Disentangling the Effects of Laser and Electron Irradiation on AgX (X = Cl, Br, and I): Insights from Quantum Chemical Calculations.

The effects on the lattice structure and electronic properties of different polymorphs of silver halide, AgX (X = Cl, Br, and I), induced by laser irradiation (LI) and electron irradiation (EI) are investigated using a first-principles approach, based on the electronic temperature (Te) within a two-temperature model (TTM) and by increasing the total number of electrons (Ne), respectively. Ab initio molecular dynamics (AIMD) simulations provide a clear visualization of how Te and Ne induce a structural and electronic transformation process during LI/EI. Our results reveal the diffusion processes of Ag and X ions, the amorphization of the AgX lattices, and a straightforward interpretation of the time evolution for the formation of Ag and X nanoclusters under high values of Te and Ne. Overall, the present work provides fine details of the underlying mechanism of LI/EI and promises to be a powerful toolbox for further cross-scale modeling of other semiconductors.

American Cutaneous Leishmaniasis in Eastern Minas Gerais: veiled reality of a neglected disease / Leishmaniose Tegumentar Americana no Leste de Minas Gerais: realidade velada de uma doença negligenciada

Objective: to analyze the notified and confirmed cases of ACL in a municipality in east Minas Gerais, from 2007 to 2020. Methods: a combined study was carried out as a cross-sectional and an ecological approach of time series type, using notified and confirmed ACL cases, from 2007 to 2020. Primary and secondary data were used. Data were analyzed using descriptive and inferential statistics (simple linear regression, T-test, Mann-Whitney, chi-square (χ2) at a 5% significance level). Results: a total of 219 cases were reported with a decreasing temporal trend, with a higher frequency observed for the cutaneous form (82.6%), age group 40 to 59 years (32.1%), black race (56.4%), and completed elementary school (47.7%). Individuals with the mucosal clinical form had lesions for a longer time, a greater chance of not progressing to cure, and used more vials of meglumine antimoniate when compared to patients with the cutaneous form. Conclusions: different correlations were observed between the variables studied and the profile of involvement described in the scientific literature, with the clinical form predominantly cutaneous and with a good prognosis.

Objetivo: analisar os casos notificados e confirmados de LTA em um município do leste de Minas Gerais, no período de 2007 a 2020. Métodos: foi realizado um estudo combinado com abordagem transversal e ecológica do tipo série temporal, utilizando casos notificados e confirmados de LTA, de 2007 a 2020. Foram utilizados dados primários e secundários. Os dados foram analisados por meio de estatística descritiva e inferencial (regressão linear simples, teste T, Mann-Whitney, qui-quadrado (χ2) com nível de significância de 5%). Resultados: foram notificados 219 casos com tendência temporal decrescente, com maior frequência observada para a forma cutânea (82,6%), faixa etária de 40 a 59 anos (32,1%), raça negra (56,4%) e ensino fundamental completo (47,7%). Indivíduos com a forma clínica mucosa apresentaram maior tempo de lesão, maior possibilidade de não evoluir para cura e utilizaram mais ampolas de antimoniato de meglumina quando comparados aos pacientes com a forma cutânea. Conclusões: foram observadas diferentes correlações entre as variáveis estudadas e o perfil de acometimento descrito na literatura científica, com a forma clínica predominantemente cutânea e com bom prognóstico.

Disclosing the Biocide Activity of α-Ag2-2xCuxWO4 (0 ≤ x ≤ 0.16) Solid Solutions.

In this work, α-Ag2-2xCuxWO4 (0 ≤ x ≤ 0.16) solid solutions with enhanced antibacterial (against methicillin-resistant Staphylococcus aureus) and antifungal (against Candida albicans) activities are reported. A plethora of techniques (X-ray diffraction with Rietveld refinements, inductively coupled plasma atomic emission spectrometry, micro-Raman spectroscopy, attenuated total reflectance-Fourier transform infrared spectroscopy, field emission scanning electron microscopy, ultraviolet-visible spectroscopy, photoluminescence emissions, and X-ray photoelectron spectroscopy) were employed to characterize the as-synthetized samples and determine the local coordination geometry of Cu2+ cations at the orthorhombic lattice. To find a correlation between morphology and biocide activity, the experimental results were sustained by first-principles calculations at the density functional theory level to decipher the cluster coordinations and electronic properties of the exposed surfaces. Based on the analysis of the under-coordinated Ag and Cu clusters at the (010) and (101) exposed surfaces, we propose a mechanism to explain the biocide activity of these solid solutions.

VALIDITY OF THE INSTRUMENT interRAI EMERGENCY SCREENER FOR PSYCHIATRY FOR THE BRAZILIAN CONTEXT

Objective: The aim of this study was to carry out the translation and present the evidence of validity of the Brazilian version of the interRAI Emergency Screener for Psychiatry (ESP). Method: this is a cross-sectional study conducted in a municipal hospital in the metropolitan region of Porto Alegre, Rio Grande do Sul. A total of 161 patients were evaluated in the first 24 hours of emergency arrival using ESP. Exploratory factor analyses of the sections of the instrument and reliability analyses were conducted using Cronbach's alpha and McDonald's Omega. Results: the analyses suggested an appropriate structure to the purpose of the instrument, two sections containing two factors instead of the expected one-dimensional structure. However, sections with two factors have interpretability and theoretical consistency. The factors presented internal consistency. Conclusion: the Brazilian version of the interRAI Emergency Screener for Psychiatry (ESP) demonstrates adequate psychometric properties through the internal structure of the instrument. Future studies should investigate the relationship of the scores produced by the instrument with clinical diagnosis and with covariates relevant to mental health outcomes.

Objetivo: El objetivo de este estudio era realizar la traducción y presentar la evidencia de validez del examinador de emergencia interRAI para psiquiatría (ESP). Método: se trata de una encuesta transversal realizada en un hospital municipal de la región metropolitana de Porto Alegre, Rio Grande do Sul. Un total de 161 pacientes fueron evaluados en las primeras 24 horas de llegada de emergencia utilizando ESP. Los análisis exploratorios de factores de las secciones del instrumento y los análisis de fiabilidad se llevaron a cabo utilizando Cronbach's alpha y McDonald's Omega. Resultados: los análisis sugirieron una estructura adecuada a los propósitos del instrumento, dos secciones que contienen dos factores en lugar de la estructura unidimensional esperada. Sin embargo, las secciones con dos factores tienen interpretabilidad y consistencia teórica. Los factores presentaron consistencia interna. Conclusión: la versión brasileña del Examinador de Emergencia InterRAI para Psiquiatría (ESP) demuestra propiedades psicométricas adecuadas a través de la estructura interna del instrumento. Los estudios futuros deben investigar la relación de las puntuaciones producidas por el instrumento con el diagnóstico clínico y con covariables relevantes para los resultados de salud mental.

Objetivo: O objetivo do estudo foi realizar a tradução e apresentar as evidências de validade do interRAI Emergency Screener for Psychiatry (ESP). Método: trata-se de uma pesquisa transversal realizada em um hospital municipal da região metropolitana de Porto Alegre, Rio Grande do Sul. Foram avaliados 161 pacientes nas primeiras 24 hs da chegada a emergência utilizando o ESP. Foram conduzidas análises fatoriais exploratórias das seções do instrumento e análises de fidedignidade por meio do alfa de Cronbach e Ômega de McDonald. Resultados: as análises sugeriram uma estrutura adequada ao propósito do instrumento, sendo duas seções contendo dois fatores ao invés da estrutura unidimensional esperada. Contudo, as seções com dois fatores possuem interpretabilidade e consistência teórica. Os fatores apresentaram consistência interna. Conclusão: a versão brasileira do interRAI Emergency Screener for Psychiatry (ESP) demonstra adequadas propriedades psicométricas por meio da estrutura interna do instrumento. Estudos futuros deverão investigar a relação dos escores produzidos pelo instrumento com diagnóstico clínico e com covariáveis relevantes para os desfechos de saúde mental.

Seller reputation and price gouging: Evidence from the COVID-19 pandemic.

From mid-January to March 2020, 3M masks sold on Amazon by third party sellers were priced 2.4 times higher than Amazon's 2019 price. However, this price increase was not uniform across sellers. We estimate that when Amazon is stocked out (one of our measures of scarcity) new (entrant) sellers increase price by 178%, whereas the continuing sellers' increase is limited to 56.7%. This is consistent with the idea that seller reputation limits the extent of profitable price gouging. Similar results are obtained for Purell hand sanitizer and for other measures of scarcity. We also explore policy implications of our results.

PCT Kinetics in the First Week Postburn for Sepsis Diagnosis and Death Prognosis-An Accuracy Study.

Despite continuous advances in burn care, sepsis is still the main cause of death in burn patients. Procalcitonin (PCT) has been reported as an accurate sepsis biomarker and also as a fair predictor of death. The aim of this study was to assess PCT kinetics in the first week postburn regarding sepsis diagnosis and death prognosis. Sample included 142 patients with ≥15% TBSA, admitted from January 2011 to December 2014 at Coimbra Burns Unit, Portugal. Sepsis diagnosis was done according to American Burn Association criteria. PCT range and median values in the first 7 days after burns were statistically analyzed for its potential for sepsis diagnosis and death prognosis. A subanalysis was done regarding TBSA, sex, age, and inhalation injury. First week PCT range and median were significant for sepsis diagnosis and death prognosis, but the median area under the curve was greater in the last case. TBSA influenced PCT accuracy, which was greater for TBSA less than 40% either for diagnosis or prognosis. Age was inversely related to the accuracy, being better in younger than 40 years in both cases. PCT diagnostic accuracy was not affected by sex, opposing to the prognostic one which is better in women. Inhalation injury had no effect on diagnostic accuracy, but it happens with prognostic accuracy. PCT levels' variation is related to sepsis evolution and outcome. Its median performs better than its range. Always coupled with clinical examination, monitoring PCT levels kinetics may help early sepsis detection, potentially reducing morbidity and mortality, being also useful for death prognosis.

Índices de predição de mortalidade na unidade de queimados. Estudo comparativo / Mortality prediction models in the burn unit. Comparative study

INTRODUÇÃO E OBJECTIVO: Os índices de prognóstico em queimados determinam a mortalidade previsível da população, que permanece uma importante medida de avaliação dos cuidados prestados. O estudo visa comparar diferentes índices de predição de mortalidade numa unidade de queimados (UQ) e identificar potenciais aplicabilidades. MATERIAL E MÉTODOS: Estudo retrospetivo dos doentes internados na UQ entre 2016 e 2018 (n = 409). Avaliação da mortalidade e comparação das especificidades entre sobreviventes e falecidos, através de dados demográficos e clínicos na admissão. Avaliação de quatro índices (Abbreviated Burn Severity Index (ABSI), modelo de Ryan, Belgian Outcome in Burn Injury (BOBI) e revised-Baux) na determinação da mortalidade prevista versus observada, e análise da discriminação e ajuste dos modelos (curvas ROC e area under the curve, AUC; testes de Hosmer-Lemeshow). RESULTADOS: A média de idades dos doentes foi de 59.1 anos, sendo 56.5% homens, com superfície corporal queimada total (SCQT) média de 12%, queimaduras de terceiro grau presentes em 67% e lesão inalatória em 11.5%. A mortalidade global observada foi de 6.4% (n = 26). Os doentes falecidos eram significativamente mais velhos (71.7 vs. 58.3 anos; p < 0.001), apresentavam maior SCQT (23.2 vs. 11.2%; p < 0.001) e mais queimaduras de terceiro grau (92.3 vs. 65.3%; p = 0.005), sem diferenças significativas no género ou lesão inalatória. Os índices de mortalidade apresentaram ajuste e discriminação adequados. Todos os índices evidenciaram valores-p > 0.05 no teste de Hosmer-Lemeshow. O revised- Baux e o ABSI apresentaram um bom poder de discriminação (AUC 0.84 ± 0.04 e 0.81 ± 0.04, respectivamente), o BOBI moderado/bom (0.79 ± 0.04) e o Ryan moderado (0.73 ± 0.05). CONCLUSÕES: Os quatro índices de mortalidade revelaram um desempenho preditivo adequado, com o revised-Baux apresentando a melhor precisão na previsão da mortalidade. A sua utilização nas UQ constitui uma ferramenta preciosa na estratificação do risco, controlo da qualidade dos cuidados, comparação de novas estratégias terapêuticas e investigação científica

BACKGROUND AND OBJECTIVE: Prognostic scoring models in burn patients predict mortality risk in burn-injured populations. Mortality remains a main outcome measure for burn care. The study aims to compare different mortality prediction models in the burn unit (BU) and identify their potential applications. METHODS: Retrospective study of 409 burn patients admitted in the BU between 2016 and 2018, including mortality assessment and comparative analysis of survivors and deceased patients' characteristics based on admission demographic data and clinical criteria. Evaluation of four models (Abbreviated Burn Severity Index (ABSI), Ryan model, Belgian Outcome in Burn Injury (BOBI) and revised-Baux) on assessment of predicted mortality versus observed, and analysis of models' discriminative power and goodness-of-fit (ROC curves and area under the curve - AUC; and Hosmer-Lemeshow tests). RESULTS: Patients mean age was 59.1 years and mean total burned surface area (TBSA) was 12%; 56.5% were male; third degree burns were present in 67% and inhalation injury in 11.5%. Overall observed mortality rate was 6.4% (n = 26). Deceased patients were significantly older (71.7 vs. 58.3 years; p < 0.001), presented a larger TBSA (23.2 vs. 11.2%; p < 0.001) and higher frequency of third degree burns (92.3 vs. 65.3%; p = 0.005), with no significant difference on patient gender and inhalation injury. Mortality prediction models presented adequate goodness-of-fit and discrimination. All models showed p-values > 0.05 in Hosmer-Lemeshow test assessment. Revised-Baux and ABSI showed good discriminative power (AUC 0.84 ± 0.04 and 0.81 ± 0.04, respectively), BOBI discrimi¬nation was moderate / good (0.79 ± 0.04) and moderate with Ryan (0.73 ± 0.05). CONCLUSIONS: The four mortality indices revealed appropriate predictive performance, with revised-Baux presenting as the most accurate model for prediction of mortality. Their use in the BU represents a valuable tool for risk stratification, quality control of burn care, appraisal of new therapeutic strategies and scientific research purposes

Fournier's Gangrene: 10-Year Experience of a Plastic Surgery and Burns Department at a Tertiary Hospital.

INTRODUCTION: Fournier gangrene is a polymicrobial life threatening infection of perineal subcutaneous soft tissues with its point of origin in urologic, colorectal or skin diseases. Although more frequent in elderly and men, it can affect all genders and age groups. Perianal abscess, diabetes mellitus and Escherichia coli are the most frequent cause, predisposing comorbidity, and microorganism found in tissue culture analysis respectively. The objective of this study was to describe the experience of a Plastic Surgery Department of a tertiary Hospital in reconstructing Fournier's gangrene perineal defects and its detailed demography. MATERIAL AND METHODS: The sample is composed of all patients with Fournier gangrene admitted in the Plastic Surgery and Burns Department. The authors retrospectively collected and analyzed demographic and clinical data during a period of 10 years including gender, age, length of stay, cause, number of debridements, predisposing factors, microbial culture results, surgical reconstructive techniques and its associated complications, additional surgical procedures and outcomes. RESULTS: Fifteen patients were identified: 14 males (93%) and one female (7%); mean age was 66.9 years (range: 46 - 86); mean, length of stay was 46.8 days (range: 20 - 71 days) and mean number of debridements was 3.3 (range: 1 - 4). The most frequent predisposing factor was diabetes mellitus, the major cause was perianal (n = 2) and skin abscess (n = 2). Eight (53.3%) patients had no identifiable source of Fournier gangrene. Various types of reconstructive techniques were employed; and 5 additional surgical interventions (33.3%) were undertaken (one cystostomy, two orchidectomy, two ileostomy); six patients (40%) presented reconstructive technique complications with adequate final outcome. DISCUSSION: In contrast with the literature, where Escherichia coli was the most frequently isolated agent, Staphylococcus aureus was the most frequent microorganism found in tissue biopsy/pus collection analysis. A higher than expected number of patients (n = 8) had no identifiable source of Fournier gangrene. This findings can be explained by the retrospective non-multicentre study limitation, with a potencial source of bias patients that were transferred from other hospitals in advanced stage, without point of origin of Fournier's gangrene identified. CONCLUSION: Early recognition and extensive necrotic tissue debridement, along with prompt and adequate antimicrobial treatment, are the mainstay of Fournier gangrene management, thus reducing morbidity and mortality in these patients. Surgical reconstruction challenges derived from this condition should be addressed by specialized teams due to the risk of dysfunctional sequelae and conspicuous deformities. Taking in account the single-center and retrospective observational character of the present study, these premises require proper validation from a multicenter prospective study.

Introdução: A gangrena de Fournier é uma infeção polimicrobiana potencialmente fatal que afeta os tecidos moles do períneo com ponto de origem em patologias urológicas, coloretais ou cutâneas. Apesar de ser mais frequente no sexo masculino e em idosos, pode afetar ambos os géneros e qualquer idade. O abcesso perianal, a diabetes mellitus e a Escherichia coli são respetivamente a causa, a co-morbilidade e o micro-organismo mais frequentemente encontrados. Este estudo teve como objetivo descrever a experiência de um Serviço de Cirurgia Plástica e Queimados de um Hospital terciário no tratamento e reconstrução de defeitos perineais causados por gangrena de Fournier, disponibilizando detalhes sobre a sua demografia. Material e Métodos: A amostra é constituída por todos os doentes internados no serviço de Cirurgia Plástica e Queimados com o diagnóstico de gangrena de Fournier. Os autores realizaram uma colheita e análise retrospetiva de dados clínicos e demográficos durante um período de 10 anos incluindo género, idade, tempo de internamento, causa, número de desbridamentos, fatores predisponentes, resultados microbiológicos de culturas de pus, técnicas reconstrutivas cirúrgicas e suas complicações, intervenções cirúrgicas adicionais e o resultado final. Resultados: Foram identificados 15 doentes: 14 homens (93%) e uma mulher (7%); a idade média foi 66,9 anos (amplitude: 46 - 86); tempo médio de internamento foi 46,8 dias (amplitude: 20 - 71 dias) e o número médio de desbridamentos foi 3,3 (amplitude: 1 - 4). O fator predisponente mais frequente foi a diabetes mellitus, e as causas mais frequentes o abcesso perianal (n = 2) e o abcesso cutâneo (n = 2). Em oito (53,3%) doentes não foi identificada a causa da gangrena de Fournier. Foram utilizadas várias técnicas reconstrutivas e realizadas conco (33,3%) intervenções cirúrgicas adicionais (uma cistostomia, duas orquidectomias, duas ileostomias); seis doentes (40%) apresentaram complicações de técnicas reconstrutivas com resultado final adequado. Discussão: O micro-organismo mais frequentemente isolado nas culturas de pus foi o Staphylococcus aureus, o que contrasta com a literatura onde a Escherichia coli é o agente mais frequentemente isolado. Foi identificado um número superior ao esperado de doentes sem causa identificável (n = 8) de gangrena de Fournier. Estes achados podem ser explicados pelo facto de se tratar de um estudo retrospetivo multicêntrico, com um potencial viés por existirem doentes que foram transferidos de outras institucões em estado avançado de doença, sem foco de origem de gangrena de Fournier identificado. Conclusão: O precoce reconhecimento e extenso desbridamento do tecido necrosado, em conjunto com um adequado tratamento antibiótico, são os pilares do tratamento da gangrena de Fournier reduzindo assim a morbilidade e mortalidade destes doentes. Os desafios cirúrgicos reconstrutivos que advêm desta patologia devem ser abordados por uma equipa especializada, pelo risco de sequelas funcionais e estéticas. Tendo em conta o carater observacional, retrospetivo e unicêntrico do presente estudo, estas premissas requerem uma validação adequada através de um estudo prospetivo e multicêntrico.

Maximum likelihood approach suggests positive selection in platelet integrin αIIbß3 in mammalian species.

Platelet integrin αIIbß3 is crucial for platelet aggregation. Although structural and functional characteristics of this protein have been extensively studied, the evolutionary pattern studies of this protein complex in mammals are scarce. Here, we addressed this question using maximum likelihood approaches to identify codons that are evolving under positive selection. Likelihood of positive selection was estimated using CODEML implemented in PAML software applied to integrin αIIbß3 derived from nucleotide sequences of 10 different mammalian species. Four codons in mature αIIb-subunit (corresponding to residues 150, 184, 193, and 370) and three codons in mature ß3-subunit (corresponding to residues 129, 440, and 444) showed signs of positive selection with posterior probabilities over 95%. The different amino acids observed for each of the positively selected residues detected showed different physicochemical properties. These results open new research avenues to understand the physiological importance of specific residues and should allow for a better understanding of the function and the different interactions of each residue within the mature protein.

Evaluation of Procalcitonin Accuracy for the Distinction Between Gram-Negative and Gram-Positive Bacterial Sepsis in Burn Patients.

Sepsis is the main cause of death in burns. Early institution of antimicrobial therapy is crucial to optimize outcomes but superfluous therapy increases adverse events, microbial resistance, and costs. Blood cultures are the gold standard for diagnosis but can take 48 to 72 hours. Biomarkers are used to help sepsis diagnosis and distinction between Gram-negative and Gram-positive bacterial cause. The aim of this work is to evaluate procalcitonin (PCT) accuracy for this distinction in burn patients. Retrospective observational study of adult septic burn patients with ≥15% total burn surface area admitted from January 2011 to December 2014 at a Burn Unit in Portugal. A statistical analysis was done, evaluating the correlation between PCT levels on the day of the first positive blood culture and microbiological data for Gram-negative and Grand-positive bacteria. Patients with mixed bacterial and/or fungal blood cultures were excluded. Data were summarized by quartiles statistics. Blood cultures were positive in 189 patients: 75 (39.7%) showed growth for Gram-negative and 114 (60.3%) for Gram-positive bacteria. Patients with Gram-negative bacteria have significantly higher PCT levels. Receiver operating characteristic curve analysis showed accuracy for Gram-negative discrimination with area under the curve = 0.687. Most elevated levels were related to nonfermentative Gram-negative bacteria and by Klebsiella pneumoniae and other Enterobacteriaceae. PCT levels were significantly higher in burn patients with Gram-negative sepsis comparing to patients with Gram-positive sepsis and controls. The determination of PCT levels may help the choice of empirical antimicrobial therapy while microbiological culture results are not available, despite not fully ensuring the desirable degree of precision.

Tuning the Magnetic Properties of FeCo Thin Films through the Magnetoelastic Effect Induced by the Au Underlayer Thickness.

Tuning the magnetic properties of materials is a demand of several technologies; however, our microscopic understanding of the process that drives the enhancement of those properties is still unsatisfactory. In this work, we combined experimental and theoretical techniques to investigate the handling of magnetic properties of FeCo thin films via the thickness-tuning of a gold film used as an underlayer. We grow the samples by the deposition of polycrystalline FeCo thin films on the Au underlayer at room temperature by a magnetron sputtering technique, demonstrating that the lattice parameter of the sub-20 nm thickness gold underlayer is dependent on its thickness, inducing a stress up to 3% in sub-5 nm FeCo thin films deposited over it. Thus, elastic-driven variations for the in-plane magnetic anisotropy energy, Ku, up to 110% are found from our experiments. Our experimental findings are in excellent agreement with ab initio quantum chemistry calculations based on density functional theory, which helps to build up an atomistic understanding of the effects that take place in the tuning of the magnetic properties addressed in this work. The handling mechanism reported here should be applied to other magnetic films deposited on different metallic underlayers, opening possibilities for large-scale fabrication of magnetic components to be used in future devices.

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients - a retrospective observational study.

BACKGROUND: Early sepsis diagnosis is crucial for the correct management of burn patients, and it clearly influences outcomes. The systemic inflammatory response triggered by burns mimics sepsis presentation and complicates early sepsis diagnosis. Biomarkers were advocated to aid the diagnosis of early sepsis. Serum procalcitonin (PCT) exhibits fair accuracy and good correlation with sepsis severity, being used in diverse clinical settings. However, few studies have evaluated perioperative changes in PCT levels in burn patients. The present study evaluated PCT kinetics during the first days after burn injury and subsequent surgical interventions to assess PCT utility in distinguishing septic from non-septic inflammatory responses. METHODS: This study was a retrospective observational study of all burn patients admitted to the Coimbra Burns Unit (Portugal) between January 2011 and December 2014 who presented with a total burn surface area ≥ 15% and who underwent subsequent surgery. PCT kinetics were investigated a) during the first five days after burn injury and b) preoperatively during the five days after surgery in three subsets of patients, including those with no preoperative and no postoperative sepsis (NN), no preoperative but postoperative sepsis (NS), and preoperative and postoperative sepsis (SS). A total of 145 patients met the selection criteria and were included in the analysis. RESULTS: PCT levels in the first five days after burn injury were significantly higher in patients who developed at least one sepsis episode (n = 85) compared with patients who did not develop sepsis (n = 60). PCT values > 1.00 ng/mL were clearly associated with sepsis. Study participants (n = 145) underwent a total of 283 surgical interventions. Their distribution by preoperative/postoperative sepsis status was 142 (50.2%) in NN; 62 (21.9%) in NS; and 79 (27.9%) in SS. PCT values exhibited a parallel course in the three groups that peaked on the second postoperative day and returned to preoperative levels on the third day or later. The lowest PCT values were found in NN, and the highest values were observed in SS; the NS values were intermediate. CONCLUSIONS: PCT kinetics coupled with a clinical examination may be helpful for sepsis diagnosis during the first days after burn injury and burn surgery.

Myocardial infarction before and after the age of 45: Possible role of platelet receptor polymorphisms.

INTRODUCTION: We examined the potential role of polymorphisms of the platelet genes GP1BA (rs2243093, rs6065 and VNTR), ITGB3 (rs5918), ITGA2 (rs938043469) and P2RY12 (rs2046934, rs6801273 and rs6798347) as risk factors for myocardial infarction (MI). METHODS: The study population was divided into three groups: controls (n=235), MI at age ≤45 years (MI ≤45, n=44), and MI at age >45 years (MI >45, n=78). The control group was further divided into two subgroups (control ≤45 and >45), and subgroups including only men were also considered for statistical analysis. Polymorphisms were detected by polymerase chain reaction and restriction fragment length polymorphism analysis. RESULTS: Regarding non-genetic risk factors, the control group differed statistically from the MI ≤45 group (p<00.5) in terms of smoking, hypertension, diabetes and obesity, and from the MI >45 group (p<0.05) in terms of hypertension, diabetes, obesity, family history of thrombosis and high cholesterol. For the studied ITGA2 polymorphism, a statistical difference was found when MI >45 was compared with the control group, with a higher risk of MI in the TT genotype (OR 2.852; 95% CI: 1.092-7.451; p=0.032). In the GP1BA rs6065 polymorphism, a statistically significant difference was found between control ≤45 only men and MI ≤45 only men, with a higher risk in the CT genotype (OR 5.568; 95% CI: 1.421-21.822; p=0.016), despite the low numbers included. The other polymorphisms studied did not show any statistically significant correlations. CONCLUSION: There is a statistically significant association between the TT genotype of the ITGA2 rs938043469 polymorphism and increased risk for MI >45.

Checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patients.

BACKGROUND: Due to greater infection susceptibility, sepsis is the main cause of death in burn patients. Quick diagnosis and patient stratification, early and appropriated antimicrobial therapy, and focus control are crucial for patients' survival. On the other hand, superfluous extension of therapy is associated with adverse events and arousal of microbial resistance. The use of biomarkers, necessarily coupled with close clinical examination, may predict outcomes, stratifying patients who need more intensive care, and monitor the efficacy of antimicrobial therapy, allowing faster de-escalation or stop, reducing the development of resistance and possibly the financial burden, without increasing mortality. The aim of this work is to check the suitability of procalcitonin (PCT) to fulfill these goals in a large sample of septic burn patients. METHODS: One hundred and one patients, with 15% or more of total body surface area (TBSA) burned, admitted from January 2011 to December 2014 at Coimbra Burns Unit (CBU), in Portugal were included in the sample. All patients had a diagnosis of sepsis, according to the American Burn Association (ABA) criteria. The sample was factored by survival (68 survivors and 33 non-survivors). The maximum value of PCT in each day was used for statistical analysis. Data were summarized by location measures (mean, median, minimum, maximum, quartiles) and dispersion measures (standard error and range measures). Statistical analysis was performed with SPSS© 23.0 IBM© for Windows©. RESULTS: There were statistically significant differences between PCT levels of patients from the survivor and non-survivor groups during the first and the last weeks of hospitalization as well as during the first week after sepsis suspicion, being slightly higher during this period. During the first 7 days of antimicrobial therapy, PCT was always higher in the non-survivor, still without reaching statistical significance, but when the analysis was extended till the 15th day, PCT increased significantly, rapidly, and steadily, denouncing therapy failure. CONCLUSION: Despite being not an ideal biomarker, PCT proved to have good prognostic power in septic burn patients, paralleling the evolution of the infectious process and reflecting the efficacy of antimicrobial therapy, and the inclusion of its serial dosing may be advised to reinforce antimicrobial stewardship programs at burn units; meanwhile, more accurate approaches are not available.

Lesões músculo-esqueléticas em atletas de alta competição / Musculoskeletal injuries in top-level athletes

Enquadramento - A ocorrência de lesões músculo-esqueléticas em atletas de alta competição é muito frequente e deveras incapacitante, tendo implicações diretas no rendimento desportivo dos jogadores e na sua própria qualidade de vida. Objetivos ­ Avaliar lesões músculo-esqueléticas em atletas de alta competição e determinar variáveis correlacionadas com essas lesões. Métodos ­ Estudo quantitativo, descritivo e correlacional. A amostra é do tipo não probabilístico por conveniência, constituída por 71 atletas de alta competição, do Futebol Clube do Porto SAD do Departamento de Basquetebol e Hóquei em Patins, da Seleção Nacional de Hóquei em Patins, do Académico de Viseu Futebol Clube, do Clube Desportivo de Tondela, Departamento de Futebol sendo todos do sexo masculino. O instrumento de recolha de dados contém um conjunto de questões de caracterização sociodemográfica, contextual/desportivas e o Questionário Nórdico Músculo-Esquelético (Serranheira et al., 2003), para avaliar as lesões músculo-esqueléticas. Resultados ­ A maioria dos atletas pratica futebol (67.6%), seguindo-se o basquetebol (16.9%) e o hóquei em patins (15.5%). Mais de metade da amostra (69.0%) já sofreu lesões durante a prática desportiva. Prevalecem nos atletas as lesões do tipo I (estiramento). Os atletas com mais idade, que manifestam mais desconforto, mais fadiga ou dor em quase todos os segmentos corporais, mas com maior incidência ao nível do pescoço, são os que apresentam mais lesões. Os atletas da faixa etária entre os 21-25 anos manifestam menor sintomatologia, com diferença estatisticamente significativa (X2=11.716; p=0.003), sendo esta mais comum ao nível dos punhos/mãos; já os atletas mais novos manifestam mais sintomatologia ao nível dos tornozelos/pés. Conclusões ­ Os resultados apurados mostram uma prevalência elevada de lesões e apontam para a necessidade da prevenção de lesões músculo-esqueléticas em atletas de alta competição, de modo a reduzir a sua prevalência, o número de dias em que se encontram lesionados e ainda o número de recidivas.

Background - The occurrence of musculoskeletal injuries in highly competitive athletes is very frequent and very disabling, with direct implications on the players' sports performance and their own quality of life. Objectives - To evaluate musculoskeletal injuries in high competition athletes and to determine variables correlated with these injuries. Methods - Quantitative, descriptive and correlational study. The sample is of non-probabilistic type for convenience, consisting of 71 athletes of high competition, the Football Club of Porto (SAD) of the Department of Basketball and Skating Hockey, of the National Selection of Hockey in Skates, of the Academician Football Club of Viseu, of the Club Sports of Tondela, Department of Soccer being all males. The data collection instrument contains a set of socio-demographic, contextual/sporting characterization questions and the Nordic Musculoskeletal Questionnaire (Serranheira et al., 2003) to evaluate musculoskeletal injuries. Results - Most athletes practice soccer (67.6%), followed by basketball (16.9%) and roller hockey (15.5%). More than half of the sample (69.0%) has already suffered injuries during sports. Type I (stretch) injuries prevail in athletes. Older athletes, who exhibit more discomfort, more fatigue or pain in almost all body segments, but with more incidences at the neck level, are the ones with the most injuries. The athletes in the age group between 21-25 years old show less symptomatology, with a statistically significant difference (X2=11,716, p=0.003), being this one more common at the level of the wrists/hands; And younger athletes show more symptomatology at the level of the ankles/feet. Conclusions - The results show a high prevalence of injuries and point to the need to prevent musculoskeletal injuries in high competition athletes, in order to reduce their prevalence, the number of days in which they are injured and the number Of relapses

Procalcitonin for the early diagnosis of sepsis in burn patients: A retrospective study.

BACKGROUND: The gold standard for sepsis diagnosis in burn patient still relies on microbiological cultures, which take 48-72h to provide results, delaying the start of antimicrobial therapy. Thus, biomarkers allowing an earlier sepsis diagnosis in burn patients are needed. METHODS: This retrospective observational study included 150 burn patients with total burned surface area ≥15%. Clinical diagnosis of sepsis among these patients was done according to the American Burn Association criteria. Biomarker (procalcitonin, white blood cells and platelet countings, prothrombinemia, D-dimers, C-reactive protein, blood lactate and temperature) values were available for 48 patients without sepsis (2767 timepoints) and 102 patients with sepsis (652 timepoints). Quantitative variables were compared with Mann-Whitney tests and qualitative variables were compared with Pearson chi-square test. Effect size was measured by the probability of superiority. Receiver operating characteristic (ROC) curves evaluate capacity for sepsis diagnosis. Sensitivity, specificity, positive and negative predictive values were calculated for some cut-off values, including the best cut-off defined by the maximum of Youden index. RESULTS: Statistically significant differences between the groups of septic and non-septic patients, with medium to large effect size, were detected for all the biomarkers considered, except temperature. PCT was the biomarker with the largest AUC and effect size (AUC=0.71). Analysis of the PCT ROC curve showed that 0.5ng/mL cut-off presented highest sensitivity and lowest specificity, whereas 1.5ng/mL cut-off was associated with lowest sensitivity and highest specificity. CONCLUSION: Procalcitonin showed to be the best of the biomarkers studied for an early diagnosis of sepsis. Its use should be considered in antimicrobial stewardship programs in Burn Units.

The Use of Procalcitonin (PCT) for Diagnosis of Sepsis in Burn Patients: A Meta-Analysis.

The continuous development of resuscitation techniques and intensive care reduced the mortality rate induced by the initial shock in burn patients and, currently, infections (especially sepsis) are the main causes of mortality of these patients. The misuse of antimicrobial agents is strongly related to antimicrobial and adverse patient outcomes, development of microbial resistance and increased healthcare-related costs. To overcome these risks, antimicrobial stewardship is mandatory and biomarkers are useful to avoid unnecessary medical prescription, to monitor antimicrobial therapy and to support the decision of its stop. Among a large array of laboratory tests, procalcitonin (PCT) emerged as the leading biomarker to accurately and time-effectively indicate the presence of systemic infection. In the presence of systemic infection, PCT blood levels undergo a sudden and dramatic increase, following the course of the infection, and quickly subside after the control of the septic process. This work is a meta-analysis on PCT performance as a biomarker for sepsis. This meta-analysis showed that overall pooled area under the curve (AUC) is 0.83 (95% CI = 0.76 to 0.90); the estimated cut-off is 1.47 ng/mL. The overall sepsis effect in PCT levels is significant and strong (Cohen's d is 2.1 and 95% CI = 1.1 to 3.2). This meta-analysis showed PCT may be considered as a biomarker with a strong diagnostic ability to discriminate between the septic from the non-septic burn patients. Thus, this work encourages the determination of PCT levels in clinical practice for the management of these patients, in order to timely identify the susceptibility to sepsis and to initiate the antimicrobial therapy, improving the patients' outcomes.

Influence of genetic variations in platelet glycoproteins and eNOS in the development of arterial ischaemia of lower limbs in type 2 diabetes mellitus patients.

Endothelial and platelet dysfunction increase the atherothrombotic risk in diabetes mellitus patients. Therefore, arterial ischaemia of lower limbs is an important complication in diabetes mellitus. In the present work, type 2 diabetic patients were classified by a podiatrist into presence or absence of arterial ischaemia of lower limbs. Several polymorphisms in platelet glycoproteins and eNOS genes were evaluated. Our results suggest that the -5CC genotype in Kozak sequence of GPIbα may be associated with a higher risk of developing arterial ischaemia of lower limbs in type 2 diabetes mellitus patients.

Stratification of ST-elevation myocardial infarction patients based on soluble CD40L longitudinal changes.

Involvement of soluble CD40 ligand (sCD40L) in thrombosis and inflammation on the context of coronary artery disease is currently being revised. In that perspective, we had studied the association of sCD40L with markers of platelet activation and markers of endothelial and vascular function. On that cohort, a stratification of patients with acute myocardial infarction (AMI) 1 month after percutaneous coronary intervention (PCI) was observed based on concentrations of sCD40L. The study intended to identify the groups of AMI patients with different profiles of sCD40L concentrations and verify how medication, clinical evolution, biochemical data, and markers of regulation of endothelial function at genetic (endothelial nitric oxide synthase polymorphisms) and post-transcriptional levels (circulating microRNAs) affect sCD40L serum levels. Lower quartiles of sCD40L (<2.3 ng/mL) were associated with higher concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), high frequency of G894T polymorphism, and altered expression of a set of microRNAs assumed to be involved in the regulation of endothelial and cardiac function and myocardium hypertrophy, relative to patients in sCD40L upper quartiles. A characteristic sCD40L variation pattern in STEMI patients was identified. Low levels of sCD40L 1 month after PCI distinguish STEMI patients with worse prognosis, a compromised cardiac healing, and a persistent endothelial dysfunction, as given by the association between sCD40L, NT-proBNP, G894T polymorphism, and specific profile of miRNA expression. These results suggest sCD40L could have a prognostic value in STEMI patients.