Objective: Clozapine is a second-generation antipsychotic indicated for treatment-resistant schizophrenia. Studies in several countries have shown a low rate of clozapine use despite the fact that approximately 30% of schizophrenia cases are treatment-resistant. In Brazil, few studies have addressed the frequency and variety of antipsychotic use in individuals diagnosed with schizophrenia (ICD F20). The objective of this study was to measure the rates of clozapine use in this population in the last decade using Brazilian Ministry of Health data. Methods: Prescriptions made between 2010 and 2020 in all 26 states and the Federal District registered at the Outpatient Information System Database from the Brazilian Health System (SIASUS) were evaluated. Results: A total of 25,143,524 prescriptions were recorded in this period, with clozapine representing 8.86% of all antipsychotics. The most frequently prescribed antipsychotic for patients with schizophrenia was olanzapine (35.8%), followed by quetiapine (27.5%). From 2010 to 2020, the rate of clozapine prescriptions in Brazil increased from 7.2% to 10.9%. Conclusions: Despite a slight increase in prescriptions in the last decade, clozapine is still underutilized in Brazil.

Objective: Clozapine is underprescribed due to neutropenia risk. Blood tests every 3 months in those on continuous treatment for > 1 year who have never had an absolute neutrophil count (ANC) < 2,000/µL has been proposed as a monitoring strategy; however, there are no South American data to support this recommendation. This study sought to investigate whether clozapine use and other variables could explain the occurrence of ANC < 1,000/µL in patients with severe mental disorders. Methods: A total of 5,847 subjects were included, 1,038 on clozapine. We performed a Cox regression considering the outcome as ANC < 1,000/µL at any time point. Predictors were sex, age, ethnicity, clozapine use, ANC > 2,000/µL during the first year of blood monitoring, and presence of a severe medical condition. Results: In the Cox regression model, ethnicity (white) (hazard ratio [HR] 0.53; 95%CI 0.29-0.99, p < 0.05) and ANC > 2,000/µL (HR 0.04; 95%CI 0.01-0.10, p < 0.001) were protective factors, while presence of a severe medical condition (HR 69.35; 95%CI 37.45-128.44, p < 0.001) was a risk factor for ANC < 1,000/µL. Other variables were not significant, including clozapine use (HR 1.33; 95%CI 0.74-2.39, p > 0.05). Conclusions: These findings suggest that clozapine does not increase the risk of neutropenia in subjects with ANC > 2,000/µL during the first year of use and in the absence of a severe medical condition. These results could help guide clinical and public-health decisions regarding clozapine blood monitoring guidelines.

ABSTRACT The selection of the type of fuzzy systems pertinence curve allows a better representation of the mathematical model and a smaller simulation error. We aimed to study the effect of pertinence curves in fuzzy modeling of broiler performance, created in different production systems. For the development and testing of fuzzy models, three commercial aviaries (conventional, tunnel with negative pressure, and dark house) were evaluated over one year, totaling six lots per system. For the development of the model, the input variables were enthalpy in each rearing phase (initial: phases 1, 2, and 3; growth: phase 4; and final: phase 5) and the output variables were feed intake (FE), weight gain (GP), feed conversion (FE), and the productive efficiency index (PEI). Triangular, trapezoidal, and Gaussian pertinence curves were combined and applied to represent the input and output fuzzy sets, totaling nine fuzzy models for each output variable. The combinations of pertinence curves provided adequate responses for the prediction of AL, GP, RC, and PEI. However, the selection of the types of curves should be studied on a case-by-case basis, so that the smallest possible simulation errors are obtained.

ABSTRACT Broiler chickens are classified as homoeothermic animals and require a production environment within well-defined thermal comfort intervals. Therefore, the development of algorithms (mathematical models) to control the environment that can be embedded in microcontrollers becomes necessary. Hence, this work aimed to develop a fuzzy model for predicting the productive performance of broiler chickens as a function of the thermal environment during the various breeding phases. The Mamdani inference and defuzzification methods were used, by means of the gravity center, to develop the fuzzy model. Two hundred and forty-three rules with weighting factors of 1.0 each were elaborated. Three commercial warehouses (conventional system, wind tunnel with negative pressure and dark house) were evaluated for testing of the model. We recorded the thermal environment (dry bulb temperature - tdb and relative humidity - RH) and productivity data (feed intake - FI, weight gain - WG, feed conversion - FC and productive efficiency index - PEI) over six lots in each aviary. The resulting fuzzy model was capable of forecasting FI, WG, FC, and PEI, with standard deviations and mean percentage errors of 4.16 g and 5.05%, 146.53 g and 8.04%, 0.06 g g−1 and 4.96%, and 24.51 g and 12.29%, respectively.

ABSTRACT Broiler chickens are homoeothermic animals, i.e., animals capable of maintaining their body temperature within quite narrow limits; therefore, climate change poses a great challenge to poultry. With this in mind, this research aims to evaluate the performance of broilers submitted to different commercial production systems and exposed to different future scenarios, taking into account the climate change trends. To achieve this objective, we developed and validated a fuzzy model able to predict the performance of a broiler as a function of enthalpy along its life stages. This model was developed and validated in part I of this article based on experimental data collected for one year in three aviaries: conventional, negative pressure, and dark house systems. A Mann-Kendall nonparametric test and linear regression analysis were applied to the enthalpy values, which were calculated as a function of the ambient air temperature and relative humidity in order to study the climate change trends. Later, simulations were performed using the fuzzy model for 2025, 2050, 2075, and 2100 future scenarios. Specific improvements were observed when the heating trends coincided with the initial stages of breeding; however, in general, the productive responses of broilers in the different evaluated systems worsened with the climate change trends. Faced with the climate change trends, the responses improved in the order dark house aviary > negative pressure aviary> conventional aviary.

Resumo Balneário Camboriú (SC - Brasil) é uma cidade turística, onde o crescimento desordenado da população urbana e a implementação de obras costeiras sem uma avaliação adequada tem gerado impactos ambientais e afetado severamenteou a qualidade sanitária da água e do sedimento do rio Camboriú e da área marinha adjacente. Um dos fenômenos mais recentes e alarmantes observados são as florações de briozoários invasivos (Arboscuspis bellula e Membraniporopsis tubigera) associados com as diatomáceas epibênticas (Amphitetras antediluviana e Biddulphia biddulphiana). Vários indícios associam esses fenômenos, iniciados em 2003, com o excesso de nutrientes e matéria orgânica na enseada Camboriú e com grandes obras costeiras locais, como dragagem, aterro e construção de molhes, levando a mudanças na estrutura ecológica bêntica. Sendo um problema de estético e ambiental, a preocupação da comunidade e órgãos governamentais gerou uma intensificação nos estudos, uma vez que as ocorrências se tornaram mais frequentes e persistentes. O presente trabalho aborda este problema através de estudos ambientais e experimentais. A coleta de material bêntico com embarcação e mergulhos e monitoramento florações junto a praia compuseram a abordagem ambiental. Os trabalhos de laboratório incluíram o isolamento e a cultura de algas e brioozários, bem como a avalição do crescimento desses organismos, além da análise e avaliação química biomassa. Os dados de monitoramento mostraram uma tendência sazonal nas florações, com eventos mais evidentes nos meses mais quentes. Diatomáceas aumentaram em abundância nos meses mais frios e briozoários nos mais quentes. A diatomácea A. antediluviana, predominante nas florações, cresceu de forma satisfatória em cultivo laboratorial, mostrando um melhor crescimento em meios com concentrações mais elevadas de silicato e fosfato. Os briozoários mostraram crescimento lento em condições de laboratório. O material depositado no ambiente mostrou baixas concentrações de ácidos graxos, predominantemente saturados, mas a elevada biomassa sugere um possível uso para a produção de biocombustíveis. Amostras de biomassa dominadas por briozoários apresentaram atividade antimicrobiana moderada contra Klebsiella pneumoniae. A explicação para a ocorrência destes eventos ainda são inconclusivas, mas há evidências consideráveis de que há um efeito sinérgico entre a alta concentração de bactérias e detritos orgânicos na água, relacionada com a poluição local, e a eliminação de competidores naturais pelos impactos das obras costeiras.

Abstract Balneário Camboriu (SC - Brazil) is a touristic city where the disordered growth of the urban population and the implementation of coastal works without proper evaluation generated environmental impacts and affected the sanitary quality of water and sediment of Camboriu River and marine adjacent area. One of the most recent and alarming phenomena observed are the blooms of invasive bryozoans (Arboscuspis bellula and Membraniporopsis tubigera) associated with epibenthic diatoms (Amphitetras antediluviana and Biddulphia biddulphiana). Several clues associate these phenomena, started in 2003, with the excess of nutrients and organic matter in the Camboriú cove and large coastal works such as dredging, landfills and construction of jetties, leading to changes in benthic ecological structure. Being an aesthetic and environmental health problem, the concern of the scientific community and government agencies intensified as the occurrences become more frequent and persistent. This research addresses this issue through environmental and experimental studies. Samplings of the benthic material collected by boat and diving, and blooms monitoring were the environmental approach. The laboratory work included the algal isolation and culture, in addition to growth conditions assessment and chemical biomass analysis. Monitoring data showed a seasonal trend in the blooms, with more conspicuous events in warmer months. Diatoms increase in abundance in colder months and bryozoans in the warmer ones. The diatom A. antediluviana, predominant in the blooms, grew satisfactorily in laboratory cultivation, showing better growth in media with higher concentrations of silicate and phosphate. Bryozoans showed slow growth in laboratory conditions. The deposited material collected in the environment showed low concentrations of saturated fatty acids, but the high biomass suggest a possible use for biofuels production. Biomass samples dominated by bryozoans showed moderate antimicrobial activity against Klebsiella pneumoniae. The explanation for the occurrence of these blooms are still inconclusive, but there is considerable evidence that it is a synergistic effect between the high concentration of bacteria and organic debris in the water related to local pollution and the elimination of natural competitors by coastal works.

Resumo Parâmetros de qualidade da água, composição e abundância do fitoplâncton e do proto e meso-zooplâncton foram avaliadas espaço-temporalmente no estuário receptor de efluentes de uma fazenda produtora de camarão Litopenaeus vannamei na Lagoa dos Patos, Brasil. As amostras foram tomadas em sete pontos antes (BD) e; 1 dia (1 PD), 5 dias (5 PD), 10 dias (10 PD), 20 dias (20 PD) e 30 dias (30 PD) após a descarga dos efluentes. Alguns dos parâmetros de qualidade de água sofreram alterações devido ao lançamento dos efluentes, restritos a 20 m de distância do canal de descarga dos efluentes e por um período máximo de 5 dias. A comunidade microbiana sofreu variação em 1 PD comparativamente a BD. A abundância zooplanctônica foi baixa na maioria das amostras, com exceção de alguns pontos em 30 PD. Os copépodos foram o único grupo encontrado no meso-zooplâncton, na sua grande maioria a espécie Acartia tonsa. Apesar de modificações em alguns parâmetros avaliados nos primeiros dias após o lançamento dos efluentes, essas alterações foram assimiladas em um curto período. Os parâmetros de qualidade de água mantiveram-se dentro dos limites estipulados pela legislação e o ambiente assimilou de maneira rápida as mudanças ocorridas.

Abstract Water quality, chlorophyll a, phytoplankton, proto and mezo-zooplankton abundance were spatiotemporally evaluated in an estuary receiving effluents from a Pacific white shrimp Litopenaeus vannamei farm in Patos Lagoon estuary, Southern Brazil. Samples were taken before (BD) and; 1 day (1 PD) 5 days (5 PD), 10 days (10 PD), 20 days (20 PD) and 30 days (30 PD) after the effluents discharge. Some water quality parameters were affected by the effluents discharge; however, these changes were restricted to a distance of 20 m from the effluent discharge channel for a period of 5 days. The microbial community was dominated by chlorophyceae, followed by diatoms, cyanobacteria and ciliates. There was an increase in the abundance of different groups on the 1 PD sampling compared to BD. The zooplankton abundance was low in practically all sites, except for 30 PD sampling. The meso-zooplanktonic organisms were represented by copepods, mostly Acartia tonsa. Despite some effects on water quality and phytoplankton and protozooplankton abundance until 5 PD sampling, these alterations dissipated in a short period of time. We conclude that the environment quickly assimilated the effluents discharge, and the water quality parameters remained within the limits stipulated by standard guidelines.

RESUMO Os ovos são um dos alimentos que oferecem nutrientes de grande valor biológico. Entretanto, no armazenamento, alguns componentes da clara e gema podem se alterar, deteriorando a qualidade dos ovos. Assim, este trabalho objetivou avaliar semanalmente parâmetros de qualidade como unidade Haugh, perda de peso, largura/comprimento do ovo, densidade específica, dimensões da clara/gema e pH durante 9 semanas de armazenamento. Foram coletados 270 ovos de duas linhagens de poedeiras e avaliados a temperatura ambiente (20 a 35 °C no verão; 11,2 a 29,7 °C no outono) e refrigerada (0 a 5 °C no verão; -3,1 a 6,5 ºC no outono). Para as condições de armazenamento, foi realizada uma análise de desdobramento por regressão por polinômios ortogonais. Ainda, análise de componentes principais (PCA), objetivou avaliar correlações entre parâmetros de qualidade em diferentes condições de armazenamento e linhagens de poedeira. Após 9 semanas de armazenamento, os ovos refrigerados apresentaram qualidade similar àqueles armazenados a temperatura ambiente por 3 semanas. Porém, sem refrigeração, os ovos apresentaram uma degradação mais rápida da semana 1 a 5. Não foram observadas diferenças nos parâmetros de qualidade dos ovos entre as diferentes colorações de casca (linhagens de poedeiras). PCA sugere que a melhor qualidade dos ovos (primeira semana) foi associada principalmente com valores elevados de peso e densidade específica do ovo, unidade Haugh e altura do albúmen. Ovos armazenados a temperatura ambiente devem ser consumidos até duas semanas ou mantidos sob refrigeração até 8 semanas, preservando a qualidade interna desde a granja até o armazenamento no varejo.

ABSTRACT Eggs are one of nearly perfect protein foods, offering nutrients of great biological value. However, during storage, egg albumen and yolk components may alter and deteriorate egg quality. Therefore, the aim of this work was to assess egg quality during 9-week storage. Parameters such as Haugh unit, weight loss, egg width and length, specific gravity, yolk and albumen dimensions and their pH were evaluated weekly. A total of 270 eggs (n=5) collected from two different hen strains were evaluated under room (20 to 35 °C in summer; 11.2 to 29.7 °C in autumn) and refrigerated (0 to 5 °C in summer; -3.1 to 6.5 °C in autumn) temperatures. For storage time, an unfolding analysis was accomplished by regression analysis using orthogonal polynomials. As a second approach, principal component analysis (PCA) was performed in order to assess correlations among quality parameters on storage conditions and laying hen strains. By the end of the 9-week storage period, eggs kept under refrigeration presented similar quality parameters to eggs stored at room temperature for only 3 weeks. In contrast, eggs kept at room temperature presented faster degradation from week 1 to 5. No differences on egg quality parameters were noticed between white and brown shells eggs. PCA suggests that better egg quality (first week) was associated mainly with higher egg weight and its specific gravity, Haugh unit and albumen height. Eggs stored at room temperature should be consumed in 2 weeks or refrigerated until 8 weeks, preserving internal quality from farm to retail.

ABSTRACT Four soybean meal-based diets containing increasing levels of an enzyme complex (E50, E100, E150 and E200 at 50, 100, 150 and 200 g ton-1, respectively) and one soybean meal-based diet without the enzyme complex (E0) were fed in triplicate to M. liza juveniles in a semi-static flow system with 20 fish per tank for 75 days. There were no differences between the treatments for animal performance parameters, but fish fed the enzyme complex treatment exhibited significantly (P<0.05) higher values of calcium bone retention compared with control fish. Although there was no relationship between bacterial counts in different sections of the gastrointestinal tract or enzyme levels, filamentous bacteria were increased in E50 compared with E150. All of the treatments resulted in higher bacterial counts in the stomach than in intestinal segments. Histological screening showed serious to moderate infiltration of inflammatory cells, modification in villus morphology and necrosis in some cases in fish fed the E0 diet. In addition, fish from the E0 treatment exhibited significantly (P<0.05) lower lipid deposition in the peritoneal cavity. Therefore, the use of low levels of exogenous enzyme is recommended in diets for M. liza when soybean meal is used as the main source of protein.

Objective: To evaluate trends in psychiatric bed occupancy by elderly inpatients in the Brazilian public health care system between 2000 and 2010 and to determine the leading psychiatric diagnosis for hospital admissions. Methods: Data from all 895,476 elderly psychiatric admissions recorded in the Brazilian Public Health Care Database (DATASUS) between January 2000 and February 2010 were analyzed. Polynomial regression models with estimated curve models were used to determine the trends. The number of inpatient days was calculated for the overall psychiatric admissions and according to specific diagnoses. Results: A moderate decreasing trend (p < 0.001) in the number of inpatient days was observed in all geriatric psychiatric admissions (R2 = 0.768) and in admissions for organic mental disorders (R2 = 0.823), disorders due to psychoactive substance use (R2 = 0.767), schizophrenia (R2 = 0.680), and other diagnoses (R2 = 0.770), but not for mood disorders (R2 = 0.472). Most admissions (60 to 65%) were due to schizophrenia. Conclusion: There was a decreasing trend in inpatient days for elderly psychiatric patients between 2000 and 2010. The highest bed occupancy was due to schizophrenia, schizotypal, and delusional disorders.

RESUMO Objetivou-se, neste trabalho, avaliar a variação espacial da temperatura, umidade relativa e índice de temperatura de globo negro e umidade (ITGU) em instalações de suínos na fase de crescimento e terminação, com e sem resfriador de ar evaporativo. O experimento foi conduzido em uma edificação de 60 x 9 m, contendo 32 baias de 3,20 x 4,00 m cada uma, divididos em dois setores. Os tratamentos foram sem resfriador de ar evaporativo (controle) e com resfriador de ar evaporativo sendo os dados de temperatura e umidade relativa coletados semanalmente em dois períodos (manhã e tarde) em 32 pontos de amostragem diferentes abrangendo o centro de cada baia e o perímetro exterior das instalações. As variáveis de desempenho dos animais foram: consumo de ração, conversão alimentar, peso ao sair da creche, peso ao abate, ganho de peso e ganho de peso diário. Os resultados mostraram que as variáveis analisadas apresentaram dependência espacial com temperatura mais baixa e umidade do ar mais alta no setor com resfriador evaporativo. Desta forma, o resfriamento evaporativo melhorou as condições térmicas ambientais no interior da instalação, reduzindo os valores do ITGU, os quais foram menores no setor de resfriamento adiabático. Embora o conforto térmico do ambiente com resfriamento evaporativo tenha sido melhor, os suínos não responderam a esta melhoria, em termos de desempenho.

ABSTRACT The purpose of this study was to evaluate the spatial variation of temperature, relative humidity and black globe humidity temperature (BGHT) index in growing-finishing swine facilities, with and without evaporative air cooler. The experiment was conducted in a 60 x 9 m facility containing 32 pens of 3.20 x 4.00 m each, divided into two sectors. The treatments were without evaporative air cooler (control) and with evaporative air cooler. Temperature and relative humidity data were collected weekly in two periods (morning and afternoon) at 32 different sampling points, encompassing the center of each pen and the outer perimeter of the facility. Animal performance variables were: feed intake, feed conversion, weight out of the nursery, slaughter weight, weight gain and daily weight gain. According to the results, the analyzed variables showed spatial dependence, with lower temperature and higher relative humidity in the evaporative air cooler environment. However, evaporative air cooler system provided better environment thermal conditions inside the facilities, lowering BGHT values, which were lower in the adiabatic cooling sector. Although thermal conditions were better in the air cooler environment, swine performance was not affected.

Objetivo Descrever o caso de um paciente com esquizofrenia em tratamento com clozapina acometido por um episódio de heat stroke. Descrição do caso Durante uma onda de calor em janeiro e fevereiro de 2014, um paciente com esquizofrenia em tratamento com clozapina foi inicialmente encaminhado para diagnóstico diferencial de infecção sistêmica e síndrome neuroléptica maligna, tendo obtido o diagnóstico final de heat stroke, tratado com controle de temperatura corporal e hidratação. Comentários Este relato de caso tem como objetivo alertar os clínicos para este diagnóstico diferencial, que pode surgir com mais frequência à medida que as temperaturas globais continuarem a aumentar, e também destacar a importância da realização de um diagnóstico mais acurado, que possa melhorar as decisões de tratamento e os desfechos clínicos para os pacientes.

Objective To describe the case of a patient with schizophrenia on clozapine treatment who had an episode of heat stroke. Case description During a heat wave in January and February 2014, a patient with schizophrenia who was on treatment with clozapine was initially referred for differential diagnose between systemic infection and neuroleptic malignant syndrome, but was finally diagnosed with heat stroke and treated with control of body temperature and hydration. Comments This report aims to alert clinicians take this condition into consideration among other differential diagnoses, especially nowadays with the rise in global temperatures, and to highlight the need for accurate diagnosis of clinical events during pharmacological intervention, in order to improve treatment decisions and outcomes.

This work compared the use of dextrose and molasses as carbon sources for biofloc development, water quality maintenance, microorganism composition and growth performance of Litopenaeus vannamei juveniles in biofloc technology (BFT). Two treatments, dextrose and molasses, were tested with four replicates each. Carbon was added to achieve a C:N-AT (N-(NH3+NH4+)) ratio of 6:1. Physical and chemical water quality variables were monitored daily, and shrimp growth was estimated through periodic biometry. After 30 days, survival, final biomass, and feeding conversion rate (FCR) were determined. Dissolved organic carbon, chlorophyll-a, floc volume, total ammonia, nitrite, nitrate and phosphate concentrations, and microorganisms (qualified by groups), were measured every three days. Water quality variables remained within acceptable levels throughout the experimental period, except for nitrite, which reached higher levels than recommended for this species. The use of dextrose resulted in higher water transparency, which influenced the remaining centric diatoms. A superior shrimp performance was observed at this treatment, presumably because of variations on the microbial community. Therefore, it is concluded that the addition of dextrose results in a superior growth performance of L. vannamei when cultured in BFT systems.

Se comparó el uso de dextrosa y melaza como fuentes de carbono en el desarrollo del biofloco, mantención de la calidad del agua, composición microbiana y crecimiento de juveniles de camarón blanco Litopenaeus vannamei en sistemas de cría con tecnología de biofloco (BFT). Se probaron dos tratamientos, dextrosa y melaza, con cuatro réplicas cada uno. Se agregó carbono para mantener la relación carbono: N-AT (N-(NH3+NH4+)) en 6:1. Las variables físicas y químicas de calidad del agua se controlaron diariamente y el crecimiento de los camarones se estimó mediante biometría en forma periódica. Después de 30 días se determinó la sobrevivencia, biomasa final y tasa de conversión de alimento. Cada tres días se determinaron las concentraciones de carbono orgánico disuelto, clorofila-a, amonio total, nitrito, nitrato y fosfato, y microorganismos (de los grupos clasificados), en el agua. Las variables de calidad de agua se mantuvieran dentro de niveles aceptables durante el periodo experimental, excepto la concentración de nitrito que alcanzó niveles superiores a los recomendados para esta especie. El uso de dextrosa mostró una mayor transparencia del agua, lo que influyó en la mayor permanencia de diatomeas céntricas. En este mismo tratamiento los camarones tuvieron un mejor crecimiento debido probablemente a variaciones en la comunidad microbiana. Por esta razón, se concluye que la adición de dextrosa proporciona un mejor crecimiento del camarón blanco L. vannamei cultivado en sistema de bioflocos.