Warming and top predator loss drive direct and indirect effects on multiple trophic groups within and across ecosystems.

The interspecific interactions within and between adjacent ecosystems strongly depend on the changes in their abiotic and biotic components. However, little is known about how climate change and biodiversity loss in a specific ecosystem can impact the multiple trophic interactions of different biological groups within and across ecosystems. We used natural microecosystems (tank-bromeliads) as a model system to investigate the main and interactive effects of aquatic warming and aquatic top predator loss (i.e. trophic downgrading) on trophic relationships in three integrated food web compartments: (a) aquatic micro-organisms, (b) aquatic macro-organisms and (c) terrestrial predators (i.e. via cross-ecosystem effects). The aquatic top predator loss substantially impacted the three food web compartments. In the aquatic macrofauna compartment, trophic downgrading increased the filter feeder richness and abundance directly and indirectly via an increase in detritivore richness, likely through a facilitative interaction. For the microbiota compartment, aquatic top predator loss had a negative effect on algae richness, probably via decreasing the input of nutrients from predator biological activities. Furthermore, the more active terrestrial predators responded more to aquatic top predator loss, via an increase in some components of aquatic macrofauna, than more stationary terrestrial predators. The aquatic trophic downgrading indirectly altered the richness and abundance of cursorial terrestrial predators, but these effects had different direction according to the aquatic functional group, filter feeder or other detritivores. The web-building predators were indirectly affected by aquatic trophic downgrading due to increased filter feeder richness. Aquatic warming did not affect the aquatic micro- or macro-organisms but did positively affect the abundance of web-building terrestrial predators. These results allow us to raise a predictive framework of how different anthropogenic changes predicted for the next decades, such as aquatic warming and top predator loss, could differentially affect multiple biological groups through interactions within and across ecosystems.

As interações interespecíficas dentro e entre ecossistemas adjacentes dependem fortemente das mudanças de seus componentes abióticos e bióticos. Entretanto, pouco se sabe sobre como mudanças climáticas e a perda de biodiversidade em um ecossistema específico pode impactar as múltiplas interações tróficas de diferentes grupos biológicos dentro e entre ecossistemas. Nós utilizamos micro ecossistemas naturais (bromélias-tanque) como sistema modelo para investigar os efeitos individuais e interativos do aquecimento e da perda de predadores aquáticos (simplificação trófica) nas relações tróficas em três compartimentos integrados da teia alimentar: i) micro-organismos aquáticos, ii) macroorganismos aquáticos e iii) predadores terrestres (via efeito entre ecossistemas). A perda de predadores de topo aquáticos afetou substancialmente os três compartimentos da rede trófica. No compartimento da macrofauna aquática, a simplificação trófica aumentou a riqueza e abundância de filtradores, direta e indiretamente, por meio de um aumento da riqueza de espécies de detritívoros, provavelmente através de uma interação de facilitação. Para o compartimento da microbiota, a perda de predadores de topo aquáticos teve um efeito negativo sobre a riqueza de espécies de algas, provavelmente por meio da diminuição da entrada de nutrientes provenientes das atividades biológicas dos predadores. Além disso, os predadores terrestres mais ativos responderam mais à perda de predadores de topo aquáticos, por meio de um aumento de alguns componentes da macrofauna aquática, do que predadores terrestres mais estacionários. A simplificação trófica aquática alterou indiretamente a riqueza e abundância de predadores cursoriais terrestres, mas esses efeitos tiveram direção diferente de acordo com o grupo funcional aquático, filtradores ou outros detritívoros. Os predadores construtores de teias foram indiretamente afetados pela simplificação trófica aquática devido ao aumento da riqueza de filtradores. O aquecimento aquático não afetou os micro ou macro organismos aquáticos, mas afetou positivamente a abundância de predadores terrestres construtores de teias. Esses resultados nos permitem levantar um quadro preditivo de como diferentes mudanças antropogênicas preditas para as próximas décadas, como o aquecimento e a perda de predadores de topo aquáticos, podem afetar diferencialmente vários grupos biológicos por meio de interações dentro e entre os ecossistemas.

Trophic downgrading decreases species asynchrony and community stability regardless of climate warming.

Theory and some evidence suggest that biodiversity promotes stability. However, evidence of how trophic interactions and environmental changes modulate this relationship in multitrophic communities is lacking. Given the current scenario of biodiversity loss and climate changes, where top predators are disproportionately more affected, filling these knowledge gaps is crucial. We simulated climate warming and top predator loss in natural microcosms to investigate their direct and indirect effects on temporal stability of microbial communities and the role of underlying stabilising mechanisms. Community stability was insensitive to warming, but indirectly decreased due to top predator loss via increased mesopredator abundance and consequent reduction of species asynchrony and species stability. The magnitude of destabilising effects differed among trophic levels, being disproportionally higher at lower trophic levels (e.g. producers). Our study unravels major patterns and causal mechanisms by which trophic downgrading destabilises large food webs, regardless of climate warming scenarios.

Knowledge and Practice of the Concept of Driving Pressure: A Survey of Pediatric Intensivists in Brazil.

The objective of this study was to investigate the knowledge and clinical practices of Brazilian pediatric intensivists in relation to usage of the concept of driving pressure. Knowledge and practice patterns were assessed using a survey tool. The overall response rate was 22.8% (84 of 369); 69% of physicians responded that they had sufficient knowledge on the concept of driving pressure but only 56% correctly answered to specific knowledge questions about it. The majority of respondents (72.6%) claim to use this concept in their clinical practice although pediatric data are insufficient to routinely support the practice. This also suggests a good degree of knowledge translation from adult studies.

Arthropod-bacteria interactions influence assembly of aquatic host microbiome and pathogen defense.

The host-associated microbiome is vital to host immunity and pathogen defense. In aquatic ecosystems, organisms may interact with environmental bacteria to influence the pool of potential symbionts, but the effects of these interactions on host microbiome assembly and pathogen resistance are unresolved. We used replicated bromeliad microecosystems to test for indirect effects of arthropod-bacteria interactions on host microbiome assembly and pathogen burden, using tadpoles and the fungal amphibian pathogen Batrachochytrium dendrobatidis as a model host-pathogen system. Arthropods influenced host microbiome assembly by altering the pool of environmental bacteria, with arthropod-bacteria interactions specifically reducing host colonization by transient bacteria and promoting antimicrobial components of aquatic bacterial communities. Arthropods also reduced fungal zoospores in the environment, but fungal infection burdens in tadpoles corresponded most closely with arthropod-mediated patterns in microbiome assembly. This result indicates that the cascading effects of arthropods on the maintenance of a protective host microbiome may be more strongly linked to host health than negative effects of arthropods on pools of pathogenic zoospores. Our work reveals tight links between healthy ecosystem dynamics and the functioning of host microbiomes, suggesting that ecosystem disturbances such as loss of arthropods may have downstream effects on host-associated microbial pathogen defenses and host fitness.

Correlação entre anamnese e clínica na claudicação intermitente com auxílio de teste de esteira / Correlation between anamnesis and clinic in intermittent claudication with belt testing

INTRODUÇÃO: A doença arterial obstrutiva periférica afeta mais de 250 milhões de pessoas no mundo. Um terço relata ter claudicação intermitente, descrita como cãibra, dor ou cansaço iniciado durante a caminhada fazendo o paciente parar após percorrer uma determinada distância - descanso para retomar sua atividade. Além de prejudicar a qualidade de vida do paciente, é utilizada como critério para tratamento da e na maioria dos casos, avaliada através da anamnese. OBJETIVO: Identificar a correlação da percepção do paciente claudicante a respeito da sua caminhada e a realidade observada em uma avaliação em esteira. METODOLOGIA: Foi realizada uma anamnese inicial indagando a percepção do paciente sobre sua caminhada com posterior avaliação em esteira. As variáveis foram analisadas segundo distribuição Gausiana, teste Exato de Fisher e teste T Student. Através destes testes avaliamos as diferenças entre os resultados (anamnese versus caminhada na esteira) e valores de p menores do que 0.05 foram considerados significativos. RESULTADOS: Avaliamos 39 pacientes com doença arterial obstrutiva periférica e obtivemos uma média de 88,1% de diferença entre a anamnese e a caminhada na esteira. CONCLUSÃO: A avaliação da distância máxima percorrida do paciente com doença arterial obstrutiva periférica mostra-se inconsistente através da anamnese

BACKGROUND: Peripheral arterial obstructive disease affects more than 250 million people worldwide. Of these, one-third report having intermittent claudication, a symptom described as cramp, pain or tiredness initiated during the walk causing the patient to stop after walking a certain distance, and then a rest break is necessary to resume his activity. Intermittent claudication, in addition to impairing the patient's quality of life, is used as a criterion for the treatment of peripheral obstructive arterial disease and in the majority of cases, evaluated through anamnesis done with the patient. OBJECTIVE: To identify the correlation of the patient's claudicating perception regarding their walk and the reality observed in a treadmill evaluation. METHODS: An initial anamnesis was performed investigating the perception of the patient with intermittent claudication on their walk with subsequent evaluation of the same on a treadmill. The variables were analyzed according to Gaussian distribution, Fisher's exact test and Student's T test. Through these tests we evaluated the differences between the results (anamnesis versus treadmill walking) and p values of less than 0.05 were considered significant for this study. RESULTS: A total of 39 patients with peripheral arterial obstructive disease were evaluated, with a mean of 88.1% difference between anamnesis and treadmill walking. CONCLUSION: The evaluation of the maximum distance walked by the patient with PAD is inconsistent considering only the anamnesis

Hanseníase em menores de 15 anos em área hiperendêmica da região norte do Brasil / Leprosy in children under 15 years old in a hyperdemetic area of the northern region of Brazil

Palmas é a capital mais hiperendêmica para hanseníase no Brasil, com transmissão ativa e persistência de focos de transmissão. O objetivo do estudo foi descrever o perfil clínico e epidemiológico da hanseníase em menores de 15 anos avaliados pelo Protocolo Complementar de Investigação Diagnóstico para menores de 15 anos de idade (PCID < 15 anos) em Palmas, Tocantins. Realizou-se um estudo descritivo dos casos diagnosticados e avaliados pelo PCID < 15 anos entre 2016 e 2017. Foram avaliados 71 casos pelo protocolo. Desses, 83,10% tinham nervos acometidos, 92,96% multibacilares, 38,03% com grau 1 ou 2 de incapacidade. O escore OMP variou entre 1 e 6 em 22,54% dos casos. O tempo de aparecimento dos sinais e sintomas foi de 6 meses a 1 ano em 35,21% dos casos. 73,24% tinham pessoas com problema de pele na família; 87,32% tinham pessoas com hanseníase na família. Entre 1 e 26 lesões/manchas de pele foi constatada em 88,73% com perda de sensibilidade. A presença de 1 ou 2 cicatrizes de BCG foi registrada em 90,14% dos casos. A busca dos contatos de casos confirmados e a avaliação em tempo oportuno é crucial para o diagnóstico precoce da hanseníase em crianças e adolescentes, pois só assim será possível diminuir as fontes de infecção, interromper a cadeia de transmissão, prevenir incapacidades físicas, psicológicas e sociais(AU).

Palmas is the most hyperendemic capital for leprosy in Brazil, with active transmission and persistence of transmission focus. The objective of this study was to describe the clinical and epidemiological profile of leprosy in children younger than 15 years evaluated by Complementary Diagnostic Investigation Protocol for children under 15 years of age (PCID<15 years) in Palmas, Tocantins. A descriptive study of the cases diagnosed and evaluated by PCID <15 years between 2016 and 2017 was carried out. A total of 71 cases were evaluated by protocol. Of these, 83.10% had affected nerves, 92.96% multibacillary, 38.03% with degree 1 or 2 of disability. The OMP score ranged from 1 to 6 in 22.54% of the cases. The time of onset of the signs and symptoms was from 6 months to 1 year in 35.21% of the cases. 73.24% had people with skin problems in the family; 87.32% people with leprosy in the family. Between 1 and 26 lesions / skin patches were observed in 88.73% with loss of sensitivity. The presence of 1 or 2 BCG scars was recorded in 90.14% of the cases. The search for confirmed case contacts and timely evaluation is crucial for the early diagnosis of leprosy in children and adolescents, since only then it will be possible to reduce the sources of infection, interrupt the transmission chain, prevent physical, psychological and social disabilities(AU).

Conhecimento de puérperas sobre identificação e prevenção do acidente loxoscélico / Puerperal women's knowledge on the identification and prevention of loxoscelic acidentes / Conocimiento de las puérperas sobre la identificación y prevención de accidentes loxoscélicos

Objetivos: este estudo teve como objetivo identificar o grau de conhecimento que puérperas possuíam a respeito da aranha Loxosceles, sua picada e conduta no caso de acidente com elas ou seus filhos. Métodos: estudo transversal quantitativo, que utilizou um questionário estruturado abrangendo perfil socioeconômico, conhecimento sobre aranha-marrom e o loxoscelismo. Foram incluídas pacientes em puerpério imediato, considerado entre o primeiro e décimo dia do parto, internadas na maternidade do Hospital do Trabalhador em Curitiba-PR, entre julho e outubro de 2011. Participaram 208 puérperas, das quais oito foram excluídas porque os questionários foram preenchidos de forma incorreta. Os dados obtidos foram tabulados no programa Microsoft Excel 2007® e analisados pelos testes χ2 e Exato de Fisher. Resultados: sobre o conhecimento da aranha, 61% das puérperas afirmaram reconhecer a aranha e apontaram a imagem correta. Sobre a conduta em caso de acidente, 87,5% responderam a conduta correta, porém apenas 37% apontaram a sintomatologia correta. Hipóteses testadas mostraram que idade, escolaridade e acidente loxoscélico prévio são diretamente proporcionais ao conhecimento das participantes (p<0,05). Conclusão: a maioria das puérperas pesquisadas conhecia a aranha-marrom e grande parte reconhecia a lesão provocada pela picada, mas a gravidade da lesão foi superestimada. Contraditoriamente, o conhecimento dos sintomas foi pequeno, o que pode levar ao atraso do tratamento delas mesmas ou dos seus filhos. O conhecimento da aranha foi diretamente relacionado à idade, escolaridade e a acidente loxoscélico prévio.

Objectives: this study aimed to identify puerperal women's level of knowledge about the Loxosceles spider, its bite, and their own conduct in the event of a loxoscelic accident involving them or their children. Methods: this was a quantitative cross-sectional study using a structured questionnaire that included the socioeconomic profile of the participants, and knowledge about the brown spider and loxoscelism. Participants included postpartum women (between the first to tenth day of delivery), admitted to the maternity ward of the Hospital do Trabalhador, Curitiba-PR, between July and October 2011. From a total of 208 postpartum women, eight were excluded because the questionnaires were filled incorrectly. Data were tabulated using Microsoft Excel 2007® and analyzed using the χ2 test and Fisher's exact test. Results: regarding the knowledge about the spider, 61% of the participants said that they knew the spider and identified the correct picture. About their conduct in case of loxoscelic accidents, 87.5% gave appropriate responses, but only 37% identified the correct symptoms. Hypothesis testing revealed that age, education, and prior experience of loxoscelic accidents were directly proportional to the participants' knowledge (p<0.05). Conclusion: most of the women surveyed could identify the brown spider and largely recognized the spider's bite injury, but they overestimated its severity. On the contrary, they had little knowledge about the symptoms, which may lead to delayed treatment for them or their children. The participants' knowledge about the spider was directly related to age, education, and prior experience of a loxoscelic accident.

Objetivos: este estudio tuvo como objetivo identificar el grado de conocimiento que las puérperas tenían respeto la araña Loxosceles, su picadura y la conducta en el caso de un accidente con ellas o sus hijos. Métodos: estudio transversal cuantitativo en que se utilizó un cuestionario estructurado con el perfil socio-económico, el conocimiento sobre la araña marrón y el Loxoscelismo. Las pacientes incluidas fueron aquellas en el período inmediatamente posterior al parto, del primero hasta el décimo día puerperal, admitidas en la Maternidad y Hospital del Trabajador en Curitiba- PR, entre julio y octubre del 2011. Participaron 208 puérperas, de las cuales ocho fueron prohibidas debido a que sus cuestionarios fueron completados incorrectamente. Los datos fueron tabulados en Microsoft® Excel 2007 y analizados mediante el Test de χ2 y Exacto de Fisher. Resultados: respeto al conocimiento de la araña, el 61% de las madres dijeron reconocer la araña y apuntaron a la imagen correcta. Acerca de la conducta en caso de accidentes, el 87,5% respondieron la conducta correcta, pero sólo el 37% identificaron los síntomas correctos. Las hipótesis testadas mostraron que la edad, la educación y el accidente loxoscélico anterior son directamente proporcionales a los conocimientos de las participantes (p<0,05). Conclusión: la mayoría de las mujeres encuestadas conocía la araña marrón y en gran parte reconoció el daño causado por la picadura, pero sobrestimaran la gravedad de las lesiones. Paradójicamente, el conocimiento de los síntomas fue pequeño, lo que puede llevar al retraso del tratamiento para sí mismas o para sus hijos. El conocimiento sobre la araña estuvo directamente relacionado con la edad, la educación y el accidente loxoscélico anterior

Case report: rupture of popliteal artery aneurysm / Relato de caso: aneurisma roto de artéria poplítea

An 83-year-old female patient with a history of prior endovascular treatment to repair an abdominal aortic aneurysm presented with intense pain and edema in the left leg, with hyperemia and localized temperature increase. Doppler ultrasonography revealed a voluminous aneurysm of the popliteal artery with a contained rupture, and hematoma involving the popliteal fossa and the medial and anterior surfaces of the knee causing compression of the popliteal vein. Endovascular repair was accomplished with covered stents and the rupture was confirmed. during the procedure The aneurysm was excluded and the signs and symptoms it had caused resolved completely, but during the postoperative period the patient developed sepsis of pulmonary origin and died.

Mulher de 83 anos, com tratamento endovascular prévio de aneurisma de aorta abdominal, iniciou com quadro de dor intensa e edema de perna esquerda, evoluindo com hiperemia e calor local. Ao exame eco-Doppler, apresentou aneurisma volumoso de artéria poplítea roto contido, com hematoma abrangendo fossa poplítea, nas faces medial e anterior de joelho, causando compressão da veia poplítea. Durante a correção endovascular com stent recoberto, foi confirmada a presença de rotura do aneurisma. O aneurisma foi excluído e a paciente teve regressão completa dos sinais e sintomas decorrentes dele; porém, evoluiu no pós-operatório com sepse de origem pulmonar e óbito.

Carotid endarterectomy in awake patients: safety, tolerability and results / Endarterectomia de carótida em pacientes acordados: segurança, tolerabilidade e resultados

Objective: To analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch. Methods: One hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%). Results: A carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%). Conclusion: Carotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates. .

Objetivo: Analisar os resultados de 125 endarterectomias carotídeas, realizadas sob anestesia loco-regional com uso seletivo de shunt e remendo de pericárdio bovino. Métodos: Cento e dezessete pacientes com estenose na artéria carótida interna ≥ 70% ao ecoDoppler colorido + arteriografia ou angiorressonância magnética foram submetidos a 125 endarterectomias carotídeas. As medidas de proteção farmacológica intraoperatória incluíam a administração endovenosa de alfentanil e dexametazona. Clopidogrel, aspirina e estatinas eram utilizadas em todos os casos. Setenta e sete pacientes eram do sexo masculino (65,8%). A idade média foi de 70,8 anos, variando de 48 a 88 anos. A operação foi indicada por estenose sintomática em 69 artérias (55,2%), e por estenose assintomática em 56 artérias (44,8%). Resultados: O shunt de carótida foi necessário em 3 casos (2,4%) devido a sintomas de isquemia cerebral após a colocação do clampe carotídeo durante o ato cirúrgico, e os três pacientes tiveram boa evolução. Remendo de pericárdio bovino foi utilizado em 71 artérias ≤ 6 mm de diâmetro (56,8%). A mortalidade perioperatória foi de 0,8%: um paciente faleceu devido a infarto agudo do miocárdio. Dois pacientes (1,6%) tiveram infartos cerebrais isquêmicos ipsilaterais menores com boa recuperação, e 2 pacientes (1,6%) tiveram infartos do miocárdio não-fatais com boa recuperação. O tempo médio de seguimento foi de 32 meses. No pós-operatório tardio, houve reestenose significativa em apenas três artérias (2,4%). Conclusão: A endarterectomia carotídea no paciente acordado é uma técnica segura, sendo realizada com baixas taxas de morbimortalidade. .

Carotid endarterectomy in awake patients: safety, tolerability and results.

OBJECTIVE: To analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch. METHODS: One hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%). RESULTS: A carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%). CONCLUSION: Carotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates.