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The Santa Marta Sabrewing Campylopterus phainopeplus is listed as a “Critically Endangered” hummingbird endemic to the Sierra Nevada de Santa Marta (SNSM) in Colombia. Prior to 2022, there were only three documented sightings of the sabrewing since it was described in 1879, including only one record between 1946 and 2022. As a result, this “lost” species has long been one of the most poorly known birds in Colombia. We located a resident population of Santa Marta Sabrewing along the Guatapurí River near the Chemesquemena and Guatapurí villages in July 2022, and at its type locality, San José, in January 2023. Based on historical data and newly collected field observations, we assess the species’ status and describe aspects of its natural history and ecology. Our review indicates that the species has been frequently misidentified in the past, and that to date, documented evidence of its presence is limited to four localities, all of them restricted to the south-eastern slope of the SNSM, along the mid Guatapurí River basin. Consequently, this bird appears to represent a case of microendemism. This species is likely to remain listed as Critically Endangered until conclusive evidence suggests otherwise. Field observations indicate that the species is highly associated with watercourses, where males hold year-round territories and form leks. We obtained records of males in mid-elevation habitats (1,150–1,850 m) for 16 consecutive months between July 2022 and October 2023, suggesting that the species might not be an elevational migrant, as previously speculated. More information is needed to understand the species’ ecology so that effective conservation actions can be designed in collaboration with the indigenous communities with which the species coexists.
The chapter begins with a review of the historical and current socio-political context for sexual minority and gender diverse (SMGD) individuals living in Brazil, followed by relevant research on the associations between minority stress and well-being. A particular focus is devoted to presenting data collected as part of the SMGD-MN study. The chapter concludes with recommendations for future psychological research with SMGD communities in Brazil.
This paper reports the methods and preliminary findings of Germina, an ongoing cohort study to identify biomarkers and trajectories of executive functions and language development in the first 3 years of life. 557 mother-infant dyads (mean age of mothers 33.7 years, 65.2% white, 48.7% male infants) have undergone baseline and are currently collecting data for other timepoints. A linear regression was used to predict baseline Bayley-III using scores derived from data-driven sparse partial least squares utilizing a multiple holdout framework of 15 domains. Significant associations were found between socioeconomic/demographic characteristics (B = 0.29), epigenetics (B = 0.11), EEG theta (B = 0.14) and beta activity (B = 0.11), and microbiome functional pathways (B = 0.08) domains, and infant development measured by the Bayley-III at T1, suggesting potential interventions to prevent impairments.
We aimed to determine whether benchmarking antimicrobial use (AU) to antimicrobial resistance (AR) using select AU/AR ratios is more informative than AU metrics in isolation.
Design:
We retrospectively measured AU (antimicrobial therapy days per 1,000 days present) and AU/AR ratios (specific antimicrobial therapy days per corresponding AR event) in two hospitals during 2020 through 2022. We then had antimicrobial stewardship committee members evaluate each AU and corresponding AU/AR value and indicate whether they believed it represented potential overuse, appropriate use, or potential underuse of the antimicrobials, or whether they could not provide an assessment.
Setting:
Two acute-care hospitals.
Patients:
Hospitalized patients.
Results:
In semi-annual facility-wide analyses, echinocandins had a median AU/AR ratio of 658.5 therapy days per fluconazole-resistant Candida event in Hospital A, IV vancomycin had a median AU/AR ratio of 114.9 and 108.2 therapy days per methicillin-resistant Staphylococcus aureus event in Hospital A and B, respectively, and linezolid had a median AU/AR ratio of 33.8 and 88.0 therapy days per vancomycin-resistant Enterococcus event in Hospital A and B, respectively. When AU and AU/AR values were evaluated by stewardship committees, more respondents were able to assess antimicrobial use based on AU/AR values compared to AU values. Based on AU/AR ratios, most respondents identified potential overuse of echinocandins and IV vancomycin in Hospital A, and potential overuse of linezolid and IV vancomycin in Hospital B.
Conclusion:
Select AU/AR ratios provided informative metrics to antimicrobial stewardship personnel, which can be used to motivate audits of antimicrobial administration to determine appropriateness.
Public hospitals in São Paulo can be held financially responsible for costs related to medications prescribed outside the recommendations of the Brazilian Unified Health System (SUS). The objective of this study was to describe these expenses in a public hospital and the measures implemented and evaluated to reduce this problem.
Methods
In January 2023, the Health Technology Assessment Center collected data on legal proceedings filed against a tertiary teaching hospital from January 2021 to November 2023. The data were obtained from monthly reports sent by the São Paulo State Department of Health (SES). The proceedings were categorized according to the type of technology and its availability in the SUS, costs, and the prescribing specialties. The indicators developed were used to plan improvement actions to guide care teams, negotiate with the SES, and resolve current legal proceedings.
Results
The cost of legal proceedings for 136 patients was BRL4,410,278 (USD890,965). Four medicines for six patients constituted 56 percent of the total cost. A group created an informative folder explaining how to access the National List of Essential Medicines, prescribe medicines from the high-cost program, and make administrative requests. Other related actions were the creation of a standardized process for requesting medicines, monthly assessment of judicialization data, clinical discussions with prescribers, and educational activities with residents. The interventions reduced average monthly costs from BRL177,268 (USD35,811) to BRL85,493 (USD17,271) in the last trimester.
Conclusions
Knowledge and measurement of judicialization costs allowed the hospital to implement improvements to help avoid new legal proceedings and to understand the demands of medical specialties regarding situations not covered by SUS guidelines. The Health Technology Assessment Center’s work with managers made it possible to identify opportunities for improving the education of professionals regarding the procedures and technologies available in the SUS.
While implementing an evidence-based guideline for venous thromboembolism (VTE) prophylaxis in a Brazilian tertiary hospital, we identified an unmet need for patients undergoing major orthopedic surgery. The Brazilian Unified Health System (SUS) does not provide access to direct oral anticoagulants (DOACs) or enoxaparin. Therefore, an assessment of the efficacy, safety, and budgetary impact of these medications from a hospital perspective is warranted.
Methods
Our Health Technology Assessment Center performed an overview of systematic reviews (SR) to compare the efficacy and safety of DOACs with enoxaparin. The Cochrane Library, Embase, and MEDLINE databases were searched in May 2023. The relative risks of symptomatic VTE, clinically relevant bleeding, and mortality were collected. The AMSTAR-2 tool was used to assess the methodological quality of included SRs. Treatment costs and estimates of the number of patients undergoing knee or hip arthroplasty were derived from historical institutional data.
Results
Of the 32 SRs included in the analysis, seven performed a network meta-analysis. All SRs had at least one flaw in a critical methodological domain, mainly in not providing the list of excluded studies. Regarding mortality rates, most SRs did not detect any differences between the treatments. The risk of experiencing VTE was lower with DOACs in eight SRs for hip arthroplasty and in five SRs for knee arthroplasty. The risk of major bleeding was similar between the treatments in all but two SRs. Substituting enoxaparin for DOACs led to a cost reduction of BRL490 (USD98) per patient, which could save BRL29,890 (USD6,038) per year.
Conclusions
Patients undergoing hip and knee arthroplasties are at high risk for the occurrence of VTE. Our overview of SRs showed that the efficacy and safety of DOACs are well recognized. DOACs reduce the risk of VTE, but to date patients in Brazil do not have access to these medicines through the SUS. By providing DOACs, hospitals could ensure adequate prophylaxis without increasing costs.
Childhood and puberty can affect metabolism, leading to tissue injury and malfunction later in life. The consumption of high-processed foods rich in salt and sugar is increasing in middle- and high-income countries, especially among young people. It is necessary to evaluate the effects of high salt and sugar levels in the youth on most injured organs during metabolic challenges. We aimed to investigate whether high-salt/sucrose intake affects whole-body development and leads to end-organ injury. Weaned male Wistar rats were divided into two groups: a control group fed a standard diet and tap water, and an experimental group (SS) fed a standard diet and a beverage containing 1·8 % NaCl and 20 % sucrose instead of tap water. The animals were treated for 60 d, starting after weaning at 21 d of age, after which the animals were subjected to glucose and insulin tolerance tests, urine collection and heart rate monitoring and euthanised for sample collection at 81 d of age. SS showed reduced body weight gain and increased food intake of sodium/sucrose solution. Interestingly, high-salt/sucrose intake led to increased body adiposity, liver lipid inclusion, heart rate and renal dysfunction. SS exhibits increased levels of PPAR alpha to counterbalance the hypertrophy of brown adipose tissue. Our findings reveal that the SS rat model exhibits non-obvious obesity with end-organ damage and preserved brown adipose tissue function. This model closely parallels human conditions with normal BMI but elevated visceral adiposity, providing a relevant tool for studying atypical metabolic disorders.
In Northeastern Brazil, successful release programmes have been implemented for the conservation of West Indian manatees (Trichechus manatus) since the 1990s. Recently, the non-government organization AQUASIS started releasing manatees in the state of Ceará, where oceanographic conditions and the absence of sheltered places pose new challenges for the release and monitoring of manatees. This research investigates the movement of a manatee named Tico, released in Icapuí, Ceará, Brazil, that travelled approximately 4017 km over 62 days through deep oceanic waters. Correlating Tico's trajectory and velocity with surface currents revealed the influence of the North Brazil Current (NBC) and its vortices on his movement. Tico crossed the diluted Amazon River plume with surface salinity as low as 26 g kg−1 in early August, potentially encountering areas of even lower salinity. Additionally, Tico experienced several storms, with significant rainfall during his journey, which may have provided freshwater. The erratic movement patterns and significant weight loss prompted the rescue of Tico on Isla la Blanquilla, Bolivarian Republic of Venezuela. Tico is currently being temporarily housed in Parque Zoológico y Botánico Bararida in Venezuela. Understanding the nature of Tico's long-distance movement could help inform decisions about his future. AQUASIS proposes to return Tico to Brazil, a region with an ecologically and genetically distinct population from Venezuela, for a second release attempt, incorporating lessons learned from the first release. Furthermore, AQUASIS has the necessary human and financial resources to ensure the continuous monitoring of Tico during his readaptation to the wild.
The aim of this study is to determine if the offspring of mothers with obesity, present disorders in the expression of genes related to atrophy or protein synthesis in the muscle and if these disorders are modified with the (−)-epicatechin (Epi) treatment. Six male offspring per group were randomly assigned to the control groups [C and offspring of maternal obesity (MO)] or the Epi intervention groups, Epi treatment for 13 weeks (C + Epi long or MO + Epi long), or Epi administration for two weeks (C + Epi short or MO + Epi short). The effect of Epi in the gastrocnemius tissue was evaluated, analyzing mRNA and protein levels of Murf1, MAFbx, Foxo1, NFkB, and p70S6K-alpha. After the analysis by two-way ANOVA, we found an influence of the Epi long treatment over the model, by decreasing the Murf1 gene expression in both groups treated with the flavonoid (C + Epi long and MO + Epi long) (p = 0.036). Besides, Epi long treatment over the NFκB expression, by decreasing the fold increase in both groups treated with the flavonoid (C + Epi long and MO + Epi long) (p = 0.038). We not find any interaction between the variables or changes in the MAFbx, Foxo1 mRNA, neither in the phosphorylated/total protein ratio of NFκB, Foxo1, or p70S6K-alpha. In conclusions, treatment with a long protocol of Epi, reduces the mRNA of the muscle atrophy genes Murf 1 and NFkB, in the gastrocnemius muscle; however, these changes are not maintained at protein level.
Schrankiana are gastrointestinal parasites of anurans, distributed throughout Central and South America. Schrankiana formosula and Schrankiana inconspicata are some of the most commonly reported species parasitising anurans from Brazil, and the morphological differences between them are unclear. In the present study, we redescribed S. formosula based on a re-examination of type series and newly collected material from the frog Leptodactylus pentadactylus in the state of Amapá, Brazil. Additionally, we re-examined the type series of S. inconspicata, and propose it as a junior synonym of S. formosula. We provide detailed morphological and morphometric data with intraspecific variation analyses and new molecular data for S. formosula. In the present phylogeny, S. formosula formed a well-supported clade with Raillietnema sp. and Labeonema synodontisi. Based on molecular phylogenetic analyses and some morphological similarities, our findings support the hypothesis that Schrankiana is a member of the family Cosmocercidae, not Atractidae. Additionally, we provide the first ultrastructural descriptions of S. formosula, and establish the species' phylogenetic position from the Cosmocercidae.
To evaluate postoperative outcomes among patients undergoing colon surgery who receive perioperative prophylaxis with ertapenem compared to other antibiotic regimens.
Design and setting:
Multicenter retrospective cohort study among adults undergoing colon surgery in seven hospitals across three health systems from 1/1/2010 to 9/1/2015.
Methods:
Generalized linear mixed logistic regression models were applied to assess differential odds of select outcomes among patients who received perioperative prophylaxis with ertapenem compared to other regimens. Postoperative outcomes of interest included surgical site infection (SSI), Clostridioides difficile infection (CDI) and clinical culture positivity for carbapenem-resistant Enterobacteraciae (CRE). Inverse probability weights were applied to account for differing covariate distributions across ertapenem and non-ertapenem groups.
Results:
A total of 2,109 patients were included for analysis. The odds of postoperative SSI was 1.56 times higher among individuals who received ertapenem than among those receiving other perioperative antimicrobial prophylaxis regimens in our cohort (46 [3.5%] vs 20 [2.5%]; IPW-weighted OR 1.56, [95% CI, 1.08–2.26], P = .02). No statistically significant differences in odds of postoperative CDI (24 [1.8%] vs 16 [2.0%]; IPW-weighted OR 1.07 [95% CI, .68–1.68], P = .78) were observed between patients who received ertapenem prophylaxis compared to other regimens. Clinical CRE culture positivity was rare in both groups (.2%–.5%) and did not differ statistically.
Conclusions:
Ertapenem use for perioperative prophylaxis was associated with increased odds of SSI among patients undergoing colon surgery in our study population, though no differences in CDI or clinical CRE culture positivity were identified. Further study and replication of these findings are needed.
Background: External comparisons of antimicrobial use (AU) may be more informative if adjusted for encounter characteristics. Optimal methods to define input variables for encounter-level risk-adjustment models of AU are not established. Methods: This retrospective analysis of electronic health record data included 50 US hospitals in 2020-2021. We used NHSN definitions for all antibacterials days of therapy (DOT), including adult and pediatric encounters with at least 1 day present in inpatient locations. We assessed 4 methods to define input variables: 1) diagnosis-related group (DRG) categories by Yu et al., 2) adjudicated Elixhauser comorbidity categories by Goodman et al., 3) all Clinical Classification Software Refined (CCSR) diagnosis and procedure categories, and 4) adjudicated CCSR categories where codes not appropriate for AU risk-adjustment were excluded by expert consensus, requiring review of 867 codes over 4 months to attain consensus. Data were split randomly, stratified by bed size as follows: 1) training dataset including two-thirds of encounters among two-thirds of hospitals; 2) internal testing set including one-third of encounters within training hospitals, and 3) external testing set including the remaining one-third of hospitals. We used a gradient-boosted machine (GBM) tree-based model and two-staged approach to first identify encounters with zero DOT, then estimate DOT among those with >0.5 probability of receiving antibiotics. Accuracy was assessed using mean absolute error (MAE) in testing datasets. Correlation plots compared model estimates and observed DOT among testing datasets. The top 20 most influential variables were defined using modeled variable importance. Results: Our datasets included 629,445 training, 314,971 internal testing, and 419,109 external testing encounters. Demographic data included 41% male, 59% non-Hispanic White, 25% non-Hispanic Black, 9% Hispanic, and 5% pediatric encounters. DRG was missing in 29% of encounters. MAE was lower in pediatrics as compared to adults, and lowest for models incorporating CCSR inputs (Figure 1). Performance in internal and external testing was similar, though Goodman/Elixhauser variable strategies were less accurate in external testing and underestimated long DOT outliers (Figure 2). Agnostic and adjudicated CCSR model estimates were highly correlated; their influential variables lists were similar (Figure 3). Conclusion: Larger numbers of CCSR diagnosis and procedure inputs improved risk-adjustment model accuracy compared with prior strategies. Variable importance and accuracy were similar for agnostic and adjudicated approaches. However, maintaining adjudications by experts would require significant time and potentially introduce personal bias. If findings are confirmed, the need for expert adjudication of input variables should be reconsidered.
Disclosure: Elizabeth Dodds Ashley: Advisor- HealthTrackRx. David J Weber: Consultant on vaccines: Pfizer; DSMB chair: GSK; Consultant on disinfection: BD, GAMA, PDI, Germitec
The aim of this study is to assess the effects of substituting soybean meal with extruded urea in the diet of crossbred Texel x no defined racial pattern lambs under continuous grazing on Brachiaria ssp., focusing on both their productive and nutritional performance. 60 Texel crossbred lambs (12 animals for each treatment) were used, with an average initial weight of 20.7 ± 0.87 kg and an average age of 2.5 ± 0.70 months, fed treatments with increasing levels of UE (Urea extruded Amireia® 200S): 0; 6; 12; 18 and 24 grams of EU 100/kg of body weight, with trial period was 5 months, using the multivariate technique. The data were subjected to principal component and canonical discriminant analysis to check possible differences between the evaluated treatments and identify the variables that best discriminate and use these variables to create a discriminant function that represents the differences between treatments. Of the 12 variables initially used, we observed that 9 were used by the main components, but 6 were those that presented the greatest discriminatory power for the study. Main component 1 was characterized by biometric measurements and showed the greatest power of variation in the study (60%), followed by main component 2, represented by slaughter weight and empty body weight (13%). These correlations indicate that biometric measurements can serve as reliable indirect indicators for estimating carcass traits in sheep, offering a practical alternative to visual assessments.
Sodium overload during childhood impairs baroreflex sensitivity and increases arterial blood pressure and heart rate in adulthood; these effects persist even after high-salt diet (HSD) withdrawal. However, the literature lacks details on the effects of HSD during postnatal phases on cardiac ischemia/reperfusion responses in adulthood. The current study aimed to elucidate the impact of HSD during infancy adolescence on isolated heart function and cardiac ischemia/reperfusion responses in adulthood. Male 21-day-old Wistar rats were treated for 60 days with hypertonic saline solution (NaCl; 0.3M; experimental group) or tap water (control group). Subsequently, both groups were maintained on a normal sodium diet for 30 days. Subsequently, the rats were euthanized, and their hearts were isolated and perfused according to the Langendorff technique. After 30 min of the basal period, the hearts were subjected to 20 min of anoxia, followed by 20 min of reperfusion. The basal contractile function was unaffected by HSD. However, HSD elevated the left ventricular end-diastolic pressure during reperfusion (23.1 ± 5.2 mmHg vs. 11.6 ± 1.4 mmHg; p < 0.05) and increased ectopic incidence period during reperfusion (208.8 ± 32.9s vs. 75.0 ± 7.8s; p < 0.05). In conclusion, sodium overload compromises cardiac function after reperfusion events, diminishes ventricular relaxation, and increases the severity of arrhythmias, suggesting a possible arrhythmogenic effect of HSD in the postnatal phases.