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Cardiac tumours can be classified as neoplastic or non-neoplastic, with secondary tumours being significantly more common than primary ones. Among secondary tumours, melanoma has the highest propensity for cardiac involvement. Pleomorphic dermal sarcoma (PDS) is a rare skin neoplasm, with an estimated metastatic risk of 10% to 20%. This report presents the case of a 52-year-old male who, after a history of PDS, developed cardiac metastasis 4 years postexcision. Despite clear surgical margins and adjuvant radiotherapy, he later exhibited metastatic disease affecting the lungs and heart. Advanced imaging revealed tumour invasion into the left atrium, leading to palliative chemotherapy and ultimately the patient's transition to palliative care 7 months after diagnosis. This case underscores the need for vigilance in monitoring potential metastasis in rare tumours like PDS.

Introduction: In kidney transplant (KT) recipients diabetes mellitus (DM) are associated with an increased mortality and a poorer graft survival. Glucagon-like peptide 1 receptor agonists (GLP1-RA) have demonstrated cardiovascular and renal benefits in the general population. However, there is lacking evidence in KT recipients. Objective: To analyze the efficacy and safety of glucagon-like peptide 1 receptor GLP1-RA in a cohort of KT recipients. Methods: Multicenter retrospective cohort study of KT patients with DM who started subcutaneous GLP1-RA in 3 hospitals in the province of Cádiz between February 2016 and July 2022. Estimated glomerular filtration rate (eGFR), proteinuria, and weight at baseline and after 6 and 12 months were collected. We analyzed glycemic control, blood pressure, lipid profile, and doses and trough levels of tacrolimus. We document episodes of acute rejection (AR), de novo donor-specific antibodies (dnDSA), and adverse effects. Results: During this period, 96 KT with DM started treatment with GLP1-RA, of which 84 had a minimum follow-up of 6 months and 61 were followed for 12 months. A significant reduction was observed in proteinuria (−19.1 mg/g, p = 0.000; −46.6 mg/g, p = 0.000), weight (−3.6 kg, p = 0.000; −3.6 kg, p = 0.000), glycosylated hemoglobin (−0.7%, p = 0.000; −0.9%, p = 0.000), systolic blood pressure (−7.5 mmHg, p = 0.013; −7.3 mmHg, p = 0.004), total cholesterol (−11.5 mg/dL, p = 0.001; −15.6 mg/dl, p = 0.002) and LDL cholesterol (−9.2 mg/dl, p = 0.002; −16.8 mg/dl, p = 0.000) at 6 months and 1 year of follow-up. The eGFR remained stable and the dose and trough levels of tacrolimus did not change. No episodes of AR or development of dnDSA were observed during follow-up. Conclusions: GLP1-RA in KT patients can be a safe and effective option for the management of DM in KT. Resumen: Introducción: En los pacientes receptores de trasplante renal (TR) la diabetes mellitus (DM) se relaciona con una mayor mortalidad y menor supervivencia del injerto. Los agonistas del receptor del péptido 1 similar al glucagón (ar-GLP1) han demostrado beneficios cardiovasculares y renales en la población general. Sin embargo, su evidencia en pacientes TR es limitada. Objetivo: Analizar la eficacia y seguridad de los ar-GLP1 en una cohorte de pacientes TR. Métodos: Estudio de cohortes retrospectivo multicéntrico de los pacientes TR con DM que iniciaron ar-GLP1 de administración subcutánea en 3 hospitales de la provincia de Cádiz entre febrero de 2016 y julio de 2022. Se recogió filtrado glomerular estimado (FGe), proteinuria y peso al inicio del tratamiento y tras 6 y 12 meses. Analizamos control glucémico, tensión arterial, perfil lipídico y niveles valle y dosis de tacrolimus. Documentamos episodios de rechazo agudo (RA), anticuerpos donantes específicos de novo (DSAn) y efectos adversos. Resultados: En este periodo 96 TR con DM iniciaron tratamiento con ar-GLP1, de los cuales 84 cumplieron el seguimiento mínimo de 6 meses y 61 pacientes de 1 año. Se observó una reducción significativa de la proteinuria (−19.1 mg/g, p = 0.000; −46.6 mg/g, p = 0.000), peso (−3.6 kg, p = 0.000; −3.6 kg, p = 0.000), hemoglobina glicosilada (−0.7 %, p = 0.000; −0.9%, p = 0.000), tensión arterial sistólica (−7.5 mmHg, p = 0.013; −7.3 mmHg, p = 0.004), colesterol total (−11.5 mg/dL, p = 0.001; −15.6 mg/dl, p = 0.002) y LDL colesterol (− 9.2 mg/dl, p = 0.002; −16.8 mg/dl, p = 0.000) a los 6 meses y al año de seguimiento. El FGe se mantuvo estable y no se modificó ni la dosis ni los niveles valle de tacrolimus. No se objetivaron episodios de RA ni desarrollo de DSAn durante el seguimiento. Conclusiones: Los ar-GLP1 en pacientes TR demuestran que puede ser una opción segura y eficaz para el manejo de la DM en TR.

The beech marten (Martes foina) is a small-size mustelid endangered according to the IUCN Red List. Despite the plethora of parasites potentially affecting its population decline, subcutaneous filarioids are occasionally reported in martens and their competent arthropod vectors are to date unknown. Therefore, from January 2023 to August 2024, this study investigated the presence of subcutaneous filarioids and ectoparasites of road-killed beech martens (n = 7) from southwestern Italy. One marten (14.3 %, 95 % CI: 2.6–51.3) was massively infected with subcutaneous filarioids, i.e., 18 specimens (11 males and 7 females) in the dorso-posterior region, where mild redness and sloughing of skin were found. All the filarioids were identified as Filaria martis via morphology and Sanger sequencing of the cytochrome c oxidase subunit I (cox1) gene that revealed a single sequence type (GenBank accession number PQ034642) having 100 % nucleotide identity with those available in the literature. The phylogenetic analysis displayed a bootstrap value of 100 % between the cox1 sequences of F. martis of this study and those of beech martens from Italy and European minks from Spain. Haemolymph, gut, and salivary glands of the Ixodes ricinus ticks collected from the infected marten scored negative for F. martis larvae and DNA by dissection and PCR, respectively. This study reported for the first time F. martis subcutaneous filariosis in southwestern Italy, previously outlined only in northern and southeastern areas, indicating the circulation of this poorly investigated filarioid. Knowledge of the competent vectors involved in the biological cycle of F. martis requires further experimental studies.

The synergistic effects of soil acidity alleviation and nitrogen (N) fertilization on soil physical attributes and their impacts on crop yields in highly weathered soils have not been assessed. The study was carried out in southeastern Brazil, in a tropical climate environment, in a sandy clay textured Oxisol. In total there were 12 treatments, that investigated the effects of surface application of lime, phosphogypsum, and N fertilization on soil chemical and physical attributes and soybean and maize nutrition and yield in two seasons (2020–2022). The treatments consisted of a control (no lime or, phosphogypsum), lime (2.9 Mg ha−1), and lime + phosphogypsum (2.0 Mg ha−1) combined with four different N rates applied to maize (0, 80, 160 and 240 kg ha−1). Lime and gypsum increased maize and soybean yields, especially under low N input. Lime and gypsum enhanced soil aggregate stability up to a depth of 60 cm and increased aggregate size up to a depth of 40 cm at N rates of up to 160 kg ha−1. Lime and gypsum also increased soil surface and subsurface pH and soil calcium and magnesium levels up to a depth of 60 cm, particularly under low N input. Moreover, lime and gypsum increased soil organic matter content in both the surface and subsurface layers, particularly under high N input. Overall, our findings emphasize the benefits of combining lime and gypsum with moderate input of N-fertilizer for improving crop yields through enhanced soil physical and chemical properties.

The trypsin inhibitor isolated from tamarind seeds (TTI) is being investigated for potential applications in the treatment of noncommunicable diseases (NCD), such as hypertension, obesity, and diabetes. This study aimed to assess TTI embryotoxicity and acute toxicity in adult zebrafish (Danio rerio). TTI was extracted and isolated from tamarind seeds. Embryonic and adult zebrafish were exposed for 96 hours to three concentrations of TTI (12.5, 25, and 50 mg/L). Zebrafish embryos (n=60 per group) were evaluated for survival, hatching, malformations, and potential developmental marker alterations, in addition to cardiotoxicity and neurotoxicity tests. For acute toxicity assessment in adults (n=20 per group), survival and locomotor and anxiety-like behaviors were assessed, along with genotoxicity (micronucleus) evaluation. Embryos exposed to TTI showed no significant adverse effects, presented normal heart rates and positive reflex response in the neurotoxicity tests. In adult fish, TTI did not cause mortality or significant behavioral changes, suggesting no neurotoxicity and no genotoxicity. Histopathological analyses of the whole body showed only changes in the liver and spinal cord, similar to those observed in the control group not exposed to TTI. These findings indicate TTI's biosafety and therapeutic potential in complex organisms. Further research is required to evaluate its long-term effects and efficacy in treating non-communicable diseases.

Lipoprotein (a) [Lp(a)] is a lipoprotein with multiple deleterious characteristics and is a recognized cardiovascular (CV) risk factor. The pro-atherogenic, pro-thrombotic, and pro-inflammatory features of Lp(a) are associated not only with atherosclerotic vascular disease but also with aortic valve calcification and all-cause mortality. One of the most interesting aspects of Lp(a) is that its level is determined by genetics in more than 90% of cases, with lifestyle habits having very little influence. Therefore, the recommendation is to test it, at least, once in a lifetime. Contrary to previous beliefs, evidence in recent decades has shown that women have the same or even greater CV risk than men of the same age, attributed to female sex hormones. Different stages of a woman's life can impact on Lp(a) levels, from newborn to menopause, including other critical moments such as menarche and pregnancy. The main objective of this review is to describe and analyze the effect of different specific periods of a woman's life on Lp(a) levels and the potential clinical relevance on their CV risk.

Summary: Background: Ultra-processed food (UPF) consumption has been linked with higher risk of mortality. This multi-centre study investigated associations between food intake by degree of processing, using the Nova classification, and all-cause and cause-specific mortality. Methods: This study analyzed data from the European Prospective Investigation into Cancer and Nutrition. All-cause mortality and cause-specific mortality due to cancer, circulatory diseases, digestive diseases, Parkinson’s disease, and Alzheimer’s disease served as endpoints. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models. Substitution analyses were also performed. Findings: Overall, 428,728 (71.7% female) participants were included in the analysis and 40,016 deaths were documented after 15.9 years of follow-up. UPFs (in percentage grams per day [g/d]) were positively associated with all-cause mortality (HRs per 1-SD: 1.04; 95% CI: 1.02,1.05), as well as mortality from circulatory diseases (1.09; 95% CI: 1.07,1.12), cerebrovascular disease (1.11; 95% CI: 1.05,1.17), ischemic heart disease (1.10; 95% CI: 1.06,1.15), digestive diseases (1.12; 95% CI: 1.05,1.20), and Parkinson’s disease (1.23; 95% CI: 1.06,1.42). No associations were found between UPFs and mortality from cancer or Alzheimer’s disease. Replacing processed and UPFs with unprocessed/minimally processed foods was associated with lower mortality risk. Interpretation: In this pan-European analysis, higher UPF consumption was associated with greater mortality from circulatory diseases, digestive diseases, and Parkinson’s disease. The results support growing evidence that higher consumption of UPFs and lower consumption of unprocessed foods may have a negative impact on health. Funding: l’Institut National du Cancer, and World Cancer Research Fund International.

Background/aims: Myocarditis is an inflammatory disease with diverse clinical presentations. It is known that low-risk patients have a good prognosis compared to high-risk patients. There are few data regarding the prognosis of intermediate-risk patients. This study aimed to analyze the long-term outcomes of patients with acute myocarditis with different risk profiles at presentation, focusing on the intermediate risk one. Methods: A retrospective multicenter study was conducted, enrolling patients who met the diagnostic criteria for clinically suspected myocarditis with acute presentation. Patients were stratified into high, intermediate and low risk, according to the classification proposed by Sinagra and his team. Cardiovascular adverse events (AEs) were assessed after a median follow-up of 19 months. Echocardiographic and cardiac magnetic resonance (CMR) parameters predictive of adverse events have been reported. Results: We enrolled 127 patients (mean age 30 ± 13 years; 103 men, 24 women). High-risk patients had a higher frequency of adverse events (80 %) compared to other groups (16 %–16 %, p

Introdução: A hepatite C é uma doença viral crônica que afeta milhões de pessoas em todo o mundo, representando um sério desafio à saúde pública. Objetivo: Caracterizar o perfil epidemiológico dos casos de Hepatite C notificados no estado do Paraná, Brasil. Método: Estudo transversal, quantitativo, cujos dados foram obtidos por meio das fichas do Sistema de Informações de Agravos de Notificação (SINAN), de pacientes notificados com Hepatite B e residentes no estado do Paraná, no período de janeiro de 2007 a novembro de 2023. Os dados foram analisados no Programa Statistical Package for the Social Sciences, por meio de frequências simples. CAAE n° 21738719.9.0000.523. Resultados: Foram notificados um total de 19.582 casos, destacando-se os anos de 2015 (9,1%), 2016 (8,7%) e 2011(8,4%) como os de maior número de notificações. A análise demográfica revelou uma predominância de casos em adultos jovens (77%), do sexo masculino (58,2%), de raça branca (74,3%), não institucionalizados (80%), com baixo nível de escolaridade (37,6%) e residentes em áreas urbanas ou periurbanas (94,8%), com maior concentração de casos na macrorregional leste (59,1%). A detecção do RNA do vírus da hepatite C foi positiva em 9.524 casos, com os genótipos mais comuns sendo o GEN 1(18,8%) e GEN 3(17,9%). A forma crônica da doença foi identificada em 16.218 casos. As prováveis fontes de infecção incluem o uso de drogas (11,4%), contato sexual (9,1%) e transfusão de sangue (6,2%). Conclusão: Este estudo destacou a predominância de casos suspeitos de hepatites virais em adultos jovens do sexo masculino, de raça branca e não institucionalizados, residentes em áreas urbanas com predominância da macrorregional leste entre os anos de 2007 a 2023. Esses achados oferecem informações valiosas para entender a epidemiologia e as características da hepatite C, ressaltando áreas cruciais para intervenção e prevenção.

Introdução: A hepatite B, uma infecção viral, é um grave problema de saúde pública, afetando milhões globalmente. Objetivo: Caracterizar o perfil epidemiológico dos casos de Hepatite B notificados e confirmados no estado do Paraná (PR). Método: Estudo transversal, quantitativo, cujos dados foram obtidos por meio das fichas do Sistema de Informações de Agravos de Notificação (SINAN), de pacientes notificados com Hepatite B e residentes no estado do Paraná, no período de janeiro de 2021 a novembro de 2023. Os dados foram analisados no Programa Statistical Package for the Social Sciences, por meio de frequências simples. CAAE n° 21738719.9.0000.523. Resultados: Foram notificados 5.691 casos suspeitos de hepatite B, com 51,7% confirmados por critérios laboratoriais ou clínico-epidemiológicos. O ano com maior incidência foi 2022, representando 47,7% dos casos. Houve predominancia do sexo masculino 56,8%, idades entre 19 a 59 anos (67,6%), de raça branca (71,9%) e com pouca escolaridade (34%). As macrorregiões com mais concentração dos casos foram a leste (33,6%) e a oeste (32,8%), e a regional de saúde com maior número de confirmados foi a de Curitiba (27,4%). Conclusão: A análise dos dados revela uma significativa carga de hepatite B na região, com uma alta proporção de casos confirmados em relação aos suspeitos. A predominância de casos em homens, adultos jovens, de raça branca e com baixa escolaridade destaca a necessidade de estratégias de saúde pública voltadas para esses grupos. A concentração de casos nas macrorregiões leste e oeste, bem como na regional de saúde de Curitiba, ressalta a importância de medidas preventivas e de controle específicas nessas áreas para reduzir a incidência da doença.

Medicinal plants and herbal medicines are used as integrative and complementary practices to provide comprehensive care, disease prevention, health promotion, and to improve quality of life (QoL). This scoping review aimed to identify and describe the use of phytotherapy in oral health care by adults and their outcomes, with a focus on perceptions of oral health-related QoL, healthcare access, and costs. A systematic search was conducted in six databases and supplemented in grey literature. According to a PRISMA-ScR protocol and eligibility criteria, publications were assessed for final inclusion, data charting, and narrative synthesis. Out of 4124 records, 542 publications were selected for full-text reading. A total of 32 studies were included: 21 studies assessed QoL, 7 reported access issues, and 11 reported costs issues. Herbal mouthwashes to prevent or treat non-infectious oral conditions were the most frequent treatment. Efficacy of phytotherapy was usually better than placebo or control treatment. Most studies reported QoL improvement, but several instruments were used with heterogeneous results. Limited healthcare access and high costs favoured traditional folk herbal medicine in underserved populations. It can be concluded that phytotherapy for oral health is used by adults worldwide, following modern clinical pharmacology and traditional knowledge concepts. Further studies should incorporate assessment of QoL, access, and costs in addition to clinical efficacy and safety, which are complementary aspects for delivering a comprehensive and efficient health care for all people.

Introduction and objectives: The efficacy of fluconazole as a prophylactic strategy in patients with chronic kidney disease (CKD) on peritoneal dialysis (PD) with prior antibiotic exposure is controversial in the current literature. This study aimed to compare a strategy of fluconazole prophylaxis versus no-prophylaxis for patients in PD on antibiotics for previous episodes of peritonitis. Materials and methods: We performed a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) comparing fluconazole prophylaxis with no prophylaxis for PD-related peritonitis. The search was conducted on PubMed, EMBASE, and Cochrane Central in January 23, 2023. The outcome of interest was the occurrence of fungal peritonitis (FP). Results: We included six studies (1 RCT, 5 observational) with 4515 occurrences of peritonitis, of which 1098 (24.8%) received fluconazole prophylaxis in variable doses, whereas 3417 (75.6%) did not receive prophylaxis during peritonitis episodes. Overall, fluconazole prophylaxis was associated with a lower incidence of FP (OR 0.22; 95% CI 0.12–0.41; p

Introduction and objectives: The efficacy of fluconazole as a prophylactic strategy in patients with chronic kidney disease (CKD) on peritoneal dialysis (PD) with prior antibiotic exposure is controversial in the current literature. This study aimed to compare a strategy of fluconazole prophylaxis versus no-prophylaxis for patients in PD on antibiotics for previous episodes of peritonitis. Materials and methods: We performed a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) comparing fluconazole prophylaxis with no prophylaxis for PD-related peritonitis. The search was conducted on PubMed, EMBASE, and Cochrane Central in January 23, 2023. The outcome of interest was the occurrence of fungal peritonitis (FP). Results: We included six studies (1 RCT, 5 observational) with 4515 occurrences of peritonitis, of which 1098 (24.8%) received fluconazole prophylaxis in variable doses, whereas 3417 (75.6%) did not receive prophylaxis during peritonitis episodes. Overall, fluconazole prophylaxis was associated with a lower incidence of FP (OR 0.22; 95% CI 0.12–0.41; p

Summary: Background: Bacille Calmette-Guérin (BCG) vaccination has off-target (non-specific) effects that are associated with protection against unrelated infections and decreased all-cause mortality in infants. We aimed to determine whether BCG vaccination prevents febrile and respiratory infections in adults. Methods: This randomised controlled phase 3 trial was done in 36 healthcare centres in Australia, Brazil, the Netherlands, Spain, and the United Kingdom. Healthcare workers were randomised to receive BCG-Denmark (single 0.1 ml intradermal injection) or no BCG in a 1:1 ratio using a web-based procedure, stratified by stage, site, age, and presence of co-morbidity. The difference in occurrence of febrile or respiratory illness were measured over 12 months (prespecified secondary outcome) using the intention-to-treat (ITT) population. This trial is registered with ClinicalTrials.gov, NCT04327206. Findings: Between March 30, 2020, and April 1, 2021, 6828 healthcare workers were randomised to BCG-Denmark (n = 3417) or control (n = 3411; no intervention or placebo) groups. The 12-month adjusted estimated risk of ≥1 episode of febrile or respiratory illness was 66.8% in the BCG group (95% CI 65.3%–68.2%), compared with 63.4% in the control group (95% CI 61.8%–65.0%), a difference of +3.4 percentage points (95% CI +1.3% to +5.5%; p 0.002). The adjusted estimated risk of a severe episode (defined as being incapacitated for ≥3 consecutive days or hospitalised) was 19.4% in the BCG group (95% CI 18.0%–20.7%), compared with 18.8% in the control group (95% CI 17.4%–20.2%) a difference of +0.6 percentage points (95% CI −1.3% to +2.5%; p 0.6). Both groups had a similar number of episodes of illness, pneumonia, and hospitalisation. There were three deaths, all in the control group. There were no safety concerns following BCG vaccination. Interpretation: In contrast to the beneficial off-target effects reported following neonatal BCG in infants, a small increased risk of symptomatic febrile or respiratory illness was observed in the 12 months following BCG vaccination in adults. There was no evidence of a difference in the risk of severe disease. Funding: Bill & Melinda Gates Foundation, Minderoo Foundation, Sarah and Lachlan Murdoch, the Royal Children's Hospital Foundation, Health Services Union NSW, the Peter Sowerby Foundation, SA Health, the Insurance Advisernet Foundation, the NAB Foundation, the Calvert-Jones Foundation, the Modara Pines Charitable Foundation, the UHG Foundation Pty Ltd, Epworth Healthcare, the National Health and Medical Research Council, the Swiss National Science Foundation and individual donors.

Rationale & Objective: The use of hemodiafiltration (HDF) as a kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD) has sparked a debate regarding its advantages over conventional hemodialysis (HD). The present study aims to shed light on this controversy by comparing mortality rates and cause-specific deaths between ESKD patients receiving HDF and those undergoing HD. Study Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). The search was conducted using PubMed, EMBASE, and Cochrane Central on July 1, 2023. Setting & Participants: Adult patients with ESKD on regular KRT. Exposure: Studies with participants undergoing HDF. Outcomes: Primary outcomes were all-cause mortality, cardiovascular (CV) mortality, deaths related to infections, and kidney transplant. We also evaluated the endpoints for deaths related to malignancy, myocardial infarction, stroke, arrhythmias, and sudden death. Analytical Approach: We included RCTs evaluating HDF versus HD. Crossover trials and studies with overlapping populations were excluded. Two authors independently extracted the data following predefined search criteria and quality assessment. The risk of bias was assessed with Cochrane’s RoB2 tool. Results: We included 5 RCTs with 4,143 patients, of which 2,078 (50.1%) underwent HDF, whereas 2,065 (49.8%) were receiving HD. Overall, HDF was associated with a lower risk of all-cause mortality (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.73-0.91; P

Objective: to evaluate the effects of the red and near-infrared wavelength lasers in isolated and simultaneous way on the modulation of inflammatory cytokines produced by human keratinocytes (HaCaT) challenged by cytokines of human monocytes stimulated by lipopolysaccharide from Escherichia coli. Design: HaCaT cells was previously exposed to the laser with wavelengths red (660 nm), near-infrared (808 nm). Then, HaCat cells were stimulated with the supernatant of lipopolysaccharide-challenged peripheral blood cells. The cytokines expressed by HaCat cells were measured using multiplex CBA assay. Results: HaCaT cells increased the production of inflammatory cytokines when stimulated with infrared laser compared to the control group (IFN-α2, IFN-γ, TNF-α, MCP-1, IL-6, IL-8, IL-10, IL -12p70, IL -17A, IL-23, IL-33), the red laser group (IFN-γ and IL-23) and the group of two lasers used simultaneously (IFN-α2, IFN-γ, IL-6 and IL-8, IL-17A, IL-18 and IL-23) (p

Ceratophrys ornata is an iconic and regionally threatened amphibian of the temperate grasslands from Argentina, Brazil, and Uruguay. Conservation assessments suggested that habitat loss is the main threat to the species, although no studies have yet explored the link between grassland replacement and C. ornata decline. Using a robust database with ∼1000 records from herpetological collections, citizen science, and long-term monitoring, we modeled the species' ecological niche to produce a map of suitable areas, where we searched for C. ornata using active and passive techniques. After exhaustive efforts, we failed to obtain recent records from Brazil and Uruguay. We also conducted Generalized Linear Models to explore the relationship between land use/cover, landscape configuration, and current species occurrence. Overall, results showed that C. ornata occurrence is negatively associated with variables related to native grasslands fragmentation and replacement (i.e., Distance to the Nearest Patch, Forest Plantations), suggesting that habitat loss may have driven local extinctions and population declines of the species. Finally, we outline the regional and national conservation needs of C. ornata and recommend focusing on in-situ conservation strategies for the Argentinean populations to ensure the species' viability.

Summary: Background: The COVID-19 pandemic led to the rapid development and deployment of several highly effective vaccines against SARS-CoV-2. Recent studies suggest that these vaccines may also have off-target effects on the immune system. We sought to determine and compare the off-target effects of the adenovirus vector ChAdOx1-S (Oxford-AstraZeneca) and modified mRNA BNT162b2 (Pfizer-BioNTech) vaccines on immune responses to unrelated pathogens. Methods: Prospective sub-study within the BRACE trial. Blood samples were collected from 284 healthcare workers before and 28 days after ChAdOx1-S or BNT162b2 vaccination. SARS-CoV-2-specific antibodies were measured using ELISA, and whole blood cytokine responses to specific (SARS-CoV-2) and unrelated pathogen stimulation were measured by multiplex bead array. Findings: Both vaccines induced robust SARS-CoV-2 specific antibody and cytokine responses. ChAdOx1-S vaccination increased cytokine responses to heat-killed (HK) Candida albicans and HK Staphylococcus aureus and decreased cytokine responses to HK Escherichia coli and BCG. BNT162b2 vaccination decreased cytokine response to HK E. coli and had variable effects on cytokine responses to BCG and resiquimod (R848). After the second vaccine dose, BNT162b2 recipients had greater specific and off-target cytokine responses than ChAdOx1-S recipients. Interpretation: ChAdOx1-S and BNT162b2 vaccines alter cytokine responses to unrelated pathogens, indicative of potential off-target effects. The specific and off-target effects of these vaccines differ in their magnitude and breadth. The clinical relevance of these findings is uncertain and needs further study. Funding: Bill & Melinda Gates Foundation, National Health and Medical Research Council, Swiss National Science Foundation and the Melbourne Children’s. BRACE trial funding is detailed in acknowledgements.

The valleys in the northern part of Los Glaciares National Park, Southern Patagonia, Argentina, are highly dynamic due to glacier shrinkage. To improve our understanding of slope instability in deglaciated environments, we generated and analyzed a Landslide Susceptibility Map (LSM). The proposed methodology includes remote sensing, interpretation of geological maps, both performed in a Geographic Information System (GIS), and finally a Frequency Ratio Model (FRM). Factors included in the slope instability analysis were lithology, geomorphology, land cover/land use, slope, aspect, elevation, curvature, distance to geologic fault, and distance to roads and trails. Slope instability events identified in the inventory include moraine landslides, debris flows, and rockfalls. The area is modeled by glacial action and has numerous geographic features related to erosional and depositional processes of glaciofluvial, cryogenic, and paraglacial origin. According to their high frequency ratio values, geomorphology, land cover and land use, lithology, and elevation are the most influential predisposing factors. The three best performing classes are Quaternary deposits, ice-contact topography, and the innermost lateral moraines on the western side of the study area, which surround glaciers and proglacial lakes. The performance and accuracy of the LSM was evaluated and verified using the Area Under Curve (AUC) with an accuracy of 0.804. The study provides knowledge of the deglaciated environment and landslide-prone areas in the study area. In this way it will help to provide tools for action to prevent and manage potential hazards to infrastructure, residents and/or tourists.

Introduction: Bisphosphonates are commonly used to prevent osteoporotic fractures. Many randomized controlled trials have proved the efficacy of bisphosphonates, showing their ability to increase bone mineral density and decrease the risk of hip and vertebral fractures. Atypical, bisphosphonate-related fractures concerning the femur have been widely described and a list of primary and secondary clinical and radiographic criteria are used in order to achieve diagnosis. Research question: To identify clinical and radiographic findings for a possible association of vertebral fractures to prolonged bisphosphonate therapy. Material and methods: In this paper we present a case of an atraumatic bilateral pedicle lumbar fracture, assuming the hypothesis of an insufficiency atypical fracture due to prolonged Alendronate therapy for osteoporosis. We highlight the various aspects for diagnosis, treatment and a review of the existing literature was carried out. Discussion and conclusion: Atypical fractures in the spine are rarely reported in the literature. Pedicle anatomy is partially similar to a long bone, described as a strong bridge between the posterior arch and the vertebral body composed of a cortical bone and a cancellous core. Stress fractures are reported as a result of an underlying bone disease, trauma, post-surgery and stress fractures. In our opinion, the criteria described for atypical femoral fractures are a useful tool to also classify these rare pedicle lesions as insufficiency, bisphosphonate-correlated fractures.

Summary: Epithelial-mesenchymal transition (EMT) empowers epithelial cells with mesenchymal and stem-like attributes, facilitating metastasis, a leading cause of cancer-related mortality. Hybrid epithelial-mesenchymal (E/M) cells, retaining both epithelial and mesenchymal traits, exhibit heightened metastatic potential and stemness. The mesenchymal intermediate filament, vimentin, is upregulated during EMT, enhancing the resilience and invasiveness of carcinoma cells. The phosphorylation of vimentin is critical to its structure and function. Here, we identify that stabilizing vimentin phosphorylation at serine 56 induces multinucleation, specifically in hybrid E/M cells with stemness properties but not epithelial or mesenchymal cells. Cancer stem-like cells are especially susceptible to vimentin-induced multinucleation relative to differentiated cells, leading to a reduction in self-renewal and stemness. As a result, vimentin-induced multinucleation leads to sustained inhibition of stemness properties, tumor initiation, and metastasis. These observations indicate that a single, targetable phosphorylation event in vimentin is critical for stemness and metastasis in carcinomas with hybrid E/M properties.

Purpose: To report a case of XEN45 gel stent implantation in a pediatric patient with WAGR syndrome as a successful surgical intervention in the management of multifactorial secondary open-angle glaucoma. Observations: A 6-year-old female with a history of WAGR syndrome, bilateral congenital aniridia, pseudophakia OD and glaucoma OD, was referred for a XEN45 gel stent OD. IOP was persistently elevated at 24 mm Hg despite two glaucoma medications. Implantation of the XEN45 gel stent was performed using a transconjunctival ab externo approach. There were no significant intra-or-postoperative adverse events associated with the stent. The patient achieved good IOP-lowering control without glaucoma medications across the 18-month follow-up period. Conclusions: A XEN45 stent through a transconjunctival ab externo approach may be an effective surgical intervention in pediatric patients with secondary open-angle glaucoma associated with aniridia and aphakia.

This work presents the developments and initial results obtained using X-ray excited optical luminescence (XEOL) at the Carnaúba, the nanoprobe beamline from Sirius, the Brazilian 4th generation synchrotron source. XEOL is a highly important tool to study luminescence mechanisms and identify optical channels in various types of materials under X-ray irradiation. Using this capability combined with a nanoprobe, one can probe optical channels, for example, in heterogenous materials, and directly correlate them with chemical composition, oxidizing state of absorbers, structure and/or morphology in simultaneous studies. Carnaúba is composed by two experimental station and at the Tarumã station, the first entering in operation, it has been possible to investigate XEOL in the integrated and emission modes, and 2D images in hyperspectral mapping with submicrometric resolution. Herein, it is showed some examples of studies combining excitation energy, emission wavelength and emission intensity in 3D spectra, 2D imaging, and XEOL emission on the study of very sensitive samples that can be easily damaged by the probe. This work also highlights some of the upcoming developments that include the time-resolved and in situ experiments, this last one using microfluidic cells, and the improvement of the covered emission wavelength up to 1700 nm, which will open new opportunities for studying optical materials.

Petroleum-based food packaging materials are non-degradable and considerably affect the environment. In this context, edible films and coatings for food preservation represent a feasible alternative that could potentially reduce conventional non-biodegradable materials. It has been shown the suitability of starch as a non-toxic, widely available, low-cost and adequate film-forming biopolymer. In addition, natural compounds contained in tropical fruits are of great interest due to their proven antioxidant and antimicrobial properties, which are beneficial for the health of consumers and for obtaining more stable and safe foods. This review focuses on the new trends and benefits of incorporating tropical fruit extracts into starch-based edible films and coatings formulations as a source of bioactive compounds. The starch and fruit resources, extraction techniques, filmmaking methods, assays for determining functional properties and the potential uses of edible films and coatings in the food industry were stated and described.

The measles virus (MeV) and canine distemper virus (CDV) belong to the genus Morbillivirus of the Paramyxoviridae family. They are enveloped viruses harboring a non-segmented negative-sense RNA. Morbilliviruses are extremely contagious and transmitted through infectious aerosol droplets. Both MeV and CDV may cause respiratory infections and fatal encephalitis, although a high incidence of brain infections is unique to CDV. Despite the availability of a safe and effective vaccine against these viruses, in recent years we are witnessing a strong resurgence of Morbillivirus infection. Measles still kills more than 100,000 people each year, and CDV causes widespread outbreaks, especially among wild animals, including non-human primates.No drugs are currently approved for MeV and CDV. Therefore, the identification of effective antiviral agents represents an unmet medical need. Here, we have investigated the potential antiviral properties of nitazoxanide (NTZ) against MeV and CDV. Antiviral activity was explored with live virus and cell-based assays. NTZ is a thiazolide that is approved by the FDA as an antiprotozoal agent for the treatment of Giardia intestinalis and Cryptosporidium parvum. Further, nitazoxanide and its metabolite tizoxanide have recently emerged as broad-spectrum antiviral agents. We found that NTZ blocks the MeV and CDV replication, acting at the post-entry level. Moreover, we showed that NTZ affects the function of the viral fusion protein (F), impairing viral spread. Our results indicate that NTZ should be further explored as a therapeutic option in measles and canine distemper virus treatment.

Summary: Background: Recurrences of herpes simplex virus (HSV) in the orofacial region (herpes labialis or cold sores) impact quality-of-life. We aimed to study whether the bacille Calmette-Guérin (BCG) vaccine can attenuate cold sore recurrences through off-target immunomodulatory effects. Methods: In this nested randomised controlled trial within the multicentre, phase 3 BRACE trial, 6828 healthcare workers were randomised in 36 sites in Australia, the Netherlands, Spain, the United Kingdom and Brazil, to receive BCG-Denmark or no BCG (1:1 ratio using a web-based procedure) and followed for 12 months with 3-monthly questionnaires. Exclusion criteria included contraindication to BCG vaccine or previous vaccination with BCG within the past year, any other live-attenuated vaccine within the last month, or any COVID-specific vaccine. The intervention group received one intradermal dose of 0.1 mL of BCG-Denmark corresponding to 2−8 x 105 colony forming units of Mycobacterium bovis, Danish strain 1331. The primary outcome was the difference in restricted mean survival time (i.e., time to first cold-sore recurrence), in participants with frequent recurrent herpes labialis (≥4 recurrences/year), analysed by intention-to-treat. Secondary outcomes addressed additional questions, including analyses in other sub-populations. Adverse events were monitored closely during the first 3 months and were reported in all participants who received one dose of study drug according to intervention received. The BRACE trial is registered with ClinicalTrials.gov, NCT04327206. Findings: Between March 30, 2020 and February 18, 2021, 84 individuals with frequent recurrent cold sores were randomly assigned to BCG (n = 38) or control (n = 46). The average time to first cold-sore recurrence was 1.55 months longer in the BCG group (95% CI 0.27–2.82, p = 0.02) than the control group (hazard ratio 0.54, 95% CI 0.32–0.91; intention-to-treat). The beneficial effect of BCG was greater in the as-treated population (difference 1.91 months, 95% CI 0.69–3.12, p = 0.003; hazard ratio 0.45, 95% CI 0.26–0.76). In prespecified subgroup analyses, only sex modified the treatment effect (interaction p = 0.007), with benefit restricted to males. Over 12 months, a greater proportion of participants in the BCG group compared with the control group reported a decrease in duration (61% vs 21%), severity (74% vs 21%), frequency (55% vs 21%), and impact on quality of life (42% vs 15%) of cold sore recurrences. In participants who had ever had a cold sore, there was also a decrease in self-reported burden of recurrences in the BCG group. In participants who had never had a cold sore, there was an increased risk of a first episode in the BCG group (risk difference 1.4%; 95% CI 0.3–2.6%, p = 0.02). There were no safety concerns. Interpretation: BCG-Denmark vaccination had a beneficial effect on herpes labialis, particularly in males with frequent recurrences, but may increase the risk of a first cold sore. Funding: Bill & Melinda Gates Foundation, the Minderoo Foundation, Sarah and Lachlan Murdoch, the Royal Children's Hospital Foundation, Health Services Union NSW, the Peter Sowerby Foundation, SA Health, the Insurance Advisernet Foundation, the NAB Foundation, the Calvert-Jones Foundation, the Modara Pines Charitable Foundation, the UHG Foundation Pty Ltd, Epworth Healthcare, and individual donors.

Introduction: CSF Neurofilament light chain(NfL) is a promising biomarker of neurodegeneration, but its utility in discriminating between Alzheimer's disease(AD) and frontotemporal dementia(FTD) is limited. Methods: 105 patients with clinical-biological diagnosis of mild cognitive impairment(MCI) due to AD (N = 72) or clinical diagnosis of FTD (N = 33) underwent neuropsychological assessment and CSF Aβ42/40, p-tau181, total-tau and NfL quantification. Group comparisons, correlations between continuous variables and ROC curve analysis were carried out to assess NfL role in discriminating between MCI due to AD and FTD, exploring the associations between NfL, ATN biomarkers and neuropsychological measures. Results: NfL levels were significantly lower in the AD group, while levels of total-tau were higher. In the FTD group, significant correlations were found between NfL, p-tau181 and total-tau, and between NfL and cognitive performances. In the AD group, NfL levels were directly correlated with total-tau and p-tau181; Aβ42/40 ratio was inversely correlated with total-tau and p-tau181, but not with NfL. Moreover, p-tau181 and t-tau levels were found to be associated with episodic memory and lexical-semantic impairment. Total-tau/NfL ratio differentiated prodromal-AD from FTD with an AUC of 0.951, higher than the individual measures. Discussion & conclusions: The results support that NfL and total-tau levels reflect distinct pathophysiological neurodegeneration mechanisms, independent and dependent of Aβ pathology, respectively, Combining them may enhance both markers reliability, their ratio showing high accuracy in distinguishing MCI due to AD from FTD. Moreover, our results revealed associations between NfL and disease severity in FTD and between tauopathy and episodic memory and lexical-semantic impairment in prodromal-AD.

Introdução/objetivo: A tuberculose é uma doença de alta transmissibilidade, um dos principais agravos de saúde e uma das principais causas de morte em todo o mundo. Na população idosa, a tuberculose comporta-se de modo diferente, visto que os sintomas da doença são difíceis de serem medidos devido a concomitância de outras patologias respiratórios, cardiovasculares e sistêmicas, associada a senilidade do idoso, o que resultado na demora do diagnóstico e aumentos de morbimortalidade. Assim, objetivou descrever os casos de óbitos por tuberculose pulmonar notificados na população idosa nas 22 Regionais de Saúde do estado do Paraná, nos anos de 2016 a 2021 segundo o perfil epidemiológico. Métodos: Estudo transversal, utilizando banco de dados do Sistema de Informações de Agravos e Notificação (SINAN), no período de 2016 a 2021, dos óbitos ocorridos por tuberculose na população idosa. Os dados foram analisados por meio do software Statistical Package for the Social Science (SPSS), versão 22.0, por meio de frequência simples e relativa. O estudo foi aprovado pelo Comitê de Ética em Pesquisa (CAAE 38855820.6.0000.5231). Resultados: No período estudado, foram analisados 1623 casos de tuberculose pulmonar em idosos de 60 a 97 anos dos casos notificados, onde 148 idosos foram a óbito em decorrência da tuberculose. Em relação aos óbitos (n=148), em 2020 houve a maior taxa de 22,3% (n=33) por tuberculose pulmonar. No que diz respeito à população, a maioria possuía a idade de 60 a 93 anos com média de 70,81, sendo maior o número de óbitos no sexo masculino 74,3% (n= 110). Quanto à histopatologia, 73,6% (n=109) não realizaram teste, 2,0% (n=3) foram sugestivos para TB e 17,6% (n=26) possuíam Baar positivo. Acerca do tipo de entrada, 85,8% (n=127) eram casos novos, 86,5% possuíam a radiografia de tórax suspeita. Em relação aos agravos associados, 24,3% alcoolismo, 22,3% diabéticos, 4,1% apresentavam doença mental, 3,4% eram usuários de drogas ilícitas e 32,4% tabagistas. A respeito do teste molecular rápido, 58,1% não o realizaram e 29,7% foram sensíveis à rifampicina. Já no teste de sensibilidade, 17,6% não o fizeram e 14,9% foram sensíveis. Conclusão: A adequada atenção aos fatores relacionados à ocorrência de óbito por tuberculose pulmonar em idosos contribui para a identificação de riscos, acompanhamento e evolução dos casos, assim como possíveis intervenções pelos profissionais de saúde.

Introdução/objetivo: O combate à tuberculose persiste como desafio para a saúde pública no Brasil. E quando associado ao envelhecimento populacional, os idosos são mais susceptíveis a diversas doenças, entre elas a tuberculose. Assim, objetivou-se caracterizar os casos de tuberculose pulmonar notificados na população maior de 60 anos, entre os anos de 2016 a 2021, no estado do Paraná, segundo os fatores sociodemográficos e epidemiológicos. Métodos: Trata-se de um estudo quantitativo e transversal, utilizando banco de dados do Sistema de Informações de Agravos e Notificação, no período de 2016 a 2021. Os dados foram analisados por meio do software Statistical Package for the Social Science, versão 22.0, por meio de frequência simples e relativa e aprovado pelo Comitê de Ética em Pesquisa sob CAAE (38855820.6.0000.5231). Resultados: Foram notificados 1623 casos de tuberculose pulmonar em idosos de 60 a 97 anos. Quanto ao perfil sociodemográfico, 71% (n = 1152) eram do sexo masculino, 70,2% (n = 1139) cor branca, 8,5% com idade de 61 anos, 59,2% (n = 961) com até 9 anos de estudo, 26,5% (n = 430) estudaram da 1ª à 4ª série do fundamental, 89,7% (n = 1456) residentes em zona urbana, 96,3% (n = 1563) sem privação de liberdade, 95,0% (n = 1542) não estavam em situação de rua e 81,9% (n = 1329) não eram beneficiários de programas de transferência de renda do governo. Com relação ao tipo de casos 84,5% (n = 1372) eram casos novos, 6,4%(n=104) transferência, 6,3% (n =102) recidiva, 1,1% (n = 18) abandono, 0,8% (n = 13) eram pós óbitos e 0,9% (n = 14) não referido. Para o diagnóstico 81,6% (n = 1325) apresentaram raios-X de tórax suspeito, 53,7% (n = 871) baciloscopia de escarro positiva 28,5% (n = 462) cultura de escarro positiva. Aos agravos associados, destaca-se diabetes mellitus 21,1% (n = 343) e tabagistas 26,2% (n = 425). No encerramento dos casos, 53,7% (n = 872) evoluíram para cura, 2,2% (n = 35) abandono e 0,1% (n = 1) abandono primário. Quanto ao perfil epidemiológico, 31,1% (n = 504) dos casos ocorreram na 2ª Regional de Saúde do estado e em relação ao porte dos municípios, aqueles de grande porte 57,9% (n = 939) e pequeno porte 34,1% (n = 554) foram os mais notórios. O ano de 2021 apresentou a maior taxa (22,9%) e 2019 à menor (7,8%). Conclusão: A maioria dos casos de tuberculose em idosos foi do sexo masculino, raça/cor branca, com baixa escolaridade e um aumento de casos no ano de 2021, reforçando a necessidade de realizar ações mais assertivas de controle e acompanhamento nessa população.

Objective: To analyze, by means of a systematic review and meta-analysis, the proportion of patients with Meniere’s disease who have altered caloric test and vHIT, as well as to determine the prevalence of altered caloric test and normal vHIT dissociation in the diagnosis of Meniere’s disease. Methods: The literature search had no restriction regarding the period of publication on the following indexed data platforms: PubMed, PubMed PMC, BVS-Bireme, Web of Science, Embase and Cochrane Library. Articles that evaluated patients with Meniere’s disease who underwent caloric test and vHIT were included. Two researchers independently conducted the analysis of the articles, promoting the selection and capture of data, following the recommendations of the PRISMA method, and complying with the criteria for articles inclusion and exclusion defined in the research protocol. In case of disagreement during the selection process, a third researcher was included for analysis. Results: From a total of 427 initial studies, the researchers selected 12 articles, published between 2014 and 2021, with a total of 708 patients evaluated, with a mean age of 52.72 years old. The prevalence of patients with Meniere’s disease with altered caloric reflex test was 64% (95% CI 57%‒71%), while the prevalence of altered vHIT was only 28% (95% CI 16%–40%). The prevalence of the altered caloric test + normal vHIT dissociation was 47% (95% CI 37%–57%). Conclusion: The video head impulse test and the caloric test are valuable tools for vestibular assessment. The dissociation of findings between these two tests in patients with Meniere’s disease was more prevalent in this meta-analysis and may be a result of the tonotopy of specialized hair cells in the ampullary crest. The prevalence of altered caloric test was 64% and anormal vHIT was 28%. The dissociation caloric asymmetry and normal vHIT was observed in 47% of the patients. Level of evidence: 1.

Introduction: People who consume drugs have a higher risk of latent tuberculosis infection (LTBI). Our objective was to study the characteristics of people who use drugs and who attended the Centers for Drug Dependence Care and Follow-up of Barcelona during 2017–2021 and presented LTBI or did not perform the reading of the tuberculin skin test (TST) after the test had been done. Material and methods: A cross-sectional, descriptive study in Centers for Drug Dependence Care and Follow-up of Barcelona was performed during 2017–2021. The sociodemographic and epidemiological profile of people who use drugs that underwent a TST was analyzed and were examined the factors associated with LTBI. Additionally, the same sociodemographic and epidemiological analyses were made in PWUD that did not perform the reading of the TST after the test had been done. Adjusted odds ratios (ORa) and 95% confidence intervals (95% CI) were calculated. Results: Nine hundred forty-eight persons were profiled. The prevalence of LTBI was 22.9%, and the following factors were associated with it: be older than 41 years; be users of CAS Baluard, or CAS Horta-Guinardó; coming from a WHO region of high TB incidence; be homeless; and low territorial socioeconomic index. The following factors were associated with not performing the reading of the TST after the test had been done: be users from the CAS Baluard, Barceloneta, Nou Barris and Robadors; be homeless and low TSI. Conclusions: This study improves TB control and highlights the need for this LTBI control program in CASs. Resumen: Introducción: Las personas que consumen drogas tienen un mayor riesgo de infección tuberculosa latente (ITL). Nuestro objetivo fue medir las características de las personas que cosumen drogas y que acudieron a los centros de atención y seguimiento (CAS) a las drogodependencias de Barcelona entre 2017-2021 y que presentaron ITL, así como conocer el perfil de las que no acudieron a la lectura de la prueba de la tuberculina (PT). Material y métodos: Se realizó un estudio descriptivo transversal en los centros de atención y seguimiento a las drogodependencias de Barcelona durante el periodo 2017-2021. Se analizó el perfil sociodemográfico y epidemiológico de las personas que consumen drogas que se sometieron a una PT y se examinaron los factores asociados a la ITL. Además, los mismos análisis sociodemográficos y epidemiológicos se realizaron en las personas que consumen drogas que no realizaron la lectura de la PT después de realizarla. Se calcularon las odds ratio ajustadas (ORa) y los intervalos de confianza de 95% (IC 95%). Resultados: Se estudiaron 948 personas. La prevalencia de ITL fue de 22,9%, y los factores asociados fueron: ser mayor de 41 años, ser usuarios del CAS Baluard, o del CAS Horta-Guinardó, provenir de una región de la Organización Mundial de la Salud de alta incidencia de TB, ser una persona sin hogar y bajo índice socioeconómico territorial (IST). Los siguientes factores se asociaron con no acudir a la lectura de PT después de la realización de la prueba: ser personas usuarias del CAS Baluard, Barceloneta, Nou Barris y Robadors; personas sin hogar y bajo IST. Conclusiones: Este estudio mejora el control de la TB y destaca la necesidad de este programa de control de ITL en los CAS.

Schistosomiasis is a neglected disease caused by parasites of the genus Schistosoma and transmitted by snails of the genus Biomphalaria. At least five species have the potential to infect humans living in or visiting tropical areas worldwide. In Latin America, Schistosoma mansoni is particularly common; however, it has not been reported in Ecuador. In this study, we assess the available official data on schistosomiasis in Ecuador to describe the prevalence of this neglected disease. We conducted a nationwide study to determine the demographic and spatial distribution patterns of schistosomiasis infection in Ecuador, using hospital discharge official data as a proxy for infection incidence from 2011 to 2021. We calculated crude and age-sex-adjusted morbidity and hospital admission rates by region, province, canton, and elevation. In the last decade of available data, schistosomiasis accounted for at least 551 hospital admissions in Ecuador. Women represented 53.7% (n = 296) of cases, equivalent to 3.2 cases per 1,000,000 inhabits. The highest number of cases (61.2%, n = 337) was found in the Coastal region. However, the highest incidence rates were observed in the Amazon region's provinces of Pastaza (173.44 cases/1,000,000).

Oligometastatic colorectal cancer (CRC) is a clinically relevant entity, and surgery is the gold standard therapeutic option. Current guidelines recommend evaluating other local ablative treatments (LATs) in patients not eligible for surgery. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) and stereotactic body radiation therapy (SBRT) are emerging as highly beneficial less-invasive LATs in alternative to surgery. In our paper, we report the first case in literature of lymph node metastases from CRC treated sequentially with EUS-RFA and SBRT, providing evidence of their efficacy and safety. LATs combined with systemic chemotherapy might be included in a multimodal therapeutic approach to oligometastatic disease.

Introduction and Objectives: Monitoring wastewater for traces of viruses allows effective surveillance of entire communities, including symptomatic and asymptomatic infected individuals, providing information on whether a specific pathogen is circulating in a population. Such is the case of hepatitis A and E viruses (HAV, HEV). This study aimed to detect HAV and HEV in wastewater samples from Córdoba, Argentina, to provide insights into their circulation dynamics. Materials and Methods: Sewage samples were monthly and weekly collected from 2017 to 2020 and from 2020 to 2021, respectively, from 4 wastewater treatment plants located in different regions of Córdoba. Furthermore, sewage collectors of 7 neighborhoods in Córdoba city were weekly sampled during 2021. A standardized methodology was carried out for virus concentration using PEG6000 and NaCl. After automated nucleic acid extraction, HAV and HEV molecular detection were performed by TaqMan® Fast Applied Biosystems single-step multiplex RT-qPCR and specific RT-Nested PCR. Positive samples were sequenced. Results: From a total of 575 samples analyzed, 16 were RNA-HAV+ (2.80%) and 17 RNA-HEV+ (2.96%). Eight and two sequences were obtained, respectively. The HAV+ specimens were genotype IA. The majority of them belonged to 2017-2018 and were genetically close to those reported in the clinical specimens from the same period when the HAV outbreak in men who have sex with men occurred in Córdoba. The HEV+ samples belonged to genotype 3, and HEV higher occurrence was in 2021, mainly in 2 neighborhoods from Córdoba city. Conclusions: The results show HAV and HEV circulation in Córdoba, despite the low number of clinical cases reported, suggesting a continuous silent circulation of these viruses in the general population. Environmental surveillance of wastewater, together with clinical monitoring, are key tools to track the viral circulation trends over time in the population and to identify hotspots of virus excretion.

Genetic and omics analyses frequently require independent observations, which is not guaranteed in real datasets. When relatedness cannot be accounted for, solutions involve removing related individuals (or observations) and, consequently, a reduction of available data. We developed a network-based relatedness-pruning method that minimizes dataset reduction while removing unwanted relationships in a dataset. It uses node degree centrality metric to identify highly connected nodes (or individuals) and implements heuristics that approximate the minimal reduction of a dataset to allow its application to complex datasets. When compared with two other popular population genetics methodologies (PLINK and KING), NAToRA shows the best combination of removing all relatives while keeping the largest possible number of individuals in all datasets tested and also, with similar effects on the allele frequency spectrum and Principal Component Analysis than PLINK and KING. NAToRA is freely available, both as a standalone tool that can be easily incorporated as part of a pipeline, and as a graphical web tool that allows visualization of the relatedness networks. NAToRA also accepts a variety of relationship metrics as input, which facilitates its use. We also release a genealogies simulator software used for different tests performed in this study.

Skenitis refers to the infection of the Skene's glands. Skene's glands are paraurethral glands localized on the upper wall of the vagina. The diagnosis of Skene's glands abscess or infection is usually made based on the history and physical examination, but half of women with para-urethral gland symptoms present with non-palpable lesions and necessitate further evaluation with imaging. Patients may present with chronic urethral pain, recurrent urinary tract infections, unexplained dyspareunia, and dysuria. At imaging Skene's glands are typically located on the anterior vaginal wall, at symphysis level and paramedian to urethra. Clinicians should consider Skenitis in the differential diagnosis of lower urinary tract symptoms. We report a case of a 48-year-old woman with acute lower urinary tract symptoms with a final diagnosis of Skene's glands abscess.

Objective: The present study aimed to evaluate the antibacterial effect and inhibitory capacity against NorA, TetK and MepA efflux pump of Staphylococcus aureus multiresistant by in vitro and in silico approach of α, β and δ-damascone compounds. Results: The compounds α, β and δ-damascone showed a clinically relevant effect against S. aureus ATCC 6538 standard strain. A modulating effect was also observed in association with antibiotics against MDR strains. Regarding the inhibition of the efflux pump, the compounds showed a modulating effect with antibiotics, against SA-1199, SA-1199B, SA IS-58 and K2068. Only δ-damascone demonstrated an efflux pump inhibitory effect. Regarding ADME properties, α, β and δ-damascone showed similar physicochemical properties with good pharmacokinetic characteristics, such as lipophilicity, oral bioavailability and low toxicity. In addition, they exhibited the binding energy and Ligand Efficiency (LE) −81.17 (5.4), −77.48(-5.4) and −64.55 (-5.1), which shows good interactions with the critical residues of the MepA receptor. Conclusions: From the results it is concluded that the compounds α, β and δ-damascone do not have antibacterial activity, but show a modulating effect in association with antibiotics, as well as not showing direct activity on the efflux pump, but they do have a modulating effect with antibiotics and with EtBr (α and β-damascone).

Lutzomyia longipalpis and Nyssomyia whitmani were incriminated as vectors of Leishmania sp. Spatial heterogeneity together with seasonal changes in abundance constitute important elements for the understanding of the dynamics of vector populations, and there are fundamental for the development of adequate prevention and control strategies. The aim of this work was to compare the spatial and seasonal abundance of Lu. longipalpis and Ny. whitmani at a city spatial scale between two periods separated by three years. To study the spatial distribution, we compared the abundance distribution of these species at two warm times, 2011 with 2014. Respect to inter-annual seasonal abundance changes, we compared the four seasons of the year between two periods (2011–2012 vs 2014–2016). The spatial distribution for both species were found to be distributed mainly in the same areas of the city in both periods. We change for: Respect to the seasonal pattern of abundance, we observed that seasonal patterns showed changes between periods. Our study defines the ‘where’ and ‘when’ implement the actions to mitigate leishmaniasis cases.

Brazil has the world's fifth-largest population and seventh-largest economy. However, it also has many inequalities, especially in health education, which impacts health sector services. Thus, this article aims to describe the situation of planetary health and health education in Brazil, identifying how current policies support the cause of planetary health. This study had a qualitative approach characterised as exploratory research based on an integrative review and documentary research. The results show that, in recent decades, there have been positive improvements to achieve collective and planetary health, which advocates empathy and pro-environmental and humanitarian attitudes. However, the pursuit of planetary health in Brazil is being influenced by various challenges, ranging from the need for a sound policy framework to provisions of education and training on planetary health. Based on the need to address these deficiencies, the paper suggests some measures which should be considered as part of efforts to realise the potential of planetary health in the fifth largest country in the world.

Introduction: Caloric testing is the most frequently used test to assess peripheral vestibular function since the beginning of the 20th century. However, the video head impulse test, vHIT, has gained prominence in the field of neurotology, as it is a faster examination, easier to perform and less uncomfortable for the patient. Objective: To compare, through systematic review and meta-analysis, the proportion of altered cases between vHIT tests and caloric testing in patients with chronic dizziness, in addition to assessing the sensitivity and specificity of vHIT, with caloric testing as the gold standard. Methods: The literature search was carried out in the PubMed, Scopus, BVS-Bireme, Web of Science, Embase, Cochrane and ProQuest indexed databases, with no restrictions regarding the publication period. All articles that contained the results of the two tests were included in the evaluation of patients with dizziness. Two researchers independently conducted data selection and extraction from the studies, strictly following the inclusion and exclusion criteria defined in the research protocol. In case of disagreement during the selection, a discussion was carried out with a third evaluator. Results: Eleven of the 1293 initial articles met the eligibility criteria and were analyzed. 2670 patients were evaluated, of which 1112 (41.6%) were males and 1558 (58.4%) females, with a mean age of 51.6 years. The proportion of altered results in the vHIT was 21% (95%CI 9% –33%), and 55% in the caloric testing (95%CI 43% –67%). Conclusion: The vHIT does not substitute for caloric testing. The tests are complementary in assessing the patient with dizziness, as they describe the tonotopy of the ampullary crest at different frequency ranges of stimulation. In chronic cases, the vHIT has a low sensitivity and high diagnostic specificity in comparison to caloric testing.

Nephrobronchial fistula is an extremely rare complications of renal infections. We present a case of nephrobronchial fistula in a middle age immunocompetent woman who complained cough and weight loss, with underlying asymptomatic nephrolithiasis. She underwent a chest X-ray that showed left lower lobe infiltrate and abdominal ultrasound. Abdominal ultrasound showed a complicated pyonephrosis ; CT of chest-abdomen-pelvis with intravenous contrast was performed in order to stage and define the extension of the pathology. At CT, a suspected diagnosis of stage III xanthogranulomatous pyelonephritis complicated with pyonephrosis and a nephrobronchial fistula was formulated. A nephrostomy tube was placed, and the patient was treated with antibiotics. Follow up CT, performed after 15 days, showed the healing of the fistulous connection between the perinephric abscess and bronchi; the patient underwent nephrectomy with no airway complication during intubation. Histopathological diagnosis confirmed the presence on complicated xanthogranulomatous pyelonephritis.

Summary: Background: In January 2018, Ecuador changed its routine immunization schedule by replacing one full dose of inactivated poliovirus vaccine (IPV) administered intramuscularly at 2 months of age with two doses of fractional IPV (1/5th of full dose, fIPV) administered intradermally at 2 and 4 months of age; and bivalent oral poliovirus vaccine (serotypes 1 and 3, bOPV) continues to be used. We compared seroprevalence and titres of polio antibodies achieved by the past and the current immunization schedules. Methods: This was a cross-sectional serological survey in children in Ecuador who received bOPV and either one IPV dose in 2017 or two fIPV doses in 2018. One blood sample was collected between October 2020 and March 2021 and analysed for presence of poliovirus neutralizing antibodies at CDC, Atlanta by microneutralization assay. Findings: We obtained 321 analysable samples from 329 (97·6%) enrolled children (160 received IPV and 161 fIPV). For serotype 2, seroprevalence was 50·0% (CI95%= 44·2-55·8%) for IPV and 83·2% (CI95%=78·5-87·1%) for fIPV recipients (p

The effect of different types of nanoparticles on plants has been of great interest in recent years. Within this general context, the specific purpose of the present work was to study the interaction between carbon nanoparticles and the photosynthetic electron chain, to determine whether they induced a beneficial or toxic effect on the primary steps of photosynthesis. Two types of nanoparticles were synthesized and physicochemically characterized: nanocarbon black (nano-CB) and graphene quantum dots (GQD). They were sprayed over Cichorium intybus leaves and their effect on the photosynthetic chain was studied using chlorophyll-a fluorescence analysis. Nano-CB was prepared by an acid exfoliation method from commercial carbon black, whereas GQD were obtained by pyrolysis of L-glutamic acid. The nanoparticulate systems displayed luminescent properties and the fluorescence quantum yield for GQD resulted about six times higher than the value for nano-CB. Both kind of nanoparticles presented similar effects on the plant leaves, but the action of GQD was more pronounced. They induced an evident decrease in the content of photosynthetic pigments, a reduced xanthophyll cycle and a lower ability to dissipate excess energy by non-photochemical quenching. Changes in the concentration ratios Chlorophyll a/b and Chlorophylls/Carotenoids were similar to those previously found for shaded leaves but could not be assigned to shading effects in this case. The results of this work suggested a particular deleterious action on the performance of photosystem I (PSI). The phytotoxicity of the tested carbon nanoparticles on Cichorium intybus, at the level of the primary photosynthesis stages was, thus, demonstrated.

Background: Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson’s disease (PD). However, few studies have compared their nonmotor effects. Objective: To compare nonmotor effects of STN-DBS and GPi-DBS. Methods: In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, –III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size. Results: In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains. Conclusions: To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients’ individual motor and nonmotor profiles.

Although cardiac metastases (CM) are more common than primary cardiac malignant tumors, they remain a rare localization of metastatic cancer. Until recently, CM were surgically treated as a palliative approach because of a lack of ablative solutions even for oligometastatic patients. Technological advances in radiation therapy (RT) in thoracic oncology have led to high precision delivery that enlarged the indications for stereotactic body radiotherapy (SBRT). To date, there are limited reports of cardiac SBRT for CM. Herein, we report a cardiac SBRT performed in curative intent for a lung cancer patient metastatic to the heart. Keywords: Cardiac metastasis, Lung cancer, SBRT