Occurrence of a "forever chemical" in the atmosphere above pristine Amazon Forest.

Per- and polyfluoroalkyl substances (PFAS), often referred to as "forever chemicals", are a class of man-made, extremely stable chemicals, which are widely used in industrial and commercial applications. Exposure to some PFAS is now known to be detrimental to human health. By virtue of PFAS long residence times, they are widely detected in the environment, including remote locations such as the Arctics, where the origin of the PFAS is poorly understood. It has been suggested that PFAS may be transported through contaminated waters, leading to accumulation in coastal areas, where they can be aerosolised via sea spray, thereby extending their geographical distribution far beyond their original source regions. The aim of this work is to investigate, for the first time, whether "forever chemicals" could be transported to areas considered to be pristine, far from coastal sites. This study was performed at the Amazonian Tall Tower Observatory (ATTO), a unique remote site situated in the middle of the Amazon rainforest, where a restricted PFAS, perfluorooctanoic acid (PFOA), was observed with concentrations reaching up to 2 pg/m3. A clear trend of increasing concentration with sampling height was observed and air masses from the south over Manaus had the highest concentrations. Atmospheric lifetime estimations, removal mechanisms supported by measurements at two heights (320 and 42 m above the rainforest), and concentration spikes indicated a long-range transport of PFOA to pristine Amazon rainforest. Potential sources, including industrial activities in urban areas, were explored, and historical fire management practices considered. This research presents the first measurements of PFAS in the atmosphere of Amazon rainforest. Remarkably, even in this remote natural environment, appreciable levels of PFAS can be detected. This study provides valuable insights into the long-range transport of the anthropogenic "forever chemical" into a remote natural ecosystem and should raise awareness of potential environmental implications.

Rapid diagnostic of multidrug-resistant sepsis pathogens directly from blood culture bottles using MALDI-TOF and the EUCAST RAST.

In this study, rapid diagnostic of multidrug-resistant (MDR) sepsis pathogens, directly from positive blood culture (BC) bottles, was evaluated by combining MALDI-TOF and the EUCAST Rapid Antimicrobial Susceptibility Testing (RAST). Carbapenemase production in Escherichia coli and Klebsiella pneumoniae isolates was also evaluated by RAST. From 171 positive BC bottles analyzed, 79 (46 %) MDR species, including E. coli (4/34, 12 %), K. pneumoniae (33/48, 69 %), Pseudomonas aeruginosa (12/12, 100 %), Acinetobacter baumannii (15/15, 100 %), and Staphylococcus aureus (14/37, 38 %) displaying resistance to beta-lactams, fluoroquinolones, aminoglycosides, and/or trimethoprim/sulphamethoxazole, were identified. In this regard, turnaround time of direct MALDI-TOF identification and RAST was < 7 h, which was significantly (p< 0.05) lower than our routine method. Carbapenemase detection by RAST displayed 100% sensitivity and 88.7 % specificity at 8 h. This protocol could offer advantages for the treatment and clinical outcomes of septic patients, improving the rapid diagnostic of sepsis by MDR pathogens.

Evaluation of the ionization of noble gases under the effect of an electric field for the generation of useful energy.

This work originated from the demand presented by an electric power transmission company and addresses a possible solution for the sector by exploring alternatives to extend the flight time of drones in the inspection of transmission lines. This original article demonstrates the use of the electromagnetic field of a transmission line to generate useful electrical power at the terminals of a bulb containing argon gas. It is an unprecedented application in power transmission. In this work, the tests based on a proof of concept are documented, where the results obtained were satisfactory and still allowed to connect an LED through the constructed arrangement. It is observed that the continuity of this research can provide scalability for applications whose main source of ion excitation is given from the energy dissipated as electric field loss in high-voltage lines.

Effects of corn straw on meat characteristics of lambs in the Brazilian semi-arid region.

The present study aimed to evaluate the influence of increasing levels of corn straw replacement of sorghum silage on average daily gain, loin eye area, subcutaneous fat thickness, weight of commercial cuts, leg tissue composition, and physico-chemical characteristics of the meat from F1 Santa Inês × Dorper lambs maintained in a feedlot system. Treatments consisted of 0, 33, 66 and 100% corn straw replacement of sorghum silage. There were thirty-six 150-day-old male lambs. Corn straw replacement of sorghum silage in lamb feed reduced the average daily gain and weight of the ribs, besides promoting a quadratic influence on leg fat content. However, there was no influence on commercial carcass cuts, leg muscle index, leg tissue composition, and physico-chemical characteristics of the meat. Thus, corn straw can be used as alternative feedstuff for sheep rations to improve the production of high-quality sheep meat in semi-arid regions.

Is bedding material a more effective thermal insulator than trap cover for small mammal trapping? A field experiment.

Live trapping is a key technique for conducting ecological studies on small mammals. All-metal live traps are popular in monitoring schemes owing to their tested performance, lightweight design (aluminium) and foldability. However, capture represents a stressful situation for small mammals, particularly during cold seasons, when individuals are susceptible to cold weather starvation resulting from low temperature and insufficient food to maintain body temperature. Metal live traps provide limited protection against cold temperatures, and it is often recommended to use covers to buffer external temperature fluctuations and prevent entry of moisture. Here, we compared the insulative performance of a PVC cover designed for Sherman traps and of bedding material, using data loggers to record temperature and humidity inside traps. We conducted different experiments simulating field conditions (traps at night with a heat source inside) and different treatments (cover, bedding material) to test the thermal insulation capacity of three models of widely used commercial traps: Longworth, Sherman, and Heslinga. Our findings indicated that Longworth and Sherman traps were better insulated against ambient air temperature fluctuations than Heslinga traps (+2.0 °C warmer on average). Bedding material was paramount in reducing relative humidity and increasing thermal insulation capacity of traps (+3.1 °C), an effect that was strengthened when a PVC cover was additionally used (+4.2 °C). The covered traps prevented the direct entrance of rain and dew (reducing damp bedding), provided camouflage (reducing thefts), and improved thermal and humidity conditions of traps (potentially increasing survival of captive small mammals). Our results suggest that using covers and bedding materials can improve thermal and humidity conditions within live traps, thus reducing the metabolic costs of thermoregulation and increasing survival chances for trapped small mammals during cold seasons.

Emergence of KPC-113 and KPC-114 variants in ceftazidime-avibactam-resistant Klebsiella pneumoniae belonging to high-risk clones ST11 and ST16 in South America.

Two novel variants of Klebsiella pneumoniae carbapenemase (KPC) associated with resistance to ceftazidime-avibactam (CZA) and designated as KPC-113 and KPC-114 by NCBI were identified in 2020, in clinical isolates of Klebsiella pneumoniae in Brazil. While K. pneumoniae of ST16 harbored the blaKPC-113 variant on an IncFII-IncFIB plasmid, K. pneumoniae of ST11 carried the blaKPC-114 variant on an IncN plasmid. Both isolates displayed resistance to broad-spectrum cephalosporins, ß-lactam inhibitors, and ertapenem and doripenem, whereas K. pneumoniae producing KPC-114 showed susceptibility to imipenem and meropenem. Whole-genome sequencing and in silico analysis revealed that KPC-113 presented a Gly insertion between Ambler positions 264 and 265 (R264_A265insG), whereas KPC-114 displayed two amino acid insertions (Ser-Ser) between Ambler positions 181 and 182 (S181_P182insSS) in KPC-2, responsible for CZA resistance profiles. Our results confirm the emergence of novel KPC variants associated with resistance to CZA in international clones of K. pneumoniae circulating in South America. IMPORTANCE KPC-2 carbapenemases are endemic in Latin America. In this regard, in 2018, ceftazidime-avibactam (CZA) was authorized for clinical use in Brazil due to its significant activity against KPC-2 producers. In recent years, reports of resistance to CZA have increased in this country, limiting its clinical application. In this study, we report the emergence of two novel KPC-2 variants, named KPC-113 and KPC-114, associated with CZA resistance in Klebsiella pneumoniae strains belonging to high-risk clones ST11 and ST16. Our finding suggests that novel mutations in KPC-2 are increasing in South America, which is a critical issue deserving active surveillance.

Brazilian Registry of Interventional Cardiology during the COVID-19 Pandemic (RBCI-COVID19). / Registro Brasileiro de Cardiologia Intervencionista durante a Pandemia de COVID-19 (RBCI-COVID19).

BACKGROUND: At the beginning of the COVID-19 pandemic, patients with myocardial infarction (MI) took longer to present to hospitals because of fear of contamination and health care access difficulties. OBJECTIVES: To assess interventional cardiology procedures performed during the COVID-19 pandemic and its implications for MI approach. METHODS: Prospective registry of 24 cardiac catheterization laboratories in Brazil, with adult patients undergoing interventional cardiology procedures between May 26 and November 30, 2020. The outcomes were cardiovascular (CV) and non-CV complications, death, and MI. Concomitant COVID-19 was confirmed using RT-PCR. Machine learning techniques were used with nonparametric Classification Trees models, and Simple Correspondence Analysis, with R statistical software package. Significance level adopted of 5%. RESULTS: This study included 1282 patients, 435 of whom (33.9%) had MI as follows: ST-segment elevation MI (STEMI), 239 (54.9%); and non-ST-segment elevation MI (NSTEMI), 196 (45.1%). Of the 1282 patients, 29 had CV complications, 47 had non-CV complications, and 31 died. The diagnosis of COVID-19 was confirmed in 77 patients (6%), with 15.58% mortality and non-CV complications in 6.49%. Most patients had significant coronary artery disease (63%), and an intracoronary thrombus was more often found in the presence of STEMI (3.4%) and COVID-19 (4%). A door-to-table time longer than 12 hours in NSTEMI was associated with 30.8% of complications, 25% in COVID-19 patients. CONCLUSIONS: All deaths were preceded by CV or non-CV complications. The presence of COVID-19 was associated with death and non-fatal complications of patients undergoing interventional cardiology procedures during the pandemic.

FUNDAMENTO: No início da pandemia de COVID-19, os pacientes com infarto do miocárdio (IM) demoraram para procurar um hospital por medo de contágio ou dificuldades no acesso aos serviços de saúde. OBJETIVOS: Avaliar procedimentos de cardiologia intervencionista realizados durante a pandemia de COVID-19 e implicações na abordagem do IM. MÉTODOS: Registro prospectivo de 24 centros de hemodinâmica no Brasil, com pacientes adultos submetidos a procedimentos de cardiologia intervencionista entre 26 de maio e 30 de novembro de 2020. Os desfechos foram complicações cardiovasculares (CV) e não CV, morte e IM. A concomitância de COVID-19 foi confirmada com RT-PCR. Técnicas de machine learning foram usadas com modelos não paramétricos de árvores de classificação. Usou-se análise de correspondência simples com o software R. Adotou-se nível de significância de 5%. RESULTADOS: Este estudo incluiu 1.282 pacientes, 435 dos quais (33,9%) apresentaram IM: IM com supra de ST (IMCSST), 239 (54,9%); e IM sem supra de ST(IMSSST), 196 (45.1%). Dos 1.282 pacientes, 29 tiveram complicações CV, 47 tiveram complicações não CV e 31 morreram. O diagnóstico de COVID-19 foi confirmado em 77 pacientes (6%), com 15,58% de mortalidade e 6,49% de complicações não CV. A maioria dos pacientes apresentou significativa doença arterial coronariana (63%). Trombo intracoronariano foi mais frequente na presença de IMCSST (3,4%) e COVID-19 (4%). Tempo porta-mesa superior a 12 horas no IMSSST associou-se a 30,8% de complicações, 25% em pacientes com COVID-19. CONCLUSÕES: Todos os óbitos foram precedidos por complicações CV ou não CV. A presença de COVID-19 foi associada a óbito e complicações não fatais dos pacientes submetidos a procedimentos de cardiologia intervencionista durante a pandemia.

Spatial variability of chemical indicators of Amazon agricultural soils through geomultivariate statistics, Brazil.

This work focuses on evaluating the spatial variability of chemical attributes of soils under different agricultural use and native forest, indicating which are the possible indicator attributes of changes in environmental, through the use and management of the soil. The study was carried out in the southern region of the Amazonas state, in an Argissolo Vermelho-Amarelo (Ultisol). Sampling grids were established measuring: 90 m × 70 m with regular soil collection spacing of 10 m for the guarana and forest areas; 90 m × 56 m spaced at 10 m × 8 m for annatto area; and 54 m × 42 m with spacing between points of 6 m for the cupuaçu area, totaling 80 sampling points in each area, with soil samples collected at depths of 0.0-0.05; 0.05-0.10 m and 0.10-0.20 m. The following attributes were determined: pH, Al3+, K+, Ca2+, Mg2+, P, H + Al, CEC, V% and m%. Descriptive, geostatistical and multivariate statistical analyzes were performed. The results show that it is possible to state that the descriptive, geostatistical and multivariate statistical techniques were able to identify the difference between the spatial variability of the attributes according to each specific use of individual soils. The multivariate analysis made it possible to select the attributes that most contribute to the variability of these soils, and with that, it was found that the forest showed less spatial variability in the surface layer, with higher reach values by scaled semivariograms.

Oily wastewater treatment by a continuous flow electrocoagulation reactor with polarity switch: Assessment of the relation between process variables and the aluminum released to the environment.

Electrocoagulation with electrical polarity inversion was used to treat oil in water emulsions (145 ± 5 mg dm-3) using a cylindrical 4.8 dm3 reactor in continuous mode. The effects of spatial time and time between polarity inversion were explored using a three-level full factorial design (32), followed by Spearman correlation (ps), which has shown that the aluminum concentration in the treated effluent is not directly dependent on the mass of aluminum released by the electrodes. Nonetheless, the loss of mass of the electrodes is correlated (ps = 0.6970) to oil removal and to less electric power consumption (ps = -0.6909). Surface response analysis revealed that increasing the number of inversion cycles reduces electrode degradation. The treatment reduced the effluent's chemical oxygen demand by over 92.8%. Regarding environmental impact, there is an inverse statistical correlation between aluminum in the treated effluent and oil removal (ps = -0.7426), indicating that removing more oil with less environmental impact is possible. The better condition, considering oil removal and lower electrode consumption, was obtained with a spatial time of 36 min and a polarity inversion time of 10 s; for this condition, oil removal reached 87.0% with an energy expenditure of about 7.21 kW h.m-3.

Comparative cohort analysis of pressure ulcer/injury in intensive care unit patients before and during the COVID-19 pandemic.

COVID-19 has emerged as a global pandemic leading to an increase in hospitalization and intensive care unit (ICU) admissions worldwide. Due to severe acute respiratory distress syndrome (ARDS), many patients require prone positioning, which is associated with increased pressure ulcer/injury (PU/PI) incidence. COVID-19 pathophysiology may favor the occurrence of PU/PI due to hypoxemia, inflammatory status, and vasculopathy. This study aimed to compare the incidence of PU/PI in ICU patients before and during the COVID-19 pandemic. A retrospective cohort study was conducted at a university hospital in Brazil. Data from the medical charts of every adult patient admitted to ICU from March to July 2019 and the same period in 2020 were collected. The group from 2019 included 408 patients admitted due to multiple causes, and the group from 2020 included 229 patients admitted due to COVID-19 infection. The incidence of PU/PI was significantly higher in patients admitted in 2020 compared to 2019 (62,5 vs. 33,8%, respectively). Also, PU/PI location and severity have been different between groups, with the patients with COVID-19 (2020 group) more exposed to stage 3, 4, and non-stageable lesions, as well as more PU/PI on face skin and other less common locations. In conclusion, the COVID-19 pandemic has highlighted a higher PU/PI incidence. ICU patients were older during the pandemic, had higher body mass index and comorbidities, and needed more invasive medical devices and pronation. The occurrence of PU/PI was also associated with prolonged hospitalization and mortality.

Human Genome Polymorphisms and Computational Intelligence Approach Revealed a Complex Genomic Signature for COVID-19 Severity in Brazilian Patients.

We present a genome polymorphisms/machine learning approach for severe COVID-19 prognosis. Ninety-six Brazilian severe COVID-19 patients and controls were genotyped for 296 innate immunity loci. Our model used a feature selection algorithm, namely recursive feature elimination coupled with a support vector machine, to find the optimal loci classification subset, followed by a support vector machine with the linear kernel (SVM-LK) to classify patients into the severe COVID-19 group. The best features that were selected by the SVM-RFE method included 12 SNPs in 12 genes: PD-L1, PD-L2, IL10RA, JAK2, STAT1, IFIT1, IFIH1, DC-SIGNR, IFNB1, IRAK4, IRF1, and IL10. During the COVID-19 prognosis step by SVM-LK, the metrics were: 85% accuracy, 80% sensitivity, and 90% specificity. In comparison, univariate analysis under the 12 selected SNPs showed some highlights for individual variant alleles that represented risk (PD-L1 and IFIT1) or protection (JAK2 and IFIH1). Variant genotypes carrying risk effects were represented by PD-L2 and IFIT1 genes. The proposed complex classification method can be used to identify individuals who are at a high risk of developing severe COVID-19 outcomes even in uninfected conditions, which is a disruptive concept in COVID-19 prognosis. Our results suggest that the genetic context is an important factor in the development of severe COVID-19.

Endocrine disrupting activity in sewage sludge: Screening method, microbial succession and cost-effective strategy for detoxification.

Sewage sludge (SS) presents a high agronomic potential due to high concentrations of organic matter and nutrients, encouraging its recycling as a soil conditioner. However, the presence of toxic substances can preclude this use. To enable the safe disposal of this waste in agriculture, SS requires additional detoxification to decrease the environmental risks of this practice. Although some alternatives have been proposed in this sense, little attention is provided to eliminating endocrine-disrupting chemicals (EDCs). To fill this gap, this study aimed to develop effective and low-cost technology to eliminate EDCs from SS. For this, a detoxification process combining microorganisms and biostimulating agents (soil, sugarcane bagasse, and coffee grounds) was performed for 2, 4, and 6 months with aerobic and anaerobic SSs. The (anti-)estrogenic, (anti-)androgenic, retinoic-like, and dioxin-like activities of SSs samples were verified using yeast-based reporter-gene assays to prove the effectiveness of the treatments. A fractionation procedure of samples, dividing the target sample extract into several fractions according to their polarity, was conducted to decrease the matrix complexity and facilitate the identification of EDCs. A decrease in the abundance and microbial diversity of the SS samples was noted along the biostimulation with the predominance of filamentous fungal species over yeasts and gram-positive bacteria and non-fermenting rods over enterobacteria. Among the 9 EDCs quantified by LC-ESI-MS/MS, triclosan and alkylphenols presented the highest concentrations in both SS. Before detoxification, the studied SSs induced significant agonistic activity, especially at the human estrogen receptor α (hERα) and the human aryl hydrocarbon receptor (AhR). The raw anaerobic sludge also activated the androgen (hAR), retinoic acid (RARα), and retinoid X (RXRα) receptors. However, no significant endocrine-disrupting activities were observed after the SS detoxification, showing that the technology applied here efficiently eliminates receptor-mediated toxicity.

Revolução tecnológica e smartphone: considerações sobre a constituição do sujeito contemporâneo / Revolución tecnológica y smartphone: consideraciones sobre la constitución del sujeto contemporáneo / Technological revolution and smartphone: considerations about the constitution of the contemporary subject

RESUMO. O texto, resultante de estudos teóricos empreendidos à luz da Psicologia Histórico-Cultural entre 2016 e 2020, tem como objetivo recuperar a revolução tecnológica como um recurso para a compreensão da constituição dos sujeitos contemporâneos, partindo da máquina a vapor da Primeira Revolução Industrial, empregada nos meios de produção, até o smartphone, empregado na cotidianidade. O smartphone possui níveis tão altos de compactação, portabilidade e operacionalidade que o tornaram uma das mais avançadas tecnologias da história, revelando o elevado grau de desenvolvimento do psiquismo alcançado pelo gênero humano. Ele, mais do que outras tecnologias digitais de informação e comunicação (TDICs), tem impactado notadamente a constituição dos sujeitos contemporâneos, especialmente suas funções psicológicas cognitivas. Os resultados demonstram que recuperar dialeticamente o percurso histórico das criações tecnológicas é essencial à psicologia, permitindo ampliar o espectro de análise de como os sujeitos se constituem na atualidade. Conclui-se que a revolução microtecnológica deve ser tomada sob um viés crítico e ético, por tudo o que pode impactar nas relações entre os sujeitos e no desenvolvimento dos seus processos psíquicos.

RESUMEN. El texto, resultante de estudios teóricos realizados a la luz de la Psicología Histórico-Cultural entre 2016 y 2020, tiene como objetivo recuperar la revolución tecnológica como un recurso para comprender la constitución de los sujetos contemporáneos, a partir de la máquina de vapor de la Primera Revolución Industrial, empleada en los medios de producción, hasta el smartphone, utilizado en la vida cotidiana. El smartphone tiene niveles tan altos de compacidad, portabilidad y operabilidad que se ha convertido en una de las tecnologías más avanzadas de la historia, revelando el alto grado de desarrollo de la psique alcanzado por la humanidad. Él, más que otras tecnologías digitales de información y comunicación, ha impactado notablemente la constitución de los sujetos contemporáneos, especialmente sus funciones psicológicas cognitivas. Los resultados demuestran que recuperar dialécticamente el camino histórico de las creaciones tecnológicas es esencial para la psicología, lo que permite ampliar el espectro de análisis de cómo se constituyen los sujetos en la actualidad. Concluye que la revolución microtecnológica debe tomarse desde una perspectiva crítica y ética, para todo lo que pueda afectar las relaciones entre los sujetos y el desarrollo de sus procesos psíquicos.

ABSTRACT. The text, resulting from theoretical studies undertaken in the light of Historical-Cultural Psychology between 2016 and 2020, aims to recover the technological revolution as a resource for understanding the constitution of contemporary subjects, starting from the steam engine of the First Industrial Revolution, used in the means of production, even the smartphone, used in everyday life. The smartphone has such high levels of compactness, portability and operability that it has become one of the most advanced technologies in history, revealing the high degree of development of the psyche achieved by mankind. It, more than other digital information and communication technologies, has impacted notably on the constitution of contemporary subjects, especially on their cognitive psychological functions. The results demonstrate that recovering dialectically the historical path of technological creations is essential to Psychology, allowing to expand the spectrum of analysis of how subjects are constituted today. It concludes that the microtechnological revolution must be taken under a critical and ethical bias, due to everything that can impact on the relationships between the subjects and the development of their psychic processes.

Metastasis of Pulmonary Carcinoma to the Breast: Case Report / Metástase de Carcinoma Pulmonar para Mama: Relato de Caso / Metástasis de Carcinoma Pulmonar a la Mama: Informe de Caso

Introduction: Pulmonary carcinoma is the most prevalent cancer in the world, followed by breast cancer. It has high mortality rates in men and women mainly due to its ability to metastasize. Metastases from lung carcinoma to the breast are extremely rare. The first case described occurred in 1965 and since then there are few cases of this condition reported in the world medical literature. Case report: A 59-year-old woman who complained of low back pain in May 2017. The investigation revealed a metastatic site in the fifth vertebra of the lumbar spine with unknown origin. Six months later, a new lesion was found in the ninth vertebra of the thoracic spine. Immunohistochemistry showed positivity for cytokeratin 7 and TTF1 markers, confirming the hypothesis of lung carcinoma as the primary site. In March 2018, the patient evolved with a symptomatic nodule in the right breast on ultrasound and with positivity for TTF1 on immunohistochemical study, confirming the metastasis of lung carcinoma to the breast. Treated for two years until March 2020, when she presented multiple brain metastases. Patient had no therapeutic success and died. Conclusion: The difficulty in diagnosing lung carcinoma metastasis to the breast stands out, surgeons, clinicians and pathologists should consider this diagnosis, although rare.

Introdução: O carcinoma pulmonar é o câncer mais prevalente no mundo, seguido pelo de mama. Apresenta altas taxas de mortalidade em homens e mulheres, principalmente em virtude da sua capacidade de metastatizar. As metástases do carcinoma de pulmão para a mama são extremamente raras. O primeiro caso descrito ocorreu em 1965 e, desde então, há poucos casos dessa condição relatados na literatura médica mundial. Relato do caso: Mulher, 59 anos, apresentou dor lombar em maio de 2017. A investigação revelou um local metastático na quinta vértebra da coluna lombar sem descobrir sua origem. Seis meses depois, uma nova lesão foi encontrada na nona vértebra da coluna torácica. A imuno-histoquímica mostrou positividade para os marcadores citoqueratina 7 e TTF1, confirmando a hipótese de carcinoma de pulmão como sítio primário. Em março de 2018, a paciente evoluiu com um nódulo sintomático na mama direita ao ultrassom e com positividade para TTF1 no estudo imuno-histoquímico, confirmando tratar-se de metástase de carcinoma de pulmão para a mama. Foi tratada por dois anos até março de 2020, quando apresentou múltiplas metástases cerebrais. A paciente não teve sucesso terapêutico e faleceu. Conclusão: Ressalta-se a dificuldade no diagnóstico de metástase de carcinoma de pulmão para a mama e alertar clínicos, cirurgiões e patologistas para que considerem esse diagnóstico, embora raro.

Introducción: Carcinoma de pulmón es el cáncer más prevalente del mundo, seguido del cáncer de mama. Presenta elevadas tasas de mortalidad en hombres y mujeres, debido principalmente a su capacidad de metástasis. Las metástasis del carcinoma de pulmón hacia la mama son extremadamente raras. El primer caso descrito fue en 1965 y, desde entonces, existen pocos casos de esta afección en la literatura médica de todo el mundo. Informe del caso: Mujer, 59 años, comenzó a experimentar dolor lumbar en mayo de 2017. La investigación reveló un foco metastásico en la quinta vértebra de la columna lumbar sin descubrir su origen. Seis meses después, se encontró una nueva lesión en la novena vértebra de la columna torácica. Inmunohistoquímica mostró positividad para los marcadores citoqueratina 7 y TTF1, confirmando la hipótesis de carcinoma de pulmón como localización primaria. En marzo de 2018, la paciente evolucionó con un nódulo sintomático en la mama derecha en la ecografía y con positividad para TTF1 en el estudio inmunohistoquímico, confirmando que se trataba de una metástasis de carcinoma pulmonar a la mama. Tratada durante dos años hasta marzo de 2020, cuando presentó múltiples metástasis cerebrales. La paciente no tuvo éxito terapéutico y falleció. Conclusión: Destacan la dificultad en el diagnóstico de metástasis de carcinoma pulmonar a la mama y alertar clínicos, cirujanos y patólogos para que consideren este diagnóstico, aunque poco frecuente.

Registro Brasileiro de Cardiologia Intervencionista durante a Pandemia de COVID-19 (RBCI-COVID19) / Brazilian Registry of Interventional Cardiology during the COVID-19 Pandemic (RBCI-COVID19)

Resumo Fundamento No início da pandemia de COVID-19, os pacientes com infarto do miocárdio (IM) demoraram para procurar um hospital por medo de contágio ou dificuldades no acesso aos serviços de saúde. Objetivos Avaliar procedimentos de cardiologia intervencionista realizados durante a pandemia de COVID-19 e implicações na abordagem do IM. Métodos Registro prospectivo de 24 centros de hemodinâmica no Brasil, com pacientes adultos submetidos a procedimentos de cardiologia intervencionista entre 26 de maio e 30 de novembro de 2020. Os desfechos foram complicações cardiovasculares (CV) e não CV, morte e IM. A concomitância de COVID-19 foi confirmada com RT-PCR. Técnicas de machine learning foram usadas com modelos não paramétricos de árvores de classificação. Usou-se análise de correspondência simples com o software R. Adotou-se nível de significância de 5%. Resultados Este estudo incluiu 1.282 pacientes, 435 dos quais (33,9%) apresentaram IM: IM com supra de ST (IMCSST), 239 (54,9%); e IM sem supra de ST(IMSSST), 196 (45.1%). Dos 1.282 pacientes, 29 tiveram complicações CV, 47 tiveram complicações não CV e 31 morreram. O diagnóstico de COVID-19 foi confirmado em 77 pacientes (6%), com 15,58% de mortalidade e 6,49% de complicações não CV. A maioria dos pacientes apresentou significativa doença arterial coronariana (63%). Trombo intracoronariano foi mais frequente na presença de IMCSST (3,4%) e COVID-19 (4%). Tempo porta-mesa superior a 12 horas no IMSSST associou-se a 30,8% de complicações, 25% em pacientes com COVID-19. Conclusões Todos os óbitos foram precedidos por complicações CV ou não CV. A presença de COVID-19 foi associada a óbito e complicações não fatais dos pacientes submetidos a procedimentos de cardiologia intervencionista durante a pandemia.

Abstract Background At the beginning of the COVID-19 pandemic, patients with myocardial infarction (MI) took longer to present to hospitals because of fear of contamination and health care access difficulties. Objectives To assess interventional cardiology procedures performed during the COVID-19 pandemic and its implications for MI approach. Methods Prospective registry of 24 cardiac catheterization laboratories in Brazil, with adult patients undergoing interventional cardiology procedures between May 26 and November 30, 2020. The outcomes were cardiovascular (CV) and non-CV complications, death, and MI. Concomitant COVID-19 was confirmed using RT-PCR. Machine learning techniques were used with nonparametric Classification Trees models, and Simple Correspondence Analysis, with R statistical software package. Significance level adopted of 5%. Results This study included 1282 patients, 435 of whom (33.9%) had MI as follows: ST-segment elevation MI (STEMI), 239 (54.9%); and non-ST-segment elevation MI (NSTEMI), 196 (45.1%). Of the 1282 patients, 29 had CV complications, 47 had non-CV complications, and 31 died. The diagnosis of COVID-19 was confirmed in 77 patients (6%), with 15.58% mortality and non-CV complications in 6.49%. Most patients had significant coronary artery disease (63%), and an intracoronary thrombus was more often found in the presence of STEMI (3.4%) and COVID-19 (4%). A door-to-table time longer than 12 hours in NSTEMI was associated with 30.8% of complications, 25% in COVID-19 patients. Conclusions All deaths were preceded by CV or non-CV complications. The presence of COVID-19 was associated with death and non-fatal complications of patients undergoing interventional cardiology procedures during the pandemic.

Influence of the Peek Abutments on Mechanical Behavior of the Internal Connections Single Implant.

The present study aimed to evaluate the biomechanical behavior of PEEK abutments with different heights on single titanium implants. To investigate the implant surface, different tests (scanning electron microscopy, energy-dispersive X-ray, and X-ray diffraction) were adopted. Herein, 20 implants received the 4.5 × 4.0 mm PEEK short abutment (SA) and 20 received the 4.5 × 5.5 mm PEEK long abutment (LA). The abutments were installed using dual-cure resin cement. To determine the fatigue test, two specimens from each group were submitted to the single load fracture test. For this, the samples were submitted to a compressive load of (0.5 mm/min; 30°) in a universal testing machine. For the fatigue test, the samples received 2,000,000 cycles (2 Hz; 30°). The number of cycles and the load test was analyzed by the reliability software SPSS statistics using Kaplan-Meier and Mantel-Cox tests (log-rank) (p < 0.05). The maximum load showed no statistically significant differences (p = 0.189) for the SA group (64.1 kgf) and the LA group (56.5 kgf). The study groups were statistically different regarding the number of cycles (p = 0.022) and fracture strength (p = 0.001). PEEK abutments can be indicated with caution for implant-supported rehabilitation and may be suitable as temporary rehabilitation.

Neurological and Psychiatric Disorders in Patients with Rheumatic Heart Disease: Unveiling what is Beyond Cardiac Manifestations.

Background: Rheumatic heart disease (RHD) is the most serious manifestation of rheumatic fever, which may also affect the brain. The current study assessed the prevalence of neuropsychiatric manifestations in patients with RHD, including clinical features associated with basal ganglia motor dysfunction (BGMD). Methods: We conducted neurologic and psychiatric assessments in consecutive patients with RHD referred to a tertiary center for heart valve diseases. Echocardiography was performed to assess the pattern of valvular involvement and RHD severity. Validated questionnaires for the evaluation of cognition, depression, anxiety, and obsessive-compulsive symptoms (OCS) were applied. BGMD was clinically defined by the presence of hyperkinetic movement disorders. Results: Fifty patients with age of 43.2 ± 10.8 years, 84% female, were included. Mitral valve was affected in 47 patients (94%), and 21 of them (42%) also had aortic valve involvement. Chorea (22%), chronic tics (18%), OCS (48%), major depression (34%), generalized anxiety disorder (54%), cognitive complaints (66%), migraine (52%) and seizures (18%) were frequently reported. The factors associated with BGMD were age (p = 0.018), major depression (p = 0.013), and Yale-Brown Obsessive Compulsive (Y-BOCS) score (p = 0.011). The severity of heart disease was not associated with BGMD. Conclusions: Neuropsychiatric manifestations are frequent in RHD patients, which may persist up to three decades after acute rheumatic fever. Age, major depression and severity of OCS were independently associated with BGMD. These manifestations deserve a close attention of clinicians and researchers dealing with adult patients with RHD.

The Modified versus the Conventional Winograd Technique for the Treatment of Onychocryptosis: A Retrospective Study.

The Winograd technique is a common surgical treatment for ingrown toenails. Attempting to improve the results of this technique, two modifications were adopted: the incisional approach and the use of adhesive approximation strips. This study aimed to compare the conventional technique and the modified version based on (i) postoperative complications, (ii) healing time, (iii) recurrence rate, and (iv) overall patient satisfaction. A longitudinal, observational, and retrospective design was used, with a sample of 208 patients divided into the modified Winograd technique (n = 111) and the conventional Winograd technique (n = 97) in three clinics in Portugal, with follow-up periods of more than 15 years and 10 years, respectively. The modifications to the Winograd technique revealed fewer postsurgical complications, in terms of infections (1.8% vs. 20.62%, p < 0.010), recurrence rate (2.7% vs. 5.21%, p > 0.05), shorter recovery time (8.10 ± 0.76 vs. 14.51 ± 3.48 days, p < 0.001), and lower postoperative pain and better satisfaction with the functional and esthetic results, with the patient's overall satisfaction, and with significant differences in relation to the conventional technique (p < 0.001). The modifications performed showed a lower rate of infection, decreased healing time, and better patient satisfaction, suggesting that it may be adopted in clinical practice for the treatment of stages II and III ingrown toenails.

Assessment of phytotoxic potential and pathogenic bacteria removal from secondary effluents during ozonation and UV/H2O2.

Wastewater reuse is an important strategy for water resource management. For this reason, the disinfection process must be appropriated, eliminating pathogenic microorganisms. Ozonation (O3) and UV/H2O2 treatments can be used for effluent disinfection, but few studies just address the Escherichia coli quantification. In this study, secondary effluents from two wastewater treatment plants with different characteristics were exposed to O3 (5 and 10 mg L-1) or UV/H2O2 (H2O2: 90 mg L-1) treatments and evaluated by BD Phoenix ™ 100 (Becton Dickinson, USA) and MALDI-TOF for the characterization of the indigenous microorganisms in the effluents, before and after treatments. Additionally, all the samples were tested for phytotoxicity by Lactuca sativa bioassay. The results showed that the highest ozone dose and the UV/H2O2 treatment were effective in removing E. coli. UV/H2O2 was more efficient as it eliminated most of the microorganisms. Acinetobacter sp., Aeromonas and Pseudomonas were still found after O3 treatment. Bacillus sp. was found after O3 and UV/H2O2 treatments. The results with L. sativa showed inhibition of root growth for all dry period (low rainfall) samples of one of the WWTP, due to the high concentration of the phytotoxicity compounds. For environmental and human health safety, treated effluents should be evaluated for their toxic and pathogenic potential before being released into the environment. Pathogens evaluation on treated effluents should cover a wider range of pathogenic microorganisms than those routinely required by legislation.

Dissimilar use of an external heat source for thermoregulation by shrews from different geographic regions.

Ambient temperature has a substantial influence on the thermoregulation costs of small mammals due to their high surface-to-volume ratio. Shrews are among the smallest of mammals and have adopted different behavioral and physiological strategies to deal with cold temperatures. In this study, we assessed the use of an external heat source in the thermoregulatory strategy of two Crocidurinae species, Crocidura russula and C. suaveolens, and one Soricinae species, Sorex araneus. Crocidura russula inhabits western Europe and is better adapted to a Mediterranean climate; C. suaveolens inhabits central Europe; and S. araneus inhabits northern Europe and is better adapted to a Palearctic climate. We predicted that C. russula (most southern species) would spend larger amounts of time using an external heat source because it is the most cold-sensitive species, while S. araneus (most northern species) would spend less time using an external heat source or not respond to it. Shrews were experimentally tested in captivity inside a terrarium where they had access to a heat rock, which could be turned off (cold) or on (heated), depending on treatment. Our results confirmed our initial prediction: C. russula was the species that spent significantly more time on the heated rock, followed by C. suaveolens. Only a quarter of S. araneus individuals spent large amounts of time on the heat rock, which suggests this thermoregulation strategy is not generally adopted by this species, but may be rather associated with some individual personalities. We also analyzed the influence of the heat rock on rewarming from heterothermy, but heterothermy was not different between rock treatments. Overall, our results show that shrew species use external heat sources for thermoregulation according to their sensitivity to cold.