Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved

Epidemiología de enfermedades fúngicas de postcosecha en frutos de Papaya

Se analizó el impacto de las enfermedades fúngicas en las pérdidas de postcosecha de papaya en la fase de comercialización, evaluando la influencia de la temperatura en la manifestación de las enfermedades de postcosecha y del binomio temperatura- humedad relativa en la severidad de la pudrición causada por Lasiodiplodia theobromae.Cuatro supermercados, en la ciudad de Recife (Estado de Pernambuco, Brasil), fueron analizados en cuanto al impacto de las enfermedades fúngicas post-cosecha en las pérdidas de frutos de papaya. Estas fueron las principales causas de descarte, correspondiendo un 98% al Cultivar Formosa y 90,5% al Cultivar Sunrise Solo.Los principales hongos involucrados en el proceso de infección fueron Colletotrichum gloeosporoides, L. theobromae y Rhizopus stolonifer , agentes causales de la antracnosis, pudrición peduncular y pudrición acuosa, respectivamente. Al analizar la influencia de la tempreatura (5, 15 y 30°C) en los frutos con aspecto sano, se constató que las principales enfermedades fueron las mismas observadas en los frutos descartados. A temperaturas de 5 y 15°C, la antracnosis presentó una mayor incidencia en relación con las otras enfermedades, mientras  que la pudrición peduncular fue constatada solamente a 30°C, con incidencia superior a las demás. En el análisis de la influencia de la temperatura y la humedad sobre la severidad de la pudrición causada por L. theobromae, no se observaron síntomas de la enfermedad en frutos en humedad relativa inferior o igual a 90%. En presencia de elevada humedad, solo a partir de 25°C fue constatada la incidencia de la enfermedad, con un aumento en la severidad de la misma con la elevación de la temperatura y del período de humedad relativa

The origin of the modern Amazon rainforest: implications of the palynological and palaeobotanical record

Northern South America harbours a highly diversified forest vegetation. However, it is not clear when this remarkable diversity was attained and how it was produced. Is the high diversity the product of a positive speciation-extinction balance that accumulated species over long time periods, or is it the product of high origination rates over short time periods, or both? Middle Cretaceous floras, although very poorly studied, are dominated by non-angiosperm taxa. By the Paleocene, pollen and macrobotanical fossils suggest that the basic phylogenetic composition and floral physiognomy of Neotropical rainforests were already present. Hence there was a profound change in Amazonian flora during the Late Cretaceous, that still needs to be documented. Levels of Paleocene diversity are much lower than those of modern tropical rainforests. By the Early Eocene, however, pollen diversity was very high, exceeding values of modern rainforests. At the Eocene-Oligocene a major drop in diversity coincided with an episode of global cooling. The palynological and palaeobotanical records of Amazonia suggest that high levels of diversity existed during the Miocene, a period when the boundary conditions for sustaining a rainforest (e.g. low seasonality, high precipitation, edaphic heterogeneous substrate) were met. The predecessor of the present rainforest was formed during the Paleogene and Neogene when the western Amazon lowlands were affected by Andean tectonism, which radically changed drainage systems and promoted wetland development. An overall global cooling during the Neogene also may have affected the rainforest, decreasing its area and expanding adjacent savanna belts. Recent events like the Quaternary ice ages also played a role in the forest dynamics and composition, although it seems to have been minor. In this chapter we will review the main characteristics of the Neogene palynological and palaeobotanical records in Amazonia, and we will make some comparisons with pre- and post-Neogene records. The data indicate that the Amazonian rainforest is more likely to be a product of a dynamic geological history stretching back over the past 25 million years rather than the last few hundred thousand years