Análise dos registros perioperatórios baseados na sistematização da assistência de enfermagem perioperatória: estudo transversal / Analysis of perioperative records based on the systematization of perioperative nursing care: a cross-sectional study / Análisis de registros perioperatorios a partir de la sistematización de la atención de enfermería perioperatoria: estudio transversal

Objetivo: analisar os registros perioperatórios baseados nas etapas de sistematização da assistência de enfermagem perioperatória em um hospital regional público do agreste de Pernambuco. Método: estudo transversal, descritivo, com abordagem quantitativa, obtido com dados secundários, conduzido em um hospital público. A amostra foi composta por 276 prontuários de indivíduos que se submeteram a procedimentos anestésico-cirúrgicos, durante os meses de janeiro a maio de 2023. Utilizou-se a análise descritiva e inferencial. Resultados: a efetuação dos registros da sistematização da assistência de enfermagem perioperatória foi predominante na maioria do período perioperatório, com respectiva significância principalmente no pré-operatório. Conclusão: as atividades satisfatórias corresponderam à visita pré-operatória de enfermagem, histórico, diagnóstico e prescrição de enfermagem. Já as fragilidades identificadas destacaram-se a ausência de reservas sanguíneas, a verificação de alergia e a colocação de placa de eletrocautério, inserção de sonda vesical, a efetuação do controle de perdas sanguíneas, fisiológicas e secreção gástrica.

Objective: analyzing perioperative records based on the phases of systematization of perioperative nursing care in a public regional hospital in Pernambuco's harsh region. Method: a cross-sectional, descriptive study with a quantitative approach, using secondary data, conducted in a public hospital. The sample consisted of 276 medical records of individuals who underwent anesthetic-surgical procedures between January and May 2023. Descriptive and inferential analysis was used. Results: the recording of the systematization of perioperative nursing care was predominant in the majority of the perioperative period, with significance mainly in the preoperative period. Conclusion: the satisfactory activities corresponded to the preoperative nursing visit, history, diagnosis, and nursing prescription. The weaknesses identified were the lack of blood reserves, checking for allergies and placing the electrocautery plate, inserting a urinary catheter, controlling blood loss, physiological loss, and gastric secretion.

Objetivo: analizar los registros perioperatorios a partir de las etapas de sistematización de la atención de enfermería perioperatoria en un hospital público regional de la zona rural de Pernambuco. Método: estudio descriptivo transversal, con enfoque cuantitativo, a partir de datos secundarios, realizado en un hospital público. La muestra estuvo compuesta por 276 historias clínicas de personas sometidas a procedimientos anestésico-quirúrgicos, de enero a mayo de 2023. Se utilizó análisis descriptivo e inferencial. Resultados: el registro de la sistematización de la atención de enfermería perioperatoria predominó en la mayor parte del periodo perioperatorio, con significación principalmente en el periodo preoperatorio. Conclusión: las actividades satisfactorias correspondieron a la visita de enfermería preoperatoria, registro, diagnóstico y prescripción de enfermería. Las debilidades identificadas incluyeron falta de reservas de sangre, comprobación de alergias y colocación de placa de electrocauterio, inserción de sonda vesical, control de la pérdida de sangre, fisiológica y secreción gástrica.

Ferritin, inflammation, and iron deficiency in acute heart failure: evidence from the EDIFICA cohort.

BACKGROUND: Ferritin is commonly used to evaluate iron stores and guide therapeutic decisions regarding intravenous iron supplementation. However, in the context of AHF, inflammation-driven upregulation of ferritin might disrupt its correlation with iron stores, restricting iron bioavailability and potentially amplifying the inflammatory response. AIM: This study aims to assess the clinical and prognostic associations of ferritin levels in an AHF cohort and to determine whether the prognostic value of ferritin is influenced by the presence of infection, inflammatory activation, and other markers of iron deficiency. METHODS: The association between ferritin and clinical outcomes (180 days) in AHF was evaluated in a cohort of 526 patients from the EDIFICA registry. RESULTS: The median ferritin plasma concentration at admission was 180 pg/mL. Patients with higher ferritin levels at admission were predominantly men, exhibiting a high prevalence of chronic kidney disease and alcohol consumption, and presenting with lower blood pressure and a higher incidence of clinical infection. Higher ferritin levels were associated with increased risk of the composite of heart failure hospitalization or cardiovascular death (Tertile 2: HR 1.75; 95% CI 1.10-2.79; p = 0.017; Tertile 3: HR 1.79; 95% CI 1.08-2.97; p = 0.025), independently of classical HF prognostic factors, inflammatory and iron-related markers. No significant associations were found between admission serum iron or transferrin saturation tertiles, iron status categories, or guideline-defined iron deficiency (ID) criteria and the primary composite outcome. However, at discharge, patients who met the criteria for defective iron utilization, low iron storage, or guideline-defined ID had a lower risk of the composite endpoint compared to those with normal iron utilization or who did not meet the guideline-defined ID criteria, respectively. CONCLUSIONS: Elevated ferritin levels are independently associated with poor prognosis in AHF. Low ferritin levels are associated with a favorable outcome and do not carry significant value in identifying ID in this population.

Occurrence of blaNDM-1, blaNDM-5, blaNDM-7, and blaKPC-2 genes in clinical isolates of enterobacterales with high genetic variability, from colonization and infection in patients with or without COVID-19, from a hospital in Brazil.

AIMS: This study aimed to investigate the presence of beta-lactams resistance genes and the clonal relationship of clinical isolates of Enterobacterales obtained from patients with and without COVID-19, in a hospital in northeastern Brazil. METHODS AND RESULTS: The study analyzed 45 carbapenem-resistant clinical isolates using enterobacterial repetitive intergenic consensus (ERIC-PCR), PCR, and amplicon sequencing to detect resistance genes (blaKPC, blaGES, blaNDM, blaVIM, and blaIMP). The main species were Klebsiella pneumoniae, Serratia marcescens, and Proteus mirabilis. Detected genes included blaNDM (46.66%), blaKPC (35.55%), and both (17.79%). ERIC-PCR showed multiclonal dissemination and high genetic variability. The main resistance gene was blaNDM, including blaNDM-5 and blaNDM-7. CONCLUSIONS: The presence of Enterobacterales carrying blaKPC and blaNDM in this study, particularly K. pneumoniae, in infections and colonizations of patients with COVID-19 and non-COVID-19, highlights genetic variability and resistance to carbapenems observed in multiple species of this order.

Office- versus home-based evaluation of quality of life in heart failure with reduced ejection fraction: A randomized study.

BACKGROUND: Heart failure (HF) patients often experience poor health-related quality-of-life (HR-QoL). The Kansas City Cardiomyopathy Questionnaire (KCCQ) is frequently used for assessing HR-QoL in HF. Whether KCCQ scores vary in a clinical meaningful manner according to the setting (home vs office) where patients respond to the questionnaire is currently unknown. AIMS: Assess the differences in the responses to KCCQ-23 questionnaire when completed at home or office. METHODS: Randomized parallel-group study, including patients with HF with reduced ejection fraction (HFrEF). Primary outcome was home vs office comparison of overall summary score (KCCQ-OSS). Main secondary outcomes were clinical summary score (KCCQ-CSS) and total symptom score (KCCQ-TSS). RESULTS: A total of 100 patients were included in the study: 50 home vs 50 office. Mean age was 71 yrs. Most baseline characteristics were well balanced between groups, except male sex, MRA use, and prior HF hospitalizations which were more frequent in the home group. No statistically-significant between-group differences were found regarding KCCQ-OSS (median [percentile25-75]) scores: home 69.1 (42.0-86.5) vs office 63.1 (44.3-82.3) points, P-value = 0.59, or main secondary outcomes: KCCQ-CSS home 62.2 (46.5-79.9) vs office 68.1 (51.9-79.2) points, P-value = 0.69, and KCCQ-TSS home 84.7 (59.7-97.2) vs office 76.4 (66.7-94.4) points, P-value = 0.85. Results remained similar after adjustment for differences in baseline characteristics and using non-parametric regressions. CONCLUSIONS: No major differences were found in KCCQ-23 scores regardless of whether the questionnaire was completed at home or office. These findings can be useful to make HR-QoL more accessible, allowing patients to respond at home using email or cell-phone applications.

Genetic profile and characterization of antimicrobial resistance in Acinetobacter baumannii post-COVID-19 pandemic: a study in a tertiary hospital in Recife, Brazil.

AIMS: To investigate the genetic profile and characterize antimicrobial resistance, including the main ß-lactam antibiotic resistance genes, in Acinetobacterbaumannii isolates from a tertiary hospital in Recife-PE, Brazil, in the post-COVID-19 pandemic period. METHODS AND RESULTS: Acinetobacter baumannii isolates were collected between 2023 and 2024 from diverse clinical samples. Antimicrobial resistance testing followed standardized protocols, with ß-lactamase-encoding genes detected via PCR and sequencing. Investigation into ISAba1 upstream of blaOXA-carbapenemase and blaADC genes was also conducted. Genetic diversity was assessed through ERIC-PCR. Among the 78 A. baumannii, widespread resistance to multiple antimicrobials was evident. Various acquired ß-lactamase-encoding genes (blaOXA-23,-24,-58,-143, blaVIM, and blaNDM) were detected. Furthermore, this is the first report of blaVIM-2 in A. baumannii isolates harboring either the blaOXA-23-like or the blaOXA-143 gene in Brazil. Molecular typing revealed a high genetic heterogeneity among the isolates, and multi-clonal dissemination. CONCLUSION: The accumulation of genetic resistance determinants underscores the necessity for stringent infection control measures and robust antimicrobial stewardship programs to curb multidrug-resistant strains.

Host tracheal and intestinal microbiomes inhibit Coccidioides growth in vitro.

Coccidioidomycosis, also known as Valley fever, is a disease caused by the fungal pathogen Coccidioides. Unfortunately, patients are often misdiagnosed with bacterial pneumonia, leading to inappropriate antibiotic treatment. The soil Bacillus subtilis-like species exhibits antagonistic properties against Coccidioides in vitro; however, the antagonistic capabilities of host microbiota against Coccidioides are unexplored. We sought to examine the potential of the tracheal and intestinal microbiomes to inhibit the growth of Coccidioides in vitro. We hypothesized that an uninterrupted lawn of microbiota obtained from antibiotic-free mice would inhibit the growth of Coccidioides, while partial in vitro depletion through antibiotic disk diffusion assays would allow a niche for fungal growth. We observed that the microbiota grown on 2×GYE (GYE) and Columbia colistin and nalidixic acid with 5% sheep's blood agar inhibited the growth of Coccidioides, but microbiota grown on chocolate agar did not. Partial depletion of the microbiota through antibiotic disk diffusion revealed diminished inhibition and comparable growth of Coccidioides to controls. To characterize the bacteria grown and identify potential candidates contributing to the inhibition of Coccidioides, 16S rRNA sequencing was performed on tracheal and intestinal agar cultures and murine lung extracts. We found that the host bacteria likely responsible for this inhibition primarily included Lactobacillus and Staphylococcus. The results of this study demonstrate the potential of the host microbiota to inhibit the growth of Coccidioides in vitro and suggest that an altered microbiome through antibiotic treatment could negatively impact effective fungal clearance and allow a niche for fungal growth in vivo. IMPORTANCE: Coccidioidomycosis is caused by a fungal pathogen that invades the host lungs, causing respiratory distress. In 2019, 20,003 cases of Valley fever were reported to the CDC. However, this number likely vastly underrepresents the true number of Valley fever cases, as many go undetected due to poor testing strategies and a lack of diagnostic models. Valley fever is also often misdiagnosed as bacterial pneumonia, resulting in 60%-80% of patients being treated with antibiotics prior to an accurate diagnosis. Misdiagnosis contributes to a growing problem of antibiotic resistance and antibiotic-induced microbiome dysbiosis; the implications for disease outcomes are currently unknown. About 5%-10% of symptomatic Valley fever patients develop chronic pulmonary disease. Valley fever causes a significant financial burden and a reduced quality of life. Little is known regarding what factors contribute to the development of chronic infections and treatments for the disease are limited.

Virulent Klebsiella pneumoniae ST11 clone carrying blaKPC and blaNDM from patients with and without COVID-19 in Brazil.

AIMS: Investigated and compared the occurrence of virulence genes fimH, mrkD, irp2, entB, cps, rmpA, and wabG, resistance genes blaKPC and blaNDM, and the genetic variability and clonal relationship of 29 Klebsiella pneumoniae clinical isolates of patients with and without COVID-19, from a hospital in Brazil. METHODS AND RESULTS: All isolates were resistant to beta-lactams. The genes were investigated by PCR, and for molecular typing, enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) and MLST were used. The detection of blaNDM was greater (n = 23) when compared to that of blaKPC (n = 14). The virulence genes that most occurred were fimH, entB, cps, and wabG, which are responsible for adhesins, siderophore enterobactin, capsule, and lipopolysaccharides, respectively. Among the isolates, 21 distinct genetic profiles were found by ERIC-PCR, with multiclonal dissemination. Four isolates belonged to the ST11 clone. CONCLUSIONS: The occurrence of the ST11 is worrying as it is a high-risk clone involved in the dissemination of virulent strains throughout the world.

Spatial-temporal distribution of visceral leishmaniasis in Rio de Janeiro, Brazil, 2001-2020: expansion and challenges.

BACKGROUND: Visceral leishmaniasis results from complex interactions among humans, dogs and environment. Brazil accounts for 97% of cases in the Americas. METHODS: Twenty years (2001-2020) of the endemic disease in the state of Rio de Janeiro were studied. Incidence, lethality, sociodemographic and clinical characteristics were investigated, complemented with spatial methodologies (kernel and clusters). RESULTS: Ninety-seven human cases and 625 dogs were reported. Of the 92 cities, 22 were human endemic areas. The state had a low incidence level (0.6 per 100 000). Lethality was higher compared with the Brazilian average. More than 90% of infections occurred in urban areas. Most cases (66%) occurred in men. The predominant age groups were 0-4 y (28.7%) and 20-39 y (32.9%). Fever (89.5%), splenomegaly (83.2%) and hepatomegaly (76.8%) were the main clinical manifestations. Spatial analysis showed a displacement of the human endemic: in the first decade (2001-2010), cases were concentrated in the Metropolitan region, and in the second decade (2011-2020) in the Médio Paraíba region of the state. Most of the endemic area (56.4%) had canine infections without reported human cases. CONCLUSIONS: Disorderly urbanisation and precarious living conditions favour the transmission of the disease. Changes in the environment and migratory processes contribute to its expansion.

Platelet-Derived Microvesicles Contribute to the Pathophysiogenesis of Human Cutaneous Leishmaniasis: A Nano-Flow Cytometric Approach in Plasma Samples from Patients before and under Antimonial Treatment.

Cutaneous leishmaniasis is a neglected tropical disease caused, in Brazil, mainly by Leishmania braziliensis, which is a protozoan transmitted during the blood feeding of infected female sandflies. To control leishmaniasis, the participation of CD4+ Th1 cells together with macrophages, neutrophils, and other peripheral blood cells, including platelets, is necessary. These anuclear fragments, when activated, produce microvesicles (MVs) that can reach locations outside the blood, carrying molecules responsible for activating pro-inflammatory responses and antigen presentation. Using flow cytometry, this current study evaluated the frequency and concentration of platelet-derived MVs (pMVs) in plasma samples obtained from patients in the acute phase and undergoing treatment, as well as from healthy volunteers. Our results revealed a higher frequency and concentration of pMVs in the plasma of patients with acute CL when compared to all other groups studied. These results highlight the impact of pMVs in modulating the immune response of CL patients, correlating their higher concentrations and frequencies in CL-patient plasmas, with the acute inflammatory status of the disease and their reduction with beneficial results of systemic treatment with antimony. This knowledge is essential to define potential treatment protocols, as well as highlight pMVs as biomarkers for the different clinical stages of CL.

Self-reporting of hearing loss and tinnitus in the diagnosis of ototoxicity by meglumine antimoniate in patients treated for American tegumentary Leishmaniasis.

INTRODUCTION: American Tegumentary Leishmaniasis (ATL) treatment is based on pentavalent antimonials (Sb5+), but these drugs have been associated to several adverse effects. Hearing loss and tinnitus during treatment with meglumine antimoniate (MA) have already been reported. This study aimed to describe the usefulness of self-reporting of hearing loss and tinnitus in diagnosing MA-induced ototoxicity. METHODS: A prospective longitudinal study was conducted with 102 patients with parasitological diagnosis of ATL, treated with different MA schemes. The presence of clinical auditory toxicity was defined as the emergence or worsening of self-reporting hearing loss and/or tinnitus during monitoring. Measures of sensitivity, specificity, and the positive and negative predictive value of the patient's self-reporting of hearing loss and tinnitus in relation to the result of the audiometric test (considered the gold standard) were calculated. RESULTS: The age of the evaluated patients ranged from 15 to 81 years, with a median of 41 years, and most were male (73.5%). Seventy-five patients (73.5%) had cutaneous leishmaniasis and 27 (26.5%) mucosal leishmaniasis. Eighty-six patients (84.3%) received intramuscular (IM) treatment and 16 (15.7%) were treated with intralesional MA. During treatment, 18 (17,6%) had tinnitus and 7 (6,9%) had complaint of hearing loss. 53 (52%) patients had cochlear toxicity confirmed by tone threshold audiometry and high frequency audiometry, from which 60% received a dose of 20 mg Sb5+/kg/day (p = 0.015) and 96.2% were treated with IM MA (p = 0.001). Tinnitus has greater specificity and positive predictive value than hearing loss, with a low number of false positives, but with a high false negative value. CONCLUSION: Although the large number of false negatives suggests that self-report of hearing loss or tinnitus cannot be considered a good screening test for referring the patient to an audiometry, the low number of false positives suggests the need to value the patient's complaint for referral. Otherwise, this study reinforces the importance of audiological monitoring during treatment with MA, especially in those patients with self-reporting of hearing loss or tinnitus when treated with 20 mg Sb5+/kg/day via IM.

Consumo das principais substâncias psicoativas em tempos de pandemia COVID-19 nos estudantes do ensino superior / Use of the main psychoactive drugs during the COVID-19 pandemic among higher education students / Consumo de las principales sustancias psicoactivas en tiempos de la pandemia de COVID-19 en estudiantes de enseñanza superior

Resumo Enquadramento: A população estudantil do ensino superior tem especial risco de consumo e abuso de substâncias psicoativas. Objetivo: Analisar o consumo das principais substâncias psicoativas nos estudantes do ensino superior e a sua relação com as variáveis sóciodemográficas e com o surgimento da pandemia COVID-19. Metodologia: Estudo analítico, observacional e transversal. Dados recolhidos por questionário aplicado após o primeiro semestre do ano letivo 2020/2021, na população de 8875 estudantes do Instituto Politécnico de Bragança em Portugal. Amostra de 825 estratificada para cada uma das cinco escolas. Resultados: Álcool e tabaco são as mais consumidas e de forma abusiva pela prática de binge drinking/smoking. Os medicamentos psicoativos e as drogas recreativas são menos consumidos. Os consumos são afetados pelas variáveis sociodemográficas: sexo, idade, escola, portadores de doença crónica, escolaridade e profissão dos pais. Durante a pandemia COVID-19, os estudantes percecionaram aumento dos consumos exceto o álcool. Conclusão: O consumo de substâncias psicoativas pelos estudantes do ensino superior é afetado pelas variáveis sociodemográficas e pela pandemia COVID-19.

Abstract Background: The higher education student population has a special risk of use and abuse of psychoactive drugs. Objective: To analyze the use of psychoactive drugs in higher education students and their relationship with the sociodemographic variables and the COVID-19 pandemic onset. Methodology: An analytical, observational, and cross-sectional study was conducted. Data were collected through a questionnaire applied after the first semester of the 2020/2021 school year to 8875 students of the Polytechnic Institute of Bragança from Portugal. A stratified sample of 825 participants for each of the five schools. Results: Alcohol and tobacco are the most used and abused substances due to the practice of binge drinking/smoking. Psychoactive and recreational drugs are less used. Use is affected by sociodemographic variables: gender, age, school, chronic diseases, and parents' education/occupation. During the pandemic COVID-19, students perceive an increase in use except for alcohol. Conclusion: The use of psychoactive drugs in higher education students is affected by sociodemographic variables and the COVID-19 pandemic.

Resumen Marco contextual: La población estudiantil de la enseñanza superior está especialmente expuesta al riesgo de consumo y abuso de sustancias psicoactivas. Objetivo: Analizar el consumo de las principales sustancias psicoactivas entre los estudiantes de enseñanza superior y su relación con las variables sociodemográficas y la irrupción de la pandemia de la COVID-19. Metodología: Estudio analítico, observacional y transversal. Datos recogidos mediante un cuestionario realizado después del primer semestre del año académico 2020/2021, en una población de 8875 estudiantes del Instituto Politécnico de Braganza, en Portugal. Muestra de 825 estratificada para cada una de las cinco escuelas. Resultados: El alcohol y el tabaco son las sustancias más consumidas y de las que más se abusa a través de borracheras/tabaco (binge drinking/smoking). Los medicamentos psicoactivos y las drogas recreativas se consumen menos. El consumo se ve afectado por variables sociodemográficas: sexo, edad, escolaridad, enfermedad crónica, educación y profesión de los padres. Durante la pandemia de la COVID-19, los estudiantes percibieron un mayor consumo, excepto de alcohol. Conclusión: El consumo de sustancias psicoactivas de los estudiantes de enseñanza superior se ve afectado por variables sociodemográficas y por la pandemia de la COVID-19.

Host tracheal and intestinal microbiomes inhibit Coccidioides growth in vitro.

Coccidioidomycosis, also known as Valley fever, is a disease caused by the fungal pathogen Coccidioides. Unfortunately, patients are often misdiagnosed with bacterial pneumonia leading to inappropriate antibiotic treatment. Soil bacteria B. subtilis-like species exhibits antagonistic properties against Coccidioides in vitro; however, the antagonistic capabilities of host microbiota against Coccidioides are unexplored. We sought to examine the potential of the tracheal and intestinal microbiomes to inhibit the growth of Coccidioides in vitro. We hypothesized that an uninterrupted lawn of microbiota obtained from antibiotic-free mice would inhibit the growth of Coccidioides while partial in vitro depletion through antibiotic disk diffusion assays would allow a niche for fungal growth. We observed that the microbiota grown on 2xGYE (GYE) and CNA w/ 5% sheep's blood agar (5%SB-CNA) inhibited the growth of Coccidioides, but that grown on chocolate agar does not. Partial depletion of the microbiota through antibiotic disk diffusion revealed that microbiota depletion leads to diminished inhibition and comparable growth of Coccidioides growth to controls. To characterize the bacteria grown and narrow down potential candidates contributing to the inhibition of Coccidioides, 16s rRNA sequencing of tracheal and intestinal agar cultures and murine lung extracts was performed. The identity of host bacteria that may be responsible for this inhibition was revealed. The results of this study demonstrate the potential of the host microbiota to inhibit the growth of Coccidioides in vitro and suggest that an altered microbiome through antibiotic treatment could negatively impact effective fungal clearance and allow a niche for fungal growth in vivo.

Occurrence of high-risk clones of Klebsiella pneumoniae ST11, ST340, and ST855 carrying the blaKPC-2, blaNDM-1, blaNDM-5, and blaNDM-7 genes from colonized and infected patients in Brazil.

AIMS: Determine which sequence type (ST) clones were carrying the blaKPC, blaNDM, blaVIM, blaIMP, and blaGES genes and their variants in clinical isolates of multidrug-resistant Klebsiella pneumoniae. METHODS AND RESULTS: Ten K. pneumoniae isolates were obtained from the colonized and infected patients in a public hospital in the city of Recife-PE, in northeastern Brazil, and were further analyzed. The detection of carbapenem resistance genes and the seven housekeeping genes [for multilocus sequence typing (MLST) detection] were done with PCR and sequencing. The blaKPC and blaNDM genes were detected concomitantly in all isolates, with variants being detected blaNDM-1, blaNDM-5, blaNDM-7, and blaKPC-2. The blaKPC-2 and blaNDM-1 combination being the most frequent. Molecular typing by MLST detected three types of high-risk ST clones, associated with the clonal complex 258, ST11/CC258 in eight isolates, and ST855/CC258 and ST340/CC258 in the other two isolates. CONCLUSIONS: These findings are worrying, as they have a negative impact on the scenario of antimicrobial resistance, and show the high genetic variability of K. pneumoniae and its ability to mutate resistance genes and risk of dissemination via different ST clones.

Classification of bloodstains deposited at different times on floor tiles using hierarchical modelling and a handheld NIR spectrometer.

Bloodstains are commonly encountered at crime scenes, especially on floor tiles, and can be deposited over different periods and intervals. Therefore, it is crucial to develop techniques that can accurately identify bloodstains deposited at different times. This study builds upon a previous investigation and aims to enhance the performance of three distinct hierarchical models (HMs) designed to differentiate and identify stains of human blood (HB), animal blood (AB), and common false positives (CFPs) on nine different types of floor tiles. Soft Independent Modeling Class Analogies (SIMCA), and Partial Least Squares-Discriminant Analysis (PLS-DA) were employed as decision rules in this process. The originally published model was constructed using a training set that included samples with a known time of deposit of six days. This model was then tested to predict samples with various deposition times, including human blood samples aged for 0, 1, 9, 20, 30, and 162 days, as well as animal blood samples aged for 0, 1, 10, 13, 20, 29, 105, and 176 days. To improve the identification of human blood, the models were modified by adding zero-day and one-day-old bloodstains to the original training set. All models showed improvement when fresher samples were included in the training set. The best results were achieved with the hierarchical model that used partial least squares-discriminant analysis as the second decision rule and incorporated one-day-old samples in the training set. This model yielded sensitivity values above 0.92 and specificity values above 0.7 for samples aged between zero and 30 days.

Gasoline discrimination using infrared spectroscopy and virtual samples based on measurement uncertainty.

In a previous work, we proposed a methodology for pair-wise discrimination of gasoline samples by creating virtual samples based on physicochemical assays or distillation curves. Satisfactory results were achieved, although specialist and specific apparatus (not commonly available at police laboratories) were required. The present study goes a step further and for the first time investigates the possibility of infrared (IR) spectroscopy to enable a virtual samples-based methodology for comparison of gasoline samples in pairs. IR spectroscopy feasibility for in situ applications is attractive for forensic investigations. The performances of one handheld NIR device and one dual-range (FT-NIR and FT-IR) benchtop spectrometer were evaluated. The estimation of uncertainty in infrared spectral measurement (needed to generate virtual samples) is barely discussed in literature. So far, there are no literature reports describing quantification and comparison of measurement uncertainties for the spectral acquisitions evaluated here, especially regarding their use for generating virtual samples. A stepwise procedure to quantify uncertainties associated with IR spectral acquisition, at each wavenumber, is described. This method can be useful for understanding both the sources of variability in IR measurements and the system under investigation. Uncertainty estimation was based on experimental data and considered intermediate precision, repeatability and variations in sample temperature as sources of variability. Virtual samples were employed in a discrimination approach using SIMCA models. Results for portable NIR, FT-NIR and FT-IR data sets showed complete discrimination for 96.3%, 93.4% and 93.7% of the 1431 pairs of gasoline samples evaluated, respectively. These results were comparable and similar to those obtained for the physicochemical properties data set (95.7%), although slightly inferior to the result obtained for distillation curves (99.2%). Using IR non-destructive methods in this case could enable faster investigations and simpler analysis, especially for the low-cost handheld spectrometer. In a screening approach, atmospheric distillation assays can be employed only if infrared techniques are not capable of distinguishing the samples subject to comparison. In this work, a pair of samples was considered to be completely discriminated only when a null false positive error (FPR) was achieved, although a more flexible criterium may be acceptable in practice. Finally, the methodology could be extended to other applications where sample comparison is important.

Entrenamiento para el desarrollo de competencias en evaluación de impacto social a gestores de proyectos

Introducción: El contexto tecnocientífico cubano actual promueve proyectos de ciencia, tecnología e innovación, que tributan al progreso del modelo de desarrollo económico social socialista que propone el país. Pero, en la práctica, estos proyectos evidencian poca sistematicidad en la evaluación de impacto social, lo que da al traste con la transformación social que se pretende. Debido a esto, se considera necesaria la superación de los profesionales que, desde las universidades cubanas, gestionan proyectos. Objetivo: Proponer un entrenamiento para el desarrollo de competencias en evaluación de impacto social para gestores de proyectos de las universidades cubanas. Materiales y métodos: El diagnóstico realizado con métodos científicos teóricos y con la aplicación de encuestas y entrevistas a gestores de proyectos, y el análisis documental a proyectos en ejecución y a sus resultados, así como a los documentos rectores del posgrado en Cuba, permitieron conformar la propuesta de entrenamiento que se presenta. Resultados: Se identificó un nivel bajo de conocimientos y habilidades en evaluación de impacto social de los proyectos, y una alta disposición hacia la superación profesional en el tema. Esto conduce a la propuesta de un entrenamiento que consta de acciones para el desarrollo de competencias en los gestores de proyecto. Conclusiones: El entrenamiento que se propone resulta una vía esencial para atender demandas y necesidades de superación profesional en torno a conocimientos, habilidades y valores, para la evaluación de impacto social por gestores de proyectos de las universidades cubanas.

Introduction: The current Cuban techno-scientific context promotes projects of science, technology and innovation, which contribute to the progress of the model of socialist social economic development the country proposes. But, in practice, these projects show little systematicity in the social impact assessment, which ruins the social transformation that is pretended. Due to this, it is considered necessary the upgrading of the professionals who manage projects of Cuban universities. Objective: To propose training for the development of skills in social impact assessment for project managers of Cuban universities. Materials and methods: The diagnosis, carried out with scientific-theoretical methods, and with the application of inquiries and interviews to project managers, and the documentary analysis of projects in execution and their results, as well as of leading documents of post-graduate studies in Cuba, allowed to elaborate the training proposal presented. Results: A low level of knowledge and skills in the social impact assessment of the projects and a high disposition towards professional upgrading on the topic were identified. This leads to the proposal of a training that consists on actions for the development of skills in project managers. Conclusions: The training proposed results an essential way to meet demands and needs of professional upgrading regarding knowledge, skills and values, for the assessment of the social impact by project managers of Cuban universities.

Description of the dermatoscopic features observed in sporotrichosis and American cutaneous leishmaniasis in a reference center in Rio de Janeiro, Brazil.

BACKGROUND: The evaluation of American cutaneous leishmaniasis (CL) and sporotrichosis (SP) with dermoscopy may improve the diagnosis accuracy and clinical monitoring. OBJECTIVES: To describe the dermoscopic findings and patterns of skin lesions of patients with CL and SP followed up at the Laboratory of Clinical Research and Surveillance in Leishmaniasis (LaPClinVigiLeish), Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. METHODS: The authors included patients with a diagnosis of CL or SP, who attended at INI/ Fiocruz, between 2019‒2021. All patients had 3 dermoscopic examinations (DermLite DL4): before treatment (T0), during treatment (T1), and after healing (T2). Up to three lesions per patient were evaluated. RESULTS: The authors studied 47 patients with CL (74 lesions), and 19 patients with SP (24 lesions). The authors described dermoscopic structures such as rosettes, white lines, white dots, brown focal structureless areas, brown lines and dots, white perilesional circles, perilesional hyperchromic circles, microulcerations and the rainbow patterns. The authors created specific patterns; in CL: CL-T0 "central yellow scales with a white perilesional circle pattern", CL-T1 "diffuse structureless white area pattern" and CL-T2 "white and brown focal structureless areas pattern". In SP: SP-T0 the "pustule with erythema pattern"; SP-T1 the "focal structureless white areas with erythema pattern" and SP-T2 the "white linear pattern". STUDY LIMITATIONS: This study does not correlate dermoscopic findings with time of disease evolution at the first medical examination. CONCLUSIONS: The recognition of CL and SP dermoscopy patterns may be helpful tool for the differential diagnosis and monitoring of disease evolution.

Is There Any Difference in the In Situ Immune Response in Active Localized Cutaneous Leishmaniasis That Respond Well or Poorly to Meglumine Antimoniate Treatment or Spontaneously Heal?

Localized cutaneous leishmaniasis caused by Leishmania braziliensis can either respond well or poorly to the treatment or heal spontaneously; It seems to be dependent on the parasite and/or host factors, but the mechanisms are not fully understood. We evaluated the in situ immune response in eighty-two active lesions from fifty-eight patients prior to treatment classified as early spontaneous regression (SRL-n = 14); treatment responders (GRL-n = 20); and non-responders (before first treatment/relapse, PRL1/PRL2-n = 24 each). Immunohistochemistry was used to identify cell/functional markers which were correlated with the clinical characteristics. PRL showed significant differences in lesion number/size, clinical evolution, and positive parasitological examinations when compared with the other groups. SRL presented a more efficient immune response than GRL and PRL, with higher IFN-γ/NOS2 and a lower percentage of macrophages, neutrophils, NK, B cells, and Ki-67+ cells. Compared to SRL, PRL had fewer CD4+ Tcells and more CD163+ macrophages. PRL1 had more CD68+ macrophages and Ki-67+ cells but less IFN-γ than GRL. PRL present a less efficient immune profile, which could explain the poor treatment response, while SRL had a more balanced immune response profile for lesion healing. Altogether, these evaluations suggest a differentiated profile of the organization of the inflammatory process for lesions of different tegumentary leishmaniasis evolution.

Advancement in Leishmaniasis Diagnosis and Therapeutics.

Leishmaniasis is a complex of clinical manifestations that affects thousands of people in the world each year according to WHO [...].