Description of the pupa, female and male genitalia of Aedes (Howardina) guerrero Berlin and first record of Ae. (How.) guatemala Berlin (Diptera: Culicidae) in Puebla, Mexico.

The pupa, female and male genitalia of Aedes (Howardina) guerrero Berlin, 1969 are described and illustrated for the first time. Additionally, the geographical distribution of Ae. (How.) guatemala Berlin, 1969 is extended. Valuable information on the distribution, larval habitats, taxonomy and keys to species within the Sexlineatus Section of the subgenus Howardina is provided.

List of the type specimens of Triatominae (Hemiptera: Heteroptera: Reduviidae) in the Hemimetabola Collection of the Museum für Naturkunde, Berlin.

The Hemimetabola Collection of the Museum für Naturkunde Berlin, Leibniz-Institut für Evolutions- und Biodiversitätsforschung, located in Berlin, Germany, holds types of 22 species of Triatominae (Hemiptera: Heteroptera: Reduviidae) belonging to six genera: Belminus Stål, 1859; Eratyrus Stål, 1859; Meccus Stål, 1859; Panstrongylus Berg, 1879; Rhodnius Stål, 1859; and Triatoma Laporte, 1832. We present a detailed list containing nomenclatural, taxonomic and label data, and photographs of specimens and their labels.

Type specimens of Coenosiini (Diptera, Muscidae) deposited in the Museum für Naturkunde, Humboldt-Universität zu Berlin (Berlin, Germany).

The Museum für Naturkunde of the Humboldt-Universität zu Berlin houses one of the most important and extensive collections of Muscidae (Diptera) in Europe as it includes more than 700 species described by Paul Stein and many others described by two other European dipterists, F. H. Loew and T. Becker. The relevance of the collection is even greater due to the excellent geographic coverage of this material. In this paper, we give a morphological and taxonomic revision of the 114 types of Coenosiini deposited in this collection. Differential diagnoses, notes on the types and photographs of some of them (habitus and labels) are provided.

Two new synonyms in Neotropical Philonthina (Coleoptera: Staphylinidae).

As part of an ongoing phylogenetic study on the Neotropical Philonthina (Coleoptera: Staphylinidae) that includes species of Belonuchus Nordmann, 1837, Hesperus Fauvel, 1874 and Paederomimus Sharp, 1885 (Chani Posse Ramírez Salamanca in prep.), we examined type material of species belonging to these genera as well as conspecific material from different European and North American collections. Type and non-type material were either examined by MCP during a visit to the Natural History Museum, London, UK (BMNH) or borrowed from the following institutions: Field Museum of Natural History, Chicago, IL, USA (FMNH), Museum für Naturkunde der Humboldt-Universität, Berlin, Germany (ZMHB), Naturhistorisches Museum Wien, Vienna, Austria (NMW), Canadian National Collection of Insects, Ottawa, Canada (CNC) and Snow Entomological Collection, Natural History Museum/Biodiversity Research Center, University of Kansas, Lawrence, USA (SEMC). Based on our revision of relevant material from the abovementioned collections, two new synonyms are here proposed.

The influence of gender on symptoms associated with obstructive sleep apnea.

BACKGROUND: It has been reported that the clinical expression of obstructive sleep apnea (OSA) may differ in women and men. OBJECTIVE: The objective of this study was to evaluate the influence of gender on reported OSA-related symptoms in a large clinical population of patients. METHODS: The database from the sleep laboratory of a tertiary care center was examined. Adult patients who had undergone a diagnostic polysomnography and completed the Berlin questionnaire, a sleep questionnaire, and the Epworth sleepiness scale were selected. Multiple logistic regression analysis was performed to assess the relationship between OSA-associated symptoms and different potential explanatory variables. RESULTS: The study sample included 1084 patients, median age was 53 years, 46.5% (504) were women, 72.7% (788) had OSA (apnea/hypopnea index ≥ 5), and 31.2% were obese. After adjusting for age, body mass index, and apnea/hypopnea index, men were more likely to report snoring (OR 4.06, p < 0.001), habitual or loud snoring (OR 2.34, p < 0.001; 2.14, p < 0.001, respectively) and apneas (OR 2.44, p < 0.001), than women. After controlling for multiple variables, female gender was an independent predictive factor for reported tiredness (OR 0.57, p 0.001), sleep onset insomnia (OR 0.59, p 0.0035), and morning headaches (OR 0.32, p < 0.001). Reports of excessive daytime sleepiness, nocturia, midnight insomnia, and subjective cognitive complaints were not significantly associated with gender. CONCLUSION: Women with OSA were more likely to report tiredness, initial insomnia, and morning headaches, and less likely to complain of typical OSA symptoms (snoring, apneas) than men.

Sarcopenia and Endothelial Function in Patients With Chronic Heart Failure: Results From the Studies Investigating Comorbidities Aggravating Heart Failure (SICA-HF).

OBJECTIVES: Skeletal muscle wasting, also known as sarcopenia, has recently been identified as a serious comorbidity in patients with heart failure (HF). We aimed to assess the impact of sarcopenia on endothelial dysfunction in patients with HF with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). DESIGN: Cross-sectional study. SETTING: Ambulatory patients with HF were recruited at Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany. PARTICIPANTS: We assessed peripheral blood flow (arm and leg) in 228 patients with HF and 32 controls who participated in the Studies Investigating Comorbidities Aggravating HF (SICA-HF). MEASUREMENTS: The appendicular skeletal muscle mass of the arms and the legs combined was assessed by dual energy x-ray absorptiometry (DEXA). Sarcopenia was defined as the appendicular muscle mass two standard deviations below the mean of a healthy reference group of adults aged 18 to 40 years, as suggested for the diagnosis of muscle wasting in healthy aging. All patients underwent a 6-minute walk test and spiroergometry testing. Forearm and leg blood flow were measured by venous occlusion plethysmography. Peak blood flow was assessed after a period of ischemia in the limbs to test endothelial function. RESULTS: Sarcopenia was identified in 37 patients (19.5%). Patients with sarcopenia presented with lower baseline forearm blood flow (2.30 ± 1.21 vs. 3.06 ± 1.49 vs. 4.00 ± 1.66 mL min-1 100 mL-1; P = .02) than those without sarcopenia or controls. The group of patients with sarcopenia showed similar baseline leg blood flow (2.06 ± 1.62 vs. 2.39 ± 1.39 mL min-1 100 mL-1; P = .11) to those without but lower values when compared to controls (2.06 ± 1.62 vs. 2.99 ± 1.28 mL min-1 100 mL-1; P = .03). In addition, patients with and without sarcopenia presented with lower peak flow in the forearm when compared to controls (18.37 ± 7.07 vs. 22.19 ± 8.64 vs. 33.63 ± 8.57 mL min-1 100 mL-1; P < .001). A similar result was observed in the leg (10.89 ± 5.61 vs. 14.66 ± 7.19 vs. 21.37 ± 13.16 mL min-1 100 mL-1; P < .001). Peak flow in the forearm showed a significant correlation with exercise capacity (relative peak VO2: R = 0.47; P < .001; absolute peak VO2: R = 0.35; P < .001; and 6-min walk distance: R = 0.20; P < .01). Similar correlations were observed between peak flow in the leg and exercise capacity (absolute peak VO2: R = 0.42, P < .001; relative peak VO2: R = 0.41, P < .001; and 6-min walk test: R = 0.33; P < .001). Logistic regression showed peak flow in the leg to be independently associated with the 6-min walk distance adjusted for age, hemoglobin level, albumin, creatinine, presence of sarcopenia, and coronary artery disease (hazard ratio, 0.903; 95% confidence interval, 0.835-0.976; P = .01). CONCLUSION: Patients with HF associated with sarcopenia have impaired endothelial function. Lower vasodilatation had a negative impact on exercise capacity, particularly prevalent in patients with sarcopenia.

Diagnostic accuracy of the Berlin questionnaire in detecting obstructive sleep apnea in patients with resistant hypertension.

OBJECTIVES: Obstructive sleep apnea (OSA) is strongly associated with resistant hypertension. The Berlin questionnaire is the most widely used screening tool to identify patients at high risk of having OSA. The objective was to test the diagnostic accuracy of the Berlin questionnaire in detecting OSA in resistant hypertensive patients. METHODS: A cross-sectional analysis of 422 resistant hypertensive patients [31% men; mean (SD) age 62.4 (9.9) years] submitted to polysomnography (PSG), in whom the Berlin questionnaire was previously applied. OSA was defined by an apnea-hypopnea index of at least 5 per hour and moderate-to-severe OSA by an apnea-hypopnea index of at least 15. Statistical analysis included bivariate comparisons between patients at high and low risk by the Berlin questionnaire, and logistic regression to assess the predictors of agreement between the Berlin questionnaire and PSG. Sensitivity, specificity, positive and negative predictive values and likelihood ratios for the Berlin questionnaire in detecting OSA were calculated. RESULTS: OSA was diagnosed in 347 patients (82.2%) and moderate-to-severe OSA in 234 patients (55.5%). In patients at high risk, moderate-to-severe OSA was confirmed in 58.3%, whereas in those at low risk, it was excluded in 50.4%. The accuracy of the Berlin questionnaire in detecting OSA was 55.6%. The specificity, sensitivity, positive and negative predictive value of the Berlin questionnaire in detecting moderate-to-severe OSA was 40, 69, 58 and 50%, respectively. The positive and negative likelihood ratios were 1.15 and 0.78, with a very low agreement (kappa = 0.081). CONCLUSION: In a large cohort of resistant hypertensive patients, the Berlin questionnaire had a low accuracy of identifying patients with OSA and should not be used as a screening method for selecting patients to PSG.

Questionário de Berlim é um bom instrumento diagnóstico para apneia obstrutiva do sono em indivíduos hipertensos? / Berlin questionnaire is a good diagnostic tool for obstructive sleep apnea in hypertensive individuals?

Esta revisão aborda a definição, a prevalência e o diagnóstico clínico e complementar da apneia obstrutiva do sono (AOS). Discute as complicações geradas pela AOS, que se caracteriza como um fator de risco independente para desenvolvimento de lesões em órgãos-alvo, incluindo o processo aterosclerótico; além de avaliar o questionário de Berlim, um importante instrumento de screening validado para detectar pacientes de risco para AOS. Os autores também mostram a relação existente entre AOS e hipertensão, uma vez que a AOS pode ser um das causas de hipertensão arterial secundária, bem como de hipertensão resistente, situações nas quais o uso do questionário torna-se útil para pesquisar essa associação. Discutem-se os mecanismos fisiopatogênicos que associam a AOS à hipertensão arterial sistêmica (HAS). Por fim, revisa aspectos básicos da abordagem terapêutica.

This review covers the definition, the prevalence, and clinical and complementary diagnosis of the obstructive sleep apnea (OSA). Discusses the complications caused by OSA, which is characterized as an independent risk factor for development of lesions in target-organs, including the atherosclerotic process; in addition to evaluating the Berlin Questionnaire, an important validated screening tool to detect patients at risk for OSA. The authors also show the relationship between OSA and hypertension, since OSA can be a cause of secondary hypertension and resistant hypertension, situations in which the use of the questionnaire is useful to investigate this association. We discuss the pathophysiological mechanisms linking OSA to hypertension. Finally, we review basic aspects of the therapeutic approach.

High risk for sleep apnea in the Berlin questionnaire and coronary artery disease.

INTRODUCTION: Obstructive sleep apnea (OSA) affects up to 30% of the adult population and is a risk factor for coronary artery disease (CAD). The diagnostic process, involving polysomnography, may be complex. Berlin questionnaire (BQ) is a validated and economical screening tool. PURPOSE: The aim of this study was to assess the performance of the BQ for the diagnosis of OSA in individuals with angina complaints. METHODS: Patients undergoing diagnostic cineangiography, portable type III polysomnography to determine the apnea-hypopnea index (AHI), and who answered the BQ were included. We excluded patients older than 65 years that were smokers, diabetics, and morbidly obese. High risk for OSA was based on positive responses in two of three symptom criteria of the BQ. CAD was defined by the presence of >50% lesion in coronary arteries. RESULTS: In 57 included cases, high risk in the BQ indicates significant odds ratio [95% confidence interval] for the presence of CAD (4.5[1.03-19.25], P = 0.045), adjusted for usual confounders: gender, age, and body mass index. The sensitivity and the specificity of BQ for CAD were 70% and 48%, respectively; the positive and negative predictive values are 56% and 64%. CONCLUSIONS: In conclusion, simple questionnaire-based diagnostic tools can be included in the screening procedures of patients with angina to detect the need for further OSA evaluation. In conclusion, the BQ is an effective instrument for this purpose.

Hemoglobin mass and peak oxygen uptake in untrained and trained residents of moderate altitude.

Blood composition, hemoglobin mass (CO rebreathing method) and VO2peak were measured in 15 untrained (UT-Bogotá) and 14 trained males (TR-Bogotá) living at 2600 m of altitude, and in 14 untrained lowlanders (UT-Berlin). [Hb] amounted to 15.3 + 0.2(SE) g/dl in UT-Berlin, 17.4 + 0.2 g/dl in UT-Bogotá and 16.0 + 0.2 g/dl in TR-Bogotá. Hb mass was significantly higher in UT-Bogotá (13.2 + 0.4 g/kg, P < 0.01) and in TR-Bogotá (14.7 + 0.5 g/kg, P < 0.001) than in UT-Berlin (11.7 + 0.2 g/kg). In TR-Bogotá also plasma volume was expanded. Erythropoietin concentrations in UT-Bogotá and TR-Bogotá were not significantly increased. There was a positive correlation between blood volume and VO2peak for the pooled values of all subjects, if the oxygen uptake of UT-Berlin was corrected for an ascent to 2600 m. For the Hb mass - VO2peak relation two groups are indicated pointing to two types of altitude acclimatization with different Hb mass increases but similar distribution of aerobic performance capacity. We suggest that different genetic properties in a population of mixed ethnic origin might play a role.