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Introdução: A anemia hemolítica é uma condição caracterizada pela destruição prematura das hemácias, reduzindo a capacidade de transporte de oxigênio, ocasionando sintomas como fadiga e icterícia. Já o Triptofano é um aminoácido essencial, precursor da serotonina e melatonina, encontrado na dieta e em suplementos. Embora geralmente seguro, o uso de triptofano pode estar associado a reações hematológicas adversas, como a anemia hemolítica. O metabolismo do Triptofano pode influenciar processos imunológicos e metabólicos que afetam a estabilidade das hemácias, contribuindo para a sua destruição. Objetivo: Relatar um caso de pancitopenia associada ao uso de Triptofano secundária a uma anemia hemolítica. Material e métodos: A pesquisa foi realizada com base em dados fornecidos pela participante da pesquisa e em revisões em prontuários fornecidos pela Instituição envolvida. O tempo necessário foi durante a internação até a alta, tendo sido realizado contato com a participante quando necessário. Relato de caso: Uma mulher de 52 anos com histórico de hipotireoidismo, ansiedade generalizada e HAS, apresentou fraqueza generalizada, colúria, hêmese e icterícia. A paciente relatou na admissão que estava no quinto dia de sintomas após realização de soroterapia injetável, visando uma melhora da sua disposição cotidiana. Os sinais vitais eram normais e o exame físico foi indicativo de icterícia, mas não havia hepatomegalia ou esplenomegalia. Os exames laboratoriais acusavam uma bilirrubina total de 2,77 mg/dL, direta de 0,47 mg/dL e indireta de 2,30 mg/dL, hemácias de 1,450,000/m3 com hemoglobina de 5,7 g/dL e desidrogenase lática de 3209 U/L, indicando quadro de anemia hemolítica. Na história clínica a paciente alegou que a soroterapia realizada foi composta por uma solução de Complexo B sem B1, L taurina, Inositol, Aminoácidos essenciais (Leucina, Lisina, Valina, Isoleucina, Treonina, Fenilalanina, Metionina e Triptofano), Metilfolato, Vitamina C e 5-hidroxitriptofano. Discussão: Foram investigadas causas alternativas para o quadro de hemólise, porém foram descartadas hipóteses relacionadas a deficiências nutricionais e condições hematológicas ou autoimunes que poderiam explicar o quadro de anemia. O Triptofano foi escolhido como hipótese principal para a causa da pancitopenia referida por exclusão, uma vez que os demais componentes da soroterapia já foram amplamente estudados e não demonstraram relação significativa com a indução de hemólise severa em pacientes, especialmente nas doses administradas. O tratamento com infusão sanguínea, administrado para corrigir a anemia, resultou em uma melhora significativa tanto clínica quanto laboratorial, evidenciada pela recuperação dos níveis de hemoglobina e pela redução dos marcadores de hemólise. Esses achados sugerem uma correlação provável entre o uso de triptofano e a anemia hemolítica, corroborando a hipótese de que o Triptofano pode ter um papel importante no desenvolvimento da anemia hemolítica nesta situação específica. Conclusão: O caso destaca a necessidade de cautela no uso de terapias injetáveis e reforça a importância de validar a real necessidade desses procedimentos. Ademais, é essencial uma maior investigação dos possíveis efeitos adversos dos suplementos nutricionais. A conscientização sobre os riscos associados a essas terapias pode ajudar a prevenir situações semelhantes e garantir a segurança dos pacientes.

Objetivo: Relatar um caso de Linfoma folicular com lesões osteolíticas ao diagnóstico. Material e métodos: Revisão do prontuário médico, dos exames de imagem e dos histopatológicos. Relato do caso: Mulher de 49 anos vem apresentando dor óssea de forte intensidade na região lombo-sacra há um ano. Relata dislipidemia, amigdalectomia na infância e cesárea aos 23 anos. Parou de fumar há 10 anos. A Ressonância magnética mostrou múltiplas lesões ósseas nos corpos vertebrais e bacia e tecido de partes moles invadindo o canal sacral. Dois meses depois, a paciente notou adenomegalias cervicais e foi encaminhada para o serviço de hematologia do HUAP. Ao exame a paciente tinha fácies de dor, estava levemente hipocorada, com adenomegalias cervicais e axilares bilaterais. Não havia visceromegalias. A biópsia de um linfonodo cervical diagnosticou Linfoma folicular clássico e a biópsia de medula óssea confirmou infiltração pelo linfoma. As tomografias do estadiamento mostraram lesão expansiva na asa maior do esfenóide e parede posterior da órbita, múltiplas linfonodomegalias no tórax, abdome e pescoço, provável infiltração neoplásica das submandibulares, acometimento ósseo secundário de vértebras cervicais e lombares e lesões heterogêneas nos ilíacos, colos femorais e trocanter femoral esquerdo. Exames laboratoriais: Hemograma: Hb 11 g/dL / Hto 32,8% / VCM:88,5 fL / Plaquetas: 434.000/mm3 / Leucometria 16300/mm3 / Segmentados:13529 / Linfócitos: 1956/ Ausência de blastos. As sorologias para HIV, sífilis e hepatites foram negativas e os exames bioquímicos, dentro da normalidade, exceto a Fosfatase Alcalina que estava aumentada. A biópsia da vértebra L3 confirmou que a origem das lesões ósseas era o Linfoma folicular. Discussão: O Linfoma não Hodgkin pode acometer os ossos de forma primária ou secundária. Linfomas ósseos primários ocorrem como lesões únicas ou múltiplas, sem acometimento linfonodal ou visceral e representam cerca de 1% dos linfomas em geral. Os linfomas que afetam os ossos secundariamente são mais frequentes que os primários. O tipo histológico mais encontrado, em ambos os casos é o Linfoma de grandes células B difuso (LGCBD). Ossos longos como o fêmur, as vértebras e a bacia são os mais acometidos. O sintoma principal é a dor óssea e as fraturas ocorrem raramente. As lesões mais frequentes são as osteolíticas, mas lesões osteoblásticas ou mistas também podem ocorrer. Os linfomas indolentes representam apenas 8% daqueles que acometem os ossos. O Linfoma folicular é o linfoma indolente mais comum, caracterizado por adenomegalia generalizada de evolução lenta, por diagnóstico em estádios avançados, pelas recidivas frequentes e pela transformação para LGCBD. O acometimento de sítios extra-nodais como medula óssea, baço, fígado e trato gastro-intestinal é comum, porém o aparecimento de lesões ósseas é muito raro. Dentre as neoplasias hematológicas o Mieloma múltiplo é o tumor que mais frequentemente causa lesões ósseas. O esqueleto é o terceiro sítio mais comum de metástases de tumores sólidos, após o pulmão e o fígado. Os carcinomas são o tipo de tumor mais frequente associado à lesão óssea secundária e as metástases mais comumente se iniciam a partir de neoplasias das mamas, pulmões e próstata. Conclusão: Devido à raridade da ocorrência de dor de forte intensidade por lesões ósseas associadas ao Linfoma folicular, a confirmação histopatológica foi necessária para descartar a possibilidade de uma segunda neoplasia.

Introdução e objetivos: A mortalidade por neoplasias hematológicas, embora menos prevalente que outras formas de câncer, apresenta padrões específicos que refletem disparidades regionais e demográficas significativas. Estudos recentes têm destacado a importância de compreender essas variações para aprimorar estratégias de diagnóstico, tratamento e políticas de saúde. Este estudo tem como objetivo investigar as taxas de mortalidade por neoplasias hematológicas e sua evolução ao longo dos últimos cinco anos. Materiais e métodos: Estudo epidemiológico, descritivo, do número de mortes e da mortalidade por neoplasias hematológicas, no Brasil, durante o período de janeiro de 2019 a dezembro de 2023. Os números de óbitos e a mortalidade foram obtidos no Departamento de Informática do Sistema Único de Saúde (DATASUS) segundo a lista de morbidade do CID-10. Resultados: A taxa de mortalidade por neoplasias hematológicas em 2019 foi de 7,95, em 2020 de 7,4, em 2021 de 7,01, em 2022 de 6,98 e em 2023 de 6,96, representando 7,14% dos óbitos por neoplasias no país. No período analisado, ocorreram um total de 25,672 mortes decorrentes de neoplasias sanguíneas. A população negra e a feminina foram identificadas como as mais afetadas, com a região Sul apresentando as maiores taxas de mortalidade e o Centro-Oeste as menores. As taxas de mortalidade aumentaram com a idade, com um incremento de aproximadamente 23% na faixa etária de 40 a 49 anos comparada à faixa de 30 a 39 anos. O Linfoma não-Hodgkin foi a neoplasia hematológica com a maior taxa de mortalidade, com as regiões Norte e Nordeste apresentando as alíquotas mais elevadas para esse tipo de câncer. Discussão: Os dados indicam que a população negra e feminina enfrenta uma carga desproporcionalmente alta de mortalidade por neoplasias hematológicas, possivelmente refletindo desigualdades no acesso a cuidados de saúde e tratamento. A redução nas taxas de mortalidade poderia ser atribuída a avanços nos tratamentos, embora a possibilidade de aumento na subnotificação também deva ser considerada. A elevação das taxas de mortalidade com a idade ressalta a necessidade de estratégias de diagnóstico e tratamento mais eficazes para as faixas etárias mais avançadas. A prevalência do Linfoma não-Hodgkin como a neoplasia hematológica mais letal e suas altas taxas de mortalidade nas regiões Norte e Nordeste destacam a necessidade de uma atenção específica para essas regiões. Conclusão: O estudo revela padrões importantes na mortalidade por neoplasias hematológicas no Brasil, com implicações significativas para estratégias de saúde pública. As disparidades regionais e demográficas sublinham a necessidade de abordagens direcionadas para melhorar o diagnóstico e tratamento das neoplasias hematológicas, especialmente para as populações e regiões mais vulneráveis.

Abstract Background Globally, substance use is a leading contributor to the burden of disease among young people, with far reaching social, economic and health effects. Following a finding of harmful alcohol use among 5-8-year-old children in Mbale District, Uganda, this study aims to investigate community members’ views on early childhood substance use among children below the age of 10 years. Methods In 2016, we conducted eight focus group discussions with 48 parents and 26 key informant interviews with teachers, health workers, alcohol distributors, traditional healers, religious leaders, community leaders and youth workers. We used thematic content analysis. Four participants and two research assistants reviewed and confirmed the findings. Results Alcohol in everyday life: ‘Even children on laps taste alcohol’: Almost all participants confirmed the existence of and concern for substance use before age 10. They described a context where substance use was widespread in the community, especially intake of local alcoholic brews. Children would access substances in the home or buy it themselves. Those living in poor neighbourhoods or slums and children of brewers were described as particularly exposed. Using substances to cope: ‘We don’t want them to drink’: Participants explained that some used substances to cope with a lack of food and resources for childcare, as well as traumatic experiences. This made children in deprived families and street-connected children especially vulnerable to substance use. Participants believed this was a result of seeing no alternative solution. Conclusions To our knowledge, this is the first study to describe the context and conditions of childhood substance use before age 10 in Mbale District, Uganda. The study shows that community members attributed early childhood substance use to a social context of widespread use in the community, which was exacerbated by conditions of material and emotional deprivation. These social determinants for this practice deserve public health attention and intervention.

Objective: To evaluate the anti-angiogenic and anticancer activities of Psidium guajava leaf extracts against angiogenesis-dependent colorectal cancer. Methods: Three extracts were produced using distilled water, ethanol, and n-hexane as solvents. The extracts were physically characterised through gas chromatography–mass spectrometry, ultraviolet-visible spectroscopy, and Fourier transform infrared spectroscopy. Their antioxidant activity was evaluated using the 2,2-diphenyl-1-picrylhydrazyl, total phenolic content, and total flavonoid content assays. To assess their anti-angiogenic activity, cell viability and rat aortic ring assays were conducted, while cell migration, tube formation, colony formation, and VEGF ELISA assays were conducted to elucidate their effects on different aspects of angiogenesis. Molecular docking was used to assess the anti- angiogenic potential of some possible compounds in the extracts. Tumour spheroid assay was used to assess the extracts’ potential as a treatment for colorectal cancer. Results: The ethanol extract showed the best antioxidant activity. The distilled water and ethanol extracts exhibited more inhibitory activity against EA.hy926 cell viability and aortic ring microvessel growth. In addition, the ethanol extract performed significantly better than the distilled water extract against cell migration and colony formation, and VEGF expression of the cells was suppressed by the ethanol extract. Both the distilled water and ethanol extracts showed significant inhibitory effect on EA.hy926 tube formation and tumour spheroids consisting of EA.hy926 and HCT116 cells. The ethanol extract contained β-caryophyllene and β-elemene by phytochemical analysis and subsequent docking studies, which may contribute to its anti-angiogenic activity. Conclusions: The ethanol extract of Psidium guajava has potential in the treatment of colorectal cancer through the inhibition of angiogenesis.

Summary: Background: During the COVID-19 pandemic, the scarcity of resources has necessitated triage of critical care for patients with the disease. In patients aged 65 years and older, triage decisions are regularly based on degree of frailty measured by the Clinical Frailty Scale (CFS). However, the CFS could also be useful in patients younger than 65 years. We aimed to examine the association between CFS score and hospital mortality and between CFS score and admission to intensive care in adult patients of all ages with COVID-19 across Europe. Methods: This analysis was part of the COVID Medication (COMET) study, an international, multicentre, retrospective observational cohort study in 63 hospitals in 11 countries in Europe. Eligible patients were aged 18 years and older, had been admitted to hospital, and either tested positive by PCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or were judged to have a high clinical likelihood of having SARS-CoV-2 infection by the local COVID-19 expert team. CFS was used to assess level of frailty: fit (CFS1–3), mildly frail (CFS4–5), or frail (CFS6–9). The primary outcome was hospital mortality. The secondary outcome was admission to intensive care. Data were analysed using a multivariable binary logistic regression model adjusted for covariates (age, sex, number of drugs prescribed, and type of drug class as a proxy for comorbidities). Findings: Between March 30 and July 15, 2020, 2434 patients (median age 68 years [IQR 55–77]; 1480 [61%] men, 954 [30%] women) had CFS scores available and were included in the analyses. In the total sample and in patients aged 65 years and older, frail patients and mildly frail patients had a significantly higher risk of hospital mortality than fit patients (total sample: CFS6–9 vs CFS1–3 odds ratio [OR] 2·71 [95% CI 2·04–3·60], p

Optical waveguide Bragg gratings (WBGs) can be created in transparent materials using femtosecond laser pulses. The technique is conducted without the need for lithography, ion-beam fabrication methods, or clean room facilities. This paper reviews the field of ultrafast laser-inscribed WBGs since its inception, with a particular focus on fabrication techniques, WBG characteristics, WBG types, and WBG applications.

Newly hatched (24 h old) larvae of Tribolium castaneum and T. confusum were allowed to feed on different doses of cyromazine or pirimiphos-methyl, or on a combined dose of both compounds up to pupation. All the treatments produced deformities at all the life stages. Cyromazine produced a number of abnormalities in the larval stage (P < 0.001) of the two species. Both the compounds produced similar type of deformities in the adults, but the effect was slightly more in the female T. confusum. The combined action (10 ppm cyromazine + 0.1 ppm pirimiphos-methyl) of the compounds also produced deformities at each stage; and the effects were more pronounced than the effect caused by a single dose of either 10 ppm cyromazine or 0.1 ppm pirimiphos-methyl, and this will produce less stress on the environment and human health.

Insects show color preferences mostly to those which resembles the color of foliage, flower or even their hosts. In the present study observations were made to determine vision towards different colored surfaces in young (second instar), and advanced (fourth instar) larvae, and adults of Tribolium castaneum (Herbst) (Coleoptera: Tenebrionidae). The larva and adult beetles showed significant color preferences when given a choice between white (control) and colored surfaces at 24- and 48-h exposures. The second instar larvae were more attracted by yellow and pink than green surfaces. The fourth instar larvae did not show any significant preference between white and colored surfaces at 24-h exposure, but avoided red and pink surfaces (P>0.05) and had a marginal choice for black (P

The combination of Neutron Tomography (NT), Scanning Electron Microscopy (SEM, with and without elemental analysis), pH profiling and Microindentation Mapping techniques was used to develop a methodology for the assessment of concrete sewer pipe deterioration. We demonstrate a viable method for health monitoring of concrete sewer pipes and the evaluation of competing mitigation strategies.

Radionuclides produced in fission process moves from its source, to human food chain to become available for human consumption determines their effects on his health. According to models used to predict health effects of these radionuclides enter the human body, a large number of fatalities, malignancies, thyroid cancer, born (genic) defects, etc. Nevertheless, the actual data after Chernobyl and TMI accidents, and nuclear detonations, were not consistent with these models. Deep Atomic Binding Hypothesis (DAB)), interprets the actual field data.

Detailed studies of intense light – material interactions has led to new insights into fs laser induced refractive index change in a range of glass types. This body of knowledge enables the development of advanced processing methodologies, resulting in novel planar and 3D guided wave devices. We will review the chemistry and morphology associated with fs laser induced refractive index change in multi-component glasses such as ZBLAN, phosphates and silicates, and discuss how these material changes inform our research programs developing a range of active and passive lightwave systems.

Femtosecond laser inscription of fluoride Fiber Bragg Gratings (FBGs) has enabled the realization of all-fiber laser sources at mid-infrared wavelengths. However, many fundamental aspects of the fabrication process remain unknown, which hinders further development. In this paper, we for the first time reveal the physical mechanisms that underpin the laser-induced permanent refractive index change in the periodic grating elements that constitute an FBG. Quadriwave lateral shearing interferometry and micro-reflectivity measurements are introduced as techniques for the full characterization of the refractive index change profile of the grating structure. The fundamental processes that eventually result in a permanent index change were found to differ significantly between the chemically closely related fluoroindate and fluorozirconate glass families. In fluoroindate fibers, the index change can almost entirely be attributed to elemental migration, whereas in fluorozirconate fibers the involved processes are more intricate and include the selective migration of fluorine ions as well as the formation of F-centers, more specifically unpaired electrons trapped in anion vacancies. In addition, in fluorozirconate fibers, the formation of dynamic stress regions in-between the grating planes was observed, more specifically a build-up of higher stress in areas adjacent to positive index-change regions and of lower stress in areas adjacent to negative index-change regions, which for the first time explains the unusual annealing behavior of mid-IR FBGs. [ABSTRACT FROM AUTHOR]

Life on Earth uses DNA as the central template for self‐replication, genetic encoding, and information transfer. However, there are no physical laws precluding life's existence elsewhere in space, and alternative life forms may not need DNA. In the search for exobiology, knowing what to look for as a biosignature remains a challenge – especially if it is not from the obvious list of biologic building blocks. Clues from chemicals recently discovered on Mars and in the Taurus Molecular Cloud 1 (TMC‐1), show that intriguing organic compounds exist beyond Earth, which could provide a starting point for unconventional exobiotic designs. Here we present a new potential self‐replicating system with structural similarities to recently discovered compounds on Mars and TMC‐1. Rather than using DNA's hydrogen‐bonding motif for reliable base‐paring, our design employs sulfur‐nitrogen interactions to selectively template unique benzothiadiazole units in sequence. We synthesized and studied two versions of this system, one reversible and the other irreversible, and found experimental evidence of self‐replication in d‐chloroform solvent. These results are part of a larger pursuit in our lab for developing a basis for a potential exobiological system using starting blocks closely related to these cosmic compounds. [ABSTRACT FROM AUTHOR]

Abstract Postoperative delirium has the potential to impact individuals of all age groups, with a significant emphasis on the elderly population. Its presence leads to an increase in surgical morbidity and mortality rates, as well as a notable prolongation of hospital stays. However, there is a lack of research regarding the prevalence, risk factors, and implications of postoperative delirium in developing nations like Ethiopia, which affects both patients and healthcare institutions. An observational study was conducted at hospitals in the South Gondar Zone to diagnose postoperative delirium in the Post-Anesthesia Care Unit (PACU) using the Nursing Delirium Screening Scale. Both bivariable and multivariable logistic regression techniques were employed to analyze the association between independent factors and postoperative delirium. The strength of the association was indicated by the odds ratio with a 95% confidence interval (CI). Any p-values below 0.05 were considered statistically significant. The incidence of postoperative delirium was determined to be 41%. In the multivariate logistic regression analysis, several factors were identified as significantly associated with postoperative delirium. These factors include an age of 75 or older (AOR, 11.24; 95% CI, 4.74–26.65), ASA-PS IV (AOR, 3.25; 95% CI, 1.81–5.85), severe functional impairment of activities of daily living (AOR, 3.29; 95% CI, 1.06–10.20), premedication with benzodiazepine (AOR, 4.61; 95% CI, 2.48–8.57), intraoperative estimated blood loss exceeding 1000 ml (AOR, 2.74; 95% CI, 1.50–4.98), and intraoperative ketamine use (AOR, 3.84; 95% CI, 2.21–6.68). Additionally, postoperative delirium was found to significantly prolong the duration of stay in the post-anesthesia care unit (PACU) and the length of hospital stay (p-value

Abstract This study explores the intersection of performing arts and cultural tourism, identifying key trends and research gaps through a scoping review with selected bibliometric components. The analysis examines publication trends and citation metrics from 11 documents sourced from the Scopus database, using bibliometric analysis software, biblioMagika® version 2.9. The research reveals key themes, including the relationship between culture and tourism, the role of technology, such as augmented reality, in enhancing heritage experiences, and the preservation of local traditions amid tourism pressures. The study highlights that the role of performing arts in promoting sustainable tourism practices remains underexplored. The findings emphasize the need for a multidisciplinary approach and propose integrating performing arts more effectively into cultural tourism policies and practices. This study provides a foundation for future research aimed at enhancing sustainable tourism and expanding the geographical and cultural scope of analysis to include underrepresented regions.