Incorporating biodiversity responses to land use change scenarios for preventing emerging zoonotic diseases in areas of unknown host-pathogen interactions.

The need to reconcile food production, the safeguarding of nature, and the protection of public health is imperative in a world of continuing global change, particularly in the context of risks of emerging zoonotic disease (EZD). In this paper, we explored potential land use strategies to reduce EZD risks using a landscape approach. We focused on strategies for cases where the dynamics of pathogen transmission among species were poorly known and the ideas of "land-use induced spillover" and "landscape immunity" could be used very broadly. We first modeled three different land-use change scenarios in a region of transition between the Cerrado and the Atlantic Forest biodiversity hotspots. The land-use strategies used to build our scenarios reflected different proportions of native vegetation cover, as a proxy of habitat availability. We then evaluated the effects of the proportion of native vegetation cover on the occupancy probability of a group of mammal species and analyzed how the different land-use scenarios might affect the distribution of species in the landscape and thus the risk of EZD. We demonstrate that these approaches can help identify potential future EZD risks, and can thus be used as decision-making tools by stakeholders, with direct implications for improving both environmental and socio-economic outcomes.

Climate determines transmission hotspots of Polycystic Echinococcosis, a life-threatening zoonotic disease, across Pan-Amazonia.

Polycystic Echinococcosis (PE), a neglected life-threatening zoonotic disease caused by the cestode Echinococcus vogeli, is endemic in the Amazon. Despite being treatable, PE reaches a case fatality rate of around 29% due to late or missed diagnosis. PE is sustained in Pan-Amazonia by a complex sylvatic cycle. The hunting of its infected intermediate hosts (especially the lowland paca Cuniculus paca) enables the disease to further transmit to humans, when their viscera are improperly handled. In this study, we compiled a unique dataset of host occurrences (~86000 records) and disease infections (~400 cases) covering the entire Pan-Amazonia and employed different modeling and statistical tools to unveil the spatial distribution of PE's key animal hosts. Subsequently, we derived a set of ecological, environmental, climatic, and hunting covariates that potentially act as transmission risk factors and used them as predictors of two independent Maximum Entropy models, one for animal infections and one for human infections. Our findings indicate that temperature stability promotes the sylvatic circulation of the disease. Additionally, we show how El Niño-Southern Oscillation (ENSO) extreme events disrupt hunting patterns throughout Pan-Amazonia, ultimately affecting the probability of spillover. In a scenario where climate extremes are projected to intensify, climate change at regional level appears to be indirectly driving the spillover of E. vogeli. These results hold substantial implications for a wide range of zoonoses acquired at the wildlife-human interface for which transmission is related to the manipulation and consumption of wild meat, underscoring the pressing need for enhanced awareness and intervention strategies.

Body yield and quality of fresh and post-freezing filet of Nile tilapia (Oreochromis niloticus) genetic groups.

The aim of this study was to evaluate the body yield and quality of fresh and post-freezing filet of male and female fish of inbred and non-inbred AquaAmérica genetic group and the hybrid between the AquaAmérica and Tilamax varieties. Forty fish (20 males and 20 females) of each genetic group were housed in four 48-m3 hapa net cages, getting 120 fish per cage. The fish were housed at 51 days of age and farmed for 269 days. Pre-slaughter weight was higher (P<0.05) in the AquaAmérica × Tilamax males (0.805±0.204 kg) than in the inbred AquaAmérica male (0.643±0.115 kg). Filet yield percentage was higher (P<0.05) in the AquaAmérica × Tilamax males (32.14±4.72%) than in the inbred AquaAmérica (28.15±2.67%) and non-inbred AquaAmérica (29.06±2.80%) males. Head and viscera yield percentages, pH, color values (L*, a* and b*), shear force, drip loss and cooking loss did not differ significantly between the genetic groups and sexes. Alterations in meat quality were observed after freezing. In conclusion, inbreeding in the AquaAmérica variety resulted in reduced slaughter weight for males; AquaAmérica × Tilamax males have a higher filet yield; and filet quality is not influenced by crossing, inbreeding, or sex, but is changed after freezing.

Oxygen in interstitial lung diseases.

Domiciliary oxygen is essential in the care of hypoxaemic interstitial lung disease (ILD) patients. Guidelines concur in advising prescription of long-term oxygen therapy (LTOT) for ILD patients with severe hypoxaemia at rest, in view of its beneficial impact on breathlessness/disability and extrapolating potential survival benefits seen in COPD patients. A less severe hypoxaemia threshold for initiation of LTOT is recommended for patients with pulmonary hypertension (PH)/right heart failure, requiring careful evaluation in all ILD patients. In light of evidence suggesting a link between nocturnal hypoxaemia, development of PH and poor survival, studies assessing the impact of nocturnal oxygen are urgently needed. Severe exertional hypoxaemia is frequent in ILD patients, with impact on exercise tolerance, quality of life and mortality. Ambulatory oxygen therapy (AOT) has been associated with improvement in breathlessness and quality of life in ILD patients with exertional hypoxaemia. However, given the paucity of evidence, not all current AOT guidelines are in agreement. Ongoing clinical trials will provide further useful data. Despite its beneficial effects, supplemental oxygen imposes burdens and challenges to patients. A key unmet area of need is the development of less cumbersome and more efficient oxygen delivery systems to reduce the negative impact of AOT on patients' lives.

South Atlantic explosive cyclones in 2014-2015: study employing NCEP2 and MERRA-2 reanalyses.

An analysis of explosive cyclone cases was produced by comparing the reanalysis of MERRA-2 (high spatial resolution) and NCEP2 (low spatial resolution) to South Atlantic in the 2014-2015 period. A total of 51 cases were found, of which 49 were detected by the first reanalysis and 33 by the second (2 cases identified by NCEP2 were not identified by MERRA-2). Spring was the dominant season in the formation of the cases in both reanalyses. It was observed that most systems are formed preferentially eastward of a preexisting trough at higher levels, while others are formed under an almost zonal upper airstream. This difference is more evident in the NCEP2. It was also diagnosed that the MERRA-2 shows more clearly the diffluence in the 250 hPa flow. The analysis of the composite fields revealed a negative horizontal tilt of the trough in 500 hPa, influenced by intense convection as the system develops. Besides, it pointed to a more pronounced jet stream in intense explosive cyclones and more prominent diffluence in non-intense cases. Since the NCEP2 reanalysis detected fewer cases (and only 2 intense) than MERRA-2, it was considered that the former is less suited to the analysis of this type of event.

The Nutritional Status of Chronic Obstructive Pulmonary Disease Exacerbators.

Introduction: Malnutrition is underdiagnosed in chronic obstructive pulmonary disease. Objectives: This study aimed to evaluate the nutritional status of COPD patients and the link between dyspnea and nutritional status. Methods: This longitudinal observational study included patients hospitalized with exacerbated COPD. Nutritional status was assessed using Nutrition Risk Screening 2002, anthropometric, and biochemical assessments, in the first 48 hours of hospitalization. Results: Thirty patients were evaluated. According to the Nutrition Risk Screening 2002, half of the patients were at increased risk of malnutrition. 36.7% were classified as malnourished if we only considered the body mass index. From the evaluation of the tricipital skin fold, 69.0% were classified as malnourished, with 48.3% having severe malnutrition. According to the serum albumin level, 29.6% had malnutrition criteria. A significant association between dyspnea and increasing age (p=0.037) was found. There was a strong association between the fold classification and the degrees of severity of dyspnea (Fisher exact test: 13.60, p=0.001, V Cramer = 0.826). Most patients were malnourished and had higher grades of dyspnea. Tricipital skinfold reflects subcutaneous adipose tissue; this anthropometric measurement seems to be a good method to classify the nutritional status of COPD patients. It classified the biggest portion of patients as malnourished. Conclusion: The number of patients classified as malnourished changed with the method under analysis. The tricipital skin fold parameter was strongly associated with the dyspnea score. Most patients had adipose tissue and muscular mass depletion.

Left atrial minimum volume is better correlate of left atrial dysfunction by two-dimensional strain

BACKGROUND: The analysis of left atrial (LA) function can add important information to the understanding of cardiovascular diseases. Therefore, to assess its functioning the use of volumetric measurements is adopted. The maximum LA volume is the most echocardiography parameter used, however, some studies demonstrated that minimum LA volume is better to correlate with atrial dysfunction. Purpose: The purpose of this study was compare the accuracy of the phasic volumes of the left atrium in determining LA dysfunction identified by the two-dimensional strain. METHODS: This observational, cross-sectional study admitted 109 participants with diagnosis of acute coronary syndrome non-ST-segment elevation. The exams were performed within 72 hours of admission. LA volume was defined by the mean of measurements performed in the four and two-chamber apical windows using Simpson's method. The phasic volumes of the left atrium were measured using an electrocardiogram synchronized with the device. Reservoir LA strain less than 21% was the cut off to LA dysfunction. RESULTS: The phasic LA volume variables analyzed were maximal (LAVMAX), minimal (LAVMIN) and before atrial contraction (LAVBAC) volume, and each variable indexed for body surface (LAVIMAX, LAVIMIN and LAVIBAC). Therefore, a Roc curve was generated for each volume variable to assess which would be more accurate in predicting left atrial dysfunction. The Youden index was used to determine the cutoff point for each one of them. The areas under the Roc curves were: 0.83 (LAVIMIN), 0.81 (LAVMIN), 0.78 (LAVBAC), 0.76 (LAVIMAX), 0.74 (LAVIBAC) and 0.71 (LAVMAX). CONCLUSION: This study concluded that phasic volumes were good determinants of left atrial dysfunction identified by 2D strain. The minimum left atrial volume was the better correlated with left atrial dysfunction.

Left atrial minimum volume is better correlate of left atrial dysfunction by two-dimensional strain

BACKGROUND: The analysis of left atrial (LA) function can add important information to the understanding of cardiovascular diseases. Therefore, to assess its functioning the use of volumetric measurements is adopted. The maximum LA volume is the most echocardiography parameter used, however some studies demonstrated that minimum LA volume is better to correlate with atrial dysfunction. PURPOSE: The purpose of this study was compare the accuracy of the phasic volumes of the left atrium in determining LA dysfunction identified by the two-dimensional strain. METHODS: This observational, cross-sectional study admitted 109 participants with diagnosis of acute coronary syndrome non-ST-segment elevation. The exams were performed within 72 hours of admission. LA volume was defined by the mean of measurements performed in the four and two-chamber apical windows using Simpson's method. The phasic volumes of the left atrium were measured using an electrocardiogram synchronized with the device. Reservoir LA strain less than 21% was the cut off to LA dysfunction. RESULTS: The phasic LA volume variables analyzed were maximal (LAVMAX), minimal (LAVMIN) and before atrial contraction (LAVBAC) volume, and each variable indexed for body surface (LAVIMAX, LAVIMIN and LAVIBAC). Therefore, a Roc curve was generated for each volume variable to assess which would be more accurate in predicting left atrial dysfunction. The Youden index was used to determine the cutoff point for each one of them. The areas under the Roc curves were: 0.83 (LAVIMIN), 0.81 (LAVMIN), 0.78 (LAVBAC), 0.76 (LAVIMAX), 0.74 (LAVIBAC) and 0.71 (LAVMAX). CONCLUSION: This study concluded that phasic volumes were good determinants of left atrial dysfunction identified by 2D strain. The minimum left atrial volume was the better correlate with left atrial dysfunction.

AMAZONIA CAMTRAP: A data set of mammal, bird, and reptile species recorded with camera traps in the Amazon forest.

The Amazon forest has the highest biodiversity on Earth. However, information on Amazonian vertebrate diversity is still deficient and scattered across the published, peer-reviewed, and gray literature and in unpublished raw data. Camera traps are an effective non-invasive method of surveying vertebrates, applicable to different scales of time and space. In this study, we organized and standardized camera trap records from different Amazon regions to compile the most extensive data set of inventories of mammal, bird, and reptile species ever assembled for the area. The complete data set comprises 154,123 records of 317 species (185 birds, 119 mammals, and 13 reptiles) gathered from surveys from the Amazonian portion of eight countries (Brazil, Bolivia, Colombia, Ecuador, French Guiana, Peru, Suriname, and Venezuela). The most frequently recorded species per taxa were: mammals: Cuniculus paca (11,907 records); birds: Pauxi tuberosa (3713 records); and reptiles: Tupinambis teguixin (716 records). The information detailed in this data paper opens up opportunities for new ecological studies at different spatial and temporal scales, allowing for a more accurate evaluation of the effects of habitat loss, fragmentation, climate change, and other human-mediated defaunation processes in one of the most important and threatened tropical environments in the world. The data set is not copyright restricted; please cite this data paper when using its data in publications and we also request that researchers and educators inform us of how they are using these data.

Beyond the skin - A rare case of primary pulmonary melanoma and endobronchial aspergilloma.

Melanoma is an aggressive skin tumor, but it may be present in other locations. Primary lung melanoma and endobronchial aspergilloma are rare entities. The authors report a case of a 72-year-old, asthmatic woman, with worsening of her respiratory complaints. Imaging revealed finger in glove sign at the left hemithorax. Bronchoscopy revealed an elongated mass with evidence of Aspergillus. Despite endoscopic mass removal, the patient maintained the nodular imaging at the left hemithorax. She underwent thoracic surgery, and the histological evaluation identified malignant melanoma. After undergoing a thorough evaluation, we excluded other melanocytic lesions, and assumed the diagnosis of primary malignant lung melanoma. This case demonstrates a rare association between endobronchial aspergilloma and primary lung melanoma, raising awareness of considering the co-existence of lung tumor in the presence of endobronchial aspergilloma, and showing endobronchial aspergilloma mimicking malignant lesions.

Tarumã case study: Telemedicine and Artificial Intelligence applied for reducing Cardiovascular Diseases mortality and Health Cost Optimization / Estudo de caso de Tarumã: O uso de telemedicina e Inteligência Artificial para redução da mortalidade por doenças cardíacas e otimização dos recursos em saúde

Background: Telemedicine supported by Artificial Intelligence (AI) has been an ally in the fight against cardiovascular disease. Tarumã, a municipality located in São Paulo, has been using these kinds of techniques as part of a project to decrease mortality from chronic non-communicable diseases (NCDs). Objective: This study aimed to analyze the results obtained after one year of implementation of telemedicine and AI in cardiology in the city of Tarumã. Methods: All the data was supplied by the companies "iSalut" and "Portal Telemedicina", the Municipal Health Department, the health surveillance department and the company 4R Municipality Software Advisory Service. To verify the significance of data, an ANOVA analysis was carried out for non-parametric data. secondary data have been also related to demographic indicators and healthy care on national basis. Results: As a result, there was a decrease of 21% in premature deaths from cardiovascular diseases and of 25% in premature deaths from circulatory diseases. In addition, between January and August 2020, the number of deaths from CNCD dropped by 45% when compared to the same period in 2019. By relating the previous years, the ANOVA analysis showed a significance F(4,113)=14, 30 (p = 0.001), and the greatest difference was regarding the circulatory system diseases. Besides, the average cost per consultation decreased 60% and the reduction in the number of trips per patient represented a saving of R$5,300.00 in fuel expenses. Conclusion: It can be concluded that in addition to enhancing the patient care by health services, telemedicine reduced the revenue related to health expenses and optimized the use of resources by the municipality.

Introdução: A telemedicina apoiada por Inteligência Artificial (IA) tem sido aliada na luta contra as doenças cardiovasculares. Tarumã, município localizado em São Paulo, tem utilizado essas técnicas como parte de um projeto para  diminuir a mortalidade por doenças crônicas não transmissíveis (DCNT). Objetivos: Analisar os resultados obtidos após um ano de implementação da telemedicina e da IA na cardiologia no município de Tarumã. Métodos: Foram utilizados dados fornecidos pelas empresas "iSalut" e "Portal Telemedicina", Secretaria Municipal de Saúde, Vigilância Sanitária  e a empresa 4R Sistemas e Assessoria de município. Para verificar a significância dos dados foi realizada uma análise ANOVA para dados não paramétricos. Também foram acessados dados secundários relacionados aos índices demográficos populacionais e serviços de saúde em bases nacionais. Resultados: Houve diminuição de 21% dos óbitos prematuros por doenças cardiovasculares e 25% dos óbitos prematuros por doenças circulatórias. Além disso, entre os meses de janeiro e agosto de 2020, o número de óbitos  por DCNT caiu em 45% quando comparado com o mesmo período em 2019. A análise ANOVA, relacionando os anos anteriores demonstrou uma significância F(4,113)=14,30 (p =0,001), sendo que a maior diferença foi em relação às doenças do aparelho circulatório. Além disso, o custo médio  por consulta diminuiu 60% e a redução do número de deslocamento por pacientes representou uma economia de R$5.300,00 em gastos em combustível. Conclusões: Com isso, pode-se concluir que a telemedicina além de potencializar a prestação de cuidados ao paciente pelos serviços de saúde, diminuiu a receita relacionada aos gastos em saúde e otimizou a utilização de recursos pelo município.

A portrait of Brazilian primary care: municipal expenditure and infrastructure in Brazilian municipalities. / Retrato da atenção básica no Brasil: gastos e infraestrutura em municípios brasileiros.

The paper presents the relationship between the allocation of financial resources and the type of local basic health infrastructure in an initial sample of 5,570 Brazilian municipalities. This is an explanatory research using multiple correspondence analysis and quantile regression between expenditure/control variables and the type of structure of PHC Units. The correspondence between the type and the representative variables of expenditure shows that inferior typologies are related to lower per capita expenditure in these variables, and vice versa. Quantile regression showed a positive relationship with the type of infrastructure in the two cycles evaluated. There is evidence that expenditure variables are positively related to infrastructure, which allows us to understand that allocating more resources leads to better infrastructure. Results point to the need to improve the governance of financial resources for health, as municipalities with lower socioeconomic indicators have an infrastructure in the lower categories. We can conclude that there are multiple actors, and the various criteria for allocating and decentralizing resources bring about difficulties of coordination and integration between the entities, restricting the appropriate prioritization in the distribution of resources.

O trabalho apresenta a relação entre a alocação de recursos financeiros e a tipologia da infraestrutura básica local de saúde em amostra inicial de 5.570 municípios do Brasil. Trata-se de uma pesquisa explicativa com uso da análise de correspondência múltipla e regressão quantílica entre variáveis de gastos/controle e a tipologia da estrutura das Unidades Básicas de Saúde. As correspondências entre a tipologia e variáveis representativas dos gastos mostram que tipologias inferiores estão relacionadas com menores gastos per capita nessas variáveis, e vice-versa. A regressão quantílica apresentou relação positiva com a tipologia da infraestrutura nos dois ciclos avaliados. Há evidência das variáveis de gasto estarem relacionadas, de maneira positiva, à infraestrutura, permitindo entender que alocar mais recursos leva a melhor infraestrutura. No entanto, há a necessidade de melhoria na governança dos recursos financeiros da saúde, pois municípios com indicadores socioeconômicos inferiores têm infraestrutura nas categorias inferiores. Conclui-se que há grande multiplicidade de atores e os múltiplos critérios para alocação e descentralização de recursos trazem dificuldades de coordenação e integração entre os entes, restringindo a adequada priorização na alocação dos recursos.

Combining experiments and in silico modeling to infer the role of adhesion and proliferation on the collective dynamics of cells.

The collective dynamics of cells on surfaces and interfaces poses technological and theoretical challenges in the study of morphogenesis, tissue engineering, and cancer. Different mechanisms are at play, including, cell-cell adhesion, cell motility, and proliferation. However, the relative importance of each one is elusive. Here, experiments with a culture of glioblastoma multiforme cells on a substrate are combined with in silico modeling to infer the rate of each mechanism. By parametrizing these rates, the time-dependence of the spatial correlation observed experimentally is reproduced. The obtained results suggest a reduction in cell-cell adhesion with the density of cells. The reason for such reduction and possible implications for the collective dynamics of cancer cells are discussed.

Wild meat consumption in tropical forests spares a significant carbon footprint from the livestock production sector.

Whether sustainable or not, wild meat consumption is a reality for millions of tropical forest dwellers. Yet estimates of spared greenhouse gas (GHG) emissions from consuming wild meat, rather than protein from the livestock sector, have not been quantified. We show that a mean per capita wild meat consumption of 41.7 kg yr-1 for a population of ~ 150,000 residents at 49 Amazonian and Afrotropical forest sites can spare ~ 71 MtCO2-eq annually under a bovine beef substitution scenario, but only ~ 3 MtCO2-eq yr-1 if this demand is replaced by poultry. Wild meat offtake by these communities could generate US$3M or US$185K in carbon credit revenues under an optimistic scenario (full compliance with the Paris Agreement by 2030; based on a carbon price of US$50/tCO2-eq) and US$1M or US$77K under a conservative scenario (conservative carbon price of US$20.81/tCO2-eq), representing considerable incentives for forest conservation and potential revenues for local communities. However, the wild animal protein consumption of ~ 43% of all consumers in our sample was below the annual minimum per capita rate required to prevent human malnutrition. We argue that managing wild meat consumption can serve the interests of climate change mitigation efforts in REDD + accords through avoided GHG emissions from the livestock sector, but this requires wildlife management that can be defined as verifiably sustainable.

A portrait of Brazilian primary care: municipal expenditure and infrastructure in Brazilian municipalities. / Retrato da atenção básica no Brasil: gastos e infraestrutura em municípios brasileiros.

The paper presents the relationship between the allocation of financial resources and the type of local basic health infrastructure in an initial sample of 5,570 Brazilian municipalities. This is an explanatory research using multiple correspondence analysis and quantile regression between expenditure/control variables and the type of structure of PHC Units. The correspondence between the type and the representative variables of expenditure shows that inferior typologies are related to lower per capita expenditure in these variables, and vice versa. Quantile regression showed a positive relationship with the type of infrastructure in the two cycles evaluated. There is evidence that expenditure variables are positively related to infrastructure, which allows us to understand that allocating more resources leads to better infrastructure. Results point to the need to improve the governance of financial resources for health, as municipalities with lower socioeconomic indicators have an infrastructure in the lower categories. We can conclude that there are multiple actors, and the various criteria for allocating and decentralizing resources bring about difficulties of coordination and integration between the entities, restricting the appropriate prioritization in the distribution of resources.

O trabalho apresenta a relação entre a alocação de recursos financeiros e a tipologia da infraestrutura básica local de saúde em amostra inicial de 5.570 municípios do Brasil. Trata-se de uma pesquisa explicativa com uso da análise de correspondência múltipla e regressão quantílica entre variáveis de gastos/controle e a tipologia da estrutura das Unidades Básicas de Saúde. As correspondências entre a tipologia e variáveis representativas dos gastos mostram que tipologias inferiores estão relacionadas com menores gastos per capita nessas variáveis, e vice-versa. A regressão quantílica apresentou relação positiva com a tipologia da infraestrutura nos dois ciclos avaliados. Há evidência das variáveis de gasto estarem relacionadas, de maneira positiva, à infraestrutura, permitindo entender que alocar mais recursos leva a melhor infraestrutura. No entanto, há a necessidade de melhoria na governança dos recursos financeiros da saúde, pois municípios com indicadores socioeconômicos inferiores têm infraestrutura nas categorias inferiores. Conclui-se que há grande multiplicidade de atores e os múltiplos critérios para alocação e descentralização de recursos trazem dificuldades de coordenação e integração entre os entes, restringindo a adequada priorização na alocação dos recursos.

Ethmoid glomangioma and oncogenic osteomalacia: a case report.

BACKGROUND: Glomangioma is a benign tumor of mesenchymal origin, derived from the glomus body. It is responsible for the thermal regulation of the dermis. The occurrence of oncogenic osteomalacia related to glomangioma is rare. Only two cases have been reported thus far. CASE PRESENTATION: A 32-year-old female, Brazilian, presented diffuse pain, during pregnancy, that developed progressively, limiting her mobility. Imaging showed a femoral neck fracture, and rheumatological laboratory examination showed hypophosphatemia. Also, the patient reported episodes of epistaxis during childhood and recurrence along with progressively right nasal obstruction. Endoscopic resection of the tumor was performed, and immunohistochemistry was conclusive for glomangioma. This case report describes the third case in which endonasal endoscopic surgery resulted in a favorable outcome. CONCLUSION: This case of glomangioma-induced oncogenic osteomalacia suggests that surgeons and clinicians should consider sinonasal tumors as a differential diagnosis of osteomalacia, and endonasal endoscopic surgery should be a possible curative resection.

Comparing explosive cyclogenesis cases of different intensities occurred in Southern Atlantic.

Six events of explosive cyclogenesis occurred in the south Atlantic were compared using reanalysis data and satellite water vapor imagery. Cases of different intensities (weak, moderate and strong) occurred during 2014 summer season and 2012 winter season were studied. Despite the similarities the tropopause anomaly was more prominent and vertical movements were stronger in the strong cyclogenesis cases. The tropopause anomalies behind the cold front and ahead of the warm front appear only in the mature stage of the weak and moderate cases while in the strong case it is already evident and more intense behind the cold front since the beginning of the cycle. In all the cases confluence of the jet streams took place at higher levels forming a jet streak with difluence occurring downstream and the cyclone beginning in the exit region. The trajectories of the cyclones were in the southeast direction but longer and more meridional in the strong cases. The results indicated the baroclinicity of the region as the main mechanism for the development of these cyclones as well as the amplitude of the upper level jet stream perturbation. Furthermore, all the explosive cyclones developed following the Shapiro & Keyser cyclone conceptual model.

From the Heart to the Lung: A Case of Drug Toxicity.

BACKGROUND Amiodarone is an anti-arrthymic drug used to treat and prevent several types of dysrhythmias. This drug is known for multiple-organ toxicity. Lung toxicity occurs in about 1% to 5% of cases. A wide variety of lung manifestations have been described, from mild to severe forms. Pulmonary toxicity can be acute, sub-acute, or chronic. Amiodarone-induced lung toxicity is a diagnosis of exclusion. The main treatment is discontinuation of the drug. Lung disease may progress initially due to the prolonged half-life and the accumulation of amiodarone in adipose tissue. Regarding the prognosis, lung toxicity can be reversible, but in some cases, it is irreversible and is sometimes fatal. The risks associated with its use must always be considered. Amiodarone should only be used for short periods. CASE REPORT The authors present a case of a 71-year-old female patient, taking amiodarone 200 mg/day for 18 months. The patient presented with amiodarone-induced lung toxicity. After drug withdrawal, without corticosteroid therapy, we observed clinical, functional, and radiological improvement. CONCLUSIONS This case shows that not all cases of amiodarone-induced lung toxicity require corticosteroid therapy, and highlights that is important to consider this diagnosis in patients on amiodarone therapy with respiratory symptoms.