Simulador de Técnicas de Depuração Extra-Renal/Hemofiltração: Uso da Simulação para Treino no Manuseamento deste Dispositivo

Introdução: A simulação possibilita o ensino e treino de técnicas de suporte de vida complexas sem riscos para o doente. Até ao momento, as únicas opções de treino no manuseamento de terapêuticas de depuração extra-renal contínua (TDEC) eram a aprendizagem directa em doentes submetidos a esta técnica ou mediante observação dos efeitos da manipulação do circuito não conectado ao doente. Por este motivo foi elaborado um simulador de TDEC, usado em cursos de simulação realizados para treino de equipas de cuidados intensivos pediátricos (UCIP). Objectivos: Analisar a performance e utilidade de um novo simulador que possibilita o controlo externo do dispositivo de TDEC, simulando "in situ" cenários que mimetizam condições de doentes tratados com TDEC. Métodos: Foi criado um dispositivo que, uma vez conectado ao aparelho de TDEC, permite o controlo em tempo real de todas as pressões de hemofiltração, de acordo com as condições clínicas e acções dos participantes. Foram simulados diversos cenários e complicações possíveis em doentes submetidos a estas técnicas e avaliada a performance deste dispositivo "in vitro". A satisfação dos participantes foi avaliada mediante a aplicação de um inquérito. Resultados: Foram realizados 4 cursos de TDEC de Maio de 2009 a Março de 2012. Incluídos 60 participantes, todos com experiência clínica prévia em UCIP. Realizados 32 cenários, abrangendo complicações relacionados com o cateter, coagulação dos filtros e ajuste inadequado dos parâmetros de hemofiltração. Nos cenários simulados, o dispositivo simulador permitiu, em tempo real, mudanças simples e rápidas nas pressões do monitor de TDEC e em resposta às atitudes tomadas pelos participantes para a sua resolução. Não foram registadas intercorrências relacionadas com disfunção do dispositivo. Os participantes consideraram-no muito útil como ferramenta de aprendizagem activa, permitindo uma gestão realista das condições clínicas simuladas, com potencial impacto sobre a sua futura prática diária. Os instrutores consideraram-no fácil de manusear e realista. Conclusões: Este simulador permite uma simulação mais fidedigna dos cenários de TDEC, resolvendo o problema da interferência do instrutor no cenário simulado. Este poderia melhorar as capacidades dos simuladores de alta fidelidade disponíveis e utilizar-se como uma ferramenta docente na formação de profissionais de saúde

MuSCA: A multi-scale source-sink carbon allocation model to explore carbon allocation in plants. An application to static apple tree structures

Background and aims: Carbon allocation in plants is usually represented at a topological scale, specific to each model. This makes the results obtained with different models, and the impact of their scales of representation, difficult to compare. In this study, we developed a multi-scale carbon allocation model (MuSCA) that allows the use of different, user-defined, topological scales of a plant, and assessment of the impact of each spatial scale on simulated results and computation time. Methods: Model multi-scale consistency and behaviour were tested on three realistic apple tree structures. Carbon allocation was computed at five scales, spanning from the metamer (the finest scale, used as a reference) up to first-order branches, and for different values of a sap friction coefficient. Fruit dry mass increments were compared across spatial scales and with field data. Key Results: The model was able to represent effects of competition for carbon assimilates on fruit growth. Intermediate friction parameter values provided results that best fitted field data. Fruit growth simulated at the metamer scale differed of ~1 % in respect to results obtained at growth unit scale and up to 60 % in respect to first order branch and fruiting unit scales. Generally, the coarser the spatial scale the more predicted fruit growth diverged from the reference. Coherence in fruit growth across scales was also differentially impacted, depending on the tree structure considered. Decreasing the topological resolution reduced computation time by up to four orders of magnitude. Conclusions: MuSCA revealed that the topological scale has a major influence on the simulation of carbon allocation. This suggests that the scale should be a factor that is carefully evaluated when using a carbon allocation model, or when comparing results produced by different models. Finally, with MuSCA, trade-off between computation time and prediction accuracy can be evaluated by changing topological scales

ICTV virus taxonomy profile: Bromoviridae

Bromoviridae is a family of plant viruses with tri-segmented, positive-sense, single-stranded RNA genomes of about 8 kb in total. Genomic RNAs are packaged in separate virions that may also contain subgenomic, defective or satellite RNAs. Virions are variable in morphology (spherical or bacilliform) and are transmitted between hosts mechanically, in/on the pollen and non-persistently by insect vectors. Members of the family are responsible for major disease epidemics in fruit, vegetable and fodder crops such as tomato, cucurbits, bananas, fruit trees and alfalfa. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the family Bromoviridae, which is available at www.ictv.global/report/bromoviridae

Typhoid and Paratyphoid Cost of Illness in Pakistan: Patient and Health Facility Costs from the Surveillance for Enteric Fever in Asia Project II

Background: The objective of this study was to estimate the cost of illness from enteric fever (typhoid and paratyphoid) at selected sites in Pakistan. Methods: We implemented a cost-of-illness study in 4 hospitals as part of the Surveillance for Enteric Fever in Asia Project (SEAP) II in Pakistan. From the patient and caregiver perspective, we collected direct medical, nonmedical, and indirect costs per case of enteric fever incurred since illness onset by phone after enrollment and 6 weeks later. From the health care provider perspective, we collected data on quantities and prices of resources used at 3 of the hospitals, to estimate the direct medical economic costs to treat a case of enteric fever. We collected costs in Pakistani rupees and converted them into 2018 US dollars. We multiplied the unit cost per procedure by the frequency of procedures in the surveillance case cohort to calculate the average cost per case. Results: We collected patient and caregiver information for 1029 patients with blood culture-confirmed enteric fever or with a nontraumatic terminal ileal perforation, with a median cost of illness per case of US $196.37 (IQR, US$72.89-496.40). The median direct medical and nonmedical costs represented 8.2% of the annual labor income. From the health care provider perspective, the estimated average direct medical cost per case was US $50.88 at Hospital A, US$52.24 at Hospital B, and US $11.73 at Hospital C. Conclusions: Enteric fever can impose a considerable economic burden in Pakistan. These new estimates of the cost of illness of enteric fever can improve evaluation and modeling of the costs and benefits of enteric fever prevention and control measures, including typhoid conjugate vaccines

A Multi-Scale Model to explore Carbon Allocation in Plants

International audienceUnderstanding and simulating carbon allocation in plants is necessary to distribute carbohydrates among growing and competing organs and to predict plant growth and structure development in relation to climatic conditions. In this context several carbon allocation models have been developed but no clear consensus exists on (i) the most appropriate topological scale (organ, metamer, compartment...) to represent this process on complex plant structures, (ii) the importance of distances between organs in carbon transport, (iii) the priorities in carbon allocation among plant parts, that can depend on growth stages. Multi-scale tree graph (MTG) is a formalism allowing the representation of geometry and topology of a tree structure at different scales. In this study, several models were implemented to compute carbon allocation at user-defined spatial scales by using the MTG formalism. This allows multiple scales (e.g. metamer, growing unit, branch) to be combined during the computation of carbon allocation (e.g. allocation first within leafy shoots at metamer scale and then between growing units). The model describes carbon transport, taking into account the distances between sources and sinks, the strength of the sinks and the available carbohydrates, following the equations of the SIMWAL and QualiTree models. Simulations on simplified branching structures, represented at different scales, showed how the scales chosen to represent the system influence the results of predicted carbon allocation. This modelling approach will be first applied to apple tree to analyze the impact of the scale of representation (branch, growth unit, metamer, and inflorescence) on the predicted fruit growth variability which, in turn, will be compared with field observations. The present work is available through the OpenAlea platform and provides existing Functional Structural Plant Models with a new generic model to simulate carbon allocation in plants depending on user-defined biological hypotheses, such as the choice of the scale of representation or the effect of distance

Parasitación por Babesia canis en Galicia

Un estudio analítico llevado a cabo sobre 213 perros, infectados por el piroplasma Babesia canis en Galicia durante el año 1996, sugiere que una intensa anemia hemolítica regenerativa junto con una trombocitopenia son las características constantes de la infección, además de observarse en algunos casos una evolución a insuficiencia renal

Infección por Theileria annae en un perro esplenectomizado

La babesiosis canina es una enfermedad infecciosa de distribución mundial debida a la proliferación en los hematíes del perro de unas babesias específicas transmitidas por garrapatas. Si bien ha sido tradicionalmente asumido que las únicas especies que causan enfermedad en la especie canina son Babesia canis y Babesia gibsoni, publicaciones recientes demuestran que una tercera especie (Theileria annae) también puede causar una enfermedad muy severa. Este trabajo presenta el segundo caso publicado de esta forma de Theileria annae en un perro de 14 años, de raza Basset Hound, esplenectomizado cinco meses antes, que se presentó en la clínica veterinaria con signos de hipertermia, hemoglobinuria, temblores y apatía. El estudio de laboratorio constató una acusada anemia hemolítica regenerativa y una intensa trombocitopenia como datos más característicos. En la extensión de sangre periférica se visualizaron múltiples merozoítos intra (22%) y extraeritrocitarios de pequeño tamaño (1-2 micras), forma anular y presentación única en la mayoría de hematíes. La prontitud del diagnóstico y del tratamiento específico con dipropionato de imidocarb hizo que el cuadro clínico evolucionase con rapidez hacia la curación, en contra de lo que es habitual en los animales esplenectomizados.

Recognition of cis-acting sequences in RNA 3 of Prunus necrotic ringspot virus by the replicase of Alfalfa mosaic virus

Supramolecular & Biomaterials Chemistr