Sex-based differences and risk of recurrence in patients with atrial fibrillation undergoing pulmonary vein isolation.

INTRODUCTION: Studies suggest increased likelihood of atrial fibrillation (AF) recurrence after catheter ablation (CA) in women than in men, indicating that sex may be an independent risk factor for recurrence. Nevertheless, the influence of sex on AF recurrence and underlying mechanisms remains unclear. METHODS: Retrospective, single-centre study including patients undergoing AF CA between 2017 and 2021. Late recurrence (LR) was defined as AF recurrence ≥90 days after ablation, whereas early recurrence (ER) occurred within 90 days. RESULTS: 656 patients (32% women) were included, with a median follow-up period of 26 months. Compared to men, women undergoing CA were older, had higher body mass indexes, and had higher rates of hypertension, thyroid dysfunction, and valvular disease. Women also had increased LR risk after CA (HR 1.76, 95% CI [1.19, 2.59]). A time-split multivariable analysis at one year of follow-up showed no difference in LR risk during the first 12 months after CA (HR 1.19, 95% CI [0.73, 1.94]); however, LR risk increased in women (HR 2.90, 95% CI [1.68, 5.01]) after 12 months. In a sex-stratified analysis, coronary calcium score (CCS) >100 was associated with increased LR risk in men (HR 1.81, 95% CI [1.06, 3.08]), but not in women. Cardiac adipose tissue volume was not associated with increased LR risk. CONCLUSIONS: Fewer women underwent CA than men and LR was more frequent in women, particularly one year after the procedure. CCS was associated with increased LR risk in men.

On the Impact of Synchronous Electrocardiogram Signals for Heart Sounds Segmentation.

In this paper we study the heart sound segmentation problem using Deep Neural Networks. The impact of available electrocardiogram (ECG) signals in addition to phonocardiogram (PCG) signals is evaluated. To incorporate ECG, two different models considered, which are built upon a 1D U-net - an early fusion one that fuses ECG in an early processing stage, and a late fusion one that averages the probabilities obtained by two networks applied independently on PCG and ECG data. Results show that, in contrast with traditional uses of ECG for PCG gating, early fusion of PCG and ECG information can provide more robust heart sound segmentation. As a proof of concept, we use the publicly available PhysioNet dataset. Validation results provide, on average, a sensitivity of 97.2%, 94.5%, and 95.6% and a Positive Predictive Value of 97.5%, 96.2%, and 96.1% for Early-fusion, Late-fusion, and unimodal (PCG only) models, respectively, showing the advantages of combining both signals at early stages to segment heart sounds.Clinical relevance- Cardiac auscultation is the first line of screening for cardiovascular diseases. Its low cost and simplicity are especially suitable for screening large populations in underprivileged countries. The proposed analysis and algorithm show the potential of effectively including electrocardiogram information to improve heart sound segmentation performance, thus enhancing the capacity of extracting useful information from heart sound recordings.

The impact of fast-growing eucalypt plantations on C emissions in tropical soil: effect of belowground and aboveground C inputs.

Planted forest soils can have great potential for CO2-C sequestration, mainly due to belowground C inputs, which impact deep soil C (DSC) accumulation. However, there are still gaps in understanding the CO2 emission dynamics in eucalypt plantations. Therefore, we used isotopic techniques to investigate the dynamics of the soil surface CO2-C flux and CO2-C concentration with depth for a eucalypt plantation influenced by different C inputs (above- and belowground). The gas evaluations were carried in depth the root to valuation of root priming effect (RPE) was calculated. In addition, measurements of the plant (C-fine root and C-litterfall) and soil (total organic carbon - TOC, total nitrogen - TN, soil moisture - SM, and soil temperature - ST) were performed. After planting the eucalypt trees, there was an increase in the soil surface CO2-C flux with plant growth. Root growth contributed greatly to the soil surface CO2-C flux, promoting greater surface RPE over time. In comparison to the other factors, SM had a greater influence on litterfall decomposition and root respiration. It was not possible to detect losses in TOC and TN in the different soil layers for the 31-month-old eucalypt. However, the 40-month-old eucalypt showed a positive RPE with depth, indicating possible replacement of DSC ("old C") by rhizodeposition-C ("new C") in the soil. Thus, in eucalyptus plantations, aboveground plant growth influences CO2 emissions on the soil surface, while root growth and activity influence C in deeper soil layers. This information indicates the need for future changes in forest management, with a view to reducing CO2 emissions.

Enhancing performance: unveiling the physiological impact of submaximal and supramaximal tests on mixed martial arts athletes in the -61 kg and -66 kg weight divisions.

This study delves into the intricate details of Mixed Martial Arts (MMA) by examining key variables such as maximal oxygen uptake (VO2 peak), aerobic energy (EAER), anaerobic energy (EAN), and accumulated O2 deficit (DOA). By investigating associations and comparing athletes in the -61 kg bantamweight and -66 kg featherweight weight divisions, we aim to shed light on their physiological characteristics. The sample consisted of 20 male volunteers separated into two paired groups: ten athletes in the category up to 61 kg (age: 27.7 ± 5.9 years old, height: 170.9 ± 3.4 cm, body mass: 72.8 ± 1.4 kg, fat percentage: 9.5% ± 3.0%, professional experience: 7.5 ± 7.1 years) and ten athletes up to 66 kg (age: 27.6 ± 2.9 years old, height: 176.0 ± 5.5 cm, body mass: 77.0 ± 1.5 kg, fat percentage: 7.85% ± 0.3%, professional experience: 5.5 ± 1.5 years). Remarkably, our findings revealed striking similarities between the two weight divisions. Furthermore, we discovered a negative correlation between VO2 peak and the number of MMA fights, indicating a potential impact of professional experience on aerobic capacity (r = -0.65, p < 0.01). Additionally, the number of fights exhibited negative correlations with anaerobic energy (r = -0.53, p < 0.05) and total energy cost (r = -0.54, p < 0.05). These results provide valuable insights for designing training programs in the context of MMA. While training both weight divisions together can be beneficial, it is equally crucial to incorporate specific weight-class-focused training to address each division's unique physical demands and requirements.

Influence of Advancing Biological Maturation on Aerobic and Anaerobic Power and on Sport Performance of Junior Rowers: A Longitudinal Study.

Background: Researches are linking Biological Maturation (BM) with the performance of adolescent rowers from both genders. Despite this, there is still not enough information about the influence of BM advancement correlating to sports, aerobic and anaerobic performance in adolescent athletes at the sport modality rowing. Objective: Investigate the influence of Biological Maturation on sports performance and aerobic and anaerobic power in adolescent rowing athletes. Methods: A longitudinal observational study, developed over 3 years, with a sample of 52 adolescents, rowing athletes, of both genders (61% male and 39% female) mean age of 16.0 ± 0.5 years old at the start and 18.4 ± 0.5 years old at the end of the study. Analysis was performed once a year. BM was evaluated through maturational groups generated from Age Peak Height Velocity; maximum aerobic power [VO2Max (ml/kg/min)] and mean anaerobic power (Watts) through the ergometer test (indoor rowing); peak anaerobic power (Watts) through a mathematical model derived from competition time, to determine sports performance analyzed the race time during world championship tryouts. Results: The advancement of BM influenced the reduction of the test time and increase of the mean anaerobic power (Watts) in indoor rowing (η2p > 0.36, p < 0.05), as well as an improvement in performance in sports competition (η2p > 0.35, p < 0.05). However, the advancement of BM did not affect VO2Max (ml/kg/min) in young elite rowing athletes of both sexes (p > 0.05). Conclusion: Advances in biological maturation have been shown to influence the anaerobic and sports performance (reduction of the execution time in 2,000-m) of adolescent rowing athletes of both genders.

Cold Atmospheric Plasma Apoptotic and Oxidative Effects on MCF7 and HCC1806 Human Breast Cancer Cells.

Breast cancer (BC) is a malignant neoplasia with the highest incidence and mortality rates in women worldwide. Currently, therapies include surgery, radiotherapy, and chemotherapy, including targeted therapies in some cases. However, treatments are often associated with serious adverse effects. Looking for new options in BC treatment, we evaluated the therapeutic potential of cold atmospheric plasma (CAP) in two cell lines (MCF7 and HCC1806) with distinct histological features. Apoptosis seemed to be the most prevalent type of death, as corroborated by several biochemical features, including phosphatidylserine exposure, the disruption of mitochondrial membrane potential, an increase in BAX/BCL2 ratio and procaspase 3 loss. Moreover, the accumulation of cells in the G2/M phase of the cell cycle points to the loss of replication ability and decreased survival. Despite reported toxic concentrations of peroxides in culture media exposed to plasma, intracellular peroxide concentration was overall decreased accompanying a reduction in GSH levels shortly after plasma exposure in both cell lines. In HCC1806, elevated nitric oxide (NO) concentration accompanied by reduced superoxide levels suggests that these cells are capable of converting plasma-derived nitrites into NO that competes with superoxide dismutase (SOD) for superoxide to form peroxinitrite. The concomitant inhibition of the antioxidative activity of cells during CAP treatment, particularly the inhibition of cytochrome c oxidase with sodium azide, synergistically increased plasma toxicity. Thus, this in vitro research enlightens the therapeutic potential of CAP in the treatment of breast cancer, elucidating its possible mechanisms of action.

Abnormal average increase in sea surface temperature may promote the first documented mortality event of a marine sponge in the Southeastern Brazil / Aumento na temperatura média do mar pode ter causado o primeiro evento registrado de mortalidade de esponjas marinhas no Sudeste do Brasil

Abstract Frequent heat waves and mass mortality events on marine biota are positively correlated to ocean warming. Although literature has indicated some species of marine sponges, and some oceanic regions, like the Brazilian Exclusive Economic Zone, may be less affected or seem to be more resilient under future scenarios of climate changes, few studies have focused on the species responses on the climate change issue along Brazilian coast. This paradigm was undone throughout 2019 after an exceptional average increase of 2 °C in the sea surface temperature (SST) and on precipitation values since 2015 at Ilha Grande Bay (IGB, SE Brazil). The combination of SST and precipitation average increase possibly favored an environmental context for the unprecedented strong population decline and mass mortality rate of the marine sponge species Desmapsamma anchorata in the austral spring. The species used to be one of the most frequent benthic species at IGB however it was only recorded in 41.7% sites (n = 12). From 162 individuals recorded at Abraãozinho along 180 m rocky shore, 83 individuals (51.2%) were healthy, 74 (45.7%) were intensively covered by cyanobacteria and locally bleached, and five (3.1%) were completely bleached or died. Desmapsamma anchorata population deterioration in a biogeographic transition zone (Rio de Janeiro state) may reflect a shift in the marine community of IGB, opening space for opportunistic species establishment and coverage increase, since IGB has a high species turnover. The three-dimensionality, the shelter for several species, the high competitive ability and the potential to indicate polluted or not polluted areas make D. anchorata a key species for IGB monitoring in a climate change scenario.

Resumo Ondas de calor e eventos de mortalidade em massa da biota marinha são cada vez mais frequentes e estão positivamente correlacionados ao aquecimento do oceano. Embora a literatura tenha indicado que algumas espécies de esponjas marinhas e algumas regiões oceânicas, como a Zona Econômica Exclusiva do Brasil, podem ser menos afetadas ou serem mais resilientes em cenários futuros de mudanças climáticas, poucos estudos focaram na resposta das espécies à problemática das mudanças climáticas na costa brasileira. Esse paradigma foi desfeito em 2019 após um excepcional aumento médio de 2 °C na temperatura da superfície do mar e nos valores de precipitação, desde 2015 na Baía da Ilha Grande (BIG, SE Brasil). Essa combinação de fatores possivelmente favoreceu um contexto ambiental sem precedentes, levando ao forte declínio populacional e alta taxa de mortalidade da esponja marinha Desmapsamma anchorata na primavera austral. A espécie costuma ser uma das espécies bentônicas mais frequentes na BIG, mas só foi observada em 41,7% dos sítios (n = 12). De 162 indivíduos registrados em Abraãozinho ao longo de 180 m de costão rochoso, 83 indivíduos (51,2%) estavam saudáveis, 74 (45,7%) estavam cobertos por cianobactéria e localmente branqueados e cinco (3,1%) estavam completamente branqueados ou mortos. A deterioração da população de D. anchorata na zona de transição biogeográfica (estado do Rio de Janeiro) pode refletir em uma alteração na comunidade marinha da BIG, abrindo espaço para o estabelecimento de espécies oportunistas, uma vez que a BIG possui alto turnover. A tridimensionalidade, o abrigo a diversas espécies, a alta capacidade competitiva e o potencial de indicar áreas poluídas ou não tornam D. anchorata uma espécie chave no monitoramento da BIG em um cenário de mudanças climáticas.

A regulamentação das parcerias público-privadas como tática para aprofundar a privatização das universidades federais e do aparato público de ciência e tecnologia no Brasil / The regulation of public-private partnerships as a tactic to deep in the privatization of federal universities and the public science and technology apparatus in Brazil

O presente texto traz reflexões sobre as novas regulamentações que incidem sobre a gestão da educação superior pública e do aparato público de ciência, tecnologia e inovação. Trazemos, neste artigo, parte dos resultados de um estudo documental realizado sobre normas e legislações federais que afetam as universidades federais brasileiras no século XXI. Nosso percurso analítico compreende que os dispositivos legais que regulamentam as parcerias público-privadas, e principalmente o novo Marco de Ciência, Tecnologia e Inovação (Lei n.º 13243/2016), são táticas que aprofundam o processo de privatização da política educacional superior. Esse movimento de contrarreforma do Estado sobre o financiamento impacta na autonomia universitária e altera o papel social desempenhado pelas universidades federais brasileiras, colocando-as ainda mais a serviço do mercado. Por isso, essas modificações ocorridas no século XXI representam o aprofundamento e o aprimoramento da ofensiva neoliberal às políticas sociais, em específico as políticas de educação superior e de ciência e tecnologia.

This text shares reflections on the new regulations that affect the management of public higher education and the public apparatus of science, technology and innovation. Based on documentary study on federal rules and laws that affect Brazilian federal universities since the beginning of the 21st century, our analytical path understands that the legal devices that regulate public-private partnerships, and especially the new Framework for Science, Technology, and Innovation (Law 13.243/2016), are tactics that deepen the privatization process of higher education policy. This process keeps the counter-reform of the State on financing that impacts on the university autonomy and change the social role played by Brazilian federal universities, placing the mat the service of market needs. For this reason, these changes that occurred in the 21st century represent the deepening of the direction and improvement of the eoliberal offensive to social policies, in this case, Brazilian public universities.

Effects of bovine somatotropin on productive performance and Minas Padrão cheese.

We aimed to evaluate the effects of two brands of bST (bovine somatoropin) on productive performance and on Minas Padrão cheese yield. Fifteen Girolando cows with more than 60 days of lactation were used. The animals were distributed in a randomized block design, according to days in milk, with three treatments (somatotropin A, somatotropin B, and control). The animals received a balanced diet with commercial concentrate and corn silage as roughage. It was measured milk yield and composition, dry matter intake, body condition score (BCS), and feeding behavior; it was compared by Tukey at 5.0% of significance level. Physical-chemical composition of Minas Padrão cheese was obtained from the different treatments, was also measured, being evaluated in a completely randomized design, and compared by Tukey at 1.0% of significance level. The dry matter intake per body weight lower in control treatment (p < 0.05) was equal to 2.85, somatotropin A was equal to 3.17, and somatotropin B was equal to 3.17. Animals that received bST showed higher milk production (p < 0.05), with control being 17.56 kg/day, somatotropin A 21.12 kg/day, and somatotropin B 20.69 kg/day. The physical-chemical composition of milk showed significant differences (p < 0.05) for the fat, protein, and dry extract contents. The somatotropin applications also influenced the BCS (p < 0.05) and the feeding behavior in time for total intake, time spent with rumination, and idleness. The application of bST increased milk yield and technical and economic yields of Minas Padrão cheese did not show significant differences between treatments.

Suppression of tumorigenicity 2 after exercise: a systematic review.

Exercise is a pivotal physiological activity, associated with benefits. Whilst the importance of physical activity is consensual along different steps of the cardiovascular (CV) continuum, there has been interest in assessing the CV adaptations to vigorous exercise. Indeed, exercise can be associated with increases in cardiac biomarkers, though the scope of this observation remains elusive. Interleukin 1 receptor related protein, Suppression of tumorigenicity 2 (ST2) is a biomarker related to the pathophysiology of fibrosis, having shown promise in the study of heart failure. Knowledge of ST2 kinetics could improve understanding of the mechanistic pathways related to CV adaptations to exercise. To assess the current state-of-the-art concerning ST2 levels after exercise in healthy individuals. A systematic review was carried out on three databases (Pubmed, ISI Web of Science and Scopus), up to October 2020, using the queries "ST2" or "ST-2" + "exercise" or "running". A total of six studies were included in the review, encompassing 349 subjects (73% male gender) in which ST2 was assessed. Most studies reported increases in ST2 levels after exercise. Three studies, encompassing a total of 219 individuals, described a cut-off level of 35 ng/dL for ST2. In these, 92.7% of subjects had ST2 levels above this cut-off after exercise (running in all studies). Most studies report increased levels of ST2 after exercise, with an important number of individuals exceeding the 35 ng/dL threshold. Given the small number of individuals represented and the lack of imaging data and long-term follow-up, further prospective larger studies should target this.

Hyperinflammation in COVID-19 Obese Patients Treated With Tocilizumab: A Successful Case Series.

The cytokine storm syndrome has been suggested as a mechanism in the pathophysiology of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; COVID-19 [coronavirus disease 2019]) infection. Drugs such as tocilizumab, an interleukin-6 antagonist, have shown good results in other scenarios of hyperinflammatory state and might also be effective in COVID-19 disease. However, the best dosing regimen and the timing of infusion is currently unknown, specifically in obese patients. We report the first cases of tocilizumab administration in obese patients during the first days of COVID-19 worsening hypoxemia. This infusion was not adjusted by weight, following the manufacturer maximal dose limit. We kept a strict monitoring for possible infections, prior and during the treatment. All patients showed good improvements on chest-computed tomography images and oxygenation and were discharged from hospital shortly after, without complications or intubation. This case series highlights that tocilizumab seems to be effective to treat hyperinflammation of critical COVID-19 obese patients, even when the infusion of the ideal dose is not feasible to be administered. It also shows the importance of early timing in the decision to treat and the relevance of infections exclusion prior to the induction of immunosuppression by tocilizumab.

Plasma activated media and direct exposition can selectively ablate retinoblastoma cells.

A new therapy based on atmospheric plasma, the fourth state of matter, has raised the medical community's attention by circumventing many undesirable effects of old anticancer treatments. This work aimed to evaluate the effect, selectivity, and mechanisms of action of cold atmospheric plasma (CAP) in human retinoblastoma cells. An electronic device was designed to generate CAP in the open air, 2 mm above seeded cell cultures. Three approaches were performed: direct use of CAP, plasma-activated media (PAM), and conditioned media (CM). Timely-resolved output voltage measurement, emission spectroscopy, and quantification of reactive species (RS) of PAM were performed. To evaluate cytotoxicity and selectivity, similarly treated Y79, fibroblasts HFF1, and retinal RPE-D407 cells were assessed. After 60 s of direct CAP treatment, the metabolic activity of retinoblastoma cells decreased more than 50%, mainly due to apoptosis, while HFF1 and RPE-D407 remained viable. Similar results were obtained with indirect treatment (PAM and CM). Cell survival was reduced, and cells accumulated in S and G2/M phases; however, no DNA strand breaks were detected. Regarding RS, plasma increased extracellular and intracellular concentrations of peroxides and nitric oxide, despite glutathione activation and lack of success in reverting cytotoxicity with some RS inhibitors. RS increase comes in two timely distant waves, the first one originating from the plasma itself with secondary solubilization and passive diffusion, the second wave deriving from the mitochondrion. The addition of low doses of carboplatin to CAP-treated cells resulted in a significant increase in cytotoxicity compared with either regimen alone. Additionally, maximal antiangiogenic effects were obtained with 60 s of plasma exposure. Direct and indirect treatment with CAP might be a selective therapy with the potential to target tumour cells and supporting the microenvironment.

Urgent/emergency surgery during COVID-19 state of emergency in Portugal: a retrospective and observational study.

Background: SARS-CoV-2 virus changed society's behaviour. Population was advised to reduce unnecessary heath care use to accommodate urgent cases and daily increase of COVID-19 patients. Health care facilities faced huge challenges, having to readjust their response to preserve good quality of care. In Portugal, a significant reduction in the number of admissions to the Emergency Department (ED) was reported all over the country, however the impact on the dynamics of undeferrable surgery remains to be reported. This study compares the volume and characteristics of urgent/emergency surgery during the 2020 COVID-19 pandemic with the homologous period in 2019, chronologically illustrating the national evolution of new COVID-19 cases and the social and hospital containment response. Methods: A retrospective observational study was conducted in a tertiary hospital center located in the most affected region by COVID-19 in Portugal. Medical records of patients who underwent urgent/emergency surgery between March 1st and May 2nd of both 2020 and 2019 were examined and the volume of surgeries were compared. Also, daily national updates from Portuguese Directorate-General for Health were analysed. Results: During the COVID-19 pandemic approximately 30% less patients underwent urgent/emergency surgery (99%CI = 0.18-0.61, p < 0.001). Waiting time for surgery showed no difference between both years (p = 0.068), but patients who did surgery during the 2020 pandemic had higher mortality rates than the ones who did it in 2019 (11.4% in 2020 and 5.9% in 2019, p = 0.001). Reduction in surgery volume was correlated with the increasing number of infected cases nationally. Conclusion: This study demonstrates decreasing numbers of urgent/emergency procedures during the COVID-19 pandemic that may be justified by the national growth number of infected cases. Preoperative mass screening strategy was implemented without compromising the efficiency of surgical service, but patients' mortality was higher. The importance of visiting the ED during COVID-19 pandemic for serious cases that cannot be managed in other settings should be highlighted.

Cold Atmospheric Plasma, a Novel Approach against Bladder Cancer, with Higher Sensitivity for the High-Grade Cell Line.

Antitumor therapies based on Cold Atmospheric Plasma (CAP) are an emerging medical field. In this work, we evaluated CAP effects on bladder cancer. Two bladder cancer cell lines were used, HT-1376 (stage III) and TCCSUP (stage IV). Cell proliferation assays were performed evaluating metabolic activity (MTT assay) and protein content (SRB assay). Cell viability, cell cycle, and mitochondrial membrane potential (Δψm) were assessed using flow cytometry. Reactive oxygen and nitrogen species (RONS) and reduced glutathione (GSH) were evaluated by fluorescence. The assays were carried out with different CAP exposure times. For both cell lines, we obtained a significant reduction in metabolic activity and protein content. There was a decrease in cell viability, as well as a cell cycle arrest in S phase. The Δψm was significantly reduced. There was an increase in superoxide and nitric oxide and a decrease in peroxide contents, while GSH content did not change. These results were dependent on the exposure time, with small differences for both cell lines, but overall, they were more pronounced in the TCCSUP cell line. CAP showed to have a promising antitumor effect on bladder cancer, with higher sensitivity for the high-grade cell line.

Food safety in global supply chains: A literature review.

This paper aimed to revisit the literature on food safety in global supply chains and analyze the evolution and contemporary challenges in this research field. It conducted a systematic literature review in two steps based on a selection of 178 articles. It analyzed safety in food supply chains using the Six T's Framework to evaluate food safety management. In the supply chain literature, traceability was the most studied element of the original framework. The research identified studies that have incorporated the topics of "tactics" and "targets" in their analysis of safety in supply chains. This article presented an expanded framework, a tool for categorizing research, and areas for advancement in the identification of quality indicators in global food chains for the current research agenda. The paper contributed theoretically to the discussion of safety elements in food supply chains and incorporated new elements into the originally conceived framework. Thus, it helped to delineate the research field and opened up an agenda for future research.

Fulminant acute hepatitis in pediatrics in Latin America and the Caribbean.

OBJECTIVE: The objective of this review was to investigate the epidemiology of Fulminant Acute Hepatitis in Latin America and the Caribbean and identify possible measures aimed at a better understanding and improvement of patient support. METHODS: We used 3 different researchers to investigate the topic of Fulminant Acute Hepatitis in pediatrics in papers published by Latin American and Caribbean authors in the PubMed and SciELO databases from 2000 to 2016. RESULTS: We found 2,879 articles in the databases searched. After selecting and excluding articles according to the study protocol, 68 remaining studies were obtained for analysis. A total of 1,265 cases of acute fulminant hepatitis were detected, with a predominance of females (42.9%), followed by males (39.4%), with no description of sex in 17.7% of the cases. The main cause was viral hepatitis, representing 45.1% of the cases. The hepatitis A virus was responsible for 34.7% of the total cases and 76.9% of the infectious causes. Of the total number of patients, 26.9% were described as idiopathic, and 11.5% had no cause. CONCLUSION: The preventable causes of Fulminant Acute Hepatitis include hepatitis viruses - primarily the hepatitis A virus - and poisoning. Active vaccination, basic sanitation, and public awareness can reduce the number of patients and, consequently, the costs of liver transplantation due to these causes.

Fulminant acute hepatitis in pediatrics in Latin America and the Caribbean

SUMMARY OBJECTIVE: The objective of this review was to investigate the epidemiology of Fulminant Acute Hepatitis in Latin America and the Caribbean and identify possible measures aimed at a better understanding and improvement of patient support. METHODS: We used 3 different researchers to investigate the topic of Fulminant Acute Hepatitis in pediatrics in papers published by Latin American and Caribbean authors in the PubMed and SciELO databases from 2000 to 2016. RESULTS: We found 2,879 articles in the databases searched. After selecting and excluding articles according to the study protocol, 68 remaining studies were obtained for analysis. A total of 1,265 cases of acute fulminant hepatitis were detected, with a predominance of females (42.9%), followed by males (39.4%), with no description of sex in 17.7% of the cases. The main cause was viral hepatitis, representing 45.1% of the cases. The hepatitis A virus was responsible for 34.7% of the total cases and 76.9% of the infectious causes. Of the total number of patients, 26.9% were described as idiopathic, and 11.5% had no cause. CONCLUSION: The preventable causes of Fulminant Acute Hepatitis include hepatitis viruses - primarily the hepatitis A virus - and poisoning. Active vaccination, basic sanitation, and public awareness can reduce the number of patients and, consequently, the costs of liver transplantation due to these causes.

RESUMO OBJETIVO: O objetivo desta revisão foi investigar a epidemiologia da hepatite aguda fulminante na América Latina e Caribe e identificar possíveis ações objetivando melhor compreensão e melhora do suporte desses pacientes. MÉTODOS: Pesquisou-se o tema hepatite aguda fulminante em pediatria, publicado por autores da América Latina e Caribe nas bases de dados PubMed e SciELO por três diferentes investigadores no período de 2000 a 2016. RESULTADOS: Foram encontrados 2.879 artigos nos bancos de dados pesquisados. Após seleção e exclusão de artigos de acordo com o protocolo de pesquisa, resultaram 68 estudos remanescentes para análise. Foram avaliados 1.265 casos com hepatite aguda fulminante, havendo predominância no sexo feminino (42,9%), seguido do masculino (39,4%), sendo que não houve a descrição de sexo em 17,7% dos casos. A principal causa foram as hepatites virais (HV), representando 45,1% dos casos. O vírus da hepatite A foi responsável por 34,7% do total de casos e por 76,9% das causas infecciosas. Do total de pacientes, 26,9% foram descritos como idiopáticos e 11,5% não tiveram causa descrita. CONCLUSÃO: As causas evitáveis de hepatite aguda fulminante incluem os vírus da hepatite — principalmente o vírus da hepatite A — e intoxicações. A vacinação ativa, o saneamento básico e a conscientização pública podem reduzir o número de doentes e, consequentemente, os custos com transplante hepático por essas causas.

Exploring the association between genetic and environmental factors and molar incisor hypomineralization: evidence from a twin study.

BACKGROUND: The etiology of molar-incisor hypomineralization (MIH) remains unknown. Studies indicate that it is multifactorial, and that genetic and environmental factors are involved. Research with twins provides important subsidy to investigate the Influence of genetics and environmental factors that act during pregnancy on the etiology of alterations. AIM: This cross-sectional study evaluated the agreement of molar incisor hypomineralization (MIH) between monozygotic and dizygotic twin pairs and the association with environmental factors. DESIGN: The sample consisted of 167 pairs of twins (8-15 years old), 94 monozygotic and 73 dizygotic. The parents answered a questionnaire on sociodemographic data and pre-, peri-, and postnatal health. A dental examination was performed by two calibrated examiners (Kappa ≥0.88) for MIH diagnosis, following the criteria proposed by the European Academy of Pediatric Dentistry in 2003. RESULTS: The prevalence of MIH was 29.3%. There was greater concordance of MIH between monozygotic twins for affected first molars and permanent incisors (P = 0.0012) and pairs of twins assessed (P = 0.0211). The presence of MIH was associated with family income between one and two wages (P = 0.009, prevalence ratio [PR] = 3.82, confidence interval [CI 95%] 1.40-10.44), above two wages (P = 0.007, PR = 4.60, 95% CI: 1.51-14.05), and gestational hemorrhage (P = 0.032, PR = 5.70, 95% CI: 1.16-28.14). CONCLUSIONS: The greater concordance in the diagnosis of MIH among monozygotic twins indicates a genetic influence, although environmental factors, such as family income and hemorrhage during pregnancy, are also associated with the occurrence of MIH.