Major discrepancy between clinical diagnosis of death and anatomopathological findings in adolescents with chronic diseases during 18-years

Abstract Objectives: To evaluate the inconsistency between clinical diagnosis of death and autopsy findings in adolescents with chronic diseases. Methods: A cross-sectional study including a sample of adolescents' autopsies who died in a pediatric and adolescent tertiary hospital over 18 consecutive years. During this period, there were n = 2912 deaths, and n = 581/2912(20%) occurred in adolescents. Of these, n = 85/581(15%) underwent autopsies and were analyzed. Further results were divided into two groups: Goldman classes I or II (high disagreement between main clinical diagnosis of death and anatomopathological findings, n = 26) and Goldman classes III, IV or V (low or no disagreement between these two parameters, n = 59). Results: Median age at death (13.5 [10‒19] vs. 13 [10‒19] years, p = 0.495) and disease duration (22 [0‒164] vs. 20 [0‒200] months, p = 0.931), and frequencies for males (58% vs. 44%, p = 0.247) were similar between class I/II vs. class III/IV/V. The frequency of pneumonia (73% vs. 48%, p = 0.029), pulmonary abscess (12% vs. 0%, p = 0.026), as well as isolation of yeast (27% vs. 5%, p = 0.008), and virus (15% vs. 2%, p = 0.029) identified in the autopsy, were significantly higher in adolescents with Goldman class I/II compared to those with Goldman class III/IV/V. In contrast, cerebral edema was significantly lower in adolescents of the first group (4% vs. 25%, p = 0.018). Conclusion: This study showed that 30% of the adolescents with chronic diseases had major discrepancies between clinical diagnosis of death and autopsy findings. Pneumonia, pulmonary abscess, as well as isolation of yeast and virus were more frequently identified at autopsy findings in the groups with major discrepancies.

Biotecnología y vacunas COVID-19 / Biotechnology and vaccines COVID-19

Introducción: la enfermedad por coronavirus 2019 (COVID-19) causada por el nuevo coronavirus (SARS-CoV-2) ha planteado una emergencia médica y una crisis mundial rápidamente, desde que surgió por primera vez en diciembre de 2019. El 11 de marzo de 2020, la Organización Mundial de la Salud (OMS) declaró una pandemia. Las vacunas COVID-19 son ahora actores críticos en la situación global del SARS-CoV-2, con el objetivo de alcanzar progresivamente la inmunidad colectiva. La OMS ha aprobado 9 vacunas entre el 30 de diciembre de 2020 y el 20 de diciembre de 2021. Objetivo: el objetivo de este estudio es analizar, desde los aportes hechos por la Biotecnología, las distintas vacunas que están siendo administradas, así como también las que están en investigación y desarrollo, para la prevención del COVID-19. Materiales y métodos: se realizó una revisión exhaustiva de la literatura dedicada a vacunas aprobadas o en instancias clínicas destinadas a la prevención de COVID-19. Palabras clave: COVID-19, SARS-CoV-2, vacunas, biotecnología, vectores, y coronavirus; en las bases de datos MEDLINE/PubMed, Scielo (Scientific Electronic Library Online), Nature, Lancet y Google Scholar. Criterios de inclusión de trabajos científicos: i) idioma inglés o español, ii) publicados entre 2019-2021, iii) referidos a Biotecnología. Criterio de exclusión: i) fármacos/vacunas convencionales no aprobadas ni recomendadas por la Organización Mundial de la Salud (OMS) o el Centro de Control de Enfermedades y prevención (CDC por sus siglas en inglés) para su uso en la enfermedad causada por COVID-19. Luego, se describieron los hallazgos de los artículos seleccionados de forma cualitativa. Resultados: el presente trabajo expone los distintos tipos de plataformas vacunales desarrollados hasta el momento para enfrentar la pandemia de COVID-19. Conclusiones: debido a que las vacunas contra el COVID-19 se han desarrollado hace tan solo unos meses, aún se desconoce la duración de la inmunidad que confieren. Sin embargo, hay datos alentadores que indican que la mayoría de las personas que han sido vacunadas adquieren una inmunidad apropiada que protege contra una nueva infección, al menos durante un cierto tiempo, y permite disminuir significativamente la gravedad de esta nueva infección. (AU)

Introduction: the coronavirus disease 2019 (COVID-19) caused by the novel coronavirus (SARS-CoV-2) has quickly posed a medical emergency and global crisis, since it first emerged in December 2019. On March 11, 2020, the World Health Organization (WHO) declared a pandemic. COVID-19 vaccines are now critical players in the global SARS-CoV-2 situation, with the goal of progressively achieving herd immunity. The WHO has approved 9 vaccines between December 30, 2020 and December 20, 2021. Objective: the objective of this study is to analyze, from the contributions made by Biotechnology, the different vaccines that are being administered, as well as in research and development, for the prevention of COVID-19. Materials and methods: an exhaustive review of the literature dedicated to approved vaccines or in clinical instances intended for the treatment of COVID-19 was carried out. Key words: "COVID-19", "SARS-CoV-2", "vaccines", "biotechnology", "vectors", and "coronavirus"; in the MEDLINE/Pubmed, Scielo (Scientific Electronic Library Online), Nature, Lancet and Google Scholar databases. Criteria for the inclusion of scientific papers: i) English or Spanish language, ii) published between 2019-2021, iii) referring to Biotechnology. Exclusion criteria: i) conventional drugs/vaccines not approved or recommended by the World Health Organization (WHO) or the Center for Disease Control and Prevention (CDC) for use in disease caused by the COVID 19. Then, the findings of the selected articles were described qualitatively. Results: this study presents the pathophysiology of SARS-CoV-2 infection and the use of the different types of vaccine platforms developed to date to face the COVID-19 pandemic. Conclusions: the pandemic generated by COVID-19 has represented a great challenge around the world in many aspects, from the medical, scientific to the social and economic.Since COVID-19 vaccines were developed only a few months ago, the duration of immunity they confer is still unknown and more research is needed to answer this question. However, there is encouraging data indicating that most people who recover from the disease acquire an immunity that protects against a new infection, at least for a certain time, although to what degree and for what duration is still being determined. (AU)

The effects of pharmacist interventions on health outcomes in patients with advanced prostate cancer in Brazil

Abstract This study examined the effects of pharmacist interventions for patients with advanced prostate cancer. A pre-post study was conducted between October 2014 and August 2017 in a community pharmacy in Brazil for outpatients with advanced prostate cancer, aged ≥ 18 years, using cyproterone acetate and/or goserelin. The patients had face-to-face meetings with a pharmacist who dispensed antiandrogenic drugs and performed interventions aimed at solving and/or preventing drug-therapy problems. Primary outcomes regarding prostate-specific antigen (PSA) and testosterone levels were compared at 0, 6, and 12 months, whereas secondary outcomes-medication adherence and quality of life-were compared at baseline and at the 12-month follow-up. Medication adherence was assessed using the Morisky-Green test, and quality of life was measured by the Medical Outcomes Study 36-item Short Form (SF-36) and the Functional Assessment of Cancer Therapy-Prostate (FACT-P). The analysis included 20 patients; 311 drug-therapy problems were identified and most of them were related to adverse reactions (78.5%). The most common adverse reactions were reduced libido, erectile dysfunction, hyperglycemia, fatigue, and gynecomastia. Testosterone levels significantly decreased at 6 months, and PSA levels at 6 and 12 months. No significant changes in adherence were noted at the end of the study. A significant increase in the "pain" domain and an improvement trend in the "physical aspects" and "vitality" domains were observed based on the SF-36 instrument. The findings show that pharmacist interventions were able to improve PSA and testosterone levels, and some domains of quality of life of patients.

Does [18F]F-FDG-PET/MRI add metabolic information to magnetic resonance image in childhood-onset Takayasu's arteritis patients? A multicenter case series

Abstract Background: The observation that 2-deoxy-2[18F]fluoro-D-glucose-positron emission tomography/magnetic resonance imaging ([18F]F-FDG-PET/MRI) revealed high-grade arterial wall FDG uptake, without arterial wall thickening with contrast-enhancement, in a considerable number of c-TA patients in our previous study, encouraged us to compare patients with both PET and MR angiography (MRA) positives, with those with PET positive but MRA negative. Our aim was to evaluate the relevance of these two imaging modalities together. Methods: A three-center cross-sectional study with 17 patients who fulfilled the EULAR/PRINTO/PReS criteria for c-TA and who underwent [18F]F-FDG-PET/MRI was previously performed. Herein we compared patients/vessels with positive PET (arterial wall 18F-FDG uptake higher than liver) and positive MRA (arterial wall thickening with contrast-enhancement)—group 1, with those with positive PET but negative MRA—group 2. Results: Median disease duration of 17 c-TA patients was 10.4 years. Nine patients were classified as group 1 and six as group 2. Median of metabolic inflammatory volume (MIV) of all arterial segments was significantly higher in group 1 (2346 vs. 1177 cm3; p = 0.036). Fifty-four (19%) from 284 available arterial segments presented positive findings in vessel wall in one or both images. Positive findings were concordant between PET and MRA in only 13% arterial segments (group 1); most changes (28-59.6%) that were discordant between both images, were positive in PET and negative in MRA (group 2). Conclusions: Our study demonstrated that [18F]F-FDG-PET/MRI added information about inflammation in vessel wall of c-TA patients. Prospective multicenter studies are needed in order to get solid data to guide immunosuppressive tapering and withdrawal.

Seroconversion in asymptomatic COVID-19 pediatric patients with rheumatic diseases of one tertiary referral hospital

Abstract Objectives: To evaluate seroconverted asymptomatic COVID-19 in pediatric Autoimmune Rheumatic Diseases (ARDs) patients and to identify the risk factors related to contagion. Methods: A cross-sectional study was conducted in March 2021, before vaccination of children and adolescents in Brazil, including 77 pediatric ARDs patients, followed at a tertiary hospital and 45 healthy controls, all of them without a previous diagnosis of COVID-19. Data was obtained by a questionnaire with demographic data, symptoms compatible with COVID-19 over the previous year, and contact with people with confirmed COVID-19. Patient's medical records were reviewed to access data regarding disease and current medications. A qualitative immunochromatographic SARS-CoV-2 test was performed on all participants. Results: Patients and controls were similar in terms of female gender (70.1% vs. 57.8%, p = 0.173), age (14 vs. 13 years, p = 0.269) and SARS-CoV-2 positive serology (22% vs. 15.5%, p = 0.481). 80.5% of rheumatic patients were in use of immunosuppressive drugs: 27.3% of them used corticosteroids (33.3% in high doses), and 7.8% on immunobiologicals. No statistical differences were found between positive (n = 17) and negative serology (n = 60) patients regarding demographic/socioeconomic data, contact with people with confirmed COVID-19, use and number of immunosuppressive drugs, use and dose of corticosteroids, use of hydroxychloroquine and immunobiological drugs (p > 0.05). Conclusions: Pediatric rheumatic disease patients were infected at the same rate as healthy ones. Neither the underlying pathology nor its immunosuppressive treatment seemed to interfere with contagion risk.

Inserción laboral del cirujano joven en la Ciudad de Buenos Aires. Necesidad de reestructuración del sistema de formación del cirujano general / Young surgeons entering the workforce in the City of Buenos Aires. Need for restructuring of the general surgery training system

RESUMEN Antecedentes: la formación en cirugía se mantuvo uniforme desde la instauración del modelo de re sidencias. El avance de la ciencia ha llevado a la superespecialización y un 70% de los cirujanos conti núan en formación con una especialidad posbásica. Objetivos: identificar la proporción de cirujanos que derivan horas a otra actividad y analizar la inser ción laboral del cirujano. Material y métodos: estudio prospectivo, descriptivo, de corte transversal. 1) Encuesta, 2) Registros de la Dirección General de Docencia e Investigación, 3) Concursos y Perfiles profesionales de acceso público. Resultados: sobre 435 encuestados, al finalizar la residencia, un 73,3% continuó su formación en una posbásica. Solamente un 24,7% se insertó inmediatamente en el mercado como cirujano general. En cuanto a la inserción laboral actual de aquellos que finalizaron la formación como cirujano general, apenas un 17,4% se desempeña de manera exclusiva como cirujano general. Conclusiones: la falta de confianza para actuar de manera independiente y la necesidad de completar 4 años de formación para ingresar en el campo de interés aparecen como las problemáticas para resol ver. Se propone un programa de 5 años con formato 2+3. El período de formación básica abordará en 24 meses las generalidades de la práctica quirúrgica. El segundo, de formación avanzada, desarrollará en profundidad la subespecialidad elegida. El quinto año otorgará a todos la posibilidad de actuar a modo de cirujano independiente. Planteada como una subespecialidad, la Cirugía General volvería a ser un fin en sí misma y no un medio para llegar a una subespecialidad.

ABSTRACT Background: Training in surgery has remained relatively uniform since the residency programs were introduced. The continuous advances in science have led to the progressive super-specialization of surgeons; 70% of them continue their training with a subspecialty. Objectives: The aim of this study was to identify the proportion of surgeons who dedicate hours of their practice in another activity and to analyze how surgeons enter the workforce. Material and methods: We conducted a prospective and descriptive cross-sectional study with data from a survey, records of the General Directorate of Teaching and Research, and records of competitive selection processes and professional profiles available online. Results: Of 435 survey respondents, 73.3% of the resident graduates continued postresidency training in a surgical subspecialty. Only 24.7% immediately started working in general surgery. Among the graduate trainees in general surgery, only 17.4% were exclusively dedicated to general surgery. Conclusions: The lack of confidence to perform procedures independently and the need for completing 4 years of training in the residency program in general surgery to start training in the professional field of interest, appear as the issued to be solved. We propose a 5-year program with a 2+3 model. The initial period comprises 24 months of basic training covering the general aspects of surgical practice. The second period of advanced training will provide thorough training in the subspecialty chosen. In the last year of the 5-year program trainees will have the opportunity to act as attending surgeons. General surgery, conceived as a subspecialty, would regain its status as an objective and no longer a pathway to become a subspecialist.

COVID-19 en el paciente pediátrico / COVID-19 in the pediatric patient

Resumen Este documento fue preparado (en junio de 2020) por y para los profesionales médicos (clínicos y proveedores de salud), y está disponible públicamente para propósitos de recomendaciones relacionada con pacientes pediátricos y enfermedad por coronavirus 2019 (COVID-19). Según datos disponibles hasta la fecha, los niños de todas las edades pueden contraer la COVID-19; sin embargo, tienen mejor pronóstico que los adultos, siendo pocos los casos graves reportados, y los casos leves se recuperan en 1-2 semanas después del inicio de la enfermedad. El objetivo de este documento es aportar peculiaridades que consideramos importantes para el diagnóstico y tratamiento. Debido a los cambios en la actual situación epidemiológica se pueden modificar algunos conceptos y acciones, por lo que la información aquí contenida debe ser adaptada a cada paciente, basada en el juicio clínico, necesidades del paciente y recursos disponibles.

Abstract This document was prepared (June 2020) by and for medical professionals (clinicians and health providers), and it is available as a guideline for pediatric patients with coronavirus disease 2019 (COVID-19). So far, according to available data although children of all ages can acquire COVID-19, they have better outcome than adults, with a little proportion of severe disease, and in mild cases they have a 1 to 2-week recovery after the beginning of the infection. The objective of this document is to provide particularities that we consider important for diagnosis and treatment. Owe to the changing epidemiological situation some concepts and actions can change, so this information must be adapted to each specific case, based on the clinical judgement according to patient requirements and available resources.

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

Cardiometabolic risk factors associated with renal function in apparently healthy young students: a cross-sectional study

ABSTRACT Background: Cardiometabolic risk factors (CMRFs) appear decades before developing chronic kidney disease (CKD) in adulthood. Objective: The objective of the study was to identify the prevalence and association between CMRFs and kidney function in apparently healthy young adults (18-25 years old). Methods: We included 5531 freshman year students. Data collected on CMRFs included central obesity, high body mass index (hBMI >25), blood pressure, glycemia, lipids, uric acid (UA >6.8 mg/dL), and insulin. Glomerular filtration rate (GFR) was estimated by CKD-Epidemiology Collaboration formula. We used logistic regression and a log linear for odds ratio (OR) (95% confidence level) and probabilities. Results: The presence of any CMRF was observed in 78% (4312) of individuals; GFR ≥120/130 mL/min/1.73 m2sc was found in 33%, GFR <90 mL/min/1.73 m2sc in 3%, and proteinuria in 3%. Factors associated with high GFR were hBMI (OR 1.3 [1.14, 1.47]), UA (OR 0.2 [0.15, 0.26]), high-density lipoprotein (HDL) (OR 1.4 [1.2, 1.6]), and insulin resistance (OR 1.3 [1.05, 1.7]). CMRF associated with low GFR was UA (OR 1.8 [1.3, 2.6]), low-density lipoprotein cholesterol (OR 1.66 [1.05, 2.6]), and proteinuria (OR 3.4 [2.07, 5.7]). Proteinuria was associated with high UA (OR 1.59 [1.01, 2.5]) and hypercholesterolemia (OR 1.8 [1.03, 3.18]). The sole presence of hBMI+UA predicted low GFR with p = 0.6 and hBMI+UA+low HDL predicted proteinuria with p = 0.55. Conclusions: CMRFs were highly prevalent among this freshman student population and were associated with proteinuria and GFR abnormalities. Future studies should focus on public health programs to prevent or delay the development of CKD.

Ultrasound and clinical findings in the metacarpophalangeal joint assessment of show jumping horses in training

Background@#Physical exercise is known to cause significant joint changes. Thus, monitoring joint behavior of athletic horses is essential in early disorders recognition, allowing the proper management. @*Objectives@#The aims of this study were to determine the morphological patterns, physical examination characteristics and ultrasound findings of show jumping horses in training and to establish a score-based examination model for physical and ultrasound follow-ups of metacarpophalangeal joint changes in these animals. @*Methods@#A total of 52 metacarpophalangeal joints from 26 horses who were initially in the taming stage were evaluated, and the horses’ athletic progression was monitored. The horses were evaluated by a physical examination and by B-mode and Doppler-mode ultrasound examinations, starting at time zero (T0), which occurred concomitantly with the beginning of training, and every 3 months thereafter for a follow-up period of 18 months. @*Results@#The standardized examination model revealed an increase in the maximum joint flexion angles and higher scores on the physical and ultrasound examinations after scoring was performed by predefined assessment tools, especially between 3 and 6 months of evaluation, which was immediately after the horses started more intense training. The lameness score and the ultrasound examination score were slightly higher at the end of the study. @*Conclusions@#The observed results were probably caused by the implementation of a training regimen and joint adaptation to physical conditioning. The joints most likely undergo a pre-osteoarthritic period due to work overload, which can manifest in a consistent or adaptive manner, as observed during this study. Thus, continuous monitoring of young athlete horses by physical and ultrasound examinations that can be scored is essential.

Cercyon Leach, 1817 (Coleoptera: Hydrophilidae: Sphaeridiinae) from Brazil: new species and records

Abstract The study of ca. 280 specimens of Cercyon Leach, 1817 (Hydrophilidae: Sphaeridiinae: Megasternini) deposited in the Coleção Entomológica Pe. J.S. Moure, Universidade Federal do Paraná, Brazil, revealed a new species from Atlantic Rain Forest biome in Paraná State (Southern Brazil) and new records. Cercyon (Cercyon) curi sp. nov. is herein described and illustrated, belonging to the Neotropical C. variegatus species group. Cercyon (Cercyon) nigriceps (Marsham, 1802) is recorded for the first time in Paraná State, and Cercyon (Cercyon) inquinatus Wollaston, 1854 from Amazonas State (Northern Region); these records extend the distributional range of both species in Brazil. Cercyon (Cercyon) praetextatus (Say, 1825) is recorded for the first time from Brazil based on specimens collected in Paraná. Those three species were previously recorded as introduced in South America.

Aplicación de un diseño factorial 23 en la extracción asistida por microondas y evaluación de la actividad antioxidante de los compuestos presentes en frutos de Vaeeinium meridionale / Application of a 23 factorial design in the assisted extraction by microwave and evaluation of the antioxidant activity of the compounds present in Vaccinium meridionale fruits

RESUMEN El arándano (Vaeeinium meridonale) forma parte de la familia Ericaceae; es un fruto rico en compuestos polifenólicos como antocianinas y flavonoides con propiedades antioxidantes, compuestos que presentan algunas características para la inhibición de radicales libres. Se empleó un diseño factorial 23 para investigar los efectos de las variables temperatura, tiempo y el porcentaje de etanol en la extracción asistida por microondas (MAE) de los antioxidantes presentes en frutos de arándanos, como técnica alternativa, con la cual se pretende una economía destacable en cuanto al empleo de disolventes, tiempo y energía, en comparación con los procesos de extracción convencionales. Las extracciones se realizaron bajo las siguientes condiciones: temperatura (343,15 -383,15 K), tiempo (5-15 minutos), %EtOH (0-80%). Se planteó un diseño factorial, con un total de 8 experimentos para determinar la influencia de la relación de las variables en el proceso de extracción de compuestos con actividad antioxidante por el método de DPPH-, obteniendo un modelo factorial de primer orden con interacciones, bajo un nivel de confianza del 100% y R2=1. El diseño experimental y la evaluación de los resultados se realizó con el software R Studio® versión libre.

SUMMARY Blueberry (Vaccinium meridionale) forms part of the family Ericaceae; it is a fruit rich in flavonoids and anthocyanins (polyphenols), which have antioxidant properties and also shows some properties suitable for inhibition of free radicals. A 23 factorial design was performed to investigate the variables effects: temperature, time and the ethanol percentage %, on the antioxidants extraction process by Microwave Assisted Extraction (MAE). The extraction conditions were: temp (343.15-383.15 K), time (5-15 min), ethanol (0- 80%). A factorial design was performed, with a total of 8 experiments, allowing to determine the influence of the relation of the variables related to the extraction process of compounds with antioxidant activity by DPPH- method, getting a first order factorial model with interactions and a 100% reliability level and a R2 =1. The experimental design and evaluation of the results were performed with the software R Studio® free version.

Nuevo paradigma clínico en la decisión médica antes de someter a un paciente a cirugía cardíaca central Scores de fragilidad

La expectativa de vida promedio está aumentando en la población mundial, y como resultado de ello también se ve incrementado el número de individuos frágiles con enfermedades cardiovasculares (ECV), frecuentemente, asociadas con comorbilidades. La fragilidad es un síndrome biológico que refleja un estado de reserva fisiológica disminuido y padecerla conlleva a un estado de vulnerabilidad ante factores estresantes, como por ejemplo, la cirugía cardiovascular. Cuando los pacientes que padecen fragilidad se exponen a estos factores estresantes corren el riesgo de una descompensación marcada, a menudo desproporcionada, con alto tenor de efectos adversos, complicaciones de procedimiento, recuperación prolongada, deterioro funcional, discapacidad y mortalidad. Por ello, la fragilidad se ha convertido en un tema de alta prioridad, pues a pesar de su reconocimiento como un elemento fundamental en la evaluación de adultos mayores con ECV, todavía no se ha establecido una hoja de ruta para facilitar su adopción en la práctica clínica habitual. Por lo tanto, buscamos sintetizar el cuerpo de evidencia existente y ofrecer una perspectiva sobre cómo integrar la fragilidad en la práctica clínica. El objetivo de este artículo científico es realizar una actualización sobre la utilización de los scores de fragilidad para la evaluación prequirúrgica de los pacientes que serán sometidos a cirugía cardiovascular central para conocer el valor predictivo de complicaciones, mortalidad, tiempo estimado de postoperatorio, recuperación y necesidad de asistencia de terceros posterior a la realización de la misma.

Multiple myeloma and central nervous system involvement: experience of a Brazilian center

Abstract Introduction: The estimated involvement of the central nervous system in patients with multiple myeloma is rare at about 1%. The infiltration can be identified at the time multiple myeloma is diagnosed or during its progression. However, it is more common in refractory disease or during relapse. Methods: This retrospective cohort study reviewed data from medical records of patients followed up at the Gammopathy Outpatient Clinic of Santa Casa de Misericórdia de São Paulo from January 2008 to December 2016. Results: Twenty patients were included, with a median follow-up of 33.5 months after central nervous system infiltration. The prevalence was 7%. The median age at diagnosis of multiple myeloma was 56.1 years, with 70% of participants being female. Sixteen patients had central nervous system infiltration at diagnosis of multiple myeloma. Seventeen patients had exclusive osteodural lesions and three had infiltrations of the leptomeninge, of which one had exclusive involvement and two had associated osteodural lesions. The median overall survival was 40.3 months after central nervous system involvement. The median overall survival in the group with central nervous system infiltration at relapse was 7.4 months. The patients with leptomeningeal involvement had a median overall survival of 5.8 months. Conclusion: Central nervous system infiltration is a rare condition, but it should be considered as a possibility in patients with multiple myeloma and neurological symptoms. The best treatment regimen for this condition remains unknown and, in most cases, the prognosis is unfavorable.

A checklist of Rutelinae MacLeay, 1819 (Coleoptera, Melolonthidae) of Bahia, Brazil / Um checklist dos Rutelinae MacLeay, 1819 (Coleoptera, Melolonthidae) da Bahia, Brasil

Abstract A list of species of Rutelinae from Bahia state, Northeastern Brazil, is presented. The list is based on specimens deposited in Brazilian collections. The list includes 4 tribes, 23 genera, 101 species and 17 subspecies. The genera Byrsopolis Burmeister, 1844, Pseudodorysthetus Soula, 2008 and Trizogeniates Ohaus, 1917 are recorded for the first time in Bahia and Northeastern Brazil. Thirty species are newly recorded in Bahia: Areoda espiritosantensis Ohaus, 1905, B. laticollis Burmeister, 1855, Bolax flavolineata (Mannerheim, 1829), Chlorota abdominalis Ohaus, 1926, C. espiritosantensis Ohaus, 1912, Dorysthetus espiritosantensis Ohaus, 1905, D. fulgidus (Waterhouse, 1881), Leucothyreus acanthurus Ohaus, 1917, L. albopilosus Ohaus, 1917, L. campestris Burmeister, 1855, L. cayapo Ohaus, 1931, L. duplopunctatus Frey, 1976, L. eligius Ohaus, 1918, L. fluminensis Ohaus, 1918, L. iridipennis Ohaus, 1917, L. lucipetens Ohaus, 1931, L. occipitalis Ohaus, 1931, L. pallefactus Ohaus, 1924, L. paulista Ohaus, 1917, L. punctulatus Blanchard, 1851, L. suturalis Laporte, 1840, L. trochantericus Ohaus, 1917, L. verticalis Ohaus, 1924, Macraspis cincta (Drury, 1872), Paranomala tricostulata (Ohaus, 1897), P. violacea (Burmeister, 1844), Pseudodorysthetus calcaratus (Spinola, 1835), and Trizogeniates planipennis Ohaus, 1917. Pelidnota unicolor unicolor (Drury, 1778) is recorded for the first time in Bahia. Fourteen species are identified and will be described in subsequent papers: 10 of Leucothyreus MacLeay, 1819, 2 of Lobogeniates Ohaus, 1917 and 1 species of Byrsopolis Burmeister, 1844 and Pelidnota MacLeay, 1819. Rutelini is the richest tribe with 16 genera and 49 species. The information presented in the list generates an important set of knowledge regarding the diversity of Rutelinae of Bahia and Brazil and provides the basis for conducting future research within the group.

Resumo É apresentada uma lista de espécies de Rutelinae do estado da Bahia, Nordeste do Brasil. A lista é baseada em espécimes depositados em coleções brasileiras. A lista inclui quatro tribos, 23 gêneros, 101 espécies e 17 subespécies. É feito o primeiro registro para a Bahia e região Nordeste dos gêneros Byrsopolis Burmeister, 1844, Pseudodorysthetus Soula, 2008 e Trizogeniates Ohaus, 1917. Trinta espécies de Rutelinae foram registradas pela primeira vez para a Bahia e região Nordeste: Areoda espiritosantensis Ohaus, 1905, B. laticollis Burmeister, 1855, Bolax flavolineata (Mannerheim, 1829), Chlorota abdominalis Ohaus, 1926, C. espiritosantensis Ohaus, 1912, Dorysthetus espiritosantensis Ohaus, 1905, D. fulgidus (Waterhouse, 1881), Leucothyreus acanthurus Ohaus, 1917, L. albopilosus Ohaus, 1917, L. campestris Burmeister, 1855, L. cayapo Ohaus, 1931, L. duplopunctatus Frey, 1976, L. eligius Ohaus, 1918, L. fluminensis Ohaus, 1918, L. iridipennis Ohaus, 1917, L. lucipetens Ohaus, 1931, L. occipitalis Ohaus, 1931, L. pallefactus Ohaus, 1924, L. paulista Ohaus, 1917, L. punctulatus Blanchard, 1851, L. suturalis Laporte, 1840, L. trochantericus Ohaus, 1917, L. verticalis Ohaus, 1924, Macraspis cincta (Drury, 1872), Paranomala tricostulata (Ohaus, 1897), P. violacea (Burmeister, 1844), Pseudodorysthetus calcaratus (Spinola, 1835) e Trizogeniates planipennis Ohaus, 1917. Foi feito o primeiro registro de Pelidnota unicolor unicolor (Drury, 1778) para a Bahia. Foram identificadas 14 espécies, que serão descritas em trabalhos posteriores: dez de Leucothyreus MacLeay, 1819, duas de Lobogeniates Ohaus, 1917 e uma de Byrsopolis Burmeister, 1844 e Pelidnota MacLeay, 1819. A tribo Rutelini apresenta a maior riqueza com 16 gêneros e 49 espécies. Os resultados aqui apresentados têm importantes informações para o conhecimento de Rutelinae, no estado da Bahia e no Brasil, e servirão de base para a realização de futuras pesquisas com o grupo.

Psyllobora picta (Germain) species complex (Coleoptera: Coccinellidae), with descriptions of two new species from Chile

Abstract The Psyllobora picta species complex (Coleoptera: Coccinellidae: Coccinellini) was revised, with the description of two new species, Psyllobora lueri sp. nov. and Psyllobora pauline sp. nov., both from Chile. Psyllobora bicongregata was recorded for the first time from Brazil, and there is no confirmed record of this species for Chile. Also, P. picta was not recognized from Paraguay and Uruguay. Male and female genitalia characters are illustrated for all the species.

Three new species of Pelidnota MacLeay (Coleoptera, Scarabaeidae, Rutelinae) and new distributional records from northeast Brazil

Abstract Three new species of Pelidnota MacLeay, 1819 are described from Brazil, P. beckeri sp. nov., P. nordestina sp. nov., and P. pernambucana sp. nov. The diagnostic characters of the new species are presented, and they are included in the previously published key to Pelidnota. Illustrations of the male genitalia and photographs of males and females of the new species are also provided. It is reported the first record of the genus for the Brazilian Caatinga (tropical seasonal forest). New records of four species and two subspecies of Pelidnota are presented, all from Bahia state, northeastern Brazil.