Plastic pollution has reached the remote terrestrial ecosystems of Antarctica, but the extent to which microplastics are affecting native terrestrial invertebrates has not been assessed. Using Antarctica's only endemic insect, the chironomid midge Belgica antarctica, as a focal species, the objectives of this study were two-fold: 1) Investigate the physiological consequences of polyethylene microplastic exposure in a laboratory setting and 2) Determine the extent to which field-collected larvae contain ingested microplastics. We exposed B. antarctica larvae to ingestible polyethylene microplastic beads (∼27-45 μm diameter) at various concentrations (up to 2000 mg kg-1 substrate) for 10 days. Ingestion of beads was only observed at the two highest concentrations, and survival and metabolic rates were unchanged across all concentrations. While carbohydrates and proteins stores were unaffected by plastic exposure, lipid stores tended to decrease with increasing plastics concentration. For Objective 2, field-collected larvae from 13 islands were screened for microplastics with two approaches, either imaging digestive samples with μ-FTIR and μ-Raman microscopy or spotting digested guts onto glass filters and scanning with μ-Raman. While the latter approach was inconclusive, two of the 29 larvae (7 %) imaged with μ-FTIR had potential plastics, and one of these particles was confirmed as plastic using μ-Raman. Thus, the presence of plastics in larvae is likely rare at present, although our results do provide further evidence that microplastics can enter Antarctic food webs. Taken together, our results indicate that high concentrations of plastics can have physiological consequences, although it appears unlikely that these levels are currently approached in the field.
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The larval morphology of the endemic species Belgica antarctica Jacobs, collected in January and February (2022) from six sites of Antarctica, was studied. The mouth apparatus and the parapods of one hundred seventy-six larvae were analyzed. No differences were found in the morphology of these structures between individuals of different sites. However, differences (with the exception of the length of 2nd antennal segment) were estimated in the sizes of the morphological features, as 2023 measurements were made of fifteen kinds of these structures and larval body. Deformities of mentum, mandible, antennal blade and antennal segments in percentage were established in larvae of almost all of the studied sites. The reasons for the differences and deformities are discussed.
Snow flies (Chionea) are wingless crane flies uniquely adapted to extreme cold environments. Adults remain active throughout winter and move rapidly across the snow, even at temperatures below freezing. To investigate the molecular adaptations that make this possible, we sequenced and annotated the genome of Chionea alexandriana and compared it with related species and with the cold-adapted midge, Belgica antarctica. We identify ∼20 lineage-specific and 8 shared gene-family expansions in Chionea and Belgica, corresponding to functions ranging from sensory signaling to DNA packaging. The Chionea genome encodes antifreeze proteins (AFPs), and we show that transgenic expression of an AFP in Drosophila is sufficient to protect larvae from freezing-induced death. Our results also reveal a coordinated expansion of mitochondrial and peroxisomal enzymes, as well as regulators of peroxisome-mitochondria interactions involved in mammalian thermogenesis. Consistent with this, direct measurements reveal that snow flies produce brief bursts of endogenous heat in response to cooling at sub-freezing temperatures, indicating active thermogenic capacity. Finally, our results demonstrate that Chionea has evolved mechanisms to cope with high levels of reactive oxygen species (ROS), a byproduct of mitochondrial activity and a hallmark of cold exposure. These include a 35-fold increase in the threshold for ROS activation of the insect nociceptor TRPA1, as measured in vitro by patch-clamp electrophysiology. Together, our results reveal specific molecular adaptations that enable the snow fly to thrive in extreme cold conditions and suggest that selective gene-family expansion may represent a key mechanism for the adaptation of insects to cold environments.
Spinal anesthesia (SA) is widely used for elective total knee arthroplasty (TKA) but is frequently associated with episodes of low blood pressure. Because baricity influences intrathecal spread, plain bupivacaine (PB) and hyperbaric bupivacaine (HB) may differ in their early hemodynamic effects. This trial compared the early hemodynamic consequences of PB versus HB for SA in elective TKA. This prospective, double-blinded, single-center randomized controlled superiority trial enrolled adult patients undergoing elective TKA under SA, randomized 1:1 to receive 2 mL of 0.5% PB or 2 mL of 0.5% HB. Hemodynamics were measured using automated non-invasive brachial blood pressure every 2.5 min during the first 20 min and every 5 min thereafter up to 1 hour after SA. The primary endpoint was the maximal relative decrease in mean arterial pressure (MAP) from preoperative baseline within 1 hour. Secondary outcomes included nadir MAP, MAP and heart rate trajectories, incidence of intraoperative nausea and vomiting, and ephedrine or atropine use. 60 patients were analyzed, 30 in each group. The maximal relative decrease in MAP during the first hour after SA was similar between groups, with mean (SD) decreases of 33.1% (13.3) in the HB group and 33.1% (11.5) in the PB group. Nadir MAP was also similar, with mean (SD) values of 74.2 (9.2) mm Hg in the HB group and 74.1 (12.4) mm Hg in the PB group. Mixed-model analyses showed a significant effect of time on MAP and heart rate, with no significant group effect or group-by-time interaction. Nausea and vomiting occurred in 7 of 30 patients (23.3%) in the HB group and 5 of 30 patients (16.7%) in the PB group. In this superiority trial using 10 mg intrathecal bupivacaine for elective TKA, superiority of PB over HB for early hemodynamic stability was not demonstrated. EudraCT 2022-000857-10 and registry URL https://www.clinicaltrialsregister.eu/ctr-search/trial/2022-000857-10/BE.
BackgroundOccupational exposure to hazardous drugs is a recognised occupational risk in hospital pharmacy practice. Although international guidelines are available, the implementation is heterogeneous, and there are currently no formally endorsed national recommendations regarding the safety of pharmacy technicians in Portugal.ObjectiveTo develop consensus-based national recommendations for the safe handling of hazardous drugs by pharmacy technicians in Portugal.MethodsA modified Delphi study was conducted involving 43 invited experts from Portuguese hospital pharmacies. Fifty-eight statements were evaluated using a 0-10 agreement scale through one formal quantitative round, followed by a structured online consensus validation meeting and documentary confirmation. Consensus was predefined as a median score >7.ResultsThirty-six experts completed Round 1 (response rate 83.7%). All 58 statements voted on in Round 1 achieved consensus, with median scores of 10 for all recommendations and 98% of ratings ≥7. Following consolidation and merging procedures, the final set comprised 55 recommendations. The final recommendations were organised into five domains: occupational health surveillance, engineering controls and PPE, preparation technique and quality assurance, administrative safeguards, and environmental contamination and waste management.ConclusionsThis study establishes the first structured national consensus on hazardous drug handling safety for pharmacy technicians in Portugal. The resulting framework supports harmonisation of institutional practices, strengthens occupational risk governance, and provides a foundation for future implementation and evaluation studies.
Cryptococcal meningitis (CM) remains one of the leading causes of morbidity and mortality among people living with HIV, particularly in low and middle-income countries where access to standard antifungal therapy is limited. Despite global advances in HIV care, early diagnosis and effective treatment of cryptococcal disease continue to represent major challenges in resource-limited settings. We conducted a retrospective registry-based cohort study of HIV patients and a first episode of CM admitted to a Peruvian national referral hospital between 2005 and 2015. Cox proportional hazards models were used to identify independent variables related to 30- and 90-day mortality. A total of 83 patients were included, 87% were males with a median age (interquartile range) of 33.8 (28.7-45.1) years. At baseline, 27.7% of patients had received antiretroviral therapy. Mortality at 30 and 90 days was 26.5% and 31.3%, respectively. In multivariable Cox models, the limited sample availability (59 for baseline and 83 for treatment analyses), constrained the precision estimates; nevertheless, altered consciousness, hyponatremia, and headache as independent predictors of mortality [30-day Hazard Ratios (HR): 7.6 (2.2-26.0); 5.4 (1.6-18.2); 0.1 (0.02-0.4); and 90-day HR: 7.1 (2.0-26.0); 10.9 (2.8-41.8); 0.1 (0.02-0.4), respectively]. In treatment analyses, fluconazole monotherapy or the absence of antifungals were significantly associated with higher mortality [30-day HR: 2.7 (1.1-6.8); 21.1 (7.8-57.5) and 90-day HR: HR: 2.8 (1.1-7.3); 20.1 (7.4-54.5), respectively]. In resource-limited settings, mortality from HIV-associated CM remains unacceptably high. These findings underscore the urgent need to enhance early diagnostic strategies and ensure access to optimal antifungal therapy to improve survival outcomes. The study found high mortality among patients with first-episode HIV-associated cryptococcal meningitis in a middle-income setting lacking standard therapy. Fluconazole monotherapy increased deaths, while altered consciousness predicted poor outcomes; low serum sodium may also indicate death risk.
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HEARTS in the Americas is the largest-scale implementation of the WHO's global initiative, with 33 countries participating, 28 having adopted standardized clinical pathways, and about 10 000 primary healthcare facilities engaged. Despite progress, fragmented care, limited availability of validated blood pressure devices, restricted access to essential medicines, and weak quality assurance systems continue to hinder hypertension control and cardiovascular risk management. In response, PAHO and participating countries co-developed the HEARTS Quality Framework. Grounded in regional implementation, this model synthesizes global evidence and lessons from Latin America and the Caribbean. Co-designed by Ministries of Health, care providers, and international experts, it translates HEARTS strategies into actionable system-level objectives. Clearly defined outcome indicators and implementation targets promote institutionalization, quality improvement, and primary healthcare strengthening- supporting HEARTS scale-up and equitable outcomes. With appropriate contextualization, the HEARTS Quality Framework provides a practical roadmap for countries beyond the Region to advance primary healthcare-based chronic disease care. HEARTS en las Américas constituye la implementación a mayor escala de la iniciativa mundial HEARTS de la Organización Mundial de la Salud (OMS), con la participación de 33 países, 28 de los cuales han adoptado vías clínicas estandarizadas, y cerca de 10 000 centros de atención primaria implicados. A pesar de los avances, algunos factores como la atención fragmentada, la escasa disponibilidad de dispositivos validados para medir la presión arterial, el acceso restringido a medicamentos esenciales y la debilidad de los sistemas de garantía de la calidad continúan obstaculizando el control de la hipertensión y la gestión del riesgo cardiovascular. En respuesta, la Organización Panamericana de la Salud (OPS) y los países participantes elaboraron conjuntamente el marco de calidad de HEARTS. Partiendo de las experiencias regionales de implementación, este modelo sintetiza la evidencia mundial y las enseñanzas de América Latina y el Caribe. Diseñado conjuntamente por ministerios de salud, prestadores de servicios y expertos internacionales, este marco de calidad traduce las estrategias de HEARTS en objetivos operativos ejecutables a nivel del sistema de salud. Los indicadores de resultados y las metas de implementación, claramente definidos, fomentan la institucionalización, la mejora continua de la calidad y el fortalecimiento de la atención primaria de salud, apoyando la expansión de HEARTS y la obtención de resultados equitativos. Con la contextualización adecuada, el marco de calidad de HEARTS ofrece una hoja de ruta práctica para que otros países fuera de la Región de las Américas avancen hacia una atención de las enfermedades crónicas basada en la atención primaria de salud. A iniciativa HEARTS nas Américas é a implementação em maior escala da iniciativa mundial HEARTS da Organização Mundial da Saúde (OMS), com a participação de 33 países – 28 dos quais adotaram itinerários clínicos padronizados – e de cerca de 10 000 centros de atenção primária. Apesar dos avanços, alguns fatores, como a atenção fragmentada, a disponibilidade limitada de aparelhos validados para medir a pressão arterial, o acesso restrito a medicamentos essenciais e a fragilidade dos sistemas de garantia da qualidade, continuam dificultando o controle da hipertensão arterial e o manejo do risco cardiovascular. Em resposta, a Organização Pan-Americana da Saúde (OPAS) e os países participantes elaboraram conjuntamente o marco de qualidade da iniciativa HEARTS. Com base nas experiências regionais de implementação, esse modelo sintetiza as evidências mundiais e as lições aprendidas na América Latina e no Caribe. Elaborado em conjunto por ministérios da Saúde, prestadores de serviços e especialistas internacionais, o marco de qualidade traduz as estratégias da iniciativa HEARTS em objetivos operacionais executáveis no âmbito do sistema de saúde. Os indicadores de resultados e as metas de implementação, claramente definidos, fomentam a institucionalização, a melhoria contínua da qualidade e o fortalecimento da atenção primária à saúde, apoiando a expansão da iniciativa HEARTS e a obtenção de resultados equitativos. Com a devida contextualização, o marco de qualidade da iniciativa HEARTS oferece um roteiro prático para que outros países fora da Região das Américas promovam a atenção às doenças crônicas no âmbito da atenção primária à saúde.
The Antarctic midge, Belgica antarctica, is a unique insect endemic to Antarctica. It has a 2-year life cycle, with larvae overwintering in two different instars and adults emerging the following summer. This seasonality is crucial for adaptation to Antarctica's harsh climates and ephemeral growing seasons; however, the underlying mechanisms remain unclear. We found that, under summer-like conditions, larvae could develop from egg to the fourth-instar larval stage without interruption, but they never pupated. Spontaneous developmental arrest at this stage suggests that they overwinter in obligate diapause, a genetically determined period of dormancy. The winter cold can terminate this diapause, and long-term cold exposure is more effective. Although this species can utilise two alternative cold tolerance strategies with diapause for overwintering, freezing was more successful than cryoprotective dehydration in allowing survival and developmental resumption in our experimental conditions. In contrast, the first three larval instars continued their development under the same conditions as the fourth-instar larvae. Although we do not exclude the possibility of facultative diapause, they likely overwinter in a quiescent state, an immediate developmental arrest in response to adversity, to maximise exploitation of the short Antarctic summer. Diapause and quiescence ensure developmental and reproductive success in this extremophile insect.
X-linked adrenoleukodystrophy (X-ALD) is a rare, inherited peroxisomal disorder caused by pathogenic variants in the ABCD1 gene, which encodes an ATP-binding cassette transporter located on Xq28. These pathogenic variants result in defective peroxisomal beta-oxidation and accumulation of very long-chain fatty acids (VLCFAs) in plasma and tissues, primarily affecting the adrenal cortex, myelin in the central nervous system, and Leydig cells. The estimated incidence is approximately 1 in 17,000 individuals (Kemp et al. 2016). Clinically, X-ALD is characterized by a broad phenotypic spectrum, including three main presentations: isolated adrenocortical insufficiency, adrenomyeloneuropathy (AMN), and cerebral X-ALD (Raymond et al. 1999). Considerable clinical overlap exists among these forms, and disease severity can vary. The cerebral form most commonly presents in childhood, between ages 4 and 8, whereas adult-onset cerebral X-ALD is rare, representing only about 1% of cases (Bezman et al., American Journal of Medical Genetics. 76(5):415-419, 1998). The parieto-occipital white matter is classically involved, while predominant frontal lobe lesions are unusual. Misdiagnosis is frequent, with rates up to 31%, particularly when cognitive and behavioral changes mimic frontotemporal dementia (Jiang et al., Acta Neurologica Belgica. 123(6):2259-2268, 2023). This report describes a 53-year-old man with an atypical adult-onset cerebral X-ALD presenting with frontal lobe involvement and rapid progression. The case underscores the importance of considering X-ALD in adults presenting with atypical cognitive decline and non-classical MRI patterns.
The monthly reports from the Tobacco Market Commission in Spain (CMT, by its acronym in Spanish), while data-rich, have critical deficiencies that limit their usefulness for public health. A critical analysis reveals three fundamental problems: institutional ambiguity, methodological opacity, and relevant analytical omissions. The authorship of the reports is uncertain, as they are published under the name of an advisory committee with representation from the tobacco industry, which compromises their independence. Methodologically, they lack clear definitions for key variables and use excessively aggregated data categories, preventing rigorous analysis and the replicability of findings. The reports are based on data self-reported by the industry itself, with no evidence of independent audits, which constitutes a serious conflict of interest. Furthermore, they systematically omit crucial information that the CMT derives from its activities, such as breakdowns of tax revenue by product, price-elasticity analyses, estimates of illicit trade, and the sector's advertising and promotion expenditures. For these reports to become an effective tool for formulating evidence-based policies, a reform is essential to ensure transparency in authorship, methodological rigor, data verification, and the inclusion of relevant economic and fiscal analyses.
Iron deficiency is a clinical condition characterized by the depletion of iron stores, potentially affecting up to 95% of pregnant women in Portugal. If not identified and treated early, this condition can progress from fatigue, tiredness and reduced work productivity to anemia, increasing the risk of maternal-fetal complications. Therefore, early detection of iron deficiency during pregnancy is crucial for promptly addressing iron deficits and preventing complications during childbirth and the postpartum period. Scientific evidence and international guidelines recognize serum ferritin as the most reliable marker for detecting iron deficiency. However, in Portugal, its measurement is not currently standardized in the pregnancy monitoring guidelines for any trimester. This lack of formal recommendation leads to a heterogeneous clinical approach, contributing to the underdiagnosis and undertreatment of iron deficiency, with a significant negative impact on maternal and fetal health. To address this gap, the Portuguese Association of Family Medicine, the Portuguese Society of Obstetrics and Maternal-Fetal Medicine, and the Anemia Working Group Portugal established a working group of four clinical experts. This group convened to develop a set of practical guidelines aimed at standardizing serum ferritin measurements across all three trimesters of pregnancy in the national healthcare system. Through these recommendations, experts aim to raise awareness among key stakeholders involved in pregnancy monitoring in Portugal and to urge national health authorities to incorporate this indicator into the digital IT systems used for pregnancy surveillance in primary healthcare. The aim of this initiative is to ensure a more effective approach to gestational iron deficiency and reduce its burden on maternal and fetal health. A ferropenia é uma condição clínica caracterizada pela depleção das reservas de ferro, podendo afetar até 95% das grávidas portuguesas. Se não for identificada e tratada precocemente, esta condição pode evoluir de fadiga, cansaço e redução da produtividade laboral para anemia, aumentando o risco de complicações materno-fetais. O diagnóstico precoce da ferropenia na gravidez é, portanto, fundamental para a correção atempada do défice de ferro, prevenindo complicações no parto e puerpério. A evidência científica e as diretrizes internacionais reconhecem a ferritina sérica como o melhor indicador para a deteção da ferropenia. No entanto, o seu doseamento não está atualmente parametrizado nas diretrizes oficiais de monitorização da gravidez, em nenhum dos trimestres gestacionais, em Portugal. Esta ausência de recomendação formal leva a uma abordagem clínica heterogénea, favorecendo o subdiagnóstico e subtratamento da ferropenia, com impacto negativo significativo na saúde materno-fetal. Face a esta lacuna, a Associação Portuguesa de Medicina Geral e Familiar, a Sociedade Portuguesa de Obstetrícia e Medicina Materno-Fetal e o Anemia Working Group Portugal promoveram a criação de um grupo de trabalho composto por quatro peritos clínicos. Este grupo reuniu-se com o objetivo de desenvolver um documento de orientações práticas para a uniformização do doseamento da ferritina sérica ao longo dos três trimestres da gravidez, nos cuidados de saúde a nível nacional. Com estas recomendações, os peritos pretendem consciencializar os principais intervenientes na vigilância das grávidas em Portugal, e sensibilizar as autoridades nacionais para a necessidade urgente de integrar este indicador nos sistemas informáticos de monitorização da gravidez nos cuidados de saúde primários, garantindo uma abordagem mais eficaz à ferropenia gestacional e um menor impacto na saúde materno-fetal.
To validate the applicability of the Rose Bengal (RB) test, indirect IgG or IgM enzyme-linked immunosorbent assay (ELISA), and the Brucellacapt test® to the local context, determine the seroprevalence of brucellosis, and evaluate knowledge of the disease in people at risk in a dairy-producing area of La Maica, Cochabamba (Plurinational State of Bolivia). The tests were initially validated with a group of 76 people; the final study population was 330 people, who also participated in a socio-epidemiological survey. Of 330 samples tested, 12.7% were positive, using either the RB or Brucellacapt test®. The indirect IgG ELISA gave false positive results, indicating that the cut-off point should be adapted to the local epidemiological situation. Almost all RB-positive cases were asymptomatic. The socio-epidemiological survey highlights a lack of information and awareness about brucellosis, with regard to its zoonotic nature, mode of transmission, and symptoms. This study revealed a high seroprevalence of brucellosis in the La Maica dairy-producing area in Cochabamba (Plurinational State of Bolivia), with many asymptomatic cases and a high number of false positives from IgG indirect ELISA. It is recommended to conduct awareness-raising campaigns on the risks of this disease and to discourage the consumption of raw milk. Validar la aplicabilidad de la prueba de rosa de bengala (RB), enzimoinmunoensayo (ELISA) indirecto IgG o IgM y la prueba Brucellacapt® al contexto local, determinar la seroprevalencia de brucelosis y evaluar el conocimiento sobre la enfermedad en personas a riesgo en una zona lechera de La Maica, Cochabamba (Estado Plurinacional de Bolivia). La validación de las pruebas se realizó inicialmente en un grupo de 76 personas, la población de estudio final fue de 330 personas, que además participaron en una encuesta socioepidemiológica. De 330 muestras analizadas, 12,7 % fueron positivas, ya sea por la prueba de rosa de bengala (RB) o por Brucellacapt®. El ELISA indirecto IgG dio resultados falsos positivos, lo que indica que se debe adaptar el punto de corte a la situación epidemiológica local. Casi la totalidad de casos positivos por RB fueron asintomáticos. La encuesta socioepidemiológica resalta la falta de información y de conciencia sobre la naturaleza zoonótica, el modo de transmisión y los síntomas de la brucelosis. Este estudio reveló una seroprevalencia elevada de brucelosis en la zona lechera La Maica en Cochabamba (Estado Plurinacional de Bolivia), con muchos casos asintomáticos y un número elevado de falsos positivos con ELISA indirecto IgG. Se recomienda realizar campañas de concientización sobre los riesgos de esta enfermedad y desalentar el consumo de leche cruda. Validar a aplicabilidade do teste de rosa bengala (RB), do ensaio imunoenzimático (ELISA) indireto de IgG ou IgM e do teste Brucellacapt® no contexto local, determinar a soroprevalência da brucelose e avaliar o conhecimento sobre a doença entre pessoas em risco em uma área de produção de laticínios de La Maica, Cochabamba (Estado Plurinacional da Bolívia). A validação dos testes foi feita inicialmente em um grupo de 76 pessoas, e a população final do estudo foi de 330 pessoas. As pessoas incluídas também participaram de uma pesquisa socioepidemiológica. Das 330 amostras analisadas, 12,7% apresentaram resultado positivo, seja pelo teste de rosa bengala ou pelo Brucellacapt®. O ELISA indireto de IgG apresentou resultados falso-positivos, o que indica que o ponto de corte deve ser adaptado à situação epidemiológica local. Quase todos os casos positivos no RB eram assintomáticos. A pesquisa socioepidemiológica destaca a falta de informações e de conscientização sobre a natureza zoonótica, o modo de transmissão e os sintomas da brucelose. Este estudo revelou uma alta soroprevalência de brucelose na área de produção de laticínios de La Maica, Cochabamba (Estado Plurinacional da Bolívia), com muitos casos assintomáticos e um número elevado de falso-positivos pelo ELISA indireto de IgG. Recomenda-se realizar campanhas de conscientização sobre os riscos da doença e desestimular o consumo de leite cru.
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Perioperative psychological stress and pharmacological anxiolysis can negatively affect the quality of recovery after total knee arthroplasty. We aimed to assess whether hypnosis combined with virtual reality could reduce intraoperative pharmacological sedation and improve quality of recovery after total knee arthroplasty surgery. In this prospective randomized clinical trial, 60 patients scheduled for total knee arthroplasty with spinal anesthesia were randomly divided into 2 groups of 30 patients each. Intraoperatively, intermittent boluses of midazolam 1 mg were administered at 5 min intervals at the patient's request, with a maximum driven by the clinical assessment of sedation depth. During surgery, patients received standard care (group control) or virtual reality hypnosis (group VRH). An unblinded observer recorded the total dose of midazolam administered during surgery, and changes in the Quality-of-Recovery 15-item score, comfort, fatigue, pain and anxiety before and 1, 3 and 7 days after surgery. Patients in the VRH group required a lower dose of midazolam (mg; median (range)) intraoperatively (group VRH: 0 (0-4) and group control: 2 (0-9), p<0.001). Quality-of-Recovery 15-item, anxiety, and pain were similar between groups. In total knee arthroplasty with spinal anesthesia, VRH reduces the requirement for intraoperative pharmacological sedation, without a change in the quality of recovery. NCT05707234.
 Over the past decade, research using various methods has claimed the material nature, including nanoparticles (NPs), of high homeopathic potencies. The current study aims to verify these findings using NP tracking analysis (NTA).  Six independent serial dilutions of commonly used homeopathic medicines-either soluble (Gelsemium, Pyrogenium, Kalium mur) or insoluble (Cuprum, Argentum, Silicea)-were prepared according to European Pharmacopoeia standards. We compared the homeopathic dynamisations (DYNs) in pure water with their potentised controls and with simple dilutions (DIL) up to 30cH/10-60. We also tested the influence of the container (glass or PET) on the solvent controls.  We observed the presence of particles from 20 to 300-400 nm in all DYNs, DILs and controls, except in pure unstirred water. The sizes and size distributions of NPs in high homeopathic potencies were smaller than those in controls for soluble sources and larger for insoluble sources, even above 11cH. The opposite behaviour was observed in the number of NPs. When comparing DYN and DIL, the number, size, presence of aggregates or chains and brightness of NPs increased with DYNs, which was also observed above 11cH. Many NPs scattered light of low intensity, indicating the presence of material particles. The container had a significant effect on the number and size of NPs, indicating the involvement of the atmosphere and leaching processes.  Homeopathic medicines contain NPs with specific properties, even when diluted beyond Avogadro's number. Homeopathic potentisation is not a simple dilution. The starting material, the solvent used, the type of container and the manufacturing method influence the characteristics of these NPs. The nature of these NPs is not known, but most likely they are a mixture of nanobubbles and elements from the atmosphere and container, including insoluble ones.
The COVID-19 pandemic has affected millions globally, with persistent impacts extending beyond the acute phase. One such effect is post-COVID (long COVID), characterized by symptoms such as fatigue and exercise intolerance lasting more than 60 days. Although regular exercise is associated with reduced risk of severe outcomes, reports of decreased athletic performance after COVID-19 - even among highly active individuals (HAIs) - have raised concerns regarding the long-term effects on physical health. Cardiopulmonary exercise testing (CPET) is a valuable tool to assess exercise intolerance and to investigate the metabolic and ventilatory consequences of COVID-19. To evaluate the impact of COVID-19 on cardiopulmonary function in HAIs by analyzing metabolic and ventilatory responses using CPET before and after infection. CPET data were retrospectively analyzed from HAIs of both sexes. Primary outcomes included changes in peak oxygen uptake ( V ⋅ O2peak) and ventilatory efficiency ( V ⋅ E/ V ⋅ CO2 slope). Statistical significance was set at 5% (p < 0.05). A total of 43 HAIs (72.1% male; 44 ± 10 years) were included. The median interval between CPETs was 479 days, with testing performed a mean of 44 ± 27 days after COVID-19. V ⋅ O2peak decreased by a mean of 1.5 mL/kg/min (p = 0.017), representing a 3.84% reduction in predicted V ⋅ O2peak values (p = 0.045). V ⋅ E/ V ⋅ CO2 slope increased by 1.2 (p = 0.017). Although HAIs are not immune to the effects of COVID-19, their high baseline physical activity levels appear to confer substantial cardiopulmonary resilience. Only minimal post-infection alterations were observed, which suggests that maintaining fitness may provide protective benefits against long-term sequelae of COVID-19. A pandemia de covid-19 afetou milhões de pessoas em todo o mundo, com impactos persistentes que se estendem além da fase aguda. Um desses efeitos é a condição conhecida como pós-covid (ou covid longa), caracterizada por sintomas como fadiga e intolerância ao exercício com duração superior a 60 dias. Embora o exercício físico regular esteja associado à redução do risco de desfechos graves, relatos de queda no desempenho atlético após a infecção — mesmo entre indivíduos altamente ativos (IAAs) — têm gerado preocupações quanto aos efeitos de longo prazo sobre a saúde física. O teste de esforço cardiopulmonar (TECP) é uma ferramenta valiosa para avaliar a intolerância ao exercício e investigar as consequências metabólicas e ventilatórias da covid-19. Avaliar o impacto da covid-19 na função cardiopulmonar de IAAs por meio da análise das respostas metabólicas e ventilatórias obtidas em TECP realizado antes e após a infecção. Foram analisados retrospectivamente dados de TECP de IAAs de ambos os sexos. Os desfechos primários incluíram alterações no consumo máximo de oxigênio ( V ⋅ O2pico) e na eficiência ventilatória (relação V ⋅ E/ V ⋅ CO2). O nível de significância estatística foi estabelecido em 5% (p < 0,05). Foram incluídos 43 IAAs (72,1% do sexo masculino; 44 ± 10 anos). O intervalo mediano entre os testes foi de 479 dias, sendo o segundo TECP realizado em média 44 ± 27 dias após a infecção por covid-19. Observou-se uma redução média de 1,5 ml/kg/min no V ⋅ O2pico (p = 0,017), correspondendo a uma diminuição de 3,84% nos valores previstos de V ⋅ O2pico (p = 0,045). A relação V ⋅ E/ V ⋅ CO2 aumentou em média 1,2 (p = 0,017). Embora os IAAs não sejam imunes aos efeitos da covid-19, seu elevado nível basal de atividade física parece conferir uma considerável resiliência cardiopulmonar. As alterações observadas após a infecção foram mínimas, sugerindo que a manutenção da aptidão física pode oferecer benefícios protetores contra sequelas prolongadas da doença. The COVID-19 pandemic has affected millions globally, with persistent impacts extending beyond the acute phase. One such effect is post-COVID (long COVID), characterized by symptoms such as fatigue and exercise intolerance lasting more than 60 days. Although regular exercise is associated with reduced risk of severe outcomes, reports of decreased athletic performance after COVID-19 — even among highly active individuals (HAIs) — have raised concerns regarding the long-term effects on physical health. Cardiopulmonary exercise testing (CPET) is a valuable tool to assess exercise intolerance and to investigate the metabolic and ventilatory consequences of COVID-19. To evaluate the impact of COVID-19 on cardiopulmonary function in HAIs by analyzing metabolic and ventilatory responses using CPET before and after infection. CPET data were retrospectively analyzed from HAIs of both sexes. Primary outcomes included changes in peak oxygen uptake ( V⋅ O2peak) and ventilatory efficiency ( V⋅ E/ V⋅ CO2slope). Statistical significance was set at 5% (p < 0.05). A total of 43 HAIs (72.1% male; 44 ± 10 years) were included. The median interval between CPETs was 479 days, with testing performed a mean of 44 ± 27 days after COVID-19. V⋅ O2peak decreased by a mean of 1.5 mL/kg/min (p = 0.017), representing a 3.84% reduction in predicted V⋅ O2peak values (p = 0.045). V⋅ E/ V⋅ CO2slope increased by 1.2 (p = 0.017). Although HAIs are not immune to the effects of COVID-19, their high baseline physical activity levels appear to confer substantial cardiopulmonary resilience. Only minimal post-infection alterations were observed, which suggests that maintaining fitness may provide protective benefits against long-term sequelae of COVID-19.
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