Laparoscopic Versus Open Gastrectomy for Advanced Gastric Cancer: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Laparoscopy-assisted gastrectomy (LAG) is a well-established surgical technique in treating patients with early gastric cancer. However, the efficacy and safety of LAG versus open gastrectomy (OG) in patients with advanced gastric cancer (AGC) remains unclear. METHODS: We systematically searched PubMed, Embase, and Cochrane Library in June 2023 for RCTs comparing LAG versus OG in patients with AGC. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for binary and continuous endpoints, respectively. We performed all statistical analyses using R software version 4.3.1 and a random-effects model. RESULTS: Nine RCTs comprising 3827 patients were included. There were no differences in terms of intraoperative complications (RR 1.14; 95% CI 0.72 to 1.82), number of retrieved lymph nodes (MD -0.54 lymph nodes; 95% CI -1.18 to 0.09), or mortality (RR 0.91; 95% CI 0.30 to 2.83). LAG was associated with a longer operative time (MD 49.28 minutes; 95% CI 30.88 to 67.69), lower intraoperative blood loss (MD -51.24 milliliters; 95% CI -81.41 to -21.06), shorter length of stay (MD -0.83 days; 95% CI -1.60 to -0.06), and higher incidence of pancreatic fistula (RR 2.44; 95% CI 1.08 to 5.50). Postoperatively, LAG was also superior to OG in reducing bleeding rates (RR 0.44; 95% CI 0.22 to 0.86) and time to first flatus (MD -0.27 days; 95% CI -0.47 to -0.07), with comparable results in anastomotic leakage, wound healing issues, major complications, time to ambulation, or time to first liquid intake. In the long-term analyses at 3 and 5 years, there were no significant differences between LAG and OG in terms of overall survival (RR 0.99; 95% CI 0.96 to 1.03) or relapse-free survival (RR 0.99; 95% CI 0.94 to 1.04). CONCLUSION: This meta-analysis of RCTs suggests that LAG may be an effective and safe alternative to OG for treating AGC; albeit, it may be associated with an increased risk for pancreatic fistula.

Adjunctive low-voltage area ablation for patients with atrial fibrillation: An updated meta-analysis of randomized controlled trials.

BACKGROUND: The efficacy and safety of adjunctive low-voltage area (LVA) ablation on outcomes of catheter ablation (CA) for atrial fibrillation (AF) remains uncertain. METHODS: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing CA with versus without LVA ablation for patients with AF. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random-effects model. Our primary endpoint was recurrence of atrial tachyarrhythmia (ATA), including AF, atrial flutter, or atrial tachycardia. We used R version 4.3.1 for all statistical analyses. RESULTS: Our meta-analysis included 10 RCTs encompassing 1780 patients, of whom 890 (50%) were randomized to LVA ablation. Adjunctive LVA ablation significantly reduced recurrence of ATA (RR 0.76; 95% CI 0.67-0.88; p < .01) and reduced the number of redo ablation procedures (RR 0.54; 95% CI 0.35-0.85; p < .01), as compared with conventional ablation. Among 691 (43%) patients with documented LVAs on baseline substrate mapping, adjunctive LVA ablation substantially reduced ATA recurrences (RR 0.57; 95% CI 0.38-0.86; p < .01). There was no significant difference between groups in terms of periprocedural adverse events (RR 0.78; 95% CI 0.39-1.56; p = .49). CONCLUSIONS: Adjunctive LVA ablation is an effective and safe strategy for reducing recurrences of ATA among patients who undergo CA for AF.

Cardiovascular benefits of statin plus ezetimibe combination therapy versus statin monotherapy in acute coronary syndrome: a meta-analysis of randomized controlled trials

BACKGROUND: The efficacy of adding ezetimibe to statin therapy for event reduction in patients with acute coronary syndromes (ACS) remains a topic of ongoing debate. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ezetimibe plus statin versus statin monotherapy in patients with ACS. We searched PubMed, Embase, and Cochrane for eligible trials. Random-effects model was used to calculate the risk ratios (RRs), with 95% confidence intervals (CIs). Statistical analyses were performed using RStudio version 4.2.3. RESULTS: Six RCTs comprising 20,574 patients with ACS were included, of whom 10,259 (49.9%) were prescribed ezetimibe plus statin. The patient population had an average age of 63.8 years and 75.1% were male. Compared with statin monotherapy, ezetimibe plus statin significantly reduced major adverse cardiovascular events (MACE) (RR 0.93; 95% CI 0.90-0.97; p<0.01) and non-fatal myocardial infarction (RR 0.88; 95% CI 0.81-0.95; p<0.01). There was no significant difference between groups for revascularization (RR 0.94; 95% CI 0.88-1.01; p=0.07), all-cause death (RR 0.87; 95% CI 0.63-1.21; p=0.42), or unstable angina (RR 1.05; 95% CI 0.86-1.27; p=0.64). CONCLUSION: In this meta-analysis of patients with ACS, the combination of ezetimibe plus statin was associated with a reduction in MACE and non-fatal myocardial infarction, compared with statin monotherapy.

Long-term impact of home-based monitoring after an admission for acute decompensated heart failure: a systematic review and meta-analysis of randomised controlled trials.

Background: Patients with heart failure have high rehospitalisation rates and poor cardiovascular outcomes. Home-based monitoring (HBM) has emerged with promising results in different settings. However, its long-term effects on patients recently admitted for acute decompensated heart failure (ADHF) remain uncertain. Methods: We systematically searched PubMed, Embase, and Cochrane Library for randomised controlled trials (RCTs) comparing HBM with usual care (UC) that were published between database inception and June 24, 2023. We included studies with patients admitted for ADHF in the previous 6 months and with a minimum follow-up of 6 months. We excluded studies with patients hospitalised for reasons other than ADHF and studies with disproportional education interventions between arms. Statistical analyses were performed using R software version 4.3.2. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for categorical and continuous outcomes, respectively. Cochrane Collaboration's tool for assessing risk of bias in RCTs (RoB 2) was used to assess study quality. Publication bias was assessed via funnel plots and Egger's test, and heterogeneity was assessed through I2 statistics and sensitivity analysis. The protocol for this systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42023465359). Findings: We included 16 RCTs comprising 4629 patients, of whom 2393 (51.7%) were randomised to HBM and 3150 (68%) were men. Follow-up ranged from six to fifteen months. As compared with UC, HBM significantly reduced all-cause mortality (RR 0.75; 95% CI 0.61, 0.91; p = 0.005), all-cause hospitalisations (RR 0.82; 95% CI 0.70, 0.97; p = 0.018), cardiovascular (CV) mortality (RR 0.53; 95% CI 0.36, 0.79; p = 0.002), hospitalisations for heart failure (RR 0.75; 95% CI 0.62, 0.91; p = 0.004), and CV hospitalisations (RR 0.72; 95% CI 0.55, 0.95; p = 0.018). There were no significant differences in length of hospital stay (MD 0.97 days; 95% CI -0.90, 2.84; p = 0.308). Interpretation: In patients recently admitted with ADHF, HBM significantly reduces long-term all-cause mortality and hospitalisations, CV mortality and hospitalisations, and hospitalisations for heart failure, as compared with UC. This supports the implementation of HBM as a standard practice to optimise patient outcomes following admissions for ADHF. However, future studies are warranted to evaluate the efficacy and safety of implementing HBM in the real-world setting. Funding: None.

Safety and efficacy of catheter ablation for atrial fibrillation in cancer survivors: a systematic review and meta-analysis

BACKGROUND: Cancer survivors are at increased risk for atrial fibrillation (AF). However, data on the efficacy and safety of catheter ablation (CA) in this population remain limited. Therefore, we aimed to perform a systematic review and meta-analysis comparing outcomes after CA for AF in patients with versus without prior or active cancer. METHODS: We systematically searched PubMed, Cochrane Library, and Embase from inception to April 2023 for studies comparing the safety and efficacy of CA for AF in cancer survivors. Outcomes of interest were bleeding events, late AF recurrence, and need for repeat ablation. Statistical analyses were performed using Review Manager 5.4.1. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints. RESULTS: We included 5 retrospective cohort studies comprising 998 patients, of whom 41.4% had a history of cancer. Cancer survivors were at significantly higher risk of clinically relevant bleeding (OR 2.17; 95% CI 1.17-4.0; p=0.01) as compared with those without cancer. The efficacy of CA for AF was similar between groups. Late AF recurrence at 12 months was not significantly different between patients with vs. without a history of cancer (OR 1.29; 95% CI 0.78-2.13; p=0.32). Similar findings were observed in the outcome of repeat ablations (OR 0.71; 95% CI 0.37-1.37; p=0.31). CONCLUSIONS: These findings suggest that cancer survivors have an increased risk of bleeding after CA for AF relative to patients without cancer, with no significant difference in the efficacy of CA for maintenance of sinus rhythm between groups. STUDY REGISTRATION: This systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023394538.

Safety and efficacy of catheter ablation for atrial fibrillation in cancer survivors: a systematic review and meta-analysis.

BACKGROUND: Cancer survivors are at increased risk for atrial fibrillation (AF). However, data on the efficacy and safety of catheter ablation (CA) in this population remain limited. Therefore, we aimed to perform a systematic review and meta-analysis comparing outcomes after CA for AF in patients with versus without prior or active cancer. METHODS: We systematically searched PubMed, Cochrane Library, and Embase from inception to April 2023 for studies comparing the safety and efficacy of CA for AF in cancer survivors. Outcomes of interest were bleeding events, late AF recurrence, and need for repeat ablation. Statistical analyses were performed using Review Manager 5.4.1. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints. RESULTS: We included 5 retrospective cohort studies comprising 998 patients, of whom 41.4% had a history of cancer. Cancer survivors were at significantly higher risk of clinically relevant bleeding (OR 2.17; 95% CI 1.17-4.0; p=0.01) as compared with those without cancer. The efficacy of CA for AF was similar between groups. Late AF recurrence at 12 months was not significantly different between patients with vs. without a history of cancer (OR 1.29; 95% CI 0.78-2.13; p=0.32). Similar findings were observed in the outcome of repeat ablations (OR 0.71; 95% CI 0.37-1.37; p=0.31). CONCLUSIONS: These findings suggest that cancer survivors have an increased risk of bleeding after CA for AF relative to patients without cancer, with no significant difference in the efficacy of CA for maintenance of sinus rhythm between groups. STUDY REGISTRATION: This systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023394538.

Bone Marrow Aspirate Matrix: A Convenient Ally in Regenerative Medicine.

The rise in musculoskeletal disorders has prompted medical experts to devise novel effective alternatives to treat complicated orthopedic conditions. The ever-expanding field of regenerative medicine has allowed researchers to appreciate the therapeutic value of bone marrow-derived biological products, such as the bone marrow aspirate (BMA) clot, a potent orthobiologic which has often been dismissed and regarded as a technical complication. Numerous in vitro and in vivo studies have contributed to the expansion of medical knowledge, revealing optimistic results concerning the application of autologous bone marrow towards various impactful disorders. The bone marrow accommodates a diverse family of cell populations and a rich secretome; therefore, autologous BMA-derived products such as the "BMA Matrix", may represent a safe and viable approach, able to reduce the costs and some drawbacks linked to the expansion of bone marrow. BMA provides -it eliminates many hurdles associated with its preparation, especially in regards to regulatory compliance. The BMA Matrix represents a suitable alternative, indicated for the enhancement of tissue repair mechanisms by modulating inflammation and acting as a natural biological scaffold as well as a reservoir of cytokines and growth factors that support cell activity. Although promising, more clinical studies are warranted in order to further clarify the efficacy of this strategy.

Genetic variability of selected Passiflora alata genotypes based on the physical characteristics of fruits / Variabilidade genética de genótipos selecionados de Passiflora alata baseada em características físicas de frutos

ABSTRACT: Over several past centuries, specific plant populations have been carefully selected to filter strains with higher agronomic performance. Genetic variability is most essential for successful selection. The Passiflora genus offers great inter- and intra-specific variability. This study aimed to evaluate the physical characteristics of the genotypes of the elite passion fruit (Passiflora alata) for selection purpose. We considered the physical traits of fruit mass, longitudinal and equatorial diameters, peel thickness and color, and pulp mass and volume without and with seeds and pulp yield. The sources of variation for the analysis of variance included the fruits of 8 elite genotypes, with 3 replications, whose means were compared by Tukey's test at 1% probability. We also performed multivariate analysis and correlation between these characteristics. Statistical differences were noted between elite genotypes for most of the tested traits. The elite 7 genotype presented with the highest seedless pulp yield in relation to the fruit and the largest fruit mass. Cluster analysis and graphic dispersion revealed a tendency for clustering of the elite genotypes based on their fruit shape. The tested population showed genetic variability, which allowed new selection cycles toward gaining pulp yield and fruit mass.

RESUMO: Há séculos, populações de plantas vem sendo selecionadas a fim de se obter linhagens com maior desempenho agronômico. Para o sucesso da seleção, a variabilidade genética é essencial, sendo que dentro do gênero Passiflora há grande variabilidade inter e intraespecífica. Neste trabalho, objetivou-se avaliar as características físicas de frutos de genótipos elite de maracujazeiro-doce (Passiflora alata) para fins de seleção. Foram avaliadas a massa, diâmetros longitudinal e equatorial de frutos, espessura e coloração da casca e massa e volume de polpa com e sem sementes e rendimentos de polpa. As fontes de variação para análise de variância foram os frutos de oito genótipos elite, com três repetições, cujas médias foram comparadas pelo teste de Tukey a 1% de probabilidade. Foram realizadas ainda análises multivariadas e de correlação entre as características. Houve diferenças estatísticas entre os genótipos elite para a maioria das características avaliadas. O genótipo elite sete foi o que apresentou maior rendimento de polpa sem sementes, em relação ao fruto e maior massa de fruto. Análises de agrupamento e dispersão gráfica evidenciaram uma tendência de agrupamento dos genótipos elite com base no formato dos frutos. A população apresenta variabilidade genética, que permite novos ciclos de seleção para ganho em rendimento de polpa e massa dos frutos.

Genetic diversity of macauba from natural populations of Brazil.

BACKGROUND: The macauba has been identified as the most promising native species for the production of vegetable oil and biomass. Several studies confirm its potential for numerous purposes (liquid and solid biofuels, food, cosmetics and pharmaceuticals), but this Brazilian biodiversity resource has been little explored, and work aimed at their domestication and genetic improvement are relatively recent. This study consisted of a multivariate approach to levels of trans fatty acids, oil yield and physical characteristics found in fruits of macauba of natural populations. The objective was to quantify the genetic variability among 35 genotypes of natural populations of macauba from 16 locations in different regions of Brazil. Euclidean Distance measurements were estimated and the cluster analysis obtained by the UPGMA method considering separately the fatty acid profile, and traits related to physical part and the fruits oil content. RESULTS: It was observed the formation of seven groups for the profile of fatty acids and five groups for physical characteristics and oil yield. Large variations were observed for different types of mesocarp (pulp) fatty acids and kernel. Oleic acid (18: 1) in mesocarp was the largest contribution to the total divergence. The results indicate variations to the physical characteristics and oil yield, especially the oil percentage in mesocarp and weight of the whole fruit which contributed 64.58% of the divergence between genotypes. CONCLUSIONS: The study identified genotypes potential to generate variability and obtaining selection gains, directing plant breeding programs according with demands of oils market.

Análise do consumo alimentar e das alterações bioquímicas de pacientes queimados internados em hospital de referência / Análisis de la ingesta y las alteraciones bioquímicas en pacientes quemados ingresados en un hospital de referencia / Analysis of dietary intake and biochemical alterations in burned patients admitted to hospital for reference

Objetivo: Analisar quantitativamente o consumo alimentar de macro e micronutrientes e identificar as alterações bioquímicas de pacientes queimados. Método: O estudo é descritivo, analítico/inferencial e transversal, realizado no Centro de Tratamento de Queimados de um hospital de referência, Ananindeua/Pará, de agosto a outubro de 2014, com amostra de 25 pacientes. As variáveis foram: número de prontuário, sexo, faixa etária, percentual de área queimada, tipo de queimadura, consumo alimentar de macro e micronutrientes e dados bioquímicos. Adotou-se a estatística descritiva (média e desvio-padrão) para os dados quantitativos; e a estatística inferencial por meio do teste t de Student para comparação entre as médias das variáveis, com nível de significância de 95% (p <0,05). Resultados: Houve maior prevalência no gênero masculino (60%); faixa etária entre 20 a 30 anos (44%); queimadura de origem térmica (76%). Comparando as médias dos valores da 1ª e 2ª avaliações bioquímicas, de acordo com o tipo de queimadura, observou-se alterações entre as duas avaliações. Porém, somente leucócitos, linfócitos e contagem total de linfócitos apresentaram significância estatística. A média de ingestão de carboidratos teve um percentual abaixo do valor recomendado, e de proteínas e lipídios acima do preconizado. Quanto aos micronutrientes, a ingestão de zinco, selênio, vitamina C e vitamina E ficou abaixo do recomendado; porém, a vitamina A estava de acordo com o valor referencial. Houve significância estatística (p <0,05) para todas as análises do consumo alimentar. Conclusão: As variáveis analisadas possibilitaram verificar as alterações bioquímicas e do consumo alimentar, permitindo, assim, possíveis estratégias de intervenções nutricionais.

Objective: To quantitatively analyze the macro and micronutrients food consumption and identify the biochemical changes of burn patients. Method: The study is descriptive, analytical/inferential and cross, held in Burn Treatment Centre for a referral hospital, Ananindeua/Pará, from August to October 2014, with a sample of 25 patients. The variables were: number of records, sex, age, percentage of burned area, type of burn, macro and micronutrient food intake and biochemical data. It adopted the descriptive statistics (mean and standard deviation) for quantitative data; and inferential statistics through the Student t test to compare the means of variables, with significance level of 95% (p<0.05). Results: There was a higher prevalence in males (60%); aged between 20-30 years (44%); burn type of thermal origin (76%). Comparing the mean values of the 1st and 2nd biochemical evaluations, according to the type of burn, there was a change between the two evaluations. But only leukocytes, lymphocytes and total lymphocyte count were statistically significant. The average carbohydrate intake had a percentage below the recommended amount, and proteins and lipids above the recommended. The micronutrients, zinc intake, selenium, vitamin C and vitamin E below the recommended; However, vitamin A was in accordance with the reference value. There were statistically significant (p<0.05) for all analyzes of food consumption. Conclusion: The variables analyzed allowed to check the biochemical and food consumption changes; thus allowing possible strategies of nutritional interventions.

Objetivo: Analizar cuantitativamente el consumo de macro y micronutrientes de alimentos e identificar los cambios bioquímicos de los pacientes quemados. Método: El estudio es descriptivo, analítico/inferencial y transversal, realizado en centro de tratamiento de un hospital de referencia, Ananindeua/Pará, de agosto/ octubre de 2014. Las variables fueron: número de registros, el sexo, la edad, el porcentaje de la superficie quemada, tipo de quemadura, la ingesta de macro y micronutrientes y datos bioquímicos. Realizada estadística descriptiva (media y desviación-estándar) para datos cuantitativos; y estadística inferencial, t de Student, para comparar las medias de las variables, con un nivel de significación del 95% (p<0,05). Resultados: Participaron 25 pacientes. Se observó mayor prevalência en los hombres (60%) e con edades comprendidas entre 20-30 años (44%); quemadura de origen térmica (76%). En la comparación de los valores medios de la 1ª y 2º evaluación bioquímica, según el tipo de quemadura, se observó un cambio entre las dos evaluaciones. Pero sólo los leucocitos, linfocitos y recuento total de linfocitos fueron estadísticamente significantes. El consumo promedio de carbohidratos tuvo un porcentaje abajo de la cantidad recomendada, y las proteínas y los lípidos arriba de lo recomendado. Los micronutrientes, la ingesta de zinc, selenio, vitamina C y vitamina E abajo de lo recomendado. Sin embargo, la vitamina A estaba de acuerdo con el valor de referencia. Todos los análisis de consumo de alimentos fueron estadísticamente significantes (p<0,05). Conclusión: Las variables analizadas permitieron comprobar cambios bioquímicos y de consumo de alimentos; permitiendo así posibles estrategias de intervenciones nutricionales.

Cognition and norms: toward a developmental account of moral agency in social dilemmas.

Most recent developments in the study of social dilemmas give an increasing amount of attention to cognition, belief systems, valuations, and language. However, developments in this field operate almost entirely under epistemological assumptions which only recognize the instrumental form of rationality and deny that "value judgments" or "moral questions" have cognitive content. This standpoint erodes the moral aspect of the choice situation and obstructs acknowledgment of the links connecting cognition, inner growth, and moral reasoning, and the significance of such links in reaching cooperative solutions to many social dilemmas. Concurrently, this standpoint places the role of communication and mutual understanding in promoting cooperation in morally relevant conflicts of action in a rather mysterious situation. This paper draws on Habermas's critique of instrumental action, and on the most recent developments in institutional and behavioral economics with a view to enhancing our knowledge of the interventions used to cope with social dilemmas. We conclude the paper with a brief presentation of a research strategy for examining the capacity of alternative developmental models to predict dissimilar choices under similar incentive conditions in social dilemmas.

Evolução das disparidades da extração vegetal e da silvicultura na Amazônia Legal: uma aplicação da cadeia de Markov / The development of differences in vegetal extraction and silviculture production in the legal amazon: an application of Markov chains

O artigo analisa a convergência municipal da produtividade vegetal (extração vegetal e silvicultura) na região da Amazônia Legal entre os anos de 1996 e 2006. Para analisar a convergência, optou-se pela metodologia da matriz de transição de Markov (Processo Estacionário de Primeira Ordem de Markov). Os resultados mostram a existência de 13 classes de convergência da produtividade vegetal. No longo prazo, a hipótese de convergência absoluta não se mantém, visto que 68,23% dos municípios encontram-se numa classe inferior à média municipal, 33,54% em uma classe intermediária acima da média e 13,41% em uma classe superior acima da média.

This paper analyzes the convergence of the municipalities vegetable productivity in the Legal Amazon region between 1996 and 2006. The convergence analyses use the Markov transition matrix methodology (First Order Stationary Markov Process). The results show that existence of 13 classes of vegetable productivity convergence. In the long run, the hypothesis of absolute convergence is not maintained, whereas 68.23% of the municipalities are in a class lower than the municipal average, 33.54% in an intermediate class above average and 13.41% in a class higher than average.

Impacto da campanha de vacinação para influenza em uma empresa / Impact of influenza vaccination campaign in a company

A influenza é uma das doenças respiratórias agudas mais prevalentes e importante causa de absenteísmo e presenteísmo. Entretanto, a eficácia vacinal para influenza pode alcançar 80% quando há elevada correspondência entre cepas vacinais e circulantes. Por este motivo, a empresa há anos promove campanha de vacinação, contudo, sem estimar sua efetividade (eficácia na redução da carga da doença) e o impacto econômico (produtividade) para o aprimoramento de sua política de saúde ocupacional. Considerou-se que a efetividade da campanha seria determinada pela eficácia vacinal previamente demonstrada en estudos randomizados, pelo grau de acurácia diagnosticada ou de triagem dos casos, pelo nível de adesão do profissional de saúde ao registro no prontuário e do paciente ao informar a ocorrência dos sintomas e pela cobertura vacinal alcançada. Com os objetivos de avaliar a efetividade e impacto econômico da campanha de vacinação para influenza, optou-se por um desenho de estudo observacional de coorte histórico com características de estudo de intervenção baseado em dados históricos da campanha de 2008 e informações individuais sobre a frequência de sintomas respiratórios e absenteísmo, idade, gênero, função (administrativa e peracional), renda e tabagismo, obtidas mediante revisão de prontuário dos 12 meses subsequentes, comparadas entre os grupos de vacinados e não-vacinados (qui-quadrado e test t) e analisadas por regressão logística, e estimada a fração previnível (proporção de episódios potenciais de influenza evitados pela vacinação). Foram analisados os prontuários de 2.425 trabalhadores (1.651 não-vacinados e 754 vacinados) correspondendo à cobertura de 31,1%. A prevalência de influenza observada foi de 10,4% e a vacinação foi feita entre os trabalhadores (RR=0,51; IC95% 39-67), quando considerados os sintomas de alta probabilidade de influenza. A fração prevenível foi 0,09 (9 casos evitados a cada 100 trabalhadores vacinados)...

Population structure and reproduction of Deuterodon langei travassos, 1957 (Teleostei, Characidae) in a neotropical stream basin from the Atlantic Forest, Southern Brazil

Aspects of the biology of D. langei were studied at different sites along a longitudinal gradient formed by the Ribeirão stream basin, a Neotropical stream of the Atlantic Forest, southern Brazil. Differences were observed in population structure and reproduction along the longitudinal gradient and during the study period. Juvenile fishes occurred in high abundance, mainly in the downstream site after the rainy months. Adults occurred mainly in the intermediate and upstream sites. During their life cycle, adults optimise their reproductive strategy by concentrating the reproductive period with total spawn in a short time interval before summer rains dragged the juvenile, larval forms and/or eggs downstream. The downstream site was characterized by a wide range of microhabitats (ex. submerged grass and shallow flooded area). Thus, the species used different portions of the basin in distinct stages of its life, being ecologically adapted to variation patterns in its temporal and physical environments.

Aspectos da biologia de D. langei foram estudados em diferentes locais da bacia do rio Ribeirão, um riacho litorâneo da Floresta Atlântica do sudeste do Brasil. Foram observadas diferenças na estrutura da população e na reprodução, ao longo do gradiente longitudinal da bacia e do período de estudo. Os peixes juvenis ocorreram em grande abundância, principalmente no trecho a jusante da bacia, após os meses mais chuvosos. Adultos ocorreram principalmente nos trechos intermediários e a montante. Não houve diferença significativa na relação sexual entre os locais amostrados, estações do ano, meses e classes de comprimento. O comprimento médio de primeira maturação (L50) foi o mesmo para machos e fêmeas, entre 6,1 e 7,0 cm de comprimento total (Lt). O período reprodutivo foi curto (entre o final da primavera e início do verão), antes dos meses mais chuvosos, com desova total. O Índice de Atividade Reprodutiva (IAR) indicou que D. langei reproduz em toda a bacia, porém a atividade reprodutiva é mais intensa nos trechos mais a montante da bacia. O período chuvoso e as chuvas torrenciais se mostraram fatores abióticos muito importantes para a dinâmica da população. Durante seu ciclo de vida os adultos maximizam sua estratégia reprodutiva concentrando o período reprodutivo, com desova total em um curto espaço de tempo antes das chuvas de verão que carregam juvenis, formas larvais e/ou ovos para as regiões a jusante onde existe uma ampla quantidade de micro-ambientes (gramíneas submersas e áreas rasas e calmas). Desta forma a espécie estudada utilizou diferentes porções da bacia em distintos estágios de seu ciclo de vida, demonstrando estar ecologicamente adaptada às variações temporais e físicas do ambiente.

Reproduction period of Mimagoniates microlepis, from an Atlantic Forest Stream in Southern Brazil

Mimagoniates microlepis was collected between January and December/2002. Three sample points were chosen at higher, medium and lower portions of Ribeirão river, located at the east of Paraná state. The reproduction period was observed by the frequency of gonad developmental stages, variation of the gonosomatic relation (RGS) and gonad condition (K). The average length at the first sexual maturity (L50) and the average length when 100 percent of individuals were adults (L100) were calculated. The intensity of the reproductive activity (IAR) was estimated at each sample point. The reproduction period started in the winter and ended at the end of spring. The high values of IAR encountered demonstrated that the reproductive activity occurred in the whole study area, mainly at the middle portion of the river. Apparently M. microlepis synchronize its fecundation and spawning with the rain regimes using the most suitable times for the cospecific encounters and offspring survival.

Exemplares de Mimagoniates microlepis foram coletados entre janeiro e dezembro de 2002. Foram escolhidos três pontos amostrais localizados em regiões a montante, média e a jusante do rio Ribeirão no litoral do Paraná. A época reprodutiva foi determinada através da freqüência de estágios de desenvolvimento das gônadas, índice gonadosomático (RGS) e fator de condição gonadal (K). O comprimento médio da primeira maturação (L50) e o comprimento médio em que 100 por cento dos indivíduos são adultos (L100) foi calculado. Também foi estimado o índice de atividade reprodutiva (IAR) em cada ponto amostral. O período reprodutivo teve inicio durante o inverno e terminou ao final da primavera. Os valores altos do IAR demonstram que a atividade reprodutiva ocorre em toda área estudada e principalmente na porção média do rio. Aparentemente M. microlepis sincroniza sua fecundação e desova com o ciclo das chuvas, utilizando os momentos mais adequados para encontros coespecíficos e para sobrevivência dos alevinos.

Púrpura trombocitopênica trombótica: remissão completa em paciente com mau prognóstico após tratamento com plasmaférese terapêutica e rituximabe / Successful outcome in poor-prognostic acute thrombotic thrombocytopenic purpura treated with plasma exchange and rituximab

A púrpura trombocitopênica trombótica (PTT) é uma doença rara e fatal que deve ser diagnosticada e tratada prontamente a fim de se obter melhor resposta terapêutica. Apresentamos um caso de PTT aguda grave tratada com plasmaférese e rituximabe. Ao diagnóstico, a paciente apresentava anemia hemolítica microangiopática, icterícia, febre, convulsões, seguidas por coma e choque hipovolêmico. Os exames laboratoriais iniciais mostravam DHL=2.860 IU/L, contagem de plaquetas de 37 x 10(9)/L, hemoglobina de 5,1 g/dL e no esfregaço de sangue periférico havia a presença de esquizócitos. Iniciado tratamento para PTT com pulsoterapia com metilprednisolona e plasmaféreses terapêuticas diárias com troca de uma volemia plasmática e substituição com plasma fresco congelado. Após cinco sessões de plasmaférese, houve piora no quadro neurológico, acompanhado por aumento importante de DHL, ALT, AST e a contagem de plaquetas era de 72 x 10(9)/L. Iniciamos o uso de rituximabe na dose padrão de 375mg/m²/semana/4 semanas e passamos a utilizar plasma pobre em crioprecipitado como reposição durante as plasmaféreses. Dois dias após a mudança na conduta terapêutica, houve importante melhora do quadro neurológico, estabilização da contagem de plaquetas e queda acentuada de DHL. Após 23 procedimentos de plasmaférese e quatro doses de rituximabe, a paciente apresentou remissão completa, mantida há 34 meses. A plasmaférese terapêutica com plasma pobre em crioprecipitado e o uso concomitante de rituximabe foi uma estratégia útil no tratamento deste caso de PTT aguda grave. Porém, ensaios clínicos prospectivos e randomizados são necessários para confirmar estes achados.

Thrombotic thrombocytopenic purpura (TTP) is a rare severe disease that must be diagnosed and treated promptly for a successful outcome. We report a case of severe acute TTP treated with plasma exchange and rituximab. The patient presented at diagnosis with severe microangiopathic haemolytic anemia, jaundice, fever, seizures followed by coma and hypovolemic shock. Her LDH was 2,860 IU/L; platelet count 37 x 10(9)/L; hemoglobin 5.1 g/dL; blood smears contained schistocytes. Treatment for TTP was started with pulses of methylprednisolene and daily single-volume plasma exchange using fresh frozen plasma. After five plasma exchanges, the neurological status worsened, LDH increased sharply as did ALT and AST and the platelet count dropped to 72 x 10(9)/L. Rituximab (weekly doses of 375 mg/m² for 4 weeks) and plasma exchange with cryosupernatant substitution fluid were initiated. Within two days there was neurological improvement, stable platelet levels and decreased LDH. Complete remission, achieved after 23 plasma exchanges and four doses of rituximab, has been maintained for 34 months. Plasma exchange with cryosupernatant substitution fluid and rituximab played an important role in the successful treatment of this patient with severe acute TTP. A systematic clinical trial should be considered in order to confirm these findings.

Ontogenetic, spatial and temporal variations in the feeding ecology of Deuterodon langei Travassos, 1957 (Teleostei: Characidae) in a Neotropical stream from the Atlantic rainforest, southern Brazil

Information related to the diet of one species always contributes to the knowledge of its bionomy and the functioning of the ecosystem in which the species lives. Therefore, understanding the feeding ecology of one fish population and its ontogenetic, spatial and temporal aspects help to understand the structure of fish assemblages and river communities. Knowledge of this structure is essential for habitat management and biodiversity conservation. The feeding ecology of Deuterodon langei Travassos, 1957 was studied through analyses of diet composition, sharing of resources, feeding strategy and contribution of food items to the width of its niche. The analysis included an assessment of ontogenetic, spatial and seasonal variations. The species was considered omnivorous with great plasticity caused by seasonal variation in food availability throughout the river basin, but mainly through ontogeny. The diet of smaller individuals revealed a predominance of insects and other arthropods, while the diet of larger specimens showed allochthonous plant items as the main components. The low intestinal quotient (IQ) values for the smaller individuals were accounted for their mainly insectivorous diet. The greater relative length of the intestine can account for the greater plasticity of the adult diet, enabling them to use diet items of larger size and more difficult digestion, such as plant items. Therefore, shifts in feeding ecology during growth are confirmed in this omnivorous tropical river fish, strengthening the concept that, when comparing food habits among species, fish size must be taken into account. This study also provides needed information regarding the feeding ecology of fishes intrinsically associated with the Atlantic rainforest, one of the most threatened and biodiverse ecosystems of the planet.

Informações relacionadas à alimentação de uma espécie contribuem para o conhecimento de sua bionomia e funcionamento do ecossistema no qual ela vive. Desta forma, entender a ecologia alimentar de uma população de peixes e seus aspectos ontogenéticos, temporais e espaciais auxiliam na compreensão da assembléia de peixes e de toda a comunidade de um rio. Reconhecer tal estrutura é fundamental para o manejo e conservação da biodiversidade do habitat. A ecologia alimentar de Deuterodon langei Travassos, 1957 foi analisada por meio da composição da dieta, partilha de recursos, estratégia alimentar e contribuição dos itens alimentares para o nicho alimentar. As análises incluem uma abordagem das variações ontogenéticas, espaciais e temporais. A espécie foi considerada onívora com uma grande plasticidade alimentar causada pela variabilidade sazonal na disponibilidade de recursos e ao longo da bacia hidrográfica, mas principalmente ao longo de sua ontogenia. A dieta dos indivíduos menores revelou uma predominância de insetos e outros artrópodes, enquanto nos indivíduos maiores ocorreu um predomínio de vegetais alóctones. Os baixos valores de Quociente Intestinal (IQ) para os indivíduos menores foram associados a uma dieta predominantemente insetívora. Os maiores comprimentos intestinais estiveram associados com uma maior plasticidade dos adultos, os quais são capazes de utilizar itens maiores e de difícil digestão, como itens de origem vegetal. Neste sentido, mudanças na ecologia alimentar durante o crescimento são confirmadas neste peixe onívoro de rios tropicais, ampliando o conceito de que, quando se compara os hábitos alimentares entre espécies, o tamanho dos peixes examinados deve ser levado em consideração. Este estudo contribui também com informações necessárias sobre a ecologia alimentar de peixes intrinsecamente associados com a Floresta Atlântica, um dos mais biodiversos e ameaçados ecossistemas do planeta.

(Re) Inventando a mulher e sua sexualidade: alteridade em tempos de AIDS...

Artigo do psicólogo Marcelo Braga publicado na Revista do Círculo Brasileiro de Psicanálise - RJ. Apresenta uma reflexão crítica sobre a posição da mulher na sociedade, a contribuição da Medicina enquanto ciência, e a perpetuação desta condição de forma epidemiológica pela vulnerabilidade ao vírus da AIDS.

Programa de Saúde da Família: uma análise prospectiva / Family Health Program: a prospective analysis

Este artigo resulta da aplicação do método formalizado de previsão de cenários de Godet à realidade do Programa de Saúde da Família. Compõe-se de uma síntese do método, da contextualização histórica da proposição do Programa de Saúde da Família (PSF) e da análise prospectiva do PSF. O exercício se desenvolve em 7 passos e ao final define-se um cenário central, um otimista e um pessimista. Entre as variáveis consideradas, evidencia-se o controle social e flexibilidade para adaptação local como as que desempenham papel mais estratégico para o sucesso do programa. (AU)

Programa de Saúde da Família: uma análise prospectiva / Family Health Program: a prospective analysis

Este artigo resulta da aplicaçäo do método formalizado de previsäo de cenários de Godet à realidade do Programa de Saúde da Família. Compöe-se de uma síntese do método, da contextualizaçäo histórica da proposiçäo do Programa de Saúde da Família (PSF) e da análise prospectiva do PSF. O exercício se desenvolve em 7 passos e ao final define-se um cenário central, um otimista e um pessimista. Entre as variáveis consideradas, evidencia-se o controle social e flexibilidade para adaptaçäo local como as que desempenham papel mais estratégico para o sucesso do programa.