Dissecção espontânea de tronco celíaco: relato de caso e revisão de literatura: Celiac trunk spontaneous dissection: case report and literature review

A Dissecção Espontânea do Tronco Celíaco (DETC) sem dissecção aórtica associada é uma condição rara, de apresentação clínica variada. O sintoma mais prevalente é dor abdominal em região epigástrica. A popularização da tomografia computadorizada (TC) de abdome contribuiu para aumento na incidência desse diagnóstico. As modalidades terapêuticas variam desde a observação clínica à abordagem intervencionista. No entanto, não há consenso acerca do melhor manejo terapêutico e do prognóstico da afecção. Por esse motivo, o presente estudo objetiva relatar um caso singular de DETC sem dissecção aórtica associada e, oportunamente, apresentar uma revisão literária acerca do tema. Nesse sentido, a pesquisa foi realizada nas principais bases de dados, constituindo-se importante contribuição para a literatura, no que concerne a essa incomum doença. O paciente relatado é do sexo masculino, 62 anos, leucoderma, queixando-se de dor “em barra” em abdome superior, de caráter contínuo e intensidade progressiva. Relata distensão abdominal e hiporexia concomitantes. Os exames laboratoriais evidenciaram dislipidemia e hipertrigliceridemia. A TC de abdome sem contraste evidenciou pequenas calcificações residuais no parênquima hepático, calcificações ateromatosas aorto-ilíacas discretas, baço acessório, discreta densificação da gordura adjacente ao tronco celíaco de aspecto inespecífico. Solicitada angiotomografia arterial e venosa de abdome, que evidenciou dilatação do tronco celíaco associada à banda de dissecção no segmento ectasiado, estabelecendo o diagnóstico de DETC

Particularidades inerentes à alopécia areata: fisiopatologia incerta e suas opções terapêuticas atuais: Particularities inherent to alopecia areata: uncertain pathophysiology and its current therapeutic options

A alopecia areata (AA) é uma complexa doença autoimune, que se caracteriza pela perda capilar transitória e não cicatricial, podendo afetar tanto os folículos pilosos quanto as unhas. Ainda, a AA detém um aspecto imprevisível e sua evolução é inconstante, apresentando-se de maneira recorrente ou remitente, a depender de cada paciente. Quanto à sua fisiopatologia, diversas são as indagações existentes no que tange ao verdadeiro fator desencadeante da afecção, sendo aventada a possibilidade da influência de elementos imunes correlacionados a questões genéticas e ambientais, como estresse físico ou emocional, infecções, doenças febris, drogas, vacinações, flutuações hormonais e dieta. No entanto, apesar de estudos recentes postularem algumas vias etiopatogênicas envolvidas na AA, seu exato mecanismo fisiopatológico ainda habita a penumbra científica, sendo imprescindível o desenvolvimento de novas pesquisas para sanar tal problemática. Uma vez revelada, tornar-se-á possível e inequívoca a investigação diagnóstica, culminando em uma classificação adequada da doença. Até o presente estudo, a diagnose da AA é pautada basicamente em uma anamnese e um exame físico bem feitos, complementados pela tricoscopia e a análise histopatológica do folículo piloso. Nesse cenário, apesar de existir uma miscelânea de possibilidades terapêuticas, nenhum tratamento mostrou-se indubitavelmente eficaz, muito provavelmente pela escassez de dados consolidados da fisiopatologia da AA

Perfil microbiológico da mastite bovina no Agreste e Brejo Paraibano

Bovine mastitis is the most common disease in dairy herds worldwide, affecting producers, the dairy industry and milk quality, in addition to having a negative impact on public health. This study aimed to follow the microbiological profile of the causative agents of bovine mastitis in dairy farms in the Agreste and Brejo microregion of Paraiba from August 2018 to December 2019. A total of 421 milk samples were collected from 987 mammary quarters of 250 cows diagnosed with clinical (CM) and subclinical  mastitis (MSC) . MSC had a higher frequency of cases 405 (41.03 %) than MC 51 (5.16%). In the microbiological analyses, 16.63% of the samples collected from animals with MC or MSC were found to be negative. The most isolated genera in microbiological growth amostras were Staphylococcus spp. (26,36 %), Corynebacterium spp. (22,32 %), and Streptococcus spp. (12,59 %), while environmental agents showed sporadic cases in their isolation. In the evaluation of the CMT dynamics, it was found that samples with positive CMT results with negative microbiological exam result in M1, tended to have a significant reduction in CMT scores in M2. The findings highlight the importance of conducting health education in the region's milking process, as well as reinforcing the importance of using CMT in a systematic and criterion-based manner.A mastite bovina é considerada a doença de maior prevalência nos rebanhos leiteiros no mundo, impactando produtores, indústria de laticínios e influenciando negativamente a qualidade do leite, além do impacto na saúde pública. Nesse contexto, objetivou-se traçar o perfil microbiológico dos agentes causadores da mastite bovina em propriedades leiteiras da microrregião do Agreste e Brejo paraibano entre o período de agosto de 2018 a dezembro de 2019 e avaliar o comportamento da dinâmica do California mastitis test (CMT) em diferentes perfis microbiológicos do leite. Foram analisadas um total de 421 amostras de leite provenientes de 920 quartos mamários de 230 vacas que foram submetidas ao diagnóstico da mastite clínica (MC) e subclínica (MSC). Observou-se uma expressiva ocorrência de casos de MSC (n = 370, 40,22%) e de MC (n = 51, 5,54%). As amostras de quartos mamários com MC ou MSC resultou em 16,63% de ausência de crescimento no exame microbiológico. Das amostras com crescimento microbiológico, Staphylococcus spp. (26,36%), Corynebacterium spp. (22,32%) e Streptococcus spp. (12,59%) foram os microrganismos mais frequentemente isolados, já os agentes etiológicos ambientais foram esporadicamente isolados. Na avaliação da dinâmica do CMT observou-se que as amostras com resultado positivo no CMT e negativos no exame microbiológico apresentaram tendência a uma redução expressiva dos escores de CMT no momento da coleta subsequente (após 30 dias). Os resultados demonstram a necessidade de realizar educação no processo de ordenha na região, bem como, reforçar a importância do uso do CMT e do exame microbiológico de forma criteriosa no controle da mastite bovina

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

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

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

Mechanical ventilation and death in pregnant patients admitted for COVID-19: a prognostic analysis from the Brazilian COVID-19 registry score

Abstract Background The assessment of clinical prognosis of pregnant COVID-19 patients at hospital presentation is challenging, due to physiological adaptations during pregnancy. Our aim was to assess the performance of the ABC2-SPH score to predict in-hospital mortality and mechanical ventilation support in pregnant patients with COVID-19, to assess the frequency of adverse pregnancy outcomes, and characteristics of pregnant women who died. Methods This multicenter cohort included consecutive pregnant patients with COVID-19 admitted to the participating hospitals, from April/2020 to March/2022. Primary outcomes were in-hospital mortality and the composite outcome of mechanical ventilation support and in-hospital mortality. Secondary endpoints were pregnancy outcomes. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC). Overall performance was assessed using the Brier score. Results From 350 pregnant patients (median age 30 [interquartile range (25.2, 35.0)] years-old]), 11.1% had hypertensive disorders, 19.7% required mechanical ventilation support and 6.0% died. The AUROC for in-hospital mortality and for the composite outcome were 0.809 (95% IC: 0.641–0.944) and 0.704 (95% IC: 0.617–0.792), respectively, with good overall performance (Brier = 0.0384 and 0.1610, respectively). Calibration was good for the prediction of in-hospital mortality, but poor for the composite outcome. Women who died had a median age 4 years-old higher, higher frequency of hypertensive disorders (38.1% vs. 9.4%, p < 0.001) and obesity (28.6% vs. 10.6%, p = 0.025) than those who were discharged alive, and their newborns had lower birth weight (2000 vs. 2813, p = 0.001) and five-minute Apgar score (3.0 vs. 8.0, p < 0.001). Conclusions The ABC2-SPH score had good overall performance for in-hospital mortality and the composite outcome mechanical ventilation and in-hospital mortality. Calibration was good for the prediction of in-hospital mortality, but it was poor for the composite outcome. Therefore, the score may be useful to predict in-hospital mortality in pregnant patients with COVID-19, in addition to clinical judgment. Newborns from women who died had lower birth weight and Apgar score than those who were discharged alive