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Febrile ulceronecrotic Mucha-Habermann disease is a rare and severe variant of pityriasis lichenoides, characterized by sudden onset of generalized ulceronecrotic papules that rapidly coalesce into ulcers associated with high fever. Systemic manifestations such as intravascular disseminated coagulation and pulmonary, cardiac, gastrointestinal, and central nervous system involvement are common. Treatment is based on oral corticosteroids, immunosuppressive drugs such as methotrexate, and general supportive treatment. The present case describes a stepwise approach to a patient with Mucha-Habermann disease with insufficient response to methotrexate.

This article presents an Eulerian physical and biogeochemical dataset from the Iberian Margin Cape St. Vincent Ocean observatory (IbMa-CSV), a facility of the European Multidisciplinary Seafloor and water column Observatory European Research Infrastructure Consortium (EMSO-ERIC), located 10 nautical miles south of Cape St. Vincent (Portugal), the southwest tip of the Iberian Peninsula and western limit of the northern margin of the Gulf of Cádiz (GoC). The observatory was installed on the shelf break, and the data time series spans 4 months for most of the variables. The upper 150 m were sampled intensively with a wave-powered vertical profiler at an average rate of 4.5 profiles per hour recording at 2 Hz when ascending at an approximate velocity of 0.2 m s−1 and 10 Hz when descending at a variable velocity. The vertical resolution was always higher than 0.2 m. Measured channels were conductivity, temperature, pressure, chlorophyll a, dissolved O2 concentration, and turbidity. Derived channels are sea pressure, depth, salinity, speed of sound, specific conductivity, dissolved O2 saturation, density anomaly, spiciness, and Brunt–Väisälä frequency. The acquired dataset includes the flow velocity and direction along the water column, taken from an upward-looking 300 kHz acoustic Doppler current profiler (ADCP) recorded every hour for 3 m depth bins extending the same depth range of the vertical profiler. A standard quality-control scheme was applied to the dataset. The dataset is preserved for multiple use and is accessible in the Sea Open Scientific Data Publication (SEANOE) repository via the following address: https://doi.org/10.17882/94769 (Rautenbach et al., 2022).

Introdução: A Tuberculose (TB) é uma infecção crônica causada por micobactérias, sendo o M. tuberculosis a principal espécie. Cerca de 1,7 bilhões de pessoas vivem com TB no mundo. A evolução é insidiosa, com formas e sintomas variáveis, a depender dos órgãos afetados e se há imunossupressão. Este relato destaca o quadro clínico de paciente transplantado (TX) renal, diagnosticado com TB disseminada que evolui de forma complexa e paradoxal durante tratamento. Objetivo: Detalhar caso clínico atípico; Destacar apresentações da TB e correlacioná-las com a imunossupressão; Discutir individualizações de tratamento; Discorrer sobre a Síndrome de Reconstituição Imune (SRI). Método: Relato de caso realizado na CSSM. Aplicação de TCLE, revisão de prontuário médico, definição do cronograma, compilados exames de imagens e laboratoriais. Discussão de dados baseada em revisão de literatura nacional e internacional. Resultados: M.P.A., homem, 31 anos, TX renal em 2021, imunossuprimido, evolui em Jul/2023 com nódulo cervical à esquerda, febre e disfagia há 1 mês. É internado para investigação, sendo diagnosticada TB disseminada (pulmonar, laríngea e ganglionar), iniciado tratamento com RHZE com boa adesão, e reduzida a imunossupressão. Após 1 mês, é reinternado por surgimento de febre e flogismo cervical. Pela suspeita de abscesso cervical bacteriano, é iniciada antibioticoterapia empírica. A cultura de material pós-punção resultou positiva para Staphylococcus haemolyticus, com descalonamento de antimicrobianos. A TC de tórax demonstrou padrão miliar. Evolui com melhora apenas parcial de sintomas, com suspeitas de TB resistente, novas infecções bacterianas e/ou micoses. Não houve indícios destas hipóteses em exames investigativos, mantendo-se a TB como etiologia primária do quadro e responsabilizando a imunossupressão pela evolução não linear. O paciente manteve boa adesão ao RHZE, sem falhas, com extensão da fase inicial para 4 meses. Apresenta nova piora sintomática paradoxal após nova redução de imunossupressores. Cogitada SRI, com melhora de sintomas após aumento de corticoterapia. Em Nov/2023, recebe alta hospitalar com melhora clínica sustentada. Conclusão: A TB engloba tratamento prolongado, sequelas orgânicas, estigmas sociais e reduz qualidade de vida. O caso descrito correlaciona a TB disseminada com a imunossupressão. A evolução lenta/paradoxal, ajustes em imunossupressores e a individualização do tratamento evidenciam as especificidades do caso, com manejo desafiador e necessitando de abordagem multidisciplinar.

Considerada como a família de maior importância entre as fanerógamas, a família Asteraceae representa dez por cento do total da flora de angiospermas. As Asteraceae apresentam distribuição cosmopolita, encontrando-se disseminadas por todos os continentes. No norte do Brasil, uma planta representante da família Asteraceae que se destaca é o jambu, uma hortaliça não convencional, mais que apresenta diversos benefícios para quem consome. Além de ser uma planta que sustenta e levanta a economia dos agricultores familiares que produzem essa hortaliça, uma vez que, esta planta traz abrangentes benefícios no consumo, alimentação, economia e saúde, como por exemplo utilizando espilantol que a planta possui, tratando um vasto leque de enfermidades. Apesar de muita difundida na região norte do país, à Acmella oleracea L. ou simplesmente jambu, como é popularmente conhecida, apresenta poucos trabalhos e pesquisas que englobam esta planta. Visando isso, o presente artigo, se trata a respeito do uso, das características agronômicas e da importância que essa planta traz para o povo da região amazônica, podendo levar este conhecimento, através desta pesquisa para outros lugares do Brasil.

Study design: Systematic review; meta-analysis. Purpose: Lumbar degenerative disease is frequent and has a tremendous impact on patients’ disability and quality-of-life. Open and minimally invasive procedures have been used to achieve adequate decompression and fusion. Endoscopic lumbar interbody fusion (Endo-LIF) is emerging as an alternative, trying to reduce morbidity, while achieving comparable to superior clinical outcomes. The aim of this work is to perform a systematic review and meta-analysis to investigate how Endo-LIF compares to open or minimally invasive procedures. Methods: Electronic databases (MEDLINE, Scopus, Web of Science, Cochrane) were systematically reviewed using the query: ‘(percutaneous OR endoscop*) AND (open OR minimal* invasive) AND lumbar AND fusion’. PRISMA guidelines were followed. Results: Twenty-seven articles were included (25 cohort study, 1 quasi-experimental study, and 1 randomized control trial; for meta-analytical results, only observational studies were considered). Endo-LIF conditioned longer operative time, with significantly lower blood loss, bedtime, and hospital length of stay. Early post-operative back pain favored endoscopic techniques. Endo-LIF and non-Endo-LIF minimally invasive surgery displayed comparable results for most back and leg pain or disability outcomes, despite Endo-LIF having been associated with higher disability at late follow-up (versus Open-LIF). No differences were found regarding fusion rates, cage subsidence, or adverse events. Definitive conclusions regarding fusion rate cannot be drawn due to low number of studies and unstandardized fusion definition. Conclusion: Endo-LIF is an effective and safe alternative to conventional lumbar interbody fusion procedures. Evidence shortcomings may be addressed, and future randomized control trials may be performed to compare techniques and to validate results.

IntroductionMicrobiome-based clinical applications that improve diagnosis related to oral health are of great interest to precision dentistry. Predictive studies on the salivary microbiome are scarce and of low methodological quality (low sample sizes, lack of biological heterogeneity, and absence of a validation process). None of them evaluates the impact of confounding factors as batch effects (BEs). This is the first 16S multi-batch study to analyze the salivary microbiome at the amplicon sequence variant (ASV) level in terms of differential abundance and machine learning models. This is done in periodontally healthy and periodontitis patients before and after removing BEs.MethodsSaliva was collected from 124 patients (50 healthy, 74 periodontitis) in our setting. Sequencing of the V3-V4 16S rRNA gene region was performed in Illumina MiSeq. In parallel, searches were conducted on four databases to identify previous Illumina V3-V4 sequencing studies on the salivary microbiome. Investigations that met predefined criteria were included in the analysis, and the own and external sequences were processed using the same bioinformatics protocol. The statistical analysis was performed in the R-Bioconductor environment.ResultsThe elimination of BEs reduced the number of ASVs with differential abundance between the groups by approximately one-third (Before=265; After=190). Before removing BEs, the model constructed using all study samples (796) comprised 16 ASVs (0.16%) and had an area under the curve (AUC) of 0.944, sensitivity of 90.73%, and specificity of 87.16%. The model built using two-thirds of the specimens (training=531) comprised 35 ASVs (0.36%) and had an AUC of 0.955, sensitivity of 86.54%, and specificity of 90.06% after being validated in the remaining one-third (test=265). After removing BEs, the models required more ASVs (all samples=200–2.03%; training=100–1.01%) to obtain slightly lower AUC (all=0.935; test=0.947), lower sensitivity (all=81.79%; test=78.85%), and similar specificity (all=91.51%; test=90.68%).ConclusionsThe removal of BEs controls false positive ASVs in the differential abundance analysis. However, their elimination implies a significantly larger number of predictor taxa to achieve optimal performance, creating less robust classifiers. As all the provided models can accurately discriminate health from periodontitis, implying good/excellent sensitivities/specificities, the salivary microbiome demonstrates potential clinical applicability as a precision diagnostic tool for periodontitis.

Abstract Background Sickle Cell Disorder is Africa’s most prevalent genetic disease. Yet, it remains a neglected condition, with high mortality under-five, and a lack of population-based studies in the region. This is the first of its kind in São Tomé e Príncipe, aiming to estimate the prevalence of sickle cell trait and other haemoglobin variants in women of reproductive age and its associated factors. Methods We conducted a cluster survey in 35 neighbourhoods. Haemoglobin was assessed through point-of-care capillary electrophoresis or high-performance liquid chromatography, and sociodemographic data through questionnaires. The weighted prevalence of sickle cell trait (HbAS) and HbC carriers was estimated with a 95% confidence interval (95% CI). We calculated weighted prevalence ratios (95% CI) through robust Poisson regression for its association with age and individual and collective genetic heritage. Findings The prevalence of sickle cell trait in women of reproductive age in São Tomé e Príncipe (n = 376) was 13.45% (95% CI: 9.05-19.00). The prevalence of HbC carriers was 8.00% (95% CI: 4.71-12.00). Older age and speaking Forro or Angolar were positively associated with having sickle cell trait. Interpretation The prevalence of sickle cell trait in São Tomé e Príncipe ranks high in the West African region. The country should follow international guidelines, implementing newborn screening and comprehensive healthcare management.

Background: Prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP) are commonly used to manage bleeding in patients during cardiac surgery. However, the relative efficacy and safety of these 2 strategies remain uncertain. Methods: MEDLINE, Embase, and Cochrane were searched for studies comparing PCC and FFP in patients who underwent cardiac surgery complicated by bleeding. Review Manager (RevMan) ver. 5.4 (Nordic Cochrane Centre, The Cochrane Collaboration) was used for statistical analysis. Binary and continuous outcomes were compared using pooled risk ratios and mean differences, respectively. The meta-analysis protocol was registered in the International Prospective Register of Systematic Reviews under protocol number CRD42022379144. Results: We included 8 studies with 1,500 patients, of whom 613 (40.9%) received PCC. The mean follow-up period ranged from 28 to 90 days. The PCC group had significantly lower chest tube drainage at 24 hours (mean difference [MD], -148.50 mL; 95% CI, -253.02 to -43.99 mL; p=0.005; I2=42%). Fewer units of red blood cells (RBCs) were transfused within the first 24 hours (MD, -1.02 units; 95% CI, -1.81 to -0.24 units; p=0.01; I2=56%), and fewer patients required RBC transfusion within the first 24 hours (risk ratio, 0.85; 95% CI, 0.78–0.93; p

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease, involving the selective degeneration of cortical upper synapses in the primary motor cortex (M1). Excitotoxicity in ALS occurs due to an imbalance between excitation and inhibition, closely linked to the loss/gain of astrocytic function. Using the ALS SOD1G93A mice, we investigated the astrocytic contribution for the electrophysiological alterations observed in the M1 of SOD1G93A mice, throughout disease progression. Results showed that astrocytes are involved in synaptic dysfunction observed in presymptomatic SOD1G93A mice, since astrocytic glutamate transport currents are diminished and pharmacological inhibition of astrocytes only impaired long-term potentiation and basal transmission in wild-type mice. Proteomic analysis revealed major differences in neuronal transmission, metabolism, and immune system in upper synapses, confirming early communication deficits between neurons and astroglia. These results provide valuable insights into the early impact of upper synapses in ALS and the lack of supportive functions of cortical astrocytes, highlighting the possibility of manipulating astrocytes to improve synaptic function.

Introdução A consulta pré-operatória de enfermagem pode ser percecionada como um momento privilegiado para a transmissão de informação à pessoa em situação perioperatória, visando melhor prepará-la para a cirurgia e promovendo a sua colaboração nos cuidados perioperatórios. Não sendo um procedimento concretizado regularmente, importa, por isso, realizar investigação sobre as causas da sua não realização. Objetivo Conhecer os constrangimentos à operacionalização da consulta pré-operatória de enfermagem, por via da perceção dos enfermeiros do bloco operatório, bem como identificar as suas sugestões para superar os constrangimentos, e, analisar estratégias apontadas pelos enfermeiros que permitam a priorização da referida consulta. Método Estudo exploratório, descritivo, de natureza qualitativa. Recolha de dados: entrevista focus group mediante guião de entrevista semiestruturada, complementada no final da mesma com questionário individual contendo dados socioprofissionais e duas questões abertas. Participantes: amostra intencional - três grupos de enfermeiros, de três blocos operatórios de um hospital central da zona centro de Portugal. Implementada análise de conteúdo segundo o referencial de Bardin. O estudo considerou os princípios éticos e de integridade científica. Resultados Foi possível conhecer os constrangimentos apontados pelos enfermeiros: metodologia para a operacionalização, ainda indefinida; escassez de tempo disponível; alocação de leito tardia; privacidade comprometida, na realização da consulta; falta de reconhecimento pelas estruturas hierárquicas; dificuldades no espaço físico adequado; prolongamento imprevisível das atividades intraoperatórias; residência longínqua da pessoa em situação perioperatória, e recursos humanos deficitários. Identificou-se as seguintes sugestões/estratégias para se superar os constrangimentos: alocação de mais recursos humanos; espaço físico apropriado; necessidade de maior articulação interdisciplinar e de se criar visibilidade. Conclusão A consulta pré-operatória de enfermagem é um procedimento autónomo que os enfermeiros estão motivados para operacionalizar, superando os constrangimentos que assinalam e priorizando as suas sugestões.

Abstract The nexus between prenatal greenspace exposure and low birth weight (LBW) remains largely unstudied in low- and middle-income countries (LMICs). We investigated a nationwide retrospective cohort of 4,021,741 live births (263,728 LBW births) across 31 provinces in Iran during 2013–2018. Greenness exposure during pregnancy was assessed using satellite-based normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). We estimated greenness-LBW associations using multiple logistic models, and quantified avoidable LBW cases under scenarios of improved greenspace through counterfactual analyses. Association analyses provide consistent evidence for approximately L-shaped exposure-response functions, linking 7.0–11.5% declines in the odds of LBW to each 0.1-unit rise in NDVI/EVI with multiple buffers. Assuming causality, 3931–5099 LBW births can be avoided by achieving greenness targets of mean NDVI/EVI, amounting to 4.4–5.6% of total LBW births in 2015. Our findings suggest potential health benefits of improved greenspace in lowering LBW risk and burden in LMICs.

Abstract Microglia are the largest myeloid cell population in the brain. During injury, disease, or inflammation, microglia adopt different functional states primarily involved in restoring brain homeostasis. However, sustained or exacerbated microglia inflammatory reactivity can lead to brain damage. Dynamic cytoskeleton reorganization correlates with alterations of microglial reactivity driven by external cues, and proteins controlling cytoskeletal reorganization, such as the Rho GTPase RhoA, are well positioned to refine or adjust the functional state of the microglia during injury, disease, or inflammation. Here, we use multi-biosensor-based live-cell imaging approaches and tissue-specific conditional gene ablation in mice to understand the role of RhoA in microglial response to inflammation. We found that a decrease in RhoA activity is an absolute requirement for microglial metabolic reprogramming and reactivity to inflammation. However, without RhoA, inflammation disrupts Ca2+ and pH homeostasis, dampening mitochondrial function, worsening microglial necrosis, and triggering microglial apoptosis. Our results suggest that a minimum level of RhoA activity is obligatory to concatenate microglia inflammatory reactivity and survival during neuroinflammation.

Several techniques have been described for maxillary sinus graft augmentation, including the lateral window technique and crestal approach with osteotomes or osseodensification. Platelet-rich fibrin has been used in maxillary sinus lift procedures due to its ability to accelerate soft and hard tissue healing. The aim of this study was to evaluate the potential of PRF in combination with the synthetic hydroxyapatite NanoBone® to enhance bone regeneration in sinus floor elevation with the lateral window technique. Out of the 50 individuals screened in a preoperative assessment visit from the CESPU—Famalicão clinical unit and intervened upon between January 2023 and December 2023, only 6 patients who met the study’s inclusion criteria consented to participate. In a split-mouth study, twelve sinus graft surgeries were carried out. Our observations reveal that for the test group (NanoBone®/PRF), there is a 27.5 ± 4.9% increase new vital bone, 23.0 ± 3.7% increase in inert bone particles, and 49.4 ± 2.8% increase in connective tissue. Meanwhile, for the control group (NanoBone®), there is a 19.5 ± 3.0% increase in new vital bone, 23.4 ± 5.7% increase in inert bone particles, and 57.0 ± 3.5% increase in connective tissue. The results strongly indicate that mixing liquid PRF with NanoBone® does not have a negative influence on the amount of viable bone formation, and it seems to slightly increase the amount of new bone formation and revascularization in sinus bone graft procedures with the lateral window technique compared to the single use of NanoBone®.

ABSTRACT Background: The riverine communities of the Amazon comprise different social groups that inhabit the rural areas on the banks of rivers and lakes. Residents usually travel by river to rural and urban areas and are then exposed to urbanized diseases such as those caused by arbovirus infection. In Brazil, emerging diseases such as dengue, Zika, chikungunya, and those caused by infection with Oropouche and Mayaro viruses necessitate epidemiological surveillance. This study was aimed at determining the frequency of positivity for immunoglobulin (Ig)G and IgM antibodies against Zika, chikungunya, and dengue viruses and performing molecular analyses to detect viral RNA for the Zika, chikungunya, dengue virus, Oropouche, and Mayaro viruses, in the same serum samples obtained from riverside populations. Methods: This cross-sectional study was conducted in a riverside population in the Humaitá municipality of the Brazilian Amazon. More than 80% of the local population participated in this study. Entomological samples were collected to identify local mosquito vectors. Results: Analysis of 205 human serological samples revealed IgG antibodies against the dengue virus in 85 individuals. No molecular positivity was observed in human samples. Entomological analyses revealed 3,187 Diptera species, with Mansonia being the most frequent genus. Aedes aegypti and Aedes albopictus were not detected in the two collections. Conclusions: IgG antibodies against the dengue virus were highly prevalent, suggesting previous exposure. The absence of the arbovirus vectors Aedes aegypti and Aedes albopictus in the samples supports the hypothesis that the infections recorded likely occurred outside the riverside communities investigated.

Vitamin D deficiency is a well-established cause of rickets in children and has been reported as associated to impacts on other systems and organs. Vitamin D deficiency and insufficiency are pediatric worldwide global health problems. Although data on the prevalence of vitamin D deficiency and insufficiency in the Portuguese pediatric population are scarce, data for Portuguese subpopulations and equivalent regions allows us to speculate that the prevalence of vitamin D deficiency in Portugal should be also relevant. The current article focuses on vitamin D supplementation at pediatric age in Portugal reviewing the prevalence data of vitamin D insufficiency/deficiency for Portugal, the main groups and the risk factors for vitamin D deficiency and educational measures and vitamin D supplementation recommendations for different risk factors/groups.

Resumo Objetivo Mapear sistematicamente as pesquisas de implementação com foco em intervenções voltadas ao desenvolvimento na primeira infância, suas principais características e estratégias de implementação. Métodos Uma revisão de escopo da literatura global foi planejada e executada conforme as recomendações do Instituto Joanna Briggs. A busca foi realizada em nove bases eletrônicas (PubMed, Scopus, Embase, Health System Evidence, Social Systems Evidence, Cochrane, ERIC e CINHAL e BVS), do início da indexação até agosto de 2021. Resultados As buscas mapearam 4.105 referências, sendo 2.805 únicas. Após triagem, 211 estudos foram lidos na íntegra e 82 incluídos. O setor saúde foi o mais frequente nas intervenções, seguido da educação e serviço social. Programas voltados ao desenvolvimento infantil e estratégias focadas na parentalidade, família, nutrição, foram principais intervenções. No total, 89,0% apresentaram as crianças como beneficiárias diretas das estratégias. A duração média das intervenções foi de 14,5 meses e 25,6% dos estudos fundamentaram sua metodologia em frameworks para analisar a implementação das intervenções. A metade analisou adaptações das intervenções ou programas, enquanto 29,3% citaram aspectos de equidade da implementação. Conclusão Esta revisão de escopo permitiu a análise de um conjunto de intervenções voltadas à primeira infância, demonstrando o potencial das pesquisas de implementação de programas de desenvolvimento da primeira infância, identificando estratégias mais adequadas aos contextos e o alcance dos objetivos pretendidos, a partir da incorporação dos desfechos de implementação.

Summary: Microglia, the largest population of brain immune cells, continuously interact with synapses to maintain brain homeostasis. In this study, we use conditional cell-specific gene targeting in mice with multi-omics approaches and demonstrate that the RhoGTPase Rac1 is an essential requirement for microglia to sense and interpret the brain microenvironment. This is crucial for microglia-synapse crosstalk that drives experience-dependent plasticity, a fundamental brain property impaired in several neuropsychiatric disorders. Phosphoproteomics profiling detects a large modulation of RhoGTPase signaling, predominantly of Rac1, in microglia of mice exposed to an environmental enrichment protocol known to induce experience-dependent brain plasticity and cognitive performance. Ablation of microglial Rac1 affects pathways involved in microglia-synapse communication, disrupts experience-dependent synaptic remodeling, and blocks the gains in learning, memory, and sociability induced by environmental enrichment. Our results reveal microglial Rac1 as a central regulator of pathways involved in the microglia-synapse crosstalk required for experience-dependent synaptic plasticity and cognitive performance.

Under certain environmental and oceanographic conditions, macroalgae can overgrow and accumulate in massive quantities on beaches, causing serious ecological and economic impacts. To address this problem, a citizen science monitoring platform was created to determine the spatial and temporal distribution of macroalgae accumulations along the beaches of Algarve in southern Portugal, with the aim to assess the extent of beach-cast events and their relationship with abiotic factors. A Redundancy Analysis (RDA) and a permutational analysis of variance (PERMANOVA) were carried out to explore the relationship between macroalgae accumulation level and the abiotic variables: sea surface temperature, wind speed, wind direction, currents, maximum sea level, significant wave height, salinity, nitrate, ammonium, phosphate, precipitation and radiation. The citizen science campaign showed great participation, resulting in 404 submissions between July 2021 and September 2023. The campaign revealed that three species of macroalgae accumulated on the beaches of Algarve, Ulva sp. (with the presence of Ectocarpales and Dyctiotales) along the sandy eastern coast, and the invasive species Asparagopsis armata and Rugulopteryx okamurae in the rocky central and western beaches, respectively. The accumulations of R. okamurae increased from 2021 to 2023, were registered throughout the year and were more abundant than those of Ulva sp. and A. armata, which were only observed in spring and summer. The highest levels of R. okamurae beach-cast depositions were related to strong wave conditions, and high sea surface temperature and salinity. The accumulation of Ulva sp. was related to high sea surface temperature and salinity whereas A. armata was also correlated with winds parallel to the shore (NW-W). PERMANOVA analysis revealed that sea surface temperature and wave conditions had a significant effect on the overall abundance of macroalgae beach-cast accumulations. Overall, our citizen science campaign effectively involved the public, leading to the collection of important data on monitoring macroalgae accumulations. Through these findings, we were able to pinpoint the environmental, atmospheric, and hydrodynamic factors that contribute to their development, movement, and buildup along the Algarve coastlines.

A deficiência adquirida do fator VIII da coagulação é uma doença autoimune rara caracterizada pelo aparecimento de autoanticorpos contra o fator VIII, que pode levar a graves focos hemorrágicos de difícil controle devido a um desequilíbrio da hemostasia. Geralmente está associada a doenças autoimunes, neoplasias e algumas infecções, como os vírus da hepatite B (HBV) e C (HCV), sendo a associação com o vírus da imunodeficiência humana (HIV) rara. Este trabalho tem por objetivo relatar caso de associação da infeção pelo HIV e deficiência adquirida do fator VIII. Mulher, 41 anos, vivendo com HIV por 3 anos em acompanhamento regular e carga viral indetectável, evoluiu com quadro de artralgia aditiva associada a pequenos hematomas de resolução espontânea, não relacionados a traumas, 2 meses antes da admissão hospitalar. Foi internada para investigação após queixa de dor em membro inferior direito associada. A despeito de hemotransfusões e sem anticoagulantes prescritos, cursou com sangramentos cutâneos extensos e crescentes, consumo de hemoglobina e provas de hemólise aumentadas. Fora levantada a hipótese diagnóstica de Deficiência de Fator VIII possivelmente associada ao HIV, confirmada após dosagem de fator VIII de 1%. Com realização de ciclo de corticoterapia e ciclofosfamida houve recrudescimento do fator VIII em nova coleta (6%), estabilização de hemoglobina e desaparecimento de hematomas e equimoses. Distúrbios autoimunes podem ocorrer em pacientes que vivem com HIV e alguns não são raros, sendo possível a ocorrência em pacientes com bom controle virológico sob uso de terapia antirretroviral. A deficiência adquirida do fator VIII não é uma doença comum em pessoas que vivem com HIV, sendo de suma importância a suspeição clínica em contextos de sangramento com tempo prolongado de tromboplastina parcial ativada (TTPa). O desenvolvimento de ferramentas para o diagnóstico e tratamento desses pacientes é essencial, tendo em vista a raridade de acomentimento, o risco significativo de mortalidade e a fisiopatologia ainda desconhecida.

Tumoral melanosis is a rare histopathological finding characterized by aggregates of melanophages, in the absence of melanocytes, usually observed in sites of regressed melanocytic lesions, including melanoma. A 72-year-old woman with a history of a completely excised melanoma on her right arm (T3bN0M0, Stage IIb) presented with clinically-evident regional lymph node metastasis. This was treated with right axillary lymphadenectomy. Subsequently, a 2-centimeter blue-colored patch over the excision scar was identified, along with a blue nodule within the posterior aspect of the same arm, consistent with in-transit metastases. Additional metastases on the right hilar region of the lungs were detected by PET/CT. Hence, the patient began immunotherapy with pembrolizumab. After three months, a second PET/CT revealed a complete response, but the patient maintained the blue-colored patch previously observed. Given the discrepancy between the clinical and metabolic response she underwent a skin biopsy; histological examination showed findings compatible with tumoral melanosis resulting from complete regression of a metastatic lesion. In cases of metastatic melanoma under immunotherapy with anti-PD1 agents, especially pembrolizumab, tumoral melanosis has been anecdotally associated with tumor regression and favorable treatment response. The patient has been maintained on pembrolizumab, accomplishing 15 cycles, and has had a complete response to date.

The current study aims to analyse the vertical structure of the ocean during upwelling events using in situ and modelled data. Additionally, the influence of climate patterns, namely the North Atlantic Oscillation (NAO) and the East Atlantic (EA) pattern, on the vertical structure and their impact on the upwelling activity are assessed for a period of 25 years (1993–2017). The study focuses on the central part of the Canary Current (25–35∘ N) with persistent upwelling throughout the year, with an annual cycle and the strongest events from June to September. Upwelling is determined using two different approaches: one index is calculated based on temperature differences between the coastal and the offshore area, and the other is calculated based on wind data and the resulting Ekman transport. Different datasets were chosen according to the indices. Stable coastal upwelling can be observed in the study area for the analysed time span, with differences throughout the latitudes. A deepening of the isothermal layer depth and a cooling of temperatures are observed in the vertical structure of coastal waters, representing a deeper mixing of the ocean and the rise of cooler, denser water towards the surface. During years of a positive NAO, corresponding to a strengthening of the Azores High and the Icelandic Low, stronger winds lead to an intensification of the upwelling activity, an enhanced mixing of the upper ocean, and a deeper (shallower) isothermal layer along the coast (offshore). The opposite is observed in years of negative NAO. Both effects are enhanced in years with a coupled, opposite phase of the EA pattern and are mainly visible during winter months, where the effect of both indices is the greatest. The study therefore suggests that upwelling activities are stronger in winters of positive North Atlantic Oscillation coupled with a negative East Atlantic pattern and emphasizes the importance of interactions between the climate patterns and upwelling.

Abstract We present a machine-readable and open-access dataset on vaccination results among children under five years old in Brazil from 1996 to 2021. This dataset is interoperable with epidemiological data from the VAX*SIM project and reusable by the research community worldwide for other purposes, such as monitoring vaccination coverage and studying its determinants and impacts on child morbidity and mortality. The dataset gathers official and public information from the Brazilian National Immunisation Program, the Institute of Geography and Statistics, the Institute for Applied Economic Research, and the Ministry of Health. It includes 2,442,863 observations and 35 attributes aggregated by years, policy-relevant geographic units (country, macroregions, states, municipalities, and capitals), and age groups on 1,344,480,329 doses of 28 vaccines aimed to prevent 15 diseases, estimates of their target-population coverage, indicators of the vaccination coverage’s homogeneity, dropout rates, and spatial, demographic, and socioeconomic data. We automated all data processing and curation in the free and open software R. The codes can be audited, replicated, and reused to produce alternative analyses.

Background Risky health decisions and impulse control profiles may impact on metabolic control in type 1 diabetes mellitus (T1DM). We hypothesize that the neural correlates of cognitive impulsivity and decision-making in T1DM relate to metabolic control trajectories. Methods We combined functional magnetic resonance imaging (fMRI), measures of metabolic trajectories (glycosylated hemoglobin [HbA1c] over multiple time points) and behavioral assessment using a cognitive impulsivity paradigm, the Balloon Analogue Risk Task (BART), in 50 participants (25 T1DM and 25 controls). Results Behavioral results showed that T1DM participants followed a rigid conservative risk strategy along the iterative game. Imaging group comparisons showed that patients showed larger activation of reward related, limbic regions (nucleus accumbens, amygdala) and insula (interoceptive saliency network) in initial game stages. Upon game completion differences emerged in relation to error monitoring (anterior cingulate cortex [ACC]) and inhibitory control (inferior frontal gyrus). Importantly, activity in the saliency network (ACC and insula), which monitors interoceptive states, was related with metabolic trajectories, which was also found for limbic/reward networks. Parietal and posterior cingulate regions activated both in controls and patients with adaptive decision-making, and positively associated with metabolic trajectories. Conclusion We found triple converging evidence when comparing metabolic trajectories, patients versus controls or risk averse (non-learners) versus patients who learned by trial and error. Dopaminergic reward and saliency (interoceptive and error monitoring) circuits show a tight link with impaired metabolic trajectories and cognitive impulsivity in T1DM. Activity in parietal and posterior cingulate are associated with adaptive trajectories. This link between reward-saliency-inhibition circuits suggests novel strategies for patient management.

Congenital cutaneous candidiasis (CCC) is a rare condition in neonates, mainly in term neonates, that develops in the 1st week of life. Its broad clinical spectrum makes it challenging to differentiate it from other exanthemas in the newborn. The involvement of palms and soles and the presence of pustules are important clinical clues for the differential diagnosis, with cultural examination confirming the diagnosis by identification of Candida spp. Treatment of clinically stable term neonates without evidence of invasive disease is currently controversial. We report a case of CCC in a term newborn with no evidence of invasive disease that evolved into a clinical cure after systemic and topical antifungal treatment.

Chagas disease (CD) is a typical tropical illness caused by Trypanosoma cruzi. The objective of this study was to assess the prevalence of Chagas disease in communities in two states of the Brazilian Amazon. Data collection occurred in July in the Alto Juruá region of Acre and in December in the communities of Humaitá, Amazonas, in 2019. A total of 477 participants were included in the study. In the communities of Alto Juruá, triatomine collections and analyses of T. cruzi infection were also carried out. All confirmed cases were found in the state of Acre, resulting in a total prevalence of 1.67. Of these eight cases, seven underwent ECG, all of which were concluded as normal by the physician team’s cardiologists. Seventeen triatomine bugs, all belonging to the Rhodnius genus, were captured. The natural infection rate by T. cruzi was 25% in the Nova Cintra community and 66.67% in the Boca do Moa community (Alto Juruá). This research found that more than 1% of the studied population exhibited positive serological results for Chagas disease in the riverine communities during the study period, representing a small portion of cases among those who have not yet been diagnosed.

The subtidal surface water circulation at the northern margin of the Gulf of Cádiz, at the southern extremity of the Iberian upwelling system, is described based on validated hourly high-frequency radar measurements from 2016 to 2020. Statistical analyses (mean, standard deviation, eccentricity and empirical orthogonal functions) are applied to the dataset, which is completed with ADCP time series from multiple moorings at five inner-shelf stations and ERA5 wind. Off the shelf, the main circulation pattern consists of a slope current, best developed in summer when north-westerlies dominate, in particular at the most exposed western region. Mechanisms other than upwelling must contribute to this flow in order to explain its seasonal persistence. The slope circulation reverses for regional wind events with an east component > 10 m s−1, approximately. On the shelf, currents are mainly alongshore and balanced. The circulation is generally continuous along the coast, except for weak (< 0.1 m s−1, broadly) poleward flows. In the latter case, the flow tends to remain equatorward near Cape Santa Maria. In winter, coastal poleward flows often extend over the entire margin and are mainly wind-driven. In summer, these flows generally consist of coastal counter currents (CCCs) with the poleward direction opposed to that of the slope current. The CCCs are associated with significant cyclonic recirculation, strongest to the west, where a transient eddy is shortly observed for weak wind stress. This circulation develops after periods of strong north-westerlies, supporting that CCCs result from the imbalance of a regional alongshore pressure gradient.

A pandemia poderá ter contribuído para um aumento do stresse, ansiedade e depressão, especialmente em pessoas com doenças crónicas (DC) prévias, uma vez que a perceção que se tem da COVID-19 pode ser muito importante para a saúde mental. O presente estudo comparativo entre pessoas com e sem DC visa analisar o impacto da doença na previsão de stresse, ansiedade e depressão. O estudo contou com a participação de 1208 adultos portugueses (numa relação amorosa), dos quais 83,3% mulheres (16,1% homens, 0,2% pessoas queer e 0,4% outros), com idades entre os 18 e os 81 anos (M = 44,40; DP = 10,52). A recolha de dados foi realizada durante o primeiro ano da pandemia, considerando todos os princípios éticos. Realizaram-se análises descritivas, diferenças de médias, correlações de Pearson e modelos de regressão hierárquica. Os sintomas ansiosos, depressivos e de stresse estão associados a uma maior perceção de ameaça da COVID-19. Finalmente, ter uma DC e uma elevada perceção de ameaça da COVID-19 prevê distress emocional. É destacada a importância da perceção da COVID-19 na previsão do distress emocional durante a pandemia.

Abstract This study aimed to search parasites in 333 ornamental fish from five Brazilian states (Ceará, Minas Gerais, São Paulo, Paraná and Santa Catarina). Fish were sent from eight farms located in the municipalities of Fortaleza, Patrocínio do Muriaé, São Francisco do Glória, Cascavel, Timbó, Iguape, Jacareí and Mairinque. All fish received anesthesia earlier to euthanasia procedures. After the search for parasites, it was verified that 70.6% (235/333) of fishes were infected by at least one type of parasite, being 12 types of parasites identified: monogeneans, digenean metacercariae, cestodes, nematodes, Lernaea cyprinacea, trichodinids, Piscinoodinium pillulare, Ichthyophthirius multifiliis, diplomonad flagellates, Ichthyobodo sp., Chilodonella sp., and Tetrahymena sp. The proportion of infected fishes among the farms is compared through statistical tests, besides, animal handling adopted in each farm is also discussed. The importance of ensuring fish health in order to make the ornamental freshwater fish industry economically viable and reduce losses in production is highlighted.