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ABSTRACT Objective: To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. Methods: An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). Results: A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). Conclusion: This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients. ClinicalTrials.gov registry: NCT04176445

RESUMO Objetivo: Avaliar o impacto de diferentes posicionamentos verticais na aeração pulmonar em pacientes em ventilação mecânica invasiva. Métodos: Trata-se de ensaio clínico aberto, randomizado e transversal, realizado entre janeiro e julho de 2020. Adultos em ventilação mecânica invasiva por mais de 24 horas e menos de 7 dias com estabilidade hemodinâmica, respiratória e neurológica foram distribuídos aleatoriamente em uma proporção de 1:1 à postura sentada seguida da condição de ortostatismo passivo ou o ortostatismo passivo seguido de postura sentada. O desfecho primário foi a aeração pulmonar avaliada pelo lung ultrasound score. O escore varia de zero (melhor) a 36 (pior). Resultados: Foram selecionados 186 indivíduos; destes, 19 foram incluídos (57,8% do sexo masculino; média idade de 73,2 anos). Todos os participantes foram selecionados para receber pelo menos um protocolo de verticalização. O ortostatismo passivo resultou em escores médios de aeração pulmonar por ultrassonografia que não diferiram significativamente da postura sentada (11,0 versus 13,7; diferença média, -2,7; IC95% -6,1 a 0,71; p = 0,11). Ocorreram eventos adversos em três indivíduos no grupo ortostatismo passivo e em um no grupo postura sentada (p = 0,99). Conclusão: Esta análise não encontrou diferenças significativas na aeração pulmonar entre os grupos ortostatismo passivo e postura sentada. É factível conduzir um estudo clínico transversal randomizado para avaliar o impacto do posicionamento vertical na aeração pulmonar em pacientes em ventilação mecânica invasiva. Infelizmente, o estudo foi interrompido devido à necessidade de tratar pacientes com COVID-19. Registro ClinicalTrials.gov: NCT04176445

https://doi.org/10.5935/2965-2774.20230069-en

Heart Transplantation in Becker Muscular Dystrophy Patient: Case-Report of a 15-Year Follow-up
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Madeira, Marcio

; Ranchordás, Sara

; Nolasco, Tiago

; Marques, Marta

; Rebocho, Maria José

; Neves, José

International Journal of Cardiovascular Sciences

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feb 2018, Volume 31 N. 1 Pages 82 - 84

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/2359-4802.20170083 2489 downloads

Trypanosoma janseni n. sp. (Trypanosomatida: Trypanosomatidae) isolated from Didelphis aurita (Mammalia: Didelphidae) in the Atlantic Rainforest of Rio de Janeiro, Brazil: integrative taxonomy and phylogeography within the Trypanosoma cruzi clade
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Lopes, Camila Madeira Tavares

; Menna-Barreto, Rubem Figueiredo Sadok

; Pavan, Márcio Galvão

; Pereira, Mirian Cláudia De Souza

; Roque, André Luiz R

Memórias do Instituto Oswaldo Cruz

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jan 2018, Volume 113 N. 1 Pages 45 - 55

Abstract: En | Text: En | PDF: En

BACKGROUND Didelphis spp. are a South American marsupial species that are among the most ancient hosts for the Trypanosoma spp. OBJECTIVES We characterise a new species (Trypanosoma janseni n. sp.) isolated from the spleen and liver tissues of Didelphis aurita in the Atlantic Rainforest of Rio de Janeiro, Brazil. METHODS The parasites were isolated and a growth curve was performed in NNN and Schneider's media containing 10% foetal bovine serum. Parasite morphology was evaluated via light microscopy on Giemsa-stained culture smears, as well as scanning and transmission electron microscopy. Molecular taxonomy was based on a partial region (737-bp) of the small subunit (18S) ribosomal RNA gene and 708 bp of the nuclear marker, glycosomal glyceraldehyde-3-phosphate dehydrogenase (gGAPDH) genes. Maximum likelihood and Bayesian inference methods were used to perform a species coalescent analysis and to generate individual and concatenated gene trees. Divergence times among species that belong to the T. cruzi clade were also inferred. FINDINGS In vitro growth curves demonstrated a very short log phase, achieving a maximum growth rate at day 3 followed by a sharp decline. Only epimastigote forms were observed under light and scanning microscopy. Transmission electron microscopy analysis showed structures typical to Trypanosoma spp., except one structure that presented as single-membraned, usually grouped in stacks of three or four. Phylogeography analyses confirmed the distinct species status of T. janseni n. sp. within the T. cruzi clade. Trypanosoma janseni n. sp. clusters with T. wauwau in a well-supported clade, which is exclusive and monophyletic. The separation of the South American T. wauwau + T. janseni coincides with the separation of the Southern Super Continent. CONCLUSIONS This clade is a sister group of the trypanosomes found in Australian marsupials and its discovery sheds light on the initial diversification process based on what we currently know about the T. cruzi clade.

https://doi.org/10.1590/0074-02760170297 1973 downloads

Diagnostic-driven antifungal therapy in neutropenic patients using the D-index and serial serum galactomannan testing
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Garnica, Marcia

; Sinhorelo, Aline

; Madeira, Laura

; Portugal, Rodrigo

; Nucci, Marcio

Brazilian Journal of Infectious Diseases

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aug 2016, Volume 20 N. 4 Pages 354 - 359

Abstract: En | Text: En | PDF: En

Abstract Introduction Invasive mold disease is an important complication of patients with hematologic malignancies, and is associated with high mortality. A diagnostic-driven approach has been an alternative to the classical empiric antifungal therapy. In the present study we tested an algorithm that incorporated risk stratification using the D-index, serial serum galactomannan and computed tomographic-scan to guide the decision to start antifungal therapy in neutropenic patients. Patients and methods Between May 2010 and August 2012, patients with acute leukemia in induction remission were prospectively monitored from day 1 of chemotherapy until discharge or death with the D-index and galactomannan. Patients were stratified in low, intermediate and high risk according to the D-index and an extensive workup for invasive mold disease was performed in case of positive galactomannan (≥0.5), persistent fever, or the appearance of clinical manifestations suggestive of invasive mold disease. Results Among 29 patients, 6 (21%), 11 (38%), and 12 (41%) were classified as high, intermediate, and low risk, respectively. Workup for invasive mold disease was undertaken in 67%, 73% and 58% (p = 0.77) of patients in each risk category, respectively, and antifungal therapy was given to 67%, 54.5%, and 17% (p = 0.07). Proven or probable invasive mold disease was diagnosed in 67%, 45.5%, and in none (p = 0.007) of high, intermediate, and low risk patients, respectively. All patients survived. Conclusion A risk stratification using D-index was a useful instrument to be incorporated in invasive mold disease diagnostic approach, resulting in a more comprehensive antifungal treatment strategy, and to guide an earlier start of treatment in afebrile patients under very high risk.

https://doi.org/10.1016/j.bjid.2016.04.007 644 downloads

ST Elevation Myocardial Infarction Early After Heart Transplantation
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Madeira, Sérgio Lourenço

; Raposo, Luís Filipe

; Madeira, Márcio

; Marques, Marta

; Rebocho, Maria José

; Neves, José Pedro

Arquivos Brasileiros de Cardiologia

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jul 2015, Volume 105 N. 1 Pages 93 - 96

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/abc.20140202 2434 downloads

Neurofibromatosis: part 2 – clinical management
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Batista, Pollyanna Barros

; Bertollo, Eny Maria Goloni

; Costa, Danielle de Souza

; Eliam, Lucas

; Cunha, Karin Soares Gonçalves

; Cunha-Melo, José Renan

; Darrigo Junior, Luiz Guilherme

; Geller, Mauro

; Gianordoli-Nascimento, Ingrid Faria

; Madeira, Luciana Gonçalves

; Mendes, Hérika Martins

; Miranda, Débora Marques de

; Mata-Machado, Nikolas Andre

; Morato, Eric Grossi

; Pavarino, Érika Cristina

; Pereira, Luciana Baptista

; Rezende, Nilton Alves de

; Rodrigues, Luíza de Oliveira

; Sette, Jorge Bezerra Cavalcanti

; Silva, Carla Menezes da

; Souza, Juliana Ferreira de

; Souza, Márcio Leandro Ribeiro de

; Martins, Aline Stangherlin

; Valadares, Eugênia Ribeiro

; Vidigal, Paula Vieira Teixeira

; Waisberg, Vanessa

; Waisberg, Yehuda

; Rodrigues, Luiz Oswaldo Carneiro

Arquivos de Neuro-Psiquiatria

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jun 2015, Volume 73 N. 6 Pages 531 - 543

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A primeira parte desta diretriz abordou o diagnóstico diferencial das neurofibromatoses (NF): neurofibromatose do tipo 1 (NF1), neurofibromatose do tipo 2 (NF2) e schwannomatose (SCH). As NF compartilham algumas características, como a origem neural dos tumores e sinais cutâneos, e afetam cerca de 80 mil brasileiros. O aumento do conhecimento científico sobre as NF tem permitido melhor manejo clínico e redução da morbidade das complicações, resultando em melhor qualidade de vida para os pacientes com NF. A maioria dos médicos é capaz de realizar o diagnóstico das NF, mas a variedade de manifestações clínicas e a dificuldade de se prever o surgimento e a gravidade de complicações, torna o manejo da NF um desafio para o clínico e envolve diferentes especialistas para o tratamento adequado e aconselhamento genético, especialmente a NF2 e a SCH. O presente texto sugere algumas orientações para o acompanhamento dos portadores de NF, com ênfase na NF1.

Part 1 of this guideline addressed the differential diagnosis of the neurofibromatoses (NF): neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and schwannomatosis (SCH). NF shares some features such as the genetic origin of the neural tumors and cutaneous manifestations, and affects nearly 80 thousand Brazilians. Increasing scientific knowledge on NF has allowed better clinical management and reduced rate of complications and morbidity, resulting in higher quality of life for NF patients. Most medical doctors are able to perform NF diagnosis, but the wide range of clinical manifestations and the inability to predict the onset or severity of new features, consequences, or complications make NF management a real clinical challenge, requiring the support of different specialists for proper treatment and genetic counseling, especially in NF2 and SCH. The present text suggests guidelines for the clinical management of NF, with emphasis on NF1.

https://doi.org/10.1590/0004-282X20150042 13090 downloads

Neurofibromatoses: part 1 ? diagnosis and differential diagnosis
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Rodrigues, Luiz Oswaldo Carneiro

; Batista, Pollyanna Barros

; Goloni-Bertollo, Eny Maria

; Souza-Costa, Danielle de

; Eliam, Lucas

; Eliam, Miguel

; Cunha, Karin Soares Gonçalves

; Darrigo Junior, Luiz Guilherme

; Ferraz Filho, José Roberto Lopes

; Geller, Mauro

; Gianordoli-Nascimento, Ingrid F.

; Madeira, Luciana Gonçalves

; Malloy-Diniz, Leandro Fernandes

; Mendes, Hérika Martins

; Miranda, Débora Marques de

; Pavarino, Erika Cristina

; Baptista-Pereira, Luciana

; Rezende, Nilton A.

; Rodrigues, Luíza de Oliveira

; Silva, Carla Menezes da

; Souza, Juliana Ferreira de

; Souza, Márcio Leandro Ribeiro de

; Stangherlin, Aline

; Valadares, Eugênia Ribeiro

; Vidigal, Paula Vieira Teixeira

Arquivos de Neuro-Psiquiatria

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mar 2014, Volume 72 N. 3 Pages 241 - 250

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Neurofibromatoses (NF) constituem um grupo de doenças genéticas com predisposição ao crescimento de múltiplos tumores: tipo 1 (NF1), tipo 2 (NF2) e schwannomatose (SCH). Estas doenças têm em comum a origem neural dos tumores e os sinais cutâneos. Afetam cerca de 80 mil brasileiros. O maior conhecimento científico sobre as NF tem permitido melhor manejo clínico, redução da morbidade das complicações e melhor qualidade de vida. Na maioria dos casos, os especialistas em neurologia, dermatologia, genética clínica, oncologia e medicina interna estão capacitados a realizar o diagnóstico diferencial e identificar suas principais complicações. Devido à sua variabilidade fenotípica, curso progressivo, multiplicidade de órgãos acometidos e evolução imprevisível, as NF frequentemente necessitam de especialistas em NF para o acompanhamento. A Parte 1 deste texto oferece orientações para o diagnóstico de cada tipo de NF e discute os diagnósticos diferenciais com outras doenças. A Parte 2 oferecerá orientações em relação ao manejo clínico das NF.

Neurofibromatoses (NF) are a group of genetic multiple tumor growing predisposition diseases: neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and schwannomatosis (SCH), which have in common the neural origin of tumors and cutaneous signs. They affect nearly 80 thousand of Brazilians. In recent years, the increased scientific knowledge on NF has allowed better clinical management and reduced complication morbidity, resulting in higher quality of life for NF patients. In most cases, neurology, psychiatry, dermatology, clinical geneticists, oncology and internal medicine specialists are able to make the differential diagnosis between NF and other diseases and to identify major NF complications. Nevertheless, due to its great variability in phenotype expression, progressive course, multiple organs involvement and unpredictable natural evolution, NF often requires the support of neurofibromatoses specialists for proper treatment and genetic counseling. This Part 1 offers step-by-step guidelines for NF differential diagnosis. Part 2 will present the NF clinical management.

https://doi.org/10.1590/0004-282X20130241 22696 downloads

Inseminação artificial intra-uterina em leitoas com sêmen criopreservado com dimetilacetamida e glicerol
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Bianchi, Ivan

; Calderam, Kérlin

; Maschio, Éder Francisco

; Madeira, Elisângela Mirapalheta

; Ulguim, Rafael da Rosa

; Rambo, Gissele

; Corrêa, Érico Kunde

; Lucia Júnior, Thomaz

; Deschamps, João Carlos

; Corrêa, Marcio Nunes

Ciência Rural

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oct 2008, Volume 38 N. 7 Pages 1978 - 1983

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Este estudo teve por objetivo avaliar o uso da dimetilacetamida (DMA) e de glicerol na criopreservação de sêmen suíno sobre as taxas de concepção e fertilização in vivo, utilizando o método de inseminação artificial pós-cervical. Foram sincronizadas 60 leitoas pré-púberes e inseminadas com o uso de sêmen congelado com glicerol 3% (30 fêmeas) e DMA 5% (30 fêmeas). O método de inseminação utilizado foi o pós-cervical, com concentração de 1 x 10(9) espermatozóides vivos por dose. Após 36 a 40h da inseminação, as fêmeas foram abatidas, sendo realizada a contagem de corpos hemorrágicos (CH) nos ovários. Foi realizada a lavagem dos ovidutos das fêmeas, verificando o número de estruturas recuperadas (oócitos e embriões), calculando-se as taxas de concepção e fertilização. A média de CH nas fêmeas do grupo glicerol 3% não diferiu (P>0,05) daquelas do grupo DMA 5% (10,4 x 10,2, respectivamente). Não houve diferença (P>0,05) nas taxas de recuperação de estruturas entre os grupos glicerol 3% (68,9%) e DMA 5% (66,9%). Os resultados obtidos nos grupos glicerol 3% e DMA 5% para as taxas de concepção (73,3 x 76,6%) e fertilização (48,6 x 59,4%) não apresentaram diferença (P>0,05). Conclui-se que não há diferenças nas taxas de concepção e fertilização in vivo utilizando-se sêmen congelado com o uso de dimetilacetamida ou de glicerol.

The objective of this study was to evaluate the use of dimethylacetamide (DMA) and glycerol in boar semen cryopreservation on the conception and fertility rates.Sixty pre-pubertal gilts were synchronized and inseminated with semen including either glycerol 3% or DMA 5% as cryoprotectants (n=30 for both groups). Artificial insemination was conducted with the intrauterine method using doses with 1 x 10(9) viable spermatozoa. The gilts were slaughtered 36-40h after the insemination and the hemorrhagic bodies (CH) in the ovaries were counted. The oviducts were washed, so oocytes and embryos could be recovered to determine the conception and fertility rates. The average CH obtained with glycerol 3% did not differ (P>0.05) from those observed with DMA (10.4 x 10.2, respectively). Recovery rates also did not differ (P>0.05) between groups (68.9% with glycerol and 66.9% with DMA). Conception (73.3 x 76.6%) and fertility rate (48.6 x 59.4%) were also similar (P>0.05) for glycerol and DMA, respectively. Those results indicate that DMA 5% can replace glycerol 3% in the composition of extenders for frozen boar semen.

3951 downloads Cited 1 time in SciELO

Qual o seu diagnóstico?
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Nacif, Marcelo Souto

; Oliveira Júnior, Amarino Carvalho de

; Moreira, Denise Madeira

; Nagano, Mônica Regina

; Luz, José Hugo Mendes

; Martins, Marcio dos Santos

; Oliveira, Mauro Esteves de

; Mendes, Luiz Fernando

; Montera, Marcelo

; Rochitte, Carlos Eduardo

Radiologia Brasileira

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aug 2007, Volume 40 N. 4 Pages XI - XIII

Abstract: Pt | Text: Pt | PDF: Pt

2358 downloads Cited 6 times in SciELO

10.

Qual o seu diagnóstico?
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Nacif, Marcelo Souto

; Oliveira Júnior, Amarino Carvalho de

; Moreira, Denise Madeira

; Nagano, Mônica Regina

; Luz, José Hugo Mendes

; Martins, Marcio dos Santos

; Oliveira, Mauro Esteves de

; Mendes, Luiz Fernando

; Rochitte, Carlos Eduardo

Radiologia Brasileira

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apr 2007, Volume 40 N. 2 Pages VII - IX

Abstract: Pt | Text: Pt | PDF: Pt

2993 downloads Cited 6 times in SciELO

11.

The Carbohydrate-binding Specificity of a Highly Toxic Protein from Abrus pulchellus Seeds
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Ramos, Márcio V

; Teixeira, Clarissa R

; Bomfim, Liezelotte R

; Madeira, Socorro VF

; Moreira, Renato A

Memórias do Instituto Oswaldo Cruz

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mar 1999, Volume 94 N. 2 Pages 185 - 188

Abstract: En | Text: En | PDF: En

1632 downloads

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