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Non-secretory multiple myeloma (NSMM) is a rare cancer of plasma cells characterized by the absence of detectable monoclonal M protein in the blood or urine. A 57-year-old woman presented with mandibular pain but without intraoral swelling. Imaging studies revealed multiple osteolytic lesions in her mandible and pronounced root resorption of the left mandibular second molar. Biopsy results showed atypical plasmacytoid cells positive for anti-kappa, CD138, MUM1, and CD79a antibodies, but negative for anti-lambda and CD20. These results were indicative of a malignant plasma cell neoplasm. No abnormalities were revealed by free light chain assay or by serum or urine protein electrophoresis, leading to a diagnosis of NSMM. The patient began chemotherapy in conjunction with bisphosphonate therapy and achieved remission following treatment. This case underscores the critical role of dentists in the early detection and prevention of NSMM complications, as the disease can initially present in the oral cavity.
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BACKGROUND AND OBJECTIVES: According to the manufacturer, the Bispectral Index (BIS) has a processing time delay of 5-10s. Studies addressing this have suggested longer delays. We evaluated the time delay in the Bispectral Index response. METHODS: Based on clinical data from 45 patients, using the difference between the predicted and the real BIS, calculated during a fixed 3minutes period after the moment the Bispectral Index dropped below 80 during the induction of general anesthesia with propofol and remifentanil. RESULTS: The difference between the predicted and the real BIS was in average 30.09±18.73s. CONCLUSION: Our results may be another indication that the delay in BIS processing may be much longer than stated by the manufacture, a fact with clinical implications.
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Anestesia Geral/métodos , Monitores de Consciência , Propofol/administração & dosagem , Remifentanil/administração & dosagem , Adulto , Idoso , Anestésicos Intravenosos/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Fatores de Tempo , Adulto JovemRESUMO
Abstract Background and objectives According to the manufacturer, the Bispectral Index (BIS) has a processing time delay of 5-10 s. Studies addressing this have suggested longer delays. We evaluated the time delay in the Bispectral Index response. Methods Based on clinical data from 45 patients, using the difference between the predicted and the real BIS, calculated during a fixed 3 minutes period after the moment the Bispectral Index dropped below 80 during the induction of general anesthesia with propofol and remifentanil. Results The difference between the predicted and the real BIS was in average 30.09 ± 18.73 s. Conclusion Our results may be another indication that the delay in BIS processing may be much longer than stated by the manufacture, a fact with clinical implications.
Resumo Justificativa e objetivos De acordo com o fabricante, o índice bispectral (BIS) tem um tempo de processamento de cinco a dez segundos. Estudos que avaliaram esse tempo de processamento sugeriram atrasos mais longos. Nós avaliamos o tempo de atraso na resposta do BIS. Métodos Com base em dados clínicos de 45 pacientes, calculamos a diferença entre o tempo de atraso previsto e real do índice bispectral durante um período fixo de três minutos após o momento em que o BIS caiu abaixo de 80 durante a indução da anestesia geral com propofol e remifentanil. Resultados A diferença entre o BIS previsto e real foi em média 30,09 ± 18,73 segundos. Conclusão Nossos resultados sugerem que o atraso no processamento do índice bispectral pode ser muito maior do que o declarado pelo fabricante, um fato com implicações clínicas.
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Humanos , Masculino , Feminino , Adulto , Idoso , Adulto Jovem , Propofol/administração & dosagem , Monitores de Consciência , Remifentanil/administração & dosagem , Anestesia Geral/métodos , Fatores de Tempo , Monitorização Intraoperatória/métodos , Anestésicos Intravenosos/administração & dosagem , Pessoa de Meia-IdadeRESUMO
A recent collection of the seasonal killifish found Leptopanchax splendens c. 5 km from the type locality, 74 years after its last record. The species was historically common in its type locality, the Estrela River basin in south-eastern Brazil, until 1950, after which it was not encountered and thought to have become extinct due to widespread deforestation and urbanization in the region. Despite the rediscovery, this study finds that other recently published reports of L. splendens are misidentifications.
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Ciprinodontiformes , Espécies em Perigo de Extinção , Animais , Brasil , Conservação dos Recursos Naturais , Florestas , Masculino , RiosRESUMO
Abstract Background and objectives Postoperative delirium and postoperative cognitive dysfunction are some of the most common complications in older surgical patients and are associated with adverse outcomes. The aim of this study was to evaluate portuguese anesthesiologists' perspectives and knowledge about adverse postoperative cognitive disorders, and routine clinical practice when caring for older surgical patients. Methods We used a prospective online survey with questions using a Likert scale from 1 to 5 (completely disagree to completely agree), or yes/no/don't know answer types. Potential participants were portuguese anesthesiologists working in hospitals affiliated with the portuguese national health system and private hospitals. Results We analyzed 234 surveys (17.7% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (78.6%). When caring for an agitated and confused patient postoperatively, 62.4% would first administer an analgesic and 11.1% an anxiolytic. Protocols to screen and manage postoperative cognitive disorders are rarely used. Nearly all respondents believe that postoperative delirium and postoperative cognitive dysfunction are neglected areas in anesthesiology. Conclusions Overall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anesthesia are aware of the main risk factors for their development but may lack information on prevention and management of postoperative delirium. The majority of hospitals do not have protocols regarding preoperative cognitive assessment, diagnosis, management or follow-up of patients with delirium and postoperative cognitive dysfunction.
Resumo Justificativa e objetivos O delírio pós-operatório e a disfunção cognitiva pós-operatória são algumas das complicações mais comuns em pacientes cirúrgicos mais idosos e estão associados a desfechos adversos. O objetivo deste estudo foi avaliar as perspectivas e conhecimentos de anestesiologistas portugueses sobre distúrbios cognitivos pós-operatórios e a prática clínica de rotina ao cuidar de pacientes cirúrgicos idosos. Métodos Pesquisa prospectiva on-line com perguntas usando uma escala Likert de 1-5 (discordo completamente-concordo completamente), ou respostas como sim/não/não sei. Os potenciais participantes eram anestesiologistas portugueses que trabalhavam em hospitais afiliados ao sistema nacional de saúde português e hospitais privados. Resultados Analisamos 234 resultados (17,7% do total dos potenciais respondentes). A maioria acreditava que o risco de efeitos colaterais cognitivos deveria ser considerado ao escolher o tipo de anestesia (87,6%) e que a função cognitiva pré-operatória deveria ser rotineiramente avaliada (78,6%). Ao cuidar de um paciente agitado e confuso no pós-operatório, 62,4% administraram primeiro um analgésico e 11,1% um ansiolítico. Protocolos para detectar e tratar distúrbios cognitivos pós-operatórios são raramente usados. Quase todos os entrevistados acreditam que o delírio pós-operatório e a disfunção cognitiva pós-operatória são áreas negligenciadas na anestesiologia. Conclusões Em geral, os participantes percebem os distúrbios cognitivos pós-operatórios como importantes resultados adversos após a cirurgia e anestesia, estão cientes dos principais fatores de risco para seu desenvolvimento, mas podem não ter informações sobre como prevenir e tratar o delírio pós-operatório. A maioria dos hospitais não possui protocolos de avaliação cognitiva pré-operatória, diagnóstico, tratamento ou acompanhamento de pacientes com delírio e disfunção cognitiva no pós-operatório.
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Humanos , Transtornos Neurocognitivos/fisiopatologia , Complicações Cognitivas Pós-Operatórias , Período Pós-Operatório , Inquéritos e Questionários , Fatores de RiscoRESUMO
A great diversity of animal species adapted to life in the semi-arid Caatinga of northeastern Brazil, including seasonal killifishes, has been reported in the last three decades. More recently, field and molecular data have shown a high occurrence of cryptic species. The killifish group herein analysed, the Hypsolebiasmagnificus species complex, is endemic to the middle and southern portion of the Caatinga, occupying about 120 km along the floodplains of the middle São Francisco River and some adjacent tributaries. Species of this complex are rare and presently considered threatened with extinction, being uniquely found in pools protected by trees and bushes. Single-locus delimitation methods were used to test species limits of populations displaying different colour patterns along the whole distribution of the complex. All analyses consistently supported the three nominal species and two new, herein described: H.gardneri Costa, sp. n., from the floodplains of the middle São Francisco River and H.hamadryades Costa, sp. n., from the Gorotuba River floodplains. The phylogenetic analysis highly supports H.hamadryades as sister to a clade comprising H.gardneri and H.harmonicus. Our field observations suggest that H.hamadryades is a miniature species. This study indicates that the H.magnificus complex comprises cryptic species apparently endemic to small areas and extremely vulnerable to environmental changes, deserving high concern.
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BACKGROUND AND OBJECTIVES: Postoperative delirium and postoperative cognitive dysfunction are some of the most common complications in older surgical patients and are associated with adverse outcomes. The aim of this study was to evaluate portuguese anesthesiologists' perspectives and knowledge about adverse postoperative cognitive disorders, and routine clinical practice when caring for older surgical patients. METHODS: We used a prospective online survey with questions using a Likert scale from 1 to 5 (completely disagree to completely agree), or yes/no/don't know answer types. Potential participants were portuguese anesthesiologists working in hospitals affiliated with the portuguese national health system and private hospitals. RESULTS: We analyzed 234 surveys (17.7% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (78.6%). When caring for an agitated and confused patient postoperatively, 62.4% would first administer an analgesic and 11.1% an anxiolytic. Protocols to screen and manage postoperative cognitive disorders are rarely used. Nearly all respondents believe that postoperative delirium and postoperative cognitive dysfunction are neglected areas in anesthesiology. CONCLUSIONS: Overall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anesthesia are aware of the main risk factors for their development but may lack information on prevention and management of postoperative delirium. The majority of hospitals do not have protocols regarding preoperative cognitive assessment, diagnosis, management or follow-up of patients with delirium and postoperative cognitive dysfunction.
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The high diversity of Neotropical fishes has been attributed to major South American palaeogeographic events, such as Andean uplift, rise of the Isthmus of Panama and marine transgressions. However, the unavailability of temporal information about evolution and diversification of some fish groups prevents the establishment of robust hypotheses about correlations between species diversification and proposed palaeogeographical events. One example is the Anablepidae, a family of teleost fishes found mostly in coastal habitats of Central and South America, but also in some inner river basins of South America. Historical aspects of the distribution patterns of the Anablepidae were never analysed and no accurate estimation of time of its origin and diversification is presently available. A multi-gene analysis was performed to estimate Anablepidae phylogenetic position, age and biogeography, comprising seven nuclear genes. The suborder Cyprinodontoidei was recovered in three major clades, one comprising all the Old World Cyprinodontoidei and two comprising New World lineages. Anablepidae was recovered as the sister group of the New World Poeciliidae, with the Amazonian genus Fluviphylax as their sister group. The ages found for the origin and diversification of Cyprinodontiformes were congruent with the pattern recorded for other vertebrate groups, with an origin anterior to the Cretaceous-Paleogene (K-Pg) transition and diversification during the Paleogene. The age estimated for the split between the Atlantic and Pacific lineages of Anableps was congruent with the rise of Panamanian Isthmus. The results suggest Miocene marine transgressions as determinant to the current distribution of Jenynsia.
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Ciprinodontiformes/genética , Animais , Ciprinodontiformes/fisiologia , Variação Genética/genética , Geologia , Família Multigênica/genética , Filogenia , Filogeografia , América do SulRESUMO
The Caatinga is the largest nucleus of seasonally dry tropical forests in South America, but little is known about the evolutionary history and biogeography of endemic organisms. Evolutionary diversification and distribution of terrestrial vertebrates endemic to the Caatinga have been explained by palaeogeographical Neogene episodes, mostly related to changes in the course of the São Francisco River, the largest river in the region. Our objective is to estimate the timing of divergence of two endemic groups of short-lived seasonal killifishes inhabiting all ecoregions of the Caatinga, testing the occurrence of synchronic events of spatial diversification in light of available data on regional palaeogeography. We performed independent time-calibrated phylogenetic molecular analyses for two clades of sympatric and geographically widespread seasonal killifishes endemic to the Caatinga, the Hypsolebias antenori group and the Cynolebias alpha-clade. Our results consistently indicate that species diversification took place synchronically in both groups, as well as it is contemporary to diversification of other organisms adapted to life in the semi-arid Caatinga, including lizards and small mammals. Both groups originated during the Miocene, but species diversification started between the Late Miocene and Early Pliocene, when global cooling probably favoured the expansion of semi-arid areas. Synchronic diversification patterns found are chronologically related to Tertiary palaeogeographical reorganizations associated to continental drift and to Quaternary climatic changes, corroborating the recent proposal that South American biodiversity has been continuously shaped between the Late Paleogene and Pleistocene.
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Peixes Listrados , Animais , Biodiversidade , Brasil , Florestas , Especiação Genética , Variação Genética , História Antiga , Peixes Listrados/classificação , Peixes Listrados/genética , Filogenia , Filogeografia , Estações do Ano , Clima TropicalRESUMO
The rich biological diversity of South America has motivated a series of studies associating evolution of endemic taxa with the dramatic geologic and climatic changes that occurred during the Cainozoic. The organism here studied is the killifish tribe Cynolebiini, a group of seasonal fishes uniquely inhabiting temporary pools formed during the rainy seasons. The Cynolebiini are found in open vegetation areas inserted in the main tropical and subtropical South American phytogeographical regions east of the Andes. Here, we present the first molecular phylogeny sampling all the eight genera of the Cynolebiini, using fragments of two mitochondrial and four nuclear genes for 35 species of Cynolebiini plus 19 species as outgroups. The dataset, 4448bp, was analysed under Bayesian and maximum likelihood approaches, providing a relatively well solved tree, which retrieves high support values for the Cynolebiini and most included clades. The resulting tree was used to estimate the time of divergence in included lineages using two cyprinodontiform fossils to calibrate the tree. We further investigated historical biogeography through the likelihood-based DEC model. Our estimates indicate that divergence between the clades comprising New World and Old World aplocheiloids occurred during the Eocene, about 50Mya, much more recent than the Gondwanan fragmentation scenario assumed in previous studies. This estimation is nearly synchronous to estimated splits involving other South American and African vertebrate clades, which have been explained by transoceanic dispersal through an ancient Atlantic island chain during the Palaeogene. We estimate that Cynolebiini split from its sister group Cynopoecilini in the Oligocene, about 25Mya and that Cynolebiini started to diversify giving origin to the present genera during the Miocene, about 20-14Mya. The Cynolebiini had an ancestral origin in the Atlantic Forest and probably were not present in the open vegetation formations of central and northeastern South America until the Middle Miocene, when expansion of dry open vegetation was favoured by cool temperatures and strike seasonality. Initial splitting between the genera Cynolebias and Simpsonichthys during the Miocene (about 14Mya) is attributed to the uplift of the Central Brazilian Plateau.