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BACKGROUND: Traumatic brain injury (TBI) represents one of the leading public health problems and a significant cause of neurological damage. Unintentional causes of TBI are the most frequent. However, fruit falling over the head causing TBI is extremely rare. In the Amazon region, accidents with ouriços, a coconut-like shell fruit, seem relatively common. However, to the best our knowledge, it has never been described in a scientific journal before. Therefore, we aim to evaluate a series of TBI caused by this tropical fruit. METHODS: This study is a retrospective review of 7 TBI cases due to the fall of ouriços admitted to two tertiary hospitals in the Amazon region from January 2017 to December 2018. The collected data included: age, Glasgow Coma Scale, skull fracture, venous sinus injury, hematoma, surgical treatment, and outcome. RESULTS: All patients were men, with an average age of 38, ranging from 8 to 77-years-old. Four out of seven had skull fractures. Five patients developed an epidural hematoma, and two of them had an associated subdural hematoma. Dura mater injury was observed in two patients, whereas four patients were operated. There was one related death. CONCLUSION: This case series is the first to describe an unconventional but potentially fatal cause of TBI in the Amazon: the falling of the Brazil-nut fruit. Most patients were diagnosed with mild TBI. Nevertheless, patients may have cranial fractures and epidural hematomas, leading to death when there's a delay in medical assistance.

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BACKGROUND: The need for neurosurgical care across the globe remains a public health issue. The creation of sustainable neurological surgery departments and training programs will be indispensable in alleviating the burden of neurological disease in low to middle income countries (LMICs). METHODS: We reviewed the history of the neurological surgery department and residency program of Santarém in the state of Pará, Brazil, from 1999 to the present. We have described the epidemiology unique to the region and provided evidence of a sustainable practice in a LMIC. The challenges, limitations, and resources were explored. RESULTS: We have provided a historical vignette of the evolution of neurological surgery in the Brazilian Amazon, including the creation of a sustainable neurological surgery practice and accredited residency program. In addition, we assessed the neurological surgery burden and epidemiology unique to the region, with an emphasis on the community and indigenous health in this remote area. We also explored the future directions of this example, which could affect the international neurological surgery community. CONCLUSION: A sustainable neurosurgery practice and training program is possible in a LMIC. Training neurosurgeons in developing regions of LMICs is a sustainable method to decrease the morbidity and mortality of neurological diseases and prevent the misdistribution of physicians in a country. We encourage adaptation of sustainable neurological surgery practices in similar regions across the world to increase access to necessary neurosurgical care.

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Las aves y mamíferos constituyen la principal fuente de proteína animal para las poblaciones humanas originarias de la selva amazónica. La carne es destinada a la alimentación y otras partes del cuerpo son utilizadas en artesanías, adornos y objetos de uso cotidiano. Considerando el aprovechamiento y uso de la fauna, los objetivos del estudio fueron a) identificar las especies de aves y mamíferos aprovechadas por las poblaciones locales, b) determinar el uso de las aves y mamíferos, y c) calcular el valor económico de la biomasa extraída. Se realizó el registro del aprovechamiento de especies, mediante encuestas y la información recopilada fue sistematizada. Como resultado se encontró que en el Bajo Urubamba se aprovechan 10 especies de aves y 12 de mamíferos. El paujil (Mitu tuberosum) y las perdices (Crypturellus sp. y Tinamus tao) son las aves más aprovechadas. Se identificaron al majáz (Cuniculus paca), venado rojo (Mazama americana) y tapir o sachavaca (Tapirus terrestris) como los mamíferos con mayor biomasa extraída. El principal uso de la diversidad capturada es la alimentación de subsistencia.

Birds and mammals are the most important resource of protein for original groups of the amazon rainforest. Most of the meat is used for food and other parts of the animals are designates for the production of handicrafts, ornaments and other daily objects. Considering the use and exploitation of the fauna, the objectives of this study were: a) to identify the species of birds and mammals used by the local population; b) to determine what the uses of this animal are, and c) to calculate the economic value of the biomass extracted. We registered the exploitation and use of the species through surveys between the families. All the information was recorded, analyzed and systematized. We found that in the Lower Urubamba River, local families use 10 species of birds and 12 species of mammals. Paujil (Mitu tuberosum), Tinammus (Crypturellus sp. and Tinamus tao) are the species more commonly used. The lowland pacca (Cuniculus paca), Red brocket deer (Mazama americana) and tapir (Tapirus terrestris) are the mammals with the more extracted biomass. The most important use of these animals is for food (as meat) for subsistence of the families.

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Piracatinga (Callophysius macropterus) are a type of bottom feeder catfish encountered in the Amazon River and its tributaries. We report two cases in which human remains were first located based on a characteristic circular distortion of the surface of the river that the Piracatinga make while they feed. Human skin samples of one of the victims recovered from the Piracatinga digestive tract were subjected to mitochondrial DNA analysis that allowed identification of the body of Case 1; the family recognized body parts of Case 2. Importantly, the location of human body parts and their identification based on DNA analysis enabled the respective families to obtain a death certificate expeditiously in the absence of identifiable remains-a process that normally requires 5 years under current Brazilian law, and in the absence of closure, imposes severe emotional stress on the family of the deceased.

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Hemocytes mediate a series of immune reactions essential for bivalve survival in the environment, however, the impact of harmful algal species and their associated phycotoxins upon bivalve immune system is under debate. To better understand the possible toxic effects of these toxins, Crassostrea gigas hemocytes were exposed to brevetoxin (PbTx-2). Hemocyte viability, monitored through the neutral red retention and MTT reduction assays, and apoptosis (Hoechst staining) remained unchanged during 12 h of exposure to PbTx-2 in concentrations up to 1000 µg/L. Despite cell viability and apoptosis remained stable, hemocytes incubated for 4 h with 1000 µg/L of PbTx-2 revealed higher expression levels of Hsp70 (p < 0.01) and CYP356A1 (p < 0.05) transcripts and a tendency to increase FABP expression, as evaluated by Real-Time quantitative PCR. The expression of other studied genes (BPI, IL-17, GSTO, EcSOD, Prx6, SOD and GPx) remained unchanged. The results suggest that the absence of cytotoxic effects of PbTx-2 in Crassostrea gigas hemocytes, even at high concentrations, allow early defense responses to be produced by activating protective mechanisms associated to detoxification (CYP356A1 and possibly FABP) and stress (Hsp70), but not to immune or to antioxidant (BPI, IL-17, EcSOD, Prx6, GPx and SOD) related genes.

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