Are ventriculopleural shunts the second option for treating hydrocephalus? A meta-analysis of 543 patients.

BACKGROUND: Some centers utilize ventriculopleural shunt (VPLS) for treating hydrocephalus when conventional approaches are not feasible. Nonetheless, the literature regarding this approach is scarce. PURPOSE: Evaluate the outcomes of VPLS through a single-arm meta-analysis. METHODS: Following PRISMA guidelines, the authors systematically searched for articles utilizing the VPLS in a cohort with more than four patients. Outcomes included: mortality, pleural effusion, number of patients who underwent revisions, obstructions, shunt migration, emphysema, and subdural hematoma. RESULTS: A total of 404 articles were reviewed, resulting in the inclusion of 13 retrospective studies encompassing 543 patients, with the majority being children (62.6 %). The median average follow-up period was 35.4 months (10-64.1). After analysis, results yielded a revision rate of 54 % (95 % CI: 44 %-64 %; I2=73 %). The most common complication observed was pleural effusion, with a post-analysis incidence of 16 % (95 % CI: 11 %-21 %; I2=63 %), followed by infections at 7 % (95 % CI: 4 %-10 %; I2=33 %). Shunt obstruction occurred in 13 % (95 % CI: 4 %-21 %; I2=84 %) of cases after analysis, while migrations, overdrainage, subdural hematoma, and cutaneous emphysema had minimal occurrence rates (0 %, 95 % CI: 0 %-1 %; I2=0 %). Notably, there were no reported cases of shunt-related mortality. CONCLUSION: VPLS can be considered when there are no other suitable options for placing the distal catheter. However, the notable rates of shunt revisions, pleural effusion, infections, and the inherent heterogeneity of outcomes currently limit the widespread adoption of VPLS. In this scenario, other alternatives should be given priority.

Abastecimento e segurança alimentar: os limites da liberalizaçäo / The safe and food supply: limits of liberalization

Tem como preocupaçäo principal, a disponibilidade e o acesso aos alimentos. Enfoca os diversos aspectos envolvidos na problemática do abastecimento alimentar no Brasil e no mundo, tendo a busca por segurança alimentar como referência principal. Considera que o contexto atual demanda um esforço nesse sentido. Observa que a alimentaçäo é um direito humano que näo será assegurado se gerido segundo estritos critérios empresariais e de mercado. Relata que ao lado do problema da fome ainda persiste o desperdício e que a homogeneizaçäo dos hábitos de consumo, a desregulamentaçäo dos mercados e a liberalizaçäo do comércio internacional recolocam a questäo da segurança alimentar em novas bases. Quais os limites das políticas nacionais de abastecimento alimentar? Como integrar a produçäo agrícola local aos novos fluxos alimentares? Como atuam os agentes econômicos no espaço ampliado pela abertura dos mercados? Estas säo algumas das questöes discutidas.