Percutaneous vs. surgical treatment of patent ductus arteriosus in children and adolescents

INTRODUÇÃO: Estudos comparando os métodos percutâneo e cirúrgico no tratamento da persistência do canal arterial (PCA) são raros na literatura. Nosso objetivo foi realizar análise comparativa entre os dois métodos de tratamento da PCA, enfatizando os aspectos de eficácia e morbidade. MÉTODOS: Estudo observacional com 2 coortes de crianças e adolescentes &gt; 5 kg e < 14 anos, portadores de PCA, tratados durante um projeto de avaliação de incorporação de novas tecnologias ao Sistema Único de Saúde (SUS), realizado em um hospital cardiológico de excelência, em parceria com o Ministério da Saúde do Brasil. Foi feita análise prospectiva no grupo percutâneo entre 2009 e 2011 e retrospectiva no grupo cirúrgico entre 2006 e 2011. RESULTADOS: Foram incluídos 80 pacientes no grupo percutâneo (60% do sexo feminino) e 39 no grupo cirúrgico (51% do sexo feminino; P = 0,37). A mediana de idade e de peso dos grupos percutâneo e cirúrgico foi de 39,4 meses vs. 25,5 meses (P = 0,04) e de 14 kg vs. 11,1 kg (P = 0,052), respectivamente. No grupo percutâneo, 78 pacientes (92%) tinham PCA do tipo A e o diâmetro mínimo do canal à angiografia foi de 2,5 ± 1,2 mm. As próteses mais utilizadas foram Amplatzer®, molas de Gianturco e CeraTM. A técnica cirúrgica mais utilizada foi a clipagem. A taxa de sucesso dos procedimentos foi de 100% nos dois grupos. O grupo cirúrgico apresentou maiores taxas de complicação, incluindo quilotórax, infecções, necessidade de hemoderivados, hipertensão arterial sistêmica e uso de opioides, como também maior necessidade de terapia intensiva. A mediana do tempo de internação foi de 1,3 dia no grupo percutâneo e de 7,9 dias no grupo cirúrgico (P < 0,01). À alta hospitalar, as taxas de oclusão foram semelhantes nos dois grupos (91% no grupo percutâneo e 87% no grupo cirúrgico; P = 0,71). CONCLUSÕES: Em decorrência da menor morbidade, do menor tempo de internação e da igual eficácia, o tratamento percutâneo da PCA deve ser considerado a modalidade terapêutica de escolha para pacientes selecionados

Trend analysis of the quality indicators for the Brazilian cervical cancer screening programme by region and state from 2006 to 2013

Quality indicators for the Brazilian cervical cancer screening programme can provide a perspective on its effectiveness in Brazilian macro-regions and states. The aim of this study was to perform a trend analysis of the cervical cancer screening program's quality indicators, according to Brazilian regions and states, from 2006 to 2013.(undefined)info:eu-repo/semantics/publishedVersio

Systematic surveillance tools to reduce rodent pests in disadvantaged urban areas can empower communities and improve public health

Rodents are notorious pests, known for transmitting major public health diseases and causing agricultural and economic losses. The lack of site-specific and national standardised rodent surveillance in several disadvantaged communities has rendered interventions targeted towards rodent control as often ineffective. Here, by using the example from a pilot case-study in the Bahamas, we present a unique experience wherein, through multidisciplinary and community engagement, we simultaneously developed a standardised national surveillance protocol, and performed two parallel but integrated activities: (1) eight days of theoretical and practical training of selected participants; and (2) a three-month post-training pilot rodent surveillance in the urban community of Over-the-Hill, Nassau, The Bahamas. To account for social and environmental conditions influencing rodent proliferation in the Bahamas, we engaged selected influential community members through a semi-structured interview and gathered additional site-specific information using a modified Centers for Diseases Control and Prevention (CDC) exterior and interior rodent evaluation form, along with other validated instruments such as tracking plates and snap trapping, to test and establish a standardised site-specific rodent surveillance protocol tailored for the Bahamas. Our engagement with community members highlighted poor disposal of animal and human food, irregular garbage collection, unapproved refuse storage, lack of accessible dumpsters, poor bulk waste management, ownership problems and structural deficiencies as major factors fuelling rodent proliferation in the study areas. Accordingly, results from our pilot survey using active rodent signs (that is, the presence of rodent runs, burrows, faecal material or gnawed material) as a proxy of rodent infestation in a generalized linear model confirmed that the variables earlier identified during the community engagement program as significantly correlated with rodent activities (and capturing) across the study areas. The successful implementation of the novel site-specific protocol by trained participants, along with the correlation of their findings with those recorded during the community engagement program, underscores its suitability and applicability in disadvantaged urban settings. This experience should serve as a reference for promoting a standardised protocol for monitoring rodent activities in many disadvantaged urban settings of the Global South, while also fostering a holistic understanding of rodent proliferation. Through this pilot case-study, we advocate for the feasibility of developing sustainable rodent control interventions that are acceptable to both local communities and public authorities, particularly through the involvement of a multidisciplinary team of professionals and community members

Flow cytometry immunophenotyping for diagnostic orientation and classification of pediatric cancer based on the euroflow solid tumor orientation tube (Stot)

© 2021 by the authors.Early diagnosis of pediatric cancer is key for adequate patient management and improved outcome. Although multiparameter flow cytometry (MFC) has proven of great utility in the diagnosis and classification of hematologic malignancies, its application to non-hematopoietic pediatric tumors remains limited. Here we designed and prospectively validated a new single eight-color antibody combination—solid tumor orientation tube, STOT—for diagnostic screening of pediatric cancer by MFC. A total of 476 samples (139 tumor mass, 138 bone marrow, 86 lymph node, 58 peripheral blood, and 55 other body fluid samples) from 296 patients with diagnostic suspicion of pediatric cancer were analyzed by MFC vs. conventional diagnostic procedures. STOT was designed after several design–test–evaluate–redesign cycles based on a large panel of monoclonal antibody combinations tested on 301 samples. In its final version, STOT consists of a single 8-color/12-marker antibody combination (CD99-CD8/numyogenin/CD4-EpCAM/CD56/GD2/smCD3-CD19/cyCD3-CD271/CD45). Prospective validation of STOT in 149 samples showed concordant results with the patient WHO/ICCC-3 diagnosis in 138/149 cases (92.6%). These included: 63/63 (100%) reactive/disease-free samples, 43/44 (98%) malignant and 4/4 (100%) benign non-hematopoietic tumors together with 28/38 (74%) leukemia/lymphoma cases; the only exception was Hodgkin lymphoma that required additional markers to be stained. In addition, STOT allowed accurate discrimination among the four most common subtypes of malignant CD45− CD56++ non-hematopoietic solid tumors: 13/13 (GD2++ numyogenin− CD271−/+ nuMyoD1− CD99− EpCAM−) neuroblastoma samples, 5/5 (GD2− numyogenin++ CD271++ nuMyoD1++ CD99−/+ EpCAM−) rhabdomyosarcomas, 2/2 (GD2−/+ numyogenin− CD271+ nuMyoD1− CD99+ EpCAM−) Ewing sarcoma family of tumors, and 7/7 (GD2− numyogenin− CD271+ nuMyoD1− CD99− EpCAM+) Wilms tumors. In summary, here we designed and validated a new standardized antibody combination and MFC assay for diagnostic screening of pediatric solid tumors that might contribute to fast and accurate diagnostic orientation and classification of pediatric cancer in routine clinical practice.This research was funded by the EuroFlow Consortium; Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro, Brazil (FAPERJ), numbers: E26/110.105/2014, E-26/010.101259/2018, and E26/102.191/2013; grant from Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brasília, Brazil (CNPQ), Brasília, Brazil, numbers: 303765/2018-6, 409440/2016-7, and 400194/2014-7; and Instituto Desiderata/Chevron, Rio de Janeiro, Brazil, grant “Actions to improve pediatric cancer assistance in RJ”; the EuroFlow Consortium (grant LSHB-CT-2006-018708); Centro de Investigación Biomédica en Red de Cáncer (CIBER-ONC; Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain and FONDOS FEDER), numbers: CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480; grant from Bilateral Cooperation Program between Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-CAPES (Brasília/Brazil) and Dirección General de Políticas Universitárias (DGPU)-Ministério de Educación, Cultura y Deportes (Madrid/Spain) number DGPU 311/15

Evaluation of the process of reabilitation of a stretch of Riparian forest in Itapemirim river watershed - ES

Este estudo foi realizado em uma área de floresta ciliar em processo de recuperação mediante reabilitação.A área de estudo está localizada na sub-bacia hidrográfica do rio Itapemirim, no Município de Alegre, ES, Brasil.A ocupação e uso do solo antes da revegetação eram de pastagem com Brachiaria sp. A revegetação da áreafoi feita em 1997, com espécies autóctones e alóctones arbóreas, em arranjo de distribuição aleatório, em umaárea de 1,2 ha. Para a realização dos estudos foram feitos inventários florestais nos períodos de 2004/2005e 2005/2006, sendo medidos os indivíduos de hábito arbustivo e arbóreo com circunferência à altura do peito(CAP) > 5 cm e suas alturas totais. As espécies encontradas na área foram identificadas e classificadas de acordocom seus grupos ecológicos, síndromes de dispersão e presença silvestre, sendo calculados os parâmetros florísticos,a estrutura vertical e a dinâmica estrutural desse povoamento. O objetivo do trabalho foi avaliar o desenvolvimentodo povoamento implantado para subsidiar práticas silviculturais quanto à seleção e implantação de espécies pararevegetação de áreas de floresta ciliar degradadas, em condições semelhantes. Os resultados demonstraram quefoi implantado um povoamento florestal com grande diversidade de espécies e a estratificação em classes dealtura foi à semelhança de povoamentos heterogêneos naturais. As espécies identificadas como edificadoras darevegetação da área estudada foram: Anadenanthera colubrina, Caesalpinia leyostachia, Acacia auriculiformis,Acacia mangium, Handroanthus serratifolius, Inga edulis, Joannesia princeps, Pterogyne nitens, Enterelobiumcontortisiliquum, Tabernaemontana hystrix e Anthocephalus indicus. A distribuição em classes de tamanho dacomunidade implantada ocorre em forma de "J" reverso, havendo a predominância de indivíduos pioneiros emtodas as classes de CAP. A dinâmica da estrutura horizontal apontou que, para o sucesso, continuidade e desenvolvimentoda recuperação da área, seja monitorada a regeneração natural em relação à sua presença e à eficiência dos fatoresbióticos e abióticos que nela interferem. A não observância de indivíduos arbustivos e arbóreos regenerados naturalmente,na classe de inclusão do estudo, indica a fragilidade inicial da área rumo à sustentabilidade do sistema.The study was realized in an area of riparian forest in process by means of rehabilitation. Thestudy area is located in Rio Itapemirim, in Alegre city, Brazil. The occupation and use of the soil beforethe recovery were of pasture with Brachiaria sp. The recovery of this area was in 1997, with autochthonousand allochthonous species, in casually distribution arrangement, in an area of 1,2 ha. For this studies wasrealized forest inventories in the periods of 2004/2005 and 2005/2006, being measured the arboreal individualswith circumference at breast height (CBH) and total heights. The species found in the area were identifiedand classified in this ecological groups, dispersion syndromes and wild presence, it forms calculated thefloristic parameters, the vertical structure and the structural dynamics of this plantation. The objective ofthis work went evaluate the development of the plantation implanted to subsidize practical silviculture withrelationship to the selection and plantation of species for the revegetation of degraded areas of riparianforest, in similar conditions. The results of the studies demonstrated that a forest plantation was implantedwith great diversity of species and the bedding in height classes it went to the likeness of natural heterogeneous.The species identified as builders of the plantation of the studied area were: Anadenanthera colubrina, Caesalpinia leyostachia, Acacia auriculiformis, Acacia mangium, Handroanthus serratifolius, Inga edulis, Joannesia princeps,Pterogyne nitens, Enterelobium contortisiliquum, Tabernaemontana hystrix, and Anthocephalus indicus . Theimplanted community's distribution diametric happens in reverse J shape having the pioneer individuals'predominance in all the classes of CBH. The dynamics of the horizontal structure points that for the success,continuity and development of the recovery of the area, the natural regeneration be monitored in relationto its presence and efficiency of the biotic factors and abiotic those interfere in the same. The not tree individualsobservance in natural regeneration, in the class of inclusion of the study, indicate the initial fragility of thearea heading for sustentabilidade of the system