ABSTRACT Objective: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. Methods: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. Results: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). Conclusion: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.
RESUMO Objetivo: Definir o perfil epidemiológico e os principais determinantes de morbimortalidade dos pacientes cirúrgicos não cardíacos de alto risco no Brasil. Métodos: Estudo prospectivo, observacional e multicêntrico. Todos os pacientes cirúrgicos não cardíacos admitidos nas unidades de terapia intensiva, ou seja, considerados de alto risco, no período de 1 mês, foram avaliados e acompanhados diariamente por, no máximo, 7 dias na unidade de terapia intensiva, para determinação de complicações. As taxas de mortalidade em 28 dias de pós-operatório, na unidade de terapia intensiva e hospitalar foram avaliadas. Resultados: Participaram 29 unidades de terapia intensiva onde foram realizadas cirurgias em 25.500 pacientes, dos quais 904 (3,5%) de alto risco (intervalo de confiança de 95% - IC95% 3,3% - 3,8%), tendo sido incluídos no estudo. Dos pacientes envolvidos, 48,3% eram de unidades de terapia intensiva privadas e 51,7% de públicas. O tempo de internação na unidade de terapia intensiva foi de 2,0 (1,0 - 4,0) dias e hospitalar de 9,5 (5,4 - 18,6) dias. As taxas de complicações foram 29,9% (IC95% 26,4 - 33,7) e mortalidade em 28 dias pós-cirurgia 9,6% (IC95% 7,4 - 12,1). Os fatores independentes de risco para complicações foram Simplified Acute Physiology Score 3 (SAPS 3; razão de chance − RC = 1,02; IC95% 1,01 - 1,03) e Sequential Organ Failure Assessment Score (SOFA) da admissão na unidade de terapia intensiva (RC =1,17; IC95% 1,09 - 1,25), tempo de cirurgia (RC = 1,001; IC95% 1,000 - 1,002) e cirurgias de emergências (RC = 1,93; IC95% 1,10 - 3,38). Em adição, foram associados com mortalidade em 28 dias idade (RC = 1,032; IC95% 1,011 - 1,052) SAPS 3 (RC = 1,041; IC95% 1,107 - 1,279), SOFA (RC = 1,175; IC95% 1,069 - 1,292) e cirurgias emergenciais (RC = 2,509; IC95% 1,040 - 6,051). Conclusão: Pacientes com escores prognósticos mais elevados, idosos, tempo cirúrgico e cirurgias emergenciais estiveram fortemente associados a maior mortalidade em 28 dias e mais complicações durante permanência em unidade de terapia intensiva.
Basilar invagination (BI) and Chiari malformation type I (CM-I) are very important anomalies that introduce instability and compression in the occipitocervical transition region and have complex clinical characteristics. These anomalies vary according to the affected structures. The present study revises current knowledge regarding the anatomy, anatomo-physiology, clinical manifestations, and radiological findings of these entities and the associated surgical treatment approaches. A bibliographic survey was performed through a search in the Medline, PubMed, SciELO, Science and LILACS databases. When associated, these craniovertebral malformations result in neurological deficits due to neural parenchyma compression; however, the presence of microtraumas due to repetitive lesions caused by the bulb and cervical marrow instability has been highlighted as a determinant dysfunction. Surgical treatment is controversial and has many technical variations. Surgery is also challenging due to the complex anatomical characteristics and biomechanics of this region. Nevertheless, advances have been achieved in our understanding of related mechanisms, and compression and atlantoaxial instability are considered key elements when selecting the surgical approach.
BACKGROUND The association between Staphylococcus haemolyticus and severe nosocomial infections is increasing. However, the extent to which fomites contribute to the dissemination of this pathogen through patients and hospital wards remains unknown. OBJECTIVES In the present study, sphygmomanometers and thermometers were evaluated as potential fomites of oxacillin-resistant S. haemolyticus (ORSH). The influence of oxacillin and vancomycin on biofilm formation by ORSH strains isolated from fomites was also investigated. METHODS The presence of ORSH on swabs taken from fomite surfaces in a Brazilian hospital was assessed using standard microbiological procedures. Antibiotic susceptibility profiles were determined by the disk diffusion method, and clonal distribution was assessed in pulsed-field gel electrophoresis (PFGE) assays. Minimum inhibitory concentrations (MICs) of oxacillin and vancomycin were evaluated via the broth microdilution method. Polymerase chain reaction (PCR) assays were performed to detect the mecA and icaAD genes. ORSH strains grown in media containing 1/4 MIC of vancomycin or oxacillin were investigated for slime production and biofilm formation on glass, polystyrene and polyurethane catheter surfaces. FINDINGS ORSH strains comprising five distinct PFGE types were isolated from sphygmomanometers (n = 5) and a thermometer (n = 1) used in intensive care units and surgical wards. ORSH strains isolated from fomites showed susceptibility to only linezolid and vancomycin and were characterised as multi-drug resistant (MDR). Slime production, biofilm formation and the survival of sessile bacteria differed and were independent of the presence of the icaAD and mecA genes, PFGE type and subtype. Vancomycin and oxacillin did not inhibit biofilm formation by vancomycin-susceptible ORSH strains on abiotic surfaces, including on the catheter surface. Enhanced biofilm formation was observed in some situations. Moreover, a sub-lethal dose of vancomycin induced biofilm formation by an ORSH strain on polystyrene. MAIN CONCLUSIONS Sphygmomanometers and thermometers are fomites for the transmission of ORSH. A sub-lethal dose of vancomycin may favor biofilm formation by ORSH on fomites and catheter surfaces.
ABSTRACT: New techniques in tropical regions such as use of transparent plastic covering (TPC), have been employed in grapes to avoid the wetting leaves and fruits, which can reduce the occurrence of fungal diseases, reduce the use of sprays, and reduce damage caused by hail and high winds. TPC may significantly affect the photosynthetic rates of grapevines cultivated in tropical regions, and thus have strong effects on plant productivity and improve fruit quality. However, in the North of Rio de Janeiro region there are lacks of studies related to TPC effects on photosynthetic capacity. The objective of this study was to evaluate the photosynthetic capacity in 'Niagara Rosada' vines grown under TPC and without transparent plastic covering (WTPC). The experiment was conducted between April and June 2013, on Tabuinha farm, located in the 3rd district of São Fidélis, Rio de Janeiro State, Brazil. A completely randomized block design was used with two treatments (TPC and WTPC) and twelve replications. Evaluations consisted of climatological variables, gas exchange and maximum quantum efficiency of open photosystem II centers-quantum yield (Fv/Fm) It was possible to observe that under TPC maximum temperature increase of 2.3°C, relative humidity reduced 1.5%, vapor pressure deficit increase 0.4kPa, and light intensity reduced 47.7%. These changes did not cause photochemical damage to the leaves. The TPC promoted higher net photosynthetic rate at 800h, which was associated with higher stomatal conductance. Thus, the TPC used in the northern region of Rio de Janeiro State did not impair the photosynthetic capacity of 'Niagara Rosada' vines.
RESUMO: A cobertura plástica tem sido utilizada com a finalidade de evitar os efeitos negativos do molhamento foliar sobre a incidência de doenças em videiras 'Niagara Rosada', reduzir a aplicação de defensivos agrícolas e, dessa maneira, melhorar a qualidade dos frutos. Contudo, na região Norte Fluminense, não se tem estudos relacionados aos efeitos do uso da cobertura plástica na assimilação fotossintética do carbono e na eficiência fotoquímica associada ao fotossistema II (PSII) dessa espécie. O objetivo deste experimento foi avaliar a capacidade fotossintética em videiras 'Niagara Rosada' cultivadas sob cobertura plástica e sem cobertura plástica no Norte Fluminense. O experimento foi realizado entre abril e junho de 2013, no sítio Tabuinha, localizado no 3o distrito do município de São Fidélis, RJ. O delineamento experimental utilizado foi inteiramente casualizado com 2 tratamentos, com cobertura plástica e sem cobertura plástica, e 12 repetições. As avaliações foram relacionadas às variáveis climáticas, às trocas gasosas e ao rendimento quântico máximo do fotossistema II. Nesta pesquisa, sob a cobertura plástica, foi possível observar a elevação no valor da temperatura máxima do ar em 2,3ºC, redução na umidade relativa em 1,5%, incremento no déficit de pressão de vapor do armax em 0,4kPa, e redução na intensidade luminosa em 47,7%. Essas alterações não causaram comprometimento na eficiência fotoquímica das folhas. O sistema com cobertura plástica promoveu maior taxa fotossintética líquida (A) pela manhã (8h), e este aumento em A foi associado à maior condutância estomática nesse horário. Neste trabalho, a cobertura plástica utilizada não causou comprometimentos na capacidade fotossintética da videira 'Niagara Rosada'.
The styloid process is a bony projection that arises from the tympanic portion of the temporal bone, and its elongation is considered an anomaly that may be related to calcification of the stylohyoid and stylomandibular ligaments, which can trigger a series of symptoms that characterize the Eagle's syndrome. The objective of this study was to report three cases of elongated styloid process seen in human skulls, trying to alert the dentists in the knowledge of this disease in order to include it in their diagnosis, associated with atypical facial pain or in the oral cavity of to facilitate better treatment for these cases.
El proceso estiloides es una proyección ósea que tiene su origen en la porción timpánica del hueso temporal y su elongación es considerado una anomalía que puede relacionarse con la calcificación de los ligamentos estilohioídeo y estilomandibular, y de esta forma desarrollar una serie de síntomas que caracterizan al Síndrome de Eagle. El objetivo de este trabajo fue describir en tres cráneos humanos la elongación del proceso estiloides y dar a conocer al cirujano dentista esta anomalía, para que la incluya en su diagnóstico, cuando se éste presenta dolores atípicos de la cara o de la cavidad oral, y así facilitar el mejor tratamiento en estos casos.
The roots of the understorey shrub Carapichea ipecacuanha (ipecac) have medicinal properties, and the uprooting of wild plants has supplied most of the world demand for this species. Although under severe population decline, C. ipecacuanha lacks legal protection. In the wild, the aerial stems of ipecac clump together to form clusters with well-defined borders. Cluster size may range from several to hundreds of aerial stems. To investigate the extent of clonality among aerial stems in ipecac clusters, we sampled 50 wild clusters (a total of 291 aerial stems) and screened them with 89 inter-simple sequence repeat (ISSR) markers. The 291 aerial stems were grouped into 42 putative clones. The clonal groups generally consisted of aerial stems from the same cluster, and there was little or no genetic differentiation among aerial stems at the cluster level. These findings suggest that strategies designed to conserve ipecac in situ should not rely upon census data, which are based on the number of aerial stems per cluster and the number of clusters per population, because such data greatly underestimate the species effective population size and genetic diversity. Our results also indicate that this species needs protection at a federal level.