To evaluate the temporal trend of bronchopulmonary dysplasia (BPD) in preterm infants who survived to at least 36 weeks' post-menstrual age (PMA) and BPD or death at 36 weeks' PMA, and to analyse ...variables associated with both outcomes.
Retrospective cohort with data retrieved from an ongoing national registry.
19 Brazilian university public hospitals.
Infants born between 2010 and 2019 with 23-31 weeks and birth weight 400-1499 g.
Temporal trend was evaluated by Prais-Winsten model and variables associated with BPD in survivors or BPD or death were analysed by logistic regression.
Of the 11 128 included infants, BPD in survivors occurred in 22%, being constant over time (annual per cent change (APC): -0.80%; 95% CI: -2.59%; 1.03%) and BPD or death in 45%, decreasing over time (APC: -1.05%; 95% CI: -1.67%; -0.43%). Being male, small for gestational age, presenting with respiratory distress syndrome, air leaks, needing longer duration of mechanical ventilation, presenting with treated patent ductus arteriosus and late-onset sepsis were associated with an increase in the chance of BPD. For the outcome BPD or death, maternal bleeding, multiple gestation, 5-minute Apgar <7, late-onset sepsis, necrotising enterocolitis and intraventricular haemorrhage were added to the variables reported above as increasing the chance of the outcome.
The frequency of BPD in survivors was constant and BPD or death decreased by 1.05% at each study year. These results show some improvement in perinatal care in Brazilian units which resulted in a reduction of BPD or death, but further improvements are still needed to reduce BPD in survivors.
The Modified Sphygmomanometer Test (MST) is a method for assessing muscle strength that offers objective measures similar to those of a portable dynamometer, while also being cost-effective. However, ...previous studies have not investigated the measurement properties of the MST in adolescents. Thus, the objectives of the study were (1) to examine the concurrent criterion validity, test-retest and interrater reliability of the Modified Sphygmomanometer Test (TMS) for assessing muscle strength in adolescents, (2) to calculate the Standard Error of Measurement (EPM) and the smallest real difference (SRD) of muscle strength values; and (3) analyze the different forms of operationalization and their influence on the results obtained. Fifty-two adolescents (mean age: 16.5 ± 0.70 years) participated in the study. Muscle strength of the upper limbs (UL) and trunk was assessed using the MST and portable dynamometers. The Spearman test was used to determine concurrent criterion validity and the intraclass correlation coefficient (ICC) was used to assess reliability (α = 0.05). To analyze the stability of the measurements (SEM and SRD), the 95% test-retest confidence interval (CI) and inter-rater reliability were considered for all data collected. ANOVA was performed to explore different methods of operationalizing the MST. Criterion validity, test-retest reliability and moderate to very high inter-rater reliability (0.61≤r ≤ 0.94; p < 0.001; 0.63≤ICC≤0.97; p < 0.001) were found for the groups assessed muscles and different forms of operationalization, with no statistically significant differences between the different operationalization approaches. Therefore, the MST demonstrated adequate measurement properties for assessing muscle strength in adolescents.
With the uncertainties of COVID-19, people infected with coronavirus present with diverse psychiatric presentations. Some institutions have had to manage their patients with existing protocols, ...others have had to create them. In this article we aimed to report the challenges and good practices in the management of psychiatric conditions and delirium coexisting with COVID-19 across continents.
Early Career Psychiatrists (ECPs) from across five continents were approached to share their experiences on the management of psychiatric conditions in patients with COVID-19 during the current pandemic.
We collected information about the experiences from sixteen countries. Commonalities were similar psychiatric presentations and poor preparedness across countries. Differences were varying adjustments made in the management of psychiatric conditions coexisting with COVID-19 and different innovations. Good practices which can be adopted by other countries are novel approaches such as telepsychiatry, proactive consultation-liaison units and enhanced community services targeted at circumventing challenges faced when providing mental health services.
These findings highlight the need for global preparedness in the mental health sector during outbreaks of infectious diseases, and the need for concerted efforts targeted at global and locally sensitive adaptation of existing protocols and the development of new guidelines for the management of psychiatric conditions for the present pandemic and subsequent occurrences.
•ECPs provided their perspective on the management of psychiatric conditions in patients with COVID-19.•We found commonalities and differences in the management of psychiatric conditions coexisting with COVID-19.•There are shared similarities and differences, likewise modifications in pre-existing protocols for management of delirium.•A common factor is the need to adapt guidelines and protocols for the management of psychiatric conditions.
•The proposed new hybrid generation microgrid for the Brazilian scenario.•The proposed system’s modelling.•Economic feasibility of the proposed system, through a cost analysis.•Clean, sustainable ...energy gains evidence, through simulation results.
This paper proposes a profitable, affordable hybrid generation power plant, to be integrated upon sugar cane plants, considering the Brazilian energy scenario. The future of energy generation is discussed and highlights are given to the Brazilian sugar cane industry, key national activity for the production of sugar and ethanol. A novel microgrid structure is proposed as a new approach to hybrid generation, which integrates the recycling of the sugar cane remains (as biomass and biogas) combined with the use of renewable sources, such as photovoltaic panels and wind power turbines, aiming to reduce environmental impact. The plant modeling is based on the Energy Hubs methodology, that allows the integration of different energy carriers in the same model. Simulation results show the satisfying microgrid operation and its flexibility to fulfill different energy production scenarios, as well as economic and sustainability gains. Profits and possible implementation costs are discussed, through a payback analysis.
The downer cow syndrome (DCS) is characterized by an alert cow showing inability or reluctance to stand for 12 hours or more. This paper reported clinical, laboratory, and pathological findings in a ...Guzerá heifer with rhabdomyolysis, pigmenturia and acute renal failure following DCS. A 17-month-old Guzerá heifer was transported via a 350-km ride in a truck and showed sternal recumbency and severe difficulty in standing and walking. Neurological examination was unremarkable, and the heifer presented normal response to cranial nerves and spinal cord tests. Rectal palpation revealed a 5-month gravid uterus. No other abnormalities were noted in the pelvis or around the coxofemoral joints. Biochemical abnormalities included extremely high muscular enzyme activities (creatine phosphokinase and aspartate aminotransferase) and high creatinine levels. Urinalysis revealed blackish and cloudy urine, proteinuria, and a positive occult blood test. Spinal cord ultrasonography showed no abnormalities. This report highlighted an uncommon clinical presentation (myoglobinuria) and pathological findings in a heifer with DCS as a consequence of severe compressive muscle damage. Practitioners and producers must be aware of the risk of careless road transportation for long distances of cattle, especially obese cows, avoiding unnecessary suffering and expenses due to DCS.
RESUMO: A síndrome da vaca caída (SVC) é caracterizada por um bovino alerta que mostra incapacidade ou relutância em permanecer em estação por 12 horas ou mais. O objetivo deste trabalho é relatar os achados clínicos, laboratoriais e patológicos em uma novilha Guzerá com rabdomiólise, pigmentúria e insuficiência renal aguda após a SVC. Uma novilha da raça Guzerá, de 17 meses de idade, foi transportada de caminhão por 350 km e apresentou decúbito esternal, grande dificuldade para assumir estação e caminhar. O exame neurológico não demonstrou alterações, e a novilha possuía resposta normal aos testes de nervos cranianos e medula espinhal. A palpação retal revelou útero grávido de cinco meses. Nenhuma outra anormalidade foi observada na pelve ou na região das articulações coxofemorais. As anormalidades bioquímicas incluíram atividades de enzimas musculares (creatina fosfoquinase e aspartato aminotransferase) extremamente aumentadas e níveis elevados de creatinina. A urinálise revelou urina enegrecida e turva, proteinúria e teste de sangue oculto positivo. O exame ultrassonográfico da medula espinhal não apresentou anormalidades. Este relato evidencia uma apresentação clínica (mioglobinúria) e achados patológicos incomuns em uma novilha com SVC em consequência de extensa lesão muscular compressiva. Veterinários e produtores devem estar atentos aos riscos do transporte rodoviário descuidado por longas distâncias de bovinos, especialmente vacas obesas, evitando assim sofrimento e despesas desnecessárias decorrentes da SVC.
The action of extracts from the stem, leaves, and fruit of Jatropha gossypiifolia on Biomphalaria glabrata was studied by analyzing survival, feeding capacity and oviposition ability. The extracts ...were obtained by macerating the plant parts in 92% ethanol, which were then evaporated until a dry residue was obtained and phytochemically studied. The molluscicidal activity on B. glabrata was investigated using the procedures recommended by WHO (1965). The amount of food ingested and oviposition were measured during each experiment. The extract of leaves from J. gossypiifolia was shown to be a strong molluscicidal agent, causing 100% mortality of B. glabrata, even in the lowest concentration tested, of 25 ppm. Regarding the fruit extract, there was variation in the mortality, depending on the concentration used (100, 75, 50 and 25 ppm). The snails that were in contact with the fruit extract had significant reduction in feeding and number of embryos in comparison to the control. The stem extract did not present molluscicidal activity nor had any influence on the feeding and oviposition abilities of B. glabrata, in the concentrations tested. In conclusion, the extracts of leaves and fruits of J. gossypiifolia investigated in this work show molluscicidal effect and may be sources of useful compounds for the schistosomiasis control.
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