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Introdução: A implementação de um programa hospitalar de Gestão do Sangue do Paciente (Patient Blood Management - PBM) envolve a “abordagem centrada no paciente, sistemática e baseada em evidências para melhorar os resultados do paciente, gerenciando e preservando o sangue do próprio paciente, ao mesmo tempo em que promove a segurança e o empoderamento do paciente.” O PBM não se caracteriza apenas como um protocolo isolado, requer a participação multidisciplinar. Objetivos: Descrever o processo de implementação do programa de PBM num hospital privado, com foco em pacientes submetidos a cirurgias cardíacas de grande porte, comparando os dados da fase inicial de implementação, quando as ações de melhoria que ainda estavam sendo desenvolvidas, com os dados da fase de consolidação, quando elas já estavam implementadas. Material e métodos: Foram implementadas diversas ações, incluindo o desenvolvimento de um protocolo compreendendo as fases de pré, intra e pós-operatório, incorporando os 3 pilares do PBM. Além disso, foram estruturadas intervenções educativas e de monitoramento de indicadores, com feedback para as equipes clínicas. Resultados: Na fase inicial da implementação, de setembro de 2022 a junho de 2023, foram monitorados 229 pacientes submetidos a cirurgia cardíaca. Na fase de consolidação, de julho de 2023 a abril de 2024, mais 294 pacientes foram avaliados. Na análise de práticas intraoperatórias de PBM, observou-se que o uso de antifibrinolíticos oscilou de 81% para 83% (aumento de 2,5%; p = 0,561). A utilização de autotransfusão intraoperatória, aumentou de 55% para 69% (incremento de 25,5%; p = 0,001). A adoção de tromboelastometria para guiar a hemostasia subiu de 40% para 57% (aumento de 42,5%; p < 0,001). Quanto ao uso de hemocomponentes, o número médio de concentrados de hemácia por paciente diminuiu de 1,46 para 1,31 (redução de 10,3%; p = 0,784). De forma similar, a proporção de pacientes transfundidos caiu de 44% para 39% (redução de 11,3%; p = 0,327). Na análise dos desfechos, a ocorrência de complicações pós-operatórias reduziu de 52% para 20% (redução de 60,8%; p < 0,001), enquanto a incidência de infecção pós-operatória diminuiu de 27% para 17% (redução de 37%; p = 0,005). O tempo médio de permanência na unidade de terapia intensiva reduziu-se de 4,7 dias para 4,3 (redução de 8,7%; p = 0,543). A mortalidade intra-hospitalar caiu de 4,8% para 4,1% (redução de 15%; p = 0,830). Discussão: Um programa de PBM foi implementado com foco nas cirurgias cardíacas, sendo que algumas equipes já utilizavam técnicas de PBM mesmo antes da fase inicial da implementação. A comparação do período de implementação com o de consolidação revelou melhora importante nas práticas intraoperatórias, traduzidas pelo aumento no uso de autotransfusão e tromboelastometria. Redução importante na taxa de complicações e de infecção pós-operatória foi observada. Como todo processo de mudança de cultura e de processos, verificou-se a necessidade de intensificar os esforços de educação continuada e padronização de procedimentos para obtenção de melhores desfechos clínicos. Conclusão: A implementação bem-sucedida de um programa de PBM é factível com a elaboração de protocolos, ações educativas e monitoramento de indicadores. Com abordagem assertiva, tais estratégias do PBM podem levar a melhores resultados clínicos, maior segurança dos pacientes e a utilização mais racional dos recursos sanguíneos.

Introdução: Segundo dados da Organização Mundial da Saúde (OMS), a anemia é um indicador de má nutrição e problemas de saúde e afeta mais de 2,9 bilhões de pessoas na população, sendo, portanto, considerada um problema de saúde pública mundial, afetando negativamente a vida de bilhões de pessoas que se consideram relativamente saudáveis. Sabemos que boa parte dessas pessoas desconhece esse diagnóstico, mas já pode estar apresentando os sintomas mais frequentes. como fraqueza, cansaço, dores de cabeça e irritabilidade, entre outros. Se a anemia piorar, evolui com dispneia, tontura, sangramento menstrual anormal ou úlceras na boca. Pensando na importância dessa conscientização e fazendo parte integrante da implementação do PBM (Patient Blood Management) no Hospital do Coração (Hcor) – SP, foi feito uma conscientização “in loco” com os colaboradores do hospital, realizado no Dia Mundial da Conscientização da Anemia, 13 de fevereiro. Metodologia: Utilizamos um aparelho específico de tecnologia israelense aprovado pela ANVISA, que faz uma análise fotoplestimográfica do tecido capilar da ponta de dedo em segundos, para realizar a triagem hematimétrica dos colaboradores do hospital em um único dia, no período de 8 horas. Utilizamos como valor de corte para anemia os valores de hemoglobina preconizados pela OMS, sendo 13 g/dL para os homens e 12 g/dL para mulheres. Os colaboradores com exames alterados foram encaminhados para a equipe que atua com medicina do trabalho. Essa ação incluiu também a divulgação de conceitos de anemia em posts divulgados pelo e mail corporativo e canais oficiais do hospital. Resultados: Foram avaliados 185 colaboradores no período, sendo 122 (66%) do sexo feminino e 63 (34%) do sexo masculino. No total 7,5% dos exames de triagem se mostraram alterados (4 homens e 10 mulheres) e nenhum deles tinha conhecimento do diagnóstico prévio. Um fator relevante, foi o predomínio do sexo feminino nos exames alterados, ratificando a causa mais comum da anemia em nosso meio, que é a deficiência de ferro e seu tratamento envolve a identificação do motivo dessa falta. Em geral está relacionado a uma combinação na redução do aporte de ferro (dietas alimentares) e perda de ferro (sangramentos menstruais excessivos). Isso pode explicar, o grande interesse demonstrado pelos participantes avaliados, principalmente em poder realizar de forma rápida e simples um exame de anemia, como forma de conscientização, mostrando a importância de ações mais regulares. Conclusão: Um dos principais desafios de implantação do PBM é a mudança da cultura institucional. Nesse contexto, se insere essa ação que buscou a conscientização dos funcionários de um hospital geral para a anemia e seu impacto nos desfechos clínicos, oque em última análise reflete-se na prática junto aos pacientes

Wildland firefighting is physically and mentally demanding. The aerobic capacity of firefighters is important due to the demands of the activity and the associated occupational risks. The main objectives of this study were to identify and characterise the physically demanding tasks undertaken by volunteer firefighters during wildland fires (real work conditions). A total of 125 firefighters replied to a survey about sociodemographic, biometric data, and work fitness assessment. A group of 23 was evaluated in a physical stress test using a VO2peak protocol to determine maximum oxygen consumption and ventilatory thresholds. The physical demands and physiological responses were collected during the operations at the firefront (n = 21). The results revealed that wildland firefighting entails physical demands that exceed established reference values, with maximum oxygen uptake exceeding 40%. The cardiovascular strain is particularly notable in tasks performed near the firefront, reflecting fatigue. The physical and cardiac demands associated with forest fire fighting have been demonstrated to contribute to occupational illnesses with prolonged exposure. This study underscores the imperative for interventions to enhance the identification and real-time monitoring of physiological parameters to enhance firefighters’ overall health and well-being.

Background and Clinical Significance: A brain abscess, defined as a localized intracranial infection that evolves into a purulent collection encased by a vascularized capsule, has higher prevalence among immunocompromised populations. Patients with sickle cell disease (SCD) are particularly vulnerable to bacterial infections due to their compromised immune systems, increasing their susceptibility to pathogens like Salmonella. While Salmonella is typically associated with gastroenteritis, osteomyelitis, and septicemia, its involvement in brain abscesses is exceedingly rare. There are few documented cases of Salmonella brain abscesses in the general population, and among patients with SCD, only one such case has been reported to date. In this report, we describe the second known case of a brain abscess caused by Salmonella infection in a patient with sickle cell disease, contributing to the limited literature on this rare and life-threatening condition. Case Presentation: A 32-year-old African American woman with sickle cell disease presented to the ER after a generalized seizure, reporting two weeks of worsening headaches, fevers, and left upper extremity weakness. Imaging revealed a right frontoparietal brain abscess, which was surgically drained, and cultures identified Salmonella enterica. After antibiotic treatment and a 23-day hospital stay, she was discharged. Four months later, she returned with another seizure during a sickle cell crisis, but follow-up MRI showed only minor scarring, and she was discharged on anticonvulsant therapy. Conclusions: This case emphasizes that Salmonella infections, though typically linked to osteomyelitis and sepsis, can also cause brain abscesses in immunocompromised patients like those with sickle cell disease. It highlights the need to consider infections alongside vascular causes in acute neurological cases and underscores the value of a multidisciplinary approach in managing such complex conditions.

An isotope synthesis of 1257 global lakes revealed on average 20% of inflow is lost to evaporation, but 10% of Earth’s lakes show extreme evaporative losses. Stable water isotope monitoring is an effective way to detect comparative climatic and catchment-scale impacts on lake water-balance budgets.

Abstract Background To describe the spontaneous closure of a degenerative lamellar macular hole with epiretinal proliferation (LHEP) as documented with tracked spectral domain optical coherence tomography (SD-OCT). Case presentation A 54-years-old diabetic female patient presented with progressive vision loss in the left eye. SD-OCT illustrated LHEP associated with cystic fluid in the outer nuclear layer. Sequentially tracked SD-OCT showed progressive closure of the degenerative lamellar macular hole and resolution of the CME over almost 4 years, in the absence of any surgical intervention. Discussion/conclusion LHEP may represent a specialized form of degenerative epiretinal membrane associated with Muller cell activation. Spontaneous degenerative LMH closure may rarely occur with these lesion types, in the absence of surgical intervention, possibly due to Muller cell proliferation preceded by PVD.

The aim of the present studies were to evaluate the effects of treatments with essential oil emulsion on the sanitary and physiological quality of creole corn seeds. In the studies were evaluated the essential oils of neem (Azadirachta indica), citronella (Cymbopogon nardus), lemon balm (Cymbopogon citratus), melissa (Melissa officinalis L.), and the combinations neem-citronella, neem-lemon balm, neem-melissa, citronella-lemon balm, citronella-melissa and lemon balm-melissa. The tests carried out were germination, length of seedlings (aerial part and root), dry mass and pathology for Fusarium sp and Aspergillus sp, in seeds of creole corn produced without the use of synthetic pesticides. The studies were carried out in vitro and consisted of the preparation of water emulsion, 5,000 ppm of essential oil and 1% of triton X100 and direct application on the seeds of creole corn, following the protocol of Rules of Seed Analysis (RSA). The results showed a significant decrease in the occurrence of fungi Fusarium sp and Aspergillus sp with treatment with essential oils of citronella, lemon balm and melissa, while the oil of neither reduced the occurrence of Fusarium sp, but increased the occurrence of Aspergillus sp in almost four times. All binary combinations of essential oils reduced the occurrence of both fungi. On the other hand, the physiological quality was strongly affected by the death of creole corn seeds, except for the treatment with lemon balm essential oil. Therefore, these studies allow to affirm that essential oils can be efficient in the control of pathogens, however they can kill the seeds of creole corn.

The space-for-time substitution approach provides a valuable empirical assessment to infer temporal effects of disturbance from spatial gradients. Applied to predict the response of different ecosystems under current climate change scenarios, it remains poorly tested in microbial ecology studies, partly due to the trophic complexity of the ecosystems typically studied. The McMurdo Dry Valleys (MDV) of Antarctica represent a trophically simple polar desert projected to experience drastic changes in water availability under current climate change scenarios. We used this ideal model system to develop and validate a microbial space-for-time sampling approach, using the variation of geochemical profiles that follow alterations in water availability and reflect past changes in the system. Our framework measured soil electrical conductivity, pH, and water activity in situ to geochemically define 17 space-for-time transects from the shores of four dynamic and two static Dry Valley lakes. We identified microbial taxa that are consistently responsive to changes in wetness in the soils and reliably associated with long-term dry or wet edaphic conditions. Comparisons between transects defined at static (open-basin) and dynamic (closed-basin) lakes highlighted the capacity for geochemically defined space-for-time gradients to identify lasting deterministic impacts of historical changes in water presence on the structure and diversity of extant microbial communities. We highlight the potential for geochemically defined space-for-time transects to resolve legacy impacts of environmental change when used in conjunction with static and dynamic scenarios, and to inform future environmental scenarios through changes in the microbial community structure, composition, and diversity.

Covid-19 is an infectious disease caused by a coronavirus. In Brazil, the first cases arrived via the airports of the city of São Paulo and spread throughout the country. In this paper maps of the Southern region allow the visualization of COVID-19 cases by municipality, cumulative cases, cumulative deaths, incidence rate of cases per 100,000 inhabitants (relationship between cases and population of the municipality) and the case-fatality rate (relationship between the number of deaths and the number of people infected). The maps indicate that the highest concentrations occur on a few sections of the road network, mainly along the BR-386 motorway, which connects Carazinho - RS to Porto Alegre - RS, of the Freeway motorway, which connects the capital from the State to the beaches, and BR-101, one of the most important of the north-south link. Although not conclusive, the diagrams presented can be used to plan emergency actions for the disease.

PURPOSE: Gastric cancer (GC) is the fourth most common cancer and the second leading cause of cancer death worldwide. Platinum agents and fluoropyrimidines are the main compounds used in the first-line setting for advanced GC. Given the activity of fluorouracil (FU) bolus, the PFL protocol, a chemotherapy regimen combining cisplatin, FU bolus, and leucovorin, was incorporated at the Brazilian National Cancer Institute, because this schedule does not require hospitalization or infusion pumps. This study aims to evaluate the outcomes of PFL in the first-line setting for patients with advanced GC. MATERIALS AND METHODS: This was a retrospective cohort study evaluating patients with advanced GC treated in the first-line setting with cisplatin 80 mg/m2 on day 1 and FU bolus 400 mg/m2 plus leucovorin 20 mg/m2 on days 1, 8, 15, and 22 every 4 weeks, from January 2008 to December 2014. RESULTS: A total of 109 patients were enrolled. The median number of cycles received per patient was four (one to 11). Complete responses were achieved in 6.4% and partial responses in 14.7%. Median progression-free survival was 6.3 months (95% CI, 5.08 to 7.58 months) and median overall survival was 8.3 months (95% CI, 6.79 to 9.87 months). Thirty-four (31.2%) patients were alive in 1 year. Grade 3 and 4 adverse events were experienced by 26.6% and 3.7% of patients, respectively, with dose reduction necessary in 9.1%. CONCLUSION: PFL is active in advanced GC and could be an alternative for FU continuous infusion protocols in institutions with limited resources and/or low budget, which is the reality in many nations all over the world.

In an attempt to assist the recovery of the panmictic population of the European eel, declining since the late 1980s, the restocking of areas with low or no natural recruitment has been one of the measures adopted to reverse this trend. However, the main focus in several monitoring programmes for these actions, has been in the best interest of its viability and cost/benefit relationships and, for that, the condition of the released stocks has been the main concern. Yet, so far, no studies have assessed the potential ecological impacts that restocking might have on other biological communities. This pioneer pilot study aimed to evaluate the early ecological impact of a restocking event on other biological communities, considering inter-specific competition (other fish species) and feeding impact (macroinvertebrates).The reference condition of the biological communities of an inland tributary of the Mondego river, the River Ceira, was determined in three sites inaccessible to the natural recruitment of eels, followed by a post-stocking assessment. The results showed no significant changes in the fish assemblages in restocked areas, contrary to the macroinvertebrate community. However, the ecological status for the macroinvertebrate community showed no deleterious effects, with the results suggesting exactly the opposite. This may be related to the low density of the restocked eels and factors influencing the local trophic web. This study confirms the suitability of the habitat for restocking with glass eels, during its early stages, without disrupting the local ecological status, using densities close to those of natural recruitment. Keywords: Stocking, Elvers, Competition, Trophic disruption, Macroinvertebrates, Fish species, Inland tributary, Mondego basin

Abstract Background Sudden visual loss and optic disc edema caused by optic neuritis (ON) is usually followed by significant visual recovery. However, little or no recovery occurs when the loss is caused by atypical ON, especially in patients with neuromyelitis optica (NMO). Optic disc drusen (ODD) is a cause of pseudo optic disc edema and may be a predisposing factor for non-arteritic anterior ischemic optic neuropathy (NAION), thereby mimicking atypical ON. In such cases, if globular concretions are seen protruding from the disc substance, ODD may be suspected. The purpose of this paper is to describe two patients with acute visual loss followed by optic disc atrophy initially labeled as atypical ON. Though not suspected on clinical examination, optical coherence tomography (OCT) revealed deeply buried ODD as a predisposing factor for NAION. Case presentations Case 1: A 48-year-old woman had bilateral sequential visual loss associated with optic disc edema. Despite treatment, vision did not improve and severe disc pallor ensued. Atypical ON was suspected. Eventually, she was started on immunosuppressant therapy based on a tentative diagnosis of NMO-spectrum disorder. On examination 5 years later, only severe optic disc pallor was observed, but OCT radial B-scans showed ovoid hyporeflective areas in the retrolaminar region of both eyes, compatible with ODD; this led to a diagnosis of NAION and deeply buried ODD. Case 2. A 35-year-old woman with suspicion of ON in the left eye and a history of previous atypical ON in the right eye was referred for neuro-ophthalmic examination which revealed diffuse optic disc pallor and a dense arcuate visual field defect in the right eye. OCT B-scans passing through the disc showed large ovoid areas of reduced reflectivity in the retrolaminar region of the optic disc in the right eye. These findings helped confirm the diagnosis of NAION in one eye, with deeply buried ODD as predisposing factor. Conclusions Deeply buried ODD may be associated with NAION causing irreversible visual loss and optic disc pallor, a condition easily mistaken for atypical ON. Awareness of such occurrence is important to avoid unnecessary testing and minimize the risk of mismanagement.

The development of more economically and energy-efficient processes for the sustainable production of fuels and chemicals is becoming increasingly necessary. In this context, it is relevant to understand the behaviour of thermal degradation of different biomasses in oxygen free atmosphere to investigate the breakdown of polymer chains, which can be converted into new products. Good effects on the acceleration of degradation of organic molecules can be achieved with the use of catalysts in these breaking processes, thus increasing the yield of bio-oil production. In this work, fiber of crushed and sifted green coconut shell, submitted to thermogravimetry analysis (TG), was used as biomass. Some types of a catalyst were incorporated into the biomass, based on cobalt ferrite, Fe2CoO4. The design of a biomass pyrolysis reactor requires knowledge of kinetic parameters, activation energy (Ea), pre-exponential factor (k0) and order of reaction (n). In this context, the present study aimed to perform the thermogravimetric (TG) analysis in an inert atmosphere of pure nitrogen, and to determine the kinetic parameters involved in the lignin pyrolysis process, to assist in the design of biomass conversion reactors. This work presents a solution to obtain the kinetic parameters for thermogravimetric reaction of lignin breaking present in the biomass of the green coconut. Two computational methods were used: genetic algorithm and particle swarm optimization. The results obtained for activation energy, pre-exponential factor and order reaction are in the range of values found in the literature.