Avaliação do modelo de predição clínica de Wells et al. no diagnóstico da trombose venosa profunda dos membros inferiores

CONTEXTO: A aplicação de uma estratégia baseada em um modelo clínico associado ao mapeamento dúplex (MD) pode permitir um diagnóstico da trombose venosa profunda (TVP) mais seguro, eficaz e custo-efetivo. OBJETIVO: Testar o modelo clínico de Wells et al. associado ao MD e verificar a ocorrência de TVP nos pacientes categorizados quanto à probabilidade de apresentar a doença, e determinar se, a partir dos resultados obtidos, seria possível reduzir o número de exames seriados com o MD. MÉTODOS: Os pacientes com suspeita clínica de TVP foram categorizados quanto à apresentação de TVP em baixa, moderada e alta probabilidade (BP, MP, AP) e, em seguida, submetidos ao MD. Pacientes com MD negativo repetiram o exame em 24-48 horas e em 7 dias. Pacientes com exame positivo para TVP foram tratados. Todos os pacientes sem TVP foram convocados para reavaliação clínica em 3 meses. RESULTADOS: A ocorrência de TVP entre os 489 pacientes avaliados foi de 39,1% (191), sendo 35,6% identificados no exame inicial e 3,5% no exame seriado. Os índices de pacientes que apresentaram TVP foram de 6,1% no grupo de BP, 26,9% no grupo de MP e 79,5% no grupo de AP. No exame seriado, o percentual de TVP foi de 2,4, 7,8 e 15,1% nos grupos BP, MP e AP, respectivamente. Dos pacientes com MD negativo, 62,4% compareceram após 3 meses, e piora dos sintomas foi apresentada por apenas um paciente. Neste, o MD mostrou TVP de veia poplítea. CONCLUSÃO: Os resultados obtidos sugerem que, para os pacientes com BP para TVP e MD negativo, seria possível prescindir do exame seriado, devido à baixa ocorrência de TVP neste grupo, tornando, assim, a abordagem diagnóstica mais simples.

Fatal myocardial infarction at 4.5 years in a case of homozygous familial hypercholesterolaemia

Management of homozygous familial hypercholesterolaemia is notoriously difficult. For these patients, LDL apheresis is considered the treatment of choice. Treatment initiation is advocated generally from the age of seven years onwards (Thompson et al., Atherosclerosis 198:247-255, 2008). Here, we present the case of a young girl from a large inbred family of Turkish descent with homozygous familial hypercholesterolaemia and fatal outcome at the early age of 4(1/2) years.In conclusion, this case suggests that management of homozygous familial hypercholesterolaemia may require earlier and more aggressive treatment, including LDL apheresis before the age of seven years.

Varved sediments of the Arabian Sea

The upper Holocene marine section from a kasten core taken from the oxygen minimum zone off Karachi (Pakistan) at water depth 700 m contains continuously laminated sediments with a sedimentation rate of 1.2 mm/yr and a unique record of monsoonal climatic variability covering the past 5000 years. Our chronostratigraphy is based on varve counts verified by conventional and AMS14C dating. Individual hemipelagic varve couplets are about 0.8-1.5 mm thick, with light-colored terrigenous laminae (A) deposited mainly during the winter monsoon alternating with dark-colored laminae (B) rich in marine organic matter, coccoliths, and fish debris that reflect deposition during the high-productivity season of the late summer monsoon (August-October). Precipitation and river runoff appear to control varve thickness and turbidite frequency. We infer that precipitation decreased in the river watershed (indicated by thinning varves) after 3500-4000 yr B.P. This is about the time of increasing aridification in the Near East and Middle East, as documented by decreasing Nile River runoff data and lake-level lowstands between Turkey and northwestern India. This precipitation pattern continued until today with precipitation minima about 2200-1900 yr B.P., 1000 yr B.P., and in the late Middle Ages (700-400 yr B.P.), and precipitation maxima in the intervening periods. As documented by spectral analysis, the thickness of varve couplets responds to the average length of a 250-yr cycle, a 125-yr cycle, the Gleissberg cycle of solar activity (95 yr), and a 56-yr cycle of unknown origin. Higher frequency cycles are also present at 45, 39, 29-31, and 14 yr. The sedimentary gray-value also shows strong variability in the 55-yr band plus a 31-yr cycle. Because high-frequency cyclicity in the ENSO band (ca. 3.5 and 5 yr) is only weakly expressed, our data do not support a straightforward interaction of the Pacific ENSO with the monsoon-driven climate system of the Arabian Sea.

Age determination and grain size distribution of sediment core GeoB3375-1

The palaeoclimatic conditions during the Last Glacial Maximum (LGM) of southern South America and especially latitudinal shifts of the southern westerly wind belt are still discussed controversially. Longer palaeoclimatic records covering the Late Quaternary are rare. A particularly sensitive area to Late Quaternary climatic changes is the Norte Chico, northern Chile, because of its extreme climatic gradients. Small shifts of the present climatic zonation could cause significant variations of the terrestrial sedimentary environment which would be recorded in marine terrigenous sediments. To unveil the history of shifting climatic zones in northern Chile, we present a sedimentological study of a marine sediment core (GeoB 3375-1) from the continental slope off the Norte Chico (27.5°S). Sedimentological investigations include bulk- and silt grain-size determinations by sieving, Atterberg separation, and detailed SediGraph analyses. Additionally, clay mineralogical parameters were obtained by X-ray diffraction methods. The 14C-dated core, covering the time span from approximately 10,000 to 120,000 cal. yr B.P., consists of hemipelagic sediments. Terrigenous sedimentological parameters reveal a strong cyclicity, which is interpreted in terms of variations of sediment provenance, modifications of the terrestrial weathering regimes, and modes of sediment input to the ocean. These interpretations imply cyclic variations between comparatively arid climates and more humid conditions with seasonal precipitation for northern Chile (27.5°S) through the Late Quaternary. The cyclicity of the terrigenous sediment parameters is strongly dominated by precessional cycles. For the palaeoclimatic signal, this means that more humid conditions coincide with maxima of the precession index, as e.g. during the LGM. Higher seasonal precipitation for this part of Chile is most likely derived from frontal winter rain of the Southern Westerlies. Thus, the data presented here favour not only an equatorward shift of this atmospheric circulation system during the LGM, but also precession-controlled latitudinal movements throughout the Late Quaternary. Precessional forcing of latitudinal movements of the westerly atmospheric circulation system may be conceivable through teleconnections to the Northern Hemisphere monsoonal system in the Atlantic Ocean region.

Northwards and eastwards velocities extracted from a historical run (for the year 2000) of the UVic Earth System Climate Model of Weaver et al. (2001)

This study provides a theoretical assessment of the potential bias due to differential lateral transport on multi-proxy studies based on a range of marine microfossils. Microfossils preserved in marine sediments are at the centre of numerous proxies for paleoenvironmental reconstructions. The precision of proxies is based on the assumption that they accurately represent the overlying watercolumn properties and faunas. Here we assess the possibility of a syn-depositional bias in sediment assemblages caused by horizontal drift in the water column, due to differential settling velocities of sedimenting particles based on their shape, size and density, and due to differences in current velocities. Specifically we calculate the post-mortem lateral transport undergone by planktic foraminifera and a range of other biological proxy carriers (diatoms, radiolaria and fecal pellets transporting coccolithophores) in several regions with high current velocities. We find that lateral transport of different planktic foraminiferal species is minimal due to high settling velocities. No significant shape- or size-dependent sorting occurs before reaching the sediment, making planktic foraminiferal ideal proxy carriers. In contrast, diatoms, radiolaria and fecal pellets can be transported up to 500km in some areas. For example in the Agulhas current, transport can lead to differences of up to 2°C in temperature reconstructions between different proxies in response to settling velocities. Therefore, sediment samples are likely to contain different proportions of local and imported particles, decreasing the precision of proxies based on these groups and the accuracy of the temperature reconstruction.

Age determination, planktic foraminifera and stable istopes of sediment core MSM05/5_712-2

A sediment core from the West Spitsbergen continental margin was studied to reconstruct climate and paleoceanographic variability during the last ~9 ka in the eastern Fram Strait. Our multiproxy evidence suggests that the establishment of the modern oceanographic configuration in the eastern Fram Strait occurred stepwise, in response to the postglacial sea-level rise and the related onset of modern sea-ice production on the shallow Siberian shelves. The late Early and Mid Holocene interval (9 to 5 ka) was generally characterized by relatively unstable conditions. High abundance of the subpolar planktic foraminifer species Turborotalita quinqueloba implies strong intensity of Atlantic Water (AW) inflow with high productivity and/or high AW temperatures, resulting in a strong heat flux to the Arctic. A series of short-lived cooling events (8.2, 6.9. and 6.1 ka) occurred superimposed on the warm late Early and Mid Holocene conditions. Our proxy data imply that simultaneous to the complete postglacial flooding of Arctic shallow shelves and the initiation of modern sea-ice production, strong advance of polar waters initiated modern oceanographic conditions in the eastern Fram Strait at ~5.2 ka. The Late Holocene was marked by the dominance of the polar planktic foraminifer species Neogloboquadrina pachyderma, a significant expansion of sea ice/icebergs, and strong stratification of the water column. Although planktic foraminiferal assemblages as well as sea surface and subsurface temperatures suggest a return of slightly strengthened advection of subsurface Atlantic Water after 3 ka, a relatively stable cold-water layer prevailed at the sea surface and the study site was probably located within the seasonally fluctuating marginal ice zone during the Neoglacial period.

Electron spin resonance (ESR) and 14C dating in sediments of Bonaire, Leeward Antilles

The coastal deposits of Bonaire, Leeward Antilles, are among the most studied archives for extreme-wave events (EWEs) in the Caribbean. Here we present more than 400 electron spin resonance (ESR) and radiocarbon data on coarse-clast deposits from Bonaire's eastern and western coasts. The chronological data are compared to the occurrence and age of fine-grained extreme-wave deposits detected in lagoons and floodplains. Both approaches are aimed at the identification of EWEs, the differentiation between extraordinary storms and tsunamis, improving reconstructions of the coastal evolution, and establishing a geochronological framework for the events. Although the combination of different methods and archives contributes to a better understanding of the interplay of coastal and archive-related processes, insufficient separation, superimposition or burying of coarse-clast deposits and restricted dating accuracy limit the use of both fine-grained and coarse-clast geoarchives to unravel decadal- to centennial-scale events. At several locations, distinct landforms are attributed to different coastal flooding events interpreted to be of tsunamigenic origin. Coastal landforms on the western coast have significantly been influenced by (sub)-recent hurricanes, indicating that formation of the coarse-clast deposits on the eastern coast is likely to be related to past events of higher energy.

Age determination of sediments and biomarkers of ODP Hole 169-1034C

The radiocarbon contents of various biomarkers extracted from the varve-counted sediments of Saanich Inlet, Canada, were determined to assess their applicability for dating purposes. Calibrated ages obtained from the marine planktonic archaeal biomarker crenarchaeol compared favorably with varve-count ages. The same conclusion could be drawn for a more general archaeal biomarker (GDGT-0), although this biomarker proved to be less reliable due to its less-specific origin. The results also lend support to earlier indications that marine crenarchaeota use dissolved inorganic carbon (DIC) as their carbon source. The average reservoir age offset DR of 430 years, determined using the crenarchaeol radiocarbon ages, varied by ±110 years. This may be caused by natural variations in ocean-atmosphere mixing or upwelling at the NE Pacific coast but variability may also be due to an inconsistency in the marine calibration curve when used at sites with high reservoir ages.