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RESUMO Introdução: O aumento global da alimentação não saudável está intimamente ligado a uma tendência de redução na preparação da comida feita em casa. Já existem estudos que mostram uma associação positiva entre o aumento das habilidades culinárias e a redução de risco cardiovascular. Somado a isso, o baixo tempo destinado à educação nutricional no currículo das faculdades de Medicina contrasta com as altas taxas de mortalidade atribuíveis à má alimentação. A medicina culinária (MC) é um campo emergente da medicina, que traz uma nova abordagem educacional, baseada em evidências científicas, cujo objetivo é ensinar o poder que a comida tem sobre a saúde e melhorar os comportamentos alimentares dos profissionais de saúde e, consequentemente, de seus pacientes. Relato da experiência: Desenvolveu-se uma disciplina eletiva de MC na Escola Paulista de Medicina da Universidade Federal de São Paulo (Unifesp) que resultou em um relato de experiência, com abordagem qualitativa, realizado com 18 alunos que participaram de encontros semanais durante cinco semanas de forma 100% online, por meio da plataforma Zoom. Os dados deste estudo foram coletados por meio de portfólios, em que cada estudante descreveu sua experiência com o curso. A avaliação do material foi feita por meio de análise temática. Aplicou-se um questionário que avaliou o Índice de Habilidades Culinárias, desenvolvido e validado segundo a autoeficácia no desempenho das habilidades culinárias e tendo como referencial teórico o Guia alimentar para a população brasileira. Discussão: Existem inúmeros desafios, como a conscientização dos médicos sobre a importância desse assunto, que muitas vezes parece ser mais prático do que técnico, e a subjetividade do tema sobre mudança de comportamento de médicos e pacientes. No entanto, os resultados deste estudo evidenciam que os alunos que realizaram a eletiva acreditam que essa reformulação curricular é extremamente importante e urgente. Conclusão: Observa-se uma tendência mundial de transformação da grade curricular dos profissionais da saúde, e acredita-se que esse processo pode ser iniciado nas faculdades de Medicina por meio de disciplinas eletivas de MC como a que foi implementada na Escola Paulista de Medicina da Unifesp.

ABSTRACT Introduction: The global increase in unhealthy eating is closely linked to a downward trend in food preparation at home. There are studies showing a positive association between increased cooking skills and reduced cardiovascular risk. In addition, the little time devoted to nutrition education in the curriculum of medical schools contrasts with the high mortality rates attributable to poor diet. Culinary Medicine (CM) is an emerging field of Medicine, which brings a new educational approach, based on scientific evidence, whose objective is to teach the power that food has on health and to improve the eating behaviors of healthcare professionals and, consequently, of their patients. Experience report: An elective discipline of CM was developed at Unifesp, which resulted in a descriptive study with a qualitative approach, carried out with 18 students who participated in weekly meetings during 5 weeks of training. The meetings were carried out 100% online, through the Zoom platform. Data from this study were collected through portfolios, in which each student described their experience with the course. The analysis of the material was carried out through thematic analysis. A questionnaire was applied to evaluate the Culinary Skills Index developed and validated according to self-efficacy in the performance of culinary skills and having as theoretical reference the Dietary Guideline for the Brazilian Population. Discussion: There are numerous challenges such as the physicians' awareness about the importance of this approach, which often seems to be more practical than technical, and the subjectivity of the topic on changing the behavior of physicians and patients. However, the results of this study show that the students who took the elective course believe that this curricular reformulation is extremely important and urgent. Conclusion: There is a worldwide transformation trend in the curriculum of healthcare professionals, and it is believed that this process can be initiated in medical schools through elective courses in Culinary Medicine, such as the one implemented at Unifesp.

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The introduction of rotavirus A (RVA) vaccines has considerably reduced the RVA-associated mortality among children under 5 years of age worldwide. The ability of RVA to reassort gives rise to different combinations of surface proteins G (glycoprotein, VP7) and P (protease sensitive, VP4) RVA types infecting children. During the epidemiological surveillance of RVA in the Northwest Amazon region, an unusual rotavirus genotype G6P[8] was detected in feces of a 2-year-old child with acute gastroenteritis (AGE) that had been vaccinated with one dose of Rotarix® (RV1). The G6P[8] sample had a DS-1-like constellation with a Wa-like VP3 gene mono-reassortment similar to equine-like G3P[8] that has been frequently detected in Brazil previously. The results presented here reinforce the evolutionary dynamics of RVA and the importance of constant molecular surveillance.

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Plasmodium spp. and some other blood parasites belonging to the order Haemosporida are the focus of many epidemiological studies worldwide. However, haemosporidian parasites from wild animals are largely neglected in scientific research. For example, Polychromophilus parasites, which are exclusive to bats, are described in Europe, Asia, Africa, and Oceania, but little is known about their presence and genetic diversity in the New World. In this study, 224 samples of bats from remaining fragments of the Atlantic Forest and Pantanal biomes, as well as urbanized areas in southern and southeastern Brazil, were analyzed for the presence of haemosporidian parasites by PCR of the mitochondrial gene that encodes cytochrome b (cytb). The PCR fragments of the positive samples were sequenced and analyzed by the Bayesian inference method to reconstruct the phylogenetic relationships between Polychromophilus parasites from bats in Brazil and other countries. Sequences from Brazilian lineages of Polychromophilus were recovered in a clade with sequences from Polychromophilus murinus and close to the one Polychromophilus sequence obtained in Panama, the only available sequence for the American continent. This clade was restricted to bats of the family Vespertilionidae and distinct from Polychromophilus melanipherus, a parasite species mainly found in bats of the family Miniopteridae. The detection of Polychromophilus and the genetic proximity to P. murinus were further confirmed with the amplification of two other genes (clpc and asl). We also found a Haemosporida parasite sequence in a sample of Noctilio albiventris collected in the Pantanal biome, which presents phylogenetic proximity with avian Haemoproteus sequences. Morphological and molecular studies are still needed to conclude and describe the Polychromophilus species in Brazilian Myotis bats in more detail and to confirm Haemoproteus parasites in bats. Nevertheless, these molecular results in Brazilian bats confirm the importance of studying these neglected genera.

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Changes in physical habitat that are associated with anthropogenic disturbances facilitate the establishment and expansion of non-native species in receiving environments. Here, we evaluated the relative importance of ecosystem variables for the presence and abundance of the invasive fish Poecilia reticulata in Brazil. We collected fish species and assessed environmental variables through an established physical habitat protocol in 220 stream sites located in southeastern and midwestern Brazil. A total of 14,816 P. reticulata individuals were collected in 43 stream sites, and 258 variables that describe the physical characteristics of streams were assessed, including measures of channel morphology, substrate size and type, habitat complexity and cover, riparian vegetation cover and structure, and human influence. Dimensionality reduction methods were employed to limit redundancy, resulting in a smaller set of the most relevant environmental variables. Subsequently, we used random forest models to assess the relative importance of these variables in determining the presence and abundance of P. reticulata. The presence of this invasive fish was primarily explained by human disturbance variables related to urbanization (total impact, pavement, artificial structure areal cover, riparian canopy cover, electrical conductivity, mean thalweg depth, and sand), whereas channel morphology (mean bank full height) and fish cover variables (natural fish cover, and aquatic macrophyte areal cover) were important predictors of its abundance. Identifying which ecosystem variables are favorable to the establishment of non-native species is an important step in preventing future biological invasions, as well as managing those that already occur.

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In developing countries, outbreaks of zoonotic diseases (ZDs) result from intertwined ecological, socioeconomic, and demographic processes that shape conditions for (i) increased contact between vulnerable human population and wildlife in areas undergoing environmental degradation and (ii) the rapid geographic spread of infections across socially vulnerable regions. In Brazil, recent increases in environmental and social vulnerabilities, amplified by economic and political crises, are potential triggers for outbreaks. We discuss Brazilian features that favor outbreaks and show a novel quantitative method for zoonotic risk assessment. Using data on nine ZDs from 2001 to 2019, we found that the most significant causal variables were vegetation cover and city remoteness. Furthermore, 8 of 27 states presented low-level risk of ZD outbreaks. Given the ZD-bushmeat connection, we identified central hunted mammals that should be surveilled to prevent spillover events. The current challenge is to coordinate intersectoral collaboration for effective One Health management in megadiverse countries with high social vulnerability and growing environmental degradation like Brazil.

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INTRODUCCIÓN: la diabetes mellitus gestacional (DMG) es una complicación común del embarazo siendo su prevalencia muy variable según la población estudiada y los criterios diagnósticos empleados. Sabemos que la DMG se asocia con un aumento de numerosas complicaciones a nivel materno-fetal, así como a un aumento del riesgo de DMG en futuros embarazos y de diabetes tipo 2 a largo plazo. Objetivos: nuestro objetivo es investigar de forma retrospectiva la evolución a largo plazo (9 años) de las 225 pacientes diagnosticadas de DMG en el Hospital Severo Ochoa en el año 2013 en el screening prenatal. Determinar la incidencia a largo plazo de alteración del metabolismo hidrocarbonado (AMH) y su relación con parámetros clínicos y bioquímicos en la gestación. Métodos: se ha realizado la revisión de Historias Clínicas informatizadas en el programa Selene y en papel del archivo hospitalario. Se han revisado las analíticas en los programas infinity/ Omega y la evolución en el programa Horus de Atención Primaria. Se ha revisado los tratamientos en el módulo de prescripción única (MUP). Conclusiones: la incidencia de AMH en nuestra serie a 9 años de seguimiento es del 22%. El porcentaje de screening postparto es bajo (41%). Los factores asociados independientemente con el desarrollo de AMH son la glucemia basal en el screening, la existencia de obesidad pregestacional y la aparición de trastornos hipertensivos durante la gestación.

INTRODUCTION: gestational diabetes mellitus (GDM) is a common complication of pregnancies with a variable prevalence depending on the studied population and the diagnostic criteria used. We know that GDM is associated to numerous complications for the mother and the baby as well as a higher risk of GDM in future pregnancies and type 2 diabetes on the long term. Objective: our objective is to investigate retrospectively the long term (9 years) evolution of 225 patients diagnosed with GDM in the Hopital Severo Ochoa along 2013 in the prenatal screening. To determinate the long term incidence of hydrocarbonate metabolism alterations (HMA) and its relationship with clinical and biochemical parameters in the pregnancy. Methods: we have search the Medical Records computerized in the Selene program and in paper in the hospital Archives. The analyses in the programs Infinity and Omega have been reviewed as well as the clinical evolution in the Primary Care program Horus. The actual treatments have been searched in the Madrid system of electronical prescription (MUP). Conclusions: HMA incidence in our patients series is 22% at 9 years. After delivery the screening is low (41%). Basal glucose at screening during pregnancy, pregestational obesity and the ocurrence of hypertensive alterations during pregnancy were the independent factors associated to HMA at long term.

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BACKGROUND: The population history of Plasmodium simium, which causes malaria in sylvatic Neotropical monkeys and humans along the Atlantic Coast of Brazil, remains disputed. Genetically diverse P vivax populations from various sources, including the lineages that founded the species P simium, are thought to have arrived in the Americas in separate migratory waves. METHODS: We use population genomic approaches to investigate the origin and evolution of P simium. RESULTS: We find a minimal genome-level differentiation between P simium and present-day New World P vivax isolates, consistent with their common geographic origin and subsequent divergence on this continent. The meagre genetic diversity in P simium samples from humans and monkeys implies a recent transfer from humans to non-human primates - a unique example of malaria as a reverse zoonosis of public health significance. Likely genomic signatures of P simium adaptation to new hosts include the deletion of >40% of a key erythrocyte invasion ligand, PvRBP2a, which may have favored more efficient simian host cell infection. CONCLUSIONS: New World P vivax lineages that switched from humans to platyrrhine monkeys founded the P simium population that infects nonhuman primates and feeds sustained human malaria transmission in the outskirts of major cities.

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Brazil concentrates the largest number of primate species in the world. In the present study, an extensive literature review of ticks on New World wild monkeys has been carried out, demonstrating that between the years 1912 to 2018, 182 larvae, 137 nymphs and 31 adult ticks (10 males and 21 females) were collected on 78 primates (from 12 different species) in 28 distinct localities in the Brazilian territory. Additionally, examination of allotments of 11 tick collections of Brazil revealed that from 1919 to 2019, 93 larvae, 91 nymphs and 175 adult ticks (62 males and 113 females) were collected from 100 monkeys (among 20 different species) from 43 localities in distinct Brazilian biomes. Overall, 19 tick species were identified on wild primates in the country: Amblyomma aureolatum (Pallas, 1772), Amblyomma cajennense (Fabricius, 1787) sensu stricto, Amblyomma coelebs Neumann, 1899, Amblyomma dubitatum Neumann, 1899, Amblyomma geayi Neumann, 1899, Amblyomma incisum Neumann, 1906, Amblyomma longirostre (Koch, 1844), Amblyomma naponense (Packard, 1869), Amblyomma nodosum Neumann, 1899, Amblyomma ovale Koch, 1844, Amblyomma parkeri Fonseca & Aragão, 1952, Amblyomma romarioi Martins, Luz & Labruna, 2019, Amblyomma rotundatum Koch, 1844, Amblyomma sculptum Berlese, 1888, Haemaphysalis juxtakochi Cooley, 1946, Ixodes fuscipes Koch, 1844, Rhipicephalus microplus (Canestrini, 1888), Rhipicephalus sanguineus (Latreille, 1806) sensu lato,and Ornithodoros rostratus Aragão, 1911. The presence of A. incisum, A. naponense, A. nodosum, A. rotundatum and I. fuscipes on monkeys is recorded for the first time. Thisresearch is therefore a significant contribution to the knowledge of tick speciesassociated with non-human primates in the Neotropical region.

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Non-human primates (NHPs) have been shown to be infected by parasites of the genus Plasmodium, the etiological agent of malaria in humans, creating potential risks of zoonotic transmission. Plasmodium brasilianum, a parasite species similar to P. malariae of humans, have been described in NHPs from Central and South America, including Brazil. The merozoite surface protein 1 (MSP1), besides being a malaria vaccine candidate, is highly immunogenic. Due to such properties, we tested this protein for the diagnosis of parasite infection. We used recombinant proteins of P. malariae MSP1, as well as of P. falciparum and P. vivax, for the detection of antibodies anti-MSP1 of these parasite species, in the sera of NHPs collected in different regions of Brazil. About 40% of the NHP sera were confirmed as reactive to the proteins of one or more parasite species. A relatively higher number of reactive sera was found in animals from the Atlantic Forest than those from the Amazon region, possibly reflecting the former more intense parasite circulation among NHPs due to their proximity to humans at a higher populational density. The presence of Plasmodium positive NHPs in the surveyed areas, being therefore potential parasite reservoirs, needs to be considered in any malaria surveillance program.

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We investigated Malassezia spp. in external ear canal and haircoat of free-ranging golden-headed lion tamarins (Leontopithecus chrysomelas). A total of 199 animals were restrained, and 597 clinical samples were collected. After the amplification of the 26S ribosomal gene by polymerase chain reaction (PCR), the RFLP technique was performed. Two additional PCR protocols were performed in 10 randomly selected strains. Malassezia sp. was isolated in 38.2% (76/199) of the animals and 14.6% (87/597) of the samples; all strains were lipodependent. The 10 sequenced strains showed a high identity with Malassezia japonica, species described in man, but not in animals, so far.

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Simian foamy viruses (SFV) infect a wide range of Old World and Neotropical primates (NP). Unlike Old World primates, little is known about the diversity and prevalence of SFV in NP, mainly from a free-living population. Phylogenetic analyses have shown that SFV coevolved with their hosts. However, viral strains infecting Leontopithecus chrysomelas did not behave as expected for this hypothesis. The purpose of this study was to determine the eco-epidemiological profile and molecular characterization of SFV in a recently captured invasive population of L. chrysomelas located in Niteroi/RJ using buccal swab as an alternative collection method. A prevalence of 34.8% (32/92) and a mean viral load of 4.7 log copies of SFV/106 cells were observed. With respect to time since capture, SFV prevalence was significantly higher in the group of animals sampled over 6 months after capture (55.2%) than in those more recently captured (25.4%) (p = 0.005). Infected solitary animals can contribute to SFV transmission between different groups in the population. SFV strains formed two distinct clades within the SFV infecting the Cebidae family. This is the first study to use buccal swabs as a tool to study SFV diversity and prevalence in a recently free-living NP population upon recent capture.

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Non-human primates are susceptible to many bacteria, some of which bear zoonotic potential. We report the pathologic features of spontaneous fulminating meningoencephalitis by Staphylococcus aureus in a captive infant golden-headed lion tamarin (Leontopithecus chrysomelas) from Brazil.

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BACKGROUND: A smooth and rapid recovery from anesthesia allowing safe release is desirable, especially for wild species. This study describes the clinical effects of the combination of dexmedetomidine and ketamine and the partial reversal with atipamezole in golden-headed lion tamarins. METHODS: Dexmedetomidine 10 µg kg-1 and ketamine 15 mg kg-1 were administered to 45 golden-headed lion tamarins undergoing vasectomy. Following surgery, animals were assigned to three groups: control (SAL; 0.9% NaCl), atipamezole 20 µg kg-1 (ATI20), and atipamezole 40 µg kg-1 (ATI40). RESULTS AND CONCLUSIONS: All animals presented great scores of sedation and muscle relaxation during the procedure. Recovery in the control group was smooth and uneventful. Salivation, muscle tremors, and head movements were observed in ATI 20 and ATI40. The administration of atipamezole did not change total recovery times (ATI20 69 ± 23 minutes; ATI40 72 ± 45 minutes; SAL 57 ± 23 minutes).

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The world currently faces severe biodiversity losses caused by anthropogenic activities such as deforestation, pollution, the introduction of exotic species, habitat fragmentation, and climate changes. Disease ecology in altered environments is still poorly understood. The golden-headed lion tamarin (GHLT, Leontopithecus chrysomelas) is an endangered species that became invasive in an urban park in Niterói, Rio de Janeiro, Brazil. The initially few invasive GHLT individuals became hundreds, adapted to living in proximity to humans and domestic animals. These GHLTs were captured as part of a conservation project; some animals were translocated to Bahia and some were kept in captivity. This study tested 593 GHLT for Leptospira serology; 100 and 95 GHLT for polymerase chain reaction (PCR) toLeptospira and hepatitis E virus genotype 3 (HEV-3), respectively, and 101 familiar groups for PCR to viruses (rotavirus A, norovirus GI and GII, and HEV-3). One animal had antibodies for Leptospira serovar Shermani and another for serovar Hebdomadis. One saprophyticLeptospira was found by the 16S PCR and sequencing. Viruses were not detected in samples tested. Findings suggest that the epidemiological importance of such pathogens in this GHLT population is either low or nonexistent. These data are important to understand the local disease ecology, as well as monitoring a translocation project, and to contribute data for species conservation.

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Malignant adipocytic neoplasia is rare among nonhuman primates. We report the gross and microscopic features of a retroperitoneal liposarcoma with myxofibrosarcoma-like dedifferentiation in a free-ranging juvenile golden-headed lion tamarin (Leontopithecus chrysomelas). To our knowledge, this is the first report of such tumor subtype in New World primates.

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BACKGROUND: The Atlantic Forest where the animals were captured is surrounded by residences, so this close contact could favor the presence of disease-transmitting pathogens, putting the local population at risk. For these and other factors, it is important to perform laboratory tests enabling the performance of important diagnoses. METHODS: Blood samples of 268 golden-headed lion tamarins (Leontopithecus chrysomelas) inhabiting an Atlantic Forest area in Rio de Janeiro, Brazil, were processed for accessing age and sex influence in hematological parameters and to establish normative hematology values. RESULTS: Mean values of red blood cells, hematocrit, hemoglobin, and platelet count were significantly higher in adult males than in adult females. Adult animals had significantly higher mean neutrophil count, and young animals had higher averages than adults in lymphocyte values. Anisocytosis and platelet indices parameters were also provided for the first time. CONCLUSIONS: Averages presented can be used as hematological parameters for golden-headed lion tamarins.

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We examined the mitogenomes of a large global collection of human malaria parasites to explore how and when Plasmodium falciparum and P. vivax entered the Americas. We found evidence of a significant contribution of African and South Asian lineages to present-day New World malaria parasites with additional P. vivax lineages appearing to originate from Melanesia that were putatively carried by the Australasian peoples who contributed genes to Native Americans. Importantly, mitochondrial lineages of the P. vivax-like species P. simium are shared by platyrrhine monkeys and humans in the Atlantic Forest ecosystem, but not across the Amazon, which most likely resulted from one or a few recent human-to-monkey transfers. While enslaved Africans were likely the main carriers of P. falciparum mitochondrial lineages into the Americas after the conquest, additional parasites carried by Australasian peoples in pre-Columbian times may have contributed to the extensive diversity of extant local populations of P. vivax.

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BACKGROUND: The golden-headed lion tamarin (Leontopithecus chrysomelas), originally endemic to Bahia, was introduced in Rio de Janeiro. The species is currently found in remaining forests within the region of original occupation of the golden lion tamarin (Leontopithecus rosalia), which may compromise the survival of the golden lion tamarin. Groups of golden-headed lion tamarins were captured and translocated to Bahia. However, the area chosen reached its limit and males underwent to vasectomy procedures. METHODS: Animals were separated into 3 groups: S-ketamine and midazolam, S-ketamine and dexmedetomidine, and racemic ketamine and dexmedetomidine. RESULTS AND CONCLUSIONS: Heart rate, sedation and muscle relaxation degrees, antinociception, and lidocaine consumption presented significant difference between midazolam and dexmedetomidine groups. Bradycardia was present on dexmedetomidine groups, with values remaining within the normal range. Dexmedetomidine groups present the best outcomes for muscle relaxation, sedation, and antinociception and were safe for vasectomy surgery in golden-headed lion tamarins.

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