Remdesivir and three other drugs for hospitalised patients with COVID-19: final results of the WHO Solidarity randomised trial and updated meta-analyses.

BACKGROUND World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs - remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a - in patients hospitalized with coronavirus disease 2019 (Covid-19). METHODS We randomly assigned inpatients with Covid-19 equally between one of the trial drug regimens that was locally available and open control (up to five options, four active and the local standard of care). The intention-to-treat primary analyses examined in-hospital mortality in the four pairwise comparisons of each trial drug and its control (drug available but patient assigned to the same care without that drug). Rate ratios for death were calculated with stratification according to age and status regarding mechanical ventilation at trial entry. RESULTS At 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750 were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir (without interferon), 2063 to interferon (including 651 to interferon plus lopinavir), and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment, with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death, day 8; interquartile range, 4 to 14). The Kaplan-Meier 28-day mortality was 11.8% (39.0% if the patient was already receiving ventilation at randomization and 9.5% otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to 1.11; P = 0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P = 0.23), in 148 of 1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio, 1.00; 95% CI, 0.79 to 1.25; P = 0.97), and in 243 of 2050 patients receiving interferon and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39; P = 0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced initiation of ventilation or hospitalization duration. CONCLUSIONS These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay. (Funded by the World Health Organization; ISRCTN Registry number, ISRCTN83971151; ClinicalTrials.gov number, NCT04315948.)

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

A ética do silêncio racial no contexto urbano: políticas públicas e desigualdade social no Recife, 1900-1940

Mais de meio século após o preconceito racial ter se tornado o principal alvo dos movimentos urbanos pelos direitos civis nos Estados Unidos e na África do Sul, e décadas depois do surgimento dos movimentos negros contemporâneos no Brasil, o conjunto de ferramentas legislativas criado no Brasil para promover o direito à cidade ainda adere à longa tradição brasileira de silêncio acerca da questão racial. Este artigo propõe iniciar uma exploração das raízes históricas desse fenômeno, remontando ao surgimento do silêncio sobre a questão racial na política urbana do Recife, Brasil, durante a primeira metade do século XX. O Recife foi eé um exemplo paradigmático do processo pelo qual uma cidade amplamente marcada por traços negros e africanos chegou a ser definida política e legalmente como um espaço pobre, subdesenvolvido e racialmente neutro, onde as desigualdades sociais originaram na exclusão capitalista, e não na escravidão e nas ideologias do racismo científico. Neste sentido, Recife lança luzes sobre a política urbana que se gerou sob a sombra do silêncio racial.More than half a century after racial prejudice became central to urban civil rights movements in the United States and South Africa, and decades after the emergence of Brazil’s contemporary Black movements, Brazil's internationally recognized body of rights-to-the-city legislation still adheres to the country's long historical tradition of racial silence. This article explores the historical roots of this phenomenon by focusing on the emergence of racial silence in Recife, Brazil during the first half of the 20th Century. Recife was and remains a paradigmatic example of the process through which a city marked by its Black and African roots came to be legally and politically defined as a poor, underdeveloped and racially neutral space, where social inequalities derived from capitalist exclusion rather than from slavery and scientific racism. As such, Recife'sexperience sheds light on the urban policies that were generated in the shadow of racial silence

Rescuing the genetic diversity and demographic history of native american peoples through mestizo populations of Southern Brazil and Uruguay

Após a chegada dos conquistadores europeus, as populações nativas americanas foram dizimadas por diversas razões, como guerras e doenças, o que possivelmente levou diversas linhagens genéticas autóctones à extinção. Entretanto, durante essa invasão, houve miscigenação entre os colonizadores e os povos nativos e muitos estudos genéticos têm mostrado uma importante contribuição matrilinear nativa americana na formação da população colonial. Portanto, se muitos indivíduos na atual população urbana brasileira carregam linhagens nativas americanas no seu DNA mitocondrial (mtDNA), muito da diversidade genética nativa perdida durante o período colonial pode ter se mantido, por miscigenação, nas populações urbanas. Assim, essas populações representam, efetivamente, um importante reservatório genético de linhagens nativas americanas no Brasil e em outros países americanos, constituindo o reflexo mais fiel da diversidade genética pré-colombiana em populações nativas. Baseado nisso, este estudo teve como objetivos 1) comparar os padrões de diversidade genética de linhagens nativas americanas do mtDNA em populações nativas do Sul do Brasil e da população urbana (miscigenada) adjacente; e 2) comparar, através de Computação Bayesiana Aproximada (ABC), a história demográfica de ambas populações para chegar a uma estimativa do nível de redução do tamanho efetivo populacional (Ne) das populações indígenas aqui tratadas. Foram utilizados dados já publicados da região hipervariável (HVS-I) do mtDNA de linhagens nativas de 396 indivíduos Nativos Americanos (NAT) pertencentes aos grupos Guarani, Caingangue e Charrua e de 309 indivíduos de populações miscigenadas urbanas (URB) do Sul do Brasil e do Uruguai As análises de variabilidade e estrutura genética, bem como testes de neutralidade, foram feitos no programa Arlequin 3.5 e a rede de haplótipos mitocondriais foi estimada através do método Median-Joining utilizando o programa Network 5.0. Estimativas temporais do tamanho populacional efetivo foram feitas através de Skyline Plot Bayesiano utilizando o pacote de programas do BEAST 1.8.4. Por fim, o programa DIYABC 2.1 foi utilizado para testar cenários evolutivos e para estimar o Ne dos nativos americanos pré- (Nanc) e pós-contato (Nnat), para assim, se estimar o impacto da redução de variação genética causada pela colonização europeia. Os resultados deste estudo indicam que URB é a melhor preditora da diversidade nativa ancestral, possuindo uma diversidade substancialmente maior que NAT, pelo menos na região Sul do Brasil e no Uruguai (H = 0,96 vs. 0,85, Nhap = 131 vs. 27, respectivamente). Ademais, a composição de haplogrupos é bastante diferente entre as populações, sugerindo que a população nativa tenha tido eventos de gargalo afetando os haplogrupos B2 e C1 e super-representando o haplogrupo A2. Em relação à demografia histórica, observou-se que URB mantém sinais de expansão remetendo à entrada na América, contrastando com NAT em que esses sinais estão erodidos, apenas retendo sinais de contração populacional recente. De acordo com as estimativas aqui geradas, o declínio populacional em NAT foi de cerca de 300 vezes (84 – 555). Em outras palavras, a população efetiva nativa amricana nessa região corresponderia a apenas 0,33% (0,18% – 1,19%) da população ancestral– 99,8%, corroborando os achados de outros estudos genéticos e também com os registros históricos.After the arrival of the European conquerors, the Native American populations were decimated due to multiple reasons, such as wars and diseases, which possibly led many autochtonous genetic lineages to extinction. However, during the European invasion of the Americas, colonizers and indigenous people admixed, and many genetic studies have shown an important Native American matrilineal contribution to the formation of the Colonial population. Therefore, if many individuals in the current urban population harbor Native American lineages in their mitochondrial DNA (mtDNA), much of Native American genetic diversity that have been lost during the Colonial Era may have been mantained by admixture in urban populations. In this case, these populations effectively represent an important reservoir of Native lineages in Brazil and other American countries, constituting the most accurate portrait of pre-Columbian genetic diverstity of Native populations. Based on this, the aims of the presente study were 1) to compare the patterns of genetic diversity of Native American mtDNA lineages in Native populations from Southern Brazil and the surrounding admixed urban populations; and 2) to compare, using Approximate Bayesian Computation (ABC), the demographic history of both groups to estimate the level of reduction in the effective population size (Ne) for the indigenous groups present here. We used mtDNA hypervariable segment (HVS-I) data of indigenous origin already published from 396 Native American individuals (NAT) belonging to the Guarani, Kaingang, and Charrua groups, and 309 individuals from Southern Brazilian and Uruguayan admixed urban populations (URB) The analyzes of variability and genetic structure, as well as the neutrality tests were accomplished using Arlequin 3.5, and the mitochondrial haplotype network estimated through the Median-Joining method available in Network 5.0. Time estimates for effective population size were performed using Bayesian Skyline Plot available in the BEAST 1.8.4 package. Finally, the DIYABC 2.1 software was used to test evolutionary scenarios and to estimate the pre (Nanc) and post-contact (Nnat) Native American Ne, and estimate the impact of the colonization process on the Native American genetic variability. The results indicate that URB is the best predictor of ancestral Native diversity, having substancially greater genetic diversity than NAT, at least in the Southern Brazilian and Uruguayan regions (H = 0.96 vs. 0.85, Nhap = 11 vs. 27, respectively). Moreover, the haplogroup compositions are very distinct between these groups, suggesting that the Native population passed through bottleneck events affecting the haplogroups B2 and C1, and overrepresenting the haplogroup A2. In relation to demographic history, we observed that URB retains signals of population expansion back to the entry in the Americas. In contrast, these signals are eroded in NAT, which maintains only signals of recent population contraction. According to our estimates, the population decline in NAT was around 300x (84 – 555x). In other words, the effective Native American population in this region would correspond to only 0.33% (0.18% – 1.19%) of the ancestral population, corroborating the findings of other genetic studies and historical records

Rescuing the genetic diversity and demographic history of native american peoples through mestizo populations of Southern Brazil and Uruguay

Após a chegada dos conquistadores europeus, as populações nativas americanas foram dizimadas por diversas razões, como guerras e doenças, o que possivelmente levou diversas linhagens genéticas autóctones à extinção. Entretanto, durante essa invasão, houve miscigenação entre os colonizadores e os povos nativos e muitos estudos genéticos têm mostrado uma importante contribuição matrilinear nativa americana na formação da população colonial. Portanto, se muitos indivíduos na atual população urbana brasileira carregam linhagens nativas americanas no seu DNA mitocondrial (mtDNA), muito da diversidade genética nativa perdida durante o período colonial pode ter se mantido, por miscigenação, nas populações urbanas. Assim, essas populações representam, efetivamente, um importante reservatório genético de linhagens nativas americanas no Brasil e em outros países americanos, constituindo o reflexo mais fiel da diversidade genética pré-colombiana em populações nativas. Baseado nisso, este estudo teve como objetivos 1) comparar os padrões de diversidade genética de linhagens nativas americanas do mtDNA em populações nativas do Sul do Brasil e da população urbana (miscigenada) adjacente; e 2) comparar, através de Computação Bayesiana Aproximada (ABC), a história demográfica de ambas populações para chegar a uma estimativa do nível de redução do tamanho efetivo populacional (Ne) das populações indígenas aqui tratadas. Foram utilizados dados já publicados da região hipervariável (HVS-I) do mtDNA de linhagens nativas de 396 indivíduos Nativos Americanos (NAT) pertencentes aos grupos Guarani, Caingangue e Charrua e de 309 indivíduos de populações miscigenadas urbanas (URB) do Sul do Brasil e do Uruguai As análises de variabilidade e estrutura genética, bem como testes de neutralidade, foram feitos no programa Arlequin 3.5 e a rede de haplótipos mitocondriais foi estimada através do método Median-Joining utilizando o programa Network 5.0. Estimativas temporais do tamanho populacional efetivo foram feitas através de Skyline Plot Bayesiano utilizando o pacote de programas do BEAST 1.8.4. Por fim, o programa DIYABC 2.1 foi utilizado para testar cenários evolutivos e para estimar o Ne dos nativos americanos pré- (Nanc) e pós-contato (Nnat), para assim, se estimar o impacto da redução de variação genética causada pela colonização europeia. Os resultados deste estudo indicam que URB é a melhor preditora da diversidade nativa ancestral, possuindo uma diversidade substancialmente maior que NAT, pelo menos na região Sul do Brasil e no Uruguai (H = 0,96 vs. 0,85, Nhap = 131 vs. 27, respectivamente). Ademais, a composição de haplogrupos é bastante diferente entre as populações, sugerindo que a população nativa tenha tido eventos de gargalo afetando os haplogrupos B2 e C1 e super-representando o haplogrupo A2. Em relação à demografia histórica, observou-se que URB mantém sinais de expansão remetendo à entrada na América, contrastando com NAT em que esses sinais estão erodidos, apenas retendo sinais de contração populacional recente. De acordo com as estimativas aqui geradas, o declínio populacional em NAT foi de cerca de 300 vezes (84 – 555). Em outras palavras, a população efetiva nativa amricana nessa região corresponderia a apenas 0,33% (0,18% – 1,19%) da população ancestral– 99,8%, corroborando os achados de outros estudos genéticos e também com os registros históricos.After the arrival of the European conquerors, the Native American populations were decimated due to multiple reasons, such as wars and diseases, which possibly led many autochtonous genetic lineages to extinction. However, during the European invasion of the Americas, colonizers and indigenous people admixed, and many genetic studies have shown an important Native American matrilineal contribution to the formation of the Colonial population. Therefore, if many individuals in the current urban population harbor Native American lineages in their mitochondrial DNA (mtDNA), much of Native American genetic diversity that have been lost during the Colonial Era may have been mantained by admixture in urban populations. In this case, these populations effectively represent an important reservoir of Native lineages in Brazil and other American countries, constituting the most accurate portrait of pre-Columbian genetic diverstity of Native populations. Based on this, the aims of the presente study were 1) to compare the patterns of genetic diversity of Native American mtDNA lineages in Native populations from Southern Brazil and the surrounding admixed urban populations; and 2) to compare, using Approximate Bayesian Computation (ABC), the demographic history of both groups to estimate the level of reduction in the effective population size (Ne) for the indigenous groups present here. We used mtDNA hypervariable segment (HVS-I) data of indigenous origin already published from 396 Native American individuals (NAT) belonging to the Guarani, Kaingang, and Charrua groups, and 309 individuals from Southern Brazilian and Uruguayan admixed urban populations (URB) The analyzes of variability and genetic structure, as well as the neutrality tests were accomplished using Arlequin 3.5, and the mitochondrial haplotype network estimated through the Median-Joining method available in Network 5.0. Time estimates for effective population size were performed using Bayesian Skyline Plot available in the BEAST 1.8.4 package. Finally, the DIYABC 2.1 software was used to test evolutionary scenarios and to estimate the pre (Nanc) and post-contact (Nnat) Native American Ne, and estimate the impact of the colonization process on the Native American genetic variability. The results indicate that URB is the best predictor of ancestral Native diversity, having substancially greater genetic diversity than NAT, at least in the Southern Brazilian and Uruguayan regions (H = 0.96 vs. 0.85, Nhap = 11 vs. 27, respectively). Moreover, the haplogroup compositions are very distinct between these groups, suggesting that the Native population passed through bottleneck events affecting the haplogroups B2 and C1, and overrepresenting the haplogroup A2. In relation to demographic history, we observed that URB retains signals of population expansion back to the entry in the Americas. In contrast, these signals are eroded in NAT, which maintains only signals of recent population contraction. According to our estimates, the population decline in NAT was around 300x (84 – 555x). In other words, the effective Native American population in this region would correspond to only 0.33% (0.18% – 1.19%) of the ancestral population, corroborating the findings of other genetic studies and historical records

Insights into the evolutionary history of the most skilled tool-handling platyrrhini monkey: Sapajus libidinosus from the Serra da Capivara National Park

Abstract Sapajus libidinosus members of the Pedra Furada group, living in the Serra da Capivara National Park, use stone tools in a wider variety of behaviors than any other living animal, except humans. To rescue the evolutionary history of the Caatinga S. libidinosus and identify factors that may have contributed to the emergence and maintenance of their tool-use culture, we conducted fieldwork seasons to obtain biological samples of these capuchin monkeys. UsingCYTBsequences, we show a discrete but constant population growth from the beginning of the Holocene to the present, overlapping the emergence of the Caatinga biome. Our habitat suitability reconstruction reports the presence of plants whose hard fruits, seeds, or roots are processed by capuchins using tools. TheS. libidinosusindividuals in the Caatingawere capable of dynamically developing and maintaining their autochthonous culture thanks to: a) cognitive capacity to generate and execute innovation under selective pressure; b) tolerance favoring learning and cultural inheritance; c) an unknown genetic repertoire that underpins the adaptive traits; d) a high degree of terrestriality; e) presence and abundance of natural resources, which makes some places “hot spots” for innovation, and cultural diversification within a relatively short time

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer

ABSTRACT Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer

Seminário de Dissertação (2024)

Página da disciplina de Seminário de Dissertação (MPPP, UFPE, 2022) Lista de participantes == https://docs.google.com/spreadsheets/d/1mrULe1y04yPxHUBaF50jhaM1OY8QYJ3zva4N4yvm198/edit#gid=