Political analysis of the neonatal screening for severe combined immunodeficiency - Curitiba, Brazil

Severe Combined Immunodeficiency (SCID) is the most aggressive form of primary immunodeficiencies, being able to death within 2 years after birth. In the USA, the screening found that the incidence of SCID was double that previously stipulated, before screening. Israel, Taiwan, Spain and others European countries are also testing for SCID. The long-term survival of patients diagnosed and treated before 4 months of life reaches 94%. Brazil does not perform neonatal screening for SCID through the Public Health System (SUS), numbers are unknown and under-diagnosed, even the treatment for SCID is funded by SUS. Analyze the political dimensions of the bill that aims to implement neonatal screening for SCID in Curitiba, Brazil. Participatory research was carried out between March - October 2019 and, bibliographic research on policy analysis in the context of emerging countries, to understand the criteria are taken into account for the political agenda, the influence of interest groups and the influence of the political arena in the implementation of a public policy through policy analysis. The project is pending in the municipal legislature of Curitiba and faces issues related to the financing of the implementation - a wide range of dependent variables act in the construction of a public policy. Its materialization, although important for public health, must consider real possibilities of implementation. In parallel, independent of the bill, a screening pilot project is under preparation by doctors, academics, and civil society. Brazil has a feasible technique that can be implemented on a large scale for neonatal SCID screening. However, although strongly recommended by the medical community, the implementation of this policy can be unviable by political and financial issues.

Key messages

The implementation of a public policy involves decisions between institutions, rules of the game and political forces. Early diagnosis may reduce treatment costs, requiring public policies for SCID.

Distinct Profiles of Consumers of Psychoactive Substances in People Attending French Sexual Transmitted Infections Centers

The objective of this cross-sectional survey was to assess the prevalence of psychoactive substance use (PSU) in people attending 11 French Sexual Transmitted Infection Centers, and to specify their profiles (PSU and link with risky sexual behaviors) using the ascending hierarchical clustering method. Among the 5220 individuals who completed the survey, 55.6% were men and the median age was 24 years [IQR: 20-31]. Among the participants, 2751 (52.7%) reported PSU at least once in their life. Ascending hierarchical clustering identified seven distinct profiles of participants based on their PSU. This study shows a high prevalence of PSU and alcohol consumption in this young population. Moreover, subgroup analysis allowed identifying groups of psychoactive substance users who presented specific risks or vulnerabilities and who should be priority targets for interventions, particularly sexual minority groups.

Morphological, histochemical and morphometric study of the myotomal muscle tissue of the pacu (Piaractus mesopotamicus Holmberg 1887: Serrasalminae, Characidae, Teleostei)

Histochemical, ultrastructural and morphometric methods were used to study growth patterns of red, pink and white muscle fibres and their relation to body weight and total length in the fast-growing freshwater fish Piaractus mesopotamicus Holmberg. The correlations amongst body weight, body length and diameter of red, pink and white fibres were low. From 10-15 to 40-50 cm, body weight increased 102.7 times, while the diameter of each type of fibre increased by factors of 0.94, 0.74 and 0.70, respectively. Muscle fibres revealed different morphological and histochemical stages of maturation. The frequencies of < 20 microns fibres of red, pink and white muscle tissue in the youngest and oldest classes were 64.5 and 11.0, 38.2 and 7.7 and 24.0 and 1.4%, respectively. In 30-40 cm fish, the frequency of < 20 microns fibres in the red and pink tissue was 24.5 and 25.5%, while in the white tissue it was 11.5%. During sexual maturity (40-50 cm), the recruitment of < 20 microns fibres in white muscle was 1.4%. Muscle fibres of this species showed continuous growth by both hyperplastic and hypertrophic mechanisms, and hyperplasia was particularly active in the juvenile phase.

Ultrastructure of Sorubim lima (Teleostei, Siluriformes, Pimelodidae) spermiogenesis

The spermiogenesis and the spermatozoon ultrastructure of Sorubim lima were studied. Our observations showed that early spermatids are round-shaped cells, have spherical nucleus with diffuse chromatin, small quantity of mitochondria and large amount of vesicles in the cytoplasm. During the differentiation process in the nucleus, chromatin compacts in a progressive and homogeneous way, and the flagellum is formed. In the cytoplasm the vesicles, that have double membranes, aggregate and fuse on the plasma membrane. The spermatozoa of S. lima have no acrosome and show spherical nucleus with homogeneous and highly compacted chromatin, intermediary piece with mitochondria and double wall vesicles contiguous to the plasma membrane, as well as a flagellum formed by a basic axoneme (9 + 2).

[Gastrointestinal bleeding]

OBJECTIVE: To present an analysis of the occurrence of gastrointestinal bleeding in children and emphasize: i) diagnostic methods; ii) the organized use of different therapeutic approaches in upper gastrointestinal bleeding; iii) the review of concepts, classifications and techniques used in endoscopy, which are important to the practice of clinical pediatrics. METHODS: Literary review of chapters selected from textbooks, pertinent articles obtained through the Medline system and active search, as well as personal archives belonging to the authors. RESULTS: The differential diagnosis of gastrointestinal bleeding in children varies according to the age. The causes of upper gastrointestinal bleeding are subdivided into variceal and nonvariceal. Nonselective beta-blockers are recommended to prevent variceal bleeding. Vasoactive drugs, such as somatostatin, octreotide, and glypressin may be used, showing good results in both variceal and nonvariceal acute bleeding. Both sclerotherapy and variceal ligation can be used in children to achieve variceal eradication. Cyanoacrylate is effective and presents the lowest complication rate related to gastric variceal bleeding. The presence of hemorrhage stigmata, such as active bleeding and visible vessel in ulcers is indicative of a higher risk for recurrent bleeding, suggesting the need for endoscopic hemostasis. Proton pump inhibitors are more efficacious than H2-receptor antagonists to promote the peptic ulcer healing. CONCLUSION: The correct etiologic diagnosis of gastrointestinal bleeding in children is fundamentally important to adopt the adequate therapeutic approach, whose main advances concern the pharmacological and the endoscopic treatment.