Anesthesia in Patient with Lead Poisoning: Case Report

SummaryBackground and objectivesLead poisoning, also Saturnism, results from chronic lead poisoning, common after occupational exposure. Projectiles retained in the body may result in increased levels of plasma lead with numerous clinical implications, particularly neurological. We report a case of a symptomatic patient, undiagnosed, whose diagnosis was made during the preanesthesia evaluation.Case reportThe patient was attended at our hospital to remove a bullet lodged in his left knee 14 years ago, presenting with polyneuropathy without investigation. During the preanesthetic visit, saturnism was hypothesized and confirmed by high plasma lead levels (129μg.dL-1). Surgery was performed under general anesthesia before starting lead chelation. During anesthesia, the patient developed apnea, without chest-wall rigidity after administration of fentanyl (50μg).ConclusionLead poisoning interferes with the function of various organs and systems, alters oxidative metabolism and intracellular signaling mechanisms. Neurological involvement, with reduced neural conduction, deserves special attention from anesthesiologists

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

Educomunicação, Transformação Social e Desenvolvimento Sustentável

Esta publicação apresenta os principais trabalhos dos GTs do II Congresso Internacional de Comunicação e Educação nos temas Transformação social, com os artigos que abordam principalmente Educomunicação e/ou Mídia-Educação, no contexto de políticas de diversidade, inclusão e equidade; e, em Desenvolvimento Sustentável os artigos que abordam os avanços da relação comunicação/educação no contexto da educação ambiental e desenvolvimento sustentável

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

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Estudo das complicações e fatores determinantes de óbito materno e near miss em gestantes com doneça falciforme

Exportado OPUSMade available in DSpace on 2019-08-14T20:36:12Z (GMT). No. of bitstreams: 1 cpg_disserta__o_de_mestrado_sa_de_da_mulher___patr_cia_s_r_c.pdf: 2385258 bytes, checksum: 78aa3e33ac069abb5a5611e533812151 (MD5) Previous issue date: 27INTRODUÇÃO - A doença falciforme durante a gravidez está associada com aumento de complicações relacionadas à própria doença e com morbimortalidade materna e perinatal mais elevada. O objetivo do estudo foi analisar as complicações clínicas de gestantes com doença falciforme, com enfoque principal naquelas potencialmente graves e ameaçadoras de óbito (near miss ) ou que levaram a óbito materno. Buscou-se identificar fatores preditivos de near miss ou óbito materno com o intuito de prover informações para diminuir as complicações e melhorar o prognóstico materno e perinatal. MÉTODOS - As 104 pacientes encontravam-se cadastradas no Hemocentro de Belo Horizonte (Fundação Hemominas) e foram atendidas em diversos serviços de Pré-Natal de Alto Risco. O estudo teve o desenho de coorte prospectiva. Quanto aos genótipos da doença falciforme, as gestantes foram divididas em dois grupos: Grupo I (n=54), constituído por anemia falciforme (Hb SS, n=51) ou S0-talassemia (n=3) e Grupo II (n=50), hemoglobinopatia SC (n=49) ou S+-talassemia (n=1). A idade mediana dos dois grupos foi de 25 e 26 anos, respectivamente. Os fatores preditivos para near miss ou óbito materno com probabilidade de erro alfa p 0,25 na análise univariada foram incluídos em modelo multivariado de regressão logística, sendo considerados significativos aqueles com p 0,05. RESULTADOS - As gestantes do Grupo I apresentaram, em relação às do Grupo II, número mais elevado de episódios de crises vaso-oclusivas durante a gestação, maior número de transfusões no pré-parto e puerpério e maior porcentagem de partos pré-termos. A frequência de infecções e crises álgicas durante o puerpério foram semelhantes nos dois grupos. As infecções urinárias foram igualmente frequentes nos dois grupos. A taxa de mortalidade foi de 4,8%, sendo três óbitos no grupo da anemia falciforme e dois no grupo da hemoglobinopatia SC. Um terço das g estantes em cada um dos grupos apresentou complicações graves classificadas como indicativas de near miss . A mais frequente foi a pneumonia/síndrome torácica aguda. A co -herança de alfa talassemia e os haplótipos dos genes da beta globina (CAR/CAR, Benin/Benin ou CAR/Benin) não se associaram significativamente com near miss ou óbito materno. Os fatores preditivos de near miss ou óbito materno, com significância estatística na análise multivariada das pacientes dos grupos I e II, foram paridade maior que um e macrocitose basal (volume médio das hemácias elevado). No Grupo I, a hipoxemia basal (saturação basal abaixo de 94%) também foi preditiva de near miss ou óbito materno. CONCLUSÕES - As gestantes com doença falciforme apresentaram diversas complicações durante a gravidez e no puerpério. Um terço das gestantes sofreu near miss e quase 5% foram ao óbito. Gestantes SS e SC apresentaram o mesmo risco de complicações graves e de morte materna, principalmente no terceiro trimestre e puerpério.Complicações pulmonares foram as mais frequentes e devem merecer cuidado especial, inclusive com realização de exsanguineotransfusão parcial. Treinamento especializado no pré-natal de alto risco para o seguimento das complicações da doença falciforme e identificação precoce dos fatores de risco para near miss ou óbito materno são fundamentais para melhorar a atenção à gestante com doença falciforme.INTRODUCTION Sickle cell disease during pregnancy is associated with increased complications due to the disease itself and with a higher maternal and perinatal mortality. The aim of the study was to analyze the clinical complications of pregnant women with sickle cell disease, with primary focus on those potentially serious and life-threatening (near miss) or leading to actual maternal death. We sought to identify predictors of near miss or maternal death in order to provide information to reduce complications and improve maternal or perinatal prognosis.METHODS The 104 patients were enrolled in the Blood Center of Belo Horizonte (Hemominas Foundation) and were treated at several institutions that provide high-risk prenatal care. The study was a prospective cohort. As for the genotypes of sickle cell disease, patients were divided into two groups: Group I (n=54), consisting of sickle cell anemia (HbSS, n=51) or S 0 -talassemia (n=3) and Group II (n=50), SC hemoglobinopathy (n=49) or S +-talassemia(n=1). The median age of both groups was 25 and 26 years, respectively. Predictive factors for near miss or maternal death with alpha error probability p 0,25 in univariate analysis were included in a multivariate logistic regression model and then those with p0,05 were considered significant. RESULTS Women in Group I showed, compared to Group II, higher number of episodes of vaso-occlusive crises during pregnancy, higher number of blood transfusions in both antepartum and postpartum and a higher percentage of preterm births. The frequency of infections and pain crises during the postpartum period was similar in both groups. Urinary infect ions were equally common in both groups. The overall mortality rate was 4,8%, three deaths in the sickle cell anemia group and two in the SC group. One third of the women in each group had severecomplications classified as indicative of near miss. The most frequent complication was pneumonia/acute chest syndrome. The co-inheritance of alpha thalassemia and beta globin gene haplotypes (CAR/CAR, Benin/Benin or CAR/Benin) were not significantly associated with near miss or maternal death. Significant predictive factors for near miss or maternal death in both groups together were: mother with parity > 1 and basal red cell macrocytosis. In Group I, baseline hypoxemia (oxygen saturation below 94%) was also predictive of near miss or maternal death. CONCLUSIONS - Pregnant women with sickle cell disease had several complications during pregnancy and postpartum. One third of the women suffered near miss and almost 5% died. SS and SC pregnant women had the same risk of severe complications and maternal deaths, especially in the third trimester and postpartum period. Pulmonary events were the most frequent complications and deserve special care, including performing partial exchange blood transfusion. Specialized training in high- risk prenatal care for several complications o f sickle cell disease and early identification of risk factors for near miss or maternal death are fundamental to improving care for pregnant women with sickle cell disease

Consensus of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy (ABHH) and the Brazilian Ministry of Health - General management of blood and blood products on the tests necessary for the release of exceptional medicines for sickle cell disease

To date, hydroxyurea is the only effective and safe drug that significantly reduces morbidity and mortality of individuals with Sickle cell disease. Twenty years of real-life experience has demonstrated that hydroxyurea reduces pain attacks, vaso-occlusive events, including acute chest syndrome, the number and duration of hospitalizations and the need for transfusion. The therapeutic success of hydroxyurea is directly linked to access to the drug, the dose used and adherence to treatment which, in part, is correlated to the availability of hydroxyurea. This consensus aims to reduce the number of mandatory exams needed to access the drug, prioritizing the requesting physician's report, without affecting patient safety