**Etiology**

**Chapter 2**

**Provisional chapter**

**Twinning as an Evolved Age-Dependent Physiological**

**Twinning as an Evolved Age-Dependent Physiological**

Multiple pregnancies occur in humans and other primates, which indicate that the twinning propensity is phylogenetically old.  In human populations, despite its costs, twinning has a genetic basis and in Europe, Africa, and America, it was found that it increases mothers' fitness. Here, we explore the hypothesis that twinning represents an evolved physiological mechanism, particularly in mothers of higher age, as an 'all-or-nothing' last chance strategy for reproduction just before menopause. We present decade-long, large-scale population data about maternities from the city of São Paulo and the entire country of Brazil that indicate a considerable main effect of advanced age in promoting twinning, particularly dizygotic (DZ) twinning, but also monozygotic (MZ) twinning and higher order maternities. We also show that socioeconomic status is an important contextual factor increasing twinning. Besides the theoretical implications, these datasets establish a Brazilian countrywide twinning rate of 9.39‰ and highlight an increasing historical trend. This chapter promotes the importance of integrating proximate patterns from human and nonhuman animals and evolutionary factors in order to reach a comprehensive view about twinning.

**Keywords:** twinning rates, age dependence, physiological mechanism, evolutionary

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.5772/intechopen.79907

**Mechanism: Evidence from Large Brazilian Samples**

**Mechanism: Evidence from Large Brazilian Samples**

Marco Varella, Eloisa Fernandes, Jonas Arantes,

Marco Varella, Eloisa Fernandes, Jonas Arantes, Tiziana Acquaviva, Tania Lucci, Rafael Hsu,

Vinicius David, Vera Bussab, Jaroslava Valentova,

Vinicius David, Vera Bussab, Jaroslava Valentova,

Tiziana Acquaviva, Tania Lucci, Rafael Hsu,

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

theories, population data, socioeconomic status

Nancy Segal and Emma Otta

Nancy Segal and Emma Otta

**Abstract**

http://dx.doi.org/10.5772/intechopen.79907

#### **Twinning as an Evolved Age-Dependent Physiological Mechanism: Evidence from Large Brazilian Samples Twinning as an Evolved Age-Dependent Physiological Mechanism: Evidence from Large Brazilian Samples**

DOI: 10.5772/intechopen.79907

Marco Varella, Eloisa Fernandes, Jonas Arantes, Tiziana Acquaviva, Tania Lucci, Rafael Hsu, Vinicius David, Vera Bussab, Jaroslava Valentova, Nancy Segal and Emma Otta Marco Varella, Eloisa Fernandes, Jonas Arantes, Tiziana Acquaviva, Tania Lucci, Rafael Hsu, Vinicius David, Vera Bussab, Jaroslava Valentova, Nancy Segal and Emma Otta

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.79907

#### **Abstract**

Multiple pregnancies occur in humans and other primates, which indicate that the twinning propensity is phylogenetically old.  In human populations, despite its costs, twinning has a genetic basis and in Europe, Africa, and America, it was found that it increases mothers' fitness. Here, we explore the hypothesis that twinning represents an evolved physiological mechanism, particularly in mothers of higher age, as an 'all-or-nothing' last chance strategy for reproduction just before menopause. We present decade-long, large-scale population data about maternities from the city of São Paulo and the entire country of Brazil that indicate a considerable main effect of advanced age in promoting twinning, particularly dizygotic (DZ) twinning, but also monozygotic (MZ) twinning and higher order maternities. We also show that socioeconomic status is an important contextual factor increasing twinning. Besides the theoretical implications, these datasets establish a Brazilian countrywide twinning rate of 9.39‰ and highlight an increasing historical trend. This chapter promotes the importance of integrating proximate patterns from human and nonhuman animals and evolutionary factors in order to reach a comprehensive view about twinning.

**Keywords:** twinning rates, age dependence, physiological mechanism, evolutionary theories, population data, socioeconomic status

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


**5.1 Selection of paving materials**

Apart from all the afore-mentioned parameters, the overheating of paving materials depends on the geometrical characteristics of the urban open spaces. A preliminary effort to define those "worst-case scenario" instances, namely the instances of urban open spaces where full -or almost full- insolation occurs during the summer months, is presented in a previous study by the author Bougiatioti (2006). The cases of urban canyons with North-to-South direction and with NW-to-SE direction, where the materials of the horizontal surfaces were bound to overheat during the summer, comprise of height-to-width (referred to from now on as H/W) ratios from 0 to 0.5 (or 1). For canyons with NE-to-SW direction, including narrower canyons, have H/W ratio of 1 (or 1.5). Finally, the horizontal surfaces of urban configurations, whose main axis runs East-to-West are prone to overheating in the summer, even in the case of a H/W ratio of 2.

In all the above cases, the negative contribution to the urban microclimate and to thermal comfort is important, and material selection should, thus, aim for:

The application of one or more of the above solutions depends on the character and the use of the urban space, as well as on its design principles. Issues of visual comfort should also be taken into consideration, as the choice of certain materials (i.e. materials with light colours and/or glossy surfaces) can cause glare.

Finally, the materials for urban space should be chosen according to its peculiarities, its character and its patterns of use. During summer days, there should be shaded areas, where the solar radiation is blocked and the surface temperatures of the materials remain low (Khandaker Shabir, 2000). Similarly, during winter and the intermediate seasons (spring and autumn), there should be areas with no obstruction for solar radiation access.


**5. The management of skin NSAID hypersensitivity**

The management of skin reactions to NSAIDs will aim to educate the patient on which drugs to avoid and to provide written therapeutic advice on which

alternatives to NSAIDs are potentially safe, after having tested adequate tolerance to them through SBPCOC.

Depending on the diagnosis and outcome of the SBPCOC, the patient can be advised to avoid only the culprit or all NSAID. Then, there might be a need to investigate the safety of other alternative analgesics. Selective COX-2 inhibitors are often a safe alternative, especially in cross-reactive patients who can tolerate acetaminophen. So, below 5% of patients with skin NH reacted to a selective COX-2 inhibitor [17, 18]. Even in those cases with a COXiB reaction, it is possible that the patient may tolerate other COXib without reaction and therefore an second challenge with an alternative COXIb must be performed [16].

Early presentations of periorbital angioedema as key features of cross-reactive reactions to NSAIDs in an atopic children also precluded the use of potent COX-1 inhibitor NSAID. Paracetamol is often well tolerated in these patients. The use of a cyclooxygenase-2-specific medication may not be feasible in this population, and limits options for other medical antiinflammatory treatment. However, Loh et al. have recently demonstrated that etoricoxib can be used as a safe alternative in older children (mean age 13,5 years) with hypersensitivity to multiple antipyretics [19].

Patient with selective urticaria or systemic anaphylaxis presents a selective pattern of sensitivity to NSAID, and even those with high COX-1 inhibition potency, but non chemically related, can be tolerated [3, 5].

Desensitization with aspirin is recommended by clinical guidelines only in patients with aspirin exacerbated respiratory disease and in cases of NECD or NIUA, in which it is strictly necessary to administer any NSAID as an antiaggregate, anti-inflammatory or analgesic treatment [20]. The desensitization procedure consists of administering progressively increasing doses of aspirin until a reaction is provoked which is as controllable as possible, with the aim of inducing a post-reaction refractory period and which we will use to reach the therapeutic dose, culminating the desensitization process after the administration of a dose of aspirin (or other NSAID) without a reaction.

Rossini et al. have published a multicenter, prospective study that demonstrates that a rapid standardized desensitization protocol in patients with aspirin hypersensitivity undergoing coronary angiography is safe and effective, irrespective of the type of NH which have the patients. A low-dose aspirin could be safely continued without reaction in all patients throughout the next year [20].


**Abstract**

Cystic fibrosis (CF) is a multisystem genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Microbial infection is the defined characteristics of cystic fibrosis airway disease. This infection is caused by bacteria, fungi, and viruses which increase complications leading to patient death. Additionally, bacterial pathogens including *Haemophilus influenza*, *Staphylococcus aureus*, *Pseudomonas aeruginosa*, nontuberculous mycobacterium (NTM) species, and MRSA are attributed to pulmonary infections. Subsequently, fungal pathogens such as *Candida* sp. and filamentous fungi such as *Aspergillus fumigatus* can also lead to pulmonary infections. On the other hand, *Pseudomonas aeruginosa* is the most common bacterial pathogen leading to complications in CF distal airways disease. Also, *Aspergillus fumigatus* can lead to aspergillus lung diseases including allergic bronchopulmonary aspergillosis and aspergilloma formation. Control of pathogenic microorganisms associated with cystic fibrosis may prevent pulmonary complications and has the potential to improve the prognosis of this life-limiting disease.

**Keywords:** cystic fibrosis, *Pseudomonas aeruginosa*, *Aspergillus fumigatus*, *Haemophilus influenzae*, MRSA, CFTR, NTM, microbial infection, respiratory diseases