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INTRODUÇÃO: Na cardiomiopatia hipertrófica (CMH) o achado mais típico na ressonância magnética é o realce tardio do mesocárdico, localizado principalmente na parede inferosseptal. Este realce não está presente em todos os casos e ocorre preferencialmente em paredes onde há maior hipertrofia. Apresentamos dois casos com fenótipo típico de CMH e padrão atípico de realce tardio. RELATO DE CASO: CASO 1-Assintomático, confirmou o diagnóstico de CMH durante a investigação de quadro recorrente de acidente vascular encefálico isquêmico. CASO 2- Histórico familiar de morte súbita, assintomático, feito diagnóstico de CMH por cascata familiar. Demais detalhes das características e achados podem ser avaliados na tabela 1. Na ressonância cardíaca: 1: hipertrofia ventricular esquerda com predomínio septal, com espessura máxima de 20 mm em septo ínfero-medial associado a presença de realce tardio miocárdico com predomínio subendocárdico difuso nos segmentos apicais. (Figura A/B). 2- aumento significativo da espessura do ápice do ventrículo direito causando redução da sua cavidade efetiva e dilatação do átrio direito. Função sistólica do ventrículo direito preservadas com presença de realce tardio subendocárdico no ápice. Espessura normal das paredes do ventrículo esquerdo com a presença de áreas de realce tardio subendocárdico circunferencial envolvendo as porções basal, médio e apical com pontos de infiltração gordurosa esparsos predominantemente na porção apical e média (Figura C/D). DISCUSSÃO E CONCLUSÃO: Na CMH, o padrão de realce tardio mais prevalente é o mesocárdico, geralmente nas paredes ventriculares onde há maior hipertrofia, e é puntiforme. Na presença de aneurisma apical na CMH, tem sido descrito o padrão transmural de realce. O realce subendocárdico circunferencial evidenciado no presente estudo, representa um achado radiológico atípico e infrequente da CMH. Suscitando amplo debate quanto a sua fisiopatologia. Após discussão, sua ocorrência foi atribuída a um possível infarto tipo 2, relacionado à isquemia na CMH por desproporção entre oferta e demanda. Assim sendo, propomos a consideração do realce tardio subendocárdico circunferencial como uma potencial apresentação da CMH e concluímos ser de suma importância clínica o reconhecimento dos diversos padrões de realce tardio, ainda que atípicos, para uma abordagem propedêutica mais precisa e eficaz.
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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.
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OBJECTIVE: To evaluate the prevalence and characteristics of concurrent bacterial sexually transmitted infections (bSTIs) among individuals with mpox. DESIGN: Prospective cohort study of participants aged 18âyears or older with confirmed mpox conducted in Rio de Janeiro, Brazil. This cross-sectional analysis includes only participants who underwent bSTI testing at baseline between June 2022 and January 2024. METHODS: Participants were offered testing for chlamydia/gonorrhea (NAAT, anorectal swabs) and syphilis (active diagnosis if VDRL ≥ 1/8). Baseline prevalence of bSTIs was calculated, and participant characteristics were described based on concomitant bSTI diagnosis (yes/no). Chi-squared/Fisher's tests were used for qualitative variables, and the Wilcoxon rank-sum test for quantitative variables. RESULTS: Out of 634 enrolled participants, 538 (84.9%) were tested for STIs and included in this analysis, mostly cisgender men, aged 30-39âyears with postsecondary education. Overall prevalence of concomitant bSTI was 37.3%, mainly syphilis, followed by chlamydia and gonorrhea. Half of the participants were living with HIV, and one third was on HIV pre-exposure prophylaxis. Concomitant bSTI diagnosis at the time of mpox assessment was associated with being aged 30-39âyears, self-identifying as cisgender men, having HIV-positive status, reporting proctitis symptoms and reporting any STI in the past 12âmonths. CONCLUSIONS: Our data reveals a notable prevalence of concomitant bSTIs among participants with confirmed mpox at a prominent infectious diseases' referral center in Rio de Janeiro, Brazil. These findings underscore the importance of integrating mpox into the differential diagnosis of anogenital manifestations and the promotion of combination prevention strategies within sexual healthcare services.
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Sífilis , Humanos , Brasil/epidemiologia , Masculino , Adulto , Feminino , Estudos Prospectivos , Estudos Transversais , Prevalência , Adulto Jovem , Sífilis/epidemiologia , Sífilis/diagnóstico , Pessoa de Meia-Idade , Adolescente , Gonorreia/epidemiologia , Gonorreia/diagnóstico , Gonorreia/prevenção & controle , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/prevenção & controle , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/prevenção & controle , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Doenças Bacterianas Sexualmente Transmissíveis/diagnóstico , Doenças Bacterianas Sexualmente Transmissíveis/prevenção & controleRESUMO
Two new heptapeptides, [1-7-NαC]-crocaorbs A1 (1) and A2 (2), were isolated from the latex of Croton campanulatus. Their structures were determined using NMR spectroscopic techniques, ESI-HRMS data, Marfey's method, and further refined using molecular dynamics with simulated annealing (MD/SA). Molecular dynamics calculations of peptides 1 and 2 demonstrated greater stability in simulations using a biological solvent compared to those using DMSO. Compound 1, the most abundant peptide in latex, was assessed for NO production, antiplasmodial and cytotoxicity activities. The peptide significantly increased nitric oxide (NO) production at concentrations of 40, 20 or 10 µM (17.932 ± 1.1, 18.270 ± 0.9, 18.499 ± 0.7, respectively). Its antiplasmodial activity exhibited limited efficacy, with only 5% inhibition of Plasmodium falciparum 3D7 growth at a concentration of 50 µM. Also, it exhibited no cytotoxic effects in the J774A.1 murine macrophages cell line. This study represents the first report of a phytochemical investigation of the species C. campanulatus, which showed orbitides with distinctive sequences in contrast to other peptides described for the genus Croton and contributes to the study of structural diversity within this particular class of compounds.
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Antimaláricos , Croton , Látex , Óxido Nítrico , Plasmodium falciparum , Croton/química , Animais , Camundongos , Látex/química , Plasmodium falciparum/efeitos dos fármacos , Estrutura Molecular , Antimaláricos/farmacologia , Antimaláricos/isolamento & purificação , Antimaláricos/química , Óxido Nítrico/metabolismo , Linhagem Celular , Compostos Fitoquímicos/farmacologia , Compostos Fitoquímicos/isolamento & purificação , Macrófagos/efeitos dos fármacosRESUMO
In this paper, the development of a 3D adaptive probabilistic explicit cracking model for concrete is reported. The contribution offered herein consists in a new adaptive mesh strategy designed to optimize the use of interface elements in probabilistic explicit cracking models. The proposed adaptive mesh procedure is markedly different from other strategies found in the literature, since it takes into account possible influences on the redistribution of stresses after cracking and can also be applied to purely deterministic cracking models. The process of obtaining the most appropriate adaptive mesh procedure involved the development and evaluation of three different adaptivity strategies. Two of these adaptivity strategies were shown to be inappropriate due to issues related to stress redistribution after cracking. The validation results demonstrate that the developed adaptive probabilistic model is capable of predicting the scale effect at a level similar to that experimentally observed, considering the tensile failure of plain concrete specimens. The results also show that different softening levels can be obtained. The proposed adaptive mesh strategy proved to be advantageous, being able to promote significant reductions in the simulation time in comparison with the classical strategy commonly used in probabilistic explicit cracking models.
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The study evaluated the regenerative responses of the lacrimal functional unit (LFU) after lacrimal gland (LG) ablation. The LG of Wistar rats was submitted to G1) partial LG ablation, G2) partial ablation and transplantation of an allogeneic LG, or G3) total LG ablation, (n = 7-10/group). The eye wipe test, slit lamp image, tear flow, and histology were evaluated. RT-PCR analyzed inflammatory and proliferation mediators. The findings were compared to naïve controls after 1 and 2 months (M1 and M2). G3 presented increased corneal sensitivity, and the 3 groups showed corneal neovascularization. Histology revealed changes in the LG and corneal inflammation. In the LG, there was an increase in MMP-9 mRNA of G1 and G2 at M1 and M2, in RUNX-1 at M1 and M2 in G1, in RUNX-3 mRNA at M1 in G1, and at M2 in G2. TNF-α mRNA rose in the corneas of G1 and G2 at M2. There was an increase in the IL-1ß mRNA in the trigeminal ganglion of G1 at M1. Without changes in tear flow or evidence of LG regeneration, LG ablation and grafting are unreliable models for dry eye or LG repair in rats. The surgical manipulation extended inflammation to the LFU.
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Síndromes do Olho Seco , Inflamação , Aparelho Lacrimal , Ratos Wistar , Regeneração , Animais , Aparelho Lacrimal/metabolismo , Aparelho Lacrimal/patologia , Aparelho Lacrimal/cirurgia , Síndromes do Olho Seco/metabolismo , Síndromes do Olho Seco/etiologia , Síndromes do Olho Seco/patologia , Ratos , Inflamação/patologia , Inflamação/metabolismo , Masculino , Córnea/metabolismo , Córnea/patologia , Lágrimas/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/genética , Fator de Necrose Tumoral alfa/metabolismo , Fator de Necrose Tumoral alfa/genética , Interleucina-1beta/metabolismo , Interleucina-1beta/genética , Modelos Animais de DoençasRESUMO
Currently, the search for new alternatives to conventional antibiotics to combat bacterial resistance is an urgent task, as many microorganisms threaten human health due to increasing bacterial resistance to traditional medicines. Thus, new molecules such as antimicrobial peptides have emerged as promising alternatives because of their low induction of resistance and broad spectrum of action. In this context, in the past few years, our research group has synthesized and characterized a peptide derived from the C-terminal region of the Lys49 PLA2-like BthTX-I, named p-BthTX-I. After several studies, the peptide (p-BthTX-I)2K was proposed as the molecule with the most considerable biotechnological potential. As such, the present work aimed to evaluate whether the modifications made on the peptide (p-BthTX-I)2K can be applied to other molecules originating from the C-terminal region of PLA2-like Lys49 from snake venoms. The peptides were obtained through the solid-phase peptide synthesis technique, and biochemical and functional characterization was carried out using dichroism techniques, mass spectrometry, antimicrobial activity against ESKAPE strains, hemolytic activity, and permeabilization of lipid vesicles. The antimicrobial activity of the peptides was promising, especially for the peptides (p-AppK)2K and (p-ACL)2K, which demonstrated activity against all strains that were tested, surpassing the model molecule (p-BthTX-I)2K in most cases and maintaining low hemolytic activity. The modifications initially proposed for the (p-BthTX-I)2K peptide were shown to apply to other peptides derived from Lys49 PLA2-like from snake venoms, showing promising results for antimicrobial activity. Future assays comparing the activity of the dimers obtained through this strategy with the monomers of these peptides should be carried out.
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Fosfolipases A2 , Fosfolipases A2/farmacologia , Fosfolipases A2/química , Hemólise/efeitos dos fármacos , Peptídeos Antimicrobianos/farmacologia , Peptídeos Antimicrobianos/química , Peptídeos Antimicrobianos/síntese química , Animais , Testes de Sensibilidade Microbiana , Antibacterianos/farmacologia , Antibacterianos/síntese química , Antibacterianos/química , Humanos , Anti-Infecciosos/farmacologia , Anti-Infecciosos/química , Anti-Infecciosos/síntese química , Bactérias/efeitos dos fármacosRESUMO
Robotic milking systems are successful innovations in the development of dairy cattle. The objective of this study was to analyse the milking characteristics and behavior of dairy cows of different calving orders in "milk first" robotic milking systems. The data were collected from a commercial herd located in the Midwest region of Minas Gerais (Brazil), which uses an automatic milking system (AMS TM, DeLaval). Were analysed 26,574 observations of 235 Holstein cows were available. Data were evaluated by multivariate analysis of variance and the Tukey test. - Tthe characteristics milk flow and milking efficiency were more favourable for multiparous cows (p <0.01), while the time in the stall was more favourable for primiparous females (p <0.01). The values of handling time were better in the primiparous cows (p <0.01). Primiparous cows had higher amounts of kick-off (p <0.001), and multiparous cows had higher incomplete milkings (p <0.001). The number of incomplete milkings showed a higher ratio in terms of reduction in milk production in 26.6% in primiparous cows and 26.7% in multiparous cows (p <0.01). Regarding the behavioral characteristics, primiparous cows had higher amounts of kickbacks, while multiparous cows had greater quantities of incomplete milkings.
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Comportamento Animal , Indústria de Laticínios , Lactação , Paridade , Robótica , Animais , Bovinos/fisiologia , Feminino , Paridade/fisiologia , Lactação/fisiologia , Indústria de Laticínios/métodos , Comportamento Animal/fisiologia , Gravidez , Leite/química , BrasilRESUMO
Background: Household transmission studies seek to understand the transmission dynamics of a pathogen by estimating the risk of infection from household contacts and community exposures. We estimated within/extra-household SARS-CoV-2 infection risk and associated factors in a household cohort study in one of the most vulnerable neighbourhoods in Rio de Janeiro city. Methods: Individuals ≥1 years-old with suspected or confirmed COVID-19 in the past 30 days (index cases) and household members aged ≥1 year were enrolled and followed at 14 and 28 days (study period November/2020-December/2021). RT-PCR testing, COVID-19 symptoms, and SARS-CoV-2 serologies were ascertained in all visits. Chain binomial household transmission models were fitted using data from 2024 individuals (593 households). Findings: Extra-household infection risk was 74.2% (95% credible interval [CrI] 70.3-77.8), while within-household infection risk was 11.4% (95% CrI 5.7-17.2). Participants reporting having received two doses of a COVID-19 vaccine had lower extra-household (68.9%, 95% CrI 57.3-77.6) and within-household (4.1%, 95% CrI 0.4-16.6) infection risk. Within-household infection risk was higher among participants aged 10-19 years, from overcrowded households, and with low family income. Contrastingly, extra-household infection risk was higher among participants aged 20-29 years, unemployed, and public transportation users. Interpretation: Our study provides important insights into COVID-19 household/community transmission in a vulnerable population that resided in overcrowded households and who struggled to adhere to lockdown policies and social distancing measures. The high extra-household infection risk highlights the extreme social vulnerability of this population. Prioritising vaccination of the most socially vulnerable could protect these individuals and reduce widespread community transmission. Funding: Fundação Oswaldo Cruz, CNPq, FAPERJ, Royal Society, Instituto Serrapilheira, FAPESP.
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Resumen Introducción : La prevención combinada (PC) se con sidera la estrategia clave frente a la epidemia de HIV. El objetivo del estudio fue evaluar la percepción de riesgo de infección por HIV y el conocimiento sobre uso de antirretrovirales (ARV) para prevención, entre pacien tes que concurren a un consultorio de Infecciones de Transmisión Sexual (ITS). Métodos : Una encuesta sobre datos personales y percepción de riesgo de infección por HIV, conocimiento sobre profilaxis posterior a la exposición (PEP) y previa a la exposición (PrEP), fue administrada a pacientes al momento de aplicar dosis de penicilina para tratamiento de sífilis, o de extraer muestra de sangre para diagnós tico de ITS, entre mayo y diciembre, 2022. Resultados : De 100 personas encuestadas, 43 eran menores de 25 años, 67 reportaron sexo-género mascu lino y 33 femenino. Treinta de 91, (33%), percibían haber tenido en su vida algún riesgo de infección, 19 de ellas en el último año; 77/96 (80%) manifestaron no tener conocimiento sobre PEP, y 82/100, sobre PrEP. Solo 22% respondió que los antirretrovirales podrían brindar be neficio para prevenir el HIV; 26 (60%) de los 43 menores de 25 años, y 18 de los 57 ≥ 25 años (31.6%) respondieron haber tenido dos o más parejas sexuales el último año. No se observaron diferencias estadísticamente signifi cativas, relacionadas con género y grupo etario. Discusión : La baja percepción de riesgo de infección y del conocimiento sobre uso de antirretrovirales para prevención de HIV, evidencian las dificultades existentes en la implementación de prevención combinada (PEP-PrEP) en esta población.
Abstract Introduction : Combined prevention (CP) is considered the key strategy against the HIV epidemic. The objective of the study was to evaluate the perception of risk of HIV infection and the knowledge about the use of antiretro virals (ARV) for prevention, among patients who attend a Sexually Transmitted Infections (STI) clinic. Methods : A survey on personal data and perception of risk of HIV infection, knowledge about post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), was administered to patients at the time of applying doses of penicillin for the treatment of syphilis, or when taking a blood sample for STI diagnosis, between May and December, 2022. Results : 100 persons were surveyed: 43 were under 25 years of age, 67 reported male sex-gender and 33 fe males. Thirty of 91 (33%) perceived they had had some risk of infection in their lives, 19 of them in the last year; 77/96 (80%) stated that they had no knowledge about PEP, and 82/100, about PrEP. Only 22 out of 100 responded that antiretrovirals could provide benefit in preventing HIV; 26 (60%) of the 43 patients <25 years of age, and 18 of the 57 ≥ 25 years (31.6%) responded they have had two or more sexual partners in the last year. No statistically significant differences were observed related to gender and age group. Discussion : The low perception of infection risk and knowledge about the use of antiretrovirals in HIV pre vention, show the existing difficulties for the imple mentation of combined prevention (PEP-PrEP) in this population.
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The development of a portable analytical procedure is described for rapid sequential detection and quantification of the explosives 2,4,6-trinitrotoluene (TNT) and cyclotrimethylenetrinitramine (RDX) in forensic samples using a graphite sheet (GS). A single GS platform works as a collector of explosive residues and detector after its assembly into a 3D-printed cell. The detection strategy is based on cyclic square-wave stripping voltammetry. The cathodic scan from + 0.1 to -1.0 V with accumulation at 0.0 V enables the TNT detection (three reduction peaks), and the anodic scan from + 0.2 to + 1.55 V with accumulation at -0.9 V provides the RDX detection (two oxidation processes). Low detection limit values (0.1 µmol L-1 for TNT and 2.4 µmol L-1 for RDX) and wide linear ranges (from 1 to 150 µmol L-1 for TNT and from 20 to 300 µmol L-1 for RDX) were obtained. The sensor did not respond to pentaerythritol tetranitrate (PETN), which was evaluated as a potential interferent, because plastic explosives contain mixtures of TNT, RDX, and PETN. The GS electrode was also evaluated as a collector of TNT and RDX residues spread on different surfaces to simulate forensic scenarios. After swiping over different surfaces (metal, granite, wood, cloths, hands, money bills, and cellphone), the GS electrode was assembled in the 3D-printed cell ready to measure both explosives by the proposed method. In all cases, the presence of TNT and RDX was confirmed, attesting the reliability of the proposed device to act as collector and sensor.
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Leucemia Mieloide Aguda , Proteína Tumoral p73 , Humanos , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/genética , Prognóstico , Proteína Tumoral p73/genética , Proteína Tumoral p73/metabolismo , Feminino , Masculino , Pessoa de Meia-Idade , Proteínas Nucleares/genética , Proteínas Nucleares/metabolismo , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo , Proteínas Supressoras de Tumor/genética , Proteínas Supressoras de Tumor/metabolismo , Idoso , Regulação Leucêmica da Expressão Gênica , AdultoRESUMO
We introduce a family of complex networks that interpolates between the Apollonian network and its binary version, recently introduced in E. M. K. Souza et al. [Phys. Rev. E 107, 024305 (2023)2470-004510.1103/PhysRevE.107.024305], via random removal of nodes. The dilution process allows the clustering coefficient to vary from C=0.828 to C=0 while maintaining the behavior of average path length and other relevant quantities as in the deterministic Apollonian network. Robustness against the random deletion of nodes is also reported on spectral quantities such as the ground-state localization degree and its energy gap to the first excited state. The loss of the 2π/3 rotation symmetry as a treelike network emerges is investigated in the light of the hub wavefunction amplitude. Our findings expose the interplay between the small-world property and other distinctive traits exhibited by Apollonian networks, as well as their resilience against random attacks.
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INTRODUCTION: A reduction in platelet count in critically ill patients is a marker of severity of the clinical condition. However, whether this association holds true in acute kidney injury (AKI) is unknown. We analyzed the association between platelet reduction in patients with AKI and major adverse kidney events (MAKE). METHODS: In this retrospective cohort, we included AKI patients at the Hospital Civil of Guadalajara, in Jalisco, Mexico. Patients were divided according to whether their platelet count fell >21% during the first 10 days. Our objectives were to analyze the associations between a platelet reduction >21% and MAKE at 10 days (MAKE10) or at 30-90 days (MAKE30-90) and death. RESULTS: From 2017 to 2023, 400 AKI patients were included, 134 of whom had a > 21% reduction in platelet count. The mean age was 54 years, 60% were male, and 44% had sepsis. The mean baseline platelet count was 194 x 103 cells/µL, and 65% of the KDIGO3 patients met these criteria. Those who underwent hemodialysis (HD) had lower platelet counts. After multiple adjustments, a platelet reduction >21% was associated with MAKE10 (OR 4.2, CI 2.1-8.5) but not with MAKE30-90. The mortality risk increased 3-fold (OR 2.9, CI 1.1-7.7, p = 0.02) with a greater decrease in the platelets (<90 x 103 cells/µL). As the platelets decreased, the incidence of MAKE was more likely to increase. These associations lost significance when accounting for starting HD. CONCLUSION: In our retrospective cohort of patients with AKI, a > 21% reduction in platelet count was associated with MAKE. Our results are useful for generating hypotheses and motivating us to continue studying this association with a more robust design.
A reduction in platelet count in critically ill patients has been associated with a worse prognosis, but it is not yet known whether this relationship also exists in patients with acute kidney injury, who are more susceptible to platelet decrease due to the syndrome or due to the onset of hemodialysis. In our study of acute kidney injury patients, we found that those whose platelet count decreased >21% during the first days were more likely to experience a major kidney event. In addition, the greater the decrease in platelet count was, the more likely these events were to occur. The significance of this association was lost in patients who start hemodialysis. Our conclusions could serve to generate hypotheses about this interesting relationship.
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Injúria Renal Aguda , Humanos , Masculino , Estudos Retrospectivos , Feminino , Injúria Renal Aguda/sangue , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/etiologia , Pessoa de Meia-Idade , Contagem de Plaquetas , México/epidemiologia , Idoso , Adulto , Diálise Renal , Estado Terminal , Trombocitopenia/sangue , Fatores de RiscoRESUMO
PURPOSE: This review emphasizes the effect of light on visual efficiency, the impact of different lighting focuses, types of lighting, and their influence on vision and productivity. Light sources and standards are intriguing subjects for ophthalmologists. Guidelines regarding the level of lighting influence on visual activities can enhance visual performance.Methods: This article was developed based on literature reviews, with a bibliographic survey conducted in databases such as PubMed, MEDLINE, Web of Science, Embase, LILACS, and SciELO. RESULTS: Provides recommendations for understanding information regarding the influence of lighting on visual performance. CONCLUSION: Proper workplace lighting is crucial for improving visual efficiency, safety, productivity, and worker health. Efficient workplace lighting should avoid light sources directed towards the worker's face, prevent harmful glare, be more intense in the work area, and uniform in the rest of the room. Ophthalmologists should be knowledgeable about and provide guidance on correct lighting to ensure patient comfort and satisfaction with visual correction.
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Iluminação , Humanos , Visão Ocular/fisiologia , Acuidade Visual/fisiologia , Local de Trabalho , Saúde Ocupacional , Ofuscação , LuzRESUMO
ABSTRACT: The introduction of all-trans retinoic acid combined with anthracyclines has significantly improved the outcomes for patients diagnosed with acute promyelocytic leukemia (APL), and this strategy remains the standard of care in countries in which arsenic trioxide is not affordable. However, data from national registries and real-world databases indicate that low- and middle-income countries (LMIC) still face disappointing results, mainly because of high induction mortality and suboptimal management of complications. The American Society of Hematology established the International Consortium on Acute Leukemias (ICAL) to address this challenge through international clinical networking. Here, we present the findings from the International Consortium on Acute Promyelocytic Leukemia study involving 806 patients with APL recruited from 2005 to 2020 in Brazil, Chile, Paraguay, Peru, and Uruguay. The induction mortality rate has notably decreased to 14.6% compared with the pre-ICAL rate of 32%. Multivariable logistic regression analysis revealed as factors associated with induction death: age of ≥40 years, Eastern Cooperative Oncology Group performance status score of 3, high-risk status based on the Programa Español de Tratamiento en Hematologia/Gruppo Italiano Malattie EMatologiche dell'Adulto classification, albumin level of ≤3.5 g/dL, bcr3 PML/RARA isoform, the interval between presenting symptoms to diagnosis exceeding 48 hours, and the occurrence of central nervous system and pulmonary bleeding. With a median follow-up of 53 months, the estimated 4-year overall survival rate is 81%, the 4-year disease-free survival rate is 80%, and the 4-year cumulative incidence of relapse rate is 15%. These results parallel those observed in studies conducted in high-income countries, highlighting the long-term effectiveness of developing clinical networks to improve clinical care and infrastructure in LMIC.
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Leucemia Promielocítica Aguda , Leucemia Promielocítica Aguda/tratamento farmacológico , Leucemia Promielocítica Aguda/mortalidade , Leucemia Promielocítica Aguda/epidemiologia , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adolescente , Adulto Jovem , Resultado do Tratamento , Taxa de Sobrevida , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
The disease coronavirus COVID-19 has been the cause of millions of deaths worldwide. Among the proteins of SARS-CoV-2, non-structural protein 12 (NSP12) plays a key role during COVID infection and is part of the RNA-dependent RNA polymerase complex. The monitoring of NSP12 polymorphisms is extremely important for the design of new antiviral drugs and monitoring of viral evolution. This study analyzed the NSP12 mutations detected in circulating SARS-CoV-2 during the years 2020 to 2022 in the population of the city of Manaus, Amazonas, Brazil. The most frequent mutations found were P323L and G671S. Reports in the literature indicate that these mutations are related to transmissibility efficiency, which may have contributed to the extremely high numbers of cases in this location. In addition, two mutations described here (E796D and R914K) are close and have RMSD that is similar to the mutations M794V and N911K, which have been described in the literature as influential on the performance of the NSP12 enzyme. These data demonstrate the need to monitor the emergence of new mutations in NSP12 in order to better understand their consequences for the treatments currently used and in the design of new drugs.
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COVID-19 , RNA-Polimerase RNA-Dependente de Coronavírus , SARS-CoV-2 , Humanos , Brasil , Simulação por Computador , COVID-19/virologia , COVID-19/transmissão , Mutação/genética , SARS-CoV-2/genética , Proteínas não Estruturais Virais/genética , RNA-Polimerase RNA-Dependente de Coronavírus/genética , RNA-Polimerase RNA-Dependente de Coronavírus/metabolismoRESUMO
Lysergic acid diethylamide (LSD) and two phenethylamine classes (NBOHs and NBOMes) are the main illicit drugs found in seized blotter papers. The preliminary identification of these substances is of great interest for forensic analysis. In this context, this work constitutes the inaugural demonstration of an efficient methodology for the selective detection of LSD, NBOHs, and NBOMes, utilizing a fully 3D-printed electrochemical double cell (3D-EDC). This novel 3D-EDC enables the use of two working electrodes and/or two supporting electrolytes (at different pHs) in the same detection system, with the possibility of shared or individual auxiliary and pseudo-reference electrodes. Thus, the selective voltammetric detection of these substances is proposed using two elegant strategies: (i) utilizing the same 3D-EDC platform with two working electrodes (boron-doped diamond (BDD) and 3D-printed graphite), and (ii) employing two pH levels (4.0 and 12.0) with 3D-printed graphite electrode. This comprehensive framework facilitates a fast, robust, and uncomplicated electrochemical analysis. Moreover, this configuration enables a rapid and sensitive detection of LSD, NBOHs, and NBOMes in seized samples, and can also provide quantitative analysis. The proposed method showed good stability of the electrochemical response with RSD <9 % for Ip and <5 % for Ep, evaluating all oxidation processes observed for studied analytes (n = 7) at two pH levels, using the same and different (n = 3) working electrodes. It demonstrates a broad linear range (20-100 and 20-70 µmol L-1) and a low LOD (1.0 µmol L-1) for quantification of a model molecule (LSD) at the two pHs studied. Hence, the 3D-EDC combined with voltammetric techniques using BDD and 3D-printed graphite electrodes on the same platform, or only with this last sensor at two pH values, provide a practical and robust avenue for preliminary identification of NBOHs, NBOMes, and LSD. This method embodies ease, swiftness, cost-efficiency, robustness, and selectivity as an on-site screening tool for forensic analysis.
Assuntos
Técnicas Eletroquímicas , Eletrodos , Dietilamida do Ácido Lisérgico , Impressão Tridimensional , Dietilamida do Ácido Lisérgico/análogos & derivados , Dietilamida do Ácido Lisérgico/química , Dietilamida do Ácido Lisérgico/análise , Técnicas Eletroquímicas/métodos , Fenetilaminas/análise , Drogas Ilícitas/análise , Humanos , Limite de Detecção , Grafite/químicaRESUMO
TÍTULO: Impacto do estudo genético negativo na cardiomiopatia hipertrófica: relato de caso. INTRODUÇÃO: A realização do painel genético na cardiomiopatia hipertrófica (CMH) tem importância tanto para confirmação diagnóstica, investigação de familiares e também para afastar fenocópias, algumas delas com tratamento específico e outras que requerem tratamento individualizado. Na CMH, em cerca de 60% dos casos, não se consegue isolar uma mutação responsável. Pretendemos ressaltar, neste relato de caso, um resultado negativo de painel molecular com implicações diagnósticas e prognósticas. RELATO DE CASO: masculino, 35 anos, portador de transtorno cognitivo importante, iniciou investigação cardiológica devido histórico familiar - irmão, com diagnóstico de CMH e também portador de transtorno cognitivo, falecido aos 21 anos em decorrência de complicações de CMH. Realizou eletrocardiograma sendo evidenciado intervalo PR curto e onda delta, padrão de Wolff-Parkinson-White (WPW); ecocardiograma transtorácico (ECOTT) demonstrou hipocontratilidade difusa de ventrículo esquerdo (VE), fração de ejeção de 45%, septo interventricular e parede posterior medindo 30mm/18mm; exames laboratoriais normais. A ressonância magnética além dos achados já flagrados pelo ECOTT, demonstrou extensa fibrose miocárdica de padrão não-coronariano em VE e porção apical de ventrículo direito. Pela evolução para disfunção ventricular, grande magnitude de hipertrofia do ventrículo esquerdo, WPW, sexo masculino, transtorno cognitivo e história familiar, foi aventada a hipótese de doença de Danon, uma lisossomopatia de herança ligada ao cromossomo X. O painel genético com pesquisa dos principais genes implicados em CMH, incluindo o gene LAMP2, foi negativo para todos os genes testados, inclusive sem evidência de variantes de significado indeterminado. COMENTÁRIOS E CONCLUSÃO: o painel genético negativo neste caso teve importância crucial para afastar a doença de Danon, já que vários aspectos clínicos apontavam para este diagnóstico. Se o painel genético fosse positivo, haveria uma implicação terapêutica e quanto à orientação genética no que diz respeito à questão reprodutiva. Vale a pena ressaltar também a importância dos exames laboratoriais de enzimas hepáticas e creatinofosfoquinase que costumam estar alterados na doença de Danon e estavam normais no presente caso. Além de afastar fenocópias, o painel molecular pode ajudar a delimitar novos espectros de CMH com seus respectivos prognósticos e propiciar aconselhamento genético preciso, além de, no futuro, auxiliar nas terapias de edição gênica.
RESUMO
Na prática clínica, o cardiologista se depara com pacientes que convivem com o vírus da imunodeficiência humana (HIV). Pesquisas indicam um aumento de doenças cardiovasculares (CV), que são as principais causas de morte nesse grupo. A terapia antirretroviral (TARV) contribuiu para a diminuição da morbimortalidade associada ao HIV/AIDS, porém observado um aumento na incidência de fatores de risco CV, tanto entre os em uso da TARV quanto nos sem. Os estudos Start e Smart possuem importância na avaliação do risco CV em indivíduos com HIV, pois proporcionaram uma compreensão mais clara da relação entre a presença do vírus e o uso da TARV. Por outro lado, o estudo Reprieve demonstrou benefícios surpreendentes em pacientes que recebiam estatina, com redução de 35% nos eventos CV adversos graves, gerando o término prematuro do grupo placebo. MÉTODOS: Realizou-se uma pesquisa retrospectiva e observacional com uma amostra de 148 pacientes vivendo com HIV em um Centro de Referência de IST/AIDS (CR) em São Paulo, Brasil, no período de 01 de janeiro de 2011 a fevereiro de 2023. Incluídos pacientes maiores de 18 anos, selecionados por sorteio através do número de matrícula. DISCUSSÃO: Comparado os dados do CR com os de Start e Smart na tabela 1, sendo detalhadas as características da amostras, enquanto na tabela 2 apresentados os fatores de risco CV. A carga viral apresentou variação entre os estudos, sendo a média no CR de 500.000 cópias/ml, 12.759 cópias/ml no Start e inferior a 400 cópias/ml no Smart. A dislipidemia e o dano endotelial estão associados ao HIV, sendo propostos como causas do aumento do risco de eventos cardiovasculares, e a replicação do HIV é determinante na disfunção endotelial. Diferentemente das informações da literatura, todos os pacientes do CR com cardiopatia mantinham carga viral indetectável e contagem de células CD4+ acima de 500 células/mm³. CONCLUSÃO: no CR a taxa de eventos CV foi de 1,3%, no entanto este índice baixo deva-se à abordagem multidisciplinar aplicada ao paciente, com foco na prevenção primária e secundária por meio de orientações e acompanhamento intensivos. Além disso, o usuário tem fácil acesso aos medicamentos, sendo disponibilizados pelo CR. A utilização de biomarcadores poderia contribuir para entender melhor os efeitos da presença do vírus e do tratamento antirretroviral na doença CV. Por se tratar de uma população de maior vulnerabilidade, sugere-se um controle mais eficaz.