Early epilepsy in children with Zika-related microcephaly in a cohort in Recife, Brazil: Characteristics, electroencephalographic findings, and treatment response.

OBJECTIVE: To estimate the incidence of epilepsy in children with Zika-related microcephaly in the first 24 months of life; to characterize the associated clinical and electrographic findings; and to summarize the treatment responses. METHODS: We followed a cohort of children, born during the 2015-2016 Zika virus (ZIKV) epidemic in Brazil, with congenital microcephaly and evidence of congenital ZIKV infection on neuroimaging and/or laboratory testing. Neurological assessments were performed at ≤3, 6, 12, 15, 18, 21, and 24 months of life. Serial electroencephalograms were performed over the first 24 months. RESULTS: We evaluated 91 children, of whom 48 were female. In this study sample, the cumulative incidence of epilepsy was 71.4% in the first 24 months, and the main type of seizure was infantile spasms (83.1%). The highest incidence of seizures occurred between 3 and 9 months of age, and the risk remained high until 15 months of age. The incidence of infantile spasms peaked between 4 and 7 months and was followed by an increased incidence of focal epilepsy cases after 12 months of age. Neuroimaging results were available for all children, and 100% were abnormal. Cortical abnormalities were identified in 78.4% of the 74 children evaluated by computed tomography and 100% of the 53 children evaluated by magnetic resonance imaging. Overall, only 46.1% of the 65 children with epilepsy responded to treatment. The most commonly used medication was sodium valproate with or without benzodiazepines, levetiracetam, phenobarbital, and vigabatrin. SIGNIFICANCE: Zika-related microcephaly was associated with high risk of early epilepsy. Seizures typically began after the third month of life, usually as infantile spasms, with atypical electroencephalographic abnormalities. The seizure control rate was low. The onset of seizures in the second year was less frequent and, when it occurred, presented as focal epilepsy

Comparison of venous plasma glycemia and capillary glycemia for the screening of type 2 diabetes mellitus in the Japanese-Brazilian community of Mombuca (Guatapará-SP)

<p>Abstract</p> <p>Background</p> <p>To identify the most appropriate cut-off points of fasting glycemia for the screening of diabetes mellitus type 2 (DM2) with the comparison of the properties of capillary glycemia (CG) and venous blood plasma glycemia (PG) in a population of Japanese origin from the community of Mombuca, Guatapará - SP, Brazil.</p> <p>Methods</p> <p>This was a population-based descriptive cross-sectional study conducted on a sample of 131 individuals of both genders aged 20 years or more (66.8% of the target population). CG was measured with a glucometer in a blood sample obtained from the fingertip and PG was determined by an enzymatic method (hexokinase) in venous blood plasma, after a 10-14 hour fast in both cases. Data were analyzed by the receiver operating characteristic (ROC) curve in order to identify the best cut-off point for fasting glycemia (CG and PG) for the diagnosis of DM, using the 2-hour plasma glycemia > 200 mg/dl as gold - standard.</p> <p>Results</p> <p>The ROC curve revealed that the best cut-off point for the screening of DM was 110 mg/dl for CG and 105 mg/dl for PG, values that would optimize the relation between individuals with positive and false-positive results. The area under the ROC curve was 0.814 for CG (p < 0.01) and 0.836 for PG (p < 0.01).</p> <p>Conclusions</p> <p>The cut-off points of 105 mg/dl(5.8 mmol/l) for PG and of 110 mg/dl(6.1 mmol/l) for CG appear to be the most appropriate for the screening of DM2 in the population under study, with emphasis on the fact that the value recommended for CG is 5 mg/dl higher than that for PG, in contrast to WHO recommendations.</p

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

Distribuição espacial da taxa de mortalidade infantil e principais determinantes no Ceará, Brasil, no período 2000-2002 Spatial distribution of the infant mortality rate and its principal determinants in the State of Ceará, Brazil, 2000-2002

A distribuição geográfica dos agravos à saúde e sua relação com potenciais fatores de risco vêm abrindo um vasto campo para a investigação epidemiológica. O presente estudo visa a identificar padrões de distribuição espacial dos componentes neonatal (TMIN) e pós-neonatal (TMIP) da taxa de mortalidade infantil (TMI) dos municípios do Ceará, Brasil, e discute os principais fatores sócio-econômicos, demográficos e de atenção à saúde que contribuíram para dependência espacial destes componentes. Trata-se de um estudo ecológico transversal, utilizando regressão linear múltipla, cuja análise espacial desses componentes foi obtida através do índice de Moran. Conclui-se que as condições de assistência à gravidez, ao parto e ao recém-nascido somadas a uma melhor distribuição de renda são decisivas para a sobrevivência no primeiro mês de vida, enquanto que a má alimentação, imunização, saneamento, educação e situação econômica são possíveis determinantes da mortalidade pós-neonatal. Reconhece-se a importância que as ações de atenção seletiva à saúde exercem para o declínio da TMI. No entanto, mudanças estruturais e intersetoriais são as que irão gerar a sustentabilidade necessária para levar esse indicador ao nível dos países desenvolvidos.<br>The geographic distribution of health problems and its relationship to potential risk factors has opened a vast field for epidemiological research. The present study aims to identify spatial distribution patterns for the neonatal and post-neonatal components of the infant mortality rate (IMR) in Ceará State, Brazil, and discuss the main socioeconomic, demographic, and healthcare factors contributing to the spatial dependence of these components. This cross-sectional ecological study uses multiple linear regression, in which spatial analysis of the components was obtained through the Moran index. Prenatal, childbirth, and neonatal care as well as improved income distribution are decisive for survival in the first month of life, while other factors related to nutrition, immunization, sanitation, education, and economic status are possible determinants of post-neonatal mortality. Selective healthcare measures are known to play a decisive role in decreasing the IMR. However, structural and inter-sector changes generate the sustainability needed to maintain this indicator on the same level as in developed countries