Impact of a methane emission tax on circular economy scenarios in small wastewater treatment plants.

This paper analyzes the impact of methane emissions taxation on the recovery of the investments required for implementing technologies that use biogas energy in small wastewater treatment plants (WWTPs) in Brazil. It is based on the hypothesis that the adoption of a national methane emission tax policy would encourage small WWTPs to become sustainable power plants. The procedure involved 173 anaerobic plants to analyze: (a) methane production; (b) available useful energy; (c) investments and avoided costs for implementing STHIL system (thermal drying sludge) and motor generator (electricity generation); (d) financial impact for two scenarios (C1: no emissions tax; C2: with tax). Positive environmental and financial results were observed for WWTPs, varying according to the period of time analyzed for both technologies. Investments must be made in cogeneration in anaerobic WWTPs for achieving satisfactory results. Taxation must not be viewed simply as a punitive instrument; on the contrary, it should be seen as a tool to encourage continuous process improvement. The circular economy may support the enlargement of the wastewater collection and treatment system, guaranteeing widespread sanitation conditions in urban areas. However, the actual implementation of a methane emission tax in Brazil still requires many rounds of discussion among sanitation companies, government, and civil society, to establish emission limits, and unit taxes, as well as to consolidate a carbon trade to follow through with this decision in the sanitation sector.

SARS-CoV-2 reinfections with BA.1 (Omicron) variant among fully vaccinated individuals in the northeast of Brazil

BackgroundThe first case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Rio Grande do Norte, northeast Brazil, was diagnosed on March 12, 2020; thereafter, the pattern of COVID-19 followed the multiple waves as seen elsewhere. Those waves were mostly due to the SARS-CoV-2 virus mutations leading to emergence of variants of concern (VoC). The introduction of new VoCs in a population context of prior SARS-CoV-2 infections or after vaccination has been a challenge in understanding the kinetics of the protective immune response against SARS-CoV-2. The aim of this study was to investigate the outbreak of SARS-CoV-2 reinfections observed in mid-January 2022 in Rio Grande do Norte state, Brazil when the omicron variant was introduced. Methodology/Principal findingsFrom a total of 172,965 individuals with mild to severe respiratory symptoms, 58,097 tested positive for SARS-CoV-2 between March 2020 through mid-February 2022. Of those previously infected, 444 had documented a second SARS-CoV-2 infection and 9 of these reinfection cases were selected for sequencing. Genomic analysis revealed that virus lineages diverged between primary and the reinfection, with the latter caused by the Omicron (BA.1) variant among individuals fully vaccinated against SARS-CoV-2. Conclusions/SignificanceOnce all subjects whose samples were sequenced had prior SARS-CoV-2 infection and were also fully vaccinated, our data suggest that the Omicron variant evades natural and vaccine-induced immunities, confirming the continuous need to decrease transmission and to develop effective blocking vaccines. Author summaryThe pattern of the COVID-19 pandemic has been characterized by multiple waves of cases with a variety of outcomes from asymptomatic, to moderate or to severe fatal cases. By December 2021, about 75.3% of Rio Grande do Norte population, northeast Brazil, had already been fully vaccinated against SARS-CoV-2 and a decrease in newer detection cases was seen to about 8% of the suspected ones. Nevertheless, with the introduction of the Omicron variant at the end of 2021, the number of new SARS-CoV-2 infections reached its highest peak since the start of the pandemic with 75% of the suspected cases testing positive. From March 2020 to February 2022, we confirmed 444 reinfection cases among the ones tested, of which 62.3% (n=277) occurred during the Omicron outbreak, from December 2021 to early February 2022. Of the reinfection cases, 9 were sequenced and genetic analysis showed that they belong to a BA.1 lineage, which seems to have been introduced multiple times into the region. The primary isolates varied. Thus, our data suggest that the Omicron variant evades immunity provided from either natural infection from any other SARS-CoV-2 variants or from different types of vaccines.

The carbon sink of tropical seasonal forests in southeastern Brazil can be under threat.

Tropical forests have played an important role as a carbon sink over time. However, the carbon dynamics of Brazilian non-Amazon tropical forests are still not well understood. Here, we used data from 32 tropical seasonal forest sites, monitored from 1987 to 2020 (mean site monitoring length, ~15 years) to investigate their long-term trends in carbon stocks and sinks. Our results highlight a long-term decline in the net carbon sink (0.13 Mg C ha-1 year-1) caused by decreasing carbon gains (2.6% by year) and increasing carbon losses (3.4% by year). The driest and warmest sites are experiencing the most severe carbon sink decline and have already moved from carbon sinks to carbon sources. Because of the importance of the terrestrial carbon sink for the global climate, policies are needed to mitigate the emission of greenhouse gases and to restore and protect tropical seasonal forests.

Fresh and stored copra meal in meat quail diets.

The aim of the current study was to evaluate the addition of fresh and stored copra meal to the diet of meat quails. Two hundred eighty-seven-day-old male and female quails were distributed in a completely randomized design, with five treatments, in a 2 × 2 + 1factorial arrangement. Two copra meal types (fresh and stored) at inclusion levels of 12.5% and 25%, respectively, were added to a corn-soybean meal-based diet, with seven replicates, of eight quails each. Copra meal acidity index recorded oleic acid percentage increase from 0.47 to 3.03% after six storage months. However, regardless of storage type, its addition to quails' diet resulted in higher values of metabolizable energy, in lower feed intake and better feed conversion than corn-soybean meal diet. Copra meal addition to quails' diet did not affect carcass traits, liver and pancreas relative weight, and bone growth and quality. Although copra meal storage for 180 days resulted in higher free fatty acid content in the provided feed, it can be used fresh or after storage, in diet of meat quails from 7 to 42 days of age up to 25%.

Brain metastasis as initial presentation of papillary adenocarcinoma of the lung: case report / Metástase cerebral como apresentação inicial de adenocarcinoma papilífero de pulmão: relato de caso

The authors describe the case of a 33-year-old patient with history of seizures alone without any previous symptom, being diagnosed with brain metastases from primary papillary adenocarcinoma of the lung. Emphasis is given to the diagnostic investigation for brain metastasis and prognostic evaluation of papillary adenocarcinoma of the lung, and a brief literature review on such diseases is performed.

Os autores descrevem um caso de paciente de 33 anos de idade com história de crises convulsivas isoladas sem qualquer antecedente, sendo diagnosticadas metástases cerebrais tendo como sítio primário um adenocarcinoma papilífero de pulmão. É enfatizada a investigação diagnóstica para metástase cerebral e avaliação prognóstica do adenocarcinoma papilífero de pulmão, além de realizar breve revisão sobre essas doenças.

Determinação do Nível de Evidência Científica de Artigos sobre Prótese Total Fixa Implanto-Suportada / Determination of Scientific Evidence Level of Fixed Implant-Supported Denture Papers

Determinar o nível de evidência científica de artigoscientíficos sobre Prótese Total Fixa Implanto-Suportada(PTFIS), considerando os aspectos clínicos envolvidos.Material e Métodos: Realizou-se pesquisa bibliográfica dodescritor “Implant-supported denture” na PubMed, utilizandoos filtros: “Dates – Last 10 years”; “Text options – Links toFree Full Text” e “Languages – English; Spanish andPortuguese”. Encontraram-se 93 artigos, os quais foramanalisados de modo a verificar o cumprimento dos critériosde inclusão para análise da evidência científica. Foramexcluídos da análise as publicações: Cartas ao Editor,Editoriais, e os textos completos que não versaram sobre otema de próteses totais fixas implanto-suportadas. Os artigosforam classificados quanto ao nível de evidência científica.Resultados: Dentre os 93 artigos encontrados, 13 (13,98%)atenderam aos critérios de inclusão. Quanto à análise daevidência científica, os estudos selecionados estão entre osníveis 1 (revisão de literatura) e 5 (estudo observacional),com exceção do nível 2. Eles versam sobre indicações,contraindicações, resistência, mastigação, satisfação dopaciente, estabilidade oclusal e protocolo de reabilitação oral.Conclusão: O grau de evidência científica em PTFIS é baixo,restringindo-se a relatos de casos clínicos, estudosobservacionais e revisões bibliográficas, sendo indicaçõese contraindicações o principal assunto abordado...

To describe the scientific evidence level on originalarticles about fixed implant-supported denture (FISD),regarding the clinical aspects implicated. Material andMethods: A literature search was carried out by using thedescriptor “Implant-supported denture” on PubMed and thefilters: “Dates - Last 10 years”; “Text options - Links to FreeFull Text” and “Languages - English; Spanish and Portuguese”.The 93 articles found were analyzed in order to verify theircompliance with the inclusion criteria for analysis of scientificevidence. Were excluded from analysis the followingpublications: Letters to the Editor, Editorials, and the full textsthat did not address “fixed implant-supported denture”. Thearticles were classified according to level of scientificevidence. Results: Among the 93 articles identified, 13(13.98%) met the inclusion criteria. As regards the analysisof scientific evidence, the studies selected are among levels1 (literature review) and 5 (observational study), exceptinglevel 2, and were about indications, contraindications,resistance, chewing, patient satisfaction, occlusal stabilityand protocol for oral rehabilitation. Conclusion: The degreeof scientific evidence in FISD is low and restricted to casereports, descriptive studies and literature reviews, beingindications and contraindications the main topic addressedby the studies...

Avaliação dos estágios extracurriculares de medicina em unidade de terapia intensiva adulto / Evaluation of extracurricular internships in the adult's intensive care units

OBJETIVOS: A formação em medicina intensiva pelos estudantes de Salvador (BA) tem acontecido através de estágios extracurriculares. Este estudo visou detectar mudanças na postura e no interesse dos acadêmicos que concluíram estes estágios e os tipos mais comuns de atividades desenvolvidas. MÉTODOS: Estudo transversal descritivo realizado com estudantes que fizeram estágios extracurriculares em unidades de terapia intensiva adulto no segundo semestre de 2006. Utilizou-se um questionário auto-aplicável com questões objetivas. RESULTADOS: Foram entrevistados 49 estudantes. O interesse em se tornar intensivista foi classificado como alto/muito alto por 32,7 por cento antes do estágio, ao final 61,2 por cento referiram aumento do interesse. A média de 1 a 5, sobre a importância da medicina intensiva para o acadêmico atualmente foi de 4,55±0,70. Após o estágio 98 por cento sentem-se mais seguros em indicar um paciente para unidades de terapia intensiva e 95,9 por cento em avaliar, sob supervisão, os pacientes internados em unidades de terapia intensiva e 89,8 por cento em atender pacientes nas emergências. Os procedimentos mais observados foram: acesso venoso central (100 por cento), acesso venoso periférico (91,8 por cento) e a intubação orotraqueal (91,8 por cento). Numa escala de 1 a 5, os tópicos classificados como de maior interesse foram: síndrome de resposta inflamatória sistêmica e sepse (4,82±0,48), choque (4,81 ± 0,44) e reanimação cardiopulmonar (4,77 ± 0,55). CONCLUSÕES: O presente estudo mostrou que os estágios extracurriculares em unidades de terapia intensiva adulto de Salvador (BA) fornecem ao estudante maior segurança em avaliar pacientes graves, aumenta o interesse do mesmo pela carreira de intensivista e permite o contato com os principais procedimentos e tópicos relacionados à MI no dia-a-dia das unidades de terapia intensiva.

OBJECTIVES: Students of Salvador - BA, Brazil were trained in critical care medicine by accomplishing extracurricular internships. This study aims to detect changes in attitude and interest of students who concluded these internships as well as the most frequent activities developed. METHODS: Descriptive cross-sectional survey conducted with students who did extracurricular internships in adult intensive care units during the second semester of 2006. A self-administered questionnaire was given using objective questions. RESULTS: We evaluated 49 students. Interest in becoming an intensivist was classified as high/very high by 32.7 percent before internship, after which 61.2 percent reported increased interest. Before internship, students on a 1 to 5 scale rated the importance of critical care medicine as 4.55 ± 0.70. After internship, 98 percent felt more confident to refer a patient to the intensive care unit, 95.9 percent to evaluate with supervision, patients admitted to intensive care units and 89.8 percent to attend patients in the emergency room. The most common procedures observed were: central venous access (100 percent), peripheral venous access (91.8 percent) and orotracheal intubation (91.8 percent). Topics ranked in terms of interest from 1 to 5 were: systemic inflammatory response syndrome/sepsis (4.82 ± 0.48), shock (4.81 ± 0.44) and cardiopulmonary resuscitation (4.77 ± 0.55). CONCLUSIONS: This study showed that internships in adult intensive care units of Salvador (BA), Brazil provided students with greater assurance to evaluate critical patients, increased their interest to follow an intensivist physician career and allowed contact with the main procedures and topics related to critical care medicine.

Spontaneous splenic rupture due to dengue fever: report of two cases

Dengue is a febrile illness caused by Flavivírus and mainly transmitted by the mosquito Aedes aegypiti which have been a serious epidemic in Rio de Janeiro. In most of cases it was a self limited disease. We report two cases of a serious and rare complication of this viral infection.

Spontaneous splenic rupture due to dengue fever: report of two cases.

Dengue is a febrile illness caused by Flavivírus and mainly transmitted by the mosquito Aedes aegypiti which have been a serious epidemic in Rio de Janeiro. In most of cases it was a self limited disease. We report two cases of a serious and rare complication of this viral infection.

Evaluation of extracurricular internships in the adult's intensive care units. / Avaliação dos estágios extracurriculares de medicina em unidade de terapia intensiva adulto.

OBJECTIVES: Students of Salvador - BA, Brazil were trained in critical care medicine by accomplishing extracurricular internships. This study aims to detect changes in attitude and interest of students who concluded these internships as well as the most frequent activities developed. METHODS: Descriptive cross-sectional survey conducted with students who did extracurricular internships in adult intensive care units during the second semester of 2006. A self-administered questionnaire was given using objective questions. RESULTS: We evaluated 49 students. Interest in becoming an intensivist was classified as high/very high by 32.7% before internship, after which 61.2% reported increased interest. Before internship, students on a 1 to 5 scale rated the importance of critical care medicine as 4.55 ± 0.70. After internship, 98% felt more confident to refer a patient to the intensive care unit, 95.9% to evaluate with supervision, patients admitted to intensive care units and 89.8% to attend patients in the emergency room. The most common procedures observed were: central venous access (100%), peripheral venous access (91.8%) and orotracheal intubation (91.8%). Topics ranked in terms of interest from 1 to 5 were: systemic inflammatory response syndrome/sepsis (4.82 ± 0.48), shock (4.81 ± 0.44) and cardiopulmonary resuscitation (4.77 ± 0.55). CONCLUSIONS: This study showed that internships in adult intensive care units of Salvador (BA), Brazil provided students with greater assurance to evaluate critical patients, increased their interest to follow an intensivist physician career and allowed contact with the main procedures and topics related to critical care medicine.

Avaliação do conhecimento de estudantes de medicina sobre morte encefálica / Evaluation of medical students knowledge on brain death

JUSTIFICATIVA E OBJETIVOS: Por ser um conceito relativamente novo e pouco divulgado na sociedade, o diagnóstico de morte encefálica (ME) ainda não é bem aceito pela população em geral, inclusive entre médicos e estudantes de Medicina. O objetivo deste estudo foi avaliar o conhecimento de uma amostra de estudantes de Medicina sobre o protocolo diagnóstico de ME. MÉTODO: Estudo descritivo de corte transversal, avaliando acadêmicos de duas faculdades de Medicina de Salvador-BA. Foi distribuído um questionário auto-aplicável composto por questões referentes à conhecimento, técnico e ético, contidos na Resolução nº 1.480/97 do Conselho Federal de Medicina, que dispõe sobre os critérios para caracterização de ME. RESULTADOS: Foram avaliados 115 estudantes. A média de acertos nas 14 questões sobre o conhecimento dos critérios da ME foi de 6,7 ± 1,8; sendo maior entre os estudantes que haviam assistido alguma apresentação sobre ME. A maioria dos estudantes (87,4 por cento) soube identificar os pacientes candidatos ao protocolo de ME. No entanto, apenas 5,2 por cento e 16,1 por cento dos estudantes acertaram, respectivamente, os testes clínicos e complementares que devem ser realizados durante o protocolo. Frente a um paciente não-doador com diagnóstico confirmado de ME, 66,4 por cento referiram que o suporte artificial de vida deve ser suspenso. Apenas 15 por cento dos estudantes entrevistados já avaliaram um paciente com ME, sendo este percentual maior entre os que já haviam realizado estágio em UTI (38,2 por cento versus 5,1 por cento; p < 0,001). CONCLUSÕES: Os resultados deste estudo apontaram para um conhecimento limitado dos estudantes avaliados sobre os critérios para caracterização da ME, principalmente em relação à sua abordagem prática.

BACKGROUND AND OBJECTIVES: Because brain death (BD) is a new concept and little divulged, itÆs not well accepted in general population, including doctors and Medical students. This study aims to evaluate the knowledge of a sample of Medical students on the Brazilian BD diagnosis protocol. METHODS: Descriptive cross-sectional survey that evaluated students from two medical schools in Salvador-BA. We used a questionnaire composed by questions about technical and ethical knowledge contained in the Federal Council of MedicineÆs Resolution nº 1480/97 that establishes the criteria for BD diagnosis. RESULTS: We evaluated 115 Medical students. In 14 questions about the knowledge of BD criteria, the mean of right answers were 6.7 ± 1.8, which were higher among the students that had attended some presentation on BD. Most of the students (87.4 percent) knew how to identify the candidates to the BD diagnosis protocol. However, only 5.2 percent and 16.1 percent of the students answered right, respectively, the clinical and complementary tests that should be accomplished during the diagnosis protocol. Facing a no-donor patient with confirmed diagnosis of BD, 66.4 percent referred that artificial life support should be suspended. Only 15 percent of the interviewed students had already evaluated a patient with BD, being this percentage higher among those who had already frequented ICU (38.2 percent versus 5.1 percent; p < 0.001). CONCLUSIONS: The results of this study showed a limited knowledge of the evaluated students on BD diagnosis criteria, mainly in relation to the practical approach of this condition.

[Evaluation of medical students knowledge on brain death]. / Avaliação do conhecimento de estudantes de medicina sobre morte encefálica.

BACKGROUND AND OBJECTIVES: Because brain death (BD) is a new concept and little divulged, it’s not well accepted in general population, including doctors and Medical students. This study aims to evaluate the knowledge of a sample of Medical students on the Brazilian BD diagnosis protocol. METHODS: Descriptive cross-sectional survey that evaluated students from two medical schools in Salvador-BA. We used a questionnaire composed by questions about technical and ethical knowledge contained in the Federal Council of Medicine’s Resolution nº 1480/97 that establishes the criteria for BD diagnosis. RESULTS: We evaluated 115 Medical students. In 14 questions about the knowledge of BD criteria, the mean of right answers were 6.7 ± 1.8, which were higher among the students that had attended some presentation on BD. Most of the students (87.4%) knew how to identify the candidates to the BD diagnosis protocol. However, only 5.2% and 16.1% of the students answered right, respectively, the clinical and complementary tests that should be accomplished during the diagnosis protocol. Facing a no-donor patient with confirmed diagnosis of BD, 66.4% referred that artificial life support should be suspended. Only 15% of the interviewed students had already evaluated a patient with BD, being this percentage higher among those who had already frequented ICU (38.2% versus 5.1%; p < 0.001). CONCLUSIONS: The results of this study showed a limited knowledge of the evaluated students on BD diagnosis criteria, mainly in relation to the practical approach of this condition.