Understanding the clinical spectrum of complicated Plasmodium vivax malaria: a systematic review on the contributions of the Brazilian literature

The resurgence of the malaria eradication agenda and the increasing number of severe manifestation reports has contributed to a renewed interested in the Plasmodium vivax infection. It is the most geographically widespread parasite causing human malaria, with around 2.85 billion people living under risk of infection. The Brazilian Amazon region reports more than 50% of the malaria cases in Latin America and since 1990 there is a marked predominance of this species, responsible for 85% of cases in 2009. However, only a few complicated cases of P. vivax have been reported from this region. A systematic review of the Brazilian indexed and non-indexed literature on complicated cases of vivax malaria was performed including published articles, masters' dissertations, doctoral theses and national congresses' abstracts. The following information was retrieved: patient characteristics (demographic, presence of co-morbidities and, whenever possible, associated genetic disorders); description of each major clinical manifestation. As a result, 27 articles, 28 abstracts from scientific events' annals and 13 theses/dissertations were found, only after 1987. Most of the reported information was described in small case series and case reports of patients from all the Amazonian states, and also in travellers from Brazilian non-endemic areas. The more relevant clinical complications were anaemia, thrombocytopaenia, jaundice and acute respiratory distress syndrome, present in all age groups, in addition to other more rare clinical pictures. Complications in pregnant women were also reported. Acute and chronic co-morbidities were frequent, however death was occasional. Clinical atypical cases of malaria are more frequent than published in the indexed literature, probably due to a publication bias. In the Brazilian Amazon (considered to be a low to moderate intensity area of transmission), clinical data are in accordance with the recent findings of severity described in diverse P. vivax endemic areas (especially anaemia in Southeast Asia), however in this region both children and adults are affected. Finally, gaps of knowledge and areas for future research are opportunely pointed out

Resection of myxoma in the left ventricle after embolic stroke

Cardiac myxoma is the most common primary tumor of the heart. The tumor is located mainly in the left atrium but can arise from any heart chamber. Clinical symptoms are variable but dyspnea and embolism are the most frequent. We report a case of a young man that had embolic ischemic stroke caused by a large left ventricular myxoma. The patient underwent surgery three weeks after the stroke. The tumor was carefully resected without fragmentation. Surgical treatment was effective. We emphasize the rarity of this location together with a review of the current literature.23457858

Aspectos epidemiológicos de um foco de malária no município de São Luis, MA Epidemilogical aspects of a malaria focus in the districts of São Luis, MA

O estudo foi realizado na localidade de Residencial Paraíso, São Luis, Maranhão, de 1999 a 2001, com o objetivo de analisar os aspectos epidemiológicos da malária, tendo sido constatado que a localidade é receptiva e vulnerável. Houve 129 casos, com maior acometimento do sexo masculino e da faixa etária de 20 a 29 anos. O Plasmodium vivax foi o agente responsável pelas infecções, tendo como vetor o Anopheles aquasalis. Foram identificadas evidências de transmissão extradomiciliar.<br>The study was developed in the neighborhood of Residencial Paraíso, São Luis, Maranhão, Brazil, from 1999 to 2001. The aim was to analyze the epidemiological aspects of malaria. The location is receptive and vulnerable to malaria. There were 129 cases. Men from 20 to 29 years of age were most involved. Plasmodium vivax was the agent of all cases and Anopheles aquasalis was the vector. There was no evidence of transmission occurring outside of the houses

Homens e violência conjugal: uma análise de estudos brasileiros Men and conjugal violence: an analysis of Brazilian studies

O estudo analisou qualitativamente 54 textos brasileiros sobre homens e violência conjugal, relacionados a atividades de pesquisa ou de intervenção. Primeiramente caracterizou-se o material quanto aos temas abordados, ao foco principal e ao tipo de texto. A seguir fizeram-se sínteses e análises das principais considerações dos textos a partir dos eixos temáticos encontrados: diferentes inteligibilidades da problemática, magnitude da violência conjugal, sentidos de homens relacionados à violência e intervenções e/ou políticas junto a homens agressores. A análise teve como parâmetro o ramo de discussões nacionais e internacionais que se esforça por ultrapassar a polêmica em torno da definição do problema como "violência de gênero" ou "violência conjugal", cunhando sobretudo o pressuposto de que existem diversos estilos de conjugalidade violenta. Concluiu-se que a maior unanimidade dos estudos é pensar a problemática como questão relacional de gênero. Defendeu-se, por fim, a ideia de que a escolha da melhor abordagem articuladora entre os polos da polêmica ainda demanda mais investigações, com metodologias qualitativas junto a atores de diferentes camadas e grupos sociais. Quanto às intervenções, propõem-se investimentos no maior número possível de alternativas, valorizando a singularidade dos casos.<br>This study consisted of a qualitative analysis of 54 Brazilian texts about men and conjugal violence related to research or intervention activities. Initially, the material was divided up according to the topics under scrutiny, the main focus and the type of text. Analysis and synthesis of the main considerations of the texts, based on the thematic points revealed, was then carried out. This included the different approaches to the problem, the magnitude of conjugal violence, the attitudes of men vis-à-vis violence and interventions and/or policies towards male aggressors. The parameter for the analysis was the national and international debate seeking to overcome the controversy surrounding the definition of the problem as "gender violence" or conjugal violence," essentially fostering the hypothesis of various types of violent conjugal relationships. It was concluded that the unanimous outcome of the study was to view the problem as a gender relationship issue. Lastly, it was argued that the choice of the best approach between the poles of the controversy requires further investigation using qualitative methodologies together with players from different classes and social backgrounds. With respect to further intervention, it was considered necessary to examine a broad gamut of alternatives emphasizing the singular nature of the cases

Speciation and demographic history of Atlantic eels (Anguilla anguilla and A. rostrata) revealed by mitogenome sequencing

Processes leading to speciation in oceanic environments without obvious physical barriers remain poorly known. European and American eel (Anguilla anguilla and A. rostrata) spawn in partial sympatry in the Sargasso Sea. Larvae are advected by the Gulf Stream and other currents towards the European/North African and North American coasts, respectively. We analyzed 104 mitogenomes from the two species along with mitogenomes of other Anguilla and outgroup species. We estimated divergence time between the two species to identify major events involved in speciation. We also considered two previously stated hypotheses: one where the ancestral species was present in only one continent but was advected across the Atlantic by ocean current changes and another where population declines during Pleistocene glaciations led to increasing vicariance, facilitating speciation. Divergence time was estimated to ∼3.38 Mya, coinciding with the closure of the Panama Gateway that led to reinforcement of the Gulf Stream. This could have advected larvae towards European/North African coasts, in which case American eel would be expected to be the ancestral species. This scenario could, however, not be unequivocally confirmed by analyses of dN/dS, nucleotide diversity and effective population size estimates. Extended bayesian skyline plots showed fluctuations of effective population sizes and declines during glaciations, and thus also lending support to the importance of vicariance during speciation. There was evidence for positive selection at the ATP6 and possibly ND5 genes, indicating a role in speciation. The findings suggest an important role of ocean current changes in speciation of marine organisms