ANÁLISE EPIDEMIOLÓGICA DOS CASOS DE LEISHMANIOSE VISCERAL NO ESTADO DE MINAS GERAIS, BRASIL

Objetivo: O objetivo deste trabalho é descrever o perfil clínico e epidemiológico das notificações de casos Leishmaniose Visceral do estado de Minas Gerais, entre os anos de 2007 e 2018. Método: Esse é um estudo descritivo, quantitativo, baseado em dados secundários provenientes do Sistema de Informação de Agravos de Notificação (SINAN) relativos a casos de Leishmaniose Visceral registrados no estado de Minas Gerais no período de janeiro de 2007 a dezembro de 2018. Foram realizadas análises estatísticas de incidência e letalidade, além de analises descritivas, utilizando medidas de dispersão, tendência central e medidas de frequência, bem como testes de Qui-quadrado, considerando um intervalo de confiança de 95%. Resultados: A taxa de mortalidade observada no estudo foi de 22,55%, notando-se prevalência nos ambientes urbanos tanto para notificações como para óbitos. Constatou-se um predomínio de casos em homens, 61,07% (±0,39), com potencial relação com atividade laboral em 2,25% dos casos. A idade média observada nos registros foi de 33,03 (±2,37) anos. 69,61% (±1,30) dos casos registrados eram referentes a indivíduos com até o ensino fundamental completo e observou-se significativa redução nos índices de incidência da doença com o aumento do grau de escolaridade. Os sintomas mais frequentemente relatados foram febre, fraqueza, emagrecimento, e palidez, em ordem decrescente. Conclusões: Apesar de discreto, um aumento na incidência dos casos de Leishmaniose Visceral foi constatado no período amostral analisado. Destaca-se a relação do processo de urbanização com o aumento do número de casos fora do nicho típico do vetor, que parece induzir também o aumento de casos de coinfecção com o HIV

Epidemiologia da Leishmaniose Tegumentar Americana no estado de Minas Gerais

Introdução: A leishmaniose tegumentar, uma doença causada pelos protozoários do gênero Leishmania, é considerada autóctone em todo o território brasileiro e faz parte da lista de agravos de notificação obrigatória desde 2014. Objetivo: O objetivo desse estudo é a análise do perfil epidemiológico da leishmaniose tegumentar no estado de Minas Gerais entre 2007 e 2018. Método: Foram coletados dados oriundos do Sistema de Informação de Agravos de Notificação referentes aos casos de leishmaniose tegumentar no estado de Minas Gerais, entre os anos de 2007 e 2018, os quais foram analisados com base em distribuição anual e mensal, faixa etária, sexo, escolaridade, raça/cor, zona de residência e gestação. Resultados: Dentre os dados analisados destacam-se a predominância de casos no sexo masculino na faixa etária de 40 a 60 anos e a semelhança entre os números de casos em ambientes urbanos e rurais. Discussão: Comparando-se os dados coletados à estudos semelhantes, percebem-se algumas divergências no perfil do estado de Minas Gerais, como a tendência de casos em faixas etárias superiores, maior incidência em indivíduos de etnia parda e grande tendência a indivíduos de baixa escolaridade, além da distribuição urbana em magnitude muito semelhante à rural. Conclusões: Conclui-se que a análise do estado de Minas Gerais, o estudo estabelece uma importante linha de base para futuras investigações locais, possibilitando a consolidação de conhecimento detalhado sobre os perfis da Leishmaniose tegumentar nas regiões, para que então intervenções efetivas possam ser planejadas

Biomaterials and Adipose-Derived Mesenchymal Stem Cells for Regenerative Medicine: A Systematic Review

The use of biological templates for the suitable growth of adipose-derived mesenchymal stem cells (AD-MSC) and “neo-tissue” construction has exponentially increased over the last years. The bioengineered scaffolds still have a prominent and biocompatible framework playing a role in tissue regeneration. In order to supply AD-MSCs, biomaterials, as the stem cell niche, are more often supplemented by or stimulate molecular signals that allow differentiation events into several strains, besides their secretion of cytokines and effects of immunomodulation. This systematic review aims to highlight the details of the integration of several types of biomaterials used in association with AD-MSCs, collecting notorious and basic data of in vitro and in vivo assays, taking into account the relevance of the interference of the cell lineage origin and handling cell line protocols for both the replacement and repairing of damaged tissues or organs in clinical application. Our group analyzed the quality and results of the 98 articles selected from PubMed, Scopus and Web of Science. A total of 97% of the articles retrieved demonstrated the potential in clinical applications. The synthetic polymers were the most used biomaterials associated with AD-MSCs and almost half of the selected articles were applied on bone regeneration

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research