Evidence of Zika Virus Reinfection by Genome Diversity and Antibody Response Analysis, Brazil.

We generated 238 Zika virus (ZIKV) genomes from 135 persons in Brazil who had samples collected over 1 year to evaluate virus persistence. Phylogenetic inference clustered the genomes together with previously reported ZIKV strains from northern Brazil, showing that ZIKV has been remained relatively stable over time. Temporal phylogenetic analysis revealed limited within-host diversity among most ZIKV-persistent infected associated samples. However, we detected unusual virus temporal diversity from >5 persons, uncovering the existence of divergent genomes within the same patient. All those patients showed an increase in neutralizing antibody levels, followed by a decline at the convalescent phase of ZIKV infection. Of interest, in 3 of those patients, titers of neutralizing antibodies increased again after 6 months of ZIKV infection, concomitantly with real-time reverse transcription PCR re-positivity, supporting ZIKV reinfection events. Altogether, our findings provide evidence for the existence of ZIKV reinfection events.

Detection and persistence of Zika virus in body fluids and associated factors: a prospective cohort study.

This study aimed to analyze the detection and duration of the Zika virus (ZIKV) in plasma, urine, saliva, sweat, rectal swabs, vaginal secretions, breast milk, and semen and to explore risk factors associated with prolonged viral persistence. A prospective cohort study of symptomatic patients and their household contacts was conducted in Brazil from July 2017 to June 2019. A total of 260 individuals (184 women and 76 men) with confirmed ZIKV infection were enrolled and followed up for 12 months. ZIKV RNA was present in all body fluid specimens and detectable for extended periods in urine, sweat, rectal swabs, and semen. The longest detection duration was found in semen, with high viral loads in the specimens. ZIKV RNA clearance was associated with several factors, including age, sex, education level, body mass index, non-purulent conjunctivitis, joint pain, and whether the participant had a history of yellow fever vaccination. The influence of each of these factors on the low or fast viral clearance varied according to the specific body fluid under investigation. Recurrent ZIKV detection events after total viral clearance were observed in the cohort. Our findings provide valuable insights into the persistence and potential recurrence of ZIKV infection, highlighting the need for continued monitoring and follow-up of individuals infected with ZIKV and for effective prevention measures to reduce the risk of transmission.

Clinical and Acoustic Alterations of Swallowing in Children Exposed to Zika Virus during Pregnancy in a Cohort in Amazonas, Brazil: A Case Series Study.

Oropharyngeal dysphagia (OD) is a swallowing disorder that involves difficulty in safely passing the food bolus from the oral cavity to the stomach. OD is a common problem in children with congenital Zika virus syndrome (CZS). In this case series, we describe the clinical and acoustic alterations of swallowing in children exposed to the Zika virus during pregnancy in a cohort from Amazonas, Brazil. From July 2019 to January 2020, 22 children were evaluated, 6 with microcephaly and 16 without microcephaly. The mean age among the participants was 35 months (±4.6 months). All children with microcephaly had alterations in oral motricity, mainly in the lips and cheeks. Other alterations were in vocal quality, hard palate, and soft palate. Half of the children with microcephaly showed changes in cervical auscultation during breast milk swallowing. In children without microcephaly, the most frequently observed alteration was in lip motricity, but alterations in auscultation during the swallowing of breast milk were not observed. Regarding swallowing food of a liquid and pasty consistency, the most frequent alterations were incomplete verbal closure, increased oral transit time, inadequacy in capturing the spoon, anterior labial leakage, and increased oral transit time. Although these events are more frequent in microcephalic children, they can also be seen in non-microcephalic children, which points to the need for an indistinct evaluation of children exposed in utero to ZIKV.

Does the Presence or a High Titer of Yellow Fever Virus Antibodies Interfere with Pregnancy Outcomes in Women with Zika Virus Infection?

Zika virus (ZIKV) and yellow fever virus (YFV) originated in Africa and expanded to the Americas, where both are co-circulated. It is hypothesized that in areas of high circulation and vaccination coverage against YFV, children of pregnant women have a lower risk of microcephaly. We evaluated the presence and titers of antibodies and outcomes in women who had ZIKV infection during pregnancy. Pregnancy outcomes were classified as severe, moderate, and without any important outcome. An outcome was defined as severe if miscarriage, stillbirth, or microcephaly occurred, and moderate if low birth weight and/or preterm delivery occurred. If none of these events were identified, the pregnancy was defined as having no adverse effects. A sample of 172 pregnant women with an acute ZIKV infection confirmed during pregnancy were collected throughout 2016. About 89% (150 of 169) of them presented immunity against YFV, including 100% (09 of 09) of those who had severe outcomes, 84% (16 of 19) of those who had moderate outcomes, and 89% (125 of 141) of those who had non-outcomes. There was no difference between groups regarding the presence of anti-YFV antibodies (p = 0.65) and YFV titers (p = 0.6). We were unable to demonstrate a protective association between the presence or titers of YFV antibodies and protection against serious adverse outcomes from exposure to ZIKV in utero.

Integrated production of hydrogen and methane in a dairy biorefinery using anaerobic digestion: Scale-up, economic and risk analyses.

Anaerobic digestion has emerged as the most appealing waste management strategy in biorefineries. Particularly, recent studies have highlighted the energy advantages of waste co-digestion in industrial biorefineries and the use of two-stage systems. However, there are some concerns about moving the system from laboratory testing to industrial scale. One of them is the high level of investment that is required. Therefore, this study carried out a techno-economic analysis (scale-up and energy production, economic and risk analysis, and factorial design) to assess the feasibility of single- and two-stage systems in the treatment of cheese whey and glycerin for the production of hydrogen and methane. Scenarios (S1 to S9) considered thermophilic and mesophilic single and two-stage systems with different applied organic loading rates (OLRA). The analyses of scale-up and energy production revealed that S3 (a thermophilic single-stage system operated at high OLRA 17.3 kg-COD.m-3.d-1) and S9 (a thermophilic-mesophilic two-stage system operated at high OLRA 134.8 kg-COD.m-3.d-1 and 20.5 kg-COD.m-3.d-1, respectively) were more compact and required lower initial investment compared to other scenarios. The risk analysis performed by a Monte Carlo simulation showed low investment risks (10 and 11%) for S3 and S9, respectively, being the electricity sales price, the key determining factor to define whether the project in the baseline scenario will result in profit or loss. Lastly, the factorial design revealed that while the net present value (NPV) is positively impacted by rising inflation and electricity sales price, it is negatively impacted by rising capitalization rate. Such assessments assist in making decisions regarding which system can be fully implemented, the best market circumstances for the investment, and how market changes may favorably or unfavorably affect the NPV and the internal rate of return (IRR).

One versus two-stage codigestion of sugarcane vinasse and glycerol: Assessing combinations at mesophilic and (hyper) thermophilic conditions.

Sugarcane vinasse exits the distillation process at high temperatures, which may differ from the optimal temperatures for dark fermentation and anaerobic digestion. A 15 °C temperature increase, for example, stops sugarcane vinasse methane generation, making distillery vinasse digestion complicated. Conversely, in other aspects, co-digesting vinasse and glycerol has been proven to stabilize methane production from vinasse because of sulfate dilution. However, glycerol has not been tested to stabilize vinasse digestion under temperature changes. Thus, this study compared the effects of different temperature settings on the co-digestion of 10 g COD L-1 of vinasse and glycerol (50 %:50 % on a COD basis) in anaerobic fluidized bed reactors (AFBR), i.e., an acidogenic and a methanogenic one-stage AFBRs operated at 55, 60, and 65 °C, and two methanogenic AFBRs fed both with acidogenic effluent (one operated at room temperature (25 °C) and the other at 55, 60, and 65 °C). The co-digestion provided steady methane generation at all AFBRs, with methane production rates ranging from 2.27 to 2.93 L CH4 d-1 L-1, whether in one or two stages. A feature of this research was to unravel the black box of the role of sulfate in the digestion of sugarcane vinasse, which was rarely studied. Desulfovibrio was the primary genus degrading 1,3-propanediol into 3-hydroxypropanoate after genome sequencing. Phosphate acetyltransferase (EC: 2.3.1.8, K00625) and acetate kinase (EC: 2.7.2.1, K00925) genes were also found, suggesting propionate was metabolized. In practical aspects, regarding the two-stage systems, the thermophilic-mesophilic (acidogenic-methanogenic) configuration is best for extracting additional value-added products because 1,3-propanediol may be recovered at high yields with steady methane production at reduced energy expenditure in a reactor operated at room temperature. However, the one-stage design is best for methane generation per system volume since it remained stable with rising temperatures, and all systems presented similar methane production rates.

Why are pediatricians uncomfortable with prescribing emergency contraception for adolescents?

OBJECTIVE: Emergency contraception (EC) is an effective and safe method for preventing unplanned pregnancy after unprotected sexual intercourse among adolescents but is infrequently prescribed by pediatricians. Because of the scarcity of data on the discomfort with EC prescription among physicians in Brazil, this study aimed to identify associated factors with discomfort with EC prescription among pediatricians in the state of Amazonas. METHODS: A web-based, cross-sectional study including sociodemographic data, knowledge, attitudes, and discomfort with EC prescription was used. Multivariate logistic regression and artificial intelligence methods such as decision tree and random forest analysis were used to identify factors associated with discomfort with EC prescriptions. RESULTS: Among 151 physicians who responded to the survey, 53.0% were uncomfortable with prescribing EC, whereas only 33.1% had already prescribed it. Inexperience was significantly associated with discomfort with EC prescription (odds ratio 4.47, 95% confidence interval 1.71-11.66). Previous EC prescription was protective against discomfort with EC prescription in the three models. CONCLUSIONS: EC is still infrequently prescribed by pediatricians because of inexperience and misconceptions. Training these professionals needs to be implemented as part of public health policies to reduce unplanned adolescent pregnancy.

From start-up to maximum loading: An approach for methane production in upflow anaerobic sludge blanket reactor fed with the liquid fraction of fruit and vegetable waste.

This investigation provides a reproducible approach for determining the limits of an upflow anaerobic sludge blanket (UASB) reactor designed for the methanization of the liquid fraction of fruit and vegetable waste (FVWL). Two identical mesophilic UASB reactors were operated for 240 days with a three-day fixed hydraulic retention time and an organic load rate (OLR) increased from 1.8 to 10 gCOD L-1 d-1. Because of the previous estimation of flocculent-inoculum methanogenic activity, it was possible to design a safe OLR for the quick start-up of both UASB reactors. The operational variables obtained from the operation of the UASB reactors did not show statistical differences, ensuring the experiment's reproducibility. As a result, the reactors achieved methane yield close to 0.250 LCH4 gCOD-1 up to the OLR of 7.7 gCOD L-1 d-1. Furthermore, the maximum volumetric methane production rate of 2.0 LCH4 L-1 d-1 was discovered for the OLR ranges between 7.7 and 10 gCOD L-1 d-1. The possible overload at OLR of 10 gCOD L-1 d-1 resulted in a significant reduction of methane production in both UASB reactors. Based on the methanogenic activity of the UASB reactors sludge, a maximum loading capacity of approximately 8 gCOD L-1 d-1 was estimated.

Growth Velocity and Nutritional Status in Children Exposed to Zika Virus during Pregnancy from Amazonas Cohort, Brazil.

The high incidence of Zika virus (ZIKV) infection in the period of 2015-2016 in Brazil may have affected linear height growth velocity (GV) in children exposed in utero to ZIKV. This study describes the growth velocity and nutritional status based on the World Organization (WHO) standards of children exposed to ZIKV during pregnancy and followed up in a tertiary unit, a reference for tropical and infectious diseases in the Amazon. Seventy-one children born between March 2016 and June 2018 were monitored for anthropometric indices: z-score for body mass index (BMI/A); weight (W/A); height (H/A) and head circumference (HC/A); and growth velocity. The mean age at the last assessment was 21.1 months (SD ± 8.93). Four children had congenital microcephaly and severe neurological impairment. The other 67 were non-microcephalic children (60 normocephalic and 7 macrocephalic); of these; 24.2% (16 children) had neurological alterations, and 28.8% (19 children) had altered neuropsychomotor development. Seventeen (24.2%) children had inadequate GV (low growth velocity). The frequencies of low growth among microcephalic and non-microcephalic patients are 25% (1 of 4 children) and 23.9% (16 of 67 children); respectively. Most children had normal BMI/A values during follow-up. Microcephalic patients showed low H/A and HC/A throughout the follow-up, with a significant reduction in the HC/A z-score. Non-microcephalic individuals are within the regular ranges for H/A; HC/A; and W/A, except for the H/A score for boys. This study showed low growth velocity in children with and without microcephaly, highlighting the need for continuous evaluation of all children born to mothers exposed to ZIKV during pregnancy.

Biomethane recovery through co-digestion of cheese whey and glycerol in a two-stage anaerobic fluidized bed reactor: Effect of temperature and organic loading rate on methanogenesis.

Anaerobic digestion for CH4 recovery in wastewater treatment has been carried out with different strategies to increase process efficiency, among which co-digestion and the two-stage process can be highlighted. In this context, this study aimed at evaluating the co-digestion of cheese whey and glycerol in a two-stage process using fluidized bed reactors, verifying the effect of increasing the organic loading rate (OLR) (2-20 g-COD.L-1.d-1) and temperature (thermophilic and mesophilic) in the second stage methanogenic reactor. The mesophilic methanogenic reactor (R-Meso) (mean temperature of 22 °C) was more tolerant to high OLR and its best performance was at 20 g-COD.L-1.d-1, resulting in methane yield (MY) and methane production (MPR) of 273 mL-CH4.g-COD-1 and 5.8 L-CH4.L-1.d-1 (with 67% of CH4), respectively. Through 16S rRNA gene massive sequencing analysis, a greater diversity of microorganisms was identified in R-Meso than in R-Thermo (second stage methanogenic reactor, 55 °C). Firmicutes was the phyla with higher relative abundance in R-Thermo, while in R-Meso the most abundant ones were Proteobacteria and Bacteroidetes. Regarding the Archaea domain, a predominance of hydrogenotrophic microorganisms could be observed, being the genera Methanothermobacter and Methanobacterium the most abundant in R-Thermo and R-Meso, respectively. The two-stage system composed with a thermophilic acidogenic reactor + R-Meso was more adequate for the co-digestion of cheese whey and glycerol than the single-stage process, promoting increases of up to 47% in the energetic yield (10.3 kJ.kg-COD-1) and 14% in organic matter removal (90.5%).

Two problems in one shot: Vinasse and glycerol co-digestion in a thermophilic high-rate reactor to improve process stability even at high sulfate concentrations.

Anaerobic co-digestion (AcoD) of sugarcane vinasse and glycerol can be profitable because of the destination of two biofuel wastes produced in large quantities in Brazil (ethanol and biodiesel, respectively) and the complementary properties of these substrates. Thus, the objective of this study was to assess the effect of increasing the organic loading rate (OLR) from 2 to 20 kg COD m-3 d-1 on the AcoD of vinasse and glycerol (50 %:50 % on a COD basis) in a thermophilic (55 °C) anaerobic fluidized bed reactor (AFBR). The highest methane production rate was observed at 20 kg COD m-3 d-1 (8.83 L CH4 d-1 L-1), while the methane yield remained stable at around 265 NmL CH4 g-1 CODrem in all conditions, even when influent vinasse reached 1811 mg SO42- L-1 (10 kg COD m-3 d-1). Sulfate was not detected in the effluent. Bacterial genera related to sulfate removal, such as Desulfovibrio and Desulfomicrobium, were observed by means of shotgun metagenomic sequencing at 10 kg COD m-3 d-1, as well as the acetoclastic archaea Methanosaeta and prevalence of genes encoding enzymes related to acetoclastic methanogenesis. It was concluded that process efficiency and methane production occurred even in higher sulfate concentrations due to glycerol addition.

Why are pediatricians uncomfortable with prescribing emergency contraception for adolescents? / Por que os pediatras têm desconforto para prescrever contracepção de emergência para adolescentes?

Abstract Objective: Emergency contraception (EC) is an effective and safe method for preventing unplanned pregnancy after unprotected sexual intercourse among adolescents but is infrequently prescribed by pediatricians. Because of the scarcity of data on the discomfort with EC prescription among physicians in Brazil, this study aimed to identify associated factors with discomfort with EC prescription among pediatricians in the state of Amazonas. Methods: A web-based, cross-sectional study including sociodemographic data, knowledge, attitudes, and discomfort with EC prescription was used. Multivariate logistic regression and artificial intelligence methods such as decision tree and random forest analysis were used to identify factors associated with discomfort with EC prescriptions. Results: Among 151 physicians who responded to the survey, 53.0% were uncomfortable with prescribing EC, whereas only 33.1% had already prescribed it. Inexperience was significantly associated with discomfort with EC prescription (odds ratio 4.47, 95% confidence interval 1.71-11.66). Previous EC prescription was protective against discomfort with EC prescription in the three models. Conclusions: EC is still infrequently prescribed by pediatricians because of inexperience and misconceptions. Training these professionals needs to be implemented as part of public health policies to reduce unplanned adolescent pregnancy.

RESUMO Objetivo: A contracepção de emergência (CE) é um método eficaz e seguro para prevenir gravidez não planejada após relação sexual desprotegida entre adolescentes, mas raramente prescrito por pediatras. Diante da escassez de dados sobre o desconforto com a prescrição de CE entre médicos no Brasil, o objetivo deste estudo foi identificar fatores associados a esse desconforto entre pediatras do estado do Amazonas. Métodos: Uma pesquisa do tipo e-survey coletou dados sociodemográficos, conhecimento, atitudes e desconforto com relação à prescrição de CE. Métodos de regressão logística multivariada e inteligência artificial, como árvore de decisão e random forest, foram usados para identificar fatores associados ao desconforto para a prescrição de CE. Resultados: Entre os 151 médicos que responderam à pesquisa, 53,0% sentiam-se desconfortáveis para prescrever CE e apenas 33,1% já a haviam prescrito. A inexperiência foi associada a esse desconforto (odds ratio — OR 4,47, intervalo de confiança — IC95% 1,71-11,66). A prescrição prévia de CE foi fator de proteção com relação ao desconforto nos três modelos. Conclusões: A CE ainda é pouco prescrita por pediatras. Apesar de sua segurança e eficácia, a inexperiência e conceitos equivocados foram associados ao desconforto para sua prescrição. Investigações sobre o assunto são importantes para subsidiar políticas públicas de saúde para a redução da gravidez não intencional na adolescência.

Would Zika virus Infection in Pregnancy Be a Sentence of Poor Neurological Prognosis for Exposed Children? Neurodevelopmental Outcomes in a Cohort from Brazilian Amazon.

Infections with Flavivirus in pregnant women are not associated with vertical transmission. However, in 2015, severe cases of congenital infection were reported during the Zika virus outbreak in Brazil. More subtle infections in children born to mothers with ZIKV still remain uncertain and the spectrum of this new congenital syndrome is still under construction. This study describes outcomes regarding neurodevelopment and neurological examination in the first years of life, of a cohort of 77 children born to pregnant women with ZIKV infection in Manaus, Brazil, from 2017 to 2020. In the group of normocephalic children (92.2%), most showed satisfactory performance in neuropsychomotor development, with a delay in 29.6% and changes in neurological examination in 27.1%, with two children showing muscle-strength deficits. All microcephalic children (5.2%) evolved with severe neuropsychomotor-development delay, spastic tetraparesis, and alterations in the imaging exam. In this cohort, 10.5% of the children had macrocephaly at birth, but only 2.6% remained in this classification. Although microcephaly has been considered as the main marker of congenital-Zika-virus syndrome in previous studies, its absence does not exclude the possibility of the syndrome. This highlights the importance of clinical follow-up, regardless of the classification of head circumference at birth.

Compliance in handling of donated raw breast milk to human milk banks regarding microbiological quality / Conformidade no manuseio do leite materno cru doado aos bancos de leite humano em relação à qualidade microbiológica

Abstract Objectives: microbiological quality of raw human milk (HM) from donors at the HMB (Human Milk Bank) of Santa Casa de Misericórdia de Ouro Preto was evaluated. Methods: the microbiological quality of milk from each of 10 donors in triplicate (30 samples) was evaluated by enumeration of Staphylococcus aureus and total aerobic mesophiles (surface plating) and total and thermotolerant coliforms (Most Probable Number - MPN). A questionnaire and a checklist were applied after the end of sample collection to verify the compliance of milk extraction and storage procedures by the donors. Results: inadequacies in the procedures for expression and storage of donated HM were observed. The presence of all microorganisms studied were verified in the milk of all donors, and in some cases exceeded the safety limits. The checklist indicated that some necessary hygienic-sanitary procedures were not carefully performed, making it important to properly guide the donors. Conclusions: this study points to an unfavorable scenario for the safety and quality of donated HM, and it is important to encourage further studies to be conducted so that the Brazilian network of HMB adopts stricter criteria for instructions on procedures and support for HM donors.

Resumo Objetivos: avaliou-se a qualidade microbiológica do leite humano (LH) cru de doadoras do Banco de Leite Humano (BLH) da Santa Casa de Misericórdia de Ouro Preto. Métodos: a qualidade microbiológica do leite de cada uma das 10 doadoras em triplicata (30 amostras) foi avaliada por meio da enumeração de Staphylococcus aureus e mesóflos aeróbios totais (plaqueamento em superfície) e coliformes totais e termotolerantes (Número Mais Provável -NMP). Para verificar a conformidade dos procedimentos de extração e armazenamento do leite pelas doadoras, aplicou-se um questionário e um checklist após o término da coleta das amostras. Resultados: observou-se inadequações nos procedimentos de expressão e armazenamento do LH doado. A presença de todos os microrganismos estudados foram verificados no leite de todas as doadoras e, em alguns casos, excedeu os limites de segurança. O checklist indicou que alguns procedimentos higiênico-sanitários necessários não foram realizados criteriosamente, tornando importante orientar adequadamente as doadoras. Conclusões: este estudo aponta um cenário desfavorável para a segurança e a qualidade do LH doado, sendo importante incentivar mais estudos a serem realizados para que a rede brasileira de BLH adote critérios mais rigorosos de instruções sobre procedimentos e suporte para doadoras de LH.

Prevalence of arboviruses and other infectious causes of skin rash in patients treated at a tertiary health unit in the Brazilian Amazon.

BACKGROUND: In the clinical course of diseases such as arboviruses, skin rashes may appear, as is often seen in other infectious diseases. The aim of this study was to estimate the prevalence of arboviruses and other infectious causes of skin rash in a tertiary health unit in Manaus, Amazonas state, Western Brazilian Amazon. METHODOLOGY/PRINCIPAL FINDINGS: This was a cross-sectional study of patients presenting with rash who sought care at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) from February 2018 to May 2019. Individuals of either gender, aged over 18 years, were invited to participate voluntarily. Infection by Zika virus (ZIKV), dengue virus (DENV), chikungunya virus (CHIKV), Mayaro virus (MAYV), Oropouche virus (OROV) and measles was evaluated using RT-qPCR (real-time polymerase chain reaction). Immunodiagnostic tests for EBV, CMV, HIV, syphilis, rubella and measles were also performed. A total of 340 participants were included, most were female (228, 67.1%) with an average age of 36.5 years (SD ± 12.2 years). The highest prevalence was of ZIKV monoinfections (65.3%, 222/340), followed by DENV (0.9%, 3/340) and CHIKV infection (0.3%, 1/340). No cases of MAYV, OROV or rubella were found. Other causes of skin rash were detected: measles (2.9%, 10/340), parvovirus B19 (0.9% 3/340), HIV (0.3%, 1/340) and syphilis 0.6% (2/340). The co-infections identified were ZIKV+HIV (0.3%, 1/340), ZIKV+measles (0.3%, 1/340), ZIKV+parvovirus B19 (0.3%, 1/340), ZIKV+EBV (0.3%, 1/340), EBV+parvovirus B19 (0.3%, 1/340), CMV+parvovirus B19 (0.6%, 2/340), CMV+syphilis (0.3%, 1/340), ZIKV+EBV+parvovirus B19 (0.3%, 1/340) and CMV+EBV+parvovirus B19 (0.9%, 3/340). Approximately one quarter of patients had no defined cause for their skin rash (25.3%, 86/340). CONCLUSIONS: Despite the benign clinical evolution of most of the diseases diagnosed in this series of cases, syndromic surveillance of diseases such as syphilis and HIV are of utmost importance. Periodic serosurveillance might also aid in evaluating the trends of endemic diseases and eventual outbreaks.

Myopericarditis associated with acute Zika virus infection: a case report.

BACKGROUND: Zika virus infection is commonly described as a mild and self-limiting illness. However, cardiac complications were associated with acute Zika virus infection. CASE PRESENTATION: A 46-year-old woman without previous comorbidities with a 1-day history of symptoms tested positive for ZIKV by real time reverse transcriptase polymerase chain reaction (rRT-PCR). She was admitted two days after with clinical worsening, cardiac enzymes elevated, and cardiac imaging findings, and the diagnosis of myopericarditis was made. The patient was treated and presented significant clinical improvement after one year. CONCLUSIONS: Cardiac complication following ZIKV infection appears to be infrequent. Here, we report a rare case of viral myopericarditis caused by ZIKV infection.

Patient-perceived barriers to surgical treatment of cleft lip and palate in Brazil: A multi-region study.

INTRODUCTION: Many patients worldwide are unable to access timely primary repair of cleft lip and palate. The aim of this study was to assess patient-perceived barriers to accessing timely cleft lip and palate repair across Brazil. METHODS: A 29-item questionnaire was applied to patients undergoing surgery for cleft lip and/or palate across five contrasting sites in Brazil from February 2016 to November 2017. Differences in patient timelines, demographics, and patient-reported barriers were compared by region. A multivariate logistic regression was used to determine predictors of delayed care. RESULTS: Of 181 patients, 42% of patients received timely primary surgical repair. The age of the patient at the interview was 82 months (standard deviation [SD] 107) and 52% were male. The majority of delays occurred between diagnosis and primary surgical repair. The mean number of barriers to accessing timely surgical care cited by each patient was 3.77. The most common barrier was perceived "lack of hospitals that provided the surgery in my area" (48% (n = 86)). Univariate logistic regression showed increased odds of receiving late care in the state of Amazonas (odds ratio [OR] 2.91; 95% confidence interval [CI] 1.07-7.96; P = 0.037) or Para (OR 4.46; 95% CI 1.09-19.70; P = 0.037). Multivariate logistic regression determined predictors of delayed care to be female sex (OR = 2.05; 95% CI 1.05-3.99; P = 0.035) and perceived poor availability of care (OR = 0.045; 95% CI 1.02-4.37; P = 0.045). CONCLUSION: The majority of patients in Brazil are not receiving timely primary repair of their clefts. Improvements in the coordination of care, patient education and patient empowerment are required.

Anti-Trichomonas vaginalis activity and chemical analysis of metabolites produced by marine-associated fungi.

Trichomoniasis is the most common non-viral sexually transmitted infection worldwide and it may have serious consequences, especially for women. Currently, 5-nitroimidazole drugs are the treatment of choice for trichomoniasis, although presenting adverse effects and reported cases of drug resistance. Metabolites isolated from marine fungi have attracted considerable attention due to their unique chemical structures with diverse biological activities, including antiprotozoal activity. In this study, we showed the anti-Trichomonas vaginalis activity of fractions obtained from marine fungi and the chemical composition of the most active fraction was determined. Ethyl acetate fractions of the fungus Aspergillus niger (EAE03) and Trichoderma harzianum/Hypocrea lixii complex (EAE09) were active against T. vaginalis. These samples, EAE03 and EAE09, were also effective against the fresh clinical isolate metronidazole-resistant TV-LACM2R, presenting MIC values of 2.0 mg/mL and 1.0 mg/mL, respectively. The same MIC values were found against ATCC 30,236 T. vaginalis isolate. In vitro cytotoxicity revealed only the fraction named EAE03 with no cytotoxic effect; however, the active fractions did not promote a significant hemolytic effect after 1-h incubation. Already, the in vivo toxicity evaluation using Galleria mellonella larvae demonstrated that none of the tested samples caused a reduction in animal survival. The fraction EAE03 was followed for purification steps and analyzed by LC-DAD-MS. Eleven compounds were annotated, including butyrolactone, butanolide, and atromentin. Overall, the range of activities reported confirms the potential of marine fungi to produce bioactive molecules.

One waste and two products: choosing the best operational temperature and hydraulic retention time to recover hydrogen or 1,3-propanediol from glycerol fermentation.

This study aimed to compare the production of hydrogen and 1,3-propanediol from crude glycerol (10 g/L) in mesophilic (30 °C) and thermophilic (55 °C) anaerobic fluidized bed reactors, namely AFBR30 °C and AFBR55 °C, respectively, at hydraulic retention times (HRT) reduced from 8 to 1 h. In AFBR30 °C, the absence or low hydrogen yields can be attributed to the production of 1,3-propanediol (maximum of 651 mmol/mol glycerol), and the formation of caproic acid (maximum of 1097 mg/L) at HRTs between 8 and 2 h. In AFBR55 °C, the hydrogen yield of 1.20 mol H2/mol glycerol consumed was observed at the HRT of 1 h. The maximum yield of 1,3-propanediol in AFBR55 °C was equal to 804 mmol/mol glycerol at the HRT of 6 h and was concomitant with the production of hydrogen (0.87 mol H2/mol glycerol consumed) and butyric acid (1447 mg/L).