Ectoparasitic flies (Diptera: Streblidae) on bats (Mammalia: Chiroptera) from a Private Natural Heritage Reserve in southeastern Brazil

Due to the small number of records of Streblidae on bats, despite extensive study on these mammals in the state of Rio de Janeiro, a survey was carried out in an area of the Atlantic Forest. The present study was carried out at Bom Retiro Farm Natural Heritage Private Reserve. We captured 401 bats of 17 species, 13 genera, and four families; bat flies infested 221 bats of only four species. Carollia perspicillata (Linnaeus, 1758) has the highest fly diversity, with seven fly species: Trichobius joblingi (Wenzel, 1966) (n = 23), Megistopoda proxima (Séguy, 1926) (n = 15), Strebla guajiro (García & Casal, 1965) (n = 15), Aspidoptera falcata (Wenzel, 1976) (n = 6) Paratrichobius longicrus (Miranda Ribeiro, 1907) (n = 8), Paraeuctenodes similis (Wenzel 1976) (n = 3), and Trichobius anducei (Guerrero, 1998) (n = 1). Two species infested Platyrrhinus lineatus (É. Geoffroy, 1810): Aspidoptera falcata (n = 1) and Anastrebla caudiferae (Wenzel, 1996) (n = 1). Paradyschiria parvula (Falcoz, 1931) (n = 11) infested Noctilio leporinus (Linnaeus, 1758) and M. proxima (n = 12) and Trichobius uniformis (Curran, 1935) (n = 1) infested Sturnira lilium (É. Geoffroy, 1842). Sturnira lilium has the highest infestation rate, with ten out of 46 captured individuals parasitized, followed by Carollia perspicillata, with 33 out of 164 captured parasitized, and by P. lineatus with only two parasitized individuals out of ten. Among 97 streblid flies captured, M. proxima was the most abundant (27.83%), followed by T. joblingi (23.71%), and S. guajiro (15.46%). All remaining bat fly species represented 33%. Paradichyria parvula has the first record for Rio de Janeiro State

COGNITION AND FUNCTIONALITY IN BREAST CANCER SURVIVORS UNDERGOING HORMONE THERAPY

O objetivo foi descrever a função cognitiva e a capacidade funcional de sobreviventes de câncer de mama que praticam exercício físico. Oito mulheres diagnosticadas com câncer de mama em estágios I-III participaram deste estudo. Testes cognitivos foram aplicados para avaliar a função cognitiva geral, velocidade de processamento, função executiva e atenção. A capacidade funcional foi determinada por testes de resistência aeróbia, agilidade dinâmica e equilíbrio e testes de força de membros superiores e inferiores. As mulheres do presente estudo tinham 64,5 ± 4,8 anos, índice de massa corporal de 32,6 ± 5,4 kg.m-2 e escolaridade de 10,0 ± 3,5 anos. Os resultados demonstraram desempenho no questionário MSSE e teste de fluência verbal preservados em mulheres idosas diagnosticadas com câncer de mama há quatro anos, com obesidade e que estavam se exercitando por aproximadamente 2,5 anos. Por outro lado, elas apresentaram desempenho inferior no teste cognitivo Trail Making Test e nos testes funcionais do que os valores normativos da literatura, indicando um prejuízo na atenção, velocidade de processamento, flexibilidade cognitiva e baixa capacidade funcional.El objetivo fue describir la función cognitiva y la capacidad funcional de las supervivientes de cáncer de mama que practican ejercicio físico. Ocho mujeres diagnosticadas con cáncer de mama en estadio I-III participaron en este estudio. Se aplicaron pruebas cognitivas para evaluar la función cognitiva general, la velocidad de procesamiento, la función ejecutiva y la atención. La capacidad funcional se determinó mediante pruebas de resistencia aeróbica, agilidad dinámica y equilibrio y pruebas de fuerza superior e inferior. Las mujeres del presente estudio tenían 64,5 ± 4,8 años, el índice de masa corporal 32,6 ± 5,4 kg.m-2 y la escolaridad de 10,0 ± 3,5 años. Los resultados demostraron un desempeño preservado en el cuestionario MSSE y la prueba de fluidez verbal en mujeres mayores diagnosticadas con cáncer de mama hace cuatro años, con obesidad y que hacían ejercicio durante aproximadamente 2,5 años. Por otro lado, ellas presentaron un desempeño más bajo en el Trail Making Test cognitivo y en las pruebas funcionales que los valores normativos de la literatura, indicando un deterioro en la atención, velocidad de procesamiento, flexibilidad cognitiva y baja capacidad funcional.The study aimed to describe the cognitive function and the functional capacity of breast cancer survivors who practice physical exercise. Eight women diagnosed with stages I-III breast cancer participated in this study. Cognitive tests were applied to assess overall cognitive function, processing speed, executive function, and attention. The women in the present study were 64.5 ± 4.8 years old, had a body mass index of 32.6 ± 5.4 kg.m-2, and had 10.0 ± 3.5 years of schooling. The results showed a preserved performance in the MSSE questionnaire and verbal fluency test in older women diagnosed with breast cancer four years ago, with obesity, who have been exercising for approximately 2.5 years. On the other hand, they presented a lower performance in the cognitive Trail Making Test and the functional tests than the normative values in the literature, indicating an impaired attention, processing speed, cognitive flexibility, and low functional capacity

Bilateral asymptomatic fibrous-ankylosis of the temporomandibular joint associated with rheumatoid arthritis: a case report

The American Academy of Orofacial Pain (AAOP) defines ankylosis of the temporomandibular joint (TMJ) as a restriction of movements due to intracapsular fibrous adhesions, fibrous changes in capsular ligaments (fibrous-ankylosis) and osseous mass formation resulting in the fusion of the articular components (osseous-ankylosis). The clinical features of the fibrous-ankylosis are severely limited mouth-opening capacity (limited range of motion during the opening), usually no pain and no joint sounds, marked deflection to the affected side and marked limitation of movement to the contralateral side. A variety of factors may cause TMJ ankylosis, such as trauma, local and systemic inflammatory conditions, neoplasms and TMJ infection. Rheumatoid arthritis (RA) is one of the systemic inflammatory conditions that affect the TMJ and can cause ankylosis. The aim of this study is to present a case of a female patient diagnosed with bilateral asymptomatic fibrous-ankylosis of the TMJ associated with asymptomatic rheumatoid arthritis. This case illustrates the importance of a comprehensive clinical examination and correct diagnosis of an unusual condition causing severe mouth opening limitation

Isolamento e identificação presuntiva de Staphylococcus coagulase positiva e coagulase negativa em queijos minas frescal artesanal comercializados em feiras livres de Ipatinga – MG / Isolation and presucific identification of positive coagulase and negative coagulase Staphylococcus in artisanal minas fresh cheesese marketed at fairs in Ipatinga - MG

Introdução: dentre os diferentes tipos de queijos existentes no Brasil, o Minas Frescal Artesanal destaca-se por ser um produto alimentício bastante consumido e frequentemente fabricado com higiene precária. Por apresentar alto teor de umidade e baixo teor de sal, o queijo Minas Frescal Artesanal é susceptível a contaminações microbianas resultantes, tanto do leite utilizado como matéria-prima, como de contaminações cruzadas na manipulação e no pós-processamento. Os microrganismos contaminantes podem causar deterioração do produto ou até doenças em quem o ingerir, como a intoxicação alimentar. Objetivos: o estudo objetiva verificar de forma presuntiva a existência de Staphylococcus coagulase positiva e negativa por meio do isolamento em uma amostragem de queijos Minas Frescal Artesanal comercializados em feiras livres do Município de Ipatinga, Minas Gerais. Método: foram coletadas amostras de 6 queijos Minas Frescal Artesanal de feiras livres de Ipatinga-MG, sendo cada um deles pertencentes aos seguintes locais: Canaã, Veneza 2, Bom Jardim, Bom Retiro, Ipatingão e Cariru. A partir destas amostras foi isolado o microrganismo Staphylococcus coagulase positiva e negativa por meio de cultura e identificação da bactéria pelo método de Gram e das provas de catalase e coagulase. Resultados: foi constatado que 100% das amostras de queijo Minas Frescal Artesanal apresentaram contaminação em relação à contagem e análise presuntiva de Staphylococcus sp. Conclusão: os produtos analisados obtiveram valores de contaminação por Staphylococcus sp. acima do permitido pela legislação vigente, demonstrando uma precariedade nas boas práticas de fabricação. Dessa forma, entende-se que a fiscalização pelos órgãos competentes precisa ser mais eficaz e rigorosa nas feiras livres do município de Ipatinga.

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.&nbsp; Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities. &nbsp; Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.&nbsp; The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.&nbsp; The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.&nbsp; &nbsp;&nbsp; Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.&nbsp;&nbsp;&nbsp; Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp