Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries: A prospective analysis of the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR) data / 中华创伤杂志(英文版)

PURPOSE@#To identify risk factors for developing pressure ulcers (PUs) in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries (SCIs).@*METHODS@#Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran (NSCIR-IR) from individuals with traumatic spinal fractures with or without SCIs, inclusive of the hospital stay from admission to discharge. Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay. The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification. In addition to PU, following data were also extracted from the NSCIR-IR datasets during the period of 2015 - 2021: age, sex, Glasgow coma scale score at admission, having SCIs, marital status, surgery for a spinal fracture, American Spinal Injury Association impairment scale (AIS), urinary incontinence, level of education, admitted center, length of stay in the intensive care unit (ICU), hypertension, respiratory diseases, consumption of cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI).@*RESULTS@#Altogether 2785 participants with traumatic spinal fractures were included. Among them, 87 (3.1%) developed PU during their hospital stay and 392 (14.1%) had SCIs. In the SCI population, 63 (16.1%) developed PU during hospital stay. Univariate logistic regression for the whole sample showed that marital status, having SCIs, urinary incontinence, level of education, treating center, number of days in the ICU, age, and Glasgow coma scale score were significant predictors for PUs. However, further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center, marital status, having SCIs, and the number of days in the ICU. For the subgroup of individuals with SCIs, marital status, AIS, urinary incontinence, level of education, the treating center, the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis. After adjustment in the multivariate model, the treating center, marital status (singles vs. marrieds, OR = 3.06, 95% CI: 1.55 - 6.03, p = 0.001), and number of days in the ICU (OR = 1.06, 95% CI: 1.04 - 1.09, p < 0.001) maintained significance.@*CONCLUSIONS@#These data confirm that individuals with traumatic spinal fractures and SCIs, especially single young patients who suffer from urinary incontinence, grades A-D by AIS, prolonged ICU stay, and more extended hospitalization are at increased risk for PUs; as a result strategies to minimize PU development need further refinement.

Troponina I de alta sensibilidad para el descarte temprano del infarto agudo de miocardio / High sensitivity troponin I to early rule out for acute myocardial infarction

Resumen Introducción: La mayor utilidad de las troponinas de alta sensibilidad (Tn-hs) es descartar tempranamente el infarto agudo de miocardio (IAM). El algoritmo recomendado por la guía de práctica clínica (GPC) del Ministerio de Salud de Colombia para descartar el IAM es respaldado por evidencia de baja calidad y no ha sido validado en población colombiana. Objetivo: evaluar la capacidad de este algoritmo empleando troponina I de alta sensibilidad (TnI-hs) para descartar el IAM sin elevación del segmento ST (IAMSEST). Métodos: se analizaron pacientes con sospecha de síndrome coronario agudo (SCA) atendidos en un servicio de urgencias de un centro de alta complejidad. El desenlace primario fue el diagnóstico de IAMSEST tipo 1 y tipo 4b. Se determinaron las características operativas para los puntos de corte del algoritmo para el desenlace primario, reingreso hospitalario y muerte a 30 días. Resultados: se incluyeron 2.282 pacientes en los que el desenlace primario ocurrió en 389. El algoritmo de la GPC colombiana tuvo S del 90,9% (IC 95%: 74-100) y VPN del 99% (IC 95%: 99-100) utilizando el percentil 99 (p99) no discriminado por sexo, pero tanto la S como el VPN mejoraron al 100% cuando se utilizó el p99 por sexo. Conclusión: el algoritmo recomendado por la GPC colombiana utilizando TnI-hs y con el p99 ajustado por sexo tiene excelente capacidad para descartar de manera temprana y segura el diagnóstico de IAMSEST.

Abstract Introduction: The greatest utility of high-sensitivity troponins (Tn-hs) is to rule out acute myocardial infarction (AMI) early. The algorithm recommended by the Colombian practice guideline clinical (CPG) of Health’s Ministry to rule out AMI is supported by low-quality evidence and has not been validated in the Colombian population. This research aims to evaluate the ability of this algorithm using high sensitivity troponin I (TnI-hs) to rule out AMI without ST segment elevation (STEMI). Methods: Patients with suspected acute coronary syndrome (ACS) treated in an emergency department of a highly complex center were analyzed. The primary outcome was the diagnosis of STEMI type 1 and type 4b. The operativing characteristics for the algorithm cut-off points were determined for the primary outcome, hospital readmission death at and 30 days. Results: 2282 patients were included in whom the primary outcome occurred in 389. The Colombian CPG algorithm had S of 90.9% (95% CI 74-100) and NPV of 99% (95% CI 99-100) using the 99th percentile (p99) not discriminated by sex, but both S and NPV improved 100% when p99 was used by sex. Conclusion: The algorithm recommended by the Colombian CPG using TnI-hs and with the p99 adjusted for sex has an excellent capacity to rule out early and safely the diagnosis of STEMI.

Mielopatía cervical degenerativa: una patología cada vez más frecuente y que requiere diagnóstico y manejo precoz / Degenerative cervical myelopathy

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Its prevalence is increasing as a result of population aging. The diagnosis of DCM is often delayed or overlooked, resulting in secondary neurologic morbidity. The natural course of DCM typically presents as a gradual neurological deterioration, with symptoms ranging from muscle weakness to complete paralysis, with variable degrees of sensory deficits and sphincter dysfunction. Magnetic resonance imaging (MRI) and electrophysiological studies allow the assessment of spinal cord function and its structural damage to determine treatment and clinical outcomes. All patients with signs and symptoms consistent with DCM should be referred to a spine surgeon for assessment and tailored treatment. Those patients with mild DCM can be managed non-operatively but require close monitoring and education about potentially alarming signs and symptoms. Surgery is not currently recommended for asymptomatic patients with evidence of spinal cord compression or cervical spinal stenosis on MRI, but they require a structured follow-up. Patients with moderate or severe DCM require surgical decompression to avoid further progression. The objective of this review is to raise awareness of degenerative cervical myelopathy and its increasing prevalence as well as to aid non-surgical healthcare workers for a timely diagnosis and management of this disabling condition.

The correlation of population, population density, age, and sex to the number of confirmed cases of COVID-19 among local government units in the National Capital Region / The Health Sciences Journal

INTRODUCTION@#The NCR had amassed 752,668 cases of COVID-19 as of September 2021, the highest among the regions in the Philippines. This study aimed to determine the correlation between population, population density, age, and sex with the number of cases among local government units (LGU) in the National Capital Region (NCR).@*METHODS@#The data for population, population density, age, and sex distribution of the LGUs of NCR were retrieved from the 2015 Philippine census while the data for cases were from DOH’s COVID-19 Tracker. Pearson correlation coefficient was computed to determine the correlation between population, population density and cases. Phi and Cramer’s V statistic were computed to determine associations between sex, age groups, and cases.@*RESULTS@#There was little or no correlation between population density and number of cases (r = 0.236) but was good (r = 0.905) when Quezon City was excluded for being an outlier. There was good correlation between population and number of cases (r = 964, p < 0.001). There was very weak to no association between sex and number of COVID-19 cases. There was a statistically significant moderate association between age and COVID-19 cases (f = 0.145, p < 0.001).@*CONCLUSION@#The study has shown that population density and population have a good correlation with the number of COVID-19 after Quezon City was removed as a data point. There is a moderate association between age and number of COVID-19 cases. There is a very weak to no association between sex and COVID-19 cases.

Serratia marcescens healthcare-associated ventriculitis and cerebral abscess in a neonate with chiari II malformation: A case report and systematic review

@#<p style="text-align: justify;">Serratia marcescens is a recognized nosocomial opportunistic pathogen but rarely caused central nervous system infection especially in the neonates. Outbreaks have been documented in the neonatal intensive care units (NICU) and a higher incidence among those with surgical procedures. This review aims to describe a neonate with nonleaking lumbosacral myelomeningocele presenting with multiple pyogenic brain abscesses caused by S. marcescens admitted in a NICU. This review also presents a concise literature review discussing the potential risk factor involved, diagnostic measures and therapeutic possibilities. We present a neonate with Chiari II malformation admitted in the NICU developing S. marcescens ventriculitis after a lumbosacral myelomeningocele repair. With an empiric treatment of meropenem for one week, repeat ventricular cerebrospinal fluid analysis worsened and developed cerebral abscess as detected using cranial ultrasound. Ciprofloxacin was added and completed for six weeks with improved neurologic status. On a 6-month follow-up, sensorineural hearing loss, focal epilepsy and developmental delay were documented. A systematic review showed that prematurity and NICU outbreaks were among the most common risk factors for the central nervous system involvement of S. marcescens. Meropenem remains to be the antibiotic of choice adjunct with timely neurosurgical intervention. Brain abscess showed the worst prognosis among the neurologic sequelae.</p>

Assessing extinction risk from geographic distribution data in Neotropical freshwater fishes

The IUCN Red List (RL) provides high-quality conservation assessments for individual species, yet the rate and scale of environmental deterioration globally challenges the conservation community to develop expedited methods for risk assessment. Here we compare threat assessments for 3,001 species of Neotropical freshwater fishes (NFF) in the IUCN-RL using readily accessible data types as proxies for extinction risk: geographic range, elevation, and species publication date. Furthermore, using geographic and taxonomic data alone, we generated preliminary conservation assessments for 2,334 NFF species currently awaiting IUCN assessment, identifying an additional 671 NFF species as potentially threatened. This number of potentially threatened species represents an increase of 59% over the number of species currently assigned to threat categories by the IUCN-RL. These results substantially expand the number of threatened NFF species from 422 currently on the IUCN RL to 1,093 species as threatened or potentially threatened, representing about 18% of all NFF species. Extinction risk is greater in species with smaller geographic ranges, which inhabit upland rivers, and which were described more recently. We propose the Central and Southern Andes, and Eastern Guiana Shield as priorities in the upcoming IUCN RL assessment of NFF species conservation risk.(AU)

A Lista Vermelha (IUCN) fornece avaliações precisas sobre status de conservação das espécies, porém a taxa e escala de deterioração ambiental desafia a comunidade conservacionista a desenvolver métodos rápidos para avaliações de riscos de extinção. Aqui, comparamos as avaliações da IUCN para 3.001 espécies de peixes dulcícolas neotropicais com dados facilmente acessíveis de risco de extinção: extensão de ocorrências, altitude e data de publicação das espécies. Além disso, usando apenas dados geográficos e taxonômicos, geramos avaliações preliminares de conservação para 2.334 espécies de peixes neotropicais aguardando avaliação da IUCN, e identificamos 671 espécies adicionais como potencialmente ameaçadas. Este número de espécies potencialmente ameaçadas representa um aumento de 59% em relação aquelas classificadas nas categorias de ameaça pela IUCN. Estes resultados expandem o número de espécies ameaçadas segundo a IUCN de 422 para 1.093 espécies ameaçadas ou potencialmente ameaçadas, representando cerca de 18% das espécies de peixes neotropicais. O risco de extinção é maior para espécies com distribuições geográficas restritas, que habitam rios de terras altas e que foram descritas mais recentemente. Sugerimos a região Central e Meridional do Andes e o Escudo das Guianas Orientais como prioridades para as próximas avaliações da IUCN sobre a conservação das espécies de peixes dulcícolas neotropicais.(AU)

Péptidos natriuréticos en la detección de disfunción ventricular izquierda en población de alto riesgo. Metaanálisis de pruebas diagnósticas / Natriuretic peptides in the detection of left ventricular dysfunction in a high risk population. A meta-analysis of diagnostic tests

Resumen Introducción: Las concentraciones de los péptidos natriuréticos en el plasma se han propuesto como un método de tamización para disfunción ventricular temprana. Objetivo: Comparar las características operativas del péptido natriurético tipo B (BNP) y de la fracción N-terminal (NT-proBNP) en población con factores de riesgo. Método: Metaanálisis de pruebas diagnósticas. Resultados: Se aplicó una estrategia de búsqueda mediante la cual se encontraron 86 referencias, de las cuales se seleccionaron 12 por criterios de inclusión. En 8 de estos estudios se evaluó el desempeño del BNP, en 3 el NT-proBNP y en uno ambas pruebas. Los puntos de corte para el BNP oscilaron entre 8 y 169,5 pg/ml, con una sensibilidad agrupada de 82,1% (IC 95%, 76,7-86,4%), una especificidad agrupada de 69% (IC 95%, 61,5-75,6%), un LR+ 2,65 (IC 95%, 2,17-3,23) y un LR( 0,26 (IC 95%, 0,21-0,32). Cuando solo se analizaron los datos para puntos de corte por debajo de 50 pg/ml la sensibilidad agrupada mejoró a 89,2% (IC 95%, 82,6-94%) y el LR( fue 0,23 (IC 95%, 0,14-0,40). Solo se analizaron 3 estudios sobre NT-proBNP, con puntos de corte entre 125 y 902 pg/ml, con sensibilidad agrupada del 97,2% (IC 95%, 90,2-99,7%), especificidad agrupada del 76,9% (IC 95%, 74,5-79,1%), LR+ 3,39 (IC 95%, 1,67-6,85) y LR( 0,07 (IC 95%, 0,02-0,23). Conclusión: El BNP y el NT-proBNP pueden ser útiles para descartar disfunción ventricular izquierda asintomática en pacientes en riesgo.

Abstract Introduction: The concentration of natriuretic peptides in plasma has been proposed as a screening method for early ventricular dysfunction. Objective: To compare the operative characteristics of B-type natriuretic peptide (BNP) and N-terminal pro b-type natriuretic peptide (NT-proBNP) fraction in a population with risk factors. Method: A meta-analysis of diagnostic tests. Results: A search strategy was applied that found 86 references, of which 12 were selected according to the inclusion criteria. The role of BNP was evaluated in 8 of these studies, that of NT-proBNP in 3, and both tests in one of them. The cut-off points for BNP varied between 8 and 169.5 pg/mL, with a grouped sensitivity of 82.1% (95% CI; 76.7-86.4%), a grouped specificity of 69% (95%CI; 61.5-75.6%), a positive likelihood ratio (LR+) of 2.65 (95% CI; 2.17-3.23) and a negative likelihood ratio (LR() of 0.26 (95% CI; 0.21-0.32). When the data were only analysed for cut-off points below 50 pg/mL, the grouped sensitivity improved to 89.2% (95% CI; 82.6-94%), and the LR( was 0.23 (95% CI; 0.14-0.40). Only 3 studies on NT-proBNP were analysed, with cut-off points between 125 and 902 pg/mL, a grouped specificity of 97.2% (95% CI; 90.2-99.7%), a grouped sensitivity of 76.9% (95% CI; 74.5-79.1%), LR+ 3.39 (95% CI; 1.67-6.85), and LR( 0.07 (95% CI; 0.02-0.23). Conclusion: BNP and NT-proBNP can be useful in ruling out asymptomatic left ventricular dysfunction in patients at risk.

Pituitary tumor resection in a patient with SARS-CoV-2 (COVID-19) infection. A case report and suggested airway management guidelines / Assistência perioperatória de paciente com infecção pelo SARS-CoV-2 (COVID-19) submetido a ressecção de tumor de hipófise urgente. Relato de caso e diretrizes para manejo de via aérea

Abstract The 2020 pandemic caused by the novel coronavirus, COVID-19, had its headquarters in China. It causes Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and presents a broad spectrum of clinical manifestations, ranging from entirely asymptomatic through severe acute respiratory failure and death. Presuming a significant quantity of ventilator-dependent patients, several institutions strategically delayed elective surgeries. Particularly procedures performed involving the nasal mucosa, such as a transsphenoidal approach of the pituitary gland, considering the tremendous level of viral shedding. Nevertheless, critical cases demand expeditious resolution. Those situations are severe pituitary apoplexy, declining consciousness level, or risk of acute visual loss. This case presents a successful urgent perioperative management of a 47 year-old male COVID-19 positive patient who presented to the Emergency Department with a left frontal headache that culminated with diplopia, left eye ptosis, and left visual acuity loss after 5 days. Transsphenoidal hypophysectomy was uneventfully performed, and the patient was discharged from the hospital on postoperative day four. It additionally describes in detail the University of Mississippi Medical Center airway management algorithm for patients infected with the novel coronavirus who need emergent surgical attention.

Resumo A pandemia de 2020 causada pelo novo coronavírus, COVID-19, teve seu epicentro na China. Causa Síndrome Respiratória Aguda Grave pelo Coronavírus 2 (SARS-CoV-2) e apresenta um amplo espectro de manifestações clínicas, que vão desde nenhum sintoma a insuficiência respiratória aguda grave e óbito. Com a expectativa de um número significativo de pacientes dependentes de ventilador, várias instituições estrategicamente adiaram cirurgias eletivas. Esse é o caso principalmente de procedimentos envolvendo a mucosa nasal, como a via transesfenoidal para a hipófise, devido ao nível imenso de disseminação de material viral. Não obstante, casos críticos requerem resolução acelerada. Essas situações são grave apoplexia hipofisária, diminuição do nível de consciência ou risco de perda visual aguda. O presente caso relata o manejo perioperatório bem sucedido de urgência de paciente do sexo masculino de 47 anos de idade com COVID-19 que chegou ao Pronto Socorro com cefaleia frontal à esquerda que culminou com diplopia, ptose do olho esquerdo e perda de acuidade visual à esquerda após 5 dias. A hipofisectomia transesfenoidal ocorreu sem intercorrências e o paciente recebeu alta do hospital no quarto dia do pós-operatório. Adicionalmente, descrevemos em detalhe o algoritmo de manejo de via aérea da University of Mississippi Medical Center para pacientes infectados pelo novo coronavírus e que necessitam de atenção cirúrgica de emergência.

Using community phylogenetics to assess phylogenetic structure in the Fitzcarrald region of Western Amazonia

Here we explore the use of community phylogenetics as a tool to document patterns of biodiversity in the Fitzcarrald region, a remote area in Southwestern Amazonia. For these analyses, we subdivide the region into basin-wide assemblages encompassing the headwaters of four Amazonian tributaries (Urubamba, Yuruá, Purús and Las Piedras basins), and habitat types: river channels, terra firme (non-floodplain) streams, and floodplain lakes. We present a robust, well-documented collection of fishes from the region including 272 species collected from 132 field sites over 63 field days and four years, comprising the most extensive collection of fishes from this region to date. We conduct a preliminary community phylogenetic analysis based on this collection and recover results largely statistically indistinguishable from the random expectation, with only a few instances of phylogenetic structure. Based on these results, and of those published in other recent biogeographic studies, we conclude that the Fitzcarrald fish species pool accumulated over a period of several million years, plausibly as a result of dispersal from the larger species pool of Greater Amazonia.(AU)

Aquí exploramos el uso de la filogenética de comunidades como herramienta para documentar patrones de biodiversidad en la región de Fitzcarrald, un área remota en el suroeste de la Amazonía. Para estos análisis subdividimos la región en grupos de toda la cuenca que abarcan las cabeceras de cuatro tributarios del Amazonas (cuencas Urubamba, Yuruá, Purús y Las Piedras) y en los tipos de hábitat: canales fluviales, arroyos de tierra firme (sin planicie aluvial) y lagos de planicie aluvial. Presentamos una colección de peces robusta y bien documentada que incluye 272 especies, colectadas a lo largo de cuatro años y 63 días de campo, en 132 puntos de monitoreo. Convirtiéndose en la colección más extensa de peces de esta región hasta la fecha. Realizamos un análisis filogenético preliminar de la comunidad basado en esta recopilación y recuperamos resultados en gran medida estadísticamente indistinguibles de la expectativa aleatoria, con sólo unos pocos casos de estructura filogenética. Basándonos en estos resultados y los publicados en otros estudios biogeográficos recientes, concluimos que el grupo de especies de peces de Fitzcarrald acumulado durante un período de varios millones de años, se debe posiblemente al resultado de la dispersión del mayor grupo de especies de la Gran Amazonia.(AU)

Genetic differentiation through dispersal and isolation in two freshwater fish species from coastal basins of Northeastern Brazil

The coastal basins in Northeastern Brazil used in this study make up two different ecoregions for freshwater fishes (Amazonas estuary and coastal drainages, and Parnaiba) and two areas of endemism for Characiformes (Maranhão and Parnaíba), and exhibits a diversified yet poorly explored freshwater fish fauna. The population structure and biogeography of two migratory freshwater fish species that are commercially exploited from Maranhão and Parnaíba regions were herein analyzed. Molecular sequence data and statistical analyses were used to estimate haplotypes networks and lineage divergence times and correlated with hydrographic history of drainage and paleodrainages of the region. A total of 171 sequences was produced for both species, Schizodon dissimilis (coI, n = 70) and Prochilodus lacustris (D-loop, n = 101). All analyses identified the presence of three genetically delimited groups of S. dissimilis and six groups of P. lacustris. The lineage time analyses indicate diversification among these species within the past 1 million year. The results indicate the influence of geodispersal in the formation of the ichthyofauna in the studied area through headwater stream capture events and reticulated connections between the mouths of rivers along the coastal plain due to eustatic sea level fluctuations.(AU)

As bacias costeiras do nordeste do Brasil usadas neste estudo compõem duas ecorregiões diferentes para peixes de água doce (Estuário do Amazonas e drenagens costeiras e Parnaíba) e duas áreas de endemismo para Characiformes (Maranhão e Parnaíba), exibindo uma diversificada e ainda pouco explorada fauna de peixes de água doce. A estrutura populacional e biogeografia de duas espécies migradoras de peixes de água doce exploradas comercialmente nas regiões do Maranhão e Parnaíba foram analisadas. Dados de sequências moleculares e análises estatísticas foram utilizados para estimar redes de haplótipos e tempos de divergência entre linhagens, e foram correlacionados com a história hidrográfica das drenagens e paleodrenagens da região. Um total de 171 sequências foram geradas para ambas espécies, Schizodon dissimilis (coI, n = 70) e Prochilodus lacustris (D-loop, n = 101). Todas análises identificaram a presença de três grupos geneticamente delimitados para S. dissimilis e seis grupos para P. lacustris. A análise de tempo de divergência das linhagens indicou uma diversificação entre estas espécies nos últimos 1 Ma. Os resultados indicam influência da geodispersão na formação da ictiofauna do Maranhão, devido eventos de capturas de cabeceira e conexões reticuladas entre as fozes dos rios ao longo da planície costeira devido às flutuações eustáticas do nível do mar.(AU)

A redescription of deep-channel ghost knifefish, Sternarchogiton preto (Gymnotiformes: Apteronotidae), with assignment to a new genus

From a study of morphological and molecular datasets we determine that a species originally described as Sternarchogiton preto does not form a monophyletic group with the other valid species of Sternarchogiton including the type species, S. nattereri. Previously-published phylogenetic analyses indicate that this species is sister to a diverse clade comprised of six described apteronotid genera. We therefore place it into a new genus diagnosed by the presence of three cranial fontanels, first and second infraorbital bones independent (not fused), the absence of an ascending process on the endopterygoid, and dark brown to black pigments over the body surface and fins membranes. We additionally provide a redescription of this enigmatic species with an emphasis on its osteology, and provide the first documentation of secondary sexual dimorphism in this species.(AU)

RESUMO Através de um estudo com dados morfológicos e moleculares, nós propomos que a espécie originalmente descrita como Sternarchogiton preto não forma um grupo monofilético com outras espécies válidas de Sternarchogiton incluindo a espécie-tipo, S. nattereri. Análises filogenéticas anteriormente publicadas indicam que essa espécie é irmã de um clado diverso contendo seis gêneros descritos de Apteronotidae. Nós então a alocamos em um novo gênero diagnosticado pela presença de três fontanelas craniais, primeiro e segundo ossos infraorbitais independentes (não fusionados), ausência de um processo ascendente do endopterigoide e pigmentação marrom-escura à negra sobre a superfície do corpo e membranas das nadadeiras. Adicionalmente, nós realizamos a redescrição dessa enigmática espécie com ênfase na sua osteologia, e fazemos o primeiro registro de dimorfismo sexual secundário nessa espécie.(AU)

The Perception of Residents of Makurdi, Benue State, Nigeria about the Veterinary Profession

Veterinary medicine is the medical science that is concerned with the diagnosis, treatment, prevention and control of diseases, disorders and injuries of animals. A questionnaire-based study was conducted to investigate the perception of Nigerians resident in Makurdi city about the veterinary profession. Makurdi city, located in Central Nigeria, was divided into 10 sub-study areas for the purpose of the survey. Exactly 965 questionnaires were administered randomly to respondents in the study areas and collected immediately they were completed. Data obtained from the study was collated and analyzed using Chi square (statistical package for social sciences, SPSS) and values of P<0.05 were significant. Majority of the respondents (n=936 or 96.99 %) confirmed they had prior knowledge about the identity of a veterinary doctor before the study. Most respondents (P<0.05) strongly agreed that veterinary doctors usually receive more standard professional training than animal scientists. Half of the respondents (n=485 or 50.2%) (P<0.05) strongly agreed that veterinary and human medicine are complimentary in the disease control strategy plan of any nation. Majority of the respondents (P<0.05) either strongly agreed or agreed that ranches should be established for rearing livestock in Nigeria to prevent frequent farmer-herdsmen clashes that have been on the increase in recent times. The significance of these findings and the implication on the development of the livestock industry in Nigeria are discussed.

Incidência, fatores de risco e desfechos da extubação não planejada em pacientes adultos em um hospital de ensino com recursos limitados nas Filipinas: um estudo de coorte / Incidence, risk factors, and outcomes of unplanned extubation in adult patients in a resource-limited teaching hospital in the Philippines: a cohort study

RESUMO Objetivo: Determinar a incidência, os fatores de risco e os desfechos da extubação não planejada em pacientes adultos. Métodos: Conduzimos estudo prospectivo de coorte de pacientes adultos intubados admitidos em ala de atendimento gratuito em um hospital governamental terciário de ensino nas Filipinas. Incluíram-se tanto pacientes em cuidados de terapia intensiva quanto fora dela. Os pacientes foram seguidos até a alta ou até o sétimo dia após a extubação. Resultados: Os desfechos dos 191 pacientes incluídos foram: extubação planejada (35%), extubação não planejada (19%), óbito (39%) e alta a pedido (7%). A regressão de riscos competitivos demonstrou que o sexo masculino (OR bruta de 2,25; IC95% 1,10 - 4,63) e a idade (OR bruta: 0,976; IC95%: 0,957 - 0,996) foram fatores basais significantes. O turno da noite (OR bruta: 24,6; IC95%: 2,87 - 211) também teve associação consistente com maior ocorrência de extubação não planejada. Dentre os desfechos após a extubação, ocorreram significantemente mais, entre os pacientes com extubação não planejada, reintubação (extubação não planejada, com 61,1%, versus extubação planejada, com 25,4%), insuficiência respiratória aguda (extubação não planejada, com 38,9%, versus extubação planejada, com 17,5%) e eventos cardiovasculares (extubação não planejada, com 8,33%, versus extubação planejada, com 1,49%). A admissão à unidade de terapia intensiva não se associou com risco menor de extubação não planejada (OR bruta de 1,15; IC95% 0,594 - 2,21). Conclusão: Muitos pacientes intubados tiveram extubação não planejada. Os pacientes admitidos em outras unidades, que não a de terapia intensiva, não tiveram tendências mais elevadas de extubação não planejada.

ABSTRACT Objective: We aimed to determine the incidence, risk factors, and outcomes of unplanned extubation among adult patients. Methods: We conducted a prospective cohort study of adult intubated patients admitted to the charity wards of a government tertiary teaching hospital in the Philippines. Patients managed in both intensive care and nonintensive care settings were included. Patients were followed-up until discharge or until seven days postextubation. Results: The outcomes of the 191 included patients were planned extubation (35%), unplanned extubation (19%), death (39%), and discharge against advice (7%). Competing risk regression showed that male sex (Crude OR: 2.25, 95%CI: 1.10 - 4.63) and age (Crude OR 0.976, 95%CI: 0.957 - 0.996) were significant baseline factors. The night shift (Crude OR: 24.6, 95%CI: 2.87 - 211) was also consistently associated with more unplanned extubations. Among postextubation outcomes, reintubation (unplanned extubation: 61.1% versus planned extubation: 25.4%), acute respiratory failure (unplanned extubation: 38.9% versus planned extubation: 17.5%), and cardiovascular events (unplanned extubation: 8.33% versus planned extubation: 1.49%) occurred significantly more often among the unplanned extubation patients. Admission in an intensive care unit was not associated with a lower risk of unplanned extubation (Crude OR 1.15, 95%CI: 0.594 - 2.21). Conclusion: Many intubated patients had unplanned extubation. Patients admitted in nonintensive care unit settings did not have significantly higher odds of unplanned extubation.

Historical biogeography of fishes from coastal basins of Maranhão State, northeastern Brazil

The Amazonian ichthyofauna is one of the most diverse in the world, yet fishes from the adjacent coastal basins of Maranhão State in Northeastern Brazil remain poorly known. We use phylogeographic, community phylogenetic and phylogenetic beta diversity methods to study the biogeographic history of fishes from the coastal basins of Maranhão State. We report a total of 160 fish species from the basins of the Maranhão region, representing a 93% increase over results of previous studies. All the fish species assemblages from Maranhão are polyphyletic, with only a few putative sister species pairs inhabiting the region. The modern watershed divides among Maranhão basins do not form substantial barriers to dispersal for freshwater fish species, and are more effectively modelled as biogeographic islands than as biogeographic provinces. In combination these results suggest that the Maranhão ichthyofauna was assembled under the influence of several macroevolutionary (extinction, dispersal) and landscape evolution processes, during the Miocene and Pliocene, as well as by the modern ecological characteristics of the region. The results indicate that the distinctive geological and climatic conditions and history of Northeastern Brazil strongly constrained the formation of aquatic faunas in coastal basins of Maranhão State.(AU)

A ictiofauna da Amazônia é uma das mais diversificadas do mundo, mas os peixes das bacias costeiras adjacentes do estado do Maranhão, no Nordeste do Brasil, ainda são pouco conhecidos. Utilizamos métodos filogeográficos, filogenia de comunidade e de diversidade beta filogenética para estudar a história biogeográfica de peixes das bacias costeiras do estado do Maranhão. Nós relatamos um total de 160 espécies de peixes das bacias da região do Maranhão, representando um aumento de 93% sobre os resultados de estudos anteriores. Todas as assembleias de espécies de peixes do Maranhão são polifiléticas, com apenas alguns supostos pares de espécies irmãs habitando a região. As divisões modernas das bacias hidrográficas do Maranhão não formam barreiras substanciais para a dispersão de espécies de peixes de água doce, e são mais efetivamente modeladas como ilhas biogeográficas do que como províncias biogeográficas. Em conjunto, esses resultados sugerem que a ictiofauna maranhense foi montada sob a influência de vários processos de evolução macroevolutiva (extinção, dispersão) e paisagística, durante o Mioceno e Plioceno, bem como pelas características ecológicas modernas da região. Os resultados indicam que as distintas condições geológicas e climáticas e a história do Nordeste do Brasil restringiram fortemente a formação de faunas aquáticas em bacias costeiras do estado do Maranhão.(AU)

The changing course of the Amazon River in the Neogene: center stage for Neotropical diversification

We review geological evidence on the origin of the modern transcontinental Amazon River, and the paleogeographic history of riverine connections among the principal sedimentary basins of northern South America through the Neogene. Data are reviewed from new geochronological datasets using radiogenic and stable isotopes, and from traditional geochronological methods, including sedimentology, structural mapping, sonic and seismic logging, and biostratigraphy. The modern Amazon River and the continental-scale Amazon drainage basin were assembled during the late Miocene and Pliocene, via some of the largest purported river capture events in Earth history. Andean sediments are first recorded in the Amazon Fan at about 10.1-9.4 Ma, with a large increase in sedimentation at about 4.5 Ma. The transcontinental Amazon River therefore formed over a period of about 4.9-5.6 million years, by means of several river capture events. The origins of the modern Amazon River are hypothesized to be linked with that of mega-wetland landscapes of tropical South America (e.g. várzeas, pantanals, seasonally flooded savannahs). Mega-wetlands have persisted over about 10% northern South America under different configurations for >15 million years. Although the paleogeographic reconstructions presented are simplistic and coarse-grained, they are offered to inspire the collection and analysis of new sedimentological and geochronological datasets.(AU)

Este trabalho é uma revisão das evidências geológicas sobre a origem do moderno rio Amazonas transcontinental, e a história paleogeográfica das conexões ribeirinhas entre as principais bacias sedimentares do norte da América do Sul durante o Neógeno. São revisados novos conjuntos de dados geocronológicos usando isótopos radiogênicos e estáveis, e de métodos geocronológicos tradicionais, incluindo sedimentologia, mapeamento estrutural, exploração sísmica e bioestratigrafia. O atual rio Amazonas e sua bacia continental se formaram durante o final do Mioceno e do Plioceno, através de alguns dos maiores eventos de captura de rio na história da Terra. Os sedimentos andinos são registrados pela primeira vez no leque fluvial do Amazonas por volta de 10,1-9,4 Ma, com um grande aumento na sedimentação a cerca de 4,5 Ma. O rio Amazonas transcontinental, portanto, se formou durante um período de cerca de 4,9 a 5,6 milhões de anos, por meio de vários eventos de captura de rios. Acredita-se que as origens do moderno rio Amazonas estejam ligadas às paisagens de inundação da América do Sul tropical (por exemplo, várzeas, pantanais, savanas sazonalmente inundadas). As áreas pantanosas persistiram em cerca de 10% do norte da América do Sul sob diferentes configurações por mais de 15 milhões de anos. Embora as reconstruções paleogeográficas apresentadas sejam simplistas, elas são oferecidas para inspirar a coleta e análise de novos conjuntos de dados sedimentológicos e geocronológicos.(AU)

Measurement of total phenolic content and antioxidant activity of aerial parts of medicinal plant Coronopus didymus

OBJECTIVE@#To evaluate the total phenolic content and compare the antioxidant activity of various solvent extracts and fractions from the aerial parts of Coronopus didymus through various assays.@*METHODS@#Total phenolic content was determined using the Folin-Ciocalteu assay and the in vitro antioxidant activity of a number of different extracts was investigated in a dose-dependent manner with three different methods: the 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) and ferric reducing antioxidant power (FRAP) assays. A flavone was isolated from the most active ethanolic extract with high antioxidant activity using size exclusion chromatography. IC values were calculated for the DPPH and ABTS methods. The FRAP activity was assessed in terms of μM Fe (II) equivalent.@*RESULTS@#The phenolic content was found to be highest in the ethanol extract (CDA Et; 47.8 mM GAE) and the lowest in the dichloromethane extract (CDA DCM; 3.13 mM GAE). The ethanol extract showed high radical scavenging activity towards DPPH and ABTS radicals with IC values of (7.80 × 10) and (4.32 × 10) μg/mL, respectively. The most active ethanol extract had a FRAP value of 1921.7 μM Fe (II) equivalent. The isolated flavone F10C (5,7,4'-trihydroxy-3'-methoxy flavone) was far more effective for scavenging free radicals in the DPPH and ABTS assays with IC of 43.8 and 0.08 μg/mL, than the standard trolox, with IC values of 97.5 and 21.1 μg/mL, respectively. In addition, the flavone F10C and the standard ascorbic acid had FRAP values of 1621.7 and 16 038.0 μM Fe (II) equivalents, respectively.@*CONCLUSIONS@#The total phenolic content of extracts in decreasing order is ethanol extract (CDA Et) > acetone extract (CDA ACE) > phenolic extract (CDA MW) > n-hexane extract (CDA nHX)> chloroform extract (CDA CHL) > dichloromethane extract (CDA DCM). The ordering of extracts in terms of antioxidant activity from highest to lowest is CDA Et > CDA MW > CDA DCM > CDA CHL > CDA ACE > CDA nHX in DPPH, ABTS and FRAP assays. A significant relationship is found between antioxidant potential and total phenolic content, suggesting that phenolic compounds are the major contributors to the antioxidant activity of C. didymus.

Taxonomic revision of the deep channel electric fish genus Sternarchella (Teleostei: Gymnotiformes: Apteronotidae), with descriptions of two new species

This paper provides a taxonomic revision of the Neotropical electric fish genus Sternarchella, with redescriptions of seven valid species and descriptions of two new species. A maximum parsimony analysis of 76 morphological characters from seven ingroup and seven outgroup taxa recovered a non-monophyletic Sternarchella, in which a clade comprising two species with a ventral mouth (S. orinoco + S. sima) is the sister group to a clade comprising seven species that possess a terminal or superior mouth. Nested within this higher-diversity clade is the genus Magosternarchus (recognized herein as a junior synonym of Sternarchella) comprising M. duccis and M. raptor. The Magosternarchus clade forms a polytomy with S. orthos and S. schotti. Sternarchella calhamazon + a new species from the upper Río Madeira (sister species to S. calhamazon), and a new larger-bodied species from the central and upper Río Amazonas also form a clade. Sternarchella orthos is distributed in both the Amazon and Orinoco basins, where it exhibits considerable phenotypic diversity. Sternarchella orthos includes most specimens from the Amazon formerly assigned to the nominal species S. terminalis (recognized herein as a junior synonym of S. schotti).(AU)

Este artigo propõe uma revisão taxonômica do gênero Neotropical de peixe-elétrico Sternarchella, incluindo a redescrição de sete espécies válidas e duas novas espécies. Análise de máxima parcimônia com 76 caracteres morfológicos e amostragem de sete grupos internos e sete grupos externos indica que Sternarchella não constitui grupo monofilético, sendo um clado composto por duas espécies com bocas ventrais (S. orinoco + S. sima) e outro com sete espécies com bocas terminais ou superiores. Dentro deste último clado estão as espécies do gênero Magosternarchus (reconhecido aqui como um sinônimo júnior de Sternarchella): M. duccis e M. raptor. O clado de Magosternarchus forma uma politomia com S. orthos e S. schotti. Sternarchella calhamazon + uma nova espécie do alto rio Madeira (espécie irmã de S. calhamazon) e uma nova espécie de corpo maior do rio Amazonas central e superior também formam um clado. Sternarchella orthos está distribuída nos rios amazônicos e no Orinoco, onde apresenta elevada diversidade fenotípica. Sternarchella orthos inclui a maioria dos espécimes do rio Amazonas anteriormente atribuídos à S. terminalis (considerada neste estudo como sinônimo júnior de S. schotti).(AU)

Measurement of total phenolic content and antioxidant activity of aerial parts of medicinal plant Coronopus didymus

Objective To evaluate the total phenolic content and compare the antioxidant activity of various solvent extracts and fractions from the aerial parts of Coronopus didymus through various assays. Methods Total phenolic content was determined using the Folin-Ciocalteu assay and the in vitro antioxidant activity of a number of different extracts was investigated in a dose-dependent manner with three different methods: the 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) and ferric reducing antioxidant power (FRAP) assays. A flavone was isolated from the most active ethanolic extract with high antioxidant activity using size exclusion chromatography. IC

Association of EMR Adoption with Minority Health Care Outcome Disparities in US Hospitals / 대한의료정보학회지

OBJECTIVES: Disparities in healthcare among minority groups can result in disparate treatments for similar severities of symptoms, unequal access to medical care, and a wide deviation in health outcomes. Such racial disparities may be reduced via use of an Electronic Medical Record (EMR) system. However, there has been little research investigating the impact of EMR systems on the disparities in health outcomes among minority groups. METHODS: This study examined the impact of EMR systems on the following four outcomes of black patients: length of stay, inpatient mortality rate, 30-day mortality rate, and 30-day readmission rate, using patient and hospital data from the Medicare Provider Analysis and Review and the Healthcare Information and Management Systems Society between 2000 and 2007. The difference-in-difference research method was employed with a generalized linear model to examine the association of EMR adoption on health outcomes for minority patients while controlling for patient and hospital characteristics. RESULTS: We examined the association between EMR adoption and the outcomes of minority patients, specifically black patients. However, after controlling for patient and hospital characteristics we could not find any significant changes in the four health outcomes of minority patients before and after EMR implementation. CONCLUSIONS: EMR systems have been reported to support better coordinated care, thus encouraging appropriate treatment for minority patients by removing potential sources of bias from providers. Also, EMR systems may improve the quality of care provided to patients via increased responsiveness to care processes that are required to be more time-sensitive and through improved communication. However, we did not find any significant benefit for minority groups after EMR adoption.

Association of EMR Adoption with Minority Health Care Outcome Disparities in US Hospitals / 대한의료정보학회지

OBJECTIVES: Disparities in healthcare among minority groups can result in disparate treatments for similar severities of symptoms, unequal access to medical care, and a wide deviation in health outcomes. Such racial disparities may be reduced via use of an Electronic Medical Record (EMR) system. However, there has been little research investigating the impact of EMR systems on the disparities in health outcomes among minority groups. METHODS: This study examined the impact of EMR systems on the following four outcomes of black patients: length of stay, inpatient mortality rate, 30-day mortality rate, and 30-day readmission rate, using patient and hospital data from the Medicare Provider Analysis and Review and the Healthcare Information and Management Systems Society between 2000 and 2007. The difference-in-difference research method was employed with a generalized linear model to examine the association of EMR adoption on health outcomes for minority patients while controlling for patient and hospital characteristics. RESULTS: We examined the association between EMR adoption and the outcomes of minority patients, specifically black patients. However, after controlling for patient and hospital characteristics we could not find any significant changes in the four health outcomes of minority patients before and after EMR implementation. CONCLUSIONS: EMR systems have been reported to support better coordinated care, thus encouraging appropriate treatment for minority patients by removing potential sources of bias from providers. Also, EMR systems may improve the quality of care provided to patients via increased responsiveness to care processes that are required to be more time-sensitive and through improved communication. However, we did not find any significant benefit for minority groups after EMR adoption.