Critical role of acute hypoxemia on the cognitive impairment after severe COVID-19 pneumonia: a multivariate causality model analysis.

BACKGROUND: A high proportion of coronavirus disease 2019 (COVID-19) survivors may develop long-term cognitive impairment. We aimed to develop a multivariate causal model exposing the links between COVID-19-associated biomarkers, illness-related variables, and their effects on cognitive performance. METHODS: In this prospective study, we assess the potential drivers for the development of cognitive impairment in patients with severe COVID-19 pneumonia aged ≥ 18 years at 6-month follow-up after hospital discharge, using the Montreal Cognitive Assessment (MoCA). Patients with pre-existing cognitive impairment were excluded. Laboratory results at hospital admission were clustered by principal component analysis (PCA) and included in a path analysis model evaluating the causal relationship between age, comorbidities, hypoxemia, invasive mechanical ventilation (IMV) requirement, in-hospital delirium, and cognitive performance. RESULTS: We studied 92 patients: 54 (58.7%) men and 38 (41.3%) women, with median age of 50 years (interquartile range 42-55), among whom 50 (54.4%) tested positive for cognitive impairment at 6-month follow-up. Path analysis revealed a direct link between the thrombo-inflammatory component of PCA (C-reactive protein, fibrinogen, and neutrophils) and hypoxemia severity at hospital admission. Our model showed that low PaO2/FiO2 ratio values, unlike the thrombo-inflammatory component, had a direct effect on cognitive performance, independent from age, in-hospital delirium, and invasive mechanical ventilation. CONCLUSION: In this study, biomarkers of thrombo-inflammation in COVID-19 and low PaO2/FiO2 had a negative effect on cognitive performance 6 months after hospital discharge. These results highlight the critical role of hypoxemia as a driver for impaired cognition in the mid-term.

Microplastics as vectors of the antibiotics azithromycin and clarithromycin: Effects towards freshwater microalgae.

Water pollution due to microplastics (MPs) is recognized as a major anthropogenic impact. Once MPs reach the ecosystems, they are exposed to a variety of other pollutants, which can be sorbed on them, transported and eventually desorbed. In this work, we tested the hypothesis that MPs can behave as conveyors for delivering chemicals toxic to aquatic microorganisms by investigating the vector role of MPs of polyethylene terephthalate (PET), polylactic acid (PLA), polyoxymethylene (POM) and polystyrene (PS) to the macrolide antibiotics azithromycin (AZI) and clarithromycin (CLA). AZI and CLA were chosen, as they are included in the Watch List for EU monitoring concerning water policy by Decision (EU) 2018/840. MPs were loaded in contact with 500 µg/L of AZI or 1000 µg/L of CLA. Results showed that both antibiotics were sorbed on all tested MPs. The more hydrophobic AZI was sorbed in higher proportion than CLA. Both antibiotics were desorbed from MPs upon contact with water with percentages between 14.6 ± 2.6% for AZI and 1.9 ± 1.4% for CLA of the concentrations to which the MPs were initially exposed. Virgin MPs were not toxic to the cyanobacterium Anabaena sp. PCC7120. However, antibiotic-loaded MPs significantly inhibited the growth and chlorophyll content of the cyanobacterium. Most of the sorbed antibiotics became released upon contact with cyanobacterial cultures, which was the cause for the observed toxicity. Therefore, MPs can play a role as vectors of antibiotics in freshwaters systems affecting the basic trophic level of photosynthetic microorganisms.

Characterization and responses to environmental cues of a photosynthetic antenna-deficient mutant of the filamentous cyanobacterium Anabaena sp. PCC 7120.

The cyanobacterial phycobilisome (PBS) is a giant pigment-protein complex which harvests light energy for photosynthesis and comprises two structures: a core and peripheral rods. Most studies on PBS structure and function are based on mutants of unicellular strains. In this report, we describe the phenotypic and genetic characterization of a transposon mutant of the filamentous Anabaena sp. strain PCC 7120, denoted LC1, which cannot synthesize the phycobiliprotein phycocyanin (PC), the main component of the rods; in this mutant, the transposon had inserted into the cpcB gene (orf alr0528) which putatively encodes PC-ß chain. Mutant LC1 was able to synthesize phycoerythrocyanin (PEC), a phycobiliprotein (PBP) located at the terminal region of the rods; but in the absence of PC, PEC did not attach to the PBSs that only retained the allophycocyanin (APC) core; ferredoxin: NADP+-oxidoreductase (FNR) that is associated with the PBS in the wild type, was not found in isolated PBSs from LC1. The performance of the mutant exposed to different environmental conditions was evaluated. The mutant phenotype was successfully complemented by cloning and transfer of the wild type complete cpc operon to mutant LC1. Interestingly, LC1 compensated its mutation by significantly increasing the number of its core-PBS and the effective quantum yield of photosystem II (PSII) photochemistry; this feature suggests a more efficient energy conversion in the mutant which may be useful for biotechnological applications.

Toxicity of five antibiotics and their mixtures towards photosynthetic aquatic organisms: implications for environmental risk assessment.

The individual and combined toxicities of amoxicillin, erythromycin, levofloxacin, norfloxacin and tetracycline have been examined in two organisms representative of the aquatic environment, the cyanobacterium Anabaena CPB4337 as a target organism and the green alga Pseudokirchneriella subcapitata as a non-target organism. The cyanobacterium was more sensitive than the green alga to the toxic effect of antibiotics. Erythromycin was highly toxic for both organisms; tetracycline was more toxic to the green algae whereas the quinolones levofloxacin and norfloxacin were more toxic to the cyanobacterium than to the green alga. Amoxicillin also displayed toxicity to the cyanobacterium but showed no toxicity to the green alga. The toxicological interactions of antibiotics in the whole range of effect levels either in binary or multicomponent mixtures were analyzed using the Combination Index (CI) method. In most cases, synergism clearly predominated both for the green alga and the cyanobacterium. The CI method was compared with the classical models of additivity Concentration Addition (CA) and Independent Action (IA) finding that CI could accurately predict deviations from additivity. Risk assessment was performed by calculating the ratio between Measured Environmental Concentration (MEC) and the Predicted No Effect Concentration (PNEC). A MEC/PNEC ratio higher than 1 was found for the binary erythromycin and tetracycline mixture in wastewater effluents, a combination which showed a strong synergism at low effect levels in both organisms. From the tested antibiotic mixtures, it can be concluded that certain specific combinations may pose a potential ecological risk for aquatic ecosystems with the present environmentally measured concentrations.

Implante dentário unitário imediato / Immediate unitary dental implant

O presente estudo trata-se de uma revisão de literatura a respeito de Implante Dentário Unitário Imediato e também uma revisão atualizada com critérios de inclusão pré-estabelecidos relatando taxas de longevidade do ano de 1999 a 2009, bem como procedimentos clínicos associados a sua instalação. Foi realizada uma revisão de literatura com busca de artigos científicos na base de dados MEDLINE e os critérios de inclusão dos mesmos foram: artigos publicados de 1999 a 2009; ensaios clínicos randomizados e não-randomizados; estudos de coorte; estudos de caso-controle; relatos de casos clínicos com um número mínimo de 10 casos; taxas de sucesso e de longevidade devem ter um período de proservação de pelo menos 6 meses; relatos de casos clínicos somente com instalação de implantes imediatos. Foram identificados um total de dez estudos que preenchiam os critérios de seleção desta revisão. Eles relatam as taxas de longevidade de implantes imediatos e alguns ainda comparam com implantes tardios. O período de observação dos mesmos foi de seis meses a seis anos. Na presente revisão, a maior parte dos estudos apresentaram taxas de longevidade de implantes imediatos acima de 90%, ou seja, similar aos implantes colocados em alvéolos cicatrizados. Os autores não encontraram diferenças estatísticas significantes nas taxas de longevidade para técnicas de colocação imediata e tardia. A taxa de longevidade de implantes imediatos foi de 100% em quatro estudos. Dois estudos apresentaram maior taxa de sucesso com colocação imediata (96,8%) quando comparada com a tardia (93,9%). As menores taxas encontradas foram a de 89,3% e 85%. Com isso, os autores concluem que a técnica de instalação de Implante Unitário Imediato é uma técnica confiável e segura apresentado taxas de sucesso semelhante a implantes tardios

The present study is about a literature review regarding it Implants Dental Unitary Implants Immediate and an updated revision with inclusion criteria prestablished showing rates of longevity of the year from 1999 to 2009 as well as associated clinical procedures at its installation. A literature review was accomplished with a research of scientific MEDLINE database and the inclusion criteria of it were: Published from 1999 to 2009 ; randomized and non-randomized clinical rehearsals; cohort studies; case-control studies; reports of clinical cases with a minimum number of 10 cases; success and longevity rates should have a post accompaniment period of at least 6 months; reports of clinical cases only with placement of immediate implants. Ten studies that fitted out the criteria of selection of this revision were identified. They report the longevity rates of immediate dental implants and some still compare to late dental implants. The observation time was from six months to six years. In the present revision, most of the studies presented longevity rates of its immediate implants above 90%, in other words, similar to the implant placed in scarred alveoli. The authors didn’t find significant statistical differences in the longevity rates for techniques of immediate and late placement. The longevity rate of its immediate implant was 100% in six studies. Two studies presented larger success rate with immediate placement (96,8%) when compared with the late (93,9%). 89,3% and 85% were the lowest rates among reported ones, were found in two studies. Thus, we can conclude that the placement technique of it Immediate Unitary Dental Implants is a reliable technique and it holds presented rates of similar success to late implants

Gastroesophageal reflux in patients with recurrent laryngeal papillomatosis.

UNLABELLED: Evidence of a relation between gastroesophaeal reflux and pediatric respiratory disorders increases every year. Many respiratory symptoms and clinical conditions such as stridor, chronic cough, and recurrent pneumonia and bronchitis appear to be related to gastroesophageal reflux. Some studies have also suggested that gastroesophageal reflux may be associated with recurrent laryngeal papillomatosis, contributing to its recurrence and severity. AIM: the aim of this study was to verify the frequency and intensity of gastroesophageal reflux in children with recurrent laryngeal papillomatosis. MATERIAL AND METHODS: ten children of both genders, aged between 3 and 12 years, presenting laryngeal papillomatosis, were included in this study. The children underwent 24-hour double-probe pH-metry. RESULTS: fifty percent of the patients had evidence of gastroesophageal reflux at the distal sphincter; 90% presented reflux at the proximal sphincter. CONCLUSION: the frequency of proximal gastroesophageal reflux is significantly increased in patients with recurrent laryngeal papillomatosis.

Refluxo gastroesofágico em pacientes portadores de papilomatose recorrente de laringe / Gastroesophageal reflux in patients with recurrent laryngeal papillomatosis

A cada ano aumentam as evidências de que o refluxo gastroesofágico seja um fator que contribui para as desordens de vias aéreas, principalmente na população pediátrica, podendo gerar sintomas respiratórios como estridor, tosse crônica, pneumonias de repetição e bronquite crônica. Estudos recentes têm sugerido que a associação entre papilomatose laríngea recorrente e refluxo gastroesofágico possa ser um fator determinante na recorrência e crescimento dos papilomas. OBJETIVO: O objetivo deste estudo foi verificar a freqüência e a intensidade do refluxo gastroesofágico em crianças portadoras de Papilomatose Laríngea Recorrente (PLR). MATERIAL E MÉTODOS: Foram selecionadas 10 crianças portadoras de papilomatose laríngea recorrente, de ambos os sexos, com idade entre 3 e 12 anos. Todas foram submetidas a pH-metria de 24 horas com duplo canal para avaliação da presença e intensidade de refluxo gastroesofágico. RESULTADOS: Cinqüenta por cento dos pacientes apresentaram evidências de refluxo gastroesofágico patológico em nível do esfíncter distal, e 90 por cento apresentou refluxo proximal patológico. CONCLUSÃO: A freqüência da associação entre refluxo gastroesofágico proximal em pacientes portadores de papilomatose recorrente de laringe é extremamente alta.

Evidence of a relation between gastroesophaeal reflux and pediatric respiratory disorders increases every year. Many respiratory symptoms and clinical conditions such as stridor, chronic cough, and recurrent pneumonia and bronchitis appear to be related to gastroesophageal reflux. Some studies have also suggested that gastroesophageal reflux may be associated with recurrent laryngeal papillomatosis, contributing to its recurrence and severity. AIM: the aim of this study was to verify the frequency and intensity of gastroesophageal reflux in children with recurrent laryngeal papillomatosis. MATERIAL AND METHODS: ten children of both genders, aged between 3 and 12 years, presenting laryngeal papillomatosis, were included in this study. The children underwent 24-hour double-probe pH-metry. RESULTS: fifty percent of the patients had evidence of gastroesophageal reflux at the distal sphincter; 90 percent presented reflux at the proximal sphincter. CONCLUSION: the frequency of proximal gastroesophageal reflux is significantly increased in patients with recurrent laryngeal papillomatosis.

Técnica de Push - enteroscopia no diagnóstico do sangramento digestivo de origem indeterminada / Push-enteroscopy techique for the diagnosis of digestive bleeding of unknown oringin

A enteroscopia é uma técnica desenvolvida para visualização direta da mucosa do intestino delgado. Dois procedimentos não cirúrgicos estão disponíveis: push-enteroscopia e sonda enteroscópia e sonda enteroscópica, sendo esta última praticamente não utilizada em nosso meio. O objetivo deste estudo é avaliar o diagnóstico do sangramento oculto ou obscuro gastrointestinal através da push-enteroscopia. Estudaram-se, no período de janeiro de 1997 a junho de 2002, 71 exames do intestino delgado com a técnica de push-enteroscopiarealizados na Real e Benemérita Sociedade Portuguesa de Beneficência - Hospital São Joaquin, no serviço de Endoscopia Digestiva.Foram identificadas 37 (52,1por cento) lesões que justificam o sangramento oculto ou obscuro. As lesões identificadas foram: 17 ectasias vasculares, três lesões de Dieulafoy em duodeno, duas úlceras na terceira porção duodenal, sete casos de doença inflamatória intestinal com acometimento do intestino delgado, dois adenocarcinomas de duodeno, quatro pólipos de delgado, um divertículo e um hamartoma das glândulas de Brunner. Foi possível realizar procedimentos terapêutico e/ou diagnóstico em 26 casos

Crecimiento, producción de pigmentos y exopolisacáridos de la cianobacteria anabaena sp. PCC 7120 en función del pH y CO2 / Effect of pH and CO2 on growth, pigments and exopolysaccharides production from cianobacteria anaebaena sp. PCC 7120

El crecimiento producción de clorofila a, ficocianina, carotenoides y exopolisacáridos (EPS) de la cianobacteria filamentosa Anabaena sp. PCC 7120 fueron analizados en función del pH (5,5-10,5) con o sin soluciones amortiguadoras en cultivos discontinuos y en función del CO2 (0,03 y 5,0 por ciento) en cultivos semicontinuos a una tasa de renovación del 10 por ciento. El crecimiento de la cianobacteria se analizó por turbidez a 750nm y recuento celular, y la actividad fotosintética mediante uso de un electrodo de O2. Los cultivos, por triplicado, se mantuvieron con aireación constante, a 28 ñ 2ºC y con iluminación continua o fotoperíodo según el experimento. El pH y tampón utilizado influyeron en el crecimiento. El mayor crecimiento y contenido de EPS se alcanzaron, respectivamente, a pH 8,0-9,0 y 10,0. Sin embargo, los cultivos no tamponados resultaron con mayor contenido de clorofila a y ficocianina. El crecimiento, la actividad fotosintética y los carotenoides no variaron con la adición de CO2. Los cultivos semicontinuos con bajo CO2 produjeron los valores más elevados de clorofila a, ficocianina y exopolisacáridos, con 25,9 ñ 1,69, 2010 ñ 22,61 y 2286,0 ñ 42,76 µg.ml-1, respectivamente. El contenido de ficocianina y de EPS fue de 2,7 y 4 veces superior al obtenido a altos niveles de CO2. El pH y el sistema semicontinuo constituyen herramientas importantes para modular el crecimiento y contenido de pigmentos y de EPS de Anabaena sp. PCC 7120

Importância da endoscopia digestiva alta nas neoplasias das vias aéreas superiores. Relato de dois casos / Importance of digestive endoscopy in the neoplasm of the upper respiratory tract - a two cases presentation

Pacientes com neoplasias de cabeça e pescoço apresentam alto risco em desenvolver simultaneamente carcinoma esofágico. Esta ocorrência tem sido maior entre homens (10 homens: 1 mulher). Este artigo é ilustrado com o relato de dois casos com pacientes portadores de carcinoma espino-celular de cavidade oral e hipofaringe que desenvolveram concomitantemente carcinoma espino-celular de esôfago. A presença de múltiplos tumores no mesmo sistema (digestivo superior e respiratório) é explicado como resultado de metástases à distância ou de um processo denominado "campo de cancerizaçäo". Estes cânceres podem ser simultâneos, sincrônicos ou metacrônicos. Têm-se preconizado a realizaçäo de endoscopia digestiva de rotina associado à coloraçäo com lugol e a realizaçäo de biópsias na monitorizaçäo de pacientes com carcinoma de cavidade oral e de orofaringe para a detecçäo precoce de carcinoma esofágico concomitante

Hemorragia digestiva alta não varicosa: estudo retrospectivo / Non-variceal upper gastrointestinal bleeding: retrospective study

A hemorragia digestiva alta (HDA) é um evento frequente na prática clínica. Apesar da evolução da endoscopia terapêutica, o índice de mortalidade mantém-se em nível de 10 por cento. Foram estudados retrospectivamente 440 pacientes que realizaram endoscopia digestiva alta no período de abril de 1986 a outubro de 1998 com achado de lesões hemorrágicas, excluindo-se varizes de esôfago e fundo gástrico. Foram analisados tipo e localização das lesões, atividade do sangramento (classificação de Forrest), recidiva hemorrágica e evolução clínica dos pacientes. O tratamento endoscópico foi realizado por injeção de substância esclerosante ou termocoagulação de contato (heater probe) quando indicado. Obteve-se como lesão predominante a úlcera bulbar, Forrest II, um índice de ressangramento global de 11,8 por cento e mortalidade de 14 por cento. Acredita-se ser este último bastante dependente do agravamento pelo episódio hemorrágico de estados mórbidos pré-existentes e não somente por falha específica no tratamento da HDA

Polipectomia esdoscópica em pólipo de grande dimensäo / Endoscopic polypectomy in large dimension polyps

Paciente com 66 anos, do sexo feminino, que apresentava queixas de dor epigástrica, náuseas e emagrecimento, cujo exame endoscópico revelou lesäo polipóide, pediculada, medindo cerca de 6cm. A biópsia, realizada durante o ato endoscópico revelou tratar-se de pólipo adenomatoso tubuloviloso com atipias intensas, devendo-se considerar no diagnótico diferencial a hipótese de adenocarcinoma tubulopapilífero bem diferenciado. A paciente foi submetida a ressecçäo endoscópica, sem intercorrências, com retirada completa do material. O estudo histológico integral do material mostrou tratar-se de adenoma tubular sem indícios de malignidade. A paciente encontra-se em acompanhamento