Lesão renal aguda causada pelo veneno das cobras Crotalus e Bothrops: revisão da epidemiologia, das manifestações clínicas e do tratamento

SUMMARY Ophidic accidents are an important public health problem due to their incidence, morbidity and mortality. An increasing number of cases have been registered in Brazil in the last few years. Several studies point to the importance of knowing the clinical complications and adequate approach in these accidents. However, knowledge about the risk factors is not enough and there are an increasing number of deaths due to these accidents in Brazil. In this context, acute kidney injury (AKI) appears as one of the main causes of death and consequences for these victims, which are mainly young males working in rural areas. Snakes of the Bothrops and Crotalus genera are the main responsible for renal involvement in ophidic accidents in South America. The present study is a literature review of AKI caused by Bothrops and Crotalus snake venom regarding diverse characteristics, emphasizing the most appropriate therapeutic approach for these cases. Recent studies have been carried out searching for complementary therapies for the treatment of ophidic accidents, including the use of lipoic acid, simvastatin and allopurinol. Some plants, such as Apocynaceae, Lamiaceae and Rubiaceae seem to have a beneficial role in the treatment of this type of envenomation. Future studies will certainly find new therapeutic measures for ophidic accidents.RESUMO Os acidentes ofídicos são importante problema de saúde pública devido à incidência, morbidade e mortalidade. Aumento do número de casos tem sido registrado no Brasil nos últimos anos. Vários estudos apontam para a importância do conhecimento das complicações clínicas e do tratamento adequado desses acidentes. Entretanto o conhecimento dos fatores de risco não é suficiente, e existe número crescente de óbitos devido a esses acidentes no Brasil. Neste contexto, a injúria renal aguda (IRA) aparece como uma das principais causas de óbito e sequela nestas vítimas, que são principalmente homens trabalhadores de zonas rurais. Os gêneros Bothrops e Crotalus são os principais responsáveis pelo envolvimento renal nos acidentes ofídicos na América do Sul. O presente estudo faz uma revisão da literatura sobre a IRA causada pela picada das serpentes dos gêneros Bothrops e Crotalus em suas diversas características, enfatizando a abordagem terapêutica mais adequada para estes casos. Estudos recentes tem sido realizados para a busca de terapias complementares para o tratamento dos acidentes ofídicos, incluindo o uso de ácido lipóico, sinvastatina e alopurinol. Algumas plantas, como a Apocynaceae, Lamiaceae e Rubiaceae parecem ter papel benéfico no tratamento destes envenenamentos. Estudos futuros irão certamente encontrar novas estratégias terapêuticas para os acidentes ofídicos

Blended learning in undergraduate dental education: a global pilot study.

AIMS: To explore the global trends in blended learning in undergraduate dental education during the COVID pandemic and during the recovery phase by engaging with the students and faculty and evaluate the implications for dental education in the post-COVID era. METHODS: It was a pilot cross-sectional study which employed a convenience sampling technique to recruit representatives of dental faculty and undergraduate students in 80 dental institutions globally. A previously validated questionnaire consisting of a combination of closed and open-ended items was used for data collection. Responses to these online questionnaires were processed and analysed using the R statistical computing environment. RESULTS: A total of 320 dental students and 169 faculty members from 47 different dental institutions participated in the study. Video and Live Online Tutorials were considered to be the most effective method of online learning followed by online question banks by both groups. Significant differences were noted between faculty and students regarding time spent and effectiveness of online teaching and learning, respectively, both before and after the start of COVID. The results highlight the faculty need to engage more closely with the students to address their learning needs. Finally, the participants provided several recommendations regarding the future development of teaching and learning strategies as well as assessments in the post-pandemic era. CONCLUSIONS: This is the first study which explores blended learning in dental education with participants from multiple institutions in different regions of the globe. Compared to the faculty, students considered online learning to be less interactive and preferred learning activities and all assessments to be delivered face-to-face. The results underscore the need to adapt teaching practices to suit the learning needs of the students

Effects of religious vs. standard cognitive behavioral therapy on therapeutic alliance: A randomized clinical trial

Background: Treatments that integrate religious clients' beliefs into therapy may enhance the therapeutic alliance (TA) in religious clients. Objective: Compare the effects of religiously integrated cognitive behavioral therapy (RCBT) and standard CBT (SCBT) on TA in adults with major depression and chronic medical illness. Method: Multi-site randomized controlled trial in 132 participants, of whom 108 (SCBT = 53, RCBT = 55) completed the Revised Helping Alliance Questionnaire (HAQ-II) at 4, 8, and 12 weeks. Trajectory of change in scores over time was compared between groups. Results: HAQ-II score at 4 weeks predicted a decline in depressive symptoms over time independent of treatment group (B = −0.06, SE = 0.02, p = 0.002, n = 108). There was a marginally significant difference in HAQ-II scores at 4 weeks that favored RCBT (p = 0.076); however, the mixed effects model indicated a significant group by time interaction that favored the SCBT group (B = 1.84, SE = 0.90, degrees of freedom = 181, t = 2.04, p = 0.043, d = 0.30). Conclusions: While RCBT produces a marginally greater improvement in TA initially compared with SCBT, SCBT soon catches up

Repeatability and minimum number of evaluations for morpho-agronomic characters of elephant-grass for energy purposes.

ABSTRACT Due to the need to promote information relevant to elephant-grass breeding programs for energy purposes, this work aimed to estimate the coefficient of repeatability of the main morpho-agronomic characters and to predict the minimum number of cuts required for selection with greater efficiency. A total of 73 elephant-grass genotypes were evaluated in a randomized block design, in a subdivided plot scheme with two replicates. Nine cuts were performed at six-month intervals, from June 2012 to December 2016, in the municipality of Campos dos Goytacazes, RJ. We estimated the repeatability coefficients for dry matter yield (DMY), number of tillers (NT), plant height (PH), stem diameter (SD) and leaf blade width (LBW), using the methods of analysis of variance, principal components and structural analysis. At least nine, three, six, six and three cuts should be performed, considering the DMY, NT, PH, SD and LBW characteristics, respectively, to predict the true value of the genotypes with 80% reliability

American Cochlear Implant Alliance Task Force guidelines for clinical assessment and management of adult cochlear implantation for single-sided deafness

The indications for cochlear implantation have expanded to include individuals with profound sensorineural hearing loss in the impaired ear and normal hearing (NH) in the contralateral ear, known as single-sided deafness (SSD). There are additional considerations for the clinical assessment and management of adult cochlear implant candidates and recipients with SSD as compared to conventional cochlear implant candidates with bilateral moderate to profound sensorineural hearing loss. The present report reviews the current evidence relevant to the assessment and management of adults with SSD. A systematic review was also conducted on published studies that investigated outcomes of cochlear implant use on measures of speech recognition in quiet and noise, sound source localization, tinnitus perception, and quality of life for this patient population. Expert consensus and systematic review of the current literature were combined to provide guidance for the clinical assessment and management of adults with SSD

Chemical composition and energy yield of elephant-grass biomass as function of five different production ages.

Abstract Elephant grass has high biomass production, with qualities suitable for conversion into bioenergy, but has long been used exclusively for animal feed and only in recent years has it become an energetic alternative. Therefore, it is necessary to select genotypes with potential for energy production. This study evaluated the effect of five harvest times (8, 12, 16, 20, and 24 weeks) on the yield and chemical composition related to biomass quality through combined polynomial regression analyses of the following elephant grass genotypes: Cubano Pinda, Mercker 86-México, Pusa Napier n°1, Mole de Volta Grande, P-241-Piracicaba, and King Grass. A completely randomized design with three replicates, in a split-plot arrangement, was adopted, including two factors (plots = genotypes, subplots = harvest times). The evaluated variables were whole-plant dry matter yield, in t ha-1 (DMY), percentage of neutral detergent fiber (%NDF), and percentage of acid detergent fiber (%ADF). The elephant-grass genotypes Cubano de Pinda, Mercker 86-México, and P-241-Piracicaba showed a linear first-degree effect as a function of the harvest intervals, indicating that they did not reach their maximum production potential. Genotypes Pusa Napier n°1, Mole de Volta Grande, and King Grass, in turn, had a linear second-degree effect. For the NDF variable, all genotypes showed a significant linear second-degree effect as a function of the harvest intervals, except P-241-Piracicaba, for which no regression was observed. For this genotype, there was a significant linear first-degree effect on the %ADF variable

Prediction of genetic gains by selection indices using mixed models in elephant grass for energy purposes.

Genetically improved cultivars of elephant grass need to be adapted to different ecosystems with a faster growth speed and lower seasonality of biomass production over the year. This study aimed to use selection indices using mixed models (REML/BLUP) for selecting families and progenies within full-sib families of elephant grass (Pennisetum purpureum) for biomass production. One hundred and twenty full-sib progenies were assessed from 2014 to 2015 in a randomized block design with three replications. During this period, the traits dry matter production, the number of tillers, plant height, stem diameter, and neutral detergent fiber were assessed. Families 3 and 1were the best classified, being the most indicated for selection effect. Progenies 40, 45, 46, and 49 got the first positions in the three indices assessed in the first cut. The gain for individual 40 was 161.76% using Mulamba and Mock index. The use of selection indices using mixed models is advantageous in elephant grass since they provide high gains with the selection, which are distributed among all the assessed traits in the most appropriate situation to breeding programs

Factors associated with thrombocytopenia in severe leptospirosis (Weil's disease)

OBJECTIVE: This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area. METHODS: This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet coun