Search

The syndrome of thrombotic microangiopathy (TMA) is a clinical-pathological entity characterized by microangiopathic hemolytic anemia, thrombocytopenia, and end organ involvement. It comprises a spectrum of underlying etiologies that may differ in children and adults. In children, apart from ruling out shigatoxin-associated hemolytic uremic syndrome (HUS) and other infection-associated TMA like Streptococcus pneumoniae-HUS, rare inherited causes including complement-associated HUS, cobalamin defects, and mutations in diacylglycerol kinase epsilon gene must be investigated. TMA should also be considered in the setting of solid organ or hematopoietic stem cell transplantation. In this review, acquired and inherited causes of TMA are described with a focus on particularities of the main causes of TMA in children. A pragmatic approach that may help the clinician tailor evaluation and management is provided. The described approach will allow for early initiation of treatment while waiting for the definitive diagnosis of the underlying TMA., Author(s): Lilian Monteiro P. Palma [sup.1] , Maria Helena Vaisbich-Guimarães [sup.2] , Meera Sridharan [sup.3] , Cheryl L. Tran [sup.4] , Sanjeev Sethi [sup.5] Author Affiliations: (1) grid.411087.b, 0000 0001 [...]

OBJETIVO: descrever a freqüência das lesões precursoras do câncer de colo uterino em mulheres de 15 a 29 anos, associando o grau de acometimento com características epidemiológicas e fatores de risco associados. MÉTODOS: foi realizado estudo transversal com a pesquisa de lesões precursoras do câncer de colo uterino, pelo exame de Papanicolaou, em mulheres de 15 a 29 anos com vida sexual ativa, residentes no município de Rio Branco, no período de janeiro a setembro de 2001. Como instrumento de investigação, foi aplicada ficha clínico-ginecológica, constando dados epidemiológicos, fatores de risco e resultados do exame físico-ginecológico, incluindo teste de Schiller e coleta de espécime para exame citopatológico. RESULTADOS: das 2.397 mulheres estudadas, 155 (6,4%) apresentaram algum tipo de alteração epitelial cervical, sendo 146 (94,2%) lesões escamosas e 9 (5,8%) lesões glandulares. Nas mulheres com faixa etária de 15 a 19 anos a freqüência de alteração celular epitelial foi de 6,9%, semelhante a 6,3% observada naquelas de 20 a 29 anos (p>0,65). Este tipo de alteração foi associada ao baixo grau de escolaridade (p

The quality of life (QoL) in cities has increasingly been used as a symbol of urban success. Studies addressing this issue tend to focus, however, on large cities and/or on cities from different countries. By using a set of data from a single country, comprehending cities with different population sizes and densities, observations for 11 performance dimensions, and an approach combining the Data Envelopment Analysis (DEA) technique and multivariate regression modeling, this study analyses the QoL of Portuguese cities and explores some of its determinants. The results of this analysis show that both small and large cities can offer high levels of QoL with "transport and accessibility," "safety," "housing," "education," and "culture and entertainment" being the dimensions that most contribute to the QoL assessment. While Lisbon and Oporto (the two largest Portuguese cities) are benchmark cities, some of the highly populated cities located in their Metropolitan Areas present the most potential for improvement in terms of QoL. The results also show that cities located in the hinterland tend to present higher QoL scores than those on the coast. Equally, cities with lower population size and density, those that are district capitals and those with higher per capita current public expenditures present higher levels of QoL. These findings suggest, therefore, that the cities' typology, their population size and density, and their dependence from local governments' public expenditures can significantly contribute to the differences identified in their QoL performance. [ABSTRACT FROM AUTHOR]

Preferential trade agreements are now the dominant trend in the international trading regime. Unlike earlier 'first generation' agreements, the new agreements became more comprehensive in their coverage, impinging on areas that are subject to subnational jurisdiction of federal systems. Given constitutionally-prescribed competences allocated to subnational governments, the diversity of interests and sensitivities of subnational entities bring deeply entrenched regulatory practices under scrutiny. Few studies have focused on whether the combination of economic liberalization and political fragmentation will push federal and sub-federal entities to address domestic market fragmentation. We examine whether international market liberalization fosters domestic regulatory and structural reforms to cross-border barriers to trade in Canada and the United States. We show that while the political incentives and functional pressures generated by free trade agreements have fostered attempts at addressing internal market restrictions in Canada, the US has not followed the same path due to weaker mechanisms of intergovernmental coordination. [ABSTRACT FROM AUTHOR]