Checklist of parasites associated with 'reptiles' in Northeast Brazil.

Reptiles, as well as other vertebrate groups, harbour a significant diversity of parasitic organisms, from nematodes and other helminths to viruses and bacteria. The Northeast is one of the richest regions in Brazil in terms of the reptile diversity, number of species and endemism. Parasites are diverse organisms and knowledge about the parasitic fauna of vertebrates is an important factor in understanding the ecological relationships between hosts and the environment. Studies on the parasitic fauna of reptiles in South America have increased in the past few years. The present review is a compilation of 122 studies published from 1924 to 2021. We present information on 101 species of reptiles from five groups (amphisbaenians, crocodile, testudines, snakes and lizards) and 183 parasitic taxa belonging to four phyla: Nematoda; Arthropoda; Platyhelminthes; and Acanthocephala. Nematodes were the most frequently recorded species. Lizards and snakes had more records of parasitism and higher levels of parasite richness and diversity. Ceará was the state with most studies and recorded cases of parasite-host association. The Caatinga and Atlantic Forest were the most investigated environments. The objective of this review was to contribute knowledge on the parasitic biodiversity in reptiles from Northeast Brazil, which may help identify gaps in our knowledge and guide future studies.

Endoparasite community structure of an anuran assemblage in the Caatinga, Northeastern Neotropical Region.

Amphibians are a widespread Chordata taxon and are important for maintaining the balance of both terrestrial and aquatic ecosystems. Brazil has a rich amphibian fauna; however, little is known about the role of their ecology and phylogenetic relationships during the assembly processes of associated endoparasite communities. Herein, we describe an endoparasite community in an anuran assemblage in the Caatinga, a unique biome of dry forests in north-eastern Brazil. We studied endoparasite diversity, as well as the effects of body length, body mass, body volume and sex on parasite abundance. We also investigated the influence of ecological and historical factors and anuran microhabitat use on endoparasite composition. We analysed individuals from 13 anuran species distributed across five families: Odontophrynidae (Proceratophrys cristiceps); Leptodactylidae (Leptodactylus fuscus, Leptodactylus vastus, Leptodactylus macrosternum, Leptodactylus troglodytes and Physalaemus cuvieri); Hylidae (Pithecopus gonzagai, Scinax x-signatus, Boana raniceps and Dendropsophus nanus); Bufonidae (Rhinella diptycha and Rhinella granulosa); and Microhylidae (Dermatonotus muelleri). We found nine species of endoparasites, including seven nematodes (Aplectana membranosa, Cosmocerca sp., Oswaldocruzia mazzai, Raillietnema spectans, Rhabdias fuelleborni, Schrankiana sp. and Physaloptera sp.), one species of Trematoda (Glypthelmins pseudium) and one non-identified cestode. There was no significant relationship between endoparasite abundance and host body length, body mass, body volume and sex. A phylogenetic principal component analysis showed that ecological factors had a greater influence on endoparasite assemblage than historical factors. Similarly, our results showed that ecological factors had a greater influence on anuran microhabitat use compared to historical factors, which contributed to the generalist characteristics presented by most of the sampled endoparasite species.

Clinical efficacy of new α-bisabolol mouthwashes in postoperative complications of maxillofacial surgeries: a randomized, controlled, triple-blind clinical trial.

OBJECTIVES: The present study aimed to evaluate the efficacy of α-bisabolol (BISA)-based mouthwashes in the oral hygiene of patients submitted to oral and maxillofacial surgery. MATERIALS AND METHODS: A randomized, controlled, triple-blind clinical trial was conducted with 30 patients, undergoing oral and maxillofacial surgery. Three types of mouthwashes were developed, based at 0.12% chlorhexidine, 0.5% BISA, and 0.12% chlorhexidine + 0.5% BISA. The patients were evaluated in the preoperative and postoperative period, divided into three groups according to the mouthwash to be used. In the postoperative period, the oral hygiene quality of the patients was evaluated through the simplified oral hygiene index; the healing of the wounds was evaluated observing the presence of suture dehiscence and/or infection, and the pain was established using the Visual Analogue Scale. The antiseptic effect of the mouthwashes was evaluated in vitro. RESULTS: There were no differences in the efficacy of BISA-containing mouthwashes for oral hygiene, healing, and pain, compared to chlorhexidine based at 0.12%. There were no differences in the antiseptic activity of chlorhexidine and chlorhexidine + α-bisabolol-based mouthwashes. CONCLUSION: The results indicate that BISA-based mouthwashes have clinical efficacy, in the improvement of oral hygiene and wound healing, as well as in the reduction of postoperative pain. CLINICAL RELEVANCE: Considering that BISA has analgesic, antimicrobial, and anti-inflammatory properties, it is relevant to evaluate the efficacy of BISA-based mouthwashes in the oral hygiene of patients undergoing oral and maxillofacial surgery, seeking a better postoperative recovery.

Raillietiella Mottae (Pentastomida: Raillietiellidae) Parasitizing Four Species of Gekkota Lizards (Gekkonidae and Phyllodactylidae) in the Brazilian Caatinga.

We tested the role of sex, size, and mass of the lizards Phyllopezus pollicaris, Gymnodactylus geckoides, Hemidactylus agrius, Lygodactylus klugei, and Hemidactylus brasilianus on the rates of pentastomid infection in the Brazilian Caatinga. We collected 355 individuals of these five species, of which four (prevalence of infection: P. pollicaris 15.9 %, G. geckoides 1.4 %, H. agrius 28.57 %, and H. brasilianus 4.16 %) were infected by Raillietiella mottae. Parasite abundance was influenced by host body size and mass only in P. pollicaris. Host sex did not infl uence the abundance of parasites in any species. Hemidactylus agrius, G. geckoides, and H. brasilianus are three new host records for pentastomids.

Safety and technological properties of bacteriocinogenic enterococci isolates from Tunisia.

AIMS: To investigate the safety and technological traits of previously isolated bacteriocinogenic enterococci strains for potential use as starter/adjunct cultures in foods. METHODS AND RESULTS: Fifty-five bacteriocinogenic enterococci strains previously isolated from different origins in Tunisia were screened for safety. Twenty-two strains did not harbour the genes coding for virulence traits, were susceptible to relevant antibiotics such as vancomycin, and tested negative for haemolysis, histamine production, gelatinase activity and DNase activity. These strains were further assessed for some technological properties, demonstrating low milk-acidifying ability, low proteolytic activity, high peptidolytic activity and diacetyl production in milk. CONCLUSIONS: This study revealed that 22 bacteriocinogenic enteroccoci strains did not present virulence features and could be safely applied in food preservation. Some strains also showed good technological potential as adjunct/protective cultures in milk fermentation and cheese production. SIGNIFICANCE AND IMPACT OF THE STUDY: This is one of very few studies that identified safe Enterococcus strains capable of producing a wide variety of enterocins against different spoilage and pathogenic micro-organisms that have good potential for application as adjunct/protective cultures in foods.

Technological properties of bacteriocin-producing lactic acid bacteria isolated from Pico cheese an artisanal cow's milk cheese.

AIM: Evaluate technologically relevant properties from bacteriocin-producing strains to use as starter/adjunct cultures in cheese making. METHODS AND RESULTS: Eight isolates obtained from Pico cheese produced in Azores (Portugal) were found to produce bacteriocins against Listeria monocytogenes and three isolates against Clostridium perfringens. They were identified as Lactococcus lactis and Enterococcus faecalis and submitted to technological tests: growth at different conditions of temperature and salt, acid production, proteolysis, lipolysis, coexistence, enzymatic profile and autolytic capacity. Safety evaluation was performed by evaluating haemolytic, gelatinase and DNase activity, resistance to antibiotics and the presence of virulence genes. Some isolates presented good technological features such as high autolytic activity, acid and diacetyl production. Lactococcus lactis was negative for all virulence genes tested and inhibit the growth of all Lactic acid bacteria (LAB) isolates. Enterococci were positive for the presence of some virulence genes, but none of the isolates were classified as resistant to important antibiotics. CONCLUSIONS: The bacteriocin-producing Lc. lactis present good potential for application in food as adjunct culture in cheese production. The study also reveals good technological features for some Enterococcus isolates. SIGNIFICANCE AND IMPACT OF THE STUDY: Bacteriocin-producing strains presented important technological properties to be exploited as new adjunct culture for the dairy industry, influencing flavour development and improve safety.

Antimicrobial activity and chemical composition of fixed oil extracted from the body fat of the snake Spilotes pullatus.

CONTEXT: Ethnozoological studies have shown that Spilotes pullatus Linn. (Colubridae: Ophidia), is associated with medicinal and magic-religious uses in Brazil. OBJECTIVES: This study was designed to determine the chemical composition of the oil extracted from the body fat of S. pullatus and to test its antimicrobial properties, alone and in association with aminoglycosides, against fungi and bacterial strains in concentrations ranging between 1024 and 0.5 µg/mL. MATERIAL AND METHODS: The snakes were collected in the Chapada do Araripe, county of Crato, Ceará State, Brazil. The oil was extracted in a Soxhlet apparatus using hexane. The methyl esters of the fatty acids present in the samples were identified using GC-MS. The antimicrobial and drug modulatory activities of oil were tested by microdilution against fungal and bacterial strains. RESULTS: The chemical composition of the fixed oils of S. pullatus identified 10 constituents representing 94.97% of the total sample. The percentages of saturated and unsaturated fatty acids were 33.59 and 61.38%, respectively, with the most abundant components being elaidic (37.26%). The oil did not demonstrate any antimicrobial or antifungal activity when tested alone, presenting MIC values ≥ 1024 µg/mL. However, when associated with antibiotics, it demonstrated synergistic effects with gentamicin against all the bacterial lineages assayed, and antagonistic effects with amikacin and neomycin against strains of Escherichia coli. CONCLUSIONS: Oil extracted from the body fat of S. pullatus did not demonstrate any inhibitory effects on bacterial or fungal activities, but was effective in modulating the effects of certain antibiotics.

Gastrointestinal nematodes of the lizard Tropidurus hispidus (Squamata: Tropiduridae) from a semi-arid region of north-eastern Brazil.

The tropidurid lizard Tropidurus hispidus has a wide distribution in South America. However, knowledge about its helminth fauna is patchy and has been reported for only a few localities along its range of distribution. This study presents data on helminth fauna composition and parameters of infection for a population of T. hispidus from an area within the Brazilian Caatinga biome (semi-arid physiognomy). We found five nematode species within the gastrointestinal tract of lizards: Parapharyngodon sceleratus (Pharyngodonidae); Physaloptera lutzi, Physaloptera retusa and Physalopteroides venancioi (Physalopteridae); and Strongyluris oscari (Heterakidae). The overall prevalence was 84.2% and the mean intensity of infection was 8.5 ± 1.1. The body size of adult male lizards influenced positively the intensity of infection. The infracommunities of nematodes presented an intermediate aggregated distribution (discrepancy index; D= 0.519) and a depauperate nematode fauna. The presence of generalist parasite species has contributed to an increase in the overall richness of the component community. This sampled host population presented the highest prevalence of parasites compared with other studies on T. hispidus, but their relatively low richness can be related to the disturbed environment of the study area.

A rapid screening method to evaluate acidifying activity by lactic acid bacteria.

The determination of pH in fermented milk is an important parameter for monitoring the production of acid by lactic acid bacteria (LAB). In this work, a colorimetric method is proposed that allows a fast determination of LAB acidification ability by evaluation of pH drop in whey fermentation. The proposed method uses spectrophotometry to measure the pH change by bacteria and uses bromocresol purple as a pH indicator dye. The absorbance at 430 nm of a buffer solution with bromocresol purple was found to be correlated with pH values. This colorimetric assay was linear within the pH range of 4.6-7.0. Upon regression analysis, linear equation y = -0.1267× + 0.9196 was obtained having r2 value of 0.9927. The assay was validated by the use of LAB fermentation in sweet whey and comparison to the values obtained by glass electrode/pH meter. Estimation of acidification activity of LAB in whey was found to be similar in both methods (r = 0.801, p > 0.05). The proposed procedure presents a viable alternative to the measurement of pH by the standard method and allows the simultaneous and fast screening of LAB acidifying activity.

Helminth fauna of Norops fuscoauratus (D'Orbigny, 1837) (Squamata: Dactyloidae) in the Atlantic Forest, northeastern Brazil.

The composition of macro endoparasites associated with the lizard Norops fuscoauratus (Squamata) was analysed in two localities in the Atlantic Forest on the northeast of Brazil between December 2012 and July 2015. 74 specimens of N. fuscoauratus were examined and five species of helminths were reported, being: (a) for the population of Pernambuco: Cystacanth (Prevalence=37.5%), Physaloptera retusa Rudolphi, 1819 (Prevalence=4.16%), larva of flatworm (Prevalence=2.08%), Rhabdias sp. (Prevalence=2.08%) and Strongyluris oscari Travassos, 1923 (Prevalence=2.08%), and (b) of Alagoas: S. oscari (Prevalence=17.85%) and Rhabdias sp. (Prevalence=3.57%). The differences in the composition of endoparasites in the two populations are attributed to individualities of environments occupied by the lizards. The collection period does not influence the abundance of parasites, but when associated with sex, there was a positive correlation with the abundance of helminths, with more females than males being infected with parasites in the rainy season.

Nonviral gene delivery to mesenchymal stem cells using cationic liposomes for gene and cell therapy.

Mesenchymal stem cells (MSCs) hold a great promise for application in several therapies due to their unique biological characteristics. In order to harness their full potential in cell-or gene-based therapies it might be advantageous to enhance some of their features through gene delivery strategies. Accordingly, we are interested in developing an efficient and safe methodology to genetically engineer human bone marrow MSC (BM MSC), enhancing their therapeutic efficacy in Regenerative Medicine. The plasmid DNA delivery was optimized using a cationic liposome-based reagent. Transfection efficiencies ranged from approximately 2% to approximately 35%, resulting from using a Lipid/DNA ratio of 1.25 with a transgene expression of 7 days. Importantly, the number of plasmid copies in different cell passages was quantified for the first time and approximately 20,000 plasmid copies/cell were obtained independently of cell passage. As transfected MSC have shown high viabilities (>90%) and recoveries (>52%) while maintaining their multipotency, this might be an advantageous transfection strategy when the goal is to express a therapeutic gene in a safe and transient way.

Optimization of gene delivery to HEK293T cells by microporation using a central composite design methodology.

Microporation is an efficient method for delivering plasmid DNA molecules into cultured cells. Herein, we present the optimization of gene delivery by microporation using a Central Composite Design methodology. It was given relevance not only to the transfection efficiency but also to the cell recovery. Different amounts of DNA (1 and 3 µg) mainly affected cell viabilities and cell recoveries, which decrease from 93 to 76% and from 47 to 25% respectively, when higher DNA quantity is used. With this work we suggest an easy methodology to improve transfection of mammalian cells underlining the feasibility to achieve 60% of gene delivery efficiencies whilst recovering 50% of cells, with 90% of viability.

Raillietiella mottae (Pentastomida: Raillietiellidae) infecting Ameiva ameiva (Squamata: Teiidae) in Araripe Plateau, Northeast Brazil.

We investigated the infection by pulmonary parasites in the lizard Ameiva ameiva (Teiidae) inhabiting the Environmental Protection Area of Araripe (APA-Araripe). A total of 45 specimens were collected in three areas between the cities of Várzea Alegre and Barbalha. A Pentastomid species (Raillietiella mottae) was parasitizing (nine specimens) a male of A. ameiva with a prevalence of 2.22% considering all lizards collected in the region and prevalence of 50% considering only rainforest environment. The Pentastomids infection rates shown in this study are similar to data found for infections of other insectivorous lizards. Raillietiella mottae is considered a generalist parasite, which uses insects as intermediate hosts. The results of this study represent the first record of a Pentastomid infecting this species of lizard in South America.

Nematodes associated with Iguana iguana (Linnaeus, 1758) (Squamata, Iguanidae) in Semi-arid areas of Northeastern Brazil.

Nematodes were analyzed in Iguana iguana, a large lizard Iguanidae that is widely distributed throughout the Americas. The aims of the study were investigate the helminths associated with the lizard, I. iguana in semi-arid areas of northeastern Brazil and analyze the parasitological indices (prevalence, and mean intensity of infection). A total of 18 specimens of I. iguana were examined (8 males and 10 females). The overall prevalence of infection was 66.6% (12/18), while in males, it was 75% (6/8) and in females, 60% (6/10). Iguana iguana was identified as a new host for Physaloptera sp., Atractis sp., Piratuba sp. and Subulura sp. This registered contributes to the knowledge of helminth diversity associated with this host.

Helminths of the Lizard Salvator merianae (Squamata, Teiidae) in the Caatinga, Northeastern Brazil.

The lizard Salvator merianae is a widely distributed species in South America, occurring from southern Amazonia to the eastern Andes and northern Patagonia. Studies on the parasitic fauna of this lizard have revealed that it is a host for helminths in various Brazilian biomes. The present work provides new parasitological data on the gastrointestinal nematodes associated with the lizard S. merianae. Sixteen specimens were analyzed from nine different locations in a semi-arid region in northeastern Brazil. Five species of nematodes were identified. Oswaldofilaria petersi was first recorded as a parasite of the S. merianae, thus increasing the knowledge of the fauna of parasites that infect large Neotropical lizards.

Helminth fauna of Norops fuscoauratus (D'Orbigny, 1837) (Squamata: Dactyloidae) in the Atlantic Forest, northeastern Brazil / Helmintofauna de Norops fuscoauratus (D'Orbigny, 1837) (Squamata: Dactyloidae) na Mata Atlântica, Nordeste, Brasil

The composition of macro endoparasites associated with the lizard Norops fuscoauratus (Squamata) was analysed in two localities in the Atlantic Forest on the northeast of Brazil between December 2012 and July 2015. 74 specimens of N. fuscoauratus were examined and five species of helminths were reported, being: (a) for the population of Pernambuco: Cystacanth (Prevalence=37.5%), Physaloptera retusa Rudolphi, 1819 (Prevalence=4.16%), larva of flatworm (Prevalence=2.08%), Rhabdias sp. (Prevalence=2.08%) and Strongyluris oscari Travassos, 1923 (Prevalence=2.08%), and (b) of Alagoas: S. oscari (Prevalence=17.85%) and Rhabdias sp. (Prevalence=3.57%). The differences in the composition of endoparasites in the two populations are attributed to individualities of environments occupied by the lizards. The collection period does not influence the abundance of parasites, but when associated with sex, there was a positive correlation with the abundance of helminths, with more females than males being infected with parasites in the rainy season.

A composição de macro endoparasitas associada com o lagarto Norops fuscoauratus (Squamata) foi analisada em duas localidades da Mata Atlântica no nordeste do Brasil, entre dezembro de 2012 e julho de 2015. 74 espécimes foram examinados e cinco espécies de helmintos foram encontradas, sendo: (a) para a população de Pernambuco: Cistacanto (Prevalência=37.5%), Physaloptera retusa Rudolphi, 1819 (Prevalência=4.16%), larva de platelminto (Prevalência=2.08%), Rhabdias sp. (Prevalência =2.08%) e Strongyluris oscari Travassos, 1923 (Prevalência =2.08%) e (b) Alagoas: S. oscari (Prevalência=17.85%) e Rhabdias sp. (Prevalência =3.57%). As diferenças na composição dos endoparasitas nas duas populações pode ser atribuída as individualidades dos ambientes ocupados por esses lagartos. O período de coleta não influenciou na abundância de parasitas, mas quando associado com o sexo, houve uma correlação positiva com a abundância de helmintos, com mais fêmeas do que machos, infectadas na estação chuvosa.

Helminth fauna of Norops fuscoauratus (D'Orbigny, 1837) (Squamata: Dactyloidae) in the Atlantic Forest, northeastern Brazil / Helmintofauna de Norops fuscoauratus (D'Orbigny, 1837) (Squamata: Dactyloidae) na Mata Atlântica, Nordeste, Brasil

The composition of macro endoparasites associated with the lizard Norops fuscoauratus (Squamata) was analysed in two localities in the Atlantic Forest on the northeast of Brazil between December 2012 and July 2015. 74 specimens of N. fuscoauratus were examined and five species of helminths were reported, being: (a) for the population of Pernambuco: Cystacanth (Prevalence=37.5%), Physaloptera retusa Rudolphi, 1819 (Prevalence=4.16%), larva of flatworm (Prevalence=2.08%), Rhabdias sp. (Prevalence=2.08%) and Strongyluris oscari Travassos, 1923 (Prevalence=2.08%), and (b) of Alagoas: S. oscari (Prevalence=17.85%) and Rhabdias sp. (Prevalence=3.57%). The differences in the composition of endoparasites in the two populations are attributed to individualities of environments occupied by the lizards. The collection period does not influence the abundance of parasites, but when associated with sex, there was a positive correlation with the abundance of helminths, with more females than males being infected with parasites in the rainy season.

A composição de macro endoparasitas associada com o lagarto Norops fuscoauratus (Squamata) foi analisada em duas localidades da Mata Atlântica no nordeste do Brasil, entre dezembro de 2012 e julho de 2015. 74 espécimes foram examinados e cinco espécies de helmintos foram encontradas, sendo: (a) para a população de Pernambuco: Cistacanto (Prevalência=37.5%), Physaloptera retusa Rudolphi, 1819 (Prevalência=4.16%), larva de platelminto (Prevalência=2.08%), Rhabdias sp. (Prevalência =2.08%) e Strongyluris oscari Travassos, 1923 (Prevalência =2.08%) e (b) Alagoas: S. oscari (Prevalência=17.85%) e Rhabdias sp. (Prevalência =3.57%). As diferenças na composição dos endoparasitas nas duas populações pode ser atribuída as individualidades dos ambientes ocupados por esses lagartos. O período de coleta não influenciou na abundância de parasitas, mas quando associado com o sexo, houve uma correlação positiva com a abundância de helmintos, com mais fêmeas do que machos, infectadas na estação chuvosa.

Helminth fauna of Norops fuscoauratus (DOrbigny, 1837) (Squamata: Dactyloidae) in the Atlantic Forest, northeastern Brazil

Abstract The composition of macro endoparasites associated with the lizard Norops fuscoauratus (Squamata) was analysed in two localities in the Atlantic Forest on the northeast of Brazil between December 2012 and July 2015. 74 specimens of N. fuscoauratus were examined and five species of helminths were reported, being: (a) for the population of Pernambuco: Cystacanth (Prevalence=37.5%), Physaloptera retusa Rudolphi, 1819 (Prevalence=4.16%), larva of flatworm (Prevalence=2.08%), Rhabdias sp. (Prevalence=2.08%) and Strongyluris oscari Travassos, 1923 (Prevalence=2.08%), and (b) of Alagoas: S. oscari (Prevalence=17.85%) and Rhabdias sp. (Prevalence=3.57%). The differences in the composition of endoparasites in the two populations are attributed to individualities of environments occupied by the lizards. The collection period does not influence the abundance of parasites, but when associated with sex, there was a positive correlation with the abundance of helminths, with more females than males being infected with parasites in the rainy season.

Resumo A composição de macro endoparasitas associada com o lagarto Norops fuscoauratus (Squamata) foi analisada em duas localidades da Mata Atlântica no nordeste do Brasil, entre dezembro de 2012 e julho de 2015. 74 espécimes foram examinados e cinco espécies de helmintos foram encontradas, sendo: (a) para a população de Pernambuco: Cistacanto (Prevalência=37.5%), Physaloptera retusa Rudolphi, 1819 (Prevalência=4.16%), larva de platelminto (Prevalência=2.08%), Rhabdias sp. (Prevalência =2.08%) e Strongyluris oscari Travassos, 1923 (Prevalência =2.08%) e (b) Alagoas: S. oscari (Prevalência=17.85%) e Rhabdias sp. (Prevalência =3.57%). As diferenças na composição dos endoparasitas nas duas populações pode ser atribuída as individualidades dos ambientes ocupados por esses lagartos. O período de coleta não influenciou na abundância de parasitas, mas quando associado com o sexo, houve uma correlação positiva com a abundância de helmintos, com mais fêmeas do que machos, infectadas na estação chuvosa.

The DST as a predictor of outcome in depression: a meta-analysis.

OBJECTIVE: The authors undertook a review of the literature on the dexamethasone suppression test (DST) as a predictor of course and outcome in major depression, to illustrate clinical and pathophysiological implications of studying the relation between biological measures and course of illness in psychiatry. METHOD: In computerized searches and cross-references, 144 articles were found that related DST results to prediction of treatment response or outcome. Meta-analysis was performed on pooled data from all of the studies and separately on data from selected studies that had used stricter methodology. RESULTS: 1) Baseline DST status did not predict response to antidepressant treatment or outcome after hospital discharge. 2) Non-suppression of cortisol on the baseline DST predicted poorer response to placebo. 3) Persistent nonsuppression of cortisol on the DST after treatment was associated with high risk of early relapse and poor outcome after discharge. CONCLUSIONS: Baseline DST results may be devoid of prognostic value, but posttreatment nonsuppression of cortisol on the DST is strongly associated with poor outcome. Persistent nonsuppression may reflect a partially treated index episode or identify sicker patients who are unresponsive to treatment. The findings reiterate the importance of studying biological measures in relation to multiple validators of psychiatric illness beyond cross-sectional diagnosis.