CURB-65 and Other Markers of Illness Severity in Community-Acquired Pneumonia Among HIV-Positive Patients

As the relative burden of community-acquired bacterial pneumonia among HIV-positive patients increases, adequate prediction of case severity on presentation is crucial. We sought to determine what characteristics measurable on presentation are predictive of worse outcomes. We studied all admissions for community-acquired bacterial pneumonia over one year at a tertiary centre. Patient demographics, comorbidities, HIV-specific markers and CURB-65 scores on Emergency Department presentation were reviewed. Outcomes of interest included mortality, bacteraemia, intensive care unit admission and orotracheal intubation. A total of 396 patients were included: 49 HIV-positive and 347 HIV-negative. Mean CURB-65 score was 1.3 for HIV-positive and 2.2 for HIV-negative patients (p < 0.0001), its predictive value for mortality being maintained in both groups (p = 0.03 and p < 0.001, respectively). Adjusting for CURB-65 scores, HIV infection by itself was only associated with bacteraemia (adjusted odds ratio [AOR] 7.1, 95% CI [2.6-19.5]). Patients with < 200 CD4 cells/µL presented similar CURB-65 adjusted mortality (aOR 1.7, 95% CI [0.2-15.2]), but higher risk of intensive care unit admission (aOR 5.7, 95% CI [1.5-22.0]) and orotracheal intubation (aOR 9.1, 95% CI [2.2-37.1]), compared to HIV-negative patients. These two associations were not observed in the > 200 CD4 cells/µL subgroup (aOR 2.2, 95% CI [0.7-7.6] and aOR 0.8, 95% CI [0.1-6.5], respectively). Antiretroviral therapy and viral load suppression were not associated with different outcomes (p > 0.05). High CURB-65 scores and CD4 counts < 200 cells/µL were both associated with worse outcomes. Severity assessment scales and CD4 counts may both be helpful in predicting severity in HIV-positive patients presenting with community-acquired bacterial pneumonia.

Liver resection for hemoperitoneum caused by spontaneous rupture of unrecognized hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is an increasingly common form of cancer. Although its spontaneous rupture is rare in Western countries, it constitutes a surgical emergency and is associated with high mortality. There is a lack of consensus as to the best approach and what parameters to use in choosing it. The three main approaches are conservative, endovascular and resection - the treatment of choice for acute abdominal bleeding. We report a case of hemoperitoneum following the spontaneous rupture of an unrecognized HCV-related HCC in a patient with no history of liver disease. The patient was successfully treated by emergency surgery, with resection of two segments of the left liver.

Influence of P53 on the radiotherapy response of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and it has a poor prognosis and few therapeutic options. Radiotherapy is one of the most effective forms of cancer treatment, and P53 protein is one of the key molecules determining how a cell responds to radiotherapy. The aim of this study was to determine the therapeutic efficacy of iodine-131 in three human HCC cell lines.

Qualidade dos sistemas de informação no serviço de radiologia do Hospital de Curry Cabral

A preocupação com a qualidade dos serviços prestados pelas organizações de saúde é uma realidade. Em resultado de várias pressões e diferentes metodologias têm sido implementadas nas instituições Sistemas de Informação a fim de melhorar a qualidade e segurança dos procedimentos aí desenvolvidos. A qualidade dos Sistemas de Informação assume um destaque pela sua componente de mais-valia, neste trabalho procuramos avalia-la e verificar a sua correta implementação. A presente dissertação reporta-se ao estudo dos Sistemas de informação no Serviço de Radiologia do HCC, tendo como objetivo principal saber se os Sistemas de Informação, potenciaram a melhoria da qualidade de desempenho dos profissionais de saúde, assim como caracterizar a qualidade dos Sistemas de Informação. Como estratégia de pesquisa optamos por um estudo de natureza descritiva, utilizando um modelo de análise quantitativo. Aplicou-se um questionário elaborado pela investigadora, tendo sido aceites as respostas de 55 questionários realizados aos utilizadores dos SI. De uma forma geral os resultados demonstram que os Sistemas de Informação foram bem aceites por parte dos profissionais deste serviço, existindo porem algumas deficiências que não permite que se atinja níveis de qualidade elevados. Relativamente à formação depreendemos que existem algumas lacunas relativas ao processo de formação dos utilizadores, que podem ser colmatadas por uma intervenção adequada. ABSTRACT: The concern about the quality of the accounted services by the health organizations is a reality. Information Systems have been installed in many establishments as a result of many pressures and different methodologies in order to improve the quality and safety of the procedures developed in such places. The quality of the Information Systems gains relevance due to its “rise” character; on this essay we aimed to evaluate and verify its adequate execution. The present essay is about the study of the Information Systems on the Radiology Service of Hospital Curry Cabral (HCC) being its main objective to know if the Information Systems improved the performance of the health professionals, as well as to point out their quality. We decided to build a study of descriptive nature using a quantitative analysis method. We applied an inquiry elaborated by the researcher and accepted the answers of 55 inquiries made to the SI users. In general, the results revealed that the Information Systems were well accepted by the professionals of this service. However, some minor problems do not allow high standard of quality to be obtained. As regards training we understand that there are a few defaults concerning the process of formation of the users which can be surpassed if using an adequate intervention.

Rôle de SOCS1 dans l’immunogénicité de la tumeur en particulier au niveau du carcinome hépatocellulaire

Résumé : Le carcinome hépatocellulaire (HCC) est la troisième cause commune de décès de cancer et affecte plus les hommes que les femmes. Le HCC résulte d’une dérégulation des voies de signalisation impliquées dans l’initiation de l’inflammation menant ainsi à des répercussions désastreuses. De part la complexité de ce type de cancer, les traitements qui existent à ce jour ne sont pas très prometteurs et ont un faible pourcentage de « rémission ». L’immunothérapie soulève beaucoup d’espoir quant à l’orientation vers un traitement efficace plausible. En effet, plusieurs suppresseurs de tumeur se retrouvent réprimés, parmi lesquels le SOCS1. C’est dans cette optique que nos recherches se sont orientées en mettant la lumière sur le SOCS1 «suppresseur de signalisation des cytokines 1 (SOCS1) » qui est réprimé au niveau du HCC et dont la restauration pourrait contribuer à un pronostic favorable à la rémission. La protéine SOCS1 a beaucoup attisé la curiosité des chercheurs de part son rôle suppresseur de tumeur. Pour comprendre les mécanismes d’action de SOCS1 et son implication dans la neutralisation de la tumeur, nous avons généré trois types stables de la lignée cellulaire du carcinome hépatocellulaire de souris Hepa1-6, une portant un vecteur vide, l’autre exprimant le type sauvage du gène SOCS1 (SOCS1-WT; Hepa-S) et une portant une mutation au niveau du domaine SH2 (SOCS1-R105K; Hepa-R). Le mutant ne peut plus inhiber la signalisation des cytokines. Lors de l'implantation sous-cutanée des cellules Hepa1-6 modifiées, chez des souris C57BL/6 et NOD.scid.gamma (NSG). Nous avons observé que les cellules Hepa1-6 exprimant le vecteur de contrôle (Hepa-V) formaient de grosses tumeurs tandis que les cellules Hepa-S formaient de petites tumeurs chez les deux types de souris. Les cellules Hepa-R quant à elles, formaient de grosses tumeurs seulement chez des souris immunodéficientes (NSG) mais montraient une croissance nettement retardée lorsqu’elles étaient greffées aux souris (C57BL/6) immunocompétentes. Partant de ce constat intrigant, nous avons postulé que SOCS1 favorise l'immunogénicité des cellules tumorales par son domaine SOCS Box. Par conséquent, les cellules Hepa-R offrent une occasion unique de démêler le potentiel pro-immunogène de SOCS1, et ceci dans le but d'élucider les fonctions immunogènes de SOCS1 dans le cancer du foie. Jusqu'à présent aucune précédente recherche ne s’est aventurée à chercher l’implication de SOCS1 dans l’augmentation de l’immunogénicité.