INCIDÊNCIA DE TROMBOSE VENOSA PROFUNDA EM JOELHO FLUTUANTE

Objective: To report the incidence between Deep Vein Thrombosis (DVT) in ipsilateral femur and tibia fractures (floating knee), considering its relation with hospitalization time, fracture classification, treatment implemented and comorbidities. Methods: This is a retrospective observational analytical study using the medical charts of thirty patients admitted with floating knee to a trauma hospital between October 2016 and July 2017. Results: Of the 30 patients assessed, 25 (83%) were men and 5 (17%) women. The most affected age range was between 21 and 30 years (36%). The dominant limb was affected in 17 (57%) patients. A total of 19 (63%) patients were classified as Fraser type I, 18 (60%) had open (compound) fractures, 16 (53%) fractures of the tibia and 8 (26%) of the femur. The most widely used emergency treatment was external fixation of the femur and tibia (25 patients = 83%). Seven patients used a femur plate and external fixator in the tibia as definitive treatment. Of the 30 patients studied, 14 (46%) suffered infectious complications, 9 (30%) superficial and 5 (16%) deep. Deep venous thrombosis was observed in 17% of patients (p=0.409).  Conclusion: Despite the use of antithrombotic prophylaxis, there was a high incidence of DVT in the affected limb of patients with floating knee. Fraser I fractures, being male and the non-dominant limb increases the likelihood of developing DVT. Level of Evidence: Level IObjetivo: Relatar a incidência de trombose venosa profunda (TVP) em fratura ipsilateral de fêmur e tíbia (joelho flutuante), levando-se em conta sua relação com o tempo de internação, com a classificação da fratura, o tempo para fazer o procedimento cirúrgico, o tratamento implementado e com as comorbidades. Materiais e métodos: Realizado um estudo retrospectivo, observacional e analítico por meio da avaliação de prontuários de trinta pacientes admitidos com joelho flutuante em um hospital de trauma durante o período de outubro de 2016 a julho de 2017.  Resultados: Dos 30 pacientes avaliados, foi observado que 25 (83%) dos pacientes eram do gênero masculino e 5 (17%) dos pacientes eram do gênero feminino. A faixa etária mais acometida foi entre 21 e 30 anos (36%). O acometimento do membro dominante ocorreu em 17 (57%) dos pacientes avaliados. Dezenove (63%) pacientes acometidos foram classificados como Fraser Tipo I. Dezoito (60%) pacientes tiveram fratura exposta, sendo 16 (53%) em tíbia e 8 (26%) em fêmur. O tratamento mais utilizado como urgência foi o de controle de danos com fixador externo em fêmur e tíbia (25 pacientes ou 83%). Sete pacientes utilizaram placa no fêmur e fixador externo na tíbia como tratamento definitivo. Dos 30 pacientes estudados, 14 (46%) tiveram complicações infecciosas, sendo 9 (30%) superficiais e 5 (16%) profundas. Observamos trombose venosa profunda em 17% dos pacientes (p=0,409).  Conclusão: Apesar do uso da profilaxia antitrombótica medicamentosa, houve uma grande incidência de TVP no membro acometido em pacientes com joelho flutuante na população estudada. As fraturas classificadas como Fraser I, pacientes do sexo masculino e o membro não dominante levaram ao aumento da probabilidade do surgimento de TVP. Nível de Evidência: Nível

COVID-19 in Brazil: advantages of a socialized unified health system and preparation to contain cases

oai:ops.preprints.scielo.org:preprint/7The outbreak of new coronavirus disease 2019 (COVID-19) reported for the first time in Wuhan, China in late December 2019 have rapidly spread to other countries and it was declared on January 30, 2020 as a public health emergency of international concern (PHEIC) by the World Health Organization. Before the first COVID-19 cases were reported in Brazil, several measures have been implemented including the adjustment of legal framework to carry out isolation and quarantine. As the cases increased significantly, new measures, mainly to reduce mortality and severe cases, have also been implemented. Rapid and robust preparedness actions have been undertaken in Brazil while first cases have not yet been identified in Latin-American. The outcome of this early preparation should be analyzed in future studies

Os impactos da pandemia de Coronavírus na Saúde mental de enfermeiros

Introduction: This work is based on concerns related to the increase in mental health impact rates that have been affecting nursing professionals, and which are mainly highlighted during the COVID-19 pandemic. Objective: To produce a theoretical reflection on emotional exhaustion in the hospital environment of nurses in the face of the pandemic. Methodology: This is an Integrative Literature Review (RIL) or was developed through a search for publications obtained in the databases: LILACS and VHL. The descriptors of mental health, nursing and coronavirus infections were used. Finally, 06 publications were chosen to compose the study. Results: During the research, it became clear how, in times of COVID-19, nurses have been developing considerable problems in their mental health, such as stress, fatigue, anxiety and even depression. This can be caused by work overload, as well as fatigue, both physical and mental, the feeling of incapacity and professional uncertainty. Final considerations: Therefore, it is important to ensure attention to the psycho-emotional health of nurses, supported by interventions aimed at better space and working conditions.Introdução: Este trabalho parte da inquietação relacionada aos acréscimos das taxas de impactos na saúde mental que vem afetando os profissionais da enfermagem, e que durante a pandemia da COVID-19 estão principalmente acentuadas. Objetivo: Produzir uma reflexão teórica sobre o esgotamento emocional no ambiente hospitalar dos enfermeiros frente à pandemia. Metodologia: Trata-se de uma Revisão Integrativa da Literatura (RIL) o qual foi desenvolvido mediante a busca de publicações obtidas nas bases de dados: LILACS e BVS. Foram utilizados os descritores de saúde mental, enfermagem e infecções por coronavírus. Por fim, optou-se por 06 publicações para compor o estudo. Resultados: No decorrer da pesquisa, foi tornando-se notório como, em tempos de COVID-19, os enfermeiros vêm desenvolvendo inúmeros problemas em sua saúde mental, tais como estresse, fadiga, ansiedade e até mesmo depressão. Isso pode ser ocasionado pela sobrecarga de trabalho, bem como pelo cansaço, tanto físico como mental, pela sensação de incapacidade e incerteza profissional. Considerações finais: Constata-se, portanto, a importância em   garantir uma atenção para a saúde psicoemocional do enfermeiro(a), apoiado em intervenções que visem um melhor espaço e condições de trabalho

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

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

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 understanding 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,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 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 underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities 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 organism 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 neglected 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 lost