Surgical treatment of a transorbital penetrating brain injury

Penetrating injury of the skull and brain are relatively uncommon events, representing about 0.4% of all head injuries. Transorbital penetrating brain injury is an unusual occurrence in emergency practice and presents with controversial management. We report the case of a 10-year-old boy who fell forward on a bamboo stick while playing with other children, causing a penetrating transorbital injury, resulting in meningitis. We performed a combined surgical approach with neurosurgeons and ophthalmogic surgeons. Upon discharge, the patient had a Glasgow Coma Scale score of 15, no motor deficit and no visual loss. We discuss the management of this case and review current literature

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

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

Avaliação dos marcadores prognósticos de pacientes com DPOC no período de nove anos

As manifestações locais e sistêmicas da Doença Pulmonar Obstrutiva Crônica (DPOC) são bem relatadas na literatura, entretanto, há poucos estudos que avaliaram a evolução de seus marcadores prognósticos por períodos acima de cinco anos. Dessa forma, o objetivo desse estudo foi avaliar os marcadores prognósticos de pacientes com DPOC durante o período de nove anos e identificar os preditores de mortalidade. Os pacientes foram avaliados no momento basal e após nove anos por meio de avaliação clínica, espirometria, composição corporal, distância percorrida em seis minutos (DP6), qualidade de vida, intensidade de dispneia, Índice BODE e comorbidades pelo Índice Charlson. Dos 133 pacientes incluídos no início do estudo não foi possível identificar a causa do óbito e o tempo de vida de 23 indivíduos, portanto, 110 foram incluídos na análise dos preditores de mortalidade e, para avaliação dos marcadores prognósticos, foram incluídos 33 indivíduos, uma vez que 64 morreram, 23 perderam seguimento, 12 recusaram participar e um paciente foi excluído em decorrência de exacerbações recorrentes. Após nove anos foi identificada piora da espirometria, da oximetria de pulso, da DP6, da qualidade de vida e da intensidade da dispneia (p<0,001). Além disso, houve aumento no Índice Charlson [3 (2-4) vs 4 (3-5); p<0,001)] e na massa magra corporal [(41,1±6,4 vs 47,7±7,9; p<0,001)]. Os modelos de regressão de Cox foram ajustados para o gênero masculino, idade e SpO2. Foram avaliadas a associação do Índice BODE e as variáveis que o constitui, Índice GOLD, Índice de Charlson e número de exacerbações nos três primeiros anos de seguimento com o risco de mortalidade. Identificou-se que o Índice de Massa Corporal ≤ 21kg/m2, a maior gravidade do Índice BODE, o maior número de exacerbações nos três primeiros anos de seguimento e no Índice Charlson estiveram associados com maior risco de mortalidade.Local and systemic manifestations of chronic obstructive pulmonary disease (COPD) are well reported in the literature; however, there are few studies that evaluated the evolution of their prognostic markers above five years. Thus, the aim of this study was to evaluate the prognostic markers in COPD patients over nine years and identify predictors of mortality. Patients were evaluated at baseline and after nine years by clinical evaluation, spirometry, evaluation of body composition, six-minute walk distance (6MWD), quality of life, dyspnea intensity, BODE index and Charlson comorbidity index. Of the 133 patients included in the baseline was not possible to identify the cause of death and the lifetime of 23 individuals, therefore, 110 were included in the analysis of predictors of mortality and to evaluate the prognostic markers were included 33 individuals, as it 64 died, 23 lost follow-up, 12 refused to participate and one patient was excluded because of recurrent exacerbations. After nine years we identified significant worsening in spirometry, pulse oximetry, 6MWD, quality of life and dyspnea intensity (p <0.001). Furthermore, there were an increase in Charlson Index [3 (2-4) vs 4 (3-5); p <0.001)] and in the fat-free body mass [(41.1 ± 6.4 vs. 47.7 ± 7.9; p <0.001)]. The Cox regression models was adjusted by male gender, age and SpO2. We assessed the association of BODE index and variables that constitute, GOLD index, Charlson index and number of exacerbations in the first three years of follow-up and the risk of mortality. We identified the body mass index ≤ 21kg / m2, higher values of the BODE index, highest number of exacerbations in the first three years of follow-up and the higher Charlson index were associated with increased risk of mortality

3D Preoperative Planning in the ER with OsiriX®: When There is No Time for Neuronavigation

The evaluation of patients in the emergency room department (ER) through more accurate imaging methods such as computed tomography (CT) has revolutionized their assistance in the early 80s. However, despite technical improvements seen during the last decade, surgical planning in the ER has not followed the development of image acquisition methods. The authors present their experience with DICOM image processing as a navigation method in the ER. The authors present 18 patients treated in the Emergency Department of the Hospital das Clínicas of the University of Sao Paulo. All patients were submitted to volumetric CT. We present patients with epidural hematomas, acute/subacute subdural hematomas and contusional hematomas. Using a specific program to analyze images in DICOM format (OsiriX®), the authors performed the appropriate surgical planning. The use of 3D surgical planning made it possible to perform procedures more accurately and less invasively, enabling better postoperative outcomes. All sorts of neurosurgical emergency pathologies can be treated appropriately with no waste of time. The three-dimensional processing of images in the preoperative evaluation is easy and possible even within the emergency care. It should be used as a tool to reduce the surgical trauma and it may dispense methods of navigation in many cases

Efficacy of BREATHOX^® Device Inhalation on Acute Symptoms Associated with COVID-19 (BREATH Study): A Randomized Pilot Clinical Trial

(1) Background: A high concentration of sodium chloride on in vitro cell culture leads to reduced SARS-CoV-2 replication. Therefore, our aim was to evaluate the effects of inhaling hypertonic NaCl particles (BREATHOX®) on the duration of COVID-19-induced acute symptoms. (2) Methods: A prospective, open label, randomized, standard of care-controlled group (SOC) pilot trial compared inhaled oral and nasal administered BREATHOX® (2.0 mg NaCl, particles size between 1–10 μm), with five or ten inhalations per day for ten days. The primary endpoint was the time to resolve COVID-19-related symptoms. Safety outcomes included adverse clinical and laboratory events. (3) Results: A total of 101 individuals were screened and 98 were randomly assigned to BREATHOX® ten sessions per day (Group 1; 33 patients), BREATHOX® five sessions per day (Group 2; 32 patients), or SOC (33 patients), and followed up for 28 days. There was an association with cough frequency after 10 days BREATHOX® compared to SOC [Group 1: hazard ratio (HR) 2.01, 95% confidence interval (CI) 1.06–3.81; Group 2: HR 2.17, 95% CI 1.17–4.04]. No differences between the groups for the reported symptoms’ resolution time were seen after 28 days. After combining both BREATHOX® groups, the period to cough resolution 10 days after randomization was significantly lower than in SOC (HR 2.10, 95% CI 1.20–3.67). An adverse event occurred in 30% of Group 1, 36% of Group 2, and 9% in SOC individuals. One patient from SOC had a serious adverse event. Nasal burning, sore or itchy nose, and dry mouth were considered related to BREATHOX® use and resolved after stopping inhalations. (4) Conclusion: BREATHOX® inhalation is safe and may be effective in reducing the duration of COVID-19-induced coughing