Newborn screening for sickle cell disease in Brazil: the Campinas experience

Newborn screening for sickle cell disease commenced in 1992 in Sao Paulo State and by the end of 2000, the programme covered 78 institutions in 36 municipalities with the screening of 281,884 babies. Initially based on liquid cord blood samples, these are being replaced by dried filter paper capillary samples to ease handling and avoid diagnostic confusion from maternal contamination. The prevalence of sickle cell trait (2.0%) and HbC trait (0.6%) increased significantly between 1996 and 2000, apparently because of improved detection rather than the later introduction of institutions serving populations with higher trait frequencies. There were 29 babies with homozygous sickle cell SS disease and 26 with sickle cell-haemoglobin C (SC) disease, the latter significantly exceeding expectation and possibly attributable to a nonrandom selection of partners. Sickle cell-beta thalassaemia syndromes were proportionately more common than in Jamaica, and it is possible that this results from interaction with other Brazilian populations carrying higher beta thalassaemia gene frequencies. The frequency of abnormal haemoglobins in this population is lower than in Jamaica, but clinically significant sickle cell disease occurred once in every 5527 births, comparable with the frequencies of other significant inborn errors of metabolism.

Construction and characterization of metal ion-containing DNA nanowires for synthetic biology and nanotechnology

DNA is an attractive candidate for integration into nanoelectronics as a biological nanowire due to its linear geometry, definable base sequence, easy, inexpensive and non-toxic replication and self-assembling properties. Recently we discovered that by intercalating Ag+ in polycytosine-mismatch oligonucleotides, the resulting C-Ag+-C duplexes are able to conduct charge efficiently. To map the functionality and biostability of this system, we built and characterized internally-functionalized DNA nanowires through non-canonical, Ag+-mediated base pairing in duplexes containing cytosine-cytosine mismatches. We assessed the thermal and chemical stability of ion-coordinated duplexes in aqueous solutions and conclude that the C-Ag+-C bond forms DNA duplexes with replicable geometry, predictable thermodynamics, and tunable length. We demonstrated continuous ion chain formation in oligonucleotides of 11-50 nucleotides (nt), and enzyme ligation of mixed strands up to six times that length. This construction is feasible without detectable silver nanocluster contaminants. Functional gene parts for the synthesis of DNA- and RNA-based, C-Ag+-C duplexes in a cell-free system have been constructed in an Escherichia coli expression plasmid and added to the open-source BioBrick Registry, paving the way to realizing the promise of inexpensive industrial production. With appropriate design constraints, this conductive variant of DNA demonstrates promise for use in synthetic biological constructs as a dynamic nucleic acid component and contributes molecular electronic functionality to DNA that is not already found in nature. We propose a viable route to fabricating stable DNA nanowires in cell-free and synthetic biological systems for the production of self-assembling nanoelectronic architectures.

In vivo assessment of a new multifunctional coating architecture for improved Mg alloy biocompatibility

Magnesium alloys are regarded as potential biodegradable load-bearing biomaterials for orthopedic applications due to their physico-chemical and biomechanical properties. However, their clinical applicability is restricted by their high degradation rate, which limits the physiological reconstruction of the neighbouring tissues. In this work, a multifunctional coating architecture was developed on an AZ31 alloy by conjoining an anodization process with the deposition of a polymeric-based layer consisting of polyether imine reinforced with hydroxyapatite nanoparticles, aiming at improved control of the corrosion activity and biological performance of the Mg substrate. Anodization and coating protocols were evaluated either independently or combined for corrosion resistance and biological behaviour, i.e. the irritation potential and angiogenic capability within a chicken chorioallantoic membrane assay, and bone tissue response following tibia implantation within a rabbit model. Electrochemical impedance spectroscopy (EIS) analysis showed that coated Mg constructs, particularly anodized plus coated with AZ31, exhibited excellent stability compared to the anodized alloy and, particularly, to the bare AZ31. Microtomographic evaluation of the implanted samples correlated with these degradation results. Mg constructs displayed a non-irritating behaviour, and were associated with high levels of vascular ingrowth. Bone ingrowth neighbouring the implanted constructs was observed for all samples, with coated and anodized plus coated samples presenting the highest bone formation. Gene expression analysis suggested that the enhanced bone tissue formation was associated with the boost in osteogenic activity through Runx2 upregulation, following the activation of PGC-1α/ERRα signaling. Overall, the developed multifunctional coatings appear to be a promising strategy to obtain safe and bioactive biodegradable Mg-based implants with potential applications within bone tissue.

Effects of animal type (wild vs. domestic) and diet alfalfa level on intake and digestibility of European adult rabbits (Oryctolagus cuniculus)

The aim of this study was to evaluate the effect of the level of alfalfa in the diet on feed intake and digestibility of two types of rabbits, wild (Oryctolagus cuniculus algirus) vs. domestic (O. cuniculus cuniculus). Ten wild (W; mean LW = 927 g) and 10 domestic (D; mean LW = 4,645 g) adult rabbit does were fed ad libitum two pelleted diets: a control diet (C) with 15% of dehydrated alfalfa hay (as feed basis) and a test diet (A) with 36% of dehydrated alfalfa hay (as feed basis), according to a change-over design. Wild does dry matter (DM) intake per kg live weight (BW) was 55% higher (p < .001) than the intake of the D ones (58 g vs. 37 g DM per kg BW respectively). However, no difference (p > .05) was found when intake was expressed per kg^0.75 BW (ca. 56 g DM) and tended to be higher (p = .07) in D does when expressed per kg^0.67 BW (62 g vs. 55 g DM). Domestic does showed a higher (p < .05) DM, organic matter, crude energy and neutral detergent fibre digestibility (3; 2; 3; 3 percentage points respectively) than W does. The amount of nutrients and energy digested by D does was lower per kg BW (p < .001), similar per kg^0.75 BW (p > .05) and tended to be higher per kg^0.67 BW (p < .1) than in W does. The diet content of alfalfa did not affect (p > .05) the feed intake nor the diet digestibility. This study suggests that W rabbits exhibit a higher intake per kg BW and a lower digestibility than their D counterparts, which results in similar digestible nutrient and energy intake per kg BW powered to 0.75. The nutritive value of dehydrated alfalfa for rabbits, evaluated through intake and digestibility, seems to be equivalent to their base diets (forage plus concentrate).

Impact of the 2009-2014 economic crisis on suicide attempts and self-harm in Portugal

Background

Following the worldwide economic crisis of 2008, studies have found an increased risk for self-harm and suicide attempts, many of which need hospital care. There is no research in Portugal on the matter. Therefore, our goal was to estimate the impact of the Portuguese economic crisis of 2009-2014 on the hospital admission rates by attempted suicide and self-harm in Portugal.

Methods

A retrospective ecological study, with an interrupted time series analysis of hospital admissions by suicide attempts (data from the national Hospital Mobility Database) in mainland Portugal, between 2003 and 2014, was performed. Resident population data over 15 years old was retrieved from the National Statistics Institute. Poisson regression models were used to compare rates and trends before (2003-2008) and during (2009-2014) the Portuguese economic crisis. All rates were adjusted for seasonality.

Results

A total of 35,077 hospital admission episodes by suicide attempt were retrieved. The mean admission rate was 2.947 per 100 000 inhabitants per month before the crisis, falling to 2.798 during the crisis period. Before the crisis, the total admission rate was decreasing 1% per year. After the crisis erupted, there was a level change, with a sudden increase of 7.9%. The suicide and self-harm admission rate, after 2008, was constant and approximately 38.8% higher than expected if the earlier trend had continued.

Conclusions

There was an increase in the total hospital admission rate by suicide attempts and self-harm during the economic crisis period in Portugal, when compared to the previous period.

Key messages

Economic crisis can pose considerable suicide risks. Urgent action is needed to prevent economic crisis leading to additional suicides.

COVID-19 government response measures: analysis in the European Union

Introduction

The global spread of COVID-19 has led to a wide range of responses from governments, including in the European Union (EU). Measures involve travel restrictions, school closings, bans on public gatherings, emergency investments in healthcare, contact tracing and social welfare. However, responses have varied in scope, stringency and timing. The aim of this study was to analyse government response measures in the EU and differences across EU countries, in 2020.

Methods

Using Oxford COVID-19 Government Response Tracker indices (Stringency Index, Containment and Health Index, Economic Support Index, Overall Government Response Index; all scored 1-100), estimates were analysed for the EU and each country, in 2020.

Results

While the Stringency, Overall Government Response and Containment and Health indices were generally in line with COVID-19 incidence progression (peak in April-May, decrease in the summer, new increase in the fall and second peak in November-December), for all EU countries, the Economic Support Index showed heterogeneous patterns between countries. In the EU, the Stringency Index ranged from 1,85 to 96,30 (median:54,63; SD:21,07), the highest median in Ireland and the lowest Croatia. The Containment and Health Index ranged from 1,92 to 84,29 (median:52,88; SD:17,77), again with Ireland showing the highest median, but this time, Estonia the lowest. For the Economic Support Index, ranging from 12,50 to 100 (median:75,00;SD:20,36), Cyprus had the highest median, and Germany the lowest. The Overall Government Response Index ranged from 1,67 to 83,78 (median:55,83; SD:18,36), with the highest median in Cyprus and the lowest in Estonia.

Conclusions

There was wide variation in response measures across the EU countries, in 2020. The Economic Support Index showed quite a different pattern compared to the other ones. Understanding these trends and patterns allows for mutual learning and better preparedness for future pandemics.

Key messages

There was wide variation in response measures across the EU in 2020, especially in economic support. Understanding these patterns allows for better preparedness in future pandemics.

Fracture of the fabella with radiologic and MRI

The fabella is an inconstant sesamoid bone. A handful of cases have been reported so far describing fabella fracture, usually involving high energy mechanism or stress fractures after total knee arthroplasty. This paper presents a fabella fracture in a man in his 40s after suffering a car crash, the clinical and radiographic presentation, treatment and complete recovery at 4-months follow-up.

The 2009-2014 economic crisis and deaths by suicide in Portugal: time series analysis

Introduction

Population health, including mental health, is influenced by its socioeconomic context. After the 2008 global economic crisis, studies found contradicting results: some showed an increased risk for self-harm and suicidal behavior, while others found the opposite association. To the best of our knowledge, there is no research in Portugal on the subject. Thus, our aim was to estimate the impact of the Portuguese economic crisis of 2009-2014 on the death rate by suicide and self-inflicted injury in Portugal.

Methods

A retrospective ecological study with an interrupted time series analysis of deaths by suicide and self-inflicted injury (data from the National Statistics Institute) in mainland Portugal, in 2003-2014, was performed. Resident population data was also retrieved from the National Statistics Institute. Binomial negative generalized linear models were used to compare rates and trends before (2003-2008) and during (2009-2014) the economic crisis. All rates were stratified and adjusted for seasonality.

Results

The economic crisis was associated with 13% a step increase in the death rate due to suicide and self-inflicted injury, with unemployment playing a significant mediating role, being negatively associated to the outcome. Differences between groups exist, with males, working-age groups and the North and Centre regions being the most impacted, globally.

Conclusions

Economic downturns pose risks for suicidal behavior. Unemployment may play a role in this association. Employment protection schemes can prevent this impact, so urgent action is needed to prevent economic crisis leading to additional suicides, especially in the context of the COVID-19 pandemic and the economic crisis it caused.

Key messages

• The Portuguese economic crisis of 2009-2014 was associated with an increased death rate due to suicide, especially in males, working-age groups and the North and Centre regions.

• Unemployment may play a role in this association, and active labour market programmes can prevent the negative impacts of economic crisis leading to additional suicides.

The economic burden of Diabetes Mellitus in Belgium from 2013 to 2017

Background

Considering the growing prevalence of chronic disease and diabetes mellitus (DM) in Belgium, alongside population aging, insight into the economic burden of DM is essential for decision makers. To the best of our knowledge, there is no research on the subject in Belgium. Thus, our aim was to estimate the direct and indirect costs associated to DM in Belgium between 2013 and 2017.

Methods

On a first phase, we performed a retrospective observational study, calculating the direct (i.e., ambulatory care, hospitalizations and medications) and indirect (work absenteeism, by multiplying mean daily wage and days absent from work) costs in the Belgian population with DM in 2013-2017. Data was retrieved from the Belgian Intermutualistic Agency (which manages compulsory health insurance) database and the Belgian Health Interview Survey database, namely DM prevalence, healthcare costs, days absent from work and sociodemographic and health factors. Subsequently, negative binomial regression models were used to assess the association of mean yearly costs to DM and adjustments for age, education level, physical activity, sugared drink consumption and body-mass index were included. Mean incremental costs were estimated through recycled predictions, considering the observed DM prevalence in Belgium in the study period and a counterfactual scenario with null prevalence.

Results

We found a direct mean yearly incremental cost of €2 477 per DM patient, in Belgium, associated with age, low educational level and low physical activity. In the total Belgian population, the total yearly incremental healthcare cost of DM was €1.5 billion. Indirect yearly incremental cost of DM resulted to be not significantly different from the population without DM.

Conclusions

DM has a major economic burden in Belgium, one that is expected to continue to rise in the future, alongside population aging. These results are essential for health planning and resource allocation.

Key messages

• DM has a major economic burden in Belgium, especially when it comes to direct health expenditures with ambulatory care, hospitalizations and medications.

• Considering the growing prevalence of DM and population aging, these results are essential for health planning and resource allocation.

Maternal low-dose caffeine intake during the perinatal period promotes short- and long-term sex-dependent hormonal and behavior changes in the offspring

AIM

Maternal caffeine crosses the placenta and mammary barriers, reaching the baby and, because his/her caffeine metabolism is immature, our hypothesis is that even a low caffeine intake (250 mg/day), lower than the dose limit recommended by the World Health Organization, can promote caffeine overexposure in the offspring, leading to short- and long-term changes.

MAIN METHODS

Pregnant Wistar rats received intragastric caffeine (CAF) (25 mg/Kg/day) or vehicle during the gestation and lactation periods. We evaluated morphometrical, metabolic, hormonal, and behavioral parameters of male and female offspring at different ages.

KEY FINDINGS

Even a low caffeine intake promoted lower maternal body mass and adiposity, higher plasma cholesterol and lower plasma T3, without changes in plasma corticosterone. Female CAF offspring exhibited lower birth weight, body mass gain and food intake throughout life, and hyperinsulinemia at weaning, while male CAF offspring showed reduced food intake and lower plasma T3 at weaning. At puberty and adulthood, male CAF showed higher preference for palatable food, aversion to caffeine intake and higher locomotor activity, while female CAF only showed lower preference for high fat diet (HFD) and lower anxiety-like behavior. At adulthood, both male and female offspring showed higher plasma T3. Male CAF showed hypertestosteronemia, while female CAF showed hypoinsulinemia without effect on glucose tolerance.

SIGNIFICANCE

A low caffeine intake during the perinatal period affects rat's offspring development, promoting sex-dependent hormonal and behavior changes. Current data suggest the need to review caffeine recommendations during the perinatal period.