Estimulação diafragmática elétrica transcutânea (EDET) para fortalecimento muscular respiratório: estudo clínico controlado e randomizado

O objetivo do estudo foi demonstrar o efeito de dois protocolos da estimulação diafragmática elétrica transcutânea (EDET) sobre a força muscular respiratória de mulheres saudáveis, sendo um protocolo segundo Geddes et al. (1988) e outro padronizado pelo equipamento Phrenics. Mulheres saudáveis foram divididas em 3 grupos: Controle (n=7); EDET com Phrenics (n=7) e EDET com Dualpex (n=7), sendo o tratamento realizado 2 vezes por semana, durante 6 semanas (12 sessões). Foram avaliadas a pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx), antes e após o tratamento. A análise estatística foi realizada pelo teste Shapiro-Wilk e Kruskal Wallis com pós-hoc de Dunn (p<0,05). Os dois grupos experimentais apresentaram aumento na PImáx (Phrenics: 32,9%; Dualpex: 63,2%) e na PEmáx (Phrenics: 44,7%; Dualpex: 60,9%), diferentemente do Controle que não apresentou diferença. Em conclusão, os dois protocolos de EDET promoveram aumento da força muscular inspiratória e expiratória em mulheres saudáveis

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Quantitative Dot Blot Assays to determine Vibrio cholerae O1 Lipopolysaccharide concentration using Monoclonal Antibody

Introduction: Rapid diagnosis is fundamental for epidemiological control of Cholera disease. Contradictorily the gold standard test (stool culture) takes several days. Finlay Vaccine Institute obtained an Immunoagglutination test for rapid diagnosis of Cholera (FCIT), based on a monoclonal antibody anti- LPS O1 coupled to latex particles. FCIT,includes a positive control (LPS O1 Ogawa), which quantification is mandatory to obtain the registration of the test.The objective of the work was to develop a quantitative Dot Blot to determine the LPS O1 concentration in FCIT Positive control, using a peroxidase-conjugated mAb.Materials and Methods: Conjugation of mAb anti LPS O1 to peroxidase enzyme was carry out by periodate method. Quantitation of LPS O1 was accomplish by quantity Dot Blot. For capture Vibrio cholerae 569B Lipopolysaccharides from Sigma, was used as standard of the curve (40 μg/mL to 0.6 μg/mL) and fi ve lots of FCIT positive control were applied as sample. For detection conjugated mAb-HRP was employed at dilution 1:5000. The development of the reaction was carried out using SIGMAFAST™ DAB Tablet. The images were captured using the GS-800 densitometer and the spots density (Int/mm2) were calculated using the ImageJ software. The LPS concentration in positive control lots was calculated employed Ascent Software.Results: The mAb was conjugated to the HRP effi ciently with working dilutions range from 1:2500 to 1:10,000. A four-parameter fi t model curve was obtained with R2 of 0.99. Of the fi ve FCIT positive control lots evaluated, four complied with 30% of the expected concentration, for an 80% effectiveness of the technique.Conclusions: These results suggest that the quantitative Dot Blot using the mAbC anti Vibrio cholerae LPS O1, can be employed for the quantifi cation of LPS in batches of the FCIT positive control, from the purifi cation and production stages, as well as for the stability evaluation.</p

Durvalumab After Chemoradiation for Unresectable Stage III Non-Small Cell Lung Cancer: Inferior Outcomes and Lack of Health Equity in Hispanic Patients Treated With PACIFIC Protocol (LA1-CLICaP)

Objectives: To compare the rate disparity between outcomes (overall survival (OS), progression-free survival (PFS), and safety) of concurrent chemoradiation (cCRT) followed by durvalumab in two patient cohorts with locally advanced (LA) stage III non-small cell lung cancer (NSCLC), one non-Hispanic White (NHW), and the other Latin-American. Methods: A multicenter retrospective study was performed, including 80 Hispanic and 45 NHW LA stage III NSCLC patients treated with cCRT followed by durvalumab. Both cohorts were analyzed in terms of main outcomes (OS, PFS, and safety) and compared between them and with the PACIFIC trial population outcomes. The efficacy-effectiveness gap was assessed using an efficacy-effectiveness (EE) factor that was calculated by dividing each cohort median overall survival by the corresponding reference OS from the PACIFIC trial. In both cohorts, results of PD-L1 testing were recorded, and the main outcomes were compared according to PD-1 expression levels (≥50%, 1–49%, and <1%). Results: For the entire population (N=125), the overall response rate (ORR) was 57.6% (N=72), and 18.4% (N=25) achieved stable disease. OS was 26.3 months (95%CI 23.9-28.6), and PFS was 20.5 months (95%CI 18.0-23.0). PFS assessed by ethnicity showed a median for the Hispanic population of 19.4 months (95%CI 16.4-22.5) and 21.2 months (95%CI 17.2-23.3p=0.76) for the NHW group. OS by race showed a significant difference in favor of the NHW group, with a median OS of 27.7 months (95%CI 24.6-30.9) vs. 20.0 months (95%CI 16.4-23.5) for Hispanics. (P=0.032). Unadjusted 12-month and 24-month OS was 86.6% (95%CI 79.9–88.0) and 46.6% (95%CI 40.2–48.3) for NHW compared to 82.5% (95%CI 77.1–84.2) and 17.5% (95%CI 15.6-24.5) in Hispanics. NHW had an EE factor of 0.78 and Hispanics had 0.58, showing a reduction in survival versus NHW and PACIFIC of 20% and 42%, respectively. HR for the OS among NHWs and Hispanics was 1.53 (95%CI 1.12-1.71P=0.052) and 2.31 (95%CI 1.76-2.49P=0.004). Fifty-six patients (44.8%) had some degree of pneumonitis due to cCRT plus durvalumab. There was no difference in the proportion of pneumonitis according to race (P=0.95), and the severity of pneumonitis was not significantly different between Hispanics and NHWs (P=0.41). Conclusions: Among patients with LA stage III NSCLC, NHW had better survival outcomes when compared to Hispanics, with an OS that seems to favor the NHW population and with an EE factor that shows a shorter survival in Hispanics compared with NHW and with the PACIFIC trial group. Copyright © 2022 Raez, Arrieta, Chamorro, Soberanis-Piña, Corrales, Martín, Cuello, Samtani, Recondo, Mas, Zatarain-Barrón, Ruíz-Patiño, García-Robledo, Ordoñez-Reyes, Jaller, Dickson, Rojas, Rolfo, Rosell and Cardona