Effects of prevention programmes on injury risk in military personnel: a systematic review with meta-analysis.

INTRODUCTION: Exercise programmes have been used to prevent injuries in military personnel, as they can reduce modifiable risk factors for injuries. Our aim was to review the literature to evaluate the effects of different exercise protocols on the prevention of injuries in military personnel. METHODS: A systematic literature review examined the effects of different exercise protocols on the prevention of musculoskeletal injuries in the military. Several databases were explored to find experimental studies that investigated the effects of prevention programmes on the risk of injury. We have extracted from the studies: profile of participants, sample size, study design and characteristics of the control group (CG), the type of intervention and the relative risk (RR) in the experimental group and CG, with their significance levels. For data analysis, we used the RevMan V.5.3 software. The measure of RR was investigated. The risk of publication bias was analysed with Begg's test. RESULTS: A total of 13 694 titles and studies were recovered from the databases and by manual search. After the removal of duplicate titles and studies that did not meet the eligibility criteria, 17 studies were selected. The protocols were composed of neuromuscular training, stretching, agility training or combined exercises. The meta-analysis showed that injury prevention exercise programmes reduced the risk of musculoskeletal injuries in military personnel by 14% (RR=0.86; 95% CI=0.76 to 0.98). CONCLUSION: Injury prevention exercise programmes promoted a slight reduction in the risk of musculoskeletal injuries in military personnel. LEVEL OF EVIDENCE: Very low. TRIAL REGISTRATION NUMBER: CRD 42017077946.

A Review of the Use of Black Soldier Fly Larvae, Hermetia illucens (Diptera: Stratiomyidae), to Compost Organic Waste in Tropical Regions.

Hermetia illucens (L., 1758) is a fly of the family Stratiomyidae frequently found in tropical zones. Adult flies are not considered pathogens as they are incapable of biting and feeding thus not transmitting sicknesses to humans. The larval stage feeds off organic matter and offer a rich protein source naturally consumed by animals. The use of black soldier fly (BSF) larvae to treat organic waste is growing around the world. This is especially true for tropical low- and middle-income countries as their favourable climate conditions mean that the BSF technology has significant potential to solve existing problems associated with a poorly developed sanitation infrastructure. In this study, we evaluate the feasibility, benefits and limitations of implementing BSF projects in tropical regions using Belem, in Brazil, as a case study. Black soldier fly prepupae, arising from the waste reduction process, can be used as animal feed. It therefore offers potential to promote regional development, create jobs and dispose of organic waste locally. Legal requirements as outlined in the Brazilian National Policy on Waste offer further incentives. However, more studies are needed to compare BSF waste reduction efficiency and prepupae yield to other technologies such as traditional composting and vermiculture, which can inform the decision-making for implementation of organic waste treatment facilities.

Investigação do gene p53 de frangos expostos às aflatoxinas / Investigation of p53 gene in poultries exposed to aflatoxins

Identificou-se o efeito das aflatoxinas (AFs) sobre o gene p53 de frangos de corte, de linhagem comercial, separados em: grupo experimental, tratado (GT) com ração comercial contendo 2,8ppm de AFs totais durante 21 dias consecutivos, e grupo-controle (GC), sem exposição às AFs. Macroscopicamente, as alterações caracterizaram-se por hepatomegalia e aspecto pálido-amarelado com alguns focos hemorrágicos e, histologicamente, por desarranjo trabecular, pleomorfismo hepatocítico com cariomegalia, degeneração vacuolar intracitoplasmática, necrose com infiltração linfocítica e hiperplasia de ductos biliares. A PCR com os primers GSPT53c-1 com base no gene candidato a p53 (GenBank XM_424937.2) gerou um produto de aproximadamente 350 pares de base. O amplicon sequenciado a partir do DNA dos frangos do GT não apresentou mutação ou deleção, assim como padrão de bandas do PCR-RFLP não foi distinto entre ambos os grupos experimentais e a sequência depositada no banco de genes. Os resultados sugerem que não ocorreu transversão devido à exposição às AFs no fragmento amplificado. Conclui-se que a PCR-RFLP e o sequenciamento do produto da PCR não são ferramentas apropriadas para diagnóstico da exposição de frangos às AFs nas condições experimentais empregadas.

To identify the effects of aflatoxins (AFs), Cobb lineage poultry were separated in an experimental group in which they were treated with commercial ration containing 2.8ppm of total AFs during 21 days (TG) and a control group without AFs exposure (CG). In the liver of poultries exposed to AFs, alterations were microscopically observed, which were characterized by hepatomegaly, a pale yellowish aspect with some hemorrhagic spots, and histologically a trabecullar disarranging pleomorphic hepatocytes with cariomegaly, intracytoplasmatic vacuolar degeneration, necrosis, lymphocytic infiltration and hyperplasia of biliary ducts. The PCR with GSPT53c-1 primers based on p53 candidate gen (GenBank XM_424937.2) generated a product of approximately 350 base pairs. The sequenced amplicon obtained from the DNA of treated poultry did not display any mutation or deletion, and the PCR- RFLP bands patterns were also not distinct in both experimental groups. The results indicated that transversion did not occur in the fragment amplified due to AFs exposure. As a consequence of results obtained with p53 gene (NM_205264.1) we concluded that PCR-RFLP and sequencing of PCR product are not appropriate diagnostic tools for the detection of poultry exposure to AFs, at least in the experimental conditions performed.

Antimicrobial activity of synthetic bornyl benzoates against Trypanosoma cruzi.

We report here for the first time the in vitro effects of (1S,2R,4S)-1,7,7-trimethyl-bicyclo[2·2·1]heptan-2-yl-3',4',5'-trimethoxy benzoate (1) and (1S,2R,4S)-1,7,7-trimethyl-bicyclo[2·2·1]heptan-2-yl benzoate (2) on the growth and ultrastructure of Trypanosoma cruzi. These two synthetic compounds exerted an antiproliferative effect on the epimastigote forms of the parasite. The ICs(50/72h) of two synthetic L-bornyl benzoates, 1 and 2, was 10·1 and 12·8 µg/ml, respectively. Both compounds were more selective against epimastigotes than HEp-2 cells. Ultrastructural analysis revealed intense cytoplasmic vacuolization and the appearance of cytoplasmic materials surrounded by membranes. The treatment of peritoneal macrophages with compounds 1 and 2 caused a significant decrease in the number of T. cruzi-infected cells. L-Bornyl benzoate derivatives may serve as a potential source for the development of more effective and safer chemotherapeutic agents against T. cruzi infections.

Design and technology in the development of potters' lathes for modeling with terracota: the case of Cabo de Santo Agostinho.

This article reports the experience of the design team of the Laboratory The Imaginary in the process of developing an electric potter's lathe which respects the biomechanics of the body, helps to development the task, maintains the archetype of traditional equipment, and improves the mechanical efficiency of the power transmission system. The design method used was based on the axes of research, analysis, development and monitoring, and focused on the product and with partners: the artisans and engineering and production teams. The main results point to ergonomic improvements in the biomechanical and dimensional aspects, and a decrease in the risk of accidents and occupational diseases. The experience of this case also highlights the gains arising from the relationship between design, engineering and users (artisans) in developing products with a design that can be easily replicated for other communities of potters in the state. This and other actions are part of the outlook of the Laboratory the Imaginary which in partnership with local authorities, wishes to see the craft activities continue and to give value to the culture of the city.

In vivo anthelmintic activity of an aqueous extract from sisal waste (Agave sisalana Perr.) against gastrointestinal nematodes in goats.

The resistance of gastrointestinal nematodes (GINs) of small ruminants to anthelmintics has required the investigation of new alternatives. The aim of the present study was to evaluate the in vivo anthelmintic activity of an aqueous extract from sisal waste (Agave sisalana) (AESW) against GINs in goats and to observe the animals for toxic effects. Thirty animals that were naturally infected with GINs were distributed into three groups: group I, was treated with daily doses of AESW (1.7 g/kg) for eight days; Group II, the positive control, was treated with a single dose of levamisole phosphate (6.3mg/kg); and group III, the negative control, was left untreated. Faecal eggs counts (FECs), coprocultures and post-mortem worm counts were performed to assess the efficacy of the treatments. Clinical and laboratory analyses were performed to evaluate any toxic effects associated with the treatment. In the goats in groups I and II, a significant reduction (p<0.05) of the number of eggs and infective larvae (L(3)) was observed. The maximum reductions of the FECs were 50.3% and 93.6% for groups I and II, respectively, whereas the percent reductions of the total number of L(3) larvae were 80% (group I) and 85.6% (group II). There was no difference between groups I and III with respect to worm burden, and the percent reductions were 28.8% and 63.4% for Oesophagostomum columbianum and Trichostrongylus colubriformis, respectively. No reduction was detected for the Haemonchus contortus. The positive control group demonstrated a 74% reduction of the parasites that were recovered from the digestive tract. There were no changes in clinical and haematological parameters. The levels of serum urea and creatinine were higher in group I, but remained within the normal range. At necropsy, pale mucous membranes, abomasitis and enteritis were associated with parasitism. In addition, a histological analysis of the liver and kidney did not reveal any changes suggestive of toxicity. A chemical analysis of the AESW demonstrated the presence of saponins, which after acid-hydrolyses reaction, gave the sapogenins hecogenin and tigogenin. The AESW had a low efficacy for the parasitic stages and was moderately effective against eggs and free-living stages. Furthermore, the treatment was not toxic to the goats.

Structural determination of 3beta-stearyloxy-urs-12-ene from Maytenus salicifolia by 1D and 2D NMR and quantitative 13C NMR spectroscopy.

Six pentacyclic triterpenoids, 3beta-stearyloxy-urs-12-ene (1), friedelin (2), 3beta-friedelinol (3), alpha-amyrin (4), beta-amyrin (5), and lupeol (6), have been isolated from the hexane extract of Maytenus salicifolia Reissek (Celastraceae) leaves. The molecular and structural formula as well as the stereochemistry of a new pentacyclic triterpene (1) were determined using data obtained from 1H and 13C NMR spectra, DEPT135 and by 2D HSQC, HMBC, COSY and NOESY experiments. The molecular formula C48H84O2 was established using quantitative 13C NMR, and the molecular weight (692 Da) was confirmed by elemental analysis and mass spectrometry (GC-MS).

Avaliação da atividade antiulcerogênica da Maytenus truncata Reiss (Celastraceae) / Evaluation of antiulcerogenic activity of Maytenus truncata Reiss (Celastraceae)

Maytenus truncata Reiss (Celastraceae) é uma planta nativa da Bahia (Brasil), sendo conhecida como "espinheira-santa". É usada popularmente na forma de decoto das folhas (chás) como antiulcerogênico, similarmente à Maytenus ilicifolia, a verdadeira "espinheira-santa". O objetivo do presente estudo foi avaliar a atividade antiúlcera e cicatrizante, assim como o perfil fitoquímico dos extratos brutos em acetato de etila e metanol da Maytenus truncata. A administração per os desses extratos nas doses de 120 mg/kg e 240 mg/kg reduziu a severidade da lesão gástrica induzida pelo estresse ao frio (-18 °C por 45 minutos) em ratos, com resultados mais significativos para o extrato bruto obtido em metanol. A administração dos extratos provocou o aumento do pH. Os resultados obtidos na administração do extrato bruto em metanol não contrariam seu uso popular, não somente pela atividade observada, mas também por se tratar de um extrato de alta polaridade cujos princípios podem ser obtidos a partir de uma infusão, embora estudos clínicos devam ser realizados para confirmação dessa hipótese.

Maytenus truncata Reiss (Celastraceae) is a native plant from Bahia (Brazil), known as "espinheira-santa". It is popularly used in the form of decoct of leaves (tea) as antiulcerogenic, similarly to Maytenus ilicifolia, the true "espinheira-santa". This study aims to evaluate antiulcerogenic and healing activities, as well as the phytochemical profile, of ethyl acetate and methanol crude extracts of Maytenus truncata. Per os administration of these extracts at 120 mg/kg and 240 mg/kg doses decreased the severity of gastric lesions induced by cold-restraint stress (-18 °C for 45 minutes) in rats, with more significant results for the crude methanol extract. The administration of the extracts caused pH increase. The results obtained with the administration of crude methanol extract are not contrary to its popular use, not only for the activity observed but, also, for its high polarity that enables the obtention of the active principles through infusion, though clinical studies should be performed to confirm this assertion.

Determinants of acquisition and carriage of Staphylococcus aureus in infancy.

Nasal carriage of Staphylococcus aureus is a major risk factor for invasive S. aureus disease. The aim of this study was to define factors associated with carriage. We conducted a prospective, longitudinal community-based study of infants and their mothers for a period of 6 months following delivery. The epidemiology of carriage was examined for 100 infant-mother pairs. Infant carriage varied significantly with age, falling from 40 to 50% during the first 8 weeks to 21% by 6 months. Determinants of infant S. aureus carriage included maternal carriage, breastfeeding, and number of siblings. Bacterial typing of S. aureus was performed by pulsed-field gel electrophoresis and multilocus sequence typing. The majority of individuals carried a single strain of S. aureus over time, and the mother was the usual source for colonizing isolates in infants. The effect of other components of the normal nasal flora on the development of S. aureus carriage was examined in 157 consecutive infants. Negative associations (putative bacterial interference) between S. aureus and other species occurred early in infancy but were not sustained. An increasing antistaphylococcal effect observed over time was not attributable to bacterial interference. S. aureus carriage in infants is likely to be determined by a combination of host, environmental, and bacterial factors, but bacterial interference does not appear to be an ultimate determinant of carrier status.

Comparison of multilocus sequence typing and pulsed-field gel electrophoresis as tools for typing Staphylococcus aureus isolates in a microepidemiological setting.

Multilocus sequence typing (MLST) of Staphylococcus aureus is well suited to the study of global or long-term epidemiology, but its role in local epidemiology has not been defined. The present study has compared MLST with pulsed-field gel electrophoresis (PFGE) by using S. aureus isolates associated with carriage and disease in a busy regional renal unit. One hundred forty-four patients were prospectively recruited, of whom 103 were receiving hemodialysis and 41 were on continuous ambulatory peritoneal dialysis. Three nasal swab specimens were obtained 1 month apart on entering the study. A nasal swab was positive for S. aureus on at least one occasion in 50 patients (35%). Typing of the 104 carriage isolates demonstrated 21 PFGE types and 21 sequence types (STs). Thirty-one carriers had two or more positive nasal swabs; of these, the isolates in all swabs from a given carrier had identical PFGE types for 29 carriers; the isolates in all of the same 29 swabs had identical STs. The carriage strain in two patients changed both PFGE type and STs during the period of swabbing. Eight patients (6%) had an episode of S. aureus bacteremia during the 12-month study period, and two of these were nasal carriers. One of these invasive isolates had the same PFGE type and ST as the carriage isolate. There were no differences between Simpson's index of diversity for PFGE and Simpson's index of diversity for MLST for both invasive and carriage isolates, suggesting that the two methods have very similar discriminatory abilities. We conclude that PFGE and MLST performed equally in this study.

The ica operon and biofilm production in coagulase-negative Staphylococci associated with carriage and disease in a neonatal intensive care unit.

Coagulase-negative staphylococci (CoNS) are a major cause of sepsis in the neonatal intensive care unit (NICU). We evaluated the hypothesis that the ica operon and biofilm production are associated with CoNS disease in this setting. CoNS associated with bacteremia or blood culture contamination and from the skin of infants with CoNS bacteremia or healthy controls were obtained during a prospective case-control study on a busy NICU. A total of 180 strains were identified, of which 122 (68%) were Staphylococcus epidermidis and the remainder were S. capitis (n = 29), S. haemolyticus (n = 11), S. hominis (n = 9), S. warneri (n = 8), and S. auricularis (n = 1). The presence of the genes icaA, icaB, icaC, and icaD was determined by PCR, and biofilm production was examined using qualitative (Congo red agar [CRA]) and quantitative (microtiter plate) techniques. There were no significant differences in the presence of the ica operon or CRA positivity among the four groups of strains. However, quantitative biofilm production was significantly greater in strains isolated from either the blood or the skin of neonates with S. epidermidis bacteremia. We conclude that the quantity of biofilm produced may be associated with the ability to cause CoNS infection. This conclusion suggests that the regulation of biofilm expression may play a central role in the disease process.

Genetic population structure of coagulase-negative staphylococci associated with carriage and disease in preterm infants.

Coagulase-negative staphylococci (CoNS) are a leading cause of sepsis in the neonatal intensive care unit (NICU) setting. To evaluate the hypothesis that isolates of CoNS associated with disease belong to hypervirulent clones, as opposed to being drawn randomly from the neonatal unit carriage flora, we conducted a prospective, case-controlled study in a busy NICU. Using pulsed-field gel electrophoresis (PFGE), we compared the population structures of CoNS isolates associated with bacteremia with isolates from the skin of healthy and infected neonates and with blood culture contaminants. Endemic clones of CoNS were identified, but there was no difference in the distribution of the 6 species or 73 PFGE types between the carriage and disease isolate groups; this suggests that hypervirulent clones with an enhanced ability to cause disease were not present in this NICU setting.

Evaluation of the tablet coating by the conventional spouted-bed process.

The purpose of this paper was to present an analysis of the tablet coating by the conventional spouted-bed process. To analyze the equipment performance, the rate of increase of the tablets mass, K1, and the adhesion coefficient eta were determined as a function of the feed flow rate of coating suspension Ws; of the Reynolds number Rep; of the flow rate of atomizing gas Wat, and of the cone base angle gamma. To analyze the product quality, the uniformity of coating mass deposition onto the tablet's surface was used. Three different procedures for description of kinetics growth, weighing method, image analysis, and measurements with a micrometer were used to verify the validity of the commonly used weighing method. Comparison between experimental results of kinetics growth with estimates obtained by a literature model was also performed. A tendency toward an increase in K1 and in eta with the feeding flow rate of coating suspension Ws was detected. The weighing method can be used for the process analysis. The kinetics of growth can be described by the growth model used. The variable that produce more pronounced effect on K1 and eta was the feed flow rate of coating suspension, the weighing method describes very well the increase of particle diameter with coating time, the growth model can be used for the describe the kinetics of growth during the coating operation, and the coating does not deposit uniformly onto the tablet's surface.

Evidence for dual effects of nitric oxide in the forced swimming test and in the tail suspension test in mice.

L-Arginine (L-Arg), a substrate for nitric oxide synthase (NOS) at a dose of 250-500 mg/kg, i.p., significantly reduced the duration of immobility both in the forced swimming test (FST) and in the tail suspension test (TST), two models of depression in mice, without changing locomotion in an open field. Paradoxically, a similar effect was observed with the administration of N(G)-nitro-L-arginine (L-NNA) (0.3-10 mg/kg, i.p.), an inhibitor of NOS. However, higher doses of L-Arg (750-1000 mg/kg) and L-NNA (30 mg/kg) did not produce any anti-immobility effect in FST and TST. The inactive isomers D-Arg (100-1000 mg/kg, i.p.) and D-NNA (0.3-30 mg/kg, i.p.) did not affect immobility duration in either the FST and TST. Preadministration of L-NNA (30 mg/kg, i.p.), but not of D-NNA completely blocked the anti-immobility effect of L-Arg (500 mg/kg, i.p.) in the FST. Similarly, L-Arg (750 mg/kg, i.p.), but not D-Arg blocked the anti-immobility effect of L-NNA (3 mg/kg, i.p.) in the FST. The results indicate that either the synthesis of NO or the inhibition of its synthesis may produce antidepressant-like effects when assessed in the FST and TST. The physiological meaning of this finding is still obscure, but it could indicate that NO has a dual role in the modulation of depression.

Relationship of mercury with aluminum, iron and manganese oxy-hydroxides in sediments from the Alto Pantanal, Brazil.

Sediments from nine floodplain lakes in Pantanal were analyzed for a large-scale (300 km) survey of mercury (Hg) load in sediments and soils of the Alto Pantanal and to study the relationship between Hg and reactive aluminum, iron, and manganese oxy-hydroxides. The results were compared with the Hg content in river and stream sediments from the Poconé gold mining area, where Hg has been extensively used and still is in use. The results indicate that the Hg concentrations were elevated in river sediment close to the mining area in Bento Gomes river basin (average in the < 74-microm fraction 88.9 ng Hg g(-1) dry wt.; interquartile range 50.3-119.5), but there was no clear indication that the local Hg emissions have contaminated the remote floodplain lakes, where concentrations were surprisingly low (average in the < 74-microm fraction 33.2 ng Hg g(-1) dry wt. sediment; interquartile range 18.4-46.8), in particular when considering geochemical characteristics of the sediment. The sediment from the floodplain lakes contained less Hg-tot and more reactive iron oxy-hydroxides than soils from the Tapajós area in the Amazon basin. This resulted in a mass ratio between Hg and amorphous oxy-hydroxides of only 5 x 10(-6) for Hg-tot/Fe-oxa (interquartile range 3-7 x 10(-6).

Obstetric performance, perinatal outcome and risk of infection to the newborn in spontaneous and artificial rupture of membranes during labour.

OBJECTIVE: To compare the obstetric performance, perinatal outcome and risk of neonatal infection in labour following spontaneous (SROM) and artificial (AROM) rupture of membranes. DESIGN: Prospective, non-randomised, comparative study during a one-month period in 1995. The study was approved by the ethics committee of the Faculty of Medicine, University of Colombo. SETTING: University Obstetrics Unit at De Soysa Hospital for Women, Colombo. PATIENTS: 324 women who were in early established labour after 37 weeks of gestation. 151 of these had SROM and 173 AROM. The AROM and SROM groups among primigravidae and multigravidae were considered separately. RESULTS: Oxytocin use in multigravidae was significantly higher in the AROM group than in the SROM group (p < 0.001). The emergency caesarean section (LSCS) rate in primigravidae was significantly higher in the AROM group than the SROM group (p < 0.001). A significantly larger number of primigravid AROM women had abnormal fetal heart rate changes on auscultation (p < 0.05) and cardiotopographic (CTG) patterns (p < 0.001) when compared with primigravid SROM women. Choreoamnionitis and funisitis were commoner in the AROM group although the difference was not statistically significant. CONCLUSIONS: AROM appears to be associated with a higher chance of fetal distress particularly in primigravidae. Both AROM and SROM are associated with a potential risk of infection at intrauterine sites.

PIP: Artificial rupture of the membranes during established labor is believed to augment labor progression, but this practice carries the risk of maternal and neonatal infection. A prospective study conducted at De Soysa Hospital for Women in Colombo, Ceylon, in 1995 compared the obstetric performance, perinatal outcome, and risk of neonatal infection in 151 women with spontaneous rupture of membranes (SROM) and 173 women with artificial rupture of membranes (AROM). The need for oxytocin was higher in both primi- and multigravidae in the AROM group (37.5% and 38.8%, respectively) than the SROM group (24.7% and 18.9%, respectively), but this association reached statistical significance only among multigravidae. Also higher in the AROM group than the SROM group, but not significantly, were the rates of instrumental delivery and emergency cesarean section. Compared with primigravid AROM women, a significantly larger number of primigravid AROM women had abnormal auscultated fetal heart rates and cardiotopographic patterns. The appearance of meconium in liquor and the occurrence of low Apgar scores were similar in both groups. There were no clinical maternal or neonatal infections, but the intrauterine sites showed evidence of inflammation soon after membrane rupture. 36.1% of women in the SROM group and 24.0% of those in the AROM group whose cord and membranes were evaluated had histologic evidence of inflammation. Choreoamnionitis and funisitis were slightly more common in the AROM group. The potential for infection at intrauterine sites had no linear relationship to the mean membrane rupture-delivery interval or the number of vaginal examinations.

Myocardial infarction in an infant due to anomalous origin of the left coronary artery.

Myocardial infarction in an infant due to anomalous origin of the left coronary artery from the pulmonary trunk is reported. The pathological features, haemodynamics related to morphology and differential diagnosis are discussed.

Is it Munchausen syndrome by proxy?

We describe two cases of children who were victims of illness fabricated by their mothers. Such clinical situations are identified as Munchausen syndrome by proxy (MSP). Although considered a form of child abuse, MSP often goes unrecognised in paediatric practice. The two children involved were unnecessarily investigated, and the underlying problems in the mothers were identified only after several hospital admissions. One mother had a major psychiatric disorder, and the other had serious marital problems. Maintaining a high degree of suspicion regarding inexplicable illness in a child with inappropriate or incongruous symptoms and signs, even when parents behave in an exemplary manner, would help in early diagnosis and management.