Blood Biochemical Reference Intervals of Black Caimans (Melanosuchus niger) and Spectacled Caimans (Caiman crocodilus) in the Brazilian Amazon Region.

Reference intervals for physiologic parameters, crucial for assessing the health status of animals, have been documented for various crocodilian species across the globe. Nonetheless, the establishment of plasma biochemical reference intervals specific to Amazonian crocodilians remains incomplete. In an effort to address this gap, we procured blood samples from 65 black caimans (Melanosuchus niger) and 58 spectacled caimans (Caiman crocodilus) during the period of September-December 2019 within the Anavilhanas National Park in the Brazilian Amazon region We aimed to define reference intervals for 11 key plasma variables measured, namely glucose, triglycerides, total cholesterol, calcium, magnesium, sodium, potassium, albumin, total protein, uric acid, and urea. In general, the determined blood reference intervals aligned closely with those established for other crocodilian species. Some specific measurements, such as total cholesterol, sodium, and magnesium, exhibited distinct variations based on the species. Furthermore, female black caimans showcased elevated cholesterol levels compared with their male counterparts. Within the spectacled caimans, disparities related to sex were evident solely in the case of electrolytes sodium and potassium, with males demonstrating higher levels compared with females. These reference intervals not only provide data for assessing potential fluctuations in the health of wild or captive Amazonian crocodilians but also hold value for veterinary management.

Physiological stress response in free-living Amazonian caimans following experimental capture.

When captured, free-living crocodilians respond by hyperstimulation of the hypothalamic-pituitary-adrenal (HPA) axis, which triggers a cascade of downstream events of physiological stress. We examined these responses in two unstressed, and stressed Amazonian caimans, Caiman crocodilus and Melanosuchus niger. Plasma corticosterone levels increased in both stressed caiman species. In M. niger, the levels of this hormone increased 5.2-fold compared with the basal range values, while in C. crocodilus this was only 1.7-fold. After stress, M. niger needed more than 6 h to return its corticosterone levels to basal range values, whereas in C. crocodilus just 0.5 h was enough. Downstream events were characterized by an increase in glucose levels, which is associated with corticosterone increments. Excessive muscle activity resulted in increased plasma lactate content in both species. Lactate levels were also related to plasma calcium concentration, possibly due to the buffering capacity for preventing lactic acidosis. Clearance of excessive lactate load was faster in M. niger (0.5 h) than in C. crocodilus (more than 6 h). Although both caiman species respond in the same way to capture, the amplitude and duration of activation of the HPA axis are different. M. niger may be potentially more sensitive to acute stress than C. crocodilus. On the other hand, C. crocodilus needs more time to recover from the lactic acid load. Our experiment provides a useful diagnostic tool for management and conservation programs, as well as evaluating the impacts of tourism and recreational capture on caimans in the Amazon.

Black women health inequity: The origin of perinatal health disparity.

Black enslaved women endured sexual exploitation and reproductive manipulation to produce a labor workforce on the southern plantations during the Antebellum Period. Health care inequity has continued from slavery and into the 21th century primarily due of racial segregation, poverty, access, poor quality of care, eugenics and the assault of forced sterilizations. Racial disparity in maternal and infant mortality is an outcome rooted in racial injustice, social and economic determinants as well as the stresses during pregnancy throughout the generations of Black births. Affordable, available, quality and equitable care and narrowing the economic gap for Black women and families is the most significant barrier in combating racial disparity in perinatal health outcomes and health inequity.

Intracerebral transfection of anti-rabies virus antibodies is an effective therapy for rabies.

Rabies is a neurological disease with 100% lethality. Some of the rare human patients who survived after multiple drug treatment had severe sequelae. The present study showed that after 48 h of RABV inoculation, mice injected intracerebrally with anti-RABV F (ab')2 plus Bioporter® showed 70% survival compared to the control group, suggesting that transfection of anti-RABV antibodies to the brain may prevent or delay the spread of RABV at an early stage of infection. This result may provide important protocol results in intracellular antibody delivery to prevent the fatal outcome of the disease.

Prophylaxis for Tuberculosis in Pregnant Women.

As more women at increased risk for tuberculosis (TB) reactivation immigrate to the United States, perinatal screening and chemoprophylaxis are increasingly important. Interferon-gamma release assays and the tuberculin skin test are acceptable screening tests with the latter supported by more data in pregnancy. Women screening positive should have active TB excluded, and if negative, latent TB is likely. Prophylaxis should be deferred until 3 months postpartum except in those severely immunosuppressed, human immunodeficiency virus positive, or recently exposed. Isoniazid with pyridoxine for 9 months is preferred with reasonable safety in pregnancy and breastfeeding. Monitoring for maternal hepatotoxicity is recommended.

English on cigarette packs from six non-Anglophone low- and middle-income countries.

OBJECTIVES: Low- and middle-income countries (LMICs) are vital to the global tobacco market. The pack is key to cigarette branding, and review of cigarette packs revealed English as a common feature. The prevalence of English and its potential branding utility is explored. METHODS: Every available unique cigarette pack was purchased from diverse retailers in six LMICs where English is not the official language (Bangladesh, Brazil, China, Egypt, Ukraine, Vietnam). Packs' front panels were coded for English on pack fronts. English penetration was quantified by country and a comparison of English use between multinational and national brands was undertaken. A qualitative analysis of symbolic and utilitarian usage of English was conducted. RESULTS: Of 1303 unique cigarette packs analyzed, 67% (n = 876) included some English. English text conveyed product information and usage instruction. English was more prevalent for multinational brands. Qualitatively, English use frequently connected cigarettes with concepts of quality, style, luxury, and aspirational lifestyle. CONCLUSIONS: Restricting English use should be incorporated into plain packaging policy to protect populations from deceptive branding practices, specifically presenting cigarettes as an aspirational product.

Exploiting nonlinearity of the speech production system for voice disorder assessment by recurrence quantification analysis.

This work summarizes the research related to digital speech signal processing with recurrence quantification analysis (RQA) applied to voice disorder assessment. The main motivation for these studies is the fact that RQA is able to exploit the nonlinear dynamical nature of the speech production system. Due to the use of recurrence quantification measures to represent the behavior of speech signals, promising results were obtained in the characterization and classification of laryngeal pathologies and voice disorders. These contributions may help one to evaluate the usability and efficiency of RQA in vocal disorder assessment.

Pregnancy-Related Deaths, Florida, 1999-2012: Opportunities to Improve Maternal Outcomes.

Objectives To examine pregnancy-related deaths (PRDs) in Florida, to identify quality improvement (QI) opportunities, and to recommend strategies aimed at reducing maternal mortality. Methods The Florida Pregnancy-Associated Mortality Review (PAMR) Committee reviewed PRDs occurring between 1999 and 2012. The PAMR Committee determined causes of PRDs, identified contributing factors, and generated recommendations for prevention and quality improvement. Information from the PAMR data registry, and live births from Florida vital statistic data were used to calculate pregnancy-related mortality ratios (PRMR) and PRD univariate risk ratios (RR) with 95% confidence intervals (CI). Results Between 1999 and 2012, the PRMR fluctuated between 14.7 and 26.2 PRDs per 100,000 live births. The five leading causes of PRD were hypertensive disorders (15.5%), hemorrhage (15.2%), infection (12.7%), cardiomyopathy (11.1%), and thrombotic embolism (10.2%), which accounted for 65% of PRDs. Principal contributing factors were morbid obesity (RR = 7.0, 95% CI 4.9-10.0) and late/no prenatal care (RR = 4.2, 95% CI 3.1-5.6). The PRMR for black women was three-fold higher (RR = 3.3, 95% CI 2.7-4.0) than white women. Among the five leading causes of PRDs, 42.5% had at least one clinical care or health care system QI opportunity. Two-third of these were associated with clinical quality of care, which included standards of care, coordination, collaboration, and communication. The QI opportunities varied by PRD cause, but not by race/ethnicity. Conclusion Gaps in clinical care or health care systems were assessed as the primary factors in over 40% of PRDs leading the PAMR Committee to generate QI recommendations for clinical care and health care systems.

Comparative evaluation of Amblyomma ovale ticks infected and noninfected by Rickettsia sp. strain Atlantic rainforest, the agent of an emerging rickettsiosis in Brazil.

In 2010, a novel spotted fever group rickettsiosis was reported in the Atlantic rainforest coast of Brazil. The etiological agent was identified as Rickettsia sp. strain Atlantic rainforest, and the tick Amblyomma ovale was incriminated as the presumed vector. The present study evaluated under laboratory conditions four colonies of A. ovale: two started from engorged females that were naturally infected by Rickettsia sp. strain Atlantic rainforest (designated as infected groups); the two others started from noninfected females (designated as control groups). All colonies were reared in parallel from F0 engorged female to F2 unfed nymphs. Tick-naïve vesper mice (Calomys callosus) or domestic rabbits were used for feeding of each tick stage. Rickettsia sp. strain Atlantic rainforest was preserved by transstadial maintenance and transovarial transmission in A. ovale ticks for at least 2 generations (from F0 females to F2 nymphs), because nearly 100% of the tested larvae, nymphs, and adults from the infected groups were shown by PCR to contain rickettsial DNA. All vesper mice and rabbits infested by larvae and nymphs, and 50% of the rabbits infested by adults from the infected groups seroconverted, indicating that these tick stages were vector competent for Rickettsia sp. strain Atlantic rainforest. Expressive differences in mortality rates and reproductive performance were observed between engorged females from the infected and control groups, as indicated by 75.0% and 97.1% oviposition success, respectively, and significantly lower egg mass weight, conversion efficiency index, and percentage of egg hatching for the infected groups. Our results indicate that A. ovale can act as a natural reservoir for Rickettsia sp. strain Atlantic rainforest. However, due to deleterious effect caused by this rickettsial agent on engorged females, amplifier vertebrate hosts might be necessary for persistent perpetuation of Rickettsia sp. strain Atlantic rainforest in A. ovale under natural conditions.

Texture Analysis of Recurrence Plots Based on Wavelets and PSO for Laryngeal Pathologies Detection.

This paper deals with the discrimination between healthy and pathological speech signals using recurrence plots and wavelet transform with texture features. Approximation and detail coefficients are obtained from the recurrence plots using Haar wavelet transform, considering one decomposition level. The considered laryngeal pathologies are: paralysis, Reinke's edema and nodules. Accuracy rates above 86% were obtained by means of the employed method.

Maternal and hospital characteristics of non-medically indicated deliveries prior to 39 weeks.

Non-medically indicated (NMI) deliveries prior to 39 weeks increase the risk of neonatal mortality, excess morbidity, and health care costs. The study's purpose was to identify maternal and hospital characteristics associated with NMI deliveries prior to 39 weeks. The study included 207,775 births to women without a previous cesarean and 38,316 births to women with a previous cesarean, using data from Florida's 2006-2007 linked birth certificate and inpatient record file. Adjusted risk ratios (ARR) and 95 % confidence intervals (CI) for characteristics were calculated using generalized estimating equation for multinomial logistic regression. Among women without a previous cesarean, NMI deliveries occurred in 18,368 births (8.8 %). Non-medically indicated inductions were more likely in women who were non-Hispanic white (ARR: 1.41, 95 % CI 1.31-1.52), privately-insured (ARR: 1.42, 95 % CI 1.26-1.59), and delivered in hospitals with <500 births per year. Non-medically indicated primary cesareans were more likely in women who were older than 35 years (ARR: 2.96, 95 % CI 2.51-3.50), non-Hispanic white (ARR: 1.44, 95 % CI 1.30-1.59), and privately-insured (ARR: 1.43, 95 % CI 1.17-1.73). Non-medically indicated primary cesareans were also more likely to occur in hospitals with <30 % nurse-midwife births, <500 births per year, and in large metro areas. Among women with previous cesarean, NMI repeat cesareans occurred in 16,746 births (43.7 %). Only weak risk factors were identified for NMI repeat cesareans. The risk factors identified varied by NMI outcome. This information can be used to inform educational campaigns and identify hospitals that may benefit from quality improvement efforts.

The effect of abused substances on antenatal and intrapartum fetal testing and well-being.

Recognition that use and abuse of substances by pregnant patients perpetuates, despite ongoing efforts to educate the public, necessitates clinicians to integrate understanding of potential effects on antepartum and intrapartum fetal testing into their interpretation and implementation of clinical findings. This includes acknowledging some anticipated alterations in results and selecting the appropriate type and frequency of testing methods and interventions. Certain substances are well documented in terms of expected variations in test results; others are not as clearly defined. An overview of information that may be helpful to the clinician is presented to promote understanding of fetal evaluation performed through common tests such as contraction stress test, the nonstress test, the biophysical profile, the modified biophysical profile, fetal movement counting, and Doppler velocimetry. What evidence is available should be used to assist in defining the actual status of the fetus as best as possible, even when the effects of substances may be unknown or have obscure results.

Pregnancy-related deaths due to pulmonary embolism: findings from two state-based mortality reviews.

This report presents findings from two state-based pregnancy-related reviews of deaths due to pulmonary embolism to describe prevalence, risk factors, and timing of symptoms and fatal events (N = 46). We examined the utility of state-based maternal mortality review teams as a means to gain more complete data on maternal deaths from which guidelines for prevention and intervention can be developed. The Florida Pregnancy-Associated Mortality Review Team and Virginia Maternal Mortality Review Team collaborated on findings from 9 years of pregnancy-related mortality review conducted in each state. Pregnancy-related deaths due to pulmonary embolism occurring within 42 days of pregnancy between 1999 and 2007 in Florida and Virginia were identified. Retrospective review of records was conducted to obtain data on timing of the fatal event in relation to the pregnancy, risk factors, and the presence and timing of symptoms suggestive of pulmonary embolism. Forty-six cases of pregnancy-related death due to pulmonary embolism were identified. The combined pregnancy-related mortality ratio (PRMR) was 1.6/100,000 live births. The PRMR for patients undergoing cesarean section delivery was 2.8 compared to 0.2 among those with vaginal deliveries (95 % CI = 1.8-4.2 and 0.1-0.5 respectively). Women aged 35 and older had the highest PRMR at 2.6/100,000 live births. BMI over 30 kg/m(2) and presence of chronic conditions were frequently identified risk factors. One in five decedents (21.7 %) reported at least two symptoms suggestive of pulmonary embolism in the days before death. This combined state-based maternal death review confirms age over 35 years, obesity, and the presence of chronic conditions are risk factors for pregnancy-related mortality due to venous thromboembolism in the US. Expanding and standardizing the process of state-based reviews offers the potential for reducing pregnancy-related mortality in the US.

Chronic toxicologic study of the ethanolic extract of the aerial parts of Jatropha gossypiifolia in rats

This work presents the observed changes in Wistar rats under long treatment (thirteen weeks) with different oral doses of the ethanolic extract (EE) from Jatropha gossypiifolia L., Euphorbiaceae. The most significant toxic signs indicated a reduction of the activity in the central nervous system and digestive disturbances. The histopathological analysis shows hepatotoxity and pulmonary damages. The lethality was 46.6% among males under the higher experimental dose (405 mg/kg) and 13.3% both in females under the higher dose and among the animals treated with 135 mg/kg of the product. These data show the significant oral chronic toxicity of EE of J. gossypiifolia in rats.

Pregnancy-associated mortality review: the Florida experience.

At the beginning of the 20th century, maternal mortality was a leading cause of death for women of reproductive age in the United States. Obstetrical care was not standardized, and there was a lack of universal systems for monitoring maternal deaths. Public health efforts of surveillance, along with advances in medicine and sanitation, resulted in a significant decrease in maternal deaths by the early 1980s. Today, maternal death is considered to be a rare event; however, the rates of maternal mortality have not improved in almost 3 decades. There is growing evidence that many maternal deaths can still be prevented through enhanced surveillance that influences improvements in overall health and delivery of care. This paper describes the experience of establishing and maintaining a pregnancy-associated mortality surveillance system in Florida. Emphasis is placed on the process and importance of a statewide review and the value of engagement with the medical community.