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Scimitar syndrome is a rare congenital abnormality resulting from right-sided pulmonary venous return to the inferior vena cava rather than to the left atrium. It is usually detected in early childhood with symptoms of recurrent chest infection and finding of pulmonary hypertension due to left to right shunt. We report a case of a 40-year-old woman with scimitar syndrome discovered on chest X-ray during evaluation of recurrent pneumonia. Surgical correction was achieved with a novel technique of using a synthetic graft connecting the scimitar vein across the right atrium to the left atrium along with ligation of the scimitar vein connection to the inferior vena cava. The patient continues to do well 10 years after surgery, and the shunt graft shows good flow on echocardiogram. We present her clinical and imaging data and details of the surgical technique along with a brief review of surgical literature.

Percutaneous coronary intervention (PCI) is a routine procedure undertaken in adult patients. In children, the procedure remains rare and challenging due to a multitude of factors including but not limited to complex congenital heart disease anatomy, catheter and stent to patient size mismatch, and lack of data for post-PCI antiplatelet therapy. We present a case of PCI in an 8-month-old infant with anomalous left coronary artery from pulmonary artery (ALCAPA) who developed severe ostial kinking of the left main coronary artery (LMCA) after surgical reimplantation of the anomalous coronary. A 3.5 × 8 mm Vision bare metal stent was successfully placed into the LMCA and postdilated with excellent results. Follow-up echocardiography at 6 months post-PCI demonstrated a patent stent with normal Doppler flow signals. Despite initial success, the infant developed severe heart failure and was listed for orthotopic heart transplantation at age 20 months, one year after PCI. Given the paucity of published data regarding PCI and outcomes in infants with ALCAPA after surgical reimplantation, we describe our case and present a review of the available literature.

Low-molecular-weight (LMW) thiols are produced in all living cells in different forms and concentrations. Glutathione (GSH), coenzyme A (CoA), bacillithiol (BSH), mycothiol (MSH), ergothioneine (ET) and trypanothione T(SH)2 are the main LMW thiols in eukaryotes and prokaryotes. LMW thiols serve as electron donors for thiol-dependent enzymes in redox-mediated metabolic and signaling processes, protect cellular macromolecules from oxidative and xenobiotic stress, and participate in the reduction of oxidative modifications. The level and function of LMW thiols, their oxidized disulfides and mixed disulfide conjugates in cells and tissues is tightly controlled by dedicated oxidoreductases, such as peroxiredoxins, glutaredoxins, disulfide reductases and LMW thiol transferases.This review provides the first summary of the current knowledge of structural and functional diversity of transferases for LMW thiols, including GSH, BSH, MSH and T(SH)2. Their role in maintaining redox homeostasis in single-cell and multicellular organisms is discussed, focusing in particular on the conjugation of specific thiols to exogenous and endogenous electrophiles, or oxidized protein substrates. Advances in the development of new research tools, analytical methodologies, and genetic models for the analysis of known LMW thiol transferases will expand our knowledge and understanding of their function in cell growth and survival under oxidative stress, nutrient deprivation, and during the detoxification of xenobiotics and harmful metabolites. The antioxidant function of CoA has been recently discovered and the breakthrough in defining the identity and functional characteristics of CoA S-transferase(s) is soon expected.

Background: Delays in starting postoperative radiotherapy (PORT) have been established as negative predictors for clinical outcomes in head and neck squamous cell carcinomas (HNSCC). Our study aimed to examine the effect of delays during PORT, and the impact of national holidays in Canada, a publicly funded system, on oncologic outcomes such as Overall Survival (OS) and Local Recurrence (LR). Methods: The provincial cancer registry was queried to obtain demographic, pathologic, and outcomes data from cancer patients treated for all squamous cell carcinomas of the head and neck region treated between January 1, 2007 and November 30, 2019. All extracted information was cross-referenced and supplemented by chart review of patient electronic medical records. Extracted data were analyzed for OS and LR, in the context of Canadian national holidays causing delays during PORT. Results: 1433 patients treated for HNSCCs were identified, of whom 338 were treated curatively with surgery followed by PORT. 68.6% of patients experienced at least one day of interruption during treatments due to holidays. LR was 15.4% and OS was 59.6% at 5 years. Treatment interruptions by holidays were predictive of local recurrence (HR, 2.38; 95% CI 1.17–4.83; p = 0.017). Patients that developed early recurrence prior to PORT had very poor oncologic outcomes. Conclusion: Our findings were consistent with previously published studies in limiting the interval between surgery and PORT. We identified the novel finding of paired holidays as a significant predictor in determining LR, suggesting the importance of modifying RT delivery schedules and timing.

Despite the known importance and necessity of the standardized collection and use of patient-reported outcomes (PROs), there remain challenges to successful clinical implementation. Facilitated through a quality improvement initiative spearheaded by the Canadian Partnership for Quality Radiotherapy (CPQR), and now guided by the Canadian Association of Radiation Oncology (CARO)’s Quality and Standards Committee, patient representatives and early-adopter radiation treatment programs continue to champion the expansion of PROs initiatives across the country. The current review discusses the evolution of a pan-Canadian approach to PROs use, striving to fill in gaps between clinical practice and guideline recommendations through multi-centre and multidisciplinary collaboration.

Introdução: A Síndrome Metabólica (SM) constitui importante fator de risco para o desenvolvimento de doenças cardiovasculares e diabetes mellitus. Quando já associada a cardiopatias torna-se, ainda, responsável por um pior prognóstico e alta morbimortalidade. Objetivo: Identificar e caracterizar os possíveis portadores de SM em pacientes atendidos em um ambulatório privado de cardiologia em Boa Vista-RR. Materiais e métodos: Estudo transversal e documental com amostra de 92 pacientes em acompanhamento cardiológico de agosto de 2017 a julho de 2018 em Boa Vista, Roraima. As variáveis avaliadas foram: sexo, idade, cor de pele, tabagismo, dados antropométricos (peso, estatura, IMC (peso (Kg) /altura2) e circunferência abdominal), pressão arterial, glicemia, triglicerídeos, HDL e síndrome metabólica. Resultados: A SM englobou 52,17% dos pacientes, sendo que 68,75% dos portadores eram do sexo feminino. Também se observou um aumento marginalmente significativo de 20% de probabilidade de as mulheres desenvolverem a SM em relação aos homens (p

In turbulent and competitive scenarios, strategic intelligence is a crucial process for organizations to reduce uncertainties during decision-making and to anticipate changes that may affect their performance and sustainability. Despite the relevance of the activity, continuous and structured processes based on intelligence in organizations are not a reality due to the difficulty of implementing and formalizing it. Executing a diagnosis to evaluate conditions that precede the adoption of a structured intelligence activity allows companies to recognize their efficiency to perform monitoring, to further improve or implement it. This paper explores organizational, informational, individual, technological and material conditions that precede the adoption of the intelligence process, reviews six diagnostic models and proposes a diagnostic tool to evaluate issues that must be considered in advance. The Delphi method was used to exploit opinions among 30 intelligence practitioners in order to define which conditions of the process should be evaluated before its adoption in companies. As a result, this work contributes to filling the gap observed in the literature about the motivation to initiate the intelligence process in organizations and presents a formalized tool to evaluate its pre-adoption stage.