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Weeds are the major menace to agriculture, which greatly impact crop growth and development, resulting in economic yield loss or crop failures. Therefore, it is indispensable to take up appropriate weed management practices to prevent the effects of weeds on crops. Chemical herbicides have immense potential for effective control of weeds, but, in the long run, the persistent nature of herbicides adversely affects the soil microbes and also that terrestrial and aquatic ecosystems. Bioherbicides are products derived from plant extracts, allelochemicals or microbes and their secondary metabolites with weed-suppressing abilities. Most microbial bioherbicides are based on fungi and its active ingredients, which successfully control weeds with different mode of actions. Moreover, the toxins or secondary metabolites the fungi produce also possess herbicidal properties. So, exploring the fungal pathogens and their toxins for managing weeds seems to be a feasible and eco-friendly way for the management of weeds. There is a wider scope for utilizing fungi and their secondary metabolites as mycoherbicides, which have the potential to replace hazardous chemical herbicides in the near future. This review article mainly emphasizes the scope of mycoherbicides and explores the fungal secondary metabolites for eco-friendly weed control.

Introdução: O Linfoma de Burkitt é uma neoplasia hematológica altamente agressiva derivada de células B, marcada pela translocação do gene MYC no cromossomo 8. Suas formas incluem a endêmica, a esporádica e a associada à imunossupressão, como em pacientes com HIV. O linfoma de Burkitt tem uma prevalência 10 vezes maior em indivíduos HIV positivos do que na população geral, sendo uma condição definidora de AIDS. A patogênese envolve imunossupressão crônica, permitindo proliferação descontrolada das células B e reativação do EBV, que frequentemente é latente em pacientes com HIV. A apresentação clínica pode variar, incluindo linfadenopatia generalizada, febre, perda de peso e envolvimento extranodal. O diagnóstico requer avaliação clínica, radiológica e confirmação histopatológica através de biópsia e imunohistoquímica. O tratamento envolve quimioterapia intensiva, além da gestão eficaz do HIV para melhorar a resposta imunológica e reduzir complicações infecciosas. Relato do caso: Paciente masculino, 28 anos, sem comorbidades, apresentou nódulo de 1 cm em região infraclavicular direita, que, em 7 meses, evoluiu progressivamente para uma massa palpável, com cerca de 20 cm, sem sinais flogísticos, pétrea, imóvel e indolor. Paciente nega febre, sudorese noturna ou emagrecimento durante o período. Tomografia computadorizada (TC) de Tórax e Pescoço evidenciou conglomerado linfonodal infraclavicular à direita (13 × 7 cm) de aspecto suspeito para doença linfoproliferativa. Realizada biópsia percutânea da massa, cujo histopatológico identificou uma neoplasia maligna com imunorreatividade para os marcadores CD20, BCL6, CD10, cMYC e Ki-67 (> 95%) na imunohistoquímica, compatível com Linfoma não-Hodgkin de células B, tipo Burkitt. Concomitantemente, realizou investigação para HIV, com Teste de Antígenos e Anticorpos reagente para HIV-1 e HIV-2, e Imunoblot rápido reagente para HIV-1. Realizada a investigação de TB pelo LF-LAM com resultado não reagente, análise liquórica sem alterações, dosagem de Carga Viral em 161 mil cópias e Contagem de CD4 em 295 céls/mm3, sendo iniciada a Terapia Antirretroviral com Lamivudina, Tenofovir e Dolutegravir. A Biópsia de Medula Óssea não evidenciou infiltração por Linfoma. Iniciado quimioterapia com o protocolo CODOX/IVAC, que cursou com redução considerável da massa com cerca de 1 semana de tratamento, levando a significativa melhora clínica. Conclusão: Este caso discute uma doença rara, que representa 1-2% dos linfomas não-Hodgkin em adultos, e enfatiza a necessidade de uma abordagem integrada no manejo do Linfoma de Burkitt associado ao HIV. A detecção precoce e o tratamento quimioterápico são essenciais devido à natureza agressiva do linfoma. Deve-se destacar ainda a associação de anticorpos monoclonais, que aumenta as taxas de remissão, mas ainda tem acesso limitado no Sistema Único de Saúde. A ausência de infiltração medular e a resposta positiva ao tratamento destacam a eficácia do protocolo para linfomas de alta agressividade e a importância do controle eficaz da AIDS para melhorar a sobrevida. O manejo adequado da infecção por HIV, incluindo monitoramento da carga viral e contagem de CD4, juntamente com quimioterapia intensiva, é crucial para melhorar os desfechos clínicos e otimizar estratégias para pacientes com doenças malignas associadas ao HIV.

Objetivos: Analisar os casos diagnosticados de linfoma não-Hodgkin na população de 0 a 19 anos, de 2019 a 2024. Material e método: Foi realizado o levantamento de dados de ano do diagnóstico no território brasileiro, durante o período de 2019 a 2024, disponíveis nos seguintes sistemas: Sistema de Informação Ambulatorial (SIA), através do Boletim de Produção Ambulatorial Individualizado (BPA-I) e da Autorização de Procedimento de Alta Complexidade; Sistema de Informação Hospitalar (SIH); Sistema de Informações de Câncer (SISCAN). Resultados: Entre 2019 a 2025, foram diagnosticados no Brasil 1.869 casos de Linfoma Não-Hodgkin (LNH), sendo o número de casos de LNH Difuso (1.754) significantemente superior ao LNH Folicular (115). O Sudeste foi a região com maior quantidade de casos de LNH difuso (604) e de Linfoma Folicular (45). Em comparação, a região Norte possui a menor quantidade de casos do tipo difuso (170) e apresenta 16 casos diagnosticados do tipo folicular. Além disso, podemos observar que no mesmo período descrito acima o Sul foi a região que apresentava menos casos de Linfoma Folicular (15) e sobre casos de LNH Difuso seriam 332. Já a região Centro-Oeste obteve o menor índice de casos de LNH Difuso (169) e, sobre os casos de Linfoma Folicular, foram diagnosticados 21. Por último, a região Nordeste teve um número baixo de casos de Linfoma Folicular (18), porém apresentou o segundo maior índice de casos de LNH difuso (479). Discussão: Os dados de 2019 a 2024 revelam que, no tocante ao perfil sociodemográfico, o Linfoma Não-Hodgkin difuso (LNH) é consideravelmente mais prevalente do que o linfoma folicular no Brasil. As disparidades regionais na incidência, que se correlacionam com a prevalência de LNH em todas as regiões, sugerem interferência devido a fatores como as condições socioeconômicas e as diferenças nas infraestruturas médicas, sublinhando a importância das estratégias de saúde pública para melhorar o acesso ao diagnóstico e ao tratamento nas zonas sub atendidas. Assim, vale ressaltar que o maior registro de número de casos corresponde a região sudeste, o que pode ser explicado por uma maior densidade populacional e melhor acesso aos serviços de saúde. Por outro lado, nas regiões centro-oeste e norte, há uma quantidade consideravelmente menor de casos de LNH difuso e folicular, provavelmente, devido às barreiras no acesso ao diagnóstico e tratamento, bem como potenciais subnotificações. Conclusão: Diante dos dados apresentados, observa-se que as internações por Linfoma Não-Hodgkin (LNH) na faixa etária de 0 a 19 anos no Brasil, entre 2019 a 2024, superam as ocorrências de linfoma folicular. Ademais, os dados evidenciam disparidades regionais que refletem a influência de fatores socioeconômicos e estruturais na incidência e no registro dos casos de LNH. As discrepâncias na disponibilidade e qualidade dos serviços de saúde destacam a necessidade urgente de estratégias de saúde pública que visem melhorar o acesso ao diagnóstico precoce e ao tratamento adequado. Portanto, este estudo sublinha a importância de intervenções estratégicas e planejadas no sistema de saúde brasileiro, com o objetivo de não apenas promover a detecção precoce e o tratamento eficaz, mas também de reduzir as desigualdades regionais.

A leucemia linfocítica crônica (LLC) caracteriza-se pela alta frequência de alterações genéticas, que se correlacionam com o prognóstico da doença. O cariótipo com bandas G permite a investigação simultânea de alterações citogenéticas em todos os cromossomos. Entretanto, o linfócito apresenta baixa taxa de divisão celular em cultura, e por isto o cariótipo pode não ser informativo. A hibridização in situ fluorescente (FISH), por dispensar a necessidade de células metafásicas, apresenta maior sensibilidade na detecção de alterações citogenéticas na LLC. Este estudo tem como objetivo investigar a frequência de alterações citogenéticas detectadas por FISH realizadas entre abril/2017 a abril/2024 no laboratório de Citogenética do Instituto Hermes Pardini. Foi utilizado um painel de sondas para pesquisa de oito alterações citogenéticas em núcleos interfásicos: as deleções de MYB (6q23.3), ATM (11q22.3), 13q14.3 e TP53 (17p13), trissomia de cromossomo 12, rearranjo em IGH (14q32) e as fusões IGH::CCND1 e IGH::BCL2. Neste período foram analisados 155 pacientes (96 do sexo masculino), com média de idade de 70 ± 10 anos. Foi detectada pelo menos uma alteração citogenética em 107 casos (69%), com 1 a 5 alterações por caso. A alteração citogenética mais frequente foi a deleção em 13q14.3 (71 casos/66,4%), seguida pela trissomia de cromossomo 12 (26 casos/24,3%), deleção TP53 (15 casos/14,0%), deleção de ATM (13 casos/12,1%), fusão IGH::CCND1 (8 casos/7,5%), deleção de MYB (5 casos/4,7%) e fusão IGH::BCL2 (2 casos/1,9%). Dentre os 107 casos com alteração citogenética, em 33 (30,8%) foram detectadas entre duas a cinco alterações, destacando-se por maior frequência a dupla alteração trissomia 12 com deleção 13q14.3. A frequência das alterações citogenéticas detectadas é semelhante ao observado em outros estudos. Foram detectadas alterações citogenéticas importantes para o prognóstico da LLC, como a deleção de TP53, cujo prognóstico é desfavorável e relevante para terapia.

ABCs and LRP transport proteins are involved in several metabolic processes, among which the transport of lipids and xenobiotics can be highlighted. Thus, the overexpression of some of these proteins, such as ABC-G2 and the LRP protein, are associated with the phenotype of resistance to multiple drugs, one of the main causes of relapses and relapses in patients with acute myeloid leukemia. Mesenchymal stem cells (MSC) are multipotent cells present in the bone marrow and are part of the hematopoietic niche. Phenotypic changes in MSCs are related to AML progression. The oxysterols, 7-KC and Triol, are derived from the auto-oxidation of the cholesterol molecule; and have functions in cell signaling, survival and death. Therefore, the objective of this work was to evaluate the action of oxysterols, in subtoxic concentrations, of 7-KC (30 μM, 50 μM and 70 μM) and Triol (20 μM, 30 μM and 40 μM) on the ABCs and LRP transport proteins of MSCs derived from bone marrow from patients with AML (MSC-D), being used as a comparator MSC of bone marrow from healthy individuals (MSC-S). Using the indirect immunofluorescence technique, it was observed that the amount of ABC-A1 protein was higher in MSC-S strains and that treatment with 30 μM of 7-KC increased ABC-A1 only in MSC-S strains. On the other hand, treatment with Triol decreased the concentration of ABC-A1 in MSC-S strains, and this decrease in ABC-A1 was associated with a decrease in the amount of the LXR-β receptor. Furthermore, treatment with 70 μM of 7-KC decreased LRP protein expression in MSC-S strains, while in MSC-D strains there was no difference. Treatment with Triol showed no significant effect on LRP protein expression in MSC-S, only in MSC-D strains, where there was an increase in the concentration of 20 μM, followed by a decrease in the concentrations of 30 μM and 40 μM of Triol. Both 7-KC and Triol treatment increased the concentration of SMO protein in the cytoplasm and its translocation to the nucleus in MSC-S cell lines. This effect was not observed in MSC-D strains. Treatment with Triol increased the concentration of ABC-D4 protein in the cytoplasm. Furthermore, the presence of ABC-D4 protein was observed in the nucleus of MSC-S and MSC-D strains. Our results demonstrated that in the MSCs lineages the effect of 7-KC and Triol is mainly metabolic, in which an increase in the oxidized glutathione content, alteration in the processes of mitochondrial dynamics with induction of genes related to the fission and fusion process in both 7-KC and Triol-treated MSC lines. Increased expression of the BCL2 gene and cytoplasmic survivin was also observed in MSCs treated with 7-KC. In conclusion, it is possible to observe differences in the expression of ABC transporters and LRP between CTM-S and CTM-D strains. Furthermore, at the same concentrations of 7-KC and Triol used, the observed effect was different between MSC-S and MSC-D, which demonstrates that there are different mechanisms between mesenchymal stem cell lines. In summary, our results are characteristic of the metabolic action of the oxysterols 7-KC and Triol on MSCs.

Objetivo: Descrever as principais reações transfusionais imediatas e tardias ocorridas em hospitais atendidos pelo Grupo GSH no país. Material e métodos: O levantamento dos dados, foi realizado pelas informações obtidas do sistema informatizado do Grupo GSH e da avaliação do livro de registro de notificações de reações transfusionais imediatas e tardias com o parecer do responsável médico, ocorridas no período de janeiro a dezembro de 2023, os dados são referentes à atendimentos de cerca de 240 hospitais e clínicas. Para a caracterização das reações transfusionais foram avaliadas quanto ao tipo de reação transfusional que podem ser classificadas como imediatas (aguda) ocorridas durante ou em até 24h da transfusão. E reações do tipo tardia que ocorrem após 24h até cerca de 3 semanas, após a transfusão. Resultado: Dos casos analisados, constatou-se que, das 390.000 bolsas transfundidas, 2.812 apresentaram sinais ou sintomas relacionados a reações transfusionais, afetando o total de 1.039 receptores. Isso representa um percentual de 0,72% de reações transfusionais. Das reações identificadas, suas causas foram classificadas das seguintes formas: 0,04% de distúrbios metabólicos (1 caso), 0,07% de dor aguda relacionada à transfusão (2 casos), 0,18% de reação hemolítica tardia (5 casos), 0,25% de outras reações tardias (7 casos), 0,3% de reação hipotensiva relacionada à transfusão (8 casos), 0,4% de reação hemolítica aguda imunológica (11 casos), 0,82% de lesão pulmonar aguda relacionada à transfusão (23 casos), 1,03% de dispneia associada à transfusão (29 casos), 1,21% de aloimunização/aparecimento de anticorpos irregular (34 casos), 4,1% de outras reações imediatas (116 casos), 5,7% de sobrecarga circulatória associada à transfusão (159 casos), 28,3% de reação febril não hemolítica (797casos) e 57,6% de reação alérgica (1620). Discussão: Durante os meses avaliados pode-se observar uma maior incidência das reações imediatas com 98,36%, com predominância dos tipos alérgica com 57,6% e febril não hemolítica com 28,3%. Quanto as reações tardias, totalizou 1,64%, sendo descritos três tipos de reações tardias no período, todas com baixa expressividade, sendo a aloimunização com 1,21%, outras reações tardias 0,25% e hemolítica tardia 0,18%. Como limitação do presente estudo, pode haver subnotificação de reações transfusionais, devido a não correlação de sinais apresentados por receptores, principalmente tardios, que possam ser associados à transfusão prévia. Conclusão: Os resultados obtidos com este estudo corroboram com os dados já descritos na literatura. Sabe-se que as reações podem ocorrer em decorrência de algum incidente do ciclo do sangue, ou do resultado inerente do processo. Portanto, a hemovigilância é a principal forma de garantir a segurança transfusional dos receptores com o registro e notificação dos eventos adversos, evitando-se a incidência de subnotificações. Sendo assim, é importante que as reações sejam identificadas corretamente e as condutas tomadas sejam adequadas, prevenindo-as através de equipes bem treinadas, processos bem definidos e qualidade dos hemocomponentes, a fim de manter a taxa de reações transfusionais conforme literatura.

Objetivo: Analisar a incidência de aloimunização em pacientes internados nos hospitais das agências transfusionais do país atendidas pela Grupo GSH. Material e métodos: Estudo retrospectivo realizado através do levantamento de dados obtidos do sistema informatizado no período de janeiro de 2021 a dezembro de 2023, os quais foram agrupados e tratados em planilha do programa Microsoft Excel. Os dados coletados incluíam sexo, idade e resultados de anticorpos eritrocitários detectados. Resultados: No período do estudo, foram registrados 62 casos de reações transfusionais classificadas como aloimunização, envolvendo a identificação de 86 anticorpos, dentre os quais pode-se observar a ocorrência da identificação em 23 casos (26,7%) do anticorpo anti-E e 14 casos (16,8%) identificados anti-Kell, seguidos de anti-Jka com 11 casos (12,8%), anti-c e anti-D com 7 casos cada ( 8,1%), anti-C 6 casos (7%), anti-M 5 casos (5,8%) e os demais anticorpos identificados que apresentaram baixa expressividade, que somados representam 13 casos (15,1%), sendo identificados: anti-Ch, anti-Dia, anti-Fya, anti-Jkb, anti-Lea, anti-Lua, anti-s, anticorpo frio. Quanto ao sexo dos receptores, 33 casos (53,2%) eram de receptores do sexo feminino e 29 casos do sexo masculino (46,8%). Quanto a idade, na distribuição por faixa etária observou-se 21 pacientes entre 61-75 anos (34%), 20 pacientes entre 46-60 anos (32,2%), 15 pacientes acima dos 75 anos (24,2%), 3 pacientes entre 16-30 anos (5%), 2 pacientes entre 0-15 anos (3,2%) e 1 paciente entre 31-45 anos (1,4%). Discussão: Ao analisar os dados, observou-se que a maior prevalência dos anticorpos identificados com 26,7% foi de anticorpos anti-E, 16,8% anti-K e 12,8% anti-Jka, os demais anticorpos identificados apresentaram baixa incidência variando de 1 e 7 casos, ficando entre 1,1% e 8,1%. A relação com o sexo dos receptores que aloimunizaram, após serem submetidos às transfusões tem-se a prevalência no sexo feminino (53,2%). As idades dos receptores variaram de 5 anos a 99 anos, com maior incidência na faixa etária de 61 a 75 anos, resultados estes que são correlacionadas as condições clínicas e laboratoriais dos receptores, que consequentemente acarretaram um maior número de transfusões com exposição maior a diferentes doadores. Conclusão: A Organização Mundial de Saúde (OMS) recomenda que o fornecimento de sangue seguro e adequado seja parte da política e infraestrutura de saúde de todos os países. Atualmente a transfusão de sangue é um recurso que salva vidas e melhora a saúde de quem se beneficia em diversas circunstâncias, porém pode resultar no desenvolvimento de aloanticorpos. Essa aloimunização predispõe o paciente ao risco de reações transfusionais hemolíticas tardias. Os anticorpos mais encontrados na aloimunização são dirigidos contra antígenos dos sistemas Rh e Kell, por serem estes considerados os mais imunogênicos. A identificação dos fenótipos eritrocitários dos grupos sanguíneos em pacientes e doadores de sangue, possibilita a classificação da frequência dos genes mais imunogênicos de cada sistema, sendo essencial para diminuir o risco de aloimunização, havendo a possiblidade do sangue compatível tornar a transfusão mais segura.

Introduction: The EBMT recommends an ATG (Thymoglobulin) dose of 4.5‒6.0 mg/kg for an unrelated (URD) hematopoietic cell transplant (HCT). The PTCy-based Baltimore protocol for haploidentical (Haplo) HCT included MMF 45 mg/kg starting at D+5, however MMF 30 mg/kg starting at D0 has also been reported. In our institution, the first 6 Haplo received 45 mg/kg MMF, with a 50% incidence of CMV disease, prompting us to reduce MMF to 30 mg/kg. Objective: To compare 6.0 mg/kg ATG-based URD versus PTCy-based with MMF 30 mg/kg Haplo HCT. Methods: This single-center study was conducted in a public hospital in Rio de Janeiro, Brazil. We included all patients who underwent Haplo or URD HCT for acute leukemia or myelodysplasia between 2016 and 2024. URD received 6 mg/kg ATG with a Calcineurin Inhibitor (CNI) and an antimetabolite. Haplo received PTCy combined with a CNI and approximately, due to rounding, MMF 30 mg/kg. All follow-up times were longer than 30 days. Survival and cumulative incidence curves were carried out with Kaplan-Meier and Gray methods and compared with logrank and Gray tests. Propensity Score (PS) weighted-Cox models were performed to control for relevant variables. The study was approved by the Ethics Committee and registered at ClinicalTrials (NCT02759822). Results: With a median follow-up of 13- and 28-months, 74 Haplo and 83 URD were included, respectively. Except for conditioning intensity (reduced-intensity conditioning in 30% of Haplo and 6% of URD) and graft (peripheral blood in 51% of Haplo and 35% of URD), all other variables were relatively well-balanced. In the URD group, 82% were HLA 8/8 matched, while 18% were 7/8 matched. 2-y OS, for Haplo and URD, respectively, were 51% and 70% (p = 0.10); 2-y RFS 51% and 64% (p = 0.23); GRFS 22% and 47% (p = 0.01); 2-y relapse 17% and 18% (p = 0.62); 2-y NRM 32% and 17% (p = 0.08); 2-y cGVHD 39% and 35% (p = 0.52), 2-y moderate/severe cGVHD 22% and 15% (p = 0.49); 6-month II‒IV aGVHD 50% and 49% (p = 0.72); and 6-month III‒IV aGVHD 15% and 23% (p = 0.51). In the PS-weighted model, only GRFS was different: HR = 1.70 for Haplo vs. URD, p = 0.01. In other PS-weighted models, nor OS, HR = 1.50, p = 0.17; PFS, HR = 1.40, p = 0.24; relapse, HR = 1.00, p = 0.97; II‒IV aGVHD, HR = 1.10, p = 0.63; III‒IV aGVHD, HR = 1.30, p = 0.56; cGVHD, HR = 1.40, p = 0.24; nor moderate and severe cGVHD, HR = 1.70, p = 0.23 were statistically different, although, numerically, most outcomes favored the URD group. Discussion: Our results suggest it might not be safe to systematically offer Haplo transplants for patients with suitable URD. PS-weighted GRFS was statistically improved with URD, compared with Haplo. Overall, our Haplo results were comparable with those already reported, although, in most comparisons of Haplo versus URD, ATG was not given to all URD patients. Importantly, GVHD control was not hampered by MMF reduction from 45 mg/kg to 30 mg/kg in the Haplo arm, even in a highly miscegenated country like Brazil. Time to transplant is usually shorter in Haplo, and therefore we cannot rule out survival bias favoring the URD group. Although not randomized, it was a relatively large sample that included patients with only hematologic malignancies.

Objetivo: Avaliar a frequência de consulta odontológica antes do transplante de células tronco hematopoiéticas (TCTH) no Instituto Nacional de Câncer. Materiais e métodos: Trata-se de um estudo observacional, descritivo, transversal, retrospectivo, com base em dados secundários provenientes dos prontuários da instituição. Foram incluídos pacientes submetidos ao TCTH na instituição, no período de janeiro de 2020 a dezembro de 2023. As variáveis de interesse foram referentes às características epidemiológicas, diagnóstico e tratamento oncológicos e consulta odontológica na Instituição antes do TCTH. Os dados foram submetidos à análise descritiva no programa estatístico SPSS. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa responsável (CAAE 79133224.0.0000.5274; parecer 6.834.603). Resultados: Entre 2020 e 2023 foram realizados 276 TCTH na Instituição. Destes, 129 foram alogênicos e 147 autólogos, tendo 2023 (29,5%) e 2021 (32,7%) como os anos de maior número de transplantes, respectivamente. Dentre os pacientes submetidos ao transplante alogênico, a maioria era do sexo masculino (52,7%), com 40 anos e diagnosticados com Leucemia Mielóide Aguda (31,7%). Os transplantes alogênicos aparentados foram maioria (43,4%). No transplante autólogo, houve predominância de mulheres (59,9%), com 50 anos e diagnosticadas com Mieloma Múltiplo (42,2%). Para ambos os tipos de transplante, o sangue periférico foi a fonte de células mais utilizado, representando 64,3% nos alogênicos e 99,3% nos autólogos. A realização de consulta odontológica antes do TCTH, na Seção de Odontologia do hospital, ocorreu em 86,6% considerando ambos os transplantes, 77,5% nos transplantes alogênicos e 94,6% nos autólogos. Discussão: O tratamento citotóxico realizado antes do TCTH resulta em neutropenia e trombocitopenia transitórias, tornando o paciente suscetível a complicações como hemorragia e infecção, inclusive na cavidade oral, que podem ter consequências fatais. O preparo odontológico tem por objetivo a eliminação de focos infecciosos dentários crônicos ou agudos com a intenção de prevenir complicações durante e/ou após o tratamento que podem ocorrer devido a aplasia apresentada por esses pacientes. O encaminhamento dos pacientes para o cirurgião-dentista deve fazer parte do check list dos centros transplantadores. A avaliação em um serviço odontológico especializado que faz parte da equipe multiprofissional permite um atendimento realizado por profissionais com expertise na área permitindo um alinhamento do plano de tratamento com a equipe médica. Um estudo realizado em Edimburgo refere que 94,7% dos pacientes transplantados realizaram consulta odontológica prévia, o que se assemelha à taxa de encaminhamento observada para os transplantes autólogos neste estudo e é superior à constatada nos transplantes alogênicos. Vale ressaltar que os pacientes que não foram avaliados pelos cirurgiões-dentistas da Instituição podem ter sido avaliados nos hospitais de origem. Conclusão: A frequência de avaliação odontológica antes do TCTH no Instituto Nacional de Câncer foi alta para ambos os tipos de transplante, apesar de menor no transplante alogênico. Desta forma, ratifica-se a necessidade de educação continuada da equipe multiprofissional para reforçar o fluxo de encaminhamento, assim como, da importância de cirurgiões-dentistas especializados na Instituição para realizar o atendimento destes pacientes.

Objetivo: Descrever a perspectiva dos profissionais acerca do grupo de familiares destinado aos acompanhantes de pacientes da oncologia pediátrica. Método: Relato de experiência de profissionais da equipe assistencial sobre o grupo de acolhimento aos familiares da unidade de oncologia pediátrica em hospital de referência do sul do Brasil. A atividade é realizada semanalmente e coordenada por duas enfermeiras assistenciais, juntamente com a psicóloga da unidade. Resultados: Os encontros semanais são caracterizados por um espaço de acolhimento, em que ocorre a valorização do cuidador através de um momento de convivência social. É utilizado como um espaço de troca de experiência entre familiares a respeito da doença do seu filho, proporcionando o desenvolvimento de uma rede de apoio, assim como o fortalecimento de vínculos com a equipe assistencial. Por ser um espaço seguro e de educação em saúde, os profissionais ali presentes acabam desmistificando algumas temáticas, como também somando informações pertinentes sobre rotinas da unidade, cuidados a serem seguidos durante o tratamento. Além disso, são trabalhadas demandas psicológicas dos acompanhantes, as quais surgem durante o processo de tratamento da doença. Desta forma, novos questionamentos emergem, e as temáticas são adaptadas para serem abordadas de acordo com as necessidades expostas pelos familiares, trazendo uma devolutiva de novos assuntos em próximos grupos. Conclusão: Por meio deste momento semanal foi possível observar o fortalecimento do vínculo com a equipe assistencial. As famílias relatam sentir-se mais inseridas nos contextos do cuidado, gerando autonomia no que tange os conhecimentos acerca de temáticas que submergem durante o período da internação hospitalar. Além disso, proporciona um melhor entendimento do tratamento e seus impactos na vida cotidiana da família, promovendo um momento de protagonismo e de valorização do acompanhante.

Introduction: Multiple Myeloma (MM) represents a malignant proliferation of plasma cells derived from a single clone. Imaging of the skeleton beyond symptomatic areas is useful for myeloma staging and subsequent follow-up for treatment response and disease relapse. Despite research comparing the Dixon sequence to conventional sequences in a variety of musculoskeletal disorders, there is a lack of studies regarding the Dixon sequence’s application in MM. Aim: To compare the contrast of MM focal lesions in all four T2-weighted Dixon and Conventional T1-weighted spin-echo and Short Tau Inversion Recovery (STIR) images. Materials and Methods: This cross-sectional study was conducted in the Department of Radiology at Kovai Medical Centre and Hospitals (KMCH), Coimbatore, Tamil Nadu, India. All newly diagnosed and known cases of MM, either biopsy-proven or strongly suspected based on other diagnostic testing conforming to International Myeloma Working Group (IMWG) criteria from December 2020 to July 2022, were included in the study. A total of 43 patients with 142 focal MM lesions were included. Contrast between focal MM lesions and surrounding bone marrow was calculated on T1-weighted spin-echo, STIR, and T2-weighted Dixon (all four) images. Statistical analysis was done using repeated measures of Analysis of Variance (ANOVA) with Bonferroni correction to control the type I error on multiple comparisons to find the significant difference between multivariate analyses. A probability value of 0.05 was considered a significant level for all statistical tools. Results: The study population consisted of 21 men and 22 women with a mean age of 65.3±8.6 years {Mean±Standard Deviation (SD)}. Contrast values in all four T2 Dixon images, STIR, and T1-weighted images were as follows: T2 Dixon Fat-only (FO) images (0.86.±0.09) (SD); range: (0.46-0.99), T2-weighted Dixon Water-only (WO) images (0.54±0.14) (SD); range: (0.14-0.82), T2 Dixon In-phase (IP) images (0.20±0.13) (SD); range: (0.02-0.41), T2-weighted Dixon Out-phase (OP) images (0.53±0.19) (SD); range: (0.12-0.87), STIR images (0.47±0.12) (SD); range: (0.12-0.73), and T1 images (0.23±0.12) (SD); range: (0.01-0.55). The mean contrast was highest on T2 Dixon fat-only images (p

Industrial tuna and artisanal fisheries targeting multiple species in the eastern Pacific Ocean (EPO) interact with the Critically Endangered East Pacific (EP) leatherback turtle Dermochelys coriacea. In 2021, a revised Inter-American Tropical Tuna Commission (IATTC) resolution on sea turtles aimed to reduce sea turtle bycatch in EPO industrial tuna fisheries and ensure their safe handling and release. A new ecological risk assessment approach—Ecological Assessment for the Sustainable Impacts of Fisheries (EASI-Fish)—was used to assess vulnerability status and to better understand the potential efficacy of 70 scenarios that compared simulated conservation and management measures (CMMs) for EPO industrial (purse-seine and longline) and artisanal (longline and gillnet) fisheries to the status quo in 2019. In 2019, a fishing mortality proxy (F̃2019) and the breeding stock biomass per recruit (BSR2019) exceeded precautionary biological reference points (F80% and BSR80%), classifying the stock as ‘most vulnerable’. Industrial and artisanal longline fisheries had the highest impacts because they had the highest areal overlap with the modelled EP leatherback distribution. Of the 70 CMM scenarios, 42 resulted in significant improvements in vulnerability status (i.e. to ‘least vulnerable’). The use of large circle hooks, finfish bait, and best handling and release practices each decreased vulnerability; however, the most effective scenarios involved using these 3 measures in concert. The benefits predicted from EASI-Fish for CMM scenarios assume full compliance and attaining the modelled levels of efficacy, our modelling provides stakeholders with evidence-based recommendations to address key threats to EP leatherback turtles to improve their conservation status by reducing fishing impacts.

BackgroundThe biological characteristics of mosquito vectors vary, impacting their response to control measures. Thus, having up-to-date information on vector bionomics is essential to maintain the effectiveness of existing control strategies and tools, particularly as India aims for malaria elimination by 2030. ObjectiveThis study aims to assess the proportions of vector species resting indoors and outdoors, determine their preference for host biting/feeding, identify transmission sites, and evaluate the susceptibility of vectors to insecticides used in public health programs. MethodsMosquito collections were conducted in 13 districts across 8 Indian states from 2017 to 2020 using various methods to estimate their densities. Following morphological identification in the field, sibling species of Anopheles mosquitoes were identified molecularly using polymerase chain reaction (PCR)–specific alleles. Plasmodium falciparum and Plasmodium vivax infections in the vectors were detected using enzyme-linked immunosorbent assay (ELISA) and PCR assays. In addition, we assessed the insecticide susceptibility status of primary malaria vectors following the World Health Organization (WHO) protocol. ResultsAnopheles culicifacies, a primary malaria vector, was collected (with a man-hour density ranging from 3.1 to 15.9) from all states of India except those in the northeastern region. Anopheles fluviatilis, another primary vector, was collected from the states of Madhya Pradesh, Maharashtra, Karnataka, and Odisha. In Haryana and Karnataka, An. culicifacies sibling species A predominated, whereas species C and E were predominant in Madhya Pradesh and Maharashtra. An. culicifacies displayed mainly endophilic behavior across all states, except in Madhya Pradesh, where the proportion of semigravid and gravid mosquitoes was nearly half of that of unfed mosquitoes. The human blood index of An. culicifacies ranged from 0.001 to 0.220 across all study sites. The sporozoite rate of An. culicifacies ranged from 0.06 to 4.24, except in Madhya Pradesh, where none of the vector mosquitoes were found to be infected with the Plasmodium parasite. In the study area, An. culicifacies exhibited resistance to DDT (dichlorodiphenyltrichloroethane; with

Rationale Intracranial atherosclerotic disease (ICAD) is a pathological process that causes progressive stenosis and cerebral hypoperfusion, leading to stroke occurrence and recurrence around the world. The exact duration of dual antiplatelet therapy (DAPT) for ICAD is unclear in view of long-term risk of bleeding complications.Aim The current study aims to study the efficacy and safety of long-term DAPT (up to 12 months) in patients with ICAD.Sample size Using 80% power and an alpha error of 5 %, presuming a 10%–15% drop-out rate, a total of 2200 patients will be recruited for the study.Methodology This is a prospective, randomised, double-blind, placebo controlled trial.Study outcomes The primary outcomes include recurrent ischaemic stroke (IS) or transient ischaemic attack and any intracranial haemorrhage (ICH), major or minor systemic bleeding at the end of 12 months. Secondary outcomes include composite of any stroke, myocardial infarction or death at the end of 12 months. The safety outcomes include any ICH, major or minor bleeding as defined using GUSTO (Global Use of Streptokinase and tPA for occluded Coronary Arteries) classification at the end of 12 months and 1 month after completion of the drug treatment phase.Discussion The study will provide level I evidence on the duration of DAPT among patients with IS due to ICAD of more than or equal to 50%.

Introduction: Coronavirus Disease 2019 (COVID-19) is associated with an increased risk of Venous Thromboembolism (VTE) and coagulopathy. The available studies have shown the anticoagulant and mucolytic effects of nebulised heparin in non COVID-19 patients. Hence it was decided to conducted to study the efficacy of nebulised heparin in patients suffering from COVID-19 pneumonia requiring mechanical ventilation. Aim: To evaluate the safety and efficacy of nebulised heparin administered to patients with COVID-19. Materials and Methods: A double-blinded randomised controlled trial was conducted at Basaveshwara Medical College and Hospital in Chitradurga, Karnataka, India among 100 patients with COVID-19 who required mechanical ventilation from February 2021 to May 2021. They were randomly assigned to two equal groups of 50 patients each. One group received nebulised heparin, and the other group received a placebo. The patients were compared for baseline characteristics, coagulation characteristics, and Oxygen Saturation (SpO2 ). Data were analysed using Statistical Package for Social Sciences (SPSS) version 22.0, expressed as frequency and percentages, and displayed in tables and figures. The association between two variables was determined using the Chi-square test and paired t-test. Results: The two groups did not differ significantly in terms of age, sex, respiratory failure, vasopressin use, and severity score. Respiratory failure was present in 54% of the heparin group and 38% of the placebo group. Vasopressin was used in 64% of the heparin group and 56% of the placebo group. The severity score was 4.44 in the heparin group and 4.42 in the placebo group. Activated Partial Thromboplastin Time (APTT) levels did not differ significantly between the groups. None of these parameters showed significant differences between the heparin and placebo groups. However, both groups showed a significant difference in Thrombin Antithrombin (TAT) complex levels from baseline to follow-up (p

Abstract Background Precise prognostication is the key to optimum and effective treatment planning for early-stage hormone receptor (HR) positive, HER2/neu negative breast cancer patients. Differences in the breast cancer incidence and tumor anatomical features at diagnosis, pharmacogenomics data between Western and Indian women along with the vast diversity in the economic status and differences in insurance policies of these regions; suggest recommendations put forward for Western women might not be applicable to Indian/Asian women. Opinions from oncologists through a voting survey on various prognostic factors/tools to be considered for planning adjuvant therapy are consolidated in this report for the benefit of oncologists of the sub-continent, SAARC and Asia’s LMIC (low and middle-income countries). Methods A three-phase DELPHI survey was conducted to collect opinions on prognostic factors considered for planning adjuvant therapy in early-stage HR+/HER2/neu negative breast cancer patients. A panel of 25 oncologists with expertise in breast cancer participated in the survey conducted in 2021. The experts provided opinions as ‘agree’ or disagree’ or ‘not sure’ in phases-1 and 2 which were conducted virtually; in the final phase-3, all the panel experts met in person and concluded the survey. Results Opinions on 41 statements related to prognostic factors/tools and their implications in planning adjuvant endocrine/chemotherapy were collected. All the statements were supported by the latest data from the clinical trials (prospective/retrospective). The statements with opinions of consensus less than 66% were disseminated in phase-2, and later in phase-3 with supporting literature. In phase-3, all the opinions from panelists were consolidated and guidelines were framed. Conclusions This consensus guideline will assist oncologists of India, SAARC and LMIC countries in informed clinical decision-making on adjuvant treatment in early HR+/HER2/neu negative breast cancer patients.

Abstract Background Hypertension is the second leading risk factor for death in South Africa, and rates have steadily increased since the end of Apartheid. Research on the determinants of hypertension in South Africa has received considerable attention due to South Africa’s rapid urbanization and epidemiological transition. However, scant work has been conducted to investigate how various segments of the Black South African population experience this transition. Identifying the correlates of hypertension in this population is critical to the development of policies and targeted interventions to strengthen equitable public health efforts. Methods This analysis explores the relationship between individual and area-level socioeconomic status and hypertension prevalence, awareness, treatment, and control within a sample of 7,303 Black South Africans in three municipalities of the uMgungundlovu district in KwaZulu-Natal province: the Msunduzi, uMshwathi, and Mkhambathini. Cross-sectional data were collected on participants from February 2017 to February 2018. Individual-level socioeconomic status was measured by employment status and educational attainment. Ward-level area deprivation was operationalized by the most recent (2011 and 2001) South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and diabetes diagnosis. Results The prevalence of hypertension in the sample was 44.4% (n = 3,240). Of those, 2,324 were aware of their diagnosis, 1,928 were receiving treatment, and 1,051 had their hypertension controlled. Educational attainment was negatively associated with hypertension prevalence and positively associated with its control. Employment status was negatively associated with hypertension control. Black South Africans living in more deprived wards had higher odds of being hypertensive and lower odds of having their hypertension controlled. Those residing in wards that became more deprived from 2001 to 2011 had higher odds of being aware of their hypertension, yet lower odds of receiving treatment for it. Conclusions Results from this study can assist policymakers and practitioners in identifying groups within the Black South African population that should be prioritized for public health interventions. Black South Africans who have and continue to face barriers to care, including those with low educational attainment or living in deprived wards had worse hypertension outcomes. Potential interventions include community-based programs that deliver medication to households, workplaces, or community centers.

Abstract Background HIV remains an epidemic of major public health importance in Cameroon but a decline in HIV prevalence has been observed according to population-based surveys conducted in 2004, 2011 and 2018. We sought to review current evidence for declining HIV prevalence despite increasing survival owing to ‘universal test and treat’ and to explore the reason for the decrease, particularly the role of behavioural change. Methods We conducted a secondary analysis using HIV prevalence, behavioural and social determinants data of the Demographic and Health Survey Program databases. Trend lines were fitted to data that were available for a minimum of three points in time during the 1991–2018 period. Regression coefficients associated p-values and 95% confidence intervals were obtained using Microsoft Excel software. Results Overall adult HIV prevalence decreased significantly from 5.4% (95%CI: 4.8-6.0) in 2004 to 4.3% (95%CI: 3.8–4.8) in 2011 and further down to 2.7% (95%CI: 2.3–3.1) in 2018 at a rate of about 1.4% every septennium (β = -1.4, R² = 0.98, p = 0.03). Yet, the number of persons surviving with HIV increased from about 0.05 million in 1991 to 0.5 million in 2018 corresponding to an increase in access to antiretroviral therapy from less than 10% to universal coverage of 80% respectively. Concurrent reductions in risky sexual behaviours were observed: a delayed sexual debut by one year, decreased sexual violence by 7%, decreased polygamous unions by 16%, decreased multiple sexual partners by 15.3% and increased condom use by 26.3%. Conclusion The observed decline in HIV prevalence is statistically valid and reflects the observed decline in risky sexual behaviour that need to be sustained by the National HIV programme. Though universal access to ART has increased the number of persons surviving with HIV, this has not led to an increased prevalence of HIV in a setting with a rising population.

Sickle cell anemia (SCA) is one of the types of sickle cell disease (SCD), which is characterized by hematological events such as hemolysis and endothelial damage that culminate in vaso-occlusion, leading to the appearance of several clinical manifestations. SCD is the result of erythrocyte alteration conditioned by a mutation in the HBB gene that leads to the formation of hemoglobin S (HbS). Fetal hemoglobin (HbF) is known to positively affect the clinical condition of individuals with SCA, by interfering with the role of HbS in erythrocyte alteration. Genetic polymorphisms are known to positively modulate clinical phenotypes of SCD, with the BCL11A gene being an important marker in this regard. However, polymorphisms in the BCL11A gene have been described as negatively change the clinical status of patients with SCD. The aim of this present study was associate laboratory biomarkers in the presence of polymorphisms rs766432 (C>A) and rs6732518 (C>T) in the BCL11A gene. Hematological and biochemical markers were investigated by automated methods and genetic markers were identified by polymerase chain reaction and Restriction Fragment Length Polymorphism (PCR-RFLP) techniques. Statistical analyses were performed using the GraphPad Prism software, version 9.0. HbF showed a statistically significant association in the presence of the rs766432 polymorphism (p = 0.0306) as well as simultaneously with the rs6732518 polymorphism (p = 0.0302), and HbS concentration (p = 0.0464). The concentration of hemoglobin (Hb) (p = 0.0008), hematocrit (Ht) (p = 0.0243) (p = 0.0329) and red blood cell count (RBC) (p = 0.0069) (p = 0.00466) were high in the presence of polymorphisms. Total (p = 0.0264) and direct (p = 0.0039) bilirubin concentration showed lower values in the presence of the rs766432 polymorphism, as well as in the co-inheritance of both polymorphisms (p = 0.0073) (p = 0. 0154). High concentrations of HDL cholesterol were associated with the presence of the variant allele of the polymorphism rs766432 (p = 0.0402) and high levels of alpha1-antitrypsin were associated with the presence of the variant allele of the polymorphism rs6732518 (p = 0.0320). There was no correlation between HbF and HDL (r = 0.03705). It is concluded that polymorphisms in the BCL11A locus are important for the variation in HbF levels, and that they may have a pleiotropic effect by determining laboratory parameters not related thus hemoglobin.

Introdução/Objetivos: Em 1960 Peter Nowell e David Hungerford identificaram o cromossomo Filadélfia, que mais tarde foi descoberto ser o responsável pela produção do gene BCR-ABL. Esse oncogene ativa várias vias de sinalização durante a maturação das células mieloides na medula óssea, o que resulta em maior adesão celular ao estroma e à matriz extracelular, inibição da apoptose e aumento da capacidade de proliferação e de sobrevivência celular. O gene anormal BCR-ABL induz a perpetuação da atividade da enzima tirosinoquinase, cuja atividade aumentada é o fator causal principal para o desenvolvimento da Leucemia Mieloide Crônica (LMC). No início do século XX, o principal tratamento consistia no uso do arsênico, radioterapia do baço, bussulfano e um agente alquilante. No entanto, o primeiro tratamento capaz de provocar remissão citogenética foi o interferon-α em meados da década de 80. Em 1996, o tratamento da LMC foi revolucionado pelo advento do composto CPG57148, um inibidor de tirosinoquinase da classe 2-fenil-aminopirimidina, e, em 2001, pelo mesilato de imatinibe, outro inibidor da tirosinoquinase, só que mais específico, agora com a alcunha de TKI (do inglês, tyrosine kinase inhibitor). O objetivo do presente trabalho visa descrever a histórica compreensão da patogênese da LMC e evidenciar as mudanças em seu tratamento com o passar do tempo, algo que impactou de maneira sensível o prognóstico da doença. Materiais e métodos: Foi realizada uma busca por artigos sobre o tema na base de dados do PUBMED a partir do ano 1979. Foram utilizados os descritores: Chronic Myeloid Leukemia e Treatment or therapy. Foram obtidos 17.328.811 artigos, desses, 79 artigos foram escolhidos por apresentarem o tema relacionado a fatos históricos relevantes para o objetivo deste projeto revisional. Resultados: Seis TKIs estão atualmente aprovados – imatinibe, dasatinibe, nilotinibe, bosutinibe, ponatinibe e radotinibe (esse apenas na Coreia do Sul). Imatinibe é referido como um TKI de primeira geração (1G), dasatinibe, nilotinibe, bosutinibe e radotinibe são TKIs de segunda geração (2G) e ponatinibe é um TKI de terceira geração. Todos compõem, atualmente, a primeira escolha de tratamento para LMC, pois mantém a sobrevida de um paciente com LMC semelhante a sobrevida de um indivíduo sadio. Discussão: Os TKIs diferem em sua potência, atividade contra mutantes BCR/ABL, farmacocinética e perfis de efeitos adversos. Porém, independente da escolha por um determinado TKI, o fato é que houve uma mudança positiva brutal na sobrevida dos pacientes, considerando antes e após a introdução do primeiro TKI - imatinibe - como o precursor da nova era de tratamento. A tal ponto que o transplante de medula óssea, que antes era considerado uma importante opção curativa de tratamento, agora se tornou apenas razoável naquele percentual de casos refratários ao uso de TKIs. Antigamente, o objetivo era retardar a progressão para a fase blástica, minimizar os sintomas e aumentar a sobrevida global. Hoje, buscam-se novos resultados, tais como manter a remissão da doença após a descontinuação do TKI. Conclusão: Houve uma melhora significativa na sobrevida dos pacientes com o advento dos TKIs, algo que impulsionou a indústria terapêutica para uma nova era de abordagem de muitas outras doenças por meio da terapia-alvo.

Introdução/Objetivos: Trombose e plaquetopenia podem apresentar-se de maneira síncrona durante a manifestação da doença causada pelo coronavírus SARS-CoV-2, COVID-19 (do inglês, Coronavirus disease 2019), denominada, em inglês, pela sigla TTS (Thrombosis with thrombocytopenia syndrome), ou ainda, como manifestação pós-vacinal para esse vírus, situação denominada em inglês, pela sigla VITT (Vaccine-induced immune thrombotic thrombocytopenia). Em ambos os casos, se trata de uma emergência médica e ainda possui como fatores de confusão outros diagnósticos diferenciais que podem mimetizar tal situação crítica, o que obriga o médico a ser rápido no diagnóstico e no descarte dos diagnósticos diferenciais, e preciso na abordagem clínica. O objetivo do presente trabalho visa evidenciar as características dessa apresentação clínica, bem como apresentar os prováveis diagnósticos diferenciais através de uma revisão bibliográfica. Materiais e métodos: Foi realizada uma busca por artigos de revisão sobre o tema na base de dados do PUBMED a partir de janeiro de 2020. Foram utilizados os descritores: thrombosis, thrombocytopenia, vaccine-induced immune thrombotic thrombocytopenia, thrombosis with thrombocytopenia syndrome e differential diagnosis. A busca resultou em 3.071 artigos, dos quais, foram escolhidos 52 artigos por apresentarem o tema de forma mais precisa e abrangente. Resultados: Entre as possíveis causas sugeridas, a mais em voga é que a proteína Spike do coronavírus esteja envolvida diretamente, tanto na patogênese da plaquetopenia, quanto nos eventos de trombose. Discussão: Durante a infecção pelo vírus, ensaios clínicos têm sugerido que a proteína Spike se liga no receptor da enzima conversora de angiotensina-2, o que desencadearia a ativação da via complemento e, por consequência, vasoconstrição e lesão endotelial. Por outro lado, proteínas do complemento ativariam os neutrófilos, que, por meio de armadilhas extracelulares de neutrófilos (sigla em inglês, NETs), ativariam a cascata de coagulação, o que, na soma dos eventos, poderia provocar trombose. Na situação pós-vacinal, os ensaios clínicos também têm sugerido que a patogênese está associada ao epítopo Spike, que induziria a liberação, pelas plaquetas, do PF4 (sigla em inglês, para platelet factor 4). O DNA viral e/ou seu capsídeo formariam um complexo PF4/poliânion, que induziria a formação de anticorpos anti-PF4 e, por consequência, eventos pró-trombóticos. Estudos sugerem que tanto a trombocitopenia durante a infecção pelo Sars-Cov-2, quanto aquela pós-imunização poderiam ocorrer como resultado da ativação da coagulação ou por consequência de processo inflamatório provocado pela presença da própria proteína Spike, que geraria destruição plaquetária e dano endotelial sistêmico. Diante disso, faz-se necessário o diagnóstico diferencial principalmente com trombocitopenia induzida por heparina, púrpura trombocitopênica trombótica, síndrome do anticorpo antifosfolipídeo, coagulação intravascular disseminada e hemoglobinúria paroxística noturna. Conclusão: A compreensão cada vez maior da relação da proteína Spike com eventos de trombose e de trombocitopenia poderão promover a geração de exames laboratoriais que auxiliem o diagnóstico rápido e preciso desta emergência médica, seja no combate às consequências da infecção pelo vírus Sars-Cov-2, ou seja para prevenção de situações críticas pós-vacinação.

Introdução: A transfusão de hemocomponentes é um procedimento médico essencial para o tratamento de pacientes com diferentes condições de saúde, como anemias, traumas, distúrbios de coagulação e certas doenças crônicas. No entanto, o descarte de hemocomponentes é uma prática comum em agências transfusionais, seja por motivos relacionados à qualidade ou por razões de segurança, o que pode resultar em desperdício e impacto financeiro significativo. Neste estudo, investigamos o padrão de descarte de hemocomponentes em agências transfusionais em São Paulo e os motivos subjacentes para tal prática. Metodologia: Foram coletados dados de 25 agências transfusionais de hospitais particulares em São Paulo, totalizando 10.335 descartes de hemácias, plaquetas, plasma e crioprecipitados. Os hemocomponentes foram separados de acordo com os tipos sanguíneos (A, B, AB e O) e fatores Rh (positivo e negativo). Além disso, os motivos específicos para o descarte de cada hemocomponente foram registrados, incluindo validade vencida, abertura do sistema, não utilização de hemocomponente, hemocomponente com tesde de Coombs positivo, bolsa acidentada, bolsa hemolisada ou lipêmica, bolsa com baixo volume e por questões de segurança. Resultados: No ano de 2022 foram descartados 10.335 hemocomponentes, dentre eles 68% concentrados de plaquetas, 15% concentrado de hemácias, 13% plasma fresco congelado e 4% crioprecipitados. Quando analisamos os motivos dos desprezos 82% é devido a validade vencida, dentre esses, a maior porcentagem é de concentrado de plaquetas, pois, a validade desse hemocomponente é de apenas 3 a 5 dias úteis, não tendo tempo hábil de realizar o remanejamento para outras unidades ou o volume desse hemocomponente esteja excedente em determinados períodos do mês. Analisamos que apenas 0,5% dos motivos é por segurança, consequência do efetivo controle de qualidade estabelecido no banco de sangue que atende essas agências transfusionais. O tipo de hemácia que mais foi desprezado no ano de 2022 foi B+ com 27% em relação ao total de hemácias, seguido de AB+ com 23% em relação ao total de hemácias. O tipo sanguíneo de concentrado de plaqueta mais desprezado em 2022 foi O+(41%) e A+(31%), o tipo sanguíneo O+ e A+ foram os mais desprezados relacionados ao plasma fresco congelado ambos com 30% do total de plasmas desprezados, os mesmos tipos sanguíneos foram os mais descartados quando observamos os resultados de crioprecipitados O+ 33% e A+ 25%. Conclusão: A análise dos dados dos descartes dos hemocomponentes de 25 hospitais particulares do estado de São Paulo no ano de 2022 demonstrou que o maior número de descartes é devido a validade dos hemocomponentes e o concentrado de plaquetas foi o hemocomponente mais desprezado devido o tempo curto de validade. Podemos avaliar que os concentrados de hemácias mais desprezados foram aqueles em que são descritos em literatura que a porcentagem da população que possuem esses tipos sanguíneos é menor (B+ e AB+). Vimos que o controle de qualidade e as barreiras realizadas no banco de sangue, que abastece essas unidades são eficazes, devido aos baixos índices de hemocomponentes descartados por segurança. Os resultados sugerem que necessitamos de estratégias para diminuir o desprezo dos hemocomponentes sem que haja impacto ao atendimento dos pacientes que necessitam de transfusão.

Introdução: Segundo dados da Organização Mundial da Saúde (OMS), a anemia é um indicador de má nutrição e problemas de saúde e afeta mais de 2,9 bilhões de pessoas na população, sendo, portanto, considerada um problema de saúde pública mundial, afetando negativamente a vida de bilhões de pessoas que se consideram relativamente saudáveis. Sabemos que boa parte dessas pessoas desconhece esse diagnóstico, mas já pode estar apresentando os sintomas mais frequentes. como fraqueza, cansaço, dores de cabeça e irritabilidade, entre outros. Se a anemia piorar, evolui com dispneia, tontura, sangramento menstrual anormal ou úlceras na boca. Pensando na importância dessa conscientização e fazendo parte integrante da implementação do PBM (Patient Blood Management) no Hospital do Coração (Hcor) – SP, foi feito uma conscientização “in loco” com os colaboradores do hospital, realizado no Dia Mundial da Conscientização da Anemia, 13 de fevereiro. Metodologia: Utilizamos um aparelho específico de tecnologia israelense aprovado pela ANVISA, que faz uma análise fotoplestimográfica do tecido capilar da ponta de dedo em segundos, para realizar a triagem hematimétrica dos colaboradores do hospital em um único dia, no período de 8 horas. Utilizamos como valor de corte para anemia os valores de hemoglobina preconizados pela OMS, sendo 13 g/dL para os homens e 12 g/dL para mulheres. Os colaboradores com exames alterados foram encaminhados para a equipe que atua com medicina do trabalho. Essa ação incluiu também a divulgação de conceitos de anemia em posts divulgados pelo e mail corporativo e canais oficiais do hospital. Resultados: Foram avaliados 185 colaboradores no período, sendo 122 (66%) do sexo feminino e 63 (34%) do sexo masculino. No total 7,5% dos exames de triagem se mostraram alterados (4 homens e 10 mulheres) e nenhum deles tinha conhecimento do diagnóstico prévio. Um fator relevante, foi o predomínio do sexo feminino nos exames alterados, ratificando a causa mais comum da anemia em nosso meio, que é a deficiência de ferro e seu tratamento envolve a identificação do motivo dessa falta. Em geral está relacionado a uma combinação na redução do aporte de ferro (dietas alimentares) e perda de ferro (sangramentos menstruais excessivos). Isso pode explicar, o grande interesse demonstrado pelos participantes avaliados, principalmente em poder realizar de forma rápida e simples um exame de anemia, como forma de conscientização, mostrando a importância de ações mais regulares. Conclusão: Um dos principais desafios de implantação do PBM é a mudança da cultura institucional. Nesse contexto, se insere essa ação que buscou a conscientização dos funcionários de um hospital geral para a anemia e seu impacto nos desfechos clínicos, oque em última análise reflete-se na prática junto aos pacientes

Climate change is resulting in decreased sea ice extent and increased industrial activity in Arctic regions. In northern Alaska, USA, sea ice loss has increased the frequency of land-based polar bear Ursus maritimus maternal dens, leading to greater potential for overlap between industrial activities and denning bears. Responses of denning bears to human disturbance could result in costly reproductive outcomes, although observation of these responses is logistically challenging and expensive. We developed a method to standardize the process of classifying the response of denning polar bears to disturbance using decision rules based on polar bear biology and denning chronology. We applied this method to 46 maternal polar bear dens exposed to human activity (e.g. vehicle traffic, ground-based monitoring). Because the timing of disturbance influences the response and subsequent fitness consequences, we determined outcomes specific to 4 denning periods: (1) den establishment (excavation to cub birth); (2) early denning (cub birth to 60 d old); (3) late denning (60 d old to emergence); and (4) post-emergence (emergence to den site departure). We classified the outcomes of 79 exposures as 37 having ‘no documented effect’ (no observed response), 7 as ‘behavioral’ (observed behavioral disruption), 17 as ‘early emergence’ (den emergence occurring earlier than an undisturbed emergence), 14 as ‘early departure’ (den site abandonment post-emergence earlier than if undisturbed), and 4 as ‘cub mortality’ (death or abandonment of ≥1 cub). Outcomes with potential fitness consequences occurred in every denning period. Our classification method facilitated a standardized approach that can be used to classify the outcome of den disturbance. Determining outcomes in relation to a specific denning period may facilitate improved implementation of mitigation strategies to reduce disturbance to denning bears.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the agent of a major global outbreak of respiratory tract disease known as Coronavirus Disease 2019 (COVID-19). SARS-CoV-2 infects mainly lungs and may cause several immune-related complications, such as lymphocytopenia and cytokine storm, which are associated with the severity of the disease and predict mortality. The mechanism by which SARS-CoV-2 infection may result in immune system dysfunction is still not fully understood. Here, we show that SARS-CoV-2 infects human CD4+ T helper cells, but not CD8+ T cells, and is present in blood and bronchoalveolar lavage T helper cells of severe COVID-19 patients. We demonstrated that SARS-CoV-2 spike glycoprotein (S) directly binds to the CD4 molecule, which in turn mediates the entry of SARS- CoV-2 in T helper cells. This leads to impaired CD4 T cell function and may cause cell death. SARS-CoV-2-infected T helper cells express higher levels of IL-10, which is associated with viral persistence and disease severity. Thus, CD4-mediated SARS-CoV-2 infection of T helper cells may contribute to a poor immune response in COVID-19 patients.

Introduction Kidney transplant candidates (KTCs) need to be in optimal physical and psychological condition prior to surgery. However, KTCs often experience compromised functional capacity which can be characterised as frailty. Prehabilitation, the enhancement of a person’s functional capacity, may be an effective intervention to improve the health status of KTCs. The PREhabilitation of CAndidates for REnal Transplantation (PreCareTx) study aims to examine the effectiveness of a multimodal prehabilitation programme on the health status of KTCs, and to explore the potential of implementation of prehabilitation in daily clinical practice.Methods and analysis This study uses a single centre, effectiveness-implementation hybrid type I study design, comprised of a randomised controlled trial and a mixed-methods study. Adult patients who are currently on the transplant waiting list or are waitlisted during the study period, at a university medical centre in The Netherlands, will be randomly assigned to either prehabilitation (n=64) or care as usual (n=64) groups. The prehabilitation group will undergo a 12-week home-based, tailored prehabilitation programme consisting of physical and/or nutritional and/or psychosocial interventions depending on the participant’s deficits. This programme will be followed by a 12-week maintenance programme in order to enhance the incorporation of the interventions into daily life. The primary endpoint of this study is a change in frailty status as a proxy for health status. Secondary endpoints include changes in physical fitness, nutritional status, psychological well-being, quality of life and clinical outcomes. Tertiary endpoints include the safety, feasibility and acceptability of the prehabilitation programme, and the barriers and facilitators for further implementation.Ethics and dissemination Medical ethical approval was granted by the Medical Ethics Committee Groningen, Netherlands (M22.421). Written informed consent will be obtained from all participants. The results will be disseminated at international conferences and in peer-reviewed journals.Trial registration number ClinicalTrials.gov, NCT05489432.

The experiments were conducted at Agro Climate Research Centre, TNAU, Coimbatore. Calibration and validation of AquaCrop model was done using Winter and Kharif, 2022 data. Calibration showed that AquaCrop accurately simulated the canopy cover by low RMSE≤13.1%, good E≤0.76, high d≤0.94 and high R2 values ≥0.98 and biomass development by low RMSE≤13.2%, high E≤0.92, good d≤0.68 and high R2 values ≥0.95. During calibration, model well-simulated the CC under second sowing (D2) and biomass under third sowing (D3). Validation showed almost good fit of CC by low RMSE≤22.0%, good E≤0.68, high d≤0.84 and high R2 values ≥0.97 and biomass development with low RMSE≤7.1%, good E≤0.66, good d≤0.60 and high R2 values ≥0.98. During Validation, model well-simulated the CC and biomass under third sowing (D3). Model showed good fit of yield during first sowing window (D1) with a less deviation for both calibration and validation (15.6% and 5.8% respectively). From the result it could be concluded that sowing windows influence on baby corn production was accurately simulated using AquaCrop during calibration (R2=0.94) and validation (R2=0.98). Hence, AquaCrop proved to be a feasible tool for maximizing the Baby corn yield under different sowing windows.

Objective:The incidence of female breast cancer in the world is 11.7% with a mortality rate of 6.9%. According to Globocon 2020, breast cancer is the most commonly diagnosed cancer (24.5%) and the leading cause of cancer-related death amongst women worldwide. The purpose of this study was to analyze the impact of Body Mass Index (BMI) on pathological complete response (pCR) rates for operable breast cancer after neoadjuvant chemotherapy (NACT). The primary endpoint was to assess histopathological features of the surgical specimen in response to NACT and to investigate the relationship with pre-chemotherapy BMI taking into account the various molecular subtypes of breast cancer.Materials and Methods:Patients with biopsy-proven breast carcinoma who underwent surgery after NACT between January 2017 and May 2021 were included. All patients were initially divided into three groups depending on their pre-chemotherapy BMI. With BMI

The study aimed at exploring the critical enablers to the development and usage of information security governance frameworks for cloud computing in Uganda. The study was motivated by the continuous information security governance challenges in the Public Cloud. The theoretical frameworks that underpinned this study included; Contingency management theory, the Risk Management framework, the Technological Organisational and Environmental (TOE) model and the Information Security Governance model. This study adopted a quantitative research approach to obtain data through a survey. Five key factors for information security governance were identified: a) Technological factors: flexibility, scalability, availability, agility, data protection governance, trust of cloud, data source, maintenance, data retention and policy. b) Organisation: size and structure of the organisation, top management support. c) Environmental factors: governance and regulation, marketing, vendor, resource availability, obsoleteness. d) Individual: user resistance, attitude, skills, belief and learnability. e) Risk management and control factors: risk assessment, disaster recovery, access and authorisation control, monitoring, auditing, and process risk control. The study contributes to theory and practice in information security. The developed framework and its accompanying model helped to inform public departments, organisational top management and information security strategies to avoid excessive information risks and potential regulatory compliance failures in public cloud. The study was inclined on subjective information security, which alone may not fully address all information security problems in a public cloud. Therefore, it is recommendable that future research studies on objective security in public cloud

Haematological malignancies are at a high risk of fungal infection and subsequent high mortality. A patient with a relapsed acute lymphocytic leukaemia (ALL) and a rare fungal infection is presented. A four-year-old patient with ALL relapsed after 3 years of remission. He presented with a papular, erythematous rash mainly on the limbs and trunk, accompanied with high intermittent fever which did not respond to broad spectrum antibiotics. Histopathological examination of a skin biopsy revealed yeast cells. Trichosporon species was isolated on culture. Voriconazole was started according to sensitivity test results and a brief response was demonstrated. Clinical deterioration was seen with worsening of the underlying malignancy. Amphotericin B was added with poor response. Unfortunately, he succumbed to his disease process without recovery from fever, skin rash or the malignancy. Trichosporon species is a rare infection even in patients with haematological malignancies. Recovery from neutropenia is an important prognostic factor in the treatment of trichosporonosis.

Abstract Amit Rauthan Introduction Nivolumab monotherapy is approved for the treatment of metastatic renal cell carcinoma (mRCC) patients who have progressed on prior therapies based on the pivotal Checkmate-025 trial. There is limited literature on the efficacy and safety profile of usage of nivolumab in the treatment of mRCC in India in a real-world setting. Methods A retrospective analysis was performed of patients who received nivolumab monotherapy for mRCC after having progressed on prior therapies. Tumor response was graded according to RECIST v1.1 and Kaplan–Meier survival analysis was used to estimate progression-free survival (PFS) and overall survival (OS). Immune-related adverse events (irAEs) were documented and graded according to CTCAE v5.0. Results Between 2016 and 2019, 35 patients received nivolumab for mRCC at our center after progression on prior therapies. A majority of the patients (n = 30, 85.7%) received it in a second-line setting, and the remaining in the third line and beyond setting. Clear cell was the most common histology (n = 26, 74.3%). There were 18 patients (51.42%) who belonged to IMDC intermediate risk, while 17 (48.58%) patients were at poor risk. The overall response rate was 60%, with complete response (CR) in 11.4%. Median duration of response was not reached among responders. Median PFS was 5 months (95% confidence interval [CI]: 3.06–6.93) and median OS was 26 months (95% CI: 1.90–50.09). Ongoing survival of 47, 42, 34, and 22 months was noted in four patients with CR, respectively. In our study, 23 patients (65.71%) experienced any grade of irAE. Grade 3 irAEs was seen in four patients (11.42%). Most common irAE was thyroid dysfunction seen in 12 patients (34.2%). Treatment discontinuation due to irAEs occurred in three patients (8.57%). Conclusion Nivolumab showed good efficacy with high response rates and an OS comparable to the pivotal Checkmate-025 trial. It was well tolerated with safety profile in terms of irAE consistent with those reported in literature.

Improved Human Resources Performance can be realized in the employee’s absence. The sophistication of technology to accommodate the absence is the use of a Mobile-Based Attendance Application. Attendance can be used to measure employee performance. One of the measuring tools in measuring performance is the Key Performance Indicator (KPI). KPI values can be obtained from the Mobile-based Attendance Application, as currently implemented by an IT Company. But in its development, there is a shortage on the application features of Daily Attendance, Leave, Report Recaps Attendance and Report Recaps Leave. The value engineering method with the Analytical Hierarchy Process is used in this paper to obtain prioritized alternatives in the development of application feature updates. The results of the research show that the alternative with the largest percentage is owned by Alternative IV (45.6%). These results indicate that this alternative can be used as a recommendation for renewal of attendance application features on IT Company. Alternative IV shows optimal results such as the realization of application feature requirements for users, consumption of fewer workdays for 1-2 days, low costs, easy-to-understand feature design, and uncomplicated programming techniques.

The need for significant infrastructure development in Nigeria; the high demand for cement; the challenges associated with the disposal of agricultural waste; and—most significantly—the emission of CO2 associated with cement production and use, which has a negative impact on the environment, have created opportunities for research in the construction sector. The urgent need for researchers to explore substitute materials that may sustainably replace cement in the construction sector has also been prompted by the necessity to manage Nigeria’s natural resources. This paper investigates the properties of hollow blocks produced by replacing cement with nanosilica produced from rice husk waste at 1%, 2%, 3%, 4%, and 5% in order to assess the impact on the hollow block’s strength. The hollow blocks have four mixes: cement-to-sand ratios of 1:4, 1:6, 1:8, and 1:10 for different curing durations (1, 3, 7, 14, 28, and 56 days by spraying water). The results from the findings showed that the nanosilica produced from rice husk ash and used in this study are a good reactive pozzolana with particle sizes in the range of 1–49 nm, with majority of the particles within 1–7 nm. Hollow blocks produced at 1, 2, 3, 4, and 5% replacement by weight of cement (nanosilica-crete) proved stronger than hollow blocks produced at 0% cement replacement (conventional sandcrete), with an optimal nanosilica percentage replacement of 3% by weight of cement.

Saat ini permintaan akan gerabah mengalami penurunan yang cukup signifikan karena jumlah penggunaan yang semakin berkurang. Meski produksinya tampak menurun, para perajin gerabah di Bali masih terus membuat produk warisan leluhur ini. Pengrajin meyakini bahwa gerabah merupakan hasil alam yang mampu menjalankan fungsinya dalam berbagai peran dalam kehidupan budaya di Bali. Artikel ini akan mengkaji fungsi gerabah Bali dalam hubungan manusia dengan alam dalam konteks budaya Bali. Analisis menggunakan teori fungsi kompleks dalam aspek fungsi dari Papanek. Konsep Pangider Bhuwana dan Tri Hita Karana digunakan untuk memahami fungsi gerabah Bali dalam konteks budaya spiritual. Hasilnya, peran gerabah dalam kehidupan masyarakat Hindu Bali yaitu gerabah sebagai alat, menjalankan fungsi praktis untuk peralatan rumah tangga; gerabah sebagai komunikasi, berupa ornamen, memberikan informasi, misalnya tentang jenis bangunan, gengsi, dan status pemiliknya; gerabah sebagai simbol, adalah gerabah sebagai upakara dalam upacara agama Hindu. Penggunaan gerabah di Bali masih penting, terutama dalam konteks adat dan ritual karena gerabah mencerminkan hubungan yang kuat antara manusia dan alam. Unsur-unsur alam yang terkandung dalam gerabah melambangkan unsur-unsur yang terkandung dalam tubuh manusia. Kata kunci: gerabah, fungsi, relasi

Graphitic carbon nitride/niobium oxide (g-C3N4/Nb2O5) heterostructure within a hyperbranched polyethyleneimine (HPEI) template was prepared via the in-situ hydrothermal method. This heterostructure was embedded for a polyethersulfone (PES) polymer matrix using the phase inversion technique and applied on the photodegradation of tetracycline pollutant in water. To determine the structural formation of the membranes Fourier transform infrared spectroscopy (FTIR) was used. The hydrophilicity, water flux and morphology of the fabricated nanocomposite were investigated using water contact angle and SEM techniques, respectively. The nanocomposite membranes showed improved hydrophilicity from 60° up to 48° as compared to pure PES (65°). Furthermore, adding the heterostructure to the PES matrix improved the morphological features of the nanocomposite membrane resulting in large macrovoids and reduced pore size. The performance, pathway and mechanism of the tetracycline photocatalytic degradation by the g-C3N4/Nb2O5/HPEI/PES photocatalytic membrane were investigated using liquid chromatography-mass spectrometry (LC-MS). Tetracycline, as an active pharmaceutical compound, was fragmented into seven innocuous by-products with 2,3-butadienoate and methoxyacetylene, appearing at 83m/z and 59 m/z respectively, being the most stable fragments. The tetracycline degradation efficiency of the 0.3% g-C3N4/Nb2O5/HPEI/PES photocatalytic membrane at pH 10 was the highest with 88% efficiency over 180 minutes of consecutive irradiations.

Mucormycosis is a rare, but potentially fatal, fungal infection which is caused by mucormyctes. These forms of fungi are typically known to infect immuno-compromised individuals but are rare in immunocompetent individuals. Herein, we report the case of a 52 year-old female who was diagnosed with right breast carcinoma in Manipal Hospital, a tertiary cancer care center. The patient was a known diabetic and hypertensive and who had recently recovered from coronavirus disease-2019 (COVID-19) pneumonia. In the due course of management, she developed mucormycosis infection at the operative site in her right breast where she had a radiation therapy-induced wound. This patient was successfully treated with an aggressive regimen of early surgical debridement along with administration of systemic amphotericin B.

Osteomyelitis associated with periprosthetic joint infection (PJI) signals a chronic infection and the need for revision surgery. An osteomyelitic bone exhibits distinct morphological features, including evidence for osteolysis and an accelerated bone remodelling into poorly organised, poor-quality bone. In addition to immune cells, various bone cell-types have been implicated in the pathology. The present study sought to determine the types of bone-cell activities in human PJI bones. Acetabular biopsies from peri-implant bone from patients undergoing revision total hip replacement (THR) for chronic PJI (with several identified pathogens) as well as control bone from the same patients and from patients undergoing primary THR were analysed. Histological analysis confirmed that PJI bone presented increased osteoclastic activity compared to control bone. Analysis of osteocyte parameters showed no differences in osteocyte lacunar area between the acetabular bone taken from PJI patients or primary THR controls. Analysis of bone matrix composition using Masson’s trichrome staining and second-harmonic generation microscopy revealed widespread lack of mature collagen, commonly surrounding osteocytes, in PJI bone. Increased expression of known collagenases, such as matrix metallopeptidase (MMP) 13, MMP1 and cathepsin K (CTSK), was measured in infected bone compared to non-infected bone. Human bone and cultured osteocyte-like cells experimentally exposed to Staphylococcus aureus exhibited strongly upregulated expression of MMP1, MMP3 and MMP13 compared to non-exposed controls. In conclusion, the study identified previously unrecognised bone-matrix changes in PJI caused by multiple organisms deriving from osteocytes. Histological examination of bone collagen composition may provide a useful adjunct diagnostic measure of PJI.

As mediators in soil formation, lichens play an essential role in the physical and biological formation of the natural environment. A recent study showed that they are capable of biodegrading stone substrates in a little amount of time, despite being excluded in a geological setting. Many species, mainly those able to produce an oxalate at the thallus-substratum interface, can alter the surface, affecting it chemically. The oxalate remains a noticeable increase even after the lichen has faded, and it makes a major contribution to the structure and composition of the thallus itself. These severe oxalate deposits on historical sites have been alternatively attributed to the earlier as the consequence of air pollutants, prior mechanical/chemical renovation treatments, as well as environmental deterioration. Lichen growth on building materials and biodegradation are frequently based on environmental variables. The biogeophysical and biogeochemical weathering of the substrate by the lichens is the mechanism underlying biodegradation. For stone surfaces, lichens can endeavor bio protection by acting as a barrier against weathering, holding humidity, improving permeability, reducing heat stress and erosion, and absorbing contaminants. Lichen’s significance as a biodeteriorant, its colonization and impact on monuments, as well as bioprotection, are all discussed in the current review.

An experiment was designed in Coimbatore, Tamil Nadu during two successive summer seasons, 2021 and 2022, to investigate the effects of high night temperature (HNT) (ambient+3oC) and CO2 (600ppm) on the yield and seed quality parameters of green gram under ten treatments in SPAR (Soil Plant Atmospheric Research) and ambient conditions. The objective of this research was to i) quantify the short-term effects of HNT and CO2 on yield contribution factors and (ii) quantify seed quality parameters employing biochemical analysis. Green gram yield and quality parameters were significantly reduced under HNT and CO2 when compared to ambient condition. Pooled data from two successive summer seasons revealed that when stress was imposed from (i) 43 to 49 DAS (Day After Sowing), the number of flowers dropped per plant significantly increased by 41.3% (ii) 29 to 35 DAS, pod setting percentage decreased by 18.5% (iii) 36 to 42 DAS, grain yield and biomass/plant decreased by 26.9 % and 29.3%respectively. In aspects of seed quality parameters, data revealed that under stress (i) Seed protein decreased by 20.5% from 50 to 56 DAS. (ii) Total sugars, polyphenols, calcium and iron decreased by 17.7, 19.9, 19.9 and 37.3%, respectively from 43 to 49 DAS. (iii) Seed moisture was reduced by 19.7% during 57 to 63 DAS. (iv) The levels of proline and phytic acid increased by 64.3 and 33.8%, respectively, from 50 to 56 DAS and 43 to 49 DAS. Overall, green gram yield was adversely affected on three treatments from 35 to 56 DAS (flower initiation stage to pod filling stage) and seed quality parameters such as protein, total sugars, polyphenols, seed moisture, proline, phytic acid, calcium and iron were reduced under HNT and CO2 from 50% flowering to pod development stage (42 to 56 DAS).

In the recent past the tremendous growth of populace, industrial development, and urbanization adds to the inevitable production of wastewater sludge (WWS), needing more sludge disposal and renewable energy generation technologies. The thermochemical technologies namely combustion/or incineration, pyrolysis, and gasification have a great prospect of energy recovery with the possibility to be feasible when considering costs and efficiencies. This research paper seeks an investigation on the selection of the finest or feasible thermochemical conversion technology to treat, dispose and generate gas energy in turn heat and electric power. This can be achieved through an advance multi-criteria decision making (MCDM) model using analytical hierarchy process (AHP) and the technique for order of preference by similarity to ideal solution (TOPSIS) to form a AHP-TOPSIS focused on technical and economic criteria. Results show that combustion or/incineration is the most viable technology due to its ability to lessens enormous sludge volume, recuperate energy, demolish pollutants. Gasification is favourable due to benefits such as high efficiency, continual volumetrically heating, and fast thermal reaction. With regards to pyrolysis conversion technology, this process is regarded among of the most feasible thermochemical technologies with zero-waste production, it can gas recover energy and materials such as biogas, biochar, water, tar, etc. With the aforesaid advance thermochemical technologies, the sludge treatment and energy conversion difficulties are foreseen to be limited or lessened.

Boerka goat is the best meat type goat. Feed quality is one of the biggest factors that affect productivity, so it is necessary to know in advance the need for nutrients. The purpose of this study was to determine the dietray of crude protein (CP) and Total Digestible Nutrients (TDN) in efficient feed for the production of Boerka goats male growing phase. This study was designed in a completely randomized design, consisting of six combination feed treatments with six replications. Namely: 1 (CP 13.00% and TDN 63.10%); 2 (CP 13.03% and TDN 65.07%); 3 (CP 13.00% and TDN 70.00%); 4 (CP 15.00% and TDN 62.69%); 5 (CP 15.12% and TDN 65.00%); 6 (CP 15.00% and TDN 70.00%). The observed variables were feed consumption, feed consumption ratio (FCR), nutrient digestibility (dry matter, organic matter, crude protein) and average daily gain (ADG). Results of this study show that the balanced of CP and TDN has no significant effect on consumption and FCR. However, it was significantly different for digestibility and ADG. Feed treatment (CP 13.03% and TDN 65.07%) obtained the higher digestibility of DM and OM (71.49 and 70.5%), while the highest CP digestibility was treated with CP 15.05% and TDN 62.69% (71.59%). The ADG response of Boerka goats with CP 13.03% and TDN 65.07% was the good results (144.90 g head-1day-1) while the lowest response was on CP 13.08% and TDN 63.10%. It is concluded that the dietray of CP 13.03% and TDN 65.07% is a recommended of Boerka goat male growing phase.

Primary pulmonary EWS/PNET(PPES) is extremely rare and is associated with a poor prognosis. Tumor angiogenesis plays an important role in tumor, so it has become a hot topic in molecular targeted therapy. Anlotinib is a new oral small molecular multi-targeted receptor tyrosine kinase (RTK) inhibitor. This report describes a 20 year-old man with PPES. After 4 neoadjuvant chemotherapy cycles (VACwith alternating IE) combined with anlotinib, the left total pneumonectomy was performed. Then maintenance anlotinib monotherapy was continued, no sign of recurrence to date as an outcome. To our knowledge, this is the first demonstration of anlotinib combined with neoadjuvant chemotherapy efficacy in PPES.

Unintentional fish bone ingestion is a common perception in emergency surgery department especially in coastal areas. Authors present a case series of three patients with ingested fish bones, successfully removed from the upper digestive tract in two patients who presented immediately after ingestion. Another patient who had similar history with late presentation, had various complications and was managed conservatively. Computed Tomography (CT) scan is an important diagnostic tool in locating the foreign body and its associated complications. Contrast Enhanced Computed Tomography (CECT) carries a vital role in identifying the associated vascular injury in patients with delayed presentation with hematemesis or malena, which can be missed in plain CT. Most of the foreign bodies following ingestion pass spontaneously through the oesophagus without any complications, whereas sharp foreign body like fish bones may get stuck in the oesophagus or penetrate the oesophageal wall causing life threatening complications such as aorto-oesophageal fistula, trachea-oesophageal fistula mediastinitis, mediastinal abscess and pneumothorax. Hence, early endoscopy and intervention is the key to treatment of foreign body ingestion in upper digestive tract.

Our aim was to present a rare case of tumor megaendoprosthetic replacement with restitution of the extensor mechanism of the knee via reattachment of the patellar tendon to the prosthesis and myoplasty with the medial head of gastrocnemius muscle.

The most advanced form of Pulmonary Atrial Hypertension (PAH), linked with Congenital Heart Abnormalities (CHD), is Eisenmenger Syndrome (ES). This report is about a 26-year-old female who presented with ES treated with Phosphodiesterase type 5 (PDE5) inhibitors, cardiac glycosides, Angiotensin-Converting Enzyme (ACE) inhibitors, loop diuretics, antipyretics, iron and vitamin supplements. Investigations revealed unilateral renal agenesis of left kidney, pulmonary hypertension, ES with large ventricular septal defect and bidirectional shunt. Loop diuretics and PDE5 inhibitors remained the mainstay of the treatment which induced hearing loss and the patient self reported hearing improvement after ceasing furosemide administration. Additional treatment strategy is to be used to improve the symptoms and quality of life of patients.

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration number NCT04323644

ABSTRACTBackground Intrathecal morphine (ITM) has proven to be excellent in reducing postoperative pain. However, its use is associated with the occurrence of postoperative nausea and vomiting (PONV). In this study, we wish to compare the efficacy between the combination therapy of granisetron and dexamethasone versus granisetron alone on the occurrence of postoperative nausea and vomiting (PONV) in parturients undergoing elective Caesarean delivery.Method This is a prospective double-blinded, randomised controlled trial (RCT) involving 126 parturients of American Society of Anesthesiologist (ASA) physical status I and II undergoing elective Caesarean deliveries. Subjects were randomly allocated into 2 groups (n = 63), to either receive a combination of 1 mg intravenous (IV) granisetron plus 4 mg IV dexamethasone (Group A) or to receive 1 mg IV granisetron (Group B). They were assessed at 1, 4, 8, 12 and 24-hour postoperatively. Episodes of nausea, retching, vomiting and the requirement of rescue antiemetics at these time intervals were recorded.Results There are no statistically significant differences in the occurrence of nausea, retching and vomiting between both groups at 1, 4, 8, 12 and 24 h postoperatively. The usage of rescue antiemetics were similar in both groups of subjects.Conclusion The use of granisetron is comparable with the use of granisetron and dexamethasone in the prevention of PONV in parturients receiving intrathecal morphine for elective Caesarean section.

Introduction: Around 10-30% of mother during their antenatal period can be classified as high risk and out of these 70-80% accounts to perinatal morbidity or mortality. Special care must be given to women with high risk pregnancies to make sure the best possible outcomes. Early identification and regular follow-up of high risk pregnancies will reduce the loss of mother as well as newborn. Aim: To identify the prevalence of high risk pregnancies and factors associated with it in rural Tamil Nadu, India. Materials and Methods: The present community-based cross-sectional study was conducted in rural field practice area in the Department of Community Medicine, Annapoorna Medical College, Salem, Tamil Nadu, India. High risk pregnancies were identified using a pretested semi-structured questionnaire and a scoring system developed by Dutta and Das (1990) on 235 women of more than 20 weeks of pregnancy. The association between high risk pregnancies and socio-demographic variables were analysed. The frequency, percentage and analytical statistics was done using Pearson’s Chi-square test. Results: The prevalence of high risk pregnancy among total of 235 pregnant mothers who were interviewed was found to be 15.32%, Moderate and high risk pregnancies combined were 42.13%, whereas 57.87% were of low risk pregnancy with no known risk factors. Major risk factors identified were anaemia (33.19%), undernutrition (31.06%), previous Lower Segment Caesarean Section (LSCS) (13.62%), abortion (8.51%). Early and late age at pregnancy was not associated with moderate to high risk pregnancy. Parity and high socio-economic condition were significantly associated with high risk pregnancy. Conclusion: The present study found that 42.13% pregnancies were moderate to high risk pregnancies. Early detection of these high risk pregnancies must be done at primary healthcare level using a uniform scoring system by a trained health workers, which may reduce the adverse events.