A Novel Fluid Resuscitation Strategy Modulates Pulmonary Transcription Factor Activation in a Murine Model of Hemorrhagic Shock

INTRODUCTION: Combining the hemodynamic and immune benefits of hypertonic saline with the anti-inflammatory effects of the phosphodiesterase inhibitor pentoxifylline (HSPTX) as a hemorrhagic shock resuscitation strategy reduces lung injury when compared with the effects of Ringer's lactate (RL). We hypothesized that HSPTX exerts its anti-inflammatory effects by interfering with nuclear factor kappa B/cAMP response element-binding protein (NF-κB-CREB) competition for the coactivator CREB-binding protein (CBP) in lung tissue, thus affecting pro-inflammatory mediator production. METHODS: Male Sprague-Dawley rats underwent 60 minutes of hemorrhagic shock to reach a mean arterial blood pressure of 35 mmHg followed by resuscitation with either RL or HSPTX (7.5% HS + 25 mg/kg PTX). After four hours, lung samples were collected. NF-κB activation was assessed by measuring the levels of phosphorylated cytoplasmic inhibitor of kappa B (I-κB) and nuclear NF-κB p65 by western blot. NF-κB and CREB DNA-binding activity were measured by electrophoretic mobility shift assay (EMSA). Competition between NF-κB and CREB for the coactivator CBP was determined by immunoprecipitation. Interleukin-8 (IL-8) levels in the lung were measured by ELISA. RESULTS: RL resuscitation produced significantly higher levels of lung IL-8 levels, I-κB phosphorylation, p65 phosphorylation, and NF-κB DNA binding compared with HSPTX. NF-κB-CBP-binding activity was similar in both groups, whereas CREB-CBP-binding activity was significantly increased with HSPTX. CREB-DNA binding-activity increased to a greater level with HSPTX compared with RL. DISCUSSION: HSPTX decreases lung inflammation following hemorrhagic shock compared with conventional resuscitation using RL through attenuation of NF-κB signaling and increased CREB-DNA binding activity. HSPTX may have therapeutic potential in the attenuation of ischemia-reperfusion injury observed after severe hemorrhagic shock

Uncomplicated acute cholecystitis: early or delayed laparoscopic cholecystectomy?

Recent meta-analyses suggested that early laparoscopic cholecystectomy (within 1 week of symptom onset) for uncomplicated acute gallbladder disease is safe and feasible. However, surveys on surgical practices indicated that early laparoscopic cholecystectomy is performed by only a minority of surgeons. Furthermore, the exact time-point for performing this procedure as well as its cost-effectiveness remain a matter of debate. The TBE - CiTE Journal Club performed a critical appraisal of the most relevant evidence recently published on timing of laparoscopic cholecystectomy and its cost-effectiveness for the management of uncomplicated acute cholecystitis and provides evidence-based recommendations on the topic. The literature encompasses small trials with high risk of biases. It suggests that early laparoscopic cholecystectomy is safe and shortens hospital stay. There is scarcity of well-designed and large cost-utility analyses. The following main recommendations were generated: (1) Early laparoscopic cholecystectomy should be attempted as the first-line treatment within one week of symptoms onset; and (2) The cost-effectiveness of early laparoscopic cholecystectomy should be evaluated at the individual hospital level, taking into consideration local resources such as the availability of trained personal, operating room and laparoscopic equipment.Metanálises recentes sugerem que a colecistectomia laparoscópica precoce (dentro de uma semana do início dos sintomas) para a doença aguda, não complicada, da vesícula biliar é segura e viável. No entanto, enquetes sobre as práticas cirúrgicas indicam que a colecistectomia laparoscópica precoce é realizada por apenas uma minoria dos cirurgiões. Além disso, o melhor momento para realização deste procedimento, bem como sua relação custo-eficácia continuam sendo uma questão de debate. A reunião de revista TBE - CiTE realizou uma avaliação crítica dos artigos mais relevantes, publicados recentemente, sobre o momento da colecistectomia laparoscópica e sua relação custo-eficácia para o tratamento da colecistite aguda não complicada e fornece recomendações baseadas em evidências sobre o tema. A literatura engloba pequenos ensaios com alto risco para vieses. Ela sugere que colecistectomia laparoscópica precoce é segura e encurta o período de internação. Há uma escassez de estudos bem desenhados e de grandes séries analisando custo-utilidade. As seguintes recomendações foram geradas: (1) a colecistectomia laparoscópica precoce deve ser tentada como o tratamento de primeira linha dentro de uma semana do início dos sintomas, e (2) O custo-efetividade da colecistectomia laparoscópica precoce deve ser avaliada em cada local, levando-se em consideração os recursos, tais como a disponibilidade de pessoal treinado e de equipamentos laparoscópicos.43644

Individual patient data meta-analysis of organ failure in acute pancreatitis : protocol of the PANCREA II study

Context Organ failure is a major determinant of mortality in patients with acute pancreatitis. These patients usually requireadmission to high dependency or intensive care units and consume considerable health care resources. Given a low incidence rate of organ failure and a lack of large non-interventional studies in the field of acute pancreatitis, the characteristics of organ failure that influence outcomes of patients with acute pancreatitis remain largely unknown. Therefore, the Pancreatitis Across Nations Clinical Research and Education Alliance (PANCREA) aims to conduct a meta-analysis of individual patient data from prospective non-interventional studies to determine the influence of timing, duration, sequence, and combination of different organ failures on mortality in patients with acute pancreatitis. Methods Pancreatologists currently active with acute pancreatitis clinical research will be invited to contribute. To be eligible for inclusion patients will have to meet the criteria of acute pancreatitis, develop at least one organ failure during the first week of hospitalization, and not be enrolled into an intervention study. Raw data will then be collated and checked. Individual patient data analysis based on a logistic regression model with adjustment for confounding variables will be done. For all analyses, corresponding 95% confidence intervals and P values will be reported. Conclusion This collaborative individual patient data meta-analysis will answer important clinical questions regarding patients with acute pancreatitis that develop organ failure. Information derived from this study will be used to optimize routine clinical management and improve care strategies. It can also help validate outcome definitions, allow comparability of results and form a more accurate basis for patient allocation in further clinical studies

Coalescing disparate data sources for the geospatial prediction of mosquito abundance, using Brazil as a motivating case study

One of the barriers to performing geospatial surveillance of mosquito occupancy or infestation anywhere in the world is the paucity of primary entomologic survey data geolocated at a residential property level and matched to important risk factor information (e.g., anthropogenic, environmental, and climate) that enables the spatial risk prediction of mosquito occupancy or infestation. Such data are invaluable pieces of information for academics, policy makers, and public health program managers operating in low-resource settings in Africa, Latin America, and Southeast Asia, where mosquitoes are typically endemic. The reality is that such data remain elusive in these low-resource settings and, where available, high-quality data that include both individual and spatial characteristics to inform the geospatial description and risk patterning of infestation remain rare. There are many online sources of open-source spatial data that are reliable and can be used to address such data paucity in this context. Therefore, the aims of this article are threefold: (1) to highlight where these reliable open-source data can be acquired and how they can be used as risk factors for making spatial predictions for mosquito occupancy in general; (2) to use Brazil as a case study to demonstrate how these datasets can be combined to predict the presence of arboviruses through the use of ecological niche modeling using the maximum entropy algorithm; and (3) to discuss the benefits of using bespoke applications beyond these open-source online data sources, demonstrating for how they can be the new “gold-standard” approach for gathering primary entomologic survey data. The scope of this article was mainly limited to a Brazilian context because it builds on an existing partnership with academics and stakeholders from environmental surveillance agencies in the states of Pernambuco and Paraiba. The analysis presented in this article was also limited to a specific mosquito species, i.e., Aedes aegypti, due to its endemic status in Brazil

An Evaluation of the OpenWeatherMap API versus INMET Using Weather Data from Two Brazilian Cities: Recife and Campina Grande

Certain weather conditions are inadvertently related to increased population of various mosquitoes. In order to predict the burden of mosquito populations in the Global South, it is imperative to integrate weather-related risk factors into such predictive models. There are a lot of online open-source weather platforms that provide historical, current and future weather forecasts which can be utilised for general predictions, and these electronic sources serve as an alternate option for weather data when physical weather stations are inaccessible (or inactive). Before using data from such online source, it is important to assess the accuracy against some baseline measure. In this paper, we therefore evaluated the accuracy and suitability of weather forecasts of two parameters namely temperature and humidity from the OpenWeatherMap API (an online weather platform) and compared them with actual measurements collected from the Brazilian weather stations (INMET). The evaluation was focused on two Brazilian cites, namely, Recife and Campina Grande. The intention is to prepare an early warning model which will harness data from OpenWeatherMap API for mosquito prediction

Temporal and Spatiotemporal Arboviruses Forecasting by Machine Learning: A Systematic Review

Arboviruses are a group of diseases that are transmitted by an arthropod vector. Since they are part of the Neglected Tropical Diseases that pose several public health challenges for countries around the world. The arboviruses' dynamics are governed by a combination of climatic, environmental, and human mobility factors. Arboviruses prediction models can be a support tool for decision-making by public health agents. In this study, we propose a systematic literature review to identify arboviruses prediction models, as well as models for their transmitter vector dynamics. To carry out this review, we searched reputable scientific bases such as IEE Xplore, PubMed, Science Direct, Springer Link, and Scopus. We search for studies published between the years 2015 and 2020, using a search string. A total of 429 articles were returned, however, after filtering by exclusion and inclusion criteria, 139 were included. Through this systematic review, it was possible to identify the challenges present in the construction of arboviruses prediction models, as well as the existing gap in the construction of spatiotemporal models

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide