Potential role of transthoracic echocardiography for screening LV systolic dysfunction in patients with a history of dengue infection. A cross-sectional and cohort study and review of the literature

Background

Dengue virus can affect the cardiovascular system and men may be at higher risk of severe complications than women. We hypothesized that clinical dengue virus (DENV) infection could induce myocardial alterations of the left ventricle (LV) and that these changes could be detected by transthoracic echocardiography.

Methodology/Principal findings

We examined individuals from Acre in the Amazon Basin of Brazil in 2020 as part of the Malaria Heart Study. By questionnaires we collected information on self-reported prior dengue infection. All individuals underwent transthoracic echocardiography, analysis of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). We included 521 persons (mean age 40±15 years, 39% men, 50% urban areas) of which 253 (49%) had a history of dengue infection. In multivariable models adjusted for clinical and sociodemographic data, a history of self-reported dengue was significantly associated with lower LVEF (β = -2.37, P < 0.01) and lower GLS (β = 1.08, P < 0.01) in men, whereas no significant associations were found in women (P > 0.05). In line with these findings, men with a history of dengue had higher rates of LV systolic dysfunction (LVEF < 50% = 20%; GLS < 16% = 17%) than those without a history of dengue (LVEF < 50% = 7%; GLS < 16% = 8%; P < 0.01 and 0.06, respectively).

Conclusions/Significance

The findings of this study suggest that a clinical infection by dengue virus could induce myocardial alterations, mainly in men and in the LV, which could be detected by conventional transthoracic echocardiography. Hence, these results highlight a potential role of echocardiography for screening LV dysfunction in participants with a history of dengue infection. Further larger studies are warranted to validate the findings of this study.

Prevalence and Dynamic Changes in Lung Ultrasound Findings among Adults with Uncomplicated Malaria and Controls in the Amazon Basin, Brazil

Malaria patients are at risk of cardiopulmonary complications but diagnosis and management can be difficult in resource-limited settings. B-lines on lung ultrasound (LUS) mark changes in lung density; however, little is known about their role in malaria. We aimed to examine the prevalence of B-lines in adults with malaria at baseline and follow-up compared with controls in the Amazon Basin. We also examined the relationship between B-lines and left ventricular ejection fraction. We performed eight-zone LUS, echocardiography, and blood smears in 94 adults (mean age 40 years, 54% men) with uncomplicated malaria and 449 controls without heart failure, renal insufficiency or lung disease (mean age 41 years, 38% men). Examinations of adults with malaria were repeated after antimalarial treatment, corresponding to a median of 30 days (interquartile range [IQR] 27-39). Adults with malaria suffered from Plasmodium vivax (N = 70, median 2,823 [IQR 598-7,698] parasites/μL) or P. falciparum (N = 24, median 1,148 [IQR 480-3,128] parasites/μL). At baseline, adults with malaria more frequently had ≥ 3 B-lines (summed across eight zones) compared with controls (30% versus 2%, P value < 0.001), indicating higher lung density. When examinations were repeated, only 6% of adults with malaria had ≥ 3 B-lines at follow-up, which was significant lower compared with baseline (median reduction 3 B-line; P value < 0.001). B-lines were not significantly associated with left ventricular ejection fraction in adults with malaria. In conclusion, B-lines detected by LUS were more frequent in adults with uncomplicated malaria compared with controls and decreased after completed antimalarial treatment.

Prevalence of rheumatic heart disease in adults from the Brazilian Amazon Basin

BACKGROUND

Rheumatic heart disease (RHD) continues to be a burden in low- and middle-income countries and prevalence estimates are lacking from South America. We aimed to determine the prevalence of RHD in the Brazilian Amazon Basin.

METHODS

We examined a random sample of adults (≥18 years) from the general population, who underwent echocardiographic image acquisition by a medical doctor. All images were analyzed according to (i) the 2012 World Heart Federation criteria and (ii) a simplified algorithm for RHD from a previously validated risk score (categories: low-, medium-, high-risk) which involved assessment of the mitral valve (leaflet thickening and excessive motion, regurgitation jet length) and aortic valve (thickening and any regurgitation).

RESULTS

A total of 488 adults were screened (mean age 40 ± 15 years, 38% men). The prevalence of RHD was 39/1000 adults (n = 17 definite and n = 2 borderline). Fourteen (74%) had pathological mitral regurgitation, four (21%) mitral stenosis, 0 (0%) pathological aortic regurgitation and six (32%) both mitral and aortic valve disease. None had a prior diagnosis of RHD, 10 (53%) had positive cardiac auscultation and two (11%) reported a history of rheumatic fever. The simplified algorithm identified four (21%) adults as low-risk, six (32%) as intermediate, and nine (47%) as high-risk.

CONCLUSIONS

The prevalence of RHD was 39/1000 in adults from the Brazilian Amazon Basin, indicating the need for screening programs in remote areas. A simplified model was only able to categorize every second case of RHD as high-risk. External validation of simplified screening models to increase feasibility in clinical practice are encouraged.

Whole genome sequencing reveals large deletions and other loss of function mutations in Mycobacterium tuberculosis drug resistance genes

Drug resistance in Mycobacterium tuberculosis, the causative agent of tuberculosis disease, arises from genetic mutations in genes coding for drug-targets or drug-converting enzymes. SNPs linked to drug resistance have been extensively studied and form the basis of molecular diagnostics and sequencing-based resistance profiling. However, alternative forms of functional variation such as large deletions and other loss of function (LOF) mutations have received much less attention, but if incorporated into diagnostics they are likely to improve their predictive performance. Our work aimed to characterize the contribution of LOF mutations found in 42 established drug resistance genes linked to 19 anti-tuberculous drugs across 32689 sequenced clinical isolates. The analysed LOF mutations included large deletions (n=586), frameshifts (n=4764) and premature stop codons (n=826). We found LOF mutations in genes strongly linked to pyrazinamide (pncA), isoniazid (katG), capreomycin (tlyA), streptomycin (e.g. gid) and ethionamide (ethA, mshA) (P<10^-5), but also in some loci linked to drugs where relatively less phenotypic data is available [e.g. cycloserine, delaminid, bedaquiline, para-aminosalicylic acid (PAS), and clofazimine]. This study reports that large deletions (median size 1115 bp) account for a significant portion of resistance variants found for PAS (+7.1% of phenotypic resistance percentage explained), pyrazinamide (+3.5%) and streptomycin (+2.6%) drugs, and can be used to improve the prediction of cryptic resistance. Overall, our work highlights the importance of including LOF mutations (e.g. large deletions) in predicting genotypic drug resistance, thereby informing tuberculosis infection control and clinical decision-making.

Diagnostic value of electrocardiograms to identify pericardial effusion in acute malaria: a cross-sectional study

Background

Patients with acute malaria are at risk of pericarditis and may benefit from timely identification of pericardial effusion. However, diagnostic imaging tools, such as echocardiography, are not always available in malaria endemic regions.

Purpose

The aim of this study is to examine the diagnostic yield of pathology in electrocardiograms (ECG) to identify pericardial effusion in acute malaria.

Methods

We enrolled adult acute malaria patients in community healthcare clinics in a remote area in South America. All patients underwent ECG, echocardiography, and peripheral blood smears. We excluded patients on anti-malarial medication, suspected concomitant infection and pregnant women. All ECGs were examined for the following criteria: (i) PR-depression &gt;0.5mm and/or ST-elevation 0.5–1mm (I, II, aVL, aVF, V2–6) (ii) PR-elevation &gt;0.5mm (only aVR), (iii) ST/T-ratio &gt;0.25 (only V6), (v) low voltage, defined as QRS amplitude &lt;5 mm in limb leads or &lt;10 mm in precordial leads, and (vi) Spodick's sign (all leads). A criterion was positive when present in ≥2 leads. Information on shortness of breath and/or chest pain was also collected. Pericardial effusion was diagnosed by echocardiography and had to be ≥0.5cm in width.

Results

We included 99 non-severe malaria patients (age 40±15 years, 55% men, median parasite density 1517/mm3, [interquartile range 528 to 6,585/mm3]) who suffered from Plasmodium vivax (n=75), falciparum (n=22 falciparum) and mixed vivax/falciparum (n=2). The ECGs showed a mean frequency of 78±16bpm, PR-interval 147±20ms, QRS 88±11ms and QT-interval 376±34ms. A total of 11 patients displayed pericardial effusion (mean width 0.9±0.3cm, n=7 vivax, n=2 falciparum, n=2 mixed). Patients with effusion were older (mean age 39 vs 53 years, P=0.003), but displayed no difference in sex, parasite density or parasite species compared to patients without pericardial effusion (P&gt;0.05). Distribution of ECG findings and symptoms are displayed in figure 1A. PR-depression had a sensitivity and specificity for diagnosing pericardial effusion of 73% and 90%, respectively. The sensitivity and specificity for other ECG findings and clinical symptoms are displayed in Figure 1B.

Conclusion

ECG findings may aid in identifying pericardial effusion in acute malaria, specifically PR depression which had a diagnostic yield of 73% sensitivity and 90% specificity. Based on this, ECG in acute malaria may improve treatment and risk stratification when echocardiography is not an option.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation, Independent Research Fund Denmark ECG findings in malaria patients

Do river basins influence the composition of functional traits of fish assemblages in Neotropical reservoirs?

In aquatic environments, dams are considered one of the main threats to fish species, acting as an environmental filter for certain functional traits. Although there is some predictability in the composition of the functional traits in reservoirs, it is hypothesized that the environmental filters imposed by evolutionary processes, linked to the characteristics of the basins, are determinant for the functional composition of the traits in reservoirs. For this we performed a PCoA using the functional traits composition matrix of the reservoirs. We used PERMANOVA to test the difference in functional composition between basins. We performed the same process for the species composition matrix to compare the patterns. In this study, there were taxonomic and functional differences among reservoirs inserted in different basins. It was observed that the basin is a determining factor for the functional structure of fish assemblage in reservoirs. When compared, functional and taxonomic structures follow the same pattern, although functionally the reservoir tends to be more similar. These results reinforce the idea that reservoirs act as filters for functional traits (e.g., related with reproduction, feeding and habitat use), although there is a great influence of evolutionary processes related to the basin's characteristics and origin of the ichthyofaunistic province.

Cardiopulmonary alterations by ultrasound in a patient with uncomplicated mixed malaria infection: a case report from the Amazon Basin

BACKGROUND

Information on cardiopulmonary complications in clinical malaria is sparse and diagnosis may be difficult in resource-limited areas due to lack of proper diagnostic tools and access to medical care. A case of pericardial effusion and pulmonary alterations assessed by ultrasound in a patient with uncomplicated mixed malaria infection is described.

CASE PRESENTATION

A previously healthy 23-year-old male from the Amazon Basin was diagnosed with mixed infection of Plasmodium vivax and Plasmodium falciparum by peripheral blood smear. The patient presented with mild malaria symptoms without signs of severe malaria, but reported moderate chest pain and shortness of breath. Laboratory analyses revealed thrombocytopenia and anemia. The electrocardiogram had PR depressions and bedside ultrasound of the cardiopulmonary system showed pericardial effusion (18 mm) accompanied by multiple B-lines in the lungs, identified as vertical artifacts extending from the pleural line. Cardiac biomarkers were normal. The patient was treated according to national guidelines for malaria and suspected pericarditis, respectively. At follow-up on day 5, the pericardial effusion (9mm) and B-lines had markedly decreased. By day 21 the patient was asymptomatic, had completed the treatment, and the electrocardiogram and ultrasound findings had normalized.

CONCLUSIONS

This case report highlight the usefulness of bedside ultrasound to identify cardiopulmonary involvement in patients with uncomplicated malaria and relevant symptoms.

Prevalence of Cardiovascular Complications in Malaria: A Systematic Review and Meta-Analysis

Recent studies have suggested that malaria may affect the cardiovascular system. The aim of this systematic review and meta-analysis was to determine the prevalence of cardiovascular complications in symptomatic malaria patients. We searched databases such as Pubmed, Embase, Cochrane, and Web of Science (January 1950-April 2020) for studies reporting on cardiovascular complications in adults and children with malaria. Cardiovascular complications were defined as abnormalities in electrocardiogram (ECG), cardiac biomarkers, and echocardiography on admission or during outpatient examination. Studies of patients with known heart disease or cardiovascular evaluation performed after the start of intravenous antimalarial medication were excluded. The study was registered in International Prospective Register of Systematic Reviews (PROSPERO) (No.: CRD42020167672). The literature search yielded 1,243 studies, and a total of 43 studies with symptomatic malaria patients were included. Clinical studies (n = 12 adults; n = 5 children) comprised 3,117 patients, of which a majority had Plasmodium falciparum (n = 15) and were diagnosed with severe malaria (n = 13). In random-effects models of adults, the pooled prevalence estimate for any cardiovascular complication was 7% (95% CI: 5-9). No meta-analysis was conducted in children, but the range of abnormal ECG was 0-8%, cardiac biomarkers 0-57%, and echocardiography 4-9%. We analyzed 33 cases (n = 10 postmortem), in which the most common cardiovascular pathologies were myocarditis and acute coronary syndrome. All histopathological studies found evidence of parasitized red blood cells in the myocardium. Cardiovascular complications are not uncommon in symptomatic adults and children with malaria. Additional studies investigating malaria and cardiovascular disease are encouraged.

The potential advantages of using a poly(HPMA) brush in urinary catheters: effects on biofilm cells and architecture

Infections related to bacterial colonization of medical devices are a growing concern given the socio-economical impacts in healthcare systems. Colonization of a device surface with bacteria usually triggers the development of a biofilm, which is more difficult to eradicate than free-floating or adhered bacteria and can act as a reservoir for subsequent infections. Biofilms often harbor Viable but nonculturable (VBNC) cells that are likely to be more resistant to antibiotic treatment and that can become active in more favorable conditions causing infection. Biofilm formation is dependent on different factors, chiefly the properties of the surface and of the surrounding medium, and the hydrodynamic conditions. In this work, the antifouling performance of a poly[N-(2-hydroxypropyl) methacrylamide] (poly(HPMA)) brush was evaluated in vitro in conditions that mimic a urinary catheter using Escherichia coli as a model organism. The results obtained with the brush were compared to those obtained with two control surfaces, polydimethylsiloxane (PDMS) (the most common material for catheters) and glass. A decrease in initial adhesion and surface coverage was observed on the brush. This antifouling behavior was maintained during biofilm maturation and even in a simulated post-bladder infection period when the reduction in total cell number reached 87 %. Biofilms were shown to adapt their architecture during that period and VBNC cells adsorbed weakly on the brushes and were completely washed away. Taken together, these results suggest that the use of the poly(HPMA) brush in urinary tract devices such as catheters and stents may reduce biofilm formation and possibly render the formed biofilms more susceptible to antibiotic treatment and with reduced infectivity potential.

Impact of modified diamond-like carbon coatings on the spatial organization and disinfection of mixed-biofilms composed of Escherichia coli and Pantoea agglomerans industrial isolates

This work investigated the effects of diamond-like carbon (DLC) coatings on the architecture and biocide reactivity of dual-species biofilms mimicking food processing contaminants. Biofilms were grown using industrial isolates of Escherichia coli and Pantoea agglomerans on bare stainless steel (SST) and on two DLC surface coatings (a-C:H:Si:O designated by SICON® and a-C:H:Si designated by SICAN) in order to evaluate their antifouling activities. Quantification and spatial organization in single- and dual-species biofilms were examined by confocal laser scanning microscopy (CLSM) using a strain specific labelling procedure. Those assays revealed that the E. coli isolate exhibited a higher adhesion to the modified surfaces and a decreased susceptibility to disinfectant in presence of P. agglomerans than alone in axenic culture. While SICON® reduced the short-term growth of E. coli in axenic conditions, both DLC surfaces increased the E. coli colonization in presence of P. agglomerans. However, both modified surfaces triggered a significantly higher log reduction of E. coli cells within mixed-species biofilms, thus the use of SICON® and SICAN surfaces may be a good approach to facilitate the disinfection process in critical areas of food processing plants. This study presents a new illustration of the importance of interspecies interactions in surface-associated community functions, and of the need to evaluate the effectiveness of hygienic strategies with relevant multi-species consortia.

Salinity does not alter the effectiveness of menthol as an anesthetic and sedative during the handling and transport of juvenile fat snook (Centropomus parallelus)

The effectiveness of menthol as anesthetic and sedative for fat snook (Centropomus parallelus) was tested at different salinities. In the first experiment, the fish were exposed to different concentrations of menthol (25, 37 and 50 mg L-1) in water at different salinities (0, 17 and 36 ppt). In the second experiment, the fish were transported for 10 hours in water with menthol at concentrations of 0, 3.7 and 7.4 mg L-1 under different salinities. Na+ and K+ ions from fish body and water were analyzed after transport. The optimal concentrations of menthol for a short handling period and surgical induction was 37 and 50 mg L-1, respectively, and these values were independent of salinity. After transport, neither mortality nor significant changes in ammonia or dissolved oxygen were observed between treatments at the different salinities. The nitrite levels were lower in freshwater than in brackish and saltwater, but did not change with mentol. The total body levels of Na+ increased with the salinity increase. Menthol is an effective anesthetic for handling of juvenile fat snook at different salinities. Menthol did not influence the measured water parameters and body ions, and it is not necessary for the transport of fat snook.

Fish reproductive guilds downstream of dams

Fish reproductive guilds were used to evaluate the responses of species with different reproductive strategies during two different periods of post-dam construction. The data used for the comparisons were collected in the upper Paraná River floodplain (Brazil), downstream of the Porto Primavera dam, 2 and 10 years after impoundment. The abundance (catch per unit effort, CPUE), species richness, evenness and structure of communities, all within reproductive guilds, were used to test the hypothesis that these metrics vary spatially and temporally. The influence of damming on species structure and the diversity of fish reproductive guilds varied spatiotemporally, and species with opportunistic reproductive strategies tended to be less affected. Conversely, long-distance migratory species responded more markedly to spatiotemporal variations, indicating that the ecosystem dynamics exert greater effects on populations of these species. Thus, the effects of a dam, even if attenuated, may extend over several years, especially downstream. This finding emphasizes the importance of maintaining large undammed tributaries downstream of reservoirs.

Escherichia coli adhesion, biofilm development and antibiotic susceptibility on biomedical materials

The aim of this work was to test materials typically used in the construction of medical devices regarding their influence in the initial adhesion, biofilm development and antibiotic susceptibility of Escherichia coli biofilms. Adhesion and biofilm development was monitored in 12-well microtiter plates containing coupons of different biomedical materials--silicone (SIL), stainless steel (SS) and polyvinyl chloride (PVC)--and glass (GLA) as control. The susceptibility of biofilms to ciprofloxacin and ampicillin was assessed, and the antibiotic effect in cell morphology was observed by scanning electron microscopy. The surface hydrophobicity of the bacterial strain and materials was also evaluated from contact angle measurements. Surface hydrophobicity was related with initial E. coli adhesion and subsequent biofilm development. Hydrophobic materials, such as SIL, SS, and PVC, showed higher bacterial colonization than the hydrophilic GLA. Silicone was the surface with the greatest number of adhered cells and the biofilms formed on this material were also less susceptible to both antibiotics. It was found that different antibiotics induced different levels of elongation on E. coli sessile cells. Results revealed that, by affecting the initial adhesion, the surface properties of a given material can modulate biofilm buildup and interfere with the outcome of antimicrobial therapy. These findings raise the possibility of fine-tuning surface properties as a strategy to reach higher therapeutic efficacy.

96-well microtiter plates for biofouling simulation in biomedical settings

Microtiter plates with 96 wells are routinely used in biofilm research mainly because they enable high-throughput assays. These platforms are used in a variety of conditions ranging from static to dynamic operation using different shaking frequencies and orbital diameters. The main goals of this work were to assess the influence of nutrient concentration and flow conditions on biofilm formation by Escherichia coli in microtiter plates and to define the operational conditions to be used in order to simulate relevant biomedical scenarios. Assays were performed in static mode and in incubators with distinct orbital diameters using different concentrations of glucose, peptone and yeast extract. Computational fluid dynamics (CFD) was used to simulate the flow inside the wells for shaking frequencies ranging from 50 to 200 rpm and orbital diameters from 25 to 100 mm. Higher glucose concentrations enhanced adhesion of E. coli in the first 24 h, but variation in peptone and yeast extract concentration had no significant impact on biofilm formation. Numerical simulations indicate that 96-well microtiter plates can be used to simulate a variety of biomedical scenarios if the operating conditions are carefully set.

Macroscale versus microscale methods for physiological analysis of biofilms formed in 96-well microtiter plates

Microtiter plates with 96 wells have become one of the preferred platforms for biofilm studies mainly because they enable high-throughput assays. In this work, macroscale and microscale methods were used to study the impact of hydrodynamic conditions on the physiology and location of Escherichia coli JM109(DE3) biofilms formed in microtiter plates. Biofilms were formed in shaking and static conditions, and two macroscale parameters were assayed: the total amount of biofilm was measured by the crystal violet assay and the metabolic activity was determined by the resazurin assay. From the macroscale point of view, there were no statistically significant differences between the biofilms formed in static and shaking conditions. However, at a microscale level, the differences between both conditions were revealed using scanning electron microscopy (SEM). It was observed that biofilm morphology and spatial distribution along the wall were different in these conditions. Simulation of the hydrodynamic conditions inside the wells at a microscale was performed by computational fluid dynamics (CFD). These simulations showed that the shear strain rate was unevenly distributed on the walls during shaking conditions and that regions of higher shear strain rate were obtained closer to the air/liquid interface. Additionally, it was shown that wall regions subjected to higher shear strain rates were associated with the formation of biofilms containing cells of smaller size. Conversely, regions with lower shear strain rate were prone to have a more uniform spatial distribution of adhered cells of larger size. The results presented on this work highlight the wealth of information that may be gathered by complementing macroscale approaches with a microscale analysis of the experiments.

Percentage of Impervious Surface Soil as Indicator of Urbanization Impacts in Neotropical Aquatic Insects

Several recent studies have shown a strong correlation between the area of impervious surface soil (IS) and the insect community structure from urban streams. This study assessed whether this relationship is observed in Neotropical streams. We examined if an increased IS reduces the diversity and simplifies the trophic structure of the community of Ephemeroptera, Plecoptera, and Trichoptera. An IS threshold was detected between 1.6 and 9.3%, in which there is a change in the community, both in taxonomic richness and trophic structure. Among the 27 genera identified, only 15 occurred in streams with IS > 9%, while 24 genera were registered in streams with IS < 2%. The trophic guilds of predators and shredders were not observed in streams with high IS, decreasing the number of guilds in these streams from 5 to 3, compared with the streams with low IS. Three hypotheses with cumulative effect have been proposed to explain such variations. Based on the IS threshold verified, the creation of a mosaic of land use, where some subbasins would be sacrificed and others would be preserved, was suggested as a mitigation measure for the impacts caused by urbanization in the Neotropical aquatic insects' fauna.

Cage culture with tilapia induces alteration in the diet of natural fish populations: the case of Auchenipterus osteomystax

Fish rearing in cages installed in reservoirs has developed rapidly in Brazil over the last decade. However, this type of aquaculture induces some changes in the environment because of the high quantity of nutrients released into the surroundings. This study evaluated trophic changes resulting from these nutrient inputs into the diet, feeding activity and nutritional condition of Auchenipterus osteomystax, an insectivore that alternatively feeds on zooplankton. Fish were sampled with gillnets in two tilapia (Oreochromis niloticus) experimental caging aquaculture areas of the Rosana reservoir (Paranapanema River), at different distances from the cages. Samplings were carried out for 90 days (before the cages were installed and 30 and 60 days after installation). Diet analysis was based on 250 stomach contents evaluated with occurrence and volumetric methods, combined into a Feeding Index. The spatial and temporal variations in feeding activity were inferred by the stomach repletion index (stomach weight). The relative condition factor was used to evaluate the individual nutritional condition of the sampled fish. Insects and zooplankton accounted for more than 85% of the diet in any sample. Insects predominated before caging culture started and at the end of the sampling period, whereas zooplankton predominated 30 days after caging began. The repletion index increased at 30 days after caging in both areas when the condition factor was the lowest, with some recovery at the end of this period. The input of nutrients near caging areas caused a short elevation in zooplankton availability, which promoted changes in the diet of this opportunist species, increasing its feeding activity. However, these changes appeared to be unsustainable due to the poor nutritional condition of the individuals.

Transportation of juvenile tambaqui (Colossoma macropomum) in a closed system

The objective of this study was to investigate the effect of density, duration and the use of additives to the water during the transportation of juvenile tambaqui (Colossoma macropomum) and use of this data to establish a safe transportation protocol for the species. The tested products and dosages were: salt (1000, 2000 and 3000 mg/L), gypsum (100, 300 and 500 mg/L) and benzocaine (10, 20 and 30 mg/L). Fish were transported in closed systems (plastic bag) at different densities and time periods of up to 24 h. Fish survival (FS) and water quality parameters were monitored immediately after transportation. The remaining fish were kept in floating cages in order to evaluate mortality which occurred up to 96 h after transportation (S96). The best fish density, additives dosages and time period of the transportation was estimated with a general linear model. The effect of the condition factor on FS and S96 was also evaluated. As expected, FS and S96 were significantly related to time and density. FS but not S96, were also were significantly related to treatment. FS with gypsum treatment was not different from controls and FS with table salt and benzocaine treatments were significantly reduced. The condition factor was not related to either FS or S96. FS was inversely correlated with carbon dioxide concentration. It was concluded that the additives did not improve fish transportation survival. Linear models were developed to predict the best transportation densities as a function of time.

Metabolic adjustments in two Amazonian cichlids exposed to hypoxia and anoxia

The effects of graded hypoxia on the physiological and biochemical responses were examined in two closely related species of cichlids of the Amazon: Astronotus crassipinnis and Symphysodon aequifasciatus. Ten fish of each species were exposed to graded hypoxia for 8 h in seven oxygen concentrations (5.92, 3.15, 1.54, 0.79, 0.60, 0.34, and 0.06 mg O(2) L(-)(1)), with the aim to evaluate hypoxia tolerance and metabolic adjustments, where plasma glucose and lactate levels, hepatic and muscle glycogen contents, and maximum enzyme activities (PK, LDH, MDH and CS) in skeletal and cardiac muscles were measured. Another experimental set was done to quantify oxygen consumption (MO(2)) and opercular movements in two oxygen concentrations. Hypoxia tolerance differed between the two species. Astronotus crassipinnis was able to tolerate anoxia for 178 min while S. aequifasciatus was able to withstand 222 min exposure in deep hypoxia (0.75 mg O(2) L(-)(1)). Suppressed MO(2) was observed during exposure to 0.34 (A. crassipinnis) and 0.79 mg O(2) L(-)(1) (S. aequifasciatus), while opercular movements increased in both species exposed to hypoxia. Higher levels of muscle and liver glycogen and larger hypoxia-induced increases in plasma glucose and lactate were observed in A. crassipinnis, which showed a higher degree of hypoxia tolerance. Changes in enzyme levels were tissue-specific and differed between species suggesting differential abilities in down-regulating oxidative pathways and increasing anaerobic metabolism. Based on the present data, we conclude that these animals are good anaerobes and highly adapted to their environment, which is allowed by their abilities to regulate metabolic pathways and adjust their enzyme levels.

[Illness, hospitalization and anxiety: an approach to mental health]

With the purpose of completely approaching the patient in the hospital, this research had the goal to identify the generating factors of the of anxiety patient and how they express their uneasiness towards the illness and the hospitalization the data were collected from april/may/96 with adults in a school-hospital and was based on a guide for observation of the anxieting situations and in an interview guide. We found out that the patients' major concerns were: Knowing if their illness has aure, how long they will be there, their and the support of the family. They get sadder at night and in the afternoon, when the staff is reduced, there is more silence and they feel lonely. Only a small percentage of them have the consistent information about the disease and treatment, however, the hospital is mainly identified as a good place for the possibility of cure, good assistance and food. Witnessing the suffering and the dying risk of the neighbour, be discharged, exams and treatment procedures suspended on cancelled, bling communicated of the necessity of bling operated on that the disease doesn't have a cure, were the anxieting factors that were remanked not only in the immediate sections, but also in the late ones of the anxieting situations, prevail passive attitudes such as sadness, crying, depression and negativism. We concluded that the psychic and emotional conditions of the patients in the hospital have to be taken on consideration on hospitals emphasizing a comsiete approach, with special care of the speed of the actions and the consistence of the information given to the patient about their health and treatment.