Inverted Variant of Takotsubo Syndrome Caused by Inhaled Adrenergic Beta-2 Agonists

Takotsubo syndrome (TS) is an acute and reversible clinical syndrome characterized by transient hypokinesis of the left ventricular (LV) apex. Variant forms of LV dysfunction have been reported, including inverted Takotsubo syndrome (ITS), which represents only 5% of cases and has previously been linked to excessive use of inhaled adrenergic beta-2 agonists. The authors describe the case of a 60-year-old female patient who was diagnosed with ITS after the excessive use of inhaled adrenergic beta-2 agonists. This case highlights an uncommon variant of this syndrome that may not be obvious and must be suspected in this particular context

Gestão da pandemia COVID-19 numa Escola de Enfermagem Portuguesa: um relato de experiencia

Introdução: A pandemia COVID-19, decretada pela OMS em março de 2020, originou enormes desafios. As instituições de ensino viram-se confrontadas com a necessidade de tomar medidas para controlar a disseminação da doença. Para manter a comunidade escolar segura, desenvolveu- se um plano de contingência abrangente para que toda a comunidade educativa se sentisse envolvida e apta a seguir as medidas propostas. Objetivos: (I) Descrever o processo de construção de um plano de contingência para responder à situação de pandemia COVID-19, numa Escola Superior de Enfermagem; (II) Descrever a implementação do plano de contingência e sua adequação, em função da evolução da situação pandémica e (III) Descrever os principais desafios encontrados e as estratégias corretivas adotadas. Metodologia: Relato de experiência da construção e implementação do plano de contingência da Instituição. Foi nomeada uma Equipa de Plano de Contingência que elaborou um plano em conformidade com as orientações das diversas entidades reguladoras da saúde, estruturado em quatro tópicos: 1) organização de estruturas; 2) formação; 3) organização das atividades letivas e laborais; 4) acompanhamento e monitorização. Foram, ainda, elaborados vários documentos orientadores de práticas seguras, destinados à readequação do processo ensino-aprendizagem e à segurança dos colaboradores e estudantes. Resultados: Foi instituída uma sala de isolamento para apoio às situações de casos suspeitos, em cada edifício. Reorganizaram-se os espaços para garantir distâncias de segurança; disponibilizaram-se antisséticos em pontos estratégicos para promover a higienização das mãos; adotou-se sinalética para facilitar a circulação das pessoas; alteraram-se dinâmicas internas e procedimentos específicos; organizaram-se sessões de esclarecimento dirigidas aos professores e formação online, para estudantes e funcionários não docentes, e formação presencial para as equipas de limpeza e de apoio e vigilância. Para monitorizar a evolução da pandemia na comunidade escolar, foi criado um processo de notificação/registo de casos. Conclusões: O plano de contingência tem respondido às necessidades da instituição. Mostrou-se dinâmico e flexível, sendo sempre ajustado de acordo com as normas/orientações nacionais e em parceria com as Autoridades de Saúde Locais. As mudanças implementadas mostraram-se eficazes e tiveram a adesão da comunidade escolar, que passou a integrar as novas regras no seu dia a dia. O número muito reduzido de casos com origem na instituição parece ser revelador do sucesso das medidas implementadas.Introduction: The COVID-19 pandemic, decreed by the WHO in March 2020, created enormous challenges. Our Institution was faced with the need to take measures to control the spread of the disease and keep the academic community safe, for which a comprehensive contingency plan was created so that the entire community felt involved and able to follow the proposed measures. Objectives: (I) Describe the process of building a contingency plan to respond to the COVID-19 pandemic situation in a Nursing School; (II) Describe the implementation of the contingency plan and its adequacy, depending on the evolution of the pandemic situation and (III) Describe the main challenges encountered and the corrective strategies adopted. Methodology: Experience report of the construction and implementation of the Institution’s contingency plan. A Contingency Plan Team was appointed that created a plan following the guidelines of the various health regulatory authorities, structured in four topics: 1) organization of structures; 2) training; 3) organization of academic and work activities; 4) follow-up and monitoring. In addition, several guiding documents for safe practices were also prepared, aimed at readjusting the teaching-learning process and the safety of employees. Results: 1) organization of structures: An isolation room was established in each building, Spaces were reorganized to ensure safe distances; antiseptics were distributed; Signals was adopted to make the path; internal dynamics and specific procedures changed. 2) training: Clarification sessions were organized with teachers and online training for students and non-teaching staff, and face-to-face training for cleaning staff and support teams. 3) organization of academic and work activities: plan the beginning and breaks according to the maximum amount of people in the same room, fixed the capacity of each classroom. 4) follow-up and monitoring: a case notification/registration process was created and spread the message for all community on the website and by email. Conclusions: The contingency plan has responded to the Institution› s needs. It was dynamic and flexible, always be adjusted according to national norms/guidelines and in partnership with Local Health Authorities. The implemented changes proved to be effective and supported the entire school community, which started to integrate the new rules into their daily lives. The very low cases report of covid-19 with the beginning in our institution, seems to reveal the success of the implemented measures.info:eu-repo/semantics/publishedVersio

Sarcopenia and atherosclerotic occlusive disease: how much we know and what we need to know about this association?

Purpose/Background: Sarcopenia (decrease of muscle mass and function) has been linked with atherosclerosis [1]. The EWGSOP2 updated consensus, uses low muscle strength as the primary indicator of sarcopenia [2]. It is acknowledged that strength is better than mass for predicting adverse outcomes [2]. Handgrip strength (HGS) is a simple assessment to estimate overall muscular strength [3]. and is associated with cardiovascular mortality [4]. Objective: Analyze the relationship between HGS and atherosclerotic disease (carotid artery disease + lower extremity artery disease). Methods: Prospective observation study was conducted from January to December 2019. The clinical and demographic data was recorded. Isometric HGS was measured with an adjustable handheld dynamometer (Jamar The higher value of each arm was used to classify the patient as sarcopenic or non-sarcopenic. Definition of sarcopenia: HGS <30 kgf in men and <20 kgf in women [5]. Results: 94 patients (aged 44–86 years) were analyzed: 64 sarcopenic and 30 non sarcopenic. Groups differed in the prevalence of diabetes and smoking status (Table 1). No differences were found in the carotid parameters analyzed (Table 1). There was, a difference in the prevalence of chronic limb-threatening ischemia (CLTI) in sarcopenic versus non-sarcopenic group (23.44% versus 6.67% p = 0.046). Importantly, binary logistic regression showed that diabetes (p = 0.014), and HGS (p = 0.027) have a significant effect on CLTI (Table 2). Conclusions: No relationship was found between sarcopenia (measured by HGS) and carotid atherosclerosis, differing from other authors [1,6]. In this study, sarcopenic had a higher incident of diabetes and CLTI. Sarcopenia and diabetes are reciprocally related and may share a similar pathogenetic pathway [7

Cytogenomic assessment of the diagnosis of 93 patients with developmental delay and multiple congenital abnormalities: The Brazilian experience

OBJECTIVE: The human genome contains several types of variations, such as copy number variations, that can generate specific clinical abnormalities. Different techniques are used to detect these changes, and obtaining an unequivocal diagnosis is important to understand the physiopathology of the diseases. The objective of this study was to assess the diagnostic capacity of multiplex ligation-dependent probe amplification and array techniques for etiologic diagnosis of syndromic patients. METHODS: We analyzed 93 patients with developmental delay and multiple congenital abnormalities using multiplex ligation-dependent probe amplifications and arrays. RESULTS: Multiplex ligation-dependent probe amplification using different kits revealed several changes in approximately 33.3% of patients. The use of arrays with different platforms showed an approximately 53.75% detection rate for at least one pathogenic change and a 46.25% detection rate for patients with benign changes. A concomitant assessment of the two techniques showed an approximately 97.8% rate of concordance, although the results were not the same in all cases. In contrast with the array results, the MLPA technique detected ∼70.6% of pathogenic changes. CONCLUSION: The obtained results corroborated data reported in the literature, but the overall detection rate was higher than the rates previously reported, due in part to the criteria used to select patients. Although arrays are the most efficient tool for diagnosis, they are not always suitable as a first-line diagnostic approach because of their high cost for large-scale use in developing countries. Thus, clinical and laboratory interactions with skilled technicians are required to target patients for the most effective and beneficial molecular diagnosis

A chemical survey of exoplanets with ARIEL

Thousands of exoplanets have now been discovered with a huge range of masses, sizes and orbits: from rocky Earth-like planets to large gas giants grazing the surface of their host star. However, the essential nature of these exoplanets remains largely mysterious: there is no known, discernible pattern linking the presence, size, or orbital parameters of a planet to the nature of its parent star. We have little idea whether the chemistry of a planet is linked to its formation environment, or whether the type of host star drives the physics and chemistry of the planet’s birth, and evolution. ARIEL was conceived to observe a large number (~1000) of transiting planets for statistical understanding, including gas giants, Neptunes, super-Earths and Earth-size planets around a range of host star types using transit spectroscopy in the 1.25–7.8 μm spectral range and multiple narrow-band photometry in the optical. ARIEL will focus on warm and hot planets to take advantage of their well-mixed atmospheres which should show minimal condensation and sequestration of high-Z materials compared to their colder Solar System siblings. Said warm and hot atmospheres are expected to be more representative of the planetary bulk composition. Observations of these warm/hot exoplanets, and in particular of their elemental composition (especially C, O, N, S, Si), will allow the understanding of the early stages of planetary and atmospheric formation during the nebular phase and the following few million years. ARIEL will thus provide a representative picture of the chemical nature of the exoplanets and relate this directly to the type and chemical environment of the host star. ARIEL is designed as a dedicated survey mission for combined-light spectroscopy, capable of observing a large and well-defined planet sample within its 4-year mission lifetime. Transit, eclipse and phase-curve spectroscopy methods, whereby the signal from the star and planet are differentiated using knowledge of the planetary ephemerides, allow us to measure atmospheric signals from the planet at levels of 10–100 part per million (ppm) relative to the star and, given the bright nature of targets, also allows more sophisticated techniques, such as eclipse mapping, to give a deeper insight into the nature of the atmosphere. These types of observations require a stable payload and satellite platform with broad, instantaneous wavelength coverage to detect many molecular species, probe the thermal structure, identify clouds and monitor the stellar activity. The wavelength range proposed covers all the expected major atmospheric gases from e.g. H2O, CO2, CH4 NH3, HCN, H2S through to the more exotic metallic compounds, such as TiO, VO, and condensed species. Simulations of ARIEL performance in conducting exoplanet surveys have been performed – using conservative estimates of mission performance and a full model of all significant noise sources in the measurement – using a list of potential ARIEL targets that incorporates the latest available exoplanet statistics. The conclusion at the end of the Phase A study, is that ARIEL – in line with the stated mission objectives – will be able to observe about 1000 exoplanets depending on the details of the adopted survey strategy, thus confirming the feasibility of the main science objectives.Peer reviewedFinal Published versio

Convalescent plasma for COVID-19 in hospitalised patients : an open-label, randomised clinical trial

Background: The effects of convalescent plasma (CP) therapy in hospitalised patients with coronavirus disease 2019 (COVID-19) remain uncertain. This study investigates the effect of CP on clinical improvement in these patients. Methods: This is an investigator-initiated, randomised, parallel arm, open-label, superiority clinical trial. Patients were randomly (1:1) assigned to two infusions of CP plus standard of care (SOC) or SOC alone. The primary outcome was the proportion of patients with clinical improvement 28 days after enrolment. Results: A total of 160 (80 in each arm) patients (66.3% critically ill, 33.7% severely ill) completed the trial. The median (interquartile range (IQR)) age was 60.5 (48–68) years; 58.1% were male and the median (IQR) time from symptom onset to randomisation was 10 (8–12) days. Neutralising antibody titres >1:80 were present in 133 (83.1%) patients at baseline. The proportion of patients with clinical improvement on day 28 was 61.3% in the CP+SOC group and 65.0% in the SOC group (difference −3.7%, 95% CI −18.8–11.3%). The results were similar in the severe and critically ill subgroups. There was no significant difference between CP+SOC and SOC groups in pre-specified secondary outcomes, including 28-day mortality, days alive and free of respiratory support and duration of invasive ventilatory support. Inflammatory and other laboratory marker values on days 3, 7 and 14 were similar between groups. Conclusions: CP+SOC did not result in a higher proportion of clinical improvement on day 28 in hospitalised patients with COVID-19 compared to SOC alone

A list of land plants of Parque Nacional do Caparaó, Brazil, highlights the presence of sampling gaps within this protected area

Brazilian protected areas are essential for plant conservation in the Atlantic Forest domain, one of the 36 global biodiversity hotspots. A major challenge for improving conservation actions is to know the plant richness, protected by these areas. Online databases offer an accessible way to build plant species lists and to provide relevant information about biodiversity. A list of land plants of “Parque Nacional do Caparaó” (PNC) was previously built using online databases and published on the website "Catálogo de Plantas das Unidades de Conservação do Brasil." Here, we provide and discuss additional information about plant species richness, endemism and conservation in the PNC that could not be included in the List. We documented 1,791 species of land plants as occurring in PNC, of which 63 are cited as threatened (CR, EN or VU) by the Brazilian National Red List, seven as data deficient (DD) and five as priorities for conservation. Fifity-one species were possible new ocurrences for ES and MG states

Práticas artísticas no ensino básico e secundário

O terceiro número da Revista Matéria-Prima afirma-se como mais uma plataforma de disseminação e de registo na área da educação e ensino artísticos. Ao propor-se o desafio da Matéria-Prima está a lançar-se um repto de intervenção e partilha a três tipos de intervenientes na educação pela arte: — Os professores, profissionais experimentados; — Os que se iniciam na profissão, através da frequência de mestrados e estágios formativos; — Os investigadores e professores universitários desta área. Esta chamada coloca em cima da mesa a partilha das experiências didácticas em sala de aula, a pesquisa sobre práticas profissionais. Experiências, algumas bem-sucedidas, outras menos, porventura, todas com um mérito substancial, que é a vontade de estabelecer comunidade entre os interessados pela educação artística. Este conjunto de textos poderá ajudar a cartografar práticas que se observam bastante distintas, entre as realidades dos países representados, Portugal, Espanha, Brasil, Argentina. Observa-se também que a prática dos educadores está longe de ser homogénea. É surpreendente determinar as diferenças entre contextos e regiões. Se umas são mais metódicas, e por isso consistentes, outras abrem-se à descoberta. Em todas um ponto de encontro: a revista Matéria-Prima, que assim assume cada vez mais o seu nome como um desígnio de intervenção.info:eu-repo/semantics/publishedVersio

FungalTraits:A user-friendly traits database of fungi and fungus-like stramenopiles

The cryptic lifestyle of most fungi necessitates molecular identification of the guild in environmental studies. Over the past decades, rapid development and affordability of molecular tools have tremendously improved insights of the fungal diversity in all ecosystems and habitats. Yet, in spite of the progress of molecular methods, knowledge about functional properties of the fungal taxa is vague and interpretation of environmental studies in an ecologically meaningful manner remains challenging. In order to facilitate functional assignments and ecological interpretation of environmental studies we introduce a user friendly traits and character database FungalTraits operating at genus and species hypothesis levels. Combining the information from previous efforts such as FUNGuild and Fun(Fun) together with involvement of expert knowledge, we reannotated 10,210 and 151 fungal and Stramenopila genera, respectively. This resulted in a stand-alone spreadsheet dataset covering 17 lifestyle related traits of fungal and Stramenopila genera, designed for rapid functional assignments of environmental studies. In order to assign the trait states to fungal species hypotheses, the scientific community of experts manually categorised and assigned available trait information to 697,413 fungal ITS sequences. On the basis of those sequences we were able to summarise trait and host information into 92,623 fungal species hypotheses at 1% dissimilarity threshold