Delayed Fever and Neurological Outcome after Cardiac Arrest: A Retrospective Clinical Study.

BACKGROUND: The aim of this study was to evaluate the association between fever after the first days of ICU stay and neurological outcome after cardiac arrest (CA). METHODS: We retrospectively analyzed CA patients admitted to intensive care unit (ICU). INCLUSION CRITERIA: age ≥18 years, Glasgow Coma Scale score ≤8 at ICU admission and assessment of body core temperature (BCT) using bladder or intravascular probes. EXCLUSION CRITERIA: ICU length of stay (LOS) <3 days and pregnancy. The primary endpoint was neurological outcome assessed with Cerebral Performance Category (CPC) scale 6 months after CA. RESULTS: One hundred thirty-two patients were analyzed. Fever was present in 105 (79.6%) patients. Variables associated with unfavorable outcome were (1) older age (p < 0.0025); (2) non-shockable cardiac rhythms (p < 0.0001); (3) higher Simplified Acute Physiology Score (SAPS) II (p < 0.0001); (4) pupillary abnormalities at ICU admission (p < 0.018); and (5) elevated degree of maximal BCT (Tmax) during ICU stay (p < 0.046). After multivariate analysis, Tmax maintained a significant relationship with neurological outcome. An increase of 1 °C in Tmax during ICU stay decreased the odds ratio for a favorable outcome by a factor of 31% (p < 0.001). Moreover, we discovered a significant interaction between the day of Tmax (t-Tmax) and Tmax (p = 0.004); the later Tmax occurs, the more deleterious effects are observed on outcome. CONCLUSIONS: Fever is frequent after CA, and Tmax in ICU is associated with worsened neurological outcome. This association becomes stronger as the timing of Tmax extends further from the CA.

Intravenous paracetamol for fever control in acute brain injury patients: cerebral and hemodynamic effects.

BACKGROUND: Fever occurs frequently in acute brain injury patients, and its occurrence is associated with poorer outcomes. Paracetamol, an antipyretic frequently employed in patients with cerebral damage, may cause hypotension. We evaluated the cerebral and hemodynamic effects of intravenous (IV) paracetamol for the control of fever in Neuro-Intensive Care Unit (NICU) patients. METHODS: This is a prospective observational study in which we enrolled 32 NICU patients: Subarachnoid Hemorrhage (SAH, n = 18), Traumatic Brain Injury (TBI, n = 10), Intracerebral Hemorrhage (ICH, n = 2) and Acute Ischemic Stroke (AIS, n = 2). RESULTS: The administration of paracetamol resulted in a decrease of core body temperature (Tc) (p = 0,0001), mean arterial pressure (MAP) (p = 0,0006), cerebral perfusion pressure (CPP) (p = 0,0033), and jugular venous oxygen saturation (SjVO2) (p = 0.0193), and in an increase of arteriojugular venous differences of oxygen (AVDO2) (p = 0.0012). The proportion of patients who had an infusion of norepinephrine increased from 47 % to 75 % (p = 0.0039 McNemar Test). When intracranial pressure (ICP) at the start of paracetamol infusion (t-0) was compared with the measurement of ICP after 2 h, a significant correlation was observed (r = 0.669, p = 0.0002). This marked and significant correlation can be explained by the fact that for the higher levels of ICP assessed at t-0 (greater than 15 mmHg), we observed a marked reduction of ICP concomitant with the decrease of Tc. No problems related to norepinephrine administration and/or increase in dosage were observed. CONCLUSION: Paracetamol administration is effective but exposes patients to hypotensive episodes that must be recognized and treated expeditiously to prevent further damage to the injured brain.

Right open nephrectomy under combined spinal and peridural operative anesthesia and analgesia (CSE): A new anesthetic approach in abdominal surgery.

A case of right open nephrectomy performed under combined spinal and epidural anesthesia and analgesia was presented. This new anesthetic technique gives significant advantages to the patient by avoiding endotracheal intubation with mechanical ventilation and curare administration and by reducing the use of opioids.

Publisher Correction: A database of the coseismic effects following the 30 October 2016 Norcia earthquake in Central Italy.

In the original version of the Data Descriptor the surname of author Anne Socquet was misspelled. This has now been corrected in the HTML and PDF versions of the Data Descriptor. Some authors were also not appropriately associated with their affiliations in the HTML version, due to formatting errors made by the publisher. This has now been corrected in the HTML version of the Data Descriptor, the affiliations in the PDF were correct from the time of publication.

Multi-segment rupture of the 2016 Amatrice-Visso-Norcia seismic sequence (central Italy) constrained by the first high-quality catalog of Early Aftershocks.

We present the first high-quality catalog of early aftershocks of the three mainshocks of the 2016 central Italy Amatrice-Visso-Norcia normal faulting sequence. We located 10,574 manually picked aftershocks with a robust probabilistic, non-linear method achieving a significant improvement in the solution accuracy and magnitude completeness with respect to previous studies. Aftershock distribution and relocated mainshocks give insight into the complex architecture of major causative and subsidiary faults, thus providing crucial constraints on multi-segment rupture models. We document reactivation and kinematic inversion of a WNW-dipping listric structure, referable to the inherited Mts Sibillini Thrust (MST) that controlled segmentation of the causative normal faults. Spatial partitioning of aftershocks evidences that the MST lateral ramp had a dual control on rupture propagation, behaving as a barrier for the Amatrice and Visso mainshocks, and later as an asperity for the Norcia mainshock. We hypothesize that the Visso mainshock re-activated also the deep part of an optimally oriented preexisting thrust. Aftershock patterns reveal that the Amatrice Mw5.4 aftershock and the Norcia mainshock ruptured two distinct antithetic faults 3-4 km apart. Therefore, our results suggest to consider both the MST cross structure and the subsidiary antithetic fault in the finite-fault source modelling of the Norcia earthquake.

A database of the coseismic effects following the 30 October 2016 Norcia earthquake in Central Italy.

We provide a database of the coseismic geological surface effects following the Mw 6.5 Norcia earthquake that hit central Italy on 30 October 2016. This was one of the strongest seismic events to occur in Europe in the past thirty years, causing complex surface ruptures over an area of >400 km2. The database originated from the collaboration of several European teams (Open EMERGEO Working Group; about 130 researchers) coordinated by the Istituto Nazionale di Geofisica e Vulcanologia. The observations were collected by performing detailed field surveys in the epicentral region in order to describe the geometry and kinematics of surface faulting, and subsequently of landslides and other secondary coseismic effects. The resulting database consists of homogeneous georeferenced records identifying 7323 observation points, each of which contains 18 numeric and string fields of relevant information. This database will impact future earthquake studies focused on modelling of the seismic processes in active extensional settings, updating probabilistic estimates of slip distribution, and assessing the hazard of surface faulting.

Os aspectos éticos que envolvem a educação na terceira idade / The ethical aspects involved in third age education

Durante muitos anos a educação de idosos foi considerada desnecessária em nossa sociedade, pois somente crianças e jovens adultos tinham o direito a esse privilégio em nossas escolas. Somente nos últimos anos, com o aumento da expectativa de vida, a sociedade começou a pensar e criar condições para um envelhecimento intelectualmente saudável por meio da educação continuada. Neste artigo, objetiva-se mostrar a necessidade de desenvolver um caminho na educação para melhorar a vida da comunidade da terceira idade. Como aspectos ligados à moral e à ética poderiam ajudar a mudar o ponto de vista da sociedade a respeito dessas pessoas?.

During many years, elderly education was considered an unnecessary thing in our society because just children and young adults had the right to this privilege in our schools. Only recently, with the increase in life expectancy, has the society begun to think and to create conditions for an intellectually healthy aging by means of continuing education. This paper aims to show the need to develop a way in education so as to improve the life of the third age community. How could aspects like morals and ethics help to change the society’s point of view about these people?.

Evaluation of the possible role of ants (Hymenoptera: Formicidae) as mechanical vectors of nematodes and protists

Nematodes and protists can be transmitted to humans in many ways and little concern has been given to the mechanical transmission by ants. This study aimed at analysing how the eggs of Ascaris lumbricoides and cysts of Entamoeba coli could be mechanically transmitted to the man by Formicidae. Through the experiments using nests of Tapinoma melanocephalum, Linepithema humile and Monomorium pharaonis reared in the laboratory allied to observations of some 17 ant species in an urban park area in Mogi das Cruzes (SP), it was found that L. humile was capable of carrying eggs of A. lumbricoides both in the field and laboratory conditions (1 worker), as well as was Camponotus rufipes (2), Solenopsis saevissima (1) and Acromyrmex niger (1). The cysts of Escherichia coli were found over three workers of C. rufipes. Although the frequency of the workers found transporting pathogens was low, the capacity of common household species in carrying pathogens like nematodes and protists was demonstrated.

Os Nematoda e Protista podem ser transmitidos ao homem de diversas maneiras, mas pouca ênfase é dada para a transmissão mecânica por intermédio de formigas. Assim, esse trabalho procurou investigar a transmissão mecânica de ovos de Ascaris lumbricoides e cistos de Entamoeba coli pelos Formicidae. Através de experimentos com espécies mantidas em ninhos no laboratório (Tapinoma melanocephalum, Linepithema humile e Monomorium pharaonis) e com 17 espécies de formigas de uma área antropizada na região de Mogi as Cruzes (SP), foi possível constar que os ovos A. lumbricoides foram transportados por L. humile, tanto no campo (1 operária) como no laboratório (1 operária), por Camponotus rufipes (2), por Solenopsis saevissima (1) e por Acromyrmrex niger (1). Em três operárias de C. rufipes foram encontrados cistos de E. coli. Apesar da baixa incidência de transporte, as três primeiras espécies pelo fato de viverem muito próximas ao ser humano, podem levar para dentro do ambiente domiciliar patógenos de Nematoda e Protista.