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Polycyclic aromatic hydrocarbons (PAHs) are organic compounds ubiquitous in the environment and known for their toxic, mutagenic, and carcinogenic effects. These compounds can bioaccumulate in the biota and be transferred through trophic webs. The franciscana dolphin (Pontoporia blainvillei), as top predators, can be an environmental sentinels. Thus, this study aimed to provide data about PAHs concentration in their hepatic tissue collected on the coast of Espírito Santo (Franciscana Management Area, FMA Ia), Rio de Janeiro (FMA IIa), and São Paulo states (FMA IIb), in Southeastern Brazil. PAHs were detected in 86 % of franciscana dolphins (n = 50). The highest ∑PAHsTotal median concentration was reported in FMA Ia followed by FMA IIb and FMA IIa (1055.6; 523.9, and 72.1 ng.g-1 lipid weight, respectively). Phenanthrene was detected in one fetus and two neonates, showing maternal transfer of PAHs in these dolphins. Evaluating PAHs with potential toxic effects is of utmost importance for the conservation of a threatened species.
Assuntos
Golfinhos , Monitoramento Ambiental , Hidrocarbonetos Policíclicos Aromáticos , Poluentes Químicos da Água , Animais , Hidrocarbonetos Policíclicos Aromáticos/análise , Hidrocarbonetos Policíclicos Aromáticos/metabolismo , Poluentes Químicos da Água/análise , Poluentes Químicos da Água/metabolismo , Golfinhos/metabolismo , Oceano Atlântico , Brasil , FemininoRESUMO
Organochlorine compounds (OCs) are persistent organic pollutants linked to damaging the immune and endocrine systems, leading to a greater susceptibility to infectious diseases at high concentrations. Sepetiba Bay, in the Southeastern Brazilian coast, historically presents anthropogenic activities and environmental contamination that could negatively impact resident populations. In this context, this study aimed to investigate the temporal trends in the accumulation of organochlorine compounds over a 12-year database in the Guiana dolphins' (Sotalia guianensis) resident population from Sepetiba Bay, including individuals collected before, during, and after an unusual mortality event triggered by morbillivirus (n = 85). The influence of biological parameters was also evaluated. The OCs concentrations in the blubber ranged from 0.98 to 739 µg/g of ΣPCB; 0.08-130 µg/g of ΣDDT; <0.002-4.56 µg/g of mirex; <0.002-1.84 µg/g of ΣHCH and <0.001-0.16 µg/g of HCB in lipid weight. Increased temporal trends were found for OCs in Guiana dolphins coinciding with periods of large events of dredging in the region. In this way, our findings suggest that the constant high OCs concentrations throughout the years in this Guiana dolphin population are a result of the constant environmental disturbance in the area, such as dredging. These elevated OCs levels, e.g., ΣPCB concentrations found above the known thresholds, may impair the response of the immune system during outbreak periods, which could lead the population to a progressive decline.
Assuntos
Golfinhos , Hidrocarbonetos Clorados , Bifenilos Policlorados , Poluentes Químicos da Água , Animais , Baías , Estuários , Poluentes Químicos da Água/toxicidade , Poluentes Químicos da Água/análise , Hidrocarbonetos Clorados/toxicidade , Monitoramento AmbientalRESUMO
Hepatic and pulmonary lesions are common in cetaceans, despite their poorly understood viral etiology. Herpesviruses (HV), adenoviruses (AdV) and hepatitis E virus (HEV) are emerging agents in cetaceans, associated with liver and/or pulmonary damage in mammals. We isolated and molecularly tested DNA for HV and AdV (n = 218 individuals; 187 liver and 108 lung samples) and RNA for HEV (n = 147 animals; 147 liver samples) from six cetacean families. All animals stranded or were bycaught in Brazil between 2001 and 2021. Positive-animals were analyzed by histopathology. Statistical analyses assessed if the prevalence of viral infection could be associated with the variables: species, family, habitat, region, sex, and age group. All samples were negative for AdV and HEV. Overall, 8.7% (19/218) of the cetaceans were HV-positive (4.8% [9/187] liver and 11.1% [12/108] lung), without HV-associated lesions. HV-prevalence was statistically significant higher in Pontoporiidae (19.2%, 10/52) when compared to Delphinidae (4.1%, 5/121), and in southeastern (17.1%, 13/76)-the most industrialized Brazilian region-when compared to the northeastern region (2.4%, 3/126). This study broadens the herpesvirus host range in cetaceans, including its description in pygmy sperm whales (Kogia breviceps) and humpback whales (Megaptera novaeangliae). Further studies must elucidate herpesvirus drivers in cetaceans.
Assuntos
Infecções por Adenoviridae , Vírus da Hepatite E , Herpesviridae , Jubarte , Humanos , Animais , Brasil/epidemiologia , Adenoviridae/genética , Herpesviridae/genética , Infecções por Adenoviridae/epidemiologia , Infecções por Adenoviridae/veterinária , Fígado , PulmãoRESUMO
INTRODUCTION: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. METHODS: The study included all patients admitted between 2009 and 2019 with a diagnosis of «PPHF¼. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. RESULTS: Seventy-eight patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45-92). Sixty-nine patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was 1 139 650.17. The average cost was 14 610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). CONCLUSIONS: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was 14 610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.
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Trace elements bioaccumulation patterns can be an important tool to assess differences among cetaceans' populations. In this work, their use as potential chemical markers to differentiate franciscanas (Pontoporia blainvillei) populations was evaluated. Franciscanas were collected from three states in southeastern Brazil, which comprise three different Franciscana Management Areas (FMAs): Espírito Santo (FMA Ia), southern Rio de Janeiro (FMA IIa), and central São Paulo (FMA IIb). The concentrations of As, Cd, Cu, Fe, Hg, Mn and Zn were determined in the muscle, liver and kidney of the animals. Cadmium was the most valuable chemical marker to differentiate stocks, separating at least FMA IIa from the others. The higher Cd levels in FMA IIa, along with dietary information, indicate that the predominant consumption of cephalopods by this population is the main reason for the differences found. Additionally, environmental characteristics of the areas should also be considered as divergent sources of trace elements. Our findings suggest that non-essential trace elements, such as Cd, can be successful markers to differentiate populations. The Mn concentrations in FMA Ia raised concern and must be carefully monitored, as well as other elements that compose the iron ore tailings that have impacted the Espírito Santo coastal area. Additionally, this is the first study to report trace element concentration in the franciscanas from FMA IIa (southern Rio de Janeiro). Trace element concentrations found in franciscanas may represent different contamination levels in their preys and environments, which might pose specific threats to distinct populations. Therefore, our findings are important to characterize and differentiate franciscana populations and to guide precise management and conservation actions for the distinct stocks of this endangered species.
Assuntos
Golfinhos , Oligoelementos , Poluentes Químicos da Água , Animais , Oceano Atlântico , Bioacumulação , Brasil , Cádmio , Monitoramento Ambiental , Oligoelementos/análise , Poluentes Químicos da Água/análiseRESUMO
INTRODUCTION: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. METHODS: The study included all patients admitted between 2009 and 2019 with a diagnosis of "PPHF". We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. RESULTS: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45-92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was 1,139,650.17. The average cost was 14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). CONCLUSIONS: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was 14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.
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One of the largest environmental disasters worldwide occurred on November 5th, 2015, when the Fundão dam collapsed in Mariana (Minas Gerais State, Southeast Brazil). The tailing mud flooded the Doce River basin and reached the sea in the coast of Espírito Santo State (ES), Southeast Brazil. This coastal region is the habitat of the most isolated population of franciscana dolphins (Pontoporia blainvillei), with the lowest populational census and lowest genetic diversity in Franciscana Management Area Ia (FMA Ia) - 18° 25'S and 21° 17'S. This study aimed to assess the bioaccumulation of trace-elements (As, Cd, Cu, Fe, Hg, Mn, and Zn) in muscle, liver and kidney of franciscana dolphins collected near the Doce River's mouth before (n = 32) and after (n = 19) the tailing mud reached the sea. The Generalized Additive Model (GAM) showed increasing temporal trends of Hg and Zn in muscle and liver after the dam failure, probably related to higher concentrations and bioavailability in the water column and sediments from the Doce River. Declining trends were found for As and Cu muscular and hepatic concentrations and Fe concentrations in kidney due to their lower bioavailability after the disaster, caused by association with tailings mud trapped in the riverbanks and suspended particulate material. Additionally, higher As and Hg concentrations found in the first period of sampling may be due to historical contamination by mining activities. The full extent of the impacts caused by the Fundão dam failure is still unknown. However, due to their rapid increase and remobilization process, toxic effects can be induced in the biota by these elements. Elements' bioaccumulation in this study contributes to the knowledge of franciscana dolphins from FMA Ia. Considering the conservation concern regarding this franciscana population and its scarce knowledge, the impact of this disaster can be alarming for species conservation.
Assuntos
Desastres , Golfinhos , Oligoelementos , Poluentes Químicos da Água , Animais , Bioacumulação , Brasil , Monitoramento Ambiental , Mineração , Rios , Oligoelementos/análise , Poluentes Químicos da Água/análiseRESUMO
The density, colour and texture, plus mineral and chemical features of 18 ceramic-like CDW samples from the Abruzzo region (Central Italy) were characterised. The concretes, natural stones, tiles, roof-tiles, bricks and perforated bricks are either aphanitic to porphyric. Concretes and natural stones are grey to white and tend to be > 2.0 g/cm3; the masonries are brown to reddish and close to < 2.0 g/cm3. Concrete and natural stone are rich or even exclusively made up of calcite, with high amounts of CaO (>40 wt%) and LOI (volatiles, CO2 + H2O). The masonries are instead calcite-, CaO- (<25 wt%) and LOI-poor (<8 wt%) but enriched in SiO2 (45 to 70 wt%) stabilised as quartz and/or cristobalite, with significant amount of Al2O3 (12 to 20 wt%). S and Cl contents are similar among concrete, bricks and perforated bricks. The petrography of CDW concretes is similar among geographical areas with abundance of limestones used as aggregates. However, in limestone-poor areas CDW are SiO2- and Al2O3-rich, reflecting the prevalent use of masonry and/or silicate-rich construction materials, implying that each geographical area is characterised by peculiar CDW composition. Therefore, the knowledge of mesoscopic, physical and petrographic aspects has to be known for planning adequate sorting methods, promoting upcycling reusing applications. Some of the studied CDW samples are susceptible to release relative high Cr and As content.
Assuntos
Indústria da Construção , Gerenciamento de Resíduos , Materiais de Construção , Resíduos Industriais/análise , Itália , Reciclagem , Dióxido de SilícioRESUMO
Objetivo: Averiguar a efetividade da utilização da cirurgia de MOHS no manejo de tumores cutâneos tipo não melanoma em comparação a outros métodos de terapia. Métodos: O estudo consiste em uma revisão sistemática, cuja coleta de artigos ocorreu nas bases de dados MEDLINE, PubMed Central (PMC), LILACS e SciELO, utilizando os termos "Cirurgia de MOHS", "Câncer de pele", "Ensaio clínico", excluindo "melanoma". Resultados: Do total de 132 artigos identificados, foram considerados elegíveis 11. A análise dos artigos demonstrou que a CMM, comparada a outros métodos, apresentou resultados estéticos melhores, além de menor grau de complicações em tumores recorrentes e um custo/benefício variável com o país onde foi feita operação. A CMM também apresentou menores índices de recorrência em todos os estudos. Conclusão: No geral, a cirurgia de MOHS se mostrou um método terapêutico promissor. No entanto, existem ainda poucos estudos comparativos sobre a eficácia da CMM e os que existem se concentram em poucas regiões do mundo. (AU)
Objective: Evaluating the effectiveness of using MOHS surgery in the management of non-melanoma skin tumors compared to other therapy methods. Methods: The study consists of a systematic review, whose search for articles was performed using databases MEDLINE, PubMed Central (PMC), LILACS and SciELO, using the terms "MOHS surgery", "Skin cancer", "Clinical trial", excluding "melanoma". Results: from a total of 132 identified articles, 11 were considered eligible. The analysis of the articles showed that MMS, compared to other methods, presented better cosmetic results, in addition to a lower grade of complications in recurrent tumors and a variable cost/benefit according to the country where the surgery was performed. MMS also had lower recurrence rates in all studies. Conclusion:Overall, MOHS surgery has shown promising therapeutic results. However, there are still few comparative studies on the effectiveness of MMS and those that exist are concentrated in a few regions of the world. (AU)
Assuntos
Humanos , Recidiva , Neoplasias Cutâneas , Efetividade , Cirurgia de Mohs , Custos e Análise de Custo , MelanomaRESUMO
Epithelioma cuniculatum is characterized as a slow growing lesion on the sole of the foot. A diagnosis is usually delayed by a low clinical suspicion and misdirection due to its similarity to an infection. This tumor rarely metastasize but a local invasion of adjacent soft tissues is common, requiring ample surgical resection or even amputation in advanced cases. We report a case a 76-year-old patient with a 5-year-old lesion on the sole of the foot, which was originally treated as a wart without improvement while the lesion slowly evolved. The patient was referred to our center with a diagnosis of chronic osteomyelitis. An excisional biopsy revealed an invasive keratinizing squamous carcinoma. In this advanced phase of the disease the only possible treatment was a Syme amputation.
El epitelioma cuniculatum se caracteriza por una lesión de crecimiento lento en la planta del pie cuyo diagnóstico suele retrasarse por la baja sospecha clínica y por su similitud con una infección. Este tumor raramente metastatiza, pero es común que produzca una invasión local a los tejidos blandos adyacentes, requiriendo una amplia resección quirúrgica o incluso una amputación en casos avanzados. Presentamos un caso de un paciente de 76 años con una lesión de 5 años de edad en la planta del pie, que originalmente fue tratada como una verruga plantar común sin mejoría, mientras que la lesión evolucionó lentamente. El paciente fue remitido a nuestro centro con un diagnóstico de osteomielitis crónica. Una biopsia excisional reveló un carcinoma escamoso queratinizante invasivo. En esta fase avanzada de la enfermedad el único tratamiento posible fue una amputación de Syme.
Assuntos
Neoplasias Ósseas , Carcinoma Verrucoso , Doenças do Pé , Idoso , Amputação Cirúrgica , Pré-Escolar , Pé , Doenças do Pé/diagnóstico , Doenças do Pé/cirurgia , HumanosRESUMO
INTRODUCTION: The COVID-19 pandemic has led to the confinement of approximately one third of the world population, causing a drastic change in the activities of daily life with many repercussions at the health, economic and social levels. OBJECTIVES: The objective of the present work is to present the epidemiological variations in the production of fractures in the period of mandatory confinement in our reference population. METHODS: Analytical retrospective comparative study of two groups of patients: Group A: patients admitted before the state of alarm that forced confinement in the period from January 13 to March 13 compared to Group B: patients admitted in the two months of confinement, until the de-escalation period began, March 13-May 13. Epidemiological variables including age, personal history, type of fracture, mechanism of injury, outpatient rate, and hospital stay were recorded. RESULTS: A total of 190 patients were included. 112 in the pre-confinement period and 78 in the confinement (30% decrease). The mean age (p = 0.007) and falls at home (p < 0.001) were higher in the confinement group. The postoperative (p = 0.006) and overall (p < 0.001) hospital stay were significantly less in the confinement group. No differences were found in the anatomical location of the lesion, sex, comorbidities, mechanism of injury, outpatient rate, or death. CONCLUSIONS: Based on the results of our study, the period of forced confinement due to the COVID-19 pandemic has produced a drastic decrease in the total number of fractures admitted to the traumatology service of a third level hospital. On the other hand, osteoporotic hip fractures have not varied in their incidence and a decrease in the average postoperative and overall stay has been observed.
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The water produced (PW) by the petroleum industry is a potential contaminant to aquatic biota, due to its complex mixture that may contain polycyclic aromatic hydrocarbons (PAHs), organic chemical compounds, including benzene, toluene, ethylbenzene and xylene (BTEX), metals and other components that are known to be toxic. The aim of this investigation was to examine the acute toxicity produced by a PW sample in aquatic organisms Vibrio fischeri and Daphnia similis prior to and after 4 treatments using advanced oxidative processes such as photocatalysis, photoelectrocatalysis, ozonation and photoelectrocatalytic ozonation. Data demonstrated that exposure to PW was toxic to both organisms, as evidenced by reduced luminescence in bacterium Vibrio fischeri and induced immobility in Daphnia similis. After treatment of PW with 4 different techniques, the PW remained toxic for both tested organisms. However, photoelectrocatalysis was more efficient in decreasing toxicity attributed to PW sample. Therefore, data demonstrate the importance of treating PW for later disposal in the environment in order to mitigate ecotoxicological impacts. Further photoelectrocatalysis appeared to be a promising tool for treating PW samples prior to disposal and exposure of aquatic ecosystems.
Assuntos
Organismos Aquáticos/efeitos dos fármacos , Indústria de Petróleo e Gás , Eliminação de Resíduos Líquidos/métodos , Poluentes Químicos da Água/química , Poluentes Químicos da Água/toxicidade , Aliivibrio fischeri/efeitos dos fármacos , Animais , Daphnia/efeitos dos fármacos , Oxigênio/química , Petróleo/toxicidade , Testes de Toxicidade AgudaRESUMO
Abstract: Epithelioma cuniculatum is characterized as a slow growing lesion on the sole of the foot. A diagnosis is usually delayed by a low clinical suspicion and misdirection due to its similarity to an infection. This tumor rarely metastasize but a local invasion of adjacent soft tissues is common, requiring ample surgical resection or even amputation in advanced cases. We report a case a 76-year-old patient with a 5-year-old lesion on the sole of the foot, which was originally treated as a wart without improvement while the lesion slowly evolved. The patient was referred to our center with a diagnosis of chronic osteomyelitis. An excisional biopsy revealed an invasive keratinizing squamous carcinoma. In this advanced phase of the disease the only possible treatment was a Syme amputation.
Resumen: El epitelioma cuniculatum se caracteriza por una lesión de crecimiento lento en la planta del pie cuyo diagnóstico suele retrasarse por la baja sospecha clínica y por su similitud con una infección. Este tumor raramente metastatiza, pero es común que produzca una invasión local a los tejidos blandos adyacentes, requiriendo una amplia resección quirúrgica o incluso una amputación en casos avanzados. Presentamos un caso de un paciente de 76 años con una lesión de 5 años de edad en la planta del pie, que originalmente fue tratada como una verruga plantar común sin mejoría, mientras que la lesión evolucionó lentamente. El paciente fue remitido a nuestro centro con un diagnóstico de osteomielitis crónica. Una biopsia excisional reveló un carcinoma escamoso queratinizante invasivo. En esta fase avanzada de la enfermedad el único tratamiento posible fue una amputación de Syme.
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Persistent organic pollutants (POPs) were determined in Gymnura altavela liver samples from one of the most impacted estuarine environments in the Atlantic Ocean (Guanabara Bay, Brazil). PCBs were the predominant compounds (91.2%) averaging 6773 ± 4659 ng.g-1 lipid weight (lw). DDT, Mirex, HCH and HCB concentrations were 633 ± 715, 6.2 ± 9.3, 3.4 ± 1.4 and 0.5 ± 0.5 ng.g-1 lw, respectively. Recent DDT input in the estuary was minimum, as verified by the p,p'-DDE/∑DDT ratio (0.67). The prevalence of industrial compounds was highlighted by the ΣDDT/ΣPCB ratio (0.08). A negative correlation detected between disc width and PCBs, Mirex and HCH concentrations may be a consequence of maternal offloading. High POP concentrations in G. altavela liver samples from Guanabara Bay suggests that PCBs, in particular, may pressure the conservation of this threatened with extinction tropical estuarine batoid species.
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Hidrocarbonetos Clorados , Bifenilos Policlorados , Poluentes Químicos da Água , Animais , Oceano Atlântico , Brasil , Espécies em Perigo de Extinção , Monitoramento Ambiental , Hidrocarbonetos Clorados/análise , Poluentes Orgânicos Persistentes , Bifenilos Policlorados/análise , Poluentes Químicos da Água/análiseRESUMO
An unusual mortality event (UME) attributed to morbillivirus infection was identified in two Guiana dolphin populations from the Southeastern Brazilian coast. The aim of this study was to characterize total mercury (THg), methylmercury (MeHg) and selenium (Se) bioaccumulation and body burden in Guiana dolphins from Sepetiba Bay (RJ) collected before (n = 61) and during the UME (n = 20). Significantly lower Se concentrations were found in the livers of individuals collected during the UME (Mann-Whitney test; p = 0.03), probably due to impairment of the detoxification process in the liver. There were differences in THg and Se concentrations in the organs and tissues of individuals (Kruskal-Wallis test, p < 0.05), but not MeHg (Kruskal-Wallis test, p = 0.07). For THg, the liver showed the higher concentrations and differed among organs and tissues analyzed such as blubber (Tukey's test for unequal N; p = 0.003). For Se concentrations, the skin and kidney presented the higher concentrations and varied among other tissues/organs, like muscle (Tukey's test for unequal N; p = 0.02). Differences in body burdens were observed among specimens collected previously and during the UME probably due to the remobilization and transport of the muscle-stored MeHg to other tissues/organs. This abrupt input of MeHg into the bloodstream may cause serious health damage. Indeed, evidences of methylmercury intoxication was observed in Guiana dolphins in Sepetiba Bay. In conclusion, bioaccumulation patterns, the detoxification process and body burden were affected by morbillivirus.
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Golfinhos , Mercúrio , Compostos de Metilmercúrio , Morbillivirus , Selênio , Poluentes Químicos da Água , Animais , Carga Corporal (Radioterapia) , Brasil , Monitoramento Ambiental , Humanos , Mercúrio/análise , Compostos de Metilmercúrio/análise , Compostos de Metilmercúrio/toxicidade , Selênio/análise , Poluentes Químicos da Água/análise , Poluentes Químicos da Água/toxicidadeRESUMO
CONTEXT: Active surveillance (AS) of thyroid cancer with serial ultrasounds is a newer management option in the United States. OBJECTIVE: This work aimed to understand factors associated with the adoption of AS. METHODS: We surveyed endocrinologists and surgeons in the American Medical Association Masterfile. To estimate adoption, respondents recommended treatment for 2 hypothetical cases appropriate for AS. Established models of guideline implementation guided questionnaire development. Outcome measures included adoption of AS (nonadopters vs adopters, who respectively did not recommend or recommended AS at least once; and partial vs full adopters, who respectively recommended AS for one or both cases). RESULTS: The 464 respondents (33.3% response) demographically represented specialties that treat thyroid cancer. Nonadopters (45.7%) were significantly (Pâ <â .001) less likely than adopters to practice in academic settings, see more than 25 thyroid cancer patients/year, be aware of AS, use applicable guidelines (Pâ =â .04), know how to determine whether a patient is appropriate for AS, have resources to perform AS, or be motivated to use AS. Nonadopters were also significantly more likely to be anxious or have reservations about AS, be concerned about poor outcomes, or believe AS places a psychological burden on patients. Among adopters, partial and full adopters were similar except partial adopters were less likely to discuss AS with patients (Pâ =â .03) and more likely to be anxious (Pâ =â .04), have reservations (Pâ =â .03), and have concerns about the psychological burden (Pâ =â .009) of AS. Few respondents (3.2%) believed patients were aware of AS. CONCLUSION: Widespread adoption of AS will require increased patient and physician awareness, interest, and evaluation of outcomes.
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Padrões de Prática Médica/estatística & dados numéricos , Neoplasias da Glândula Tireoide/terapia , Conduta Expectante , Adulto , Carcinoma/diagnóstico , Carcinoma/epidemiologia , Carcinoma/patologia , Carcinoma/terapia , Estudos Transversais , Endocrinologistas/normas , Endocrinologistas/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/estatística & dados numéricos , Otorrinolaringologistas/normas , Otorrinolaringologistas/estatística & dados numéricos , Médicos/normas , Médicos/estatística & dados numéricos , Padrões de Prática Médica/normas , Medição de Risco , Cirurgiões/normas , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Carga Tumoral , Estados Unidos/epidemiologia , Conduta Expectante/métodos , Conduta Expectante/normas , Conduta Expectante/estatística & dados numéricosRESUMO
In the present study, we analyzed a unique phytophysiognomy in the Amazon region, which is formed by savanna-like vegetation on iron-rich soil (known locally as canga) located within an iron-ore mining region. We used the habitat template theory to test the hypothesis that changes in the physical-chemical properties of streams and the physical structure of their habitats at in-stream and micro-basin (landscape) levels affect the taxonomic and trophic composition of immature aquatic insects. For this, we used a local environmental matrix composed of nine physical-chemical and structural habitat variables, together with the Habitat Integrity Index. We also calculated landscape metrics based on the area of the micro-basin, such as relief, slope, mean current flow, and vegetation cover. We divided the aquatic insects into five functional feeding groups based on their diet and food sources. Our results indicate that changes in the trophic level of the insects of the orders Ephemeroptera, Plecoptera, and Trichoptera are more easily observed than the taxonomic structure of communities. The loss of environmental integrity and vegetation cover were responsible for 84% of the variation observed in the composition of functional feeding groups (FFGs). Our study shows that aquatic insect communities in the canga and in the Amazon regions dominated by forest require specific in-stream and landscape conditions. These findings reinforce the need for the preservation of areas of canga vegetation, which not only have a unique levels of biological diversity, but are also targeted for the exploitation of their economically valuable natural resources.
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Biodiversidade , Insetos/classificação , Rios , Animais , Organismos Aquáticos/classificação , Brasil , FlorestasRESUMO
Acoustic data was collected across 15 sites distributed through the coastal area of Rio de Janeiro, Brazil, encompassing regions of different natural characteristics. Noise levels and the acoustic complexity index were calculated. Quantity and composition of anthropogenic sound sources varied across recording sites, with at least one type of sound source being registered in each location. A cluster analysis using third-octave levels from eight frequency bands divided recording sites into two groups, one considered as impacted by anthropogenic noise and the other as less-impacted. The noisiest recording locations were those with higher numbers of anthropogenic sound sources, specifically large ships. It was evidenced that anthropogenic noise affects not only noise levels, but also low-frequency acoustic complexity, which decreased in the presence of vessel traffic. The constant noise input of human activities tended to mask natural variability in the soundscape at lower frequencies.
Assuntos
Ruído , Som , Acústica , Brasil , Humanos , NaviosRESUMO
INTRODUCTION: There is currently great controversy about the ideal treatment of intraarticular calcaneal fractures. The objective of this study is to determine the usefulness of postoperative computed tomography (CT). PATIENTS AND METHODS: We conducted a retrospective descriptive study of patients operated on in the period 2007 to 2015 in our center. Epidemiological variables, specific fracture data, surgical intervention as well as results and complications were collected. The radiological evaluation was performed using simple radiology (Böhler angle) and coronal CT (congruence of posterior subtalar joint). For the functional results we use the AOFAS hindfoot scale and the EVA scale for the level of pain. RESULTS: We included 46 fractures in 43 patients (three bilateral). Thirty-five were male and eight female, with an average age of 42 years (18-79) and an average follow-up of 57.39 months (33-129). Preoperative CT was performed in all cases, of which 11 were Sanders ii, 23 type iii and 12 type iv. Postoperative CT was only performed in 17 cases. The subsequent subtalar reduction measured by CT was satisfactory (articular step < 2 mm) in 12 cases. The average presurgical Böhler angle was 6.45 ± 10.21 ([-22]-25) and the post-surgical angle of 20.46 ± 7.09 (4-38). Subtalar osteoarthritis developed in 19 cases (symptomatic in 12) and calcaneo-cuboid osteoarthritis in six cases (only one symptomatic). The AOFAS was 74.28 ± 18.98 (27-100) and the EVA was 4.14 ± 2.98 (2-9). A CT scan with a step of less than 2 mm was statistically significant, with a higher result on the AOFAS scale (77.17 average points) as well as lower EVA on average (2.83) (p = 0.002). Regarding the Böhler, it was statistically significant the relationship of an angle > 20° post-surgical with higher AOFAS (80.82) and lower VAS (3.18) (p = 0.001). The literature search obtained a total of 117 articles that met the search criteria, of which only 29 requested postoperative CT. CONCLUSIONS: The indication of postoperative CT in patients operated by intraarticular calcaneal fracture is the best technique to corroborate the correct reduction of the subtalar joint surface, although it is not universally accepted, according to the literature.
Assuntos
Calcâneo/lesões , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Articulação Talocalcânea/cirurgia , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Calcâneo/diagnóstico por imagem , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Fraturas Intra-Articulares/classificação , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Estudos Retrospectivos , Articulação Talocalcânea/diagnóstico por imagem , Resultado do Tratamento , Adulto JovemRESUMO
Decision aids (DAs) are evidence-based tools that support shared decision-making (SDM) implementation in practice; this study aimed to identify existing osteoporosis DAs and assess their quality and efficacy; and to gain feedback from a patient advisory group on findings and implications for further research. We searched multiple bibliographic databases to identify research studies from 2000 to 2019 and undertook an environmental scan (search conducted February 2019, repeated in March 2020). A pair of reviewers, working independently selected studies for inclusion, extracted data, evaluated each trial's risk of bias, and conducted DA quality assessment using the International Patient Decision Aid Standards (IPDAS). Public contributors (patients and caregivers with experience of osteoporosis and fragility fractures) participated in discussion groups to review a sample of DAs, express preferences for a new DA, and discuss plans for development of a new DA. We identified 6 studies, with high or unclear risk of bias. Across included studies, use of an osteoporosis DA was reported to result in reduced decisional conflict compared with baseline, increased SDM, and increased accuracy of patients' perceived fracture risk compared with controls. Eleven DAs were identified, of which none met the full set of IPDAS criteria for certification for minimization of bias. Public contributors expressed preferences for encounter DAs that are individualized to patients' own needs and risk. Using a systematic review and environmental scan, we identified 11 decision aids to inform patient decisions about osteoporosis treatment and 6 studies evaluating their effectiveness. Use of decision aids increased accuracy of risk perception and shared decision-making but the decision aids themselves fail to comprehensively meet international quality standards and patient needs, underpinning the need for new DA development.