It's not just what we don't know: The mapping problem in the acquisition of negation

How do learners learn what no and not mean when they are only presented with what is? Given its complexity, abstractness, and roles in logic, truth-functional negation might be a conceptual accomplishment. As a result, young children's gradual acquisition of negation words might be due to their undergoing a gradual conceptual change that is necessary to represent those words' logical meaning. However, it's also possible that linguistic expressions of negation take time to learn because of children's gradually increasing grasp of their language. To understand what no and not mean, children might first need to understand the rest of the sentences in which those words are used. We provide experimental evidence that conceptually equipped learners (adults) face the same acquisition challenges that children do when their access to linguistic information is restricted, which simulates how much language children understand at different points in acquisition. When watching a silenced video of naturalistic uses of negators by parents speaking to their children, adults could tell when the parent was prohibiting the child and struggled with inferring that negators were used to express logical negation. However, when provided with additional information about what else the parent said, guessing that the parent had expressed logical negation became easy for adults. Though our findings do not rule out that young learners also undergo conceptual change, they show that increasing understanding of language alone, with no accompanying conceptual change, can account for the gradual acquisition of negation words.

BCG is protective against death in male but not female patients with pulmonary tuberculosis in Guinea-Bissau

BACKGROUND

Growing evidence supports the existence of a sex difference in immunity to tuberculosis (TB). This is most often to the detriment of males. This study aimed to assess the association between scar size from bacillus Calmette-Guérin (BCG) and mortality risk stratified by sex.

METHODS

Kaplan-Meier survivor functions and Cox proportional hazard models were used to assess mortality risk by sex and scar size. Groups were further compared by clinical and epidemiological characteristics.

RESULTS

Between 2003 and 2019, 2944 eligible patients were identified, of whom 1003 were included in the final analysis. Males with BCG scars, particularly large scars, were less likely to die within 1 y of diagnosis than males with no scar (adjusted hazard ratio 0.36 [95% confidence interval 0.15 to 0.88]). In contrast, females with small scars trended towards higher mortality than females with no scars or females with large scars.

CONCLUSIONS

BCG protects against death in male but not female patients with TB. More research is needed to determine the mechanisms underpinning these sex differences and whether they are generalizable beyond this setting.

Life expectancy among patients with pulmonary tuberculosis is less than one-third of life expectancy in the background population in Guinea-Bissau-an observational study

BACKGROUND

Few studies have assessed life expectancy of patients with tuberculosis (TB) against a comparable background population, particularly in low-income, high-incidence settings. This study aimed to estimate the life expectancy (LE) of patients with TB in the West African country of Guinea-Bissau and compare it with the LE of the background population.

METHODS

This study used data from the Bandim TB cohort from 2004-20 as well as census data from the capital of Guinea-Bissau. LE was estimated using a bootstrapped Kaplan-Meier survival analysis for patients with TB and the background population, stratifying by age of entry and various patient subgroups. The analysis was further stratified by diagnosis period and length of schooling (an indicator of socioeconomic status), to assess their influence on LE. A sensitivity analysis was performed assuming death at loss to follow-up.

RESULTS

The analysis included 2278 patients and a background population of 169 760 individuals. Overall median LE among 30-year-old patients with TB was 10.7 years (95% CI: 8.7-12.6), compared with 35.8 (95% CI: 35.1-36.5) in the background population. LE was shorter in HIV-infected patients and those who had unsuccessful treatment outcome; however, even among those who were both uninfected with HIV and experienced successful treatment outcome, LE was 20% shorter than in the background population. Longer schooling appeared to decrease mortality.

CONCLUSIONS

TB substantially shortens LE. This effect is present even in patients who are uninfected with HIV and who have successful treatment outcome.

TB-related deaths among adults in Guinea-Bissau

SETTING: In an urban demographic, high TB burden surveillance site in Guinea-Bissau, most deaths occur at home, and information on cause of death (CoD) is lacking.OBJECTIVE: To examine CoD and the proportion of TB deaths in three groups: among patients examined for TB without a verified diagnosis after diagnostic workup, described as "assumed TB-negative" (aTBneg), among patients with a confirmed diagnosis of TB and in a sample of the background population.DESIGN: Verbal autopsies (VAs) were obtained for registered deaths occurring between 1 January 2010 and 15 June 2016. All deaths among aTBneg and patients with TB, and a sample of deaths in the background population were included.RESULTS: VAs were obtained from 104/112 aTBneg patients, 140/155 patients with TB, and 172/219 from the general population. The leading CoD was TB in respectively 20%, 69% and 9% of the cohorts. HIV/AIDS-related deaths were the most frequent CoD among aTBneg patients (45%) and in the background population (27%), and accounted for 9% of patients with TB.CONCLUSION: TB was shown to be a frequent CoD, not only among patients diagnosed with TB, but also among aTBneg patients and the background population. This indicates a low TB case detection rate.

A self-rated health score predicts severe disease and high mortality in patients with pulmonary TB

BACKGROUND: Health-related quality of life (HRQoL) in patients with pulmonary TB may be predictive of disease outcome; however, HRQoL instruments are often complicated and unsuitable for use in low-resource settings. A single-item self-rated health (SRH) score may represent a simpler alternative which could be used in clinical decision-making.AIMS: To evaluate internal and external validity of SRH and its correlation with TBscore/TBscoreII in a low-resource setting.METHODS: We used data from our ongoing prospective TB cohort study in Guinea-Bissau. Cohen´s d was used to assess internal validity, and receiver-operating characteristics and mortality statistics to assess external validity. Correlation between SRH and TBscore/TBscoreII was estimated using linear regression.RESULTS: SRH showed satisfactory internal validity and ability to discriminate between fatal cases at high and low scores, although not at middling scores. SRH and TBscore/TBscoreII correlated well at each examination but changes in scores did not, which may be due to ceiling/floor effects and a lag between disease severity and HRQoL.CONCLUSION: SRH shows potential as a quick and simple method to identify patients in need of intensified follow-up during treatment provision. More research is needed to assess its generalisability beyond our setting and to develop models for clinical use of SRH.

Risk factors related to the appearance of umbilical disorders in dairy calves

ABSTRACT The objective of this study was to determine the types of calve housing used in dairy farms, the prevalence of umbilical disorders and related risk factors. The 16 farms studied were visited to characterize the types of installation and possible risk factors, as well as information obtained from a questionnaire applied to the farmers. 806 Holstein calves were physically examined, in addition to collecting blood samples for the evaluation of Failures in Passive Immunity Transfer (FPIT), in animals that manifested inflammatory omphalopathies, and were also submitted to ultrasound examination. The prevalence of omphalopathies was assessed by Fisher's test, and multivariate logistic regression to assess risk factors. Eight types of installation were found: tropical house, suspended cage, collective stall, collective picket, Argentinean type, single-story cage, individual stall, and collective picket with chain. Omphalopathies accounted for 6.45% of the calves. Small size farms (up to 99 lactation cows) had high risk for umbilical disorders, ground floor collective calves, without side protection, with sand floor, in closed sheds and without heatstroke were considered risk factors for omphalopathies. Adequate colostrum and umbilical antisepsis are not associated with disease, its appearance being related to the housing conditions of the animals.

Assessing gender differences among presumed and diagnosed patients with pulmonary TB: observations from Guinea-Bissau

BACKGROUND

Globally, more males than females are diagnosed with pulmonary TB (PTB); however, the cause of this gender disparity remains unknown. We aimed to assess gender differences in an observational cohort of patients with presumed PTB (prePTB) at the Bandim Health Project, Guinea-Bissau.

METHODS

Adult patients with signs and symptoms suggestive of PTB seeking medical care were invited to participate and were referred to comprehensive diagnostic work-up.

RESULTS

We included 2020 patients with prePTB; 54.6% were female. Females were younger than males and more often infected with HIV. More male patients with prePTB were diagnosed with PTB and the proportion of smear-positive cases was greater among males. There was no gender difference in loss to follow-up during the diagnostic process. Of 219 patients with PTB, 205 started treatment, with no difference between genders regarding pretreatment loss to follow-up or treatment outcome.

CONCLUSIONS

More women sought help for symptoms indicative of PTB, yet more men were diagnosed. Women did not have more clinically severe disease at presentation, did not drop out of diagnostic procedures more frequently and did not experience a worse outcome than men. This suggests that the gender gap in PTB is unlikely to be due solely to differences in care-seeking behaviour or diagnostic procedures in our setting.

Morbidity and mortality in Holstein calves from birth to 145 days of age on a large dairy farm in Brazil

ABSTRACT The present study aimed to investigate the morbidity and mortality associated with the most common diseases during the rearing period of Holstein calves in a high-production dairy farm. The calves (n = 600) were allocated to three groups based on age: G1 (1-7 days, n = 216), G2 (30-40 days, n = 188), and G3 (69-85 days, n = 196). They were evaluated over 60 days at eight different times. The morbidity rates were 47.67% (286/600) for diarrhea, 73.00% (438/600) for bovine respiratory disease (BRD), and 3.83% (23/600) for umbilical inflammation (UI). The mortality rate was 2.33% (14/600) for all the animals studied. The morbidity differed in the groups, with higher rates of diarrhea (78.85%, 166/216) and UI (6.94%, 15/216) in G1, and the highest rate of BRD in G3 (79.59%, 156/196). Diarrhea was associated with the occurrence of BRD in G1 and G2. Even in farms with good management practices, there is high morbidity associated with diarrhea and BRD, with the morbidity rate for diarrhea decreasing and that for BRD increasing as the animals get older. In addition, diarrhea is an important risk factor for BRD, especially in younger animals.

Haptoglobin and its association with naturally occurring diseases in Holstein heifer calves

ABSTRACT The present study evaluated the use of haptoglobin (Hp) as an indicator of health and performance in 166 Holstein heifer calves reared in an intensive production system. Calves were evaluated at D6-9; D10-13; D20-23; D35-38 and D65-68, corresponding to the days of life. The absence or presence of diseases was evaluated by physical examination and classification of scores. The performance parameters evaluated were body weight, height at withers and hind width. Hp was measured by spectrophotometric technique. The highest prevalence of diarrhea (59.4%; 98/165) was observed in D10-13, bovine respiratory disease (BRD) was on D35-38 (25.8%; 42/163), and umbilical inflammations in D6-D9 (7.8%; 13/166). Highest values of Hp were observed in animals with diarrhea (P=0.02), and umbilical inflammation (P=0.057), in comparison with the group of healthy calves. A significant negative correlation was observed between Hp and performance index. This protein presented an important relation with diarrhea and performance of the calves, opening perspectives on its utilization as a biomarker of diseases.

Efeito dos anticorpos maternos sobre a resposta imune induzida pela vacinação em bezerros Holandeses

RESUMO Objetivou-se avaliar o efeito dos anticorpos (ACs) maternos sobre resposta imune humoral induzida pela vacinação em bezerros Holandeses. Bezerros foram distribuídos aleatoriamente em quatro grupos: G1 - vacinados no D14 e D44 (n=6); G2 - vacinados no D90 e D120 (n=5); G3 - vacinados no D180 e D210 (n=8); controle: não vacinado (n=5). Utilizaram-se 5mL de vacina comercial (Cattle Master Gold FP5+L5® - Zoetis, Brasil), por via subcutânea. Foi realizada vírus neutralização (VN) no momento da vacinação, booster e 30 dias após a revacinação. Não foram observadas diferenças entre controle e G1 ou G2 para a frequência de soropositivos ou títulos de ACs contra os vírus respiratórios (P≥0,05). G3 apresentou maior produção de ACs em relação ao controle para BoHV-1 (P<0,01), BRSV (P<0,01) e BPIV-3 (P=0,02) após o booster (D240). A análise no tempo também demonstrou aumento nos títulos de ACs no G3 (P≤0,05). O perfil clínico revelou broncopneumonia apenas no grupo controle (n=4/5) entre 80-135 dias de vida. A imunidade colostral e a vacinal apresentaram perfis inversamente proporcionais, com maior produção de ACs aos seis meses de idade. Devido à precocidade da doença respiratória, estudos complementares são necessários para esclarecer o papel da resposta imune celular na vacinação diante dos ACs maternos.

Acute undifferentiated leukemia: data on incidence and outcomes from a large population-based database

Acute undifferentiated leukemia (AUL) is rare and defined by the absence of bona fide myeloid and lymphoid markers. Little is known about its incidence, survival and optimal management in the recent time period. Based on a case observed in our clinic, we queried the Surveillance, Epidemiology, and End Results database between 2000 and 2016. A total of 1,888 cases of AUL were diagnosed (1.34 per million person-years). The incidence of AUL has significantly decreased over time. Compared to other acute leukemias, patients with AUL have the highest median age (74 years); in contrast to acute myeloid leukemia (AML, 65) and acute lymphoblastic leukemia (ALL, 12). Excluding patients with preexisting malignancies, 1,444 patients with AUL were analyzed for survival. Only 35% of AUL patients had received chemotherapy. Comparatively, 94% of ALL and 71% of AML cases received chemotherapy. Among AUL patients who received chemotherapy, the median survival was 12 months as opposed to 1 month in the group who did not receive chemotherapy (or unknown status). Among adults, AUL patients had the worst prognosis, with a median overall survival (OS) of 9 months, compared to 27 months in ALL and 13 months in AML. Among children, the median OS was superior for all three groups of leukemias, the OS of AUL patients being better than in AML and very similar to ALL. On multivariate analysis, older age and time period were associated with worse outcome. We describe here the largest series of cases with AUL published to date.

Hematological and immunological development from birth to six months of age in Holstein calves

ABSTRACT The hematological and immunological development of calves from birth to 6 months of age was performed by hemogram and cellular phenotype. Ten male Holstein calves were assessed in 13 moments: before colostrum intake (D0), every 2 days until the 10th day of life (D2 to D10), at the 15th day after birth (D15), and then monthly up to 6 months (D180). Calves presented hemoconcentration on day (D) 0 and showed a gradual decrease in hematimetric rates until D180. The inversion of the neutrophilic for lymphocytic profile was observed on D4. The percentage of CD3+ cells on D10 was higher than D30 up to D180. The number of CD4+ and CD8+ cells did not change between time points. The number of CD21+ lymphocytes was significantly higher at early time points of D0 up to D15, compared on D30 until D150. In conclusion, the neonatal period was marked by stress leukogram in the first 4 days, and low number of B lymphocytes. These might be risk factors for bacterial infections responsible for navel inflammation and diarrhea. The increase in the number of B cells from 30 days of age demonstrated that the calves were functional and able to generate an immune response.

Transferência de imunidade passiva (TIP) e dinâmica de anticorpos específicos em bezerros naturalmente expostos para as viroses respiratórias

RESUMO Esta pesquisa avaliou a TIP e a dinâmica de anticorpos (ACs) específicos em bezerros naturalmente expostos aos agentes causadores da doença respiratória bovina (DRB). Foram selecionados 19 bezerros Holandeses alimentados com colostro proveniente de doadoras vacinadas para DRB. Amostras de soro foram obtidas antes e após a ingestão do colostro (48h) para a soroneutralização (SN). Os valores médios (log2) detectados após colostragem foram de 11,5±1,6 (BVDV), 8,8±1,3 (BoHV-1), 5,5±1,6 (BRSV) e 8,4±1,5 (BPIV-3). Cinco bezerros foram criados do nascimento aos 240 dias de vida, observando-se decréscimo nos títulos de ACs para BVDV, BoHV-1 e BPIV-3 ao longo do tempo (P≤0,001). As taxas de infecções detectadas entre o D14 e o D240 foram de 40% (2/5), 20% (1/5), 80% (4/5), e 60% (3/5), respectivamente, para BVDV, BoHV-1, BRSV e BPIV-3. A maioria dos bezerros manifestou broncopneumonia após as infecções virais. Os bezerros apresentaram ACs para todas as viroses às 48 horas de vida, porém os títulos adquiridos para o BRSV foram baixos. A susceptibilidade para as infecções variou de acordo com os níveis e a duração dos títulos de ACs maternos.

Effects of injectable trace minerals administered concurrently with a modified live virus vaccine on long-term protection against bovine viral diarrhea virus acute infection in dairy calves

The objective was to evaluate the effects of injectable trace minerals (ITM) concurrent with modified-live virus (MLV) vaccination on protection from bovine viral diarrhea virus (BVDV) infection in dairy calves. In a previous study (Palomares et al., 2016), thirty dairy calves received two doses of a MLV vaccine subcutaneously (SC), concurrently with ITM (n = 15) or saline (n = 15), SC. Five months later, 20 of these calves received ITM (G1, n = 10) or saline (G2, n = 10) according to their previous groups and were challenged intranasally with BVDV2. Five unvaccinated calves were also challenged with BVDV2 (G3). Blood samples were collected on days 0 (BVDV challenge), 3, 5, 6, 7, 8, 9, 11, 14, 18, 21, 32 and 61 for leukocyte count, virus isolation and BVDV serum neutralizing antibodies (SNA). Mild-moderate clinical signs were observed in G3 after BVDV challenge. Group 1 showed lower sum health score and nasal score on d5 and fecal score on d8 compared to G2. Rectal temperature and leukocyte counts were not different between G1 and G2. In contrast, G3 calves had significant leukopenia and lymphopenia from d3 to d7 (P < .05) and higher rectal temperatures on d6 to d8, compared to values on d0 (P < .05). All unvaccinated calves became viremic, while viremia was not detected in G1 or G2. Average daily gain was not different between vaccinated groups, however, only G1 calves had significantly greater (P = .04) ADG compared to non-vaccinated calves during the first 14 days post challenge. Vaccinated calves treated or not with ITM were protected from BVDV2 infection five months post-vaccination.

Littoral Cell Angioma of the Spleen: An Additional Report of Four Cases with Emphasis on the Association with Visceral Organ Cancers

Aims and background

Littoral cell angioma (LCA) is an uncommon vascular tumor of the spleen recently described and interpreted as the tumoral counterpart of the normally present littoral cells lining the splenic sinus channels of red pulp. The diagnosis of LCA is suggested by a quite characteristic morphology and confirmed by the demonstration of a hybrid endothelial/histiocytic phenotype.

Methods

Four original and previously unreported cases of LCA are presented. All four splenic vascular tumors were investigated by light microscopy and immunohistochemistry for endothelial and histiocytic markers.

Results

All four cases were associated with visceral epithelial malignancies (colorectal adenocarcinoma in two cases, renal and pancreatic adenocarcinoma in one case each). One case was also associated with an intracranial tentorial meningioma.

Conclusions

We consider our findings as a novelty and signal the possible existence of a clinical syndrome. Five of a total of 21 previously reported cases in the literature were also described as being associated with other cancers (non-Hodgkin's lymphoma in two cases, two not further specified tumors of the liver and brain, an epithelial ovarian cancer, and a non-small cell lung cancer in one case each). Close follow-up and careful investigation in search of a second visceral neoplasm are strongly recommended in cases of LCA, but further clinical observations and more in-depth genetic and molecular studies are needed before any valid conclusions can be drawn.

Influência da vacinação materna na transferência de imunidade passiva contra as viroses respiratórias dos bovinos

RESUMO O objetivo deste estudo longitudinal foi avaliar a influência da vacinação materna na transferência de anticorpos (ACs) contra as viroses respiratórias em bezerros. Para tanto, vacas e bezerros foram distribuídos em dois grupos conforme a realização (VAC, n=6) ou não (NVAC, n=4) da vacinação no pré-parto. Amostras sanguíneas foram obtidas após a parição (D0); em seguida, apenas os bezerros foram acompanhados até D180. ACs séricos foram determinados pela vírus-neutralização (VN) contra BVDV, BoHV-1, BRSV e BPI3-V. Vacas VAC apresentaram diferenças para ACs contra BoHV-1 (P=0,01) em D0. As frequências (%) de bezerros soropositivos para BoHV-1 foram maiores em VAC do D2 ao D120; para BRSV em D4, D8, D10 e D150 (P≤0,08); medianas de ACs contra BoHV-1 em VAC do D2 ao D120 (P=0,08). A vacinação das vacas no pré-parto foi fundamental para a transferência e a duração de ACs contra BoHV-1 e BRSV, porém o protocolo adotado não foi eficiente para o aumento de ACs para BVDV e BPI3-V. A eficácia parcial da vacinação materna não inviabiliza a sua recomendação devido à importância do Herpesvírus e do BRSV na DRB, porém estratégias para a melhoria nas respostas imunes contra as demais viroses devem ser estabelecidas.

Imunidade celular em vacas Holandesas soropositivas para o Vírus da Leucose Bovina (BLV) durante o período de transição

RESUMO Esta pesquisa avaliou a dinâmica dos leucócitos e das subpopulações de linfócitos em vacas Holandesas soropositivas para o BLV no período de transição. Amostras de sangue (n=72) provenientes de 12 vacas foram coletadas entre as semanas -2 e +3 para a realização do leucograma, imunofenotipagem, dosagem de cortisol e haptoglobina (Hp). O perfil leucocitário foi caracterizado por leucocitose, neutrofilia, monocitose e eosinopenia próximo ao parto. Linfocitose e elevada proporção de linfócitos B CD21+ foram achados constantes entre as semanas -2 e +3; assim, as vacas foram testadas e confirmadas soropositivas para o BLV. Os valores das subpopulações de linfócitos T apresentaram-se baixos durante o período de transição, observando-se dois picos máximos que coincidiram com as elevações nas concentrações de cortisol no parto (2,11µg/dL) e semana +3 (1,97µg/dL). Hp apresentou aumento crescente de -2 (166µg/mL) a +3 (576µg/mL), provavelmente associada à elevada taxa de infecções uterinas observadas nas semanas +2 e +3. As vacas soropositivas para o BLV apresentaram leucograma de estresse próximo ao parto, exceto para linfócitos. A linfocitose e as elevadas proporções de células B CD21+, associadas com as baixas proporções de células T, podem ser indicativo de imunossupressão e predisposição aos processos inflamatórios no período pós-parto.

A new species of snail-case caddisflies (Trichoptera: Helicopsychidae) and new records of caddisflies from Chapada Diamantina, Bahia, Brazil

A new species of Helicopsyche subgenus Feropsyche from Chapada Diamantina is diagnosed, described, and illustrated. Helicopsyche catoles n. sp. is easily distinguished from congeners by the following features: inferior appendages clavate, each bearing a posteroventral projection with 2-4 setae in lateral view, and tergum X with a notched apex and a short setal row along its length in dorsal view. Additionally, new records from Chapada Diamantina, Bahia, Brazil, are presented. A total of 31 species, including the new species, are recorded, belonging to 14 genera and 8 families. Two of these species constitute new records to Brazil (Helicopsyche (Feropsyche) succincta and Marilia misionensis) and another 10 of these species represent new records for Bahia [Chimarra (Curgia) hyoeides, Macronema hageni, M. partitum, Polyplectropus tragularius, Smicridea coronata, S. helenae, S. iguazu, S. jundiai, S. radula and Marilia major].

Taxonomy of Atopsyche Banks (Trichoptera: Hydrobiosidae) from Brazil: New species, distributional notes and identification key

Three new species of Atopsyche Banks 1905 are described and illustrated from Brazil: Atopsyche diamantina n. sp., A. kamakan n. sp., and A. muelleri n. sp. New records of A. apurimac Schmid 1989, A. sanctipauli Flint 1974, A. serica Ross 1953, and A. zernyi Flint 1974 are included, as well as the first records to states of Bahia, Goiás, and Rio Grande do Sul. Atopsche rinconi Holzenthal & Cressa 2002 is recorded from Brazil for the first time. An identification key is also provided for species of the genus from Brazil. Moreover additional characters and illustrations of A. sanctipauli and A. zernyi are presented.

Perfil sérico proteico de vacas Holandesas no período de transição

RESUMO O objetivo deste trabalho foi avaliar, de forma longitudinal, o perfil sérico proteico de 13 vacas Holandesas durante o período de transição. Amostras de sangue (n=78) foram coletadas semanalmente, da segunda semana pré-parto (M-2) até a terceira semana pós-parto (M3), para determinação do perfil sérico proteico, por meio de teste bioquímico (proteínas séricas totais - PT) e eletroforese em gel de poliacrilamida SDS-PAGE, para as outras proteínas analisadas. Os valores de PT diminuíram de forma gradativa (P=0,000) de M-2 (6,4g/dL) a M0 (6,2g/dL), aumentando nos momentos subsequentes (M3=7,3g/dL). As concentrações da IgG de cadeia pesada (M-2=919,4; M-1=1074,5mg/dL) e de cadeia leve (M-2=393,9; M-1=466,7mg/dL) foram menores no pré-parto em relação ao pós-parto (M1=1283,3; M2=1374,2 e M3=1630,3 mg/dL para IgG pesada e M1=463,4; M2=573,7; M3=651,8mg/dL para IgG leve). Para a IgA, houve diminuição nos valores (P=0,001), de M-2 (51,9mg/dL) a M1 (34,0mg/dL), e aumento em M2 (45,4g/dL) e M3 (62,6g/dL). Os valores de haptoglobina (Hp) e ceruloplasmina (Cp) aumentaram (P=0,000) de M-2 (Hp=16,6mg/dL; Cp=8,6mg/dL) a M3 (Hp=60,9mg/dL; Cp=127,1mg/dL). A albumina apresentou ligeiras variações durante o período de transição (P=0,000), enquanto a transferrina sérica (P=0,101) e a glicoproteína ácida (P=0,105) foram estáveis. O escore de condição corporal (ECC) também foi analisado durante o período de transição, verificando-se diferença (P=0,003) entre M-2 (ECC=4,0) e M1 (ECC=3,0). Foi relatada ainda a ocorrência de distocias (4/13), retenção de placenta (1/13) e hipocalcemia (1/13) no dia da parição (M0) e infecções uterinas (5/13) e cetose (1/13) ocorridas no pós-parto. Concluiu-se, portanto, que houve aumento nas concentrações séricas de Hp e Cp e diminuição nos valores de imunoglobulina e transferrina em vacas Holandesas no período de transição, relacionados às doenças ocorridas nesse período e ao elevado ECC, promovendo modificações metabólicas e imunossupressão.

Decline in overall, smear-negative and HIV-positive TB incidence while smear-positive incidence stays stable in Guinea-Bissau 2004-2011

OBJECTIVE

To calculate Tuberculosis (TB) incidence rates in Guinea-Bissau over an 8-year period.

METHODS

Since 2003, a surveillance system has registered all TB cases in six suburban districts of Bissau. In this population-based prospective follow-up study, 1205 cases of pulmonary TB were identified between January 2004 and December 2011. Incidence rates were calculated using census data from the Bandim Health and Demographic Surveillance System (HDSS).

RESULTS

The overall incidence of pulmonary TB was 279 per 100,000 person-years of observation; the male incidence being 385, and the female 191. TB incidence rates increased significantly with age in both sexes, regardless of smear or HIV status. Despite a peak with unknown cause of 352 per 100,000 in 2007, the overall incidence of pulmonary TB declined over the period. The incidence of HIV infected TB cases declined significantly from 108 to 39 per 100,000, while the incidence of smear-positive TB cases remained stable; the overall figure was 188 per 100,000.

CONCLUSIONS

Overall incidence of pulmonary TB in Guinea-Bissau has declined from 2004 to 2011. The decline was also seen in the subgroups of smear-negative and HIV-positive TB cases, probably due to antiretroviral treatment. Smear-positive TB incidence remains stable over the period.

Diversidade de ixodida em roedores e marsupiais capturados no Parque Estadual da Pedra Branca, Rio de Janeiro, Brasil

Durante 24 meses foram capturados, inspecionados e liberados no mesmo espaço do Parque Estadual da Pedra Branca, Rio de Janeiro, 96 marsupiais e 64 roedores. Neles foram recolhidos manualmente 105 carrapatos, de 10 espécies em duas famílias. A espécie de carrapato dominante entre os roedores foi Amblyomma longirostre e entre os marsupiais foi Ixodes loricatus. Houve correlação direta significativa entre a temperatura e a intensidade de parasitismo por carrapatos.

Treatment delay affects clinical severity of tuberculosis: a longitudinal cohort study

OBJECTIVES

To describe the risk factors for treatment delay and the effect of delay on the severity of tuberculosis (TB) in a prospectively followed TB cohort at the Bandim Health Project in Guinea-Bissau.

BACKGROUND

Treatment delay in patients with TB is associated with increased mortality and transmission of disease. However, it is not well described whether delay influences clinical severity at diagnosis. Previously reported risk factors for treatment delay vary in different geographical and cultural settings. Such information has never been investigated in our setting. Change in delay over time is rarely reported and our prospectively followed TB cohort gives an opportunity to present such data.

PARTICIPANTS

Patients were included at the time of diagnosis at three local TB clinics and the national TB reference hospital. Inclusion criteria were age >15 years and diagnosis of TB by either sputum examination or by the WHO clinical criteria. Patients with extrapulmonary TB were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was treatment delay. Delay was assessed by patient questionnaires. The secondary outcome was Bandim TBscore as a measure of TB morbidity and all-cause mortality.

RESULTS

A total of 1424 persons were diagnosed with TB in the study area between 2003 and 2010. We included 973 patients with TB in the study. The median treatment delay was 12.1 weeks. Risk factors for delay were low educational level, HIV-1+HIV-2 dual infection and negative sputum smear. TB treatment delay decreased by 10.3% (7.9-12.6%) per year during the study period. Delay was significantly associated with clinical severity at presentation with 20.8% severe TB cases in the low delay quartile compared with 33.9% if delay was over the median of 12.1 weeks.

CONCLUSIONS

Long treatment delay was associated with more severe clinical presentation. Treatment delay in TB cases is decreasing in Guinea-Bissau.

Dinâmica da celularidade do colostro de vacas da raça Holandesa no pós-parto imediato

Avaliou-se a celularidade do colostro de 53 vacas da raça Holandesa, utilizando-se 171 amostras, colhidas após a primeira e a segunda ordenha pós-parto. Para a análise citológica quantitativa e qualitativa, foram utilizadas as técnicas de microscopia direta e citocentrifugação. O total de leucócitos obtido por contagem microscópica direta foi de 0,878x10(6) e 1,260x10(6), antes da primeira e da segunda ordenha, respectivamente, e os valores da mediana dos fagócitos obtidos antes da primeira e da segunda ordenha foram de 0,657 e 0,828x10(6) leucócitos mononucleares, e 0,178 e 0,392x10(6) leucócitos polimorfonucleares (P<0,0001). Os valores da mediana dos tipos leucocitários, antes da primeira e da segunda ordenha, foram: 0,640x10(6) e 0,772 monócitos/células epiteliais; 0,136x10(6) e 0,098 linfócitos; 0,045x10(6) e 0,203x10(6) neutrófilos, respectivamente. Concluiu-se que o colostro bovino da segunda ordenha apresentou aumento da quantidade de células somáticas e leucócitos polimorfonucleares/mL de colostro. Essas variações podem estar relacionadas à importância do colostro aos neonatos, ou a modificações fisiológicas e de defesa da glândula mamária, durante o período de adaptação dela.

Sleep apnea-hypopnea syndrome and acute coronary syndrome - an association not to forget

AIM

To evaluate the prevalence of Sleep Apnea-Hypopnea Syndrome (SAHS) in patients who were admitted with Acute Coronary Syndrome (ACS) to the Coronary Care Unit (CCU) and the clinical predictors of SAHS in patients with ACS and to compare the results of the simple sleep test (SST) with polysomnography (PSG).

METHODS

This was a prospective study that included patients who were admitted to the CCU with ACS, which was confirmed by coronary angiography. Demographic and anthropometric data, cardiovascular risk factors and measures on the Epworth Sleepiness Scale were collected. The SST was conducted with the ApneaLink(TM) device during hospitalization or after discharge. Patients with an apnea-hypopnea index (AHI) ≥ 10/h were invited to participate in PSG.

RESULTS

Ninety-one patients with ACS were consecutively included over 4 months. Of the fifty-eight patients who completed the study 43 (74.1%) were male. The mean age was 61.7±12.2 years, and the mean body mass index was 27.4±3.5 kg/m(2). The median time for SST performance was 17.5 days. This study was compatible with SAHS in 25 cases (43.1%). Patients who had an AHI ≥ 10/h in the SST were submitted to PSG and SST simultaneously. The median interval between the ACS and the execution of PSG was 30 days. PSG confirmed that all of the cases that were detected by SST were positive.

CONCLUSION

In our study, we found a high prevalence of SAHS in patients who were admitted to the CCU with ACS (43.1%). These results support the need for SAHS screening in patients who are hospitalized with ACS. The SST may have a role in the screening of SAHS in this population.

[Painful thyroid palpation]

A 37-years-old woman, complaining of fever, malaise, myalgia, sore throat and dysphagia lasting for 15 days, had been taking antibiotics and paracetamol for 7 days, without symptoms' improvement. The clinical examination revealed hyperaemic oropharynx and enlarged, painful thyroid. Further exams showed increased analytic inflammatory serum parameters as well as thyrotoxicosis. The thyroid gland had heterogeneous echostructure, with markedly hypoechoic areas and significant capsular oedema as well as decreased radionuclide uptake in the scintigraphy. Both symptoms and imaging improved with paracetamol and ibuprofen. Thyroid gland function normalized in two months. The patient remains in follow-up. This case reports the clinical features of subacute or De Quervain's thyroiditis. The differential medical approach to the patient with painful thyroid palpation is discussed. The diagnosis is essentially clinic, highlighting the importance of a rigorous physical exam. These patients' follow-up is required, considering the clinical and analytic progression.

Active tuberculosis and Mycobacterium tuberculosis latent infection in patients with HIV/AIDS

OBJECTIVES

Tuberculosis (TB) remains an important disease associated with HIV infection and AIDS in Brazil, even in a setting of free access to antiretroviral therapy (ART) and TB treatment. In previous studies, isoniazid therapy (IT) for latent infection with Mycobacterium tuberculosis (LIMTb) was found to reduce the risk of TB by 62% in patients with a tuberculin test (TT)>5 mm. The objectives of this study were to investigate the occurrence of TB, the prevalence of LIMTb and the coverage of the TT and IT, and to estimate the number of missed opportunities to prevent TB in patients with HIV/AIDS.

METHODS

A random sample of patients with HIV/AIDS was selected; data from the medical files were obtained, and a TT was performed in consenting subjects.

RESULTS

In the 203 subjects included in the study, TB occurrence was 13.3%, LIMTb prevalence was 20% and the coverage of the TT and IT was 59.2 and 55%, respectively. Patients with TB had a lower nadir CD4 cell count, but their CD4 recovery was comparable to that of non-TB patients. Patients with LIMTb always had a higher CD4 cell count.

CONCLUSIONS

By expanding the coverage of the TT and IT to nearly 100%, we could more than double the number of prevented cases of TB. TB prevention programmes must be reinforced to reduce the number of missed opportunities for diagnosis, and IT must be improved to reduce TB among patients with HIV/AIDS. Empowering patients with knowledge about TB, the preventive role of IT and the need for an annual TT may be the best way of lowing rates of TB in patients with HIV/AIDS.

CONTAGEM TOTAL E DIFERENCIAL DOS LEUCÓCITOS PRESENTES NO LEITE DE CABRAS SADIAS UTILIZANDO-SE A COLORAÇÃO DE VERDE DE METIL E PIRONINA E A CITOCENTRIFUGAÇÃO

RESUMO As particularidades da secreção láctea do tipo apócrina, na espécie caprina, tornam necessárias técnicas específicas para a determinação da quantidade e da qualidade das células presentes no leite desta espécie. Dentre estas particularidades, pode-se citar a presença dos corpúsculos citoplasmáticos. De acordo com estas características, o objetivo do presente trabalho foi determinar a contagem total de leucócitos no leite de cabras sadias, por meio da contagem microscópica direta com verde de metil e pironina-Y, e a contagem celular automática por citometria de fluxo, assim como determinar os tipos leucocitários, através da técnica de citocentrifugação. Foram analisadas 102 de leite de cabras sadias, das raças Saanen, Parda Alpina e Toggenburg. O valor mediano obtido pela contagem microscópica direta e automática foi de 142.840 e 406.000 células somáticas/mL de leite, respectivamente. Os valores médios obtidos na citocentrifugação foram de 73,24 ± 18,35% de neutrófilos, 3,55 ± 3,06% de linfócitos e 24,33 ± 18,89% de monócitos e células epiteliais. De acordo com os resultados, pode-se concluir que o valor obtido pela coloração de verde de metil e pironina-Y é significativamente menor, sendo um importante método para a determinação da celularidade presente no leite de cabras, pois exclui os corpúsculos citoplasmáticos característicos desta espécie.

A perspective on the history of the Iberian gypsies provided by phylogeographic analysis of Y-chromosome lineages

The European Gypsies, commonly referred to as Roma, are represented by a vast number of groups spread across many countries. Although sharing a common origin, the Gypsy groups are highly heterogeneous as a consequence of genetic drift and different levels of admixture with surrounding populations. With this study we aimed at contributing to the knowledge of the Roma history by studying 17 Y-STR and 34 Y-SNP loci in a sample of 126 Portuguese Gypsies. Distinct genetic hallmarks of their past and migration route were detected, namely: an ancestral component, shared by all Roma groups, that reflects their origin in India (H1a-M82; approximately 17%); an influence from their long permanence in the Balkans/Middle-East region (J2a1b-M67, J2a1b1-M92, I-M170, Q-M242; approximately 31%); traces of contacts with European populations preceding the entrance in the Iberian Peninsula (R1b1c-M269, J2b1a-M241; approximately 10%); and a high proportion of admixture with the non-Gypsy population from Iberia (R1b1c-M269, R1-M173/del.M269, J2a-M410, I1b1b-M26, E3b1b-M81; approximately 37%). Among the Portuguese Gypsies the proportion of introgression from host populations is higher than observed in other groups, a fact which is somewhat unexpected since the arrival of the Roma to Portugal is documented to be more recent than in Central or East Europe.

Risk factors for positive tuberculin skin test in Guinea-Bissau

BACKGROUND

The tuberculin skin test is used for tracing of tuberculosis transmission and identifying individuals in need of prophylactic treatment.

METHODS

Using a case-control study design, we recruited 220 smear-positive tuberculosis cases and 223 randomly selected healthy community controls in Bissau, Guinea-Bissau, during 1999-2000. Tuberculin skin tests were performed on family members of cases and controls (n = 1059 and n = 921, respectively). Induration of 10 mm or greater was considered positive. Risk factors were calculated for children (<15 years) and adults separately in multivariate logistic regression analysis.

RESULTS

The prevalence of positive tuberculin skin test was 41% in case-contacts compared with 22% in control-contacts, resulting in a prevalence ratio of 1.48 (95% confidence interval = 1.37-1.60). Positive skin tests among case-contacts increased with age for children, as well as with proximity to a case during the night, for both children and adults. A Bacille Calmette Guerin scar increased the likelihood of having a positive tuberculin skin test for adults in case households, but not in other categories of contacts. Among control-contacts the prevalence of positive skin test was associated with older age in children, history of tuberculosis in the family, and a positive tuberculin skin test of the control person.

CONCLUSIONS

Risk factors for a positive tuberculin skin test among case- and control-contacts are closely related to tuberculosis exposure. Having a BCG scar did not increase the risk of positive skin test in unexposed individuals. Tuberculin skin testing remains a useful tool for diagnosing tuberculosis infection.

OCORRÊNCIA DA DERMATOFILOSE (DERMATOPHILUS CONGOLENSIS) EM SUÍNOS CRIADOS NO ESTADO DE SÃO PAULO, BRASIL

RESUMO Descreveu-se a ocorrência da Dermatofilose em suínos adultos atendidos pela Clínica de Bovinos do Centro de Pesquisa e Diagnóstico de Enfermidades de Ruminantes da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo. Os animais enfermos apresentaram uma epidermite exsudativa caracterizada pela formação de crostas que se destacavam com facilidade e que apresentavam uma secreção com aspecto purulento, principalmente nas regiões do dorso e nas orelhas dos animais. Os esfregaços das crostas e secreções revelaram a presença de estruturas similares a cocos que se arranjavam em filamentos, morfologicamente semelhantes ao zoósporo do Dermatophilus congolensis, sendo a confirmação do diagnóstico realizada por biopsia de pele e isolamento do agente etiológico da doença em amostras colhidas dos dois animais enfermos.

Predictive value of soluble haemoglobin scavenger receptor CD163 serum levels for survival in verified tuberculosis patients

Pre-treatment serum levels of sCD163 were measured in a cohort of 236 suspected tuberculosis (TB) cases from Guinea-Bissau, with a median follow-up period of 3.3 years (range 0-6.4 years). In 113 cases, the diagnosis of TB was verified by positive sputum microscopy and/or culture. Among the verified TB cases, a decreased survival rate was found in 27 patients with sCD163 levels above the upper reference limit (3.95 microg/mL). The difference in survival was significant during TB treatment (log rank, p<0.02) and after long-term follow-up (log rank, p<0.001). The decrease in survival rate during TB treatment remained significant in a multivariate Cox model controlling for human immunodeficiency virus (HIV) status, age and gender, with a mortality increase of 1.19 (95% CI, 1.04-1.36) per microg of sCD163, and a hazard ratio (HR) for sCD163 levels above the upper reference limit of 4.18 (95% CI, 1.06-16.4). The difference was not significant after excluding patients with concomitant HIV-1 and HIV-2 infection in Kaplan-Meier analyses (log rank, p 0.11). In contrast, the difference in survival remained significant in Kaplan-Meier analyses after long-term follow-up, even after excluding patients with concomitant HIV-1 and HIV-2 infection (log rank, p 0.002). In the Cox model, the mortality increase per microg of sCD163 was 1.27 (95% CI, 1.14-1.40), with an HR for elevated sCD163 levels of 2.85 (95% CI, 1.44-5.63). The HRs for concomitant HIV-1 and HIV-2 infection were 6.92 (95% CI, 3.28-14.58) and 2.48 (95% CI, 1.09-5.67), respectively. Thus, sCD163 levels appeared to be an independent predictor of survival in verified TB patients.

[Techniques and "tricks": different uses of Foley catheter in cardiovascular surgery]

The use of Foley catheter is well established for bladder catheterization. The authors have used it, occasionally, in many unconventional ways to cope with difficult situations found at surgery. 1.Catastrophic haemorrhage during redo sternotomy. 2. Non touch technique for graft to aorta proximal anastomosis during CABG surgery in patients with heavily calcified aortas. 3. Proximal anastomosis of ventricle to pulmonary artery conduits, done with a beating heart. The use of this simple ''Colombo egg'' method has been useful to us in many difficult situations. It is safe and non expensive and should make part of everyone's surgical armamentarium.

[Coronary revascularization with extracorporeal circulation, aortic clamping or OPCAB: does the method's choice influence the results?]

BACKGROUND AND OBJECTIVES

Off pump CABG-OPCAB is the most recent development in coronary surgery and is aimed to avoid the complications of extracorporeal circulation and to compete with interventional cardiology. The objective of this study is to compare 3 methods for cardiac support for CABG.

METHODS

Between February 2001 and December 2002 ninety consecutive patients were operated by the same surgeon and the same team with the following techniques: extracorporeal circulation (CEC) and ischaemic arrest, CEC and beating heart, and OPCAB.

RESULTS

There were no difference in mortality and morbidity for the 3 groups of patients. The OPCAB group showed less ventilation time, less blood transfusion needs and shorter hospital stays than the other 2 groups of patients that showed no differences between each other.

CONCLUSION

OPCAB is safe and showed slight advantage over CEC supported groups but the number of grafts per patient was smaller.