Purpose
To describe trends in outcomes of cancer patients with unplanned admissions to intensive-care units (ICU) according to cancer type, organ support use, and performance status (PS) over an ...8-year period.
Methods
We retrospectively analyzed prospectively collected data from all cancer patients admitted to 92 medical–surgical ICUs from July/2011 to June/2019. We assessed trends in mortality through a Bayesian hierarchical model adjusted for relevant clinical confounders and whether there was a reduction in ICU length-of-stay (LOS) over time using a competing risk model.
Results
32,096 patients (8.7% of all ICU admissions; solid tumors, 90%; hematological malignancies, 10%) were studied. Bed/days use by cancer patients increased up to more than 30% during the period. Overall adjusted mortality decreased by 9.2% 95% credible interval (CI), 13.1–5.6%. The largest reductions in mortality occurred in patients without need for organ support (9.6%) and in those with need for mechanical ventilation (MV) only (11%). Smallest reductions occurred in patients requiring MV, vasopressors, and dialysis (3.9%) simultaneously. Survival gains over time decreased as PS worsened. Lung cancer patients had the lowest decrease in mortality. Each year was associated with a lower sub-hazard for ICU death SHR 0.93 (0.91–0.94) and a higher chance of being discharged alive from the ICU earlier SHR 1.01 (1–1.01).
Conclusion
Outcomes in critically ill cancer patients improved in the past 8 years, with reductions in both mortality and ICU LOS, suggesting improvements in overall care. However, outcomes remained poor in patients with lung cancer, requiring multiple organ support and compromised PS.
The exploration of novel synthetic methodologies that control both size and shape of functional nanostructure opens new avenues for the functional application of nanomaterials. Here, we report a new ...and versatile approach to synthesize SnO
2
nanocrystals (rutile-type structure) using microwave-assisted hydrothermal method. Broad peaks in the X-ray diffraction spectra indicate the nanosized nature of the samples which were indexed as a pure cassiterite tetragonal phase. Chemically and physically adsorbed water was estimated by TGA data and FT-Raman spectra to account for a new broad peak around 560 cm
−1
which is related to defective surface modes. In addition, the spherical-like morphology and low dispersed distribution size around 3–5 nm were investigated by HR-TEM and FE-SEM microscopies. Room temperature PL emission presents two broad bands at 438 and 764 nm, indicating the existence of different recombination centers. When the size of the nanospheres decreases, the relative intensity of 513 nm emission increases and the 393 nm one decreases. UV–Visible spectra show substantial changes in the optical absorbance of crystalline SnO
2
nanoparticles while the existence of a small tail points out the presence of localized levels inside the forbidden band gap and supplies the necessary condition for the PL emission.
Background Chagas Disease (CD) affects 6-7 million people worldwide and is related to poverty-promoting conditions. Chronic asymptomatic cases are mostly invisible to health systems. Aiming (1) to ...translate CD discoveries into education/information practices to raise alertness and empowerment of affected people; and (2) to perform an active search of CD cases, articulating intersectoral actions to improve the access of infected people to the local health service for the treatment of CD; our research group developed and tested under field conditions as innovative social technology: an itinerant education interdisciplinary setting named "Chagas Express XXI" (CE21). Methodology CE21 was created as an "imaginary train" with ~40 ArtScience workshops, games, laboratory activities and conversation circles. An entry/exit plus six activity modules combined associations of affected people, microscopic observations, One Health education, and wellness activities. CE21 was conceived as a social technology, since all the processes were co-created with CD patients and inter-sector local partners. Descriptive statistics showed quantitative data collected throughout the expeditions (CD knowledge, serological results). Qualitative data accessed the public perceptions about the education activities. Principal findings CE21 was exhibited in local educational institutions (schools, universities) in four cities, engaging 2,117 people that evaluated the 41 activities carried out. Citizens and health professionals enjoyed acquisition of information related to blood, parasites, vectors, reservoirs, environmental changes, and social determinants of CD. Further, local legacies of 600 participants volunteer for health promotion groups and CD associations, local empowerment groups to fight for better health conditions, and 05 mural paintings. We observed that 81% of the participants ignored the possibility of treating CD while 52% of the participants requested a blood test for CD showing seropositivity in 20% of them. Conclusions CE21 is a social technology potentially useful for health and science education and active search of asymptomatic CD chronic cases. Moreover, this technology may be adapted to understand and to cooperate in other potentially epidemic situations, especially NTDs related.
Our main purpose was to evaluate the expression of plastic and evolved genes involved in ecological speciation in the noctuid moth Spodoptera frugiperda, the fall armyworm (FAW); and to demonstrate ...how host plants might influence lineage differentiation in this polyphagous insect. FAW is an important pest of several crops worldwide, and it is differentiated into host plant-related strains, corn (CS) and rice strains (RS). RNA-Seq and transcriptome characterization were applied to evaluate unbiased genetic expression differences in larvae from the two strains, fed on primary (corn) and alternative (rice) host plants. We consider that genes that are differently regulated by the same FAW strain, as a response to different hosts, are "plastic". Otherwise, differences in gene expression between the two strains fed on the same host are considered constitutive differences.
Individual performance parameters (larval and pupal weight) varied among conditions (strains vs. hosts). A total of 3657 contigs was related to plastic response, and 2395 contigs were differentially regulated in the two strains feeding on preferential and alternative hosts (constitutive contigs). Three molecular functions were present in all comparisons, both down- and up-regulated: oxidoreductase activity, metal-ion binding, and hydrolase activity.
Metabolization of foreign chemicals is among the key functions involved in the phenotypic variation of FAW strains. From an agricultural perspective, high plasticity in families of detoxifying genes indicates the capacity for a rapid response to control compounds such as insecticides.
The extensive oil spill (> 2,900 km) that occurred in the southwestern Atlantic (2019/2020) increased the vulnerability of the Brazilian coast, affecting marine and coastal protected areas (MPAs). In ...addition to supporting conservation, MPAs are sustainably used by local populations to help maintain ocean-dependent livelihoods. In this sense, we aim to assess the socioeconomic vulnerability of human communities in MPAs affected by this major oil spill. Using digital mapping, we assessed the socioeconomic vulnerability of 68 human communities living in or near 60 MPAs of different categories that were impacted by this spill. This is the first assessment of the vulnerability status of human populations under significant levels of poverty and social inequality, which are particularly dependent on healthy and effective Brazilian MPAs. More than 6,500 enterprises and institutions were mapped, including trade activities, services, tourism, and leisure venues. Most enterprises (34.4%) were involved in the food sector, related to the ocean economy, and, therefore, highly vulnerable to oil spills. Furthermore, the majority (79.3%) of the vulnerable activities are concentrated in multiple-use MPAs, with extractive reserves coming second and accounting for 18%. This result shows the high vulnerability of this tropical coast to oil accidents and the risks to food security for traditional communities. We also found a heterogeneous vulnerability indicator along the coast, with the most vulnerable regions having an undiversified economic matrix heavily dependent on activities such as fishing, family farming, tourism, accommodation, and the food sector. Thus, this study provides a tool to help prevent and mitigate economic losses and increases the understanding of the weaknesses of MPAs in the face of large-scale disasters, thus helping to build socioeconomic and ecological resilience.
Chagas disease (caused by Trypanosoma cruzi infection) evolves to chronic chagasic cardiomyopathy (CCC) affecting 1.8 million people worldwide. This is the first randomized, placebo-controlled, ...double-blinded, clinical trial designed to estimate efficacy and safety of selenium (Se) treatment in CCC.
66 patients with CCC stages B1 (left ventricular ejection fraction LVEF > 45% and no heart failure; n = 54) or B2 (LVEF < 45% and no heart failure; n = 12) were randomly assigned to receive 100 mcg/day sodium selenite (Se, n = 32) or placebo (Pla, n = 34) for one year (study period: May 2014-September 2018). LVEF changes over time and adverse effects were investigated. Trial registration number: NCT00875173 (clinicaltrials.gov).
No significant differences between the two groups were observed for the primary outcome: mean LVEF after 6 (β= +1.1 p = 0.51 for Se vs Pla) and 12 months (β= +2.1; p = 0.23). In a subgroup analysis, statistically significant longitudinal changes were observed for mean LVEF in the stage B2 subgroup (β= +10.1; p = 0.02 for Se n = 4 vs Pla n = 8). Se treatment was safe for CCC patients, and the few adverse effects observed were similarly distributed across the two groups.
Se treatment did not improve cardiac function (evaluated from LVEF) in CCC. However, in the subgroup of patients at B2 stage, a potential beneficial influence of Se was observed. Complementary studies are necessary to explore diverse Se dose and/or associations in different CCC stages (B2 and C), as well as in A and B1 stages with longer follow-up.
Brazilian Ministry of Health, Fiocruz, CNPq, FAPERJ.
Prediction of perioperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. However, these patients frequently die as a consequence of primary ...or secondary multiple organ failure (MOF), often as a result of sepsis. We investigated the early perioperative risk factors for in-hospital death due to MOF in surgical patients.
This was a prospective, multicenter, observational cohort study performed in 21 Brazilian intensive care units (ICUs). Adult patients undergoing noncardiac surgery who were admitted to the ICU within 24 hours after operation were evaluated. MOF was characterized by the presence of at least 2 organ failures. To determine the relative risk (RR) of in-hospital death due to MOF, we performed a logistic regression multivariate analysis.
A total of 587 patients were included (mean age, 62.4 ± 17 years). ICU and hospital mortality rates were 15% and 20.6%, respectively. The main cause of death was MOF (53%). Peritonitis (RR 4.17, 95% confidence interval CI 1.38-12.6), diabetes (RR 3.63, 95% CI 1.17-11.2), unplanned surgery (RR 3.62, 95% CI 1.18-11.0), age (RR 1.04, 95% CI 1 0.01-1.08), and elevated serum lactate concentrations (RR 1.52, 95% CI 1.14-2.02), a high central venous pressure (RR 1.12, 95% CI 1.04-1.22), a fast heart rate (RR 3.63, 95% CI 1.17-11.2) and pH (RR 0.04, 95% CI 0.0005-0.38) on the day of admission were independent predictors of death due to MOF.
MOF is the main cause of death after surgery in high-risk patients. Awareness of the risk factors for death due to MOF may be important in risk stratification and can suggest routes for therapy.
In order to assess the risk of exposure of human populations to dichlorodiphenyltrichloroethane (DDT) and mercury, muscles of five fish species were analysed, along with the surface sediment of 14 ...Iriri River sampling sites. The fish specimens were sacrificed by the spinal section, prior to sex identification, body weight determination and total length. Considering the fish specimens studied, 11% of them showed concentrations of mercury higher than the maximum established by the World Health Organization for safe human consumption. A positive correlation between fish body weight and mercury concentration was observed, besides a positive correlation between the fish size and Hg concentration. Significant differences (P < 0.05) were found between mean concentrations of DDT and metabolites among species of fish studied. In the Plagioscion squamossissimus species, the highest concentration of total DDT (151.4 ng/g) was found, while in Eugerres Brasilianus species, the lowest. However, the DDT levels in fish muscle of studied species are below the maximum set by FAO-Alimentarius CODEX. In the sediments, total DDT ranged from 11.58 ng/g to 48.4 ng/g, which is associated with the historical DDT use in the Amazon. According to sediment quality guidelines, these levels have a moderate toxic effect in almost all of the studied region.