Challenges in treating radioiodine-refractory thyroid cancer: a global perspective with a focus on developing nations in Latin America.

PURPOSE: This article aims to comprehensively analyze the unique challenges in managing patients with metastatic Differentiated Thyroid Cancer (DTC) that develop radioiodine-refractory disease, especially in developing countries in Latin America. We discuss key contentious aspects of their treatment, such as the optimal timing for initiating systemic therapy, the choice of first-line medications, the appropriate timing for requesting molecular interrogation, and the challenges associated with accessing these drugs and molecular panels. METHODS: To illustrate these challenges and enhance understanding, we present five real clinical cases from the authors' experiences. RESULTS: Patients with Differentiated Thyroid Cancer (DTC) generally have an excellent prognosis, with an overall 10-year survival rate exceeding 97%. However, approximately 5% of DTC patients, especially those with distant metastases, may develop radioiodine-refractory disease, reducing survival rates. Access to medications remains difficult and time-consuming, particularly for patients within the public healthcare system. Urgent discussions on drug pricing involving all stakeholders are imperative. To break free from complacency, stakeholders must prioritize patient well-being by advocating for evidence-based drug pricing, increased participation in clinical trials, and streamlined regulatory processes. CONCLUSION: Beyond the recognized need for prospective randomized clinical trials to determine the optimal first-line drug and the timing of molecular testing, this type of manuscript plays a pivotal role in stimulating discussions and disseminating comprehensive knowledge about the challenges associated with treating and monitoring patients with radioiodine-refractory thyroid carcinoma, especially in developing countries.

Comparing the efficacy of stimbiotic and a combination of xylanase and beta-glucanase, in broilers fed wheat-barley based diets with high or low AME.

A stimbiotic is defined as a product that stimulates a fiber-degrading microbiome to increase fiber fermentability. The aim of this study was to examine if it is more advantageous to feed a stimbiotic (xylanase + xylo-oligosaccharides [STB]) or a combination of xylanase and beta-glucanase (Xyl + BG) to broilers fed wheat-barley based diets with differing AME levels. Cobb 500 broilers (n = 480, 80 birds per treatment) were fed 6 dietary treatments in a 2 × 3 factorial arrangement; 2 AME levels, 'High' or 'Low', which differed by 100 kcal ME/kg, and 3 additive supplementations, with no supplemental additives, STB or Xyl + BG. Diets were fed as 3 phases, starter (d 0-14), grower (d 14-21) and finisher (d 21-35). On bird age d 14, 21 and 35, total pen body weight and feed intake were determined, and feed conversion ratio corrected for mortality (cFCR) was calculated. On d 21 and d 35 ileal viscosity and beta-glucan content and caecal SCFA concentration were determined. Additive suplementation had no impact on cFCR in birds fed the low AME diet, but in birds fed the high AME diet the cFCR value was reduced in the presence of the additives (P = 0.001 and P = 0.015, at d 14-21 and d 21-35, respectively). At d 21, cecal SCFA concentration was consistently higher (P = 0.015), and ileal beta-glucan level lower (P = 0.002), in birds fed the diet supplemented with STB compared to those without additives. At d 35, ileal viscosity was lower in birds fed STB compared to those fed the diet without supplementation of additives, irrespective of diet AME level (P = 0.017). These results suggest that both STB and Xyl + BG ameliorate the antinutritive effects of the non-starch polysaccharides (NSP) present in wheat-barley based diets, resulting in improved bird performance. However, supplementation with STB induces a comparatively greater positive effect on NSP hydrolysis and SCFA production.

Identifying Frailty Levels and Associated Factors in a Population Living in the Context of Poverty and Social Vulnerability.

This study aimed to investigate a vulnerable population living in the context of poverty in a Brazilian municipality, in order to identify the factors that are associated with frailty syndrome in elderly people. From the total population living in the area, a random sample of 363 community-dwelling people, 60 years and older, age and gender-stratified, was selected to participate in the research. After losses, a sample of 304 older adults was classified as non-frail, pre-frail and frail. According to the Fried frailty criteria, the prevalence was 12.2% for non-frail individuals, 60.5% pre-frail and 27.3% frail. The main factors associated with frailty in the studied sample were low level of physical activity (OR: 5.2, 95%CI: 2.5-11.0), the occurrence of two or more falls within 12 months (OR: 3.1, 95%CI: 1.4-7.1), mobility deficits (OR: 3.0, 95%CI: 1.5-5.8), and depressive symptoms (OR: 1.9, 95%CI: 1.1-3.7). This study identified the most important factors that must be evaluated to identify frailty syndrome in a socially vulnerable population in the context of poverty. The data should help to encourage effective strategies concerning public health policies for this population.

Use of enzymes in diets with different percentages of added fat for broilers / Uso de enzimas em dietas com diferentes porcentagens de adição de gordura para frangos de corte

We assessed the extent to which the removal of fat source, and consequently its compounds, such as linoleic acid, can affect the performance of broilers. We used 600 male Cobb 500 day old chicks. The birds were distributed in a completely randomized experimental design, with five treatments and six replicates of 20 birds each. The treatments were: (T1) diet - positive control (PC), which met the nutritional needs; (T2) diet - negative control (CN), a reduction of 100kcal/kg and low linoleic acid content; (T3): diet - negative control reformulated for low linoleic acid content and a set of Quantum phytase XT and Econase XT 25 (BAL + QFit-Eco), (T4): diet - negative control reformulated, with the percentage of linoleic acid adjusted to an intermediate value between the value of the diet and diet CP and CN to use a set of Quantum phytase XT and XT Econase 25 (IAL + QFit-Eco) and (T5): diet - negative control reformulated, with the percentage of linoleic acid adjusted to a value similar to that of the positive control diet and joint use of Quantum phytase XT and XT Econase 25 (AAL + QFit-Eco). The joint use of Quantum Phytase and Econase promoted improvement in the performance of broilers from 1 to 21 days. The greatest weight gain was obtained with diets containing percentages of total fat and linoleic acids. Dietary supplementation with enzymes resulted in higher levels of calcium in the tibia, whatever the percentage of linoleic studied.

Avaliou-se até que ponto a retirada de fonte de gordura e, consequentemente, de seus compostos, como o ácido linoleico, pode afetar o desempenho dos frangos de corte. Foram utilizados 600 pintos de um dia, machos da linhagem Cobb 500. As aves foram distribuídas num delineamento experimental inteiramente ao acaso, com cinco tratamentos e seis repetições de 20 aves cada. Os tratamentos foram: (T1) dieta-controle positivo (CP), que atendeu às necessidades nutricionais; (T2) dieta-controle negativo (CN), com redução de 100kcal de EM/kg e baixo teor de ácido linoleico; (T3): dieta- controle negativo reformulada, para baixo teor de ácido linoleico e com uso conjunto de Quantum fitase XT e Econase XT 25 (BAL+ Qfit-Eco); (T4): dieta-controle negativo reformulada, com porcentagem de ácido linoleico ajustada para um valor intermediário entre o valor da dieta CN e da dieta CP e com uso conjunto de Quantum fitase XT e Econase XT 25 (IAL + Qfit-Eco) e (T5): dieta-controle negativo reformulada, com porcentagem de ácido linoleico ajustada para um valor semelhante ao da dieta-controle positivo e com uso conjunto de Quantum fitase XT e Econase XT 25 (AAL+ Qfit-Eco ). O uso conjunto de Quantum Fitase e Econase promoveu melhora no desempenho dos frangos de corte de um a 21 dias. O maior ganho de peso foi obtido com dietas que continham porcentagens de gorduras totais e de ácido linoleico. A suplementação com as enzimas resultou em maior teor de cálcio nas tíbias, independentemente da porcentagem de ácido linoleico estudada.

Histology and histochemistry of the ventriculus of Dolichoderus (=Monacis) bispinosus (OLIVIER, 1792) (Hymenoptera: Formicidae).

In this study we histologically and histochemically describe the ventriculus of Dolichoderus bispinosus. The epithelium consists of two basic cell types, highly basophilic generative cells, and digestive cells. The latter present several cytoplasmic vesicles, rich in acidic and neutral polysaccharides, and basic proteins. Also, these cells exhibit an apocrine secretion pattern. A mass of fibrous material is observed on the surface of the epithelium. Finally, we discuss the results obtained.

Constituents of Bowdichia virgilioides.

The isolation and (13)C-NMR data of flavone derivatives from Bowdichia virgilioides roots are reported.