[Diagnosis of neurocysticercosis in patients with epilepsy living in the south-western Dominican Republic]

INTRODUCTION

Neurocysticercosis (NCC), a possible cause of epilepsy with limited epidemiological data in the Dominican Republic, is endemic in four provinces in the country's south-western region. This study aimed to determine the association between NCC and epilepsy among people living in these endemic regions, and to obtain preliminary data on the prevalence of NCC in these provinces.

PATIENTS AND METHODS

A case-control design was used, consisting of 111 patients with epilepsy with unknown causes, and 60 controls without epilepsy or NCC. The diagnosis of NCC was based on computed tomography and magnetic resonance imaging of the skull, as well as Western immunoblotting for serum antibodies using Taenia solium, following the criteria of Del Brutto et al. RESULTS. NCC was found in 27% of the epileptic patients (n = 30/111) and in 5% of the controls (n = 3/60); the probability of the epileptic patients having NCC was seven times higher than the controls (odds ratio = 7.04, 95% confidence interval: 2.04-24.18; p < 0.001). The participants' sociodemographic characteristics, including their age, sex, level of education, occupation, and province of residence presented no statistical significance in terms of their association with NCC.

CONCLUSIONS

This study suggests that NCC is strongly associated with epilepsy in the south-western region of the Dominican Republic, and highlights the need for public health measures to improve the prevention, diagnosis and treatment of both diseases.

Large-Vessel Vasculitis and Q Fever Correlation

Q fever is a zoonotic infection caused by the pathogen Coxiella burnetii, and patients can present with a wide spectrum of clinical manifestations, depending on whether it is an acute or a chronic infection. We present the case of a 61-year-old male with fatigue, posterior thoracalgia, intermittent fever, night sweats and weight loss for a month. After an extensive workup, he was diagnosed with acute Q fever with large-vessel vasculitis. The FDG-PET/CT scan suggested an active vasculitis specifically in the thoracic aorta, proximal abdominal aorta, subclavian and carotid vessels, suggesting an immunologic response to acute Q fever infection, barely reported worldwide.

LEARNING POINTS

Large-vessel vasculitis is a possible immunologic response to acute Q fever infection.There are few data about the management and treatment of patients with Q fever related large-vessel vasculitis.

Physical and physiological soybean seed qualities stored under different environmental conditions and storage bag depths

The Brazilian Midwest is responsible for 54.3% of the country's soybean production. Adequate storage technologies are essential to maintain physical, physiological, and sanitary seed qualities while also minimizing deterioration processes and consequent germination and vigor declines. In this context, the aim of the present study was to evaluate the physiological potential and physical qualities of soybean seeds stored under different environmental conditions and storage bag depths. Assays were carried out in September 2021 employing Foco 74i77 RSF IPRO cultivar seeds stored from April to August 2021 under three conditions, as follows: chilled at an average temperature of ≤20 °C, at an average temperature of ≤25 °C using a with blanket, and in without blanket warehouse structure at an average temperature of ≥25 °C with no with blanket. A completely randomized 3x3 factorial experimental design was applied, comprising three storage environments and three bag positions (top, middle, and bottom), with three replication each. Physical, physiological, and biochemical tests were performed on the stored seeds. The findings indicate better seed preservation in the chilled environment or when using a with blanket, with significant differences noted for seeds stored the middle of the storage bag. Therefore, soybean seed storage in a chilled environment or using a with blanket aids in slowing down the seed deterioration processes, preserving physiological quality and vigor compared to a conventional storage environment. Additionally, the quality of soybean seeds stored under these conditions in the middle of storage bags is maintained.

Snapshot of the Phylogenetic Relationships among Avian Poxviruses Circulating in Portugal between 2017 and 2023

Avipoxvirus (APV), a linear dsDNA virus belonging to the subfamily Chordopoxvirinae of the family Poxviridae, infects more than 278 species of domestic and wild birds. It is responsible for causing avian pox disease, characterized by its cutaneous and diphtheric forms. With a high transmission capacity, it can cause high economic losses and damage to the ecosystem. Several diagnostic methods are available, and bird vaccination can be an effective preventive measure. Ten APV-positive samples were analyzed to update the molecular characterization and phylogenetic analysis of viruses isolated in Portugal between 2017 and 2023. A P4b gene fragment was amplified using a PCR, and the nucleotide sequence of the amplicons was determined using Sanger sequencing. The sequences obtained were aligned using ClustalW, and a maximum likelihood phylogenetic tree was constructed. With this study, it was possible to verify that the analyzed sequences are distributed in subclades A1, A2, B1, and B3. Since some of them are quite similar to others from different countries and obtained in different years, it is possible to conclude that there have been several viral introductions in Portugal. Finally, it was possible to successfully update the data on Avipoxviruses in Portugal.

Genome-Scale Characterization of Mycobacterium abscessus Complex Isolates from Portugal

The Mycobacterium abscessus complex (MABC) is an emerging, difficult to treat, multidrug-resistant nontuberculous mycobacteria responsible for a wide spectrum of infections and associated with an increasing number of cases worldwide. Dominant circulating clones (DCCs) of MABC have been genetically identified as groups of strains associated with higher prevalence, higher levels of antimicrobial resistance, and worse clinical outcomes. To date, little is known about the genomic characteristics of MABC species circulating in Portugal. Here, we examined the genetic diversity and antimicrobial resistance profiles of 30 MABC strains isolated between 2014 and 2022 in Portugal. The genetic diversity of circulating MABC strains was assessed through a gene-by-gene approach (wgMLST), allowing their subspecies differentiation and the classification of isolates into DCCs. Antimicrobial resistance profiles were defined using phenotypic, molecular, and genomic approaches. The majority of isolates were resistant to at least two antimicrobials, although a poor correlation between phenotype and genotype data was observed. Portuguese genomes were highly diverse, and data suggest the existence of MABC lineages with potential international circulation or cross-border transmission. This study highlights the genetic diversity and antimicrobial resistance profile of circulating MABC isolates in Portugal while representing the first step towards the implementation of a genomic-based surveillance system for MABC at the Portuguese NIH.

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.

Impacts of aqueous extracts of wildfire ashes on aquatic life-stages of Xenopus laevis: Influence of plant coverage

Wildfires have emerged as a global ecological concern due to their wide-ranging off-site effects. One particular consequence is the adverse impact on aquatic environments, as wildfires are acknowledged as a significant source of aquatic contamination through ash runoffs containing toxic compounds. Yet, amphibian response to this source of contamination remains largely undocumented. This study assessed how ash runoffs from Eucalyptus sp. and Pinus sp. affect early aquatic life-stages of Xenopus laevis. Embryos and tadpoles were exposed, respectively, for 96 h and 14 days to serial concentrations (26.9% - 100%) of aqueous extracts of ashes (AEAs; 10 gL-1) composed of eucalypt (ELS) and pine (PLS) ashes. Mortality and development were monitored, and biometric data (snout-to-vent, tail and total length, and weight) measured. Sub-individual endpoints regarding oxidative stress (catalase-CAT; total glutathione-TG; lipid peroxidation-TBARS), neurotoxicity (acetylcholinesterase-AChE), transformation metabolism (glutathione-S-transferase-GST) and energetic metabolism (carbohydrate, lipid and protein content and O2 consumption), were also measured. The two AEAs induced no significant lethal effects on embryos or tadpoles. However, in general, AEAs caused a developmental delay in both life stages. Effects of AEAs on biometric endpoint were only reported for tadpoles, which showed a decreased body length (snout-to-vent, tail and total) and weight (embryos were not weighed), with PLS exerting higher effect than ELS. As for the sub-individual endpoints, embryos showed mostly no alterations on the activity of the monitored parameters, except for PLS, which reduced embryos' carbohydrate content (at ≥59.2%) and increased O2 consumption (at ≥35.0%). Regarding tadpoles, AEA exposure decreased the activity of CAT and GST (at ≥26.0%) and decreased carbohydrate (at ≥26.0%) and lipid (at ≥45.5%), whereas oxygen consumption increased (at ≥26.0%) only on PLS. Overall, the tested AEAs differentially affected amphibians across life-stages, indicating that plant coverage might affect ash toxicity.

Nanostructured Electrospun Fibers with Self-Assembled Cyclo-L-Tryptophan-L-Tyrosine Dipeptide as Piezoelectric Materials and Optical Second Harmonic Generators

The potential use of nanostructured dipeptide self-assemblies in materials science for energy harvesting devices is a highly sought-after area of research. Specifically, aromatic cyclo-dipeptides containing tryptophan have garnered attention due to their wide-bandgap semiconductor properties, high mechanical rigidity, photoluminescence, and nonlinear optical behavior. In this study, we present the development of a hybrid system comprising biopolymer electrospun fibers incorporated with the chiral cyclo-dipeptide L-Tryptophan-L-Tyrosine. The resulting nanofibers are wide-bandgap semiconductors (bandgap energy 4.0 eV) consisting of self-assembled nanotubes embedded within a polymer matrix, exhibiting intense blue photoluminescence. Moreover, the cyclo-dipeptide L-Tryptophan-L-Tyrosine incorporated into polycaprolactone nanofibers displays a strong effective second harmonic generation signal of 0.36 pm/V and shows notable piezoelectric properties with a high effective coefficient of 22 pCN-1, a piezoelectric voltage coefficient of geff=1.2 VmN-1 and a peak power density delivered by the nanofiber mat of 0.16μWcm-2. These hybrid systems hold great promise for applications in the field of nanoenergy harvesting and nanophotonics.

Prevalence Rate of Thalassemia Carriers among Individuals with Microcytosis or Hypochromia in Portugal

INTRODUCTION

Microcytosis and hypochromia result from deficient hemoglobin synthesis in red blood cells and are easily detected in a complete blood count test. These conditions are mainly due to iron nutritional deficiency, but may also result from some genetic diseases, such as thalassemia. The aim of this study was to determine the contribution of β- and α-thalassemia to these abnormal hematological phenotypes in a representative sample of adult individuals living in Portugal who participated in the first Portuguese National Health Examination Survey (INSEF).

MATERIAL AND METHODS

Among the 4808 INSEF participants, 204 had microcytosis, hypochromia or both. The corresponding 204 DNAs were screened for changes in the β-globin gene by next-generation sequencing and Sanger sequencing. In addition, α-thalassemia deletions within the α-globin cluster were investigated by Gap-PCR and multiplex ligation-dependent probe amplification.

RESULTS

In this selected subgroup of INSEF participants, 54 had α-thalassemia (26%), predominantly caused by the -α3.7kb deletion, and 22 were β-thalassemia carriers (11%) mainly due to point mutations in the β-globin gene previously known in Portugal.

CONCLUSION

Thalassemia trait is a frequent cause of microcytosis or hypochromia in Portugal since this genetic condition was found in 37% of the investigated cases.

Development of an amplicon-based sequencing approach in response to the global emergence of mpox

The 2022 multicountry mpox outbreak concurrent with the ongoing Coronavirus Disease 2019 (COVID-19) pandemic further highlighted the need for genomic surveillance and rapid pathogen whole-genome sequencing. While metagenomic sequencing approaches have been used to sequence many of the early mpox infections, these methods are resource intensive and require samples with high viral DNA concentrations. Given the atypical clinical presentation of cases associated with the outbreak and uncertainty regarding viral load across both the course of infection and anatomical body sites, there was an urgent need for a more sensitive and broadly applicable sequencing approach. Highly multiplexed amplicon-based sequencing (PrimalSeq) was initially developed for sequencing of Zika virus, and later adapted as the main sequencing approach for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Here, we used PrimalScheme to develop a primer scheme for human monkeypox virus that can be used with many sequencing and bioinformatics pipelines implemented in public health laboratories during the COVID-19 pandemic. We sequenced clinical specimens that tested presumptively positive for human monkeypox virus with amplicon-based and metagenomic sequencing approaches. We found notably higher genome coverage across the virus genome, with minimal amplicon drop-outs, in using the amplicon-based sequencing approach, particularly in higher PCR cycle threshold (Ct) (lower DNA titer) samples. Further testing demonstrated that Ct value correlated with the number of sequencing reads and influenced the percent genome coverage. To maximize genome coverage when resources are limited, we recommend selecting samples with a PCR Ct below 31 Ct and generating 1 million sequencing reads per sample. To support national and international public health genomic surveillance efforts, we sent out primer pool aliquots to 10 laboratories across the United States, United Kingdom, Brazil, and Portugal. These public health laboratories successfully implemented the human monkeypox virus primer scheme in various amplicon sequencing workflows and with different sample types across a range of Ct values. Thus, we show that amplicon-based sequencing can provide a rapidly deployable, cost-effective, and flexible approach to pathogen whole-genome sequencing in response to newly emerging pathogens. Importantly, through the implementation of our primer scheme into existing SARS-CoV-2 workflows and across a range of sample types and sequencing platforms, we further demonstrate the potential of this approach for rapid outbreak response.

Bioinspired Cyclic Dipeptide Functionalized Nanofibers for Thermal Sensing and Energy Harvesting

Nanostructured dipeptide self-assemblies exhibiting quantum confinement are of great interest due to their potential applications in the field of materials science as optoelectronic materials for energy harvesting devices. Cyclic dipeptides are an emerging outstanding group of ring-shaped dipeptides, which, because of multiple interactions, self-assemble in supramolecular structures with different morphologies showing quantum confinement and photoluminescence. Chiral cyclic dipeptides may also display piezoelectricity and pyroelectricity properties with potential applications in new sources of nano energy. Among those, aromatic cyclo-dipeptides containing the amino acid tryptophan are wide-band gap semiconductors displaying the high mechanical rigidity, photoluminescence and piezoelectric properties to be used in power generation. In this work, we report the fabrication of hybrid systems based on chiral cyclo-dipeptide L-Tryptophan-L-Tryptophan incorporated into biopolymer electrospun fibers. The micro/nanofibers contain self-assembled nano-spheres embedded into the polymer matrix, are wide-band gap semiconductors with 4.0 eV band gap energy, and display blue photoluminescence as well as relevant piezoelectric and pyroelectric properties with coefficients as high as 57 CN-1 and 35×10-6 Cm-2K-1, respectively. Therefore, the fabricated hybrid mats are promising systems for future thermal sensing and energy harvesting applications.

Comparative Effectiveness of COVID-19 Vaccines in Preventing Infections and Disease Progression from SARS-CoV-2 Omicron BA.5 and BA.2, Portugal

We estimated comparative primary and booster vaccine effectiveness (VE) of SARS-CoV-2 Omicron BA.5 and BA.2 lineages against infection and disease progression. During April-June 2022, we implemented a case-case and cohort study and classified lineages using whole-genome sequencing or spike gene target failure. For the case-case study, we estimated the adjusted odds ratios (aORs) of vaccination using a logistic regression. For the cohort study, we estimated VE against disease progression using a penalized logistic regression. We observed no reduced VE for primary (aOR 1.07 [95% CI 0.93-1.23]) or booster (aOR 0.96 [95% CI 0.84-1.09]) vaccination against BA.5 infection. Among BA.5 case-patients, booster VE against progression to hospitalization was lower than that among BA.2 case-patients (VE 77% [95% CI 49%-90%] vs. VE 93% [95% CI 86%-97%]). Although booster vaccination is less effective against BA.5 than against BA.2, it offers substantial protection against progression from BA.5 infection to severe disease.

Development of an amplicon-based sequencing approach in response to the global emergence of human monkeypox virus

The 2022 multi-country monkeypox (mpox) outbreak concurrent with the ongoing COVID-19 pandemic has further highlighted the need for genomic surveillance and rapid pathogen whole genome sequencing. While metagenomic sequencing approaches have been used to sequence many of the early mpox infections, these methods are resource intensive and require samples with high viral DNA concentrations. Given the atypical clinical presentation of cases associated with the outbreak and uncertainty regarding viral load across both the course of infection and anatomical body sites, there was an urgent need for a more sensitive and broadly applicable sequencing approach. Highly multiplexed amplicon-based sequencing (PrimalSeq) was initially developed for sequencing of Zika virus, and later adapted as the main sequencing approach for SARS-CoV-2. Here, we used PrimalScheme to develop a primer scheme for human monkeypox virus that can be used with many sequencing and bioinformatics pipelines implemented in public health laboratories during the COVID-19 pandemic. We sequenced clinical samples that tested presumptive positive for human monkeypox virus with amplicon-based and metagenomic sequencing approaches. We found notably higher genome coverage across the virus genome, with minimal amplicon drop-outs, in using the amplicon-based sequencing approach, particularly in higher PCR cycle threshold (lower DNA titer) samples. Further testing demonstrated that Ct value correlated with the number of sequencing reads and influenced the percent genome coverage. To maximize genome coverage when resources are limited, we recommend selecting samples with a PCR cycle threshold below 31 Ct and generating 1 million sequencing reads per sample. To support national and international public health genomic surveillance efforts, we sent out primer pool aliquots to 10 laboratories across the United States, United Kingdom, Brazil, and Portugal. These public health laboratories successfully implemented the human monkeypox virus primer scheme in various amplicon sequencing workflows and with different sample types across a range of Ct values. Thus, we show that amplicon based sequencing can provide a rapidly deployable, cost-effective, and flexible approach to pathogen whole genome sequencing in response to newly emerging pathogens. Importantly, through the implementation of our primer scheme into existing SARS-CoV-2 workflows and across a range of sample types and sequencing platforms, we further demonstrate the potential of this approach for rapid outbreak response.

Increased footwear comfort is associated with improved running economy - a systematic review and meta-analysis

Footwear with or without custom foot orthotics have the potential to improve comfort, but the link with running performance needs further investigation. We systematically reviewed the association of footwear comfort on running economy in recreational runners. Nine electronic databases were searched from inception to March 2020. Eligible studies investigated both direct outcome measures of running performance (e.g. running speed) and/or physiological measures (e.g. running economy (RE)) alongside comfort for each footwear condition tested. Methodological quality was assessed using the "Effective Public Health Practice Project" (EPHPP). RE during submaximal running was the most common physiological outcome reported in 4 of the 6 eligible studies. The absolute difference in RE between the most and least comfortable footwear condition was computed, and meta-analysis was conducted using a random effect model. The most comfortable footwear is associated with a reduction in oxygen consumption (MD: -2.06 mL.kg^-1.min^-1, 95%CI: -3.71, -0.42, P = 0.01) while running at a set submaximal speed. There was no significant heterogeneity (I² = 0%, P = 0.82). EPHPP quality assessment demonstrated weak quality of the studies, due to reporting bias and failing to disclose the psychometric properties of the outcome measures. It can be concluded with moderate certainty that improved RE in recreational athletes is associated with wearing more comfortable footwear compared to less comfortable footwear.HighlightsThis systematic review reports on the association of footwear comfort with running economy in recreational runners.Running economy during constant submaximal running is likely improved in recreational runners wearing more comfortable compared to less comfortable footwear.This finding is based on a meta-analysis, including four studies, showing a small but statistically significant decreased oxygen consumption at steady state speeds while wearing the most comfortable footwear.

Modeling aortic stenosis progression: impact on follow-up, treatment and survival

Background

Aortic stenosis (AS) is one of the main valvular heart diseases in developed countries. Degenerative fibrocalcific aortic stenosis is a progressive disease of the valve and ultimately of the myocardium, which can be fatal when symptomatic. There is no medical treatment that can halt or delay its progression. AS does not evolve linearly over time, and not every patient has the same progression rate.

Aims

The aim of this study is to 1) compare different mathematical models of aortic stenosis progression, 2) cluster patients into rapid and slow progressors and explore possible predictors, 4) evaluate the impact of different progression rates on cardiac structure and function, and 5) evaluate survival and optimal timing for follow-up and treatment.

Methods

We retrospectively studied consecutive patients with aortic peak velocities from 2012 to 2020. Follow-up echocardiograms, seriated biomarker assessment, and clinical records were consulted, providing a multiparametric data frame for longitudinal and dynamic modeling of aortic stenosis progression and its consequences.

Results

This study included 9583 studies from 752 patients with a median total follow-up of 4.26 years (interquartile range: 1.28 to 7.24 years). A logistic model was selected with the best accuracy to predict the rate of AS progression. Patients were categorized into slow and rapid progressors in a ratio of 5:1. Multiparametric analysis showed no association between these profiles and clinical variables. However, anti-hypertensive drugs before and after adjustment for blood pressure control (Calcium Channel Blockers, p=0.013, OR 0.50) were associated with slower progression. Meanwhile, elevated inflammatory markers (erythrocyte sedimentation rate, p=0.01) were associated with faster AS progression. Despite no survival difference between these groups, higher rates of valvular intervention were registered in rapid progressors (p&lt;0.001). Moreover, faster progressors were associated with earlier cardiac damage (as demonstrated by early onset of moderate mitral and tricuspid valve regurgitation, left auricle dilation, and left ventricle hypertrophy, p&lt;0.05).

Conclusions

These results can potentially modify follow-up times and deliver more personalized and individualized health care to different AS patients, thereby optimizing resources.

Funding Acknowledgement

Type of funding sources: None.

Phylogenomic characterization and signs of microevolution in the 2022 multi-country outbreak of monkeypox virus

The largest monkeypox virus (MPXV) outbreak described so far in non-endemic countries was identified in May 2022 (refs. 1-6). In this study, shotgun metagenomics allowed the rapid reconstruction and phylogenomic characterization of the first MPXV outbreak genome sequences, showing that this MPXV belongs to clade 3 and that the outbreak most likely has a single origin. Although 2022 MPXV (lineage B.1) clustered with 2018-2019 cases linked to an endemic country, it segregates in a divergent phylogenetic branch, likely reflecting continuous accelerated evolution. An in-depth mutational analysis suggests the action of host APOBEC3 in viral evolution as well as signs of potential MPXV human adaptation in ongoing microevolution. Our findings also indicate that genome sequencing may provide resolution to track the spread and transmission of this presumably slow-evolving double-stranded DNA virus.

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.

OP0207-HPR EFFECT OF FOOT ORTHOSES IN REDUCING PAIN IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS: A 12-MONTH RANDOMISED CLINICAL TRIAL

Background

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and adolescents [1]. The manifestation of JIA may include joint swelling, tenderness, and painful limitation with joint movement. Only few studies have explored the effect of foot orthoses (FOs) alone in children with JIA [2,3]. These studies showed FOs can reduce pain in children with JIA, however, further research with larger sample sizes and longer follow-ups are needed [4]. Prescribing FOs on the same day of the initial assessment may promote early clinical and targeted intervention, which is the gold standard approach in paediatric rheumatology.

Objectives

This single blinded multicentre randomised clinical trial (RCT) aims to investigate the effect of customised prefabricated FOs in reducing pain amongst children and adolescents with JIA.

Methods

Overall, 66 children and adolescents with JIA presenting with foot symptoms were recruited from the Sydney Children’s Hospitals Network (Westmead and Randwick) and John Hunter Children’s Hospital (Newcastle). The primary outcome measure was pain with a minimal clinical significance of 8mm on the visual analogue scale (VAS). Participants were randomly allocated to receive either customised prefabricated or sham FOs. The trial intervention was a low-density Slimflex Simple device that was customised at chair-side. The control (sham) device was made of 2mm flat leather board with no corrective modifications. Standardised tests such as the Foot Posture Index, navicular drift and drop were used to identify biomechanical abnormalities. The FOs were worn for a total of 12 months, with data collected at baseline, 4 weeks, 3, 6 months and 12 months.

Results

Reduction in self-reported pain was statistically and clinically significant at 4-weeks (p=0.018, -14.92 [-27.30, -2.55]) and 3 months (p=<0.001, -28.93 [-40.90, -16.96]) post intervention in favour of the trial group. The 6- and 12-month follow-ups were not statistically or clinically significant. Parent reported pain was statistically and clinically significant at the 3-month (p=<0.001, -21.92 [-33.16, -10.67]) in the reduction of pain in favour of the trial group. However, parent reported pain was not statistically significant at the 4-week, 6- and 12- month follow-ups. These results are similar to child reported pain with a p-value of less than 0.001 and average coefficients twice that of the clinical significance cut-off for VAS pain in paediatric rheumatology. The trial intervention was safe and tolerated well by participants with high compliance and adherence rates.

Conclusion

Results of this clinical trial indicate customised preformed FOs can be effective in reducing pain and in children with JIA experiencing foot and ankle symptoms. Significant clinical effects appear to be within the first 3-months of intervention prescription and reduce beyond 6 months. Overall, this podiatric intervention was safe, inexpensive, well tolerated and it can be easily implemented as part of the multidisciplinary paediatric rheumatology care.

References

[1]Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369:767–78.

[2]Powell M, Seid M, Szer IS. Efficacy of custom foot orthotics in improving pain and functional status in children with juvenile idiopathic arthritis: a randomized trial. J Rheumatol 2005;32:943–50.

[3]Coda A, Fowlie PW, Davidson JE et al. Foot orthoses in children with juvenile idiopathic arthritis: a randomised controlled trial. Arch Dis Child 2014;99:649–51.

[4]Fellas A, Coda A, Hawke F. Physical and mechanical therapies for lower-limb problems in juvenile idiopathic arthritis: a systematic review with meta-analysis. Journal of the American Podiatric Medical Association. 2017 Sep;107(5):399-412.

Acknowledgements

We would like to acknowledge all parents and children for their precious time.

Disclosure of Interests

None declared

Copper impair autophagy on zebrafish (Danio rerio) gill epithelium

Copper (Cu) is an essential element for organism's metabolism, being controversially listed as a priority pollutant. Importantly, the toxicity of Cu has been linked to several cell death pathways. Thus, this study aimed to assess if macroautophagic pathways are triggered by Cu in zebrafish gill, the main target of waterborne pollutants. The electron microscopy findings indicated that Cu induced profound impacts on zebrafish gill structure and functions, being this tissue a biomarker sensitive enough to indicate early toxic effects. The findings also support a clear impairment of autophagy, througth the absence of phagossomes and the significant down-regulation mRNA transcript levels of microtubule-associated protein light chain 3 (LC3). The reduction of LC3 levels was often associated to an increase of apoptotic activation, indicating that the inhibition of macroautophagy triggers apoptosis in zebrafish gills. This study highlighted that the autophagic down-regulation might be affected through the activation of other cell death signaling pathway.

Effect of Low-Input Organic and Conventional Farming Systems on Maize Rhizosphere in Two Portuguese Open-Pollinated Varieties (OPV), "Pigarro" (Improved Landrace) and "SinPre" (a Composite Cross Population)

Maize is one of the most important crops worldwide and is the number one arable crop in Portugal. A transition from the conventional farming system to organic agriculture requires optimization of cultivars and management, the interaction of plant-soil rhizosphere microbiota being pivotal. The objectives of this study were to unravel the effect of population genotype and farming system on microbial communities in the rhizosphere of maize. Rhizosphere soil samples of two open-pollinated maize populations ("SinPre" and "Pigarro") cultivated under conventional and organic farming systems were taken during flowering and analyzed by next-generation sequencing (NGS). Phenological data were collected from the replicated field trial. A total of 266 fungi and 317 bacteria genera were identified in "SinPre" and "Pigarro" populations, of which 186 (69.9%) and 277 (87.4%) were shared among them. The microbiota of "Pigarro" showed a significant higher (P < 0.05) average abundance than the microbiota of "SinPre." The farming system had a statistically significant impact (P < 0.05) on the soil rhizosphere microbiota, and several fungal and bacterial taxa were found to be farming system-specific. The rhizosphere microbiota diversity in the organic farming system was higher than that in the conventional system for both varieties. The presence of arbuscular mycorrhizae (Glomeromycota) was mainly detected in the microbiota of the "SinPre" population under the organic farming systems and very rare under conventional systems. A detailed metagenome function prediction was performed. At the fungal level, pathotroph-saprotroph and pathotroph-symbiotroph lifestyles were modified by the farming system. For bacterial microbiota, the main functions altered by the farming system were membrane transport, transcription, translation, cell motility, and signal transduction. This study allowed identifying groups of microorganisms known for their role as plant growth-promoting rhizobacteria (PGPR) and with the capacity to improve crop tolerance for stress conditions, allowing to minimize the use of synthetic fertilizers and pesticides. Arbuscular mycorrhizae (phyla Glomeromycota) were among the most important functional groups in the fungal microbiota and Achromobacter, Burkholderia, Erwinia, Lysinibacillus, Paenibacillus, Pseudomonas, and Stenotrophomonas in the bacterial microbiota. In this perspective, the potential role of these microorganisms will be explored in future research.

Street Medical Consultation: health access of the Homeless People and intersectoral articulation

Background

The Homeless People is marked by serious social vulnerability, related to the absence of human dignity. Requirements of personal and residential documents, reception and inadequate approaches are barriers to access these people. The creation of Street Medical Consultation (CnaR), based on the logic of harm reduction in association with the other services, is a strategy that seeks to expand access to the services of the Public Healthcare System (SUS) in Brazil. The research aimed to analyze the characteristics and vulnerabilities of this population, the performance of CnaR and its articulation with services from the health care and the social assistance care network.

Methods

Study of a qualitative approach using 8 semi-structured interviews and the Thematic Content Analysis method. The study scenario was the CnaR multiprofissional team in a city in the interior of São Paulo.

Results

Three categories were found: (1) Population in Street Situation - complexity of those who live on the street: prejudices, violence and barriers in society and health institutions constitute a process of invisibility. (2) CnaR's work in the perspective of harm reduction: it is organized to meet the clinical and alcohol and other drugs demands through fixed fields, mobile fields and team meeting. (3) Beyond CnaR - network relationships: bringing dynamics to relationships, being strengthened or weakened. Ignorance of the service and their performance also generates CnaR invisibility process. The strategies developed include coping, dialogue, building partnerships and the process of visibility and fighting for the rights of the Homeless Persons.

Conclusions

CnaR finds itself as an insufficient service to meet all the demands of this vulnerable population in isolation, needing the network to expand access to health and other goods. It is necessary to combat prejudice against this population among health professionals and develop more efficient intersectoral articulation.

Key messages

The Homeless People have serious vulnerability and need humanization, guaranteeing equity in assistance in all sectors of society, especially the health care and the social assistance. The Street Medical Consultation faces performance difficulties to guarantee access to the Homeless People within the intersectoral network, often being the sole responsible for this population.

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.

Relationship of salt added during preparation and salt intake of cooks

Introduction The excessive consumption of sodium is one of the main problems in public health and responsible for the loss of years of a healthy life. The salt added to the meals represents a large part of the salt ingested, and the collaborators/cooks responsible for its addition need careful analysis, and intervention adjusted to the analysed reality, its salt consumption and its perception of saltiness may influence the amount of salt added.

Objectives This study had as main objective to perceive the relationship between the perception of salt of the employees of the Food and Nutrition Unit and the amount of salt added in the meals that were confectioned.

Methodology An observational, analytical, cross-sectional study was conducted, in which 6 selected cooks from the IPSS’s of Águeda participated. In order to estimate the amount of salt added to the meals, 20 samples of meals prepared by the cooks were taken, and a quantitative assessment of average salt per meal was made using Flame Photometry. The cooks were also subjected to two taste sensitivity tests. The data treatment was performed using the statistical software SPSS, and a statistical significance level of 5% was considered.

Results A better perception of the salty taste was observed in the cooks of Institution B. Although there were no differences with statistical significance in the quantity of salt of the meals between the two institutions, the mean and maximum addition of salt in the cooked meals was higher in institution B, regardless of the cook evaluated.

Conclusion The perception of the salty taste of the cooks does not seem to determine the amount of salt added to the meals.

Experimental and DFT studies on the ultrasonic energy-assisted extraction of the phytochemicals of Catharanthus roseus as green corrosion inhibitors for mild steel in NaCl medium

Catharanthus roseus (Apocynaceae family) extract is rich in organic phytochemicals such as alkaloids, polyphenolic compounds, and flavonoids. It contains several functional entities such as fused heterocycles, and hydroxyl and carbonyl groups, which could be useful for corrosion inhibition of mild steel in NaCl environments. In the present work, ultrasonic energy was used to obtain the ethanolic extracts of root and stem which were then tested as corrosion inhibitors for mild steel in the presence of 3.5% NaCl. The corrosion inhibition process was studied by UV-visible spectroscopy, Fourier transform infrared spectroscopy, atomic force microscopy, weight loss, and electrochemical methods. After immersing in the corrosive medium, the microstructures of mild steel were investigated by scanning electron microscopy, X-ray diffraction, and ellipsometry. The extract of C. roseus showed excellent adsorption on mild steel surface as confirmed by DFT calculations. The results indicate that the extract of C. roseus acts as a mixed type corrosion inhibitor, where the stem extract is the most efficient inhibitor in 3.5% NaCl solution possibly due to the higher active area of stem phytochemicals.

C. roseus phytochemicals are physisorbed on the 111 Fe surface, and the oxygen non-bonding electron chemisorbed on the polarized state 111 Fe surface.

Influence of Pseudowollastonite on the Performance of Low Calcium Amorphous Hydraulic Binders

A systematic investigation of the influence of pseudowollastonite on the performance of a new family of low calcium hydraulic binders is described. Samples of the new low calcium binder were produced by an innovative process consisting of heating and homogenizing the mix of raw materials (limestone, sand, and fuel cracking catalyst) at a constant temperature followed by the rapid cooling of the mixture itself. Different maximum temperatures, close to the melting temperature of the mix, were tested, and materials with CaO/SiO₂ (C/S) ratios of 0.9, 1.1, and 1.25 were produced into the form of the amorphous phase with small percentages of pseudowollastonite. Compressive strength results were determined at 7, 28, and 90 days of hydration, and the hydrated phases were analyzed using isothermal calorimetry, X-ray diffraction (XRD) analysis, thermogravimetry analysis (TGA), scanning electron microscopy (SEM), and differential scanning calorimetry (DSC). The present work is focused on the influence of the percentage of the pseudowollastonite phase on the binder compressive strength performance.

Acetylation as a major determinant to microtubule-dependent autophagy: Relevance to Alzheimer's and Parkinson disease pathology

Protein post-translational modifications (PTMs) that potentiate protein aggregation have been implicated in several neurological disorders, including Alzheimer's (AD) and Parkinson's disease (PD). In fact, Tau and alpha-synuclein (ASYN) undergo several PTMs potentiating their aggregation and neurotoxicity. Recent data posits a role for acetylation in Tau and ASYN aggregation. Herein we aimed to clarify the role of Sirtuin-2 (SIRT2) and HDAC6 tubulin deacetylases as well as p300 acetyltransferase in AD and PD neurodegeneration. We used transmitochondrial cybrids that recapitulate pathogenic alterations observed in sporadic PD and AD patient brains and ASYN and Tau cellular models. We confirmed that Tau protein and ASYN are microtubules (MTs)-associated proteins (MAPs). Moreover, our results suggest that α-tubulin acetylation induced by SIRT2 inhibition is functionally associated with the improvement of MT dynamic determined by decreased Tau phosphorylation and by increased Tau/tubulin and ASYN/tubulin binding. Our data provide a strong evidence for a functional role of tubulin and MAPs acetylation on autophagic vesicular traffic and cargo clearance. Additionally, we showed that an accumulation of ASYN oligomers imbalance mitochondrial dynamics, which further compromise autophagy. We also demonstrated that an increase in Tau acetylation is associated with Tau phosphorylation. We found that p300, HDAC6 and SIRT2 influences Tau phosphorylation and autophagic flux in AD. In addition, we demonstrated that p300 and HDAC6 modulate Tau and Tubulin acetylation. Overall, our data disclose the role of Tau and ASYN modifications through acetylation in AD and PD pathology, respectively. Moreover, this study indicates that MTs can be a promising therapeutic target in the field of neurodegenerative disorders in which intracellular transport is altered.

Fascicular nerve stimulation and recording using a novel double-aisle regenerative electrode

OBJECTIVE

As artificial prostheses become more refined, they are most often used as a therapeutic option for hand amputation. By contrast to extra- or intraneural interfaces, regenerative nerve electrodes are designed to enable electrical interfaces with regrowing axonal bundles of injured nerves, aiming to achieve high selectivity for recording and stimulation. However, most of the developed designs pose an obstacle to the regrowth mechanisms due to low transparency and cause impairment to the nerve regeneration.

APPROACH

Here we present the double-aisle electrode, a new type of highly transparent, non-obstructive regenerative electrode. Using a double-side thin-film polyimide planar multi-contact electrode, two nerve fascicles can regenerate without physical impairment through two electrically isolated aisles.

MAIN RESULTS

We show that this electrode can be used to selectively record and stimulate fascicles, acutely as well as chronically, and allow regeneration in nerve gaps of several millimeters without impairment.

SIGNIFICANCE

This multi-aisle regenerative electrode may be suitable for neuroprosthetic applications, such as prostheses, for the restoration of hand function after amputation or severe nerve injuries.

Resemblance in physical activity levels: The Portuguese sibling study on growth, fitness, lifestyle, and health

OBJECTIVES

To investigate the relationships of biological, behavioral, familial, and environmental characteristics with siblings´ physical activity (PA) levels as well as the intrapair resemblance in PA.

METHODS

The sample comprises 834 (390 females) biological siblings [brother-brother (BB), sister-sister (SS), brother-sister (BS)] aged 9 to 20 years. Total PA index (TPAI) was estimated by questionnaire. Information on potential behavioral, familial, and environmental correlates was obtained by self-report; body mass index (BMI), biological maturation, and physical fitness were measured. Multilevel models were used to analyze siblings´ clustered data, and sibling resemblance was estimated with the intraclass correlation (ρ).

RESULTS

On average, younger sibs, those more physically fit, and those with more parental support had greater TPAI. Further, BB pairs had higher TPAI levels than SS or BS pairs, but also had greater within-pair variance. When adjusted for all covariates, SS pairs demonstrated greater resemblance in TPAI (ρ = 0.53, 95%CI = 0.38-0.68) than BS (ρ = 0.26, 95%CI = 0.14-0.43) or BB pairs (ρ = 0.18, 95%CI = 0.06-0.44).

CONCLUSIONS

Age, physical fitness, and parental support were the best predictors of TPAI levels. A moderate level of resemblance in TPAI was observed in SS pairs, while lower resemblance was found for BS and BB pairs. These findings may be due to differences in the roles of shared genetic factors, familial, and environmental characteristics across different sibling types.

Correlates of children's compliance with moderate-to-vigorous physical activity recommendations: a multilevel analysis

This study aimed to investigate the association between individual and school characteristics associated with the number of school days children comply with moderate-to-vigorous physical activity (MVPA) recommendations. Sample comprises 612 Portuguese children, aged 9-11 years, from 23 schools. Time spent in MVPA was measured by accelerometry, while individual-level correlates were obtained by anthropometry and questionnaires. School-level variables were collected by questionnaire, and accelerometer wear time and season were also considered. Maximum likelihood estimates of model parameters were obtained via a multilevel analysis with children as level-1, and school as level-2. Children who spent more time in sedentary activities and girls were less likely to comply with MVPA/daily. More mature children and those who use active transportation to school were more likely to attain the PA recommendation. Furthermore, greater accelerometer wear time and spring season increased the chance to achieve the recommended MVPA. In terms of school-level correlates, a greater number of available facilities was negatively associated with children MVPA compliance. Given the set of variables, our results showed that individual characteristics seem to be more relevant for children's compliance rates with PA/day than school context variables, which should be taken into account in the implementation of school policies and practices.

Electrochemical oxidation of humic acid and sanitary landfill leachate: Influence of anode material, chloride concentration and current density

The influence of applied current density and chloride ion concentration on the ability of Ti/Pt/PbO2 and Ti/Pt/SnO2-Sb2O4 anodes for the electrochemical oxidation of humic acid and sanitary landfill leachate samples was assessed and compared with that of BDD anode. For the experimental conditions used, results show that both organic load and nitrogen removal rates increase with the applied current density and chloride ion concentration, although there is an optimum COD/[Cl-]0 ratio below which there is no further increase in COD removal. Metal oxide anodes present a similar performance to that of BDD, being the results obtained for Ti/Pt/PbO2 slightly better than for Ti/Pt/SnO2-Sb2O4. Contrary to BDD, Ti/Pt/PbO2 promotes lower nitrate formation and is the most suitable material for total nitrogen elimination. The importance of the optimum ratio of Cl-/COD/NH4 +initial concentrations is discussed.

Biotransformation of magnetic nanoparticles as a function of coating in a rat model

Long-term in vivo studies in murine models have shown that DMSA-coated nanoparticles accumulate in spleen, liver and lung tissues during extended periods of time (at least up to 3 months) without any significant signs of toxicity detected. During that time, nanoparticles undergo a process of biotransformation either by reducing the size or the particle aggregation or both. Using a rat model, we have evaluated the transformations of magnetic nanoparticles injected at low doses. Particles with two different coatings, dimercaptosuccinic acid (NP-DMSA) and polyethylene glycol (NP-PEG-(NH2)2) have been administered to animals, to evaluate the role of coating in the degradation of the particles. We have found that low doses of magnetic nanoparticles are quickly metabolized by the animals. In fact, using a nanoparticle dose four times lower than in previous experiments, NP-DMSA were not observed 24 h after the administration either in the liver or in the lungs. Interestingly, an increased amount of ferritin, the iron storage protein, was observed in liver tissues from rats that were treated with the low dose of NP-DMSA in comparison with the control ones, suggesting a rapid metabolization of the particles into ferritin iron. On the other side we have found that, NP-PEG-(NH2)2 are still detectable in several organs 24 h after their administration at low doses. Probably, due to the longer circulation times of the NP-PEG-(NH2)2, there is a delay in the arrival of the particles to the tissue and this is the reason why we are able to see the particles 24 h post-administration. PEG coating could also be protecting the nanoparticles from rapid degradation of the reticuloendothelial system. Knowledge on the biodistribution, circulation time and degradation processes is required to gain a better understanding of the safety evaluation of this kind of nanomaterial for biomedical applications.