Elderly patients with cancer admitted to intensive care unit: A multicenter study in a middle-income country.

BACKGROUND: Very elderly critically ill patients (ie, those older than 75 or 80 years) are an increasing population in intensive care units. However, patients with cancer have encompassed only a minority in epidemiological studies of very old critically-ill patients. We aimed to describe clinical characteristics and identify factors associated with hospital mortality in a cohort of patients aged 80 or older with cancer admitted to intensive care units (ICUs). METHODS: This was a retrospective cohort study in 94 ICUs in Brazil. We included patients aged 80 years or older with active cancer who had an unplanned admission. We performed a mixed effect logistic regression model to identify variables independently associated with hospital mortality. RESULTS: Of 4604 included patients, 1807 (39.2%) died in hospital. Solid metastatic (OR = 2.46; CI 95%, 2.01-3.00), hematological cancer (OR = 2.32; CI 95%, 1.75-3.09), moderate/severe performance status impairment (OR = 1.59; CI 95%, 1.33-1.90) and use of vasopressors (OR = 4.74; CI 95%, 3.88-5.79), mechanical ventilation (OR = 1.54; CI 95%, 1.25-1.89) and renal replacement (OR = 1.81; CI 95%, 1.29-2.55) therapy were independently associated with increased hospital mortality. Emergency surgical admissions were associated with lower mortality compared to medical admissions (OR = 0.71; CI 95%, 0.52-0.96). CONCLUSIONS: Hospital mortality rate in very elderly critically ill patients with cancer with unplanned ICU admissions are lower than expected a priori. Cancer characteristics, performance status impairment and acute organ dysfunctions are associated with increased mortality.

Guidelines for the pharmacological treatment of COVID-19. The task-force/consensus guideline of the Brazilian Association of Intensive Care Medicine, the Brazilian Society of Infectious Diseases and the Brazilian Society of Pulmonology and Tisiology. / Diretrizes para o tratamento farmacológico da COVID-19. Consenso da Associação de Medicina Intensiva Brasileira, da Sociedade Brasileira de Infectologia e da Sociedade Brasileira de Pneumologia e Tisiologia.

INTRODUCTION: Different therapies are currently used, considered, or proposed for the treatment of COVID-19; for many of those therapies, no appropriate assessment of effectiveness and safety was performed. This document aims to provide scientifically available evidence-based information in a transparent interpretation, to subsidize decisions related to the pharmacological therapy of COVID-19 in Brazil. METHODS: A group of 27 experts and methodologists integrated a task-force formed by professionals from the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB), the Brazilian Society of Infectious Diseases (Sociedad Brasileira de Infectologia - SBI) and the Brazilian Society of Pulmonology and Tisiology (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT). Rapid systematic reviews, updated on April 28, 2020, were conducted. The assessment of the quality of evidence and the development of recommendations followed the GRADE system. The recommendations were written on May 5, 8, and 13, 2020. RESULTS: Eleven recommendations were issued based on low or very-low level evidence. We do not recommend the routine use of hydroxychloroquine, chloroquine, azithromycin, lopinavir/ritonavir, corticosteroids, or tocilizumab for the treatment of COVID-19. Prophylactic heparin should be used in hospitalized patients, however, no anticoagulation should be provided for patients without a specific clinical indication. Antibiotics and oseltamivir should only be considered for patients with suspected bacterial or influenza coinfection, respectively. CONCLUSION: So far no pharmacological intervention was proven effective and safe to warrant its use in the routine treatment of COVID-19 patients; therefore such patients should ideally be treated in the context of clinical trials. The recommendations herein provided will be revised continuously aiming to capture newly generated evidence.

Genome wide association study identifies novel single nucleotide polymorphic loci and candidate genes involved in soybean sudden death syndrome resistance.

Fusarium virguliforme is a soil borne root pathogen that causes sudden death syndrome (SDS) in soybean [Glycine max (L.) Merrill]. Once the fungus invades the root xylem tissues, the pathogen secretes toxins that cause chlorosis and necrosis in foliar tissues leading to defoliation, flower and pod drop and eventually death of plants. Resistance to F. virguliforme in soybean is partial and governed by over 80 quantitative trait loci (QTL). We have conducted genome-wide association study (GWAS) for a group of 254 plant introductions lines using a panel of approximately 30,000 SNPs and identified 19 single nucleotide polymorphic loci (SNPL) that are associated with 14 genomic regions encoding foliar SDS and eight SNPL associated with seven genomic regions for root rot resistance. Of the identified 27 SNPL, six SNPL for foliar SDS resistance and two SNPL for root rot resistance co-mapped to previously identified QTL for SDS resistance. This study identified 13 SNPL associated with eight novel genomic regions containing foliar SDS resistance genes and six SNPL with five novel regions for root-rot resistance. This study identified five genes carrying nonsynonymous mutations: (i) three of which mapped to previously identified QTL for foliar SDS resistance and (ii) two mapped to two novel regions containing root rot resistance genes. Of the three genes mapped to QTL for foliar SDS resistance genes, two encode LRR-receptors and third one encodes a novel protein with unknown function. Of the two genes governing root rot resistance, Glyma.01g222900.1 encodes a soybean-specific LEA protein and Glyma.10g058700.1 encodes a heparan-alpha-glucosaminide N-acetyltransferase. In the LEA protein, a conserved serine residue was substituted with asparagine; and in the heparan-alpha-glucosaminide N-acetyltransferase, a conserved histidine residue was substituted with an arginine residue. Such changes are expected to alter functions of these two proteins regulated through phosphorylation. The five genes with nonsynonymous mutations could be considered candidate SDS resistance genes and should be suitable molecular markers for breeding SDS resistance in soybean. The study also reports desirable plant introduction lines and novel genomic regions for enhancing SDS resistance in soybean.

Doses de potássio em cobertura na primeira soca da cultura da cana-de-açúcar cultivada no norte matogrossense / Doses of potassium in coverage in the first cane ratoon of sugar cane crop cultivated in north matogrossense

A cultura da cana-de-açúcar vem sendo cultivada em todas as regiões do país, ocupando diferentes tipos de solos. A região norte Matogrossense possui condições climáticas muito propícias para a cultura, porém tem-se alcançado baixas produtividades em função da não aplicação de fertilizantes ou de doses ineficientes. Sendo o potássio o elemento mineral absorvido em maiores quantidades pela cultura, objetivou-se com este trabalho avaliar o efeito de doses crescentes do nutriente aplicadas em cobertura no segundo ciclo da variedade de cana-de-açúcar IAC86-2480. O delineamento experimental utilizado foi o de blocos casualizados com quatro repetições. As doses de potássio foram: 0; 60; 120; 180 e 240 kg ha-1 de K2O. Avaliou-se o ºBrix, diâmetro, massa, altura e produtividade de colmos. Não houve efeito significativo para a variável ºBrix em resposta às doses de potássio, já as demais, apresentaram resposta quadrática. A dose de máxima eficiência agronômica foi de 150 kg ha-1 de K2O obtendo produtividade de 85 t ha-1 de colmos, representando 25% de acréscimo de produtividade.

The sugar cane crop has been cultivated in all regions of the Brazil, occupying different soil types. The north region of Mato Grosso has favorable climate conditions for the culture, however, has been achieved low productivity due to the not application of fertilizer and inefficient doses. Being the potassium the mineral element absorbed in large amount by culture. Aimed to with this work to evaluate the effect of growing doses of the nutrient applied in coverage in the second cycle of the variety of sugar cane IAC86-2480. The experimental design was randomized blocks, with four replications. The Potassium doses were: 0; 60; 120; 180 e 240 kg ha-1 of K2O. Was evaluated the oBrix, diameter, weigth, height and productivity of stalk. No was significant effects for the variable oBrix in response to potassium doses, since to others had response quadratic. The dose of maximum agronomic efficiency was of 150 kg ha-1 de K2O obtaining productivity of 85 t ha-1 of stalk, representing 25% increase in productivity.

Doses de inoculante e nitrogênio na semeadura da soja em área de primeiro cultivo / Doses of inoculant and nitrogen at sowing of soybean in first cultivation area

A inoculação da cultura da soja com bactérias do gênero Bradyrhizobium, é uma prática amplamente difundida, devido aos ótimos resultados alcançados em produtividade, porém, algumas dúvidas ainda surgem em relação à necessidade de aplicação de nitrogênio mineral na semeadura. Neste sentido, este trabalho teve como objetivo avaliar a resposta da cultura da soja a doses de inoculante e nitrogênio mineral na semeadura em solo de primeiro ano de cultivo. Os experimentos foram realizados no Campo Experimental da Universidade do Estado de Mato Grosso, Campus de Alta Floresta, MT, nos anos agrícolas de 2006/2007 e 2007/2008. O delineamento experimental foi em blocos ao acaso, num esquema fatorial 2x4, com quatro repetições. Os fatores consistiram de inoculação das sementes com Bradyrhizobium japonicum (3 e 6 mL kg-1 de sementes), e adubação nitrogenada na semeadura (0, 10, 20 e 40 kg de N ha-1). As seguintes variáveis foram avaliadas: altura de plantas, altura de inserção da primeira vagem, número de vagens por planta, número de grãos por vagem, massa de 100 grãos e produtividade de grãos. Nos dois anos agrícolas não houve diferença significativa para as doses de inoculante aplicadas em primeiro ano de cultivo com soja. Para a aplicação de nitrogênio na semeadura da cultura da soja houve efeito quadrático para altura de plantas e de inserção da primeira vagem e linear crescente para número de vagens por planta no segundo ano de cultivo, porém, sem incremento significativo na produtividade.

The inoculation of soybean crop with Bradyrhizobium bacteria is a widespread practice, due to excellent results achieved in productivity, however, some doubt still arise in relation the need of application of mineral nitrogen at sowing. In that mean, this work aimed to evaluate the response of the doses at inoculant and mineral nitrogen in the sowing of crop soybean in area of first cultivation. The experiments were carried in the experimental field of the University of the Estate of Mato Grosso, Campus of Alta Floresta - MT, Brazil, in the growing seasons of 2006/2007 and 2007/2008. The experimental design was randomized blocks, in a factorial escheme 2 x 4, with four replications. The factors consisted in the inoculation of seeds with Bradyrhizobium japonicum (3 e 6 mL kg-1 of seeds), and nitrogen fertilizer at sowing (0, 10, 20 e 40 kg ha-1). The following variables were evaluated: plant height, insertion height of first pod, number of pod per plant, number of grain per pod, mass of 100 grain and grain productivity. In the two growing seasons there was no significant difference for doses of inoculants applied in first year of cultivation with soybean. To nitrogen application at sowing of soybean crop there was quadratic effect to plant height and of insertion height of first pod and growing linear to number of pod per plant in the second year of cultivation, however, without significant increase the productivity

Cutaneous and visceral leishmaniasis in dogs from a rural community in northeastern Brazil.

A community-based epidemiological study was carried out in a rural area in northeastern Brazil, where visceral leishmaniasis is endemic, but the primary vector Lutzomyia longipalpis has never been found. Forty-one dogs were screened by an indirect immunofluorescence antibody test (IFAT) for the presence of anti-Leishmania antibodies and 12 (29.3%) of them were positive. One of the IFAT-positive dogs was also positive for Leishmania amastigotes in bone marrow cytology and for Leishmania infantum by real-time polymerase chain reaction (PCR) on blood. One IFAT-negative dog was positive for L. infantum by PCR on bone marrow and other for Leishmania amastigotes in skin stained-smears. When tested for L. braziliensis by PCR, 20 dogs were positive. Considering all diagnostic tests, the estimated prevalence of Leishmania spp. infection in the studied rural dog population was 58.5%. There was no significant difference in IFAT-positivity in relation to age, gender, and clinical status of the dogs. When tested for L. infantum by real-time PCR, 20 ticks collected from IFAT-positive dogs were all negative. This study shows a high level of exposure to Leishmania spp. infection in dogs from a rural community in northeastern Brazil. In general, the results do not support the participation of ticks as vectors of L. infantum in this area, which is likely to be transmitted by Lutzomyia spp. other than L. longipalpis. Finally, this study highlights that the use of IFAT in areas where both L. infantum and L. braziliensis are present should be withdraw in order to avoid the unnecessary culling of dogs that are actually infected only by L. braziliensis.

Eustachian valve endocarditis.

Eustachian valve endocarditis is a rare condition that affects mostly injectable drug users and patients using pacemakers or central venous catheter. We describe the case of a patient who underwent myocardial revascularization with extracorporeal circulation and who presented Eustachian valve endocarditis in the postoperative period, diagnosed by echocardiogram. The blood culture identified Klebsiella pneumoniae. He received appropriate antibiotic therapy and presented resolution of the condition within four weeks.

Phlebotomine sandfly species from an American visceral leishmaniasis area in the Northern Rainforest region of Pernambuco State, Brazil.

The aim of this study was to identify the fauna of phlebotomine sandflies in an area with incidence of American visceral leishmaniasis (AVL) in São Vicente Férrer, a municipality (county) located in the northern Zona da Mata in Pernambuco State, Brazil. Sandfly captures were conducted monthly for four nights/month from December 2002 to November 2003, by means of manual captures (with a Shannon trap) and by CDC light traps. A total of 23,156 specimens of phlebotomines sandflies were collected in a remnant of the Atlantic rainforest, houses, and animal shelters. Lutzomyia complexa was the most prevalent species, with a frequency of 62.5% (14,445/23,156), followed by Lutzomyia migonei, with 33.2% (7,677/23,156). No Lutzomyia longipalpis (the main vector of Leishmania chagasi in Brazil and the Americas) was found in the target area. Some specimens were dissected, but no Leishmania parasites were found.

Phlebotomine sandfly species from an American visceral leishmaniasis area in the Northern Rainforest region of Pernambuco State, Brazil

The aim of this study was to identify the fauna of phlebotomine sandflies in an area with incidence of American visceral leishmaniasis (AVL) in São Vicente Férrer, a municipality (county) located in the northern Zona da Mata in Pernambuco State, Brazil. Sandfly captures were conducted monthly for four nights/month from December 2002 to November 2003, by means of manual captures (with a Shannon trap) and by CDC light traps. A total of 23,156 specimens of phlebotomines sandflies were collected in a remnant of the Atlantic rainforest, houses, and animal shelters. Lutzomyia complexa was the most prevalent species, with a frequency of 62.5 percent (14,445/23,156), followed by Lutzomyia migonei, with 33.2 percent (7,677/23,156). No Lutzomyia longipalpis (the main vector of Leishmania chagasi in Brazil and the Americas) was found in the target area. Some specimens were dissected, but no Leishmania parasites were found.

Este estudo teve como objetivo identificar a fauna de flebotomíneos envolvida em área de incidência de leishmaniose visceral americana no Município de São Vicente Férrer, localizado na Zona da Mata de Pernambuco, Brasil. Capturas de flebotomíneos foram realizadas mensalmente durante quatro noites, entre dezembro de 2002 e novembro de 2003, através de capturas manuais com auxílio da armadilha de Shannon e armadilhas luminosas modelo CDC. O total de 23.156 exemplares de flebotomíneos foi coletado em resquícios de Mata Atlântica, casas e abrigos de animais. Lutzomyia complexa apresentou predominância de 62,5 por cento (14.445/23.156), seguida por Lutzomyia migonei, 33,2 por cento (7.677/23.156). Lutzomyia longipalpis, principal vetor de Leishmania chagasi no Brasil e nas Américas, não foi encontrado nesta região. Alguns exemplares foram dissecados para a pesquisa de infecção natural, mas não foram detectadas formas características de Leishmania.

Sandfly fauna in a military training area endemic for American tegumentary leishmaniasis in the Atlantic Rain Forest region of Pernambuco, Brazil

Esse estudo teve como objetivo geral caracterizar a fauna de flebotomíneos envolvida em unidade de treinamento militar localizada na Zona da Mata do Estado de Pernambuco, Brasil, onde foram verificados casos humanos autóctones de leishmaniose tegumentar americana (LTA) associados a Leishmania (Viannia) braziliensis. A presença de 16 espécies de flebotomíneos no Centro de Instrução Militar Marechal Newton Cavalcanti indicou uma importante diversidade na área de estudo. Lutzomyia complexa constituiu a espécie mais abundante (51,36%), seguida de L. choti (43,54%). Todas as capturas foram realizadas nas áreas onde foram desenvolvidos treinamentos militares, nas quais foram verificados casos clínicos em indivíduos após realizarem treinamentos. Os dados obtidos sobre a fauna local, associados com achados prévios nessa área da Zona da Mata, apresentam evidências consistentes sobre a manutenção de um ciclo enzoótico, com a ocorrência de surtos periódicos de LTA, posteriores à realização de treinamentos, em áreas correspondentes à Mata Atlântica remanescente e matas secundárias.

Sandfly fauna in a military training area endemic for American tegumentary leishmaniasis in the Atlantic Rain Forest region of Pernambuco, Brazil.

The aim of this study was to characterize the sandfly fauna in a military training area situated in the "Zona da Mata" region of Pernambuco State, Brazil, where human cases of American tegumentary leishmaniasis (ATL) had been observed, caused by Leishmania (Viannia) braziliensis. The occurrence of 16 sandfly species in the Marshall Newton Cavalcanti Military Training Camp (CIMNC) indicates an important diversity of sandfly species in this study area. Lutzomyia complexa was the most common species (51.36%) followed by L. choti (43.54%). All the captures were made in areas where training activities were conducted and where clinical cases had been detected in individuals performing training, following this period. The data relating the sandfly behavior to previous data in the same area provides strong evidence for the occurrence of an enzootic cycle of the parasite, and outbreaks followed the period of training activities in the remaining Atlantic Rain Forest and secondary forest areas.