Características clínicas da leishmaniose tegumentar em crianças de 0 a 5 anos em uma área endêmica de Leishmania (Viannia) braziliensis

Para caracterizar a clínica da leishmaniose tegumentar em crianças de 0 a 5 anos de idade, foram avaliadas, retrospectivamente, 4.464 fichas clínicas do Centro de Saúde de Corte de Pedra, Presidente Tancredo Neves, Bahia, Brasil, área endêmica de leishmaniose tegumentar americana, entre maio de 1987 e dezembro de 1995. Foram registrados neste período 4.275 casos novos de leishmaniose, dos quais, 491 (11,5%) correspondiam a crianças de 0 a 5 anos. A razão entre gênero masculino e feminino nas crianças foi 1,1:1. A forma clínica predominante foi a cutânea (98%) e as lesões ulceradas foram as mais freqüentes (99%). A localização das lesões ocorreu, principalmente, acima da cintura (p<0,05), e 35,5% apresentaram lesões múltiplas. A magnitude da doença em crianças, a freqüência semelhante observada em ambos os gêneros e a localização das lesões sugere a possibilidade de transmissão vetorial no domicílio ou peridomicílio.

Parasitoses intestinais e a sua relação com a desnutrição em crianças dos 0 aos 5 anos de São Tomé e Príncipe

Introdução: Os países de clima subtropical, tropical e húmido, onde as populações têm acesso limitado a água potável, saneamento básico efectivo, educação e cuidados de saúde, apresentam as condições favoráveis para o desenvolvimento de doenças transmissíveis, nomeadamente as parasitoses intestinais, cuja prevalência é elevada. A infecção por parasitas intestinais patogénicos pode provocar diversas alterações patológicas tais como anemia, desnutrição e outras patologias orgânicas, afectando principalmente as crianças. Objectivos: Avaliar a prevalência das parasitoses intestinais e determinar a sua relação com o estado nutricional, em crianças dos 0 aos 5 anos de São Tomé e Príncipe. Material e Métodos: Estudo observacional, transversal e analítico, com colheita de dados antropométricos e de fezes, entre Fevereiro e Março de 2011, nos distritos de Água Grande, Mé-Zochi e Lobata, em São Tomé e Príncipe, numa amostra de 390 crianças. A detecção microscópica dos parasitas intestinais foi executada no Instituto de Higiene e Medicina Tropical. O estado nutricional de cada criança foi avaliado através dos z-scores do peso para a idade (PIZ), da estatura para a idade (EIZ), do peso para altura (PEZ) e do IMC para a idade (IMCZ). A relação entre a infecção por parasitas intestinais e a desnutrição foi analisada através de métodos estatísticos. Resultados: A amostra foi constituída maioritariamente por crianças com idade inferior a 24 meses (58%). Foram detectados parasitas intestinais patogénicos em 38,7% das crianças, tendo-se observado uma probabilidade mais alta de infecção em crianças com idade superior a 24 meses. Destacaram-se as infecções simples ou mistas por G. lamblia (27,4%), A. lumbricoides (12,8%), T. trichiura (2,6%), Hymenolepis nana (1%), E. histolytica (0,5%), ancilostomideos (0,5%), Schistosoma intercalatum (0,3%) e Taenia spp. (0,3%). No que se refere à desnutrição, 35,6% de crianças tinham baixo peso, 33,6% apresentavam desnutrição crónica, 27,7% e 27,4% desnutrição aguda (PEZ e IMCZ), destacando-se o grau ligeiro em cada uma. Verificou-se uma associação estatisticamente significativa entre a infecção por parasitas intestinais patogénicos e a desnutrição crónica. Discussão e Conclusão: Este estudo contribuiu para um melhor conhecimento das prevalências e relação das parasitoses intestinais patogénicas com a desnutrição em crianças menores de 5 anos em São Tomé e Príncipe, nomeadamente da associação entre desnutrição crónica e a infecção por parasitas intestinais patogénicos. Sugere-se a execução de estudos semelhantes a este nas restantes regiões do país para fundamentar a adopção de medidas adequadas de combate às infecções por parasitas intestinais patogénicos. Considerando o número de crianças infectadas com G. lamblia encontrada neste estudo, seria recomendável medidas específicas de combate à transmissão de protozoários e a realização de exames anuais das fezes de todas as crianças seguida de tratamento dos casos positivos.

Transporte ativo em alunos do 5º e 6º ano de escolaridade, por género, em meio predominantemente rural

Relatório de atividade profissional de mestrado em Ensino de Educação Física nos Ensinos Básico e Secundário

Diagnóstico pela ecocardiografia transesofágica e evolução de 35 pacientes portadores de flail mitral valve

OBJETIVO: Descrever os achados ao ecocardiograma transesofágico e evolução clínica de portadores de flail mitral valve. MÉTODOS: No período de janeiro/93 a março/97, 1675 pacientes foram submetidos, em nossa instituição, a ecocardiograma transesofágico, sendo que em 35 casos foi feito o diagnóstico de flail mitral valve e, posteriormente, obtida sua evolução clínica. RESULTADOS: A idade dos pacientes variou 12 a 87 anos (média 65±15) e 27 (77%) eram do sexo masculino. O folheto posterior foi o mais acometido (25 pacientes, 71%). O mecanismo do flail foi ruptura de cordoalha tendínea em todos os casos, exceto um, que apresentava importante alongamento e redundância de cordoalha. A etiologia foi prolapso e/ou degeneração mixomatosa em 15 pacientes, degenerativa em 9, isquêmica em 5, reumática em 4 e endocardite em 3. Regurgitação mitral de grau importante ocorreu em 25 (71%) pacientes e moderada em 10 (29%). O tempo médio de acompanhamento foi de 375±395 dias (1 a 1380). Foram submetidos a tratamento clínico 19 pacientes e a tratamento cirúrgico 16, sendo que em todos foi confirmado o diagnóstico transesofágico. O número total de óbitos (hospitalar e pós-hospitalar) foi alto (34%), tanto em pacientes submetidos a tratamento clínico quanto cirúrgico. Entre os sobreviventes, 17 estão em classe funcional (CF) I e 6 em CF II da NYHA. CONCLUSÃO: O diagnóstico de flail mitral valve ao ecocardiograma transesofágico é acurado, permitindo a definição de sua etiologia e mecanismo. A alta mortalidade à época do diagnóstico, provavelmente, se relaciona à gravidade da doença subjacente. Embora os pacientes não operados estejam evoluindo bem, a baixa CF observada nestes pacientes pode ser atribuída ao curto período de seguimento.

La responsabilidad social corporativa en las empresas del IBEX-35

La responsabilitat social corporativa és un concepte molt genèric i, en moltes ocasions, bastant abstracte i desconegut que no significa que no estigui molt present i citat avui en dia. El treball de la responsabilitat social corporativa en les empreses de l’IBEX-35 té per objectiu ensenyar i educar al lector sobre què consisteix exactament aquest concepte i conèixer més profundament les raons per les quals és imprescindible incorporar-lo en el món empresarial, sota un context de globalització i de competència permanent. Tanmateix, una vegada interioritzat aquesta matèria és molt important per als clients, proveïdors i membres afectats per les activitats de l’empresa rebre la informació de forma detallada sobre quina metodologia, accions i missió que pren l’empresa per aconseguir complir amb els reptes i objectius que se li plantegen i es marca sobre RSC cosa que fa necessari per a assolir una bona conducta, coordinació i feed-back positiu entre l’empresa i els diferents grups d’interès una bona comunicació amb aquests grups d’interès. Això es possible gràcies a l’elaboració d’un informe de RSC. Per dur-lo a terme amb coherència, claredat i, sobretot, perquè pugui arribar a ser útil per a la gestió i govern de l’organització, serà necessari definir-lo i emmarcar-lo en els àmbits i temàtiques que té que contenir i el procediment per elaborar-lo. Tot informe precisa d’anàlisis per a avaluar la qualitat de la informació reflexada i, d’aquesta manera, poder realitzar accions correctores oportunes. Mitjançant la definició d’una sèrie d’indicadors de desenvolupament i altres, intentarem aproximar-nos a l’anàlisi dels continguts de les memòries de les empreses que componen l’IBEX-35 de l’any 2006, ja que podem considerar-les com les més representatives i més influents d’Espanya. Amb tot això sabrem quina és la situació en l’àmbit general dels informes que presenten aquestes empreses i podrem recomanar per a que les empreses puguin completar-lo i respondre més eficientment les necessitats dels futurs lectors d’aquest informe i obtenir millor imatge corporativa.

Alveolar echinococcosis: from a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years.

BACKGROUND/AIMS: Alveolar echinococcosis (AE) is a serious liver disease. The aim of this study was to explore the long-term prognosis of AE patients, the burden of this disease in Switzerland and the cost-effectiveness of treatment. METHODS: Relative survival analysis was undertaken using a national database with 329 patient records. 155 representative cases had sufficient details regarding treatment costs and patient outcome to estimate the financial implications and treatment costs of AE. RESULTS: For an average 54-year-old patient diagnosed with AE in 1970 the life expectancy was estimated to be reduced by 18.2 and 21.3 years for men and women, respectively. By 2005 this was reduced to approximately 3.5 and 2.6 years, respectively. Patients undergoing radical surgery had a better outcome, whereas the older patients had a poorer prognosis than the younger patients. Costs amount to approximately Euro108,762 per patient. Assuming the improved life expectancy of AE patients is due to modern treatment the cost per disability-adjusted life years (DALY) saved is approximately Euro6,032. CONCLUSIONS: Current treatments have substantially improved the prognosis of AE patients compared to the 1970s. The cost per DALY saved is low compared to the average national annual income. Hence, AE treatment is highly cost-effective in Switzerland.

Long-term follow-up of patients with follicular lymphoma receiving single-agent rituximab at two different schedules in trial SAKK 35/98.

PURPOSE: We report the long-term results of a randomized clinical trial comparing induction therapy with once per week for 4 weeks single-agent rituximab alone versus induction followed by 4 cycles of maintenance therapy every 2 months in patients with follicular lymphoma. PATIENTS AND METHODS: Patients (prior chemotherapy 138; chemotherapy-naive 64) received single-agent rituximab and if nonprogressive, were randomly assigned to no further treatment (observation) or four additional doses of rituximab given at 2-month intervals (prolonged exposure). RESULTS: At a median follow-up of 9.5 years and with all living patients having been observed for at least 5 years, the median event-free survival (EFS) was 13 months for the observation and 24 months for the prolonged exposure arm (P < .001). In the observation arm, patients without events at 8 years were 5%, while in the prolonged exposure arm they were 27%. Of previously untreated patients receiving prolonged treatment after responding to rituximab induction, at 8 years 45% were still without event. The only favorable prognostic factor for EFS in a multivariate Cox regression was the prolonged rituximab schedule (hazard ratio, 0.59; 95% CI, 0.39 to 0.88; P = .009), whereas being chemotherapy naive, presenting with stage lower than IV, and showing a VV phenotype at position 158 of the Fc-gamma RIIIA receptor were not of independent prognostic value. No long-term toxicity potentially due to rituximab was observed. CONCLUSION: An important proportion of patients experienced long-term remission after prolonged exposure to rituximab, particularly if they had no prior treatment and responded to rituximab induction.

Gemcitabine, oxaliplatin and 5-FU in advanced bile duct and gallbladder carcinoma: two parallel, multicentre phase-II trials.

BACKGROUND: Gemcitabine, oxaliplatin and 5-fluorouracil (5-FU) are active in biliary tract cancer and have a potentially synergistic mode of action and non-overlapping toxicity. The objective of these trials was to determine response, survival and toxicity separately in patients with bile duct cancer (BDC) and gallbladder cancer (GBC) treated with gemcitabine/oxaliplatin/5-FU chemotherapy. METHODS: Eligible patients with histologically proven, advanced or metastatic BDC (n=37) or GBC (n=35) were treated with gemcitabine (900 mg m(-2) over 30 min), oxaliplatin (65 mg m(-2)) and 5-FU (1500 mg m(-2) over 24 h) on days 1 and 8 of a 21-day cycle. Tumour response was the primary outcome measure. RESULTS: Response rates were 19% (95% CI: 6-32%) and 23% (95% CI: 9-37%) for BDC and GBC, respectively. Median survivals were 10.0 months (95% CI: 8.6-12.4) and 9.9 months (95% CI: 7.5-12.2) for BDC and GBC, respectively, and 1- and 2-year survival rates were 40 and 23% in BDC and 34 and 6% in GBC (intention-to-treat analysis). Major grade III and IV adverse events were neutropenia, thrombocytopenia, elevated bilirubin and anorexia. CONCLUSION: Triple-drug chemotherapy achieves comparable results for response and survival to previously reported regimens, but with more toxicity.

Long-term follow-up of follicular lymphoma (FL) patients receiving single agent rituximab at two different schedules in trial SAKK 35/98

Background: In FL, Rituximab as a single agent delivered in the standard schedule (4 times weekly) may induce a response rate of 50−70% with an event-free survival (EFS) of 1−3 years according to patients' characteristics. Prolonged Rituximab exposure seems to improve EFS at least in responding patients and to increase the rate of longterm responders. Here we report long-term results of a clinical trial comparing single agent Rituximab delivered in the standard schedule versus prolonged exposure, with focus on the proportion of long-term responders and their characteristics. Material and Methods: Between 1998 and 2002, chemotherapy na¨ıve (n = 64) or pre-treated (n = 138) FL patients received Rituximab in the standard schedule. Those responding or with stable disease were randomized to no further treatment (observation, n = 78) or 4 additional doses of Rituximab given at 2-month intervals (prolonged exposure, n = 73). EFS was calculated from the first dose of standard schedule until progression, relapse, second tumor or death. Results: At a median follow up of 9.4 years and with all living patients having been followed for at least 5 years, the median EFS is 13 months for the observation and 24 months for the prolonged exposure arm (p = 0.0007). In the observation arm 13% had no event at 5-years and only 4% at 8 years, while in the prolonged exposure arm it was 27% at 5 years and remained 21% at 8 years. The only significant prognostic factor for EFS in a multivariate Cox regression was the prolonged Rituximab schedule (hazard ratio 0.58, CI 0.39−0.86, p = 0.007), whereas being chemotherapy na¨ıve, presenting with stage

Functional Characterization of a Novel Frameshift Mutation in the C-terminus of the Nav1.5 Channel Underlying a Brugada Syndrome with Variable Expression in a Spanish Family.

INTRODUCTION We functionally analyzed a frameshift mutation in the SCN5A gene encoding cardiac Na(+) channels (Nav1.5) found in a proband with repeated episodes of ventricular fibrillation who presented bradycardia and paroxysmal atrial fibrillation. Seven relatives also carry the mutation and showed a Brugada syndrome with an incomplete and variable expression. The mutation (p.D1816VfsX7) resulted in a severe truncation (201 residues) of the Nav1.5 C-terminus. METHODS AND RESULTS Wild-type (WT) and mutated Nav1.5 channels together with hNavβ1 were expressed in CHO cells and currents were recorded at room temperature using the whole-cell patch-clamp. Expression of p.D1816VfsX7 alone resulted in a marked reduction (≈90%) in peak Na(+) current density compared with WT channels. Peak current density generated by p.D1816VfsX7+WT was ≈50% of that generated by WT channels. p.D1816VfsX7 positively shifted activation and inactivation curves, leading to a significant reduction of the window current. The mutation accelerated current activation and reactivation kinetics and increased the fraction of channels developing slow inactivation with prolonged depolarizations. However, late INa was not modified by the mutation. p.D1816VfsX7 produced a marked reduction of channel trafficking toward the membrane that was not restored by decreasing incubation temperature during cell culture or by incubation with 300 μM mexiletine and 5 mM 4-phenylbutirate. CONCLUSION Despite a severe truncation of the C-terminus, the resulting mutated channels generate currents, albeit with reduced amplitude and altered biophysical properties, confirming the key role of the C-terminal domain in the expression and function of the cardiac Na(+) channel.

Hottentottisch. 5 : Nama, Bergdamaramundart : Homonyme ; Hottentottisch. 6 : Nama, Bergdamaramundart : einzelne Sätze / gespr. von Missionar Baumann

[Traditions. Afrique du sud. Namibie. Khoïkhoï]

Quality Assessment of Cardiac Magnetic Resonance Images at 1.5/3.0 T: Description and Validation of Standardized Criteria

PURPOSE: Cardiovascular magnetic resonance (CMR) has become a robust and important diagnostic imaging modality in cardiovascular medicine. However,insufficient image quality may compromise its diagnostic accuracy. No standardized criteria are available to assess the quality of CMR studies. We aimed todescribe and validate standardized criteria to evaluate the quality of CMR studies including: a) cine steady-state free precession, b) delayed gadoliniumenhancement, and c) adenosine stress first-pass perfusion. These criteria will serve for the assessment of the image quality in the setting of the Euro-CMR registry.METHOD AND MATERIALS: First, a total of 45 quality criteria were defined (35 qualitative criteria with a score from 0-3, and 10 quantitative criteria). Thequalitative score ranged from 0 to 105. The lower the qualitative score, the better the quality. The quantitative criteria were based on the absolute signal intensity (delayed enhancement) and on the signal increase (perfusion) of the anterior/posterior left ventricular wall after gadolinium injection. These criteria were then applied in 30 patients scanned with a 1.5T system and in 15 patients scanned with a 3.0T system. The examinations were jointly interpreted by 3 CMR experts and 1 study nurse. In these 45 patients the correlation between the results of the quality assessment obtained by the different readers was calculated.RESULTS: On the 1.5T machine, the mean quality score was 3.5. The mean difference between each pair of observers was 0.2 (5.7%) with a mean standarddeviation of 1.4. On the 3.0T machine, the mean quality score was 4.4. The mean difference between each pair of onservers was 0.3 (6.4%) with a meanstandard deviation of 1.6. The quantitative quality assessments between observers were well correlated for the 1.5T machine: R was between 0.78 and 0.99 (pCONCLUSION: The described criteria for the assessment of CMR image quality are robust and have a low inter-observer variability, especially on 1.5T systems.CLINICAL RELEVANCE/APPLICATION: These criteria will allow the standardization of CMR examinations. They will help to improve the overall quality ofexaminations and the comparison between clinical studies.

Derivats financers al mercat espanyol: el Model de Black-Scholes i corbes de volatilitat per opcions sobre l'índex niniIBEX-35

El nostre treball es centrarà en conèixer i aprendre les nocions bàsiques del mercat financer espanyol, primer; i aplicar uns coneixements per veure si es verifica unahipòtesi plantejada, després. La incògnita que volem resoldre és la següent: comprovarsi tots els supòsits i resultats que faciliten els models teòrics emprats en l’estudi dels mercats financers a l’hora de la veritat es compleixen.D’entre els múltiples conceptes que ens proporcionen els estudis de mercatsfinancers ens centrarem sobretot en el model de Black-Scholes i els somriures devolatilitat per desenvolupar el nostre treball. Després de cercar les dades necessàries a través de la web del M.E.F.F., entrevistar-nos amb professionals del sector i fer un seguiment d’aproximadament dos mesos dels moviments de les opcions sobre l’Índex Mini-Íbex 35, amb l’ajuda d’un programa informàtic en llenguatge C, hem calculat les corbes de volatilitat de les opcions sobre l’Índex Mini-Íbex 35.Les conclusions més importants que hem extret són que el Model de Black-Scholes, malgrat va revolucionar el món dels mercats financers, està basat en 2 supòsits que no es compleixen a la realitat: la distribució lognormal del preu de les accions i unavolatilitat constant. Tal i com hem pogut comprovar, la corba de volatilitat de lesopcions sobre l’Índex Mini-Íbex 35 és decreixent amb el preu d’exercici i laMoneyness, tal i com sostenen les teories dels somriures de volatilitat; per tant, no és constant. A més, hem comprovat que a mesura que s’apropa el venciment d’una opció,el preu acordat de l’actiu subjacent a l’opció s’apropa al preu de mercat.

A non-interventional phase IV Belgian survey to assess the antiviral effectiveness of pegylated interferon-alpha-2b and ribavirin treatment according to the stage of liver fibrosis in previously untreated patients with genotype 1/4/5/6 chronic hepatitis C (PRACTICE).

BACKGROUND AND STUDY AIMS: This was an observational, non-interventional, multicenter, phase IV study, in patients with genotype 1/4/5/6 chronic hepatitis C (CHC). The primary objectives were to evaluate SVR in patients with no or minimal fibrosis (METAVIR F0-F1) versus well established fibrosis (F2-F4), and to estimate response on Weeks 12, 24 and 48 on treatment in previously untreated patients with genotypes 1/4/5/6 CHC. PATIENTS AND METHODS: 538 patients treated with pegylated interferon alfa 2b 1.5 mcg/kg in combination with ribavirin 800-1200 mg/day were enrolled in 55 sites in Belgium and Luxembourg, 505 being considered for the analysis. 40% of the patients were female and 60% male, the average age was 47.5 years, 10.5% were 65 or older. RESULTS: SVR was observed in 35% of the patients, EVR in 68%, of which pEVR in 33% and cEVR in 35%. SVR was observed in 43% of the low fibrosis group (F0, F1) and 30% of the high fibrosis group (F2, F3, F4) (p = 0.005). SVR rates were 34% for genotype 1, 37% for genotype 4, and 47% for genotype 5 (NS). Multivariate analysis showed that EVR and baseline METAVIR score are independent prognostic factors for SVR. CONCLUSIONS: This trial confirms that fibrosis stage and early viral response are the most important key-factors to predict sustained response, suggesting that the earlier patients are treated, the better the outcome. Non-invasive techniques enable us to closely monitor progression of fibrosis, allowing a better selection of patients for antiviral treatment in the DAA-era.