Apparent Efficacy of Low-Dose Constant-Infusion Crotalidae Antivenom for Control of Defibrinogenation Recurrence Syndrome Following Envenomation by the Eastern Diamondback Rattlesnake (Crotalus adamanteus)

Background: Eastern Diamondback rattlesnake bites produce coagulopathy in the bite victims. The syndrome is treated with antivenom called Crotalidae Polyvalent Immune Fab. However following resolution of coagulopathy with the antidote, and sometimes days later, fibrinogen drops to very low levels. Rare bleeding may occur due to this recurrent defibrinogenation syndrome. No guidelines exist at this time of how these patients should be treated. However, many centers repeat the initial treatment protocol using another 6-18 vials of antidote acquiring significant treatment costs. Methods: We analyzed all cases treated at the University of Florida between 2013 and 2014 for the rattlesnake bites.  All cases were treated with Crotalidae Polyvalent Immune Fab as recommended per manufacturer recommendations upon initial presentation.  However, upon the recurrence of defibrinogenation, we administered the antivenom 1 vial diluted in 250 ml of normal saline and administered by continuous IV infusion over 2 to 12 hours tapered over 2 to 3 days. The patients and their coagulation labs were monitored at least daily during the recurrence of the defibrinogenation. Results: We identified 5 cases treated for Eastern Diamondback snake bites. All cases had recurrent defibrinogenation syndrome and treated as described above. All patients had normalization in their fibrinogen levels with the reinstitution of the antidote. Additionally, none of them had any further bleeding. No chills, fevers or cloudiness of solution reported during the continuous antidote administration

Civil society participation in building resilient cities : Ipiranga neighborhood, city of São Paulo, Brazil

Different nationalities, even in the same natural environment, build different settlement forms. The natural environment has a great influence on the formation of village spatial form. In places with similar natural conditions, the same ethnic groups have similar settlement forms. However,different nationalities, even in the same natural environment, have different settlement forms. The spatial composition of the settlement plays a decisive role in the spatial concept of the residents, rather than simply depending on the local environment

A large scale hearing loss screen reveals an extensive unexplored genetic landscape for auditory dysfunction

The developmental and physiological complexity of the auditory system is likely reflected in the underlying set of genes involved in auditory function. In humans, over 150 non-syndromic loci have been identified, and there are more than 400 human genetic syndromes with a hearing loss component. Over 100 non-syndromic hearing loss genes have been identified in mouse and human, but we remain ignorant of the full extent of the genetic landscape involved in auditory dysfunction. As part of the International Mouse Phenotyping Consortium, we undertook a hearing loss screen in a cohort of 3006 mouse knockout strains. In total, we identify 67 candidate hearing loss genes. We detect known hearing loss genes, but the vast majority, 52, of the candidate genes were novel. Our analysis reveals a large and unexplored genetic landscape involved with auditory function

Open spaces and public life spatialities: a conceptual proposal to the research of the country's urban open spaces system

Este texto é o resultado da primeira etapa de trabalhos da fase número quatro do Projeto de pesquisa Quapá – Quadro do Paisagismo no Brasil, em desenvolvimento desde 1994 no Laboratório da Paisagem da FAUUSP, e que se voltará para o estudo teórico e metodológico dos sistemas de espaços livres na cidade brasileira, tendo como foco um conjunto das principais cidades de médio e grande porte do país. São apresentados conceitos que nortearão o novo processo de pesquisa, destacando-se os de espaço livre, sistema de espaços livres e áreas verdes.This paper is the result of the first part of the newest stage of projeto Quapá – Quadro do Paisagismo no Brasil in developing at FAUUSP. Nowadays the main subject of the research is the discussion of the adequate concepts to the open and green spaces in a brazilian urban reality and to investigate how it has been its development in the main brazilian cities

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Áreas Residuais de Sistemas Viários: projeto e apropriação pública - Rua Agostinho Rodrigues Filho, bairro Vila Mariana, SP

As diversas formas que assumem as cidades brasileiras são, enquanto sistema, resultantes da somatória e inter-relação entre os espaços livres de edificação e edificados, entre as questões de propriedade da terra – pública e privada, entre a aplicação ou não da legislação urbana bem como da materialização de políticas públicas para o incentivo da economia (produção e consumo) além das ideologias vigentes para a produção do espaço urbano. As mudanças na forma de apropriação pública dos espaços destinados à caminhar urbano vem sofrendo alterações nas últimas décadas. Faz-se necessária, portanto, a atualização dos instrumentos de pesquisa associados ao conhecimento do espaço urbano. Esta pesquisa de iniciação científica surgiu a partir de trabalhos realizados pelo escritório modelo do curso de arquitetura e urbanismo do FIAM-FAAM Centro Universitário. Dando andamento aos estudos do Projeto de Pesquisa Sistema de Espaços Livres, parte integrante do programa de mestrado profissional Projeto, Produção e Gestão do Espaço Urbano da mesma instituição de ensino, o objetivo deste trabalho de pesquisa foi o de refletir sobre a forma e as condições físicas ofertadas pelos espaços livres destinados à fruição e apropriação das pessoas com foco em comunidades de bairro, ou ainda, numa escala de projeto local. A partir da aplicação do método de observação urbana de Jan Gehl associado aos instrumentos de análise do Active Design para a realização de diagnóstico e projeto de um sistema de espaços livres composto por áreas residuais urbanas (ruas e glebas) junto à Rua Agostinho Rodrigues Filho, SP. As pesquisas contaram com o suporte metodológico advindo do acordo de cooperação técnica entre a instituição e a organização social Cidade Ativa

SHELTER FOR THE URBAN POOR IN SANPASADA

With urbanization comes the problem of shelter provision for the urban poor in developing countries like the Philippines. The objective of this paper is to assess the socialized housing provision for the urban poor in the local government units of the Municipality of Sta. Cruz, Panabo City, Island Garden City of Samal, and Davao City (also known as SANPASADA). The assessment of the physical stock as an indicator includes the provision of land and the housing structure.  The study shows that both local and national government units mostly assisted only in the lot acquisition of housing beneficiaries. The provision of housing structures was mostly provided through the initiative and ingenuity of the urban poor beneficiaries or with the assistance of the non-government organizations. Site development and the provision of infrastructure and utilities were done phase by phase through the initiative of the homeowners associations and from limited assistance of local government units.  It is generally recommended that to promote a comprehensive approach in the provision of shelter needs of the urban poor, both the local and national government units should encourage the active participation and collaboration with NGOs and urban poor beneficiaries

Can we develop effective combination antiangiogenic therapy for patients with hepatocellular carcinoma?

Antiangiogenic therapy has shown promise in the treatment of patients with hepatocellular carcinoma (HCC). Bevacizumab, sorafenib, and sunitinib showed efficacy in patients with HCC; and sorafenib is approved by the FDA for treatment of this cancer. In practice, the clinical benefit of these agents has been heterogeneous; and in patients who do respond, the benefit is modest and/or short-lived. Recent advances in the molecular understanding of tumor angiogenesis along with the rapid development of targeted drug discovery have made it possible to explore novel combination therapy for HCC. We review the clinical trial results, discuss possible molecular mechanisms of resistance, and suggest novel combinations with antiangiogenic therapy

Combination therapy for renal cell cancer: what are possible options?

Antiangiogenic therapy has shown promise in the treatment of patients with renal cell carcinoma (RCC). Two classes of antiangiogenic drugs, the anti-vascular endothelial growth factor antibody bevacizumab and the tyrosine kinase inhibitors sorafenib, sunitinib and pazopanib, have shown efficacy in patients with RCC and are approved by the US Food and Drug Administration for treatment of this cancer. In practice, the clinical benefit of antiangiogenic drugs in RCC has been heterogeneous, and in patients who do respond, benefits are modest and/or short-lived. To improve efficacy, combination targeted therapy has been attempted, but with either very limited additional efficacy or nontolerable toxicities. Recent advances in the molecular understanding of tumor angiogenesis and mechanism of resistance, along with the rapid development of targeted drug discovery, have made it possible to further explore novel combination therapy for RCC