Peripheral vascular catheter use in Latin America (the vascular study): A multinational cross-sectional study.

Background: Peripheral intravenous catheter (PIVC) insertion is one of the most common clinical procedures worldwide, yet little data are available from Latin America. Our aim was to describe processes and practices regarding PIVC use in hospitalized patients related to hospital guidelines, characteristics of PIVC inserters, prevalence of PIVC complications, and idle PIVCs. Methods: In 2019 we conducted a multinational, cross-sectional study of adult and pediatric patients with a PIVC in hospitals from five Latin American countries: Argentina, Brazil, Chile, Colombia, and Mexico. We used two data collection tools to collect hospital guidelines and patient-specific data on the day of the study. The vessel health and preservation (VHP) model guided synthesis of the study aims/questions and suggested opportunities for improvement. Results: A total of 9,620 PIVCs in adult (86%) and pediatric inpatients in 132 hospitals were assessed. Routine replacement 8-72 hourly was recommended for adults in 22% of hospitals, rather than evidence-based clinical assessment-based durations, and 69% of hospitals allowed the use of non-sterile tape rather than the international standard of a sterile dressing. The majority (52%) of PIVCs were inserted by registered nurses (RNs), followed by nursing assistants/technicians (41%). Eight percent of PIVCs had pain, hyperemia, or edema, 6% had blood in the extension tubing/connector, and 3% had dried blood around the device. Most PIVCs had been inserted for intravenous medications (81%) or fluids (59%) in the previous 24 h, but 9% were redundant. Conclusion: Given the variation in policies, processes and practices across countries and participating hospitals, clinical guidelines should be available in languages other than English to support clinician skills and knowledge to improve PIVC safety and quality. Existing and successful vascular access societies should be encouraged to expand their reach and encourage other countries to join in multinational communities of practice.

Insulin degludec and glutamine dipeptide modify glucose homeostasis and liver metabolism in diabetic mice undergoing insulin-induced hypoglycemia.

This study investigated whether a 30-day co-treatment with 1 g/kg glutamine dipeptide (GdiP) and 1 U/kg regular (rapid acting) or 5 U/kg degludec (long acting) insulins modifies glucose homeostasis and liver metabolism of alloxan-induced type 1 diabetic (T1D) male Swiss mice undergoing insulin-induced hypoglycemia (IIH). Glycemic curves were measured in fasted mice after IIH with 1 U/kg regular insulin. One hour after IIH, the lipid profile and AST and ALT activities were assayed in the serum. Morphometric analysis was assessed in the liver sections stained with hematoxylin-eosin and glycolysis, glycogenolysis, gluconeogenesis and ureagenesis were evaluated in perfused livers. T1D mice receiving GdiP or the insulins had a smaller blood glucose drop at 60 minutes after IIH, which was not sustained during the subsequent period up to 300 minutes. The 30-day treatment of T1D mice with insulin degludec, but not with regular insulin, improved fasting glycemia, body weight gain and serum activity of AST and ALT. Treatments with insulin degludec, GdiP and insulin degludec + GdiP decreased the liver capacity in synthesizing glucose from alanine. GdiP, in combination with both insulins, was associated with increases in the serum triglycerides and, in addition, regular insulin and GdiP increased AST and ALT activities, which could be the consequence of hepatic glycogen overload. GdiP and the insulins improved the IIH, although to a small extent. Caution is recommended, however, with respect to the use of GdiP because of its increasing effects on serum triglycerides and AST plus ALT activities.

LDLR variants functional characterization: Contribution to variant classification.

BACKGROUND AND AIMS: Familial hypercholesterolaemia (FH) is an autosomal disorder of lipid metabolism presenting with increased cardiovascular risk. LDLR mutations are the cause of disease in 90% of the cases but functional studies have only been performed for about 15% of all LDLR variants. In the Portuguese Familial Hypercholesterolemia Study (PFHS), 142 unique LDLR alterations were identified and 44 (30%) lack functional characterization. The aim of the present work is to increase evidence for variant classification by performing functional characterization of 13 LDLR missense alterations found in Portugal and in 20 other countries. METHODS: Different LDLR mutants were generated by site-directed mutagenesis and expressed in CHO-ldlA7 cells lacking endogenous expression of LDLR. To determine the effects of alterations on LDLR function, cell surface expression, binding and uptake of FITC-LDL were assessed by flow cytometry and Western blot. RESULTS: Of the 13 variants studied 7 were shown to affect LDLR function - expression, binding or uptake, with rates lower than 60%: p.(Cys184Tyr), p.(Gly207_Ser213del); p.(His211Asp); p.(Asp221Tyr); p.(Glu288Lys); p.(Gly592Glu) and p.(Asp601Val)). The remaining 6 variants do not alter the LDLR function. CONCLUSIONS: These studies contributed to an update of these variants classification: from the 9 variants classified as variants of unknown significance, 7 have reached now a final classification and 3 variants have improved classification from likely pathogenic to pathogenic. In Portugal, an additional 55 patients received an FH definite diagnosis thanks to these studies. Since only likely pathogenic and pathogenic variants are clinically actionable, this work shows the importance of functional studies for variant classification.

Differential Responses of Liver and Hypothalamus to the Nutritional Condition During Lactation and Adult Life.

It was previously reported that liver glucose metabolism in rats under caloric restriction differs from that of freely-fed rats. This study hypothesized that these changes (1) were related to the expression of hypothalamic neuropeptides involved in metabolic control, and (2) were not a residual effect of litter size. To those purposes, liver glucose metabolism and hypothalamic expression of the orexigenic neuropeptides NPY (neuropeptide Y) and AgRP (agouti gene-related peptide); and of the anorexigenic neuropeptides POMC (pro-opiomelanocortin) and CART (cocaine- and amphetamine-related transcripts) were investigated. Male Wistar rats from two different litter sizes (G6 and G12, with 6 or 12 pups, respectively) were subjected to free feeding (GL, ad libitum), 50% caloric restriction (GR) or caloric restriction+ad libitum refeeding (GRL) until the age of 90 days. Biometric values were lower in GR than in GL, while in GRL they were totally or partially recovered. Blood glucose variation during the pyruvate tolerance test (PTT) was small in GR. During in situ liver perfusion, total, basal, and adrenaline-stimulated liver glucose outputs were high in GR, but additional glucose output in the presence of alanine was negligible. Refeeding (GRL) yielded values close to those of GL. Litter size did not consistently influence any of these variables. The expression of transcripts of the hypothalamic neuropeptides was responsive to feeding regimen, litter size and/or their interaction and differed from G6 to G12, while the metabolic changes of the liver were qualitatively equal in both GR. Therefore, the changes in glucose metabolism in the liver of rats under caloric restriction were not determined by either litter size or hypothalamic neuropeptide expression and were linked only to the prevailing feeding regimen of the adult animal.

Best Safety Practices in nursing care in Neonatal Intensive Therapy.

OBJECTIVES: to identify the perception of nursing professionals on human errors in nursing care at a Neonatal Intensive Care Unit and to assess Best Practices strategies proposed by these professionals for patient safety in nursing care. METHODS: this is a quantitative-qualitative, descriptive study. Setting: Neonatal Intensive Care Unit. Participants: 22 nursing professionals. Data collection was performed through interviews and sent to the thematic analysis. RESULTS: human errors in nursing care, such as wasted catheters; errors in the medication process; causes for error in nursing care, with a focus on work overload; Best Practices for patient safety in nursing care, such as professional training and improved working conditions. CONCLUSIONS: it is of utmost importance to invest in Best Practices strategies for Patient Safety, aimed at consolidating the culture of organizational safety and encouraging an adequate environment to manage errors.

Best Safety Practices in nursing care in Neonatal Intensive Therapy / Las Buenas Prácticas de seguridad en los cuidados de enfermería en Terapia Intensiva Neonatal / Boas Práticas de segurança nos cuidados de enfermagem em Terapia Intensiva Neonatal

ABSTRACT Objectives: to identify the perception of nursing professionals on human errors in nursing care at a Neonatal Intensive Care Unit and to assess Best Practices strategies proposed by these professionals for patient safety in nursing care. Methods: this is a quantitative-qualitative, descriptive study. Setting: Neonatal Intensive Care Unit. Participants: 22 nursing professionals. Data collection was performed through interviews and sent to the thematic analysis. Results: human errors in nursing care, such as wasted catheters; errors in the medication process; causes for error in nursing care, with a focus on work overload; Best Practices for patient safety in nursing care, such as professional training and improved working conditions. Conclusions: it is of utmost importance to invest in Best Practices strategies for Patient Safety, aimed at consolidating the culture of organizational safety and encouraging an adequate environment to manage errors.

RESUMEN Objetivos: identificar la percepción de los profesionales de enfermería sobre el error humano en los cuidados de enfermería en la Unidad de Terapia Intensiva Neonatal; analizar las estrategias de Buenas Prácticas propuestas por estos profesionales para la seguridad del paciente en los cuidados de enfermería. Métodos: estudio cuantitativo cualitativo, descriptivo. Escenario: Unidad de Terapia Intensiva Neonatal. Participantes: 22 profesionales de enfermería. La recolección de los datos fue realizada por medio de entrevistas y sometidos al análisis temático. Resultados: el error humano en los cuidados de enfermería, identificándose pérdidas de catéteres y errores en el proceso de medicación; causas para el error en los cuidados de enfermería, destacándose la sobrecarga de trabajo; Buenas Prácticas para la seguridad del paciente en los cuidados de enfermería, como la capacitación profesional y las mejoras en las condiciones de trabajo. Conclusiones: se demuestra la importancia de invertir en estrategias de Buenas Prácticas para la Seguridad del Paciente, buscando sedimentar la cultura de seguridad organizacional y estimular un ambiente propicio para la gestión del error.

RESUMO Objetivos: identificar a percepção dos profissionais de enfermagem sobre o erro humano nos cuidados de enfermagem na Unidade de Terapia Intensiva Neonatal; analisar as estratégias de Boas Práticas propostas por esses profissionais para a segurança do paciente nos cuidados de enfermagem. Métodos: estudo quanti-qualitativo, descritivo. Cenário: Unidade de Terapia Intensiva Neonatal. Participantes: 22 profissionais de enfermagem. Coleta dos dados realizada por meio de entrevistas e submetidos a análise temática. Resultados: erro humano nos cuidados de enfermagem, identificando-se perdas de cateteres e erros no processo de medicação; causas para o erro nos cuidados de enfermagem, destacando-se a sobrecarga de trabalho; Boas Práticas para a segurança do paciente nos cuidados de enfermagem, como capacitação profissional e melhorias das condições de trabalho. Conclusões: demonstra-se a importância de investir em estratégias de Boas Práticas para a Segurança do Paciente, buscando-se sedimentar a cultura de segurança organizacional e estimular um ambiente propício ao gerenciamento do erro.

Best Safety Practices in nursing care in Neonatal Intensive Therapy / Las Buenas Prácticas de seguridad en los cuidados de enfermería en Terapia Intensiva Neonatal / Boas Práticas de segurança nos cuidados de enfermagem em Terapia Intensiva Neonatal

ABSTRACT Objectives: to identify the perception of nursing professionals on human errors in nursing care at a Neonatal Intensive Care Unit and to assess Best Practices strategies proposed by these professionals for patient safety in nursing care. Methods: this is a quantitative-qualitative, descriptive study. Setting: Neonatal Intensive Care Unit. Participants: 22 nursing professionals. Data collection was performed through interviews and sent to the thematic analysis. Results: human errors in nursing care, such as wasted catheters; errors in the medication process; causes for error in nursing care, with a focus on work overload; Best Practices for patient safety in nursing care, such as professional training and improved working conditions. Conclusions: it is of utmost importance to invest in Best Practices strategies for Patient Safety, aimed at consolidating the culture of organizational safety and encouraging an adequate environment to manage errors.

RESUMEN Objetivos: identificar la percepción de los profesionales de enfermería sobre el error humano en los cuidados de enfermería en la Unidad de Terapia Intensiva Neonatal; analizar las estrategias de Buenas Prácticas propuestas por estos profesionales para la seguridad del paciente en los cuidados de enfermería. Métodos: estudio cuantitativo cualitativo, descriptivo. Escenario: Unidad de Terapia Intensiva Neonatal. Participantes: 22 profesionales de enfermería. La recolección de los datos fue realizada por medio de entrevistas y sometidos al análisis temático. Resultados: el error humano en los cuidados de enfermería, identificándose pérdidas de catéteres y errores en el proceso de medicación; causas para el error en los cuidados de enfermería, destacándose la sobrecarga de trabajo; Buenas Prácticas para la seguridad del paciente en los cuidados de enfermería, como la capacitación profesional y las mejoras en las condiciones de trabajo. Conclusiones: se demuestra la importancia de invertir en estrategias de Buenas Prácticas para la Seguridad del Paciente, buscando sedimentar la cultura de seguridad organizacional y estimular un ambiente propicio para la gestión del error.

RESUMO Objetivos: identificar a percepção dos profissionais de enfermagem sobre o erro humano nos cuidados de enfermagem na Unidade de Terapia Intensiva Neonatal; analisar as estratégias de Boas Práticas propostas por esses profissionais para a segurança do paciente nos cuidados de enfermagem. Métodos: estudo quanti-qualitativo, descritivo. Cenário: Unidade de Terapia Intensiva Neonatal. Participantes: 22 profissionais de enfermagem. Coleta dos dados realizada por meio de entrevistas e submetidos a análise temática. Resultados: erro humano nos cuidados de enfermagem, identificando-se perdas de cateteres e erros no processo de medicação; causas para o erro nos cuidados de enfermagem, destacando-se a sobrecarga de trabalho; Boas Práticas para a segurança do paciente nos cuidados de enfermagem, como capacitação profissional e melhorias das condições de trabalho. Conclusões: demonstra-se a importância de investir em estratégias de Boas Práticas para a Segurança do Paciente, buscando-se sedimentar a cultura de segurança organizacional e estimular um ambiente propício ao gerenciamento do erro.

Modulation of liver glucose output by free or restricted feeding in the adult rat is independent of litter size.

BACKGROUND: Caloric restriction since birth changes glucose metabolism by the liver in overnight-fasted rats to a fed-like pattern, in which glucose output is large but gluconeogenesis is negligible. It was investigated whether these changes could be a residual effect of the nutritional condition during lactation and what could be the mechanism of such change. METHODS: Newborn Wistar rat pups were arranged in litters of 6 or 12 (G6 and G12). After weaning, the male pups were divided in: G6L and G12 L, fed freely until the age of 90 days (freely-fed groups); G6R and G12R, given 50% of the GL ingestion (food-restricted groups) until 90 days of age; G6RL and G12RL, given 50% of the GL ingestion until 60 days of age and fed freely until 90 days of age (refed groups). The experimental protocols were carried out at the age of 90 days after overnight fasting. Pairs of groups were compared through t test; other statistical comparisons were made with one-way ANOVA with Tukey post hoc text. RESULTS: Caloric restriction was effective in decreasing body and fat weights, total cholesterol and LDL. These effects were totally or partially reversed after 30 days of refeeding (groups GRL). During liver perfusion, the high glucose output of the GRs was further enhanced by adrenaline (1 µM), but not by lactate infusion. In contrast, in groups G6L, G12 L, G6RL and G12RL glycogenolysis (basal and adrenaline-stimulated glucose output) was low and gluconeogenesis from lactate was significant. A twofold increase in liver content of PKA in group G6R suggests that liver sensitivity to glucagon and adrenaline was higher because of caloric restriction, resulting in enhanced glucose output. CONCLUSIONS: As glucose output was not affected by litter size, liver glucose metabolism in the adult rat, in contrast to other metabolic processes, is not a programmed effect of the nutritional condition during lactation. In addition, the increased expression of PKA points to a higher sensitivity of the animals under caloric restriction to glycogenolytic hormones, a relevant condition for glucose homeostasis during fasting.

Procedimentos dolorosos agudos no recém-nascido pré-termo em uma unidade neonatal / Acute painful procedures pain in the preterm newborn in a neonatal unit / Procedimientos dolorosos agudos en el recién nacido pre-término en una unidad neonatal

Objetivo: analisar o número de procedimentos dolorosos agudos e manejo da dor em recém-nascidos pré-termo em uma unidade neonatal. Método: estudo descritivo, transversal. Teve como campo uma unidade neonatal de uma instituição pública de saúde. Os participantes da pesquisa foram recém-nascidos abaixo de 35 semanas. Resultados: foram incluídos 17 recémnascidos. Foi quantificado um total de 729 procedimentos dolorosos. Em média foram realizados 42,9 procedimentos por recém-nascido durante os primeiros 14 dias de vida, sendo aproximadamente três procedimentos realizados por bebê no serviço diurno. Dentre os procedimentos, o mais frequente foi a punção de calcâneo (23,9%). O manejo predominante foi a contenção facilitada (32,7%). A (re)inserção de pronga foi o segundo procedimento mais realizado. Conclusões: O estudo permitiu apreender que o manejo da dor no recém-nascido pré-termo internado em uma unidade neonatal ainda é um desafio

Objective: to analyze the number of acute painful procedures and pain management in preterm infants in a neonatal unit. Method: a cross-sectional and descriptive study. It was conducted in a neonatal unit of a public health institution. The newborns younger than 35 weeks were the participants in the survey. Results: seventeen preterm newborns were included. A total of 729 painful procedures were quantified. On average, 42.9 procedures per newborn were performed during the first 14 days of birth, and approximately three procedures performed per day service by child. The most common procedure was the hell-stick (23.9%). The predominant management was facilitated tucking (32.7%). The CPAP prongs insertion/reinsertion was the second most performed procedure. Conclusions: The present study showed that the management of pain in the preterm newborns in a neonatal unit is strongly neglected by the professionals

Objetivo: analizar el número de procedimientos dolorosos agudos y manejo del dolor en recién nacidos prematuros en una unidad neonatal. Método: estudio descriptivo, transversal. Tuvo como campo una unidad neonatal de una institución pública de salud. Los participantes de la investigación fueron recién nacidos por debajo de 35 semanas. Resultados: se incluyeron 17 recién nacidos. Se cuantificó un total de 729 procedimientos dolorosos. En promedio se realizaron 42,9 procedimientos por recién nacido durante los primeros 14 días de vida, siendo acerca de tres procedimientos realizados por bebé en el servicio diurno. Entre los procedimientos, el más frecuente fue la punción de calcáneo (23,9%). El manejo predominante fue la contención facilitada (32,7%). La (re) inserción de prong fue el segundo procedimiento más realizado. Conclusiones: El estudio permitió aprehender que el manejo del dolor en el recién nacidos prematuros internado en una unidad neonatal se muestra fuertemente descuidado por el equipo.

Correção cirúrgica de pseudoaneurismas e fístula arteriovenosa complexa entre vasos poplíteos / Surgical repair of pseudoaneurysms and complex arteriovenous fistula between popliteal vessels

A fístula arteriovenosa (FAV) é uma comunicação anormal e permanente entre uma artéria e uma veia devido a traumas penetrantes e lesões iatrogênicas. O trauma penetrante na parede arterial pode levar à formação de pseudoaneurismas (PSA) e, se houver lesão venosa concomitante, à formação de uma FAV. Os autores apresentam o caso de um paciente portador de FAV complexa de vasos poplíteos associada a pseudoaneurisma de artéria poplítea, sugeridos a partir de exames clínicos e exames de imagem, e tratados por cirurgia convencional devido à indisponibilidade de um stent graft com diâmetro apropriado, além de a cirurgia endovascular não estar disponível no serviço em que o paciente foi operado

An arteriovenous fistula (AVF) is an abnormal and permanent communication between an artery and a vein caused by penetrating traumas or iatrogenic injuries. A penetrating trauma to the endothelial wall can lead to formation of pseudoaneurysms (PSA) and to formation of an AVF. Here, the authors present the case of a patient with a complex AVF of popliteal vessels, associated with popliteal artery pseudoaneurysm, suggested by clinical features and imaging exams, and treated with conventional surgery due to unavailability of a stent graft with appropriate diameter and because endovascular surgery isn't provided at the service where this patient was operated

Surgical repair of pseudoaneurysms and complex arteriovenous fistula between popliteal vessels.

An arteriovenous fistula (AVF) is an abnormal and permanent communication between an artery and a vein caused by penetrating traumas or iatrogenic injuries. A penetrating trauma to the endothelial wall can lead to formation of pseudoaneurysms (PSA) and to formation of an AVF. Here, the authors present the case of a patient with a complex AVF of popliteal vessels, associated with popliteal artery pseudoaneurysm, suggested by clinical features and imaging exams, and treated with conventional surgery due to unavailability of a stent graft with appropriate diameter and because endovascular surgery isn't provided at the service where this patient was operated.

Supplementation with L-Glutamine and L-Alanyl-L-Glutamine Changes Biochemical Parameters and Jejunum Morphophysiology in Type 1 Diabetic Wistar Rats.

We evaluated the effects of the supplementation with L-glutamine and glutamine dipeptide (GDP) on biochemical and morphophysiological parameters in streptozotocin-diabetic rats. For this purpose, thirty animals were distributed into six groups treated orally (gavage) during thirty days: non diabetic rats (Control) + saline, diabetic + saline; Control + L-glutamine (248 mg/kg), Diabetic + L-glutamine (248 mg/kg), Control + GDP (400 mg/kg), Diabetic + GDP (400 mg/kg). Diabetes was induced by an intravenous injection of streptozotocin (60 mg/kg) and confirmed by fasting glucose ≥ 200 mg/dL. Physiological parameters, i.e., body mass, food intake, blood glucose, water intake, urine and faeces were evaluated during supplementation. After the period of supplementation, the animals were euthanized. The blood was collected for biochemical assays (fructosamine, transaminases, lipid profile, total protein, urea, ammonia). Moreover, the jejunum was excised and stored for morphophysiological assays (intestinal enzyme activity, intestinal wall morphology, crypt proliferative index, number of serotoninergic cells from the mucosa, and vipergic neurons from the submucosal tunica). The physiological parameters, protein metabolism and intestinal enzyme activity did not change with the supplementation with L-glutamine or GDP. In diabetic animals, transaminases and fructosamine improved with L-glutamine and GDP supplementations, while the lipid profile improved with L-glutamine. Furthermore, both forms of supplementation promoted changes in jejunal tunicas and wall morphometry of control and diabetic groups, but only L-glutamine promoted maintenance of serotoninergic cells and vipergic neurons populations. On the other hand, control animals showed changes that may indicate negative effects of L-glutamine. Thus, the supplementation with L-glutamine was more efficient for maintaining intestinal morphophysiology and the supplementation with GDP was more efficient to the organism as a whole. Thus, we can conclude that local differences in absorption and metabolism could explain the differences between the supplementation with L-glutamine or GDP.

Modelling the influence of time and temperature on the respiration rate of fresh oyster mushrooms.

The respiration rate of mushrooms is an important indicator of postharvest senescence. Storage temperature plays a major role in their rate of respiration and, therefore, in their postharvest life. In this context, reliable predictions of respiration rates are critical for the development of modified atmosphere packaging that ultimately will maximise the quality of the product to be presented to consumers. This work was undertaken to study the influence of storage time and temperature on the respiration rate of oyster mushrooms. For that purpose, oyster mushrooms were stored at constant temperatures of 2, 6, 10, 14 and 18 ℃ under ambient atmosphere. Respiration rate data were measured with 8-h intervals up to 240 h. A decrease of respiration rate was found after cutting of the carpophores. Therefore, time effect on respiration rate was modelled using a first-order decay model. The results also show the positive influence of temperature on mushroom respiration rate. The model explaining the effect of time on oyster mushroom's respiration rate included the temperature dependence according to the Arrhenius equation, and the inclusion of a parameter describing the decrease of the respiration rate, from the initial time until equilibrium. These yielded an overall model that fitted well to the experimental data. Moreover, results show that the overall model is useful to predict respiration rate of oyster mushrooms at different temperatures and times, using the initial respiration rate of mushrooms. Furthermore, predictive modelling can be relevant for the choice of an appropriate packaging system for fresh oyster mushrooms.

Long-Term and Sustained Therapeutic Results of a Specific Promonocyte Cell Formulation in Refractory Angina: ReACT(®) (Refractory Angina Cell Therapy) Clinical Update and Cost-Effective Analysis.

Mononuclear stem cells have been studied for their potential in myocardial ischemia. In our previous published article, ReACT(®) phase I/II clinical trial, our results suggest that a certain cell population, promonocytes, directly correlated with the perceived angiogenesis in refractory angina patients. This study is ReACT's clinical update, assessing long-term sustained efficacy. The ReACT phase IIA/B noncontrolled, open-label, clinical trial enrolled 14 patients with refractory angina and viable ischemic myocardium, without ventricular dysfunction, who were not suitable for myocardial revascularization. The procedure consisted of direct myocardial injection of a specific mononuclear cell formulation, with a certain percentage of promonocytes, in a single series of multiple injections (24-90; 0.2 ml each) into specific areas of the left ventricle. Primary endpoints were Canadian Cardiovascular Society Angina Classification (CCSAC) improvement at the 12-month follow-up and ischemic area reduction (scintigraphic analysis) at the 12-month follow-up, in correlation with ReACT's formulation. A recovery index (for patients with more than 1 year follow-up) was created to evaluate CCSAC over time, until April 2011. Almost all patients presented progressive improvement in CCSAC beginning 3 months (p=0.002) postprocedure, which was sustained at the 12-month follow-up (p=0.002), as well as objective myocardium ischemic area reduction at 6 months (decrease of 15%, p<0.024) and 12 months (decrease of 100%, p<0.004) The recovery index (n=10) showed that the patients were graded less than CCSAC 4 for 73.9 ± 24.2% over a median follow-up time of 46.8 months. After characterization, ReACT's promonocyte concentration suggested a positive correlation with CCSAC improvement (r=-0.575, p=0.082). Quality of life (SF-36 questionnaire) improved significantly in almost all domains. Cost-effectiveness analysis showed decrease in angina-related direct costs. Refractory angina patients presented a sustained long-term improvement in CCSAC and myocardium ischemic areas after the procedure. The long-term follow-up and strong improvement in quality of life reinforce effectiveness. Promonocytes may play a key role in myocardial neoangiogenesis. ReACT dramatically decreased direct costs.

Transtorno afetivo bipolar: um estudo sobre a relevância na região centro-oeste de Minas Gerais / Trastorno afectivo bipolar: estudio sobre su relevancia en la region centro-oeste de Minas Gerais / Bipolar disorder: a study about its relevance in the midwest area of the state of Minas Gerais

Trata-se de um estudo retrospectivo e exploratório, realizado na Clínica São Bento Menni (CSBM), referência parainternações psiquiátricas da região Centro-Oeste de Minas Gerais, com os seguintes objetivos: caracterizar os pacientesacometidos por transtorno afetivo bipolar (TAB) e identificar a ocorrência de TAB por sexo e idade, bem como aprocedência do paciente, tempo de internação, tipo de alta, tipo de internação e fonte financiadora dos serviçosprestados ao paciente. A pesquisa foi realizada com base no banco de dados do Sistema de Internações Hospitalarese Prontuários do Arquivo Médico da CSBM, entre 1980 e 2005. A amostra foi constituída de 24.161 pacientes admitidosna CSBM, dos quais 1.967 tiveram diagnóstico de TAB (8,1%). Houve a predominância do sexo feminino com 1.167(59,3%) e na faixa etária de 41 a 50 anos, com 455 (23,1%). A maior procedência para internação decorreu da própriafamília, com 793 (40,3%) pacientes. No que se refere ao tempo de internação 1.070 (54,4%), o período foi de até 30dias. O maior tipo de alta foi a classificada como alta médica, com 1.685 (85,7%) pacientes. O tipo de internação queprevaleceu foi a reinternação hospitalar, com 1.116 (56,7%). O principal financiador das internações hospitalares foi oSistema Único de Saúde (SUS), com 1.742 (88,5%) internações pagas.

This is a retrospective and exploratory study carried out in the São Bento Menni Clinic (CSBM) a reference for psychiatrichospitalization in the Midwest region of Minas Gerais. Its main objectives were to characterize the patients suffering frombipolar disorder syndrome and to identify its occurrence according to sex and age as well as the patient’s origins, length ofhospital stay, type of hospital discharge, type of hospitalization, and funding for services rendered to patient. The survey wasbased on data from the System of Hospital Admissions and medical records from the CSBM Medical Archives between 1980and 2005. The sample consisted of 24.161 patients admitted to CSBM. Out of this 1.967 (8.1%) were diagnosed as sufferingfrom bipolar disorder. Females formed the largest group with 1.167 (59. 3%), 455 were between the ages of 41 and 50 (23.1%). 793 or 40. 3% were admitted on family request. Regarding the duration of hospitalization 1.070 (54. 4%) patients stayedin hospital for 30 days. Medical discharge was the highest with 1.685 (85.7%). 1.116 (56.7%) were readmitted (56.7%) andthe funding came basically from the Public Health Service System (SUS) with 1.742 (88.5%) of paid admissions.

Se trata de un estudio retrospectivo exploratorio realizado en la Clínica São Bento Menni (CSBM), centro de referenciapara internaciones psiquiátricas de la región centro oeste de Minas Gerais. El estudio se realizó con miras a caracterizara los pacientes acometidos por el Trastorno Afectivo Bipolar (TAB); identificar la incidencia de TAB por sexo y edad, asícomo procedencia del paciente, tiempo de internación, tipo de alta, tipo de internación y fuente financiadora de losservicios prestados al paciente. La investigación se realizó entre 1980 y 2005 a partir del banco de datos del Sistemade Internaciones y Prontuarios del Archivo Médico de la CSBM. La muestra consistió en 24.161 pacientes admitidos enla CSBM de los cuales 1.967 tuvieran diagnóstico de TAB (8,1%). Se constató predominio del sexo femenino con 1.167(59,3%) entre 41 y 50 años con 455 casos (23,1%). La mayoría de las internaciones ocurrió por iniciativa de las propiasfamilias con 793 (40,3%) pacientes. Respecto al tiempo de internación 1.070 (54,4%) permanecieron en la instituciónhasta 30 días. El tipo de alta más frecuente fue la clasificada como alta médica con 1.685 (85,7%) pacientes. El tipo deinternación prevalente fue la re-internación con 1.116 (56,7%). El Sistema Único de Salud (SUS) fue la fuente financiadorade la mayoría de las internaciones, pagando 1.742 (88,5%) casos.

Refractory angina cell therapy (ReACT) involving autologous bone marrow cells in patients without left ventricular dysfunction: a possible role for monocytes.

Autologous bone marrow mononuclear cell (BMMC) transplantation has emerged as a potential therapeutic option for refractory angina patients. Previous studies have shown conflicting myocardium reperfusion results. The present study evaluated safety and efficacy of CellPraxis Refractory Angina Cell Therapy Protocol (ReACT), in which a specific BMMC formulation was administered as the sole therapy for these patients. The phase I/IIa noncontrolled, open label, clinical trial, involved eight patients with refractory angina and viable ischemic myocardium, without left ventricular dysfunction and who were not suitable for conventional myocardial revascularization. ReACT is a surgical procedure involving a single series of multiple injections (40-90 injections, 0.2 ml each) into ischemic areas of the left ventricle. Primary endpoints were Canadian Cardiovascular Society Angina Classification (CCSAC) improvement at 18 months follow-up and myocardium ischemic area reduction (assessed by scintigraphic analysis) at 12 months follow-up, in correlation with a specific BMMC formulation. Almost all patients presented progressive improvement in angina classification beginning 3 months (p = 0.008) postprocedure, which was sustained at 18 months follow-up (p = 0.004), as well as objective myocardium ischemic area reduction at 12 months (decrease of 84.4%, p < 0.004). A positive correlation was found between monocyte concentration and CCSAC improvement (r = -0.759, p < 0.05). Improvement in CCSAC, followed by correlated reduction in scintigraphic myocardium ischemic area, strongly suggests neoangiogenesis as the main stem cell action mechanism. The significant correlation between number of monocytes and improvement strongly supports a cell-related effect of ReACT. ReACT appeared safe and effective.

Células-Tronco - conceitos gerais e definições / Stem cells - general concepts and definitions

Uma nova era na biologia das células-tronco se iniciou em 1998 com a derivação de células a partir do blastocisto humano e tecido fetal, com habilidade única de se diferenciar em células de todos os tecidos do corpo. Desde então, várias equipes de pesquisadores têm demonstrado algumas das características moleculares e desenvolvido métodos para cultura destas células. A célula-tronco é um tipo especial de célula que tem capacidade única de se automultiplicar ou de dar origem a tipos celulares especializados. Embora a maioria das células do corpo, como células cardíacas ou células da derme, sejam diferenciadas para exercer uma função específica, a célula-tronco é indiferenciada e assim permanece até que receba um sinal para se desenvolver em algum tipo celular. Sua capacidade proliferativa combinada a sua habilidade de se especializar fazem delas células únicas

Avaliaçäo epidemiológica da hanseníase e dos serviços responsáveis por seu atendimento em Ribeiräo Preto-SP no ano de 1992 / Epidemiological evaluation of leprosy and leprosy health services in Ribeiräo Preto City, Brazil, in 1992

A partir de dados registrados na planilha epidemiológica de hanseníase, instituída pelo Ministério da Saúde, sobre os casos atendidos no Município de Ribeiräo Preto-SP, buscou-se traçar um perfil epidemiológico da hanseníase, no ano de 1992, e avaliar a eficácia dos serviços responsáveis pela assistência aos hansenianos. Encontrou-se um coeficiente de prevalência de 1,72/1000 habitantes, pouco abaixo do coeficiente nacional de 1992 (1,78/1000 habitantes), e superior àquele preconizado pela OMS para definir àreas de baixa prevalência (0,2/1000 habitantes). A maioria dos casos (65,4 por cento) era de formas multibacilares, e o esquema terapêutico predominante foi o DNDS (apesar das recomendaçöes do Ministério da Saúde). Detectou-se, também, que cerca da metade dos pacientes näo recebeu avaliaçäo de incapacidades durante o ano, havendo 60 por cento dos pacientes com incapacidades de graus II e III, entre os que saíram do programa por alta, por cura e foram avaliados quanto a incapacidades, apesar do comparecimento dos pacientes ter sido satisfatório. Com base em tais resultados inquietantes, os autores propöem a descentralizaçäo do atendimento para as Unidades Básicas de Saúde, aproximando o serviço à comunidade. Encaminhamentos a serviços de nível secundário e terciário seriam feitos apenas para determinaçäo diagnóstica mais apurada, e na ocorrência de complicaçöes. Grupos terapêuticos com orientaçäo multiprofissional e multidisciplinar deveriam ser formados para discutir o estigma e formas de reintegrar, socialmente, os pacientes.