Favorável de infecção por SARS-COV-2 em paciente com insuficiência hipofisária

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outbreak originated in Wuhan (China) rapidly turned into a pandemic. Due to a national compulsive decree of quarantine, office visits for chronic disease control were delay.Hypopituitarism includes all clinical conditions that result in partial or complete failure of the pituitary gland's ability to secrete hormones. Pituitary insufficiency per sehas been associated with an increase in both morbidity and mortality, particularly due tocardiovascular disease, which is an important risk factor for COVID-19 disease severity. Objective: To report the first case of SARS-CoV-2 infection in a patient with hypopituitarism, discuss the implications of the treatments the patient was taking and grade up the value of telemedicine in the present scenario. Methods: Report of the clinical record of a patient with hypopituitarism and infection with SARS-CoV-2. Results: During the span of the infection, the patient remained on the same hormonal therapeutic scheme (thyroid, gonadal and adrenal axis). The dose of hydrocortisone was not changed during the course of the infection as she was asymptomatic. We use telemedicine to control and advise her on the treatment. Conclusion: Health care professionals should carefully follow up on the evolution of patients with hypopituitarism to provide them a safer outcome. The use of telemedicine as a methodology for selected patients acquires relevance in the present epidemiological context.Introducción: El nuevo coronavirus 2 del Síndrome Respiratorio Agudo Grave (SARS-CoV-2), la cepa viral que está causando la enfermedad pandémica conocida como COVID-19, está generando un desafío sin precedentes para los sistemas de salud de todo el mundo. Dicho escenario puede favorecer el deterioro de las patologías crónicas por la dificultad en el acceso al sistema sanitario. El hipopituitarismo es una condición clínica que se asocia a comorbilidades desfavorables en la evolución de la infección por coronavirus. Objetivo: reportar el primer caso de infección por SARS-CoV-2 en una paciente con hipopituitarismo. Métodos: se describe el primer caso de una mujer con insuficiencia hipofisaria e infección por SARS-CoV-2. Se destaca el aporte de la telemedicina como estrategia para seguir al paciente en forma remota. Resultados: la paciente permaneció con el mismo esquema de terapia de reemplazo hormonal (eje tiroideo, gonadal y adrenal). Se implementó la telemedicina para asesorar sobre la adaptación del tratamiento. Debido a que cursó el proceso infeccioso en forma asintomática no se modificó la dosis de hidrocortisona, evidenciando una evolución favorable. Conclusiones: los profesionales de la salud deben permanecer atentos y vigilar la evolución de los pacientes con insuficiencia hipofisaria e infección por SARS-CoV-2. El uso de la telemedicina, en pacientes seleccionados, se jerarquiza en el contexto epidemiológico actual.Introdução: O novo coronavírus 2 da Síndrome Respiratória Aguda Grave (SARS-CoV-2), a cepa viral que está causando a doença pandêmica conhecida como COVID-19, está criando um desafio sem precedentes para os sistemas de saúde em todo o mundo. Esse cenário pode favorecer o agravamento das patologias crônicas devido à dificuldade de acesso ao sistema de saúde. O hipopituitarismo é uma condição clínica associada a comorbidades desfavoráveis na evolução da infecção por coronavírus. Objetivo:relatar o primeiro caso de infecção por SARS-CoV-2 em paciente com hipopituitarismo. Métodos: é descrito o primeiro caso de uma mulher com insuficiência hipofisária e infecção por SARS-CoV-2. A contribuição da telemedicina é destacada como estratégia para acompanhar o paciente à distância. Resultados: a paciente permaneceu com o mesmo esquema de terapia de reposição hormonal (eixo tireoidiano, gonadal e adrenal). A telemedicina foi implantada para orientar sobre a adaptação do tratamento. Devido ao processo infeccioso assintomático, a dose de hidrocortisona não foi modificada, apresentando evoluçãofavorável. Conclusões: os profissionais de saúde devem permanecer vigilantes e acompanhar a evolução dos pacientes com insuficiência hipofisária e infecção por SARS-CoV-2. O uso da telemedicina, em pacientes selecionados, é hierárquico no contexto epidemiológico atual.publishedVersionFil: Fux Otta, Carolina. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Fil: Moreno, Laura. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Fil: Vitaloni, Roberto. Dirección de Epidemiología del Departamento Castellanos de la Provincia de Santa Fe; Argentina.Fil: Iraci, Gabriel S. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina

Uptake of hypobromous acid (HOBr) by aqueous sulfuric acid solutions: low-temperature solubility and reaction

International audienceHypobromous acid (HOBr) is a key species linking inorganic bromine to the chlorine and odd hydrogen chemical families. We have measured the solubility of HOBr in 45-70wt% sulfuric acid solutions representative of upper tropospheric and lower stratospheric aerosol composition. Over the temperature range 201-252 K, HOBr is quite soluble in sulfuric acid, with an effective Henry's law coefficient, H*=104-107mol L-1atm-1. H* is inversely dependent on temperature, with ?H=-45.0±5.4 kJ mol-1 and ?S=-101±24 J mol-1K-1 for 55-70wt% H2SO4 solutions. Our study includes temperatures which overlap both previous measurements of HOBr solubility. For uptake into 55-70wt% H2SO4, the solubility is described by log H*=(2349±280)/T-(5.27±1.24). At temperatures colder than ~213K, the solubility of HOBr in 45wt% H2SO4 is at least a factor of five larger than in 70wt% H2SO4, with log H*=(3665±270)/T-(10.63±1.23). The solubility of HOBr is comparable to that of HBr, indicating that upper tropospheric and lower stratospheric aerosols should contain equilibrium concentrations of HOBr which equal or exceed those of HBr. Upon uptake of HOBr into aqueous sulfuric acid in the presence of other brominated gases, particularly for 70wt% H2SO4 solution, our measurements demonstrate chemical reaction of HOBr followed by evolution of gaseous products including Br2O and Br2

Analyzing Carbon Dioxide and Methane Emissions in California Using Airborne Measurements and Model Simulations

Greenhouse gas (GHG) concentrations have increased over the past decades and are linked to global temperature increases and climate change. These changes in climate have been suggested to have varying effects, and uncertain consequences, on agriculture, water supply, weather, sea-level rise, the economy, and energy. To counteract the trend of increasing atmospheric concentrations of GHGs, the state of California has passed the California Global Warming Act of 2006 (AB-32). This requires that by the year 2020, GHG (e.g., carbon dioxide (CO2) and methane (CH4)) emissions will be reduced to 1990 levels. To quantify GHG fluxes, emission inventories are routinely compiled for the State of California (e.g., CH4 emissions from the California Greenhouse Gas Emissions Measurement (CALGEM) Project). The major sources of CO2 and CH4 in the state of California are: transportation, electricity production, oil and gas extraction, cement plants, agriculture, landfills/waste, livestock, and wetlands. However, uncertainties remain in these emission inventories because many factors contributing to these processes are poorly quantified. To alleviate these uncertainties, a synergistic approach of applying air-borne measurements and chemical transport modeling (CTM) efforts to provide a method of quantifying local and regional GHG emissions will be performed during this study. Additionally, in order to further understand the temporal and spatial distributions of GHG fluxes in California and the impact these species have on regional climate, CTM simulations of daily variations and seasonality of total column CO2 and CH4 will be analyzed. To assess the magnitude and spatial variation of GHG emissions and to identify local hot spots, airborne measurements of CH4 and CO2 were made by the Alpha Jet Atmospheric eXperiment (AJAX) over the San Francisco Bay Area (SFBA) and San Joaquin Valley (SJV) in January and February 2013 during the Discover-AQ-CA study. High mixing ratios of GHGs were observed in-flight with a high degree of spatial variability. To provide an additional method to quantify GHG emissions, and analyze AJAX measurement data, the GEOS-Chem CTM is used to simulate SFBA/SJV GHG measurements. A nested-grid version of GEOS-Chem will be applied and utilizes varying emission inventories and model parameterizations to simulate GHG fluxes/emissions. The model considers CO2 fluxes from fossil fuel use, biomass/biofuel burning, terrestrial and oceanic biosphere exchanges, shipping and aviation, and production from the oxidation of carbon monoxide, CH4, and non-methane volatile organic carbons. The major sources of CH4 simulated in GEOS-Chem are domesticated animals, rice fields, natural gas leakage, natural gas venting/flaring (oil production), coal mining, wetlands, and biomass burning. Preliminary results from the comparison between available observations (e.g., AJAX and CALGEM CH4 emission maps) and GEOS-Chem results will be presented, along with a discussion of CO2 and CH4 source apportionment and the use of the GEOS-Chem-adjoint to perform inverse GHG modeling

Sports Hernia/Athletic Pubalgia Among Women

© The Author(s) 2018. Background: “Athletic pubalgia,” a term that has gained acceptance over “sports hernia,” is more common in men than women; however, it represents a significant source of morbidity for patients of both sexes. Inconsistent terminology surrounding this entity poses a diagnostic challenge and makes studying the populations at risk difficult. Purpose: To review a case series of women with athletic pubalgia by analyzing their presentations, concomitant pathologies, and surgical outcomes. Study Design: Case series; Level of evidence, 4. Methods: Between 2013 and 2016, 197 patients were seen and evaluated for the diagnosis of athletic pubalgia. Eighteen patients seen during this time were women. All patients received “pubalgia protocol” magnetic resonance imaging and subsequent surgical intervention for their pathologies. Outcomes among 17 women were assessed with a patient questionnaire \u3e1 year after surgery. Results: Of the 17 women, 9 had rectus aponeurotic plate injury only, or pure athletic pubalgia; the remaining 8 had athletic pubalgia in combination with ≥1 inguinal, obturator, and femoral hernias. Regarding female patients in both groups, 88.2% reported that the surgery was a success at follow-up. Conclusion: Surgical repair of athletic pubalgia among women is successful in dramatically reducing pain levels in this important subset of patients

A Phase II, Randomized, Double-Blind, Placebo Controlled, Dose-Response Trial of the Melatonin Effect on the Pain Threshold of Healthy Subjects

Background: Previous studies have suggested that melatonin may produce antinociception through peripheral and central mechanisms. Based on the preliminary encouraging results of studies of the effects of melatonin on pain modulation, the important question has been raised of whether there is a dose relationship in humans of melatonin on pain modulation. Objective: The objective was to evaluate the analgesic dose response of the effects of melatonin on pressure and heat pain threshold and tolerance and the sedative effects. Methods: Sixty-one healthy subjects aged 19 to 47 y were randomized into one of four groups: placebo, 0.05 mg/kg sublingual melatonin, 0.15 mg/kg sublingual melatonin or 0.25 mg/kg sublingual melatonin. We determine the pressure pain threshold (PPT) and the pressure pain tolerance (PPTo). Quantitative sensory testing (QST) was used to measure the heat pain threshold (HPT) and the heat pain tolerance (HPTo). Sedation was assessed with a visual analogue scale and bispectral analysis. Results: Serum plasma melatonin levels were directly proportional to the melatonin doses given to each subject. We observed a significant effect associated with dose group. Post hoc analysis indicated significant differences between the placebo vs. the intermediate (0.15 mg/kg) and the highest (0.25 mg/kg) melatonin doses for all pain threshold and sedation level tests. A linear regression model indicated a significant association between the serum melatonin concentrations and changes in pain threshold and pain tolerance (R2 = 0.492 for HPT, R2 = 0.538 for PPT, R2 = 0.558 for HPTo and R2 = 0.584 for PPTo). Conclusions: The present data indicate that sublingual melatonin exerts well-defined dose-dependent antinociceptive activity. There is a correlation between the plasma melatonin drug concentration and acute changes in the pain threshold. These results provide additional support for the investigation of melatonin as an analgesic agent. Brazilian Clinical Trials Registry (ReBec): (U1111-1123-5109). IRB: Research Ethics Committee at the Hospital de Clínicas de Porto Alegre

A31N-03: Lower-Tropospheric CO2 from Near-Infrared ACOS-GOSAT Observations

We present two new products from near-infrared GOSAT observations: lower tropospheric (LMT, from 0-2.5 km) and upper tropospheric/stratospheric (U, above 2.5 km) carbon dioxide partial columns. We compare these new products to aircraft profiles and remote surface flask measurements and find that the seasonal and year-to-year variations in the new partial columns significantly improve over the ACOS-GOSAT initial guess/a priori, with distinct patterns in the LMT and U seasonal cycles which match validation data. For land monthly averages, we find errors of 1.9, 0.7, and 0.8 ppm for retrieved GOSAT LMT, U, and XCO2; for ocean monthly averages, we find errors of 0.7, 0.5, and 0.5 ppm for retrieved GOSAT LMT, U, and XCO2. In the southern hemisphere biomass burning season, the new partial columns show similar patterns to MODIS fire maps and MOPITT multispectral CO for both vertical levels, despite a flat ACOS-GOSAT prior, and CO/CO2 emission factor consistent with published values. The difference of LMT and U, useful for evaluation of model transport error, has also been validated with monthly average error of 0.8 (1.4) ppm for ocean (land). The new LMT partial column is more locally influenced than the U partial column, meaning that local fluxes can now be separated from CO2 transported from far away

Neurobiological Effects of Transcranial Direct Current Stimulation: A Review

Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique that is affordable and easy to operate compared to other neuromodulation techniques. Anodal stimulation increases cortical excitability, while the cathodal stimulation decreases it. Although tDCS is a promising treatment approach for chronic pain as well as for neuropsychiatric diseases and other neurological disorders, several complex neurobiological mechanisms that are not well understood are involved in its effect. The purpose of this systematic review is to summarize the current knowledge regarding the neurobiological mechanisms involved in the effects of tDCS. The initial search resulted in 171 articles. After applying inclusion and exclusion criteria, we screened 32 full-text articles to extract findings about the neurobiology of tDCS effects including investigation of cortical excitability parameters. Overall, these findings show that tDCS involves a cascade of events at the cellular and molecular levels. Moreover, tDCS is associated with glutamatergic, GABAergic, dopaminergic, serotonergic, and cholinergic activity modulation. Though these studies provide important advancements toward the understanding of mechanisms underlying tDCS effects, further studies are needed to integrate these mechanisms as to optimize clinical development of tDCS

Fibromialgia e disfunção temporomandibular: uma revisão de escopo

A fibromialgia (FM) é uma síndrome complexa com alterações nociplásticas, caracterizadas por hiperalgesia e alodinia, frequentemente acompanhada pela presença de dor orofacial. Estudos têm demonstrado alta prevalência de disfunção temporomandibular (DTM) em pacientes fibromiálgicos, como fator etiológico ou agravante. O objetivo desta revisão foi avaliar a ocorrência concomitante da DTM e da síndrome fibromiálgica e o seu tratamento. Tratamentos não-farmacológicos, como psicoterapia e exercícios físicos, melhoram a dor, a qualidade de vida e a saúde mental dos pacientes. Duloxetina e Pregabalina são aprovadas pela ANVISA para o tratamento da FM, aos quais o FDA inclui o milnaciprano. Os principais fármacos utilizados para os sintomas de FM são pregabalina, amitriptilina, antidepressivos duais, tramadol, baixas doses de naltrexona e canabinoides. A associação de fármacos pode ser útil para aumentar a eficácia do tratamento e reduzir as doses dos mesmos. Por outro lado, novas terapias não farmacológicas, como as técnicas modulatórias não-invasivas, surgem como opções promissoras, promovendo alterações neuroplásticas importantes no tratamento. Conclusão: Há diversas opções terapêuticas farmacológicas e não-farmacológicas disponíveis no tratamento do paciente fibromiálgico para o especialista em DTM e Dor Orofacial. Portanto, a combinação de diferentes abordagens pode auxiliar na obtenção de um protocolo individualizado, adequado às necessidades do paciente

Terrain trapped airflows and precipitation variability during an atmospheric river event

We examine thermodynamic and kinematic structures of terrain trapped airflows (TTAs) during an atmospheric river (AR) event impacting Northern California 10–11 March 2016 using Alpha Jet Atmospheric eXperiment (AJAX) aircraft data, in situ observations, and Weather and Research Forecasting (WRF) Model simulations. TTAs are identified by locally intensified low-level winds flowing parallel to the coastal ranges and having maxima over the near-coastal waters. Multiple mechanisms can produce TTAs, including terrain blocking and gap flows. The changes in winds can significantly alter the distribution, timing, and intensity of precipitation. We show here how different mechanisms producing TTAs evolve during this event and influence local precipitation variations. Three different periods are identified from the time-varying wind fields. During period 1 (P1), a TTA develops during synoptic-scale onshore flow that backs to southerly flow near the coast. This TTA occurs when the Froude number (Fr) is less than 1, suggesting low-level terrain blocking is the primary mechanism. During period 2 (P2), a Petaluma offshore gap flow develops, with flows turning parallel to the coast offshore and with Fr \u3e 1. Periods P1 and P2 are associated with slightly more coastal than mountain precipitation. In period 3 (P3), the gap flow initiated during P2 merges with a pre-cold-frontal low-level jet (LLJ) and enhanced precipitation shifts to higher mountain regions. Dynamical mixing also becomes more important as the TTA becomes confluent with the approaching LLJ. The different mechanisms producing TTAs and their effects on precipitation pose challenges to observational and modeling systems needed to improve forecasts and early warnings of AR events

Scientific and Technical Assistance for the Deployment of a Flexible Airborne Spectrometer System During C-MAPExp and COMEX

The COMEX (CO2 and MEthane eXperiment) campaign supports the mission definition of CarbonSat and HyspIRI (Hyperspectral Infrared Imager) by providing representative airborne remote sensing data MAMAP (Methane Airborne MAPper) for CarbonSat; the Airborne Visual InfraRed Imaging Spectrometer (Classic & Next Generation) AVIRISC/AVIRISNG for HyspIRI as well as ground-based and airborne insitu data. The objectives of the COMEX campaign activities are (see Campaign Implementation Plan (RD4)): 1. Investigate spatial/spectral resolution tradeoffs for CH4 anomaly detection and flux inversion by comparison of MAMAPderived emission estimates with AVIRIS/AVIRISNG derived data. 2. Evaluate sunglint observation geometry on CH4 retrievals for marine sources. 3. Characterize the effect of Surface Spectral Reflectance (SSR) heterogeneity on trace gas retrievals of CO2 and CH4 for medium and lowresolution spectrometry. 4. Identify benefits from joint SWIR/TIR (ShortWave InfraRed/Thermal InfraRed ) data for trace gas detection and retrieval by comparison of MAMAP and AVIRIS/AVIRISNG NIR/SWIR data with MAKO (Aerospace Corp.)TIR data. The ability to derive emission source strength for a range of strong emitting targets by remote sensing will be evaluated from combined AVIRISNG and MAMAP data, adding significant value to the HyspIRI campaign AVIRISNG dataset. The data will be used to quantify anomalies in atmospheric CO2 and CH4 from strong local greenhouse gas sources e.g. localized industrial complexes, landfills, etc. and to derive CO2 and CH4 emissions estimates from atmospheric gradient measurements. The original campaign concept was developed by University of Bremen and BRI. The COMEX campaign is funded bilaterally by NASA and ESA (European Space Agency). Whereas NASA funds the US part of the project via a contract with Dr. Ira Leifer, BRI (Bubbleology Research International), the contribution of MAMAP to the COMEX campaign is funded by ESA within the COMEXE project and NASA with respect to a 50 percent contribution to the flight-related costs of flying MAMAP on a US aircraft. The Data Acquisition Report (RD9) describes the instrumentation used, the measurements made by the team during the COMEX campaign in May/June 2014 and August/September 2014 in California, and an initial assessment of the data quality