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The surface topography and ultrastructure of the tegument of Paranaella luquei Kohn, Baptista-Farias & Cohen, 2000, a microcotylid monogenean parasite from the gills of Hypostomus regani (Ihering, 1905) (Loricariidae) was studied by scanning (SEM) and transmission electron microscopy (TEM). By SEM, it was observed that the tegument presents transversal ridges, forming folds in the ventral and dorsal surfaces and microvillous-like tegumental projections in the anterior and median regions of body. These projections were also observed by TEM. The tegument is made up of a syncytium delimited by apical and basal plasma membranes, containing inclusion bodies and mitochondria, connected to the nucleated region by means of cytoplasmatic processes. The tegumental cells present a well developed nucleus and cytoplasm containing inclusion bodies, similar to those found on the external layer, mitochondria, rough endoplasmatic reticulum and free ribossomes.

Background: Obstetric violence involves the mistreatment, disrespect, and abuse of birthing people and the problem has been recognized in healthcare systems worldwide. Obstetric violence is a gendered, sex-specific form of violence against women that is a public health problem and a violation of human rights. There are an unknowable number of online posts and social media messages that describe obstetric violence experiences. There are no known studies about self-published experiences of obstetric violence in the US maternity care system., Objective: To understand the meaning of obstetric violence experiences in the US maternity care system from a naturally occurring, purposive sample., Design: A secondary analysis of the textual data from the original Break the Silence social media campaign using qualitative content analysis. The theory of social justice in nursing provided a theoretical framework. A healthcare systems approach was used for a wide-angle view of the multidirectional structure, processes, and outcome of obstetric violence., Setting: The study setting is the public Facebook page where the Break the Silence social media campaign can be seen. Break the Silence was an online activism response to the problem of obstetric violence in the US maternity care system with signboard messages posted from 31 known US states. The setting is bounded by the digital page where the campaign is published., Participants: There were 139 participants, and 11 of them posted more than one signboard message. Most participants were birthing people (n = 125) followed by doulas (n = 10)., Methods: Krippendorff's methodology for qualitative content analysis was applied to 156 signboard messages posted on Break the Silence from 2014 to 2016. Qualitative content analysis was supported by Atlas.ti 23., Results: Four themes illustrated the meaning of obstetric violence in US maternity care: 1) pregnancy and birth as a battle with healthcare providers and the healthcare system, 2) sacrifice of the maternal body normalized and assumed as a gender stereotype, 3) disrupted rites of passage from childbirth, and 4) abuse of fiduciary power by healthcare providers., Conclusions: This study demonstrated thematic meanings for the experience of obstetric violence in US maternity care with a healthcare systems approach that included structural and organizational considerations to increase understanding. Categories and forms of obstetric violence from the existing literature were expanded and strengthened by findings from this study. Themes were validated in principle with consistency in findings across the international evidence base on obstetric violence., Tweetable Abstract: The meaning of #obstetricviolence experiences is interpersonal and structural with thematic consistency across international studies., 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 © 2024 Elsevier Ltd. All rights reserved.)

During a study on the helminth fauna of fishes in the Juruá and Moa Rivers, State of Acre, north Brazil, three new species of Demidospermus Suriano, 1983 were found parasitizing Ageneiosus inermis (Auchenipteridae). Demidospermus juruaensis sp. nov. is characterized by its accessory piece, which is robust and straight, anchor-shaped distally, as well as by morphology of its hooks, which have a delicate and expanded shaft with a spear-shape ending. Demidospermus bifurcatus sp. nov. is characterized by a male copulatory organ (MCO) composed of a robust tube, with a bisected tip at the distal end and a robust accessory piece, that embraces the MCO along its entire length. Demidospermus takemotoi sp. nov. differs from its congeners by its long, tubular and slender accessory piece, which is almost the same length as the MCO. These findings bring the number of valid Demidospermus species to 36. The results of this research on the helminth parasites of fishes in Acre State underscore the importance of carrying similar studies on other fish species, thereby enhancing understanding of biodiversity in the Neotropical Region.

Purpose: Postpartum hypertension (PPHTN) poses increased risks, including of stroke. Timely assessment and management by clinicians is imperative but challenging. Team-based care involving pharmacists has shown promise in improving blood pressure control, yet its application in PPHTN management remains unexplored. The objective of this study was to determine the impact and feasibility of an interprofessional model for PPHTN management., Summary: This initiative implemented a novel interprofessional model at a safety-net hospital to address previous workflow limitations. Ambulatory care pharmacists collaborated with an obstetric nurse (OBRN) and a maternal fetal medicine specialist to manage high-risk patients with PPHTN utilizing electronic consults (e-consults). Data collection and symptom assessment were completed by an OBRN via telemedicine appointments. Pharmacists employed a collaborative practice agreement based on a preestablished algorithm to initiate medications. Data on patient demographics, consult volume, prescriptions, and pharmacist comfort were collected during the first quarter of full integration. Pharmacists completed 55 e-consults and generated 54 prescriptions. The average time spent per chart review was 12.5 minutes, and the average time to completion of e-consults was 54 minutes. Forty-five unique patients received care, who were primarily non-English-speaking and non-Hispanic Black patients. Pharmacists reported moderate to high comfort levels in managing PPHTN based on the algorithm and provided feedback leading to workflow adjustments., Conclusion: Integration of pharmacists into PPHTN care enables prompt medication initiation and titration. This innovative model, involving remote blood pressure monitoring, telemedicine visits with an OBRN, and e-consults completed by pharmacists, ensures delivery of timely and equitable care and improved access across a diverse population., (© American Society of Health-System Pharmacists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The aim of this study was to describe a new species of Didymozoidae (Trematoda) found in the mesentery of Euthynnus alletteratus (Rafinesque) off Cabo Frio, in the coastal area of the state of Rio de Janeiro, Brazil. Thirty specimens of E. alletteratus were obtained between August 2023 and June 2024, directly from traders who sell fresh fish in markets. The parasites were fixed in AFA (93% ethanol 70%, 5% formaldehyde and 2% glacial acetic acid) with or without compression, stained with Langeron's hydrochloric carmine, dehydrated in an alcohol series, clarified in clove oil and mounted in Canada balsam as permanent slides. The new species was assigned to the genus Lobatozoum Ishii, 1935, mainly by the presence of lobes in the posterior region of the body and by the arrangement of the testes, ovary and vitellaria. Lobatozoum woodi n. sp. differs from all congeneric species mainly by presenting three testicular tubules, by the size of pharynx, larger than the oral sucker, and by the absence of digestive glands cells in esophagus and initial portion of caeca. The finding of a new species of Lobatozoum represents the eleventh valid species in the genus.

Purpose: Direct oral anticoagulants (DOACs) are the preferred choice of anticoagulation therapy for nonvalvular atrial fibrillation and venous thromboembolism. Inadequate monitoring of patients on DOACs may lead to suboptimal outcomes and safety concerns. This project aimed to implement a standardized telemedicine-based DOAC monitoring service and track pharmacist-based interventions. Methods: This project was conducted at a safety-net hospital over 6 months. Anticoagulation pharmacists developed a scheduling process for telemedicine DOAC follow-up appointments, integrated them into the electronic health record, and implemented standardized protocols and documentation tools. Outcomes of interest included the average number of pharmacist interventions per encounter and per patient. Results: One hundred sixty-four encounters involving 120 patients were included in the analysis. 92.7% of encounters resulted in at least 1 intervention, with 73.8% involving an education intervention. The average number of interventions per patient was 2.0, with 37.2% of encounters having multiple interventions. Conclusion: Implementation of a standardized telemedicine-based monitoring service allowed for pharmacist identification and management of issues related to DOAC therapy. These findings emphasize the importance of pharmacist-led interventions and telemedicine-based follow-up of DOAC therapy., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Populations of freshwater species have been declining rapidly and species are becoming extinct. Thus, understanding freshwater species distribution, trends and patterns is required. The Munim River basin is situated in a region with a phytogeographic interface between the Amazon and Cerrado biomes. Although the Munim basin ichthyofauna is currently relatively well-known, data on its helminth fauna is scarce. The present study aimed to characterize the nematofauna of Bryconops cf. affinis (Günther) and Saxatilia brasiliensis (Bloch) from two different localities in the middle section of the Munim River, and thus to contribute to the knowledge of biodiversity in this region. Specimens of Bryconops cf. affinis were parasitized with the nematodes Procamallanus (Spirocamallanus) krameri (Petter, 1974) and "Porrocaecum-like" species (larvae) in both localities. Saxatilia brasiliensis presented the nematodes P. (S.) krameri, Pseudoproleptus sp. (larvae), Cucullanus sp. and Procamallanus sp. (larvae). Procamallanus (S.) krameri was found parasitizing S. brasiliensis only from the Feio stream. Morphometric data and parasitological parameters are given. The present study provides the first record of nematodes for B. cf. affinis and for S. brasiliensis contributing to the knowledge of the helminth fauna of freshwater fishes from locations that have not yet been studied, such as the Munim River basin.

Warts, hypogammaglobulinaemia, infections and myelokathexis syndrome (WHIMS) is a rare combined primary immunodeficiency caused by the gain of function of the CXCR4 chemokine receptor. We present the prevalence of cancer in WHIMS patients based on data from the French Severe Chronic Neutropenia Registry and an exhaustive literature review. The median follow-up of the 14 WHIMS 'patients was 28.5 years. A central review and viral evaluation of pathological samples were organized, and we conducted a thorough literature review to identify all reports of WHIMS cases. Six French patients were diagnosed with cancer at a median age of 37.6 years. The 40-year risk of malignancy was 39% (95% confidence interval [CI]: 6%-74%). We observed two human papillomavirus (HPV)-induced vulvar carcinomas, three lymphomas (two Epstein-Barr virus [EBV]-related) and one basal cell carcinoma. Among the 155 WHIMS cases from the literature, 22 cancers were reported in 16 patients, with an overall cancer 40-year risk of 23% (95% CI: 13%-39%). Malignancies included EBV-associated lymphoproliferative disorders and HPV-positive genital and anal cancers as in the French cohort. Worldwide, nine cases of malignancy were associated with HPV and four with EBV. Immunocompromised WHIMS patients appear to be particularly susceptible to developing early malignancy, mainly HPV-induced carcinomas, followed by EBV-related lymphomas., (© 2024 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)

Laryngeal and airway surgery continues to see innovation and advances, similar to other specialties of modern medicine. Research in this field has led to a greater understanding of conditions resulting in new terminology, diagnoses and change in management. This article looks at advances in laryngeal and upper airway surgery and discusses their ongoing impact on clinical practice.

COVID-19 vaccination and acute infection result in cellular and humoral immune responses with various degrees of protection. While most studies have addressed the difference in humoral response between vaccination and acute infection, studies on the cellular response are scarce. We aimed to evaluate differences in immune response among vaccinated patients versus those who had recovered from COVID-19. This was a prospective study in a tertiary medical centre. The vaccinated group included health care workers, who had received a second dose of the BNT162b2 vaccine 30 days ago. The recovered group included adults who had recovered from severe COVID-19 infection (<94% saturation in room air) after 3-6 weeks. Serum anti-spike IgG and cytokine levels were taken at entry to the study. Multivariate linear regression models were applied to assess differences in cytokines, controlling for age, sex, BMI, and smoking status. In total, 39 participants were included in each group. The mean age was 53 ±14 years, and 53% of participants were males. Baseline characteristics were similar between the groups. Based on multivariate analysis, serum levels of IL-6 (β=-0.4, p<0.01), TNFα (β=-0.3, p=0.03), IL-8 (β=-0.3, p=0.01), VCAM-1 (β=-0.2, p<0.144), and MMP-7 (β=-0.6, p<0.01) were lower in the vaccinated group compared to the recovered group. Conversely, serum anti-spike IgG levels were lower among the recovered group (124 vs. 208 pg/mL, p<0.001). No correlation was identified between antibody level and any of the cytokines mentioned above. Recovered COVID-19 patients had higher cytokine levels but lower antibody levels compared to vaccinated participants. Given the differences, these cytokines might be of value for future research in this field.

During a study conducted on the helminth fauna of fishes in the middle Munim River basin, State of Maranho, northeastern Brazil, three species (two new) of Diaphorocleidus Jogunoori, Kritsky & Venkatanarasaiah, 2004 are reported from the gills of the piaba Bryconops cf. affinis (Iguanodectidae): Diaphorocleidus affinis (Mizelle, Kritsky & Crane, 1968), D. forcipiformis n. sp. and D. munimensis n. sp. New morphological data, drawings, and geographic distribution were provided for D. affinis. Diaphorocleidus forcipiformis n. sp. is characterized by a male copulatory organ with 2 rings counterclockwise and base forming a small tube with two circular flanges and accessory piece bifurcated, claw-shaped, with parts similar in shape and size, one of them distally bifid. Diaphorocleidus munimensis n. sp. is differentiated by the accessory piece, which is composed of two large pieces, united in their proximal part, claw-shaped, and distally hooked. The findings of this initial survey on the helminth parasites of fishes in this area emphasize the importance of carrying out comparable surveys on other fish species. Such surveys may lead to the identification of unknown species or new occurrences.

During studies on fish parasites, two new species of Anacanthorus were found parasitizing serrasalmid fishes, Anacanthorus simpliciphallus sp. n. from the hybrid Piaractus mesopotamicus x Piaractus brachypomus and Anacanthorus brandtii sp. n. from Serrasalmus brandtii. Anacanthorus simpliciphallus sp. n. resembles Anacanthorus reginae in the morphology of the male copulatory organ (MCO) and accessory piece but differs from A. reginae in terms of the smaller size of the accessory piece, which corresponds approximately half the size of the MCO and by the presence of a conspicuous metraterm, with a membranous terminal region. Anacanthorus brandtii sp. n. differs from Anacanthorus scapanus by the expansion of the accessory piece, from Anacanthorus jegui by the ratio MCO (male copulatory organ) /AP (accessory piece) and by the expansion of hook shank, from Anacanthorus sciponophallus and A. reginae by the ratio MCO/AP. Anacanthorus brandtii sp. n. can be distinguished from A. reginae and A. simpliciphallus sp.n. by the size of hooks which is similar in A. reginae and A. simpliciphallus sp. n. and dissimilar in A. brandtii sp. n. The two new species also differ from each other by the expansion of shank.

A new and two previously described species of Ameloblastella Kritsky, Mendoza-Franco & Scholz, 2000 were found in the gills of two pimelodid catfishes from the Tocantins River, Maranhão State, Brazil: Ameloblastella prima n. sp. from Pimelodina flavipinnis Steindachner, and A. edentensis Mendoza-Franco, Mendoza-Palmero & Scholz, 2016 and A. peruensis Mendoza-Franco, Mendoza-Palmero & Scholz, 2016 from Hypophthalmus marginatus Valenciennes. The new species differs from its congeners by having an accessory piece tubular, covered by a delicate membranous cap at 2/3 of the length, by the shape of the ventral and dorsal anchors, in which the ventral anchor is represented by a curved shaft in a position of 80° degrees, with delicate ornamentations located at the superficial and deep root areas, and the dorsal anchor with a long, well-developed and convex superficial root and short deep root, also presenting delicate ornamentations at the superficial and deep root areas. The present study provides new biogeographical data on the two previously described species of Ameloblastella and improves the knowledge on the species of Monogenoidea from the Neotropical Region, increasing to 14 the number of known species of Ameloblastella for this region., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Cemeteries can be compared to landfills, as the leachate produced in these areas, also known as necroleachate, can be environmentally transported, polluting groundwater, surface water, and soil. In Brazil, to ensure no negative environmental impacts and public health risks, cemetery management is the responsibility of states and municipalities. In this context, this article aims to discuss Brazilian sanitary-environmental legislation concerning cemetery waste management. Only half of all Brazilian states have established sanitary-environmental cemetery legislation, and only 19 municipalities have specific laws. These laws, however, are broad and contain many gaps. Necroleachate care and control require both sanitary and environmental assessments to avoid environmental vulnerability and contamination risks for populations inhabiting surrounding areas. In this regard, new water analysis parameters in environmentally vulnerable areas should be established to control the population's drinking water quality, such as the detection of C. perfringens . Furthermore, the construction of vertical cemeteries instead of horizontal ones and the adoption of cremation procedures should also be considered. This assessment comprises a novel research framework, as no studies on the impact of Brazilian laws on environmental necroleachate contamination are available to date.

Several studies have demonstrated parasitism by monogenoids in characiform fish in the Neotropics. During studies on the helminth fauna of curimatids from the Tocantins River, specimens of Psectrogasteramazonica Eigenmann & Eigenmann, 1889 were examined and species of Curvianchoratus Hanek, Molnar & Fernando, 1974 were found. Species of the genus are characterized mainly by the complex shape of haptoral anchors with a modified dorsal anchor, composed by two subunits, dorsal-median and dorsal. To date, two species of Curvianchoratus are known to parasitize curimatid fishes: the type species Curvianchoratushexacleidus Hanek, Molnar & Fernando, 1974 and Curvianchoratussingularis (Suriano, 1980). During examination of specimens of P.amazonica collected in the Tocantins River, Embiral, Imperatriz, Maranhão State, Brazil, two new species of Curvianchoratus were found and are described herein. Curvianchoratuspsectrogasteri sp. nov. and Curvianchoratusdominguesi sp. nov. are characterized by possessing the male copulatory organ formed by a long cirrus and a claw-shaped accessory piece, connected to the base of the male copulatory organ by a ligament. The new species differs from the two known congeneric species mainly by the morphology of the dorsal-median and dorsal subunits of the dorsal anchor. Curvianchoratuspsectrogasteri sp. nov. also differs from other species of the genus by the absence of the ventral bar and Curvianchoratusdominguesi sp. nov. by the size and shape of the ventral bar. An amendment to the diagnosis of Curvianchoratus is provided to accommodate the new species. The present study increases the number of Curvianchoratus species to four and extends the occurrence of the genus to the Tocantins-Araguaia Basin., Competing Interests: No conflict of interest was declared., (Carine Almeida Miranda Bezerra, Simone Chinicz Cohen, Yuri Costa de Meneses, Helyab Gabriel Chaves Neres, Diego Carvalho Viana, Marcia Cristina Nascimento Justo.)

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

Monogenoids are ectoparasites that have a simple one-host lifecycle, high species diversity, and a relatively high host specificity. During studies on the helminth fauna of fishes from the Jurua River, in Acre State, Brazil, a new species of the monotypic genus Unibarra Suriano & Incorvaia, 1995 was found parasitizing Oxydoras niger Valenciennes, 1821. Unibarra juruaensis n. sp. is allocated in the genus based on the presence of a single haptoral bar, marginal hooks similar in shape and size, gonads partially overlapping, and a conspicuous filament which connects the base of the male copulatory organ with the accessory piece. The new species differs from the only species of the genus by the smaller size of the body and of the structures, by the morphology of copulatory complex, with an accessory piece thinner than that of U. paranoplatensis Suriano & Incorvaia, 1995 and by the presence of two eyespots. The type species, U. paranoplatensis, is referred in a new host, Pimelodus blochii Valenciennes, 1840, with new morphological data. A table of measurements of the new species and previous and the present reports of U. paranoplatensis is presented., (© 2023. The Author(s) under exclusive licence to Witold Stefański Institute of Parasitology, Polish Academy of Sciences.)

Changes in the regulatory and legal framework for Brazil's water and sanitation sector (Law 14,026, July 15, 2020) require competitive bidding for service contracts, even in cases where the provision of services was previously delegated to state-owned utilities under program contracts. The aim of this study was to identify the actors who benefited from these changes to the legislation and assess the social effectiveness of the privatization of water supply and sewerage services in the state of Rio de Janeiro by investigating the auction of services provided by the public utility CEDAE in four blocks comprising 35 municipalities in April 2021. We conducted an exploratory analysis of secondary data and used the systemic integration method to identify the main actors involved in the concession process and the role they played. It is concluded that federal, state, and municipal governments, the Brazilian Development Bank, and the concessionaires have gained from the concessions, while the percentage of low-income populations connected to the sewage collection or drainage network is lower and tariffs are higher in municipalities served by the private sector when compared to the municipalities encompassed by the auction.

Five new species of Cosmetocleithrum were described parasitizing the gill filaments of neotropical doradid fishes. Cosmetocleithrum undulatum n. sp., Cosmetocleithrum brachylecis n. sp. and Cosmetocleithrum ludovicense n. sp. are described from Platydoras brachylecis from a market-place of São Luís, State of Maranhão, Brazil. Cosmetocleithrum sacciforme n. sp. and Cosmetocleithrum basicomplexum n. sp. are described from Oxydoras niger from Juruá River, State of Acre, Brazil. Cosmetocleithrum undulatum and Cosmetocleithrum brachylecis resemble Cosmetocleithrum falsunilatum Feronato, Razzolini, Morey & Boeger, 2022 mainly by the unique male copulatory organ (MCO) morphology but differ from these and all congeneric species mainly by the morphology of the MCO, accessory piece and hooks pairs. Cosmetocleithrum ludovicense is closer to Cosmetocleithrum confusus Kritsky, Thatcher & Boeger, 1986 and to Cosmetocleithrum akuanduba Soares, Santos Neto & Domingues, 2018 but differs from those mainly by the morphology of the accessory piece. Cosmetocleithrum sacciforme differs from all congeneric species mainly by the morphology of the accessory piece formed by a single plate of saccular appearance. Cosmetocleithrum basicomplexum also shares morphological characters with Cosmetocleithrum gigas Morey, Cachique & Babilonia, 2019 considering the size of the body and shape of the anchors, but differs mainly in the morphology of the bars and hooks. Besides the new species, new data are presented for Cosmetocleithrum leandroi Soares, Neto & Domingues, 2018, C. akuanduba and C. confusus regarding morphological characteristics and biogeography., (© A.L. Silva et al., published by EDP Sciences, 2023.)

Based on the broader concept of health proposed by the Pan-American Health Organization/World Health Organization (PAHO/ WHO), 2018, and the absence in the literature of indices that translate the causal relationship between sanitation and health, a methodology for assessing the health impact of a water and sanitation programmes, known as a Health Impact Assessment (HIA), was developed, specifically in the Brazilian context, and focused on a school in the northeast of the country. Through exploratory and descriptive evidence, and using documentary research as a method, a retrospective survey was carried out from 2000 to 2022 using documents proposing evaluation methodologies. A single document was found to fit the research objective, which was used to develop the proposed HIA methodology. Development of the methodology consisted of two stages: definition of the health dimensions and selection of the indicators making up each dimension. The HIA methodology was then applied to a school in northeast Brazil to test its use, before a water-efficient management intervention was going to be used. The overall score of 46% indicated that there was room for improvement, which the new management approach could facilitate. This methodology is therefore proposed to be an instrument for the evaluation of public water and sanitation policies, thus assisting managers in the decision-making process and in guiding sanitation programs and plans.

Objective: To evaluate temporal trends in the management of sinogenic intracranial suppuration and its outcomes in children., Data Sources: A systematic search of databases was performed (Medline, Embase, Cochrane, ClinicalTrials.gov)., Review Methods: Studies in children (age <18 years) with sinogenic subdural empyema, extradural abscess, and intraparenchymal abscess were included. Data on treatment strategies were extracted. Primary outcome was death <90 days. Secondary outcomes were return to theater, neurologic disability at 6 months, and length of stay. Random effects meta-analysis and meta-regression were performed to investigate the effect of time and endoscopic sinus surgery (ESS) on these outcomes., Results: A total of 32 retrospective observational studies involving 533 patients recruited across a 45-year period (1975-2020) were included. The pooled estimates for 90-day mortality, permanent neurologic disability, and return to theater were 2.3% (95% CI, 1.1%-3.6%; I 2 = 0, P > .99), 21.3% (95% CI, 15.3%-27.3%; I 2 = 75.2%, P < .001), and 37.3% (95% CI, 29.5%-45%; I 2 = 71.2%, P < .001), respectively, with no significant differences found across the study period. The pooled estimate for ESS was 58.4% (95% CI, 44.2%-72.6%; I 2 = 97.1%, P < .001) with a significantly increasing trend in its use in the more recent years. ESS was not associated with improved mortality, reduced need for revision surgery, or neurologic disability., Conclusion: The outcomes of sinogenic intracranial complications have not changed over the last 45 years, and ESS was not associated with improved patient outcomes. Further high-quality studies are required to determine the most appropriate treatment modalities to improve the burden of morbidity associated with sinogenic intracranial suppuration in children.

During a survey of the helminth fauna of characiform fishes from the Tocantins River, Brazil, 185 fish specimens from 22 species were studied. Twelve species of Nematoda and nine species of Digenea were collected. Some of these helminth species were reported for the first time in their hosts, thus representing new host records: Procamallanus (Spirocamallanus) sp. in Bivibranchia notata, Brycon pesu, Chalceus macrolepidotus, Hemiodus microlepis and Hemiodus unimaculatus; Procamallanus (Spirocamallanus) inopinatus in Triportheus elongatus; Goezia sp. (larva) in Boulengerella cuvieri; Rhabdochona acuminata in Brycon pesu and Triportheus trifurcatus; Raphidascaris sp. (larva) in Caenotropus labyrinthicus; Cosmoxynema vianai in Cyphocharax gouldingi; Rondonia rondoni in Leporinus fasciatus and Mylesinus paucisquamatus; Klossinemella iheringi in Mylesinus paucisquamatus; Cucullanidae gen. sp. in Myloplus rubripinnis; Rhabdochona sp. in Triportheus elongatus; Alphamphistoma sp. in Myleus setiger; Chalcinotrema sp. in Cyphocharax gouldingi; Pacudistoma guianense in Hemiodus unimaculatus and Myleus torquatus; Pseudocladorchis cylindricus in Hemiodus unimaculatus; Dadaytrema oxycephala in Mylesinus paucisquamatus; Travassosinia dilatata in Myloplus asterias; and Genarchella genarchella in Raphiodon vulpinus. Studies identifying new hosts and new localities for parasites have contributed to the knowledge of local biodiversity. A list of previous records of helminths included in the present study, providing hosts, localities, and references, is presented here.

Background and Objectives: Since the 2014 Food and Drug Administration communication regarding the use of power morcellation, gynecologists have adopted alternative tissue extraction strategies. The objective of this study is to investigate the current techniques used by gynecologic surgeons for tissue extraction following minimally invasive hysterectomy or myomectomy for fibroids., Methods: An online survey was distributed to all AAGL members and responses were collected between March 26, 2019 and April 17, 2019., Results: Four hundred thirty-six respondents completed the survey. For hysterectomy, the most common methods of tissue extraction were manual morcellation through the colpotomy (72.4%) or minilaparotomy (66.9%). Nearly one-third (31.7%) endorsed using power morcellation. For myomectomy, manual morcellation via minilaparotomy (71.9%) was the most common approach, followed by power morcellation (35.7%). Use of containment bags was common. Minilaparotomy incisions were typically three cm and most often at the umbilicus.Geographic differences were detected, particularly with power morcellation. During hysterectomy, 18.4% of US-based surgeons reported its use, compared to 56.9% of nonUS-based surgeons. During myomectomy, 20.5% of US-based surgeons reported its use compared to 67.5% of their international counterparts. Age, years in practice, fellowship training, and practice location were all significantly associated with power morcellator use., Conclusion: A large majority of practitioners are performing manual morcellation through the colpotomy or minilaparotomy. Use of containment bags is common with all routes of tissue removal. Power morcellation use is less common in the United States than in other countries., (© 2022 by SLS, Society of Laparoscopic & Robotic Surgeons.)

Background: Community water fluoride (CWF) is the proven cornerstone of primary dental health care promotion. In 2002 CWF was made mandatory at a national level in Israel, however a new government revoked these regulations in August 2014. "Maccabi" is the second largest national health care provider with 2.3 million members, "Maccabi-Dent", its dental branch, has 53 clinics, employing 1100 dentists. The aim of this study was to evaluate the cumulative effect on treatment rates 6 years after CWF was terminated in Israel, based on the number of dental treatments provided to children aged 3-12 years in "Maccabi-Dent" clinics., Methods: For this retrospective study, computerized dental treatment codes were collected. The "rate of treatment" was calculated by dividing the number of restorative treatments or extractions, by the number of individuals receiving treatment. The population size and the age group visiting the specific clinic were also considered., Results: The independent variables were fluoride concentration in drinking water, age and socioeconomic position (SEP). There was a significant increase in restorative dental treatments after 2014, (R 2  = 0.0402), with approximately twice the number of treatments required in the absence of CWF. Age had a significant association (β =  - 0.389, p < 0.001) as did SEP (β = 0.086, p = 0.019)., Conclusion: After CWF cessation in Israel, rates of dental treatments significantly increased., Practical Implication: By examining accepted notions with up-to-date information, new confirmatory evidence helps decision makers understand the importance of adding fluoride to drinking water., (© 2022. The Author(s).)

Background: Peanut (Arachis hypogaea L.) belongs to an exceptional group of legume plants, wherein the flowers are produced aerially, but the pods develop under the ground. In such a unique environment, the pod's outer shell plays a vital role as a barrier against mechanical damage and soilborne pathogens. Recent studies have reported the uniqueness and importance of gene expression patterns that accompany peanut pods' biogenesis. These studies focused on biogenesis and pod development during the early stages, but the late developmental stages and disease resistance aspects still have gaps. To extend this information, we analyzed the transcriptome generated from four pod developmental stages of two genotypes, Hanoch (Virginia-type) and IGC53 (Peruvian-type), which differs significantly in their pod shell characteristics and pathogen resistance., Results: The transcriptome study revealed a significant reprogramming of the number and nature of differentially expressed (DE) genes during shell development. Generally, the numbers of DE genes were higher in IGC53 than in Hanoch, and the R5-R6 transition was the most dynamic in terms of transcriptomic changes. Genes related to cell wall biosynthesis, modification and transcription factors (TFs) dominated these changes therefore, we focused on their differential, temporal and spatial expression patterns. Analysis of the cellulose synthase superfamily identified specific Cellulose synthase (CesAs) and Cellulose synthase-like (Csl) genes and their coordinated interplay with other cell wall-related genes during the peanut shell development was demonstrated. TFs were also identified as being involved in the shell development process, and their pattern of expression differed in the two peanut genotypes. The shell component analysis showed that overall crude fiber, cellulose, lignin, hemicelluloses and dry matter increased with shell development, whereas K, N, protein, and ash content decreased. Genotype IGC53 contained a higher level of crude fiber, cellulose, NDF, ADF, K, ash, and dry matter percentage, while Hanoch had higher protein and nitrogen content., Conclusions: The comparative transcriptome analysis identified differentially expressed genes, enriched processes, and molecular processes like cell wall biosynthesis/modifications, carbohydrate metabolic process, signaling, transcription factors, transport, stress, and lignin biosynthesis during the peanut shell development between two contrasting genotypes. TFs and other genes like chitinases were also enriched in peanut shells known for pathogen resistance against soilborne major pathogens causing pod wart disease and pod damages. This study will shed new light on the biological processes involved with underground pod development in an important legume crop., (© 2021. The Author(s).)

Objective: Primary resection of adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma has become a front-line standard-of-care treatment for Cushing disease. However, surgical intervention can be challenging because of elevated blood pressure, as well as direct cortisol impacts on endothelial cells, vascular permeability, and tissue friability-potentially resulting in increased intraoperative bleeding. Tranexamic acid (TXA) is a well-studied, widely used intravenous hemostatic; however, the potential benefit during resection of ACTH-secreting pituitary adenoma is unstudied. The purpose of this study was to define an institutional protocol for perioperative administration of TXA in patients undergoing endoscopic endonasal approach for resection of ACTH-secreting pituitary adenoma, and to study the implementation of our novel protocol in a prospective fashion., Methods: Criteria for preoperative TXA were defined by age, medical history, and risk factors. Descriptive statistics were reported for all patients receiving perioperative TXA., Results: Thirty patients met inclusion criteria and underwent perioperative administration of TXA, using a standardized dosing protocol of a 10 mg/kg bolus in 30 minutes prior to incision, followed by maintenance infusion of 2 mg/kg/hour for the duration of the procedure. No incidence of myocardial infarction or postoperative thromboembolic events were noted. Subjective assessments indicated satisfaction with the patient selection protocol, and meaningful reduction in the extent of intraoperative bleeding., Conclusions: Perioperative TXA represents a potentially efficacious approach for control of intraoperative bleeding during endonasal resection of ACTH-secreting tumors. Careful preoperative patient selection is emphasized, given the potential for thromboembolic complications; however, initial experience with our institutional protocol suggests a favorable risk/benefit profile when this treatment is applied judiciously., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: Describe a new species of didymozoid digenean Neonematobothrium Yamaguti, 1965 from the operculum of the scombrid fish, Euthynnus alletteratus (Rafinesque, 1810), in the Southwest Atlantic Ocean off Brazil., Methods: Thirty-four specimens of E. alletteratus were collected in the coastal zone of the state of Rio de Janeiro and obtained from local fishermen between 2006 and 2018 in the municipal market of São Pedro in Niterói, Brazil. The parasites were fixed in AFA (93% ethanol 70%, 5% formaldehyde, 2% glacial acetic acid) without pressure, stained with Langeron alcoholic acid carmine, dehydrated in an alcohol series, cleared in beachwood creosote or clove oil and mounted in Canada balsam as permanent slides., Results: Neonematobothrium annakohnae n. sp. is a member of the genus based on a combination of the following characteristics: body free, uncapsulated; body long and dorsoventrally flattened; esophagus surrounded by gland cells; ovary and vitellarium single, long, narrow and unbranched in the anterior and posterior halves of the body, respectively; uterus with three loops; and site of infection in subcutaneous tissue of scombrid fish. The new species differs from the two recognized species of the genus mainly by the size of the body, which is much larger, the shape of the genital pore, which is differentiated in a structure similar to a small sucker and by esophagus without diverticula., Conclusions: Neonematobothrium annakohnae n. sp. parasite of E. alletteratus from the Southwest Atlantic Ocean, described herein, represents the third species of Didymozoidae belonging to the genus Neonematobothrium. The two known species Neonematobothrium kawakawa Yamaguti, 1965 and Neonematobothrium dorsale Yamaguti, 1970 were described from fish belonging to the same genus of the host from Pacific Ocean. The diagnosis of the genus is enlarged to "esophagus with or without diverticula", to fill the characteristics presented by the new species. The description of N. annakohnae n. sp. demonstrates the need to expand the studies of these interesting and intriguing group of parasites, due to the fact that number of known didymozoids taxa in the Atlantic Ocean is far from representing the real situation., (© 2021. Witold Stefański Institute of Parasitology, Polish Academy of Sciences.)

Background: Gonadotroph pituitary adenoma (Gn-PA) may rarely cause ovarian hyperstimulation syndrome, leading to infertility in women, although this remains poorly described., Methods: We present a quantitative systematic review including 2 patients from our institutional and 48 from the literature with Gn-PA causing ovarian hyperstimulation syndrome to thoroughly describe the clinical features and therapeutic outcomes from multidisciplinary aspects., Results: The patients had a mean age of 31.5 years and a mean follicle-stimulating hormone level of 14.4 IU/L. Estradiol level was high in 82% of patients, at >350 pg/mL. The mean maximal adenoma diameter was 22 mm, with a Knosp grade ≥3 in 10 patients. Abdominal surgery preceded adenoma resection in 24 patients (48%). Among 25 patients for whom extent of resection was recorded, total adenoma resection was achieved in 12. Through a mean follow-up of 25 months, adenoma recurrence was observed in 5 patients, who were treated with re-resection (n = 2), radiation (n = 2), and medical therapy followed by bilateral oophorectomy (n = 1). Medical therapies were partially effective or ineffective, and adenoma shrinkage did not follow; gonadotropin-releasing hormone agonists/antagonists were partially effective in 20% of patients (2/10), dopamine agonists in 44% (8/18), and somatostatin analogues in 50% (1/2). Four experienced swelling of tumor/ovaries after gonadotropin-releasing hormone agonists/antagonists administration. Overall, chemical remission was obtained in 26 of 28 patients, normalization of ovaries in 25 of 27, and successful pregnancy in 12 of 14., Conclusions: Adenoma resection is the main treatment, leading to reduction in ovarian size and biochemical remission, with a high likelihood of subsequent spontaneous pregnancy. Increased awareness of this rare condition may help avoid unnecessary abdominal procedures., (Copyright © 2021 Elsevier Inc. All rights reserved.)

A juvenile specimen of a mermithid (Nematoda) was found parasitizing a third instar nymph of Triatoma sordida from Mato Grosso, Brazil. This is the first record of mermithid parasitism in a triatomine species. The Mermithidae represents a family of nematodes that are specialized insect parasites. Entomonematodes are one of the highly influential agents regulating the population dynamics of insects. This report introduces the opportunity to think about mermithids as a possible candidate for use as triatomine biological control., (Mirian Francisca Martins, Sinara Cristina de Moraes, Simone Chinicz Cohen, Melissa Querido Cárdenas, Cleber Galvão.)

Context: Patient care delivered by well-functioning teams provides integrated and cohesive responses to the patients' needs and is considered more effective than care delivered by independent health professionals. The University of New England (UNE) College of Osteopathic Medicine integrates interprofessional education (IPE) curriculum into each year of its program. The UNE Center for Excellence in Collaborative Education coordinates strategically planned interprofessional learning opportunities., Objective: To assess the implementation of interprofessional competencies and learning outcomes using the Interprofessional Team Immersion (IPTI) at UNE., Methods: A team of students from various health profession programs worked on a simulated case with trained actors to learn about the roles and responsibilities of their professions in the optional IPTI. Pre- and postsurveys used the Interprofessional Core Competencies Assessment Scale (ICCAS) and the Interprofessional Socialization and Valuing Scale (ISVS) to evaluate student outcomes., Results: Fifty-five students from various health profession programs at UNE participated in the IPTI activity in February/March 2018. Forty-four students (80%) responded to the surveys, and 43 (78%) completed both surveys. The mean (SD) total ICCAS score increased from presurvey (122 [27]) to postsurvey (127 [26]) (P=.018). The ISVS mean total scores increased from 48.3 presurvey to 57.9 postsurvey (P<.0001)., Conclusion: The significant differences in the ICCAS and the ISVS scores indicate that the IPTI changed students' attitudes toward IPE and future collaborative practice. Interprofessional learning at UNE is a valuable experience for both students and faculty. UNE College of Osteopathic Medicine continues to develop IPE activities for all 4 years of its programming.

Background: Uterine leiomyomas are common benign tumours found in women of reproductive age that are rarely associated with intra-abdominal haemorrhage. The aetiology behind this relationship is poorly understood and the aforementioned association poorly recognized from a patient's clinical presentation. Available information in the literature is limited to case reports. The aim of this systematic review is to document and highlight the occurrence of intra-abdominal haemorrhage from uterine fibroids, and determine associated morbidity and mortality., Methods: A systematic review of Medline, EMBASE, Web of Science, Scopus, and The Cochrane Library - CENTRAL was performed from the databases inception through to December 2018 for case report and series of patients who experienced intra-abdominal haemorrhage from uterine fibroids. Findings were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines., Results: We identified 115 publications reporting on 125 original case reports. The documented intra-abdominal haemorrhage were commonly due to the rupture of superficial blood vessels over the surface of a fibroid, followed by rupture and avulsion of the fibroid involved. A clinical picture of sudden and profound hypovolemic shock with severe abdominal pain was often the presenting complaint, with a correct pre-operative diagnosis only made in 7 cases on computed tomography imaging. Hysterectomy and myomectomy were the most common surgery performed. Mortality was reported in 4 cases which were directly related to complications of uterine fibroids., Conclusion: Intra-abdominal haemorrhage secondary to uterine fibroids remained a rare phenomenon which is poorly recognized among clinicians. While this association is not representative of the population of interest, it highlights the pathophysiological spectrum of uterine fibroids and its relevance to emergency physicians, surgeons and gynaecologists during clinical practice.

Objective: To describe patient characteristics at presentation, management, and fertility preservation rates among a cohort of Israeli children and adolescents with gender dysphoria (GD). Methods: We performed a retrospective chart review of 106 consecutive children and adolescents with GD (<18 years) referred to and followed at the multidisciplinary Israeli Pediatric Gender Dysphoria Clinic from March 2013 through December 2018. Results: Of the 106 patients, 10 were prepubertal (9 prepubertal transgender females), and 96 were pubertal (38 pubertal transgender females). The GD population increased 11-fold since the establishment of our clinic in 2013. The subject's median age at referral was 15.5 years (range, 4.6 to 18 years). At the time of referral, 91 (95%) of the pubertal group had completed sexual maturation in their assigned gender at birth. Thirteen (13.5%) patients had attempted suicide, and 11 (11.5%) reported having had suicidal thoughts. Fourteen (45%) pubertal transgender females and 3 (6.5%) pubertal transgender males completed fertility preservation. Gonadotropin-releasing hormone analog treatment was prescribed in 77 (80%) patients at a mean age of 15.9 ± 1.6 years. Gender-affirming hormones were prescribed in 61 (64%) patients at a mean age of 16.5 ± 1.3 years. No severe side effects were recorded. Two (2%) of the pubertal group expressed regret about medical treatment. Conclusion: Children and adolescents with GD are presenting for medical attention at increasing rates. Israeli adolescents with GD have high fertility preservation rates, perhaps attributable to cultural perspectives. Taking advantage of the option to preserve fertility can be achieved when proper counseling is both available and promoted by medical personnel. Abbreviations: GAH = gender-affirming hormone; GD = gender dysphoria; GnRHa = gonadotropin-releasing hormone analog; MHP = mental health professional.

Two species of Cosmetocleithrum Kritsky, Thatcher & Boeger, 1986 (both new) and two species of Demidospermus Suriano, 1983 (one new) are reported from the gills of the catfish Auchenipterus nuchalis, popularly known as "mapará", from the Tocantins River and tributaries, North Region of Brazil. Cosmetocleithrum berecae n. sp. differs from all other species presently known in the genus by the morphology of the anchors presenting an elongate shaft and short recurved point, a coiled male copulatory organ (MCO) with three rings, and an elongate slender accessory piece with a bifurcated distal end. Cosmetocleithrum nunani n. sp. differs from its congeners by the combination of the following features: (1) Ventral and dorsal anchors with moderately long curved shaft and short point; (2) Hooks with poorly developed thumb; (3) Hook pairs 5 and 6 similar to each other, but morphologically distinct from remaining hook pairs; and (4) MCO coiled, with approximately 1.5 rings. Demidospermus tocantinensis n. sp. is easily distinguished from other species of the genus by presenting an inverted-G-shaped MCO with a median knee-like expansion. Demidospermus osteomystax Tavernari, Takemoto, Lacerda & Pavanelli, 2010 is redescribed based on paratypes and specimens from the gills of A. nuchalis from the Tocantins River, a new host and locality records for this species. The monotypic Paracosmetocleithrum Acosta, Scholz, Blasco-Costa, Alves & Silva, 2017, the only other Neotropical genus reported in siluriforms besides Cosmetocleithrum with species presenting two ribbon-like projections on the posterior margin of the dorsal bar, is considered a junior subjective synonym of Cosmetocleithrum., (© S.C. Cohen et al., published by EDP Sciences, 2020.)

Coconut oil (CO) from fifteen different varieties of coconuts (Cocos nucifera L.) and one CO processed on an industrial scale were analyzed by electrospray ionization mass spectrometry (ESI-MS) and the data processed using the chemometric tools principal component analysis and independent component analysis. ESI-MS fingerprinting of lipid compounds showed predominance of diacylglycerols and triacylglycerols, as confirmed by high-resolution MS measurements. Chemometric processing of the ESI-MS data differentiated the coconut oil samples, showing that different coconut varieties/cultivars produce oils with distinguishable abundances of lipidic compounds. Thus ESI-MS analysis followed by data treatment using chemometric tools offers a tool able to classify the industrial coconut oils in a fast, simple and effective way, as well as serving as a potential method to identify the coconut varieties by the CO origin, and the occurrence of any adulteration. The procedure may also be applied for quality control of the industrial processes., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

In an effort to increase access to contraception, the pharmacist scope of practice is being expanded to allow prescribing. While this is being accomplished in the United States by a variety of models, legislation that allows pharmacists to prescribe hormonal contraception under a statewide protocol is the most common. This study was designed to explore the outlooks of pharmacists regarding prescribing contraception in the period following the first state legislation and prior to statewide protocol development and availability. A qualitative study of community pharmacists in California using structured phone interviews explored their opinions regarding access to contraception in pharmacies and outlooks regarding prescribing. Data were analyzed using an inductive approach to identify themes. Among the thirty participants, the majority worked in a chain pharmacy. Themes were identified in five overarching domains: Pharmacist barriers, system barriers, patient issues, safety concerns, and pharmacist role. Most were unfamiliar with the new law, yet were interested in expanding access for patient benefit despite foreseeing challenges with implementing the service in community pharmacies. Barriers will need to be addressed and requisite training disseminated widely to facilitate successful implementation and thus improve access on a broad scale. Further research following protocol implementation is needed to understand service implementation, as well as patient utilization and satisfaction.

Background: Following anterior cruciate ligament reconstruction, individuals exhibit sagittal plane knee loading deficits as they underload their injured limb during running. These between-limb biomechanical differences are difficult to clinically detect. Wearable accelerometers may aid in the development of early rehabilitation programs to improve symmetrical loading. This study aimed to identify whether segment accelerations from wearable accelerometers can predict knee loading asymmetry in an anterior cruciate ligament reconstructed population., Methods: 14 individuals 5-months post-anterior cruciate ligament reconstruction performed self-selected speed running. Data were collected concurrently using a marker-based motion system and accelerometers positioned on participants' shanks and thighs. Stepwise linear regression was used to determine predictive value of accelerometer data on biomechanical variables., Finding: Shank acceleration was not predictive of any biomechanical variable. Between-limb differences in thigh axial acceleration explained 30% of the variance in between-limb differences in knee power absorption (p = 0.045), suggesting that accelerometers placed on proximal joint segments may provide information regarding knee loading asymmetry. Between-limb differences in thigh axial acceleration also explained 38% of the variance in between-limb differences in ground reaction force (p = 0.002)., Interpretation: These relationships indicate that accelerations from wearable accelerometers may provide some useful information regarding knee loading during running in individuals following anterior cruciate ligament reconstruction., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To examine adolescent attitudes toward accessing contraception through a new pharmacist prescribing model in the State of California., Study Design: In-depth telephone interviews were conducted in summer 2015 with 30 females ages 18 to 19 in California. Participants were recruited using a social media advertisement. Semi-structured interviews utilized open-ended questions to understand teens' experiences with pharmacies, experiences obtaining contraception, and views on pharmacist prescribing of contraception. Responses were transcribed and qualitatively analyzed using an independent-coder method to identify salient themes., Results: Participants were ethnically diverse and primarily living in suburban areas. All participants had completed high school and many had completed one year of college. Nearly all participants were supportive of California's new law allowing pharmacist prescribing of contraception. Thematic analyses revealed that while participants were satisfied with traditional service providers and valued those relationships, they appreciated the benefit of increased access and convenience of going directly to a pharmacy. Participants expected increased access to contraception in pharmacies would lead to both personal and societal benefits. They expressed concerns regarding parental involvement, as well as confidentiality in the pharmacy environment and with insurance disclosures., Conclusion: Older teens in California are very supportive of pharmacies and pharmacists as direct access points for contraception, but confidentiality concerns were noted. Policy makers and pharmacies can incorporate study findings when designing policies, services, and physical pharmacy spaces to better serve teens. Further research is warranted after pharmacies implement this new service to assess teen utilization and satisfaction as well as outcomes., Implication Statement: Several states recently passed legislation enabling pharmacists to prescribe contraception and other states are considering similar legislation. Older teens are interested in this additional method of contraceptive access and understanding their perspectives can help guide implementation by states and in individual pharmacies., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Research into the work of Szachna Eliasz Cynamon in the Rio Doce Valley Program (1952-1960) is presented. The key sources are from the Department of Archives and Documentation and the Department of Sanitation and Environmental Health at Fiocruz, as well as the family's own archive. At the time, the rates of malaria in the region were high. Born in Poland, Cynamon migrated to Brazil in the 1930s while still a child, where he graduated in sanitary engineering. He was hired to work in Colatina (Espírito Santo) and Governador Valadares (Minas Gerais) between 1952 and 1960, focusing on sewage and water treatment and supply, while also holding sanitation education courses for the local people as part of a Brazil-USA cooperation agreement.

This study investigated the occurrence, prevalence, mean abundance and mean intensity of monogenoidean parasites in Piaractus mesopotamicus farmed in cages in the reservoir of the Itaipu Hydroelectric Power Station, Paraná River, Brazil. The parasite distribution pattern and the correlation of prevalence and abundance with the total length of hosts were also investigated. Four monogenoidean species were collected: Anacanthorus penilabiatus, A. toledoensis, Mymarothecium ianwhitingtoni and M. viatorum. All the parasites collected in P. mesopotamicus showed the typical aggregated distribution pattern, and the abundance and the prevalence did not shown any correlation with the total length of hosts.

The objective of the present study was to analyze the seasonality of parasitic helminths of Leporinus macrocephalus from fish farms in the municipality of Cruzeiro do Sul, Acre, Brazil, and their parasitism rates. Between June 2014 and March 2015, 200 specimens were sampled from two fish farms: one with a semi-intensive system and the other with an extensive system (100 fish from each farm: 50 during the dry season and 50 during the rainy season). Fifteen species of parasites were found, with seasonal variations of some according to the farming system. In the semi-intensive fish farm, there was greater prevalence of infection during the dry season. Also, Urocleidoides paradoxus, Procamallanus (Spirocamallanus) inopinatus, Goezia leporini and Rhabdochona (Rhabdochona) acuminata presented differences in their parasitism rates between the seasons. In the extensive fish farm, no variation in the prevalence of infection was observed between the seasons and two species Tereancistrum parvus and G. leporini demonstrated differences only regarding the mean intensity of infection. The data presented here may help fish farmers to understand the parasite dynamics of L. macrocephalus in farming systems during the dry and rainy seasons in the state of Acre.

Background: Intraventricular cavernous malformations are unusual intracranial vascular malformations; their deep anatomical location complicates their surgical management. Microsurgical approaches are the gold standard approaches for the resection of ventricular lesions, however, they imply considerable neurovascular risks., Case Description: A 51-year-old patient presented with acute headache, diplopia, vertigo, blurred vision, and a depressed level of consciousness. A ventricular hemorrhage was treated with a ventriculostomy and the patient was discharged without hydrocephalus. After 11 days, he developed ataxia, diplopia, and a depressed level of consciousness. The patient was diagnosed with hydrocephalus secondary to the previous third ventricle hemorrhage. An endoscopic exploration using a 30° rigid ventricular endoscope was performed; after the third ventriculostomy, an intraventricular cavernous malformation located on the floor of the third ventricle and the aqueduct of Sylvius was resected., Conclusions: Three days after the surgery, magnetic resonance imaging demonstrated a gross total resection and adequate third ventriculostomy flow. One year after the surgery, the patient was asymptomatic. Neuroendoscopy has evolved towards minimally invasiveness, and in selected cases is an equally effective surgical approach to ventricular lesions. It provides minimal cerebral cortex disruption and vascular manipulation., Competing Interests: There are no conflicts of interest.

Objective: Irritability is listed as a common side effect of psychostimulant medications. However, psychostimulants have been demonstrated as an effective treatment in reducing irritability and aggression in children with attention-deficit/hyperactivity disorder (ADHD). The goal of this study was to quantify the risk of irritability as a side effect of psychostimulant treatment for ADHD., Data Sources and Study Selection: A PubMed search was conducted on August 18, 2013, to identify all double-blind, randomized, placebo-controlled trials published in English examining the efficacy of psychostimulant medications in the treatment of children with ADHD. Trials were excluded if (1) they required additional psychiatric or medical comorbidity in addition to ADHD, (2) they involved fewer than 20 subjects (parallel group trials), or (3) children received psychostimulant medication for less than 1 week., Data Extraction: A fixed-effects meta-analysis was used to examine the risk ratio of irritability reported as a side effect in children treated with psychostimulants compared to placebo. Stratified subgroup analysis and meta-regression were used to examine the effects of stimulant type, dosage, duration of use, and trial design on the measured risk of irritability., Results: From 92 potentially eligible trials, the meta-analysis identified 32 trials involving 3,664 children with ADHD that reported data on irritability as a side effect. The relative risk of irritability significantly differed between psychostimulant classes (test for subgroup differences χ²₁ = 7.6, P = .006). Methylphenidate derivatives were associated with a significantly decreased risk of irritability compared to placebo (risk ratio [RR] = 0.89 [95% CI, 0.82 to 0.96], z = -2.87, P = .004, k = 32, I² = 50%), whereas amphetamine derivatives were associated with a significantly increased risk of irritability (RR = 2.90 [95% CI, 1.26 to 6.71], z = 2.5, P = .01, k = 5, I² = 0%)., Conclusions: This meta-analysis suggests an increased risk of irritability may be confined to amphetamine-derived psychostimulants. Future meta-analyses examining the effects of amphetamine and methylphenidate derivatives on irritability as a continuous measure, as well as head-to-head trials between methylphenidate and amphetamine derivatives examining effects on irritability, will be important to replicate the findings of this meta-analysis., (© Copyright 2017 Physicians Postgraduate Press, Inc.)

Purpose: Inter-subject variability in oral drug absorption is usually reported using bioavailability, which has the components: fraction absorbed (fa), fraction passing the gut wall (fg) and fraction escaping hepatic metabolism (fh). In this study, we sought to separate the absorption (fa∗fg) and elimination (fh) components of bioavailability to study variability of absorption and to investigate the effect of formulations, gastric pH and food on absorption variability., Methods: Four compounds from the AstraZeneca database with a range of reported bioavailabilities (high, intermediate 1&2 and low) were selected. First, a disposition model using intravenous data was developed; Second, intrinsic clearance and hence hepatic extraction ratio was estimated based on the "well stirred" model; lastly, the oral data were included to enable estimation of fa∗fg as a separate component to hepatic extraction. Population pharmacokinetic model fitting was undertaken with NONMEM v.7.2., Results: The limiting step in absorption for intermediate 1 was dissolution rate and fa∗fg variability increased under elevated gastric pH (15% vs. 38%, respectively). Absorption of solution formulation intermediate 2 increased by 17% in the presence of food but the prolonged release formulation's absorption didn't differ under fasted or fed state. Variability wasn't affected by food for both formulations (~30%). For the low bioavailable compound, variability decreased when formulated as a prolonged-release formulation (39% vs. 15%)., Conclusions: The method described here enables an exploration of drug absorption inter-subject variability using population pharmacokinetics. Implementation of such an approach may aid the formulation design process through a better understanding of the factors affecting oral drug absorption variability., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Article 225 of the Brazilian Constitution establishes that all citizens have the right to an ecologically balanced environment, as a common good that is essential for a healthy life, and that the government and society have the duty to protect and preserve the environment for present and future generations. This article outlines a methodology for promoting social mobilization to address water scarcity developed under the National Environmental Education and Social Mobilization for Sanitation Program (PEAMSS, acronym in Portuguese). The main aim of this article is to show the importance of education as a driving force for empowerment for water resources management. It outlines the main concepts of emancipatory environmental education and then goes on to describe the elaboration of a PEAMMS action plan. It concludes that the universalization of the right to safe and clean drinking water and access to sanitation is only possible through democratic and participatory water resources management. Actions are necessary to evaluate the reach of the PEAMSS and define the way ahead for the program.

Objective: Anxiety is a commonly reported side-effect of psychostimulant treatment. Our goal was to quantify the risk of anxiety as a side effect of psychostimulant treatment for attention-deficit/hyperactivity disorder (ADHD)., Methods: We conducted a PubMed search to identify all double-blind, randomized, placebo-controlled trials examining the efficacy of psychostimulant medications in the treatment of children with ADHD. We used a fixed-effects meta-analysis to examine the risk ratio of anxiety reported as a side effect in children treated with psychostimulants compared with those treated with placebo. We used stratified subgroup analysis and meta-regression to examine the effects of stimulant type, dosage, duration of use, and trial design on the measured risk of anxiety., Results: We identified 23 studies involving 2959 children with ADHD for inclusion in our meta-analysis. The risk of anxiety associated with psychostimulant treatment was significantly lower than that experienced with placebo (relative risk [RR] = 0.86 [95% CI: 0.77, 0.95], z = -2.90, p < 0.05). Higher doses of psychostimulants were associated with a reduced measured risk of anxiety of psychostimulants when compared with placebo (β = -0.0039 [95% CI: -0.00718, -0.00064], z = -2.34, p = 0.019)., Conclusions: Meta-analysis suggests that treatment with psychostimulants significantly reduced the risk of anxiety when compared with placebo. This finding does not rule out the possibility that some children experience increased anxiety when treated with psychostimulants, but suggests that those risks are outweighed by the number of children who experience improvement in anxiety symptoms (possibly as a secondary effect of improved control of ADHD symptoms). Clinicians should consider rechallenging children with ADHD who report new-onset or worsening anxiety with psychostimulants, as these symptoms are much more likely to be coincidental rather than caused by psychostimulants.

Objective: Clinical practice currently restricts the use of psychostimulant medications in children with tics or a family history of tics for fear that tics will develop or worsen as a side effect of treatment. Our goal was to conduct a meta-analysis to examine the risk of new onset or worsening of tics as an adverse event of psychostimulants in randomized, placebo-controlled trials., Method: We conducted a PubMed search to identify all double-blind, randomized, placebo-controlled trials examining the efficacy of psychostimulant medications in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). We used a fixed effects meta-analysis with risk ratio of new onset or worsening tics in children treated with psychostimulants compared to placebo. We used stratified subgroup analysis and meta-regression to examine the effects of stimulant type, dose, duration of treatment, recorder of side effect data, trial design, and mean age of participants on the measured risk of tics., Results: We identified 22 studies involving 2,385 children with ADHD for inclusion in our meta-analysis. New onset tics or worsening of tic symptoms were commonly reported in the psychostimulant (event rate = 5.7%, 95% CI = 3.7%-8.6%) and placebo groups (event rate = 6.5%, 95% CI = 4.4%-9.5%). The risk of new onset or worsening of tics associated with psychostimulant treatment was similar to that observed with placebo (risk ratio = 0.99, 95% CI = 0.78-1.27, z = -0.05, p = .962). Type of psychostimulant, dose, duration of treatment, recorder, and participant age did not affect risk of new onset or worsening of tics. Crossover studies were associated with a significantly greater measured risk of tics with psychostimulant use compared to parallel group trials., Conclusion: Meta-analysis of controlled trials does not support an association between new onset or worsening of tics and psychostimulant use. Clinicians may want to consider rechallenging children who report new onset or worsening of tics with psychostimulant use, as these symptoms are much more likely to be coincidental rather than caused by psychostimulants., (Copyright © 2015 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)