446 research outputs found
Radiotherapy combined or not with chemotherapy in adult or pediatric patients with brainstem glioma: a population-based study
Background: The purpose of this study was to assess the treatment outcomes and prognostic factors of brainstem glioma (BCG) patients treated by radiotherapy (RT) or chemoradiation (CHRT) in the last 20 years in a population cohort.
Materials and methods: Patients diagnosed with BSG from 2000â2020 treated by RT or CHRT were identified from The Fundação Oncocentro de SĂŁo Paulo database. Data on age, gender, practice setting, period of treatment, and treatment modality were extracted. The overall survival (OS) was estimated, and the subgroups were compared with the log-rank test. Cox proportional test was used in multivariate analysis.
Results: A total of 253 patients with a median follow-up of 12 months were included. There were 197 pediatric and 56 adult patients. For the entire cohort, the 1 and 3-year OS was 46%, and 23%, with a median OS of 11 months. In the subgroup analysis, adults had a median survival of 33 months versus 10 months in pediatric patients (p = 0.002). No significant difference in OS between RT and CHRT was observed in pediatric or adult subgroups (p > 0.05). The use of CHRT has significantly increased over the years. In the multivariate analysis, adult patients were the only independent prognostic factor associated with a better OS (p < 0.001).
Conclusions: BSG had poor survival with no significant improvement in the treatment outcomes over the last 20 years, despite the addition of chemotherapy. Adult patients were independently associated with better survival.
ABORTO: UMA QUESTĂO DE SAĂDE PĂBLICA
The issue of abortion has been a source of considerations since the dawn of civilization, and it calls for great circumspection when one attempts to fit it socially throughout the history of Human Thinking. It is established as a personal and social problem . and for this exact reason, and also given its irrefutable occurrence . abortion features as a public health concern. Sanitary safety during abortion is related to each country.s own regulations and practices, and to the socio-economic condition of the woman who aborts. The authors reflect on its adoption, its characteristic, and its impact on the Brazilian society. The objective is to debate the relationship amongst the basic principles that guide State and public health policies, and the issue of abortion . which poses a serious public health problem due to its nature. Therefore, a perspective is presented as an argumentative alternative that brings evidence to the proposed debate.A questĂŁo do aborto Ă© fonte de reflexĂ”es desde os primĂłrdios da civilização e demanda diligĂȘncias para a tentativa de seu enquadramento social ao longo da histĂłria do pensamento humano. Instaura-se como problemĂĄtica pessoal, social e exatamente por isso, torna-se pelo fato irrefutĂĄvel de acontecer, objeto de saĂșde pĂșblica. A segurança sanitĂĄria com que o abortamento Ă© realizado estĂĄ relacionada com a legalidade federativa particular de cada paĂs e a condição sĂłcio-econĂŽmica da mulher que aborta. Os autores tecem consideraçÔes sobre sua inserção, caracterĂstica e influĂȘncia na sociedade brasileira. O objetivo Ă© debater a relação entre os fundamentos que norteiam as polĂticas de Estado e de saĂșde pĂșblica e a questĂŁo do abortamento, na medida em que tal assunto, pela relevĂąncia, constitui tambĂ©m um problema de saĂșde pĂșblica. Apresenta-se, assim, uma perspectiva que figura como um caminho argumentativo que conduz evidĂȘncias ao debate proposto
Assessing the efficacy of palliative radiation treatment schemes for locally advanced squamous cell carcinoma of the head and neck: a meta-analysis
Background: The objective to assess the outcomes from different palliative radiotherapy (RT) schedules in incurable head and neck cancer (HNC), to evaluate if there is a relationship between RT dose, technique, and fractionation with tumor response in contrast to the occurrence of adverse effects.
Materials and methods: Eligible studies were identified on Medline, Embase, the Cochrane Library, and annual meetings proceedings through June 2020. Following PRISMA and MOOSE guidelines, a cumulative meta-analysis of studies for overall response rate (ORR), overall survival (OS), progression-free survival (PFS), pain/dysphagia relief, and toxicity was performed. A meta-regression analysis was done to assess if there is a connection between RT dose, schedule, and technique with ORR.
Results: Twenty-eight studies with 1,986 patients treated with palliative RT due to incurable HNC were included. The median OS was 6.5 months [95% confidence interval (CI): 5.6â7.4], and PFS was 3.6 months (95% CI: 2.7â4.3). The ORR, pain and dysphagia relief rates were 72% (95% CI: 0.6â0.8), 83% (95% CI: 52â100%), and 75% (95% CI: 52â100%), respectively. Conventional radiotherapy (2D-RT) or conformational radiotherapy (3D-RT) use were significantly associated with a higher acute toxicity rate (grade â„ 3) than intensity-modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). On meta-regression analyses, the total biological effective doses (BED) of RT (p = 0.001), BED > 60 Gy10 (p = 0.001), short course (p = 0.01) and SBRT (p = 0.02) were associated with a superior ORR.
Conclusions: Palliative RT achieves tumor response and symptom relief in incurable HNC patients. Short course RT of BED > 60 Gy using IMRT could improve its therapeutic ratio. SBRT should be considered when available
Characteristics of Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) Strains Isolated from Skin and Soft-Tissue Infections in Uruguay
We analyzed 90 nonduplicates community-associated methicillin-resistant S. aureus (CA-MRSA) strains isolated from skin and soft-tissue infections. All strains were mecA positive. Twenty-four of the 90 strains showed inducible macrolide-lincosamide-streptogramin B resistance. All strains produced α-toxin; 96% and 100% of them displayed positive results for lukS-F and cna genes, respectively. Eigthy-five strains expressed capsular polysaccharide serotype 8. Six different pulsotypes were discriminated by pulsed-field gel electrophoresis (PFGE) and three predominant groups of CA-MRSA strains (1, 2, and 4) were identified, in agreement with phenotypic and genotypic characteristics. Strains of group 1
(pulsotype A, CP8+, and Panton-Valentine leukocidin (PVL)+) were the most frequently recovered and exhibited a PFGE band pattern identical to other CA-MRSA strains previously isolated in Uruguay and Brazil.
Three years after the first local CA-MRSA report, these strains are still producing skin and soft-tissue infections demonstrating the stability over time of this community-associated emerging pathogen
Appropriateness of the 30-day expected mortality metric in palliative radiation treatment: a narrative review
BACKGROUND AND OBJECTIVE
The 30-day expected mortality rate is frequently used as a metric to determine which patients benefit from palliative radiation treatment (RT). We conducted a narrative review to examine whether its use as a metric might be appropriate for patient selection.
METHODS
A literature review was conducted to identify relevant studies that highlight the benefits of palliative RT in timely symptom management among patients with a poor performance status, the accuracy of predicting survival near the end of life and ways to speed up the process of RT administration through rapid response clinics.
KEY CONTENT AND FINDINGS
Several trials have demonstrated substantial response rates for pain and/or bleeding by four weeks and sometimes within the first two weeks after RT. Models of patient survival have limited accuracy, particularly for predicting whether patients will die within the next 30 days. Dedicated Rapid Access Palliative RT (RAPRT) clinics, in which patients are assessed, simulated and treated on the same day, reduce the number of patient visits to the radiation oncology department and hence the burden on the patient as well as costs.
CONCLUSIONS
Single-fraction palliative RT should be offered to eligible patients if they are able to attend treatment and could potentially benefit from symptom palliation, irrespective of predicted life expectancy. We discourage the routine use of the 30-day mortality as the only metric to decide whether to offer RT. More common implementation of RAPRT clinics could result in a significant benefit for patients of all life expectancies, but particularly those having short ones
Addressing concerns and uncertainties surrounding the application of palliative radiotherapy in cases with a 30-day expected mortality
Safety and effectiveness of RBD-specific polyclonal equine F(abÂŽ)2 fragments for the treatment of hospitalized patients with severe Covid-19 disease: A retrospective cohort study
Background Passive immunotherapy has been evaluated as a therapeutic alternative for patients with COVID-19 disease. Equine polyclonal immunotherapy for COVID-19 (EPIC) showed adequate safety and potential efficacy in a clinical trial setting and obtained emergency use authorization in Argentina. We studied its utility in a real world setting with a larger population. Methods We conducted a retrospective cohort study at âHospital de Campaña Escuela-Hogar" (HCEH) in Corrientes, Argentina, to assess safety and effectiveness of EPIC in hospitalized adults with severe COVID-19 pneumonia. Primary endpoints were 28-days all-cause mortality and safety. Mortality and improvement in modified WHO clinical scale at 14 and 21 days were secondary endpoints. Potential confounder adjustment was made by logistic regression weighted by the inverse of the probability of receiving the treatment (IPTW) and doubly robust approach. Findings Subsequent clinical records of 446 non-exposed (Controls) and 395 exposed (EPIC) patients admitted between November 2020 and April 2021 were analyzed. Median age was 58 years and 56.8% were males. Mortality at 28 days was 15.7% (EPIC) vs. 21.5% (Control). After IPTW adjustment the OR was 0.66 (95% CI: 0.46â0.96) P = 0.03. The effect was more evident in the subgroup who received two EPIC doses (complete treatment, n = 379), OR 0.58 (95% CI 0.39 to 0.85) P = 0.005. Overall and serious adverse events were not significantly different between groups. Conclusions In this retrospective cohort study, EPIC showed adequate safety and effectiveness in the treatment of hospitalized patients with severe SARS-CoV-2 disease.Fil: Farizano Salazar, Diego H.. Hospital de Campaña Escuela Hogar; ArgentinaFil: Achinelli, Fernando. Hospital de Campaña Escuela Hogar; ArgentinaFil: Colonna, Mariana. Inmunova; ArgentinaFil: PĂ©rez, LucĂa. Hospital Italiano; ArgentinaFil: GimĂ©nez, AnalĂa A.. Hospital de Campaña Escuela Hogar; ArgentinaFil: Ojeda, Maria Alejandra. Hospital de Campaña Escuela Hogar; ArgentinaFil: Miranda Puente, Susana N.. Hospital de Campaña Escuela Hogar; ArgentinaFil: SĂĄnchez Negrette, LĂa. Hospital de Campaña Escuela Hogar; ArgentinaFil: Cañete, Florencia. Hospital de Campaña Escuela Hogar; ArgentinaFil: Martelotte Ibarra, Ornela I.. Hospital de Campaña Escuela Hogar; ArgentinaFil: Sanguineti, Santiago. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. Instituto de Investigaciones BioquĂmicas de Buenos Aires. FundaciĂłn Instituto Leloir. Instituto de Investigaciones BioquĂmicas de Buenos Aires; ArgentinaFil: Spatz, Linus. Inmunova; ArgentinaFil: Goldbaum, Fernando Alberto. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. Instituto de Investigaciones BioquĂmicas de Buenos Aires. FundaciĂłn Instituto Leloir. Instituto de Investigaciones BioquĂmicas de Buenos Aires; ArgentinaFil: Massa, Carolina. Inmunova; ArgentinaFil: Rivas, Marta. Inmunova; ArgentinaFil: Pichel, Mariana. Inmunova; ArgentinaFil: Hiriart, Yanina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Centro CientĂfico TecnolĂłgico Conicet - La Plata. Instituto de Estudios InmunolĂłgicos y FisiopatolĂłgicos. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Estudios InmunolĂłgicos y FisiopatolĂłgicos; ArgentinaFil: Zylberman, Vanesa. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Gallego, Sandra Veronica. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; Argentina. Universidad Nacional de CĂłrdoba. Facultad de Medicina. Instituto de VirologĂa Dr. J. M. Vanella; ArgentinaFil: Konigheim, Brenda Salome. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; Argentina. Universidad Nacional de CĂłrdoba. Facultad de Medicina. Instituto de VirologĂa Dr. J. M. Vanella; ArgentinaFil: FernĂĄndez, Francisco. No especifĂca;Fil: Deprati, MatĂas. No especifĂca;Fil: Roubicek, Ian. Inmunova; ArgentinaFil: Giunta, Diego Hernan. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; Argentina. Hospital Italiano; ArgentinaFil: Nannini, Esteban. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Centro CientĂfico TecnolĂłgico Conicet - Rosario. Instituto de InmunologĂa Clinica y Experimental de Rosario. Universidad Nacional de Rosario. Facultad de Ciencias MĂ©dicas. Instituto de InmunologĂa Clinica y Experimental de Rosario; ArgentinaFil: Lopardo, Gustavo. No especifĂca;Fil: Belloso, Waldo Horacio. Hospital Italiano; Argentin
Hantavirus reservoir hosts associated with peridomestic habitats in Argentina
Five species of sigmodontine rodents have been identified in Argentina as the putative reservoirs of six circulating hantavirus genotypes. Two species of Oligoryzomys are associated with the genotypes causing hantavirus pulmonary syndrome, Oligoryzomys flavescens for Lechiguanas and O. longicaudatusfor Andes and Oran genotypes. Reports of human cases of hantavirus pulmonary syndrome prompted rodent trapping (2,299 rodents of 32 species during 27,780 trap nights) at potential exposure sites in three disease-endemic areas. Antibody reactive to Sin Nombre virus was found in six species, including the known hantavirus reservoir species. Risk for peridomestic exposure to host species that carry recognized human pathogens was high in all three major disease-endemic areas.Fil: CalderĂłn, Gladys. ANLIS Dr.C.G.MalbrĂĄn. Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui; Argentina.Fil: Pini, NoemĂ. ANLIS Dr.C.G.MalbrĂĄn. Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui; Argentina.Fil: Bolpe, Jorge. Departamento de Zoonosis Rurales de Azul; Argentina.Fil: Levis, Silvana. ANLIS Dr.C.G.MalbrĂĄn. Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui; Argentina.Fil: Mills, James. Centers for Disease Control and Prevention; Estados Unidos.Fil: Segura, Elsa. ANLIS Dr.C.G.MalbrĂĄn. Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui; Argentina.Fil: Guthmann, Nadia. Universidad Nacional del Comahue; Argentina.Fil: Cantoni, Gustavo. Consejo Provincial de Salud PĂșblica, Rio Negro; ArgentinaFil: Becker, JosĂ©. ANLIS Dr.C.G.MalbrĂĄn. Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui; Argentina.Fil: Fonollat, Ana. FundaciĂłn Lillo; Argentina.Fil: Ripoll, Carlos. Departamento de Chagas y PatologĂas Regionales; Argentina.Fil: Bortman, Marcelo. SubsecretarĂa de Salud, NeuquĂ©n; Argentina.Fil: Benedetti, Rosendo. Zona Sanitaria Noroeste; Argentina.Fil: Sabattini, Marta S. ANLIS Dr.C.G.MalbrĂĄn. Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui; Argentina.Fil: Enria, Delia. ANLIS Dr.C.G.MalbrĂĄn. Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui; Argentina.Fil: Hantavirus Study Group; Argentina
Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory
The Auger Engineering Radio Array (AERA) is part of the Pierre Auger
Observatory and is used to detect the radio emission of cosmic-ray air showers.
These observations are compared to the data of the surface detector stations of
the Observatory, which provide well-calibrated information on the cosmic-ray
energies and arrival directions. The response of the radio stations in the 30
to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of
the incoming electric field. For the latter, the energy deposit per area is
determined from the radio pulses at each observer position and is interpolated
using a two-dimensional function that takes into account signal asymmetries due
to interference between the geomagnetic and charge-excess emission components.
The spatial integral over the signal distribution gives a direct measurement of
the energy transferred from the primary cosmic ray into radio emission in the
AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air
shower arriving perpendicularly to the geomagnetic field. This radiation energy
-- corrected for geometrical effects -- is used as a cosmic-ray energy
estimator. Performing an absolute energy calibration against the
surface-detector information, we observe that this radio-energy estimator
scales quadratically with the cosmic-ray energy as expected for coherent
emission. We find an energy resolution of the radio reconstruction of 22% for
the data set and 17% for a high-quality subset containing only events with at
least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO
Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy
We measure the energy emitted by extensive air showers in the form of radio
emission in the frequency range from 30 to 80 MHz. Exploiting the accurate
energy scale of the Pierre Auger Observatory, we obtain a radiation energy of
15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV
arriving perpendicularly to a geomagnetic field of 0.24 G, scaling
quadratically with the cosmic-ray energy. A comparison with predictions from
state-of-the-art first-principle calculations shows agreement with our
measurement. The radiation energy provides direct access to the calorimetric
energy in the electromagnetic cascade of extensive air showers. Comparison with
our result thus allows the direct calibration of any cosmic-ray radio detector
against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI.
Supplemental material in the ancillary file
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