Specific cognitive and psychological alterations are more strongly linked to increased migraine disability than chronic migraine diagnosis.

INTRODUCTION: The efficiency of The International Classification of Headache Disorders (ICHD-3) in reflecting patients' disability has recently been questioned. This prompts consideration that clinical features beyond pain may more accurately indicate the extent of underlying brain impairment than the mere frequency of headache days. Important cognitive dysfunctions and psychological impairment have been reported in burdensome cases of migraine, and the presence of these alterations has been associated with biological changes in the nervous system. This study aimed to compare migraine-related disability within a specific patient group, classified using ICHD-3 criteria or classified based on findings from a neuropsychological evaluation using machine learning. Additionally, a complementary voxel-based morphometry (VBM) comparison was conducted to explore potential neuroanatomical differences between the resulting groups. PATIENTS AND METHODS: The study included episodic and chronic migraine patients seeking consultation at a specialized headache department. A neuropsychological evaluation protocol, encompassing validated standardized tests for cognition, anxiety, depression, perceived stress, and headache-related impact (HIT-6) and disability (MIDAS), was administered. Results from this evaluation were input into an automated K-means clustering algorithm, with a predefined K=2 for comparative purposes. A supplementary Voxel-based Morphometry (VBM) evaluation was conducted to investigate neuroanatomical contrasts between the two distinct grouping configurations. RESULTS: The study involved 111 participants, with 49 having chronic migraine and 62 having episodic migraine. Seventy-four patients were assigned to cluster one, and 37 patients were assigned to cluster two. Cluster two exhibited significantly higher levels of depression, anxiety, and perceived stress, and performed worse in alternating and focalized attention tests. Differences in HIT-6 and MIDAS scores between episodic and chronic migraine patients did not reach statistical significance (HIT-6: 64.39 (±7,31) vs 62.92 (±11,61); p= 0. 42 / MIDAS: 73.63 (±68,61) vs 84.33 (±63,62); p=0.40). In contrast, patients in cluster two exhibited significantly higher HIT-6 (62.32 (±10,11) vs 66.57 (±7,21); p=0.03) and MIDAS (68.69 (±62,58) vs 97.68 (±70,31); p=0.03) scores than patients in cluster one. Furthermore, significant differences in grey matter volume between the two clusters were noted, particularly involving the precuneus, while differences between chronic and episodic migraine patients did not withstand correction for multiple comparisons. CONCLUSIONS: The classification of migraine patients based on neuropsychological characteristics demonstrates a more effective separation of groups in terms of disability compared to categorizing them based on the chronic or episodic diagnosis of ICHD-3. These findings could reveal biological changes that might explain differences in treatment responses among apparently similar patients.

[Spontaneous cholecysto-cutaneous fistula: about two cases]. / Fístula colecisto-cutánea espontánea: a propósito de dos casos.

Cholecysto-cutaneous fistula (CCF) is a rare complication of untreated biliary pathology, with fewer than 100 cases documented in the literature. Most are secondary to bacterial infection, although it has also been described in gallbladder adenocarcinoma and post trauma. Its clinical presentation is variable, being able to present systemic affection, and its most frequent external drainage site is in the right hypochondrium. Due to the low incidence of this pathology, and the variety of forms of presentation, its management does not have, to date, standardized bases. We present two cases of patients who consulted in the emergency room at the Hospital Nacional de Clínicas for presenting cholecysto-cutaneous fistula. The treatment of both was surgical.

La fístula colecisto-cutáneas (FCC) es una rara complicación de la patología biliar no tratada, habiendo menos de 100 casos documentados en la literatura. La mayoría son secundarias a infección bacteriana, aunque también fue descripta en el adenocarcinoma de vesícula y posterior a traumatismo. Su presentación clínica es variable, pudiendo presentar afección sistémica, y su sitio más frecuente de drenaje externo es en hipocondrio derecho. Debido a la baja incidencia de esta afección, y a la variedad de formas de presentación, su manejo no tiene hasta el momento bases estandarizadas. Presentamos dos casos de pacientes que consultaron por guardia de urgencias en el Hospital Nacional de Clínicas por presentar fistula colecisto-cutánea. El tratamiento de ambos fue quirúrgico.

Fístula colecisto-cutánea espontánea: a propósito de dos casos / Spontaneous cholecysto-cutaneous fistula: about two cases

Resumen La fístula colecisto-cutáneas (FCC) es una rara com plicación de la patología biliar no tratada, habiendo menos de 100 casos documentados en la literatura. La mayoría son secundarias a infección bacteriana, aunque también fue descripta en el adenocarcinoma de vesícula y posterior a traumatismo. Su presentación clínica es variable, pudiendo presentar afección sistémica, y su sitio más frecuente de drenaje externo es en hipocon drio derecho. Debido a la baja incidencia de esta afección, y a la variedad de formas de presentación, su manejo no tiene hasta el momento bases estandarizadas. Presentamos dos casos de pacientes que consulta ron por guardia de urgencias en el Hospital Nacional de Clínicas por presentar fistula colecisto-cutánea. El tratamiento de ambos fue quirúrgico.

Abstract Cholecysto-cutaneous fistula (CCF) is a rare com plication of untreated biliary pathology, with fewer than 100 cases documented in the literature. Most are secondary to bacterial infection, although it has also been described in gallbladder adenocarcinoma and post trauma. Its clinical presentation is variable, being able to present systemic affection, and its most frequent exter nal drainage site is in the right hypochondrium. Due to the low incidence of this pathology, and the variety of forms of presentation, its management does not have, to date, standardized bases. We present two cases of patients who consulted in the emergency room at the Hospital Nacional de Clínicas for presenting cholecysto-cutaneous fistula. The treat ment of both was surgical.

Effectiveness of management zones for recovering parrotfish species within the largest coastal marine protected area in Brazil.

The establishment of multiple zones offering different protection levels within a Marine Protected Area (MPA) can minimize social conflicts while maintaining associated biodiversity benefits such as fish population replenishment. Parrotfishes are among one of the most ecologically important reef fishes; yet extremely overexploited worldwide. In this context, well-designed priority management areas allowing no fishing activity (no-take zones) could help recover fish species, such as parrotfishes, through a MPA zoning process. Here, we tested this hypothesis by identifying the spatial configuration of zones that maximize the recovery of endangered parrotfish species (Scarus trispinosus; Scarus zelindae; Sparisoma amplum; Sparisoma axillare; Sparisoma frondosum) at the largest MPA in Brazil protecting nearshore coral reefs (MPA Costa dos Corais). We used parrotfish distribution data to produce species distribution models (SDMs) and combined them with conservation planning tools to delineate priority zones following a systematic approach. Then, we contrasted priority zones against non-systematic, newly designed no-take zones based on managers' and stakeholders' perspectives. After mapping the predicted abundance of each species within both zones based upon field surveys, we found that priority zones were more effective than non-systematic ones for the protection of two out of the five species: Scarus trispinosus and Sparisoma amplum. Thus, we considered that designing systematic zones was particularly relevant for increased protection of the two parrotfish species facing the largest decline. The prioritization analyses also showed that priority areas for parrotfish conservation following a systematic approach were mostly located surrounding and within no-take zones delineated by local stakeholders. The spatial overlap between systematic and non-systematic zones was of 38%. Hence, our study reinforces the importance of considering scientific information and methods (e.g., spatial distribution data and prioritization analyses) as a complementary strategy along with local stakeholders' knowledge, for delineating and refining management zones within MPAs.

AC-Redes semânticas de hashtags: modelo de estudo métrico de informações em saúde em mídias sociais / CA-Hashtags semantic networks: a metric study model of health information on social media / AC-Redes semánticas de hashtags: un modelo de estudio métrico de información de salud en las redes sociales

As mídias sociais são importantes canais de difusão de informações em saúde. O objetivo deste artigo é apresentar um modelo de estudo métrico de informações para minerar temáticas relacionadas à covid-19 no Facebook, intitulado AC-Redes semânticas de hashtags. O modelo é composto pelos métodos de análise de redes semânticas e de análise de coocorrência. As métricas aplicadas no período de maio de 2020 a janeiro de 2021 foram: as frequências de hashtags, as centralidades de grau e de intermediação e o índice incidência-fidelidade; e o estudo de ilhas. As temáticas identificadas foram: 'Educação na pandemia'; 'Trabalho e pandemia'; 'Ciência, saúde e pandemia'; 'Isolamento social na pandemia'; e 'Política e pandemia'. Por meio desse modelo, foi possível identificar as temáticas mais relevantes sobre a covid-19 para os usuários do Facebook.

Social media are important channels for the dissemination of information on public health. The goal of this paper is to present a model of quantitative analysis of information from the hashtags with respect to covid-19 on Facebook, called CA-Hashtag semantic networks. This model consists of the methods of semantic network analysis and co-occurrence analysis.The metrics used from May 2020 to January 2021 were: hashtag's frequency, degree and betweenness centralities and incidence-fidelity index; and study of islands. The themes identified have been: 'Education in the pandemic'; 'Work and pandemic'; 'Science, health and pandemic'; 'Social isolation in the pandemic'; and 'Politics and pandemic'. Applying the proposed model, it has been possible to identify the most relevant themes about covid-19 for Facebook users.

Las redes sociales son canales importantes para la difusión de información sobre salud pública. El objetivo del artículo es presentar un modelo de análisis cuantitativo de información a partir de los contenidos de hashtags relacionadas con covid-19 en Facebook, llamado de AC-Redes semánticas de hashtags. Este modelo es compuesto por los métodos de análisis de redes semánticas y análisis de co-ocurrencia. Las métricas utilizadas desde mayo de 2020 hasta enero de 2021 han sido: la frecuencia de hashtags, las centralidades de grado e intermediación y el índice incidencia-fidelidad; e el estudio de islas. Los temas identificados han sido: 'Educación en la pandemia'; 'Trabajo y pandemia'; 'Ciencia, salud y pandemia'; 'Aislamiento social en la pandemia'; y 'Política y pandemia'. Con basis en el modelo propuesto, ha sido posible identificar los temas más relevantes sobre covid-19 para los usuarios de Facebook.

High rates of (treated) hypothyroidism among chronic migraine patients consulting a specialized headache clinic: are we missing something?

BACKGROUND: Roughly three percent of episodic migraine patients evolve into the most burdensome chronic form of this condition every year. While some of the determinants behind this transformation are well established, others are still ill defined. Hypothyroidism is a prevalent endocrinological disorder that can both produce a secondary headache or aggravate a pre-existing primary headache disorder such as migraine. OBJECTIVE: We aimed to re-assess the association between hypothyroidism and chronic migraine controlling for factors such as hormone replacement treatment status and bodyweight. METHODS: We retrospectively analyzed the medical records of episodic and chronic migraine patients who consecutively consulted our headache clinic in order to determine the prevalence of adequately treated hypothyroidism in each group. Only patients receiving a stable dose regimen were included. The body mass index and other possibly confounding covariates were also collected. RESULTS: Data from 111 migraine patients was included for analysis. Most (88.6%) of chronic migraine sufferers were overusing acute medication. Treated hypothyroidism was significantly more prevalent in chronic migraine patients (29.55%) compared to episodic migraine patients (8.96%). This association was independent of the patients' body mass index or other variables. CONCLUSION: Alterations of neuronal metabolism, deficient calcitonin release, or focal inflammation causing local hormonal deactivation might explain why hypothyroidism, in spite of levothyroxine replacement therapy, is associated with migraine chronification. Further studies evaluating these factors are warranted.

Trachoma Rapid Assessments in Venezuela, an Example of the Integration of Data Gathering with Service Delivery in Hard-to-reach Populations.

A) PURPOSE: The objective of the study was to assess the presence of trachoma in high priority districts in the Amazon state of Venezuela (the Bolivarian Republic of), and use trachoma data gathering platform to offer integrated primary health care services to underserved hard-to-reach populations living in the border with Colombia. B) METHODS: Trachoma Rapid Assessments (TRA) were conducted in indigenous communities of three municipalities of the Amazonas State of Venezuela from June 2018 to April 2019 using the World Health Organization (WHO) guidelines. Integrated health services were delivered based on the identified needs of the population of the assessed communities. C) RESULTS: 1,185 children aged 1-9 years were examined for trachoma in the three municipalities, of which 6.92% had active trachoma; 994 people 15 years and above were examined for trachomatous trichiasis (TT) finding two cases (0.2%). 1,635 people were examined for other health-related problems and the most common diagnoses were intestinal parasites (54.74%), eye diseases (16.81%), cavities (7.34%), scabies (5.56%), headache (4.40%), and malaria (2.81%); additionally, 2,233 vaccine doses were provided to children and adults to complete vaccination series. D) CONCLUSION: The results of the TRA in the Amazon state of Venezuela suggest that trachoma could be a public health problem and standardized population-based surveys to establish the prevalence and determine the interventions to implement are needed.

Drivers of ecological effectiveness of marine protected areas: A meta-analytic approach from the Southwestern Atlantic Ocean (Brazil).

With the rapid global increase in the number and extent of marine protected areas (MPAs), there is a need for methods that enable an assessment of their actual contribution to biodiversity conservation. In Brazil, where MPAs have been designated to replenish biodiversity, there is a lack of regional-scale analysis of MPA impacts and the factors related to positive ecological change. This study aims to quantify the magnitude of the ecological effects of Brazilian MPAs and test whether some study and MPA characteristics (e.g., taxonomic group studied, exploitation level of species, MPA area, protection time, management effectiveness, level of connectedness, etc.) were underlying factors associated with their performance. We conducted a structured search in a database of scientific articles, selecting comparative studies of direct biodiversity metrics inside and outside MPAs offering different protection levels (i.e., fully- or partially-protected MPAs) or within MPAs with distinct zones. We then carried out a meta-analysis based on 424 observations found in 18 articles. Averaged across all studies, we found that MPAs had a 17% increase in the abundance of species, length of individuals, and community diversity. When compared to open-access areas, fully-protected MPAs increased biodiversity by 45%. However, MPAs offering partial protection had variable effects, ranging from significant positive to significant negative effects. MPA effects depended on the taxonomic group and exploitation level of species, with the strongest positive effects seen on exploited fish species and benthic invertebrates. Partially-protected MPAs that reported strong positive effects required long time of protection (>15years) and high level of connectivity. Conversely, fully-protected MPAs (i.e., no-take ones) could be effective even when small, under intense fishing pressure in their surroundings, and regardless of their level of connectivity. We used the Brazilian MPAs as a case study, but these results can contribute to a more comprehensive assessment of the association between ecological impacts of MPAs and drivers of conservation success, and offer key information to consolidate MPA networks that sustain biodiversity.

Kelch13 mutations in Plasmodium falciparum and risk of spreading in Amazon basin countries.

BACKGROUND: The first potential focus for artemisinin resistance in South America was recently confirmed with the presence of the C580Y mutation in the Plasmodium falciparum kelch 13 gene (pfk13) in Guyana. OBJECTIVES: This study aimed to strengthen pfk13 monitoring in the Amazon basin countries, to compile the available data and to evaluate the risk of spreading of mutations. METHODS: Sanger sequencing was done on 862 samples collected between 1998 and 2019, and a global map of pfk13 genotypes available for this region was constructed. Then, the risk of spreading of mutations based on P. falciparum case importation between 2015 and 2018 within countries of the Amazon basin was evaluated. RESULTS: No additional pfk13 C580Y foci were identified. Few mutations (0.5%, 95% CI = 0.3%-0.8%) in the propeller domain were observed in the general parasite population of this region despite a high proportion of K189T mutations (49.1%, 95% CI = 46.2%-52.0%) in the non-propeller domain. Case information revealed two patterns of intense human migration: Venezuela, Guyana and the Roraima State in Brazil; and French Guiana, Suriname and the Amapá State in Brazil. CONCLUSIONS: There are few pfk13 mutant foci, but a high risk of dispersion in the Amazon basin, mainly from the Guiana Shield, proportionate to mining activities. Therefore, access to prompt diagnosis and treatment, and continuous molecular monitoring is essential in these geographical areas.

[Usefulness of the Difficult Cholecystectomy Score according to laparoscopic conversion]. / Utilidad del Score de la Colecistectomía Dificultosa según conversión laparoscópica.

Introduction: Biliary lithiasis (LB) is a very frequent problem in the daily consultation of a general surgeon, so currently, 10 to 15% of the adult population in the experienced countries has LB. Methodology: A descriptive, observational and cross-sectional study was carried out with patients sometimes having a laparoscopic cholecystectomy in a period between January 1, 2018 and December 31, 2018. The main objective of this study is to determine the differences in the risk scoring means of difficult cholecystectomy according to the conversion to open surgery in patients diagnosed with symptomatic biliary lithiasis. Results: Through the registered data, it can be said that being a man, with a leukocyte count> 12,000 mm3, with a BMI> 30, the presence of choledocholithiasis and a greater gallbladder cut with 3 mm are factors that increase the risk of conversion to open surgery in this series of patients. It is feasible and safe to use this score to determine the patients with the highest risk of conversion since all the independent factors identified are not modifiable. Conclusion: In short, being a man, with a leukocyte count> 10,000 mm3, with a BMI> 30, the presence of choledocholithiasis and a gallbladder wall greater than 3 mm are factors that increase the risk of conversion to open surgery in a series of patients undergoing video laparoscopy. in a university hospital and it is feasible and safe to use this score to identify those patients with the highest risk of conversion.

Introducción: La litiasis biliar (LB) es un problema muy frecuente en la consulta diaria de un cirujano general, por lo que actualmente, del 10 al 15% de la población adulta en los países desarrollados presenta LB. Metodología: Se realizó un estudio descriptivo, observacional y transversal con los pacientes sometidos a colecistectomía laparoscópica en un período comprendido entre el 1 de enero del 2018 y el 31 de diciembre del 2018. El objetivo principal de este estudio es determinar diferencias de media del score de riesgo de colecistectomía dificultosa según conversión a cirugía abierta en pacientes con diagnóstico de litiasis biliar sintomática. Resultados: A través de los datos registrados se puede decir que ser hombre, con recuento de leucocitos >12.000 mm3, con IMC >30, presencia de coledocolitiasis y pared vesicular mayor a 3 mm son factores que incrementan el riesgo de conversión a cirugía abierta en esta serie de pacientes. Es factible y seguro utilizar este score para determinar aquellos pacientes con mayor riesgo de conversión dado que todos los factores independientes identificados no son modificables. Conclusión: En definitiva, ser hombre, con recuento de leucocitos >10.000 mm3, con IMC >30, presencia de coledocolitiasis y pared vesicular mayor a 3 mm son factores que incrementan el riesgo de conversión a cirugía abierta en una serie de pacientes sometidos a video laparoscopía en un Hospital universitario y es factible y seguro utilizar este score para identificar esos pacientes con mayor riesgo de conversión.

Mysterious oil spill in the Atlantic Ocean threatens marine biodiversity and local people in Brazil.

This study provides the first preliminary assessment of the potential impact from the recent oil spill in the Southern Atlantic Ocean. Using information on the occurrence of oil patches along the Brazilian coast, we quantified potential exposure of marine coastal habitats (estuaries, mangroves, beaches, seagrass meadows, tidal flats, and coral reefs) to oil-related disturbances. We also evaluated which threatened species in the coastal zone may have been impacted and the magnitude of the impacts on socioeconomic activities (i.e. artisanal fisheries and local tourism). Estuaries, mangroves, and seagrass meadows had the highest footprint among the habitats assessed. A total of 27 threatened coastal species occur within the area impacted by the oil residue. Approximately 870,000 people, employed in both artisanal fisheries and local tourism, appear to have been affected by the oil spill. We pinpointed priority areas for monitoring of contamination and accumulation in marine biota.

A single polyploidization event at the origin of the tetraploid genome of Coffea arabica is responsible for the extremely low genetic variation in wild and cultivated germplasm.

The genome of the allotetraploid species Coffea arabica L. was sequenced to assemble independently the two component subgenomes (putatively deriving from C. canephora and C. eugenioides) and to perform a genome-wide analysis of the genetic diversity in cultivated coffee germplasm and in wild populations growing in the center of origin of the species. We assembled a total length of 1.536 Gbp, 444 Mb and 527 Mb of which were assigned to the canephora and eugenioides subgenomes, respectively, and predicted 46,562 gene models, 21,254 and 22,888 of which were assigned to the canephora and to the eugeniodes subgenome, respectively. Through a genome-wide SNP genotyping of 736 C. arabica accessions, we analyzed the genetic diversity in the species and its relationship with geographic distribution and historical records. We observed a weak population structure due to low-frequency derived alleles and highly negative values of Taijma's D, suggesting a recent and severe bottleneck, most likely resulting from a single event of polyploidization, not only for the cultivated germplasm but also for the entire species. This conclusion is strongly supported by forward simulations of mutation accumulation. However, PCA revealed a cline of genetic diversity reflecting a west-to-east geographical distribution from the center of origin in East Africa to the Arabian Peninsula. The extremely low levels of variation observed in the species, as a consequence of the polyploidization event, make the exploitation of diversity within the species for breeding purposes less interesting than in most crop species and stress the need for introgression of new variability from the diploid progenitors.

A modelling approach to assess the impact of land mining on marine biodiversity: Assessment in coastal catchments experiencing catastrophic events (SW Brazil).

Analysis that link hydrological processes with oceanographic dispersion offer a promising approach for assessing impacts of land-based activities on marine ecosystems. However, such an analysis has not yet been customised to quantify specific pressures from mining activities on marine biodiversity including those from spillages resulting from tailing dam failure. Here, using a Brazilian catchment in which a tailing dam collapsed (Doce river) as a case study, we provide a modelling approach to assess the impacts on key ecosystems and marine protected areas subjected to two exposure regimes: (i) a pulse disturbance event for the period 2015-2016, following the immediate release of sediments after dam burst, which witnessed an average increase of 88% in sediment exports; and (ii) a press disturbance phase for the period 2017-2029, when impacts are sustained over time by sediments along the river's course. We integrated four components into impact assessments: hydrological modelling, coastal-circulation modelling, ecosystem mapping, and biological sensitivities. The results showed that pulse disturbance causes sharp increases in the amount of sediments entering the coastal area, exposing key sensitive ecosystems to pollution (e.g. rhodolith beds), highlighting an urgent need for developing restoration strategies for these areas. The intensity of impacts will diminish over time but the total area of sensitive ecosystems at risk are predicted to be enlarged. We determined monitoring and restoration priorities by evaluating and comparing the extent to which sensitive ecosystems within marine protected areas were exposed to disturbances. The information obtained in this study will allow the optimization of recovery efforts in the marine area affected, and valuation of ecosystem services lost.

High Rate of Infection by Only Oncogenic Human Papillomavirus in Amerindians.

Human papillomavirus (HPV), an etiological agent of cervical cancer (CC), has infected humans since ancient times. Amerindians are the furthest migrants out of Africa, and they reached the Americas more than 14,000 years ago. Some groups still remain isolated, and some migrate to towns, forming a gradient spanning urbanization. We hypothesized that, by virtue of their history, lifestyle, and isolation from the global society, remote Amerindian women have lower HPV diversity than do urban women (Amerindian or mestizo). Here we determined the diversity of the 25 most relevant cervical HPV types in 82 Amerindians spanning urbanization (low, medium, and high, consistent with the exposure to urban lifestyles of the town of Puerto Ayacucho in the Venezuelan Amazonas State), and in 29 urban mestizos from the town. Cervical, anal, oral, and introitus samples were taken, and HPVs were typed using reverse DNA hybridization. A total of 23 HPV types were detected, including 11 oncogenic or high-risk types, most associated with CC. Cervical HPV prevalence was 75%, with no differences by group, but Amerindians from low and medium urbanization level had significantly lower HPV diversity than mestizos did. In Amerindians, but not in mestizos, infections by only high-risk HPVs were higher than coinfections or by exclusively low-risk HPVs. Cervical abnormalities only were observed in Amerindians (9/82), consistent with their high HPV infection. The lower cervical HPV diversity in more isolated Amerindians is consistent with their lower exposure to the global pool, and transculturation to urban lifestyles could have implications on HPV ecology, infection, and virulence.IMPORTANCE The role of HPV type distribution on the disparity of cervical cancer (CC) incidence between human populations remains unknown. The incidence of CC in the Amazonas State of Venezuela is higher than the national average. In this study, we determined the diversity of known HPV types (the viral agent of CC) in Amerindian and mestizo women living in the Venezuelan Amazonas State. Understanding the ecological diversity of HPV in populations undergoing lifestyle transformations has important implication on public health measures for CC prevention.

Natural infection of Plasmodium brasilianum in humans: Man and monkey share quartan malaria parasites in the Venezuelan Amazon.

BACKGROUND: The quartan malaria parasite Plasmodium malariae is the widest spread and best adapted human malaria parasite. The simian Plasmodium brasilianum causes quartan fever in New World monkeys and resembles P. malariae morphologically. Since the genetics of the two parasites are nearly identical, differing only in a range of mutations expected within a species, it has long been speculated that the two are the same. However, no naturally acquired infection with parasites termed as P. brasilianum has been found in humans until now. METHODS: We investigated malaria cases from remote Yanomami indigenous communities of the Venezuelan Amazon and analyzed the genes coding for the circumsporozoite protein (CSP) and the small subunit of ribosomes (18S) by species-specific PCR and capillary based-DNA sequencing. FINDINGS: Based on 18S rRNA gene sequencing, we identified 12 patients harboring malaria parasites which were 100% identical with P. brasilianum isolated from the monkey, Alouatta seniculus. Translated amino acid sequences of the CS protein gene showed identical immunodominant repeat units between quartan malaria parasites isolated from both humans and monkeys. INTERPRETATION: This study reports, for the first time, naturally acquired infections in humans with parasites termed as P. brasilianum. We conclude that quartan malaria parasites are easily exchanged between humans and monkeys in Latin America. We hypothesize a lack of host specificity in mammalian hosts and consider quartan malaria to be a true anthropozoonosis. Since the name P. brasilianum suggests a malaria species distinct from P. malariae, we propose that P. brasilianum should have a nomenclatorial revision in case further research confirms our findings. The expansive reservoir of mammalian hosts discriminates quartan malaria from other Plasmodium spp. and requires particular research efforts.

Effect of influenza-induced fever on human bioimpedance values.

BACKGROUND AND AIMS: Bioelectrical impedance analysis (BIA) is a widely used technique to assess body composition and nutritional status. While bioelectrical values are affected by diverse variables, there has been little research on validation of BIA in acute illness, especially to understand prognostic significance. Here we report the use of BIA in acute febrile states induced by influenza. METHODS: Bioimpedance studies were conducted during an H1N1 influenza A outbreak in Venezuelan Amerindian villages from the Amazonas. Measurements were performed on 52 subjects between 1 and 40 years of age, and 7 children were re-examined after starting Oseltamivir treatment. Bioelectrical Impedance Vector Analysis (BIVA) and permutation tests were applied. RESULTS: For the entire sample, febrile individuals showed a tendency toward greater reactance (p=0.058) and phase angle (p=0.037) than afebrile individuals, while resistance and impedance were similar in the two groups. Individuals with repeated measurements showed significant differences in bioimpedance values associated with fever, including increased reactance (p<0.001) and phase angle (p=0.007), and decreased resistance (p=0.007) and impedance (p<0.001). CONCLUSIONS: There are bioelectrical variations induced by influenza that can be related to dehydration, with lower extracellular to intracellular water ratio in febrile individuals, or a direct thermal effect. Caution is recommended when interpreting bioimpedance results in febrile states.

Abundancia y diversidad de especies de Culicinae (Diptera: Culicidae) del Alto Orinoco, estado Amazonas, Venezuela / Abundance and species diversity of Culicinae (Diptera: Culicidae) from Alto Orinoco, Amazonas, Venezuela

Se realizó un estudio longitudinal en 18 comunidades o shabonos de las localidades Yanomami Ocamo y Mavaca del municipio Alto Orinoco entre Junio 1998 y Diciembre 2000 para caracterizar la fauna de culicinos. Se colocaron trampas CDC dentro de viviendas entre 1900 y 0600 horas a fin de capturar los mosquitos atraídos por personas protegidas por mosquiteros. Se capturaron un total de 4.635 culicinos pertenecientes a nueve géneros y 25 especies. Del total de especies identificadas, 18 especies (72%) constituyen nuevos registros para el estado Amazonas. Las especies más abundantes fueron Mansonia (Mansonia) titillans (48%), Aedes (Ochlerotatus) fulvus (16,9%) y Culex (Melanoconion) spissipes (12%). Se observaron correlaciones negativamente significativas entre precipitación, nivel del río y abundancia de Ma. titillans y Ae. fulvus. La abundancia y diversidad de especies resultó diferente entre comunidades. La mayor diversidad y abundancia se encontró en las comunidades Santa María de los Guaicas y Carlitos. El esfuerzo de captura, disponibilidad de criaderos y diversidad de hábitats en estas comunidades influye en esta diferencia con respecto a las otras comunidades. El presente constituye el primer y único estudio longitudinal realizado en el estado Amazonas para caracterizar la fauna de culicinos, la cual incluye especies de importancia en salud pública.

A longitudinal study was conducted in 18 communities or "shabonos" in the Yanomami inhabited Ocamo and Mavaca regions in the Alto Orinoco municipality between June 1998 and December 2000. CDC light traps were placed inside dwellings to catch mosquitoes attracted to humans protected by mosquito nets between 1900 and 0600 hours. A total of 4.635 culicines belonging to 9 genera and 25 species were captured. Of the total number of species identified, 18 (72%) are new reports for Amazonas state. The most abundant species were Mansonia (Mansonia) titillans (48%), Aedes (Ochlerotatus) fulvus (16.9%) and Culex (Melanoconion) spissipes (12%). There were significantly negative correlations between rainfall and river levels, and the abundance of Ma. titillans and Ae. fulvus. The abundance and species diversity of culicines differed among communities, with the highest values of both these parameters found in Santa María de los Guiacas and Carlitos. These differences were partly due to sampling effort but could also have been produced by the availability of larval habitats and niche diversity in these communities compared to the others surveyed. Up until, now this is the only longitudinal study to characterize the culicine fauna in Amazonas state, which includes several species of public health importance.

The nutrition transition in the Venezuelan Amazonia: increased overweight and obesity with transculturation.

OBJECTIVES: Amerindians have a particularly high propensity to overweight and obesity as they change lifestyle and experience a nutrition transition. The aim of this study was to evaluate the effects of transculturation on nutritional status in three Amazonian Amerindian villages. METHODS: Nutritional status was assessed in 232 volunteers: 65 Yanomami from an isolated village and 167 Guahibo subjects from villages with intermediate and high levels of transculturation. RESULTS: There was a significant pattern of decreasing stunting and increasing overweight and obesity across the gradient of transculturation. From the jungle Yanomami to the intermediate and transculturated Guahibo, stunting was respectively 72, 55, and 39%, and children /adult overweight was 0, 3/44, and 15/89%. These anthropometric-based patterns were confirmed by bioimpedance vector analysis. CONCLUSIONS: Transculturation in these Amerindian populations is associated with an increase in overweight and obesity coexisting with undernourished children.

Conocimientos, actitudes y prácticas del personal de salud y de una muestra reducida de pacientes relacionados con la adherencia al tratamiento antimalárico, Municipio Atures, Estado Amazonas, Venezuela / Knowledge, attitudes and practices of health staff and a reduced sample of patients associated with adherence to antimalarial treatment in Atures Municipality, Amazonas State, Venezuela

El propósito de este trabajo fue estudiar los factores asociados con el sistema de salud y con los pacientes, que determinan la adherencia al tratamiento antimalárico en el municipio Atures, estado Amazonas. Se utilizó el Método Comparativo Constante como técnica cualitativa para el análisis de los datos recogidos mediante la observación participante y las entrevistas semi-estructuradas. Los resultados mostraron que las deficiencias del Programa de Control de Malaria, como errores en el diagnóstico, registro y seguimiento de los casos maláricos y suministro del tratamiento son factores que afectan negativamente la adherencia al tratamiento antimalárico. Por otro lado, las actitudes positivas de los pacientes ante el Programa de Control de Malaria y sus conocimientos sobre la enfermedad son factores que determinan una adherencia positiva. Sin embargo, la muestra reducida de pacientes no permite que los resultados concernientes a estos actores sean conclusivos.

The aim of this study was to investigate the factors that determine adherence to antimalarial treatment associated with the Malaria Control Program and patients in the Atures municipality, Amazonas state. The Constant Comparative Method was used as a qualitative technique for analyzing data collected through participant observation and semi-structured interviews. The results showed that deficiencies in the Malaria Control Program, such as misdiagnosis, mistakes in record keeping and monitoring of malaria cases, and treatment supply are all factors that negatively affect adherence to antimalarial treatment. On the other hand, patients´ positive attitudes to the control programme and their knowledge about the disease positively affected adherence to treatment. The small sample of patients meant, however, that the results obtained remain inconclusive.