[Trauma Injuries Associated with Rope Bullfights in the Azores: A Cross-Sectional Study]

INTRODUCTION

The aim of the study was to describe trauma injuries associated with rope bullfights in the Azores, Portugal, regarding the cause of the incident, trauma mechanism, most affected anatomical areas, and injury severity.

METHODS

Two-year cross-sectional study in the local hospital with prospective data collection. Patients who were consecutively admitted to the local hospital's emergency department with trauma injuries from the bull's direct impact or from falls either during the bull's escape or when handling the rope, were included. Data on general demographics, lesion characteristics, treatments, need for hospitalization and mortality were collected.

RESULTS

Fifty-six incidents and 80 trauma injuries were identified. The main cause of trauma was the bull's direct impact (37; 66.07%) and the mechanism of injury was blunt trauma in all patients (100%; 56). Head and neck injuries (27; 33.75%) were the most common. The median Injury Severity Score at the emergency department admission was 4. Major trauma was noted in five patients (8.92%). Ten patients (17.85%) needed hospitalization with a median hospital stay of seven days. Three of the 10 hospitalized patients (30%) were previously admitted to the intensive care unit. Surgery was performed in six patients (10.71%).

CONCLUSION

The main cause of trauma was the bull's direct impact, and the mechanism of injury was blunt trauma. The most affected anatomical areas were the head and neck. These findings are a wake-up call to the impact of these events regarding the economic costs they entail, the costs for the health of the local population, the safety measures currently implemented and the availability of the necessary means to treat these patients.

Treatment of intracardiac thrombi using ultra-slow low-dose thrombolytic therapy: A case report

A 57-year-old male with previously known severe primary mitral regurgitation was admitted to the intensive care unit (ICU) due to massive venous thromboembolism, associated with right ventricular dysfunction and two large mobile right atrial thrombi. Due to deterioration in his clinical condition despite standard treatment with unfractionated heparin, it was decided to use an ultra-slow low-dose thrombolysis protocol, which consisted of a 24-hour infusion of 24 mg of alteplase at a rate of 1 mg per hour, without initial bolus. The treatment was continued for 48 consecutive hours, with clinical improvement and resolution of the intracardiac thrombi and no complications. One month after ICU admission, successful mitral valve repair surgery was conducted. This case demonstrates that ultra-slow low-dose thrombolysis is a valid bailout treatment option in patients with large intracardiac thrombi refractory to the standard approach.

Predicting kill sites of an apex predator from GPS data in different multiprey systems

Kill rates are a central parameter to assess the impact of predation on prey species. An accurate estimation of kill rates requires a correct identification of kill sites, often achieved by field-checking GPS location clusters (GLCs). However, there are potential sources of error included in kill-site identification, such as failing to detect GLCs that are kill sites, and misclassifying the generated GLCs (e.g., kill for nonkill) that were not field checked. Here, we address these two sources of error using a large GPS dataset of collared Eurasian lynx (Lynx lynx), an apex predator of conservation concern in Europe, in three multiprey systems, with different combinations of wild, semidomestic, and domestic prey. We first used a subsampling approach to investigate how different GPS-fix schedules affected the detection of GLC-indicated kill sites. Then, we evaluated the potential of the random forest algorithm to classify GLCs as nonkills, small prey kills, and ungulate kills. We show that the number of fixes can be reduced from seven to three fixes per night without missing more than 5% of the ungulate kills, in a system composed of wild prey. Reducing the number of fixes per 24 h decreased the probability of detecting GLCs connected with kill sites, particularly those of semidomestic or domestic prey, and small prey. Random forest successfully predicted between 73%-90% of ungulate kills, but failed to classify most small prey in all systems, with sensitivity (true positive rate) lower than 65%. Additionally, removing domestic prey improved the algorithm's overall accuracy. We provide a set of recommendations for studies focusing on kill-site detection that can be considered for other large carnivore species in addition to the Eurasian lynx. We recommend caution when working in systems including domestic prey, as the odds of underestimating kill rates are higher.

Family Satisfaction With Critical Care: Before and After the COVID-19 Outbreak

Introduction Family satisfaction with intensive care units (ICU) is recognized as a key component of the quality of care. As a result, family members are now more involved in the care process, and their needs are recognized throughout the ICU stay. The coronavirus disease 2019 (COVID-19) changed healthcare worldwide, due to the several restrictions imposed; the communication patterns changed drastically, and institutions were forced to adapt to create a balance between security and the needs of relatives. The aim of this study was to assess family members' satisfaction with the ICU and determine if the COVID-19 restructuring affected family satisfaction. Methods A prospective observational study was performed among the designated family members (DFM) of ICU patients over two time periods, a pre-pandemic period from December 2019 to February 2020 and a pandemic period from May 2020 to February 2021. The Family Satisfaction in the Intensive Care Unit 24 (FS-ICU 24) questionnaire, which was given to the DFM, was the instrument used to determine family satisfaction. Results The study involved 290 DFM, 175 during the pre-pandemic phase and 115 during the pandemic period. The overall and domain-specific family satisfaction scores were high (score > 80) in both the pre-pandemic and pandemic periods. The greatest satisfaction levels were related with symptom management and how nurses and doctors cared for the patient. No statistical differences were found between the two time periods. Lastly, a positive association between the two domains explored by FS-ICU 24, satisfaction with care and satisfaction with decision-making process, was verified in both time frames. Conclusion The data obtained revealed very good outcomes on the different FS-ICU 24 domains, in line with other studies in literature. No significant differences were found between the pre-pandemic and pandemic periods, suggesting that the measures implemented during the COVID-19 were successful. The importance of involving families in the decision-making process, providing them with accurate information, and active listening, as well as using better communication skills, is emphasized throughout all these results. The relevance of measuring family satisfaction should be brought to the attention of family members and healthcare professionals so that additional research may be conducted.

[Bacterial Coinfection in Patients with SARS-CoV-2 in an Intensive Care Unit in Portugal]

N/a.

Trends in osteoporosis care patterns during the COVID-19 pandemic in Alberta, Canada

PURPOSE/INTRODUCTION

The objective of this study was to describe osteoporosis-related care patterns during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada, relative to the 3-year preceding.

METHODS

A repeated cross-sectional study design encompassing 3-month periods of continuous administrative health data between March 15, 2017, and September 14, 2020, described osteoporosis-related healthcare resource utilization (HCRU) and treatment patterns. Outcomes included patients with osteoporosis-related healthcare encounters, physician visits, diagnostic and laboratory test volumes, and treatment initiations and disruptions. The percent change between outcomes was calculated, averaged across the control periods (2017-2019), relative to the COVID-19 periods (2020).

RESULTS

Relative to the average control March to June period, all HCRU declined during the corresponding COVID-19 period. There was a reduction of 14% in patients with osteoporosis healthcare encounters, 13% in general practitioner visits, 9% in specialist practitioner visits, 47% in bone mineral density tests, and 13% in vitamin D tests. Treatment initiations declined 43%, 26%, and 35% for oral bisphosphonates, intravenous bisphosphonates, and denosumab, respectively. Slight increases were observed in the proportion of patients with treatment disruptions. In the subsequent June to September period, HCRU either returned to or surpassed pre-pandemic levels, when including telehealth visits accounting for 33-45% of healthcare encounters during the COVID periods. Oral bisphosphonate treatment initiations remained lower than pre-pandemic levels.

CONCLUSIONS

This study demonstrates the COVID-19 pandemic and corresponding public health lockdowns further heightened the "crisis" around the known gap in osteoporosis care and altered the provision of care (e.g., use of telehealth and initiation of treatment). Osteoporosis has a known substantial care and management disparity, which has been classified as a crisis. The COVID-19 pandemic created additional burden on osteoporosis patient care with healthcare encounters, physician visits, diagnostic and laboratory tests, and treatment initiations all declining during the initial pandemic period, relative to previous years.

Trends in osteoporotic fracture and related in-hospital complications during the COVID-19 pandemic in Alberta, Canada

Fragility fractures (i.e., low-energy fractures) account for most fractures among older Canadians and are associated with significant increases in morbidity and mortality. Study results suggest that low-energy fracture rates (associated with surgical intervention and outcomes) declined slightly, but largely remained stable in the first few months of the COVID-19 pandemic.

PURPOSE/INTRODUCTION

This study describes rates of low-energy fractures, time-to-surgery, complications, and deaths post-surgery in patients with fractures during the coronavirus disease (COVID-19) pandemic in Alberta, Canada, compared to the three years prior.

METHODS

A repeated cross-sectional study was conducted using provincial-level administrative health data. Outcomes were assessed in 3-month periods in the 3 years preceding the COVID-19 pandemic and in the first two 3-month periods after restrictions were implemented. Patterns of fracture- and hospital-related outcomes over the control years (2017-2019) and COVID-19 restrictions periods (2020) were calculated.

RESULTS

Relative to the average from the control periods, there was a slight decrease in the absolute number of low-energy fractures (n = 4733 versus n = 4308) during the first COVID-19 period, followed by a slight rise in the second COVID-19 period (n = 4520 versus n = 4831). While the absolute number of patients with low-energy fractures receiving surgery within the same episode of care decreased slightly during the COVID-19 periods, the proportion receiving surgery and the proportion receiving surgery within 24 h of admission remained stable. Across all periods, hip fractures accounted for the majority of patients with low-energy fractures receiving surgery (range: 58.9-64.2%). Patients with complications following surgery and in-hospital deaths following fracture repair decreased slightly during the COVID-19 periods.

CONCLUSIONS

These results suggest that low-energy fracture rates, associated surgeries, and surgical outcomes declined slightly, but largely remained stable in the first few months of the pandemic. Further investigation is warranted to explore patterns during subsequent COVID-19 waves when the healthcare system experienced severe strain.

Active surveillance protocol in prostate cancer in Portugal

OBJECTIVE

To examine clinical practice patterns in locally managing patients under an active surveillance protocol among Portuguese urologists.

INTRODUCTION

Prostate cancer (PCa) is a heterogeneous disease with many prostate adenocarcinomas being indolent and a low probability of ever causing symptoms or death. Active surveillance (AS) is a form of conservative management aimed to reduce over-treatment for low-risk PCa patients. Over the years, experience with AS has grown considerably and is now standard in some countries, however a universal protocol still does not exist.

METHODS

Nationwide anonymous e-survey concerning habits and practices on AS among Portuguese urologists, that consisted of twelve questions and was sent electronically to all 368 current members of the Portuguese Urological Association.

RESULTS

56 urologists were surveyed (15.21% answer rate), evenly distributed geographically and allocated according to years of experience as well as number of PCa patients managed monthly. The vast majority of respondents recommends AS to their patients, particularly ISUP grade 1 patients, whose PSA serum level is bellow 20 ng/mL. Observance of AS programs by patients was not in question but concerns exist over psychological morbidity while harboring disease. Majority believed that international guidelines surveillance protocols were adequate and sufficient, but there are some constraints concerning availability of periodic MRIs and re-biopsy needs.

CONCLUSIONS

AS seems to be sustained in urologist clinical practice, although patients still lag to adhere and choose for active treatment. AS may not be an easy choice for patients and clinicians due to uncertainty of disease progression, risk of loss to follow-up and repeated biopsies but is also a cause for anxiety, depression, uncertainty and a perception of danger.

Multi-seasonal systematic camera-trapping reveals fluctuating densities and high turnover rates of Carpathian lynx on the western edge of its native range

Camera-trapping and capture-recapture models are the most widely used tools for estimating densities of wild felids that have unique coat patterns, such as Eurasian lynx. However, studies dealing with this species are predominantly on a short-term basis and our knowledge of temporal trends and population persistence is still scarce. By using systematic camera-trapping and spatial capture-recapture models, we estimated lynx densities and evaluated density fluctuations, apparent survival, transition rate and individual's turnover during five consecutive seasons at three different sites situated in the Czech-Slovak-Polish borderland at the periphery of the Western Carpathians. Our density estimates vary between 0.26 and 1.85 lynx/100 km² suitable habitat and represent the lowest and the highest lynx densities reported from the Carpathians. We recorded 1.5-4.1-fold changes in asynchronous fluctuated densities among all study sites and seasons. Furthermore, we detected high individual's turnover (on average 46.3 ± 8.06% in all independent lynx and 37.6 ± 4.22% in adults) as well as low persistence of adults (only 3 out of 29 individuals detected in all seasons). The overall apparent survival rate was 0.63 ± 0.055 and overall transition rate between sites was 0.03 ± 0.019. Transition rate of males was significantly higher than in females, suggesting male-biased dispersal and female philopatry. Fluctuating densities and high turnover rates, in combination with documented lynx mortality, indicate that the population in our region faces several human-induced mortalities, such as poaching or lynx-vehicle collisions. These factors might restrict population growth and limit the dispersion of lynx to other subsequent areas, thus undermining the favourable conservation status of the Carpathian population. Moreover, our study demonstrates that long-term camera-trapping surveys are needed for evaluation of population trends and for reliable estimates of demographic parameters of wild territorial felids, and can be further used for establishing successful management and conservation measures.

Impacts of social distancing during the covid19 pandemic on the development of children with autism in Brazil

Introduction

COVID-19 is a respiratory disease and its main symptoms are fever, dry cough and difficulty breathing. It spread to several countries, which led the World Health Organization to decree, on March 11, 2020, a pandemic state that deeply affected Brazil. Due to the impossibility of leaving the house, the routine of children with autism was changed. Children in Autism Spectrum Disorder (ASD) have a qualitative deficit in social interaction. Clinical and daily observations reinforce several scientific studies that defend the importance of maintaining a routine as stable as possible for people with ASD, without this stability they may become emotionally disorganized, feel discomfort or even irritability.

Objectives

Investigate the impact caused by social distancing on the development of children and adolescents with autism.

Methods

An online questionnaire based on the DIR/Floortime basic map of emotional functional capacity development was distributed in Brazil from April to May, 2020. The results were analyzed using SPSS software.

Results

Results obtained from 122 questionnaires showed that after 30 days of quarantine 20% of children no longer had the characteristic of being able to remain calm and organized for at least 2 minutes; 11% no longer initiates interactions with their parents; 27% demonstrated more protests and anger than before the social distancing; 18% demonstrated more emotions such as anger, fear and intimacy, 28% began to understand their limits and 12% of the children are using greater facial expression during the social distancing.

Conclusions

This study brings results that can help to understand the processes in a child with autism.

Discrimination of Benign and Malignant Lesions in Canine Mammary Tissue Samples Using Raman Spectroscopy: A Pilot Study

Breast cancer is a health problem that affects individual life quality and the family system. It is the most frequent type of cancer in women, but men are also affected. As an integrative approach, comparative oncology offers an opportunity to learn more about natural cancers in different species. Methods based on Raman spectroscopy have shown significant potential in the study of the human breast through the fingerprinting of biological tissue, which provides valuable information that can be used to identify, characterize and discriminate structures in breast tissue, in both healthy and carcinogenic environments. One of the most important applications of Raman spectroscopy in medical diagnosis is the characterization of microcalcifications, which are highly important diagnostic indicators of breast tissue diseases. Raman spectroscopy has been used to analyze the chemical composition of microcalcifications. These occur in benign and malignant lesions in the human breast, and Raman helps to discriminate microcalcifications as type I and type II according to their composition. This paper demonstrates the recent progress in understanding how this vibrational technique can discriminate through the fingerprint regions of lesions in unstained histology sections from canine mammary glands.

The Functioning of Outreach Programs Of/On the Street and the Work Processes of the Nurse

Problem

Homeless people (PSR) are a heterogeneous and fragile group. They are among the most excluded ones from health service access because they cannot present a regular home. They are also a population who have great difficulty of accessing the entrance and mostly search only for emergency and urgency services when their lives are at stake. This intervention is important because it aims at decreasing the inequalities to health access and, moreover, it decreases the difficulties to health access.

Description of the problem

A field visit to an outreach program on the street (CR) in Belo Horizonte was made on April, 22nd and on May, 6th in 2019. This program is linked to a Health Center. The objectives were knowing the functioning of outreach programs on the street and understanding the assignments and participation of the team nurse on working with PSR.

Results

By acting with and approaching PSR, the nurse can create contact and humanized listening. This is an attempt to establish user / professional bonds. During this contact, the professional struggles to encourage the user to search the health attention net. This professional also approaches the rupture with home, with the family, with the work, and with others. He/She tries to support users to face the challenges and to stimulate social reinsertion as well. Tests on the street to detect HIV/AIDS and syphilis are made, guaranteeing the individual privacy right. By approaching PSR, it is crucial that the nurse, who is part of the multi-professional team, be free of any prejudice and stigmas which can make the attendance success difficult. The application of health expanded concept was also present because it considers the complexity of health, mainly to those who inhabit the streets.

Lessons

The nurse can succeed in facing inequity. This decreases not only the barriers established by social inequalities but also the organizational barriers PSR are exposed all the time.

Key messages

Attendance prioritizes local care. It not only tries to attend social and health problems but also shared actions with Health Centers. At last, it should be an example to other countries. It is important for health professionals to reinvent their practices, searching partnerships and the acquisition of new knowledge to succeed in decreasing individuals’ demands.

Profile of incarcerated women in the interior of Brazil and the challenge of education in prison

According to the Ministry of Justice and Public Security, Brazil is fourth in the world position in relation to the absolute size of female prison population, with 42.000 women deprived of freedom (2016), behind the United States, China and Russia. Around 50% are young (< 29 years old), 62% are black and 66% have not yet attended high school. This study aimed to characterize the profile of women incarcerated in a penitentiary in the interior of Brazil, through the survey of sociodemographic data, education, health, legal and life expectations. This is a descriptive and exploratory study conducted with 68 women (20 to 67 years old) in 2019 and 2020. Most women declared themselves black or brown (56%), incomplete elementary school (42%), have work experience (73%). Around 69% reported needing health treatment and 76% have already used psychoactive substances including alcohol, cigarettes, marijuana, cocaine or crack. The main reasons that led to the arrest were drug trafficking (54%) and theft (26%) and the majority (53%) are repeat offenders in prison system. Regarding the biggest dream of life, the main answers were related to family life (44%), having a job (26%) and access to education (20%). With these results, an extension project was proposed to offer a professional qualification in vegetable gardens, aromatic and medicinal plants for women prisoners. In addition to professional qualification, the project is dedicated to promoting debates on map of life, ethics, human relations, citizenship, gender, women's rights and health, quality of life, body and verbal expression, digital inclusion, food and nutrition security, entrepreneurship, cooperativism, solidary economy, rights and duties of the worker, aiming at better employment conditions. This research contributed to articulate actions between university and society, empower women through access to education and allowed the work team to develop competencies related to collaborative work and interdisciplinarity.

Key messages

This study aimed to characterize the profile of women incarcerated in a penitentiary in Brazil, through the survey of sociodemographic data, education, health, legal and life expectations. This research contributed to articulate actions between university-society, empower incarcerated women through access to education and allowed the work team collaborative and interdisciplinarity work.

Microtomographic characterization of calcifications in canine mammary tumours

The present work describes the microtomographic characterization of macro- and microcalcifications present in excised canine mammary glands. In human breast cancer, microcalcifications are highly relevant for diagnosis and prognosis, often being the sole element determining biopsy. Canine mammary tumours are considered a model for human breast cancer, but the morphological features of calcifications had still to be studied in this species. The objective of this research is to contribute to the characterization of the mineralization features of the canine mammary gland. In the present study, the excised mammary glands of 33 bitches underwent fluoroscopic examination. In 30 of the samples, the presence of calcification was suspected, and multiple biopsies were taken of these areas. Biopsy fragments underwent microtomographic scanning. Microcalcifications were found in non-neoplastic glandular tissue, benign and malign lesions, as it is known to happen in humans. Qualitative evaluation regarding morphology of the imaged calcifications showed similarities to breast cancer findings, based on the BI-RADS 2013 classification, such as pleomorphism and shape. No differences in the quantitative morphological parameters of volume, surface, surface/volume, SMI and structure thickness were found when macrocalcifications were considered. However, although significant differences existed in these parameters between microcalcifications from malignant canine mammary tumours and the two other groups, none were found between non-neoplastic and benign tumours. Findings further support the use of this spontaneous animal model for the study of human breast cancer, considering how clinically relevant microcalcifications are in humans.

Impaired decision-making and time perception in individuals with stroke: Behavioral and neural correlates

Several studies have demonstrated that stroke subjects present impairment of functions related to decision-making and timing, involving the information processing in the neural circuits of the cerebellum in association with the prefrontal cortex. This review is aimed to identify the gaps, and demonstrate a better understanding of decision-making and timing functions in the patients with stroke. Electronic literature database was searched and the findings of relevant studies were used to explore the mechanisms of decision-making and timing in patients with stroke, as well as the circuit connections in timing mediated by prefrontal cortex and cerebellum. A literature review was conducted with 65 studies that synthesized findings on decision-making and time perception in individuals with stroke. Types of neurobiological modalities in this study included: Relationships among decision-making, time perception, related cognitive aspects (such as discrimination tasks, verbal estimation, bisection tasks, time production and motor reproduction), and motor control. We demonstrate that the timing processes are important for the performance in cognitive tasks and that the cerebellum and prefrontal cortex are involved in decision-making and time perception. In the context, the decision-making is impaired in stroke patients has a great impact on executive functions, and this seems to be important in determining neurobiological aspects relevant to the time interval interpretation.

Adhesion in Dentin Prepared with Er,Cr:YSGG Laser: Systematic Review

Background:

In dentistry, cavities prepared with Erbium lasers present more advantages, compared to traditional methods, but there is still a lack of investigation about the adhesion in dentin surfaces prepared with Erbium lasers, especially with Erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser.

Aim:

The purpose of this systematic review was to find out which might be “The most adequate adhesive and laser parameters for adhesion in dentin prepared with Er,Cr:YSGG laser.”

Methods:

An electronic search was performed in the PubMed database. The search was limited to studies between 2009 and 2016.

Results:

Ten articles were selected to the systematic review according to TRANSPARENT REPORTING of Systematic Reviews and Meta-ANALYSES checklist.

Conclusions:

The adhesive that showed the best bond strength results in dentin prepared with Er,Cr:YSGG laser was the self-adhesive Clearfil™ SE (Kuraray), with preconditioning with 40% phosphoric acid. The settings 2 W, 75% water, 60% air, 140 μs pulse duration, and 20 Hz showed the best adhesion outcome.

Reduction of Breast Cancer Treatment Delay as a Result of Efforts Carried Out by Two Brazilian NGOs

Background: Brazilian breast cancer patients present disease often at advanced stages (III, IV). Previous studies indicated that system delay is a causal factor of bad prognosis and increased mortality rate. In the state of Paraíba, northeast of Brazil, two non-governmental organizations (NGOs) Américas Amigas and Mulheres de Peito de Campina Grande (MLDP), promote faster access to treatment by donating diagnostic mammography and biopsies as well as anatomo-histopathological and immunohistochemical analysis. Aim: The current study aimed at evaluating the effectiveness of the assistance provided by both NGOs and comparing patient flow between HNL and FAP, two reference cancer centers in João Pessoa and Campina Grande, respectively. Methods: Time-to-treatment was analyzed for different time intervals between first medical consultation and initiation of treatment. Comparison was performed between three groups of patients: 40 patients from Hospital Napoleão Laureano (HNL) in João Pessoa; 80 patients from Fundação Assistencial da Paraíba (FAP) in Campina Grande and 15 patients from FAP, who received support from the NGOs. Kaplan-Meier analysis was performed to compare time-intervals among the groups. To estimate the impact of socioeconomic variables Cox regression analysis was performed. Results: Mean time-interval between first medical consultation and hospital admission was 135 (SD=21.0), 370 (SD=73.7) and 515 (SD=36.6) days, for patients of HNL, MLDP and FAP, respectively ( P = 0.0021). Time intervals analyzed for patients within the FAP hospital, between first medical consultation and hospital admission, tended to be shorter for patients who were assisted by the NGOs, compared with those who did not receive any assistance from the NGOs. Patients who had consulted specialized oncological health services beforehand had an increased chance (HZ=2.32; 95% CI: 1.17-4.60; P = 0.016) of being admitted at the reference hospital within 90 days after the first medical consultation, compared with those who had not consulted such specialized services. There were no significant differences between HNL and FAP, regarding the time interval between hospital admission and treatment initiation ( P = 0.21). Conclusion: The assistance to patients provided by the two NGOs, aimed at speeding up the diagnosis process, accelerated patient flow between first medical consultation and admission at the hospitals. Regarding HNL, patients from the inland had been sent by primary health units in their municipalities, directly to the cancer reference hospital in João Pessoa, without being referred to an in-between health service. Such procedure explains the variation of time intervals when admissions at FAP and HNL are compared. The results of the current study indicate that by providing faster breast cancer diagnosis, the NGOs’ mediation can significantly improve patient flow.

Alopecia ou Algo Mais…

O Kerion celsi é uma forma rara e inflamatória de tinha do couro cabeludo, causada por fungos dermatófitos.1Apresenta-se clinicamente com placas e nódulos supurativos, cobertos de exsudado viscoso e crostas sobre áreas pilosas, sendo muitas vezes erroneamente diagnosticada como infeção bacteriana. Há queda de cabelos, podendo evoluir para alopecia cicatricial definitiva.2,3Descrevemos o caso de uma criança do sexo masculino, com três anos de idade, previamente saudável, sem história de viagens recente. [...] Albarrán F, Desgarennes MD, Guzmán EC. Tiña inflamatoria de la cabeza (Querión de Celso) por Microrporum canis. Comuni-cación de un caso. Rev Cent Dermatol Pascua. 2006;15:35-9.1. Albarrán F, Desgarennes MD, Guzmán EC. Tiña inflamatoria de la cabeza (Querión de Celso) por Microrporum canis. Comuni-cación de un caso. Rev Cent Dermatol Pascua. 2006;15:35-9. Silva I, Morais RB, Francisco T, Dessai S, Pastilha P, Cunha F. Dois casos de Quérion por Trichophyton mentagrophytes. Nascer Crescer. 2012;21:237-40. Anahory B, Santos P, Borges M. Querion do couro cabeludo – a propósito de um caso clínico. Rev Port Med Geral Fam. 2013;29:394-7.

Females know better: Sex-biased habitat selection by the European wildcat

The interactions between animals and their environment vary across species, regions, but also with gender. Sex-specific relations between individuals and the ecosystem may entail different behavioral choices and be expressed through different patterns of habitat use. Regardless, only rarely sex-specific traits are addressed in ecological modeling approaches. The European wildcat (Felis silvestris silvestris) is a species of conservation concern in Europe, with a highly fragmented and declining distribution across most of its range. We assessed sex-specific habitat selection patterns for the European wildcat, at the landscape and home range levels, across its Iberian biogeographic distribution using a multipopulation approach. We developed resource selection functions in a use-availability framework using radio-telemetry data from five wildcat populations. At the landscape level, we observed that, while both genders preferentially established home ranges in areas close to broadleaf forests and far from humanized areas, females selected mid-range elevation areas with some topographic complexity, whereas males used lowland areas. At the home range level, both females and males selected areas dominated by scrublands or broadleaf forests, but habitat features were less important at this level. The strength of association to habitat features was higher for females at both spatial levels, suggesting a tendency to select habitats with higher quality that can grant them enhanced access to shelter and feeding resources. Based on our results, we hypothesize that sex-biased behavioral patterns may contribute to the resilience of wildcats' genetic integrity through influencing the directionality of hybridization with domestic cats. Our study provides information about European wildcats' habitat use in an Iberian context, relevant for the implementation of conservation plans, and highlights the ecological relevance of considering sex-related differences in environmental preferences.

Effect of carbohydrate mouth rinse on exercise performance in horses

The mechanism related to the practice of oral carbohydrate (CHO) supplementation prior to intense exercise of a short duration (<30 min) for athletic horses remains unclear. Several studies in human athletes showed that the central nervous system played an important role in the enhancement of athletic performance due to CHO contact with undefined receptors in the oropharyngeal mucosa. This study aims to investigate the influence of CHO mouth rinse on the exercise performance of horses. In this double blind, randomised, placebo-controlled study, seven Mangalarga Marchador horses underwent a standardised exercise test (SET) in a field. The following protocols involving a single mouthwash (1 litre) had been used: a mouth rinse of 6.4% maltodextrin-water solution (CHO test), and a mouth rinse of only water solution (placebo test). The mean plasma lactate concentration immediately after SET (lactate peak) was higher in the CHO test (24.33±3.72 mmol/l) than in the placebo test (18.19±4.01 mmol/l), (P<0.001). No difference was observed in the mean time-to-exhaustion, mean and maximum heart rate, plasma glucose concentration and serum creatinine-kinase activity. Several studies described that there were improvements in the time-trial performance of cyclists and runners after a mouth rinse of CHO solution, whereas some did not. Carbohydrate mouth rinse had no influence on exercise performance in this study. Further investigations are required, as the significance of an increased plasma lactate concentration due to a CHO mouth rinse has yet to be elucidated.

Pulp tissue response to Portland cement associated with different radio pacifying agents on pulpotomy of human primary molars

The objective of this research was to evaluate the response of Portland cement associated with different radio pacifying agents on pulp treatment of human primary teeth by clinical and radiographic exams and microscopic analysis. Thirty mandibular primary molars were randomly divided into the following groups: Group I - Portland cement; Group II - Portland cement with iodoform (Portland cement + CHI3 ); Group III - Portland cement with zirconium oxide (Portland cement + ZrO2 ); and treated by pulpotomy technique (removal of a portion of the pulp aiming to maintain the vitally of the remaining radicular pulp tissue using a therapeutic dressing). Clinical and radiographic evaluations were recorded at 6, 12 and 24 months follow-up. The teeth at the regular exfoliation period were extracted and processed for histological analysis. Data were tested using statistical analysis with a significance level of 5%. The microscopic findings were descriptively analysed. All treated teeth were clinically and radiographically successful at follow-up appointments. The microscopic analysis revealed positive response to pulp repair with hard tissue barrier formation and pulp calcification in the remaining roots of all available teeth. The findings of this study suggest that primary teeth pulp tissue exhibited satisfactory biological response to Portland cement associated with radio pacifying agents. However, further studies with long-term follow-up are needed to determine the safe clinical indication of this alternative material for pulp therapy of primary teeth.

Copper phytoremediation by a salt marsh plant (Phragmites australis) enhanced by autochthonous bioaugmentation

Here we evaluated whether the potential of Phragmites australis to phytoremediate Cu contaminated sediments could be enhanced by bioaugmentation with an autochthonous microorganism consortium (AMC) that is resistant to Cu. Saltmarsh plants with sediment attached to their roots were collected, placed in vessels and kept in greenhouses, under tidal simulation. Sediments were contaminated with Cu and the AMC was added to half of the vessels. After two months, plants accumulated significant amounts of Cu (2-10 times more) in all tissues although in higher amounts (7-10 times more) in belowground structures. AMC addition increased Cu bioavailability (5-10%) in sediments leading to a decrease in belowground structures biomass. However, bioaugmentation increased Cu translocation, with higher amounts (2 times more) of Cu in the plant stems, without significant visual toxicity signs. Therefore, autochthonous bioaugmentation can increase Cu phytoextraction potential of P. australis, which can be a valuable strategy for the recovery and management of moderately impacted estuaries.

Instrumented hip implants: electric supply systems

Instrumented hip implants were proposed as a method to monitor and predict the biomechanical and thermal environment surrounding such implants. Nowadays, they are being developed as active implants with the ability to prevent failures by loosening. The generation of electric energy to power active mechanisms of instrumented hip implants remains a question. Instrumented implants cannot be implemented without effective electric power systems. This paper surveys the power supply systems of seventeen implant architectures already implanted in-vivo, namely from instrumented hip joint replacements and instrumented fracture stabilizers. Only inductive power links and batteries were used in-vivo to power the implants. The energy harvesting systems, which were already designed to power instrumented hip implants, were also analyzed focusing their potential to overcome the disadvantages of both inductive-based and battery-based power supply systems. From comparative and critical analyses of the methods to power instrumented implants, one can conclude that: inductive powering and batteries constrain the full operation of instrumented implants; motion-driven electromagnetic energy harvesting is a promising method to power instrumented passive and active hip implants.

Biochemistry of adipose tissue: an endocrine organ

Adipose tissue is no longer considered to be an inert tissue that stores fat. This tissue is capable of expanding to accommodate increased lipids through hypertrophy of existing adipocytes and by initiating differentiation of pre-adipocytes. Adipose tissue metabolism exerts an impact on whole-body metabolism. As an endocrine organ, adipose tissue is responsible for the synthesis and secretion of several hormones. These are active in a range of processes, such as control of nutritional intake (leptin, angiotensin), control of sensitivity to insulin and inflammatory process mediators (tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), resistin, visfatin, adiponectin, among others) and pathways (plasminogen activator inhibitor 1 (PAI-1) and acylation stimulating protein (ASP) for example). This paper reviews some of the biochemical and metabolic aspects of adipose tissue and its relationship to inflammatory disease and insulin resistance.

Excess mortality and morbidity during the July 2006 heat wave in Porto, Portugal

The purpose of this study was to understand the effects of the July 2006 heat wave through the use of the heat index, in mortality (all causes) and morbidity (all causes, respiratory and circulatory diseases) in general, and in people over 74 years and by gender, in Porto. In this paper, the Poisson generalized additive regression model was used to estimate the impact of apparent temperature (heat index) and daily mortality and morbidity during the July 2006 heat wave. Daily mortality, morbidity and heat index were correlated with lags of apparent temperature up to 7 days using Pearson correlation. For a 1°C increase in mean apparent temperature we observed a 2.7 % (95 % CI: 1.7-3.6 %) increase in mortality (all cause), a 1.7 % (95 % CI: 0.6-2.9 %) increase in respiratory morbidity, a 2.2 % (95 % CI: 0.4-4.1 %) increase in respiratory morbidity in women, a 5.4 % (95%CI: 1.1-6.6 %) increase in chronic obstructive pulmonary morbidity, and a 7.5 % (95 % CI: 1.3-14.1 %) increase in chronic obstructive pulmonary morbidity in women, for the entire population. For people ≥ 75 years, our results showed a 3.3 % increase (95 % CI: 1.7-5.0 %) in respiratory morbidity, a 2.7 % (95 % CI: 0.4-5.1 %) increase in respiratory morbidity in men, a 3.9 % (95 %CI: 1.6-6.3 %) increase in respiratory morbidity in women, a 7.0 % (95 % CI: 1.1-13.2 %) in chronic obstructive pulmonary disease, and a 9.0 % (95 % CI: 0.3-18.5 %) in chronic obstructive pulmonary disease in women. The use of heat index in a Mediterranean tempered climate enabled the identification of the effects of the July 2006 heat wave in mortality due to all causes and in respiratory morbidity of the general population, as well as in respiratory morbidity of individuals with more than 74 years of age.

Effects of Game Location, Period, and Quality of Opposition in Elite Handball Performances

The aims of the present study were to identify (i) home advantage in elite handball according to the quality of opponent, (ii) the game periods where the teams score more goals, and (iii) the game statistics associated with the teams' success according to the game's location. The sample comprised 480 regular season games (2007–2009) from the Spanish Professional Handball League. The goals scored and shot effectiveness (6 m, 7 m, 9 m and fast breaks) were analyzed for each 5-min. game period in games between players of balanced and unbalanced quality. The home advantage was 64%, with higher values (71%) in balanced and lower values (55%) in unbalanced games. The 5-min. game periods in which teams scored more goals were the last 5-min. period of each half, especially in the second half. The effectiveness was only different in shots closer to the goal (6 m), which supports the territoriality theory of home advantage.

Portable miniaturized extracorporeal membrane oxygenation systems for H1N1-related severe acute respiratory distress syndrome: a case series

BACKGROUND

Technological advances improved the practice of "modern" extracorporeal membrane oxygenation (ECMO). In the present report, we describe the experience of a referral ECMO center using portable miniaturized ECMO systems for H1N1-related severe acute respiratory distress syndrome (ARDS).

METHODS

An observational study of all patients with H1N1-associated ARDS treated with ECMO in Hospital S. João (Porto, Portugal) between November 2009 and April 2011 was performed. Extracorporeal membrane oxygenation support was established using either ELS or Cardiohelp systems (Maquet-Cardiopulmonary-AG, Hirrlingen, Germany).

RESULTS

Ten adult patients with severe ARDS secondary to H1N1 infection (Pao(2)/fraction of inspired oxygen, 69 mm Hg [56-84]; Murray score, 3.5 [3.5-3.8]) were included, and 60% survived to hospital discharge. Five patients were uneventfully transferred on ECMO from referring hospitals to our center by ambulance. Six patients were treated during the first postpandemic influenza season. All patients were treated with oseltamivir, and 1 received in addition zanamivir. Four patients received corticosteroids. Nosocomial infection was the most common complication (40%). Of the 4 deaths, 2 were caused by hemorrhagic shock; 1, by irreversible multiple organ failure; and 1, by refractory septic shock.

CONCLUSION

In our experience, ECMO support was a valuable therapeutic option for H1N1-related severe ARDS. The use of portable miniaturized systems allowed urgent rescue of patients from referring hospitals and safe interhospital and intrahospital transport during ECMO support.

[Positive bronchoalveolar lavage and quantitative cultures results in suspected late-onset ventilator associated penumonia evaluation--retrospective study]

INTRODUCTION

Bronchoalveolar lavage (BAL) with quantitative cultures has been used in order to increase ventilator associated pneumonia (VAP) diagnosis specificity, although the accurate technique for this entity diagnosis remains controversial.

OBJECTIVES

To evaluate the influence of using positive BAL and quantitative cultures results in microbiologic diagnosis and treatment of patients with suspected late VAP and prior antibiotherapy.

MATERIAL AND METHODS

Retrospective analysis of intensive care unit (UCI) patients, during a one year period, with clinical suspicion of late VAP and prior use of antibiotics that presented a growth in BAL cultures.

RESULTS

Of 243 BAL performed, there were 71 (29.2%) positive cultures (60 patients, 76.7% male, 54 ± 19 years). BAL was done after 13 days (median) of invasive mechanical ventilation, 11 days of ICU antibiotherapy and in the day in which a new antibiotic for VAP suspicion was started. Colony forming units (CFU)/ml count was performed in 71.8% and endotracheal aspirate (ETA) simultaneously collected for qualitative analysis in 85.9%. Therapeutic approach was changed in 38.0%: correction (16.9%), de-escalation (12.7%) and directed antibiotherapy start (8.4%). Therapeutic changes were made in the presence of CFU > 10(4) in 84.2% and in agreement with ETA in 70.8%. In cases in which antibiotherapy was maintained (62.0%), quantitative cultures would have allowed de-escalation in 9.1%. Changes in prescription were more frequent when CFU was > 10(4) (48.5%), comparing with situations in which counts were lower and BAL analysis was qualitative (28.9%), p = 0.091. There were no significant differences between patients submitted to different therapeutic approaches concerning to ICU mortality or length of stay.

CONCLUSION

In late onset VAP, positive BAL and quantitative cultures allowed therapeutic changes, leading to antibiotic adequacy and consumption reduction, which can however be maximised.