"'It is very difficult in this business if you want to have a good conscience': pharmaceutical governance and on-the-ground ethical labor in Ghana": a letter to editors.

Establishing effective pharmaceutical governance is a challenge for government agencies, private enterprises, and professionals working on the ground, demanding complex ethical decisions from the actors involved, especially in a lower-middle-income country like Ghana. This letter aims to share the author's perspectives and additional considerations on the analyses of the reports in the paper "It is very difficult in this business if you want to have a good conscience": pharmaceutical governance and on-the-ground ethical labor in Ghana by Hampshire et al. The letter's authors discuss the need to advance universal health coverage in Ghana, the everyday ethics, and the disparities between the collective and individual moral consciousness of the participants, as well as other aspects of governance in the pharmaceutical sector.

Judicialização no acesso a medicamentos: análise das demandas judiciais no estado do Piauí, Brasil / Judicialization in access to medicines: analysis of lawsuits in the State of Piauí, Brazil

Resumo: Este trabalho objetivou analisar acórdãos de fornecimento de medicamentos pelo Estado no Tribunal de Justiça do Estado do Piauí (TJ-PI) entre 2018 e 2021. Foram analisados 209 acórdãos, tendo sido predominantes mandados de segurança (49%), concessão de liminar (95%), decisões favoráveis (93%), medicamentos do sistema nervoso (24,6%) e antineoplásicos (23,7%), transtornos mentais (13,4%) e neoplasias (9,8%). Os resultados e análises demonstram o dever do Estado em prover os medicamentos solicitados.

Abstract: This work aimed to analyze judgments on the supply of medicines by the State in the Court of Justice of the State of Piauí (TJ-PI) between 2018 and 2021. 209 judgments were analyzed, predominantly injunctions (49%); granting of an injunction (95%); favorable decisions (93%); nervous system drugs (24.6%) and antineoplastics (23.7%); mental disorders (13.4%) and neoplasms (9.8%). The results and analyses demonstrate the State's duty to provide the requested medication.

Síndrome inflamatória multissistêmica em crianças infectadas por coronavírus: uma revisão integrativa / Multisystemic inflamatory syndrome in children infected by coronavirus: an integrative review / Síndrome inflamatorio multisistémico en niños infectados por coronavirus: una revisión integradora

Durante a pandemia de COVID-19, foram observadas manifestações atípicas em pacientes pediátricos em diversas regiões do mundo, e o conjunto desses sintomas caracterizou uma nova patologia denominada Síndrome Inflamatória Multissistêmica em Crianças (MIS-C), ou Síndrome Inflamatória Multissistêmica Pediátrica Temporariamente associada ao COVID-19 (PIMS- TS). O objetivo desta revisão foi analisar as manifestações clínicas e as possíveis complicações relacionadas a tal quadro inflamatório. Foi realizada uma busca por artigos científicos nas bases de dados Embase, PubMed e Web of Science, por meio da combinação dos descritores "MIS-C", "PIMS- TS" e "COVID-19". Após a análise dos artigos encontrados, e considerando critérios de inclusão e exclusão, foram selecionados 15 estudos para compor esta revisão. A maioria dos estudos mencionaram complicações gastrointestinais, cardiovasculares, respiratórias e mucocutâneas. Ademais, foram encontrados marcadores que indicavam estado inflamatório generalizado e coagulopatia. Assim, concluiu-se que MIS-C provavelmente é uma síndrome manifestada após a infecção por SARS-CoV-2, podendo ocasionar quadros mais graves, mas com baixas taxas de mortalidade.

During the COVID-19 pandemic, atypical manifestations were observed in pediatric patients in different regions of the world, and the set of these symptoms characterized a new pathology called Multisystemic Inflammatory Syndrome in Children (MIS-C), or Pediatric Multisystemic Inflammatory Syndrome Temporarily associated with COVID-19 (PIMS-TS). The purpose of this review was to analyze the clinical manifestations and possible complications related to such an inflammatory condition. A search for scientific articles was carried out in the databases Embase, PubMed and Web of Science, by combining the descriptors "MIS-C", "PIMS-TS" and "COVID-19". After analyzing the articles found, and considering inclusion and exclusion criteria, 15 studies were selected to compose this review. Most studies mentioned gastrointestinal, cardiovascular, respiratory and mucocutaneous complications. In addition, markers were found that indicated generalized inflammatory status and coagulopathy. Thus, it was concluded that MIS-C is probably a syndrome manifested after infection by SARS-CoV-2, which can cause more severe conditions, but with low mortality rates.

Durante la pandemia de COVID-19 se observaron manifestaciones atípicas en pacientes pediátricos de diferentes regiones del mundo, y el conjunto de estos síntomas caracterizó una nueva patología denominada Síndrome Inflamatorio Multisistémico en Niños (SMI-C), o Síndrome Inflamatorio Multisistémico Pediátrico Asociado Temporalmente a COVID-19 (SIPM-TS). El propósito de esta revisión fue analizar las manifestaciones clínicas y las posibles complicaciones relacionadas con dicha condición inflamatoria. Se realizó una búsqueda de artículos científicos en las bases de datos Embase, PubMed y Web of Science, combinando los descriptores "MIS-C", "PIMS- TS" y "COVID-19". Tras analizar los artículos encontrados, y teniendo en cuenta los criterios de inclusión y exclusión, se seleccionaron 15 estudios para componer esta revisión. La mayoría de los estudios mencionaron complicaciones gastrointestinales, cardiovasculares, respiratorias y mucocutáneas. Además, se encontraron marcadores que indicaban un estado inflamatorio generalizado y coagulopatía. Así pues, se concluyó que el SMI-C es probablemente un síndrome que se manifiesta tras la infección por el SARS-CoV-2, que puede causar cuadros más graves, pero con bajas tasas de mortalidad.

Public awareness and engagement in relation to the coastal oil spill in northeast Brazil.

Social media data is a rich source of information to assess human activities in catastrophic events. Here, we use social media data to understand how the 2019 Brazilian oil spill influenced social attitudes. Data were collected from the globally popular Instagram platform between August 1, 2019 and March 1, 2020. First, we manually identified the 5 most popular (portuguese language) hashtags related to the oil spill #oleonononordeste; #desastreambiental; #marsemoleo; #sosnordeste; #marsempetroleo. In the sequence, we collected information on captions, post metadata and users associated with posts retrieved using the selected hashtags. We identified a total of 7,413 posts. These posts were grouped in topics: government (47.76%), protest (24.37%), volunteers (24.45%), biodiversity (0.003%), origin (0.006%), tourism (0.008%) and others (0.016%). All topics had the peak of posts in October and November 2019. Nevertheless, interest in the oil spill was temporary, with most posts appearing in the 2-4 months after the beginning of the disaster. Our findings illustrate the enormous potential of using social media data for understanding and monitoring human engagement with environmental disasters, but also suggest that conservationists and environmental groups may only have a limited 'window of opportunity' to engage and mobilize public support for remediation and restoration efforts.

A Review of the Phytochemistry and Pharmacological Properties of the Genus Arrabidaea.

The genus Arrabidaea, consisting of ~170 species, belongs to the family Bignoniaceae, distributed around the Neotropics and temperate zone. The center of diversity of the family is in Brazil, where 56 genera and about 340 species exist. Most species of the genus Arrabidaea are traditionally utilized as diuretics and antiseptics, as well as for treating intestinal colic, diarrhea, kidney stones, rheumatoid arthritis, wounds, and enterocolitis. The genus is chemically diverse with different substance classes; most of them are triterpenes, phenolic acids, and flavonoids, and they exhibit valuable pharmacological properties, such as antitumor, antioxidant, leishmanicidal, trypanocidal, anti-inflammatory, and healing properties. This review presents information on the chemical constituents isolated from seven Arrabidaea species, and the pharmacological activities of the extracts, fractions and pure substances isolated since 1994, obtained from electronic databases. The various constituents present in the different species of this genus demonstrate a wide pharmacological potential for the development of new therapeutic agents, however its potential has been underestimated.

Effects of Microalgae Addition and Fish Feed Supplementation in the Integrated Rearing of Pacific White Shrimp and Nile Tilapia Using Biofloc Technology.

This study aims to evaluate a Pacific white shrimp and Nile tilapia integrated system using biofloc technology with or without the addition of the microalgae Scenedesmus obliquus and with or without fish feed supplementation in a two-factor 62-day experiment. The shrimp (2.16 ± 0.01 g) were reared under a density of 400 shrimp m−3 and the fish (1.53 ± 0.12 g) were reared under a density of 522 fish m−3. The microalgae was added to the culture water two times a week. Growth performance, sludge production, and water microbiology were evaluated. Fish feed and the microalgae addition improved fish final biomass in 58% and 14%, respectively (p < 0.05). Fish survival was significantly higher when microalgae was added (93.9 ± 1.8%) compared with the treatments without microalgae addition (86.2 ± 7.6%) (p < 0.05). The yield of the overall system was higher in the treatments with fish feed supplementation (4.2 ± 0.2 kg m−3) compared with no addition (3.9 ± 0.2 kg m−3) (p < 0.05). These results suggest that fish feed supplementation at the rate of 1% of the biomass and microalgae inoculation can improve fish growth performance and system yield, without affecting sludge production and water microbiology. This work is an expansion of a conference paper with the same title.

Efeitos da judicialização de medicamentos antineoplásicos nos serviços farmacêuticos em oncologia / Judicialization effects of antineoplastic drugs in a public cancer care facility / Efectos de la judicialización de los fármacos antineoplásicos en un servicio público de atención oncológica

Objetivo: analisar como os efeitos das demandas judiciais quanto aos aspectos regulatório, técnico, logístico e clínico impactam os serviços farmacêuticos em oncologia. Metodologia: estudo descritivo e exploratório, utilizando dados de processos judiciais recebidos pelo Instituto Nacional do Câncer (INCA), entre janeiro de 2009 e dezembro de 2018, e que resultaram no fornecimento de antineoplásicos. As variáveis foram analisadas nas dimensões médico-sanitária e político-administrativa, e correlacionadas aos seus efeitos nos serviços farmacêuticos em oncologia, nas perspectivas regulatória, logística, técnica e clínica. Resultados: foram identificados 41 processos judiciais que demandaram 14 antineoplásicos diferentes no período. Todos os medicamentos possuíam registro válido na Agência Nacional de Vigilância Sanitária; os anticorpos monoclonais foram os mais demandados; e o gasto total no período ultrapassou R$ 3 milhões. O descumprimento de aspectos normativos; as implicações técnicas e logísticas para preparo de antineoplásicos adquiridos pelos pacientes com recursos advindos de demandas judiciais; e a insuficiência de evidências científicas que suportem a adequada tomada de decisão foram alguns dos efeitos da judicialização para os serviços farmacêuticos em oncologia. Conclusão: os resultados permitiram ampliar o debate sobre os efeitos da judicialização da saúde, considerando aspectos basilares da assistência farmacêutica imbricados na rotina dos serviços de saúde.

Objective: to analyze the effects of lawsuits regarding the regulatory, technical, logistical and clinical aspects that impact the pharmaceutical services. Methods: descriptive and exploratory study using data from lawsuits received by a reference cancer care facility between January 2009 and December 2018, and which resulted in the supply of antineoplastic drugs. The variables were analyzed in the clinical-sanitary and regulatory-institutional dimensions and correlated to its effects on pharmaceutical services in oncology, from regulatory, logistical, technical, and clinical perspectives. Results: a total of 41 lawsuits demanded 14 different antineoplastic drugs in the period. All medicines had a valid Brazilian National Health Surveillance Agency registration, monoclonal antibodies were the most demanded and the total expenditure in the period exceeded R$ 3 million. Non-compliance with normative aspects, technical and logistical implications for the preparation of antineoplastic drugs purchased by patients with resources from lawsuits and lack of scientific evidence to support adequate decision-making were discussed as some of the judicialization effects for pharmaceutical services. Conclusion: the results made it possible to broaden the debate on the effects of health judicialization considering the basic aspects of pharmaceutical care imbricated in the routine of health services.

Objetivo: analizar los efectos de los juicios sobre los aspectos regulatorios, técnicos, logísticos y clínicos que impactan los servicios farmacéuticos. Metodología: estudio descriptivo y exploratorio con datos de los juicios recibidos por un centro oncológico de referencia entre enero de 2009 y diciembre de 2018 y que resultaron en el suministro de fármacos antineoplásicos. Las variables fueron analizadas en las dimensiones médico-sanitaria y político-administrativa, y correlacionado con sus efectos sobre los servicios farmacéuticos en oncología, desde las perspectivas regulatoria, logística, técnica y clínica. Resultados: un total de 41 demandas demandaron 14 antineoplásicos diferentes en el período. Todos los medicamentos tenían un registro válido de la Agencia Nacional de Vigilancia Sanitaria de Brasil, los anticuerpos monoclonales fueron los más demandados y el gasto total en el período superó los R$ 3 millones. El incumplimiento de aspectos normativos, las implicaciones técnicas y logísticas para la preparación de fármacos antineoplásicos adquiridos por pacientes con recursos de litigios y la falta de evidencia científica que sustente una adecuada toma de decisiones se discutieron como algunos de los efectos de judicialización para los servicios farmacéuticos. Conclusión: los resultados permitieron ampliar el debate sobre los efectos de la judicialización de la salud, considerando los aspectos básicos de la atención farmacéutica imbricados en la rutina de los servicios de salud.

Intensification of Penaeid Shrimp Culture: An Applied Review of Advances in Production Systems, Nutrition and Breeding.

Intensification of the shrimp sector, also referred to as vertical expansion, has been predominately driven by consecutive incidences of global disease outbreaks, which have caused enormous economic loss for the main producer countries. A growing segment of the shrimp farming industry has opted to use production systems with higher density, biosecurity, and operating control to mitigate the risks posed by disease. However, successful super-intensive shrimp production is reliant on an advanced understanding of many important biological and economic parameters in the farming system, coupled with effective monitoring, to maintain optimal production. Compared to traditional extensive or semi-intensive systems, super-intensive systems require higher inputs of feed, energy, labor, and supplements. These systems are highly sensitive to the interactions between these different inputs and require that the biological and economical parameters of farming are carefully balanced to ensure success. Advancing nutritional knowledge and tools to support consistent and efficient production of shrimp in these high-cost super-intensive systems is also necessary. Breeding programs developing breeding-lines selected for these challenging super-intensive environments are critical. Understanding synergies between the key areas of production systems, nutrition, and breeding are crucial for super-intensive farming as all three areas coalesce to influence the health of shrimp and commercial farming success. This article reviews current strategies and innovations being used for Litopenaeus vannamei in production systems, nutrition, and breeding, and discusses the synergies across these areas that can support the production of healthy and high-quality shrimp in super-intensive systems. Finally, we briefly discuss some key issues of social license pertinent to the super-intensive shrimp farming industry.

Influence of design and material characteristics on 3D printed flow-cells for heat transfer-based analytical devices.

Redesigning 3D-printed flow cells is reported used for heat transfer based detection of biomolecules from a flow-through system to an addition-type measurement cell. The aim of this study is to assess the performance of this new measurement design and critically analyse the influence of material properties and 3D printing approach on thermal analysis. Particular attention is paid to reduce the time to stabilisation, the sample volume in order to make the technique suitable for clinical applications, and improving the sensitivity of the platform by decreasing the noise and interference of air bubbles. The three different approaches that were studied included a filament polylactic acid cell using only fused filament fabrication (FFF), a resin cell printed using stereolitography (SLA), and finally a design made of copper, which was manufactured by combining metal injection moulding (MIM) with fused filament fabrication (FFF). Computational fluid dynamic (CFD) modelling was undertaken using ANSYS Fluent V18.1 to provide insight into the flow of heat within the measurement cell, facilitating optimisation of the system and theoretical response speed.It was shown that the measurement cells using SLA had the lowest noise (~ 0.6%) and shortest measurement time (15 min), whereas measurement cells produced using other approaches had lower specificity or suffered from voiding issues. Finally, we assessed the potential of these new designs for detection of biomolecules and amoxicillin, a commonly used beta lactam antibiotic, to demonstrate the proof of concept. It can be concluded that the resin addition-type measurement cells produced with SLA are an interesting affordable alternative, which were able to detect amoxicillin with high sensitivity and have great promise for clinical applications due to the disposable nature of the measurement cells in addition to small sample volumes.

Ionic concentration in periradicular medium after dissolution of endodontic file fragments: an in vitro study.

The aim of this study was to obtain ionic quantification in periradicular medium after diffusion tests of the solution used inside root canals during the electrochemical dissolution of endodontic file fragments and the NiTi-containing dissolution product via an apical foramen. Thirty single-rooted extracted human teeth had root canals prepared and were attached to Eppendorf tubes filled with sterile saline. The samples were divided into 3 groups (n = 10) according to the solution used inside the root canal during the diffusion tests: Group 1: [NaF 12 g/L + NaCl 1 g/L]; Group 2: [NaF 12 g/L + NaCl 1 g/L + NiTi 0.50 g/L]; Group 3: [NaF 6 g/L + NaCl 0.5 g/L + NiTi 0.25 g/L]. The sample in each Eppendorf tube was then analyzed to assay the ionic quantification in periradicular medium. The groups were compared in relation to ionic quantifications (Kruskal-Wallis and Dunn's tests, p ≤ 0.05). Group 2 showed significantly higher F-, Ni and Ti quantities than groups 1 and 3 (p < 0.05). Group 3 showed significantly higher Ti and Ni quantities than group 1, where no measurable quantities of Ti and Ni were observed (p < 0.05). The conclusions were that a 50% dilution of the NiTi-containing dissolution product resulted in significantly lower F-, Ni and Ti quantities compared to the undiluted product. The quantifications observed here suggest that irrigation is recommendable during the electrochemical dissolution process to reduce the resultant ion concentrations in both the root canal and the periradicular medium.

Ionic concentration in periradicular medium after dissolution of endodontic file fragments: an in vitro study

Abstract The aim of this study was to obtain ionic quantification in periradicular medium after diffusion tests of the solution used inside root canals during the electrochemical dissolution of endodontic file fragments and the NiTi-containing dissolution product via an apical foramen. Thirty single-rooted extracted human teeth had root canals prepared and were attached to Eppendorf tubes filled with sterile saline. The samples were divided into 3 groups (n = 10) according to the solution used inside the root canal during the diffusion tests: Group 1: [NaF 12 g/L + NaCl 1 g/L]; Group 2: [NaF 12 g/L + NaCl 1 g/L + NiTi 0.50 g/L]; Group 3: [NaF 6 g/L + NaCl 0.5 g/L + NiTi 0.25 g/L]. The sample in each Eppendorf tube was then analyzed to assay the ionic quantification in periradicular medium. The groups were compared in relation to ionic quantifications (Kruskal-Wallis and Dunn's tests, p ≤ 0.05). Group 2 showed significantly higher F-, Ni and Ti quantities than groups 1 and 3 (p < 0.05). Group 3 showed significantly higher Ti and Ni quantities than group 1, where no measurable quantities of Ti and Ni were observed (p < 0.05). The conclusions were that a 50% dilution of the NiTi-containing dissolution product resulted in significantly lower F-, Ni and Ti quantities compared to the undiluted product. The quantifications observed here suggest that irrigation is recommendable during the electrochemical dissolution process to reduce the resultant ion concentrations in both the root canal and the periradicular medium.

TRANSHIATAL ESOPHAGECTOMY IN SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS: WHAT ARE THE BEST INDICATIONS?

BACKGROUND: Overall survival in patients who underwent transhiatal esophagectomy submitted or not to neoadjuvant therapy. Southern Brazil has one of the highest incidences of esophageal squamous cell carcinoma in the world. Transthoracic esophagectomy allows more complete abdominal and thoracic lymphadenectomy than transhiatal. However, this one is associated with less morbidity. AIM: To analyze the outcomes and prognostic factors of squamous esophageal cancer treated with transhiatal procedure. METHODS: All patients selected for transhiatal approach were included as a potentially curative treatment and overall survival, operative time, lymph node analysis and use of neoadjuvant therapy were analyzed. RESULTS: A total of 96 patients were evaluated. The overall 5-year survival was 41.2%. Multivariate analysis showed that operative time and presence of positive lymph nodes were both associated with a worse outcome, while neoadjuvant therapy was associated with better outcome. The negative lymph-node group had a 5-year survival rate of 50.2%. CONCLUSION: Transhiatal esophagectomy can be safely used in patients with malnutrition degree that allows the procedure, in those with associated respiratory disorders and in the elderly. It provides considerable long-term survival, especially in the absence of metastases to local lymph nodes. The wider use of neoadjuvant therapy has the potential to further increase long-term survival.

A Learning Analytics Framework to Analyze Corporal Postures in Students Presentations.

Communicating in social and public environments are considered professional skills that can strongly influence career development. Therefore, it is important to proper train and evaluate students in this kind of abilities so that they can better interact in their professional relationships, during the resolution of problems, negotiations and conflict management. This is a complex problem as it involves corporal analysis and the assessment of aspects that until recently were almost impossible to quantitatively measure. Nowadays, a number of new technologies and sensors have being developed for the capture of different kinds of contextual and personal information, but these technologies were not yet fully integrated inside learning settings. In this context, this paper presents a framework to facilitate the analysis and detection of patterns of students in oral presentations. Four steps are proposed for the given framework: Data collection, Statistical Analysis, Clustering, and Sequential Pattern Mining. Data Collection step is responsible for the collection of students interactions during presentations and the arrangement of data for further analysis. Statistical Analysis provides a general understanding of the data collected by showing the differences and similarities of the presentations along the semester. The Clustering stage segments students into groups according to well-defined attributes helping to observe different corporal patterns of the students. Finally, Sequential Pattern Mining step complements the previous stages allowing the identification of sequential patterns of postures in the different groups. The framework was tested in a case study with data collected from 222 freshman students of Computer Engineering (CE) course at three different times during two different years. The analysis made it possible to segment the presenters into three distinct groups according to their corporal postures. The statistical analysis helped to assess how the postures of the students evolved throughout each year. The sequential pattern mining provided a complementary perspective for data evaluation and helped to observe the most frequent postural sequences of the students. Results show the framework could be used as a guidance to provide students automated feedback throughout their presentations and can serve as background information for future comparisons of students presentations from different undergraduate courses.

Nannochloropsis spp. as Feed Additive for the Pacific White Shrimp: Effect on Midgut Microbiology, Thermal Shock Resistance and Immunology.

This work aimed to evaluate Nannochloropsis spp. as feed additive in the diet of Pacific white shrimp for their effect on midgut microbiology, thermal shock resistance and immunological parameters. Initially, the digestibility of the microalgae meal was assessed, and the apparent digestibility coefficient (ADC) was determined. The ADC was, in general, high in lipids (78.88%) and eicosapentaenoic fatty acid (73.86%). Then, Nannochloropsis spp. were included in diets at four levels (0, 0.5, 1 and 2% inclusion). The shrimp were reared in 500 L clear water tanks containing 20 shrimp per tank with an initial weight of 6.05 ± 0.06 g and fed four times a day. Shrimp fed with supplemented diets containing Nannochloropsis spp. (0.5 and 2%) presented higher resistance to thermal shock when compared to the non-supplemented group (control). Shrimp fed with 1 and 2% of algae inclusion had a higher production of reactive oxygen species (ROS) when compared to other treatments. No statistical difference was observed in the immunological parameters and microbiology of the intestinal tract. Thus, the inclusion of Nannochloropsis spp. in shrimp diets at 0.5 and 2% levels increases resistance to thermal shock and ROS production in shrimp.

Brazilian Consensus on Endoscopic Sleeve Gastroplasty.

PURPOSE: Bariatric endoscopy is a less invasive approach for obesity management, with better efficacy than pharmacological treatment and low morbidity. Endoscopic sleeve gastroplasty (ESG) is the remodeling of the stomach using a suturing device showing technical feasibility, safety, and sustained weight loss. With growing numbers of procedures worldwide, there is a need to standardize the procedure. MATERIALS AND METHODS: A consensus meeting was held in São Caetano do Sul-SP, Brazil, in June 2019, bringing together 47 Brazilian endoscopists with experience in ESG from all regions of the country. Topics on indications and contraindications of the procedure, pre-procedure evaluation and multidisciplinary follow-up, technique and post-procedure follow-up, and training requirements were discussed. An electronic voting was carried, and a consensus was defined as ≥ 70% agreement. RESULTS: The panel's experience consisted of 1828 procedures, with a mean percentage total body weight loss (TBWL) of 18.2% in 1 year. Adverse events happened in 0.8% of the cases, the most common being hematemesis. The selected experts discussed and reached a consensus on several questions concerning patient selection, contraindications for the procedure, technical details such as patient preparation, procedure technique, and patient follow-up. CONCLUSIONS: This consensus establishes practical guidelines for performance of ESG. The experience of 1828 procedures shows the expertise of the selected specialists participating in this consensus statement. The group's experience has a satisfactory weight loss with low adverse events rate. The main points discussed in this paper may serve as a guide for endoscopists performing ESG. Practical recommendations and technique standardization are described.

Mortalidade por Covid-19 em pacientes portadores de doença renal crônica estágio 5 em programa de diálise: diabetes mellitus e idade como fatores de risco adicionais / Covid-19 mortality in stage 5 chronic kidney disease patients on dialysis: diabetes mellitus and age as additional risk factors

Objetivo: Avaliar a incidência e a evolução da Covid-19 em indivíduos com diagnóstico prévio de doença renal crônica estágio 5D e também comparar diabéticos e não diabéticos. Métodos: Foi analisada a mortalidade por Covid-19 em pacientes com doença renal crônica estágio 5D sem diabetes e no subgrupo de pacientes diabéticos. A comparação da idade média entre diabéticos e não diabéticos e pacientes que morreram e sobreviventes foi realizada por meio do teste t de Student para amostras independentes. A proporção de óbitos entre diabéticos e não diabéticos foi calculada pelo teste do qui-quadrado de Pearson. Resultados: A pro- porção de óbitos entre pacientes diabéticos e não diabéticos com doença renal crônica estágio 5D foi significativamente diferente (p=0,0245; razão de chance de 5,03; IC95% 1,26-21,84). A idade média foi de 55,0±15,6, e 15 pacientes (35,7%) eram diabéticos e significativamente mais velhos que os não diabéticos (p=0,0233). Não foi observada diferença na proporção de diabéticos entre homens e mulheres (p=0,5758) e nem na idade média entre diabéticos e não diabéticos (p=0,1829). Conclusão: A mortalidade por Covid-19 em pacientes com doença renal crônica estágio 5D é significativamente maior do que na população em geral, e este estudo mostrou diabetes mellitus e idade como fatores de risco adicionais para mortalidade nesta população.

Objective: To evaluate the incidence and progression of Covid-19 in individuals previously diagnosed with stage 5 chronic kidney disease and compare diabetic and nondiabetic indi- viduals. Methods: Covid-19 mortality in nondiabetic 5 chronic kidney disease patients and in the subgroup of diabetic patients was analyzed. The average age comparison between diabetic and nondiabetic patients and those who died and survived was performed using Student t test for independent samples. The proportion of deaths between diabetics and nondiabetics was calculated using Pearson's Chi-squared test. Results: The proportion of deaths between diabetic and nondiabetic 5 chronic kid- ney disease patients was significantly different (p=0.0245), odds ratio of 5.03 (95%CI= 1.26-21.84). The average age was 55.0±15.6, and 15 patients (35.7%) were diabetic and significantly older than nondiabetic (p=0.0233). No difference was observed in the proportion of diabetics between men and women (p=0.5758) or in the average age between diabetics and nondiabetics (p=0.1829). Conclusion: Covid-19 mortality in 5 chronic kidney disease patients is significantly higher than in general popula- tion and this study has shown diabetes mellitus and age as ad- ditional risk factors for mortality in this population.

Lipopolysaccharide triggers different transcriptional signatures in taurine and indicine cattle macrophages: Reactive oxygen species and potential outcomes to the development of immune response to infections.

Macrophages are classified upon activation as classical activated M1 and M2 anti-inflammatory regulatory populations. This macrophage polarization is well characterized in humans and mice, but M1/M2 profile in cattle has been far less explored. Bos primigenius taurus (taurine) and Bos primigenius indicus (indicine) cattle display contrasting levels of resistance to infection and parasitic diseases such as C57BL/6J and Balb/c murine experimental models of parasite infection outcomes based on genetic background. Thus, we investigated the differential gene expression profile of unstimulated and LPS stimulated monocyte-derived macrophages (MDMs) from Holstein (taurine) and Gir (indicine) breeds using RNA sequencing methodology. For unstimulated MDMs, the contrast between Holstein and Gir breeds identified 163 Differentially Expressed Genes (DEGs) highlighting the higher expression of C-C chemokine receptor type five (CCR5) and BOLA-DQ genes in Gir animals. LPS-stimulated MDMs from Gir and Holstein animals displayed 1,257 DEGs enriched for cell adhesion and inflammatory responses. Gir MDMs cells displayed a higher expression of M1 related genes like Nitric Oxide Synthase 2 (NOS2), Toll like receptor 4 (TLR4), Nuclear factor NF-kappa-B 2 (NFKB2) in addition to higher levels of transcripts for proinflammatory cytokines, chemokines, complement factors and the acute phase protein Serum Amyloid A (SAA). We also showed that gene expression of inflammatory M1 population markers, complement and SAA genes was higher in Gir in buffy coat peripheral cells in addition to nitric oxide concentration in MDMs supernatant and animal serum. Co-expression analyses revealed that Holstein and Gir animals showed different transcriptional signatures in the MDMs response to LPS that impact on cell cycle regulation, leukocyte migration and extracellular matrix organization biological processes. Overall, the results suggest that Gir animals show a natural propensity to generate a more pronounced M1 inflammatory response than Holstein, which might account for a faster immune response favouring resistance to many infection diseases.

Transhiatal esophagectomy in squamous cell carcinoma of the esophagus: what are the best indications? / Esofagectomia transhiatal no carcinoma de células escamosas do esôfago: quais são suas melhores indicações?

ABSTRACT Background: Southern Brazil has one of the highest incidences of esophageal squamous cell carcinoma in the world. Transthoracic esophagectomy allows more complete abdominal and thoracic lymphadenectomy than transhiatal. However, this one is associated with less morbidity. Aim: To analyze the outcomes and prognostic factors of squamous esophageal cancer treated with transhiatal procedure. Methods: All patients selected for transhiatal approach were included as a potentially curative treatment and overall survival, operative time, lymph node analysis and use of neoadjuvant therapy were analyzed. Results: A total of 96 patients were evaluated. The overall 5-year survival was 41.2%. Multivariate analysis showed that operative time and presence of positive lymph nodes were both associated with a worse outcome, while neoadjuvant therapy was associated with better outcome. The negative lymph-node group had a 5-year survival rate of 50.2%. Conclusion: Transhiatal esophagectomy can be safely used in patients with malnutrition degree that allows the procedure, in those with associated respiratory disorders and in the elderly. It provides considerable long-term survival, especially in the absence of metastases to local lymph nodes. The wider use of neoadjuvant therapy has the potential to further increase long-term survival.

RESUMO Racional: O sul do Brasil tem uma das maiores incidências de carcinoma epidermoide do esôfago no mundo. A esofagectomia transtorácica permite linfadenectomia abdominal e torácica mais completa do que a transhiatal. No entanto, esta está associado à menor morbidade. Objetivo: Analisar os desfechos e fatores prognósticos do câncer epidermoide do esôfago que foram tratados com procedimento transhiatal. Métodos: Foram incluídos todos os pacientes selecionados para abordagem transhiatal como tratamento potencialmente curativo correlacionando sobrevida geral, tempo operatório, análise de linfonodos e uso de terapia neoadjuvante. Resultados: Foram avaliados 96 pacientes. A sobrevida geral em cinco anos foi de 41,2%. A análise multivariada mostrou que o tempo operatório e a presença de linfonodos positivos foram associados a pior resultado, enquanto a terapia neoadjuvante contribuiu para melhor resultado. O grupo de linfonodos negativos teve taxa de sobrevivência em cinco anos de 50,2%. Conclusão: A esofagectomia transhiatal pode ser empregada com segurança em pacientes que apresentem desnutrição com grau que permita o procedimento, nos com distúrbios respiratórios associados e nos idosos. Proporciona sobrevida em longo prazo considerável, especialmente na ausência de metástases para linfonodos locais. O uso mais amplo da terapia neoadjuvante tem o potencial de aumentar ainda mais a sobrevida em longo prazo.

Exploring the Impact of the Biofloc Rearing System and an Oral WSSV Challenge on the Intestinal Bacteriome of Litopenaeus vannamei.

We provide a global overview of the intestinal bacteriome of Litopenaeus vannamei in two rearing systems and after an oral challenge by the White spot syndrome virus (WSSV). By using a high-throughput 16S rRNA gene sequencing technology, we identified and compared the composition and abundance of bacterial communities from the midgut of shrimp reared in the super-intensive biofloc technology (BFT) and clear seawater system (CWS). The predominant bacterial group belonged to the phylum Proteobacteria, followed by the phyla Bacteroidetes, Actinobacteria, and Firmicutes. Within Proteobacteria, the family Vibrionaceae, which includes opportunistic shrimp pathogens, was more abundant in CWS than in BFT-reared shrimp. Whereas the families Rhodobacteraceae and Enterobacteriaceae accounted for almost 20% of the bacterial communities of shrimp cultured in BFT, they corresponded to less than 3% in CWS-reared animals. Interestingly, the WSSV challenge dramatically changed the bacterial communities in terms of composition and abundance in comparison to its related unchallenged group. Proteobacteria remained the dominant phylum. Vibrionaceae was the most affected in BFT-reared shrimp (from 11.35 to 20.80%). By contrast, in CWS-reared animals the abundance of this family decreased from 68.23 to 23.38%. Our results provide new evidence on the influence of both abiotic and biotic factors on the gut bacteriome of aquatic species of commercial interest.