Identificação de pacientes idosos com maior risco para delirium no departamento de emergência

O delirium é uma disfunção cerebral aguda associada a um aumento na mortalidade, hospitalização prolongada e diminuição dos resultados funcionais. O diagnóstico de delirium no departamento de emergência (DE) é frequentemente perdido, e a triagem para delirium tem sido proposta como uma solução para aumentar seu diagnóstico. Nesta tese de doutorado, foi realizada uma revisão sistemática para identificar potenciais fatores de risco para delirium e implementado um protocolo de triagem utilizando o Delirium Triage Screen (DTS) seguido do Brief Confusion Assessment Method (bCAM) para pacientes do DE. Além disso, foi desenvolvido um escore de estratificação de risco utilizando variáveis clínicas disponíveis no momento da visita ao DE para identificar pacientes de alto risco para delirium. Também foi avaliado se intervenções realizadas no DE, como cateterização vesical ou administração de opioides ou benzodiazepínicos, aumentaram o risco de desenvolver delirium durante a internação hospitalar. Por fim, a associação entre delirium e aumento da mortalidade foi investigada para entender melhor o prognóstico desses pacientes. Os resultados desta tese demonstraram que é possível identificar subgrupos de idosos com maior risco para delirium na emergência, o que pode ser utilizado para otimizar a identificação precoce desses pacientes. É importante destacar que o delirium está associado a um prognóstico ruim, com aumento da mortalidade e piora dos resultados funcionais. Portanto, é fundamental que os profissionais de saúde coloquem mais esforços na triagem de pacientes de alto risco para delirium, a fim de melhorar o prognóstico desses pacientes.Delirium is an acute brain dysfunction associated with increased mortality, prolonged hospitalization, and decreased functional outcomes. The diagnosis of delirium in the emergency department (ED) is often missed, and screening for delirium has been proposed as a solution to increase its diagnosis. In this doctoral thesis, a systematic review was conducted to identify potential risk factors for delirium, and a screening protocol was implemented using the Delirium Triage Screen (DTS) followed by the Brief Confusion Assessment Method (bCAM) for ED patients. Additionally, a risk stratification score was developed using clinical variables available at the time of the ED visit to identify high-risk patients for delirium. The study also evaluated whether interventions performed in the ED, such as bladder catheterization or administration of opioids or benzodiazepines, increased the risk of developing delirium during hospitalization. Finally, the association between delirium and increased mortality was investigated to better understand the prognosis of these patients. The results of this thesis demonstrated that it is possible to identify subgroups of older adults with a higher risk of delirium in the ED, which can be used to optimize early identification of these patients. It is important to highlight that delirium is associated with a poor prognosis, including increased mortality and worsening functional outcomes. Therefore, healthcare professionals should put more efforts into screening high-risk patients for delirium

NMR Relaxation by Redfield's equation in a spin system I=7/2I=7/2

Redfield's master equation is solved analytically for a nuclear system with spin $I=7/2$. The solutions of each density matrix element are computed using the irreducible tensor operator basis. The $^{133}$Cs nuclei of the caesium-pentadecafluorooctanoate molecule in a lyotropic liquid crystal sample at the nematic phase and at room temperature was used as an experimental setup. Experimental longitudinal and transverse magnetization dynamics of the $^{133}$Cs nuclei signal were monitored and by numerical procedures the theoretical approach generates valuable mathematical expressions with the highest accuracy. The methodology introduced could be extended without major difficulties to other nuclei species

Increasing the reaction kinetics of alkali-activated fly ash binders for stabilisation of a silty sand pavement sub-base

The paper addresses several options to improve the reaction kinetics of alkali-activated low-calcium fly ash binders for soil stabilisation in road platforms. For that purpose, an experimental programme was established to assess the strength evolution, with time, of different binders, based on ash, lime, sodium chloride and alkali solutions, applied in the stabilisation of a silty sand. The tests included unconfined compression strength tests, triaxial tests and seismic wave measurements performed at different curing periods. The results were compared with a binder made of Portland cement and a commercial additive specifically designed for soil stabilisation in road applications. The activated ash mixtures with lime were the most performing producing a significant increase in the reactions development and, consequently, in the strength gain rate. The sodium chloride significantly improved the lime and lime-ash mixtures, but provided only a slight improvement in the activated ash mixtures.The authors would like to acknowledge the company CJR Wind – Energy for life, for the funding which enable the presented research; the MCTES/FCT (Portuguese Science and Technology Foundation of Portuguese Ministry of Science and Technology) for their financial support through the SFRH/BPD/85863/2012 scholarship, which is co-funded by the European Social Fund by POCH program; and the Microscopy Unit of the University of Trás- os-Montes e Alto Douro. In addition, a special acknowledgment is also due to PEGOP – Energy Eléctrica, S.A. and LUSICAL – Companhia Lusitana de Cal, S.A. for providing respectively fly ash and lime for this study

A recuperação de informação em trabalhos apresentados em encontros nacionais e regionais de estudantes de biblioteconomia, documentação, ciência e gestão da informação: uma proposta de utilização do programa open conference systems

O conhecimento científico-tecnológico oriundo de pesquisas visa a solucionar os problemas da sociedade e contribuir para seu desenvolvimento. A partir disso, o processo de comunicação científica, através de canais formais ou informais, torna-se essencial para que a evolução do estado da arte de uma área seja sempre constante. Porém, nem sempre as informações são encontradas nos meios tradicionais de publicação de conhecimento, fazendo com que a literatura cinzenta torne-se uma fonte valiosa para diversas áreas do conhecimento. O desenvolvimento e a evolução das novas tecnologias de informação garantem a essa comunicação um caráter ágil e dinâmico, permitindo que a literatura cinzenta avance para um reconhecimento de sua importância no meio acadêmico. Portanto, faz-se necessário o gerenciamento desse tipo de literatura, que possibilita uma alternativa aos meios tradicionais de aquisição de informação científica. A proposta de criar um ambiente de recuperação de informação e gerenciamento da literatura gerada em encontros de estudantes desenvolve-se a partir da ideia de que, muitas vezes, é possível antecipar tendências que só seriam perceptíveis quando da publicação das mesmas pesquisas em meios já consolidados, muitas vezes ocasionando uma perda de informações existentes apenas em seu andamento, subtraídas quando da redação de artigos ou livros. Assim, a proposta de utilização do programa Open Conference Systems possibilita não somente uma maior agilidade e dinamismo na organização de eventos, tendo também como objetivo a possibilidade para a criação de um ambiente digital em que trabalhos apresentados nos eventos estudantis de biblioteconomia, documentação, ciência e gestão da informação, permitindo uma interação entre pesquisadores, tornando-se uma alternativa para publicação, exercendo função memorial para os eventos estudantis da área e constituir uma fonte de informação relevante para a comunidade

Testosterone represses ubiquitin ligases atrogin-1 and Murf-1 expression in an androgen-sensitive rat skeletal muscle in vivo

Pires-Oliveira M, Maragno AL, Parreiras-E-Silva LT, Chiavegatti T, Gomes MD, Godinho RO. Testosterone represses ubiquitin ligases atrogin-1 and Murf-1 expression in an androgen-sensitive rat skeletal muscle in vivo. J Appl Physiol 108: 266-273, 2010. First published November 19, 2009; doi:10.1152/japplphysiol.00490.2009.-Skeletal muscle atrophy induced by denervation and metabolic diseases has been associated with increased ubiquitin ligase expression. in the present study, we evaluate the influence of androgens on muscle ubiquitin ligases atrogin-1/MAFbx/FBXO32 and Murf-1/Trim63 expression and its correlation with maintenance of muscle mass by using the testosterone-dependent fast-twitch levator ani muscle (LA) from normal or castrated adult male Wistar rats. Gene expression was determined by qRT-PCR and/or immunoblotting. Castration induced progressive loss of LA mass (30% of control, 90 days) and an exponential decrease of LA cytoplasm-to-nucleus ratio (nuclear domain; 22% of control after 60 days). Testosterone deprivation induced a 31-fold increase in LA atrogin-1 mRNA and an 18-fold increase in Murf-1 mRNA detected after 2 and 7 days of castration, respectively. Acute (24 h) testosterone administration fully repressed atrogin-1 and Murf-1 mRNA expression to control levels. Atrogin-1 protein was also increased by castration up to 170% after 30 days. Testosterone administration for 7 days restored atrogin-1 protein to control levels. in addition to the well known stimulus of protein synthesis, our results show that testosterone maintains muscle mass by repressing ubiquitin ligases, indicating that inhibition of ubiquitin-proteasome catabolic system is critical for trophic action of androgens in skeletal muscle. Besides, since neither castration nor androgen treatment had any effect on weight or ubiquitin ligases mRNA levels of extensor digitorum longus muscle, a fast-twitch muscle with low androgen sensitivity, our study shows that perineal muscle LA is a suitable in vivo model to evaluate regulation of muscle proteolysis, closely resembling human muscle responsiveness to androgens.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Dept Pharmacol, BR-04044020 São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Dept Biochem & Immunol, Ribeirao Preto, BrazilUniversidade Federal de São Paulo, Dept Pharmacol, BR-04044020 São Paulo, BrazilFAPESP: 05/59006-1FAPESP: 2006/58629-8Web of Scienc

Chronic low back pain and its differential diagnoses: a case report

Low back pain is a common problem which accompanies a large part of the population. It is estimated that up to 84% of adults will have low back pain at some point in their lives. Rarely, low back pain may be the first manifestation of a serious illness. This case report presents the clinical history of a 79 year-old male, with multiple comorbities, including a report of a discal hernia treated by surgery approximately 30 years before presentation, with residual low back pain since then. The pain was progressively worsening, associated with loss of muscle strength and paresthesia in the right lower limb, with significant weight loss. During screening, significant anemia and acute kidney injury with associated hypercalcemia were observed. A spine CT scan revealed a large expansile lesion obliterating the medullary canal at T8/T9 segment. A monoclonal spike in protein electrophoresis was found, along with sparse lytic lesions in long bones leading to the diagnosis of multiple myeloma. Therefore, this report highlights the importance of considering different differential diagnoses as a cause of low back pain. The correct determination of the etiology is essential for adequate clinical management and improvement of the patient's quality of life

COMÉRCIO E USO DE PIMENTEIRAS (Capsicum spp., SOLANACEAE) NO MUNICÍPIO DE FLORIANO (PI)

Os recursos genéticos vegetais correspondem às plantas cultivadas e silvestres que possuem valor de utilização real ou potencial. São exemplos desses recursos a batata inglesa, o tomate, a berinjela, e também as pimentas e pimentões do gênero Capsicum. Considerando a importância e a utilização de pimenteiras, o presente trabalho teve por objetivo averiguar o uso de recursos vegetais de Capsicum spp. pela comunidade de Floriano, Piauí, bem como a identificação das pimenteiras mais cultivadas e comercializadas no município em questão. O estudo foi realizado no município de Floriano no estado do Piauí, onde agricultores e varejistas bem como não agricultores e não varejistas foram convidados a participar da entrevista. As pimenteiras mais cultivadas são: pimenta de cheiro, pimenta malagueta e pimentão verde, respectivamente. Já as mais comercializadas são: pimentão-verde, pimenta-de-cheiro e a pimenta-malagueta, respectivamente. Esses mesmos tipos de pimenteiras citadas anteriormente foram também os mais utilizados na culinária, em forma de molhos e conservas e para fins medicinais. A grande demanda por pimenteiras na região indica a importância em investir no cultivo dessas hortaliças, bem como em possíveis programas de melhoramento genético, priorizando as pimenteiras que são mais utilizadas localmente

Identification by MALDI-TOF MS of Sporothrix brasiliensis isolated from a subconjunctival infiltrative lesion in an immunocompetent patient

Sporotrichosis is a globally distributed subcutaneous fungal infection caused by dimorphic fungi belonging to the Sporothrix species complex that affects the skin of limbs predominantly, but not exclusively. A rare case of ocular sporotrichosis in an immunocompetent Brazilian patient from the countryside of Rio de Janeiro State is reported. A 68-year-old woman presented with a subconjunctival infiltrative lesion in the right eye with pre-auricular lymphadenopathy of onset 4 months ago that evolved to suppurative nodular lesions on the eyelids. Conjunctival secretion was evaluated by histopathological examination and inoculated on Sabouraud Dextrose Agar (SDA). Histopathology showed oval bodies within giant cells and other mononucleated histiocytes. Fungus grown on SDA was identified as Sporothrix sp. by morphological observations. The isolated strain was finally identified by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) associated with an in-house database enriched with reference Sporothrix complex spectra. The strain presented a MALDI spectrum with the ion peaks of the molecular mass profile of S. brasiliensis. The patient was adequately treated with amphotericin B subsequently replaced by itraconazole. Due to scars left by the suppurative process, the patient presented poor final visual acuity. The present work presents an overview of ocular sporotrichosis and discusses the diagnostic difficulty that can lead to visual sequelae in these cases.Financial support for this work by Fundação de Amparo à Pesquisa do Rio de Janeiro [FAPERJ] (Grants: INST E-26/010.001784/2016; JCNE E-26/203.301/2017), by Conselho Nacional de Desenvolvimento Científico e Tecnológico [CNPq] (Grant Proc. 409227/2016-1). This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES). MALDI-TOF MS analyses were partially developed using equipment funded by CONICYT/Chile through the project Fondequip EQM160054 2016. The Universidad de La Frontera (Temuco, Chile) partially funded this work through the Project DIUFRO PIA19-0001. Furthermore, this study was also supported by FCT under the scope of the strategic funding of UID/BIO/04469/2019 unit and BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020 - Programa Operacional Regional do Norte.info:eu-repo/semantics/publishedVersio