Climate change impacts on Anopheles (K.) cruzii in urban areas of Atlantic Forest of Brazil: Challenges for malaria diseases.

Around 27% of South Americans live in central and southern Brazil. Of 19,400 human malaria cases in Brazil in 2018, some were from the southern and southeastern states. High abundance of malaria vectors is generally positively associated with malaria incidence. Expanding geographic distributions of Anopheles vector mosquito species (e.g. A. cruzii) in the face of climate change processes would increase risk of such malaria transmission; such risk is of particular concern in regions that hold human population concentrations near present limits of vector species' geographic distributions. We modeled effects of likely climate changes on the distribution of A. cruzii, evaluating two scenarios of future greenhouse gas emissions for 2050, as simulated in 21 general circulation models and two greenhouse gas scenarios (RCP 4.5 and RCP 8.5) for 2050. We tested 1305 candidate models, and chose among them based on statistical significance, predictive performance, and complexity. The models closely approximated the known geographic distribution of the species under current conditions. Under scenarios of future climate change, we noted increases in suitable area for the mosquito vector species in São Paulo and Rio de Janeiro states, including areas close to 30 densely populated cities. Under RCP 8.5, our models anticipate areal increases of >75% for this important malaria vector in the vicinity of 20 large Brazilian cities. We developed models that anticipate increased suitability for the mosquito species; around 50% of Brazilians reside in these areas, and ∼89% of foreign tourists visit coastal areas in this region. Under climate change thereefore, the risk and vulnerability of human populations to malaria transmission appears bound to increase.

A via das quinureninas e suas implicações na esquizofrenia / Kynurenine pathway and its implications in schizophrenia

Introdução: a esquizofrenia é uma doença mental grave heterogênea, de extrema complexidade, manifestada por vários distúrbios de cognição, pensamento, memória, comportamento e afeto. Sua fisiopatologia, apesar dos avanços, continua de difícil compreensão. Objetivo: realizar uma revisão da literatura a respeito da relação entre a via das quinureninas e a fisiopatologia da esquizofrenia. Metodologia: foi conduzida a busca de artigos através das bases de dados Medline e Lilacs, utilizando os descritores schizophrenia/ esquizofrenia e as palavras-chave kynurenine pathways/via das quinureninas. Por meio desta busca, foram selecionados 38 artigos publicados entre os anos de 1990 e 2018. Resultados: estudos mais recentes vêm demonstrando que anormalidades no metabolismo do triptofano por meio da via das quinureninas poderiam estar relacionadas com os mecanismos neurofisiopatológicos da esquizofrenia. Os metabólitos gerados pela via das quinureninas possuem propriedades neuroativas. Dentre eles, destaca-se o ácido quinurênico, antagonista endógeno do receptor N-metil-D-aspartato. Seus níveis cerebrais estão aumentados em pacientes esquizofrênicos, provavelmente devido a uma condição pró-inflamatória, resultando dessa forma, em possíveis alterações neurológicas responsáveis pelo desenvolvimento da esquizofrenia. Conclusão: não somente uma melhor compreensão da fisiopatologia da esquizofrenia, como também o desenvolvimento de novos alvos terapêuticos, poderão ser obtidos a partir de um melhor entendimento da relação entre anormalidades na via das quinureninas e a gênese da esquizofrenia.

Introduction: Schizophrenia is a severe heterogeneous mental illness of extreme complexity, manifested by various disorders of cognition, thought, memory, behavior and affection. Its pathophysiology, despite advances, remains difficult to understand. Objective: to review the literature on the relationship between the kynurenine pathway and the pathophysiology of schizophrenia. Methodology: a literature review was carried out using the descriptors kynurenine pathways/via das quinureninas and the keywords kynurenine pathways/via das quinureninas using Medline and Lilacs databases. Through this search, were selected 38 articles published between the years of 1990 and 2018. Results: recent studies have shown that abnormalities in tryptophan metabolism through the kynurenine pathway may be related to the neuropathophysiological mechanisms of schizophrenia. The metabolites generated by the kynurenine pathway have neuroactive properties. Among them, kynurenic acid, an endogenous antagonist of the N-methyl-D-aspartate receptor, stands out. Their brain levels are increased in schizophrenic patients, probably due to a pro-inflammatory condition, resulting in possible neurological changes responsible for the development of schizophrenia. Conclusion: not only a better knowledge of pathophysiology, but also the development of new therapeutic targets will be obtained with a better understanding of the relationship between abnormalities in the kynurenine pathway and the genesis of schizophrenia.

Study of the influence of wavelengths and intensities of LEDs on the growth, photosynthetic pigment, and volatile compounds production of Lippia rotundifolia Cham in vitro.

Lippia rotundifolia Cham. is in the family Verbenaceae and is endemic to the Cerrado. This species is aromatic and characterized by the presence of glandular trichomes on its leaves that are rich in monoterpenes. The objective of this study was to evaluate the growth, photosynthetic pigment production, and chemical composition of L. rotundifolia grown in vitro under different light wavelengths and intensities. The light intensities consisted of five treatments using cool white fluorescent lamps at 20, 54, 78, 88, and 110 µmol m-2 s-1. The light quality consisted of six treatments using light-emitting diodes (LEDs) in different light wavelengths, namely, white, red, blue, and their interactions: 1R:1B, 2.5R:1B, and 1R:2.5B. After 45 days, the biometric parameters, photosynthetic pigment content, and volatile compounds were evaluated. The lower light intensities of 20 and 54 µmol m-2 s-1 generated higher growth, photosynthetic pigment content, and biomass accumulation. Myrcene and pentadecane were highest under light intensities of 88 and 110 µmol m-2 s-1, respectively. The highest limonene and ocimenone levels were obtained at 20 and 54 µmol m-2 s-1 intensity, respectively, and the highest myrcenone content was obtained at 78 µmol m-2 s-1 intensity. Regarding the light wavelengths, the combination of red and blue spectra further stimulated plantlet growth, and the 2.5R:1B combination obtained the best biometric data and total chlorophyll content. The z-ocimenone chemical compound contents were highest under the 1R:2.5B light spectrum. The monochromatic blue spectrum increased the myrcene and limonene content but decreased the myrcenone content, which was increased by red light. The highest pentadecane contents were obtained with the white spectrum and the red and blue combinations.

O Uso da Estratégia Gameficação na Educação Médica / The Use of Gamefication Strategy in Medical Education

RESUMO Introdução O ensino por meio de metodologia ativa vem ganhando cada vez mais destaque no cenário da educação médica, complementando, ou mesmo substituindo, o método de ensino tradicional. Diante disso, o sistema de gameficação, bem aceito por estudantes, inova, uma vez que o aprendizado se torna lúdico e participativo, contribuindo para a formação holística dos acadêmicos. Objetivos: Descrever a realização de uma gincana - composta por quatro fases e de caráter competitivo -, bem como comprovar a eficácia do método como uma forma inovadora de aprendizagem. Ao todo, 16 acadêmicos de Medicina participaram da gincana. Metodologia Caracteriza-se como um estudo de delineamento observacional transversal, com uso de metodologias quantitativas e qualitativas. O estudo é composto pela aplicação de um método de ensino e aprendizado baseado no processo de gameficação, com posterior aplicação de um questionário avaliativo aos alunos, para análise crítica. Resultados Foi observada satisfação dos alunos quanto à atividade, sendo unânime a afirmação de que a técnica utilizada facilita o aprendizado. Entre os integrantes, 87,5% preferiram a aplicação de práticas de metodologias ativas em detrimento das tradicionais, e 81,25% dos participantes apontaram a necessidade de integrar métodos com abordagens lúdicas às suas atividades curriculares. Por outro lado, 12,5% dos estudantes concordaram em que a atividade lúdica aplicada não contribui para o trabalho em equipe e 6,25% preferiram adesão às práticas de metodologia tradicional. Conclusão O método de gameficação desenvolve um ambiente propício ao aprendizado, com grande adesão dos estudantes. Percebe-se também a necessidade de mudança, apoiada pelos alunos, nas formas de ensino utilizadas na graduação, devendo-se buscar metodologias que abranjam o desenvolvimento de múltiplas competências e que possam usar a ludicidade como atrativo para o processo de aprendizado.

ABSTRACT Introduction Education through active methodology is increasingly gaining attention in the medical education scenario, complementing, or even replacing, the traditional teaching method. Bearing this in mind, the system of gamification, a well-accepted one among students, innovates, since the learning process becomes playful and participatory, contributing to the holistic formation of the students. Objectives To describe the accomplishment of a four-round, competitive championship, and to prove the effectiveness of the method as an innovative form of learning. In all, 16 medical students participated in the championship. Methods This was a cross-sectional, observational study, using quantitative and qualitative methodologies. The study consists of the application of a teaching and learning method based on the gamification process and the subsequent application of an evaluation questionnaire to the students for critical analysis. Results Student satisfaction with the activity was observed, with the unanimous assertion that the technique used facilitates learning. 87.5% of the members preferred the application of active methodologies over traditional ones. 81.25% of the participants asserted the need to integrate methods with playful approaches into their curricular activities. On the other hand, 12.5% of the students agreed that the applied leisure activity does not corroborate for teamwork and 6.25% preferred the traditional teaching methods. Conclusion It was demonstrated that the method of gamification develops a propitious environment for the learning process, with substantial student support. The requirement for change in the educational methods used in undergraduate training could also be perceived, as well as support for such changes among students, and hence the need to seek more and more methodologies that support the development of multiple competences and that can use playfulness as an incentive for the learning process.

Chikungunya on Kidney Transplant Recipients: Is It the Same?

BACKGROUND: Chikungunya virus (CHIKV) infection is an acute febrile illness with polyarthralgia and arthritis. There are few data about CHIKV infection in kidney transplant recipients (KTR). We report the largest case series of CHIKV infection in this population. METHODS: We retrospectively analyzed 32 cases of CHIKV infection in KTR between January 2016 and December 2017 at Hospital Universitário Walter Cantídio of Federal University of Ceará. RESULTS: All patients had been in endemic areas before the beginning of the symptoms. All presented arthralgia, 15 (46.9%) with joint inflammatory symptoms and 14 (43.8%) evolved to chronic arthralgia. Seven (21.9%) showed acute kidney injury (AKI) by Kidney Disease: Improving Global Outcomes criteria during the acute phase. Acute kidney injury was not related to prednisone use (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.04-2.61, P = 0.3) nor chronic arthralgia (OR, 1.2; 95% CI, 0.2-8.4, P = 0.8) as well as male sex, chronic kidney disease and older than 60 years (OR, 1.7; 95% CI, 0.3-10.3, P = 0.58; OR, 0.4; 95% CI, 0.1-2.7, P = 0.4; and OR, 2.1; 95% CI, 0.3-14.9, P = 0.45, respectively). Hospitalization was associated to AKI (OR, 44.0; 95% CI, 3.8-503.1; P = 0.002), probably due to diarrhea or dehydration. One patient died throughout the study, possibly unassociated with CHIKV infection. CONCLUSIONS: KTR with CHIKV infection have a clinical presentation and evolution similar to those seen in the general population. Kidney function is generally well preserved, with transitory graft dysfunction without negative impact after 3 months from the beginning of the symptoms. Previous costicosteroids use did not relate with AKI or chronic arthralgia.

Desfechos Clínicos da Intervenção Percutânea na Doença Triarterial e de Tronco da Coronária Esquerda / Clinical Outcomes of Percutaneous Intervention in Triple-Vessel and Left Main Coronary Artery Diseases

Fundamentos: A revascularização do miocárdio na doença triarterial e de tronco da coronária esquerda (TCE) pode ser realizada por intervenção coronariana percutânea (ICP) ou cirurgia de revascularização do miocárdio (CRM). O estudo SYNTAX demonstrou resultados clínicos equivalentes em pacientes de baixa a moderada complexidade anatômica submetidos a CRM ou ICP. Objetivos: Avaliar a incidência de eventos cardiovasculares e taxa de nova revascularização coronariana em pacientes com lesão de TCE e triarterial submetidos à ICP. Métodos: Estudo de coorte observacional não randomizado que avaliou pacientes com doença coronariana triarterial ou de TCE submetidos à ICP com stent farmacológico no período de junho de 2013 a maio de 2015 no Hospital SOS Cardio de Florianópolis. Foram relatados dados basais, características anatômicas principais e desfechos clínicos durante a fase intra-hospitalar e durante seguimento de 12 meses. Resultados: Foram avaliados 46 pacientes com idade média de 69,9 anos. No momento basal, 39,1% apresentavam diabetes mellitus, 19,6% eram tabagistas, 78,3% eram dislipidêmicos, 10,9% apresentavam disfunção renal crônica e 15,2% disfunção ventricular moderada a severa. Quanto ao número de artérias acometidas, 24% eram triarteriais e 76% apresentavam lesão em TCE. Durante o período intra-hospitalar, ocorreu uma taxa de 4,34% de infarto agudo do miocárdio sem supradesnível de ST. Durante esse período, não foi necessária reintervenção e não ocorreram óbitos. No seguimento de 12 meses, a mortalidade por causa cardiovascular foi de 4,35%. A taxa de nova revascularização por CRM foi de 4,3% e por angioplastia foi de 2,2%. Conclusão: Ocorreram baixas taxas de eventos cardiovasculares, indicando que a ICP pode ser uma alternativa aceitável em casos selecionados

Background: Myocardial revascularization in triple-vessel and left main coronary artery (LMCA) diseases can be performed by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The SYNTAX trial demonstrated equivalent clinical results in patients with low to moderate anatomical complexity undergoing CABG or PCI. Objectives: To evaluate the incidence of cardiovascular events and rates of new myocardial revascularization in patients with LMCA and triple-vessel lesions undergoing PCI. Methods: Nonrandomized, observational cohort study that evaluated patients with triple-vessel or LMCA diseases undergoing PCI with drug-eluting stent in the period from June 2013 to May 2015 at the Hospital SOS Cardio in Florianópolis. Baseline data, main anatomical features, and clinical outcomes were reported during the in-hospital phase and during a 12-month follow-up. Results: In total, 46 patients with a mean age of 69.9 years were evaluated. At baseline, 39.1% had diabetes mellitus, 19.6% were smokers, 78.3% had dyslipidemia, 10.9% had chronic renal dysfunction, and 15.2% had moderate to severe ventricular dysfunction. As regards the number of arteries affected, 24% had triple-vessel disease and 76% had lesions in the LMCA. During the in-hospital period, there was a 4.34% rate of acute myocardial infarction without ST elevation. During this period, reintervention was not required and no deaths occurred. In the 12-month follow-up, mortality from cardiovascular causes was 4.35%. The rate of new revascularization was 4.3% by CABG and 2.2% by angioplasty. Conclusion: The rates of cardiovascular events were low, indicating that PCI may be an acceptable alternative in selected cases

Decreased Circulating Levels of APRIL: Questioning Its Role in Diabetes.

Diabetes mellitus is a chronic disease that affects over 382 million people worldwide. Type-1 Diabetes (T1D) is classified as an autoimmune disease that results from pancreatic ß-cell destruction and insulin deficiency. Type-2 Diabetes (T2D) is characterized principally by insulin resistance in target tissues followed by decreased insulin production due to ß-cell failure. It is challenging to identify immunological markers such as inflammatory molecules that are triggered in response to changes during the pathogenesis of diabetes. APRIL is an important member of the TNF family and has been linked to chronic inflammatory processes of various diseases since its discovery in 1998. Therefore, this study aimed to evaluate APRIL serum levels in T1D and T2D. For this, we used the ELISA assay to measure serum APRIL levels of 33 T1D and 30 T2D patients, and non-diabetic subjects as control group. Our data showed a decrease in serum APRIL levels in T1D patients when compared with healthy individuals. The same pattern was observed in the group of T2D patients when compared with the control. The decrease of serum APRIL levels in diabetic patients suggests that this cytokine has a role in T1D and T2D. Diabetes is already considered as an inflammatory condition with different cytokines being implicated in its physiopathology. Our data suggest that APRIL can be considered as a potential modulating cytokine in the inflammatory process of diabetes.