Comparative genomics and stable isotope analysis reveal the saprotrophic-pathogenic lifestyle of a neotropical fungus.

In terrestrial forested ecosystems, fungi may interact with trees in at least three distinct ways: (i) associated with roots as symbionts; (ii) as pathogens in roots, trunks, leaves, flowers, and fruits; or (iii) decomposing dead tree tissues on soil or even on dead tissues in living trees. Distinguishing the latter two nutrition modes is rather difficult in Hymenochaetaceae (Basidiomycota) species. Herein, we have used an integrative approach of comparative genomics, stable isotopes, host tree association, and bioclimatic data to investigate the lifestyle ecology of the scarcely known neotropical genus Phellinotus, focusing on the unique species Phellinotus piptadeniae. This species is strongly associated with living Piptadenia gonoacantha (Fabaceae) trees in the Atlantic Forest domain on a relatively high precipitation gradient. Phylogenomics resolved P. piptadeniae in a clade that also includes both plant pathogens and typical wood saprotrophs. Furthermore, both genome-predicted Carbohydrate-Active Enzymes (CAZy) and stable isotopes (δ13C and δ15N) revealed a rather flexible lifestyle for the species. Altogether, our findings suggest that P. piptadeniae has been undergoing a pathotrophic specialization in a particular tree species while maintaining all the metabolic repertoire of a wood saprothroph. IMPORTANCE: This is the first genomic description for Phellinotus piptadeniae. This basidiomycete is found across a broad range of climates and ecosystems in South America, including regions threatened by extensive agriculture. This fungus is also relevant considering its pathotrophic-saprotrophic association with Piptadenia goanocantha, which we began to understand with these new results that locate this species among biotrophic and necrotrophic fungi.

Understanding the Elevated Lethality of COVID-19 in Liver Transplant Recipients: Does Immunosuppression Management Matter? Results from a Brazilian Multicentric Historical Cohort.

BACKGROUND: Infections by SARS-CoV-2 in liver transplant recipients (LT) patients are of particular concern, notably due to perceived added risks related to immunosuppression and comorbidity burden. Current literature on this topic often relies on small, non-standardized, and geographically limited studies. This manuscript describes COVID-19 presentations and causes for elevated mortality in a large cohort of LT recipients. METHODS: This study was designed as a multicentric historical cohort, including LT recipient patients with COVID-19 in 25 study centers, with the primary endpoint being COVID-related death. We also collected demographic, clinical, and laboratory data regarding presentation and disease progression. RESULTS: Two hundred and thirty-four cases were included. The study population was predominantly male and White and had a median age of 60 years. The median time from transplantation was 2.6 years (IQR 1-6). Most patients had at least one comorbidity (189, 80.8%). Patient age (P = .04), dyspnea (P < .001), intensive care unit admission (P < .001), and mechanical ventilation (P < .001) were associated with increased mortality. Modifications of immunosuppressive therapy (P < .001), specifically the suspension of tacrolimus, maintained significance in multivariable analysis. CONCLUSIONS: Attention to risk factors and the individualization of patient care, especially regarding immunosuppression management, is crucial for delivering more precise interventions to these individuals.

Infective Endocarditis Surgery. Insights from 328 Patients Operated in a University Tertiary Hospital. / Cirurgia de Endocardite Infecciosa. Análise de 328 Pacientes Operados em um Hospital Universitário Terciário.

BACKGROUND: Infectious endocarditis (IE) refers to infection of the endocardial surface of the heart and usually occurs in native or prosthetic valves. OBJECTIVE: This study aimed to raise IE data reflecting the surgical therapy in a University Hospital in the interior of the State of Sao Paulo-Brazil. METHOD: Retrospective and observational approach of 328 patients with IE who underwent surgery between 1982 and 2020. RESULTS: The main data (n=121/37%), congestive heart failure (n=114/35%), valve disease (n=92/28%), diabetes mellitus (n=85/26%), chronic kidney disease (n=59/18%), and rheumatic fever (49/15%). Renal failure is one of the main and most relevant pre-surgical risk factors for a poor prognosis. CONCLUSION: For a better clinical and surgical outcome, an early syndromic and etiological diagnosis of IE is necessary, especially in patients with multiple comorbidities.

FUNDAMENTO: A endocardite infecciosa (EI) refere-se à infecção da superfície endocárdica do coração e geralmente ocorre em valvas nativas ou protéticas. OBJETIVO: Este estudo teve como objetivo levantar dados de EI refletindo a terapêutica cirúrgica, em um Hospital Universitário do interior do estado de São Paulo ­ Brasil. MÉTODO: Abordagem retrospectiva e observacional de 328 pacientes com EI operados entre 1982 e 2020. RESULTADOS: Os principais dados (n=121/37%), insuficiência cardíaca congestiva (n=114/35%), valvopatia (n=92/28%), diabetes mellitus (n=85/26%), doença renal crônica (n=59/18%) e febre reumática (49/15%). A insuficiência renal é um dos principais e mais relevantes fatores de risco pré-cirúrgicos para um mau prognóstico. CONCLUSÃO: Para um melhor resultado clínico e cirúrgico é necessário o diagnóstico sindrômico e etiológico precoce da EI, principalmente em pacientes com múltiplas comorbidades.

Effects of Intensive Blood Glucose Control on Surgical Site Infection for Liver Transplant Recipients: A Randomized Controlled Trial.

BACKGROUND: The evidence supporting intensive blood glucose control to prevent surgical site infections (SSIs) among liver transplant recipients is insufficient. We aimed to assess the effects of postoperative intensive blood glucose control (IBGC) against standard blood glucose control (SBGC) on the incidence of SSIs among adult liver transplant recipients. METHODS: We performed a randomized controlled trial (ClinicalTrials.gov identifier NCT03474666). The IBGC target was 80 to 130 mg/dL, and the SBGC target was below 180 mg/dL. Analyses were made on an intention-to-treat basis. RESULTS: Of the 41 recipients enrolled onto the trial, 20 were randomly allocated to the IBGC group and 21 to the SBGC group. There were no significant differences in SSIs among recipients allocated to either group (relative risk [RR], 0.78; 95% confidence interval [CI], 0.21-2.88; P = .69). Mean (SD) blood glucose levels were significantly lower in the IBGC group in the 24-hour period after surgery (145.0 [20.7] mg/dL and 230.2 [51.6] mg/dL; P = .001). While there were fewer episodes of hypoglycemia in the IBGC group, this was not statistically significant. There were no episodes of severe hypoglycemia in either group. Hyperglycemia and severe hyperglycemia were significantly more frequent in the SBGC group (RR, 0.70; 95% CI, 0.52-0.93; P = .001 and RR, 0.07; 95% CI, 0.01-0.48; P = .001, respectively). Length of hospital stay was significantly shorter for recipients in the IBGC group (13.1 [5.5] days vs 19.3 [12.1] days; P = .04). CONCLUSIONS: Although this small trial did not find intensive control reduced SSI, it was associated with lower blood glucose levels, fewer episodes of hyperglycemia and severe hyperglycemia, and shorter length of hospital stay.

Cirurgia de Endocardite Infecciosa. Análise de 328 Pacientes Operados em um Hospital Universitário Terciário / Infective Endocarditis Surgery. Insights from 328 Patients Operated in a University Tertiary Hospital

Resumo Fundamento A endocardite infecciosa (EI) refere-se à infecção da superfície endocárdica do coração e geralmente ocorre em valvas nativas ou protéticas. Objetivo Este estudo teve como objetivo levantar dados de EI refletindo a terapêutica cirúrgica, em um Hospital Universitário do interior do estado de São Paulo - Brasil. Método Abordagem retrospectiva e observacional de 328 pacientes com EI operados entre 1982 e 2020 Resultados Os principais dados (n=121/37%), insuficiência cardíaca congestiva (n=114/35%), valvopatia (n=92/28%), diabetes mellitus (n=85/26%), doença renal crônica (n=59/18%) e febre reumática (49/15%). A insuficiência renal é um dos principais e mais relevantes fatores de risco pré-cirúrgicos para um mau prognóstico. Conclusão Para um melhor resultado clínico e cirúrgico é necessário o diagnóstico sindrômico e etiológico precoce da EI, principalmente em pacientes com múltiplas comorbidades.

Abstract Background Infectious endocarditis (IE) refers to infection of the endocardial surface of the heart and usually occurs in native or prosthetic valves. Objective This study aimed to raise IE data reflecting the surgical therapy in a University Hospital in the interior of the State of Sao Paulo-Brazil. Method Retrospective and observational approach of 328 patients with IE who underwent surgery between 1982 and 2020 Results The main data (n=121/37%), congestive heart failure (n=114/35%), valve disease (n=92/28%), diabetes mellitus (n=85/26%), chronic kidney disease (n=59/18%), and rheumatic fever (49/15%). Renal failure is one of the main and most relevant pre-surgical risk factors for a poor prognosis. Conclusion For a better clinical and surgical outcome, an early syndromic and etiological diagnosis of IE is necessary, especially in patients with multiple comorbidities.

Multi-predictor mapping of soil organic carbon in the alpine tundra: a case study for the central Ecuadorian páramo.

BACKGROUND: Soil organic carbon (SOC) affects essential biological, biochemical, and physical soil functions such as nutrient cycling, water retention, water distribution, and soil structure stability. The Andean páramo known as such a high carbon and water storage capacity ecosystem is a complex, heterogeneous and remote ecosystem complicating field studies to collect SOC data. Here, we propose a multi-predictor remote quantification of SOC using Random Forest Regression to map SOC stock in the herbaceous páramo of the Chimborazo province, Ecuador. RESULTS: Spectral indices derived from the Landsat-8 (L8) sensors, OLI and TIRS, topographic, geological, soil taxonomy and climate variables were used in combination with 500 in situ SOC sampling data for training and calibrating a suitable predictive SOC model. The final predictive model selected uses nine predictors with a RMSE of 1.72% and a R2 of 0.82 for SOC expressed in weight %, a RMSE of 25.8 Mg/ha and a R2 of 0.77 for the model in units of Mg/ha. Satellite-derived indices such as VARIG, SLP, NDVI, NDWI, SAVI, EVI2, WDRVI, NDSI, NDMI, NBR and NBR2 were not found to be strong SOC predictors. Relevant predictors instead were in order of importance: geological unit, soil taxonomy, precipitation, elevation, orientation, slope length and steepness (LS Factor), Bare Soil Index (BI), average annual temperature and TOA Brightness Temperature. CONCLUSIONS: Variables such as the BI index derived from satellite images and the LS factor from the DEM increase the SOC mapping accuracy. The mapping results show that over 57% of the study area contains high concentrations of SOC, between 150 and 205 Mg/ha, positioning the herbaceous páramo as an ecosystem of global importance. The results obtained with this study can be used to extent the SOC mapping in the whole herbaceous ecosystem of Ecuador offering an efficient and accurate methodology without the need for intensive in situ sampling.

Embryonic and larval development is conditioned by water temperature and maternal origin of eggs in the sea urchin Arbacia dufresnii (Echinodermata: Echinoidea) / El desarrollo embrionario y larvario está condicionado por la temperatura del agua y el origen materno de los huevos en el erizo de mar Arbacia dufresnii (Echinodermata: Echinoidea)

Introduction: Embryonic and larval development in sea urchins is highly dependent on maternal nutritional status and on the environmental conditions of the seawater. Objective: To compare the development of Arbacia dufresnii in two different water temperatures and in progeny with varying maternal origins. Methods: We induced A. dufresnii females and males from Nuevo Gulf to spawn, collected the eggs of each female individually (progeny), separated them into two seawater temperatures (12 and 17 °C), and fertilized them. We recorded the percentage of fertilized eggs and embryos per developmental stage according to time, temperature and progeny. We measured larval growth by total length (TL) and midline body length (M) according to time post fecundation (DPF), temperature, and progeny. Results: Temperature did not affect fertilization, but embryo development was faster and more synchronized in the high temperature treatment. The generalized linear models indicate that embryo development depends on a quadruple interaction between the embryonic stage, time (h), seawater temperature and progeny. Larval growth was faster, producing larger larvae at the highest temperature. Larval growth depends on a triple interaction between time (DPF), seawater temperature and progeny. Conclusions: We found a temperature and progeny impact during embryonic and larval development and, in both cases, these factors generate a synergistic effect on developmental timing and larval size. This probably provides a survival advantage as a more rapid speed of development implies a decrease in the time spent in the water column, where the sea urchins are vulnerable to biotic and abiotic stressors.

Introducción: El desarrollo embrionario y larvario de los erizos de mar depende en gran medida del estado nutricional materno y de las condiciones ambientales del agua de mar. Objetivo: Comparar el desarrollo de Arbacia dufresnii en dos temperaturas de agua diferentes y en progenies con diferentes orígenes maternos. Métodos: Indujimos a las hembras y machos de A. dufresnii del Golfo Nuevo a desovar, recolectamos los huevos de cada hembra individualmente (progenie), los separamos en dos temperaturas de agua de mar (12 y 17 ° C) y los fertilizamos. Registramos el porcentaje de óvulos fecundados y el porcentaje de embriones por etapa de desarrollo según tiempo, temperatura y descendencia. Medimos el crecimiento larvario según la longitud total (TL) y la longitud corporal de la línea media (M) de acuerdo con el tiempo en días post fecundación, la temperatura y la progenie. Resultados: La temperatura no afectó la fertilización, pero el desarrollo del embrión fue más rápido y más sincronizado en el tratamiento de alta temperatura. Los modelos lineales generalizados indican que el desarrollo del embrión depende una interacción cuádruple entre el estadio embrionario, el tiempo (h), la temperatura del agua de mar y la progenie. El crecimiento larvario fue más rápido, produciendo larvas más grandes a la temperatura más alta. El crecimiento de las larvas depende de una triple interacción entre el tiempo (DPF), la temperatura del agua de mar y la progenie. Conclusiones: Encontramos un impacto en la temperatura y en la progenie durante el desarrollo embrionario y larvario y, en ambos casos, estos factores generaron un efecto sinérgico sobre el tiempo de desarrollo y el tamaño de las larvas. Esto probablemente proporciona una ventaja de supervivencia, ya que una velocidad de desarrollo más rápida implica una disminución en el tiempo que pasan en la columna de agua, donde los erizos de mar son vulnerables a los factores estresantes bióticos y abióticos.

Winter roost selection of Lasiurine tree bats in a pyric landscape.

Day-roost selection by Lasiurine tree bats during winter and their response to dormant season fires is unknown in the southeastern United States where dormant season burning is widely applied. Although fires historically were predominantly growing season, they now occur in the dormant season in this part of the Coastal Plain to support a myriad of stewardship activities, including habitat management for game species. To examine the response of bats to landscape condition and the application of prescribed fire, in the winter of 2019, we mist-netted and affixed radio-transmitters to 16 Lasiurine bats, primarily Seminole bats (Lasiurus seminolus) at Camp Blanding Joint Training Center in northern Florida. We then located day-roost sites to describe roost attributes. For five Seminole bats, one eastern red bat (Lasiurus borealis), and one hoary bat (Lasiurus cinereus), we applied prescribed burns in the roost area to observe bat response in real-time. Generally, Seminole bats selected day-roosts in mesic forest stands with high mean fire return intervals. At the roost tree scale, Seminole day-roosts tended to be larger, taller and in higher canopy dominance classes than surrounding trees. Seminole bats roosted in longleaf (Pinus palustris), slash (Pinus elliotii) and loblolly pine (Pinus taeda) more than expected based on availability, whereas sweetbay (Magnolia virginiana), water oak (Quercus nigra) and turkey oak (Quercus laevis), were roosted in less than expected based on availability. Of the seven roosts subjected to prescribed burns, only one male Seminole bat and one male eastern red bat evacuated during or immediately following burning. In both cases, these bats had day-roosted at heights lower than the majority of other day-roosts observed during our study. Our results suggest Seminole bats choose winter day-roosts that both maximize solar exposure and minimize risks associated with fire. Nonetheless, because selected day-roosts largely were fire-dependent or tolerant tree species, application of fire does need to periodically occur to promote recruitment and retention of suitable roost sites.

Manifestaciones neurológicas y cutáneas del complejo de esclerosis tuberosa en adulto. Reporte de un caso / Tuberous sclerosis complex in adults. A case report

El Complejo de Esclerosis Tuberosa es una enfermedad neurocutánea infrecuente, de característica hereditaria por la mutación de antioncogenes por lo que dentro de sus manifestaciones clínicas están la formación de tumores en diferentes órganos lo que causa una amplia variación de signos y sintomatología. Se presenta el caso clínico de un adulto varón con manifestaciones neurológicas y cutáneas predominantemente.

Tuberous Sclerosis Complex is an infrequent neurocutaneous disease, hereditary due to the mutation of antioncogenes, so that within its clinical manifestations are the formation of tumors in different organs, causing a wide variation of signs and symptoms. The clinical case of a male adult with predominantly neurological and cutaneous manifestations is presented.

Encapsulating Peritoneal Sclerosis in a kidney transplant recipient - Case Report / Peritonite esclerosante encapsulante em receptora de transplante renal - relato de caso

Abstract Encapsulating Peritoneal Sclerosis (EPS) is a severe and rare condition frequently associated with peritoneal dialysis, characterized by bowel obstruction, with lethal consequences in 20% of the patients. The disease presents as a mass of fibrous tissue encapsulating visceral organs that may potentially compromise digestive tract function. This report describes the case of a patient under peritoneal dialysis (PD) due to chronic kidney disease secondary to focal segmental glomerulosclerosis diagnosed with EPS. The patient had undergone two living-donor kidney transplant procedures. Surgical techniques and clinical measures employed to unravel bowel obstruction are described, which have been shown to ameliorate EPS secondary complications. Parenteral nutrition has significantly contributed to afford adequate nutrition, improving tissue healing as well as serum protein levels, vitamins and electrolytes. Therapy with tamoxifen and sodium thiosulfate effectively delayed the development of EPS.

Resumo A peritonite esclerosante encapsulante (PEE) é uma condição rara e grave, frequentemente associada à diálise peritoneal, caracterizada por obstrução intestinal, que pode ter uma evolução fatal em 20% dos pacientes. Apresenta-se como uma massa de tecido fibroso, recobrindo os tecidos viscerais, e pode comprometer o funcionamento fisiológico de todo o aparelho digestivo. O presente estudo relata um caso de PEE decorrente de diálise peritoneal (DP) devido à insuficiência renal por glomeruloesclerose focal e segmentar. No caso relatado, a paciente foi submetida a DP e passou por dois transplantes renais intervivos. São descritas as técnicas cirúrgicas e as medidas clínicas adotadas, que se revelaram úteis na resolução da obstrução intestinal, com melhora dos efeitos secundários da PEE. A dieta parenteral mostrou ser um importante fator para a manutenção do aporte nutricional, auxiliando na cicatrização e no nível sérico de proteínas, vitaminas e eletrólitos. A terapia com tamoxifeno e a administração de hipossulfito de sódio foram eficientes para retardar o avanço da PEE.

Liver transplantation in undifferentiated embryonal sarcoma of the liver in adults: a case report / Transplante hepático em sarcoma embrionário indiferenciado de fígado em adultos: relato de caso

Undifferentiated embryonal sarcoma of the liver (UESL) consists of a rare malignant neoplasm with a still poorly known etiopathogenesis, affecting mostly children between the ages of 6 and 10 years. It corresponds to 7% of primary liver tumors, and is the fourth most common liver cancer in pediatrics. The diagnosis of UESL is based on a set of imaging findings, age and level of alpha-fetoprotein (AFP), which is usually normal, as well as liver function tests. Early diagnosis is hampered by non-specific symptoms, such as abdominal pain, a rapidly growing palpable abdominal mass, fever, weight loss, and gastrointestinal symptoms. The most characteristic image finding is that of a large, unique, and well-defined mass. Ultrasonography shows a predominantly solid and echogenic mass. Computed tomography, on the other hand, shows a mass that takes on a mainly cystic characteristic. Histologically, myxoid tissue with spindle-shaped neoplastic cells is evidenced. Some immunohistochemical studies indicate UESL mesenchymal origin. The macroscopic aspect of the tumor appears as a large hepatic mass, with a predominantly solid component, with some cystic areas, hemorrhage, and necrosis in up to 80% of its surface. The best approach for the treatment of primary liver sarcoma is not yet well defined. Therapeutic options include surgical resection, chemotherapy, radiotherapy, and liver transplantation (LT). However, in cases of unresectable tumors, LT is an option that must be considered, since in this histological type both chemotherapy and radiotherapy have questionable benefits. This article aims to report a case of giant UESL, with vascular invasion, submitted to LT with good postoperative evolution and without signs of recurrence after nine months of LT.

O sarcoma embrionário indiferenciado de fígado (SEIF) consiste em uma neoplasia maligna rara com etiopatogenia ainda pouco conhecida, acometendo em sua maioria crianças na faixa etária entre 6 e 10 anos. Corresponde a 7% dos tumores primários de fígado, e é a quarta neoplasia hepática mais frequente na pediatria. O diagnóstico do SEIF se dá em um conjunto de achados de imagem, idade e nível de alfa-fetoproteína (AF), que geralmente está normal, assim como as provas de função hepática. O diagnóstico precoce é prejudicado pelos sintomas inespecíficos, como dor abdominal, massa abdominal palpável de rápido crescimento, febre, perda de peso e sintomas gastrintestinais. O achado de imagem mais característico é o de massa grande, única e bem-delimitada. A ultrassonografia mostra massa predominantemente sólida e ecogênica. Já a tomografia computadorizada evidencia uma massa que assume característica principalmente cística. Histologicamente é evidenciado tecido mixoide com células neoplásicas fusiformes. Alguns estudos imuno-histoquímicos indicam origem mesenquimal do SEIF. O aspecto macroscópico do tumor se apresenta como grande massa hepática, de componente sólido predominantemente, com algumas áreas císticas, hemorragia e necrose em até 80% de sua superfície. Ainda não é bem-definida a melhor abordagem para o tratamento do sarcoma primário de fígado. As opções terapêuticas incluem ressecção cirúrgica, quimioterapia, radioterapia e transplante hepático (TH). Porém, nos casos de tumores irressecáveis, o TH é uma opção que deve ser considerada, uma vez que nesse tipo histológico tanto quimioterapia como radioterapia têm benefício questionável. Este artigo tem por objetivo relatar um caso de SEIF gigante, com invasão vascular, submetido a TH com boa evolução pós-operatória e sem sinais de recidiva após nove meses de TH.

Encapsulating Peritoneal Sclerosis in a kidney transplant recipient - Case Report.

Encapsulating Peritoneal Sclerosis (EPS) is a severe and rare condition frequently associated with peritoneal dialysis, characterized by bowel obstruction, with lethal consequences in 20% of the patients. The disease presents as a mass of fibrous tissue encapsulating visceral organs that may potentially compromise digestive tract function. This report describes the case of a patient under peritoneal dialysis (PD) due to chronic kidney disease secondary to focal segmental glomerulosclerosis diagnosed with EPS. The patient had undergone two living-donor kidney transplant procedures. Surgical techniques and clinical measures employed to unravel bowel obstruction are described, which have been shown to ameliorate EPS secondary complications. Parenteral nutrition has significantly contributed to afford adequate nutrition, improving tissue healing as well as serum protein levels, vitamins and electrolytes. Therapy with tamoxifen and sodium thiosulfate effectively delayed the development of EPS.

Selective collection of recyclable waste in Universities of low-middle income countries: Lessons learned in Bolivia.

The implementation of solid waste selective collection (SC) systems is quite difficult in low-middle income countries. Lack of awareness, infrastructure, administrative support and knowledge about recycling are the main barriers for its operation, reducing the possibility of successes. This paper introduces the methodological approach for assessing a recyclable waste SC project in a Bolivian public University. The waste fractions generated before (2016) and after (2019) the action were assessed, as well as the opinion and knowledge of the students, providing reliable indicators of the improvements and benefits obtained. Results of the waste characterization analysis reported that, after one month of implementation of the system, about 15 kg of plastic and 37.1 kg of paper and cardboard were collected, about 8 wt% and 42.9 wt% of the recyclable waste produced. At the same time, the questionnaire survey allows demonstrating that the SC behavior of the students improved considerably from 2018 to 2019, (t[608] = -7.654, p < 0.05***), as well as the satisfaction about the waste collection service provided (t[608] = -6.6224, p < 0.05***) and about the diffusion of information with awareness campaigns (t[608] = -8.708, p < 0.05***). The project and the phases followed for its implementation can be of reference for other local and international stakeholders, for replicating the study in other Universities and public areas. The novelty of the study is the introduction of a step by step methodology for assessing the SC of recyclable waste for supporting the recycling policies of developing cities in low-middle income countries and for boosting sustainable development according to the principle of the circular economy.

The "Brain Stress Timing" phenomenon and other misinterpretations of randomized clinical trial on aneurysmal subarachnoid hemorrhage.

Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. Retreatment and rebleeding rates clearly favors clipping, although short-term functional outcome seems to be beneficial for clipping, while this different is not such if we perform the comparison at a longer follow up. Long-term follow ups and cost analysis are mandatory to have a clear view of the current picture in treatment of subarachnoid hemorrhage. Treatment strategy should be made by a multi-disciplinary team in accredited centers with proficient experience in both techniques.

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation.

BACKGROUND: Surgical site infection is an important complication in the postoperative period among liver transplant recipients. However, little is known about the risk factors in this patient group. Therefore, the objective of this study was to analyze the incidence and risk factors for surgical site infections among adult liver transplant recipients. METHODS: Medical records of adult liver transplant recipients from January 1, 2009, to December 31, 2015, were analyzed in this retrospective cohort study. RESULTS: We enrolled 156 recipients' medical records. Forty-two (26.9%) cases of surgical site infections were identified. The main isolated microorganisms were methicillin-resistant Staphylococcus species, extended spectrum ß-lactamase-producing Klebsiella species, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii, and vancomycin-susceptible Enterococcus faecalis. We found that long operative times (≥487 minutes) and differences in body mass index between donor and recipient (≥1.3 kg/m2) increased the risk for surgical site infections by approximately 5 times (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.5-11.8), and capillary glycemia ≥175 mg/dL in the first 96 postoperative hours increased the risk by approximately 3 times (OR, 2.97; 95% CI, 1.43-6.17). CONCLUSIONS: There was a high incidence of surgical site infections among the studied population and that some risk factors identified differ from those reported in the scientific literature.

Leaf architecture of Rubiaceae Juss. from caatinga vegetation in Brazil / Arquitetura foliar de espécies de Rubiaceae Juss. da caatinga brasileira

Abstract: The study and characterization of leaf venation plays a key role in the recognition of taxonomic groups that have been identified mainly based on reproductive traits. This study aimed at characterizing the pattern of leaf venation of Rubiaceae, recognizing individual characters among the taxa of this group and testing the use of leaf architecture as a taxonomic tool capable of providing vegetative and diagnostically characteristics between species. Leaves of 14 species distributed in eight genera from Rubiaceae were diaphanized and classified. The study area is located in Área de Proteção Ambiental Serra Branca/Raso da Catarina, Bahia State, Brazil. The characterization of secondary veins, including type, spacing and number of pairs, third veining patterns, fourth and fifth order, and the conformation of the areola were useful to delimit taxa when used together, providing subsidies to more comprehensive studies.

Resumo: O estudo e a caracterização da venação foliar representam uma possibilidade no reconhecimento de grupos taxonômicos, identificados predominantemente com base em caracteres reprodutivos. O presente estudo objetivou caracterizar o padrão de nervação foliar de Rubiaceae, reconhecer caracteres particulares dentre os táxons deste grupo e testar a utilização da arquitetura foliar como ferramenta taxonômica capaz de fornecer características diagnósticas vegetativas entre as espécies. Foram diafanizadas e classificadas as folhas de 14 espécies distribuídas em 8 gêneros de Rubiaceae na APA Serra Branca/Raso da Catarina. A caracterização das nervuras secundárias, incluindo tipo, espaçamento e número de pares, padrões de nervuras de terceira, quarta e quinta ordem, bem como a conformação das aréolas foram úteis para delimitar os táxons quando utilizados em conjunto, fornecendo subsidío para estudos mais abrangentes.

Efeitos da oxigenoterapia em neonatologia: revisão integrativa de literatura / Effects of oxygenotherapy in neonatology: integrating literature review

Objetivo: Buscar evidências na literatura sobre os efeitos da utilização de oxigenoterapia em neonatologia. Método: Revisão integrativa realizada em janeiro de 2017, com busca nas bases de dados: Pubmed, Lilacs, Scielo e Web of Science. Resultados: Identificaram-se dezesseis artigos e, após análise, emergiram duas categorias: Patologias relacionadas ao uso da oxigenoterapia em neonatologia e fatores de risco associados ao uso de oxigênio no período neonatal. Conclusão: O uso do oxigênio em neonatos apresenta-se como um paradoxo, caracterizado por um lado, pelo seu efeito lesivo, e por outro, pelo reconhecimento de seu papel indispensável na correção da hipóxia. Quanto mais longo o tempo em oxigenoterapia, em todas as suas formas, e maior a fração de oxigênio inspirado, maiores são as chances para o desenvolvimento de problemas nos recém-natos. Há necessidade de maior envolvimento dos profissionais no manejo do oxigênio, bem como de ampliar a produção de conhecimento nessa área de modo a subsidiar a prática baseada em evidências

Objective: To search for evidence in the literature about the effects of oxygen therapy in neonatology. Method: Integrative review conducted in January 2017, with search in databases: PubMed, Lilacs, Scielo and Web of Science. Results: Sixteen articles were identified and, after analysis, two categories emerged: Pathologies related to the use of oxygen therapy in neonatology and risk factors associated with the use of oxygen in the neonatal period. Conclusion: The use of oxygen in newborns presents a paradox, characterized by its harmful effect and by the recognition of its indispensable role in the correction of hypoxia. The longer the time in oxygen therapy, in all its forms, and the greater the fraction of inspired oxygen, the greater the chances for the development of problems in newborns. There is a need for greater involvement of professionals in oxygen management, as well as to increase the production of knowledge in this area in order to subsidize the practice based on evidence

Percepciones de los sanadores andinos de Saraguro sobre la hibridación en salud y la influencia de la cultura occidental / Perceptions of the Saraguro andean healers about hy-bridization in health and the influence of western cul-ture

La hibridación cultural en salud permite reconocer diversas prácticas que conviven en el mismo espacio y tiempo, un proceso que se cumplen en Saraguro, cantón de la sierra sur-ecuatoriana con una población indígena y mestiza con experiencias en salud que responden a racionalidades distintas. Objetivo:Analizar las concepciones de los sanadores de Saraguro con respecto a la hibridación en salud. Material y métodos:El presente es un estudio cualitativo-interpretativo, con entrevistas a sabios del lugar; las categorías trabajadas son: hibridación, conceptualización y realidad híbrida, a la que se sumó el reto de la integración. Las entrevistas fueron grabadas y luego transcritas a word; para el procesamiento se utilizó el programa Atlas.ti. La triangulación se realizó con un experto universitario en temas de medicina ancestral y la bibliografía consultada.Resultados: Los sanadores de Saraguro mantienen su cosmovisión ancestral en los fenómenos de la salud-enfermedad, en algunas prácticas coexisten expresiones de otras culturas, esta hibridación en salud muestra saberes andinos con elementos de la medicina occidental y de orden religioso. Conclusiones:En Saraguro la medicina ancestral se mantiene vigente a través de los sanadores, sabios en sanación acorde a la cosmovisión andina.Los sanadores mantienen su práctica de acuerdo a las concepciones andinas del proceso salud-enfermedad.Las prácticas en salud ancestral sufren un proceso de hibridación entre lo ancestral y lo occidental además de elementos religiosos.

The cultural hybridization in health allows to recognize diverse practices that coexist in the same space and time, a process that is fulfilled in Saraguro, county of the South-Ecuadorian Andes with an indigenous and mixed ethnic population with health experiences that respond to different rationalities. Objetive:Analyzing the conceptions of Saraguro healers with respect to health hybridization.Method:The present is a qualitative-interpretative study, with interviews to wise people of the place; the worked categories are: Hybridization, conceptualization and hybrid reality, to which the integration challenge was added. The interviews were recorded and then transcribed to word for processing, the Atlas.ti program was used. The triangulation was carried out with a university expert in ancestral medicine subjects and the bibliography consulted. Results: The healers of Saraguro keep their ancestral worldview in the phenomena of health-disease, in some practices expressions of other cultures coexist, this hybridization in health shows Andean knowledge with elements of Western medicine and religious order. Conclusions:In Saraguro the Ancestral Medicine is still valid through the healers, wise in healing according to the Andean cosmovision.The Andean healers keep their practice according to the Andean conceptions of the health-disease process.Ancestral health practices undergo a process of hybridization between the ancestral and the Western as well as religious elements

Ébola, abordaje clínico integral / Ebola, comprehensive clinical approach

Resumen Introducción. El virus del Ébola, antes llamado fiebre hemorrágica del Ébola, es una enfermedad altamente contagiosa con mortalidad entre 50% y 90%, para la cual existen prometedoras opciones de tratamiento que se encuentran en fase de evaluación y uso compasional. Objetivos. Revisar la mejor evidencia médica publicada y analizar el comportamiento de las epidemias por virus del Ébola, sus manifestaciones clínicas, sus complicaciones, los elementos más significativos para su diagnóstico y las nuevas opciones terapéuticas disponibles, para así aprender y aplicar estas experiencias en nuevos brotes. Materiales y métodos. Se realizó una búsqueda sistemática en las bases de datos PubMed, ProQuest, Embase, Redalyc, Ovid, Medline, DynaMed y ClinicalKey durante el periodo 2009-2017 en el contexto internacional, regional y local. Resultados. La revisión sistemática de artículos aportó un total de 51 430 registros, de los cuales 772 eran elegibles; de estos, 722 no eran relevantes, por lo que quedaron incluidos 50. A punto de partida se pudieron precisar los aspectos objeto de esta revisión. Conclusión. La enfermedad causada por el virus del Ébola, a pesar de su alta mortalidad, puede ser prevenida, diagnosticada oportunamente y tratada con efectividad, lo cual permite evaluar su impacto epidemiológico en las áreas endémicas y a nivel mundial. Existe un potencial arsenal terapéutico en fase de experimentación con resultados prometedores.

Abstract Introduction: The Ebola virus, also known as Ebola hemorrhagic fever, is a highly contagious disease with mortality rates that range between 50% and 90%. There are promising treatment options that are currently under evaluation and compassionate use. Objectives: To review the best published medical material and analyze the behavior of Ebola virus outbreaks, clinical manifestations, complications, the most significant elements for diagnosis and new therapeutic options available, in order to learn and apply these experiences during new outbreaks. Materials and methods: A systematic search was carried out in the PubMed, ProQuest, Embase, Redalyc, Ovid, Medline, DynaMed and ClinicalKey databases during the 2009-2017 period in the international, regional and local context. Results: The systematic review yielded a total of 51 430 documents, of which 772 were eligible; of these, 722 were not relevant, and only 50 were included. Conclusion: Ebola virus disease, despite its high mortality, can be prevented, diagnosed promptly and treated effectively, which allows evaluating its epidemiological impact in endemic areas and worldwide. There are potential therapeutic tools under experimentation with promising results.