Eritrodermia secundária a dermatite atópica grave: um relato de caso

A eritrodermia é uma síndrome inflamatória grave que se apresenta com eritema cutâneo generalizado. As etiologias desta patologia são inúmeras e após determinar a causa base, adiciona-se às condutas iniciais o tratamento específico. Trata-se de estudo de caso de um adolescente de 13 anos, do sexo masculino, que apresentou quadro de eritrodermia secundária à dermatite atópica grave de difícil manejo, com prejuízo psicossocial. O controle só foi possível mediante imunossupressão sistêmica com ciclosporina, levando em consideração a refratariedade à terapia habitual

Experiência no desenvolvimento e execução de processos educativos no PET-Saúde

The need for education and health of the Brazilian population has been thoroughly discussed in all walks of government. At the federal level was launched the PET – Health/HS program. This program has several projects and one of them aimed to guide and educate people for prevention of diseases transmited by insects and caused by microorganism, besides informing about the proper handling of garbage in an attempt to prevent proliferation of infectious and parasitic diseases associated with those vectors in the municipality of Divinópolis–MG. Health education was based on didactic lectures, distribution of folders, play educational videos, and photo exhibitions. Health education was based on: didactic lectures, distribution of brochures, play educational videos and photo exhibitions. Activities were impactful and transmitted to people a message conscientizing, aiming at reducing the number of cases of diseases related to vectors and proper waste management.Las necesidades de educación y la salud la población brasileña se ha debatido a fondo en todos los ámbitos de gobierno. En el plano federal se puso en marcha el programa PET - Salud/VS. Este programa tiene varios proyectos y uno de ellos dirigidos a orientar y educar al público acerca de la prevención de los insectos hospederos de microorganismos causante de la enfermedad, además proporciona información sobre lo manejo de la basura en un intento de evitar la propagación de enfermedades infecciosas y parasitarias asociadas con vectores en el municipio de Divinópolis-MG. La educación en salud se basa en charlas didácticas, distribución de carpetas, reproducir vídeos educativos, y exposiciones fotográficas. Eran actividades que impactan y enviado el mensaje concienciación para reducir el número de casos relacionados con los vectores y lo manejo adecuado de la basura.As necessidades de educação e saúde da população brasileira vem sendo discutidas exaustivamente em todas as esferas de governo. Na esfera federal foi lançado o programa PET-Saúde/VS. Esse programa tem vários projetos e um deles teve como objetivo orientar e educar a população sobre a prevenção dos insetos hospedeiros dos micro-organimos causadores de doenças, além de informar sobre o manejo adequado do lixo na tentativa de se evitar a proliferação de doenças infecto-parasitárias associadas aos vetores no município de Divinópolis - MG. Como metodologia, foram confeccionados materiais para ampliação do conhecimento da população sobre a temática trabalhada: Lixo, insetos vetores da Dengue, Febre amarela e Leishmaniose. A educação em saúde foi baseada em palestras didáticas, distribuição de folders, reprodução de vídeos educativos e exposições fotográficas. Um CD com todos os materiais foi disponibilizado às unidades de saúde para futuras atividades. Foram atividades impactantes e que transmitiram à população uma mensagem conscientizadora, visando à diminuição do número de casos de doenças relacionadas aos vetores e ao manejo adequado do lixo

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

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

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Invasive Trichosporon cutaneum infection in an infant with wilms' tumor Infecção invasiva por Trichosporon cutaneum em um infante com tumor de Wilms

Fungal infections are increasingly being reported in immuno-compromised patients. In this study we report a case of systemic Trichosporon cutaneum infection in an infant with Wilms' tumor. This is the first time that an invasive infection for T. cutaneum has been reported in a Wilms' tumor patient.<br>As infecções fungicas estão sendo relatadas cada vez mais em pacientes imunocomprometidos. Neste estudo nós relatamos um caso de infecção sistêmica por Trichosporon cutaneum em um infante com tumor de Wilms. Esta é a primeira vez que uma infecção invasiva por T. cutaneum é relatada em paciente com tumor de Wilms