Long-term outcome comparing histological grades of follicular lymphoma patients treated with immunochemotherapy as first-line therapy: A retrospective analysis from two institutions.

OBJECTIVES: To clarify the impact of histological grades in follicular lymphoma. METHODS: We retrospectively analysed 250 patients diagnosed with FL treated with chemoimmunotherapy: 188 patients were grades 1-2 and 62 grade 3A. RESULTS: In our series, grade 3A FL patients were older, higher proportion of localised disease and lower bone marrow infiltration at diagnosis comparing grades 1-2 FL patients. Estimated six-year progression-free survival and time to progression showed no differences between both groups [grade 3A: 56% (95%CI: 39%-73%) and 51% (95%CI: 41%-61%) vs grades 1-2:55% (95%CI: 46%-63%) and 57% (95%CI: 49%-65%), P = .782 and P = .521, respectively]. Estimated six-year overall survival was lower, 76% (95%CI: 64%-88%) for the grade 3A group than grades 1-2 83% (95%CI: 77%-89%); P = .044. In addition to that, cumulative incidence curves of death not related to lymphoma at 10 years between groups were as follows: [0.26 (95%CI: 0.25-0.27) and 0.05 (95%CI: 0.04-0.06) for G3AFL and G1-2FL, respectively], P = .010. Grade 3A FL showed in PFS curve no relapses after 6 years. These results were absolutely reproduced in 199 patients receiving R-CHOP regimen as induction. CONCLUSIONS: Our results indicate similar long-term outcomes in terms of progression-free survival and time to progression in grades 1-2 and 3A. No relapses were observed in G3AFL group after 6 years.

Fermented milk beverage: formulation and process / Bebida láctea fermentada: formulação e processo

ABSTRACT: Dairy products are an adequate alternative as functional foods since they present excellent nutritional value, have wide acceptance with consumers, and are potential matrices for inoculation of probiotic microorganisms. The present study aimed to develop a fermented milk beverage with fruits and a probiotic culture included, to evaluate the acceptance of this product among consumers to define the ideal formulation, and to perform Lactobacillus acidophilus counting in order to characterize the product as a probiotic food. For the formulation of the beverage, milk, whey, sugar, and pasteurized orange and papaya pulps were used as main ingredients. The beverage formulation consisted of mixing the fruit pulps with a dairy substrate of milk and whey which was previously fermented using a mixed commercial probiotic ABT-5 culture. Six formulations were tested. The milk substrate was maintained at 70%. These formulations consisted of 50% of mineral water and 50% of skimmed milk with a concentration of probiotics of 0.5g/L. Sugar concentration varied between 40g, 70g, or 100g. As for flavoring, the juice was composed of 180mL of papaya and 120mL of orange, or 150mL of papaya and 150mL of orange. Beverages were prepared and then stored at 5±1°C. These products were evaluated after 24 hours of preparation/storage by 90 tasters (consumers) for acceptance and sensory characterization. Data were analyzed by ANOVA. The differences between samples were evaluated using the Tukey test at a significance level of 5%. Acceptance of the beverage samples among tasters varied from 5.1 to 6.9 and ranged between the hedonistic terms I neither liked nor disliked it and somewhat enjoyed it in a 9-point hedonic scale. The enumeration of Lactobacillus acidophilus LA-5 ranged from 7.83 to 8.09log CFU/mL in the first week of refrigerated storage. Our results suggested that the beverages analyzed were suitable for inoculation of probiotics and met the legislation requirements. Therefore, these beverages should be classified as probiotic products. Samples with 10% sugar were the least preferred by the study participants whereas beverages containing 40g, 70g and 180mL of papaya juice and 120mL of orange juice and the sample with 70g of sugar, 150mL of papaya juice, and 150mL of orange juice did not differ significantly from each other in terms of acceptance and were; therefore, the 3 formulations that received the highest means of acceptance by consumers.

RESUMO: Produtos lácteos são uma alternativa adequada como alimentos funcionais por apresentarem excelente valor nutricional, por serem amplamente aceitos e consumidos além de apresentar potenciais matrizes para inoculação de microrganismos probióticos. O objetivo deste estudo foi desenvolver uma bebida láctea fermentada com frutas adicionada de cultura probiótica e avaliar a aceitação entre os consumidores para definição da formulação ideal, bem como, realizar a contagem de Lactobacillus acidophilus para caracterização do produto como alimento probiótico. Para a formulação da bebida utilizou-se leite, soro de leite, açúcar e polpas de mamão e laranja pasteurizadas como principais ingredientes. A formulação das bebidas consistiu em misturar as polpas de frutas com uma base láctea de leite e soro de leite, previamente fermentada por cultura mista probiótica comercial ABT-5. Foram testadas seis formulações mantendo a base láctea fixa em 70%, composta por 50% de água mineral e 50% de leite desnatado com a concentração de probióticos 0,5g/L, variando a concentração de açúcar em 40,70 ou 100ge, quanto à saborização, o suco foi composto por 180mL de mamão e 120mL de laranja, ou 150mL de mamão e 150mL de laranja. As bebidas elaboradas foram armazenadas a 5±1°C e após 24h avaliadas por 90 avaliadores quanto à aceitação e a caracterização sensorial. Os dados foram analisados por ANOVA e as diferenças entre as amostras foi avaliada através do teste de Tukey, ao nível de significância de 5%. A aceitação das amostras variou de 5,1 até 6,9 situando-se entre os termos hedônicos não gostei nem desgostei e gostei regularmente em escala hedônica de nove pontos. A enumeração de Lactobacillus acidophilus LA-5 variou de 7,83 a 8,09log UFC/mL na 1ª semana de armazenamento refrigerado. Os resultados sugerem que as bebidas se mostraram adequadas para inoculação de probióticos e atenderam a exigência da legislação, sendo, portanto, um produto probiótico. As amostras com 10% de açúcar foram as menos preferidas pelos participantes do estudo, enquanto as bebidas com teor de 40g e 70g e 180mL de suco de mamão e 120mL de suco de laranja e a amostra com 70g de açúcar e 150mL de suco de mamão e 150mL de suco de laranja não diferiram significativamente entre si quanto à aceitação, tendo sido, portanto, as três formulações que receberam as médias mais altas de aceitação pelos consumidores.

The cortical matrix of femur in adult-aged Wistar rats is critically affected by maternal malnutrition during lactation period / La matriz cortical del fémur en ratas Wistar de edad adulta se ve críticamente afectada por la malnutrición materna durante el período de lactancia

Osteoporosis is associated with poor dietary habits. Malnutrition is characterized as a deficit on the intake of necessary nutrients that are essential for optimal health maintenance. It is known that malnutrition during the lactation period can affect the offspring. The present study aims to evaluate the chronic effects caused by maternal energy-protein restriction during lactation period in the offspring. At parturition, Wistar rat dams were divided in three groups: (1) Control group (C) - which received a 23 % protein diet without restrictions; (2) Protein-Energy restriction group (PER)- which received a 8 % protein diet; (3) Energy restriction group (ER) which received a 23 % protein diet in limited amounts, according to the ingestion of the second group. Each group had 12 pups. After weaning, all pups received free access to a 23 % protein diet until 180 days and then were euthanized. Their femur was excised, decalcified, histologically processed and analyzed under a microscope. The measurements of the osteon lacunae on the C, ER and PER groups were, respectively: 2.1 µm, 10.9 µm and 14.7 µm (p<0.05). A poor ingestion of proteins and calories during lactation period provoked critical and permanent changes on the bone matrix of the femur, which simulated osteoporosis.

La osteoporosis se asocia con malos hábitos alimenticios. La desnutrición se caracteriza como un déficit en la ingesta de los nutrientes necesarios que son esenciales para un mantenimiento óptimo de la salud. Se sabe que la malnutrición durante el período de lactancia puede afectar a la descendencia. El presente estudio tiene como objetivo evaluar los efectos crónicos causados por la restricción energética-proteína materna durante el período de lactancia en la descendencia. En el parto, las hijas de rata Wistar se dividieron en tres grupos: (1) grupo control (C) - que recibió una dieta con 23 % de proteína sin restricciones; (2) Grupo restricción de energía de proteína (PER) - que recibió una dieta con 8 % de proteína; (3) Grupo restricción de energía (ER) - que recibió una dieta de 23 % de proteína en cantidades limitadas, de acuerdo con la ingestión del segundo grupo. Cada grupo tenía 12 crías. Después del destete, todas las crías recibieron acceso libre a una dieta con 23 % de proteína hasta 180 días y luego fueron sacrificadas. Su fémur fue extirpado, descalcificado, procesado histológicamente y analizado bajo un microscopio. Las mediciones de las lagunas de osteón en los grupos C, ER y PER fueron, respectivamente: 2,1 mm, 10,9 mm y 14,7 mm (p <0,05). Una mala ingesta de proteínas y calorías durante el período de lactancia provocó cambios críticos y permanentes en la matriz ósea del fémur, que simulaba osteoporosis.

Effects of land use and spatial processes in water and surface sediment of tropical reservoirs at local and regional scales.

The effects of land use and connectivity on the characteristics of aquatic ecosystems are thought to be scale-dependent. This study aimed to evaluate the relationships between land use and reservoir characteristics at two spatial scales, after controlling for spatial processes. Water and surface sediment samples were collected from 31 sites (7 reservoirs) in the Paiva Castro and Piracicaba River basins (Cantareira System, São Paulo State, Brazil), during austral summer and winter. The dataset included 15 water quality variables and 6 surface sediment variables. Land use variables (natural areas, pasture, agriculture and urban areas) were obtained at two spatial scales (buffer and watershed) in each reservoir. Spatial variables were calculated using Moran's Eigenvectors Maps and Asymmetric Eigenvector Maps. The strengths of the relationships between land use and sediment variables were stronger than those between land use and water quality variables. The strengths of some of the relationships were scale-dependent. Finally, spatial processes, mostly hydrological connectivity, play an important role in water-sediment quality and should be considered in landscape management programs.

Reservatório de ardósia para sistemas de aproveitamento de água de chuva / Slate tank for rainwater storage systems

RESUMO No contexto da crescente pressão exercida no mundo todo sobre os recursos hídricos, qualitativa e quantitativamente, o desenvolvimento de tecnologias apropriadas para sistemas de aproveitamento de água de chuva surge como alternativa promissora. Este trabalho tem como principal objetivo apresentar uma tecnologia inovadora para armazenamento de água de chuva, trazendo como modelo a construção de um reservatório executado com placas de ardósia, com capacidade para 250 m3, que faz parte de um sistema de aproveitamento de água de chuva implantado em uma instalação suinícola no Oeste Catarinense. Nesse sistema, a água de chuva é destinada para dessedentação animal e higienização das instalações. Também são apresentados, porém com menos enfoque, os dispositivos de tratamento da água de chuva desenvolvidos no projeto. Realizou-se uma análise comparativa de custos entre esse reservatório e os comumente utilizados na região de estudo. Também foram feitas análises físico-químicas e bacteriológicas da água de chuva em diferentes pontos do sistema, a fim de verificar se a qualidade da água é adequada para os usos pretendidos. A tecnologia de construção de reservatórios de ardósia apresentou rapidez e facilidade de execução e baixo custo de construção. A ardósia, além de servir de forma para a moldagem da armadura e para a argamassagem, é um material natural e abundante na região central do Estado de Santa Catarina. As análises físico-químicas e bacteriológicas mostraram a eficiência dos dispositivos de tratamento da água de chuva aplicados neste trabalho. Por fim, observou-se que a água de chuva é adequada para dessedentação animal, já que atende às condições e padrões para as águas de Classe 3 da Resolução CONAMA 357. Deste modo, a nova tecnologia apresenta grande potencial de aplicação e viabilidade econômica para a região de estudo.

ABSTRACT In the context of increasing pressure, in quantitative and qualitative aspects, on water resources, the development of appropriate technologies for rainwater harvesting systems emerges as a promising alternative. This paper aims to present an innovative technology for building rainwater storage tanks in western Santa Catarina. It presents a slate tank with a capacity of 250 m3, which is part of a rainwater harvesting system implanted on a pig production in western Santa Catarina (Brazil). In this system, the rainwater is used for livestock drinking and to sanitation farms. It also presents, with less focus, rainwater treatment devices developed in this research project. A comparative analysis of costs between this tank and commonly used tanks in the study area was realized. Physico-chemical and bacteriological tests of rainwater were done in different parts of the system in order to check if the water quality is suitable for the intended uses. This technology showed speed and ease construction and low cost of implementation. The slate plaque, besides serving as a form to ferrocement layer, it’s a natural and abundant material in the central region of Santa Catarina. The physical-chemical and bacteriological tests displayed the efficiency of the rainwater treatment devices applied in this research project. Finally, it was noted that rainwater is suitable for animal consumption, since it observed the conditions and standards for waters of Class 3 of CONAMA Resolution 357. Thus, this new technology has great potential for application and economic viability for the study area.

Eltrombopag safety and efficacy for primary chronic immune thrombocytopenia in clinical practice.

BACKGROUND: Eltrombopag is effective and safe in chronic immune thrombocytopenia (ITP). However, clinical trials may not accurately reflect what happens in clinical practice. We evaluated the efficacy and safety of eltrombopag in primary chronic ITP in a real-world setting. METHODS: A total of 164 primary patients with chronic ITP from 40 Spanish centers, who had been treated with eltrombopag, were retrospectively evaluated. RESULTS: The median age of our cohort (72% women) was 63 yr (interquartile range, IQR, 45-75 yr). The median time with ITP diagnosis was 81 months (IQR, 30-192 months). The median number of therapies prior to eltrombopag was 3 (IQR, 2-4). At the time of eltrombopag start, 45 patients (30%) were receiving concomitant treatment for ITP. Forty-six patients (30%) had bleeding signs/symptoms the month before the treatment started. The median platelet count at eltrombopag initiation was 22 × 10(9) /L (IQR, 8-39 × 10(9) /L). A total of 135 patients (88.8%) achieved a platelet response. The median time to platelet response was 12 d (95% CI, 9-13 d). Maintained platelet response rate during the 15-month period under examination was 75.2%. Twenty-eight patients (18.4%) experienced adverse events, mainly grades 1-2. CONCLUSION: Eltrombopag is highly effective and well tolerated in unselected patients with primary chronic ITP.

Brief considerations on the dispensation profile of the botulinum toxin type A by the Brazilian Unified Health System for treatment of dystonias: Datasus data.

Botulinum toxin injections are the most effective approach for the treatment of focal dystonia. Despite growing demand and clinical indications over the years, there are few reports or publications of its use and benefit to patients seen at the Sistema Único de Saúde - SUS (Unified Health System). Analyzing the Datasus data (Unified Health System Information Department of Brazilian Ministry of Health), it was noticed that in Brazil the percentage of dystonic patient benefited from this procedure is still low. We therefore suggest some strategies to increase the dispensation of the toxin by the Brazilian Unified Health system for the dystonic patients.

Hypertriglyceridemic waist phenotype and cardiometabolic alterations in Brazilian adults / Fenotipo cintura hipertrigliceridémica y alteraciones cardiometabólicas en adultos brasileños

Aims: the present study aims to evaluate the prevalence of cardiometabolic changes according to the hypertriglyceridemic waist (HW) phenotype in Brazilian adults. Methods: it is a population based transversal study with 976 adults (n = 533 women) 20-59 years old. Phenotype was defined by triglycerides concentration (TGL) ≥ 150 mg/dl and waist circumference (WC) ≥80 cm in females and ≥ 90 cm in males. All the analyses were adjusted according to the study design and pondered by gender, age and schooling. A descriptive analysis was performed through averages and ratios; their respective confidence intervals were herein presented (CI 95%). The prevalence of cardiometabolic changes due to the presence of HW and to gender was calculated and compared by means of Pearson’s chi-square test. Statistic significance level was 0.05. The probability of coronary event risk was estimated in 10 years and calculated from Framinghan score, using Kernel density graph. Results: no difference in phenotype prevalence between genders was observed. Higher averages in all the cardiometabolic risk factors analyzed and higher probability of evolving to a cardiovascular event in 10 years were observed in individuals with the HW phenotype. Lower HDL values were only verified in this group. Conclusion: the HW phenotype is an important cardiovascular risk sign and allows the premature identification of individuals with higher risk, so that its use in clinical practice must be encouraged, mainly because it is a simple low cost asset (AU)

Objetivos: evaluar la prevalencia de alteraciones cardiometabólicas según el fenotipo cintura hipertrigliceridémica (CH) en adultos brasileños. Métodos: estudio transversal, de base poblacional, con 976 (n = 533 mujeres) individuos de 20 a 59 años. El CH fue definido por un aumento en las concentraciones de triglicéridos y en la circunferencia de la cintura (CC). Todos los análisis fueron ajustados por el efecto del diseño del estudio y ponderados por género, edad y escolaridad. Fue realizado un análisis descriptivo de promedio y presentados sus respectivos intervalos de confianza (IC 95%). La prevalencia de las alteraciones cardiometabólicas según la presencia o no del fenotipo CH y según el sexo fue calculada y comparada a través del test chi-cuadrado de Pearson. El nivel de significancia estadística adoptado fue de 0,05. Se estimó la probabilidad de riesgo de evento coronario en 10 años, a partir del score de Framinghan a través del gráfico de densidad de Kernel. Resultados: la prevalencia del fenotipo CH en la muestra fue de 17,32% (IC 95% 13,54-21,89), no se observó diferencia entre sexos. Se observaron mayores promedios para todos los factores de riesgo cardiometabólico analizados en aquellos con CH. Sólo Se verificaron menores valores medianos para el HDL en este grupo. Los individuos con CH presentaban mayor probabilidad de evolucionar hacia un evento cardiovascular en 10 años que aquellos sin el fenotipo. Conclusión: el fenotipo CH constituye un importante marcador precoz del riesgo cardiovascular. Su utilización en la práctica clínica debe ser incentivada, ya que se trata de una herramienta sencilla y de bajo coste (AU)

HYPERTRIGLYCERIDEMIC WAIST PHENOTYPE AND CARDIOMETABOLIC ALTERATIONS IN BRAZILIAN ADULTS.

AIMS: the present study aims to evaluate the prevalence of cardiometabolic changes according to the hypertriglyceridemic waist (HW) phenotype in Brazilian adults. METHODS: it is a population based transversal study with 976 adults (n = 533 women) 20-59 years old. Phenotype was defined by triglycerides concentration (TGL) ≥ 150 mg/dl and waist circumference (WC) ≥80 cm in females and ≥ 90 cm in males. All the analyses were adjusted according to the study design and pondered by gender, age and schooling. A descriptive analysis was performed through averages and ratios; their respective confidence intervals were herein presented (CI 95%). The prevalence of cardiometabolic changes due to the presence of HW and to gender was calculated and compared by means of Pearson's chi-square test. Statistic significance level was 0.05. The probability of coronary event risk was estimated in 10 years and calculated from Framinghan score, using Kernel density graph. RESULTS: no difference in phenotype prevalence between genders was observed. Higher averages in all the cardiometabolic risk factors analyzed and higher probability of evolving to a cardiovascular event in 10 years were observed in individuals with the HW phenotype. Lower HDL values were only verified in this group. CONCLUSION: the HW phenotype is an important cardiovascular risk sign and allows the premature identification of individuals with higher risk, so that its use in clinical practice must be encouraged, mainly because it is a simple low cost asset.

Objetivos: evaluar la prevalencia de alteraciones cardiometabolicas segun el fenotipo cintura hipertrigliceridemica (CH) en adultos brasilenos. Métodos: estudio transversal, de base poblacional, con 976 (n = 533 mujeres) individuos de 20 a 59 anos. El CH fue definido por un aumento en las concentraciones de trigliceridos y en la circunferencia de la cintura (CC). Todos los analisis fueron ajustados por el efecto del diseno del estudio y ponderados por genero, edad y escolaridad. Fue realizado un análisis descriptivo de promedio y presentados sus respectivos intervalos de confianza (IC 95%). La prevalencia de las alteraciones cardiometabolicas segun la presencia o no del fenotipo CH y segun el sexo fue calculada y comparada a traves del test chi-cuadrado de Pearson. El nivel de significancia estadistica adoptado fue de 0,05. Se estimo la probabilidad de riesgo de evento coronario en 10 anos, a partir del score de Framinghan a traves del grafico de densidad de Kernel. Resultados: la prevalencia del fenotipo CH en la muestra fue de 17,32% (IC 95% 13,54-21,89), no se observo diferencia entre sexos. Se observaron mayores promedios para todos los factores de riesgo cardiometabolico analizados en aquellos con CH. Solo Se verificaron menores valores medianos para el HDL en este grupo. Los individuos con CH presentaban mayor probabilidad de evolucionar hacia un evento cardiovascular en 10 anos que aquellos sin el fenotipo. Conclusión: el fenotipo CH constituye un importante marcador precoz del riesgo cardiovascular. Su utilizacion en la practica clinica debe ser incentivada, ya que se trata de una herramienta sencilla y de bajo coste.

Successful discontinuation of eltrombopag after complete remission in patients with primary immune thrombocytopenia.

Eltrombopag is effective and safe in immune thrombocytopenia (ITP). Some patients may sustain their platelet response when treatment is withdrawn but the frequency of this phenomenon is unknown. We retrospectively evaluated 260 adult primary ITP patients (165 women and 95 men; median age, 62 years) treated with eltrombopag after a median time from diagnosis of 24 months. Among the 201 patients who achieved a complete remission (platelet count >100 × 10(9) /l), eltrombopag was discontinued in 80 patients. Reasons for eltrombopag discontinuation were: persistent response despite a reduction in dose over time (n = 33), platelet count >400 × 10(9) /l (n = 29), patient's request (n = 5), elevated aspartate aminotransferase (n = 3), diarrhea (n = 3), thrombosis (n = 3), and other reasons (n = 4). Of the 49 evaluable patients, 26 patients showed sustained response after discontinuing eltrombopag without additional ITP therapy, with a median follow-up of 9 (range, 6-25) months. These patients were characterized by a median time since ITP diagnosis of 46.5 months, with 4/26 having ITP < 1 year. Eleven patients were male and their median age was 59 years. They received a median of 4 previous treatment lines and 42% were splenectomized. No predictive factors of sustained response after eltrombopag withdrawal were identified. Platelet response following eltrombopag cessation may be sustained in an important percentage of adult primary ITP patients who achieved CR with eltrombopag. However, reliable markers for predicting which patients will have this response are needed.

Use of eltrombopag after romiplostim in primary immune thrombocytopenia.

The thrombopoietin receptor agonists (THPO-RAs), romiplostim and eltrombopag, are effective and safe in immune thrombocytopenia (ITP). However, the value of their sequential use when no response is achieved or when adverse events occur with one THPO-RA has not been clearly established. Here we retrospectively evaluated 51 primary ITP adult patients treated with romiplostim followed by eltrombopag. The median age of our cohort was 49 (range, 18-83) years. There were 32 women and 19 men. The median duration of romiplostim use before switching to eltrombopag was 12 (interquartile range 5-21) months. The reasons for switching were: lack of efficacy (n = 25), patient preference (n = 16), platelet-count fluctuation (n = 6) and side-effects (n = 4). The response rate to eltrombopag was 80% (41/51), including 67% (n = 35) complete responses. After a median follow-up of 14 months, 31 patients maintained their response. Efficacy was maintained after switching in all patients in the patient preference, platelet-count fluctuation and side-effect groups. 33% of patients experienced one or more adverse events during treatment with eltrombopag. We consider the use of eltrombopag after romiplostim for treating ITP to be effective and safe. Response to eltrombopag was related to the cause of romiplostim discontinuation.

Professional knowledge in primary health care of the person/family in mental distress: Le Boterf perspective / Los conocimientos profesionales en la atención primaria de la salud de la persona/familia en la angustia mental: perspectiva Le Boterf / Saberes profissionais na atenção primária à saúde da pessoa/família em sofrimento mental: perspectiva Le Boterf

Aim of this study was to identify knowing-doing actions constituted the practice of Family Health (FH), in view of nurses in relation to the person and family care in mental distress in terms of professional knowledge of Le Boterf. Method: Descriptive exploratory qualitative study, to deepen contruction of nurse in FH. The survey was conducted in 3 Units FH. Result: Doing a thematic analysis, came to the following categories: “Knowing how to act and react with relevance”; “Knowing how to combine resources and mobilize them in a professional context”; “Knowing how to interact with multiple knowledges”; “Knowing how to transpose”; “Knowing how to learn and knowing how to learn to learn”; “Knowing how to engage”. Final considerations: the greatest difficulty was "be able to transpose," and that the daily demand of the FH teams requires a lot of this knowledge. Little transposition of knowing-doing in real situations has been verified.

El objetivo del estudio fue identificar los conocimientos y acciones en la práctica de la Salud de la Familia (SF), a la vista de las enfermeras en relación con la persona y la familia en el cuidado angustia mental en términos de conocimientos profesionales de Le Boterf. Método: Un estudio cualitativo exploratorio descriptivo, se indica para introducir y profundizar en el desarrollo de habilidades de las enfermeras, aplicado a 3 unidades SF. Resultados: hacer un análisis temático, llegó a las siguientes categorías: “Saber actuar correctamente”; “Conociendo a movilizar conocimientos y experiencia en el ámbito profesional”; “Sabiendo que interactúan múltiples saberes”; “Sabiendo transponer”; “El saber aprender y saber cómo aprender a aprender”; “Sabiendo participar”. Consideraciones finales: se encontró el conocimiento de la mayor dificultad es la de "ser capaz de incorporar", y que los equipos diarias SF requiere mucho este conocimiento. Poco transposición del saber/hacer en situaciones reales ha sido verificada.

O objetivo deste trabalho foi identificar os saberes e fazeres constituídos na prática da Saúde da Família (SF), na visão dos enfermeiros, no que se refere ao atendimento à pessoa e família em sofrimento mental na perspectiva dos saberes profissionais de Le Boterf. Método: Foi feito uma pesquisa descritiva exploratória de abordagem qualitativa, delineada para apresentar e aprofundar a construção de competências dos profissionais enfermeiros, foi aplicada em 3 Unidades da SF. Resultados: fazendo uma análise temática, chegou-se às seguintes categorias: “Saber agir com pertinência”; “Saber mobilizar saberes e conhecimentos em um contexto profissional”; “Saber interagir saberes múltiplos”; “Saber transpor”; “Saber aprender e saber aprender a aprender”; “Saber envolver-se”. Considerações finais: verificou-se que entre os saberes a maior dificuldade é a de “saber transpor”, e que o cotidiano das equipes de SF exige muito desse saber. Foi verificado pouca transposição de saberes/fazeres em situações reais.

Professional knowledge in primary health care of the person/family in mental distress: Le Boterf perspective.

UNLABELLED: Aim of this study was to identify knowing-doing actions constituted the practice of Family Health (FH), in view of nurses in relation to the person and family care in mental distress in terms of professional knowledge of Le Boterf. METHOD: Descriptive exploratory qualitative study, to deepen contruction of nurse in FH. The survey was conducted in 3 Units FH. RESULT: Doing a thematic analysis, came to the following categories: "Knowing how to act and react with relevance"; "Knowing how to combine resources and mobilize them in a professional context"; "Knowing how to interact with multiple knowledges"; "Knowing how to transpose"; "Knowing how to learn and knowing how to learn to learn"; "Knowing how to engage". FINAL CONSIDERATIONS: the greatest difficulty was "be able to transpose," and that the daily demand of the FH teams requires a lot of this knowledge. Little transposition of knowing-doing in real situations has been verified.

Racional e desenho do registro brasileiro de implante de bioprótese aórtica por cateter / Rationale and design of the Brazilian transcatheter aortic valve implantation registry

Introdução: A substituição cirúrgica da valva aórtica é o tratamento de eleição para pacientes com estenose aórtica acentuada. Entretanto, o risco cirúrgico aumenta expressivamente com o avançar da idade e com a associação de comorbidades. Recentemente, iniciou-se a experiência com o implante por cateter de biopróteses aórticas no Brasil. Justifica-se, portanto, a criação de um registro nacional para conhecimento dos resultados desse tipo de procedimento em nosso meio. Descrevemos o racional e o desenho do Registro Brasileiro de Implante de Bioprótese Aórtica por Cateter. Métodos: Trata-se de um registro multicêntrico, prospectivo, que incluirá 200 pacientes portadores de estenose valvar aórtica sintomática de alto risco cirúrgico submetidos a implante por cateter de bioprótese valvular aórtica em centros brasileiros. O desfecho primário do estudo é a mortalidade por qualquer causa aos 30 dias, 12 meses e 24 meses. Os desfechos secundários avaliados incluem, entre outros: 1) sucesso técnico do implante da bioprótese;2) mortalidade cardiovascular aos 30 dias, 12 meses e 24 meses; 3) desfecho combinado de segurança aos 30 dias; e 4) desfecho combinado de eficácia aos 12 meses e 24 meses. Conclusões: A análise dos resultados desse registro nacional permitirá avaliar os defechos do implante percutâneo de biopróteses aórticas em nosso meio.

Background: Surgical replacement of the aortic valve is the therapy of choice for patients with severe aortic stenosis.However, the surgical risk increases dramatically as age advances and with the association of comorbidities. Recently, transcatheter aortic valve implantation has been introduced in Brazil. Therefore, it was important to create a national registry to determine the outcomes of this procedure in our country. The rationale and design of the Brazilian Transcatheter Aortic Valve Implantation Registry is described.Methods: This is a multicenter prospective registry, including 200 patients with symptomatic aortic valve stenosis and high surgical risk submitted to transcatheter aortic valve implantation in Brazilian institutions. The primary endpoint of the study is all cause mortality at 30 days, 12 and 24 months. Secondary endpoints, among others, are: 1) technical success of transcatheter valve implantation; 2)cardiovascular mortality at 30 days, 12 and 24 months; 3) composite safety endpoint at 30 days; and 4) compositeefficacy endpoint at 12 and 24 months. Conclusions: The analysis of the results of this national registry will enable us to evaluate the outcomes of transcatheter aortic valve implantation in our country.

Capítulos da história sanitária no Brasil: a atuação profissional de Souza Araújo entre os anos 1910 e 1920 / Chapters of health history in Brazil: the role of professional Souza Araújo between the years 1910 and 1920

Décadas antes de se tornar um renomado estudioso da lepra, o paranaense Heraclídes de Souza-Araujo vivenciou os dilemas próprios de qualquer indivíduo impelido a fazer escolhas profissionais: onde estudar, que carreira seguir, o que pesquisar. Mesmo depois de optar pela medicina, nosso personagem dedicou-se a temas sanitários que despertavam grande interesse entre os médicos e cientistas brasileiros nos primeiros anos do século XX, mas que não guardavam relação direta com a hanseníase, que se tornaria seu principal objeto de pesquisa ao longo da vida. Granuloma venéreo, malária, doença de Chagas, febre tifóide, sífilis e gripe espanhola foram algumas das doenças estudadas e combatidas por Souza-Araujo nos primeiros anos de sua carreira. Este trabalho se dedica, essencialmente, ao período compreendido entre 1910 e 1921. O primeiro marco teve como referência o ingresso do personagem na Faculdade de Medicina do Rio de Janeiro. O segundo, a saída de Souza-Araujo do cargo de chefe do Serviço de Profilaxia Rural em seu estado natal. No decorrer destes anos, em instituições localizadas no Rio de Janeiro, Paraná, Alemanha, Argentina e Uruguai, foram forjadas as bases da identidade sanitarista-leprologista, sustentada pelo personagem até o final de seus dias. (AU)

Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital

BACKGROUND: The mortality rate due to Acinetobacter baumannii nosocomial meningitis (ANM) is high. OBJECTIVE: The aim of this study was to evaluate the factors that have influence over the outcomes in ANM patients. METHODS: A retrospective analysis of 22 cases of ANM was conducted in a hospital with high incidence of multidrug resistance. RESULTS: The mean age of patients was 43 years (21 to 91) and 54.5 percent were male. All ANM cases occurred within 60 days of admission and the mean duration of illness was of 18.2 days. All cases were associated with previous neurosurgical procedures: elective surgery (27.2 percent), external shunt (54.4 percent) and emergency surgery due to trauma (18.1 percent). Imipenem resistance was observed in 40.9 percent of cases, but ampicillin/sulbactam resistance was lower (27.2 percent). The mortality rate of ANM patients was of 72.7 percent. The only risk factor associated with mortality was inappropriate therapy within five days after CSF collection. All patients who survived the meningitis episode had received appropriate therapy, in contrast to only 69.2 percent of those who did not survive (OR = 5.15; IC = 0.45-54.01). CONCLUSIONS: The high mortality rate observed in our study suggests the need for aggressive empirical treatment with addition of drugs, including intrathecal therapy, where multi-resistant A. baumannii is endemic.

Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital.

BACKGROUND: The mortality rate due to Acinetobacter baumannii nosocomial meningitis (ANM) is high. OBJECTIVE: The aim of this study was to evaluate the factors that have influence over the outcomes in ANM patients. METHODS: A retrospective analysis of 22 cases of ANM was conducted in a hospital with high incidence of multidrug resistance. RESULTS: The mean age of patients was 43 years (21 to 91) and 54.5% were male. All ANM cases occurred within 60 days of admission and the mean duration of illness was of 18.2 days. All cases were associated with previous neurosurgical procedures: elective surgery (27.2%), external shunt (54.4%) and emergency surgery due to trauma (18.1%). Imipenem resistance was observed in 40.9% of cases, but ampicillin/sulbactam resistance was lower (27.2%). The mortality rate of ANM patients was of 72.7%. The only risk factor associated with mortality was inappropriate therapy within five days after CSF collection. All patients who survived the meningitis episode had received appropriate therapy, in contrast to only 69.2% of those who did not survive (OR = 5.15; IC = 0.45-54.01). CONCLUSIONS: The high mortality rate observed in our study suggests the need for aggressive empirical treatment with addition of drugs, including intrathecal therapy, where multi-resistant A. baumannii is endemic.

Cerejeiras e cafezais: relações médico-científicas entre Brasil e Japão e a saga de Hideyo Noguchi / Cherry trees and coffee farms: medical scientific relations between Brazil and Japan and the saga of Hideyo noguchi

A imagem de um caleidoscópio com as múltiplas figuras que se formam à medida que o manuseamos é o que nos ocorre quando nos debruçamos sobre 'Cerejeiras e cafezais; relações médico-científicas entre Brasil e Japão e a saga de Hideyo Noguchi. Em primeiro lugar porque os apresenta nas imagens, em segundo porque essa combinação nos faz pensar no significado de cada pedacinho em meio ao conjunto. O livro poderia ser mais uma das tantas publicações que homenageiam as relações entre Brasil e Japão no filão do centenário da imigração japonesa no Brasil _ vai, entretanto, muito além. A proposta de celebrar a presença de um milhão e meio de brasileiros descendentes de japoneses saiu do lugar-comum de recontar meros aspectos da história de imigrantes para se aprofundar na análise de um dos componentes deste caleidoscópio - a trajetória dos cientistas japoneses em missões de pesquisa no Brasil no início do século XX. [AU]

Cerejeiras e cafezais: relações médico-científicas entre Brasil e Japão e a saga de Hideyo Noguchi / Cherry trees and coffee fields: medical and scientific relations between Brazil and Japan and the saga of Hideyo Noguchi

História dos sanitaristas da FSP/USP destaque nas páginas, 220-229, 297-299, 397, entre outras....