Síndrome compartimental após extravasamento de contraste: Compartment syndrome after contrast extravasation

Introdução: A síndrome compartimental decorrente do extravasamento de contraste pode ter diversas complicações, merecendo atenção para que seja evitada ou uma vez instaurada, tratada. Apresentação do caso: Paciente do sexo feminino, 65 anos de idade, ex-tabagista, hipertensa e portadora de doença aterosclerótico vascular periférica, em uso de Losartana e AAS. Sofreu queda sobre membro superior esquerdo e foi submetida à Tomografia Computadorizada com contraste iodado que extravasou ocasionando náusea, episódios de vômito e dor, edema, parestesia e prurido local, sendo diagnosticada com síndrome compartimental e tratada com fasciotomia. Discussão: A síndrome compartimental decorre do aumento da pressão em um compartimento osteofascial fechado, diversas podem ser as etiologias da compressão dentre elas o extravasamento de contraste iodado usado em Tomografias Computadorizadas, provocando de alterações cutâneas e comprometendo elementos vasculares, nervos e músculos levando a prejuízo tecidual, demandando intervenção rápida para diminuir a extensão dos agravos através da Fasciotomia associada a aspiração do contraste. Conclusão: A Síndrome compartimental causada por extravasamento de contraste iodado pode ter desfechos locais e sistêmicos severos, assim que feito seu diagnóstico deve ter abordagem definitiva o quanto antes para minimizar suas complicações

Síndrome de Patau: Patau syndrome

Introdução: A Síndrome de Patau, ou trissomia do 13, é um distúrbio autossômico. A principal causa dessa síndrome é a não disjunção do cromossomo 13 durante a primeira divisão meiótica e sua incidência é cerca de 1:20.000 a 25.000. Apresentação do caso: Paciente do sexo feminino,37 anos de idade, natural e procedente de Goiânia/Go,casada e dona de casa.G3P2A0C0 com 33 semanas e 2 dias de gestação.Admitida no hospital das Clínicas de Goiânia com quadro de sangramento vaginal em pequena quantidade e dor em baixo ventre há 2 horas.Negou comorbidades, tabagismo, etilismo e uso de drogas ilícitas. Discussão: A Síndrome de Patau está relacionada a várias malformações, sendo as principais do trato gastrointestinal, sistema nervoso central e cardiopatias. Certas anomalias ou malformações são incompatíveis com a vida, mas alguns casos de trissomia parcial do cromossomo 13 podem ter sobrevida mais longa. Portadores dessa anomalia costumam vir a óbito devido a complicações cardiorrespiratórias. A idade materna avançada é o principal fator de risco. O diagnóstico dessa síndrome pode ser feito por ultrassom obstétrico de qualidade. Conclusão: Logo, nota-se que é primordial que as mulheres realizem o pré-natal adequado. E caso apresentem os fatores de risco é importante o aconselhamento genético pré-natal e pré-concepcional para que a mulher e o feto tenham a assistência adequada

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

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

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Effects of Brazilian green propolis on proteinuria and renal function in patients with chronic kidney disease: a randomized, double-blind clinical study, placebo-controlled

A Doença Renal Crônica (DRC) é um importante problema de saúde pública ao redor do mundo e a proteinúria é um marcador de progressão da doença bem estabelecido. A própolis, uma resina natural produzida por abelhas a partir de resíduos e seivas de diferentes partes de plantas, possui propriedades anti-inflamatória, imunomoduladora, anti-câncer, anti-oxidante, bem como demonstrou ter efeito antiproteinúrico em modelo experimental de DRC. O objetivo deste estudo foi avaliar o efeito do extrato de Própolis verde brasileiro na proteinúria e ritmo de filtração glomerular estimada (RFG) em pacientes com DRC. Este foi um estudo clínico, randomizado, duplo-cego, controlado por placebo que reuniu pacientes com DRC de etiologias diabética e não-diabética, com idade entre 18 e 90 anos, com RFG estimado entre 25-70 ml/min/1.73 m2 e proteinúria (excreção urinária de proteína > 300mg/dia) ou microalbuminúria ou macroalbuminúria (taxa urinária de albumina-creatinina > 30mg/g Cr ou > 300mg/g Cr, respectivamente). Nós pesquisamos 148 pacientes e selecionamos randomicamente 32 para receberam, por 12 meses, extrato de própolis verde brasileiro na dose de 500mg/dia (n=18) ou placebo (n=14). No final do tratamento, a proteinúria foi significantemente menor no grupo Própolis do que no grupo Placebo--695 mg/24 h (IC de 95%, 483 a 999) x 1403 mg/24 h (IC de 95%, 1031 a 1909); P=0.004--independente de variações no RFG e pressão arterial, os quais não foram diferentes entre os grupos. O subgrupo de pacientes com DRC de etiologia diabética que recebeu Própolis apresentou redução significativa da albuminúria ao final do estudo (de 981 mg/g uCr [IC de 95%, 223 a 1739] para 476 mg/g uCr [IC de 95%, -282 a 1235]; p= 0,031), ao passo que o subgrupo de diabéticos que recebeu Placebo apresentou elevação da albuminúria (de 1261 mg/g uCr [IC de 95%, 569 a 1953] para 1451 mg/g uCr [IC de 95%, 758 a 2143]; p = 0,999). O Monocyte Chemoattractant Protein-1 (MCP-1) urinário também foi menor no grupo Própolis do que no grupo Placebo ao final do tratamento -- 58 pg/mg Cr [IC de 95%, 36 a 95] x 98 pg/mg Cr [IC de 95%, 62 a 155]; P=0.038. O extrato de própolis verde brasileiro foi seguro e bem tolerado, bem como reduziu significativamente a proteinúria em pacientes com DRC de etiologia diabética e não-diabéticaChronic kidney disease (CKD) is a public health problem worldwide, and proteinuria is a well-established marker of disease progression. Propolis, a natural resin produced by bees from residues and sap of different parts of plants, has anti-inflammatory, immunomodulatory, anti-cancer, anti-oxidant properties, as well as having been shown to have an antiproteinuric effect in experimental CKD. The aim of this study was to evaluate the effect that Brazilian green propolis extract has on proteinuria and on the estimated glomerular filtration rate (eGFR). This was a randomized, double-blind, placebo-controlled study including patients with CKD caused by diabetes or non-diabetic etiology, 18-90 years of age, with an eGFR of 25-70 ml/min per 1.73 m2 and proteinuria (urinary protein excretion > 300 mg/day) or micro- or macro-albuminuria (urinary albumin-to-creatinine ratio > 30 mg/g or > 300 mg/g, respectively). We screened 148 patients and selected 32, randomly assigning them to receive 12 months of Brazilian green propolis extract at a dose of 500 mg/day (n=18) or 12 months of a placebo (n=14). At the end of treatment, proteinuria was significantly lower in the propolis group than in the placebo group--695 mg/24 h (95% CI, 483 to 999) vs. 1403 mg/24 h (95% CI, 1031 to 1909); P=0.004--independent of variations in eGFR and blood pressure, which did not differ between the groups during follow-up. The subgroup of patients with CKD of diabetic ethiology who received Propolis presented a significant reduction of albuminuria at the end of the study (from 981 mg / g uCr [95% CI, 223 to 1739] to 476 mg / g uCr [95% CI, (P = 0.031), whereas the subgroup of diabetics receiving Placebo presented elevation of albuminuria (from 1261 mg / g uCr [95% CI, 569 to 1953] to 1451 mg / g uCr [CI 95%, 758 to 2143], p = 0.999). Urinary Monocyte Chemoattractant Protein-1 (MCP-1) was also significantly lower in the propolis group than in the placebo group -- 58 pg/mg creatinine (95% CI, 36 to 95) vs. 98 pg/mg creatinine (95% CI, 62 to 155); P=0.038. Brazilian green propolis extract was found to be safe and well tolerated, as well as to reduce proteinuria significantly in patients with diabetic and non-diabetic CK

Effects of Brazilian green propolis on proteinuria and renal function in patients with chronic kidney disease: a randomized, double-blind clinical study, placebo-controlled

A Doença Renal Crônica (DRC) é um importante problema de saúde pública ao redor do mundo e a proteinúria é um marcador de progressão da doença bem estabelecido. A própolis, uma resina natural produzida por abelhas a partir de resíduos e seivas de diferentes partes de plantas, possui propriedades anti-inflamatória, imunomoduladora, anti-câncer, anti-oxidante, bem como demonstrou ter efeito antiproteinúrico em modelo experimental de DRC. O objetivo deste estudo foi avaliar o efeito do extrato de Própolis verde brasileiro na proteinúria e ritmo de filtração glomerular estimada (RFG) em pacientes com DRC. Este foi um estudo clínico, randomizado, duplo-cego, controlado por placebo que reuniu pacientes com DRC de etiologias diabética e não-diabética, com idade entre 18 e 90 anos, com RFG estimado entre 25-70 ml/min/1.73 m2 e proteinúria (excreção urinária de proteína > 300mg/dia) ou microalbuminúria ou macroalbuminúria (taxa urinária de albumina-creatinina > 30mg/g Cr ou > 300mg/g Cr, respectivamente). Nós pesquisamos 148 pacientes e selecionamos randomicamente 32 para receberam, por 12 meses, extrato de própolis verde brasileiro na dose de 500mg/dia (n=18) ou placebo (n=14). No final do tratamento, a proteinúria foi significantemente menor no grupo Própolis do que no grupo Placebo--695 mg/24 h (IC de 95%, 483 a 999) x 1403 mg/24 h (IC de 95%, 1031 a 1909); P=0.004--independente de variações no RFG e pressão arterial, os quais não foram diferentes entre os grupos. O subgrupo de pacientes com DRC de etiologia diabética que recebeu Própolis apresentou redução significativa da albuminúria ao final do estudo (de 981 mg/g uCr [IC de 95%, 223 a 1739] para 476 mg/g uCr [IC de 95%, -282 a 1235]; p= 0,031), ao passo que o subgrupo de diabéticos que recebeu Placebo apresentou elevação da albuminúria (de 1261 mg/g uCr [IC de 95%, 569 a 1953] para 1451 mg/g uCr [IC de 95%, 758 a 2143]; p = 0,999). O Monocyte Chemoattractant Protein-1 (MCP-1) urinário também foi menor no grupo Própolis do que no grupo Placebo ao final do tratamento -- 58 pg/mg Cr [IC de 95%, 36 a 95] x 98 pg/mg Cr [IC de 95%, 62 a 155]; P=0.038. O extrato de própolis verde brasileiro foi seguro e bem tolerado, bem como reduziu significativamente a proteinúria em pacientes com DRC de etiologia diabética e não-diabéticaChronic kidney disease (CKD) is a public health problem worldwide, and proteinuria is a well-established marker of disease progression. Propolis, a natural resin produced by bees from residues and sap of different parts of plants, has anti-inflammatory, immunomodulatory, anti-cancer, anti-oxidant properties, as well as having been shown to have an antiproteinuric effect in experimental CKD. The aim of this study was to evaluate the effect that Brazilian green propolis extract has on proteinuria and on the estimated glomerular filtration rate (eGFR). This was a randomized, double-blind, placebo-controlled study including patients with CKD caused by diabetes or non-diabetic etiology, 18-90 years of age, with an eGFR of 25-70 ml/min per 1.73 m2 and proteinuria (urinary protein excretion > 300 mg/day) or micro- or macro-albuminuria (urinary albumin-to-creatinine ratio > 30 mg/g or > 300 mg/g, respectively). We screened 148 patients and selected 32, randomly assigning them to receive 12 months of Brazilian green propolis extract at a dose of 500 mg/day (n=18) or 12 months of a placebo (n=14). At the end of treatment, proteinuria was significantly lower in the propolis group than in the placebo group--695 mg/24 h (95% CI, 483 to 999) vs. 1403 mg/24 h (95% CI, 1031 to 1909); P=0.004--independent of variations in eGFR and blood pressure, which did not differ between the groups during follow-up. The subgroup of patients with CKD of diabetic ethiology who received Propolis presented a significant reduction of albuminuria at the end of the study (from 981 mg / g uCr [95% CI, 223 to 1739] to 476 mg / g uCr [95% CI, (P = 0.031), whereas the subgroup of diabetics receiving Placebo presented elevation of albuminuria (from 1261 mg / g uCr [95% CI, 569 to 1953] to 1451 mg / g uCr [CI 95%, 758 to 2143], p = 0.999). Urinary Monocyte Chemoattractant Protein-1 (MCP-1) was also significantly lower in the propolis group than in the placebo group -- 58 pg/mg creatinine (95% CI, 36 to 95) vs. 98 pg/mg creatinine (95% CI, 62 to 155); P=0.038. Brazilian green propolis extract was found to be safe and well tolerated, as well as to reduce proteinuria significantly in patients with diabetic and non-diabetic CK