[Thyroid surgery in a context of scarce resources at Saint Martin de Porres Dominican Hospital (Yaounde, Cameroon)]. / Chirurgie thyroïdienne dans le contexte de populations avec de faibles ressources à l'hôpital dominicain Saint Martin de Porres (Yaoundé, Cameroun).

Introduction: Surgical campaigns for thyroid surgery in low-income environments are very efficient, but there is little literature reporting results. These campaigns are complex due to multiple particularities: highly evolved cases, the need for professionals to travel or an obvious socio-cultural barrier influence towards the surgical act. We describe a surgical campaign in Cameroon to treat patients with goiter and issue some medical and sociocultural recommendations in view of our experience for its implementation with guarantees. Material and methods: An experienced group carried out an 11-day campaign at the Saint Martin de Porres Dominican Hospital, Yaounde, Cameroon. Demographic data, TSH values, surgery and complications after a 12-month follow-up were analyzed. Results: Thirty-eight patients with goiter were selected for the campaign and 32 patients (mean age, 40-years-old; 30 females) were operated. Bilateral goiter, as assessed with echography, was diagnosed in 13 patients (41%). Ten patients (31%) had a WHO grade II goiter (visible with the neck in a normal position). The surgical procedures were 18 unilateral thyroidectomy with isthmectomie, 13 total thyroidectomy, and 1 totalizing thyroidectomy, due to previous unilateral thyroidectomy (cancer recurrence). A pathological study in 13 patients (40%, extra cost 60 €) showed benign multinodular goiter/thyroid nodule (12 patients) and an extensive papillary carcinoma (one patient). Six months postoperatively, 3 patients had a slight dysphonia and one patient had persistent hypocalcemia. Follow-up was completed in all patients, either face to face (75%, 24 patients) or by phone (25%, 8 patients who failed to have a TSH test because of its cost, 23 €). Conclusions: Surgical campaigns to treat thyroid pathology can be carried out with guarantees if a series of important steps are followed: active participation of the patient's environment, thyroid ultrasound by the surgical team to decide which technique, intense awareness about monitoring and hormone replacement therapy, and the participation of local personnel for long-term follow-up.

Physicochemical properties of wild and cultivated Saccharina latissima macroalgae harvested in the Canadian boreal-subarctic transition zone.

Saccharina latissima is a brown seaweed used as a food ingredient. The aim of this work was to study possible differences between S. latissima chemical composition, color, mode of cultivation, harvesting period and site and its environmental conditions. Water temperature, salinity, radiation, and fluorescence were monitored in each harvesting site. Chemical composition of S. latissima varied greatly with period and site, with a high content of carbohydrates and ash. Crude protein content varied from 3.7 % to 12.8 %, with a higher concentration observed in wild samples harvested in Bas-St. Laurent (11.1-12.8 %). Cultivated seaweed also presented a high crude protein (12.2 %) and ash (52 % against 27 % in wild samples) concentrations, but crude fiber and carbohydrates concentrations were lower, reaching up to 2.7 and 1.9-fold, respectively, than those in wild seaweeds. S. latissima presented a more intense yellow color in June. A trend of darker and more green-colored seaweeds when cultivated in the end of summer was confirmed. Our results suggest that variations in chemical components and chromaticity of this species are probably affected by complex interactions of environmental conditions.

Viral Interference between the Insect-Specific Virus Brejeira and the Saint Louis Encephalitis Virus In Vitro.

The Saint Louis encephalitis virus (SLEV) is an encephalitogenic arbovirus (Flaviviridae family) that has a wide geographical distribution in the western hemisphere, especially in the Americas. The negevirus Brejeira (BREV) was isolated for the first time in Brazil in 2005. This study aimed to verify the existence of a possible interfering effect of BREV on the course of SLEV infection and vice versa. We used clone C6/36 cells. Three combinations of MOIs were used (SLEV 0.1 × BREV 1; SLEV 1 × BREV 0.1; SLEV 1 × BREV 1) in the kinetics of up to 7 days and then the techniques of indirect immunofluorescence (IFA), a plaque assay on Vero cells, and RT-PCR were performed. Our results showed that the cytopathic effect (CPE) caused by BREV was more pronounced than the CPE caused by SLEV. Results of IFA, the plaque assay, and RT-PCR showed the suppression of SLEV replication in the co-infection condition in all the MOI combinations used. The SLEV suppression was dose-dependent. Therefore, the ISV Brejeira can suppress SLEV replication in Aedes albopictus cells, but SLEV does not negatively interfere with BREV replication.

Acute disseminated encephalomyelitis following Saint Louis encephalitis virus infection.

Saint Louis encephalitis virus (SLEV) infection is an arbovirosis associated with a broad spectrum of neurological complications. We present a case of a 55-year-old man hailing from Manaus, a city situated in the heart of the Amazon Rainforest, who exhibited symptoms of vertigo, tremors, urinary and fecal retention, compromised gait, and encephalopathy 3 weeks following SLEV infection. Neuroaxis MRI revealed diffuse, asymmetric, and poorly defined margins hyperintense lesions with peripheral and ring enhancement in subcortical white matter, as well as severe spinal cord involvement. Serology for SLEV was positive both on serum and cerebrospinal fluid. To the best of our knowledge, the present report is the first to show brain lesions along with myelitis as a post-infectious complication of SLEV infection.

Suicidal Behaviour among School-Going Adolescents in Saint Lucia: Analysis of Prevalence and Associated Factors.

Suicide poses a debilitating threat to adolescents' lives worldwide. Although suicide prevention efforts are evident globally, there is limited evidence on the prevalence and correlations of suicidal behaviour among school-going adolescents in Saint Lucia. We used a dataset from the 2018 Global School-based Student Health Survey to examine the prevalence and associated factors of suicidal behaviour among 1864 students from schools in Saint Lucia. Prevalence rates of 25.5%, 22.1%, and 17.5% were found for suicidal ideation, suicide plan, and suicide attempt, respectively. After adjusting for other factors, being male and having understanding parents were protective against suicidal behaviour. However, suicidal ideation was predicted by being physically attacked and bullied, parental guidance, tobacco use, loneliness, and worry. Moreover, being a victim of physical attacks and bullying, having close friends, being lonely, and worrying were predictive of making suicidal plans among adolescents. Attempting suicide was predicted by cigarette smoking, current use of tobacco and related products, bullying, having close friends, being lonely, and worrying. School-based preventive interventions are required to help address triggers of suicidal behaviour among adolescents in Saint Lucia and to help attain the targets for suicide prevention in the global Sustainable Development Goals.

Arboviruses in Mammals in the Neotropics: A Systematic Review to Strengthen Epidemiological Monitoring Strategies and Conservation Medicine.

Arthropod-borne viruses (arboviruses) are a diverse group of ribonucleic acid (RNA) viruses, with the exception of African swine fever virus, that are transmitted by hematophagous arthropods to a vertebrate host. They are the important cause of many diseases due to their ability to spread in different environments and their diversity of vectors. Currently, there is no information on the geographical distribution of the diseases because the routes of transmission and the mammals (wild or domestic) that act as potential hosts are poorly documented or unknown. We conducted a systematic review from 1967 to 2021 to identify the diversity of arboviruses, the areas, and taxonomic groups that have been monitored, the prevalence of positive records, and the associated risk factors. We identified forty-three arboviruses in nine mammalian orders distributed in eleven countries. In Brazil, the order primates harbor the highest number of arbovirus records. The three most recorded arboviruses were Venezuelan equine encephalitis, Saint Louis encephalitis and West Nile virus. Serum is the most used sample to obtain arbovirus records. Deforestation is identified as the main risk factor for arbovirus transmission between different species and environments (an odds ratio of 1.46 with a 95% confidence interval: 1.34-1.59). The results show an increase in the sampling effort over the years in the neotropical region. Despite the importance of arboviruses for public health, little is known about the interaction of arboviruses, their hosts, and vectors, as some countries and mammalian orders have not yet been monitored. Long-term and constant monitoring allows focusing research on the analysis of the interrelationships and characteristics of each component animal, human, and their environment to understand the dynamics of the diseases and guide epidemiological surveillance and vector control programs. The biodiversity of the Neotropics should be considered to support epidemiological monitoring strategies.

Serological Evidence of Exposure to Saint Louis Encephalitis and West Nile Viruses in Horses of Rio de Janeiro, Brazil.

Infections with arboviruses are reported worldwide. Saint Louis encephalitis (SLEV) and West Nile (WNV) viruses are closely related flaviviruses affecting humans and animals. SLEV has been sporadically detected in humans, and corresponding antibodies have been frequently detected in horses throughout Brazil. WNV was first reported in western Brazil over a decade ago, has been associated with neurological disorders in humans and equines and its prevalence is increasing nationwide. Herein, we investigated by molecular and serological methods the presence of SLEV and WNV in equines from Rio de Janeiro. A total of 435 serum samples were collected from healthy horses and tested for specific neutralizing antibodies by plaque reduction neutralization test (PRNT90). Additionally, samples (serum, cerebrospinal fluid, central nervous system tissue) from 72 horses, including horses with neurological disorders resulting in a fatal outcome or horses which had contact with them, were tested by real-time reverse transcription-polymerase chain reaction (RT-qPCR) for both viruses. Adopting the criterion of four-fold antibody titer difference, 165 horses (38%) presented neutralizing antibodies for flaviviruses, 89 (20.4%) for SLEV and five (1.1%) for WNV. No evidence of SLEV and WNV infection was detected by RT-qPCR and, thus, such infection could not be confirmed in the additional samples. Our findings indicate horses of Rio de Janeiro were exposed to SLEV and WNV, contributing to the current knowledge on the distribution of these viruses in Brazil.

Baseline marine litter abundance and distribution on Saint Martin Island, Bay of Bengal, Bangladesh.

Baseline marine litter abundance and distribution on Saint Martin Island, Bay of Bengal, were assessed. Seventy-two transects (100-150 m) along 12 km of coastline were surveyed for litter items every two weeks for two months. The most abundant items were polythene bags, food wrappers, plastic bottles/caps, straws, styrofoam, plastic cups, plastic fragments, fishing nets, clothes, and rubber buoys. Tourism, local markets, hotels, domestic waste, and fishing activities were primary sources of marine litter. According to the mean clean coast index (CCI), all transects were clean, of which 11.3 % and 14.1 % of sandy beaches and rocky shores with sandy beaches were reported dirty, respectively. Northern Saint Martin Island comprised sandy beaches (2.8 %) and was extremely dirty. In addition, plastic abundance index (PAI) analysis showed that 24 % of sites, out of 72 sites, were under "very high abundance", 33 % were "high abundance", 33 % showed "moderate abundance", and 4 % were classified as "low abundance". Establishing baseline results of marine litter abundance and distribution on Saint Martin Island may help improve island conservation and mitigation strategies (e.g., improved waste management, beach cleaning activities to raise public awareness, local government litter reduction policies, and increase local pro-environmental behavioral change).

Improving cardiovascular health in primary care in Saint Lucia through the HEARTS Initiative.

Objective: To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods: From January 2020 to December 2021, St Lucia's Ministry of Health, with support of the Pan American Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular management, team-based care and systems for monitoring. Results: Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions: The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.

Cancer Survivors in Saint Lucia Deeply Value Social Support: Considerations for Cancer Control in Under-Resourced Communities.

Understanding the views of cancer survivors on their experience is important for informing community-based interventions. We studied, for the first time, the views of cancer survivors residing in Saint Lucia on their overall care experience. We used interview data from a cohort of adult cancer survivors from Saint Lucia between 2019 and 2020. We performed a thematic analysis to derive themes from codes. Forty-four survivors provided responses to at least one of the three questions. The majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average five years after diagnosis. Four common themes emerged; "Availability of support groups", "Importance of support from family and friends", "Access to finances" and "Health education and patient navigation". Travel overseas for health services was common among survivors. Survivors expressed emotional distress during travel due to isolation from family and local providers. This is typical among island populations and is distinct from existing patient frameworks. Survivors also suggested that networking amongst providers and interventions assisted families of cancer survivors. Although tertiary care services are limited, we showed that survivors deeply value and depend on their inter-personal relationships during care. Interventions aimed at strengthening the inter-personal environment of survivors are warranted.

Occurrence, spatial distribution, and risk assessment of microplastics in surface water and sediments of Saint Martin Island in the Bay of Bengal.

Microplastics (MPs) are emerging contaminants in aquatic and terrestrial ecosystems and have caused substantial concern worldwide. This study surveyed the presence of MPs in surface water and sediments across the coastal area of Saint Martin Island in the Bay of Bengal. MPs were collected following the standard protocol and identified as various types like expanded polystyrene, foam, filaments, fragments, lines, fibres, and paint flakes. Total MPs pollution in beach sediment was 317 particles/kg across 14 sampling sites, varied from 11 to 10589 particles/m2 of dry sediment and 0.95 particles/m3, having ~2 to 19 particles/30 min trawl in coastal surface water samples. Most of the frequent MPs in beach sediments ranged from 1.0 to 2.0 mm, whereas the fragments were predominant in sediment and surface water samples. MPs distribution revealed that different shapes were dominant at different sites within the Island. The calculated pollution risk index due to the presence of MPs indicated that the sediment and surface water samples were under the low-risk category. However, polymeric risk assessment and contamination factors suggest that the coastline is significantly polluted, as high pollution load indices (PLI >1) were observed for sediments and coastal surface water samples. This work provides the detailed MPs data in the coastal environment of Saint Martin Island for the first time; hence it may be helpful to develop proper strategies to deal with environmental problems.

Disaster aid? Mapping historical responses to volcanic eruptions from 1800-2000 in the English-speaking Eastern Caribbean: their role in creating vulnerabilities.

This paper uses volcanic eruptions on the Caribbean islands of Montserrat and Saint Vincent to explore the role that British colonial rule in the past and near past (1800-2000) has played in response to and recovery from hazardous events, and in turn, the influence that the nature of the hazards has on these responses. It shows that systemic vulnerabilities to natural hazards have been created by inadequate aid responses and longer-term chronic problems and demonstrates that hazard impacts are compounded by them. Vulnerabilities could be reduced by analysing integrated hazard impacts to generate mitigative measures across hazards and identify actions that more closely match timescales of political decision-making. Incorporating local knowledge and experience into risk analysis will enable the most effective use of aid resources, ahead of emergencies. Finally, coupling aid for long-term development with emergency response would improve outcomes and adaptation to longer-term vulnerabilities in immediate rebuilding and short-term recovery.

Migrant Pharmacopoeias: An Ethnobotanical Survey of Four Caribbean Communities in Amazonia (French Guiana).

French Guiana is an overseas French department in South America at the margin of the Amazon basin. Its population is characterized by an important number of cultural groups. Many inhabitants originate from the Caribbean (mostly Saint Lucia, Martinique, Guadeloupe, Haiti, and the Dominican Republic). The objectives of this study were to present an overview of the main uses of plants among the Caribbean populations in French Guiana, and how they contribute to the dynamics of plant-based practices, in order to provide insights into ethnobotanical convergences, divergences, and hybridizations (such as the importation of new species and associated practices, and the adoption of Amazonian species by Caribbean people). Interviews and botanical voucher collections were conducted throughout the coastal area of French Guiana. Sixteen Saint Lucian, nineteen Haitian, eighteen French Caribbean, and twelve Dominican informants were interviewed during the fieldwork. Altogether they use 212 botanical species. Some plants have recently been imported directly from the Caribbean, while adaptations have also taken place: some species that do not exist locally are abandoned while Amazonian species are integrated to form hybrid pharmacopoeias. The phytotherapies of these communities in French Guiana are still conserved as consistent sets of knowledge, although they tend to blend through an ongoing process of hybridization. Supplementary Information: The online version contains supplementary material available at 10.1007/s12231-021-09529-0.

La Guyane française est un département français d'Amérique du Sud situé à la marge nord du bassin amazonien. La composition de sa population est caractérisée par une très grande diversité d'appartenances culturelles. De nombreux habitants sont notamment originaires des Caraïbes (principalement de Sainte­Lucie, Martinique, Guadeloupe, Haïti et de la République dominicaine). Les objectifs de cette étude étaient de présenter une vue d'ensemble des principaux usages de soin par les plantes chez les populations caribéennes de Guyane française, et la manière dont ils contribuent à la dynamique des pratiques de phytothérapie locales, afin d'apporter un éclairage sur les modalités de convergences, de divergences et d'hybridations ethnobotaniques (telles que l'importation de nouvelles espèces et d'usages associés et l'adoption d'espèces amazoniennes par les migrants caribéens) auxquelles elles donnent naissance. Des entretiens et des collectes d'herbiers ont été menés sur l'ensemble de la zone côtière de la Guyane française. Seize informateurs saint­luciens, dix­neuf haïtiens, dix­huit caribéens français et douze dominicains ont été interrogés au cours du travail de terrain. Au total, ceux­ci ont mentionné utiliser 212 espèces botaniques. Certaines plantes ont récemment été directement importées des îles de la Caraïbe, et des adaptations ont également eu lieu: certaines espèces qui n'existent pas localement sont progressivement délaissées par les migrants caribéens tandis que, a contrario, des espèces amazoniennes sont intégrées à leurs pharmacopées respectives. On observe enfin que les phytothérapies de ces communautés caribéennes de Guyane française conservent un ensemble cohérent de connaissances ethnomédicinales, qui tend cependant à se mélanger dans un processus continu d'hybridation bioculturelle.

Detection of Saint Louis encephalitis virus in two Brazilian states.

We describe the circulation of Saint Louis encephalitis virus (SLEV) in two Brazilian States during outbreaks of Dengue and Zika viruses. We detected the virus in a patient from Araraquara, State of São Paulo, and in patients and in a mosquito pool of Culex quinquefasciatus from Sinop, State of Mato Grosso. Phylogenetic analysis grouped samples from this study within genotype V, which are closely related to other strains that previously circulated in other parts of the country. Genotype V seems to have established circulation in Brazil.

Improving cardiovascular health in primary care in Saint Lucia through the HEARTS Initiative / Mejorar la salud cardiovascular en la atención primaria en Santa Lucía por medio de la iniciativa HEARTS / Melhorando a saúde cardiovascular na atenção primária em Santa Lúcia por meio da Iniciativa HEARTS

ABSTRACT Objective. To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods. From January 2020 to December 2021, St Lucia's Ministry of Health, with support of the Pan American Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular management, team-based care and systems for monitoring. Results. Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions. The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.

RESUMEN Objetivo. Mejorar el control de la presión arterial y aumentar la cobertura del registro de la hipertensión en seis centros de referencia en Santa Lucía. Métodos. Entre enero del 2020 y diciembre del 2021, el Ministerio de Salud de Santa Lucía, con el apoyo de la Organización Panamericana de la Salud, implementó el paquete técnico HEARTS en seis centros de atención primaria de salud acompañado de un seguimiento semestral del control de la presión arterial y la cobertura del registro de la hipertensión. Se incluyeron los siguientes módulos: asesoramiento sobre hábitos y estilos de vida saludables, protocolos clínicos basados en la evidencia, acceso a medicamentos y tecnologías esenciales, manejo de las enfermedades cardiovasculares basado en la estratificación del riesgo, trabajo basado en equipos multidisciplinarios y sistemas de monitoreo. Resultados. Los niveles de control de la presión arterial a los 6, 12, 18 y 24 meses después de la intervención fueron de 37,1%, 28,9%, 33,9% y 36,5% respectivamente. La cobertura del registro de la hipertensión aumentó en 17,8% (de 1 434 a 1 689) para los pacientes que acceden al servicio. Con la implementación de la iniciativa de seguimiento entre los 12 y 15 meses después del inicio de la intervención se lograron cambios operativos y en las políticas, se mejoró la documentación y se obtuvieron datos rigurosos y fiables. Conclusiones. La iniciativa HEARTS reveló los desafíos básicos relativos a la infraestructura que afronta el control de la presión arterial. Los factores principales que contribuyeron al éxito fueron: 1) la aceptación en todos los niveles del sector de la salud; 2) el abordaje de cambios políticos y operativos; 3) una documentación rigurosa y la ejecución de los análisis necesarios; 4) la estandarización de los equipos y procedimientos; y 5) la ejecución de labores de seguimiento y evaluación con regularidad. El fortalecimiento de la capacidad fue la base de todos los cambios.

RESUMO Objetivo. Melhorar o controle da pressão arterial e a cobertura do registro de hipertensão em seis locais-piloto em Santa Lúcia. Métodos. De janeiro de 2020 a dezembro de 2021, o Ministério da Saúde de Santa Lúcia, com apoio da Organização Pan-Americana da Saúde, implementou o pacote técnico HEARTS em seis unidades básicas de saúde com monitoramento semestral do controle da pressão arterial e cobertura do registro de hipertensão. Os módulos incluíram aconselhamento sobre estilo de vida saudável, protocolos de tratamento baseados em evidências, acesso a medicamentos e tecnologias essenciais, manejo cardiovascular baseado em risco, cuidados em equipe e sistemas de monitoramento. Resultados. Os níveis de controle da pressão arterial aos 6, 12, 18 e 24 meses após a intervenção foram de 37,1%, 28,9%, 33,9% e 36,5%, respectivamente. A cobertura do registro de hipertensão aumentou 17,8% (de 1 434 para 1 689) para pacientes que acessam o serviço. A implementação da iniciativa de monitoramento para ação, 12 a 15 meses após o início da intervenção, resultou em mudanças de política e operacionais, melhoria da documentação e fornecimento de dados exatos e confiáveis. Conclusões. A iniciativa HEARTS revelou desafios básicos de infraestrutura para o controle da pressão arterial. Os elementos essenciais para o sucesso foram: (1) adesão em todos os níveis do setor de saúde; (2) abordagem das mudanças de política e operacionais; (3) documentação exata e análise necessária; (4) padronização de equipamentos e procedimentos; e (5) monitoramento e avaliação regulares. A capacitação foi a base de todas as mudanças.

Serosurvey of Nonhuman Primates in Costa Rica at the Human-Wildlife Interface Reveals High Exposure to Flaviviruses.

Arthropod-borne viruses belonging to the flavivirus genus possess an enormous relevance in public health. Neotropical non-human primates (NPs) have been proposed to be susceptible to flavivirus infections due to their arboreal and diurnal habits, their genetic similarity to humans, and their relative closeness to humans. However, the only known flavivirus in the American continent maintained by sylvatic cycles involving NPs is yellow fever virus (YFV), and NPs' role as potential hosts of other flaviviruses is still unknown. Here, we examined flavivirus exposure in 86 serum samples including 83.7% samples from free-range and 16.3% from captive NPs living in flavivirus-endemic regions of Costa Rica. Serum samples were opportunistically collected throughout Costa Rica in 2000-2015. We used a highly specific micro-plaque reduction neutralization test (micro-PRNT) to determine the presence of antibodies against YFV, dengue virus 1-4 (DENV), Zika virus, West Nile virus (WNV), and Saint Louis encephalitis virus (SLEV). We found evidence of seropositive NPs with homotypic reactivity to SLEV 11.6% (10/86), DENV 10.5% (9/86), and WNV 2.3% (2/86). Heterotypic reactivity was determined in 3.5% (3/86) of individuals against DENV, 1.2% (1/86) against SLEV, and 1.2% (1/86) against WNV. We found that 13.9% (12/86) of NPs were positive for an undetermined flavivirus species. No antibodies against DENV-3, DENV-4, YFV, or ZIKV were found. This work provides compelling serological evidence of flavivirus exposure in Costa Rican NPs, in particular to DENV, SLEV, and WNV. The range of years of sampling and the region from where positives were detected coincide with those in which peaks of DENV in human populations were registered, suggesting bidirectional exposure due to human-wildlife contact or bridging vectors. Our work suggests the continuous exposure of wildlife populations to various flaviviruses of public health importance and underscores the necessity of further surveillance of flaviviruses at the human-wildlife interface in Central America.

Difficulties in Accessing Cancer Care in a Small Island State: A Community-Based Pilot Study of Cancer Survivors in Saint Lucia.

Developing robust systems for cancer care delivery is essential to reduce the high cancer mortality in small island developing states (SIDS). Indigenous data are scarce, but community-based cancer research can inform care in SIDS where formal research capacity is lacking, and we describe the experiences of cancer survivors in Saint Lucia in accessing health services. Purposive and snowball sampling was used to constitute a sample of survivors for interviews. Subjects were interviewed with a questionnaire regarding socio-demographics, clinical characteristics, health services accessed (physicians, tests, treatment), and personal appraisal of experience. We recruited 50 survivors (13 men, 37 women). Only 52% of first presentations were with general practitioners. The mean turnaround for biopsy results in Saint Lucia was three times longer than overseas (p = 0.0013). Approximately half of survivors commenced treatment more than one month following diagnosis (median of 32 days, IQR 19-86 days), and 56% of survivors traveled out-of-country for treatment. Most survivors (60%) paid for care with family/friends support, followed by savings and medical insurance (38% each). In conclusion, cancer survivors in Saint Lucia are faced with complex circumstances, including access-to-care and health consequences. This study can guide future research, and possibly guide practice improvements in the near term.

Serologic evidence of West Nile virus and Saint Louis encephalitis virus in horses from Southern Brazil.

Flaviviruses as West Nile virus (WNV), Saint Louis encephalitis virus (SLEV), Ilhéus virus (ILHV), and Rocio virus (ROCV) are previously reported in different Brazilian regions, but studies in Southern Brazil are still scarce. To improve the information regarding flaviviruses in Southern Brazil, horse serum samples were analyzed using RT-qPCR and a commercial ELISA-Ab against WNV followed by PRNT75. All 1000 samples analyzed by real-time RT-PCR resulted negative. The 465 subsampled samples were analyzed by a commercial ELISA-Ab against WNV, and the 18.5% (86/465) positive samples were further analyzed by PRNT75. In the PRNT75, 13/86 and 2/86 horses were positive for SLEV and WNV, respectively. It was observed that 5.8% (13/226) of the farms presented at least one positive animal for SLEV in PRNT75, whereas 0.9% (2/226) for WNV. Apart from the lower seroprevalences identified when compared to data previously reported in other Brazilian regions, our results suggest that public health professionals must be aware of the presence of these potential zoonotic pathogens.

Serosurvey of West Nile virus (WNV) in free-ranging raptors from Brazil.

West Nile virus (WNV) is a mosquito-borne Flavivirus that can affect birds, horses, and humans, and is the only zoonotic Flavivirus that has been identified in six continents. In Brazil, until 2010, there was no evidence of WNV circulation. Recently, the virus was isolated from a horse with encephalitis, and the first human cases were registered in Brazil. Despite that, there is still no information on the enzootic cycle of this virus in birds or wildlife. This study aimed to investigate whether there is evidence of WNV circulation among wild birds from Southern Brazil. For this, we used free-living wild raptors (live-trapped or rescued) as potential sentinels to investigate the presence of WNV antibodies using ELISA and plaque reduction neutralization test (PRNT) assay. In addition, the presence of nucleic acids from Flavivirus family members was investigated. None of the birds sampled presented clinical findings compatible with WNV. Of the 200 serum samples from birds of prey belonging to 21 species, ten (5%) were positive for the presence of WNV antibodies on ELISA testing. The PRNT test did not confirm the ELISA results, but indicated that three birds had possibly been exposed to Saint Louis encephalitis virus (SLEV). All samples were negative for Flavivirus RNA. The results presented here evince the need for permanent surveillance for emerging flaviviruses in Brazil, as well as for a contingency policy in the case of human/animal outbreaks, particularly in high-risk areas.

Caracterización biológica de cepas del virus Encefalitis San Luis en células de la inmunidad innata / Biological characterization of St. Louis Encephalitis virus strains in cells of innate immunity

Los flavivirus transmitidos por mosquitos son una amenaza actual y emergente en todo el mundo. Dentro de este género, el virus Encefalitis San Luis (VESL) causa una forma severa de enfermedad neuroinvasiva donde la respuesta inmune es un componente crucial de la defensa del huésped. En este trabajo se investigó la interacción entre VESL y células de la inmunidad innata, en un modelo de infección in vitro de monocitos humanos (células U937) con cepas de distinta virulencia y condiciones epidemiológicas de aislamiento (CbaAr-4005 y 78V-6507). Se evaluó la capacidad de infectar y replicar del virus, como también el efecto citopático y la cinética de viabilidad de monocitos durante la infección. Los resultados demostraron la susceptibilidad de los monocitos a la infección, replicación y muerte por ambas cepas virales. Sin embargo, se hallaron diferencias significativas entre ellas. La cepa epidémica y de mayor virulencia CbaAr-4005 registró una tasa de infección y replicación superior a la de la cepa endémica y de menor virulencia 78V-6507. Se comprobó también que el VESL indujo la muerte de monocitos humanos, dependiendo del tiempo post-infección (pi) y de la cepa. Así, CbaAr-4005 provocó a partir del día 3 pi el doble de mortalidad celular que 78V-6507. Además, en los monocitos infectados se observaron alteraciones de parámetros morfológicos que podrían relacionarse con el tipo de mecanismo de muerte celular asociado a la infección por VESL.

Mosquitoes borne Flavivirus infections are an actual and emergent worldwide threat to human health. Within this genus, Saint Louis Encephalitis Virus (SLEV) causes a severe neuroinvasive disease where immune response is crucial for host survival. In this study the interaction between SLEV and innate immune cells was evaluated. An in vitro infection model with human monocytes (U937 cells) and strains with variations in virulence and isolation conditions (CbaAr-4005 and 78V-6507) were used. Infection capacity, replication capacity, cytopathic effect and monocyte viability kinetics were measured. The results showed susceptibility to infection and replication to both strains. However, significant differences were found among them. CbaAr-4005, the epidemic and more virulent strain, showed higher infection and replication ratios compared to 78V-6507. SLEV infection that induces cell death of human monocytes was also found in a post-infection time and in a strain dependent manner. Since day 3 post-infection, twice the mortality in CbaAr-4005 infected cells was observed. Furthermore, infected monocytes showed alterations in morphologic parameters that could be related with apoptosis mechanisms associated to SLEV infections.

Os Flavivírus transmitidos por mosquitos são uma ameaça atual e emergente no mundo todo. Nesse gênero, o vírus Encefalite Saint Louis (VESL) causa uma forma grave de doença neuroinvasiva onde a resposta imune é um componente crucial da defesa do hospedeiro. Neste trabalho nos investigamos a interação entre VESL e células de imunidade inata em um modelo de infecção in vitro de monócitos humanos (células U937) com estirpe de diferentes virulências e condições epidemiológicas de isolamento (CbaAr-4005 e 78V-6507). Foi avaliada a capacidade do vírus de infectar e replicar , assim como o efeito citopático e a viabilidade cinética dos monócitos durante a infecção. Os resultados demonstraram a suscetibilidade dos monócitos à infecção, replicação e morte por ambas as estirpes virais. No entanto, foram detectadas diferenças significativas entre eles. A estirpe epidémica e de maior virulenta CbaAr-4005 teve uma maior taxa de infecção e replicação do que a estirpe endémica e menos virulenta 78V-6507. Foi comprovado também que o VESL induziu a morte de monócitos humanos, dependendo do tempo pós-infecção (pi) e da estirpe. Assim, a CbaAr-4005 causou a partir do dia 3 pi o dobro da mortalidade celular o que a 78V- 6507. Além disso, alterações nos parâmetros morfológicos foram observadas nos monócitos infectados que poderiam estar relacionadas ao tipo de mecanismo de morte celular associado à infecção pelo VESL.