RESUMO
Abstract Introduction: Leptodactylus latinasus and Physalaemus cuqui are sympatric anuran species with similar environmental requirements and contrasting reproductive modes. Climatic configuration determines distribution patterns and promotes sympatry of environmental niches, but specificity/selectivity determines the success of reproductive modes. Species distribution models (SDM) are a valuable tool to predict spatio-temporal distributions based on the extrapolation of environmental predictors. Objectives: To determine the spatio-temporal distribution of environmental niches and assess whether the protected areas of the World Database of Protected Areas (WDPA) allow the conservation of these species in the current scenario and future. Methods: We applied different algorithms to predict the distribution and spatio-temporal overlap of environmental niches of L. latinasus and P. cuqui within South America in the last glacial maximum (LGM), middle-Holocene, current and future scenarios. We assess the conservation status of both species with the WDPA conservation units. Results: All applied algorithms showed high performance for both species (TSS = 0.87, AUC = 0.95). The L. latinasus predictions showed wide environmental niches from LGM to the current scenario (49 % stable niches, 37 % gained niches, and 13 % lost niches), suggesting historical fidelity to stable climatic-environmental regions. In the current-future transition, L. latinasus would increase the number of stable (70 %) and lost (20 %) niches, suggesting fidelity to lowland regions and a possible trend toward microendemism. P. cuqui loses environmental niches from the LGM to the current scenario (25 %) and in the current-future transition (63 %), increasing the environmental sympathy between both species; 31 % spatial overlap in the current scenario and 70 % in the future. Conclusion: Extreme drought events and rainfall variations, derived from climate change, suggest the loss of environmental niches for these species that are not currently threatened but are not adequately protected by conservation units. The loss of environmental niches increases spatial sympatry which represents a new challenge for anurans and the conservation of their populations.
Resumen Introducción: Leptodactylus latinasus y Physalaemus cuqui son especies de anuros simpátricos con requerimientos ambientales similares y modos reproductivos contrastantes. La configuración climática determina los patrones de distribución y promueve la simpatría de los nichos ambientales, pero la especificidad/selectividad determina el éxito de los modos reproductivos. Los modelos de distribución de especies (MDE) son una herramienta valiosa para predecir distribuciones espacio-temporales basadas en la extrapolación de predictores ambientales. Objetivos: Determinar la distribución espacio-temporal de los nichos ambientales y evaluar si las áreas protegidas de la base de Datos Mundial de Áreas Protegidas (DMAP) permiten la conservación de estas especies en el escenario actual y futuro. Métodos: Aplicamos diferentes algoritmos para predecir la distribución y superposición espacio-temporal de nichos ambientales de L. latinasus y P. cuqui dentro de América del Sur en el último máximo glacial (UGM), Holoceno medio, actual y futuro. Evaluamos el estado de conservación de ambas especies con las unidades de conservación de la DMAP. Resultados: Todos los algoritmos aplicados mostraron un alto rendimiento para ambas especies (TSS = 0.87, AUC = 0.95). Las predicciones de L. latinasus mostraron amplios nichos ambientales desde LGM hasta el escenario actual (49 % de nichos estables, 37 % de nichos ganados y 13 % de nichos perdidos), sugiriendo fidelidad histórica por regiones climático-ambientales estables. En la transición actual-futura L. latinasus incrementaría la cantidad de nichos estables (70 %) y perdidos (20 %), sugiriendo fidelidad por regiones de tierras bajas y la posible tendencia hacia el microendemismo. P. cuqui pierde nichos ambientales desde el LGM al escenario actual (25 %) y en la transición actual-futura (63 %), incrementando la simpatría ambiental entre ambas especies; 31 % de superposición espacial en el escenario actual y 70 % en el futuro. Conclusión: Los eventos de sequía extrema y las variaciones de precipitaciones, derivados del cambio climático, sugieren la pérdida de nichos ambientales para estas especies, actualmente no se encuentran amenazadas, pero no están adecuadamente protegidas por las unidades de conservación. La pérdida de nichos ambientales aumenta la simpatría espacial que representa un nuevo desafío para estos anuros y la conservación de sus poblaciones.
Assuntos
Animais , Anuros/classificação , Análise Espaço-Temporal , América do Sul , Mudança ClimáticaRESUMO
BACKGROUND: Brain metastases (BMs) represent the most common intracranial neoplasms in adults, affecting up to 25% of patients with metastatic cancers. Primary cancers of the lung, melanoma and colorectal are responsible for the majority of diagnosed BMs. Current therapies for BMs include stereotactic radiosurgery, whole-brain radiotherapy, surgical resection, interstitial laser thermal therapy, systemic cytotoxic chemotherapy, targeted agents, and PD1/PDL-1 blockage, which play a crucial role in cancer immunotherapy. METHODS: A systematic search was conducted through PubMed, Embase and Cochrane databases for studies that assess the benefit of neoadjuvant treatment with PD-1/PD-L1 inhibitors plus steroids and the impact of this combination on treatment effectiveness. Hazard ratios (HRs) were computed for binary endpoints, with 95% confidence intervals (CIs). We performed the meta-analysis using RStudio v4.4.2 software. RESULTS: The systematic analysis, including 1,658 patients, assessed the impact of PD-1/PD-L1 inhibitors on overall survival (OS) and progression-free survival (PFS) in treating BMs from non-small cell lung cancer (NSCLC) and melanoma. For OS, eight studies with 848 patients indicated a significant improvement using steroids (HR: 1.978; 95% CI 1.308-2.992; I2 = 62%) compared to non-users. Regarding PFS, data from four studies involving 790 patients did not reach statistical significance (HR: 1.483; 95% CI: 0.843-2.608; I2 = 82%). The addition of steroids did not show a clear beneficial effect on the efficacy of PD-1/PD-L1 inhibitors in extending progression-free survival. CONCLUSIONS: The systematic analysis underscores the effectiveness of PD-1/PD-L1 blockage in improving overall survival in patients with BMs from NSCLC and melanoma, however, their impact on delaying disease progression, especially when combined with steroids, requires further investigation to clarify their role and optimize therapeutic strategies.
Assuntos
Esteroides , Neoplasias Encefálicas , Receptor de Morte Celular Programada 1RESUMO
[ABSTRACT]. Objective. To evaluate whether use of a culturally adapted mobile application (app) for adolescents with type 1 diabetes is associated with improved metabolic control. Methods. The Dominican Republic’s National Institute of Diabetes, Endocrinology, and Nutrition and the Learning to Live clinic recruited 23 pediatric participants for the study. Blood tests were performed before and after use of the app for a period of 3 months. Based on the user profile, participants were encouraged to use the app’s bolus insulin calculator after each meal. The app included a list of regionally and culturally specific foods, color-coded to indicate a high glycemic index (GI) as red; medium GI as yellow; and low GI as green. The color-coding was designed to assist participants in making healthier eating choices. Results. There were statistically significant improvements in lipid profile. Mean high-density lipoprotein values rose to acceptable levels, while low-density lipoproteins and triglyceride levels fell to the recommended values. The overall quality of life increased, although glycated hemoglobin levels showed no statistically significant changes. Conclusion. The findings of this study suggest that using this culturally tailored app can help young patients with type 1 diabetes to improve metabolic health.
[RESUMEN]. Objetivo. Evaluar si el uso de una aplicación móvil (app) para adolescentes con diabetes tipo 1, adaptada desde el punto de vista cultural, se asocia a una mejora del control metabólico. Métodos. El Instituto Nacional de Diabetes, Endocrinología y Nutrición de República Dominicana y Learning to Live Clinic reclutaron a 23 participantes pediátricos para el estudio. Se realizaron análisis de sangre antes y después de utilizar la aplicación durante un período de 3 meses. En función del perfil de usuario, se alentó a los participantes a utilizar la calculadora del bolo de insulina de la aplicación después de cada comida. La aplicación incluía una lista de alimentos propios de la región y la cultura, codificados por colores para indicar un índice glucémico (IG) alto (rojo), medio (amarillo) o bajo (verde). El código de colores se diseñó para ayudar a los participantes a adoptar opciones de alimentación más saludables. Resultados. Se observaron mejoras estadísticamente significativas en el perfil lipídico. Los valores medios de las lipoproteínas de alta densidad aumentaron hasta niveles aceptables, mientras que los niveles de las lipoproteínas de baja densidad y los triglicéridos descendieron hasta los valores recomendados. Se observó una mejora en la calidad de vida general, si bien no se observaron cambios estadísticamente significativos en los niveles de hemoglobina glucosilada. Conclusiones. Los resultados de este estudio sugieren que el uso de esta aplicación adaptada desde el punto de vista cultural puede ayudar a los pacientes jóvenes con diabetes mellitus tipo 1 a mejorar su salud metabólica.
[RESUMO]. Objetivo. Avaliar se o uso de um aplicativo móvel culturalmente adaptado para adolescentes com diabetes tipo 1 está associado a um melhor controle metabólico. Métodos. O Instituto Nacional de Diabetes, Endocrinologia e Nutrição da República Dominicana e a clínica Learning to Live recrutaram 23 participantes pediátricos para o estudo. Foram realizados exames de sangue antes e depois do uso do aplicativo por um período de 3 meses. Com base no perfil de usuário, os participantes foram incentivados a usar a calculadora de bolus de insulina do aplicativo após cada refeição. O aplicativo incluía uma lista de alimentos específicos da região e da cultura, codificados por cores para indicar índices glicêmicos (IG) altos em vermelho; IG médios em amarelo; e IG baixos em verde. O código de cores foi criado para ajudar os participantes a fazer escolhas alimentares mais saudáveis. Resultados. Houve melhoras estatisticamente significantes no perfil lipídico. Os valores médios de lipoproteínas de alta densidade subiram para níveis aceitáveis, e os níveis de lipoproteínas de baixa densidade e de triglicerídeos caíram para os valores recomendados. A qualidade de vida geral aumentou, embora os níveis de hemoglobina glicada não tenham apresentado alterações estatisticamente significantes. Conclusão. Os resultados deste estudo sugerem que o uso desse aplicativo culturalmente adaptado pode ajudar pacientes jovens com diabetes tipo 1 a melhorar sua saúde metabólica.
Assuntos
Diabetes Mellitus Tipo 1 , Controle Glicêmico , Insulisina , Aplicativos Móveis , Diabetes Mellitus Tipo 1 , Controle Glicêmico , Insulina , Aplicativos Móveis , Controle Glicêmico , Aplicativos MóveisRESUMO
Objetivo: Determinar in vitro si la microdureza superficial Knoop de las manchas blancas mejora con la infiltración de resinas de baja viscosidad en comparación con la microdureza del esmalte sano. Materiales y métodos: Se desmineralizaron 93 muestras de esmalte bovino simulando lesiones de manchas blancas, para luego ser tratadas mediante la infiltración de resinas. Se midió la microdureza Knoop de las muestras antes de desmineralizarlas, luego de este proceso y a continuación de la infiltración. Resultados: Las muestras desmineralizadas mostraron una disminución del 50% en la microdureza. La infiltración con resinas mejoró esta propiedad, aunque los valores obtenidos se encontraron muy por debajo de la microdureza del esmalte sano. El análisis estadístico, mediante análisis de varianza (ANOVA) y prueba post-hoc de Tukey, mostraron diferencias estadísticamente significativas entre los tres grupos (p<0.001). Conclusiones: El tratamiento de las lesiones de manchas blancas artificiales con resinas infiltrantes aumentó la dureza Knoop, pero sin recuperar totalmente los valores próximos a la dureza del esmalte sano. (AU)
Aim: Determine in vitro if the Knoop surface microhardness of white spots lesions improve with the infiltration of low viscosity resins and compare it with the microhardness of healthy enamel. Materials and methods: 93 samples of bovine enamel were demineralized simulating white spot lesions, and then treated by infiltration of resins. The Knoop microhardness of the samples was measured before demineralization, after this process and after infiltration. Results: Demineralized samples showed a decrease in microhardness of 50%. The infiltration with resins improved this property, although the obtained values were far below the microhardness of healthy enamel. The statistical analysis, through analysis of variance (ANOVA) and Tukey's posthoc test, showed statistically significant differences between groups (p<0.001). Conclusions: Treatment of artificial white spot enamel lesions with infiltrating resins increased Knoop hardness but failed to reach values close to the hardness of healthy enamel. (AU)
RESUMO
Introducción : La Organización Mundial de la Salud (OMS) efectuó recomendaciones en relación con la recopilación y notificación de datos agregados semanales de COVID-19. Objetivo : Investigar el grado de cumplimiento de las recomendaciones elaboradas por la OMS para la notificación de casos y muertes de COVID-19 en la Argentina durante el año 2020 a 2022, y comparar la notificación de muertes con el número de defunciones por COVID-19 consolidadas en el registro de estadísticas vitales del país. Materiales y métodos : Estudio cuantitativo descriptivo, basado en revisión documental y en fuentes de datos secundarias. Se utilizó los reportes diarios de información epidemiológica y la base de datos Dataset, COVID-19 casos registrados en la República Argentina. Adicionalmente, para estimar la omisión en los registros epidemiológicos de fallecimientos por COVID-19 en los años 2020 y 2021, se cotejaron los resultados de las bases de datos Dataset COVID-19 con la base de las Estadísticas vitales de mortalidad por causa de defunción, proporcionadas por la Dirección de Estadísticas e Información en Salud (DEIS). Se analizaron las variables recomendadas por la OMS para la notificación de casos y muertes por COVID-19. En cuanto a las consideraciones éticas relacionadas con el uso de la información utilizada en este trabajo, las bases de datos cumplen con lo estipulado por la Ley Nacional N° 17.622 de Resguardo del Secreto Estadístico, garantizando que la información mantiene el carácter confidencial y reservado del informante. Resultados: Del análisis de los reportes diarios, durante 2020 se observó que, de los 13 indicadores recomendados, 9 presentan datos algunos meses y los 4 restantes no se relevaron; en 2021 solo 7 indicadores presentaron datos algunos meses, y en 2022 solo 3 indicadores se continuaron informando. Respecto al análisis de la base de datos Dataset COVID-19, la mayoría fueron captadas. Respecto a la comparación de los valores de las defunciones registradas por el sistema de vigilancia epidemiológica y por la DEIS para los años 2020 y 2021, las muertes registradas fueron superiores en el registro de la DEIS (9,6% y 14,2%). Conclusiones : El Estado argentino cumplió con gran parte de las recomendaciones que establece la OMS para la notificación de los casos de COVID-19. Estudios posteriores deberían analizar otros componentes de la calidad de los datos, así como la oportunidad de los registros de defunciones, característica necesaria para la toma de decisiones en salud pública.
Introduction : The World Health Organization (WHO) establishes recommendations regarding the collection and reporting of weekly aggregated data on COVID-19. Objective : To investigate the degree of compliance with the recommendations made by the WHO for the reporting of COVID-19 cases and deaths in Argentina during the years 2020 to 2022, and to compare death notifications with the number of COVID-19 deaths recorded in the country's vital statistics registry. Materials and methods : Descriptive quantitative study, based on a documentary review and secondary data sources. Daily reports of epidemiological information and the Dataset database containing registered COVID-19 cases in the Argentine Republic were used. Additionally, to estimate the omission in the epidemiological records of COVID-19 deaths in the years 2020 and 2021, the results of the Dataset COVID-19 databases were compared with the vital statistics death registry on cause of death, provided by the Directorate of Statistics and Health Information (DEIS, by its acronym in Spanish). The variables recommended by the WHO for the reporting of COVID-19 cases and deaths were analyzed. As for the ethical considerations related to the use of the information in this study, the databases comply with the provisions of National Law 17,622 on the Protection of Statistical Secrecy, ensuring that the information remains confidential and reserved for the informant. Results : From the analysis of daily reports, it was observed that in 2020, out of the 13 recommended indicators, 9 had data for some months, and the remaining 4 were not reported. In 2021 only 7 indicators had data for some months, and in 2022 only 3 indicators continued to be reported. Regarding the analysis of the Dataset COVID-19 database, most data were captured. In comparing the values of deaths recorded by the epidemiological surveillance system and by the DEIS for the years 2020 and 2021, the deaths recorded were higher in the DEIS registry (9.6% and 14.2%). Conclusions : The Argentine state largely complied with the recommendations established by the WHO for the reporting of COVID-19 cases. Subsequent studies should analyze other components of data quality, as well as the timeliness of death records, a necessary characteristic for public health decision-making.
RESUMO
OBJECTIVES: To determine the inflammatory profile of CRSwNP in Brazil and characterize the subgroups of CRSwNP patients in this population through cluster analysis. STUDY DESIGN: Multicenter cross-sectional study involving 15 centers representing different regions of Brazil. SUBJECTS AND METHODS: Clinical data of 166 patients and 80 controls, aged 18 to 70 years old, number of surgeries for CRS, history of asthma and aspirin sensitivity, and Lund-Mackay scores on CT scans. During nasal endoscopy, we obtained the Lund-Kennedy scores and collected 2 samples of nasal polyps: one for eosinophil and neutrophil tissue counts and one to quantify different cytokines. RESULTS: 79.6% of our patients had 10 or more eosinophils/HPF. CRSwNP groups exhibited significantly lower concentrations of TNF-alpha and significantly higher concentrations of IFN-gamma, CCL11/Eotaxin, CCL24/Eotaxin-2/MPIF-2, and CCL26/Eotaxin-3 versus the control group (Kruskal-Wallis test). Comparison between CRSwNP groups (≥10 vs <10 eosinophils/HPF) showed no difference in cytokine concentration (Mann-Whitney test). Hierarchical clustering and PCA according to cytokine concentrations revealed 2 main Clusters, with a significantly higher concentration of all cytokines in Cluster 1 (n = 35) than in Cluster 2 (n = 121), except IL-6 and IL-33 (Mann-Whitney test). According to ROC curve analysis the best cut-off to differentiate the 2 clusters was 43 eosinophils/HPF. The group with ≥43 presented a higher prevalence of men and a higher Lund-Mackay score (Mann-Whitney test). CONCLUSIONS: CRSwNP patients in Brazil present mixed inflammation, with 2 distinct groups (high and low inflammatory pattern) that can be distinguished by tissue eosinophilia of ≥43 eosinophils/HPF cut-off in nasal polyps.
RESUMO
OBJECTIVE: There is limited information regarding the incidence of treatment-related adverse events (AE) following antiretroviral therapy (ART) in women. So, this review aimed to describe the incidence of AE of ART in women living with HIV/AIDS. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, Cochrane Library, Epistemonikos, Lilacs and Who Index, from inception to 9 April 2023. ELIGIBILITY CRITERIA: We included randomised controlled trials with at least 12 weeks of follow-up and evaluated AE of ART in women at any age living with HIV/AIDS, without restrictions on status, year or language of publication. We excluded post hoc or secondary analyses and open-label extensions without comparator, and trials involving pregnant or breastfeeding women or with a focus on coinfection with tuberculosis, hepatitis B or C. The primary outcomes were the incidence rate of participants with any clinical and/or laboratory AE related or not to ART and treatment discontinuation. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed the risk of bias using Cochrane's risk of bias tool 2. We used Bayesian random-effects meta-analysis to summarise event rates. Results were presented as event rates per 1000 person-years (95% credibility intervals, 95% CrI). The pooled incidence rate per 1000 person-years adjusted for duration and loss to follow-up was estimated. We assessed the certainty of the evidence using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: A total of 24 339 studies were identified for screening, of which 10 studies (2871 women) met the eligibility criteria, with 11 different antiretrovirals (ARVs) regimens. Seven studies included exclusively women, while in the remaining three, the proportion of women ranged from 11% to 46%. Nine studies received industry funding. The pooled analysis showed a mean incidence rate of ART-related clinical and laboratory AE of 341.60 events per 1000 person-years (95% CrI 133.60-862.70), treatment discontinuation of 20.78 events per 1000 person-years (95% CrI 5.58-57.31) and ART-related discontinuation of 4.31 per 1000 person-years (95% CrI 0.13-54.72). Summary estimates were subject to significant uncertainty due to the limited number of studies and sparse data. The certainty of the evidence was graded as very low for all outcomes assessed. CONCLUSION: Existing randomised trials do not provide sufficient evidence on the incidence rates of safety outcomes from antiretroviral treatment in women living with HIV/AIDS. Large comparative studies in well-characterised populations are needed to provide a more comprehensive landscape of the safety profile of these ARV therapies in women with HIV/AIDS. PROSPERO REGISTRATION NUMBER: CRD42021251051.
Assuntos
Infecções por HIV , Humanos , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Incidência , Antirretrovirais/efeitos adversos , Antirretrovirais/uso terapêutico , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/epidemiologiaRESUMO
Objective: After deep brain stimulation (DBS), patients with Parkinson's disease (PD) typically still present significant gait and postural stability problems, and thus additional interventions are needed. In this way, our purpose was evaluate the comparative effectiveness of treadmill training, with and without body weight support, on balance outcomes among patients with PD after DBS. Methods: Eleven patients with PD that were using bilateral subthalamic nucleus DBS were evaluated using Time Up and Go test (TUG); Berg Balance Scale (BBS) and Static Posturography. In phase 1, all subjects participated in 8-weeks of treadmill training in conjunction with conventional physiotherapy. After six weeks (wash-out), each patient then participated in a subsequent 8-weeks of treadmill training with partial body weight support. Results: After the phase 1, there were improvements on the cognitive TUG performance (Before: 15.7 ± 1,8 sec; After: 13.7 ± 3.1 sec; p < 0.01) and an increase of anteroposterior and medio-lateral body oscillation with eyes closed. After the phase 2, there were improvements in conventional (Before: 12.3 ± 2.0 sec; After: 10.7 ± 1.7 sec; p < 0.01) and cognitive (Before: 14.6 ± 3.5 sec; After: 12.5 ± 1.6 sec; p < 0.05) TUG performances. There were no significant changes in the Berg Balance Scale following either training protocol. Conclusion: Both trainings improved static and dynamic balance and had similar results; however, supported treadmill training seemed to be a potentially superior option, as patients tended to feel safer. Level of Evidence II, therapeutic studies - investigation of treatment outcomes.
Objetivo: Mesmo após a estimulação cerebral profunda (ECP), os pacientes com doença de Parkinson (DP) muitas vezes ainda apresentam problemas significativos de marcha e estabilidade postural, e, portanto, intervenções adicionais são necessárias. Avaliar a eficácia comparativa do treinamento em esteira, com e sem suporte de peso corporal, nos resultados de equilíbrio de pacientes com DP após ECP. Métodos: Onze pacientes com DP em uso de ECP bilateral do núcleo subtalâmico foram avaliados pelos testes Time Up and Go (TUG), escala de equilíbrio de Berg (EEB) e posturografia estática. Na fase 1, todos participaram de oito semanas de treinamento em esteira em conjunto com fisioterapia convencional. Após seis semanas (wash-out), cada paciente participou de oito semanas subsequentes de treinamento em esteira com suporte parcial de peso corporal. Resultados: Depois da fase 1, houve melhora no desempenho cognitivo do TUG (antes: 15,7 ± 1,8 s; depois: 13,7 ± 3,1 s; p < 0,01) e aumento da oscilação anteroposterior e médio-lateral do corpo com os olhos fechados. Após a fase 2, os resultados do TUG convencional (antes: 12,3 ± 2,0 seg; depois: 10,7 ± 1,7 seg; p < 0,01) e cognitivo (antes: 14,6 ± 3,5 s; depois: 12,5 ± 1,6 s; p < 0,05) demonstraram melhora. Os protocolos de treinamento não causaram mudanças significativas na EEB.. Conclusão: Ambos os treinos melhoraram o equilíbrio estático e dinâmico e tiveram resultados semelhantes; no entanto, o treinamento em esteira com suporte é uma opção potencialmente superior, uma vez que os pacientes tendiam a se sentir mais seguros. Nível de Evidência II, estudos terapêuticos - investigação de resultados de tratamento.
RESUMO
In the wake of the COVID-19 pandemic, millions worldwide are still struggling with persistent or recurring symptoms known as long COVID. Fatigue is one of the most prevalent symptoms associated with long COVID, and for many it can be debilitating. Understanding the potential pathological processes that link fatigue to long COVID is critical to better guide treatment. Challenges with diagnosis and treatment are reviewed, recognizing that post-COVID fatigue does not always present with corroborating clinical evidence, a situation that is frustrating for both patients and healthcare providers. Firefighters are a group of public safety workers who are particularly impacted by long COVID-related fatigue. Firefighters must be able to engage in strenuous physical activity and deal with demanding psychological situations, both of which may be difficult for those suffering from fatigue. Disruption in public safety worker health can potentially impact community welfare. This review creates a framework to explain the clinical-pathological features of fatigue resulting from long COVID, addresses diagnosis and treatment challenges, and explores the unique impact fatigue may pose for public safety workers and their organizations.
RESUMO
Acute abdominal pathologies can cause electrocardiogram (ECG) changes mimicking an acute coronary syndrome (ACS), resulting in diagnostic uncertainty and delay. We report a 65-year-old male with multiple risk factors for ACS who presented with four hours of progressive epigastric and chest pain that resolved in the emergency department. ECG findings were concerning for new deeply inverted T-waves with normal troponins, raising concerns for Wellens Syndrome. Emergent heart catheterization was negative but abdominal computed tomography angiography showed occlusion of the superior mesenteric vessels. Subsequent exploratory laparotomy revealed a small bowel volvulus with extensive necrosis, resulting in a 430 cm resection.
RESUMO
INTRODUCTION: Incarcerated individuals exhibit higher suicide rates compared to the general population. Investigating risk factors aids in developing effective public policies and interventions. The goal of this study was to assess and analyze factors predicting both suicidal thoughts and suicide attempts in a population of male incarcerated individuals who engage in the use of multiple psychoactive substances. METHODS: A cross-sectional observational study was conducted. A total of 174 male individuals deprived of liberty participated in the study, all of whom were serving a closed regime sentence during the data collection steps. Participants were assessed with the following instruments: the "Addiction Severity Index" (ASI-6) and the "Barratt Impulsiveness Scale" (BIS-11). RESULTS: Amongst our sample, prevalences of 36.7% in suicidal ideation and of 16.0% in suicide attempts were found. Impulsivity (OR = 1.098, 95% CI: 1.008 - 1.197), social support (OR = 0.281, 95% CI: 0.085 - 0.925), witnessing someone being killed or beaten (OR = 5.173, 95% CI: 2.143 - 12.486), cigarette use (OR = 3.309, 95% CI: 1.063 - 10.293), and cocaine use (OR = 2.678, 95% CI: 1.040 - 6.897) were also found to be associated with suicidal ideation. No significant associations were found between drug use and suicide attempts. CONCLUSION: A high prevalence of suicidal behaviors was observed in the study's sample, with findings demonstrating that impulsivity moderately differentiates the groups 'with' and 'without' suicidal ideation. Traumatic life events and substance use were also associated with suicide ideation, while social support was established as a protective factor for it.
RESUMO
New parameterizations for the Lennard-Jones 12/6 potential capable of reproducing the vapor pressure and surface tension with sufficient precision, but not the liquid-vapor equilibrium densities for the case of simple fluids that include Ar, Kr, Xe, Ne, and CH4 are presented in this work. These results are compared with those derived from the family of Mie(n, 6) potentials, which adequately reproduce the coexistence curve and the vapor pressure, leaving aside the surface tension. In addition, a detailed analysis is presented on different parameterizations and methodologies, which have been developed in recent decades to estimate the interfacial properties of interest here for simple fluids, such as argon, which is a molecule that is, in principle, "simple" to study but that clearly reveals the enormous discrepancy between the results reported in the literature throughout these years. These facts undoubtedly reveal one of the fundamental problems in the context of molecular thermodynamics of fluids: reproducing different thermodynamic properties with sufficient precision from a single set of free parameters for some interaction potential. In order to show the scope of the parameterizations presented for the Lennard-Jones model, they were successfully applied to the case of binary mixtures, which included Ar-Kr, Ar-CH4, and Xe-Kr. Finally, and with the aim of showing a possible solution to the problem posed in this research, results of the same interfacial properties above mentioned for argon and methane were presented in this work by using a set of molecular interactions, called ANC2s, whose flexibility allowed to reproduce the experimental evidence with just one parameterization. The results reported in this work were generated using molecular dynamics simulations.
RESUMO
Congenital Central Hypoventilation Syndrome (CCHS) is a rare genetic condition affecting the autonomic nervous system and respiratory center due to mutations in the PHOX2B gene, and it is associated with alveolar hypoventilation during sleep and sudden death. It requires early invasive mechanical ventilation (IMV). OBJECTIVE: To report a neonatal case successfully treated with non-invasive ventilatory support (NVS), avoiding tracheostomy. CLINICAL CASE: Full-term newborn, whose mother uses nocturnal NVS due to CCHS. During the transition period, she presented desaturations associated with hypercapnia and respiratory acidosis, without pulmonary involvement. She developed severe hypoventilation during sleep, with no respiratory effort, peripheral oxygen saturation (SpO2) < 80%, plus respiratory acidosis. While awake, she had good respiratory effort and normal SpO2 without assistance. Noninvasive continuous positive airway pressure and oxygen therapy worsened her condition while sleeping. Complete NVS with nasal interface and bi-level airway positive pressure, inspiratory/expiratory pressure 14-16/4 cm H2O, normalized SpO2 during sleep, and arterial blood gases while awake. Sequencing of the PHOX2B gene confirmed the presence of a heterozygous pathogenic variant with the 20/26 genotype. At 2 months of age, she was discharged maintaining NVS with nasal interface and 0 PEEP, achieving adequate neurodevelopment. CONCLUSION: We highlight the importance of genetic diagnosis of CCHS in neonates with clinical presentation of early alveolar hypoventilation, especially if there is a family history. We are not aware of other reports of neonatal onset in which NVS prevents IMV, in this potentially lethal pathology.
Assuntos
Proteínas de Homeodomínio , Hipoventilação , Apneia do Sono Tipo Central , Fatores de Transcrição , Humanos , Apneia do Sono Tipo Central/diagnóstico , Apneia do Sono Tipo Central/terapia , Apneia do Sono Tipo Central/genética , Recém-Nascido , Hipoventilação/congênito , Hipoventilação/terapia , Hipoventilação/diagnóstico , Hipoventilação/genética , Feminino , Proteínas de Homeodomínio/genética , Fatores de Transcrição/genética , Ventilação não Invasiva , Pressão Positiva Contínua nas Vias Aéreas , Acidose Respiratória/diagnóstico , Acidose Respiratória/terapia , Acidose Respiratória/etiologia , Mutação , OxigenoterapiaRESUMO
Preterm infants, especially those of lower gestational age (GA), are at high risk of hospital readmission in the early years. OBJECTIVE: To describe the frequency and characteristics of readmissions in preterm infants younger than 32 weeks of GA or weighing less than 1500 g (< 32w/< 1500 g) at 2 years post-discharge from neonatology. PATIENTS AND METHOD: Retrospective observational study of a cohort of newborns < 32w/< 1500 g discharged from a public health care center (2009-2017). The frequency, time of occurrence, risk factors, causes, and severity of hospital readmissions were analyzed. The respective perinatal characteristics and subsequent readmissions were described. The Ethics Committee approved the data collection protocol. RESULTS: 989 newborns < 32w/< 1500 g were included; 410 (41.5%) were readmitted at least once before the age of 2 years, equivalent to 686 episodes (1.7/child); 129 children (31.4%) were admitted to the Pediatric Intensive Care Unit (PICU), with a mean length of stay of 7.7 days. The greatest risk for hospital readmission was during the first 6 months post-discharge. The main cause was respiratory (70%) and respiratory syncytial virus was the most frequent germ. The risk factors associated with readmission due to respiratory causes were bronchopulmonary dysplasia (BPD) (OR: 1.73; 95%CI: 1.26-2.37) and number of siblings (OR: 1.18; 95%CI: 1.04-1.33). CONCLUSIONS: Newborns < 32s/< 1500 g are at high risk of hospital readmission due to respiratory causes and PICU admission in the first months post-discharge; BPD and number of siblings were the main risk factors.
Assuntos
Idade Gestacional , Recém-Nascido Prematuro , Readmissão do Paciente , Humanos , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Recém-Nascido , Feminino , Masculino , Fatores de Risco , Lactente , Tempo de Internação/estatística & dados numéricos , Alta do Paciente , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/terapia , Pré-EscolarRESUMO
INTRODUCTION: Postoperative fracture site infection can lead to notable patient morbidity, increase cost of care, and further contribute to healthcare disparities globally. Dogma suggests surgical blades as a vehicle for introducing bacteria into the surgical site; however, there is a paucity of literature to support this claim. This study uses advanced DNA sequencing to detect bacterial DNA on surgical blades used in upper extremity fracture surgeries. METHODS: This was a prospective study, conducted at a high-volume level 1 trauma center. All acute, closed upper extremity fractures requiring surgical stabilization were consecutively enrolled in a prospective fashion. The primary end point was the presence of bacterial DNA on the surgical blade using next-generation sequencing (NGS). At the time of surgery, two blades were sterilely opened. One blade served as the control while the other was used for the initial skin incision. Two negative control blades were opened directly into a sterile container. Two positive control blades were used for skin incision through known infections. All samples were sent for NGS analysis. RESULTS: Forty patients were enrolled in this study. The median age was 33.5 years, and 30% were female; the median body mass index was 26.52. Humerus fractures were the most common injury (N = 17, 42.5%), followed by clavicle fractures (13, 32.5%) and radius/ulna fractures (10, 25.0%). NGS analysis revealed no contamination of test blades used for skin incision. Three control blades tested positive for bacterial DNA. Negative control blades tested negative for bacterial DNA (0/2); the positive control blades resulted positive for bacterial DNA contamination (2/2). CONCLUSION: Surgical blades used for skin incision in the upper extremity are not contaminated with bacterial DNA as analyzed by NGS. This finding challenges previous surgical dogma regarding surgical blade contamination and supports that the same surgical blade can safely be used for deeper dissection. LEVEL OF EVIDENCE: Level II study: IRB approval-IRB#848938.
Assuntos
Sequenciamento de Nucleotídeos em Larga Escala , Infecção da Ferida Cirúrgica , Humanos , Estudos Prospectivos , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/microbiologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Fraturas Ósseas/cirurgia , DNA Bacteriano/análise , Adulto Jovem , Extremidade Superior/cirurgia , Extremidade Superior/lesões , Contaminação de Equipamentos , Estudos de Coortes , Fraturas do Úmero/cirurgiaRESUMO
Monoxenous trypanosomatid Strigomonas culicis harbors an endosymbiotic bacterium, which enables the protozoa to survive without heme supplementation. The impact of H2O2 resistance and symbiont elimination on intracellular heme and Fe2+ availability was analyzed through a comparison of WT strain with both WT H2O2-resistant (WTR) and aposymbiotic (Apo) protozoa. The relative quantification of the heme biosynthetic pathway through label-free parallel reaction monitoring targeted mass spectrometry revealed that H2O2 resistance does not influence the abundance of tryptic peptides. However, the Apo strain showed increased coproporphyrinogen III oxidase and ferrochelatase levels. A putative ferrous iron transporter, homologous to LIT1 and TcIT from Leishmania major and Trypanosoma cruzi, was identified for the first time. Label-free parallel reaction monitoring targeted mass spectrometry also showed that S. culicis Iron Transporter (ScIT) increased 1.6- and 16.4-fold in WTR and Apo strains compared to WT. Accordingly, antibody-mediated blockage of ScIT decreased by 28.0% and 40.0% intracellular Fe2+concentration in both WTR and Apo strains, whereas no effect was detected in WT. In a heme-depleted medium, adding 10 µM hemin decreased ScIT transcript levels in Apo, whereas 10 µM PPIX, the substrate of ferrochelatase, increased intracellular Fe2+ concentration and ferric iron reduction. Overall, the data suggest mechanisms dependent on de novo heme synthesis (and its substrates) in the Apo strain to overcome reduced heme availability. Given the importance of heme and Fe2+ as cofactors in metabolic pathways, including oxidative phosphorylation and antioxidant systems, this study provides novel mechanistic insights associated with H2O2 resistance in S. culicis.
Assuntos
Heme , Peróxido de Hidrogênio , Simbiose , Heme/metabolismo , Peróxido de Hidrogênio/metabolismo , Trypanosomatina/metabolismo , Trypanosomatina/genética , Ferro/metabolismo , Resistência a Medicamentos , Proteínas de Protozoários/metabolismo , Proteínas de Protozoários/genéticaRESUMO
Pregnancy Hypertensive Disorders (PHD), particularly Preeclampsia (PE), are significant contributors to maternal-fetal morbidity and mortality, with chronic arterial hypertension (CH) being a major risk factor. The prevalence of CH has risen alongside obesity and advanced maternal age. While antihypertensive treatment mitigates adverse pregnancy outcomes, the duration of effective blood pressure (BP) control, termed Time in Therapeutic Range (TTR), has not been extensively studied in pregnant women. TTR, reflecting the proportion of time BP remains within target ranges, predicts long-term cardiovascular and renal events in the general population but remains unexplored in pregnancy. This study investigates the association between TTR, assessed through office BP (OBP) and ambulatory BP monitoring (ABPM), and PE development in pregnant women with CH. In a retrospective longitudinal study, data from 166 pregnant women with HA referred to our hospital analyzed. BP was measured using OBP and ABPM from 10 weeks of gestation, with TTR calculated as the percentage of visits where BP remained within target ranges. The study defined four TTR control groups: 0%, 33%, 50-66%, and 100%. Results showed that 28% of the participants developed PE, with a higher incidence correlating with lower TTR in ABPM. TTR in ABPM was a significant predictor of PE risk, with the best-controlled group (100% TTR) demonstrating a 92% reduced risk compared to those with 0% TTR. The agreement between OBP and ABPM TTR was low, emphasizing the importance of ABPM for accurate BP monitoring in pregnancy. This study indicates that integrating ABPM for TTR assessment in high-risk pregnancies has the potential to reduce maternal and fetal complications.
Assuntos
Pré-Eclâmpsia , Humanos , Gravidez , Feminino , Pré-Eclâmpsia/epidemiologia , Adulto , Estudos Retrospectivos , Estudos Longitudinais , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Fatores de Risco , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Adulto Jovem , Determinação da Pressão ArterialRESUMO
OBJECTIVE: Tumor hypoxia is associated with a poorer prognosis in cancer patients and can diminish the efficacy of radiation therapy (RT). This study investigates the potential of metformin to enhance radiosensitivity in hypoxic cancer cells. METHODS: Preliminary experiments were conducted to validate the impact of hypoxia on radiation response. Reactive oxygen species (ROS) levels, cell migration, and cell death were assessed in hypoxic, radiated cells treated with metformin. Proteomic and ontological analyses were employed to identify molecular targets associated with the radiosensitizing effect of metformin. Proteomic and ontological findings were validated through patient samples and in vitro studies. RESULTS: Metformin amplified cell death, induced DNA fragmentation, decreased cell migration, and elevated ROS levels in hypoxic, radiated cells. Proteomic analyses revealed that GAPDH and TAGLN2 were identified as pivotal targets linked to the radiosensitizing effect of metformin. Oral cancer patients exhibited elevated levels of TAGLN2 and reduced levels of GAPDH. Metformin downregulated TAGLN2 and upregulated GAPDH in hypoxic, radiated cells. Additionally, metformin reduced levels of mutated p53. CONCLUSIONS: This study suggests that metformin can enhance radiosensitivity in hypoxic cells, operating through modulation of GAPDH and TAGLN2. Furthermore, metformin effectively reduces mutated p53 levels in radiated cells under hypoxic conditions.
Assuntos
Carcinoma de Células Escamosas , Metformina , Neoplasias Bucais , Radiossensibilizantes , Humanos , Metformina/farmacologia , Metformina/uso terapêutico , Neoplasias Bucais/radioterapia , Radiossensibilizantes/farmacologia , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Tolerância a Radiação/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Proteômica , Gliceraldeído-3-Fosfato Desidrogenases , Gliceraldeído-3-Fosfato Desidrogenase (Fosforiladora) , Hipóxia Celular/efeitos dos fármacos , Hipóxia Tumoral/efeitos dos fármacosRESUMO
To evaluate the polymerization shrinkage stress and cuspal strain (CS) generated in an artificial (typodont) and in a natural tooth using different resin composites. Twenty artificial and 20 extracted natural molars were selected. Each tooth was prepared with a 4x4 mm MOD cavity. The natural and typodont teeth were divided into four experimental groups (n=10), according to the resin composite used: Filtek Z100 (3M Oral Care) and Beautifil II LS (Shofu Dental). The cavities were filled using two horizontal increments and the CS (µS) was measured by the strain gauge method. Samples were sectioned into stick-shaped specimens and the bond strength (BS) (MPa) was evaluated using a microtensile BS test. Shrinkage stress and CS were analyzed using 3D finite element analysis. No difference was found between the type of teeth for the CS as shown by the pooled averages: Natural tooth: 541.2 A; Typodont model: 591.4 A. Filtek Z100 CS values were higher than those obtained for Beautifil II LS, regardless of the type of teeth. No statistical difference was found for the BS data. Adhesive failures were more prevalent (79.9%). High shrinkage stress values were observed for Filtek Z100 resin, regardless of tooth type. The CS of typodont teeth showed a shrinkage stress effect, generated during restoration, equivalent to that of natural teeth.
Assuntos
Resinas Compostas , Análise do Estresse Dentário , Análise de Elementos Finitos , Teste de Materiais , Polimerização , Estresse Mecânico , Resistência à Tração , Resinas Compostas/química , Humanos , Valores de Referência , Propriedades de Superfície , Reprodutibilidade dos Testes , Colagem Dentária/métodos , Coroa do DenteRESUMO
Cildáñez stream (in Matanza-Riachuelo basin, Buenos Aires) is one of the most polluted watercourses of Argentina, containing a mixed contamination from agricultural and industrial wastes. The application of water bioremediation processes for this kind of effluent will require microorganisms with a high tolerance to contamination. In this sense, obtaining higher contaminant-resistant microalgae lines is widely desired. In this study, adaptive laboratory evolution (ALE) and random mutagenesis were used to obtain Chlorella vulgaris LMPA-40 strains adapted to grow in polluted water from the Cildáñez stream. The ALE process was performed by 22 successive subcultures under selective pressure (Cildáñez wastewater alone or with the addition of phenol or H2O2) while random mutagenesis was performed with UV-C radiation at 275nm. Not all the cell lines obtained after ALE could adapt enough to overcome the stress caused by the Cildáñez wastewater, indicating that the process is quite random and depends on the stressor used. The best results were obtained for the Cildáñez wastewater adapted cells (Cild 3 strain) that were more resistant than the original strain. The concentration of protein, Chlorophyll A, Chlorophyll B, and carotenoids in the Cild 3 ALE evolved strain was higher than that of the control strain. However, this strain exhibited half of the lipid content compared to the same control strain. Interestingly, these alterations and the acquired tolerance may be reversed over time during storage. These findings suggest that the acquisition of novel cell lines could not be permanent, a fact that must be considered for future trials.