EPIDEMIOLOGIA E PERFIL DE SENSIBILIDADE DOS GERMES ISOLADOS DE HEMOCULTURAS DE PACIENTES HEMATOLÓGICOS COM NEUTROPENIA FEBRIL

Introdução: A neutropenia febril (NF) é uma complicação muito freqüente nos pacientes com neoplasias hematológicas submetidos à quimioterapia. O manejo da NF permanece muito problemático especialmente pela mudança constante do espectro dos germes e da sensibilidade aos antimicrobianos. Desta forma, torna-se imprescindível conhecer a epidemiologia local das infecções associadas à NF. Objetivo: Determinar a prevalência e a sensibilidade aos antimicrobianos dos germes isolados de hemoculturas (HMC) de pacientes hematológicos com NF internados no HCPA. Métodos: Foram analisadas, retrospectivamente, todas as HMC solicitadas para pacientes com NF (contagem total de neutrófilos 38,5oC ou duas medidas >38oC em 24 horas. Comparou-se o perfil de sensibilidade das infecções em pacientescom NF em relação às demais unidades de internação clínica do hospital.Resultados: Foram solicitadas no período em estudo 2389 hemoculturas para 178 pacientes. Destas, 719 (30,1%) foram positivas sendo que este percentual subiu para 38,7% quando consideradas apenas as hemoculturas coletas sem a vigência de antibiótico. A análise dos germes isolados revelou que a maioria das infecções foi causada por Bacilos Gram-negativos (53,8%) seguido pelos Cocos Gram-positivos (31,2%). Os microrganismos isolados com maior freqüência foram: E. coli (14,6%), S. aureus (13,8%), K. pneumoniae (12,2%), Streptococcus sp. (8,5%), Pseudomonas sp. (7,9%), Staphylococcus coagulase-negativo (7,3%). A sensibilidade dos Bacilos Gram-negativos aos diferentes antimicrobianos foi: Cefepime (63%), Amicacina (65%), Ciprofloxacin (63%), Piperacilina/Tazobactam (71%), Ceftazidima (63%),Meropenem (97%). A sensibilidade dos Cocos Gram-positivos foi: Oxacilina (30%), Levofloxacin (38%), Vancomicina (100%). Comparativamente ao perfil de sensibilidade das unidades de internação clínica adulta não-hematológicas constatou-se diferença estatisticamente significante (p<0,05) entre a sensibilidade dos Bacilos Gram-negativos ao Cefepime (63% x 82%) e a Ceftazidima (63% x 82%) e entre os Cocos Gram-positivos à Oxacilina (30% x 50%). Conclusões: A coleta constante de dados sobre a prevalência dos germes e sua sensibilidade aos antimicrobianos é indispensável para o estabelecimento de tratamentos empíricos para a NF. O perfil de sensibilidade diferenciado em relação às demais unidades de internação faz necessária a criação de protocolos específicos de tratamento da NF. Unitermos: Neutropenia febril; hemoculturas; epidemiologia; perfil de sensibilidadehematologia

A methodology for procedural piano music composition with mood templates using genetic algorithms

Creating music in an automatic way has been studied since the beginning of artificial intelligence. One of the biggest obstacles of music generation is the vagueness and subjectivity of the mood or emotion transmitted by a music piece. In this work, we experiment with the generation of piano music using template pieces, represented in MIDI format, as a mood directive. We generated a population of random pieces for templates of two opposing moods - happy and sad - and evolved them with a genetic algorithm until their intended mood was close enough to their respective templates. The fitness function that we implemented uses MIDI statistical features to calculate the distance between the given piece and the template. The generated music pieces were evaluated by human listeners thorough a questionnaire. This evaluation has shown that the generated music pieces were able to express the same mood as the template. However, they still sounded computer-generated, probably due to the lack of rhythm regularity and synchronicity

Regeneration dynamics in fragmented landscapes at the leading edge of distribution: Quercus suber woodlands as a study case

[EN] Aims We studied the regeneration dynamics of woodlands and abandoned old fields in a landscape dominated by Quercus suber in its lower limits of rainfall and temperature. Two hypotheses were established: (1) regeneration of Quercus species is strongly favored by the presence of tree cover; and (2) growth of Q. suber is driven by the climatic variables that represent the lower ecological limit of its leading distribution edge. Methods We selected woodlands and old fields with and without tree remnants (n = 3 per type), and analyzed stand structure, soil parameters and tree growth. Results Succession was arrested in old fields without tree remnants. By contrast, remnant trees were accelerators of forest recovery in old fields. Tree cover played a fundamental role in Quercus recruitment throughout seed dispersal and facilitation that mitigate the effects of summer drought on seedlings. Also, tree cover improved soil parameters (e.g., organic matter) that are important factors for understanding differences in regeneration. Winter/spring precipitation exerted a positive effect on tree growth, as well as temperatures during winter/spring and September. Conclusions Regeneration dynamics are modeled by the density of tree cover in the cold and dry edge of the distribution area of Q. suber where Q. ilex is increasing in abundance. Although temperature has a positive effect on the tree growth of Q. suber, when demographic processes are considered, decreases in water availability likely play a critical role in Q. ilex recruitment. This in turn changes dominance hierarchies, especially in abandoned areas with little or no tree cover.This study was funded by project SA013G19 from “Junta de Castilla y León” and by research grants awarded for final projects directed in the Master’s degree in Biology and Conservation of Biodiversity at the University of Salamanca, Spain.Publicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCL

Simultaneous analysis of free amino acids and biogenic amines in honey and wine samples using in loop orthophthalaldeyde derivatization procedure

This work presents a RP-HPLC method for the simultaneous quantification of free amino acids and biogenic amines in liquid food matrices and the results of the application to honey and wine samples obtained from different production processes and geographic origins. The developed methodology is based on a pre-column derivatization with o-phthaldialdehyde carried out in the sample injection loop. The compounds were separated in a Nova-Pack RP-C18 column (150 mm × 3.9 mm, 4 μm) at 35 °C. The mobile phase used was a mixture of phase A: 10 mM sodium phosphate buffer (pH 7.3), methanol and tetrahydrofuran (91:8:1); and phase B: methanol and phosphate buffer (80:20), with a flow rate of 1.0 ml/min. Fluorescence detection was used at an excitation wavelength of 335 nm and an emission wavelength of 440 nm. The separation and quantification of 19 amino acids and 6 amines was carried out in a single run as their OPA/MCE derivatives elute within 80 min, ensuring a reproducible quantification. The method showed to be adequate for the purpose, with an average RSD of 2% for the different amino acids; detection limits varying between 0.71 mg/l (Asn) and 8.26 mg/l (Lys) and recovery rates between 63.0% (Cad) and 98.0% (Asp). The amino acids present at the highest concentration in honey and wine samples were phenylalanine and arginine, respectively. Only residual levels of biogenic amines were detected in the analysed samples

Efficacy and safety of preoperative preparation with Lugol''s iodine solution in euthyroid patients with Graves’ disease (LIGRADIS Trial): Study protocol for a multicenter randomized trial

Background: Currently, both the American Thyroid Association and the European Thyroid Association recommend preoperative preparation with Lugol''s Solution (LS) for patients undergoing thyroidectomy for Graves’ Disease (GD), but their recommendations are based on low-quality evidence. The LIGRADIS trial aims to provide evidence either to support or refute the systematic use of LS in euthyroid patients undergoing thyroidectomy for GD. Methods: A multicenter randomized controlled trial will be performed. Patients =18 years of age, diagnosed with GD, treated with antithyroid drugs, euthyroid and proposed for total thyroidectomy will be eligible for inclusion. Exclusion criteria will be prior thyroid or parathyroid surgery, hyperparathyroidism that requires associated parathyroidectomy, thyroid cancer that requires adding a lymph node dissection, iodine allergy, consumption of lithium or amiodarone, medically unfit patients (ASA-IV), breastfeeding women, preoperative vocal cord palsy and planned endoscopic, video-assisted or remote access surgery. Between January 2020 and January 2022, 270 patients will be randomized for either receiving or not preoperative preparation with LS. Researchers will be blinded to treatment assignment. The primary outcome will be the rate of postoperative complications: hypoparathyroidism, recurrent laryngeal nerve injury, hematoma, surgical site infection or death. Secondary outcomes will be intraoperative events (Thyroidectomy Difficulty Scale score, blood loss, recurrent laryngeal nerve neuromonitoring signal loss), operative time, postoperative length of stay, hospital readmissions, permanent complications and adverse events associated to LS. Conclusions: There is no conclusive evidence supporting the benefits of preoperative treatment with LS in this setting. This trial aims to provide new insights into future Clinical Practice Guidelines recommendations. Trial registration: ClinicalTrials.gov identifier: NCT03980132. © 202