Tricoepitelioma familiar múltiplo: um relato de caso raro

Introdução: O Tricoepitelioma Familiar múltiplo (TFM) é uma variante fenotípica da Síndrome de Brooke-Spiegler, autossômica dominante, prevalente no sexo feminino (70%), caracterizada pelo aparecimento de múltiplas pápulas e/ou nódulos normocrômicos em face e couro cabeludo. O diagnóstico é clínico e cerca de 60% dos casos possuem história familiar. Objetivo: Relatar um caso raro e exuberante de Tricoepitelioma Familiar Múltiplo em paciente do sexo masculino com incidência familiar e reforçar a imporância do diagnóstico precoce. Material e métodos: Trata-se de um relato de caso, e portanto, estudo retrospectivo e descritivo com dados coletados em prontuário do paciente com o diagnóstico de Tricoepitelioma Familiar Múltiplo. Atendendo às questões éticas, foi obtido o Termo de Consentimento Livre e Esclarecido (TCLE) dos envolvidos, bem como a autorização para publicação das fotos. Resultados: Paciente, sexo masculino, 73 anos, com múltiplas lesões papulonodulares em face, presentes desde a infância e filho com lesões similares. Ao exame dermatológico, lesões normocrômicas e lesão vegetante, friável, eritematosa em região supra labial além de lesão semelhante com crostas hemáticas em zona supralabial direita com obliteração do introito nasal. A análise histológica revelou a presença de ninhos ramificados de células basalóides e cistos de queratina, corroborando com o diagnóstico de Tricoepitelioma Familiar Múltiplo. O paciente evoluiu com exulceração da lesão em sulco nasolabial, face desfigurada,  quadro infeccioso e consequente internação. Foi realizado antibioticoterapia, programada a exérese de algumas lesões e o acompanhamento regular implementado. Conclusão: O tricoepitelioma familiar múltiplo impacta significativamente o âmbito estético, social e psicológico do paciente. Dada a raridade da doença, não há estudos clínicos que definam o melhor tratamento para a doença, sendo esses controversos e sem padronização até o momento. As estratégias vão desde a espera e observação, até técnicas de ablação agressivas. O presente estudo visa reforçar a importância do reconhecimento e tratamento precoce do Tricoepitelioma Familiar Múltiplo, bem como seu acompanhamento clínico, tendo em vista a possibilidade de recidivas e transformações neoplásicas. Além disso, a doença pode ocasionar desfiguração e gerar impactos sociais significativos na vida do paciente, com consequente exclusão social. Dessa forma, o acompanhamento dermatológico é imprescindível

REMOÇÃO DE MICROCYSTIS AERUGINOSA E MICROCISTINA EM ÁGUA EUTROFIZADA ATRAVÉS DO PROCESSO COMBINADO DE COAGULAÇÃO/FLOCULAÇÃO SEGUIDO DE NANOFILTRAÇÃO

O processo de tratamento convencional é capaz de remover as células de cianobactérias, mas são pouco eficientes na remoção das cianotoxinas, necessitando de técnicas complementares para a remoção dessa fração dissolvida. Nesse contexto, a nanofiltração apresenta-se como tecnologia eficaz na remoção de cianotoxinas. Assim, a associação dos processos de coagulação/floculação/sedimentação (C/F/S) e nanofiltração (NF), como uma sequência de tratamento para águas oriundas de ambientes eutrofizados, torna-se relevante e, desta forma, foi adotada como objeto do presente estudo. Para os testes, foi preparada uma "água sintética", utilizando água deionizada e posterior contaminação com células de Microcystisaeruginosa, para obter concentração da ordem de 106 – 107céls/mL. A metodologia adotada neste trabalho foi realizada em duas etapas: 1) processo C/F/S usando os Tanfloc SG, SL e SS como coagulantes naturais para determinação da concentração ótima do coagulante 2) processo de NF utilizando as membranas NF-90 e NF-270, com características ligeiramente distintas, na pressão de 5 bar. O desempenho do tratamento como um todo C/F/S+NF, avaliado a partir dos parâmetros físico-químicos (turbidez, cor e pH) e microbiológicos (contagem de células de cianobactéria e concentração de microcistina-LR).AbstractThe conventional treatment process is capable of removing cyanobacteria cells but are inefficient in removing cyanotoxins, requiring additional techniques for removing dissolved fraction of that. In this context, nanofiltration, is presented as a technology effective in removing cyanotoxins and, for this reason, the combination of the processes of coagulation / flocculation / sedimentation (C / F / S) and nanofiltration (NF), as a result of treatment for waters originating from eutrophic environments, it becomes wide relevance, having been adopted as the object of this study. For the tests was prepared a "synthetic water", using deionized water and subsequent contamination with cells from Microcystisaeruginosa, to obtain concentration in the range 106-107 cells / mL. The methodology adopted in this study was performed in two steps: 1) Case C / F / S using Tanfloc SG, SL and SS as natural coagulants for determining the optimum concentration of coagulant 2) process using NF membranes NF-90 and NF -270 with slightly different characteristics, at a pressure of 5 bar. The performance of the treatment as a whole C / F / S + NF was evaluated from the physico-chemical parameters (turbidity, color and pH) and microbial (cyanobacterial cell counts and concentration of microcystin-LR)

Intersocietal consensus on the treatment of obesity in adolescents in Argentina

En un contexto socioeconómico mundial de profundas desigualdades, mientras que poblaciones enteras están siendo arrasadas por la desnutrición, es notorio el aumento de la obesidad en niños, adolescentes y adultos. La prevalencia de obesidad ha aumentado a un ritmo alarmante y está afectando progresivamente a muchos países de bajos y medianos ingresos, sobre todo en el medio urbano. Preocupa, especialmente de bido a las severas complicaciones clínicas que ocasiona1,2. De manera coincidente con las tendencias internacionales, en la Argentina la 2º Encuesta Nacional de Nutrición y Salud ( ENNYS) del año 2019 revela cifras del 20,7% y 20,4% de sobrepeso y obesidad en niños de 5 a 17 años, y en la tercera Encuesta Mundial de Salud Escolar del 2018 ( EMSE) , las cifras de la población de 13 a 17 años fueron de 30,7 % de sobrepeso y 7,4 % de obesidad3,4. La obesidad es una enfermedad crónica. Recientemente, la Asociación Europea para el Estudio de la Obesidad (EASO), la resume como una enfermedad por exceso de tejido adiposo. Las severas consecuencias en la salud que provoca dependen de la cantidad, la distribución y la localización del tejido adiposo. La enfermedad se produce, tanto a partir de la alteración en la función endócrina e inmulogógica del organismo, como causando alteraciones anatómicas en el organismo a partir del espacio físico que ocupa...Fil: Kovalskys, Irina. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires"; ArgentinaFil: Mayer, Marcos Alejandro. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Patagonia Confluencia. Instituto de Ciencias de la Tierra y Ambientales de la Pampa. Grupo Vinculado Fundacion Centro de Salud E Investigaciones Medicas | Universidad Nacional de la Pampa. Facultad de Ciencias Exactas y Naturales. Instituto de Ciencias de la Tierra y Ambientales de la Pampa. Grupo Vinculado Fundacion Centro de Salud E Investigaciones Medicas.; ArgentinaFil: Armeno, Marisa. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Matto, Liliana. Asociación Psiquiátrica de América Latina; Argentina. Asociación de Psiquiatras Argentinos; ArgentinaFil: Roussos, Adriana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Schuldberg, Jacqueline. Asociación Argentina de Dietistas- Nutricionistas Dietistas; ArgentinaFil: Tozzi, Karina. Sociedad Argentina de Endocrinología Ginecológica y Reproductiva; ArgentinaFil: Valenti, Claudia. Gobierno de la Ciudad Autonoma de Buenos Aires. Ministerio de Salud. Subsecretaria de Atencion Primaria Ambulatoria y Comunitaria.; ArgentinaFil: Anger, Vanesa E.. Universidad Maimónides; ArgentinaFil: Araujo, María Beatriz. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Bakalarz, Beatriz. Asociación Psiquiatras Argentinos; ArgentinaFil: Bazan, Nelio Eduardo. Universidad Nacional de Rosario; ArgentinaFil: Ganduglia Cazaban, Mercedes. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina. Asociación Argentina de Nutricionistas y Nutricionistas Dietistas; ArgentinaFil: Ozuna, Blanca Acela. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Rampi, Gabriela. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Ruiz, Laura. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Sarubbi, Susana. Sociedad Argentina de Nutrición; ArgentinaFil: Tonietti, Miriam. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Zonis, Luciana. Sociedad Argentina de Nutrición; ArgentinaFil: Salinas, Victoria. Sociedad Argentina de Nutrición; ArgentinaFil: Aguirre Ackermann, Marianela. Sociedad Argentina de Nutrición; Argentina. Universidad Nacional del Nordeste; Argentina. Universidad Favaloro; ArgentinaFil: Sguassero, Yanina. Sociedad Argentina de Nutrición; ArgentinaFil: Katz, Mónica. Sociedad Argentina de Nutrición; Argentina. Universidad Favaloro; Argentin

VizieR Online Data Catalog: MACS J0416.1-2403 redshift catalogue (Caminha+, 2017)

We used archival MUSE (Bacon et al., 2012, The Messenger, 147, 4) data from two different programs which covered the North-East (NE) and South- West (SW) regions of MACS 0416. (2 data files). <P /

VLT/MUSE MACS J0416.1-2403 redshift catalogue

VizieR online Data Catalogue associated with article published in journal Astronomy &amp; Astrophysics with title 'The MUSE Deep Lensed Field on the Hubble Frontier Field MACS J0416. Star-forming complexes at cosmological distances.' (bibcode: 2021A&amp;A...646A..57V

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora

A Bayesian reanalysis of the Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial

Background Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney injury and found neutral results for 90-day all-cause mortality. Probabilistic exploration of the trial endpoints may enable greater understanding of the trial findings. We aimed to perform a reanalysis using a Bayesian framework. Methods We performed a secondary analysis of all 2927 patients randomized in multi-national STARRT-AKI trial, performed at 168 centers in 15 countries. The primary endpoint, 90-day all-cause mortality, was evaluated using hierarchical Bayesian logistic regression. A spectrum of priors includes optimistic, neutral, and pessimistic priors, along with priors informed from earlier clinical trials. Secondary endpoints (KRT-free days and hospital-free days) were assessed using zero–one inflated beta regression. Results The posterior probability of benefit comparing an accelerated versus a standard KRT initiation strategy for the primary endpoint suggested no important difference, regardless of the prior used (absolute difference of 0.13% [95% credible interval [CrI] − 3.30%; 3.40%], − 0.39% [95% CrI − 3.46%; 3.00%], and 0.64% [95% CrI − 2.53%; 3.88%] for neutral, optimistic, and pessimistic priors, respectively). There was a very low probability that the effect size was equal or larger than a consensus-defined minimal clinically important difference. Patients allocated to the accelerated strategy had a lower number of KRT-free days (median absolute difference of − 3.55 days [95% CrI − 6.38; − 0.48]), with a probability that the accelerated strategy was associated with more KRT-free days of 0.008. Hospital-free days were similar between strategies, with the accelerated strategy having a median absolute difference of 0.48 more hospital-free days (95% CrI − 1.87; 2.72) compared with the standard strategy and the probability that the accelerated strategy had more hospital-free days was 0.66. Conclusions In a Bayesian reanalysis of the STARRT-AKI trial, we found very low probability that an accelerated strategy has clinically important benefits compared with the standard strategy. Patients receiving the accelerated strategy probably have fewer days alive and KRT-free. These findings do not support the adoption of an accelerated strategy of KRT initiation

Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis.

ObjectivesAmong patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant.DesignSecondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.gov number NCT02568722).SettingOne hundred-fifty-three ICUs in 13 countries.PatientsAltogether 2693 critically ill patients with AKI, of whom 994 were North American, 1143 European, and 556 from Australia and New Zealand (ANZ).InterventionsNone.Measurements and main resultsTotal mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p p p p p p p p = 0.007).ConclusionsAmong STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions