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Current antimicrobial treatment recommendations for melioidosis, the disease caused by Burkholderia pseudomallei, are largely based on studies of strains isolated from the Eastern Hemisphere (EH), ...

Rubella virus is the most teratogenic virus known to science and is capable of causing large epidemics. The RA 27/3 rubella vaccine, usually combined with measles vaccine, has eliminated rubella and congenital rubella syndrome from much of the world, notably from the Western Hemisphere. Except in immunosuppressed individuals, it is remarkably safe. Together with rubella vaccine strains used in China and Japan, eradication of the rubella virus is possible, indeed more feasible than eradication of measles or mumps.

BACKGROUND: Haiti has the highest incidence rate of TB in the Western Hemisphere, with an estimated 170 cases per 100,000 in 2019. Since 2010, control efforts have focused on targeted case-finding activities in urban areas, implementation of rapid molecular diagnostics at high-volume TB centers, and improved reporting. TB analyses are rarely focused on lower geographic units; thus, the major goal was to determine if there were focal areas of TB transmission from 2011 to 2016 at operational geographic levels useful for the National TB Control Program (PNLT).METHODS: We created a geocoder to locate TB cases at the smallest geographic level. Kulldorff’s space-time permutation scan, Anselin Moran’s I, and Getis-Ord Gi* statistics were used to determine the spatial distribution and clusters of TB.RESULTS: With 91% of cases linked using the geocoder, TB clusters were identified each year. Getis-Ord Gi* analysis revealed 14 distinct spatial clusters of high incidences in the Port-au-Prince metropolitan area. One hundred retrospective space-time clusters were detected.CONCLUSION: Our study confirms the presence of TB hotspots in the Ouest département, with most clusters in the Port-au-Prince metropolitan area. Results will help the PNLT and its partners better design case-finding strategies for these areas.

Coccidioidomycosis is a fungal infection of the Western hemisphere that is endemic to the soil in areas with limited rainfall. Human and animal infections result with inhalation of arthroconidia. Most often, this is an asymptomatic event. When illness occurs, it is primarily a pneumonic presentation. A small minority of infections eventuate in disseminated disease. Predominately, this presents as meningitis or osteoarticular or integumentary disease. Treatment may not be required for the mildest illness. Azoles are commonly prescribed. Severe infections may require amphotericin B.

OBJETIVO: o presente objetiva caracterizar o impacto dos óbitos em decorrência da dengue no Brasil nos últimos dez anos. MÉTODOS: para estimativa do impacto socioeconômico, utilizou-se a variável Anos Potenciais de Vida Perdidos (APVP), estabelecendo-se como limite para o cálculo a idade de 75 anos. Foram selecionados os dados referentes aos óbitos por dengue no Brasil no período de 2009 a 2018. RESULTADOS: o número de óbitos notificados de indivíduos até 75 anos, em decorrência da dengue foi de 4.295, totalizando 144.301 APVP. A dengue, apesar de ser uma doença negligenciada, gera perdas econômicas elevadas ao país, as maiores dentre o Hemisfério Ocidental. CONCLUSÃO: destarte, é imprescindível aumentar os investimentos nessa temática, de forma a permitir profilaxia e manejo adequados dessa condição, para que seja possível fortalecer estratégias com potencial para minimização da morbimortalidade pela doença.

Gastric cancer is the third most common cause of cancer related death. Although its incidence is globally declined, prognosis remains dismal in the Western hemisphere, while better outcomes are evidenced in Asian countries. Endoscopic or surgical resection with or without lymphadenectomy represents the only chance of cure, with limited improvements of the prognosis in case of associated chemotherapy in a neoadjuvant or adjuvant setting. This could be mainly attributed to the uniform fashion of treatment of gastric cancer, mainly based on the histological features, that usually do not reflect the complexity of the disease. With the recent introduction of genomic technologies and new generation sequencing techniques, gastric cancer biology is now investigated in great details. This has brought to the publication of three main molecular classifications, based on the underlying molecular biology of gastric cancer. Although only few clinical reports are currently present in literature, the identification of gastric cancer molecular subtypes has shown interesting findings that may pave the way to a tailored clinical and surgical management. The aim of this review is, thus, to give a comprehensive overview of the current molecular classifications as compared to the available histopathological ones, also focusing on the potential clinical and surgical benefits and the future perspectives for a more personalized treatment of gastric cancer.

Wider use of clozapine, one of the most effective antipshychotic drugs, is precluded by its propensity to cause agranulocytosis. Currently, clozapine is used for treatment-resistant schizophrenia, with mandatory blood count monitoring for the duration of treatment. Agranulocytosis occurs in up to 0.8% of patients and presents a significant medical challenge, despite decreasing mortality rates. In this paper, we review the epidemiology of clozapine-induced agranulocytosis (CLIA), advances in identifying genetic risk factors, and the preventive measures to reduce the risk of CLIA. We discuss the pathogenesis of CLIA, which, despite receiving considerable scientific attention, has not been fully elucidated. Finally, we address the clinical management and suggest the approach to clozapine re-challenge in patients with a previous episode of neutropenia. With a significant proportion of clozapine recipients in Western hemisphere being Black, we comment on the importance of recognizing benign ethnic neutropenia as a potential impediment to clozapine administration. This review aims to aid haematologists and psychiatrists to jointly manage neutropenia and agranulocytosis caused by clozapine.

Venous leg ulceration (VLU) is one of the most predominate medical disorders worldwide and in the western hemisphere it affects around 1-2% of the general population and up to 5% of the elderly population. The prospective study of 82 patients with VLU who undergoing endovenous varicose veins ablation at the AngioLife Vascular Center. As a result of comprehensive treatment in 97.5% of patients with VLU completely healed during the year, but there were some differences, particularly in terms of healing and symptoms of CVD dynamics depending on how fast the endovenous superficial venous treatment has been provided. Early endovenous superficial venous ablation is an effective, safe and affordable method of treatment for patients with active varicose leg ulcers. Limitations of this study include lack of a control arm or a standardized intervention. In addition, data were not collected on the size of the ulcer and it is possible that small ulcers of short duration may have healed with continued compression and conservative treatment alone. Further randomized controlled studies are needed to confirm these findings. Key words:varicoseveins, endovenouscoagulation.

The 1999 unprecedented emergence of West Nile virus in the western hemisphere represented a health security warning intelligence failure. This paper reviews the timeline of warning signal recogniti...

The five-item Coronavirus Anxiety Scale (CAS) was found to be a useful and valid mental health screener. Participants in the respective surveys were mostly from single countries such as the US, Turkey, Mexico, or Brazil. However, a cross-cultural re-examination is lacking. This study fills this gap. In several multigroup confirmatory factor analyses with 25 countries from five continents as groups, sex and age as groups, and different stages of concern with COVID-19 infection, CAS was found to be invariant across all groups; this indicates that CAS is appropriate for meaningfully comparing the results across different groups. On a global basis, Coronavirus anxiety did not differ between female and male participants. Regarding age, however, younger individuals suffered more from anxiety of the pandemic. Individualistic cultures and those with low power distance such as in the Western hemisphere had higher COVID-19 anxiety. CAS values were also higher for those individuals who had been infected by COVID-19, those whose relatives had been infected, and those who experienced COVID-19-related death in the family. Overall, CAS is a parsimonious, valid, and reliable mental health screener on a global basis.

Knowing the size of the workforce in any specialty and understanding the number of years it takes to produce a specialist makes the difference between future shortages or surpluses. While studies on the cardiothoracic workforce at country level are somewhat available in the Western hemisphere not much is known, other than shortages are abundant, about the current size of the global cardiothoracic surgery workforce, particularly in low and middle income countries. While this ambitious attempt to catalogue our global workforce suffers the same limitations as its sources, it will hopefully shine a light on the need to a more robust and accurate specialty database. Beyond the relative shortcomings of this study, our results undoubtedly point at the overall global shortage of surgeons in each branch of our respective sub-specialties (Adult Cardiac, Thoracic and Congenital), but most importantly, it confirms vast inequities on the global distribution of our workforce.

Simple Summary An estimated 70 million persons in the Western Hemisphere are living at risk for Chagas disease, a parasitic infection transmitted to humans by over 156 different competent triatomine insect vector species. Prior Pan American Health Organization insecticide campaigns throughout Latin America in the 1990s and 2000s demonstrated that domestic insecticide spraying had temporary effects, which resulted in the re-establishment of triatomine species within a few years. Serendipitously, our team found ectoparasitic mites parasitizing triatomines collected from the field in multiple locations in the southwestern United States, where human–triatomine interaction was high but human parasite infection remains low. Upon further investigation of 408 triatomines collected across multiple field sampling sites in Arizona and New Mexico, 13% were found to be parasitized by mites. Mites were found on both Triatoma rubida and Triatoma protracta species and corporally dispersed on the head, thorax, abdomen and legs of these species. Interestingly, there was no statistical difference in Trypanosoma cruzi infection status between parasitized and unparasitized triatomines. Upon further review of the scientific literature, two Latin American-based studies suggest that the presence of mites on triatomines might reduce vector competency via decreased fitness and fecundity. This study provides the first contemporary report of triatomine ectoparasitism, which warrants further investigation as the biologic role of this host-attached mites on Trypanosoma cruzi transmission efficacy. Abstract Background: Chagas disease is a leading cause of cardiac failure in Latin America. Due to poor safety profiles and efficacy of currently available therapeutics, prevention is a priority for the millions living at risk for acquiring this clinically important vector-borne disease. Triatomine vectors of the Chagas disease parasite, Trypanosoma cruzi, are found in the southwestern United States, but risk for autochthonous transmission is thought to be low. The role of ectoparasitic mites is under-explored regarding the ecology of triatomines and Chagas disease transmission. Methods: Triatomine collections were performed using three common entomologic techniques in 2020–2021 from four different locations in southern Arizona and New Mexico. Triatomines were analyzed visually under a 112.5× microscope for the presence of externally attached mites. Following mite removal, triatomines were tested for T. cruzi infection by PCR. Results: Approximately 13% of the collected triatomines had mites securely attached to their head, thorax, abdomen, and legs. More than one mite attached was a common finding among ectoparasitized triatomines. Mite presence, however, did not statistically influence triatomine T. cruzi status. Conclusions: Our findings add to a growing body of literature demonstrating the sustainability of mite-infested triatomine populations throughout the Western Hemisphere. Future investigations are warranted to better understand the biologic impact of triatomine mites and their potential to serve as a potential biological control tool.

The incidence of melanoma is steadily increasing in the Western hemisphere, and one key factor is UV exposure. Sun protection is essential, particularly in patients with diagnosed melanoma. However, data on the psychological implications of sunscreen protection in melanoma patients are lacking. This project was designed as a randomised controlled feasibility trial to explore the feasibility of the diary method and tube count to assess patient compliance in the setting of a monocentric trial, furthermore to observe any recognisable trends regarding anxiety and QoL between the intervention and control group.

Background: Myiasis is a disease caused by the infestation of human tissue by the larval stage of various flies. It has been identified in sub-Saharan Africa and in tropical parts of the Americas. Cases have also been identified among travelers returning to the United States. Infestations may involve any part of the body, including the scalp, and open wounds may become infected with these larvae. The primary cause of wound myiasis in the western hemisphere is Cochliomyia hominivorax. Case Report: We present a case of wound myiasis in an adult Haitian male with a persistent wound for 2 years. To our knowledge, only 1 other report of wound myiasis in Haiti caused by C hominivorax has been published. Conclusion: Wound myiasis can occur in many tropical regions of the world, including Haiti. Because of the prevalence of global travel, clinicians should be familiar with the condition's diagnosis and management.

Purpose of Review: The aim of this report is to summarize the conclusions of the II Regional Meeting on Histoplasmosis in the Americas held in Manaus, Brazil, on March 22–24, 2019. Recent Findings: Persons living with advanced HIV are at high risk for developing histoplasmosis. Clinical signs and symptoms of this disease are often non-specific, making it difficult to establish a diagnosis. Although with the recent technological advances, in vitro diagnostics and medicines for histoplasmosis are often not available in many regions around the world. In addition, histoplasmosis is often not included in HIV care and treatment programs, resulting in inadequate health system planning and missed opportunities to save lives. Summary: The II Regional Meeting on Histoplasmosis in the Americas gathered a multidisciplinary audience. Developed recommendations to be included in the WHO guidelines for diagnosis and treatment of histoplasmosis in advanced HIV were the product of this meeting, and guidelines are aimed to be published in early 2020. © 2019, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

Now more than ever, regions other than Africa and Asia, such as the USA, are being affected by the rising epidemic of vector-borne illnesses, specifically Chikungunya, Dengue, and Zika viruses; this has prompted this review aimed at discussing the changing epidemiology of the three diseases as well as the current treatment and vaccines in development to control the diseases. With the viruses being spread through a variety of ways, including, but not limited to, mosquito bites, fetal transmission, sexual contact, breast milk, and saliva, there is no doubt that more preventative measures are required. The changing epidemiology of the three viruses is already creating an impact, with the spread of Dengue in 2009 in Florida, to the 2013 spread of Chikungunya through the Caribbean, and now, the Zika virus making its mark on the tropics with major concerns of it spreading to the Western Hemisphere, including the USA. Although, they are all vector-borne illnesses, each carries its own clinical presentations that sometimes make it hard to diagnose. Collectively, there are no current vaccines or antiviral drugs against these three viruses, and with no sign of the spread slowing down, more geographic regions are in danger of being hit by these diseases in the near future. As the evolving world for the three viruses continues due to changes in epidemiology, there is a dire need to develop vaccines for each of the three diseases that will target a variety of mechanisms to help fight the transmission and provide succor to affected communities. Public health preventive strategies need to be employed for proper actions to be take aimed at preventing viral transmission and ultimately, helping to fight this changing epidemiology of vector-borne diseases.

BACKGROUND Marked changes in the epidemiology of acute coronary syndromes (ACS) have been observed over the last few decades in the Western Hemisphere. Incidence rates of ACS in Iceland 2003-2012 are presented. METHODS All patients with unstable angina (UA), non ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarc-tion (STEMI) admitted to Landspitali were included in the study. Data were obtained from hospital records and changes during the period were examined. RESULTS The total number of ACS cases was 7,502. STEMI incidence was reduced from 98/100,000 inhabitants in 2003 to 63 in 2012, a reduction of nearly 36%. Age standardized incidence rates of STEMI declined annually by 5.5% in men and 5.3% in women (p

Zika virus (ZIKV) is a historically neglected mosquito-borne flavivirus that has caused recent epidemics in the western hemisphere. ZIKV has been associated with severe symptoms including infant microcephaly and Guillain-Barré syndrome, stimulating interest in understanding factors governing ZIKV infection. Heat shock protein 70 (Hsp70) has been shown to be an infection factor for multiple viruses, leading us to investigate the role of Hsp70 in the ZIKV infection process. ZIKV infection induced Hsp70 expression in host cells 48-h post-infection. Inducing Hsp70 expression in mammalian cells increased ZIKV production, whereas inhibiting Hsp70 activity reduced ZIKV viral RNA production and virion release from the cell. Hsp70 was localized both on the cell surface where it could interact with ZIKV during the initial stages of the infection process, and intracellularly where it localized with viral RNA. Blocking cell surface-localized Hsp70 using antibodies decreased ZIKV cell infection rates and production of infectious virus particles, as did competition with recombinant Hsp70 protein. Overall, Hsp70 was found to play a functional role in both the pre- and post-ZIKV infection processes affecting viral entry, replication, and egress. Understanding the interactions between Hsp70 and ZIKV may lead to novel therapeutics for ZIKV infection.

Winter Wonderland Cave contains perennial ice associated with two types of cryogenic cave carbonate (CCC) formed during the freezing of water. CCCfine is characterized by relatively high δ13C values, whereas CCCcoarse exhibits notably low δ18O values indicating precipitation under (semi)closed-system conditions in a pool of residual water beneath an ice lid. Previous work has concluded that CCCcoarse forms during permafrost thaw, making the presence of this precipitate a valuable indicator of past cryospheric change. Available geochronologic evidence indicates that CCC formation in this cave is a Late Holocene or contemporary process, and field observations suggest that the cave thermal regime recently changed in a manner that permits the ingress of liquid water. This is the first documented occurence of CCCcoarse in the Western Hemisphere and one of only a few locations where these minerals have been found in association with ice. Winter Wonderland Cave is a natural laboratory for studying CCC genesis.

The genus Porophyllum (family Asteraceae) is native to the western hemisphere, growing in tropical and subtropical North and South America. Mexico is an important center of diversification of the genus. Plants belong of genus Porophyllum have been used in Mexican traditional medicine to treat kidney and intestinal diseases, parasitic, bacterial, and fungal infections and anti-inflammatory and anti-nociceptive activities. In this sense, several trials have been made on its chemical and in vitro and in vivo pharmacological activities. These studies were carried on the extracts and isolated compounds and support most of their reported uses in folk medicine as antifungal, antileishmanial, anti-inflammatory, anti-nociceptive and burn repair activities, and as a potential source of new class of insecticides. Bio guided phytochemical studies showed the isolation of thiophenes, terpenes and phenolics compounds, which could be responsible for the pharmacological activities. However, more pre-clinical assays that highlight the mechanisms of action of the compounds involved in pharmacological function are lacking. This review discusses the current knowledge of their chemistry, in vitro and in vivo pharmacological activities carried out on the plants belonging to the Porophyllum genus.

One of the major causes of mortality in the western hemisphere is cardiovascular disease. Therefore, a variety of markers to identify those at risk are required. Interleukin-32 (IL-32) is a cytokine that is associated with inflammation. The aim of the current study was to investigate variations in single nucleotide polymorphisms (SNPs) of IL-32 and plasma expression, and their associations with mortality. A population of 486 elderly community-living persons were evaluated. The participants were followed for 7.1 years and underwent a clinical examination and blood sampling. SNP analyses of IL-32 rs28372698 using allelic discrimination and plasma measurement of IL-32, using ELISA, were performed. During the follow-up period, 140 (28.8%) all-cause and 87 (17.9%) cardiovascular deaths were registered. No significant difference between mortality and plasma concentration of IL-32 was observed. The A/A genotype group exhibited significantly higher all-cause mortality (P=0.036), and an almost two-fold increased risk in a multivariate Cox regression model for all-cause and cardiovascular mortality. A highly significant difference in all-cause and cardiovascular mortality between the A/A and the T/T groups was demonstrated (P=0.015 resp. P=0.014). In the present study, the cytokine IL-32 was demonstrated to have prognostic information, with an increased risk of all-cause and cardiovascular mortality for those with the A/A genotype rs28372698 of IL-32. The A/A genotype could therefore be regarded as a possible biomarker for mortality risk that may be used to offer optimized cardiovascular patient handling in the future. However, the present study sample was small, and the results should be regarded as hypothesis-generating. Funding Agencies|County Council of Ostergotland; University of Linkoping, Linkoping, Sweden; Swedish Heart and Lung FoundationSwedish Heart-Lung Foundation

The origin of anti-infective therapy in the Western hemisphere dates back to the use of cinchona bark to treat malaria by the indigenous peoples in South America. This discovery was taken to Europe in the seventeenth century. These observations were used to develop the drug quinine, which is still used in the treatment of malaria today. The Chinese have a 5,000 year history of using herbal remedies that may still lead to new anti-infective agents.

Coccidioidomycosis is a fungal disease endemic to the southwestern United States and other areas in the Western Hemisphere. Infection is usually acquired through inhalation. While infection is most often asymptomatic, early respiratory illness and infrequently extrapulmonary dissemination may occur. Immunocompromised individuals, particularly those with impaired cell-mediated immunity, are at greatest risk for dissemination. We present an atypical case of disseminated coccidioidomycosis in an immunocompetent male manifesting as peritoneal disease diagnosed during elective inguinal herniorrhaphy.

Purpose of review This review describes mosquito- and tick-borne diseases found in the Western Hemisphere. It focuses on emerging diseases and recent geographic shifts in the presence of disease vectors. Recent Findings Mosquito and tick vectors have become more widespread as environmental conditions have become more favorable. Zika recently has emerged as a concern for fetal anomalies. West Nile Virus has become widespread. Lyme disease and other tick-borne diseases are more prevalent in areas previously inhospitable to these ticks. Summary Healthcare providers must consider the possibility of mosquito- and tick-borne diseases in broader geographic areas and council patients traveling to endemic areas on precautions against these diseases. Treatment for suspected cases of serious tick-borne illnesses should not be delayed pending culture results.

Native Americans developed agronomic practices throughout the Western Hemisphere adapted to regional climate, edaphic conditions, and the extent of dependence on agriculture for subsistence. These included the mounding or "corn hill" system in northeastern North America. Iroquoian language speakers of present-day New York, USA, and Ontario and Québec, Canada were among those who used this system. While well-known, there has been little archaeological documentation of the system. As a result, there is scant archaeological evidence on how Iroquoian farmers maintained soil fertility in their often-extensive agricultural fields. Using δ15N values obtained on fifteenth- and sixteenth-century AD maize kernels from archaeological sites in New York and Ontario, adjusted to take into account changes that result from charring as determined through experiments, we demonstrate that Iroquoian farmers were successful at maintaining nitrogen in their agricultural fields. These results add to our archaeological knowledge of Iroquoian agronomic practices. Our results also indicate the potential value of obtaining δ15N values on archaeological maize in the investigation of Native American agronomic practices.

Brazilian spotted fever (BSF), caused by Rickettsia rickettsii, is the most lethal tick-borne disease in the western hemisphere. In Brazil, Amblyomma sculptum ticks are the main vector. Capybaras (Hydrochoerus hydrochaeris), the largest living rodents of the world (adults weighing up to 100 Kg), have been recognized as amplifying hosts of R. rickettsii for A. sculptum in BSF-endemic areas; i.e., once primarily infected, capybaras develop bacteremia for a few days, when feeding ticks acquire rickettsial infection. We conducted experimental infections of five capybaras with an A. sculptum-derived strain of R. rickettsii and performed clinical and bacteremia evaluation during primary and subsequent infections. Bacteremia was detected in all capybaras during primary infection, but not in subsequent infections. All animals seroconverted to R. rickettsii (titres range: 64–32,768), and remained seropositive throughout the study. Primary infection resulted in clinical spotted fever illness in four capybaras, of which two had a fatal outcome. Subsequent infections in seropositive capybaras resulted in no clinical signs. Capybaras developed a sustained immune response that prevented a second bacteremia. This condition may imply a high reproduction rate of capybaras in BSF-endemic areas, in order to continuously generate capybaras susceptible to bacteremia during primary infection.

Rhinosporidiosis is a chronic infection of the mucous membrane caused by the Rhinosporiduim seeberi, which infects through transepithelial penetration. Although described worldwide, this entity is mostly found in the western hemisphere, afflicting young people, predominantly males, associated in many cases with recreational or professional contact with bath in ponds, rivers, or stagnant waters. The clinical features are varied depending on the affected membrane, in some cases mimicking other diseases postponing the correct diagnosis. Although nasal obstruction and epistaxis are the common clinical presentations in sinonasal rhinosporidiosis, patients with epiphora without a nasal mass often challenge the diagnosis. In the present case, we have documented a case of isolated lacrimal sac rhinosporidiosis masquerading as chronic dacryocystitis, which was successfully managed by endoscopic excision, accompanied by a literature review.

Basidiomata of Phallales have a diversified morphology with adhesive gleba that exudes an odor, usually unpleasant that attracts mainly insects, which disperse the basidiospores. The genus Blumenavia belongs to the family Clathraceae and, based on morphological features, only two species are currently recognized: B. rhacodes and B. angolensis. However, the morphological characters adopted in species delimitations within this genus are inconsistent, and molecular data are scarce. The present study aimed to review and identify informative characters that contribute to the delimitation of Blumenavia species. Exsiccates from America and Africa were analyzed morphologically, and molecularly, using ITS, LSU, ATP6, RPB2 and TEF-1α markers for Maximum Parsimony, Bayesian and Maximum likelihood analyses, and also for coalescent based species delimitations (BP&P), as well as for bPTP, PhyloMap, Topo-phylogenetic and Geophylogenetic reconstructions. According to our studies, seven species can be considered in the genus: B. rhacodes and B. angolensis are maintained, B. usambarensis and B. toribiotalpaensis are reassessed, and three new species are proposed, B. baturitensis Melanda, M.P. Martín & Baseia, sp. nov., B. crucis-hellenicae G. Coelho, Sulzbacher, Grebenc & Cortez, sp. nov., and B. heroica Melanda, Baseia & M.P. Martín, sp. nov. Blumenavia rhacodes is typified by selecting a lectotype and an epitype. Macromorphological characters considered informative to segregate and delimit the species through integrative taxonomy include length of the basidiomata, color, width and presence of grooves on each arm as well as the glebifer position and shape. These must be clearly observed while the basidiomata are still fresh. Since most materials are usually analyzed after dehydration and deposit in collections, field techniques and protocols to describe fugacious characters from fresh specimen are demanded, as well as the use of molecular analysis, in order to better assess recognition and delimitation of species in Blumenavia. © 2020 Melanda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The highly prevalent and virulent disease in the Western Hemisphere Coccidioidomycosis, also known as Valley Fever, can cause serious illness such as severe pneumonia with respiratory failure. It can also take on a disseminated form where the infection spreads throughout the body. Thus, a serious impetus exists to develop effective detection of the disease that can also operate in a rapid and high-throughput fashion. Here, we report the assembly of a highly sensitive biosensor using reduced graphene oxide (rGO) with Coccidioides(cocci) antibodies as the target analytes. The facile design made possible by the scalable microcontact printing (μCP) surface patterning technique which enables rapid, ultrasensitive detection. It provides a wide linear range and sub picomolar (2.5 pg/ml) detection, while also delivering high selectivity and reproducibility. This work demonstrates an important advancement in the development of a sensitive label-free rGO biosensor for Coccidioidomycosis detection. This result also provides the potential application of direct pathogen diagnosis for the future biosensor development.

While major progress has been made in the control of rabies in the Western Hemisphere, large parts of Europe and some parts of Asia, the disease continues to kill tens of thousands of people every year. Its highest burden is in resourcelimited countries in Asia and Africa, disproportionately affecting children and poor rural communities. Today, domesticated dogs are responsible for the vast majority of human rabies cases. In late 2015, rabies experts from around the world gathered at the Rabies Global Conference in Geneva, Switzerland, and launched the ambitious initiative to end deaths from dog-mediated human rabies by 2030. The most cost-effective and sustainable approach to achieve this goal is to eliminate the disease at source through mass dog vaccination. In this article, the role of and challenges faced by Veterinary Services in resourcelimited settings in implementing the dog vaccination strategy to reduce the human rabies burden are discussed, together with the role of wildlife in disease control and why the 'One Health' approach is indispensable on the path towards a dograbies- free future.

espanolPopulismo es un termino que ha devenido moda en el discurso politico contemporaneo, despues de que algunos lo creian desaparecido. El termino es aun de uso impreciso y se utiliza en diversas realidades discursivas, las que a su vez remiten a diferentes mundos objetivos: ideologias politicas, movimientos y agrupaciones politicas, estilos discursivos y programas de accion politica y modos de obrar, tanto en los regimenes autoritarios como democraticos. Una primera parte de este trabajo se destina a un intento de despejar esta selva semantica y tratar de ubicar el uso de los conceptos en su nivel adecuado, buscando definir los componentes que permiten caracterizar a un discurso populista. En alguna de las aproximaciones del populismo este ha sido caracterizado como ideologia, lo que tambien se analiza. En un segundo momento se estudian las perspectivas del analisis del discurso politico, poniendo enfasis en la practica de la cortesia y la descortesia en las manifestaciones concretas del discurso sobre el populismo, donde aparece como una forma particular de lograr adhesion afectiva, recurriendo a la construccion de una imagen social del otro o del destinatario favorable o positiva, en oposicion al diferente u opuesto. Se analizan discursos de diferentes politicos del hemisferio occidental, tomados de los medios de comunicacion, donde se busca ubicar los elementos populistas y el contexto en el que tienen o tuvieron lugar, tratando de analizar los efectos de ese discurso. Se toma en cuenta que en los debates politicos de cualquier escenario alrededor del populismo son mas las expresiones de agresividad verbal y descortesia que las derivadas de una actitud de cortesia. EnglishAlthough some people believed that it had disappeared, populism is a term that has become more common in the modern political discourse. The use of the term is still ambiguous and it is used in different discursive realities, which at the same time refer to different objective worlds: political ideologies, movements and political groups, discursive styles and political action programs, and behaviors, in authoritarian and democratic regimes. The first part of this work is intended to try to clear this semantic confusion and aims to place the use of the concepts at their correct level, looking to give a definition to the components that allow the characterization of the populist discourse. In one of our approaches, populism has been characterized as an ideology, and this is also analyzed. Secondly, we examine the perspectives of the analysis of the political discourse, focusing on the practice of politeness and impoliteness in the concrete demonstrations of discourse about populism, where it appears as a particular way to create an affectional bond, using it as a resort to build a social image of the other or of the receiver that is positive or negative, in opposition to different or contrary. We analyze several political discourses from the Western Hemisphere that were extracted from the media by trying to locate the populist elements therein and the context where they come from, seeking to analyze the effects of that discourse. It is also taken into account that political debates in any situation around populism are more likely to be verbally aggressive and impolite than those that come from a courtesy attitude.

Chikungunya virus is a mosquito-borne alphavirus that causes an acute febrile illness with severe polyarthralgia. The first local transmission of chikungunya virus in the Western Hemisphere was reported in December 2013. In the following year, the virus spread throughout much of the Americas and the number of cases among travelers increased substantially. We reviewed the epidemiology of chikungunya virus disease cases reported among U.S. travelers from 2014 to 2016. A total of 3,941 travel-acquired cases were reported from 49 states and the District of Columbia; 3,616 (92%) reported travel to other countries or territories in the Americas; the remaining 8% reported travel to Asia, Africa, or the Western Pacific. The most commonly reported travel destinations were the Dominican Republic, Puerto Rico, and Haiti. The largest number of cases (N = 2,780, 71%) had illness onset in 2014, followed by 2015 (N = 913, 23%) and 2016 (N = 248, 6%). Cases occurred in every month, but 70% of case-patients had illness onset from April to September, the months when mosquitoes are most likely to be active in the continental United States. Travel-acquired chikungunya cases will likely continue to occur and present a risk of introduction of the virus to locations in the continental United States. Clinicians and public health officials should be educated about the recognition, diagnosis, management, and timely reporting of chikungunya cases.

Superficial venous thrombosis of the lower extremity is a common medical condition worldwide. Most of its epidemiologic data have come from the Western hemisphere suggesting female predominance and a high risk of venous thromboembolism. Initial diagnosis is still based on clinical suspicion and physical findings, but duplex ultrasound is often required to rule out concomitant deep venous thrombosis. Management options, including surgical and medical means, have been attempted with inconsistent result. In the last decade, clinical trials using anticoagulants such as low molecular weight heparin and new oral anti-Xa anticoagulants have demonstrated beneficial effects. Currently, oral nonsteroidal anti-inflammatories with or without compression are still the predominant initial treatment despite the proven clinical efficacy of oral anticoagulation in lowering thrombotic risk and symptom relief. In this review, most of the studies analyzed are after the year 2010 through PubMed index search and thus making it a contemporary update.

The Zika outbreak that began in 2015 has spread from Brazil to countries across the Western Hemisphere including the United States, presenting global public health challenges that call for the expedited development and availability of preventive vaccines to protect against Zika virus disease. While the general principles guiding the nonclinical and clinical development for Zika vaccines are the same as those of other preventive vaccines, unique considerations apply, in particular if development occurs during a public health emergency. Furthermore, incomplete information about the pathogenesis of Zika virus disease and the mechanism by which candidate preventive vaccines potentially may confer protection presents additional challenges to their clinical development. Nevertheless, definition of clinical development strategies to enable sound regulatory assessment, with a goal toward licensure is critical for these products. This article will provide an overview of the regulatory considerations for the clinical development and licensure of Zika vaccine candidates including a discussion of clinical study designs, approaches to demonstrate vaccine effectiveness, and regulatory pathways to licensure.

Louisiana Waterthrush (Parkesia motacilla) is a familiar singer in the Western Hemisphere family Parulidae, yet apparent geographic variations in its song and potentially related causal mechanisms have not received detailed examination in previously published studies. Here, we analyzed song pattern variations of 651 Louisiana Waterthrush singers in audio spectrogram recordings obtained from our field work and publicly accessible bioacoustics archives. Visual and auditory assessment of the introductory note sequence of each song identified three distinct song types (A, B, and C) and 88.3% of the songs were assigned to one of these types. Linear Discriminant Analysis and Random Forest methods were used to verify the assignments and showed strong agreement (>90%) for Type A with slightly less agreement on Types B and C. User error rates (proportion of the Linear Discriminant Analysis classifications that were incorrect) were 25% for Types A and C, but

Löfgren’s syndrome (LS) is a variant of sarcoidosis characterised by the triad of erythema nodosum (EN), radiographic bilateral hilar adenopathy, and arthralgia/arthritis. Like all cases of sarcoidosis, it is of unknown aetiology and may constitute a diagnostic difficulty in the ambiguous phenotype. Löfgren’s syndrome is associated with a good prognosis and commonly undergoes spontaneous remission within four months. However, the co-existence of multiple good and adverse prognostic factors in a patient may call for guarded expectation. Sarcoidosis is generally more prevalent among people of African descent, but the vast majority of the literature on sarcoidosis are from the western hemisphere. Löfgren’s syndrome has been rarely documented in West Africans despite the availability of some reports of sarcoidosis in the region. We present a case of a Nigerian woman with LS that started out as isolated EN, which was ignored for months until the onset of florid pulmonary and systemic symptoms.

Aim Examining the biogeography of body size is crucial for understanding how animal communities are assembled and maintained. In tetrapods, body size varies predictably with temperature, moisture, productivity seasonality and topographical complexity. Although millennial-scale human pressures are known to have led to the extinction of primarily large-bodied tetrapods, human pressure history is often ignored in studies of body size that focus on extant species. Here, we analyse 11,377 tetrapod species of the Western Hemisphere to test whether millennial-scale human pressures have left an imprint on contemporary body mass distributions throughout the tetrapod clade. Location Western Hemisphere. Time period Contemporary. Major taxa studied Tetrapods (birds, mammals, amphibians and reptiles). Methods We mapped the distribution of assemblage-level median tetrapod body mass at a resolution of 110 km across the Western Hemisphere. We then generated multivariate models of median body mass as a function of temperature, moisture, productivity seasonality and topographical complexity, as well as two variables capturing the history of human population density and human-induced land conversion over the past 12,000 years. We controlled for both spatial and phylogenetic autocorrelation effects on body mass–environment relationships. Results Human pressures explain a small but significant portion of geographical variation in median body mass that cannot be explained by ecological constraints alone. Overall, the median body mass of tetrapod assemblages is lower than expected in areas with a longer history of high human population density and land conversion, but there are important differences among tetrapod classes. Main conclusions At this broad scale, the effect of human pressure history on tetrapod body mass is low relative to that of ecology. However, ignoring spatial variation in the history of human pressure is likely to lead to bias in studies of the present-day functional composition of tetrapod assemblages, at least in areas that have long been influenced by humans.

The bacterium Burkholderia pseudomallei causes melioidosis, which is mainly associated with tropical areas. We analyzed single-nucleotide polymorphisms (SNPs) among genome sequences from isolates of B. pseudomallei that originated in the Western Hemisphere by comparing them with genome sequences of isolates that originated in the Eastern Hemisphere. Analysis indicated that isolates from the Western Hemisphere form a distinct clade, which supports the hypothesis that these isolates were derived from a constricted seeding event from Africa. Subclades have been resolved that are associated with specific regions within the Western Hemisphere and suggest that isolates might be correlated geographically with cases of melioidosis. One isolate associated with a former World War II prisoner of war was believed to represent illness 62 years after exposure in Southeast Asia. However, analysis suggested the isolate originated in Central or South America.

Haiti has the highest burden of rabies in the Western hemisphere, with 130 estimated annual deaths. We present the cost-effectiveness evaluation of an integrated bite case management program combining community bite investigations and passive animal rabies surveillance, using a governmental perspective. The Haiti Animal Rabies Surveillance Program (HARSP) was first implemented in three communes of the West Department, Haiti. Our evaluation encompassed all individuals exposed to rabies in the study area (N = 2,289) in 2014-2015. Costs (2014 U.S. dollars) included diagnostic laboratory development, training of surveillance officers, operational costs, and postexposure prophylaxis (PEP). We used estimated deaths averted and years of life gained (YLG) from prevented rabies as health outcomes. HARSP had higher overall costs (range: $39,568-$80,290) than the no-bite-case-management (NBCM) scenario ($15,988-$26,976), partly from an increased number of bite victims receiving PEP. But HARSP had better health outcomes than NBCM, with estimated 11 additional annual averted deaths in 2014 and nine in 2015, and 654 additional YLG in 2014 and 535 in 2015. Overall, HARSP was more cost-effective (US$ per death averted) than NBCM (2014, HARSP: $2,891-$4,735, NBCM: $5,980-$8,453; 2015, HARSP: $3,534-$7,171, NBCM: $7,298-$12,284). HARSP offers an effective human rabies prevention solution for countries transitioning from reactive to preventive strategies, such as comprehensive dog vaccination.

Chronic lymphocytic leukemia (CLL) is a neoplasm of small mature B lymphocytes, and is the most common leukemia in the Western hemisphere with an estimated 18,650 cases diagnosed in 2016 and almost...

Until recently, the occurrence of Hepatitis E in the western hemisphere did not amount to a clinical concern

To date, reviews of retinal prostheses have focused primarily on devices undergoing human trials in the Western Hemisphere and fail to capture significant advances in materials and engineering research in countries such as Japan and Korea, as well as projects in early stages of development. To address these gaps, this systematic review examines worldwide advances in retinal prosthetic research, evaluates engineering characteristics and clinical progress of contemporary device initiatives, and identifies potential directions for future research in the field of retinal prosthetics.A literature search using PubMed, Google Scholar, and IEEExplore was conducted following the PRISMA Guidelines for Systematic Review. Inclusion criteria were peer-reviewed papers demonstrating progress in human or animal trials and papers discussing the prosthetic engineering design. For each initiative, a description of the device, its engineering considerations, and recent clinical results were provided.Ten prosthetic initiatives met our inclusion criteria and were organized by stimulation location. Of these initiatives, four have recently completed human trials, three are undergoing multi- or single-center human trials, and three are undergoing preclinical animal testing. Only the Argus II (FDA 2013, CE 2011) has obtained FDA approval for use in the United States; the Alpha-IMS (CE 2013) has achieved the highest visual acuity using a Landolt-C test to date and is the only device presently undergoing a multicenter clinical trial.Several distinct approaches to retinal stimulation have been successful in eliciting visual precepts in animals and/or humans. However, many clinical needs are still not met and engineering challenges must be addressed before a retinal prosthesis with the capability to fully and safely restore functional vision can be realized.

Like many aspects of the crisis in Venezuela, migration troubles have already begun and could become far worse. Apocalyptic levels of violent crime, food and medicine shortages, and government repression have been pushing Venezuelans out for years. That steady migration has been largely overlooked; it is too gradual to draw headlines, and it is understandably overshadowed by the millions of Syrian refugees fleeing civil war, and more recently, the hundreds of thousands of Rohingya escaping Myanmar for Bangladesh. But of all the troubling aspects of Venezuela’s meltdown, it is the prospect of a refugee crisis that keeps US national security professionals up at night. As Venezuela struggles to pay its creditors, observers are watching for signs of a mass exodus, and wondering whether the international community has the wherewithal to handle yet another migration nightmare.

Allergic diseases have emerged as a major health care burden, especially in the western hemisphere. They are defined by overshooting reactions of an aberrant immune system to harmless exogenous stimuli. The TH1/TH2 paradigm assumes that a dominance of TH2 cell activation and an inadequate TH1 cell response are responsible for the development of allergies. However, the characterization of additional T helper cell subpopulations such as TH9, TH17, TH22, THGM-CSF and their interplay with regulatory T cells suggest further layers of complexity. This review summarizes state-of-the-art knowledge on T cell diversity and their induction, while revisiting the TH1/TH2 paradigm. With respect to these numerous contributors, it offers a new perspective on the pathogenesis of asthma, allergic rhinitis (AR) and atopic dermatitis (AD) incorporating recent discoveries in the field of T cell plasticity.

West Nile virus (WNV) was introduced for the first time in the western hemisphere in 1999 in New York City. In 2002, a phenotype-modifying mutation (Env-V159A) defined the first North American genotype WN02. So far, three genotypes has been described in North America but little is known about WNV evolution in Canada. We report the phylogenetic characterization of twenty-six WNV genomes isolated from mosquitoes in the province of Quebec. WNV strains found in Quebec are phylogenetically related to American strains collected in northern and southern regions. We also noted the presence of two robust monophyletic groups of isolates characterized by distinct conserved amino acid motifs. These emerging genotypes were detected for several years in different ecosystems. These results highlight the need for the maintenance of a nationwide surveillance to follow the dispersion of emergent WNV genotypes.

Venezuela’s tumbling economy and authoritarian rule have precipitated an unprecedented humanitarian crisis. Hyperinflation rates now exceed 45,000%, and Venezuela’s health system is in free fall. The country is experiencing a massive exodus of biomedical scientists and qualified healthcare professionals. Reemergence of arthropod-borne and vaccine-preventable diseases has sparked serious epidemics that also affect neighboring countries. In this article, we discuss the ongoing epidemics of measles and diphtheria in Venezuela and their disproportionate impact on indigenous populations. We also discuss the potential for reemergence of poliomyelitis and conclude that action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. We further provide specific recommendations for addressing this crisis. © 2019 Centers for Disease Control and Prevention (CDC). All rights reserved.

White piedra of the hair is a rare superficial fungal infection caused by several Trichosporon spp. It typically manifests as white to light brown hard nodules, firmly attached to frontal, occipital and parietal scalp hair. The incidence of white piedra varies from country to country, and men and women of all ages are affected. In Latin America, children and women appear to be the most affected with white piedra of the hair. Given the variability of causative agents and the paucity of literature, very little is known about the geographical distribution of white piedra of the hair in American continent countries to help understand its epidemiology and aid in its diagnosis and treatment. In this report, we describe a case of white piedra of the hair in a Peruvian woman...

Ehrlichia ruminantium, a tick-borne rickettsial, causes heartwater in ruminants resulting from vascular damage. Severity of heartwater varies greatly in ruminant species and breeds, age of animals and for diverse geographic E. ruminantium strains. E. ruminantium and a tick vector, Amblyomma variegatum, originating from Africa, are well established in certain Caribbean islands two centuries ago. Besides the possibility of introduction of heartwater through African exotic animal importation, presence of the pathogen, and the tick vector in the Caribbean pose a high risk to ruminants in the USA and other western hemisphere countries. Scientific evidence supporting the heartwater threat to nonendemic regions, however, is lacking. We describe the first infection study in sheep reared in the USA with seven E. ruminantium strains. All infected sheep exhibited clinical signs characteristic of subacute to subclinical disease, which included labored breathing, depression, coughing, and nasal discharges. Gross and microscopic lesions consistent with heartwater disease including edema and hemorrhage were observed in several organs. Pathogen-specific IgG antibody response was detected in animals infected with all seven strains, while molecular analysis confirmed the pathogen presence only when infected with in vitro cultures. This is the first infection study demonstrating severe heartwater in sheep reared in North America.

We report the first case of "Candidatus Rickettsia amblyommii" detected in Amblyomma mixtum ticks on humans on the west coast of Mexico. This is the most western record of "Ca. R. amblyommii" in the Western Hemisphere, representing the first record for the western coast of the Americas. Even if the record is far from the previously known locations for the species it does not represent a new record regarding temperature, precipitation and topographic parameters. Since "Ca. R. amblyommii" antibodies have been detected in patients suspected of Rocky Mountain spotted fever, and the tick A. mixtum has been associated with humans, it is important to consider "Ca. R. amblyommii" as a potential risk for the human population that has not been considered at risk before.