Causes of synthetic disease-modifying drug discontinuation in rheumatoid arthritis : data from a large real-life cohort

The treatment of rheumatoid arthritis (RA) has evolved rapidly in recent years. Nonetheless, conventional synthetic disease-modifying drugs (csDMARDs) remain the gold standard for RA treatment. The treatment for RA is expensive and this has a negative impact on public health. Given the low cost of csDMARDs compared to those of other treatment strategies, it is important to manage this type of treatment properly. Information on the duration of use of each drug and the reasons for their discontinuation is relevant to medical practitioners as it could improve the information available regarding side effects and their proper management. Moreover, data from clinical practice in the population can provide health care managers with information for resource allocation and optimization of csDMARD use with a consequent cost reduction in the treatment of RA. In this cross-sectional study, we aimed to describe the use of csDMARDs in public health services in Brazil, emphasizing on the duration of use and reasons for discontinuation of each drug. This study is a part of the REAL, a multicenter project that evaluated Brazilian patients with RA from eleven rheumatology services from August to October 2015. Patients were examined clinically, and an analysis of complementary exams and medical records was performed. A total of 1125 patients were included. 98.5% were women with a median age of 55.6 years. 36% and 90.84% patients were using biological disease-modifying drugs (bDMARDs) and csDMARDs, respectively. The duration of use and doses of each medication and the causes of suspension were analyzed. Most of the patients analyzed in this study were using csDMARDs for prolonged periods and methotrexate showed the longest duration of use. Interruption indexes due to ineffectiveness and side effects were analyzed. The knowledge of common adverse effects may alert attending physicians to the proper management of effective and low-cost therapeutic groups

A New Species of Grigiotermes (Apicotermitinae, Termitidae) from the Northern Atlantic Forest, Delimited by Morphological and Molecular Data

In this paper, we described a new species of Grigiotermes, G. piassava sp. n., from the Brazilian Atlantic Forest. The imago and worker caste are described, including the gut morphology. The inclusion of the new species in Grigiotermes was based on morphological and DNA data. Apparently, the distribution of the species is limited to the northern region of the Atlantic Forest, located above the São Francisco River, which is considered one of the most threatened sectors of the biome

Microenxertia ex vitro para eliminação do vírus CABMV em maracujá-azedo

The objective of this work was to evaluate the effect of different culture media, used over grafting spot, in ex vitro micrografting, in order to eliminate the Cowpea aphid-borne mosaic virus (CABMV) in sour passion fruit plants (Passiflora edulis Sims f. flavicarpa Deg.). Cauline apexes, originated from infected plants, were micrografted in seedlings obtained by the germination of seeds in commercial sterilized substrate. Experiments were conducted with the micrografting performed on the hypocotyl and epicotyl using five culture media, which differed on their concentration of phytoregulators applied on the grafting spot. The average rate of micrografting showing expanded leaf was 27.22 and 32.22%, when micrografting was performed on hypocotyl and epicotyl, respectively. In the micrografting performed on the hypocotyl, there was no effect of the culture media applied. In the micrografting performed on epicotyl, the MS medium supplemented with 0.1 mg L-1 3-indolbutiric acid (IBA) and 1 mg L-1 6-benzylaminopurine (BAP) resulted in 53.3% of micrografting showing expanded leaf, a number superior to the other treatments, and in a larger development of shoots. The indexing performed by the indirect ELISA test, within 80 to 100 days after micrografting, showed that 93% of the plants tested presented no detectable virus.O objetivo deste trabalho foi avaliar diferentes meios de cultura, utilizados sobre o ponto da enxertia, na microenxertia ex vitro para a eliminação do Cowpea aphid-borne mosaic virus (CABMV), em plantas de maracujá-azedo (Passiflora edulis Sims f. flavicarpa Deg.). Ápices caulinares, provenientes de plantas infectadas, foram microenxertados em plântulas obtidas pela germinação de sementes em substrato comercial esterilizado. Foram conduzidos experimentos com a microenxertia realizada no hipocótilo e no epicótilo, e foram utilizados cinco meios de cultura, que diferiam na concentração de fitorreguladores, aplicados no local da enxertia. O índice médio de microenxertos com folha expandida foi de 27,22 e 32,22%, quando a microenxertia foi realizada no hipocótilo e no epicótilo, respectivamente. Na microenxertia realizada no hipocótilo, não houve efeito da aplicação de meios de cultura. Na microenxertia realizada no epicótilo, o meio MS acrescido de 0,1 mg L-1 de AIB e 1 mg L-1 de BAP proporcionou 53,3% de microenxertos com folha expandida, número superior aos demais tratamentos e maior desenvolvimento das brotações. A indexação realizada pelo teste ELISA indireto, 80 a 100 dias após a microenxertia, mostrou que 93% das plantas testadas não apresentavam vírus detectável

O uso de métodos estatísticos na pesquisa científica em turismo no Brasil

Ainda que o número de pesquisas qualitativas nos periódicos científicos internacionais de turismo esteja crescendo, as pesquisas quantitativas são claramente predominantes. Partindo dessa constatação preliminar, o presente artigo objetiva examinar o uso de métodos estatísticos para a análise de dados nas pesquisas em turismo no Brasil. Este trabalho examinou o uso de métodos estatísticos inferenciais ou multivariados para a análise de dados nas pesquisas publicadas na forma de artigos em três dos principais periódicos científicos brasileiros de turismo – Revista Brasileira de Pesquisa em Turismo (RBTUR), Revista Turismo em Análise (RTA) e Revista Turismo – Visão e Ação (RTVA). Foram selecionados todos os artigos publicados ao longo de dois períodos distintos de sete anos cada: o inicial (1990-96) e o mais recente (2012-18). Os métodos utilizados foram retratados por meio de estatísticas descritivas. Os resultados mostram que a pesquisa brasileira faz pouco uso de métodos estatísticos avançados em comparação com a prática corrente nos principais periódicos científicos internacionais da área. Ademais, a lista de métodos estatísticos mais frequentes revela uma tendência de aprimoramento e complexidade metodológica da pesquisa em turismo no país. Os métodos atualmente mais empregados são aqueles relacionados à análise de variáveis latentes, como a análise fatorial e a modelagem de equações estruturais. Por outro lado, uma vasta gama de alternativas metodológicas não tem sido explorada. Dessa forma, a pesquisa aponta para a existência de diversas oportunidades de inovação e aprimoramento metodológico das pesquisas em turismo no Brasil

Artificial intelligence to growth stresses predicting in Eucalyptus clones using dendrometric variables and wood density

Eucalyptus planted forests contribute to maximizing lumber production but problems such as longitudinal growth strain can negatively influence the quality of the products. Knowing dendrometric variables and wood properties can help in the prediction of longitudinal growth strain, mainly with the help of artificial intelligence. Thus, the aim of this research was to evaluate the use of artificial neural networks to predict longitudinal growth strain in Eucalyptus trees based on dendrometric variables, spacing between trees and wood density. The longitudinal growth strain was measured in trees of four Eucalyptus clones planted in three spacings. The diameter and height of each tree were measured. The basic wood density was determined. Artificial neural networks were used to estimate longitudinal growth strain as a function of dendrometric variables, tree spacing and wood density. The results showed that the artificial neural networks presented good results for training and validation, with most of them resulting in high correlation coefficient values. The trained artificial neural networks showed a correlation coefficient above 0,56. Artificial neural networks showed that the variables clone and basic wood density were the ones that most contributed to the prediction of longitudinal growth strain. On the other hand, the spacing between trees, the height of the tree and the diameter at breast height were not relevant to predict growth stresses

Searching for the critically endangered European eel in oceanic islands: a pioneer study in the freshwater systems of Madeira, Macaronesia

1. The globally threatened European eel (Anguilla anguilla) is the only freshwater fish native to Macaronesia. Despite being a keystone species to freshwater habitats, little is known about its population, environmental associations and conservation requirements in oceanic islands. 2. The density and geographical-related factors influencing the distribution of A. anguilla in the subtropical Archipelago of Madeira (Portugal) were examined. Data on the species occurrence was initially collected using an online survey addressed to citizens. Eels were then sampled through electrofishing in 31 sampling sites along 11 streams on Madeira Island, and eel-habitat associations were investigated using LMMs and GLMMs. One stream was also sampled in Porto Santo Island. 3. The presence of A. anguilla was confirmed in the two islands of the archipelago with streams (Madeira and Porto Santo). Eels are distributed throughout Madeira Island, being more abundant – particularly small size individual– at lower altitudes (mostly below 150 m). The number of weirs was an important predictor of eel density, suggesting that these flood-control structures limit their upstream migration. 4. This study represents a pioneer sampling effort of the European eel in Madeira and results provide much-needed baseline information on the species distribution and related environmental factors in oceanic islands. While most eel research has historically focused on mainland habitats where dams pose a significant threat to eel habitats, our study underscores the critical importance of addressing smaller, often overlooked barriers that may also cause habitat fragmentation. 5. The European eel is a panmictic species, thus, the conservation of the Macaronesian subpopulations can have substantial benefits for its global recovery. A comprehensive investigation of the impact of man-made obstacles on eel habitat is still needed. Similarly, other common threats such as interactions with non-indigenous species and infection by Anguillicola crassus should be a research priority in future studies

Uso de sustancias psicoactivas entre estudiantes universitários

El objetivo del estudio fue identificar el perfil del uso de sustancias psicoactivas entre estudiantes de Ciencias Biológicas, Educación Física, Enfermería, Fisioterapia, Farmacia, Odontología y Nutrición. Se trata de un estudio transversal, cuantitativo, exploratorio y descriptivo, con 567 estudiantes. Los datos fueron recolectados por medio de un cuestionario y analizados a través de la estadística descriptiva. En los resultados, se constató que el 11,6% de los estudiantes nunca experimentó el consumo de sustancias psicoactivas. Las drogas prevalentemente consumidas fueron: alcohol (n = 501), tabaco (n = 161), marihuana (n = 115) y cocaína (n = 26). Se concluye que el consumo de sustancias psicoactivas entre los estudiantes es un problema y que debe ser enfrentado a través de acciones preventivas y de reducción de daños.The objective of this study was to identify the profile of use of psychoactive substances among students of Biological Sciences, Physical Education, Nursing, Physiotherapy, Pharmacy, Dentistry and Nutrition courses. It was a cross - sectional, quantitative, exploratory and descriptive study with 567 students. Data were collected through a questionnaire and analyzed through descriptive statistics. In the results, it was found that 11.6% of students had never tried psychoactive substances in their lives. The most prevalent drugs among university students were alcohol (n = 501), tobacco (n = 161), marijuana (n = 115), and cocaine (n = 26). The result led to the conclusion that consumption of psychoactive substances among students is a problem that must be faced through the implementation of preventive and harm reduction actions.O objetivo do estudo foi identificar o perfil do uso de substâncias psicoativas entre estudantes dos cursos de Ciências Biológicas, Educação Física, Enfermagem, Fisioterapia, Farmácia, Odontologia e Nutrição. Trata-se de estudo transversal, quantitativo, exploratório e descritivo, com 567 estudantes. Os dados foram coletados por meio de um questionário e analisados através da estatística descritiva. Nos resultados, verificou-se que 11,6% dos estudantes nunca experimentaram substâncias psicoativas na vida. As drogas mais prevalentes entre os universitários foram o álcool (n=501), tabaco (n=161), maconha (n=115) e cocaína (n=26). Conclui-se que o consumo de substâncias psicoativas entre os estudantes é problema que deve ser enfrentado através da implantação de ações preventivas e de redução de danos

Green Anaconda (Eunectes murinus) with Bacterial Clinical Stomatitis

Background: Stomatitis is an infectious disease common in serpents and responsible for high mortality rates. It is characterized by the infection of the oral mucosa and neighboring tissues, related to the opportunistic character of bacteria present in the normal microbiota, pathogenic in stressful situations. Few studies have described the profile of sensibility of these agents in serpents of the Brazilian fauna. Therefore, this study has aimed at describing the isolation and identification of the infectious agents involved in the clinic stomatitis in a specimen of green anaconda (Eunectes murinus), and the profile of susceptibility to antimicrobial agents.Case: The serpent has been rescued in an urban environment, without previous records and featured erosive injuries in its oral cavity, with the presence of secretion. In a clinical evaluation, it has been assessed that the specimen had erosive injuries in its oral cavity, with hyperemic points in its mucosa and serous secretion. Then the specimen went through a collection of the secretion from its oral cavity for microbiological analysis. Typical colonies of Enterococcus, Citrobacter and Enterobacter were identified by the colony morphology and their typical odor. The results of these tests were able to confirm and identify the Citrobacter freundii, Enterobacter spp. and Enterococcus spp. The profile of sensibility to antimicrobials of the isolated microorganisms has been determined through the method of diffusion in the disk of Kirby-Bauer. There was not any sensitive antimicrobial drug for the three agents.Discussion: Immunodepression, malnutrition, and temperatures and humidity outside the animal thermal comfort zone, are predisposing factors for the development of bacterial diseases in reptiles. Little information about pathogen agents affecting constrictor serpents in their native area is available. Most reports on stomatitis in serpents approach cases occurred in captive animals, differently from what has been presented in this case, which is about a free animal rescued when invading an urban area. The bacteria isolated from the oral cavity of the serpent here reported belong to the normal microbiota of the oral cavity of these animals. Notwithstanding, these bacteria may become pathogenic in certain circumstances. Conditions of undernutrition, stress and oral trauma are considered as predisposing factors to the occurrence of stomatitis in serpents, what can be correlated to the occurrence of the disease in this case. The gram-negative agents causing bacterial diseases in serpents are generally resistant to medicines of the most common spectrum used in the clinical routine of wild animals. This way, veterinarians often deal with these diseases in reptiles empirically, using a wide range of antibiotics. This practice might result in the development of resistant bacterial stumps, what stands out due to the potential that resistant bacteria have to generate infections and zoonoses in humans

Caseous Stomatitis Caused by Pseudomonas aeruginosa in Boa constrictor amarali

Background: Pseudomonas aeruginosa is a bacterium that belongs to the microbiota of snakes, but it may also be an opportunistic pathogen and contaminate humans through fecal contact, bites, and injuries. In snakes, this microorganism may present high pathogenicity at certain conditions and have been associated with high morbidity and mortality. Reports of infection of Boa constrictor by this pathogen are rare. Thus, this study aimed to describe the P. aeruginosa oral infection in a snake specimen (Boa constrictor amarali), approaching the isolation and identification of the infectious agents involved, the antimicrobial sensitivity and resistance, and the therapeutic protocol adopted.Case: A free-living adult female specimen of Boa constrictor amarali (Amaral's boa), with no described previous history was rescued in an urban area by the Environmental Police. Clinical evaluations showed structures of caseous aspect in the oral cavity, with hyperemia spots in the mucosa. Samples of these lesions were sent for mycological examination, and fungal forms were not found. Samples were collected for isolation and culture. The antimicrobial susceptibility of the isolated microorganisms was determined by the modified Kirby-Bauer disk diffusion method. P. aeruginosa was isolated and showed susceptibility to amikacin, gentamicin, and polymyxin-B; intermediate susceptibility to azithromycin, and ciprofloxacin; and resistance to cephalexin, ceftiofur, chloramphenicol, and enrofloxacin. The treatment consisted of cleaning of the oral cavity, local infiltration of lidocaine for debridement of the caseous area that were later cauterized with iodine. Systemic antibiotic therapy was used, with intramuscular administration of amikacin (5 mg/kg) for the first dose and (2.5 mg/kg) for the other doses with intervals of 72 h, and oral administration of metronidazole (20 mg/kg) with intervals of 48 h, both during 21 days. Daily subcutaneous fluid therapy was performed as support treatment, using Lactated Ringer's solution (25 mg/kg) and Vitamin C (10 mg/kg) with intervals of 24 h, being the cure observed at the end of treatment.Discussion: This paper presents the pathological findings of the Pseudomonas aeruginosa oral infection in a B. constrictor amarali. This bacterium is an opportunistic pathogen that is commonly found  in snakes, thus, humans in contact with these animals may be contaminated with this pathogen. However, oral cavity lesions associated with P. aeruginosa had not yet been related to Boa constrictor amarali, which is a non-venomous species. Few bacteria associated with reptile diseases are primary causative agents. Clinical bacterial infections generally tend to be secondary to viral infections. Predisposing factors for the development of bacterial diseases in these reptiles include immunodepression, malnutrition, poor adaptation to captivity, and the maintenance of these animals at temperatures and humidities outside their thermal comfort range. In the present study, the P. aeruginosa behaved as an opportunistic pathogen, resulting in clinical manifestations with caseous lesions in the oral cavity, probably due to an imbalance of the microbiota caused by stress or immunodepression. The antibiogram allowed the adoption of a correct therapeutic protocol based on the susceptibility of the pathogen, resulting in remission of lesions and clinical signs after 21 days of treatment

Dermatopathy Caused by Enterobacter aerogenes and Pseudomonas aeruginosa in Boa constrictor amarali

Background: Bacterial diseases are the main cause of the high mortality rates of snakes, especially those caused by gramnegative agents. However, studies on dermatopathy caused by these bacterial agents in snakes are scarce; and no reports have been found on Enterobacter aerogenes as causative agent of dermatopathy in snake species. Thus, the objective of this study was to describe the clinical signs, and lesion evolution of a dermatopathy in a male snake (Boa constrictor amarali) specimen of approximately seven years old; and to describe the isolation and identification of the Enterobacter aerogenes and Pseudomonas aeruginosa agents involved in the cause of this disease.Case: The Boa constrictor amarali evaluated presented blackened cutaneous lesions in the dorsal, snout-vent and tail regions; and well-defined subcutaneous nodules of 2.0-3.0 cm diameter, with soft consistency, reddish color, cutaneous flaccidity, and areas of scale ulceration in the dorsolateral region. The clinical evaluation of the animal showed dehydration signs and pale mucous membranes. The blackened lesions were subjected to mycological analysis - after procedure of deep scale scraping - which showed presence of septate hyphae. The nodule was punctured for microbiological and biochemical analysis. The sample was collected with a sterilized alginate cotton tip swab, and was stored in a plastic tube containing a semi-solid Stuart transport medium, for microbiological analysis. Then, this sample was incubated in a bacteriological oven at 37°C for 24 h. Typical colonies of Pseudomonas and Enterobacter grew on MacConkey agar medium; these bacteria were identified by the colony morphology and their typical odor. The colonies grown in MacConkey agar were also identified through biochemical tests in the mediums: Phenol red, Lysine, Phenylalanine, Citrate, Urea and SIM (Sulfide, Indole, Motility). The results of these tests were able to confirm and identify the P. aeruginosa and E. aerogenes species. The animal died within 36 h, before the identification of the causative agents of the disease, thus, no pharmacological interference was possible.Discussion: Immunodepression, malnutrition, and temperatures and humidity outside the animal thermal comfort zone, are predisposing factors for the development of bacterial diseases in reptiles. Little information about pathogen agents affecting Boa constrictor specimens in their native area is available; however, captive snakes are subject to a wide variety of diseases - most of which caused or intensified by the captivity conditions. Among the bacteria involved in reptile diseases, few are primary causative agents. In general, clinical bacterial infections tend to be secondary to viral infections. The bacterial agents found in this study are commonly described in scientific literature with location in the oral cavity, differently from the results found in this study. Moreover, the bacterium E. aerogenes has not yet been described in other studies as a causative agent of dermatopathy. Reptiles are considered reservoirs of important zoonotic microorganisms, such as P. aeruginosa, which can be transmitted by fecal contact, bites and wounds. However, the little information on P. aeruginosa in captive reptiles indicates the need for further studies to establish its zoonotic potential. A most adequate management conditions for the snake species could have decreased the severity of the lesions. The occurrence of P. aeruginosa and E. aerogenes found in this work may alert professionals for future clinical suspicions and adequate therapeutic management