Left atrial appendage occlusion for recurrent stroke while on oral anticoagulation: a case series.

Background: Clinical practice guidelines recommend oral anticoagulation (OAC) for stroke prevention in selected patients with atrial fibrillation (AF). However, some patients still experience thrombo-embolic events despite adequate anticoagulation. The optimal management of these cases remains uncertain, leading to practice pattern variability. We present a series of three cases illustrating the use of left atrial appendage occlusion (LAAO) as an adjunctive stroke prevention strategy in AF patients with recurrent thrombo-embolic events despite adequate anticoagulation. Case summary: Case one describes an 89-year-old female on apixaban who presented with a thrombus and underwent successful mechanical thrombectomy. Left atrial appendage occlusion was performed, and no subsequent thrombo-embolic events were reported. Case 2 involves a 72-year-old female on full-dose apixaban who experienced recurrent strokes despite adequate anticoagulation. Thrombectomy was performed twice, and complications arose during LAAO. The patient was discharged on warfarin + clopidogrel and remained event-free at the six-month follow-up. Case 3 features an 88-year-old female on rivaroxaban who experienced recurrent cerebral ischaemic events and gastrointestinal bleeding. Left atrial appendage occlusion using an Amplatzer Amulet™ device was successful, and the patient remained event-free at the one-year follow-up. Discussion: This case series emphasizes the complexity of stroke prevention in AF patients and underscores the need for an individualized approach. Incorporating LAAO alongside OAC can provide additional stroke protection for patients with inadequate response to anticoagulation. Further randomized controlled trials are needed to evaluate the efficacy and safety of this approach. In light of the limited evidence available, these cases contribute to the growing body of knowledge on the potential role of LAAO in secondary stroke prevention in AF patients with recurrent thrombo-embolic events despite appropriate anticoagulation.

Outdoor air pollution as a risk factor for testing positive for SARS-CoV-2: A nationwide test-negative case-control study in the Netherlands.

Air pollution is a known risk factor for several diseases, but the extent to which it influences COVID-19 compared to other respiratory diseases remains unclear. We performed a test-negative case-control study among people with COVID-19-compatible symptoms who were tested for SARS-CoV-2 infection, to assess whether their long- and short-term exposure to ambient air pollution (AAP) was associated with testing positive (vs. negative) for SARS-CoV-2. We used individual-level data for all adult residents in the Netherlands who were tested for SARS-CoV-2 between June and November 2020, when only symptomatic people were tested, and modeled ambient concentrations of PM10, PM2.5, NO2 and O3 at geocoded residential addresses. In long-term exposure analysis, we selected individuals who did not change residential address in 2017-2019 (1.7 million tests) and considered the average concentrations of PM10, PM2.5 and NO2 in that period, and different sources of PM (industry, livestock, other agricultural activities, road traffic, other Dutch sources, foreign sources). In short-term exposure analysis, individuals not changing residential address in the two weeks before testing day (2.7 million tests) were included in the analyses, thus considering 1- and 2-week average concentrations of PM10, PM2.5, NO2 and O3 before testing day as exposure. Mixed-effects logistic regression analysis with adjustment for several confounders, including municipality and testing week to account for spatiotemporal variation in viral circulation, was used. Overall, there was no statistically significant effect of long-term exposure to the studied pollutants on the odds of testing positive vs. negative for SARS-CoV-2. However, significant positive associations of long-term exposure to PM10 and PM2.5 from specifically foreign and livestock sources, and to PM10 from other agricultural sources, were observed. Short-term exposure to PM10 (adjusting for NO2) and PM2.5 were also positively associated with increased odds of testing positive for SARS-CoV-2. While these exposures seemed to increase COVID-19 risk relative to other respiratory diseases, the underlying biological mechanisms remain unclear. This study reinforces the need to continue to strive for better air quality to support public health.

Unstable Angina Risk Stratification Using High-Sensitivity Cardiac Troponin and Coronary Angiography.

Patients formerly diagnosed with unstable angina (UA) are being reclassified as non-ST-elevation myocardial infarction with the widespread adoption of high-sensitivity troponin (hsTn) assays, leading to significant changes in the incidence and prognosis of UA. This study aimed to evaluate the value of hsTn and the presence of significant obstructive coronary artery disease (CAD) in the risk stratification of patients with UA. We conducted a retrospective, single-center study of 742 patients hospitalized for UA between 2016 and 2021. The primary end point of this study was all-cause mortality. The secondary outcome (major adverse cardiac events [MACEs]) was defined as a composite of nonfatal myocardial infarction (MI), hospitalization for heart failure (hHF), and repeated coronary angiography because of recurring UA (rUA) after the index event. The outcomes were assessed within 1 month, 1 year, and up to 5 years of follow-up. The average follow-up duration was 45 ± 24 months, and 37.2% (n = 276) of patients completed a 5-year follow-up. No in-hospital death was observed, and 6.9% of patients died during follow-up, which was more commonly a late event (>12 months). The composite secondary end point (MI+hHF+rUA) was observed in 16.7% of the patients. There were 3.2% nonfatal MI, 2.3% hHF, and 11.6% rUA during follow-up. We developed a risk model (UA mortality risk) using variables with the highest discriminatory power: age, hsTn, and ST-segment deviation. Our model performed well against the Global Registry of Acute Coronary Events and Thrombolysis in Myocardial Infarction risk scores in predicting death during follow-up. Obstructive CAD on coronary angiography was the only independent predictor of MACEs during follow-up. In conclusion, a contemporary cohort of patients with UA presented with favorable prognosis, particularly, within the first year after the index event. Nonsignificant increases in hsTn levels add to the risk stratification of patients with UA, and the presence of obstructive CAD was the only independent predictor of MACEs, highlighting the potential importance of assessing coronary anatomy.

Effects of long-term exposure to outdoor air pollution on COVID-19 incidence: A population-based cohort study accounting for SARS-CoV-2 exposure levels in the Netherlands.

Several studies have linked air pollution to COVID-19 morbidity and severity. However, these studies do not account for exposure levels to SARS-CoV-2, nor for different sources of air pollution. We analyzed individual-level data for 8.3 million adults in the Netherlands to assess associations between long-term exposure to ambient air pollution and SARS-CoV-2 infection (i.e., positive test) and COVID-19 hospitalisation risks, accounting for spatiotemporal variation in SARS-CoV-2 exposure levels during the first two major epidemic waves (February 2020-February 2021). We estimated average annual concentrations of PM10, PM2.5 and NO2 at residential addresses, overall and by PM source (road traffic, industry, livestock, other agricultural sources, foreign sources, other Dutch sources), at 1 × 1 km resolution, and weekly SARS-CoV-2 exposure at municipal level. Using generalized additive models, we performed interval-censored survival analyses to assess associations between individuals' average exposure to PM10, PM2.5 and NO2 in the three years before the pandemic (2017-2019) and COVID-19-outcomes, adjusting for SARS-CoV-2 exposure, individual and area-specific confounders. In single-pollutant models, per interquartile (IQR) increase in exposure, PM10 was associated with 7% increased infection risk and 16% increased hospitalisation risk, PM2.5 with 8% increased infection risk and 18% increased hospitalisation risk, and NO2 with 3% increased infection risk and 11% increased hospitalisation risk. Bi-pollutant models suggested that effects were mainly driven by PM. Associations for PM were confirmed when stratifying by urbanization degree, epidemic wave and testing policy. All emission sources of PM, except industry, showed adverse effects on both outcomes. Livestock showed the most detrimental effects per unit exposure, whereas road traffic affected severity (hospitalisation) more than infection risk. This study shows that long-term exposure to air pollution increases both SARS-CoV-2 infection and COVID-19 hospitalisation risks, even after controlling for SARS-CoV-2 exposure levels, and that PM may have differential effects on these COVID-19 outcomes depending on the emission source.

Exploring associations between residential exposure to pesticides and birth outcomes using the Dutch birth registry.

BACKGROUND: Maternal occupational exposure to pesticides has been linked to adverse birth outcomes but associations with residential pesticide exposures are inconclusive. OBJECTIVES: To explore associations between residential exposure to specific pesticides and birth outcomes using individual level exposure and pregnancy/birth data. METHODS: From all 2009-2013 singleton births in the Dutch birth registry, we selected mothers > 16 years old living in non-urban areas, who had complete address history and changed addresses at most once during pregnancy (N = 339,947). We estimated amount (kg) of 139 active ingredients (AI) used within buffers of 50, 100, 250 and 500 m around each mother's home during pregnancy. We used generalized linear models to investigate associations between 12 AIs with evidence of reproductive toxicity and gestational age (GA), birth weight (BW), perinatal mortality, child́s sex, prematurity, low birth weight (LBW), small for gestational age (SGA) and large for gestational age (LGA), adjusting for individual and area-level confounders. For the remainder 127 AIs, we used minimax concave penalty with a stability selection step to identify those that could be related to birth outcomes. RESULTS: Regression analyses showed that maternal residential exposure to fluroxypyr-meptyl was associated with longer GA, glufosinate-ammonium with higher risk of LBW, linuron with higher BW and higher odds of LGA, thiacloprid with lower odds of perinatal mortality and vinclozolin with longer GA. Variable selection analysis revealed that picoxystrobin was associated with higher odds of LGA. We found no evidence of associations with other AIs. Sensitivity and additional analysis supported these results except for thiacloprid. DISCUSSION: In this exploratory study, pregnant women residing near crops where fluroxypyr-meptyl, glufosinate-ammonium, linuron, vinclozolin and picoxystrobin were applied had higher risk for certain potentially adverse birth outcomes. Our findings provide leads for confirmatory investigations on these compounds and/or compounds with similar modes of action.

Phenotype of BTK-lacking myeloid cells during prolonged COVID-19 and upon convalescent plasma.

XLA patient with 7-month course of COVID-19 with persistent plasma SARS-CoV-2 load revealed a sustained non-inflammatory profile of myeloid cells in association with contained severity of disease, arguing in favor of the use of BTK inhibitors in SARS-COV-2 infection.

Fatores associados a multimorbidades autorreferidas em trabalhadores da rede de saúde municipal / Factors associated with self-reported multimorbidities in workers from the municipal health network

Resumo Objetivo: estimar a prevalência de doenças crônicas não transmissíveis (DCNT) e investigar fatores associados a multimorbidades crônicas entre trabalhadores da rede de saúde municipal. Métodos: estudo transversal com profissionais da atenção básica à saúde de Diamantina, Minas Gerais, Brasil. Os dados foram coletados por entrevista com aplicação de instrumentos validados. Houve identificação das características individuais, hábitos e estilo de vida, estado de saúde e condições de trabalho da população estudada. Utilizou-se regressão logística para construção de modelos multivariáveis. Resultados: participaram da pesquisa 203 dos 257 trabalhadores elegíveis, 144 do sexo feminino e 59 do masculino. As morbidades mais prevalentes foram: sobrepeso (27,0%), hipertensão (17,2%) e depressão/estresse (16,2%). A presença de multimorbidades (28,6%) foi significativamente associada à idade superior a 48 anos (Odds ratio - OR: 4,28; intervalo de confiança de 95% - IC95%: 1,66;11,04), à presença de transtornos mentais comuns (OR: 3,23; IC95%: 1,50;6,96), enquanto o apoio social adequado no trabalho permaneceu como fator de proteção (OR: 0,25; IC95%: 0,11;0,57). Conclusão: a presença de multimorbidades foi associada a maior idade, presença de transtornos mentais comuns e características organizacionais do trabalho.

Abstract Objective: to estimate the prevalence of non-communicable chronic diseases (NCD) and investigate factors associated with chronic multimorbidities among workers from the municipal health network. Methods: cross-sectional study involving basic health care professionals from Diamantina, Minas Gerais, Brazil. The data were collected by an interview applying validated instruments. The studied population's individual characteristics, habits and lifestyle, health and work conditions were identified. Logistics regression was used to build the multivariate models. Results: 203 of the 257 eligible workers participated in this research, 144 women and 59 men. The most prevalent morbidities were: overweight (27.0%), hypertension (17.2%) and depression/stress (16.2%). The presence of multimorbidities (28.6%) was significantly associated to age over 48 years old (odds ratio - OR: 4,28; confidence interval of 95% - 95%CI: 1.66;11.04), to the presence of common mental disorders (OR: 3.23; 95%CI: 1.50;6.96), whereas the adequate social support at work remained as a protection factor (OR: 0.25; 95%CI: 0.11;0.57). Conclusion: the presence of multimorbidities was associated with older age, presence of common mental disorders, and work organizational characteristics.

Calcinose em área de queimadura tardia: relato de caso e discussão da conduta / Calcinosis in an area of late burn: a case report and management discussion

Introdução: Calcinose cutânea é uma doença rara caracterizada por precipitações de cristais de cálcio no tecido cutâneo. Pode ser localizada ou generalizada, distrófica, metastática, iatrogênica ou idiopática. Relato do Caso: Paciente feminina, 66 anos, vítima de queimaduras de segundo e terceiro graus por fogo em abdome inferior e coxas aos 8 anos de idade atingindo 25% de superfície corpórea. Após 58 anos, recebeu o diagnóstico de calcinose distrófica na cicatriz da queimadura, contemplado através de biópsia e análise histopatológica. Submetida a exérese cirúrgica associada a rotação de retalho dermogorduroso de abdome superior e enxertia de pele total para correção de cicatrizes. Conclusão: Embora a melhor escolha terapêutica ainda não seja clara, o tratamento de complicações que podem culminar em incapacidade funcional é fundamental para reduzir a morbidade e aumentar a qualidade de vida do paciente.

Introduction: Cutaneous calcinosis is a rare disease characterized by the precipitation of calcium crystals in the skin tissue. It can be localized, generalized, dystrophic, metastatic, iatrogenic, or idiopathic. Case Report: Female patient, 66 years old, victim of second and third-degree burns by fire in the lower abdomen and thighs at 8 years old, reaching 25% of the body surface. After 58 years, she was diagnosed with dystrophic calcinosis in the burn scar, which was confirmed through biopsy and histopathological analysis. She underwent surgical excision associated with rotation of the upper abdomen dermal-fat flap and total skin graft for scar correction. Conclusion: Although the best therapeutic choice is still unclear, treating complications leading to functional disability is essential to reduce morbidity and increase the patient's quality of life.

Size does not matter: molecular phylogeny reveals one of the largest trematodes from vertebrates, the enigmatic Ithyoclinostomum dimorphum, as a species of Clinostomum (Trematoda: Clinostomidae).

Despite the recent advances raised in the molecular era to the taxonomic knowledge of species of the family Clinostomidae, especially those belonging to the specious genus Clinostomum, some groups of these vertebrate parasites remain poorly studied. This is the case of species of the enigmatic genus Ithyoclinostomum Witenberg, 1926, until recently monotypic and restricted to South America, but with its occurrence expanded to North America after the description of I. yamagutii Rosser et al., 2020. Nevertheless, molecular data for the type species of the genus, Ithyoclinostomum dimorphum (Diesing, 1850), is lacking so far. In the present study, large clinostomid metacercariae morphologically indistinguishable from I. dimorphum were obtained from two erythrinid fishes from the Rio Doce River, Southeast Brazil. Samples of the parasites were subjected to a multigene (28S rDNA, ITS and cox1) molecular characterization followed by phylogenetic reconstructions. Phylogenies based on single-gene and concatenated datasets revealed unequivocally that I. dimorphum falls in a well-supported clade together with species of the genus Clinostomum. Moreover, the molecular divergences observed in relation to Clinostomum spp. [ranges of 2.4-6%, 2.4-3.8% and 14.7-19.3% for the ITS, 28S and cox1 genes, respectively] are compatible with a congeneric status with these species. Therefore, the genus Ithyoclinostomum is here synonymized with Clinostomum Leidy, 1856 and C. dimorphum (Diesing, 1850) Braun, 1899 re-established. In the phylogenetic analysis, the recently described 'Ithyoclinostomum' yamagutii, presented as an isolated, independent lineage, showing significant molecular divergences to C. dimorphum (12.6%, 7.6%, 18,6% for the ITS, 28S and cox1 genes, respectively). However, given the complex scenario raised in the morphology-based taxonomy of Clinostomidae, we took a conservative approach by not proposing a new genus to 'I.' yamagutii until molecular data of other clinostomid genus from birds, Clinostomatopsis, become available. Data here presented reveals that body size is not a useful criterion for higher-level classification in Clinostomidae. Finally, we highlighted the importance of the availability of molecular data for the type species of trematode genera proposed from South America to support a trans- or intercontinental distribution.

Origin and function of activated fibroblast states during zebrafish heart regeneration.

The adult zebrafish heart has a high capacity for regeneration following injury. However, the composition of the regenerative niche has remained largely elusive. Here, we dissected the diversity of activated cell states in the regenerating zebrafish heart based on single-cell transcriptomics and spatiotemporal analysis. We observed the emergence of several transient cell states with fibroblast characteristics following injury, and we outlined the proregenerative function of collagen-12-expressing fibroblasts. To understand the cascade of events leading to heart regeneration, we determined the origin of these cell states by high-throughput lineage tracing. We found that activated fibroblasts were derived from two separate sources: the epicardium and the endocardium. Mechanistically, we determined Wnt signalling as a regulator of the endocardial fibroblast response. In summary, our work identifies specialized activated fibroblast cell states that contribute to heart regeneration, thereby opening up possible approaches to modulating the regenerative capacity of the vertebrate heart.

Residential proximity to livestock animals and mortality from respiratory diseases in The Netherlands: A prospective census-based cohort study.

BACKGROUND: There is increasing evidence of associations between residential proximity to livestock farms and respiratory morbidity, but less is known about potential effects on respiratory mortality among residents. OBJECTIVES: We aimed to assess potential associations between respiratory mortality and residential proximity to (intensive) livestock farming. METHODS: In DUELS, a national census-based cohort, we selected all inhabitants from rural and semi-urban areas of the Netherlands, aged ≥30 years and living at the same address for five years up to baseline (2004). We followed these ∼4 million individuals for respiratory mortality (respiratory system diseases, chronic lower respiratory diseases, pneumonia) from 2005 to 2012. We computed the average number of cattle, pigs, chicken, and mink present in 500 m, 1000 m, 1500 m and 2000 m of each individual's residence in the period 1999-2003. Analyses were conducted using Cox proportional hazards regression, adjusting for potential confounders at individual and neighbourhood level. RESULTS: We found evidence that living up to 2000 m of pig farms was associated with respiratory mortality, namely from chronic lower respiratory diseases, with Hazard Ratios ranging from 1.06 (1.02, 1.10) in people living close to low numbers (

An annotated checklist of the genus Pterygodermatites Wedl, 1861 (Nematoda: Rictulariidae), with notes on hosts and geographical distribution.

Species of rictulariid nematodes belonging to the genus Pterygodermatites Wedl, 1861 are parasites of mammals with a wide geographical distribution. The taxonomy of this speciose genus is complex and based mainly on morphological traits of the cephalic structures and cuticular processes. Currently, the known species are allocated to five subgenera [P. (Paucipectines), P. (Neopaucipectines), P. (Multipectines), P. (Pterygodermatites) and P. (Mesopectines)], based on the classification proposed in 1969 by Quentin. Studies on life cycles, taxonomy, biogeography and association of these parasites with mammals peaked at the end of the 1960s. Although the momentum was lost, new species and geographic records have been added in the last 50 years. Therefore, an updated checklist of species of Pterygodermatites is presented here, based on a literature survey. Information on classification, geographical distribution and host range obtained for 68 species is presented, including a distribution map. Moreover, the main differential morphological traits related to each species are tabulated. More than 140 species from 10 different mammalian orders (Carnivora, Chiroptera, Didelphimorphia, Erinaceomorpha, Macroscelidae, Microbiotheria, Paucituberculata, Primates, Rodentia and Xenarthra) have been reported as hosts of Pterygodermatites spp. The taxonomic information here compiled can contribute to future studies on the biogeography, in addition to evolutionary and ecological aspects of this diverse but poorly known genus of parasitic nematodes of mammals.

Residential proximity to crops and agricultural pesticide use and cause-specific mortality: A prospective census-based cohort study in the Netherlands.

BACKGROUND: There is continued concern about residential proximity to agricultural pesticide use and possible adverse health effects. Studies on this subject have been scarce with inconsistent results. We explored associations between residential proximity to specific crops, pesticide use and cause-specific mortality in a prospective census-based cohort study in The Netherlands. METHODS: Selecting inhabitants aged >30 living in less urbanized areas, at the same address for nine years up to baseline (2004) from a national register-based cohort, we followed ~3.1 million individuals for cause-specific mortality until 2012. We estimated the area of specific crop groups cultivated within buffers of 50 m, 100 m and 250 m around each individual's residence and the amount of fungicides, herbicides and insecticides used within the same buffers for the period 1995-2003. The association between these exposure proxies and 25 primary causes of death was investigated using Cox proportional hazards regression, adjusting for individual and area-level confounders. RESULTS: Residential proximity to crops was associated with decreased mortality risks overall. In contrast to the overall trend an increased risk was observed for chronic lower respiratory diseases and proximity to maize cultivation. We found no evidence of an association between the amount of pesticides used and cause-specific mortality. CONCLUSIONS: In a large prospective census-based cohort study in The Netherlands we found evidence of an increased risk of chronic lower respiratory diseases in relation to maize cultivation which was not reflected in general pesticide use, hinting to specific pesticides or practices in maize cultivation that may lead to the observed increased risk.

Fetomaternal hemorrhage: a clue to intraplacental choriocarcinoma and neonatal malignancy.

Fetomaternal hemorrhage (FMH) is a known cause of neonatal anemia due to fetal blood loss to the maternal circulation, occurring when the maternal-fetal barrier is disrupted. Several causes must be considered, although in most cases the etiology remains unknown. Intraplacental choriocarcinoma (ICC) is a rare entity and has been related with massive FMH, intrauterine fetal demise, severe neonatal anemia and metastatic choriocarcinoma in both mother and infant. There are 25 cases of histopathologically confirmed ICC complicated with FMH described in the literature. Because FMH occurs unexpectedly and the majority of patients with ICC are asymptomatic, this diagnosis may be missed. Once FMH is confirmed, underlying malignancy should be kept in mind. The authors present a case report of severe neonatal anemia following FMH related to ICC and highlight the importance of serum ß-hCG monitoring in cases of massive FMH.

Self-reported psychological distress and self-perceived health in residents living near pesticide-treated agricultural land: a cross-sectional study in The Netherlands.

OBJECTIVES: There is rising concern regarding possible health effects from exposure to pesticides in residents living near agricultural land. Some studies indicated increased risks of reporting symptoms of anxiety and depression among agricultural workers but less is known about the mental and perceived health of rural residents. We aimed to study possible associations between self-reported psychological distress (SPD) and self-perceived health (SPH) in residents near pesticide-treated agricultural land. METHODS: Using the Public Health Monitor national survey from 2012, we selected 216 932 participants who lived in rural and semi-urban areas of the Netherlands and changed addresses at most once in the period 2009-2012. Psychological distress (PD) was assessed via the Kessler Psychological Distress scale (K10) and participants were asked to assess their own health. We estimated the area of specific crop groups cultivated within buffers of 50 m, 100 m, 250 m and 500 m around each individual's residence for the period 2009-2012. Association between these exposure proxies and the outcomes was investigated using logistic regression, adjusting for individual, lifestyle and area-level confounders. RESULTS: Overall, results showed statistically non-significant OR across all buffer sizes for both SPD and SPH, except for the association between SPH and 'all crops' (total area of all considered crop groups) with OR (95% CI) ranging from 0.77 (0.63 to 0.93) in 50 m to 1.00 (1.00 to 1.00) in 500 m. We observed that most ORs were below unity for SPH. CONCLUSIONS: This study provides no evidence that residential proximity to pesticide treated-crops is associated with PD or poorer perceived health.

Progressive Multifocal Leukoencephalopathy in a Chemotherapy-Naive Patient With Chronic Lymphocytic Leukemia: A Case Report.

Progressive multifocal leukoencephalopathy is a rare, progressive demyelinating disease of the central nervous system caused by reactivation and replication of the John Cunningham (JC) virus in cerebral oligodendrocytes. The JC virus is a small ubiquitous polyomavirus that can be detected in up to 50% of the adult population. It affects almost exclusively immunocompromised patients and is generally observed in patients with acquired immunodeficiency syndrome and patients with hematologic malignancies and autoimmune or chronic inflammatory diseases medicated with immunosuppressive and immunomodulatory drugs. However, it is rarely described in patients with hematologic malignancies, not undergoing chemotherapy or immunosuppressive therapy. It has a poor prognosis, and the treatment is based on restoring the immune system, given that no specific antiviral treatment is available. We present a case of a chemotherapy-naive patient with chronic lymphocytic leukemia associated with progressive multifocal leukoencephalopathy.

Neurosyphilis: The Great Imitator.

Syphilis is a sexually transmitted disease caused by spirochete Treponema pallidum, with a growing incidence documented in recent years. Its clinical course is divided into three phases - primary, secondary, and tertiary syphilis - and virtually any organ can be affected, resulting in diverse clinical manifestations, making the diagnosis challenging. Neurosyphilis is a progressive, destructive disease of the central nervous system (CNS) that can develop at any stage of the infection, leading to meningeal involvement, meningovascular disease, or parenchymal syphilis (including tabes dorsalis and general paresis). Its clinical manifestations are heterogeneous and vary from focal neurologic signs to neuropsychiatric manifestations. The diagnosis is based mainly on the clinical picture and study of cerebrospinal fluid. Neuroimaging is helpful and sometimes essential, with magnetic resonance imaging being the most sensitive radiologic method, although there are no pathognomonic radiologic signs. Treatment of all forms of neurosyphilis is based on parenteral penicillin. We present a case of neurosyphilis in a patient presenting with a subacute confusional state and initial imaging findings suggestive of metastatic CNS lesions.

Banco de pele de Curitiba, Brasil: epidemiologia de doadores e receptores / Skin bank of Curitiba, Brazil: epidemiology of donors and recipients

Introdução: A enxertia homóloga de pele pode representar a diferença entre a vida e a morte de pacientes grandes queimados. Sua utilização consiste em um tratamento precioso quando não há a disponibilidade do enxerto autólogo. Os bancos de tecidos foram criados para realizar o processamento e armazenamento da pele alógena. O objetivo é analisar o perfil epidemiológico de doadores e receptores de pele do banco de pele do Hospital Universitário Evangélico Mackenzie (HUEM) e a sua produtividade, desde a inauguração em 2013 até 2019. Métodos: Consulta aos relatórios anuais do período de sete anos. Resultados: Captou-se a pele de 187 doadores, dos quais 61% eram homens e 39%, mulheres. A idade média foi de 41,07 anos. O número de doadores atingiu a média de 21,3 por ano. Foram coletados, no total, 201.000cm2 de tecido viável, que resultaram na produção de 3.770 lâminas de pele. Desde 2013, foram realizados no HUEM, 325 enxertos alógenos que beneficiaram 194 pessoas. A idade média dos pacientes que receberam a pele foi de 34,67 anos. A maior parte da pele captada, processada e armazenada pelo banco do HUEM (cerca 91%) foi utilizada em enxertias realizadas na própria instituição. Conclusão: O banco de pele do HUEM disponibilizou aloenxertos que beneficiaram 194 pessoas em 7 anos de funcionamento. Em sua maioria, os doadores e receptores eram do sexo masculino e tinham, aproximadamente, 40 anos de idade. O número de captações realizadas por este banco de pele foi compatível com o de outras instituições do Brasil

Introduction: Homologous skin grafting may represent the difference between the life and death of large burned patients. Its use consists of a precious treatment when there is no availability of autologous graft. The tissue banks were created to perform the processing and storage of the allogenous skin. The objective is to analyze the epidemiological profile of skin donors and recipients from the skin bank of the Hospital Universitário Evangélico Mackenzie (HUEM) and its productivity, from its inauguration in 2013 to 2019. Methods: Consultation of annual reports for the seven years. Results: The skin of 187 donors was captured, of which 61% were men and 39% were women. The mean age was 41.07 years. The number of donors averaged 21.3 per year. A total of 201,000cm2 of viable tissue were collected, which resulted in 3,770 skin slides. Since 2013, 325 allogenous grafts have been performed at HUEM that have benefited 194 people. The mean age of patients receiving the skin was 34.67 years. Most of the skin captured, processed, and stored by the HUEM bank (about 91%) was used in grafting carried out in the institution itself. Conclusion: The HUEM skin bank provided allografts that benefited 194 people in 7 years of operation. Most donors and recipients were male and approximately 40 years old. The number of captures performed by this skin bank was compatible with that of other institutions in Brazil.

Risk factors for common mental disorders in health care workers in the city of Diamantina, state of Minas Gerais.

INTRODUCTION: The increased prevalence of mental health symptoms in primary care workers in recent years is a major cause of concern, and highlights the need to identify modifiable risk factors for mental health disorders in this population. OBJECTIVES: To analyze the prevalence of common mental disorders and associated factors in primary care workers in the city of Diamantina, state of Minas Gerais. METHODS: This was a cross-sectional, exploratory study involving 203 workers in different sectors of primary health care. Participants completed the Self-Report Questionnaire (20 item version), the Job Stress Scale (JSS), and a form with questions regarding sociodemographic factors, occupational characteristics, lifestyle and habits. RESULTS: The prevalence of common mental disorders in the sample was 20.2%. These disorders were significantly associated (p ≤ 0.05) with younger age, poor self-assessed health, poor sleep quality and physically demanding work. CONCLUSIONS: Poor working conditions may directly and indirectly affect the occurrence of mental health disorders by influencing lifestyle and habits. The restructuring of organizational norms, together with worker support policies, may positively contribute to the mental health of workers.

Escore de risco para tromboembolismo e prevenção em pacientes hospitalizados em uma clínica cirúrgica / Puntuación de riesgo de tromboembolismo y prevenciónen pacientes hospitalizados en una clínica quirúrgica / Risk score and prevention of thromboembolism in hospitalized patients in a surgical clinic

Objetivo: Identificar o risco tromboembolítico em pacientes cirúrgicos e o uso das medidas preventivas. Método: Estudo epidemiológico transversal, retrospectivo por meio de entrevistas e abordagem aos prontuários de pacientes cirúrgicos. O risco para tromboembolismo foi avaliado, conforme escala validada e adaptada. As análises foram processadas pelo software estatístico Stata versão 12.1. Resultados: Foram entrevistados e analisados os prontuários de 100 pacientes. Todos os participantes apresentaram pelo menos um fator de risco para tromboembolismo. Dos entrevistados, 41% foram classificados como de alto risco, 7% receberam tromboprofilaxia medicamentosa e 11% recebendo profilaxia não medicamentosa. Conclusão: Apesar de todos os participantes apresentarem pelo menos um fator de risco para tromboembolismo venoso, a implementação de medidas preventivas foi baixa indicando a necessidade de múltiplas intervenções, tais como implementação de protocolos, educação permanente - principalmente da equipe de enfermagem, uso de ferramentas de monitoramento e auditoria de resultados(AU)

Objective: Identify thromboembolic risk in surgical patients and the use of preventive measures. Method: Cross-sectional, retrospective epidemiological study through interviews and approach to the medical records of surgical patients. The risk for thromboembolism was assessed, according to a validated and adapted scale. The analyzes were processed using the statistical software Stata version 12.1. Results: The medical records of 100 patients were interviewed and analyzed. All participants had at least one risk factor for thromboembolism. Of the interviewees, 41% were classified as high risk, 7% received drug thromboprophylaxis and 11% received non-drug prophylaxis. Conclusion: Although all participants had at least one risk factor for venous thromboembolism, the implementation of preventive measures was low, indicating the need for multiple interventions, such as the implementation of protocols, permanent education mainly of the nursing staff, use of monitoring tools and results audit.(AU)

Objetivo: Identificar elriesgo tromboembólico en pacientes quirúrgicos y el uso de medidas preventivas. Método: Estudio epidemiológico transversal, retrospectivo a través de entrevistas y abordaje de la historia clínica de los pacientes quirúrgicos. Se evaluó el riesgo de tromboembolismo, según una escala validada y adaptada. Los análisis se procesaron utilizando el software estadístico Stata versión 12.1. Resultados: Se entrevistó y analizó la historia clínica de 100 pacientes. Todos los participantes teníanal menos um factor de riesgo de tromboembolismo. De los entrevistados, el 41% fueron clasificados como de alto riesgo, el 7% recibió tromboprofilaxis farmacológica y el 11% recibió profilaxis no farmacológica. Conclusión: Si bien todos los participantes tenían al menos um factor de riesgo de tromboembolismo venoso, la implementación de medidas preventivas fue baja, lo que indica la necesidad de múltiples intervenciones, como la implementación de protocolos, educación permanente principalmente delpersonal de enfermería, uso de herramientas de seguimiento y auditoría de resultados(AU)