Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Discutindo alguns fatores que interferem no processo de aprendizado e memória

O trabalho foi realizado na disciplina de Tópicos Avançados em Aprendizado e Memória, com 12 alunos de pós graduação dos Programas de Pós Graduação em Educação em Ciências: Química e Saúde da Vida e do Programa de Pós Graduação Fisiologia Animal Comparada, FURG. Foram estudados os processos neuroquímicos relacionados ao aprendizado e a memória na forma de aulas expositivas e apresentados seminários, pelos alunos, sobre fatores que influenciam diretamente o aprendizado e a memória, tais como: estresse, sono, álcool, envelhecimento e atenção. Os resultados apontaram que esta temática possibilitou não somente a formação dos alunos, bem como e a sua aplicabilidade como educadores. Como perspectiva futura está prevista a publicação de uma cartilha direcionada a educadores e educandos abordando temas que influenciam na memória

Effect of silymarin on biochemical parameters of oxidative stress in aged and young rat brain

Silymarin (SM), the active complex of milk thistle, is a lipophilic fruit extract and is composed of several isomer flavonolignans. Flavonoids are antioxidants found molecules capable of intercepting reactive oxygen species (ROS). The oxidative stress (OS) is caused by imbalance between antioxidant defenses and production of ROS causing oxidative damage to macromolecules. Brain is susceptible to oxidative stress and it is associated with age-related brain dysfunction. This study evaluated the effect of SM on biochemical parameters that evaluate OS in aged and young rat brain. For measures of OS were used measures of total oxyradical scavenging capacity (ACAP) through the concentration of ROS by fluorescence, lipid peroxidation (LPO), via FOX and TBARS, proteins oxidation by Western blot (WB). Rats were treated with SM at doses of 200 and 400 mg/kg/day (SM200 and SM400). The LPO analyzed through FOX was increased in the hippocampus of aged animals treated with SM400, but in the cortex of young and aged, the highest dose of SM decreased LPO analyzed through TBARS. Both doses have seemed most effective in the reduction of oxidized proteins in aged brain. These results suggest that SM may contribute to the prevention of aged-related and pathological degenerative processes in the brain

Do technological advances dehumanize medical teaching?

Submitted by Ilno Conceição ([email protected]) on 2012-11-07T23:48:02Z No. of bitstreams: 1 Os avanços tecnológicos desumanizam o ensino médico.pdf: 176921 bytes, checksum: 2ed4b164d50dfb8d3be92b45cabf22e4 (MD5)Approved for entry into archive by Gabriela Silva da Rosa([email protected]) on 2013-03-21T22:19:22Z (GMT) No. of bitstreams: 1 Os avanços tecnológicos desumanizam o ensino médico.pdf: 176921 bytes, checksum: 2ed4b164d50dfb8d3be92b45cabf22e4 (MD5)Made available in DSpace on 2013-03-21T22:19:22Z (GMT). No. of bitstreams: 1 Os avanços tecnológicos desumanizam o ensino médico.pdf: 176921 bytes, checksum: 2ed4b164d50dfb8d3be92b45cabf22e4 (MD5) Previous issue date: 2012Os recursos tecnológicos são ferramentas que auxiliam docentes e o uso racional desses enriquece a aula, auxiliando os alunos no processo de aprendizagem. Essa perspectiva reflete no ensino médico, o qual necessita se adaptar as novas demandas da educação. Nessa linha de pensamento, no presente artigo, apresentamos a educação médica em cenários pedagógicos distintos em que o uso de Tecnologias da Informação e Comunicação (TICs) auxilia professores no processo de ensino/aprendizagem, interferindo positivamente na relação entre aluno, professor e conteúdos. Destacamos ainda, o fato de que o uso das TICs é uma alternativa interessante diante da necessidade de humanizar o ensino médico.The technological resources are tools that help teachers and the rational use of these enriches the classroom, helping students in the learning process. This perspective reflects on medical education, which needs to adapt to the new demands of education. In this line of thought, in this article we present the medical education in different pedagogical scenarios in which the use of Information and Communication Technologies (ICTs) assists teachers in the process of teaching, interfering positively in the relationship between student, professor and subjects. We highlight the fact that the use of ICTs is an interesting alternative in the face of the need to humanize the medical teaching

Os avanços tecnológicos desumanizam o ensino médico?

Os recursos tecnológicos são ferramentas que auxiliam docentes e o uso racional desses enriquece a aula, auxiliando os alunos no processo de aprendizagem. Essa perspectiva reflete no ensino médico, o qual necessita se adaptar as novas demandas da educação. Nessa linha de pensamento, no presente artigo, apresentamos a educação médica em cenários pedagógicos distintos em que o uso de Tecnologias da Informação e Comunicação (TICs) auxilia professores no processo de ensino/aprendizagem, interferindo positivamente na relação entre aluno, professor e conteúdos. Destacamos ainda, o fato de que o uso das TICs é uma alternativa interessante diante da necessidade de humanizar o ensino médico.The technological resources are tools that help teachers and the rational use of these enriches the classroom, helping students in the learning process. This perspective reflects on medical education, which needs to adapt to the new demands of education. In this line of thought, in this article we present the medical education in different pedagogical scenarios in which the use of Information and Communication Technologies (ICTs) assists teachers in the process of teaching, interfering positively in the relationship between student, professor and subjects. We highlight the fact that the use of ICTs is an interesting alternative in the face of the need to humanize the medical teaching

Os avanços tecnológicos desumanizam o ensino médico?

Os recursos tecnológicos são ferramentas que auxiliam docentes e o uso racional desses enriquece a aula, auxiliando os alunos no processo de aprendizagem. Essa perspectiva reflete no ensino médico, o qual necessita se adaptar as novas demandas da educação. Nessa linha de pensamento, no presente artigo, apresentamos a educação médica em cenários pedagógicos distintos em que o uso de Tecnologias da Informação e Comunicação (TICs) auxilia professores no processo de ensino/aprendizagem, interferindo positivamente na relação entre aluno, professor e conteúdos. Destacamos ainda, o fato de que o uso das TICs é uma alternativa interessante diante da necessidade de humanizar o ensino médico

Effects of prenatal and postnatal exposure to a low dose of bisphenol A on behavior and memory in rats

Endocrine disruptors (EDs) are increasingly common chemicals in the environment. Bisphenol A (BPA), used to manufacture polycarbonate plastics, is an ED recognized for its estrogenic, anti-estrogenic, and anti-androgenic effects. Behavior is considered a vital characteristic for an animal’s life cycle. This study evaluated the effect of exposure to lowdoses of BPA during pregnancy and/or lactation on several aspects of rat behavior, including memory, locomotion, and the exploratory instinct. Pups at 16 weeks of age (females andmales)were divided into groups according to themother’s exposure to BPA (40g/kg/day): CON(vehicle only); PRE (during pregnancy); LAC (during lactation); PRE-LAC (during both pregnancy and lactation). In the PRE-LAC group, exposure to BPA impaired both short-term (STM) and long-term mem-ory (LTM) in inhibitory avoidance and the object recognition task, and also affected locomotor activity and spatial memory. Some sex-specific behavioral characteristics disappeared in the LAC group. Sex-specific memory and behavior impairment were caused by BPA exposure during brain organogenesis and differentiation

O uso de animais pelo ensino e pela pesquisa: prós e contras

Em busca de conhecimento, atividades de ensino e pesquisa são, historicamente, realizadas com o uso de animais. Este artigo fundamenta-se na existência de um novo paradigma em relação à utilização de animais em estudos acadêmicos. Objetivou–se questionar como a ciência aplicada a animais de laboratório, prática presente no cotidiano de alunos dos cursos de Medicina e Ciências Biológicas da Universidade Federal do Rio Grande -FURG, contribui para a formação acadêmica e profissional. Os conflitos gerados por este tema evidenciam-se nos questionamentos deste artigo, revelando a necessidade de reflexões éticas quanto à utilização de animais pelo ensino e pela pesquisa. Constatou-se a necessidade de emersão da Ciência em Animais de Laboratório como fornecedora de conhecimentos específicos sobre o uso de animais para fins didático-científicos

The effects of aging on leukocyte glucocorticoid receptor concentration and response to dexamethasone in dogs

Glucocorticoid receptor concentration (GR) was determined in mononuclear (MNS) and polymorphonuclear (PMNS) cells isolated from 8 aged and 9 young male dogs. In addition, leukocyte responses to dexamethasone (0.1 mg kg21 iv) and plasma glucose concentration were also measured. The GR in MNS and PMNS was higher ðp , 0:05Þ in young dogs (6.64 ^ 0.57 and 7.04 ^ 0.29 fmoles £ 106 cells, respectively, versus 4.40 ^ 0.24 and 5.06 ^ 0.33 fmoles £ 106 cells, respectively, in aged dogs). The maximum increase in neutrophils (D NEU) was lower ðp , 0:05Þ in aged dogs 6003.38 ^ 1398.5 £ 106 versus 11168.67 ^ 1863.16 £ 106 cells l21 in young dogs. The maximum decrease in lymphocytes (D LYM) was lower ðp , 0:05Þ in aged dogs 550 ^ 56.75 £ 106 cells l21 versus 1825.89 ^ 313.1 £ 106 cells l21 in young dogs. In young dogs, significant ðp , 0:05Þ correlations between GR in PMNS and D NEU ðr ¼ 0:80Þ and between GR in MNS and D LYM ðr ¼ 0:76Þ were observed. In aged dogs, these correlations were not significant. The lower GR value and the lack of correlation between this parameter and its respective D in aged dogs suggest that changes in leukocytes responsiveness to glucocorticoids is occurring during the aging process

Behavioral alterations induced by repeated saxitoxin exposure in drinking water

Abstract Background Blooms of the saxitoxin-producing cyanobacterium Cylindrospermopsis raciborskii have been contaminating drinking water reservoirs in Brazil for many years. Although acute effects of saxitoxin intoxication are well known, chronic deleterious outcomes caused by repeated saxitoxin exposure still require further investigation. The aim of the present work is to investigate the effects of consumption of drinking water contaminated with C. raciborskii for 30 days on learning and memory processes in rats. Methods The effects of saxitoxin (3 or 9 μg/L STX equivalents) or cyanobacteria on behavior was determined using the open field habituation task, elevated plus maze anxiety model task, inhibitory avoidance task, and referential Morris water maze task. Results No effects of saxitoxin consumption was observed on anxiety and motor exploratory parameters in the elevated plus maze and open field habituation tasks, respectively. However, groups treated with 9 μg/L STX equivalents displayed a decreased memory performance in the inhibitory avoidance and Morris water maze tasks. Conclusions These results suggest an amnesic effect of saxitoxin on aversive and spatial memories