Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. METHODS: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. FINDINGS: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2-11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75-1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58-1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91-1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70-1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11-0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50-0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38-0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45-0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. INTERPRETATION: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. FUNDING: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Green turtle head trauma with intracerebral hemorrhage: image diagnosis and treatment Traumatismo craniano com hemorragia intracerebral em tartaruga verde: diagnóstico por imagem e tratamento

Sea turtles are threatened to the point of extinction. The major goal of rehabilitating injured individuals is to eventually reintroduce them back into their habitat. Sea turtles are vulnerable to anthropogenic effects, and impact traumas are a common cause of death among these animals. Carapace and skull fractures are usually related to vessel collisions or propeller impacts. However, intentional traumas inflicted by humans are also considered as a potential threat. The purpose of this article is to describe the diagnosis and rehabilitation procedures of a juvenile green turtle (Chelonia mydas) after severe head trauma with brain hemorrhage. The data presented here can be used as a reference for future cases of head trauma in chelonians.Tartarugas marinhas são animais ameaçados de extinção. Por isso, o principal objetivo em reabilitar indivíduos feridos é posteriormente reintroduzi-los em seu habitat. Quelônios marinhos apresentam grande vulnerabilidade a efeitos antropogênicos, e a ocorrência de traumatismos impactantes constituem uma importante causa de óbitos entre esses animais. Fraturas de carapaça e crânio estão normalmente associadas a colisões por embarcações. No entanto, lesões intencionais provocadas por humanos também podem ser consideradas ameaças em potencial. O objetivo deste estudo é descrever o diagnóstico e a reabilitação de um indivíduo jovem de tartaruga verde (C. mydas) após traumatismo craniano severo com hemorragia cerebral. Os dados apresentados poderão ser utilizados como referências para casos futuros de traumatismos afetando a região da cabeça de quelônios

Activity and in vivo dynamics of Bacillus subtilis DisA are affected by RadA/Sms and by Holliday junction-processing proteins

Bacillus subtilis c-di-AMP synthase DisA and RecA-related RadA/Sms are involved in the repair of DNA damage in exponentially growing cells. We provide genetic evidence that DisA or RadA/Sms is epistatic to the branch migration translocase (BMT) RecG and the Holliday junction (HJ) resolvase RecU in response to DNA damage. We provide genetic evidence damage. Functional DisA-YFP formed dynamic foci in exponentially growing cells, which moved through the nucleoids at a speed compatible with a DNA-scanning mode. DisA formed more static structures in the absence of RecU or RecG than in wild type cells, while dynamic foci were still observed in cells lacking the BMT RuvAB. Purified DisA synthesizes c-di-AMP, but interaction with RadA/Sms or with HJ DNA decreases DisA-mediated c-di-AMP synthesis. RadA/Sms-YFP also formed dynamic foci in growing cells, but the foci moved throughout the cells rather than just on the nucleoids, and co-localized rarely with DisA-YFP foci, suggesting that RadA/Sms and DisA interact only transiently in unperturbed conditions. Our data suggest a model in which DisA moving along dsDNA indicates absence of DNA damage/replication stress via normal c-di-AMP levels, while interaction with HJ DNA/halted forks leads to reduced c-di-AMP levels and an ensuing block in cell proliferation. RadA/Sms may be involved in modulating DisA activities

2nd Meeting for Accessibility and Inclusion in Art and Heritage : book proceedings

Obra publicada por ocasião do Segundo Encontro de Acessibilidade e Inclusão na Arte e no Património, decorrido nos dias 24 e 25 de junho de 2022 Resumo2ª edição do encontro Acessibilidade e Inclusão na Arte e no Património é uma iniciativa da Faculdade de Belas-Artes da Universidade de Lisboa e do Museu da Farmácia. Tem como objetivo ser um espaço de discussão e troca de ideias, reunindo trabalhos associados à acessibilidade à arte e ao património cultural. Divulgando estratégias que visam melhorar o acesso e a inclusão dos diversos públicos, nomeadamente de públicos com deficiência, ao património. Este livro de atas reúne nove artigos. São abordados temas associados à teoria e legislação sobre acessibilidade e inclusão no património; avaliação da acessibilidade nos museus; experiências multissensoriais em museus e monumentos e ainda o desenvolvimento de produtos que promovam acessibilidade em museus. O Encontro contou com a participação de investigadores e profissionais da área provenientes de várias instituições nacionais e internacionaisinfo:eu-repo/semantics/publishedVersio

O direito fundamental ao trabalho decente sob a ótica da erradicação do trabalho infantil e proteção do adolescente.

O texto aborda o trabalho decente como direito fundamental, com ênfase na situação juvenil, na medida em que pontua a necessidade de erradicação do trabalho infantil como forma de alcança-lo, aliado à medidas de proteção dos adolescentes no mercado de trabalho.The issue of child labor is a matter of concern worldwide, especially in view of its harmful consequences, particularly as regards the perpetuation of the cycle of poverty and school drop-out

Neotropical xenarthrans: a dataset of occurrence of xenarthran species in the Neotropics.

International audienceXenarthrans—anteaters, sloths, and armadillos—have essential functions forecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosys-tem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts withdomestic dogs, these species have been threatened locally, regionally, or even across their fulldistribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths.Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae(3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data onDasypus pilo-sus(Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized,but new genetic studies have revealed that the group is represented by seven species. In thisdata paper, we compiled a total of 42,528 records of 31 species, represented by occurrence andquantitative data, totaling 24,847 unique georeferenced records. The geographic range is fromthe southern United States, Mexico, and Caribbean countries at the northern portion of theNeotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regardinganteaters,Myrmecophaga tridactylahas the most records (n=5,941), andCyclopessp. havethe fewest (n=240). The armadillo species with the most data isDasypus novemcinctus(n=11,588), and the fewest data are recorded forCalyptophractus retusus(n=33). Withregard to sloth species,Bradypus variegatushas the most records (n=962), andBradypus pyg-maeushas the fewest (n=12). Our main objective with Neotropical Xenarthrans is to makeoccurrence and quantitative data available to facilitate more ecological research, particularly ifwe integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, andNeotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure,habitat loss, fragmentation effects, species invasion, and climate change effects will be possiblewith the Neotropical Xenarthrans data set. Please cite this data paper when using its data inpublications. We also request that researchers and teachers inform us of how they are usingthese data