Improving access to cancer clinical research in Brazil: recent advances and new opportunities. Expert opinions from the 4th CURA meeting, São Paulo, 2023.

Clinical research is the cornerstone of improvements in cancer care. However, it has been conducted predominantly in high-income countries with few clinical trials available in Brazil and other low-and-middle-income countries (LMIC). Of note, less than one-third of registered clinical trials addressing some of the most commonly diagnosed cancers (breast, lung and cervical) recruited patients from LMIC in the last years. The Institute Project CURA promoted the fourth CURA meeting, discussing barriers to cancer clinical research and proposing potential solutions. A meeting was held in São Paulo, Brazil, in June 2023 with representatives from different sectors: Brazilian Health Regulatory Agency (Anvisa), National Commission of Ethics in Research (CONEP), non-governmental organisations, such as the Latin American Cooperative Oncology Group, the Brazilian Society of Clinical Oncology (SBOC), Contract Research Organisations, pharmaceutical companies and investigators. A total of 16 experts pointed out achievements as shortening the time of regulatory processes involving Anvisa and CONEP, development of staff training programs, maintenance of the National Program of Oncological Attention (PRONON), and the foundation of qualified centres in North and Northeast Brazilian regions. Participants also highlighted the need to be more competitive in the field, which requires optimising ongoing policies and implementing new strategies as decentralisation of clinical research centres, public awareness campaigns, community-centered approaches, collaborations and partnerships, expansion of physicians-directed policies, exploring the role of the steering committee. Active and consistent reporting of the initiatives might help to propagate ongoing advances, increasing Brazilian participation in clinical cancer research. Engagement of all players is crucial to maintain continuous progress with further improvements in critical points including regulatory timelines and increments in qualified human resources which aligned with new educational initiatives focused on physicians and the general population will expand access to cancer clinical trials in Brazil.

Interoperable workflows by exchanging grid-based data between quantum-chemical program packages.

Quantum-chemical subsystem and embedding methods require complex workflows that may involve multiple quantum-chemical program packages. Moreover, such workflows require the exchange of voluminous data that go beyond simple quantities, such as molecular structures and energies. Here, we describe our approach for addressing this interoperability challenge by exchanging electron densities and embedding potentials as grid-based data. We describe the approach that we have implemented to this end in a dedicated code, PyEmbed, currently part of a Python scripting framework. We discuss how it has facilitated the development of quantum-chemical subsystem and embedding methods and highlight several applications that have been enabled by PyEmbed, including wave-function theory (WFT) in density-functional theory (DFT) embedding schemes mixing non-relativistic and relativistic electronic structure methods, real-time time-dependent DFT-in-DFT approaches, the density-based many-body expansion, and workflows including real-space data analysis and visualization. Our approach demonstrates, in particular, the merits of exchanging (complex) grid-based data and, in general, the potential of modular software development in quantum chemistry, which hinges upon libraries that facilitate interoperability.

Recurrent acquired ocular toxoplasmosis associated with Kyrieleis plaques and documented allergy to sulfonamide-A treatment proposal for two rare conditions.

The aim of this study was to describe a case of a patient with ocular toxoplasmosis, which has resulted in Kyrieleis plaques formation (segmental periarteritis associated with severe inflammation) and later follow-up and alternative treatment due to documented allergy to sulfonamide. A 33-year-old Brazilian woman diagnosed with acute toxoplasmosis, initially treated with sulfonamide, developed a critical cutaneous rash. Cotrimoxazole was changed to clindamycin and pyrimethamine, and prednisone was started. The medication was maintained for 45 days. Four months later, she developed retinal lesions suggestive of toxoplasmosis with Kyrieleis plaques in the upper temporal vessels. Pyrimethamine, clindamycin, and prednisone were initiated until healing. She presented reactivation months later, and a suppressive treatment with pyrimethamine was instituted for one year. This is the first report to use the combination of clindamycin with pyrimethamine in the treatment and recurrence prophylaxis for OT in a documented allergy to sulfonamide.

A Measure of Synergy Based on Union Information.

The partial information decomposition (PID) framework is concerned with decomposing the information that a set of (two or more) random variables (the sources) has about another variable (the target) into three types of information: unique, redundant, and synergistic. Classical information theory alone does not provide a unique way to decompose information in this manner and additional assumptions have to be made. One often overlooked way to achieve this decomposition is using a so-called measure of union information-which quantifies the information that is present in at least one of the sources-from which a synergy measure stems. In this paper, we introduce a new measure of union information based on adopting a communication channel perspective, compare it with existing measures, and study some of its properties. We also include a comprehensive critical review of characterizations of union information and synergy measures that have been proposed in the literature.

Generating Airy beams through multimode fibres.

Focussing light through a multimode fibre (MMF) is the basis of holographic endoscopes, which currently enable detailed imaging of deep tissue. Achieving high fidelity and purity diffraction-limited foci has been shown to be possible, when fully controlling the amplitude, phase, and two orthogonal polarisation states of the input field. Yet, generating more complex field distributions with similar performance remains to be assessed. Here, we demonstrate the generation of Airy beams through an MMF containing in excess of 90 % of the optical power delivered by the fibre. We discuss two distinct methods for generating optical landscapes: the direct field and the Fourier domain synthesis. Moreover, we showcase the flexibility of the Fourier domain synthesis to modify the generated beam.

Real-World Effectiveness and Safety of Glecaprevir/Pibrentasvir for the Treatment of Chronic Hepatitis C: A Prospective Cohort Study in Portugal.

INTRODUCTION: Information about pan-genotypic treatments for hepatitis in Portugal is scarce. We aimed to evaluate the effectiveness and safety of glecaprevir plus pibrentasvir (GLE/PIB) treatment for hepatitis C virus (HCV) infection in real-world clinical practice. METHODS: An observational prospective study was implemented in six hospitals with 121 adult HCV patients who initiated treatment with GLE/PIB between October 2018 and April 2019, according to clinical practice. Eligible patients had confirmed HCV infection genotype (GT) 1 to 6 and were either treatment-naïve or had experience with interferon-, ribavirin- or sofosbuvir-based regimens, with or without compensated cirrhosis. Baseline sociodemographic and safety data are described for the total population (N = 115). Effectiveness [sustained virologic response 12 weeks after treatment (SVR12)] and patient-reported outcomes are presented for the core population with sufficient follow-up data (n = 97). RESULTS: Most patients were male (83.5%), aged < 65 years (94.8%), with current or former alcohol consumption (77.3%), illicit drug use (72.6%), and HCV acquisition through intravenous drug use (62.0%). HIV co-infection occurred in 22.6% of patients. The prevalence of each GT was: GT1 51.3%, GT2 1.7%, GT3 30.4%, GT4 16.5%, and GT5.6 0%. Most patients were non-cirrhotic (80.9%) and treatment-naïve (93.8%). The SVR12 rates were 97.9% (95% CI: 92.8 - 99.4), and > 95% across cirrhosis status, GT, illicit drug use, alcohol consumption, and HCV treatment experience. The adverse event rate was 2.6%, and no patient discontinued treatment due to adverse events related to GLE/PIB. CONCLUSION: Consistent with other real-world studies and clinical trials, treatment with GLE/PIB showed high effectiveness and tolerability overall and in difficult-to-treat subgroups (ClinicalTrials.gov: NCT03303599).

Advancing the path to in-vivo imaging in freely moving mice via multimode-multicore fiber based holographic endoscopy.

Significance: Hair-thin multimode optical fiber-based holographic endoscopes have gained considerable interest in modern neuroscience for their ability to achieve cellular and even subcellular resolution during in-vivo deep brain imaging. However, the application of multimode fibers in freely moving animals presents a persistent challenge as it is difficult to maintain optimal imaging performance while the fiber undergoes deformations. Aim: We propose a fiber solution for challenging in-vivo applications with the capability of deep brain high spatial resolution imaging and neuronal activity monitoring in anesthetized as well as awake behaving mice. Approach: We used our previously developed M3CF multimode-multicore fiber to record fluorescently labeled neurons in anesthetized mice. Our M3CF exhibits a cascaded refractive index structure, enabling two distinct regimes of light transport that imitate either a multimode or a multicore fiber. The M3CF has been specifically designed for use in the initial phase of an in-vivo experiment, allowing for the navigation of the endoscope's distal end toward the targeted brain structure. The multicore regime enables the transfer of light to and from each individual neuron within the field of view. For chronic experiments in awake behaving mice, it is crucial to allow for disconnecting the fiber and the animal between experiments. Therefore, we provide here an effective solution and establish a protocol for reconnection of two segments of M3CF with hexagonally arranged corelets. Results: We successfully utilized the M3CF to image neurons in anaesthetized transgenic mice expressing enhanced green fluorescent protein. Additionally, we compared imaging results obtained with the M3CF with larger numerical aperture (NA) fibers in fixed whole-brain tissue. Conclusions: This study focuses on addressing challenges and providing insights into the use of multimode-multicore fibers as imaging solutions for in-vivo applications. We suggest that the upcoming version of the M3CF increases the overall NA between the two cladding layers to allow for access to high resolution spatial imaging. As the NA increases in the multimode regime, the fiber diameter and ring structure must be reduced to minimize the computational burden and invasiveness.

Formulation and Implementation of Frequency-Dependent Linear Response Properties with Relativistic Coupled Cluster Theory for GPU-Accelerated Computer Architectures.

We present the development and implementation of relativistic coupled cluster linear response theory (CC-LR), which allows the determination of molecular properties arising from time-dependent or time-independent electric, magnetic, or mixed electric-magnetic perturbations (within a common gauge origin for the magnetic properties) as well as taking into account the finite lifetime of excited states in the framework of damped response theory. We showcase our implementation, which is capable to offload the computationally intensive tensor contractions characteristic of coupled cluster theory onto graphical processing units, in the calculation of (a) frequency-(in)dependent dipole-dipole polarizabilities of IIB atoms and selected diatomic molecules, with a particular emphasis on the calculation of valence absorption cross sections for the I2 molecule; (b) indirect spin-spin coupling constants for benchmark systems such as the hydrogen halides (HX, X = F-I) as well the H2Se-H2O dimer as a prototypical system containing hydrogen bonds; and (c) optical rotations at the sodium D line for hydrogen peroxide analogues (H2Y2, Y = O, S, Se, Te). Thanks to this implementation, we are able to show the similarities in performance, but often the significant discrepancies, between CC-LR and approximate methods such as density functional theory. Comparing standard CC response theory with the flavor based upon the equation of motion formalism, we find that for valence properties such as polarizabilities, the two frameworks yield very similar results across the periodic table as found elsewhere in the literature; for properties that probe the core region, such as spin-spin couplings, on the other hand, we show a progressive differentiation between the two as relativistic effects become more important. Our results also suggest that as one goes down the periodic table, it may become increasingly difficult to measure pure optical rotation at the sodium D line due to the appearance of absorbing states.

"There's plenty of room at the bottom": deep brain imaging with holographic endo-microscopy.

Significance: Over more than 300 years, microscopic imaging keeps providing fundamental insights into the mechanisms of living organisms. Seeing microscopic structures beyond the reach of free-space light-based microscopy, however, requires dissection of the tissue-an intervention seriously disturbing its physiological functions. The hunt for low-invasiveness tools has led a growing community of physicists and engineers into the realm of complex media photonics. One of its activities represents exploiting multimode optical fibers (MMFs) as ultra-thin endoscopic probes. Employing wavefront shaping, these tools only recently facilitated the first peeks at cells and their sub-cellular compartments at the bottom of the mouse brain with the impact of micro-scale tissue damage. Aim: Here, we aim to highlight advances in MMF-based holographic endo-microscopy facilitating microscopic imaging throughout the whole depth of the mouse brain. Approach: We summarize the important technical and methodological prerequisites for stabile high-resolution imaging in vivo. Results: We showcase images of the microscopic building blocks of brain tissue, including neurons, neuronal processes, vessels, intracellular calcium signaling, and red blood cell velocity in individual vessels. Conclusions: This perspective article helps to understand the complexity behind the technology of holographic endo-microscopy, summarizes its recent advances and challenges, and stimulates the mind of the reader for further exploitation of this tool in the neuroscience research.

Are we ready to stratify BI-RADS 4 lesions observed on magnetic resonance imaging? A real-world noninferiority/equivalence analysis / Estamos prontos para estratificar lesões BI-RADS 4 na ressonância magnética? Uma análise de não inferioridade/equivalência do mundo real

Abstract Objective: To demonstrate that positive predictive values (PPVs) for suspicious (category 4) magnetic resonance imaging (MRI) findings that have been stratified are equivalent to those stipulated in the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for mammography and ultrasound. Materials and Methods: This retrospective analysis of electronic medical records generated between January 4, 2016 and December 29, 2021 provided 365 patients in which 419 suspicious (BI-RADS category 4) findings were subcategorized as BI-RADS 4A, 4B or 4C. Malignant and nonmalignant outcomes were determined by pathologic analyses, follow-up, or both. For each subcategory, the level 2 PPV (PPV2) was calculated and tested for equivalence/noninferiority against the established benchmarks. Results: Of the 419 findings evaluated, 168 (40.1%) were categorized as malignant and 251 (59.9%) were categorized as nonmalignant. The PPV2 for subcategory 4A was 14.2% (95% CI: 9.3-20.4%), whereas it was 41.2% (95% CI: 32.8-49.9%) for subcategory 4B and 77.2% (95% CI: 68.4-84.5%) for subcategory 4C. Multivariate analysis showed a significantly different cancer yield for each subcategory (p < 0.001). Conclusion: We found that stratification of suspicious findings by MRI criteria is feasible, and malignancy probabilities for sub-categories 4B and 4C are equivalent to the values established for the other imaging methods in the BI-RADS. Nevertheless, low suspicion (4A) findings might show slightly higher malignancy rates.

Resumo Objetivo: Demonstrar que os valores preditivos positivos (VPPs) para lesões suspeitas (categoria 4) identificadas por ressonância magnética (RM) são equivalentes aos estipulados no ACR BI-RADS para mamografia e ultrassonografia. Materiais e Métodos: Análise retrospectiva de dados em prontuário eletrônico, entre 4 de janeiro de 2016 e 29 de dezembro de 2021, resultou em 365 pacientes elegíveis, com 419 lesões classificadas como BI-RADS 4A, 4B ou 4C. Desfechos malignos e não malignos foram determinados por estudo patológico e/ou acompanhamento. Realizamos o cálculo do VPP nível 2 (VPP2) para cada subcategoria e testamos para não inferioridade/equivalência em relação aos valores de referência. Resultados: Dos 419 achados, 168 (40,1%) foram malignos e 251 (59,9%), não malignos. O VPP2 para subcategoria 4A foi 14,2% (IC 95%: 9,3-20,4%), para 4B foi 41,2% (IC 95%:, 32,8-49,9%) e para 4C foi 77,2% (IC 95%: 68,4-84,5%). Análise multivariada demonstrou diferenças estatisticamente significantes entre as subcategorias (p < 0,001). Conclusão: A estratificação de achados suspeitos por RM é factível, sendo que a probabilidade de malignidade das subcategorias 4B e 4C é equivalente à estabelecida para outros métodos de imagem pelo BI-RADS. Contudo, lesões de baixa suspeição (4A) podem apresentar taxas mais altas de malignidade.

Are we ready to stratify BI-RADS 4 lesions observed on magnetic resonance imaging? A real-world noninferiority/equivalence analysis.

Objective: To demonstrate that positive predictive values (PPVs) for suspicious (category 4) magnetic resonance imaging (MRI) findings that have been stratified are equivalent to those stipulated in the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for mammography and ultrasound. Materials and Methods: This retrospective analysis of electronic medical records generated between January 4, 2016 and December 29, 2021 provided 365 patients in which 419 suspicious (BI-RADS category 4) findings were subcategorized as BI-RADS 4A, 4B or 4C. Malignant and nonmalignant outcomes were determined by pathologic analyses, follow-up, or both. For each subcategory, the level 2 PPV (PPV2) was calculated and tested for equivalence/noninferiority against the established benchmarks. Results: Of the 419 findings evaluated, 168 (40.1%) were categorized as malignant and 251 (59.9%) were categorized as nonmalignant. The PPV2 for subcategory 4A was 14.2% (95% CI: 9.3-20.4%), whereas it was 41.2% (95% CI: 32.8-49.9%) for subcategory 4B and 77.2% (95% CI: 68.4-84.5%) for subcategory 4C. Multivariate analysis showed a significantly different cancer yield for each subcategory (p < 0.001). Conclusion: We found that stratification of suspicious findings by MRI criteria is feasible, and malignancy probabilities for sub-categories 4B and 4C are equivalent to the values established for the other imaging methods in the BI-RADS. Nevertheless, low suspicion (4A) findings might show slightly higher malignancy rates.

Objetivo: Demonstrar que os valores preditivos positivos (VPPs) para lesões suspeitas (categoria 4) identificadas por ressonância magnética (RM) são equivalentes aos estipulados no ACR BI-RADS para mamografia e ultrassonografia. Materiais e Métodos: Análise retrospectiva de dados em prontuário eletrônico, entre 4 de janeiro de 2016 e 29 de dezembro de 2021, resultou em 365 pacientes elegíveis, com 419 lesões classificadas como BI-RADS 4A, 4B ou 4C. Desfechos malignos e não malignos foram determinados por estudo patológico e/ou acompanhamento. Realizamos o cálculo do VPP nível 2 (VPP2) para cada subcategoria e testamos para não inferioridade/equivalência em relação aos valores de referência. Resultados: Dos 419 achados, 168 (40,1%) foram malignos e 251 (59,9%), não malignos. O VPP2 para subcategoria 4A foi 14,2% (IC 95%: 9,3­20,4%), para 4B foi 41,2% (IC 95%:, 32,8­49,9%) e para 4C foi 77,2% (IC 95%: 68,4­84,5%). Análise multivariada demonstrou diferenças estatisticamente significantes entre as subcategorias (p < 0,001). Conclusão: A estratificação de achados suspeitos por RM é factível, sendo que a probabilidade de malignidade das subcategorias 4B e 4C é equivalente à estabelecida para outros métodos de imagem pelo BI-RADS. Contudo, lesões de baixa suspeição (4A) podem apresentar taxas mais altas de malignidade.

Estágios da doença renal crônica e suas associações com o nível de atividade física, qualidade de vida e perfil nutricional / Stages of chronic kidney disease and their associations with the level of physical activity, quality of life and nutritional profile

Estudos apresentaram resultados benéficos da prática de exercício físico no tratamento adjuvante à doença renal crônica (DRC). O objetivo desse estudo foi comparar e associar os estágios da evolução da DRC dos pacientes em tratamento conservador com o nível de atividade física, qualidade de vida e o perfil nutricional. A amostra foi composta por pacientes de ambos os sexos, com idade superior aos 18 anos em tratamento conservador para DRC. Foram avaliados o perfil nutricional (índice de massa corporal, circunferência de cintura e percentual de gordura); nível de atividade física (IPAQ); nível de qualidade de vida (WHOQOL-Bref ). Participaram do estudo 52 pacientes com idade média de 60,30 ± 9,10 anos, 53,8% mulheres, 57,6% diabéticos e 76,9% hipertensos. Para o perfil nutricional e nível de atividade física, 38,4% eram pessoas com obesidade; 82,6% com valores elevados de circun-ferência da cintura (CC); e 67% apresentaram baixos níveis baixos de atividade física. Para o nível de qualidade de vida, menores escores em satisfação com saúde (2,98 ± 0,83) e meio ambiente (2,75 ± 0,38); melhores escores em domínio psicológico (3,80 ± 0,53) e relações sociais (3,58 ± 0,58). Não houve associação significativa entre as variáveis do estudo e a estratificação dos pacientes em níveis de filtração glomerular. A correlação foi positiva do estágio DRC somente com a dimensão de relações sociais (rho = 0,247, p = 0,07) do nível de qualidade de vida. Os sujeitos apresentaram baixos níveis de atividade física e elevado prevalência de excesso de peso/obesidade, mas estes níveis não se alteraram em associação com os estágios da DRC

Studies have shown beneficial results of the practice of physical exercise in the adjuvant treatment of chronic kidney disease (CKD). The aim of this study was to compare and associate the stages of evolution of CKD in patients undergoing conservative treatment with the level of physical activity, quality of life and nutri-tional profile. The sample consisted of patients of both genders, aged over 18 years, undergoing conservative treatment for CKD. The nutritional profile (body mass index, waist circumference and fat percentage) were evaluated; level of physical activity (IPAQ); level of quality of life ( WHOQOL-Bref ). The study included 52 patients with a mean age of 60.30 ± 9.10 years, 53.8% women, 57.6% diabetic and 76.9% hypertensive. For the nutritional profile and level of physical activity, 38.4% were obese people; 82.6% with higher waist circumference ( WC) values; and 67% had low levels of physical activity. For the level of quality of life, lower scores in satisfaction with health (2.98 ± 0.83) and environment (2.75 ± 0.38); better scores in the psychological domain (3.80 ± 0.53) and social relationships (3.58 ± 0.58). There was no significant associa-tion between study variables and patients' stratification in glomerular filtration levels. The correlation was positive for the DRC stage only with the dimension of social relationships (rho = 0.247, p = 0.07) of the level of quality of life. The subjects had low levels of physical activity and a high prevalence of overweight/obesity, but these levels did not change in association with the stages of CKD

Gravidez na adolescência: perfil sociodemográfico de adolescentes grávidas no período de 2015 até 2019 / Embarazo en adolescentes: perfil sociodemográfico de las adolescentes embarazadas en el periodo de 2015 a 2019 / Adolescent pregnancy: sociodemographic profile of pregnant adolescents from 2015 to 2019

Objetivo: analisar o perfil sociodemográfico de adolescentes grávidas no Brasil entre os anos de 2015 até 2019. Método: estudo transversal descritivo, com abordagem quantitativa, proveniente do Departamento de Informática do Sistema Único de Saúde. A análise de dados utilizou frequências absolutas e relativas (%). Resultados: foram registradas 2.405.248 adolescentes grávidas. A maioria das gestações ocorreram em meninas de 15 a 19 anos (95,2%), de cor parda (65,4%), solteiras (64,9%), com 8 a 11 anos de instrução materna (66,9%). Quanto as características da gestação, 98,7% foram gravidez única, com duração de 37 a 41 semanas (81,7%) e tipo de parto vaginal (61,2%). A análise temporal apresentou queda de 2015 a 2019. Conclusão: a gravidez na adolescência constitui-se como um evento complexo em que a atenção deve abordar um contexto biopsicossocial. Assim, delinear o perfil sociodemográfico dessas adolescentes é necessário, pois possibilita conhecer a população em estudo e suas condições de vulnerabilidade.

Objective: to analyze the sociodemographic profile of pregnant adolescents in Brazil between 2015 and 2019. Method: descriptive cross-sectional study, with a quantitative approach, coming from the Information Technology Department of the Unified Health System. Data analysis used absolute and relative frequencies (%). Results: 2,405,248 pregnant adolescents were registered. The majority of pregnancies occurred in girls aged 15 to 19 years (95.2%), of a brown color (65.4%), single (64.9%), with 8 to 11 years of maternal education (66.9%). As for the characteristics of pregnancy, 98.7% were single pregnancy, lasting 37 to 41 weeks (81.7%) and vaginal type of delivery (61.2%). The temporal analysis showed a drop from 2015 to 2019. Conclusion: teenage pregnancy is a complex event in which attention must address a biopsychosocial context. Thus, delineating the sociodemographic profile of these adolescents is necessary, as it makes it possible to get to know the population under study and its vulnerability conditions.

Objetivo: analizar el perfil sociodemográfico de las adolescentes embarazadas en Brasil entre los años 2015 y 2019. Método: estudio descriptivo transversal, con enfoque cuantitativo, del Departamento de Informática del Sistema Único de Salud. En el análisis de los datos se utilizaron frecuencias absolutas y relativas (%). Resultados: se registraron 2.405.248 adolescentes embarazadas. La mayoría de los embarazos se produjeron en chicas de entre 15 y 19 años (95,2%), morenas (65,4%), solteras (64,9%), con entre 8 y 11 años de educación materna (66,9%). En cuanto a las características del embarazo, el 98,7% fueron embarazos únicos, con una duración de 37 a 41 semanas (81,7%) y tipo de parto vaginal (61,2%). El análisis temporal mostró un descenso de 2015 a 2019. Conclusión: el embarazo en la adolescencia constituye un evento complejo en el que se debe prestar atención a un contexto biopsicosocial. Por lo tanto, es necesario delinear el perfil sociodemográfico de los adolescentes, ya que permite conocer a la población en estudio y sus condiciones de vulnerabilidad.

Medidas de segurança ocupacional no transoperatório de quimioterapia hipertérmica intraperitoneal: scoping review / Medidas de seguridad ocupacional en el transoperatorio de quimioterapia hipertérmica intraperitoneal: scoping review / Occupational safety measures in the intraoperative period of hyperthermic intraperitoneal chemotherapy: scoping review

Resumo Objetivo Mapear as medidas de segurança ocupacional recomendadas aos profissionais envolvidos no atendimento transoperatório de pacientes submetidos à Quimioterapia Intraperitoneal Hipertérmica. Métodos Estudo qualitativo com ênfase em scoping review, fundamentado no Instituto Joanna Briggs. Realizou-se buscas nas bases de dados Pubmed, BVS, ScIELO, Scopus, Web of Science, Google Scholar, The Chocrane Library e literatura cinzenta. Pergunta de pesquisa utilizou o acrônimo PCC: quais medidas de segurança ocupacional são necessárias no Centro Cirúrgico para profissionais que atuam, direta ou indiretamente, no transoperatório da HIPEC? A Busca de artigos ocorreu entre 2015 a 2019. Resultados Evidenciou-se escassa literatura sobre a temática. Selecionados dez artigos: uma revisão sistemática; dois casos-controle; dois estudos descritivos; quatro estudos de revisão bibliográfica; um relato de experiência. Análise dos artigos evidenciou as medidas de segurança recomendadas para profissionais que atuam direta ou indiretamente nesse procedimento cirúrgico, a saber: educação e capacitação da equipe envolvida; utilização de equipamentos de proteção individual e coletiva; oferecer infraestrutura e orientações gerais. Conclusão Medidas de segurança recomendadas para os profissionais envolvidos no atendimento transoperatório do paciente submetido à Quimioterapia Intraperitoneal Hipertérmica são: capacitação da equipe; utilização de equipamentos específicos de proteção individual e coletiva; infraestrutura necessária como ajuste do ar condicionado com pressão maior dentro da sala cirúrgica; e orientações gerais em relação à organização da sala cirúrgica, descarte dos resíduos, limpeza da sala/materiais utilizados e acompanhamento da saúde ocupacional da equipe envolvida em procedimento cirúrgico.

Resumen Objetivo Mapear las medidas de seguridad ocupacional recomendadas a los profesionales involucrados en la atención transoperatoria de pacientes sometidos a Quimioterapia Intraperitoneal Hipertérmica. Métodos Estudio cualitativo con énfasis en el scoping review, fundamentado en el Instituto Joanna Briggs. Se realizaron búsquedas en las bases de datos Pubmed, BVS, ScIELO, Scopus, Web of Science, Google Scholar, The Chocrane Library y literatura gris. Pregunta de encuesta utilizó el acrónimo PCC: ¿qué medidas de seguridad ocupacional se hacen necesarias en el Quirófano para profesionales que actúan, directa o indirectamente, en el transoperatorio de la HIPEC? La búsqueda de los artículos ocurrió entre el 2015 y el 2019. Resultados Se puso en evidencia una escasa literatura sobre la temática. Seleccionados diez artículos: una revisión sistemática; dos casos-control; dos estudios descriptivos; cuatro estudios de revisión bibliográfica; un relato de experiencia. Análisis de los artículos evidenció las medidas de seguridad recomendadas para profesionales que actúan directa o indirectamente en ese procedimiento quirúrgico, a saber: educación y capacitación del equipo involucrado; utilización de equipos de protección individual y colectiva; brindar infraestructura y orientaciones generales. Conclusión Representan medidas de seguridad recomendadas para los profesionales involucrados en la atención transoperatoria del paciente sometido a Quimioterapia Intraperitoneal Hipertérmica: capacitación del equipo; utilización de equipos específicos de protección individual y colectiva; infraestructura necesaria como ajuste del aire acondicionado con una presión más alta dentro del quirófano; y orientaciones generales con relación a la organización del quirófano, descarte de los deshechos, limpieza de la sala/materiales utilizados y acompañamiento de la salud ocupacional por el equipo involucrado en el procedimiento quirúrgico.

Abstract Objective To map the occupational safety measures recommended to professionals involved in the intraoperative care of patients undergoing Hyperthermic Intraperitoneal Chemotherapy. Methods Qualitative scoping review based on the Joanna Briggs Institute. Searches were performed in Pubmed, VHL, ScIELO, Scopus, Web of Science, Google Scholar, The Chocrane Library databases and gray literature. The PCC acronym was used in the research question: what occupational safety measures are necessary in the operating room for professionals working directly or indirectly in the intraoperative period of HIPEC? A search for articles published between 2015 and 2019 was performed. Results Literature on the subject was scarce. Ten articles were selected: a systematic review; two control cases; two descriptive studies; four literature review studies; an experience report. In the analysis of articles, the recommended safety measures for professionals who work directly or indirectly in this surgical procedure was evidenced, namely: education and training of the staff involved; use of individual and collective protective equipment; provision of infrastructure and general guidelines. Conclusion Recommended safety measures for professionals involved in the intraoperative care of patients undergoing Hyperthermic Intraperitoneal Chemotherapy are: team training; use of specific individual and collective protection equipment; necessary infrastructure, such as adjusting the air conditioning to higher pressure inside the operating room; and general guidelines regarding the organization of the operating room, waste disposal, cleaning of the room/materials used, and monitoring of the occupational health of the team involved in the surgical procedure.

A amamentação em tempos da COVID-19: uma revisão narrativa / Breastfeeding during COVID-19 period: a narrative review

Analisar a amamentação em tempos de pandemia da COVID-19. Método: Revisão narrativa da literatura que selecionou artigos na base dados USA National Library of Medicine (Pubmed), no portal regional da Biblioteca Virtual em Saúde (BVS) e na biblioteca eletrônica Scientific Eletronic Library Online (Scielo) utilizando os termos de busca "Aleitamento Materno", "Coronavírus" e "Infecções por Coronavírus", e entre os termos o operador boleano AND. Na Pudmed os descritores foram "Breast Feeding", "Coronavirus" e "Coronavirus Infections", conforme o Medical Subject Headings (MeSH). Incluíram-se artigos em português e publicado entre 2019-2021. Resultados: 129 artigos foram selecionados, 125 foram excluídos e três foram analisados. Conclusão: Ainda há escassez de estudos abordando a temática principalmente em português. Contudo, até o momento, as recomendações vigentes encorajam a amamentação pelas nutrizes com suspeita ou positivas para COVID-19, porém com medidas de biossegurança corretas devido aos benefícios da amamentação.(AU)

Objective: Analyze breastfeeding during COVID-19 pandemic. Method: Narrative review of the literature that selected articles in the USA National Library of Medicine (Pubmed) database, in the regional portal of the Virtual Health Library (VHL) and in the electronic library Scientific Electronic Library Online (Scielo) using the descriptors "Breastfeeding","Coronavirus "and" Coronavirus Infections", and between the terms the Boolean operator AND. At Pudmed, the descriptors were "Breast Feeding", "Coronavirus" and "Coronavirus Infections", according to the Medical Subject Headings (MeSH). Articles in Portuguese and published between 2019-2021 were included. Results: 129 articles were selected, 125 were excluded and three were analyzed. Conclusion: There is still a shortage of studies addressing the theme mainly in Portuguese. However, to date, current recommendations encourage breastfeeding by breastfeeding mothers who are suspected or positive for COVID-19, but with correct biosafety measures due to the benefits of breastfeeding. (AU)

Objetivo: Analizar la lactancia materna en tiempos de la pandemia de COVID-19. Método: Revisión narrativa de la literatura que seleccionó artículos en la base de datos de la Biblioteca Nacional de Medicina de EE. UU. (Pubmed), en el portal regional de la Biblioteca Virtual en Salud (BVS) y en la biblioteca electrónica Scientific Eletronic Library Online (Scielo) utilizando los términos de búsqueda. "Lactancia materna", "Coronavirus" e "Infecciones por coronavirus", y entre los términos el operador booleano AND. En Pudmed, los descriptores fueron "Lactancia materna", "Coronavirus" e "Infecciones por coronavirus", de acuerdo con Medical Subject Headings (MeSH). Se incluyeron artículos en portugués y publicados entre 2019-2021. Resultados: se seleccionaron 129 artículos, se excluyeron 125 y se analizaron tres. Conclusión: todavía hay una escasez de estudios que aborden el tema principalmente en portugués. Sin embargo, hasta la fecha, las recomendaciones actuales fomentan la lactancia materna en madres que amamantan con sospecha o positividad de COVID-19, pero con las medidas de bioseguridad correctas debido a los beneficios de la lactancia materna. (AU)

Óbitos evitáveis em crianças menores de cinco anos em Passos/MG / Avoidable deaths in children under five years in Passos/MG / Muertes evitables de niños menores de cinco años Passos/MG

Objetivo: Descrever as principais causas de óbitos evitáveis em crianças menores de cinco anos no município de Passos, Minas Gerais, entre os anos de 2010 a 2018, segundo a "Lista Brasileira de Causas de Mortes Evitáveis". Método: Pesquisa descritiva, retrospectiva, com abordagem quantitativa, por meio dos dados coletados pela base de dados do Sistema de Informação sobre Mortalidade (SIM), posteriormente digitados em planilhas do Excel 2010 e analisados por estatística descritiva simples. Resultados: Houve maior ocorrência de óbitos em crianças do sexo masculino, no período neonatal precoce. As causas mais prevalentes foram as reduzíveis por adequada atenção à mulher na gestação, seguida por adequada atenção ao recém-nascido. Conclusão: Há necessidade de maior envolvimento dos gestores em saúde quanto à assistência pré-natal, com implementação de ações que promovam a saúde e a prevenção de doenças e agravos, garantindo assim serviços de excelência para o atendimento destes grupos vulneráveis.(AU)

Objective: To describe the main causes of preventable deaths in children under five years of age in the municipality of Passos, Minas Gerais, between 2010 and 2018, according to the "Brazilian List of Causes of Avoidable Deaths". Method: Descriptive, retrospective research, with a quantitative approach, using data collected from the Mortality Information System (SIM) database, which were later entered into Excel 2010 spreadsheets and analyzed using simple descriptive statistics. Results: There was a higher occurrence of deaths in male children in the early neonatal period. The most prevalent causes were those that could be reduced by adequate care for women during pregnancy, followed by adequate care for the newborn. Conclusion: There is a need for greater involvement of health managers in terms of prenatal care, with the implementation of actions that promote health and the prevention of diseases and injuries, thus guaranteeing excellent services for the care of these vulnerable groups.(AU)

Objetivo: Describir las principales causas de muertes evitables en menores de cinco años en el municipio de Passos, Minas Gerais, entre 2010 y 2018, según la "Lista Brasileña de Causas de Muertes Evitables". Método: Investigación descriptiva, retrospectiva, con enfoque cuantitativo, utilizando datos recolectados de la base de datos del Sistema de Información de Mortalidad (SIM), que luego fueron ingresados en hojas de cálculo Excel 2010 y analizados mediante estadística descriptiva simple. Resultados: Hubo una mayor incidencia de muertes en niños varones en el período neonatal temprano. Las causas más prevalentes fueron las que podrían reducirse con una atención adecuada a la mujer durante el embarazo, seguida de una atención adecuada al recién nacido. Conclusión: Existe la necesidad de una mayor participación de los gestores de salud en materia de atención prenatal, con la implementación de acciones que promuevan la salud y la prevención de enfermedades y lesiones, garantizando así excelentes servicios para la atención de estos grupos vulnerables.(AU)

Can the positions of the spastic upper limb in stroke survivors help muscle choice for botulinum toxin injections? / A posição do membro superior de indivíduos com doença cerebrovascular pode auxiliar na escolha de músculos para a injeção de toxina botulínica?

ABSTRACT Motor impairments in stroke survivors are prevalent and contribute to dependence in daily activities, pain and overall disability, which can further upper-limb disability. Treatment with botulinum toxin A (BoNT-A) is indicated for focal spasticity and requires knowledge of biomechanics and anatomy to best select muscles to be injected in the limb. Objective: We aimed to describe the frequency of posture patterns in a Brazilian sample of stroke survivors and correlate them with recommendations of muscle selection for treatment with BoNT-A. Methods: Fifty stroke patients with spastic upper limbs scheduled for neuromuscular block were photographed and physically examined, to be classified by three independent evaluators according to Hefter's classification. Muscles that were injected with BoNT-A by their routine doctors were retrieved from medical charts. Results: Pattern III and IV were the most common (64.7%, 21.6%). We further subclassified pattern III according to the rotation of the shoulder, which effectively interfered in muscle choice. The muscles most frequently treated were shoulder adductors and internal rotators, elbow flexors and extensors, in forearm, the pronator teres and finger and wrist flexors, and, in the hand the adductor pollicis. Conclusion: Frequencies of upper-limb postures differed from previous reports. Other clinical features, besides spasticity, interfered with muscle choice for BoNT-A injection, which only partially followed the recommendations in the literature.

RESUMO As deficiências motoras que ocorrem nos indivíduos com doença cerebrovascular (DCV) são prevalentes e contribuem para dependência, dor e incapacidade, o que pode atrasar a reabilitação do membro superior e sua funcionalidade. O tratamento com toxina botulínica do tipo A (BoNT-A) é indicado para a espasticidade focal e requer conhecimento da biomecánica e anatomia para melhor selecionar os músculos a serem injetados. Objetivo: Descrever a frequência de padrões posturais numa amostra de brasileiros com sequelas de DCV e correlacioná-los com as recomendações de seleção de músculos. Métodos: Cinquenta pacientes com comprometimento do membro superior devido a DCV do ambulatório de bloqueios neuromusculares foram fotografados e examinados para categorização de acordo com a Classificação de Hefter. Os músculos tratados pelos seus médicos de rotina foram obtidos a partir dos prontuários. Resultados: Os padrões III e IV de Hefter foram mais comuns (64,7%; 21,6%). Nós propusemos a subclassificação do padrão III de acordo com a rotação do ombro, pois isso interferiu na escolha dos músculos tratados. Os músculos tratados com maior frequência foram os adutores e rotadores internos do ombro; flexores e extensores do cotovelo; no antebraço, o pronador redondo, flexores dos dedos e do carpo e na mão, o adutor do polegar. Conclusão: As frequências das posições do membro superior diferiram de relatos prévios. Além da espasticidade, outros fatores interferiram na escolha dos músculos tratados, que seguiram parcialmente as recomendações da literatura.

Measuring the distance between sternoclavicular joint and hilar structures with tomography / Medida da distância da articulação esternoclavicular as estruturas hilares por tomografia

ABSTRACT Objectives To evaluate the tomographic distance between the sternoclavicular joints and the nearest hilar structures. Methods Computed tomography images (axial and sagittal slices) in 120 healthy individuals (60 men and 60 women) between 18 and 60 years old were prospectively analyzed. The distances from both sternoclavicular joints to the respective brachiocephalic veins, trachea, esophagus, and lung apexes were measured and related to age, sex, and body mass index. Results Statistically significant differences were found in the distance from the right and left sternoclavicular joint distances and the corresponding brachiocephalic vein, esophagus, and lung apexes. In women, both sides were closer to the noble structures. In patients with body mass index <25, the distances were significantly less than in heavier patients. Conclusion The left sternoclavicular joint is closer to the hilar structures than the contralateral side. In women, both sternoclavicular joints are closer to the brachiocephalic veins, esophagus, and lung apexes than in men. Patients with body mass index <25 have shorter distances between these joints and the brachiocephalic veins and esophagus. Level of Evidence II; Prognostic studies - Investigating the effect of a patient characteristic on the outcome of disease.

RESUMO Objetivos avaliar a distância tomográfica entre as articulações esternoclaviculares até as estruturas hilares mais próximas. Métodos foram analisados prospectivamente cortes tomográficos axiais e sagitais em 120 indivíduos hígidos (60 homens e 60 mulheres), entre 18 e 60 anos, sendo mensuradas as distâncias de ambas as articulações esternoclaviculares até as respectivas veias braquiocefálicas, traqueia, esôfago e ápices pulmonares, relacionando-as com idade, gênero e índice de massa corporal. Resultados houve diferença estatisticamente significativa entre as distâncias da articulação esternoclavicular direita e esquerda até a veia braquiocefálica correspondente, esôfago e ápices pulmonares. Nas mulheres, ambos os lados estavam mais próximos das estruturas nobres. Pacientes com índice de massa corporal <25 as distâncias foram significativamente menores quando comparados a índices superiores. Conclusão articulação esternoclavicular esquerda está mais próxima às estruturas hilares do que o lado direito. Nas mulheres, as articulações esternoclaviculares bilaterias encontram-se mais próximas das veias braquiocefálicas, esôfago e ápices pulmonares, comparadas aos homens. Pacientes com índice de massa corporal <25 apresentam distâncias menores da articulação até as veias braquiocefálicas e esôfago. Nível de Evidência II. Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença.

Influência da órtese estática de punho na atividade muscular e amplitude de movimento de ombro e cotovelo durante uma tarefa funcional: estudo biomecânico / Influencia de la ortesis estática de puño en la actividad muscular y la amplitud de movimiento de hombro y codo durante una tarea funcional: el estudio biomecánico / Influence of static wrist orthosis on muscle activity and shoulder and elbow range of motion during a functional task: a biomechanical study

RESUMO As órteses são recursos terapêuticos indicados para proteger, corrigir deformidades ou auxiliar em certas funções; porém, seu uso pode acarretar compensações proximais no ombro. O objetivo deste estudo é avaliar a influência da órtese estática dorsal do punho, em 30° de extensão na biomecânica do ombro e cotovelo, em 25 voluntários assintomáticos durante uma tarefa funcional. Os dados da amplitude de movimento e ativação muscular foram adquiridos de forma sincronizada e simultânea durante parte do teste funcional Elui, que simula alimentação, dividida em alcance, deslocamento e liberação, de uma jarra, nas condições sem e com órtese. Para possibilitar a comparação entre os diferentes sujeitos e músculos, os dados foram analisados pela integral do sinal EMG de cada músculo e, para análise cinemática, foram construídos sistemas de coordenadas de marcadores pré-definidos. Os sinais captados foram filtrados e processados por um software personalizado, e utilizou-se o teste t para amostras pareadas - software SPSS, p<0,05. Notou-se um aumento significativo da ativação dos músculos deltoide anterior e peitoral maior na fase de alcance, e trapézio superior, deltoide anterior e posterior na fase de liberação com a órtese. A cinemática mostrou aumento significativo na amplitude de movimento na abdução do ombro, flexão do cotovelo e pronação do antebraço na fase de deslocamento, e dos movimentos extensão do ombro e flexão do cotovelo na fase de liberação. Nossos achados sugerem que o uso da órtese estática do punho durante a execução de uma tarefa pode acarretar compensações, com predomínio da ativação dos músculos mais proximais do membro superior.

RESUMEN Las ortesis son recursos terapéuticos indicados para proteger, corregir deformidades o auxiliar en ciertas funciones; sin embargo, su uso puede acarrear compensaciones proximales en el hombro. El objetivo de este estudio, entonces, es evaluar la influencia de la ortesis estática dorsal del puño, en 30° de extensión en la biomecánica del hombro y codo, en 25 voluntarios asintomáticos durante una tarea funcional. Los datos de la amplitud de movimiento y de la activación muscular han sido adquiridos de manera sincronizada y simultánea durante parte de la prueba funcional Elui, que simula la alimentación, dividida en alcance, desplazamiento y liberación, de un jarrón, en las condiciones sin y con ortesis. Para posibilitar la comparación entre los distintos individuos y músculos, los datos han sido analizados por la integral de la señal EMG de cada músculo y, para el análisis cinemático, han sido construidos sistemas de coordinadas de marcadores predefinidos. Las señales captadas han sido filtradas y procesadas por un software personalizado, y se ha utilizado la prueba t para muestras pareadas - software SPS®, p<0,05. Se ha visto un incremento significativo de la activación de los músculos deltoide anterior y pectoral más grande en la etapa de alcance, y trapecio superior, deltoide anterior y posterior en la etapa de liberación con la ortosis. La cinemática ha mostrado incremento significativo en la amplitud de movimiento en la abducción del hombro, flexión del codo y pronación del antebrazo en la etapa de desplazamiento, y de los movimientos extensión del hombro y flexión del codo en la etapa de liberación. En nuestros hallazgos se sugieren que el uso de la ortosis estática del puño durante la ejecución de una tarea puede acarrear compensaciones, con predominio de la activación de los músculos más proximales del miembro superior.

ABSTRACT Orthoses are therapeutic resources that are appropriate to protect and remedy deformities or to help in the performance of certain functions; however, its use may lead to proximal compensations in the shoulder. Thus, this study aims to evaluate the influence of dorsal static 30° extension orthoses on the shoulder and elbow biomechanics in 25 asymptomatic individuals during a functional task. The range of motion and muscle activation was collected by simultaneous and synchronized analysis during the Elui functional test related to feeding, under the conditions with and without the orthosis. In order to allow a comparison of the different subjects and muscles, the data were analyzed by EMG signal of each muscle and, for kinematic analysis, pre-defined marker coordinate systems were constructed. The captured signals were filtered and processed by custom software, and the t-test for paired samples, SPSS® software, p<0.05, was used. We found significant increase in activation of the anterior deltoid and pectoralis major muscle in the reach phase and upper trapezius, anterior and posterior deltoid in the release phase with the orthosis. The kinematic analysis showed a significant increase in the range of motion of shoulder abduction movements, elbow flexion and pronation in the displacement phase and shoulder extension and elbow flexion movements in the release phase. Our findings suggest that the use of static wrist orthosis while performing a task can lead to compensations, with predominant activation of more proximal muscles of the upper limb.

Implication of Tityus apiacas (Lourenco, 2002) in scorpion envenomations in the Southern Amazon border, Brazil

Abstract Herein, four cases of scorpion stings caused by Tityus apiacas recorded from the municipality of Apuí, in the southern region of the Brazilian Amazon, are described. Patients showed systemic clinical manifestations, described as unusual, involuntary, and generalized tingling and numbness, reported by patients as an electric shock sensation, lasting up to 24 hours after the sting. All patients described local pain and sensation, along with other clinical symptoms including local edema and erythema. Systemic manifestations were not life threatening. Antivenom therapy was administered to all patients, who were discharged without complaints.