Although anuran tadpoles are widely distributed and abundant in tropical aquatic habitats, there is a lack of taxonomic keys for the Atlantic Forest. Herein, we developed a dichotomous key for identifying the tadpoles for all species with known larval phase and already recorded in the Atlantic Forest north of the São Francisco River. We analyzed discrete characteristics of 1,042 tadpoles encompassing 63 species of 28 genera from 32 localities. The user-friendly key includes illustration and pictures, and it is a significant step towards improving our knowledge of tadpoles of the Atlantic Forest.
Siphonops paulensis Boettger, 1892 is a Neotropical siphonopid caecilian widely distributed in South America. Herein, we fill knowledge gaps in the distribution of S. paulensis mostly in northeastern Brazil, including four new state records.
Objective The aim of this study was to estimate the cost of illness (COI) of Duchenne muscular dystrophy (DMD) and its relation to disease progression, using age as a proxy, and according to the ambulatory status of patients. Methods We conducted a cross-sectional study of patients diagnosed with DMD identified through the Portuguese Neuromuscular Patients Association (APN). Data regarding patient and caregiver demographics, patient health status, resource utilization and cost, and informal care were collected using a custom semistructured questionnaire. Labor productivity and absenteeism losses were captured using the Work Productivity and Activity Impairment questionnaire. Costs were valued using a societal perspective. Results A total of 46 patient-caregiver pairs were included, of which eight of the patients were ambulant and 38 were nonambulant. Age had a decreasing effect on COI, independent of the patient's disease stage. Annualized lifetime costs were at their highest in nonambulant patients around the mean age of loss of ambulation (10 years of age). The mean per patient stage-specific costs (year 2019 values) of DMD were estimated at €48,991 in the nonambulant stage and €19,993 in the ambulant stage. Direct nonmedical costs were the main cost drivers, followed by indirect costs. Conclusions Our results indicate a close relation between overall disease costs and disease progression. DMD is associated with a substantial economic burden, which appears to be larger around the time ambulation is lost (10 years of age). The availability of new therapeutic options that delay disease progression, especially loss of ambulation, may prove to be highly beneficial for not only patients with DMD but also their families and society.
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