Latitudinal and temporal distribution of aerosols and precipitable water vapor in the tropical Andes from AERONET, sounding, and MERRA-2 data

The aerosol and precipitable water vapor (PW) distribution over the tropical Andes region is characterized using Aerosol Robotic Network (AERONET) observations at stations in Medellin (Colombia), Quito (Ecuador), Huancayo (Peru), and La Paz (Bolivia). AERONET aerosol optical depth (AOD) is interpreted using PM2.5 data when available. Columnar water vapor derived from ozone soundings at Quito is used to compare against AERONET PW. MERRA-2 data are used to complement analyses. Urban pollution and biomass burning smoke (BBS) dominate the regional aerosol composition. AOD and PM2.5 yearly cycles for coincident measurements correlate linearly at Medellin and Quito. The Andes cordillera's orientation and elevation funnel or block BBS transport into valleys or highlands during the two fire seasons that systematically impact South America. The February-March season north of Colombia and the Colombian-Venezuelan border directly impacts Medellin. Possibly, the March aerosol signal over Quito has a long-range transport component. At Huancayo and La Paz, AOD increases in September due to the influence of BBS in the Amazon. AERONET PW and sounding data correlate linearly but a dry bias with respect to soundings was identified in AERONET. PW and rainfall progressively decrease from north to south due to increasing altitude. This regional diagnosis is an underlying basis to evaluate future changes in aerosol and PW given prevailing conditions of rapidly changing atmospheric composition.

Oxidized organic molecules in the tropical free troposphere over Amazonia

New particle formation (NPF) in the tropical free troposphere (FT) is a globally important source of cloud condensation nuclei, affecting cloud properties and climate. Oxidized organic molecules (OOMs) produced from biogenic volatile organic compounds are believed to contribute to aerosol formation in the tropical FT, but without direct chemical observations. We performed in situ molecular-level OOMs measurements at the Bolivian station Chacaltaya at 5240 m above sea level, on the western edge of Amazonia. For the first time, we demonstrate the presence of OOMs, mainly with 4-5 carbon atoms, in both gas-phase and particle-phase (in terms of mass contribution) measurements in tropical FT air from Amazonia. These observations, combined with air mass history analyses, indicate that the observed OOMs are linked to isoprene emitted from the rainforests hundreds of kilometers away. Based on particle-phase measurements, we find that these compounds can contribute to NPF, at least the growth of newly formed nanoparticles, in the tropical FT on a continental scale. Thus, our study is a fundamental and significant step in understanding the aerosol formation process in the tropical FT.

COVID-19 New Cases and Environmental Factors During Wet and Dry Seasons in West and Southern Africa

Sub-Saharan Africa has been the last continent to experience a significant number of cases in the novel Coronavirus (COVID-19). Studies suggest that air pollution is related to COVID-19 mortality; poor air quality has been linked to cardiovascular, cerebrovascular, and respiratory diseases, which are considered co-morbidities linked to COVID-19 deaths. We examine potential connections between country-wide COVID-19 cases and environmental conditions in Senegal, Cabo Verde, Nigeria, Cote D'Ivorie, and Angola. We analyze PM2.5 concentrations, temperatures from cost-effective in situ measurements, aerosol optical depth (AOD), and fire count and NO2 column values from space-borne platforms from 1 January 2020 through 31 March 2021. Our results show that the first COVID-19 wave in West Africa began during the wet season of 2020, followed by a second during the dry season of 2020. In Angola, the first wave starts during the biomass burning season but does not peak until November of 2020. Overall PM2.5 concentrations are the highest in Ibadan, Nigeria, and coincided with the second wave of COVID-19 in late 2021 and early 2022. The COVID-19 waves in Cabo Verde are not in phase with those in Senegal, Nigeria, and Cote, lagging by several months in general. Overall, the highest correlations occurred between weekly new COVID-19 cases meteorological and air quality variables occurred in the dry season.

Factors associated with perceived performance drops and musculoskeletal injuries in Brazilian recreational triathletes

OBJECTIVE

The aim of the study was to investigate sleep characteristics, use of supplements, and training volume of recreational triathletes, and to verify possible associations with perceived performance drops and occurrence of injuries.

MATERIALS AND METHODS

Recreational triathletes (n=942) answered a questionnaire inquiring about their demographic characteristics, performance, injuries and training volume.

RESULTS

When comparing athletes who slept more (9-10 hours) with those who slept less, less sleep was associated with a higher prevalence of perceived performance drops. Regarding difficulties in initiating sleep, the absence of initiating difficulties (p<0.001) was a protective factor against perceived performance drops. Regarding weekly training volume, compared to those who trained more than 20 hours, training less than 3 hours (p<0.001), 3-5 hours (p<0.001), or 12-14 hours (p<0.001) were protective factors against perceived performance drops. Concerning training volume and injuries, we found that compared to those who trained more than 20 hours, training 18-20 hours (p<0.001), 15-17 hours (p<0.001), 12-14 hours (p<0.001), 6-8 hours (p<0.001), or 3-5 hours (p<0.001) were protective factors against injuries.

CONCLUSIONS

Triathletes with a lower sleep quantity and those who have difficulties initiating sleep frequently experience drops in performance. Training volumes can influence both performance and the likelihood of injuries.

B-esterases characterisation in the digestive tract of the common octopus and the European cuttlefish and their in vitro responses to contaminants of environmental concern

Cephalopods are a group of marine invertebrates that have received little attention as sentinel species in comparison to other molluscs, such as bivalves. Consequently, their physiological and biochemical xenobiotic metabolism responses are poorly understood. Here we undertake a comparative analysis of the enzymatic activities involved in detoxification reactions and neural transmission in the digestive tract of two commercial cephalopods: the Common octopus, Octopus vulgaris, and the European cuttlefish, Sepia officinalis. For methodological purposes, several common B-esterases (five carboxylesterase (CE) substrates and three cholinesterase (ChE) determinations) were assayed as a proxy of metabolic and neuronal activities, respectively. Four components of the digestive tract in each species were considered: salivary glands, the stomach, the digestive gland and the caecum. The in vitro responses of digestive gland homogenates to model chemicals and contaminants of environmental concern were contrasted between both cephalopod species. The baseline biochemical activities in the four digestive tract components were also determined. Moreover, in order to validate the protocol, purified proteins, recombinant human CE (CE1 and CE2) and purified eel acetylcholinesterase (AChE) were included in the analysis. Overall, carboxylesterase activities were higher in octopus than in cuttlefish, with the activity quantified in the digestive tract components in the following order: digestive gland ≈ caecum > stomach ≈ salivary glands, with higher hydrolysis rates reached with naphthyl-derived substrates. In contrast, cuttlefish hydrolysis rates with ChE substrates were higher than in octopus. This trend was also reflected in a higher sensitivity to CE inhibitors in octopus and to AChE inhibitors in cuttlefish. Given the detoxification character of CEs and its protective role preventing AChE inhibition, octopus could be regarded as more efficiently protected than cuttlefish from neurotoxic exposures. A full characterisation of B-esterases in the digestive tract of the two common cephalopods is also provided.

Detection and Quantification of Enteric Pathogens in Aerosols Near Open Wastewater Canals in Cities with Poor Sanitation

Urban sanitation infrastructure is inadequate in many low-income countries, leading to the presence of highly concentrated, uncontained fecal waste streams in densely populated areas. Combined with mechanisms of aerosolization, airborne transport of enteric microbes and their genetic material is possible in such settings but remains poorly characterized. We detected and quantified enteric pathogen-associated gene targets in aerosol samples near open wastewater canals (OWCs) or impacted (receiving sewage or wastewater) surface waters and control sites in La Paz, Bolivia; Kanpur, India; and Atlanta, USA, via multiplex reverse-transcription qPCR (37 targets) and ddPCR (13 targets). We detected a wide range of enteric targets, some not previously reported in extramural urban aerosols, with more frequent detections of all enteric targets at higher densities in La Paz and Kanpur near OWCs. We report density estimates ranging up to 4.7 × 10² gc per m_air³ across all targets including heat-stable enterotoxigenic Escherichia coli, Campylobacter jejuni, enteroinvasive E. coli/Shigella spp., Salmonella spp., norovirus, and Cryptosporidium spp. Estimated 25, 76, and 0% of samples containing positive pathogen detects were accompanied by culturable E. coli in La Paz, Kanpur, and Atlanta, respectively, suggesting potential for viability of enteric microbes at the point of sampling. Airborne transmission of enteric pathogens merits further investigation in cities with poor sanitation.

Left ventricular myocardial work in patients with high gradient severe symptomatic aortic stenosis

Background

Left ventricular myocardial work (LVMW) is a novel method to evaluated left ventricular (LV) function using pressure-strain loops. It might correct global longitudinal strain (GLS) for afterload, being eventually useful to assess whether GLS reduction is due to reduced contractility (reflected as reduced myocardial work) or increased afterload (reflected as increased myocardial work).

Aim

To describe indices of LVMW in a group of patients with severe symptomatic aortic stenosis (AS).

Methods

We prospectively studied 104 consecutive patients (age: 71 years [IQR 66.5–75.5] years, 51% men) with severe symptomatic high gradient AS: mean transaortic pressure gradient: 56.5mmHg [IQR 46.8–67.8]; aortic valve area: 0.73cm2 [IQR 0.61–0.88]; indexed stroke volume: 47.7±1.3 mL/m2 (11 patients with low-flow AS), preserved LV ejection fraction (EV) (LVEF: 56.0% [51.0–61.3]; GLS: −14.5% [IQR −16.1 to −10.6]), with no previous coronary artery disease and no history of cardiomyopathy. Beyond complete transthoracic echocardiography, all patients underwent cardiac magnetic resonance for LV myocardium tissue characterization. As proposed for AS, LV systolic pressure was corrected adding the mean transaortic pressure gradient to non-invasive systolic blood pressure cuff measurement in the echocardiographic algorithm. Four LVMW indices were collected in 83 patients (patients excluded for atrial fibrillation, left bundle branch block or absence of non-invasive blood pressure registration) and correlated to LV function indexes, LV hypertrophy and remodeling, myocardial tissue characterization, BNP and troponin levels (Pearson or Spearman correlation). These same indexes were compared in patients with LV ejection fraction (EF) below and above 50%, normal and reduced flow and presence of replacement fibrosis.

Results

Global constructive work (GCW) (2658.6±76.4mmHg%), global myocardial work (GMW) (2218.7±74.9mmHg%) and global wasted work (GWE) (262.0mmHg% [198.8–339.5]) were high above normal with concomitant lower work efficiency (WE) (88.0% [83.2–91.8]. Weak correlations were found between LVMW indexes and parameters describing aortic valve severity, flow and LV function (table). Except for significant differences of LVMI in patients with reduced LV ejection fraction (GCW 2770.3±687.4 vs 2056.0±380.7mmHg%, p=0,014 and GMW 2362.5±657.9 vs 1621.3±319.9, p=0,021 in patients with LV EF&gt;50% vs. LV EF&lt;50%, respectively) work indexes were neither significantly different in low-flow patients nor in those with myocardial late gadolinium enhancement.

Conclusions

Global constructive and myocardial work are increased in these patients with severe aortic stenosis. This might reflect an increased afterload predominance rather than a LV functional impairment, particularly relevant in this group of patients with exclusive high gradient disease and preserved LVEF.

Funding Acknowledgement

Type of funding sources: None. Correlations between LVMI – LV function

Antimicrobial resistance genes are enriched in aerosols near impacted urban surface waters in La Paz, Bolivia

Antibiotic resistance poses a major global health threat. Understanding emergence and dissemination of antibiotic resistance in environmental media is critical to the design of control strategies. Because antibiotic resistance genes (ARGs) may be aerosolized from contaminated point sources and disseminated more widely in localized environments, we assessed ARGs in aerosols in urban La Paz, Bolivia, where wastewater flows in engineered surface water channels through the densely populated urban core. We quantified key ARGs and a mobile integron (MI) via ddPCR and E. coli spp. as a fecal indicator by culture over two years during both the rainy and dry seasons in sites near wastewater flows. ARG targets represented major antibiotic groups-tetracyclines (tetA), fluoroquinolines (qnrB), and beta-lactams (blaTEM)-and an MI (intI1) represented the potential for mobility of genetic material. Most air samples (82%) had detectable targets above the experimentally determined LOD: most commonly blaTEM and intI1 (68% and 47% respectively) followed by tetA and qnrB (17% and 11% respectively). ARG and MI densities in positive air samples ranged from 1.3 × 101 to 6.6 × 104 gene copies/m3 air. Additionally, we detected culturable E. coli in the air (52% of samples <1 km from impacted surface waters) with an average density of 11 CFU/m3 in positive samples. We observed decreasing density of blaTEM with increasing distance up to 150 m from impacted surface waters. To our knowledge this is the first study conducting absolute quantification and a spatial analysis of ARGs and MIs in ambient urban air of a city with contaminated surface waters. Environments in close proximity to urban wastewater flows in this setting may experience locally elevated concentrations of ARGs, a possible concern for the emergence and dissemination of antimicrobial resistance in cities with poor sanitation.

Bioaerosol sampling optimization for community exposure assessment in cities with poor sanitation: A one health cross-sectional study

Evidence of exposure to enteric pathogens through the air and associated risk of infection is scarce in the literature outside of animal- or human-waste handling settings. Cities with poor sanitation are important locations to investigate this aerial exposure pathway as their rapid growth will pose unprecedented challenges in waste management. To address this issue, simple surveillance methods are needed. Therefore, the objectives of this study were to optimize a community exposure bioaerosol surveillance strategy for urban outdoor locations with poor sanitation, and to determine which bioaerosols could contribute to exposure. Passive and active bioaerosol sampling methods were used to characterize the fate and transport of sanitation-related bioaerosols during the rainy and dry seasons in La Paz, Bolivia. Median coliform bacteria fluxes were 71 CFU/(m2 × h) during the rainy season and 64 CFU/(m2 × h) during the dry season, with 38% of the dry season samples testing positive for E. coli. Wind speed, relative humidity and UVB irradiance were identified as significant covariates to consider in bioaerosol transport models in La Paz. Active sampling yielded one positive sample (10%) for human adenovirus (HadV) and one sample (10%) for influenza A virus during the rainy season. HadV was detected at the site with the highest bacterial flux. Four samples (8%) were positive for influenza A virus in the dry season. These findings suggest that aerosols can contribute to community exposure to potentially pathogenic microorganisms in cities with poor sanitation. The use of passive sampling, despite its limitations, can provide quantitative data on microorganisms' viability within realistic timeframes of personal exposure.

Carnival in Brazil as production of health care: narratives from a samba school community

Introduction

Carnival is a popular festival that was introduced in Brazil from the European heritage. However, it was the enslaved African people who saw forms and processes of resistance for the construction of identity during this festive period. The reframing and resistance that blacks establish with carnival is the result of a cultural need to stay alive both as a subject and as a collective. This is how samba schools emerge in the urban peripheries of Rio de Janeiro as a form of artistic, cultural and leisure production. Associations acquire for themselves the role of the State in providing access to rights that many are denied, neglected or scrapped. In these schools, it is possible to observe a relationship of belonging and donation (”principle of gift”) on the part of their so-called community, they are passions and meanings that produce relationships of self-care reaffirmation of intersubjectivity.

Objective

This work aims to identify the carnival as a space for the production of projects, resistances and protagonisms and to analyze the meanings of the subjective processes of health, disease, care and carnival, through the narratives of a samba school community.

Methodology

This is an exploratory analysis of a qualitative approach in public health. A samba school was chosen from the special group of the capixaba carnival, which is located in a peripheral region. We will use it to define snowball technical sampling. The data will be collected through semi-structured interviews and on-site observations by the researcher. The data analysis methodology used will be discourse analysis.

Expected Results

It is expected to understand the different practices and processes of health, disease, care and carnival, among a peripheral community that is part of a samba school.

Key messages

This work aims to analyze health care about a cultural aspect of marginalized populations and how health policies are related to carnival. Impact on the production of knowledge about popular culture and health.

Care for women in a situation of violence: an institutionalist look

Objective

To know the dynamic processes that involve the production of care for women in situations of violence.

Methods

Study of qualitative approach and cartographic inspiration based on the theoretical reference of Institutionalism that had as scenario a reference center for women in domestic violence located in Espírito Santo, Brazil. Six professionals who worked directly in the care of women participated in the research. Interventions were carried out, through seven workshops, using storytelling. The material production tools were narratives, the researcher's field diary and the collective field diary, which was built from the record and observation of all the participants in the study. The workshops were held at the center according to the availability of participants and lasted an average of 60 minutes. The meetings were recorded and later transcribed together with the notes of the field diaries, seeking, through a cartography, to give meaning to the experiences lived by the participants. Through the analysis of implication, it was possible to give visibility to the various relationships that constitute a certain reality, in which the researcher is involved.

Results

The study pointed out that violence crosses all women influencing the production of care offered by professionals at the reference center. The narratives multiplied senses contributing to the problematization of the care offered, providing the qualification of other ways of thinking/acting in health.

Conclusions

From an ethical-aesthetic-political paradigm it is possible to produce reflections that broaden the view of care for women in violent situations beyond biological issues, contributing with desirable productive processes in the prevention of violence and the promotion of health.

Key messages

It gives visibility to micropolitical processes and contributes to the construction of policies for women's health capable of welcoming differences and singularities. It shows innovation for the field of qualitative health research, broadening the view on the care of women in situations of violence beyond biological issues.

The access to complementary and integrative health practices in public health system in Brazil

Background

A qualitative and exploratory study that analyzed the perspective of access to Integrative and Complementary Practices in Health (PICS) by listening users from a selected service of primary care of a municipality.

Objective

Analyze the access to PICS in a health public service of a municipality in a state of Brazil, from the perspective of users, as well as aimed at understand the needs and desires of health care these users in the search process and use of PICS, identifying facilitators and barriers in this trajectory.

Methods

The theoretical reference from Frenk on access was used, which systematizes the flow of events at the moment when the health need is perceived until the effectiveness of the care, besides the demand and entrance in the health services and the continuity of the treatment. The data collection was done by participant observation and semi-structured interview with 29 users of the service. The narratives were worked through the analysis of thematic content.

Results

The results indicated two groups of PICS: complex medical systems and therapeutic resources. There were differences in the organization of the offer with consequent influence on the different forms of access. It was registered the interest for the use of health care in a non-biomedical logic and a re-signification of the health-disease process in PICS users, contributing to the continuity of health production.

Conclusions

It was concluded that the current models of access analysis do not contemplate the diversities of access to the PICS, and the various possibilities of encounters with these practices allow the identification of the marginality of this care in all cases analyzed.

Key messages

Integrative and Complementary Health Practices gain national relevance as they contribute to the development of health promoting activities, focus on the individual, prevention and comprehensive care. However, considered a controversial topic in a hegemonically biomedical scenario, the incorporation of these new knowledge and practices in the health field occurs in a marginal way.

A MODIFIED MOUSE-TAIL LYMPHEDEMA MODEL

One of the main obstacles to studying the pathophysiology of lymphedema development is the lack of appropriate experimental models. Following up on a mouse-tail method that has been described, we performed changes to the method which made it easier to perform in our hands and demonstrated similar results. Twenty C57Black mice were operated on using the previous technique and euthanized after 3 or 6 weeks. Another twenty mice were submitted to the new technique developed in our laboratory and euthanized at the same time points. Tissue samples were collected from the proximal part of the tail (control) and from the distal part (lymphedema) for both models. Animals in both operative groups developed marked edema in the distal part of the tail. This was characterized by lymph vessels dilation, edema, inflammatory cell infiltration, and adipose tissue deposition. Lymphedema was detected after 3 weeks in both models, reaching its maximum after 6 weeks. Adipocytes detected by histology (Oil red O staining) and molecular markers for adipogenesis, lymphangiogenesis and inflammation (lipin 1 and 2, SLP76, and F4-80) were demonstrated to be increased equally in both models. In conclusion, both models provide a reliable method to study lymphedema pathophysiology. However, our modified technique is easier and faster to perform while still providing reliable and consistent results.

A modified mouse-tail lymphedema model

One of the main obstacles to studying the pathophysiology of lymphedema development is the lack of appropriate experimental models. Fol-lowing up on a mouse-tail method that has been described, we performed changes to the method which made it easier to perform in our hands and demonstrated similar results. Twenty C57Black mice were operated on using the previous tech-nique and euthanized after 3 or 6 weeks. Another twenty mice were submitted to the new technique developed in our laboratory and euthanized at the same time points. Tissue samples were collected from the proximal part of the tail (control) and from the distal part (lymphedema) for both mod-els. Animals in both operative groups developed marked edema in the distal part of the tail. This was characterized by lymph vessels dilation, edema, inflammatory cell infiltration, and adipose tissue deposition. Lymphedema was detected after 3 weeks in both models, reaching its maximum after 6 weeks. Adipocytes detected by histology (Oil red O staining) and molecular markers for adipogenesis, lymphangiogenesis and inflam-mation (lipin 1 and 2, SLP76, and F4-80) were demonstrated to be increased equally in both models. In conclusion, both models provide a reliable method to study lymphedema pathophys-iology. However, our modified technique is easier and faster to perform while still providing reliable and consistent results.

1098 Atrial thickening: a surprisingly "gouty" heart

Case Presentation

A 49 year-old male presented to the emergency department with fever and lower limb myalgia for 5 days. His past history was notable for acute episodes of microcrystalline pyrophosphate oligoarthritis for which he was receiving allopurinol 100mg, colchicine 1mg and prednisolone 5mg. Physical examination was unrevealing. Laboratory workup showed normocytic normochromic anemia (Hb 12.8g/dL), leukocytosis (22 490 /mm3), neutrophilia (86.8%), increased C-reactive protein (CRP

26mg/dL), low procalcitonin (0.82ng/mL) and mildly elevated creatinine-kinase (83 UI/L). The patient was admitted with fever of unknown origin and started on ceftriaxone after blood and urine cultures.

He remained febrile with persistently heightened inflammation. Cultures, infectious and auto-immune tests, bone marrow biopsy, myelogram and abdominopelvic CT scan were negative. Three weeks later, syncope due to complete atrioventricular (AV) block led to temporary pacemaker implantation. Transoesophageal echocardiography (TOE) revealed a left atrial (LA) wall thickening,

evident on MRI as an 8-10mm T2-hyperintensity sign, with right atrial (RA) and ventricular sparing. PET/CT scan showed an 18F FDG uptake exclusively in the LA. As a neoplasia was highly suspected, a transspeptal biopsy was attempted, yet the sample was scarce for analysis. Thus, a biopsy via sternotomy was performed, now sampling both the LA and RA. Indeed, repeated TOE showed de novo RA involvement with a prominent nodular finding (19x24mm) in the lateral wall.

Myocyte inflammation and necrosis accompanied with granulocyte infiltration (mostly neutrophils but also eosinophils) was observed in all samples. There were no findings suggestive of neoplasia. The patient was still on allopurinol, which has been reported to involve the myocardium in a late (type IV) hypersensitivity reaction (the so-called DRESS syndrome), even in the absence of systemic inflammation. Thus, allopurinol was stopped and 1mg/Kg prednisolone was started. The patient

significantly improved and was discharged home with negative CRP the following two weeks. After 1 month, MRI was repeated and no atrial inflammation was found. After 4 months follow-up, he is doing well on 2.5mg of prednisolone and febuxostat 80mg.

Methods to Investigate the Global Atmospheric Microbiome

The interplay between microbes and atmospheric physical and chemical conditions is an open field of research that can only be fully addressed using multidisciplinary approaches. The lack of coordinated efforts to gather data at representative temporal and spatial scales limits aerobiology to help understand large scale patterns of global microbial biodiversity and its causal relationships with the environmental context. This paper presents the sampling strategy and analytical protocols developed in order to integrate different fields of research such as microbiology, -omics biology, atmospheric chemistry, physics and meteorology to characterize atmospheric microbial life. These include control of chemical and microbial contaminations from sampling to analysis and identification of experimental procedures for characterizing airborne microbial biodiversity and its functioning from the atmospheric samples collected at remote sites from low cell density environments. We used high-volume sampling strategy to address both chemical and microbial composition of the atmosphere, because it can help overcome low aerosol and microbial cell concentrations. To account for contaminations, exposed and unexposed control filters were processed along with the samples. We present a method that allows for the extraction of chemical and biological data from the same quartz filters. We tested different sampling times, extraction kits and methods to optimize DNA yield from filters. Based on our results, we recommend supplementary sterilization steps to reduce filter contamination induced by handling and transport. These include manipulation under laminar flow hoods and UV sterilization. In terms of DNA extraction, we recommend a vortex step and a heating step to reduce binding to the quartz fibers of the filters. These steps have led to a 10-fold increase in DNA yield, allowing for downstream omics analysis of air samples. Based on our results, our method can be integrated into pre-existing long-term monitoring field protocols for the atmosphere both in terms of atmospheric chemistry and biology. We recommend using standardized air volumes and to develop standard operating protocols for field users to better control the operational quality.

Antimicrobial assessment of phage therapy using a porcine model of biofilm infection

Antibiotic resistant bacterial communities persist in many types of wounds, chronic wounds in particular, in the form of biofilms. Biofilm formation is a major cause of severe infections and the main reason for a negative treatment outcome and slow healing progression. Chronic wounds are a silent epidemic essentially affecting people with co-morbid conditions such as diabetes and obesity and elderly persons particularly those with movement limitations. The development of complementary and alternative effective strategies to antibiotics for the treatment of chronic wounds is highly desired. Phage therapy constitutes a very promising approach in the control of topical microbial populations. In this work newly isolated phages were tested for their efficacy to control bacterial species that predominate in chronic wounds. Phage effectiveness was studied on 24-h old biofilms formed in polystyrene microplates and in porcine skin explants using two treatment approaches: individual phage and a cocktail of phages against four main pathogens commonly isolated from chronic wounds. The two models produced variations in the surface colonization ability, assessed by viable bacterial counts and microscopy visualization after using peptide nucleic acid (PNA) or locked nucleic acid probes (LNA) and 2'-O-methyl (2'-OMe) in fluorescence in situ hybridization (FISH), and in the phage-host interactions. Phages alone and combined caused greater reductions in the number of viable cells when biofilms had been formed on porcine skins and with greater variations detected at 4 h and 24 h of sampling. These results suggest that porcine skin models should be preferentially used to assess the use of phages and phage cocktails intended for topical use in order to understand the fate, throughout treatment time, of the population when dealing with biofilm-related infections.

Reduction of Breast Cancer Treatment Delay as a Result of Efforts Carried Out by Two Brazilian NGOs

Background: Brazilian breast cancer patients present disease often at advanced stages (III, IV). Previous studies indicated that system delay is a causal factor of bad prognosis and increased mortality rate. In the state of Paraíba, northeast of Brazil, two non-governmental organizations (NGOs) Américas Amigas and Mulheres de Peito de Campina Grande (MLDP), promote faster access to treatment by donating diagnostic mammography and biopsies as well as anatomo-histopathological and immunohistochemical analysis. Aim: The current study aimed at evaluating the effectiveness of the assistance provided by both NGOs and comparing patient flow between HNL and FAP, two reference cancer centers in João Pessoa and Campina Grande, respectively. Methods: Time-to-treatment was analyzed for different time intervals between first medical consultation and initiation of treatment. Comparison was performed between three groups of patients: 40 patients from Hospital Napoleão Laureano (HNL) in João Pessoa; 80 patients from Fundação Assistencial da Paraíba (FAP) in Campina Grande and 15 patients from FAP, who received support from the NGOs. Kaplan-Meier analysis was performed to compare time-intervals among the groups. To estimate the impact of socioeconomic variables Cox regression analysis was performed. Results: Mean time-interval between first medical consultation and hospital admission was 135 (SD=21.0), 370 (SD=73.7) and 515 (SD=36.6) days, for patients of HNL, MLDP and FAP, respectively ( P = 0.0021). Time intervals analyzed for patients within the FAP hospital, between first medical consultation and hospital admission, tended to be shorter for patients who were assisted by the NGOs, compared with those who did not receive any assistance from the NGOs. Patients who had consulted specialized oncological health services beforehand had an increased chance (HZ=2.32; 95% CI: 1.17-4.60; P = 0.016) of being admitted at the reference hospital within 90 days after the first medical consultation, compared with those who had not consulted such specialized services. There were no significant differences between HNL and FAP, regarding the time interval between hospital admission and treatment initiation ( P = 0.21). Conclusion: The assistance to patients provided by the two NGOs, aimed at speeding up the diagnosis process, accelerated patient flow between first medical consultation and admission at the hospitals. Regarding HNL, patients from the inland had been sent by primary health units in their municipalities, directly to the cancer reference hospital in João Pessoa, without being referred to an in-between health service. Such procedure explains the variation of time intervals when admissions at FAP and HNL are compared. The results of the current study indicate that by providing faster breast cancer diagnosis, the NGOs’ mediation can significantly improve patient flow.

EPR and 51V NMR studies of prospective anti-diabetic bis(3-hydroxy-4-pyridinonato)oxidovanadium(iv) complexes in aqueous solution and liposome suspensions

EPR/⁵¹V-NMR parallel studies of [VO(3,4-HPO)₂] complexes in MOPS buffer and POPC liposome suspensions provide information regarding solvents for oral administration.

Impacts of brown carbon from biomass burning on surface UV and ozone photochemistry in the Amazon Basin

The spectral dependence of light absorption by atmospheric particulate matter has major implications for air quality and climate forcing, but remains uncertain especially in tropical areas with extensive biomass burning. In the September-October 2007 biomass-burning season in Santa Cruz, Bolivia, we studied light absorbing (chromophoric) organic or "brown" carbon (BrC) with surface and space-based remote sensing. We found that BrC has negligible absorption at visible wavelengths, but significant absorption and strong spectral dependence at UV wavelengths. Using the ground-based inversion of column effective imaginary refractive index in the range 305-368 nm, we quantified a strong spectral dependence of absorption by BrC in the UV and diminished ultraviolet B (UV-B) radiation reaching the surface. Reduced UV-B means less erythema, plant damage, and slower photolysis rates. We use a photochemical box model to show that relative to black carbon (BC) alone, the combined optical properties of BrC and BC slow the net rate of production of ozone by up to 18% and lead to reduced concentrations of radicals OH, HO2, and RO2 by up to 17%, 15%, and 14%, respectively. The optical properties of BrC aerosol change in subtle ways the generally adverse effects of smoke from biomass burning.

Motherhood – a disturbed beginning: A review of a case series

Introduction

Perinatal mental illness is one of the most frequent complications of pregnancy and the postpartum period. During the puerperium, the risk of developing a mental disease, such as a psychotic episode, is higher than in any other time in a woman's life.

Objectives

The two main objectives are to describe a case series of 4 patients diagnosed with pospartum psychosis, and to synthesize the most important facets of this mental illness based on a literature review.

Aims

The aim is to provide an overview of the clinical and epidemiological aspects of postpartum psychosis.

Methods

The four clinical cases are presented by describing the similar as opposed to the differential aspects between all patients, using the information obtained through successive clinical interviews and the case file. Research was accomplished through Clinical Key and PubMed (2005-2015) using the keywords: postpartum psychosis.

Results

In all four cases, the patients developed symptoms of sleep disturbance, mood fluctuation, altered thinking process with delusions or obsessions, and bizarre behaviours. This occurred within the first four weeks after labour, which was in all cases an obstrutced labour. The data suggests that postpartum psychosis is a presentation of bipolar disorder. Clinical aspects and risk factors related to this perinatal complication all coincide with the cases presented.

Conclusions

Postpartum psychosis is a rare presentation of perinatal mental illness. However, it presents itself, as a psychiatric emergency, and the early and correct assessment are crucial to reset the development of the mother–child bond.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Why Portugal is pushing towards migration?

Background

International professional mobility is a reality, people have skills they can put in the global marketplace. The increasing migration of health professionals to wealthy countries is a phenomenon known as “brain drain”.

Objectives/Aims

This work aims to present the push factors that pressure people to migrate from Portugal.

Methods

A cross-sectional survey was carried out with the psychiatric trainees in Portugal. A self-administered structured questionnaire was distributed to collect psychiatry trainees’ demographic and educational characteristics.

Results

In Portugal, the majority of trainees have a Portuguese citizenship. Almost 2/3 did not have a short-mobility experience, and the majority never migrated to another country. Less than half consider staying in Portugal in the next years, and nearly 4/5 have considered leaving the country. Working conditions ranked first as the priority condition to be improved in psychiatry in Portugal, followed by financial conditions. In fact, an attractive job for psychiatry trainees in Portugal must have as the most important feature a pleasant work environment.

Conclusions

An alarming percentage of psychiatry trainees from Portugal intend to migrate. Impact on future career, financial conditions of doctors, job opportunities and better working conditions were some of the motivating factors behind the migration.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Diagnosis and treatment of primary lymphedema. Consensus document of the International Union of Phlebology (IUP)-2013

Primary lymphedema can be managed effectively as a form of chronic lymphedema by a sequenced and targeted treatment and management program based around a combination of Decongestive Lymphatic Therapy (DLT) with compression therapy, when the latter is desired as an adjunct to DLT. Treatment in the maintenance phase should include compression garments, self-management, including self-massage, meticulous personal hygiene and skin care, in addition to lymphtransport-promoting excercises and activities, and, if desired, pneumatic compression therapy applied in the home. When conservative treatment fails, or gives sub-optimal outcomes, the management of primary lymphedema can be improved, where appropriate, with the proper addition of surgical interventions, either reconstructive or ablative. These two surgical therapies can be more effective when fully integrated with manual lymphatic drainage (MLD)-based DLT postoperatively. Compliance with a long-term commitment to MLD/DLT and particularly compression postoperatively is a critical factor in determining the success of any new treatment strategy involving either reconstructive or palliative surgery. The future of management of primary lymphedema has never been brighter with the new prospect of gene-and perhaps stem-cell oriented management.

Thyroid hormone activates rat liver adenosine 5,-monophosphate-activated protein kinase: relation to CaMKKb, TAK1 and LKB1 expression and energy status

AMP-activated protein kinase (AMPK) is a sensor of energy status supporting cellular energy homeostasis that may represent the metabolic basis for 3,3,,5-triiodo-L-thyronine (T3) liver preconditioning. Functionally transient hyperthyroid state induced by T3 (single dose of 0.1 mg/kg) in fed rats led to upregulation of mRNA expression (RT-PCR) and protein phosphorylation (Western blot) of hepatic AMPK at 8 to 36 h after treatment. AMPK Thr 172 phosphorylation induced by T3 is associated with enhanced mRNA expression of the upstream kinases Ca2+ -calmodulin-dependent protein kinase kinase-beta (CaMKKbeta) and transforming growth-factor-beta-activated kinase-1 (TAK1), with increased protein levels of CaMKKbeta and higher TAK1 phosphorylation, without changes in those of the liver kinase B1 (LKB1) signaling pathway. Liver contents of AMP and ADP were augmented by 291 percent and 44 percent by T3 compared to control values (p less than 0.05), respectively, whereas those of ATP decreased by 64&#x0025; (p less than 0.05), with no significant changes in the total content of adenine nucleotides (AMP + ADP + ATP) at 24 h after T3 administration. Consequently, hepatic ATP/ADP content ratios exhibited 64 percent diminution (p less than 0.05) and those of AMP/ATP increased by 425 percent (p less than 0.05) in T3-treated rats over controls. It is concluded that in vivoT3 administration triggers liver AMPK upregulation in association with significant enhancements in AMPK mRNA expression, AMPK phosphorylation coupled to CaMKKbeta and TAK1 activation, and in AMP/ATP ratios, which may promote enhanced AMPK activity to support T3-induced energy consuming processes such as those of liver preconditioning.