2 nd Brazilian Consensus on Chagas Disease, 2015

Abstract Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Gonadal development in the freshwater crab Sylviocarcinus pictus (H. Milne Edwards, 1853) (Brachyura: Trichodactylidae) from the Guamá river, state of Pará, Brazil

The development stages of male and female gonads in the freshwater crab Sylviocarcinus pictus (H. Milne Eduards, 1853) were described through macroscopic and microscopic (histology) examinations. The histological description was based on 40 specimens (20 each sex). Four gonadal development stages were found for females: immature, ripening, mature and spawned. The following female cells were found: ovogonia, oocytes in initial vitellogenesis, oocytes in advanced vitellogenesis, follicular cells and post-ovulatory follicles. Three development stages were found for males: immature, maturing and mature, with the indication of: spermatogonia, spermatocytes, spermatids, spermatozoids and spermatophores. These data suggest the pattern described in the literature. Size at sexual maturity was 32.3 mm of carapace width for males and 31.5 mm for females. The gonadal stages observed macroscopically by volume and color were validated through histological analysis and proved to be useful method for the rapid identification of sexual maturity in the species. The present study offers previously unpublished data on the reproductive biology of Sylviocarcinus pictus.<br>Os estádios de desenvolvimento das gônadas de machos e fêmeas de caranguejos Sylviocarcinus pictus (H. Milne Eduards, 1853) foram descritos por meio de observações macroscópicas e microscópicas (técnica histológica). A descrição histológica foi baseada em 40 espécimes (20 de cada sexo). Foram identificados quatro estádios de desenvolvimento para as fêmeas: imaturo, em maturação, maturo e em reabsorção. As seguintes células foram encontradas: ovogônias, ovócitos em vitelogênese inicial, ovócitos em vitelogênese avançada, células foliculares e folículos pós-ovulatórios. Três estádios de desenvolvimento foram encontrados para os machos: imaturo, em maturação e maturo, com indicação de: espermatogônias, espermatócitos, espermátides, espermatozóides e espermatóforos. Tais dados sugerem o padrão descrito na literatura. O tamanho da maturidade sexual foi de 32,3 mm de largura da carapaça para machos e 31,5 mm para fêmeas. Os estádios gonadais observados macroscopicamente por meio do volume e da coloração das gônadas foram validados pela análise histológica, sendo um critério útil e ágil para a identificação da maturidade sexual para a espécie. O presente estudo oferece informações inéditas sobre a biologia reprodutiva de Sylviocarcinus pictus