Systematic review: hereditary thrombophilia associated to pediatric strokes and cerebral palsy

AbstractObjectivesThis review aimed to organize and consolidate the latest knowledge about mutations and genetic polymorphisms related to hereditary thrombophilia and their potential association with pediatric stroke and cerebral palsy (CP).SourcesScientific articles published from 1993 to 2013, written in Portuguese, English, French, and Spanish, were selected and reviewed. The publications were searched in electronic databases, and also in the collections of local libraries. The terms “hereditary thrombophilia”, “polymorphisms”, “mutation”, “pediatric strokes”, and “cerebral palsy” were used for the research.Summary of the findingsThe search in databases and in the bibliographic references retrieved 75 articles for inclusion in this review. Studies that investigated hereditary thrombophilias and their associations to CP and arterial and venous pediatric stroke presented contradictory results. The meta‐analysis and case‐control studies that showed positive results for this association described only slightly increased relative risks and sometimes had questionable conclusions. The association of two or more hereditary thrombophilias, or the association between thrombophilia and other specific clinical risk factors, suggest a higher risk of CP and pediatric stroke than isolated hereditary thrombophilia.ConclusionsLarger, multicenter studies should be developed in order to elucidate the role of mutations leading to hereditary thrombophilia and the development of CP and pediatric stroke. The complex and multifactorial etiology of CP and stroke makes this an arduous and difficult task; however, the benefits generated by these studies are immeasurable.ResumoObjetivoSistematizar e integrar os últimos conhecimentos sobre mutações e polimorfismos genéticos relacionados às trombofilias hereditárias e suas potenciais associações com acidentes vasculares cerebrais pediátricos (AVC) e paralisia cerebral (PC).MaterialArtigos científicos publicados de 1993 a 2013, escritos em português, inglês, francês e espanhol foram selecionados e revisados. As publicações foram pesquisadas nas bases de dados eletrônicas, como também nos acervos das bibliotecas locais. Os termos mutação, polimorfismos, trombofilias hereditárias, acidentes vasculares cerebrais pediátricos e paralisia cerebral foram usados para a pesquisa.ResultadosA pesquisa nas bases de dados e nas referências bibliográficas identificou 75 artigos para inclusão nesta revisão. Os estudos que investigaram as trombofilias hereditárias e suas associações à PC e aos AVC pediátricos arteriais e venosos apresentaram resultados contraditórios. As metanálises e os estudos caso‐controle que demonstraram resultados positivos para essa associação descreveram riscos relativos discretamente aumentados e, algumas vezes, questionáveis. A associação de duas ou mais trombofilias hereditárias, ou a junção de trombofilias específicas com demais fatores de riscos clínicos, sugerem maior risco no aparecimento da PC e do AVC pediátrico do que as trombofilias hereditárias isoladas.ConclusãoEstudos multicêntricos de grande porte devem ser conduzidos para elucidar o papel real das mutações que levam às trombofilias hereditárias e ao aparecimento da PC e AVC pediátricos. A etiologia multifatorial e complexa da PC e dos AVC torna essa tarefa árdua e difícil, porém, os benefícios gerados por esses estudos são incalculáveis

Triple Compton effect: A photon splitting into three upon collision with a free electron

The process in which a photon splits into three after the collision with a free electron (triple Compton effect) is the most basic process for the generation of a high-energy multi-particle entangled state composed out of elementary quanta. The cross section of the process is evaluated in two experimentally realizable situations, one employing gamma photons and stationary electrons, and the other using keV photons and GeV electrons of an x-ray free electron laser. For the first case, our calculation is in agreement with the only available measurement of the differential cross section for the process under study. Our estimates indicate that the process should be readily measurable also in the second case. We quantify the polarization entanglement in the final state by a recently proposed multi-particle entanglement measure.Comment: 5 pages; RevTeX; to be published in Phys.Rev.Let

Study on heavy metals levels and its risk assessment in edible fish (Himantura imbricate) from Persian Gulf

Heavy metals are contaminants of great environmental concern due to their multiple origins (natural and anthropogenic), the ability to accumulate in organs and tissues, and the deleterious effects they can cause in organisms. Studies on the accumulation of metals in seafood, such as fish, have increased in importance due to the risk for human health when consuming fish contaminated by metals. The present work was aimed at verifying the concentrations of cadmium (Cd), Nickel (Ni) and lead (Pb) in the muscular tissue of Himantura imbricate (from the Persian Gulf in Hormozgan province, Iran. Samples were analyzed by Atomic Absorption Spectroscopy. There were significant variations among heavy metal accumulation levels of the species and their regions. The heavy metal concentrations found in regions varied for Cd: 0.14, Ni: 0.33, Pb: 0.02 in Qeshm and Cd: 0.25, Ni: 0.48, Pb: 0.03, µg/g in Suoroo. The heavy metal concentrations of fish in Qeshm were lower than those of fish from Suoroo regions. This research showed that heavy metal concentrations in muscle of investigated specie were also lower than the maximum levels set by law

First report on classical biological control releases of the larval parasitoid Ganaspis brasiliensis against Drosophila suzukii in northern Italy

Current management strategy of the invasive fruit fly Drosophila suzukii (Matsumura) (Diptera: Drosophilidae) exploits different tools but relies mainly on chemical control. In the invaded areas, the local natural enemy community mostly consists of generalist pupal parasitoids unable to control the pest efficiently. Conversely, in the pest native area, there are more specialized sympatric larval parasitoids attacking D. suzukii. Following foreign explorations and quarantine risk assessments, the larval endoparasitoid Ganaspis brasiliensis (Ihering) (Hymenoptera: Figitidae) was selected as the best candidate for classical biological control programs. In 2021, the first ever propagative biocontrol program using a Japanese G1 lineage of G. brasiliensis started in Italy. Here we report the results of the first year of releases in the province of Trento (Northeast Italy), wherein G. brasiliensis was released in 12 locations. Pre- and post-release samplings on fresh and fallen fruits were performed around the release points to assess the recapture rate, the impact of the exotic parasitoid on D. suzukii and its potential interactions with local non-target species. After releases, G. brasiliensis was recovered at 50% of the locations. The exotic parasitoid only emerged from D. suzukii, mostly from fresh fruit still on the plant. Post-overwintering monitoring revealed the presence of a four G. brasiliensis individuals at two release locations

Individuals with prediabetes identified by HbA1c undergoing coronary angiography have worse cardiometabolic profile than those identified by fasting glucose

Background: Type 2 diabetes mellitus has well known deleterious effects on coronary artery disease (CAD). the role of milder hyperglycemic states such as prediabetes (PD) on CAD is debatable. Glycated hemoglobin (HbA1c) has recently been advocated as a diagnostic tool for diabetes mellitus (DM) and PD. This study aims to assess the cardiometabolic risk profile and coronary lesions of patients with PD undergoing coronary angiography identified either by fasting plasma glucose (FPG) or HbA1c levels.Methods: We studied 514 individuals without previously known glucose disturbances. Their glycemic status was assessed by FPG and HbA1c (HPLC) and classified according to ADA guidelines, using each parameter independently, as having normal glucose tolerance (N), PD, or DM. CAD was defined as stenosis greater than 50% in one major coronary vessel or branch. Framingham score was calculated.Results: Subjects with PD had a similar frequency of CAD compared do N individuals by both FPG (61 vs. 59.3%) and HbA1c (55.4 vs 61.2%) (p non-significant for linear-by-linear association). PD individuals identified by FPG had worse HOMA2B (mean [95% CI] 65.4 [60.9-69.9] vs. 76.6 [71.4-81.9]) and HOMA2-IR (1.10 [0.98-1.22] vs. 0.80 [0.72-0.89]) when compared to N controls. PD individuals identified by HbA1c had higher frequency of Framingham risk above 20% (25.4 vs 11.8%), arterial hypertension (87.8 vs 72.6%), and dyslipidemia (83.8 vs 72%) compared to N individuals. PD associated with an increased number of coronary lesions only when diagnosed by HbA1c (median [interquartile interval] 2 [0-4] PD versus 1 [0-3.75] N, p = 0.03 for trend).Conclusions: HbA1c was more effective than FPG in identifying individuals with PD associated with high cardiovascular risk profile in a sample of individuals undergoing coronary angiography.Universidade Federal de São Paulo, Endocrinol Unit, Diabet Ctr, São Paulo, BrazilUniv Estado Bahia, Dept Ciencias Vida, Colegiado Med, BR-41150000 Salvador, BA, BrazilCtr Endocrinol Estado Bahia CEDEBA, Salvador, BA, BrazilUniversidade Federal de São Paulo, Endocrinol Unit, Diabet Ctr, São Paulo, BrazilWeb of Scienc

Perceptions and evaluations of front-line health workers regarding the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ): a mixed-method approach

Although it is well known that a successful implementation depends on the front-liners’ knowledge and participation, as well as on the organizational capacity of the institutions involved, we still know little about how front-line health workers have been involved in the implementation of the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ). This paper develops a contingent mixed-method approach to explore the perceptions of front-line health workers - managers, nurses, community health workers, and doctors - regarding the PMAQ (2nd round), and their evaluations concerning health unit organizational capacity. The research is guided by three relevant inter-related concepts from implementation theory: policy knowledge, participation, and organizational capacity. One hundred and twenty-seven health workers from 12 primary health care units in Goiânia, Goiás State, Brazil, answered semi-structured questionnaires, seeking to collect data on reasons for adherence, forms of participation, perceived impact (open-ended questions), and evaluation of organizational capacity (score between 0-10). Content analyses of qualitative data enabled us to categorize the variables “level of perceived impact of PMAQ” and “reasons for adhering to PMAQ”. The calculation and aggregation of the means for the scores given for organizational capacity enabled us to classify distinct levels of organizational capacity. We finally integrated both variables (Perceived-Impact and Organizational-Capacity) through cross-tabulation and the narrative. Results show that nurses are the main type of professional participating. The low organizational capacity and little policy knowledge affected workers participation in and their perceptions of the PMAQ

Analisis fungsi lagu terhadap struktur naratif dalam visual filem muzikal Malaysia. Kajian kes: Magika 2011

Penyelidikan kajian ini merupakan salah satu usaha dalam menganalisis fungsi dan kepentingan elemen lagu dalam pembentukan struktur naratif filem muzikal Malaysia melalui filem Magika (2011). Filem muzikal Magika (2011) yang telah dinobatkan sebagai sebuah filem terbaik pada Festival Filem Malaysia ke -23 telah membuktikan bahawa filem muzikal merupakan sebuah karya yang diiktiraf yang telah mewarnai industri perfileman di Malaysia. Sejajar dengan itu, kajian terhadap sturktur naratif pada filem muzikal Magika dilakukan dalam memberi gambaran terhadap fungsi lagu filem Magika dalam menggerakkan naratif plot penceritaan. Tzvetan Todorov (1960) telah memperkenalkan satu model dalam pembentukan naratif yang paling asas yang bersifat linear storyline. Bermula dengan equilibrium, disruption, recognition (realisation), repair, dan restoration (new equilibrium) dalam pembentukan struktur naratif. Setiap satu elemen yang diwakili sebagai tindakan di dalam sebuah karya. Pengkaji terlebih dahulu telah menjalankan persampelan ke atas 15 buah lagu dalam filem Magika bagi memudahkan proses pengenalpastian jumlah lagu-lagu yang terdapat dalam filem muzikal Magika. Seterusnya, pendekatan model naratif Todorov dan Blake Snyder’s 15 beats digunakan bagi mendapatkan data secara deskriptif dalam mengenalpasti struktur naratif secara terperinci. 5 buah lagu yang dipilih dianalisis dan dihurai melalui teks lirik mahupun visual berlandaskan model Conceptual Integration Network. Hasil daripada kajian ini, didapati kepentingan fungsi lagu dalam filem Magika bukan sebagai hiburan semata-mata, namun mampu menggerakkan plot naratif Magika berdasarkan adanya pertimbangan daripada elemen-elemen lagu. Fungsi lagu contohnya menjadi hubungan komunikatif antara watak-watak bagi mengembangkan keseluruhan cerita. Kajian terhadap fungsi lagu dalam struktur naratif filem muzikal ini diharapkan dapat dijadikan sebagai salah satu rujukan untuk membantu para industri perfileman dalam menghasilkan plot naratif muzikal fantasi Malaysia setanding dengan muzikal antarabangsa

Association of classical risk factors and coronary artery disease in type 2 diabetic patients submitted to coronary angiography

Background: Coronary artery disease (CAD) is the leading cause of death among individuals with type 2 diabetes (T2DM). T2DM accelerates atherosclerosis alongside classical risk factors such as dyslipidemia and hypertension. This study aims to investigate the association of hyperglycemia and associated risk factors with CAD in outpatients with T2DM undergoing coronary angiography.Methods: 818 individuals referred to coronary angiography were evaluated for glucose disturbances. After exclusion of those with prediabetes, 347 individuals with T2DM and 94 normoglycemic controls were studied for BMI, blood pressure, fasting plasma glucose, HbA1c, lipids, HOMA, adiponectin, Framingham risk score, number of clinically significant coronary lesions (stenosis > 50%).Results: Among T2DM subjects, those with CAD (n = 237) had worse glycemic control (fasting glucose 162.3 + 69.8 vs. 143.4 + 48.9 mg/dL, p = 0.004; HbA1c 8.03 + 1.91 vs. 7.59 + 1.55%, p = 0.03), lower HDL (39.2 + 13.2 vs. 44.4 + 15.9 mg/dL, p = 0.003), and higher triglycerides (140 [106-204] vs. 121 [78.5-184.25] mg/dL, p = 0.002), reached more often therapeutic goals for LDL (63.4% vs. 51.4%, p = 0.037) and less often goals for HDL (26.6% vs. 37.3%, p = 0.04), when compared to CAD-free individuals (n = 110). the same differences were not seen in normoglycemic controls. in T2DM subjects HbA1c tertiles were associated with progressively higher number of significant coronary lesions (median number of lesions 2 [A1c 8.2%]; p = 0.01 for trend).Conclusions: Classic risk factors such as glycemic control and lipid profile were associated with presence of CAD in T2DM subjects undergoing coronary angiography. Glycemic control is progressively associated with number and extent of coronary lesions in patients with T2DM.Universidade Federal de São Paulo UNIFESP, Escola Paulista Med, Ctr Diabet, BR-04039002 São Paulo, BrazilCEDEBA, BR-41820000 Salvador, BA, BrazilUniversidade Federal de São Paulo UNIFESP, Escola Paulista Med, Ctr Diabet, BR-04039002 São Paulo, BrazilWeb of Scienc