Transport and preservation of calcareous and organic-walled dinoflagellate cysts off Cape Blanc (NW africa) in relation to nepheloid layers.

Our understanding of dinoflagellates' present-day and past ecology is limited due to the scarcity of data on the transport of dinoflagellate cysts in oceanic environments. Previous studies have shown that lateral transport affects the source-to-sink trajectory of cysts in the very productive region off Cape Blanc (NW Africa). Unsolved questions remain, such as: how far these cysts can be advected, whether the cyst sources vary over time and whether lateral transport is a permanent feature or restricted to individual events. To fill these gaps and assess the role of nepheloid layers on the lateral transport and preservation of dinoflagellate cysts, new data on dinoflagellate cyst distributions in the water column and sediments along a land-sea transect were obtained. Samples were collected in November 2018 along a shelf break-offshore transect during intense upwelling, notably, within and between the nepheloid layers. The composition and abundance of cysts with organic walls in the water column and surface sediments were studied. Moreover, the distribution of calcareous cysts was also analysed in the water samples, using non-destructive acid-free preparation methods. The records were dominated by empty cysts, but no clear indications that these originated from local resuspension of older sediments were observed. Clustering, principal component analysis and redundant discriminant analysis were used to compare cyst assemblages in the water column and surface sediments, and environmental conditions in the upper water column. The strong similarity in species composition of water samples collected in the active upwelling region to those collected from the more onshore parts of the Benthic Nepheloid Layer (BNL), upper Intermediate Nepheloid Layer (INL) (∼1000 m depth) and lower INL (∼2200 m depth) indicated that lateral transport of cysts within these NLs occurred until about ∼110 km from the shelf break. Cyst assemblages from above and below these NLs showed significantly different taxa composition reinforcing the role of NLs in the lateral advection of cysts. In the more offshore stations, vertically similar cyst assemblages were observed in the same station, independent of the sample depth, within or between the NLs, which supported that at these stations vertical transport was the dominant process influencing cyst assemblages. Consequently, the cyst signal in sediments off Cape Blanc may be affected both by horizontal transport of allochthonous cysts and vertical deposition of locally-produced cysts, particularly in the more offshore stations (>2000 m depth). Despite lateral transport and possible species-specific preservation effects, horizontal distributions of most cyst taxa in the water column and the surface sediments could be explained to a great extent by the main environmental gradients in the upper water column. This agrees with observations made in other regions, and reinforces that dinoflagellate cysts as good proxies to reconstruct past environmental conditions in offshore environments. New data on dinoflagellate cyst distribution, transport and accumulation patterns in deep environments off Cape Blanc may be useful for interpreting past environmental signals in the region. This is particularly relevant regarding calcareous cysts, as information on their distribution and ecology is very scarce. The present work contributes to a better understanding of the dispersal patterns of dinoflagellate cysts in the deep ocean, highlighting the significant role played by nepheloid layers in this process and thus on the dinoflagellate cyst signature in deep-sea sediments.

Enfermagem em Prática Avançada no pronto atendimento: uma reflexão promissora / Nursing in Advanced Practice in emergency care unit: a promising reflection

OBJETIVO: Refletir acerca das Unidades de Pronto Atendimento 24h como cenário de atuação para a Prática Avançada de Enfermeiros nos serviços de urgência e emergência. MÉTODO: Este estudo utilizou a metodologia de reflexão. RESULTADOS: A Enfermagem de Prática Avançada é uma especialidade em que atuam enfermeiros com conhecimento e habilidades ampliado, capazes de tomar decisões complexas, além de possuírem nível avançado de práticas específicas. Os serviços de urgência e emergência são cenários promissores ao desenvolvimento da Enfermagem de Prática Avançada, incluindo as Unidade de Pronto Atendimento 24h, pela capacidade de atendimentos de alta complexidade e atuação de profissionais altamente capacitados. Portanto, há necessidade de reflexão sobre avanços e entraves na atuação, regulamentação, sobretudo no que se refere a este cenário, pouco discutido no contexto da Enfermagem de Prática Avançada no Brasil. CONCLUSÃO: Existe grande necessidade de ampliação da discussão da Enfermagem de Prática Avançada para os demais níveis de atenção no Brasil. Há serviços com amplo potencial a serem desenvolvidos, sendo um deles as Unidades de Pronto Atendimento 24h. Observa-se que o enfermeiro de práticas avançadas nestes serviços poderá trazer grandes benefícios para a população, além de melhorar a qualidade da assistência, trazendo maior autonomia aos profissionais destes serviços.

OBJECTIVE: To reflect about the Emergency Care Unit an action scenario for the Advanced practice of nurses in emergency and urgency services. METHOD: This study utilized the methodology of reflection. RESULTS: Advanced Practice Nursing is a specialty in which nurses with expanded knowledge and additional skills can make complex decisions in addition to having an advanced level of specific practices. Emergency and urgency services are promising scenarios for the development of Advanced Practice Nursing, including the 24-hour Care Unit, especially due to the capacity of high complexity care and the performance of highly qualified professionals. Therefore, there is a need for reflection on the advances, obstacles in the performance and regulation, especially in relation to this scenario, which is little discussed in the context of Advanced Practice Nursing in Brazil. CONCLUSION: There is a great need to expand the discussion of Advanced Practice Nursing to the other levels of care in Brazil. There are services with vast potential to be developed, one of them being the 24-hour Care units. It is observed that nurses from advanced practices in these services can bring great benefits to the population, in addition to improving the quality of care, bringing greater autonomy for nurses in these services.

Sufentanil Sublingual Tablet System vs. Intravenous Patient-Controlled Analgesia with Morphine: Postoperative Pain Control and Its Impact in Quality of Recovery.

CONTEXT: Patient-controlled analgesia (PCA) is commonly used for postoperative pain control. Although widely used, intravenous (IV) morphine PCA may not be suitable for all patients. Sufentanil sublingual tablet system (SSTS) PCA is a recent technique that has had success as a safe and effective alternative for acute pain management. AIMS: This study aims to compare both the efficacy and safety of SSTS PCA versus IV morphine PCA in postoperative pain control and the quality of recovery in adult patients following scheduled gynecological or orthopedic surgery. SETTINGS AND DESIGN: Open-label, parallel-group, randomized controlled trial with 54 patients. The primary outcome was postoperative pain control, while the secondary outcomes included adverse effects associated with two analgesic modalities, total opioid dose required, patient satisfaction, and impact on the quality of postoperative recovery. METHODS AND MATERIAL: Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The chi-squared test was used in categorical variables. When distribution was normal, T-student (mean ± standard deviation) was used in continuous variables. In contrast, when distribution was not normal, the Mann-Whitney test (median (minimal-maximal)) was used. RESULTS: The results showed that there was a statistically significant difference in the total dose of opioid used by patients at 24 hours postoperatively, with patients receiving SSTS PCA requiring a higher total dose when compared to those receiving IV morphine PCA. However, there were no statistically significant differences in pain scores, adverse events, or patient satisfaction. CONCLUSIONS: The study suggests that both IV morphine and sublingual sufentanil are safe and effective for postoperative pain management.

Trilhas nômades nordestinas de cuidado entre GAM e redução de danos / Northeastern nomad care trails between GAM and harm reduction / Senderos nómados nordestinos de cuidado entre GAM y reducción de daños

O presente trabalho tem por objetivo cartografar as potencialidades do encontro entre a estratégia da Gestão Autônoma da Medicação (GAM) com a perspectiva ético-política da Redução de Danos, a partir da experiência de um grupo GAM no Centro de Atenção Psicossocial para Álcool e Outras Drogas (Caps-Ad) da cidade de Garanhuns-PE. Nos valemos de diários de campo produzidos durante o grupo e, depois, em retorno ao campo para atualização da experiência. Os diários auxiliaram na composição de narrativas de análise com foco nas práticas de cuidado de si e nos efeitos do grupo nas trajetórias dos atores envolvidos e do serviço. Conclui-se que a estratégia GAM enriquece e amplia o paradigma da Redução de Danos, potencializando o cuidado integral aos que usam drogas e gerando efeitos de autonomia e emancipação nas trajetórias de cuidado e vida. (AU)

The present work aims to map the potential of the clash between the Autonomous Medication Management (GAM) strategy with the ethical-political perspective of Harm Reduction, based on the experience of a GAM group at the Psychosocial Care Center for Alcoholand Others Drugs (Caps-Ad) in the city of Garanhuns-PE. We made use of field diaries produced during the group and, later, back in the field to update the experience. The diaries helped in the composition of analysis narratives focusing on Self-Care practices and on the effects of the group on the trajectories of the actors involved and on the service. It is concluded that the GAM strategy enriches and expands the Harm Reduction paradigm, enhancing comprehensive care for drug users and generating effects of autonomy and emancipation in care and life trajectories. (AU)

El presente trabajo tiene como objetivo mapear el potencial del encuentro entre la estrategia de Gestión Autónoma de Medicamentos (GAM) con la perspectiva ético-política de Reducción de Daños, a partir de la experiencia de un grupo GAM del Centro de Atención Psicosocial de Alcohol y Otras Drogas (Caps-Ad) en la ciudad de Garanhuns-PE. Hicimos uso de diarios de campo elaborados durante el grupo y, posteriormente, de vuelta en el campo para actualizar la experiencia. Los diarios ayudaron en la composición de narrativas de análisis centradas en las prácticas de autocuidado y en los efectos del grupo en las trayectorias de los actores involucrados y el servicio. Se concluye que la estrategia GAM enriquece y amplía el paradigma de Reducción de Daños, potenciando la atención integral a los usuarios de drogas y generando efectos de autonomía y emancipación en el cuidado y en las trayectorias de vida. (AU)

Sleep assessment in adults with Down syndrome: correlation between functionality and polysomnographic findings / Avaliação do sono de adultos com síndrome de Down: correlações entre funcionalidade e achados polissonográficos

Abstract Background Sleep disorders have a negative impact on health, being associated with neurocognitive problems, cardiovascular diseases and obesity, influencing children's development and learning. Objective To assess the sleep pattern of people with Down syndrome (DS) and correlate changes with functionality and behavior. Methods A cross-sectional study was conducted to evaluate the sleep pattern in adults with DS > 18 years old. Twenty-two participants were assessed using the Pittsburgh Sleep Quality Index, the Functional Independence Measure and the Strengths and Difficulties Questionnaire, and the 11 who presented indications of disorders by the screening questionnaires were referred to polysomnography. Statistical tests were performed using a significance level of 5%, including sample normality tests and correlation tests (sleep and functionality). Results Impairment in sleep architecture was found due to an increase in the rate of awakenings in 100% of the participants, a decrease in the number of slow waves, and a high prevalence of sleep disordered breathing (SDB), with higher averages in the Apnea and Hypopnea Index (AHI) in the group. There was a negative correlation between sleep quality and global functionality (p= 0.011) and the motor (p= 0.074), cognitive (p= 0.010), and personal care (p= 0.072) dimensions in the group. Global and hyperactivity behavior changes were related to worse sleep quality (p= 0.072; p= 0.015, respectively). Conclusion There is an impairment in the sleep quality of adults with DS, with an increase in the rate of awakenings, a decrease in the number of slow waves, and a high prevalence of SDB affecting this population in the functional and behavioral aspects.

Resumo Antecedentes Os distúrbios de sono têm impacto negativo na saúde, estando associados a problemas neurocognitivos, doenças cardiovasculares e obesidade, influenciando no desenvolvimento e aprendizado. Objetivo Avaliar o padrão de sono de pessoas com síndrome de Down (SD) e correlacionar as alterações com a funcionalidade e comportamento. Métodos Foi realizado um estudo transversal para avaliação do padrão de sono em adultos com SD > 18 anos. Foram avaliados 22 participantes, através do Índice de Qualidade do Sono de Pittsburgh, da Medida de Independência Funcional e do Questionaário de Capacidades e Dificuldades. Os 11 participantes que apresentaram indicativos de presença de distúrbios pelos questionários de triagem foram indicados a polissonografia. Os testes estatísticos foram realizados com nível de significância de 5%, incluindo testes de normalidade e testes de correlação (sono e funcionalidade). Resultados Foi encontrado prejuízo na arquitetura de sono pelo aumento do índice de despertares em 100% dos participantes, diminuição na quantidade de ondas lentas, e alta prevalência de distúrbio respiratório do sono (DRS), com maiores médias nos Índices de Apneia e Hipopneia (IAH). Houve correlação negativa entre a qualidade de sono e a funcionalidade global (p= 0,011), e as dimensões motora (p= 0,074), cognitiva (p= 0,010) e cuidados pessoais (p= 0,072). As alterações de comportamento global e comportamentos de hiperatividade foram relacionados à pior qualidade do sono (p= 0,072; p= 0,015, respectivamente). Conclusão Existe prejuízo na qualidade de sono de adultos com SD, com aumento de índice de despertares, diminuição na quantidade de ondas lentas, e alta prevalência de DRS, afetando essa população nos aspectos funcionais e comportamentais.

Critical Factors Associated with Morbimortality in COVID-19 Patients Attended at a Brazilian Public Hospital: a Cross-Sectional Study / Fatores Críticos Associados à Morbimortalidade em Pacientes com COVID-19 Atendidos em um Hospital Público Brasileiro: um Estudo Transversal

The association between death from Covid-19 and case management, especially in small and medium-sized municipalities, is still uncertain. To analyze sociodemographic, clinical, and pharmacological factors associated with death in patients with Coronavirus Disease 2019 (COVID-19), from a Brazilian referral public hospital. This is a cross-sectional study, with data from the hospital records of patients (≥ 18 years old) diagnosed with COVID-19, from March 2020 to March 2021. The sample was classified according to the clinical outcome into two groups (death and discharge), among which statistical associations were performed with the variables of interest, with a 5% significance level. Factors such as need for intensive care, use of mechanical ventilation, and total length of hospital stay was related to higher hospital mortality, as well as the permanence of changes in clinical laboratory testing, including lactic acid, D-dimer, markers of hepatic and renal function, C-Reactive protein, anemia, leukocytosis, lymphopenia, thrombocytopenia, pH, and blood oxygen saturation (SpO2) (P < 0.05). Medications used most frequently in the studied hospital for the treatment of COVID-19, such as enoxaparin, dexamethasone, ivermectin, acetylcysteine, chloroquine, and clarithromycin were correlated with morbimortality (P < 0.05). Clinical outcome was influenced by patient-related factors, such as age and comorbidities, however, therapeutic interventions and the choice of medication also impacted morbimortality. These results reinforce the need for preventive actions and adequate clinical protocols in the treatment of hospitalized COVID-19 patients.(AU)

A associação entre o óbito pela Covid-19 e o manejo dos casos, principalmente em municípios de pequeno e médio porte, ainda é incerta. Analisar os fatores sociodemográficos, clínicos e farmacológicos associados à morte em pacientes com a doença do Coronavírus 2019 (COVID-19) em um hospital público brasileiro de referência. Trata-se de um estudo transversal realizado com dados dos prontuários de pacientes (≥ 18 anos) diagnosticados com COVID-19 no período de março de 2020 a março de 2021. A amostra foi classificada de acordo com o desfecho clínico em dois grupos (óbito e alta) e foram realizados testes de associação estatística com as variáveis de interesse com nível de significância de 5%. Fatores como necessidade de terapia intensiva, uso de ventilação mecânica e tempo total de internação estiveram relacionados com maior mortalidade hospitalar, assim como a permanência de alterações nos exames laboratoriais clínicos, incluindo ácido lático, D-dímero, marcadores de função hepática e renal, proteína C reativa, anemia, leucocitose, linfopenia, trombocitopenia, pH e saturação de oxigênio no sangue (SpO2) (P < 0,05). Os medicamentos utilizados com maior frequência no hospital para o tratamento de COVID-19, como enoxaparina, dexametasona, ivermectina, acetilcisteína, cloroquina e claritromicina, foram correlacionados com morbimortalidade (P < 0,05). O desfecho clínico foi influenciado por fatores relacionados ao paciente, como idade e comorbidades, porém as intervenções terapêuticas e a escolha dos medicamentos também impactaram na morbimortalidade. Esses resultados reforçam a necessidade de ações preventivas e protocolos clínicos adequados no tratamento de pacientes hospitalizados com COVID-19.(AU)

Combined neuraxial-general anesthesia in opsoclonus-myoclonus syndrome: A case report.

Opsoclonus-myoclonus syndrome (OMS) is a very rare neurological disorder thought to be the result of autoimmune responses in the nervous system. The relationship between this disorder and anesthesia procedures has not been studied in detail. To our knowledge, there are only 4 case reports, none of them with epidural-general combined anesthesia. We present a 9-year-old female with OMS due to low-grade neuroblastoma, for 7 years, who underwent tumor remotion due to the large size. Intravenous induction was done with alfentanil, lidocaine, propofol and rocuronium and ropivacaine was administered via lumbar epidural catheter. Adding to the sparse anesthetic management information in OMS, we now show one more possible approach, that can be valuable in high-risk cases, where general anesthesia can be involved with higher risk for the patient.

Seroprevalence of SARS-CoV-2 antibodies in schoolchildren in the city of São Paulo, 2020 / Soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares no município de São Paulo, 2020

ABSTRACT OBJECTIVE To estimate seroprevalence of SARS-CoV-2 antibodies in schoolchildren aged 4 to 14 years living in the city of São Paulo, according to clinical, demographic, epidemiological, and social variables, during the school closure period as a measure against covid-19 spread. METHODS A serological survey was made in September 2020 with a random sample stratified by school system (municipal public, state public and private) type. A venous blood sample was collected using the Wondfo SARS-CoV-2 Antibody Test (lateral flow method) for detection of total SARS-CoV-2 virus antibodies. Semi-structured questionnaires were applied to collect clinical, demographic, social, and epidemiological data. RESULTS Seroprevalence of SARS-CoV-2 antibodies in schoolchildren was of 16.6% (95%CI 15.4-17.8). The study found higher seroprevalence in the municipal (18.5%; 95%CI 16.6-20.6) and state (16.2%; 95%CI 14.4-18.2) public school systems compared to the private school system (11.7; 95%CI 10.0-13.7), among black and brown students (18.4%; 95%CI 16.8-20.2) and in the most vulnerable social stratum (18.5 %;95%CI 16.9-20.2). Lower seroprevalence was identified in schoolchildren who reported following the recommended protective measures against covid-19. CONCLUSION Seroprevalence of SARS-CoV-2 antibodies is found mainly in the most socially vulnerable schoolchildren. This study can contribute to support public policies that reinforce the importance of suspending face-to-face classes and developing strategies aimed at protective measures and monitoring of the serological status of those who have not yet been included in the vaccination schedule.

RESUMO OBJETIVO Estimar a soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares de quatro a 14 anos de idade residentes no município de São Paulo, segundo variáveis clínicas, demográficas, epidemiológicas e sociais, durante o período de fechamento das escolas como medida de controle da covid-19. MÉTODOS Realizou-se um inquérito sorológico em setembro de 2020 com amostra aleatória estratificada por tipo de rede de ensino (pública municipal, pública estadual e privada). Foi coletada amostra de sangue venoso utilizando-se o teste de imunoensaio de fluxo lateral da fabricante Wondfo para detecção de anticorpos totais contra o vírus SARS-CoV-2. Aplicaram-se questionários semiestruturados para o levantamento de dados clínicos, demográficos, sociais e epidemiológicos. RESULTADOS A soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares foi de 16,6% (IC95% 15,4-17,8). O estudo encontrou soroprevalências mais elevadas na rede pública municipal (18,5%; IC95% 16,6-20,6) e estadual (16,2%; IC95% 14,4-18,2) em relação à rede privada (11,7; IC95% 10,0-13,7) e entre escolares da raça/cor preta e parda (18,4%; IC95% 16,8-20,2) e no estrato social mais vulnerável (18,5%; IC95% 16,9-20,2). A pesquisa identificou menores soroprevalências nos escolares que relataram seguir as medidas recomendadas de proteção contra a covid-19. CONCLUSÃO A soroprevalência de anticorpos contra o vírus SARS-CoV-2 atinge principalmente os escolares socialmente mais vulneráveis. Este estudo pode contribuir para embasar políticas públicas que reforcem a importância da suspensão das aulas presenciais e da necessidade de estratégias de medidas de proteção e acompanhamento do status sorológico daqueles que ainda não foram contemplados no calendário vacinal.

A publicidade testemunhal de medicamentos difundida por influenciadores digitais e seu enquadramento no direito luso-brasileiro / The testimonial advertising of medicines disseminated by digital influencers and its framework in Portuguese-Brazilian law

A indústria farmacêutica tem encontrado novas técnicas para promover os medicamentos isentos de prescrição médica junto do público geral. Neste contexto, a publicidade testemunhal permite incrementar a credibilidade da mensagem, ficando o seu enquadramento dependente da categoria do emissor nos ordenamentos jurídicos português e brasileiro. Adotando uma perspectiva de direito comparado, o presente trabalho visou analisar a publicidade testemunhal, com especial enfoque nos depoimentos veiculados por influenciadores digitais que recomendam o consumo de medicamentos. Trata-se de um estudo qualitativo, assente no levantamento bibliográfico e legislativo, bem como na análise detalhada de decisões dos organismos de autorregulação competentes, tanto em Portugal como no Brasil. Concluiu-se que alguns influenciadores digitais podem ser considerados pessoas famosas, e não meros consumidores, o que determina a ilicitude da publicidade difundida, atenta a necessidade de acautelar a objetividade e o uso racional dos medicamentos. No entanto, resultou das decisões analisadas uma abordagem tradicional destas novas técnicas de promoção de medicamentos, centrada ainda nas menções obrigatórias e nos princípios gerais vigentes em matéria de publicidade.

The pharmaceutical industry has found new techniques to promote over-the-counter drugs to the public. In this context, testimonial advertising makes it possible to increase the credibility of the message, its framework being dependent on the category of the sender, in the Portuguese and Brazilian legal systems. Adopting a comparative law perspective, the present work aimed at analysing testimonial advertising, with a special focus on testimonies given by digital influencers who recommend the consumption of drugs. It is a qualitative study, based on a bibliographic and legislative survey, as well as on a detailed analysis of decisions by competent self-regulatory bodies, both in Portugal and Brazil. It is concluded that some digital influencers can be considered famous people and not just consumers, which determines the unlawfulness of widespread advertising, considering the need to safeguard objectivity and the rational use of drugs. However, a traditional approach to these new techniques of drugs promotion, still focused on mandatory mentions and the general principles of advertising, resulted from the decisions analyzed.

The Portuguese version of the visual vertigo analog scale

Abstract Objectives: Visual vertigo occurs after a vestibular disorder compromising daily living. It can be assessed by "the Visual Vertigo Analogue Scale" (VVAS), a self-administered questionnaire without Portuguese version. To perform the translation, cross cultural adaptation, and validation of VVAS from English to Portuguese. Methods: Prospective study involving the translation and cross-cultural adaptation of the VVAS into the Portuguese language, according to recognized guidelines. It was completed by 63 healthy controls and 198 participants with vestibulopathy who also completed the Dizziness Handicap Inventory (DHI) to further explore the link between DHI and VVAS. Groups were compared for severity of visual vertigo and VVAS reliability and internal consistency were tested. Results: The VVAS score was significantly higher in vestibular group (p < 0.001). A Cronbach's α of 0.9 confirmed the valid internally consistent of the applied version. The severity score of VVAS showed a positive strong correlation with DHI (p < 0.0001). Conclusion: The present Portuguese translation of the scale showed satisfactory properties for the assessment of self-perceived and severity of visual vertigo in a significant group of vestibular Portuguese patients. Level of evidence: 2.

Infective Endocarditis: An Embolic Case.

Infective endocarditis is a sudden illness that rapidly causes cardiac and extracardiac injury. Embolic material travels into the arterial circulation causing embolic events in 20-50% of patients. The brain is one of the most frequent sites of embolism that potentially interferes with treatment options. Neurologic complications are the presenting symptom in 20% of the cases being associated with poor prognosis (45% of deaths versus 24% in patients without these complications). This is the case of a 63-year-old male patient presenting with main clinic of stroke. Multifocal signs and past aortic valvuloplasty raised the suspicion of infective endocarditis and antimicrobial therapy was initiated despite an initial negative transthoracic echocardiography (TTE). Imaging study revealed vascular lesions in different arterial territories of the brain, some of them with hemorrhagic transformation and multiple splenic and renal areas of infarction. Hemodynamic instability and acute pulmonary edema developed just before surgery. Transoesophageal echocardiography (TEE) confirmed a typical image of vegetation, conditioning severe aortic regurgitation, and a perivalvar abscess with fistulization to the right ventricle. Both were surgically repaired. The immediate postoperative period was characterized by cardiogenic shock, but the patient evolved favorably being transferred to the hospital ward where he continued his motor recovery. Early surgery is a mainstay in the treatment of infective endocarditis, reducing the embolic risk. Once happened, neurologic embolization may worsen the prognosis and raise doubts about further deterioration or hemorrhagic conversion following cardiopulmonary bypass. Optimal time interval between ischemic stroke and surgery has not yet been determined but recent data favour early surgery that, when indicated, should not be delayed. Most of the embolic events occur before admission making presentation variable. Clinical suspicion is highly important to the prompt institution of antibiotic therapy and the avoidance of subsequent embolic events. TTE is a sensitive tool in the diagnosis of endocarditis, but a negative result does not exclude the diagnosis specially when endocarditis is clinicalliy expected. Imaging should be systematically performed in the course of the disease to detect new and relevant complications, always being aware of the higher sensitivity of TEE to detect intracardiac complications.

Playing hide and seek: Distribution with depth of potentially harmful epibenthic dinoflagellates of Southern El Hierro Island, Canary Islands (NE Atlantic).

The study of epibenthic assemblages of harmful dinoflagellates (BHABs) is commonly conducted in shallow infralittoral zones (0 - 5 m) and are seldom investigated at deeper waters. In this study, the distribution with depth of five BHAB genera (Gambierdiscus, Ostreopsis, Prorocentrum, Coolia and Amphidinium) was investigated in the south of El Hierro island (Canary Islands, Spain). Sampling involved the use of a standardized artificial substrate deployed at three depth levels (5, 10 and 20 m) that were visited at three different times throughout one year. The influence of three depth-correlated abiotic parameters, i.e. light, water motion and water temperature, on the vertical and seasonal distribution of the BHAB assemblage was also assessed. Two vertical distribution patterns were observed consistently through time: cell abundances of Ostreopsis and Coolia decreased from 5 to 20 m while those of Gambierdiscus, Prorocentrum and Amphidinium showed the reverse pattern, although significant differences were only observed between 5 and 10 - 20 m depth. In April, two members of the latter group, Gambierdiscus and Amphidinium, were even absent at 5 m depth. The recorded environmental parameters explained a high percentage of the observed distribution. In particular, model selection statistical approaches indicated that water motion was the most significant parameter. An analysis of Gambierdiscus at species level revealed the co-occurrence of four species in the study area: G. australes, G. belizeanus, G. caribaeus and G. excentricus. The species G. excentricus, reported here for the first time in El Hierro, showed a more restricted vertical and seasonal distribution than the other species, which may explain not being detected in previous studies in the area. The results obtained in this study highlight the importance of considering a wider depth range and different seasons of the year when investigating the ecology of BHABs and assessing their risk and impacts on human health and the environment. Only then, efficient monitoring programs will be implemented in the Canary Islands and globally in areas affected by these events.

Grupo terapêutico on-line: dispositivo de cuidado para saúde mental de universitários em tempos de pandemia / On-line therapeutic group: care device for the mental health of college students in pandemic times

A pandemia da COVID-19 provocou alterações nos pilares geopolíticos e culturais da sociedade, podendo resultar em impactos psicológicos negativos frente as incertezas do cenário. Os jovens universitários, frequentemente identificados como uma população vulnerável ao desenvolvimento de ansiedade, depressão e estresse, demandam cuidados qualificados oriundos de dispositivos da saúde mental, a fim de acolher o sofrimento e elaborar estratégias de enfrentamento diante de emergências sanitárias. Diante disso, objetivou-se relatar a experiência acerca de uma intervenção grupal breve, com a finalidade de refletir sobre a importância de grupos terapêuticos online estruturados de forma transdisciplinar. Considera-se que estes se apresentam como potentes ferramentas de atenção psicossocial e podem ser incluídos em programas de prevenção e remediação dos danos causados pela pandemia da COVID-19. O grupo terapêutico se mostrou como potencial ferramenta para o enfrentamento dos impactos causados pelo cenário de emergência sanitária e acolhimento das demandas emocionais da comunidade acadêmica, corroborando para uma maior qualidade de vida dos universitários.

The COVID-19 pandemic caused changes in the geopolitical and cultural pillars of society, which may result in negative psychological impacts in the face of the uncertainties of the scenario. Young university students, often identified as a population vulnerable to the development of anxiety, depression and stress, demand qualified care from mental health devices, in order to welcome suffering and develop coping strategies in the face of health emergencies. Therefore, the objective was to report the experience of a brief group intervention, in order to reflect on the importance of online therapeutic groups structured in a transdisciplinary way. These are considered to be powerful psychosocial care tools and can be included in programs to prevent and remediate the damage caused by the COVID-19 pandemic. Therapeutic groups proved to be potential tools for coping with the impacts caused by the health emergency scenario and welcoming the emotional demands of the academic community, contributing to a better quality of life for university students.

Unraveling the Gonyaulax baltica Species Complex: Cyst-theca Relationship of Impagidinium variaseptum, Spiniferites pseudodelicatus sp. nov. and S. ristingensis (Gonyaulacaceae, Dinophyceae), With Descriptions of Gonyaulax bohaiensis sp. nov, G. amoyensis sp. nov. and G. portimonensis sp. nov.

The taxonomy of the extant dinoflagellate genus Gonyaulax is challenging since its thecate morphology is rather conservative. In contrast, cysts of Gonyaulax are varied in morphology and have been related with the fossil-based genera Spiniferites and Impagidinium. To better understand the systematics of Gonyaulax species, we performed germination experiments on cysts that can be identified as S. ristingensis, an unidentified Spiniferites with petaloid processes here described as Spiniferites pseudodelicatus sp. nov. and Impagidinium variaseptum from Chinese and Portuguese waters. Despite marked differences in cyst morphology, motile cells of S. pseudodelicatus and I. variaseptum are indistinguishable from Gonyaulax baltica. Motile cells hatched from S. ristingensis are morphologically similar to G. baltica as well but differ in the presence of one pronounced antapical spine. Three new species, Gonyaulax amoyensis (cyst equivalent S. pseudodelicatus), Gonyaulax bohaiensis (cyst equivalent I. variaseptum), and Gonyaulax portimonensis (cyst equivalent S. ristingensis), were erected. In addition, a new ribotype (B) of G. baltica was reported from South Korea and a bloom of G. baltica ribotype B is reported from New Zealand. Molecular phylogeny based on LSU and SSU rRNA gene sequences revealed that Gonyaulax species with minute or short antapical spines formed a well-resolved clade, whereas species with two pronounced antapical spines or lack of antapical spines formed the sister clade. Six strains of four above species were examined for yessotoxin production by liquid chromatography coupled with tandem mass spectrometry, and very low concentrations of yessotoxin were detected for one G. bohaiensis strain.

IFNγ and GM-CSF control complementary differentiation programs in the monocyte-to-phagocyte transition during neuroinflammation.

During inflammation, Ly6Chi monocytes are rapidly mobilized from the bone marrow (BM) and are recruited into inflamed tissues, where they undergo monocyte-to-phagocyte transition (MTPT). The in vivo developmental trajectories of the MTPT and the contribution of individual cytokines to this process remain unclear. Here, we used a murine model of neuroinflammation to investigate how granulocyte-macrophage colony-stimulating factor (GM-CSF) and interferon-γ (IFNγ), two type 1 cytokines, controlled MTPT. Using genetic fate mapping, gene targeting and high-dimensional single-cell multiomics analyses, we found that IFNγ was essential for the gradual acquisition of a mature inflammatory phagocyte phenotype in Ly6Chi monocytes, while GM-CSF was required to license interleukin-1ß (IL-1ß) production, phagocytosis and oxidative burst. These results suggest that the proinflammatory cytokine environment guided MTPT trajectories in the inflamed central nervous system (CNS) and indicated that GM-CSF was the most prominent target for the disarming of monocyte progenies during neuroinflammation.

Leukocyte ratios are useful early predictors for adverse outcomes of COVID-19 infection

ABSTRACT Leukocyte biomarkers, including the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte-(MLR), platelet-to-lymphocyte (PLR) ratios and systemic immune-inflammation index (SII) have been associated with severity and mortality of patients with COVID-19. The purpose of this study was to evaluate the association of baseline leukocyte biomarkers calculated in the emergency department (ED) with the disease severity and mortality. This was a retrospective cohort study that evaluated 1,535 (mean age 57+18 years) patients with SARS-CoV-2 infection in the ED of a single reference center. Outcomes were severity, defined as intensive care unit (ICU) admission requirement, and in-hospital mortality. All leukocyte biomarkers were calculated in the ED before the hospital admission. Their ability to predict the severity and mortality was measured using receiver operating characteristic (ROC) curves. Severity and mortality were observed in 30.9% and 12.6% of the patients, respectively, and were significantly correlated with NLR, MLR, PLR and SII, but only NLR was independently associated with both outcomes on multivariate analysis. Analysis of ROC curves revealed that NLR (0.78 for severity and 0.80 for mortality) and SII (0.77 for severity and 0.75 for mortality) had the best ability to predict mortality, when compared to other ratios. The highest AUC was observed for NLR, employing cut-off points of 5.4 for severity and 5.5 for mortality. Leukocyte biomarkers, particularly NLR, are capable of predicting the severity and mortality of patients with SARS-CoV-2 infection and could be important adjunct tools to identify patients in the ED that are more prone to develop adverse outcomes.

Escore de risco de Framingham em pacientes diabéticos da estratégia de saúde da família / Framingham risk score among diabetic patients in the family health strategy / Puntuación de riesgo de Framingham en pacientes diabéticos de la estrategia de salud familiar

A maioria dos indivíduos com diabetes mellitus também apresenta obesidade, hipertensão arterial sistêmica (HAS) e dislipidemia. Por esse motivo, preconiza-se a Estratificação de Risco de Framingham (ERF), de modo a identificar o risco de desenvolvimento de doenças cardiovasculares (DCV) em dez anos. Este estudo analisa a prevalência de diabetes mellitus para determinar o risco cardiovascular pelo ERF na Estratégia de Saúde da Família (ESF), visando um cuidado integral para a prevenção de DCV. Trata-se de uma pesquisa de corte transversal com população (n = 746) dividida em 150 indivíduos diabéticos (apenas quatro do tipo 1) e 596 não diabéticos a partir de 3.325 prontuários. Foi identificado 57,9% (n = 432) de indivíduos com baixo risco (ERF < 10%); 24,7% (n = 185) em médio risco (ERF 10-20%), e 17,2% (n = 129) em alto risco (ERF > 20%). Os diabéticos de baixo risco representam 23,3% (n = 35/150); 36,6% (n = 55/150) com médio risco e 40% (n = 60/150) com alto risco. Os grupos são significativamente distintos entre si quanto ao ERF (P < 0, 0001) ao comparar os subgrupos de risco (baixo, médio, alto), assim como as taxas de glicemia (P < 0,0001). A prevalência de médio e alto risco aumenta a partir dos 48 anos de idade; o sexo feminino prevalece em todos os níveis de risco e faixas etárias. O risco cardiovascular para diabéticos é 2,5 vezes maior; há impacto aumentado se concomitante com hipertensão, tabagismo, obesidade, sedentarismo e etilismo. O panorama do risco cardiovascular, determinado pelo ERF, é relevante para o uso clínico pela equipe de saúde básica ao lidar com pacientes diabéticos.

Most individuals with diabetes mellitus also present obesity, hypertension and dyslipidemia. Hence, the Framingham Risk Stratification (ERF) is recommended to identify the risk of developing cardiovascular diseases (CVD) in 10 years. This study analyzes the prevalence of diabetes mellitus to determine cardiovascular risk using the ERF in the Family Health Strategy, aiming at comprehensive care for CVD prevention. Cross-sectional research was conducted with 746 patients divided into 150 diabetic individuals (only four with type 1) and 596 non-diabetic individuals, identified from 3,325 medical records. Of the total, 57.9% (n = 432) were low-risk individuals (ERF < 10%), 24.7% (n = 185) medium risk (ERF 10-20%), and 17.2% (n = 129) high risk (ERF > 20%). Among diabetics, 23.3% (n = 35/150) were at low risk, 36.6% (n = 55/150) at medium risk, and 40% (n = 60/150) at high risk. The groups are significantly different regarding ERF (P < 0.0001), and when comparing risk subgroups (low, medium, high) and blood glucose rates (P < 0.0001). The prevalence of medium and high risk increases from 48 years of age. Women prevails at all risk levels and age groups. Diabetics have a 2.5 times higher cardiovascular risk, presenting an increased impact if concomitant with hypertension, smoking, obesity, sedentary lifestyle, and alcoholism. The panorama of cardiovascular risk determined by the ERF is relevant for clinical use by primary care staff when treating diabetic patients.

La mayoría de las personas que padecen diabetes mellitus también tiene obesidad, hipertensión arterial sistémica (HAS) y dislipidemia. Por este motivo, se recomienda la Estratificación de Riesgo de Framingham (ERF) para identificar el riesgo de desarrollar enfermedades cardiovasculares (ECV) en 10 años. Este estudio busca analizar la prevalencia de la diabetes mellitus para determinar el riesgo cardiovascular utilizando la ERF en la Estrategia de Salud Familiar, con el objetivo de proporcionar una atención integral para la prevención de las ECV. Este es un estudio de corte transversal con una población (n = 746) dividida en 150 individuos diabéticos (solo 4 de tipo 1) y 596 individuos no diabéticos desde 3.325 historias clínicas. Se identificaron un 57,9% (n = 432) de individuos de bajo riesgo (ERF <10%); el 24,7% (n = 185) de riesgo medio (ERF 10-20%) y el 17,2% (n = 129) de alto riesgo (ERF > 20%). Los diabéticos de bajo riesgo constituyen el 23,3% (n = 35/150); con riesgo medio el 36,6% (n = 55/150) y con riesgo alto el 40% (n = 60/150). Los grupos son significativamente diferentes entre sí con respecto a la ERF (P < 0,0001) al comparar subgrupos de riesgo (bajo, medio, alto) y las tasas de glucosa en sangre (P < 0,0001). La prevalencia de riesgo medio y alto aumenta a partir de los 48 años; el género femenino predomina en todos los niveles de riesgo y grupos de edad. El riesgo cardiovascular para los diabéticos es 2,5 veces mayor; hay un mayor impacto si es concomitante con hipertensión, tabaquismo, obesidad, inactividad física y alcoholismo. El panorama de riesgo cardiovascular, determinado por la ERF, es relevante para el uso clínico por parte del equipo básico de salud cuando se trata de pacientes diabéticos.

Protection against autoimmunity is driven by thymic epithelial cell-mediated regulation of Treg development.

Medullary thymic epithelial cells (mTECs) are key antigen-presenting cells mediating T cell tolerance to prevent harmful autoimmunity. mTECs both negatively select self-reactive T cells and promote the development of thymic regulatory T cells (tTregs) that mediate peripheral tolerance. The relative importance of these two mechanisms of thymic education to prevent autoimmunity is unclear. We generated a mouse model to specifically target the development and function of mTECs by conditional ablation of the NF-κB­inducing kinase (NIK) in the TEC compartment. In contrast to germline-deficient NIK−/− mice, Foxn1CreNIKfl/fl mice rapidly developed fatal T cell­dependent multiorgan autoimmunity shortly after birth. Thymic transplantation and adoptive transfer experiments demonstrated that autoimmunity arises specifically from the emergence of dysfunctional tTregs. Thus, Treg function, rather than negative selection, enforces the protection of peripheral tissues from autoimmune attack.

Preconceitos que se cruzam: a relação entre o racismo, sexismo e valores / Prejudices that cross: therelationship between racism, sexism and values / Preconceptos que se cruzan: la relación entre el racismo, el sexismo y los valores

Essa pesquisa objetivou analisar a relação entre o Racismo Moderno e o Sexismo Ambivalente utilizando os Valores Humanos como terceira variável que pudesse explicar essa relação, tendo em vista seu poder de predição de fenômenos sociais. A amostra foi composta por 200 participantes distribuídos quase igualmente quanto ao sexo, sendo 101(50,5%) do sexo feminino e 99 (49,5%) do sexo masculino. A média de idade dos respondentes foi de 23 anos (DP = 5,41). Observou-se que o Sexismo Ambivalente e o Racismo Moderno estão correlacionados positivamente como também se relacionam com as subfunções Realização, Interativa e Normativa dos Valores Humanos explicando parcialmente a relação entre o racismo e o sexismo. Concluiu-se que as expressões modernas de racismo e sexismo estão interligadas e que os valores normativos, que visam manter a estabilidade social e tradição, podem desempenhar um papel importante na explicação parcial dessa ligação. (AU)

This study aimed to analyze the relationship between Modern Racism and Ambivalent Sexism using Human Values as a third variable that could explain this relationship, given its predictive power against social phenomena. The sample consisted of 200 participants distributed almost equally regarding gender, including 101 (50.5%) women and 99 (49.5%) men. The mean age of the respondents was 23 years (SD = 5.41). It was observed that Ambivalent Sexism and Modern Racism are positively correlated as they are also related to the Realization, Interactive, and Normative subfunctions of Human Values, partially explaining the relationship between racism and sexism. It was concluded that modern expressions of racism and sexism are interconnected and that normative values, which aim to maintain social stability and tradition, may play an important role in partially explaining this connection. (AU)

Esta investigación objetivó analizar la relación entre el Racismo Moderno y el Sexismo Ambivalente utilizando los Valores Humanos como la tercera variable que pudiera explicar esa relación, considerando su poder de predicción de fenómenos sociales. La muestra fue compuesta por 200 participantes distribuidos casi por igual cuanto al sexo, siendo 101 (50, 5%) mujeres y 99 (49,5%) hombres. La edad media de los encuestados fue de 23 años (DS = 5,41). Se observó que el Sexismo Ambivalente y el Racismo Moderno se correlacionaron positivamente, dado que también se relacionaron con las subfunciones Realización, Interactiva y Normativa de los Valores Humanos, explicando parcialmente la conexión entre el racismo y el sexismo. Se concluyó que las expresiones modernas de racismo y sexismo están interconectadas y que los valores normativos, que apuntan a mantener la estabilidad social y la tradición, pueden ejecutar un papel importante en la explicación parcial de esta conexión. (AU)

Pericytes regulate vascular immune homeostasis in the CNS.

Pericytes regulate the development of organ-specific characteristics of the brain vasculature such as the blood-brain barrier (BBB) and astrocytic end-feet. Whether pericytes are involved in the control of leukocyte trafficking in the adult central nervous system (CNS), a process tightly regulated by CNS vasculature, remains elusive. Using adult pericyte-deficient mice (Pdgfbret/ret ), we show that pericytes limit leukocyte infiltration into the CNS during homeostasis and autoimmune neuroinflammation. The permissiveness of the vasculature toward leukocyte trafficking in Pdgfbret/ret mice inversely correlates with vessel pericyte coverage. Upon induction of experimental autoimmune encephalomyelitis (EAE), pericyte-deficient mice die of severe atypical EAE, which can be reversed with fingolimod, indicating that the mortality is due to the massive influx of immune cells into the brain. Additionally, administration of anti-VCAM-1 and anti-ICAM-1 antibodies reduces leukocyte infiltration and diminishes the severity of atypical EAE symptoms of Pdgfbret/ret mice, indicating that the proinflammatory endothelium due to absence of pericytes facilitates exaggerated neuroinflammation. Furthermore, we show that the presence of myelin peptide-specific peripheral T cells in Pdgfbret/ret ;2D2tg mice leads to the development of spontaneous neurological symptoms paralleled by the massive influx of leukocytes into the brain. These findings indicate that intrinsic changes within brain vasculature can promote the development of a neuroinflammatory disorder.