RESUMO

Cyanobacterial harmful algal blooms can pose risks to ecosystems and human health worldwide due to their capacity to produce natural toxins. The potential dangers associated with numerous metabolites produced by cyanobacteria remain unknown. Only select classes of cyanopeptides have been extensively studied with the aim of yielding substantial evidence regarding their toxicity, resulting in their inclusion in risk management and water quality regulations. Information about exposure concentrations, co-occurrence, and toxic impacts of several cyanopeptides remains largely unexplored. We used liquid chromatography-mass spectrometry (LC-MS)-based metabolomic methods associated with chemometric tools (NP Analyst and Data Fusion-based Discovery), as well as an acute toxicity essay, in an innovative approach to evaluate the association of spectral signatures and biological activity from natural cyanobacterial biomass collected in a eutrophic reservoir in southeastern Brazil. Four classes of cyanopeptides were revealed through metabolomics: microcystins, microginins, aeruginosins, and cyanopeptolins. The bioinformatics tools showed high bioactivity correlation scores for compounds of the cyanopeptolin class (0.54), in addition to microcystins (0.54-0.58). These results emphasize the pressing need for a comprehensive evaluation of the (eco)toxicological risks associated with different cyanopeptides, considering their potential for exposure. Our study also demonstrated that the combined use of LC-MS/MS-based metabolomics and chemometric techniques for ecotoxicological research can offer a time-efficient strategy for mapping compounds with potential toxicological risk. Environ Toxicol Chem 2024;43:2222-2231. © 2024 SETAC.

Assuntos

RESUMO

PURPOSE: To determine the incidence of VTE and clinical outcomes in a cohort of cancer patients and COVID-19 infection, and to establish possible predictive factors of VTE. METHODS/PATIENTS: A single-center retrospective cohort study was performed to determine the incidence of VTE and mortality in 118 cancer patients with SARS-CoV-2 infection from March to August 2020. We calculated individual Khorana Risk and CATS-MICA scores in order to evaluate their utility to identify risk of VTE or death. Continuous variables were compared using Wilcoxon or Student's T test, and categorical variables were compared using the Chi-Square or Fisher's exact text among patients with and without VTE. A Log-Rank test was performed to detect mortality differences between the groups. RESULTS: A total of 118 patients were included. VTE global incidence was 4.2% (n = 5), and mortality 25.4% (n = 30). Obesity (p = 0.05), recent chemotherapy (p = 0.049) and use of steroids (p = 0.006) were related to higher risk of VTE in the univariate analysis, although they were not confirmed in the multivariate analysis as independent risk factors. Statistically significant differences in all-cause, COVID-19-related and cancer-related mortality according to the Khorana risk score (KRS) were observed. CATS-MICA score (CMS) also showed statistically significant differences in mortality between low- and high-risk patients. Prediction of risk of VTE development with these scores showed a tendency towards significance. CONCLUSIONS: In this cohort, VTE incidence was similar to previously reported in the general population with SARS-CoV-2 infection. KRS was associated with overall and specific-cause mortality, and might be a useful prognostic tool in this setting.

RESUMO

Background and Purpose: The purpose of this study was to map the instruments for assessing the comfort of hospitalized older adults in the scientific literature, identifying those instruments validated and transculturally adapted to the realities of Brazil. Methods: This was a scoping review of 14 articles and a website retrieved from the following databases: MEDLINE/PubMed, CINAHL, EMBASE, Web of Science, Scopus, Science Direct/Elsevier, and gray literature (Oasisbr, Catalog of Theses and Dissertations [CAPES], OATD, BDBTD, and The Comfort Line). Results: Seventeen instruments for assessing the comfort of hospitalized older adults were mapped; however, none were specifically designed for this population, as they were originally intended for adults or individuals with neuropsychiatric conditions. Among these, three have been validated and transculturally adapted to the Brazilian context. Conclusions: This study reveals the need for a specific instrument tailored for hospitalized older adults without neuropsychiatric conditions.

RESUMO

INTRODUCTION: The implant disease risk assessment (IDRA) tool was designed to assess an individual's risk of developing peri-implant diseases by evaluating and integrating multiple risk factors. This study aimed to evaluate the IDRA tool to determine the risk of developing peri-implant disease in patients rehabilitated with dental implants. METHODS: A retrospective observational cross-sectional study was conducted, collecting data from 92 patients with 92 selected dental implants. Data included the history of periodontitis, sites with bleeding on probing (BoP), teeth and/or implants with probing depths (PDs) ≥ 5 mm, alveolar bone loss relative to the patient's age, susceptibility to periodontitis, the frequency of supportive periodontal therapy (SPT), the distance from the restorative margin (RM) of the implant-supported prosthesis to the marginal bone crest (MBC), and factors related to the prosthesis itself. Additionally, the validated instrument periodontal risk assessment (PRA) was employed for comparison. Statistical analyses utilized Chi-square, Mann-Whitney, and ROC curve. RESULTS: Outcomes indicated that 62 implants (67.4%) were classified as high-risk. Among the IDRA parameters, history of periodontitis was the primary factor contributing to an increased risk (p < 0.001). IDRA revealed high sensitivity (100%) and low specificity (63%) (AUC = 0.685; 95% CI: 0.554-0.816; p = 0.047), and there was a low agreement between the IDRA and PRA tools (Kappa = 0.123; p = 0.014). The peri-implant disease developed in 16 implants with 5.44 (±2.50) years of follow-up, however, no significant association was observed between the high- and low-medium risk groups and the occurrence of peri-implant diseases. CONCLUSION: Most of the evaluated implants presented high IDRA risk. The IDRA tool exhibited high sensitivity and low specificity; no significant association was observed between the risk profile and the development of peri-implant diseases.

Assuntos

RESUMO

OBJECTIVES: The objective of this long-term retrospective study was to evaluate the fracture rate and the risk factors associated with the fracture of 3.3 mm narrow diameter implants (NDIs). MATERIALS AND METHODS: A total of 524 records of patients rehabilitated with 3.3 mm NDIs between 1997 and 2015 were assessed. Data on patients, implants, and prostheses were collected, and descriptive analysis of the variables was performed. NDIs were separated into 2 groups: "fractured" and "non-fractured", and a multilevel logistic regression model was applied to identify the risk factors associated with NDI fracture. RESULTS: Eighty-four patients were removed from the analysis for interrupting follow-up or presenting failures other than fractures. Of the 440 patients included (64.66 ± 13.4 years), 272 were females (61.8%), and 168 males (38.2%), and mean follow-up time was 129 ± 47.1 months. Of the 1428 NDIs, 15 (1.05%) in 9 patients (2.04%) fractured during the studied period. Ten fractures (66.66%) happened in 6 patients (66.66%) showing signs of parafunction. NDI with modified sandblasted, large grit, acid-etched surface was the only implant variable to show a protective statistical significance (p = .0439). CONCLUSIONS: NDI fracture was a rare event in the studied sample. NDIs manufactured with modified sandblasted, large grit, acid-etched surface may provide extra protection against NDI fracture. Patient-specific factors and implant characteristics should be carefully considered to limit the risk of fracture of 3.3 mm NDIs.

RESUMO

Organochlorine, organophosphate, triazole, and strobilurin pesticides were determined in fish samples. Relative standard deviations lower than 9.3% were obtained for organochlorine pesticides and 10.8% for other pesticides. Accuracy ranged from 73% to 119% for organochlorine pesticides and 80.4% to 116% for organophosphate, triazole, and strobilurin pesticides. A total of 28 pesticides were analysed and 7 of them were detected (exceeding 10 µg/kg) in some samples, with the highest concentration recorded at 68.5 µg/kg, corresponding to heptachlor epoxide A. The pesticide most frequently detected was ß HCH, found in 30 of the 100 analysed samples. Hazard Quotient values were estimated for men, women, and children. These values exceeded 1 for heptachlor epoxide in women and children, as well as for endrin in children. These findings emphasise the need for stricter controls to reduce fish contamination and mitigate health risks.

RESUMO

The study conducted in the state of Colima, western Mexico, aimed to assess the 1) occurrence, 2) temporal variability, 3) spatial variability, and 4) potential risk for honeybees and human consumption of pesticide-contaminated honey. For that purpose, 48 pesticides were determined in bees and their honey during both dry and wet seasons. The research considered two variables: land use categorization (irrigated agriculture, rainfed agriculture, grassland, and forest area) and location (coastal, valley, and mountain). Bee and honey samples were collected, pre-treated using solid-phase extraction (SPE), and analyzed using LC-MS/MS and GC-MS techniques. Occurrence: of the total number of pesticides, 17 were detected in the bee samples and 12 in the honey samples. The pesticides with the highest concentrations in the bee samples were glufosinate ammonium, picloram, and permethrin, while in the honey samples, picloram, permethrin, and atrazine were the most prevalent. Temporal variability: analyses revealed significant differences between dry and wet seasons for glufosinate ammonium and DEET in bee samples and only for glufosinate ammonium in honey samples. Spatial variability: analyses showed a trend in the number of detected pesticides, with irrigated agriculture areas having the highest detection and grassland areas having the least. The human potential risk assessment of contaminated honey consumption indicated no risk. The bee's potential risk for consumption of pesticides contaminated honey revealed chronic effects due to permethrin in a general scenario, and carbofuran, diazinon and permethrin in the worst scenario, and potential risk of acute effects by permethrin. The findings of this study contribute to understanding the contamination levels of pesticides in bees and their honey, emphasizing the importance of monitoring and mitigating the adverse effects of pesticide exposure on bee populations and environmental health.

Assuntos

RESUMO

Pollution by microplastics (MPs) in mangroves is a growing concern, given its potential ecological and human health impacts. The characteristics of microplastic pollution and a risk assessment of MPs in the Amazon region's coastal sediments are still insufficient, and information about MP pollution in the benthic component of the mangrove ecosystem is lacking. We analyzed MP concentrations in the surface sediment of 9 stations in three tidal channels along the Ajuruteua Peninsula connected to the Caeté River estuary, aiming to assess the hazard level on the environment based on the Pollution Load Index (PLI). Raman and Fourier transform infrared spectroscopy determined the MP's chemical composition. The results showed that the abundance of sediment MPs ranged from 100 to 1200 items kg-1, with an average of 433 ± 261.6 items kg-1. The MPs were mainly composed of transparent and blue fragments and fibers, ranging in size from 100 to 5000 µm. Six types of polymers were identified, including alkyd varnish (AV), resin dispersion (RD), chlorinated polyethylene (CPE), polyethylene-polypropylene (PE-PP), low-density polyethylene (LDPE), and hostaperm blue (HB). Hydrodynamic processes within estuaries and tidal channels play a crucial role in explaining the concentrations found, as circulation determines the pattern of sediment deposition and the particles adhered to it. PLI risk assessment showed that all sampling sites were at hazard level I: a low level of contamination in the mangrove sediments. However, a more comprehensive and systematic monitoring campaign is needed to expand our knowledge about pollution and contamination by MPs in Amazon mangrove areas.

Assuntos

RESUMO

BACKGROUND: This study investigates the contamination level, spatial distribution, pollution sources, potential ecological risks, and human health risks associated with heavy metal(loid)s (i.e., arsenic (As), copper (Cu), iron (Fe), manganese (Mn), lead (Pb), and zinc (Zn)) in surface soils within the mining region of Matehuala, located in central Mexico. OBJECTIVES: The primary objectives are to estimate the contamination level of heavy metal(loid)s, identify pollution sources, assess potential ecological risks, and evaluate human health risks associated with heavy metal(loid) contamination. METHODS: Soil samples from the study area were analysed using various indices including Igeo, Cf, PLI, mCd, EF, and PERI to evaluate contamination levels. Source apportionment of heavy metal(loid)s was conducted using the APCS-MLR and PMF receptor models. Spatial distribution patterns were determined using the most efficient interpolation technique among five different approaches. The total carcinogenic risk index (TCR) and total non-carcinogenic index (THI) were used in this study to assess the potential carcinogenic and non-carcinogenic hazards posed by heavy metal(loid)s in surface soil to human health. RESULTS: The study reveals a high contamination level of heavy metal(loid)s in the surface soil, posing considerable ecological risks. As was identified as a priority metal for regulatory control measures. Mining and smelting activities were identified as the primary factors influencing heavy metal(loid) distributions. Based on spatial distribution mapping, concentrations were higher in the northern, western, and central regions of the study area. As and Fe were found to pose considerable and moderate ecological risks, respectively. Health risk evaluation indicated significant levels of carcinogenic risks for both adults and children, with higher risks for children. CONCLUSION: This study highlights the urgent need for monitoring heavy metal(loid) contamination in Matehuala's soils, particularly in regions experiencing strong economic growth, to mitigate potential human health and ecological risks associated with heavy metal(loid) pollution.

Assuntos

RESUMO

We investigated the occurrence and the environmental risk of eight contaminants of emerging concern (CECs; acetaminophen, naproxen, diclofenac, methylparaben, 17ß-estradiol, sulfathiazole, sulfadimethoxine, and sulfamethazine) in three Brazilian water bodies, namely, the Monjolinho River Basin (São Paulo State), the Mogi Guaçu River (São Paulo State), and the Itapecuru River (Maranhão State) in three sampling campaigns. The CECs were only quantified in surface water samples collected at the Monjolinho River Basin. Acetaminophen, naproxen, and methylparaben were detected in the range of <200 to 575.9 ng L-1, <200 to 224.7 ng L-1, and <200 to 303.6 ng L-1, respectively. The detection frequencies of the three measured compounds were between 33% and 67%. The highest concentrations of CECs were associated with intense urbanization and untreated sewage discharge. Furthermore, CEC concentrations were significantly correlated with total organic carbon, electrical conductivity, and dissolved oxygen levels, suggesting that domestic pollution from urban areas is an important source in the distribution of CECs in the Monjolinho River Basin. The environmental risk assessment indicated a high risk for acetaminophen (risk quotient [RQ] values between 2.1 and 5.8), a medium risk for naproxen (RQs between 0.6 and 0.7), and a low risk for methylparaben (RQs < 0.1) to the freshwater biota of the Monjolinho River Basin. Our findings show potential threats of CECs in Brazilian water bodies, especially in vulnerable areas, and reinforce the need for improvements in environmental regulations to include monitoring and control of these compounds in aquatic systems. Environ Toxicol Chem 2024;43:2199-2210. © 2024 SETAC.

Assuntos

RESUMO

Pharmaceuticals are considered as contaminants of emerging concern, and their occurrence in diverse environmental matrices has been described during the last 25 years. Nonetheless, pharmaceutical occurrence has not been evenly described worldwide, and reports from some geographical areas such as most parts of Latin America are scarce. This work aims to address the situation of water pollution due to pharmaceuticals in Latin America by means of two main goals: i. First, reviewing the monitoring studies performed in Latin America on this topic (period 2009-2024), which were conducted in Brazil, Mexico, Colombia, Ecuador, Peru and Argentina, to highlight the most frequently detected compounds from each therapeutic group in the region. ii. Second, analyzing the case of Costa Rica through the hazard assessment and prioritization of pharmaceuticals based on the monitoring performed in this country (years 2011; 2018-2019). The monitoring in Costa Rica comprised a total of 163 sampling points: wastewater treatment plants (WWTPs) (14 urban WWTPs plus two landfill WWTPs; total samples n = 44 influents and n = 34 effluents), nine hospital effluents (n = 32), wastewater from livestock farms (six swine farms and seven dairy farms; n = 23 influents and n = 37 effluents), 64 continental surface water sampling points (n = 137), and 61 coastal seawater sampling points (n = 61). Risk assessment of detected concentrations by the hazard quotient (HQ) approach (period 2018-2019) revealed a total of 25 medium or high-hazard compounds (out of 37 detected compounds). The prioritization approach (which included the Frequency of Appearance (FoA), the Frequency of PNEC exceedance (FoE), and the Extent of predicted no-effect concentration (PNEC) exceedance (EoE)), showed a critical list of nine pharmaceuticals: caffeine, diphenhydramine, acetaminophen, lovastatin, gemfibrozil, ciprofloxacin, ibuprofen, doxycycline and norfloxacin. These compounds should be taken into account as a first concern during the implementation of environmental policies related to pharmaceutical products in the region.

Assuntos

RESUMO

The present systematic review (SR) aims to evaluate manuscripts in order to help further elucidate the following question: is the micronucleus assay (MA) also a useful marker in gingiva, tongue, and palate for evaluating cytogenetic damage in vivo? A search was performed through the electronic databases PubMed/Medline, Scopus, and Web of Science, all studies published up to December 2023. The comparisons were defined as standardized mean difference (SMD), and 95% confidence intervals (CIs) were established. Full manuscripts from 34 studies were carefully selected and reviewed in this setting. Our results demonstrate that the MA may be a useful biomarker of gingival tissue damage in vivo, and this tissue could be a useful alternative to the buccal mucosa. The meta-analysis analyzing the different sites regardless of the deleterious factor studied, the buccal mucosa (SMD = 0.69, 95% CI, - 0.49 to 1.88, p = 0.25) and gingiva (SMD = 0.31, 95% CI, - 0.11 to 0.72, p = 0.15), showed similar results and different outcome for the tongue (SMD = 1.19, 95% CI, 0.47 to 1.91, p = 0.001). In summary, our conclusion suggests that the MA can be a useful marker for detecting DNA damage in gingiva in vivo and that this tissue could be effective site for smearing.

RESUMO

This work assessed the psychosocial risks of 124 workers from the plywood industry in Ecuador's Amazon region. Two psychosocial risk assessment (PRA) methods were selected due to their widespread use in Ecuadorian organisations: FPSICO from the Spanish National Institute for Occupational Safety and Health and the "Psychosocial Risk Assessment Questionnaire" (PRAQ) from the Ecuadorian Labour Ministry. Therefore, two surveys of 89 and 58 items were applied to evaluate nine scales and eight risk dimensions for FPSICO and PRAQ, respectively. Results show that according to FPSICO, the main psychosocial risks were detected in the scales of working time (WT), variety and content (VC), and workload (WL), with a prevalence of 34.8 % and 41.7 %. For PRAQ, the margin of action and control (D4), load and work rate (D1), and leadership (D3) were the most affected dimensions, with a risk prevalence between 29.1 % and 43.6 %. Although there is a lower risk prevalence in the rest of the scales and dimensions assessed, improvement actions are needed in the short term. Furthermore, the findings suggest an association between gender and risk prevalence, especially in the dimensions of Leadership (D3), Skills development (D2), and Self-perceived health (D8.8), where being a woman increases the likelihood of suffering from these conditions by up to three times. In addition, a brief comparative analysis was conducted, looking for coincidences in the scales that each PRA instrument assesses and the prevalence of the psychosocial risks detected.

RESUMO

The research aimed to carefully review the chemical hazards linked to the coffee production chain to analyse the risks and opportunities for consumers and the environment, as well as identify potential knowledge gaps. The Scopus database was consulted from 1949 to April 2024 to conduct a bibliometric analysis. As a result, 680 articles were analysed. Results indicated a significant increase in research activity since 2015. China, Brazil, and the USA were the leading countries in scientific production and collaborations. The most prolific journals in this field were Chemosphere, Science of the Total Environment, Food Chemistry, Journal of Agricultural and Food Chemistry, and Journal of Environmental Management, all of which are in the first quartile. The word analysis revealed two main themes: the first focuses on the chemical hazards of coffee and their impact on health, while the second explores the waste generated during coffee production and its potential for reuse. The topics covered in the research include the composition of coffee, associated chemical hazards, possible health risks, and ways to reuse waste for environmental protection. Future research should concentrate on optimising techniques and processes to ensure quality, safety, and sustainability.

RESUMO

Climate change is an environmental emergency threatening species and ecosystems globally. Oceans have absorbed about 90% of anthropogenic heat and 20%-30% of the carbon emissions, resulting in ocean warming, acidification, deoxygenation, changes in ocean stratification and nutrient availability, and more severe extreme events. Given predictions of further changes, there is a critical need to understand how marine species will be affected. Here, we used an integrated risk assessment framework to evaluate the vulnerability of 132 chondrichthyans in the Eastern Tropical Pacific (ETP) to the impacts of climate change. Taking a precautionary view, we found that almost a quarter (23%) of the ETP chondrichthyan species evaluated were highly vulnerable to climate change, and much of the rest (76%) were moderately vulnerable. Most of the highly vulnerable species are batoids (77%), and a large proportion (90%) are coastal or pelagic species that use coastal habitats as nurseries. Six species of batoids were highly vulnerable in all three components of the assessment (exposure, sensitivity and adaptive capacity). This assessment indicates that coastal species, particularly those relying on inshore nursery areas are the most vulnerable to climate change. Ocean warming, in combination with acidification and potential deoxygenation, will likely have widespread effects on ETP chondrichthyan species, but coastal species may also contend with changes in freshwater inputs, salinity, and sea level rise. This climate-related vulnerability is compounded by other anthropogenic factors, such as overfishing and habitat degradation already occurring in the region. Mitigating the impacts of climate change on ETP chondrichthyans involves a range of approaches that include addressing habitat degradation, sustainability of exploitation, and species-specific actions may be required for species at higher risk. The assessment also highlighted the need to further understand climate change's impacts on key ETP habitats and processes and identified knowledge gaps on ETP chondrichthyan species.

El cambio climático es una emergencia medioambiental que amenaza a especies y ecosistemas en todo el mundo. Los océanos han absorbido alrededor del 90% del calor antropogénico y entre el 20% y el 30% de las emisiones de carbono, lo que ha provocado su calentamiento, acidificación, desoxigenación, cambios en la estratificación de los océanos y en la disponibilidad de nutrientes, así como fenómenos extremos más pronunciados. Dadas las predicciones de cambios, hay una importante necesidad de entender cómo las especies marinas se verán afectadas. En este estudio utilizamos una Evaluación Integrada de Riesgos para evaluar la vulnerabilidad de 132 condrictios del Pacífico Tropical Oriental (PTO) a los impactos del cambio climático. Adoptando un enfoque preventivo, estimamos que la vulnerabilidad general al cambio climático es Alta para casi una cuarta parte (23%) de las especies de condrictios del PTO evaluadas y Moderada para gran parte del resto (76%). La mayoría de las especies altamente vulnerables son batoideos (77%), y una gran proporción de éstas (90%) son especies costeras o especies pelágicas que utilizan los hábitats costeros como áreas de crianza. Seis especies de batoideos tuvieron una vulnerabilidad Alta en los tres componentes de la evaluación. Esta evaluación indica que las especies costeras, en particular las que dependen de áreas de crianza costeras, son las más vulnerables al cambio climático. Es probable que el calentamiento de los océanos, junto con la acidificación y la posible desoxigenación, tenga efectos generalizados sobre las especies de condrictios del PTO, pero las especies costeras se verán también afectadas por los cambios en los aportes de agua dulce, la salinidad y el aumento del nivel del mar. Esta vulnerabilidad relacionada con el clima se ve agravada por otros factores antropogénicos que ya se están produciendo en la región, como la sobrepesca y la degradación del hábitat. La mitigación de los impactos del cambio climático sobre los condrictios del PTO implica medidas que incluyan abordar la degradación del hábitat y la sostenibilidad de la explotación pesquera, y acciones para las especies de mayor riesgo son necesarias. Esta evaluación también destaca la necesidad de comprender mejor los impactos del cambio climático en los hábitats y procesos clave del PTO y las lagunas de conocimiento identificadas en relación con las especies de condrictios del PTO.

Assuntos

RESUMO

Indoor house dust is considered an important human exposure route to polybrominated diphenyl ethers (PBDEs), which has raised concern about their environmental persistence and toxicity properties. In this study, eight PBDEs (BDE-28, -47, -99, -100, -153, -154, -183, and -209) were determined in house dust from two cities with different socio-demographic characteristics from Brazil, examining possible relationships with factors that potentially influence contamination (population density, economic activities, presence of electronic equipment, and so on) and also estimating the risk of human exposure through oral ingestion and dermal contact. The Σ8PBDE concentration in Sorocaba city ranged between 380 and 4269 ng/g dw, while in Itapetininga city ranged from 106 to 1000 ng/g dw. In both regions, BDE-209 was the most abundantly found congener, followed by BDE-99. House dust from Sorocaba presented significantly greater concentrations of BDE-183 and BDE-209 than Itapetininga. Regarding risk exposure assessment, the estimated daily intake (EDI) of PBDEs was much lower than their respective reference doses (RfDs) in all pathways estimated (non-dietary ingestion and dermal contact). This study provided valuable data to improve the knowledge about the presence and exposure to PBDEs in Brazilian house dust in comparison to other developing countries and the need to control environmental pollution and protect human health.

Assuntos

RESUMO

Background: The Molecular International Prognostic Scoring System (IPSS-M) has improved the prediction of clinical outcomes for myelodysplastic syndromes (MDS). The Artificial Intelligence Prognostic Scoring System for MDS (AIPSS-MDS), based on classical clinical parameters, has outperformed the IPSS, revised version (IPSS-R). For the first time, we validated the IPSS-M and other molecular prognostic models and compared them with the established IPSS-R and AIPSS-MDS models using data from South American patients. Methods: Molecular and clinical data from 145 patients with MDS and 37 patients with MDS/myeloproliferative neoplasms were retrospectively analyzed. Results: Prognostic power evaluation revealed that the IPSS-M (Harrell's concordance [C]-index: 0.75, area under the receiver operating characteristic curve [AUC]: 0.68) predicted overall survival better than the European MDS (EuroMDS; C-index: 0.72, AUC: 0.68) and Munich Leukemia Laboratory (MLL) (C-index: 0.70, AUC: 0.64) models. The IPSS-M prognostic discrimination was similar to that of the AIPSS-MDS model (C-index: 0.74, AUC: 0.66) and outperformed the IPSS-R model (C-index: 0.70, AUC: 0.61). Considering simplified low- and high-risk groups for clinical management, after restratifying from IPSS-R (57% and 32%, respectively, hazard ratio [HR]: 2.8; P=0.002) to IPSS-M, 12.6% of patients were upstaged, and 5% were downstaged (HR: 2.9; P=0.001). The AIPSS-MDS recategorized 51% of the low-risk cohort as high-risk, with no patients being downstaged (HR: 5.6; P<0.001), consistent with most patients requiring disease-modifying therapy. Conclusions: The IPSS-M and AIPSS-MDS models provide more accurate survival prognoses than the IPSS-R, EuroMDS, and MLL models. The AIPSS-MDS model is a valid option for assessing risks for all patients with MDS, especially in resource-limited centers where molecular testing is not currently a standard clinical practice.

RESUMO

Since 2019, the Brazilian Institute of Environment and Renewable Natural Resources (IBAMA) has actively developed pesticide environmental risk assessment (ERA) frameworks adapted to Brazil's specific ecological contexts. This endeavor, supported by funding from the Brazilian Ministry of Justice and in partnership with academic institutions, has led to a concerted effort to establish ERA protocols for various taxa, including birds and mammals, soil organisms, aquatic organisms, and reptiles and amphibians. The outcomes of this initiative were conveyed in two workshops held in February and November 2023, during which the agency communicated its findings to the technical-regulatory community. This article represents one of two articles that provide more detailed insights into the ERA propositions for all taxa. In this article, we summarize the proposals for aquatic organisms presented and discussed during the workshops, which can be used as an informational source by the technical-regulatory community. Integr Environ Assess Manag 2024;20:1787-1792. © 2024 The Author(s). Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Assuntos

RESUMO

OBJECTIVE: To derive and validate internally a novel risk assessment tool to identify young children at risk for all-cause mortality ≤60 days of discharge from hospitals in sub-Saharan Africa. STUDY DESIGN: We performed a prospective observational cohort study of children aged 1-59 months discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania and John F. Kennedy Medical Center in Monrovia, Liberia (2019-2022). Caregivers received telephone calls up to 60 days after discharge to ascertain participant vital status. We collected socioeconomic, demographic, clinical, and anthropometric data during hospitalization. Candidate variables with P < .20 in bivariate analyses were included in a multivariable logistic regression model with best subset selection to identify risk factors for the outcome. We internally validated our tool using bootstrapping with 500 repetitions. RESULTS: There were 1933 young children enrolled in the study. The median (IQR) age was 11 (4, 23) months and 58.7% were males. In total, 67 (3.5%) died during follow-up. Ten variables contributed to our tool (total possible score 82). Cancer (aOR 10.6, 95% CI 2.58, 34.6), pedal edema (aOR 6.94, 95% CI 1.69, 22.6), and leaving against medical advice (aOR 6.46, 95% CI 2.46, 15.3) were most predictive of post-discharge mortality. Our risk assessment tool demonstrated good discriminatory value (optimism corrected area under the receiver operating characteristic curve 0.77), high precision, and sufficient calibration. CONCLUSIONS: After validation, this tool may be used to identify young children at risk for post-discharge mortality to direct resources for follow-up of high-risk children.

Assuntos