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To mitigate mortality among critically ill COVID-19 patients, both during their Intensive Care Unit (ICU) stay and following ICU discharge, it is crucial to measure its frequency, identify predictors and to establish an appropriate post-ICU follow-up strategy. In this multicentre, prospective cohort study, we included 586 critically ill COVID-19 patients. We observed an overall ICU mortality of 20.1% [95%CI: 17.1% to 23.6%] (118/586) and an overall hospital mortality of 25.4% [95%CI: 22.1% to 29.1%] (149/586). For ICU survivors, 30 days (early) post-ICU mortality was 5.3% [95%CI: 3.6% to 7.8%] (25/468) and one-year (late) post-ICU mortality was 7.9% [95%CI: 5.8% to 10.8%] (37/468). Pre-existing conditions/comorbidities were identified as the main independent predictors of mortality after ICU discharge: hypertension and heart failure were independent predictors of early mortality; and hypertension, chronic kidney disease, chronic obstructive pulmonary disease and cancer were independent predictors of late mortality. Early and late post-ICU mortality exhibited an initial surge (in the first 30 days post-ICU) followed by a subsequent decline over time. Close monitoring of critically ill COVID-19 post-ICU survivors, especially those with pre-existing conditions, is crucial to prevent adverse outcomes, reduce mortality and to establish an appropriate follow-up strategy.

Heterotopic pregnancy is an uncommon and potentially life-threatening condition that presents a significant diagnostic challenge, particularly in spontaneous conceptions. We describe the case of a 38-year-old multigravida who presented to the emergency department with acute abdominal pain and signs of hemorrhagic shock. Point-of-care transabdominal ultrasound revealed a moderate volume of intraperitoneal free fluid with echogenic content, raising suspicion for hemoperitoneum or peritonitis, and also demonstrated a viable intrauterine pregnancy at nine weeks' gestation. Emergency laparoscopy confirmed a ruptured ectopic pregnancy in the right fallopian tube, requiring salpingectomy and peritoneal lavage. Despite initial maternal stabilization, intrauterine fetal death was confirmed on the first postoperative day. This case underscores the need for heightened clinical suspicion in symptomatic pregnant patients, even when an intrauterine pregnancy has been documented and typical risk factors are absent. Timely diagnosis and prompt surgical management remain critical to optimize maternal outcomes.

Seed treatment with chemical pesticides is commonly used as an initial plant protection procedure against pests and diseases. However, the use of such chemicals may impair the survival and performance of beneficial microorganisms introduced via inoculants, such as the plant growth-promoting bacterium Azospirillum brasilense. We assessed the compatibility between the most common pesticide used in Brazil for the treatment of maize seeds, composed of two fungicides, and one insecticide, with the commercial strains Ab-V5 and Ab-V6 of A. brasilense, and evaluated the impacts on initial plant development. The toxicity of the pesticide to A. brasilense was confirmed, with an increase in cell mortality after only 24 hours of exposure in vitro. Seed germination and seedling growth were not affected neither by the A. brasilense nor by the pesticide. However, under greenhouse conditions, the pesticide affected root volume and dry weight and root-hair incidence, but the toxicity was alleviated by the inoculation with A. brasilense for the root volume and root-hair incidence parameters. In maize seeds inoculated with A. brasilense, the pesticide negatively affected the number of branches, root-hair incidence, and root-hair length. Therefore, new inoculant formulations with cell protectors and the development of compatible pesticides should be searched to guarantee the benefits of inoculation with plant growth-promoting bacteria.

Monoclonal gammopathy of renal significance (MGRS) is a group of pathologies that includes all kidney disorders related to a monoclonal protein in patients without diagnostic criteria for B-cell malignancies. There are multiple MGRS-associated kidney disorders, and more are still being discovered, which makes this diagnosis challenging. The relationship between monoclonal gammopathies and thrombotic microangiopathy (TMA) is of growing interest in literature. This article describes the case of a patient with newly diagnosed MGRS, presenting with rapidly progressing kidney failure and with histologic characteristics of TMA. The patient progressed to end-stage renal disease (ESRD) despite treatment with plasmapheresis and clone-directed therapy, as is currently advised in the literature. Although rare, the association between these two entities should not be unnoticed because of patients' renal and vital prognosis.

Flame retardants (FRs) are used in a variety of common items from furniture to carpet to electronics to reduce flammability and combustion, but the potential toxicity of these compounds is raising health concerns globally. Organophosphate FRs (OPFRs) are becoming more prevalent as older, brominated FRs are phased out, but the toxicity of these compounds, and the FR mixtures that contain them, is poorly understood. Work in a variety of in vitro model systems has suggested that FRs may induce metabolic reprogramming such that bone density is compromised at the expense of increasing adiposity. To address this hypothesis, the present studies maternally exposed Wistar rat dams orally across gestation and lactation to 1000 µg daily of the FR mixture Firemaster 550 (FM 550) which contains a mixture of brominated FRs and OPFRs. At six months of age, the offspring of both sexes were examined for evidence of compromised bone composition. Bone density, composition, and marrow were all significantly affected, but only in males. The fact that the phenotype was observed months after exposure suggests that FM 550 altered some fundamental aspect of mesenchymal stem cell reprogramming. The severity of the phenotype and the human-relevance of the dose employed, affirm this is an adverse outcome meriting further exploration.

In most cases, the atypical hemolytic uremic syndrome (aHUS) is a genetic disease resulting from defects in the regulation of the complement cascade, which conditions the development of thrombotic microangiopathy. Clinically, aHUS presents with acute kidney injury, thrombocytopenia, and microangiopathic hemolytic anemia, with frequent renal and extrarenal thrombotic phenomena. Early diagnosis and treatment are essential. Plasmapheresis is an alternative treatment being frequently used considering the high cost of eculizumab, despite its lower clinical efficacy. This article describes the clinical case of a patient admitted to intensive care with a personal history of aHUS diagnosed 10 years ago, with recurrent aHUS triggered by viral infection. The patient presented with acute kidney injury and thrombocytopenia. Despite the institution of admission of plasmapheresis, the clinical evolution was only favorable after the administration of eculizumab, highlighting the importance of early initiation of this therapy.

Interactions with boats can cause several behavioural changes in cetaceans. The purpose of this research is to analyse if Guiana dolphins, Sotalia guianensis, change their surfacing patterns in the presence of different boat categories, and their contact distances to boats at Port of Malhado, Ilheus, Bahia, Brazil. Data were collected from a fixed point from September 2008 to August 2009 and totalled 362.6 h of sampling effort and 213.22 h of effective effort. The number of dolphin breathing events was recorded during one minute periods, every time a boat passed nearby, and the same measurements were performed during periods of boat absence (control). Dolphin group composition was classified into groups with calves and groups without calves. Boat types were classified as inboard motor (IM), outboard motor (OM), ships (S) and without a motor (WM). Distances between the dolphins and passing boats were classified as near, intermediate and far. In total, 365 samples of one minute observations in absence of boats, and 379 observations in their presence were collected. Inboard motorboats had the highest occurrence in the study area (n = 478) and in interactions with Guiana dolphins (n = 260). However, outboard motorboats were mainly responsible for the reduction in surface patterns with an average of 1.82 and median of 2.2. In groups with calves, the number of breaths decreased significantly with an average of 2.13 per minute. There were no significant variations concerning the distances in the breathing pattern for any of the boat categories. The variation in the S. guianensis breathing pattern in the presence of boats may be a strategy of boat avoidance or a response to the difficulty of communication between animals.Original Abstract: Las interacciones con embarcaciones pueden causar cambios de comportamiento en los cetaceos. El proposito de esta investigacion es analizar si los delfines costeros, Sotalia guianensis, modifican su patron de afloramiento para respirar, en presencia de diferentes categorias de embarcaciones y de la distancia de contacto con las mismas en el puerto de Malhado, Ilheus, Bahia, Brasil. Los datos se obtuvieron desde un punto fijo, de septiembre 2008 a agosto 2009, totalizando 362,6 h de esfuerzo de muestreo y 213,2 h de esfuerzo efectivo de observacion. El numero de salidas a la superficie fue contabilizado durante periodos de un minuto, cada vez que pasaba una embarcacion, y tambien durante la ausencia de embarcaciones. La composicion de los grupos de delfines se clasificaron como: grupos con crias y grupos sin crias. Los tipos de embarcaciones fueron clasificadas como: con motor central (CM), con motor fuera de borda (OM), barcos (S) y sin motor (WM). Las distancias entre los defines y las embarcaciones que pasaban se clasificaron como: cerca, intermedia y lejana. En total se efectuaron 365 observaciones de un minuto en ausencia de embarcaciones y 379 en su presencia. Los barcos de motor central fueron los mas frecuentes (n = 478) en el area de estudio y en interaccion con los delfines (n = 260). Sin embargo, las embarcaciones con motor fuera de borda eran las principales responsables de la disminucion de los patrones superficiales con un promedio de 1,82 y una mediana de 2,2. En los grupos con crias, el numero de subidas a la superficie se redujo significativamente con un promedio de 2,13 por minuto. No hubo variaciones significativas con respecto a las distancias en el patron de subida a la superficie con ningun tipo de embarcacion. La variacion de este comportamiento de S. guianensis en presencia de embarcaciones puede ser una estrategia de evasion de embarcaciones o una respuesta a la dificultad de comunicacion entre los animales.

The harvestman genus PropachylusRoewer, 1913 is herein revalidated from the synonymy of Discocyrtus Holmberg, 1878. Its type species, Propachylus singularisRoewer, 1913 has a convoluted taxonomic history, connected to Discocyrtus fornicatusSørensen, 1884 (currently known as Metadiscocyrtus fornicatus). The monotypic genus MetadiscocyrtusRoewer, 1929 is herein considered a junior subjective synonym of Propachylus. Propachylus singularis (known only from males) is herein considered a junior subjective synonym of M. fornicatus (Sørensen, 1884) (known only from a single female). Accordingly, this species is herein newly combined as Propachylus fornicatus (Sørensen, 1884) comb. nov. The males and females of this species are considered congeneric for the first time. As this species does not possess diagnostic characteristics of the concept of Pachylinae stricto sensu, it is here removed from Pachylinae but is left unplaced. The geographical distribution of this species is updated to the Brazilian state of Bahia.

Paragangliomas (PGLs) are rare neuroendocrine tumors that, when functional, can release excessive catecholamines, causing health conditions ranging from asymptomatic arterial hypertension to life-threatening arrhythmias and cardiogenic shock. Early diagnosis of functional PGLs is extremely important as timely treatment can be curative and prevent vascular sequelae. We describe the clinical case of a 30-year-old woman with arterial hypertension under study, who was presented to the emergency department with a hypertensive crisis that progressed to adrenergic shock, in the context of a functional PGL.

: Transcranial direct current stimulation (tDCS) is investigated to modulate neuronal function including cognitive neuroscience and neuropsychiatric therapies. While cases of human stimulation with rudimentary batteries date back more than 200 years, clinical trials with current controlled stimulation were published intermittently since the 1960s. The modern era of tDCS only started after 1998. : To review methods and outcomes of tDCS studies from old literature (between 1960 and 1998) with intention of providing new insight for ongoing tDCS trials and development of tDCS protocols especially for the purpose of treatment. : Articles were identified through a search in PubMed and through the reference list from its selected articles. We included only non-invasive human studies that provided controlled direct current and were written in English, French, Spanish or Portuguese before the year of 1998, the date in which modern stimulation paradigms were implemented. : Fifteen articles met our criteria. The majority were small-randomized controlled clinical trials that enrolled a mean of approximately 26 subjects (Phase II studies). Most of the studies (around 83%) assessed the role of tDCS in the treatment of psychiatric conditions, in which the main outcomes were measured by means of behavioral scales and clinical observation, but the diagnostic precision and the quality of outcome monitoring, including adverse events, were deficient by modern standards. Compared to modern tDCS dose, the stimulation intensities used (0.1-1 mA) were lower, however as the electrodes were typically smaller (e.g., 1.26 cm ), the average electrode current density (0.2 mA/cm ) was approximately 4× higher. The number of sessions ranged from one to 120 (median 14). Notably, the stimulation session durations of several minutes to 11 h (median 4.5 h) could markedly exceed modern tDCS protocols. Twelve studies out of 15 showed positive results. Only mild side effects were reported, with headache and skin alterations the most common. : Most of the studies identified were for psychiatric indications, especially in patients with depression and/or schizophrenia and majority indicated some positive results. Variability in outcome is noted across trials and within trials across subjects, but overall results were reported as encouraging, and consistent with modern efforts, given some responders and mild side effects. The significant difference with modern dose, low current with smaller electrode size and interestingly much longer stimulation duration may worth considering.