Temporal relationship between successful pancreas transplantation and control of ocular complications in alloxan-induced diabetic rats

Purpose. The impact of pancreas transplantation (PT) on the progression of eye disease is still controversial. This study evaluated the course of retinopathy in transplanted rats in two different diabetic stages.Methods. Sixty inbred male Lewis rats were assigned to four experimental groups: NC-15 nondiabetic control rats; DC-15 untreated diabetic control rats; PT1-15 diabetic rats that received syngeneic pancreas transplants 2 weeks after alloxan diabetes induction; PT2-15 diabetic rats that received pancreas transplants 12 weeks after diabetes onset. Clinical and laboratory parameters and tens opacity were examined in all rats prior to treatment and at 1-, 6-, and 12-months follow-up. Nucleated eyes from five rats in each group processed for ultrastructural study of the retinal at 6 and 12 months after PT or at follow-up.Results. Cataracts were observed in 20%, 60%, and 100% of DC rats at 1-, 6-, and 12-months follow-up, respectively. Early PT (2 weeks) significantly reduced the prevalence of this complication but not late (12 weeks) PT. PT1 rats also showed improved ultrastructure of the superficial and deep capillary plexuses of the retina, and of Muller cells, compared with DC and PT2. In the last group, retinopathy continued to evolve despite successful PT.Conclusion. Our results suggested that prevention of diabetic ocular lesions by PT was closely dependent on earlier performance of the procedure.

Successful carnivore identification with faecal DNA across a fragmented Amazonian landscape

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Teaching in the community: Changing and implementing a new curriculum

The Faculdade de Medicina de Botucatu is changing to, and implementing a new curriculum aimed at integrating teaching and learning in the community. Emphasis is on preparing the community settings for teaching, learning and providing health care. A particular task is staff development with emphasis on problem-based learning (PBL) and training medical and nursing students in the leadership to participate in this process. The new curriculum includes the gradual introduction of clinical practice during First Year, integration of the basic sciences with clinical sciences, through integrated modules studied in small groups, and maintenance of the two year clerkship. The undergraduates are introduced gradually to the community: 8% of the total curriculum during First Year, 10% during Second Year, 10% during Third Year, 20% during Fourth Year, 30% during Fifth and Sixth Years. The basic health units at primary care level, and the regional specialty outpatients and hospitals at the second level, are the main teaching sites. An Education Development Committee was established to discuss the strategies for supporting the changes and to structure the planning for promoting the gradual transformation of staff development. After 18 months of implementation of the curriculum, there followed discussions and monitoring of the objectives of changes in medical education at our school. Successful implementation of the new curriculum would fail, if the objectives were not absorbed by every member of the implementation Committee.

Development and validation of a successful microbiological agar assay for determination of ceftriaxone sodium in powder for injectable solution

Ceftriaxone sodium is a cephalosporin with broad-spectrum antimicrobial activity and belongs to the third generation of cephalosporins. Regarding the quality control of medicines, a validated microbiological assay for the determination of ceftriaxone sodium in powder for injectable solution has not been reported yet. This paper reports the development and validation of a simple, accurate and reproducible agar diffusion method to quantify ceftriaxone sodium in powder for injectable solution. The assay is based on the inhibitory effect of ceftriaxone sodium on the strain of Bacillus subtilis ATCC 9371 IAL 1027 used as test microorganism. The results were treated statistically by analysis of variance and were found to be linear (r = 0.999) in the selected range of 15.0-60.0 μg/mL, precise with a relative standard deviation (RSD) of repeatability intraday = 1.40%, accurate (100.46%) and robust with a RSD lower than 1.28%. The results demonstrated the validity of the proposed bioassay, which allows reliable ceftriaxone sodium quantitation in pharmaceutical samples and therefore can be used as a useful alternative methodology for the routine quality control of this medicine. © 2012 by the authors; licensee MDPI, Basel, Switzerland.

Successful prevention of tunneled central catheter infection by antibiotic lock therapy using cefazolin and gentamicin

Catheter-related bacteremia (CRB) is one of the various complications related to hemodialysis (HD). As a result of this high rate of infection, the antibiotic lock technique (ALT) has been recommended to prevent CRB. However, adverse effects of ALT such as increased emergence of strains resistant to antibiotics and increased mechanical dysfunction catheter were poorly evaluated. We prospectively evaluated the efficacy of catheter-restricted filling using an antibiotic lock solution in preventing CRB. A total of 233 HD patients requiring 325 new tunneled catheters while waiting for placement and maturation of an arteriovenous fistula or graft were enrolled in this study. Patients with a tunneled catheter were assigned to receive either an antibiotic-heparin lock solution (antibiotic group: cefazolin 10 mg/ml, gentamicin 5 mg/ml, heparin 1,000 U/ml) or a heparin lock solution (no-antibiotic group: heparin 1,000 U/ml) as a catheter lock solution during the interdialytic period. The present study aimed to assess the efficacy of ALT using cefazolin and gentamicin in reducing CRB in patients undergoing HD with tunneled central catheter and to identify its adverse effects. CRB developed in 32.4 % of patients in the no-antibiotic group and in 13.1 % of patients in the antibiotic group. CRB rates per 1,000 catheter-days were 0.57 in the antibiotic group versus 1.74 in the no-antibiotic group (p < 0.0001). Kaplan-Meier analysis also showed that mean CRB-free catheter survival was significantly higher in the antibiotic group than in the no-antibiotic group (log-rank statistic 17.62, p < 0.0001). There was statistically significant difference between the two groups in causative organisms of CRB, with predominance of negative culture in both groups, but this prevalence was higher in ALT group (57.9 vs 90.1 %, p < 0.0001), and the two groups also were different in prevalence of gram-positive bacteria as causing organisms (ALT group 21.05 vs = 0 % in control group, p < 0.0001). There was no statistically significant difference between the two groups in drug-resistant germs. There were statistically significant differences between the two groups in the catheter removal causes, with higher rate of infectious cause in control group (12.32 vs 2.22 %, p < 0.0001) and mechanical cause in ALT group (28.26 vs 37.78 %, p < 0.0001). The results suggest that ALT may be a beneficial means of reducing the CRB rate in HD patients with tunneled catheter, without association between ALT and emergence of strains resistant. However, mechanical complications were more prevalent in antibiotic group. Further studies are required to determine the optimal drug regimen, concentrations for ALT, and its adverse effects. © 2012 Springer Science+Business Media Dordrecht.

The meaning of evidence-based management to brazilian senior nurse leaders

Purpose: The study objective was to understand the meaning of evidence-based management for senior nurse leaders in accredited, public hospitals in the State of Sao Paulo, Brazil. Design and Method: A phenomenological approach was used to analyze interviews conducted with 10 senior nurse leaders between August 2011 and March 2012. The analytic method was developed by the Brazilian phenomenologist, Martins. Findings: Senior nurse leaders described how they critically appraise many sources of evidence when making managerial decisions. They emphasized the importance of working with their teams to locally adapt and evaluate best evidence associated with managerial decision making and organizational innovations. Their statements also demonstrated how they use evidence-based management to support the adoption of evidence-based practices. They did not, however, provide specific strategies for seeking out and obtaining evidence. Notable challenges were traditional cultures and rigid bureaucracies, while major facilitators included accreditation, teamwork, and shared decision making. Conclusions: Evidence-based management necessitates a continuous process of locating, implementing, and evaluating evidence. In this study leaders provided multiple, concrete examples of all these processes except seeking out and locating evidence. They also gave examples of other leadership skills associated with successful adoption of evidence-based practice and management, particularly interdisciplinary teamwork and shared decision making. Clinical Relevance: This study demonstrates senior nurse leaders' awareness and utilization of evidence-based management. The study also suggests what aspects of evidence-based management need further development, such as more active identification of potential, new organizational innovations. © 2013 Sigma Theta Tau International.

The Relationship between Biofilm and Physical-Chemical Properties of Implant Abutment Materials for Successful Dental Implants

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

TERRESTRIAL PLANET FORMATION IN A PROTOPLANETARY DISK WITH A LOCAL MASS DEPLETION: A SUCCESSFUL SCENARIO FOR THE FORMATION OF MARS

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Extending lean manufacturing in supply chains: a successful case in Brazil

Purpose – The purpose of this paper is to present the results of a success story involving the extending of lean manufacturing practices between a focal firm and its supplier, both located in Brazil, thereby configuring a case of excellence. Design/methodology/approach – An in-depth case study was conducted involving two companies: Company A, focal, leader in its segment, located in Brazil; and Company B, Company A's supplier, also located in Brazil. Findings – Results indicate there are several mechanisms for extending lean manufacturing practices in the supply chain, such as workshops, training, and integrated teams. These mechanisms are shown and guidelines are also introduced for companies seeking to successfully extend lean manufacturing practices. Originality/value – An original use of define, measure, analyze, improve, control for structuring the extending of lean manufacturing practices to suppliers and, consequently, the importance of the lean six-sigma relationship in this context. Furthermore, the guidelines introduced serve as a benchmark for other companies interested in the topic.