Avian host composition, local speciation and dispersal drive the regional assembly of avian malaria parasites in South American birds.

Identifying the ecological factors that shape parasite distributions remains a central goal in disease ecology. These factors include dispersal capability, environmental filters and geographic distance. Using 520 haemosporidian parasite genetic lineages recovered from 7,534 birds sampled across tropical and temperate South America, we tested (a) the latitudinal diversity gradient hypothesis and (b) the distance-decay relationship (decreasing proportion of shared species between communities with increasing geographic distance) for this host-parasite system. We then inferred the biogeographic processes influencing the diversity and distributions of this cosmopolitan group of parasites across South America. We found support for a latitudinal gradient in diversity for avian haemosporidian parasites, potentially mediated through higher avian host diversity towards the equator. Parasite similarity was correlated with climate similarity, geographic distance and host composition. Local diversification in Amazonian lineages followed by dispersal was the most frequent biogeographic events reconstructed for haemosporidian parasites. Combining macroecological patterns and biogeographic processes, our study reveals that haemosporidian parasites are capable of circumventing geographic barriers and dispersing across biomes, although constrained by environmental filtering. The contemporary diversity and distributions of haemosporidian parasites are mainly driven by historical (speciation) and ecological (dispersal) processes, whereas the parasite community assembly is largely governed by host composition and to a lesser extent by environmental conditions.

ED50 of remifentanil for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of muscle relaxants in children: dose-finding clinical trial.

PURPOSE: Previous studies evidenced that orotracheal intubation without neuromuscular blockers is feasible in children and has some potential advantages. Remifentanil has favorable pharmacodynamic and pharmacokinetic properties as an opioid for orotracheal intubation, but its dose for excellent intubation conditions when co-administered with propofol has not been established. This study was designed to find the minimum effective dose of remifentanil for excellent intubation conditions of children when co-administered with propofol, without neuromuscular relaxant drugs. METHOD: Blinded adaptive clinical trial, with sequential allocation of 27 children between 2 and 9 years-old, American Society of Anesthesiologists' physical status PI or PII, scheduled for elective surgery under general anesthesia. Remifentanil dose began at 2 µg/kg and varied by 0.25 µg/kg according to the sequential allocation up-and-down rule designed by Dixon and Massey. Remifentanil was infused in 30 s and followed by propofol (3 mg/kg) in 20 s. Laryngoscopy and intubation were performed and assessed using Viby-Mogensen criteria, 90 s after the end of opioid administration. Inclusion of patients stopped after six crossovers, and remifentanil effective dose was estimated using pooled adjacent-violators algorithm. RESULTS: Remifentanil effective dose for 50% was established in 3.04 µg/kg (IC 95% 2.68-3.11, p < 0.05). The most frequent adverse effect was difficult positive pressure facial mask ventilation, which occurred in four children (15%). CONCLUSION: Minimum remifentanil effective dose for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of neuromuscular blockers in children is 3.04 µg/kg. TRIAL REGISTRATION: NCT02454868.

Results of the Surgical Approach of Idiopathic Scoliosis in Adolescents and Postoperative Quality of Life: Systematic Literature Review.

Adolescent idiopathic scoliosis is considered the most severe and common spinal deformity, affecting children and adolescents still in the neuropsychomotor development phase before they reach skeletal maturity. This study aimed to evaluate the surgical approach to adolescent idiopathic scoliosis (AIS), considering the results associated with the reduction of pathological curvature, pulmonary function, and repercussions on the quality of life of adolescents undergoing such treatment. Systematic literature review, with a quantitative and qualitative approach to the data collected, structured according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), carried out in the databases linked to the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS). The total sample of the studies was 638 adolescents with AIS, with a mean age of 14.93 years ± 1.24. The mean correction of the main pathological curvature in the studies was 55.06% ± 12.24. In all of the selected studies using posterior spinal fusion to correct AIS, there was a significant reduction in pathological curvatures (> 49%), and the recurrence of curvature in none of the studies exceeded a pathological gain of more than 5%. As for lung function, the studies showed significant increases in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in patients with severe AIS, and no pulmonary function losses were reported after surgery to correct AIS.

Coconut shell-based biochars produced by an innovative thermochemical process for obtaining improved lignocellulose-based adsorbents.

The urgent need for a simple and cost-effective thermochemical process to produce biochar has prompted this study. The aim was to develop a straightforward thermochemical process under O2-limited conditions for the production of coconut-based biochar (CBB) and to assess its ability to remove methylene blue (MB) through adsorption, comparing it with CBB produced by slow pyrolysis. CBBs were obtained under different atmospheric conditions (O2-limited, muffle furnace biochar (MFB); and inert, pyrolytic reactor biochar (PRB)), at 350, 500, and 700 °C, and for 30 and 90'. MFB and PRB were characterized using FTIR, RAMAN, SEM, EDS, and XRD analyses. Adsorption tests were conducted using 1.0 g L-1 of MFB and PRB, 10 mg L-1 of MB at 25 °C for 48 h. Characterization revealed that atmospheric conditions significantly influenced the yield and structural features of the materials. PRB exhibited higher yields and larger cavities than MFB, but quite similar spectral features. Adsorption tests indicated that MFB and PRB had qt values of 33.1 and 9.2 mg g-1, respectively, which were obtained at 700 °C and 90', and 700 °C and 30', respectively. This alternative method produced an innovative and promising lignocellulose-based material with great potential to be used as a biosorbent.

Doped Carbon Quantum Dots/PVA Nanocomposite as a Platform to Sense Nitrite Ions in Meat.

A sensor device based on doped-carbon quantum dots is proposed herein for detection of nitrite in meat products by fluorescence quenching. For the sensing platform, carbon quantum dots doped with boron and functionalized with nitrogen (B,N-Cdot) were synthesized with an excellent 44.3% quantum yield via a one-step hydrothermal route using citric acid, boric acid, and branched polyethylenimine as carbon, boron, and nitrogen sources, respectively. After investigation of their chemical structure and fluorescent properties, the B,N-Cdot at aqueous suspensions showed high selectivity for NO2- in a linear range from 20 to 50 mmol L-1 under optimum conditions at pH 7.4 and a 340 nm excitation. Furthermore, the prepared B,N-Cdots successfully detected NO2- in a real meat sample with recovery of 91.4-104% within the analyzed range. In this manner, a B,N-Cdot/PVA nanocomposite film with blue emission under excitation at 360 nm was prepared, and a first assay detection of NO2- in meat products was tested using a smartphone application. The potential application of the newly developed sensing device containing a highly fluorescent probe should aid in the development of a rapid and inexpensive strategy for NO2- detection.

Silver nanoparticles (AgNPs) internalization and passage through the Lactuca sativa (Asteraceae) outer cell wall.

Silver nanoparticle (AgNPs) toxicity is related to nanoparticle interaction with the cell wall of microorganisms and plants. This interaction alters cell wall conformation with increased reactive oxygen species (ROS) in the cell. With the increase of ROS in the cell, the dissolution of zero silver (Ag0) to ionic silver (Ag+) occurs, which is a strong oxidant agent to the cellular wall. AgNP interaction was evaluated by transmission electron microscopy (TEM) on Lactuca sativa roots, and the mechanism of passage through the outer cell wall (OCW) was also proposed. The results suggest that Ag+ binds to the hydroxyls (OH) present in the cellulose structure, thus causing the breakdown of the hydrogen bonds. Changes in cell wall structure facilitate the passage of AgNPs, reaching the plasma membrane. According to the literature, silver nanoparticles with an average diameter of 15nm are transported across the membrane into the cells by caveolines. This work describes the interaction between AgNPs and the cell wall and proposes a transport model through the outer cell wall.

Desenvolvimento da CEL: equipamento de baixo-custo parareação e leitura de ensaios LAMP - Loop-mediated Isothermal Amplification / Development of CEL: a low-cost equipment for Loop-mediated Isothermal Amplification (LAMP) assays

O sistema de saúde brasileiro é constituído por um conjunto de ações e serviços que prestam assistência a população por meio de estratégias que visam a promoção, proteção e recuperação da saúde. Um dos pontos de maior destaque é a prevenção, na qual incluem-se o diagnóstico e o tratamento precoce das doenças. A detecção e a identificação clássica de patógenos baseiam-se na microscopia e cultura, entretanto a baixa sensibilidade; a necessidade de profissionais capacitados e de infraestrutura adequada resultam, em alguns casos, na falha do diagnóstico e no atraso para o início do tratamento. Objetivo: desenvolver um equipamento para realização de ensaios LAMP (Loop Mediated Isothermal Amplification) em ambientes com reduzida infraestrutura laboratorial. Resultados: Foram padronizados protocolos para cinco importantes doenças encontradas na região amazônica: tuberculose, malária, dengue e as febres mayaro e oropouche para utilização na CEL, equipamento portátil para a realização dos ensaios LAMP. O equipamento possui detecção fotométrica integrada, com capacidade de oito reações simultâneas, detectando a alteração da cor nas reações positivas. O resultado é mostrado em um display alfanumérico, de fácil leitura, mesmo para pessoas sem experiência com a técnica. Os resultados também podem ser transferidos por bluetooth para um smartphone, onde é possível, com o aplicativo próprio fazer a visualização gráfica. Conclusão: por se tratar de um equipamento de baixo-custo, desenvolvido para a aplicação em diagnóstico molecular, pode representar uma alternativa para ampliação da oferta de diagnóstico molecular nos serviços da rede básica de saúde, permitindo maior acesso da população, mesmo em áreas remotas.

The Brazilian Health System consists of a set of actions and services that assist the population through strategies aimed at the promotion, protection, and health recovery. One of the highlights is prevention, which includes the diagnosis and early treatment of diseases. The detection and classical identification of pathogens are based on microscopy and culture, however the low sensitivity; the need for trained professionals and adequate infrastructure leads, in some cases, to the failure of the diagnosis and in the delay to start treatment. Objective: to develop CEL, an equipment for LAMP (Loop-Mediated Isothermal Amplification) assays for use in low-resource settings laboratories. Results: Protocols were standardized for five important diseases found in the Amazon region: tuberculosis, malaria, dengue, mayaro and oropouche fevers. The equipment has integrated photometric detection, with the capacity of eight simultaneous reactions, detecting the color change observed in the positive reactions. The results are shown in an easy-to-read alphanumeric display, even for people with no experience with the technique. The results can also be transferred by bluetooth to a smartphone with the CEL App, where it is possible to see the results in a graphical interface. Conclusion: Once CEL is a low-cost device, developed for molecular diagnostics, it can represent an alternative to the expansion of the molecular diagnosis in the services of the primary health attention, allowing higher population access, even in remote areas.

Desgaste laboral em docentes de medicina: uma revisão de literatura / Labor stress in medical school staff: a literature review

O burnout ou síndrome do desgaste laboral é um conjunto de sintomas que ocorre em consequência do excessivo desgaste laboral e se manifesta em docentes de Medicina, com repercussões negativas nas atividades acadêmicas.

Burnout is a set of symptoms that occurs as a result of excessive stress in the workplace. This condition has affected professors of Medicine with anegative impact in their academic activities.

Medicamentos anti-hipertensivos na gestação e puerpério / Antihypertensive medications in pregnancy and puerperium

A toxemia gravídica é uma doença multissistêmica, que ocorre principalmente no final da gravidez, caracterizada por manifestações clínicascomo hipertensão, edema e proteinúria. É a complicação médica maiscomum da gravidez e a principal causa de morbimortlidade materna eperinatal. O objetivo deste artigo é rever os principais aspectos concernentesao uso de agentes antihipertensivosna gravidez e puerpério. Osdados foram coletados no Pubmed e Bireme, período de 2006 a 2010utilizando-se os descritores “anti-hipertensivo e gravidez” e “antihypertensive and pregnancy”. O conhecimento da hipertensão durante a gestação e sua terapêutica está em evolução; a busca por medicações quepossam proteger a mãe dos perigos agudos e garantir um recém nascidosaudável deve ser o foco. Faltam evidências sobre a melhor terapia aser adotada, período de início, duração e resultados. Apesar do avançofarmacológico, ainda não há fármacos totalmente isentos de comprometimentopara a mãe e ao concepto.

Pregnancy toxemia is a multisystemic disease, which occurs mainly atthe end of pregnancy, characterized by clinical manifestations such ashypertension, edema and proteinuria. It is the most commonly occurredmedical complication in pregnancies and the main cause for perinataland maternal morbimortalities. The purpose of this article is to reviewthe main aspects concerning the use of antihypertensive agents duringpregnancy and puerperium. The data has been collected from Pubmedand Bireme, from 2006 to 2010 using the words “anti-hipertensivo egravidez” and “antihypertensive and pregnancy”. The knowledge regardinghypertension during pregnancy and its therapy is evolving; the searchfor medication that could protect the mother from acute dangers and to ensure a healthy newborn must be the focus. Evidence is still lacking regarding the best therapy, beginning period, duration and results. In spite of the pharmacological advances, there are still no drugs completely exempt of compromises to the mother and the conceptus.

Relato de caso: Síndrome de Fournier após implantação de sling transobturatório / Case report: Fournier’s syndrome after implantation of transobturator sling

Introdução: As infecções hospitalares são um problema comum que,além da alta taxa de morbimortalidade associada, gera altos custos aosistema de saúde brasileiro. No processo de infecção hospitalar, as patologiasde base e os procedimentos invasivos terapêuticos ou diagnósticossão importantes fatores determinantes; afetando os mecanismosde defesa, ou mesmo veiculando os agentes infecciosos. No sistemategumentar, uma infecção que gera grande preocupação é a FasciiteNecrosante. Um tipo de Fasciite Necrosante importante por suas característicasde gravidade é a Gangrena de Fournier. A doença acomete asregiões genital, perineal e perianal.Objetivos: Relatar o caso de uma paciente com diagnóstico de distopiaVesical grau II que evoluiu com gangrena de Fournier, após cirurgiapara implantação transobturatória de sling sintético de marlex, no HospitalRegional de Sobradinho- DF, visando discutir os aspectos relacionadosà infecção do sitio cirúrgico.Metodologia: Trata-se de um estudo de caso clínico compreendidoentre o período de outubro de 2010 e julho de 2011, avaliando todaa evolução clínica e complicações de uma paciente com Gangrena deFournier algum tempo após cirurgia ginecológica para implantação desling.Resultados: A paciente do presente estudo evoluiu, após reintervençãocirúrgica e medicamentosa, com melhora progressiva, recebendo altano 38.° dia após a colocação de sling, com orientação para acompanhamentoambulatorial.Conclusão: Entre as infecções hospitalares, ainda comuns dentro darotina médica, a Gangrena de Fournier, de grave impacto, requer diagnósticoe intervenção rápidos para um desfecho satisfatório.

Introduction: Hospital infections are a common problem, generatinghigh costs to the Brazilian health system, besides the high mortality rateassociated. In the process of hospital infection, the basic pathologiesand invasive therapeutic or diagnostic procedures are important determinantsfactors; affecting defense mechanisms or even conveying infectiousagents. In the tegumentary system, an infection that causes concernis Necrotizing Fasciitis. An important type of Necrotizing Fasciitisfor its characteristics and gravity is the Fournier Gangrene. The diseaseaffects the genital, perianal and perineal regions.Objectives: We report a case of Fournier’s gangrene in a female patientwith a diagnosis of vesical dystopia grade II who underwent surgicalimplantation of synthetic transobturator marlex sling at Sobradinho’sRegional Hospital, in Distrito Federal, Brazil, in order to discuss relatedsite infection surgery aspects.Methodology: This is a report case related to the period between October2010 and July 2011, compreending evolutive complications andclinical outcome of a patient with Fournier Gangrene sometime aftergynecological surgery for transobturatory sling implant.Results: The patient involved in this study evolved after surgical interventionand drug therapy, with progressive improvement and wasdischarged from the hospital on the 38th day after the sling placement,with guidance for outpatient treatment.Conclusion: Among nosocomial infections, still common in the medicalroutine, Fournier gangrene, of severe impact, requires rapid diagnosisand intervention for satisfactory outcome.