Morfologia e morfometria do forame tireoidiano da laringe e suas implicações clínico-cirúrgicas

Introdução: O forame da tireoide é uma variação anatômica caracterizada por uma abertura na porção póstero-superior da lâmina da cartilagem tireoide da laringe. O conhecimento anatômico sobre as estruturas vasculares e nervosas da região do pescoço, bem como o conhecimento da existência de variações anatômicas, tais como o forame da tireoide são de suma importância para o sucesso cirúrgico. Nessa perspectiva, o presente estudo teve como objetivo investigar a incidência, a morfometria e a morfologia do forame tireóideo da cartilagem tireoide em laringes humanas cadavéricas, bem como discutir as relações cirúrgicas e clínicas decorrentes dessa variação anatômica. Método: Foram selecionadas 100 laringes humanas do acervo de peças cadavéricas do Departamento de Anatomia da UFPE que permitissem a visualização do esqueleto cartilaginoso da laringe, em especial, da cartilagem tireoide da laringe. Resultados: Das 100 (cem) laringes selecionadas, 02 (duas) apresentaram o forame tireoidiano, indicando uma incidência de 2%. Conclusão: O estudo embasou a importância do conhecimento anatômico sobre o forame tireóideo. Observou-se uma incidência de 2% do forame tireóideo, que foi circular medindo 7 mm na cartilagem laríngea com apresentação unilateral e 0,45 mm e 0,5 mm no lado esquerdo e direito, respectivamente, na apresentação bilateral. Ademais, o presente estudo apontou importantes dados morfológicos e morfométricos dessa variação anatômica, que não deve ser negligenciada no momento de procedimentos na região do pescoço

ANTEPROYECTO MECÁNICO DE MULTIROTOR AGRÍCOLA PULVERIZADOR

El concepto de agricultura de precisión surgió con el uso de técnicas avanzadas y tecnológicas en el manejo de cultivos. La tecnología, cuando se usa correctamente, promueve una mayor seguridad y productividad. Reconocer el área plantada y tratar cada lugar según sea necesario es una de las ventajas que la tecnología ofrece al campo. Una de las actividades que se llevan a cabo en el tratamiento de varios cultivos es la pulverización de fertilizantes, donde el uso de aeronaves pilotadas a distancia es una forma de implementar tecnología, controlar la actividad y proteger a las personas frente a productos tóxicos. Este trabajo desarrolla el diseño mecánico preliminar de una aeronave de fuente de energía híbrida para pulverización, utilizando gasolina como combustible. Las principales ventajas de un sistema de energía híbrido son que no requiere el uso de múltiples baterías y el reabastecimiento rápido reemplaza una carga eléctrica. Se creó un modelo pequeño para cumplir con su actividad sin generar dificultades en la formación de pilotos a distancia y normativa legal

Mortality due to malignant neoplasms of the liver and intrahepatic biliary tract in the state of Mato Grosso in 2020

Malignant neoplasms of the liver and intrahepatic biliary tract occupy the third place of cancer deaths in the world and the second most deadly in men and the sixth in women. Eating habits characterized by the consumption of food with high caloric and glycemic indexes, associated with a sedentary lifestyle, provide a greater risk of developing hepatic steatosis, as well as obesity, which, together with the increased incidence of chronic viral hepatitis, excessive alcoholism, and age over 50 years, constitute the main risk factors for the development of these types of cancer. In addition, due to the chronicity of liver pathologies, the diagnosis is usually late, a factor that contributes to increase the mortality rate. Thus, the objective of this work is to analyze the epidemiological profile of deaths due to liver cancer and intrahepatic biliary tract that occurred in the state of Mato Grosso in 2020. This is a cross-sectional study based on data from the Mortality Information System (SIM), made available by the Department of Informatics of the Unified Health System (DATASUS), and in the population estimate of the Brazilian Institute of Geography and Statistics (IBGE) for 2020. A study was carried out of the epidemiological profile of deaths related to liver and intrahepatic biliary ducts neoplasms (CID 10 C-22) of the state of Mato Grosso for the year 2020 regarding age group, sex (gender), and race. A total of 120 deaths due to malignant neoplasms of the liver and intrahepatic biliary tract were reported, corresponding to a mortality rate of approximately 3.4 deaths/100,000 inhabitants, with the proportion of deaths between men and women approximately 4:3. For both sexes, there is an abrupt increase in the incidence of deaths after the sixth decade of life, corresponding to 90% of deaths due to this pathology. Regarding the racial evaluation, deaths are more incident in the yellow race, with about 4.97 deaths/100,000 inhabitants, followed by the black race with 4.87 deaths/100,000 inhabitants. Thus, it is evident that deaths from liver and intrahepatic biliary tract malignant neoplasms in the state of Mato Grosso, in 2020, were concentrated from the sixth decade of life, especially in men, with emphasis on the yellow race. It should be noted that the analysis of epidemiological characteristics is essential for the development of screening policies and early diagnosis in patients with modifiable and non-modifiable risk factors

Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Randomized Clinical Trial.

There is no specific antiviral therapy recommended for coronavirus disease 2019 (COVID-19). In vitro studies indicate that the antiviral effect of chloroquine diphosphate (CQ) requires a high concentration of the drug.To evaluate the safety and efficacy of 2 CQ dosages in patients with severe COVID-19. This parallel, double-masked, randomized, phase IIb clinical trial with 81 adult patients who were hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted from March 23 to April 5, 2020, at a tertiary care facility in Manaus, Brazilian Amazon. - Patients were allocated to receive high-dosage CQ (ie, 600 mg CQ twice daily for 10 days) or low-dosage CQ (ie, 450 mg twice daily on day 1 and once daily for 4 days). - Label: Main Outcomes and Measures Primary outcome was reduction in lethality by at least 50% in the high-dosage group compared with the low-dosage group. Data presented here refer primarily to safety and lethality outcomes during treatment on day 13. Secondary end points included participant clinical status, laboratory examinations, and electrocardiogram results. Outcomes will be presented to day 28. Viral respiratory secretion RNA detection was performed on days 0 and 4. Out of a predefined sample size of 440 patients, 81 were enrolled (41 [50.6%] to high-dosage group and 40 [49.4%] to low-dosage group). Enrolled patients had a mean (SD) age of 51.1 (13.9) years, and most (60 [75.3%]) were men. Older age (mean [SD] age, 54.7 [13.7] years vs 47.4 [13.3] years) and more heart disease (5 of 28 [17.9%] vs 0) were seen in the high-dose group. Viral RNA was detected in 31 of 40 (77.5%) and 31 of 41 (75.6%) patients in the low-dosage and high-dosage groups, respectively. Lethality until day 13 was 39.0% in the high-dosage group (16 of 41) and 15.0% in the low-dosage group (6 of 40). The high-dosage group presented more instance of QTc interval greater than 500 milliseconds (7 of 37 [18.9%]) compared with the low-dosage group (4 of 36 [11.1%]). Respiratory secretion at day 4 was negative in only 6 of 27 patients (22.2%). - Label: Conclusions and Relevance The preliminary findings of this study suggest that the higher CQ dosage should not be recommended for critically ill patients with COVID-19 because of its potential safety hazards, especially when taken concurrently with azithromycin and oseltamivir. These findings cannot be extrapolated to patients with nonsevere COVID-19

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI