Peripheral interleukin-2 level is associated with negative symptoms and cognitive performance in schizophrenia

Although several studies have pointed to a possible role of interleukin 2 (IL-2) in schizophrenia (SZ), association between IL-2 and the different groups of symptoms has not been explored. the objective of this study was to investigate a possible correlation of peripheral IL-2 levels with symptoms and cognitive performance in patients with SZ. in addition, we compared the plasma levels of IL-2 between patients with SZ and healthy controls. Twenty-nine chronically medicated outpatients with SZ according to DSM-IV were compared with twenty-six healthy controls. the patients were evaluated with the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS), the Clinical Global Impression (CGI) and the Global Assessment of Functioning (GAF). All the participants had blood collected into EDTA tubes by venipuncture between 9:00 and 10:00 AM. Plasma concentrations of IL-2 were determined by cytometric bead array. A computerized neuropsychological battery assessed verbal learning, verbal fluency, working memory, set shifting, executive function, inhibition and intelligence. Patients with SZ had lower levels of IL-2 than healthy controls (p < 0.001). in the SZ group, IL-2 levels were positively correlated with scores in the digit span test (rho = 0.416, P = 0.025) and intelligence (rho = 0.464, P = 0.011). We also found a negative correlation between IL-2 and total score in the negative subscale of PANSS (rho = -0.447, p = 0.015). Our findings suggest that IL-2 may be involved in the mechanisms related to cognitive deterioration and negative symptomatology in schizophrenia. (C) 2014 Elsevier Inc. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Psychiat, Schizophrenia Program PROESQ, BR-04044000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Interdisciplinary Lab Clin Neurosci LINC, BR-04039032 São Paulo, BrazilUniv Fed Minas Gerais, Translat Psychoneuroimmunol Grp, BR-31270901 Belo Horizonte, MG, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Schizophrenia Program PROESQ, BR-04044000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Interdisciplinary Lab Clin Neurosci LINC, BR-04039032 São Paulo, BrazilWeb of Scienc

Is semantic verbal fluency impairment explained by executive function deficits in schizophrenia?

Objective: To investigate if verbal fluency impairment in schizophrenia reflects executive function deficits or results from degraded semantic store or inefficient search and retrieval strategies. Method: Two groups were compared: 141 individuals with schizophrenia and 119 healthy age and education-matched controls. Both groups performed semantic and phonetic verbal fluency tasks. Performance was evaluated using three scores, based on 1) number of words generated2) number of clustered/ related wordsand 3) switching score. A fourth performance score based on the number of clusters was also measured. Results: Individuals with schizophrenia produced fewer words than controls. After controlling for the total number of words produced, a difference was observed between the groups in the number of cluster-related words generated in the semantic task. In both groups, the number of words generated in the semantic task was higher than that generated in the phonemic task, although a significant group vs. fluency type interaction showed that subjects with schizophrenia had disproportionate semantic fluency impairment. Working memory was positively associated with increased production of words within clusters and inversely correlated with switching. Conclusion: Semantic fluency impairment may be attributed to an inability (resulting from reduced cognitive control) to distinguish target signal from competing noise and to maintain cues for production of memory probes.Fundacao de Amparo e Pesquisa do Estado de Sao Paulo (FAPESP)Univ Fed Sao Paulo, Dept Psiquiatria, Programa Esquizofrenia PROESQ, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Psiquiatria, LINC, Sao Paulo, SP, BrazilCtr Univ FIEO UNIFIEO, Dept Psicol Educ, Ave Franz Voegeli 300,Bloco Prata,Sala 10, BR-06020190 Osasco, SP, BrazilBrown Univ, Dept Cognit & Linguist Sci, Providence, RI 02912 USAUniv Mackenzie, Programa Posgrad Disturbios Desenvolvimento, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Psiquiatria, Programa Esquizofrenia PROESQ, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Psiquiatria, LINC, Sao Paulo, SP, BrazilFAPESP: 2011/50740-5FAPESP: 2007/58630-9Web of Scienc

Epidemiological burden of meningococcal disease in Brazil: A systematic literature review and database analysis

Objectives: The aim of this study was to evaluate the epidemiological profile of invasive meningococcal disease (IMD) in Brazil, the first Latin American country to introduce the group C meningococcal conjugate vaccine (included in the vaccination schedule in 2010). Methods: A systematic review was conducted, covering the years 2005–2017, to identify epidemiological information on IMD and Neisseria meningitidis carriers in Brazil. Documents from the Brazilian Ministry of Health and two public databases were analyzed to determine annual incidence rates, absolute numbers of diagnosed cases, serogroups identified, the relative distribution of cases per serogroup, and the case fatality rate (CFR). Results: Sixteen studies were selected. The incidence rate ranged from 0.88 to 5.3 cases per 100 000 inhabitants per year. According to secondary data, the annual incidence of IMD in 2015 was highest in males <1 year old (7.1/100 000). The number of diagnosed cases declined significantly over the years. In the literature, IMD showed a CFR from 20.0% to 50.0%, and a higher CFR for serogroup W (17.8%). Secondary data showed an absolute reduction in meningitis-attributable deaths between 2007 and 2015; however, the CFR remained stable (11.1% in 2007 and 8.4% in 2015). In 2015, serogroup W showed the highest CFR (24.1%), followed by serogroups C (19.2%), B (17.7%), and Y (14.3%). Conclusions: Despite a reduction in cases, the CFR remained stable and similar in the different age groups, even for disease caused by different serogroups. The highest CFR was found to be associated with serogroup W. Keywords: Meningitis, Meningococcal, Brazil, Epidemiology, Serogroup, Neisseria meningitidis, Meningococcal vaccine

Reply letter to “response to article by Johnna Perdrizet et al.” by Gomez and colleagues

This communication seeks to address the questions and criticisms issued by Gomez and colleagues in their letter on our original study “Cost-effectiveness analysis of replacing the 10-valent pneumococcal conjugate vaccine (PCV10) with the 13-valent pneumococcal conjugate vaccine (PCV13) in Brazil infants.” Gomez and colleagues are concerned that the assumptions used in our model may have unintended negative impacts for Brazil decision-making and we intend to clarify any potential misinterpretation of our assessment

Cost-effectiveness analysis of replacing the 10-valent pneumococcal conjugate vaccine (PCV10) with the 13-valent pneumococcal conjugate vaccine (PCV13) in Brazil infants

Brazil currently has a 10-valent pneumococcal conjugate vaccine (PCV10) pediatric national immunization program (NIP). However, in recent years, there has been significant progressive increases in pneumococcal disease attributed to serotypes 3, 6A, and 19A, which are covered by the 13-valent PCV (PCV13). We sought to evaluate the cost-effectiveness and budget impact of switching from PCV10 to PCV13 for Brazilian infants from a payer perspective. A decision-analytic model was adapted to evaluate the clinical and economic outcomes of continuing PCV10 or switching to PCV13. The analysis estimated future costs ($BRL), quality-adjusted life-years (QALYs), and health outcomes for PCV10 and PCV13 over 5 y. Input parameters were from published sources. Future serotype dynamics were predicted using Brazilian and global historical trends. Over 5 y, PCV13 could prevent 12,342 bacteremia, 15,330 meningitis, 170,191 hospitalized pneumonia, and 25,872 otitis media cases, avert 13,709 pneumococcal disease deaths, gain 20,317 QALYs, and save 172 million direct costs compared with PCV10. The use of PCV13 in the Brazilian NIP could reduce pneumococcal disease, improve population health, and save substantial health-care costs. Results are reliable even when considering uncertainty for possible serotype dynamics with different underlying assumptions

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