Either tobacco smoking or alcohol consumption during pregnancy sex-selectively increases susceptibility to drugs of abuse later in life. Considering that pregnant smoking women are frequently intermittent consumers of alcoholic beverages, here, we investigated whether a short-term ethanol exposure restricted to the brain growth spurt period when combined with chronic developmental exposure to tobacco smoke aggravates susceptibility to nicotine in adolescent and adult mice. Swiss male and female mice were exposed to tobacco smoke (SMK; research cigarettes 3R4F, whole-body exposure, 8 h/daily) or ambient air during the gestational period and until the tenth postnatal day (PN). Ethanol (ETOH, 2 g/Kg, 25%, i.p.) or saline was injected in the pups every other day from PN2 to PN10. There were no significant differences in cotinine (nicotine metabolite) and ethanol serum levels among SMK, ETOH and SMK + ETOH groups. During adolescence (PN30) and adulthood (PN90), nicotine (NIC, 0.5 mg/Kg) susceptibility was evaluated in the conditioned place preference and open field tests. NIC impact was more evident in females: SMK, ETOH and SMK + ETOH adolescent females were equally more susceptible to nicotine-induced place preference than control animals. At adulthood, SMK and SMK + ETOH adult females exhibited a nicotine-evoked hyperlocomotor profile in the open field, with a stronger effect in the SMK + ETOH group. Our results indicate that ethanol exposure during the brain growth spurt, when combined to developmental exposure to tobacco smoke, increases nicotine susceptibility with stronger effects in adult females. This result represents a worsened outcome from the early developmental dual exposure and may predispose nicotine use/abuse later in life.

The host contact network structure results from the movement and behaviour of hosts (e.g. degree of sociability; vagility and greater or lesser fidelity of shelters), which can generate heterogeneity in the transmission of parasites and influence the parasitic burden of individual hosts. In the current study, we tested the hypothesis that the burdens of Gigantolaelaps oudemansi mites are related to the characteristics of the transmission networks of individuals of Oecomys paricola, a solitary rodent. The study was carried out in a savannah habitat in north-eastern Brazil. In the dry season, the rodent network presented sub-groups of rodent individuals interacting with each other, whereas in the wet season, no modules were formed in the network. Mite burden was positively related to the number of connections that an individual host had with other host individuals in the dry season. The pairwise absolute difference between the mean mite burdens among individual rodents was negatively correlated with the similarities of node interactions. No relationships were observed during the wet season. There was a higher heterogeneity of mite burden among hosts in the dry season compare to that in the wet season. In solitary species, spatial organization may show seasonal variation, causing a change in the opportunities of host contacts, thereby influencing the transmission and dispersion of their ectoparasite burdens.

Cactaceae is one of the most threatened plant families, in part as a result of the illegal extraction of plants for ornamental use. However, reports of the seizure and reintroduction of cacti are scarce and do not include species of Melocactus, the genus of Cactaceae in Brazil that has the highest number of threatened species. The coroa-de-frade Melocactus violaceus is endemic to Brazil and categorized as Vulnerable on the IUCN Red List. We report the seizure of 37 individuals of coroa-de-frade extracted illegally from their natural habitat, the results of their reintroduction to Paulo César Vinha State Park, in Espírito Santo state, Brazil, and provide information for environmental monitoring agencies regarding how to proceed in seizure cases, with the goal of minimizing the impacts of this illegal practice on the species. After seizure, 25 individuals were cultivated in a greenhouse and 12 were reintroduced in restinga, the natural area of occurrence of the species. After 6 months, survival was 76% for those individuals cultivated in the greenhouse and 84% for those planted in restinga, showing that rapid reintroduction of species with ornamental appeal, preferentially in their natural habitat, can reduce the impacts of illegal extraction. This reintroduction protocol can be used by managers of conservation units, contributing to the maintenance of threatened cactus species in their natural habitat.

Vaccination has reduced the disease burden of vaccine-preventable diseases. However, the extent to which seasonal cycles of immunity could influence vaccine-induced immunity is not well understood. A national cross-sectional serosurveillance study performed in the Netherlands (Pienter-2) yielded data to investigate whether season of vaccination was associated with antibody responses induced by DT-IPV (diphtheria, tetanus and poliomyelitis), MMR (measles, mumps and rubella) and meningococcus C (MenC) vaccines in children. In total, 434 children met the inclusion criteria to study DT-IPV immunity, 811 for MMR and 311 for MenC. Differences in log(antibody levels) by season of vaccination were investigated with linear multivariable regression analyses. Seroconversion rates varied according to season of vaccination for rubella (90% of autumn-vaccinated children vs. 99% of winter-vaccinated had concentrations above cut-off levels). Summer-vaccinated boys showed a slower decline of tetanus antibodies (6% per month), in comparison with winter-vaccinated boys. In conclusion, season of vaccination showed little association with immunological protection. However, a number of associations were seen with a P-value of about 0.03; and adding data from a just-completed nationwide serological study might add more power to the current study. Further immunological and longitudinal investigations could help understand the mechanisms of seasonal influence in vaccine-induced responses.

This research communication addresses the hypothesis that, during the summer in the subtropics, natural tree shade helps to improve milk functional characteristics such as stability and acidity. Sixteen Holstein lactating cows were enrolled. The study consisted of three periods (pre-stress, heat stress and post-stress) based on allocating grazing cows into two treatments (with and without access to shade during the Heat Stress period). Overall THI during the trial was (mean ± se) 76.0 ± 3.4. Access to shade prevented the heat stress-related decrease in milk stability both in the ethanol and in the coagulation time test, as well as maintained milk acidity within an acceptable range (14 to 18°D).

The aim of the study was to assess the inflammatory potential of the Brazilian population’s diet and its association with demographic, socio-economic and anthropometric characteristics. A cross-sectional study was performed with 34 003 individuals aged 10 years and older, evaluated by the National Diet and Nutrition Survey from the Consumer Expenditure Survey (POF 2008–2009). The Energy-adjusted Dietary Inflammatory Index (E-DII™) was determined using thirty-four dietary parameters calculated through non-consecutive 2-d dietary records. Positive scores indicate a pro-inflammatory diet, while negative scores indicate an anti-inflammatory diet. A bivariate and multivariate linear regression analysis based on a hierarchical theoretical model was performed to verify the factors associated with the E-DII. The mean of the E-DII was 1·04 (range of −4·77 to +5·98). The highest values of the pro-inflammatory E-DII were found among adolescents (1·42; P < 0·001) and individuals with higher income (1·10; P < 0·001) and level of education (1·18; P < 0·001). In the final model, the E-DII was associated with higher income quartiles and was higher in the Northeast and South regions, in white people, individuals with ≥9 years of education and adults and adolescents age group. The Brazilian population consumes a diet with high inflammatory potential, especially adolescents, white people and those with higher income and level of education. Thus, the index presented uneven distribution among the population, emphasising groups with higher dietary inflammatory potential. The socio-economic risk profile of a diet with higher inflammatory potential in medium-income countries is different from what is observed in high-income nations.

The goal of this commentary is to expose the situation of Food and Nutrition Security (FNS) in Brazil in the context of the COVID-19 pandemic by providing a critical analysis of this scenario and suggesting ways to move forward. When COVID-19 arrived in Brazil, a crisis scenario that incorporated economic, social and political aspects became highly visible. This scenario fostered unemployment, poverty and hunger. Besides that, it exposed multiple vulnerabilities that were getting worse over the past few years prior to the pandemic. In this context, COVID-19 found in Brazil a fertile ground for its dissemination and community transmission. The impacts of the suspension of many commercial activities and other economic sectors due to the pandemic were quickly felt socially and economically in Brazil. Some of the actions carried out by the Brazilian government included the emergency aid payment and exemption from payment of energy bills for vulnerable individuals, release of funds for programmes for the direct purchase of food from family farmers, delivery of school food kits directly to students despite the closure of schools and publication of sanitary rules for the operation of restaurants. However, these actions are still insufficient, slow and not sufficiently coordinated to contain the progress of the food and nutritional insecurity crisis in Brazil. The COVID-19 pandemic highlights the urgency for the Brazilian government to again prioritise the FNS agenda. This includes implementing mechanisms to ensure the Human Right to Adequate Food and expanding existing FNS programmes.

This article deals with the presence of physicians, surgeons and apothecaries in the early modern Portuguese empire and the dissemination of medical knowledge there. In Portugal itself, the health care sector had been the target of considerable royal interference since the final years of the fifteenth century, during the construction of the early modern state. Regulatory frameworks were established to harmonise health care practice throughout the country and to control the organisation and distribution of the available health care practitioners among local communities. As this was also the time when Portugal was investing heavily in its colonies, how were these policies reflected in the empire? Did health care feature in the Portuguese government’s colonial strategies? How did the official policy to send medical personnel overseas work on the ground? Did it operate at a large enough scale to transform local practices?

Background: Trauma is defined by the NHSN as “blunt or penetrating traumatic injury.” Therefore, if the surgery was performed because of a recent fall, for example, then it is a trauma surgery. Here, we investigated which preoperative and operative parameters are associated with surgical site infection (SSI) after orthopedic trauma surgery. Objective: We aimed to answer 3 main questions: What is the risk of wound infection for patients undergoing trauma surgery? What are the main etiologic agents of SSI after trauma surgery? And what are the risk factors associated with SSI after trauma surgery? Methods: This prospective multicenter cohort study included 2,035 patients undergoing trauma surgery between July 2016 and June 2018 in 4 hospitals in Belo Horizonte, Brazil. Outcome variables were SSI, hospital mortality, and length of hospital stay. The following preoperative and operative parameters were evaluated: age, length of hospital stay before surgery, duration of surgery, number of professionals at surgery, number of hospital admissions, surgical wound classification, American Society of Anesthesiologists (ASA) preoperative assessment score, type of surgery (elective, emergency), general anesthesia (yes, no), trauma surgery (yes, no), and the 3-point prediction Nosocomial Infections Surveillance (NNIS) risk index. Results: The overall estimated SSI risk was 2.8% (95% CI, 2.0%–3.6%). Hospital mortality risk after trauma surgery was 3.4% (95% CI, 2.8%–4.4%). Hospital length of stay parameters in noninfected patients were as follows: mean, 8 days; median, 3 days; SD, 12 days. Hospital length of stay parameters in infected patients were mean, 30 days; median, 23 days; with SD, 31 days. The parameters for hospital stay in infected patients were mean, 10 days; median, 3 days, and SD, 15.9 (P < .001). Trauma orthopedic surgery lasting >2 hours was associated with approximately twice the risk (RR, 2.2) of developing an SSI compared to ≤2 hours of surgery: 27 of 739 (3.7%) versus 21 of 1,290 (1.6%), respectively, (P = .005) (Fig. 1). The NNIS risk index predicts the risk of SSI after trauma surgery (P = .003): 13 of 737 SSIs (1.8%) had an NNIS risk index of 0; 20 of 736 SSIs (2.7%) had an NNIS risk index of 1; 8 of 211 SSIs (3.8%) had an NNIS risk index of 2; and 2 of 11 SSIs (18.2%) had an NNIS risk index of 3 (Fig. 2). Conclusions: We identified intrinsic risk factors for SSI after orthopedic trauma surgery. The identification of the actual SSI incidence after trauma surgery in developing country hospitals and associated risk factors may support actions to minimize the complications caused by SSI.

Funding: None

Disclosures: None

Human visceral leishmaniasis (HVL) cases are important public health problems due to their zoonotic aspect, with high rates of morbidity and mortality in Brazil. The aim of this this study was to identify spatial patterns in both rates of HVL cases in Brazilian states during the period from 2006 to 2015. This is an ecological study, using geoprocessing tools to create choropleth maps, based on secondary data from open access platforms, to identify priority areas for control actions of the disease. Data were collected in 2017 and analysed according to the global and local Moran's I, using TerraView 4.2.2 software. Similar clusters were observed in neighbouring municipalities in thematic maps of HVL, suggesting spatial similarity in the distribution of the disease in humans mainly in the North and Northeast Regions, which concentrate the states with the highest rates of HVL. Heterogeneous spatial patterns were observed in the distribution of HVL, which show municipalities that need higher priority in the intensification of disease surveillance and control strategies.

Direct numerical simulations, performed with a high-order spectral-element method, are used to study coherent structures in turbulent pipe flow at friction Reynolds numbers $Re_{\tau } = 180$ and $550$ . The database was analysed using spectral proper orthogonal decomposition (SPOD) to identify energetically dominant coherent structures, most of which turn out to be streaks and quasi-streamwise vortices. To understand how such structures can be modelled, the linear flow responses to harmonic forcing were computed using the singular value decomposition of the resolvent operator, using the mean field as a base flow. The SPOD and resolvent analysis were calculated for several combinations of frequencies and wavenumbers, allowing the mapping out of similarities between SPOD modes and optimal responses for a wide range of relevant scales in turbulent pipe flows. In order to explore physical reasons behind the agreement between both methods, an indicator of lift-up mechanism in the resolvent analysis was introduced, activated when optimal forcing is dominated by the wall-normal and azimuthal components, and associated response corresponds to streaks of streamwise velocity. Good agreement between leading SPOD and resolvent modes is observed in a large region of parameter space. In this region, a significant gain separation is found in resolvent analysis, which may be attributed to the strong amplification associated with the lift-up mechanism, here understood as nonlinear forcing terms leading to the appearance of streamwise vortices, which in turn form high-amplitude streaks. For both Reynolds numbers, the observed concordances were generally for structures with large energy in the buffer layer. The results highlight resolvent analysis as a pertinent reduced-order model for coherent structures in wall-bounded turbulence, particularly for streamwise elongated structures corresponding to near-wall streamwise vortices and streaks.

This study investigated the comprehension of plural morphosyntactic markers and its relationship with numerical comparison abilities in children with Down syndrome (DS). It evaluated 16 Spanish-speaking children with DS (mean verbal mental age = 3;6) and 16 typically developing children with similar receptive vocabulary (mean chronological age = 3;5). Children participated in two preferential looking tasks assessing their abilities to map singular and plural markers to their visual referents and to distinguish one object from more than one. Results showed that both groups of children correctly mapped plural markers to their referents but failed to map singular ones. Furthermore, results also indicated that both groups also looked at collections of more than one object with four objects but not at those with two. The eye movement patterns of children who looked at collections of more than one object suggest a counting-like strategy. These results indicate that comprehension of plural markers of children with DS is similar to that of their typically developing peers; however, it is not related to their numerical abilities.

The nosologies founded by Kraepelin (Psychotic Disorders) and Freud (Neurotic Disorders) still remain actual in categories F20-29, F30-39 and F40-49 of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). The psychopathological mechanisms observed in classic disorders are shared with disorders considered in other categories regarding recognized etiologies (F10-19), ages of onset (F90-98), symptoms as precocious and enduring traces (F60-69) or specific symptoms (F50-59). Each classic pathology and its psychopathological mechanisms may be prototypical for a specific nosological spectrum that includes diseases which seem different at first glance. Accordingly, based on the combined knowledge of psychopathology and neurosciences, we assume that it is possible to conceive a more logical, rational and simpler way of organizing psychiatric nosology based on different psychopathological mechanisms emerging from five major questions:

1. 1. does the patient recognize his territory? (Dementia and delirium spectra),

2. 2. does the patient accurately recognise himself and the other? (Schizophrenic vs. autistic spectra),

3. 3. does the patient conserve his synchronicity with environmental and interpersonal rhythms? (Manic and depressive spectra),

4. 4. how does the patient feel about and react to threatening experiences? (Phobic vs. paranoid spectra), and

5. 5. how does the patient behave towards appetizing experiences? (Obsessive vs. Dissociative spectra).

We also discuss the relationship of these major questions with the encephalic stages (telencephalon, diencephalon, mesencephalon, and rhombencephalon).

The purpose of this study is to investigate if the MDA plasma concentrations are correlated to negative psychopathology in paranoid schizophrenic inpatients.

We present the case of a schizophrenic patient with severe insomnia that had a partial response to high doses of benzodiazepines and sedating antipsychotics. Treatment with agomelatine allowed to suspend benzodiazepine treatment and restore quality of sleep.

The imprecise status of Psychiatry may be due to Cartesian dualism and the mind / body assumption. We can clarify this status resorting to an alternative ontology. Popper's Worlds 1, 2 and 3, and the corresponding concepts of matter, energy and information, from Von Bertalanffy and his General Systems Theory, are candidates for a new ontology. Applying them to the history and present structure of Western Medicine, we can assume that General Surgery is the branch of medicine which deals with bodily matter, Internal Medicine deals with energy and Psychiatry is the branch which deals with information. The respective basic disciplines are Anatomy, Physiology and Psychology. None of them is a medical specialty, because specialties, such as Neurology, Urology and Cardiology, deal with a sub-system of the organism and may have a surgical, medical or even psychiatric emphasis. In the same way that the body / mind problem seemed important for Cartesian dualism, this triadic structure of Medicine may also inform a new ontology. The recent history of Philosophy may be interpreted as an attempt of looking for it.

ECT is the most powerful therapeutic tool in the treatment of acute mood episodes. However, data on the efficacy and safety of ECT in the long term management of affective disorders is lacking, despite overwhelming rates of chronicity and/or frequent relapses among patients with unipolar and bipolar depression. In this presentation we will review the data of the ECT unit of Hospital de Santa Maria, Lisboa, on maintenace ECT (m-ECT) in these patients. We compare intra and inter-individual evolution prior and after the institution of m-ECT. Considering the number of hospital admissions, mood symptoms and other parameters, our data support the use of this technique as a prophylatic approach for patients with mood disorders and a previous good response to ECT in the acute phase of disease.