Much needed studies of the three players of Chagas disease in Central America: vertebrate blood meal sources and EcoHealth, a new vector species description, and key phylogenetic analysis of the trypanosome parasite.

The protozoan parasite Trypanosoma cruzi (Trypanosomatida: Trypanosomatidae) is the etiological agent of Chagas disease, reported by the World Health Organization (WHO) as responsible for over 10,000 deaths in 2015. Chagas disease is considered a Neglected Tropical Disease by the WHO, this designation highlights the challenges to overcoming the disease as it afflicts the most vulnerable populations, mainly the rural poor in Latin America. Understanding T. cruzi transmission dynamics is particularly difficult because it can be vectored by over 150 species of Triatominae insects, and all mammal species are potential hosts. Thus, results from one locale may not be generalizable to other regions. Chagas disease was discovered in Brazil by Carlos Chagas (1909) over a century ago, yet there is still a serious lack of information from North America (NA) and Central America (CA); the majority of vector and parasite research is focused on South America. The research presented in this dissertation addresses the three main players with respect to the gap of information from NA and CA. I used entomological information along with a variety of molecular tools (i.e. from conventional PCR to genome wide sequencing) and a diversity of genetic markers (i.e. the nuclear internal transcribed spacer (ITS-2), the mitochondrial cytochrome b (cytb), among others) in three studies. The first evaluated base-line ecological conditions in three regions of Central America prior to Ecohealth interventions designed to reduce human-parasite contact. The second described and characterized a new species of insect vector, Triatoma huehuetenanguensis. The third, investigated the evolutionary history and population genetics of the major T. cruzi genetic lineages circulating across NA and CA regions. The results of the first study stress the importance of considering local conditions for vector control success. The second study highlights that undescribed vector species represent a challenge to vector control strategies. The third study showed three major genetic lineages circulating across NA and CA that are distinct from South America, a finding that is fundamental not only for drug development, but to develop accurate diagnostic tools and to understand clinical outcomes of the disease in the region. The population genetic analysis of samples from Guatemala and El Salvador revealed that genetic diversity has a geographic component with parasite movement occurring at both large and small geographic scales, with important implications for the epidemiology of Chagas disease

Implementation science : epidemiology and feeding profiles of the Chagas vector Triatoma Dimidiata prior to Ecohealth intervention for three locations in Central America

This work was supported with a subsidy of the Ecohealth Initiative Program of the Center of Investigations for the Development of Canada (IDRC)(Subsidy no 106531) to Carlota Monroy; a grant from the World Health Organization (Tropical Disease Research-World Health Organization grant, TDR –WHO ID# A10249) awarded to MCM, by National Science Foundation (NSF) grant BCS-1216193 as part of the joint NSF-NIH-USDA (United States Department of Agriculture) Ecology and Evolution of Infectious Diseases program to MCM and LS and grant R03AI26268/1-2 from the National Institute of Allergy and Infectious Disease (NIAID) at the National Institutes of Health (NIH) to LS. This article was drafted and reviewed during the scientific writing workshop organized by the Program Disease Research, Department of Communicable Diseases and Health Analysis, Pan American Health Organization to support the dissemination of research funded by IDRC conducted with Ecohealth approach. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Blood feeding insects from the subfamily Triatomine are involved in the transmission of Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, a neglected tropical disease endemic from southern Mexico through Central to northern South America. Chagas disease mostly affects rural areas and especially people living in houses made of lowcost, natural materials such as bajareque or adobe that have mud walls and a dirt floor. A multidisciplinary data-driven Ecohealth vector control program that includes house improvements (wall plastering and cement flooring), as well as insecticide spraying, was developed in Jutiapa department, Guatemala, and has been shown to decrease vectorhuman contact. Because Chagas vectors feed on a wide variety of vertebrates, knowing the local feeding profiles of the insect vectors before interventions can strengthen Ecohealth program development. To facilitate scaling up the Ecohealth program developed in Jutiapa to three new locations in three different countries, Texistepeque, El Salvador; San Marcos de la Sierra, Honduras and Olopa, Guatemala, and with distinct ecological scenarios, we assessed the entomological indices, feeding profiles and parasite infection of vectors collected in and around houses in the new locations prior to any interventions. Our results show all three metrics varied among locations. The results highlight the importance of domestic, synanthropic and sylvatic blood meal sources on the disease transmission cycle and the need to consider local conditions for vector control

INCONTINÊNCIA URINÁRIA DE ESFORÇOS EM MULHERES: UMA REVISÃO LITERÁRIA

Introduction:  Stress urinary incontinence (SUI) significantly impacts the quality of life of many women, especially postpartum and during menopause. It is characterized by the involuntary loss of urine during activities that increase intra-abdominal pressure. Objective:  This study systematically reviews the literature on SUI in women from 2019 to 2024 to analyze prevalence, risk factors, pathophysiology, psychosocial impact, diagnosis, and treatment. Methodology: Research was conducted in databases such as PubMed, Scopus, and Cochrane Library, using specific terms. Studies published between 2019 and 2024, addressing SUI in women were included. Results and Discussion: SUI prevalence ranges from 10% to 40%, influenced by age, parity, BMI, and menopause. Diagnosis involves clinical history, physical examination, and specific tests. Treatments include Kegel exercises, behavioral therapies, pharmacological, and surgical interventions. Conclusion: SUI is common and negatively affects women's lives. A multimodal treatment approach and education are essential to improve patients' quality of life.Introdução: A incontinência urinária por esforços (IUE) afeta significativamente a qualidade de vida de muitas mulheres, especialmente no pós-parto e na menopausa. Caracteriza-se pela perda involuntária de urina durante atividades que aumentam a pressão intra-abdominal. Objetivo: Este estudo revisa sistematicamente a literatura sobre IUE em mulheres, de 2019 a 2024, para analisar prevalência, fatores de risco, fisiopatologia, impacto psicossocial, diagnóstico e tratamento. Metodologia:  A pesquisa foi realizada em bases de dados como PubMed, Scopus e Cochrane Library, utilizando termos específicos. Foram incluídos estudos publicados entre 2019 e 2024, abordando a IUE em mulheres. Resultados e Discussão A prevalência de IUE varia entre 10% e 40%, influenciada por idade, paridade, IMC e menopausa. O diagnóstico envolve história clínica, exame físico e testes específicos. Tratamentos incluem exercícios de Kegel, terapias comportamentais, farmacológicas e cirúrgicas. Conclusão: A IUE é comum e afeta negativamente a vida das mulheres. A abordagem multimodal de tratamento e a educação são essenciais para melhorar a qualidade de vida das pacientes

Systemic aspergillosis in an oiled magallanic penguin (Spheniscus magellanicus).

This report describes a case of fatal aspergillosis caused by A. fumigatus during the recovery of an oiled Magallanic penguin. The possible role of aspergillosis as a possible complication responsible for the mortality of penguins surviving the first days of treatment for oil is emphasized

Systemic aspergillosis in an oiled magallanic penguin (Spheniscus magellanicus).

This report describes a case of fatal aspergillosis caused by A. fumigatus during the recovery of an oiled Magallanic penguin. The possible role of aspergillosis as a possible complication responsible for the mortality of penguins surviving the first days of treatment for oil is emphasized

Cost-Effectiveness of Cabozantinib in the Second-Line Treatment of Advanced Hepatocellular Carcinoma

Background: Treatment options are limited for patients with advanced hepatocellular carcinoma (HCC) that progresses after treatment with sorafenib. Cabozantinib, an oral small molecule inhibitor of multiple tyrosine kinase receptors, recently showed improved overall survival (OS) compared with placebo in sorafenib-pretreated patients with advanced HCC in the CELESTIAL trial. This study assessed the cost-effectiveness of cabozantinib for second-line treatment of patients with advanced HCC from a US healthcare system perspective. Patients and Methods: Cost and utility data were extracted from the CELESTIAL trial and used to determine the cost-effectiveness of cabozantinib compared with placebo plus best supportive care. The main outcome of this study was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) gained by using cabozantinib compared with placebo plus best supportive care in sorafenib-pretreated HCC. Results: In the base-case analysis using data from the CELESTIAL trial, the incremental QALY and ICER were 0.067 and $1,040,675 for cabozantinib compared with placebo and best supportive care. OS reported in the CELESTIAL trial (hazard ratio, 0.76; 95$50 per pill to be cost-effective considering a willingness to pay of $100,000 per QALY. Although the CELESTIAL trial demonstrated that cabozantinib improves OS compared with placebo in patients with HCC that progresses after treatment with sorafenib, our analysis shows that cabozantinib is not a cost-effective therapy in this scenario. Conclusions: At current costs, cabozantinib is not cost-effective for second-line therapy of HCC in the United States

Dental fluorosis in Brazil: a systematic review from 1993 to 2004 Fluorose dentária no Brasil: uma revisão sistemática do período 1993/2004

The current article proposes a reflection on several aspect pertaining to dental fluorosis in Brazil, based on a systematic review of epidemiological surveys. The authors assess the prevalence and degrees of severity found in different studies and show that in methodological terms, there is a need for progress in procedures for population-based studies on fluorosis. Despite the different data collection approaches, there is some consensus among the different studies as to the limited severity of fluorosis in Brazil, as well as its association with the independent variables age and socioeconomic status. The authors also highlight the importance of adding subjective aspects to the normative diagnosis as a contribution to public health policy decisions, since the use of exclusively clinical criteria gives dental fluorosis more space than society ascribes to it. There is a lack of empirical evidence to reassess the fluoride content in public water supplies, a method that is known to be necessary to improve dental caries epidemiological indicators.<br>O presente trabalho propõe uma reflexão sobre alguns aspectos relativos à fluorose dentária no Brasil, a partir de uma revisão sistemática de estudos e inquéritos epidemiológicos. A prevalência e os níveis de severidade encontrados nos diferentes estudos são avaliados, verificando-se que, quanto aos aspectos metodológicos, há necessidade de avançar no que diz respeito aos procedimentos para estudo da fluorose em âmbito populacional. Apesar das diferentes abordagens para coleta de dados, há algum consenso, entre os diferentes estudos, quanto à baixa severidade da fluorose no Brasil e a sua associação com as variáveis independentes idade e condição sócio-econômica. Destaca-se também a importância de incluir aspectos subjetivos ao diagnóstico normativo, como uma contribuição às decisões que envolvem o planejamento de políticas públicas de saúde, uma vez que o uso de critérios exclusivamente clínicos oferece à fluorose dentária um espaço maior que aquele que lhe confere a sociedade. Nota-se a ausência de evidência empírica para a reavaliação dos teores de flúor nas águas de abastecimento público, um método reconhecidamente necessário no contexto brasileiro para a melhoria dos indicadores epidemiológicos de cárie