Interactions with humans reduce the success of foraging for anthropogenic food by capuchin monkeys (Sapajus libidinosus) in Brasília National Park, Brazil.

The progressive growth of urban environments has increasingly forced populations of nonhuman primates to coexist with humans in many cities, which has resulted in problems such as behavioral alterations, conflicts with humans, and threats to the health of the monkeys, due to their consumption of anthropogenic foodstuffs. These anthropogenic foods, which are rich in calories, are the principal driver of the proximity between humans and primates, even though the acquisition of these foods tends to be risky for the monkeys and involve a variety of challenges derived from specific features of the urban environment. The present study evaluated the success/risk relationship of foraging for anthropogenic food by tufted capuchins (Sapajus libidinosus) in Brasília National Park. The data were analyzed using a binary logistic regression, with the backward-stepwise Wald method, to investigate the factors related to the foraging success of the capuchins, considering variables such as their sex and age, the type of approach and its context, and interactions with humans. The capuchins were influenced by the anthropogenic context, which affected their foraging strategies and diet. Interactions with humans reduced the success of foraging for anthropogenic foods. Conflicts between humans and the capuchins were common, especially in the context of access to food. The capuchins thus preferred to access feeding resources directly, probably due to the reduced human interference, which resulted in greater foraging success for unattended food brought by park visitors and the raiding of trash cans. Based on the observed behavior patterns, a number of measures can be proposed to mitigate these conflicts. These recommendations include not bringing food into areas frequented by the capuchins, not reacting to approaching animals, and removing all trash generated during a visit. A cleaning team dedicated to the maintenance of the visitation area free of anthropogenic waste is also be recommended.

Cardiovascular events in children with brain injury: A systematic review.

BACKGROUND: Brain injury is a leading cause of morbidity and mortality in the pediatric population. Neurogenic stunned cardiomyopathy is a complication associated with several neurological conditions that can lead to worse outcomes. It presents as alterations in blood pressure, cardiac rhythm disturbances and the increase in cardiac injury biomarkers. This systematic review aims to assess the hemodynamic consequences of brain injury in the pediatric population to identify better management strategies and improve outcomes. METHODS: An electronic literature search was performed in Pubmed, Scopus and WebOfScience, up until October 3rd, 2022. The selected articles underwent quality assessment using the National Heart, Lung and Blood Institute tools for cohort and case-control studies. RESULTS: This systematic review includes thirteen articles on the effects of brain injury in arterial pressure, rhythm disturbances and biomarkers of myocardial injury. These studies showed the following key results: both hypotension and hypertension are associated with worse outcomes; brain injury could be related to longer QTc intervals; neurogenic stunned cardiomyopathy was a common found after brain injury. CONCLUSION: This is the first systematic review to report cardiovascular abnormalities arising from brain injury in children. An early arterial pressure, electrocardiographic and echocardiographic evaluation, as well as the measure of serum biomarkers for myocardial injury, can be critical in identifying poor prognostic factors. Further research is required to understand the implications of our findings in clinical practice.

Organizing Pneumonia: A Clinical Challenge in a Child With Previous Rhabdomyosarcoma.

Organizing pneumonia is a pulmonary disease of undefined etiology, with few reported cases in children. It may be secondary to chemotherapy, radiation therapy, infectious agents, or hematopoietic cell transplantation. We present a case of an 18-year-old boy who presented to a follow-up consult with respiratory symptoms at the age of 11 years, 8 years after finishing treatment for a prostatic relapse of a pelvic rhabdomyosarcoma. Chest radiography revealed nodular opacities in the left lung, the one in the left lower lobe with silhouette sign with the left hemidiaphragm. Chest computerized tomography showed 2 nodular lesions in the left upper lobe, one of them cavitated, and another nodular lesion in the left lower lobe; 2 of these nodules had surrounding ground-glass opacities. Microbiological work-up, including tuberculosis screening, was negative. Biopsy revealed findings suggestive of organizing pneumonia. He presented spontaneous resolution. This case presented a diagnostic challenge due to rarity of this condition and its indetermined association with the patient's history of rhabdomyosarcoma. With this case, the authors alert that organizing pneumonia must be considered in patients presenting with pulmonary lesions with a history of previous hematopoietic stem cell transplants, lung irradiation, or immunosuppression. Pulmonary metastases and secondary tumors must be considered as a differential diagnosis in patients with a heavily treated relapsed rhabdomyosarcoma.

Lupus Pneumonitis: Case Report of a Rare Manifestation of Neonatal Lupus.

Neonatal lupus is a rare entity, secondary to placental transfer of antibodies from mothers with immune-mediated conditions. While pulmonary involvement is common in lupus, its incidence in neonates is extremely rare, with very few cases being reported in the literature. The authors report a case of a neonate whose mother was diagnosed with systemic lupus erythematosus, with a prenatal diagnosis of third-degree atrioventricular block. While initially admitted in the neonatal intensive care unit with no need for organ support, he presented progressive respiratory failure, initially attributed to sepsis. Favorable clinical progression after pacemaker placement allowed ventilatory weaning, but respiratory failure was again apparent. Chest computer tomography revealed areas of ground-glass lesions, raising the suspicion for lupus pneumonitis. He was started on immunoglobulin and corticosteroids, with clinical improvement. The authors consider this case to be relevant due to the rarity of acute lupus pneumonitis in neonates, alerting that it must be considered a differential diagnosis in neonates with prolonged ventilator dependency.

Congenital Dislocation of the Knee: Idiopathic or Arthrogryposis?

Fetal akinesia associated with fixed joints is a common cause for suspicion of arthrogryposis multiplex congenita, a severe condition with heterogeneous etiology. We present the case of a rarer but more benign condition, congenital knee dislocation. The authors report the case of a 27-year-old woman medicated with levetiracetam for epilepsy whose prenatal ultrasound at 22 weeks of gestational age revealed bilateral clubfoot, permanent extension of the inferior limbs with internal knee rotation, normal amniotic fluid quantity, and fetal echocardiography. The remaining ultrasounds revealed similar results. Prenatal genetic testing revealed no pathological findings. The pregnancy was otherwise uneventful. A female newborn was delivered at 39 weeks by cesarean section, with no need for resuscitation. She presented with bilateral knee hyperextension and clubfoot, spontaneous movements, and normal mobility in all other joints. The remaining physical examination and brain and hip ultrasound on the second day of life were normal. These findings were compatible with idiopathic congenital dislocation of the knee (CDK). The patient was undergoing treatment with favorable evolution and adequate neurodevelopment, at the time of this report.  This case describes a diagnostic workup with the exclusion of severe syndromic pathologies, namely arthrogryposis. Despite the initial suspicion of arthrogryposis, a condition with a poor prognosis, this infant presented a more benign disease with favorable evolution.

Upper Airway Obstruction in a Newborn: A Rare Cause of Respiratory Distress.

Newborns are considered obligate nasal breathers until the eighth week of life. Therefore, upper nasal obstruction in a newborn can present as a potentially life-threatening complication. Congenital nasal pyriform aperture stenosis (CNPAS) is a rare form of upper airway obstruction caused by a narrowing without occlusion in the most anterior opening of the bony nasal airways. According to the severity of this stenosis, early onset of respiratory symptoms can arise in the newborn. In this article, we present the case of a male term newborn with no prior relevant family history and uneventful gestation delivered in a eutocic manner with an adequate transition to the extra-uterine environment. On his first day of life, progressive respiratory distress, inability to breastfeed, and impossibility to make nasogastric probe progress through both sides of the nose were observed, leading the newborn to be admitted to a neonatal intensive care unit. During imagiological assessment with perinasal computerized tomography (CT) scan, an almost total occlusion of the pyriform aperture and a solitary median maxillary central incisor (SMMCI) were identified. Additional evaluation with brain magnetic nuclear resonance imaging (MRI) was unremarkable with no midline defects identified. Endocrine laboratory assessment was also normal. The newborn underwent pyriform aperture permeabilization surgery via a sublabial approach with bilateral nasal stent introduction, enabling total resolution of the initial respiratory symptoms. No incurrences were reported during the post-operatory follow-up period. With the present case report, the authors are trying to raise awareness for CNPAS not only as a rare cause of respiratory distress in the newborn but also as a clinical entity that can be associated with midline defects, which require further additional investigation and intervention.

Developmental hemostasis in the neonatal period.

BACKGROUND: The hemostatic system is complex and evolves continuously since gestation and well into the adult years, in a process known as "developmental hemostasis." DATA SOURCES: A comprehensive review was performed after an extensive literature search on PubMed/MEDLINE concerning developmental hemostasis during the neonatal period. Relevant cross references were also included. RESULTS: Although part of a system, each component of the hemostatic system evolves differently, with many displaying both quantitative and qualitative age-related differences. This leads to drastic disparities between the coagulation system of neonates and both other children's and adults', while still maintaining a generally balanced and physiological hemostasis. The motives behind this process remain to be fully elucidated but may be, at least in part, related to non-hemostatic factors. CONCLUSIONS: Knowledge regarding "developmental hemostasis" is essential for everyone caring for newborns or even children in general and in this review, we describe each hemostatic system component's neonatal characteristics and age-related progression as well as explore some of the possible physiological motives behind the process.

Assessment of a score's performance in predicting positive culture studies in preterm neonates with clinical suspicion of sepsis.

The goal of this study is to assess the use of a score composed of markers of inflammation and organ failure to predict positive cultures for preterm newborns with clinical suspicion of late-onset sepsis. The score was calculated at the first suspicion and 24-48 hours later. We retrospectively compared score results between neonates with positive and negative cultures. Neonates with positive cultures had a significantly higher score at the second instance; the receiver operator characteristics curve presented an area under the curve of 0.798 (p=0.007). A score for early prediction of sepsis could be an important tool for prognostic improvement in the future.

Estilos de parentalidade e funcionalidade familiar: O recurso à urgência hospitalar na adolescência / Parenting styles and family functioning: The use of hospital emergency care in adolescence

Enquadramento: Atualmente, a ciência entende que, estudar a relação pais/filhos é de uma importância vital, pois esta repercute-se no desenvolvimento dos adolescentes, quer ao nível psicossocial, quer em outras áreas de funcionamento. Tendo como pressuposto a ideia sistémica de que as transformações relacionais e sociais atuam nos seus membros, considera-se relevante analisar a perceção que os filhos têm acerca dos estilos de socialização parental. Objetivo: Analisar a influência das variáveis sociodemográficas dos adolescentes nas situações clínicas que motivaram o recurso ao serviço de urgência pediátrica; Identificar os estilos de socialização parentais e a funcionalidade familiar presente nas famílias dos adolescentes. Métodos: Trata-se de um estudo descritivo e transversal, de análise quantitativa realizado numa amostra de 64 adolescentes da região de Viseu, com idades compreendidas entre os 12 e os 17 anos, e que recorreram ao Serviço de Urgência Pediátrica do CHTV,EPE. Para recolha de informação foi aplicado um questionário onde foram avaliados alguns parâmetros sociodemográficos, assim como aplicadas a escala de funcionalidade familiar de Smilkstein (1978) e a Escala de Estilos de Socialização Parental na Adolescência (ESPA29) desenvolvida por Musitu e García (2004), e validada para a população portuguesa por Nunes, Luís e Lemos (2010). Resultados: Existe uma percentagem ainda significativa de adolescentes que considera a sua família como disfuncional (9,4%) ou moderadamente disfuncional (18,8%); Nos adolescentes do sexo masculino verifica-se uma percentagem mais elevada (50,0%) do que no sexo feminino (41,0%) de vindas ao serviço de urgência pediátrica, provocadas por acidentes ou traumatismos; Na perceção dos adolescentes, a mãe demonstrou um maior grau de afeto que o pai, o qual geralmente se mostrava mais indiferente que a mãe ou até mais displicente; Conclui-se que, a generalidade da amostra, perceciona que ambos os pais se enquadram no estilo de socialização parental permissivo, caracterizando-se como sendo mais afetuosos do que exigentes. Conclusões: As evidências encontradas realçam a necessidade de se investir na formação e sensibilização dos enfermeiros sobre a importância das relações pais/filhos, nomeadamente ao nível da funcionalidade familiar e dos estilos de socialização parentais.

Background: Currently, science believes that studying the relationship parents/children is vitally important, because this impacts the development of adolescents, whether the psychosocial level, or in other areas of functioning. Based on the assumption systemic idea that relational and social transformations act on its members, it is considered important to analyze the perception that children have about the styles of parental socialization. Objective: To analyze the influence of sociodemographic variables of adolescents in clinical situations which led to the use of the pediatric emergency department; Identify the types of parental socialization and family functionality present in families of adolescents. Methods: This was a descriptive cross-sectional study, quantitative analysis performed on a sample of 64 adolescents in the region of Viseu, aged between 12 and 17 years, and that appealed to the Pediatric Emergency CHTV, EPE. To collect information a questionnaire where they evaluated a sociodemographic parameters was applied, as well as the scale of family functionality Smilkstein (1978) and the Scale of Parental Socialization Styles in Adolescence (ESPA29) developed by Musitu and García (2004) were applied, and validated for the Portuguese population by Nunes, Luis and Lemos (2010). Results: There is still a significant percentage of adolescents who consider their family as dysfunctional (9.4%) or moderately dysfunctional (18.8%); In male adolescents there is a higher percentage (50.0%) than females (41.0%) of coming to the pediatric emergency department caused by accidents or injuries; In the perception of adolescents, mothers showed a greater degree of affection to his father, which generally showed more indifferent to the mother or even more careless; We conclude that the majority of the sample perceives both parents fit the style of permissive parenting socialization, characterized as being more affectionate than demanding. Conclusions: The evidences highlight the need to invest in training and education of nurses about the importance of parent / child relationships, particularly in terms of family functioning and parenting styles of socialization. Keywords: family functioning; recourse to the Pediatric Emergency; styles of parental socialization.

Infecção pelo HIV no idoso / HIV infection in elderly patients

Justificativa e objetivos: a infecção pelo vírus do HIV vem aumentando sua incidência em pacientes maiores de 50 anos. Diante disso, faz-se necessário entender as peculiaridades da epidemia nesta faixa etária, a abordagem do diagnóstico e as interações farmacológicas mais frequentes nesta população, em função das doenças degenerativas.Relato do caso: trata-se de relato de caso de paciente de 65 anos com diagnóstico de pancitopenia à esclarecer, posteriormente diagnosticada como infecção pelo vírus da imunodeficiência humana (HIV).Conclusão: a faixa etária do paciente não deve ser considerada como fator de exclusão para suspeita de diagnósticos, tais como a infecção pelo HIV.

[Role of bacteria associated with sexually transmitted infections in the etiology of lower urinary tract infection in primary care]. / Papel de las bacterias asociadas a infecciones de transmisión sexual en la etiología de la infección de vías urinarias bajas en el primer nivel de atención médica.

INTRODUCTION: Urinary tract infections (UTI) are the second most frequent type of infectious pathology treated in primary care clinics. The participation of microorganisms associated with sexually transmitted infection has been reported as a cause of UTI; nevertheless this concept is still controversial. To gather data on this subject, we carried out a search for Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis and Streptococcus agalactiae besides the common microorganisms involved in UTI. METHODS: A total of 1507 urine cultures from patients with a clinical diagnosis of low UTI were analyzed. Samples were inoculated onto 5% sheep blood agar and McConkey agar, as well as HBT medium for G. vaginalis, and U9B broth and agar E broth for M. hominis and U. urealyticum. The following parameters were analyzed as possible risk factors: age, sex, pregnancy and diabetes status. RESULTS. There were 436 (28.9%) positive urine cultures. Escherichia coli was isolated in 44.34% of cases. Microorganisms associated with sexually transmitted disease were found in 162 (37%): G. vaginalis (25.7%), U. urealyticum (5.9%), S. agalactiae (3.4%) and M. hominis (2%). UTI were more frequent among the 20 to 40 year-old age group, in women and in diabetic patients. CONCLUSIONS: Microorganisms associated with sexually transmitted disease were found in a large percentage of cultures, indicating the need for studies to clarify their role in the etiology of UTI.

Infección de transmisión sexual / Sexually transmitted infection

INTRODUCCIÓN. Se reconoce la infección de vías urinarias (IVU) bajas como la segunda causa de patología de tipo infeccioso en clínicas de primer nivel de atención médica. Se estudia la participación de microorganismos asociados a infecciones de transmisión sexual como causa de IVU por lo que, además de realizar la búsqueda de microorganismos comunes, se realizó la búsqueda de Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis y Streptococcus agalactiae. MÉTODOS. Se analizaron 1.507 urocultivos de pacientes con diagnóstico clínico de IVU bajas. Las muestras se inocularon en medios de agar sangre de carnero al 5 per cent, agar McConkey, así como en medio HBT (para G. vaginalis); caldo U9B y agar E (para M. hominis y U. urealyticum). Se analizaron la edad, el sexo, el embarazo y la diabetes como posibles factores de riesgo. RESULTADOS. Se obtuvieron 436 (28,9 per cent) cultivos positivos.Escherichia coli fue aislado en 44,34 per cent de los casos. Se recuperaron 162 (37 per cent) cultivos positivos con bacterias asociadas a infecciones de transmisión sexual como G. vaginalis (25,7 per cent), U. urealyticum (5,9 per cent), S. agalactiae (3,4 per cent) y M. hominis (2 per cent). La IVU es más común entre los 20-40 años, en mujeres y en diabéticos. CONCLUSIONES. Debido a la alta frecuencia con que se aíslan estos microorganismos, se sugiere realizar estudios que aclaren su papel etiológico en las IVU (AU)

Experiência inicial da estimulaçäo cardíaca artificial com marcapasso VDD de eletrodo único / Initial experience of a single lead VDD pacing system

Objetivo: O objetivo deste estudo é avaliar o desempenho do marcapasso VDD com eletrodo único Dromos-Biotronic. Casuística e Métodos: Num período de 12 meses foram realizados 21 implantes de sistemas VDD com eletrodo único, no Instituto do Coraçao do Hospital Madre Teresa. Onze pacientes eram do sexo feminino, a média de idades foi de 59,8 anos (16 a 77). Todos os pacientes apresentavam bloqueio atrioventricular (BAV) avançado (BAV total e BAV segundo grau). A miocardiopatia chagásica foi a etiologia de maior prevalência (76,1 por cento), seguido de pós-cirúrgico (14,3 por cento), miocardioesclerose (4,7 por cento) e de etiologia desconhecida (4,7 por cento). Os pacientes utilizaram eletrodo SL 60-/13-UP Biotronic. A técnica de implante foi a tradicional para implantes VVI endocavitários, apenas com o cuidado de posicionar os anéis de "sensing" atrial em posiçao alta ou médio-alta no átrio e medir os potenciais desta cavidade. A avaliaçao pós-operatória foi realizada a nível ambulatorial, no terceiro mês de pós-operatório, constando de análise telemétrica, ecocardiográfica e teste de esforço em esteira, para avaliaçao da funçao ventricular, tolerância ao exercício e manutençao do sincronismo AV no repouso e durante movimento. Resultados: A análise telemétrica demonstrou boa captura atrial no repouso em todos os pacientes (100 por cento). O teste de limiar de sensibilidade atrial revelou onda "P" média de 1,27 mV, sendo que apenas um paciente tinha sensibilidade atrial reprogramada para 0,1 mV devido a perda de captura dependente de posiçao; os demais pacientes foram mantidos com programaçao à nominal deste parâmetro (0,2 mV). A ecocardiografia revelou melhora da fraçao de ejeçao em 71,4 por cento dos pacientes e 90,47 por cento relataram melhora funcional (NYHA). Ao teste de esforço 95,23 por cento dos pacientes mantiveram o sincronismo AV no pico do esforço. Conclusao: A estimulaçao cardíaca artificial em VDD com eletrodo único demonstrou excelente alternativa à estimulaçao em DDD, porque manteve o sincronismo AV em repouso e no exercício, melhorou o desempenho hemodinâmico e, conseqüentemente, a classe funcional da maioria dos pacientes, sem a necessidade de se utilizar um segundo eletrodo, evitando, assim, as complicaçoes de implante e seu acompanhamento deste. Desta forma, o sistema VDD com eletrodo único reúne as facilidades de implante dos sistemas VVI, com os benefícios hemodinâmicos dos sistemas DDD...