Carbapenem combination therapy versus standard of care for persistent methicillin-susceptible Staphylococcus aureus bacteraemia.

BACKGROUND: Successful use of carbapenems in combination with cefazolin or oxacillin for treatment of MSSA bacteraemia has been described; however, comparative data to standard treatment approaches are lacking. METHODS: This was a multicentre, retrospective study of adult patients with MSSA bacteraemia for >48 h. Standard treatment was considered monotherapy with cefazolin, oxacillin or nafcillin. Combination therapy was defined as the addition of ertapenem or meropenem to standard treatment for at least 24 h. The primary outcome was duration of bacteraemia defined as time from administration of an antibiotic with in vitro activity to first negative blood culture. Time to blood culture sterilization was compared through risk-set matching with aid of a propensity score. RESULTS: Overall, 238 patients were included; 66% (157/238) received standard treatment and 34% (81/238) received combination therapy. The median (IQR) time to carbapenem initiation was 4.7 (3.63-6.5) days. Patients who received combination therapy were younger (P = 0.012), more likely to have endocarditis (P = 0.034) and had longer median duration of bacteraemia (P < 0.001). After applying risk-set matching, patients who received combination therapy experienced faster time to blood culture sterilization compared with control patients [HR = 1.618 (95% CI; 1.119-2.339) P = 0.011]. Using a paired hazard model, 90 day mortality rates were not statistically different among patients who received combination therapy versus matched controls [HR = 1.267 (95% CI; 0.610-2.678), P = 0.608]. DISCUSSION: Carbapenem combination therapy resulted in faster time to blood culture sterilization, but no differences in overall mortality rates. Randomized trials are critical to determine the utility of carbapenem combination therapy.

Myelodysplasia cutis masquerading as granulomatous dermatitis.

Myelodysplastic syndromes (MDS) are a group of clonal hematopoietic neoplasms resulting from mutations in stem cells. They carry a risk of transformation to acute myeloid leukemia. Cutaneous manifestations of MDS, including myelodysplasia cutis or infiltration by MDS tumor cells, are rare, but significantly associated with increased risk of progression to high-grade myeloid tumors. The clinical and histopathologic differential diagnosis for myelodysplasia cutis includes interstitial granulomatous dermatitis (IGD), a reactive granulomatous dermatitis (RGD) associated with systemic diseases including rheumatologic diseases, and hematologic malignancy like MDS. We report a patient with MDS who presented with myelodysplasia cutis masquerading as IGD both in a clinical and histopathological manner.

Kidney transplant recipient with history of HIV, HBV, and past HCV infection.

Chronic viral infections caused by the human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV) are common among patients with end-stage renal disease (ESKD). These infections were once considered contraindications to kidney transplantation due to potential risks associated with long-term immunosuppression. Improved management and antiviral therapies have changed the prognosis and survival of this group of patients, along with an increased experience in transplanting people with these viral infections. We report the first successful kidney transplant in an ESKD patient on hemodialysis with a history of concomitant HIV, HCV and HBV infection in Mexico.

Performance of Staging Systems for Non-Head and Neck Cutaneous Squamous Cell Carcinoma.

BACKGROUND: The performance of staging systems in non-head and neck cutaneous squamous cell carcinomas has not been well established. OBJECTIVE: To evaluate the performance of the American Joint Committee on Cancer 8th Edition and Brigham and Women's Hospital staging systems in non-head and neck squamous cell carcinomas. MATERIALS AND METHODS: Eligible tumors were identified and staged from an existing retrospective database. Cumulative incidence function curves of any poor outcome were generated. Distinctiveness, sensitivity, specificity, positive and negative predictive value, and concordance index were calculated. RESULTS: 1,042 primary tumors were included, with 38 resulting in any poor outcome and 16 in any major poor outcome. High-stage tumors represented 2.2% and 3.5% of tumors; these accounted for 10/38 of the poor outcomes (26.3%) and 8/16 of the major poor outcomes (50%). High-stage tumors predicted major poor outcomes with a sensitivity of 0.5 and specificity of 0.99 for the Brigham and Women's Hospital system, and a sensitivity of 0.5 and specificity of 0.97 for the American Joint Committee on Cancer 8th edition system. The concordance index for both was 0.74. CONCLUSION: Current staging systems can be used to predict poor outcomes in cutaneous squamous cell carcinomas off the head and neck.

Red propolis extract as a natural ionophore for confined sheep: performance and morphological and histopathological changes.

This study aimed to evaluate the effect of increasing levels of red propolis extract (RPE) in the diet of confined sheep on performance and histomorphometric parameters of rumen and intestine and histopathological parameters of liver and kidney. Thirty-five male sheep (17.08 ± 2.36 kg) were used, distributed in a completely randomized design, with five treatments (0, 7, 14, 21, and 28 mL day-1 RPE) and seven replications, submitted to 68 days of experiment. At the end of the experimental period, the animals were euthanized, and samples of rumen, intestine, liver, and kidney were collected to histomorphometry and histopathology analyzes. Higher RPE inclusions (21 and 28 mL day-1) maintained dry matter intake and increased total weight (5.78 x 6.14 and 6.95 kg, respectively) gain up to 20.24%. In the rumen, the inclusion of RPE led to an increase in the thickness of the epithelium and the highest level also increased the thickness of the keratinized portion of this epithelium (21.71 x 32.15 µm). The level of 21 mL day-1 provided larger ruminal papillae (1620.68 x 1641.70 µm) and greater ruminal absorption area (561791.43 x 698288.50 µm2). In intestine 21 and 28 mL-1 of RPE provided greater mucosal thickness (468.54 x 556.20 and 534.64 µm), higher goblet cell index (23.32 x 25.82 and 25.64) and higher hepatic glycogen index (1.47 x 1.64 and 1.62), supporting higher nutrients absortion and glicogenolise and intestinal health, corroborating the weight gain indices. The inclusion of RPE did not cause renal histopathological lesions. Therefore, levels of 21 and 28 mL day-1 of RPE can be used in sheep diets, promoting greater final weight gain, causing positive histomorphological changes in the rumen, intestine and liver, without causing kidney or liver damage.

Doubly Misdiagnosed: Exophiala Masquerading as Squamous Cell Carcinoma and Chromoblastomycosis.

ABSTRACT: Deep cutaneous fungal infections (DCFI) can arise in the setting of skin trauma and immunosuppression. DCFI may be secondary to chromoblastomycosis, which is typically characterized by pseudoepitheliomatous hyperplasia histologically and can be mistaken for squamous cell carcinoma. In addition, "copper penny" spore-like pigmented yeast forms on Grocott's methenamine silver stain can suggest chromoblastomycosis, but this finding is not specific. By contrast, phaeohyphomycosis characteristically exhibits circumscribed pseudocyst or abscess on histopathology, and both yeast and hyphae can be seen. Our case reports a DCFI with pseudoepitheliomatous hyperplasia and "copper penny" yeast forms, ultimately diagnosed as phaeohyphomycosis after isolating Exophiala spinifera on fungal culture.

Intraoperative Diagnosis of Histologic Change in Irradiated Skeletal Muscle.

ABSTRACT: Adjuvant radiation may be used to reduce the recurrence of high-risk cutaneous squamous cell carcinoma after resection. Adjuvant radiation can produce histologic changes in the skeletal muscle that mimic keratinocyte atypia, presenting a diagnostic challenge during subsequent resections. We present a case of cutaneous squamous cell carcinoma and histologic changes observed in a fresh frozen section that were consistent with degenerative changes of irradiated skeletal muscle that had a muscle-specific actin+, Melan-A-, and cytokeratin- immunophenotype on paraffin-embedded permanent sections. We also reviewed the literature of other similar reported findings on irradiated skeletal muscle.

Hospitalization is associated with handgrip strength decline in older adults: a longitudinal study.

BACKGROUND: Hospitalization episodes in older people are considered critical events because they act in a complex interaction among immobilization effects. AIM: The purpose of this study was to evaluate the effects of hospitalization on older adults' handgrip strength (HGS) and to identify factors related to its performance on the test. METHODS: A cohort study was conducted in a hospital in Natal, Brazil, and enrolled all patients aged 60 years and older between January 2014, and April 2015. Cognitive (Leganés Cognitive Test) and functional status (Katz Index, Lawton Scale and Functional limitation Nagi), physical performance (HGS and gait speed) and depressive symptom assessment (GDS-15) were evaluated at admission and discharge time, as well as information about health and functional status prior to hospitalization. Linear Mixed Models were used to create a predictive model for handgrip strength. RESULTS: A total of 1168 hospitalized older adults were evaluated. A significant decrease in HGS means was observed between admission and discharge time for men (28.12 ± 10.35 and 20.22 ± 14.08 Kgf, p < 0.01) and for women (19.18 ± 7.87 and 14.88 ± 9.79 Kgf, p < 0.01). Undergoing surgery and basal values of the Katz Index were associated with worse HGS performance at discharge. CONCLUSION: A significant decline in handgrip strength during the hospitalization period was observed, which was more pronounced in men. Performing surgery during hospitalization was an important factor for HGS decline in men and women. This study reinforces the importance of early mobilization and muscle strength loss prevention protocols in hospitalized older patients.

HRV Monitoring Using Commercial Wearable Devices as a Health Indicator for Older Persons during the Pandemic.

Remote monitoring platforms based on advanced health sensors have the potential to become important tools during the COVID-19 pandemic, supporting the reduction in risks for affected populations such as the elderly. Current commercially available wearable devices still have limitations to deal with heart rate variability (HRV), an important health indicator of human aging. This study analyzes the role of a remote monitoring system designed to support health services to older people during the complete course of the COVID-19 pandemic in Brazil, since its beginning in Brazil in March 2020 until November 2021, based on HRV. Using different levels of analysis and data, we validated HRV parameters by comparing them with reference sensors and tools in HRV measurements. We compared the results obtained for the cardiac modulation data in time domain using samples of 10 elderly people's HRV data from Fitbit Inspire HR with the results provided by Kubios for the same population using a cardiac belt, with the data divided into train and test, where 75% of the data were used for training the models, with the remaining 25% as a test set for evaluating the final performance of the models. The results show that there is very little difference between the results obtained by the remote monitoring system compared with Kubios, indicating that the data obtained from these devices might provide accurate results in evaluating HRV in comparison with gold standard devices. We conclude that the application of the methods and techniques used and reported in this study are useful for the creation and validation of HRV indicators in time series obtained by means of wearable devices based on photoplethysmography sensors; therefore, they can be incorporated into remote monitoring processes as seen during the pandemic.

Psychophysiological Stress Markers During Preseason Among Elite Female Soccer Players.

ABSTRACT: Botelho, R, Abad, CCC, Spadari, RC, Winckler, C, Garcia, MC, and Guerra, RLF. Psychophysiological stress markers during preseason among elite female soccer players. J Strength Cond Res 36(6): 1648-1654, 2022-This study aimed to investigate changes and correlations between mood states and various physiological stress markers after a 7-week preseason period among elite female soccer players. Twenty-four elite female soccer players participated in this study (26.4 ± 3.7 years). Their internal training load, mood states, day and evening salivary testosterone and cortisol concentrations, blood creatine kinase concentration (CK), and heart rate variability (HRV) were assessed during the first week of preseason (PRE), and again 7 weeks after a systematic training period (END). After the preseason, there were significant increases in subject negative mood scales (p ≤ 0.03; Effect Size [ES] > 0.60), total mood scores (p = 0.01; QI = 100/0/0; ES = 1.32), day and evening testosterone and cortisol concentrations (p ≤ 0.03; ES > 0.54), and CK concentrations (p = 0.01; QI = 100/0/0; ES = 1.54). Correlations were found between cortisol and tension (r = 0.53 and 0.60; p ≤ 0.02), cortisol and confusion (r = 0.75; p = 0.01), and cortisol and the LF/HF index of HRV (r = -0.52; p = 0.04). Mood states (except vigor), salivary testosterone, and cortisol concentrations, as well as CK, showed significant changes after a 7-week systematic training system. The cortisol was the factor most highly related to various mood states (including tension and confusion), and with the HRV indices. Coaches and researchers can use these data to design, monitor, and control soccer training programs, in particular throughout the preseason period.

Lambs fed diets containing by-product from coconut processing: histomorphometry characteristics in the digestive and renal systems.

This study aimed to evaluate the histological characteristics in the digestive and renal systems of lambs fed diets containing coconut by-product (CB). A total of 35 male lambs with an initial weight of 16.9 ± 2.93 kg were distributed in a completely randomized design with five levels of CB in the diet (0; 4.8; 9.6; 14.4 and 19.2% in total dry matter). Samples of the liver, kidney, rumen, and intestine were histomorphometrically evaluated, and the data were submitted to regression analysis, at a 5% error probability. The inclusion of CB linearly decreased the dry matter intake and caused a quadratic effect for the height of ruminal papillae, absorption area, epithelium thickness, as well as for average daily gain. The inclusion of CB linearly increased the mucous layer and reduced the submucosal layer, as well as promoted a decrease in goblet cells in the small intestine. The inclusion of CB did not influence hepatic glycogen; additionally, the histopathological examination did not reveal liver damage or congestion, vacuolization, and necrosis of the renal tissue. Therefore, our results indicate that CB can be included in lambs diet up to the level of 7.2% without causing changes in the histomorphometry characteristics of the gastrointestinal tract and changes in liver and kidney tissue that compromise animal performance.

Performance and ruminal and intestinal morphometry of Santa Inês sheep submitted to feed restriction and refeeding.

A study was carried out to evaluate the performance and ruminal and intestinal morphology of Santa Inês sheep subjected to feed restriction followed by refeeding. A total of 40 uncastrated lambs with an approximate age of 120 ± 15 days and mean body weight (BW) of 17.04 ± 1.18 kg were randomly divided into two groups of BW (20 and 25 kg of BW), which were subjected to different levels of feed restriction (0%, 25%, and 40% of feed restriction). For performance variables, six treatments were considered (0, 25%, and 40% of feed restriction for both groups (20 and 25 kg of BW)) and five treatments for morphometric variables (ad libitum, 25% and 40% for both groups (20 and 25 kg of BW)). All animals were slaughtered with 14 weeks of experimentation. During the feed restriction phase, the dry matter intake (DMI), feed efficiency (FE), and average daily gain (ADG) decreased (P < 0.05) as the level of restriction increased. During the refeeding phase, lambs with 20 kg of body weight subjected to restriction presented lower (P < 0.05) DMI in the ad libitum treatment. However, lambs with 25 kg of body weight under feed restriction presented DMI, FE, and ADG similar (P > 0.05) to the group ad libitum. The final body weight of restricted lambs after refeeding (both groups 20 and 25 kg of body weight) was lower (P < 0.05) than lambs feed ad libitum. In relation to morphology, restricted lambs showed greater height ruminal papillae and larger (P < 0.05) area of ruminal absorption and intestinal absorption, especially the lambs under treatment 40% of feed restriction. The feed restriction followed by refeeding in sheep provided partial compensatory gain, in addition, caused morphological changes in the rumen and intestine that allowed greater absorption and possibly compensatory gain in periods of greater refeeding.

Hepatitis C-Associated Osteosclerosis: Improvement After Treatment with Sofosbuvir, Daclatasvir, and Ibandronate: Case Report and Literature Review.

Hepatitis C-associated osteosclerosis (HCAO) remains a rare condition despite the growing prevalence of hepatitis C virus (HCV) infection worldwide. Since the first case reported in 1992, this is the twenty-second case described. Patients with HCAO present with severe bone pain and elevated serum levels of bone markers, especially alkaline phosphatase (ALP), with increased bone density. We report here the case of a 59-year-old man with generalized bone pain and diagnosis of HCV infection. Biochemical tests showed elevated bone turnover markers, specifically, ALP, carboxy-terminal collagen crosslinks and osteocalcin. Imaging studies revealed generalized bone sclerosis. Bone mineral density was elevated in all validated sites. His clinical symptoms and bone-related findings were attributed to HCAO. He was sequentially treated with cholecalciferol, prednisone, sofosbuvir associated with daclatasvir and ibandronate, and progressed with undetectable viral load after HCV treatment, normalization of ALP levels after introduction of ibandronate, and pain improvement 1 year after discontinuation of the bisphosphonate. Bone pain complaints must be investigated in patients with HCV. HCAO is a differential diagnosis of increased bone mass.

An unusual case of T-cell prolymphocytic leukemia mimicking a cutaneous vasculitis.

T-cell prolymphocytic leukemia (T-PLL) is an aggressive post-thymic T-cell malignancy, which accounts for 2% of mature lymphocytic leukemias in adults. Though typically presenting with a brief history of B symptoms, hepatosplenomegaly, and marked lymphocytosis, erythematous or nodular skin rashes involving the trunk or limbs may be seen in 25% to 30% of patients, as well as a purpuric rash in a periorbital distribution. Cutaneous involvement typically presents in the context of patients with an established history of T-PLL, but it can less frequently present as an initial symptom heralding the diagnosis. An unusual case of T-PLL is described, presenting initially as palmoplantar ulcerated nodules with an initial biopsy suggestive of perniosis, followed by rapid progression of dark violaceous and bright red papules throughout the body after initiation of obinutuzumab. The diagnosis of T-PLL was subsequently fully supported by the clinical, laboratory, cytologic, and immunophenotypic findings. This case highlights the importance of a multidisciplinary team approach to address such rare and atypical presentations.

Falls and life-space mobility: longitudinal analysis from The International Mobility in Aging Study.

OBJECTIVES: To investigate a 4-year longitudinal relationship between falls, recurrent falls, and injurious falls, according to different levels of life-space mobility (LSM). METHODS: Longitudinal analysis of an international cohort study. The participants were older adults from the International Mobility in Aging Study (IMIAS) aged between 65 and 74 years at baseline. Three waves of data (2012, 2014, 2016) were used. Fall history during the past year was recorded. Recurrent fallers were identified as those who fell at least twice and injurious fallers as participants who required medical attention. LSM measurements included Total Life-Space (LS-C), Maximal Life-Space (LS-M), Assisted Life-Space (LS-A), Independent Life-Space (LS-I) and Restricted Life-space (LS-ID) scores. Generalized estimation equation (GEE) models were used to determine whether life-space mobility measures and their change over time differed between recurrence of falls and injurious falls. RESULTS: At baseline, the prevalence of falls in the last year was 28%. 11.8% reported recurrent falls and 2.6% had serious injurious falls in the last year preceding the assessments. Recurrent fallers were more likely to be female, with insufficient income and, with comorbidities. GEE models showed that life-space mobility was lower among those with recurrent falls or serious injurious falls compared to those who never fell, but the rate of change did not differ over the 4-year follow-up except for the LS-A and LS-I scores, where some improvements were observed over time. CONCLUSIONS AND IMPLICATIONS: Falls were independently associated with a decrease in LSM over 4 years. Targeting older adults with recurrent and injurious falls with appropriate interventions may improve community mobility and social participation.

Recurrent fungating tumor and a chronic rash in an immunosuppressed transgender patient: a case of Buschke-Lowenstein condyloma and epidermodysplasia verruciformis.

A transgender female in her 40s with history of HIV and testicular cancer status post-genital X-irradiation presented with a perianal mass and pruritic rash across her chest. Physical examination revealed a bulky, verrucous tumor protruding outward from the anus involving the medial buttocks. Examination of the chest and arms showed numerous guttate, pink, flat-topped papules coalescing into plaques. Clinically and histologically the lesions were consistent with Buschke-Löwenstein condyloma (BLC) and acquired epidermodysplasia verruciformis (AEDV). Buschke-Löwenstein condyloma incisional biopsy tested negative for common low- and high-risk human papillomavirus (HPV) subtypes, including 6, 11, 16, and 18, possibly implicating beta HPV subtype or a less common pathogenic subtype. The patient underwent abdominoperineal resection of the BLC, which tested positive for low-risk HPV subtypes, suggesting the possibility of multiple implicated HPV subtypes in the same tumor. This case demonstrates a possible role of beta HPV or rarer HPV subtypes in the pathogenesis of verrucous carcinoma, particularly in the setting of immunosuppression.

Transoral robotic resection of unusual spindle cell/pleomorphic lipoma of the larynx.

Spindle cell/pleomorphic lipoma (SC/PL) is a subcutaneous mass usually localised on nape, shoulder or upper back. It is a benign lipogenic tumour composed of primitive CD34-positive spindle cells, floret-like multinucleated giant cells and mature adipocytes. Complete surgical excision is the optimal treatment. This unusual tumour in the larynx has only been reported in the medical literature once and was treated surgically by open approach. Actually, transoral robotic surgery (TORS) is most suitable because provides tridimensional magnified view plus a greater mobility with instruments, allowing complete and safe removal of the supraglottic mass, allowing rapid healing and recovery. We present the first case of a SC/PL of larynx managed with TORS. Four hours after surgery, the patient was able to take a soft diet and was discharged 2 h later. The follow-up showed an excellent clinical and functional outcome.

Ruminal and histological characteristics and nitrogen balance in lamb fed diets containing cactus as the only roughage.

This study examined rumen fermentation, histological, blood, and urinary characteristics as well as ammoniacal nitrogen concentration, pH, nitrogen balance, and microbial protein in lamb fed diets containing spineless cactus as the sole roughage source plus levels of wheat bran (WB) in comparison with a control diet based on spineless cactus and buffelgrass. Twenty-eight uncastrated, crossbreed lambs with an average initial weight of 22.6 ± 2.37 kg were used in the experiment. The treatments consisted of a standard diet (control) containing buffelgrass and spineless cactus and three diets containing cactus as the only roughage source plus varied concentrations of WB (30, 37, and 44%, on a dry matter basis). Results were evaluated by analysis of variance, and contrasts were applied at the 5% probability level for mean comparison. Rumen villus height and width were greater and musculature was lower in the lamb fed diets containing 37% and 44% WB compared with those fed control diet. In the intestine, the crypts were smaller in the animals which consumed the diets with 30, 44, and 37% WB. All WB levels resulted in lower nitrogen intake and retention. Microbial protein concentration, microbial protein efficiency, microbial nitrogen, urea, and glucose were not significantly affected. Feeding lamb with diets containing levels of wheat bran, with cactus as the only roughage source, does not negatively affect their ruminal-fermentation, blood, and urinary characteristics; ammoniacal nitrogen concentration; pH; or microbial protein. However, nitrogen balance and ruminal and intestinal morphometric characteristics are impaired.

Life-Space and Cognitive Decline in Older Adults in Different Social and Economic Contexts: Longitudinal Results from the IMIAS Study.

Psychosocial, socioeconomic and sociocultural aspects can influence cognitive function among community-dwelling older adults. Life-space restriction is potentially related to cognitive status. We examined the longitudinal association between life-space mobility and changes in cognitive function in community-dwelling older adults in different social settings of North and South America and Europe. We used data from 1486 participants of the International Mobility in Aging Study (IMIAS) conducted at five sites: Tirana (Albania), Natal (Brazil), Manizales (Colombia), Kingston and Saint-Hyacinthe (Canada). Life-space mobility was assessed using the Life-Space Assessment (LSA) questionnaire at baseline (2012), and the Leganes Cognitive Test was used to evaluate cognitive function at baseline and follow-up (2016). The Quantile regressions (QR) were used to evaluate the factors associated with cognitive score in 2016 by adjusting for the cognitive score in 2012, with two distinct models for analyzing variables. A decrease in the cognitive function was observed at all research sites, except in Manizales. Participants with more restricted life-space at baseline had a decrease in their cognitive function 4 years later (ß = -0.79, 95% CI: -1.400 to -0.18, p value<0.01) compared to those with the highest level. This decrease was independent of gender, age, research site, education, income sufficiency, social support, depression, cognitive function at baseline, chronic conditions and physical performance. Restriction in life-space is an important prognostic factor for cognitive function. Maintaining life-space can be a goal in public policies aimed at encouraging healthy aging, and might be useful in clinical practice to promote health status and to monitor older people at higher risk of cognitive decline.

Coat and skin morphology of hair sheep breeds in an equatorial semi-arid environment.

This study aims to address if are there annual changes in the hair coat traits and skin morphology of hair sheep breeds raised in an equatorial semi-arid region? Coat and skin samples were taken from thirty Morada Nova (4 ±â€¯2 years old; red coat; ±SD) and twenty Santa Inês multiparous ewes (5 ±â€¯2 years old; brown and black coat; ±SD) every 3 months over a year. Hair coat traits included thickness (mm), density (number of hairs cm-2), length (mm), and diameter (mm), plus epidermal and dermal thickness (µm), sweat glands and blood capillaries area (µm cm-2) were determined. Means of solar irradiance and ambient air temperature were higher between September and December. Annual changes (P < 0.05) in hair density, diameter, length and thickness, as well as the skin blood capillaries and sweat gland area differed between breeds. The modifications on hair coat traits resulted in minor changes on the effective thermal conductivity of the hair coat surface both for Morada Nova and Santa Ines sheep. Nevertheless, it was clearly evident that the overall cutaneous thermal insulation for Morada Nova sheep was lowest in September that was coupled with lower hair density, coat thickness, and higher sweat gland and blood capillary area (P < 0.05). In conclusion, even in an equatorial region, phenotypic acclimatization on morphological traits of cutaneous surface and skin traits can modify the overall thermal insulation of sheep breeds.