Neurotuberculose em paciente imunocompetente: desafio diagnóstico e tratamento

Neurotuberculosis is a serious disease, occurring in about 5 to 10% of cases of extrapulmonary tuberculosis. The clinical spectrum varies according to the affected site (meningeal, cerebral parenchyma or spinal cord). Herein we present the case of a 32-year-old male patient with cough and weight loss who presented with hemiparesis and disorientation, receiving a diagnosis of neurotuberculosis using the Xpert MTB / RIF® test. The present case aims to report the clinical and neuroimaging data of an immunocompetent patient with neurotuberculosis.The definitive diagnosis is made by the detection of tuberculosis bacilli in cerebrospinal fluid. The RIF® Xpert MTB test has similar sensitivity and specificity to other diagnostic methods for tuberculosis and the advantage of providing information on resistance to rifampicin. The prognosis depends on the stage and onset of treatment.5 a 10% dos casos de tuberculose extrapulmonar. O espectro clínico varia de acordo com o local afetado (meninge, parênquima cerebral ou medula espinhal). Aqui, apresentamos o caso de um paciente do sexo masculino de 32 anos com quadro de tosse e perda de peso que apresentou à admissão hemiparesia e desorientação, recebendo diagnóstico de neurotuberculose através do teste Xpert MTB/RIF®. O presente caso objetiva relatar os dados clínicos e de neuroimagem de um paciente imunocompetente com neurotuberculose. O diagnóstico definitivo é feito pela detecção de bacilos da tuberculose no líquido cefalorraquidiano. O teste RIF® Xpert MTB apresenta sensibilidade e especificidade semelhantes a outros métodos de diagnóstico da tuberculose e a vantagem de fornecer informações sobre a resistência à rifampicina. O prognóstico depende do estágio e do início do tratamento

Bridging the Gap between Brazilian Startups and Business Processes – Process Thinking’s Initial Exploratory Case Study

Startup is a new business segment that has been growing up in the last years. These companies have an innovative spirit and are usually searching for new solutions to real problems that can be transformed into scalable businesses. The majority of these companies are not aware of their processes and how the company need to be organized. For this kind of companies, we propose Process Thinking, an innovative approach that makes the business process management viable in the daily lives of startups. This paper presents the Process Thinking framework, which prescribes 10 main processes that a startup needs and a utility belt to help the startup to organize their processes. We illustrate this proposal through an exploratory case study with a real IT startup company that used a 5-step methodology in an immediate implementation of proposed processes and artifacts. The results indicate a positive impact in the short and medium term strategies and management of the startup. However, these results cannot be generalized to other startups and should be received with caution, since this is an initial exploratory study limited to a single company

Estudo das implicações ambientais no município de João Pessoa-PB devido ao crescimento urbano.

Com o processo de migração da população para os centros urbanos, as cidades foram crescendo e se desenvolvendosem nenhum planejamento prévio. Dessa forma, surgiram diversos problemas impactantes que afetaram o ambiente  e consequentemente a qualidade de vida de seus moradores. Por outro lado, a urbanização planejada pode trazer significativos benefícios para sociedade. Nesse sentido, as técnicas de Geoprocessamento são ferramentas importantes que permitem a confecção de mapas para o acompanhamento da expansão urbana dos municípios. No presente trabalho é apresentado um estudo de caso cujo objetivo principal foi estimar a evolução espacial da área urbana do município de João Pessoa, Paraíba, ocorrida entre os anos de 1990 e 2006. Para tanto, foram usadas imagens orbitais para definição das classes: urbano, solo exposto, vegetaçãoe água; tendo em vista, a quantificação dessas áreas, através da classificação digital supervisionada utilizando o método da Máxima Verossimilhança (MaxVer). Como resultados identificou-se que a classe do tipo urbano foi a que obteve a maior estimativa de crescimento no período estudado, apresentando no ano de 1990 a porcentagem de 17,98%, que passou a totalizar no ano de 200638,26% da área total do município.

Early detection of weed in sugarcane using convolutional neural network

Weed infestation is an essential factor in sugarcane productivity loss. The use of remote sensing data in conjunction with Artificial Intelligence (AI) techniques, can lead the cultivation of sugarcane to a new level in terms of weed control. For this purpose, an algorithm based on Convolutional Neural Networks (CNN) was developed to detect, quantify, and map weeds in sugarcane areas located in the state of Alagoas, Brazil. Images of the PlanetScope satellite were subdivided, separated, trained in different scenarios, classified and georeferenced, producing a map with weed information included. Scenario one of the CNN training and test presented overall accuracy (0,983), and it was used to produce the final mapping of forest areas, sugarcane, and weed infestation. The quantitative analysis of the area (ha) infested by weed indicated a high probability of a negative impact on sugarcane productivity. It is recommended that the adequacy of CNN’s algorithm for Remotely Piloted Aircraft (RPA) images be carried out, aiming at the differentiation between weed species, as well as its application in the detection in areas with different culture crop

Hepatites virais no contexto Amazônico: análise dos casos confirmados na região do baixo amazonas no ano de 2018 / Viral hepatitis in the Amazon context: analysis of confirmed cases in the low amazon region in the year 2018

Introdução: As hepatites virais são importante problema de saúde pública no Brasil. Elas possuem diferentes agentes etiológicos, mas com propensão de infectar o tecido hepático (BRASIL, 2008, p.07). Elas têm grande importância clínica e epidemiológica, tanto pelas complicações das formas agudas e crônicas, quanto pelo número expressivo de indivíduos atingidos. Sua transmissão ocorre por meio da ingestão de água e alimentos contaminados, mas principalmente através de sangue e secreções contaminados (BRASIL, 2005). Objetivo: Analisar a frequência das infecções pelos vírus das hepatites A, B, C, D e E, nos 15 municípios pertencentes à Região do Baixo Amazonas, no Estado do Pará. Métodos: Estudo transversal, retrospectivo, quantitativo, referente ao ano de 2018, cuja base de dados é disponibilizada pelo Departamento de Informática do Sistema Único de Saúde (DATASUS), considerando sexo, faixa etária, classificação etiológica, fonte de infecção e município de notificação. Resultados: Santarém liderou no número de notificações desses casos (91,66%), seguida de Oriximiná (4,16%), Alenquer (1,66%), Mojuí dos Campos (0,84%), Óbidos (0,84%) e Prainha (0,84%). Os casos confirmados se distribuíram em: vírus B (66,6%), vírus C (17,8%), vírus B + C (10%) e vírus A (5,6%). Não foram registradas infecções por vírus D e E. Observou-se que a maioria, 42,5%, contraíram por via sexual. A faixa etária de maior risco foi entre os 40 e 59 anos de idade (45%). Conclusão: Os dados demonstrados evidenciaram a necessidade de aprimorar a vigilância de novos casos de hepatite viral na Região do Baixo Amazonas, bem como a de aperfeiçoar métodos diagnósticos e preventivos por meio de estratégias de captação das infecções, no intuito de promover o diagnóstico e tratamento precoces. 

Intoxicação por chá de Brugmansia suaveolens (trombeta de anjo) em paciente jovem previamente hígido: relato de caso

 Introdução: A Brugmansia suaveolens, conhecida como “trombeta de anjo,” é uma planta com alcaloides anticolinérgicos que provocam inibição da atividade de receptores muscarínicos no sistema nervoso central e periférico. Sua toxicidade resulta em agitação, alucinações, hipertermia, taquicardia, rabdomiolise, insuficiência renal e morte. Objetivo: Descrever um caso de intoxicação aguda por chá de trombeta, cursando com hepatite fulminante. Materiais e Métodos: Trata-se de um relato de caso, com dados clínicos e laboratoriais coletados a partir dos registros em prontuário. Termo de Consentimento Livre e Esclarecido foi obtido com familiar e o projeto foi aprovado pelo Comitê de Ética em Pesquisa. Relato de Caso: Masculino de 19 anos, saudável, internado por quadro de febre de 41°C e crises convulsivas tônico-clônicas generalizadas, evoluindo para intubação orotraqueal. Apresentava midríase fixa e rigidez de nuca. Família relata que o paciente tinha feito uso de chá de “trombeta de anjo”. À admissão, realizou tomografia computadorizada de crânio, que não evidenciou desvio de linha média, líquor sem alterações, gasometria arterial com acidose metabólica grave, insuficiência renal aguda com necessidade dialítica e insuficiência hepática aguda fulminante. Conclusões: A intoxicação pelo “chá de trombeta” é uma emergência neurológica que deve ser rapidamente reconhecida por ser potencialmente fatal. Tendo meningite como diagnóstico diferencial, é importante obter história clínica completa para investigar possível contato prévio com a planta. Para nosso conhecimento, esse é o primeiro caso a relatar quadro de hepatite fulminante pela “trombeta de anjo,” além dos sintomas neurológicos já descritos em literatura, o que corrobora ainda mais para a importância do tema em questão.INTRODUCTION: Brugmansia suaveolens, popularly known as “angel’s trumpet,” is a plant with anticholinergic alkaloids that inhibit the activity of muscarinic receptors in the central and peripheral nervous system. Its toxicity results in agitation, hallucinations, hyperthermia, tachycardia, rhabdomyolysis, renal failure, and death. OBJECTIVE: Report a case of acute intoxication due to ingestion of “angel’s trumpet” tea, with associated fulminant hepatitis. METHODS: We present a case report with clinical and laboratory data collected from medical records. The study was approved by the Research Ethics Committee, and Written Informed Consent was obtained from a legally responsive relative. CASE REPORT: A healthy 19-year-old male was hospitalized with a fever of 41°C and generalized tonic-clonic seizures, progressing to orotracheal intubation. He exhibited fixed mydriasis and neck stiffness. We were informed by the family that the patient had made use of the tea from the “angel’s trumpet” plant. At admission, he performed a computerized cranial tomography, which showed no midline shift, cerebrospinal fluid without alterations, arterial blood gas analysis with severe metabolic acidosis, acute renal failure requiring dialysis, and fulminant acute liver failure. CONCLUSIONS: “Trumpet tea” intoxication is a neurological emergency that must be quickly recognized for its potential fatal effects. With meningitis as a differential diagnosis, it is important to collect a complete history taking to investigate possible previous contact with the plant. To our knowledge, this is the first case report of fulminant hepatitis caused by “angel’s trumpet,” in addition to the neurological symptoms already described in the literature, which further corroborates the importance of the topic in question

Convalescent plasma for COVID-19 in hospitalised patients : an open-label, randomised clinical trial

Background: The effects of convalescent plasma (CP) therapy in hospitalised patients with coronavirus disease 2019 (COVID-19) remain uncertain. This study investigates the effect of CP on clinical improvement in these patients. Methods: This is an investigator-initiated, randomised, parallel arm, open-label, superiority clinical trial. Patients were randomly (1:1) assigned to two infusions of CP plus standard of care (SOC) or SOC alone. The primary outcome was the proportion of patients with clinical improvement 28 days after enrolment. Results: A total of 160 (80 in each arm) patients (66.3% critically ill, 33.7% severely ill) completed the trial. The median (interquartile range (IQR)) age was 60.5 (48–68) years; 58.1% were male and the median (IQR) time from symptom onset to randomisation was 10 (8–12) days. Neutralising antibody titres >1:80 were present in 133 (83.1%) patients at baseline. The proportion of patients with clinical improvement on day 28 was 61.3% in the CP+SOC group and 65.0% in the SOC group (difference −3.7%, 95% CI −18.8–11.3%). The results were similar in the severe and critically ill subgroups. There was no significant difference between CP+SOC and SOC groups in pre-specified secondary outcomes, including 28-day mortality, days alive and free of respiratory support and duration of invasive ventilatory support. Inflammatory and other laboratory marker values on days 3, 7 and 14 were similar between groups. Conclusions: CP+SOC did not result in a higher proportion of clinical improvement on day 28 in hospitalised patients with COVID-19 compared to SOC alone

Basin-wide variation in tree hydraulic safety margins predicts the carbon balance of Amazon forests

Funding: Data collection was largely funded by the UK Natural Environment Research Council (NERC) project TREMOR (NE/N004655/1) to D.G., E.G. and O.P., with further funds from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES, finance code 001) to J.V.T. and a University of Leeds Climate Research Bursary Fund to J.V.T. D.G., E.G. and O.P. acknowledge further support from a NERC-funded consortium award (ARBOLES, NE/S011811/1). This paper is an outcome of J.V.T.’s doctoral thesis, which was sponsored by CAPES (GDE 99999.001293/2015-00). J.V.T. was previously supported by the NERC-funded ARBOLES project (NE/S011811/1) and is supported at present by the Swedish Research Council Vetenskapsrådet (grant no. 2019-03758 to R.M.). E.G., O.P. and D.G. acknowledge support from NERC-funded BIORED grant (NE/N012542/1). O.P. acknowledges support from an ERC Advanced Grant and a Royal Society Wolfson Research Merit Award. R.S.O. was supported by a CNPq productivity scholarship, the São Paulo Research Foundation (FAPESP-Microsoft 11/52072-0) and the US Department of Energy, project GoAmazon (FAPESP 2013/50531-2). M.M. acknowledges support from MINECO FUN2FUN (CGL2013-46808-R) and DRESS (CGL2017-89149-C2-1-R). C.S.-M., F.B.V. and P.R.L.B. were financed by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES, finance code 001). C.S.-M. received a scholarship from the Brazilian National Council for Scientific and Technological Development (CNPq 140353/2017-8) and CAPES (science without borders 88881.135316/2016-01). Y.M. acknowledges the Gordon and Betty Moore Foundation and ERC Advanced Investigator Grant (GEM-TRAITS, 321131) for supporting the Global Ecosystems Monitoring (GEM) network (gem.tropicalforests.ox.ac.uk), within which some of the field sites (KEN, TAM and ALP) are nested. The authors thank Brazil–USA Collaborative Research GoAmazon DOE-FAPESP-FAPEAM (FAPESP 2013/50533-5 to L.A.) and National Science Foundation (award DEB-1753973 to L. Alves). They thank Serrapilheira Serra-1709-18983 (to M.H.) and CNPq-PELD/POPA-441443/2016-8 (to L.G.) (P.I. Albertina Lima). They thank all the colleagues and grants mentioned elsewhere [8,36] that established, identified and measured the Amazon forest plots in the RAINFOR network analysed here. The authors particularly thank J. Lyod, S. Almeida, F. Brown, B. Vicenti, N. Silva and L. Alves. This work is an outcome approved Research Project no. 19 from ForestPlots.net, a collaborative initiative developed at the University of Leeds that unites researchers and the monitoring of their permanent plots from the world’s tropical forests [61]. The authros thank A. Levesley, K. Melgaço Ladvocat and G. Pickavance for ForestPlots.net management. They thank Y. Wang and J. Baker, respectively, for their help with the map and with the climatic data. The authors acknowledge the invaluable help of M. Brum for kindly providing the comparison of vulnerability curves based on PAD and on PLC shown in this manuscript. They thank J. Martinez-Vilalta for his comments on an early version of this manuscript. The authors also thank V. Hilares and the Asociación para la Investigación y Desarrollo Integral (AIDER, Puerto Maldonado, Peru); V. Saldaña and Instituto de Investigaciones de la Amazonía Peruana (IIAP) for local field campaign support in Peru; E. Chavez and Noel Kempff Natural History Museum for local field campaign support in Bolivia; ICMBio, INPA/NAPPA/LBA COOMFLONA (Cooperativa mista da Flona Tapajós) and T. I. Bragança-Marituba for the research support.Tropical forests face increasing climate risk1,2, yet our ability to predict their response to climate change is limited by poor understanding of their resistance to water stress. Although xylem embolism resistance thresholds (for example, Ψ50) and hydraulic safety margins (for example, HSM50) are important predictors of drought-induced mortality risk3-5, little is known about how these vary across Earth's largest tropical forest. Here, we present a pan-Amazon, fully standardized hydraulic traits dataset and use it to assess regional variation in drought sensitivity and hydraulic trait ability to predict species distributions and long-term forest biomass accumulation. Parameters Ψ50 and HSM50 vary markedly across the Amazon and are related to average long-term rainfall characteristics. Both Ψ50 and HSM50 influence the biogeographical distribution of Amazon tree species. However, HSM50 was the only significant predictor of observed decadal-scale changes in forest biomass. Old-growth forests with wide HSM50 are gaining more biomass than are low HSM50 forests. We propose that this may be associated with a growth-mortality trade-off whereby trees in forests consisting of fast-growing species take greater hydraulic risks and face greater mortality risk. Moreover, in regions of more pronounced climatic change, we find evidence that forests are losing biomass, suggesting that species in these regions may be operating beyond their hydraulic limits. Continued climate change is likely to further reduce HSM50 in the Amazon6,7, with strong implications for the Amazon carbon sink.Publisher PDFPeer reviewe

Longer-term effectiveness of a heterologous coronavirus disease 2019 (COVID-19) vaccine booster in healthcare workers in Brazil

Abstract Objective: To compare the long-term vaccine effectiveness between those receiving viral vector [Oxford-AstraZeneca (ChAdOx1)] or inactivated viral (CoronaVac) primary series (2 doses) and those who received an mRNA booster (Pfizer/BioNTech) (the third dose) among healthcare workers (HCWs). Methods: We conducted a retrospective cohort study among HCWs (aged ≥18 years) in Brazil from January 2021 to July 2022. To assess the variation in the effectiveness of booster dose over time, we estimated the effectiveness rate by taking the log risk ratio as a function of time. Results: Of 14,532 HCWs, coronavirus disease 2019 (COVID-19) was confirmed in 56.3% of HCWs receiving 2 doses of CoronaVac vaccine versus 23.2% of HCWs receiving 2 doses of CoronaVac vaccine with mRNA booster (P < .001), and 37.1% of HCWs receiving 2 doses of ChAdOx1 vaccine versus 22.7% among HCWs receiving 2 doses of ChAdOx1 vaccine with mRNA booster (P < .001). The highest vaccine effectiveness with mRNA booster was observed 30 days after vaccination: 91% for the CoronaVac vaccine group and 97% for the ChAdOx1 vaccine group. Vacine effectiveness declined to 55% and 67%, respectively, at 180 days. Of 430 samples screened for mutations, 49.5% were SARS-CoV-2 delta variants and 34.2% were SARS-CoV-2 omicron variants. Conclusions: Heterologous COVID-19 vaccines were effective for up to 180 days in preventing COVID-19 in the SARS-CoV-2 delta and omicron variant eras, which suggests the need for a second booster