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Sarcopenia screening tools have a low capacity to predict adverse outcomes that are consequences of sarcopenia in the elderly population. This study aimed to evaluate the ability of a new sarcopenia screening tool SARC-GLOBAL to predict negative clinical outcomes in the elderly. A total of 395 individuals were evaluated in a 42-month period. The screening tools SARC-GLOBAL, SARC-F, and SARC-CalF and the diagnosis of sarcopenia according to European Working Group on Sarcopenia in Older Persons (EWGSOP2) were performed at the beginning of the study. Logistic and Poisson regression models were applied to assess the predictive value of the tools for the odds and risks of negative clinical outcomes, respectively. The most common negative clinical outcome in the followed population was falls (12.9%), followed by infections (12.4%), hospitalizations (11.8%), fractures (4.3%), and deaths (2.7%). Both SARC-GLOBAL and SARC-F were similar in predicting the odds of falls and hospitalizations during the follow up period, however SARC-CalF only predicted the odds of hospitalizations at 42 months.

Poor nutrition increases the risk of diseases and adverse health outcomes in older adults. We evaluated the potential inadequacy of nutrient intake among older adults in Brazil and its association with body anthropometry and composition outcomes. Dietary intake was obtained from 295 community-living older adults (>60 years old), of both genders, using a seven-day food record. Nutrient inadequacy was further identified based on the Dietary Reference Intakes and European Guidelines. Skeletal muscle mass (SM), strength and performance, and the diagnosis of sarcopenia were assessed using reference methods. Nutritional inadequacy was high, with energy, dietary fiber, and six micronutrients exhibiting the greatest inadequacy levels (>80%). Energy intake was correlated with SM strength ( p = 0.000) and performance ( p = 0.001). Inadequate energy, fiber, and protein intakes influenced BMI, while inadequate intake of vitamin B6 directly affected the diagnosis of sarcopenia ( p ≤ 0.005). Further research is required to investigate whether these inadequacies can be associated with other clinical health outcomes.

This study aimed to form a basis for future predictive modeling efforts in support of the harmful algal blooms (HAB) surveillance program currently in force in the Brazilian State of Santa Catarina (SC). Data from monitoring toxin-producing algae were merged with both meteorological and oceanographic data and analyzed. Data from four sources were used in this study: climate reanalysis (air temperature, pressure, cloud cover, precipitation, radiation, U and V winds); remote sensing (chlorophyll concentration and sea surface temperature); Oceanic Niño Index; and HAB monitoring data (phytoplankton counts and toxin levels in shellfish samples obtained from 39 points located in shellfish farms distributed along the SC coastline). This study analyzed the period from 2007-01-01 to 2019-12-31 (7035 records in the HAB database) and used descriptive, bivariate and multivariate analyses to draw correlations among environmental parameters and the occurrence of algal blooms (AB), HAB and toxic events. Dinophysis spp. AB were the most registered type of event and tended to occur during the late autumn and winter months. These events were associated with high atmospheric pressure, predominance of westerly and southerly winds, low solar radiation and low sea and air temperature. An inverted pattern was observed for Pseudo-nitzschia spp. AB, which were mostly registered during the summer and early autumn months. These results give evidence that the patterns of occurrence of highly prevalent toxin-producing microalgae reported worldwide, such as the Dinophysis AB during the summer, differ along the coast of SC. Our findings also show that meteorological data, such as wind direction and speed, atmospheric pressure, solar radiation and air temperature, might all be key predictive modeling input parameters, whereas remote sensing estimates of chlorophyll, which are currently used as a proxy for the occurrence of AB, seem to be a poor predictor of HAB in this geographic area., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: From late 2016 to early 2021, cases of Haff disease, a rare cause of rhabdomyolysis, possibly due to poisoning by palytoxin-like compounds in seafood, were detected in Salvador, Brazil. Surveillance was established to detect additional cases aiming at describing the clinical characteristics of the cases, identifying associated factors, estimating disease attack rate, and investigating the presence of biotoxins and trace metals in selected fish specimens obtained from cases., Method: Between December/2016-January/2021, surveillance investigated Haff disease suspected cases, and obtained clinical and fish samples to test., Findings: Of 65 cases investigated during the 2016-2017 outbreak, 43 (66%) had high creatine phosphokinase (CPK) levels. Among those with laboratory-confirmed rhabdomyolysis, 38 (88%) were hospitalized, 11 (26%) required intensive care, and three (7%) dialysis. Ingestion of marine fish 24h before disease onset was reported by 74% of the cases with elevated CPK and by 41% of those without CPK measurement (P=0·02). Attack rate for individuals who ate fish related to the outbreak was 55%. Following this outbreak, surveillance identified 12 suspected cases between 2017-2019, and a second outbreak in 2020-2021, with 16 laboratory-confirmed rhabdomyolysis patients (five required intensive care; one died). No traces of ciguatoxins and metals were detected in fish specimens obtained in 2016, found to be Seriola rivoliana . Some fish samples from 2020 were screened for palytoxin (PlTX)-like compounds and contained detectable levels of molecule fragments characteristics of isobaric PlTX, ovatoxin-a (OVTX-a), OVTX-b and OVTX-d., Interpretation: These findings support the hypothesis that compounds related to PlTX accumulated in marine fish may be the toxic agent causing the disease. Haff disease is a life-threatening condition, requiring clinical suspicion for patients with sudden-onset myalgia following fish ingestion. Suspected cases should be reported to health authorities for investigation., Competing Interests: All authors have nothing to disclose., (© 2021 The Author(s).)

We evaluated the accumulation of okadaic acid (OA), a diarrhetic toxin, and the antioxidant responses in the marine annelid Laeonereis acuta exposed to the benthic toxigenic dinoflagellate Prorocentrum cf. lima. Nontoxic Tetraselmis sp. was used as a control diet. Living cells of the two algae were supplied as food to animals kept in agar medium for 72 h. To assess the significance of the observed effects, our experimental design treated the algal species (diet), algal cell densities, and exposure time as fixed factors. Responses of the organisms were assessed through oxidative stress biomarkers (glutathione-S-transferase [GST], catalase [CAT], reduced glutathione [GSH] and lipid peroxidation [LPO]). Toxin accumulation was measured by LC-MS/MS in whole-body homogenates after 12, 24 and 72 h of exposure. Worms exposed to the toxigenic dinoflagellate gradually accumulated OA, with toxin levels directly related to the cell density of Prorocentrum cf. lima. Worms fed with Prorocentrum cf. lima exhibited decreased CAT activity, increased LPO levels - both interactively affected by algal species and time - and decreased GSH levels, which were interactively affected by algal species and cell density. Higher LPO levels, along with the inhibition of CAT and GSH, clearly indicated an oxidative stress situation in worms exposed to the toxigenic dinoflagellate. Laeonereis acuta accumulated moderate OA levels and may act as a vector of OA to food webs in estuarine areas under high Prorocentrum cf. lima abundance., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Prorocentrum lima is a cosmopolitan benthic dinoflagellate capable of producing the diarrhetic shellfish toxins (DSTs) okadaic acid (OA) and dinophysistoxin (DTX). These compounds may cause oxidative stress and accumulate in bivalve tissues, which become vectors of intoxication to human consumers. We investigated DST accumulation, detoxification and oxidative stress biomarkers in clams (Anomalocardia flexuosa) experimentally exposed to P. lima cells or their compounds. Experimental diets consisted of 6000 cells mL -1 of the non-toxic chlorophyte Tetraselmis sp. (C; control condition), and combinations of C with 10 P. lima cells mL -1 (T10), 100 P. lima cells mL -1 (T100), or to a toxin concentration of ∼4 μg OA L -1 and ∼0.65 μg DTX-1 L -1 (T100d). Clams were exposed to these diets for 7 days (uptake phase), followed by a 7-day depuration period. No DSTs were detected in clams exposed to treatments C (control) nor to T100d (dissolved compounds) during either uptake or detoxification phase. Conversely, clams exposed to T10 or T100 accumulated, on average, up to 2.5 and 35 μg DST kg -1 in their whole bodies at the end of the uptake phase. These concentrations are ∼64 and ∼4.5 times lower than the regulatory level of 160 μg OA kg -1 , respectively. Accumulated OA quotas were 12-22 times higher in the digestive gland (DG) than in remaining tissues over the uptake phase. Quick toxin transformation was indicated by the early detection of conjugated compounds - DTX-1 and OA esters - in the DG after 6 h of exposure, with OA-ester representing the main compound (30 - 100 %) in that tissue over the experiment. During the depuration period, detoxification rates represented 0.024 h -1 , 0.04 h -1 and 0.052 h -1 for OA, DTX-1 and OA-ester, respectively. The activities of catalase, glutathione S-transferase, glutathione peroxidase and the levels of oxidative stress by lipoperoxidation varied similarly in the DG of A. flexuosa individuals subjected to T100, T100d and the control condition. However, contrasting antioxidant responses were measured in those exposed to T10. These findings indicate that no oxidative stress was primarily induced by DST-producing dinoflagellates in this clam species under laboratory conditions representative of toxic bloom situations. Even though, possible interactions should be considered under multistressor scenarios., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Organic contamination is a major environmental concern in coastal regions, and it can be evaluated by the determination of aliphatic hydrocarbons (AHs), polycyclic aromatic hydrocarbons (PAHs), faecal sterols and linear alkylbenzenes (LABs). The concentrations of these organic markers were obtained from nine surface sediment samples to evaluate a possible contamination near a fringing reef on the west coast of Havana, Cuba. The AH levels ranged from 1.24 to 135.6 μg g -1 , the PAH levels were up to 2133 ng g -1 , the faecal sterol levels ranged from 0.03 to 1.54 μg g -1 , and the total LAB levels were up to 22.7 ng g -1 . The highest concentrations were obtained at sites close to Havana Bay and at the sources of untreated sewage input. A decreasing concentration gradient was observed from Havana Bay to the outer sites. Although only two sites presented high levels of contamination, untreated sewage discharged close to the fringing reef may affect its environment., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Dinophysis spp. are a major source of diarrheic toxins to marine food webs, especially during blooms. This study documented the occurrence, in late May 2016, of a massive toxic bloom of the Dinophysis acuminata complex along the southern coast of Brazil, associated with an episode of marked salinity stratification. The study tracked the daily vertical distribution of Dinophysis spp. cells and their ciliate prey, Mesodinium cf. rubrum , and quantified the amount of lipophilic toxins present in seston and accumulated by various marine organisms in the food web. The abundance of the D. acuminata complex reached 43 × 10⁴ cells·L −1 at 1.0 m depth at the peak of the bloom. Maximum cell densities of cryptophyceans and M. cf. rubrum (>500 × 10⁴ and 18 × 10⁴ cell·L −1 , respectively) were recorded on the first day of sampling, one week before the peak in abundance of the D. acuminata complex. The diarrheic toxin okadaic acid (OA) was the only toxin detected during the bloom, attaining unprecedented, high concentrations of up to 829 µg·L −1 in seston, and 143 ± 93 pg·cell −1 in individually picked cells of the D. acuminata complex. Suspension-feeders such as the mussel, Perna perna , and barnacle, Megabalanus tintinnabulum , accumulated maximum OA levels (up to 578.4 and 21.9 µg total OA·Kg −1 , respectively) during early bloom stages, whereas predators and detritivores such as Caprellidae amphipods (154.6 µg·Kg −1 ), Stramonita haemastoma gastropods (111.6 µg·Kg −1 ), Pilumnus spinosissimus crabs (33.4 µg·Kg −1 ) and a commercially important species of shrimp, Xiphopenaeus kroyeri (7.2 µg·Kg −1 ), only incorporated OA from mid- to late bloom stages. Conjugated forms of OA were dominant (>70%) in most organisms, except in blenny fish, Hypleurochilus fissicornis , and polychaetes, Pseudonereis palpata (up to 59.3 and 164.6 µg total OA·Kg −1 , respectively), which contained mostly free-OA throughout the bloom. Although algal toxins are only regulated in bivalves during toxic blooms in most countries, including Brazil, this study indicates that human seafood consumers might be exposed to moderate toxin levels from a variety of other vectors during intense toxic outbreaks.

This study evaluated an 8-year dataset (2007 to 2015, except 2008) in the attempt to identify the most susceptible periods for the occurrence of diarrheic shellfish poisoning (DSP) episodes associated with the presence of toxigenic dinoflagellates, Dinophysis spp., in the mussel farming area of Babitonga Bay (southern Brazil). Dinophysis acuminata complex was the most frequent (present in 66% of the samples) and abundant (max. 4100 cells L -1 ) taxon, followed by D. caudata (14%; max. 640 cells L -1 ) and D. tripos (0.9%; max. 50 cells L -1 ). There was a marked onset of the annual rise in Dinophysis spp. abundance during weeks 21-25 (early winter) of each year, followed by a second peak on week 35 (spring). Mussel (Perna perna) samples usually started testing positive in DSP mouse bioassays (MBA) in late winter. Positive results were more frequent in 2007 and 2011 when the mean D. acuminata complex abundance was ~ 500 cells L -1 . Although positive DSP-MBA results were observed in only 11% of the samples during the studied period, the toxin okadaic acid (OA) was present in 90% of the analyzed mussels (max. 264 μg kg -1 ). MBA results were positive when D. acuminata complex cell densities exceed 1200 ± 300 cells L -1 , while trace toxin amounts could be detected at cell densities as low as 150 ± 50 cells L -1 (free OA) to 200 ± 100 cells L -1 (conjugated OA). Low salinity and the meteorological conditions triggered by La Niña events were the main factors associated with both Dinophysis abundance and OA accumulation in mussels.

The study assessed the effect of Acacia mearnsii tannin extract supplementation grazing dairy cows on dry matter (DM) intake, enteric methane (CH 4 ) emission, and performance. Twelve Holstein cows were divided into two groups and subjected to two treatments that consisted of millet pasture (Pennisetum glaucum L.) plus supplementation with 6 kg of concentrate (750-g/kg ground corn and 250-g/kg soybean meal) including or excluding 120-g tannin extract. The trial design was a double reversal using three periods of 28 days each, with 21 days for the adaption period, and 7 days for sample collection. Herbage intake was measured using the n-alkane technique, and daily CH 4 emission was measured with the sulfur hexafluoride tracer gas technique. Individual total DM intake (mean = 17.1 kg/day), herbage DM intake (mean = 11.8 kg/day), and milk production (mean = 19.2 kg/day) were similar between treatments. CH 4 emission significantly decreased (32%, P < 0.05) in the animals supplemented with tannin extract, compared to non-supplemented animals. On the other hand, as proportion of DM intake or milk production, methane emission tended to decrease in tannin-supplemented animals. Supplementing dairy cows grazing a millet pasture with 120-g tannin extract reduced daily CH 4 emission without affecting animal performance.

Background: The purpose of this study is to establish a relationship between the skin lines on the upper third of the face in cadavers, which represent the muscle activity in life and the skin lines achieved by voluntary contraction of the forehead, glabellar, and orbital muscles in patients., Methods: Anatomical dissection of fresh cadavers was performed in 20 fresh cadavers, 11 females and 9 males, with ages ranging from 53 to 77 years. Subcutaneous dissection identified the muscle shape and the continuity of the fibers of the eyebrow elevator and depress muscles. Subgaleal dissection identified the cutaneous insertions of the muscles. They were correlated with skin lines on the upper third of the face of the cadavers that represent the muscle activity in life. Voluntary contraction was performed by 20 voluntary patients, 13 females and 7 males, with ages ranging from 35 to 62 years. Distinct patterns of skin lines on the forehead, glabellar and orbital areas, and eyebrow displacement were identified., Results: The frontalis exhibited four anatomical shapes with four different patterns of horizontal parallel lines on the forehead skin. The corrugator supercilii showed three shapes of muscles creating six patterns of vertical glabellar lines, three symmetrical and three asymmetrical. The orbicularis oculi and procerus had single patterns. The skin lines exhibited in voluntary contraction of the upper third of the face in patients showed the same patterns of the skin lines achieved in cadavers., Conclusions: Skin lines in cadavers, which are the expression of the muscle activity in life, were similar to those achieved in the voluntary contraction of patients, allowing us to assert that the muscle patterns of patients were similar to those identified in cadavers., No Level Assigned: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

This study aimed to model the habitat suitability for an invasive clam Corbicula fluminea in a coastal shallow lagoon in the southern Neotropical region (-30.22, -50.55). The lagoon (19km2, maximum deep 2.5m) was sampled with an Ekman dredge in an orthogonal matrix comprising 84 points. At each sampling point, were obtained environmental descriptors as depth, organic matter content (OMC), average granulometry (Avgran), and the percentage of sand (Pcsand). Prediction performance of Generalized Linear Models (GLM), Generalized Additive Models (GAM) and Boosted Regression Tree (BRT) were compared. Also, niche overlapping with other native clam species (Castalia martensi, Neocorbicula limosa and Anodontites trapesialis) was examined. A BRT model with 1400 trees was selected as the best model, with cross-validated correlation of 0.82. The relative contributions of predictors were Pcsand-42.6%, OMC-35.8%, Avgran-10.9% and Depth-10.8%. Were identified that C. fluminea occur mainly in sandy sediments with few organic matter, in shallow areas nor by the shore. The PCA showed a wide niche overlap with the native clam species C. martensi, N. limosa and A. trapesialis.

Background: Exercise training (T) blunts functional deficits and renin-angiotensin system (RAS) hyperactivity in hypertensive individuals. There is no information on T-induced temporal changes of brain RAS. We evaluate now the simultaneous effects of T on functional responses and time course changes in the expression/activity of brain RAS components in autonomic cardiovascular-controlling areas., Methods and Results: Spontaneously hypertensive rats (SHR) and age-matched normotensive controls (WKY) were trained for 0, 1, 2, 4, 8 and 12 weeks. Sedentary (S) groups served as time-controls. After arterial pressure (AP) and heart rate (HR) recordings at rest, fresh and fixed brains were harvested for qPCR and immunofluorescence assays. SHR-S vs. WKY-S exhibited higher mean AP (MAP) and HR, increased pressure variability and sympathetic activity, elevated AT1 receptor (AT1) expression in nucleus tractus solitarii (NTS) and higher Mas receptor expression in the rostroventrolateral medulla (RVLM). In SHR, T promptly (T2 on) reduced sympathetic variability to heart/vessels and largely decreased angiotensinogen expression in the paraventricular hypothalamic nucleus (PVN) and NTS, with a late RVLM reduction (T4). AT1 expression was only reduced at T12 (PVN and NTS) with transient, not maintained Mas receptor changes in PVN and RVLM. These responses were accompanied by baseline MAP and HR reduction in the SHR-T (from T4 on). In the SHR group, PVN angiotensinogen expression correlated positively with sympathetic activity, resting MAP and HR. In WKY-T, a precocious (T2-T12) RVLM AT1 decrease preceded the appearance of resting bradycardia (from T8 on)., Conclusions: Early and maintained reduction of angiotensinogen content in autonomic areas of the SHR is the most prominent effect of training on brain RAS. Down-regulation of PVN RAS expression is an essential factor to drive cardiovascular benefits in SHR-T, while resting bradycardia in WKY-T is correlated to RVLM AT1 reduction.

Objectives: This study aimed to evaluate the concentration of lactoferrin in the saliva of HIV infected and healthy children and analyze the associations between lactoferrin levels, Candida sp. colonization, oral manifestations and medical data. Also, the antifungal ability of lactoferrin to inhibit the growth of Candida albicans isolated from saliva of these children was investigated in vitro., Subjects and Methods: Saliva was collected from 70 HIV-infected and 50 healthy children, followed by oral manifestation assessments. The salivary lactoferrin was quantified using an ELISA Kit. The salivary samples were cultured and the Candida spp. colonies counted and then identified by sugar assimilation and fermentation. The antifungal activity of lactoferrin was analyzed in vitro with 10 isolates of C. albicans from each group., Results: The HIV infected children (mean age 9.8 ± 2.8) had higher lactoferrin levels (median 6.13 μg/ml (3.58-7.89)) and were colonized three times more by Candida sp. than the control group (mean age 9.4 ± 2.4) (median 5.74 μg/ml (3.12-6.86)) (p=0.003). Statistical associations were found considering the salivary lactoferrin levels and Candida sp. and oral manifestations between the groups. No associations between lactoferrin concentrations and oral manifestations, immunosuppression, presence of AIDS and use of HAART were observed in the HIV group. The percentage of dead C. albicans due to lactoferrin was inversely proportional to C. albicans cell density for both groups (p<0.001)., Conclusions: HIV-infected children have higher concentrations of lactoferrin and it was associated with Candida sp. colonization but no association with medical data was found. Also, both groups showed similar lactoferrin antifungal activity., (Copyright © 2014. Published by Elsevier Ltd.)

The amount of digesta flowing to the duodenum is a relevant measurement for the evaluation of nutrient supply to ruminants, which is usually estimated in animals fitted with a duodenal T-type cannula using internal or external markers. This study evaluated acid detergent fiber (ADF) compared with external (C32n-alkane) and internal [sulfuric acid lignin (ADL) and n-alkanes C31 and C33] markers for estimating duodenal flow and(or) ruminal digestibility of dry matter (DM) in cattle and sheep. In the first assay, 4 duodenally cannulated Holstein steers housed in metabolism cages, dosed with C32n-alkane, and fed Avena strigosa plus concentrate and increasing levels of tannin extract to reduce ruminal digestibility, were used in a Latin square design. The mobile-bag technique was used to measure the intestinal disappearance of ADL and ADF from forage (Avena strigosa, Pennisetum purpureum, Cynodon dactylon, and Medicago sativa) and concentrate (corn grain, soybean meal, and sunflower meal) samples that were previously incubated in the rumen of additional fistulated steer for 12, 24, 36, or 48 h. The ADF concentration in residues recovered in the feces was strongly related to the ADF concentration in residues at the duodenum (R(2)=0.93, standard deviation=30.0, n=901). This relationship showed a lower precision for ADL fraction (R(2)=0.88, standard deviation=12.6, n=590). In a second assay, duodenal flow and ruminal DM digestibility were calculated from the duodenal and fecal concentration of either marker. We observed a significant effect of marker type on ruminal DM digestibility values, and the effect of tannin treatments was observed only when ADF or ADL was used as the marker. The lowest residual error was obtained for ADF. Ruminal DM digestibility was, on average, higher for C31 and C(33)n-alkanes, and the use of dosed C(32)n-alkane resulted in a negative value. In the third assay, a data set of 235 individual observations was compiled from digestibility trials to compare ADF and ADL as markers for estimating duodenal digesta flow in wethers (n=204) and cattle (n=31). We observed a strong relationship between markers (R(2)=0.84 in sheep and R(2)=0.88 in cattle), but variance analysis within trials indicated that ADF was more precise than ADL. In conclusion, in digestibility trials in which fecal output was measured and spot samples of the duodenal digesta were obtained, duodenal flow and ruminal digestibility of the DM may be estimated from the relationship between the ADF concentration in feces and that in the duodenal digesta of ruminants., (Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Changes in lifestyle such as increase in high-fat food consumption are an important cause for vascular diseases. The present study aimed to investigate the involvement of ACE and TGF- β in the aorta stiffness induced by high-fat diet. C57BL/6 male mice were divided in two groups according to their diet for 8 weeks: standard diet (ST) and high-fat diet (HF). At the end of the protocol, body weight gain, adipose tissue content, serum lipids and glucose levels, and aorta morphometric and biochemical measurements were performed. Analysis of collagen fibers by picrosirius staining of aorta slices showed that HF diet promoted increase of thin (55%) and thick (100%) collagen fibers deposition and concomitant disorganization of these fibers orientations in the aorta vascular wall (50%). To unravel the mechanism involved, myeloperoxidase (MPO) and angiotensin I converting enzyme (ACE) were evaluated by protein expression and enzyme activity. HF diet increased MPO (90%) and ACE (28%) activities, as well as protein expression of ACE. TGF-β was also increased in aorta tissue of HF diet mice after 8 weeks. Altogether, we have observed that the HF diet-induced aortic stiffening may be associated with increased oxidative stress damage and activation of the RAS in vascular tissue.

An oral ranula is a retention cyst that arises from the sublingual gland as a result of ductal obstruction and fluid retention. This report describes the successful management of a rare case of oral ranula in an infant. A 4-month-old male infant was referred for emergency treatment due to a 2-month history of a swelling in the right sublingual region. The examination revealed a lesion of approximately 3.5 cm in diameter, which was jeopardizing the infant's breastfeeding. The lesion's dimensions suggested a ranula. Surgical specimens were sent for histopathological analysis to confirm the diagnosis. Although there are many different ways to treat an oral ranula, the marsupialization method was followed in this case due to the serious consequences of the infant's restricted access to nourishment. The treatment proved to be successful and after 18 months of follow-up, there was no sign of recurrence.

Studies have documented an association between chronic kidney disease (CKD) and increased risk of end stage renal disease, death and comorbidities, including cardiovascular disease and metabolic syndrome, in the general population. However, there is little data on the relationship between CKD and ADE (AIDS defining event), and to our knowledge, no studies have analyzed death as a competing risk for ADE among HIV-infected persons. An observational cohort study was performed to determine the incidence and risks for developing an ADE or death among HIV-infected persons with and without CKD from 1998 - 2005. CKD was defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 using the CKDEpidemiology Collaboration (CKD-EPI) equation. Log rank test and Cox regression which determined time to development of ADE and/or death as combined and separate outcomes, and competing risk models for ADE versus mortality, were performed. Among the 2,127 persons that contributed to the 5,824 person years of follow-up: 22% were female, 34% African American, 38% on HAART, and 3% had CKD at baseline. ADE occurred in 227 (11%) persons and there were 80 (4%) deaths. CKD was not significantly associated with ADE/death (HR 1.3, 95% CIs: 0.5, 3.2), ADE (HR 1.0, 95% CIs: 0.4, 3.1), or death (HR 1.6, 95% CIs: 0.4, 3.1). Competing risk analyses confirmed no statistically significant associations between CKD and these outcomes. CKD was uncommon in HIV-infected persons presenting for care in this racially diverse cohort, and was not independently associated with risk of developing an ADE or dying during follow-up.

Background: Previous studies have shown that patients with chronic kidney disease, including those with diabetic nephropathy, are more likely to die of cardiovascular disease than reach end-stage renal disease (ESRD). This analysis was conducted to determine whether ESRD is a more common outcome than cardiovascular death in patients with type 2 diabetic nephropathy, significant proteinuria, and decreased kidney function who were selected for participation in a clinical trial., Study Design: Retrospective analysis of the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database derived from 2 prospective randomized controlled clinical trials (IDNT [Irbesartan Diabetic Nephropathy Trial] and RENAAL [Reduction of Endpoints in Non-Insulin-dependent Diabetes With the Angiotensin II Antagonist Losartan])., Setting & Participants: 3,228 adult patients with type 2 diabetic nephropathy from IDNT and RENAAL were combined to establish the DIAMETRIC database. This is the largest global source of clinical information for patients with type 2 diabetic nephropathy who have decreased kidney function and significant proteinuria., Intervention: Angiotensin receptor blocker versus non-angiotensin receptor blocker therapy to slow the progression of type 2 diabetic nephropathy (in the prospective trials)., Outcomes & Measurements: Incidence rates of ESRD, cardiovascular death, and all-cause mortality., Results: Mean follow-up was 2.8 years; 19.5% of patients developed ESRD, approximately 2.5 times the incidence of cardiovascular death and 1.5 times the incidence of all-cause mortality. ESRD was more common than cardiovascular death in all subgroups analyzed with the exception of participants with low levels of albuminuria (albumin excretion <1.0 g/g) and well-preserved levels of kidney function (estimated glomerular filtration rate >45 mL/min/1.73 m(2)) at baseline., Limitations: All participants were included in a prospective clinical trial., Conclusions: Patients with type 2 diabetic nephropathy, characterized by decreased kidney function and significant proteinuria, are more likely to reach ESRD than die during 3 years' mean follow-up. Given the rapidly increasing number of cases of type 2 diabetes worldwide, this has implications for predicting future renal replacement therapy requirements., (Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: The burden of HIV-associated chronic kidney disease (CKD) is growing in the United States, partially because of increased HIV-infection rates among African Americans. We determined the prevalence, incidence, and risk of rapid estimated GFR (eGFR) decline, ESRD, and death among HIV-infected (HIV+) African-American and non-African-American individuals cared for at the Comprehensive Care Center in Nashville, Tennessee, from January 1, 1998, through December 31, 2005., Design, Setting, Participants, & Measurements: Mixed effects, competing risks, and Poisson and Cox regression models were used to assess the risk of rapid eGFR decline (defined as ≥50% decrease in baseline eGFR), CKD5/ESRD, and death. The Chronic Kidney Disease Epidemiology Collaboration equation was used to calculate eGFR. Confounders were adjusted with a propensity score that related patient characteristics to the probability of being African American. Mixed effects models compared the rate of rapid eGFR decline for HIV-infected African Americans and non-African Americans., Results: There were 2468 HIV-infected individuals in the study: 33% African American; 21% female. Among all patients, HIV-infected African Americans did not have a statistically significant increased risk for rapid eGFR decline compared with non-African Americans. However, African Americans had a significantly higher risk of ESRD and tended toward a higher risk of death., Conclusions: HIV-infected African Americans did not have a statistically significant difference in the risk of eGFR decline when compared with HIV-infected non-African Americans. The findings in this study have potential public health significance.

Introduction: The work was conducted to study phlebotomine fauna (Diptera: Psychodidae) and aspects of American cutaneous leishmaniasis transmission in a forested area where Leishmania (Leishmania) amazonensis occurs, situated in the municipality of Bela Vista, State of Mato Grosso do Sul, Brazil., Methods: The captures were conducted with modified Disney traps, using hamster (Mesocricetus auratus) as bait, from May 2004 to January 2006., Results: Ten species of phlebotomine sandflies were captured: Brumptomyia avellari, Brumptomyia brumpti, Bichromomyia flaviscutellata, Evandromyia bourrouli, Evandromyia lenti, Lutzomyia longipalpis, Psathyromyia campograndensis, Psathyromyia punctigeniculata, Psathyromyia shannoni and Sciopemyia sordellii. The two predominant species were Ev bourrouli (57.3%) and Bi flaviscutellata (41.4%), present at all sampling sites. Two of the 36 hamsters used as bait presented natural infection with Leishmania. The parasite was identified as Leishmania (Leishmania) amazonensis., Conclusions: Analysis of the results revealed the efficiency of Disney traps for capturing Bichromomyia flaviscutellata and the simultaneous presence of both vector and the Leishmania species transmitted by the same can be considered a predictive factor of the occurrence of leishmaniasis outbreaks for the human population that occupies the location.

In several studies, patients with CKD seemed to be at greater risk for dying from cardiovascular disease (CVD) than reaching ESRD. The purpose of this study was to compare incident ESRD rates with rates of total mortality, CVD death, and a CVD composite (CVD mortality and CVD hospitalization) among participants who had hypertensive nephrosclerosis and were enrolled in the African American Study of Kidney Disease and Hypertension (AASK). The study period included the AASK trial phase (1996 through 2001) and a subsequent cohort phase (2002 through 2007). The AASK enrolled 1094 participants. Of the 764 participants who completed the trial phase without an event, 691 (90%) enrolled in the cohort phase. During 11 years of follow-up, there were 59 CVD-related deaths and 118 non-CVD-related deaths. The rate of ESRD (3.9/100 patient-years) was significantly higher than the rates of total mortality (2.2/100 patient-years), CVD mortality (0.8/100 patient-years), and the CVD composite (3.2/100 patient-years). The incidence rate ratio of ESRD to CVD mortality was 5.0. The rate of ESRD consistently exceeded the various mortality rates across most of the subgroups defined by age, gender, income, education, previous CVD, baseline urine protein excretion, and baseline estimated GFR. In conclusion, AASK participants were more likely to reach ESRD than to die.

Introduction: Visceral leishmaniasis is a systemic infectious disease of broad geographical distribution, characterized by high potential for lethality. With the purpose of contributing towards reducing mortality and helping healthcare professionals in clinical management of patients with this disease, this paper aimed to investigate the clinical and laboratory characteristics of cases with a fatal outcome in hospitals in Campo Grande, Mato Grosso do Sul, between 2003 and 2008., Methods: Fifty-five medical files on patients who died due to visceral leishmaniasis were analyzed., Results: Among the 55 patients studied, 37 were from the municipality of Campo Grande; 41 (74.5%) were males; and age over 40 years predominated. The patients presented with fever in 89.1% of the cases. The duration of the illness from the onset of symptoms to hospitalization was 78.2 days on average. Leukopenia was seen in 85.5% of the patients. Comorbidities were present in 39 (70.9%) patients; malnutrition and alcoholism were the most frequent of these. Confirmation of the diagnosis occurred on average 6.7 days after admission. Pentavalent antimoniate was the drug most used, and 87.5% of the patients presented some type of adverse reaction. Bacterial infections occurred in 36 patients and were one of the causes of death in 27 (49%)., Conclusions: The data showed that early identification of these clinical and laboratory characteristics, at the time when patients are first attended, is extremely important for reducing mortality through instituting efficient therapeutic and prophylactic measures.

The occurrence of an outbreak of cutaneous leishmaniasis associated with Leishmania (Leishmania) amazonensis in the municipality of Bela Vista, state of Mato Grosso do Sul, Brazil, and the absence of information on its vectors in this area led the authors to undertake captures of phlebotomine sand flies, using Shannon traps and automatic CDC light traps, in domiciles, forested areas and animal shelters from February 2004-January 2006. A total of 808 specimens belonging to 18 sandfly species have been identified: Bichromomyia flaviscutellata, Brumptomyia avellari, Brumptomyia brumpti, Brumptomyia sp, Evandromyia aldafalcaoae, Evandromyia cortelezzii, Evandromyia evandroi, Evandromyia lenti, Evandromyia teratodes, Evandromyia termitophila, Lutzomyia longipalpis, Nyssomyia whitmani, Pintomyia christenseni, Psathyromyia aragaoi, Psathyromyia campograndensis, Psathyromyia punctigeniculata, Psathyromyia shannoni and Sciopemyia sordellii. The presence of Lu. longipalpis, Ny. whitmani and Bi. flaviscutellata, vectors of Leishmania chagasi, Leishmania braziliensis and L. amazonensis, respectively, has increased.

This paper describes the modifications made to the original model of the Disney trap, with a view to easier handling of the same, greater practicability in the collection of sand flies, protection of the animal bait and durability of the trap in the field.

Within the process analytical technology (PAT) framework, as presented in the US Food and Drug Administration guidelines, the aim is to design, develop and operate processes consistently to ensure a pre-defined level of quality at the end of the manufacturing process. Three PAT implementation scenarios can be envisaged. Firstly, PAT could be used in its most modest version (in an almost non-PAT manner) to simply replace an existing quality control protocol (eg, using near-infrared spectroscopy for an in-process quality control, such as moisture content). Secondly, the use of in-process monitoring and process analysis could be integrated to enhance process understanding and operation for an existing industrial process. Thirdly, PAT could be used extensively and exclusively throughout development, scale-up and full-scale production of a new product and process. Although the first type of implementations are well known, reports of the second and third types remain scarce. Herein, results obtained from PAT implementations of the second and third types are described for two industrial processes for preparing bulk active pharmaceutical ingredients, demonstrating the benefits in terms of increased process understanding and process control.

Nine cases of American tegumentary leishmaniasis were reported at a Training Military Unit located in Bela Vista City, State of Mato Grosso do Sul. Parasites obtained from lesions of six patients were isolated in culture media followed by identification, through isoenzymes analysis, as being Leishmania amazonensis. This is the first evidence of the presence of the parasite in Mato Grosso do Sul.

Near-infrared spectroscopy (NIRS) is known to be a suitable technique for rapid fermentation monitoring. Industrial fermentation media are complex, both chemically (ill-defined composition) and physically (multiphase sample matrix), which poses an additional challenge to the development of robust NIRS calibration models. We investigated the use of NIRS for at-line monitoring of the concentration of clavulanic acid during an industrial fermentation. An industrial strain of Streptomyces clavuligerus was cultivated at 200-L scale for the production of clavulanic acid. Partial least squares (PLS) regression was used to develop calibration models between spectral and analytical data. In this work, two different variable selection methods, genetic algorithms (GA) and PLS-bootstrap, were studied and compared with models built using all the spectral variables. Calibration models for clavulanic acid concentration performed well both on internal and external validation. The two variable selection methods improved the predictive ability of the models up to 20%, relative to the calibration model built using the whole spectra., (Copyright 2005 Wiley Periodicals, Inc.)