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Objetivo: Anemia Hemolítica Autoimune (AHAI) é uma doença cujas hemácias são destruídas em decorrência da ligação de autoanticorpos em sua superfície. COVID é uma infecção respiratória viral aguda causada pelo SARS-CoV-2. As imunoglobulinas (Ig), juntamente com citocinas pró e anti-inflamatórias, são responsáveis pela resposta imune ao patógeno. Pacientes com mieloma múltiplo (MM), neoplasia de plasmócitos caracterizada por produção monoclonal de Ig, quando tratados com Daratumumabe frequentemente apresentam citopenias, comprometendo a resposta imune e aumentando a suscetibilidade a infecções. Quando infectados pelo SARS-CoV-2, tendem a desenvolver formas mais graves da doença e têm risco aumentado de complicações. A COVID pode desencadear tempestade de citocinas e uma resposta imune desregulada, envolvendo células T pró-inflamatórias, que estão fortemente associadas à autoimunidade. Outros mecanismos, como mimetismo molecular, ativação de células adjacentes e modificações na membrana das hemácias, podem levar ao surgimento de doenças autoimunes pós-COVID. O objetivo deste trabalho é relatar o caso de paciente com MM em tratamento de 2ªlinha, que desenvolveu AHAI pós-COVID, destacando potenciais associações. Material e métodos: Foram coletados dados do prontuário do paciente e realizada pesquisa sobre “mieloma múltiplo, COVID e anemia hemolítica”no PubMed. Relato do caso: Paciente masculino, 83 anos, portador de MM IgG/Lambda há 15 meses, em 2ªlinha de tratamento com DRd há 7 meses com resposta, inclusive com desaparecimento da proteína monoclonal nos exames complementares, apresentou quadro gripal leve com sorologia positiva para COVID. Após 5 dias do fim dos sintomas, evoluiu com anemia sintomática [hemoglobina (Hb) de 7,2 g/dL] e Coombs direto positivo. Foi tratado com dexametasona, e a Hb subiu para 10 g/dL nos primeiros dias, porém se mantém corticodependente há dois meses. Atualmente, continua com corticoide e os níveis de Hb em torno de 10 g/dL. Discussão: No caso apresentado, o paciente teve quadro leve de COVID, ao contrário do esperado, mas desenvolveu AHAI muito provavelmente pelos mecanismos já citados. O uso do Daratumumbe pode ser fator adicional para o desenvolvimento da AHAI pós-COVID. Embora ainda não haja estudos conclusivos quanto ao possível risco de produção de autoanticorpos e hemólise associados ao Daratumumabe, pode-se hipotetizar que isso ocorra devido ao aumento na contagem absoluta de células T CD4+ e CD8+, assim como das porcentagens de linfócitos no sangue periférico e medula óssea. Além disso, o Daratumumabe induz apoptose in vitro através da ligação cruzada mediada por Fc e modula a atividade enzimática por CD38, inibindo a enzima ciclase e simulando a atividade da hidrolase. Assim, supõe-se que a combinação desses fatores - hemólise, ativação de linfócitos e reação cruzada com Fc resultando em apoptose - pode contribuir para a formação de autoanticorpos. O uso desta medicação emerge como possível fator preditivo para o desenvolvimento de AHAI pós-COVID. Este risco é exacerbado pelos próprios riscos que a infecção já apresenta no desenvolvimento de autoanticorpos. Conclusão: O caso ressalta a complexa interação entre MM, tratamento com Daratumumabe e infecção por COVID, culminando no desenvolvimento de AHAI, destacando a necessidade de um acompanhamento clínico rigoroso e de estudos adicionais para compreender melhor tais associações, orientando estratégias terapêuticas mais seguras para esses pacientes.

Objetivo: Fator V de Leiden (FVL) é o mais relevante indicador de risco genético de trombose. Trata-se de uma mutação que interfere diretamente na atuação da proteína C (PC) na sua forma ativada, um dos reguladores do sistema de coagulação, que atua na inativação proteolítica dos fatores Va e VIIIa. Esta alteração é decorrente da troca da arginina 506 do fator V por uma glutamina. Assim, há indução à resistência da PC ativada, em que a clivagem e inativação do fator Va é feita de forma insatisfatória, logo levando ao acúmulo e consequentemente aumentando o risco de trombose. O objetivo deste trabalho é relatar o caso de duas irmãs com a referida mutação, em heterozigose, que sofreram eventos trombóticos. Material e métodos: Foram coletados dados do prontuário das pacientes e realizada pesquisa sobre “fator V de Leiden e carga genética em heterozigotos”no PubMed e Scielo. Relato do caso: Paciente nº1, feminino, atualmente com 46 anos; aos 34 anos, teve trombose venosa profunda no membro inferior direito. Nega comorbidades, uso de medicações, de drogas ilícitas, de anticoncepcional e tabagismo. Foi então investigada quanto a trombofilias primárias e identificada mutação do FVL em heterozigose. Nesses 12 anos de acompanhamento, esse foi seu único evento tromboembólico. A paciente fez uso de Varfarina por 6 meses e após esse período usa apenas aspirina profilática, sem intercorrências. Paciente nº2, feminino, irmã caçula da paciente nº1, atualmente com 38 anos. Há 3 meses sofreu acidente vascular encefálico (AVE), evoluindo com hemiparesia completa à direita como sequela. Refere ser hipertensa leve controlada com losartana há 2 anos. Nega outras comorbidades, uso de outras medicações, de drogas ilícitas, de anticoncepcional e tabagismo. Após tal evento também foi investigada quanto a trombofilia primária, sendo detectada a mesma mutação que a irmã. Após AVE, está em uso também de aspirina, e atorvastatina. Discussão: A prevalência da mutação do FVL na população brasileira é de cerca de 2%. Sabe-se que esta mutação aumenta de 3 a 10 vezes a chance de eventos trombóticos, especialmente em homozigotos. Ademais, em um estudo realizado em Minas Gerais, a frequência da mutação do FVL foi observada em heterozigose em 7,52% dos indivíduos e em 0,36% em homozigose. Nos casos descritos neste trabalho, há duas irmãs com a mutação do FVL, em heterozigose, o que corrobora com os dados da literatura brasileira, porém uma não tem outros fatores de risco trombótico e a outra é hipertensa leve controlada. Entende-se que a irmã que é hipertensa, mesmo que leve e controlada, possui risco trombótico superior ao da irmã que possui apenas a mutação. A hipertensão arterial propicia o surgimento de aterosclerose e esta pode ser uma explicação para o fato de a irmã caçula ter desenvolvido um evento arterial e com sequela. Ambas as pacientes, mesmo em heterozigose, evoluíram com eventos antes dos 40 anos de idade, favorecendo o conceito de que esta mutação aumenta o risco trombótico independente do número de alelos comprometidos. Na heterozigose desta mutação, o risco não é desprovido de relevância clínica. Conclusão: Os casos ressaltam a significância da mutação do FVL como fator de risco para eventos tromboembólicos, mesmo em casos de heterozigose. Esse risco é ainda maior quando observadas outras causas, destacando a necessidade de mais estudos para confirmar essas associações e oferecer um acompanhamento mais assertivo para os pacientes, prevenindo agravos.

During the excavations of the XIX century Meadowlark cemetery (Manhattan, Kansas, US), samples of sediments were taken from around five skeletons, and analyzed to detect intestinal parasites. No helminth eggs were found, but immunological ELISA tests for Entamoeba histolytica were positive in three samples. The immunological techniques have been successfully used in paleoparasitology to detect protozoan infections. Amoebiasis could have been a severe disease in the past, especially where poor sanitary conditions prevailed, and there is evidence that this cemetery may have been used in a situation where poor sanitary conditions may have prevailed. The presence of this protozoan in US during the late XIX century gives information on the health of the population and provides additional data on the parasite's evolution since its appearance in the New World.

In this study, nine organic sediment samples from a medieval archaeological site at Pineuilh, France, were examined for Giardia intestinalis using two commercially available immunological kits [enzyme-linked immuno sorbent and immunofluorescence (IFA) assays]. Both techniques detected G. intestinalis in one sample, dated to 1,000 Anno Domini. This is the first time IFA was successfully used to detect protozoa in Old World archaeological samples. Such immunological techniques offer important perspectives concerning ancient protozoa detection and identification.

Discriminant analysis was used to identify eggs of Capillaria spp. at specific level found in organic remains from an archaeological site in Patagonia, Argentina, dated of 6,540 ± 110 years before present. In order to distinguish eggshell morphology 149 eggs were measured and grouped into four arbitrary subsets. The analysis used on egg width and length discriminated them into different morphotypes (Wilks' lambda = 0.381, p < 0.05). The correlation analysis suggests that width was the most important variable to discriminate among the Capillaria spp. egg morphotypes (Pearson coefficient = 0.950, p < 0.05). The study of eggshell patterns, the relative frequency in the sample, and the morphometric data allowed us to correlate the four morphotypes with Capillaria species.

Background: The sense of coherence (SOC) is important for the well-being, especially mothers of children and adolescents with cerebral palsy (CP)., Objective: This study aimed to investigate the relationship between Mother's SOC and oral health status in children/adolescents with and without CP., Materials and Method: A paired cross-sectional study was conducted with 102 children/adolescents with CP, 102 without CP, and their respective mothers. Participants were aged between 3 and 17 years, matched by sex and age. Antonovsky's SOC questionnaire (SOC-13) was answered by mothers from both groups, characteristics and the oral status of the children were investigated. Clinical type of CP, Gross Motor Function (GMFCS), oral hygiene quality (OHI-S), and dental caries experience (DMFT/dmft) were evaluated., Results: The CP condition of the children was significantly associated with Mother's SOC (P < 0.001). Mothers of children with CP had lower SOC scores (mean: 27.6 [±3.0]) than mothers of children without CP (mean: 30.2 [±7.7]). In the CP group, level IV, V of Gross Motor function was associated with lower mother's SOC scores (p = 0.001). In both groups, dental caries experience was associated with lower mother's SOC scores, CP group (p < 0.001), without CP group (p = 0.002). Regarding the individual characteristics, CP group presented with lower-quality of oral hygiene (p < 0.001) and high prevalence of dental caries (p = 0.001). Regarding marital status, mothers of CP group were majority single, separated, or divorced (p < 0.001), and presented more difficulties in finding a dentist for their child (p < 0.001)., Conclusion: Mother's SOC was statistically significantly associated with the presence of dental caries in children/adolescents with and without CP. Mothers of children/adolescents with CP presented with lower values of SOC., (© 2025 Special Care Dentistry Association and Wiley Periodicals LLC.)

Aim: The angiotensin-converting enzyme 2 (ACE2) and its homolog, the angiotensin converting enzyme 1 (ACE), are involved in COVID-19 physiopathology. Alterations in the enzymatic structure, expression, and/or activity may influence the risk of infection and severity of disease. For this reason, we aimed to identify different allelic forms of ACE2 G8790A and ACE I/D polymorphisms in a Brazilian cohort and evaluate their impact on ACE and ACE2 activities and their association with COVID-19 susceptibility and severity., Main Methods: A total of 549 COVID-19-negative and 270 COVID-19-positive participants from Ipaussu, Sao Paulo, Brazil, were recruited. ACE2 and ACE activities were measured by fluorogenic assays using MCA-Ala-Pro-Lys(Dnp) as the substrate for ACE2 and Z-Phe-His-Leu-OH (Z-FHL) and Hippuryl-His-Leu-OH (h-HL) as substrates for ACE. Genomic DNA was extracted from EDTA-peripheral blood, and the regions of the genes containing ACE2 G8790A and ACE I/D polymorphisms were amplified by PCR-restriction fragment length polymorphism and real-time PCR, respectively., Key Findings: The G allele of ACE2 G8790A polymorphism and D allele of ACE I/D polymorphism are associated with increased ACE and ACE2 activities. ACE activity ratio (Z-FHL/h-HL), an inflammatory marker, is increased in women with GG genotype and COVID-19-positive diagnosis., Significance: For the first time, it was demonstrated that in females, the GG genotype is associated with increased ACE activity ratio (Z-FHL/h-HL) in the COVID-19-positive group. Elevated ACE activity ratio (Z-FHL/h-HL) is highly linked to inflammation and may justify the associations between the G genotype and COVID-19 severity of symptoms and outcomes., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study aimed to evaluate the prevalence of thyroid, glycemic, lipid and metabolic bone disorders among adult patients with pulmonary arterial hypertension (PAH)., Methods: This was an observational cross-sectional clinical study with patients with PAH, matched by sex and age with a control group without PAH. All individuals were enrolled into a clinical assessment, metabolic workup, thyroid ultrasound, and bone densitometry protocol., Results: The PAH group included 35 participants (34 females, 46 ± 15.5 years), and the control group, 40 (39 females, 41.8 ± 13.1 years). There was no difference in body mass index (BMI) between PAH and control group (27.5 ± 5.9 and 26.9 ± 4.3 kg/m 2 , respectively, p = 0.63; 95 % CI: -1.8, 2.94), neither in physical activity time per week (60.3 ± 103.3 and 98.9 ± 137.6, respectively, p = 0.17; 95 % CI: -95.23, 18.06). Although there was no difference in the prevalence of insulin resistance between the PAH (51.4 %) and the control group (47.5 %), p = 0.74, patients with PAH had a higher median of glycated hemoglobin (A1c) than the control group (6.1 % and 5.57 %, respectively, p = 0.006; 95 % CI: -0.14, 1.22). PAH group presented lower mean total cholesterol (170.46 ± 35.51 mg/dL) and median LDL-cholesterol [105 (83-129) mg/dL, median (P25-P75)] levels than the control group [192.1 ± 34.44 mg/dL, p = 0.009; 95 % CI = -37.76, 5.52 and 121.6 (97-145) mg/dL, p = 0.012; 95 % CI: -34.08, 0.77, respectively]. It was found a higher prevalence of hypothyroidism (22.9 %) in PAH group than in control group (2.5 %), p = 0.007. We found hyperparathyroidism (HPT) among 8 patients of PAH group (23 %), but none in the control group. Considering bone mineral density disorders, 12 patients from PAH group presented low bone mass, osteopenia, or osteoporosis (34 %), and 8 individuals in the control group (20 %), p = 0.032, which represented a 2.13 higher relative risk for those conditions for the former group. The patients with HPT presented a higher creatinine level (0.98 ± 0.12 mg/dL) than the PAH patients with normal parathyroid hormone (0.76 ± 0.14 mg/dL), p = 0.0004; 95 % CI: 0.12, 0.33. The PAH group also presented lower total hip (-0.15 ± 1.25) and femoral neck (-0.14 ± 1.07) bone mineral density (BMD) Z-scores than the control group (0.50 ± 1.13, p = 0.021; 95 % CI: -0.18, -0.027 and 0.35 ± 0.94, p = 0.038; 95 % CI: -0.16, -0.01, respectively)., Conclusion: In this cohort, the findings of higher A1c levels, hypothyroidism prevalence, lower LDL and total cholesterol levels, and a higher prevalence of hyperparathyroidism, as well as lower total hip and femoral neck BMD Z-scores in the PAH group, compared to the control group and highlighting the dysregulation of various metabolic pathways in patients with HAP, suggesting the need for targeted interventions to enhance patient care. Additionally, they underscore the importance of gaining a deeper understanding of the mechanisms driving these changes and their potential pathophysiological connections to the disease., 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 article., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: Knowledge on mental health consultations in immigration detention and characteristics of people receiving consultations is scarce. Based on a sample of 230 adult men in immigration detention in Switzerland, we aimed to: (1) Quantify the proportion of persons receiving mental health consultations during detention; and (2) Identify socio-demographic and clinical characteristics associated with mental health consultations. Methods: Retrospective observational study with a cross-sectional design. Prevalence estimates, logistic regressions, and contingency tables were used to analyse the data. Results: A total of 30% of the sample received mental health consultations during detention. Time spent in immigration detention, mental health problems during detention, use of psychotropic medication, and self-harm were associated with mental health consultations. Although mental health consultations are provided to people with more severe mental health problems, 41% of persons with assessed mental health needs during the initial screening and 26% of those who self-harmed during detention did not receive mental health consultations. Conclusion: Mental health resources and screening procedures could be improved to ensure that mental health consultations are matched to clinical need in immigration detention settings., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Gonçalves, Heller, Bachmann, Barbolini, Fuhrer, Gétaz, Luke, Wolff and Baggio.)

Cosmetic residues have been found in water resources, especially trace elements of precursors, couplers, and pigments of hair dyes, which are indiscriminately disposed of in the sewage system. These contaminants are persistent, bioactive, and bioaccumulative, and may pose risks to living beings. Thus, the present study assessed the ecotoxicity of two types of effluents generated in beauty salons after the hair dyeing process. The toxicity of effluent derived from capillary washing with water, shampoo, and conditioner (complete effluent-CE) and effluent not associated with these products (dye effluent-DE) was evaluated by tests carried out with the aquatic organisms Artemia salina , Daphnia similis , and Danio rerio . The bioindicators were exposed to pure samples and different dilutions of both effluents. The results showed toxicity in D. similis (CE 50 of 3.43% and 0.54% for CE and DE, respectively); A. salina (LC 50 8.327% and 3.874% for CE and DE, respectively); and D. rerio (LC 50 of 4.25-4.59% and 7.33-8.18% for CE and DE, respectively). Given these results, we can infer that hair dyes, even at low concentrations, have a high toxic potential for aquatic biota, as they induced deleterious effects in all tested bioindicators.

Background: Complications of leprosy neuritis are considered serious and apparent, with the potential to disable and/or limit individuals. These complications affect not only a patient's physical functioning, but also their family and social lives, while directly impacting the ability to work and/or maintain financial independence, subsequently interfering with their overall quality of life. The present review, therefore, aimed to analyze the effectiveness of neurolysis as an alternative treatment for the complications associated with leprosy neuritis., Methods: The present review was performed based on the Joanna Briggs Institute methodology, in an effort to answer the following research question: what is the effectiveness of neurolysis as a treatment for leprosy neuritis complications? This research question was defined using the patient-intervention-outcome (PIO) framework, where leprosy represents 'P', neurolysis for 'I', and neuropathic pain/motor function/sensorial function/physical disability/quality of life for 'O'. Randomized and non-randomized clinical trials and prospective observational cohort studies were included in the present review, with no time or date restrictions., Results: The present review included 1 randomized clinical trial and 10 prospective studies, published between 1976 and 2020. All of the outcomes showed improvement, with relief from neuropathic pain being the primary finding., Conclusions: The evidence obtained in the present review suggested that neurolysis is an effective alternative for the treatment of physical disabilities, the recovery of sensory and motor function, the restoration of quality of life, and neuropathic pain relief.

The burden of mental health problems in detained persons is high. At the same time, mental health problems are discussed as possible predictors of criminal recidivism. During detention, mental health tends to improve. The aims of the study were twofold: First, to identify group-based trajectories of mental health problems over the course of detention; second, to test the association between trajectories and criminal recidivism. A prospective cohort of 1,904 adult males detained in Dutch pre-trial detention facilities was assessed at three time points after imprisonment (week 3, month 3, and month 9). Mental health problems were measured using the Brief Symptom Inventory. Recidivism was defined as reconviction and re-incarceration up to 18 months post-release. We used group-based trajectory modeling and logistic regressions for the analyses. On average, self-reported mental health improved during incarceration. Two distinct groups of mental health trajectories were identified: The majority (81%) reported relatively low levels of mental health problems, remaining stable over time. A small group (19%) reported high distress after prison entry with improvements over time. Older age, pre-existing functional impairment due to alcohol or drug use, diagnosis of psychiatric disorders, debts, use of psychiatric care during detention, and a more severe experience of detention were associated with membership in the second group. Group membership did not predict reoffending. The study confirms prior findings illustrating a generally positive change in mental health symptoms during detention. The course of mental health was associated with pre-existing socio-demographic and psychological characteristics that seem worthy to be considered in correctional treatment plans. Changes in mental health did not result in better legal outcomes. An interesting avenue for future research would be to examine changes in specific mental health symptoms or disorders in relation to recidivism risk., 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 © 2022 Weber, Baggio, Gonçalves, Nieuwbeerta and Dirkzwager.)

A new technique of guided implant surgery is presented. A conventional complete denture is converted into both tomographic and surgical guides and later into an interim implant-supported fixed prosthesis. A plate derived from a computed tomography scan becomes the physical link between the virtual planning and tube positioning device. Furthermore, the interim placement of mini-implants adjacent to the symphysis region stabilizes the guide throughout the guided surgery. This technique reduces treatment time and costs., (Copyright © 2021 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

The spleen plays a central role in human and canine visceral leishmaniasis, where the activation of the immune response occurs in one of the tissues where Leishmania infantum reproduces. Therefore, this organ is both a target to understand the mechanisms involved in the parasite control and a parameter for assessing the therapeutic response. In this sense, this study aimed to evaluate the main histological, immunological and parasitological aspects in the spleen of symptomatic dogs naturally infected by L. infantum treated with the therapeutic vaccine LBMPL. For this, dogs were divided into four groups: dogs uninfected and untreated (NI group); L. infantum -infected dogs that were not treated (INT group); L. infantum -infected dogs that received treatment only with monophosphoryl lipid A adjuvant (MPL group); and L. infantum -infected dogs that received treatment with the vaccine composed by L. braziliensis promastigote proteins associated with MPL adjuvant (LBMPL group). Ninety days after the therapeutics protocol, the dogs were euthanized and the spleen was collected for the proposed evaluations. Our results demonstrated a reduction of hyperplasia of red pulp and follicular area of white pulp, increased mRNA expression of IFN-γ, TNF-α, IL-12 and iNOS, and decreased IL-10 and TGF-β1, and intense reduction of splenic parasitism in dogs treated with the LBMPL vaccine. These results possibly suggest that the pro-inflammatory environment promoted the progressive organization of the splenic architecture favoring the cellular activation, with consequent parasite control. Along with previously obtained data, our results propose the LBMPL vaccine as a possible treatment strategy for canine visceral leishmaniasis (CVL).

The prevalence of patients hospitalized in ICUs with COVID-19 and co-infected by pathogenic bacteria is relevant in this study, considering the integrality of treatment. This systematic review assesses the prevalence of co-infection in patients admitted to ICUs with SARS-CoV-2 infection, using the PRISMA guidelines. We examined the results of the PubMed, Embase, and SciELO databases, searching for published English literature from December 2019 to December 2021. A total of 542 rec ords were identified, but only 38 were eligible and, and of these only 10 were included. The tabulated studies represented a sample group of 1394 co-infected patients. In total, 35%/138 of the patients were co-infected with Enterobacter spp., 27% (17/63) were co-infected with methicillin-sensitive Staphylococ cus aureus , 21% (84/404) were co-infected with Klebsiella spp., 16% (47/678) of patients were co-infected with coagulase-negative Staphylococcus , 13% (10/80) co-infected with Escherichia coli (ESBL), and 3% (30/1030) of patients were co-infected with Pseudomonas aeruginosa . The most common co-infections were related to blood flow; although in the urinary and respiratory tracts of patients Streptococcus pneumoniae was found in 57% (12/21) of patients, coagulase negative Staphylococcus in 44% (7/16) of patients, and Escherichia coli was found in 37% (11/29) of patients. The present research demonstrated that co-infections caused by bacteria in patients with COVID-19 are a concern.

Objective: The clinical cases of patients with multisystem inflammatory syndrome (MIS-C) were analyzed via a systematic review and meta-analysis of the clinical findings, treatments, and possible outcomes of articles retrieved via database searches., Sources: The authors searched the PubMed, Scielo, Web of Science, Science Direct, EMBASA, EBSCO, and Scopus databases for articles containing the keywords "multisystem inflammatory syndrome in children" or "MIS-C" or "PIMS-TS" or "SIMP" and "COVID-19" or "SARS-CoV-2" published between December 1st, 2019 and July 10th, 2021. Patient characteristics, tissue and organ comorbidities, the incidence of symptoms after COVID-19 infection, treatment, and patient evolution in the articles found were evaluated. The data were abstracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Newcastle-Ottawa Scale (NOS)., Findings: In total, 98 articles (2275 patients) were selected for demographics, clinical treatment, and outcomes of patients diagnosed with MIS-C. The average age of children with MIS-C, 56.8% of whom were male, was of nine years. Fever (100%), gastrointestinal (GI) (82%), and abdominal pain (68%) were the decisive symptoms for the diagnosis of MIS-C. Shock and/or hypotension were common in patients with MIS-C. Cardiac symptoms (66%) predominated over respiratory (39%) and neurological (28%) symptoms. MIS-C treatment followed the common guidelines for treating children with septic shock and Kawasaki disease (KD) and proved to be effective., Conclusions: This meta-analysis highlights the main clinical symptoms used for the diagnosis of MIS-C, the differences between MIS-C and KD, and the severity of the inflammatory process and urgency for hospital care., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2021 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Carbapenem-resistant Klebsiella pneumoniae has become a public health problem with therapeutic limitations and high mortality associated with comorbidities. Methods: This is a systematic review and meta-analysis with a search in PubMed, SciELO, and Lilacs. Ten articles were selected, considering cohort, case-control, and cross-sectional studies. Tests for proportions and relative risk of mortality were performed, considering a 5% threshold for significance. Statistical analyses were performe dusing Rstudio® software, version 4.0.2 of Ross Ihaka and Robert Genleman in Auckland, New Zealand. Results: Klebsiella pneumoniae, associated with chronic kidney disease, was responsible for 26%/258 deaths, chronic lung disease 28%/169, diabetes 31%/185, liver disease 15%/262, and heart disease 51%/262 deaths. Carbapenem-resistant Klebsiella pneumoniae associated with chronic kidney disease was responsible for 49%/83 deaths, with diabetes 29%/73, and with liver disease 33%/73 deaths. The risk of death from carbapenem-resistant Klebsiella pneumoniae was twice as high as the number of deaths associated with carbapenem-sensitive Klebsiella pneumoniae, RR = 2.07 (p < 0.00001). Conclusions: The present study showed an increase in mortality from carbapenem-resistant Klebsiella pneumoniae when associated with comorbidities.

Bovine anaplasmosis causes considerable economic losses in dairy cattle production systems worldwide, ranging from $300 million to $900 million annually. It is commonly detected through rectal temperature, blood smear microscopy, and packed cell volume (PCV). Such methodologies are laborious, costly, and difficult to systematically implement in large-scale operations. The objectives of this study were to evaluate (1) rumination and activity data collected by Hr-Tag sensors (SCR Engineers Ltd.) in heifer calves exposed to anaplasmosis; and (2) the predictive ability of recurrent neural networks in early identification of anaplasmosis. Additionally, we aimed to investigate the effect of time series length before disease diagnosis (5, 7, 10, or 12 consecutive days) on the predictive performance of recurrent neural networks, and how early anaplasmosis disease can be detected in dairy calves (5, 3, and 1 d in advance). Twenty-three heifer calves aged 119 ± 15 (mean ± SD) d and weighing 148 ± 20 kg of body weight were challenged with 2 × 10 7 erythrocytes infected with UFMG1 strain (GenBank no. EU676176) isolated from Anaplasma marginale. After inoculation, animals were monitored daily by assessing PCV. The lowest PCV value (14 ± 1.8%) and the finding of rickettsia on blood smears were used as a criterion to classify an animal as sick (d 0). Rumination and activity data were collected continuously and automatically at 2-h intervals, using SCR Heatime Hr-Tag collars. Two time series were built including last sequence of -5, -7, -10, or -12 d preceding d 0 or a sequence of 5, 7, 10, or 12 d randomly selected in a window from -50 to -15 d before d 0 to ensure a sequence of days in which PCV was considered normal (32 ± 2.4%). Long short-term memory was used as a predictive approach, and a leave-one-animal-out cross-validation (LOAOCV) was used to assess prediction quality. Anaplasmosis disease reduced 34 and 11% of rumination and activity, respectively. The accuracy, sensitivity, and specificity of long short-term memory in detecting anaplasmosis ranged from 87 to 98%, 83 to 100%, and 83 to 100%, respectively, using rumination data. For activity data, the accuracy, sensitivity, and specificity varied from 70 to 98%, 61 to 100%, and 74 to 100%, respectively. Predictive performance did not improve when combining rumination and activity. The use of longer time-series did not improve the performance of models to predict anaplasmosis. The accuracy and sensitivity in predicting anaplasmosis up to 3 d before clinical diagnosis (d 0) were greater than 80%, confirming the possibility for early identification of anaplasmosis disease. These findings indicate the great potential of wearable sensors in early identification of anaplasmosis diseases. This could positively affect the profitability of dairy farmers and animal welfare., (The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Background/objectives: Implantable cardioverter defibrillators are used to prevent sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator was newly developed to overcome the limitations of the conventional implantable cardioverter defibrillator-transvenous device. The subcutaneous implantable cardioverter defibrillator is indicated for young patients with heart disease, congenital heart defects, and poor venous access, who have an indication for implantable cardioverter defibrillator without the need for anti-bradycardic stimulation. We aimed to compare the efficacy and complications of subcutaneous with transvenous implantable cardioverter- defibrillator devices., Methodology: A systematic review was conducted using different databases. The inclusion criteria were observational and clinical randomized trials with no language limits and no publication date limit that compared subcutaneous with transvenous implantable cardioverter-defibrillators. The selected patients were aged > 18 years with complex ventricular arrhythmia., Results: Five studies involving 2111 patients who underwent implantable cardioverter defibrillator implantation were included. The most frequent complication in the subcutaneous device group was infection, followed by hematoma formation and electrode migration. For the transvenous device, the most frequent complications were electrode migration and infection. Regarding efficacy, the total rates of appropriate shocks were 9.04% and 20.47% in the subcutaneous and transvenous device groups, respectively, whereas inappropriate shocks to the subcutaneous and transvenous device groups were 11,3% and 10,7%, respectively., Conclusion: When compared to the transvenous device, the subcutaneous device had lower complication rates owing to lead migration and less inappropriate shocks due to supraventricular tachycardia; nevertheless, infection rates and improper shocks due to T wave oversensing were comparable for both devices CRD42021251569., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

This study evaluated the effects of different moist orange pulp (MOP) inclusions in corn grain rehydration for silage production as a strategy to store and use MOP and whether these inclusions result in adequate fermentation and aerobic stability (AE) and acceptable losses. Ground corn grain and MOP were weighed separately and mixed to obtain MOP inclusions of 21%, 34%, or 42%. The control treatment was obtained with corn rehydrated with distilled water and MOP inclusion of 0%, with five laboratory silos (15-L buckets) per treatment. Acid detergent fiber, acid detergent insoluble protein, acid detergent lignin, lactic acid, acetic acid, and ethanol contents increased linearly with increasing MOP inclusion, whereas starch, in vitro dry matter (DM) digestibility and butyric acid contents and pH decreased linearly. NH 3 -N/TN content reduced quadratically and was minimal with 8.34 g/kg DM at 14% MOP inclusion. Total DM losses increased quadratically with maximal losses of 4.26% DM at 25% MOP inclusion. AE reduced by 2.8 h for each 1% increase in MOP inclusion. Rehydration of corn grain with MOP results in an adequate fermentation process. The inclusion of 34% MOP was the best because DM losses were lower and AE was not drastically reduced., (© 2022 Japanese Society of Animal Science.)

Coronavirus disease 2019 (COVID-19) was first reported in late December 2019 in Wuhan, China. The etiological agent of this disease is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the high transmissibility of the virus led to its rapid global spread and a major pandemic (ongoing at the time of writing this review). The clinical manifestations of COVID-19 can vary widely from non-evident or minor symptoms to severe acute respiratory syndrome and multi-organ damage, causing death. Acute kidney injury (AKI) has been recognized as a common complication of COVID-19 and in many cases, kidney replacement therapy (KRT) is required. The presence of kidney abnormalities on hospital admission and the development of AKI are related to a more severe presentation of COVID-19 with higher mortality rate. The high transmissibility and the broad spectrum of clinical manifestations of COVID-19 are in part due to the high affinity of SARS-CoV-2 for its receptor, angiotensin (Ang)-converting enzyme 2 (ACE2), which is widely expressed in human organs and is especially abundant in the kidneys. A debate on the role of ACE2 in the infectivity and pathogenesis of COVID-19 has emerged: Does the high expression of ACE2 promotes higher infectivity and more severe clinical manifestations or does the interaction of SARS-CoV-2 with ACE2 reduce the bioavailability of the enzyme, depleting its biological activity, which is closely related to two important physiological systems, the renin-angiotensin system (RAS) and the kallikrein-kinin system (KKS), thereby further contributing to pathogenesis. In this review, we discuss the dual role of ACE2 in the infectivity and pathogenesis of COVID-19, highlighting the effects of COVID-19-induced ACE2 depletion in the renal physiology and how it may lead to kidney injury. The ACE2 downstream regulation of KKS, that usually receives less attention, is discussed. Also, a detailed discussion on how the triad of symptoms (respiratory, inflammatory, and coagulation symptoms) of COVID-19 can indirectly promote renal injury is primary aborded., (Copyright © 2021 Azinheira Nobrega Cruz, Gonçalves de Oliveira, Tedesco Silva Junior, Osmar Medina Pestana and Casarini.)

Background: Cardiac resynchronization therapy is an important validated technique for patients with dyssynchrony and heart failure. However, the response rate to conventional resynchronization is approximately 50%; therefore, new techniques and schedules have emerged. This study aimed to evaluate the different clinical and echocardiographic variables of conventional versus multipoint cardiac resynchronization therapy., Research Design and Method: A systematic review was conducted of randomized clinical trials in the PubMed, Cochrane, and Embase databases on cardiac resynchronization intervention with multipoint stimulation clinical and echocardiographic outcomes evaluated before and 3 months after the intervention., Results: Three studies (N = 139) were ultimately selected, and 100% of patients had a New York Heart Association functional class of II-IV, QRS > 120 ms, and a left ventricular ejection fraction < 35%. Significantly greater improvement was observed in the functional class of patients who underwent multipoint versus conventional therapy. The final systolic volume and ejection fraction improved in the multipoint group, but the difference was not statistically significant., Conclusions: The literature lacks sufficient randomized controlled studies to enable conclusions regarding cardiac resynchronization therapy responses using different strategies. Moreover, the improvement in functional class in the multipoint pacing group involved few patients and had slight statistical relevance.

Aims of the Study: Although many studies have investigated the influence of personal characteristics on recidivism, knowledge about the impact of correctional policies remains limited. The present study adds to this debate by investigating the effect of the dualistic system of custodial sanctions in Switzerland over time. Specifically, we: (1) tested the influence that different types of custodial sanctions &ndash; sentences (offering regular prison treatment) and measures (offering crime-related rehabilitation programmes) &ndash; have on reconviction rates; and (2) forecasted future reconviction rates to estimate their value in the year 2020., Methods: National level data from the Swiss Federal Statistical Office were collected, including 3-year reconviction rates after release from custody and the number of persons serving custodial sentences and measures. A time series framework was used for the analyses, which included data available from 1988 to 2013 (n = 26 years)., Results: The number of persons serving custodial sentences had no effect on recidivism (p = 0.582); however, a higher number of persons serving custodial measures was significantly associated with a decrease in recidivism (p = 0.003). For the year 2020, a reconviction rate of 28% (range 23&ndash;33%) was predicted., Conclusions: Custodial measures seem to be associated with a reduction in recidivism. However, owing to the indeterminate time associated with some custodial measures, often at the cost of the prisoners&rsquo; rights and the criminal justice system, future studies are needed to determine the optimal serving time for custodial measures.

Objectives: To develop and validate a screening tool designed to identify detained people at increased risk for COVID-19 mortality, the COVID-19 Inmate Risk Appraisal (CIRA)., Design: Cross-sectional study with a representative sample (development) and a case-control sample (validation)., Setting: The two largest Swiss prisons., Participants: (1) Development sample: all male persons detained in Pöschwies, Zurich (n = 365); (2) Validation sample: case-control sample of male persons detained in Champ-Dollon, Geneva (n = 192, matching 1:3 for participants at risk for severe course of COVID-19 and participants without risk factors)., Main Outcome Measures: The CIRA combined seven risk factors identified by the World Health Organization and the Swiss Federal Office of Public Health as predictive of severe COVID-19 to derive an absolute risk increase in mortality rate: Age ≥60 years, cardiovascular disease, diabetes, hypertension, chronic respiratory disease, immunodeficiency and cancer., Results: Based on the development sample, we proposed a three-level classification: average (<3.7), elevated (3.7-5.7) and high (>5.7) risk. In the validation sample, the CIRA identified all individuals identified as vulnerable by national recommendations (having at least one risk factor). The category “elevated risk” maximised sensitivity (1) and specificity (0.97). The CIRA had even higher capacity in discriminating individuals vulnerable according to clinical evaluation (a four-level risk categorisation based on a consensus of medical staff). The category “elevated risk” maximised sensitivity and specificity (both 1). When considering the individuals classified as extremely high risk by medical staff, the category “high risk” had a high discriminatory capacity (sensitivity =0.89, specificity =0.97)., Conclusions: The CIRA scores have a high discriminative ability and will be important in custodial settings to support decisions and prioritise actions using a standardised valid assessment method. However, as knowledge on risk factors for COVID-19 mortality is still limited, the CIRA may be considered preliminary. Underlying data will be updated regularly on the website (http://www.prison-research.com), where the CIRA algorithm is freely available.

The purpose of this study was to determine the energy partition of pregnant F1 Holstein x Gyr with average initial body weight (BW) of 515.6 kg and Gyr cows with average initial BW of 435.1 kg at 180, 210 and 240 days of gestation, obtained using respirometry. Twelve animals in two groups (six per genetic group) received a restricted diet equivalent to 1.3 times the net energy for maintenance (NEm). The proportion of gross energy intake (GEI) lost as feces did not differ between the evaluated breeds and corresponded to 28.65% on average. The daily methane production (L/d) was greater for (P<0.05) F1 HxG compared to Gyr animals. However, when expressed as L/kg dry matter (DM) or as percentage of GEI there were no differences between the groups (P>0.05). The daily loss of energy as urine (mean of 1.42 Mcal/d) did not differ (P>0.05) between groups and ranged from 3.87 to 5.35% of the GEI. The metabolizable energy intake (MEI) of F1 HxG animals was greater (P < 0.05) at all gestational stages compared to Gyr cows when expressed in Mcal/d. However, when expressed in kcal/kg of metabolic BW (BW0,75), the F1 HxG cows had MEI 11% greater (P<0.05) at 240 days of gestation and averaged 194.39 kcal/kg of BW0,75. Gyr cows showed no change in MEI over time (P>0.05), with a mean of 146.66 kcal/kg BW0. 75. The ME used by the conceptus was calculated by deducting the metabolizable energy for maintenance (MEm) from the MEI, which was obtained in a previous study using the same cows prior to becoming pregnant. The values of NEm obtained in the previous study with similar non-pregnant cows were 92.02 kcal/kg BW0.75 for F1 HxG, and 76.83 kcal/kg BW0.75 for Gyr (P = 0.06). The average ME for pregnancy (MEp) was 5.33 Mcal/d for F1 HxG and 4.46 Mcal/d for Gyr. The metabolizability ratio, averaging 0.60, was similar among the evaluated groups (P>0.05). The ME / Digestible Energy (DE) ratio differed between groups and periods evaluated (P<0.05) with a mean of 0.84. The heat increment (HI) accounted for 22.74% and 24.38% of the GEI for F1 HxG and Gyr cows, respectively. The proportion of GEI used in the basal metabolism by pregnant cows in this study represented 29.69%. However, there were no differences between the breeds and the evaluation periods and corresponded to 29.69%. The mean NE for pregnancy (NEp) was 2.76 Mcal/d and did not differ between groups and gestational stages (P>0.05)., Competing Interests: The ‘Empresa de Pesquisa Agropecuária de Minas Gerais (EPAMIG)’ cannot be classified as a commercial company. It was established as a public company in 1974 with the purpose of developing research and experimentation directly and indirectly related to agriculture and with the objective of becoming the main instrument for carrying out agricultural research activities in the State of Minas Gerais, Brazil. The author ‘Edilane Aparecida Silva’ associated with EPAMIG, provided support by donating research material. EPAMIG made the experimental animals available (all of them was originated from the experimental EPAMIG farm located at Felixlândia, Minas Gerais), but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript and that no competing or conflict of interests exists.

Cyanobacteria are prokaryotes involved in the contamination of aquatic environments since they release toxins that are highly potent and dangerous for living organisms. Prokaryotes produce endo and exotoxins, among others. Exotoxins are highly toxic, while endotoxins have milder toxic effects. The present study evaluated the cytotoxicogenetic potency of both toxins studying them in different concentrations of cyanobacterial biomasses (1 μg/L, 1.5 μg/L, 2 μg/L), to assess the amount of exotoxin present in the cultured medium in which the cyanobacteria were grown. For this evaluation, we used an extract taken from the medium in a concentration of 10%. Our results showed that genotoxic and mutagenic changes in Allium cepa could be observed in all of the varying concentrations of biomass (endotoxin action) and also in the medium induced with exotoxin. Even at low concentrations, these toxins were highly effective at triggering changes in the DNA molecules of organisms exposed to them. This information is highly significant when considering environmental contamination caused by cyanobacteria blooms, since the results of this study show that these toxins may not only kill organisms when found in high concentrations, but also induce mutations when found in low concentrations. Since these mutations are expressed later on in the organisms, it is impossible to associate the observed effect with the event that induced the damage., 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 © 2020 Elsevier Ltd. All rights reserved.)

This study evaluated the validity of the Static-99 and Static-99R in assessing sexual recidivism in Switzerland, based on a sample of 142 male sex offenders. Both tools showed predictive validity, but the Static-99R had better discrimination (OR = 1.82, AUC = .81) and calibration (Brier = .078, P/E = 0.96) than the Static-99. A cut score of four on the Static-99R maximized sensitivity (92.9%) and specificity (60.2%). However, although most offenders (98.7%) with a score < 4 did not commit sexual offenses in the 5-year follow-up period, only one in five (20.3%) offenders with a score ≥ 4 actually recidivated. Furthermore, the predicted number of recidivists in the well above average risk category (Static-99R ≥ 6) was 24% higher than expected in routine samples. The results suggest that the Static-99R may be a useful screening tool to identify low-risk individuals but offenders with scores ≥ 4 should be subjected to a more thorough assessment.

The Sexual Sadism Scale (SeSaS) was developed to assist in the diagnosis of sexual sadism, and it revealed adequate psychometric properties in prior research. This study cross validated the SeSaS in Switzerland using a sample of 179 male sex offenders. Specifically, the SeSaS conformed to a Mokken model of double monotonicity (scalability coefficient [ H ] = .46, coefficient of reproducibility [CR] = .89), indicating that it measures a unidimensional construct of sexual sadism with hierarchically ordered items. The reliability of the scale was acceptable to high (ρ = .80, λ 2 = .75, κ = .88). In addition, the SeSaS was strongly associated with sexual sadism diagnoses based on mental health manuals ( r pb = .60, odds ratio [OR] = 13.02, area under the curve [AUC] = 1) but not with recidivism. The results suggest that the use of the SeSaS may improve the validity and reliability of sexual sadism diagnoses, therefore playing a role in the assessment and management of sex offenders.

The life cycle of Parasitengona includes major morphological changes precluding an instar association based only on the morphology. This makes rearing and/or molecular data necessary to associate the heteromorphic instars. Most of the described species are known from either post larval instars or larva. Following a previous study on Palearctic Erythraeidae, in the present study the instar association was made through an integrative approach including rearing trials and molecular analysis of the cytochrome oxidase I (COI) gene with the Bayesian Generalized Mixed Yule Coalescent (bGMYC) algorithm for species delimitation. Two new cave dwelling Erythraeidae (Trombidiformes: Parasitengona) species are described Lasioerythraeus jessicae sp. nov. and Leptus sidorchukae sp. nov. including all active instars. Additionally, a complete description of the previously unknown adults of Charletonia rocciai Treat Flechtmann, 1979 is provided with notes on the larva and deutonymph. We also demonstrate experimentally that Ch. rocciai larvae are not attached to the same individual host during the entire feeding stage. We discuss the presence of troglomorphisms in Le. sidorchukae sp. nov.; and the distribution of the species.

Although some previous studies have described the microbial diversity of termite in Brazil, the lack of studies about this subject is still evident. In the present study, we described by whole genome sequencing, the gut microbiota of seven species of termites (Termitidae) with different feeding habits from four Brazilian locations. For the litter species, the most abundant bacterial phylum was Firmicutes, where Cornitermes cumulans and Syntermes dirus (Syntermitinae) were identified. For the humus species, the most abundant bacterial phylum was Proteobacteria where three species were studied: Cyrilliotermes strictinasus (Syntermitinae), Grigiotermes bequaerti (Apicotermitinae), and Orthognathotermes mirim (Termitinae). For the wood termites, Firmicutes and Spirochaetes were the most abundant phyla, respectively, where two species were identified: Nasutitermes aquilinus and Nasutitermes jaraguae (Nasutitermitinae). The gut microbiota of all four examined subfamilies shared a conserved functional and carbohydrate-active enzyme profile and specialized in cellulose and chitin degradation. Taken together, these results provide insight into the partnerships between termite and microbes that permit the use of refractory energy sources.

MKRN3 mutations represent the most common genetic cause of central precocious puberty (CPP) but associations between genotype and clinical features have not been extensively explored. This systematic review and meta-analysis investigated genotype-phenotype associations and prevalence of MKRN3 mutations in CPP. The search was conducted in seven electronic databases (Cochrane, EMBASE, LILACS, LIVIVO, PubMed, Scopus, and Web of Science) for articles published until 4 September 2018. Studies evaluating MKRN3 mutations in patients with CPP were considered eligible. A total of 22 studies, studying 880 subjects with CPP, fulfilled the inclusion criteria. Eighty-nine subjects (76 girls) were identified as harboring MKRN3 mutations. Girls, compared with boys, exhibited earlier age at pubertal onset (median, 6.0 years; range, 3.0 to 7.0 vs 8.5 years; range, 5.9 to 9.0; P < 0.001), and higher basal FSH levels (median, 4.3 IU/L; range, 0.7 to 13.94 IU/L vs 2.45 IU/L; range, 0.8 to 13.70 IU/L; P = 0.003), and bone age advancement ( Δ BA; median, 2.3 years; range, -0.9 to 5.2 vs 1.2 years; range, 0.0 to 2.3; P = 0.01). Additional dysmorphisms were uncommon. A total of 14 studies evaluating 857 patients were included for quantitative analysis, with a pooled overall mutation prevalence of 9.0% (95% CI, 0.04 to 0.15). Subgroup analysis showed that prevalence estimates were higher in males, familial cases, and in non-Asian countries. In conclusion, MKRN3 mutations are associated with nonsyndromic CPP and manifest in a sex-dimorphic manner, with girls being affected earlier. They represent a common cause of CPP in western countries, especially in boys and familial cases.

Microcystin-LR (MCLR) is a toxin mainly produced by Microcystis aeruginosa, cyanobacteria most commonly found in eutrophic environments. Cyanobacteria blooms have affected Salto Grande reservoir (Americana, State of São Paulo/Brazil) for several decades, often observed during periods of drought. In this study, the genotoxic effects of MCLR (95% purity) and water samples contaminated by this toxin were evaluated during cyanobacteria bloom using assays with the test organism Allium cepa. The results showed genotoxic action for pure microcystin and cytotoxic, genotoxic and mutagenic action for water samples collected during flowering. Chromosomal aberration assays have shown that MCLR induces chromosomal breaks that persist in the daughter cells as MN. Therefore, it is possible to infer a clastogenic action for this toxin. The MCLR present in the environmental samples was shown to be more cytogenotoxic for the cells than the different concentrations tested in this study with the pure substance. This amplified toxic action can be related to a synergistic effect between the MCLR and other compounds present in the environmental samples. The genotoxicity studies with MCLR show inconsistent and inconclusive results, so this toxin needs to be better investigated in order to obtain further information about the action mode of it is on the biological system., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: 11β-hydroxylase deficiency accounts for 5% of congenital adrenal hyperplasia cases. Diagnosis suspiction is classically based on the association between abnormal virilization, precocious puberty, and hypertension in 46XX or 46XY subjects. We investigated two families with siblings presenting with opposed clinical features, and provided a review of the mechanisms involved in mineralocorticoid-dependent phenotypic heterogeneity., Methods: The coding region of the CYP11B1 gene of 4 patients was sequenced and familial segregation was confirmed. Clinical characterization and blood steroid profile were performed., Results: Family 1 comprised a female and a male siblings who presented in middle childhood with genital ambiguity (Prader II) and precocious puberty, respectively, associated with hypertension. In the second decade of life, the woman had three full-term pregnancies, and then evolved normotensive with no treatment over a 5-year follow up. On the other hand, her brother had hypertensive end-organ damage at age 24. In family 2, a 2.9 year-old boy presented with precocious puberty and hypertension, whereas his 21 days-old sister had genital ambiguity (Prader III) and salt wasting. A homozygous exon 4 splice site mutation was identified (IVS4ds-1G > A; c.799 G > A) in family 1, while a nonsense mutation in exon 6 (p. Q356X; c.1066 C > T) was found in family 2., Conclusion: CYP11B1 mutations were associated with highly variable phenotypes, from mild to severe virilization, and early-onset hypertension or salt wasting. Further analysis of variants in other hypertension-related genes, steroid synthesis and metabolism compensatory pathways, and/or the investigation of chimeric CYP11B genes are needed to clarify the phenotypic heterogeneity in 11β-hydroxylase deficiency.

Introduction: Only few reports are known about the use of robotic surgery for prostate benign enlargement. The robotic surgery can be improved by laparoscopic tricks. We show a video of robotic adenomectomy where a laparoscopic dissector is used to help create the plan between prostatic capsule and adenoma., Materials and Methods: A 62 years old male had severe urinary flow outlet obstruction. Medical therapy was not effective. Ultrasound detected a 92gr enlarged prostate with a large middle lobe. Robotic assisted adenomectomy was scheduled. The procedure followed this sequence: opening of Retzius space, superficial suture of the Dorsal vein complex, horizontal cistotomy. The plan was created with electrocautery and blunt dissection with the laparoscopic dissector. Haemostatic sutures were placed between prostate fossa and the posterior bladder neck and closure of the cistotomy., Results: Whole operation time was 160 minutes, with a blood loss of 80cc. There was no perioperative or post-operative complication. Catheter was removed after 4 days. Post-operatory uroflowmetry shows a peak flow of 30ml/sec. Pathological examination is negative for tumor. After 60 days IPSS was 8., Conclusion: Robotic prostate adenomectomy using the laparoscopic dissector is a safe and effective minimally invasive treatment for benign prostatic enlargement. It is a novel technique to find and dissect the plane between prostatic adenoma and capsule. This could be one more use of laparoscopic technology to improve surgical outcomes in robotic field., Competing Interests: Conflict of interest: None declared., (Copyright® by the International Brazilian Journal of Urology.)

The aim of this study was to determine the energy metabolism and partition of lactating Gyr and F1 Holstein x Gyr (F1 HxG) cows in different planes of nutrition. Six F1 HxG and six Gyr cows with 130 days in milking (DIM) fed corn silage and concentrate were evaluated. The experiment consisted of four periods with different levels of feeding: 1st ad libitum dry matter intake (DMI) and the others with 5, 10 and 20% restricted DMI, related to the first one. An apparent digestibility assay was performed before measurements in the respiration chamber. Total feces were collected for three days. The cows were confined for 24h in the chamber in each period to determine methane and heat production (HP). F1 HxG had higher gross energy intake (GEI), metabolisable energy intake (MEI) and digestible energy intake (DEI). GE lost in feces was higher in F1 HxG (23.7% GEI) than in Gyr (20.5%) cows. Energy lost as methane and urine was similar between the groups. The metabolisability (q) was 0.67, and the efficiency of converting ME to NE (k) was 0.56. There was no difference in the energy requirements for maintenance between breeds (426.6 MJ/kg BW0,75 average value). The energy requirements for lactation were higher in F1 HxG animals due to the higher volume of milk produced, since there was no difference in energy requirements for production of one kg of milk., Competing Interests: The authors have declared that no competing interest exist.

The commercialization of silage in many countries, including Brazil, has increased in recent years. Re-ensiling of previously ensiled forage occurs when silage is relocated from one farm to another, where it will be compacted and sealed again. During this process, silage is exposed to oxygen before being ensiled, which may affect its quality. We exposed sorghum silage to air during the anaerobic storage phase to simulate the transportation of silages between farms. Experimental treatments included silage exposed to air for 0 or 12 h, with or without the use of an inoculant containing a mixture of Lactobacillus plantarum and the propionic bacteria Propionibacterium acidipropionici (1 × 10 6 cfu/g of forage; Biomax corn, Lallemand, Saint-Simon, France), totaling 4 treatments: conventional silage, conventional silage with inoculant use, re-ensilage after exposure to air, and re-ensilage after exposure to air with use of an inoculant. The sorghum was stored in experimental silos containing about 9.0 kg of fresh forage per replicate. Treatments were tested in a factorial 2 × 2 design with 5 replicates each. Chemical composition, in vitro dry matter digestibility, fermentative characteristics, losses (due to gas, effluents, and total dry matter), microorganism counts, and aerobic stability of sorghum silage were evaluated. Dry matter content of sorghum before ensiling was 273.12 g/kg. The 12-h re-ensiling process increased the effluent loss of the silage when compared with conventional silage (456.42 vs. 201.19 g/kg of FM, respectively). In addition, re-ensiled silages presented lower concentrations of lactic acid and higher concentrations of propionic acid than the silages that had not been opened during storage. The aerobic stability of silage was not affected by the re-ensiling process and the use of inoculant. The use of inoculant increased the pH and loss of dry matter of the silages (4.23 vs. 3.98 and 14.05 vs. 7.82%, respectively) and therefore did not provide any benefits in this study., (Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Forage production is primarily limited by weather conditions under dryland production systems in Brazilian semi-arid regions, therefore sowing at the appropriate time is critical. The objectives of this study were to evaluate the CSM-CERES-Pearl Millet model from the DSSAT software suite for its ability to simulate growth, development, and forage accumulation of pearl millet [ Pennisetum glaucum (L.) R.] at three Brazilian semi-arid locations, and to use the model to study the impact of different sowing dates on pearl millet performance for forage. Four pearl millet cultivars were grown during the 2011 rainy season in field experiments conducted at three Brazilian semi-arid locations, under rainfed conditions. The genetic coefficients of the four pearl millet cultivars were calibrated for the model, and the model performance was evaluated with experimental data. The model was run for 14 sowing dates using long-term historical weather data from three locations, to determine the optimum sowing window. Results showed that performance of the model was satisfactory as indicated by accurate simulation of crop phenology and forage accumulation against measured data. The optimum sowing window varied among locations depending on rainfall patterns, although showing the same trend for cultivars within the site. The best sowing windows were from 15 April to 15 May for the Bom Conselho location; 12 April to 02 May for Nossa Senhora da Gloria; and 17 April to 25 May for Sao Bento do Una. The model can be used as a tool to evaluate the effect of sowing date on forage pearl millet performance in Brazilian semi-arid conditions.

Objective: To compare cleaning effectiveness by histological analysis of a reciprocating single-file system with ProTaper rotary instruments during the preparation of curved root canals in extracted teeth., Methods: A total of 40 root canals with curvatures ranging between 20 - 40 degrees were divided into two groups of 20 canals. Canals were prepared to the following apical sizes: Reciproc size 25 (n=20); ProTaper: F2 (n=20). The normal distribution of data was tested by the Kolmogorov-Smirnov test and the values obtained for the test (Mann-Whitney U test, P < .05) were statistically analyzed using the GraphPad InStat for the Mac OS software (GraphPad Software, La Jolla, CA, USA)., Results: There were no significant differences in remaining debris (P > .05) between the two groups., Conclusion: The application of reciprocating motion during instrumentation did not result in increased debris when compared with continuous rotation motion, even in the apical part of curved canals. Both instruments resulted in debris in the canal lumen, irrespective of the movement kinematics applied.

Background: Food allergy is an increasing problem in public health, especially in childhood. Its incidence has increased in the last decade. Despite this, estimates of the actual incidence and prevalence are uncertain. The aim of this study was to estimate the prevalence of food allergy in infants and pre-schoolers., Methods: The parents of 3897 children completed questionnaires on the occurrence of any reaction to food. Children with parentally reported reactions were selected for further examination including a clinical interview, physical examination, allergic tests, and if necessary, oral food challenge to conclude the diagnosis of FA., Results: The estimated prevalence of allergy in children aged 4-59 months was 0.61%, being, 1.9% in infants and 0.4% in pre-schoolers. Among the 604 patients physicians evaluated with parent-reported FA, 24 (4%) had a confirmed diagnosis of food allergy, and 580 (96%) were excluded in the remaining. Of these, approximately half (51/52.6%) of 97 infants and (128/48%) of 487 pre-schoolers already performed the diet exclusion suspected food for a period of time., Conclusion: This study shows that high overall prevalence of parental belief of current food allergy however the same was not observed in the in physician-diagnosed food allergy. The prevalence of food allergy was lower than that observed in the literature. This study alerts health professionals to the risk entailed by overestimation of cases of food allergy and unnecessary dietary exclusion, which may result in impairment in growth and development of children, especially in their first years of life., (Copyright © 2016. Published by Elsevier España, S.L.U.)

The aim of this study is to evaluate the effects of replacing poorly fitting dentures on patient's masticatory function, satisfaction and oral health-related quality of life. Fourteen patients with conventional maxillary complete dentures and mandibular overdentures retained by two implants bar clip system had their dentures replaced. The laboratory tests for the analysis of masticatory performance were conducted using an "Optocal" food simulator test. Questionnaires were used to evaluate patient satisfaction with dentures and impact of oral health on quality of life. Tests were conducted and questionnaires were administered before and 1, 3 and 6 months after the patient had adapted to the new dentures. Masticatory performance data and satisfaction with dentures (Visual Analogic Scale) were statistically analyzed by ANOVA and Tukey b test, satisfaction with dentures (SATs P) and impact of oral health on quality of life were evaluated using the Wilcoxon and Friedman tests (a=.05). There was no statistically significant improvement in masticatory function after denture replacement, although better outcomes were observed. Satisfaction with dentures and total score obtained using the OHIPedent showed significant improvement. It can be suggested that the potential for grinding food, patient satisfaction and aspects of quality of life improved immediately after denture replacement., (Sociedad Argentina de Investigación Odontológica.)

Background: Despite the high prevalence rate of mental health problems among young prisoners, little is known about the longitudinal course and covariates of their mental health symptoms during incarceration, especially the influence of the correctional climate. The current study aimed: (1) to examine changes in young prisoners' mental health symptoms during incarceration, (2) to identify personal factors associated with their mental health symptoms and perceptions of the correctional climate, and (3) to test the incremental effect of perceptions of the correctional climate on mental health symptoms., Methods: Data were obtained from a sample of 75 youths (aged 17 to 22 years) detained in a Portuguese young offender prison. Data were gathered 1, 3, and 6 months after their admission in this facility. Socio-demographic, clinical and criminological variables were collected. Mental health symptoms and perceptions of the correctional climate were assessed through self-report assessment tools. Linear and logistic (multi-level) regressions and tests for differences between means were performed to analyze the data., Results: Overall, mental health symptoms marginally declined by the sixth month in prison. Prisoners with a history of mental health treatment were more likely to have increased symptoms. Higher levels of mental health symptoms were associated with a history of mental health treatment, remand status, and a lower educational level. Better perceptions of the correctional climate were associated with Black race and participation in prison activities. A negative perception of the correctional climate was the strongest covariate of young prisoners' mental health symptoms and had incremental validity over that of personal variables., Conclusions: The results highlight that both characteristics of the prisoners and of the prison environment influence young prisoners' mental health. Prison management can try to reduce young prisoners' mental health problems by developing scientific procedures for their mental health assessment and creating a more beneficial correctional climate.

In vitro batch cultures were used to screen four fibrolytic enzyme mixtures at two dosages added to a 60 : 40 silage : concentrate diet containing the C(4) tropical grass Andropogon gayanus grass ensiled at two maturities - vegetative stage (VS) and flowering stage (FS). Based on these studies, one enzyme mixture was selected to treat the same diets and evaluate its impact on fermentation using an artificial rumen (Rusitec). In vitro batch cultures were conducted as a completely randomized design with two runs, four replicates per run and 12 treatments in a factorial arrangement (four enzyme mixtures×three doses). Enzyme additives (E1, E2, E3 and E4) were commercial products and contained a range of endoglucanase, exoglucanase and xylanase activities. Enzymes were added to the complete diet 2 h before incubation at 0, 2 and 4 μl/g of dry matter (DM). Gas production (GP) was measured after 3, 6, 12, 24 and 48 h of incubation. Disappearance of DM (DMD), NDF (NDFD) and ADF (ADFD) were determined after 24 and 48 h. For all four enzyme mixtures, a dosage effect (P>0.05) DM, N, NDF or ADF disappearance after 48 h of incubation nor daily ammonia-N, volatile fatty acids or CH(4) production. However, enzyme application increased (P<0.05) microbial N production in feed particle-associated (loosely-associated) and silage feed particle-bound (firmly associated) fractions. With A. gayanus silage diets, degradation may not be limited by microbial colonization, but rather by the ability of fibrolytic enzymes to degrade plant cell walls within this recalcitrant forage.

Unlabelled: Heart failure (HF) is a common cause of hospitalization and requires accuracy in clinical judgment and appropriate nursing diagnoses., Objective: to determine the accuracy of nursing diagnoses of fatigue, intolerance to activity and decreased cardiac output in hospitalized HF patients., Method: descriptive study applied to nurses with experience in NANDA-I and/or HF nursing diagnoses. Evaluation and accuracy were determined by calculating efficacy (E), false negative (FN), false positive (FP) and trend (T) measures. Nurses who showed acceptable inspection for two diagnoses were selected., Results: the nursing diagnosis of fatigue was the most commonly mistaken diagnosis identified by the nursing evaluators., Discussion: the search for improving diagnostic accuracy reaffirms the need for continuous and specific training to improve the diagnosis capability of nurses., Conclusion: the training allowed the exercise of clinical judgment and better accuracy of nurses.

Objectives: Fibromyalgia (FM) is a complex syndrome that is characterized by lasting and diffuse chronic musculoskeletal pain, derived from non-inflammatory causes and classically associated with the presence of specific tender points. However, studies have highlighted other important symptoms associated with a lower quality of life (QOL) in FM, such as sleep disturbances and alexithymia. This study aimed to investigate the pain, sleep and alexithymia patterns of FM patients treated in a Brazilian tertiary center., Methods: 20 patients with FM who were followed-up in the Rheumatology outpatient clinic of a Brazilian tertiary center (Faculdade de Medicina de São José do Rio Preto - FAMERP, São Paulo, Brazil) and 20 patients without FM from other outpatient services of the FAMERP completed a clinical and socio-demographic questionnaire, the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), the Toronto Alexithymia Scale (TAS-20) and the SF-36 (WHOQOL)., Results: The patients with FM presented worse performances in all QOL dimensions of the SF-36 and higher scores on the PSQI (p=0.01), and the TAS-20 (p=0.02). Patients with FM also scored significantly higher in all specific domains of PSQI and TAS-20., Discussion: The present data were in accordance with literature, disclosing a worse performance of patients with FM on pain impact, sleep complains and more presence of alexithymia., Conclusion: Studies have disclosed the presence of important and frequently underdiagnosed symptoms beyond pain complaints in FM, such as sleep complaints and alexithymia, and a better knowledge of such disturbances might improve FM patients' approach and treatment., (Copyright © 2014 Elsevier Editora Ltda. All rights reserved.)

Andropogon gayanus is an important grass due to its high biomass production, drought tolerance and favorable growth on low fertility acidic soils. Currently, there is little research on the impact of growth stage on the nutritional quality or the degree of CH4 production that may arise from this forage during ruminal fermentation. The objectives of this study were to determine the effects of regrowth stage of A. gayanus on its chemical composition, in vitro production of gas and CH4, as well as in vitro dry matter (DM) digestibility when grown under tropical Brazilian conditions and conserved as hay or as silage. The nutritional value of A. gayanus grass declined with increasing maturity; however digestible DM yield linearly increased. After 112 d of regrowth, A. gayanus produced higher quality silage (higher lactate and lower pH and butyrate content) and higher DM yield. However, the low levels of crude protein at this time would make protein supplementation a necessity for proper rumen fermentation. No differences in CH4 kinetic parameters were found with advancing maturity or preservation method (hay or silage).

The study population comprised HNSCC patients, risk-positive controls (tabagism and alcoholism habits), and risk-negative controls (without risk factors). Significant increases in the activation status of CD4(+)and CD8(+) T-cells, and higher migration potentials of lymphocytes were observed in HNSCC patients compared with control groups. Although decreased frequency of CD19(+)-B lymphocytes was observed in HSNCC patients, a higher percentage of HLA-DR(+)CD19(+)-B lymphocytes was detected in these individuals as compared with other evaluated groups. Metastasis and tumor grading were the major pathological parameters associated with significant alterations in the expression of activation molecules on circulating CD4(+) and CD8(+) T-cells. A reduced frequency of CD38-expressing CD8(+) T-cells was the most relevant biomarker associated with HNSCC aggressiveness. Performance analysis suggested a cut-off point for the CD8(+)CD38(+)/CD8(+) T-cell ratio of 7.0 for segregating patients according to tumor grading. In contrast, a higher proportion of CD8(+)CD54(+)/CD8(+) T-cells could represent a relevant biomarker associated with metastasis in HNSCC patients, and performance analysis suggested a cut-off point for the CD8(+)CD54(+)/CD8(+) T-cell ratio of 30 for segregating patients according to absence or presence of metastasis. The results obtained can increment immunological aspects of HNSCC and provide tools for the determination of cut-off scores of clinically relevant immunophenotypic prognostic biomarkers., (Copyright © 2013 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.)

In this proof-of-concept study, we describe the use of the main red beet pigment betanin for the quantification of calcium dipicolinate in bacterial spores, including Bacillus anthracis. In the presence of europium(III) ions, betanin is converted to a water-soluble, non-luminescent orange 1∶1 complex with a stability constant of 1.4 × 10(5) L mol(-1). The addition of calcium dipicolinate, largely found in bacterial spores, changes the color of the aqueous solution of [Eu(Bn)(+)] from orange to magenta. The limit of detection (LOD) of calcium dipicolinate is around 2.0 × 10(-6) mol L(-1) and the LOD determined for both spores, B. cereus and B. anthracis, is (1.1 ± 0.3)× 10(6) spores mL(-1). This simple, green, fast and low cost colorimetric assay was selective for calcium dipicolinate when compared to several analogous compounds. The importance of this work relies on the potential use of betalains, raw natural pigments, as colorimetric sensors for biological applications.

A model betalainic dye was semisynthesized from betanin, the magenta pigment of the red beet, and was effective for live-cell imaging of Plasmodium-infected red blood cells. This water-soluble fluorescent probe is photostable, excitable in the visible region and cell membrane-permeable, and its photophysical properties are not notably pH-sensitive. Fluorescence imaging microscopy of erythrocytes infected with Plasmodium falciparum, a causative agent of malaria in humans, showed that only the parasite was stained. Z-stacking analysis suggested that the probe accumulates proximal to the nucleus of the parasite. Indicaxanthin, one of the natural fluorescent betalains found in the petals of certain flowers, did not stain the parasite or the red blood cell.