Time between inhibitor detection and start of immune tolerance induction: Association with outcome in the BrazIT study.

BACKGROUND: Immune tolerance induction (ITI) is the treatment of choice for eradication of anti-factor VIII (FVIII) neutralizing alloantibodies (inhibitors) in people with inherited hemophilia A and high-responding inhibitor (PwHA-HRi). The association between ITI outcome and time elapsed between inhibitor detection and start of ITI (∆tinhi-ITI ) is debatable. OBJECTIVE: The aim of this study was to evaluate this association among a large cohort of severe PwHA-HRi. METHODS: Severe (factor VIII activity level <1%) PwHA-HRi on ITI (n = 142) were enrolled in 15 hemophilia treatment centers. PwHA-HRi were treated according to the Brazilian ITI Protocol. ITI outcomes were defined as success (i.e., recovered responsiveness to exogenous FVIII) and failure (i.e., no responsiveness to exogenous FVIII and requirement of bypassing agents to control bleeding). RESULTS: Median ages at inhibitor detection and at ITI start were 3.2 years (interquartile range [IQR], 1.6-8.1) and 6.9 years [IQR, 2.6-20.1), respectively. PwHA-HRi were stratified according to ∆tinhi-ITI quartiles: first (0.0-0.6 year), second (>0.6-1.7 year), third (>1.7-9.2 years), and fourth quartile (>9.2-24.5 years). The overall success rate was 65.5% (93/142), with no difference among first, second, third, and fourth quartiles (62.9%, 69.4%, 58.3%, and 71.4%, respectively) even after adjusting the analyses for potential confounders. CONCLUSION: In conclusion, delayed ITI start is not associated with failure of ITI in PwHA-HRi. Therefore, ITI should be offered for these patients, regardless of the time elapsed between the detection of inhibitor and the ITI start.

Parenting during the COVID-19 Lockdown in Portugal: Changes in Daily Routines, Co-Parenting Relationships, Emotional Experiences, and Support Networks.

The COVID-19 pandemic challenged parental resources pertinent to coping with lockdowns. The main objective of this work was to study parenting during the COVID-19 lockdown. Specifically at focus were parental behaviors concerning key domains for the family (daily routine, co-parenting, emotional experience, and support network) and changes related to the pandemic and associated with the parents' employment statuses. An online survey was carried out through an ad hoc questionnaire where participants completed questions about their sociodemographic data and rated how much their family routines, their co-parenting relationship, their emotional experiences, and the support available in the family network varied on a 5-point scale. The participants included 1384 parents, of which 286 responded to open questions regarding impactful experiences during the lockdown. The results showed differences in daily routine, co-parenting, emotional experience, and support network according to the parents' employment statuses. Between-group comparisons showed that at-home parents caring for children with governmental aids generally revealed more positive parenting behavior changes, while at-home parents who were teleworking reported more difficulties in parent-child activities and co-parenting. Furthermore, the content analysis of the data confirmed how important themes such as family dynamics, professional activities, and the relationship with the school community were throughout the participants' accounts of gains and losses. Overall, parents' employment statuses are associated with diverse experiences during lockdown. The COVID-19 pandemic highlighted the importance of family resources and parental resilience, particularly during circumstances jeopardizing the ever-sensitive work-family balance.

Plasticity in the timing of activity in the Red-rumped Agouti, Dasyprocta leporina (Mammalia: Rodentia), in the Atlantic Forest of southeastern Brazil / Plasticidade comportamental no horário de atividade de cutia, Dasyprocta leporina (Mammalia: Rodentia), na Mata Atlântica do sudeste do Brasil

Abstract Timing of activity is a consequence of adaptations to daily and seasonal changes in the environment and examining these patterns is important to better understand the temporal niches of the species. Here we examine temporal activity in the Red-rumped Agouti (Dasyprocta leporina) in two fragments of Atlantic Forest and those factors that influence the circadian rhythm in the study areas. Camera traps were used to gather data in two protected areas (one montane and other coastal) in the state of Espírito Santo, southeastern Brazil. A total of 49 photos were taken in the mountains and 152 in the coastal area. Activity patterns were diurnal and bimodal, and animals were active for 14-15 hours each day. Activity peaked in the morning soon after sunrise and then before and during dusk. Activity patterns were different in the two study areas (W = 6.77, p = 0.034). There was a longer peak in the morning in the coastal area, and a higher peak in the evening in the mountains, where activity starts later and becomes less intense earlier. The difference between activity patterns in the two locations suggests plasticity in agouti behavior. Because the two study areas are at about the same latitude, we suggest that the behavioral plasticity is due to different temperature regimes associated with a local effect of altitude and topography of the terrain on the incidence of solar rays inside the forest. The influence of other factors is also discussed. In addition to a better understanding of the temporal niche of the Red-rumped Agouti, the behavior patterns we describe here can be useful to optimize strategies for D. leporina conservation in southeastern Brazil once the species is more susceptible to poaching at times when animals are most active.

Resumo O horário de atividade reflete adaptações e respostas das espécies às variações diárias e sazonais do ambiente, sendo o entendimento destes padrões importante para uma melhor compreensão do nicho temporal das espécies. Este trabalho objetivou caracterizar o horário de atividade da cutia (Dasyprocta leporina) em dois remanescentes de Mata Atlântica e estabelecer os fatores que podem interferir no ritmo circadiano da espécie considerando peculiaridades das áreas amostradas. Foram analisados dados obtidos a partir de armadilhas fotográficas em duas áreas protegidas, sendo uma na região serrana e outra próximo à costa, ambas no estado do Espírito Santo, sudeste do Brasil. Foram obtidos 49 registros na região serrana e 152 registros na área costeira. A espécie apresentou padrão de atividade diurno e bimodal, mantendo-se ativa por 14-15 horas. Foi detectado um pico de atividade matutino, logo após o nascer do sol, e outro vespertino. O padrão de distribuição diária dos registros foi diferente entre as áreas amostradas (W = 6,766; p = 0,034), ressaltando que o pico de atividade matutino apresentou maior duração na área costeira, enquanto o pico vespertino foi proporcionalmente mais representativo na região serrana, onde as atividades se iniciam mais tarde e se tornam menos intensas mais cedo. Estas diferenças evidenciam a ocorrência de plasticidade comportamental em D. leporina no que se refere ao padrão de atividade local. Entretanto, a diferença entre as áreas estudadas não pode ser atribuída à latitude, uma vez que a distância entre as localidades é de menos de um grau. Sugere-se que a variação do horário de atividade de cutias nas áreas amostradas seja devido a diferenças na temperatura ambiente, associadas a variações locais decorrentes do efeito da altitude e da topografia do terreno na incidência de raios solares no interior da floresta. A influência de outros fatores também é discutida. Além do melhor entendimento do nicho temporal de cutias, os padrões comportamentais descritos no presente estudo podem ser úteis para otimizar estratégias de conservação de D. leporina no sudeste do Brasil considerando que a espécie é mais suscetível à caça quando os animais estão mais ativos.

Queixas recorrentes: diagnóstico diferencial em psiquiatria / Recurrent complaints: differential diagnosis in psychiatry

Neste capítulo, buscamos descrever, brevemente, as principais características dos transtornos psiquiátricos que podem causar queixas recorrentes, com o intuito de auxiliar o médico não-psiquiatra a diferenciar os diagnósticos e a abordar mais adequadamente os pacientes.

In this chapter, we briefly describe the main features of psychiatric disorders that may cause recurrent complaints, in order to assist the physician to differentiate diagnoses and to address more adequately the patients.

Estado confusional agudo / Acute confusional status

Estado confusional agudo é um termo utilizado na prática médica para a designação de delirium, uma síndrome neuropsiquiátrica aguda decorrente de uma patologia orgânica subjacente. Apesar de ser altamente prevalente e um potencial alerta para um distúrbio em evolução, o delirium pode passar despercebido. Os autores fazem uma revisão sobre o assunto, com ênfase no diagnóstico etiológico de suas principais patologias de base.

Acute confusional state is a termination used in the clinical practice to designate delirium, an acute neuropsychiatric syndrome due to an underlying organic pathology. Despite being highly prevalent and a potential alert for an ongoing disorder, delirium may go unnoticed. The authors make a review about the subject, emphasizing the etiologic diagnosis of its main base pathologies.

Conjutivite alérgica / Allergic conjunctivitis

Neste artigo, os autores fazem uma revisão bibliográfica sobre a conjuntivite alérgica e seus subtipos, abordando suas manifestações clinicas, fisiopatologia, diagnóstico e manejo específicos.