Cytochemical study of Rhodnius neglectus and Rhodnius prolixus salivary gland cells (Hemiptera, Triatominae)

Triatomines are hematophagous bugs of medical interest in South and Central America, where they may act as invertebrate hosts of the hemoflagellate protozoa Trypanosoma cruzi (the causative of Chagas’ disease) and Trypanosoma rangeli (Tejera, 1920). Triatomines of Rhodnius genus have salivary gland formed by two close and independent units: the principal and the accessory. This gland secretes saliva that abounds in substances that facilitate and permit feeding. Despite this importance, there are few reports on its cytochemistry. In purpose of amplifying this understanding, in this work it was investigated the nuclear structures (chromatin and nucleolar corpuscles) of salivary gland cells of Rhodnius neglectus (Lent, 1954) and Rhodnius prolixus (Stål, 1859). The salivary glands were removed from adult insects, fixed and submitted to different cytochemical methods: lacto-acetic orcein, silver ion impregnation, Feulgen reaction, Toluidine Blue, Variant method of critical electrolyte concentration and C-banding. The results evidenced predominance of binucleated cells, with bulky and polyploid nucleus, decondensed chromatin and a large nucleolar area. In addition, cytoplasmic metachromasy and a clear association between nucleolar and heterochromatic corpuscles were observed. Such characteristics were associated with intense synthesis activity to produce saliva. Besides, the heterochromatic corpuscles observed with C Banding permitted the differentiation of sexes and species.

Simulium argentiscutum sp. nov. (Diptera: simuliidae), a member of the S. amazonicum-group of species; description of adults, pupa and larva

The adult, pupal and larval morphology of S. argentiscutum sp. nov., a member of the S. amazonicum-group, is compared with S. amazonicum Goeldi and its distribution, biology and medical importance are discussed. S. argentiscutum is one the most important anthropophilic species in the S. amazonicum-group as it is responsible, together with S. amazonicum, for the transmission of Mansonella ozzardi in Brazil.

Biosyslematics and distribution of Simuliid vectors of human onchocerciasis in South America

A brief review is given of the taxonomic status, biology and medical importance, and distribution of the vectors of human onchocerciasis in Latin America. Key reference works are cited and distribution maps of each vector species in relation to the known onchocerciasis foci are given.

Traitement pharmacologique de la schizophrénie: évaluation comparative de la qualité des recommandations de pratique clinique [Comparative evaluation of clinical practice guidelines for the treatment of schizophrenia]

INTRODUCTION: Many clinical practice guidelines (CPG) have been published in reply to the development of the concept of "evidence-based medicine" (EBM) and as a solution to the difficulty of synthesizing and selecting relevant medical literature. Taking into account the expansion of new CPG, the question of choice arises: which CPG to consider in a given clinical situation? It is of primary importance to evaluate the quality of the CPG, but until recently, there has been no standardized tool of evaluation or comparison of the quality of the CPG. An instrument of evaluation of the quality of the CPG, called "AGREE" for appraisal of guidelines for research and evaluation was validated in 2002. AIM OF THE STUDY: The six principal CPG concerning the treatment of schizophrenia are compared with the help of the "AGREE" instrument: (1) "the Agence nationale pour le développement de l'évaluation médicale (ANDEM) recommendations"; (2) "The American Psychiatric Association (APA) practice guideline for the treatment of patients with schizophrenia"; (3) "The quick reference guide of APA practice guideline for the treatment of patients with schizophrenia"; (4) "The schizophrenia patient outcomes research team (PORT) treatment recommendations"; (5) "The Texas medication algorithm project (T-MAP)" and (6) "The expert consensus guideline for the treatment of schizophrenia". RESULTS: The results of our study were then compared with those of a similar investigation published in 2005, structured on 24 CPG tackling the treatment of schizophrenia. The "AGREE" tool was also used by two investigators in their study. In general, the scores of the two studies differed little and the two global evaluations of the CPG converged; however, each of the six CPG is perfectible. DISCUSSION: The rigour of elaboration of the six CPG was in general average. The consideration of the opinion of potential users was incomplete, and an effort made in the presentation of the recommendations would facilitate their clinical use. Moreover, there was little consideration by the authors regarding the applicability of the recommendations. CONCLUSION: Globally, two CPG are considered as strongly recommended: "the quick reference guide of the APA practice guideline for the treatment of patients with schizophrenia" and "the T-MAP".

Mass spectrometry for the evaluation of cardiovascular diseases based on proteomics and lipidomics.

The identification and quantification of proteins and lipids is of major importance for the diagnosis, prognosis and understanding of the molecular mechanisms involved in disease development. Owing to its selectivity and sensitivity, mass spectrometry has become a key technique in analytical platforms for proteomic and lipidomic investigations. Using this technique, many strategies have been developed based on unbiased or targeted approaches to highlight or monitor molecules of interest from biomatrices. Although these approaches have largely been employed in cancer research, this type of investigation has been met by a growing interest in the field of cardiovascular disorders, potentially leading to the discovery of novel biomarkers and the development of new therapies. In this paper, we will review the different mass spectrometry-based proteomic and lipidomic strategies applied in cardiovascular diseases, especially atherosclerosis. Particular attention will be given to recent developments and the role of bioinformatics in data treatment. This review will be of broad interest to the medical community by providing a tutorial of how mass spectrometric strategies can support clinical trials.

Medical aspects of helicopter rescue missions involving winching of a physician

Introduction: Whereas the use of helicopters as a rapid means toreach victims and to bring them to a secure place is well-recognized,very few data are available about the value of winching physicians toprovide medical care for the victims directly on-site. We sought to studythe medical aspects of alpine helicopter rescue operations involving thewinching of an emergency physician to the victim.Methods: We retrospectively reviewed the medical reports of a singlehelicopter-based emergency medical service. Data from 1 January 2003to 31 December 2008 were analyzed. Cases with emergency callindicating that the victim was deceased were excluded. Data includedthe category (trauma or illnesses), and severity (NACA score) of theinjuries, along with the main medical procedures performed on site.Results: 9879 rescue missions were conducted between 1 January2003 and 31 December 2008. The 921 (9.3%) missions involvingwinching of the emergency physician were analysed. 840 (91%)patients suffered from trauma-related injuries. The cases of the 81 (9%)people presenting with medical emergencies were, when compared tothe trauma victims, significantly more severe according to the NACAindex (p <0.001). Overall, 246 (27%) patients had a severe injury orillness, namely, a potential or overt vital threat (NACA score between4-6, table 1). A total of 478 (52%) patients required administration ofmajor analgesics: fentanyl (443 patients; 48%), ketamine (42 patients;5%) or morphine (7 patients; 1%). The mean dose of fentanyl was 188micrograms (range 25-750, SD 127). Major medical interventions wereperformed 72 times on 39 (4%) patients (table 2).Conclusions: The severity of the patients' injuries or illnesses alongwith the high proportion of medical procedures performed directlyon-site validate emergency physician winching for advanced life supportprocedures and analgesia.

Ultrastructure of the male terminalia of Cochliomyia hominivorax and C. macellaria

Cochliomyia hominivorax and C. macellaria are species that cause primary and secondary myiasis, respectively of medical and veterinary importance in the New World. The male terminalia of both insects show morphological differences that are now described from scanning electron microscope (SEM) observations.

Potassium channel alterations mediate peripheral nerve hyperexcitability in a mouse model of type 2 diabetes mellitus

Diabetes mellitus (DM) is a major cause of peripheral neuropathy. More than 220 million people worldwide suffer from type 2 DM, which will, in approximately half of them, lead to the development of diabetic peripheral neuropathy. While of significant medical importance, the pathophysiological changes present in DPN are still poorly understood. To get more insight into DPN associated with type 2 DM, we decided to use the rodent model of this form of diabetes, the db/db mice. During the in-vivo conduction velocity studies on these animals, we observed the presence of multiple spiking followed by a single stimulation. This prompted us to evaluate the excitability properties of db/db peripheral nerves. Ex-vivo electrophysiological evaluation revealed a significant increase in the excitability of db/db sciatic nerves. While the shape and kinetics of the compound action potential of db/db nerves were the same as for control nerves, we observed an increase in the after-hyperpolarization phase (AHP) under diabetic conditions. Using pharmacological inhibitors we demonstrated that both the peripheral nerve hyperexcitability (PNH) and the increased AHP were mostly mediated by the decreased activity of Kv1-channels. Importantly, we corroborated these data at the molecular level. We observed a strong reduction of Kv1.2 channel presence in the juxtaparanodal regions of teased fibers in db/db mice as compared to control mice. Quantification of the amount of both Kv1.2 isoforms in DRG neurons and in the endoneurial compartment of peripheral nerve by Western blotting revealed that less mature Kv1.2 was integrated into the axonal membranes at the juxtaparanodes. Our observation that peripheral nerve hyperexcitability present in db/db mice is at least in part a consequence of changes in potassium channel distribution suggests that the same mechanism also mediates PNH in diabetic patients. ∗Current address: Department of Physiology, UCSF, San Francisco, CA, USA.

Daily physical activity assessment: what is the importance of upper limb movements vs whole body movements?

OBJECTIVE: The movement of the upper limbs (eg fidgeting-like activities) is a meaningful component of nonexercise activity thermogenesis (NEAT). This study examined the relationship between upper limb movements and whole body trunk movements, by simultaneously measuring energy expenditure during the course of the day. DESIGN: A cross-sectional study consisting of 88 subjects with a wide range in body mass index (17.3-32.5 kg/m(2)). The energy expenditure over a 24-h period was measured in a large respiratory chamber. The body movements were assessed by two uniaxial-accelerometers during daytime, one on the waist and the other on the dominant arm. The accelerometry scores from level 0 (=immobile) up to level 9 (=maximal intensity) were recorded. The activities of subjects were classified into eight categories: walking at two speeds on a horizontal treadmill (A & B), ambling (C), self-care tasks (D), desk work (E), meals (F), reading (G), watching TV (H). RESULTS: There was a significant relationship between the accelerometry scores from the waist (ACwaist) and that from the wrist (ACwrist) over the daytime period (R(2)=0.64; P<0.001). The ACwrist was systematically higher than the ACwaist during sedentary activities, whereas it was the reverse for walking activities. ACwrist to ACwaist ratio of activities E-H were above 1.0 and for walking activities (A-C) were below 1.0. A multiple regression analysis for predicting daytime energy expenditure revealed that the explained variance improved by 2% only when the ACwrist was added as a second predictor in addition to the ACwaist. This indicates that the effect of the ACwrist for predicting energy expenditure was of limited importance in our conditions of measurement. CONCLUSIONS: The acceleration of the upper limbs which includes fidgeting is more elevated than that of the whole body for sitting/lying down activities. However, their contribution to energy expenditure is lower than whole body trunk movements, thus indicating that the weight-bearing locomotion activities may be a key component of NEAT. However, its contribution may depend on the total duration of the upper limb movements during the course of the day.

Number of X-ray examinations performed on paediatric and geriatric patients compared with adult patients.

The age of the patient is of prime importance when assessing the radiological risk to patients due to medical X-ray exposures and the total detriment to the population due to radiodiagnostics. In order to take into account the age-specific radiosensitivity, three age groups are considered: children, adults and the elderly. In this work, the relative number of examinations carried out on paediatric and geriatric patients is established, compared with adult patients, for radiodiagnostics as a whole, for dental and medical radiology, for 8 radiological modalities as well as for 40 types of X-ray examinations. The relative numbers of X-ray examinations are determined based on the corresponding age distributions of patients and that of the general population. Two broad groups of X-ray examinations may be defined. Group A comprises conventional radiography, fluoroscopy and computed tomography; for this group a paediatric patient undergoes half the number of examinations as that of an adult, and a geriatric patient undergoes 2.5 times more. Group B comprises angiography and interventional procedures; for this group a paediatric patient undergoes a one-fourth of the number of examinations carried out on an adult, and a geriatric patient undergoes five times more.

Wild birds as hosts of Amblyomma cajennense (Fabricius, 1787) (Acari: Ixodidae)

We evaluated the prevalence, mean intensity and relative density of ticks in 467 wild birds of 67 species (12 families) from forest and cerrado habitats at two protected areas of Minas Gerais, between March and September 1997. Ticks collected (n=177) were identified as larvae and nymphs of Amblyomma cajennense and four other species of Amblyomma. We report for the first time 28 bird species as hosts of the immature stages of A. cajennense, demonstrating the lack of host specificity of the larvae and nymphs. A. cajennense had 15% prevalence on birds, with a mean infestation intensity of 0.37 ticks per host sampled, and 2.5 ticks per infested bird. Prevalence varied in relation to host species, diet and between birds from forests at two successional stages. There were no differences in relation to host forest dependence, participation in mixed flocks of birds, and nest type constructed. A. cajennense is a species of medical and veterinary importance, occurring on domestic animals but is known little of its occurrence on wildlife.

Susceptibility of Biomphalaria straminea (Dunker, 1848) from Serra da Mesa Dam, Goiás, Brazil to infection with three strains of Schistosoma mansoni Sambon, 1907

Ecological changes from water resources development projects often affect the epidemiology of water-associated diseases. In order to investigate the occurrence and distribution of freshwater snails of medical and veterinary importance in the area of influence of the Serra da Mesa Hydroelectric a survey has been performed since 1997 and revealed the occurrence of well-established populations of Biomphalaria straminea (Dunker, 1848) in the 8 municipalities surrounding the lake. Areas of epidemiologic risk for schistosomiasis were selected and studies of parasite-mollusc compatibility were undertaken using specimens from 19 populations of B. straminea and 3 strains (CM, EC and PB) originally isolated from B. straminea. Among 1,135 specimens used 15 became infected (infection index of 1.3%) and 8 populations were susceptible to the schistosome strains: B. straminea from Campinorte (Castelão, susceptible to CM and EC strains, and Planeta Água, EC strain), Colinas (Tocantinzinho river, CM and EC strains), Minaçu (Canabrava river, EC strain), Niquelândia (Codemin, CM and PB strains, and Almas river, CM strain), Uruaçu (touristic area, PB strain) and Santa Rita do Novo Destino (Maranhão river, CM and EC strains). These results, associated with marked social and ecological changes occurred, strongly suggest the possibility of B. straminea coming to act as a vector of schistosomiasis in the studied area.

Review of Measures to Reduce Costs in the Private Health Insurance Market 2014

5.11.2014 This report was prepared independently by Mr McLoughlin with the support of the health insurers, and the Health Insurance Authority, for consideration by the Minister for Health and the insurers.  All parties were very conscious of the importance of respecting competition law when dealing with issues such as prices and costs. The work of the Group has been conducted in two phases, with the first phase report published on 26 December 2013. The Phase 1 report sets out the context, establishment, membership and terms of reference for both phases of the Groups work.  The report also outlines the legislative provisions for private health insurance in Ireland, the objectives of both phases of the review and the approach and methodology followed. Phase 2 of the process focused on the compilation and analysis by the Health Insurance Authority (HIA) of claims data to assess the cost drivers for health insurance, the effects of medical technology and innovations on costs, and claims processing issues.The report and submissions from relevant stakeholders which were examined and considered under the Phase 2 Review can be downloaded below. Download the Review of Measures to Reduce Costs in the Private Health Insurance Market 2014 -  Independent Report to the Minister for Health and Health Insurance Council here. Submissions received HSE Submission to Pat McLoughlin, Chair of Review Group IHAI submission 11 April 2014 IHCA submission to Chair 1 May 2014 Insurance Ireland submission Society of Actuaries in Ireland submission St. Patricks Mental Health Services submission April 2014 St John of Gods Submission        

Simulium lobatoi, new species of blackfly (Diptera: Simuliidae) from the states of Mato Grosso and Goiás, Central Brazil

During studies on the taxonomy of the Simuliidae of Brazil, a new species of Simulium was found. Full descriptions of the adults and pupae of this species are described here, its affinities with other species are discussed and its distribution, biology, and medical importance in Brazil are recorded.

Susceptibility of Biomphalaria amazonica and Biomphalaria occidentalis from Manso Dam, Mato Grosso, Brazil to infection with three strains of Schistosoma mansoni

As well as malaria and yellow fever, schistosomiasis is one of the main endemic diseases associated to environments which suffered some impact related to the development of great economic projects, as for example the construction of hydroelectric power stations. Aiming to investigate the occurrence and distribution of freshwater snails of medical and veterinary importance in the area which suffered impact from the Manso hydroelectric power station a survey was performed during the period of 2002 to 2003 and revealed the occurrence of populations of Biomphalaria amazonica and Biomphalaria occidentalis. Studies on parasite-mollusc compatibility were undertaken using five B. amazonica colonies (Barão de Melgaço, Poconé, Santo Antônio do Leverger, and Chapada dos Guimarães, in the Manso and Casca rivers), and four B. occidentalis colonies (Cuiabá, Santo Antônio do Leverger, and Chapada dos Guimarães, in the Água Fria district and Casca river) were exposed to miracidia of Schistosoma mansoni. Of 257 snails of B. amazonica used, 17 became infected (infection index of 6.61%) and all specimens of B. occidentalis proved unsusceptible. According to the strains used, of the 158 snails exposed to BH miracidia, 6 became infected (3.79%); of the 44 exposed to SJ miracidia, 6 became infected (13.63%); and of the 55 snails of B. amazonica exposed to EC miracidia, 5 became infected (9.09%). These results point out the low possibility of introduction of schistosomiasis in those areas, but we believe it can not be discarded as due the presence of B. amazonica.