Hemofilia adquirida A e B principais apresentações clínicas da doença de Pott em crianças: Hemofilia adquirida A e B main clinical presentations of Pott disease in children

A hemofilia é uma doença sanguínea caracterizada por distúrbios nos mecanismos de coagulação do sangue, podendo ser de origem hereditária ou adquirida. A hemofilia adquirida ocorre devido à produção de autoanticorpos contra a atividade pró-coagulante dos fatores VIII (Hemofilia A) e IX (Hemofilia B). O objetivo desse trabalho é a realização de um estudo observacional e exploratório sobre os artigos publicados nos últimos 5 anos sobre a hemofilia adquirida A e B, uma vez que é uma enfermidade considerada rara. Dos 68 resultados obtidos na pesquisa, apenas 7 abordaram de forma objetiva sobre o tema, sendo utilizados na confecção do estudo. Segundo a literatura, as manifestações clínicas envolvem sangramento mucocutâneo, urogenital e gastrointestinal, e são mais prevalentes em idosos. Em crianças, o sangramento pode ser menos expressivo, provocando dúvidas quanto ao diagnóstico. O tratamento da hemofilia envolve a reposição dos fatores de coagulação deficientes e o uso de imunossupressores, ainda que nas obras analisadas apenas o tratamento hemostático tenha sido descrito, revelando uma carência de estudos sobre o uso de imunossupressores nos casos de hemofilia adquirida

A list of land plants of Parque Nacional do Caparaó, Brazil, highlights the presence of sampling gaps within this protected area

Brazilian protected areas are essential for plant conservation in the Atlantic Forest domain, one of the 36 global biodiversity hotspots. A major challenge for improving conservation actions is to know the plant richness, protected by these areas. Online databases offer an accessible way to build plant species lists and to provide relevant information about biodiversity. A list of land plants of “Parque Nacional do Caparaó” (PNC) was previously built using online databases and published on the website "Catálogo de Plantas das Unidades de Conservação do Brasil." Here, we provide and discuss additional information about plant species richness, endemism and conservation in the PNC that could not be included in the List. We documented 1,791 species of land plants as occurring in PNC, of which 63 are cited as threatened (CR, EN or VU) by the Brazilian National Red List, seven as data deficient (DD) and five as priorities for conservation. Fifity-one species were possible new ocurrences for ES and MG states

Incidência da síndrome pré-menstrual na prática de esportes: aspectos atuais: Incidence of pre-menstrual syndrome in sports: current aspects

A síndrome pré-menstrual (SPM) é uma constelação complexa de alterações de humor, comportamentais e físicas que se limitam à fase pré-menstrual. Esses sintomas se recuperam dentro de alguns dias após o início da menstruação.  Assim, o objetivo desse estudo é demonstrar a incidência da síndrome pré-menstrual na prática de esportes a partir de uma revisão integrativa sobre o tema. Para isso, foi realizado uma revisão integrativa sobre o tema, onde foi considerado textos publicados desde 2010, em inglês e português e que estejam disponíveis para leitura, no PUBMED, LILACs e Scielo. Esta revisão sistemática fornece algum suporte adicional para diretrizes clínicas que recomendam o exercício como um tratamento eficaz para a TPM. As análises secundárias realizadas também fornecem novas evidências de que o exercício pode ser útil no alívio de sintomas psicológicos, físicos e comportamentais específicos associados à TPM, além de auxiliar no gerenciamento do perfil global de sintomas

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

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

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

Anatomotopographic aspects and sevoflurane anesthesia for fibropapilloma excision in green turtles (Chelonia mydas)

Fibropapilomatose é uma enfermidade panzoótica tumoral de tartarugas verdes (Chelonia mydas), cujas lesões são caracterizadas como massas papilares na pele, especialmente no membro torácico. O objetivo do estudo foi levantar aspectos anatomotopográficos do membro torácico e plexo braquial e avaliar a anestesia com sevofluorano em tartarugas verdes para exérese de fibropapilomas cutâneos. Doze cadáveres de tartarugas verdes foram dissecados para identificação dos músculos da cintura peitoral e do plexo braquial. As dissecções foram efetuadas após a retirada do plastrão das tartarugas, e divulsão de pele e tecido subcutâneo, separando as fáscias e perimísio para identificação de origem e inserção da musculatura do membro torácico, bem como a divulsão para visualização das raízes ventrais cervicais e torácicas que originam o plexo braquial na espécie. Dezoito tartarugas verdes com fibropapilomatose foram submetidas à anestesia por sevofluorano, após indução com 5 mg/kg de propofol. A fração expirada de sevofluorano (FESevo) foi inicialmente estabelecida em 2,5%, sendo gradualmente elevada até a ausência de resposta dolorosa frente a um estímulo elétrico de 50 Hz, 20 Voltz e 6,5 milissegundos de duração. Ato contínuo, os tumores foram removidos com bisturi convencional. Os animais foram monitorados a cada 5 minutos por eletrocardiografia (ECG), concentração de CO2 no final da expiração (ETCO2), oximetria de pulso (SPO2), reflexos palpebral, corneal, cloacal, e de dor superficial e profunda. Ao estudo anatômico observou-se que o plexo braquial origina-se de raízes ventrais caudais entre a quinta vértebra cervical até a primeira vértebra torácica, cujo tronco superior origina os nervos sub e supraescapular, deltoide, e o supracoracoide; o tronco medial origina os nervos musculocutâneo, mediano e ulnar, e o tronco inferior o nervo radial. O FESevo estabelecido em tartarugas verdes para que obtivesse resposta negativa frente ao estímulo elétrico foi de 4,0% ± 0,31. Naquele momento, a FC foi de 33 ± 5,8 batimentos por minuto (bpm), a SPO2 foi de 95,6% ± 2,6, o ETCO2 foi de 21 mmHg [6;35] e temperatura cloacal de 29,5 ± 0,58°C. Foi notório o aumento no tempo de equilíbrio entre as frações inspiradas e expiradas de anestésico, sugerindo que isso deva ser decorrente do desvio intracardíaco, reduzindo respostas cardiovasculares vagalmente mediadas. Diante dos dados, conclui-se que o membro torácico apresenta complexa anatomia nervosa do plexo braquial, compatível com diversas outras Classes do Reino Animal, cujas ramificações inervam músculos e dermátomos notavelmente mais afetados pela fibropapilomatose. Para a remoção cirúrgica, é necessária a manutenção anestésica com aproximadamente 4% de sevofluorano, o qual promove cronotropismo cardíaco negativo nas tartarugas.Fibropapillomatosis is a panzootic tumoral disease of green turtles (Chelonia mydas), whose lesions are characterized as papillary masses on the skin, especially on the thoracic limb. The aim of the study was to survey anatomotopographic aspects of the thoracic limb and brachial plexus and to evaluate the anesthesia with sevoflurane in green turtles for the removal of cutaneous fibropapillomas. Twelve green turtle cadavers were dissected to identify the muscles of the pectoral girdle and brachial plexus. The dissections were performed after removing the plastron from the turtles, and divulsion of skin and subcutaneous tissue, separating the fascia and perimysium to identify the origin and insertion of the musculature of the thoracic limb, as well as the dissection to visualize the ventral cervical and thoracic roots that originate the brachial plexus in the species. Eighteen green turtles with fibropapillomatosis were submitted to sevoflurane anesthesia after induction with 5 mg/kg of propofol. The expired fraction of sevoflurane (FESevo) was initially established at 2.5%, being gradually increased until the absence of a painful response to an electrical stimulus of 50 Hz, 20 Voltz and 6.5 milliseconds in duration. Then, the tumors were removed with a conventional scalpel. The animals were monitored every 5 minutes by electrocardiography (ECG), end-expiratory CO2 concentration (ETCO2), pulse oximetry (SPO2), eyelid, corneal, cloacal, and superficial and deep pain reflexes. The anatomical study showed that the brachial plexus originates from ventral caudal roots between the fifth cervical vertebra and the first thoracic vertebra, whose upper trunk originates the sub and suprascapular, deltoid, and supracoracoid nerves; the medial trunk gives rise to the musculocutaneous, median and ulnar nerves, and the inferior trunk to the radial nerve. The FESevo established in green turtles to obtain a negative response to electrical stimulus was 4.0% ± 0.31. At that time, HR was 33 ± 5.8 beats per minute (bpm), SPO2 was 95.6% ± 2.6, ETCO2 was 21 mmHg [6;35] and cloacal temperature was 29.5 ± 0.58°C. It was notorious the increase in the equilibrium time between the anesthetic inspired and expired fractions, suggesting that this must be due to the intracardiac shunt, reducing vagally mediated cardiovascular responses. Given the data, it is concluded that the thoracic limb has a complex nervous anatomy of the brachial plexus, compatible with several other classes of the animal kingdom, whose branches innervate muscles and dermatomes notably more affected by fibropapillomatosis. For surgical removal, anesthetic maintenance with approximately 4% of sevoflurane is necessary, which promotes negative cardiac chronotropism in turtles

Comparative study between photodynamic and antibiotic therapies for treatment of footpad dermatitis (bumblefoot) in Magellanic penguins (Spheniscus magellanicus)

Background: Bumblefoot, referring to bed-sore-like foot lesions, is one of the most important clinical complications in captive birds and has a multifactorial etiology. Photodynamic therapy has been proposed as an alternative treatment for localized infections in response to the escalating problem of antibiotic resistance. The aim of this study was to compare outcomes in a group of captive Spheniscus magellanicus with bumblefoot lesions treated with photodynamic therapy (PDT) or antibiotics (ATB).Methods: Ten captive Magellanic penguins with preexisting stage III bumblefoot lesions were selected and randomly divided into one PDT and one ATB group, each including 11 pelvic-limb lesions. All animals underwent surgical debridement of lesions. In the ATB group, antibiotic ointment was applied topically three times a week, and systemic antibiotic and anti-inflammatory drugs were administered daily. In the PDT group, photodynamic therapy was applied three times a week without the use of topical or systemic medication. Lesion areas were photographed, and swabs were collected for culture and sensitivity, on the first day and every 14 days for a total of 84 days. The four species of bacteria showing the most resistance to the antibiotics screened on. the antibiogram were used to determine resistance to PDT with an in vitro test.Results: There were significant differences in healing rate and average healing time between the PDT and ATB groups (63.62% vs. 9.09% and 42 vs. 70 days, respectively).Conclusion: The findings of this study attest to the effectiveness of photodynamic therapy for the treatment of stage III bumblefoot in Spheniscus magellanicus. (C) 2015 The Authors. Published by Elsevier B.V.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Confiabilidade da informação sobre uso recente de medicamentos em um estudo caso-controle de base hospitalar Reliability of the information on the recent use of medication in a hospital based case-control study

A qualidade da informação é fundamental para que se possa obter estimativas sem vieses da associação entre variáveis de exposição e de desfecho. Um estudo caso-controle está em curso com o objetivo de investigar uma possível associação entre o consumo de medicamentos e a hospitalização de idosos por fraturas decorrentes de quedas. Na ausência de um padrão-ouro, avaliou-se a confiabilidade da informação sobre o consumo desses medicamentos nas duas semanas que antecederam a queda, incluindo-se as últimas 24 horas, por meio de uma estratégia teste-reteste. Reentrevistaram-se 61 idosos, com idade igual ou superior a sessenta anos, a um intervalo de cinco a sete dias após a primeira entrevista. Os valores do coeficiente Kappa foram altos, mostrando uma elevada consistência da informação obtida sobre medicamentos usados recentemente. Dentre as variáveis investigadas, apenas gênero mostrou-se associada com a confiabilidade, sendo a informação mais consistente entre as mulheres do que entre os homens.Accuracy of the information is essential to produce unbiased estimates of the association between exposure and outcome. We are carrying out a case-control study which aim is to investigate the association between the use of medication and falling injuries leading to hospitalisation in the elderly. As there is no gold-standard available, we estimated the reliability of the information on the use of these drugs within the 24 hours and two weeks before the fall using a test-retest strategy. Sixty-one individuals aged 60 years or more were re-interviewed within an interval of 5-7 days after the first interview. Kappa coefficients were high, showing a good consistence of collected data on medication recently used. Among the variables investigated, only gender showed an association with reliability of the information, which was more consistent among women compared to men