Explore the vast range of titles available.

Background Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. Methods Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. Results Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). Conclusions Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.

This study describes and demonstrates key steps in a carbon-negative process for manufacturing cement from widely abundant seawater-derived magnesium (Mg) feedstocks. In contrast to conventional Portland cement, which starts with carboncontaining limestone as the source material, the proposed process uses membrane-free electrolyzers to facilitate the conversion of carbon-free magnesium ions (Mg2+) in seawater into magnesium hydroxide [Mg(OH)₂] precursors for the production of Mg-based cement. After a low-temperature carbonation curing step converts Mg(OH)₂ into magnesium carbonates through reaction with carbon dioxide (CO₂), the resulting Mg-based binders can exhibit compressive strength comparable to that achieved by Portland cement after curing for only 2 days. Although the proposed “cement-from-seawater” process requires similar energy use per ton of cement as existing processes and is not currently suitable for use in conventional reinforced concrete, its potential to achieve a carbon-negative footprint makes it highly attractive to help decarbonize one of the most carbon-intensive industries.

Point-of-care ultrasound (POCUS) has been established as an essential bedside tool for real-time image guidance of invasive procedures in critically ill neonates and children. While procedural guidance using POCUS has become the standard of care across many adult medicine subspecialties, its use has more recently gained popularity in neonatal and pediatric medicine due in part to improvement in technology and integration of POCUS into physician training programs. With increasing use, emerging data have supported its adoption and shown improvement in pediatric outcomes. Procedures that have traditionally relied on physical landmarks, such as thoracentesis and lumbar puncture, can now be performed under direct visualization using POCUS, increasing success, and reducing complications in our most vulnerable patients. In this review, we describe a global and comprehensive use of POCUS to assist all steps of different non-vascular invasive procedures and the evidence base to support such approach. Conclusion: There has been a recent growth of supportive evidence for using point-of-care ultrasound to guide neonatal and pediatric percutaneous procedural interventions. A global and comprehensive approach for the use of point-of-care ultrasound allows to assist all steps of different, non-vascular, invasive procedures. What is Known: • Point-of-care ultrasound has been established as a powerful tool providing for real-time image guidance of invasive procedures in critically ill neonates and children and allowing to increase both safety and success. What is New: • A global and comprehensive use of point-of-care ultrasound allows to assist all steps of different, non-vascular, invasive procedures: from diagnosis to semi-quantitative assessment, and from real-time puncture to follow-up.

Abstract We aim was to evaluate the chemical attributes of the soil under the effect of the incorporation of agronomic/lignocellulosic residues, in natura and spent/post-cultivation of mushrooms and the remineralizer from bentonite in Chromic Abruptic Acrisol, in the municipality of Areia, PB, Brazil. The research was carried out in a greenhouse and consisted of 13 treatments, resulting from a 3 × 2 × 2 + 1 factorial arrangement in CRD, with four replications. Data were evaluated for normality and homogeneity of variance using the of Shapiro-Wilk and Bartlett, and when significant then submitted to analysis of variance (ANOVA), Scott-Knott means test, and Dunnett at 5% significance. In addition, principal component analysis (PCA) and Pearson correlation were performed. The incorporation of agronomic wastes under in natura conditions and SMS with the remineralizer increased the fertility variables of the Chromic Abruptic Acrisol, with a significant increase in the levels of exchangeable bases, organic carbon, soil organic matter, cation exchange capacity, base saturation, and phosphorus available. The PCA showed that sugarcane bagasse and banana leaf treatments, both in the in natura condition and without incorporation of remineralizer, were the most correlated with the CEC, SB, and V% variables. Then, the application of lignocellulosic waste in the in natura and spent mushroom substrate (SMS) conditions without the use of a remineralizer increases total organic carbon and cation exchange capacity and phosphorus available. Resumo Objetivou-se avaliar os atributos químicos do solo sob o efeito da incorporação de resíduos lignocelulósicos, in natura e pós-cultivo de cogumelo (SMS), e de um remineralizador oriundo da extração de bentonita em Argissolo Vermelho-Amarelo, no município de Areia, PB, Brasil. A pesquisa foi realizada em casa de vegetação e constou de 13 tratamentos, resultantes de um esquema fatorial 3 × 2 × 2 + 1 em DIC, com quatro repetições. Os dados foram avaliados quanto à normalidade e homogeneidade de variância pelos testes de Shapiro-Wilk e Bartlett, e quando significativos submetidos à análise de variância (ANOVA), teste de médias de Scott-Knott e Dunnett ao nível de 5% de significância. Além disso, foram realizadas análise de componentes principais (ACP) e correlação de Pearson. A incorporação de resíduos lignocelulósicos em condições in natura e SMS com o remineralizador aumentaram as variáveis de fertilidade do Argissolo Vermelho-Amarelo, com aumento significativo nos teores de bases trocáveis, carbono orgânico, matéria orgânica do solo, capacidade de troca catiônica, saturação por bases e fósforo disponível. A ACP demonstrou que os tratamentos com bagaço de cana-de-açúcar e folha de bananeira, tanto na condição in natura quanto sem incorporação de remineralizador, foram os mais correlacionados com as variáveis CTC, SB e V%. Logo, a aplicação de resíduo lignocelulósico nas condições in natura e pós-cultivo de cogumelo (SMS) sem o uso de remineralizador aumentaram o carbono orgânico total, capacidade de troca catiônica e o fósforo disponível.

AbstractAssessing soil organic matter (SOM) dynamics in the semi-arid region must consider the heterogeneity of the environment. Despite numerous studies exploring the role of landform on SOM, the micro-topographic features have been overlooked. This study aimed to quantify the carbon stock and humic fractions in associated carbon of soil profiles in different microrelief (straight, convex, and concave) in Brazilian semi-arid region. Three sequences of soils on slopes with different forms were studied: T1 (straight), T2 (convex), and T3 (concave). Soil chemical and physical attributes, and humic fractions-associated in total organic carbon (TOC) were determined. The increase of TOC from the upper to the lower slope in T1 confirms that erosion processes can be considered efficient for carbon distribution in semiarid region. The degree of humification of organic matter was similar in all slopes, with predominance of humic acid and humin fractions in soil. The predominance of humin in the surface horizons indicates a strong interaction between organic matter and the mineral matrix, being these organic mineral complexes facilitated by the presence of exchangeable cations. Our study confirms that change in the humic fractions occur on slopes with low topographic features, demonstrating that SOM fractions are influenced by microrelief.

Abstract Water scarcity is growing every day, especially in semi-arid regions. Consequently, the amount of groundwater used in agriculture is strictly limited, and it has become necessary to explore alternative water sources. This study aimed to evaluate the potential of wastewater in restoring the fertility of degraded soil and in the vegetative growth of forage palm (Opuntia tuna) and sabiá (Mimosa caesalpiniifolia Benth). The experiment was conducted in the semi-arid region of Paraíba in a randomized block design arranged in a 3x2 factorial arrangement, with three types of irrigation water: i) irrigation with a volume of 500 ml plant/week with water supply; ii) irrigation with a volume of 500 ml plant/week of domestic sewage wastewater; iii) irrigation with a volume of 1000 ml plant/week of domestic sewage wastewater/ and two plant species: i) forage palm and ii) sabiá, with 10 replications. The biometric variables of the forage palm and sabiá plants were assessed. Soil samples were taken before and after irrigation to characterize soil fertility. It was found that wastewater changed pH in water, cation exchange capacity, base saturation, organic carbon, Ntotal, and available phosphorus. The treatment with the highest level of wastewater favored the vegetative growth of the forage palm, while the sabiá plants showed no significant response. Resumo A escassez de água cresce a cada dia, principalmente nas regiões semiáridas. Consequentemente, a quantidade de água subterrânea usada na agricultura é estritamente limitada, e tornou-se necessário explorar fontes alternativas de água. O presente trabalho teve como objetivo avaliar o potencial da água residuária na recuperação da fertilidade de um solo degradado e no crescimento vegetativo de palma forrageira (Opuntia tuna) e sabiá (Mimosa ceasalpinifolea Benth). O experimento foi conduzido no semiárido paraibano em blocos casualizados em arranjo fatorial com 3x2, sendo três tipos de água de irrigação: i) irrigação com volume de 500 ml planta/semana com água de abastecimento; ii) irrigação com volume de 500 ml planta/semana de água residuária de esgoto doméstico; iii) irrigação com volume de 1000 ml planta/semana de água residuária de esgoto doméstico e duas espécies vegetais: i) palma forrageira e ii) sabiá, com 10 repetições. Foram avaliadas as variáveis biométricas na palma forrageira e nas plantas de sabiá. Foram coletadas amostras de solo antes e depois da aplicação da irrigação para caracterização da fertilidade do solo. Verificou-se que, o uso da água residuária promoveu alterações no pH em água, capacidade de troca cátions, saturação de bases, carbono orgânico, Ntotal e P disponível. O tratamento com maior lâmina de água residuária favoreceu o crescimento vegetativo da palma forrageira, já as plantas de sabiá não apresentaram respostas significativas.

Background:SARS-CoV-2 infections can cause severe inflammation and serve as a trigger for immune-mediated manifestations. Several case reports in adults have described auto-antibodies production (45-57%) and musculoskeletal (MSK) manifestations after the infection (2.7-5.9%), but in children the information is scarce [1-6].Objectives:To describe the MSK manifestations, after SARS-CoV-2 infection, in a multicentric pediatric population without previously known rheumatic disease.Methods:The clinical records of all new patients, between April 2020 to March 2023, from five centers, with MSK manifestations and/or serologic findings related to rheumatic diseases (RD) after SARS-CoV-2 infection, were reviewed. Based on available data in adults, 60 days were defined as the longest period of time between exposure to the virus and the onset of MSK manifestations or serologic findings. Patients with previous known RD were excluded. Data on demographic variables and clinical features were collected and presented as frequencies and median [interquartile range] for categorical and continuous variables, respectively.Results:During the study period 1063 new patients were observed, of which 36 (3.4%) had MSK manifestations and serologic findings related to RD after SARS-CoV-2 infection (Table 1). Considering these 36 patients (56% female), the median age at infection was 15 [12-16] years and the median time for serological or MSK manifestations after SARS-CoV-2 infection was 23 [15-40] days. All patients had asymptomatic (54%) or mild infection, and none required hospitalization.Following infection, the main MSK manifestations were arthralgia (23/36, 64%), fatigue (16/36, 44%), myalgia (16/36, 44%) and acrocyanosis (8/36, 22%). The most frequent diagnosis identified were nonspecific musculoskeletal pain (NMKP: 11/36, 31%), perniosis (8/36, 22%), myositis (4/36, 11%) and connective tissue diseases (CTD: 3/36, 8%). Two patients (0.2%) had positive serologic findings (one with ANCA-PR3 and one with lupus anticoagulant), but no clinical manifestations related to these markers.Five patients (14%) were hospitalized due to the severity of the developed RD: two with systemic lupus erythematosus (6%) and three with myositis (8%).After a median follow-up of 15 [7.5-18] months, nearly all patients presented favorable outcomes. Regarding the patients who fulfilled diagnostic criteria of an inflammatory RD: four (11.1%) patients had complete remission, eight (22.2%) had remained with minimal disease activity and one (2.7%) with active disease. From the non-inflammatory patients, 11 (30.6%) had complete remission.Conclusion:To the best of our knowledge, this is one of the few studies analyzing the MSK involvement induced by SARS-CoV-2 in a pediatric population. In this cohort, the MSK manifestations were uncommon (3.4%), and the most frequent were NMKP, perniosis, myositis and CTD. The manifestations had a wide spectrum of severity, from mild to potentially fatal, but were early identified, treated and 41.6% reached complete remission.REFERENCES:[1] Gracia-Ramos AE. Cells. 2021.[2] Cui,. Open Forum Infect Dis. 2022.[3] Essien F. Ther Adv Chronic Dis. 2022.[4] Luchetti Gentiloni MM. Front Immunol. 2022.[5] Sacchi MC. Clin Transl Sci. 2021.[6] Pascolini S. Clin Transl Sci. 2021.Acknowledgements:NIL.Disclosure of Interests:None declared.

Due to its multisystemic involvement, systemic lupus erythematosus (SLE) can have a significant impact on patients' quality of life (QoL). Sexual (dis)function is a key component of QoL but is often underappreciated. Little is known about sexual disfunction in SLE patients, a condition that primarily affects women during their fertile age. We aimed at determining the prevalence of sexual dysfunction among women with SLE and predictors thereof. We performed a cross-sectional multicenter study in which women (18-70 years-old) with a clinical diagnosis of SLE (according to their treating rheumatologist) were included. An anonymous online questionnaire was perfomed where data on demographics (e.g., age), symptoms of depression and anxiety [Hospital Anxiety and Depression Scale (HADS)), health-related QoL (Short Form Health Survey Index 36 Item (SF36)]) and sexual function [Female Sexual Function Index (FSFI) - a 19-item patient-report outcome that assesses female sexual function]) were collected. Data on clinical features [disease activity according to the Safety of Estrogens in Lupus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI), organ involvement and evaluation of comorbidity (Charlson Comorbidity Index)] and on treatment status were collected from medical records. The main outcome was sexual dysfunction, defined as FSFI<26.5 (validated cut-off). A multivariable logistic regression was perfomed to test the association of clinical and demographic characteristics with sexual dysfunction (present vs absent). In total, 194 female patients with SLE were included (mean age 44 years-old [standard deviation (SD) 11]). The mean SELENA-SLEDAI score was 1.7 (SD: 2.2), corresponding to low disease activity, and 94% of patients were on classical disease-modifying antirheumatic drugs. The mean value of HADS was 9 (0-21), for both depression and anxiety scores. Regarding SF36, the mental component had a mean value of 61 (0-100) and the physical one of 70 (0-100). Sexual disfunction was present in 128 (66%) patients. In the multivariable analysis (Table 1), older age (OR: 1.04; 95%CI: 1.01; 1.07), higher SELENA-SLEDAI (OR: 1.18; 95%CI: 1.01; 1.40), higher HADS depression score (OR: 1.20; 95%CI: 1.01; 1.43), as well as a lower (that is, worse) SF36 mental component score (OR: 0.97; 95%CI: 0.95; 0.98) were independently associated with sexual dysfunction. Sexual disfunction is common in women with SLE and is influenced by both physical and mental health components. Clinicians should consider both for the optimal management of their patients in order to improve their sexual QoL. NIL. NIL. None Declared. Table 1Factors associated with sexual dysfunction in female patients with SLEUnivariable analysisOR (95% CI)(N=192-194)p-valueMultivariable analysisOR (95% CI)(N=193)Age1.04 (1.01; 1.07)0.011.04 (1.01; 1.07)Menopause (yes vs no)2.38 (1.11; 5.61)0.03†SELENA-SLEDAI1.09 (0.94; 1.28)0.241.18 (1.01; 1.40)CCI1.39 (1.00; 2.02)0.06†bDMARDs (yes vs no)0.85 (0.30; 2.59)0.76*cDMARDs (yes vs no)0.16 (0.01; 0.87)0.09†Glucocorticoids (yes vs no)1.15 (0.63; 2.09)0.66*HADS Depression1.20 (1.03; 1.42)0.021.20 (1.01; 1.43)HADS Anxiety1.19 (1.04; 1.38)0.02†SF36 Mental0.97 (0.95; 0.98)< 0.010.97 (0.95; 0.98)SF36 Physical0.99 (0.98;1.00)0.03†* Not selected in the univariable model (p>0.25)† Not selected in the multivariable model (p>0.05)CCI, Charlson Comorbidity IndexbDMARDs, biologic disease-modifying anti-rheumatic drugscDMARDs, classic disease-modifying anti-rheumatic drugs

Background:Axial spondyloarthritis (axSpA) symptoms usually begin before the age of 45. However, due to longer life expectancy and improved healthcare, late-onset axSpA (Lo-axSpA) is becoming more recognized. Previous studies have shown different clinical characteristics between the late and early onset (Eo) forms of the disease. Nonetheless, there is limited data available on the efficacy of biological disease-modifying antirheumatic drugs (bDMARDs) in Lo-axSpA.Objectives:To evaluate drug survival of bDMARDs in Lo-axSpA patients compared to those with Eo-axSpA.Methods:We performed a retrospective multicenter national cohort study on patients with a diagnosis of axSpA, registered in Reuma.pt, the Portuguese registry of patients with rheumatic diseases. Adult patients who were clinically diagnosed with axSpA by their rheumatologist and had available information on the age of symptom onset were included. The patients were divided into 2 groups based on their age at symptom onset: Eo-axSpA (<45 years) and Lo-axSpA (≥45 years). Non-parametric tests were used to evaluate the group differences. Drug survival was calculated as the time in months from the initiation of bDMARD until its discontinuation/switch and the log-rank test was used to calculate the persistence rate in biological treatment. R software version 4.3.2 was used, and a p ≤ 0.05 was considered statistically significant.Results:A total of 1953 patients (1703 with Eo-axSpA and 250 with Lo-axSpA) were included. The Lo-axSpA group had a higher body mass index (BMI), higher prevalence of inflammatory bowel disease and lower prevalence of acute anterior uveitis, HLA-B27 positivity and SpA family history. Lo-axSpA were more likely to have higher disease-associated parameters at baseline, 6, and 12 months of bDMARD therapy (Table 1). The drug retention rate was lower in Lo-axSpA and the survival analysis showed a higher probability of discontinuing treatment in this group (HR 1.50 (1.20-1.88), p<0.001). When adjusting for confounders, the Lo-axSpA group had no significant differences in treatment persistence. However, a higher age of disease onset increased the risk of discontinuing therapy by 2% (HR 1.02 (1.01-1.04), p=0.001). Being male (HR 0.77 (0.65-0.92), p=0.004), HLA-B27 positivity (HR 0.80 (0.67-0.95), p=0.01) and higher CRP levels (HR 0.80 (0.66-0.96), p=0.02) were associated with a lower risk of discontinuing therapy, while having a good response to NSAIDs (HR 1.22 (1.01-1.45), p=0.03) and higher BMI (1.02 (1.00-1.04), p=0.02) were associated with an increased risk. Regarding bDMARD therapy, patients who were on etanercept (HR 0.92 (0.50-0.78), p=<0.001), infliximab (HR 0.69 (0.53-0.90), p=0.006) and golimumab (HR 0.75 (0.58-0.97), p=0.03) had a lower risk of discontinuing therapy compared to the adalimumab reference group.Conclusion:Based on real-world nationwide data, we found that bDMARDs had lower clinical efficacy in patients with Lo-axSpA, with shorter drug retention time. Although Lo-axSpA itself was not a significant factor in predicting drug discontinuation, age at disease onset was associated with a higher risk of discontinuation. Additionally, HLA-B27 absence, female gender and higher BMI were also linked to a higher risk of therapy discontinuation. Even though it represents a minority, clinicians should be aware of this phenotype, since it can be associated with a higher clinical burden and lower treatment efficacy.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.