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Introduction: Acute migraine headaches are common causes of presentation to the emergency department (ED). There is great variability in the efficacy of the available parenteral agents to manage pain, though triptans are among the recommended treatments. The objective of this systematic review was to update a previous review examining the effectiveness of parenteral agents for the treatment of acute migraine in the ED or equivalent acute care setting; our review examined pain management in emergency settings and assessed the effectiveness of triptan agents. Methods: A comprehensive search of 10 electronic databases and grey literature was conducted to supplement the previous systematic review. Two independent reviewers completed study selection, quality assessment, and data extraction. Any discrepancies were resolved by third party adjudication. Pain scale scores were analyzed using standardized mean difference (SMD) with 95% confidence intervals (CIs) calculated using a random effects model; heterogeneity (I2) was reported. Results: Titles and abstracts of 5039 unique studies were reviewed, of which, 51 studies were included. Sixty-four studies from the original review were included, resulting in a total of 115 included studies. Pain was measured within the ED or equivalent acute care setting using a variety of pain scales, most commonly the 0-10 cm or 100 mm visual analog scale. Four studies compared pain scores between patients receiving sumatriptan vs. other agents, of which, patients receiving sumatriptan reported higher pain scale scores (SMD = 0.53; 95% CI: 0.04, 1.02; I2 = 80%). In particular, patients receiving sumatriptan reported higher pain scale scores than patients receiving metoclopramide (SMD = 0.68; 95% CI: 0.31, 1.04; n = 1) or ketorolac (SMD = 1.39; 95% CI: 0.56, 2.21; n = 1). Overall, studies comparing anti-inflammatory agents (i.e., ketorolac or dexketoprofen) to other agents reported improved pain scale scores among patients receiving anti-inflammatory agents (SMD = -0.38; 95% CI: -0.73, -0.03; I2 = 66%; n = 5). Conclusion: Limited evidence suggests that patients treated with metoclopramide or anti-inflammatory agents experience greater pain reduction compared to patients treated with sumatriptan. This review will conduct a network analysis of parenteral agents to examine the comparative effectiveness of parenteral agents to manage pain among patients with acute migraine. Further analysis will also consider the balance between efficacy and adverse events.
Introduction: Although a variety of parenteral agents exist for the treatment of acute migraine, relapse after an emergency department (ED) visit is still a common occurrence. The objective of this systematic review was to update a previous review examining the effectiveness of parenteral agents for the treatment of acute migraine in the ED or equivalent acute care setting; our review focused on those studies aiming a reduction in relapse after an ED visit. Methods: A comprehensive search of 10 electronic databases and grey literature was conducted to identify comparative studies to supplement the previous systematic review. Two independent reviewers completed study selection, quality assessment, and data extraction. Any discrepancies were resolved by third party adjudication. Relative risks (RR) with 95% confidence intervals (CIs) were calculated using a random effects model and heterogeneity (I2) was reported. Results: Titles and abstracts of 5039 unique studies were reviewed, of which, 51 studies were included. Sixty-four studies from the original review were included, resulting in a total of 115 included studies. Relapse was reported in 44 (38%) included studies and occurred commonly in patients receiving placebo or no interventions (median = 39%; IQR: 14%, 47%). Overall, no differences in headache relapse were found between patients receiving sumatriptan or placebo (RR = 1.09; 95% CI: 0.55, 2.17; I2 = 93%; n = 8). Conversely, patients receiving neuroleptic agents experienced fewer relapses compared to placebo (RR = 0.27; 95% CI: 0.12, 0.58; I2 = 0%; n = 3); however, patients receiving neuroleptics reported an increase in adverse events (RR = 1.87; 95% CI: 1.17, 3.00; I2 = 0%; n = 3). Compared to placebo, patients receiving dexamethasone were less likely to experience a headache recurrence (RR = 0.71; 95% CI: 0.53, 0.95; I2 = 60%, n = 9); however, no differences were found in reported adverse events (RR = 1.09; 95% CI: 0.81, 1.47; I2 = 0%; n = 3). Conclusion: Relapse is a common occurrence for patients with migraine headaches. This review found patients receiving neuroleptics or dexamethasone experienced fewer headache recurrences. Conversely, triptan agents appear to have minimal effect on reducing the risk for headache recurrence following discharge from an acute care setting. Limited available data on adverse events is an important limitation to inform decision-making. Guidelines should be revised to reflect these results.
Sourdough fermentation is considered to have beneficial effects on postprandial satiety and metabolic responses, but studies demonstrating effects at physiological conditions are lacking. The aim of this acute breakfast intervention study was to determine the effect of consumption of sourdough-fermented and unfermented rye crispbread on self-rated appetite, postprandial glucose and insulin response in healthy subjects. In all, twenty-four Swedish adults were included in a single-blinded, randomised cross-over trial. Three crispbreads (sourdough-fermented and unfermented whole grain rye and yeast-fermented refined wheat as control) were consumed as part of a standardised breakfast. Subjective appetite score, assessed using visual analogue scale, and plasma glucose and insulin concentrations were measured at baseline and postprandially until 360 and 240 min, respectively. Structural changes and viscosity during mastication and gastric digestion were investigated using in vitro methods. Hunger and desire to eat were lower (P<0·05) based on AUC measurements after intake of sourdough-fermented rye crispbread compared with after intake of yeast-fermented refined wheat crispbread. On the basis of AUC (0–230 min), insulin response was lowest after intake of unfermented rye crispbread compared with sourdough-fermented rye and yeast-fermented refined wheat crispbread. Degradation of viscous fibres and faster bolus disintegration for the sourdough-fermented bread may partly explain the less favourable metabolic responses compared with unfermented bread. Our results showed that food processing affects the composition and structural characteristics of rye bread, which has implications for appetite and metabolic responses.
In chemodynamical evolution models it is usually assumed that the Milky Way galaxy forms from the inside-out implying that gas inflows onto the disk decrease with galactocentric distance. Similarly, to reproduce differences between chemical abundances of the thick disk and bulge with respect to those of the thin disk, higher accretion fluxes at early times are postulated. By using a suite of Milky Way-like galaxies extracted from cosmological simulations, we investigate the accretion of gas on the simulated stellar disks during their whole evolution. In general, we find that the picture outlined above holds, although the detailed behavior depends on the assembly history of the Galaxy and the complexities inherent to the physics of galaxy formation.
The Brazilian Twin Registry (BTR) was established in 2013 and has impelled twin research in South America. The main aim of the initiative was to create a resource that would be accessible to the Brazilian scientific community as well as international researchers interested in the investigation of the contribution of genetic and environmental factors in the development of common diseases, phenotypes, and human behavior traits. The BTR is a joint effort between academic and governmental institutions from Brazil and Australia. The collaboration includes the Federal University of Minas Gerais (UFMG) in Brazil, the University of Sydney and University of Melbourne in Australia, the Australian Twin Registry, as well as the research foundations CNPq and CAPES in Brazil. The BTR is a member of the International Network of Twin Registries. Recruitment strategies used to register twins have been through participation in a longitudinal study investigating genetic and environmental factors for low back pain occurrence, and from a variety of sources including media campaigns and social networking. Currently, 291 twins are registered in the BTR, with data on demographics, zygosity, anthropometrics, and health history having been collected from 151 twins using a standardized self-reported questionnaire. Future BTR plans include the registration of thousands of Brazilian twins identified from different sources and collaborate nationally and internationally with other research groups interested on twin studies.
Specimens of Fissidentalium candidum collected at Campos Basin, south-eastern Brazil, had their diet investigated in order to assess its feeding habits. Benthic prey exceeded the planktonic ones as expected and Foraminifera constituted the most frequent prey taxa, comprising about 99.5% of the scaphopod diet; the remaining components included a few molluscs (gastropods, bivalves and scaphopods), a nematode, an ostracod crustacean, fish otoliths, unknown partial organisms and inorganic material (e.g. sediment grains and polymetallic nodules). Amongst the species previously studied, F. candidum stood out by presenting the highest dietary diversity (H = 3.35) and species richness (N = 118). Predator and prey dimensions were not correlated and no spatial variation was observed in the diet amongst the three collection sites in the mid-slope of Campos Basin. Generalism, high rate of rare or unimportant species and high contribution of within-phenotype component to the niche width were important features of the trophic ecology of F. candidum. Inhabiting the deep water of Campos Basin, this dentaliid obtained most of its energy from the benthic microfauna, being a specialized foram predator with moderate preference for, and moderate selection against, several species.
Crude glycerin, a potential energy source for ruminant animals, has been evaluated, mainly, in diets with high starch content. However, a limit number of studies have evaluated the inclusion of crude glycerin in low starch diets. This study aimed to evaluate the effects of the association of crude glycerin with corn grain or citrus pulp on carcass traits and meat quality of Nellore bulls (n=30, 402±31 kg initial weight). The treatment consisted of: CON=control, without crude glycerin; CG10=10% of crude glycerin and corn grain; CG15=15% of crude glycerin and corn grain; CP10=10% of crude glycerin and citrus pulp; CP15=15% of crude glycerin and citrus pulp. The performance parameters and carcass traits were not affected by treatments (P>0.05). The inclusion of crude glycerin decreased yellow color intensity and increased fatty acids pentadecanoic and heptadecenoic in meat (P<0.05), without affecting neither the concentration of polyunsaturated fatty acids nor the relationship of saturated and unsaturated fatty acids. The association of crude glycerin with corn or citrus pulp has no adverse effects on carcass characteristics and meat quality.
Government regulations have created new markets for non-timber forest products such as tropical forest seeds for ecological restoration and agroforestry in Brazil. This paper examines whether and how participation in the seed market has affected assets that will shape households’ ability to pursue new livelihood opportunities. These impacts may vary across different dimensions of capital and among sociocultural groups. Impacts were characterized through semi-structured interviews following the sustainable livelihoods approach; 40 producers in the Xingu Seed Network, from settler farmer, urban and indigenous groups, were interviewed. The groups differed in perceptions of impacts on their natural, social and human capital, which could be related to the sociocultural background and vulnerability context of each group. Communities that were already organized were most likely to strengthen their social capital through participation. Cash income earned from sale of seeds was correlated with household-reported gains in financial capital, but not correlated with changes in other dimensions of capital. Contrary to expectations, sociocultural groups less integrated with the market achieved better livelihood outcomes through participation in the seed market.
The objective of this work was to estimate genetic parameters for a measure of persistency of milk yield and to evaluate its association with 305-d cumulative milk yield and lactation length. 12 346 records from 8202 dairy Gyr cows including lactations up to fifth calving were used. The measure of persistency was obtained from one of the parameters of a quadratic model that describes the cumulative yield across lactation as a function of days in milk. A three-trait multivariate analysis was done. Heritability and repeatability for persistency were 0·08 and 0·21, respectively. Deviance Information Criterion provided evidence that the additive genetic covariance between the measure of persistency studied and 305-d cumulative yield is zero. Genetic correlations between persistency and lactation length were 0·50 and 0·27 for first or all lactations, respectively. Milk yield persistency as measured in this study has low heritability. Selection for persistency can increase lactation length. The measure of milk yield persistency studied here is genetically independent of total milk yield and can be included in routine genetic evaluations of dairy cattle.
In order to understand the Barium abundance distribution in the Galactic disk based on Cepheids, one must first be aware of important effects of the corotation resonance, situated a little beyond the solar orbit. The thin disk of the Galaxy is divided in two regions that are separated by a barrier situated at that radius. Since the gas cannot get across that barrier, the chemical evolution is independent on the two sides of it. The barrier is caused by the opposite directions of flows of gas, on the two sides, in addition to a Cassini-like ring void of HI (caused itself by the flows). A step in the metallicity gradient developed at corotation, due to the difference in the average star formation rate on the two sides, and to this lack of communication between them. In connection with this, a proof that the spiral arms of our Galaxy are long-lived (a few billion years) is the existence of this step. When one studies the abundance gradients by means of stars which span a range of ages, like the Cepheids, one has to take into account that stars, contrary to the gas, have the possibility of crossing the corotation barrier. A few stars born on the high metallicity side are seen on the low metallicity one, and vice-versa. In the present work we re-discuss the data on Barium abundance in Cepheids as a function of Galactic radius, taking into account the scenario described above. The [Ba/H] ratio, plotted as a function of Galactic radius, apparently presents a distribution with two branches in the external region (beyond corotation). One can re-interpret the data and attribute the upper branch to the stars that were born on the high metallicity side. The lower branch, analyzed separately, indicates that the stars born beyond corotation have a rising Barium metallicity as a function of Galactic radius.
To evaluate the association between food and nutrition insecurity and asthma in children from Latin America.
São Francisco do Conde, Bahia, north-eastern Brazil.
The study included 1307 children aged 6–12 years from public elementary schools. Asthma symptoms were collected using a questionnaire that was translated and adapted from the International Study of Asthma and Allergies in Childhood, phase III. The diagnosis of asthma was determined based on reports of wheezing in the previous 12 months. The Brazilian Food Insecurity Scale was used to identify food insecurity. We also obtained demographic, socio-economic and anthropometric information for each participant. We used multivariate logistic regression analyses to assess the associations of interest.
Of the children surveyed, 10·4 % had a history of wheezing and 64·5 % had some degree of food and nutrition insecurity. We found a positive dose–response relationship and statistically significant associations of asthma with moderate (OR = 1·71, 95 % CI 1·01, 2·89) and severe (OR = 2·51, 95 % CI 1·28, 4·93) food and nutrition insecurity.
The results show that moderate and severe food and nutrition insecurity are markers of vulnerability to wheezing. It is important to note that the results of studies in this field have potential implications for social policies that promote food security. Further studies to identify the mechanisms involved in the relationship between food and nutrition insecurity and asthma are needed.
Resonances play an important role in the evolution of the disks of spiral galaxies, and in particular in the chemical abundance evolution. The dominant effect is that of corotation; this effect can be even used as a tool to estimate the age of the present spiral arm pattern, which are usually found to be long-lived, contrary to a recent common belief. We investigated a sample of galaxies for which the corotation radius is known and for which there are available in the literature measurements of abundance gradients for Oxygen. A very good correlation is found between corotation radii and the radii at which there is a break in the slope of the gradients. The gradients are usually decreasing in the inner regions and become flat or rising at larger radii. In several galaxies, including the Milky Way, one observes not only a change in the slope of the abundance gradient, but also an abrupt step in metallicity, at corotation. This step is due to the fact that corotation separates the disk of a galaxy in two regions (inside corotation and outside corotation) which are isolated one from the other, so that the two sides evolve in an independent way. The barrier between the two regions is produced by the flow of gas in opposite directions in the two sides and by the ring-shaped void of gas observed at corotation. Besides this, an independent effect of corotation is a minimum of star formation associated with the minimum velocity at which the spiral arms (seen as potential wells) are fed with interstellar gas. Still another effect is the scattering of stars by the resonance, which causes their migration to different galactic radii. Other resonances, like 4:1, have properties almost opposite to corotation; they stimulate star-formation, and tend to gather the stars in the resonant orbit, instead of scattering them out, as shown by numerical simulations. Due to this property, one can see arms which have the shape of resonant stellar orbits, which depart from logarithmic spirals.
Infection with the protozoan parasite Trypanosoma cruzi, the agent of Chagas disease, is characterised by a variable clinical course – from symptomless cases to severe chronic disease with cardiac and/or gastrointestinal involvement. The variability in disease outcome has been attributed to host responses as well as parasite heterogeneity. In this article, we review studies indicating the importance of immune responses as key determinants of host resistance to T. cruzi infection and the pathogenesis of Chagas disease. Particular attention is given to recent studies defining the role of cognate innate immune receptors and immunodominant CD8+ T cells that recognise parasite components – both crucial for host–parasite interaction and disease outcome. In light of these studies we speculate about parasite strategies that induce a strong and long-lasting T-cell-mediated immunity but at the same time allow persistence of the parasite in the vertebrate host. We also discuss what we have learned from these studies for increasing our understanding of Chagas pathogenesis and for the design of new strategies to prevent the development of Chagas disease. Finally, we highlight recent studies employing a genetically engineered attenuated T. cruzi strain as a vaccine shuttle that elicits potent T cell responses specific to a tumour antigen and protective immunity against a syngeneic melanoma cell line.
The aim of this study was to compare the population structure of the invasive bivalve Isognomon bicolor in three different areas on the coast of Rio de Janeiro State and to verify its temporal variation. All the areas presented high densities, reaching more than 1000 live individuals per 100 cm2. The number of dead individuals and recruits was higher in Ilha do Brandão (Angra dos Reis) than in the other areas. The individuals sampled at Praia Vermelha (Rio de Janeiro) presented the highest maximum and mean sizes, compared to those found at Ilha do Brandão. In this area, vermetid molluscs are dominant and build a complex reef structure where only a few individuals of I. bicolor can really grow.
In his critical period, Kant thought that scepticism was a threat to the metaphysical enterprise of Enlightenment. He consequently tried to tackle three of its species: Baylean scepticism, which doubts that reason could establish any truth concerning its ideas; Humean scepticism, which must be distinguished from Hume's formulation of the problem if we want to show that synthetic a priori judgements are possible; and Cartesian scepticism, which puts in doubt the reference of empirical concepts to things in the external world. Kant's treatment reveals the fundamental role played by scepticism in his critical enterprise not only as a triple challenge to the critical project, but also as an ally against idealist dogmatism.
We characterized 15 Trypanosoma cruzi isolates from bats captured in the Amazon, Central and Southeast Brazilian regions. Phylogenetic relationships among T. cruzi lineages using SSU rDNA, cytochrome b, and Histone H2B genes positioned all Amazonian isolates into T. cruzi I (TCI). However, bat isolates from the other regions, which had been genotyped as T. cruzi II (TC II) by the traditional genotyping method based on mini-exon gene employed in this study, were not nested within any of the previously defined TCII sublineages, constituting a new genotype designated as TCbat. Phylogenetic analyses demonstrated that TCbat indeed belongs to T. cruzi and not to other closely related bat trypanosomes of the subgenus Schizotrypanum, and that although separated by large genetic distances TCbat is closest to lineage TCI. A genotyping method targeting ITS1 rDNA distinguished TCbat from established T. cruzi lineages, and from other Schizotrypanum species. In experimentally infected mice, TCbat lacked virulence and yielded low parasitaemias. Isolates of TCbat presented distinctive morphological features and behaviour in triatomines. To date, TCbat genotype was found only in bats from anthropic environments of Central and Southeast Brazil. Our findings indicate that the complexity of T. cruzi is larger than currently known, and confirmed bats as important reservoirs and potential source of T. cruzi infections to humans.
The effects of sublethal concentrations of the insect growth regulators (IGRs) diflubenzuron and methoprene on some fitness components of an Aedes aegypti (L.) population in south-eastern Brazil were investigated. The fourth instar larvae of the mosquito were exposed to 20 ppb methoprene and 3 ppb diflubenzuron, and adult survivors were evaluated for fitness parameters, including body size and biomass, fecundity, fertility, longevity and symmetry. The sublethal concentrations had negative effects on longevity, but biomass, fecundity and fertility were not affected by either IGR. In separate experiments, A. aegypti individuals' surviving concentrations of 2, 3 and 3.5 ppb diflubenzuron and 5, 10 and 20 ppb methoprene were used for morphological analyses (size and symmetry). Diflubenzuron had negative effects on the mosquito's body symmetry. The observed decreases in longevity and symmetry may have negative impacts on the population dynamics of A. aegypti.