First record of feather-loss disorder in Antarctic penguins

Little is known about diseases affecting Antarctic wildlife (Kerry & Riddle 2009). Understanding the patterns, causes and effects of disease in these populations is crucial as many of these species are already threatened by rapid environmental changes brought about by climate change and increases in human activity. Although Antarctic penguins are one of the best studied organisms on the continent in terms of health, the published information is also scarce and fragmented (Barbosa & Palacios 2009). This paper reports for the first time, a new disease present in Antarctic penguins, the feather-loss disorder. The feather-loss disorder is characterized by premature loss of feathers resulting in exposed skin.In penguins, the disorder was first observed in African penguin (Spheniscus demersus (L)) chicks, both in captivity and the wild in 2006 and 2008, respectively, and in Magellanic penguins (S. magellanicus (Forster, 1781)) in 2007 (Kane et al. 2010). The cause is still uncertain but avian polyomavirus, the beak and feather disease virus or a bacterial pathogen have been proposed as potential agentsFil: Barbosa, Andrés. Consejo Superior de Investigaciones Científicas; España. Museo Nacional de Ciencias Naturales. Departamento de Ecología Evolutiva; EspañaFil: Colominas Ciuró, Roger. Consejo Superior de Investigaciones Científicas; España. Museo Nacional de Ciencias Naturales. Departamento de Ecología Evolutiva; EspañaFil: Coria, Néstor Rubén. Ministerio de Relaciones Exteriores, Comercio Interno y Culto. Dirección Nacional del Antártico. Instituto Antártico Argentino; ArgentinaFil: Centurión, Mara. Ministerio de Relaciones Exteriores, Comercio Interno y Culto. Dirección Nacional del Antártico. Instituto Antártico Argentino; ArgentinaFil: Sandler, Rosana Veronica. Ministerio de Relaciones Exteriores, Comercio Interno y Culto. Dirección Nacional del Antártico. Instituto Antártico Argentino; ArgentinaFil: Negri, Agustina. Ministerio de Relaciones Exteriores, Comercio Interno y Culto. Dirección Nacional del Antártico. Instituto Antártico Argentino; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Santos, Mercedes. Ministerio de Relaciones Exteriores, Comercio Interno y Culto. Dirección Nacional del Antártico. Instituto Antártico Argentino; Argentin

Seronegative human T-cell lymphotropic virus 1 carriers in blood banks: A potential viral source for silent transmission?

Background and Objectives: Transfusion-transmitted viruses count among the greatest threats to blood safety. In Argentina, current laws oblige testing all donated blood for the presence of antibodies against human T-cell lymphotropic viruses 1 and 2 (HTLV-1/2). In endemic zones of the country, a high rate of seronegative HTLV-1 individuals with clear evidence of infection because of symptoms and/or presence of tax sequences of HTLV-1 and/or IgG anti-Tax antibodies has been recently described. Migration from endemic to nonendemic zones of Argentina is very frequent. Materials and Methods: During a 1-year period, in the blood bank of Córdoba city, we performed molecular screening of all donors who were born in or arose from endemic zones for HTLV-1/2 in Argentina and neighbouring countries. Results: By screening 219 bp of HTLV-1/2 tax gene, 0.6% (2/317) of the blood donors proved to be positive for HTLV-1 tax sequence. One of the donors presented anti-Tax antibodies, demonstrating the transcriptional activity of the tax gene, and the other donor was also positive for LTR and pol gene sequences. The HTLV-1 genetic analysis of the LTR sequence determined that it belonged to the Cosmopolitan subtype HTLV-1aA. Conclusion: These findings suggest potential limitations of some currently approved screening assays for HTLV-1 detection applied in some donor populations and the possibility of an HTLV-1 seronegative carrier state with the potential for silent transmission by blood.Fil: Frutos, Maria Celia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Virología Dr. J. M. Vanella; ArgentinaFil: Blanco, Sebastian. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Virología Dr. J. M. Vanella; Argentina. Fundacion Banco Central de Sangre; ArgentinaFil: Balangero, Marcos Cesar. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Virología Dr. J. M. Vanella; ArgentinaFil: Carrizo, Luis Horacio. Fundacion Banco Central de Sangre; ArgentinaFil: Santos Rocha, Anderson. Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas; Brasil. Interdisciplinary HTLV Research Group; BrasilFil: Figueiredo Barbosa Stancioli, Edel. Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas; Brasil. Interdisciplinary HTLV Research Group; BrasilFil: Nates, Silvia Viviana. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Virología Dr. J. M. Vanella; ArgentinaFil: Gallego, Sandra Veronica. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Virología Dr. J. M. Vanella; Argentin

Objective Structured Clinical Examination’s adaptation for final evaluation of the curricular component “Semiological Bases”

BACKGROUND: The combination of both physiological knowledge of a variety of sistems and the clinical findings it is of extreme relevance to the medical student learning process. The proposal of a simulated enviroment, with clinical data collection and regular physical examination, is crucial to this process. The Semiological bases of Escola Bahiana de Medicina e Saúde Pública module, used by the OSCE’s 4th semester medical students, capacitate them for such means. SUMMARY OF WORK: The evaluation logistic was divided into two segments: the first one was made through a theorical exam with close questioning, exhibiting images and videos, but also containing an open-ended question requesting a construction of a fictional clinical case; in the second one it was applied a practical exam segmented by different fields of medical knowledge (neurological, cardiovascular and respiratory/abdomen), with the evaluation of 120 students and followed by the teacher’s feedbacks at the conclusion of each field exam. SUMMARY OF RESULTS: The experience was important, however, it is notable the need for a complex management and understanding of the evaluational process. Discussion between students and teachers happened in behalf of the development of such proposal. CONCLUSIONS: The application of theorical exams throughout the semester combined with a practical exam (the OSCE) at the conclusion of the curricular component Bases Semiológicas had significant weight to the whole process

Changes in assistance and care in the pregnancy-puerperal cycle in times of coronavirus / Mudanças da assistência e cuidado no ciclo gravídico-puerperal em tempos de coronavírus

Objective: to know the specific procedures and care provided to pregnant women, puerperal women and newborns in times of a pandemic and to analyze changes in prenatal care, labor, delivery and the postpartum period during the coronavirus pandemic. Methods: this is a qualitative, descriptive and exploratory study involving 26 women. The interviews were conducted via the Google Forms platform, with closed and open questions. Results: Two categories emerged from the study: 1) Influence of social isolation on the emergence of mental disorders; 2) Adaptations with loss of sexual and reproductive, social and labor rights. Conclusion: mental health and sexual and reproductive, social and labor rights were shown to be more vulnerable in women who experienced pregnancy and postpartum in the coronavirus pandemic. DESCRIPTORS: Parturition; Postpartum Period; Covid-19; Pregnancy; Nursing.Objetivo: conocer los procedimientos y cuidados específicos que se brindan a las gestantes, puérperas y recién nacidos en tiempos de pandemia y analizar los cambios en la atención prenatal, del trabajo de parto, del parto y del puerperio durante la pandemia del coronavirus. Métodos: se trata de un estudio cualitativo, descriptivo y exploratorio con 26 mujeres. Las entrevistas se realizaron a través de la plataforma Google Forms, con preguntas cerradas y abiertas. Resultados: Del estudio surgieron dos categorías: 1) Influencia del aislamiento social en la aparición de trastornos mentales; 2) Adaptaciones con pérdida de derechos sexuales y reproductivos, sociales y laborales. Conclusión: la salud mental y los derechos sexuales y reproductivos, sociales y laborales se mostraron más vulnerables en mujeres que vivieron el embarazo y el posparto en la pandemia del coronavirus. DESCRIPTORES:  Parto; Periodo Posparto; Covid-19; Embarazo; Enfermería.Objetivos: conhecer os procedimentos e cuidados específicos prestados à gestante, à puérpera e ao neonato em tempos de pandemia e analisar as mudanças na assistência pré-natal, no trabalho de parto, no parto e no puerpério durante a pandemia de coronavírus. Método: trata-se de um estudo qualitativo, descritivo e exploratório englobando 26 mulheres. As entrevistas foram realizadas via plataforma Google Forms, com perguntas fechadas e abertas. Resultados: do estudo emergiram duas categorias: 1) Influência do isolamento social no surgimento de distúrbios mentais; 2) Adaptações com perdas de direitos sexuais e reprodutivos, sociais e trabalhistas. Conclusão: a saúde mental e os direitos sexuais e reprodutivos, sociais e trabalhistas mostraram-se em maior vulnerabilidade nas mulheres que vivenciaram a gestação e o pós-parto na pandemia de coronavírus.

Autochthonous cases of schistosomiasis in children in Recife, Northeastern Brazil

OBJETIVO : Investigar criadouros com moluscos hospedeiros e casos humanos autóctones para esquistossomose. MÉTODOS : Entre julho de 2010 e setembro de 2012 foram realizados: (1) levantamento malacológico para busca ativa de criadouros, coleta e identificação de caramujos Biomphalaria positivos para Schistosoma mansoni em Recife, PE; (2) inquérito de prevalência com 2.718 escolares, de sete a 14 anos, para diagnóstico de casos de esquistossomose; (3) exame clínico e ultrassonografia nos casos positivos para S. mansoni. Os casos foram investigados quanto à sua autoctonia e avaliados clinicamente. Os casos e criadouros foram georreferenciados e espacializados. RESULTADOS : Foram identificados 30 criadouros de B. straminea , quatro deles potenciais focos de transmissão, uma vez que os testes moleculares identificaram DNA de S. mansoni nos caramujos coletados. Foram diagnosticadas 14 crianças com esquistossomose; entre elas, cinco foram consideradas casos autóctones da doença. CONCLUSÕES : Ações emergenciais pela vigilância em saúde são necessárias para evitar que a esquistossomose se endemize em Recife, como acontece em localidades litorâneas do estado de Pernambuco.OBJETIVO Investigar criaderos con moluscos hospedadores y casos humanos autóctonos para esquistosomiasis. MÉTODOS Se ejecutaron: estudio malacológico para búsqueda activa de criaderos, colecta e identificación de caracoles Biomphalaria positivos para S. mansoni en Recife, PE, entre julio de 2010 y septiembre de 2012, pesquisa de prevalencia con 2.718 escolares, de siete a 14 años, para diagnóstico de casos de esquistosomiasis, examen clínico y de ultrason en los casos positivos para S. mansoni. Los casos fueron investigados con respecto a su autoctonía y evaluados clínicamente. Los casos y criaderos fueron geo-referenciados y espacializados. RESULTADOS Se identificaron 30 criaderos de B. straminea, cuatro de ellos potenciales focos de transmisión, luego que las pruebas moleculares identificaron DNA de S. mansoni en los caracoles colectados. Se diagnosticaron 14 niños con esquistosomiasis, entre ellas cinco fueron considerados casos autóctonos de la enfermedad. CONCLUSIONES Acciones de emergencia para vigilancia de salud son necesarias para evitar que la esquistosomiasis se vuelva endémica en Recife como sucede en localidades del litoral de Pernambuco.OBJECTIVE : Investigate breeding sites with host snails and autochthonous human cases of schistosomiasis. METHODS : Between July 2010 and September 2012 were performed: (1) malacological survey searching for breeding sites, collection and identification of Biomphalaria snails positive for Schistosoma mansoni in Recife, PE, Northeastern Brazil; (2) prevalence survey in 2,718 schoolchildren aged from seven to 14 years old to identify cases of schistosomiasis, clinical examination and ultrasound in positive cases of S. mansoni. The autochthony of the cases was investigated and the case were clinically evaluated. The cases and breeding sites were georeferenced and spatially described. RESULTS : The results identified 30 breeding with B. straminea, four of which were potential foci of transmission, as molecular testing identified snails with S. mansoni DNA. There were 14 children diagnosed with schistosomiasis, of which five were considered to be autochthonous cases of the disease. CONCLUSIONS : Urgent measures are required in order to avoid schistosomiasis becoming endemic to Recife, as has happened in other coastal areas of the state of Pernambuco

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030