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6,168 results on '"De Sousa A"'

1. When the uterine mass is not a leiomyoma

Author

Rita de Sousa, Carlos Abrantes, Sofia Pereira, and Liliana Constantino

Subjects
Gynecology, Adult, Leiomyosarcoma, medicine.medical_specialty, Postmenopausal women, Hysterectomy, Leiomyoma, business.industry, medicine.medical_treatment, Uterine bleeding, General Medicine, medicine.disease, Smooth muscle tumour, Uterine Neoplasms, Medicine, Humans, Female, Epithelioid leiomyosarcoma, business, Uterine mass, Smooth Muscle Tumor, Hormone
Abstract

A 37-year-old nulliparous woman with abnormal uterine bleeding and a uterine mass suggestive of a leiomyoma not responding to medical therapy was submitted to two hysteroscopies with histological analysis. The first one showed a ‘leiomyoma’ and the second a ‘uterine smooth muscle tumour of uncertain malignant potential/epithelioid leiomyosarcoma, with positivity for hormonal receptors’. The patient was submitted to a total hysterectomy with bilateral salpingo-oophorectomy, and the microscopic examination of the tumour revealed a ‘uterine tumour resembling ovarian sex-cord tumours’. According to the literature, most cases are diagnosed in postmenopausal women and have a favourable prognosis. These rare tumours have uncertain malignant potential and have no established treatment protocol, but it appears that a fertility-sparing approach is possible once they are well diagnosed.

Published
2023

2. Flushing episodes in the context of frontal fibrosing alopecia with facial papules

Author

Maria Auxiliadora Jeunon Sousa, Thales Lage Bicalho Bretas, Thiago Jeunon de Sousa Vargas, and Maria Claudia Almeida Issa

Subjects
medicine.medical_specialty, Erythema, Context (language use), medicine, Humans, Forehead, Retrospective Studies, Scalp, integumentary system, medicine.diagnostic_test, business.industry, Frontal fibrosing alopecia, Lichen Planus, Hydroxychloroquine, Alopecia, General Medicine, medicine.disease, Dermatology, Trichoscopy, medicine.anatomical_structure, Rosacea, Skin biopsy, Female, medicine.symptom, business, medicine.drug
Abstract

Frontal fibrosing alopecia (FFA) is a progressive frontotemporal hairline recession with eyebrow loss. Facial papules are present in up to 14% of FFA cases and can start with facial flushes. Nevertheless, these flushes are commonly associated with rosacea, a much more prevalent disease. In this case, a woman with FFA had, at first, clinical and histopathological findings of rosacea and was treated with ivermectin 1% cream with no improvement. She returned reporting new papules in the frontal region, reaching the frontotemporal hairline. Trichoscopy of the scalp showed mild perifollicular erythema and follicular scale. The new skin biopsy was compatible with FFA, and oral finasteride (5 mg/day) and hydroxychloroquine were introduced to stabilise the disease.

Published
2023

3. An alternative approach for blocking the superior trunk of the brachial plexus evaluated by a single arm clinical trial

Author

Fernanda Melhmann, Cesar Augusto Simões, Paulo César Castello Branco de Sousa, Leonardo Henrique Cunha Ferraro, Luiz Fernando dos Reis Falcão, Rioko Kimiko Sakata, and Thiago Nouer Frederico

Subjects
Adult, Shoulder, Adolescent, Shoulder surgery, Nerve block, medicine.medical_treatment, Pain, Omohyoid muscle, Young Adult, Arthroscopy, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Cadaver, medicine, Humans, Paralysis, Brachial Plexus, Prospective Studies, Anesthetics, Local, Brachial plexus, Ultrasonography, Interventional, Aged, Ultrasonography, Phrenic nerve, Bupivacaine, Pain, Postoperative, business.industry, Rotator cuff injury, General Medicine, Middle Aged, medicine.disease, Brachial Plexus Block, Trunk, Methylene Blue, Anesthesia, Diaphragmatic excursion, business, medicine.drug
Abstract

Background Interscalene brachial plexus block is associated with phrenic nerve paralysis. The objective of this study was to evaluate an alternative approach to interscalene brachial plexus blocks in terms of efficacy, grade of motor and sensory blockade, and phrenic nerve blockade. Methods The study was prospective and interventional. The ten living patients studied were 18 to 65 years old, ASA physical status I or II, and submitted to correction of rotator cuff injury. A superior trunk blockade was performed at the superior trunk below the omohyoid muscle, without blocking the phrenic nerve. The needle was advanced below the prevertebral layer until contacting the superior trunk. In order to guarantee the correct positioning of the needle tip, an intracluster pattern of the spread was visualized. The block was performed with 5 mL of 0.5% bupivacaine in ten patients. In the six cadavers, 5 mL of methylene blue was injected. Diaphragmatic excursion was assessed by ultrasonography of the ipsilateral hemidiaphragm. In three patients, pulmonary ventilation was evaluated with impedance tomography. Pain scores and analgesic consumption were assessed in the recovery room for 6 hours after the blockade. Results In the six cadavers, methylene blue didn’t reach the phrenic nerve. Ten patients underwent arthroscopic surgery, and no clinically phrenic nerve paralysis was observed. No patient reported pain during the first 6 hours. Conclusions This study suggests that this new superior trunk approach to block the superior trunk may be an alternative technique to promote analgesia for shoulder surgery in patients with impaired respiratory function.

Published
2022

4. Prevalência de lesões cervicais não cariosas na dentição decídua

Author

Francisca Janiele de Sousa, Francisco Dário Carvalho de Sousa, Maria Karen Vasconcelos Fontenele, Luiz Eduardo Gomes Ferreira, Carlos Kelvin Campos Ribeiro, and Ana de Lourdes Sá de Lira

Subjects
Abfraction, Dentition, medicine.diagnostic_test, business.industry, Tooth Erosion, Dentistry, Physical examination, General Medicine, medicine.disease, Tooth wear, Etiology, Tooth abrasion, Medicine, Maxillary central incisor, business
Abstract

Aim: To determine the prevalence of non-carious cervical lesions in children in the primary dentition and possible associated etiological factors. Method: After approval by the Ethics Committee - CEP / UESPI (3,289,732) – this cross-sectional study was carried out on 360 children, from 2 to 6 years of age, from public and private schools, divided into two groups: G1 (with cervical lesions) and G2 (without cervical lesions). A questionnaire was applied to the parents, followed by the children’s clinical examination. Lesions detected by touch and visually were considered. Evaluations of means and standard deviations were performed for quantitative variables. Percentages and frequencies were obtained, analyzing the association between qualitative variables based on the chi-square test and comparing the average age using the t test (p < 0.05). Results: Only abfraction-type lesions were found in the sample (5%), and white individuals presented a higher prevalence in relation to the others (55.5%). There was a statistically significant difference (p < 0.001), and these lesions were found only in private schools. As for sex, in G1, there was a statistically significant difference (p = 0.01) with a higher prevalence in males (66.7%). The most affected teeth in decreasing order were the canines and upper central incisors, followed by the canines and lower central incisors. Conclusion: The prevalence of non-carious cervical lesions of the abfraction type in children from 2 to 6 years of age was 5%, which was only found in private schools, with a predominance in males. An association was found between the abfraction and the type of brush used in toothbrushing, with a higher frequency of lesions when hard brushes were used and strong brushing was performed. Uniterms: Tooth wear. Tooth erosion. Tooth abrasion. Dentistry, operative.

Published
2022

5. Follow-up of children with sickle cell anemia screened with transcranial Doppler and enrolled in a primary prevention program of ischemic stroke

Author

Alessandra Palhoni Sabarense, Maristela Braga de Sousa Rodrigues Muniz, Célia Maria Silva, and Marcos Borato Viana

Subjects
Pediatrics, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Hematology, 030204 cardiovascular system & hematology, medicine.disease, Sickle cell anemia, Transcranial Doppler, Discontinuation, 03 medical and health sciences, 0302 clinical medicine, Primary prevention, Angiography, cardiovascular system, medicine, Immunology and Allergy, Complication, Prospective cohort study, business, Stroke, 030215 immunology
Abstract

Background Stroke is a serious complication of sickle cell anemia (SCA). The transcranial Doppler (TCD) is the risk-screening tool for ischemic strokes. The objective of the study was to describe the clinical progression of children with SCA who presented with high risk for stroke by TCD or relevant changes by magnetic resonance angiography (MRA) and underwent the regular transfusion program (RTP) and/or hydroxyurea (HU) treatment between 2007 and 2018. Method This was a neonatal retrospective/prospective cohort study with children born between 1999 and 2014 with the homozygotic form (HbSS) or Sβ0-thalassemia who underwent TCD at least once. Results Of the 718 children screened during this period, 675 had HbSS and 43 Sβ0-thalassemia. In 54 children (7.5%), all with HbSS, a high-risk TCD (n = 45) or, when the TCD was inconclusive, an MRA with cerebral vasculopathy (n = 9) was used for detection. Of these, 51 started the RTP and the families of three refused treatment. Of the 43 children with a high-risk TCD who initiated the RTP, 29 (67.4%) reverted to low risk. In 18 of them (62%), HU was started at the maximum tolerated dose (MTD) before transfusion discontinuation. None of these 29 patients had a stroke. Eight children (18.6%) maintained a high-risk TCD, even using the RTP/HU and two had a stroke. Conclusions The TCD was confirmed as a viable tool for tracking patients with a risk for stroke. The RTP was effective in preventing the primary event. New strategies are necessary to prevent stroke using HU and new drugs, in addition to bone marrow transplantation.

Published
2022

6. Rational Design and Evaluation of the Recombinant Multiepitope Protein for Serodiagnosis of Rubella

Author

Juliana Martins Machado, Sonia Maria de Freitas, Josiane Santos, Amanda Araújo Souza, Mariana Campos Da Paz, Patricia Aparecida Fernandes Ribeiro, Jonatas Oliveira da Silva, Maria Sueli Soares Felipe, Alexsandro Sobreira Galdino, Luana De Sousa Ramos, Fernando Araripe Gonçalves Torres, Marilen Queiroz de Souza, José Carlos dos Santos, Laís Moreira Nogueira, Daniel Dias, and Yanna Karla de Medeiros Nóbrega

Subjects
Pharmaceutical Science, Enzyme-Linked Immunosorbent Assay, Antibodies, Viral, medicine.disease_cause, Rubella, Epitope, law.invention, Epitopes, Affinity chromatography, Pregnancy, law, Escherichia coli, medicine, Humans, Serologic Tests, Child, Congenital rubella syndrome, biology, Rubella virus, medicine.disease, Virology, Recombinant Proteins, biology.protein, Recombinant DNA, Female, Antibody, Biotechnology
Abstract

Background: Rubella is an infection caused by rubella virus (RV) and is generally regarded as a mild childhood disease. The disease continues to be of public health importance mainly because when the infection is acquired during early pregnancy, it often results in fetal abnormalities, which are classified as congenital rubella syndrome (CRS). An accurate diagnosis of rubella is thus of pivotal importance for proper treatment. Objective: The aim of the study was to produce a recombinant multiepitope protein (rMERUB) for the diagnosis of rubella, based on conserved immunodominant epitopes of glycoprotein E1 and E2. Methods: A synthetic gene was designed and cloned into vector pET21a with a 6xHis tag at the C-terminal for affinity purification and overexpressed in Escherichia coli cells. Biophysical analysis of rMERUB was performed by circular dichroism. Biological activity was assessed using an in-house ELISA assay. Results: Expression in Escherichia coli showed a ~22 kDa protein that was purified and used to per-form structural assays and an IgG ELISA. Structural analyses reveal that rMERUB has a β leaf pattern that promotes the exposure of epitopes, thus allowing antibody recognition. Evaluation of 33 samples (22=positive; 11=negative) was performed using in-house ELISA and this was compared with a com-mercial kit. The sensitivity was 100% (95% CI: 85-100) and specificity 90.91% (95% CI: 62-99). Excellent agreement (Kappa index = 0.9) was obtained between ELISA assays. Conclusions: The careful choice of epitopes and the high epitope density, coupled with simple-step purification, pinpoints rMERUB as a promising alternative for rubella diagnosis, with potential for the development of a diagnostic kit.

Published
2022

7. Computer Aided Drug Design Methodologies with Natural Products in the Drug Research Against Alzheimer’s Disease

Author

Herbert Igor Rodrigues de Medeiros, Mayara Dos Santos Maia A, Érika Paiva de Moura, Marcus Tullius Scotti, Simone Mendes Lopes, Gabriela Cristina Soares Rodrigues, Natália Ferreira de Sousa, and Luciana Scotti

Subjects
Drug, media_common.quotation_subject, In silico, Plaque, Amyloid, Disease, Bioinformatics, Human health, Alzheimer Disease, Humans, Medicine, Dementia, Pharmacology (medical), Beneficial effects, Aged, media_common, Pharmaceutical industry, Pharmacology, Biological Products, business.industry, Drug discovery, General Medicine, medicine.disease, Psychiatry and Mental health, Neurology, Drug Design, Neurology (clinical), business
Abstract

Natural products are compounds isolated from plants that provide a variety of lead structures for the development of new drugs by the pharmaceutical industry. The interest in these substances increases because of their beneficial effects on human health. Alzheimer's disease (AD ) affects occur in about 80% of individuals aged 65 years. AD is the most common cause of dementia in elderly people, is characterized by progressive neurodegenerative alterations, as decrease of cholinergic impulse, increased toxic effects caused by reactive oxygen species and the inflammatory process that the amyloid plaque participates. In silico studies is relevant in the process of drug discovery; through technological advances in the areas of structural characterization of molecules, computational science and molecular biology have contributed to the planning of new drugs used against neurodegenerative diseases. Considering the social impairment caused by increased incidence of disease and that there is no chemotherapy treatment effective against the AD; several compounds are studied. In the researches for effective neuroprotectants as potential treatments for Alzheimer's disease, natural products that have been extensively studied in various AD models. This study aims to carry out a literature review with articles that address the In silico studies of natural products aimed at potential drugs against alzheimer's disease (AD) in the period from 2015 to 2021.

Published
2022

8. Clinical and electrophysiological characteristics of neuropathic pain in leprosy patients: A prospective cross-sectional study

Author

Danusa Neves Somensi, Geovanna Lemos Lopes, Emanuel de Jesus Soares de Sousa, Gustavo Celeira de Sousa, and Marília Brasil Xavier

Subjects
medicine.medical_specialty, business.industry, Cross-sectional study, Neural Conduction, Dermatology, medicine.disease, Cross-Sectional Studies, Infectious Diseases, Leprosy, Internal medicine, Neuropathic pain, Humans, Neuralgia, Medicine, Female, Prospective Studies, business
Abstract

Introduction Neuropathic pain is a common and disabling late complication of leprosy. We investigated the clinical and electrophysiological characteristics of neuropathic pain in leprosy patients by evaluating nerve conduction, sympathetic skin response (SSR) and A-waves. Methods Twenty one leprosy patients with neuropathic pain validated by the Douleur Neuropathique en 4 (DN4)Questionnaire were selected for study. Pain intensity was measured by the visual analog scale. Demographic and clinical data were collected for all patients. Clinical data included appraisal of the median, ulnar, radial, tibial and common peroneal nerves, assessment of the sympathetic skin response and conventional electrophysiological recordings. Results Among all electroneuromyographic presentations, multifocal mononeuropathy was still the most prevalent. Sensory loss was observed more frequently than motor deficits. As most patients presented advanced clinical forms of leprosy and were under treatment, this high mean was found and the ulnar nerve was most frequently affected. The sympathetic skin response was absent in 16 patients. Higher DN4 Questionnaire scores were observed in women and in those receiving corticosteroid therapy. These inferences are possible to be made, but our study's limitations don't allow us to be certain about it. The statistical significance found only permits us to evidence what we related on the textual part of the study. Limitations The small number of patients studied, the lack of sophisticated diagnostic methods for leprosy, as well as the difficulties in assessing nerve conduction were the main limitations of this study. Conclusion The neurophysiological and clinical findings in leprous neuropathy were modest despite the conspicuous neuropathic pain. Although electrophysiological studies are a vital tool to verify nerve damage, variations in the clinical presentation of leprosy neuropathic pain render the diagnosis challenging. Further studies are needed to describe the neurophysiological evolution of this disease.

Published
2021

9. Renal resistivity index as an aid in the diagnosis of acute kidney injury in bitches with pyometra

Author

Aline de Sousa Alves, Fernanda Vieira Henrique, Sabrina Barros Araújo, Dayanny de Sousa Alencar, Higina Moreira Melo, Ermano Lucena de Oliveira, Rosangela Maria Nunes da Silva, and Almir Pereira de Souza

Subjects
kidneys, Creatinine, medicine.medical_specialty, General Veterinary, business.industry, Veterinary medicine, Urinary system, Statistical difference, Acute kidney injury, Urology, canine, Renal function, ultrasonography, Pyometra, medicine.disease, chemistry.chemical_compound, chemistry, Small animal, SF600-1100, medicine, business, Resistivity index, urinary biochemistry
Abstract

This study aimed to evaluate the renal function of six bitches of various breeds and ages, with open pyometra, attended in the Small Animal Medical Clinic sector of the Veterinary Hospital from Federal University of Campina Grande, through the measurement of laboratory tests: urea and creatinine serum, dosage of the urinary Protein-Creatinine Ratio (PCR), urinary gamma-glutamyltransferase (GGT) and determination of the renal resistivity index (RI). The levels of urea and creatinine were elevated in 16.6% (1/6) of the female dogs; the urinary protein-creatinine ratio was increased in 66.6% (4/6), while the urinary gamma-glutamyltransferase value was elevated in 50% (3/6). The renal resistivity index was increased in the right and left kidneys by 66.6% (4/6) of bitches, with no statistical difference between them. It was concluded that the renal resistivity index was a practical and effective method to assist in the diagnosis of acute kidney injury, along with other early markers, such as PCR and urinary GGT.

Published
2021

10. Análise da timpanometria de banda larga na doença de Ménière

Author

Gisela Andrea Yamashita Tanno, Alessandra Spada Durante, Marcella Gameiro, Marcelo Tabosa Dutra Sanches, Nayara Michelle Costa de Freitas Roque, Kátia de Almeida, Mônica Alcantara de Oliveira Santos, and Osmar Mesquita de Sousa Neto

Subjects
medicine.medical_specialty, Timpanometria, Auditory tests, Audiology, Asymptomatic, Doença de Ménière, Tympanometry, otorhinolaryngologic diseases, Humans, Medicine, Endolymphatic Hydrops, Inner ear, Endolymphatic hydrops, Meniere’s disease, Meniere Disease, Ossicular chain, Acoustic impedance tests, medicine.diagnostic_test, business.industry, Testes de impedância acústica, medicine.disease, Cross-Sectional Studies, medicine.anatomical_structure, Acoustic Impedance Tests, Otorhinolaryngology, Tympanometry Test, Ear, Inner, Middle ear, Testes auditivos, sense organs, medicine.symptom, business, Meniere's disease
Abstract

Introduction: Endolymphatic hydrops is the pathophysiological substrate of Ménière’s disease. The changes in the inner ear, transmitted to the middle ear through changes in the ossicular chain mobility, can be quantified by wideband tympanometry, through the measurement of the acoustic absorbance at multiple frequencies, represented by the sound energy absorbed by the middle ear, even at its early stages. Studying the behavior of the middle ear through the absorbance in patients with endolymphatic hydrops under ambient pressure and under peak pressure can be useful for detecting Ménière’s disease. Objective: To characterize acoustic absorbance behavior in subjects with symptomatic and asymptomatic Ménière’s disease compared to controls, in order to verify the ability of wideband tympanometry to detect Ménière’s disease. Methods: We carried out a cross-sectional study with a diagnostic approach comparing the findings of wideband tympanometry at ambient pressure and peak pressure between the ears of the control group (n = 30), the asymptomatic group (n = 21) and the symptomatic group (n = 9). Results: Different peak pressure values were found between the ears of the control group (0daPa), the asymptomatic group (−11 daPa) and the symptomatic group (−192 daPa), with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Different absorbance values were found between the ears of the symptomatic group and the asymptomatic group compared to the control group for low frequencies at ambient pressure and peak pressure, with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Conclusions: The Wideband Tympanometry test was capable of identifying the presence of Ménières disease, and to differentiate between asymptomatic and symptomatic patients, when comparing them with healthy individuals. Resumo Introdução: A hidropsia endolinfática é o substrato fisiopatológico da doença de Ménière. As alterações desencadeadas na orelha interna, transmitidas à orelha média pelas modificações na mobilidade da cadeia ossicular, podem ser quantificadas pela timpanometria de banda larga, através da medida da absorvância acústica sob múltiplas frequências, representadas pela energia sonora absorvida pela orelha média, mesmo em estágios iniciais de sua instalação. Estudar o comportamento da orelha média através da absorvância em pacientes com hidropisia endolinfática sob pressão ambiente e sob o pico de pressão pode ser útil na detecção da doença de Ménière. Objetivo: Caracterizar o comportamento da absorvância em indivíduos com diagnóstico da doença de Ménière sintomáticos e assintomáticos, comparados com controles, a fim de verificar a capacidade da timpanometria de banda larga em detectar variações clínicas relacionadas a possível hidropisia endolinfática. Método: Foi realizado um estudo transversal, com enfoque diagnóstico, que comparou os achados da timpanometria de banda larga na pressão ambiente e no pico de pressão entre orelhas do grupo controle (n = 30), grupo assintomático (n = 21) e grupo sintomático (n = 9). Resultados: Foram encontrados valores do pico de pressão diferentes entre orelhas do grupo controle (0 daPa), do grupo assintomático (-11 daPa) e do grupo sintomático (-192 daPa), com p

Published
2022

11. Long term outcome of functional hemispherectomy for refractory epilepsy: Experience from a single center

Author

Alfredo Calheiros, João Chaves, Rui Rangel, Teresa Temudo, João Ramalheira, Sérgio Tavares de Sousa, António Martins da Silva, Vasco Sá Pinto, José Lopes Lima, and João Peças Lopes

Subjects
Adult, Drug Resistant Epilepsy, Pediatrics, medicine.medical_specialty, Hemispherectomy, medicine.medical_treatment, Single Center, 03 medical and health sciences, Epilepsy, 0302 clinical medicine, medicine, Humans, In patient, Child, business.industry, Electroencephalography, medicine.disease, Engel classification, Treatment Outcome, Functional hemispherectomy, Child, Preschool, Refractory epilepsy, Surgery, Neurology (clinical), Epilepsy unit, business, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

Background Hemispherectomy has an established role as a treatment of last resort in patients with unilateral hemispheric lesions suffering from refractory epilepsy. Methods Seven patients were evaluated at our Epilepsy Unit. We compared the seizure outcome at 6 months, 1, 2, 5 years post-surgery, as well as at end follow-up (mean 7.1 years) using Engel classification. Reduction of antiepileptic drugs (AEDs) was also assessed utilizing equal time frames. Results The mean age of seizure onset was 5.4 years. Engel I was achieved in 5 patients at 6 months (71.4%). Engel at 1 year was predicted by the Engel at 6 months (p = 0.013) with a similar number of patients being classified as Engel I outcome. Engel at 2 years was also predicted by Engel at 6 months and at 1 year (p = 0.030). At end follow-up only 3 patients (42.9%) remained categorized as Engel I outcome. There was a trend toward a stability in Engel classification. All patients with developmental causes for their epilepsy experienced some deterioration of the surgical outcomes. Conversely, all patients with acquired causes were stable throughout follow-up. Seizure outcome at 6 months was worse in the patients who had post-op complications (p = 0.044). Adult and pediatric populations did not differ significantly in any tested variable. Conclusions Hemispherectomy is a valuable resource for seizure control in properly selected patients. Engel patient's evolution could be predicted at 6 months interval. Hemispherectomy could be considered a useful attitude in difficult cases.

Published
2022

12. Debonding of orthodontic appliance changes salivary physicochemical properties and favors regression of active caries lesions: A 13‐week follow‐up study

Author

Marinês Nobre-dos-Santos, Corolina Steiner-Oliveira, Emerson Tavares de Sousa Et, and Andréia Alves Cardoso

Subjects
Saliva, Adolescent, Dental Caries Susceptibility, Dentistry, Dental Caries, Dental plaque, Active Caries, Fluorides, Young Adult, chemistry.chemical_compound, McNemar's test, Orthodontic Appliances, Humans, Medicine, Fluorides, Topical, Prospective Studies, Prospective cohort study, General Dentistry, business.industry, Follow up studies, Hydrogen-Ion Concentration, medicine.disease, Leukemia, Myeloid, Acute, chemistry, Analysis of variance, Sugars, business, Fluoride, Follow-Up Studies
Abstract

AIM This prospective cohort study aimed to investigate whether orthodontic appliances removal (OAR) combined with caries-preventive strategies and fluoride varnishes alters salivary physicochemical properties, changes the activity of carbonic anhydrase VI (CA VIACT ) and α-amylase (α-AMLACT ), and favors the regression of active carious lesions (ACL). DESIGN Twenty-two individuals aged between 13 and 24 years old were assessed for the presence of visible biofilm, daily sugar exposure, caries activity, salivary flow rate (SFR), pH, buffering capacity (BC), and CA VIACT and α-AMLACT activity at baseline, and 1, 5 and 13 weeks after OAR. Variables were assessed using repeated-measures analysis of variance, Cochran's Q and McNemar's test, and Pearson's correlation. RESULTS We verified a significant decrease in the number of ACL at the 5-week (29% reduction) and at the 13-week follow-up (58% reduction). At the 5 and 13-week follow-up, the percentage of visible biofilm and sugar exposure decreased, whereas the salivary pH and α-AMLACT activity significantly increased. BC and CA VIACT remained unchanged throughout the follow-up. CONCLUSION OAR combined with caries-preventive strategies and fluoride varnishes favored the regression of active carious lesions and increased salivary pH and α-AMLACT activity, whereas buffering capacity and CA VIACT remained stable.

Published
2022

13. Impacts of land use and land cover changes on hydrological processes and sediment yield determined using the SWAT model

Author

Edivaldo Afonso de Oliveira Serrão, Denis José Cardoso Gomes, Madson Tavares Silva, Aline Maria Meiguins de Lima, Thomás Rocha Ferreira, Lorena Conceição Paiva de Ataide, Francisco de Assis Salviano de Sousa, Vicente de Paulo Rodrigues da Silva, and Cleber Assis dos Santos

Subjects
Hydrology, Land use, Soil and Water Assessment Tool, Stratigraphy, 0207 environmental engineering, Geology, 02 engineering and technology, Land cover, 010501 environmental sciences, Seasonality, medicine.disease, 01 natural sciences, Hydrology (agriculture), medicine, Environmental science, SWAT model, Water cycle, 020701 environmental engineering, Surface runoff, 0105 earth and related environmental sciences
Abstract

Land use and land cover (LULC) changes strongly affect local hydrology and sediment yields. The current study focused on a basin in the Brazilian Amazon and had the following three objectives: (1) to perform an effective diagnosis of flow and sediment yield, (2) to evaluate the impacts of LULC changes over the last 40 years on the hydro-sedimentological variables, and (3) to investigate the impacts of the possible trends or breaking points in the flow, surface runoff, and sediment yield series. The Soil and Water Assessment Tool (SWAT) model validation showed that the simulated results were consistent with the data measured in the dynamic reproduction of flow seasonality. Furthermore, changes in LULC altered surface runoff, sediment yield, and flow according to the Mann-Kendall and Pettitt non-parametric tests. It was also observed that the sub-basins in which pastureland is predominant are more susceptible to increased surface runoff and sediment yield. According to trend and homogeneity tests, these sub-basins had break points in the time series of these variables. On the other hand, in the sub-basins whose land cover is predominantly forest, the time series is homogeneous and trendless. The current study highlighted the impacts that 40 years of LULC changes in an Amazonian basin had on hydro-sedimentological variables, which, in turn, can play an important role in changing the hydrological cycle, consequently these changes can also impact diverse human activities in the region, such as agribusiness, livestock, energy production, food security, and public water supply. Thus, it is concluded that the SWAT model is a good estimator of hydro-sedimentological processes in Amazonian basins and can be used by decision makers in the management of water and environmental resources.

Published
2022

14. Role of Baclofen in Modulating Spasticity and Neuroprotection in Spinal Cord Injury

Author

Diogo Santos, Nídia de Sousa, Nuno A. Silva, Susana Monteiro, Antón Barreiro-Iglesias, and António J. Salgado

Subjects
Baclofen, 030506 rehabilitation, medicine.medical_specialty, Central nervous system, Neuroprotection, 03 medical and health sciences, chemistry.chemical_compound, Muscle tone, 0302 clinical medicine, Physical medicine and rehabilitation, medicine, Humans, In patient, Spasticity, Spinal cord injury, Injections, Spinal, Spinal Cord Injuries, Muscle Relaxants, Central, business.industry, medicine.disease, 3. Good health, medicine.anatomical_structure, chemistry, Muscle Spasticity, Neurology (clinical), medicine.symptom, 0305 other medical science, business, Neurological impairment, 030217 neurology & neurosurgery
Abstract

Spinal cord injury (SCI) affects an estimated three million persons worldwide, with ∼180,000 new cases reported each year leading to severe motor and sensory functional impairments that affect personal and social behaviors. To date, no effective treatment has been made available to promote neurological recovery after SCI. Deficits in motor function is the most visible consequence of SCI; however, other secondary complications produce a significant impact on the welfare of patients with SCI. Spasticity is a neurological impairment that affects the control of muscle tone as a consequence of an insult, trauma, or injury to the central nervous system, such as SCI. The management of spasticity can be achieved through the combination of both nonpharmacological and pharmacological approaches. Baclofen is the most effective drug for spasticity treatment, and it can be administered both orally and intrathecally, depending on spasticity location and severity. Interestingly, recent data are revealing that baclofen can also play a role in neuroprotection after SCI. This new function of baclofen in the SCI scope is promising for the prospect of developing new pharmacological strategies to promote functional recovery in patients with SCI.

Published
2022

15. Comparação de dados de PSA e resultados da biópsia no diagnóstico do câncer de próstata, obtidos em Itaúna (MG), no período de 2002 a 2018. / Comparison of PSA data and biopsy results in the diagnosis of prostate cancer, obtained in Itaúna (MG), from 2002 to 2018

Author

Débora do Amaral Teixeira, Augusto Machado De Sousa, Maria Júlia Alves De Sousa, Sylvia Loures Vale Pujatti, Clara Martins Resende De Souza, Luiz Rodrigues Pereira Júnior, Iwens Moreira De Faria, and Maria Teresa Moura Pereira

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Urology, biópsia, General Medicine, medicine.disease, PSA, Prostate cancer, Câncer de próstata, Biopsy, Medicine, Câncer de próstata, biópsia, PSA, business
Abstract

O câncer é considerado o principal problema de saúde pública do mundo, e situa-se, na maioria dos países, entre as quatro principais causas de morte prematura.1 Considerando-se apenas o sexo masculino, o câncer de próstata é o segundo mais prevalente e está associado a elevada morbimortalidade devido a seu curso usualmente oligossintomático, com frequente diagnóstico tardio.5 Este trabalho analisou dados de pacientes de uma clínica de imagem no município de Itaúna, MG, comparando seus resultados de dosagem de PSA e biópsia, avaliando se o uso dos resultados de PSA seriam confiáveis para um screening inicial, ajudando a diminuir o número de homens a serem encaminhados desnecessariamente para biópsia. Concluiu-se que a melhor forma de reduzir o número de biópsias excessivas com todos seus impactos negativos associados, seria por meio da associação de vários métodos de rastreamento, tais como dosagem de PSA, a densidade de PSA, velocidade de PSA, toque retal e/ou presença de áreas alterada na ultrassonografia transretal.

Published
2021

16. Beriberi in Brazil: A Disease That Affects Indigenous People

Author

Anne Karine Martins Assunção, Silmery da Silva Brito Costa, Alcione Miranda dos Santos, Maria dos Remédios Freitas Carvalho Branco, Vanessa Moreira da Silva Soeiro, Bruno Luciano Carneiro Alves de Oliveira, Rejane Christine de Sousa Queiroz, Arlene de Jesus Mendes Caldas, Adriana Soraya Araújo, Maria Tereza Borges Araújo Frota, Thiago de Sousa Santos, and José de Jesus Dias Júnior

Subjects
030309 nutrition & dietetics, Geography, Planning and Development, Disease, Beriberi, Indigenous, 03 medical and health sciences, chemistry.chemical_compound, Public health surveillance, Environmental health, Humans, Medicine, Thiamine, Indigenous Peoples, Poverty, Thiamine deficiency, 0303 health sciences, 030505 public health, Nutrition and Dietetics, business.industry, Micronutrient, medicine.disease, Cross-Sectional Studies, chemistry, 0305 other medical science, business, Brazil, Food Science
Abstract

Background: Beriberi is the clinical manifestation of thiamine deficiency. It is multicausal and typically associated with poverty and food insecurity among vulnerable populations, such as indigenous people. Objective: The objective of this study was to carry out a spatial analysis of reported cases of beriberi among indigenous people in Brazil. Methods: Cross-sectional study using time series data on suspected cases of beriberi reported to the Ministry of Health via the FormSUS between July 2013 and September 2018. Indigenous villages were georeferenced, and Kernel density estimation was used to identify patterns of the spatial distribution of beriberi cases. Results: A total of 414 cases of beriberi were reported in the country of which 210 (50.7%) were indigenous people. All the cases in indigenous people occurred in states located in the Legal Amazon (Maranhão, Roraima, and Tocantins). Kernel density estimation showed high-density areas in Tocantins and Roraima. Conclusions: This is the first nationwide study of reported cases of beriberi. The findings can be used to guide actions that contribute to the monitoring and prevention of beriberi among indigenous people.

Published
2021

17. Flavonoids, alkaloids and saponins: are these plant-derived compounds an alternative to the treatment of rheumatoid arthritis? A literature review

Author

Ana Caroline Santos Ataíde, Renata Mondêgo-Oliveira, Luis Ângelo Macedo Santiago, Dâmaris Cristina Sousa Carvalho Fonseca, Joicy Cortez de Sá Sousa, Lidio Gonçalves Lima-Neto, Maria do Socorro de Sousa Cartágenes, Rafael Cardoso Carvalho, Enio Fernandes Aragão Soares, Rachel Melo Ribeiro, Eduardo Martins de Sousa, and Roberval Nascimento Moraes Neto

Subjects
Phytochemical compounds, Inflammation, Pharmacology, Articular disease, 03 medical and health sciences, Therapeutic approach, 0302 clinical medicine, Alkaloids, In vivo, Medicine, Medicinal plants, 030304 developmental biology, General Environmental Science, Flavonoids, 0303 health sciences, business.industry, Therapeutic effect, RX1-681, Homeopathy, Saponins, medicine.disease, Phytochemical, 030220 oncology & carcinogenesis, Rheumatoid arthritis, General Earth and Planetary Sciences, medicine.symptom, business, Literature survey
Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by synovial inflammation leading to progressive joint erosion and, eventually, joint deformities. RA treatment includes anti-inflammatories, corticosteroids, synthetic disease-modifying antirheumatic drugs (DMARDs), and immunosuppressants. Drug administration is associated with adverse reactions, as gastrointestinal ulcers, cardiovascular complications, and opportunistic infections. Wherefore, different plant-derived phytochemical compounds are studied like new therapeutic approach to treatment of RA. Among the phytochemical compounds of plants for treatment of RA, flavonoids, alkaloids and saponins are related for present anti-inflammatory activity and act as physiological and metabolic regulators. They have low toxicity compared to other active plant compounds, so their therapeutic properties are widely studied. The intention of the review is to present an overview of the therapeutics of flavonoids, alkaloids, and saponins for RA. An extensive literature survey was undertaken through different online platforms:PubMed, SciELO, and Virtual Health Library databases, to identify phytochemical compounds used in RA treatment and the descriptors used were medicinal plants, herbal medicines, and rheumatoid arthritis. Seventy-five research and review articles were found to be apt for inclusion into the review. The present study summarizes the phytochemicals isolated from plants that have therapeutic effects on RA models, in vitro and in vivo. The studied substances exerted anti-inflammatory, chondroprotective, immunoregulatory, anti-angiogenic, and antioxidant activities and the most compounds possess good therapeutic properties, valuable for further research for treatment of RA.

Published
2021

18. Progestin-Primed Ovarian Stimulation is a non-inferior alternative to the GnRH Antagonist Protocol in patients undergoing assisted reproductive techniques: a retrospective study

Author

Leonardo Matheus Ribeiro Pereira, Leci Veiga Caetano Amorim, Ricardo Mello Marinho, João Pedro Junqueira Caetano, Ana Luisa Menezes Campos, Luciana Campomizzi Calazans, Bruna Barbosa Coimbra, and Erica Becker de Sousa Xavier

Subjects
Infertility, medicine.drug_class, medicine.medical_treatment, Fertilization in Vitro, Andrology, Gonadotropin-Releasing Hormone, Ovulation Induction, Pregnancy, Medicine, Humans, Blastocyst, reproductive and urinary physiology, Retrospective Studies, In vitro fertilisation, business.industry, urogenital system, Antagonist, medicine.disease, progestin, Pregnancy rate, medicine.anatomical_structure, reproductive techniques, Ovulation induction, Original Article, Female, pregnancy rate, Gonadotropin, assisted, Progestins, business, Progestin, in vitro fertilization, hormones, hormone substitutes, and hormone antagonists
Abstract

Objective To demonstrate the non-inferiority of Clinical Pregnancy Rates from Progestin-Primed Ovarian Stimulation compared to the GnRH Antagonist Protocol when the freeze-all and blastocyst transfer strategy is applied. Methods A retrospective study included all IVF cycles performed at Pro-Criar Reproductive Medicine Center, Belo Horizonte, Minas Gerais, Brazil, between May 2018 and May 2019 using a GnRH antagonist analogue or oral progestins to block the LH peak in IVF/intra-cytoplasmic sperm injection (ICSI) cycles for infertility treatment. Results The primary outcome of our study was Clinical Pregnancy Rate at the first ET (Blastocyst), which were 58.4% in the progestin group and 54.9% in the antagonist group (p=0.735), a finding consistent with most studies published to date using different progestins. The mean number of retrieved oocytes was 11 in the antagonist group and 9 oocytes in the progestin group (p=0.009). The fertilization rate was 80% for both groups (p=0.935). The rate of blastocyst formation per cycle was 50% in the antagonist group and 55.6% in the progestin group (p=0.106). The stimulation lasted a mean of 10 days in the two groups (p=0.403) and did not vary with patient age in either group. The gonadotropin dose used was higher in the antagonist group (2025 IU) than in the progestin group (1950 IU) (p=0.057). In addition, the blockade was effective: there was only one case of spontaneous ovulation, which corresponded to less than 1% of the cycles. Conclusions Progestin-Primed Ovarian Stimulation is a non-inferior alternative to the GnRH Antagonist Protocol in patients undergoing assisted reproductive techniques. An incidence compatible with the 0.34 to 8% risk described in the literature for failure to control the premature LH surge in antagonist protocol cycles.

Published
2022

19. The effect of high concentration of zoledronic acid on tooth induced movement and its repercussion on root, periodontal ligament and alveolar bone tissues in rats

Author

Virgínia Cláudia Carneiro Girão-Carmona, Frederico Barbosa de Sousa, Fátima Regina Nunes de Sousa, Gerly Anne de Castro Brito, Paula Goes, Hugo Victor Dantas, Vanessa Costa de Sousa Ferreira, Conceição da Silva Martins, and Renata Ferreira de Carvalho Leitão

Subjects
Male, Tooth Movement Techniques, Periodontal Ligament, Science, Osteoporosis, Drug Evaluation, Preclinical, Dentistry, Zoledronic Acid, Bone resorption, Article, Metabolic bone disease, Anestesia, 03 medical and health sciences, 0302 clinical medicine, medicine, Alveolar Process, Periodontal fiber, Animals, Maxillary central incisor, Anesthesia, Bone Resorption, Rats, Wistar, Tooth Root, Dental alveolus, Multidisciplinary, Bone Density Conservation Agents, business.industry, Health care, 030206 dentistry, Doenças Ósseas Metabólicas, medicine.disease, Ligamento Periodontal, Resorption, Bone Diseases, Metabolic, Zoledronic acid, Risk factors, 030220 oncology & carcinogenesis, Medicine, business, medicine.drug
Abstract

Zoledronic acid (ZA) is often prescribed for osteoporosis or resorptive metabolic bone disease. This study aims to evaluate the effect of ZA on orthodontic tooth movement (OTM) and root and bone resorption and its repercussion on root, periodontal ligament and alveolar bone tissues. The experimental group consisted of 72 Wistar rats divided in four subgroups: Naive, Saline and Zoledronic Acid groups at the concentration of 0.2 mg/kg [ZA (0.2)] or 1.0 mg/kg [ZA (1.0)]. The animals were subjected to i.v (dorsal penile vein) administrations of ZA or saline solution, on days 0, 7, 14 and 42. Under anesthesia, NiTi springs were installed in the first left maxillary molar with 50gf allowing the OTM, except for the negative control group (N) for mesial movement of the left first maxillary teeth. The animals were sacrificed and maxillae were removed for macroscopic and histopathological analyzes, scanning electron microscopy, computerized microtomography and confocal microscopy. Treatment with ZA decreased the OTM and the number of osteoclasts and loss of alveolar bone when compared to the naive and saline groups. Reduction of radicular resorption, increased necrotic areas and reduced vascularization in the periodontal ligament were observed in the ZA groups. ZA interferes with OTM and presents anti-resorptive effects on bone and dental tissues associated with a decreased vascularization, without osteonecrosis.

Published
2021

20. Dermatological effects of Curcuma species: a systematic review

Author

R. de Alvares Goulart, M.L. de Sousa Gonzaga, G.A. de Souza, H.F. de Sousa Gonzaga, B. de Alvares Rezende, and Sandra Maria Barbalho

Subjects
Male, medicine.medical_specialty, Curcumin, Dose, Erythema, Anti-Inflammatory Agents, Dermatology, Antioxidants, 030207 dermatology & venereal diseases, 03 medical and health sciences, Curcuma, 0302 clinical medicine, Double-Blind Method, Psoriasis, Humans, Medicine, Radiodermatitis, Hyaluronic Acid, Randomized Controlled Trials as Topic, Skin, Wound Healing, biology, Plant Extracts, business.industry, biology.organism_classification, medicine.disease, Clinical trial, Treatment Outcome, Systematic review, Rosacea, 030220 oncology & carcinogenesis, Female, medicine.symptom, business
Abstract

Curcuma and its derivatives are associated with anti-inflammatory and antioxidant activities in the skin. They exhibit beneficial effects in wound healing and prevention of chronic ultraviolet B damage and may prevent facial redness such as rosacea and flushing. This review aims to provide an up-to-date and rigorous synthesis of studies that demonstrated the clinical efficacy of curcuminoids in the skin. We evaluated studies published in the MEDLINE-PubMed/PMC (National Library of Medicine) databases, and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for this review. This search included papers published in the past 10 years in controlled clinical trials, double-blind and randomized controlled studies, and case studies. The search resulted in 12 studies published in the past 10 years. Curcuma species (Curcuma longa and Curcuma aeruginosa) and curcumin were found to produce various dermatological effects, including influencing antioxidant and anti-inflammatory processes in the production of hyaluronan, increasing skin moisture, and reducing axillary hair growth. Curcuma was also found to reduce thickness, erythema, pruritus, burning and pain in psoriasis lesions and to improve radiodermatitis lesions. Our review results show that Curcuma species may play a role in skin health management and may exhibit various dermatological effects, thus it could be a new therapeutic arsenal for dermatology professionals. Nevertheless, more clinical trials should be conducted with humans to establish the optimum delivery method and dosages for different dermatological conditions.

Published
2021

21. Mortalidad causada por animales venenosos en Venezuela (2000-2009): nuevo patrón epidemiológico

Author

Leonardo De Sousa, Adolfo Borges, Enzo De Sousa-Insana, and Aleikar Vásquez-Suárez

Subjects
medicine.medical_specialty, serpientes, lcsh:Arctic medicine. Tropical medicine, lcsh:RC955-962, 030231 tropical medicine, lcsh:Medicine, Scorpion stings, General Biochemistry, Genetics and Molecular Biology, Limited access, 03 medical and health sciences, Health services, 0302 clinical medicine, parasitic diseases, Epidemiology, Medicine, 030212 general & internal medicine, Envenomation, escorpiones, epidemiología, scorpions, business.industry, lcsh:R, Snakes, medicine.disease, mortality, hymenopteran, himenópteros, mortalidad, epidemiology, Christian ministry, business, Demography
Abstract

Resumen Introducción. Los accidentes causados por animales venenosos ocurren con mucha frecuencia en comunidades pobres con acceso limitado a los servicios de salud. Se les consideran enfermedades desatendidas y son una de las causas importantes de morbimortalidad en varias naciones del mundo, incluida Venezuela. Objetivo. Evaluar la mortalidad por contacto traumático con animales venenosos (serie X20-X29) en Venezuela en el periodo de 2000 a 2009. Materiales y métodos. Los datos se obtuvieron de los anuarios de mortalidad del Ministerio de Salud. Resultados. Se registraron 759 decesos, la mayoría de ellos en el 2009. La primera causa fue la mordedura de serpientes (n=323; 42,6 %), seguida por la picadura de himenópteros (n=170; 22,4 %), la mordedura de centípedos (n=106; 14,0 %) y la picadura de escorpiones (n=76; 10,0 %). La mediana de la tasa de mortalidad general para el periodo fue de 0,285 fallecidos por 100.000 habitantes, en tanto que, por grupo específico, fue de 0,120 para ofidios, de 0,065 para himenópteros, de 0,035 para centípedos y de 0,025 para escorpiones. Conclusión. Al comparar estos datos con los antecedentes históricos, se evidenció la modificación del patrón de mortalidad en el país caracterizada por un aumento significativo de los decesos por centípedos, tercera causa de muerte, lo que reubica la picadura de escorpiones como la cuarta causa de mortalidad. Abstract Introduction: Injuries by venomous animals frequently occur in impoverished communities with limited access to health services. They are considered neglected diseases that stand out as important causes of morbidity and mortality in various countries, including Venezuela. Objective: To assess mortalities resulting from contact with venomous animals in Venezuela from 2000 to 2009 (X20-X29 series). Materials and Methods: The data were obtained from the annual mortality records of the Venezuelan Ministry of Health. Results: From 2000-2009, 759 fatalities were recorded with the greatest number taking place in 2009. Snakebites (n=323; 42.6%) accounted for the largest percentage of envenomation-related deaths in that period, followed by hymenopteran stings (n=170; 22.4%), centipede bites (n=106; 14.0%), and scorpion stings (n=76; 10.0%). The median value of envenomation-related deaths per 100,000 inhabitants (period 2000-2009) was 0.285: 0.120 corresponded to snakebites, 0.065 to hymenopteran stings, 0.035 to centipede bites, and 0.025 to scorpion stings. Conclusions: Taking into account previous records of animal envenomations in Venezuela, we provided evidence for a shift in the pattern of mortality. Deaths due to centipede bites have increased, making it the third leading cause of envenomation-related mortality in Venezuela. Scorpionism, on the other hand, has declined to the fourth most common cause of fatal envenomations in the country.

Published
2021

22. The epidemiology of sepsis in paediatric intensive care units in Brazil (the Sepsis PREvalence Assessment Database in Pediatric population, SPREAD PED): an observational study

Author

Daniela Carla de Souza, Joelma Gonçalves Martin, Vanessa Soares Lanziotti, Cláudio Flauzino de Oliveira, Cristian Tonial, Werther Brunow de Carvalho, José Roberto Fioretto, Jefferson Pedro Piva, Eduardo Juan Troster, Aline Siqueira Bossa, Flávia Gregorini, Josiane Ferreira, Juliana Lubarino, Alexandre Biasi Cavalcanti, Flávia Ribeiro Machado, SC Silva, J Giacomazzi, Domingos A. Boldrini, FH Gilli, LC de Castro, ML de Albuquerque, VCTG Osorio, MLC Elias, AA da Câmara, M Maia, PB de Carvalho, FM Augusto, RCCM de Figueiredo, EL Ikino, FAS Nogueres, RJ de Almeida, L Torreão, J Ramalho, MMS Camões, CS de Oliveira, VIIS Serafim, J Colleti Junior, CG de Almeida, MHM da Costa, JF Valerio, ME Navajas, PM Riveiro, A Lubiana, ACLC Brito, V Moretto, LMMD Rachid, M Valle, PP de Souza, RPL Victor, NR Castro, T Sakomura, M Molon, AR Ferreira, JG da Fonseca, VCA Cunali, VCA Chagas, G Belek, TS da Rocha, LCFF de Mello, LM Machado, NV Moliterno, C Duran, CLEB Sanos, GT Ribeiro, PSL da Silva, R Lipinski, A Soledade, KC Branco, ACO Teles, GF da Cruz, MR de Mendonça, E Malheiros, J Vicari, PNT Izidro, NMP Campos, TC Pontes, CRF Carneiro, AH Imamura, FM Yoshioka, MCMB Duarte, T Menezes, C Falconiere, F Matos, RS Zeitel, CC Nogueras, ML da Silva, M Aprille, TYM Pires, AF Portella, PVG Flores, PP Alfradique, RC Nascimento, MO Saldanha, AT Alves, WJ de Almeida, M Rodrigues, E Lopes Júnior, MRP Komka, MAR Nascimento, CRC Lopes, TMC Bernardi, RV Falcão, AR Fraga, AA Machado, JEF Godoy, J Barcellos, RLS Queiroz, VVS de Almeida, JZG Lira, M Alvo, TCP Peçanha, AM de Sousa, CS Sanches, AR Wendhausen, SR Pinheiro, MA Orione, AM Minossi, NL Bresolin, CDF Martins, VF Cury, RPB Quinet, AL Netto, R Limonge, SST Tamari, SER de Souza, R Veiga, NGCB Couto, MFP Ribeiro, AK de Aguiar, M Evangelista, JR Krauzer, H Muller, DHS Genu, PA Alvares, KL Maciel, FT Valente, M Centeville, GJ Espinheira, A da Silva, PL Vasconcelos, AZ Hädrich, ALDGC Sousa, GA Gandra, ACA Souto, L Sabatini, PRD João, ABMP Machado, FR Fonseca, APA Resende, RV da Silva, TP da Silva, LLT Barros, CSV de Souza, KO Harada, D Calçado, LSB Pinheiro, MCM Frota, LB Pulcheri, LM e Silva, KJ dos Santos, FH de Nuncio, IO Gomes Júnior, ACC Gomes, MA Klitzke, FR de Souza, FSC Carvalho, FP de Lima, LR Braun Filho, MAG de Oliveira, T Castilho, IP Pistelli, JD Paccez, C Cendon, R Sapolnick, D Fronza, C Toscan, RM Pinelli, JV Alencar, HL di Pace, AD Ramos, AC Molinari, JF Assis, APCR Chavarri, RC Pereira, CL Freitas, ICDM Salmen, RCM Guerini, J Asakura, ACR Pires, G Benvenuti, LM Fernandes, NF Oliveira, HJB Barros, LCE Nascimento, MB Machado, AOR dos Santos, AC da Silva, ACE de Oliveira, SKY Reinheimer, PCS Mello, IO Araújo, KLC Rodrigues, MN Amari, M Andersson, LMCM Petrini, AKSF Luz, ESS Serafim, RF Barbosa, D Souza, AF Delgado, ALP Guerra, JY Afiune, J Huber, S Casonato, DCB da Silva, OR de Araujo, FMD Fialho, LFR Soares, AA de Queiroz Júnior, A Sartorelli, ACP Zuccoli, M Castelani, LAA da Silva, SRA Lima, MJSL de Araújo, ACS da Cruz, PM Sillero, G Sgorlon, TRS Alves, MMB Muniz, RHP Pereira, NR Gonçalves, RPV Teixeira, IA Vasconcelos, CT Rossetti, RG Cesar, MAJ Alves, MK Martins, JAR Rocha, L Arruda, ALY Grillo, and G Barros

Subjects
Male, medicine.medical_specialty, Adolescent, Databases, Factual, Prevalence, Intensive Care Units, Pediatric, Sepsis, symbols.namesake, Epidemiology, Developmental and Educational Psychology, medicine, Humans, Hospital Mortality, Poisson regression, Child, business.industry, Septic shock, Mortality rate, Infant, Newborn, Infant, medicine.disease, Hospitalization, Child, Preschool, Relative risk, Pediatrics, Perinatology and Child Health, Emergency medicine, symbols, Female, Observational study, business, Brazil
Abstract

Data on the prevalence and mortality of paediatric sepsis in resource-poor settings are scarce. We aimed to assess the prevalence and in-hospital mortality of severe sepsis and septic shock treated in paediatric intensive care units (PICUs) in Brazil, and risk factors for mortality.We performed a nationwide, 1-day, prospective point prevalence study with follow-up of patients with severe sepsis and septic shock, using a stratified random sample of all PICUs in Brazil. Patients were enrolled at each participating PICU on a single day between March 25 and 29, 2019. All patients occupying a bed at the PICU on the study day (either admitted previously or on that day) were included if they were aged 28 days to 18 years and met the criteria for severe sepsis or septic shock at any time during hospitalisation. Patients were followed up until hospital discharge or death, censored at 60 days. Risk factors for mortality were assessed using a Poisson regression model. We used prevalence to generate national estimates.Of 241 PICUs invited to participate, 144 PICUs (capacity of 1242 beds) included patients in the study. On the day of the study, 1122 children were admitted to the participating PICUs, of whom 280 met the criteria for severe sepsis or septic shock during hospitalisation, resulting in a prevalence of 25·0% (95% CI 21·6-28·8), with a mortality rate of 19·8% (15·4-25·2; 50 of 252 patients with complete clinical data). Increased risk of mortality was associated with higher Pediatric Sequential Organ Failure Assessment score (relative risk per point increase 1·21, 95% CI 1·14-1·29, p0·0001), unknown vaccination status (2·57, 1·26-5·24; p=0·011), incomplete vaccination status (2·16, 1·19-3·92; p=0·012), health care-associated infection (2·12, 1·23-3·64, p=0·0073), and compliance with antibiotics (2·38, 1·46-3·86, p=0·0007). The estimated incidence of PICU-treated sepsis was 74·6 cases per 100 000 paediatric population (95% CI 61·5-90·5), which translates to 42 374 cases per year (34 940-51 443) in Brazil, with an estimated mortality of 8305 (6848-10 083).In this representative sample of PICUs in a middle-income country, the prevalences of severe sepsis or septic shock and in-hospital mortality were high. Modifiable factors, such as incomplete vaccination and health care-associated infections, were associated with greater risk of in-hospital mortality.Fundação de Amparo à Pesquisa do Estado de São Paulo and Conselho Nacional de Desenvolvimento Científico e Tecnológico.For the Portuguese translation of the abstract see Supplementary Materials section.

Published
2021

23. Identification of ITPR1 as a Hub Gene of Group 3 Medulloblastoma and Coregulated Genes with Potential Prognostic Values

Author

Suely Kazue Nagahashi Marie, Pablo Ferreira das Chagas, Rosane Gomes de Paula Queiroz, Carlos Alberto Scrideli, Graziella Ribeiro de Sousa, Luis Fernando Peinado Nagano, Luciana Chain Veronez, Andrea Martins-da-Silva, Elvis Terci Valera, Silvia Regina Brandalise, Gustavo Alencastro Veiga Cruzeiro, Carolina Alves Pereira Corrêa, and Luiz Gonzaga Tone

Subjects
Medulloblastoma, RNA-Seq, General Medicine, Computational biology, Biology, Proteomics, medicine.disease, Metastasis, Cellular and Molecular Neuroscience, ATP1A2, medicine, Identification (biology), KEGG, Gene
Abstract

The Group 3 Medulloblastoma (Grp3-MB) is an aggressive molecular subtype with a high incidence of metastasis and deaths. In this study, were used an RNA sequencing data (RNA-Seq) from a Brazilian cohort of MBs to identify hub genes associated with the metastatic risk. Data validation were performed by using multiple large datasets from MBs (GSE85217, GSE37418, and EGAS00001001953). DESeq2 package in R software was used to identify the differentially expressed genes (DEGs) in our RNA-Seq data. The DEGs data were accessed to construct the modules/graphs of co-expression and to identify hub genes through Cytoscape platform. The coregulated genes were enriched by the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway, and the protein-protein interaction (PPI) network was visualized by Cytoscape. The Kaplan-Meier plotter and ROC curves were used to validate the diagnostic and prognostic values of specific biomarkers identified through this model. We identified that inositol 1,4,5-trisphosphate receptor type 1 (ITPR1) as a downregulated hub gene, with a high diagnostic accuracy to Grp3-MBs and associated with tumor metastasis. In addition, we identified genes significantly correlated with ITPR1 that were associated with metastasis in Grp3-MB (ATP1A2, MTTL7A, and RGL1) and worst overall survival in MBs (ANTXR1 and RGL1). Our findings suggest that the ITPR1 hub gene is potentially involved in the metastatic process for Grp3-MB. Our data also provide evidence of targets that may serve as prognostic predictors and/or regulators for the metastatic process that maybe explored for further research of individualized therapy to Grp3-MBs.

Published
2021

24. The spread of covid-19 and psychiatric impact on indigenous peoples

Author

Modesto Leite Rolim Neto, Bárbara Silveira Dionízio, Pedro Walisson Gomes Feitosa, Danielly Gonçalves Sombra Lima, Tainã Brito Siebra de Oliveira, and Jorge Lucas de Sousa Moreira

Subjects
Oppression, medicine.medical_specialty, media_common.quotation_subject, Vulnerability, Context (language use), medicine.disease, Microbiology, Mental health, Indigenous, Intensive care, Political science, medicine, Anxiety, Affective spectrum, medicine.symptom, Psychiatry, media_common
Abstract

Background: Information on strategies adopted by Indigenous peoples against COVID-19 is scarce, and history shows that Indigenous peoples in the Amazon region may be particularly affected by the pandemic. Method: The studies were identified in well-known international journals found in two electronic databases: Scopus and Embase. The data were cross-checked with information from the main international newspapers. Results: Mental disorders in the affective spectrum (unipolar major depression, dysthymia, bipolarity) and anxiety disorders (generalized anxiety disorder, panic attacks, social phobia) also mark the reality of Indigenous psychiatric vulnerability. Conclusions: To mitigate the impact of COVID-19 on Indigenous communities in Brazil, a health service for Indigenous groups, a crisis office, and a monitoring panel were created. In the state of Amazonas, home to more Indigenous people than any other Brazilian state, 95% of the intensive care beds are occupied. Thus, mental health disparities between Indigenous and non-Indigenous peoples may be related to the underlying economic, social, and political inequities that are legacies of colonization and oppression of Indigenous cultures; the disproportionate rates of mental disorders must be understood in context, not as intrinsic predisposition of Indigenous peoples, but as reflecting persistent inequalities.

Published
2021

25. Cerebral Venous Sinus Thrombosis and Thrombotic Events After Vector-Based COVID-19 Vaccines

Author

Sotirios Tsiodras, Konstantinos Vadikolias, Androniki Naska, Pagona Lagiou, Vasiliki Papaevangelou, Ioannis Michopoulos, Theodoros I Vassilakopoulos, Sotirios Giannopoulos, Lina Palaiodimou, Georgios Tsivgoulis, Aristeidis H. Katsanos, Maria-Ioanna Stefanou, Diana Aguiar de Sousa, Konstantinos Voumvourakis, Jonathan M. Coutinho, Neurology, ACS - Atherosclerosis & ischemic syndromes, and ANS - Neurovascular Disorders

Subjects
medicine.medical_specialty, Pediatrics, COVID-19 Vaccines, Sinus Thrombosis, Intracranial/epidemiology, Sinus Thrombosis, Intracranial, Epidemiology, Medicine, Humans, Cerebral venous sinus thrombosis, COVID-19/epidemiology, business.industry, SARS-CoV-2, Mortality rate, COVID-19, Thrombosis, Middle Aged, medicine.disease, Thrombocytopenia, Clinical trial, Systematic review, Meta-analysis, Observational study, Female, Neurology (clinical), business, Sinus Thrombosis, Intracranial/epidemiology
Abstract

Background and ObjectivesThere is accumulating evidence supporting an association between the thrombosis and thrombocytopenia syndrome (TTS) and adenovirus vector-based vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Yet TTS and TTS-associated cerebral venous sinus thrombosis (CVST) remain poorly characterized. We aim to systematically evaluate the proportion of CVST among TTS cases and assess its characteristics and outcomes.MethodsWe performed a systematic review and meta-analysis of clinical trials, cohorts, case series, and registry-based studies with the aim to assess (1) the pooled mortality rate of CVST, TTS-associated CVST, and TTS and (2) the pooled proportion of patients with CVST among patients with any thrombotic event and TTS. Secondary outcomes comprised clinical characteristics of patients with postvaccination thrombotic event. This meta-analysis is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was written according to the Meta-analysis of Observational Studies in Epidemiology proposal.ResultsSixty-nine studies were included in the qualitative analysis comprising 370 patients with CVST out of 4,182 patients with any thrombotic event associated with SARS-CoV-2 vector-based vaccine administration. Twenty-three studies were included further in quantitative meta-analysis. Among TTS cases, the pooled proportion of CVST was 51% (95% confidence interval [CI] 36%–66%; I2 = 61%). TTS was independently associated with a higher likelihood of CVST when compared to patients without TTS with thrombotic events after vaccination (odds ratio 13.8; 95% CI 2.0–97.3; I2 = 78%). The pooled mortality rates of TTS and TTS-associated CVST were 28% (95% CI 21%–36%) and 38% (95% CI 27%–49%), respectively. Thrombotic complications developed within 2 weeks of exposure to vector-based SARS-CoV-2 vaccines (mean interval 10 days; 95% CI 8–12) and affected predominantly women (69%; 95% CI 60%–77%) under age 45, even in the absence of prothrombotic risk factors.DiscussionApproximately half of patients with TTS present with CVST; almost one-third of patients with TTS do not survive. Further research is required to identify independent predictors of TTS following adenovirus vector-based vaccination.Registration InformationThe prespecified study protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO (CRD42021250709).

Published
2021

26. Osmotic dehydration as a pre-treatment for jackfruit berries (Artocarpus heterophyllus): effect on physico-chemical properties, shelf life and sensory acceptability

Author

Cristiani Viegas Brandão Grisi, Raquel Alves Evaristo, Gilmar Freire da Costa, and Solange de Sousa

Subjects
Brix, Sucrose, Water activity, Chemistry, medicine.disease, Shelf life, Sensory analysis, chemistry.chemical_compound, medicine, Business, Management and Accounting (miscellaneous), Food science, Dehydration, Water content, Food Science, Osmotic dehydration
Abstract

PurposeThe aim of the study was to evaluate the effect of osmo-convective dehydration using two drying temperatures (50 and 60°C) on the physico-chemical properties, shelf life and sensory acceptability of jackfruit berries.Design/methodology/approachFour treatments were used as follows: T1 – Jackfruit berries dried in an oven at 50°C; T2 – Jackfruit berries dried in an oven at 60°C; T3 – Jackfruit berries pre-treated with an osmotic-sucrose solution (60 Brix concentration) and oven-dried at 50°C and T4 – Jackfruit berries pretreated with osmotic solution (60 Brix concentration) and oven-dried at 60°C. Berries' shelf life was monitored by moisture analysis, water activity (Wa) and microbiological analysis. The influence of treatments on physico-chemical properties and sensory quality was also investigated.FindingsOsmo-convective dehydration at 50 and 60 C significantly (p = 0.001) reduced moisture content and Wa. All treatments increased the shelf life of jackfruit berries within 30 days of storage. Regarding sensory analysis, the T3 treatment was significantly (p = 0.001) the most preferred by the tasters.Originality/valueIn general, the results indicated that osmo-convective dehydration at 50 C has great potential to be a maid in the processing of minimally processed jackfruit berries, as, in addition to providing the product with high stability, it was the one with the greatest acceptability by the tasters.

Published
2021

27. Investigating the in vitro steatotic mixture effects of similarly and dissimilarly acting test compounds using an adverse outcome pathway-based approach

Author

Jimmy Alarcan, Dajana Lichtenstein, R. Rahmani, Kyriaki Machera, Albert Braeuning, Alfonso Lampen, Petros Batakis, Anastasia Spyropoulou, Georges de Sousa, and Efrosini S. Katsanou

Subjects
AOP-wise testing, Carcinoma, Hepatocellular, Steatosis, Health, Toxicology and Mutagenesis, Pharmacology, Toxicology, chemistry.chemical_compound, Molecular Toxicology, Gene expression, Adverse Outcome Pathway, medicine, Humans, Valproic Acid, Adverse Outcome Pathways, Triglyceride accumulation, Triglyceride, Liver Neoplasms, Hepatotoxicity, Hep G2 Cells, General Medicine, Transfection, medicine.disease, In vitro, Fatty Liver, Relative potency factors, chemistry, Nuclear receptor, Mixtures, medicine.drug
Abstract

Within the EuroMix project, we have previously developed an adverse outcome pathway (AOP)-based in vitro assay toolbox to investigate the combined effects of liver steatosis-inducing compounds in human HepaRG hepatocarcinoma cells. In this study, we applied the toolbox to further investigate mixture effects of combinations, featuring either similarly acting or dissimilarly acting substances. The valproic acid structural analogs 2-propylheptanoic acid (PHP) and 2-propylhexanoic acid (PHX) were chosen for establishing mixtures of similarly acting substances, while a combination with the pesticidal active substance clothianidin (CTD) was chosen for establishing mixtures of dissimilarly acting compounds. We first determined relative potency factors (RPFs) for each compound based on triglyceride accumulation results. Thereafter, equipotent mixtures were tested for nuclear receptor activation in transfected HepG2 cells, while gene expression and triglyceride accumulation were investigated in HepaRG cells, following the proposed AOP for liver steatosis. Dose addition was observed for all combinations and endpoints tested, indicating the validity of the additivity assumption also in the case of the tested mixtures of dissimilarly acting substances. Gene expression results indicate that the existing steatosis AOP can still be refined with respect to the early key event (KE) of gene expression, in order to reflect the diversity of molecular mechanisms underlying the adverse outcome. Supplementary Information The online version contains supplementary material available at 10.1007/s00204-021-03182-1.

Published
2021

28. Detection of COX-2 in liquid biopsy of patients with prostate cancer

Author

Fernando Luiz Affonso Fonseca, Beatriz da Costa Aguiar Alves, Jaques Waisberg, Vanessa Silva Pereira, and Flávia de Sousa Gehrke

Subjects
Oncology, medicine.medical_specialty, business.industry, Cancer, General Medicine, medicine.disease, Reverse transcriptase, Pathology and Forensic Medicine, Prostate cancer, medicine.anatomical_structure, Prostate, Internal medicine, Medicine, Outpatient clinic, Biomarker (medicine), RNA extraction, Liquid biopsy, business
Abstract

AimsTo determine the profile ofCOX-2gene expression in patients with prostate cancer attended at the ABC University Health Center outpatient clinic and correlate the results with patients’ anatomopathological examinations. Prostate cancer is the sixth most common type of cancer worldwide and the second in Brazil.COX-2expression is associated with an unfavourable prognosis.Methods15.0 mL of peripheral blood were collected from 24 patients and 25 healthy men. RNA extraction was performed using the QIAamp RNA Blood Mini Kit. Complementary DNA synthesis was performed using SuperScript II RNAse Reverse Transcriptase. Quantitative real-time PCR was performed with specificCOX-2oligonucleotides and the endogenousGAPDHgene.ResultsThe mean age of the patients was 69 years old. The Gleason scoring system showed 37.5% of patients with Gleason 6 (slow growth, low risk), 45.8% with Gleason 7 (intermediate risk) and 16.7% with Gleason 8 or 9 (risk of high-grade cancer). The medianCOX-2expression in the study group was 0.97, while in the control group it was 0.11 (pConclusionsPatients with prostate cancer showed higherCOX-2expression at diagnosis compared with the control group. SinceCOX-2detection associated with prostate-specific antigen dosage shows promise as a biomarker for diagnosis and prognosis in patients with prostate cancer, further research is required to confirm these findings.

Published
2021

29. Possibilities and limitations of antidepressant use to correct depressive and negative symptoms in schizophrenia

Author

A. V. Petrov, R. F. Nasyrova, O. A. Gavrilyuk, M. A. Novitsky, A. De Sousa, and A. R. Asadullin

Subjects
Psychosis, medicine.medical_specialty, business.industry, medicine.disease, Schizophrenia, medicine, Antidepressant, Bipolar disorder, medicine.symptom, business, Major depressive episode, Psychiatry, Reuptake inhibitor, Pharmacogenetics, Depression (differential diagnoses)
Abstract

The purpose of this review is to analyze approaches to the treatment of depressive and negative disorders in schizophrenia in terms of their level of efficacy and safety. Materials and Methods: A search was conducted for full-text articles published over the last 10 years in PubMed, Springer, Wiley Online Library, Taylor & Francis Online, APA PsycInfo, CORE, Science Direct, and eLIBRARY.RU databases. Several articles published previously to this period were also included into the review due to their high scientific value. Results: Our review suggests that antidepressants (ADs) are effective medications and they can be prescribed to correct depressive disorders and negative symptoms in patients with schizophrenia when used in combination with antipsychotics (АPs). However, when administering ADs and АPs combinations, it is important to consider the safety profile of these combinations as well as their tolerance. Negative symptoms of schizophrenia, including those induced by a number of АP, are less amenable to correction by АDs monotherapy, which requires a long period of АPs (on average - 8 weeks), which can be limited in the real life of the patient outside the hospital. Current approaches to the therapy of depressive disorders in patients suffering from schizophrenia vary from country to country. However, most of АDs used in clinical psychiatric practice are widely used in the comorbid state under consideration. Conclusion: The efficacy and safety of АDs of the different classes considered in this review depends on their mechanisms of action, duration of admission, type of АPs taken, and specific clinical situation (acute depressive disorder, major depressive episode, or chronic depressive episode). Most promising in clinical practice are serotonin–norepinephrine reuptake inhibitors (SNRIs) and dual ADs. The use of tricyclic antidepressants (TCAs) is limited due to a higher risk of adverse drug reactions (ADRs). The use of most selective serotonin reuptake inhibitors (SSRIs) is limited due to the risk of aggravation of hallucinations (this risk being higher for patients with visual hallucinations, and lower for those with auditory hallucinations) and\or iatrogenic psychosis. These ADRs may probably occur in patients suffering from schizophrenia due to their ideal "poor metabolizer" pharmacogenetic profile, since most of the drugs considered in this review have hepatic metabolism.

Published
2021

30. A contemporary clinical approach to genetic testing for heritable hyperparathyroidism syndromes

Author

Alex Henderson, John Burgess, Roderick J. Clifton-Bligh, Richard W. Carroll, and Sunita M C De Sousa

Subjects
Hyperparathyroidism, Pediatrics, medicine.medical_specialty, Hypercalcaemia, endocrine system diseases, medicine.diagnostic_test, business.industry, Endocrinology, Diabetes and Metabolism, Familial primary hyperparathyroidism, Syndrome, Hyperparathyroidism, Primary, medicine.disease, Endocrinology, Gene panel, Hypercalcemia, Humans, Medicine, MEN1, In patient, Genetic Testing, Familial hypocalciuric hypercalcaemia, business, Receptors, Calcium-Sensing, Genetic testing
Abstract

PURPOSE The improved access and affordability of next generation sequencing has facilitated the clinical use of gene panel testing to test concurrently patients for multiple heritable hyperparathyroidism syndromes. However, there is little guidance as to which patients should be selected for gene panel testing and which genes should be included in such panels. In this review, we provide a practical approach to considering, interpreting and managing genetic testing for familial primary hyperparathyroidism (PHPT) syndromes and familial hypocalciuric hypercalcaemia (FHH) in patients with PTH-dependent hypercalcaemia. We discuss known genes implicated in PHPT and FHH, testing criteria and yields, pre-test counselling, laboratory considerations, and post-test management. METHODS In addition to reviewing the literature, we conducted audits of local genetic testing data to examine the real-world yield of genetic testing in patients with PTH-dependent hypercalcaemia. RESULTS Our local audits revealed a positive genetic testing rate of 15-26% in patients with suspected hyperparathyroidism syndromes. CONCLUSION Based on the particular testing criteria met, affected patients should be tested for variants in the genes currently implicated in PHPT (MEN1, CDC73, RET, CDKN1B, GCM2, CASR) and/or FHH (CASR, GNA11, AP2S1). Patients should be provided with pre- and post-test counselling, including consideration of potential implications for family members.

Published
2021

31. Incubation Period, Spore Shedding Duration, and Symptoms of Enterocytozoon bieneusi Genotype C Infection in a Foodborne Outbreak in Denmark, 2020

Author

Lasse S Vestergaard, Carl Widstrup Jensen, Sarah Mikkelsen, Luís Alves de Sousa, Lasse Dam Rasmussen, Daniela Michlmayr, Luise Müller, Susanne Schjørring, Steen Ethelberg, Pikka Jokelainen, and Christen Rune Stensvold

Subjects
Adult, Diarrhea, Male, Microbiology (medical), medicine.medical_specialty, Genotype, Denmark, Microsporidiosis, Disease Outbreaks, Infectious Disease Incubation Period, Incubation period, Feces, Internal medicine, Epidemiology, Prevalence, medicine, Humans, Enterocytozoon bieneusi, Phylogeny, Aged, Retrospective Studies, biology, business.industry, Outbreak, Retrospective cohort study, Enterocytozoon, Middle Aged, Spores, Fungal, biology.organism_classification, medicine.disease, Infectious Diseases, Female, medicine.symptom, business
Abstract

Background Microsporidia are rarely reported to cause outbreaks of diarrhea. We describe a foodborne outbreak of microsporidiosis from a workplace canteen in November 2020 in Denmark. Methods A probable case was defined as any person using the canteen between 4 November and 13 December 2020, reporting at least one gastrointestinal symptom, whereas a confirmed case also had an Enterocytozoon bieneusi positive stool sample. A web-based questionnaire was used to collect clinical, epidemiological, and food exposure data. We performed a retrospective cohort study and tested stool samples from affected individuals for bacterial, viral, and parasitic pathogens, including E. bieneusi. Results Altogether, 195 individuals completed the questionnaire. We identified 52 cases (65% male; median age 45 years [range 25–65]). Diarrhea (90%), fatigue (83%), and abdominal pain (79%) were the most commonly reported symptoms. Eight cases were laboratory-confirmed and had E. bieneusi genotype C. The incubation period was between 5 and 12 days, and polymerase chain reaction (PCR)-detectable spore shedding occurred up to 43 days after symptom onset. Disease was associated with consuming food from the workplace canteen on 4 November 2020 (relative risk [RR[, 2.8 [95% confidence interval [CI]: 1.4 – 5.4]) and lunchboxes containing open sandwiches (RR, 3.2 [95% CI: 1.4 – 7.2]) served that day. Conclusions This is the second documented foodborne outbreak of E. bieneusi genotype C-associated diarrhea worldwide. Epidemiological findings advocated an open sandwiches lunchbox from 4 November 2020, as a likely source. E. bieneusi may be an under-reported cause of outbreaks of diarrhea, and testing for it might be useful in foodborne outbreak investigations.

Published
2021

32. Do Orofacial Clefts Impair Breastfeeding and Increase the Prevalence of Anemia?

Author

Nádia Carolina Teixeira Marques, Heloisa de Sousa Gomes, Hercílio Martelli Júnior, Aluísio Eustáquio de Freitas Miranda-Filho, Roberta Bessa Veloso Silva, and Nelson Pereira Marques

Subjects
Pediatrics, medicine.medical_specialty, Design data, Anemia, business.industry, Cleft Lip, Breastfeeding, medicine.disease, Cleft Palate, Otorhinolaryngology, Iron-deficiency anemia, medicine, Humans, Statistical analysis, Oral Surgery, Child, business
Abstract

Objective This study aimed to correlate the prevalence of iron deficiency anemia and breastfeeding with orofacial clefts in children. Design Data on the participant profile, presence and type of the cleft lip and/or palate (CL/P), and records on anemia and breastfeeding were collected from patients’ charts, and submitted to statistical analysis by χ2 test ( p Results Two-hundred and ten files were divided according to: CL/P presence (cleft group; n = 132) or absence (control group; n = 78). Group CL/P was subdivided according to the type of cleft: CL/P-I (cleft lip; n = 35); CL/P-II (cleft lip and palate; n = 45); CL/P-III (cleft palate; n = 43); and CL/P-IV (rare orofacial clefts; n = 9). Group CL/P had significantly more records on anemia ( p = .016) and fewer records on breastfeeding (PConclusions Thus, it is suggested that the breastfeeding process is more complex, and the history of anemia is more frequent, in children with cleft lip and palate or rare orofacial clefts than in children without clefts.

Published
2021

33. Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke in Brazil: Results from the RESILIENT trial

Author

Juliana Safanelli, Leticia C Rebello, Bruna Stella Zanotto, Lucas Scotta Cabral, Gisele Sampaio Silva, Denizar Vianna Araújo, Henrique Diegoli, Francisco Mont’Alverne, Fabricio O Lima, Pedro S.C. Magalhaes, Marcia Lorena Fagundes Chaves, Ana Cláudia de Souza, Jeruza Lavanholi Neyeloff, João José Freitas de Carvalho, Raul G Nogueira, Bruno de Sousa Mendes Parente, Michel Frudit, Daniel Giansante Abud, Thales André Silveira Salvetti, Sheila Cristina Ouriques Martins, Leonardo A Carbonera, Carisi Anne Polanczyk, Octavio M. Pontes-Neto, and Ana Paula Bs Etges

Subjects
medicine.medical_specialty, business.industry, Cost effectiveness, medicine.disease, Mechanical thrombectomy, Neurology, Internal medicine, medicine, Cardiology, In patient, business, Stroke, Acute ischemic stroke, Large vessel occlusion
Abstract

Background The RESILIENT trial demonstrated the clinical benefit of mechanical thrombectomy in patients presenting acute ischemic stroke secondary to anterior circulation large vessel occlusion in Brazil. Aims This economic evaluation aims to assess the cost-utility of mechanical thrombectomy in the RESILIENT trial from a public healthcare perspective. Methods A cost-utility analysis was applied to compare mechanical thrombectomy plus standard medical care (n = 78) vs. standard medical care alone (n = 73), from a subset sample of the RESILIENT trial (151 of 221 patients). Real-world direct costs were considered, and utilities were imputed according to the Utility-Weighted modified Rankin Score. A Markov model was structured, and probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of results. Results The incremental costs and quality-adjusted life years gained with mechanical thrombectomy plus standard medical care were estimated at Int$ 7440 and 1.04, respectively, compared to standard medical care alone, yielding an incremental cost-effectiveness ratio of Int$ 7153 per quality-adjusted life year. The deterministic sensitivity analysis demonstrated that mRS-6 costs of the first year most affected the incremental cost-effectiveness ratio. After 1000 simulations, most of results were below the cost-effective threshold. Conclusions The intervention's clear long-term benefits offset the initially higher costs of mechanical thrombectomy in the Brazilian public healthcare system. Such therapy is likely to be cost-effective and these results were crucial to incorporate mechanical thrombectomy in the Brazilian public stroke centers.

Published
2021

34. Circulating low density neutrophils of breast cancer patients are associated with their worse prognosis due to the impairment of T cell responses

Author

Rute Salvador, M. Guadalupe Cabral, Sofia Braga, Diana P. Saraiva, António Jacinto, Nídia de Sousa, Bruna Correia, iNOVA4Health - pólo NMS, Centro de Estudos de Doenças Crónicas (CEDOC), and NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)

Subjects
tumor-associated neutrophils, medicine.medical_treatment, T cell, Population, chemotherapy response, Immune system, Breast cancer, breast cancer, SDG 3 - Good Health and Well-being, medicine, Cytotoxic T cell, education, Chemotherapy, education.field_of_study, business.industry, low density neutrophils, Cancer, Neutrophil extracellular traps, medicine.disease, medicine.anatomical_structure, Oncology, Immunology, Biomarker (medicine), biomarker, business, Research Paper
Abstract

Neutrophils are prominent immune components of solid tumors, which can protect against the onset of cancer (N1) or have pro-tumor activity (N2). Circulating neutrophils, divided into high density neutrophils (HDN) and low density neutrophils (LDN), functionally mirror those N1 and N2 cells, respectively. LDN, a rare subset in non-pathological conditions, have been extensively studied in cancer, due to their frequency in this disease and their pro-tumor phenotype. However, this has been mainly demonstrated in animal models and proper validation in humans is an urgent need. Here, we further enlighten the clinical impact of LDN in a cohort of breast cancer (BC) patients. We observed that LDN were practically absent in healthy donors’ blood, while were significantly increased in the blood of BC patients, particularly with metastatic disease. Relevant for a clinical translation, within the population of non-metastatic patients, LDN were more prevalent in patients with poor response to neoadjuvant chemotherapy than in responders. The association of a higher incidence of circulating LDN and the worse prognosis of BC patients could be explained by the pro-tumor/immunosuppressive characteristics exhibited by these cells. Namely, there are more LDN expressing the immunosuppressive marker PD-L1, than HDN. Additionally, LDN also showed increased expression of activation markers; a robust formation of neutrophil extracellular traps; an augmented phagocytic activity; and a higher capacity to release reactive oxygen species, which may contribute for tumor development and metastization. Moreover, the percentage of LDN in BC patients’ blood was negatively correlated with activated cytotoxic T lymphocytes and positively correlated with the immunosuppressive CCR4+ regulatory T cells, corroborating their impairment on the anti-tumor immune responses, which was further demonstrated ex vivo. Hence, this study reveals the potential of LDN as a clinical meaningful biomarker of BC response to treatment and opens new avenues for developing targeted immunotherapies.

Published
2021

35. Tribbles Gene Expression Profiles in Colorectal Cancer

Author

Victor Yassuda, José Bragança, Ana Luísa De Sousa-Coelho, Wolfgang Link, Bibiana I. Ferreira, and Mónica T. Fernandes

Subjects
Colorectal cancer, oncogenes, Druggability, Context (language use), colorectal cancer, Computational biology, RC799-869, Biology, 03 medical and health sciences, 0302 clinical medicine, Transcriptional regulation, medicine, transcriptional regulation, Gene, 030304 developmental biology, 0303 health sciences, Tumor microenvironment, Tribbles, Cancer, Oncogenes, Diseases of the digestive system. Gastroenterology, medicine.disease, digestive system diseases, 3. Good health, TRIB3, 030220 oncology & carcinogenesis, gene expression, Medicine, Gene expression
Abstract

Colorectal cancer (CRC) is the third most common cancer and the second leading cause of death due to cancer in the world. Therefore, the identification of novel druggable targets is urgently needed. Tribbles proteins belong to a pseudokinase family, previously recognized in CRC as oncogenes and potential therapeutic targets. Here, we analyzed the expression of TRIB1, TRIB2, and TRIB3 simultaneously in 33 data sets from CRC based on available GEO profiles. We show that all three Tribbles genes are overrepresented in CRC cell lines and primary tumors, though depending on specific features of the CRC samples. Higher expression of TRIB2 in the tumor microenvironment and TRIB3 overexpression in an early stage of CRC development, unveil a potential and unexplored role for these proteins in the context of CRC. Differential Tribbles expression was also explored in diverse cellular experimental conditions where either genetic or pharmacological approaches were used, providing novel hints for future research. This comprehensive bioinformatic analysis provides new insights into Tribbles gene expression and transcript regulation in CRC. info:eu-repo/semantics/publishedVersion

Published
2021

36. Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Author

Stephen R Knight, Catherine A Shaw, Riinu Pius, Thomas M Drake, Lisa Norman, Adesoji O Ademuyiwa, Adewale O Adisa, Maria Lorena Aguilera, Sara W Al-Saqqa, Ibrahim Al-Slaibi, Aneel Bhangu, Bruce M Biccard, Peter Brocklehurst, Ainhoa Costas-Chavarri, Kathryn Chu, Anna Dare, Muhammed Elhadi, Cameron J Fairfield, J Edward Fitzgerald, Dhruv Ghosh, James Glasbey, Mark I. van Berge Henegouwen, J.C. Allen Ingabire, T Peter Kingham, Marie Carmela Lapitan, Ismaïl Lawani, Bettina Lieske, Richard Lilford, Janet Martin, Kenneth A McLean, Rachel Moore, Dion Morton, Dmitri Nepogodiev, Faustin Ntirenganya, Francesco Pata, Thomas Pinkney, Ahmad Uzair Qureshi, Antonio Ramos-De la Medina, Aya Riad, Hosni Khairy Salem, Joana Simões, Richard Spence, Neil Smart, Stephen Tabiri, Hannah Thomas, Thomas G Weiser, Malcolm West, John Whitaker, Ewen M Harrison, Arben Gjata, Maria Marta Modolo, Sebastian King, Erick Chan, Sayeda Nazmun Nahar, Ade Waterman, Dominique Vervoort, Alemayehu Ginbo Bedada, Bernardo De Azevedo, Ana Gabriela Figueiredo, Manol Sokolov, Venerand Barendegere, Gerald Ekwen, Arnav Agarwal, Qinyang Liu, Juan Camilo Correa, Kalisya Luc Malemo, Jacques Bake, Jakov Mihanovic, Kamila Kuncarová, Julius Orhalmi, Hosni Salem, Jyri Teras, Aristotelis Kechagias, Alexis P Arnaud, Judith Lindert, Vasileios Kalles, Maria-Lorena Aguilera-Arevalo, Gustavo Recinos, Zsolt Baranyai, Basant Kumar, Harish Neelamraju Lakshmi, Sanoop Koshy Zachariah, Philip Alexander, Sunil Kumar Venkatappa, C Pramesh, Radhian Amandito, Christina Fleming, Luca Ansaloni, Gianluca Pellino, Ahmed M. Altibi, Ibrahim Nour, Intisar Hamdun, Ali M. Ghellai, Donatas Venskutonis, Tomas Poskus, Justas Zilinskas, Precious Malemia, Yong Yong Tew, Elaine Borg, Sarah Ellul, fatima Zahraa Wafqui, David W Borowski, Anne Sophie van Dalen, Cameron Wells, Harissou Adamou, Adesoji Ademuyiwa, Adewale Adisa, Kjetil Søreide, Sara Al Saqqa, Osaid Alser, Haya Tahboub, Helmut Alfredo Segovia Lohse, Sebastian Shu Yip, Piotr Major, António Sampaio Soares, Matei Razvan Bratu, Andrey Litvin, Armen Vardanyan, JC Allen Ingabire, Ahmad Gudal, Naif Albati, Jovan Juloski, Miran Rems, Sarah Rayne, Stephanie Van Straten, Yoshan Moodley, Irene Ortega Vázquez, Jaime Ruiz-Tovar, Kithsiri Janakantha Senanayake, Sujeewa Priyantha Bandara Thalgaspitiya, Omer Abdelbagi Omer, Anmar Homeida, Yucel Cengiz, Daniel Clerc, Muhammad Alshaar, Hanen Bouaziz, Yuksel Altinel, Matthew Doe, Maryna Freigofer, Ella Teasdale, Rakan Kabariti, Joshua Michael Clements, Stephen Richard Knight, Ahsan Ashfaq, Ijeoma Azodo, Gabriela Wagner, Ivan Trostchansky, Mayaba Maimbo, David Linyama, Helidon Nina, Amanda Zeko, Claudio Gabriel Fermani, Santiago Villalobos, Federico Carballo, Pablo Farina, Sebastian Guckenheimer, Marilla Dickfos, Ankit Ajmera, Chester Chong, Ralph Gourlay, Sikandar Hussaini, Yi Jia Lee, Adeeb Majid, Peter Martin, Rebecca Miles, Owen James Morris, Jamie Phua, William Ridley, Tarunpreet Saluja, Ryan Renxin Tan, Jen Teh, Anna Wells, Bharti Arora, Qaasim Dollie, Debbie Ho, Yanru Ma, Omattage Mahasha Perera, Anthony Truong, Amanda Caroline Dawson, Bryan Lim, Upuli Pahalawatta, Jacqueline Phan, Xiao-Ming Sarah Woon-Shoo-Tong, Andrea Yeoh, Lillian Charman, Andrew Drane, Sharon Laura, Charmaine Chu Wen Lo, Amy Mozes, Rita Poon, Hao Han Tan, Ellen Wall, Prakshi Chopra, Jasmine De Giovanni, Bal Dhital, Brian Draganic, Alexander Duller, Jonathan Gani, Yao Kuan Goh, Jun Young Jeong, Brendan McManus, Prakash Nagappan, Peter Pockney, Anya Rugendyke, Mahsa Sarrami, Stephen Smith, Vanessa Wills, Hsu Ven Wong, Geoffrey Ye, Geoffrey Zhang, Ethan Brooker, Daniel Feng, Bonnie Lau, Carlin Ngai, Sarah Birks, David Gyorki, Jaime Otero de Pablos, Ali Abbosh, Chris Gillespie, Ahmed Mahmoud, Bianca Kwan, Joshua Lawson, Andrea Warwick, Janne Bingham, Andrew J Cockbain, Nagendra Naidu Dudi-Venkata, Jordan Ellaby-Hall, Ben Finlay, Emily Humphries, Jade Pisaniello, Monique Pisaniello, Salma Salih, Tarik Sammour, Haidar Hadri Abd Wahab, April De Silva, Nicola Hayward, Kartik Iyer, Guy Maddern, Gian Andrea Prevost, Naga Annapureddy, Krishna Pranathi Settipalli, Jeremy Yeo, Lucy Hempenstall, Lily Pham, Shaun Purcell, Cherry Talavera, Ashish I Vaska, Gurpreet Chaggar, Phillip Chrapko, Annelise Cocco, Sarah Michelle Crystal Jade Coulter-Nile, Grahame Ctercteko, James French, Houchen Gong, Martijn Gosselink, Thuvarahan Jegathees, Ivan Jin, Michelle Kalachov, Kathryn Kiefhaber, Katherine Lee, Jason Luong, Steven Phan, Henry Pleass, Kelly Veale, Zhi Zeng, Angela Au, Ashe DeBiasio, Idy Deng, Jananee Myooran, Amrita Nair, Peter Stewart, Anton Stift, Lukas Walter Unger, Kerstin Wimmer, Nabila Ahmed, Syed Hasan, Saber Rahman, Margaret O'Shea, Greg Padmore, Adrian Peters, Pietro Perduca, Guenda Pulcina, Nicolas Tinton, Frederic Buxant, Elsa Dabin, Giulia Garofalo, Francis Dossou, Freddy Houehanou Rodrigue Gnangnon, Yacoubou Imorou Souaibou, Pako Motlaleselelo, Omphile Tlhomelang, Igor Lima Buarque, Gustavo Mendonça Ataíde Gomes, Aldo Vieira Barros, Ilia Batashki, Nikolai Damianov, Vladislav Stoyanov, Dragomir Dardanov, Svilen Maslyankov, Plamen Petkov, George Todorov, Evgeni Zhivkov, Aygulya Akisheva, Miguel Angel Castilla Moreno, Geno Genov, Ivelina Ilieva, Tsvetomir Ivanov, Martin Karamanliev, Azhar Khan, Emil Mitkov, Tsanko Yotsov, Boyko Atanasov, Nikolay Belev, Mihail Slavchev, Carlos Nsengiyumva, Elgan Jones, Simon Stock, Steve Kyota, James Brown, Tresor Mabanza K., Lemery Nigo Samuel, Chidi Otuneme, Ngwang Prosper, Franklin Umenze, Marylise Boutros, Natasha Caminsky, Sinziana Dumitra, Richard Garfinkle, Dominique Morency, Ebram Salama, Alexander Banks, Lorenzo Ferri, Haitian He, Amit Katz, Alexander Sender Liberman, Sarkis Meterissian, Allison Pang, Elena Parvez, Usmaan Hameed, Fahima Osman, Sangita Sequeira, Natalie Coburn, Alisha Jaffer, Paul Karanicolas, Matthew Mosseler, Reilly Musselman, Xinyuan Liu, Ching Wan Yip, Juan Sebastian Garces-Otero, Carolina Guzman, Sebastian Sierra, Andres Uribe Valencia, Paulo Andrés Cabrera Rivera, Saul Camelo, Andrea Gonzalez, Alejandro González-Orozco, Manuel Santiago Mosquera Paz, Carlos J- Perez Rivera, Felipe Gonzalez, Andres Isaza-Restrepo, Laura Nino- Torres, Natalia Arias Madrid, Maria Clara Mendoza Arango, Justin Tsandiraki, Damir Jemendžic, Branislav Kocman, Oliver Šuman, Renata Canic, Darko Jurišic, Ivana Karakas, Ana Krizanovic Rupcic, Vlatka Pitlovic, Josip Samardžic, Mario Kopljar, Ivan Bacic, Edgar Domini, Robert Karlo, Danijela Miljanic, Andrea Simic, Mariam Ahmed, Majdi Al Nassrallah, Rabiya Altaf, Talal Amjad, Ruba Eltoum, Heba Haidar, Alhassan Hassan, Omar Khalil, Marwan Qasem, Rommel Ramesh, Gautham Sajith, Maham Wisal, Jan Žatecký, Michele Bujda, Katerina Jirankova, Ales Paclik, Aya Abdallah, Mariam Abdulgawad Almogy, Esraa Ayman El-sawy, Ahmed Moustafa ElFayoumy, Nourhan Elghareeb, Nourhan Ahmed Esmat, Ahmed Fadel, Abdullah Habater, Heba Hamdy, Amr Hefni, Marwa Kamal, Norhan Mohamed Abobakr, Ahmed Sayed, Nancy Shaker, Ehab Taha, Hoda Tharwat, Omar Zakaria, Ibrahem Abdelmotaleb, Ali Al-Dhufri, Hamza S. Al-Himyari, Enas El sheikh, Asmaa Eldmaty, Aya Elkhalawy, Ahmed M.Elkhashen, Kithara Magdy, Safa Mostafa, Habib Doutoum Sadia, Mohamed mahmoud Saleh, Dina Samir, Mohamed Yahia Mohamed Ali, Mahmoud A. Nassar, Samar Abdelhady, Aly Abdelrazek, Israa Abdelsalam, Aya El-Sawy, Eman Essam, Mohamed Gadelkarim, Khaled Ghaly, Mohamed Hassabalnaby, Rana Masarani, Nourhan Mohamed Shaaban, Ahmed Sabry, Menatalla Salem, Nourhan Akram Soliman, Diaaaldin Zahran, Moustafa Ramadan Abou El.soud, Esraa Tarek Badr, Hala Borham, Nehal Elmeslemany, Mohammad Elsayed, Fawzia Elsherif, Sara Eslam, Gehad Gaber, Sondos Ibrahim, Yara Kamh, Abdelrahman Mahmoud, Shimaa gamal Mohamed, Eman Morshedy, Cinderella Omar, Fatima Salem Soliman, Shaza Abdelkawy, Naglaa Abdelmohsen, Mahmoud Abdelshakour, Ahmed Dahy, Norhan Gamal, Mohammed Gamal, Ahmad Hasan, Helal Hetta, Nehad Mousa, Mohamed Omar, Somia Rabie, Mahmoud Saad, Bakeer Saleh, Marwa Sayed Mohamed, Muhammad Shawqi, Heba Abdelhady Mousa, Mostafa Alnoury, Mohamed Elbealawy, Ahmed Elshafey, Muhammad Essam Ibrahim El Desouki Muhammad Ahmed, Mennatullah Ghonaim, Fawzy Hgag, Mohamed Ibrahim, Mahmoud Morsy, Mohamed Reda Loaloa, Ahmed Refaat, Hadeer Samir, Fatma Shahien, Mohamed Sobhy, Fathy Sroor, Esraa Abdellatif, Marina Adel, Amr Abdelghani Afifi, Eman Afifi, Marco Antaky, Amr Dawoud, Naira El Zoghby, Amira El-remaily, Ali Abdelazez Elzanfaly, Ahmed Gadallah, Fatma Alzahraa Gamal, Omar Hashem, Shrouk Medhat Youssef, Aliaa Muhammad Attyah, Malak Munir, Omar Shazly, Esraa Taha, Karim Wilson, Sawsan Adel, Asmaa Ali, Esraa Eid, Esraa Elhelow, Marwa Elmahdy, Bassant Elshatby, Amany Hossam el-din Zakaria, Ahmad Hossny, Eman Ibrahim, Ahmed M.Yonis, Maram Metwalli, Basant Yousry, Esraa Zid, Mina A Yacoub, Ahmed Abdelhakim, Nervana Abouelsoad, Mo'min Alkhatib, Ahmed Ashraf, Alaa Ashraf, Yasmin Elazab, Mahmoud Elfanty, Osama Elkabir, Mai Elsayed, Ahmed Elshimy, Hager Elsobky, John Eskander, Ahmed Gad, Ward Hamsho, Noura Khaled Abdelwahed, Menna Magdy, Dalia Moharam, Abeer Osama, Shereen Ramadan, Radwa Roum, Taqwa Sayed, Tarneem Shehada, Ahmed Mohy Zidan, Khalid Abbas, Amr Ali, Mohamed Attia, Mohamed Balata, Ayman El Nakeeb, Mohamed Ibrahim Elsayed Elewaily, Ahmed Elfallal, Hossam Elfeki, Ahmed Elkhadragy, Sameh Emile, Helmy Ezzat, Hasnaa Hosni, Islam Mansour, Waleed Omar, Gehad Othman, Kareem Sadek, Mostafa Shalaby, Noura Shehab-Eldeen, Rawda Anas khalifa, Helmy Badr, Mostafa Eldeep, Ahmed Eldeep, Amany Eldoseuky mohammed, Salwa Khallaf, Eman Magdy Hegazy, Rokia Mahmoud, Pola Mikhail, Mahmoud Morsi, Sara Mowafy, Dina Raafat, Amina Safy, Marwa Sera, Ahmed shible Sera, Mostafa Salim Mohamed AbdAllah, Muhammad Abdelkader, Abdulrahman Osama Abdou, Ahmedgaber Ahmed, Shireen Gaafar, Fatma Ibrahim negm, Mina Lapic, Ahmed Maher, Hagar Mahmoud, Ahmed Mostafa, Mohamed Samir, Fatma Samy, Nourhan Semeda, Hind I. Shalaby, Alaa El-taweel, Ahmed Galal Elnagar, Ahmed Gamal Hemidan, Mohamed Hussein, Ahmed.A. Kandil, Mf Moawad, Ayat Allah Nasser Hamamah, Mostafa Soliman, Mohamed Abdelkhalek, Noura Abdelmaksoud Tawakel, Ahmed Mohamed Abdelwahed, Alrawy Abdou, Khalid Atallah, Mohammed Yasser Elsherbeny, Eman Emara, Mohamed Hamdy, Omar Hamdy, Amira Haron, Salma Ismail, Islam Hany Metwally, Nihal Mohamed Hamed Elgaml, Ahmed Nassar, Basel Refky, Mirna Sadek, Mahmoud Saleh, Asmaa Yunes, Mai Zakaria, Mohammed Zuhdy, Notila Fayed, Mohammed Mustafa Hassan Mohammed, Sander Kütner, Priit Melnik, Indrek Seire, Toomas Ümarik, Eppu Ainoa, Verner Eerola, Hanna Koppatz, Laura Koskenvuo, Ville Sallinen, Sini Takala, Jevgeni Katunin, Arto Turunen, Niki Christou, Muriel Mathonnet, Vincent Lavoue, Krystel Nyangoh Timoh, Lucie Soulabaille, Romain Lesourd, Aude Merdrignac, Laurent Sulpice, Benoît André, Elodie Chantalat, Charlotte Vaysse, Bertrand Dousset, Sebastien Gaujoux, Gregory Martin, Octavian Clonda, Domantas Juodis, Klaus Kienle, Andras Mravik, Samuel Palmer, Gabor Szabadhegyi, Anita Eseenam Agbeko, Solomon Gyabaah, Frank Enoch Gyamfi, Nuhu Naabo, Atta Owusu senior, Joseph Yorke, Frank Owusu, Francis Abantanga, Theophilus Teddy Kojo Anyomih, Abdul-Jalilu Mohammed Muntaka, Emmanuel Owusu Abem, Mohammed Sheriff, Paul M. Wondoh, Dimitrios Balalis, Dimitrios Korkolis, Georgios Gkiokas, Eirini Pantiora, Theodosios Theodosopoulos, Argyrios Ioannidis, Konstantinos Konstantinidis, Sofia Konstantinidou, Nikolaos Machairas, Anna Paspala, Anastasia Prodromidou, Christos Chouliaras, Konstantinos Papadopoulos, Ioannis Baloyiannis, Ioannis Mamaloudis, George Tzovaras, Ioanna Akrida, Maria-Ioanna Argentou, Stylianos Germanos, Evangelos Iliopoulos, Ioannis Maroulis, George Skroubis, George Theofanis, Christos Chatzakis, Orestis Ioannidis, Lydia Loutzidou, Panagiotis Karathanasis, Nikolaos Michalopoulos, Charalampos Theodoropoulos, Dimitrios Theodorou, Tania Triantafyllou, Zoe Garoufalia, Natasha Hasemaki, Michalis Kontos, Gregory Kouraklis, Stylianos Kykalos, Theodore Liakakos, Eustratia Mpaili, Alexandros Papalampros, Dimitrios Schizas, Athanasios Syllaios, Ekaterini Christina Tampaki, Antonios Tsimpoukelis, Maria Ioanna Antonopoulou, Eirini Deskou, Dimitrios K. Manatakis, Dimitrios Papageorgiou, Menelaos Zoulamoglou, Christos Anthoulakis, Michalis Margaritis, Nikolaos Nikoloudis, Veronica Campo, André Ceballos, Mario-Andrés Flores, Waleska Giron, Donghyun Ko, Gabriel Martinez, Verónica Rivera Lara, Nataly Rueda, Andres Sanchez, Jorge Carlos Guillermo Tejeda Garrido, Alvaro Eduardo Alvarez Rivera, Elvis Benjamin Bamaca Ixcajoc, Lilian Elizabeth Barreda Zelaya, Patricia Chacòn-Herrera, Ligia Margarita Corea Ruiz, Guillermo Echeverria-Davila, Mario Garcia, Danilo García, Edgar Fernando Gutiérrez Mayen, Noriega José, Nery Mazariegos, Diego Méndez, Michael Paniagua Espinoza, David Bardos, Marton Benke, Kristof Illes, Balint András Kokas, Réka Szabó, Akhila Appukuttan, Anjitha Asok, Vijaykumar D.k, Kapil Malik, Praveen Ravishankaran, Ritesh Tapkire, Guru Moorthy, Joyner Abraham, Ramesh Muthuvel, John Alapatt, Abhay Kattepur, Nizamudheen Pareekutty, Mebanshanbor Garod, Caleb Harris, Cliff Wanniang, Ashish Gupta, Deepak Nehra, Sanjeev Parshad, Rajgopal Acharya, Rajendra Badwe, Manish Bhandare, Urvashi Jain, Karishma Kirti, Nita Nair, Shailesh Shrikhande, Purvi Thakkar, Premkumar Anandan, Archana C S, Arun Holenarasipur Narasannaiah, Tejaswi Jagarlamudi, Rashmi M R, Mallikarjuna Manangi, Abhishek Raghavendra, K. Seshagiri Rao, Vinay S, Vinay Sajjan, Aneesh Shenoy, Santhosh Shivashankar Chikkanayakanahalli, Kavya Tharanath, Sushmita V, Peter Adidharma, Raksheeth Agarwal, Phebe Anggita Gultom, Ghafur Rasyid Arifin, Matthew Billy, Zatira Elfizri, Alessa Fahira, Devi Felicia, Triana Hardianti Gunardi, Nadya Johanna, Nadia Rahmadiani Nugrahadi, Sonar Soni Panigoro, Siti Rahmayanti, Retta Catherina Sihotang, Santi Yuanita Brata, Hadi Winoto, Nastaran Barati, Manoochehr Karami, Hamidreza Khorshidi, Homa Naderifar, Mazin A. Abdulla, Maggie Coleman, Ronan J Doherty, Rob Hannon, Brenda Murphy, Aine Stakelum, Des Winter, Lylas Aljohmani, Richard Farnan, Yeshey Seldon, Tanna Tan, Shriya Varghese, Mohammad Alherz, Muaaz Ather, Mohammad Bajilan, Vivien Graziadei, Isobel Pilkington, Omar Quidwai, Paul Ridgway, Haaris Shiwani, Abd al-Rahman Tahir, Eimear Blunnie, Daniel Burke, Niall Kennedy, Kate Macdonagh, Maeve O'Neill, Siobhan Rooney, Giuseppe Falco, Guglielmo Ferrari, Simone Mele, Gabriela Elisa Nita, Lara Ugoletti, Maurizio Zizzo, Gianmaria Confalonieri, Giovanni Pesenti, Fulvio Tagliabue, Gianluca Baronio, Deborah Ongaro, Giacomo Pata, Bruno Compagnoni, Renato Salvadori, Lucio Taglietti, Nicola D'Alessandro, Pierpaolo Di Lascio, Giovanni Pascale, Luca Bortolasi, Tommaso Campagnaro, Massimo Carlini, Giorgio Lisi, Davide Lombardi, Corrado Pedrazzani, Domenico Spoletini, Giulia Turri, Paola Violi, Donato Francesco Altomare, Fabrizio Aquilino, Nicola Musa, Vincenzo Papagni, Arcangelo Picciariello, Leonardo Vincenti, Dario Andreotti, Savino Occhionorelli, Matteo Tondo, Stefano Maria Massimiliano. Basso, Riccardo Cirelli, Marco Enrico Mario Maino, Guglielmo Niccolò Piozzi, Emanuele Picone, Rosa Scaramuzzo, Giovanni Sinibaldi, Alfonso Amendola, Lorenzo Anastasio, Luigi Bucci, Emanuele Caruso, Antonio Castaldi, Sara Di Maso, Vincenza Paola Dinuzzi, Giovanni Esposito, Maria Gaudiello, Mariano Cesare Giglio, Paola Antonella Greco, Gaetano Luglio, Andrea Manfreda, Ester Marra, Federica Mastella, Gianluca Pagano, Roberto Peltrini, Vincenzo Pepe, Michele Sacco, Viviana Sollazzo, Giovanni Spiezio, Ettore Cianchetti, Nunzia Menduni, Michele Maria Carvello, Francesca Di Candido, Antonino Spinelli, Fabio Corsi, Luca Sorrentino, Fabio Marino, Emanuele Luigi Giuseppe Asti, Luigi Bonavina, Emanuele Rausa, Martina Asta, Andrea Belli, Francesco Bianco, Carmela Cervone, Paolo Delrio, Armando Falato, Andrea Fares Bucci, Rita Guarino, Ugo Pace, Daniela Rega, Emilia De Luca, Gaetano Gallo, Giuseppe Sammarco, Giuseppe Sena, Giuseppina Vescio, Letizia Santandrea, Giampaolo Ugolini, Davide Zattoni, Nicola Chetta, Gaetano Logrieco, Serafino Vanella, Gianluca Garulli, Nicola Zanini, Andrea Bondurri, Francesco Cammarata, Francesco Colombo, Diego Foschi, Giulia Maria Beatrice Lamperti, Anna Maffioli, Gianluca Matteo Sampietro, Al'ona Yakushkina, Gloria Zaffaroni, Enrico Cicuttin, Maria Grazia Sibilla, Harmony Impellizzeri, Marco Inama, Gianluigi Moretto, Sylvie Mochet, Elisa Ponte, Antonella Usai, Stefano Mancini, Andrea Sagnotta, Luigi Solinas, Elisa Bolzonaro, Nicolò Tamini, Gianluca Curletti, Raffaele Galleano, Michele Malerba, Sofia Campanella, Gianfranco Cocorullo, Francesco Colli, Paolino De Marco, Nicolò Falco, Tommaso Fontana, Leonel jospin Kamdem Mambou, Antonella La Brocca, Leo Licari, Brenda Randisi, Giovanna Rizzo, Giulia Rotolo, Giuseppe Salamone, Roberta Tutino, Paolina Venturelli, Stefano Malabarba, Alessandro Sgrò, Ivan Vella, Bruno Cirillo, Daniele Crocetti, Giorgio De Toma, Pierfrancesco Lapolla, Andrea Mingoli, Paolo Sapienza, Angela Belvedere, Stefania Bianchini, Margherita Binetti, Arianna Birindelli, Valeria Tonini, Mauro Podda, Fabio Pulighe, Michele De Rosa, Lorenzo Bono, Felice Borghi, Paolo Geretto, Maria Carmela Giuffrida, Corrado Lauro, Alessandra Marano, Luca Pellegrino, Paola Salusso, Diego Sasia, Michela Campanelli, Alberto Realis Luc, Mario Trompetto, Roberto Cardia, Nicola Cillara, Antonio Nicola Giordano, Antonio Costanzo, Mario Alessandro Giovilli, Luca Turati, Silvestro Canonico, Guido Sciaudone, Francesco Selvaggi, Lucio Selvaggi, Nader Albsoul, Ahmad AlBsoul, Ala'a Aldeen Alkhatib, Osama Alsallaq, Justin Z. Amarin, Rami Ayoub, Isam Bsisu, M S El Muhtaseb, Mohammad Jabaiti, Jamal Melhem, Yasmeen Z. Qwaider, Mohammad Hasan Salameh, Ahmad Suleihat, Haya H. Suradi, Mohammad Alammarin, Almoutuz Aljaafreh, Mohammad Bani hani, Zeina Bani hani, Farah Bani Hani, Toqa Fahmawee, Shadi Hamouri, Cyrine Katanani, Ra'fat Tawalbeh, Tamara Tawalbeh, Hassan Zawahrah, Mohamad K. Abou Chaar, Lana Abusalem, Mahmoud Al-Masri, Hani Al-Najjar, Lutfi Barghuthi, Zahra Ahmed, Adnan Maulana, Omar Ngotho, Charbel Kamau, Aruyaru Stanley Mwenda, Fridah Bosire, Elizabeth Mwachiro, Robert Parker, Ian Simel, Kimutai Sylvester, Abdulmunem Ahmed Mustafa Althini, Sofian Elbarouni, Aya Elseed Elbeshina, Ahmed Gwea, Ans Malek, Wedad Albashir Masoud Farag, Abdulwahab Abdalei, Abu Baker Abdel Malik, Areej Abo-khammash, Ma'aly Abuhlaiga, Nour Adnan, Marwa Albaggar, Asma Alfitory, Asma Aljanfi, Fakhruddin Almuzghi, Zohoor Altumei, Fatima Alzabti, Hana Ashoushan, Mohamed Assalhi, Joma Azzubia, Sondos Bnhameida, Malik Delhen, Houssein Elshafei, Hana Elteir, Fatima Esbaga, Abdel Aziz Gobbi, Fatma Hamouda, Hamdan Hilan, Rania Ismail, Fieruz Jebran, Muataz Kasbour, Galia Maderi, Saja Mohammad, Burooj Mohammed, Habib Murtadi, Hamassat Mustafa, Mohamed Rajab, Sarah Trenba, Mariam Wafaa, Eman Al Sagheir, Alabas Almigheerbi, Ahmed Alzahaf, Sumayyah Ghayth Bahroun, Najah Ben Dallah, Mahmoud Elshaibani, Haitem Eswaye, Maha Karar, Samah Omar, Eman Younes, Maha Younes, Dafer Zreeg, Saleh Abujamra, Firas Ashour, Mala Elgammudi, Wesal Omar F. Aljadidi, Enas Saddouh, Randa Sharif, Aya Alabuzidi, AbdulMawlay Alwerfally, Sarra Aribi, Fatma Bibas, Taha Elfaituri, Yasmine Elhajjaji, Ala Khaled, Wegdan Khalil, Tesneem Layas, Enas Soula, Ahmed Tarek, Muad fathi khalleefah Abu hallalah, Hazem Abdelkarem Ahmed, Tagwa Alsharef, Abdulsalam Ali Ben Saoud, Tasnim El Gharmoul, Ahmed Elhadi, Safa Elrais, Abdulhalim Shebani, Heba Zarti, Asaid Zeiton, Marijus Ambrazevicius, Nerijus Kaselis, Migle Stakyte, Oleg Aliosin, Agne Cizauskaite, Sarunas Dailidenas, Vitalijus Eismontas, Migle Kybransiene, Vitalija Nutautiene, Narimantas Samalavicius, Dainius Simcikas, Algirdas Slepavicius, Albinas Tamosiunas, Nerijus Ubartas, Paulius Zeromskas, Saulius Bradulskis, Edvinas Dainius, Juozas Juocas, Egle Kubiliute, Juozas Kutkevicius, Aurimas Opolskis, Audrius Parseliunas, Andrejus Subocius, Egle Virbickaite, Diana Zuikyte, Algirdas Bogusevicius, Kristina Buzaite, Daiva Cepuliene, Ieva Cesleviciene, Vaidotas Cesna, Jolanta Gribauskaite, Povilas Ignatavicius, Mantas Jokubauskas, Monika Liugailaite, Ernest Margelis, Ruta Mazelyte, Lina Pankratjevaite, Matas Pažusis, Agne Rackeviciute, Justina Saladyte, Monika Škimelyte, Vygintas Šlenfuktas, Monika Sudeikyte, Algimantas Tamelis, Tomas Vanagas, Žygimantas Žumbakys, Aivaras Atkociunas, Audrius Dulskas, Justas Kuliavas, Justas Birutis, Sigitas Paškevicius, Mindaugas Šatkauskas, Donatas Danys, Matas Jakubauskas, Lina Jakubauskiene, Marius Kryzauskas, Vytautas Lipnickas, Gabija Makunaite, Fanjandrainy Rasoaherinomenjanahary, Herizo Rasolofonarivo, Luc Hervé Samison, Bitiel Banda, Vanessa Msosa, Ahmad Imran Ahmad Izzuddin, Andre Das, Ying Yee Gan, Tan Shong Sheng, Jia yng Siaw, Mohd Fadliyazid Ab Rahim, Dyg Zahratul Hamrak Abang Jamari, Nurfariza Che Husin, Muhd Yusairi Kamarulzaman, Yi Ping Lim, Nil Amri Mohamed Kamil, Mohd Razeen Mohd Hassan, Saidah Mohd Sahid, Johari Mustafa, Elaine Hui Been Ng, Wan Khamizar Wan Khazim, Ng Chang Ern, P.g. Lingeshan, Syariz Ezuan Sulaiman, Sue Ean Ang, Muhammad Navid Bin Mohamad Sithik, Yih Jeng Cheong, Mahadevan Deva Tata, Law Jia Xian, Aravinthan Kadravello, I-Ern Koh, Li-Yen Ng, Yuki Julius Ng We Yong, Kandasami Palayan, Chi Xuan Sam, Phuah Siow Jin, Jeremy Tan Ern Hwei, Yita Tang, Alvin Zubin Ter, Michael Pak-Kai Wong, Andee Dzulkarnaen Zakaria, Zaidi Zakaria, Fitjerald Henry, Thyivya Kalaiselvan, Muhammad Fairuz Shah Abd Karim, Mohamed Rezal Abdul Aziz, Nora Abdul Aziz, Tak Loon Khong, Peng Choong Lau, Hiong Chin Lim, April Camilla Roslani, Jonathan Chen Ken Seak, Sui-Weng Wong, Lai Fen Wong, Leow Yeen Chin, Mercy Chinemerem Anyanwu, Zachary Busuttil, Thomas Calleja, Kurt Lee Chircop, Ruth Cutajar, Andrew Michael Dimech, Joseph Galea, Kiara Gascon Perai, Ruth Gatt, Lisa Kelman, Elizabeth Micallef, Favour Nwolu, Kim Sammut, Joanna Thompson, Sean Warwicker, Matthew Zammit, Fernando Cordera, Efraín Cruz González, Jorge Sánchez-García, Francisco José Barbosa Camacho, Francisco Javier Barrera López, Carlos Jose Zuloaga Fernandez del Valle, Eric Acosta, Iván Romarico González Espinoza, Perla Moreno, Ana Olivia Cortes-Flores, Clotilde Fuentes Orozco, Alejandro Gonzalez Ojeda, Samantha Corro Díaz González, Laura Martinez, Bonifacio Mosqueda Amador, Armando Novoa, Dennet Arturo Olazo Espejo, Alejandro Jimenez, Federico Lopez Rosales, Elva Gabriela Vanoye, Luis Alberto Garcia Gonzalez, Roberto Carlos Miranda-Ackerman, Manuel Solano-Genesta, Alethia Alvarez-Cano, Hector Hugo Romero-Garza, Heriberto Medina-Franco, Lorelí Mejía-Fernández, Noel Salgado-Nesme, Omar Vergara-Fernandez, Guadalupe Montserrat Gutiérrez-Mota, Francisco Xavier Hernandez Vera, Anabella Llantada Lopez, Gilberto Morgan Villela, Felipe de Jesus Ramirez Padilla, Walezka Tapia Marin, Mónica Martínez Maldonado, Ramses Sánchez Suárez, José Manuel Troche, Chaymae Benyaiche, Oumaima Outani, Souadka Amine, Amine Benkabbou, Anass Mohammed Majbar, Raouf Mohsine, Ali Rafik, Thida Oung, Moe Moe Tin, Philipp Plarre, Anna Alberga, Nina Sluiter, Jurriaan Tuynman, Robin Blok, Didem Cömert, Roel Hompes, Marianne Kalff, Merel Elisabeth Stellingwerf, Pieter Tanis, Mark van Berge Henegouwen, Elise Maria van Praag, Daan Wisselink, Michael Gerhards, Josephine Lopes Cardozo, Emma Westerduin, Joske de Jonge, Aaw van Geloven, Kaz van Schilt, Frank den Boer, Simone Stoots, Stijn Vlek, Jamie Adams, Ibrahim S. Al-Busaidi, Gabrielle Budd, Seung il Choi, Michael Jen Jie Chu, Anurag Ganugapati, Lucy McKinstry, Rebecca Pascoe, Simon Richards, Kenrick Rosser, Annie Stevenson, Rebecca White, Shebani Farik, Jin Kwun, Ahmed Murad, Sarah Cowan, Timothy Hall, Michael Hayton, Laminou Malam Sani, Souleymane Oumarou Garba, Ibrahim Amadou Magagi, Oumarou Habou, Halima Aliyu, Muhammad Daniyan, Tunde T. Sholadoye, Lawal Abdullahi, Lofty-John Anyanwu, Aminu Mohammad Mohammad, Abubakar Bala Muhammad, Abdurrahman Abba Sheshe, Ibrahim Suleiman, Alaba Adesina, Ajibola Awolowo, Clement Onuoha, Omotayo Salami, Ogechukwu Taiwo, Agboola Taiwo, Stephen Kache, Jerry Godfrey Makama, Danjuma Sale, Olajide Abiola, Akinlabi Ajao, Anthony Ajiboye, Amarachukwu Etonyeaku, Julius Olaogun, Ademola Adebanjo, Opeoluwa Adesanya, Michael Olatunji Afolayan, Olanrewaju Balogun, Ayomide Makanjuola, Samuel Nwokocha, Rufus Wale Ojewola, Thomas Olagboyega Olajide, Adewale Aderounmu, Abdul-Rashid Adesunkanmi, Augustine Agbakwuru, Adeleke Akeem Aderogba, Olusegun Isaac Alatise, Olukayode Arowolo, Oladejo Lawal, Tajudeen Mohammed, Chinedu Ndegbu, Olalekan Olasehinde, Funmilola Wuraola, Akinbolaji Akinkuolie, Arinzechukwu Mosanya, Omobolaji Ayandipo, Peter Elemile, Taiwo Akeem Lawal, Samuel Ali SANI, Stephen Garba, Rebecca Hauwa SANI, Samson Olori, Henry Onyebuashi, Ifeanyi Umoke, Adedire Adenuga, Ademola Adeyeye, Olufemi Habeeb, Bashir Lawal, Abdulrasheed Nasir, Eirik Kjus Aahlin, Didrik Kjønås, Elisabeth Myrseth, Jibran Abbasy, Abdul Alvi, Omair Saleem, Asma Afzal, Anam Nazir, Muhammad Farooq, Ayesha Liaqat, Syed Asghar Naqi, Ali Raza, Muzna Sarfraz, Muhammad Sarwar, Muntaha Banglani, Ambreen Munir, Rahmat Sehrish, Bushra Ayub, Raza Sayyed, Amna Altaf, Saima Ayub, Komal Saeed, Bilal Syed, Sana Amir Akbar, Abdul Wahid Anwer, Ruqayya Naheed Khan, Amina Iqbal Khan, Shahid Khattak, Sameen Mohtasham, Muhammad Asad Parvaiz, Aamir Ali Syed, Abdul Basit Ansari, Noman Shahzad, Tanwir Khaliq, Isbah Rashid, Shahzad Hussain Waqar, Hasan Abu Al-saleem, Amjad Abu Alqumboz, Mohammad Alqadi, Adham Amro, Rawan Assa, Eman Awesat, Rawan Ayyad, Mohammed Hammad, Ayat Haymony, Bassel Hijazi, Bara Hmeidat, Rowaa Lahaseh, Aseel Qawasmi, Alaa Rajabi, Mohammed Shehada, Sundus Shkokani, Yasmine Yaghi, Nadine Yaghi, Mohammad AlZohour, Mohammad Farid, Yousef Mahmoud Habes, Wesam Juba, Yanal Nubani, Abdelrahman Rabee, Mohammad Sa'deh, Saeed Abed, Iyad Al basos, Mohammad Alswerki, Dina Ashour, Israa Awad, Samar Diab, Alaa El Jamassi, Sahar El-Kahlout, Somaya Elhout, Ahmed N K Hajjaj, Doaa Hasanain, Baraa Nabil hajjaj, Mohammed Obaid, Eman Saikaly, Ahmed Salhi, Hiba Al-Tammam, Murad Almasri, Muath Baniowda, Doha Beshtawi, Ali Horoub, Rami Misk, Bayan Mohammad, Rami Qasrawi, Tasnim Sholi, Samar Abu-Nimeh, Abrar Abu-srour, Sadi A. Abukhalaf, Samer Adawi, Barah Alsalameh, Kholoud Ayesh, Muawiyah Elqadi, Ahmad Hammouri, Fatima Karim Mustafa, Natalie Marzouqa, Shatha Melhem, Dima Miqdad, Balqees Mohamad, Mhammed Rawhi, Ayman B. Abu Ahammala, Ahmed Abu Ataya, Israa Abu Jayyab, Samar Al-Shwaikh, Othman Alagha, Mohammed Alasttal, Haneen Awadallah, Mahmood Elblbessy, Jehad Fares, Akram Jarbou, Ibtisam Mahfouz, Moath A. Albahnasawi, Asmaa' Abo mahadi, Hasan Abuelhatal, Ayham Abuelqomboz, Abdelrahman Almoqayyad, Abdallah Alwali, Reem Balaawi, Mahmoud Hamouda, Mohammed Humeid, Abdullah Jedyan, Tasneem Mahmoud Abu hamam, Ghadeer Matar, Ali Salem, Tahani Samra, Nureddin Shaheen, Karam Shihada, Ayoob A.Nemer, Mahmoud Abu Al Amrain, Abdulwhhab Abu Alamrain, Najlaa Abu Jamie, Mohammed R. Abu-Rous, Nada Alfarra, Mohammed AlTaweel, Noor Alwhaidi, Ramadan Hamed, Bader Saqqa, Ahmad Shaheen, Dana Aljaber, Loay Aljaberi, Malak Alwaheidi, Assef Jawaada, Hani Khaldi, Rami Qahoush, Jalil Qari, Rana Saadeh, Ahlam Salim, Aseel Yacoub, Abbas Abbas, Rana Abu shua`ib, Baraa Abu Zainah, Mahmoud AbuSirrees, Basheer Babaa, Ola Barhoush, Asef Belal qadomi, Laith Daraghmeh, Reema Haji, Alaa Khatatbeh, Lana Khatib, Salsabeel Qarariah, Yara Quzmar, Khalil Safadi, Roqaya Salameh, Mohammad Hassan, Shifaa Herzallah, Loai Massad, Ahmed Nazzal, Ranin Nazzal, Dennis Escobar, Gustavo Miguel Machain V, Agustin Rodriguez Gonzalez, Jorge Emerson Chachaima Mar, Nathaly Olga Chinchihualpa Paredes, Vicente Cuba, Walter Lopez, Maria Milagros Niquen Jimenez, Nestor Alberto Sanchez Bartra, Olenka Sapallanay Ojeda, Diego Sequeiros, Andrea Toscano Pacheco, María Vergara, Sol Abarca, Rodrigo Alcorta, Giuliano Borda-Luque, Ivan Edward Eusebio Zegarra, Claudia Luján López, Mirella Marrufo, Cinthya Mogrovejo, Andrea Nomura, Yamile Rodríguez Angeles, Maitza Rosario Vidal Meza, Gabriela Zavala, José Neiser Castillo Arrascue, Jomara Caroline Hidrogo Cabrera, José Julio Mariano Larrea vera, Miguel Osorio, Edgar Alcides Ylatoma Díaz, Mark Anthony Fontanilla, Joseph Roy Fuentes, Anna Leah Salazar, Genieve Dominguez, Marc Paul Lopez, Shiela Macalindong, Mark Augustine Onglao, Arjel Ramirez, Marie Dione Sacdalan, Mayou Martin Tampo, Gemma Leonora Uy, Jeremiah Mangahas, Kenneth Yabut, Joannes Paul Cañete, Bernalynn Eris Cansana, Ernes John Castro, Maria Kaiserin Lipana, Manuel Francisco Roxas, Vlu Jean Zara, Maciej Chrol, Paula Franczak, Michal Orlowski, Piotr Budzynski, Andrzej Budzynski, Pawel Bury, Agata Czerwinska, Jadwiga Dworak, Jacek Dziedzic, Michal Kisielewski, Jan Kulawik, Anna Lasek, Piotr Malczak, Marcin Migaczewski, Michal Pedziwiatr, Magdalena Pisarska, Dorota Radkowiak, Mateusz Rubinkiewicz, Anna Rzepa, Tomasz Skoczylas, Maciej Stanek, Katarzyna Truszkiewicz, Mateusz Wierdak, Marek Winiarski, Piotr Zarzycki, Anna Zub-Pokrowiecka, Piotr Kowalewski, Rafal Roszkowski, Maciej Waledziak, Miguel Tomé, Sara Patrocinio, Ines Guerreiro, Filipe Almeida, Xavier de Sousa, Nuno Monteiro, Maria Teresa Costa Santos, Daniela de Oliveira, Marta Lopes Serra, Daniela Morgado, Christian Neves, Ana Carolina Oliveira, Alice Pimentel, Sofia Silva, Márcia Carvalho, Lúcia Carvalho, Joana Magalhães, Leonor Matos, Tânia Monteiro, Carlota Ramos, Vanessa Santos, José Barbosa, Jose Costa-Maia, Vítor Devezas, Ana Fareleira, Cristina Fernandes, Diana Gonçalves, Henrique Mora, Marina Morais, Fabiana Silva de Sousa, Sara Catarino Santos, Ana Logrado, André Tojal, Edgar Amorim, Miguel F. Cunha, Ana Fazenda, João Pedro Melo Neves, Inês Isabel Sampaio da Nóvoa Gomes Miguel, Diogo Veiga, José Azevedo, Hugo Cardoso Louro, Mariana Leite, Maria Bairos Menezes, Bárbara Gama, Diana Brito, Marta Cristina Cruz Martins, André Graça e Magalhães, Ana Catarina Longras, Rita Lourenço, Diana Matos, Luis Castro, Filipa Policarpo, Joana Romano, Cristina Monteiro, Diogo Pinto, Marina Duarte, Sónia Fortuna Martins, Mariline Oliveira, Diogo Galvão, Lisandra Martins, Anaisa Silva, Viorel Taranu, Bárbara Vieira, Jessica Neves, Simone Oliveira, Hugo Ribeiro, Margarida Cinza, Rosa Felix, Arnaldo Machado, Joana Oliveira, Joana Patrício, Rita Pedroso de Lima, Mário Pereira, Miguel Rocha Melo, Cristina Velez, Alberto Abreu da Silva, Mariana Claro, Daniel Costa Santos, Andreia Ferreira, Hugo Capote, Daniela Rosado, Filipa Taré, Oriana Nogueira, Miguel Ângelo, José Miguel Baiao, Andreia Guimarães, João Marques, Miguel Nico Albano, Marta Silva, Ana Valente da Costa, Teresa Vieira Caroço, Sara Almeida Braga, Ines Capunge, Marta Fragoso, João Guimarães, Bruno Pinto, João Ribeiro, Miguel Angel, Guilherme Fialho, Monica Guerrero, Filipa Campos Costa, Diogo Cardoso, Vasco Cardoso, Magda Alves, Inês Estalagem, Tiago Louro, Cláudia Marques, Rita Martelo, Miguel Morgado, Rita Canotilho, Ana Margarida Correia, Pedro Martins, Mariana Peyroteo, João Gomes, Rita Monteiro, Manuela Romano, Daniela Macedo Alves, Rita Peixoto, Catarina Quintela, Maria João Jervis, Débora Melo, André Pacheco, Valter Paixão, Vera Pedro, Joana Pimenta, João Pimenta de Castro, Ana Rocha, Mircea Beuran, Cezar Ciubotaru, Bogdan Diaconescu, Sorin Hostiuc, Ionut Negoi, Bogdan Stoica, NA NA, Evgeny Anokhin, Georgy Kuznetsov, Giorgi Oganezov, Fedor Paramzin, Ekaterina Romanova, Valeryan Rutkovskii, Vasilii Rutkovskii, Mikhail Shushval, Mikhail Zabiyaka, Khasan Dzhumabaev, Valerii Ivanov, Zaman Mamedli, Sergey Achkasov, Artem Balkarov, Elnur Nabiev, Marat Nagudov, Evgeny Rybakov, Karina Saifutdinova, Oleg Sushkov, Lule Joseph, Isaac Ndayishimiye, Ntirenganya Faustin, Alphonse Zeta Mutabazi, Jean Paul Mvukiyehe, Vizir J.P Nsengimana, Carine Uwakunda, Mohammad Monir Abbas, Nouf Akeel, Murad Aljiffry, Kholoud Awaji, Ali Farsi, Ghader Jamjoum, Ahmad Khoja, Ashraf Maghrabi, Nadim Malibary, Mohammed Nassif, Abdulaziz Saleem, Abdullah Sultan, Wail Tashkandi, Hanaa Tashkandi, Nora Trabulsi, Mouhamadou Bachir Ba, Adja Coumba Diallo, Abdourahmane Ndong, Vladica Cuk, Uroš Jankovic, Sharon Zhiling Koh, Frederick Koh, Kuok Chung Lee, Kai Yin Lee, Sean Lee, Wei Qi Leong, Su Ann Lui, Prajwala Prakash, Jan Grosek, Gregor Norcic, Ales Tomazic, Nicolas Fitchat, Robert Jaich, Devorah Wineberg, Modise Zacharia Koto, Daniella Baiocchi, Damian Clarke, Christina Johanna Steenkamp, Sharon Bannister, Adam Boutall, Galya Chinnery, Anna Coccia, Angela Dell, Parveen Karjiker, Christo Kloppers, Nicholas Loxton, Tumi Mabogoane, Francois Malherbe, Eugenio Panieri, Shreya Rayamajhi, Tirsa van Wyngaard, Claire Warden, T E Madiba, Nivashen Pillay, Savannah Brooks, Charlise Kruger, Lisa Hannah Van Der Merwe, Ferhana Gool, Maahir Kariem, Heather Bougard, Nazmie Kariem, Fazlin Noor, Reantha Pillay, Leandi Steynfaardt, Lucía González González, José Miguel Marín Santos, Paula Martín-Borregón, Javier Martínez Caballero, Cristina Nevado García, Pastora Rodriguez Fraga, Gonzalo De Castro Parga, Maria Pilar Fernández Veiga, Lucía Garrido López, Hugo Infante Pino, Irene Lages Cal, Marta López Otero, Manuel Nogueira Sixto, Marta Paniagua García Señorans, Laura Rodríguez Fernández, Alejandro Ruano Poblador, Erika Rufo Crespo, Raquel Sanchez-Santos, Vincenzo Vigorita, Ester Alonso Batanero, Dorisme Asnel, Isabel Cifrian Canales, Elisa Contreras Saiz, Irene De Santiago Alvarez, Tamara Díaz Vico, Sebastian Fernandez Arias, Daniel Fernández Martínez, Carmen García Bernardo, Luis Joaquín García Flórez, Carmen Garcia Gutierrez, Manuel García Munar, Carlos Alberto Márquez Zorrilla Molina, Marta Merayo, José Luis Michi Campos, Maria Moreno Gijon, Jorge L. Otero-Diez, Jose Luis Rodicio Miravalles, Lorena Solar-Garcia, Aida Suárez Sánchez, Nuria Truan, Cristina Alejandre Villalobos, Yurena Caballero Díaz, Marta Jimenez, Dacil Montesdeoca, Antonio Navarro-Sánchez, Victor Vega, Juan Beltrán de Heredia, Zahira Gómez, Carlos Jezieniecki, Ana Patricia Legido Morán, Mario Montes-Manrique, Mario Rodriguez-Lopez, María Ruiz Soriano, Jeancarlos Trujillo Díaz, Andrea Vazquez Fernandez, Nuria Argudo, Miguel Pera, Laia Torrent Jansà, Melody García Domínguez, Ignacio Goded, Marta Roldón Golet, Issa Talal El-Abur, Alejandra Utrilla Fornals, Vanesa Zambrana Campos, Maria Del Mar Aguilar Martinez, Marina Bosch, Luis García-Catalá, Luis Sánchez-Guillén, Eva Artigau, Nuria Gomez Romeu, David Julià Bergkvist, Beatriz Espina Perez, Olga Morató, Carles Olona, Beatriz Diéguez, Alexander Forero-Torres, Manuel Losada, Segundo Gomez-Abril, Paula Gonzálvez, Rosario Martinez, Sergio Navarro Martínez, Carmen Payá-Llorente, Álvaro Pérez Rubio, Sandra Santarrufina Martinez, Juan Carlos Sebastián Tomás, Ramon Trullenque Juan, Alberto Gegúndez Simón, Paloma Maté, Maria Isabel Prieto-Nieto, Ines Rubio-Perez, Aitor Urbieta, Marina Vicario Bravo, David Abelló, Matteo Frasson, Alvaro Garcia-Granero, Alfredo Abad Gurumeta, Ane Abad-Motos, Elena Lucena-de Pablo, Beatriz Nozal, Javier Ripollés-Melchor, Rut Salvachúa, Esther Ferrero, Luis Garcia-Sancho Tellez, Antonio L. Picardo, Jose Alberto Rojo López, Laura Patricia Zorrilla Matilla, Carmen Cagigas Fernandez, Sonia Castanedo Bezanilla, José Estevez Tesouro, Maria Jose Fernandez-Diaz, Juan García Cardo, Marcos Gomez Ruiz, Erik Gonzalez-Tolaretxipi, Jaime Jimeno Fraile, Cristobal Poch, Montserrat Rodriguez-Aguirre, Noemí Troche Pesqueira, Maria Soledad Trugeda-Carrera, Javier de la Torre, Ruth Blanco-Colino, Eloy Espin-Basany, Martin Espinosa-Bravo, Clara Morales Comas, Eduardo Reyes Afonso, Joaquín Rivero Déniz, Christian Siso Raber, Mireia Verdaguer Tremolosa, Pramodh Chandrasinghe, Sumudu Kumarage, Nimeshi Wijekoon Arachchilage, Ahmed Abdalla Ahmed Elkamel, Mohammed A. Adam, Nina Blomme, Anders Thorell, Fredrik Wogensen, Andreas Älgå, Dhirar Ansarei, Fuat Celebioglu, Göran Heinius, Linda Nigard, Emil Pieniowski, Sandra Ahlqvist, Ida Björklund, Andreas Frånberg, Martina Håkansson, Karin Adamo, Oskar Franklin, Malin Sund, Rebecca Wiberg, Yvette Andersson, Abbas Chabok, Maziar Nikberg, Alexander Kugelberg, Claudia Canonica, Dimitrios Christoforidis, Fabrizio Fasolini, Paolo Gaffuri, Mauro Giuliani, Francesco Meani, Sotirios Georgios Popeskou, Silvia Pozza, Wiebke Wandschneider, Lorenz Peterer, Lukas Werner Widmer, Bernd Zimmermann, Panagiotis Bakoleas, Iris Chanousi, Lydia Charalampidou, Lukasz Filip Grochola, Franziska Heid, Sotirios Ntaoulas, Michail Outos, Georgios Peros, Hanna Podolska-Skoczek, Katharina Beate Reinisch, Christian Zielasek, Nicolas Demartines, Jérôme Gilgien, Amaniel Kefleyesus, Pénélope St-Amour, Arnaud Toussaint, Maryam Alhimyar, Bayan Alsaid, Amr Alyafi, Ahmad Alkhaledi, Basel Kouz, Ahmad Omarain, Yusra Al-Sabbagh, Haya Alkhatib, Samer Sara, Ahmad Alhaj, Aghyad Danial, Lama Kadoura, Sarah Maa Albared, Yamen Monawar, Louei Nahas, Barook Abd, Ahmad Saad, Habib Wakkaf, Hatem Bouzaiene, Montassar Ghalleb, Elif Akaydin, Ata Cem Akbaba, Onur Atakul, Ege Baltaci, Sevval Besli, Gökçen Burgu, Ulukan Cenal, Cansu de Muijnck, Hasan Can Demirkaya, Alper Dogruoz, Zeynep Ipek Gezer, Yasemin Gündogdu, Merve Kara, Hasan Kürsad Korkmaz, Gökalp Kagan Kurtoglu, Volkan Ozben, Berk Baris Ozmen, Ahmet Murat Pektas, Eda Kübra Sel, Nilüfer Yenidünya, Fuat Baris Bengur, Berke Mustafa Oral, Tahir Koray Yozgatli, Seymur Abdullayev, Mehmet Emin Gunes, Nuri Alper Sahbaz, Tuba Banaz, Kübra Kargici, Omer Faruk Kuyumcu, Erkan Yanikoglu, Merve Yesilsancak, Duygu Yilmaz, Melik Kagan Aktas, Ahmet Rencuzogullari, Arda Isik, Sezai Leventoglu, Ali Yalçinkaya, Osman Yüksel, Mustafa U Kalayci, Yasin Kara, Inanc Samil Sarici, Alp Akin, Gökçe nur Alemdag, Ekin Arslan, Bahadir Emre Baki, Muhammed Selim Bodur, Adnan Calik, Bahar Candas Altinbas, Irem Cihanyurdu, Oguz Erkul, Burak Gül, Ali Guner, Beyza Köse, Anil Semiz, Sule Sevim, Serkan Tayar, Kadir Tomas, Ozan yavuz Tüfek, Serdar Türkyilmaz, Mehmet Ulusahin, Arif Usta, Reyyan Yildirim, Sertaç Ata Güler, Ozan Can Tatar, Ecenur Varol, Busenur Kirimtay, Muhammed Uysal, Alp Yildiz, Emin Kose, Ahmet Burak Ciftci, Elif Çolak, Huseyin Eraslan, Gultekin Ozan Kucuk, Kürsat Yemez, Herman Lule, Mumbere Bienfait, Emmanuel Bua, Noella Okalany, Maksym Basarab, Oleksii Bielosludtsev, Kateryna Kolhanova, Kateryna Perepelytsia, Kateryna Romanukha, Dmytro Savenkov, Stanislav Siryi, Maksym Tereshchenko, Nezamai Viacheslav, Anton Volovetskyi, Andrey Kebkalo, Yegor Tryliskyy, Volodimir Tyselskiy, Eilidh Bruce, Bing Lun Chow, Emma Iddles, Sarah McGuckin, Nicola Newall, George Ramsay, Parivrudh Sharma, Caitlin Stewart, Jeremy Wong, Abdul Badran, Michael Bath, Fanny Belais, Eman Butt, Kaustuv Joshi, Milan Kapur, Mike Shaw, Adam Townson, Christopher Yee Khang Williams, Timothy Gray, Robert Greig, Mansoor Husain, Elspeth Murray, Ahmed Mustafa, Ashar Asif, Arya Gokul, Max Shah, Mabel Temisanren Akitikori, Alexandros Charalabopoulos, Sophie Davidson, Sinead McNally, Shamil Rupani, Fatema Juma, Sarah Catherine Mills, Laura Muirhead, Kate Sellars, Una Walsh, Oliver Warren, Alice Chambers, Richard Hunt, Stephen Boyce, Hannah Cornwall, Isabel Tol, Eleftherios Orestis Argyriou, Nicola Eardley, Meical Povey, Joanna M S Aithie, Ahmer Irfan, Mari-Claire McGuigan, Robert Starr, Craig Russell Warren, Jess Archibald, Georgia Kirby, Ivan Kisyov, Chun Kheng Khoo, Rachel Lee, Dana Photiou, Rowan Davis, Uday Prasad, P Zichu Yang, Jonathan Bird, Edmund Leung, Virginia Summerour, Chelise Currow, Jianshen Kiam, Gerald Jack Soon Tan, Anitha Muthusami, Ibifunke Pegba-Otemolu, Tomas Urbonas, Joseph Nunoo-Mensah, Edgaras Smolskas, Alex Boddy, Gianpiero Gravante, David Hunter, David Andrew, Amanda Koh, Amari Thompson, Lawrence Adams, Hollie A Clements, Kasun De Silva, Ogbonnia Ekpete, Seraj Haque, Scott Henderson, Bilal Ibrahim, Thummini Jayasinghe, Jennifer Livie, Keir Mailley, Gopikrishnan Nair, Daniel Tan, Caitlin Baggaley, Aleksander Dawidziuk, Bartosz Szyszka, Charlotte Barter, Nirav Gandhi, Karen Hassell, Samantha Hitchin, Jennett Kelsall, Eva Nagy, Ashrafun Nessa, Lisa Whisker, Fady Yanni, Mahmoud Ali, Deeksha Arora, Sunanda Hediwattege, Navam Kumarasinghe, Munir Rathore, Athula Tennakoon, Syed Mustafa Ali Ahmad, Oreoluwa Bajomo, Fahema Nadira, Valerio Celentano, Ewen Griffiths, Rama Santhosh Karri, Jason Kei Chak Mak, Michelle Pipe, Muhammad Iqbal Bhatti, Mohamed Rabie, Connor Boyle, David Hamilton, Aishath Mihuna, James Chean Khun Ng, Gary Nicholson, Agata Oliwa, Robert Pearson, Anna Rose, Shun Qi Yong, Catherine Boereboom, Michael Hanna, Catherine Walter, Thomas Samuel Greensmith, Rachel Mitchell, Eimear Monaghan, James Crawford, Susan Moug, James Blackwell, Hannah Boyd-Carson, Philip Herrod, Omar Al-Allaf, Miriam Beattie, Cameron Bullock, Shivang Burman, Gemma Clark, Nicolas Flamey, Oliver Flannery, Alexander Harding, Ben Kodiatt, Samuel Lawday, Shivani Mahapatra, Navin Mukundu Nagesh, Michael Ng, Dupinderjit Rye, Andrel Yoong, Laura Clark, Chris Deans, Monisha Edirisooriya, Emma Victoria Carrington, Tsz Lun Ernest Wong, Baasil Yusuf, Carla Chamberlain, Kathryn Duke, Elizabeth Kmiotek, Azel Botes, Natalie Condie, Timothy Schrire, Reena Shah, Iolo Thomas-Jones, Charlotte Yates, Natasha Anthony, Edward Matthews, Kapil Sahnan, James Tankel, Sally Tucker, Jasmine Winter Beatty, Paul Ziprin, William Duggan, Anastasia Kantartzi, Shruthi Sridhar, Rachel Alys Khaw, Prakhar Srivastava, Charlotte Underwood, Homero Alves do Canto Brum, Sharat Chopra, Laura Davis, Rebecca Hughes, Joshua Tulley, Justin Alberts, Thomas Athisayaraj, Mojolaoluwa Olugbemi, Kasim Ahmad, Claudia Chan, Gavin Chapman, Hannah Fleming, Benjamin Fox, Julia Grewar, Kate Hulse, Duncan Rutherford, Mackay Sinead, Scott Smith, Doug Speake, Peter G Vaughan-Shaw, Natasha Christodoulides, Simrit Kudhail, Matthew Welch, Syed Muhibullah Husaini, Simon Lambracos, Chikamuche Anyanwu, Rishi Suresh, Jimmy Scott Thomas, Elizabeth Gleeson, Rebecca Platoff, Areeba Saif, Zachary Enumah, Eric Etchill, Alodia Gabre-Kidan, Mitchell Bernstein, Francesco Maria Carrano, Joseph Connors, Patricio Lynn, Marcovalerio Melis, Elliot Newman, Deshka S Foster, Kenneth Perrone, Ashley Titan, Sarwat Ahmad, Andrea Chao M.D. Bafford, Marco Dal Molin, Nader Hanna, Syed Nabeel Zafar, Mark Hemmila, Lena Napolitano, Jane J Wong, Julia Chandler, Lauren Wood, Sherry Wren, Taylor Ottesen, Lucia You, Kristin Yu, María del pilar Arciénega Yañez, Martin Ferreira Fernandes, Daniel González, Santiago Cubas, María Catalina González, Vanessa Zubiaurre, Rodrigo Demolin, Nicolas Giroff, Pablo Sciuto, Maite Campos, Gabriela Rodríguez Cantera, Garg Deepika, Elliot Simuchimba, Anadi Bulaya, Chali Chibuye, Bright Chirengendure, Mary-Rose Kabale, Kizito Kabongo, James Munthali, Oliver Mweso, Francis Pikiti, James Otieno, Log Tung Lai, Brighid Blackman, Sophie Richards, Suren Subramaniam, Rafid Karim, Nathan Kok, Yanni Dion Lee, Shabina Ali, Aanjaneya Sinha, Robert Corrigan, Nicole Barnes, Florence Wong, Grace Dennis, Julia Jedamzik, Emil Phillips, Wivine Piette, Marie Van hentenryck, Houenoukpo Koco, Souliath Lawani, Mamo Woldu Kassa, Tainá Santos Bezerra, Petar Gribnev, Dobromir Dimitrov, Panche Krastev, Sovannarith Oum, Divine Tim Bonghaseh, Maryam Al Farsi, Nourah Alsharqawi, Veronica Acevedo, Andrea Carolina Castillo Barbosa, Felipe Giron, Jimmy Paul Leon Rodriguez, Darko Kucan, Damir Rosko, Neven Barsic, Domagoj Župan, Amgad Hegazi, Vendula Truncíková, Vladimir Fryba, Mostafa Mohamed, Ahmed Sultan, Ahmed Nagi, Abdallah Rashad Temerik, Mohamed Elemam Elshawy, Moustafa Ibrahim Mahmoud, Shrouk Omar, Mohamed Anwar, Tarek Rageh, Aya Elmokadem, Khaled Gaballa, Sandra Teppo, Antti Turunen, Pasi Pengermä, Quentin Ballouhey, Damien Bergeat, Ariane Weyl, Elisabeth Hain, Adam Gyedu, Edwin Yenli, Dorcas 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Castilla Moreno M.A., Genov G., Ilieva I., Ivanov T., Karamanliev M., Khan A., Mitkov E., Yotsov T., Atanasov B., Belev N., Slavchev M., Nsengiyumva C., Jones E., Stock S., Kyota S., Brown J., Mabanza K. T., Nigo Samuel L., Otuneme C., Prosper N., Umenze F., Boutros M., Caminsky N., Dumitra S., Garfinkle R., Morency D., Salama E., Banks A., Ferri L., He H., Katz A., Liberman A.S., Meterissian S., Pang A., Parvez E., Hameed U., Osman F., Sequeira S., Coburn N., Jaffer A., Karanicolas P., Mosseler M., Musselman R., Liu X., Yip C.W., Garces-Otero J.S., Guzman C., Sierra S., Uribe Valencia A., Cabrera Rivera P.A., Camelo S., Gonzalez A., Gonzalez-Orozco A., Mosquera Paz M.S., Perez Rivera C.J., Gonzalez F., Isaza-Restrepo A., Nino- Torres L., Arias Madrid N., Mendoza Arango M.C., Tsandiraki J., Jemendzic D., Kocman B., Suman O., Canic R., Jurisic D., Karakas I., Krizanovic Rupcic A., Pitlovic V., Samardzic J., Kopljar M., Bacic I., Domini E., Karlo R., Miljanic D., Simic A., Ahmed M., Al Nassrallah M., Altaf R., Amjad T., Eltoum R., Haidar H., Hassan A., Khalil O., Qasem M., Ramesh R., Sajith G., Wisal M., Zatecky J., Bujda M., Jirankova K., Paclik A., Abdallah A., Abdulgawad Almogy M., Ayman El-sawy E., ElFayoumy A.M., Elghareeb N., Esmat N.A., Fadel A., Habater A., Hamdy H., Hefni A., Kamal M., Mohamed Abobakr N., Sayed A., Shaker N., Taha E., Tharwat H., Zakaria O., Abdelmotaleb I., Al-Dhufri A., Al-Himyari H.S., El sheikh E., Eldmaty A., Elkhalawy A., M.Elkhashen A., Magdy K., Mostafa S., Sadia H.D., Saleh M.M., Samir D., Yahia Mohamed Ali M., A. Nassar M., Abdelhady S., Abdelrazek A., Abdelsalam I., El-Sawy A., Essam E., Gadelkarim M., Ghaly K., Hassabalnaby M., Masarani R., Mohamed Shaaban N., Sabry A., Salem M., Soliman N.A., Zahran D., Abou El.soud M.R., Badr E.T., Borham H., Elmeslemany N., Elsayed M., Elsherif F., Eslam S., Gaber G., Ibrahim S., Kamh Y., Mohamed S.G., Morshedy E., Omar C., Salem Soliman F., Abdelkawy S., Abdelmohsen N., Abdelshakour M., Dahy A., Gamal N., Gamal M., Hasan A., Hetta H., Mousa N., Omar M., Rabie S., Saad M., Saleh B., Sayed Mohamed M., Shawqi M., Abdelhady Mousa H., Alnoury M., Elbealawy M., Elshafey A., Essam Ibrahim El Desouki Muhammad Ahmed M., Ghonaim M., Hgag F., Ibrahim M., Morsy M., Reda Loaloa M., Refaat A., Samir H., Shahien F., Sobhy M., Sroor F., Abdellatif E., Adel M., Afifi A.A., Afifi E., Antaky M., Dawoud A., El Zoghby N., El-remaily A., Elzanfaly A.A., Gadallah A., Gamal F.A., Hashem O., Medhat Youssef S., Muhammad Attyah A., Munir M., Shazly O., Wilson K., Adel S., Ali A., 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S., Alherz M., Ather M., Bajilan M., Graziadei V., Pilkington I., Quidwai O., Ridgway P., Shiwani H., Tahir A.A.-R., Blunnie E., Burke D., Kennedy N., Macdonagh K., O'Neill M., Rooney S., Falco G., Ferrari G., Mele S., Nita G.E., Ugoletti L., Zizzo M., Confalonieri G., Pesenti G., Tagliabue F., Baronio G., Ongaro D., Pata G., Compagnoni B., Salvadori R., Taglietti L., D'Alessandro N., Di Lascio P., Pascale G., Bortolasi L., Campagnaro T., Carlini M., Lisi G., Lombardi D., Pedrazzani C., Spoletini D., Turri G., Violi P., Altomare D.F., Aquilino F., Musa N., Papagni V., Picciariello A., Vincenti L., Andreotti D., Occhionorelli S., Tondo M., Basso S.M.M., Cirelli R., Maino M.E.M., Piozzi G.N., Picone E., Scaramuzzo R., Sinibaldi G., Amendola A., Anastasio L., Bucci L., Caruso E., Castaldi A., Di Maso S., Dinuzzi V.P., Esposito G., Gaudiello M., Giglio M.C., Greco P.A., Luglio G., Manfreda A., Marra E., Mastella F., Pagano G., Peltrini R., Pepe V., Sacco M., Sollazzo V., Spiezio G., 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G., Morshedy, E., Omar, C., Salem Soliman, F., Abdelkawy, S., Abdelmohsen, N., Abdelshakour, M., Dahy, A., Gamal, N., Gamal, M., Hasan, A., Hetta, H., Mousa, N., Omar, M., Rabie, S., Saad, M., Saleh, B., Sayed Mohamed, M., Shawqi, M., Abdelhady Mousa, H., Alnoury, M., Elbealawy, M., Elshafey, A., Essam Ibrahim El Desouki Muhammad Ahmed, M., Ghonaim, M., Hgag, F., Ibrahim, M., Morsy, M., Reda Loaloa, M., Refaat, A., Samir, H., Shahien, F., Sobhy, M., Sroor, F., Abdellatif, E., Adel, M., Afifi, A. A., Afifi, E., Antaky, M., Dawoud, A., El Zoghby, N., El-remaily, A., Elzanfaly, A. A., Gadallah, A., Gamal, F. A., Hashem, O., Medhat Youssef, S., Muhammad Attyah, A., Munir, M., Shazly, O., Wilson, K., Adel, S., Ali, A., Eid, E., Elhelow, E., Elmahdy, M., Elshatby, B., Hossam el-din Zakaria, A., Hossny, A., Ibrahim, E., M. 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G., Hussein, M., Kandil, A. A., Moawad, M., Nasser Hamamah, A. A., Soliman, M., Abdelkhalek, M., Abdelmaksoud Tawakel, N., Abdelwahed, A. M., Abdou, A., Atallah, K., Elsherbeny, M. Y., Emara, E., Hamdy, M., Hamdy, O., Haron, A., Ismail, S., Metwally, I. H., Mohamed Hamed Elgaml, N., Nassar, A., Refky, B., Sadek, M., Saleh, M., Yunes, A., Zakaria, M., Zuhdy, M., Fayed, N., Mohammed, M. M. H., Kutner, S., Melnik, P., Seire, I., Umarik, T., Ainoa, E., Eerola, V., Koppatz, H., Koskenvuo, L., Sallinen, V., Takala, S., Katunin, J., Turunen, A., Christou, N., Mathonnet, M., Lavoue, V., Nyangoh Timoh, K., Soulabaille, L., Lesourd, R., Merdrignac, A., Sulpice, L., Andre, B., Chantalat, E., Vaysse, C., Dousset, B., Gaujoux, S., Martin, G., Clonda, O., Juodis, D., Kienle, K., Mravik, A., Palmer, S., Szabadhegyi, G., Agbeko, A. E., Gyabaah, S., Gyamfi, F. E., Naabo, N., Owusu senior, A., Yorke, J., Owusu, F., Abantanga, F., Anyomih, T. T. K., Muntaka, A. -J. M., Owusu Abem, E., Sheriff, M., Wondoh, P. M., Balalis, D., Korkolis, D., Gkiokas, G., Pantiora, E., Theodosopoulos, T., Ioannidis, A., Konstantinidis, K., Konstantinidou, S., Machairas, N., Paspala, A., Prodromidou, A., Chouliaras, C., Papadopoulos, K., Baloyiannis, I., Mamaloudis, I., Tzovaras, G., Akrida, I., Argentou, M. -I., Germanos, S., Iliopoulos, E., Maroulis, I., Skroubis, G., Theofanis, G., Chatzakis, C., Ioannidis, O., Loutzidou, L., Karathanasis, P., Michalopoulos, N., Theodoropoulos, C., Theodorou, D., Triantafyllou, T., Garoufalia, Z., Hasemaki, N., Kontos, M., Kouraklis, G., Kykalos, S., Liakakos, T., Mpaili, E., Papalampros, A., Schizas, D., Syllaios, A., Tampaki, E. C., Tsimpoukelis, A., Antonopoulou, M. I., Deskou, E., Manatakis, D. K., Papageorgiou, D., Zoulamoglou, M., Anthoulakis, C., Margaritis, M., Nikoloudis, N., Campo, V., Ceballos, A., Flores, M. -A., Giron, W., Ko, D., Martinez, G., Rivera Lara, V., Rueda, N., Sanchez, A., Tejeda Garrido, J. C. 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M., Rodriguez Gonzalez, A., Chachaima Mar, J. E., Chinchihualpa Paredes, N. O., Cuba, V., Lopez, W., Niquen Jimenez, M. M., Sanchez Bartra, N. A., Sapallanay Ojeda, O., Sequeiros, D., Toscano Pacheco, A., Vergara, M., Abarca, S., Alcorta, R., Borda-Luque, G., Eusebio Zegarra, I. E., Lujan Lopez, C., Marrufo, M., Mogrovejo, C., Nomura, A., Rodriguez Angeles, Y., Vidal Meza, M. R., Zavala, G., Castillo Arrascue, J. N., Hidrogo Cabrera, J. C., Larrea vera, J. J. M., Osorio, M., Ylatoma Diaz, E. A., Fontanilla, M. A., Fuentes, J. R., Salazar, A. L., Dominguez, G., Lopez, M. P., Macalindong, S., Onglao, M. A., Ramirez, A., Sacdalan, M. D., Tampo, M. M., Uy, G. L., Mangahas, J., Yabut, K., Canete, J. P., Cansana, B. E., Castro, E. J., Lipana, M. K., Roxas, M. F., Zara, V. 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P., Cagigas Fernandez, C., Castanedo Bezanilla, S., Estevez Tesouro, J., Fernandez-Diaz, M. J., Garcia Cardo, J., Gomez Ruiz, M., Gonzalez-Tolaretxipi, E., Jimeno Fraile, J., Poch, C., Rodriguez-Aguirre, M., Troche Pesqueira, N., Trugeda-Carrera, M. S., de la Torre, J., Blanco-Colino, R., Espin-Basany, E., Espinosa-Bravo, M., Morales Comas, C., Reyes Afonso, E., Rivero Deniz, J., Siso Raber, C., Verdaguer Tremolosa, M., Chandrasinghe, P., Kumarage, S., Wijekoon Arachchilage, N., Abdalla Ahmed Elkamel, A., A. Adam, M., Blomme, N., Thorell, A., Wogensen, F., Alga, A., Ansarei, D., Celebioglu, F., Heinius, G., Nigard, L., Pieniowski, E., Ahlqvist, S., Bjorklund, I., Franberg, A., Hakansson, M., Adamo, K., Franklin, O., Sund, M., Wiberg, R., Andersson, Y., Chabok, A., Nikberg, M., Kugelberg, A., Canonica, C., Christoforidis, D., Fasolini, F., Gaffuri, P., Giuliani, M., Meani, F., Popeskou, S. G., Pozza, S., Wandschneider, W., Peterer, L., Widmer, L. 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Akram, Zahran, Diaaaldin, Abou El Soud, Moustafa Ramadan, Badr, Esraa Tarek, Borham, Hala, Elmeslemany, Nehal, Elsayed, Mohammad, Elsherif, Fawzia, Eslam, Sara, Gaber, Gehad, Ibrahim, Sondos, Kamh, Yara, Mahmoud, Abdelrahman, Mohamed, Shimaa Gamal, Morshedy, Eman, Omar, Cinderella, Salem Soliman, Fatima, Abdelkawy, Shaza, Abdelmohsen, Naglaa, Abdelshakour, Mahmoud, Dahy, Ahmed, Gamal, Norhan, Gamal, Mohammed, Hasan, Ahmad, Hetta, Helal, Mousa, Nehad, Omar, Mohamed, Rabie, Somia, Saad, Mahmoud, Saleh, Bakeer, Sayed Mohamed, Marwa, Shawqi, Muhammad, Abdelhady Mousa, Heba, Alnoury, Mostafa, Elbealawy, Mohamed, Elshafey, Ahmed, Essam Ibrahim El Desouki Muhammad Ahmed, Muhammad, Ghonaim, Mennatullah, Hgag, Fawzy, Ibrahim, Mohamed, Morsy, Mahmoud, Reda Loaloa, Mohamed, Refaat, Ahmed, Samir, Hadeer, Shahien, Fatma, Sobhy, Mohamed, Sroor, Fathy, Abdellatif, Esraa, Adel, Marina, Afifi, Amr Abdelghani, Afifi, Eman, Antaky, Marco, Dawoud, Amr, El Zoghby, Naira, El-Remaily, Amira, Elzanfaly, Ali Abdelazez, Gadallah, Ahmed, Gamal, Fatma Alzahraa, Hashem, Omar, Medhat Youssef, Shrouk, Muhammad Attyah, Aliaa, Munir, Malak, Shazly, Omar, Taha, Esraa, Wilson, Karim, Adel, Sawsan, Ali, Asmaa, Eid, Esraa, Elhelow, Esraa, Elmahdy, Marwa, Elshatby, Bassant, Hossam El-Din Zakaria, Amany, Hossny, Ahmad, Ibrahim, Eman, M Yonis, Ahmed, Metwalli, Maram, Yousry, Basant, Zid, Esraa, A Yacoub, Mina, Abdelhakim, Ahmed, Abouelsoad, Nervana, Alkhatib, Mo'min, Ashraf, Ahmed, Ashraf, Alaa, Elazab, Yasmin, Elfanty, Mahmoud, Elkabir, Osama, Elsayed, Mai, Elshimy, Ahmed, Elsobky, Hager, Eskander, John, Gad, Ahmed, Hamsho, Ward, Khaled Abdelwahed, Noura, Magdy, Menna, Moharam, Dalia, Osama, Abeer, Ramadan, Shereen, Roum, Radwa, Sayed, Taqwa, Shehada, Tarneem, Zidan, Ahmed Mohy, Abbas, Khalid, Ali, Amr, Attia, Mohamed, Balata, Mohamed, El Nakeeb, Ayman, Elewaily, Mohamed Ibrahim Elsayed, Elfallal, Ahmed, Elfeki, Hossam, Elkhadragy, Ahmed, Emile, Sameh, Ezzat, Helmy, Hosni, Hasnaa, Mansour, Islam, Omar, 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Truncíková, Vendula, Fryba, Vladimir, Mohamed, Mostafa, Sultan, Ahmed, Nagi, Ahmed, Rashad Temerik, Abdallah, Elshawy, Mohamed Elemam, Mahmoud, Moustafa Ibrahim, Omar, Shrouk, Anwar, Mohamed, Rageh, Tarek, Elmokadem, Aya, Gaballa, Khaled, Teppo, Sandra, Turunen, Antti, Pengermä, Pasi, Ballouhey, Quentin, Bergeat, Damien, Weyl, Ariane, Hain, Elisabeth, Gyedu, Adam, Yenli, Edwin, Osei-Poku, Dorcas, Rompou, Vaia-Aliki, Zoikas, Athanasios, Gaitanidis, Apostolos, Koukis, Georgios, Perivoliotis, Konstantinos, Tavlas, Panagiotis, Galanos-Demiris, Konstantinos, Zografos, George, Karavokyros, Ioannis, Xanthopoulou, Georgia, Iordanidou, Eirini, Ayau, Fernanda, Garcia, Allan, Damján, Pekli, Wason, Deepender, B L, Ashika, Rangganata, Ervandy, Kamath, Prerna, O'Connor, Donal B, Pinto, Margherita, Perrone, Fabrizio, Tropeano, Francesca Paola, Troilo, Francesca, Bossi, Daniela, Scala, Dario, Pulitanò, Lucrezia, Carella, Marcella, Pietrabissa, Andrea, Gori, Alice, Giraudo, Giorgio, De Simone, Veronica, Russo, Alfio Alessandro, Braccio, Bartolomeo, Al-Taher, Raed, Athamneh, Sarah, Parker, Andrea, Sawiee, Adnan, Kattia, Amina, Salem, Malik, Tababa, Osama, Shaeeb, Zuhour, Syminas, Vilius, Jurgaitis, Jonas, Damuleviciene, Gyte, Svagzdys, Saulius, Poskus, Tomas, Razafimanjato, Narindra Njarasoa Mihaja, Chieng Loo, Ling, Tiong, Ing Ching, Wan Muhmad, Wan Farahiyah, Vijeyan, Harinthiran, Li Ying, Teoh, Grech, Gabriella, Arrangoiz, Rodrigo, Jimenez Ley, Vania Brickelia, Arizpe, Daniel, Lagunes Lara, Elizabeth, Castro López, Elizabeth Victoria, Eaazim, Jose, Gordinou de Gouberville, Marije, Bastiaenen, Vivian, Rottier, Simone, Nahab, Fouad, Ji, Maria Yeonhee, Seyoji, Mohammed, Nwachukwu, Callistus, Emeghara, Okechukwu, Muhammed, Sayyid Egbunu, Idowu, Ayodeji, Sowemimo, Olamiposi, Ogundoyin, Olakayode, Akande, Oluwatosin, Lott, Alexander, Nadeem, Maliha, Laghari, Ahsan Ali, Loya, Asif, Mushtaq, Hassan, Abdullah, Muhammad Tariq, Abuhilal, Baseel, Atawneh, Mohammad, Hamdan, Hamdan, Alhabil, Belal, Srour, Abedelrahman, Mousa, Ibrahim, Da Silva Medina, Luis, Bartosiak, Katarzyna, Ferreira, Pedro, Francisco, Vítor, Lemos, Ricardo, Frutuoso, Luísa, Fernandes, Sara, Fonseca, Telma, Pereira, Jorge, Rachadell, Juan, Torre, Ana, Madeira Martins, Filipe, Carvalho, Ana Cristina, Rodrigues Ferreira, Joana, Ribeiro da Silva, Bruno, Devesa, Helena, Vieira, Ana, Mónica, Inês, Amaro, Margarida, Sousa, Diogo, Reia, Marta, Louro, João, Martins, Ana, Dominguez, Joaquina, Santos, Inês, Freitas Oliveira, Nuno Miguel, Pereira, José Carlos, Silva-Vaz, Pedro, Freire, Ligia, Escrevente, Ricardo, Negoita, Valentina Madalina, Shakhmatov, Dmitry, Nezerwa, Yves, Radulovic, Radosav, Obery, Gareth, Viljoen, Francois, Mendes, Tome, Suarez, Antonio, Moncada, Enrique, Fernandez-Hevia, Maria, Curtis Martínez, Carolina, Gil Garcia, Julia Maria, González Zunzarren, Mariana, Idris, Tarig, Eklöv, Karolina, Grahn, Oskar, Amin, Leila, Blomqvist, Malin, Ajani, Costanza, Kraus, Rebecca, Seeger, Nico, Willemin, Melissa, Rayya, Fadi, Ayash, Mohammad, Msouti, Raneem, Kannas, Israa, Abazid, Eias, Esper, Asil, Slim, Skander, Kavcar, Akil Serdar, Aytac, Erman, Dural, Ahmet Cem, Ilker, Ayse, Eray, Ismail Cem, Kurnaz, Eray, Altiner, Saygin, Tepe, Mustafa Deniz, Sahin, Can, Savli, Evrim, Innocent, Aryon, Babirye, Lilian, Diachenko, Andrii, Hordoskiy, Vladislav, Curry, Heather, Chau, Charlene Yat Che, Robertson, Harry, Mahmoud, Arin, Lennon, Hannah, Loi, Lynette, Kirkham, Emily, McCann, Cameron, Watts, Daniel, Gurung, Binay, Wilson, Michael, Tribedi, Thomas, Garofalo, Eleonora, Zahra, Baryab, MacDonald, Scott, Daniels, Ian, Ng, Nathan, Khosla, Shivun, Olivier, James, Yue, Sum Yu Pansy, Suresh, Gayathri, Wellington, Jack, Lorejo, Emmanuel, Mossaad, Mafdi, Crutcher, Madison, Alimi, Marjan, Baiu, Ioana, Abdou, Hossam, Conway, Alison, Peck, Connor, Perdomo Perez, Mauro Andres, Zulu, Stanley, Nakazwe, Mildred, Burger, Sule, Davies, Justine, Donaldson, Rachel, Ede, Chikwendu, Garden, O James, Lesetedi, Chiapo, Mabedi, Charles, Magill, Laura, Makinde Alakaloko, Felix, Makupe, Alex, Monahan, Mark, Mulira, Soloman, Muller, Elmi, Musowoyo, Jospeh, Olory-Togbe, Jean Léon, Roberts, Tracey, Smith, Martin, Tayler, Viki, Windsor, John, Yepez, Raul, Sundar, Sudha, Runigamugabo, Emmy, Verjee, Azmina, Chen, José, Daya, Leonid, El Aroussi, Nouhaila, Farina, Valeria, Gnintedeme Olivier, Tchianze, Gonzales Nacarino, Mauricio, Hammani, Aamr, Honjo, Sarah, Jacobs, Rebecca, Kimura, Hitomi, Nkoronko, Mugisha, Oscullo Yepez, Jasson Javier, Pin Hung, Wei, Raj, Ankit, Romani Pozo, Alina, Rommaneh, Muna, Sassamela Fabiano, Samuel Chimbioputo, Shiroma Gago, Camila Milagros, Srinivas, Abhishekh, Sung, Chia-Yen, Tai, Aswan, Valle Aranda, Yener Cristyell, Venturini, Sara, and Wilguens Lartigue, Jean

Subjects
Pediatrics, Colorectal cancer, IMPACT, Disease, Colorectal Neoplasm, 030204 cardiovascular system & hematology, Cancer, surgery, postoperative mortality, 0302 clinical medicine, Postoperative Complications, Global health, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, General Medicine, DISEASES, Income, cancer surgery, Colorectal Neoplasms, Breast Neoplasm, Cohort study, Human, Adult, Developed Countrie, medicine.medical_specialty, Global surgery, General surgery, International multicentre study, Cancer surgery, Breast Neoplasms, Department of Error, NO, Developing Countrie, 03 medical and health sciences, Breast cancer, Stomach Neoplasms, medicine, Humans, Developing Countries, Neoplasm Staging, business.industry, Developed Countries, Odds ratio, CARE, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, Prospective Studie, Postoperative Complication, business
Abstract

80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit.

Published
2021

37. Pregnancy Outcomes in Women After Arterial Switch Operation for Transposition of the Great Arteries: Results From ROPAC (Registry of Pregnancy and Cardiac Disease) of the European Society of Cardiology EURObservational Research Programme

Author

Oktay Tutarel, Karishma P. Ramlakhan, Lucia Baris, Maria T. Subirana, Judith Bouchardy, Attila Nemes, Niels G. Vejlstrup, Olga A. Osipova, Mark R. Johnson, Roger Hall, Jolien W. Roos‐Hesselink, Christopher Peter Gale, Branko Beleslin, Andrzej Budaj, Ovidiu Chioncel, Nikolaos Dagres, Nicolas Danchin, David Erlinge, Jonathan Emberson, Michael Glikson, Alastair Gray, Meral Kayikcioglu, Aldo Maggioni, Klaudia Vivien Nagy, Aleksandr Nedoshivin, Anna‐Sonia Petronio, Jolien Roos‐Hesselink, Lars Wallentin, Uwe Zeymer, Joerg Stein, William Anthony Parsonage, Werner Budts, Julie De Backer, Jasmin Grewal, Ariane Marelli, Harald Kaemmerer, Guillaume Jondeau, Mark Johnson, Aldo P. Maggioni, Luigi Tavazzi, Ulf Thilen, Uri Elkayam, Catherine Otto, Karen Sliwa, A. Aquieri, A. Saad, H. Ruda Vega, J. Hojman, J. M. Caparros, M. Vazquez Blanco, M. Arstall, C. M. Chung, G. Mahadavan, E. Aldridge, M. Wittwer, Y. Y. Chow, W. A. Parsonage, K. Lust, N. Collins, G. Warner, R. Hatton, A. Gordon, E. Nyman, J. Stein, E. Donhauser, H. Gabriel, A. Bahshaliyev, F. Guliyev, I. Hasanova, T. Jahangirov, Z. Gasimov, A. Salim, C. M. Ahmed, F. Begum, M. H. Hoque, M. Mahmood, M. N. Islam, P. P. Haque, S. K. Banerjee, T. Parveen, M. Morissens, J. De Backer, L. Demulier, M. de Hosson, W. Budts, M. Beckx, M. Kozic, M. Lovric, T. Kovacevic‐Preradovic, N. Chilingirova, P. Kratunkov, N. Wahab, S. McLean, E. Gordon, L. Walter, A. Marelli, A. R. Montesclaros, G. Monsalve, C. Rodriguez, F. Balthazar, V. Quintero, W. Palacio, L. A. Mejía Cadavid, E. Munoz Ortiz, F. Fortich Hoyos, E. Arevalo Guerrero, J. Gandara Ricardo, J. Velasquez Penagos, Z. Vavera, J. Popelova, N. Vejlstrup, L. Grønbeck, M. Johansen, A. Ersboll, Y. Elrakshy, K. Eltamawy, M. Gamal Abd‐El Aziz, A. El Nagar, H. Ebaid, H. Abo Elenin, M. Saed, S. Farag, W. Makled, K. Sorour, Z. Ashour, G. El‐Sayed, M. Abdel Meguid Mahdy, N. Taha, A. Dardeer, M. Shabaan, M. Ali, P. Moceri, G. Duthoit, M. Gouton, J. Nizard, L. Baris, S. Cohen, M. Ladouceur, D. Khimoud, B. Iung, F. Berger, A. Olsson, U. Gembruch, W. M. Merz, E. Reinert, S. Clade, Y. Kliesch, C. Wald, C. Sinning, R. Kozlik‐Feldmann, S. Blankenberg, E. Zengin‐Sahm, G. Mueller, M. Hillebrand, P. Hauck, Y. von Kodolitsch, N. Zarniko, H. Baumgartner, R. Schmidt, A. Hellige, O. Tutarel, H. Kaemmerer, B. Kuschel, N. Nagdyman, R. Motz, D. Maisuradze, A. Frogoudaki, E. Iliodromitis, M. Anastasiou‐Nana, D. Triantafyllis, G. Bekiaris, H. Karvounis, G. Giannakoulas, D. Ntiloudi, S. A. Mouratoglou, A. Temesvari, H. Balint, D. Kohalmi, B. Merkely, C. Liptai, A. Nemes, T. Forster, A. Kalapos, K. Berek, K. Havasi, N. Ambrus, A. Shelke, R. Kawade, S. Patil, E. Martanto, T. M. Aprami, A. Purnomowati, C. J. Cool, M. Hasan, R. Akbar, S. Hidayat, T. I. Dewi, W. Permadi, D. A. Soedarsono, M. M. Ansari‐Ramandi, N. Samiei, A. Tabib, F. Kashfi, S. Ansari‐Ramandi, S. Rezaei, H. Ali Farhan, A. Al‐Hussein, G. Al‐Saedi, G. Mahmood, I. F. Yaseen, L. Al‐Yousuf, M. AlBayati, S. Mahmood, S. Raheem, T. AlHaidari, Z. Dakhil, P. Thornton, J. Donnelly, M. Bowen, A. Blatt, G. Elbaz‐Greener, A. Shotan, S. Yalonetsky, S. Goland, M. Biener, G. Egidy Assenza, M. Bonvicini, A. Donti, A. Bulgarelli, D. Prandstraller, C. Romeo, R. Crepaz, E. Sciatti, M. Metra, R. Orabona, L. Ait Ali, P. Festa, V. Fesslova, C. Bonanomi, M. Calcagnino, F. Lombardi, null Colli, M. W. Ossola, C. Gobbi, E. Gherbesi, L. Tondi, M. Schiavone, M. Squillace, M. G. Carmina, A. Maina, C. Macchi, E. Gollo, F. M. Comoglio, N. Montali, P. Re, R. Bordese, T. Todros, V. Donvito, W. Grosso Marra, G. Sinagra, B. D'Agata Mottolese, M. Bobbo, V. Gesuete, S. Rakar, F. Ramani, K. Niwa, D. Mekebekova, A. Mussagaliyeva, T. Lee, E. Mirrakhimov, S. Abilova, E. Bektasheva, K. Neronova, O. Lunegova, R. Žaliūnas, R. Jonkaitienė, J. Petrauskaitė, A. Laucevicius, D. Jancauskaite, L. Lauciuviene, L. Gumbiene, L. Lankutiene, S. Glaveckaite, M. Laukyte, S. Solovjova, V Rudiene, K. H. Chee, C. C.‐W. Yim, H. L. Ang, R. Kuppusamy, T. Watson, M. Caruana, M.‐E. Estensen, M. G. A. Mahmood Kayani, R. Munir, A. Tomaszuk‐Kazberuk, B. Sobkowicz, J. Przepiesc, A. Lesniak‐Sobelga, L. Tomkiewicz‐Pajak, M. Komar, M. Olszowska, P. Podolec, S. Wisniowska‐Smialek, M. Lelonek, U. Faflik, A. Cichocka‐Radwan, K. Plaskota, O. Trojnarska, N. Guerra, L. de Sousa, C. Cruz, V. Ribeiro, S. Jovanova, V. Petrescu, R. Jurcut, C. Ginghina, I. Mircea Coman, M. Musteata, O. Osipova, T. Golivets, I. Khamnagadaev, O. Golovchenko, A. Nagibina, I. Ropatko, I. R. Gaisin, L. Valeryevna Shilina, N. Sharashkina, E. Shlyakhto, O. Irtyuga, O. Moiseeva, E. Karelkina, I. Zazerskaya, A. Kozlenok, I. Sukhova, L. Jovovic, K. Prokšelj, M. Koželj, A. O. Askar, A. A. Abdilaahi, M. H. Mohamed, A. M. Dirir, K. Sliwa, P. Manga, A. Pijuan‐Domenech, L. Galian‐Gay, P. Tornos, M. T. Subirana, N. Murga, J. M. Oliver, B. Garcia‐Aranda Dominguez, I. Hernandez Gonzalez, J. F. Delgado Jimenez, P. Escribano Subias, A. Elbushi, A. Suliman, K. Jazzar, M. Murtada, N. Ahamed, M. Dellborg, E. Furenas, M. Jinesjo, K. Skoglund, P. Eriksson, T. Gilljam, U. Thilen, D. Tobler, K. Wustmann, F. Schwitz, M. Schwerzmann, T. Rutz, J. Bouchardy, M. Greutmann, B. M. Santos Lopes, L. Meier, M. Arrigo, K. de Boer, T. Konings, E. Wajon, L. J. Wagenaar, P. Polak, E. P. G. Pieper, J. Roos‐Hesselink, I. van Hagen, H. Duvekot, J. M. J. Cornette, C. De Groot, C. van Oppen, L. Sarac, O. Batukan Esen, S. Catirli Enar, C. Mondo, P. Ingabire, B. Nalwanga, T. Semu, B. T. Salih, W. A. R. Almahmeed, S. Wani, F. S. Mohamed Farook, Al Ain, F. Gerges, A. M. Komaranchath, F. Al bakshi, A. Al Mulla, A. H. Yusufali, E. I. Al Hatou, N. Bazargani, F. Hussain, L. Hudsmith, P. Thompson, S. Thorne, S. Bowater, A. Money‐Kyrle, P. Clifford, P. Ramrakha, S. Firoozan, J. Chaplin, N. Bowers, D. Adamson, F. Schroeder, R. Wendler, S. Hammond, P. Nihoyannopoulos, R. Hall, L. Freeman, G. Veldtman, J. Kerr, L. Tellett, N. Scott, A. B. Bhatt, D. DeFaria Yeh, M. A. Youniss, M. Wood, A. A. Sarma, S. Tsiaras, A. Stefanescu, J. M. Duran, L. Stone, D. S. Majdalany, J. Chapa, K. Chintala, P. Gupta, J. Botti, J. Ting, W. R. Davidson, G. Wells, D. Sparks, V. Paruchuri, K. Marzo, D. Patel, W. Wagner, S. N. Ahanya, L. Colicchia, T. Jentink, K. Han, M. Loichinger, M. Parker, C. Longtin, A. Yetman, K. Erickson, J. Cramer, S. Tsai, B. Fletcher, S. Warta, C. Cohen, C. Lindblade, R. Puntel, K. Nagaran, N. Croft, M. Gurvitz, C. Otto, C. Talluto, D. Murphy, M. G. Perlroth, ROPAC (Registry of Pregnancy and Cardiac Disease) Investigators Group, Gale, C.P., Beleslin, B., Budaj, A., Chioncel, O., Dagres, N., Danchin, N., Erlinge, D., Emberson, J., Glikson, M., Gray, A., Kayikcioglu, M., Maggioni, A., Nagy, K.V., Nedoshivin, A., Petronio, A.S., Roos-Hesselink, J., Wallentin, L., Zeymer, U., Hall, R., Stein, J., Parsonage, W.A., Budts, W., De Backer, J., Grewal, J., Marelli, A., Kaemmerer, H., Jondeau, G., Johnson, M., Maggioni, A.P., Tavazzi, L., Thilen, U., Elkayam, U., Otto, C., Sliwa, K., Aquieri, A., Saad, A., Ruda Vega, H., Hojman, J., Caparros, J.M., Vazquez Blanco, M., Arstall, M., Chung, C.M., Mahadavan, G., Aldridge, E., Wittwer, M., Chow, Y.Y., Lust, K., Collins, N., Warner, G., Hatton, R., Gordon, A., Nyman, E., Donhauser, E., Gabriel, H., Bahshaliyev, A., Guliyev, F., Hasanova, I., Jahangirov, T., Gasimov, Z., Salim, A., Ahmed, C.M., Begum, F., Hoque, M.H., Mahmood, M., Islam, M.N., Haque, P.P., Banerjee, S.K., Parveen, T., Morissens, M., Demulier, L., de Hosson, M., Beckx, M., Kozic, M., Lovric, M., Kovacevic-Preradovic, T., Chilingirova, N., Kratunkov, P., Wahab, N., McLean, S., Gordon, E., Walter, L., Montesclaros, A.R., Monsalve, G., Rodriguez, C., Balthazar, F., Quintero, V., Palacio, W., Mejía Cadavid, L.A., Munoz Ortiz, E., Fortich Hoyos, F., Arevalo Guerrero, E., Gandara Ricardo, J., Velasquez Penagos, J., Vavera, Z., Popelova, J., Vejlstrup, N., Grønbeck, L., Johansen, M., Ersboll, A., Elrakshy, Y., Eltamawy, K., Gamal Abd-El Aziz, M., El Nagar, A., Ebaid, H., Abo Elenin, H., Saed, M., Farag, S., Makled, W., Sorour, K., Ashour, Z., El-Sayed, G., Abdel Meguid Mahdy, M., Taha, N., Dardeer, A., Shabaan, M., Ali, M., Moceri, P., Duthoit, G., Gouton, M., Nizard, J., Baris, L., Cohen, S., Ladouceur, M., Khimoud, D., Iung, B., Berger, F., Olsson, A., Gembruch, U., Merz, W.M., Reinert, E., Clade, S., Kliesch, Y., Wald, C., Sinning, C., Kozlik-Feldmann, R., Blankenberg, S., Zengin-Sahm, E., Mueller, G., Hillebrand, M., Hauck, P., von Kodolitsch, Y., Zarniko, N., Baumgartner, H., Schmidt, R., Hellige, A., Tutarel, O., Kuschel, B., Nagdyman, N., Motz, R., Maisuradze, D., Frogoudaki, A., Iliodromitis, E., Anastasiou-Nana, M., Triantafyllis, D., Bekiaris, G., Karvounis, H., Giannakoulas, G., Ntiloudi, D., Mouratoglou, S.A., Temesvari, A., Balint, H., Kohalmi, D., Merkely, B., Liptai, C., Nemes, A., Forster, T., Kalapos, A., Berek, K., Havasi, K., Ambrus, N., Shelke, A., Kawade, R., Patil, S., Martanto, E., Aprami, T.M., Purnomowati, A., Cool, C.J., Hasan, M., Akbar, R., Hidayat, S., Dewi, T.I., Permadi, W., Soedarsono, D.A., Ansari-Ramandi, M.M., Samiei, N., Tabib, A., Kashfi, F., Ansari-Ramandi, S., Rezaei, S., Ali Farhan, H., Al-Hussein, A., Al-Saedi, G., Mahmood, G., Yaseen, I.F., Al-Yousuf, L., AlBayati, M., Mahmood, S., Raheem, S., AlHaidari, T., Dakhil, Z., Thornton, P., Donnelly, J., Bowen, M., Blatt, A., Elbaz-Greener, G., Shotan, A., Yalonetsky, S., Goland, S., Biener, M., Egidy Assenza, G., Bonvicini, M., Donti, A., Bulgarelli, A., Prandstraller, D., Romeo, C., Crepaz, R., Sciatti, E., Metra, M., Orabona, R., Ait Ali, L., Festa, P., Fesslova, V., Bonanomi, C., Calcagnino, M., Lombardi, F., Colli, C., Ossola, M.W., Gobbi, C., Gherbesi, E., Tondi, L., Schiavone, M., Squillace, M., Carmina, M.G., Maina, A., Macchi, C., Gollo, E., Comoglio, F.M., Montali, N., Re, P., Bordese, R., Todros, T., Donvito, V., Grosso Marra, W., Sinagra, G., D'Agata Mottolese, B., Bobbo, M., Gesuete, V., Rakar, S., Ramani, F., Niwa, K., Mekebekova, D., Mussagaliyeva, A., Lee, T., Mirrakhimov, E., Abilova, S., Bektasheva, E., Neronova, K., Lunegova, O., Žaliūnas, R., Jonkaitienė, R., Petrauskaitė, J., Laucevicius, A., Jancauskaite, D., Lauciuviene, L., Gumbiene, L., Lankutiene, L., Glaveckaite, S., Laukyte, M., Solovjova, S., Rudiene, V., Chee, K.H., Yim, C.C., Ang, H.L., Kuppusamy, R., Watson, T., Caruana, M., Estensen, M.E., Mahmood Kayani, MGA, Munir, R., Tomaszuk-Kazberuk, A., Sobkowicz, B., Przepiesc, J., Lesniak-Sobelga, A., Tomkiewicz-Pajak, L., Komar, M., Olszowska, M., Podolec, P., Wisniowska-Smialek, S., Lelonek, M., Faflik, U., Cichocka-Radwan, A., Plaskota, K., Trojnarska, O., Guerra, N., de Sousa, L., Cruz, C., Ribeiro, V., Jovanova, S., Petrescu, V., Jurcut, R., Ginghina, C., Mircea Coman, I., Musteata, M., Osipova, O., Golivets, T., Khamnagadaev, I., Golovchenko, O., Nagibina, A., Ropatko, I., Gaisin, I.R., Valeryevna Shilina, L., Sharashkina, N., Shlyakhto, E., Irtyuga, O., Moiseeva, O., Karelkina, E., Zazerskaya, I., Kozlenok, A., Sukhova, I., Jovovic, L., Prokšelj, K., Koželj, M., Askar, A.O., Abdilaahi, A.A., Mohamed, M.H., Dirir, A.M., Manga, P., Pijuan-Domenech, A., Galian-Gay, L., Tornos, P., Subirana, M.T., Murga, N., Oliver, J.M., Garcia-Aranda Dominguez, B., Hernandez Gonzalez, I., Delgado Jimenez, J.F., Escribano Subias, P., Elbushi, A., Suliman, A., Jazzar, K., Murtada, M., Ahamed, N., Dellborg, M., Furenas, E., Jinesjo, M., Skoglund, K., Eriksson, P., Gilljam, T., Tobler, D., Wustmann, K., Schwitz, F., Schwerzmann, M., Rutz, T., Bouchardy, J., Greutmann, M., Santos Lopes, B.M., Meier, L., Arrigo, M., de Boer, K., Konings, T., Wajon, E., Wagenaar, L.J., Polak, P., Pieper, EPG, van Hagen, I., Duvekot, H., Cornette, JMJ, De Groot, C., van Oppen, C., Sarac, L., Batukan Esen, O., Catirli Enar, S., Mondo, C., Ingabire, P., Nalwanga, B., Semu, T., Salih, B.T., Almahmeed, WAR, Wani, S., Mohamed Farook, F.S., Ain, A., Gerges, F., Komaranchath, A.M., Al Bakshi, F., Al Mulla, A., Yusufali, A.H., Al Hatou, E.I., Bazargani, N., Hussain, F., Hudsmith, L., Thompson, P., Thorne, S., Bowater, S., Money-Kyrle, A., Clifford, P., Ramrakha, P., Firoozan, S., Chaplin, J., Bowers, N., Adamson, D., Schroeder, F., Wendler, R., Hammond, S., Nihoyannopoulos, P., Freeman, L., Veldtman, G., Kerr, J., Tellett, L., Scott, N., Bhatt, A.B., DeFaria Yeh, D., Youniss, M.A., Wood, M., Sarma, A.A., Tsiaras, S., Stefanescu, A., Duran, J.M., Stone, L., Majdalany, D.S., Chapa, J., Chintala, K., Gupta, P., Botti, J., Ting, J., Davidson, W.R., Wells, G., Sparks, D., Paruchuri, V., Marzo, K., Patel, D., Wagner, W., Ahanya, S.N., Colicchia, L., Jentink, T., Han, K., Loichinger, M., Parker, M., Longtin, C., Yetman, A., Erickson, K., Cramer, J., Tsai, S., Fletcher, B., Warta, S., Cohen, C., Lindblade, C., Puntel, R., Nagaran, K., Croft, N., Gurvitz, M., Talluto, C., Murphy, D., Perlroth, M.G., Neurosurgery, Pediatrics, Cardiology, ACS - Heart failure & arrhythmias, Obstetrics and gynaecology, Amsterdam Reproduction & Development (AR&D), Institut Català de la Salut, [Tutarel O] Department of Congenital Heart Disease and Paediatric Cardiology German Heart Centre MunichTechnical University of Munich School of MedicineTechnical University of Munich Germany. DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany. [Ramlakhan KP, Baris L] Department of Cardiology Erasmus University Medical Center Rotterdam the Netherlands. [Subirana MT] Unitat de Cardiopaties congènites de l’adult, Vall d'Hebron Hospital Universitari, Barcelona Spain. Hospital Sant Pau, Barcelona Spain. [Bouchardy J] Service of Cardiology University Hospital Lausanne and University of Lausanne Switzerland. Service of Cardiology University of Geneva Switzerland. [Nemes A] 2nd Department of Medicine and Cardiology Centre Medical Faculty Albert Szent-Györgyi Clinical Center University of Szeged Hungary, Szeged, Hungary, and Vall d'Hebron Barcelona Hospital Campus

Subjects
Male, Transposition of Great Vessels, pregnancy outcomes, enfermedades cardiovasculares::anomalías cardiovasculares::cardiopatías congénitas::transposición de los grandes vasos [ENFERMEDADES], Disease, 030204 cardiovascular system & hematology, Sistema cardiovascular - Malalties, Ventricular tachycardia, Vasos sanguinis - Cirurgia, 0302 clinical medicine, Pregnancy, Clinical endpoint, Registries, 030212 general & internal medicine, Cardiovascular Diseases::Pregnancy Complications, Cardiovascular [DISEASES], Original Research, Aortic dissection, Pregnancy Outcome, Congenital Heart Disease, Other subheadings::Other subheadings::/surgery [Other subheadings], arterial switch operation, pregnancy and cardiac disease, transposition of the great arteries, Europe, Great arteries, Cardiology, enfermedades cardiovasculares::complicaciones cardiovasculares del embarazo [ENFERMEDADES], Female, Maternal death, Cardiology and Cardiovascular Medicine, Adult, medicine.medical_specialty, diagnóstico::pronóstico::resultado del embarazo [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Pregnancy Complications, Cardiovascular, Embaràs - Complicacions, Cardiovascular Diseases::Cardiovascular Abnormalities::Heart Defects, Congenital::Transposition of Great Vessels [DISEASES], Risk Assessment, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Internal medicine, medicine, Humans, Heart Failure, business.industry, Infant, Newborn, Otros calificadores::Otros calificadores::/cirugía [Otros calificadores], Diagnosis::Prognosis::Pregnancy Outcome [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], medicine.disease, Arterial Switch Operation, Heart failure, Tachycardia, Ventricular, business
Abstract

Embaràs i malaltia cardíaca; Resultats de l’embaràs; Transposició de les grans artèries Embarazo y enfermedad cardíaca; Resultados del embarazo; Transposición de las grandes arterias Pregnancy and cardiac disease; Pregnancy outcomes, Transposition of the great arteries Background In the past 3 decades, the arterial switch procedure has replaced the atrial switch procedure as treatment of choice for transposition of the great arteries. Although survival is superior after the arterial switch procedure, data on pregnancy outcomes are scarce and transposition of the great arteries after arterial switch is not yet included in the modified World Health Organization classification of maternal cardiovascular risk. Methods and Results The ROPAC (Registry of Pregnancy and Cardiac disease) is an international prospective registry of pregnant women with cardiac disease, part of the European Society of Cardiology EURObservational Research Programme. Pregnancy outcomes in all women after an arterial switch procedure for transposition of the great arteries are described. The primary end point was a major adverse cardiovascular event, defined as combined end point of maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischemic coronary events, and thromboembolic events. Altogether, 41 pregnant women (mean age, 26.7±3.9 years) were included, and there was no maternal mortality. A major adverse cardiovascular event occurred in 2 women (4.9%): heart failure in one (2.4%) and ventricular tachycardia in another (2.4%). One woman experienced fetal loss, whereas no neonatal mortality was observed. Conclusions Women after an arterial switch procedure for transposition of the great arteries tolerate pregnancy well, with a favorable maternal and fetal outcome. During counseling, most women should be reassured that the risk of pregnancy is low. Classification as modified World Health Organization risk class II seems appropriate. Funding from “Zabawas Foundation” and “De Hoop Foundation” in addition to the support from EURObservational Research Programme (EORP) is greatly acknowledged. Since the start of EORP, the following companies have supported the program: Abbott Vascular Int (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc (2014–2016), Menarini Int Op (2009–2012), MSD‐Merck & Co (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2009–2021), and Vifor (2019–2022).

Published
2021

38. Cardiovascular Diseases in Obesity: What is the Role of Magnesium?

Author

Gilberto Simeone Henriques, Thayanne Gabryelle Visgueira de Sousa, Mickael de Paiva Sousa, Jennifer Beatriz Silva Morais, Juliana Soares Severo, Lyandra Dias da Silva, Stéfany Rodrigues de Sousa Melo, Loanne Rocha dos Santos, and Dilina do Nascimento Marreiro

Subjects
medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, Adipose tissue, chemistry.chemical_element, 010501 environmental sciences, Reductase, 01 natural sciences, Biochemistry, Inorganic Chemistry, 03 medical and health sciences, Nutrient, Internal medicine, medicine, Humans, Magnesium, Obesity, Triglycerides, Dyslipidemias, 0105 earth and related environmental sciences, 0303 health sciences, Lipoprotein lipase, business.industry, 030302 biochemistry & molecular biology, Biochemistry (medical), Lipid metabolism, General Medicine, medicine.disease, Endocrinology, chemistry, Cardiovascular Diseases, Acyltransferase, lipids (amino acids, peptides, and proteins), business
Abstract

An excess of adipose tissue, a characteristic of obesity, has been associated with endocrine-metabolic alterations that contribute to dyslipidemias, which are characterized by an increase in the plasma concentrations of triacylglycerols, total cholesterol, and LDL-c along with a reduction in HDL-c. Some nutrients such as the mineral magnesium play important roles in lipid metabolism. Magnesium regulates the activity of HMG-CoA reductase, increasing the activity of lipoprotein lipase and lecithin-cholesterol acyltransferase. The objective of this review is to present important aspects about the contribution of obesity to the manifestation of cardiovascular risk, to bring the main physiological functions of magnesium, as well as the role of the nutrient in the protection against cardiovascular diseases. Studies have shown that individuals with obesity have low intracellular concentrations of magnesium, which can compromise the nutrient's physiological functions. Thus, this mineral appears to play an important role in protecting against cardiovascular diseases; however, changes in the nutrient metabolism in obesity may compromise the functions of this element. Further studies are needed to clarify this.

Published
2021

39. Unveiling the meaning attributed to nursing care at the perspective of person with cancer

Author

Vanessa de Nazaré Mendes Favacho, Leliane do Nascimento do Espírito Santo, Fabio Feitosa Camacho, Glauber Marcelo Dantas Seixas, Karina Raissa Rodrigues, Gisela Pereira Xavier Albuquerque, Samara Barbosa da Silva, Everson Vando Melo Matos, Samuel Oliveira da Vera, Marcilene Souza da Silveira, Bianca Blois Pinheiro Camboim, Emerson Glauber Abreu dos Santos, Luciana Moreira Batista, Enderson Vasconcelos de Lima, Bruno Mesquita Maia, Tatyellen Natasha da Costa Oliveira, Jofre Jacob da Silva Freitas, Suane Priscila dos Santos Antunes, Cláudia Rafaela Brandão de Lima, Joelia dos Santos Oliveira, Rúbia Caroline Silva Souza, Tania de Sousa Pinheiro Medeiros, Hermana Rayanne Lucas de Andrade Bender, Regina de Oliveira Benedito, Denise Karla de Abreu Silva, Maicon de Araujo Nogueira, Wenderson Melo Martins, Izabel Silva Carvalho, Marcio Almeida Lins, Edma Nogueira da Silva, Maria Caroline Barros de Matos, Juliane Ribeiro, Simone Aguiar da Silva Figueira, Maria Liduina Melo da Silva, Antonia Margareth Moita Sá, Darllene Lucas de Andrade, Yasmim Leão Fayal, Gabriela Nunes Pinheiro, Marlene Simões e Silva, Eliane de Brito Pereira, Viviane Pinto, Eimar Neri de Oliveira Junior, Fabricia de Sousa Franco, Jamyle Guedes da Costa, Alex Miranda Franco, Flávia Cristina Duarte Silva, Emmily Oliveira Amador, Lucilena Estumano Almeida, Danielle Oliveira Maciel, Elyade Nelly Pires Rocha Camacho, Sheila do Socorro dos Santos Miranda, Camila Melo da Silva, Raimunda de Fátima Carvalho Prestes, Renata Campos de Sousa Borges, Clarissa Porfírio Mendes, and Anderson Lineu Siqueta dos Santos

Subjects
Nursing care, Psychoanalysis, Perspective (graphical), medicine, Cancer, Meaning (existential), medicine.disease, Psychology
Published
2021

40. Gut microbiota in colorectal cancer: Evidence from observational studies

Author

Betânia de Jesus e Silva de Almendra Freitas, Dallyla Jennifer Morais de Sousa, Thaís Rodrigues Nogueira, Larissa Layana Cardoso de Sousa, and Larissa Cristina Fontenele

Subjects
Oncology, medicine.medical_specialty, Nutrition and Dietetics, Recto, biology, Colon, business.industry, Colorectal cancer, Fungi, Gut flora, biology.organism_classification, medicine.disease, digestive system diseases, Malignant neoplasm, Bacterium, Internal medicine, medicine, Dysbiosis, Observational study, business, Food Science
Abstract

This study proposes to update knowledge about the relationship between microbiota and Colorectal Cancer (CRC). This is a review carried out using the methodology of the Preferred Report Item for Systematic Analysis and Meta-Analysis (PRISMA) and search for original articles, indexed in the Pubmed, Cochrane and Science Direct databases, published between 2011 and 2019, in English. Ten articles showed changes in bacterial composition and its influence on the development and progression of CRC, and only two addressed changes in the composition of fungi and their relationship with CRC. Most studies have shown that the increase in Fusobacterium nucleatum and bacteroides fragilis is strongly associated with the occurrence of CRC due to inflammatory mechanisms; and that Faecalibacterium prausnitzii is a protective factor through the production of butyrate. Additional research is recommended to assess the relationship of microorganisms with the development of CRC, with an emphasis on fungi.

Published
2020

41. Impact of oocyte donor age and breed on

Author

Roberta Machado Ferreira, Michael J. D'Occhio, Laísa da Garcia da Silva, C. A. Rodrigues, Mariana P. Viziack, Pietro Sampaio Baruselli, José Nelio de Sousa Sales, Flávia Morag Elliff, and Luana Factor

Subjects
animal structures, animal diseases, Fertilization in Vitro, Reproductive technology, Biology, Endocrinology, Animal science, Pregnancy, Follicular phase, Genetics, medicine, Animals, Lactation, Bovine somatotropin, Molecular Biology, Embryo, Embryo, Mammalian, medicine.disease, Zebu, Tissue Donors, Breed, Reproductive Medicine, Genetic gain, Oocytes, Cattle, Female, Animal Science and Zoology, Developmental Biology, Biotechnology
Abstract

Genomic selection combined with in vitro embryo production (IVEP) with oocytes from heifer calves provides a powerful technology platform to reduce generation interval and significantly increase the rate of genetic gain in cattle. The ability to obtain oocytes with developmental competence from calves has been recognised for more than 60 years. There is renewed interest in the potential of this reproductive technology as the beef and dairy industries seek to identify and multiply animals that satisfy consumer demand for efficient utilisation of natural resources, with minimal environmental impact and high product quality. Heifer calves show a good follicular response to FSH stimulation and oocytes can be recovered by ovum pick-up (OPU). However, the efficiency of OPU/IVEP remains lower for calves compared with peripubertal heifers and cows, in both indicus (Zebu, Bos indicus) and taurus (Bos taurus) breeds. Indicus cattle generally have more follicles, yield a greater number of oocytes, and have a better IVEP outcome, compared with taurus cattle. The treatment of prepubertal heifers with bovine somatotrophin (bST) and propylene glycol before OPU/IVEP has yet to show a major improvement in embryo production. Holstein (taurus) dairy heifers derived from different reproductive technologies (AI, MOET, OPU/IVEP) showed a similar age at puberty and first-lactation milk production. OPU/IVEP Holstein embryos transferred to beef or dairy cows likewise yielded heifers with the same performance. The gains in productivity that can be achieved with strategic use of OPU/IVEP in heifer calves make this a relevant and highly important reproductive technology in cattle breeding. Ongoing optimisation of the technology is needed for the potential of OPU/IVEP in young donors to be fully realised.

Published
2021

42. Síndrome de mccune albright, neoplasia papilar mucinosa intraductal e carcinoma colóide: Um relato de caso de apresentação concomitante / Mccune albright syndrome, intraductal mucin papillary neoplasia and colloid carcinoma: A concomiting presentation case report

Author

Adymila Salim Moreira de Rezende, José Luiz Bravin Junior, Victoria Tinoco Boechat, Thaís Regina Valente de Sousa, Nathalia Ferreira Nunes, Edson Augusto Pracchia Ribeiro, Ádria Camila Silva, Nataly Gomes Tolentino, and Leandro Correa Siqueira

Subjects
Marketing, Pharmacology, Gynecology, Organizational Behavior and Human Resource Management, medicine.medical_specialty, business.industry, Strategy and Management, Pharmaceutical Science, medicine.disease, Sindrome de, McCune–Albright syndrome, Drug Discovery, medicine, Carcinoma, business
Abstract

Introducao: A Sindrome de Mccune Albright associada a neoplasia papilar mucinosa intraductal e carcinoma coloide e uma patologia rara. Apresentamos esse caso clinico ocorrido no Hospital do Câncer de Muriae da Fundacao Cristiano Varella. Caso Clinico: Paciente do sexo feminino 31 anos, portadora da Sindrome de McCune-Albright, com historia de lesao tumoral solido-cistica irressecavel em ducto principal pancreatico associada a sindrome colestatica e realizacao de derivacao bileodigestiva externa e interna. Apos os exames de imagem, mediante alta suspeicao de neoplasia pancreatica, paciente foi submetida a gastroduodenopancreatectomia total, esplenectomia total, colecistectomia, linfadenectomia retroperitoneal e reconstrucao com hepatoenteroanastomose e gastroenteroanastomose em Y de Roux. O anatomopatologico demonstrou Neoplasia Intraductal Papilar Mucinosa difusa em ducto pancreatico principal associada a neoplasia maligna amplamente mucinosa, compativel com Carcinoma Coloide, alem de presenca de neoplasia em mucosa gastrica associada a area de fistula. Conclusao: Como resultado do imunohistoquimico foi constatado o diagnostico de adenocarcinoma coloide, alem de neoplasia mucinosa papilifera intraductal do pâncreas associado a sindrome de Mccune Albright.

Published
2021

43. Are Video Games Effective to Promote Cognition and Everyday Functional Capacity in Mild Cognitive Impairment/Dementia Patients? A Meta-Analysis of Randomized Controlled Trials

Author

Diana Aguiar de Sousa, Luís Carriço, Filipa Ribeiro, Ana Verdelho, Cátia Caneiras, Filipa Ferreira-Brito, and João Costa

Subjects
Psychological intervention, Neuropsychological Tests, law.invention, Cognition, Quality of life (healthcare), Bias, Randomized controlled trial, law, Activities of Daily Living, medicine, Humans, Dementia, Cognitive Dysfunction, Randomized Controlled Trials as Topic, business.industry, Working memory, General Neuroscience, General Medicine, Mental Status and Dementia Tests, medicine.disease, Executive functions, Psychiatry and Mental health, Clinical Psychology, Video Games, Meta-analysis, Quality of Life, Geriatrics and Gerontology, business, Clinical psychology
Abstract

Background: Mild cognitive impairment (MCI) and dementia are associated with increased age. MCI is a clinical entity described as a transitional state between normal cognition and dementia. Video games (VGs) can potentially promote cognition and functional capacity since multiple cognitive domains are recruited during gameplay. However, there is still a lack of consensus regarding the efficacy of VGs as therapeutic tools, particularly in neurodegenerative diseases. Objective: We aimed to analyze the impact of VGs on cognition and functional capacity outcomes in MCI/dementia patients. Methods: We conducted a systematic review and meta-analysis study (PROSPERO [CRD42021229445]). PubMed, Web of Science, Epistemonikos, CENTRAL, and EBSCO electronic databases were searched for RCT (2000-2021) that analyzed the impact of VGs on cognitive and functional capacity outcomes in MCI/dementia patients. Results: Nine studies were included (n = 409 participants), and Risk of Bias (RoB2) and quality of evidence (GRADE) were assessed. Data regarding attention, memory/learning, visual working memory, executive functions, general cognition, functional capacity, quality of life were identified, and pooled analyses were conducted. An effect favoring VGs interventions was observed on Mini-Mental State Examination (MMSE) score (MD = 1.64, 95%CI 0.60 to 2.69). Conclusion: Although promising, the effects observed should be interpreted with caution since serious methodological shortcomings were identified in the studies included. Nonetheless, the effect observed is higher than the minimum clinically important difference (1.4 points) established to MMSE. Future studies on the current topic urge. Recommendations for the design and conduction of cognitive RCT studies are presented.

Published
2021

44. Protocolo para manejo clínico da pancreatite aguda em adultos / Protocol for the clinical management of acute pancreatitis in adults

Author

Pedro Henrique de Souza Sandim Silva, Rommel de Sousa Carneiro, Pollyana Rodrigues Reis, Juliana Santana, Hiago Pereira Macedo, Cristina Monteiro Bianchi Junqueira Santos, Bianca Rodrigues da Mota, and Lucas Pereira Vasconcelos

Subjects
Marketing, Pharmacology, Gynecology, Organizational Behavior and Human Resource Management, medicine.medical_specialty, business.industry, Strategy and Management, Drug Discovery, medicine, Pharmaceutical Science, Acute pancreatitis, business, medicine.disease
Abstract

A pancreatite aguda e uma condicao inflamatoria que afeta o pâncreas e pode causar comprometimento de outros orgaos, caracteriza-se por dor abdominal e aumento de enzimas no sangue e/ou urina. E uma emergencia clinica e/ou cirurgica comum muitas vezes mal compreendida, com uma condicao desafiadora de tratamento e com morbidade e mortalidade significativas. Foi realizada uma revisao nao sistematica nas bases de dados eletronicas PubMed, google cientifico, literatura cinzenta e livros. Os descritores indexados foram “acute pancreatitis”, guidelines, “practice guideline” e management com diferentes combinacoes entre os termos associando aos buscadores booleanos. As diretrizes mais atualizadas sobre o tratamento clinico da PA sao a da International Association of Pancreatology (IAP) / American Pancreas Association (APA) publicado em 2013, American College of Gastroenterology (ACG) de 2013 e a Diretrizes Japonesas para manejo de pancreatite (JPN) de 2015 (ISAJI et al., 2015). Todas embasadas na diretriz de Atlanta revisada de 2012. Com base na revisao feita e considerando os objetivos, foi proposto um algoritmo de abordagem da pancreatite aguda e um protocolo de manejo para pacientes adultos com pancreatite aguda.

Published
2021

45. Material and relational challenges of home-based renal care: a parental perspective on child chronic kidney disease

Author

Andréa Bruno de Sousa and Anette Wickström

Subjects
paediatric chronic kidney disease, phenomenology of practice, medicine.medical_specialty, Health (social science), Sociology and Political Science, business.industry, Omvårdnad, Health Policy, Perspective (graphical), Public Health, Environmental and Occupational Health, Nursing, medicine.disease, Renal care, Home based, materialities of care, medicine, Intensive care medicine, business, home-based renal care, Kidney disease
Abstract

Caring for a child with chronic kidney disease (CKD) requires parents to reorganise mundane routines and develop advanced technical skills. Parents’ strategies used to meet these challenges need greater understanding. This article takes inspiration from phenomenology of practice and material culture studies to analyse interviews with parents in Portugal. It shows that, although home-based care leads to worsened social inequities, parents use the available financial and human resources to manage the situation and create normality. While they experience becoming confined and close relationships are strained, the mundane practices and social relations of care bring hope and meaning to the family. Funding: Erasmus Mundus Joint Doctoral Program on Dynamics of Health and Welfare, Phoenix JDP Erasmus; Linkoeping University, LEcoles des Hautes Etudes en Sciences Sociales; Universidade de Evora and Escola Nacional de Saude Publica/UNL, Lisbon, Portugal [2012-1727]

Published
2021

46. Anti Psychotic Induced Hyperprolactinaemia

Author

Zainab Lokhandwala Dawoodi and Avinash De Sousa

Subjects
medicine.medical_specialty, Endocrinology, business.industry, Internal medicine, Anti psychotic, Hyperprolactinaemia, medicine, medicine.disease, business
Published
2021

47. The Relational Trip Task, a novel ecological measure of relational memory: data from a schizophrenia sample

Author

Ana Elisa Farias de Sousa, Martin Lepage, Gabrielle Pochiet, and Jennifer D. Ryan

Subjects
congenital, hereditary, and neonatal diseases and abnormalities, Psychosis, Cognitive Neuroscience, Relational memory, Validity, Sample (statistics), 050105 experimental psychology, Task (project management), 03 medical and health sciences, Cognition, 0302 clinical medicine, medicine, Criterion validity, Humans, Learning, 0501 psychology and cognitive sciences, Memory Disorders, Measure (data warehouse), Ecology, 05 social sciences, Reproducibility of Results, medicine.disease, Psychiatry and Mental health, Schizophrenia, Psychology, 030217 neurology & neurosurgery
Abstract

INTRODUCTION Relational memory (RM) is severely impaired in schizophrenia. Unitisation can circumvent RM impairments in clinical populations as measured by the transverse-patterning (TP) task, a well-established measure of RM capacity. We compared memory performance on a new ecological RM measure, the Relational Trip Task (RTT), to that of TP at baseline and examined the effects of a unitisation intervention in RTT performance. RTT involves learning relational information of real-life stimuli, such as the relationship between people and places or objects. METHODS TP and RTT performances were examined in 45 individuals with schizophrenia. TP-impaired participants (n = 22) were randomised to either the intervention or an active control group. TP and RTT were administered again after unitisation training. Task validity and reliability were assessed. Intervention group's pre- and post-RTT accuracies were compared and contrasted to that in the control group. RESULTS RTT and TP were moderately correlated. TP non-learners had inferior performance in RTT at baseline. Improvement in RTT performance after unitisation training was observed in the intervention group; no pre-post improvement was observed in the control group. CONCLUSION RTT has an acceptable criterion validity and excellent alternate-form reliability. Unitisation seemed to be successfully generalized to support associations of real-life stimuli.

Published
2021

48. Influence of GSTP1 rs1695 polymorphism on survival in male patients’ amyotrophic lateral sclerosis: a genetic association study in Brazilian population

Author

Dhiogo da Cruz Pereira Bento, Leandro do Prado Assunção, Angela Adamski da Silva Reis, Jéssica Barletto de Sousa Barros, Rodrigo da Silva Santos, and Kamilla de Faria Santos

Subjects
Adult, Male, medicine.medical_specialty, Genotype, Polymorphism, Single Nucleotide, Gastroenterology, GSTP1, Risk Factors, Polymorphism (computer science), Internal medicine, Genetics, Humans, Medicine, Genetic Predisposition to Disease, Risk factor, Amyotrophic lateral sclerosis, Molecular Biology, Survival rate, Genetic Association Studies, Genetic association, business.industry, Amyotrophic Lateral Sclerosis, General Medicine, Middle Aged, medicine.disease, Glutathione S-Transferase pi, Case-Control Studies, Restriction fragment length polymorphism, business, Brazil, Polymorphism, Restriction Fragment Length
Abstract

Glutathione S-transferase Pi (GSTP1) enzyme has a major antioxidant effect on the central nervous system (CNS), where it acts against oxidative damage, an established risk factor for amyotrophic lateral sclerosis (ALS). Hence, the purpose of this study was to evaluate a possible relationship between GSTP1 rs1695 polymorphism and the survival rate of male ALS patients, which is the gender more affected by the disease. A case-control study was performed with 56 male ALS patients and 70 healthy male individuals from Midwestern Brazil, which were age-adjusted. GSTP1 rs1695 polymorphism molecular analysis was carried out with restriction fragment length polymorphism. The relationship between ALS patients and GSTP1 rs1695 polymorphism was analyzed using cumulative survival rate as the major outcome, where differences in survival were evaluated through the log-rank test. Our results revealed that mutant genotype (G/G) did not influence the cumulative survival rate of male ALS patients regarding the age of diagnosis (p = 0.5) and time from symptom to diagnosis (p = 0.3). On the other hand, mutant carriers exhibited a significant survival of fewer than 25 months compared to A/A and A/G genotypes that survive more than 100 months (p = 7−E10) in comparison with symptom onset to outcome (p = 0.00006). In summary, our findings revealed that mutant genotype carriers’ male patients had a reduced lifetime, which probably may be resulted from oxidative stress exposure in CNS.

Published
2021

49. Sobrepeso e obesidade em universitários: prevalências e fatores associados

Author

Sueyla Ferreira da Silva dos Santos, Thiago Ferreira de Sousa, Alynne Christian Ribeiro Andaki, and Gerleison Ribeiro Barros

Subjects
business.industry, Odds ratio, Overweight, Sitting, medicine.disease, Obesity, Sitting time, Statistical significance, Genetics, medicine, Animal Science and Zoology, medicine.symptom, business, Body mass index, Demography, Multinomial logistic regression
Abstract

O objetivo deste estudo foi estimar entre homens e mulheres universitários de Minas Gerais, as prevalências de sobrepeso e obesidade e suas associações com atividade física e tempo sentado. Este estudo transversal estimou por meio das medidas referidas da massa corporal e estatura, o índice de massa corporal (IMC) e analisou o sobrepeso (IMC: 25,0 a 29,9 kg/m2) e a obesidade (IMC: ≥30,0 kg/m2). As variáveis independentes foram a atividade física e o tempo sentado, e as variáveis de controle foram sociodemográficas, de vínculo com a universidade e comportamentais, analisadas em três modelos. As associações foram estimadas via Odds Ratio (OR) por meio da Regressão Logística Multinomial. O nível de significância foi de 5%. Participaram 1.105 universitários, sendo 61,6% de mulheres. A média etária foi de 21,25 (desvio padrão = 4,1) anos para as mulheres e para os homens foi de 21,83 (desvio padrão = 4,2) anos. As prevalências de sobrepeso e obesidade foram, respectivamente, 27,5% e 6,9% em homens e 15,5% e 8,0% em mulheres. O tempo sentado associou-se à obesidade em homens, independente apenas das características sociodemográficas (OR = 3,54; IC95%: 1,04 – 12,12) e dos atributos sociodemográficos mais as características de vínculo com a universidade (OR = 3,48; IC95%: 1,01 – 11,99). Com o ajuste para os comportamentos alimentares não houve associação (OR = 3,49; IC95%: 0,99 – 12,23). Para as mulheres não foram observadas associações significativas. Conclui-se que a prevalência de sobrepeso foi elevada em homens. Os homens universitários com elevado tempo sentado apresentaram mais chances de serem obesos.

Published
2021

50. CANINE PANCREATITIS: THE DEVELOPMENT OF THE PANCREATIC INFLAMMATORY CONDITION AND THE CLINICAL-THERAPEUTIC APPROACH

Author

Felipe Gaia de Sousa and Ana C. R. Mendes

Subjects
medicine.medical_specialty, medicine.drug_class, business.industry, Antibiotics, Disease, medicine.disease, Pathophysiology, Therapeutic approach, medicine.anatomical_structure, Fluid infusion, medicine, Pancreatitis, Canine pancreatitis, Intensive care medicine, Pancreas, business
Abstract

Pancreatitis, acute or chronic, is a serious disease for dogs, due to its harmful potential and the existence of underdiagnosis. The disease is still the target of studies regarding its pathophysiology and therapeutic mechanisms, because the signs presented by the animals are nonspecific, ranging from mild to severe presentations. It can cause morphofunctional changes in the pancreas and adjacent organs. The diagnosis can be a very difficult task, either due to the variable symptoms and severity of the disease, or the impasses experienced at the time of the complementary exams. Therapeutic management is defined based on the symptoms presented by the animals, ranging from fluid infusion for volume replacement, analgesics, antiemetics, antibiotics, special food, among others.

Published
2021

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