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Context: COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly., Objectives: To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves., Methods: This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG)., Results: Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, p  < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves., Conclusion: A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Andrade, Luz, Oliveira, Kopittke, Santa Rosa, Gomes, Bartolazzi, Francisco, Costa, Jorge, Cimini, Carneiro, Ruschel, Schwarzbold, Ponce, Ferreira, Guimarães Júnior, Silveira, Aranha, Carvalho, Godoy, Viana, Hirakata, Bicalho and Marcolino.)

The present study investigated the contamination of oysters farmed in Amazonian estuaries by microplastics (MPs). A total of 120 adult oysters (Crassostrea gasar) were collected from four sites along the Mangrove Coast of Pará/Brazil: S1, S2, S3 and S4, with 30 oyster for each. Overall, 58.33 % of the oyster samples contained microplastics, with mean concentrations of 0.23 MPs/g and 1.9 MPs/ind. The concentration of microplastics varied among the four sites, where S1 and S3 had the highest values while S4 had the lowest. PA fibers were the majority of particles (91 %), followed by PS fragments (9 %). The hepatopancreas and the gonad concentrated more microplastics than the rest of the body. As an important species for aquaculture in Amazon, we recommend additional regulation to reduce human exposure to microplastics, such as the installation of depuration facilities and constant monitoring of the contamination of oysters from farms in the region., 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.)

Background: Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia., Methods: This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events., Results: Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups., Conclusion: Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19., (© 2024. The Author(s).)

Background: Despite no evidence showing benefits of hydroxychloroquine and chloroquine with or without azithromycin for COVID-19 treatment, these medications have been largely prescribed in Brazil., Objectives: To assess outcomes, including in-hospital mortality, electrocardiographic abnormalities, hospital length-of-stay, admission to the intensive care unit, and need for dialysis and mechanical ventilation, in hospitalized COVID-19 patients who received chloroquine or hydroxychloroquine, and to compare outcomes between those patients and their matched controls., Methods: A retrospective multicenter cohort study that included consecutive laboratory-confirmed COVID-19 patients from 37 Brazilian hospitals from March to September 2020. Propensity score was used to select matching controls by age, sex, cardiovascular comorbidities, and in-hospital use of corticosteroid. A p-value <0.05 was considered statistically significant., Results: From 7,850 COVID-19 patients, 673 (8.6%) received hydroxychloroquine and 67 (0.9%) chloroquine. The median age in the study group was 60 years (46 - 71) and 59.1% were women. During hospitalization, 3.2% of patients presented side effects and 2.2% required therapy discontinuation. Electrocardiographic abnormalities were more prevalent in the chloroquine/hydroxychloroquine group (13.2% vs. 8.2%, p=0.01), and the long corrected QT interval was the main difference (3.6% vs. 0.4%, p<0.001). The median hospital length of stay was longer in the HCQ/CQ + AZT group than in controls (9.0 [5.0, 18.0] vs. 8.0 [4.0, 14.0] days). There was no statistical differences between groups in intensive care unit admission (35.1% vs. 32.0%; p=0.282), invasive mechanical ventilation support (27.0% vs. 22.3%; p=0.074) or mortality (18.9% vs. 18.0%; p=0.682)., Conclusion: COVID-19 patients treated with chloroquine or hydroxychloroquine had a longer hospital length of stay, when compared to matched controls. Intensive care unit admission, invasive mechanical ventilation, dialysis and in-hospital mortality were similar.

In this study, we evaluated the morphology and morphometry of the layers that make up the follicular complex surrounding mature oocytes in the six fish species Auchenipterichthys longimanus, Ageneiosus ucayalensis, Hypophthalmus marginatus, Baryancistrus xanthellus , Panaqolus tankei and Peckoltia oligospila , belonging to the order Siluriformes, which inhabit the Amazon basin. On the basis of the morphology and thickness of the layers of the follicular complex, the species were divided into two groups: 1- A. longimanus, A. Ucayalensis and H. marginatus and 2 - B. xanthellus , P. tankei and P. oligospila. The total thickness of the layers that make up the follicular complex showed a difference between type III and IV oocytes for all species of each group. Differences in the theca layer, follicular cells and zona radiata between species and between groups were submitted to statistical analysis. Morphologically, group 1 showed columnar follicular cells and thin zona radiata . Meanwhile, group 2 displayed a layer of cuboidal-shaped follicular cells layer and thicker zona radiata. These differences may be related to the environment and reproductive behaviors, as group 1 migrates without parental care and has eggs that are generally smaller and abundant. While group 2, represented by loricariidae, inhabit lotic environments, have reproductive tactics of parental care and eggs that are generally large and in small numbers. Therefore, we can infer that the follicular complex in mature oocytes can predict the reproductive tactics of the species., Competing Interests: 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., (© 2023 Published by Elsevier Ltd.)

This study evaluated the follicular atresia, cell proliferation, and anti-Mullerian hormone action in Aotus nancymae and Sapajus macrocephalus during three sexual phases (follicular, luteal, and gestational). Follicular quantification and immunolocalization of Caspase-3 protein, B-cell lymphoma 2 (BCL-2), proliferating cell nuclear antigen (PCNA), and anti-Mullerian hormone (AMH) were performed. A significant difference in the quantification between preantral and antral follicles, with a progressive decrease in the antrals, was identified. Protein and hormonal markers varied significantly between follicle cell types ( A. nancymae p = 0.001; S. macrocephalus , p = 0.002). Immunostaining in the preantral and antral follicles was present in all sexual phases; for Caspase-3, in granulosa cells, oocytes, and stroma; for BCL-2, in granulosa cells, oocytes, and theca; and for PCNA and AMH, in oocytes and granulosa cells. The immunostaining for Caspase-3 was more expressive in the preantral follicles (follicular phase, p < 0.05), while that for BCL-2 and PCNA was more expressive in the antral follicles of the follicular phase. The AMH was more expressive in the primary and antral follicles of nonpregnant females, in both the follicular and luteal phases. Our results contribute to understanding the ovarian follicular selection, recruitment, and degeneration of these species.

The majority of early prediction scores and methods to predict COVID-19 mortality are bound by methodological flaws and technological limitations (e.g., the use of a single prediction model). Our aim is to provide a thorough comparative study that tackles those methodological issues, considering multiple techniques to build mortality prediction models, including modern machine learning (neural) algorithms and traditional statistical techniques, as well as meta-learning (ensemble) approaches. This study used a dataset from a multicenter cohort of 10,897 adult Brazilian COVID-19 patients, admitted from March/2020 to November/2021, including patients [median age 60 (interquartile range 48-71), 46% women]. We also proposed new original population-based meta-features that have not been devised in the literature. Stacking has shown to achieve the best results reported in the literature for the death prediction task, improving over previous state-of-the-art by more than 46% in Recall for predicting death, with AUROC 0.826 and MacroF1 of 65.4%. The newly proposed meta-features were highly discriminative of death, but fell short in producing large improvements in final prediction performance, demonstrating that we are possibly on the limits of the prediction capabilities that can be achieved with the current set of ML techniques and (meta-)features. Finally, we investigated how the trained models perform on different hospitals, showing that there are indeed large differences in classifier performance between different hospitals, further making the case that errors are produced by factors that cannot be modeled with the current predictors., (© 2023. The Author(s).)

Oogenesis in fish is a process that involves cell proliferation, growth and maturation. In rivers blocked by hydroelectric dams, these factors can be altered and affect the reproduction mechanism of the species. Regarding this scenario, the present study aimed to describe oogenesis in two cichlids native to the Amazon basin, Geophagus argyrostictus and G. altifrons, during pre- and post-dam periods of the Xingu River. Females of both Geophagus species were captured and biometric measurements were taken. Afterwards, the fish were euthanized, and the gonads were removed and subjected to histological processing for light microscopy, scanning electron microscopy and immunoperoxidase staining. Oocyte diameter and zona radiata thickness were also measured. The ovaries appeared in pairs, where according to their shape, size, vascularization and cell organization, five stages were described for both species. In the post-dam period, there was a reduction in the mean diameter of the oocytes, especially type IV, and a decrease in the thickness of the zona radiata, mainly, in G. argyrostictus. In both species, there was a greater presence of oocyte atresia in the post-dam period. PCNA immunoreactivity was more intense in type I and II oocytes, while vitellogenin immunoreactivity occurred in the cytoplasm and follicular cells of oocytes III and IV. These data suggest that because of changes in the level/flow of the river, the gonads of these two species adjust to the new environment, with a decrease in mean diameter and zona radiata thickness of the oocytes, which can interfere with the reproduction of the animals., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interest for the publication of this study., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Previous studies that assessed risk factors for venous thromboembolism (VTE) in COVID-19 patients have shown inconsistent results. Our aim was to investigate VTE predictors by both logistic regression (LR) and machine learning (ML) approaches, due to their potential complementarity. This cohort study of a large Brazilian COVID-19 Registry included 4120 COVID-19 adult patients from 16 hospitals. Symptomatic VTE was confirmed by objective imaging. LR analysis, tree-based boosting, and bagging were used to investigate the association of variables upon hospital presentation with VTE. Among 4,120 patients (55.5% men, 39.3% critical patients), VTE was confirmed in 6.7%. In multivariate LR analysis, obesity (OR 1.50, 95% CI 1.11-2.02); being an ex-smoker (OR 1.44, 95% CI 1.03-2.01); surgery ≤ 90 days (OR 2.20, 95% CI 1.14-4.23); axillary temperature (OR 1.41, 95% CI 1.22-1.63); D-dimer ≥ 4 times above the upper limit of reference value (OR 2.16, 95% CI 1.26-3.67), lactate (OR 1.10, 95% CI 1.02-1.19), C-reactive protein levels (CRP, OR 1.09, 95% CI 1.01-1.18); and neutrophil count (OR 1.04, 95% CI 1.005-1.075) were independent predictors of VTE. Atrial fibrillation, peripheral oxygen saturation/inspired oxygen fraction (SF) ratio and prophylactic use of anticoagulants were protective. Temperature at admission, SF ratio, neutrophil count, D-dimer, CRP and lactate levels were also identified as predictors by ML methods. By using ML and LR analyses, we showed that D-dimer, axillary temperature, neutrophil count, CRP and lactate levels are risk factors for VTE in COVID-19 patients., (© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

Introduction: Neurological manifestations have been associated with a poorer prognosis in COVID-19. However, data regarding their incidence according to sex and age groups is still lacking., Methods: This retrospective multicentric cohort collected data from 39 Brazilian hospitals from 17 cities, from adult COVID-19 admitted from March 2020 to January 2022. Neurological manifestations presented at hospital admission were assessed according to incidence by sex and age group., Results: From 13,603 COVID-19 patients, median age was 60 years old and 53.0% were men. Women were more likely to present with headaches (22.4% vs. 17.7%, p  < 0.001; OR 1.36, 95% confidence interval [CI] 1.22-1.52) than men and also presented a lower risk of having seizures (OR 0.43, 95% CI 0.20-0.94). Although delirium was more frequent in women (6.6% vs. 5.7%, p  = 0.020), sex was not associated with delirium in the multivariable logistc regresssion analysis. Delirium, syncope and coma increased with age (1.5% [18-39 years] vs. 22.4% [80 years or over], p < 0.001, OR 1.07, 95% CI 1.06-1.07; 0.7% vs. 1.7%, p  = 0.002, OR 1.01, 95% CI 1.00-1.02; 0.2% vs. 1.3% p < 0.001, OR 1.04, 95% CI 1.02-1.06), while, headache (26.5% vs. 7.1%, OR 0.98, 95% CI 0.98-0.99), anosmia (11.4% vs. 3.3%, OR 0.99, 95% CI] 0.98-0.99 and ageusia (13.1% vs. 3.5%, OR 0.99, CI 0.98-0.99) decreased (p < 0.001 for all)., Conclusion: Older COVID-19 patients were more likely to present delirium, syncope and coma, while the incidence of anosmia, ageusia and headaches decreased with age. Women were more likely to present headache, and less likely to present seizures., (© 2022 The Authors.)

Background: Hypostominae is a subfamily of the family Loricariidae that has a great diversity of species. Accordingly, testicular studies in fish can contribute to the phylogeny and taxonomy of species and to the comparison of reproductive aspects between species. Thus, this work aimed to characterize the testicular morphology and spermatogenesis of the Hypostominae species Baryancistrus xanthellus, Peckoltia oligospila and Hypancistrus zebra., Results: B. xanthellus, P. oligospila and H. zebra had an anastomosed tubular type of testis. The germinal epithelium was continuous with unrestricted spermatogonia, and the proliferative, meiotic and spermiogenic phases were defined in all species. In the spermiogenic phase, spermatids were classified as initial, intermediate and final. Only in B. xanthellus in the final phase was there nuclear rotation. The sperm for the three species had a head with an oval shape and a single flagellum composed of the short midpiece, principal piece and end piece. B. xanthellus and P. oligospila showed a cylindrical flagellum and H. zebra showed projections that produced a flattened appearance., Conclusions: On the basis testicular structure and ultrastructural characteristics of the germ cells, there was a greater relationship between B. xanthelus and P. oligospila, while H. zebra had particular characteristics. These aspects show that despite belonging to the same subfamily, the species have distinct biological characteristics., (© 2021. The Author(s).)

Tapajós Region, is an area with intense historical artisanal and small-scale gold mining. Therefore, the core objective of this study was to evaluate the environmental status of different rivers located in this region, using biomarker endpoints in Serrasalmus rhombeus as a tool. Fish and sediment were collected from two rivers, Tropas and Crepori, affluent of Tapajós River, located inside a Federal Protection Area and in a Reference site. Mercury concentration in sediment and fish were traced, and biomarkers in gills and liver were analyzed. Results showed a clear difference between these two rivers compared to the Reference site. Fish tissues presented biomarker responses according to the site of collection. Catalase (CAT) activity was statistically higher in fish gills from Crepori, confirming the capacity of mercury interference with redox equilibrium. High levels of lipid peroxidation were also noted to contribute greatly in incidence of morphological changes in the liver and gills, suggesting that mercury bioaccumulation during continuous exposure promote biological responses in a cumulative manner, from molecules to tissues. This study also indicates adaptation in fish defense mechanisms given the conditions in the Tropas River, as well as a variation in biomarker responses to that of the Crepori river. In summary, Tapajós affluents presented high mercury levels in fish tissues leading to biomarker responses, demonstrating a hazardous signal of a long history of mercury pollution., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Chagas disease (CD) continues to be a major public health burden in Latina America. Information on the interplay between COVID-19 and CD is lacking. Our aim was to assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Consecutive patients with confirmed COVID-19 were included from March to September 2020. Genetic matching for sex, age, hypertension, diabetes mellitus and hospital was performed in a 4:1 ratio. Of the 7018 patients who had confirmed COVID-19, 31 patients with CD and 124 matched controls were included (median age 72 (64-80) years-old, 44.5% were male). At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p < 0.05). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). In-hospital management, outcomes and complications were similar between the groups. In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation., (© 2021. The Author(s).)

Objectives: The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones., Methods: Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March-July, 2020. The model was validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients., Results: Median (25-75th percentile) age of the model-derivation cohort was 60 (48-72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO 2 /FiO 2 ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829-0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833-0.885]) and Spanish (0.894 [95% CI 0.870-0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/)., Conclusions: An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Doxorubicin (DOX) is an anthracycline antibiotic used in the fight against many types of cancer. Although it is quite effective for this purpose, its clinical use is limited by its severe side effects, highlighting the relevance of efforts to identify substances that act to minimize these effects. In this work, we sought to verify the ability of andiroba oil (AO) and a nanoemulsion of andiroba oil (AN) to lessen the side effects of DOX. The animals were separated into 7 groups with 6 animals each: mice treated with AO (2000 mg/kg), AN (2000 mg/kg), the antineoplastic agent DOX (40 mg/kg), AO+DOX, AN+DOX and solvent controls was used of negative control (corn oil and nanoemulsion surfactant). AO and AN were administered for 14 consecutive days orally by gavage and on the 13th day, applied DOX by intraperitoneal route (i.p.), in order to evaluate the protective potential of andiroba. The animals were euthanized on the 15th day. Hematological, biochemical, histological, and immunohistochemical parameters were analyzed. Andiroba reduced several aspects of the severity of lesions caused by DOX, decreasing hematotoxicity and the severity of histological changes in the liver and kidneys, and reducing the frequency of apoptotic cell death. In many cases, AN showed greater efficacy than AO alone, reflecting the feasibility of using this nanotechnology to improve the pharmacokinetics of lipid compounds in the body. The study sheds new light on the therapeutic benefits of andiroba and suggests new ways for investigating how the quantity and quality of lipid compounds affect exposed organisms., (Copyright © 2021 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Studies related to morpho-physiology improve the understanding of biological mechanisms in non-human primates (NHP), contributing to research in several areas, especially those of assisted reproduction and biomedicine. The genera Aotus and Sapajus are important considerations in conducting studies related to reproductive biology and biomedical research, where animals of these genera can serve as models for species with vulnerable conservation status. The reproductive functions of animals of these genera can be used in conducting studies with other NHP species, for which biological material is difficult to access. The aim in conducting the current review was to compile the scientific literature on the biology and reproductive aspects of these two genera, to provide a for a greater understanding of these topics. In addition, a systematic review of literature allows for efficient access relevant information from an extended timeframe collated in a single document. There was, therefore, a systematic search for keywords based on reproductive studies with animals in these genera conducted, and 58 articles, 12 books, and three academic theses were subsequently selected. Even though there have been advances in knowledge of the reproductive biology of animals from these genera that have occurred in recent decades, especially research conducted when these NHP were in captivity, a wide variety of areas remain to be studied so that the understanding of reproduction in these NHP can be enhanced and the knowledge gained from these studies utilized for greater understanding of reproduction of NHP in general., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Respiratory syncytial virus (RSV) is the main cause of lower respiratory disease in infants and children under five years of age. As there is no specific treatment for RSV infections, prophylaxis with the specific monoclonal antibody palivizumab (PVZ) has been widely recommended for high-risk cases during the RSV season. The present study aimed to evaluate the effectiveness of a public prophylaxis program with palivizumab on the incidence of hospitalizations for lower respiratory tract infections and RSV in children at high risk for severe RSV infections. A retrospective cohort study was carried out with preterm children or children under two years of age with chronic lung disease or hemodynamically significant congenital heart disease; the children were selected on the basis of their exposure status, which was defined as the prophylactic use of palivizumab during the RSV season. Children were enrolled retrospectively in two hospitals located in Southern Brazil, from May 2009 to August 2016. In a sample of 129 children, 69 (53.5%) received palivizumab and adherence to three or more doses was observed in 78%; 60 (46.5%) children did not receive palivizumab. PVZ prophylaxis was independently associated with a 66% reduction in hospitalizations for any cause (26/69 - 37.7%) in the PVZ group and 34/60 (56.7%) in the control group). A 52% reduction in hospitalizations due to lower respiratory tract infection was observed in the PVZ group (15/69 -21.7%) and 25/60 (41.7%) in the control group. These findings suggest that, for the group of studied patients, the adoption of an RSV prophylaxis scheme reached the same effectiveness as those described in previous clinical trials.

In recent years, species richness and diversity in aquatic ecosystems has declined as environments are increasingly impacted by anthropic actions. Freshwater prawns are well adapted to survive in a disturbed and heterogeneous environment. For instance, Amazon river prawn ( Macrobrachium amazonicum ) populations vary in migratory behavior between rivers and estuaries, depending on factors such as dams. However, there is limited information on the influence of environmental conditions on life-history traits of this species, which we investigate here using two distinct and unconnected aquatic systems, a dammed river and an estuary, in the eastern Brazilian Amazon. The biological characteristics of M. amazonicum populations in the two environments were compared and related to environmental parameters, which differed significant differences between the two environments and between seasons. Dissolved oxygen, precipitation, and temperature varied most significantly with the seasons in both the estuary and river. M. amazonicum prawns in the estuary were larger and heavier than those in the river during rainy periods. The mass-length ratios and condition factor varied significantly between the M. amazonicum populations in the estuary and river, with negative allometric growth (grows faster in length than in weight) predominating in both populations, and condition factor was better in the estuary for males and in the river for females. The relative frequencies of occurrence of the different female maturation stages and the male morphotypes were related to precipitation and turbidity in both environments and also to salinity in the estuary. In these two distinct aquatic systems, the abiotic parameters determined by the seasonal precipitation cycle profoundly influenced the development of this crustacean, despite its ecological plasticity. Overall, the study showed that river damming triggered environmental changes in the freshwater river ecosystem and played a key role in determining the life-history characteristics of M. amazonicum in these contrasting aquatic systems., Competing Interests: I declare that the authors have no financial/personal interest and that the manuscript is for scientific purposes only., (© 2020 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

The present study was conducted to assess the testicular structure and germ cell ultrastructure of Hypophthalmus marginatus during spermatogenesis. Semen and sections of the mid-region of the testis were collected, processed, and analyzed using optical and electron microscopy. Macroscopically, the testes of H. marginatus were filiform, and the testicular parenchyma was composed of spermatogenic cells that proliferated, organized within spermatic cysts. During spermiogenesis, spermatids had no nuclear rotation. The proximal centriole was perpendicular to the distal centriole, characteristic of type III spermiogenesis. Spermatozoa were released into the lumen of the seminiferous tubules and had an ovoid head without an acrosome, condensed nucleus, and shallow nuclear fossa. The midpiece was short, with a single long flagellum. The flagellum had the typical axoneme structure, with nine pairs of peripheral and a central pair of microtubules. The thin end piece comprised only peripheral microtubules. Spermatogenesis in H. marginatus features filiform testes, cystic spermatogenesis, and type III spermiogenesis., (Copyright © 2019 Elsevier B.V. All rights reserved.)

An eight-year long case series follow-up study with pediatric bone cancer patients was conducted to compare the occurrence of adverse events associated with aprepitant with official sources of drug information (manufacturer's leaflet, clinical trials, and European Medicines Agency leaflet). All patients admitted were analyzed, representing 192 aprepitant cycles. Anorexia, febrile neutropenia, and headache were observed in frequencies over 43.8 per 100 patients, which was higher than previous estimates. Adverse events were classified as probable or possible, by using Naranjo score. The increased rates of adverse events, especially on the risk febrile neutropenia, warrant further safety studies on this population.

Menkes disease is a rare X-linked neurodegenerative disorder caused by defect in copper metabolism. Parenteral copper supplementation has been used as a potential disease-modifying treatment of Menkes disease for decades. However, recent evidence suggests its efficacy only when treatment is started within days after birth, which also has important implications related to the techniques that enable early diagnosis. We aim at proposing a guideline for prenatal and neonatal diagnosis and for disease-modifying treatment of Menkes disease, guided by a systematic review of the literature, and built in conjunction with medical experts, methodologists and patient representatives. Thirteen articles were used for our recommendations that were based on GRADE system. Reviewed evidence suggests that prenatal genetic diagnosis in families with previous diagnosis of Menkes disease is feasible; analysis of plasma catecholamine levels is accurate for neonatal diagnosis of Menkes disease; treatment with copper-histidine is effective to increase survival and reduce neurologic burden of the disease if initiated in the neonatal period; and, treatment indication should not be guided by patient's genotype. In conclusion, our guideline can contribute to standardize some aspects of the clinical care of patients with Menkes disease, especially reducing disease burden and mortality and providers' and families' anxiety., (Copyright © 2018 Elsevier Inc. All rights reserved.)

This study presents the first information on the reproduction of the recently described tiger pleco Panaqolus tankei, from Lake Bolonha in the north-eastern Amazon Basin. This loricariid has a long reproductive period, fractionated spawning and low fecundity (on average, female gonads contained 37 oocytes), a total length (L T ) at first maturity of 47.4 mm for females and 54.1 mm L T for males. Correlation of the condition factor and gonado-somatic index with environmental variables suggests that turbidity favours P. tankei reproduction in this environment., (© 2018 The Fisheries Society of the British Isles.)

Objective: To evaluate the short-term evolution of patients with septic shock refractory to norepinephrine treated with vasopressin in an intensive care unit of a university hospital., Methods: An unmatched retrospective study (case series) was performed. Clinical, laboratory, and anthropometric data were collected from patients who received vasopressin infusion for treatment of catecholamine-refractory shock from December 2014 to June 2016. For the assessment of severity, APACHE II and SOFA scores were used. The main outcome was mortality at 3 and 30 days., Results: A total of 80 patients were included, of which 60% were male. In 86.3% of the cases, APACHE II was observed in the highest ranges (> 20). The 30-day mortality was 86.2%, and 75% of the patients died within 72 hours after starting vasopressin., Conclusion: The series evaluated had high mortality in the first 72 hours of treatment with vasopressin. The use of vasopressin in patients who are refractory to norepinephrine had little or no impact on mortality. It was not possible to exclude the possibility that the high mortality in the present study was linked to the relatively late onset (after established refractoriness of norepinephrine) of vasopressin; this hypothesis should be further evaluated in a randomized study.

This contribution describes the growth of oocytes, addressing the formation of structures that compose the follicular complex, as well as the remodeling of the extracellular matrix, specifically laminin, fibronectin and type IV collagen during gonadal maturation. Thirty-seven females of the Acari zebra fish, Hypancistrus zebra were captured and the ovaries were submitted to histological processing for light and electron microscopy and immunohistochemistry techniques. Oogonia and four stages (I - IV) of oocytes were distinguished, and structures such as the postovulatory follicle and atretic oocytes (initial and advanced atresia) were observed. The follicular complex consists of the mature oocyte, zona radiata (Zr1, Zr2 and Zr3), follicular cells, basement membrane and theca. During oocyte growth, proteins of the extracellular matrix showed different intensities of staining. Based on these observations, a model of oocyte growth is proposed to define specific characteristics of the oocyte and the remodeling of the extracellular matrix in the ovary of H. zebra. This model of oocyte growth can be extended to other species of ornamental fishes. This study contributes data for induced fertilization and eventual conservation of this species.

Objectives: It is not yet established the advantages between amphotericin B lipid complex (ABLC) and liposomal (L-AmB) in patients with invasive fungal infections refractory to usual doses of conventional AmB (d-AmB), previous renal impairment, or unacceptable d-AmB renal toxicity. This systematic review aims to compare ABLC and L-AmB effectiveness and safety outcomes in these subgroups of patients., Methods: The search was performed on Medline, Cochrane Library, EMBASE, and LILACS databases., Inclusion Criteria: treatment comparing L-AmB with ABLC; patients who had (i) refractory infection after being treated with d-AmB, (ii) previous renal impairment, or (iii) unacceptable d-AmB toxicity. Two investigators independently screened the search results, assessed trial quality, and extracted data. A total of 1,054 articles were identified in the literature. Among those, eleven were selected for full-text reading and five met the inclusion criteria., Results: The five articles included reported on four separate observational studies. Overall, no significant difference was found in clinical relevant outcomes as new-onset dialysis, length of hospital stay, or mortality when comparing both lipid formulations. The studies reported a trend toward lower nephrotoxicity in patients treated with L-AmB. However, the results were imprecise and heterogeneous and the studies presented important methodological biases., Conclusions: The studies included in this systematic review pointed toward less nephrotoxicity events in the L-AmB group. However, due to low quality of evidence and no statistically significant differences in other clinical relevant outcomes, there is no definitive evidence of overall superiority in effectiveness or safety outcomes regarding one lipid formulation or another in this population subgroup.

This study evaluated the reproductive characteristics of pike-characids, Boulengerella cuvieri, during the hydrological cycle in the Xingu River, eastern Amazon. The sex ratio was 1:1 and the gonado-somatic index and relative frequency of maturation stages indicate a short breeding season of single phase spawning that coincides with a filling and flood period. Mean standard length at first sexual maturity for female B. cuvieri was estimated to be 22·9 cm., (© 2017 The Fisheries Society of the British Isles.)

Aims: To review the efficacy and safety of aprepitant in combination with ondansetron and dexamethasone (triple therapy) in children and adolescents on moderate to highly emetogenic chemotherapy., Methods: Medline, Embase, Scielo, Lilacs, Cochrane and congress abstracts published until September 2016 were used as data sources. Two reviewers independently selected manuscripts and extracted data. A third reviewer solved discrepancies in study selection and data extraction. The primary outcome was overall complete response (no vomiting from 0 to 120 h). Secondary outcomes were: response in acute phase, delayed phase and reported toxicities. Each study was considered a unit of analysis. Summarized relative risks were recalculated based on reported data. All meta-analyses used a random-effects model and heterogeneity was reported using the I 2 method., Results: From 1004 studies, we screened 288 titles and abstracts and included three trials for data extraction. The population comprised 451 patients. Most patients were males, ranging from 6 months to 19 years of age, and weighing from 6 to 134 kg. Bone cancer was the most incident (≥50%) neoplasm, followed by rhabdomyosarcoma and Hodgkin's lymphoma. Triple therapy was associated with a reduced risk of developing chemotherapy-induced vomiting (CIV) (RR = 0.48; 95% CI 0.34-0.67). There were no differences in incidence of febrile neutropenia between groups (RR = 1.02; 95% CI 0.66-1.58)., Conclusions: Triple therapy decreased CIV risk, without increasing the occurrence of febrile neutropenia. However, this review could not address which subpopulations would most benefit from using this strategy. Future studies should focus on assessing risk factors for nausea and vomiting, as many patients did not achieve a complete antiemetic response., (© 2016 The British Pharmacological Society.)