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

Inflamação subclínica e doença cardiovascular na obesidade: o papel do exercício físico contínuo e intervalado como tratamento

Nas últimas décadas o tecido adiposo passou a ser visto como um órgão endócrino, deixando então o seu status de simples estocador de energia. Jé é consensual que o tecido adiposo libera citocinas inflamatórias de fase aguda, podendo estas aumentar o risco de doenças cardiovasculares. Alguns estudos demonstraram que o exercício físico é um importante recurso para o tratamento da obesidade e pode diminuir o estado inflamatório de indivíduos obesos, porém, ainda não está bem descrito qual tipo de exercício ou intensidade.  Estudos recentes têm demonstrado prováveis benefícios das atividades de alta intensidade, predominantemente anaeróbias na capacidade de oxidação de gorduras. Entretanto, o efeito do exercício predominantemente anaeróbio na redução da obesidade e do estado inflamatório ainda é pouco conhecido. Sendo assim, o objetivo desta presente revisão foi sintetizar as informações acerca das evidências sobre o exercício, seja com predominância aeróbia ou anaeróbia e o impacto no estado de inflamação subclínica de indivíduos obesos. ABSTRACT Subclinical inflammation and cardiovascular disease in obesity: the role of continuous and interval exercise as treatmentIn recent decades the adipose tissue was seen as an endocrine organ, leaving his status simply estocador energy. The consensus is that adipose tissue release of acute phase inflammatory cytokines, which may increase the risk of cardiovascular diseases. Some studies have shown that physical exercise is an important resource for the treatment of obesity and can decrease the inflammatory state in obese individuals, however, is not well described what kind of exercise or intensity. Recent studies have shown probable benefits of high intensity activities, predominantly anaerobic in fat oxidation capacity. However, the effect of predominantly anaerobic exercise in reducing obesity and inflammatory status is still unknown. Thus, the objective of this study was to synthesize the information about the evidence of exercise, with predominantly aerobic or anaerobic and impact grade inflammation in obese state

EFFECT OF EXERCISE ON HDL-C LEVELS: A SYSTEMATIC REVIEW OF META-ANALYSES

<p></p><p>ABSTRACT The 1% increase in HDL-C is associated with a 3% reduction in cardiovascular mortality rates. However, exercising to the point of generating beneficial changes in HDL-C is still controversial. Therefore, the objective of this study was to evaluate whether there is a benefit of physical exercise on HDL-C levels. This is a systematic review of meta-analyses in articles indexed to PubMed/MEDLINE, SciELO and LILACS. We used the terms Lipoproteins, Cholesterol, HDL, Exercise and Resistance Training. Inclusion criteria: Meta-analyses published until January 22, 2015, with exercise as an intervention and with HDL-C endpoint. Exclusion criteria: No citation of confounding effects, assessment of HDL-C as a secondary endpoint, or dietary intervention. Regarding the aerobic training results, we evaluated eight studies. Four were significant for increased HDL-C. Of these the shortest duration in weeks was 21.8±19.5 and the highest was 35.3±31.8; the lowest frequency was 3.5±1.0 and the highest 4.0±1.1; the lowest intensity/%VO 2max was 64.8% and the highest 69.2±10.1. Four studies were not significant, being the shortest duration in weeks: 10.7±3.2 and the highest 23.19±17.7; the lowest frequency was 3.7±0.8 and the highest was 4.75±2.5; the lowest intensity/%VO 2maxwas 64.2±9.4 and the highest 74.7 ± 11.8. Resistance training: None of the three studies was significant. Combined training: A single study showed an increase in HDL-C levels (mean difference [95% CI]: 0.08 [95% CI, 0.05 -0.12 mmol/L]).We concluded that it is not possible to state that aerobic training, resisted or combined, provides significant increases in HDL-C levels, which limits its prescription as an efficient therapy for HDL-C increase.</p><p></p

Estrogen receptor-alpha gene XbaI A &gt; G polymorphism influences short-term cognitive decline in healthy oldest-old individuals Polimorfismo XbaI A &gt; G no gene do receptor do estrogênio-alfa influencia o declínio cognitivo em curto prazo em idosos muito id

Global aging is a challenging reality of this century. In 2010, there were 576 million people aged 65 years and over, worldwide. The expectation for 2050 is that this number will triple, reaching 1.5 billion people 1 . It is important to note that the highest population aging rates occur in developing countries. It is expected that between 2010 and 2050 the number of older people in developing countries will grow around 250%, while in developed countries the rate will be 71% 1 . Notably, the change in aging is rising: a child born in Brazil in 2015 has a life expectancy 20 years longer than Brazilians who were born just 50 years ago 2 . The maintenance of cognitive skills is fundamental for preservation of autonomy and quality of life among elderly individuals. Age-associated cognitive decline is characterized by changes in attention regulation, processing speed and memory capacity Results: The XbaI -351 AA genotype was more common among cognitive decliners, while -351G allele carriers showed cognitive stability or improvement. Conclusion: These results suggest that ESR-1 could be associated with one-year cognitive decline in healthy oldest-old individuals, since the estrogen pathway may be involved with neuroprotection, even in healthy brain aging. Keywords: estrogen receptor alpha; polymorphism, genetic; aging; cognition. Resultados: O genótipo XbaI -351 AA foi mais comum entre indivíduos que apresentaram declínio cognitivo, enquanto carreadores do alelo -351G demonstraram estabilidade ou melhora cognitiva. Conclusão: Estes resultados sugerem que ESR-1 poderia estar associado ao declínio cognitivo em curto prazo em idosos saudáveis, possivelmente por meio de propriedades neuroprotetoras do estrogênio, mesmo em cérebros idosos saudáveis. RESUMO Palavras-chave: receptor alfa de estrogênio; polimorfismo genético; envelhecimento; cognição

Cytokine Pattern of T Lymphocytes in Acute Schistosomiasis mansoni

Acute schistosomiasis is associated with a primary exposure and is more commonly seen in nonimmune individuals traveling through endemic regions. In this study, we have focused on the cytokine profile of T lymphocytes evaluated in circulating leukocytes of acute Schistosomiasis mansoni-infected patients (ACT group) before and after praziquantel treatment (ACT-TR group). Our data demonstrated increased values of total leukocytes, eosinophils, and monocytes in both groups. Interestingly, we have observed that patients treated with praziquantel showed increased values of lymphocytes as compared with noninfected group (NI) or ACT groups. Furthermore, a decrease of neutrophils in ACT-TR was observed when compared to ACT group. Analyses of short-term in vitro whole blood stimulation demonstrated that, regardless of the presence of soluble Schistosoma mansoni eggs antigen (SEA), increased synthesis of IFN-γ and IL-4 by T-cells was observed in the ACT group. Analyses of cytokine profile in CD8 T cells demonstrated higher percentage of IFN-γ and IL-4 cells in both ACT and ACT-TR groups apart from increased percentage of IL-10 cells only in the ACT group. This study is the first one to point out the relevance of CD8 T lymphocytes in the immune response induced during the acute phase of schistosomiasis

Estrogen receptor-alpha gene XbaI A > G polymorphism influences short-term cognitive decline in healthy oldest-old individuals

ABSTRACT This prospective study aimed to evaluate the influence of the -351A/G XbaI polymorphism in the estrogen receptor-alpha (ESR-1) gene on global cognitive scores of a community sample of healthy oldest-old individuals within one year of follow up. Methods The individuals were categorized in two groups according to the presence or absence of cognitive decline. Cognitive data were related to genetic information. Results The XbaI -351 AA genotype was more common among cognitive decliners, while -351G allele carriers showed cognitive stability or improvement. Conclusion These results suggest that ESR-1 could be associated with one-year cognitive decline in healthy oldest-old individuals, since the estrogen pathway may be involved with neuroprotection, even in healthy brain aging

Protective Immunity against Gamma and Zeta Variants after Inactivated SARS-CoV-2 Virus Immunization

The persistent circulation of SARS-CoV-2 represents an ongoing global threat due to the emergence of new viral variants that can sometimes evade the immune system of previously exposed or vaccinated individuals. We conducted a follow-up study of adult individuals that had received an inactivated SARS-CoV-2 vaccine, evaluating antibody production and neutralizing activity over a period of 6 months. In addition, we performed mice immunization with inactivated SARS-CoV-2, and evaluated the immune response and pathological outcomes against Gamma and Zeta variant infection. Vaccinated individuals produced high levels of antibodies with robust neutralizing activity, which was significantly reduced against Gamma and Zeta variants. Production of IgG anti-S antibodies and neutralizing activity robustly reduced after 6 months of vaccination. Immunized mice demonstrated cellular response against Gamma and Zeta variants, and after viral infection, reduced viral loads, IL-6 expression, and histopathological outcome in the lungs. TNF levels were unchanged in immunized or not immunized mice after infection with the Gamma variant. Furthermore, serum neutralization activity rapidly increases after infection with the Gamma and Zeta variants. Our data suggest that immunization with inactivated WT SARS-CoV-2 induces a promptly responsive cross-reactive immunity response against the Gamma and Zeta variants, reducing COVID-19 pathological outcomes