Reducing marine eutrophication may require a paradigmatic change

Marine eutrophication in the North-East Atlantic (NEA) strongly relies on nutrient enrichment at the river outlets, which is linked to human activities and land use in the watersheds. The question is whether human society can reduce its nutrient emissions by changing land use without compromising food security. A new version of Riverstrahler model (pyNuts-Riverstrahler) was designed to estimate the point and diffuse nutrient emissions (N, P, Si) to the rivers depending on land use in the watersheds across a large domain (Western Europe agro-food systems, waste water treatment). The loads from the river model have been used as inputs to three marine ecological models (PCOMS, ECO-MARS3D, MIRO&CO) covering together a large part of the NEA from the Iberian shelf to the Southern North Sea. The modelling of the land-ocean continuum allowed quantifying the impact of changes in land use on marine eutrophication. Pristine conditions were tested to scale the current eutrophication with respect to a "natural background" (sensu WFD), i.e. forested watersheds without any anthropogenic impact. Three scenarios representing potential management options were also tested to propose future perspectives in mitigating eutrophication. This study shows that a significant decrease in nitrogen fluxes from land to sea is possible by adapting human activities in the watersheds, preventing part of the eutrophication symptoms in the NEA rivers and adjacent coastal zones. It is also shown that any significant achievement in that direction would very likely require paradigmatic changes at social, economic and agricultural levels. This requires reshaping the connections between crop production and livestock farming, and between agriculture and local human food consumption. It also involves cultural changes such as less waste production and a shift towards lower-impact and healthier diets where half of the animal products consumption is replaced by vegetal proteins consumption, known as a demitarian diet (http://www.nine-esf.org/node/281/index.html).

Limbal and choroidal Cryptococcus infection in the acquired immunodeficiency syndrome

PURPOSE

A 30-year-old patient with the acquired immunodeficiency syndrome (AIDS) had limbal nodules and multifocal choroidal lesions.

METHODS

A biopsy of the limbal nodules was performed.

RESULTS

The biopsy showed Cryptococcus neoformans surrounded by thick mucinous capsules without inflammatory cell infiltration.

CONCLUSION

In the differential diagnosis of limbal mass in patients with AIDS, cryptococcal infection should be considered.

Predicting the effectiveness of different mulching techniques in reducing post-fire runoff and erosion at plot scale with the RUSLE, MMF and PESERA models

Wildfires have become a recurrent threat for many Mediterranean forest ecosystems. The characteristics of the Mediterranean climate, with its warm and dry summers and mild and wet winters, make this a region prone to wildfire occurrence as well as to post-fire soil erosion. This threat is expected to be aggravated in the future due to climate change and land management practices and planning. The wide recognition of wildfires as a driver for runoff and erosion in burnt forest areas has created a strong demand for model-based tools for predicting the post-fire hydrological and erosion response and, in particular, for predicting the effectiveness of post-fire management operations to mitigate these responses. In this study, the effectiveness of two post-fire treatments (hydromulch and natural pine needle mulch) in reducing post-fire runoff and soil erosion was evaluated against control conditions (i.e. untreated conditions), at different spatial scales. The main objective of this study was to use field data to evaluate the ability of different erosion models: (i) empirical (RUSLE), (ii) semi-empirical (MMF), and (iii) physically-based (PESERA), to predict the hydrological and erosive response as well as the effectiveness of different mulching techniques in fire-affected areas. The results of this study showed that all three models were reasonably able to reproduce the hydrological and erosive processes occurring in burned forest areas. In addition, it was demonstrated that the models can be calibrated at a small spatial scale (0.5 m²) but provide accurate results at greater spatial scales (10 m²). From this work, the RUSLE model seems to be ideal for fast and simple applications (i.e. prioritization of areas-at-risk) mainly due to its simplicity and reduced data requirements. On the other hand, the more complex MMF and PESERA models would be valuable as a base of a possible tool for assessing the risk of water contamination in fire-affected water bodies and for testing different land management scenarios.

Effect of Training-Detraining Phases of Multicomponent Exercises and BCAA Supplementation on Inflammatory Markers and Albumin Levels in Frail Older Persons

Nowadays, it is accepted that the regular practice of exercise and branched-chain amino acids supplementation (BCAAs) can benefit the immune responses in older persons, prevent the occurrence of physical frailty (PF), cognitive decline, and aging-related comorbidities. However, the impact of their combination (as non-pharmacological interventions) in albumin and the inflammatory markers is not fully understood. Therefore, we investigated the effect of a 40-week multifactorial intervention [MIP, multicomponent exercise (ME) associated or not with BCAAs] on plasma levels of inflammatory markers and albumin in frail older persons (≥75 years old) living at residential care homes (RCH). This study consisted of a prospective, naturalistic, controlled clinical trial with four arms of multifactorial and experimental (interventions-wahshout-interventions) design. The intervention groups were ME + BCAAs (n = 8), ME (n = 7), BCAAs (n = 7), and control group (n = 13). Lower limb muscle-strength, cognitive profile, and PF tests were concomitantly evaluated with plasma levels of albumin, anti- and pro-inflammatory cytokines [Interleukin-10 (IL-10) and Tumor Necrosis Factor-alpha (TNF-α) respectively], TNF-α/IL-10 ratio, and myeloperoxidase (MPO) activity at four different time-points: Baseline (T1), after 16 weeks of multifactorial intervention (T2), then after a subsequent 8 weeks washout period (T3) and finally, after an additional 16 weeks of multifactorial intervention (T4). Improvement of cognitive profile and muscle strength-related albumin levels, as well as reduction in the TNF-α levels were found particularly in ME plus BCAAs group. No significant variations were observed over time for TNF-α/IL-10 ratio or MPO activity. Overall, the study showed that MIP triggered slight alterations in the inflammatory and physical function of the frail older participants, which could provide independence and higher quality of life for this population.

Hand grip strength in healthy young and older Brazilian adults:

Hand grip strength (HGS) is important not only in its own right, but as an indicator of overall body strength and future outcomes as well. As we have found no studies on the HGS predictive models including Brazilian adults younger than 50 years of age, we aimed to develop a novel predictive equation using demographic and anthropometric attributes for subjects aged between 18 and 71 years. This is a cross-sectional study in which 203 (105 women) apparently healthy young and older adults were evaluated. A hydraulic dynamometer was used to measure HGS, according to the American Society of Hand Therapists recommendations. Several models were tested using age, body mass (W), body height (H), body mass index (BMI), level of physical activity (IPAQ) and gender as explanatory variables. Automated variable selection using the forward stepwise method was applied. The overall performance measures of the regression consisted of the R2 value adjusted for the number of variables retained in the proposed model, as well as of the standard error of the difference. Regression’s diagnosis using Pearson’s correlation coefficient, multicollinearity assessment and analysis of residuals were also performed to verify specific performance of the model. Statistical significance was considered at p<.05 for all analyses. Regarding the dominant (D) body side, the adjusted R2 value obtained by the stepwise method was .683. The variables age and IPAQ classification did not significantly increase the adjusted R2 value and therefore were excluded from the model (p>.100). For the non-dominant body side (ND), the adjusted R2 was .640. The final prediction models for the dominant body side was HGSPD=20.108×H+0.083×W+13.265×sexmale=1−8.737, whereas for the non-dominant body side it was HGSPND= 9.23×H+0.086×W+14.671×sexmale=1+5.904. Simple personal attributes, such as gender, body height and body mass can predict the expected values of HGS of the dominant and non-dominant upper limbs for Brazilian adults between 18 and 71 years.

Scleroderma: Assessment of posture, balance and pulmonary function in a cross-sectional controlled study

BACKGROUND

Systemic sclerosis leads to significant physical limitations in patients, such as diffuse weakness, skin sclerosis, loss of joint function and lung damage. This study aimed to assess posture and balance in systemic sclerosis patients and secondarily to verify correlations between such measurements and lung function.

METHODS

Thirty-one patients and a similar number of control subjects matched for age, gender, weight, height and body mass index underwent postural assessment using photogrammetry, balance measurement using the Berg Balance Scale and stabilometry, and pulmonary function tests.

FINDINGS

When compared to healthy volunteers, the patients had postural deviations in hip angle (P=0.009 in anterior view and P=0.028 for the right side), horizontal alignment of the pelvis (P=0.002 for the right side and P=0.004 for the left side), vertical alignment of the trunk (P=0.012 for the right side) and ankle angle (P=0.019 for the right side). Postural balance was similar between the two groups as assessed by the Berg Balance Scale and stabilometry. We observed significant correlations between balance measures and posture variables involving the knee and ankle, and between postural control and lung function (ratio between forced vital capacity and diffusing capacity for carbon monoxide).

INTERPRETATION

Our results suggest that posture and balance should be assessed in systemic sclerosis patients in clinical practice, as significant postural changes and compensations are needed to maintain balance. Furthermore, it is important to monitor lung function because vascular injury impacts on postural control in these patients.

Microalbuminuria and associated clinical features among Brazilians with insulin dependent diabetes mellitus

With the objective to determine the frequency of microalbuminuria, macroalbuminuria and the associated clinic and metabolic features among insulin dependent diabetes mellitus (IDDM) Brazilian patients attending at a general University Hospital, a total of 50 outpatients, aged 21.9 +/- 7 years with IDDM duration of 6.8 +/- 5.8 years were studied cross-sectionally. Urinary albumin excretion rate (AER) was determined in timed overnight urine samples. Microalbuminuria was defined when two out of three urine samples had AER ranging 20-200 micrograms/min. Microalbuminuria was present in 12% of our patients. No macroalbuminuric patient was found. Among patients with diabetes duration < or = 5 years (n = 24), 8.3% (n = 2) had microalbuminuria. Retinopathy was strongly associated with microalbuminuria (P = 0.004) although no proliferative retinopathy was noted. No difference was observed concerning FBG and HBAI between normo and microalbuminuria patients. Univariate analysis has revealed no influence of these variables in AER. Systolic blood pressure (sBP) was high in microalbuminuria patients and stepwise multiple regression analysis has shown that it was the only significant independent variable to influence AER. (R = 0.42 r2 = 0.18 P = 0.002). In conclusion, the frequency of microalbuminuria in this sample of IDDM Brazilian patients was similar to other populational groups and was associated with retinopathy and sBP.

Prospective study of development of microalbuminuria and retinopathy in Brazilian IDDM patients

With the aim to study potential risk factors for the development of microalbuminuria and retinopathy, baseline characteristics were examined in 50 Brazilian IDDM patients followed for 4.48 years with a 2-year reexamination. During the study, 3 patients (6%) aged 25.9 +/- 4.4 years, duration of diabetes 8.1 +/- 4.2 years, died from acute complications without microalbuminuria and retinopathy after a follow-up of 2.1 +/- 0.7 years. The standardized mortality rate for the group was 0.84 per 1000 (95% CL, 0.31, 1.83) in comparison to 0.14 per 1000 in the general population. From 34 normoalbuminuric individuals at baseline (urinary albumin excretion rate (AER) < or = 20 micrograms/min in > or = 2 overnight urine collections), 10 developed microalbuminuria with an incidence density of 6.5 cases per 100 person-years (95% CL, 2.23, 10.16). Spontaneous normalization of AER was found in 2 of 4 patients with microalbuminuria at cycle 2. Multiple stepwise regression analysis demonstrated that baseline AER (p = 0.03), but not glycated hemoglobin, blood pressure or duration of diabetes, predicted end-of-study AER. From 36 patients without retinopathy, 10 developed nonproliferative retinopathy with an incidence density of 6.6 cases per 100 person-years (95% CL, 2.75, 10.54). Retinopathy was associated with duration (p = 0.05) and age at diagnosis of diabetes (p = 0.01). A tendency with baseline AER (p = 0.06) was also noted. No patient developed macroalbuminuria, proliferative retinopathy or hypertension. By the end of our study, in a cohort of young IDDM patients followed in a developing country, 6% died from acute complications and 15 patients (44.1%) developed retinopathy and/or microalbuminuria. Our results suggest that the only predictor of end-of-study AER was baseline AER. Also, duration of diabetes and age at diagnosis appear to be risk factors for retinopathy.

Residual beta-cell function and microvascular complications in type 1 diabetic patients

To determine the influence of residual beta-cell function on retinopathy and microalbuminuria we measured basal C-peptide in 50 type 1 diabetic outpatients aged 24.96 +/- 7.14 years, with a duration of diabetes of 9.1 +/- 6.2 years. Forty-three patients (86%) with low C-peptide (<0.74 ng/ml) had longer duration of diabetes than 7 patients (14%) with high C-peptide (> or =0.74 ng/ml) (9 (2-34) vs 3 (1-10) years, P = 0.01) and a tendency to high glycated hemoglobin (HBA1) (8.8 (6-17.9) vs 7.7 (6.9-8.7)%, P = 0. 08). Nine patients (18%) had microalbuminuria (two out of three overnight urine samples with an albumin excretion rate (AER) > or =20 and <200 microg/min) and 13 (26%) had background retinopathy. No association was found between low C-peptide, microalbuminuria and retinopathy and no difference in basal C-peptide was observed between microalbuminuric and normoalbuminuric patients (0.4 +/- 0.5 vs 0.19 +/- 0.22 ng/ml, P = 0.61) and between patients with or without retinopathy (0.4 +/- 0.6 vs 0.2 +/- 0.3 ng/ml, P = 0.43). Multiple regression analysis showed that duration of diabetes (r = 0. 30, r2 = 0.09, P = 0.031) followed by HBA1 (r = 0.41, r2 = 0.17, P = 0.01) influenced basal C-peptide, and this duration of diabetes was the only variable affecting AER (r = 0.40, r2 = 0.16, P = 0.004). In our sample of type 1 diabetic patients residual ss-cell function was not associated with microalbuminuria or retinopathy.

Waldenström's macroglobulinemia - a review

Waldenström's macroglobulinemia (WM) is a lymphoproliferative disease of B lymphocytes, characterized by a lymphoplasmocytic lymphoma in the bone marrow and by IgM monoclonal hypergammaglobulinemia. It was first described in 1944 by Jan Gösta Waldenström, reporting two patients with oronasal bleeding, lymphadenopathy, anemia, thrombocytopenia, high erythrocyte sedimentation rate and serum viscosity, normal radiography and bone marrow infiltrated by lymphoid cells. The WM is a rare disease with a typically indolent clinical course, affecting mainly individuals aged between 63 and 68 years. Most patients have clinical signs and symptoms related to hyperviscosity resulting from IgM monoclonal gammopathy, and/or cytopenias resulting from bone marrow infiltration by lymphoma. The differential diagnosis with other lymphomas is essential for the assessment of prognosis and therapeutic approach. Treatment of patients with asymptomatic WM does not improve the quality of life of patients, or increase their survival, being recommended, therefore, their follow-up. For the treatment of symptomatic patients, alkylating agents, purine analogs and anti-CD20 monoclonal antibodies are used. However, the disease is incurable and the response to therapy is not always favorable. Recent studies have shown promising results with bortezomib, an inhibitor of proteasomes, and some patients respond to thalidomide. In patients with relapse or refractory to therapy, autologous transplantation may be indicated. The aim of this paper is to describe in detail the current knowledge on the pathophysiology of WM, main clinical manifestations, diagnosis, prognosis and treatment.

Salivary Markers Responses in the Post-Exercise and Recovery Period: A Systematic Review

The use of saliva to monitor immune and hormonal responses in training, competitions, and during recovery is an easy and non-invasive alternative means of collecting samples compared to serum collection. Saliva can provide insight into a number of interesting biomarkers such as cortisol, testosterone, immunoglobulins, alpha-amylase, and melatonin, among others. High-intensity and exhaustive exercises, such as training or competition, provide variations in immune, protein and hormonal markers. An adequate recovery period, calming down, and recovery methods can contribute to a fast normalization of these markers, decreasing illness, as well as the likelihood of overtraining and injuries, but their effectiveness is still inconclusive. The aim of this review was to investigate the evidence of salivary markers in post-exhaustive exercise during the recovery period. This study is a systematic review from three electronic databases with studies from 2011 to 2021 within healthy humans. The search found 213 studies, and after applying the inclusion and exclusion criteria, while excluding duplicated studies, 14 studies were included in this review. The most cited salivary markers were cortisol and testosterone, as well as their ratio, alpha-amylase and IgA. Half of the studies applied a variety of recovery methods that showed controversial results over salivary markers' impact. However, they showed an impact on the markers from the exercise, which was still dependent on exercise intensity, methodology, and duration.

Integrated monitoring of South Portugal water bodies: a methodology towards WFD

The challenge on implementation of the EU Water Framework Directive (WFD) (2000/60/EC) fosters the development of new monitoring approaches. The directive promotes the use of modelling techniques to assist all phases of the process, from characterization and establishment of reference conditions to identification of pressures and assessment of impact. This work is based on the above principles. A classical monitoring of the water status of the main transitional water bodies of Algarve (South of Portugal) is combined with advanced in situ water profiling and hydrodynamic, water quality and ecological modelling to build a complete description of the system. The aim is to demonstrate a methodology where traditional monitoring and modelling tools can be joined together to draw a holistic picture. The results show that globally the water bodies present a good trophic status. Eutrophication symptoms are not generalized. Due to physical transport and dispersion, nutrient enrichment is not the only factor limiting growth; residence time is also an important factor. Some confined regions with high residence times are at present endangered by point and diffuse sources of pollution. The microbiologic impact of waste water treatment plants (WWTP) is confined to regions between 500 m and 1 km from the discharges.

Effects of intermittent pneumatic compression as a recovery method after exercise: A comprehensive review

The aim of the study was to gather information from the literature on the use of Intermittent Pneumatic Compression (compression boots) as a recovery method after exercise. A database search methodology, just in English, was used for the review from 2000 to 2021. In this review a total of 354 studies were found which, after applying inclusion items, such as the need for a recovery method as a means of comparison, and exclusion and analysis of abstracts and full text, reached a total of 6 studies. An analysis of the studies was carried out in relation to the sample studied, the compression boots intervention protocol, the recovery methods used as a comparison, the physiological stress agent and the variables analysed and their responses. The results found showed no significant difference in the comparison between the recovery methods that indicate a superiority or inferiority for the use of compression boots. A low number of evidence was observed so that one could have a definitive position regarding the use of compression boots as a recovery method, even though the lack of positive responses and divergences regarding the use of this methodology are evident. There's still a gap to understand compression boots as recovery, even with positive responses from empiric knowledge.

Empowering frail older adults: multicomponent elastic-band exercises and BCAA supplementation unleash physical health and preserve haematological biomarkers

The effectiveness of Branched Chain Amino Acids (BCAAs) supplementation on enhancing exercise performance in both young and older adults remains a topic of debate. Recent research suggests that BCAAs combined with regular exercise might have an impact on human erythropoiesis, blood dynamics, and iron homeostasis. Given the increasing longevity of the global population, it is crucial to investigate the potential benefits of BCAA supplementation and regular exercise as non-pharmacological interventions for improving the overall health of frail older adults. To assess the influence of a 40-week multicomponent exercise intervention (MEP) combined BCCA supplementation on the haematological indicators of frail older adults (83-93 years old) residing in nursing homes. A prospective, naturalistic, controlled clinical trial employing an intervention-washout-intervention was conducted for this purpose. The study included four experimental groups: MEP plus BCAA supplementation (MEP + BCAA, n = 8), MEP only (n = 7), BCAA supplementation only (n = 7), and control group non exercising (CG, n = 13). Fried's physical frailty (PF) protocol was employed to stratify the participants. Additionally, the assessment included the evaluation of nutritional status, comorbidities, and anthropometric measurements. Among the several haematological markers examined, only mean cellular Haemoglobin Concentration (MCH) [F = 4.09; p < 0.03] and Mean Cell haemoglobin Concentration (MCHC) [F = 10, 323; p < 0,0001] showed significant effects of time group. Our findings demonstrate that a long-term intervention with BCAA plus MEP did not lead to significant alterations in the haematological profile. An 8-week withdrawal from interventions did not affect the frailty status in the MEP and MEP + BCAA groups, whereas the control group exhibited an increase in PF status. The findings, demonstrating the potential pro-immune effect and maintenance of MCH and MCHC levels, highlight the relevance of incorporating exercise and nutritional strategies to promote healthy aging. This study contributes to the achievement of the United Nations Sustainable Development Goals 3 (good health and well-being) and 10 (reduced Inequalities) for all.

Operational decision support system for large combined sewage systems: Lisbon/Tagus estuary case study

Managing combined sewage systems in large cities discharging to coastal waters, often bearing recreational activities, remains a challenge. Studying the impacts of such discharges requires the development of specific models. Hydrodynamic and water quality modelling of coastal waters employs numerical methods and algorithms, leading to the design of complex models which require expert use. The use of such models as decision support tools to simulate discharge impacts and define adequate corrective measures could represent a key part in meeting this challenge. In this paper, the authors describe the work undertaken to develop an operational decision support system (ODSS) methodology aiming to enable wastewater utilities' non-expert staff to carry out user-friendly scenario analysis based on computational fluid dynamics simulations. This article depicts the application and validation of the ODSS to the combined sewage system and the Tagus estuary of the city of Lisbon in Portugal. The ODSS was used for simulating the effects in the receiving coastal waters of a discharge caused by a scheduled maintenance operation in the sewage infrastructure. Results show that the use of such ODSS by non-expert staff increases their decision capabilities and knowledge of the wastewater utility's contribution to reducing negative impacts of sewage discharges on the receiving water bodies.

Histologic responses in sixty multibacillary leprosy patients inoculated with autoclaved Mycobacterium leprae and live BCG

Sixty lepromatous or borderline lepromatous patients were submitted to immunotherapy with a mixture of autoclaved Mycobacterium leprae and BCG. The histopathologic findings in skin biopsy specimens taken before and after immunotherapy were evaluated independently by six histopathologists in a workshop setting. Their pooled observations on diagnosis and classification were analyzed to assess the histopathologic changes following various periods of immunotherapy. Expressing the results as the average value of five to six independent observations, there were changes in classification of reversal or upgrading toward the tuberculoid end of the leprosy spectrum in 90.5% of the patients initially classified as lepromatous (LL), and in 83.3% of those initially classified as borderline lepromatous (BL). The histopathologic findings amply support the clinical, bacteriologic and immunological changes following immunotherapy from LL or BL, to BL, mid-borderline (BB) or even borderline tuberculoid (BT) leprosy.

[Dental procedures during anticoagulant administration]

Thirty-six patients on chronic anticoagulant therapy were submitted to dental surgery. The ages ranged between 20 and 68 (mean 43.5) years; twenty (55.6%) patients were female and 16 (44.4%) were female. Phenindione was administered to 33 (91.7%) patients, warfarin to one (2.7%) and hydroxycoumarin to two (5.6%). Mechanical heart valve prosthesis occurred in 23 (64%) patients, bioprosthesis in two (5.5%), mitral stenosis submitted to commissurotomy in two (5.5%) and other valvular heart disease occurred in nine patients (25%). Eighty-three elective procedures were performed. Anticoagulant drugs were stopped from two to seven days before, in order to prothrombin time reach 60%. Abnormal bleeding that was easily controlled with local measures occurred in two patients. Sixteen emergency procedures were performed without stopping anticoagulant treatment. Abnormal bleeding was observed in one patient and it subsided after local care. Thus, safe odontologic procedures may be carried on in patients during treatment with oral anticoagulants.

[Ophthalmological manifestations in AIDS: evaluation of 445 patients in one year]

The authors prospectively evaluated 445 HIV positive patients for the presence of ophthalmological manifestations. PURPOSE--To evaluate patients HIV positive with or without AIDS and correlate the data with the ocular findings mentioned in the literature. METHODS--445 HIV positive patients (66% with AIDS) were evaluated in one year at the Paulista School of Medicine, São Paulo Hospital, Brazil. There was a predominance of males (87%) and homosexuals (58.2%). RESULTS--Of the 445 patients, 52% presented ocular findings secondary to HIV infection at the first examination. The diagnosis included: CMV retinitis (25%), ocular toxoplasmosis (8.5%), herpes retinitis (3.6%), papilledema (2.2%), optic atrophy (1.6%), phthisis bulbi (1.5%), multifocal choroiditis (1.2%), retinal hemorrhages (0.9%), syphilitic uveitis (0.6%) and central vein occlusion (0.2%). CONCLUSION--The incidence of ophthalmic manifestations of AIDS in Brazil is similar to that found in the international literature. We found though a higher incidence of ocular toxoplasmosis than that in other countries. No ocular pneumocystosis was presents in the population evaluated by us.