Risk factors associated with death in Brazilian children with severe dengue: a case-control study

Objective: The purpose of this case-control study was to evaluate risk factors associated with death in children with severe dengue. Methods: The clinical condition of hospitalized patients with severe dengue who died (cases, n = 18) was compared with that of hospitalized patients with severe dengue who survived (controls, n = 77). The inclusion criteria for this study were age under 13 years; hospital admission in São Luis, northeastern Brazil; and laboratory-confirmed diagnosis of dengue. Results: Severe bleeding (hemoptysis), a defining criterion for dengue severity, was the factor most strongly associated with death in our study. We also found that epistaxis and persistent vomiting, both included as warning signs in the World Health Organization (WHO) classification of dengue, were strongly associated with death. No significant association was observed between any of the laboratory findings and death. Conclusions: The finding that epistaxis and persistent vomiting were also associated with death in children with severe dengue was unexpected and deserves to be explored in future studies. Because intensive care units are often limited in resource-poor settings, any information that can help to distinguish patients with severe dengue with a higher risk to progress to death may be crucial.

P2Y1 receptors expressed by C1 neurons determine peripheral chemoreceptor modulation of breathing, sympathetic activity, and blood pressure

Catecholaminergic C1 cells of the rostral ventrolateral medulla (RVLM) are key determinants of the sympathoexcitatory response to peripheral chemoreceptor activation. Overactivation of this reflex is thought to contribute to increased sympathetic activity and hypertension; however, molecular mechanisms linking peripheral chemoreceptor drive to hypertension remain poorly understood. We have recently determined that activation of P2Y1 receptors in the RVLM mimicked effects of peripheral chemoreceptor activation. Therefore, we hypothesize that P2Y1 receptors regulate peripheral chemoreceptor drive in this region. Here, we determine whether P2Y1 receptors are expressed by C1 neurons in the RVLM and contribute to peripheral chemoreceptor control of breathing, sympathetic activity, and blood pressure. We found that injection of a specific P2Y1 receptor agonist (MRS2365) into the RVLM of anesthetized adult rats increased phrenic nerve activity (≈55%), sympathetic nerve activity (38±6%), and blood pressure (23±1 mm Hg), whereas application of a specific P2Y1 receptor antagonist (MRS2179) decreased peripheral chemoreceptor–mediated activation of phrenic nerve activity, sympathetic nerve activity, and blood pressure. To establish that P2Y1 receptors are expressed by C1 cells, we determine in the brain slice preparation using cell-attached recording techniques that cells responsive to MRS2365 are immunoreactive for tyrosine hydroxylase (a marker of C1 cells), and we determine in vivo that C1-lesioned animals do not respond to RVLM injection of MRS2365. These data identify P2Y1 receptors as key determinants of peripheral chemoreceptor regulation of breathing, sympathetic nerve activity, and blood pressure.

Fluxes of CO2 above a sugarcane plantation in Brazil

Fluxes of CO2 were measured above a sugarcane plantation using the eddy-covariance method covering two growth cycles, representing the second and third re-growth (ratoons) harvested with stubble burning. The total net ecosystem exchange (NEE) in the first cycle (second ratoon, 393 days long) was −1964 ± 44 g C m−2; the gross ecosystem productivity (GEP) was 3612 ± 46 g C m−2 and the ecosystem respiration (RE) was 1648 ± 14 g C m−2. The NEE and GEP totals in the second cycle (third ratoon, 374 days long) decreased 51% and 25%, respectively and RE increased 7%. Accounting for the carbon emitted during biomass burning and the removal of stalks at harvest, net ecosystem carbon balance (NECB) totals were 102 ± 130 g C m−2 and 403 ± 84 g C m−2 in each cycle respectively. Thus the sugarcane agrosystem was approximately carbon neutral in the second ratoon. Yield in stalks fresh weight (SFW) attained the regional average (8.3 kg SFW m−2). Although it was a carbon source to the atmosphere, observed productivity (6.2 kg SFW m−2) of the third ratoon was 19% lower than the regional average due to the lower water availability observed during the initial 120 days of re-growth. However, the overall water use efficiency (WUE) achieved in the first cycle (4.3 g C kg−1 H2O) decreased only 5% in the second cycle. © 2013 Elsevier B.V. All rights reserved