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Determine disease activity in a low income juvenile idiopathic arthritis (JIA) cohort. 164 JIA patients from families with less than US$ 4500.00/capita mean annual income followed in Fortaleza-CE, Brazil, were cross-sectionally evaluated between May 2015-April 2016. Mean age was 14 ± 5.1 years (95 female) with 10.31 ± 3.7 years disease duration. Polyarticular category predominated, with 63 (38.4%) patients, followed by 40 (24%) enthesitis-related (ERA), and 36 (22%) oligoarticular. All but 1 out of 84 parents declared less than US$ 10,000.00 annual family income. Eighty-eight (60.7%) were receiving methotrexate and 19 (13%) leflunomide including 12 (63%) using both; 46 (28%) were on biologic DMARD including 20 (43.5%) adalimumab, 17 (41.5) etanercept, 5 (10.8%) tocilizumab, 2 (4.2%) abatacept, and 1 (2.1%) each on infliximab and canakinumab. Mean CHAQ and JADAS27 were 0.36 ± 0.55 and 5.31 ± 8.5, respectively. Thirty-two (20%) out of 159 patients had deformities. A bivariate analysis revealed that polyarticular had more deformities than oligoarticular patients (p = 0.002; OR = 2.389; 95% CI 1.37-4.14). Logistic regression showed no association between high JADAS and family income (p = 0.339; OR = 1.45; 95% CI 0.67-3.31). A general linear model showed significantly lower CHAQ score in patients from families earning more as compared to those earning less than 300.00 US$ monthly (p = 0.002). This study reports JIA disease activity in a low income population. Low income apparently did not influence prognosis given the low mean JADAS27 and CHAQ scores vis-à-vis data from other cohorts.

Dengue remains a problem in Brazil, and a substantial number of cases that progress to death are not diagnosed by health services. We evaluated the impact of a protocol adopted by the Coroner's Office Rocha Furtado (CO-RF) for the detection of unreported deaths from dengue in Brazil. We evaluated prospectively cases of deaths referred to the CO-RF with suspicion of dengue and those referred with other diagnosis in which the pathologists suspected dengue as the cause of death. Biological material was collected from all bodies autopsied, for which the suspected cause of death was dengue, between January 2011 and December 2012. Of the 214 bodies autopsied, 134 (62.6%) tested positive for dengue; of these cases, 121 were classified as dengue according to the World Health Organization's case definition (1997 or 2009, as appropriate). Thus, CO-RF detected 90 deaths from dengue, which were not suspected during disease progression. This CO-RF protocol, through a combined effort of the surveillance and laboratory teams, increased the detection of fatal dengue cases by 5-fold. This is the largest series of autopsies performed in cases of death related to dengue in the world to date., (© The American Society of Tropical Medicine and Hygiene.)

The predatory mite Neoseiulus paspalivorus (De Leon) is often found in association with the coconut mite, Aceria guerreronis Keifer. The identification of natural enemies is essential for the definition of biological control strategies. Therefore, the present study aimed to confirm whether the mite populations from different Northeastern Brazilian states identified as N. paspalivorus belong to the same species. This determination was accomplished through the study of morphometric variability in 33 anatomical characters and of molecular variability in two DNA fragments: Internal Transcribed Spacer (ITS) rDNA and cytochrome c oxidase subunit I (COI) mtDNA. This study also determined whether there is reproductive isolation between the two most morphologically distinct populations (Rio Grande do Norte and Paraíba). Intraspecific morphometric variability was observed among the five populations of N. paspalivorus. Despite this variability, the crosses and backcrosses of the most morphologically distinct populations did not show reproductive incompatibility. The molecular analysis indicated the absence of genetic differences among the N. paspalivorus populations for the ITS fragment. Three haplotypes were identified for the COI fragment, and the genetic distance ranged from 0 to 0.2 %. Despite the morphometric differences, the results of the molecular and biological analysis corroborate the previous identification of N. paspalivorus for all of the studied populations. The present study contributes to the systematics of Phytoseiidae predatory mites and to the biological control of A. guerreronis by the accurate identification and characterization of one of its main natural enemies along extensive areas in Brazil.

Amblyseius largoensis (Muma) (Acari: Phytoseiidae) and Euseius alatus De Leon (Acari: Phytoseiidae) are predatory mites that are mostly found on leaves and on the exposed fruit surface of coconut plants. Their morphology hampers the access to the microhabitat occupied by Aceria guerreronis Keifer (Acari: Eriophyidae), the most important pest of coconut fruits throughout the world. However, it was suggested that they can prey on A. guerreronis under natural conditions when this pest leaves its refuge to disperse. Since the trophic interactions between A. largoensis or E. alatus and A. guerreronis are unknown, we compare the frequencies of occurrence of A. largoensis and E. alatus under the bracts of coconut fruits and on coconut leaflets. In addition, because phytoseiids feed by liquid ingestion, we used molecular analysis to confirm the potential role of A. largoensis or E. alatus as predators of A. guerreronis and to assess how fast the A. guerreronis DNA fragment is degradated in the A. largoensis digestive tract. Our study demonstrated that E. alatus was only present on coconut leaflets whereas A. largoensis was found mostly on leaflets and, to a much lesser extent, under the bracts of coconuts. Species-specific ITS primers designed for A. guerreronis were shown to have a high degree of specificity for A. guerreronis DNA and did not produce any PCR product from DNA templates of the other insects and mites associated with the coconut agroecosystem. Based on molecular analysis, we confirmed that the predatory mites, A. largoensis and E. alatus, had preyed on the coconut mite in the field. Overall the predatory mites collected in the field exhibited low levels of predation (26.7% of A. largoensis and 8.9% of E. alatus tested positive for A. guerreronis DNA). The fragment of A. guerreronis DNA remained intact for a very short time (no more than 6 h after feeding) in the digestive tract of A. largoensis.

Introduction: The dengue classification proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic., Methods: This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations., Results: The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121) of the cases were classified as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121) of the cases were classified as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF., Conclusions: The WHO 2009 classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue.

Cryptic diversity has been confirmed for several phytophagous mites in the Eriophyoidea superfamily previously considered as presenting low host specificity. Among generalist eriophyoids is the phytoptid Retracrus johnstoni Keifer, which has been reported in 19 palm species belonging to 11 genera, causing severe damage on some of them. Surprisingly this species was recently reported on another monocot family, Heliconiaceae, infesting Heliconia plants in Costa Rica and Brazil, being the only in the tribe Mackiellini to not be associated with palm trees. This study aimed to investigate the occurrence of cryptic species in R. johnstoni and to clarify the taxonomic status of populations associated with heliconias in the Americas. With this purpose traditional and geometric morphometric analyses were conducted as well as a detailed morphological study. Measurable trait data were analysed via univariate and multivariate analyses. Shapes of specimens from different populations were compared via geometric morphometric landmark methods. Morphometric analysis supported occurrence of at least two cryptic species previously identified as R. johsntoni and suggested occurrence of cryptic species among populations associated with different palm trees. Taxonomic descriptions of two new taxa associated with heliconias, namely Retracrus costaricensis n. sp. Ferreira and Navia and Retracrus heliconiae n. sp. Ferreira and Navia are presented. Morphometric traits that can be useful in the taxonomic identification are noted and their value is discussed. Results of the traditional morphometry and geometric methods were compared and the advantages of their joint use for Eriophyoidea systematics are discussed.

Synthetic pesticide use has been the dominant form of pest control since the 1940s. However, biopesticides are emerging as sustainable pest control alternatives, with prevailing use in organic agricultural production systems. Foremost among botanical biopesticides is the limonoid azadirachtin, whose perceived environmental safety has come under debate and scrutiny in recent years. Coconut production, particularly organic coconut production, is one of the agricultural systems in which azadirachtin is used as a primary method of pest control for the management of the invasive coconut mite, Aceria guerreronis Keifer (Acari: Eriophyidae). The management of this mite species also greatly benefits from predation by Neoseiulus baraki (Athias-Henriot) (Acari: Phytoseiidae). Here, we assessed the potential behavioral impacts of azadirachtin on the coconut mite predator, N. baraki. We explored the effects of this biopesticide on overall predator activity, female searching time, and mating behavior and fecundity. Azadirachtin impairs the overall activity of the predator, reducing it to nearly half; however, female searching was not affected. In contrast, mating behavior was compromised by azadirachtin exposure particularly when male predators were exposed to the biopesticide. Consequently, predator fecundity was also compromised by azadirachtin, furthering doubts about its environmental safety and selectivity towards biological control agents.

The red palm mite, Raoiella indica Hirst (Acari: Tenuipalpidae), was recently introduced in the Americas. It spread quickly throughout coconut palm growing areas, expanding considerably its host range. The invasion of this species has caused high economic impact in several countries. In Brazil, extensive areas are expected to be affected. For logistical reasons and other concerns, chemical control does not seem desirable for the control of this pest in most Latin American countries. Biological control of R. indica by introducing exotic natural enemies seems to be an important control measure to be considered. Surveys in many countries have shown that Amblyseius largoensis (Muma) (Acari: Phytoseiidae) is a very common predator on coconut palms. This study compared the biology of a population of A. largoensis found for a long time in association with R. indica in La Reunion Island (Indian Ocean) with a population from Roraima State (northern Brazil), where R. indica was first found about two and a half years ago. No significant differences were observed between populations in relation to the duration of different immature stages or total survivorship. However, the oviposition period, prey consumption and net reproductive rate were significantly higher for the La Reunion population, warranting further investigation to determine whether that population should be released in Roraima to control the pest.

Aceria guerreronis Keifer is a major coconut pest in the Americas, Africa and some Asian countries, and occurs in high population levels in northeastern Brazil. The determination of the climatic conditions that favorably affect its population growth and the prevalence and abundance of predatory mites can promote more efficient control practices. Our objective was to evaluate the pattern of occurrence and population dynamics of A. guerreronis, their associated predators and other mites during a 2 year period in a hybrid coconut plantation in the municipality of Una, state of Bahia, northeastern Brazil. Monthly samples of fruits were taken from June 2008 to May 2010 for qualitative and quantitative evaluation of mites. Aceria guerreronis represented 99.9 % of the mites. An average density of 1,117 mites per fruit and a maximum of 23,596 mites per fruit indicated that the level of infestation can be high in Bahia. Bdella ueckermanni Hernandes, Daud and Feres was the most abundant and frequent predator. Population increase of A. guerreronis was directly related to the temperature rise and inversely related to both the increase of air relative humidity and rainfall. The highest population densities occurred from November to March. The largest A. guerreronis populations occurred in fruits with 32 and 48 % of damaged surface. The relationship between prevailing wind direction and incidence of A. guerreronis could not be corroborated or refuted.

Aceria guerreronis Keifer (Acari: Eriophyidae) is considered a major pest of coconut in many countries in the Americas, Africa and parts of Asia. Neoseiulus baraki Athias-Henriot (Acari: Phytoseiidae) is one of the predatory mites most commonly found in association with A. guerreronis in parts of northeast Brazil. The objective of this work was to study the distribution of A. guerreronis and N. baraki among and within coconut bunches. The hypothesis was tested that A. guerreronis and N. baraki are homogenously distributed over the fruits in a bunch, independent of the fruits' age and position. Five collections of bunches, each corresponding to leaves 12-16 from apex (about 2-6 month-old), were conducted in each of three fields in northeastern Brazil, from February to October, 2007. A total of 1,986 fruits were examined. The number of mites, the percentage of fruits hosting them and the level of damage caused by A. guerreronis were evaluated. The highest density of A. guerreronis was observed on fruits of bunch 4 whereas the highest density of N. baraki was observed on bunch 5. Considering all fruits together, no significant differences were observed between densities of either A. guerreronis or N. baraki among the basal, median and apical thirds of the bunches. In younger bunches, fruits of the apical region tend to have lower densities of both mites than fruits of the basal region. This pattern, in association with a similar pattern for the percentage of fruits hosting N. baraki, suggests that the predator initially reaches the basal bunch region, from where it moves to the apical region. The results of the present study suggest that the pest population reduction in bunches older than bunch 4 could be due to (1) an effect of the predator, (2) reduction of the proportion of undamaged tissues amenable to attack, and/or (3) less favorable characteristics of the fruits to attack by A. guerreronis, as indicated by their increasing lignin content as they get older.

The presence of the red palm mite, Raoiella indica Hirst, is reported for the first time in Brazil. This invasive mite was found in July 2009 infesting coconut palms and bananas in urban areas of Boa Vista, State of Roraima, in northern Brazil. Comments on the possible pathways of R. indica into the country, present and potential impact of its introduction and mitigating measures to prevent or to delay the mite spread in Brazil are presented.

Aceria guerreronis Keifer (Acari: Eriophyidae) is a major pest of coconut fruits (Cocos nucifera L.) in many countries of the Americas, Africa, and parts of Asia. Considerable attention has been given to studies of biological control agents of A. guerreronis. Proctolaelaps bulbosus Moraes, Reis and Gondim Jr. is a predator recently discovered in association with A. guerreronis. Nothing is known about its biology. The aim of this study was to determine suitable food sources for P. bulbosus, among items commonly found on coconut fruits, including A. guerreronis. Food sources evaluated included the mites A. guerreronis, Steneotarsonemus concavuscutum Lofego and Gondim Jr., and Tyrophagus putrescentiae (Schrank), the fungus Rhizopus aff. stolonifer (Ehrenb.) Vuill and coconut pollen; the mite Tetranychus urticae Koch was also included in the assessments, for being a commonly used prey for mass production and laboratory rearing of predatory mites. Proctolaelaps bulbosus was able to develop up to adulthood when fed A. guerreronis, R. aff. stolonifer and T. putrescentiae. It had the highest population growth rates when feeding on the former (R (o) = 17.5; r (m) = 0.392). These results indicate that A. guerreronis is the most suitable food for P. bulbosus among the possible food sources found on coconut fruits and that P. bulbosus can survive in the absence of eriophyid using R. aff. stolonifer as a food source.

Introduction: Chronic pelvic pain is a disease that directly affects the social and professional lives of women., Objective: To estimate the prevalence of this clinical condition and to identify independent factors associated with it in women living in Ribeirão Preto, Brazil., Methods: A one-year cross-sectional study was conducted in a population sample of 1,278 women over the age of 1,278 women over the age of 14 years. The target population was predominantly composed of women who are treated by the public health system. The questionnaire was administered by interviewers who were not linked to the city health care programs. The prevalence of the morbidity was estimated. First, we identified the significant variables associated with pelvic pain (p<0.10) and then we attributed values of 0 or 1 to the absence or presence of these variables. Logistic regression analysis was used to identify and estimate the simultaneous impact of the independent variables. The results were expressed by odds ratio and their 95% confidence interval with p<0.05., Results: The disease was found in 11.5% (147/1,278) of the sample. The independent predictors were dyspareunia, previous abdominal surgery, depression, dysmenorrhea, anxiety, current sexual activity, low back pain, constipation, urinary symptoms, and low educational level., Conclusion: The prevalence of chronic pelvic pain in Ribeirão Preto is high and is associated with conditions that can usually be prevented, controlled, or resolved by improvement of public health policies and public education.

Aceria guerreronis Keifer can cause severe damage to coconuts in several countries around the world. Rare studies have been conducted to determine the predatory mites associated with A. guerreronis in Brazil. The study evaluated the prevalence of A. guerreronis and associated predators on the bracts and on the surface of the fruits underneath the bracts, for 12 months, on coconut palms grown along the coast of the States of Alagoas, Paraíba and Pernambuco, Northeastern Brazil. Mites of 10 families were found, but by far the most abundant species was A. guerreronis, corresponding to 99.5% of the mites collected. The prevailing species amongst the predators were the Phytoseiidae mites Neoseiulus baraki (Athias-Henriot) and Neoseiulus paspalivorus (De Leon). These are flat mites that have short limbs, characteristics that allow them to invade the main habitat occupied by A. guerreronis. Other predators were found, but in low numbers, due mainly to their difficulty in reaching the fruit areas most inhabited by A. guerreronis. However, these mites could prey on that pest when it leaves its preferred habitat to disperse. No significant correlations were observed between the levels of abiotic factors and the population levels of A. guerreronis or of the phytoseiids associated with it. This probably occurred due to the simultaneous and conflicting effects of those factors on the mites in the field, or to significant differences between the climatic factors measured in the environment and those prevailing in the habitat occupied by A. guerreronis.

Coconut is an important crop in tropical and subtropical regions. Among the mites that infest coconut palms, Aceria guerreronis Keifer is economically the most important. We conducted surveys throughout the coconut growing areas of Brazil. Samples were taken from attached coconuts, leaflets, fallen coconuts and inflorescences of coconut palms in 112 localities aiming to determine the occurrence and the distribution of phytophagous mites, particularly A. guerreronis, and associated natural enemies. Aceria guerreronis was the most abundant phytophagous mite followed by Steneotarsonemus concavuscutum Lofego & Gondim Jr. and Steneotarsonemus furcatus De Leon (Tarsonemidae). Infestation by A. guerreronis was recorded in 87% of the visited localities. About 81% of all predatory mites belonged to the family Phytoseiidae, mainly represented by Neoseiulus paspalivorus De Leon, Neoseiulus baraki Athias-Henriot and Amblyseius largoensis Muma; 12% were Ascidae, mainly Proctolaelaps bickleyi Bram, Proctolaelaps sp nov and Lasioseius subterraneus Chant. Neoseiulus paspalivorus and N. baraki were the most abundant predators on attached coconuts. Ascidae were predominant on fallen coconuts, while A. largoensis was predominant on leaflets; no mites were found on branches of inflorescences. Leaflets harboured higher mite diversity than the attached coconuts. Mite diversity was the highest in the state Pará and on palms surrounded by seasonal forests and Amazonian rain-forests. Neoseiulus paspalivorus, N. baraki and P. bickleyi were identified as the most promising predators of A. guerreronis. Analyses of the influence of climatic factors revealed that dry ambient conditions favour the establishment of A. guerreronis. Neoseiulus paspalivorus and N. baraki have differing climatic requirements; the former being more abundant in warm and dry areas, the latter prevailing in moderately tempered and humid areas. We discuss the significance of our findings for natural and biological control of A. guerreronis.

This qualitative study aimed to understand how women having an abortion experience the nursing care they receive. The statements of 13 hospitalized women were analyzed through content analysis. The central category "Nursing care experienced in situations of abortion" was constituted from 4 subcategories: care centered in physical needs; fear of judgment in abortion situations; legal aspects defining care; the need for support in abortion situations. These women identified nursing care as based on physical aspects, without contemplating their individuality and specificities. Results indicated the need to create an environment that stimulates listening, helping these women to elaborate their feelings and allowing professionals to behave closer to these women's reality, in order to reduce their own desires and conflicts and contemplate the integrality of care.