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Port operation activities have been expanding globally, driven by globalization and increased cargo handling. Developing countries, such as Brazil, China, and India, are experiencing a rise in the construction of modern ports. Recently, sustainability concepts have been integrated into maritime transportation, focusing on the construction and management of ports and exploring the reuse of waste generated during operations. The main objective of this study is to evaluate the potential application of the dredging material of port of açu (DMPA), sourced from a new private port in Rio de Janeiro State, Brazil, in developing sustainable construction materials. The dredged material, collected from the bottom of the shipping canal was physically, chemically, and morphologically characterized to compare its results with the processing and application requirements for alternative materials. A standard method for primary processing was developed, providing deeper insights into the material’s condition. Results indicate that the natural dredged material can be utilized as a filler in interlocking blocks or mortar. Additionally, an alternative processing route involving calcination can enhance the material's reactivity, presenting opportunities for higher-value applications, although the energy costs must be considered. The calcination of 650 °C resulted in a higher pozzolanic index, increasing its reactivity. The study concludes that port dredging waste from this case study has significant potential for use in sustainable building material development.

Introdução: O contato de estudantes de Medicina com pacientes, precedente à fase de internato, é essencial para a formação médico-profissional. Além de desenvolver raciocínio clínico e habilidades voltadas ao desenvolvimento interpessoal, os alunos se capacitam a fazer associações entre conceitos teóricos e sua prática. O Curso de Capacitação em Hematologia Geral para Atendimento Ambulatorial de Doadores (C.C.H.G.A.A.D.), realizado em 15/06/2024, na Faculdade de Medicina de Botucatu (FMB-UNESP), ofereceu aos graduandos a teoria necessária para embasá-los no auxílio às consultas ambulatoriais dos pacientes com distúrbios eritrocitários. Objetivos: Analisar a inserção de alunos de Medicina em capacitação para a formação profissional, por meio de experiência em curso de Hematologia Geral. Método: Trata-se de relato de experiência com grupo de estudantes do 1º-3ºanos de Medicina com aulas teóricas, em metodologia participativa. Os temas foram: Semiologia e Semiotécnica Hematológicas; Poliglobulias; Anemia na Mulher em Idade Fértil; Prescrição de Sais de Ferro; Prescrição de Vitamina B12; e alterações induzidas pelo H. pylori . A aula de Semiologia explorou a avaliação clínica e laboratorial dos distúrbios hematológicos, incluindo técnicas de exame físico, interpretação de resultados de exames laboratoriais e correlações clínicas pertinentes. Sobre Poliglobulias foram descritas a fisiopatologia, manifestações clínicas, abordagem diagnóstica e opções de tratamento. O tema Anemia na Mulher em Idade Fértil e Prescrição de Sais de Ferro tratou da análise das causas mais comuns, abordagem diagnóstica diferencial e estratégias de manejo clínico-terapêutico, considerando aspectos ginecológicos e obstétricos específicos, como também as diretrizes atuais e boas práticas para prescrição de suplementos de ferro em pacientes com deficiência deste elemento. Por fim, a aula sobre Prescrição de Vitamina B12 e alterações induzidas pelo H. pylori explorou a importância da vitamina B12 na Hematopoese e no metabolismo celular, as manifestações clínicas da deficiência deste elemento, avaliações laboratoriais e estratégias diagnósticas e de tratamento, bem como a relação entre a infecção por H. pylori e a síndrome anêmica, com suas implicações no manejo clínico e terapêutico. Resultados e Discussão: O desenvolvimento de raciocínio clínico através de aulas que estimularam discussões de casos reais e um caso-padrão, de pacientes com distúrbios eritrocitários, foi amplamente exercido durante o curso. Ao integrar este grupo, os alunos puderam desenvolver diversas habilidades, a saber: compreensão da fisiopatologia dos distúrbios, diretrizes que fundamentam o fluxo de atendimento, assim como o trabalho multiprofissional. A aula teórico-prática de Semiologia revelou-se de fundamental importância para instruir os acadêmicos de Medicina sobre avaliação do exame físico em Hematologia, tanto para iniciantes como para reforço em graduandos mais antigos. Esta atividade foi determinante para maior engajamento e motivação no atendimento clínico-laboratorial dentro da Hematologia. Conclusão: O C.C.H.G.A.A.D. possibilitou novas experiências, conhecimentos e ampliação da visão sobre o processo de formação acadêmica. É determinante no desenvolvimento do médico a observação e atuação precoce nos ambulatórios, unidades de atenção primária à saúde, e enfermarias. Este curso favoreceu a inserção no ambiente clínico, com troca de saberes, e crescimento profissional significativo.

Background: In Brazil, despite the increase in coverage and access to rapid testing for syphilis in primary health care, no reduction in cases of syphilis and congenital syphilis was observed. Poor and low-educated populations are disproportionately affected by infection caused by T. pallidum. This study aims to estimate the prevalence of syphilis and associated factors among people aged 18 to 49 years old in the city of Belém, brazilian amazon. Methods: Observational, cross-sectional study carried out in a sanitary administrative district of a capital of the Brazilian Amazon, Belém, state of Pará, Brazil. Data collection was conducted from August 2021 to February 2022. The participantes consisted of residents of the Montese, Guamá and Condor neighborhoods. People aged 18 to 49 years were included. This variable was treated as dichotomous (reagent and non-reagent). The selected response event was ‘reagent result’. The independent variables were the social factors and access to health services. To identify associated factors with the presence of markers of the bacteria studied, multiple logistic rules were performed. Results: 178 people participated in the study; the median age was 35.0 years. The prevalence of IgG and/or IgM antibodies against T. pallidum was 7 % (13). In the final regression model, it was observed that participants who had sexual intercourse after using alcohol and drugs and those who did not know about the prevention of sexually transmitted infections were five times more likely to have tested positive for T. pallidum. Conclusions: Aspects of individual vulnerability and access to health services must be managed to reduce the exposure of poor urban populations to T. pallidum.

Human activities shape the structure of landscapes in different ways and hence modify animal communities depending on the type and intensity of these activities. The Montes de Maria subregion of Colombia has experienced a heavy transformation of most areas despite covering one of the last remnants of dry forest, a critically endangered ecosystem. However, the effects of this transformation have been little explored. Here, we used a multispecies occupancy model (MSOM) to understand the relative influence of three components of land-use change – deforestation (remaining forest amount), degradation of forest integrity (forest quality) and fragmentation (landscape configuration) on mammalian habitat use across a mosaic of tropical dry forest in Colombia. Our data suggest that the percentage of forest cover was substantially important for herbivores, and consistently showed a moderate effect on the entire community and some individual species. High variability in species-specific responses to the examined variables hindered broad taxonomic generalizations, nevertheless, we detected a moderate positive effect of forest cover in both diet specialists and generalists species, as well as in species with small home ranges. Although omnivores responses, tended to use less complex landscapes (mosaics of land uses), there was high uncertainty in this response. The lack of substantial effects on most species, and the absence of threatened species across this anthropogenic landscape, suggests that the current community is composed of species tolerant to habitat modifications, but not only diet generalist species. This is most likely the result of a long filtering process caused by land use transformation and hunting which could have caused non-sensitive species to distribute relatively homogenously across this landscape. Our results suggest that conservation strategies in the study area should focus on conserving and expanding as much forest as possible rather than only improving the quality of already existing forest patches.

Evapotranspiration (ET) is the main driver of the energy balance partitioning and influences hydrological and carbon cycles at global, regional and local scales. Furthermore, it is the main requirement for developing strategies to improve water use in agriculture. It is known that there is a close relationship between ET and rainfall, especially in tropical environments. Thus, the main goal of this article was to evaluate how ET and its controls (surface conductance - Gs; decoupling coefficient - Ω; Priestley-Taylor parameter - α) respond to the seasonal variability of meteorological forcing in tropical grazed pastures under the climatic conditions of Northeast Brazil. ET was measured using an Eddy covariance (EC) system and analyzed based on data from two agricultural years (2015–2016 and 2016–2017) with negative (-59 mm) and positive (356 mm) rainfall anomaly, respectively. ET exhibited pronounced seasonality, closely aligned with the seasonality of rainfall. Lower daily averages were observed during the dry season in both agricultural years (1.01 ± 0.60 and 0.89 ± 0.44 mm, respectively). On the other hand, higher daily averages were observed during the rainy season (2.44 ± 0.75 and 4.83 ± 0.96 mm, respectively). The Gs patterns and the significant correlation between Gs, Ω, and α (p < 0.01) indicate that surface control prevails over atmospheric control on an annual scale. This finding is confirmed by the annual mean values of Ω (0.27, 2015–2016) and α (0.38, 2016–2017). This relationship is likely induced by a vegetative stomatal control mechanism, which protects the vegetation against excessive water loss during periods of high temperatures and low humidity levels. These findings are crucial for understanding how droughts modulate components of the energy balance and water fluxes in pastures, especially given the intensification of these events. This has implications for the implementation of climate change mitigation policies and soil management.

The toxicity of metals presents a significant threat to human health due to the metabolic changes they induce. Thus, it is crucial to understand the impact of exposure to toxic elements on glycemic and lipid profiles. To this end, we developed a systematic review protocol registered in PROSPERO (CRD42023393681), following PRISMA-P guidelines. This review aims to assess environmental exposure to arsenic, cadmium, mercury, and lead in individuals aged over ten years and elucidate their association with glycemic markers such as fasting plasma glucose, glycated hemoglobin, as well as lipid parameters including total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein cholesterol. Articles published in the MEDLINE (PubMed), EMBASE, Web of Science, LILACS, and Google Scholar databases until March 2024 will be included without language restrictions. The modified Newcastle-Ottawa scale will be employed to assess the quality of the included studies, and the results will be presented through narrative synthesis. If adequate data are available, a meta-analysis will be conducted. This review can help understand the metabolic responses to exposure to toxic elements and the associated health risks.

Penetrating trauma is usually divided into stab and gunshot wounds (GSW). When considering GSW, the initial assessment involves the identification of all the wounds, to understand the projectile's trajectory as well as to determine which anatomic structures might have been damaged [1]. Rarely, the projectile might not leave the victim's body and embolize to a different region through large blood vessels. Known as Missile Embolism (ME), this uncommon complication can compromise multiple body segments, resulting in severe injuries, whether it occurs through an artery or a vein, such as pulmonary embolism, cardiac-valve incompetence, limb-threatening ischemia, coronary infarct, and stroke [2,3]. This is a case report of an 18-year-old male patient who suffered a gunshot wound and was submitted to an exploratory laparotomy which identified a laceration of the inferior vena cava. Further exams concluded that the bullet was embolized to the right hepatic vein. ME treatment will depend mostly on the bullet's placement; if located in the left circulation or arterial vessels, retrieval is the preferred treatment. It can be executed through surgical exploration or endovascular procedure [3,4,8] Venous ME has several treatment options, including conservative management if the patient remains asymptomatic [3–7]. Cases of paradoxical embolization might be managed as arterial ME [3,4].

Abstract: Despite considerable advances in our understanding of the pathophysiology of graft-versus-host disease (GVHD), its prediction remains unresolved and depends mainly on clinical data. The aim of this study is to build a predictive model based on clinical variables and cytokine gene polymorphism for predicting acute GVHD (aGVHD) and chronic GVHD (cGVHD) from the analysis of a large cohort of HLA-identical sibling donor allogeneic stem cell transplant (allo-SCT) patients. A total of 25 SNPs in 12 cytokine genes were evaluated in 509 patients. Data were analyzed using a linear regression model and the least absolute shrinkage and selection operator (LASSO). The statistical model was constructed by randomly selecting 85% of cases (training set), and the predictive ability was confirmed based on the remaining 15% of cases (test set). Models including clinical and genetic variables (CG-M) predicted severe aGVHD significantly better than models including only clinical variables (C-M) or only genetic variables (G-M). For grades 3-4 aGVHD, the correct classification rates (CCR1) were: 100% for CG-M, 88% for G-M, and 50% for C-M. On the other hand, CG-M and G-M predicted extensive cGVHD better than C-M (CCR1: 80% vs. 66.7%, respectively). A risk score was calculated based on LASSO multivariate analyses. It was able to correctly stratify patients who developed grades 3-4 aGVHD (P < .001) and extensive cGVHD (P < .001). The novel predictive models proposed here improve the prediction of severe GVHD after allo-SCT. This approach could facilitate personalized risk-adapted clinical management of patients undergoing allo-SCT.

Abstract: Optimal donor selection is critical for successful allogeneic hematopoietic cell transplantation (HCT). Donor sex and parity are well-established risk factors for graft-versus-host disease (GVHD), with male donors typically associated with lower rates of GVHD. Well-matched unrelated donors (URDs) have also been associated with increased risks of GVHD as compared with matched sibling donors. These observations raise the question of whether male URDs would lead to more (or less) favorable transplant outcomes as compared with parous female sibling donors. We used the Center for International Blood and Marrow Transplant Research registry to complete a retrospective cohort study in adults with acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndrome, who underwent T-cell replete HCT from these 2 donor types (parous female sibling or male URD) between 2000 and 2012. Primary outcomes included grade 2 to 4 acute GVHD (aGVHD), chronic GVHD (cGVHD), and overall survival. Secondary outcomes included disease-free survival, transplant-related mortality, and relapse. In 2813 recipients, patients receiving male URD transplants (n = 1921) had 1.6 times higher risk of grade 2 to 4 aGVHD (P < .0001). For cGVHD, recipient sex was a significant factor, so donor/recipient pairs were evaluated. Female recipients of male URD grafts had a higher risk of cGVHD than those receiving parous female sibling grafts (relative risk [RR] = 1.43, P < .0001), whereas male recipients had similar rates of cGVHD regardless of donor type (RR = 1.09, P = .23). Donor type did not significantly affect any other end point. We conclude that when available, parous female siblings are preferred over male URDs.

Abstract: We studied the association between non-HLA donor characteristics (age, sex, donor-recipient relationship, blood group [ABO] match, and cytomegalovirus [CMV] serostatus) and transplant outcomes after T-cell-replete HLA-haploidentical transplantation using posttransplantation cyclophosphamide (PT-Cy) in 928 adults with hematologic malignancy transplanted between 2008 and 2015. Siblings (n = 358) and offspring (n = 450) were the predominant donors, with only 120 patients having received grafts from parents. Although mortality risks were higher with donors aged 30 years or older (hazard ratio, 1.39; P < .0001), the introduction of patient age to the Cox regression model negated the effect of donor age. Two-year survival adjusted for CMV seropositivity, disease, and disease risk index was lower in patients aged 55 to 78 years after transplantation of grafts from donors younger than 30 years (53%) or aged at least 30 years (46%) compared with younger patients who received grafts from donors younger than 30 years (61%) and at least 30 years (60%; P < .0001). Similarly, 2-year survival in patients aged 55 to 78 years was lower after transplantation of grafts from siblings (45%) or offspring (48%) compared with patients aged 18 to 54 years after transplantation of grafts from siblings (62%), offspring (58%), and parents (61%; P < .0001). Graft failure was higher after transplantation of grafts from parents (14%) compared with siblings (6%) or offspring (7%; P = .02). Other non-HLA donor characteristics were not associated with survival or graft failure. The current analyses suggest patient and disease, rather than non-HLA donor characteristics, predominantly influence survival in adults.

Background and aim: The complex dynamic interplay between different biological pathways involved in atherosclerosis development has rendered the identification of specific therapeutic targets a challenging quest. We aimed to identify specific genes and mechanistic pathways associated with the early development of fibro-atheromas in a swine model of atherosclerosis. Methods: The Wisconsin Miniature Swine™ model of Familial Hypercholesterolemia (WMS-FH, n = 11) and genetically related WMS controls (WMS-N, n = 11) were used. The infrarenal aorta was harvested from both groups for histopathologic and transcriptomic profiling at 12 months. Bioinformatic analysis was performed to identify hub genes and pathways central to disease pathophysiology. The expression of ITGB2, the top ranked hub gene, was manipulated in cell culture and the expression of interconnected genes was tested. Results: Fibro-atheromatous lesions were documented in all WMS-FH aortic tissues and displayed internal elastic lamina (IEL) disruption, significant reduction of myofibroblast presence and disorganized collagen deposition. No fibro-atheromas were observed in the control group. A total of 266 differentially expressed genes (DEGs) were upregulated in WMS-FH aortic tissues, while 29 genes were downregulated. Top identified hub genes included ITGB2, C1QA, LCP2, SPI1, CSF1R, C5AR1, CTSS, MPEG1, C1QC, and CSF2RB. Overexpression of ITGB2 resulted in elevated expression of other interconnected genes expressed in porcine endothelial cells. Conclusion: In a swine translational model of atherosclerosis, transcriptomic analysis identified ITGB2 as a central hub gene associated inflammation and early fibroatheroma development making it a potential therapeutic target at this stage of disease.

In the ongoing energy transition, small and medium-sized industrial companies are making energy equipment investments due to the obsolescence of their current equipment as well as social, political and market pressures. These firms typically choose investments with low risk exposure based on a combination of criteria that are not always quantifiable. However, published studies on energy investment to date have not been suitable for industrial SMEs because they do not assess the value of the investment over time, ignore the qualitative aspects of decision-making, and do not consider uncertainties. To fill this gap in the literature, this paper proposes a methodology that considers both quantitative and qualitative parameters and risks over time through an extended two-stage risk-informed approach. The proposed methodology includes fuzzy and statistical techniques for evaluating both qualitative and quantitative parameters, as well as their uncertainties, at the time of decision-making and over the investment lifetime. Fuzzy logic is used in the first stage of the optimisation process to measure qualitative parameters and their uncertainty, while quantitative parameters are expressed using probability density functions to account for their uncertainty and measure the quantitative risk assumed by the investor. This methodology is applied to a case study involving a real industrial SME, and the results show that considering both quantitative and qualitative parameters and uncertainties in the optimisation process leads to a more balanced consideration of economic, environmental and social criteria and reduces the variability of the outcome compared to economic-only approaches that do not account for risks. Specifically, the case study shows that considering these parameters and uncertainties resulted in a 15.7% reduction in the size of the cogeneration system due to its environmental and social impacts, and 4.2% reduction in the variability of the economic result.

Introduction and objectives: No studies have analysed the effectiveness of treatment for constipation in critically ill children. The aim of this study was to assess the implementation, efficacy and safety of a treatment protocol using polyethylene glycol 3350 with electrolytes (PEG 3350 + E) for constipation in critically ill children. Methods: We conducted a single-centre prospective study in children admitted to the paediatric intensive care unit for a minimum of 72 h and who developed constipation. Children with previous gastrointestinal disorders or diseases were excluded. The patients were treated with rectal enemas or with the oral PEG 3350 + E protocol at the discretion of the treating physician. We compared clinical and demographic variables as well as adverse events (diarrhoea, abdominal distension and electrolyte imbalances). Results: The sample included 56 patients with a mean age of 48.2 ± 11.9 months, of who 55.4% were male. Forty-four patients (78.6%) were treated with PEG 3350 + E and 12 (21.4%) with rectal enemas. The proportion of patients that responded well to treatment was greater in the PEG 3350 + E group (79.5%) compared to the enema group (58.3%), but the difference was not statistically significant (P = .151). There were no significant differences between the groups in any of the adverse effects. Treatment with PEG 3350 + E was more effective in children aged less than 2 years (100%) compared to older children (100% vs 65.4%; P

Analytical and functional comparison is key for substantiating the level of convergence (essential sameness) or divergence between versions or variants of a given biological medicine. Accordingly, an overlapping biological activity between products meant to be equal probably reflects a highly similar structure and anticipates a comparable pharmacodynamic behavior. We developed an orthogonal approach to compare the human IgE binding features of different lots and versions of Xolair® (omalizumab), an anti-human IgE monoclonal antibody. The IgE binding affinity and kinetics were measured by surface plasmon resonance. Ability to prevent mast cell activity was assessed in vitro and in vivo in mast cell-based models. The variability of monoclonal antibodies with identical amino acid sequences produced either in Chinese hamster ovarian cells or in human HEK293 cells, was compared. Monoclonal antibodies from the two sources exhibited slightly different human IgE binding and neutralizing features. A known variant exhibiting a three amino acid replacement in the Fab region had lower IgE binding affinity than the original omalizumab. The lower binding affinity translated into reduced IgE neutralizing capacity and, in turn, a difference in the ability to prevent mast cell activation in vitro and in vivo. The proposed set of analytical and functional assays was sensitive enough to detect Fab-linked differences between anti-IgE antibody versions exhibiting an identical aminoacid sequence. In addition to add value to the comparative assessment of biosimilar candidates bearing omalizumab, these methods can aid pre-assessments of new anti-IgE agents that aim to improve therapeutic performance.

Introdução/Objetivo: Analisar o impacto da vacina adsorvida difteria, tétano e coqueluche (pertússis acelular) nos casos confirmados de coqueluche no Brasil. Métodos: Estudo ecológico de série temporal realizado por meio de dados extraídos do Departamento de Informática do Sistema Único de Saúde (DATASUS) provenientes do Sistema de Sistema de Informação do Programa Nacional de Imunizações (SI-PNI/CGPNI/DEIDT/SVS/MS) nas regiões brasileiras entre 2012 a 2022. Os participantes foram brasileiros de ambos os sexos de 0 a 80 anos. As variáveis analisadas foram: faixa etária, coberturas vacinais por ano segundo região, casos confirmados de coqueluche. As variáveis foram analisadas por meio da estatística descritiva. Resultados: Foram registrados um total de 31.149 casos confirmados de coqueluche. Houve variações no número de casos ao longo dos anos, com um pico de 8.498 casos em 2015. A Região Sudeste apresentou o maior número de casos, totalizando 12.806, seguida pela Região Nordeste (8.004) e Região Sul (6.353). A faixa etária mais afetada foi a de crianças menores de 1 ano, com 18.263 casos, seguida pela faixa etária de 1 a 4 anos, com 5.181 casos. Ao analisar as coberturas vacinais por região, observamos variações ao longo dos anos. Os anos com maior cobertura vacinal foram em 2013 (94,53%) e 2014 (90,93%), sendo que nesses anos também ocorreram altos números de casos de coqueluche. Conclusão: A coqueluche continua sendo um desafio de saúde pública no Brasil, com variações no número de casos ao longo dos anos. Embora os anos com maior cobertura vacinal não tenham necessariamente correspondido aos anos com a maioria dos casos, a vacinação é fundamental para reduzir a incidência da doença. As faixas etárias mais afetadas corroboram com a literatura: crianças menores de 1 ano e crianças de 1 a 4 anos. É necessário fortalecer a vigilância epidemiológica e a qualidade dos dados notificados, visando a um melhor monitoramento e controle da coqueluche no país.

Introdução/Objetivo: Analisar os casos confirmados de febre maculosa e sua distribuição regional no Brasil. Métodos: Estudo ecológico realizado por meio de dados extraídos do Departamento de Informática do Sistema Único de Saúde (DATASUS) provenientes do Sistema de Informação de Agravos de Notificação (SINAN) de todos estados brasileiros entre os anos de 2010 a 2020. Os participantes foram brasileiros de ambos os sexos de 0 a 80 anos que foram casos confirmados e notificados no SINAN. As variáveis analisadas foram: regiões brasileiras, anos e número de casos confirmados. As variáveis foram analisadas por meio da estatística descritiva. Resultados: Durante o período analisado, foram registrados um total de 1.977 casos confirmados de febre maculosa no Brasil. Observamos variações no número de casos ao longo dos anos, com um pico de 274 casos em 2019. A Região Sudeste apresentou o maior número de casos, totalizando 1.427, seguida pela Região Sul (472) e Região Nordeste (38). As regiões Norte e Centro-Oeste apresentaram menor número de casos, com 7 e 33, respectivamente. Conclusão: A febre maculosa continua sendo um desafio de saúde pública no Brasil, com variações no número de casos ao longo dos anos e uma distribuição geográfica desigual. A concentração de casos nas regiões Sudeste e Sul corrobora com a literatura e ressalta a importância de medidas de controle do vetor e de educação em saúde nessas áreas. No entanto, é necessário melhorar a vigilância epidemiológica e a qualidade dos dados notificados, a fim de obter uma visão mais precisa da situação da febre maculosa no país e direcionar estratégias de prevenção e controle mais eficazes.

Introdução/objetivo: A meningite viral afeta principalmente crianças e o seu principal agente etiológico é o enterovírus. A prevalência aumenta no verão e no início do outono em climas temperados, mas tem alta incidência durante todo o ano em áreas tropicais e subtropicais, isto sugere variabilidade da incidência no Brasil. Este estudo tem o objetivo de analisar o perfil epidemiológico da meningite viral em crianças no Brasil. Métodos: Estudo ecológico realizado por meio de dados extraídos do Departamento de Informática do Sistema Único de Saúde (DATASUS) provenientes do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS) em todas as regiões brasileiras no período de 2012 a 2022. Os participantes foram crianças de ambos os sexos na faixa etária de 0 a 14 anos. As variáveis analisadas foram: faixa etária, número de internações por meningite viral conforme lista de morbidade CID-10, média de permanência, valor total por Autorização de Internação Hospitalar e taxa mortalidade segundo região. As variáveis foram analisadas por meio da estatística descritiva. Resultados: No período analisado, foram registradas 17.674 internações por meningite viral em crianças no Brasil. A faixa etária com maior número de ocorrência foi de 1 a 4 anos com 5.535 internações em todo território nacional. A região Sudeste apresentou o maior número de internações, com 8.128 casos, seguida pela região Nordeste (4.092 casos), região Sul (3.552 casos), região Centro-Oeste (1.124 casos) e região Norte (778 casos). O valor total gasto com as internações foi de R$ 17.737.448,97. A média de permanência hospitalar foi de 6,3 dias. A taxa de mortalidade global foi de 1,35%, sendo mais elevada na região Norte (4,88%) e região Centro-Oeste (1,6%), e mais baixa na região Sul (0,56%). Conclusão: A análise epidemiológica das internações por meningite viral em crianças revelou uma carga significativa da doença no Brasil, corroborando o padrão epidemiológico visto na literatura. É fundamental implementar medidas de tratamento precoce para reduzir a morbidade e mortalidade associadas à meningite viral. Além disso, estratégias de educação em saúde e conscientização da população sobre os sinais e sintomas da doença são essenciais para promover a busca por atendimento médico oportuno.

Autologous cell immunotherapy using B cell maturation antigen (BCMA)-targeted chimeric antigen receptor (CAR)-T cells is an effective novel treatment for multiple myeloma (MM). This therapy has only been used for relapsed and refractory patients, at which stage the endogenous T cells used to produce the CAR-T cells are affected by the immunosuppressive nature of advanced MM and/or side effects of previous therapies. An alternative pool of “fitter” T cells is found in leukocytoapheresis products that are routinely collected to obtain hematopoietic progenitor cells for autologous stem cell transplantation (ASCT) early in the treatment of MM. However, to mobilize the progenitor cells, patients are dosed with granulocyte colony-stimulating factor (G-CSF), which is reported to adversely affect T cell proliferation, function, and differentiation. Here, we aimed to first establish whether G-CSF treatment negatively influences T cell phenotype and to ascertain whether previous exposure of T cells to G-CSF is deleterious for anti-BCMA CAR-T cells. We observed that G-CSF had a minimal impact on T cell phenotype when added in vitro or administered to patients. Moreover, we found that CAR-T cell fitness and anti-tumor activity were unaffected when generated from G-CSF-exposed T cells. Overall, we showed that ASCT apheresis products are a suitable source of T cells for anti-BCMA CAR-T cell manufacture.

Introduction: The novel SARS-CoV-2 infection has been spreading around the world since January 2020 causing the Corona Virus Disease 2019. Leukopenia, lymphopenia and hypercoagulability with elevated D- Dimers have been described in COVID-19 patients to date. This study aimed to clarify if some blood parameters can be used as biomarkers to facilitate diagnosis and establish prognosis. Methods: We selected patients who had tested positive for SARS-CoV-2 and had had a hemogram performed between the March 15 and April 15, 2020. Socio-demographic and analytical data were obtained from 274 patients at admission in two Portuguese public hospitals. We then analyzed the hemogram parameters at admission in the intensive care and collected data on patient survival during the SARS-CoV-2 disease follow-up. The data were analyzed using appropriate statistical tests. Results: Patients requiring the intensive care unit (ICU) present an increase in leukocytes and neutrophils (+3.1 × 109/L and +6.4 × 109/L, respectively), a lymphocyte decrease and a platelet rise (-1.6 × 109/L and +60.8 × 109/L, respectively). The erythrocytes, hemoglobin and median globular volume tend to decrease (-0.5 × 1012, - 1.2 g/dL; -3 fL, respectively). The lactic acid dehydrogenase (LDH) at admission was significantly higher (+58.1 U/L). The age, sex, platelets, lymphocyte count neutrophil counts, neutrophil/lymphocyte ratio, erythrocytes and cell hemoglobin concentration mean (CHCM) are independently associated with mortality (odds ratio (OR) = 0.046, p < 0.001; OR = 0.2364, p = 0.045; OR = 9.106, p = 0.001; OR = 0.194, p = 0.033; OR = 0.062, p = 0.003; OR = 0.098, p = 0.002; OR = 9.021, p < 0.001; OR = 7.016, p = 0.007, respectively). Conclusion: The hematological data at admission in the health care system can predict the mortality of the SARS-CoV-2 infection and we recommend its use in the clinical decisions and patient prognosis evaluation.

Resumen: Introducción: la prevalencia de determinadas enfermedades entre los estudiantes de Medicina (EM) parece aumentar respecto a la población en general. Sin embargo, se trata de investigaciones puntuales sin un enfoque global para un análisis de posibles causas en profundidad. Realizamos un análisis de la literatura existente que aborda las enfermedades prevalentes en los EM y su relación con posibles factores intrínsecos. Método: se ha realizado una revisión narrativa de la literatura disponible en Medline sobre el EM, incluyendo revisiones sistemáticas, metaanálisis y estudios primarios, tanto en inglés como en español de trabajos publicados entre marzo de 2016 y marzo de 2022. Las palabras clave utilizadas han sido: «ill», «sick», «morbidity», «suffering» y «students, medical», «medical student», «medical student health». Resultados: de los 567 identificados, se seleccionaron 152 (115 de psicopatología y 37 de enfermedad física). De ellos, 38 artículos cumplieron con los criterios de inclusión. Se aprecia una elevada prevalencia de síntomas depresivos (27%) y ansiosos (28-33,8%) en los EM, mayor que en la población en general de referencia. El consumo de alcohol y tabaco presenta una alta prevalencia y predominan las enfermedades físicas relacionadas con la exposición a niveles altos de estrés, como los problemas digestivos, cardiovasculares, osteomusculares y de sequedad ocular. Conclusión: la psicopatología se encuentra ampliamente estudiada, mostrando diferencias respecto a la población en general. Las enfermedades del ámbito físico más prevalentes son propias de grupos de poblaciones con altos niveles de estrés y sedentarismo. Es necesario realizar estudios contrastados con los estudiantes del ámbito universitario con niveles similares de carga lectiva y estrés. Abstract: Introduction: The prevalence of certain medical conditions appears to be increasing in medical students (MS) in relation to the general population according to studies conducted without a global focus. In-depth analysis of the existing literature is required in order to ascertain the predisposing factors in medical students for those highly prevalent medical conditions. Method: A narrative review of the literature available on Medline on MS, including systematic reviews, meta-analyses and primary studies, both in English and Spanish of papers published between March 2016 and March 2022, was conducted. The keywords used were: ''ill'', ''Sick'', ''morbidity'', ''suffering'' and ''Students, medical'', ''medical student'', ''medical student health''. Results: Of the 567 articles identified, 152 were selected (115 psychopathology and 37 physical pathology). Of these, 38 articles met the inclusion criteria. A high prevalence of depressive symptoms (27%) and anxiety (28-33.8%) was found in MS, higher than in the general reference population. Alcohol and tobacco consumption is highly prevalent and physical pathologies related to high levels of stress exposure predominate, such as digestive, cardiovascular, musculoskeletal and dry eyes. Conclusion: Psychopathology has been extensively studied, showing differences with respect to the general population. The most prevalent physical pathologies are typical of population groups with high levels of stress and sedentary lifestyles. The need is raised for studies contrasting medical students with university students in general who have similar academic loads and stress levels.

This study investigates the role of institutions on female entrepreneurial activity in Saudi Arabia, using institutional economics as the theoretical framework for developing the hypotheses. Primary data were collected and used to analyse the role that institutions play and continue to exercise in developing entrepreneurial activity among female citizens. The findings indicate that the most significant barriers to involvement in entrepreneurial activities for Saudi women are a fear of failure and intervention policies, while their perception of existing female business owners and the support they receive from their families mediates their ability to become entrepreneurs. The study also investigated female perceptions of lifting driving banning, though it showed no significant impact on their probability of becoming entrepreneurs. The results will aid policy makers and future research seeking the institutions' effect on female entrepreneurship in the Middle East and Gulf regions.

Introduction: Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread globally, becoming a long-lasting pandemic. Dengue is the most common arboviral disease in tropical and subtropical regions worldwide. COVID-19 and dengue coinfections have been reported, associated with worse outcomes with significant morbidity and mortality. Therefore, this study aims to determine the epidemiological situation of COVID-19 and dengue coinfection in Latin America. Methods: A systematic literature review was performed using PubMed, Scopus, Embase, Web of Science, LILACS, and BVS databases from January 1, 2020, to September 4, 2021. The key search terms used were ''dengue'' and ''COVID-19''. Results: Nineteen published articles were included. The studies were case reports with a detailed description of the coinfection's clinical, laboratory, diagnostic, and treatment features. Conclusion: Coinfection with SARS-CoV-2 and dengue virus is associated with worse outcomes with significant morbidity and mortality. The similar clinical and laboratory features of each infection are a challenge in accurately diagnosing and treating cases. Establishing an early diagnosis could be the answer to reducing the estimated significant burden of these conditions.

Background: The onset of the COVID-19 pandemic necessitated rapid changes to the practice of head and neck oncology in UK. There was a delay between the onset of the pandemic and the release of guidelines from cancer societies and networks, leading to a variable response of individual centres. This survey was conducted to assess the pre-Covid-19 pandemic standard of practice for head and neck oncology patients and the treatment modifications introduced during the first wave of the pandemic in UK. Methodology: The UK National Cancer Research Institute (NCRI) Head and Neck Clinical Studies Group initiated a multi-centre survey using questionnaire to investigate the effect on feeding tube practice, radiotherapy (RT) fractionation and volumes, use of chemotherapy in the neo-adjuvant, concurrent and palliative setting, the use of immunotherapy in the palliative setting, access to radiology and histopathology services, and availability of surgical procedures. Results: 30 centres were approached across UK; 23 (76.7%) centres responded and were included in the survey. There were differences in the standard practices in feeding tube policy, RT dose and fractionation as well as concurrent chemotherapy use. 21 (91%) participating centres had at least one treatment modification. 15 (65%) centres initiated a change in radical RT; changing to either a hypofractionation or acceleration schedule. For post-operative RT 10 centres (43.5%) changed to a hypofractionation schedule. 12 (52.2%) centres stopped neo-adjuvant chemotherapy for all patients; 13 (56.5%) centres followed selective omission of chemotherapy in concurrent chemo-radiotherapy patients, 17 (73.9%) centres changed first-line chemotherapy treatment to pembrolizumab (following NHS England’s interim guidance) and 8 (34.8%) centres stopped the treatment early or offered delays for patients that have been already on systemic treatment. The majority of centres did not have significant changes associated with surgery, radiology, histopathology and dental screening. Conclusion: There are variations in the standard of practice and treatment modifications for head and neck cancer patients during Covid-19 pandemic. A timely initiative is required to form a consensus on head and neck cancer management in the UK and other countries.

The current great concern about plastic pollution opens up opportunities for the production of more sustainable polymers. Inverse vulcanization has emerged as a novel procedure to obtain inorganic-organic hybrid polymeric materials. Sulfur is attained as a by-product of oil refining production and makes inverse vulcanization a sustainable process due to a large amount of sulfur without a useful life. In previous studies, vegetable oils were used as a comonomer with sulfur to form copolymers based on sustainable raw material. Nevertheless, compounds from agro-wastes, could be a third comonomer that improves new copolymers bio-applications. In this study, a new series of copolymers with castor oil as vegetable oil and sulfur was formulated by adding a third compound bearing double bonds or heteroatoms. A study was conducted to assess the antimicrobial capacity and antioxidant activity of the copolymers obtained to demonstrate the benefits of adding a new comonomer to improve their bioactivity.

Resumen: La pandemia COVID ha hecho de las consultas telemáticas una herramienta básica en la práctica diaria. El objetivo principal del estudio es valorar los resultados de la aplicación de consultas telemáticas para limitar la movilidad de los pacientes.Son objetivos operativos: proponer un plan de consultas, conocer cómo limita la asistencia a las consultas, definir qué patologías se benefician más con este plan. Material y métodos: Se propone un esquema con la creación de consultas previas a las agendadas para valorar idoneidad y posibilidad de realizarla en acto único no presencial. Resultados: Se han realizado 5.619 consultas con una falta de respuesta telefónica del 19%. El 74% de los pacientes fueron resueltos de forma virtual. Existe diferencia entre unidades, siendo más probable la respuesta telefónica para las consultas de unidad, OR = 0,60 o de traumatología general, OR = 0,67 y menos para los derivados desde urgencias.El 20% de las consultas no se acompañaban de pruebas complementarias. Las consultas de traumatología general, OR = 0,34, control postoperatorio, OR = 0,49, y unidades, OR = 0,40, cumplieron mejor este requisito. De los pacientes restantes, las consultas de traumatología general, OR = 0,50, y las derivadas a unidades, OR = 0,54 fueron las que más se resolvieron sin acudir presencialmente. Conclusiones: Se han resuelto de forma no presencial el 74% de los pacientes que atendieron a la llamada telefónica. El 20% de los pacientes acuden a la visita sin pruebas complementarias. Las consultas de seguimiento de osteosíntesis y postoperatorio de cirugía artroscópica son las que más precisan de ser realizadas de forma presencial. Abstract: The COVID pandemic has made telematic consultations a basic tool in daily practice. Aims: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. Methods: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. Results: Phone call to 5,619 patients were made with a lack of response of 19%.The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. Conclusions: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests.Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.

Objectives: The aim of this research was to address risk factors associated with death after hospitalization in intensive care units (ICUs) in 728 COVID-19 patients in Londrina, the second most populated city in the State of Paraná – Brazil, between March and December 2020. Methods: Statistical analysis, including multiple logistic regression was performed to identify risk factors associated with death in these patients. Results: The results showed that age (60 years or more, O.R. = 3.13, C.I. 95% [2.02; 4.84]), days in the ICU (11 days or more, O.R. = 1.76, C.I. 95% [1.16; 2.66]), neurological diseases (O.R. = 2.15, C.I. 95% [1.07; 4.31]), pneumopathy (O.R = 2.19, C.I. 95% [1.01; 4.82]), diabetes (O.R. = 1.55, C.I. 95% [1.03; 2.32]), and kidney disease (O.R. = 2.27, C.I. 95% [1.18; 4.70]) were associated with increased risk for death from COVID-19. Conclusion: Knowing the risk factors associated with death after ICUs hospitalization is useful for identifying the most vulnerable groups, as well as for defining vaccination priorities, considering its scarcity in many parts of the world, mainly in underdeveloped countries, including Brazil.

Background: Tropical spastic paraparesis or HTLV-associated myelopathy (TSP/HAM) may prevent, limit or restrict the performance of daily living activities, and as a consequence, several aspects of life are affected. Objective: The aim of this study was to evaluate activity limitations, risk awareness, social participation, quality of life, and pain in individuals infected with HTLV-1. Methods: This was an observational, descriptive, analytical, cross-sectional study with a quantitative approach. An interview questionnaire, the Screening of Activity Limitation and Safety Awareness (SALSA) scale, the Participation scale, a quality of life questionnaire (SF-36) and the Brief Pain Inventory were used. Results: A total of 55 patients with HTLV-1 were interviewed (62% asymptomatic and 38% symptomatic). In both groups, there was a higher frequency of patients aged 41–50 years old (35.3% asymptomatic and 38.1% symptomatic), with complete secondary education (47.1% asymptomatic and 42.9% symptomatic), and married (64.7% asymptomatic and 52.4% symptomatic). Of the symptomatic patients, 33.3% were retired; among asymptomatic patients, 20.6% performed domestic activities. The majority of patients in both groups had not received blood transfusions. Sexual intercourse was still practiced by patients. After assessment, asymptomatic patients had no activity limitations (64.7%), and symptomatic patients presented limitations (90.5%). None of the groups showed good risk awareness. There was no restriction on social participation in 97.1% of asymptomatic patients and in 52.4% among symptomatics. Both groups complained of pain, being more frequent in the lumbar spine in asymptomatic patients and in the knees in symptomatic patients. Pain was more severe in symptomatic patients and affected aspects of quality of life. Conclusion: The clinical follow-up instruments must be adopted by healthcare professionals to monitor new symptoms so as to avoid the onset of limitations identified in symptomatic patients, in addition to enabling continuous surveillance of asymptomatic patients.

Background: Bipolar smokers were more likely to develop a worse course, had more severity of depressive symptoms, as well as had experienced more childhood trauma, and had increased levels of leptin and inflammatory biomarkers Objectives: To investigate whether the co-occurrence of bipolar disorder (BD) and tobacco use disorder (TUD) was associated with severity of symptoms, childhood trauma, lower quality of life, functional impairment, alterations in the leptin levels, inflammatory biomarkers, and lipid profile, Methods: Individuals investigated were BD smokers, BD never–smokers, non-BD smokers, and non-BD never-smokers. Socio-demographic and clinical data were assessed by structured questionnaire. Other assessments used were body mass index (BMI), Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Young Mania Rating Scale, Sheehan Disability Scale, Quality of Life (WHOQOL-BREF), Childhood Trauma Questionnaire and laboratory biomarkers (leptin, high-sensitivity Creactive protein, soluble tumor necrosis factor receptor 1 and 2, and lipid profile). Results: BD smokers had significant positive correlation between leptin levels and emotional abuse, leptin and severity of depression, leptin and severity of anxiety, leptin and Castelli risk indexes 1 and 2, emotional abuse and BMI, BMI and triglycerides but a negative correlation between emotional abuse and quality of life. Conclusion: These findings suggest that bipolar smokers, whose leptin levels were increased, were linked to childhood trauma, greater severity of depressive and anxious symptoms and alterations in components of metabolism. Further studies are recommended to understand the role of leptin in the pathogenesis of bipolar smokers.

Objective: Pulmonary embolism (PE) is a common complication of SARS-CoV-2 infection. We aimed to explore the short-term outcomes among patients with acute PE and COVID-19 and to further determine and compare the performance of the different prognostic scores (PESI, sPESI, BOVA, FAST and ESC scores) for risk-stratification in this scenario. Methods: Retrospective single-centre study of 85 patients with SARS-CoV-2 infection and PE admitted to the Emergency Department (ED). The diagnostic accuracy of each above-mentioned prognostic score was calculated post hoc, and their discriminative power was evaluated through an AUC curve. Results: Among the 85 patients, all-cause death occurred within 7 days for 6 patients (7.1%) and within 30 days for 14 patients (16.5%). Despite being older and having a higher percentage of altered mental status on presentation, non-survivors patients did not differ from survivors regarding comorbidities, traditional risk factors for venous thromboembolism and signs and symptoms at the ED presentation.Each risk stratification tool had modest discriminative power for 7-day mortality (AUC range, 0.601–0.730) with slightly lower discrimination for 30-day mortality (AUC range, 0.543–0.638). The pair-wise comparison of ROC curves showed that PESI had better predictive value for short-term mortality than ESC score (z test = 3.92, p = 0.001) and sPESI (z test = 2.43, p = 0.015); there is no significant difference between PESI and BOVA score (z test = 1.05, p = 0.295) and FAST score (z test = 0.986, p = 0.324). Conclusion: The most common risk-stratification tools for PE had modest discriminative power to predict short-term mortality in patients with acute PE and COVID-19.

Fetal sex discordance is an entity that is becoming more frequent due to the expansion of the cfDNA for prenatal diagnosis. Its incidence can be estimated in 1/1500–2000 pregnancies, a frequency as high as that of some common chromosomopathies. The causes of this phenomenon are multiple and diverse, ranging from laboratory errors to important pathologies such as disorders of sexual differentiation. The management of a case of fetal sex discordance must be structured, starting with the review of the clinical history and the tests performed, and may require the performance of invasive tests to reach a diagnosis. Prevention through adequate pretest counseling and ultrasound confirmation can help to reduce its incidence.

The study of the impact of institutions on entrepreneurship has been a topic of great interest in recent years. Nevertheless, less attention has been paid to the relation that can exist between the spatial context and the entrepreneurial activities. Specifically, institutions and the space of entrepreneurial activities in a country have rarely been considered as a whole. This paper attempts to bridge the gap between these two aspects and seeks to examine the entrepreneurial activity in rural areas in comparison with urban areas based on the formal and informal institutions in an emerging economy such as Colombia. It claims that the formal institutions affect rural and urban entrepreneurs differently, examining the moderating effect of the informal institutions on this relation. Using a hierarchical logic model with panel data, 30 cities in Colombia over the period 2000–2013 are used as samples to explore the differences between rural and urban areas. It is found that the informal institutions achieve greater influence in the rural areas; these areas are favored to a greater extent by the social norms, since they are smaller territories with greater integration between citizens. However, the existence of subjective and objective insecurity affects rural entrepreneurial activity in a wider scope than urban entrepreneurial activity, decreasing the creation of new ventures. Keywords: Entrepreneurship, Formal and informal institutions, Rural areas, Urban areas

Resumen: Presentamos el caso de una mujer de 26 años con síndrome antifosfolípido primario y trombosis valvular obstructiva de prótesis mecánica en posición mitral que requirió una reintervención quirúrgica urgente. Abstract: We report a case of a 26 years old female with primary antiphospholipid syndrome and obstructive valvular thrombosis of mechanical prothesis in mitral position that required urgent surgical reintervention. Palabras clave: Síndrome antifosfolípido, Prótesis valvular cardíaca, Trombosis, Keywords: Antiphospholipid syndrome, Heart valve prosthesis, Thrombosis

Background: Evaluate comorbidities, childhood abuse, and inflammation in current heavy-smokers compared to light-smokers and never-smokers. Methods: Current-Smokers (n = 129) and never-smokers (n = 85) were screened for the use of alcohol, tobacco, and other substances, and assessed for nicotine dependence and childhood trauma. Tumor necrosis factor alpha (TNF-α) and its receptors (sTNFR1 and sTNFR2), leptin, lipid hydroperoxide, and lipid profile biomarkers were measured after overnight fasting. Results: Current-smokers presented higher prevalence of major depressive disorder (PR = 1.79, CI 95% [1.36–2.37], p

Purpose: Radiotherapy planning based only on positron emission tomography/magnetic resonance imaging (PET/MRI) lacks computed tomography (CT) information required for dose calculations. In this study, a previously developed deep learning model for creating synthetic CT (sCT) from MRI in patients with head and neck cancer was evaluated in 2 scenarios: (1) using an independent external dataset, and (2) using a local dataset after an update of the model related to scanner software-induced changes to the input MRI. Methods and Materials: Six patients from an external site and 17 patients from a local cohort were analyzed separately. Each patient underwent a CT and a PET/MRI with a Dixon MRI sequence over either one (external) or 2 (local) bed positions. For the external cohort, a previously developed deep learning model for deriving sCT from Dixon MRI was directly applied. For the local cohort, we adapted the model for an upgraded MRI acquisition using transfer learning and evaluated it in a leave-one-out process. The sCT mean absolute error for each patient was assessed. Radiotherapy dose plans based on sCT and CT were compared by assessing relevant absorbed dose differences in target volumes and organs at risk. Results: The MAEs were 78 ± 13 HU and 76 ± 12 HU for the external and local cohort, respectively. For the external cohort, absorbed dose differences in target volumes were within ± 2.3% and within ± 1% in 95% of the cases. Differences in organs at risk were

Several reports showed SARS-CoV-2 rapid antigen tests (RATs) performances among COVID-19 symptomatic subjects in outpatient settings during periods of highest incidence of infections and high rates of hospital admissions, but few data are present for asymptomatic patients. We investigated the role of RATs in an emergency department, as a novel screening tool before admission for COVID-19 asymptomatic patients. A total of 116 patients were screened on admission in a 250-bed community hospital in Morges, Switzerland. RAT detected 2/7 RT-PCR-positive patients and delivered two false-positive results. These data suggest the non-fiability of RATs screening in this clinical scenario.

Maintained gamma band activity is a key element of higher brain function, participating in perception, executive function, and memory. The pedunculopontine nucleus (PPN), as part of the reticular activating system (RAS), is a major source of the “bottom-up” flow of gamma activity to higher regions. However, interruption of gamma band activity is associated with a number of neurological and psychiatric disorders. This review will focus on the role of the PPN in activating higher regions to induce arousal and descending pathways to modulate posture and locomotion. As such, PPN deep brain stimulation (DBS) can not only help regulate arousal and stepping, but continuous application may help maintain necessary levels of gamma band activity for a host of other brain processes. We will explore the potential future applications of PPN DBS for a number of disorders that are characterized by disturbances in gamma band maintenance.

Genetically modifying autologous T cells to express an anti-CD19 chimeric antigen receptor (CAR) has shown impressive response rates for the treatment of CD19+ B cell malignancies in several clinical trials (CTs). Making this treatment available to our patients prompted us to develop a novel CART19 based on our own anti-CD19 antibody (A3B1), followed by CD8 hinge and transmembrane region, 4-1BB- and CD3z-signaling domains. We show that A3B1 CAR T cells are highly cytotoxic and specific against CD19+ cells in vitro, inducing secretion of pro-inflammatory cytokines and CAR T cell proliferation. In vivo, A3B1 CAR T cells are able to fully control disease progression in an NOD.Cg-Prkdcscid Il2rdtm1Wjl/SzJ (NSG) xenograph B-ALL mouse model. Based on the pre-clinical data, we conclude that our CART19 is clearly functional against CD19+ cells, to a level similar to other CAR19s currently being used in the clinic. Concurrently, we describe the implementation of our CAR T cell production system, using lentiviral vector and CliniMACS Prodigy, within a medium-sized academic institution. The results of the validation phase show our system is robust and reproducible, while maintaining a low cost that is affordable for academic institutions. Our model can serve as a paradigm for similar institutions, and it may help to make CAR T cell treatment available to all patients. Keywords: chimeric antigen receptor, CD19, leukemia, lymphoma, immunotherapy, 4-1BB, T cell, preclinical studies

Resumen: Objetivo: Identificar la integración de la medicina alternativa como asignatura base en la oferta académica de grado o posgrado de las carreras de Medicina y Enfermería de las universidades públicas y privadas de Perú. Diseño: Estudio documental, descriptivo, transversal. Participantes: Un total de 62 universidades peruanas entre instituciones públicas y privadas que ofertan la carrera de Medicina o Enfermería. Metodología: Se realizó una revisión completa de las mallas curriculares de las carreras de Medicina y Enfermería de las universidades peruanas, basada en la oferta académica general de grado y posgrado. Resultados: A nivel de grado, el 34% de las universidades incluyen la Medicina Alternativa como asignatura en la carrera de Medicina y el 46% en la carrera de Enfermería. Con relación al posgrado, solo el 5% de las universidades peruanas ofertan programas de cuarto nivel en esta área. Conclusiones: Existe deficiente oferta académica a nivel de grado y de posgrado relacionada con la medicina alternativa en las universidades peruanas. Abstract: Objective: To identify the integration of alternative medicine as a basic subject in undergraduate and graduate programs of the medical and nursing degrees of the public and private Peruvian universities. Design: A documental, cross-sectional descriptive study was conducted with 61 Peruvian public and private universities that offer a degree in Medicine and Nursing. Methodology: A complete review was carried out on the curriculum in the schools of Medicine and Nursing in Peruvian universities, depending on the undergraduate and graduates courses offered. Results: In undergraduate programs, 16% of universities included the subject called Alternative Medicine as part of the medical degree and 40% as part of Nursing degree, compared to posgraduate programs where only 3% of Peruvian universities offer a fourth level course in this area. Conclusions: There is a lack of academic offer in undergraduate and graduate programs related to alternative medicine in Peruvian universities. Palabras clave: Educación, Curriculum, Medicina alternativa, Universidades, Keywords: Curriculum, Education, Complementary therapies, Universities

The Pantanal is the most conserved biome in Brazil and among the last wild refuges in South America, but intensification of agriculture and other land use changes present challenges for protecting this exceptionally biodiverse wetland ecosystem. Recent studies have shed new light on the origins and biogeochemistry of a suite of >600 small saline-alkaline lakes in Nhecolândia, a floodplain setting located south of the Taquari River in south-central Pantanal. These soda lakes form a unique aquatic environment in Pantanal and nascent research on their geomicrobiology suggests that their biota may be analogous to early life, and extreme life in Earth's deep biosphere. We argue that the conservation of the soda lakes in the lower Nhecolândia region should be an important strategic component of any conservation plan that aims to mitigate the advance of unsustainable land-use change in the Pantanal. Soda lake conservation has important implications for the carbon cycle, as these landforms sequester carbon dioxide and transmit considerably lower concentrations of methane in comparison to macrophyte-rich freshwater lakes in the region. Further, minerals precipitated in the saline-alkaline lakes are leveraged for cattle consumption, and therefore the continued presence of the lakes is critical for allowing pantaneiro ranchers to pursue certified organic, sustainable beef production systems. Beyond protecting soda lakes and their surrounding forests (mata de cordilheiras) for food systems security, the conservation strategy would also allow further research of little studied extremophile biodiversity and biogeochemistry, with potential for biotechnological innovations attendant to UN Sustainable Development Goals.

Background: Since the first report by Perry et al. (1955), most studies affirmed the hypertensive effects of cadmium (Cd) in humans. Nonetheless, conclusions between studies remain inconsistent. Objective: The aim of this study was to reevaluate the evidence for a potential relationship between Cd exposure and altered blood pressure and/or hypertension, focusing on studies published between January 2010 and March 2020. Methods: We reviewed all observational studies from database searches (PubMed and SCOPUS) on Cd exposure and blood pressure or hypertension. We extracted information from studies that provided sufficient data on population characteristics, smoking status, exposure, outcomes, and design. Results: Thirty-eight studies met our inclusion criteria; of those, twenty-nine were cross sectional, three case control, five cohort and one interventional study. Blood or urinary Cd levels were the most commonly used biomarkers. Conclusions: A positive association between blood Cd levels and blood pressure and/or hypertension was identified in numerous studies at different settings. Limited number of representative population-based studies of never-smokers was observed, which may have confounded our conclusions. The association between urinary Cd and blood pressure and/or hypertension remains uncertain due to conflicting results, including inverse relationships with lack of strong mechanistic support. We point to the urgent need for additional longitudinal studies to confirm our findings.

Background: During the COVID-19 outbreak, healthcare Authorities of Lombardy modified the regional network concerning time-dependent emergencies. Specifically, 13 Macro-Hubs were identified to deliver timely optimal care to patients with acute coronary syndromes (ACS). Aim of this paper is to present the results of this experience. Methods and Results: This is a multicenter, observational study. A total of 953 patients were included, presenting with STEMI in 57.7% of the cases. About 98% of patients received coronary angiography with a median since first medical contact to angiography of 79 (IQR 45–124) minutes for STEMI and 1262 (IQR 643–2481) minutes for NSTEMI.A total of 107 patients (11.2%) had SARS-CoV2 infection, mostly with STEMI (74.8%). The time interval from first medical contact to cath-lab was significant shorter in patients with COVID-19, both in the overall population and in STEMI patients (87 (IQR 41–310) versus 160 (IQR 67–1220) minutes, P = 0.001, and 61 (IQR 23–98) versus 80 (IQR 47–126) minutes, P = 0.01, respectively). In-hospital mortality and cardiogenic shock rates were higher among patients with COVID-19 compared to patients without (32% vs 6%, P

Blastocystis has been reported as the most common eukaryotic microorganism residing in the intestines of both humans and animals, with a prevalence of up to 100% in some populations. Since this is a cryptic species, sequence polymorphism are the single strategy to analyses its genetic diversity, being traditionally used the analysis of ssu rRNA gene sequence to determine alleles and subtypes (STs) for this species. This multicopy gene has shown high diversity among different STs, making necessary to explore other genes to assess intraspecific diversity. This study evaluated the use of a novel genetic marker, succinate dehydrogenase (SDHA), for the typing and evaluation of the genetic diversity and genetic population structure of Blastocystis. In total, 375 human fecal samples were collected and subjected to PCR, subtyped using the ssu rRNA marker, and then the SDHA gene was amplified via PCR for 117 samples. We found some incongruences between tree topologies for both molecular markers. However, the clustering by ST previously established for Blastocystis was congruent in the concatenated sequence. SDHA showed lower reticulation (The origination of a lineage through the partial merging of two ancestor lineages) signals and better intra ST clustering ability. Clusters with geographical associations were observed intra ST. The genetic diversity was lower in the marker evaluated compared to that of the ssu rRNA gene (nucleotide diversity = 0.03344 and 0.16986, respectively) and the sequences analyzed showed population expansion with genetic differentiation principally among STs. The ssu rRNA gene was useful to explore interspecific diversity but together with the SDHA gene the resolution power to evaluate intra ST diversity was higher. These results showed the potential of the SDHA marker for studying the intra ST genetic diversity of Blastocystis related with geographical location and the inter ST diversity using the concatenated sequences.

The bed nucleus of the stria terminalis (BNST) is emerging as a critical region in multiple psychiatric disorders including anxiety, PTSD, and alcohol and substance use disorders. In conjunction with growing knowledge of the BNST, an increasing number of studies examine connections of the BNST and how those connections impact BNST function. The importance of this BNST network is highlighted by rodent studies demonstrating that projections from other brain regions regulate BNST activity and influence BNST-related behavior. While many animal and human studies replicate the components of the BNST network, to date, structural connections between the BNST and insula have only been described in rodents and have yet to be shown in humans. In this study, we used probabilistic tractography to examine BNST-insula structural connectivity in humans. We used two methods of dividing the insula: 1) anterior and posterior insula, to be consistent with much of the existing insula literature; and 2) eight subregions that represent informative cytoarchitectural divisions. We found evidence of a BNST-insula structural connection in humans, with the strongest BNST connectivity localized to the anteroventral insula, a region of agranular cortex. BNST-insula connectivity differed by hemisphere and was moderated by sex. These results translate rodent findings to humans and lay an important foundation for future studies examining the role of BNST-insula pathways in psychiatric disorders.

The necessity to create national to global-scale biodiversity monitoring systems as part of assessing progress toward biodiversity agendas presents a challenge for signatory countries. This is a brief review of ongoing Brazilian national initiatives that would allow the construction of a general biomonitoring network scheme in protected areas; with additional focus on linking independent monitoring schemes. We discuss some key aspects needed to include monitoring schemes under a single framework that will lead to better evaluation of pressure–state–response indicators for managing biodiversity at several scales; and we point out the potential of embracing citizen science and participatory monitoring to quantify some aspects within those schemes.

Aim: To examine clinical and biomarkers in depressed female smokers, in order to better clarify the process that link mood disorders, childhood trauma and smoking in women. Methods: The clinical sample comprised women with unipolar or bipolar depression, divided into subgroups of smokers and never-smoker. The control groups comprised two subgroups non-depressed women, separated into smokers and never-smokers. A structured questionnaire was used to assess socio-demographic and clinical data. The following scales were used: 17-item version Hamilton Depression Rating Scale, Hamilton Anxiety Rating scale (HAM-A), Sheehan disability scale, the Child Trauma Questionnaire. The following biomarkers were investigated: lipid profile, including total cholesterol, high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol, triglycerides the Castelli's Risk indexes I and II; and cytokines, including interleukins (IL)-1β, IL-6, IL-10, IL-12, soluble tumor necrosis factor receptor 1 (sTNF-R1). Results: Depressed female smokers showed a number of significant positive correlations: emotional neglect and sTNF-R1 (p = 0.02); waist circumference and sTNF-R1 (p = 0.001); body mass index and sTNF-R1 (p

Previous studies in psychosis patients have shown hippocampal volume deficits across anterior and posterior regions or across subfields, but subfield specific changes in volume along the hippocampal long axis have not been examined. Here, we tested the hypothesis that volume changes exist across the hippocampus in chronic psychosis but only the anterior CA region is affected in early psychosis patients. We analyzed structural MRI data from 179 patients with a non-affective psychotic disorder (94 chronic psychosis; 85 early psychosis) and 167 heathy individuals demographically matched to the chronic and early psychosis samples respectively (82 matched to chronic patients; 85 matched to early patients). We measured hippocampal volumes using Freesurfer 6-derived automated segmentation of both anterior and posterior regions and the CA, dentate gyrus, and subiculum subfields. We found a hippocampal volume deficit in both anterior and posterior regions in chronic psychosis, but this deficit was limited to the anterior hippocampus in early psychosis patients. This volume change was more pronounced in the anterior CA subfield of early psychosis patients than in the dentate gyrus or subiculum. Our findings support existing models of psychosis implicating initial CA dysfunction with later progression to other hippocampal regions and suggest that the anterior hippocampus may be an important target for early interventions. Keywords: Schizophrenia, Hippocampus, First episode psychosis, Volume, Subfields.

Summary: The most prominent developmental function attributed to the extracellular matrix (ECM) is cell migration. While cells in culture can produce ECM to migrate, the role of ECM in regulating developmental cell migration is classically viewed as an exogenous matrix presented to the moving cells. In contrast to this view, we show here that Drosophila embryonic hemocytes deposit their own laminins in streak-like structures to migrate efficiently throughout the embryo. With the help of transplantation experiments, live microscopy, and image quantification, we demonstrate that autocrine-produced laminin regulates hemocyte migration by controlling lamellipodia dynamics, stability, and persistence. Proper laminin deposition is regulated by the RabGTPase Rab8, which is highly expressed and required in hemocytes for lamellipodia dynamics and migration. Our results thus support a model in which, during embryogenesis, the Rab8-regulated autocrine deposition of laminin reinforces directional and effective migration by stabilizing cellular protrusions and strengthening otherwise transient adhesion states. : The role of ECM in regulating developmental cell migration is classically viewed as an exogenous matrix presented to moving cells. In contrast, using the fruit fly, Sánchez-Sánchez et al. show that Drosophila embryonic hemocytes use autocrine-produced laminins to regulate lamellipodia stability, dynamics, and persistence, thus reinforcing directional migration. Keywords: cell migration, laminins, hemocytes, Drosophila, lamellipodia dynamics, extracellular matrix