Mortality predictors in a cohort of patients with COVID-19 admitted to a large tertiary hospital in the city of São Paulo, Brazil: a retrospective study

Abstract BACKGROUND: There is discrepant information across countries regarding the natural history of patients admitted to hospitals with coronavirus disease (COVID-19), in addition to a lack of data on the scenario in Brazil. OBJECTIVE: To determine the mortality predictors in COVID-19 patients admitted to a tertiary hospital in São Paulo, Brazil. DESIGN AND SETTING: A retrospective analysis of medical records of COVID-19 patients admitted to the Hospital Central da Irmandade da Santa Casa de Misericórdia of São Paulo. METHODS: Overall, 316 patients with laboratory-confirmed COVID-19 between March 1, 2020, and July 31, 2020, were included. The analysis included the baseline characteristics, clinical progression, and outcomes. RESULTS: The mortality rate of the sample was 51.27%. Age ≥ 60 years was determined as a risk factor after multivariate logistic regression analysis. Patients with an oxygen (O2) saturation ≤ 94% upon admission accounted for 87% of the deaths (P < 0.001). Vasoactive drugs were used in 92% (P < 0.001) of patients who progressed to death, and mechanical ventilation was employed in 88% (P < 0.001) of such patients. However, patients who received corticosteroids concomitantly with mechanical ventilation had a better prognosis than those who did not. The progressive degree of pulmonary involvement observed on chest computed tomography was correlated with a worse prognosis. The presence of thrombocytopenia has been considered as a risk factor for mortality. CONCLUSION: The main predictors of in-hospital mortality after logistic regression analysis were age, O2 saturation ≤ 94% upon admission, use of vasoactive drugs, and presence of thrombocytopenia.

Mortality predictors in a cohort of patients with COVID-19 admitted to a large tertiary hospital in the city of São Paulo, Brazil: a retrospective study.

BACKGROUND: There is discrepant information across countries regarding the natural history of patients admitted to hospitals with coronavirus disease (COVID-19), in addition to a lack of data on the scenario in Brazil. OBJECTIVE: To determine the mortality predictors in COVID-19 patients admitted to a tertiary hospital in São Paulo, Brazil. DESIGN AND SETTING: A retrospective analysis of medical records of COVID-19 patients admitted to the Hospital Central da Irmandade da Santa Casa de Misericórdia of São Paulo. METHODS: Overall, 316 patients with laboratory-confirmed COVID-19 between March 1, 2020, and July 31, 2020, were included. The analysis included the baseline characteristics, clinical progression, and outcomes. RESULTS: The mortality rate of the sample was 51.27%. Age ≥ 60 years was determined as a risk factor after multivariate logistic regression analysis. Patients with an oxygen (O2) saturation ≤ 94% upon admission accounted for 87% of the deaths (P < 0.001). Vasoactive drugs were used in 92% (P < 0.001) of patients who progressed to death, and mechanical ventilation was employed in 88% (P < 0.001) of such patients. However, patients who received corticosteroids concomitantly with mechanical ventilation had a better prognosis than those who did not. The progressive degree of pulmonary involvement observed on chest computed tomography was correlated with a worse prognosis. The presence of thrombocytopenia has been considered as a risk factor for mortality. CONCLUSION: The main predictors of in-hospital mortality after logistic regression analysis were age, O2 saturation ≤ 94% upon admission, use of vasoactive drugs, and presence of thrombocytopenia.

Potentially inappropriate medication use in hospitalized elderly patients.

OBJECTIVE: This study aimed to assess the prevalence of potentially inappropriate medication prescription in hospitalized elderly patients according to the 2019 American Geriatrics Society Beers Criteria. METHODS: This study is a prospective analysis of electronic medical records of elderly patients admitted to the Department of Medicine, Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo, between 1 September 2020 and 30 April 2021. RESULTS: A total of 142 patients (85 women and 57 men) with a mean age of 74.5±7.3 years (65-99 years) were assessed. Of these, 108 (76.1%) were elderly (age ≥65 years and <80 years) and 34 (23.9%) long-lived (age ≥80 years). The average length of stay found in the sample was 25.3±28.7 days (between 2 and 235 days), and 102 out of the 140 patients assessed remained in the hospital for up to 29 days. Sixteen drugs considered potentially inappropriate medication were found in the patients' prescriptions, with at least one potentially inappropriate medication having been prescribed to 141 (99.3%) patients. Elderly patients had a mean of 2.57±0.94 potentially inappropriate medication prescribed versus 2.56±0.89 among long-lived patients. The most prescribed potentially inappropriate medication were as follows: regular human insulin as required (85.2%), and omeprazole (73.9%) and metoclopramide as required (61.3%). CONCLUSION: The study sample showed significant percentages of potentially inappropriate medication prescriptions for the elderly admitted to the hospital.

Potentially inappropriate medication use in hospitalized elderly patients

SUMMARY OBJECTIVE: This study aimed to assess the prevalence of potentially inappropriate medication prescription in hospitalized elderly patients according to the 2019 American Geriatrics Society Beers Criteria. METHODS: This study is a prospective analysis of electronic medical records of elderly patients admitted to the Department of Medicine, Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo, between 1 September 2020 and 30 April 2021. RESULTS: A total of 142 patients (85 women and 57 men) with a mean age of 74.5±7.3 years (65-99 years) were assessed. Of these, 108 (76.1%) were elderly (age ≥65 years and <80 years) and 34 (23.9%) long-lived (age ≥80 years). The average length of stay found in the sample was 25.3±28.7 days (between 2 and 235 days), and 102 out of the 140 patients assessed remained in the hospital for up to 29 days. Sixteen drugs considered potentially inappropriate medication were found in the patients' prescriptions, with at least one potentially inappropriate medication having been prescribed to 141 (99.3%) patients. Elderly patients had a mean of 2.57±0.94 potentially inappropriate medication prescribed versus 2.56±0.89 among long-lived patients. The most prescribed potentially inappropriate medication were as follows: regular human insulin as required (85.2%), and omeprazole (73.9%) and metoclopramide as required (61.3%). CONCLUSION: The study sample showed significant percentages of potentially inappropriate medication prescriptions for the elderly admitted to the hospital.

GOOD VISUAL OUTCOME IN A BILATERAL MULTIFOCAL SYPHILITIC CHORIORETINITIS, DESPITE LATE DIAGNOSIS.

PURPOSE: To report a case of a good visual outcome in a patient with bilateral multifocal syphilitic chorioretinitis, despite the late diagnosis. METHODS: Ophthalmologic examination, multimodal imaging, including fundus photography, angiography, and optical coherence tomography. RESULTS: The authors describe a 47-year-old heterosexual man with a bilateral multifocal syphilitic chorioretinitis that was lately diagnosed and despite that had a good visual outcome. CONCLUSION: The diagnosis of ocular syphilis is a challenge; however, once it has been made, even lately, it is eminently treatable.

Distillation methods affect the chemical composition of Varronia curassavica Jacq. essential oil? / Métodos de destilação afetam a composição química do óleo essencial de Varronia curassavica Jacq?

The objective of this work was to evaluate the chemical composition of essential oil from Varronia curassavica Jacq. obtained by microwave (MI) and hydrodistillation (HD) extraction methods. The MI method tested three powers (500, 600, and 700W), three distillation times (20, 30, and 40 min.), and three water volumes (0, 25, and 50 mL per sample). The HD method tested three distillation times (100, 120, and 140 min.) and three water volumes (1.0, 1.5, and 2.0 L per 3-liter flask). The essential oils were analyzed by GC/MS-FID. The optimal condition for the essential oil extraction by the MI method was 700W for 40 min. (3.28%), regardless of the volume of water. In its turn, the best condition for essential oil extraction by the HD method was 120 min. with 1.0 L of water per flask (3.34%). The most abundant compounds for MI (700 W for 40 min. without water) were shyobunol (26.53%) and bicyclogermacrene (4.96%); and the most abundant compounds for HD (120 min. with 1.0 L of water/flask) were shyobunol (24.00%) and germacrene D-4-ol (10.23%). Methyl farnesoate (2E, 6E) and farnesyl acetate (2Z, 6E) were not detected in the essential oil extracted by HD; however, they were identified by the MI method. By increasing the distillation time and/or volume of water in HD, a reduction was observed for the content of the chemical compounds -elemene (from 1.23 to 0.97%), Ecaryophyllene (from 5.49 to 4.35%), -humulene (from 1.80 to 1.43%), alloaromadendrene (from 1.78 to 1.44%), bicyclogermacrene (from 5.63 to 4.55%), and germacrene D-4-ol (from 11.40 to 9.86%). Power, extraction time, and their interactions influenced the content of essential oil obtained by microwave extraction (MI). Within each power, the highest essential oil content was extracted at the longest distillation time (40 min.), except for 600W, where no significant difference was detected between 30 and 40 min. The optimal essential oil contents for both extraction methods were statically similar by the t-test for dependent samples. However, the MI method presents advantages, such as shorter distillation time and less energy and water consumption.

O objetivo deste trabalho foi avaliar a composição química do óleo essencial de Varronia curassavica Jacq. obtido pelos métodos de extração micro-ondas (MI) e hidrodestilação (HD). Para MI, foram testadas três potências (500, 600 e 700W), três tempos de destilação (20, 30 e 40 min.) e três volumes de água (0, 25 e 50 mL por amostra). Para HD, foram testados três tempos de destilação (100, 120 e 140 min.) e três volumes de água (1,0; 1,5 e 2,0 L por balão de 3 litros). Os óleos essenciais foram analisados por CG/EM-FID. Maiores teores de óleo essencial foram obtidos nas condições de 700 W por 40 min. (3.28%), independente do volume de água para MI, e 120 min. com 1,0 L de água por balão para HD (3,34%). Os compostos mais abundantes para MI (700W, por 40 min., sem água) foram o shyobunol (26,53%) e biciclogermacreno (4,96%) e para HD (120 min. com 1,0 L de água /balão) foram shyobunol (24,00%) e germacreno D -4 -ol (10,23%). Metil farnesoato (2E, 6E) e farnesil acetato (2Z, 6E) não foram detectados no óleo essencial extraído por HD, porém, foram detectados nas amostras extraídas por MI. Com o aumento do tempo de destilação e/ou do volume de água em HD, houve redução no conteúdo dos constituintes químicos -elemeno (de 1,23 para 0,97%), E-cariofileno (de 5,49 para 4,35%), -humuleno (1,80 para 1,43%), aloaromadendreno (de 1,78 para 1,44%), biciclogermacreno (de 5,63 para 4,55%) e germacreno D-4-ol (de 11,40 para 9,86%). A potência, o tempo de extração e suas interações influenciaram no teor de óleo essencial obtido na extração por micro-ondas (MI). Dentro de cada potência, o maior teor de óleo essencial foi obtido no tempo mais longo de extração (40 min.), exceto para 600 W, que não apresentou diferença significativa entre 30 e 40 min. Nas condições ótimas de extração, os teores de óleo essencial obtidos foram estatisticamente semelhantes pelo teste t para amostras dependentes. No entanto, a extração por micro-ondas apresenta algumas vantagens em relação a HD, como menor tempo de destilação e menor consumo de energia e água.

Deltamethrin-induced nuclear erythrocyte alteration and damage to the gills and liver of Colossoma macropomum.

Deltamethrin is one of the most commonly used pyrethroids in the world, and it has a high toxic potential, mainly on aquatic organism. Thus, the purpose of this study was to evaluate LC50 values of deltamethrin on tambaqui (Colossoma macropomum) fingerlings and to investigate genotoxic effects and histopathological responses. Fish were exposed to different concentrations of deltamethrin (0, 6.16 × 10-3; 6.44 × 10-2; 1.34 × 10-1, and 1.93 × 10-1 mg L-1) for 96 h. In addition, a genotoxicity analysis was carried out on peripheral blood erythrocytes and histopathological changes were classified by the severity degree of damage and organ functioning. The 96 h LC50 value for tambaqui was estimated at 5.56 × 10-2 mg L-1 using a static test system. Nuclear abnormalities in exposed fish included micronuclei, blebbed, notched, 8-shaped, and binucleated nuclei forms. Deltamethrin significantly induced a notched nucleus compared to other abnormalities. A histopathological examination showed hepatic lesions and gill damage. Deltamethrin was found to be highly toxic; it induced genotoxicity and caused liver and gill inflammation in tambaqui.

The effects of gelatin supplementation prior to cooling on ram semen quality and fertility

The physical and chemical characteristics of gelatin have been used to justify its inclusion in extenders to preserve the sperm quality and improve results of cervical artificial insemination with cooled semen. The objective of this study was to evaluate the effects of gelatin supplementation in cooling extender on the quality and fertility of ram semen stored at 5°C. Semen samples (n = 24) of Santa Inês rams (n = 6) were diluted in Glycine-Yolk-Milk extender without (control) or with 1.5% of gelatin. The samples were loaded into 0.25 mL straws, cooled to 5°C and stored vertically for 48 and 72 hours. Sample quality was evaluated using straw homogeneity tests based on pH, osmolality and the proportion of spermatozoa (PS) in both upper and lower segments of straws (US and LS), analyses of sperm motility, plasma and acrosomal membrane integrity, and by fertility after artificial insemination. Differences between the US and LS of straws were found for pH and PS (%). They were significant only in the control group at both times: pH – 5.96 vs. 5.71 at 48 h and 6.13 vs. 5.89 at 72 h; PS – 21.66 vs. 78.34 at 48 h and 20.87 vs. 79.13 at 72 h. Storage in gelatin had very little, to no effect on the sperm kinetics or on the sperm membrane integrity evaluations. The addition of gelatin to the extender did not affect the pregnancy rate which ranged from 4.4 to 26.1%. We conclude that gelatin is effective in maintaining the physical and chemical homogeneity of the semen samples. Further research is needed in order to optimize the use of gelatin supplementation and elucidate any potential benefits.

The effects of gelatin supplementation prior to cooling on ram semen quality and fertility

The physical and chemical characteristics of gelatin have been used to justify its inclusion in extenders to preserve the sperm quality and improve results of cervical artificial insemination with cooled semen. The objective of this study was to evaluate the effects of gelatin supplementation in cooling extender on the quality and fertility of ram semen stored at 5°C. Semen samples (n = 24) of Santa Inês rams (n = 6) were diluted in Glycine-Yolk-Milk extender without (control) or with 1.5% of gelatin. The samples were loaded into 0.25 mL straws, cooled to 5°C and stored vertically for 48 and 72 hours. Sample quality was evaluated using straw homogeneity tests based on pH, osmolality and the proportion of spermatozoa (PS) in both upper and lower segments of straws (US and LS), analyses of sperm motility, plasma and acrosomal membrane integrity, and by fertility after artificial insemination. Differences between the US and LS of straws were found for pH and PS (%). They were significant only in the control group at both times: pH 5.96 vs. 5.71 at 48 h and 6.13 vs. 5.89 at 72 h; PS 21.66 vs. 78.34 at 48 h and 20.87 vs. 79.13 at 72 h. Storage in gelatin had very little, to no effect on the sperm kinetics or on the sperm membrane integrity evaluations. The addition of gelatin to the extender did not affect the pregnancy rate which ranged from 4.4 to 26.1%. We conclude that gelatin is effective in maintaining the physical and chemical homogeneity of the semen samples. Further research is needed in order to optimize the use of gelatin supplementation and elucidate any potential benefits.(AU)

The effects of gelatin supplementation prior to cooling on ram semen quality and fertility.

The physical and chemical characteristics of gelatin have been used to justify its inclusion in extenders to preserve the sperm quality and improve results of cervical artificial insemination with cooled semen. The objective of this study was to evaluate the effects of gelatin supplementation in cooling extender on the quality and fertility of ram semen stored at 5°C. Semen samples (n = 24) of Santa Inês rams (n = 6) were diluted in Glycine-Yolk-Milk extender without (control) or with 1.5% of gelatin. The samples were loaded into 0.25 mL straws, cooled to 5°C and stored vertically for 48 and 72 hours. Sample quality was evaluated using straw homogeneity tests based on pH, osmolality and the proportion of spermatozoa (PS) in both upper and lower segments of straws (US and LS), analyses of sperm motility, plasma and acrosomal membrane integrity, and by fertility after artificial insemination. Differences between the US and LS of straws were found for pH and PS (%). They were significant only in the control group at both times: pH - 5.96 vs. 5.71 at 48 h and 6.13 vs. 5.89 at 72 h; PS - 21.66 vs. 78.34 at 48 h and 20.87 vs. 79.13 at 72 h. Storage in gelatin had very little, to no effect on the sperm kinetics or on the sperm membrane integrity evaluations. The addition of gelatin to the extender did not affect the pregnancy rate which ranged from 4.4 to 26.1%. We conclude that gelatin is effective in maintaining the physical and chemical homogeneity of the semen samples. Further research is needed in order to optimize the use of gelatin supplementation and elucidate any potential benefits.

Essential oils of Varronia curassavica accessions have different activity against white spot disease in freshwater fish.

The aim of this study was to evaluate the antiprotozoal activity of essential oils from Varronia curassavica accessions against different stages of Ichthyophthirius multifiliis. Essential oils from each accession were tested in vitro at the concentrations 0, 10, 25, 50, 75, 100, and 200 mg/L. The VCUR-001, VCUR-202, VCUR-509, and VCUR-601 accessions presented the major compounds α-pinene, germacrene D-4-ol, (E)-caryophyllene and epiglobulol, and sabinene, respectively. These isolated compounds were tested in vitro at a concentration proportional to that found in the essential oil which caused 100% mortality of the parasite. The concentrations of 10 and 50 mg/L of the essential oil of accession VCUR-202 provided 100% mortality of trophonts and tomonts, respectively. For the accession VCUR-509, 100% mortality of trophonts and tomonts was observed at concentrations 75 and 200 mg/L of essential oil, respectively. The same mortality was observed at concentration 200 mg/L in both stages of the parasite for the other accessions. The major compounds α-pinene, sabinene, and the (E)-caryophyllene + epiglobulol mixture caused 100% mortality of trophonts and tomonts. The in vivo assay for white spot disease control was performed in a therapeutic bath of 1 h with the essential oil of accession VCUR-202 at concentrations of 0.5 and 2.0 mg/L. A significant reduction of about 30% of trophonts on infected fish was observed, independent of the oil concentration. The V. curassavica essential oil, especially the VCUR-202 accession, is a potential source of raw material for the formulation and commercialization of bioproducts to control freshwater white spot disease in fish.

Embryonic development and larval growth of Brycon nattereri Günther, 1864 (Characidae) and its implications for captive rearing.

The aim of this study was to describe, for the first time, the embryogenesis and larval growth of the Paraitinga Brycon nattereri Günther, 1864 reared in captivity. After artificial fertilization, eggs were incubated at constant temperature (~19°C) and collected every 15 min during the first 3 h and then every 3 h until hatching. Five larvae were collected daily over 15 days for evaluation of the length, yolk sac volume and specific growth rate. The following stages of embryonic development were identified: zygote, cleavage, gastrula, segmentation and larval. The hatching occurred after 50-54 h, with larvae poorly developed and fully depigmented, devoid of mouth and swimming capacity, presenting 6.32 mm total length and 3.64 mm3 yolk sac volume. The mouth opening was observed between days 3-4 after hatching. The yolk sac absorption was slow during the first 3 days, increasing sharply after this period, being completed on the day 11. During this period there was a decrease in the larval growth rate. After yolk sac absorption, an increase in the growth rate was observed that coincided with the start of exogenous feeding. Cannibalism was not observed during the 15 days of evaluation. The initial development of B. nattereri was slow and poorly developed larvae in relation to other Brycon species, certainly due to the lower temperature required for egg incubation and larval rearing. Other studies are needed in order to develop techniques to improve the methods of incubating eggs and feeding larvae.

Sucessfull management of bilateral presumed Candida endogenous endophtalmitis following pancreatitis / Tratamento bem sucedido de caso de endoftalmite endógena bilateral presumida por Candida pós pancreatite

ABSTRACT Endogenous endophthalmitis is a rare, and frequently devastating, ophthalmic disease. It occurs mostly in immunocompromised patients, or those with diabetes mellitus, cancer or intravenous drugs users. Candida infection is the most common cause of endogenous endophthalmitis. Ocular candidiasis develops within days to weeks of fungemia. The association of treatment for pancreatitis with endophthalmitis is unusual. Treatment with broad-spectrum antibiotics and total parenteral nutrition may explain endogenous endophthalmitis. We report the case of a patient with pancreatitis treated with broad-spectrum antibiotics and total parenteral nutrition who developed bilateral presumed Candida endogenous endophthalmitis that was successfully treated with vitrectomy and intravitreal amphotericin B.

RESUMO Endoftalmite endógena é uma condição oftalmológica rara e frequentemente devastadora. Ocorre principalmente em pacientes imunocomprometidos, diabéticos, com neoplasias ou usuários de drogas intravenosas. Infecção por Candida é a causa mais comum de endoftalmite endógena. A candidíase ocular ocorre de dias a semanas após a fungemia. A associação de endoftalmite e o tratamento para pancreatite é rara. O tratamento com antibióticos de amplo espectro e alimentação parenteral total podem explicar uma endoftalmite endógena. Neste estudo, reportamos o caso de um paciente com pancreatite tratado com antibióticos de amplo espectro e alimentação parenteral total que desenvolveu endoftalmite endógena bilateral presumida por Candida que foi tratado com sucesso com vitrectomia e injeção intravítrea de amfotericina B.

Zika virus infections in three travellers returning from South America and the Caribbean respectively, to Montpellier, France, December 2015 to January 2016.

We report three unrelated cases of Zika virus infection in patients returning from Martinique, Brazil and Colombia respectively, to Montpellier, France. They developed symptoms compatible with a mosquito-borne disease, and serological and molecular investigations indicated a recent Zika virus infection. Considering the recent warning for the likely teratogenicity of Zika virus and the presence of competent mosquito vectors in southern France, these cases highlight the need for awareness of physicians and laboratories in Europe.

Postmortem Diagnosis of Dengue as an Epidemiological Surveillance Tool.

Dengue remains a problem in Brazil, and a substantial number of cases that progress to death are not diagnosed by health services. We evaluated the impact of a protocol adopted by the Coroner's Office Rocha Furtado (CO-RF) for the detection of unreported deaths from dengue in Brazil. We evaluated prospectively cases of deaths referred to the CO-RF with suspicion of dengue and those referred with other diagnosis in which the pathologists suspected dengue as the cause of death. Biological material was collected from all bodies autopsied, for which the suspected cause of death was dengue, between January 2011 and December 2012. Of the 214 bodies autopsied, 134 (62.6%) tested positive for dengue; of these cases, 121 were classified as dengue according to the World Health Organization's case definition (1997 or 2009, as appropriate). Thus, CO-RF detected 90 deaths from dengue, which were not suspected during disease progression. This CO-RF protocol, through a combined effort of the surveillance and laboratory teams, increased the detection of fatal dengue cases by 5-fold. This is the largest series of autopsies performed in cases of death related to dengue in the world to date.

Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil.

INTRODUCTION: The dengue classification proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. METHODS: This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations. RESULTS: The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121) of the cases were classified as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121) of the cases were classified as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF. CONCLUSIONS: The WHO 2009 classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue.

Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil

Abstract: INTRODUCTION: The dengue classification proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. METHODS: This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations. RESULTS: The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121) of the cases were classified as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121) of the cases were classified as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF. CONCLUSIONS: The WHO 2009 classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue.

Branch retinal artery occlusion in Susac's syndrome

Susac's syndrome is a rare disease attribuited to a microangiopathy involving the arterioles of the cochlea, retina and brain. Encefalopathy, hearing loss, and visual deficits are the hallmarks of the disease. Visual loss is due to multiple, recurrent branch arterial retinal occlusions. We report a case of a 20-year-old women with Susac syndrome presented with peripheral vestibular syndrome, hearing loss, ataxia, vertigo, and vision loss due occlusion of the retinal branch artery.

Síndrome de Susac é uma microangiopatia rara que afeta as arteríolas da cóclea, retina e encéfalo. Encefalopatia, perda auditiva e baixa da acuidade visual formam a tríade clássica da doença. A baixa de acuidade visual ocorre devido a múltiplas e recorrentes oclusões de ramo arterial da retina. Relatamos o caso de uma paciente de 20 anos com síndrome de Susac apresentando síndrome vestibular periférica, perda auditiva, vertigem, ataxia e baixa da acuidade visual por oclusão de ramo arterial de retina.

Histochemical and morphological features of biopsied and stripped oocytes from the Brazilian endangered teleost pirapitinga, Brycon nattereri (Characiformes).

The aim of the present study was to characterize biopsied and stripped oocytes from the Brazilian endangered teleost pirapitinga (Brycon nattereri) using histochemical and morphological analyses. Biopsied oocytes had a mean diameter of 2.225 mm (modal diameter: 2.312 mm), complete vitellogenesis and a central or slightly eccentric nucleus. Neutral polysaccharides were detected in the follicular cells, zona radiata and yolk globules, while acidic polysaccharides were detected in the follicular cells and cortical alveoli. Ten out of the 19 females treated with two doses of carp pituitary extract (cPE) released oocytes, which were also analysed. Stripping occurred 292 ± 39 degree-hours after the second dose of cPE and led to a mean spawning weight of 36.2 g, 10% spawning index, 241 oocytes/g of ova, 8222 oocytes/female and 23 oocytes/g of body weight. Stripped oocytes had a mean diameter of 2.33 mm and a mode at 2.375 mm, were weakly adhesive and coloration ranged from wine to brown. Under scanning electron microscopy, stripped oocytes exhibited a single funnel-shaped micropyle located at the animal pole and a zona radiata that measured 7.7 µm in thickness with eight pore canals/µm2. Oocyte morphology in Brycon nattereri is similar to that found in other species of the genus, except for the larger size and weaker adhesiveness. These findings provide essential information for a better understanding of the reproductive biology of B. nattereri and the establishment of conservation measures for this threatened species.

Choroidal metastasis as the first sign of bronchioloalveolar lung cancer: case report.

Metastatic tumors are the most common intraocular malignances and choroid is by far the most common site. Breast and lung cancer are the first cause in women and men respectively. We report the case of a 71-year old woman who had choroidal tumor in her left eye. Further image body scans demonstrated several lesions in both sides of the lungs with dissemination to other organs. Diagnosis of a brochioloalveolar carcinoma established after a biopsy carried out. The patient died before initiating a proper treatment.