Fatal pulmonary thromboembolism in gastrectomy intraoperative procedures by gastric adenocarcinoma: case report

The case of a patient with gastric adenocarcinoma with indication for gastrectomy is reported. The surgery took place without complications. A palliative, subtotal gastrectomy was performed after para-aortic lymph nodes compromised by neoplasm were found, which was confirmed by pathological exam of frozen sections carried out during the intervention. At the end of the gastroenteroanastomosis procedure, the patient began to show intense bradycardia: 38 beats per minute (bpm), arterial hypotension, changes in the electrocardiogram's waveform (upper unlevelling of segment ST), and cardiac arrest. Resuscitation maneuvers were performed with temporary success. Subsequently, the patient had another circulatory breakdown and again was recovered. Finally, the third cardiac arrest proved to be irreversible, and the intra-operative death occurred. Necropsy showed massive pulmonary embolism. The medical literature has recommended heparinization of patients, in an attempt to avoid pulmonary thromboembolism following major surgical interventions. However, in the present case, heparinization would have been insufficient to prevent death. This case indicates that it is necessary to develop preoperative propedeutics for diagnosing the presence of venous thrombi with potential to migrate, causing pulmonary thromboembolism (PTE). If such thrombi could be detected, preventative measures, such as filter installation in the Cava vein could be undertaken.Relata-se um caso de paciente com adenocarcinoma gástrico com indicação de gastrectomia. O ato operatório transcorreu sem anormalidades. Foi realizada gastrectomia subtotal paliativa, pois encontrou-se linfonodos para-aórticos comprometidos pela neoplasia, confirmado por exame anátomo-patológico de congelação realizado no decorrer da intervenção. Ao fim da confecção da gastroêntero-anastomose o paciente passou a apresentar bradicardia intensa: 38 batimentos por minuto (bpm), hipotensão arterial, alterações do traçado do eletrocardiograma (Supra-desnivelamento do segmento ST) e parada cardíaca. Realizadas as manobras de ressucitação com sucesso temporário, já que a seguir o paciente apresentou novo colapso circulatório, sendo novamente recuperado, finalmente a 3a parada cardíaca foi irreversível e constatou-se o óbito intra-operatório

Does color polymorphism affect the predation risk on Phalotris lemniscatus (Duméril, Bibron and Duméril, 1854) (Serpentes, Dipsadidae)?

The snake Phalotris lemniscatus is a polymorphic species regarding color, which varies between light shades with a yellow predominance (pale yellow-brown) to darker shades with a red predominance (red-dark). Pale yellow-brown individuals are more frequent in coastal populations while there is a tendency of increasing the frequency of red-dark morphs in inland areas. Considering the variation in substrate color along the species distribution (light/sandy on the coast to reddish and dark/argillaceous in inland areas), we raise the hypothesis that the predation rate of each morph would be lower in sites were its crypsis potential is higher. If correct, this hypothesis would reinforce the idea that the predation risk is one of the factors influencing the spatial structuring in morph frequency distributions in populations of P. lemniscatus. To test this hypothesis, we performed a field experiment using plasticine P. lemniscatus artificial models that represent two morphs: red-dark and pale yellow-brown. The models were distributed in three localities where the following substrate types predominate: light (Coastal Site), intermediary (Lowland Site) and reddish dark (Highland Site). Our predictions were corroborated only at the coastal site, where the less cryptic morph was the most preyed one. We verified that there is a regional variation in the predation risk on different morphs. Thus, the possibility that the selective pressure by predators is a relevant element in the structuring of the frequencies of different morph populations of this species cannot be completely excluded

Os custos da aterosclerose em Portugal

Copyright © 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. All rights reserved.© 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espa ̃na, S.L.U. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Introduction and objectives: Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease-related costs. Methods: Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real-world data from primary care, the 2014 National Health Interview Survey, and expert opinion. Results: The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). Conclusions: Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.info:eu-repo/semantics/publishedVersio

Cys34-cysteinylated human serum albumin is a sensitive plasma marker in oxidative stress-related chronic diseases

The degree of oxidized cysteine (Cys) 34 in human serum albumin (HSA), as determined by high performance liquid chromatography (HPLC), is correlated with oxidative stress related pathological conditions. In order to further characterize the oxidation of Cys34-HSA at the molecular level and to develop a suitable analytical method for a rapid and sensitive clinical laboratory analysis, the use of electrospray ionization time-of-flight mass spectrometer (ESI-TOFMS) was evaluated. A marked increase in the cysteinylation of Cys34 occurs in chronic liver and kidney diseases and diabetes mellitus. A significant positive correlation was observed between the Cys-Cys34-HSA fraction of plasma samples obtained from 229 patients, as determined by ESI-TOFMS, and the degree of oxidized Cys34-HSA determined by HPLC. The Cys-Cys34-HSA fraction was significantly increased with the progression of liver cirrhosis, and was reduced by branched chain amino acids (BCAA) treatment. The changes in the Cys-Cys34-HSA fraction were significantly correlated with the alternations of the plasma levels of advanced oxidized protein products, an oxidative stress marker for proteins. The binding ability of endogenous substances (bilirubin and tryptophan) and drugs (warfarin and diazepam) to HSA purified from chronic liver disease patients were significantly suppressed but significantly improved by BCAA supplementation. Interestingly, the changes in this physiological function of HSA in chronic liver disease were correlated with the Cys-Cys34-HSA fraction. In conclusion, ESI-TOFMS is a suitable high throughput method for the rapid and sensitive quantification of Cys-Cys34-HSA in a large number of samples for evaluating oxidative stress related chronic disease progression or in response to a treatment

Uso de bebederos artificiales por el sereque centroamericano (Dasyprocta punctata) en la reserva de la biosfera de Calakmul, México

Objective: To describe the use of artificial drinking fountains by the central American Agouti (Dasyprocta punctata) in the Calakmul Biosphere Reserve. Design/methodology/approach: Eight artificial drinking fountains were monitored each one with a trap camera with the aim to estimate the relative abundance index and activity patterns of visits to the drinking fountains. The monitoring was during the dry season of 2019. The analyzes were carried out with the InfoStat and R programs. Results: From January to May 2019, with a sampling effort of 1121 days/camera, average abundance of 160.08±85.44. The pattern of visits to the drinking troughs was mainly diurnal. Limitations of the study/implications: The use of trap cameras in the artificial drinking fountains allows us to know the extent of habitat modification in the Calakmul Biosphere Reserve. Findings/conclusions: The implementation of artificial drinking fountains in the RBC during the dry season was a successful action to mitigate the effects of water scarcity. The use of the water resource by the Central American Agouti in artificial drinking fountains was constant, other species of mammals and birds were also observed making use of artificial drinking fountains.Objetivo: Describir el uso de bebederos artificiales por el sereque (Dasyprocta punctata) en la Reserva de la Biosfera de Calakmul. Diseño/metodología/aproximación: Se monitorearon ocho bebederos artificiales cada uno con una cámara trampa con la finalidad de estimar el índice de abundancia relativa y los patrones de actividad de visitas a los bebederos. El monitoreo fue durante la temporada de secas del 2019. Los análisis se realizaron con los programas R e InfoStat. Resultado: De enero a mayo de 2019, con un esfuerzo de muestreo fue de 1121 días/cámara, abundancia promedio de 160.08±85.44. El patrón de visitas a los bebederos fue principalmente diurno. Limitaciones/implicaciones: El uso de cámaras trampa en los bebederos artificiales nos permite conocer los alcances en la modificación del hábitat en la Reserva de la Biosfera de Calakmul (RBC). Hallazgos/conclusiones: La implementación de bebederos artificiales en la RBC durante la temporada de seca fue una acción de éxito para mitigar los efectos de la escases de agua. El aprovechamiento del recurso agua por el sereque en los bebederos artificiales fue constante, también se observaron otras especies de mamíferos y aves haciendo uso de los bebederos artificiales

Proficiency testing of virus diagnostics based on bioinformatics analysis of simulated in silico high-throughput sequencing data sets

Quality management and independent assessment of high-throughput sequencing-based virus diagnostics have not yet been established as a mandatory approach for ensuring comparable results. The sensitivity and specificity of viral high-throughput sequence data analysis are highly affected by bioinformatics processing using publicly available and custom tools and databases and thus differ widely between individuals and institutions. Here we present the results of the COMPARE [Collaborative Management Platform for Detection and Analyses of (Re-) emerging and Foodborne Outbreaks in Europe] in silico virus proficiency test. An artificial, simulated in silico data set of Illumina HiSeq sequences was provided to 13 different European institutes for bioinformatics analysis to identify viral pathogens in high-throughput sequence data. Comparison of the participants’ analyses shows that the use of different tools, programs, and databases for bioinformatics analyses can impact the correct identification of viral sequences from a simple data set. The identification of slightly mutated and highly divergent virus genomes has been shown to be most challenging. Furthermore, the interpretation of the results, together with a fictitious case report, by the participants showed that in addition to the bioinformatics analysis, the virological evaluation of the results can be important in clinical settings. External quality assessment and proficiency testing should become an important part of validating high-throughput sequencing-based virus diagnostics and could improve the harmonization, comparability, and reproducibility of results. There is a need for the establishment of international proficiency testing, like that established for conventional laboratory tests such as PCR, for bioinformatics pipelines and the interpretation of such results