Preventing Zoonotic Canine Leishmaniasis in Northeastern Brazil: Pet Attachment and Adoption of Community Leishmania Prevention

Visceral leishmaniasis (VL), caused by Leishmania infantum chagasi (L.i. chagasisyn. infantum) in northeastern Brazil, was responsible for 51,000 new VL cases from 1980 to 2003. Household presence of L. infantum-infected dogs is a major risk factor for human infection. Despite culling of dogs based on seropositivity, canine L. infantum seroprevalence remains near 20%, suggesting that dog culling is ineffective for preventing VL spread. We administered a cross-sectional survey to 224 households within 300 m of the homes of VL human patients diagnosed within the last year. The goal was to develop a model for voluntary preventative use based on characteristics and motivations of dog owners. We identified that owner knowledge deficiencies regarding canine transmission of L. infantum associated with increased risk of dog infection (odds ratio [OR] = 3.681, confidence interval [CI] = 1.223, 11.08). Higher owner education was associated with decreased levels of dog seropositivity (OR = 0.40, CI = 0.20, 0.81). Pet attachment (P = 0.036) and perception of risk/disease knowledge (P = 0.040) were significantly associated with willingness to voluntarily purchase canine VL prevention. These results highlight the importance of owner attachment to their pet in implementing reservoir-targeted zoonotic VL prevention

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Evaluation and perioperative management of patients with diabetes mellitus. A challenge for the anesthesiologist

Diabetes mellitus (DM) is characterized by alteration in carbohydrate metabolism, leading to hyperglycemia and increased perioperative morbidity and mortality. It evolves with diverse and progressive physiological changes, and the anesthetic management requires attention regarding this disease interference in multiple organ systems and their respective complications. Patient's history, physical examination, and complementary exams are important in the preoperative management, particularly glycosylated hemoglobin (HbA1c), which has a strong predictive value for complications associated with diabetes. The goal of surgical planning is to reduce the fasting time and maintain the patient's routine. Patients with Type 1 DM must receive insulin (even during the preoperative fast) to meet the basal physiological demands and avoid ketoacidosis. Whereas patients with Type 2 DM treated with multiple injectable and/or oral drugs are susceptible to develop a hyperglycemic hyperosmolar state (HHS). Therefore, the management of hypoglycemic agents and different types of insulin is fundamental, as well as determining the surgical schedule and, consequently, the number of lost meals for dose adjustment and drug suspension. Current evidence suggests the safe target to maintain glycemic control in surgical patients, but does not conclude whether it should be obtained with either moderate or severe glycemic control. Resumo: O diabetes melito (DM) é caracterizado por alteração no metabolismo de carboidratos que leva à hiperglicemia e ao aumento da morbimortalidade perioperatória. Cursa com alterações fisiológicas diversas e progressivas e, para o manejo anestésico, deve-se atentar para a interferência dessa doença nos múltiplos sistemas orgânicos e suas respectivas complicações. Anamnese, exame físico e exames complementares são importantes no manejo pré-operatório, com destaque para a hemoglobina glicosilada (HbA1c), que tem forte valor preditivo para complicações associadas ao diabetes. O planejamento cirúrgico tem como objetivos a redução do tempo de jejum e a manutenção da rotina do paciente. Pacientes portadores de DM Tipo 1 precisam receber, mesmo em jejum perioperatório, insulina para suprir as demandas fisiológicas basais e evitar cetoacidose. Já os pacientes portadores de DM Tipo 2, tratados com múltiplos fármacos injetáveis e/ou orais, são suscetíveis ao desenvolvimento de um estado hiperosmolar hiperglicêmico (EHH). Assim, o manejo dos hipoglicemiantes e dos diferentes tipos de insulina é fundamental, além da determinação do horário cirúrgico e, consequentemente, do número de refeições perdidas para adequação de doses ou suspensão dos medicamentos. As evidências atuais sugerem o alvo de manutenção da glicemia seguro para os pacientes cirúrgicos, sem concluir se deve ser obtido com controle glicêmico intensivo ou moderado. Keywords: Diabetes mellitus, Anesthesia, Perioperative care, Hypoglycemic agents, Insulin, Glycosylated hemoglobin, Palavras-chave: Diabetes melito, Anestesia, Cuidados perioperatórios, Hipoglicemiantes, Insulina, Hemoglobina glicosilad

Evaluation and perioperative management of patients with diabetes mellitus. A challenge for the anesthesiologist

Abstract Diabetes mellitus (DM) is characterized by alteration in carbohydrate metabolism, leading to hyperglycemia and increased perioperative morbidity and mortality. It evolves with diverse and progressive physiological changes, and the anesthetic management requires attention regarding this disease interference in multiple organ systems and their respective complications. Patient's history, physical examination, and complementary exams are important in the preoperative management, particularly glycosylated hemoglobin (HbA1c), which has a strong predictive value for complications associated with diabetes. The goal of surgical planning is to reduce the fasting time and maintain the patient's routine. Patients with Type 1 DM must receive insulin (even during the preoperative fast) to meet the basal physiological demands and avoid ketoacidosis. Whereas patients with Type 2 DM treated with multiple injectable and/or oral drugs are susceptible to develop a hyperglycemic hyperosmolar state (HHS). Therefore, the management of hypoglycemic agents and different types of insulin is fundamental, as well as determining the surgical schedule and, consequently, the number of lost meals for dose adjustment and drug suspension. Current evidence suggests the safe target to maintain glycemic control in surgical patients, but does not conclude whether it should be obtained with either moderate or severe glycemic control

Preventing Zoonotic Canine Leishmaniasis in Northeastern Brazil: Pet Attachment and Adoption of Community Leishmania Prevention

Visceral leishmaniasis (VL), caused by Leishmania infantum chagasi (L.i. chagasisyn. infantum) in northeastern Brazil, was responsible for 51,000 new VL cases from 1980 to 2003. Household presence of L. infantum-infected dogs is a major risk factor for human infection. Despite culling of dogs based on seropositivity, canine L. infantum seroprevalence remains near 20%, suggesting that dog culling is ineffective for preventing VL spread. We administered a cross-sectional survey to 224 households within 300 m of the homes of VL human patients diagnosed within the last year. The goal was to develop a model for voluntary preventative use based on characteristics and motivations of dog owners. We identified that owner knowledge deficiencies regarding canine transmission of L. infantum associated with increased risk of dog infection (odds ratio [OR] = 3.681, confidence interval [CI] = 1.223, 11.08). Higher owner education was associated with decreased levels of dog seropositivity (OR = 0.40, CI = 0.20, 0.81). Pet attachment (P = 0.036) and perception of risk/disease knowledge (P = 0.040) were significantly associated with willingness to voluntarily purchase canine VL prevention. These results highlight the importance of owner attachment to their pet in implementing reservoir-targeted zoonotic VL prevention.This article is from American Journal of Tropical Medicine and Hygiene 87 (2012): 822, doi:10.4269/ajtmh.2012.12-0251. Posted with permission.</p

Inflammatory biomarkers of osteosarcopenia in community-dwelling older woman

Summary: Background: The concomitant loss of lean muscle mass and bone mineral density is known as osteosarcopenia. This disorder can result in increased physical impairment in addition to an increased risk of falls and fractures. Although the diagnostic of osteoporosis and sarcopenia has been described, the inflammatory mediators that identify the presence of osteosarcopenia and propose possible inflammatory mechanisms implicated in muscle and bone loss are unknown. The objective of this study was to evaluate a panel of inflammatory biomarkers and investigate its relationship with the presence of osteosarcopenia. Methods: Body composition was assessed using Dual X-ray absorptiometry and handgrip strength using a Jamar dynamometer. Blood samples were collected for evaluation the plasmatic concentrations of adiponectin, brain-derived neurotrophic factor (BDNF), interferon ɣ (IFN), interleukins 2, 4, 5, 6, 8 and 10, leptin, resistin, tumour necrosis factor (TNF) and its soluble receptors (sTNFr) 1 and 2. Results: In seventy-one older women the age was 75 (±7) years, BMI 26.1 (±4.5) kg/m2, handgrip strength 19 (±6) kgf and the muscle mass index was 6.39 (±1.05) kg/m2. The diagnosis of osteosarcopenia was found in 25% of the sample. Analysis of the distribution of biomarkers demonstrate the osteosarcopenia group presented greater concentrations among all markers measured, and significant differences was found in plasmatic concentrations of interleukin 8 (p = 0.02). Subgroup analysis showed that group with osteopenia plus sarcopenia had significantly greater IL-6 (p = 0.03) and IL-8 (p = 0.007) concentrations. Conclusions: In a panel of biomarkers, IL-6 and IL-8 were found to be related with diagnosis of osteosarcopenia in community-dwelling older women. These results may contribute to understand the inflammatory mechanisms and suggest a diagnostic strategy for these patients, also informing new strategies for prevention, monitoring, and treatment of osteosarcopenia

Cisplatin and Etoposide in Childhood Germ Cell Tumor: Brazilian Pediatric Oncology Society Protocol GCT-91

Purpose In 1988, we formed a consortium of Brazilian institutions to develop uniform standards for the diagnostic assessment and multidisciplinary treatment of children and adolescents with germ cell tumors. We also implemented the first childhood Brazilian germ cell tumor protocol, GCT-91, evaluating two-agent chemotherapy with cisplatin and etoposide (PE). We now report on the clinical characteristics and survival of children and adolescents with germ cell tumors treated on this protocol. Patients and Methods From May 1991 to April 2000, 115 patients (106 assessable patients) were enrolled onto the Brazilian protocol with a diagnosis of germ cell tumor. Results Patients were treated with surgery only (n = 35) and chemotherapy (n = 71). Important prognostic factors included stage (P = .025), surgical procedure at diagnosis according to resectability (P = .032), and abnormal lactate dehydrogenase value at diagnosis (P = .001). Conclusion The improvement in survival by the introduction of a standard protocol is an important achievement. This is of particular importance for smaller institutions with previous limited experience in the treatment of childhood germ cell tumors. In addition, the results of a two-agent regimen with PE were favorable (5-year overall survival rate is 83.3% for patients in the high-risk group [n = 36] who received PE v 58.8% for patients in the high-risk patients group who received PE plus ifosfamide, vinblastine, and bleomycin [n = 17; P = .017]). Thus for selected patients, complex three-agent regimens may not be necessary to achieve long-term survival, even for some patients with advanced disease