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ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.

https://doi.org/10.5935/0103-507x.20220209-pt

The health facility as a risk factor for multidrug-resistant gram-negative bacteria in critically ill patients with COVID-19
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de Macedo, Viviane

; dos Santos, Gabriela de Souza

; da Silva, Rodolff Nunes

; Couto, Caio Nogara de Menezes

; Bastos, Camila

; Viecelli, Eloize

; Mateus, Marina do Nascimento

; Graf, Maria Esther

; Gonçalves, Raquel Bernardelli

; da Silva, Márcia Aparecida

; Bernardini, Patricia Dal Bem

; Grando, Roberta Serra Pereira

; Boaventura, Viviane Pavanelo

; Pereira, Helki Simone Rodrigues

; Levin, Anna S.

Clinics

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2022, Volumen 77 elocation 100130

Resumen: En | Texto: En | PDF: En

Abstract Background The relationship between Multidrug Resistant-Gram Negative Bacteria (MDR-GNB) infection and colonization in critically ill COVID-19 patients has been observed, however, it is still poorly understood. This study evaluated the risk factors for acquiring MDR-GNB in patients with severe COVID-19 in Intensive Care Units (ICU). Methods This is a nested case-control study in a cohort of 400 adult patients (≥ 18 years old) with COVID-19, hospitalized in the ICU of 4 hospitals in the city of Curitiba, Brazil. Cases were critical COVID-19 patients with one or more MDR GNB from any surveillance and/or clinical cultures were taken during their ICU stay. Controls were patients from the same units with negative cultures for MDR-GNB. Bivariate and multivariate analyses were done. Results Sixty-seven cases and 143 controls were included. Independent risk factors for MDR bacteria were: male gender (OR = 2.6; 95% CI 1.28‒5.33; p = 0.008); the hospital of admission (OR = 3.24; 95% CI 1.39‒7.57; p = 0.006); mechanical ventilation (OR = 25.7; 95% CI 7.26‒91; p < 0.0001); and desaturation on admission (OR = 2.6; 95% CI 1.27‒5.74; p = 0.009). Conclusions Male gender, desaturation, mechanical ventilation, and the hospital of admission were the independent factors associated with MDR-GNB in patients in the ICU with COVID-19. The only modifiable factor was the hospital of admission, where a newly opened hospital posed a higher risk. Therefore, coordinated actions toward a better quality of care for critically ill COVID-19 patients are essential.

https://doi.org/10.1016/j.clinsp.2022.100130

[SciELO Preprints] - COVID-Inconfidentes - SARS-CoV-2 seroprevalence in two Brazilian urban areas during the pandemic first wave: study protocol and initial results
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Meireles, Adriana Lucia Lourenção, Luciano Garcia Menezes Junior, Luiz Antônio Alves de Coletro, Hillary Nascimento Justiniano, Irene Carolina Sousa Moura, Samara Silva de Diniz, Amanda Popolino Sabião, Thaís da Silva Rocha, Ana Maria Sampaio Batista, Aline Priscila Lage, Nara Nunes Simões, Bárbara dos Santos Santos, Carolina Ali Mendonça, Raquel de Deus Andrade, Amanda Cristina de Souza Barbosa, Keila Furbino Masioli, Cássio Zumerle Carraro, Júlia Cristina Cardoso Menezes, Mariana Carvalho de Nascimento, Renata Cristina Rezende Macedo Roever, Leonardo Caiaffa, Waleska Teixeira Machado-Coelho, George Luiz Lins

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Fecha de publicación: 2021-07-29

Resumen: En

Background: A population study is an important tool that can be used to understand the actual epidemiological scenario of the Covid-19 in different territories, identify its magnitude, understand its transmission dynamics, and its demographic, geographical, and social distribution. Objective: The aim of this study was to determine the prevalence and dynamics of SARS-CoV-2 infection in the population of two Brazilian cities during the pandemic first wave and subsequent socioeconomic and health effects. Materials & methods: This paper described the methodological procedures adopted and the prevalence of the SARS-CoV-2 infection in the population. A household survey was conducted between October and December 2020, in two historic cities of Brazil's mining region. Anti-SARS-CoV-2 antibody was detected using the Wondfo® rapid test. The face-to-face interview consisted of administration of a questionnaire containing registration data, sociodemographic and economic variables, living habits, general health condition, mental health, sleep habits, and eating and nutrition. Results: We evaluated 1,762 residents, of which 764 (43.4%) were in Mariana and 998 (56.6%) in Ouro Preto. For both cities, 51.9% of the interviewees were female, with a predominance of the age range 35 to 59 years old (47.2%). The prevalence of the SARS-CoV-2 infection was 5.5% in all cities, 6.2% in Ouro Preto, and 4.7% in Mariana. The prevalence was similar between cities (P>0.05). Conclusion: The study was effective in verifying the seroprevalence of infection by the virus and its findings will enable further analyses of the health conditions of the population related to social isolation and the risk of infection with SARS-CoV-2.

https://doi.org/10.1590/SciELOPreprints.2720

Caracterização Histológica das Lesões da Valva Mitral de Pacientes com Cardiopatia Reumática
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Gomes, Nayana F. A.

; Pascoal-Xavier, Marcelo A.

; Passos, Livia S. A.

; Paula, Thiago Mendonça Nunes

; Aguiar, João Marcelo de Souza

; Guarçoni, Felipe Vieira

; Nassif, Maria Cecília Landim

; Gelape, Claudio Leo

; Braulio, Renato

; Costa, Paulo Henrique N.

; Passaglia, Luiz Guilherme

; Martins, Raquel Braga

; Dutra, Walderez O.

; Nunes, Maria Carmo P.

Arquivos Brasileiros de Cardiologia

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Mar 2021, Volumen 116 Nº 3 Paginas 404 - 412

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Fundamentos: Os mecanismos subjacentes pelos quais a doença cardíaca reumática (DCR) levam à disfunção valvar grave não são totalmente compreendidos. Objetivo: O presente estudo avaliou as alterações histopatológicas nas valvas mitrais (VM) buscando uma associação entre o padrão de disfunção valvar predominante e os achados histopatológicos. Métodos: Em 40 pacientes submetidos à troca da VM devido a DCR e em 20 controles submetidos a transplante cardíaco, foram analisados os aspectos histológicos da VM excisada. Dados clínicos e ecocardiográficos também foram coletados. As análises histológicas foram realizadas usando coloração com hematoxilina-eosina. Determinou-se inflamação, fibrose, neoangiogênese, calcificação e metaplasia adiposa. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados: A idade média dos pacientes com DCR foi de 53±13 anos, sendo 36 (90%) do sexo feminino, enquanto a idade média dos controles foi de 50±12 anos, semelhante aos casos, sendo a maioria do sexo masculino (70%). O endocárdio valvar reumático apresentou espessura maior que os controles (1,3±0,5 mm versus 0,90±0,4 mm, p=0,003, respectivamente), e infiltrado inflamatório mais intenso no endocárdio (78% versus 36%; p=0,004), com predominância de células mononucleares. Ocorreu fibrose moderada a acentuada mais frequentemente em válvulas reumáticas do que em válvulas controle (100% vs. 29%; p<0,001). Ocorreu calcificação em 35% das valvas reumáticas, principalmente entre as valvas estenóticas, associada à área valvar mitral (p=0,003). Conclusões: Apesar do intenso grau de fibrose, o processo inflamatório permanece ativo na valva mitral reumática, mesmo em doença tardia com disfunção valvar. A calcificação predominou em valvas estenóticas e em pacientes com disfunção ventricular direita.

Abstract Background: The underlying mechanisms by which rheumatic heart disease (RHD) lead to severe valve dysfunction are not completely understood. Objective: The present study evaluated the histopathological changes in mitral valves (MV) seeking an association between the pattern of predominant valvular dysfunction and histopathological findings. Methods: In 40 patients who underwent MV replacement due to RHD, and in 20 controls that underwent heart transplant, histological aspects of the excised MV were analyzed. Clinical and echocardiographic data were also collected. Histological analyses were performed using hematoxylin-eosin staining. Inflammation, fibrosis, neoangiogenesis, calcification and adipose metaplasia were determined. A p value<0.05 was considered to be statistically significant. Results: The mean age of RHD patients was 53±13 years, 36 (90%) were female, whereas the mean age of controls was 50±12 years, similar to the cases, with the majority of males (70%). The rheumatic valve endocardium presented greater thickness than the controls (1.3±0.5 mm versus 0.90±0.4 mm, p=0.003, respectively), and a more intense inflammatory infiltrate in the endocardium (78% versus 36%; p=0.004), with predominance of mononuclear cells. Moderate to marked fibrosis occurred more frequently in rheumatic valves than in control valves (100% vs. 29%; p<0.001). Calcification occurred in 35% of rheumatic valves, especially among stenotic valves, which was associated with the mitral valve area (p=0.003). Conclusions: Despite intense degree of fibrosis, the inflammatory process remains active in the rheumatic mitral valve, even at late disease with valve dysfunction. Calcification predominated in stenotic valves and in patients with right ventricular dysfunction.

https://doi.org/10.36660/abc.20200154 542 descargas

Hepatitis Delta Prevalence in South America: A Systematic Review and Meta-Analysis
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Scarponi, Cristiane Faria de Oliveira

; Silva, Raquel Duarte Nunes da

; Souza Filho, Job Alves de

; Guerra, Maria Regina Lage

; Pedrosa, Marco Antônio Ferreira

; Mol, Marcos Paulo Gomes

Revista da Sociedade Brasileira de Medicina Tropical

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2019, Volumen 52 elocation e20180289

Resumen: En | Texto: En | PDF: En

Abstract Hepatitis delta virus (HDV) has been associated with acute or chronic hepatitis in Latin America, but there is no prevalence study covering South American countries. This meta-analysis aimed to estimate anti-HDV prevalence through a systematic review of published articles in English, Portuguese and Spanish until December 2017. Searches were conducted in Health Virtual Library, Capes, Lilacs, PubMed, and SciELO, according to defined criteria regarding participant selection and geographical setting. Study quality was assessed using the GRADE guidelines. Pooled anti-HDV prevalence was calculated using the DerSimonian-Laird random-effects model with Freeman-Tukey double arcsine transformation. Out of the 405 identified articles, only 31 met the eligibility criteria for inclusion in the meta-analysis. In South America, pooled anti-HDV prevalence among hepatitis B virus carriers was 22.37% (95% confidence interval: 13.72-32.26), though it appeared less frequently in some countries and populations, according to the data collection date. The findings indicated significant successive reductions in anti-HDV prevalence over thirty years. However, there was a scarcity of HDV epidemiological studies outside the Amazon Basin, notably in the Southwest continent and absence of target population standardization. There was a high HDV prevalence in South American countries, despite differences in methodological characteristics and outcomes, highlighting a drastic decline in the last decades. Future studies should identify HDV prevalence estimates in other regions of the continent and identify risk factors.

https://doi.org/10.1590/0037-8682-0289-2018 3165 descargas

Philadelphia-negative myeloproliferative neoplasms as disorders marked by cytokine modulation
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Cacemiro, Maira da Costa

; Cominal, Juçara Gastaldi

; Tognon, Raquel

; Nunes, Natalia de Souza

; Simões, Belinda Pinto

; Figueiredo-Pontes, Lorena Lôbo de

; Catto, Luiz Fernando Bazzo

; Traina, Fabíola

; Souto, Elizabeth Xisto

; Zambuzi, Fabiana Albani

; Frantz, Fabiani Gai

; Castro, Fabíola Attié de

Hematology, Transfusion and Cell Therapy

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Jun 2018, Volumen 40 Nº 2 Paginas 120 - 131

Resumen: En | Texto: En | PDF: En

ABSTRACT Background: Cytokines are key immune mediators in physiological and disease processes, whose increased levels have been associated with the physiopathology of hematopoietic malignancies, such as myeloproliferative neoplasms. Methods: This study examined the plasma cytokine profiles of patients with essential thrombocythemia, primary myelofibrosis, polycythemia vera and of healthy subjects, and analyzed correlations with JAK2 V617F status and clinical-hematological parameters. Results: The proinflammatory cytokine levels were increased in myeloproliferative neoplasm patients, and the presence of the JAK2 V617F mutation was associated with high IP-10 levels in primary myelofibrosis patients. Conclusions: Essential thrombocythemia, primary myelofibrosis, and polycythemia vera patients exhibited different patterns of cytokine production, as revealed by cytokine network correlations. Together, these findings suggest that augmented cytokine levels are associated with the physiopathology of myeloproliferative neoplasms.

https://doi.org/10.1016/j.htct.2017.12.003 1128 descargas

Integrating the pastoral component in agricultural systems
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Carvalho, Paulo César de Faccio

; Barro, Raquel Santiago

; Barth Neto, Armindo

; Nunes, Pedro Arthur de Albuquerque

; Moraes, Anibal de

; Anghinoni, Ibanor

; Bredemeier, Christian

; Bayer, Cimélio

; Martins, Amanda Posselt

; Kunrath, Taise Robinson

; Santos, Davi Teixeira dos

; Carmona, Felipe de Campos

; Barros, Thiago

; Souza Filho, William de

; Almeida, Gleice Menezes de

; Caetano, Luis Augusto Martins

; Cecagno, Diego

; Arnuti, Fernando

; Denardin, Luiz Gustavo de Oliveira

; Bonetti, João de Andrade

; Toni, Cezar Augusto Gama de

; Borin, José Bernardo Moraes

Revista Brasileira de Zootecnia

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2018, Volumen 47 elocation e20170001

Resumen: En | Texto: En | PDF: En

ABSTRACT This paper aims to discuss the impact of the introduction of pastures and grazing animals in agricultural systems. For the purposes of this manuscript, we focus on within-farm integrated crop-livestock systems (ICLS), typical of Southern Brazil. These ICLS are designed to create and enhance the synergisms and emergent properties have arisen from agricultural areas where livestock activities are integrated with crops. We show that the introduction of the crop component will affect less the preceding condition than the introduction of the livestock component. While the introduction of crops in pastoral systems represents increasing diversity of the plant component, the introduction of animals would represent the entry of new flows and interactions within the system. Thus, given the new complexity levels achieved from the introduction of grazing, the probability of arising emergent properties is theoretically much higher. However, grazing management is vital in determining the success or failure of such initiative. The grazing intensity practiced during the pasture phase would affect the canopy structure and the forage availability to animals. In adequate and moderate grazing intensities, it is possible to affirm that livestock combined with crops (ICLS) has a potential positive impact. As important as the improvements that grazing animals can generate to the soil-plant components, the economic resilience remarkably increases when pasture rotations are introduced compared with purely agriculture systems, particularly in climate-risk situations. Thus, the integration of the pastoral component can enhance the sustainable intensification of food production, but it modifies simple, pure agricultural systems into more complex and knowledge-demanding production systems.

https://doi.org/10.1590/rbz4720170001 3250 descargas

Clinical-Functional Vulnerability Index-20 (IVCF-20): rapid recognition of frail older adults
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Moraes, Edgar Nunes de

; Carmo, Juliana Alves do

; Moraes, Flávia Lanna de

; Azevedo, Raquel Souza

; Machado, Carla Jorge

; Montilla, Dalia Elena Romero

Revista de Saúde Pública

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2016, Volumen 50 elocation 81

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO OBJETIVO Avaliar a adequação do Índice de Vulnerabilidade Clínico-Funcional-20 , instrumento de triagem rápida de vulnerabilidade em idosos brasileiros, para utilização pela atenção básica. O estudo incluiu amostra de conveniência de 397 pacientes com idade maior ou igual a 60 anos atendidos em um Centro de Referência para o Idoso e de 52 idosos da mesma idade atendidos na comunidade. Os resultados do questionário, constituído por 20 perguntas, foram comparados com aqueles da Avaliação Geriátrica Ampla, considerada referência para identificação do idoso frágil. Foi avaliada a correlação de Spearman do Índice de Vulnerabilidade Clínico-Funcional-20 com a Avaliação Geriátrica Ampla; a validade foi verificada pela área sob a curva ROC; a confiabilidade foi estimada pelo percentual de concordância entre avaliadores e coeficiente kappa, ambos com ponderação quadrática. Obteve-se ponto de corte com base no critério de maior acurácia. O alfa de Cronbach, medida de consistência interna, foi calculado. O coeficiente de correlação de Spearman foi elevado e positivo em ambos os grupos (0,792 para idosos atendidos no Centro de Referência para o Idoso e 0,305 para idosos da comunidade [p < 0,001]). A área sob a curva ROC para idosos atendidos no Centro de Referência para o Idoso foi substancial (0,903). O ponto de corte obtido foi seis e idosos com pontuação no Índice de Vulnerabilidade Clínico-Funcional-20 acima desse valor tinham forte possibilidade de serem frágeis. Para idosos da comunidade, a concordância ponderada quadrática entre avaliadores foi 99,5% e o coeficiente kappa ponderado quadrático global, 0,94. O alfa de Cronbach foi elevado para idosos atendidos no Centro de Referência para o Idoso (0,861) e da comunidade (0,740). CONCLUSÕES O questionário do Índice de Vulnerabilidade Clínico-Funcional-20, na amostra analisada, mostrou ser positivamente correlacionado com a Avaliação Geriátrica Ampla, além de os resultados indicarem alto grau de validade e confiabilidade. Assim, o Índice de Vulnerabilidade Clínico-Funcional-20 se mostra viável como instrumento de rastreio na atenção básica que identifica o idoso com fragilidade (idoso em risco de fragilização e idoso frágil).

ABSTRACT OBJECTIVE To evaluate the adequacy of the Clinical-Functional Vulnerability Index-20, a rapid triage instrument to test vulnerability in Brazilian older adults, for the use in primary health care. METHODS The study included convenience sample of 397 patients aged older than or equal to 60 years attended at Centro de Referência para o Idoso (Reference Center for Older Adults) and of 52 older adults the same age attended at the community. The results of the questionnaire, consisting of 20 questions, were compared with those of the Comprehensive Geriatric Assessment, considered a reference for identifying frail older adults. Spearman’s correlation was evaluated in the Clinical-Functional Vulnerability Index-20 with the Comprehensive Geriatric Assessment; the validity was verified by the area under the ROC curve; reliability was estimated by the percentage of agreement among evaluators and by the kappa coefficient, both with quadratic weighted. The cut-off point was obtained based on the higher accuracy criterion. Cronbach’s alpha, a measure of internal consistency, was estimated. RESULTS The Spearman’s correlation coefficient was high and positive for both groups (0.792 for older adults attended at the Reference Center and 0.305 for older adults from the community [p < 0.001]). The area under the ROC curve for older adults attended at the Reference Center was substantial (0.903). The cut-off point obtained was six, and older adults with scores in Clinical-Functional Vulnerability Index-20 above that value had strong possibility of being frail. For older adults from the community, the quadratic weighted agreement among evaluators was 99.5%, and the global quadratic weighted kappa coefficient was 0.94. Cronbach’s alpha was high for older adults attended at the Reference Center (0.861) and those attended at the community (0.740). CONCLUSIONS The Clinical-Functional Vulnerability Index-20 questionnaire, in the sample examined, turned out to be positively correlated with the Comprehensive Geriatric Assessment, in addition to the results indicating a high degree of validity and reliability. Thus, the Clinical-Functional Vulnerability Index-20 proves to be viable as a triage instrument in the primary health care that identifies frail older adults (older adults at risk of weakening and frail older adults).

https://doi.org/10.1590/s1518-8787.2016050006963 23726 descargas

Clinical-Functional Vulnerability Index-20 (IVCF-20): rapid recognition of frail older adults
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Moraes, Edgar Nunes de

; Carmo, Juliana Alves do

; Moraes, Flávia Lanna de

; Azevedo, Raquel Souza

; Machado, Carla Jorge

; Montilla, Dalia Elena Romero

Revista de Saúde Pública

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2016, Volumen 50 elocation 81

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/s1518-8787.2016050006963 579 descargas

10.

In house reverse membrane hybridisation assay versus GenoType MTBDRplus and their performance to detect mutations in the genes rpoB, katG and inhA
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Ferreira Junior, Sergio Luiz Montego

; Costa, Elis Regina Dalla

; Santos, Paula Gonçalves dos

; Gomes, Harrison Magdinier

; Silva, Marcia Susana Nunes

; Esteves, Leonardo Souza

; Oliveira, Martha Maria

; Maschmann, Raquel de Abreu

; Kritski, Afrânio Lineu

; Suffys, Philip Noel

; Rossetti, Maria Lucia Rosa

Memórias do Instituto Oswaldo Cruz

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Jun 2014, Volumen 109 Nº 3 Paginas 307 - 314

Resumen: En | Texto: En | PDF: En

Drug-resistant tuberculosis (TB) threatens global TB control and is a major public health concern in several countries. We therefore developed a multiplex assay (LINE-TB/MDR) that is able to identify the most frequent mutations related to rifampicin (RMP) and isoniazid (INH) resistance. The assay is based on multiplex polymerase chain reaction, membrane hybridisation and colorimetric detection targeting of rpoB and katG genes, as well as the inhA promoter, which are all known to carry specific mutations associated with multidrug-resistant TB (MDR-TB). The assay was validated on a reference panel of 108 M. tuberculosis isolates that were characterised by the proportion method and by DNA sequencing of the targets. When comparing the performance of LINE-TB/MDR with DNA sequencing, the sensitivity, specificity and agreement were 100%, 100% and 100%, respectively, for RMP and 77.6%, 90.6% and 88.9%, respectively, for INH. Using drug sensibility testing as a reference standard, the performance of LINE-TB/MDR regarding sensitivity, specificity and agreement was 100%, 100% and 100% (95%), respectively, for RMP and 77%, 100% and 88.7% (82.2-95.1), respectively, for INH. LINE-TB/MDR was compared with GenoType MTBDRplus for 65 isolates, resulting in an agreement of 93.6% (86.7-97.5) for RIF and 87.4% (84.3-96.2) for INH. LINE-TB/MDR warrants further clinical validation and may be an affordable alternative for MDR-TB diagnosis.

https://doi.org/10.1590/0074-0276130469 1524 descargas

11.

Desregulação da apoptose em neoplasias mieloproliferativas crônicas
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Tognon, Raquel

; Nunes, Natália de Souza

; Castro, Fabíola Attié de

einstein (São Paulo)

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Dic 2013, Volumen 11 Nº 4 Paginas 540 - 544

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

As neoplasias mieloproliferativas crônicas cromossomo Filadélfia negativas são doenças hematológicas clonais que se caracterizam pela independência ou pela hipersensibilidade dos progenitores hematopoiéticos às citocinas. Os mecanismos celulares e moleculares envolvidos na fisiopatologia das neoplasias mieloproliferativas crônicas ainda não estão totalmente esclarecidos. Achados fisiopatológicos relevantes para as neoplasias mieloproliferativas crônicas estão associados às alterações genéticas como, por exemplo, a mutação somática no gene que codifica o JAK2 (JAK2V617F). A desregulação do processo de morte celular programada, denominada apoptose, parece participar da patogênese dessas desordens. Sabe-se que a desregulação da expressão dos genes pró- e antiapoptóticos promove a resistência das células à apoptose, culminando com o acúmulo das células mieloides e estabelecendo a neoplasia. Esta revisão enfocou as alterações na regulação da apoptose em neoplasias mieloproliferativas crônicas e a importância da melhor compreensão desse mecanismo para o desenvolvimento de novas terapias para essas doenças.

Philadelphia-chromosome negative chronic myeloproliferative neoplasms are clonal hematologic diseases characterized by hematopoietic progenitor independence from or hypersensitivity to cytokines. The cellular and molecular mechanisms involved in the pathophysiology of myeloproliferative neoplasms have not yet been fully clarified. Pathophysiologic findings relevant for myeloproliferative neoplasms are associated with genetic alterations, such as, somatic mutation in the gene that codifies JAK-2 (JAK V617F). Deregulation of the process of programmed cellular death, called apoptosis, seems to participate in the pathogenesis of these disorders. It is known that expression deregulation of pro- and anti-apoptotic genes promotes cell resistance to apoptosis, culminating with the accumulation of myeloid cells and establishing neoplasms. This review will focus on the alterations in apoptosis regulation in myeloproliferative neoplasms, and the importance of a better understanding of this mechanism for the development of new therapies for these diseases.

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12.

Influência do índice glicêmico da dieta sobre parâmetros antropométricos e bioquímicos em pacientes com diabetes tipo 1
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Dias, Viviane Monteiro

; Pandini, Juliana Almeida

; Nunes, Raquel Ramalho

; Sperandei, Sandro Leonardo Martins

; Portella, Emilson Souza

; Cobas, Roberta Arnoldi

; Gomes, Marília de Brito

Arquivos Brasileiros de Endocrinologia & Metabologia

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Dic 2010, Volumen 54 Nº 9 Paginas 801 - 806

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar a influência de uma intervenção não farmacológica, constituída de uma dieta de baixo índice glicêmico (IG) por um período de seis meses, no controle metabólico e nos indicadores antropométricos de pacientes com diabetes melito tipo 1 (DM1). SUJEITOS E MÉTODOS: Noventa e seis pacientes com DM1 foram submetidos à avaliação antropométrica, bioquímica e dietética antes e 6 meses após a prescrição de uma dieta baseada no índice glicêmico. RESULTADOS: Observamos diminuição significativa da A1c (9,8 ± 2,26% vs. 9,1 ± 2,16%; p = 0,023) e aumento de peso (61,3 ± 11,68 kg vs. 62,8 ± 12,07 kg; p = 0,04) após o período de intervenção. CONCLUSÃO: A dieta de baixo índice glicêmico foi capaz de melhorar o controle glicêmico em pacientes com DM1. Estudos com maior tempo de seguimento serão necessários para estabelecermos se a aderência dos pacientes a esse tipo de dieta influencia na manutenção do controle glicêmico.

OBJECTIVE: To assess the influence of a non-pharmacological intervention, consisting of a diet low glycemic index (GI) for a period of six months on metabolic control and anthropometric parameters in patients with type 1 diabetes mellitus. SUBJECTS AND METHODS: Ninety-six type 1 diabetic patients underwent an anthropometric, biochemical and dietary assessment before and six months after the prescription of diet based on the glycemic index. RESULTS: After six months we observed a decrease in A1C levels (9,8 ± 2,26% vs. 9,1 ± 2.16%; p = 0,023) and increase in body weight (61,3 ± 11,68 kg vs. 62,8 ± 12,07 kg; p = 0,04). CONCLUSION: A low GI diet improved glycemic control in patients with DM1. Further studies with longer time of follow-up are needed to assess if patients' adherence to this kind of diet influences the maintenance of glycemic control.

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13.

Pig bite in Brazil: a case series from a teaching hospital
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Nishioka, Sérgio de Andrade

; Handa, Suzana Terumi

; Nunes, Raquel Souza

Revista da Sociedade Brasileira de Medicina Tropical

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Mar 1994, Volumen 27 Nº 1 Paginas 15 - 18

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Um levantamento retrospectivo revelou que 23 pacientes vítimas de mordida de porco procuraram assistência médica num hospital-escola em Uberlândia, Brasil, de 1987 a 1990. A maioria dos pacientes (21) procedia de Uberlândia. Os casos foram distribuídos uniformemente por mês e ano; a maioria deles (14/16; 87,5%) ocorreu entre às 7 e às 19 horas. A razão homem. mulherfoi de 6,7:1. A idade dos pacientes variou de 6 a 73 anos (média: 38,95 ± DP 22,06), mediana 36. As mordidas foram mais comuns nos membros superiores, particularmente nos antebraços. Em 11(47,8%) casos o ferimento foi descrito como profundo. Na maioria dos casos em que houve informação disponível, o ferimento foi relacionado com captura, transporte ou imobilização do suíno para abate. Os seguintes procedimentos médicos foram realizados: lavagem local em 19(82,6%) casos, vacina anti-rábica (12; 52,2%), soro anti-rábico (2; 8,7%), sutura (6; 26,1%), e vacina antitetânica (12; 52,2%). Pelos nossos dados, a incidência anual de mordedura de porco em Uberlândia pode ser estimada em 1,5/100.000 habitantes.

A retrospective survey done from 1987 till 1990 revealed that 23 patients bitten by pigs sought medical help at a teaching hospital in Uberlândia, in southeastern Brazil. Most cases (21) were from Uberlândia. The cases were evenly distributed by month and by year; most of them (14/16; 87.5%) occurred between 7. OOa.m. and 7.00 p. m. The male to female ratio was 6.7:1. Age ranged from 6 to 73 (mean 38.95 ± SD 22.06, median 36). The bites were more common on the upper limbs, particularly on the forearms. In 11(47.8%) cases the injury was described as deep. In most cases where information was available the injury was related to capture, transport or immobilisation ofthe pigfor slaughter. The following medical procedures were performed: local cleansing in 19(82.6%) cases, rabies vaccine (12; 52.2%), antirabies serum (2; 8.7%), suturing (6; 26.1%) and tetanus vaccine (12; 52.2%). There was no case of infection at the bite site, neither of rabies or tetanus. By our data, the annual incidence of pig bite in Uberlândia can be estimated to be about 1.5/100.000.

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14.

Presença de ovos de Toxocara spp em praças públicas da cidade de Uberlândia, Minas Gerais, Brasil
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Costa-Cruz, Julia Maria

; Nunes, Raquel Souza

; Buso, Abadia Gilda

Revista do Instituto de Medicina Tropical de São Paulo

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Feb 1994, Volumen 36 Nº 1 Paginas 39 - 42

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

O objetivo deste trabalho foi verificar a presença de ovos de Toxocara spp nos solos de praças públicas da cidade de Uberlândia, região do Triângulo Mineiro, no período de outubro de 1991 a janeiro de 1992. A cidade possui 89 praças distribuídas em 39 bairros. Para que se tivesse um perfil da ocorrência do parasita, foram colhidas amostras de terra e areia (quando existente) de uma praça, determinada por sorteio, por bairro. As amostras de solo homogeneizadas de 5 pontos distintos das 39 praças foram colhidas em frascos plásticos e analisadas empregando-se os métodos de flutuação em solução saturada de cloreto de sódio e de solução saturada de sulfato de magnésio contendo 5% de iodeto de potássio. Para cada amostra foram realizados os dois métodos em duplicata. Os resultados mostraram estarem contaminados os solos de 9 praças (23,07%), das quais 6 localizavam-se próximas ao centro da cidade. A realização de mais de um método laboratorial permitiu a identificação do agente em maior porcentagem de locais.

The objective of this study was to verify the presence of Toxocara spp eggs in the public squares ground in Uberlândia, region of Triângulo Mineiro, from October 1991 to January 1992. The city has 89 squares distributed in 39 boroughs. In order to have an outline of the parasite's occurrence, ground and sand (when existent) samples were collected from one square per boroughors. The squares were determined by draw. The homogenized ground samples of distinct points of the 39 squares, were colected in plastic flasks and analysed by the methods of fluctuation in sodium chloride saturated solution and magnesium sulphate saturated solution which contained 5% of potassium iodate. Both methods were executed twice for each sample. The results showed that the ground of 9 squares (23.07%) was contaminated, 6 of which were located near downtown. The execution of more than one laboratorial method permited the agent's identification in a grater percentage of squares.

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