Leucemia pediátrica: uma análise abrangente das terapias atuais e perspectivas de pesquisa

Childhood cancer, especially pediatric leukemia, is a complex and challenging medical condition. The present study aims to conduct a comprehensive analysis of pharmacological approaches used in the treatment of pediatric leukemia, with an emphasis on contemporary strategies. Understanding these interventions is of vital importance to optimize clinical management and enhance the quality of life for affected children. An integrative literature review was conducted, involving a thorough search for scientific articles in indexed databases, using specific descriptors related to pediatric leukemia and pharmacological interventions. Studies investigating the effectiveness of different drugs in treating leukemia were selected, prioritizing contemporary and relevant approaches. The references were meticulously analyzed and organized following the Vancouver style. Several pharmacological interventions were identified as fundamental components in the treatment of pediatric leukemia. Noteworthy among them are KIR-mismatched unrelated donor stem cell transplantation with in vivo T cell depletion in AML, as well as the effectiveness of blinatumomab in the treatment of pediatric acute lymphoblastic leukemia, among other approaches to be addressed in the course of the study. This integrative review highlights the diversity of pharmacological interventions available for the treatment of pediatric leukemia. It also underscores the need for an individualized and multidisciplinary approach, where treatment customization, taking into account the individual characteristics and clinical peculiarities of each patient, is crucial. Additionally, it is imperative to rigorously monitor the long-term safety and effectiveness of pharmacological interventions.O câncer infantil, especialmente a leucemia pediátrica, é uma condição médica complexa e desafiadora. O presente estudo tem como objetivo realizar uma análise abrangente das abordagens farmacológicas utilizadas no tratamento da leucemia pediátrica, com ênfase nas estratégias contemporâneas. Compreender essas intervenções é de vital importância para otimizar a gestão clínica e aprimorar a qualidade de vida das crianças afetadas. Uma revisão integrativa da literatura foi conduzida, envolvendo uma busca criteriosa de artigos científicos em bases de dados indexadas, utilizando descritores específicos relacionados à leucemia pediátrica e intervenções farmacológicas. Foram selecionados estudos que investigaram a eficácia de diferentes fármacos no tratamento da leucemia, priorizando abordagens contemporâneas e pertinentes. As referências foram meticulosamente analisadas e organizadas seguindo o estilo de Vancouver. Diversas intervenções farmacológicas foram identificadas como componentes fundamentais no tratamento da leucemia pediátrica. Destacam-se o transplante de células-tronco não aparentadas com incompatibilidade de KIR e depleção in vivo de células T em LMA, assim como a eficácia da blinatumomabe no tratamento de leucemia linfoblástica aguda pediátrica, dentre outras abordagens a serem pautadas no decorrer do estudo. Esta revisão integrativa evidencia a diversidade de intervenções farmacológicas disponíveis para o tratamento da leucemia pediátrica. Ela também ressalta a necessidade de uma abordagem individualizada e multidisciplinar, onde a personalização do tratamento, levando em consideração as características individuais e peculiaridades clínicas de cada paciente, é crucial. Ademais, é imperativo monitorar com rigor a segurança e eficácia a longo prazo das intervenções farmacológicas

CONDIÇÃO BUCAL DE PUÉRPERAS ATENDIDAS EM UM HOSPITAL PÚBLICO NO MUNICÍPIO DE FEIRA DE SANTANA, BAHIA, BRASIL

A gestação é um período marcado por modificações que podem refletir em alterações na cavidade bucal. Objetivo: descrever a condição bucal de puérperas examinadas no Hospital da Mulher em Feira de Santana, no período de 2010 a 2012. Materiais e Métodos: foi realizado um estudo transversal descritivo dacondição bucal de puérperas utilizando o banco de dados do projeto “Geravida” desenvolvido pelo Núcleo de Pesquisa, Prática Integrada e Investigação Multidisciplinar (NUPPIIM). A condição bucal das puérperas foi avaliada por meio de exame bucal para o diagnóstico de cárie e de doenças periodontais. Foramobtidas informações sobre as características sociodemográficas, saúde, estilo de vida e cuidado com a saúde bucal por meio de entrevista. Foi realizada uma análise descritiva das variáveis, obtendo-se a frequência simples para os dados dicotômicos e medidas de tendência central e dispersão para os dadosintervalares. Resultados: A população de estudo foi constituída por 372 puérperas com média de idade de 23,87± 6,67 anos, 71,97% não teve acesso a consulta com um cirurgião dentista durante a gestação e apenas 18,33% receberam orientação do dentista sobre saúde bucal, somente 1,35% das puérperas não realizaram pré-natal. A média do CPOD encontrada foi de 5,70± 5,14, com mediana de 5,00 [IQ:1,00-9,00]. Quanto à condição periodontal, das 371 examinadas (um dado perdido), 9,16% tiveram diagnóstico positivo para periodontite; dentre as 337 sem periodontite, 9,79% tiveram diagnóstico positivo para gengivite. Conclusão: as puérperas estão saudáveis, com baixoíndice de CPOD e doenças periodontais. Contudo é necessária uma maior divulgação sobre o pré-natal odontológico

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030