Giardia intestinalis e estado nutricional em crianças participantes do programa de nutrição complementar, melhoramento alimentar e nutricional da Antioquia (MANA) - Instituto Colombiano de Bem-Estar Familiar (ICBF), Antióquia, Colombia, maio a outubro de 2006

A infecção pela Giardia intestinalis está amplamente distribuída no mundo apresentando a maior prevalência nos países em desenvolvimento. Em crianças, esta parasitose pode ter conseqüências graves no estado geral de saúde assim como no ganho de peso e estatura. O objetivo desta pesquisa foi estabelecer a associação entre a infecção com Giardia e o estado nutricional das crianças beneficiárias do programa de complementação alimentar - MANA. Um estudo de corte no qual foram avaliadas 2035 crianças entre os oito meses e os seis anos de idade foi realizado. A informação foi obtida a partir de questionários estruturados, medições antropométricas e exame de fezes. Os resultados mostraram que 27,6% das crianças estavam infectadas com Giardia intestinalis, das quais 8,1% apresentaram desnutrição moderada, 1,9% desnutrição grave e 14,1% franca queda no crescimento. Em conclusão, nesta população a Giardíase foi indicador de desnutrição grave.Giardia intestinalis infection is prevalent throughout the world and widely distributed in developing countries. In general, children display serious consequences to their state of health, including slow height-weight development; therefore, the main aim of this study was to determine the association between Giardia infection and the nutritional status of children who participate in the program of complementary feeding (Mejoramiento Alimentario y Nutricional de Antioquia (MANA) - Instituto Colombiano de Bienestar Familiar (ICBF)). A cross-sectional study examining the association of giardiasis with nutritional status was conducted. A total of 2035 children aged eight months to six years-old were studied. Data were collected using structured questionnaires, anthropometric measurements and laboratory analysis of blood and stool samples. Analysis of the results showed that 27.6% of children were infected with G. intestinalis, while 8.1% and 1.9% were mildly and significantly underweight, respectively, and 14.1% presented stunting. Giardiasis was statistically identified as a strong predictor of stunting in this study population

Valoración clínica y parasitológica del tití gris (Primates-Saguinus leucopus): en dos poblaciones naturales presentes en San Carlos y San Rafael (Antioquia, Colombia)

Abstract While much of the natural history of Neotropical primates has been revealed through studies conducted in captive individuals, environmental factors may impose ecological and physiological differences in free-range populations. For the white-footed tamarin (Saguinus leucopus), a primate endemic to Northwest Colombia, physiological parameters that have been assessed in captivity still remain to be measured in free-range populations. In order to diagnose the health status of this species in a natural environment, we assessed several external traits, measured hematological and blood-chemistry values, and characterized the parasite community of two natural populations. Despite the identification of eleven different parasite taxa and wide distribution of filaria and Trypanosoma spp., we faieled to detect signs of poor health condition. Substantial differences were found between captive and free-range tamarin populations in the composition of their parasite communities. Likewise, hematological and blood-chemistry profiles differed between free-range populations and even between neighboring social groups, suggesting a role of environmental factors in the physiological response. However, none of the physiological parameters varied as a response to parasite infection. Our results revealed a high diversity of parasites and elevated rates of parasitic infections in natural populations of S. leucopus, that do not seem to be associated with indicators of health conditions. Future studies should emphasize on ecological, genetic and demographic factors that determine the health conditions of S. leucopus in the wild. Lastly, geographic variation of physiological profiles and parasite distribution, as well as epidemiological differences between captive and wild populations, should be incorporated in rehabilitation plans of captive tamarins in order to restrict the transmission of infectious agents between populationsResumo O estudo de indivíduos em cativeiro de primatas Neotropicais tem permitido conhecer aspectos básicos da história natural. Embora as condições ambientais podem determinar diferenças ecológicas e fisiológicas em populações silvestres. No caso do sagui cinza (Saguinus leucopus), primata endémico do noroeste colombiano, diferentes parâmetros fisiológicos tem sido avaliados em cativeiro. Com o intuito de diagnosticar o estado de saúde em condições naturais, avaliaram-se vários rasgos externos e parâmetros fisiológicos, assim como a comunidade de parasitas de duas populações naturais. Ainda que em geral não se detectassem signos de deterioro nas condições gerais de saúde, identificaram-se onze táxones de parasitas entre helmintos e protozoários, alguns com alta prevalência (filarias e Trypanosoma spp). As comunidades de parasitas em cativeiro e no estado silvestre mostram diferenças notáveis. Igualmente, identificou-se uma aparente variação entre populações silvestres e entre grupos sociais circundantes com respeito aos perfis hematológicos e de química sanguínea, que sugere diferenças na resposta fisiológica diante condições ambientais do médio. Nenhuma das mencionadas variáveis fisiológicas pareceu estar relacionada com as parasitas encontradas. Os resultados revelaram uma grande diversidade de parasitas e uma alta taxa de infecção parasitária em populações naturais de S. leucopus, que não parecem estar associados com indicadores do condição de saúde. Estudos deste tipo no futuro deveram enfatizar em aspectos ecológicos, genéticos e demográficos que determinem as condições de saúde de S. leucopus em seu médio natural. Recomenda-se que a reabilitação de indivíduos em cativeiro tenha presente possíveis diferenças em variáveis fisiológicas e epidemiológicas entre populações naturais e grupos em cativeiro com o fim de restringir a transmissão de agentes infeciosos entre populaçõesResumen El estudio de individuos en cautiverio de primates Neotropicales ha permitido conocer aspectos básicos de su historia natural. Sin embargo las condiciones medioambientales pueden determinar diferencias ecológicas y fisiológicas en poblaciones silvestres. En el caso del tití gris (Saguinus leucopus), primate endémico del noroccidente colombiano, diferentes parámetros fisiológicos han sido evaluados en cautiverio. Con el fin de diagnosticar el estado de salud en condiciones naturales, se evaluaron varias características externas y parámetros fisiológicos, así como la comunidad de parásitos de dos poblaciones naturales. Aunque en general no se detectaron signos de deterioro en las condiciones generales de salud, se identificaron once taxones de parásitos entre helmintos y protozoos, algunos con alta prevalencia (filarias y Trypanosoma spp). Las comunidades de parásitos en cautiverio y en estado silvestre muestran diferencias notables. Igualmente, se identificó una aparente variación entre poblaciones silvestres e incluso entre grupos sociales circundantes con respecto a los perfiles hematológicos y de química sanguínea, que sugiere diferencias en la respuesta fisiológica ante condiciones medioambientales. Ninguna de dichas variables fisiológicas pareció estar relacionada con los parásitos encontrados. Los resultados revelaron una amplia diversidad de parásitos y una elevada tasa de infecciones parasitarias en poblaciones naturales de S. leucopus, que parecen no estar asociadas con indicadores de la condición de salud. Futuros estudios deberán enfatizar en aspectos ecológicos, genéticos y demográficos que determinen las condiciones de salud de S. leucopus en su medio natural. Se recomienda que la rehabilitación de individuos en cautiverio tenga presente posibles diferencias en variables fisiológicas y epidemiológicas entre poblaciones naturales y grupos en cautiverio con el fin de restringir la transmisión de agentes infecciosos entre poblacione

First Sagittarius A* Event Horizon Telescope results. I. The shadow of the supermassive black hole in the center of the Milky Way

We present the first Event Horizon Telescope (EHT) observations of Sagittarius A* (Sgr A*), the Galactic center source associated with a supermassive black hole. These observations were conducted in 2017 using a global interferometric array of eight telescopes operating at a wavelength of λ = 1.3 mm. The EHT data resolve a compact emission region with intrahour variability. A variety of imaging and modeling analyses all support an image that is dominated by a bright, thick ring with a diameter of 51.8 ± 2.3 μas (68% credible interval). The ring has modest azimuthal brightness asymmetry and a comparatively dim interior. Using a large suite of numerical simulations, we demonstrate that the EHT images of Sgr A* are consistent with the expected appearance of a Kerr black hole with mass ∼4 × 106 M⊙, which is inferred to exist at this location based on previous infrared observations of individual stellar orbits, as well as maser proper-motion studies. Our model comparisons disfavor scenarios where the black hole is viewed at high inclination (i > 50°), as well as nonspinning black holes and those with retrograde accretion disks. Our results provide direct evidence for the presence of a supermassive black hole at the center of the Milky Way, and for the first time we connect the predictions from dynamical measurements of stellar orbits on scales of 103–105 gravitational radii to event-horizon-scale images and variability. Furthermore, a comparison with the EHT results for the supermassive black hole M87* shows consistency with the predictions of general relativity spanning over three orders of magnitude in central mass.http://iopscience.iop.org/2041-8205Physic

First Sagittarius A* Event Horizon Telescope Results. I. The Shadow of the Supermassive Black Hole in the Center of the Milky Way

Abstract We present the first Event Horizon Telescope (EHT) observations of Sagittarius A* (Sgr A*), the Galactic center source associated with a supermassive black hole. These observations were conducted in 2017 using a global interferometric array of eight telescopes operating at a wavelength of λ = 1.3 mm. The EHT data resolve a compact emission region with intrahour variability. A variety of imaging and modeling analyses all support an image that is dominated by a bright, thick ring with a diameter of 51.8 ± 2.3 μas (68% credible interval). The ring has modest azimuthal brightness asymmetry and a comparatively dim interior. Using a large suite of numerical simulations, we demonstrate that the EHT images of Sgr A* are consistent with the expected appearance of a Kerr black hole with mass ∼4 × 106 M ⊙, which is inferred to exist at this location based on previous infrared observations of individual stellar orbits, as well as maser proper-motion studies. Our model comparisons disfavor scenarios where the black hole is viewed at high inclination (i &gt; 50°), as well as nonspinning black holes and those with retrograde accretion disks. Our results provide direct evidence for the presence of a supermassive black hole at the center of the Milky Way, and for the first time we connect the predictions from dynamical measurements of stellar orbits on scales of 103–105 gravitational radii to event-horizon-scale images and variability. Furthermore, a comparison with the EHT results for the supermassive black hole M87* shows consistency with the predictions of general relativity spanning over three orders of magnitude in central mass.</jats:p

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications