VANTAGENS DA UTILIZAÇÃO DO PET/CT ¹⁸F-FDG NO DIAGNÓSTICO DE CÂNCER DE PULMÃO E SUA DISPONIBILIDADE NO SUS

O câncer de pulmão é considerado uma das principais causas de morte no Brasil, sendo caracterizado pela elevada taxa de multiplicação celular que pode afetar desde a traqueia até a periferia do pulmão. Detectar a doença em estágios iniciais é fundamental para um tratamento mais eficaz e melhores taxas de sobrevida. No entanto, o diagnóstico precoce é possível em apenas parte dos casos, já que muitos pacientes só apresentam sintomas em fases mais avançadas da doença. Nesse contexto, a tomografia por emissão de pósitrons conjugada com a tomografia computadorizada (PET/CT),  com o uso do radiofármaco 18F-FDG tem sido amplamente utilizada para o diagnóstico das neoplasias malignas de pulmão. Essa técnica se baseia na utilização do radiofármaco 18F-FDG como marcador do metabolismo da glicose, indicando suspeita de malignidade em áreas onde há maior captação do mesmo. A fusão de imagens anatômicas e metabólicas permite localizar com precisão a lesão pulmonar, superando outros métodos convencionais de imagem. O presente estudo tem como objetivo avaliar as aplicações da técnica de imagem PET/CT 18F-FDG no diagnóstico e estadiamento das neoplasias malignas de pulmão, por meio de uma revisão integrativa da literatura das bases de dados encontradas nos portais PubMed, Biblioteca Virtual em Saúde (BVS) e SciELO. Apesar da literatura apresentar diversas informações acerca do funcionamento e alta relevância do tema, ainda há limitações relacionadas à implementação  dessa técnica em todo território nacional no contexto do Sistema Único de Saúde (SUS).Palavras-chave: PET/CT ¹⁸F-FDG. Câncer de pulmão. Diagnóstico de imagem.

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)