-risk behaviours. Stress levels of 1,270 workers (1,019 men, 251 women) were assessed using the Perceived Stress Scale. The health-risk behaviours investigated were low intake of vegetables and fruits, daily smoking, high-risk alcohol consumption, physical inactivity, and the presence of obesity. The Student's t-test or one-way analysis of variance was used to assess differences in stress levels. Ordinal regression was used to determine the association between the degrees of stress and health-risk behaviours. Women had higher perceived stress levels than men. In addition, perceived stress levels were higher in those who had low socioeconomic status, were unmarried, had a negative perception of their health, were smokers, or had obesity. Smoking and the presence of two or more health-risk behaviours were associated with 1.84 (95% CI: 1.24-2.73) times and 1.49 (95% CI: 1.18-1.89) times higher odds of experiencing higher degrees of stress, respectively. In women, such an association was observed with the presence of obesity (odds ratio: 2.0; 95% CI: 1.01-3.98).

Perfil dos usuários vivendo com HIV/Aids atendidos em um Centro de Testagem e Aconselhamento no interior da Bahia: um estudo longitudinal retrospectivo / Profile of users living with HIV/AIDS assisted at a Counseling and Testing Center in the countryside of Bahia state: a longitudinal retrospective study

RESUMO: Objetivo: Caracterizar o perfil clínico e epidemiológico dos usuários vivendo com HIV/Aids atendidos em um Centro de Testagem e Aconselhamento (CTA) localizado no município de Paulo Afonso, no interior da Bahia. Casuística e métodos: Estudo retrospectivo, observacional, baseado em dados secundários obtidos mediante consulta aos registros dos usuários cadastrados no serviço durante o período de 2002 a 2019. Os dados foram tratados e analisa-dos por estatística descritiva e inferencial. Resultados: Foram identificados 301 indivíduos vivendo com HIV/Aids, correspondendo a uma média de 12,4 ± 9,5 casos/ano; 58,4% eram do sexo masculino com idade média de 40,6 ± 13,8 anos. Os indivíduos mais afetados possuíam o ensino fundamental incompleto e eram provenientes de bair-ros periféricos. Dos 226 indivíduos avaliados laboratorialmente, 49 (21,7%) foram diagnosticados na fase de Aids. Diferenças significativas foram observadas na contagem de linfócitos T CD4+, razão entre os linfócitos T CD4+/CD8+e linfócitos T CD45+ entre indivíduos vivendo com HIV e aqueles diagnosticados na fase de Aids (p<0,001). Con-clusão: A taxa de detecção de pessoas vivendo com HIV/Aids aumentou nos últimos anos no município de Paulo Afonso, Bahia. Esse aumento no número de casos deve-se, possivelmente, aos avanços nos métodos diagnósticos, bem como da implementação do CTA na região. O perfil dos indivíduos avaliados segue a tendência nacional, com predomínio do sexo masculino, jovem, com ensino fundamental incompleto. Como esperado, indivíduos diagnosti-cados na fase Aids apresentam resultados laboratoriais diferentes dos indivíduos vivendo com HIV. (AU)

ABSTRACT: Objective: To characterize the clinical and epidemiological profile of users living with HIV/AIDS treated at a Coun-seling and Testing Center (CTC) located in the municipality of Paulo Afonso, in the countryside of Bahia. Casuistry and methods: A retrospective, observational study, based on secondary data obtained by consulting the records of users registered within the service, during the period from 2002 to 2019. The data were treated and analyzed using descriptive and inferential statistics. Results: 301 individuals living with HIV/AIDS were identified, corresponding to a mean of 12.4 ± 9.5 cases/year; 58.4% were male with a mean age of 40.6 ± 13.8 years. The most affected individuals had incomplete primary education and came from peripheral neighborhoods. Of the 226 individuals eval-uated in the laboratory, 49 (21.7%) were diagnosed in the AIDS phase. Significant differences were observed in the CD4+ T lymphocyte count, ratio between CD4+/CD8+ T lymphocytes and CD45+ T lymphocytes between individuals living with HIV and those diagnosed in the AIDS phase (p<0.001). Conclusion: The detection rate of people living with HIV/AIDS has increased in recent years in the municipality of Paulo Afonso, Bahia. This increase in the number is possibly due to advances in diagnostic methods, as well as the implementation of CTC in the region. The profile of the individuals evaluated follows the national tendency, with a predominance of young men with incomplete el-ementary education. As expected, individuals diagnosed in the AIDS phase have different laboratory results from individuals living with HIV.

Short- and medium-term prognosis of HIV-infected patients receiving intensive care: a Brazilian multicentre prospective cohort study.

OBJECTIVES: The characteristics of critically ill HIV-positive patients and the causes of their admission to intensive care units (ICUs) are only known through retrospective and unicentric studies. This study aims to fill this knowledge gap. METHODS: This is a prospective, multicentre cohort study of short- and medium-term prognostic factors. The setting consisted of ICUs of three tertiary referral hospitals from the three largest metropolitan areas in Brazil in the period January 2014 to November 2015. In all, 161 HIV patients over 18 years old were included. RESULTS: The clinical data of the outcomes (ICU mortality, hospital mortality and 90-day survival) were extracted from medical records using the REDCap®ï¸ web-based form and analysed with the MedCalc®ï¸ application. Median age was 41.7 [interquartile range (IQR): 34-50] years, the Simplified Acute Physiologic Score 3 (SAPS 3) was 64 (IQR: 56-74), and the Sequential Organ Failure Assessment Score (SOFA) was 6 (IQR: 4-9) points. The main causes of admission were sepsis (54.5%) and acute respiratory failure (13.7%). ICU and hospital mortality rates were 32.3% and 40.4%, respectively. In a multivariate analysis, time until ICU admission ≥ 3 days (P = 0.0013), performance status (Eastern Cooperative Oncology Group score, P = 0.0344), coma (Glasgow Coma Scale ≤ 8 points, P = 0.0213) and sepsis (P = 0.0003) were associated with increased hospital mortality. Coma (P = 0.0002) and sepsis (P = 0.0008) were independently associated with 90-day survival. CONCLUSIONS: Delayed ICU admission and the severity of critical illness determine the short- and medium-term mortality rates of HIV-infected patients admitted to the ICU, rather than factors associated with HIV infection. These results suggest that prognostic factors of HIV-infected patients in the ICU are similar to those of non-HIV-infected populations.

Direct Trace Fitting of Experimental Data Using the Master Equation: Testing Theory and Experiments on the OH + C2H4 Reaction.

Laser flash photolysis coupled with laser-induced fluorescence observation of OH has been used to observe the equilibration of OH + C2H4 ↔ HOC2H4 over the temperature range 563-723 K and pressures of bath gas (N2) from 58 to 250 Torr. The time-resolved OH traces have been directly and globally fitted with a master equation in order to extract ΔRH00, the binding energy of the HOC2H4 adduct, with respect to reagents. The global approach allows the role that OH abstraction plays at higher temperatures to be identified. The resultant value ofΔRH00, 111.8 kJ mol-1, is determined to be better than 2 kJ mol-1 and is in agreement with our ab initio calculations (carried out at the CCSD(T)/CBS//M06-2X/aug-cc-pVTZ level), 111.4 kJ mol-1, and other state of the art calculations. Parameters for the abstraction channel are also in good agreement with previous experimental studies. To effect this analysis, the MESMER master equation code was extended to directly incorporate secondary chemistry: diffusional loss from the observation region and reaction with the photolytic precursor. These extensions, which, among other things, resolve issues related to the merging of chemically significant and internal energy relaxation eigenvalues, are presented.

Infecção latente pelo herpesvírus bovino tipo 1 em búfalos (Bubalus bubalis) no Rio Grande do Sul / Bovine herpesvirus type 1 latent infection in buffalo (Bubalus bubalis) in Rio Grande do Sul

Apesar dos bovinos serem considerados os hospedeiros naturais do BoHV-1, estudos sorológicos têm sugerido que búfalos podem ser suscetíveis ao BoHV-1 e a outros alfa-herpesvírus geneticamente relacionados. O objetivo deste estudo foi detectar a presença de DNA viral de BoHV-1 em 202 amostras de gânglios trigêmeos de búfalos, pela técnica de semi-nested PCR, para detecção de um segmento do gene codificante da glicoproteína D (gD) do BoHV-1. Além disso, 242 amostras de soro foram analisadas pela técnica de soroneutralização (SN) para a detecção de anticorpos neutralizantes contra BoHV-1, BoHV-5 e BuHV. Todas as amostras clínicas foram coletadas em um matadouro na cidade de Pelotas, RS, Brasil. O DNA de BoHV-1 foi detectado em 61 (30,1%) gânglios, e os resultados da SN demonstraram que 27,6% dos animais apresentaram anticorpos contra, pelo menos, um dos vírus testados. O sequenciamento genômico e a análise de 14 amplicons confirmaram a presença do DNA do BoHV-1 nos tecidos analisados. Em resumo, os resultados indicam que o BoHV-1 está distribuído em rebanhos bubalinos provenientes da região Sul do Brasil. Entretanto, são necessárias investigações adicionais, no sentido de elucidar o papel exato dos búfalos na epidemiologia das infecções pelo BoHV-1.(AU)

Although bovines are natural hosts for BoHV-1, serologic studies in several countries have suggested that buffaloes (Bubalus bubalis) may be susceptible to BoHV-1 and other genetically related alphaherpesvirus. This study aimed to investigate the presence of BoHV-1 DNA in trigeminal ganglia from 202 buffaloes by a semi-nested PCR to amplify partially the glycoprotein D (gD) gene of BoHV-1. Additionally, 242 serum samples were tested by serum neutralization (SN) for the detection of antibodies against BoHV-1, BoHV-5 and BuHV. All clinical samples were collected in a slaughterhouse located in Pelotas, RS, Brazil. BoHV-1 DNA was detected in 61 (30.1%) of the samples and SN revealed 27.6% of the animals with neutralizing antibodies against at least one of the tested viruses. Nucleotide sequencing of 15 amplicons followed by BLAST analysis confirmed the presence of BoHV-1 DNA in the analyzed tissues. Taken together, these data indicate that BoHV-1 infection is distributed in buffaloes in southern Brazil. However, the role of buffaloes in the BoHV-1 epidemiology needs further investigation.(AU)

Impulse oscillometry in the assessment of children's lung function

Purpose: To review available evidence in the literature on impulse oscillometry in the assessment of lung function in children with respiratory diseases, especially asthma. Data collection: Research in the Medline, PubMed, and Lilacs databases, with the keywords forced oscillation, impulse oscillometry, asthma and impulse oscillometry. Results: The Impulse Oscillometry System (IOS) allows the measurement of resistance and reactance of airways and is used as a diagnostic resource. A significant association between the findings of the IOS and those of spirometry is observed. In asthma, the IOS has already been used to assess the bronchodilator response and the therapeutic response to different drugs and has shown to be a sensitive technique to evaluate disease control. There are limitations to this assessment, such as children with attention deficit and in some cases it is difficult to interpret the results from a clinical point of view. Conclusion: The IOS is a useful tool for the measurement of the lung function of children. It is an easy test, although its interpretation is not straightforward

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Impulse oscillometry in the assessment of children's lung function.

PURPOSE: To review available evidence in the literature on impulse oscillometry in the assessment of lung function in children with respiratory diseases, especially asthma. DATA COLLECTION: Research in the Medline, PubMed, and Lilacs databases, with the keywords forced oscillation, impulse oscillometry, asthma and impulse oscillometry. RESULTS: The Impulse Oscillometry System (IOS) allows the measurement of resistance and reactance of airways and is used as a diagnostic resource. A significant association between the findings of the IOS and those of spirometry is observed. In asthma, the IOS has already been used to assess the bronchodilator response and the therapeutic response to different drugs and has shown to be a sensitive technique to evaluate disease control. There are limitations to this assessment, such as children with attention deficit and in some cases it is difficult to interpret the results from a clinical point of view. CONCLUSION: The IOS is a useful tool for the measurement of the lung function of children. It is an easy test, although its interpretation is not straightforward.

Kinetics of the Reaction of OH with Isoprene over a Wide Range of Temperature and Pressure Including Direct Observation of Equilibrium with the OH Adducts.

The reaction of the OH radical with isoprene, C5H8 (R1), has been studied over the temperature range 298-794 K and bath gas pressures of nitrogen from 50 to 1670 Torr using laser flash photolysis (LFP) to generate OH and laser-induced fluorescence (LIF) to observe OH removal. Measurements have been made using both a conventional LFP/LIF apparatus and a new high pressure system. The measured rate coefficient at 298 K ( k1,298K = (9.90 ± 0.09) × 10-11 cm3 molecule-1 s-1) in the high pressure apparatus is in excellent agreement with the literature, confirming the accuracy of measurements made with this instrument. Above 700 K, the OH decays were no longer single exponentials due to regeneration of OH from adduct decomposition and the establishment of the OH + C5H8 ⇌ HOC5H8 equilibrium (R1a, R-1a). This equilibrium was analyzed by comparison to a master equation model of reaction R1 and determined the well depth for OH addition to carbon C1 and C4 to be equal to 153.5 ± 6.2 and 143.4 ± 6.2 kJ mol-1, respectively. These well depths are in excellent agreement with the present ab initio-CCSD(T)/CBS//M062X/6-311++G(3df,2p)-calculations (154.1 kJ mol-1 for the C1 adduct). Addition to the less stable C2 and C3 adducts is not important. The data above 700 K also indicated that a minor but significant direct abstraction channel, R1b, was also operating with k1b = (1.3 ± 0.3) × 10-11 exp(-3.61 kJ mol-1/ RT) cm3 molecule-1 s-1. Additional support for the presence of this abstraction channel comes from our ab initio calculations and from room-temperature proton transfer mass spectrometry product analysis. The literature data on reaction R1 together with the present data were assessed using master equation analysis, using the MESMER package. This analysis produced a refined data set that generates our recommended k1a( T, [ M]). An analytical representation of k1a( T, [ M]) and k-1a( T, [ M]) is provided via a Troe expression. The reported experimental data (the sum of addition and abstraction), k1∞ = (9.5 ± 0.2) × 10-11( T/298 K)-1.33±0.07 + (1.3 ± 0.3) × 10-11 exp(-3.61 kJ mol-1/ RT) cm3 molecule-1 s-1, significantly extend the measured temperature range of R1.

Toward multifaceted roles of sucrose in the regulation of stomatal movement.

Plant atmospheric CO2 fixation depends on the aperture of stomatal pores at the leaf epidermis. Stomatal aperture or closure is regulated by changes in the metabolism of the two surrounding guard cells, which respond directly to environmental and internal cues such as mesophyll-derived metabolites. Sucrose has been shown to play a dual role during stomatal movements. The sucrose produced in the mesophyll cells can be transported to the vicinity of the guard cells via the transpiration stream, inducing closure in periods of high photosynthetic rate. By contrast, sucrose breakdown within guard cells sustains glycolysis and glutamine biosynthesis during light-induced stomatal opening. Here, we provide an update regarding the role of sucrose in the regulation of stomatal movement highlighting recent findings from metabolic and systems biology studies. We further explore how sucrose-mediated mechanisms of stomatal movement regulation could be useful to understand evolution of stomatal physiology among different plant groups.

Exploring the features on the OH + SO2 potential energy surface using theory and testing its accuracy by comparison to experimental data.

Ab initio theory has been used to identify the pre-reaction complex in the atmospherically important reaction between OH + SO2, (R1), where the binding energy of the pre-reaction complex was determined to be 7.2 kJ mol-1. Using reaction rate theory, implemented with the master equation package MESMER, the effects of this complex on the kinetics of R1 at temperatures above 250 K have been investigated. From simulations and fitting to the experimental kinetic data, it is clear that the influence of this pre-reaction complex is negligible and that the kinetics are controlled by the inner transition-state that leads to the product, HOSO2. While the effect of this complex on the thermal kinetics is small it potentially provides an efficient route to remove energy from vibrationally excited OH. The fitting to the past experimental data reveals that this inner transition-state is submerged with a barrier -0.25 kJ mol-1 below the entrance channel, which is outside the range predicted from the best theoretical calculations. The data fitting also yielded ΔR1H0K equal to -(109 ± 5.6) kJ mol-11 and a more precise expression for k∞1(T), (5.95 ± 0.83) × 10-13 × (T/298)-0.11±0.27.

Skin reactivity to aeroallergens in schistosoma mansoni-infected Brazilian individuals and modulation of CCL2 and IL-10

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Influence of chronic stretching on muscle performance: Systematic review.

The aim of the current study was to investigate the influence of chronic stretching on muscle performance (MP) by a systematic review. The search strategy included MEDLINE, PEDro, Cochrane CENTRAL, LILACS, and manual search from inception to June 2016. Randomized and controlled clinical trials, non-randomized, and single group studies that have analyzed the influence of flexibility training (FT) (using any stretching technique) on MP were included. Differently, studies with special populations (children, elderly, and people with any dysfunction/disease), and articles that have used FT protocols shorter than three weeks or 12 sessions were excluded. The MP assessment could have been performed by functional tests (e.g. jump, sprint, stretch-shortening cycle tasks), isometric contractions, and/or isotonic contractions. Twenty-eight studies were included out of 513. Seven studies evaluated MP by stretch-shortening cycle tasks, Ten studies evaluated MP by isometric contractions, and 13 studies assessed MP by isotonic contractions. We were unable to perform a meta-analysis due to the high heterogeneity among the included studies. In an individual study level analysis, we identified that 14 studies found positive effects of chronic stretching on MP. The improvements were observed only in functional tests and isotonic contractions, isometric contractions were not affected by FT. Therefore, FT might have an influence on dynamic MP. However, more studies are necessary to confirm whether FT can positively affect MP.

Estimating the burden of acute gastrointestinal illness due to Giardia, Cryptosporidium, Campylobacter, E. coli O157 and norovirus associated with private wells and small water systems in Canada.

Waterborne illness related to the consumption of contaminated or inadequately treated water is a global public health concern. Although the magnitude of drinking water-related illnesses in developed countries is lower than that observed in developing regions of the world, drinking water is still responsible for a proportion of all cases of acute gastrointestinal illness (AGI) in Canada. The estimated burden of endemic AGI in Canada is 20·5 million cases annually - this estimate accounts for under-reporting and under-diagnosis. About 4 million of these cases are domestically acquired and foodborne, yet the proportion of waterborne cases is unknown. There is evidence that individuals served by private systems and small community systems may be more at risk of waterborne illness than those served by municipal drinking water systems in Canada. However, little is known regarding the contribution of these systems to the overall drinking water-related AGI burden in Canada. Private water supplies serve an estimated 12% of the Canadian population, or ~4·1 million people. An estimated 1·4 million (4·1%) people in Canada are served by small groundwater (2·6%) and surface water (1·5%) supplies. The objective of this research is to estimate the number of AGI cases attributable to water consumption from these supplies in Canada using a quantitative microbial risk assessment (QMRA) approach. This provides a framework for others to develop burden of waterborne illness estimates for small water supplies. A multi-pathogen QMRA of Giardia, Cryptosporidium, Campylobacter, E. coli O157 and norovirus, chosen as index waterborne pathogens, for various source water and treatment combinations was performed. It is estimated that 103 230 AGI cases per year are due to the presence of these five pathogens in drinking water from private and small community water systems in Canada. In addition to providing a mechanism to assess the potential burden of AGI attributed to small systems and private well water in Canada, this research supports the use of QMRA as an effective source attribution tool when there is a lack of randomized controlled trial data to evaluate the public health risk of an exposure source. QMRA is also a powerful tool for identifying existing knowledge gaps on the national scale to inform future surveillance and research efforts.

Estimating the number of cases of acute gastrointestinal illness (AGI) associated with Canadian municipal drinking water systems.

The estimated burden of endemic acute gastrointestinal illness (AGI) annually in Canada is 20·5 million cases. Approximately 4 million of these cases are domestically acquired and foodborne, yet the proportion of waterborne cases is unknown. A number of randomized controlled trials have been completed to estimate the influence of tap water from municipal drinking water plants on the burden of AGI. In Canada, 83% of the population (28 521 761 people) consumes tap water from municipal drinking water plants serving >1000 people. The drinking water-related AGI burden associated with the consumption of water from these systems in Canada is unknown. The objective of this research was to estimate the number of AGI cases attributable to consumption of drinking water from large municipal water supplies in Canada, using data from four household drinking water intervention trials. Canadian municipal water treatment systems were ranked into four categories based on source water type and quality, population size served, and treatment capability and barriers. The water treatment plants studied in the four household drinking water intervention trials were also ranked according to the aforementioned criteria, and the Canadian treatment plants were then scored against these criteria to develop four AGI risk groups. The proportion of illnesses attributed to distribution system events vs. source water quality/treatment failures was also estimated, to inform the focus of future intervention efforts. It is estimated that 334 966 cases (90% probability interval 183 006-501 026) of AGI per year are associated with the consumption of tap water from municipal systems that serve >1000 people in Canada. This study provides a framework for estimating the burden of waterborne illness at a national level and identifying existing knowledge gaps for future research and surveillance efforts, in Canada and abroad.

The effect of folic acid supplementation with ferrous sulfate on the linear and ponderal growth of children aged 6-24 months: a randomized controlled trial.

BACKGROUND/OBJECTIVES: Studies evaluating the effect of folic acid supplementation, either alone or in combination with iron, on the linear and ponderal growth of children are practically nonexistent. The aim of this study was to assess the effect of folic acid supplementation with ferrous sulfate on both linear growth and weight gain in anemic and nonanemic children attending Municipal Daycare Centers in Goiania, State of Goias, Brazil. SUBJECTS/METHODS: A double-blind, randomized, controlled trial was conducted on 188 children aged 6-24 months. The effects of ferrous sulfate and folic acid supplementation were evaluated using the analysis of variance procedure, based on a double factorial model with two factors of fixed effects (folic acid supplementation and ferrous sulfate supplementation), adjusted for initial weight. The level of significance was 0.05. RESULTS: The children who received folic acid supplementation showed greater weight gain than the monthly average weight gain of those not given the supplement (P=0.026). This effect was independent of the dose of ferrous sulfate (P for interaction=0.693). Folic acid supplementation increased the gain of weight-for-age Z-score when compared with the placebo group (P=0.018), independent of the dose of ferrous sulfate. CONCLUSION: Folic acid had no effect on linear growth. The use of folic acid supplementation increased the monthly average weight gain and the gain in weight-for-age Z-score compared with the placebo group. This effect was independent of the dose of ferrous sulfate.

Circumscribing campo rupestre - megadiverse Brazilian rocky montane savanas.

Currently campo rupestre (CR) is a name accepted and used internationally by botanists, zoologists, and other naturalists, usually applied to a very specific ecosystem, despite the lack of a consensual published circumscription. We present a tentative geographic circumscription of the term, combining data on climate, geology, geomorphology, soil, flora, fauna and vegetation. The circumscription of campo rupestre proposed herein is based on the following premises: (1) the classification of vegetation is not an exact science, and it is difficult to attain a high degree of consensus to the circumscription of vegetation names; (2) despite this, vegetation classification is useful for conservation and management. It is thus desirable to circumscribe vegetation types with the greatest attainable precision; (3) there is a need to preserve all montane and rocky vegetation types, regardless of classification, biome, etc; (4) the CRs are formed by a complex mosaic of vegetation types including rock-dwelling, psammophilous, aquatic, epiphytic, and penumbral plant communities. Campos rupestres stricto sensu are a Neotropical, azonal vegetation complex endemic to Brazil, forming a mosaic of rocky mountaintop "archipelagos" inserted within a matrix of zonal vegetation, mainly in the Cerrado and Caatinga provinces of the Brazilian Shield (southeastern, northeastern and central-western regions), occurring mainly above 900 m asl. up to altitudes exceeding 2000 m, having measured annual precipitation between 800 and 1500 mm, and an arid season of two to five months.

Pandemic influenza immunization in primary antiphospholipid syndrome (PAPS): a trigger to thrombosis and autoantibody production?

OBJECTIVE: The objective of this report is to conduct short- and long-term evaluation of a large panel of antiphospholipid (aPL) autoantibodies following pandemic influenza A/H1N1 non-adjuvant vaccine in primary antiphospholipid syndrome (PAPS) patients and healthy controls. METHODS: Forty-five PAPS and 33 healthy controls were immunized with H1N1 vaccine. They were prospectively assessed at pre-vaccination, and three weeks and six months after vaccination. aPL autoantibodies were determined by an enzyme-linked immunosorbent assay (ELISA) and included IgG/IgM: anticardiolipin (aCL), anti-beta2glycoprotein I (anti-ß2GPI); anti-annexin V, anti-phosphatidyl serine and anti-prothrombin antibodies. Anti-Sm was determined by ELISA and anti-double-stranded DNA (anti-dsDNA) by indirect immunofluorescence. Arterial and venous thrombosis were also clinically assessed. RESULTS: Pre-vaccination frequency of at least one aPL antibody was significantly higher in PAPS patients versus controls (58% vs. 24%, p = 0.0052). The overall frequencies of aPL antibody at pre-vaccination, and three weeks and six months after immunization remained unchanged in patients (p = 0.89) and controls (p = 0.83). The frequency of each antibody specificity for patients and controls remained stable in the three evaluated periods (p > 0.05). At three weeks, two PAPS patients developed a new but transient aPL antibody (aCL IgG and IgM), whereas at six months new aPL antibodies were observed in six PAPS patients and none had high titer. Anti-Sm and anti-dsDNA autoantibodies were uniformly negative and no new arterial or venous thrombosis were observed throughout the study. CONCLUSIONS: This is the first study to demonstrate that pandemic influenza vaccine in PAPS patients does not trigger short- and long-term thrombosis or a significant production of aPL-related antibodies (ClinicalTrials.gov, #NCT01151644).