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BackgroundWe evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort.MethodsThis prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan-Meier curves and Cox proportional-hazard models were performed.Findings1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9-32.9) Kg/m² and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8-29.2)] died during hospitalization (median time 14 (IQR,9-24) days). Older age [vs

Purpose: It was noticed that anterior choroidal artery (AChoA) aneurysms appear to rupture at relatively smaller sizes compared with aneurysms in other intracranial locations, based on anecdotal clinical experience. We therefore aimed to compare ruptured AChoA aneurysms with other ruptured aneurysms in other intracranial locations, pertaining to aneurysm dimensions. This may help in finding out if the rupture risk stratification, based on the amalgamation of aneurysms of multiple locations in one group, precisely estimates aneurysm rupture risk. Methods: 255 ruptured intracranial aneurysms, which underwent assessment with catheter angiography with 3D reconstruction, in a single tertiary center between January 2000 and December 2023, were included. 6 aneurysm dimensions were compared. Results: Statistically significant larger aneurysm maximum diameter, height, width and size ratio (SR) of the ruptured posterior communicating artery (PCOMM) aneurysms were identified when compared with ruptured AChoA aneurysms. No statistically significant difference in the aneurysm maximum diameter, height and width between the ruptured AChoA and ruptured anterior cerebral artery (ACA), anterior communicating artery (Acom), pericallosal artery and basilar tip aneurysms was found. AChoA aneurysms appear to rupture at a relatively small size, which is comparable to other aneurysm locations that are often grouped into different categories in rupture risk stratification. Conclusion: More detailed location-specific rupture risk estimation may be needed. The combination of multiple intracranial aneurysm locations into a single category for risk stratification may not reflect the true aneurysm size at rupture for some aneurysms. [ABSTRACT FROM AUTHOR]

ABSTRACT Composite analysis of the atmospheric mechanisms in South Atlantic explosive cyclones was performed utilising ERA5 reanalysis for the 2010–2020 period. By a manual tracking method, 271 cases were found (127 weak, 104 moderate and 40 intense). The cyclones follow the preferential displacement from northwest to southeast. There is a trend that, as the explosive cyclone's intensity increases, its trajectory becomes less zonal and has a more significant impact in the coastal areas of Southern Brazil and Uruguay. These intensity frequencies were discretized through a compositing technique for studying explosive cyclones. The results revealed that explosive cyclones begin following the classical model from Bjerknes and Solberg, and, at the end of the explosive phase, they tend to become Shapiro–Keyser type, especially in moderate and intense ones. Vertical movements appeared more significantly at the beginning of the explosive stage. It was observed that intense explosive cyclones transition from the equatorial side of the high‐level jet to the polar side. In addition, surface latent heat flux may significantly impact the cyclone's development both in the beginning and during the explosive phase, especially in intense systems. A horizontal dipole pattern is seen for surface sensible heat fluxes, as the ocean loses and gains heat in the cold and warm sectors, respectively, at roughly the same amount. [ABSTRACT FROM AUTHOR]

The restinga habitats are coastal psammophilous environments, with only 0.47% of the original area remaining in Brazil. This environment embraces at least 36 known species of lizards, 7 of them being endemic. Besides direct anthropogenic impacts, climate change raises new cautions on Brazilian restingas‐endemic lizards conservation. We evaluated the current and future potential distribution of the endemic lizards from Brazilian restingas, considering different climate change scenarios. We hypothesized shifts in the potential distribution of the restinga‐endemic lizards. We conducted ecological niche modeling to predict the potential distribution of Brazilian restingas‐endemic lizards. Here, we used an ensemble of three modeling algorithms (Bioclim, GLM, and SVM). In predicting the effects of climate change on their future distributions, we used intermediate and pessimistic socio‐economic pathway scenarios (SSP3 70 and SSP5 85, respectively) considering projections for 2081–2100. Furthermore, we calculate the extent of future potential distribution covered by the current spatial configuration of integral protection areas to assess if they will still be effective in conserving the species in the future. We did this by binarizing predicted potential distribution with a threshold of 0.8. Our data pointed out that the species will have their potential distribution area altered for 2081–2100, considering climate change scenarios. Tropidurus hygomi, Glaucomastix abaetensis, and G. itabaianensis overlapped along their predicted potential distribution for the present and future. The same was found to Ameivula nativo and Liolaemus lutzae. Moreover, our results showed a potential marked reduction of potential distribution covered PAs. The recognition of potential distribution areas discussed here enables focal and urgent conservation strategies, besides bringing up alerts on protected areas' role in conserving these species under climate change scenarios. We propose creating planning policies using space and time criteria and developing long‐term studies, besides promoting educational programs aiming at environmental conservation. Thus, we expect our research to contribute to the protection of the land over Brazilian restingas‐endemic lizards' distribution. [ABSTRACT FROM AUTHOR]

Background/Objectives: MMAE (middle meningeal artery embolization) has emerged as a potential effective treatment for cSDH (chronic subdural hematoma). In this study, MMAE efficiency with regards to cSDH cause and architecture was explored. The comparability of cSDH thickness and volume as parameters for cSDH pre- and post-MMAE assessment was also analyzed. Methods: In this retrospective cohort study, 52 consecutive cSDH patients treated with MMAE in a single tertiary center were included. The cohort was divided into two group pairs pertaining to cSDH cause (spontaneous or traumatic) and cSDH architecture (non-mature or mature). The radiological outcome was compared in each group before and after MMAE and between each group pair using CT imaging. A correlation analysis between cSDH thickness and volume before and after MMAE was also performed. Results: A statistically significant positive linear association between cSDH thickness and volume at admission and at each follow-up interval (1–3, 3–6, 6–12 months) was noticed. cSDH thickness and volume reduction in each group was statistically significant, except for a traumatic cSDH volume reduction at 6–12 months. There was no statistically significant difference between each group pair in the cSDH thickness and volume reduction difference at all the follow-up intervals. Conclusions: A comparable efficiency of MMAE may be achieved in non-mature and mature as well as in spontaneous and traumatic cSDH, with an advantage for spontaneous cSDH at 6–12 months follow-up compared to traumatic cSDH. Traumatic cSDH may require a relatively long-term follow-up post-MMAE. cSDH thickness and volume, as parameters for pre- and post-MMAE cSDH evaluation, appear similar. [ABSTRACT FROM AUTHOR]

The study delves into the primary large-scale atmospheric features contributing to extreme weather events across Europe during early September 2023. The period was examined using a dataset composed by the European Centre for Medium-Range Weather Forecasts (ECMWF) analysis and satellite imagery. In early September 2023, an omega blocking pattern led to the development of a low-pressure system over the Iberian Peninsula producing heavy precipitation and flooding over Spain and acting as a mechanism for a mineral dust outbreak. A second low-pressure system developed over Greece. Extreme precipitation was recorded across Greece, Turkey, and Bulgaria as the system gradually shifted southward over the Mediterranean. The system earned the name "Storm Daniel" as it acquired subtropical characteristics. It caused floods over Libya and its associated circulation favoured the transport of mineral dust over Northern Egypt as it moved eastward. Meanwhile, the high-pressure blocking system associated with the omega pattern induced heatwave temperatures in countries further north. This period was compared with the large-scale circulation observed in mid-September 2020, when severe weather also affected the Mediterranean region. However, the weather systems were not directly connected by the large-scale circulation, as shown in September 2023. Although mesoscale conditions are relevant to formation and intensification of some atmospheric phenomena, the establishment of an omega blocking pattern in early September 2023 showed how large-scale atmospheric dynamics can produce abnormal weather conditions on a continental scale over several days. [ABSTRACT FROM AUTHOR]

Background: There is little information comparing the performance of community acquired central nervous system infections (CNSI) treatment by intensive care units (ICUs) specialized in infectious diseases with treatment at other ICUs. Our objective was to reduce these gaps, creating bases for benchmarking and future case-mix classification. Methods: This is a retrospective observational cohort of 785 admissions with 82 cases of CNSI admitted to the ICU of an important Brazilian referral center for infectious diseases (INI) between January 2012 and January 2019. Comparisons were made to data retrospectively collected from the 303,500 intensive care admissions from the Brazilian state health care system included in the Epimed Monitor database. Clinical, epidemiologic, and performance indicators: the standardized mortality rate (SMR) and the standardized resource use rate per ICU surviving patient (SRU) were collected. Results: Case-mix infections profile and SMR/SRU data. SUS Mixed medical/surgical ICUs: SMR = 1.26, SRU = 1.59; SUS Neurological ICUs: SMR = 1.17, SRU = 2.23; INI ICU: SMR = 1.1, SRU = 1.1; INI ICU CNSI patients: SMR = 0.95, SRU = 1.01. Conclusions: Severe patients with CNSI can be efficiently and effectively treated in an ICU specialized in infectious diseases when compared to mixed medical/surgical and neurological ICUs from the public health system. At the same time, we provided profiling and a case-mix that can help and encourage benchmarking by other institutions and other countries. [ABSTRACT FROM AUTHOR]