Single laboratory evaluation of umbilical cord blood units processing methodologies for banking.

OBJECTIVE: To compare the efficiency of 3 different processing methods (Sepax, AutoXpress [AXP], and manual processing with hydroxyethyl starch [HES] sedimentation) used at Stemlab during a 10-year period. METHODS: Historical data were compiled and the analytical results obtained for the 3 different methods were compared. RESULTS: The manual processing (HES) method yielded the highest level of total nucleated cell recovery after processing, and the AXP system yielded the highest CD34+ cell number. The red blood cell reduction was also significantly higher with the HES method. Also, HES showed comparable results to Toticyte technology for umbilical cord blood (UCB) processing. CONCLUSION: These results show that the HES method is as effective as automated technologies for UCB volume reduction; hence, it is a suitable methodology for private and public UCB banks. The HES method also proved to be superior to Toticyte technology for medical applications, with higher recovery yields of total nucleated cells after thawing and equivalent CD34+ cell recovery and functionality.

Umbilical-Cord-Derived Mesenchymal Stromal Cells Modulate 26 Out of 41 T Cell Subsets from Systemic Sclerosis Patients.

Systemic sclerosis (SSc) is an immune-mediated disease wherein T cells are particularly implicated, presenting a poor prognosis and limited therapeutic options. Thus, mesenchymal-stem/stromal-cell (MSC)-based therapies can be of great benefit to SSc patients given their immunomodulatory, anti-fibrotic, and pro-angiogenic potential, which is associated with low toxicity. In this study, peripheral blood mononuclear cells from healthy individuals (HC, n = 6) and SSc patients (n = 9) were co-cultured with MSCs in order to assess how MSCs affected the activation and polarization of 58 different T cell subsets, including Th1, Th17, and Treg. It was found that MSCs downregulated the activation of 26 out of the 41 T cell subsets identified within CD4+, CD8+, CD4+CD8+, CD4-CD8-, and γδ T cells in SSc patients (HC: 29/42) and affected the polarization of 13 out of 58 T cell subsets in SSc patients (HC: 22/64). Interestingly, SSc patients displayed some T cell subsets with an increased activation status and MSCs were able to downregulate all of them. This study provides a wide-ranging perspective of how MSCs affect T cells, including minor subsets. The ability to inhibit the activation and modulate the polarization of several T cell subsets, including those implicated in SSc's pathogenesis, further supports the potential of MSC-based therapies to regulate T cells in a disease whose onset/development may be due to immune system's malfunction.

"ZARPAR"-Educational Program for Cognitive and Behavioral Development: Results of an Experiment to Evaluate Its Impact on Antisocial and Pro-Social Behavior.

Using an experimental design and a multi-measure and multi-informant approach, the current study sought to evaluate the impact of the early developmental prevention program "ZARPAR"-an intervention designed as a social and cognitive skills training program, that seeks to promote children's behavioral adjustment. A sample of elementary school children (experimental group n = 37; control group n = 66), attending Portuguese schools, was assessed before and 6 months after the intervention on the program's key-dimensions: behavioral problems, social skills, and executive functioning. Based on parent and teacher reports, the results largely suggested that the intervention had no effect or, for some dimensions, even the existence of negative outcomes. Possible reasons for these results are discussed. The current study highlights that, despite the overwhelmingly positive message about developmental prevention programs, not all interventions work, thus reinforcing the need for rigorous evaluations, in order to enhance the success of future interventions.

Biomarkers of hypoxic-ischemic encephalopathy: a systematic review.

BACKGROUND: Current diagnostic criteria for hypoxic-ischemic encephalopathy in the early hours lack objective measurement tools. Therefore, this systematic review aims to identify putative molecules that can be used in diagnosis in daily clinical practice (PROSPERO ID: CRD42021272610). DATA SOURCES: Searches were performed in PubMed, Web of Science, and Science Direct databases until November 2020. English original papers analyzing samples from newborns > 36 weeks that met at least two American College of Obstetricians and Gynecologists diagnostic criteria and/or imaging evidence of cerebral damage were included. Bias was assessed by the Newcastle-Ottawa Scale. The search and data extraction were verified by two authors separately. RESULTS: From 373 papers, 30 met the inclusion criteria. Data from samples collected in the first 72 hours were extracted, and increased serum levels of neuron-specific enolase and S100-calcium-binding protein-B were associated with a worse prognosis in newborns that suffered an episode of perinatal asphyxia. In addition, the levels of glial fibrillary acidic protein, ubiquitin carboxyl terminal hydrolase isozyme-L1, glutamic pyruvic transaminase-2, lactate, and glucose were elevated in newborns diagnosed with hypoxic-ischemic encephalopathy. Moreover, pathway analysis revealed insulin-like growth factor signaling and alanine, aspartate and glutamate metabolism to be involved in the early molecular response to insult. CONCLUSIONS: Neuron-specific enolase and S100-calcium-binding protein-B are potential biomarkers, since they are correlated with an unfavorable outcome of hypoxic-ischemic encephalopathy newborns. However, more studies are required to determine the sensitivity and specificity of this approach to be validated for clinical practice.

Hypothermia Does Not Boost the Neuroprotection Promoted by Umbilical Cord Blood Cells in a Neonatal Hypoxia-Ischemia Rat Model.

Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the leading causes of death and long-term disability in the perinatal period. Currently, therapeutic hypothermia is the standard of care for this condition with modest efficacy and strict enrollment criteria. Therapy with umbilical cord blood cells (UCBC) has come forward as a strong candidate for the treatment of neonatal HIE, but no preclinical studies have yet compared the action of UCBC combined with hypothermia (HT) with the action of each therapy by itself. Thus, to evaluate the potential of each therapeutic approach, a hypoxic-ischemic brain lesion was induced in postnatal day ten rat pups; two hours later, HT was applied for 4 h; and 24, 48, and 72 h post-injury, UCBC were administered intravenously. The neonatal hypoxic-ischemic injury led to a brain lesion involving about 48% of the left hemisphere that was not improved by HT (36%) or UCBC alone (28%), but only with the combined therapies (25%; p = 0.0294). Moreover, a decrease in glial reactivity and improved functional outcomes were observed in both groups treated with UCBC. Overall, these results support UCBC as a successful therapeutic approach for HIE, even when treatment with therapeutic hypothermia is not possible.

Stem Cell Therapy for Neonatal Hypoxic-Ischemic Encephalopathy: A Systematic Review of Preclinical Studies.

Neonatal hypoxic-ischemic encephalopathy (HIE) is an important cause of mortality and morbidity in the perinatal period. This condition results from a period of ischemia and hypoxia to the brain of neonates, leading to several disorders that profoundly affect the daily life of patients and their families. Currently, therapeutic hypothermia (TH) is the standard of care in developing countries; however, TH is not always effective, especially in severe cases of HIE. Addressing this concern, several preclinical studies assessed the potential of stem cell therapy (SCT) for HIE. With this systematic review, we gathered information included in 58 preclinical studies from the last decade, focusing on the ones using stem cells isolated from the umbilical cord blood, umbilical cord tissue, placenta, and bone marrow. Outstandingly, about 80% of these studies reported a significant improvement of cognitive and/or sensorimotor function, as well as decreased brain damage. These results show the potential of SCT for HIE and the possibility of this therapy, in combination with TH, becoming the next therapeutic approach for HIE. Nonetheless, few preclinical studies assessed the combination of TH and SCT for HIE, and the existent studies show some contradictory results, revealing the need to further explore this line of research.

Gastos públicos em serviços ambulatoriais de Fonoaudiologia no Brasil entre 2009 e 2018: bases de dados do DATASUS / Public spending on outpatient speech therapy services in Brazil between 2009 and 2018: DATASUS databases

RESUMO Objetivo Analisar os gastos públicos em saúde destinados aos serviços ambulatoriais em Fonoaudiologia nas cinco Regiões Federativas do Brasil. Métodos Trata-se de um estudo ecológico realizado por meio da busca de dados secundários disponíveis em uma plataforma virtual de domínio público, DATASUS (Departamento de Informática do Sistema Único de Saúde). Os dados coletados referiram-se aos valores aprovados para os procedimentos da Fonoaudiologia no período de 2009 a 2018 nas cinco Regiões Federativas. Adotou-se análise descritiva dos dados e exposição dos resultados em valores absolutos, relativos e taxas de crescimento. Resultados Verificou-se que o investimento médio em reais (R$), por ano, nos serviços de Fonoaudiologia no Brasil foi de, aproximadamente, R$ 223.952.639.232,00; sendo 47,2% dos recursos destinados à Região Sudeste. Dentre as grandes áreas de especialização, a Audiologia foi responsável por 95,4% do investimento, seguida pelas áreas da Linguagem (4,0%), Motricidade Orofacial (0,5%) e Voz (0,1%). Conclusão Os serviços fonoaudiológicos demandam considerável parcela dos recursos públicos, sendo a área da Audiologia responsável por quase metade desses gastos, seguida pelas grandes áreas da Linguagem, Motricidade Orofacial e Voz.

ABSTRACT Purpose To analyze public spending on health services to outpatient services in Speech Therapy in the five federative regions of Brazil. Methods This is an ecological study carried out through the search for secondary data available on a public domain virtual platform, DATASUS. The collected data refer to the values ​​approved for the Speech Therapy procedures in the period from 2009 to 2018 in the five federative regions. Descriptive analysis of data and exposure of results in absolute and relative values ​​and growth rates were adopted. Results It was found that the average investment in reais, per year, in speech therapy services in Brazil was approximately R$ 223,952,639,232.00, with 47.2% of the resources destined for the Southeast region. Among the major areas of specialization, Audiology accounted for 95.4% of the investment, followed by Language (4.0%), Orofacial Motricity (0.5%) and Voice (0.1%). Conclusion The findings indicate that speech therapy services demand a considerable portion of public resources, with the area of ​​Audiology being responsible for almost half of these expenses, followed by the large area of ​​Language, Orofacial Motricity and Voice.

Development of RT-qPCR and semi-nested RT-PCR assays for molecular diagnosis of hantavirus pulmonary syndrome.

Hantavirus Pulmonary Syndrome is an, often fatal, emerging zoonotic disease in the Americas caused by hantaviruses (family: Hantaviridae). In Brazil, hantavirus routine diagnosis is based on serology (IgM-ELISA) while RT-PCR is often used to confirm acute infection. A Semi-nested RT-PCR and an internally controlled RT-qPCR assays were developed for detection and quantification of four hantaviruses strains circulating in the Brazilian Amazon: Anajatuba (ANAJV) and Castelo dos Sonhos (CASV) strains of Andes virus (ANDV) species; and Rio Mamoré (RIOMV) and Laguna Negra (LNV) strains of LNV species. A consensus region in the N gene of these hantaviruses was used to design the primer sets and a hydrolysis probe. In vitro transcribed RNA was diluted in standards with known concentration. MS2 bacteriophage RNA was detected together with hantavirus RNA as an exogenous control in a duplex reaction. RT-qPCR efficiency was around 100% and the limit of detection was 0.9 copies/µL of RNA for RT-qPCR and 10 copies/µL of RNA for Semi-nested RT-PCR. There was no amplification of either negative samples or samples positive to other pathogens. To assess the protocol for clinical sensitivity, specificity and general accuracy values, both assays were used to test two groups of samples: one comprising patients with disease (n = 50) and other containing samples from healthy individuals (n = 50), according to IgM-ELISA results. A third group of samples (n = 27) infected with other pathogens were tested for specificity analysis. RT-qPCR was more sensitive than semi-nested RT-PCR, being able to detect three samples undetected by conventional RT-PCR. RT-qPCR clinical sensitivity, specificity and general accuracy values were 92.5%, 100% and 97.63%, respectively. Thus, the assays developed in this study were able to detect the four Brazilian Amazon hantaviruses with good specificity and sensitivity, and may become powerful tools in diagnostic, surveillance and research applications of these and possibly other hantaviruses.

A telessaúde como estratégia de resposta do Estado: revisão sistemática

[RESUMO]. Objetivo. Identificar ações de telessaúde descritas na literatura como estratégias de políticas nacionais de saúde. Métodos. Foi realizado um estudo de revisão sistemática da produção científica sobre utilização da telessaúde como estratégia de resposta do Estado a problemas ou necessidades de saúde da população, utilizando-se as bases de dados Biblioteca Virtual em Saúde (BVS), PubMed e Google Acadêmico. Os termos utilizados na busca foram “telessaude politicas”, “implantacao telessaude”, “telehealth policy”, “telehealth America”, “telehealth Asia”, “telehealth Antartida”, “telehealth Europe”, “telehealth Africa”, “telehealth Oceania”. A coleta de dados foi feita no período de março de 2016 a fevereiro de 2017. Resultados. Foram analisados 21 artigos em português, espanhol e inglês sobre telessaúde em distintos países. Não houve concentração expressiva de artigos por local ou região. O maior número de publicações ocorreu de 2014 a 2017. A telessaúde tem sido implementada especialmente para diminuir custos na saúde, educação permanente de profissionais de saúde, interconsulta, fortalecimento da atenção primária à saúde e melhoria do acesso à saúde em áreas remotas. Conclusões. A telessaúde é utilizada como política pública na Europa, Américas, Ásia e África, existindo, no entanto, variações em relação ao estágio de implantação. As principais diferenças quanto à telessaúde nos distintos países foram de infraestrutura, financiamento, engajamento de pacientes e cuidadores e posicionamento do Estado frente ao papel da telessaúde.

[ABSTRACT]. Objective. To identify telehealth initiatives described in the literature as a strategy for national health policies. Method. A systematic review was performed to identify articles focusing on the use of telehealth as a state response strategy to health problems or needs. The Virtual Health Library, PubMed, and Google Scholar were searched using the following keywords: “telessaude politicas”, “implantacao telessaude”, “telehealth policy”, “telehealth America”, “telehealth Asia”, “telehealth Antartida”, “telehealth Europe”, “telehealth Africa”, “telehealth Oceania”. Data collection was performed from March 2016 to February 2017. Results. Twenty-one articles describing telehealth initiatives in various countries, published in Portuguese, Spanish, and English, were analyzed. Concentration of studies on specific areas or regions was not detected. Most articles were published from 2014 to 2017. Telehealth initiatives have been used mainly to decrease health costs, for continued education of health care professionals, consultations between health care professionals, to strengthen primary health care, and to improve the access to health care in remote areas. Conclusions. Telehealth is used as state policy across the five continents, with variations in the degree of implementation. The main differences in telehealth among countries refer to infrastructure, financing, engagement of patients and caretakers, and position of the state regarding the role of telehealth.

[RESUMEN]. Objetivo. Determinar las acciones de telesalud descritas en las publicaciones pertinentes como estrategia en materia de políticas nacionales de salud. Método. Se realizó un estudio de revisión sistemática de la producción científica sobre la utilización de la telesalud como estrategia de respuesta del Estado a los problemas o a las necesidades de salud de la población, en el cual se emplearon las bases de datos de la Biblioteca Virtual de Salud (BVS), PubMed y Google Académico. Los términos utilizados en la búsqueda fueron “telesalud política”, “implantación telesalud”, “telehealth policy”, “telehealth America”, “telehealth Asia”, “telehealth Antarctica”, “telehealth Europe”, “telehealth Africa” y “telehealth Oceania”. Los datos se recopilaron entre marzo del 2016 y febrero del 2017. Resultados. Se analizaron 21 artículos en español, inglés y portugués sobre telesalud en distintos países. No hubo ninguna concentración importante de artículos por lugar ni región. El mayor número de publicaciones se registró entre el 2014 y el 2017. La estrategia de telesalud se ha puesto en práctica para reducir los costos de la atención de salud, fomentar la educación permanente de los profesionales de salud y facilitar las consultas entre ellos, fortalecer la atención primaria de salud y ampliar el acceso a los servicios de salud en las zonas remotas. Conclusiones. La estrategia de telesalud se utiliza como política pública en África, América, Asia y Europa, pero existen variaciones con respecto a la fase de implantación. Las principales diferencias en materia de telesalud observadas en los distintos países correspondieron a infraestructura, financiamiento, compromiso de los enfermos y prestadores de cuidado, y postura del Estado frente al papel de la telesalud.

STROKE34 Study Protocol: A Randomized Controlled Phase IIa Trial of Intra-Arterial CD34+ Cells in Acute Ischemic Stroke.

RATIONALE/AIM: Despite the increasing efficacy of recanalization therapies for acute ischemic stroke, a large number of patients are left with long-term functional impairment, devoid of efficacious treatments. CD34+ cells comprise a subset of bone marrow-derived mononuclear cells with the capacity to promote angiogenesis in ischemic lesions and have shown promising results in observational and in vitro studies. In this study, we aim to assess the efficacy of an autotransplant of CD34+ cells in acute ischemic stroke. SAMPLE SIZE ESTIMATES: 30 patients will be randomized for a power of 90% and alpha of 0.05 to detect a difference in 3 months infarct volume. METHODS AND DESIGN: We will screen 18-80 years old patients with acute ischemic stroke due to occlusion of a middle cerebral artery (MCA) for randomization. Persistent arterial occlusions, contra-indications to magnetic resonance imaging (MRI), premorbid dependency, or other severe diseases will be excluded. Treatment will involve bone marrow aspiration, selection of CD34+ cells, and their administration intra-arterially in the symptomatic MCA by angiography. Patients will be randomized for treatment at 7 (±2) days, 20 (±5 days) or sham procedure, 10 in each group. STUDY OUTCOMES: The primary outcome will be infarct volume in MRI performed at 3 months. Secondary outcomes will include adverse events and multidimensional functional and neurological measures. DISCUSSION/CONCLUSION: STROKE34 is a PROBE design phase IIa clinical trial to assess the efficacy of intra-arterial administration of CD34+ cells 7 and 20 days after acute ischemic stroke. TRIAL REGISTRATION EU CLINICAL TRIALS REGISTER: 2017-002456-88.

[Telehealth as state response strategy: systematic reviewLa telesalud como estrategia de respuesta del Estado: revisión sistemática]. / A telessaúde como estratégia de resposta do Estado: revisão sistemática.

OBJECTIVE: To identify telehealth initiatives described in the literature as a strategy for national health policies. METHOD: A systematic review was performed to identify articles focusing on the use of telehealth as a state response strategy to health problems or needs. The Virtual Health Library, PubMed, and Google Scholar were searched using the following keywords: "telessaude politicas", "implantacao telessaude", "telehealth policy", "telehealth America", "telehealth Asia", "telehealth Antartida", "telehealth Europe", "telehealth Africa", "telehealth Oceania". Data collection was performed from March 2016 to February 2017. RESULTS: Twenty-one articles describing telehealth initiatives in various countries, published in Portuguese, Spanish, and English, were analyzed. Concentration of studies on specific areas or regions was not detected. Most articles were published from 2014 to 2017. Telehealth initiatives have been used mainly to decrease health costs, for continued education of health care professionals, consultations between health care professionals, to strengthen primary health care, and to improve the access to health care in remote areas. CONCLUSIONS: Telehealth is used as state policy across the five continents, with variations in the degree of implementation. The main differences in telehealth among countries refer to infrastructure, financing, engagement of patients and caretakers, and position of the state regarding the role of telehealth.

OBJETIVO: Determinar las acciones de telesalud descritas en las publicaciones pertinentes como estrategia en materia de políticas nacionales de salud. MÉTODO: Se realizó un estudio de revisión sistemática de la producción científica sobre la utilización de la telesalud como estrategia de respuesta del Estado a los problemas o a las necesidades de salud de la población, en el cual se emplearon las bases de datos de la Biblioteca Virtual de Salud (BVS), PubMed y Google Académico. Los términos utilizados en la búsqueda fueron "telesalud política", "implantación telesalud", "telehealth policy", "telehealth America", "telehealth Asia", "telehealth Antarctica", "telehealth Europe", "telehealth Africa" y "telehealth Oceania". Los datos se recopilaron entre marzo del 2016 y febrero del 2017. RESULTADOS: Se analizaron 21 artículos en español, inglés y portugués sobre telesalud en distintos países. No hubo ninguna concentración importante de artículos por lugar ni región. El mayor número de publicaciones se registró entre el 2014 y el 2017. La estrategia de telesalud se ha puesto en práctica para reducir los costos de la atención de salud, fomentar la educación permanente de los profesionales de salud y facilitar las consultas entre ellos, fortalecer la atención primaria de salud y ampliar el acceso a los servicios de salud en las zonas remotas. CONCLUSIONES: La estrategia de telesalud se utiliza como política pública en África, América, Asia y Europa, pero existen variaciones con respecto a la fase de implantación. Las principales diferencias en materia de telesalud observadas en los distintos países correspondieron a infraestructura, financiamiento, compromiso de los enfermos y prestadores de cuidado, y postura del Estado frente al papel de la telesalud.

A telessaúde como estratégia de resposta do Estado: revisão sistemática / Telehealth as state response strategy: systematic review / La telesalud como estrategia de respuesta del Estado: revisión sistemática

RESUMO Objetivo. Identificar ações de telessaúde descritas na literatura como estratégias de políticas nacionais de saúde. Métodos. Foi realizado um estudo de revisão sistemática da produção científica sobre utilização da telessaúde como estratégia de resposta do Estado a problemas ou necessidades de saúde da população, utilizando-se as bases de dados Biblioteca Virtual em Saúde (BVS), PubMed e Google Acadêmico. Os termos utilizados na busca foram "telessaude politicas", "implantacao telessaude", "telehealth policy", "telehealth America", "telehealth Asia", "telehealth Antartida", "telehealth Europe", "telehealth Africa", "telehealth Oceania". A coleta de dados foi feita no período de março de 2016 a fevereiro de 2017. Resultados. Foram analisados 21 artigos em português, espanhol e inglês sobre telessaúde em distintos países. Não houve concentração expressiva de artigos por local ou região. O maior número de publicações ocorreu de 2014 a 2017. A telessaúde tem sido implementada especialmente para diminuir custos na saúde, educação permanente de profissionais de saúde, interconsulta, fortalecimento da atenção primária à saúde e melhoria do acesso à saúde em áreas remotas. Conclusões. A telessaúde é utilizada como política pública na Europa, Américas, Ásia e África, existindo, no entanto, variações em relação ao estágio de implantação. As principais diferenças quanto à telessaúde nos distintos países foram de infraestrutura, financiamento, engajamento de pacientes e cuidadores e posicionamento do Estado frente ao papel da telessaúde.

ABSTRACT Objective. To identify telehealth initiatives described in the literature as a strategy for national health policies. Method. A systematic review was performed to identify articles focusing on the use of telehealth as a state response strategy to health problems or needs. The Virtual Health Library, PubMed, and Google Scholar were searched using the following keywords: "telessaude politicas", "implantacao telessaude", "telehealth policy", "telehealth America", "telehealth Asia", "telehealth Antartida", "telehealth Europe", "telehealth Africa", "telehealth Oceania". Data collection was performed from March 2016 to February 2017. Results. Twenty-one articles describing telehealth initiatives in various countries, published in Portuguese, Spanish, and English, were analyzed. Concentration of studies on specific areas or regions was not detected. Most articles were published from 2014 to 2017. Telehealth initiatives have been used mainly to decrease health costs, for continued education of health care professionals, consultations between health care professionals, to strengthen primary health care, and to improve the access to health care in remote areas. Conclusions. Telehealth is used as state policy across the five continents, with variations in the degree of implementation. The main differences in telehealth among countries refer to infrastructure, financing, engagement of patients and caretakers, and position of the state regarding the role of telehealth.

RESUMEN Objetivo. Determinar las acciones de telesalud descritas en las publicaciones pertinentes como estrategia en materia de políticas nacionales de salud. Método. Se realizó un estudio de revisión sistemática de la producción científica sobre la utilización de la telesalud como estrategia de respuesta del Estado a los problemas o a las necesidades de salud de la población, en el cual se emplearon las bases de datos de la Biblioteca Virtual de Salud (BVS), PubMed y Google Académico. Los términos utilizados en la búsqueda fueron "telesalud política", "implantación telesalud", "telehealth policy", "telehealth America", "telehealth Asia", "telehealth Antarctica", "telehealth Europe", "telehealth Africa" y "telehealth Oceania". Los datos se recopilaron entre marzo del 2016 y febrero del 2017. Resultados. Se analizaron 21 artículos en español, inglés y portugués sobre telesalud en distintos países. No hubo ninguna concentración importante de artículos por lugar ni región. El mayor número de publicaciones se registró entre el 2014 y el 2017. La estrategia de telesalud se ha puesto en práctica para reducir los costos de la atención de salud, fomentar la educación permanente de los profesionales de salud y facilitar las consultas entre ellos, fortalecer la atención primaria de salud y ampliar el acceso a los servicios de salud en las zonas remotas. Conclusiones. La estrategia de telesalud se utiliza como política pública en África, América, Asia y Europa, pero existen variaciones con respecto a la fase de implantación. Las principales diferencias en materia de telesalud observadas en los distintos países correspondieron a infraestructura, financiamiento, compromiso de los enfermos y prestadores de cuidado, y postura del Estado frente al papel de la telesalud.

Nasal closure for the treatment of epistaxis secondary to hereditary hemorrhagic telangiectasia / Cierre nasal para el tratamiento de la epistaxis secundaria a Telangiectasia Hemorrágica Hereditaria

Hereditary hemorrhagic telangiectasia (HHT), also known by the eponym Osler-Weber-Rendu syndrome, is an autosomal dominant disorder characterised by the presence of multiple arteriovenous malformations (AVMs) affecting multiple organs. Many procedures have been used for epistaxis control in patients with this disorder. The objective of this study was to report the treatment of severe HHT-related epistaxis with the modified Young’s procedure. Materials and methods: We describe the treatment of 4 patients with severe blood-transfusion dependent epistaxis who underwent a modified Young’s procedure in a tertiary hospital. The nasal closure was bilateral and complete in all cases. All patients were followed for 12 months or longer. Results: The procedure was well tolerated and complete cessation of bleeding was achieved in all the patients. Conclusion: Young’s technique is a safe surgical procedure, well tolerated by patients with severe epistaxis and HHT (AU)

La telangiectasia hemorrágica hereditaria (HHT), también conocida por el epónimo síndrome de Osler-Weber-Rendu es un trastorno autosómico dominante caracterizado por la presencia de malformaciones arteriovenosas (MAV) que afectan a múltiplos órganos y sistemas. Un gran número de procedimientos fue utilizado para el control de epistaxis en estos pacientes. El objetivo de este estudio fue reportar el tratamiento de las epistaxis severas relacionadas con HHT con procedimiento de Young modificado. Materiales y métodos: Describimos cuatro pacientes con epistaxis severa, dependientes de transfusiones de sangre, que se sometieron a un procedimiento de Young modificado en un hospital de tercer nivel. El cierre nasal fue bilateral y completo en todos los casos. Se observaron todos los pacientes durante 12 meses o más. Resultados: El procedimiento fue bien tolerado y se logró el cese completo de las hemorragias en todos los pacientes. Conclusión: La cirugía de Young es un procedimiento seguro y bien tolerado por los pacientes con epistaxis severa y HHT (AU)

Nasal closure for the treatment of epistaxis secondary to hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT), also known by the eponym Osler-Weber-Rendu syndrome, is an autosomal dominant disorder characterised by the presence of multiple arteriovenous malformations (AVMs) affecting multiple organs. Many procedures have been used for epistaxis control in patients with this disorder. The objective of this study was to report the treatment of severe HHT-related epistaxiswith the modified Young's procedure. MATERIALS AND METHODS: We describe the treatment of 4 patients with severe blood-transfusion-dependent epistaxis who underwent a modified Young's procedure in a tertiary hospital. The nasal closure was bilateral and complete in all cases. All patients were followed for 12 months or longer. RESULTS: The procedure was well tolerated and complete cessation of bleeding was achieved in all the patients. CONCLUSION: Young's technique is a safe surgical procedure, well tolerated by patients with severe epistaxis and HHT.

Multicenter survey on the use of device-assisted enteroscopy in Portugal.

BACKGROUND: Device-assisted enteroscopies (DAEs) are recent endoscopic techniques that enable direct endoscopic small-bowel evaluation. OBJECTIVE: The objective of this article is to evaluate the implementation of DAEs in Portugal and assess the main indications, diagnoses, diagnostic yield, therapeutic yield and complication rate. METHODS: We conducted a multicenter retrospective series using a national Web-based survey on behalf of the Portuguese Small-Bowel Study Group. Participants were asked to fill out two online databases regarding procedural data, indications, diagnoses, endoscopic therapy and complications using prospectively collected institutional data records. RESULTS: A total of eight centers were enrolled in the survey, corresponding to 1411 DAEs. The most frequent indications were obscure gastrointestinal bleeding (OGIB), inflammatory bowel disease and small-bowel tumors. The pooled diagnostic yield was 63%. A relation between the diagnostic yield and the indications was clear, with a diagnostic yield for OGIB of 69% (p = 0.02) with a 52% therapeutic yield. Complications occurred in 1.2%, with a major complication rate of 0.57%. Perforations occurred in four patients (0.28%). CONCLUSION: DAEs are safe and effective procedures, with complication rates of 1.2%, the most serious of which is perforation. Most procedures are performed in the setting of OGIB. Diagnostic and therapeutic yields are dependent on the indication, hence appropriate patient selection is crucial.

Sweet's syndrome complicating ulcerative colitis: a rare association.

Sweet's syndrome (SS) is a neutrophilic dermatosis disorder of unknown aetiology, characterised by acute fever, neutrophilia, painful erythematous papules, nodules and plaques, and an infiltrate consisting predominantly of mature neutrophils in the upper dermis. Classical SS is a rare extra-intestinal manifestation of inflammatory bowel disease (IBD). It is more common in Crohn's disease than in ulcerative colitis (UC). There is a predilection for women, and for patients with colonic disease and active IBD. We report the case of a 39-year-old woman with a flare of moderate severity UC treated with mesalazine who presented with a 5-day history of acute fever, painful papules and plaques on forearms and legs, episcleritis and cervical pain. Skin biopsies showed papillary dermis inflammatory cell infiltration composed mainly of neutrophils, without evidence of leukocytoclastic vasculitis or panniculitis, compatible with SS. The patient had an excellent response to systemic corticosteroids. Symptoms promptly improved and skin lesions resolved after 7 weeks.

Lysophosphatidic acid enhances survival of human CD34(+) cells in ischemic conditions.

Several clinical trials are exploring therapeutic effect of human CD34(+) cells in ischemic diseases, including myocardial infarction. Unfortunately, most of the cells die few days after delivery. Herein we show that lysophosphatidic acid (LPA)-treated human umbilical cord blood-derived CD34(+) cells cultured under hypoxic and serum-deprived conditions present 2.2-fold and 1.3-fold higher survival relatively to non-treated cells and prostaglandin E2-treated cells, respectively. The pro-survival effect of LPA is concentration- and time-dependent and it is mediated by the activation of peroxisome proliferator-activator receptor γ (PPARγ) and downstream, by the activation of pro-survival ERK and Akt signaling pathways and the inhibition of mitochondrial apoptotic pathway. In hypoxia and serum-deprived culture conditions, LPA induces CD34(+) cell proliferation without maintaining the their undifferentiating state, and enhances IL-8, IL-6 and G-CSF secretion during the first 12 h compared to non-treated cells. LPA-treated CD34(+) cells delivered in fibrin gels have enhanced survival and improved cardiac fractional shortening at 2 weeks on rat infarcted hearts as compared to hearts treated with placebo. We have developed a new platform to enhance the survival of CD34(+) cells using a natural and cost-effective ligand and demonstrated its utility in the preservation of the functionality of the heart after infarction.

Home-literacy e os precursores da alfabetização / Home literacy and precursors literacy acquisition / Home-literacy y los precursores de la alfabetización

A literatura PSI mostra que precursores cognitivos da leitura e escrita, com destaque para a consciência fonológica e o conhecimento do nome das letras, podem ser desenvolvidos junto à criança, no contexto familiar, antes do início da educação formal. Esses precursores estão associados ao desempenho positivo na leitura e escrita, bem como na escolarização inicial. A presente pesquisa teve como objetivo investigar algumas práticas cotidianas familiares realizadas com as crianças relacionadas com o aprendizado da leitura, em duas classes sociais distintas. Foram aplicados questionários de práticas cotidianas nos pais e testes de consciência fonológica, conhecimento do nome das letras e aquisição de vocabulário receptivo nas crianças. As crianças tinham entre 5 e 6 anos e suas famílias eram oriundas de escolas da rede pública e privada dos municípios de Niterói e São Gonçalo, Rio de Janeiro (RJ), totalizando 80 famílias, sendo 40 de escolas particulares e 40 de escolas públicas. Os resultados das correlações de Spearman para relacionar o estímulo parental com o desenvolvimento dos precursores da leitura e escrita e testes de Mann-Whitney para comparar os escores de desempenho das variáveis dependentes para as duas classes sociais estudadas demonstraram que o estímulo ao desenvolvimento dos preditores da leitura e escrita contribuíram de forma significativa para o desempenho das crianças. As crianças das escolas particulares tiveram escores mais altos do que das escolas públicas. A relevância para a formulação de políticas educacionais que incentivem a exploração dos precursores da leitura e escrita enquanto facilitadores do desenvolvimento da linguagem das crianças antes da alfabetização são discutidas.

The literature review shows that cognitive precursors of reading and writing, with emphasis on phonological awareness letters name knowledge can be developed by the children in family context, before the beginning of formal education, with positive effects on reading and writing performance as well as beginning formal schooling. This paper describes some everyday practices of parents and child, especially related to reading, in two distinct social classes, and its relationship to children's performance at precursors of reading at the last year from kindergarten. The parents answered a familiar everyday practices questionnaire; the children that were 5 and 6 years old and took tests of phonological awareness, letter name knowledge and receptive vocabulary acquisition. These activities were carried out in four schools, two state schools and two private schools in Niterói and São Gonçalo, Rio de Janeiro, with 80 families, 40 of them from private schools and 40 from public schools. For the data analysis nonparametric Spearman correlation related parental encouragement to the development of precursors of reading and writing and the Mann-Whitney tests showed that stimulating the development of predictors of reading and writing contributed significantly to children´s performance. Children in private schools had better performance than those in state schools. The relevance of this study is based on the importance of research on the environment in which initial learning takes place, to encourage parents activities and to help formulating social and educational policies to explore the precursors of reading and writing.

La literatura existente sobre el tema muestra que los precursores cognitivos de la lectura y la escritura, con destaque en la conciencia fonológica y el conocimiento del nombre de las letras, pueden ser desarrollados con los niños dentro de un contexto familiar, antes del inicio de su educación formal. Estos precursores están asociados al desempeño positivo en la lectura y la escritura, así como a la escolarización inicial. El objetivo de este estudio es el de investigar las prácticas familiares cotidianas llevadas a cabo en dos clases sociales diferentes con los niños en relación al aprendizaje de la lectura. 1. A los padres se aplicaron cuestionarios sobre prácticas cotidianas, y a los niños pruebas de conciencia fonológica, conocimiento del nombre de letras y adquisición de vocabulario. Los niños, de 5 y 6 años y sus familias provienen de la red pública y privada de los municipios de Niterói y São Gonçalo, en Rio de Janeiro, y totalizan 80 familias, 40 de escuelas privadas y 40 de públicas. Los resultados de las correlaciones de Spearman para relacionar el estímulo paternal con el desarrollo de los precursores de la lectura y escritura, además de pruebas Mann-Whitney para comparar las puntuaciones de desempeño de las variables dependientes para las dos clases sociales estudiadas demuestran que el estímulo al desarrollo de los predictores de la lectura y escritura contribuyen significativamente hacia el desempeño de los niños. Los niños en las escuelas privadas tuvieron mejor desempeño que en las escuelas estatales. La relevancia a la hora de formular políticas socioeducativas que incentiven el aprovechamiento de los precursores de la lectura y la escritura como facilitadores del desarrollo de la lengua entre los niños durante la etapa previa a la alfabetización es un asunto que está en discusión.

Home-literacy e os precursores da alfabetização / Home literacy and precursors literacy acquisition / Home-literacy y los precursores de la alfabetización

A literatura PSI mostra que precursores cognitivos da leitura e escrita, com destaque para a consciência fonológica e o conhecimento do nome das letras, podem ser desenvolvidos junto à criança, no contexto familiar, antes do início da educação formal. Esses precursores estão associados ao desempenho positivo na leitura e escrita, bem como na escolarização inicial. A presente pesquisa teve como objetivo investigar algumas práticas cotidianas familiares realizadas com as crianças relacionadas com o aprendizado da leitura, em duas classes sociais distintas. Foram aplicados questionários de práticas cotidianas nos pais e testes de consciência fonológica, conhecimento do nome das letras e aquisição de vocabulário receptivo nas crianças. As crianças tinham entre 5 e 6 anos e suas famílias eram oriundas de escolas da rede pública e privada dos municípios de Niterói e São Gonçalo, Rio de Janeiro (RJ), totalizando 80 famílias, sendo 40 de escolas particulares e 40 de escolas públicas. Os resultados das correlações de Spearman para relacionar o estímulo parental com o desenvolvimento dos precursores da leitura e escrita e testes de Mann-Whitney para comparar os escores de desempenho das variáveis dependentes para as duas classes sociais estudadas demonstraram que o estímulo ao desenvolvimento dos preditores da leitura e escrita contribuíram de forma significativa para o desempenho das crianças. As crianças das escolas particulares tiveram escores mais altos do que das escolas públicas. A relevância para a formulação de políticas educacionais que incentivem a exploração dos precursores da leitura e escrita enquanto facilitadores do desenvolvimento da linguagem das crianças antes da alfabetização são discutidas. (AU)

The literature review shows that cognitive precursors of reading and writing, with emphasis on phonological awareness letters name knowledge can be developed by the children in family context, before the beginning of formal education, with positive effects on reading and writing performance as well as beginning formal schooling. This paper describes some everyday practices of parents and child, especially related to reading, in two distinct social classes, and its relationship to children's performance at precursors of reading at the last year from kindergarten. The parents answered a familiar everyday practices questionnaire; the children that were 5 and 6 years old and took tests of phonological awareness, letter name knowledge and receptive vocabulary acquisition. These activities were carried out in four schools, two state schools and two private schools in Niterói and São Gonçalo, Rio de Janeiro, with 80 families, 40 of them from private schools and 40 from public schools. For the data analysis nonparametric Spearman correlation related parental encouragement to the development of precursors of reading and writing and the Mann-Whitney tests showed that stimulating the development of predictors of reading and writing contributed significantly to children´s performance. Children in private schools had better performance than those in state schools. The relevance of this study is based on the importance of research on the environment in which initial learning takes place, to encourage parents activities and to help formulating social and educational policies to explore the precursors of reading and writing. (AU)

La literatura existente sobre el tema muestra que los precursores cognitivos de la lectura y la escritura, con destaque en la conciencia fonológica y el conocimiento del nombre de las letras, pueden ser desarrollados con los niños dentro de un contexto familiar, antes del inicio de su educación formal. Estos precursores están asociados al desempeño positivo en la lectura y la escritura, así como a la escolarización inicial. El objetivo de este estudio es el de investigar las prácticas familiares cotidianas llevadas a cabo en dos clases sociales diferentes con los niños en relación al aprendizaje de la lectura. 1. A los padres se aplicaron cuestionarios sobre prácticas cotidianas, y a los niños pruebas de conciencia fonológica, conocimiento del nombre de letras y adquisición de vocabulario. Los niños, de 5 y 6 años y sus familias provienen de la red pública y privada de los municipios de Niterói y São Gonçalo, en Rio de Janeiro, y totalizan 80 familias, 40 de escuelas privadas y 40 de públicas. Los resultados de las correlaciones de Spearman para relacionar el estímulo paternal con el desarrollo de los precursores de la lectura y escritura, además de pruebas Mann-Whitney para comparar las puntuaciones de desempeño de las variables dependientes para las dos clases sociales estudiadas demuestran que el estímulo al desarrollo de los predictores de la lectura y escritura contribuyen significativamente hacia el desempeño de los niños. Los niños en las escuelas privadas tuvieron mejor desempeño que en las escuelas estatales. La relevancia a la hora de formular políticas socioeducativas que incentiven el aprovechamiento de los precursores de la lectura y la escritura como facilitadores del desarrollo de la lengua entre los niños durante la etapa previa a la alfabetización es un asunto que está en discusión. (AU)

Identificação das principais alterações fonoaudiológicas em um grupo de crianças da região metropolitana de Salvador/Bahia: relato dos pais e/ou cuidadores / Identificación de los principales cambios en la terapia del habla a un grupo de niños de la región metropolitana de Salvador / Bahia: reportado por los padres y/o cuidadores / Identification of the major changes in speech therapy a group of children in the metropolitan region of Salvador / Bahia: reported by parents and/or caregivers

Objetivo: Identificar as principais alterações nas áreas da Fonoaudiologia por meio do relato de pais e/ou cuidadores de um grupo de crianças de ambos os gêneros, com faixa etária de quatro anos e um mês até cinco anos e onze meses, das cidades de Salvador, Lauro de Freitas e Camaçari. Métodos: Aplicou-se um questionário em 335 responsáveis de crianças cadastradas no Programa de Saúde da Família das Unidades de Saúde da Família selecionadas para a pesquisa. O questionário da entrevista abordou questões acerca da saúde fonoaudiológica nas áreas da linguagem, voz, audição e motricidade orofacial. Resultados: em Salvador, a maior prevalência de desordens fonoaudiológicas, segundo relato dos pais e/ou cuidadores, ocorreu na área de motricidade orofacial, com 34 (48,57%) de ocorrências. Na cidade Lauro de Freitas, a maior prevalência ocorreu na área da linguagem, com 70 (80%) ocorrências. E em Camaçari, a maior prevalência ocorreu na área da voz, com 161 (95,26%) ocorrências. Conclusões: observou-se que grande parte dos pais e/ou cuidadores referiram que as crianças participantes possuíam desordem fonoaudiológica em, pelo menos, uma das áreas pesquisadas. Um diagnóstico precoce faz-se indispensável, visto que possibilita à criança maior oportunidade de ter um desenvolvimento adequado e mais qualidade de vida.

Objetivo: Identificar los cambios importantes en las áreas de terapia del habla a través del informe de los padres y/o cuidadores de un grupo de niños de ambos sexos, con edades comprendidas entre cuatro años y un mes hasta cinco años y once meses, en las ciudades Salvador, Lauro de Freitas y Camaçari. Métodos: Se aplicó un cuestionario a 335 tutores de los niños inscritos en el Programa de Unidades de Salud Familiar seleccionadas para la encuesta de salud de la familia. El cuestionario de la entrevista se dirigió a las preguntas acerca de la salud en el área del lenguaje y habla, de la voz, del oído y motricidad orofacial. Resultados: En Salvador, la más alta prevalencia de los trastornos del habla y lenguaje, según lo informado por los padres y/o cuidadores se produjo en la zona de motricidad orofacial, con 34 (48,57%) ocurrencias. En la ciudad Lauro de Freitas, la prevalencia más alta se produjo en el área del lenguaje, con 70 (80%) casos. Y en Camaçari, la prevalencia más alta se produjo en el área de la voz, con 161 (95.26%) ocurrencias. Conclusiones: se observó que la mayoría de los padres/cuidadores informaron que los niños participantes tenían trastorno del habla en, al menos, una de las áreas investigadas. Un diagnóstico precoz es esencial, ya que permite al niño más oportunidad de tener un buen desarrollo y una mejor calidad de vida.

Purpose: To identify major changes in the areas of speech therapy through the report of parents and/or caregivers of a group of children of both genders, in an age bracket from four years and one month to five years and eleven months in the cities of Salvador, Lauro de Freitas and Camaçari. Methods: We applied a questionnaire in 335 caregivers enrolled in the Family Health Program of Family Health Units selected for the survey. The interview questionnaire addressed questions about the health in the areas of speech language, voice, hearing and orofacial motricity. Results: In Salvador, the highest prevalence of speech-language disorders, as reported by parents and/or caregivers, occurred in the area of speech disorders, with 34 (48.57%) cases. Lauro de Freitas presented the highest prevalence occurred in the area of language, with 70 (80%) instances. And in Camaçari the highest prevalence occurred in the area of voice, with 161 (95.26%) occurrences. Conclusion: We observed that the majority of parents/caregivers reported that the participating children had speech disorders in at least one of the areas surveyed. An early diagnosis is essential, as it enables the child to be granted more opportunity to have a proper development and a better quality of life.