Description of the parasitic fauna of a specimen of Didelphis albiventris at Rio Grande do Sul.

Didelphis albiventris is considered the most common marsupial in Rio Grande do Sul. With omnivorous and synanthropic habits, it can serve as a host to various parasites, playing an important role in maintaining their biological cycle. Despite being a widespread and abundant species, it has a relatively little-known parasitic fauna. Therefore, the aim of this study was to report the diversity of parasites in a fecal sample from D. albiventris in Rio Grande do Sul, Southern Brazil. Modified Centrifugal-flotation and Spontaneous sedimentation techniques were used, revealing a high taxonomic diversity of parasites. Eggs of Ancylostoma spp., Toxocara spp., and Anoplocephalidae were reported for the first time in the host in the southern region of the country, along with the first report of pseudoparasitism by Syphacia spp. and Monocystis spp. in this animal species. The presence of different parasites in the feces of D. albiventris is of utmost importance, primarily for public health, but also for understanding the biodiversity of parasites present in wildlife, which has been poorly studied until now. This allows the implementation of effective strategies for controlling, preventing and treating these diseases.

Didelphis albiventris é considerado o marsupial mais comum no Rio Grande do Sul. Com hábitos onívoros e sinantrópicos, pode servir de hospedeiro para diversos parasitas, desempenhando importante papel na manutenção do seu ciclo biológico. Apesar de ser uma espécie difundida e abundante, possui uma fauna parasitária relativamente pouco conhecida. Portanto, o objetivo deste estudo foi relatar a diversidade de parasitas em uma amostra fecal de D. albiventris no Rio Grande do Sul, Sul do Brasil. Foram utilizadas técnicas modificadas de flutuação centrífuga e sedimentação espontânea, revelando uma alta diversidade taxonômica de parasitas. Ovos de Ancylostoma spp., Toxocara spp. e Anoplocephalidae foram relatados pela primeira vez no hospedeiro na região sul do país, juntamente com o primeiro relato de pseudoparasitismo por Syphacia spp. e Monocystis spp. nesta espécie animal. A presença de diferentes parasitas nas fezes de D. albiventris é de extrema importância, principalmente para a saúde pública, mas também para a compreensão da biodiversidade de parasitas presentes na vida selvagem, que tem sido pouco estudada até agora. Isto permite a implementação de estratégias eficazes para controlar, prevenir e tratar estas doenças.

Standard and Extend High-Frequency Audiometry in Sudden Sensorineural Hearing Loss: Impacts on Tinnitus and Mental Health.

OBJECTIVE: To analyze the results of auditory assessment in standard (SA) and extended high-frequency (EHF) audiometry, associating the findings with sudden tinnitus and mental health of patients with unilateral sudden sensorineural hearing loss (SSNHL). STUDY DESIGN: Prospective, cohort study. SETTING: Outpatient otology clinic in a tertiary care hospital. SUBJECTS AND METHODS: Patients experiencing unilateral SSNHL were evaluated with pure-tone audiometry performed at frequencies of 250 to16,000 Hz, tinnitus pitch and loudness matching tests, Tinnitus Handicap Inventory (THI), Analog and Visual Scale (AVS) for bothersome tinnitus, and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Eighteen patients with unilateral SSNHL were assessed. After starting treatment, there was a significant improvement in the SA (71.1 dB to 50 dB; p < 0.001*) and EHF audiometry (64.5 dB to 54.4 dB; p < 0.001*) thresholds at 15 days, and this persisted at 30 days of follow-up. Significant improvements were seen for tinnitus in loudness, VAS, and THI and for mental health in the realms of anxiety and depression by HADS. Despite improvements in SA, persistent EHF hearing loss was accompanied by persistent tinnitus, but it was of diminished loudness. CONCLUSION: Despite improvement in pure-tone thresholds by SA, a subset of unilateral SSNHL patients did not experience hearing recovery in EHF thresholds and reported persistent tinnitus. We postulate that their diminished anxiety and better mental health may be related to both hearing improvement in standard audiometry and reduction in tinnitus loudness. This pilot prospective study investigates the utility of performing EHF audiometry to better understand outcomes in patients with SSNHL.

Long-Term Refractive Outcomes and Visual Quality of Multifocal Intraocular Lenses Implantation in High Myopic Patients: A Multimodal Evaluation.

Purpose: To perform a multimodal assessment of refractive outcomes and quality of vision (QoV) in patients with high myopia submitted to multifocal intraocular lens (IOL) implantation. Methods: Retrospective study that included consecutive eyes with high myopia (axial length [AL] >26.00mm) submitted to multifocal IOL implantation between January 2014 and February 2020. Minimum follow-up time was 3 years. QoV was evaluated with the Objective Scatter Index (OSI) and the Modular Transfer Function (MTF) by HD Analyzer®. Two QoV questionnaires were applied to patients in which both eyes were included: the McAlinden and the Catquest-9 SF. Results: We included 50 eyes (28 patients). The mean follow-up time was 5.4±1.0 years. Comparing to month 1 after surgery, at the last follow-up visit, there was a decrease in the uncorrected visual acuity (0.14±0.13 vs 0.08±0.09 LogMAR, p=0.024), a negative increase in the spherical equivalent (-0.31±0.60 vs -0.02±0.20, p=0.006) and no changes in the best-corrected visual acuity (p>0.999). An uncorrected near visual acuity of at least J2 was achieved in 89% of eyes one month after surgery and in 91% of eyes at the last follow-up visit (p=0.829). At the last follow-up, the mean OSI was 5.1±1.8 and the mean MTF was 17.5±10.6. Some degree of near vision difficulty was reported by 91% of patients, and 74% of patients reported photic phenomena (halos, glare, starbursts). However, most patients reported that these symptoms caused none to little bothersome. At the last follow-up, 87% of patients were at least fairly satisfied with the surgery. Conclusion: Even after a mean follow-up time of 5 years, patients maintained good uncorrected visual acuity. Even though most patients experienced some degree of near vision difficulty and visual symptoms, globally, our patients were satisfied with their current vision, and the experienced symptoms did not have a significant impact on their daily lives.

Gallium maltolate, a promising low toxicity drug with curative effect on mice chronically infected with Trypanosoma evansi.

Trypanosoma evansi is a flagellate protozoan that infects a wide range of hosts, especially horses. Clinically, the infection is characterized by rapid weight loss, anemia and mobility disorders. This study evaluated the efficacy of treatment gallium maltolate (GaM) in rats infected with T. evansi in the acute and chronic phases of the disease and its influence on the enzyme and blood parameters. 48 animals (Rattus norvegicus) were divided into 8 groups (A-H) of 6 animals each, namely: A: (negative control) uninfected; B: acutely infected positive control; C: chronically infected positive control; D: acutely infected, treated with GaM for 7 days post infection (p.i.); E: acutely infected treated with GaM for 3 days before infection (b.i) and 7 days p.i.; F: chronically infected, treated with GaM for 7 days p.i.; G: chronically infected, treated with GaM for 3 days b.i. and 7 days p.i.; and H: uninfected treated with GaM for 10 days. Acute infected animals (B, D and E) had a progressive increase in parasitemia and were died or euthanized before completing treatment days (5th days p.i.) as they had high parasitemia (over 100 field trypanosomes in the blood smear). Thus, it can be concluded that GaM was not effective against an acute infection. In untreated chronically infected animals (C) the parasitemia also increased progressively and they were euthanized on the 7th day p.i.. The chronically infected and treated animals (F and G) showed low parasitemia and after treatment became negative, showing no trypanosomes in the bloodstream until the 50th day of the experiment. Thus, we conclude that GaM was effective against chronic infections. In uninfected and treated animals (H) hematological, biochemical and enzymatic parameters had no significant changes when compared to the negative control group (A) demonstrating the low toxicity of GaM.

Systematic SARS-CoV-2 S-gene sequencing in wastewater samples enables early lineage detection and uncovers rare mutations in Portugal.

As the COVID-19 pandemic reached its peak, many countries implemented genomic surveillance systems to track the evolution and transmission of SARS-CoV-2. Transition from the pandemic to the endemic phase prioritized alternative testing strategies to maintain effective epidemic surveillance at the population level, with less intensive sequencing efforts. One such promising approach was Wastewater-Based Surveillance (WBS), which offers non-invasive, cost-effective means for analysing virus trends at the sewershed level. From 2020 onwards, wastewater has been recognized as an instrumental source of information for public health, with national and international authorities exploring options to implement national wastewater surveillance systems and increasingly relying on WBS as early warning of potential pathogen outbreaks. In Portugal, several pioneer projects joined the academia, water utilities and Public Administration around WBS. To validate WBS as an effective genomic surveillance strategy, it is crucial to collect long term performance data. In this work, we present one year of systematic SARS-CoV-2 wastewater surveillance in Portugal, representing 35 % of the mainland population. We employed two complementary methods for lineage determination - allelic discrimination by RT-PCR and S-gene sequencing. This combination allowed us to monitor variant evolution in near-real-time and identify low-frequency mutations. Over the course of this year-long study, spanning from May 2022 to April 2023, we successfully tracked the dominant Omicron sub-lineages, their progression and evolution, which aligned with concurrent clinical surveillance data. Our results underscore the effectiveness of WBS as a tracking system for virus variants, with the ability to unveil mutations undetected via massive sequencing of clinical samples from Portugal, demonstrating the ability of WBS to uncover new mutations and detect rare genetic variants. Our findings emphasize that knowledge of the genetic diversity of SARS-CoV-2 at the population level can be extended far beyond via the combination of routine clinical genomic surveillance with wastewater sequencing and genotyping.

Ctenocephalides felis (Siphonaptera, Pulicidae) parasitizing White-eared opossum (Didelphis albiventris) at Southern Brazil - Case report.

Didelphis albiventris is a marsupial with synanthropic habits, whose contact with domestic animals and humans is increasing. They are considered potential disseminators of diseases, present as definitive hosts or reservoirs of various pathogenic agents. The present study aim to report, for the first time, the parasitism by Ctenocephalides felis in D. albiventris in Rio Grande, Southern Rio Grande do Sul state, Brazil. An adult female White-eared Opossum (D. albiventris), killed by being run over, was collected on the roads of the city of Rio Grande, Rio Grande do Sul, Brazil and sent to the laboratory for necropsy. During external inspection, a flea was found, which was stored in 70o alcohol until taxonomic identification, being classified as C. felis. This study reports the occurrence of parasitism by C. felis in D. albiventris for the first time in the location studied, demonstrating that these arthropods circulate between the wild and urban environments, and play an important role in the cycle of zoonotic pathogens among wild fauna, companion animals and humans.

Didelphis albiventris é um marsupial de hábitos sinantrópicos, cujo contato com animais domésticos e humanos está aumentando. São considerados potenciais disseminadores de doenças, apresentando-se como hospedeiros definitivos ou reservatórios de vários agentes patogênicos. O presente estudo tem como objetivo relatar, pela primeira vez, o parasitismo por Ctenocephalides felis em D. albiventris em Rio Grande, Sul do Rio Grande do Sul, Brasil. Uma fêmea adulta de gambá-de-orelha-branca (D. albiventris), morta por atropelamento, foi recolhida nas estradas da cidade de Rio Grande, Rio Grande do Sul, Brasil e encaminhado ao laboratório para necropsia. Durante inspeção externa foi encontrada uma pulga que foi armazenada em álcool 70º até a identificação taxonômica sendo classificado como C. felis. Este estudo relata a ocorrência de parasitismo por C. felis em D. albiventris para o primeira vez no local estudado, demonstrando que esses artrópodes circulam entre a natureza e ambientes urbanos e desempenham um papel importante no ciclo de patógenos zoonóticos entre a fauna selvagem, animais de companhia e humanos.

Refractive Management of Surgical-Induced Presbyopia in a Young Patient with Vision-Related Quality of Life Complaints: A Case Report.

Visual difficulties can negatively impact life quality. Our purpose was to report the refractive surgical planning and outcomes of a young patient with mixed astigmatism and phacoemulsification-induced presbyopia due to congenital cataracts who was unsatisfied with her vision-related quality of life. A 32-year-old woman, submitted to phacoemulsification with implantation of a monofocal intraocular lens (IOL) and Nd:YAG laser posterior capsulotomy 3 years before, due to congenital cataracts, was referred to the Refractive Surgery Unit of Centro Hospitalar Universitário de Santo António. She had mixed astigmatism (+1.00-4.00 × 10° in the right eye [RE] and +0.50-1.75 × 180° in the left eye [LE]) and surgical-induced presbyopia, was intolerant to contact lenses, and felt that her vision significantly impaired her life quality. A trifocal Sulcoflex® (Rayner) IOL was implanted to correct the spherical and near refractive errors. In a second surgical time, a photorefractive keratectomy was performed to correct the residual astigmatism (-3.50 × 10° in the RE and -1.50 × 170° in the LE). In the last visit, distance and near uncorrected visual acuity were 20/20 (Snellen) and Jaeger 1, respectively, in both eyes, and the patient was very satisfied. When assessing the surgical options of young, working-age patients, clinicians should, when possible, consider alternative solutions to monofocal IOLs. In this patient, the combination of corneal and intraocular procedures allowed the correction of both the distance and near refractive errors, with a subsequent significant improvement in the patient's quality of life.

Microplastics in Cetaceans Stranded on the Portuguese Coast.

This study characterises microplastics in small cetaceans on the coast of Portugal and assesses the relationship between several biological variables and the amount of detected microplastics. The intestines of 38 stranded dead cetaceans were processed in the laboratory, with digestion methods adapted to the amount of organic matter in each sample. The influence of several biological and health variables (e.g., species, sex, body condition) on the amount of microplastics was tested in all analysed species and particularly in common dolphins, due to the larger number of available samples. Most of the analysed individuals had microplastics in the intestine (92.11%), with harbour porpoises revealing a significantly higher median number of microplastics than common dolphins, probably due to their different diets, use of habitat and feeding strategies. None of the other tested variables significantly influenced the number of microplastics. Moreover, the microplastics found should not be enough to cause physical or chemical sublethal effects, although the correlation between microplastic ingestion and plastic additive bioaccumulation in cetacean tissues requires further investigation. Future monitoring in biota should rely on improved and standardised protocols for microplastic analyses in complex samples to allow for accurate analyses of larger samples and spatio-temporal comparisons.

Common scab disease: structural basis of elicitor recognition in pathogenic Streptomyces species.

IMPORTANCE: Common scab is a disease caused by a few Streptomyces species that affects important root and tuber crops including potato, beet, radish, and parsnip, resulting in major economic losses worldwide. In this work, we unveiled the molecular basis of host recognition by these pathogens by solving the structure of the sugar-binding protein CebE of Streptomyces scabiei in complex with cellotriose, the main elicitor of the pathogenic lifestyle of these bacteria. We further revealed that the signaling pathway from CebE-mediated transport of cellotriose is conserved in all pathogenic species except Streptomyces ipomoeae, which causes soft rot disease in sweet potatoes. Our work also provides the structural basis of the uptake of cellobiose and cellotriose in saprophytic Streptomyces species, the first step activating the expression of the enzymatic system degrading the most abundant polysaccharide on earth, cellulose.

Bladder training compared to bladder training associated with pelvic floor muscle training for overactive bladder symptoms in women: A randomized clinical trial.

AIMS: To compare the effects of bladder training (BT) versus BT with pelvic floor muscle training (PFMT) in women with overactive bladder (OAB) symptoms. METHODS: Randomized controlled clinical trial including women with OAB symptoms, randomized into two groups: BT versus BT + PFMT. For 12 consecutive weeks, the women received home BT. The BT + PFMT performed supervised PFMT, once/week, associated at home PFMT protocol. Primary outcomes were urinary urgency, daytime voiding frequency, nocturia and urgency urinary incontinence assisted by both 3-day bladder diary and International Consultation on Incontinence OAB (ICIQ-OAB) questionnaire. Secondary outcomes were 24-h pad test and Patient Global Impression of Improvement. T-test, analysis of variance, Mann-Whitney (SPSS 20.0) and power/effect size (G-power) were applied in data analyses. RESULTS: Sixty-three women were included (B = 31; BT + PFMT = 32). There was no significant statistical difference between groups in terms of urinary symptoms: daytime frequency (BT: pre: 11.59 [±5.80], post: 9.10 [±4.05]; BT + PFMT: pre: 10.67 [±3.73], post: 8.08 [±3.38]) p = 0.75; nocturia: (BT: pre: 1.46 [±0.91], post: 0.82 [±0.82]; BT + PFMT: pre: 1.80 [±2.26], post: 0.82 [±1.15]) p = 0.70; urinary urgency (BT: pre: 3.22 [±4.70], post: 4.49 [±4.32]; BT + PFMT: pre: 6.87 [±5.60], post: 6.15 [±4.52]) p = 0.10; ICIQ-OAB total score: (BT: pre: 9.16 [±2.55], post: 6.32 [±3.77]; (BT + PFMT: pre: 9.75 [±2.06], post: 5.06 [±3.44] p = 0.30. CONCLUSIONS: Supervised PFMT added to BT did not provide further improvements than isolated BT in women with OAB symptoms.

Assessment of Harbour Porpoise Bycatch along the Portuguese and Galician Coast: Insights from Strandings over Two Decades.

The Iberian harbour porpoise population is small and fisheries bycatch has been described as one of its most important threats. Data on harbour porpoise strandings collected by the Portuguese and Galician stranding networks between 2000 and 2020 are indicative of a recent mortality increase in the western Iberian coast (particularly in northern Portugal). Overall, in Portugal and Galicia, individuals stranded due to confirmed fishery interaction represented 46.98% of all analysed porpoises, and individuals stranded due to probable fishery interaction represented another 10.99% of all analysed porpoises. Considering the Portuguese annual abundance estimates available between 2011 and 2015, it was possible to calculate that an annual average of 207 individuals was removed from the population in Portuguese waters alone, which largely surpasses the potential biological removal (PBR) estimates (22 porpoises, CI: 12-43) for the same period. These results are conservative and bycatch values from strandings are likely underestimated. A structured action plan accounting for new activities at sea is needed to limit the Iberian porpoise population decline. Meanwhile, there is an urgent need for a fishing effort reorganization to directly decrease porpoise mortality.

First report of parasitism by Eutrichophilus cercolabes (Phthiraptera: Trichodectidae) on Coendou spinosus (Erethizontidae) in Rio Grande do Sul, Brazil - case report.

Coendou spinosus is a species of rodent popularly known as porcupine, it has a great ability to adapt to different habitats and is found in tropical forests in countries such as Bolivia, Brazil, Venezuela and Guianas. This mammal has already been identified as a reservoir of several pathogenic agents for humans and other animals and has a variety of ectoparasites, endoparasites and hemoparasites little studied and described. Due to this, the objective was to report the parasitism by Eutrichophilus cercolabes in C. spinosus in the central region of Rio Grande do Sul, southern Brazil. In total, 16 lice were found, one male and 15 females of the species. This is the first report of the parasitism of this Phthiraptera on C. spinosus in Rio Grande do Sul. The scarcity of reports on the taxonomy and biotic characteristics, as well as the vector capacity of pathogens of most species of ectoparasites of wild animals, highlights the need for further studies on the distribution of these arthropods in different regions and host species.

Coendou spinosus é uma espécie de roedor conhecida popularmente por porco-espinho, possui uma grande capacidade de adaptação a diferentes habitats sendo encontrada em florestas tropicais de países como Bolívia, Brasil, Venezuela e Guianas. Esse mamífero já foi identificado como reservatório de vários agentes patogênicos para o homem e outros animais e possui uma variedade de ectoparasitos, endoparasitos e hemoparasitos pouco estudados e descritos. Devido a isso, objetivou-se relatar o parasitismo por Eutrichophilus cercolabes em C. spinosus na região central do Rio Grande do Sul, Sul do Brasil. Ao total, foram encontrados 16 piolhos, sendo um macho e 15 fêmeas da espécie. Esse é o primeiro relato do parasitismo deste Phthiraptera em C. spinosus no Rio Grande do Sul. A escassez de relatos sobre a taxonomia e características bióticas, bem como a capacidade vetorial de patógenos da maioria das espécies de ectoparasitos de animais silvestres evidencia a necessidade da realização de mais estudos sobre a distribuição desses artrópodes em diferentes regiões e espécies hospedeiras.

Performance of bacterial and mitochondrial qPCR source tracking methods: A European multi-center study.

With the advent of molecular biology diagnostics, different quantitative PCR assays have been developed for use in Source Tracking (ST), with none of them showing 100% specificity and sensitivity. Most studies have been conducted at a regional level and mainly in fecal slurry rather than in animal wastewater. The use of a single molecular assay has most often proven to fall short in discriminating with precision the sources of fecal contamination. This work is a multicenter European ST study to compare bacterial and mitochondrial molecular assays and was set to evaluate the efficiency of nine previously described qPCR assays targeting human-, cow/ruminant-, pig-, and poultry-associated fecal contamination. The study was conducted in five European countries with seven fecal indicators and nine ST assays being evaluated in a total of 77 samples. Animal fecal slurry samples and human and non-human wastewater samples were analyzed. Fecal indicators measured by culture and qPCR were generally ubiquitous in the samples. The ST qPCR markers performed at high levels in terms of quantitative sensitivity and specificity demonstrating large geographical application. Sensitivity varied between 73% (PLBif) and 100% for the majority of the tested markers. On the other hand, specificity ranged from 53% (CWMit) and 97% (BacR). Animal-associated ST qPCR markers were generally detected in concentrations greater than those found for the respective human-associated qPCR markers, with mean concentration for the Bacteroides qPCR markers varying between 8.74 and 7.22 log10 GC/10 mL for the pig and human markers, respectively. Bacteroides spp. and mitochondrial DNA qPCR markers generally presented higher Spearman's rank coefficient in the pooled fecal samples tested, particularly the human fecal markers with a coefficient of 0.79. The evaluation of the performance of Bacteroides spp., mitochondrial DNA and Bifidobacterium spp. ST qPCR markers support advanced pollution monitoring of impaired aquatic environments, aiming to elaborate strategies for target-oriented water quality management.

Activity of Oyster Mushrooms, Genus Pleurotus (Agaricomycetes), on Lucilia cuprina (Diptera).

Lucilia cuprina is a vector of important diseases in humans and animals that causes myiasis in sheep, leading to enormous damage to the sheep sector. Chemical products are used to control these flies; however, there are reports of resistance in addition to these products causing toxicity to the environment, humans, and animals, so alternative controls have been studied to reduce these impacts. Pleurotus spp. are basidiomycete fungi and present bioactive compounds with medicinal properties. Due to the potential use of fungi to control Diptera, this study aimed to verify the activity of Pleurotus florida, P. ostreatus, and P. djamor in the control of larvae and adults of L. cuprina, as well as the effects of aqueous extracts of the fungi P. ostreatus, P. djamor, and P. florida on larvae and adults of L. cuprina. The aqueous extract from P. florida was the only one that showed larvicidal activity against L. cuprina, with a half-maximal effective concentration of 11.42 mg/mL. In the test with adult stages, 30 insects were used for each solution concentration, sprinkled with 1 mL of the solution. All aqueous extracts showed adulticidal activity at all concentrations, P. ostreatus showing the best results, with adult mortality ranging from 75.86 to 100%. Our results demonstrated an important larvicidal effect of P. florida and an adulticidal effect of all AE, with emphasis on P. ostreatus.

New species of Polystomoides (Monogenoidea: Polystomatidae) parasitizing the urinary bladder of a freshwater turtle in Brazil.

Trachemys dorbigni is the most abundant freshwater turtle species in Rio Grande do Sul, southern Brazil. Chelonians are known to host a wide variety of pathogens, including viruses, bacteria, hemoparasites and helminths. Among these, nine genera of polystomatid flatworms (Monogenoidea; Polystomatidae) infect freshwater turtles: Apaloneotrema, Aussietrema, Fornixtrema, Manotrema, Pleurodirotrema, Polystomoidella, Polystomoides, Uropolystomoides and Uteropolystomoides. However, little is known about the biology of these parasites in the Neotropical Realm. Through investigative cystoscopy, specimens of Polystomatidae were located inside the urinary bladder of the host T. dorbigni. Retrieved specimens were fixed and stained whole mounts prepared for taxonomic identification. In the present paper, a new species of Polystomoides (Monogenoidea: Polystomatidae) parasitizing the urinary bladder of a freshwater turtle of the species T. dorbigni in Brazil is described. Polystomoides santamariensis n. sp. differs from the congeneric species on the length of the genital spines, which are longer. Given the enormous diversity of freshwater turtles around the world, it is likely that a large number of chelonian polystomatids are still unknown.

Practical approach to referral from primary health care to a cardiology hospital consultation in 2022.

In Portugal, up to 38% of the population has cardiovascular disease, which highlights the importance of primary health care (PHC) in its management. Adequate management of people with cardiovascular disease often requires hospital referral for a cardiology consultation. However, it is not always easy to ascertain which situations should be referred, especially given that PHC does not have access to all diagnostic exams recommended by international guidelines, such as natriuretic peptides in heart failure or computed tomography coronary angiogram in chronic coronary syndromes, among others. The aim of this document is to describe a practical approach to the most frequent heart diseases that may require a referral for a hospital cardiology consultation. Thus, in the different chapters, the recommendations for referral are highlighted generically according to group of disease, as well as, albeit briefly, the initial clinical approach within the scope of PHC for a differential diagnosis and more efficient follow-up. A modified Metaplan methodology was used. A panel of 4 cardiology specialists and 3 specialists in General and Family Medicine developed this document, which should not be taken as an official guideline, but as additional guidance for the correct referral of patients. It is therefore advisable to validate these recommendations locally with the referral hospital, as well as to be aware of the respective international and national guidelines.

First record of a rare case of accidental urinary myiasis by Telmatoscopus albipunctata (Diptera: Psychodidae), with morphological description, in a human in Brazil.

Telmatoscopus albipunctata is an insect of the Psychodidae family, with a worldwide distribution, particularly in tropical and subtropical countries. Although it does not have hematophagous habits, it has veterinary medical importance due to the mechanical transmission of protozoa and bacteria, many of which cause nosocomial infections. This dipteran has been reported as one of the causative agents of accidental myiasis in humans in several countries, and since it has not been registered in South America, the objective of the present report was to describe a rare case of accidental urinary myiasis caused by T. albipunctata (Diptera: Psychodidae) in humans in Brazil. In the present report, a 25-year-old female patient, resident of the central region of the state of Rio Grande do Sul, Brazil, sought medical attention after finding larvae in her urine. She complained of vaginal itching and skin dermatitis. The larvae were sent to the Veterinary Parasitology Laboratory of the Federal University of Santa Maria, where they were mounted on permanent slides for further taxonomic identification. Morphological characteristics allowed the identification of fourth-stage larvae and pupae of T. albipunctata. Therefore, the present work reports the first record of accidental urinary myiasis caused by T. albipunctata infection in Brazil and South America.

Antibiotic resistance genes in bacteriophages from wastewater treatment plant and hospital wastewaters.

Antibiotic resistant bacteria (ARB) are a major health risk caused particularly by anthropogenic activities. Acquisition of antibiotic resistances by bacteria is known to have happened before the discovery of antibiotics and can occur through different routes. Bacteriophages are thought to have an important contribution to the dissemination of antibiotic resistance genes (ARGs) in the environment. In this study, seven ARGs (blaTEM, blaSHV, blaCTX-M, blaCMY, mecA, vanA, and mcr-1) were investigated, in the bacteriophage fraction, in raw urban and hospital wastewaters. The genes were quantified in 58 raw wastewater samples collected at five WWTPs (n = 38) and hospitals (n = 20). All genes were detected in the phage DNA fraction, with the bla genes found in higher frequency. On the other hand, mecA and mcr-1 were the least frequently detected genes. Concentrations varied between 102 copies/L and 106 copies/L. The gene coding for the resistance to colistin (mcr-1), a last-resort antibiotic for the treatment of multidrug-resistant Gram-negative infections, was identified in raw urban and hospital wastewaters with positivity rates of 19 % and 10 %, respectively. ARGs patterns varied between hospital and raw urban wastewaters, and within hospitals and WWTP. This study suggests that phages are reservoirs of ARGs, and that ARGs (with particularly emphasis on resistance to colistin and vancomycin) in the phage fraction are already widely widespread in the environment with potential large implications for public health.

Exploring the correlations between epi indicators of COVID-19 and the concentration of pharmaceutical compounds in wastewater treatment plants in Northern Portugal.

The COVID-19 pandemic caused by the SARS-CoV-2 virus led to changes in the lifestyle and human behaviour, which resulted in different consumption patterns of some classes of pharmaceuticals including curative, symptom-relieving, and psychotropic drugs. The trends in the consumption of these compounds are related to their concentrations in wastewater systems, since incompletely metabolised drugs (or their metabolites back transformed into the parental form) may be detected and quantified by analytical methods. Pharmaceuticals are highly recalcitrant compounds and conventional activated sludge processes implemented in wastewater treatment plants (WWTP) are ineffective at degrading these substances. As a results, these compounds end up in waterways or accumulate in the sludge, being a serious concern given their potential effects on ecosystems and public health. Therefore, it is crucial to evaluate the presence of pharmaceuticals in water and sludge to assist in the search for more effective processes. In this work, eight pharmaceuticals from five therapeutic classes were analysed in wastewater and sludge samples collected in two WWTP located in the Northern Portugal, during the third COVID-19 epidemic wave in Portugal. The two WWTP demonstrated a similar pattern with respect to the concentration levels in that period. However, the drugs loads reaching each WWTP were dissimilar when normalising the concentrations to the inlet flow rate. Acetaminophen (ACET) was the compound detected at highest concentrations in aqueous samples of both WWTP (98. 516 µg L - 1 in WWTP2 and 123. 506 µg L - 1in WWTP1), indicating that this drug is extensively used without the need of a prescription, known of general public knowledge as an antipyretic and analgesic agent to treat pain and fever. The concentrations determined in the sludge samples were below 1.65 µg g - 1 in both WWTP, the highest value being found for azithromycin (AZT). This result may be justified by the physico-chemical characteristics of the compound that favour its adsorption to the sludge surface through ionic interactions. It was not possible to establish a clear relationship between the incidence of COVID-19 cases in the sewer catchment and the concentration of drugs detected in the same period. However, looking at the data obtained, the high incidence of COVID-19 in January 2021 is in line with the high concentration of drugs detected in the aqueous and sludge samples but prediction of drug load from viral load data was unfeasible.

Bone mineral density progression following long-term simultaneous pancreas-kidney transplantation in type-1 diabetes.

INTRODUCTION: Simultaneous pancreas-kidney transplantation (SPKT) has demonstrated favorable impact on the progression of chronic complications in type-1 diabetes (T1D) and terminal chronic kidney disease (CKD). However, some CKD mineral and bone disorders (CKD-MBD) may persist, even after transplantation. There are only a few studies addressing the long-term progression of bone mineral density (BMD) in these patients. Our aim was to assess baseline BMD and long-term progression and consequences in patients with T1D undergoing SPKT. METHODS: A retrospective cohort included patients undergoing SPKT in our tertiary center between 2000 and 2017. BMD progression was assessed on dual X-ray absorptiometry (DXA). Only patients with baseline data and a minimum follow-up of 2 years were included. RESULTS: Seventy-three patients were included, 53.4% male, with a median age at SPKT of 35 years (interquartile range [IQR] 31; 39). At transplantation, the median T-scores for the lumbar spine (LS) and femoral neck (FN) were -1.6 (IQR -2.6; -1.1) and --2.1 (IQR -2.7; -1.6), respectively. Seventy-five percent of patients presented low BMD (osteopenia or osteoporosis) in the LS and 90% in the FN, with 33% osteoporosis in the LS and 36% in the FN. On multivariate analysis, male gender (odds ratio [OR] 10.82, 95% confidence interval (CI) 2.88-40.70) and low body-mass index (BMI) (OR 0.73, 95% CI 0.55-0.97) were significantly associated with lumbar but not femoral osteoporosis. At long-term follow-up, BMD significantly improved in the LS (ΔT-score +0.41, P<0.001) and FN (ΔT-score +0.29, P=0.01), at a median 4 years after SPKT. Twelve (16.4%) and 9 (12.3%) patients showed persistent FN and LS osteoporosis, respectively. Multivariate linear regression showed that high BMI was predictive of improvement in BMD. CONCLUSIONS: This study demonstrated severe skeletal fragility in T1D patients with terminal CKD undergoing SPKT, more than a quarter of whom showed osteoporosis. The significant improvement in BMD may result from metabolic correction by SPKT and from physiological skeleton mineralization, which continues in this age group. BMD progression was positively associated with BMI, due to improved nutritional balance after transplantation.