Proteinuria is common among HIV patients: what are we missing?

OBJECTIVES:HIV-related renal diseases are the leading causes of chronic kidney diseases worldwide. The present study aimed to investigate the prevalence of pathological proteinuria and its risk factors among HIV patients.METHODS:A review of the medical records of 666 HIV-infected individuals aged 18 years or older in an urban HIV/AIDS clinic based in Porto Alegre in southern Brazil. Overt proteinuria was defined as a protein-to-creatinine ratio greater than 150 mg/g according to Kidney Disease: Improving Global Outcomes.RESULTS:The prevalence of pathological proteinuria in the present study cohort was 20%. Characteristics associated with pathological proteinuria after univariate analysis included alcohol abuse, hepatitis C virus coinfection, the occurrence of diabetes and therapy including tenofovir. Adjusted residuals analysis indicated an association between pathological proteinuria and both a CD4 lymphocyte count below 200 cells/mm3 and a viral load higher than 1000 copies/mL. Additionally, an absence of pathological proteinuria was associated with a CD4 lymphocyte count higher than 500 cells/mm3. After adjustment for variables with

Meningite por Enterococcus gallinarum em paciente sem imunodepressão: relato de caso

Descrevemos caso raro de paciente de 53 anos com história de alcoolismo prévio, com meningite por Enterococcus gallinarum, um organismo que raramente causa infecções em humanos e é encontrado principalmente no trato gastrointestinal de aves. O paciente teve melhora importante após início de tratamento intravenoso com ampicilina e gentamicina combinados. Para o nosso conhecimento, este é o primeiro caso relatado de meningite por E. gallinarum no Brasil e possivelmente o primeiro caso descrito em paciente sem imunodepressão.We describe a rare case of a 53-year-old man with a long history of alcohol abuse, with Enterococcus gallinarum meningitis, an organism that rarely causes human infection and is primarily found in the gastrointestinal tract of poultry. The patient improved with high-dose ampicillin and gentamicin therapy. To our knowledge, this is the first Brazilian reported case of E. gallinarum meningitis and probably the first case described in an immunocompetent host

Tratamento de cromoblastomicose severa com a associação itraconazole e 5-flucitosina

Cromoblastomicose é uma infecção fúngica crônica do tecido subcutâneo causada pela inoculação traumática de um grupo específico de fungos através da pele, encontrados eventualmente em trabalhadores do campo descalços em países de clima tropical e subtropical. Relatamos aqui o caso de um paciente do sexo masculino com uma lesão dermatológica de crescimento lento e pruriginosa nos membros inferiores por 20 anos, diagnosticada e tratada com sucesso para cromoblastomicose. Apesar da prevalência desta doença em nossa região, o tratamento ainda é um desafio.Chromoblastomycosis is a chronic human melanized fungi infection of the subcutaneous tissue caused by traumatic inoculation of a specific group of dematiaceous fungi through the skin, often found in barefooted agricultural workers, in tropical and subtropical climate countries. We report the case of a male patient presenting a slow-growing pruriginous lesion on the limbs for 20 years, mistreated over that time, which was diagnosed and successfully treated as chromoblastomycosis. Besides the prevalence of this disease, treatment is still a clinical challenge

Bacteriological characteristics of primary breast abscesses in patients from the community in the era of microbial resistance

Abstract Objective: The aim of this study is to evaluate the etiological profile and antimicrobial resistance in breast abscess cultures from patients from the community, treated at a public hospital located in Porto Alegre, Brazil. Methods: This is an retrospective cross-sectional study that evaluated the medical records of patients with bacterial isolates in breast abscess secretion cultures and their antibiograms, from January 2010 to August 2022. Results: Based on 129 positive cultures from women from the community diagnosed with breast abscesses and treated at Fêmina Hospital, 99 (76.7%) of the patients had positive cultures for Staphylococcus sp, 91 (92%) of which were cases of Staphylococcus aureus. Regarding the resistance profile of S. aureus, 32% of the strains were resistant to clindamycin, 26% to oxacillin and 5% to trimethoprim-sulfamethoxazole. The antimicrobials vancomycin, linezolid and tigecycline did not show resistance for S. aureus. Conclusion: Staphylococcus aureus was the most common pathogen found in the breast abscess isolates during the study period. Oxacillin remains a good option for hospitalized patients. The use of sulfamethoxazole plus trimethoprim should be considered as a good option for use at home, due to its low bacterial resistance, effectiveness and low cost

The interannual variability of global burned area is mostly explained by climatic drivers

Better understanding how fires respond to climate variability is an issue of current interest in light of ongoing climate change. However, evaluating the global?scale temporal variability of fires in response to climate presents a challenge due to the intricate processes at play and the limitation of fire data. Here, we investigate the links between year-to-year variability of burned area (BA) and climate using BA data, the Fire Weather Index (FWI), and the Standardized Precipitation Evapotranspiration Index (SPEI) from 2001 to 2021 at ecoregion scales. Our results reveal complex spatial patterns in the dependence of BA variability on antecedent and concurrent weather conditions, highlighting where BA is mostly influenced by either FWI or SPEI and where the combined effect of both indicators must be considered. Our findings indicate that same-season weather conditions have a more pronounced relationship with BA across various ecoregions, particularly in climatologically wetter areas. Additionally, we note that BA is also significantly associated with periods of antecedent wetness and coolness, with this association being especially evident in more arid ecoregions. About 60% of the interannual variations in BA can be explained by climatic variability in a large fraction (-77%) of the world's burnable regions.A.G. thanks the Ministerio de Ciencia, Innovación y Universidades of Spain for PhD contract FPU19/06536 and extends his thanks to the Instituto Dom Luiz for its close collaboration during her stay in Lisbon. A.G., M.A.T-V., S.J., and M.T. acknowledges the support of the ONFIRE project, Grant PID2021-123193OB-I00, funded by MCIN/AEI/10.13039/501100011033 and by “ERDF A way of making Europe.” M.T. acknowledges funding by the Spanish Ministry of Science, Innovation, and Universities through the Ramón y Cajal Grant Reference RYC2019-027115-I. S.J. acknowledges funding by the Spanish Ministry of Science, Innovation, and Universities through the Ramón y Cajal Grant Reference RYC2020-029993-I

EuroGOOS roadmap for operational coastal downstream services

The EuroGOOS Coastal working group examines the entire coastal value chain from coastal observations to services for coastal users. The main objective of the working group is to review the status quo, identify gaps and future steps needed to secure and improve the sustainability of the European coastal service provision. Within this framework, our white paper defines a EuroGOOS roadmap for sustained “community coastal downstream service” provision, provided by a broad EuroGOOS community with focus on the national and local scale services. After defining the coastal services in this context, we describe the main components of coastal service provision and explore community benefits and requirements through sectoral examples (aquaculture, coastal tourism, renewable energy, port, cross-sectoral) together with the main challenges and barriers to user uptake. Technology integration challenges are outlined with respect to multiparameter observations, multi-platform observations, the land-coast-ocean continuum, and multidisciplinary data integration. Finally, the technological, financial, and institutional sustainability of coastal observing and coastal service provision are discussed. The paper gives special attention to the delineation of upstream and downstream services, public-private partnerships and the important role of Copernicus in better covering the coastal zone. Therefore, our white paper is a policy and practice review providing a comprehensive overview, in-depth discussion and actionable recommendations (according to key short-term or medium-term priorities) on the envisaged elements of a roadmap for sustained coastal service provision. EuroGOOS, as an entity that unites European national operational oceanography centres, research institutes and scientists across various domains within the broader field of operational oceanography, offers to be the engine and intermediary for the knowledge transfer and communication of experiences, best practices and information, not only amongst its members, but also amongst the different (research) infrastructures, institutes and agencies that have interests in coastal oceanography in Europe

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Reflexões sobre a pessoa e a profissão do professor na área da saúde

Este artigo deriva de um conjunto de ideias experimentadas por discentes do Programa de Pós-graduação em Medicina e Ciências da Saúde da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em uma disciplina que procurou conhecer melhor o docente típico e suas atipias. O texto pretende auxiliar no entendimento de quem é o professor na área da saúde. Discute o sujeito e sua obra, para além do já conhecido modelo centrado na profissão da saúde que exerce e que procura ensinar. Antes de docente, o professor é uma pessoa. Como pessoa, precisa sentir-se estimada e estimar ao outro (aluno). Ao prosperar em seu trabalho, o docente tem compromissos para com o desenvolvimento intelectual e moral de seus alunos e o planejamento de ações para que exerça a percepção crítica da realidade. A relação ensino-aprendizagem com o educando deve favorecer a análise de valores necessários ao convívio social. Na área da saúde, é requisitado ao aluno aprender a fazer, sendo pouca importância referida ao aprender a conhecer, ao aprender a ser ou a viver em comunhão com os pares. É essencial ter a percepção de que o professor necessita, inicialmente, acolher a si próprio: entender quem é ele, como é e porque chegou ali. A construção da identidade profissional docente é um processo contínuo estabelecido pelo domínio de sua área de ensino, pelos conhecimentos pedagógicos voltados à aprendizagem dos alunos e experiência docente, além das relações sociais do cotidiano