Síndrome da Rede Axilar após Tratamento para Câncer de Mama: Revisão Sistemática com Metanálise

Introdução: O câncer de mama é o mais incidente nas mulheres e a cirurgia é o principal tratamento de escolha. A síndrome da rede axilar (SRA) é uma condição recorrente que ocorre em até 86% das pacientes após cirurgia, se apresenta como um único cordão ou múltiplos cordões nos tecidos subcutâneos da axila ipsilateral e gera dor e limitação do movimento. Objetivo: Investigar estudos sobre a ocorrência e fatores associados à SRA após tratamento do câncer de mama. Método: Revisão sistemática com metanálise, nas bases de dados PubMed, LILACS e EMBASE, com a metodologia PECOS, seguindo a diretriz PRISMA. Resultados: Cinco artigos foram selecionados, com taxa de ocorrência da SRA de 35%. Os fatores associados encontrados apresentaram um menor risco relativo (RR) de recorrência para quem realizou biópsia de linfonodo sentinela em comparação aos que se submeteram à dissecção axilar (RR 0,49; IC 95% [0,42; 0,57] I²=95%, p=0,01). Houve uma variação de 35% a 39% de desenvolvimento para a SRA em pacientes que se submeteram à quimioterapia e radioterapia, porém o tipo de cirurgia não teve resultado estatisticamente significativo para o desencadeamento da síndrome. Conclusão: Indivíduos que realizaram biópsia de linfonodo sentinela têm menos chance de desenvolver a SRA quando comparados aos que fizeram dissecção axilar. As terapias oncológicas apresentaram proporções parecidas de aparecimento da SRA e o tipo de cirurgia não interferiu na evolução da patologia

Homozygous and Heterozygous Nuclear Lamin A p.R582C Mutation: Different Lipodystrophic Phenotypes in the Same Kindred

Background: Dunnigan-type familial partial lipodystrophy (FPLD2) is a rare autosomal dominant disease caused by heterozygous mutations in the LMNA gene that results in regional loss of subcutaneous adipose tissue with onset in puberty. However, a generalized lipodystrophy phenotype has also been associated with heterozygous mutations in this gene, demonstrating the noticeable phenotypic heterogeneity of this disease.Methods: We report and describe clinical and metabolic features of four patients from the same family with the p.R582C LMNA mutation, three homozygous and one in the heterozygous state that present with three distinct lipodystrophic phenotypes.Results: Case description: The proband was a 12-year-old girl who developed severe subcutaneous fat atrophy in limbs and abdomen followed by a remarkable dorsocervical fat accumulation in adulthood along with diabetes at age 23. The proband's sister was a phenotypically normal girl who developed hypertriglyceridemia at age 8, progressive features of partial lipodystrophy at age 11, and diabetes at age 22. The proband's mother was first examined at age 32, presenting diabetes and a severe generalized lipodystrophic phenotype; she developed kidney failure at age 41 and died due to diabetic complications. The proband's father was a 50-year-old man with abdominal fat concentration that was initially considered phenotypically normal. Massively parallel sequencing using a platform of genes related to genetic lipodystrophies, followed by Sanger sequencing, revealed the transversion c.1744C>T at exon 11 of the LMNA gene (p.R582C) in the homozygous (mother and daughters) and heterozygous (father) states.Conclusion: We documented three distinct phenotypes of the homozygous and heterozygous p. R582C LMNA mutation in the same kindred, illustrating that FPLD2 linked to mutations in this gene is a disease of great clinical heterogeneity, possibly due to associated environmental or genetic factors

Uma capitania dos novos tempos: economia, sociedade e política na São Paulo restaurada (1765-1822)

O artigo reflete sobre a trajetória da Capitania de São Paulo, a partir de 1750, apontando sua transformação, de fronteira e "boca do sertão", para território estratégico da conquista e defesa das partes meridionais e área economicamente integrada aos circuitos mercantis atlânticos.In this article, we reflect upon the history of the Captaincy of São Paulo as from 1750, drawing attention to its transformation from frontier land and "door to the backcountry" into a territory of strategic value for the purposes of conquest and defense of the southern regions, and economically integrated into the Atlantic trade routes

Impactos na Saúde Associados ao Uso de Psicoestimulantes: Uma Revisão Sistemática

This article conducts a systematic review of health impacts associated with the use of psychostimulants, encompassing clinical and recreational contexts. The introduction emphasizes the relevance of the topic given the prevalence of these substances and the need to understand their comprehensive effects. The methodology employed involved an extensive literature search on platforms such as PubMed and Scopus, establishing clear inclusion/exclusion criteria, and applying rigorous assessment of the quality of selected studies. In the discussion, we explore the therapeutic benefits of these psychostimulants, highlighting their efficacy in treating conditions such as Attention-Deficit/Hyperactivity Disorder (ADHD). However, the analysis also covers physical and mental risks, especially when these substances are used outside the medical context, demonstrating associations with cardiovascular complications and psychiatric disorders. The crucial differentiation between therapeutic and recreational use is emphasized, underscoring the importance of an individualized assessment to understand the risks and benefits associated with each usage context. The conclusion emphasizes the need for clarity in communication about the use of psychostimulants, a careful evaluation of long-term impacts, and the implementation of public health strategies sensitive to social and cultural influences. This work contributes to a comprehensive understanding of health impacts related to psychostimulants, providing valuable insights for healthcare professionals, researchers, and policymakers in managing these substances in different contexts.Este artigo realiza uma revisão sistemática dos impactos na saúde associados ao uso de psicoestimulantes, abrangendo contextos clínicos e recreativos. A introdução destaca a relevância do tema diante da prevalência dessas substâncias e da necessidade de compreender seus efeitos abrangentes. A metodologia adotada envolveu uma busca bibliográfica extensiva em bases como PubMed e Scopus, estabelecendo critérios claros de inclusão/exclusão e aplicando uma avaliação rigorosa da qualidade dos estudos selecionados. Na discussão, exploramos os benefícios terapêuticos desses psicoestimulantes, evidenciando sua eficácia no tratamento de condições como o Transtorno de Déficit de Atenção e Hiperatividade (TDAH). Contudo, a análise abrange também os riscos físicos e mentais, especialmente quando essas substâncias são utilizadas fora do contexto médico, evidenciando a associação com complicações cardiovasculares e transtornos psiquiátricos. A diferenciação crucial entre o uso terapêutico e o recreativo é destacada, enfatizando a importância de uma avaliação individualizada para compreender os riscos e benefícios associados a cada contexto de uso. A conclusão ressalta a necessidade de clareza na comunicação sobre o uso de psicoestimulantes, uma avaliação cuidadosa dos impactos a longo prazo e a implementação de estratégias de saúde pública sensíveis às influências sociais e culturais. Este trabalho contribui para a compreensão abrangente dos impactos na saúde relacionados a psicoestimulantes, fornecendo insights valiosos para profissionais de saúde, pesquisadores e formuladores de políticas no manejo dessas substâncias em diferentes contextos

Diagnóstico diferencial da Síndrome de Takotsubo e infarto agudo do miocárdio: uma revisão sistemática: Differential diagnosis of Takotsubo Syndrome and acute myocardial infarction: a systematic review

A cardiomiopatia de Takotsubo e o infarto agudo do miocárdio compartilham apresentação clínica e risco de morte semelhantes, embora uma das diferenças mais importantes seja a ausência de doença coronariana obstrutiva na cardiomiopatia de Takotsubo. Neste estudo, tem-se como objetivo analisar a literatura disponível avaliando o diagnóstico diferencial entre pacientes com CTT em comparação com pacientes com infarto agudo do miocárdio. Para isso, foi realizada uma revisão sistemática, utilizando-se a Pubmed e a Medline como base de dados. A partir da análise dos estudos e interpretação de suas principais descobertas, concluiu-se que para pacientes com CTT, outras condições e comorbidades, em vez de apenas dislipidemia e/ou outros fatores de risco estabelecidos, sejam responsáveis por um risco de morte comparável ao de IAM. No entanto, as conclusões desse estudo têm várias limitaçõe

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

Consistent patterns of common species across tropical tree communities

Trees structure the Earth’s most biodiverse ecosystem, tropical forests. The vast number of tree species presents a formidable challenge to understanding these forests, including their response to environmental change, as very little is known about most tropical tree species. A focus on the common species may circumvent this challenge. Here we investigate abundance patterns of common tree species using inventory data on 1,003,805 trees with trunk diameters of at least 10 cm across 1,568 locations1,2,3,4,5,6 in closed-canopy, structurally intact old-growth tropical forests in Africa, Amazonia and Southeast Asia. We estimate that 2.2%, 2.2% and 2.3% of species comprise 50% of the tropical trees in these regions, respectively. Extrapolating across all closed-canopy tropical forests, we estimate that just 1,053 species comprise half of Earth’s 800 billion tropical trees with trunk diameters of at least 10 cm. Despite differing biogeographic, climatic and anthropogenic histories7, we find notably consistent patterns of common species and species abundance distributions across the continents. This suggests that fundamental mechanisms of tree community assembly may apply to all tropical forests. Resampling analyses show that the most common species are likely to belong to a manageable list of known species, enabling targeted efforts to understand their ecology. Although they do not detract from the importance of rare species, our results open new opportunities to understand the world’s most diverse forests, including modelling their response to environmental change, by focusing on the common species that constitute the majority of their trees.Publisher PDFPeer reviewe

Assessment of risk scores to predict mortality of COVID-19 patients admitted to the intensive care unit

ObjectivesTo assess the ABC2-SPH score in predicting COVID-19 in-hospital mortality, during intensive care unit (ICU) admission, and to compare its performance with other scores (SOFA, SAPS-3, NEWS2, 4C Mortality Score, SOARS, CURB-65, modified CHA2DS2-VASc, and a novel severity score).Materials and methodsConsecutive patients (≥ 18 years) with laboratory-confirmed COVID-19 admitted to ICUs of 25 hospitals, located in 17 Brazilian cities, from October 2020 to March 2022, were included. Overall performance of the scores was evaluated using the Brier score. ABC2-SPH was used as the reference score, and comparisons between ABC2-SPH and the other scores were performed by using the Bonferroni method of correction. The primary outcome was in-hospital mortality.ResultsABC2-SPH had an area under the curve of 0.716 (95% CI 0.693–0.738), significantly higher than CURB-65, SOFA, NEWS2, SOARS, and modified CHA2DS2-VASc scores. There was no statistically significant difference between ABC2-SPH and SAPS-3, 4C Mortality Score, and the novel severity score.ConclusionABC2-SPH was superior to other risk scores, but it still did not demonstrate an excellent predictive ability for mortality in critically ill COVID-19 patients. Our results indicate the need to develop a new score, for this subset of patients

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection