ABC2-SPH risk score for in-hospital mortality in COVID-19 patients: development, external validation and comparison with other available scores.

OBJECTIVES: The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones. METHODS: Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March-July, 2020. The model was validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients. RESULTS: Median (25-75th percentile) age of the model-derivation cohort was 60 (48-72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829-0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833-0.885]) and Spanish (0.894 [95% CI 0.870-0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). CONCLUSIONS: An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19.

Robotic transduodenal excision of ampullary tumour.

Ampullary tumours are uncommon lesions with potential risk of malignancy. The management is excision by either endoscopic ampullectomy, pancreaticoduodenectomy or transduodenal excision. Endoscopic ampullectomy offers a less invasive approach, whereas pancreaticoduodenectomy allows radical excision of the tumour. They both carry their own limitations. Transduodenal excision of ampullary tumour offers significantly lower risks with low recurrence rate, and can be offered for benign or early grade tumours. Limited cases of laparoscopic transduodenal excision of ampullary tumours were reported in the literature, probably due to the technical difficulties in performing the operation, especially during the reconstruction of the pancreaticobiliary ducts with the laparoscopic approach. In the era with robotic surgical systems, the technical demanding procedures are greatly facilitated. Hence, we are writing to report a case of transduodenal excision of ampullary tumour with the robot assisted laparoscopic approach.

Determinação do perfil fitoquímico e avaliação das atividades biológicas de extrato da espécie Scleronema micranthum da família Bombacaceae / Determination of the phytochemical profile and evaluation of biological activities of extract of species Scleronema micranthum in the Bombacaceae family

As plantas medicinais são usadas desde a antiguidade para tratar diversas doenças e, têm subsidiado a pesquisa farmacêutica na descoberta de novos agentes biologicamente ativos. Neste contexto, foi realizada a prospecção fitoquímica, a avaliação das atividades citotóxica, antimicrobiana e antioxidante do extrato etanólico obtido das folhas da espécie Scleronema micranthum Ducke (Bombacaceae), conhecida popularmente como cedrinho. Os resultados obtidos na prospecção fitoquímica sugerem a presença dos componentes metabólicos leucoantocianidinas, flavonoides, saponinas e fenóis. As moderadas atividades citotóxica e antioxidante estabelecidas para o extrato bruto, podem despertar o interesse das empresas farmacêuticas em razão da pesquisa por novos agentes antitumorais e anti-inflamatórios oriundos da Floresta Amazônica. Deste modo, os resultados obtidos neste estudo representam uma clara oportunidade para gerar benefícios econômicos e estimular a competitividade da indústria farmacêutica nacional, a partir da prospecção de novos agentes bioativos aplicados ao controle de doenças de importância para a saúde pública.(AU)

Medicinal plants are used since ancient times to treat various diseases and have subsidized pharmaceutical research in the discovery of new biologically active agents. In this context, we evaluated the phytochemical prospection, the cytotoxicity, antimicrobial and antioxidant activities of the ethanolic extract obtained from the leaves of the species Scleronema micranthum Ducke (Bombacaceae), popularly known as "cedrinho". The results achieved in this phytochemical prospection suggest the presence of leucoanthocyanidins, flavonoids, saponins and phenols, as metabolic components. The moderate cytotoxic and antioxidant activities of the crude extract can arouse the interest of pharmaceutical companies in search of new antitumor and anti-inflammatory agents derived from the Amazon Rainforest. We hope the results obtained in this study indicates a clear opportunity of generating economic benefits and boosting the competitiveness of the national pharmaceutical industry, prospecting new bioactive agents to control diseases of public health importance.(AU)

Sonography of small bowel perforation.

OBJECTIVE: This article aims to illustrate the spectrum of sonographic findings in perforation of the small bowel due to a variety of causes and discusses the potential role of sonography in the diagnosis. CONCLUSION: Although sonography is not the first-line investigation of choice in suspected small intestinal perforation, an understanding of the characteristic appearances seen during general abdominal sonography may aid the radiologist in the early diagnosis. Recognition of small bowel perforation on general abdominal sonography will shorten the time to diagnosis and ultimate surgical management.

Perforated pyloroduodenal peptic ulcer and sonography.

OBJECTIVE: The purpose of this article is to illustrate the spectrum of sonographic findings in perforated pyloroduodenal peptic ulcer and discuss the potential role of sonography in the diagnosis. CONCLUSION: Although sonography is not the first-line investigation of choice in suspected perforated peptic ulcer, understanding of the characteristic appearances seen during general abdominal sonography may aid the reader in the diagnosis of this important and sometimes overlooked cause of nonspecific abdominal pain. This may shorten time to the diagnosis and ultimate surgical management.