A terapêutica antitrombótica: atual e em desenvolvimento

ResumoA trombose é uma das principais causas de morte e o crescente conhecimento das alterações fisiopatológicas inerentes permitiu o desenvolvimento de terapêuticas eficazes (antiagregante, anticoagulante e fibrinolítico) para a prevenção e tratamentos da doença tromboembólica.Contudo, uma compreensão melhor do processo subjacente é fundamental para o desenvolvimento de novos agentes terapêuticos mais seguros e eficazes.O objetivo da presente revisão é sumarizar os tratamentos atuais disponíveis, e destacar os novos agentes e o seu papel comprovado ou eventual na cirurgia vascular.AbstractThrombosis is one of the major causes of death worldwide. Continous increase in the knowledge about the pathophysiological changes associated with thrombosis led to the development of effective therapies (anti‐platelet, anticoagulant and fibrinolytics) for the prevention and treatment of the thromboembolic disease.However, better understanding of the underlying processes is still crucial for the development of more effective and safer antithrombotic drugs.The aim of this review is summarize the current treatment, as well as the new agentes and to highlight their proven or possible role in Vascular Surgery

CONSTRUÇÃO DE NEO-AORTA PARA RESOLUÇÃO DE CATÁSTROFE VASCULAR — SOLUÇÃO INOVADORA PARA CASOS DE INFEÇÃO PROTÉSICA

Introdução e Objetivo: A infeção protésica aórtica é uma complicação rara mas potencialmente fatal. O seu tratamento requer a excisão completa do material protésico, desbridamento dos tecidos infectados circundantes, antibiótico de largo espectro e revascularização que pode ser realizada através de uma reconstrução in situ ou bypass extra-anatómico.  Os autores apresentam um caso de reconstrução in situ com enxerto de pericárdio bovino. Métodos e Resultados: Reportamos o caso de um doente previamente submetido a um bypass aorto-bifemoral com prótese de Dacron complicada de infeção aos 6 anos e foi submetido a excisão completa da prótese vascular e recontrução in situ com prótese bifurcada de prata. Após 1 ano, o doente iniciou quadro clínico de febre e tumefação inguinal pulsátil bilateral com sinais inflamatórios. A tomografia computorizada mostrou sinais de infeção protésica, completa aposição de ansa duodenal D3 à prótese de Dacron. Foi operado com excisão total da prótese, exclusão da fistula através de uma doudenojejunostomia e reconstrução in situ com enxerto biológico tubular em Y com tubo de pericárdio bovino e artérias femorais superficiais endartrectomizadas ex vivo. Teve alta após 45 dias de antibiótico endovenoso e com bom estado geral. Discussão e Conclusão: Os doentes com infeção aórtica apresentam um estado frágil e com alto risco de mortalidade e morbilidade. Devido ás suas propriedades de disponibilidade imediata, manuseio fácil, baixo risco de reinfeção e durabilidade, os enxertos de pericárdio bovino são uma opção útil na reconstrução urgente de infeções vasculares.

A terapêutica antitrombótica: atual e em desenvolvimento

A trombose é uma das principais causas de morte e o crescente conhecimento das alterac¸ões fisiopatológicas inerentes permitiu o desenvolvimento de terapêuticas eficazes (antiagregante, anticoagulante e fibrinolítico) para a prevenc¸ão e tratamentos da doenc¸a tromboembólica. Contudo, uma compreensão melhor do processo subjacente é fundamental para o desenvolvimento de novos agentes terapêuticos mais seguros e eficazes. O objetivo da presente revisão é sumarizar os tratamentos atuais disponíveis, e destacar os novos agentes e o seu papel comprovado ou eventual na cirurgia vascular

Survivorship of Anopheles darlingi (Diptera: Culicidae) in Relation with Malaria Incidence in the Brazilian Amazon

We performed a longitudinal study of adult survival of Anopheles darlingi, the most important vector in the Amazon, in a malarigenous frontier zone of Brazil. Survival rates were determined from both parous rates and multiparous dissections. Anopheles darlingi human biting rates, daily survival rates and expectation of life where higher in the dry season, as compared to the rainy season, and were correlated with malaria incidence. The biting density of mosquitoes that had survived long enough for completing at least one sporogonic cycle was related with the number of malaria cases by linear regression. Survival rates were the limiting factor explaining longitudinal variations in Plasmodium vivax malaria incidence and the association between adult mosquito survival and malaria was statistically significant by logistic regression (P<0.05). Survival rates were better correlated with malaria incidence than adult mosquito biting density. Mathematical modeling showed that P. falciparum and P. malariae were more vulnerable to changes in mosquito survival rates because of longer sporogonic cycle duration, as compared to P. vivax, which could account for the low prevalence of the former parasites observed in the study area. Population modeling also showed that the observed decreases in human biting rates in the wet season could be entirely explained by decreases in survival rates, suggesting that decreased breeding did not occur in the wet season, at the sites where adult mosquitoes were collected. For the first time in the literature, multivariate methods detected a statistically significant inverse relation (P<0.05) between the number of rainy days per month and daily survival rates, suggesting that rainfall may cause adult mortality

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio

Efecto de los antimaláricos sobre los diferentes dominios del índice de daño SLICC en pacientes de la cohorte GLADEL

Objetivos: estimar el efecto de los antimaláricos (AM) sobre los diferentes dominios del índice de daño SLICC (SDI). Métodos: se estudiaron pacientes con diagnóstico clínico reciente (≤2 años) de lupus eritematoso sistémico (LES) de la cohorte GLADEL

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis