A case of obstructive sleep apnea syndrome associated with floppy eyelid syndrome: positive effect of CPAP therapy

The obstructive sleep apnoea syndrome (OSAS) may be associated with several eyes disorders, among which the most common is the floppy eyelid syndrome (FES). We intended to highlight the association between OSAS and FES and evaluate the effect of FES treatment with Continuous Positive Airway Pressure (CPAP). A 50-year patient with a 10-year history of snoring, sleep fragmentation and daytime sleepiness associated with several comorbidities has been studied. For six months, several ocular symptoms were present, particularly on waking up in the morning. An overnight respiratory polygraphy was performed at baseline and after CPAP titration. The treatment with CPAP corrects apnea/hypopnea events and rapidly improves patient’s daytime sleepiness and eyes FES-related symptoms. This improvement is already evident after a very short period of treatment.

Curso da vida e capacidade para o trabalho entre adultos mais velhos: ELSI-Brasil

OBJETIVO: Examinar os fatores associados à percepção da capacidade para o trabalho em amostra nacional representativa da população brasileira com 50 anos ou mais. MÉTODOS: Foram utilizados dados de 8.903 participantes da linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). A variável dependente foi a autoavaliação da capacidade para o trabalho (boa ou muito boa versus razoável, ruim ou muito ruim). As variáveis independentes incluíram fatores que operam no início, no meio e na fase atual da vida. A análise multivariada foi baseada em razões de prevalência (RP) e respectivos intervalos de confiança de 95% (IC95%) estimados por meio da regressão de Poisson. RESULTADOS: A boa capacidade para o trabalho foi informada por 49% dos participantes (49,4% entre homens e 48,6% entre mulheres). Os resultados da análise multivariada mostraram que, tanto para homens quanto para mulheres, a boa capacidade para o trabalho apresentou associações positivas e estatisticamente significantes (p < 0,05) com ter saúde boa até os 15 anos de idade (RP = 1,22 e 1,18, respectivamente), escolaridade ≥ 8 anos (RP = 1,19 e 1,21, respectivamente) e autoavaliação da saúde atual como boa (RP = 1,88 e 1,94, respectivamente). Associações negativas foram observadas para idade atual (RP = 0,99 para cada incremento de um ano), diagnóstico médico de depressão (RP = 0,70 para homens e RP = 0,87 para mulheres) e ter uma ou mais doenças crônicas (RP = 0,88 para homens e 0,91 para mulheres). Apenas entre os homens, associações positivas foram observadas para idade em que começou a trabalhar (RP = 1,14 e 1,12 para 11–17 e ≥ 18 anos) e residência com o cônjuge (RP = 1,09). CONCLUSÕES: A capacidade para o trabalho nas idades mais velhas é construída ao longo da vida, particularmente pelas condições de saúde na infância e na adolescência, pela idade em que os homens começam a trabalhar, pela escolaridade e pelas condições de saúde nas idades mais velhas. Políticas visando ao aumento da longevidade no mercado de trabalho devem levar em conta esses fatores.OBJECTIVE: To examine factors associated with perception of work ability in a nationally representative sample of Brazilians aged 50 years and over. METHODS: We used data from 8,903 participants of the baseline survey of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). The dependent variable was self-rated work ability (good or very good versus fair, poor, or very poor). Independent variables included factors that operate at the beginning, middle, and current stage of life. Multivariate analysis was based on prevalence ratios (PR) and 95% confidence intervals (95%CI) estimated by Poisson regression. RESULTS: Good work ability was reported by 49% of \ participants (49.4% among men and 48.6% among women). Results of the multivariate analysis showed that, for both men and women, good work ability showed positive and statistically significant associations (p < 0.05) with good health up to 15 years of age (PR = 1.22 and 1.18 , respectively), educational level ≥ 8 years (PR = 1.19 and 1.21, respectively), and current good self-rated health (PR = 1.88 and 1.94, respectively). Negative associations were observed for current age (PR = 0.99 for each increase of one year among men and women), medical diagnosis of depression (PR = 0.70 for men and PR = 0.87 for women), and having one or more at least chronic diseases (PR = 0.88 for men and 0.91 for women). Only for men, positive associations for the age at which they started working (PR = 1.14 and 1.12 for 11–17 and ≥ 18 years, respectively) and living with a spouse (PR = 1.09) were found. CONCLUSIONS: Work ability in older ages is built over the life course, particularly by the health conditions in childhood and adolescence, age at which men begin working, educational level, and health conditions in older ages. Policies aimed at increasing longevity in the labor market must take these factors into account

Modelling Environmental Niche for the Endangered Crayfish Austropotamobius pallipesComplex in Northern and Central Italy

The potential distribution of endangered species is a necessary step to assess species conservation status and manage reintroduction plans. In the context of a EU project on the endangered Austropotamobius pallipescomplex, we modelled the environmental niche of the species in two large areas of Northern (Lombardy, 43 records) and Central Italy (Abruzzo, Province of Isernia, Gran Sasso e Monti della Laga National Park; 69 records). Ecological niche models (ENMs) were built by using the maximum entropy approach as implemented in the MaxEnt software, which predicts the occurrence of a species using presence-only data. The environmental niche was modelled using six variables: altitude, slope, aspect, human disturbance, mean temperature of warmest quarter and distance from stream. Each study area was modelled independently. Both ENMs obtained high performance scores as measured by the AUC index (Northern Italy: 0.854; Central Italy: 0.817). Slope in Northern Italy and the mean temperature of warmest quarter in Central Italy achieved the greatest predictive power. Our results clearly show that the endangered white-clawed crayfish has a narrow range of habitat selection in the two study areas. Our findings may help researchers to select the best sites for future reintroductions in conservation projects

Real-life data on potential drug-druginteractions in patients with chronic hepatitis C viral infection undergoing antiviral therapy with interferon-free DAAs in the PITER Cohort Study

Background There are few real-life data on the potential drug-drug interactions (DDIs) between anti-HCV direct-acting antivirals (DAAs) and the comedications used. Aim To assess the potential DDIs of DAAs in HCV-infected outpatients, according to the severity of liver disease and comedication used in a prospective multicentric study. Methods Data from patients in 15 clinical centers who had started a DAA regimen and were receiving comedications during March 2015 to March 2016 were prospectively evaluated. The DDIs for each regimen and comedication were assigned according to HepC Drug Interactions (www.hep-druginteractions.org) Results Of the 449 patients evaluated, 86 had mild liver disease and 363 had moderate-to-severe disease. The use of a single comedication was more frequent among patients with mild liver disease (p = 0.03), whereas utilization of more than three drugs among those with moderate- to-severe disease (p = 0.05). Of the 142 comedications used in 86 patients with mild disease, 27 (20%) may require dose adjustment/closer monitoring, none was contraindicated. Of the 322 comedications used in 363 patients with moderate-to-severe liver disease, 82 (25%) were classified with potential DDIs that required only monitoring and dose adjustments; 10 (3%) were contraindicated in severe liver disease. In patients with mild liver disease 30% (26/86) used at least one drug with a potential DDI whereas of the 363 patients with moderate-to-severe liver disease, 161 (44%) were at risk for one or more DDI. Conclusions Based on these results, we can estimate that 30 - 44% of patients undergoing DAA and taking comedications are at risk of a clinically significant DDI. This data indicates the need for increased awareness of potential DDI during DAA therapy, especially in patients with moderate- to-severe liver disease. For several drugs, the recommendation related to the DDI changes from "dose adjustment/closer monitoring", in mild to moderate liver disease, to "the use is contraindicated" in severe liver disease

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Sistema antisismico innovativo con fusibili dissipativi per strutture in acciaio formato a freddo - Progettazione e modellazione numerica

Un innovativo sistema antisismico per strutture in acciaio formato a freddo viene proposto mediante simulazioni numeriche agli elementi finiti. Il sistema consiste in pareti di taglio con elementi di acciaio a forma di farfalla progettati per snervarsi durante i terremoti: tali elementi sono perciò fusibili dissipativi, sostituibili una volta danneggiati. I risultati numerici ottenuti evidenziano un comportamento isteretico migliore rispetto ai telai tradizionali rivestiti da pannelli ligne

A influência da política pública ambiental como promotora do desenvolvimento : a experiência do projeto de desenvolvimento sustentável do Pandeiros, município de Januária – MG

A atividade de desmate da mata nativa para produção do carvão é uma das alternativas de sobrevivência de uma expressiva parcela de moradores das comunidades da região Norte de Minas Gerais, onde há o Distrito de Pandeiros, Município de Januária-MG, situado em uma Área de Proteção Ambiental. Associando-se esse conhecimento prévio à questão ambiental de averiguar “in loco” a inserção do Projeto de Desenvolvimento Sustentável do Pandeiros (PDSP) nas comunidades por meio de uma racionalidade ambiental (saber ambiental) vista como solução para o desenvolvimento sustentável, busca-se averiguar o antes, o durante e, posteriormente, com a saída dos mediadores, como foram as condutas dos mediados após deixarem de receber os benefícios diretos. Assim, foi definido como objetivo geral analisar o processo de inserção da política pública ambiental PDSP e suas contribuições para o desenvolvimento nas comunidades do Distrito de Pandeiros, Município de Januária-MG. Essa tese surge devido às aspirações em entender e/ou conhecer os efeitos das ações de desenvolvimento sustentável propostas pelo PDSP. Para elucidar e resolver o sentido do objeto nas respostas, este trabalho fundamenta-se nas teorias do capital social enfatizando-se as características da confiança e do ato da reciprocidade associados ao campesinato como molas propulsoras do desenvolvimento, que fortalecem o empoderamento. Demonstra-se, assim, que não somente o econômico, mas também o lado humano se faz necessário na contextualização/inserção de uma política pública ambiental. Para tanto, as teorias norteadoras destacadas anteriormente são associadas a outras fundamentações teóricas para instituir as perguntas e aprimorar a clareza do objeto nas respostas, como a Racionalidade Ambiental focada no saber ambiental e associada a uma nova racionalidade produtiva alternativa, interligada diretamente ao desenvolvimento sustentável, ou seja, a uma lógica sustentável e, à visão do empoderamento tratado como um processo de absorção e não de imposição. Para ser desenvolvido o referido trabalho foi utilizada tanto a pesquisa quantitativa quanto a qualitativa, sendo os dados obtidos de vários respondentes por meio de formulário semiestruturado e não-disfarçado. Se fez uso, também, do método bibliográfico, documental e do enfoque causal por meio de estudo de caso. Obteve-se como principais resultados a inversão da lógica da depredação do meio ambiente para lógica da proteção do mesmo por uma parcela significativa dos beneficiários do PDSP e, que as características da confiança e do ato da reciprocidade entre os membros e destes com os técnicos, influenciaram na inserção das ações do PDSP, bem como na interiorização das mesmas.The activity of native forests deforestation for charcoal production is an alternative to the survival of a significant proportion of residents of communities in the North of Minas Gerais, Pandeiros District, Municipality of Januária-MG, situated in an area of Environmental Protection. Joining this prior knowledge to environmental issues to investigate "in situ" the insertion of the Sustainable Development Project Pandeiros (PDSP) in communities through an environmental rationality (environmental knowledge) seen as a solution for sustainable development, we seek to ascertain the before, the during and afterwards, with the departure of the mediators, as were the conduits of mediated after failing to receive direct benefits. Thus, it was defined as general objective to analyze the process of insertion of environmental public policy PDSP and their contributions to the development in the communities of the District of Pandeiros Municipality Januária-MG. This thesis arises due to the aspirations to understand and / or know the effects of sustainable development actions proposed by the PDSP. To elucidate and resolve the sense of the object in the responses, this work is based on the theories of social capital which emphasizes the characteristics of trust and reciprocity act associated with the peasantry as drivers of development that strengthens empowerment. It is shown, therefore, that not only the economic but also the human side it is necessary to contextualize / insertion of a public environmental policy. For this purpose, the guiding theories highlighted above are associated with other theoretical foundations to establish the questions and improve the clarity of the object in the answers, as the Environmental Rationality focused on environmental knowledge and associated with a new productive alternative rationality, directly linked to sustainable development, ie, a logic sustainable, and the vision empowerment treated as an absorption process and not imposed. To be developed that work we used either quantitative or qualitative research and the data obtained from several respondents using a questionnaire and semi-structured nondisguised. We use also the method bibliographic, documental and causal approach through a case study. Was obtained as the main results the inversion of logic destruction of the environment to logic of protection for a significant portion of the recipients of the PDSP and the characteristics of trust and reciprocity act between members and those with technics influenced the inclusion of the actions of PDSP and the internalization of the same

A influência da política pública ambiental como promotora do desenvolvimento : a experiência do projeto de desenvolvimento sustentável do Pandeiros, município de Januária – MG

A atividade de desmate da mata nativa para produção do carvão é uma das alternativas de sobrevivência de uma expressiva parcela de moradores das comunidades da região Norte de Minas Gerais, onde há o Distrito de Pandeiros, Município de Januária-MG, situado em uma Área de Proteção Ambiental. Associando-se esse conhecimento prévio à questão ambiental de averiguar “in loco” a inserção do Projeto de Desenvolvimento Sustentável do Pandeiros (PDSP) nas comunidades por meio de uma racionalidade ambiental (saber ambiental) vista como solução para o desenvolvimento sustentável, busca-se averiguar o antes, o durante e, posteriormente, com a saída dos mediadores, como foram as condutas dos mediados após deixarem de receber os benefícios diretos. Assim, foi definido como objetivo geral analisar o processo de inserção da política pública ambiental PDSP e suas contribuições para o desenvolvimento nas comunidades do Distrito de Pandeiros, Município de Januária-MG. Essa tese surge devido às aspirações em entender e/ou conhecer os efeitos das ações de desenvolvimento sustentável propostas pelo PDSP. Para elucidar e resolver o sentido do objeto nas respostas, este trabalho fundamenta-se nas teorias do capital social enfatizando-se as características da confiança e do ato da reciprocidade associados ao campesinato como molas propulsoras do desenvolvimento, que fortalecem o empoderamento. Demonstra-se, assim, que não somente o econômico, mas também o lado humano se faz necessário na contextualização/inserção de uma política pública ambiental. Para tanto, as teorias norteadoras destacadas anteriormente são associadas a outras fundamentações teóricas para instituir as perguntas e aprimorar a clareza do objeto nas respostas, como a Racionalidade Ambiental focada no saber ambiental e associada a uma nova racionalidade produtiva alternativa, interligada diretamente ao desenvolvimento sustentável, ou seja, a uma lógica sustentável e, à visão do empoderamento tratado como um processo de absorção e não de imposição. Para ser desenvolvido o referido trabalho foi utilizada tanto a pesquisa quantitativa quanto a qualitativa, sendo os dados obtidos de vários respondentes por meio de formulário semiestruturado e não-disfarçado. Se fez uso, também, do método bibliográfico, documental e do enfoque causal por meio de estudo de caso. Obteve-se como principais resultados a inversão da lógica da depredação do meio ambiente para lógica da proteção do mesmo por uma parcela significativa dos beneficiários do PDSP e, que as características da confiança e do ato da reciprocidade entre os membros e destes com os técnicos, influenciaram na inserção das ações do PDSP, bem como na interiorização das mesmas.The activity of native forests deforestation for charcoal production is an alternative to the survival of a significant proportion of residents of communities in the North of Minas Gerais, Pandeiros District, Municipality of Januária-MG, situated in an area of Environmental Protection. Joining this prior knowledge to environmental issues to investigate "in situ" the insertion of the Sustainable Development Project Pandeiros (PDSP) in communities through an environmental rationality (environmental knowledge) seen as a solution for sustainable development, we seek to ascertain the before, the during and afterwards, with the departure of the mediators, as were the conduits of mediated after failing to receive direct benefits. Thus, it was defined as general objective to analyze the process of insertion of environmental public policy PDSP and their contributions to the development in the communities of the District of Pandeiros Municipality Januária-MG. This thesis arises due to the aspirations to understand and / or know the effects of sustainable development actions proposed by the PDSP. To elucidate and resolve the sense of the object in the responses, this work is based on the theories of social capital which emphasizes the characteristics of trust and reciprocity act associated with the peasantry as drivers of development that strengthens empowerment. It is shown, therefore, that not only the economic but also the human side it is necessary to contextualize / insertion of a public environmental policy. For this purpose, the guiding theories highlighted above are associated with other theoretical foundations to establish the questions and improve the clarity of the object in the answers, as the Environmental Rationality focused on environmental knowledge and associated with a new productive alternative rationality, directly linked to sustainable development, ie, a logic sustainable, and the vision empowerment treated as an absorption process and not imposed. To be developed that work we used either quantitative or qualitative research and the data obtained from several respondents using a questionnaire and semi-structured nondisguised. We use also the method bibliographic, documental and causal approach through a case study. Was obtained as the main results the inversion of logic destruction of the environment to logic of protection for a significant portion of the recipients of the PDSP and the characteristics of trust and reciprocity act between members and those with technics influenced the inclusion of the actions of PDSP and the internalization of the same