Identification of potential prognosticators for sepsis through expression analysis of transcriptomic data from sepsis survivors and nonsurvivors

Background@#Infection can be severely complicated by a dysregulated, whole-body inflammatory response known as sepsis. While previous research showed that genetic predisposition is linked to outcome differences, current patient characterization fails to determine which septic patients have greater tendencies to develop into severe sepsis or go into septic shock. As such, the identification of prognostic biomarkers may assist in identifying these high-risk patients and help improve the clinical management of the disease.@*Objective@#In this study, we aimed to identify molecular patterns involved in sepsis. We also aimed to identify essential genes associated with the disease’s survival which could serve as potential prognosticators for the disease. @*Methods@#We used weighted gene co-expression analysis (WGCNA) to analyze GSE63042, an RNA expression dataset from 129 patients with systemic inflammatory response syndrome or sepsis, including 78 sepsis survivors and 28 sepsis nonsurvivors. This analysis included identifying gene modules that differentiate sepsis survivors from nonsurvivors and qualitatively assessing differentially expressed genes. We then used STRING’s protein-protein interaction and gene ontology analysis to determine the functional and pathway relationships of the genes in the top modules. Lastly, we assessed the prognosticator abilities of the hub genes using ROC analysis. @*Results@#We found four diverse co-expression gene modules significantly associated with sepsis survival. Our differential gene expression analysis, combined with protein-protein interaction and gene ontology analysis, revealed that the hub genes of these modules – TAF10, SNAPIN, PSME2, PSMB9, JUNB, and CEBPD – may serve as candidate markers for sepsis prognosis. These markers were significantly downregulated in sepsis nonsurvivors compared with sepsis survivors.@*Conclusion@#Weighted gene co-expression analysis, gene ontology enrichment analysis, and proteinprotein network interaction analysis of transcriptomic data from sepsis survivors and nonsurvivors revealed TAF10, SNAPIN, PSME2, PSMB9, JUNB, and CEBPD as potential biomarkers for sepsis prognosis. These genes are associated with functions related to proper immune response, and their downregulation in sepsis nonsurvivors suggests eventual immune exhaustion in late sepsis. Further analyses, however, are necessary to validate their roles in sepsis progression and patient survival.

Delayed-onset unilateral facial paralysis after mastoidectomy: A case report

Objective@#To discuss the case of a 36-year-old man who presented with left unilateral facial paralysis 11 days after mastoidectomy.@*Methods@#Design: Case Report Setting: Tertiary Government Training Hospital Patient: One@*Results@#A 36-year-old man with recurrent left ear discharge of 30 years duration underwent left canal wall-down mastoidectomy and was discharged well after 3 days. On follow up after 8 more days, he was noted to have House Brackmann IV left facial paralysis. Following 5 days methylprednisolone, neurologic evaluation and physical therapy rehabilitation, facial paralysis improved in the ensuing weeks until House-Brackmann I was achieved at week 12.@*Conclusion@#Delayed-onset Facial Palsy (DFP) following tympanomastoid surgery may be approached conservatively, including steroids, acyclovir, and, if with a history of herpes or varicella infection, immunization can be given. Prognosis for DFP is good especially when the facial nerve is identified intraoperatively during otologic surgeries

Caracterización clínica y sociodemográfica de mujeres embarazadas con COVID-19 hospitalizadas / Clinical and sociodemographic characterization of pregnant women hospitalized with COVID-19

Resumen Introducción: En las mujeres embarazadas se identifica mayor riesgo de desarrollar infecciones respiratorias virales. Objetivo: Analizar características sociodemográficas, evolución, manifestaciones clínicas y complicaciones en mujeres embarazadas con COVID-19 que fueron hospitalizadas. Métodos: Estudio en 11 hospitales públicos; se incluyeron variables sociodemográficas, comorbilidades, síntomas y signos, hallazgos de laboratorio y gabinete, características del embarazo, tratamiento y desenlace de la gestación. Resultados: La edad osciló entre 15 y 40 años; 85.1 % cursaba el tercer trimestre del embarazo, 11.9 % el segundo y 3 % el primero; 27 % presentó alguna comorbilidad como obesidad, hipertensión o asma; 89.5 % presentó fiebre, 73.1 % tos, 44.8 % disnea, 43.3 % cefalea y 35.8 % mialgias. Los diagnósticos fueron enfermedad leve (55.2 %), neumonía leve (26.9 %), neumonía severa (10.4 %), neumonía severa con síndrome de distrés respiratorio agudo (4.5 %) y neumonía severa con choque séptico (3 %); 76.2 % recibió soporte de oxígeno no invasivo y 9 %, ventilación mecánica. Se interrumpió el embarazo en 53.8 %; 95.5 % egresó por mejoría y 4.5 % falleció. Conclusiones: El rango de edad y los síntomas coinciden con los señalados en la literatura especializada. En mujeres con COVID-19 se evidenció el incremento de la operación cesárea sin una indicación clara.

Abstract Introduction: In pregnant women, a higher risk for developing viral respiratory infections is identified. Objective: To analyze sociodemographic characteristics, evolution, clinical manifestations, and complications of pregnant women hospitalized with COVID-19. Methods: Study conducted at 11 public hospitals; sociodemographic variables, comorbidities, signs and symptoms, laboratory and imaging findings, pregnancy characteristics, treatment and pregnancy outcome were included for analysis. Results: Age ranged between 15 and 40 years; 85.1% were at third trimester of pregnancy, 11.9% at second and 3% at first; 27% had any comorbidity such as obesity, hypertension or asthma; 89.5% had fever, 73.1% cough, 44.8% dyspnea, 43.3% headache and 35.8% myalgia. Diagnoses were mild disease (55.2%), mild pneumonia (26.9%), severe pneumonia (10.4%), severe pneumonia with acute respiratory distress syndrome (4.5%), and severe pneumonia with septic shock (3%); 76.2% had noninvasive oxygen support, and 9%, mechanical ventilation. Pregnancy was interrupted in 53.8%; 95.5% were discharged due to improvement of their condition and 4.5% died. Conclusions: Age range and symptoms are consistent with those previously reported. Evidence was found of an increase in cesarean section without a clear indication in women with COVID-19.

Age-stratified mean values of prostate volume among Filipino males in a tertiary hospital: A single center study

INTRODUCTION AND OBJECTIVES@#Differences in ethnicity and geographical factors may have an effect in the characteristics of the prostate in men. To date, there is no demographical data regarding the average prostate volume among Filipino males stratified per age.@*METHODS@#Retrospectively collected data from 3568 consecutive patients who had an ultrasound of the prostate from January 1, 2015 to December 31, 2016. Age and prostate volume by ultrasound were collected. Patients who had previous prostate surgery were excluded, and for uniformity of results, only patients who underwent transabdominal prostate ultrasound were included.@*RESULTS@#Patients were stratified into the following age groups: 29 and below, 30 to 39, 40 to 49, 50 to 59, 60 to 69, 70 to 79, and 80 and above, and present results showed that the mean values of prostate volume were 15.8 ± SD 5.4, 19.6 ± SD 5.7, 22.1 ± SD 7.3, 28.0 ± SD 11.0, 34.0 ± SD 17.9, 39.6 ± SD 28.13, 39.2 ± SD 23.3, respectively.@*CONCLUSION@#The mean prostate volume among Filipino males increases with age and the threshold for an enlarged prostate might need an adjustment in dealing with Filipino patients.

A genetic polymorphism in GCKR may be associated with low high-density lipoprotein cholesterol phenotype among Filipinos: A case-control study

@#<p style="text-align: justify;"><strong>Background.</strong> Low levels of high-density lipoprotein cholesterol (HDL-c) is a well-recognized risk factor in the development of cardiovascular diseases. Associated gene variants for low HDL-c have already been demonstrated in various populations. Such associations have yet to be established among Filipinos who reportedly have a much higher prevalence of low HDL-c levels compared to other races.</p><p style="text-align: justify;"><strong>Objective.</strong> To determine the association of selected genetic variants and clinical factors with low HDL-c phenotype in Filipinos.</p><p style="text-align: justify;"><strong>Methods.</strong> An age- and sex-matched case-control study was conducted among adult Filipino participants with serum HDL-c concentration less than 35 mg/dL (n=61) and those with HDL-c levels of more than 40 mg/dL (n=116). Genotyping was done using DNA obtained from blood samples. Candidate variants were correlated with the low HDL-c phenotype using chi-squared test and conditional logistic regression analysis.</p><p style="text-align: justify;"><strong>Results.</strong> Twelve single nucleotide polymorphisms (SNPs) were associated with low HDL-c phenotype among Filipinos with univariate regression analysis. The variant rs1260326 of glucokinase regulator (GCKR) (CT genotype: adjusted OR=5.17; p-value=0.007; TT genotype: adjusted OR=6.28; p-value=0.027) remained associated with low HDL-c phenotype, together with hypertension and elevated body mass index, after multiple regression analysis.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The variant rs1260326 near GCKR is associated with low HDL-c phenotype among Filipinos. Its role in the expression of low HDL-c phenotype should be further investigated prior to the development of possible clinical applications.</p>

Variants near CETP, MTTP and BUD13-ZPR1-APOA5 may be nominally associated with poor statin response among Filipinos

@#<p style="text-align: justify;"><strong>Objective.</strong> Several studies showed that genetic factors affect responsiveness to statins among different populations. This study investigated the associations of candidate genetic variants with poor response to statins among Filipinos.</p><p style="text-align: justify;"><strong>Methods.</strong> In this unmatched case-control study, dyslipidemic participants were grouped into statin responders and poor responders based on the degree of reduction in LDL-c from baseline. DNA from blood samples were genotyped and analyzed. The association of candidate variants with statin response was determined using chi-square and logistic regression analysis.</p><p style="text-align: justify;"><strong>Results.</strong> We included 162 adults on statins (30 poor responders as cases, 132 good responders as controls). The following variants are nominally associated with poor response to statin among Filipinos at a per-comparison error rate of 0.05: rs173539 near CETP (OR=3.05, p=0.015), rs1800591 in MTTP (OR=3.07, p=0.021), and rs1558861 near the BUD13-ZPR1-APOA5 region (OR=5.08, p=0.004).</p><p style="text-align: justify;"><strong>Conclusion.</strong> Genetic variants near CETP, MTTP and the BUD13-ZPR1-APOA5 region are associated with poor response to statins among Filipinos. Further study is recommended to test the external validity of the study in the general Filipino population.</p>

Management of isolated mandibular body fractures in adults

Objective@#The mandible is the most common fractured craniofacial bone of all craniofacial fractures in the Philippines, with the mandibular body as the most involved segment of all mandibular fractures. To the best of our knowledge, there are no existing guidelines for the diagnosis and management of mandibular body fractures in particular. General guidelines include the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAOHNSF) Resident Manual of Trauma to the Face, Head, and Neck chapter on Mandibular Trauma, the American Association of Oral and Maxillofacial Surgeons (AAOMS) Clinical Practice Guidelines for Oral and Maxillofacial Surgery section on the Mandibular Angle, Body, and Ramus, and a 2013 Cochrane Systematic Review on interventions for the management of mandibular fractures. On the other hand, a very specific Clinical Practice Guideline on the Management of Unilateral Condylar Fracture of the Mandible was published by the Ministry of Health Malaysia in 2005. Addressing the prevalence of mandibular body fractures, and dearth of specific guidelines for its diagnosis and management, this clinical practice guideline focuses on the management of isolated mandibular body fractures in adults.@*Purpose@#This guideline is meant for all clinicians (otolaryngologists – head and neck surgeons, as well as primary care and specialist physicians, nurses and nurse practitioners, midwives and community health workers, dentists, and emergency first-responders) who may provide care to adults aged 18 years and above that may present with an acute history and physical and/or laboratory examination findings that may lead to a diagnosis of isolated mandibular body fracture and its subsequent medical and surgical management, including health promotion and disease prevention. It is applicable in any setting (including urban and rural primary-care, community centers, treatment units, hospital emergency rooms, operating rooms) in which adults with isolated mandibular body fractures would be identified, diagnosed, or managed. Outcomes are functional resolution of isolated mandibular body fractures; achieving premorbid form; avoiding use of context-inappropriate diagnostics and therapeutics; minimizing use of ineffective interventions; avoiding co-morbid infections, conditions, complications and adverse events; minimizing cost; maximizing health-related quality of life of individuals with isolated mandibular body fracture; increasing patient satisfaction; and preventing recurrence in patients and occurrence in others.@*Action Statements@#The guideline development group made strong recommendationsfor the following key action statements: (6) pain management- clinicians should routinely evaluate pain in patients with isolated mandibular body fractures using a numerical rating scale (NRS) or visual analog scale (VAS); analgesics should be routinely offered to patients with a numerical rating pain scale score or VAS of at least 4/10 (paracetamol and a mild opioid with or without an adjuvant analgesic) until the numerical rating pain scale score or VAS is 3/10 at most; (7) antibiotics- prophylactic antibiotics should be given to adult patients with isolated mandibular body fractures with concomitant mucosal or skin opening with or without direct visualization of bone fragments; penicillin is the drug of choice while clindamycin may be used as an alternative; and (14) prevention- clinicians should advocate for compliance with road traffic safety laws (speed limit, anti-drunk driving, seatbelt and helmet use) for the prevention of motor vehicle, cycling and pedestrian accidents and maxillofacial injuries.The guideline development group made recommendations for the following key action statements: (1) history, clinical presentation, and diagnosis - clinicians should consider a presumptive diagnosis of mandibular fracture in adults presenting with a history of traumatic injury to the jaw plus a positive tongue blade test, and any of the following: malocclusion, trismus, tenderness on jaw closure and broken tooth; (2) panoramic x-ray - clinicians may request for panoramic x-ray as the initial imaging tool in evaluating patients with a presumptive clinical diagnosis; (3) radiographs - where panoramic radiography is not available, clinicians may recommend plain mandibular radiography; (4) computed tomography - if available, non-contrast facial CT Scan may be obtained; (5) immobilization - fractures should be temporarily immobilized/splinted with a figure-of-eight bandage until definitive surgical management can be performed or while initiating transport during emergency situations; (8) anesthesia - nasotracheal intubation is the preferred route of anesthesia; in the presence of contraindications, submental intubation or tracheostomy may be performed; (9) observation - with a soft diet may serve as management for favorable isolated nondisplaced and nonmobile mandibular body fractures with unchanged pre - traumatic occlusion; (10) closed reduction - with immobilization by maxillomandibular fixation for 4-6 weeks may be considered for minimally displaced favorable isolated mandibular body fractures with stable dentition, good nutrition and willingness to comply with post-procedure care that may affect oral hygiene, diet modifications, appearance, oral health and functional concerns (eating, swallowing and speech); (11) open reduction with transosseous wiring - with MMF is an option for isolated displaced unfavorable and unstable mandibular body fracture patients who cannot afford or avail of titanium plates; (12) open reduction with titanium plates - ORIF using titanium plates and screws should be performed in isolated displaced unfavorable and unstable mandibular body fracture; (13) maxillomandibular fixation - intraoperative MMF may not be routinely needed prior to reduction and internal fixation; and (15) promotion - clinicians should play a positive role in the prevention of interpersonal and collective violence as well as the settings in which violence occurs in order to avoid injuries in general and mandibular fractures in particular.

Simarouba Glauca Bark Extract Mediated Synthesis And Characterisation Of Iron Oxide And Silver Nanoparticles And Their Antibacterial, Cytotoxic And Photocatalytic Activity

Objective: The objective of the present study is the synthesis of iron oxide and silver nanoparticles using Simarouba glauca aqueous bark extract, characterization of the synthesized nanoparticles and evaluation of their antimicrobial, photocatalytic activity and cytotoxicity. Methods: The iron oxide and silver nanoparticles were synthesized using Simarouba glauca aqueous bark extract and crystal structures of the nanoparticles were determined by UV-Visible spectroscopy, Transmission Electron Microscopy, Scanning Electron Microscopy, X-ray Diffraction and Fourier Transform Infrared Spectroscopy. The in vitro cytotoxicity of the silver nanoparticles was evaluated using Dalton’s lymphoma ascites cells. The antibacterial assay of the silver nanoparticles was conducted using agar well diffusion method. Results: The UV-Visible spectrum of iron oxide nanoparticle showed an absorption maximum at 280 nm and silver nanoparticles showed an absorption maximum at 436 nm. This is XRD pattern of iron oxide nanoparticles exhibited a characteristic peak at 26.85 is of maghemite the corresponding miller indices is (211) and the synthesized iron oxide nanoparticles are amorphous in nature. TEM image reveals the size of the synthesized iron oxide nanoparticles in the range of 26-30 nm and the size of silver nanoparticles is in the range of 120-140 nm. Green synthesized iron nanoparticles using Simarouba glauca bark extract effectively degraded methylene blue dye. Conclusion: This study showed that the synthesized iron oxide and silver nanoparticles using Simarouba glauca aqueous bark extract exhibited pronounced antibacterial, anticancer and photocatalytic activity and can be used in the textile industry and also as an external antiseptic in prevention and treatment of bacterial infections.

Quimioterapia neoadyuvante: indicaciones y resultados. Experiencia de 15 años en el Instituto Alexander Fleming / Neoadjuvant chemotherapy: indications and results. Fifteen years of experience at Instituto Alexander Fleming

Introducción Existe consenso sobre los subgrupos de pacientes con más probabilidades de beneficiarse del tratamiento neoadyuvante, pero su utilización en la práctica clínica es variable. Las pacientes con cáncer de mama en etapa temprana susceptibles de requerir quimioterapia adyuvante podrían considerarse para realizar quimioterapia neoadyuvante (qtna). Objetivos Evaluar las tasas de cirugía conservadora en pacientes con cáncer de mama que reciben qtna y describir las tendencias de respuestas clínica, imagenológica y patológica en la mama y la axila. Material y método Se realizó una evaluación retrospectiva de 125 pacientes con cáncer de mama invasor (Estadios IB-IIA/B-IIIA), operadas en el Instituto Alexander Fleming en el período 2002-2018. Resultados Las tasas más altas de respuesta patológica completa (pcr) se obtuvieron en los tumores her2, tn y Luminal B-her2, representando el 56%, 55% y 40% respectivamente. En la respuesta patológica completa ganglionar, las tasas más altas se obtuvieron en los Luminal B-her2 82%, los tn 80% y los her2 70%. Las tasas de cirugía conservadora fueron: para Luminal A 44%, para Luminal B 58%, para Luminal B-her2 54%, para her2 76% y para tn 59%. Conclusiones Concordante con trabajos publicados, se describen altas tasas de cirugía conservadora y altas tasas de pcr en tumores her2 y tn

Introduction Even though there is evidence about better outcomes after neoadjuvant chemotherapy (nac) for breast cancer (bc), it is unclear who are the indicated patients and what are the correct indications for using it. Our hypothesis is that early stage bc patients, who are identified as susceptible for adjuvant chemotherapy, could be the most benefited of receiving nac. Objectives We aimed to study the number of patients who received nac and breast conserving surgery (bcs) assessing clinical, pathological and radiological response in both, breast and axilla. Materials and method We carried out a retrospective study of 125 patients newly diagnosed of bc (Stage IB-IIA-B and IIIA) who received nat and bcs in our institution, "Instituto Alexander Fleming", during the 2002-2018 period Results We obtained the higher rates of pathological complete response (pcr) in her2 being 56%; for tn was 55% and 40% for Luminal B-her2. The highest rates of complete pathological lymph node response were obtained in Luminal B-her2 82%, tn 80% and her2 70%. The rates for bcs where 44%, 58%, 54% and 76% for Luminal A, Luminal B, Luminal B-her2 and her2 respectively. Conclusions There is current data available supporting our findings, having similar results for bcs and pcr performing bcs after nat

Pelvimetry of multiparous Nellore cows in the cycling and early puerperal stages / Pelvimetria de vacas pluríparas da raça Nellore em estágio cíclico e início do puerpério

Pelvis is an osteoligamentous complex, which is classified as dolichopellic in ruminants. Impairments linked to incompatibility of pelvic canal and fetal size is directly related to pelvic anatomy and disposition. Heritability of pelvic area characteristics varies from moderate to high, demonstrating its importance for animal selection. Pelvimetry can be performed through direct and indirect methods that were accessed in this study aiming to establish a correlation between internal and external pelvic dimensions in multiparous Nellore cows (26 animals) at cycling and early puerperal (up to 30 days postpartum) reproductive stages. Pelvic dimensions measured by descriptive analysis were higher at early puerperal stage. Strong Pearson's correlation was determined between internal and external pelvic dimensions, between reproductive stages, and between pelvic girdle area and internal pelvic area. Significant Tukey's test differences between animals in internal and external dimensions were also found. According to the results, the pelvic anatomy of Nellore cows varies according to their reproductive stage. We detach that and provide data regarding the use of internal pelvic area for animal selection studies on this breed is determined and should be measured using the proposed formula, since it can confirm statistical differences in the areas of pelvic components between animals in the cycling and early puerperal stages.(AU)

A pelve é considerada um complexo osteoligamentoso, classificada como dolicopélvica em ruminantes. Prejuízos ligados à incompatibilidade canal pélvico/tamanho fetal relacionam-se diretamente à anatomia e disposição pélvica. A característica de área pélvica apresenta herdabilidade variando de moderada a alta, indicando sua importância na seleção animal. A pelvimetria inclui formas direta e indireta. Neste estudo utilizaram-se vinte e seis vacas multíparas, da raça Nelore, agrupadas de acordo com o estágio reprodutivo, cíclico e em início de estágio puerperal (até 30 dias pós-parto). Através deste, objetivou-se evidenciar a relação das medidas pélvicas internas e externas nos diferentes períodos reprodutivos e coletar obter dados referentes a utilização da área interna do hexágono no estudo pelvimétrico dessa espécie em estágio cíclico ou puerperal. Para tanto, realizou-se, a pelvimetria direta e indireta. Os resultados obtidos, pela análise descritiva, foram maiores para animais em início de estágio puerperal. Por meio da correlação de Pearson podem-se observar fortes correlações entre mensurações pélvicas internas e externas, também entre os grupos propostos, e forte correlação entre elipse pélvica e área interna do hexágono. Pelo teste Tukey diferenças significativas tanto em medidas internas e externas puderam ser demonstradas. Conclui-se que as condições anatômicas da pelve variam de acordo com o estágio reprodutivo do animal, que aferição da área pélvica utilizando a formula proposta para área do hexágono interno é relevante pois foi possível comprovar a diferenças estatísticas de áreas nas fases cíclica e puerperal.(AU)

Liver resection for non-oriental hepatolithiasis / Ressecção hepática no tratamento da hepatolitíase não oriental

ABSTRACT Background: Primary intrahepatic lithiasis is defined when the stones are formed in the liver and associated with local dilatation and biliary stricture. Liver resection is the ideal procedure. Aim: To evaluate the results of liver resection in the treatment of non-oriental intrahepatic lithiasis. Methods: Fifty-one patients with symptomatic benign non-oriental hepatolithiasis underwent surgical resection in six institutions in Brazil. Demography data, clinical symptoms, classification, diagnosis, management and postoperative course were analyzed. Results: Of the 51 patients, 28 were male (54.9%), with a mean age of 49.3 years. History of cholangitis was observed in 15 (29.4%). The types of intrahepatic lithiasis were type I in 39 (76.5%) and type IIb in 12 (23.5%), with additional type Ea in six (11.8%). Liver function test were normal in 42 patients (82.4%). Segmental atrophy was observed in 12 (23.5%). Treatments included left lateral sectionectomy in 24 (47.1%), left hepatectomy in 14 (27.5%) and right hepatectomy in eight (15.7%), with associated hepaticojejunostomy in four (7.8%). Laparoscopic liver resection was performed in eight (15.7%). Postoperative complications were observed in 20 (39.2%) with no mortality. Conclusion: Liver resection in patients with hepatolithiasis is the ideal procedure as it removes stones, stricture, atrophic parenchyma, and minimizes the risk of cholangiocarcinoma.

RESUMO Racional: Litíase intra-hepática primária é definida quando os cálculos são formados dentro do fígado, podendo estar associada à dilatação local e estenosa da via biliar. A ressecção hepática é considerada o procedimento ideal. Objetivo: Avaliar os resultados da ressecção hepática no tratamento da litíase intra-hepática não oriental. Métodos: Cinquenta e um pacientes com hepatolitíase benigna não oriental sintomática foram submetidos à ressecção hepática em seis instituições no Brazil. Os dados demográficos, sintomas clínicos, classificação, diagnóstico, tratamento e evolução pós-operatória foram analisados. Resultados: Dos 51 pacientes havia 28 homens (54,9%), e a idade média era de 49,3 anos. História de colangite foi observada em 15 pacientes (29,4%). Os tipos de litíase observados foram tipo I em 39 (76,5%) e tipo IIb em 12 (23,5%), com o tipo adicional Ea em seis pacientes (11,8%). Os testes de função hepática estavam normais em 42 (82,4%) e atrofia segmentar foi observada em 12 (23,5%). O tratamento incluiu setorectomia lateral esquerda em 24 (47,1%), hepatectomia esquerda em 14 (27,5%) e hepatectomia direita em oito pacientes (15,7%). A hepaticojejunostomia esteve associada ao procedimento inicial em quatro (7,8%). Hepatectomia por videolaparoscopia foi realizada em oito (15,7%). Complicações pós-operatórias foram observadas em 20 pacientes (39,2%) e não houve mortalidade. Conclusão: Ressecção hepática na hepatolitíase é o procedimento ideal, pois remove os cálculos, a estenose, o parênquima atrofiado e minimiza os riscos para colangiocarcinoma.

Conhecimento tático declarativo e avaliação subjetiva do treinador no voleibol / Declarative tactical knowledge and subjective evaluation of coach in volleyball

O objetivo do estudo foi verifi car o nível de Conhecimento Tático Declarativo (CTD) de iniciantes na modalidade de voleibol, a relação entre a percepção e a tomada de decisão, a avaliação subjetiva do treinador e o índice de difi culdade dos itens. Foram avaliados 28 sujeitos de ambos os sexos por meio do teste de CTD em Situação de Ataque de Rede e os resultados apontaram que, apenas considerando o tempo de prática dos jogadores encontraram-se diferenças signifi cativas na percepção (p=0,033). Encontrou-se correlação entre a percepção e o CTD, assim como a tomada de decisão e o CTD (r=0,905; r=0,698). Os Assim, conclui-se que o maior tempo de prática na modalidade é determinante para a melhor qualidade de percepção dos sinais relevantes no voleibol e os treinadores subestimaram o CTD de seus respectivos atletas....(AU)

The objective of this study was to verify the Declarative Tactical Knowledge (DTK) level of volleyball players, the relation between perception and decision making, the coach subjective evaluation and the items diffi culty index. The sample was composed by 28 volunteers of both sexes. The DTK in a net attack situation was elected and the results shows that only considering players time practice presented diff erent meanings in perception (p=0,033). There was a correlation between perception and CTD, as well as decision-making and CTD (r = 0.905; r = 0.698). Thus, it is concluded that the greater time of practice in the modality is determinant for the better quality of perception of the relevant signs in volleyball and the coaches underestimated the CTD of their respective athletes....(AU)

Population dynamics of Aphis gossypii Glover and in sole and intercropping systems of cotton and cowpea

ABSTRACT Population dynamics of aphids have been studied in sole and intercropping systems. These studies have required the use of more precise analytical tools in order to better understand patterns in quantitative data. Mathematical models are among the most important tools to explain the dynamics of insect populations. This study investigated the population dynamics of aphids Aphis gossypii and Aphis craccivora over time, using mathematical models composed of a set of differential equations as a helpful analytical tool to understand the population dynamics of aphids in arrangements of cotton and cowpea. The treatments were sole cotton, sole cowpea, and three arrangements of cotton intercropped with cowpea (t1, t2 and t3). The plants were infested with two aphid species and were evaluated at 7, 14, 28, 35, 42, and 49 days after the infestations. Mathematical models were used to fit the population dynamics of two aphid species. There were good fits for aphid dynamics by mathematical model over time. The highest population peak of both species A. gossypii and A. craccivora was found in the sole crops, and the lowest population peak was found in crop system t2. These results are important for integrated management programs of aphids in cotton and cowpea.

The behavior of Aphis gossypii and Aphis craccivora (Hemiptera: Aphididae) and of their predator Cycloneda sanguinea (Coleoptera: Coccinellidae) in cotton-cowpea intercropping systems

ABSTRACT The intercropping is an important cultural practice commonly used in pest management. It is based on the principle that increased plant diversity in the agro-ecosystem can lead to reductions of pest populations in the crop. The current study aimed to assess the impact the colored fiber cotton-cowpea intercropped systems on Aphis gossypii and Aphis craccivora and on their predator Cycloneda sanguinea and the losses and the dispersion behavior of these aphids and their predator in these cropping systems. The experiment had a randomized block experimental design with two bioassays and four treatments. The number of apterous and alate aphids (A. gossypii) per cotton plant was 1.46 and 1.73 or 1.97 and 2.19 times highest in the solid cotton system than that found in the cotton-cowpea intercropped systems (S1) and (S2), respectively. On the other hand, the cotton-cowpea intercropped systems (S1 and S2) reduced, respectively, in 43% and 31% the number of apterousA. gossypiiper cotton plant compared to the control. Implementing cotton-cowpea intercropped system in the S1 scheme reduced A. gossypii infestation, favored the multiplication of C. sanguinea, and allowed obtaining heavier open bolls.

Nutrition governance, good governance for nutrition and nutritional status of children under-five year old in Laguna, Philippines

@#ntroduction: Governance affects nutrition improvement. This study aimed to determine the association between nutrition governance (NG), nutritional status (NS) of children under five years (CU5) and good governance for nutrition (GGN) in Laguna, where malnutrition is a chronic problem. Methods: This crosssectional study obtained data from thirty cities and municipalities (C/M) using desk review and face-to-face interviews. A developed scorecard generated NG and GGN data using 3-point scale with "0" as lowest/absence to "1" indicating partial to "2" as highest/full compliance. Total NG scores was 26 while 38 for GGN. NS was determined using Operation Timbang Plus data. Spearman's rank analysis statistically determined the associations between NG, NS, and GGN. Results: Underweight and wasting prevalence were low (6.1% and 3.4%) while stunting was high (17.7%). The median percentage scores of C/M on NG and GGN were 73.0%±14.0% and 82.0%±24.0%, respectively. Rosa City and Kalayaan had the highest NG score and the lowest underweight prevalence in urban and rural areas, respectively. Significant but negative associations were found between NG and underweight (r=-0.729, p<0.001), and stunting (r=-0.753, p<0.001). Likewise, GGN and underweight (r=-0.488, p=0.006), and stunting (r=-0.380, p=0.046) showed negative associations. Conclusion: C/M in Laguna with higher NG and GGN scores have lower CU5 underweight and stunting prevalence. The study recommended to local governments to invest in establishing separate nutrition unit, hiring technical and administrative staffs, formulating vision and mission, and building capacity on nutrition programme management.

Tendances de la tuberculose pulmonaire bactériologiquement confirmée et issues thérapeutiques en République Démocratique du Congo : 2007-2017

Contexte et objectifs. La République Démocratique du Congo compte parmi les pays à lourd fardeau pour la tuberculose (TB), l'incidence réelle de la maladie n'est pas formellement connue. La présente étude vise à décrire les tendances de l'incidence notifiée des patients atteints de tuberculose pulmonaire bactériologiquement confirmée (TP+) et leurs issues thérapeutiques. Méthodes. Cette étude documentaire, analyse les données des patients diagnostiqués et traités pour tuberculose de 2007 à 2017 en RDC. L'incidence notifiée des patients TP+, le taux d'accroissement annuel, les issues thérapeutiques ont été recherchés. Les variations du nombre de patients sont exprimées par les proportions. Les tendances sont présentées à travers les courbes de régression linéaire. Les issues thérapeutiques sont comparées à l'aide du z-score avec un seuil significatif de p˂ 0,05. Résultats. Au total 884 458 patients TP+ ont été rapportés, dont 820 858 nouveaux patients (NP TP+) et 63 600 déjà traités. Le taux d'accroissement au cours de cette décade était de 28,95%, soit de 66099 en 2007 à 93767 en 2017 pour les NP TP+. L'augmentation annuelle moyenne était de 2,41% +/- 3,28 pour les NP TP+ et de 5,7% +/- 0,26 par an pour les rechutes. La notification des échecs de traitement initial et repris après abandon de traitement ont une tendance à la baisse. L'évaluation thérapeutique de tous les cas cumulés a concerné 848 163 patients dont 789 716 NP TP+ et 58447 en retraitement. Le succès thérapeutique était de 88,0 % pour les NP TP+ et 70,0 % pour les rechutes, de 64,3 % pour les échecs et de 67,8% pour les repris en traitement après abandon. En somme 70 515 (8,3%) patients ont gardé des expectorations positives. Conclusion. Cette étude montre une tendance à la hausse de notification des cas incidents dont l'issue de traitement répond aux standards de l'OMS. En outre, un nombre des personnes demeurent porteurs de germes persistants précurseurs d'une TB pharmacorésistante acquise

Tendances de la tuberculose pulmonaire bactériologiquement confirmée et issues thérapeutiques en République Démocratique du Congo : 2007-2017

Contexte et objectifs. La République Démocratique du Congo compte parmi les pays à lourd fardeau pour la tuberculose (TB), l'incidence réelle de la maladie n'est pas formellement connue. La présente étude vise à décrire les tendances de l'incidence notifiée des patients atteints de tuberculose pulmonaire bactériologiquement confirmée (TP+) et leurs issues thérapeutiques. Méthodes. Cette étude documentaire, analyse les données des patients diagnostiqués et traités pour tuberculose de 2007 à 2017 en RDC. L'incidence notifiée des patients TP+, le taux d'accroissement annuel, les issues thérapeutiques ont été recherchés. Les variations du nombre de patients sont exprimées par les proportions. Les tendances sont présentées à travers les courbes de régression linéaire. Les issues thérapeutiques sont comparées à l'aide du z-score avec un seuil significatif de p˂ 0,05. Résultats. Au total 884 458 patients TP+ ont été rapportés, dont 820 858 nouveaux patients (NP TP+) et 63 600 déjà traités. Le taux d'accroissement au cours de cette décade était de 28,95%, soit de 66099 en 2007 à 93767 en 2017 pour les NP TP+. L'augmentation annuelle moyenne était de 2,41% +/- 3,28 pour les NP TP+ et de 5,7% +/- 0,26 par an pour les rechutes. La notification des échecs de traitement initial et repris après abandon de traitement ont une tendance à la baisse. L'évaluation thérapeutique de tous les cas cumulés a concerné 848 163 patients dont 789 716 NP TP+ et 58447 en retraitement. Le succès thérapeutique était de 88,0 % pour les NP TP+ et 70,0 % pour les rechutes, de 64,3 % pour les échecs et de 67,8% pour les repris en traitement après abandon. En somme 70 515 (8,3%) patients ont gardé des expectorations positives. Conclusion. Cette étude montre une tendance à la hausse de notification des cas incidents dont l'issue de traitement répond aux standards de l'OMS. En outre, un nombre des personnes demeurent porteurs de germes persistants précurseurs d'une TB pharmacorésistante acquise

Conservation of geosites as a tool to protect geoheritage: the inventory of Ceará Central Domain, Borborema Province - NE/Brazil

ABSTRACT The Ceará Central Domain, in the northern Borborema Province/NE Brazil, encompasses important geological records (geosites) which allow understanding a relevant period of the Earth's evolution, mainly associated to Neoproterozoic Brazilian/Pan-African Cycle and West Gondwana amalgamation, besides Neoarchean to Ordovician records. The presented geoheritage inventory aims to characterise the geosites with scientific relevance of Ceará Central Domain. By applying a method for large areas, the final selection resulted in eight geological frameworks represented by 52 geosites documented in a single database. This is the first step for a geoconservation strategy based on systematic inventories, statutory protection, geoethical behaviour and awareness about scientific, educational and/or cultural relevance of geosites.

Effects of temperature on the feeding behavior of Alabama argillacea (Hübner) (Lepidoptera: Noctuidae) on Bt and non-Bt cotton plants

ABSTRACT The host acceptance behavior and environmental factors as temperature affect the feeding behavior of Lepidoptera pests. Thus, they must be considered in studies about the risk potential of resistance evolution. The current study sets the differences in the feeding behavior of neonate Alabama argillacea (Hübner) (Lepidoptera: Noctuidae) larvae exposed to Bt and non-Bt cotton plants, under different temperatures and time gap after hatching. Two cotton cultivars were used: the Bt (DP 404 BG - bollgard) and the non-transformed isoline, DP 4049. We found that the feeding behavior of neonate A. argillacea is significantly different between Bt and non-Bt cotton. Based on the number of larvae with vegetal tissue in their gut found on the plant and in the organza as well as on the amount of vegetal tissue ingested by the larvae. A. argillacea shows feeding preference for non-Bt cotton plants, in comparison to that on the Bt. However, factors such as temperature and exposure time may affect detection capacity and plant abandonment by the larvae and it results in lower ingestion of vegetal tissue. Such results are relevant to handle the resistance of Bt cotton cultivars to A. argillacea and they also enable determining how the cotton seeds mix will be a feasible handling option to hold back resistance evolution in A. argillacea populations on Bt cotton, when it is compared to other refuge strategies. The results can also be useful to determine which refuge distribution of plants is more effective for handling Bt cotton resistance to A. argillacea.

Bizygomatic width and its association with social and personality traits in males / Distancia bicigomática y su asociación con habilidades sociales y rasgos de personalidad en hombres

This study will examine how differences in measurements between bizygomatic and bigonial arches of the human face can provide relevant information regarding personality and abilities of the subject. Sample: 82 males. Group A: 55 subjects with the bizygomatic arch in contraction. Group B: 27 subjects without the bizygomatic arch in contraction. Subjects performed self-assessment tests in the following areas: ability incorporating themselves into the group, alexithymia and emotional expressiveness. Group A showed greater self-sufficiency and independence than group B, greater difficulty in describing and verbally expressing their emotions, less ability to express themselves emotionally through other forms of communication and reduced willingness to cooperate philanthropically. Results suggest a strong relationship between morphological structure of the bizygomatic arch and certain psychological characteristics.

Este estudio examina cómo la diferencia entre las anchuras del arco bicigomático y bigonial en la cara humana, proporcionan información relevante sobre la personalidad y las habilidades de un sujeto. Muestra: 82 hombres. Grupo A: 55 sujetos con el arco bicigomático en contracción. Grupo B: 27 sujetos con el arco bicigomático sin retracción. Los sujetos realizaron pruebas de autoevaluación en las siguientes áreas: adhesión/independencia al grupo, alexitimia y expresividad emocional. El grupo A mostró respecto al grupo B una mayor autosuficiencia e independencia, mayor dificultad para describir y expresar verbalmente sus emociones, menor capacidad para expresarse emocionalmente a través de diferentes formas de comunicación y reducción de la voluntad de cooperar filantrópicamente. Los resultados sugieren una fuerte relación entre la estructura morfológica del arco bicigomático y ciertas características psicológicas.