Taming the exoscope: a one-year prospective laboratory training study.

PURPOSE: Digital 3D exoscopes have been recently introduced as an alternative to a surgical microscope in microneurosurgery. We designed a laboratory training program to facilitate and measure the transition from microscope to exoscope. Our aim was to observe the effect of a one-year active training on microsurgical skills with the exoscope by repeating a standardized test task at several time points during the training program. METHODS: Two board-certified neurosurgeons with no previous exoscope experience performed the same test tasks in February, July, and November during a 12-month period. In between the test tasks, both participants worked with the exoscope in the laboratory and assisted during clinical surgeries on daily basis. Each of the test segments consisted of repeating the same task 10 times during one week. Altogether, 60 test tasks were performed, 30 each. The test task consisted of dissecting and harvesting the ulnar and radial arteries of the second segment of a chicken wing using an exoscope (Aesculap AEOS). Each dissection was recorded on video and analyzed by two independent evaluators. We measured the time required to complete the task as well as several metrics for evaluating the manual skills of the dissection and handling of the exoscope system. RESULT: There was a clear reduction in dissection time between the first and the last session, mean 34 min (SD 5.96) vs. 26 min (SD 8.69), respectively. At the end of the training, both neurosurgeons used the exoscope more efficiently utilizing more available options of the device. There was correlation between the dissection time and several of the factors we used for evaluating the work flow: staying in focus, zoom control, reduction of unnecessary movements or repetitive manual motions, manipulation technique of the vessel under dissection, handling of the instruments, and using them for multiple dissection purposes (stretching, cutting, and splitting). CONCLUSION: Continuous, dedicated long-term training program is effective for microsurgical skill development when switching from a microscope to an exoscope. With practice, the micromotor movements become more efficient and the use of microinstruments more versatile.

Intrusion Detection and Prevention in CoAP Wireless Sensor Networks Using Anomaly Detection.

It is well recognized that security will play a major role in enabling most of the applications envisioned for the Internet of Things (IoT). We must also note that most of such applications will employ sensing and actuating devices integrated with the Internet communications infrastructure and, from the minute such devices start to support end-to-end communications with external (Internet) hosts, they will be exposed to all kinds of threats and attacks. With this in mind, we propose an IDS framework for the detection and prevention of attacks in the context of Internet-integrated CoAP communication environments and, in the context of this framework, we implement and experimentally evaluate the effectiveness of anomaly-based intrusion detection, with the goal of detecting Denial of Service (DoS) attacks and attacks against the 6LoWPAN and CoAP communication protocols. From the results obtained in our experimental evaluation we observe that the proposed approach may viably protect devices against the considered attacks. We are able to achieve an accuracy of 93% considering the multi-class problem, thus when the pattern of specific intrusions is known. Considering the binary class problem, which allows us to recognize compromised devices, and though a lower accuracy of 92% is observed, a recall and an F_Measure of 98% were achieved. As far as our knowledge goes, ours is the first proposal targeting the usage of anomaly detection and prevention approaches to deal with application-layer and DoS attacks in 6LoWPAN and CoAP communication environments.

Temporal dynamics of spectral bioindicators evidence biological and ecological differences among functional types in a cork oak open woodland.

The application of spectral vegetation indices for the purpose of vegetation monitoring and modeling increased largely in recent years. Nonetheless, the interpretation of biophysical properties of vegetation through their spectral signature is still a challenging task. This is particularly true in Mediterranean oak forest characterized by a high spatial and temporal heterogeneity. In this study, the temporal dynamics of vegetation indices expected to be related with green biomass and photosynthetic efficiency were compared for the canopy of trees, the herbaceous layer, and two shrub species: cistus (Cistus salviifolius) and ulex (Ulex airensis). coexisting in a cork oak woodland. All indices were calculated from in situ measurements with a FieldSpec3 spectroradiometer (ASD Inc., Boulder, USA). Large differences emerged in the temporal trends and in the correlation between climate and vegetation indices. The relationship between spectral indices and temperature, radiation, and vapor pressure deficit for cork oak was opposite to that observed for the herbaceous layer and cistus. No correlation was observed between rainfall and vegetation indices in cork oak and ulex, but in the herbaceous layer and in the cistus, significant correlations were found. The analysis of spectral vegetation indices with fraction of absorbed PAR (fPAR) and quantum yield of chlorophyll fluorescence (ΔF/Fm') evidenced strongest relationships with the indices Normalized Difference Water Index (NDWI) and Photochemical Reflectance Index (PRI)512, respectively. Our results, while confirms the ability of spectral vegetation indices to represent temporal dynamics of biophysical properties of vegetation, evidence the importance to consider ecosystem composition for a correct ecological interpretation of results when the spatial resolution of observations includes different plant functional types.

Growth of the tropical zoanthid Palythoa caribaeorum (Cnidaria: Anthozoa) on reefs in northeastern Brazil.

In Brazilian reefs, zoanthids, especially Palythoa caribaeorum are fundamental for structuring the local benthic community. The objective of this study was to determine the growth rate of P. caribaeorum, and to assess the influence of the site (different beaches), season (dry and wet), location (intertidal or infralittoral zones), and human pressure associated with tourism. For one year we monitored the cover of P. caribaeorum in transects and focused on 20 colonies. We cut off a square (100 cm2) from the central part of the colony and monitored the bare area for four months in each season. The average growth rates varied from 0.015 and 0.021 cm.day(-1). The rate was homogeneous in all localities, and there was no influence from colony site, location, or touristic visitation, showing that the growth velocity may be an intrinsic characteristic of the species, with a strong genetic component. The growth rate of P. caribaeorum differed among months, and peaked in the first month after injury. The average cover varied from 6.2 to 22.9% and was lower on the reef visited by tourists. The present study corroborates the hypothesis that P. caribaeorum is important for coastal reef dynamics due to its fast and continuous growth.

Effectiveness and biological compatibility of different generations of dentin adhesives.

OBJECTIVES: Besides possessing good mechanical properties, dental materials should present a good biological behavior and should not injure the involved tissues. Bond strength and biocompatibility are both highly significant properties of dentin adhesives. For that matter, these properties of four generations of adhesive systems (Multi-Purpose/Single Bond/SE Plus/Easy Bond) were evaluated. MATERIALS AND METHODS: Eighty bovine teeth had their dentin exposed (500- and 200-µm thickness). Adhesive was applied on the dentin layer of each specimen. Following that, the microshearing test was performed for all samples. A dentin barrier test was used for the cytotoxicity evaluation. Cell cultures (SV3NeoB) were collected from testing materials by means of 200- or 500-µm-thick dentin slices and placed in a cell culture perfusion chamber. Cell viability was measured 24 h post-exposition by means of a photometrical test (MTT test). RESULTS: The best bonding performance was shown by the single-step adhesive Easy Bond (21 MPa, 200 µm; 27 MPa, 500 µm) followed by Single Bond (15.6 MPa, 200 µm; 23.4 MPa, 500 µm), SE Plus (18.2 MPa, 200 µm; 20 MPa, 500 µm), and Multi-Purpose (15.2 MPa, 200 µm; 17.9 MPa, 500 µm). Regarding the cytotoxicity, Multi-Purpose slightly reduced the cell viability to 92% (200 µm)/93% (500 µm). Single Bond was reasonably cytotoxic, reducing cell viability to 71% (200 µm)/64% (500 µm). The self-etching adhesive Scotchbond SE decreased cell viability to 85% (200 µm)/71% (500 µm). Conversely, Easy Bond did not reduce cell viability in this test, regardless of the dentin thickness. CONCLUSIONS: Results showed that the one-step system had the best bond strength performance and was the least toxic to pulp cells. In multiple-step systems, a correct bonding technique must be done, and a pulp capping strategy is necessary for achieving good performance in both properties. CLINICAL RELEVANCE: The study showed a promising system (one-step self-etching), referring to it as a good alternative for specific cases, mainly due to its technical simplicity and good biological responses.

Ethnobotany in Angola: The contribution of late 19th century christian missionaries to the knowledge of medicinal wild plants.

ETHNOPHARMACOLOGICAL RELEVANCE: Angola has an extraordinary plant diversity and a great ethnobotanical potential. However, there is a general lack of information about the first botanical explorations in the country and their contribution to the knowledge of the medicinal flora. AIM OF THE STUDY: The main aim of this study was to unveil the ethnobotanical legacy of José Maria Antunes and Eugène Dekindt, priests of the first Catholic mission in Huíla (Angola) and shed light on their contribution to the knowledge of medicinal wild plants of the country, including information on the uses, plant parts used, and preparation methods documented in the late 19th century. The findings are discussed considering recent ethnobotanical studies to offer a more comprehensive understanding of the historical and traditional uses of plants in Angola over the last two centuries. MATERIALS AND METHODS: Based on the information available in manuscripts and on the study of botanical collections preserved in herbaria of Portugal and Angola, we extracted relevant information about the species used in traditional medicine by the rural population of Huíla, the health conditions treated, and the mode of preparation and application. RESULTS: Our results revealed that Antunes and Dekindt conducted the first ethnobotanical study in Huíla, and documented a large number of medicinal wild plants. From these, we report 191 medicinal species, including 25 endemic and four introduced species, belonging to 56 plant families and 146 genera. Fabaceae family presents the highest richness of medicinal plants (39 taxa), followed by Rubiaceae (13), Asteraceae (10), and Apocynaceae (9). The illnesses reported were classified into 15 different categories, with the highest number of species (49) corresponding to unspecific conditions, such as general pains, chills, and fever. Thirty-seven species were reported for respiratory diseases, 31 for musculoskeletal problems, and 30 for digestive issues. Leaves were the most used plant part for medicinal purposes (84 species). Infusion was the most frequently described preparation method (40 species), followed by maceration (24 species), and powdering (36 species). CONCLUSIONS: The legacy of Antunes and Dekindt's work improves our understanding of Angola's botanical richness and traditional uses of plant resources. Our findings highlight the presence of unique medicinal resources in Angola, especially among endemic species, which hold the potential to improve the quality of life of rural communities. Moreover, our research underscores the lack of knowledge of medicinal species, emphasizing the risk of losing valuable historical information.

Association of chest computed tomography severity score at ICU admission and respiratory outcomes in critically ill COVID-19 patients.

OBJECTIVE: To evaluate the association of a validated chest computed tomography (Chest-CT) severity score in COVID-19 patients with their respiratory outcome in the Intensive Care Unit. METHODS: A single-center, prospective study evaluated patients with positive RT-PCR for COVID-19, who underwent Chest-CT and had a final COVID-19 clinical diagnosis needing invasive mechanical ventilation in the ICU. The admission chest-CT was evaluated according to a validated Chest-CT Severity Score in COVID-19 (Chest-CTSS) divided into low ≤50% (<14 points) and >50% high (≥14 points) lung parenchyma involvement. The association between the initial score and their pulmonary clinical outcomes was evaluated. RESULTS: 121 patients were clustered into the > 50% lung involvement group and 105 patients into the ≤ 50% lung involvement group. Patients ≤ 50% lung involvement (<14 points) group presented lower PEEP levels and FiO2 values, respectively GEE P = 0.09 and P = 0.04. The adjusted COX model found higher hazard to stay longer on invasive mechanical ventilation HR: 1.69, 95% CI, 1.02-2.80, P = 0.042 and the adjusted logistic regression model showed increased risk ventilator-associated pneumonia OR = 1.85 95% CI 1.01-3.39 for COVID-19 patients with > 50% lung involvement (≥14 points) on Chest-CT at ICU admission. CONCLUSION: COVID-19 patients with >50% lung involvement on Chest-CT admission presented higher chances to stay longer on invasive mechanical ventilation and more chances to developed ventilator-associated pneumonia.

The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study.

INTRODUCTION: In some studies including small populations of patients undergoing specific surgery, an intraoperative liberal infusion of fluids was associated with increasing morbidity when compared to restrictive strategies. Therefore, to evaluate the role of excessive fluid infusion in a general population with high-risk surgery is very important. The aim of this study was to evaluate the impact of intraoperative fluid balance on the postoperative organ dysfunction, infection and mortality rate. METHODS: We conducted a prospective cohort study during one year in four ICUs from three tertiary hospitals, which included patients aged 18 years or more who required postoperative ICU after undergoing major surgery. Patients who underwent palliative surgery and whose fluid balance could change in outcome were excluded. The calculation of fluid balance was based on preoperative fasting, insensible losses from surgeries and urine output minus fluid replacement intraoperatively. RESULTS: The study included 479 patients. Mean age was 61.2 ± 17.0 years and 8.8% of patients died at the hospital during the study. The median duration of surgery was 4.0 (3.2 to 5.5) h and the value of the Simplified Acute Physiology Score (SAPS) 3 score was 41.8 ± 14.5. Comparing survivors and non-survivors, the intraoperative fluid balance from non-survivors was higher (1,950 (1,400 to 3,400) mL vs. 1,400 (1,000 to 1,600) mL, P <0.001). Patients with fluid balance above 2,000 mL intraoperatively had a longer ICU stay (4.0 (3.0 to 8.0) vs. 3.0 (2.0 to 6.0), P <0.001) and higher incidence of infectious (41.9% vs. 25.9%, P = 0.001), neurological (46.2% vs. 13.2%, P <0.001), cardiovascular (63.2% vs. 39.6%, P <0.001) and respiratory complications (34.3% vs. 11.6%, P <0.001). In multivariate analysis, the fluid balance was an independent factor for death (OR per 100 mL = 1.024; P = 0.006; 95% CI 1.007 to 1.041). CONCLUSIONS: Patients with excessive intraoperative fluid balance have more ICU complications and higher hospital mortality.

Outcomes comparison between the first and the subsequent SARS-CoV-2 waves - a systematic review and meta-analysis.

Background: In the beginning of the SARS-CoV-2 pandemic, health care professionals dealing with COVID-19 had to rely exclusively on general supportive measures since specific treatments were unknown. The subsequent waves could be faced with new diagnostic and therapeutic tools (e.g., anti-viral medications and vaccines). We performed a meta-analysis and systematic review to compare clinical endpoints between the first and subsequent waves. Methods: Three databases were assessed. The primary outcome was in-hospital mortality. The secondary outcomes were intensive care unit (ICU) mortality, ICU length of stay (LOS), acute renal failure, extracorporeal membrane oxygenation (ECMO) implantation, mechanical ventilation time, hospital LOS, systemic thromboembolism, myocarditis and ventilator associated pneumonia. Results: A total of 25 studies with 126,153 patients were included. There was no significant difference for the primary endpoint (OR=0.94, 95% CI 0.83-1.07, p=0.35). The first wave group presented higher rates of ICU LOS (SMD= 0.23, 95% CI 0.11-0.35, p<0.01), acute renal failure (OR=1.71, 95% CI 1.36-2.15, p<0.01) and ECMO implantation (OR=1.64, 95% CI 1.06-2.52, p=0.03). The other endpoints did not show significant differences. Conclusions: The analysis suggests that the first wave group, when compared with the subsequent waves group, presented higher rates of ICU LOS, acute renal failure and ECMO implantation, without significant difference in in-hospital or ICU mortality, mechanical ventilation time, hospital LOS, systemic thromboembolism, myocarditis or ventilator- associated pneumonia.

Beri-Beri and Wernicke Encephalopathy in a Thirty-Year-Old Male.

A 30-year-old Turkish male was found lethargic and surrounded by vomit. At the hospital, severe hypernatremic dehydration and acute kidney failure were evident. His conscious level improved with fluid resuscitation. A differential diagnosis of altered mental status was considered. A complete clinical triad of Wernicke encephalopathy (WE), supported by MRI findings, was compatible with thiamine deficiency. Previous bariatric surgery was later confirmed. Despite no clinical signs of heart failure, a high level of NT-proBNP (N-terminal prohormone brain natriuretic peptide) and a dilated, hypokinetic myocardiopathy detected on the echocardiogram led us to assume beri-beri heart disease. High-dose intravenous thiamine, ACE (angiotensin conversing enzyme) inhibitors, beta-blockers, and physical therapy were initiated with remarkable improvement in his clinical condition.

Slow-Closing Clip for the Treatment of Nonsaccular Vertebrobasilar Aneurysms: A Retrospective Case Series.

OBJECTIVE: Vertebrobasilar artery nonsaccular aneurysms (VBANSAs) are associated with a 13% annual mortality. Revascularization and flow diversion are life-saving options in select cases; technical failures and rapid hemodynamic changes may contribute to unwanted outcomes. We describe a technique and report clinical outcomes of patients treated with an experimental slow-closing clip (SCC). METHODS: An experimental SCC was created to gradually close the parent artery of aneurysms. Clinical, radiographic, and outcome data from patients with VBANSAs who underwent experimental treatment with the SCC were retrospectively analyzed. RESULTS: Among 10 patients (7 men; mean age, 49.5 years; range, 18-73 years), 6 presented with mass effect symptoms, 1 with ischemic stroke, 2 with subarachnoid hemorrhage, and 1 with hydrocephalus. Five patients underwent revascularization plus SCC application, and 5 were treated with SCC alone. The mean follow-up was 6.7 years. The expected mortality among patients with unruptured VBANSAs with previous treatment options in this period was 52.7%, whereas the observed rate was 20%. Four patients died within 12 months after treatment. Causes of death were brainstem ischemic stroke, poor-grade subarachnoid hemorrhage, poor clinical presentation, and unknown. Six patients were alive at last follow-up, with unchanged or improved modified Rankin Scale scores. Mortality was associated with posterior-projecting aneurysms and late-stage treatment. CONCLUSIONS: In this small case series, use of SCC overcame the natural history of VBANSAs when treatment timing and aneurysm anatomy were suitable. The SCC potentially favors aneurysm thrombosis and collateral reactivation. More studies are necessary to better develop the SCC.

Early determinants of death due to multiple organ failure after noncardiac surgery in high-risk patients.

BACKGROUND: Prediction of perioperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. However, these patients frequently die as a consequence of primary or secondary multiple organ failure (MOF), often as a result of sepsis. We investigated the early perioperative risk factors for in-hospital death due to MOF in surgical patients. METHODS: This was a prospective, multicenter, observational cohort study performed in 21 Brazilian intensive care units (ICUs). Adult patients undergoing noncardiac surgery who were admitted to the ICU within 24 hours after operation were evaluated. MOF was characterized by the presence of at least 2 organ failures. To determine the relative risk (RR) of in-hospital death due to MOF, we performed a logistic regression multivariate analysis. RESULTS: A total of 587 patients were included (mean age, 62.4 ± 17 years). ICU and hospital mortality rates were 15% and 20.6%, respectively. The main cause of death was MOF (53%). Peritonitis (RR 4.17, 95% confidence interval [CI] 1.38-12.6), diabetes (RR 3.63, 95% CI 1.17-11.2), unplanned surgery (RR 3.62, 95% CI 1.18-11.0), age (RR 1.04, 95% CI 1 0.01-1.08), and elevated serum lactate concentrations (RR 1.52, 95% CI 1.14-2.02), a high central venous pressure (RR 1.12, 95% CI 1.04-1.22), a fast heart rate (RR 3.63, 95% CI 1.17-11.2) and pH (RR 0.04, 95% CI 0.0005-0.38) on the day of admission were independent predictors of death due to MOF. CONCLUSIONS: MOF is the main cause of death after surgery in high-risk patients. Awareness of the risk factors for death due to MOF may be important in risk stratification and can suggest routes for therapy.

Heterogeneity in the Response of Different Subtypes of Drosophila melanogaster Midgut Cells to Viral Infections.

Single-cell RNA sequencing (scRNA-seq) offers the possibility to monitor both host and pathogens transcriptomes at the cellular level. Here, public scRNA-seq datasets from Drosophila melanogaster midgut cells were used to compare the differences in replication strategy and cellular responses between two fly picorna-like viruses, Thika virus (TV) and D. melanogaster Nora virus (DMelNV). TV exhibited lower levels of viral RNA accumulation but infected a higher number of cells compared to DMelNV. In both cases, viral RNA accumulation varied according to cell subtype. The cellular heat shock response to TV and DMelNV infection was cell-subtype- and virus-specific. Disruption of bottleneck genes at later stages of infection in the systemic response, as well as of translation-related genes in the cellular response to DMelNV in two cell subtypes, may affect the virus replication.

Classification of the social distance during the COVID-19 pandemic from electricity consumption using artificial intelligence.

Accurately quantifying the social distancing (SD) practice of a population is essential for governments and health agencies to better plan and adapt restrictions during a pandemic crisis. In such a scenario, the reduction of social mobility also has a significant impact on electricity consumption, since people are encouraged to stay at home and many commercial and industrial activities are reduced or even halted. This paper proposes a methodology to qualify the SD of a medium-sized city, located in the northwest of the state of Rio Grande do Sul (RS), Brazil, using data of electricity consumption measured by the municipality's energy utility. The methodology consists of combining a data set, and an average consumption profile of Sundays is obtained using data from 4-months, it is then defined as a high SD profile due to the typical lower social activities on Sundays. An supervised and an unsupervised artificial neural network (ANN) are trained with this profile and used to analyze electricity consumption of this city during the COVID-19 pandemic. Low, moderate, and high SD ranges are also created, and the daily population behavior is evaluated by the ANNs. The results are strongly correlated and discussed with government restrictions imposed during the analyzed period and indicate that the ANNs can correctly classify the intensity of SD practiced by people. The unsupervised ANN is used more easily and in different scenarios, so it can be indicated for use by public administration for purposes of assess the effectiveness of SD policies based on the guidelines established during the COVID-19 pandemic.

Local Induction Heating Capabilities of Zeolites Charged with Metal and Oxide MNPs for Application in HDPE Hydrocracking: A Proof of Concept.

Zeolites are widely used in high-temperature oil refining processes such as fluid catalytic cracking (FCC), hydrocracking, and aromatization. Significant energy cost are associated with these processes due to the high temperatures required. The induction heating promoted by magnetic nanoparticles (MNPs) under radio frequency fields could contribute to solving this problem by providing a supplementary amount of heat in a nano-localized way, just at the active centre site where the catalytic process takes place. In this study, the potential of such a complementary route to reducing energetic requirements is evaluated. The catalytic cracking reaction under a hydrogen atmosphere (hydrocracking) applied to the conversion of plastics was taken as an application example. Thus, a commercial zeolite catalyst (H-USY) was impregnated with three different magnetic nanoparticles: nickel (Ni), cobalt (Co), maghemite (γ-Fe2O3), and their combinations and subjected to electromagnetic fields. Temperature increases of approximately 80 °C were measured for H-USY zeolite impregnated with γ-Fe2O3 and Ni-γ-Fe2O3 due to the heat released under the radio frequency fields. The potential of the resulting MNPs derived catalyst for HDPE (high-density polyethylene) conversion was also evaluated by thermogravimetric analysis (TGA) under hydrogen atmosphere. This study is a proof of concept to show that induction heating could be used in combination with traditional resistive heating as an additional energy supplier, thereby providing an interesting alternative in line with a greener technology.

siRNA biogenesis and advances in topically applied dsRNA for controlling virus infections in tomato plants.

A non-transgenic approach based on RNA interference was employed to induce protection against tomato mosaic virus (ToMV) infection in tomato plants. dsRNA molecules targeting the cp gene of ToMV were topically applied on plants prior to virus inoculation. Protection was dose-dependent and sequence-specific. While no protection was achieved when 0-16 µg dsRNA were used, maximum rates of resistance (60 and 63%) were observed in doses of 200 and 400 µg/plant, respectively. Similar rates were also obtained against potato virus Y when targeting its cp gene. The protection was quickly activated upon dsRNA application and lasted for up to 4 days. In contrast, no detectable antiviral response was triggered by the dsRNA from a begomovirus genome, suggesting the method is not effective against phloem-limited DNA viruses. Deep sequencing was performed to analyze the biogenesis of siRNA populations. Although long-dsRNA remained in the treated leaves for at least 10 days, its systemic movement was not observed. Conversely, dsRNA-derived siRNA populations (mainly 21- and 22-nt) were detected in non-treated leaves, which indicates endogenous processing and transport through the plant. Altogether, this study provides critical information for the development of novel tools against plant viruses; strengths and limitations inherent to the systems are discussed.

Eosinopenia as predictor of infection in patients admitted to an internal medicine ward: a cross-sectional study.

BACKGROUND: The identification of infection in an internal medicine ward is crucial but not always straightforward. Eosinopenia has been proposed as a marker of infection, but specific cutoffs for prediction are not established yet. We aim to assess whether there is difference in eosinophil count between infected and noninfected patients and, if so, the best cutoffs to differentiate them. METHODS: Cross-sectional, observational study with analysis of all patients admitted to an Internal Medicine Department during 2 consecutive months. Clinical, laboratory and imaging data were analyzed. Infection at hospital admission was defined in the presence of either a microbiological isolation or suggestive clinical, laboratory, and/or imaging findings. Use of antibiotics in the 8 days before hospital admission, presence of immunosuppression, hematologic neoplasms, parasite, or fungal infections were exclusion criteria. In case of multiple hospital admissions, only the first admission was considered.Sensitivity and specificity values for eosinophils, leukocytes, neutrophils, and C-reactive protein were determined by receiver operating characteristic curve. Statistical analysis was performed with IBM SPSS Statistics® v25 and MedCalc Statistical Software® v19.2.3. RESULTS: A total of 323 hospitalization episodes were evaluated, each corresponding to a different patient. One hundred fifteen patients were excluded. A total of 208 patients were included, 62.0% (n = 129) of them infected at admission. Ten patients had multiple infections.Infected patients had fewer eosinophils than uninfected patients (15.8 ±â€Š42 vs 71.1 ±â€Š159 cell/mm3; P < .001). An eosinophil count at admission ≤69 cell/mm3 had a sensitivity of 89.1% and specificity of 54.4% (area under the curve 0.752; 95% confidence interval 0.682-0.822) for the presence of infection. Eosinophil count of >77 cells/mm3 had a negative likelihood ratio of 0.16. CONCLUSIONS: Eosinophil count was significantly lower in infected than in uninfected patients. The cutoff 69 cells/mm3 was the most accurate in predicting infection. Eosinophil count >77 cells/mm3 was a good predictor of absence of infection.

Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol.

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital's electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.

Creating a Global Community of Practice for Oncofertility.

Fertility preservation in the cancer setting, known as oncofertility, is a field that requires cross-disciplinary interaction between physicians, basic scientists, clinical researchers, ethicists, lawyers, educators, and religious leaders. Funded by the National Institutes of Health, the Oncofertility Consortium (OC) was formed to be a scientifically grounded, transparent, and altruistic resource, both intellectual and monetary, for building this new field of practice capable of addressing the unique needs of young patients with cancer. The OC has expanded its attention to include other nonmalignant conditions that can threaten fertility, and the work of the OC now extends around the globe, involving partners who together have created a community of shared effort, resources, and practices. The OC creates materials that are translated, disseminated, and amended by all participants in the field, and local programs of excellence have developed worldwide to accelerate the pace and improve the quality of oncofertility research and practice. Here we review the global oncofertility programs and the capacity building activities that strengthen these research and clinical programs, ultimately improving patient care.