High Percentage Of Cases Research Articles

Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections.

Navigated, gap-balanced adjusted mechanical alignment (AMA) including a 0° varus tibial cut and modification of angles and resections of the femoral cuts to obtain optimal balance accepting minor axis deviations. Objectives of this study were (1) to analyse to what extent AMA achieves the goals for leg alignment and gap balance, and (2) in what percentage non-anatomical cuts are needed to achieve these goals. Out of 1000 total knee arthroplasties (TKA) all varus knees (hip-knee-ankle (HKA) angle < 178°; n = 680) were included. All surgeries were performed as computer assisted surgery (CAS) in AMA technique. CAS data at the end of surgery were analysed with respect to HKA and gap-sizes. All bone cuts were quantified. Depending on the amount of deformity, a subgroup analysis was performed. It was analysed whether the amount of deformity influences the non-anatomical cuts by correlation analysis. AMA reached the goals for postoperative HKA (3° corridor) in 636 cases (93.5%). While extension and flexion gap balance were achieved in more than 653 cases (96%), flexion and extension gap size were equalled in 615 knees (90.4%). The resections of the lateral tibia plateau and distal and posterior medial femoral condyle were anatomical (Tibia: 7.0 ± 1.7mm; medial condyle distal: 7.8 ± 1.4mm; medial posterior: 8.2 ± 1.8mm). The number of non-anatomical resections for those cuts were low; 67 (9.9%); 24 (3.5%); 32 (4.7%). For the medial tibia plateau and the lateral posterior condyle, the cuts were non-anatomical in a high percentage of cases; Tibia: 606 (89.1%), lateral posterior condyle: 398 (58.5%). Moderate but significant correlations were found between resection differences and amount of deformity (medio-lateral: tibia: 0.399; distal femur: 0.310; posterior femur: 0.167). No correlations were found between resection differences and gap values. AMA reaches the intended target for HKA and gap balance in over 612 (90%) of cases and maintains the medial femoral condyle anatomically. Non-anatomical tibial resection causes increased external rotation of the femoral component and by that non-anatomical cut of the posterior lateral condyle. Nonanatomical resections of AMA might be one reason for the persisting high rate of unsatisfied patients after TKA. Anatomical and individual alignment philosophies might help to reduce this rate of dissatisfaction.

Association between Hypodontia of the Permanent Lateral Incisors and other Dental Anomalies in School Children Aged 12-16 Years in Kosovo

Background: Hypodontia of lateral incisors (LI) is frequently associated with other dental anomalies. The objective of this study was to determine the association of LI with other dental anomalies by comparing the two groups: Group 1 with hypodontia of the maxillary LI (MLI1) and Group 2 with hypodontia of the mandibular LI (MLI2), in secondary school education students in Kosovo. Methods and Results: A total of 3306 secondary school students aged 12-16 years, regardless of gender, were included in this prospective study. The abnormalities investigated were recorded by RTG-panoramic and dental charts. The teeth were recorded as a congenital absence when the mineralization of the crown, identified by panoramic tomography, was absent. The prevalence of LI hypodontia was as follows: MLI1 (Group 1) included 36 cases (92.3%) and MLI2 (Group 2) included only 3 cases (7.6%), which indicates a much higher percentage of cases with hypodontia of MLI1. In Group 1, 21(58.3%) cases of LI hypodontia were bilateral and 15(41.7%) unilateral; in Group 2, 2(66.7%) cases were unilateral and 1(33.3%) case – bilateral. Among dental anomalies, the occurrence of rotation was found in 19(48.7%) cases with LI hypodontia: 47.2% cases in Group 1 and 66.7% cases in Group 2. The prevalence of dental inclination anomaly was 30.77% of all cases with hypodontia of LI: 27.8% of cases in Group 1 and 66.7% of cases in Group 2. The prevalence of ectopy was in 17.9% of cases of all hypodontia cases of LI: 16.7% of cases in Group 1 and 33.3% of cases in Group 2. Crown anomalies were evident in 7(17.9%) patients of all hypodontia cases of LI, all of which were in Group 1. Other anomalies such as microdontia were evident in two patients in Group 1. Transposition, bodily movement, and superposition were present in one patient in Group 1; in Group 2, one patient had transposition. At the same time, the frequency of dental transposition was significantly higher in Group 2 than in Group 1 (P=0.02088). Other dental anomalies of crown and root and infraposition were not present in both groups. There were no significant differences in the other dental anomalies between the two groups. Conclusion: The consequences of hypodontia in dental arches are obvious. Knowing the prevalence of hypodontia and its association with other dental anomalies helps classify the need for further treatment for the patients, whether orthodontic, prosthetic, or surgical.

Neoadjuvant PD-1 blockade in patients with resectable desmoplastic melanoma (SWOG 1512).

9502 Background: Desmoplastic melanoma (DM) is a rare cancer defined by a dense fibrous collagen matrix. It is associated with high UV exposure leading to a high mutational load. When locally advanced, the standard of care is wide excision and radiation therapy due to its propensity for local relapses. Metastatic DM has a high response rate (RR) to PD-1 blockade therapy (Eroglu et al. Nature 2018). We hypothesized that neoadjuvant treatment with anti-PD-1 monotherapy may induce pathologically confirmed regressions in a high percentage of cases, potentially allowing for less extensive local treatment. Methods: Patients &gt; 18 years old with histologically confirmed resectable (primary, recurrent, or regional lymph node metastasis) DM with clinical evidence of residual disease received pembrolizumab 200 mg q3 weeks (wk) 3 followed by excision. No adjuvant therapy was administered. Primary endpoint: pathological complete response (pCR), with the assumption that pCR of 25% would be considered a positive result worthy of future study. To test this hypothesis, a single arm trial with 25 eligible patients would have a 3.4% probability of a positive result with a true pCR of 5%, and a power of 90% of a positive result if the true pCR is 25%. Secondary endpoints: clinical RR by imaging and clinical exam, median overall survival (OS), and evaluation of safety/tolerability of neoadjuvant pembrolizumab. Adverse events were assessed q3 wk. Disease assessments occurred at baseline and q9 wk. NCT02775851. Results: We enrolled-29 eligible patients with resectable DM. One patient refused treatment and was omitted from further analysis. Median age was 75, 79% were male, primary sites of disease were 72% H&amp;N, 10% torso, 14% extremities, 3% unknown. No patients received prior systemic therapy. Mean time from C1D1 treatment to surgery was 84.2 (range: 52-135) days, mean number of cycles received 3.3 (range: 2-4). 26/27 (93%) of patients underwent wide excision of the resectable disease, of which 14 (54%) underwent sentinel lymph node biopsy. One patient underwent resection of a nodal recurrence thus did not require wide excision. pCR was noted in 15/27 (56%) of patients (95% CI: 35%-75%). One patient without a pCR had a major pathologic response with 0.2 mm residual melanoma. In addition, one patient with a clinical CR did not undergo resection by choice. None became inoperable. Clinical RR was 52% (95% CI: 32%-71%). Median OS has not been reached, with two nontreatment related deaths (acute hypoxic respiratory failure; unknown). No &gt; grade 2 related adverse events were observed. Conclusions: Neoadjuvant pembrolizumab in resectable DM results in a high pCR rate with excellent tolerance, which supports consideration of PD-1 blockade therapy prior to surgery. Funding: U10CA180888 and U10CA180819; and in part by Merck Sharp &amp; Dohme Corp., a subsidiary of Merck &amp; Co., Inc., Kenilworth, NJ, USA. Clinical trial information: NCT02775851.

Auditory assessment of neonates at high risk of hearing impairment admitted to the intensive care unit

Background: Permanent hearing loss is a common neonatal health problem which leads to deleterious effects on language, speech development and academic outcome. Its prevalence is much higher in newborns that need neonatal intensive care admission. Methods: This is a cross-sectional study included 314 neonates admitted to neonatal intensive care unit. The inclusion criteria included neonates with risk factors of hearing loss. They were all evaluated by Transient Evoked Otoacoustic Emissions (TEOAE). Automated auditory brainstem response (AABR) was done at 3 months of age for those who failed TEOAE screening. Results: Out of 314 neonates, 4.5% were diagnosed by permanent hearing loss. No statistical significance was detected between hearing loss and gender (P = 0.61), prematurity (P = 0.529) and birth weight (P = 0.076). The most common risk factor detected was ototoxic drug intake, with aminoglycosides being the most frequent. There was a significant P value between ototoxic medications and hearing loss (P = 0.018). The highest percentage of cases with hearing loss was detected among neonates who received both aminoglycosides and vancomycin. Conclusion: The prevalence of permanent hearing loss among admitted neonates at risk of hearing loss are high.

P239 TOLERABILITY OF SACUBITRIL/VALSARTAN TREATMENT IN OLDER PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION: PRELIMINARY DATA FROM THE REAL–WORLD AGING–HF REGISTRY

Abstract Background Although older patients with heart failure (HF) with reduced ejection fraction enrolled in PARADIGM–HF showed a good tolerance to sacubitril/valsartan (Sa/Va), more real–word data are needed to define their tolerability in this population. Aim: To describe the Sa/Va tolerability and titration in older HFrEF patients followed by our HF outpatient. Methods HFrEF patients aged ≥65 years and treated with Sa/Va from November 2016 to June 2021 were enrolled, assessing Sa/Va tolerability at six months and its clinical and hemodynamic effects. Results We enrolled 101 patients with a mean age of 78 years (⁓20% female). The aetiology was ischemic in 59% of cases while the mean ejection fraction was 31%. Sa/Va was prescribed at the starting dose (24/26mg) and intermediate dose (49/51mg) in 91% and 9% of cases, respectively. After six months, 9 of the 100 patients still alive had discontinued treatment with Sa/Va (4 for symptomatic hypotension, 3 for suspected allergic reaction and 2 for worsening renal function). Of the 91 patients still on therapy, only 17 had reached the target dose (97/103mg) while 28 were at the intermediate dose (Figure 1). Symptomatic hypotension (62%), hyperkalaemia (15%) and worsening of renal function (4%) were the main causes of maintaining Sa/Va therapy at the starting dose; note, in 15% of cases a specific cause of non–titration was not identified. Comparing HF treatment between starting dose vs higher–dose patients, after six months in low–dose patients there was a slight improvement in mineralcorticosteroid receptor antagonist (MRA) prescription and in combination therapy (Sa/Va, beta–blocker and MRA) while in patients at higher–doses there was a significant decrease (Figure 2). In patients still receiving Sa/Va, significant clinical improvement was observed while renal function, K+ levels and systolic blood pressure remained stable (Figure 3). Conclusions After six months of treatment, Sa/Va was well tolerated in most of our older patients and used in combination with a beta–blocker and an MRA in a high percentage of cases, although a reduction in MRA prescription is observed in patients taking higher dosages of Sa/Va. In addition, there was a marked improvement in the clinical variables.

Women and cardiac rehabilition in Mallorca

Abstract Funding Acknowledgements Type of funding sources: None. Background Women are less likely to be referred to a cardiac rehabilitation program (CRP) than men. Little is known about the different indications between genders and whether women who attend a CRP have different health characteristics from men. Purpose To study the differences between men and women in the frequency of referral to the only CRP in Mallorca (Spain), their indication and whether there were different health characteristics by gender among referred patients. Methods Retrospective observational study. We studied the indication, cardiovascular risk factors (CVRF), somatometric data, blood test and psychosocial health (by hospital anxiety and depression scale, HADS) of all patients referred to a CRP in Mallorca since the program was launched in 2014. Results 524 patients have been referred to the CRP. 18% (95) were women, with no differences in mean age compared to men (55.9 ± 11 vs 56.2 ± 10 years). Women were referred more frequently due to non-coronary diseases (20% vs 4%, p &amp;lt;0.05), such as congenital heart disease, valve disease, or heart failure due to other cardiomyopathies. Among patients referred with coronary disease (485), only 15.7% (76) were women. The most frequent indication (84% in men and 80% in women) was an acute coronary syndrome (ACS), with similar percentages of NSTEACS and STEACS (women 43 and 57%, men 41 and 59%). Women were referred more frequently due to chronic coronary syndrome than men (17% vs 5%, p &amp;lt;0.05) and only one woman was referred after a coronary artery bypass grafting (vs 19 men, 1% vs 4%). Among patients with coronary disease, women had less frequent history of smoking (64% vs 81%, p &amp;lt;0.05), but similar percentages of other classic CVRF (Hypertension -59 vs 56% -, diabetes -27% vs 26% - and dyslipidemia -59% vs 63% - p&amp;gt;0,05). Women didn’t have significant differences when compared to men in their levels of LDL cholesterol (73 ± 23 vs 76 ± 25), triglycerides (122 ± 64 vs 135 ± 72), HbA1c (6.2 ± 1% vs 6, 1 ± 3%), p&amp;gt;0,05. A lower percentage of women were overweight or obese (71% vs 85%, p &amp;lt;0.05). Women with ischemic heart disease referred to the CRP had a higher degree of anxiety and depression measured in the HADS questionnaire (anxiety 9.2 ± 4 vs 7.0 ± 4, depression 6.7 ± 5 vs 5.1 ± 4, p &amp;lt;0.05). The percentage of women with a high degree of anxiety or depression (score&amp;gt; 11 in HADS) was higher than for men (anxiety 44% vs 22%, depression 24% vs 13%, p &amp;lt;0.05). Conclusions Only 18% of the patients referred to a CRP in Mallorca were women. This percentage was lower (15,8%) in patients with coronary disease referred to CRP. Women were referred in a higher percentage of cases than men for non-coronary pathology and chronic coronary syndrome. A lower percentage of women with coronary disease were smokers, overweighted or obese. Finally, a higher degree of anxiety and depression was observed among women than among men.

Oncobiology and treatment of breast cancer in young women.

Female breast cancer emerged as the leading cancer type in terms of incidence globally in 2020. Although mortality due to breast cancer has improved during the past three decades in many countries, this trend has reversed in women less than 40years since the past decade. From the biological standpoint, there is consensus among experts regarding the clinically relevant definition of breast cancer in young women (BCYW), with an age cut-off of 40years. The idea that breast cancer is an aging disease has apparently broken in the case of BCYW due to the young onset and an overall poor outcome of BCYW patients. In general, younger patients exhibit a worse prognosis than older pre- and postmenopausal patients due to the aggressive nature of cancer subtypes, a high percentage of cases with advanced stages at diagnosis, and a high risk of relapse and death in younger patients. Because of clinically and biologically unique features of BCYW, it is suspected to represent a distinct biologic entity. It is unclear why BCYW is more aggressive and has an inferior prognosis with factors that contribute to increased incidence. However, unique developmental features, adiposity and immune components of the mammary gland, hormonal interplay and crosstalk with growth factors, and a host of intrinsic and extrinsic risk factors and cellular regulatory interactions are considered to be the major contributing factors. In the present article, we discuss the status of BCYW oncobiology, therapeutic interventions and considerations, current limitations in fully understanding the basis and underlying cause(s) of BCYW, understudied areas of BCYW research, and postulated advances in the coming years for the field.

Incidence, prognosis, and perinatal outcomes of and risk factors for severe twin\u2013twin transfusion syndrome with right ventricular outflow tract obstruction in the recipient twin after fetoscopic laser photocoagulation

BackgroundRight ventricular outflow tract obstruction (RVOTO) is the most frequently encountered congenital heart disease in patients with twin –twin transfusion syndrome (TTTS) and is especially prevalent in the recipient twin. In this retrospective study, we evaluated the incidence, prognosis, postnatal management, and perinatal outcomes of and risk factors for RVOTO in the recipient twin in severe TTTS cases which diagnosed before 26 weeks after fetoscopic laser photocoagulation (FLP) at a single center in Taiwan.MethodsRVOTO was diagnosed using fetal or postnatal echocardiography. The fetal outcomes evaluated were perinatal survival rate, neonatal brain image anomalies rate, gestational age at delivery, and birth weight.ResultsTotal 187 severe TTTS cases were included; 14 (7.49%) had a recipient twin with RVOTO (12 cases of pulmonary stenosis and 2 of pulmonary atresia). Of these 14 cases, 3 (21.4%) demonstrated improvements in outflow obstruction after FLP, and 11 (78.6%) resulted in perinatal survival. Of the 11 survivors, 5 (45.5%) received transcatheter balloon valvuloplasty to alleviate the RVOTO. The perinatal survival rate, gestational age at delivery, neonatal brain image anomaly rate, and birth weights did not significantly differ between the groups in which the recipient twin had versus did not have RVOTO. Generally, the recipient twin had RVOTO received FLP at a younger gestational age (in weeks; 19.3 ± 2.4 vs. 20.7 ± 2.6, p = 0.048) and had a higher percentage of cases at Quintero stage IV (50.0% vs. 12.1%, p < 0.001) than those in which the recipient twin did not have with RVOTO. Using logistic regression, we discovered that FLP at a younger gestational age (p = 0.046, odds ratio = 0.779) and TTTS at Quintero stage IV (p = 0.001, odds ratio = 7.206) were risk factors for the recipient twin developing RVOTO after FLP in severe TTTS cases.ConclusionsThe post-FLP perinatal outcomes of cases of severe TTTS in which the recipient twin had versus did not have RVOTO were comparable in this study, which may have been due to the similar gestational ages at delivery and strong influence of high Quintero stages (stages III and IV).

Stability of milk from dual purpose cows with different types of feeding

Objective: To establish milk stability using the alcohol test in cows with different feeding strategies in the tropical dairy system. Design/methodology/approach: Ten crossbred Holstein x Zebu cows whose milk frequently tested positive to the alcohol test were housed in individual yards and distributed into two groups. Experiment 1. T1: cows consumed dry Pangola grass (Digitaria eriantha); T2: cows consumed green Maralfalfa grass (Pennisetum violaceum). Forage was provided ad libitum. Experiment 2. T1 cows were supplemented with a concentrate with higher crude protein and metabolizable energy percentage than T2 cows; this percentage was gradually increased up to 4.0 kg. Milk was subjected to alcohol testing. Variance analyzes were performed under categorical data models. Results: Higher percentages of cases that tested positive for alcohol were observed in cows that consumed dry grass than in cows that consumed green grass (P&lt;0.05). The concentrate addition to diets based on dry or green forage reduced the positive case percentage. Implications: A balanced diet improves milk stability. Findings/conclusions: The improvement in the cows’ nutritional value decreases the percentage of milk with positive results in the alcohol test.

Clinical Correlations of Lipid Profiles with the Age and Gender in the Coronary Artery Disease Patients: A Study of 3878 CAD Patients from India.

Cardiovascular diseases (CVDs) are crucial cause of death and hospitalization all over the world including India. The CVDs including the coronary artery disease (CAD) are developed by the interaction of genetic and environmental factors. Hyperlipidemia is a traditional risk factor for CVD. The aim of this study was to study the clinical correlations of lipid profiles with the age and gender in the Coronary Artery Disease Patients: Methods: In this study, we have investigated the effect of age and sex on in lipid profile in 3878 (1171 females and 2707 males) CAD patients from India. The plasma TG was higher in males than in females regardless of the age. Results showed that CAD female patients had significantly increased HDL-C than their aged matched males. Moreover, the plasma TC and LDL-C were significantly higher in males than females until age 40 years. Then after the age of 40 years, TC and LDL-C become significantly higher in females than in males. In addition, we found that more than 85% of CAD cases were <55 years old, and about 30% of CAD cases had normal lipid profile. We conclude that elderly females are at a greater risk for CAD than males. Moreover, there were no significant differences in CVDs causes between nonelderly and elderly females. In addition, a higher percentage of cases were premature CAD, and 30% of CAD may be caused by loci that are not related to lipid metabolism.

Prevalence of Diabetic Neuropathy in Diabetic Type II Patients from Khyber Pakhtunkhwa

Introduction: Diabetic neuropathy is the main cause of neuropathy and major complications of diabetes mellitus throughout the world. This may lead to incapacity and amputations due to severe diabetes. The morbidity and mortality rates increase in diabetes due to severe neuropathy. The present study was aimed to determine the prevalence of diabetic diabetic neuropathy in diabetic mellitys type II affected patients. Materials and Methods: This research took place in Peshawar from September 2019 to January 2020. A total of 205 blood samples were collected from diabetic patients with type II diabetes, both neuropathic (n=105) and non-neuropathic (n=100). Blood samples were taken in order to estimate random blood sugar levels (RBS). Results: The age group 50-55 years had the highest percentage of cases (66.8%), followed by 56-60 years (21.5%), and 61-65 years (5.5%). Female patients were more likely than male patients to have diabetes, both neuropathic (62.9 percent) and non-neuropathic (58 percent). The predominance of neuropathic and non-neuropathic diabetes patients involved in this study because it was undertaken in Peshawar.(50.2 percent). Conclusion: It is concluded that female were more prone to diabetes both with neuropathy and without neuropathy. Keywords: Prevalence, Diabetes, Neuropathy, Diabetic mellitus type II,

Pancreatic Adenocarcinoma Associated to Intraductal Papillary Mucinous Neoplasia: Histopathological Particularities and Clinical Implications

Background: Pancreatic ductal adenocarcinoma (PDAC) is the most common pancreatic tumor, known for an aggressive evolution. Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic tumor, considered a premalignant lesion with the possibility of carcinogenesis towards PDAC. The clinical, surgical and histopathological particularities of the association between PDAC and IPMN are yet unknown, further research being needed. Methods: We have conducted a retrospective descriptive study, on a nine-year period (2012-2020), with the aim of comparing the characteristics of patients that underwent curative surgical interventions for solitary PDAC and PDAC associated to IPMN. Results: Fifteen patients with PDAC associated with IPMN (Group 1) and 386 patients with solitary PDAC (Group 2) were included in our study. Group 1 had a younger average age (61.8 years) compared to Group 2 (63.89 years). Total pancreatectomy was more frequently performed for Group 1 than Group 2 (33.33% vs 12.43%). Group 1 had a higher percentage of cases with positive perineural, perilymphatic and perivascular invasion. Group 1 registered a worse overall survival, as well as a worse short-time survival compared to Group 2. Conclusions: PDAC associated to IPMN registers distinct epidemiological, clinical and histopathological characteristics compared to solitary PDAC.

THE MAIN EPIDEMIOLOGICAL AND DIAGNOSTICAL FEATURES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN SERVICEMEN OF THE ARMED FORCES OF UKRAINE IN THE CONDITIONS OF JOINT FORCES OPERATION

The aim: The aim of the work was to determine the leading epidemiological, diagnostical features, disturbance of spirometric indices, changes in the immune system in servicemen with COPD, who take part in Joint Forces Operation (JFO). Materials and methods: 89 male patients were examined, who sought medical help for COPD, group B. They were divided into two groups. 1 group (42 patients) − with COPD, who took part in the JFO not more than 6 month, the 2 group consisted of 47 patients with COPD, who took part in the JFO during the period more than 6 month. Results: The patients in the group 2 had veraciously more points of cough and sputum expectoration in daily amount of 30 and more ml. The type of sputum in 53.2% patients was predominantly mucus-pus. There were also more percentage of patients with feeling short of breath and the high point, achieved at CAT. There were significant differences in systolic and diastolic blood pressure levels, LV mass index between two groups. Conclusions: It was found that servicemen who took part in JFO for more than 6 months had a more severe course of COPD with a higher score in the CAT and probably lower obstructive ventilatory indices, in a probably higher percentage of cases there were detected such a concomitant pathology as AH stage II and GERD. They had Th17 immune response predomination with significant elevation of IL-17, TGF-β, IL-6 concentrations in serum and high concentration of soluble adhesion molecules. KEY WORDS: Obstructive ventilatory defects, immune, external respiration function, fuel combustion products

ARBOALVO: territorial stratification for definition of areas for prompt response by surveillance and timely control of urban arbovirus infections

The study aimed to present the methodological proposal entitled "Prompt Response", modelled in the cities of Belo Horizonte (Minas Gerais State) and Natal (Rio Grande do Norte State), Brazil. The proposal aims to identify and demarcate priority areas for timely targeting of surveillance activities, aiming to reduce the intensity and velocity in the spread of epidemics in endemic urban areas. The methodology uses three variables that represent the necessary causes for the production and reproduction of dengue: notified cases (virus), Aedes eggs (vector), and population (host). This was an ecological study that used data from three information planes aggregated in finer temporal and spatial scales of 3 to 4 weeks and 400 to 600-meter grids, respectively. The prompt response areas were defined by Scan statistical analysis with definition of simultaneous spatial clusters for the three planes via the SaTScan program. In Natal, the areas defined as prompt response occupied, on average, 15.2% of the city's territory and concentrated 67.77% of the dengue cases in the period following demarcation of the prompt response areas. In Belo Horizonte, the observed proportions were 64.16% of cases in 23.23% of the territory. These results were obtained in two cities with different socioenvironmental and geographic realities and distinct epidemiological profiles, indicating that the methodology can be applied to different urban realities, allowing control programs to concentrate on reduced portions of the territory and impacting a high percentage of cases in timely fashion.

Efficacy and Safety of Eculizumab in Kidney Transplant Patients With Primary Atypical Hemolytic-Uremic Syndrome

The atypical hemolytic-uremic syndrome (aHUS) is characterized by the triad of non-immune hemolytic anemia, thrombocytopenia, and acute renal failure. The aHUS is related to complement dysregulation; since the approval of eculizumab for this entity (a monoclonal antibody that inhibits C5 activation and blocks the formation of the membrane attack complex) the prognosis has improved. The recurrence of aHUS after kidney transplantation is frequent and implies loss of the graft in a high percentage of cases. Eculizumab prophylaxis to prevent recurrence has allowed successful kidney transplantation in this group of patients. We present a series of kidney transplant patients with chronic kidney disease secondary to aHUS and the use of eculizumab for prevention of recurrence.

Real-time alerting system for COVID-19 and other stress events using wearable data

Early detection of infectious diseases is crucial for reducing transmission and facilitating early intervention. In this study, we built a real-time smartwatch-based alerting system that detects aberrant physiological and activity signals (heart rates and steps) associated with the onset of early infection and implemented this system in a prospective study. In a cohort of 3,318 participants, of whom 84 were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this system generated alerts for pre-symptomatic and asymptomatic SARS-CoV-2 infection in 67 (80%) of the infected individuals. Pre-symptomatic signals were observed at a median of 3 days before symptom onset. Examination of detailed survey responses provided by the participants revealed that other respiratory infections as well as events not associated with infection, such as stress, alcohol consumption and travel, could also trigger alerts, albeit at a much lower mean frequency (1.15 alert days per person compared to 3.42 alert days per person for coronavirus disease 2019 cases). Thus, analysis of smartwatch signals by an online detection algorithm provides advance warning of SARS-CoV-2 infection in a high percentage of cases. This study shows that a real-time alerting system can be used for early detection of infection and other stressors and employed on an open-source platform that is scalable to millions of users.

MicroRNA as a Biomarker for Diagnostic, Prognostic, and Therapeutic Purpose in Urinary Tract Cancer

The incidence of urologic cancers, including kidney, upper tract urothelial, and bladder malignancies, is increasing globally, with a high percentage of cases showing metastasis upon diagnosis and low five-year survival rates. MicroRNA (miRNA), a small non-coding RNA, was found to regulate the expression of oncogenes and tumor suppressor genes in several tumors, including cancers of the urinary system. In the current review, we comprehensively discuss the recently reported up-or down-regulated miRNAs as well as their possible targets and regulated pathways involved in the development, progression, and metastasis of urinary tract cancers. These miRNAs represent potential therapeutic targets and diagnostic/prognostic biomarkers that may help in efficient and early diagnosis in addition to better treatment outcomes.

Eritema fijo pigmentario en niños: reporte de 64 casos

BackgroundThe incidence of adverse drug reactions in pediatric patients occurs in around 9.5% of patients. Fixed drug eruption constitutes the second most frequent drug skin reaction, however, reports of this entity are scarce in this population. Material and methodsWe performed a cross-sectional and retrospective study that included 64 pediatric patients with a diagnosis of fixed drug eruption treated in the consulting office of dermatology during the period from January 2010 to January 2020. Data were obtained from clinical records. ResultsThe female sex accounts for 52% of the cases, the age range was 2 to 16 years with a medium of 9 years. Erythematous patches are the most common morphology (45%), while the trunk and upper extremities are the most affected sites (36% and 26%, respectively). Pharmacological agents were responsible for 91% of the cases, while non-pharmacological agents accounted for 9%. Paracetamol was the cause of disease in a higher percentage of cases (40%) and most of the injuries appeared 1–10 days after its consumption. In 28% of the patients a medical history of atopic dermatitis was detected. ConclusionsWe identified a total of 64 children diagnosed of fixed drug eruption over the past 10 years. Those aged 11–16 years are the most affected, and are predominantly female. The trunk was the area with most erythematous patches, with an evolution time of 1–10 days. Paracetamol has been identified as the main disease causative agent.

The socio-environmental production of malaria in three municipalities in the Carajás region, Pará, Brazil.

ABSTRACTOBJECTIVE To analyze the environmental production of malaria in the municipalities of Marabá, Parauapebas, and Canaã dos Carajás, in Pará, from 2014 to 2018.METHODS This ecological, cross-sectional study used epidemiological data in the Sistema de Informações de Vigilância Epidemiológica da Malária (Malaria Epidemiological Surveillance Information System) from the Secretaria de Saúde do Estado do Pará (State of Pará Health Department), cartographic data from the Brazilian Institute of Geography and Statistics (IBGE), and environmental data in the Projeto TerraClass (TerraClass Project) from the National Institute of Space Research (INPE). Statistical analyses used the chi-square test, while the spatial ones, the kernel and Moran’s (I) global bivariate techniques.RESULTS We analyzed a total of 437 confirmed cases of malaria in the selected area and period. The highest percentage of cases occurred among male miners and farmers, living in rural areas; Plasmodium vivax was the most frequent species; and the most used diagnosis, the thick drop/smear. We also observed a heterogeneous distribution of the disease — with evidence of spatial dependence between incidence areas and different forms of land use, and spatial autocorrelations related to the high variability of anthropic activities in the municipalities.CONCLUSION The environmental production of malaria relates mainly to cattle production and mining — anthropisms related to land use and occupation in the observed municipalities. Spatial data analysis technologies sufficed for the construction of the epidemiological scenario of the disease.

The Characteristic of Measles Epidemic Process in Kyrgyz Republic

The Characteristic of Measles Epidemic Process in Kyrgyz Republic