Fatores de risco para trauma vascular durante a quimioterapia antineoplásica: contribuições do emprego do risco relativo

OBJETIVO: identificar a relação entre os fatores de risco para trauma vascular e o surgimento de eventos adversos de infiltração ou flebite por quimioterapia antineoplásica. MÉTODOS: Estudo de abordagem quantitativa observacional com 30 mulheres com câncer de mama. RESULTADOS: O tipo de material do cateter apresentou associação que sugere risco (RR=2,76; IC=1,199; 6,369); o fator velocidade de infusão apresentou RR=2,22; entretanto, IC= 0,7672; 6,436; os fatores trajetória, número de punção e mobilidade da veia apresentaram RR<1 mas não podem ser considerados como fatores de proteção. Local de inserção e a visibilidade da veia apresentaram risco próximo a 1. CONCLUSÃO: O uso de cateter com metal para punção venosa foi considerado neste estudo como fator para Risco de Trauma Vascular. A análise da associação pelo RR mostrou-se concordante com os dados da literatura pesquisada.

A 'Relação' de Jacinto de Carvalho (1719), um texto inédito de etnografia amazônica

Depois de trabalhar por treze anos nas missões da Amazônia, o jesuíta português Jacinto de Carvalho (1677-1744) enviou ao superior da ordem uma relação descritiva do país e de alguns costumes da população indígena. Essa é a principal fonte etno-histórica da Amazônia na primeira metade do século XVIII, mas é conhecida somente por meio de uma tradução italiana coeva, até hoje inédita. Os trechos de interesse etnográfico foram aqui vertidos à língua portuguesa, precedidos de estudo.

Estrutura e aspectos da regeneração natural de Floresta Ombrófila Mista no Parque Estadual de Campos do Jordão, SP, Brasil

O estudo buscou avaliar diferenças florísticas e estruturais entre os componentes adulto e regenerante de trecho de Floresta Ombrófila Mista em Campos do Jordão, a fim de levantar hipóteses sobre sua trajetória sucessional. Para amostragem do componente adulto (CAP > 15 cm) foram instaladas 50 parcelas permanentes de 10 × 20 m e, em cada uma dessas, cinco subparcelas de 1 × 1 m para amostragem do componente regenerante (h > 30 cm e CAP < 15 cm). No componente adulto foram amostrados 1.770 indivíduos, distribuídos em 58 espécies, 38 gêneros e 26 famílias (H' = 3,08 e J = 0,73). Já entre os regenerantes foram observados 576 indivíduos, 55 espécies, 39 gêneros e 23 famílias (H' = 3,41 e J = 0,84). Constatou-se que são necessárias ações de manejo para a conservação in situ das coníferas locais.

Microbial Translocation Is Associated with Extensive Immune Activation in Dengue Virus Infected Patients with Severe Disease

Background: Severe dengue virus (DENV) disease is associated with extensive immune activation, characterized by a cytokine storm. Previously, elevated lipopolysaccharide (LPS) levels in dengue were found to correlate with clinical disease severity. In the present cross-sectional study we identified markers of microbial translocation and immune activation, which are associated with severe manifestations of DENV infection. Methods: Serum samples from DENV-infected patients were collected during the outbreak in 2010 in the State of Sa˜o Paulo, Brazil. Levels of LPS, lipopolysaccharide binding protein (LBP), soluble CD14 (sCD14) and IgM and IgG endotoxin core antibodies were determined by ELISA. Thirty cytokines were quantified using a multiplex luminex system. Patients were classified according to the 2009 WHO classification and the occurrence of plasma leakage/shock and hemorrhage. Moreover, a (non-supervised) cluster analysis based on the expression of the quantified cytokines was applied to identify groups of patients with similar cytokine profiles. Markers of microbial translocation were linked to groups with similar clinical disease severity and clusters with similar cytokine profiles. Results: Cluster analysis indicated that LPS levels were significantly increased in patients with a profound pro-inflammatory cytokine profile. LBP and sCD14 showed significantly increased levels in patients with severe disease in the clinical classification and in patients with severe inflammation in the cluster analysis. With both the clinical classification and the cluster analysis, levels of IL-6, IL-8, sIL-2R, MCP-1, RANTES, HGF, G-CSF and EGF were associated with severe disease. Conclusions: The present study provides evidence that both microbial translocation and extensive immune activation occur during severe DENV infection and may play an important role in the pathogenesis.

O ATO MÉDICO NO CRIME DE TORTURA

A presente pesquisa verificou se a legislação surgida após a Segunda Guerra Mundial foi apta a inibir o comportamento maleficente de médicos no auxílio em especializar, dissimular e acobertar a tortura. Foi demonstrado o envolvimento médico com experimentos em seres humanos durante a Segunda Guerra Mundial e corroborou-se que a maleficência médica ainda é usada nos dias de hoje na sociedade contemporânea, permitindo aos profissionais de saúde, desde o período da Guerra Fria, o envolvimento com a tortura e a consequente violação dos princípios da Bioética, especialmente, na conjuntura atualíssima da guerra norte-americana contra o terrorismo. Ao final foram propostas soluções, tendo em vista as noções de Bioética, as normas de Direito Internacional e os Direitos Humanos

A aplicação do Código de Defesa do Consumidor às ações judiciais por alegado erro médico

A presente pesquisa tem como objetivo analisar a responsabilidade do médico dentro do contexto doutrinário e jurisprudencial da atualidade e demonstrar, a partir da análise de ações judiciais por alegado erro médico, propostas perante o Poder Judiciário, que os direitos atribuídos ao consumidor pelo Código de Defesa do Consumidor, bem como as prerrogativas de facilitação do acesso ao Judiciário atualmente são aplicados pelos profissionais do Direito ao exercício da atividade médica de forma generalizada, ou seja, tanto em relação às sociedades empresárias – hospitais, clínicas e planos de saúde, quanto aos profissionais liberais, sem considerar que o § 4º do art. 14 do Código de Defesa do Consumidor, ao estabelecer como requisito para a responsabilidade do profissional liberal a comprovação de culpa (imprudência, negligência e imperícia), determina, a contrario sensu, a aplicação das normas do Código Civil, de forma que, também as prerrogativas de facilitação de acesso ao Judiciário, exclusivas da legislação de consumo, não poderiam ser aplicadas ao exercício da atividade pelo profissional liberal.

Changes in food intake, metabolic parameters and insulin resistance are induced by an isoenergetic, medium-chain fatty acid diet and are associated with modifications in insulin signalling in isolated rat pancreatic islets

LLong-chain fatty acids are capable of inducing alterations in the homoeostasis of glucose-stimulated insulin secretion (GSIS), but the effect of medium-chain fatty acids (MCFA) is poorly elucidated. In the present study, we fed a normoenergetic MCFA diet to male rats from the age of 1 month to the age of 4 months in order to analyse the effect of MCFA on body growth, insulin sensitivity and GSIS. The 45% MCFA substitution of whole fatty acids in the normoenergetic diet impaired whole body growth and resulted in increased body adiposity and hyperinsulinaemia, and reduced insulin-mediated glucose uptake in skeletal muscle. In addition, the isolated pancreatic islets from the MCFA-fed rats showed impaired GSIS and reduced protein kinase Ba (AKT1) protein expression and extracellular signal-related kinase isoforms 1 and 2 (ERK(1/2)) phosphorylation, which were accompanied by increased cellular death. Furthermore, there was a mildly increased cholinergic sensitivity to GSIS. We discuss these findings in further detail, and advocate that they might have a role in the mechanistic pathway leading to the compensatory hyperinsulinaemic status found in this animal model.

Risk factors associated with death in Brazilian children with severe dengue: a case-control study

Objective: The purpose of this case-control study was to evaluate risk factors associated with death in children with severe dengue. Methods: The clinical condition of hospitalized patients with severe dengue who died (cases, n = 18) was compared with that of hospitalized patients with severe dengue who survived (controls, n = 77). The inclusion criteria for this study were age under 13 years; hospital admission in São Luis, northeastern Brazil; and laboratory-confirmed diagnosis of dengue. Results: Severe bleeding (hemoptysis), a defining criterion for dengue severity, was the factor most strongly associated with death in our study. We also found that epistaxis and persistent vomiting, both included as warning signs in the World Health Organization (WHO) classification of dengue, were strongly associated with death. No significant association was observed between any of the laboratory findings and death. Conclusions: The finding that epistaxis and persistent vomiting were also associated with death in children with severe dengue was unexpected and deserves to be explored in future studies. Because intensive care units are often limited in resource-poor settings, any information that can help to distinguish patients with severe dengue with a higher risk to progress to death may be crucial.

Desenvolvimento de modelo matemático de otimização logística para o transporte multimodal de safras agrícolas pelo corredor centro-oeste

Este artigo apresenta um modelo matemático de otimização logística para o transporte multimodal de safras agrícolas pelo corredor Centro-Oeste. Tal ferramenta foi desenvolvida no contexto de três amplos projetos de pesquisa financiados pela FINEP e executados por um grupo de universidades. O modelo, conhecido genericamente como Modelo de fluxo de Custo Mínimo Multiproduto, considera a otimização de fluxos em rede, para os produtos açúcar, álcool, milho, soja, óleo de soja, farelo de soja e trigo. O modelo proposto para estimativa dos fluxos inter-regionais mostrou-se uma ferramenta factível para fins de avaliação do potencial de utilização da multimodalidade. A análise destes resultados gera importantes subsídios para a seleção dos locais com potencial para instalação de mecanismos e equipamentos de transferência de cargas, além de auxiliar no dimensionamento dessas infraestruturas. Também é um resultado importante do ferramental desenvolvido a identificação das zonas de cargas que apresentam potencial captável pelas ferrovias, hidrovias e dutovias, ou seja, possibilita a identificação das regiões que revelam potencial para uso da multimodalidade.

A phase I randomized, double-blind, controlled trial of 2009 influenza A (H1N1) inactivated monovalent vaccines with different adjuvant systems

Methods We conducted a phase I, multicenter, randomized, double-blind, placebo-controlled, multi-arm (10) parallel study involving healthy adults to evaluate the safety and immunogenicity of influenza A (H1N1) 2009 non-adjuvanted and adjuvanted candidate vaccines. Subjects received two intramuscular injections of one of the candidate vaccines administered 21 days apart. Antibody responses were measured by means of hemagglutination-inhibition assay before and 21 days after each vaccination. The three co-primary immunogenicity end points were the proportion of seroprotection >70%, seroconversion >40%, and the factor increase in the geometric mean titer >2.5. Results A total of 266 participants were enrolled into the study. No deaths or serious adverse events were reported. The most commonly solicited local and systemic adverse events were injection-site pain and headache, respectively. Only three subjects (1.1%) reported severe injection-site pain. Four 2009 influenza A (H1N1) inactivated monovalent candidate vaccines that met the three requirements to evaluate influenza protection, after a single dose, were identified: 15 μg of hemagglutinin antigen without adjuvant; 7.5 μg of hemagglutinin antigen with aluminum hydroxide, MPL and squalene; 3.75 μg of hemagglutinin antigen with aluminum hydroxide and MPL; and 3.75 μg of hemagglutinin antigen with aluminum hydroxide and squalene. Conclusions Adjuvant systems can be safely used in influenza vaccines, including the adjuvant monophosphoryl lipid A (MPL) derived from Bordetella pertussis with squalene and aluminum hydroxide, MPL with aluminum hydroxide, and squalene and aluminum hydroxide.

Properties of a new poly-ether-glycol copolymer.

Triblock copolymers are made of monomer segments, being the central part usually hydrophobic and the outer parts hydrophilic. By varying sizes, molecular weights and monomer types of the segments one obtains different final molecules, with different physico-chemical properties, which are directly related to the performance of the final product. Looking for new products to be used, among other possibilities, in biological applications, a new polymer (Figure 1) was synthesized by the Dow Chemical and studied by Size Exclusion Chromatography, Fourier Transformed Infrared Spectrometry, Small-angle X-ray Scattering (SAXS) and its cloud point was determined by measuring light transmittance. The studies showed low molecular polydispersivety, but different polarities in the macromolecules fractions. Due to the low solubility of Diol in water, a mixture of water/butyl diglycol was used as solvent. An extensive analysis by SAXS was performed for concentrations from 50 wt% to 80 wt% of Diol in solution. Small concentrations showed very low signal to noise ratio, making it impossible to be analysed. The scattering intensity including the form factor of polydisperse non-homogeneous spheres, and the structure factor of interacting hard spheres was fitted to the curves. As the polymer concentration is high, the fitting of form factors of direct and reverse micelles were compared. The results for direct micelles were better up to 80 wt%, whereas at 90 wt% and 95 wt% the curves were better fitted by reverse micelles. It might seem odd that direct micelles are present up to such high concentrations, but it might have been caused by the presence of butyl diglycol, which increases the solubility of Diol in water. The inner and outer radius of the micelles, electron density distribution, and interaction radius of the micelles were obtained. The polydispersivety increases with Diol concentration. Besides, the interaction radius increases with solvent concentration, even when reversed micelles are present. In the last case, accompanied by an increase of inner radius (water content), as there are fewer Diol molecules to involve the water nuclei, which become larger, further apart, and in less number.