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BACKGROUND: Life expectancy in recent decades has increased the prevalence of chronic diseases in the population, requiring an approach to new health topics, such as discussions on quality of life and expectations about death and dying. The concept of advance directives (ADs) gives individuals the opportunity to make known their decisions about the treatments they would like to receive at the end of life. Despite the recognition of relevance in clinical practice, the applicability of the concept presents challenges, including establishing the appropriate prognosis for each patient and the ideal time to approach the patient. Some prognostic tools were developed, such as the surprise question (SQ): "Would you be surprised if your patient died in 12 months?", which is used in some clinical settings to predict patient deaths and to make decisions regarding ADs. The main objective of the present study was to evaluate the behavior of second-year resident physicians (PGY-2) when the SQ was applied. METHOD: In our observational study, from July 1, 2016, to February 28, 2017, (PGY-2) in the Internal Medicine Residency Program (IMRP) applied SQ to all patients with multiple and varied chronic no communicable comorbidities, who were followed up at the general medicine outpatient clinic (GMOC) of a tertiary university hospital in São Paulo- Brazil. The frequency of the outcome (death or non-death within 12 months) was analyzed by correlating it with the clinical data (impact of the studied variables). RESULTS: Eight hundred forty patients entered the study. Fitfty-two of them (6.2%) died within one year. PGY-2 predicted that two hundred and fourteen patients (25.5% of total) would die within a year (answer No to SQ), of which, 32 (14.9%) did so. The correct residents' prognosis for the subgroup of 626 patients (answer "Yes" to SQ) was NPV = 96.8% (CI = 95.4%-98.2%) and PPV = 14.9% (CI 10.1%-19, 6%). Answering "Yes" to SQ correlated negatively to addressing AD while the outcomes death and the answer No to SQ were positively correlated, according to the number of comorbidities. CONCLUSION: The SQ, in addition to care, contributed to health education, communication and care planning shared by the doctor and patient.

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In floor-raised broilers, coccidiosis is responsible for reducing the use of nutrients, mainly by impairing intestinal tissue function and activating the immune system. Understanding and quantifying how balanced dietary protein (BP) is used when birds are challenged will allow nutritionists to make decisions regarding challenged flocks. This study aimed to determine the effects of Eimeria maxima on broiler performance and body composition, and to calculate changes in the maintenance and efficiency of protein utilisation (Ep). A total of 2 400 male 14-day-old Cobb500 broiler chickens were randomly allotted to ten groups with six replications of 40 birds each, with a 5 × 2 factorial arrangement of treatments. Five levels of BP in reference to digestible lysine (3.6, 7.2, 10.8, 14.4, and 18.0 g/kg) were fed to unchallenged (NCH) and challenged (CH) broilers with 7 × 103E. maxima sporulated oocysts from 14 to 28 days of age. Performance and body deposition were measured using a comparative slaughter technique to compare BP maintenance requirements and Ep. ANOVA followed by a posthoc test was performed to compare the effects of BP levels, challenge, and their interactions. A monomolecular model describing the responses of NCH and CH broilers to BP intake, maintenance, and maximum protein deposition was compared. There were significant interactions between body weight gain and digestible lysine intake among the factors studied. Infection had a negative impact on all variables analysed, proving the efficacy of the challenge. The maintenance did not differ between the CH and NCH groups. Increased levels of dietary BP did not recover the maximum protein deposition in CH broilers. Eimeria maxima significantly reduced Ep by a factor of 0.09 times on Ep compared to the control group. The Eimeria maxima challenge was responsible to modify the use of BP altering the body composition and impairing broilers performance.

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1. The purpose of this study was to determine the metabolisable energy of high-protein distiller's dried grains with solubles (HP-DDGS) for meat quail (Coturnix coturnix coturnix; Experiment I) and evaluate the effects of dietary levels of HP-DDGS on animal performance, carcase characteristics, meat quality, and organ weights (Experiment II).2. In Experiment 1, 96 meat quail were distributed in a completely randomised design with two treatments (reference or test diet) and six replicates of eight birds. The experimental period consisted of 5 d adaptation, followed by 5 d total excreta collection. The experimental diets consisted of a reference (control) and a test diet formulated with 800 g/kg reference diet and 200 g/kg HP-DDGS.3. In Experiment 2, 612 meat quail were distributed in a completely randomised design fed one of six dietary levels of HP-DDGS (0, 85, 170, 255, 340, or 425 g/kg) as a replacement for soybean meal. At 42 d of age, birds were slaughtered and evaluated for carcase yield, organ weights, and meat quality.4. Apparent metabolisable energy values corrected for nitrogen retention of HP-DDGS were 12.5 and 12.3 MJ/kg for males and females, respectively.5. In the starter phase (1-21 d of age), increasing dietary HP-DDGS levels had a quadratic effect on body weight (BW) (P = 0.020) and body weight gain (BWG) (P = 0.019). The maximum BW and BWG values were estimated to be achieved with 296.0 and 296.2 g/kg dietary HP-DDGS, respectively. Overall (1-42 d of age), increasing dietary HP-DDGS levels in replacement of soybean meal did not affect animal performance, carcase yield, meat quality or organ weight in meat quail.6. It was concluded that dietary HP-DDGS can fully replace soybean meal in meat quail diets without affecting growth performance, carcase yield, meat quality or organ weight.

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This study determined the metabolizable energy of DDGS for broiler quails (Experiment I) and evaluated the effect of different dietary levels of DDGS on performance, carcass, organ weight, meat quality, and economic viability (Experiment II). In Experiment I, 72 broiler quails were randomly distributed into two treatments (reference or test diets). The experimental period consisted of 5 days of adaptation, followed by 5 days of total excreta collection. Experimental diets consisted of a reference or a test diet containing 800 g/kg reference diet and 200 g/kg DDGS. In experiment II, 432 unsexed broiler quails were randomly distributed into groups fed six levels of DDGS (0, 50, 100, 150, 200, or 250 g/kg). At 43 days of age, birds were slaughtered and evaluated for carcass yield, organ weight, and meat quality. Apparent metabolizable energy values corrected for nitrogen retention of DDGS were 2,488 and 2,466 kcal/kg for males and females, respectively. In the growth phase and the overall period, feed intake increased linearly (p=0.015 and 0.040) and feed conversion ratio worsened (p=0.038 and 0.001) with the inclusion of DDGS in the diet, respectively. A linear increasing (p=0.001) of gizzard weight was observed with increasing dietary DDGS levels, while the economic variables were affect depending on seasonal feedstocks prices. It is concluded that dietary levels up to 250 g/kg DDGS do not affect growth, carcass characteristics, and meat quality of broiler quails. However, the prices of ingredients in the harvest and off-season period should be considered to determine the level of inclusion of DDGS.(AU)

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The parasite biodiversity of mouse opossums in Brazil remains incompletely explored. We describe a new species of Subulura (Ascaridida: Subuluroidea) from the large intestine of the white-bellied woolly mouse opossum, Marmosa constantiae, based on the results of light and scanning electron microscopy (SEM). We also partially sequenced the mitochondrial cytochrome c oxidase I (MT-CO1) gene of the new species, using molecular phylogenetic analyses to determine its relationships within the Subuluroidea superfamily. As molecular data on subuluroid species are extremely limited, few inferences could be drawn from our phylogenies. Our SEM observations showed the detailed morphology of the cephalic extremity, precloacal pseudo-sucker, caudal papillae, phasmids and vulva. Subulura eliseae sp. n. differs from the other four Subulura parasites species of marsupials by the number of caudal papillae and the structure dimensions, and size of the spicule. Moreover, S. eliseae sp. n. has ten pairs of caudal papillae, which is unique compared to other species. We present morphometric and molecular data on this new species, contributing to future studies on subuluroids.

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The objective of this study was to evaluate the levels of environmental contamination in a protected area in the Brazilian Amazon. For this, two areas were chosen along the Mearim River: the reference area (A1) and the potentially contaminated area (A2), where water samples were collected, for physicochemical and microbiological analyses, as well as specimens of Hoplias malabaricus, for the evaluation of biometric data and incidence of branchial lesions. The physicochemical analyzes of the water from both areas showed contamination (low levels of dissolved oxygen, tubidity and high iron concentrations, especially in A2). The microbiological analyzes showed that all water samples showed total coliform values higher than those acceptable by CONAMA and WHO (with higher values in A2), in addition to E. coli values higher than those allowed by legislation in A2. Regarding biometric data, male and female fishes were significantly longer and heavier in A1 during the dry and rain seasons and the gonadosomatic index also showed higher values in A1 than in A2 in both seasons. H. malabaricus showed gill lesions of minimal to moderate pathological importance in A1 and A2, indicating that specimens from both areas of the Mearim River showed biological responses to contamination. The observed changes in the water quality, bimetic parameters and the histological analyzes of the specimens of H. malabaricus directly reflect on the quality and health of the fishes in the Mearim River, and point to the urgent need for prevention and remediation of contamination in these ecosystems.

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BACKGROUND: There has been a significant increase in number of patients seeking neuropsychological rehabilitation months after the acute phase of COVID-19 infection. OBJECTIVE: Identify the cognitive and psychiatric disorders in patients with long COVID or Post-Acute Sequelae of COVID (PASC) and explore the association between disease severity during the acute phase and persistent neuropsychological manifestations. METHODS: 614 adults were assessed an average of eight months post-infection. Participants were, on average, 47.6 y.o., who sought rehabilitation for neuropsychological problems. Patients were evaluated using the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Phonemic Verbal Fluency and Clock Drawing tests (NEUPSILIN) for executive functions, and the Hospital Anxiety and Depression Scale (HADS). RESULTS: The BNIS score was significantly below reference values in all subscales, especially affect and memory. Verbal Fluency and Clock Drawing subtest results were also lower. Patients with PASC tested high for anxiety/depression, but there was no statistically significant relationship between HADS and BNIS scores. Neuropsychological evaluations showed no differences in cognitive or psychiatric profiles between hospitalized and non-hospitalized patients. CONCLUSIONS: Neuropsychological results suggest executive function problems and high incidence of anxiety/depression, irrespective of acute-phase severity, underscoring a need for neurorehabilitation programs while providing data for public policy initiatives.

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In dioecious, bee-pollinated tree species, male and female flowers offer different resources. It is unclear how this unbalanced quantity and quality of floral resources affects flower visits and pollen transfer to female flowers. We asked, what characteristics of flowering and dynamics of resource production by trees favour flights of bees between male and female trees. We quantified the floral resources produced by individual flowers and entire trees of Myracrodruon urundeuva (Anacardiaceae), measured pollen flow to female flowers, fruit set of naturally pollinated flowers and determined the effective pollinators. Crown volume of male trees was four-fold, flower number 15-fold and nectar volume 60 times higher than in female trees. While ~70% of male flowers opened in the morning, ~70% of female flowers opened in the afternoon. Fruit set was 27%. Stingless bee species were the main pollinators, while honeybees were common only on male flowers. Strongly unbalanced production of floral resources, high potential lifespan of female flowers and anticipated opening of male flowers favour pollinator movement and pollen deposition on female flowers, albeit low (0.003% of pollen that reached stigmas), but sufficient to produce thousands of fruits per tree. Besides being an astonishing pollen and nectar source for numerous social bee species, only a few of them were effective pollinators. Our quantitative approach to floral resource production of each gender provides new insights, such as the proportion of resources allocated to each gender and the corresponding behaviour of flower visitors, for understanding the reproductive strategy of dioecious tropical mass-flowering trees.

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Redoxome is the network of redox reactions and redox active species (ReAS) that affect the homeostasis of cells and tissues. Due to the intense and constant interaction with external agents, the human skin has a robust redox signalling framework with specific pathways and magnitudes. The establishment of the skin redoxome concept is key to expanding knowledge of skin disorders and establishing better strategies for their prevention and treatment. This review starts with its definition and progress to propose how the master redox regulators are maintained and activated in the different conditions experienced by the skin and how the lack of redox regulation is involved in the accumulation of several oxidation end products that are correlated with various skin disorders.

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Littoraria angulifera (Lamarck, 1822) is an estuarine gastropod of tropical occurrence, which lives mainly on trunks of mangrove tree species. This study aimed to evaluate the population attributes of this species, such as abundance, space-time distribution, sex ratio and recruitment in mangroves in Bahia State, northeastern Brazil. The specimens were collected monthly throughout 2018, on trunks of the red mangrove Rhizophora mangle L. at two heights and on two horizontal levels. Specimens that were on the marine grass Spartina alterniflora Loisel were also collected. After counting, biometrics and sexing, the specimens were returned alive to the environment. The average size and weight of L. angulifera was higher (p<0.05) in places with taller and less sparse trees and the vertical distribution on the trunks showed a preference for strata close to the soil. Both results are related to shading and protection against desiccation. Females were more abundant than males, at an approximate sex ratio F: M of 1.4: 1. Recruits were observed throughout the period, showing continuous reproduction of the species with a recruitment peak in spring (September to November). The study revealed the importance of keep the mangroves intact to allow the maintenance of the natural stocks of the species.(AU)

Littoraria angulifera (Lamarck, 1822) é um gastrópode estuarino, de ocorrência tropical, que vive principalmente sobre troncos de espécies arbóreas de mangue. Este estudo teve como objetivo avaliar os atributos populacionais dessa espécie, como abundância, distribuição espaço-temporal, razão sexual e recrutamento em manguezais do estado da Bahia, nordeste do Brasil. Os espécimes foram coletados mensalmente ao longo de 2018, em troncos do mangue vermelho Rhizophora mangle L. em duas alturas e em dois níveis horizontais. Também foram coletados espécimes que estavam na grama marinha Spartina alterniflora Loisel. Após contagem, biometria e sexagem, os espécimes foram devolvidos vivos ao ambiente. O tamanho e peso médios de L. angulifera foram maiores (p<0,05) em locais com árvores mais altas e menos esparsas e a distribuição vertical nos troncos mostrou preferência por estratos próximos ao solo. Ambos os resultados estão relacionados ao sombreamento e proteção contra a dessecação. As fêmeas foram mais abundantes que os machos, em uma proporção sexual aproximada F: M de 1,4: 1. Recrutas foram observados ao longo do período, mostrando reprodução contínua da espécie, com um pico de recrutamento na primavera (setembro a novembro). O estudo revelou a importância de manter os manguezais intactos para permitir a manutenção dos estoques naturais da espécie.(AU)

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