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BACKGROUND: Ablation Index (AI) software has allowed better atrial fibrillation (AF) ablation results, but recurrence rates remain significant. Specific serum biomarkers have been associated with this recurrence. OBJECTIVES: To evaluate whether certain biomarkers could be used (either individually or combined) to predict arrhythmia recurrence after AI-guided AF ablation. METHODS: Prospective multicenter observational study of consecutive patients referred for AF ablation from January 2018 to March 2021. Hemoglobin, brain natriuretic peptide (BNP), C-reactive protein, high sensitivity cardiac troponin I, creatinine clearance, thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were assessed for their ability to predict arrhythmia recurrence during follow-up. Statistical significance was accepted for p values of<0.05. RESULTS: A total of 593 patients were included - 412 patients with paroxysmal AF and 181 with persistent AF. After a mean follow-up of 24±6 months, overall single-procedure freedom from atrial arrhythmia was 76.4%. Individually, all biomarkers had no or only modest predictive power for recurrence. However, a TSH value >1.8 µUI/mL (HR=1.82 [95% CI, 1.89-2.80], p=0.006) was an independent predictor of arrhythmia recurrence. When assessing TSH, FT4 and BNP values in combination, each additional "abnormal" biomarker value was associated with a lower freedom from arrhythmia recurrence (87.1 % for no biomarker vs. 83.5% for one vs. 75.1% for two vs. 43.3% for three biomarkers, p<0.001). Patients with three "abnormal" biomarkers had a threefold higher risk of AF recurrence compared with no "abnormal" biomarker (HR=2.88 [95% CI, 1.39-5.17], p=0.003). CONCLUSIONS: When used in combination, abnormal TSH, FT4 and BNP values can be a useful tool for predicting arrhythmia recurrence after AI-guided AF ablation.
FUNDAMENTO: O software ablation index (AI) permitiu melhorar os resultados da ablação de fibrilação atrial (FA), mas as taxas de recorrência permanecem significativas. Biomarcadores séricos específicos têm sido associados a essa recorrência. OBJETIVOS: Avaliar se certos biomarcadores podem ser utilizados (individualmente ou combinados) para predizer a recorrência de FA pós ablação guiada pelo AI. MÉTODOS: Estudo multicêntrico, observacional, prospectivo de pacientes consecutivos, encaminhados para ablação de FA de janeiro de 2018 a março de 2021. Hemoglobina, peptídeo natriurético cerebral (BNP), proteína C reativa, troponina I ultrassensível, clearance de creatinina, Hormônio Tireoestimulante (TSH), e Tiroxina livre (T4) foram avaliados quanto à capacidade de prever a recorrência de arritmias durante o acompanhamento. Valores de p <0,05 foram aceitos como estatisticamente significativos. RESULTADOS: Um total de 593 pacientes foram incluídos 412 com FA paroxística e 181 com FA persistente. Durante o seguimento médio de 24±6 meses, 76,4% não apresentaram recidiva após ablação. Individualmente, os biomarcadores demonstraram um valor preditivo baixo ou nulo para recorrência. No entanto, TSH >1,8 µUI/mL [HR=1,82 (IC95%, 1,89-2,80), p=0,006] foi um preditor independente de recorrência. Avaliando-se a combinação de TSH, FT4 e BNP, a adição de cada valor "anormal" foi associada a uma menor sobrevida livre de recorrência (87,1% se nenhum vs. 83,5% se um vs. 75,1% se dois vs. 43,3% se três biomarcadores, p<0,001). Doentes com três biomarcadores "anormais" apresentaram três vezes maior probabilidade de recorrência de FA, comparativamente aos que não apresentaram nenhum biomarcador "anormal" (HR=2,88 [IC95%, 1,39-5,17], p=0,003). CONCLUSÕES: Quando combinados, valores anormais de TSH, FT4 e BNP podem ser uma ferramenta útil para prever a recorrência de FA pós ablação guiada pelo AI.
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Fibrilación Atrial , Biomarcadores , Ablación por Catéter , Recurrencia , Tirotropina , Humanos , Fibrilación Atrial/cirugía , Fibrilación Atrial/sangre , Biomarcadores/sangre , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Ablación por Catéter/métodos , Anciano , Tirotropina/sangre , Péptido Natriurético Encefálico/sangre , Valor Predictivo de las Pruebas , Proteína C-Reactiva/análisis , Resultado del Tratamiento , Tiroxina/sangre , Factores de Riesgo , Troponina I/sangreRESUMEN
Resumo Fundamento: O software ablation index (AI) permitiu melhorar os resultados da ablação de fibrilação atrial (FA), mas as taxas de recorrência permanecem significativas. Biomarcadores séricos específicos têm sido associados a essa recorrência. Objetivos: Avaliar se certos biomarcadores podem ser utilizados (individualmente ou combinados) para predizer a recorrência de FA pós ablação guiada pelo AI. Métodos: Estudo multicêntrico, observacional, prospectivo de pacientes consecutivos, encaminhados para ablação de FA de janeiro de 2018 a março de 2021. Hemoglobina, peptídeo natriurético cerebral (BNP), proteína C reativa, troponina I ultrassensível, clearance de creatinina, Hormônio Tireoestimulante (TSH), e Tiroxina livre (T4) foram avaliados quanto à capacidade de prever a recorrência de arritmias durante o acompanhamento. Valores de p <0,05 foram aceitos como estatisticamente significativos. Resultados: Um total de 593 pacientes foram incluídos - 412 com FA paroxística e 181 com FA persistente. Durante o seguimento médio de 24±6 meses, 76,4% não apresentaram recidiva após ablação. Individualmente, os biomarcadores demonstraram um valor preditivo baixo ou nulo para recorrência. No entanto, TSH >1,8 μUI/mL [HR=1,82 (IC95%, 1,89-2,80), p=0,006] foi um preditor independente de recorrência. Avaliando-se a combinação de TSH, FT4 e BNP, a adição de cada valor "anormal" foi associada a uma menor sobrevida livre de recorrência (87,1% se nenhum vs. 83,5% se um vs. 75,1% se dois vs. 43,3% se três biomarcadores, p<0,001). Doentes com três biomarcadores "anormais" apresentaram três vezes maior probabilidade de recorrência de FA, comparativamente aos que não apresentaram nenhum biomarcador "anormal" (HR=2,88 [IC95%, 1,39-5,17], p=0,003). Conclusões: Quando combinados, valores anormais de TSH, FT4 e BNP podem ser uma ferramenta útil para prever a recorrência de FA pós ablação guiada pelo AI.
Abstract Background: Ablation Index (AI) software has allowed better atrial fibrillation (AF) ablation results, but recurrence rates remain significant. Specific serum biomarkers have been associated with this recurrence. Objectives: To evaluate whether certain biomarkers could be used (either individually or combined) to predict arrhythmia recurrence after AI-guided AF ablation. Methods: Prospective multicenter observational study of consecutive patients referred for AF ablation from January 2018 to March 2021. Hemoglobin, brain natriuretic peptide (BNP), C-reactive protein, high sensitivity cardiac troponin I, creatinine clearance, thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were assessed for their ability to predict arrhythmia recurrence during follow-up. Statistical significance was accepted for p values of<0.05. Results: A total of 593 patients were included - 412 patients with paroxysmal AF and 181 with persistent AF. After a mean follow-up of 24±6 months, overall single-procedure freedom from atrial arrhythmia was 76.4%. Individually, all biomarkers had no or only modest predictive power for recurrence. However, a TSH value >1.8 μUI/mL (HR=1.82 [95% CI, 1.89-2.80], p=0.006) was an independent predictor of arrhythmia recurrence. When assessing TSH, FT4 and BNP values in combination, each additional "abnormal" biomarker value was associated with a lower freedom from arrhythmia recurrence (87.1 % for no biomarker vs. 83.5% for one vs. 75.1% for two vs. 43.3% for three biomarkers, p<0.001). Patients with three "abnormal" biomarkers had a threefold higher risk of AF recurrence compared with no "abnormal" biomarker (HR=2.88 [95% CI, 1.39-5.17], p=0.003). Conclusions: When used in combination, abnormal TSH, FT4 and BNP values can be a useful tool for predicting arrhythmia recurrence after AI-guided AF ablation.
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Considering the context of functional data analysis, we developed and applied a new Bayesian approach via the Gibbs sampler to select basis functions for a finite representation of functional data. The proposed methodology uses Bernoulli latent variables to assign zero to some of the basis function coefficients with a positive probability. This procedure allows for an adaptive basis selection since it can determine the number of bases and which ones should be selected to represent functional data. Moreover, the proposed procedure measures the uncertainty of the selection process and can be applied to multiple curves simultaneously. The methodology developed can deal with observed curves that may differ due to experimental error and random individual differences between subjects, which one can observe in a real dataset application involving daily numbers of COVID-19 cases in Brazil. Simulation studies show the main properties of the proposed method, such as its accuracy in estimating the coefficients and the strength of the procedure to find the true set of basis functions. Despite having been developed in the context of functional data analysis, we also compared the proposed model via simulation with the well-established LASSO and Bayesian LASSO, which are methods developed for non-functional data.
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Carditis in childhood is a rare disease with several etiologies. We report a case of infant death due to pericarditis and myocarditis after the mRNA vaccine against COVID-19 (COVIDmRNAV). A 7-year-old male child received the first dose of the COVIDmRNAV and presented with monoarthritis and a fever non-responsive to oral antibiotics. The laboratory investigation showed signs of infection (leukocytosis, high levels of c-reactive protein). His condition rapidly deteriorated, and the patient died. The autopsy identified pericardial fibrin deposits, hemorrhagic areas in the myocardium, and normal valves. A diffuse intermyocardial inflammatory infiltrate composed of T CD8+ lymphocytes and histiocytes was identified. An antistreptolysin O (ASO) dosage showed high titers. The presence of arthritis, elevated ASO, and carditis fulfills the criteria for rheumatic fever. However, valve disease and Aschoff's nodules, present in 90% of rheumatic carditis cases, were absent in this case. The temporal correlation with mRNA vaccination prompted its inclusion as one of the etiologies. In cases of myocardial damage related to COVID-19mRNAV, it appears to be related to the expression of exosomes and lipid nanoparticles, leading to a cytokine storm. The potential effects of the COVID-19mRNAV must be considered in the pathogenesis of this disease, whether as an etiology or a contributing factor to a previously initiated myocardial injury.
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Introduction: SARS-CoV-2 has rapid dissemination and high infectivity and can evolve into Severe Respiratory Distress Syndrome (SARS), which led to a high number of deaths and hospitalizations in the recent pandemic. Computed tomography (CT) of the chest has demonstrated an essential role in the initial evaluation and evolution of these patients. Methodology: This was a retrospective observational study at a single center, University Hospital in Northeastern Brazil, evaluating 97 patients hospitalized for COVID-19 with laboratory confirmation to evaluate and quantify the chest CT findings, comparing the findings with the severity of the case and relating them to the morbidities presented. The CT scans were performed by radiologists from the hospital and the data were evaluated by the university's statistics laboratory. Results: Among the main alterations, ground-glass opacities were present in more than 90% of the patients. The study observed that the magnitude of the pulmonary involvement of this finding had a relationship with the outcome of higher hospitalization. Conclusion: In this sense, the relevance of chest CT to suggest the diagnosis of Covid-19 and establish the prognosis of the disease is observed. However, further studies are still needed to confirm these finding (AU).
Introdução: O SARS-CoV-2 possui rápida disseminação e alta infectividade, podendo evoluir com Síndrome da Angústia Respiratória Grave (SARS), o que levou a um número elevado de mortes e internações na recente pandemia. A Tomografia Computadorizada (TC) de tórax demonstrou um papel essencial na avaliação inicial e evolução desses pacientes. Metodologia: Este foi um estudo observacional retrospectivo em centro único - Hospital Universitário no Nordeste do Brasil - avaliando 97 pacientes internados por COVID-19 com confirmação laboratorial, a fim de avaliar e quantificar os achados de TC de tórax, comparando os achados com a gravidade do caso e relacionando-os com as morbidades apresentadas. As TCs foram laudadas por radiologistas do próprio hospital. Após isso, os dados foram avaliados pelo laboratório de estatística da universidade para serem analisados e discutidos. Resultados: Dentre as principais alterações, o vidro fosco estava presente em mais de 90% dos pacientes. Foi observado que a magnitude do comprometimento pulmonar deste achado apresentou relação desfavorável com o desfecho da internação. Conclusão: Neste sentido, observa-se a relevância da TC de tórax para sugerir o diagnóstico de Covid-19 e estabelecer o prognóstico da doença. No entanto, ainda são necessários mais estudos para destrinchar estes achado (AU).
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Humanos , Neumonía , Tomografía , COVID-19/complicacionesRESUMEN
Objective: Evaluate the spirometry pattern of patients who persisted with respiratory symptoms after infection with SARS-Cov-2. Methods: Cross-sectional, observational, retrospective study in a single center, approved by the local Ethics Committee (registration number: 5,120,720). Patients who underwent spirometry due to Post-Covid Syndrome were evaluated to analyze the spirometric pattern presented. The following were collected: exam identification data, sex, age, symptom time, the need for mechanical ventilation, and quality of spirometry, in addition to the following exam parameters: FVC, FEV1, FEV1/FVC, FEV 25-75/FVC, and FEV 75, evaluating the Lower Limit of Normality, pre-bronchodilator and post-bronchodilator values. Results: Data from 72 patients were collected. Of these, 55.5% of patients had spirometry results within normal limits. The most frequent respiratory alteration was obstructive respiratory disorder, present in 29.2% of the patients. Conclusions: The presence of dyspnea in patients with normal spirometry may indicate further evaluation of lung function and other etiologies for dyspnea (AU).
Objetivo: Avaliar o padrão de espirometria de pacientes que persistiram com sintomas respiratórios após a infecção pelo SARS-CoV-2. Métodos: Estudo transversal, observacional e retrospectivo realizado em um único centro, aprovado pelo Comitê de Ética local (número do parecer: 5.120.720). Foram avaliados pacientes submetidos a espirometria devido à Síndrome Pós-Covid, a fim de analisar o padrão espirométrico apresentado. Os seguintes dados foram coletados: identificação do exame, sexo, idade, tempo de sintomas, necessidade de ventilação mecânica, qualidade da espirometria, além dos seguintes parâmetros do exame: CVF, VEF1, VEF1/CVF, VEF 25-75/CVF e VEF 75, avaliando o Limite Inferior da Normalidade, valores pré-broncodilatador e pós-broncodilatador. Resultados: Foram coletados dados de 72 pacientes. Destes, 55,5% apresentaram resultados espirométricos dentro dos limites normais. A alteração respiratória mais frequente foi o distúrbio ventilatório obstrutivo, presente em 29,2% dos pa-cientes. Conclusões: A presença de dispneia em pacientes com espirometria dentro da normalidade pode indicar uma avaliação adicional da função pulmonar, assim como outras etiologias para a dispneia (AU).
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Humanos , Masculino , Femenino , Pruebas de Función Respiratoria , Espirometría , Disnea , Síndrome Post Agudo de COVID-19RESUMEN
Objetivou-se investigar o processamento da consulta de enfermagem no pré-natal nas Estratégias Saúde da Família em uma cidade mineira. Trata-se de um estudo descritivo, qualitativo realizado com oito enfermeiros com três a cinco anos de experiência na Atenção Básica. Os dados foram coletados no período de agosto e setembro de 2021, por meio de uma entrevista, analisada mediante Análise Temática. Observou-se que a consulta ocorre subsidiada por linhas guia do Ministério da Saúde e instrumento próprio. O registro é realizado no prontuário, na caderneta das gestantes e em planilhas digitais. Os problemas de enfermagem recorrentes foram baixa adesão ao pré-natal, falta de apoio familiar e nutrição desequilibrada. A sobrecarga de trabalho e a falta de protocolos de enfermagem dificulta o trabalho dos enfermeiros. Conclui-se que a Sistematização da Assistência de Enfermagem é aplicada parcialmente, porém, identificar os problemas de enfermagem durante as consultas é fundamental para a integralidade da assistência
The objective of the study was to investigate nursing consultations processing in prenatal care in Family Health Strategies in a city in Minas Gerais. This is a descriptive, qualitative study carried out with eight nurses with three to five years of experience in Primary Care. Data were collected between August and September 2021, through an interview, analyzed using Thematic Analysis. It was observed that the consultation is subsidized by guidelines from the Ministry of Health and its own instrument. The registration is done on the medical record, in the pregnant women's booklet, and in digital spreadsheets. Recurrent nursing problems were low adherence to prenatal care, lack of family support, and unbalanced nutrition. Work overload and lack of nursing protocols hinder nurses' work. It is concluded that the Systematization of Nursing Care is partially applied; however, identifying nursing problems during consultations is essential for comprehensive care
El objetivo fue investigar la tramitación de las consultas de enfermería en el prenatal en Estrategias de Salud de la Familia en una ciudad de Minas Gerais. Se trata de un estudio descriptivo, cualitativo, realizado con ocho enfermeras con tres a cinco años de experiencia en Atención Primaria. Los datos fueron recolectados entre agosto y septiembre de 2021, mediante entrevista, analizados mediante Análisis Temático. Se observó que la consulta se realiza subsidiada por lineamientos del Ministerio de Salud y instrumento propio. El registro se realiza en la historia clínica, en la libreta de gestantes y en planillas digitales. Los problemas recurrentes de enfermería fueron la baja adherencia a la atención prenatal, la falta de apoyo familiar y la mala nutrición . La sobrecarga de trabajo y la falta de protocolos de enfermería dificultan el trabajo de las enfermeras. Se concluye que la Sistematización de la Atención de Enfermería se aplica parcialmente, sin embargo, identificar los problemas de enfermería durante las consultas es fundamental para la atención integral.
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Introdução: A Odontologia vem se aprimorando com a utilização de novos métodos terapêuticos, como por exemplo, a incorporação de práticas integrativas e complementares (PIC), com base na perspectiva de estabelecer novas ferramentas de atendimento integral e atuação transdisciplinar. Objetivo: Avaliar a quantidade e a distribuição de cirurgiões-dentistas habilitados em fitoterapia, terapia floral, hipnose, laserterapia, odontologia antroposófica, ozonioterapia e de especialistas em acupuntura e homeopatia, de acordo com os estados e regiões brasileiras. Material e Métodos: Tratou-se de uma pesquisa transversal, com abordagem descritiva, a partir de dados secundários e de acesso público, provenientes do Conselho Federal de Odontologia (CFO). Resultados: No Brasil, há 2.932 cirurgiões-dentistas habilitados ou especialistas em PIC, havendo um maior número de registros na prática da laserterapia (n= 1.571; 53,6%), seguida por acupuntura (n= 497; 16,9%). Dentre as PIC avaliadas, observou-se, no país, um menor número de registros na prática fitoterapia (n= 26; 0,9%), seguida por odontologia antroposófica (n= 36; 1,2%) e terapia floral (n= 49; 1,7%). Por regiões brasileiras, verifica-se que a região Sudeste detém o maior número de profissionais habilitados ou especialistas em todas as PIC avaliadas. As regiões Norte e Nordeste não apresentam profissionais habilitados em odontologia antroposófica (n= 0; 0%). Em todo o Brasil, observou-se na laserterapia, o maior número de habilitados por cirurgião-dentista, com uma proporção de 1/232. Dentre todos os estados, o Espírito Santo detém a maior proporção observada entre as PIC avaliadas, na prática da laserterapia (1/82). Conclusão: Com base nos resultados encontrados e de acordo com o grande número total de cirurgiões-dentistas em atividade no Brasil, concluiu-se que ainda existem poucos profissionais habilitados em fitoterapia, odontologia antroposófica, terapia floral, hipnose, ozonioterapia, laserterapia, e especialistas em homeopatia e acupuntura em todo o país. Além disso, nota-se discrepâncias importantes relacionadas ao número desses profissionais entre estados e regiões brasileiras.
Introduction: Dentistry has been improving with the use of new therapeutic methods, such as the incorporation of Integrative and Complementary Practices (PIC), based on the perspective of establishing new tools for comprehensive care and transdisciplinary action. Objective: To evaluate the number and distribution of qualified dentists in phytotherapy, floral therapy, hypnosis, laser therapy, anthroposophic dentistry, ozone therapy and specialists in acupuncture and homeopathy, according to Brazilian states and regions. Material and Methods: This was a cross-sectional study, with a descriptive approach, based on secondary and publicly accessible data from the Federal Council of Dentistry (CFO). Results: In Brazil, there are 2,932 qualified dentists or specialists in PIC, with a greater number of records in the practice of laser therapy (n= 1,571; 53.6%), followed by acupuncture (n= 497; 16.9%). Among the evaluated PICs, it was observed, in the country, a smaller number of records in the practice of phytotherapy (n= 26; 0.9%), followed by anthroposophic dentistry (n= 36; 1.2%) and floral therapy (n= 49; 1.7%). By Brazilian regions, it appears that the Southeast region has the largest number of qualified professionals or specialists in all the evaluated PICs. The North and Northeast regions do not have qualified professionals in anthroposophic dentistry (n= 0; 0%). In all of Brazil, laser therapy had the highest number of qualified professionals per dentist, with a ratio of 1/232. Among all the states, Espírito Santo has the highest proportion observed among the evaluated PICs, in the practice of laser therapy (1/82). Conclusion: Based on the results found and according to the large total number of dentists working in Brazil, it was concluded that there are still few professionals qualified in phytotherapy, anthroposophic dentistry, floral therapy, hypnosis, ozone therapy, laser therapy, and specialists in homeopathy and acupuncture across the country. In addition, there are important discrepancies related to the number of these professionals between Brazilian states and regions.
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A male neonate born at gestational age of 40 weeks was found to have an enlarged and darkened right hemiscrotum after birth. Left testicle was descended and normal. No clinical signs of distress were evident. A color Doppler ultrasound showed an absence of testicular blood flow, consistent with perinatal testicular torsion. The patient underwent a bilateral scrotal exploration through an inguinal incision and a necrotic right testicle was found. A right orchiectomy and left orchiopexy were performed. Perinatal testicular torsion is a rare but severe condition. A high clinical suspicion is required since most of perinatal testicular torsion are intrauterine and can often be asymptomatic, only with localized findings of the affected testis. The management of perinatal testicular torsion is still controversial; however, the most consensual approach is a prompt testicle exploration with orchiectomy of the necrotic testicle and contralateral orchiopexy
Recém-nascido do sexo masculino com idade gestacional de 40 semanas, com edema e escurecimento cutâneo do hemiescroto direito constatados após o nascimento. O testículo esquerdo era palpável na bolsa escrotal e não apresentava alterações. A ecografia escrotal com Doppler revelou ausência de fluxo vascular no testículo direito, achado compatível com torção testicular perinatal. O doente foi submetido a exploração escrotal bilateral através de abordagem por via inguinal, tendo sido confirmada a necrose do testículo direito. Foi realizada orquidectomia direita e orquidopexia esquerda. A torção testicular perinatal corresponde a uma patologia rara, mas com possíveis consequências graves. O seu diagnóstico requer elevada suspeição clínica, uma vez que a maioria dos casos ocorre no período pré-natal, podendo ser assintomáticos após o nascimento e manifestar-se com alterações localizadas ao testículo afetado. A abordagem da torção testicular perinatal é ainda controversa, sendo mais consensual uma exploração escrotal célere com orquidectomia do testículo necrosado e orquidopexia contralateral
Asunto(s)
Humanos , Masculino , Torsión del Cordón Espermático/cirugía , Recién Nacido , Orquiectomía , OrquidopexiaRESUMEN
OBJECTIVE: To develop a simple, robust, safe and efficient invasive mechanical ventilator that can be used in remote areas of the world or war zones where the practical utility of more sophisticated equipment is limited by considerations of maintainability, availability of parts, transportation and/or cost. METHODS: The device implements the pressure-controlled continuous mandatory ventilation mode, complemented by a simple assist-control mode. Continuous positive airway pressure is also possible. The consumption of compressed gases is minimized by avoiding a continuous flow of oxygen or air. Respiratory rates and inspiration/expiration time ratios are electronically determined, and an apnea/power loss alarm is provided. RESULTS: The pressure profiles were measured for a range of conditions and found to be adjustable within a ± 2.5cmH2O error margin and stable well within this range over a 41-hour period. Respiratory cycle timing parameters were precise within a few percentage points over the same period. The device was tested for durability for an equivalent period of four months. Chemical and biological tests failed to identify any contamination of the gas by volatile organic compounds or microorganisms. A ventilation test on a large animal, in comparison with a well established ventilator, showed that the animal could be adequately ventilated over a period of 60 minutes, without any noticeable negative aftereffects during the subsequent 24-hour period. CONCLUSION: This ventilator design may be viable, after further animal tests and formal approval by the competent authorities, for clinical application in the abovementioned atypical circumstances.
OBJETIVO: Desenvolver um ventilador mecânico invasivo simples, resistente, seguro e eficiente que possa ser utilizado em áreas remotas do mundo ou zonas de guerra, em que a utilidade prática de equipamentos mais sofisticados é limitada por questões de manutenção, disponibilidade de peças, transporte e/ou custo. MÉTODOS: O dispositivo implementa o modo de ventilação mandatória contínua com pressão controlada, complementado por um simples modo assisto-controlado. Pode-se também utilizar a pressão positiva contínua nas vias aéreas. Ao se evitar o fluxo contínuo de oxigênio ou ar, minimiza-se o consumo de gases comprimidos. As taxas respiratórias e as relações de tempo de inspiração e expiração são determinadas eletronicamente. Além disso, conta com um alarme de apneia/falta de energia. RESULTADOS: Os perfis de pressão foram medidos para uma série de condições, sendo considerados ajustáveis dentro de uma margem de erro de ± 2,5cmH2O, e foram considerados bem estáveis dentro dessa variação durante um período de 41 horas. Os parâmetros de tempo do ciclo respiratório foram precisos dentro de alguns pontos percentuais durante o mesmo período. O dispositivo foi testado quanto à durabilidade por um período equivalente a 4 meses. Os testes químicos e biológicos não conseguiram identificar qualquer contaminação do gás por compostos orgânicos voláteis ou micro-organismos. Em comparação com um ventilador bem estabelecido, o teste de ventilação em um animal de grande porte mostrou que este poderia ser ventilado adequadamente durante um período de 60 minutos, sem quaisquer efeitos negativos perceptíveis durante o período subsequente de 24 horas. CONCLUSÃO: Este projeto de ventilador pode ser viável após novos testes em animais e aprovação formal pelas autoridades competentes, para aplicação clínica nas circunstâncias atípicas anteriormente mencionadas.
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Presión de las Vías Aéreas Positiva Contínua , Ventiladores Mecánicos , Animales , Humanos , Respiración ArtificialRESUMEN
RESUMO Objetivo: Desenvolver um ventilador mecânico invasivo simples, resistente, seguro e eficiente que possa ser utilizado em áreas remotas do mundo ou zonas de guerra, em que a utilidade prática de equipamentos mais sofisticados é limitada por questões de manutenção, disponibilidade de peças, transporte e/ou custo. Métodos: O dispositivo implementa o modo de ventilação mandatória contínua com pressão controlada, complementado por um simples modo assisto-controlado. Pode-se também utilizar a pressão positiva contínua nas vias aéreas. Ao se evitar o fluxo contínuo de oxigênio ou ar, minimiza-se o consumo de gases comprimidos. As taxas respiratórias e as relações de tempo de inspiração e expiração são determinadas eletronicamente. Além disso, conta com um alarme de apneia/falta de energia. Resultados: Os perfis de pressão foram medidos para uma série de condições, sendo considerados ajustáveis dentro de uma margem de erro de ± 2,5cmH2O, e foram considerados bem estáveis dentro dessa variação durante um período de 41 horas. Os parâmetros de tempo do ciclo respiratório foram precisos dentro de alguns pontos percentuais durante o mesmo período. O dispositivo foi testado quanto à durabilidade por um período equivalente a 4 meses. Os testes químicos e biológicos não conseguiram identificar qualquer contaminação do gás por compostos orgânicos voláteis ou micro-organismos. Em comparação com um ventilador bem estabelecido, o teste de ventilação em um animal de grande porte mostrou que este poderia ser ventilado adequadamente durante um período de 60 minutos, sem quaisquer efeitos negativos perceptíveis durante o período subsequente de 24 horas. Conclusão: Este projeto de ventilador pode ser viável após novos testes em animais e aprovação formal pelas autoridades competentes, para aplicação clínica nas circunstâncias atípicas anteriormente mencionadas.
ABSTRACT Objective: To develop a simple, robust, safe and efficient invasive mechanical ventilator that can be used in remote areas of the world or war zones where the practical utility of more sophisticated equipment is limited by considerations of maintainability, availability of parts, transportation and/or cost. Methods: The device implements the pressure-controlled continuous mandatory ventilation mode, complemented by a simple assist-control mode. Continuous positive airway pressure is also possible. The consumption of compressed gases is minimized by avoiding a continuous flow of oxygen or air. Respiratory rates and inspiration/expiration time ratios are electronically determined, and an apnea/power loss alarm is provided. Results: The pressure profiles were measured for a range of conditions and found to be adjustable within a ± 2.5cmH2O error margin and stable well within this range over a 41-hour period. Respiratory cycle timing parameters were precise within a few percentage points over the same period. The device was tested for durability for an equivalent period of four months. Chemical and biological tests failed to identify any contamination of the gas by volatile organic compounds or microorganisms. A ventilation test on a large animal, in comparison with a well established ventilator, showed that the animal could be adequately ventilated over a period of 60 minutes, without any noticeable negative aftereffects during the subsequent 24-hour period. Conclusion: This ventilator design may be viable, after further animal tests and formal approval by the competent authorities, for clinical application in the abovementioned atypical circumstances.
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Abstract Introduction Invasive fungal diseases represent important causes of morbidity and mortality among pediatric oncohematological patients. Acute invasive fungal rhinosinusitis is a rare and aggressive disease that occurs mainly in immunocompromised patients. The mortality rate is high and therefore, accurate and early diagnosis is essential. Objectives The aim of this study was to describe the frequency of acute invasive fungal rhinosinusitis among pediatric oncohematological patients and characterize them with confirmed diagnoses. Methods This was a retrospective study that analyzed the medical records of pediatric patients diagnosed with oncohematological diseases and suspected fungal infections, who were included after obtaining informed consent, from January to December 2017, in the pediatric unit of a tertiary university hospital. Data collected from medical record analysis included the following: underlying diagnosis, absolute neutrophil count, clinical presentation, culture and biopsy results, surgical procedures performed, survival and mortality. Results A total of 27 patients were evaluated, with three suspected cases of acute invasive fungal rhinosinusitis. Histopathological and microbiological analyses confirmed two cases. In both cases, the pathogen isolated in the culture was Fusarium sp. The two confirmed cases were female, aged 12 and 14 years, both with an absolute neutrophil count of 10 cells/μL. The underlying disease of the first patient was acute myeloid leukemia (subtype M5), whereas the second patient presented idiopathic bone marrow aplasia. Conclusion Both confirmed cases of acute invasive fungal rhinosinusitis presented with constitutional symptoms and signs of nasal and sinusital inflammation. This demonstrates the importance of fever as a symptom in immunocompromised patients and it should prompt otorhinolaryngological investigation.
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Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Fusariosis , Infecciones Fúngicas Invasoras , Enfermedades Hematológicas , Sinusitis , Neutropenia Febril , FusariumRESUMEN
INTRODUCTION: Invasive fungal diseases represent important causes of morbidity and mortality among pediatric oncohematological patients. Acute invasive fungal rhinosinusitis is a rare and aggressive disease that occurs mainly in immunocompromised patients. The mortality rate is high and therefore, accurate and early diagnosis is essential. OBJECTIVES: The aim of this study was to describe the frequency of acute invasive fungal rhinosinusitis among pediatric oncohematological patients and characterize them with confirmed diagnoses. METHODS: This was a retrospective study that analyzed the medical records of pediatric patients diagnosed with oncohematological diseases and suspected fungal infections, who were included after obtaining informed consent, from January to December 2017, in the pediatric unit of a tertiary university hospital. Data collected from medical record analysis included the following: underlying diagnosis, absolute neutrophil count, clinical presentation, culture and biopsy results, surgical procedures performed, survival and mortality. RESULTS: A total of 27 patients were evaluated, with three suspected cases of acute invasive fungal rhinosinusitis. Histopathological and microbiological analyses confirmed two cases. In both cases, the pathogen isolated in the culture was Fusarium sp. The two confirmed cases were female, aged 12 and 14 years, both with an absolute neutrophil count of 10cells/µL. The underlying disease of the first patient was acute myeloid leukemia (subtype M5), whereas the second patient presented idiopathic bone marrow aplasia. CONCLUSION: Both confirmed cases of acute invasive fungal rhinosinusitis presented with constitutional symptoms and signs of nasal and sinusital inflammation. This demonstrates the importance of fever as a symptom in immunocompromised patients and it should prompt otorhinolaryngological investigation.
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Literature reports that insults, such as hormonal disturbances, during critical periods of development may modulate organism physiology and metabolism favoring cardiovascular diseases (CVDs) later in life. Studies show that leptin administration during lactation leads to cardiovascular dysfunction in young and adult male Wistar rats. However, there are sex differences regarding CVD. Thus, the present work aimed to investigate neonatal leptin administration's consequences on different outcomes in female rats at prepubertal and adult age. Newborn Wistar female rats were divided into two groups, Leptin and Control, receiving daily subcutaneous injections of this adipokine (8 µg/100 g) or saline for the first 10 of 21 d of lactation. Nutritional, biometric, hemodynamic, and echocardiographic parameters, as well as maximal effort ergometer performance, were determined at postnatal days (PND) 30 and 150. Leptin group presented lower food intake (p = 0.0003) and higher feed efficiency (p = 0.0058) between PND 21 and 30. Differences concerning echocardiographic parameters revealed higher left ventricle internal diameter (LVID) in systole (p = 0.0051), as well as lower left ventricle ejection fraction (LVEF) (p = 0.0111) and fractional shortening (FS) (p = 0.0405) for this group at PND 30. Older rats treated with leptin during lactation presented only higher LVID in systole (p = 0.0270). Systolic blood pressure and maximum effort ergometer test performance was similar between groups at both ages. These data suggest that nutritional, biometric, and cardiac outcomes due to neonatal leptin administration in female rats are age-dependent.
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Lactancia/efectos de los fármacos , Leptina/administración & dosificación , Animales , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Modelos Animales de Enfermedad , Femenino , Lactancia/metabolismo , Leptina/uso terapéutico , Ratas , Ratas Wistar , Caracteres Sexuales , Volumen Sistólico/efectos de los fármacos , Volumen Sistólico/fisiologíaRESUMEN
Visceral leishmaniosis is one of the most important zoonotic diseases on the planet and dogs are the main reservoir of canine visceral leishmaniosis (CVL) in endemic areas. They play an important role in human infection because in dogs the disease appears long time after infection, and they can move uncontrollably, contributing to disperse the parasite. To take the decision to treat the animals or for euthanasia, in an elimination programme, in order to reduce the parasitic load, it is necessary to diagnose correctly, having more effective tools. Our group has developed a new recombinant antigen-based kinesin-related gene of Leishmania braziliensis (Lbk39), which shows 59% amino acid identity to the L. infantum homologue. The Lbk39 gene was synthesized, inserted into the pLEXSY-sat2 vector and transfected into L. tarentolae cells by electroporation. The recombinant protein was secreted in the culture with a C-terminal histidine marker, purified, generating a product at 337.68 µg mL-1. A total of 152 sera from dog's endemic and non-endemic areas were used, being 78 positives and 75 negatives. The antigen Lbk39 showed 100% sensitivity and 96.1% specificity. We compared this antigen with other antigens such as total extract of the parasite, TRDPP, and our data indicate that Lbk39 has potential application in the diagnosis of CVL through antibody detection.
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Enfermedades de los Perros/diagnóstico , Leishmania braziliensis/genética , Leishmaniasis Visceral/veterinaria , Proteínas Protozoarias/uso terapéutico , Animales , Enfermedades de los Perros/parasitología , Perros , Leishmania/genética , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/parasitología , Microorganismos Modificados Genéticamente/genética , Proteínas Recombinantes/uso terapéuticoRESUMEN
Cyanobacteria comprise one of the oldest and most diverse phyla in the Bacteria domain and are recognized for their importance in the biosphere evolution. Members of this phylum can be found in a wide variety of environments reflecting their photosynthetic ability, adaptability to various environmental conditions, and diversified metabolism. Such characteristics make cyanobacteria one of the preferred targets for research on bioactive compounds and new enzymes (Schirrmeister et al., 2011; Dittmann et al., 2015). Pantanalinema was described as a new genus of the Leptolyngbyaceae cyanobacterial family by a polyphasic approach, which included morphological characteristics, 16S rRNA gene phylogeny, 16S-23S ITS rRNA secondary structures, and physiological characteristics such as adaptability to pH variations (Vaz et al., 2015). This genus has been described only in Brazilian biomes such as the Pantanal and the Amazon, the first isolates being found in a lake. These Pantanalinema isolates were characterized by their ability to grow over a wide pH range (pH 4 to 11) as well as to modify the culture medium pH around neutrality (pH 6 to 7.4). Due to these characteristics, it is thought that this genus can occupy a variety of ecological niches, such as alkaline or slightly acidic water bodies (Vaz et al., 2015; Genuário et al., 2017). Taxonomic classification of Pantanalinema isolates requires the use of molecular markers as this genus is morphologically very similar to the recently described genus Amazoninema, which, in turn, has comparable morphology to other genera of the Leptolyngbyaceae family (Genuário et al., 2018). In this work, we report the genome sequence of a new Pantanalinema strain, named GBBB05, which was isolated from the Brazilian Cerrado biome. This is the first genome assembly for the Pantanalinema genus, which, along with the analyses provided here, is expected to enhance our understanding of this genus’s metabolic potential