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Introduction Sudden sensorineural hearing loss (SSNHL) is defined as a rapid sensation of hearing impairment in one or both ears. Based on its personal impact on patients, the present study advances the analysis of new treatments for the prompt recognition and management of SSNHL, with higher chances of improvements in terms of hearing recovery and quality of life of the patients.

Introduction and objectives: Aortic stenosis is the most common valvular heart disease. The number of octogenarians proposed for intervention is growing due to increased lifespan. In this manuscript we aim to evaluate perioperative outcome and long-term survival after surgical aortic valve replacement (SAVR) in octogenarians, comparing patients with low surgical risk (EuroscoreII

Abstract In this work, we present fabricated magnetic tunnel junctions (MTJs) that can serve as magnetic memories (MMs) or vortex spin-torque nano-oscillators (STNOs) depending on the device geometry. We explore the heating effect on the devices to study how the performance of a neuromorphic computing system (NCS) consisting of MMs and STNOs can be enhanced by temperature. We further applied a neural network for waveform classification applications. The resistance of MMs represents the synaptic weights of the NCS, while temperature acts as an extra degree of freedom in changing the weights and TMR, as their anti-parallel resistance is temperature sensitive, and parallel resistance is temperature independent. Given the advantage of using heat for such a network, we envision using a vertical-cavity surface-emitting laser (VCSEL) to selectively heat MMs and/or STNO when needed. We found that when heating MMs only, STNO only, or both MMs and STNO, from 25 to 75 °C, the output power of the STNO increases by 24.7%, 72%, and 92.3%, respectively. Our study shows that temperature can be used to improve the output power of neural networks, and we intend to pave the way for future implementation of a low-area and high-speed VCSEL-assisted spintronic NCS.

Abstract The emergence of exceptional points (EPs) in the parameter space of a non-hermitian (2D) eigenvalue problem has long been interest in mathematical physics, however, only in the last decade entered the scope of experiments. In coupled systems, EPs give rise to unique physical phenomena, and enable the development of highly sensitive sensors. Here, we demonstrate at room temperature the emergence of EPs in coupled spintronic nanoscale oscillators and exploit the system’s non-hermiticity. We observe amplitude death of self-oscillations and other complex dynamics, and develop a linearized non-hermitian model of the coupled spintronic system, which describes the main experimental features. The room temperature operation, and CMOS compatibility of our spintronic nanoscale oscillators means that they are ready to be employed in a variety of applications, such as field, current or rotation sensors, radiofrequeny and wireless devices, and in dedicated neuromorphic computing hardware. Furthermore, their unique and versatile properties, notably their large nonlinear behavior, open up unprecedented perspectives in experiments as well as in theory on the physics of exceptional points expanding to strongly nonlinear systems.

Abstract Pinning at local defects is a significant road block for the successful implementation of technological paradigms which rely on the dynamic properties of non-trivial magnetic textures. Here, a comprehensive study of the influence of local pinning sites for non-homogeneous magnetic layers integrated as the free layer of a magnetic tunnel junction is presented, both experimentally and with corresponding micromagnetic simulations. The pinning sites are found to be extremely detrimental to the frequency controllability of the devices, a key requirement for their use as synapses in a frequency multiplexed artificial neural networks. In addition to describing the impact of the local pinning sites in the more conventional NiFe, a vortex-based magnetic tunnel junction with an amorphous free layer is presented which shows significantly improved frequency selectivity, marking a clear direction for the design of future low power devices.

O livro é um recurso utilizado na práxis de ensino da Educação Básica contendo elementos textuais e imagéticos, cuja fotografia expressa uma realidade sem alterações. Os cnidários são animais peçonhentos de importância ecológica, médica e social, cuja imagem fotográfica pode oportunizar olhares específicos quanto aos aspectos e às abordagens presentes nesses manuais de ensino. O estudo objetivou analisar as imagens fotográficas acerca do conteúdo ao Filo Cnidária em Livros Didáticos de Biologia do Ensino Médio para a educação em saúde. Assim, pesquisa qualitativo-descritiva mediada pela análise Bartheriana, cujos livros apresentaram baixa quantidade de fotografias de acidentes com cnidários, necessita de abordagens sobre causas e efeitos potenciais, de ações preventivas e de cuidados aos banhistas, evitando “ataques” e lesões na pele (queimaduras).

Introduction Facial nerve stimulation (FNS) is a complication in cochlear implant (CI) when the electrical current escapes from the cochlea to the nearby facial nerve. Different management to reduce its effects are available, although changes might result in a less-than-ideal fitting for the CI user, eventually reducing speech perception.

Neste artigo, iremos apresentar como ocorreu a edição virtual da Maratona do Rio de Janeiro em 2020, ainda sem autorizações sanitárias para a realização de grandes eventos. Para isso, analisaremos o Guia do corredor, apresentado aos corredores na época. A competição é realizada por meio de uso de aplicativos, mas o atleta é estimulado a correr com o slogan “Não correr nunca foi uma opção”. Abordamos os conceitos de necrodemografia e necropolítica. Entende-se que a Maratona do Rio pratica uma espécie de necropolítica ao organizar a competição em pleno período pandêmico do Brasil, apesar de valorizar a paisagem da rua em suas plataformas comunicacionais.

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.

Abstract Although analog-to-digital converters (ADCs) are critical components in mixed-signal integrated circuits (IC), their performance has not been improved significantly over the last decade. To achieve a radical improvement (compact, low power and reliable ADCs), spintronics can be considered as a proper candidate due to its compatibility with CMOS and wide applications in storage, neuromorphic computing, and so on. In this paper, a proof-of-concept of a 3-bit spin-CMOS Flash ADC using in-plane-anisotropy magnetic tunnel junctions (i-MTJs) with spin–orbit torque (SOT) switching mechanism is designed, fabricated and characterized. In this ADC, each MTJ plays the role of a comparator whose threshold is set by the engineering of the heavy metal (HM) width. Such an approach can reduce the ADC footprint. Monte-Carlo simulations based on the experimental measurements show the process variations/mismatch limits the accuracy of the proposed ADC to 2 bits. Moreover, the maximum differential nonlinearity (DNL) and integral nonlinearity (INL) are 0.739 LSB (least significant bit) and 0.7319 LSB, respectively.

Abstract The synchronisation of magnetic tunnel junctions in the high frequency domain has attracted significant interest in the context of novel computation paradigms, specifically neuromorphic spintronics and probabilistic computing. In this work, a design for the coupling and synchronization of spin torque vortex oscillators (STVOs) is implemented. The geometry comprises the fabrication of adjacent pairs of STVO nanopillars (MgO-based magnetic tunnel junctions), with an edge-to-edge distance down to 100 nm, together with individual top contacts that allow an independent electrical access to each device. In this geometry, the magneto-dipolar coupling promotes the synchronization of the two oscillators, at the same time as the access to the frequency and phase of each individual oscillator is possible. Both frequency and time domain measurements confirm a successful synchronization, with the coupling being controlled by the relative DC bias in each oscillator. As a proof-of-concept towards an oscillator-based Ising machine, it is also shown that the second harmonic injection locking of an STVO can be controlled by tuning the magneto-dipolar coupling to its correspondent STVO pair. These results represent a step forward for the implementation of magneto-dipolar coupled magnetic tunnel junctions, specifically in the field of unconventional computing hardware.

Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis — audiologic, electrophysiologic tests, and imaging; (2) Treatment — wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

Resumo: Este estudo objetivou analisar contribuições da BioArte (produções interdisciplinares entre Biologia e Arte) para o processo de ensino e de aprendizagem de Ciências e de Biologia no Instituto Oficina Cerâmica Francisco Brennand. Assim, foi conduzida uma pesquisa de campo que contou com atores sociais pertencentes ao quadro de pessoal do Instituto, os quais participaram de entrevistas estruturadas, as quais foram gravadas, transcritas e submetidas à Análise de Conteúdo na perspectiva de Bardin. Verificou-se que diversos elementos da BioArte estão presentes nas obras cerâmicas do artista, contemplando vários conteúdos e temas da Biologia, como: Anatomia, Botânica e Ecologia, nas instalações artísticas do Museu. Dessa maneira, a BioArte está fortemente imbricada no legado de Brennand, constituindo objeto de interesse para o ensino e a aprendizagem nas ciências biológicas. Por fim, espera-se, a partir deste estudo, promover a educação científica em Espaços Não Formais, como os museus e os centros de ciências.

ABSTRACT Members of the Meyerozyma guilliermondii species complex are able to cause superficial and life-threatening systemic infections with low susceptibility to azoles and echinocandins. We tested 130 bloodstream M. guilliermondii complex isolates collected from eight Latin American medical centers over 18 years (period 1 = 2000–2008 and period 2 = 2009–2018) to investigate trends in species distribution and antifungal resistance. The isolates were identified by rDNA ITS region sequencing, and antifungal susceptibility tests were performed against fluconazole, voriconazole, anidulafungin, and amphotericin B using the CLSI microbroth method. M. guilliermondii sensu stricto (s.s.; n = 116) was the most prevalent species, followed by Meyerozyma caribbica (n = 12) and Meyerozyma carpophila (n = 2). Based on rDNA ITS identification, three clades within M. guilliermondii sensu stricto were characterized (clade 1 n = 94; clade 2 n = 19; and clade 3 n = 3). In the second period of study, we found a substantial increment in the isolation of M. caribbica (3.4% versus 13.8%; P = 0.06) and clade 2 M. guilliermondii s.s. exhibiting lower susceptibility to one or more triazoles. IMPORTANCE Yeast-invasive infections play a relevant role in human health, and there is a concern with the emergence of non-Candida pathogens causing disease worldwide. There is a lack of studies addressing the prevalence and antifungal susceptibility of different species within the M. guilliermondii complex that cause invasive infections. We evaluated 130 episodes of M. guilliermondii species complex candidemia documented in eight medical centers over 18 years. We detected the emergence of less common species within the Meyerozyma complex causing candidemia and described a new clade of M. guilliermondii with limited susceptibility to triazoles. These results support the relevance of continued global surveillance efforts to early detect, characterize, and report emergent fungal pathogens exhibiting limited susceptibility to antifungals.

O presente artigo objetivou analisar a abordagem imagética do Filo Cnidaria em Livros Didáticos do Ensino Médio por meio da Teoria Cognitivista da Aprendizagem Multimídia (TCAM). As imagens foram analisadas em nove Livros de Biologia, nos capítulos referentes aos cnidários, sendo classificadas como Valor Didático (VD) e Valor não Didático (VnD). Foram identificadas 171 imagens, com 39 ilustrações de VD que apresentaram desvios imagéticos, ou seja, imagens insatisfatórias considerando a análise de acordo com os Princípios da Coerência (PC), Sinalização (PS) e Contiguidade Espacial (PCE). Todos os livros apresentaram alguma imagem com desvio, sendo o PCE o mais recorrente. É necessário estabelecer critérios para inserção de imagens em Livros Didáticos, visando diminuir equívocos de aprendizagem e facilitar o processo de ensino-aprendizagem dos estudantes. Palavras-chave: Ensino aprendizagem; imagens; zoologia; cnidários.

Extracting information from radio-frequency (RF) signals using artificial neural networks at low energy cost is a critical need for a wide range of applications from radars to health. These RF inputs are composed of multiple frequencies. Here, we show that magnetic tunnel junctions can process analog RF inputs with multiple frequencies in parallel and perform synaptic operations. Using a backpropagation-free method called extreme learning, we classify noisy images encoded by RF signals, using experimental data from magnetic tunnel junctions functioning as both synapses and neurons. We achieve the same accuracy as an equivalent software neural network. These results are a key step for embedded RF artificial intelligence.

As imagens, em suas diversas formas de representação, atuam como promotoras de significados sociais, políticos e educacionais. No âmbito escolar, são amplamente utilizadas na abordagem de conteúdos, visando colaborar na compreensão de conceitos ao estudante. Todavia, em muitos casos, isso tem implicado em vicissitudes na forma como elas são apresentadas em sala de aula. O docente quando do uso de ilustrações presentes em livros, tecnologias e multimídias necessitam de critérios que possam ajudá-los a melhorar o desenvolvimento de sua prática, propiciando a disseminação adequada do conhecimento. Este estudo qualitativo-descritivo, objetivou analisar os princípios multimidiáticos no ensino-aprendizagem em Química, em imagens postadas em um perfil educacional do Instagram. Para isso, foi selecionado um perfil que abordava e discutia sobre conteúdos químicos, a partir de imagens estáticas sobre ligações químicas. As ilustrações foram classificadas e posteriormente analisadas, tendo como base os Princípios de Coerência, Contiguidade Espacial e Sinalização, relacionados à Carga de Redução de Processamento Estranho, da Teoria Cognitiva da Aprendizagem Multimídia. A Contiguidade Espacial se apresentou satisfatória, seguindo a relação de proximidade entre texto e imagem. Já o Princípio da Sinalização e da Coerência precisam ser mais delineados, no tocante à presença de elementos que podem provocar compreensões equivocadas/inapropriadas sobre os conceitos químicos. As postagens em Rede Social como o Instagram podem auxiliar na aprendizagem de conteúdos escolares, mas é imprescindível o cuidado no processo de elaboração e de inserção, visando colaborar com o ensino.

Introduction: This study aimed to assess the clinical, economic, and humanistic impact of short-bowel syndrome/chronic intestinal failure (SBS/CIF) in Portugal. Methods: This is a retrospective multicenter cohort chart review study, with a cross-sectional component for quality-of-life (QoL) evaluation. Inclusion criteria comprised patients with SBS/CIF, aged ≥1 year, with stable parenteral nutrition (PN). Data collection included patient chart review over a 12-month period and patient/caregiver self-report and SF-36/PedsQL™ questionnaires. Main endpoints comprised clinical and PN characterization, healthcare resource use (HRU), direct costs, and patient QoL. Results: Thirty-one patients were included (11 adults and 20 children). Patients’ mean age (standard deviation [SD]) was 57.9 (14.3) years in adults and 7.5 (5.0) years in children, with a mean time since diagnosis of 10.2 (5.9) and 6.6 (4.2) years, respectively. PN was administered for a mean of 5.2 and 6.6 days/week in adults and children, respectively; home PN occurred in 81.8% of adults and 90.0% of children for a mean of 9.6 and 10.8 months/year, respectively. The mean annual number of hospitalizations was 1.9 and 2.0 which lasted for a mean of 34.0 and 29.4 days in adults and children, respectively. Twenty-one and forty hospitalization episodes were reported in adults and children, respectively, of which 71.4% and 85.0% were due to catheter-related complications. Mean annual direct costs per patient amounted to 47,857.53 EUR in adults and 74,734.50 EUR in children, with PN and hospitalizations as the main cost-drivers. QoL assessment showed a clinically significant impaired physical component in adults and a notable deterioration in the school functioning domain in children. Conclusion: In Portugal, SBS/CIF patient management is characterized by a substantial therapeutic burden and HRU, translating into high direct costs and a substantial impairment of the adults’ physical function and children’s school functioning.

Abstract In our study, we aimed to validate a method based on liquid chromatography-mass spectrometry (LC-MS) to quantify spironolactone (SPI) and its active metabolite canrenone (CAN) simultaneously in plasma samples to support in vivo experiments. Compounds were separated by using a C18 column with the isocratic elution of a mobile phase composed of 0.1% (v/v) formic acid in methanol-water (60:40 v/v) at a flow rate of 0.4 mL min−1. SPI and CAN were detected in na electrospray interface operating in a positive ionization mode and quantified using the selective ion mode monitoring of mass-charge ratios (m/z) of 439.0 for SPI and 363.1 for CAN. After calculating the matrix effect using theoretical equations, we observed the strong interference of plasma in the equipment-generated signal, which required creating analytical curves using the matrix as a solvent. The method was nevertheless linear (r 2 > 0.999) in a concentration range of 0.4-5.0 μg mL−1, as well as precise, with a coefficient of variation less than 5%. SPI’s and CAN’s recovery rates from the plasma ranged from 87.4% to 112.1%, while their limits of detection (i.e., 0.07 μg mL−1 and 0.03 μg mL−1, respectively) and quantification (i.e., 0.20 μg mL−1 and 0.08 μg mL−1, respectively) in the presence of plasma contaminants were low. Therefore, the bioanalytical method seems to be feasible for quantifying SPI and CAN in plasma.

Objectives: Cystic fibrosis (CF) is a severe autosomal recessive disease that results from mutations in a gene encoding the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein, a chloride channel. This study aims to characterize the clinical and genetic features of a cohort of pediatric people with CF (PwCF) in the center of Portugal and to determine which ones are candidates for the new drugs modulating the CFTR channel. Methods: A review of the demographic, genetic and clinical characteristics of PwCF undergoing follow-up at a CF reference center was carried out. Results: Twenty-three PwCF (12 male), with a median age of 12 years, were followed up. All patients carry the F508del mutation in at least one allele. Fifteen PwCF were F508del-homozygous, median BMI z-score was -0.13, all are pancreatic insufficient and median FEV1 value was 78.1%. These PwCF are eligible for dual therapy (lumacaftor/tezacaftor+ivacaftor) and for triple therapy (tezacaftor+ivacaftor+elexacaftor). PwCF with 711 +1G->T (n = 2), 2184insA (n = 1) mutations and a novel mutation c.3321dup (n = 1) have minimal function mutation and patients with a residual function mutation: R334W (n = 3) and P5L (n = 1) have a less severe phenotype. All these patients, because they also carry F508del mutation, are elegible to triple therapy. Conclusions: Genetic and molecular characterization of PwCF poses an important step not just for CF diagnosis and prognosis which is tightly correlated with the clinical phenotype, but also for the eligibility of CFTR modulator drugs.

Introdução: O Diabetes Mellitus (DM) é uma doença crônica que destaca- se por sua prevalência e incidência crescentes, considerado em âmbito nacional e internacional como uma das principais síndromes de evolução crônica. O tratamento medicamentoso do DM é complexo podendo abranger diferentes fármacos com várias dosagens, assim como aplicações diárias de insulina exógena. Sendo que existem evidências de que quanto mais complexo o tratamento medicamentoso menor a adesão. O cuidado farmacêutico representa um processo eficaz nesse contexto, pois tem como objetivo avaliar a relação do usuário com o tratamento proposto e compreender os problemas de adesão apresentados. Objetivo: Analisar a adesão dos pacientes portadores de diabetes mellitus, adesão farmacoterapêutica em pessoas com diabetes melittus, em insulinoterapia, em acompanhamento do Cuidado Farmacêutico, na Estratégia de Saúde da Família, na zona norte, do município de Recife, Pernambuco. Métodos: Desenvolveu-se um estudo analítico-descritivo, de abordagem quantitativa e de caráter observacional e transversal. A coleta de dados foi realizada por visitas domiciliares ou através de agendamentos de consultas farmacêuticas individuais, o qual foi solicitado a levar suas receitas médicas, medicamentos e exames laboratoriais. A coleta de dados ocorreu pela aplicação de dois questionários: um de caracterização sociodemográfica e de saúde e de adesão à terapia versão em português da Morisky Medication Adherence Scale (MMAS-8) adaptada. Resultados: Participaram do estudo 23 usuários, predominantemente do gênero feminino (73,9%). A idade dos participantes variou de 18 a 78 anos, com média de 57,1 anos, e a faixa etária mais frequente foi de 60 a 69 anos (30,4%). A distribuição por escolaridade, observa-se que a maioria possuía menos de 8 anos de estudo (74,0%), sendo desses 08 (34,9%) declarados analfabetos e 09 possuem ensino fundamental incompleto. Verificou – se a prevalência de não adesão, no qual 19 (82,6%) participantes não aderiram ao tratamento, sendo também realizada a análise bivariada das características sociodemográficas e epidemiológicas dos usuários em relação à adesão terapêutica, sendo a variável esquema terapêutico apresentou associação estatisticamente significante (p= 0,036), mostrando que os usuários que faz um esquema terapêutico menos complexo (apenas um medicamento), apresentaram uma melhor adesão. Conclusão: Os resultados indicam uma alta prevalência da não adesão com possíveis impactos negativos para os usuários e para a sociedade. Diante destes dados, fazem-se necessárias estratégias que visem potencializar o trabalho das equipes de saúde da família, a simplificação do regime terapêutico e a adequação da linguagem utilizada durante as informações para a minimização deste problema de saúde pública.

Introdução: Foram levantadas, através de revisão de literatura, as diferenças cinéticas de absorção das fontes proteicas de origem animal e vegetal, salientando a menor digestibilidade e biodisponibilidade de aminoácidos essenciais nas fontes de proteína vegetal. Destacam-se, porém, alternativas de enriquecimento e diversificação dessas fontes proteicas, que viabilizam bons resultados nutricionais no anabolismo. Objetivo: avaliar os resultados encontrados na literatura pesquisada para que o mito das diferenças anabólicas entre as proteínas vegetais e animais seja melhor esclarecido. Materiais e Métodos: As buscas foram realizadas nas bases de dados informatizados Pubmed, Lilacs, Google Acadêmico, Scielo e Science Direct. As palavras-chave utilizadas foram hipertrofia, proteína do soro do leite, fonte proteica vegetal, fonte proteica animal, massa muscular, síntese proteica muscular e degradação de proteína muscular, além de seus termos correspondentes em inglês. Resultados: nos 6 artigos comparados, 465 homens saudáveis foram submetidos à nutrição proteica animal ou vegetal, juntamente com sessões de treinamento resistido. Diferenças entre os estudos foram verificadas a alternativas sugeridas. Discussão: Os artigos demonstraram a viabilidade do aumento anabólico através de fontes proteicas vegetais, igualando-as às fontes animais. Conclusão: Apesar da vantagem das fontes proteicas animais, existem alternativas vegetais viáveis e com resultados similares àquelas.

Partindo do pressuposto de que elementos e fatos históricos podem lançar luz às questões contemporâneas, este artigo propõe-se a compreender como crises sanitárias provocadas por epidemias e doenças mais hostis têm afetado a história da cidade do Rio de Janeiro (RJ), de maneira especial no começo do século XX, até a crise sanitária do coronavírus, bem como têm atravessado seu projeto de cidade. Para tanto, inicialmente, a cidade é problematizada com base nos conceitos de ville e cité, propostos por Richard Sennett. Posteriormente, são abordadas as reformas urbanas higienistas de Carlos Sampaio e Carlos Lacerda, no começo do século XX, que projetaram uma imagem de cidade inserida no contexto da modernidade, e o projeto de inserção do Rio de Janeiro no atual mercado de cidades globais, que vem sendo desenhado ao longo dos últimos 20 anos e que culminou nos megaeventos realizados na capital no início do século XXI. Observa-se que o Rio de Janeiro tem convivido, ao longo de sua história, com momentos de doença e saúde, endemias, epidemias e pandemias, como rupturas a desorientar os ritmos cotidianos, a evidenciar suas contradições e fragilidades sociais, econômicas e políticas. Nesses momentos, no entanto, veem-se continuidades ou recorrências de questões relacionadas à desigualdade e à exclusão social, às notícias falsas e trocas de acusações entre as instâncias governamentais, à negação ao conhecimento especializado e às crises econômicas e sociais, que surgem a galope das crises sanitárias.

Objectives:. Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either “early” (within 14 d of intubation) or “late” (more than 14 d after intubation). Design:. International multi-institute retrospective cohort study. Setting:. Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. Patients:. Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. Interventions:. Not applicable. Measurements and Main Results:. A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, −16 to −8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, −23 to −9 d; p < 0.001) and 22 days (95% CI, −31 to −12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8−5.2). Differences in 90-day post-admission survival were not identified. Conclusions:. COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.

This paper evaluated steam and CO2-enhanced gasification of spent coffee ground (SCG) biomass, including energy and exergy aspects focusing on hydrogen production. The waste-to-hydrogen (WTH) conversion was performed via gasification (1000 °C) with a drop-tube-reactor investigating six different steam to biomass (SBR of 0.5, 0.8 and 1.2) and CO2 to biomass (CO2BR 0.09, 0.18 and 0.27) ratios. The syngas production indicated clear improvement against O2/N2 with an H2 yield increase up to 69.21% and 18.32% for steam and CO2 mediums. The energy and exergy analysis points out the 0.8 SBR as the optimum condition with 210% CGE and 48.05% exergy efficiency for H2 production. As a strategy for carbon capture and usage, the medium with 0.27 CO2BR provided a 28.52% exergy efficiency for H2 production and reduced soot formation, showing a potential gasification medium for SCG. Results encourage waste-to-hydrogen prospection within circular economy principles, boosting circular economy principles in urban districts.

Introduction The technology regarding bone-anchored hearing devices has been advancing. Nevertheless, complications are still often reported, which can impair treatment adherence and lead to discontinuation of use. There is a lack of studies conducted in tropical countries, where complications can be even greater, as well as standardized protocols for selection, indication and evaluation. Objective To characterize implanted patients from a Brazilian public institution and describe the medical and audiological assessment protocols to which they were submitted during the selection process and in the follow-up after surgery. Method An observational, cross-sectional study evaluating the medical records of patients with hearing loss and ear malformations and describing the care protocol through which they were treated. Results The medical records of 15 patients were reviewed: 6 received transcutaneous implants, and 9, percutaneous implants; 9 patients reported some type of skin lesion, 2 reported pain on the follow-up visit, and 3 had osseointegration failure. The time between surgery and activation ranged from 2 to 9 months. The median scores on the sentences, Sentences in Noise and Monosyllable tests were 100%, 60% and 80%, respectively. Conclusion It was possible to characterize the patients who received implants at the institution. The patients performed well in silence and had greater difficulty in noise. Even patients who had complications did not complain about the audibility and sound quality. It is essential to develop a model and to standardize the assessment and follow-up methods aimed at the benefit of users of bone-anchored hearing devices, as well as to enable the technico-scientific development in this field.

OBJECTIVES:. Cardiac surgery is frequently associated with significant postoperative bleeding. Platelet-dysfunction is the main cardiopulmonary bypass (CPB)-induced hemostatic defect. Not only the number of platelets decreases, but also the remaining are functionally impaired. Although lipid metabolism is crucial for platelet function, little is known regarding platelet metabolic changes associated with CPB-dysfunction. Our aim is to explore possible contribution of metabolic perturbations for platelet dysfunction after cardiac surgery. DESIGN:. Prospective cohort study. SETTING:. Tertiary academic cardiothoracic-surgery ICU. PATIENTS:. Thirty-three patients submitted to elective surgical aortic valve replacement. INTERVENTIONS:. Samples from patients were collected at three time points (preoperative, 6- and 24-hr postoperative). Untargeted metabolic analysis using high-performance liquid chromatography-tandem mass spectrometry was performed to compare patients with significant postoperative bleeding with patients without hemorrhage. Principal component analyses, Wilcoxon matched-pairs signed-rank tests, adjusted to FDR, and pairwise comparison were used to identify pathways of interest. Enrichment and pathway metabolomic complemented the analyses. MEASUREMENTS AND MAIN RESULTS:. We identified a platelet-related signature based on an overrepresentation of changes in known fatty acid metabolism pathways involved in platelet function. We observed that arachidonic acid (AA) levels and other metabolites from the pathway were reduced at 6 and 24 hours, independently from antiagreggation therapy and platelet count. Concentrations of preoperative AA were inversely correlated with postoperative chest tube blood loss but were not correlated with platelet count in the preoperative, at 6 or at 24 hours. Patients with significant postoperative blood-loss had considerably lower values of AA and higher transfusion rates. Values of postoperative interleukin-6 were strongly correlated with AA variability. CONCLUSIONS AND RELEVANCE:. Our observations suggest that an inflammatory-related perturbation of AA metabolism is a signature of cardiac surgery with CPB and that preoperative levels of AA may be more relevant than platelet count to anticipate and prevent postoperative blood loss in patients submitted to cardiac surgery with CPB.

Advancements in modern medicine have bolstered the usage of home-based rehabilitation services for patients, particularly those recovering from diseases or conditions that necessitate a structured rehabilitation process. Understanding the technological factors that can influence the efficacy of home-based rehabilitation is crucial for optimizing patient outcomes. As technologies continue to evolve rapidly, it is imperative to document the current state of the art and elucidate the key features of the hardware and software employed in these rehabilitation systems. This narrative review aims to provide a summary of the modern technological trends and advancements in home-based shoulder rehabilitation scenarios. It specifically focuses on wearable devices, robots, exoskeletons, machine learning, virtual and augmented reality, and serious games. Through an in-depth analysis of existing literature and research, this review presents the state of the art in home-based rehabilitation systems, highlighting their strengths and limitations. Furthermore, this review proposes hypotheses and potential directions for future upgrades and enhancements in these technologies. By exploring the integration of these technologies into home-based rehabilitation, this review aims to shed light on the current landscape and offer insights into the future possibilities for improving patient outcomes and optimizing the effectiveness of home-based rehabilitation programs.

Black fly larvae (Diptera: Simuliidae) are suspension filter-feeders which strongly depend on water velocity for proper feeding. Black fly species feature different microhabitat preferences. Studies of Holarctic black fly larvae revealed their phenotypic plasticity in response to water current velocity variation, but such studies have been rarely undertaken with Neotropical black flies. The current work presents results on the phenotypic plasticity of the black fly species Simulium nigrimanum Macquart. Twelve last instar larvae, sampled from the Brazilian Cerrado, were photographed under a stereoscopic microscope and measured using the CMEIAS Image tool software. Linear regressions with water velocity as the independent variable were performed, indicating that while body size and anal disk diameter correlated positively with water velocity, labral fan length correlated negatively. The observed relationships between water velocity and labral fan length and anal disk diameter were consistent with the literature, while the pattern of body size variation partially corroborated previous studies. The present work results suggest that potential phenotypic plasticity can be observed in black fly larvae within one population distributed in different microhabitats of the same stream section, as opposed to previous reports implying that such variation is only found among population from different streams.

Abstract In this work, a new mechanism to combine a non-volatile behaviour with the spin diode detection of a vortex-based spin torque nano-oscillator (STVO) is presented. Experimentally, it is observed that the spin diode response of the oscillator depends on the vortex chirality. Consequently, fixing the frequency of the incoming signal and switching the vortex chirality results in a different rectified voltage. In this way, the chirality can be deterministically controlled via the application of electrical signals injected locally in the device, resulting in a non-volatile control of the output voltage for a given input frequency. Micromagnetic simulations corroborate the experimental results and show the main contribution of the Oersted field created by the input RF current density in defining two distinct spin diode detections for different chiralities. By using two non-identical STVOs, we show how these devices can be used as programmable non-volatile synapses in artificial neural networks.

Abstract Background Globally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed. Methods Using a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain. Results There was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5–5 mg of each cannabinoid once or twice daily and titrates by 2.5–5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day. Conclusions In summary, using a modified Delphi process, expert consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain.

Introduction Bone conduction implants, responsible for transmitting sound from an external processor to the inner ear, can be divided into active and passive, depending on the vibratory stimulus location. The use of transcutaneous device has increased, given its aesthetic appeal, the complications and limitations of percutaneous devices, and patient's treatment adherence, focusing mainly on efficacy. However, various complications are associated with the use of transcutaneous prosthesis, which can often be serious. Objective To approach the literature on complications involving transcutaneous bone-anchored prostheses through a systematic review of articles published in the past 10 years (2011–2021). Data Synthesis The MEDLINE, EMBASE, Scopus, and Cochrane Library databases were searched. All articles written in English reporting on currently available transcutaneous prosthesis implantation and its complications were selected. Studies on both children and adults were included. The data on complications were extracted, and complications were classified as minor or major and associated to each device used. Thirty-seven articles were included in the study, of which 14 were prospective cohort studies, 22 were retrospective case series, and 1 was a case report. Most studies (18) included both adults and children. Moreover, 901 implantations were performed, of which 552 implanted Baha Attract (Cochlear Ltd., Sydney, Australia), 244 implanted BoneBridge (MED-EL, Innsbruck, Austria), and 105 implanted Sophono (Sophono Inc., Boulder, CO, USA]). Furthermore, 192 adverse events were reported (total complication rate, 21.3%), with 161 minor complications (84.3%) and 31 major complications (16.1%). Conclusion Transcutaneous prosthesis is an audiological alternative with fewer complications than percutaneous prosthesis. However, its indication should be judicious because complications are common, and although most complications are minor, serious infections requiring explantation may develop.

Eventos científicos concentram significativas discussões no Ensino de Ciências e Biologia. Assim, objetivamos analisar a abordagem do Ensino de Zoologia, enfocando o Filo Cnidaria em eventos científicos. Foram verificados os anais de cinco grandes eventos (ENPEC, CONAPESC, ENEBIO, EREBIO NE e CONGREBIO), quantificados na Área da Zoologia e seu Ensino, e identificados os que envolviam Cnidários. Captamos 16.747 trabalhos, sendo 866 da Área da Zoologia e seu Ensino, e 14 contemplando os Cnidários. O ENEBIO deteve maior número relacionado ao Ensino de Zoologia, apresentando também maior quantidade de trabalhos envolvendo Cnidários. Acreditamos que mais pesquisas possam surgir futuramente a respeito desses animais, com trabalhos que possam dar maior ênfase à importância desses organismos.

The control and manipulation of spin waves holds promise for miniaturized radio-frequency spintronic devices. The authors demonstrate electrical access to the dynamics of magnetic vortices in confined geometries: a new avenue of research for future applications exploiting super high frequency behaviour for microwave communications and computing applications.

Objective: To evaluate the efficacy of surgical treatment to correct the main deformities associated with flexible cavovarus foot due to Charcot-Marie-Tooth disease. Methods: Fifteen patients (18 feet) with flexible cavovarus feet due to Charcot-Marie-Tooth disease were evaluated and underwent surgery between 2000 and 2015. We used a “triple surgery” protocol: a combination of plantar fasciotomy, valgus-inducing osteotomy of the calcaneus, and lengthening osteotomy of the first metatarsal. After a mean follow-up time of 105 (48 to 198) months, we developed a numerical scale to assess the main aspects of patient complaints: pain (3 points), function (3 points) and deformity (4 points). The scale considered the results of the visual analog pain scale, the American Orthopedic Foot and Ankle Society Scale, and the Coleman block test, as well as clinical and radiographic evaluation of gait and cavovarus deformities. Results: According to the numerical scale, the results were considered satisfactory in 15 of the 18 feet (84%) and unsatisfactory in 3 (16%). Conclusion: In the medium term, the “triple surgery” protocol proved efficient for correcting cavovarus deformities, providing functional improvement while preserving mobility without pain complaints. In the final analysis, through the “triple surgery” protocol, early indication for arthrodesis can be avoided, postponing sacrifice of the hindfoot joints. Level of Evidence IV; Therapeutic Studies; Case Series.

In chronic shoulder pain, adaptations in the nervous system such as in motoneuron excitability, could contribute to impairments in scapular muscles, perpetuation and recurrence of pain and reduced improvements during rehabilitation. The present cross-sectional study aims to compare trapezius neural excitability between symptomatic and asymptomatic subjects. In 12 participants with chronic shoulder pain (symptomatic group) and 12 without shoulder pain (asymptomatic group), the H reflex was evoked in all trapezius muscle parts, through C3/4 nerve stimulation, and the M-wave through accessory nerve stimulation. The current intensity to evoke the maximum H reflex, the latency and the maximum peak-to-peak amplitude of both the H reflex and M-wave, as well as the ratio between these two variables, were calculated. The percentage of responses was considered. Overall, M-waves were elicited in most participants, while the H reflex was elicited only in 58–75% or in 42–58% of the asymptomatic and symptomatic participants, respectively. A comparison between groups revealed that the symptomatic group presented a smaller maximum H reflex as a percentage of M-wave from upper trapezius and longer maximal H reflex latency from the lower trapezius (p < 0.05). Subjects with chronic shoulder pain present changes in trapezius H reflex parameters, highlighting the need to consider trapezius neuromuscular control in these individuals’ rehabilitation.

Ears are a particularly difficult region of the human face to model, not only due to the non-rigid deformations existing between shapes but also to the challenges in processing the retrieved data. The first step towards obtaining a good model is to have complete scans in correspondence, but these usually present a higher amount of occlusions, noise and outliers when compared to most face regions, thus requiring a specific procedure. Therefore, we propose a complete pipeline taking as input unordered 3D point clouds with the aforementioned problems, and producing as output a dataset in correspondence, with completion of the missing data. We provide a comparison of several state-of-the-art registration and shape completion methods, concluding on the best choice for each of the steps.

Resumo Um dos fatores mais importantes em qualquer programa de gerenciamento dos recursos hídricos é ter o conhecimento sobre os processos naturais que regulam o ciclo hidrológico. O objetivo desse estudo foi realizar a estimativa da Evapotranspiração de referência (ETo) na bacia hidrográfica do Baixo São Francisco (BSF), com uso do método de Penman-Monteith (PM) recomendado pela Food and Agriculture Organization (FAO), no período de 2009 a 2018. O primeiro passo da pesquisa foi realizar o preenchimento de falhas em dados de superfície, utilizando o método estatístico média preditiva (Predictive Mean Matching-PMM). Após validação desse método, pôde-se estimar a ETo pelo método PM-FAO, onde observou-se que a dinâmica temporal da ETo na maior parte das localidades de estudo segue um padrão semelhante, tendo apenas valores diferentes nos seus máximos e mínimos. Com relação aos valores médios diários de ETo, Pão de Açúcar, em Alagoas, teve o maior valor na região de estudo, 4,69 mm.dia−1 e Arapiraca, também em Alagoas, o menor valor com 4,18 mm.dia−1. A média do total anual acumulado de ETo do BSF para o período foi de 1635,23 mm.ano−1. A baixa ETo observada durante o período chuvoso (abril a julho) está associada às temperaturas mais baixas. O trabalho obteve bons resultados, se comparado com outros estudos já realizados no BSF.

Enquadramento: a disrupção causada pela pandemia COVID-19 no acesso aos cuidados de saúde foi enorme. Muitos enfermeiros recorreram à consulta telefónica ou a outros meios digitais (telenfermagem) para mitigar o impacto na saúde das populações, não existindo recomendações para esta prática. Objetivos: definir recomendações para promover o desenvolvimento e uniformização da prestação de cuidados de telenfermagem em Portugal. Metodologia: projeto promovido pela Secção Regional do Centro da Ordem dos Enfermeiros. Em primeiro lugar, realizou-se uma quickreview da literatura e um levantamento de necessidades e propostas através de um inquérito a enfermeiros e utentes. Formou-se então um Painel de Peritos (n=29) maioritariamente constituído por enfermeiros (referenciados por associações profissionais), mas também por representantes de associações de utentes, gestores, entre outros. Para cada recomendação desenvolvida foi estabelecido o nível de acordo (entre 1 e 10) e esta foi adotada se aprovada por ≥75% dos peritos. Resultados: consensualizaram-se 4 princípios gerais e 10 recomendações para a realização de telenfermagem. Denotam-se como principais preocupações o garante da segurança, qualidade, individualidade dos cuidados, o que requer a adequabilidade de meios humanos, técnicos e formativos/organizativos. Conclusão: estas são as primeiras recomendações para a prestação de telenfermagem, elaboradas por enfermeiros, utentes e outros stakeholders em saúde.

Cystic fibrosis (CF), a life-limiting chronic disease caused by mutations in the cystic fibrosis transmembrane regulator (CFTR) gene, affects more than 90,000 people worldwide. Until recently, the only available treatments were directed to symptom control, but they failed to change the course of the disease. New drugs developed in the last decade have the potential to change the expression, function, and stability of CFTR protein, targeting the basic molecular defect. The authors seek to provide an update on the new drugs, with a special focus on the most promising clinical trials that have been carried out to date. These newly approved drugs that target specific CFTR mutations are mainly divided into two main groups of CFTR modulators: potentiators and correctors. New therapies have opened the door for potentially disease-modifying, personalized treatments for patients with CF.

OBJECTIVES:. The Sequential Organ Failure Assessment (SOFA) score is a predictor of mortality in ICU patients. Although it is widely used and has been validated as a reliable and independent predictor of mortality and morbidity in cardiac ICU, few studies correlate early postoperative SOFA with long-term survival. DESIGN:. Retrospective observational cohort study. SETTING:. Tertiary academic cardiac surgery ICU. PATIENTS:. One-thousand three-hundred seventy-nine patients submitted to cardiac surgery. INTERVENTIONS:. SOFA 24 hours, SOFA 48 hours, mean, and highest SOFA scores were correlated with survival at 12 and 24 months. Wilcoxon tests were used to analyze differences in variables. Multivariate logistic regressions and likelihood ratio test were used to access the predictive modeling. Receiver operating characteristic curves were used to assess accuracy of the variables in separating survivor from nonsurvivors. MEASUREMENTS AND MAIN RESULTS:. Lower SOFA scores have better survival rates at 12 and 24 months. Highest SOFA and SOFA at 48 hours showed to be better predictors of outcome and to have higher accuracy in distinguishing survivors from nonsurvivors than initial SOFA and mean SOFA. A decreasing score during the first 48 hours had mortality rates of 4.9%, while an unchanged or increased score was associated with a mortality rate of 5.7%. CONCLUSIONS:. SOFA score in the ICU after cardiac surgery correlated with survival at 12 and 24 months. Patients with lower SOFA scores had higher survival rates. Differences in survival at 12 months were better correlated with the absolute value at 48 hours than with its variation. SOFA score may be useful to predict long-term outcomes and to stratify patients with higher probability of mortality.

O objetivo deste artigo é apresentar a construção enunciativa-discursivas e a posição axiológica do próprio tradutor-autor da obra tradutória artístico-poética, por meio da análise da tradução comentada. A pesquisa está fundamentada na teoria dialógica da linguagem — advinda de Bakhtin e do Círculo— nos estudos da verbo-visualidade e nos estudos da tradução e da interpretação de língua de sinais (ETILS). A pesquisa apresenta uma abordagem qualitativa e traz como corpus a atividade tradutória artístico-poética(vídeo) realizada pelo tradutor-pesquisador: tradução da canção “Construção” — Chico Buarque de Hollanda — postados no canal YouTube no ano de 2020. A autoanalise mostra que o tradutor e intérprete de língua sinais (TILS), na atividade tradutória, por meio da compreensão ativa-responsiva, recria outro objeto artístico por meio da construção verbo-visual, posiciona-se valorativamente e instaura uma outra autoria. Espera-se que este artigo colabore com a investigação, compreensão e produção da tradução da LP para a libras, incidindo na formação do TILS.

O presente artigo é resultado de uma prática docente realizada junto ao projeto intitulado “Sarau literomusical: poesia, arte e música”, que aconteceu no âmbito da componente curricular de Língua Portuguesa no segundo semestre letivo do ano de 2019, no Colégio da Polícia Militar, Palmas, estado do Tocantins. Nesse sentido, o nosso objetivo é apresentar considerações relevantes acerca do Sarau, discutir sobre a postura investigativa e crítica do aluno e propor uma reflexão sobre a ampliação das práticas pedagógicas via projetos fortalecidos na participação e autoria dos envolvidos. Assim, o estudo apresenta o gênero textual poema como suporte central e articulador das atividades de ensino. O percurso vivenciado proporcionou um rico processo de ensino-aprendizagem que resultou no desenvolvimento de habilidades e competências essenciais para o trabalho docente: planejamento, pesquisa e momentos de ponderações críticas. Trataremos aqui de um evento que aborda os mecanismos de leitura, escrita, criação e exposição de poemas.

Doenças de alto contágio, como o Corona Virus Disease 2019 (COVID-19), podem ser analisadas espacialmente e uma das formas de mapeá-las é por casos desagregados em nível pontual. Essa escala de análise é importante para a formulação de estratégias de proteção da saúde. O georreferenciamento de casos por endereçamento postal é um método recorrente em aplicações do geoprocessamento na saúde. Neste estudo, é apresentada uma validação do georreferenciamento postal automático dos casos de COVID-19 no município de Uberaba, MG para um período de 14 dias. Foi utilizada a base de endereços do Google Maps (GM) por meio dos softwares Google Earth (GE) e QGIS. O procedimento consistiu em georreferenciar 391 casos por consulta manual à base do GM, com apoio de imagens do Google Street View. Os resultados foram utilizados como referência para analisar o desempenho do georreferenciamento automático no GE e QGIS, este segundo, com uso do complemento MMQGIS. Houve variações significativas entre os métodos automáticos quando aplicadas diferentes combinações de endereço, como: rua, número, CEP, bairro, cidade, estado e país. O melhor desempenho foi do complemento MMQGIS, que processa o Maps JavaScript API. Quando combinados os campos Rua, Número e Cidade resultou em 82,8% de georreferenciamentos corretos. A geocodificação automática é um ponto de partida para o mapeamento de casos, acelerando tarefas de marcação de pontos, mas, devido as possibilidades de erros, como os mostrados no presente estudo, não se deve dispensar os trabalhos de pós edição, antes da produção de mapas destinados às ações de vigilância epidemiológica.

Abstract Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune inflammatory disease. However, some patients may exhibit a histological pattern of kidney injury, with characteristics indistinguishable from lupus nephritis, but without presenting any extrarenal symptoms or serologies suggestive of SLE. Such involvement has recently been called non-lupus full-house nephropathy. The objective is to report a series of clinical cases referred to the Laboratory of the Federal University of Maranhão that received the diagnosis of "full-house" nephropathy unrelated to lupus, upon immunofluorescence and to discuss its evolution and outcomes. Non-lupus full-house nephropathy represents a diagnostic and therapeutic challenge, because it is a new entity, which still needs further studies and may be the initial manifestation of SLE, isolated manifestation of SLE or a new pathology unrelated to SLE.