Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Background: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. Methods: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0–1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0–2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4–6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. Findings: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10–2·03]; p=0·011), with low heterogeneity across studies (I2=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05–1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06–2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4–6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52–1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03–4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [<1%], adjusted OR 5·58 [1·22–25·50]; p=0·024). Interpretation: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. Funding: None

Microbiota bacteriana de ovos de jacaré-do-pantanal incubados naturalmente

RESUMO A cadeia produtiva do Caiman yacare tem-se destacado no Mato Grosso com a exportação de 143.386 peles em 2015, cujo sistema de manejo (ranching) implica a incubação artificial dos ovos. Nesse processo, a contaminação bacteriana de ovos influencia a taxa de eclosão. O conhecimento da microbiota de ovos incubados naturalmente orienta o manejo sanitário adequado no incubatório. No presente estudo, são apresentadas informações sobre essa microbiota e sua correlação com a de outros crocodilianos, apontando-se as espécies com potencial patogênico. Amostras de 20 ninhos de C. yacare foram coletadas e semeadas em ágar sangue e ágar Mac Conckey. A colônia condizente com Salmonella sp. foi confirmada pela técnica de reação em cadeia de polimerase. Das 22 espécies bacterianas isoladas, 59% pertencem à família Enterobacteriaceae e 41% a outros táxons bacterianos. A semelhança dos achados com as bactérias isoladas na microbiota oral e/ou intestinal/cloacal de crocodilianos foi de 77,27%. As bactérias mais e menos frequentes foram, respectivamente, Bacillus cereus, Flavobacterium multivorum, Citrobacter freundii, Escherichia hermannii, Hafnia alvei, Morganella, morganni, Salmonella sp., Serratia marcescens e Shigella sonnei. Das bactérias isoladas, 86,36% têm potencial patogênico para crocodilianos. A origem materna e a ambiental da microbiota de ovos incubados naturalmente são, respectivamente, de 77,27% e 27,27%

Bacterial microbiota of the Pantanal caiman eggs incubated in nature

<p></p><p>ABSTRACT The Pantanal caiman productive chain has grown in Mato Grosso with the exportation of 143.383 leather pieces in 2015, whose management system (ranching) implies the artificial incubation of eggs. In this process, the bacterial contamination of the eggs influences the hatching rate. Knowledge of the naturally incubated microbiota of eggs guides the appropriate sanitary management in the incubator room. Here we present information about this microbiota and correlate it with that of other crocodilians, indicating the species with pathogenic potential. Samples were collected in 20 nests at Pantanal, and sown in blood and Mac Conckey agar. Salmonella sp. was confirmed through polymerase chain reaction technique. From the twenty-two different species of bacteria isolated, 59% are from the Enterobacteriaceae Family and 41% from other bacterial taxonomies. The similarity of findings to isolated bacteria in the crocodilians oral and/or intestinal/cloacal microbiota was of 77,27%. The most and least frequent bacteria were, respectively, Bacillus cereus, Flavobacterium multivorum and Citrobacter freundii and Escherichia hermannii, Hafnia alvei, Morganella, morganni, Salmonella sp., Serratia marcescens and Shigella sonnei. Among the isolated bacteria, 86,36% are pathogenic for crocodilians. The maternal and environmental origin of the microbiota of eggs naturally incubated is, respectively, of 77,27% and 27,27%.</p><p></p

INSTITUCIONALIZAÇÃO DE NÚCLEOS DE INOVAÇÃO TECNOLÓGICA EM INSTITUIÇÕES DE CIÊNCIA E TECNOLOGIA DA REGIÃO SUL DO BRASIL

No contexto brasileiro, a Lei de Inovação foi promulgada em 2004 e reiterada pelo Marco Legal da Inovação em 2016, estabeleceu que as instituições de ciência e tecnologia (ICTs) nacionais dispusessem de núcleos de inovação tecnológica (NITs) para gerir suas respectivas políticas de inovação. A institucionalização, abordagem que explica como e porque estruturas e processos tornam-se legitimados, compreende um conjunto de componentes chaves, fundamentados na habitualização, que representa a formalização de arranjos em políticas e procedimentos. Nesse sentido, esta pesquisa teve como objetivo conhecer como ocorreu a institucionalização de NITs implantados no sul do Brasil, uma vez que estes representam importante pilar no sistema nacional de ciência, tecnologia e inovação (SNCT&amp;I). A fim de atingir o objetivo proposto, foi realizada uma pesquisa qualitativa e exploratória, com dados secundários extraídos de relatórios do Formulário para Informações sobre a Política de Propriedade Intelectual das ICTS do Brasil (Formict), e dados primários advindos de questionário aplicado a coordenadores de NITs de três Estados do Sul do país. Foram empregadas técnicas usuais da análise de conteúdo para codificação e interpretação dos dados. Os resultados mostraram algumas dificuldades no processo de institucionalização dos NITs, principalmente vinculadas ao não surgimento de uma cultura empreendedora, a pouca autonomia e aos entraves burocráticos na contratação de pessoal, evidenciados no modelo de organização do campo, baseado em um pilar institucional regulativo. Conclui-se que os NITs se encontram em fase de habitualização, sendo que o estágio de sedimentação e o processo de institucionalização variam conforme a instituição, embora tenha sido observado mimetismo nas ações.

Relevance of the ancestry for the variability of the Drug-Metabolizing Enzymes CYP2C9, CYP2C19 and CYP2D6 polymorphisms in a multiethnic Costa Rican population

CYP2C9, CYP2C19 and CYP2D6 metabolize around 40 % of drugs and their genes vary across populations. The Costa Rican population has a trihybrid ancestry and its key geographic location turns it into a suitable scenario to evaluate interethnic differences across populations. This study aims to describe the diversity of CYP2C9, CYP2C19 and CYP2D6 polymorphisms in Costa Rican populations in the context of their ancestry. A total of 448 healthy individuals were included in the study: Bribri (n= 47), Cabécar (n= 27), Maleku (n= 16), Guaymí (n= 30), Huetar (n= 48), Chorotega (n= 41), Admixed/Mestizos from the Central Valley/Guanacaste (n= 189), and Afro-Caribbeans (n= 50) from Limón. CYP2C9 (alleles *2, *3, *6) and CYP2C19 (*2, *3, *4, *5, *17) genotypes were determined by Real-Time PCR. African, European and Native American ancestry were inferred using 87 ancestry informative markers. The frequency of the decreased activity allele CYP2C9*2 is lower in the self-reported Amerindian groups compared to the admixed population, and the highest frequencies of CYP2C19*2 (null activity) and the CYP2C19*17 (increased activity) were found in the self-reported Afro- Caribbean population. Moreover, a frequency of 0.7 % CYP2C9 gPMs in the Admixed population and a variable frequency of CYP2C19 gUMs (0.0-32.6 %, more prevalent in Afro-Caribbeans) in Costa Rican populations, was found. Finally, the following alleles were positively correlated with genomic African ancestry and negatively correlated with genomic Native American ancestry: CYP2D6*5 (null activity), CYP2D6*17 (decreased activity), CYP2D6*29 (decreased activity) and CYP2C19*17 (increased activity). No correlation for CYP2C9 polymorphisms and genomic ancestry was found. Further studies assessing the CYP2C9 and CYP2C19 sequence in these populations, preferentially by sequencing these genes, are warranted