Decoding the Prevalent High-Risk Breast Cancers: Demographics, Pathological, Imaging Insights, and Long-Term Outcome.

Objective: To investigate the features and outcomes of breast cancer in high-risk subgroups. Materials and Methods: REB approved an observational study of women diagnosed with breast cancer from 2010 to 2019. Three radiologists, using the BI-RADS lexicon, blindly reviewed mammogram and MRI screenings without a washout period. Consensus was reached with 2 additional reviewers. Inter-rater agreement was measured by Fleiss Kappa. Statistical analysis included Mann-Whitney U, Chi-square tests for cohort analysis, and Kaplan-Meier for survival rates, with a Cox model for comparative analysis using gene mutation as a reference. Results: The study included 140 high-risk women, finding 155 malignant lesions. Significant age differences noted: chest radiation therapy (median age 44, IQR: 37.0-46.2), gene mutation (median age 49, IQR: 39.8-58.0), and familial risk (median age 51, IQR: 44.5-56.0) (P = .007). Gene mutation carriers had smaller (P = .01), higher-grade tumours (P = .002), and more triple-negative ER- (P = .02), PR- (P = .002), and HER2- (P = .02) cases. MRI outperformed mammography in all subgroups. Substantial to near-perfect inter-rater agreement observed. Over 10 years, no deaths occurred in chest radiation group, with no significant survival difference between gene mutation and familial risk groups, HR = 0.93 (95% CI: 0.27, 3.26), P = .92. Conclusion: The study highlights the importance of age and specific tumour characteristics in identifying high-risk breast cancer subgroups. MRI is confirmed as an effective screening tool. Despite the aggressive nature of cancers in gene mutation carriers, early detection is crucial for survival outcomes. These insights, while necessitating further validation with larger studies, advocate for a move toward personalized medical care, strengthening the existing healthcare guidelines.

The influence of six polymorphisms of uncoupling protein 3 (UCP3) gene and childhood obesity: a case-control study.

BACKGROUND: Obesity is defined as a multifactorial disease, marked by excessive accumulation of body fat, responsible for compromising the individual's health over the years. The energy balance is essential for the proper functioning of the body, as the individual needs to earn and spend energy in a compensatory way. Mitochondrial Uncoupling Proteins (UCP) help in energy expenditure through heat release and genetic polymorphisms could be responsible for reducing energy consumption to release heat and consequently generate an excessive accumulation of fat in the body. Thus, this study aimed to investigate the potential association between six UCP3 polymorphisms, that have not yet been represented in ClinVar®, and pediatric obesity susceptibility. METHODS: A case-control study was conducted with 225 children from Central Brazil. The groups were subdivided into obese (123) and eutrophic (102) individuals. The polymorphisms rs15763, rs1685354, rs1800849, rs11235972, rs647126, and rs3781907 were determined by real-time Polymerase Chain Reaction (qPCR). RESULTS: Biochemical and anthropometric evaluation of obese group showed higher levels of triglycerides, insulin resistance, and LDL-C and low level of HDL-C. Insulin resistance, age, sex, HDL-C, fasting glucose, triglyceride levels, and parents' BMI explained up to 50% of body mass deposition in the studied population. Additionally, obese mothers contribute 2 × more to the Z-BMI of their children than the fathers. The SNP rs647126 contributed to 20% to the risk of obesity in children and the SNP rs3781907 contribute to 10%. Mutant alleles of UCP3 increase the risk for triglycerides, total cholesterol, and HDL-C levels. The polymorphism rs3781907 is the only one that could not be a biomarker for obesity as the risk allele seem to be protective gains the increase in Z-BMI in our pediatric population. Haplotype analysis demonstrated two SNP blocks (rs15763, rs647126, and rs1685534) and (rs11235972 and rs1800849) that showed linkage disequilibrium, with LOD 76.3% and D' = 0.96 and LOD 57.4% and D' = 0.97, respectively. CONCLUSIONS: The causality between UCP3 polymorphism and obesity were not detected. On the other hand, the studied polymorphism contributes to Z-BMI, HOMA-IR, triglycerides, total cholesterol, and HDL-C levels. Haplotypes are concordant with the obese phenotype and contribute minimally to the risk of obesity.

Analysis of Post-Sample Collection EDTA Effects on Mean Platelet Volume Values in Relation to Overweight and Obese Patient Status.

BACKGROUND: Mean platelet volume (MPV) may be a useful biomarker for platelet activation in obese patients. However, storage duration and use of anticoagulant K3-ethylenediaminetetraacetic acid (EDTA) may interfere with these measurements. OBJECTIVES: The aim of this study was to measure the variability of MPV in obese patients following exposure to EDTA. METHOD: A total of 160 patients were divided into 3 groups according to body mass index (BMI; normal: <25 kg/m2; overweight: 25-30 kg/m2; obese: >30 kg/m2). Blood was collected in sterile tubes containing K3-EDTA. Blood cell counts were obtained using the CELL-DYN Ruby system immediately and 1, 2, and 3 h after collection. RESULTS: MPV was found to be directly proportional to BMI. With the addition of EDTA, MPV was increased in the first hour after collection; MPV then decreased to levels that were lower than initial baseline measurements. CONCLUSIONS: K3-EDTA use alters platelet volume. The time from collection to measurement should be standardized to reduce MPV value variance. MPV should be determined within 1 h of collection to avoid anticoagulant use-related interference.

Decomposition rate and enzymatic activity of composted municipal waste and poultry manure in the soil in a biofuel crops field.

BACKGROUND: Biofuel crops are gaining importance because of the need to replace non-renewable sources. Also, due to the increasing amounts of wastes generated, there is the need to recycle them to the soil, both to fertilize crops and to improve soil physical properties through organic matter increase and microbiological changes in the rhizosphere. We therefore studied the influence of six biofuel crops (elephant grass, giant cane, sugarcane, blue gum, black cottonwood, willow) on the decomposition rate and enzymatic activity of composted municipal solid waste and poultry manure. Organic amendments were incubated in the field (litterbag method), buried near each plant or bare soil. Biomass decrease and dehydrogenase, urease and acid phosphatase level in amendments was monitored over a 180-day period. Soil under the litterbags was analysed for the same enzymatic activity and organic matter fractions (last sampling). After 365 days, a fractionation of organic matter was carried out in both amendments and soil under the litterbags. RESULTS: For compost, willow and sugarcane generally led to the greatest enzymatic activity, at the end of the experiment. For manure, dehydrogenase activity decreased sharply with time, the smallest value near sugarcane, while phosphatase and urease generally presented the highest values, at the beginning or after 90 days' incubation. Clustering showed that plant species could be grouped based on biomass and enzymes measured over time. CONCLUSIONS: Plant species influenced the decomposition rate and enzymatic activities of the organic amendments. Overall, mineralization of both amendments was associated with a greater urease activity in soils. Dehydrogenase activity in manure was closely associated with urease activity. © 2016 Society of Chemical Industry.

Pediatric inflammatory multisystemic syndrome in Brazil: sociodemographic characteristics and risk factors to death.

OBJECTIVE: To determine the incidence of MIS-C in Brazil, describe the clinical and sociodemographic characteristics of the pediatric population affected by MIS-C and compare mortality and lethality outcomes with isolated Covid-19 and MIS-C cases. METHODS: Observational and retrospective cohort study of cases of MIS-C associated with Covid-19 in the Brazilian population between 04/01/2020 and 04/17/2021. Data from the Ministry of Health's epidemiological bulletin up to the 15th epidemiological week of 2021, were used. The analyzes were descriptive through absolute and relative frequencies. The significance level is 5% in Stata 16.0 package. RESULTS: Between 04/01/2020 and 04/07/2021, 903 cases of MIS-C associated with Covid-19 were notified in Brazil, of which, the largest part (55.26%) were male, between 0 and 4 years old (45.29%), from the Southeast region (38.76%). The deaths (61; 6.7%) were higher in the female gender, between 0 and 4 years old (47.54%) and in the Southeast region (34.43%). It was identified that the risk of death by MIS-C related to Covid-19 is 5.29 (CI = 2.83; 9.87 and P-value = <0.001) times higher in adolescents from 15-19 years old than in other age groups when compared to 0-4 years old children. Also, the residency in North region was as risk factor to death (RR = 3.72, IC = 1.29; 10.74 e P-value = 0.008). CONCLUSION: In this study, despite the numbers showing more deaths from zero to 4 years old, the risk for teenagers is notably higher. In addition, Brazil's Northern region is a risk factor that reaffirms social inequality and poor access to health.

Trends in bariatric surgeries in the Brazilian Federative Units, 2009-2019: a descriptive study.

OBJECTIVE: our objective is to describe the epidemiological distribution of hospitalizations and postoperative deaths, as well as the trends of bariatric surgeries performed by SUS in all Brazilian federative units (FUs) from an analysis of the period from 2009 to 2019. METHODS: This is an observational, descriptive ecological time-series study with quantitative and descriptive analysis, based on secondary data. The period analyzed was from 2009 to 2019. We collected, from DATASUS, data from obese men and women who were hospitalized after undergoing bariatric surgery. Prais-Winsten regression was performed to identify the trends. RESULTS: In the period, 83,829 bariatric surgeries were performed, of which 161 resulted in death, representing 0.19% of the procedures. We found an increasing trend in the number of surgeries for Brazil (ß=0.04; p<0.001), but 11 FUs showed a stationary trend and three, decreasing ones (six UFs did not have enough data to enter the analysis). In the North and Northeast regions, stationary trends prevailed, while in the Center-West, the decreasing trends, and in the South and Southeast, the increasing ones. CONCLUSIONS: we found an evident disparity between regions, suggesting deficiencies in access to health. By demonstrating which FUs and demographic characteristics have the lowest rates of surgeries, our study is able to direct public policies towards a more egalitarian Brazilian public health.

Effects of dry-wet cycles on nitrous oxide emissions in freshwater sediments: a synthesis.

BACKGROUND: Sediments frequently exposed to dry-wet cycles are potential biogeochemical hotspots for greenhouse gas (GHG) emissions during dry, wet and transitional phases. While the effects of drying and rewetting on carbon fluxes have been studied extensively in terrestrial and aquatic systems, less is known about the effects of dry-wet cycles on N2O emissions from aquatic systems. As a notable part of lotic systems are temporary, and small lentic systems can substantially contribute to GHG emissions, dry-wet cycles in these ecosystems can play a major role on N2O emissions. METHODOLOGY: This study compiles literature focusing on the effects of drying, rewetting, flooding, and water level fluctuations on N2O emissions and related biogeochemical processes in sediments of lentic and lotic ecosystems. RESULTS: N2O pulses were observed following sediment drying and rewetting events. Moreover, exposed sediments during dry phases can be active spots for N2O emissions. The general mechanisms behind N2O emissions during dry-wet cycles are comparable to those of soils and are mainly related to physical mechanisms and enhanced microbial processing in lotic and lentic systems. Physical processes driving N2O emissions are mainly regulated by water fluctuations in the sediment. The period of enhanced microbial activity is driven by increased nutrient availability. Higher processing rates and N2O fluxes have been mainly observed when nitrification and denitrification are coupled, under conditions largely determined by O2 availability. CONCLUSIONS: The studies evidence the driving role of dry-wet cycles leading to temporarily high N2O emissions in sediments from a wide array of aquatic habitats. Peak fluxes appear to be of short duration, however, their relevance for global emission estimates as well as N2O emissions from dry inland waters has not been quantified. Future research should address the temporal development during drying-rewetting phases in more detail, capturing rapid flux changes at early stages, and further explore the functional impacts of the frequency and intensity of dry-wet cycles.

River-floodplain restoration and hydrological effects on GHG emissions: Biogeochemical dynamics in the parafluvial zone.

The parafluvial zone is frequently exposed to drying-rewetting cycles with critical consequences for the biogeochemistry of soil and sediment in river-floodplain landscapes. Upon restoration of the hydrological connectivity, substantial changes in biogeochemical processes are expected. The effects of water fluctuation on the magnitude of GHG emissions were investigated in the parafluvial zone of a restored river floodplain in Austria. Sediment composition, DOM quality and N2O, CO2, CH4 fluxes were quantified during distinct hydrological periods (intermittent, desiccation and post flood) and along a hydrological gradient. The hydrological gradient ranged from non-flooded plots in the floodplain soil (used as reference plots after restoration), to rarely-flooded and frequently flooded sediment plots in the parafluvial zone. Enhanced biogeochemical turnover rates were identified during the intermittent period, when N2O and CO2 emissions peaked. In particular, the frequently flooded plots showed significantly higher CO2 and CH4 emissions compared to non-flooded and rarely-flooded plots. This indicates a strong effect of water level fluctuation on GHG emissions, with higher emissions occurring during transitional stages of drying and rewetting. Strong positive relationships were found between individual GHG fluxes, suggesting a tight link between C and N cycles. Both the C and N cycles are dependent on similar substrate characteristics that are governed by the quality of the DOM pool. Interestingly, drier sediments in the rarely-flooded plots were also active areas for emissions. This highlights the importance to include dry phases and sites in the overall C and N emission estimates of riverine landscapes. From the restoration point of view, N2O emissions in the parafluvial zone did not differ significantly from the emissions in the reference plots, whereas CO2 and CH4 fluxes did. When making management decisions to restore connectivity, one needs to carefully consider the interplay between nutrient removal from water versus GHG emissions, to reach maximum environmental benefits.

Can Meals Outside Homes Impact Sodium Intake?

BACKGROUND: The WHO currently recommends a daily sodium intake of 2 g and has established the goal of a 30% reduction in mean salt intake by 2025. OBJECTIVE: We sought to estimate sodium intake in study participants according to the locations of where they consumed meals and their demographic and socioeconomic characteristics and practices related to salt consumption. METHODS: A population-based, cross-sectional study was conducted with a sample of 2574 individuals aged ≥10 y who answered the 2015 Campinas-Brazil Nutrition Survey. Mean sodium intake was estimated using a 24-h recall log and associations with the independent variables were tested using generalized regression analysis stratified by age group. RESULTS: Sodium intake was higher in male participants as well as adolescents and adults who reported eating ≥1 meal outside the home (6.07% and 7.06% increase, respectively). Per meal, sodium was consumed more outside the home at breakfast, during an afternoon snack, and at dinner among adolescents. No significant differences were found in the analysis by type of meal among the adults and seniors. CONCLUSIONS: Sodium intake exceeded the WHO recommendation in all age groups analyzed. Having ≥1 meal outside the home was associated with greater sodium intake among adolescents and adults. Measures to regulate the food industry and dietary/nutritional education strategies targeting consumers are important to reducing the sodium intake of the population.

A simple awareness campaign to promote food waste reduction in a University canteen.

Food waste has important environmental, social and economic impacts and increasing attention has been given lately to the unparalleled scale of food waste in the food supply chain worldwide. An initiative aiming to reduce food waste was tested at the School of Agriculture canteen (University of Lisbon, Portugal). The "Clean dish, clean conscience!" initiative consisted of a simple and inexpensive education campaign to raise awareness of reducing plate waste, by establishing the connection between food waste and personal behaviour. As a first stage plate waste from canteen users was measured over a 10 day period. After this period, a waste consumption index and per capita waste consumption were calculated to evaluate the level of satisfaction of the consumer and the related concern about food wastage, and was classified as Bad. After this first stage it was concluded that the users did not have strong convictions about avoiding food waste. During the second stage of the project an education campaign was implemented with plate waste being monitored for a further 16 days to assess the effectiveness of the campaign. The approach consisted of displaying simple and affordable informative posters in strategic areas of the canteen with simple messages reminding not to accept food they knew they would not eat. This led to a mean reduction in the waste consumption index of ∼15%. A parallel action encouraging separation of organic and inorganic waste was implemented as well, with an active participation of >70% of the users. The initiative achieved its objective of reducing plate waste by raising awareness of the daily food waste problem at the institution's canteen and by suggesting "how-to" actions for reducing such waste. This study showed how avoidable waste can be reduced simply by making students aware of the topic of food waste. Simple strategies may be useful to improve behaviours and increase sustainability of the canteens at Universities although this proved to be only efficient with the collaboration of the canteen staff that needs solid education. From the results, a set of measures was presented to the University Social Services for adoption to ensure a permanent reduction of food waste and recyclables in the University canteens.

Pediatric inflammatory multisystemic syndrome in Brazil: sociodemographic characteristics and risk factors to death

Abstract Objective: To determine the incidence of MIS-C in Brazil, describe the clinical and sociodemographic characteristics of the pediatric population affected by MIS-C and compare mortality and lethality outcomes with isolated Covid-19 and MIS-C cases. Methods: Observational and retrospective cohort study of cases of MIS-C associated with Covid-19 in the Brazilian population between 04/01/2020 and 04/17/2021. Data from the Ministry of Health's epidemiological bulletin up to the 15th epidemiological week of 2021, were used. The analyzes were descriptive through absolute and relative frequencies. The significance level is 5% in Stata 16.0 package. Results: Between 04/01/2020 and 04/07/2021, 903 cases of MIS-C associated with Covid-19 were notified in Brazil, of which, the largest part (55.26%) were male, between 0 and 4 years old (45.29%), from the Southeast region (38.76%). The deaths (61; 6.7%) were higher in the female gender, between 0 and 4 years old (47.54%) and in the Southeast region (34.43%). It was identified that the risk of death by MIS-C related to Covid-19 is 5.29 (CI = 2.83; 9.87 and P-value = <0.001) times higher in adolescents from 15-19 years old than in other age groups when compared to 0-4 years old children. Also, the residency in North region was as risk factor to death (RR = 3.72, IC = 1.29; 10.74 e P-value = 0.008). Conclusion: In this study, despite the numbers showing more deaths from zero to 4 years old, the risk for teenagers is notably higher. In addition, Brazil's Northern region is a risk factor that reaffirms social inequality and poor access to health.

Assessment of the burden of caregiving for patients with chronic obstructive pulmonary disease.

OBJECTIVE: To determine the effect of chronic obstructive pulmonary disease (COPD) on the quality of life of caregivers. DESIGN AND METHODS: A cross-sectional study was carried out with forty-two COPD patients and their primary caregivers. Patients were assessed with the medical outcome survey short form (SF-36), the physical and mental component summary (PCS and MCS), Saint George's respiratory questionnaire (SGRQ), 6-min walking test, and spirometric and blood gas measurements. Caregivers were assessed using the medical outcome survey short form (SF-36), the physical and mental component summary (PCS and MCS), the 5-point Likert scale for measuring caregiver/patient relationships and the caregiver burden scale (CB scale). RESULTS: The majority of caregivers were female (85.3%), married (59%) and had low levels of income and schooling. The mean age was 51.6+/-16 years. Mean caregiver PCS and MCS scores were 45.9+/-10 and 46+/-12, while the mean total burden score was 1.79+/-0.6. The regression analysis showed caregiver/patient relationship quality, caregiver MCS scores and patient PCS scores to be important predictors of burden and explained 63% of the variance. CONCLUSIONS: COPD causes a significant impact on the quality of life of caregivers. The two most important predictors of COPD burden are the relationship between caregivers and patients and caregiver MCS scores.

Maintenance of the Results of Stage II Lower Limb Lymphedema Treatment after Normalization of Leg Size.

OBJECTIVE: The aim of this study was to identify strategies to transfer responsibility of the maintenance of the results of lymphedema treatment to the patient. METHODS: Maintenance of the reduction of edema was evaluated in a prospective clinical trial in patients with Stage II leg lymphedema. Twenty-one lymphedematous lower limbs were evaluated in Clínica Godoy in 2014 and 2016. The evaluation was done by volumetry at baseline and weekly thereafter for volume control. Patients wore Venosan® cotton 20/30 and 30/40 mmHg elastic compression stockings followed by a custom-made inelastic stocking made of grosgrain fabric. The Friedman test for multiple comparisons and Conover post hoc test were used for statistical analysis with an alpha error of 5%. RESULTS: On comparing leg volume changes using the different types of stockings, the 20/30 mmHg elastic compression stockings failed in the first week to maintain the volume reductions but the 30/40 mmHg compression stockings did not allow significant increases in volume (p value > 0.05). During one week, the grosgrain stocking reduced leg volumes to baseline values (p value = 0.24). CONCLUSION: Higher compression of elastic stockings is better than lower compression but the inelastic grosgrain stocking is even better than both to maintain the results.

Trends in bariatric surgeries in the Brazilian Federative Units, 2009-2019: a descriptive study / Tendências das cirurgias bariátricas nas Unidades Federativas brasileiras, 2009-2019: um estudo descritivo

ABSTRACT Objective: our objective is to describe the epidemiological distribution of hospitalizations and postoperative deaths, as well as the trends of bariatric surgeries performed by SUS in all Brazilian federative units (FUs) from an analysis of the period from 2009 to 2019. Methods: This is an observational, descriptive ecological time-series study with quantitative and descriptive analysis, based on secondary data. The period analyzed was from 2009 to 2019. We collected, from DATASUS, data from obese men and women who were hospitalized after undergoing bariatric surgery. Prais-Winsten regression was performed to identify the trends. Results: In the period, 83,829 bariatric surgeries were performed, of which 161 resulted in death, representing 0.19% of the procedures. We found an increasing trend in the number of surgeries for Brazil (β=0.04; p<0.001), but 11 FUs showed a stationary trend and three, decreasing ones (six UFs did not have enough data to enter the analysis). In the North and Northeast regions, stationary trends prevailed, while in the Center-West, the decreasing trends, and in the South and Southeast, the increasing ones. Conclusions: we found an evident disparity between regions, suggesting deficiencies in access to health. By demonstrating which FUs and demographic characteristics have the lowest rates of surgeries, our study is able to direct public policies towards a more egalitarian Brazilian public health.

RESUMO Objetivo: nosso objetivo é descrever a distribuição epidemiológica das internações e óbitos pós-operatórios, bem como as tendências das cirurgias bariátricas realizadas pelo SUS em todas as unidades federativas (UFs) brasileiras a partir de uma análise do período de 2009 a 2019. Métodos: trata-se de um estudo observacional descritivo ecológico de série temporal com análise quantitativa e descritiva, com base em dados secundários. O período analisado foi de 2009 a 2019. Coletamos, no DATASUS, dados de homens e mulheres que possuem obesidade e foram internados após terem sido submetidos à cirurgia bariátrica. A regressão de Prais-Winsten foi utilizada para identificar as tendências. Resultados: no período, 83.829 cirurgias bariátricas foram realizadas, tendo 161 evoluído para óbitos, o que representa 0,19% dos procedimentos. Encontramos uma tendência crescente no número de cirurgias para o Brasil (β=0,04; p<0,001), mas 11 UFs apresentaram tendência estacionária e três, decrescente (seis UFs não tinham dados suficientes para entrar na análise). Nas regiões Norte e Nordeste prevaleceram tendências estacionárias, enquanto no Centro-Oeste, as decrescentes, e no Sul e Sudeste, as crescentes. Conclusões: encontramos uma evidente disparidade entre as regiões, sugerindo deficiências de acesso à saúde. Ao demonstrar quais UFs e características demográficas apresentam menores índices de cirurgias, nosso estudo é capaz de direcionar políticas públicas para uma saúde pública brasileira mais igualitária.

Analysis of factors associated with excess weight in school children. / Análise dos fatores associados ao excesso de peso em escolares.

OBJECTIVE: To determine the prevalence of overweight and obesity in schoolchildren aged 10 to 16 years and its association with dietary and behavioral factors. METHODS: Cross-sectional study that evaluated 505 adolescents using a structured questionnaire and anthropometric data. The data was analyzed through the T Test for independent samples and Mann-Whitney Test to compare means and medians, respectively, and Chi2 Test for proportions. Prevalence Ratio (RP) and the 95% confidence interval was used to estimate the degree of association between variables. The logistic regression was employed to adjust the estimates to confounding factors. The significance level of 5% was considered for all analysis. RESULTS: Excess weight was observed in 30.9% of the schoolchildren: 18.2% of overweight and 12.7% of obesity. There was no association between weight alterations and dietary/behavioral habits in the bivariate and multivariate analyses. However, associations were observed in relation to gender. Daily consumption of sweets [PR=0.75 (0.64-0.88)] and soft drinks [PR=0.82 (0.70-0.97)] was less frequent among boys; having lunch daily was slightly more often reported by boys [OR=1.11 (1.02-1.22)]. Physical activity practice of (≥3 times/week) was more often mentioned by boys and the association measures disclosed two-fold more physical activity in this group [PR=2.04 (1.56-2.67)] when compared to girls. Approximately 30% of boys and 40% of girls stated they did not perform activities requiring energy expenditure during free periods, with boys being 32% less idle than girls [PR=0.68 (0.60-0.76)]. CONCLUSIONS: A high prevalence of both overweight and obesity was observed, as well as unhealthy habits in the study population, regardless of the presence of weight alterations. Health promotion strategies in schools should be encouraged, in order to promote healthy habits and behaviors among all students.

Preoperative preparation of a patient with grade II leg Lymphedema for his third hip replacement surgery.

INTRODUCTION: The treatment of lymphedema remains a challenge to modern medicine, due to the characteristics of the disease. CASE PRESENTATION: Report on the case of a 75-year-old patient with lower limb lymphedema for treatment prior to surgery. At age 45, he made the first hip replacement surgery in the left leg. One year later he performed the same surgery on the right leg. At that time his legs had slight ankle edema mainly of the left leg and the entire left leg was affected by lymphedema. At 68 years old the patient returned to the surgeon, who indicated a third surgery to replace the left hip prosthesis. The patient was evaluated by bioimpedance, which measured the volumes of right and left legs at 5.52 and 7.24l, respectively. Five days of intensive treatment were proposed using Mechanical Lymphatic Therapy (RAGodoy®), Manual Lymphatic Therapy and compression therapy with a grosgrain stocking for 24h per day. On the fifth day, there was significant improvement in the volume (right leg 4.45l and left leg 5.57l). DISCUSSION: In this case report intensive treatment was used to reduce the volume of leg edema prior to a surgery to replace a hip prosthesis in a patient with grade II leg lymphedema. Small positive and negative changes, which are common in the evolution of this type of case but the end result was a total reduction of the edema. CONCLUSION: The patient underwent surgery to replace the prosthesis after total reduction of edema.

Tramadol wound infiltration is not different from intravenous tramadol in children: a randomized controlled trial.

STUDY OBJECTIVE: The purpose of this trial was to assess if tramadol wound infiltration is superior to intravenous (IV) tramadol after minor surgical procedures in children because tramadol seems to have local anesthetic-like effect. DESIGN: Randomized double-blind controlled trial. SETTING: Postanesthesia care unit. PATIENTS: Forty children, American Society of Anesthesiologists physical status I or II, scheduled to elective inguinal hernia repair. INTERVENTIONS: Children were randomly distributed in 1 of 2 groups: IV tramadol (group 1) or subcutaneous infiltration with tramadol (group 2). At the end of the surgery, group 1 received 2 mg/kg tramadol (3 mL) by IV route and 3-mL saline into the surgical wound; group 2 received 2 mg/kg tramadol (3 mL) into the surgical wound and 3-mL saline by IV route. MEASUREMENTS: In the postanesthesia care unit, patients were evaluated for pain intensity, nausea and vomiting, time to first rescue medication, and total rescue morphine and dipyrone consumption. MAIN RESULTS: Pain scores measured during the postanesthesia recovery time were similar between groups. Time to first rescue medication was shorter, but not statistically significant in the IV group. The total dose of rescue morphine and dipyrone was also similar between groups. CONCLUSIONS: We concluded that tramadol was effective in reducing postoperative pain in children, and there was no difference in pain intensity, nausea and vomiting, or somnolence regarding IV route or wound infiltration.

Deciphering the impact of uncertainty on the accuracy of large wildfire spread simulations.

Predicting wildfire spread is a challenging task fraught with uncertainties. 'Perfect' predictions are unfeasible since uncertainties will always be present. Improving fire spread predictions is important to reduce its negative environmental impacts. Here, we propose to understand, characterize, and quantify the impact of uncertainty in the accuracy of fire spread predictions for very large wildfires. We frame this work from the perspective of the major problems commonly faced by fire model users, namely the necessity of accounting for uncertainty in input data to produce reliable and useful fire spread predictions. Uncertainty in input variables was propagated throughout the modeling framework and its impact was evaluated by estimating the spatial discrepancy between simulated and satellite-observed fire progression data, for eight very large wildfires in Portugal. Results showed that uncertainties in wind speed and direction, fuel model assignment and typology, location and timing of ignitions, had a major impact on prediction accuracy. We argue that uncertainties in these variables should be integrated in future fire spread simulation approaches, and provide the necessary data for any fire model user to do so.

Probabilistic fire spread forecast as a management tool in an operational setting.

BACKGROUND: An approach to predict fire growth in an operational setting, with the potential to be used as a decision-support tool for fire management, is described and evaluated. The operational use of fire behaviour models has mostly followed a deterministic approach, however, the uncertainty associated with model predictions needs to be quantified and included in wildfire planning and decision-making process during fire suppression activities. We use FARSITE to simulate the growth of a large wildfire. Probabilistic simulations of fire spread are performed, accounting for the uncertainty of some model inputs and parameters. Deterministic simulations were performed for comparison. We also assess the degree to which fire spread modelling and satellite active fire data can be combined, to forecast fire spread during large wildfires events. RESULTS: Uncertainty was propagated through the FARSITE fire spread modelling system by randomly defining 100 different combinations of the independent input variables and parameters, and running the correspondent fire spread simulations in order to produce fire spread probability maps. Simulations were initialized with the reported ignition location and with satellite active fires. The probabilistic fire spread predictions show great potential to be used as a fire management tool in an operational setting, providing valuable information regarding the spatial-temporal distribution of burn probabilities. The advantage of probabilistic over deterministic simulations is clear when both are compared. Re-initializing simulations with satellite active fires did not improve simulations as expected. CONCLUSION: This information can be useful to anticipate the growth of wildfires through the landscape with an associated probability of occurrence. The additional information regarding when, where and with what probability the fire might be in the next few hours can ultimately help minimize the negative environmental, social and economic impacts of these fires.

Axillary ultrasound and fine-needle aspiration in preoperative staging of axillary lymph nodes in patients with invasive breast cancer.

OBJECTIVE: To propose an algorithm to determine the necessity for ultrasonography-guided fine-needle aspiration (US-FNA) in preoperative axillary lymph node staging of patients with invasive breast cancer. MATERIALS AND METHODS: Prospective study developed at National Cancer Institute. The study sample included 100 female patients with breast cancer referred for axillary staging by US-FNA. RESULTS: The overall US-FNA sensitivity was set at 79.4%. The positive predictive value was calculated to be 100%, and the negative predictive value, 69.5%. The US-FNA sensitivity for lymph nodes with normal sonographic features was 0%, while for indeterminate lymph nodes it was 80% and, for suspicious lymph nodes, 90.5%. In the assessment of invasive breast tumors stages T1, T2 and T3, the sensitivity was respectively 69.6%, 83.7% and 100%. US-FNA could avoid sentinel node biopsy in 54% of cases. CONCLUSION: Axillary ultrasonography should be included in the preoperative staging of all patients with invasive breast cancer. The addition of US-FNA in cases of lymph nodes suspicious for malignancy may prevent more than 50% of sentinel lymphadenectomies, significantly shortening the time interval to definitive therapy.

OBJETIVO: Propor um algoritmo de quando a punção aspirativa por agulha fina guiada por ultrassonografia (PAAF-US) deve ser utilizada no estadiamento linfonodal axilar pré-operatório em pacientes com câncer de mama invasivo. MATERIAIS E MÉTODOS: Estudo prospectivo conduzido no Instituto Nacional de Câncer. Participaram da amostra 100 pacientes do sexo feminino portadoras de câncer de mama que foram direcionadas para estadiamento axilar por meio de PAAF-US. RESULTADOS: A sensibilidade geral da PAAF-US foi estabelecida em 79,4%. O valor preditivo positivo foi calculado em 100% e o valor preditivo negativo, em 69,5%. A sensibilidade da PAAF-US para linfonodos com características ultrassonográficas normais foi 0%, ao passo que para os indeterminados foi 80% e para os suspeitos foi 90,5%. Na avaliação de tumores de mama invasivos estádios T1, T2 e T3, as sensibilidades foram 69,6%, 83,7% e 100%, respectivamente. A realização da PAAF-US conseguiu evitar a biópsia do linfonodo sentinela em 54% dos casos. CONCLUSÃO: A ultrassonografia axilar deve estar inclusa no estadiamento pré-operatório de todas as pacientes com câncer de mama invasivo. A adição da PAAF-US nos linfonodos com características morfológicas suspeitas de malignidade pode evitar mais de 50% das linfadenectomias sentinelas, proporcionando abreviação importante do intervalo de tempo até a terapêutica definitiva.