Caracterização das infecções relacionadas à assistência à saúde em uma Unidade de Terapia Intensiva

Objective: to analyze Infections Related to Health Care (IRAS) of patients in an Intensive Care Unit. Method: epidemiological retrospective study conducted at the University Hospital of Fortaleza, between 2008 and 2011. Data were collected, organized in tables, and analyzed using descriptive statistics. Results: equal number of female and male patients; average age of 58.3 years; average length of hospitalization and of diagnosis of infection of 21.2 and 11.7 days, respectively; central venous catheter performed in 89.3% of patients; most frequent topography: respiratory in 48.1% of patients; main identified pathogen: pseudomonas aeruginosa in 18.3% of patients; most used antimicrobials: glycopeptides, represented by vancomycin and teicoplanin; and, most frequent clinical outcome: death in 65.4% of patients. Conclusion: IRAS in the intensive care environment affect a large percentage of patients, requiring the implementation of strategies aiming at reducing the statistics and at promoting a safe hospital environment.Objetivo: Analisar as Infecções Relacionadas à Assistência à Saúde (IRAS) de pacientes em Unidade de Terapia Intensiva. Método: Estudo epidemiológico, retrospectivo, realizado em Hospital Universitário de Fortaleza, no período entre 2008 a 2011. Os dados foram coletados por formulário, organizados em tabelas e analisados por meio da estatística descritiva. Resultados: Houve média equilibrada em relação ao sexo e média de idade de 58,3 anos. O tempo de internação e diagnóstico da infecção foi de 21,2 e 11,7 dias, respectivamente. O cateter venoso central foi realizado em 89,3% dos pacientes. A topografia mais incidente foi a respiratória em 48,1%, e a Pseudomonas aeruginosa foi o principal patógeno encontrado em 18,3%. Os antimicrobianos mais utilizados foram os glicopeptídeos, representados pela Vancomicina e Teicoplanina. O desfecho clínico mais frequente foi o óbito em 65,4%. Conclusão: As IRAS no ambiente da terapia intensiva acometem um grande percentual de pacientes, sendo necessário a implementação de estratégias que visem reduzir as estatísticas e promover um ambiente hospitalar seguro

AVALIAÇÃO NEUROBIOLOGICA DO USO DA RITALINA EM PACIENTES NÃO PORTADORES DE TDHA

The non-therapeutic use of Ritalin, or methylphenidate, among individuals without Attention Deficit Hyperactivity Disorder (ADHD) has increased, especially in academic settings, due to its potential to improve attention and cognitive performance. This study reviews the neurobiological effects of this use in individuals without ADHD. Changes in brain activity, especially in the prefrontal cortex and limbic system, were compared, alterations in dopaminergic neurotransmission were investigated, and differences in neuropsychological performance before and after the use of Ritalin were assessed. The review included articles published between 2011 and 2024 in the PubMed, SciELO, LILACS, and Google Scholar databases, focusing on the neurobiological effects of Ritalin in individuals without ADHD. Results indicate that, despite temporary improvements in concentration and working memory, prolonged use may cause anxiety, tachycardia, changes in appetite, and dependence, as well as reduce the effectiveness of the medication due to tolerance. It is concluded that the risks to physical and mental health outweigh the short-term cognitive benefits. It is essential to raise awareness about the dangers of non-prescribed use of Ritalin and to promote healthy alternatives for cognitive enhancement, as well as to develop evidence-based guidelines to minimize the risks of unsupervised stimulant use.O uso não terapêutico da Ritalina, ou metilfenidato, entre indivíduos sem Transtorno de Déficit de Atenção e Hiperatividade (TDAH) tem aumentado, principalmente em ambientes acadêmicos, devido ao seu potencial para melhorar a atenção e o desempenho cognitivo. Este estudo revisa os efeitos neurobiológicos desse uso em indivíduos sem TDAH. Foram comparadas as alterações na atividade cerebral, especialmente no córtex pré-frontal e sistema límbico, investigadas mudanças na neurotransmissão dopaminérgica e avaliadas as diferenças no desempenho neuropsicológico antes e após o uso da Ritalina.    A revisão incluiu artigos publicados entre 2011 e 2024 nas bases PubMed, SciELO, LILACS e Google Scholar, focando nos efeitos neurobiológicos da Ritalina em indivíduos sem TDAH. Resultados indicam que, apesar de melhorias temporárias na concentração e memória de trabalho, o uso prolongado pode causar ansiedade, taquicardia, alterações no apetite e dependência, além de reduzir a eficácia do medicamento devido à tolerância.    Conclui-se que os riscos à saúde física e mental superam os benefícios cognitivos de curto prazo. É essencial conscientizar sobre os perigos do uso não prescrito da Ritalina e promover alternativas saudáveis para o aprimoramento cognitivo, além de desenvolver diretrizes baseadas em evidências para minimizar os riscos do uso não supervisionado de estimulantes

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

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

Cianogênese em esporófitos de pteridófitas avaliada pelo teste do ácido pícrico

Os glicosídeos cianogênicos são substâncias de defesa encontradas em alguns vegetais, capazes de liberar ácido cianídrico por meio de reações de hidrólise. O presente estudo teve como objetivo avaliar a ocorrência da cianogênese em esporófitos de pteridófitas num afloramento rochoso localizado no Parque Estadual da Serra da Tiririca, Rio de Janeiro, Brasil. Foram analisadas mensalmente durante um ano, folhas férteis, estéreis, jovens (báculos) e caules de 19 espécies de pteridófitas, distribuídas em 13 gêneros e nove famílias. A cianogênese foi caracterizada pelo teste do papel de filtro gotejado com ácido pícrico. Das pteridófitas estudadas, 14 foram pela primeira vez analisadas e 14 espécies apresentaram resultado positivo para a cianogênese. Os resultados encontrados demonstraram haver variação na liberação do ácido cianídrico nas espécies em diferentes partes do vegetal ao longo do período analisado. Microgramma vacciniifolia (Langsd. & Fisch.) Copel. (Polypodiaceae) e Pteridium aquilinum (L.) Kuhn var. arachnoideum (Kaulf.) Brade (Dennstaedtiaceae) mostraram-se cianogênicas durante todo o período analisado

Hereditary myotonia in cats associated with a new homozygous missense variant p.Ala331Pro in the muscle chloride channel ClC‐1

Abstract Three‐related cats were evaluated for a history of short‐strided gait and temporary recumbency after startle. Neurological examination, electromyography (EMG), muscle biopsies, and a chloride voltage‐gated channel 1 (CLCN1) molecular study were performed. Clinically, all 3 cats presented myotonia with warm‐up phenomenon and myotonic discharges during EMG examination. Muscle biopsies showed normal muscle architecture and variation in the diameter of myofiber size with the presence of numerous hypertrophic fibers. The molecular study revealed a missense variant (c.991G>C, p.Ala331Pro) in exon 9 of the CLCN1 gene, responsible for the first chloride channel extracellular loop. This mutation was screened in 104 control phenotypically normal unrelated cats, and all were wildtype. The alanine at this position is conserved in ClC‐1 (chloride channel protein 1) in different species, and 2 mutations at this amino acid position are associated with human myotonia. This is the third CLCN1 mutation described in the literature associated with hereditary myotonia in cats and the first in domestic animals located in an extracellular muscle ClC‐1 loop

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.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora