Copepod Assemblages at the Base of Mangrove Food Webs during a Severe Drought

The effect of severe drought on the functional groups that sustain the base of the mangrove food webs in semi-arid areas is largely unknown. We therefore analyzed the intra-annual variation in the assemblages and functional groups of copepods in a shallow, low-inflow estuary of the Brazilian semi-arid coast when the most severe drought ever occurred. The lowest density was found in April (upstream region) and the highest in August (downstream region). Three main functional groups were identified, sorted by spawning strategy, and further subdivided according to feeding strategy, trophic regime, and diel vertical migration behavior. The community was significantly influenced by the extreme drought period, presenting a temporal homogenization in terms of composition, and an expressive and unexpected increase in density in the dry period, possibly due to phytoplankton blooms resistant to hypersalinity and the occurrence of copepod species adapted to stressful conditions. The few stress-tolerant species sustaining the food webs with seasonal variations were observed simplifying the trophic variability. The results indicate that hypersalinity can induce changes in the zooplankton community, increasing copepod mortality risk and, so, promoting alteration in the trophic estuarine dynami

Performance of a Brazilian sample on the computerized Wisconsin Card Sorting Test

The computerized version of the Wisconsin Card Sorting Test (WCST) is based on the same normative data developed previously for the manual version. However, equivalence of the measures of both versions is controversial. This study investigated the performance of a Brazilian student sample with subjects aged 6-15 years in the computerized version of the WCST. As a result of the analyses, the study pointed out that type of school (public or private) was significant in almost all measures and also that age and gender effects were similar to those previously described in the manual version. These results showed that the computerized WCST may not be free of cultural and socioeconomic influences and that the validation and standardization of this version is warranted.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Motor and sensory performance of infants with and without Down syndrome: a pilot study

The study aimed at assessing motor and sensory performance of infants with Down syndrome (DS) comparing them to typical infants at the age of six months. Eight infants - 4 with typical development, 4 with DS - were assessed as to motor performance by the Alberta infant motor scale (AIMS) at supine, prone, sitting, and standing positions. Sensory performance was assessed by using the Infant/toddler sensory profile (ITSP), which classifies sensorial behaviours as"low registration" (difficulty in detecting sensory stimuli), sensation seeking, excessive sensitivity to stimuli, and sensation avoiding behaviours. Results show that infants with DS had significantly lower scores in low registration when compared to typical infants, suggesting that their higher sensory threshold lead to longer reaction times. At the AIMS, infants with DS had lower performance when compared to typical infants at the prone subscale, which may be due to deficits in postural and antigravity control. No correlation was found between ITSP and AIMS scores. Results then suggest that infants with Down syndrome may less frequently engage in environmental interactions, probably due both to difficulty in perceiving day-to-day stimuli (like diverse sounds or people's) and difficulty to explore the environment by using their limited motor abilities.O estudo visou avaliar o desempenho motor e sensorial de lactentes com e sem síndrome de Down (SD) aos seis meses de vida. Foram avaliados oito lactentes, sendo quatro com SD e quatro típicos, com 24 semanas de vida. Para verificar o desempenho motor foi utilizada a escala motora infantil de Alberta (AIMS), nas posturas supina, prona, sentada e em pé. O desempenho sensorial foi avaliado por meio de entrevista com o cuidador da criança utilizando o perfil sensorial infantil ITSP (infant/toddler sensory profile), que classifica comportamentos sensoriais como de"baixo registro" (dificuldade em registrar estímulos sensoriais), busca de estímulos, excessiva sensibilidade a estímulos e comportamentos de evitar estímulos. Os resultados no ITSP mostram que os lactentes com SD obtiveram piores escores em baixo registro, possivelmente por apresentarem altos limiares neurológicos, demorando mais para responder aos estímulos. Na AIMS os lactentes com SD tiveram um desempenho inferior quando comparados aos típicos na subescala prono, o que pode advir de dificuldades no controle postural e antigravitacional. Não foi encontrada correlação entre os escores do ITSP e da AIMS. Os resultados sugerem que os lactentes com SD podem se engajar com menos freqüência em atividades de interação com o ambiente, tanto por dificuldade em registrar estímulos cotidianos (como diferentes sons e pessoas), quanto por dificuldade em explorar o meio utilizando habilidades motoras

ROTURA DE ANEURISMA DA AORTA ABDOMINAL NA ERA DO TRATAMENTO ENDOVASCULAR — VALIDAÇÃO UNICÊNTRICA DE 2 ALGORITMOS DE PREVISÃO DE RISCO

Introdução: Atualmente, o aneurisma da aorta abdominal em rotura (AAAr) continua a apresentar uma elevada taxa de mortalidade associada e consequentemente a decisão de prosseguir ou recusar tratamento cirúrgico é extremamente complexa. Os algoritmos de previsão de risco de mortalidade por AAAr desenvolvidos antes da globalização do tratamento endovascular de aneurisma da aorta abdominal (EVAR) em rotura tiveram a sua validade questionada numa era em que quer a cirurgia aberta (CA) quer o EVAR estão disponíveis. Em 2017, foram publicados dois novos algoritmos de previsão de risco, ambos baseados em variáveis clínicas facilmente obtidas e validados numa população submetida quer a CA quer a EVAR. O objetivo deste trabalho foi descrever a evolução da experiência no tratamento de AAAr na nossa instituição e validar a aplicabilidade dos algoritmos supracitados na nossa prática. Métodos: Os dados clínicos de todos os doentes admitidos entre 2010 a 2016 com o diagnóstico de AAAr foram avaliados retrospetivamente e foi realizada análise estatística usando SPSS V.22. Resultados: Foi incluído um total de 71 doentes, 19 dos quais submetidos a EVAR e 52 a CA. Houve um aumento significativo ao longo do tempo de procedimentos de EVAR, e em 2015 a taxa anual de EVAR excedeu a de CA. A população de pacientes submetidos a EVAR e CA é sobreponível em fatores como género, idade e co-morbilidades com exceção do tabagismo, mais comum no grupo EVAR (73,7% Vs 36,5%; p = 0,005). Não foram registrados casos de morte intraoperatória no grupo EVAR, por oposição a 17% no grupo CA (p = 0,049). A mortalidade aos 30 dias atingiu 49% no grupo CA e 31,6% no grupo EVAR (p> 0,05). Vários preditores de mortalidade pré-operatórios foram identificados: tabagismo (p = 0,005), instabilidade hemodinâmica pré-operatória (p = 0,003) e razão internacional normalizada (INR) à admissão (p <0,0001). Identificou-se como preditor de mortalidade pós-operatório a instabilidade hemodinâmica pós-operatória (p<0,0001) Realizou-se uma regressão logística binária e concluiu-se que o INR elevado e a instabilidade pós-operatória foram preditores de risco independentes de outcome (p <0,05). Os modelos de previsão de mortalidade supracitados foram aplicados à nossa população e a mortalidade estimada correlacionou- se significativamente com a mortalidade real (mortalidade estimada 41% e 45,3% Vs mortalidade real 45%, ambos com p <0,0001). A correlação de Pearson foi aplicada para comparar os scores e concluiu um coeficiente de correlação de 0.775 (p <0,001), descrevendo uma correlação linear positiva significativa entre scores. Conclusões: Nos últimos anos, o EVAR tornou-se cada vez mais o procedimento de escolha para rAAA na nossa instituição. Nesta população, ambos os algoritmos de previsão de pontuação foram aplicados retrospetivamente e ambos previram com acuidade a mortalidade na população estudada (p <0,001)

TURNER SYNDROME – AN UNUSUAL CAUSE FOR AORTIC DISSECTION

Turner syndrome (TS) is a disorder of female development with cardinal features of short stature and congenital cardiovascular defects. Congenital or acquired cardiological problems occur commonly in TS, being potentially progressive and responsible for severe complications, such as aortic dissection in young women. Accordingly, we describe a case of type A aortic dissection occurring in a woman with TS, highlighting the need to prioritize investigation in those patients to avoid a catastrophic aortic scenario

FIBROBLASTOMA DESMOPLÁSICO ENVOLVENDO A ARTÉRIA BRAQUIAL — UM CASO CLÍNICO ÚNICO

O fibroblastoma desmoplásico (FD), também conhecido como fibroma colagenoso, é uma neoplasia fibrosa benigna rara, de crescimento indolente, recentemente descrita. Ocorre predominantemente no tronco e membros superiores, podendo surgir em qualquer idade. Os autores descrevem um caso de uma doente do sexo feminino de 42 anos de idade com FD, com compromisso neurovascular do membro superior. Foi submetida a exérese em bloco da massa tumoral e artéria braquial, com reconstrução arterial (enxerto de interposição autólogo). A análise anatomopatológica foi consistente com FD e o diagnóstico foi validado por laboratório externo internacional1. Trata-se da primeira descrição na literatura de um FD envolvendo um segmento arterial

ENDOVASCULAR MANAGEMENT OF LIFE-THREATENING CAROTID BLOWOUT SYNDROME AFTER OSTEORADIONECROSIS OF THE MANDIBULA — A CASE REPORT AND LITERATURE REVIEW

Aim: Carotid blowout syndrome is a rare but devastating complication of head and neck malignancy, and is associated with a reported mortality and neurologic morbidity of 40% and 60% respectively. The aim of this case report is to present our experience with a single case of massive haemorrhage from the internal carotid artery (ICA) in a previously irradiated neck treated with a stentgraft, hence maintaining carotid artery patency. Methods: Relevant medical data were collected and literature review was performed. Results: The patient is a 61-year-old male with a previous history of head and neck cancer submitted to radical surgery and chemo and radiotherapy. Seven years later, the patient was diagnosed with osteoradionecrosis of the mandibula and submitted to surgery. Hospital stay was prolonged due to local infection and suture dehiscence with carotid artery exposure. No previous episodes of sentinel bleeding were registered. Life-threatening haemorrhage from the surgical wound started acutely. Under manual compression, the patient was rushed to the angiography suite and the diagnostic angiography ascertained active bleeding from the ICA. A stentgraft Atrium Advanta V12 (Maquet Getinge group, Hudson, NH, USA) was deployed maintaining ICA patency. The patient was subsequently submitted to surgical reconstruction and had an uneventful recovery. Discussion: Management of acute carotid blow syndrome is critical, often requiring a multidisciplinary approach. Stentgraft placement is a highly feasible and effective approach with lower morbimortality rates when compared to surgical repair/ ligation or endovascular embolization. However long term results with patency rates are currently lacking

PRE-OPERATIVE ANEMIA AS A PREDICTIVE MORBIDITY OUTCOME — A RETROSPECTIVE ANALYSIS OF A VASCULAR SURGERY DEPARTMENT

Introduction: Anemia is associated with increased adverse outcomes during the early postoperative period because of high physiologic stress and increased cardiac demand. The aim of this study was to assess the relationship between pre-operative anemia and morbi-mortality outcomes in patients undergoing elective carotid endarterectomy (CEA), open aortic repair (OAR) or endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) and infrainguinal bypass surgery in chronic limb-threatening ischemia.  Methods: Retrospective analysis of all elective patients between 2016-2018, who underwent: CEA, OAR, EVAR and infrainguinal bypass surgery in chronic limb-threatening ischemia. Emergency procedures and transfusion of more than 4 units of red blood cells (RBC) were excluded. Hemoglobin levels were categorized according to the WHO definition for anemia: severe (< 8 g/dL), moderate (8-10.9 g/dL), mild (11-11.9 g/dL in women and 11-12.9 g/dL in men) and no anemia (≥12 g/dL in women and ≥13 g/dL in men).  Results: Our study population comprised 257 patients, of which 74 (28%) underwent EVAR, 26 (10.1%) OAR, 67 (26.1%) CEA and 90 (35%) infrainguinal bypass. Pre-operative anemia was identified in 37.4% (n = 96) of the patients. Of those, 67.7% (n = 65) had mild anemia and 32.3% (n = 31) had moderate-severe anemia. Anemic patients have longer length of stay when compared with non-anemic patients (16.61±16.5; 7.68±4.92, respectively) (p = 0.022) and also longer stay in the post-operative care unite in comparison with patients with hemoglobin within the normal range (average 2.08 days ± 1.12; 1.77 days ± 1.01, respectively) (p<0.001). Pre-operative anemia was associated with the need of peri-operative transfusions (p < 0.001), as expected. In-hospital adverse events were influenced by the presence of anemia (p<0.001), namely surgical site infection (p = 0.002) and re-intervention (p<0.007). Patients who received blood transfusion peri-operatively were more prone to adverse outcomes (p<0.001), such as renal disfunction (p = 0.006), respiratory infections (p =0.015), surgical site infection (p = 0.001) and re-intervention (p = 0.001).  Conclusion: Pre-operative anemia evaluation should be incorporated into the preoperative risk assessment. Iron deficiency anemia is the most frequent type of anemia. In these cases, oral or IV iron supplementation pre-operatively is the preferential treatment, and might decrease the need of blood transfusions. Patients with iron deficiency without anemia also have indication to take oral iron supplementation. This situation urges the application of a well-structured protocol to optimize pre-operative hemoglobin, reduce intra-operative blood loss and improve anemic patients’ status in an effort to reach better outcomes.

ACUTE CAROTID STENT THROMBOSIS – A RARE CLINICAL ENTITY?

Introduction: Acute carotid stent thrombosis (ACST), defined according to the Academic Research Consortium as occurring in the first 24 hours after the procedure, is described as an exceedingly rare complication of CAS but it can lead to catastrophic neurologic consequences. The European Society for Vascular Surgery updated guidelines state thrombolysis and intravenous abciximab may be effective, but provide no specific recommendations. Given the lack of data concerning the optimal management, the purpose of this review was to evaluate the current literature and report on ACST aetiology and management strategies. Methods: Literature review was performed in the MEDLINE database. Results: No data on ACST is evident in large randomized controlled trials. ACST incidence rate ranges from 0.5-0.8%, reaching as high as 33% in acute-setting.   Considering aetiology, it can be subdivided into 2 main groups: systemic causes and technical complications. In the first antiplatelet non-compliance/resistance were the most reported while in the latter carotid artery dissection and plaque protrusion were the most common causes. Also, dual layer stents were associated with greater risk for ACST There are three main approaches for ACST: pharmacologic, endovascular and surgical. Pharmacologic management included anticoagulation, thrombolysis and facilitated thrombolysis. A role for thrombolysis and facilitated thrombolysis is still to be determined. Endovascular treatment was the most common approach to intraprocedural ACST: mechanical thrombectomy with or without concomitant facilitated thrombolysis. Surgical options included carotid endarterectomy with stent explantation which was a bail-out after failed endovascular treatment with excellent recanalization rates. In asymptomatic ACST conservative management with anticoagulation was unanimous. Discussion: As a conclusion, ACST is probably an underestimated clinical entity associated with multiple risk factors. Decision on the best approach depends if ACST occurs intraprocedural or afterwards, on the development of neurologic status deterioration and on centre´s experience. Additional studies must be undertaken to better define optimal management

HYBRID MANAGEMENT FOR SPONTANEOUS ISOLATED DISSECTION OF THE COMMON ILIAC ARTERY: A CLINICAL CASE

Introduction: Iliac artery dissection without aortic involvement is a rare entity, with most cases associated with predisposing factors such as trauma, atherosclerosis, connective tissue disorders or vigorous exercise. The best treatment is not unanimous, and depends on the acuteness and severity of symptoms. Criteria for intervention include prevention of aneurysmatic degeneration, acute limb ischemia, inguinal pain and aneurysm rupture. Recent results using endovascular technique showed comparability with open repair, but there is paucity of data concerning long term results. Methods: Relevant medical data were collected from hospital database. Results: The patient is a 65 years old male, referred to the emergency department for abdominal pain in the left lower quadrant with inguinal irradiation. No signs or symptoms of acute limb ischemia were present. He had no previous history of connective tissue disease, cardiovascular risk factors, trauma or vigorous exercise. A CTA was performed, which identified an acute common left iliac artery dissection, with no evidence of vascular compromise of the ipsilateral limb He was submitted to surgical left femoral approach and percutaneous right femoral approach and dissection exclusion with two stentgrafts. Resolution of abdominal pain occurred immediately. Imagiologic follow-up with CTA was performed 12 and 24 months later with no signs of dissection or residual stenosis. Conclusion: In this case, an hybrid procedure with femoral surgical approach was performed for access site control. The use of bilateral femoral access was useful to identify the true lumen more accurately and to accommodate a more precise stent placement assuring adequate sealing. At 24 months follow-up, the patient maintains asymptomatic with no evidence of complications in the imagiologic follow-up. No signs or symptoms suggestive of connective tissue disease developed