The role of maxillary sinus puncture on the diagnosis and treatment of patients with hospital-acquired rhinosinusitis

Rhinosinusitis is one of the most commom causes of fever of unknown origin in critically ill patients and should be systematically searched. OBJECTIVE: This study aims to evaluate the diagnostic and therapeutic effect of maxillary sinus puncture performed at the bedside in patients with infective rhinosinusitis hospitalized in an Intensive Care Unit of a high complexity care hospital. MATERIALS AND METHODS: This retrospective study looks into patients on mechanical ventilation with fever of unknown origin and signs of rhinosinusitis on CT images who were submitted to inferior meatus maxillary sinus puncture. RESULTS: The total study sample consisted of 27 patients (70.3% male; mean age 45.3 years). The most common Intensive Care Unit admission diagnoses were head trauma and stroke. CT scans revealed the maxillary (85.2%) and sphenoid (74.1%) sinuses were the most involved paranasal sinuses. Middle meatus purulent drainage was seen in 30.7% of the nasal cavities. Fever was reduced in 70.4% of the patients after puncture (p < 0.001). The most commonly found organisms in sinus aspirates were Pseudomonas aeruginosa and Acinetobacter baumannii. CONCLUSION: Maxillary sinus puncture performed at the bedside of the patients is an important diagnostic and theraupetic tool for critically ill patients.A rinossinusite é uma das principais causas de febre em pacientes críticos e deve ser sistematicamente pesquisada. OBJETIVO: Avaliar o impacto da punção do seio maxilar à beira leito, no diagnóstico e no tratamento dos pacientes com rinossinusite infecciosa internados em Unidade de Terapia Intensiva de um hospital universitário de alta complexidade. MATERIAIS E MÉTODOS: Estudo retrospectivo que avaliou os pacientes em ventilação mecânica com febre de origem indeterminada e sinais tomográficos de rinossinusite submetidos à punção do seio maxilar pelo meato inferior. RESULTADOS: A amostra total do estudo consistiu de 27 pacientes (70,3% do sexo masculino com média de idade 45,3 anos). Os diagnósticos de admissão mais frequentes na Unidade de Terapia Intensiva foram Trauma Crânio Encefálico e Acidente Vascular Cerebral. No exame tomográfico, os seios paranasais mais acometidos foram o maxilar, em 85,2%, e esfenoidal, em 74,1%. A secreção purulenta foi visualizada no meato médio em 30,7% das fossas nasais. Os microrganismos mais frequentes nos aspirados dos seios foram Pseudomonas aeruginosa e Acinetobacter baumannii. CONCLUSÃO: A punção do seio maxilar à beira leito demonstrou-se uma importante ferramenta diagnóstica e terapêutica nos pacientes de UTI com rinossinusite hospitalar, submetidos à ventilação mecânica invasiva.UNIFESP-EPMUNIFESP-EPM setor de RinologiaUNIFESP, EPM, setor de RinologiaSciEL

Functional independence index of patients submitted to multiprofessional rehabilitation program after cerebrovascular accident

A cerebrovascular accident (CVA) can cause death or motor and functional consequences of variable intensity. This study analyzed the rate of functional independence of patients after a cerebrovascular accident and a multi professional rehabilitation program. This was a retrospective research analyzing the medical charts of middle cerebral artery stroke survivors, admitted to a public hospital at Curitiba-Paraná between 2014 and 2019. The participants were analyzed at admission and discharge using the Modified Rankin Scale (mRS). The Chi-Squared test, Mann-Whitney test and Wilcoxon tests were applied, considering p&lt;0.05%. The sample was composed of 64 patients, mainly men (56%), with a mean age of 59 years old. The main stroke sequelae were motor deficit (98%), dysarthria (51%), aphasia (46%), pain (45%) and urinary incontinence (42%). There was a significant difference between the mRS scores at admission and discharge, with greater functional independence after the proposed rehabilitation program (p &lt;0.001). It is concluded that participation in the program led to increased autonomy in self-care and daily activities for the patients.Acidente Vascular Cerebral (AVC) pode causar óbito ou sequelas motoras e funcionais de intensidade variável. O objetivo do estudo foi avaliar o índice de independência funcional de pacientes pós-Acidente Vascular Cerebral submetidos a um programa de reabilitação multiprofissional. Trata-se de estudo retrospectivo por meio de revisão dos prontuários de sobreviventes de lesão vascular na artéria cerebral média, admitidos entre 2014 e 2019 em hospital público de Curitiba - Paraná, e que foram analisados na admissão e na alta por meio da Escala de Rankin modificada (mRS). Foram aplicados teste Qui-Quadrado, Mann-Whitney e Wilcoxon, considerando p &lt; 0,05 %. A amostra, composta por 64 pacientes, teve predomínio masculino (56 %), faixa etária média de 59 anos, e apresentou como sequelas principais déficit motor (98 %), disartria (51 %), afasia (46 %), dor (45 %) e incontinência urinária (42 %). Houve diferença significativa entre os escores aferidos por meio da mRS na admissão e na alta, com maior independência funcional após realização do programa de reabilitação proposto (p &lt; 0,001). Conclui-se que a participação no programa refletiu em ganho de autonomia no autocuidado e na realização de atividades diárias pelos pacientes

Daily Optical Coherence Tomography Examinations after First Antivascular Endothelial Growth Factor Injections: An Interventional Case Series

Purpose. To evaluate daily spectral-domain optical coherence tomography (SD-OCT) changes in naive-treatment patients with diagnosis of exudative age-related macular degeneration (AMD) treated with intravitreous bevacizumab (1.25 mg), during a 30-day follow-up period. Methods. In prospective, interventional study, SD-OCT was performed daily for 30 days after the first intravitreal injection. The baseline, initial-decrease, minimal, and final central retinal thicknesses (CRTs) were assessed. Results. Nine eyes of nine patients with neovascular AMD were enrolled. The mean baseline CRT was 625.3±182.5 μm, and the mean final CRT was 383.4±163.0 μm (mean difference, 206.1±167.6 μm), a difference that reached significance (P=0.006). After the first injection, the initial decrease in the CRT was seen as an average of one day after injection (mean CRT, 503.6±189.10 μm; P=0.0431). The speed of the reduction in the CRT tended to decrease by day 17. The mean CRT was 336.5±105.44 μm and the mean minimal CRT on day 30 was 320.75±96.38 μm. Conclusion. The CRT decreased early after the first injection. We observed a tendency for reductions in the speed with which the CRT decreased by day 17 after the first injection, which may affect retreatment regime

Imaging transcription factors dynamics with advanced fluorescence microscopy methods

Pluripotent stem cells (PSCs) are capable of self-renewing and producing all cell types derived from the three germ layers in response to developmental cues, constituting an important promise for regenerative medicine. Pluripotency depends on specific transcription factors (TFs) that induce genes required to preserve the undifferentiated state and repress other genes related to differentiation. The transcription machinery and regulatory components such as TFs are recruited dynamically on their target genes making it essential exploring their dynamics in living cells to understand the transcriptional output. Non-invasive and very sensitive fluorescence microscopy methods are making it possible visualizing the dynamics of TFs in living specimens, complementing the information extracted from studies in fixed specimens and bulk assays. In this work, we briefly describe the basis of these microscopy methods and review how they contributed to our knowledge of the function of TFs relevant to embryo development and cell differentiation in a variety of systems ranging from single cells to whole organisms.Fil: Verneri, Paula. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Romero, Juan José. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: de Rossi, María Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Alvarez, Yanina Daniela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Oses Oliveto, Camila Maite. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Guberman, Alejandra Sonia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Levi, Valeria. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentin

Cyclin B1 is essential for mitosis in mouse embryos, and its nuclear export sets the time for mitosis.

There is remarkable redundancy between the Cyclin-Cdk complexes that comprise the cell cycle machinery. None of the mammalian A-, D-, or E-type cyclins are required in development until implantation, and only Cdk1 is essential for early cell divisions. Cyclin B1 is essential for development, but whether it is required for cell division is contentious. Here, we used a novel imaging approach to analyze Cyclin B1-null embryos from fertilization onward. We show that Cyclin B1-/- embryos arrest in G2 phase after just two divisions. This is the earliest arrest of any Cyclin known and places Cyclin B1 with cdk1 as the essential regulators of the cell cycle. We reintroduced mutant proteins into this genetically null background to determine why Cyclin B1 is constantly exported from the nucleus. We found that Cyclin B1 must be exported from the nucleus for the cell to prevent premature entry to mitosis, and retaining Cyclin B1-Cdk1 at the plasma membrane precludes entry to mitosis

Genomic Changes of Chagas Disease Vector, South America

We analyzed the main karyologic changes that have occurred during the dispersion of Triatoma infestans, the main vector of Chagas disease. We identified two allopatric groups, named Andean and non-Andean. The Andean specimens present C-heterochromatic blocks in most of their 22 chromosomes, whereas non-Andean specimens have only 4–7 autosomes with C-banding. These heterochromatin differences are the likely cause of a striking DNA content variation (approximately 30%) between Andean and non-Andean insects. Our study, together with previous historical and genetic data, suggests that T. infestans was originally a sylvatic species, with large quantities of DNA and heterochromatin, inhabiting the Andean region of Bolivia. However, the spread of domestic T. infestans throughout the non-Andean regions only involved insects with an important reduction of heterochromatin and DNA amounts. We propose that heterochromatin and DNA variation mainly reflected adaptive genomic changes that contribute to the ability of T. infestans to survive, reproduce, and disperse in different environments

Sublethal RNA Oxidation as a Mechanism for Neurodegenerative Disease

Although cellular RNA is subjected to the same oxidative insults as DNA and other cellular macromolecules, oxidative damage to RNA has not been a major focus in investigations of the biological consequences of free radical damage. In fact, because it is largely single-stranded and its bases lack the protection of hydrogen bonding and binding by specific proteins, RNA may be more susceptible to oxidative insults than is DNA. Oxidative damage to protein-coding RNA or non-coding RNA will, in turn, potentially cause errors in proteins and/or dysregulation of gene expression. While less lethal than mutations in the genome, such sublethal insults to cells might be associated with underlying mechanisms of several chronic diseases, including neurodegenerative disease. Recently, oxidative RNA damage has been described in several neurodegenerative diseases including Alzheimer disease, Parkinson disease, dementia with Lewy bodies, and prion diseases. Of particular interest, oxidative RNA damage can be demonstrated in vulnerable neurons early in disease, suggesting that RNA oxidation may actively contribute to the onset of the disease. An increasing body of evidence suggests that, mechanistically speaking, the detrimental effects of oxidative RNA damage to protein synthesis are attenuated, at least in part, by the existence of protective mechanisms that prevent the incorporation of the damaged ribonucleotides into the translational machinery. Further investigations aimed at understanding the processing mechanisms related to oxidative RNA damage and its consequences may provide significant insights into the pathogenesis of neurodegenerative and other degenerative diseases and lead to better therapeutic strategies

A microleakage study of gutta-percha/AH Plus and Resilon/Real self-etch systems after different irrigation protocols

The development and maintenance of the sealing of the root canal system is the key to the success of root canal treatment. The resin-based adhesive material has the potential to reduce the microleakage of the root canal because of its adhesive properties and penetration into dentinal walls. Moreover, the irrigation protocols may have an influence on the adhesiveness of resin-based sealers to root dentin. Objective: The objective of the present study was to evaluate the effect of different irrigant protocols on coronal bacterial microleakage of gutta-percha/AH Plus and Resilon/Real Seal Self-etch systems. Material and Methods: One hundred ninety pre-molars were used. The teeth were divided into 18 experimental groups according to the irrigation protocols and filling materials used. The protocols used were: distilled water; sodium hypochlorite (NaOCl)+eDTA; NaOCl+H3PO4; NaOCl+eDTA+chlorhexidine (CHX); NaOCl+H3PO4+CHX; CHX+eDTA; CHX+ H3PO4; CHX+eDTA+CHX and CHX+H3PO4+CHX. Gutta-percha/AH Plus or Resilon/Real Seal Se were used as root-filling materials. The coronal microleakage was evaluated for 90 days against Enterococcus faecalis. Data were statistically analyzed using Kaplan-Meier survival test, Kruskal-Wallis and Mann-Whitney tests. Results: No significant difference was verified in the groups using chlorhexidine or sodium hypochlorite during the chemo-mechanical preparation followed by eDTA or phosphoric acid for smear layer removal. The same results were found for filling materials. However, the statistical analyses revealed that a final flush with 2% chlorhexidine reduced significantly the coronal microleakage. Conclusion: A final flush with 2% chlorhexidine after smear layer removal reduces coronal microleakage of teeth filled with gutta-percha/AH Plus or Resilon/Real Seal SE

Effects of dietary nitrate supplementation on microvascular physiology at 4559 m altitude – a randomised controlled trial (Xtreme Alps)

Native highlanders (e.g. Sherpa) demonstrate remarkable hypoxic tolerance, possibly secondary to higher levels of circulating nitric oxide (NO) and increased microcirculatory blood flow. As part of the Xtreme Alps study (a randomised placebo-controlled trial of dietary nitrate supplementation under field conditions of hypobaric hypoxia), we investigated whether dietary supplementation with nitrate could improve NO availability and microvascular blood flow in lowlanders. Plasma measurements of nitrate, nitrite and nitroso species were performed together with measurements of sublingual (sidestream dark-field camera) and forearm blood flow (venous occlusion plethysmography) in 28 healthy adult volunteers resident at 4559 m for 1 week; half receiving a beetroot-based high-nitrate supplement and half receiving an identically-tasting low nitrate 'placebo'. Dietary supplementation increased plasma nitrate concentrations 4-fold compared to the placebo group, both at sea level (SL; 19.2 vs 76.9 μM) and at day 5 (D5) of high altitude (22.9 vs 84.3 μM,

Perspectivas epidemiológicas, clínicas e terapêuticas do transtorno bipolar em comorbidade com o uso de drogas: revisão de sistemática: Epidemiological, clinical and therapeutic perspectives of bipolar disorder in comorbidity with drug use: a systematic review

Conhecida como transtorno maníaco-depressivo, atualmente possui um novo nome: Transtorno Afetivo Bipolar, visto que com o passar do tempo foi se percebendo que esse transtorno não se tratava de uma alteração psicótica, e mais de um prejuízo afetivo. O transtorno bipolar possui alguns tipos, não se caracterizando em apenas uma forma, sua manifestação varia conforme o indivíduo e suas tendências, disforia e/ou euforia porém independente da forma expressa o paciente bipolar pode ter sua vida social comprometida, se não tratada, visto a irregularidade no estado de humor; bem como pode fazer uso de substâncias psicoativas, o que prejudica a sua condição clínica. Objetivo central da pesquisa é de apresentar a correlação do transtorno bipolar com o uso de drogas, mediante uma revisão de literatura integrativa realizada entre os meses de março de 2022 a julho de 2022, através da busca de artigos científicos nos bancos de dados online PubMed, Scielo e Google Acadêmico, utilizando como critério de refinamento de pesquisa artigos de todas as línguas publicados entre os anos 2000 e 2022