Development of a water-in-oil-in-water multiple emulsion system integrating biomimetic aqueous-core lipid nanodroplets for protein entity stabilization. Part II: process and product characterization.

The aqueous-core enclosed in lipid nanoballoons integrating multiple emulsions of the type water-in-oil-in-water mimic, at least in theory, the environment within viable cells, thus being suitable for housing hydrophilic protein entities such as bioactive proteins, peptides and bacteriophage particles. This study reports a complete physicochemical characterization of optimized biomimetic aqueous-core lipid nanoballoons housing hydrophilic (BSA) protein entities, evolved from a statistical 23×31 factorial design study (three variables at two levels and one variable at three levels) that was the subject of the first paper of a series of three, aiming at complete stabilization of the three-dimensional structure of protein entities attempted via housing the said molecular entities within biomimetic aqueous-core lipid nanoballoons integrating a multiple (W/O/W) emulsion. The statistical factorial design followed led to the production of an optimum W/O/W multiple emulsion possessing quite homogeneous particles with an average hydrodynamic size of (186.2 ± 2.6) nm and average Zeta potential of (-36.5 ± 0.9) mV, and exhibiting a polydispersity index of 0.206 ± 0.014. Additionally, the results obtained for the diffusion coefficient of the lipid nanoballoons integrating the optimized W/O/W multiple emulsion were comparable and of the same order of magnitude (10-12 m2 s-1) as those published by other authors since, typically, diffusion coefficients for molecules range from 10-10 to 10-7 m2 s-1, but diffusion coefficients for nanoparticles are typically of the order of magnitude of 10-12 m2 s-1.

Spatial clusters of suicide in the municipality of São Paulo 1996-2005: an ecological study.

BACKGROUND: In a classical study, Durkheim mapped suicide rates, wealth, and low family density and realized that they clustered in northern France. Assessing others variables, such as religious society, he constructed a framework for the analysis of the suicide, which still allows international comparisons using the same basic methodology. The present study aims to identify possible significantly clusters of suicide in the city of São Paulo, and then, verify their statistical associations with socio-economic and cultural characteristics. METHODS: A spatial scan statistical test was performed to analyze the geographical pattern of suicide deaths of residents in the city of São Paulo by Administrative District, from 1996 to 2005. Relative risks and high and/or low clusters were calculated accounting for gender and age as co-variates, were analyzed using spatial scan statistics to identify geographical patterns. Logistic regression was used to estimate associations with socioeconomic variables, considering, the spatial cluster of high suicide rates as the response variable. Drawing from Durkheim's original work, current World Health Organization (WHO) reports and recent reviews, the following independent variables were considered: marital status, income, education, religion, and migration. RESULTS: The mean suicide rate was 4.1/100,000 inhabitant-years. Against this baseline, two clusters were identified: the first, of increased risk (RR=1.66), comprising 18 districts in the central region; the second, of decreased risk (RR=0.78), including 14 districts in the southern region. The downtown area toward the southwestern region of the city displayed the highest risk for suicide, and though the overall risk may be considered low, the rate climbs up to an intermediate level in this region. One logistic regression analysis contrasted the risk cluster (18 districts) against the other remaining 78 districts, testing the effects of socioeconomic-cultural variables. The following categories of proportion of persons within the clusters were identified as risk factors: singles (OR=2.36), migrants (OR=1.50), Catholics (OR=1.37) and higher income (OR=1.06). In a second logistic model, likewise conceived, the following categories of proportion of persons were identified as protective factors: married (OR=0.49) and Evangelical (OR=0.60). CONCLUSIONS: This risk/ protection profile is in accordance with the interpretation that, as a social phenomenon, suicide is related to social isolation. Thus, the classical framework put forward by Durkheim seems to still hold, even though its categorical expression requires re-interpretation.

Antecedentes históricos de nuestra Revista. La exanguinotransfusión en la enfermedad hemolítica del recién nacido / Historical background of our journal. Blood exchange in the hemolytic disease of the newborn

1.Se relatan diez casos de enfermedad hemolítica del recién nacido: ocho por incompatibilidad RH; uno por isoinmunización anti-B; uno por causa aún desconocida. Todos tratados favorablemente por exanguinotransfusión, cuyas técnicas se detallan. 2. Se aconseja como técnica de elección, la transfusión gota a gota por punción venosa en dorso de mano y extracción por vena umbilical o arteriotomía radial. 3. Se recomienda la transfusión lenta y la sangría lenta (duración de la operación 3 a 5 horas) con el objeto de asegurarse mejor contra bruscos desniveles en la volemia. 4. Con el fin de limitar el aporte inicial de "conglutinina" y de disminuir la dosis total de citrato de sodio, se considera útil comenzar la transfusión con glóbulos privados del plasma y resuspendidos en soluciones isotónicas: se termina con sangre total. 5. La práctica de repetidos hematocritos en la sangre que se va extrayendo, resulta de suma utilidad para controlar la marcha de la operación. 6. Se fundamentan las ventajas que, sobre la operación cesárea, tiene la inducción médica del parto (preferentemente desde el octavo mes en adelante y valorando el peso del feto in útero) para el tratamiento de la madre isoinmunizada, supeditando la terapéutica del niño al examen de la sangre del cordón. 7. Se considera que la exanguinotransfusión es actualmente, en los casos graves, el tratamiento más completo de la enfermedad hemolítica del recién nacido.

1.Ten cases of hemolytic disease of the newborn infant are reported: eight with Rh incompatibility; one with anti-B isoimmunization and one case where unable to determine the cause. All were successfully treated by exchange transfusion. The technic is explained. 2. Drop by drop transfusion technic through one of the veins of the back of the hand, is advised. Extraction is perfomed through the umbilical vein or by radial arteriotomy. 3. Slow bleeding and transfusion are recommended (the whole procedure lasts form 3 to 5 hours) to avoid sudden changes in blood volume. 4. With the purpose of restricting the initial amount of "conglutinin" and to diminish te total dosis of sodium citrate it is advisable to start the transfusion with blood cells wothout plasma and resuspended in isotonic solutions; whole blood is used to finish the operation. 5. The habit of performing several hematocrits through the procedure results in great usefulness in controling the patient's condition. 6. The advantanges of medical induction versus cesarean operation are established (preferably from the eigth month onward and determining the weight of the fetus in utero) for the treatment of the isoimmunized mother, reducing the therapeutics of the child on examining the umbilical blood cord. 7. In serious cases of hemolytic disease of the newborn infant exchange transfusion is considered the best treatment.

Antecedentes históricos de nuestra Revista. La exanguinotransfusión en la enfermedad hemolítica del recién nacido / Historical background of our journal. Blood exchange in the hemolytic disease of the newborn

1.Se relatan diez casos de enfermedad hemolítica del recién nacido: ocho por incompatibilidad RH; uno por isoinmunización anti-B; uno por causa aún desconocida. Todos tratados favorablemente por exanguinotransfusión, cuyas técnicas se detallan. 2. Se aconseja como técnica de elección, la transfusión gota a gota por punción venosa en dorso de mano y extracción por vena umbilical o arteriotomía radial. 3. Se recomienda la transfusión lenta y la sangría lenta (duración de la operación 3 a 5 horas) con el objeto de asegurarse mejor contra bruscos desniveles en la volemia. 4. Con el fin de limitar el aporte inicial de "conglutinina" y de disminuir la dosis total de citrato de sodio, se considera útil comenzar la transfusión con glóbulos privados del plasma y resuspendidos en soluciones isotónicas: se termina con sangre total. 5. La práctica de repetidos hematocritos en la sangre que se va extrayendo, resulta de suma utilidad para controlar la marcha de la operación. 6. Se fundamentan las ventajas que, sobre la operación cesárea, tiene la inducción médica del parto (preferentemente desde el octavo mes en adelante y valorando el peso del feto in útero) para el tratamiento de la madre isoinmunizada, supeditando la terapéutica del niño al examen de la sangre del cordón. 7. Se considera que la exanguinotransfusión es actualmente, en los casos graves, el tratamiento más completo de la enfermedad hemolítica del recién nacido.(AU)

1.Ten cases of hemolytic disease of the newborn infant are reported: eight with Rh incompatibility; one with anti-B isoimmunization and one case where unable to determine the cause. All were successfully treated by exchange transfusion. The technic is explained. 2. Drop by drop transfusion technic through one of the veins of the back of the hand, is advised. Extraction is perfomed through the umbilical vein or by radial arteriotomy. 3. Slow bleeding and transfusion are recommended (the whole procedure lasts form 3 to 5 hours) to avoid sudden changes in blood volume. 4. With the purpose of restricting the initial amount of "conglutinin" and to diminish te total dosis of sodium citrate it is advisable to start the transfusion with blood cells wothout plasma and resuspended in isotonic solutions; whole blood is used to finish the operation. 5. The habit of performing several hematocrits through the procedure results in great usefulness in controling the patients condition. 6. The advantanges of medical induction versus cesarean operation are established (preferably from the eigth month onward and determining the weight of the fetus in utero) for the treatment of the isoimmunized mother, reducing the therapeutics of the child on examining the umbilical blood cord. 7. In serious cases of hemolytic disease of the newborn infant exchange transfusion is considered the best treatment.(AU)

Critical analysis of the use of statistical tests in Brazilian publications related to digestive tract surgery.

OBJECTIVE: To evaluate the evolution of scientific papers published on digestive tract surgery in Brazilian journals in 20 years and examine whether the level of evidence in the studies has improved, as well as the incorporation of statistical procedures and their proper application. METHODS: We selected all original articles related to digestive tract surgery published in the years of 1987 and 2007 in 4 leading Brazilian surgical journals. Studies were divided according to the level of evidence (I: prospective, controlled and randomized, II: prospective without control or randomization and III: retrospective) and compared them to assess whether there was an improvement in the level of evidence between these two years surveyed. We also assessed whether there was increased use of analytical statistics and correct application of statistical procedures. RESULTS: Comparing the articles published in 1987 with those of 2007, we observed no improvement with respect to the level of evidence, with more than half of the articles published being case series and retrospective studies (56.14%). There has been a significant increase in the use of analytical statistics (70.4% in 2007 vs. 40% in 1987) in the 20 years, however 16.7% of the studies published in 2007 did not correctly apply or adequately describe the statistical analyses used. CONCLUSION: In this study, we observed no improvement in the level of evidence presented in publications on digestive tract surgery in the last 20 years. There was an increased use of statistical analysis, but there is a need to correctly apply statistical procedures.

Critical analysis of the use of statistical tests in Brazilian publications related to digestive tract surgery / Análise crítica do uso de testes estatísticos em publicações Brasileiras relacionadas à cirurgia do aparelho digestivo

OBJECTIVE: To evaluate the evolution of scientific papers published on digestive tract surgery in Brazilian journals in 20 years and examine whether the level of evidence in the studies has improved, as well as the incorporation of statistical procedures and their proper application. METHODS: We selected all original articles related to digestive tract surgery published in the years of 1987 and 2007 in 4 leading Brazilian surgical journals. Studies were divided according to the level of evidence (I: prospective, controlled and randomized, II: prospective without control or randomization and III: retrospective) and compared them to assess whether there was an improvement in the level of evidence between these two years surveyed. We also assessed whether there was increased use of analytical statistics and correct application of statistical procedures. RESULTS: Comparing the articles published in 1987 with those of 2007, we observed no improvement with respect to the level of evidence, with more than half of the articles published being case series and retrospective studies (56.14 percent). There has been a significant increase in the use of analytical statistics (70.4 percent in 2007 vs. 40 percent in 1987) in the 20 years, however 16.7 percent of the studies published in 2007 did not correctly apply or adequately describe the statistical analyses used. CONCLUSION: In this study, we observed no improvement in the level of evidence presented in publications on digestive tract surgery in the last 20 years. There was an increased use of statistical analysis, but there is a need to correctly apply statistical procedures.

OBJETIVO: Avaliar a evolução dos trabalhos publicados sobre cirurgia do aparelho digestivo em revistas brasileiras nos últimos 20 anos, observando se houve melhora no nível de evidência destes trabalhos além da incorporação de procedimentos estatísticos e a sua correta aplicação. MÉTODOS: Selecionamos todos os artigos originais relacionados à cirurgia do aparelho digestivo publicados nos anos de 1987 e 2007 em quatro revistas cirúrgicas nacionais de renome. Os estudos foram divididos de acordo com o nível de evidência (I: prospectivo, randomizado e controlado, II: prospectivo sem controle ou randomização e III: retrospectivo) e comparados para avaliar se houve melhora do nível de evidência entre os dois anos avaliados. Também observamos se ocorreu aumento no uso de estatística analítica e a correta aplicação dos procedimentos estatísticos. RESULTADOS: Comparando os artigos publicados em 1987 com os de 2007, não observamos melhora no nível de evidência, com mais de metade dos artigos publicados tratando de séries de casos e estudos retrospectivos (56,14 por cento). Houve um aumento significante na utilização de estatística analítica (70,4 por cento em 2007 vs. 40 por cento em 1987) nos últimos 20 anos, mas 16,7 por cento dos estudos publicados em 2007 não aplicavam corretamente ou descreviam adequadamente a análise estatística utilizada. CONCLUSÃO: Neste estudo observamos que não houve melhora no nível de evidência das publicações brasileiras relacionadas à cirurgia do aparelho digestivo nos últimos 20 anos. Houve aumento do uso de estatística analítica, porém existe a necessidade de se observar a correta aplicação dos procedimentos estatísticos.

Complementarity of Subjective Global Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients.

BACKGROUND & AIMS: We evaluated the ability of Nutritional Risk Screening 2002 (NRS 2002) and Subjective Global Assessment (SGA) to predict malnutrition related to poor clinical outcomes. METHODS: We assessed 705 patients at a public university hospital within 48 h of admission. Logistic regression and number needed to screen (NNS) were calculated to test the complementarity between the tools and their ability to predict very long length of hospital stay (VLLOS), complications, and death. RESULTS: Of the patients screened, 27.9% were at nutritional risk (NRS+) and 38.9% were malnourished (SGA B or C). Compared to those patients not at nutritional risk, NRS+, SGA B or C patients were at increased risk for complications (p=0.03, 0.02, and 0.003, respectively). NRS+ patients had an increased risk of death (p=0.03), and SGA B and C patients had an increased likelihood of VLLOS (p=0.008 and p<0.0001, respectively). Patients who were both NRS+ and SGA C had lower estimates of NNS than patients who were NRS+ or SGA C only, though their confidence intervals did overlap. CONCLUSIONS: The concurrent application of SGA in NRS+ patients might enhance the ability to predict poor clinical outcomes in hospitalized patients in Brazil.

[Impact estimates of breastfeeding over infant mortality]. / Estimativa de impacto da amamentação sobre a mortalidade infantil.

OBJECTIVE: Infant mortality in the state of São Paulo has decreased in the last years and it seems to be leveling off at a limit beyond which further reductions are challenging. Early neonatal causes account for 50% of these deaths and the remaining are mostly due to pneumonia and diarrhea. This study is to assess the impact of breastfeeding over death reduction. METHODS: Fourteen municipalities of greater São Paulo were studied. Data on breastfeeding was collected through surveys conducted on national immunization campaign days and mortality data was taken from 1999 and 2000 official records. Drawing from literature parameters on risk for death from respiratory infection and diarrhea in non-breastfed infants, fractions of mortality preventable by breastfeeding were calculated. These figures applied to the number of recorded deaths allowed assessing the impact of breastfeeding over mortality for each municipality. RESULTS: Fractions of respiratory infection mortality preventable by breastfeeding varied according to locality and age group between 33% and 72%. As to diarrhea, variation was between 35% and 86%. The impact of breastfeeding over infant mortality was an average reduction of 9.3% with values raging from 3.6% to 13%, depending on the locality considered. CONCLUSIONS: Breastfeeding in the first year of life might be the most feasible strategy to further reduce the current levels of infant mortality in the state of São Paulo.

Anxiety and depression in the first year of medical residency training.

OBJECTIVE: To perform a screening, follow-up and comparative evaluation of depression and anxiety symptoms in a group of 59 first-year internal medicine residents of a teaching hospital and evaluate the influence of their rotation, nature of rotation, subgroup, sex and the time of year on these symptoms. METHODS: We used the Spielberger State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI), applied seven times, in the last week of every rotation. RESULTS AND CONCLUSION: We obtained two identical averages (P=0.98) of trait-anxiety, six months apart one from the other. There was a significant correlation (R=0.65, P < 0.001) between the indexes of state-anxiety and depression. Women had higher levels of symptoms of both anxiety and depression (P < 0.001) compared to men. A cluster of three subgroups of residents with higher trait-anxiety levels (P=0.001) also showed significantly higher levels of symptoms of state-anxiety and depression (P < 0.001). The time of the year and the nature of the rotation (emergency or not) did not interfere with the levels of depression (P=0.47). We detected rotations where there was greater frequency of residents with symptoms compatible with moderate and severe depression. There were 2.1% of residents with symptoms compatible with severe, 4.2% with moderate and 27% with mild depression. It was possible to graduate symptoms of anxiety and depression in residents, evaluate factors involved in their genesis and locate residents with moderate and severe depression.

Genetic data showing evolutionary links between Leishmania and Endotrypanum

Striking similarities at the morphological, molecular and biological levels exist between many trypanosomatids isolated from sylvatic insects and/or vertebrate reservoir hosts that make the identification of medically important parasites demanding. Some molecular data have pointed to the relationship between some Leishmania species and Endotrypanum, which has an important epidemiological significance and can be helpful to understand the evolution of those parasites. In this study, we have demonstrated a close genetic relationship between Endotrypanum and two new leishmanial species, L. (V.) colombiensis and L. (V.) equatoriensis. we have used (a) numerical zymotaxonomy and (b) the variability of the internal transcribed spacers of the rRNA genes to examine relationship in this group. The evolutionary trees obtained revealed high similarity between L. (V.) colombiensis, L. (V.) equatoriensis and Endotrypanum, forming a tight cluster of parasites. Based on further results of (c) minicircle kDNA heterogeneity analysis and (d) measurement of the sialidase activity these parasites were also grouped together.

Susceptibility of asthmatic children to respiratory infection

Investiga, através de um estudo caso-controle de pacientes com pneumonia, se as doenças chiadoras poderiam constituir-se em fator de risco. De um hospital universitário, na cidade de Säo Paulo, Brasil, entre março e agosto de 1994, foi tomada uma amostra de 51 casos de pneumonia pareados por sexo e idade a 51 controles näo respiratórios. O diagnóstico de pneumonia e a presença de doença chiadora foram investigados de forma independente por cada pediatra tanto para casos quanto para controles. Foi confirmada pneumonia radiologicamente e a repetibilidade da informaçäo sobre doença chiadora foi medida. Foi utilizada regressäo logística para identificaçäo de riscos. As doenças chiadoras, entendidas como representantes de asma, mostraram ser importante fator de risco para pneumonia, com um odds ratio de 7,07 (IC95 por cento=2,34-21,36), controlados os efeitos de aglomeraçäo no quarto de dormir (odds ratio de 1,49 por pessoa a mais no quarto, IC95 por cento=0,95-2,32) e a baixa renda familiar (odds ratio de 5,59 contra alta renda familiar, IC95 por cento=1,38-22,63). O risco atribuível às doenças chiadoras foi calculado de forma exploratória em 51,42 por cento. Conclui-se que os clínicos devem ter atençäo sobre asmáticos para o risco de infecçäo e que ao nível da saúde pública a incidência de pneumonia poderia ser reduzida se as orientaçöes atuais da Organizaçäo Mundial da Saúde pudessem ser revistas para oferecer atençäo integral para os doentes