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Objective: The American Thyroid Association (ATA) Pediatric Guidelines recommend selective, prophylactic central neck dissection (pCND) for patients with papillary thyroid carcinoma (PTC) based on tumor focality, tumor size, and the surgeon’s experience. With the expansion of pre-surgical somatic oncogene testing and continued controversy over the benefits of pCND, oncogenic alteration data may provide an opportunity to stratify pCND. This study compared lymph node (LN) involvement in pediatric patients with PTC between tumors with low- and high-invasive-associated alterations to explore the potential utility of preoperative oncogenic alterations in the stratification of pCND. Methods: This is retrospective cohort study of pediatric patients who underwent somatic oncogene testing post thyroidectomy for PTC between July 2003 and July 2022. Results: Of 192 eligible PTC patients with postoperative somatic oncogene data, 19 tumors harbored somatic alterations associated with low-invasive disease (19/192, 10%), and 128 tumors harbored a BRAFV600E alteration (45/192, 23%) or an oncogenic fusion (83/192, 43%). Tumors with low-invasive alterations were less likely to present malignant preoperative cytology (2/18, 11%) than those with high-invasive alterations (97/124, 78%; P < 0.001). Twelve patients with low-invasive alterations had LNs dissected from the central neck (12/19, 63%) compared to 127 patients (127/128, 99%) with high-invasive alterations. LN metastasis was identified in two patients with low-invasive alterations (2/19, 11%) compared to 107 patients with high-invasive alterations (107/128, 84%; P < 0.001). Conclusion: Pediatric patients with low-invasive somatic oncogenic alterations are at low risk for metastasis to central neck LNs. Our findings suggest that preoperative knowledge of somatic oncogene alterations provides objective data to stratify pediatric patients who may not benefit from pCND.

Data are provided on two hoverfly species new to the Iberian Peninsula, Brachyopa grunewaldensis Kassebeer and Criorhina floccosa (Meigen), and one new to Spain, Eumerus consimilis Šimić & Vujić. New habitat and breeding data are presented.

Background Suicide is recognized as a significant public health issue, with adolescents/young people being a risk group of concern. Taking the integrated motivational-volitional model as a reference, this study focuses on analyzing the association between defeat and entrapment, on the one hand, and suicide risk, on the other, in a university population without depressive symptoms, while also considering the role of rumination and sex. Method The survey study involved a community sample of 650 Spanish university students. A total of 524 students (150 men (Mage = 20.6, SD = 3.7) and 374 women (Mage = 20.4, SD = 3.6)) completed self-report measures of suicide risk, defeat, entrapment, and rumination. Results Defeat and entrapment were significantly associated with suicide risk, and higher rumination was both directly and indirectly associated with higher levels of entrapment through the variable of defeat. However, the effect of rumination on entrapment varied by sex. Conclusion Despite being a cross-sectional preliminary study, this work identifies important variables in the trajectory of suicidal ideation. Adolescence and young adulthood are a critical stage for intervening to reduce the risk of death by suicide, and this study provides findings that may inform preventive approaches.

Background Although My Jump 2® consistently presented excellent values of reliability and validity when compared to force platforms (FPs) and contact mats, to date no scientific investigation assessed the validity and reliability of My Jump 2® to measure jump height in visually impaired five-a-side soccer athletes. Thus, the study aimed at analyzing the validity and reliability of the My Jump 2® to measure the vertical jump of five-a-side soccer athletes. Methods Twelve visually impaired five-a-side soccer athletes, volunteered for this study. Each player performed five countermovement jumps (CMJs) and squat jumps (SJs) on a contact platform (CP) while they were simultaneously recorded using My Jump 2®. Results There was almost perfect agreement between the My Jump 2® and the contact platform measurements of CMJ (intraclass correlation coefficient = 0.99; p < 0.001) and SJ (intraclass correlation coefficient = 0.99; p < 0.001), heights for athletes during the first and second measurement days. Bland-Altman analysis showed a bias of 0.25 ± 0.5 cm; maximum SD = 1.3; minimum SD = −0.88 for CMJ, while that Bland-Altman analysis showed bias 0.18 ± 0.5 cm; maximum SD = 1.3; minimum SD = −0.96, for SJ. Conclusion We can conclude that the My Jump 2® is a valid and reliable method to measure CMJ and SJ in visually impaired five-a-side soccer athletes.

Resumo Objetivo Verificar o efeito da dor crônica no estresse e nos sintomas depressivos de idosos cuidadores de idosos no decorrer de quatro anos. Método Estudo longitudinal, com coleta de dados em 2014 e 2018, com 104 indivíduos com idade igual ou superior a 60 anos, que realizavam cuidado a outro idoso que morava no mesmo domicílio e residentes nas áreas urbanas do município de São Carlos-SP, cadastrados nas Unidades de Saúde da Família (USF). Para as análises estatísticas, foram utilizados o modelo de regressão linear com efeitos mistos (efeitos aleatórios e fixos) e a análise de covariância (ANCOVA). Todos os modelos foram ajustados por sexo idade, escolaridade, número de medicamento e número de doenças. Resultados Participantes com dor crônica apresentaram média de 5,21 pontos maior no escore de estresse (p=0,019; IC: -9,823 – -0,604) na segunda avaliação (2018) e um aumento de 1,3 no escore dos sintomas depressivos na primeira avaliação (2014), e 1,8 na segunda avaliação (2018) (=0,020; IC:-2,530 - - 0,225 e p=0,003; IC: -3,016 - -0,640, respectivamente). A intensidade da dor esteve associada ao estresse (p=0,019; IC= 0,179- 1,958) e sintomas depressivos na primeira e segunda avaliação (p=0,001; IC: 0,218- 0,772; p=0,013; IC: 0,066- 0,538). Por meio da análise da ANCOVA, verificou-se que, quanto maior a diferença na intensidade da dor, maior a diferença nos sintomas depressivos ao longo do tempo. Conclusão É necessário realizar uma ação efetiva para o manejo da dor crônica em cuidadores idosos para minimizar os agravos relacionados ao estresse e sintomas depressivos.

Abstract Objectives: to assess the prevalence and epidemiological factors associated with group B Streptococcus (GBS) colonization in pregnant women in Porto Velho City, Rondônia. Methods: GBS was identified and isolated by genotypic and microbiological methods from rectovaginal samples of pregnant women between 35 and 37 weeks of gestation. Epidemiological data were collected using questionnaires and their correlation with colonization was assessed. The antimicrobial susceptibility profile was determined by disk diffusion method. Results: a total of 22.5% (102/453) pregnant women were colonized with GBS. A higher level of colonization was observed at the vaginal tract (17.6%), compared to the rectal area. We did not find any sociodemographic or obstetric factors associated with an increased risk of GBS colonization. All strains were susceptible to antibiotics penicillin, ampicillin, cefazolin, and ceftriaxone. In contrast, the rates of resistance to tetracycline (74.1%), erythromycin (14.1%), and clindamycin (3.5%) were observed. Conclusion: the prevalence of GBS as well as the absence of predictors of colonization demonstrated the need for universal screening for GBS in all pregnant women in the region. In addition, we showed that the first-line antibiotics recommended for prophylaxis are still good options for the prevention of neonatal GBS disease in the region.

ABSTRACT. Despite the increasing knowledge in the past years, only minimal attention has been directed to the neuropsychological aspects and the prevalence of cognitive impairment associated with reversible cerebral vasoconstriction syndrome (RCVS). Objective: To describe the frequency and expand the understanding of cognitive dysfunction in RCVS. Methods: The neuropsychological evaluation was performed using a battery consisting of specific neuropsychological instruments that were administered to patients diagnosed with RCVS. A triage was conducted to exclude other potential causes of cognitive impairment. Performance on the tests was treated as a categorical variable, and a cutoff of −1.5 Z-score was adopted to indicate impaired performance. Results: Seven patients diagnosed with RCVS were evaluated, all of whom had a bachelor's degree and normal score in the Mini-Mental State Examination. The average time between diagnosis and neuropsychological evaluation was 1.8 years. Among the patients, 85.6% (n=6) exhibited performance below that of the normal population in at least two of the administered tests. Specifically, 71.4% (n=5) showed alterations in tests from the Psychological Battery for Attention Assessment, with impairment observed in concentrated (n=1), divided (n=3), or alternating (n=4) attention. Furthermore, 28.6% (n=2) demonstrated impairments in the Phonological Verbal Fluency Task, another 28.6% (n=2) exhibited difficulties copying elements of the Rey Complex Figure, and 14.3% (n=1) displayed lower performance in the Five-Digit test, all indicating executive dysfunction. Conclusion: This study provides evidence that cognitive impairment associated with RCVS is more prevalent than previously believed and has not received sufficient attention. Specifically, attention and executive functions are the cognitive domains most significantly impacted by RCVS.

Zebrafish larvae are a model organism increasingly used in the study of the effect of neuroactive chemicals on vertebrate sleep/wake cycles. Sleep disturbances have a negative impact on mood, cognition and overall health. Here we present a protocol to assess over 24 h sleep/wake cycles in zebrafish larvae subjected to 12 h light/dark periods in 48-well plates, using video-tracking technologies. The protocol can be used to determine if the exposure to environmental pollutants or drugs can lead to sleep disturbances. The results on the effect of the tire rubber-derived 6PPD-quinone on zebrafish sleep/wake cycles presented here demonstrate the suitability of using this protocol in fish neurotoxicity studies. This protocol provides a new relevant tool to be used in the pharmacology and toxicology fields.

Primary brain neoplasms are associated with elevated mortality and morbidity rates. Brain tumour surgery aims to achieve maximal tumour resection while minimizing damage to healthy brain tissue. Research on Neuromodulation Induced Cortical Prehabilitation (NICP) has highlighted the potential, before neurosurgery, of establishing new brain connections and transfer functional activity from one area of the brain to another. Nonetheless, the neural mechanisms underlying these processes, particularly in the context of space-occupying lesions, remain unclear. A patient with a left frontotemporoinsular tumour underwent a prehabilitation protocol providing 20 sessions of inhibitory non-invasive neuromodulation (rTMS and multichannel tDCS) over a language network coupled with intensive task training. Prehabilitation resulted in an increment of the distance between the tumour and the language network. Furthermore, enhanced functional connectivity within the language circuit was observed. The present innovative case-study exposed that inhibition of the functional network area surrounding the space-occupying lesion promotes a plastic change in the network’s spatial organization, presumably through the establishment of novel functional pathways away from the lesion’s site. While these outcomes are promising, prudence dictates the need for larger studies to confirm and generalize these findings.

A pesquisa foi conduzida com o objetivo de avaliar a utilização da levedura de cana-de-açúcar (Saccharomyces cerevisiae) desidratada pelo método spray dryer nas dietas de tilápia do Nilo. Foram utilizados 144 alevinos com peso médio inicial 3,6 ± 0,03g, distribuídos em 24 tanques com capacidade de 80L, interligados a um sistema de recirculação de água, com o uso de filtro biológico para a mineralização da amônia em nitrito, e do nitrito em nitrato, e um sistema de aeração contínua. O delineamento experimental utilizado foi o inteiramente casualizado constituído de quatro tratamentos (0,00; 10,00; 20,00 e 30,00% de inclusão de levedura) e seis repetições. O experimento teve uma duração de 60 dias e foram avaliados o peso final, comprimento total, taxa de sobrevivência, ganho em peso, consumo de ração, conversão alimentar aparente, taxa de eficiência proteica, rendimento de carcaça, índices hepatossomático e lipossomático. Em relação aos parâmetros analisados, não foram observados um efeito significativo para comprimento total, consumo de ração, conversão alimentar, taxa de eficiência proteica, rendimento de carcaça, índices hepatossomático e lipossomático. No entanto, o peso final e ganho em peso apresentaram efeito quadrático, sendo os melhores níveis de inclusão de levedura apontado pela regressão para esses parâmetros foram 2,26 e 3,04%, respectivamente. Já para a taxa de sobrevivência dos animais foi observado um aumento linear. Baseado nos resultados obtidos, recomenda-se a inclusão de 3,04% de levedura para alevinos de tilápia do Nilo.

The occupation fraction of massive black holes (MBHs) in low mass galaxies offers interesting insights into initial black hole seeding mechanisms and their mass assembly history, though disentangling these two effects remains challenging. Using the {\sc Romulus} cosmological simulations we examine the impact of environment on the occupation fraction of MBHs in low mass galaxies. Unlike most modern cosmological simulations, {\sc Romulus} seeds MBHs based on local gas properties, selecting dense (n>3 cm^-3, 15 times the threshold for star formation), pristine (Z3), a difference arises as late-forming dwarfs -- which do not exist in the cluster environment -- begin to dominate in the field and pull the MBH occupation fraction down for low mass galaxies. Additionally, prior to in-fall some cluster dwarfs are similar to progenitors of massive, isolated galaxies, indicating that they might have grown to higher masses had they not been impeded by the cluster environment. While the population of MBHs in dwarf galaxies is already widely understood to be important for understanding MBH formation, this work demonstrates that environmental dependence is important to consider as future observations search for low mass black holes in dwarf galaxies.

The largest genus of Palaearctic Syrphidae, Cheilosia Meigen, 1822 (Syrphidae: Rhingiini), is currently under revision in the Ibero-Balearic region (Iberian Peninsula + Balearic Islands). Prior to this study, various species groups with putative phylogenetic support were defined for this genus of complex taxonomy. The group of Cheilosia melanura Becker, 1894 includes species distributed all over Europe, with some of these species being similar each other in both morphology and genetics. After recent fieldwork in different Iberian localities and consultation of entomological collections, a new species from Sierra Nevada (Granada, Spain) was uncovered, described, and illustrated. Data on diagnostic characters, intraspecific variability, and adult biology were also provided. Maximum likelihood analyses of the fragment “C” of the 5′ end of the cytochrome c oxydase subunit I (COI-5′) and complete COI-5′ were performed to explore and support morphological species concepts within the group. The Spanish-endemic Cheilosia andalusiaca Torp Pedersen, 1971 is recognised here to be part of the C. melanura group based both on morphological and molecular evidence. Cheilosia carbonaria Egger, 1860 and Cheilosia cynocephala Loew, 1840 from the Iberian Peninsula are reported for the first time based on specimens originating in the Spanish Pyrenees. An identification key for the Iberian species of the C. melanura group is provided.

RESUMO Objetivo Verificar se existe relação entre duração do sono, sintomas depressivos e estresse em pessoas idosas da comunidade. Métodos Estudo transversal, realizado com 116 idosas residentes em áreas de Unidades de Saúde da Família no município de São Carlos/SP. Foram utilizados os seguintes instrumentos: questionário de caracterização sociodemográfica; Índice de Qualidade do Sono de Pittsburgh; Escala de Depressão Geriátrica e Escala de Estresse Percebido. Os testes estatísticos utilizados foram teste de qui-quadrado de Pearson, Kruskall-Wallis, teste de Mann-Whitney e regressão linear múltipla. Resultados Entre as idosas, 50% referiram ter boa qualidade do sono e 49,1% dormiam entre sete e nove horas de sono noturno. Quando comparadas, as idosas com maior duração do sono apresentaram mais sintomas depressivos e escores mais elevados para o estresse percebido. Conclusão O modelo com aplicação do método hierárquico aponta que existe relação entre duração do sono, sintomas depressivos e estresse.

Objetivo: describir un paciente con isquemia miocárdica con múltiples causas. Caso Clínico: En este caso clínico se describe a un hombre de 58 años con antecedentes de hipertensión, dislipidemia, EPOC e infarto de miocardio (IAM) previo. Acudió a urgencias con dolor torácico y disnea. Los hallazgos incluyeron crepitantes bibasales, electrocardiograma con fibrosis anterior antigua, NT-ProBNP elevado y ecocardiograma con acinesia septoapical. Durante la hospitalización, experimentó taquiarritmia y deterioro hemodinámico, siendo sometido a cardioversión eléctrica (CVE). Se diagnosticó síndrome coronario agudo sin elevación del segmento ST (SCASEST) complicado con arritmia ventricular y edema pulmonar agudo. La angiografía coronaria reveló ectasias coronarias sin lesiones obstructivas, pero con estenosis leve en tres vasos. El paciente fue tratado con éxito mediante ventilación no invasiva, diuréticos, vasodilatadores y anticoagulación. Se otorgó el alta con el plan de profundizar estudios para optimizar y guiar tratamiento y finalmente se abordó al diagnóstico de Infarto de Miocardio con Arterias No Obstructivas (MINOCA) y la presencia de ectasias coronarias. Conclusión: es importante destacar las causas no isquémicas en MINOCA y la asociación entre ectasia coronaria y eventos cardiovasculares, por lo que subrayamos la necesidad de más estudios para comprender mejor la relación entre estos fenómenos.

Background: Pilomatricoma is a common benign adnexal neoplasm in children. There are few epidemiological studies on this subject, with most relying solely on descriptive statistics. Methods: A cross-sectional study conducted in two tertiary hospitals in Mexico City from January 2017 to December 2023. Clinical and electronic records of patients with histopathological diagnosis of pilomatricoma, both sexes, under 18 years old, with any type of present comorbidity were selected. Records of patients with diagnosis not confirmed by histopathology or incomplete records were not included in the study. Results: Fifty-two cases with pilomatrixoma were included in the study, showing a total of 74 lesions. About 23.1% of the cases had multiple pilomatrixomas. 40.4% of the cases experienced pain; this symptom was associated with lesions > 15 mm in diameter and with multiple pilomatrixomas. Risk factors for lesions > 15 mm included age under 8 years, positive tent sign, tumor evolution longer than a year, and a non-classical clinical variety. The head and neck were the most commonly affected areas. The left upper extremity presented larger pilomatrixomas (median 18.5 mm) and occurred more frequently in adolescent patients (mean age 12.1 years) compared to other body areas. Conclusions: Pilomatrixoma in children shows clinical diversity, with specific findings based on size, number, and anatomical location.

In a companion paper, we present the first spatially resolved polarized image of Sagittarius A* on event horizon scales, captured using the Event Horizon Telescope, a global very long baseline interferometric array operating at a wavelength of 1.3 mm. Here we interpret this image using both simple analytic models and numerical general relativistic magnetohydrodynamic (GRMHD) simulations. The large spatially resolved linear polarization fraction (24%–28%, peaking at ∼40%) is the most stringent constraint on parameter space, disfavoring models that are too Faraday depolarized. Similar to our studies of M87*, polarimetric constraints reinforce a preference for GRMHD models with dynamically important magnetic fields. Although the spiral morphology of the polarization pattern is known to constrain the spin and inclination angle, the time-variable rotation measure (RM) of Sgr A* (equivalent to ≈46° ± 12° rotation at 228 GHz) limits its present utility as a constraint. If we attribute the RM to internal Faraday rotation, then the motion of accreting material is inferred to be counterclockwise, contrary to inferences based on historical polarized flares, and no model satisfies all polarimetric and total intensity constraints. On the other hand, if we attribute the mean RM to an external Faraday screen, then the motion of accreting material is inferred to be clockwise, and one model passes all applied total intensity and polarimetric constraints: a model with strong magnetic fields, a spin parameter of 0.94, and an inclination of 150°. We discuss how future 345 GHz and dynamical imaging will mitigate our present uncertainties and provide additional constraints on the black hole and its accretion flow.

The Event Horizon Telescope observed the horizon-scale synchrotron emission region around the Galactic center supermassive black hole, Sagittarius A* (Sgr A*), in 2017. These observations revealed a bright, thick ring morphology with a diameter of 51.8 ± 2.3 μ as and modest azimuthal brightness asymmetry, consistent with the expected appearance of a black hole with mass M ≈ 4 × 10 ^6 M _⊙ . From these observations, we present the first resolved linear and circular polarimetric images of Sgr A*. The linear polarization images demonstrate that the emission ring is highly polarized, exhibiting a prominent spiral electric vector polarization angle pattern with a peak fractional polarization of ∼40% in the western portion of the ring. The circular polarization images feature a modestly (∼5%–10%) polarized dipole structure along the emission ring, with negative circular polarization in the western region and positive circular polarization in the eastern region, although our methods exhibit stronger disagreement than for linear polarization. We analyze the data using multiple independent imaging and modeling methods, each of which is validated using a standardized suite of synthetic data sets. While the detailed spatial distribution of the linear polarization along the ring remains uncertain owing to the intrinsic variability of the source, the spiraling polarization structure is robust to methodological choices. The degree and orientation of the linear polarization provide stringent constraints for the black hole and its surrounding magnetic fields, which we discuss in an accompanying publication.

Abstract The negative, mood-congruent cognitive bias described in depression, as well as excessive rumination, have been found to interfere with emotional processing. This study focuses on the assessment of facial recognition of emotions in patients with depression through a new set of dynamic virtual faces (DVFs). The sample consisted of 54 stable patients compared to 54 healthy controls. The experiment consisted in an emotion recognition task using non-immersive virtual reality (VR) with DVFs of six basic emotions and neutral expression. Patients with depression showed a worst performance in facial affect recognition compared to healthy controls. Age of onset was negatively correlated with emotion recognition and no correlation was observed for duration of illness or number of lifetime hospitalizations. There was no correlation for the depression group between emotion recognition and degree of psychopathology, excessive rumination, degree of functioning, or quality of life. Hence, it is important to improve and validate VR tools for emotion recognition to achieve greater methodological homogeneity of studies and to be able to establish more conclusive results.

Previous research with adults has shown mixed findings regarding the correlation between specificity and detailedness within autobiographical memories, and their associations with depressive symptoms. However, minimal research has tested these links in adolescents, despite the importance of this developmental period. The present investigation examined these associations in a sample of young community adolescents in Spain (N = 768; M[subscript age] = 11.04) by replicating methodology of existing studies. Cued recall was measured using the Autobiographical Memory Test and responses were subsequently coded for specificity (whether the memory referred to an event that lasted less than 24 hours) and amount of detail (time, place, sensory-perceptual information, etc.). Depressive symptoms were assessed using the Patient Reported Outcomes Measure Information System (PROMIS) measure. Two linear mixed models showed that young adolescents who retrieved more detail recalled a greater number of specific memories and that specific memories included a greater amount of detail than nonspecific memories. However, neither memory specificity nor detail were associated with depressive symptoms. Our findings suggest that, in a population of young adolescents, memory specificity and detail are distinct, but interrelated, constructs. Further longitudinal research should examine whether specificity and detail predict depressive symptoms differentially over the course of adolescence; possible mediators and moderators within this association should also be investigated.

The nature and origin of supermassive black holes (SMBHs) remain an open matter of debate within the scientific community. While various theoretical scenarios have been proposed, each with specific observational signatures, the lack of sufficiently sensitive X-ray observations hinders the progress of observational tests. In this white paper, we present how AXIS will contribute to solving this issue. With an angular resolution of 1.5″ on-axis and minimal off-axis degradation, we designed a deep survey capable of reaching flux limits in the [0.5–2] keV range of approximately 2 × 10−18 erg s−1 cm−2 over an area of 0.13 deg2 in approximately 7 million seconds (7 Ms). Furthermore, we planned an intermediate depth survey covering approximately 2 deg2 and reaching flux limits of about 2 × 10−17 erg s−1 cm−2 in order to detect a significant number of SMBHs with X-ray luminosities (LX) of approximately 1042 erg s−1 up to z∼10. These observations will enable AXIS to detect SMBHs with masses smaller than 105 M⊙, assuming Eddington-limited accretion and a typical bolometric correction for Type II AGN. AXIS will provide valuable information on the seeding and population synthesis models of SMBHs, allowing for more accurate constraints on their initial mass function (IMF) and accretion history from z∼0–10. To accomplish this, AXIS will leverage the unique synergy of survey telescopes such as the JWST, Roman, Euclid, Vera Rubin Telescope, and the new generation of 30 m class telescopes. These instruments will provide optical identification and redshift measurements, while AXIS will discover the smoking gun of nuclear activity, particularly in the case of highly obscured AGN or peculiar UV spectra as predicted and recently observed by the JWST in the early Universe.

ABSTRACT Chikungunya fever (CHIK) is a neglected tropical disease associated with chronic arthritis. CHIK is usually a self-limiting condition; however, extra-articular manifestations present as atypical illness in a minority of patients. These atypical features may mimic other conditions and potentially distract physicians from the true diagnosis. This review analyzes the evidence of many unusual extra-articular manifestations reported in cases of CHIK. Depending on the affected system, these unusual manifestations include encephalitis, myocarditis, acute interstitial nephritis, cutaneous manifestations, acute anterior uveitis, abdominal pain, and depression. In addition, coinfections and comorbidities may cause atypical illness and obscure the diagnosis. Further studies are required to clarify the pathophysiology and natural history of CHIK, as it remains a burdening condition. Exploring its atypical symptoms may be the missing scientific piece of this puzzle.

Introdução/Objetivo: O uso intensivo de antimicrobianos está entre as principais causas da emergência da resistência bacteriana que hoje enfrentamos. Durante a pandemia da COVID-19 houve um aumento no risco de desenvolvimento de infecção secundária bacteriana com consequente aumento na prescrição de antimicrobianos, o que contribui para a seleção de bactérias resistentes e sua disseminação. O objetivo deste estudo foi evidenciar mudanças na epidemiologia da resistência bacteriana entre isolados clínicos de Enterobacterales, durante a pandemia de COVID-19, no Hospital São José de Doenças Infecciosas (HSJ) – Fortaleza (CE). Métodos: Isolados bacterianos de amostras de escarro, LBA, aspirado traqueal, hemoculturas e ponta de cateter de pacientes internados no HSJ durante o período de 2020 à junho de 2023 foram submetidos ao Vitek® 2 para identificação e teste de sensibilidade. Nos isolados não repetidos de Enterobacterales resistentes aos carbapenens e às cefalosporinas de espectro estendido foram realizados os testes NG-CARBA-5® e PCR no Genexpert®CARBA-R para confirmação e detecção do tipo de carbapenemase. Resultados: No período estudado, 904 cepas de Enterobacterales isoladas foram incluídas no estudo. Destas, 426 (47,12%) mostraram-se suspeitas de produção de carbapenemases com confirmação de 271 (63,6%) pelos testes imunoenzimático e/ou genotípico. Dentre as confirmadas, 134 (49,44%) apresentaram KPC; 112 (41,33%) NDM; 3 (1,11%) IMP; 16 (5,90%) apresentaram coexpressão de KPC-NDM; 5 (1,85%) NDM-IMP e 1 (0,37%) coexpressão de KPC-IMP. A Klebsiella pneumoniae continua sendo considerada a maior produtora de carbapenemases com 243 (89,7%) isolados, seguida de Providencia stuartii com 8 (2,95%) e Enterobacter cloacae complex com 6 (2,21%), entre outras. Discussão: Verificou-se, no período do estudo, um aumento preocupante de Enterobacterales resistentes aos carbapenens e alteração significativa no perfil de resistência do hospital com a emergência de metalo-β-lactamases do tipo NDM e IMP, além de coexpressões de carbapenemases, o que reduz as opções terapêuticas e exige um melhor gerenciamento no uso das novas drogas. Desta forma, faz-se mister o uso dos testes para vigilância e detecção do tipo de resistência presente nos isolados suspeitos para orientar o tratamento, evitar desfechos negativos e reduzir os impactos da resistência bacteriana na saúde pública.

Introdução/Objetivo: O diagnóstico precoce das meningites agudas impacta na conduta médica terapêutica, e a identificação da etiologia fornece subsídios para adequação da terapia antimicrobiana. Objetivamos avaliar o impacto dos métodos moleculares e da cultura na identificação etiológica e na modificação da terapia antimicrobiana e antiviral inicial nas meningoencefalites agudas. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital São José de Doenças Infecciosas (CAAE: 52811521.7.0000.5044). Métodos: Estudo retrospectivo de pacientes com meningoencefalite aguda (

Introdução/Objetivos: A esporotricose é uma micose subcutânea endêmica, principalmente, no Sul e Sudeste do Brasil. No Ceará, em 2022, foi documentado o primeiro caso autóctone de esporotricose felina. O objetivo deste estudo foi descrever casos de esporotricose humana atendidos em um ambulatório de micoses, no Hospital São José de Doenças Infecciosas (HSJ), localizado em Fortaleza, Ceará. Metodologia: Trata-se de um estudo de corte transversal, onde foram incluídos todos os pacientes com diagnóstico de esporotricose humana, no período de 2022‒2023. Resultados: No período do estudo, cinco pacientes receberam o diagnóstico de esporotricose. Três indivíduos eram do sexo masculino e dois do sexo feminino. A idade variou de 17‒48 anos. Os casos foram procedentes dos municípios de Iracema (n=2), Fortaleza (n=2) e Porteiras (n=1). Um paciente era funcionário de uma clínica veterinária e desenvolveu a infecção após arranhadura por animal doente durante procedimento técnico. Todos os pacientes relataram história de arranhadura ou mordedura por felino doente, e os sintomas iniciaram 30 ou mais dias após evento com o animal. As principais regiões acometidas foram quirodáctilos (n=2), antebraço/punho (n=2) e região cervical (n=1). As lesões desenvolvidas foram placas hiperemiadas com crostas (n=3) e lesão ulcerada (n=2). As formas clínicas apresentadas foram linfocutânea (n=4) e cutânea fixa (n=1). Apenas um paciente precisou de internamento devido apresentar infecção secundária bacteriana na lesão. Todos os pacientes realizaram sorologia por ensaio imunoenzimático, e quatro tiveram resultado reagente. Quatro pacientes realizaram biópsia da lesão de pele. As principais alterações observadas foram granuloma não caseoso (n=3), infiltrado inflamatório misto (n=2), infiltrado predominantemente linfocitário perivascular (n=2), e espongiose (n=2). Em apenas um paciente foi isolado Sporothrix spp. em amostra de fragmento de pele. A espécie Sporothrix schenkii foi identificada por MALDI-TOF. Todos receberam tratamento com itraconazol, e seguem em acompanhamento no ambulatório de micoses. Três felinos foram eutanasiados e dois, abandonados. Conclusão: Os casos de esporotricose do interior do Ceará são procedentes de municípios que fazem fronteira com outros estados do Nordeste, onde a micose já é endêmica. Estratégias de vigilância no âmbito da saúde única, bem como a capacitação dos profissionais de saúde para identificação precoce desta doença, devem ser priorizadas.

Introdução: A esporotricose é uma doença subaguda ou crônica causada por um fungo dimórfico do gênero Sporothrix spp. O contágio acontece por atividades ocupacionais envolvendo manipulação de solo/vegetais contaminados, ou pela arranhadura/mordedura de animais infectados. As formas clínicas mais frequentes são a linfocutânea e a cutânea fixa. O diagnóstico definitivo da doença é feito a partir do isolamento do fungo em cultura. Descrição do caso: Paciente do sexo masculino, de 17 anos, procedente de Fortaleza-CE, sem comorbidades prévias, buscou atendimento, em abril de 2023, no serviço de infectologia de um hospital público de Fortaleza, com histórico de arranhadura no punho esquerdo por um gato doméstico há 30 dias. O animal apresentava feridas no corpo há cerca de 2 meses. Foi prescrito inicialmente, amoxicilina/clavulanato por 10 dias e soro antirrábico humano. Em maio de 23, o paciente procurou novo atendimento, por não haver melhora da lesão, sendo realizado biópsia da lesão e cultura de fragmento de pele. Após 10 dias da biópsia de pele, o paciente foi avaliado no ambulatório de micoses sendo observado uma placa hiperemiada com crosta no punho e cadeia linfonodal no antebraço esquerdo. A biópsia de pele revelou dermatite crônica em moderada atividade, perivascular, focalmente espongiótica. Pesquisa negativa para BAAR, fungos e Leishmania. Após 35 dias de cultivo em Ágar Sabouraud Dextrose 2% e ágar Mycosel foi identificado crescimento de colônias enrugadas e acastanhadas/enegrecidas nas bordas, sugestivas de Sporothrix spp. A visualização microscópica com lactofenol azul de algodão mostrou hifas hialinas, septadas, ramificadas com conídios dispostos em cachos terminais semelhantes a uma margarida. A identificação da espécie foi realizada por espectrometria de massa de tempo de voo de dessorção/ionização a laser (MALDI-TOF VITEK-MS®), com valor de confiança de 99,9%, onde foi identificado Sporothrix schenckii. Foi iniciado o tratamento com itraconazol 200 mg/dia, e o paciente segue em acompanhamento no ambulatório de micoses. Comentários: No Ceará os casos de esporotricose são considerados raros. A inexistência de uma rede de atenção às micoses no Estado dificulta a identificação dos casos, reforçando a necessidade de implementação de políticas que visem a capacitação dos profissionais de saúde para a suspeição e diagnóstico precoce desta micose no Ceará.

Introdução/Objetivos: A Histoplasmose Disseminada (HD) é uma doença endêmica no Ceará, em pessoas que vivem com HIV/AIDS. A cultura, que é um método tempo-dependente, ainda é o padrão-ouro para o diagnóstico. Entretanto, o teste de Antígeno (Ag) urinário de H. capsulatum tem sido usado em diversos países da América Latina, com excelentes resultados. O objetivo deste estudo foi avaliar a performance do Ag urinário de H. capsulatum em pacientes com AIDS, internados no Hospital São José de Doenças Infecciosas (HSJ), em Fortaleza/Ceará, no período de 2020 – 2022. Métodos: Estudo caso-controle, onde o teste de Ag urinário de H. capsulatum (Immuno-Mycologics [YMMY], Norman, OK, USA), através de Ensaio Imunoenzimátio (ELISA) foi utilizado em pacientes com AIDS. Foram incluídos pacientes adultos (>18 anos), de ambos os sexos, internados com síndrome febril, e com algum sinal ou sintoma respiratório (tosse, dispneia) ou de trato gastrointestinal (diarreia, icterícia, hepatomegalia, esplenomegalia, aumento das transaminases), ou alteração laboratorial (hemograma ‒ bicitopenia ou pancitopenia; aumento da LDH, das transaminases ou da creatinina). Foram excluídos do estudo, pacientes com insuficiência renal anúrica ou aqueles em uso de anfotericina B por mais de 48 horas. A cultura do creme leucocitário ou medula óssea foi usada como método padrão-ouro para o diagnóstico. Resultados: No período do estudo foram selecionados 148 pacientes. Um paciente foi excluído por apresentar IRA anúrica e outro por estar em uso de anfotericina B há mais de 48 horas. Logo, 146 pacientes realizaram o Ag urinário. No total, 43 (29,5%) pacientes tiveram o Ag urinário positivo; em 32 pacientes houve isolamento do fungo em cultura do creme leucocitário ou medula óssea. Quanto à performance do teste, observamos uma sensibilidade de 100%, especificidade de 90,3%, valor preditivo positivo de 74,4%, valor preditivo negativo 100%, acurácia de 92,5%, e índice kappa de 0,804. Houve um incremento no diagnóstico de 25,6% com o teste do Ag urinário. Não houve diagnóstico de outras infecções fúngicas invasivas nos pacientes que apresentaram teste positivo. Conclusão: A performance do Ag urinário em pacientes com AIDS internados no HSJ foi consideravelmente melhor do que a cultura. Portanto, o Ag urinário é um teste mais rápido e menos invasivo para os pacientes com HD/AIDS, e, deve estar disponível para o diagnóstico precoce, dada a gravidade da doença.

El momento adecuado para la administración de los inhibidores P2Y12 en pacientes con síndrome coronario agudo sin elevación del segmento ST es tema de debate desde hace dos décadas. Las recomendaciones actuales de las guías europeas sugieren administrar ácido acetilsalicílico y aguardar el momento de la cinecoronariografía, y una vez conocida la anatomía agregar un inhibidor P2Y12 solo en aquellos casos en que se programe una estrategia intervencionista precoz. Sin embargo, en el mundo real la estrategia de realizar o no pretratamiento es más compleja. Existe la incertidumbre respecto a que el paciente pueda acceder o no a una cinecoronariografía dentro de las 24 horas. En este escenario, el pretratamiento al ingreso de un paciente de riesgo intermedio o alto podría ser una opción si no va a ser estudiado con cateterismo dentro de las 2 a 4 horas del ingreso, analizando previamente el riesgo isquémico y de sangrado del paciente. Aún faltan estudios a gran escala que comparen estas dos opciones.

Abstract This study aims to perform a comprehensive genomic analysis to assess the influence of overexpression of MYO1E in non-small cell lung carcinoma (NSCLC) and whether there are differences in survival and mortality risk in NSCLC patients depending on both DNA methylation and RNA expression of MYO1E. The DNA methylation probe cg13887966 was inversely correlated with MYO1E RNA expression in both LUAD and LUSC subpopulations showing that lower MYO1E RNA expression was associated with higher MYO1E DNA methylation. Late stages of lung cancer showed significantly lower MYO1E DNA methylation and significantly higher MYO1E RNA expression for LUAD but not for LUSC. Low DNA methylation as well as high RNA expression of MYO1E are associated with a shorter median survival time and an increased risk of mortality for LUAD, but not for LUSC. This study suggests that changes in MYO1E methylation and expression in LUAD patients may have an essential role in lung cancer’s pathogenesis. It shows the utility of MYO1E DNA methylation and RNA expression in predicting survival for LUAD patients. Also, given the low normal expression of MYO1E in blood cells MYO1E DNA methylation has the potential to be used as circulating tumor marker in liquid biopsies.

Abstract The Laser Interferometer Space Antenna (LISA) will be a transformative experiment for gravitational wave astronomy, and, as such, it will offer unique opportunities to address many key astrophysical questions in a completely novel way. The synergy with ground-based and space-born instruments in the electromagnetic domain, by enabling multi-messenger observations, will add further to the discovery potential of LISA. The next decade is crucial to prepare the astrophysical community for LISA’s first observations. This review outlines the extensive landscape of astrophysical theory, numerical simulations, and astronomical observations that are instrumental for modeling and interpreting the upcoming LISA datastream. To this aim, the current knowledge in three main source classes for LISA is reviewed; ultra-compact stellar-mass binaries, massive black hole binaries, and extreme or interme-diate mass ratio inspirals. The relevant astrophysical processes and the established modeling techniques are summarized. Likewise, open issues and gaps in our understanding of these sources are highlighted, along with an indication of how LISA could help making progress in the different areas. New research avenues that LISA itself, or its joint exploitation with upcoming studies in the electromagnetic domain, will enable, are also illustrated. Improvements in modeling and analysis approaches, such as the combination of numerical simulations and modern data science techniques, are discussed. This review is intended to be a starting point for using LISA as a new discovery tool for understanding our Universe.