Insulinoma e gestação: anestesia e manejo perioperatório

ResumoO insulinoma é um tumor neuroendócrino funcional de células beta das ilhotas de Langerhans pancreáticas, geralmente solitários, benignos, curáveis com cirurgia (enucleação). Raramente ocorre durante a gravidez e se manifesta clinicamente por hipoglicemia, principalmente no primeiro trimestre da gravidez. Durante a gestação as condutas terapêuticas conservadoras (medicamentosas) e o tratamento cirúrgico constituem desafios tendo em vista a impossibilidade de estudos sobre teratogenicidade de fármacos, assim como as repercussões materno‐fetais durante intervenções cirúrgicas, como a hipoglicemia e alterações decorrentes do estresse.Relato de casoPaciente com 33 anos, 86 Kg, 1,62m, IMC 32,7kg/m2, primigesta, 15 semanas de idade gestacional, estado físico III da ASA, investigada por rebaixamento do nível de consciência. Aos exames laboratoriais constataram‐se: hipoglicemia (45mg/dL) associada à hiperinsulinemia (24 nUI/ml) e hemoglobina glicosilada (4,1%); demais exames laboratoriais e exame físico normais. A ressonância magnética mostrou nódulo de 1,1cm em cauda de pâncreas com hipótese de insulinoma. Devido ao difícil controle glicêmico com infusão em bolus e contínua de glicose, foi feita laparotomia para enucleação do tumor sob anestesia venosa total associada a bloqueio peridural. Monitoração, acesso venoso central e periférico, cateterização de artéria radial, diurese, glicosimetria a cada 15 minutos. No intraoperatório, observou‐se hipoglicemia acentuada nos momentos de manipulação e imediatamente antes da enucleação do tumor, controlada com infusão contínua de solução cristaloide balanceada glicosada a 10% (100 a 230ml/h). A evolução no pós‐operatório seguiu sem intercorrências, com resolução dos quadros de hipoglicemia e retirada total da infusão venosa de glicose.AbstractInsulinoma is a functional neuroendocrine tumor derived from beta cells of the pancreatic islets of Langerhans, usually solitary, benign, and curable with surgery (enucleation). It rarely occurs during pregnancy and is clinically manifested by hypoglycemia, particularly in the first trimester of pregnancy. During pregnancy, both conservative therapeutic measures (medication) and surgical treatment are challenging regarding the impossibility of studies on drug teratogenicity as well as the maternal‐fetal repercussions during surgery, such as hypoglycemia and changes due to stress.Case reportA 33‐year primiparous woman, 86kg, 1.62m, BMI 32.7kg/m2, at 15 weeks’ gestation, physical status ASA III, investigated for a reduced level of consciousness. Laboratory tests showed: hypoglycemia (45mg/dL) associated with hyperinsulinemia (24 nUI/mL), glycosylated hemoglobin (4.1%); other laboratory findings and physical examination were normal. Magnetic resonance imaging showed a 1.1cm nodule in the pancreatic tail with suspected insulinoma. Due to the difficult glycemic control with bolus and continuous infusion of glucose, laparotomy was performed for tumor enucleation under total intravenous anesthesia combined with epidural block. Monitoring, central and peripheral venous access, radial artery catheterization, diuresis, and glucosimetry were recorded every 15minutes. Intraoperatively, there was severe hypoglycemia while handling the tumor and shortly before its enucleation, which was controlled through continuous infusion of 10% glucose balanced crystalloid solution (100‐230mL/h). The patient's postoperative evolution was uneventful, with resolution of hypoglycemia and total withdrawal of glucose intravenous infusion

Estimative of reference flows for water resources planning and control: hydrologic regional indicators application

Due to limitations of hydrometeorological monitoring network related to spatial station distribution and extension of historical series, tools that aim to improve consistency and optimize available data analysis have become essential. In this context, regionalization techniques stand out, once the main focus is the delimitation of hydrologically homogeneous regions with the subsequent spatial transposition of hydrological variables of interest. Regional indicators, defined as the mean values of hydrological variables and characteristics of a homogeneous region, constitute an expeditious approach to hydrological regionalization. The main perspective of the study was to evaluate the use of regional indicators when quantifying reference flows associated with average flow, drought, or flood conditions. The study area selected was the Manhuaçu River basin, a major Doce River tributary, located in the state of Minas Gerais, Brazil. The results showed that the regional indicators allow estimates of diverse reference flows with mean errors lower than 30%, considered satisfactory for the study area. However, the conventional method of flow regionalization presented more consistent results, with mean errors usually lower than 20%, regardless of the reference flow analyzed. It was also observed that adopting historical flow series with varied extensions did not produce relevant differences when appropriating the diverse reference flows for the Manhuaçu River basin, with none exceeding 3%.Em função das limitações da rede de monitoramento hidrometeorológico, tanto do ponto de vista da distribuição espacial quanto da extensão das séries históricas, ferramentas que busquem dar consistência e otimizar a análises dos dados disponíveis vêm ganhando espaço. Neste contexto, destacam-se as técnicas de regionalização, cujo principal foco é a delimitação de regiões hidrologicamente homogêneas com a subsequente transposição espacial de variáveis hidrológicas de interesse. Os indicadores regionais, definidos como valores médios de uma variável hidrológica e característicos de uma região homogênea, constituem abordagem expedita de regionalização hidrológica. O presente estudo teve como principal perspectiva avaliar o emprego de indicadores regionais quando da quantificação de vazões de referência associadas às condições médias de escoamento, estiagens ou cheias. A área de estudo selecionada para a condução do estudo foi a bacia hidrográfica do rio Manhuaçu, importante afluente do rio Doce, Minas Gerais, Brasil. Os resultados demonstraram que os indicadores regionais permitem estimativas de diferentes vazões de referências com erros médios inferiores a 30%, considerados satisfatórios para a área de estudo. No entanto, o método convencional de regionalização de vazões apresentou resultados mais consistentes, com erros médios usualmente inferiores a 20%, independentemente da vazão de referência analisada. Observou-se, adicionalmente, que a adoção de séries históricas de vazões com diferentes extensões não produziu diferenças relevantes quando da apropriação das diferentes vazões de referência para a bacia hidrográfica do rio Manhuaçu, com diferenças que não superaram 3%.

DOWNWARD LONGWAVE RADIATION ESTIMATES FOR CLEAR AND ALL-SKY CONDITIONS IN CENTRAL AMAZONIA

The downward longwave radiation (L↓), really is difficult of the net radiation the measured values component. Therefore, different parameterizations have been proposed to estimate it. Thus, in this study we evaluated the performance of various parameterizations for the L↓ flows estimated and their interaction with other variables measured as well as the air temperature and water vapour pressure interactions with L↓. In this study evaluates the performance of the downward longwave radiation parameters for clear and cloudy sky days applied in Central Amazonia region. The datasets used in this study was measured from micrometeorological tower controlled by Large Scale Biosphere Atmosphere experiment in Amazonia (LBA) from Manaus city, Amazonas. It was also found that precipitation and water vapour pressure exert enough on L↓ flows influence, especially in the wet season. The models for clear-sky conditions proposed, using their original coefficients trend to underestimate the L↓ flows measured. Best results for clear-sky were obtained with Idso & Jackson (1969), Brutsaert (1975) and Prata (1996)

COVID-19 in long-term care facilities in Brazil: serological survey in a post-outbreak setting

This cross-sectional seroepidemiological survey presents the seroprevalence of SARS-CoV-2 in a population living in 15 Long-Term Care Facilities (LTCFs), after two intra-institutional outbreaks of COVID-19 in the city of Botucatu, Sao Paulo State, Brazil. Residents were invited to participate in the serological survey performed in June and July 2020. Sociodemographic and clinical characterization of the participants as well as the LTCF profile were recorded. Blood samples were collected, processed and serum samples were tested using the rapid One Step COVID-19 immunochromatography test to detect IgM and IgG anti-SARS-CoV-2. Among 209 residents, the median of age was 81 years old, 135 (64.6%) were female and 171 (81.8%) self-referred as being white. An overall seroprevalence of 11.5% (95% CI: 7.5% – 16.6%) was found. The highest seroprevalences of 100% and 76.9% were observed in LTCFs that had experienced COVID-19 outbreaks. Most residents with positive immunochromatography tests (70.8%) referred previous contact with a confirmed COVID-19 case. Although there was a relatively low seroprevalence of COVID-19 in the total number of elderly people, this population is highly vulnerable and LTCFs are environments at higher risk for COVID-19 dissemination. A well-established test for COVID-19 policies, the adequate characterization of the level of interaction between residents and the healthcare provider team and the level of complexity of care are crucial to monitor and control the transmission of SARS-CoV-2 in these institutions

Estimative of reference flows for water resources planning and control: hydrologic regional indicators application

Em função das limitações da rede de monitoramento hidrometeorológico, tanto do ponto de vista da distribuição espacial quanto da extensão das séries históricas, ferramentas que busquem dar consistência e otimizar a análises dos dados disponíveis vêm ganhando espaço. Neste contexto, destacam-se as técnicas de regionalização, cujo principal foco é a delimitação de regiões hidrologicamente homogêneas com a subsequente transposição espacial de variáveis hidrológicas de interesse. Os indicadores regionais, definidos como valores médios de uma variável hidrológica e característicos de uma região homogênea, constituem abordagem expedita de regionalização hidrológica. O presente estudo teve como principal perspectiva avaliar o emprego de indicadores regionais quando da quantificação de vazões de referência associadas às condições médias de escoamento, estiagens ou cheias. A área de estudo selecionada para a condução do estudo foi a bacia hidrográfica do rio Manhuaçu, importante afluente do rio Doce, Minas Gerais, Brasil. Os resultados demonstraram que os indicadores regionais permitem estimativas de diferentes vazões de referências com erros médios inferiores a 30%, considerados satisfatórios para a área de estudo. No entanto, o método convencional de regionalização de vazões apresentou resultados mais consistentes, com erros médios usualmente inferiores a 20%, independentemente da vazão de referência analisada. Observou-se, adicionalmente, que a adoção de séries históricas de vazões com diferentes extensões não produziu diferenças relevantes quando da apropriação das diferentes vazões de referência para a bacia hidrográfica do rio Manhuaçu, com diferenças que não superaram 3%

Side Effects of Chloroquine and Primaquine and Symptom Reduction in Malaria Endemic Area (Mâncio Lima, Acre, Brazil)

Side effects of antimalarial drug can overlap with malaria symptoms. We evaluated 50 patients with vivax malaria in Mâncio Lima, Acre, treated with chloroquine and primaquine. Patients were evaluated for the presence of 21 symptoms before and after treatment and for reported side effects of these drugs after treatment was started. The most frequent symptoms before medication were headache, fever, chills, sweating, arthralgia, back pain, and weakness, which were present in between 40% and 76% of respondents. The treatment reduced the occurrence of these symptoms and reduced the lack of appetite, but gastrointestinal symptoms and choluria increased in frequency. There were no reports of pale stools before medication, but 12% reported the occurrence of this symptom after treatment started. Other symptoms such as blurred vision (54%), pruritus (22%), paresthesia (6%), insomnia (46%), and “stings” into the skin (22%) were reported after chloroquine was taken. The antimalarial drugs used to treat P. vivax malaria reduce much of the systemic and algic symptoms but cause mainly gastrointestinal side effects that may lead to lack of adherence to drug treatment. It is important to guide the patient for the appearance and the transience of such side effects in order to avoid abandoning treatment

Mercury toxicity in the Amazon: contrast sensitivity and color discrimination of subjects exposed to mercury

We measured visual performance in achromatic and chromatic spatial tasks of mercury-exposed subjects and compared the results with norms obtained from healthy individuals of similar age. Data were obtained for a group of 28 mercury-exposed subjects, comprising 20 Amazonian gold miners, 2 inhabitants of Amazonian riverside communities, and 6 laboratory technicians, who asked for medical care. Statistical norms were generated by testing healthy control subjects divided into three age groups. The performance of a substantial proportion of the mercury-exposed subjects was below the norms in all of these tasks. Eleven of 20 subjects (55%) performed below the norms in the achromatic contrast sensitivity task. The mercury-exposed subjects also had lower red-green contrast sensitivity deficits at all tested spatial frequencies (9/11 subjects; 81%). Three gold miners and 1 riverine (4/19 subjects, 21%) performed worse than normal subjects making more mistakes in the color arrangement test. Five of 10 subjects tested (50%), comprising 2 gold miners, 2 technicians, and 1 riverine, performed worse than normal in the color discrimination test, having areas of one or more MacAdam ellipse larger than normal subjects and high color discrimination thresholds at least in one color locus. These data indicate that psychophysical assessment can be used to quantify the degree of visual impairment of mercury-exposed subjects. They also suggest that some spatial tests such as the measurement of red-green chromatic contrast are sufficiently sensitive to detect visual dysfunction caused by mercury toxicity

Hydrochemistry, elements distribution and their potential recoveries in gold metallurgical treatment tailings dams

Wastewaters are valuable sources of metals and metalloids and can serve as essential resources for their recovery. Characterizing and understanding the occurrence of metals and other compounds, along with identifying the most effective recovery methods, are key steps in unlocking the potential for reusing these resources. The present study focused on analyzing waters from various mining dams in the Iron Quadrangle (IQ) region of Brazil, which contained metals such as Au, Cu, Ni, Zn, and sulfates resulting from the metallurgical treatment of Au. The results revealed a range of metal concentrations in the neutral zone in three tailings. Additionally, a 3D map was created, and a statistical analysis and an exploration of the processes governing mobility and partitioning were conducted to assess the potential for reuse. Notably, the study identified a high potential for Au recovery, particularly through the utilization of sustainable and cost-effective methods such as nanofibers with biosorbents. Overall, this research contributes to the understanding and exploration of potential reuse procedures for strategic metals in various industrial applications.This research was funded by Fundação para a Ciência and Tecnologia (FCT) through projects UIDB/04683/2020, UIDP/04683/2020, and Nano-MINENV 029259 (PTDC/CTA-AMB/ 29259/2017)