Spatial analysis of pneumococcal meningitis in São Paulo in the pre- and post-immunization era

OBJECTIVE: To analyze the pneumococcal meningitis incidence rates in the State of São Paulo, Brazil, by age group, municipalities and micro-regions, as well as the spatial distribution of pneumococcal meningitis incidence rates among children under 5 years old in the pre- (2005–2009) and post-vaccination (2011–2013) periods and its associations with socioeconomic variables and vaccination coverage. METHODS: The data source was the Brazilian Notifiable Diseases Information System. For the pre- and post-vaccination periods, thematic maps were built for pneumococcal meningitis incidence in under-5 children, by São Paulo state micro-regions, vaccination coverage and socioeconomic variables, using QGIS 2.6.1 software. Scan statistics performed by the SatScan 9.2 software were used to analyze spatial and spatiotemporal clusters in São Paulo municipalities and micro-regions. A Bayesian inference for latent Gaussian model with zero-inflated Poisson model through the integrated nested Laplace approximation was used in the spatial analysis to evaluate associations between pneumococcal meningitis incidence rates and socioeconomic variables of interest in São Paulo micro-regions. RESULTS: From 2005 to 2013, 3,963 pneumococcal meningitis cases were reported in São Paulo. Under-5 children were the most affected in the whole period. In the post-vaccination period, pneumococcal meningitis incidence rates decreased among this population, particularly among infants (from 4.17/100,000 in 2005 to 2.54/100,000 in 2013). Two clusters were found in pre-vaccination – one of low risk for pneumococcal meningitis, in the northwest of the state (OR = 0.45, p = 0.0003); and another of high risk in the southeast (OR = 1.62, p = 0.0000). In the post-vaccination period, only a high-risk cluster remained, in the southeast (RR = 1.97, p = 0.0570). In Bayesian analysis, wealth was the only variable positively associated to pneumococcal meningitis (RR = 1.026, 95%CI 1.002–1.052). CONCLUSIONS: Pneumococcal meningitis is probably underdiagnosed and underreported in São Paulo. Differentiated rates of pneumococcal meningitis diagnosis and reporting in each microregion, according to the São Paulo Index of Social Responsibility, might explain our results

Níveis elevados de transaminases em um caso de coledocolitíase: a importância do reconhecimento deste padrão

Case report of a 34-year-old healthy woman diagnosed with symptomatic choledocholithiasis associated with elevated results of transaminases without hepatic disease. High levels of these enzymes can occur in choledocholithiasis cases without further causes of liver injury. Clinicians must be aware of this phenomenon, avoiding unnecessary investigation and its consequences.Relato de caso de uma mulher hígida de 34 anos de idade diagnosticada com coledocolitíase sintomática associada a elevados níveis de transaminases, sem doença hepática. Altos valores destas enzimas podem ocorrer na coledocolitíase sem outra causa de lesão hepática concomitante. Os médicos devem estar atentos a este fenômeno, a fim de se evitar investigação desnecessária e suas consequências

Testicular Morphological and Ultrasonographic Characterization of Male Gray Brocket Deers (Mazama gouazoubira) in Different Reproductive Status

Background: Gray brocket deer (Mazama gouazoubira) populations have been declining due to human intervention. Yet, only a few studies have assessed ultrasonographic testicular characteristics in cervids. Considering the relevance of monitoring testicular size, blood flow, and parenchyma, the present study aims to establish baseline information on scrotal circumference, testicular volume, and spectral Doppler parameters, to describe differences among adult male gray brocket deer in different reproductive status, and to correlate ultrasound parameters with testes size measurements.Materials, Methods & Results: Six adult male gray brocket deers were used in the study. Scrotal circumference and testicular volume were measured. B mode ultrasound images of testes (longitudinal and cross-sectional views) and epididymes were subjected to computer-assisted analysis, obtaining the numerical pixel values (NPV) and pixel standard deviation (PSD). Using spectral Doppler, supratesticular artery blood flow velocities (peak systolic velocity - PSV, end diastolic velocity - EDV, time-average maximum velocity - TAMAX, resistivity - RI and pulsatility indices - PI) were obtained. Semen was analyzed through total motility, vigor, and concentration tests. Three animals were normospermic (F+ group) and three were oligo/azoospermic (F- group). Groups were compared using were compared using a one-way ANOVA or Kruskal-Wallis followed by Student-Newman-Keuls (SNK) test. Ultrasound parameters were correlated to testes size parameters using Pearson’s correlation for parametric variables and Spearman’s correlation for non-parametric variables. F+ group presented significantly higher scrotal circumference (14.57 ± 1.19 cm), testicular volume (26.18 ± 4.94 cm3), and testes cross-sectional NPV (69.88 ± 24.00) and PSD (10.78 ± 3.42) than group F- (NPV: 28.26 ± 13.75, PSD: 6.70 ± 1.84). No significant differences were observed between the groups regarding the spectral Doppler ultrasound parameters. Significant correlations were observed between scrotal circumference and longitudinal (r = 0.76) and cross-sectional testes NPV (r = 0.89), and testicular volume was correlated with longitudinal (r = 0.78) and cross-sectional testes NPV (r = 0.91) and with cross-sectional testes PSD (ρ = 0.82).Discussion: Increased testicular echogenicity (higher NPV) has been positively associated with improved testicular growth, cell population expansion, inner and outer seminiferous tubules diameter, spermatids percentages and testis weight. In addition, more heterogenous testes (higher PSD) were associated with higher sperm output. It was suggested that the animals in group F- had compromised testicular development and spermatogenesis. The correlation observed between testes NPV and scrotal circumference was proposed to be associated with seminiferous tubules impairment. The F- group showed lower testicular volume, NPVs and PSDs in cross-sectional testicular images, suggesting higher protein levels and lower lipid contents were present in their parenchyma, influencing in testicular echogenicity and echotexture. No differences in spectral Doppler parameters were observed between the two groups. Also observed in stallions. However, PSV, EDV, TAMAX could be potential infertility indicators in other mammalians. These different results may be due to different locations of the evaluated vessel, species and techniques, age, ambient temperature, pathological conditions, and anaesthesia. Thus, it is suggested that scrotal circumference, testicular volume, and testes NPV are good indicators of male reproductive health in gray brocket deer and may help with better male selection in the species

Diet and helminth parasites of freshwater turtles Mesoclemmys tuberculata, Phrynops geoffroanus (Pleurodira: Chelidae) and Kinosternon scorpioides (Criptodyra: Kinosternidae) in a semiarid region, Northeast of Brazil

In this study, the Kinosternon scorpioides, Mesoclemmys tuberculata and Phrynops geoffroanus freshwater turtles collected in the Cariús River, State of Ceará, were analysed as to their diet composition and presence of helminths. Among the 63 examined turtles 55 (87.3%) were parasitized. We found three Nematoda species (Physaloptera retusa, Serpinema monospiculatus and Spiroxys figueiredoi) and one Trematoda species (Gorgoderina sp.). Phrynops geoffroanus had the highest indexes of prevalence (97.56%) and mean intensity of infection (33.5), followed by M. tuberculata (70% and 12.64, respectively) and K. scorpioides (50% and three, respectively). Host body size was positively related to helminths abundance in both male and female Chelidae species. A significant difference in helminths abundance between the sexes was found only in P. geoffroanus, where females had more parasites than males. Regarding diet, the main food items ingested by M. tuberculata were Odonata nymphs (Aeshnidae and Libellulidae), whilst P. geoffroanus feeds mainly on Diptera larvae (Chironomidae), Odonata nymph (Aeshnidae) and Notonectidae, and only seeds were found in the stomach contents of K. scorpioides. Here, we present the first record of S. monospiculatus parasitizing K. scorpioides, Gorgoderina sp. and P. retusa were reported for the first time in P. geoffroanus, and M. tuberculata represents a new host to P. retusa and S. figueiredoi

MANEJO DA HIPERTENSÃO ARTERIAL NA ATENÇÃO PRIMÁRIA

Discuss through scientific evidence about the management of high blood pressure in primary health care. Methods: This is an integrative review of qualitative literature. The search for the works involved in the research was carried out in the following databases: SCIELO, LILACS, BDENF and MEDLINE, based on the descriptors in health sciences: “Management”, “Primary health care” and “Hypertension”. The inclusion criteria were: published between 2014 and 2024, with free access to the journal for full texts, articles in Portuguese, English and Spanish and related to the topic. Exclusion criteria were: duplicate, incomplete articles, summaries, reviews, debates, articles published in event annals and unavailable in full. Results: This is an integrative review of qualitative literature. The search for the works involved in the research was carried out in the following databases: SCIELO, LILACS, BDENF and MEDLINE, based on the descriptors in health sciences: “Management”, “Primary health care” and “Hypertension”. The inclusion criteria were: published between 2014 and 2024, with free access to the journal for full texts, articles in Portuguese, English and Spanish and related to the topic. Exclusion criteria were: duplicate, incomplete articles, summaries, reviews, debates, articles published in event annals and unavailable in full. Conclusion: Hypertensive patients and their families must be well informed and in tune with these guidelines to ensure that blood pressure levels remain within normal limits. Health education is fundamental to expanding patients' knowledge, improving their quality of life. Furthermore, this education encourages the empowerment of individuals in self-care and promotes active participation in their own treatment process. With these approaches, it is possible to achieve more effective control of hypertension and a significant improvement in the health and well-being of patients.Discutir por meio das evidências cientificas acerca do manejo da hipertensão arterial na atenção primária a saúde. Métodos: Trata-se de uma revisão integrativa da literatura de caráter qualitativo. A busca dos trabalhos envolvidos na pesquisa foi realizada nas seguintes bases de dados: SCIELO, LILACS, BDENF e MEDLINE, a partir dos descritores em ciências da saúde: “Manejo”, “Atenção primária à saúde” e “Hipertensão”. Os critérios de inclusão foram: publicados no período entre 2014 e 2024, cujo acesso ao periódico era livre aos textos completos, artigos em idioma português, inglês e espanhol e relacionados a temática. Critérios de exclusão foram: artigos duplicados, incompletos, resumos, resenhas, debates, artigos publicados em anais de eventos e indisponíveis na íntegra. Resultados: É essencial instruir todos os hipertensos sobre a importância de reduzir o consumo de alimentos rico em sódio e incorporar exercícios físicos regulares em suas rotinas, já que a maioria não segue essas diretrizes. Embora a prática de exercícios físicos seja a mais comum entre as recomendações, ela ainda não é amplamente adotada por todos. Conclusão: Os hipertensos e seus familiares devem estar bem informados e em sintonia com essas orientações para garantir que os níveis de pressão arterial permaneçam dentro dos padrões normais. A educação em saúde é fundamental para ampliar o conhecimento dos pacientes, melhorando sua qualidade de vida. Ademais, essa educação fomenta o empoderamento dos indivíduos no autocuidado e promove uma participação ativa no seu próprio processo de tratamento. Com essas abordagens, é possível obter um controle mais eficaz da hipertensão e uma melhora significativa na saúde e bem-estar dos pacientes

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Identification of heavy-flavour jets with the CMS detector in pp collisions at 13 TeV

Many measurements and searches for physics beyond the standard model at the LHC rely on the efficient identification of heavy-flavour jets, i.e. jets originating from bottom or charm quarks. In this paper, the discriminating variables and the algorithms used for heavy-flavour jet identification during the first years of operation of the CMS experiment in proton-proton collisions at a centre-of-mass energy of 13 TeV, are presented. Heavy-flavour jet identification algorithms have been improved compared to those used previously at centre-of-mass energies of 7 and 8 TeV. For jets with transverse momenta in the range expected in simulated $\mathrm{t}\overline{\mathrm{t}}$ events, these new developments result in an efficiency of 68% for the correct identification of a b jet for a probability of 1% of misidentifying a light-flavour jet. The improvement in relative efficiency at this misidentification probability is about 15%, compared to previous CMS algorithms. In addition, for the first time algorithms have been developed to identify jets containing two b hadrons in Lorentz-boosted event topologies, as well as to tag c jets. The large data sample recorded in 2016 at a centre-of-mass energy of 13 TeV has also allowed the development of new methods to measure the efficiency and misidentification probability of heavy-flavour jet identification algorithms. The heavy-flavour jet identification efficiency is measured with a precision of a few per cent at moderate jet transverse momenta (between 30 and 300 GeV) and about 5% at the highest jet transverse momenta (between 500 and 1000 GeV)