Pancreatic PEComa, a not so uncommon neoplasm? Systematic review and therapeutic update

Pancreatic PEComas are extremely rare neoplasms with malignant potential, which mostly affect middle-aged women and are characterized by presenting melanocytic and myogenic markers in immunohistochemical analysis. There are no symptoms or pathognomonic imaging tests, so the diagnosis is established with the analysis of the surgical specimen or the FNA obtained with preoperative endoscopic ultrasound. The mean treatment consists on radical excision, adapting the intervention to the location of the tumor. To date, 34 cases have been described; however, more than 80% of them have been reported in the last decade, which suggests that it is a more frequent pathology than expected. A new case of pancreatic PEComa is reported and a systematic review of the literature is carried out according to the PRISMA guidelines with the aim of divulge this pathology, deepening its knowledge and updating its management.

ASSOCIAÇÃO ENTRE TIPO SANGUÍNEO ABO E RESULTADO DO RT-PCR PARA SARS-COV-2

Introdução

Estudos apontam relação entre grupos sanguíneos e diversas condições clínicas como, por exemplo, eventos trombóticos, doença de von Willebrande doenças infecciosas como SARS-CoV-1, H. pylori entre outros. Associação entre maior susceptibilidade à COVID-19 e pior evolução em indivíduos do grupo sanguíneo A vem sendo estudada por diversos grupos.

Objetivo

Neste estudo, analisamos a correlação entre os grupos sanguíneos ABO e resultado do teste para o vírus SARS-CoV-2 por RT-PCR em um laboratório de análises clínicas com grande fluxo de amostras representativas das cinco regiões do Brasil.

Material e métodos

Os dados foram obtidos do banco de dados do laboratório referente a 20 anos de registro, analisados de forma anonimizada e de acordo com as regras que regem a lei geral de proteção de dados (LGPD). Os registros possuem um identificador numérico único que leva em conta CPF e data de nascimento e todas as análises foram feitas considerando-se esta identificação. Foram obtidas as tipagem sanguínea ABO/Rh e os resultados de RT-PCR para SARS-CoV-2. Para este último, os indivíduos foram classificados “covid-positivo”quando ao menos um exame resultou positivo. Os demais foram considerados “covid-negativo”. As análises foram realizadas no banco de dados obtido do cruzamento do banco de indivíduos únicos com tipagem sanguínea e ao menos um teste para COVID-19. Análise estatística foi realizada do teste chi-quadrado de Pearson e V-quadrado de Cramér.

Resultados e discussão

Foram identificados 66.181 indivíduos que realizaram tipagem sanguínea e ao menos um teste para SARS-CoV-2. A distribuição global dos grupos ABO é a que segue: grupo O 44%, grupo A 41%, grupo B 11% e grupo AB 4%, compatível com a distribuição dos grupos no Brasil (O 45%, A 42%, B 10% e AB 3%).Do total de indivíduos estudado, 21% (13.617) apresentou ao menos um resultado positivo para SARS-CoV-2, distribuídos da seguinte forma por grupo sanguíneo: tipo O 42%, A 42%, B 12% e AB 4%. A distribuição dos grupos sanguíneos entre os indivíduos negativos para SARS-CoV-2 foi: tipo O 44%, A 41%, B 11% e AB 4%. As análises consideraram grupo ABO e Rh. Foi realizado um teste chi-quadrado de independência de variáveis e verificou-se associação positiva entre o tipo sanguíneo e a infecção por COVID-19 (χ2 = 27,273, df = 7, p = 0,0002975).O teste pós-hoc de comparação entre status de COVID-19 e tipo sanguíneo sugere associação entre o tipo B- e infecção por COVID-19 (p = 0.0407700).Entretanto, este dado não foi confirmado por análise adicional pelo teste V de Cramér, sugerindo que o efeito observado está provavelmente associado ao grande número de amostras do que uma associação real entre as variáveis.Sabe-se que a testagem para COVID-19 pode resultar em falso negativo quando realizada fora da janela de maior sensibilidade para detecção do vírus. Deve-se considerar que, na presente análise, a informação sobre início dos sintomas e data de realização do teste não está disponível. Entretanto, o grande número de casos analisados diminui o impacto da ausência desta informação. Outro ponto importante a ser considerado é que não foram avaliados parâmetros de evolução clínica dos pacientes, sendo os dados restritos à presença ou não de diagnóstico positivo para COVID-19.

Conclusão

Não foi demonstrada associação entre o tipo sanguíneo e a suscetibilidade a infecções por COVID-19 no grupo analisado.

Embryonic and larval development of Jundiá (Rhamdia quelen, Quoy & Gaimard, 1824, Pisces, Teleostei), a South American Catfish

The jundiá (Rhamdia quelen, Quoy & Gaimard) is an endemic South American fish species. Because this species supports cold winters and grows faster during warm months, it has begun to be viewed as an ideal species for fish production in southern South America. In the present study, jundiá oocytes used were obtained by extrusion from females after hormone injection. Soon after hydration, the eggs were transferred to 50 L conic glass incubators, with constant and controlled water influx. Samples of fertilized eggs were transferred to Petri dishes and, examined under a stereoscopic microscope, were spherical, demersal, and non-adhesive with defined perivitelline space and resistant chorion. Cleavage stages occurred during the first 3.5 h. After hatching, larvae were transferred to 200 L glass fiber incubators. First signs of embryo movement were observed 21 h after fertilization; larval eclosion occurred 30.5 h after fertilization. Present findings may provide a basis for studies aimed at determining the complete ontogeny of jundiá and may be useful in eco-toxicological studies.

Risk factors for nosocomial infections in critically ill newborns: a 5-year prospective cohort study

BACKGROUND

Nosocomial infections (NIs) are one of the most important causes of morbidity in neonatal intensive care units (NICUs). The aim of this study was to identify risk factors (RFs) for NIs among critically ill newborn patients in a Brazilian NICU.

METHODS

This 5-year prospective cohort study in an 8-bed NICU included all infants born in the hospital and admitted to the NICU from 1993 to 1997. Exposure variables were maternal and newborn data prospectively collected from patient records. Univariate and multivariate analyses were used to determine independent RFs associated with NIs.

RESULTS

Univariate analysis indicated gestational age, congenital abnormality, premature rupture of membranes, maternal illness, birth weight, mechanical ventilation, central venous catheter, total parenteral nutrition, peripheral venous catheter, and length of stay as possible RFs. Multivariate analysis identified 5 independent RFs for NIs: premature rupture of membranes (hazard ratio [HR] = 1.51 [95% CI, 1.15-1.99]), maternal disease (HR = 1.57 [95% CI, 1.18-2.07]), mechanical ventilation (HR = 2.43 [95% CI, 1.67-3.53]), central venous catheter (HR = 1.70 [95% CI, 1.21-2.41]), and total parenteral nutrition (HR = 4.04 [95% CI, 2.61-6.25]).

CONCLUSION

The recognition of RFs for NIs is an important tool for the identification and development of interventions to minimize such risks in the NICU.

Low frequency of replication errors in primary nervous system tumours

OBJECTIVES

Automated DNA technology was used to analyze the incidence of microsatellite instability (MIN) among the most frequent types of adult primary CNS tumours and to determine its relation with clinicopathological characteristics.

METHODS

Fifty six gliomas, 32 meningiomas and 11 schwannomas were screened for size changes at eight microsatellite loci using fluorescent polymerase chain reaction (PCR) followed by fragment analysis in an automated sequencer. A tumour was considered as MIN+ when a different electrophoretic pattern between constitutional and tumour DNA was evidenced in one or more microsatellite markers and as replication error positive (RER+) when at least 25% of the markers analyzed (2/8) showed instability. The MIN phenotype was correlated with relevant clinical and pathological parameters.

RESULTS

Globally, instability was found in 19/767 analyses (2.47%), with a higher rate among tetranuceotide than dinucleotide repeats (chi(2) test, p=0.018). Ten gliomas (17.9%), two meningiomas (6.3%), and two schwannomas (18.2%) were MIN+, whereas one glioma (1.8%), two meningiomas (6.3%), and one schwannoma (9.1%) were classified as RER+. A possible association between microsatellite instability and a shorter duration of clinical course was found in meningiomas. The MIN+ phenotype was more frequent in spinal than intracranial schwannomas (Fisher's exact test, p=0.018). No other significant association with clinical or histological features was detected.

CONCLUSIONS

Although microsatellite instability can be demonstrated at a low rate in some primary CNS tumours, a true replication error phenotype (revealed by widespread microsatellite instability at numerous loci) is uncommon and unlikely to play an important part in the pathogenesis of these neoplasms. This form of instability was more frequent in tetranucleotide than in dinucleotide repeats. To our knowledge, this is the first report of MIN in schwannomas, where it was associated with the spinal localisation of the tumour.

Inhaled nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis

OBJECTIVES

To evaluate the use of inhaled nitric oxide (NO) in the management of persistent pulmonary hypertension of the newborn.

METHODS

Computerized bibliographic search on MEDLINE, CURRENT CONTENTS and LILACS covering the period from January 1990 to March 1998; review of references of all papers found on the subject. Only randomized clinical trials evaluating nitric oxide and conventional treatment were included. OUTCOMES STUDIED: death, requirement for extracorporeal membrane oxygenation (ECMO), systemic oxygenation, complications at the central nervous system and development of chronic pulmonary disease. The methodologic quality of the studies was evaluated by a quality score system, on a scale of 13 points.

RESULTS

For infants without congenital diaphragmatic hernia, inhaled NO did not change mortality (typical odds ratio: 1.04; 95% CI: 0.6 to 1.8); the need for ECMO was reduced (relative risk: 0.73; 95% CI: 0.60 to 0.90), and the oxygenation was improved (PaO2 by a mean of 53.3 mm Hg; 95% CI: 44.8 to 61.4; oxygenation index by a mean of -12.2; 95% CI: -14.1 to -9.9). For infants with congenital diaphragmatic hernia, mortality, requirement for ECMO, and oxygenation were not changed. For all infants, central nervous system complications and incidence of chronic pulmonary disease did not change.

CONCLUSIONS

Inhaled NO improves oxygenation and reduces requirement for ECMO only in newborns with persistent pulmonary hypertension who do not have diaphragmatic hernia. The risk of complications of the central nervous system and chronic pulmonary disease were not affected by inhaled NO.

Risk factors for nosocomial infections in a critically ill pediatric population: a 25-month prospective cohort study

We studied risk factors for nosocomial infections among 500 critically ill children who were admitted to a pediatric intensive care unit from August 1994 through August 1996 and who were prospectively followed until death, transfer, or discharge. Age, gender, postoperative state, length of stay, device-utilization ratio, pediatric risk of mortality score, and total parenteral nutrition were the risk factors studied. Through multivariate analysis, we identified three independent risk factors for nosocomial infection: device-utilization ratio (odds ratio [OR], 1.6; 95% confidence interval [CI95], 1.10-2.34), total parenteral nutrition (OR, 2.5; CI95, 1.05 5.81) and length of stay (OR, 1.7; CI95, 1.31-2.21).

[Tubular duplication of the colon: a case report and review of the literature]

Among Gastrointestinal Duplications, colonic duplications are the less common. The case presented here consist of a duplication of the transverse colon, difficult to diagnose, which had abdominal distension as the main symptom. A 4-year-old child was referred to the Unity of Pediatric Surgery, Hospital de Base, Brasilia, DF with a history of progressive abdominal distension. Plain X-Rays of the abdomen demonstrated a large fecaloma, which demanded removal. A Barium Enema was done suggesting Congenital Megacolon. A rectal biopsy was performed under general anesthesia, demonstrating normal ganglion cells. Medical treatment was instituted for chronic constipation in the Pediatric Gastroenterology clinic. The patient returned three months later with the same complaints. A new rectal biopsy was done; normal ganglion cells were described, ruling out Hirschsprung's disease. The parents were told to insist on the medical treatment diets. Four years later the patient was seen in the Emergency Room with signs and symptoms of low intestinal obstruction. Exploratory Laparotomy was undertaken as an emergency and the findings were complete volvulus of the large bowel involving the transverse colon up to the splenic flexure, demonstrating a large duplication of the transverse colon. A resection of the duplication and end-to-end colonic anastomosis was performed with an uneventful postoperative care. Discharged on excellent conditions.

[Megacystis-microcolon-intestinal hypoperistalsis syndrome. A case report]

A case of intestinal pseudo-obstruction in the neonatal period is presented. It is known as Megacistis-microcolon-intestinal Hypoperistalsis Syndrome and is a rare cause of intestinal dismotility.A white female newborn weighing 3,110 g was admitted to the Neonatal Surgical Unit of the Hospital de Base with a small omphalocele and a history of biliary vomit. Abdominal X-rays revealed complete absence of intestinal gas. Exploratory laparotomy was carried out, and the findings were great distension of the bladder, a short poorly developed and malrotated bowel with a non-fixed cecum. Surgical treatment consisted of gastrostomy, sigmoid colostomy, vesicostomy and repair of the omphalocele. Multiple biopsies were done in the small and large bowel. Ganglion cells were present in all specimens. The patient did not tolerate enteral feeding, and total parenteral nutrition was readily initiated. Nonetheless, death occurred on the 51st postoperative day. This is a rare syndrome which presents itself at birth as chronic intestinal obstruction. A postmortem examination confirmed the diagnosis.

Selective surveillance for nosocomial infections in a Brazilian hospital

OBJECTIVE

To devise a system for surveying the frequency of nosocomial infections in a tertiary care hospital in a developing country.

DESIGN

Prospective selective surveillance by nurses of the charts of patients at high risk for nosocomial infections, as identified by a form completed by resident physicians. The sensitivity, specificity, and predictive value of this method of selective surveillance were compared with those for total prospective chart review by two infectious disease specialists.

SETTING

A university hospital in northeastern Brazil.

PATIENTS

All patients hospitalized for more than 72 hours with an identified risk factor for nosocomial infection.

RESULTS

The ratio of nosocomial infections to 100 discharges was 13.4 and the incidence density was 11.2/1,000 patient days. The surveillance method demonstrated a sensitivity of 74% and a specificity of 99.7%. Positive predictive value was 93%, negative predictive value was 99%, and overall accuracy was 98%.

CONCLUSIONS

This method of selective surveillance for nosocomial infections based on risk factors identified by physicians demonstrated excellent predictive value and overall accuracy and may be of use to other hospitals that lack a nursing care plan book such as the Kardex. The relative frequency of nosocomial infections significantly exceeded the rates reported from hospitals in developed countries.

Studies of the acetate kinase-phosphotransacetylase and the butanediol-forming systems in Aerobacter aerogenes

Mutants of Aerobacter aerogenes devoid of acetate kinase and phosphotransacetylase activities were isolated by selection for resistance to fluoroacetate on lactate medium. The mutants were used to study the role of the acetate kinase-phosphotransacetylase system in growth on acetate and glucose. Acetate kinase-negative and phosphotransacetylase-negative mutants were unable to grow on acetate minimal medium. Their growth rates on glucose minimal medium were identical with that of the parent strain under aerobic conditions, but lower growth rates were observed in the mutant strains during anaerobic growth on glucose medium. The mutants were unable to incorporate [2-(14)C]-acetate rapidly while growing on glycerol. Variations in acetate kinase and phosphotransacetylase levels during growth on glucose were studied. The specific activities of the enzymes increased approximately fivefold during aerobic growth on glucose in batch culture. The enzyme levels were also studied during anaerobic growth on glucose at constant pH (pH 5.8 and 7.0). Smaller increases in specific activities were found under these conditions. The role of acetate in the induction of the diacetyl (acetoin) reductase was investigated using a mutant deficient in both acetate kinase and phosphotransacetylase. The effect of pH on the induction of this enzyme during growth on glucose under anaerobic conditions was tested. The data support the idea that free acetic acid is the inducer for the enzymes of the butanediol-forming pathway in A. aerogenes.