Paediatric radiology seen from Africa. Part I: providing diagnostic imaging to a young population

Article approval pendingPaediatric radiology requires dedicated equipment, specific precautions related to ionising radiation, and specialist knowledge. Developing countries face difficulties in providing adequate imaging services for children. In many African countries, children represent an increasing proportion of the population, and additional challenges follow from extreme living conditions, poverty, lack of parental care, and exposure to tuberculosis, HIV, pneumonia, diarrhoea and violent trauma. Imaging plays a critical role in the treatment of these children, but is expensive and difficult to provide. The World Health Organisation initiatives, of which the World Health Imaging System for Radiography (WHIS-RAD) unit is one result, needs to expand into other areas such as the provision of maintenance servicing. New initiatives by groups such as Rotary and the World Health Imaging Alliance to install WHIS-RAD units in developing countries and provide digital solutions, need support. Paediatric radiologists are needed to offer their services for reporting, consultation and quality assurance for free by way of teleradiology. Societies for paediatric radiology are needed to focus on providing a volunteer teleradiology reporting group, information on child safety for basic imaging, guidelines for investigations specific to the disease spectrum, and solutions for optimising imaging in children

Direct-acting antivirals used in HCV-related liver disease do not affect thyroid function and autoimmunity

Purpose It is well known that interferon-alpha (IFN-alpha), used for long time as the main therapy for HCV-related disease, induces thyroid alterations, but the impact of the new direct-acting antivirals (DAAs) on thyroid is not established. Aim of this prospective study was to evaluate if DAAs therapy may induce thyroid alterations.Methods A total of 113 HCV patients, subdivided at the time of the enrollment in naive group (n = 64) and in IFN-alpha group (n = 49) previously treated with pegylated interferon-alpha and ribavirin, were evaluated for thyroid function and autoimmunity before and after 20-32 weeks of DAAs.Results Before starting DAAs, a total of 8/113 (7.1%) patients showed Hashimoto's thyroiditis (HT) all belonging to IFN-alpha group (8/49, 16.3%), while no HT cases were found in the naive group. Overall, 7/113 (6.2%) patients were hypothyroid: 3/64 (4.7%) belonging to naive group and 4/49 (8.2%) to IFN-alpha group. Furthermore, a total of 8/113 patients (7.1%) showed subclinical hyperthyroidism: 2/64 (3.1%) were from naive group and 6/49 (12.2%) from IFN-alpha group. Interestingly, after DAAs therapy, no new cases of HT, hypothyroidism and hyperthyroidism was found in all series, while 6/11 (54.5%) patients with non-autoimmune subclinical thyroid dysfunction became euthyroid. Finally, the only association between viral genotypes and thyroid alterations was genotype 1 and hypothyroidism.Conclusions This study supports evidence that DAAs have a limited or missing influence on thyroid in patients with HCV-related diseases. Moreover, it provides preliminary evidence that subclinical non-autoimmune thyroid dysfunction may improve after HCV infection resolution obtained by DAAs

Taxonomic Catalog of the Brazilian Fauna: order Trichoptera (Insecta), diversity and distribution

Caddisflies are a highly diverse group of aquatic insects, particularly in the Neotropical region where there is a high number of endemic taxa. Based on taxonomic contributions published until August 2019, a total of 796 caddisfly species have been recorded from Brazil. Taxonomic data about Brazilian caddisflies are currently open access at the “Catálogo Taxonômico da Fauna do Brasil” website (CTFB), an on-line database with taxonomic information on the animal species occurring in Brazil. The order Trichoptera at CTFB includes a catalog of species recorded for the country, with synonymic lists, distribution throughout six biomes, 12 hydrographic regions, and 27 political states (including Federal District) from Brazil. The database is constantly updated to include newly published data. In this study, we reviewed the taxonomic effort on Brazilian caddisflies based on data currently in CTFB database. The accumulation curve of species described or recorded from the country, by year, shows a strong upward trend in last 25 years, indicating that it is possible that there are many more species to be described. Based on presence/absence of caddisfly species at three geographic levels (biomes, hydrographic regions, and states), second order Jackknife estimated at least 1,586 species occurring in Brazil (with hydrographic regions as unities), indicating we currently know about 50% of the Brazilian caddisfly fauna. Species distribution by Brazilian biomes reveals that the Atlantic Forest is the most diverse, with 490 species (298 endemic), followed by the Amazon Forest, with 255 species (101 endemic). Even though these numbers may be biased because there has been more intense collecting in these two biomes, the percentage of endemic caddisfly species in the Atlantic Forest is remarkable. Considering the distribution throughout hydrographic regions, clustering analyses (UPGMA) based on incidence data reveals two groups: northwestern basins and southeastern. Although these groups have weak bootstrap support and low similarity in species composition, this division of Brazilian caddisfly fauna could be related to Amazon-Atlantic Forest disjunction, with the South American dry diagonal acting as a potential barrier throughout evolutionary time

Diagnostic accuracy of the primary care screener for affective disorder (PC-SAD) in primary care

Background: Depression goes often unrecognised and untreated in non-psychiatric medical settings. Screening has recently gained acceptance as a first step towards improving depression recognition and management. The Primary Care Screener for Affective Disorders (PC-SAD) is a self-administered questionnaire to screen for Major Depressive Disorder (MDD) and Dysthymic Disorder (Dys) which has a sophisticated scoring algorithm that confers several advantages. This study tested its performance against a ‘gold standard’ diagnostic interview in primary care. Methods: A total of 416 adults attending 13 urban general internal medicine primary care practices completed the PC-SAD. Of 409 who returned a valid PC-SAD, all those scoring positive (N=151) and a random sample (N=106) of those scoring negative were selected for a 3-month telephone follow-up assessment including the administration of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) by a psychiatrist who was masked to PC-SAD results. Results: Most selected patients (N=212) took part in the follow-up assessment. After adjustment for partial verification bias the sensitivity, specificity, positive and negative predictive value for MDD were 90%, 83%, 51%, and 98%. For Dys, the corresponding figures were 78%, 79%, 8%, and 88%. Conclusions: While some study limitations suggest caution in interpreting our results, this study corroborated the diagnostic validity of the PC-SAD, although the low PPV may limit its usefulness with regard to Dys. Given its good psychometric properties and the short average administration time, the PC-SAD might be the screening instrument of choice in settings where the technology for computer automated scoring is available

Emerging therapies in pheochromocytoma and paraganglioma: Immune checkpoint inhibitors in the starting blocks

Pheochromocytoma and paraganglioma are neuroendocrine neoplasms, originating in the adrenal medulla and in parasympathetic and sympathetic autonomic nervous system ganglia, respec-tively. They usually present as localized tumours curable with surgery. However, these tumours may exhibit heterogeneous clinical course, ranging from no/minimal progression to aggressive (progres-sive/metastatic) behavior. For this setting of patients, current therapies are unsatisfactory. Immune checkpoint inhibitors have shown outstanding results for several types of solid cancers. We therefore aimed to summarize and discuss available data on efficacy and safety of current FDA-approved immune checkpoint inhibitors in patients with pheochromocytoma and paraganglioma. After an extensive search, we found 15 useful data sources (four full-published articles, four supplements of scientific journals, seven ongoing registered clinical trials). The data we detected, even with the limit of the small number of patients treated, make a great expectation on the therapeutic use of immune checkpoint inhibitors. Besides, the newly detected predictors of response will (hopefully) be of great helps in selecting the subset of patients that might benefit the most from this class of drugs. Finally, new trials are in the starting blocks, and they are expected to shed in the next future new light on a therapy, which is considered a milestone in oncology

Diet of two syntopic species of Crenuchidae (Ostariophysi: Characiformes) in an Amazonian rocky stream

Abstract This study assessed the diet of two poorly known syntopic fish species of the family Crenuchidae, Characidium aff. declivirostre and Leptocharacidium omospilus, in a Presidente Figueiredo´ rocky stream, Amazonas, Brazil. The stomach contents were analyzed and their Frequency of Occurrence (FO %) and Relative Volume (Vol %) were combined in a Feeding Index (IAi). We examined 20 individuals of C. aff. declivirostre and 23 of L. omospilus. The Morisita-Horn Index was used to estimate the overlap between the diets of these species. Immature insects were the most valuable items consumed by both fish species. The diet of C. aff. declivirostre was mainly composed of larvae and pupae of Chironomidae, while L. omospilus predominantly consumed larvae of Hydroptilidae, Hydropyschidae and Pyralidae. Thus, both species were classified as autochthonous insectivorous. Characidium aff. declivirostre was considered a more specialized species, probably reflecting lower feeding plasticity or the use of more restricted microhabitats compared to L. omospilus. When the food items were analyzed at the family taxonomic level, the diet overlap between these species was considered moderate (Morisita-Horn Index = 0.4). However, a more thorough analysis, at the genus level, indicates a very low diet overlap. Therefore, we conclude that the feeding segregation between C. aff. declivirostre and L. omospilus may favor their co-existence, despite their high phylogenetic closeness

Aspects of the ecology of the earthworm Eisenia lucens (Waga 1857) studied in the field and in laboratory culture

This work relates data from field sampling of Eisenia lucens and from laboratory-based culture. Field sampling used soil sorting and vermifuge extraction and took place in beech-dominated forests of southwest Poland. Initial work derived population estimates from four sub-communities of the forest looking for seasonal dynamics and later work employed targeted sampling in summer within rotting wood to obtain live specimens for laboratory culture. A preliminary examination within and below rotten wood during winter was also undertaken. In the laboratory, clitellate earthworms were kept at 20 °C, the substrate changed every 6 months, and the population examined. Cocoons were incubated individually at 15 °C, with number of hatchlings per cocoon and the mass of each determined. Hatchlings were grown at 15 °C in field-collected wood and compared with growth in a 1:1 volume ratio of wood and horse manure. Further hatchlings were fed with horse manure only (at 10 °C) and after 19 weeks, half were transferred to 15 °C. In the field, mature individuals varied significantly (p < 0.01) in biomass between 2 sampling sites where found, with an overall mean density across sites of 4.14 ± 3.53 m with a mean biomass of 2.21 ± 1.93 g m . Numbers in soil varied over the sampling period, with a suggestion that this species moves from mineral soil to organic-rich dead wood as conditions permit. In summer, all life stages were recovered from rotting wood above the mineral soil. Sampling in winter found cocoons in rotting wood below snow. These hatched rapidly (within 2 weeks) when taken to the laboratory. Laboratory culture allowed maintenance of a population for 2 years. Mean cocoon mass was 50.6 mg with a mean of 2.9 hatchlings per cocoon and hatchling mass was inversely proportional to number per cocoon. Growth with 50% horse manure was significantly greater (p < 0.001) than with wood. Increased temperature from 10 to 15 °C brought more significantly (p < 0.05) rapid growth. To culture this species through its life cycle, a natural substrate is needed, but then it is necessary to acclimate the animals to something more easily obtainable. More work is needed from field sampling to fully understand the seasonal dynamics of this species, which utilises different parts of the soil profile throughout the year