Search

Abstract The ‘shark-fin’ ECG-sign is a rare electrocardiographic pattern seen in ACS, typically associated with poor prognosis. However, its manifestation in acute aortic syndromes remains largely unexplored. Here, we present a case of a patient diagnosed with Ascending Aortic Dissection, who presented to ED with acute chest pain and shark-fin ECG-pattern.

Abstract More than half of the world’s rivers dry up periodically, but our understanding of the biological communities in dry riverbeds remains limited. Specifically, the roles of dispersal, environmental filtering and biotic interactions in driving biodiversity in dry rivers are poorly understood. Here, we conduct a large-scale coordinated survey of patterns and drivers of biodiversity in dry riverbeds. We focus on eight major taxa, including microorganisms, invertebrates and plants: Algae, Archaea, Bacteria, Fungi, Protozoa, Arthropods, Nematodes and Streptophyta. We use environmental DNA metabarcoding to assess biodiversity in dry sediments collected over a 1-year period from 84 non-perennial rivers across 19 countries on four continents. Both direct factors, such as nutrient and carbon availability, and indirect factors such as climate influence the local biodiversity of most taxa. Limited resource availability and prolonged dry phases favor oligotrophic microbial taxa. Co-variation among taxa, particularly Bacteria, Fungi, Algae and Protozoa, explain more spatial variation in community composition than dispersal or environmental gradients. This finding suggests that biotic interactions or unmeasured ecological and evolutionary factors may strongly influence communities during dry phases, altering biodiversity responses to global changes.

Freshwater crayfish are amongst the largest macroinvertebrates and play a keystone role in the ecosystems they occupy. Understanding the global distribution of these animals is often hindered due to a paucity of distributional data. Additionally, non-native crayfish introductions are becoming more frequent, which can cause severe environmental and economic impacts. Management decisions related to crayfish and their habitats require accurate, up-to-date distribution data and mapping tools. Such data are currently patchily distributed with limited accessibility and are rarely up-to-date. To address these challenges, we developed a versatile e-portal to host distributional data of freshwater crayfish and their pathogens (using Aphanomyces astaci, the causative agent of the crayfish plague, as the most prominent example). Populated with expert data and operating in near real-time, World of Crayfish™ is a living, publicly available database providing worldwide distributional data sourced by experts in the field. The database offers open access to the data through specialized standard geospatial services (Web Map Service, Web Feature Service) enabling users to view, embed, and download customizable outputs for various applications. The platform is designed to support technical enhancements in the future, with the potential to eventually incorporate various additional features. This tool serves as a step forward towards a modern era of conservation planning and management of freshwater biodiversity.

Objetivos: Conhecer o perfil dos profissionais capacitados no processo de doação de órgãos sólidos, analisar o resultado de sua aprendizagem antes e após o curso, e correlacionar perfil e atuação do profissional com sua aprendizagem e indicação do curso. Métodos: Estudo retroprospectivo, quantitativo, analítico-descritivo com participantes do curso Processo de Doação de Órgãos Sólidos para Profissionais de Saúde. Utilizaram-se questionários online sobre perfil profissional, atuação na área de doação de órgãos, avaliação de conhecimento e indicação do curso. As análises e correlações foram verificadas com os testes de McNemar, postos de Spearman e ponto-bisserial. Resultados: Dos 130 profissionais, 62% eram enfermeiros, 38% médicos, 35% emergencistas, 26% intensivistas e 42% tinham mais de 10 anos de formação. Para o perfil de atuação na área de doação de órgãos, os profissionais relataram ter participado em até cinco casos em cada uma das seguintes etapas: 44% no protocolo de morte encefálica, 56% na entrevista familiar e 60% no processo de doação de órgãos. A taxa de retenção de conhecimento da turma foi de 26,7%, sendo a dos médicos 29,5% e a dos enfermeiros 24,8%. A indicação do curso foi avaliada seguindo o indicador Net Promoter Score (NPS), estando na zona de promotores. A correlação entre os grupos foi positiva e estatisticamente significante para os atuantes na emergência, com mais de 5 anos de formação e com mais de cinco casos relatados sobre as etapas questionadas na doação de órgãos. Não foi identificada correlação significativa dessas variáveis sobre a indicação do curso. Conclusão: O curso contribuiu para a aprendizagem dos profissionais com maior tempo de formação, maior experiência prévia nas etapas do processo de doação de órgãos e atuantes no setor de emergência.

ABSTRACT This case series describes four patients who presented with retinal and optic nerve vascular occlusions after administration of different COVID-19 vaccines. The first patient received the ChAdOx1 nCoV-19 vaccine (AZD1222; Oxford/AstraZeneca) and 42 days later developed central retinal artery occlusion. The second patient developed a painless visual impairment in the left eye and was diagnosed with anterior ischemic optic neuropathy 6 days after receiving the Sinovac-CoronaVac vaccine. The third patient presented with the same condition 22 days after receiving the third dose of the COVID-19 Pfizer (Comirnaty®) vaccine. The fourth patient developed bilateral retrobulbar optic neuritis after receiving the Oxford/AstraZeneca vaccine. The purpose of this case series is to discuss the possibility of a causal association between ischemic eye alterations and COVID-19 virus vaccination. Long-term follow-up and evaluation of similar cases will help elucidate the degree of the association between the vaccine and ischemic ocular events.

Aquatic ecosystems are particularly vulnerable to the introduction of non-indigenous species (NIS), leading to multi-faceted ecological, economic and health impacts worldwide. The Iberian Peninsula comprises an exceptionally biodiverse Mediterranean region with a high number of threatened and endemic aquatic species, most of them strongly impacted by biological invasions. Following a structured approach that combines a systematic review of available information and expert opinion, we provide a comprehensive and updated multi-taxa inventory of aquatic NIS (fungi, macroalgae, vascular plants, invertebrates and vertebrates) in Iberian inland waters. Moreover, we assess overall patterns in the establishment status, introduction pathways, native range and temporal introduction trends of listed NIS. In addition, we discuss the legal coverage provided by both national (Spanish and Portuguese) and European NIS regulations. We inventoried 326 aquatic NIS in Iberian inland waters, including 215 established, 96 with uncertain establishment status and 15 cryptogenic taxa. Invertebrates (54.6%) and vertebrates (24.5%) were the groups with the highest number of NIS, with Arthropoda, Mollusca, and Chordata being the most represented phyla. Recorded NIS originated from diverse geographic regions, with North and South America being the most frequent. Vertebrates and vascular plants were mostly introduced through intentional pathways (i.e. release and escape), whereas invertebrates and macroalgae arrived mostly through unintentional ways (i.e. contaminant or stowaway). Most of the recorded NIS were introduced in Iberian inland waters over the second half of the 20th century, with a high number of NIS introductions being reported in the 2000s. While only 8% of the recorded NIS appear in the European Union list of Invasive Alien Species of Union concern, around 25% are listed in the Spanish and Portuguese NIS regulations. This study provides the most updated checklist of Iberian aquatic NIS, meeting the requirements set by the EU regulation and providing a baseline for the evaluation of its application. We point out the need for coordinated transnational strategies to properly tackle aquatic invasions across borders of the EU members.

Introduction: Three tiny bones compose the human ossicular chain: malleus, incus and stapes. Also known as auditory ossicles, they are united by joints in the middle ear cavity of the petrous part of the temporal bone. Completely developed two years after birth, the ossicular chain is involved in the physiological process of hearing, by which sound waves from the environment are converted into electrochemical impulses. In the last 500 years, most studies have focused on the morphogenesis, morphological variability and clinical pathology of the ossicular chain, whilst only a few studies have added relevant knowledge to anthropology and forensic science. The auditory ossicles and the enclosing petrous bone are some of the hardest in the human skeleton. This is reflected in a relative resistance to fire and in the possibility of preservation and fossilization in millions of years. Materials and Methods: The literature and four present-day forensic cases were included in studying the postmortem loss of the auditory ossicles in skeletal or decomposing remains. Results indicate that it can be ascribed to their destruction or physical displacement, by either macro-micro-faunal action and/or any other natural or artificial disturbance. Discussion: Physical displacement is closely connected to the depositional environment of the skeletal remains, such as burial, entombment (sarcophagus, coffin, vault…), submersion or exposure to natural elements. Auditory ossicles can be recovered in situ, or very close to their anatomical location, when the skeletal material has been involved in an archaeological excavation. In the case of accessible or disturbed remains, scavengers may remove the tiny ossicles and/or they can slip out of the middle ear cavity following skull movements. Entombment offers effective protection against the displacement of the auditory ossicles, whereas aquatic submersion and aquatic movement almost invariably displace them. Conclusion: the preservation of the human auditory ossicles should be critically considered in the comprehensive context of any forensic investigation on human remains since it can assist the reconstruction of their taphonomic history. Taphonomic histories of remains can add crucial information to forensic investigations (e.g., the Post Mortem Interval, PMI). The aim of this study, limited by scarce relevant literature, is to discuss the potential role of the ossicular chain, detected by postmortem imaging techniques, as a taphonomical indicator in decomposing and/or skeletonized bodies.

The deposition, residence time, and dissolution profile of nasal suspensions containing corticosteroids play a key role in their in vivo efficacy after administration. However, the conventional methods available to characterize nasal products appear to be unsuitable to exhaustively cover these aspects. The work aims to investigate technological aspects of Ryaltris (mometasone furoate and olopatadine hydrochloride nasal spray) compared to other commercial anti-allergic nasal products, namely, Dymista (azelastine hydrochloride and fluticasone propionate), Nasonex (mometasone furoate), and Avamys (fluticasone furoate). Innovative characterization methods were combined with more traditional approaches to investigate the anti-allergic nasal sprays. These methods applied together allowed to differentiate between the different products and provided a clear picture of the nasal product behavior in terms of drug dissolution and deposition. In particular, the dissolution tests were performed exploiting the Respicell® apparatus, an innovative technique that allows for the investigation of inhalation products. Then, formulation viscosities were considered along with a formulation flow test on an inclined plane. Finally, the intranasal deposition profile of the commercial formulations was determined using a silicon nasal cast. The results highlight in vitro significant differences in terms of viscosity as well as dissolution rate of the nasal products, with Ryaltris showing a higher viscosity and lower flow compared to other products, which, along with a corticosteroid faster dissolution rate than Dymista, suggest a potential advantage in terms of clinical behavior.

Forensic entomology is primarily focused on using carrion blow flies and beetles (Diptera and Coleoptera) to estimate the time since death. However, insect artefacts, such as footprints, defecations, regurgitations, and splatters are also considered within the disciplines of bloodstain pattern analysis (BPA), and ants (Hymenoptera: Formicidae) have been studied in forensic pathology for their potential to alter bodies. Although ant activity has been mostly reported as “dry marks” (abrasions) on decomposing bodies, their colonisation of congested or hypostatic anatomical regions can produce alterations that mimic active or recent haemorrhages. Therefore, if a body exhibits external haemorrhage/s without any apparent origin, artefacts caused by insects, such as ants, should be considered. This study describes ten cases of post-mortem ant activity observed in the Andaman and Nicobar Islands (India), and analyses the resulting external haemorrhagic artefacts, which exhibit different patterns of morphology, distribution, and location. The study proposes a classification system to aid in identifying bloodstain patterns caused by ant activity, assisting in determining the mechanism/s of the lesions, the original position of the body, and any subsequent interactions with the surrounding environment. Ultimately, this classification can improve the accuracy of reconstructing the events that occurred during the early post-mortem period, as well as the circumstances surrounding death.

BackgroundUlcus Vulvae Acutum Lipschütz (UVAL) is a largely unknown disease with a broad and complex differential diagnosis.ObjectivesTo provide a description of the main characteristics of UVAL, determine the most appropriate diagnostic process and describe the current therapeutic approach.MethodsWe designed a retrospective, descriptive cohort study using the gynecological-ER database of our institution. Inclusion criteria: female patients aged between 10 and 20 years old with suspicion of a UVAL diagnosis at CHUV's gynecological ER. Data extraction: epidemiological characteristics, clinical presentation, laboratory tests, established diagnostics, treatment, and ulcer outcomes.Results15 patients were included for the analysis; average age: 15 years old; 60% of patients were virgo at the time of ulcer onset; all patients had at least one flu-like symptom concomitant with the vulvar lesion; the most-performed serology was for EBV and acute disease was present in only one patient; for diagnostic purposes two biopsies were performed with both inconclusive histopathology analysis; the main prescribed treatments were: oral NSAIDs, Paracetamol, and Lidocaine gel; 93% of cases presented signs of regression; the average follow-up time was 10 days. The diagnostic algorithm of Sadoghi et al: 10 out of 15 cases were retrospectively diagnosed with UVAL by the algorithm; half were diagnosed with UVAL, and the other half received a diagnosis of “ulcers of unknown origin” at the time of the gynecological ER visit.ConclusionsWe highly recommend the diagnostic and therapeutic algorithms developed by Sadoghi et al. as valuable tools to guide clinical reasoning and, consequently, improve acute vulvar ulcers management.

Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is a rare form of uterine mesenchymal neoplasm. Although UTROSCT generally exhibits benign behavior with a favorable prognosis, this neoplasm is nevertheless classified as being of uncertain malignant potential, given its low rate of recurrence and the fact that it rarely produces metastases (e.g., in the lymph nodes, epiploic appendix, omentum, small bowel, subcutaneous tissue, lungs). Its histogenesis is also uncertain. Typically, UTROSCT occurs in peri-menopausal or menopausal women, but it can sometimes be observed in young women. Usually, this neoplasm can be found in the uterine corpus as a nodular intramural lesion, while it is less frequently submucosal, subserosal, or polypoid/intracavitary. UTROSCT can cause abnormal bleeding, pelvic pain, enlarged uterus, and mass sensation, but sometimes it is found purely by chance. This neoplasm can be considered polyphenotypic on morphological, immunohistochemical, and genetic analyses. Generally, upon microscopic examination, UTROSCT shows a predominant pattern of the cords, nests, and trabeculae typical of sex-cord tumors of the ovary, while immunohistochemically it is characterized by a coexpression of epithelial, smooth muscle, and sex-cord markers. The aim of this review is to report clinical and pathological data and genetic alterations to establish their impact on the prognosis and management of patients affected by this rare entity.

Category: Midfoot/Forefoot; Diabetes Introduction/Purpose: Charcot arthropathy is a neurotraumatic foot disorder seen in patients with peripheral neuropathy. Surgical reconstruction via medial column arthrodesis with beams can restore plantigrade foot anatomy with decreased soft tissue dissection and improved bony compression. Methods: We identified 12 patients with midfoot (n=7) or hindfoot (n=5) Charcot who underwent medial column beaming arthrodesis between 2015 and 2021 b y one of two fellowship-trained foot and ankle surgeons at an academic medical center. Data collected from patient charts included demographics, medical history, complications, and reoperation rate. Meary’s angle was measured on lateral weightbearing radiographs preoperatively and up to two years postoperatively. Mean follow-up time was 2.50 (range, 1.04-6.98) years. Statistical analysis included correlation, two-tailed Student t-test, and Chi-squared test. Results: Meary’s angle was recorded preoperatively for 12 patients (19.3° ± 6.7°) and postoperatively at three months for 12 patients (4.0° ± 6.7°), at six months for 12 patients (7.1° ± 9.7°), at one year for 11 patients (6.1° ± 9.4°), and at two years for five patients (10.2° ± 6.4°). However, two (16.7%) patients showed a loss of deformity correction, which was demonstrated by a Meary’s angle that was greater at final follow-up than preoperatively. Overall complication, infection, reoperation rates were 50.0%, 41.7%, and 58.3%, respectively. Finally, dependent on preoperative ulceration, those with and without an ulcer did not differ in Meary’s angle at any time point, overall complication, infection, nor reoperation rate. Conclusion: Although the results showed a relatively high complication rate, the use of beaming arthrodesis was generally able to maintain a plantigrade foot and overall alignment, while decreasing the recurrence of plantar ulceration.

Este artigo emerge da atualidade da opinião “vagabundo não tem memória” e tem como objetivo analisar a produção de corpos matáveis no âmbito das práticas de segurança brasileiras. Desde a psicologia social pós-estruturalista, aproximamos os pensamentos de Michel Foucault e Walter Benjamin para produzir nossa ferramenta metodológica, bem como as ferramentas conceituais de Giorgio Agamben para compor o campo analítico sobre a matabilidade dos corpos no âmbito das práticas de segurança. As narrativas urbanas da violência movimentam as cenas com as quais nos acostumamos nos conduzimos cotidianamente. Aprendemos a conduzir nossas condutas diante do fato de que a polícia serve para proteger, mas ela mata e também é a que mais morre. Esse complexo campo da segurança pública coloca em jogo corpos matáveis e dá visibilidade a uma instituição (a polícia) cuja história de constituição e modo de operação visibilizam o racismo estrutural e a branquitude que organizam o Estado brasileiro, mesmo diante de mudanças formais na legislação referente às políticas públicas de segurança. Neste texto, analisamos a produção de corpos matáveis no âmbito das práticas de segurança a partir da problematização racial, especialmente pelo modo como a branquitude alimenta a vontade de matar que constitui as práticas de segurança brasileiras.

Since the 1940s, when maritime archaeology was established, the systematic excavation of submerged wrecks began to be refined. Systematic excavations led to the recovery of a vast array of organic and inorganic artefacts, including human and non-human bones and teeth. In order to preserve the materials recovered from the sea, the discipline of maritime conservation rapidly expanded and dealt with unique issues, including, but not limited to, marine salts’ encrustation of archaeological artefacts. Bone and teeth are organic artefacts which provide crucial information about natural and social environments of the past. When recovered from marine settings, they are often friable and require conservation processes and consolidation treatments, e.g., to prevent shrinkage during drying. However, conservation processes and consolidants can interfere with pathological, traumatic and taphonomical evidence associated with bone and teeth, and can bias sample preparation and analysis through mechanical action and chemical composition. The aim of this paper, in which a few examples of interference are listed, is to highlight the need of accurately documenting any type of conservation process and/or consolidation treatment that has been performed on bone and teeth stored in archaeological collections. This becomes essential when samples are selected for study, especially if this includes destructive analysis, and will assist in clarifying any conflicting results, leading to reliable interpretations.

Archaeoentomology is the study of insects and other arthropods recovered from an archaeological site; they can be found in association with ancient human and animal remains, food, artefacts or they can be related to the environment and its changes throughout the time. Within archaeoentomology, the branch of “funerary archeoentomology” considers insects and other arthropods especially in association with human remains in funerary and burial contexts. The presence and the location of certain insect species closely associated with or nearby the remains, can be valuable in gathering information about the ecological situation at the time of burial and the changes that occurred in the environment up until the discovery of the body. Funerary archaeoentomology investigations have been carried out globally, primarily in countries like Italy, Peru, the United Kingdom and France. Similarly to forensic entomology contexts, the abundance and diversity of insects are affected by the type of burial, the macro and micro-environment of and surrounding the burial, the items associated with the cadaver, the post-mortem practices, and the time that has elapsed from the body deposition to the discovery and the excavation. While funerary archaeoentomology and forensic entomology remain two well-distinguished disciplines, the sampling practice, the insect identification process, and the analyses of the burial ecology in funerary archaeoentomology studies follow the best practices and the general guidelines of forensic entomology. In both disciplines, the correct identification of the insects is key to providing correct information. Various methods have proven effective for insect identification, i.e., morphological, molecular and chemical analysis. This review aims to collect the current knowledge in funerary archaeoentomology, discuss the strengths and weaknesses of insect identification methods in an archaeological context, and describe the groups of the most relevant insects and other arthropods found in association with ancient human remains worldwide. Furthermore, recommendations will be provided to advance the practices of archaeoentomology examinations.