L’hypoalbuminémie dans les premières 24 heures de l’admission est associée avec la dysfonction d’organes chez les patients brûlés

L’hypoalbuminémie est une trouvaille fréquente chez le patient brulé mais sa relation avec la morbidité et mortalité n’a pas été bien établie. Objectif : Déterminer si l’hypoalbuminémie dans les premières 24 heures suivant l’admission est associée avec la dysfonction d’organes (mesurée avec le score SOFA) chez les patients présentant des brûlures graves. Méthodologie : Nous avons révisé les dossiers médicaux des patients adultes avec de brûlures de 20% ou plus de surface corporelle admis pendant les premières 24 heures à l’unité de grands brulés du CHUM entre les années 2008 et 2009. Nous avons utilisé un modèle de régression linéaire multivariée pour déterminer si l’hypoalbuminémie était un prédicteur indépendant de la dysfonction d’organes. Résultats : 56 sujets ont été analysés. L’analyse de régression linéaire multiple a montré qu’en contrôlant pour l’âge, le sexe, la surface corporelle brûlée et les brûlures par inhalation, l’hypoalbuminémie pendant les premières 24 heures suivant l’admission est un prédicteur indépendant de la dysfonction d’organes. Une concentration d’albumine ≤30g/L est aussi associée à une augmentation de la dysfonction d’organes [score SOFA au jour 0 (p = 0.005), jour 1 (p = 0.005), moyenne de la première semaine (p = 0.004)], mais n’est pas associée avec la mortalité (p = 0.061). Conclusions : L’hypoalbuminémie est associée avec la dysfonction d’organes chez les patients brulés. À la différence de facteurs non modifiables comme l’âge, le sexe, la surface corporelle brûlée et la présence de brûlures par inhalation, la correction de l’hypoalbuminémie peut être un objectif intéressant pour un futur essai clinique.

Infecciones en pacientes tratados con citorreducción peritoneal mas quimioterapia hipertérmica intraperitoneal

Introducción:Los individuos en quienes se realiza el sugarbaker tienen diagnósticos tumorales bien caracterizados. Actualmente no se dispone en la literatura médica universal de comparadores previos que permitan estimar la morbilidad relacionada específicamente con procesos infecciosos en pacientes sometidos al procedimiento, por tanto se presenta la caracterización de procesos febriles e infecciosos en el postoperatorio de la cohorte de pacientes intervenidos en la FSFB y de los factores de riesgo asociados a su manifestación. Métodos:Estudio descriptivo con componente analítico de una cohorte ambidireccional compuesta por pacientes intervenidos en la FSFB mediante el procedimiento de Sugarbaker. Resultados:En total se incluyeron en el estudio 53 pacientes consecutivos (37mujeres y 16hombres), quienes fueron llevados al procedimiento de peritonectomía radical más quimioterapia hipertérmica intraperitoneal entre el mes de nov/2007 y jun/2012 en el Hospital-Universitario Fundación Santa Fe de Bogotá. Los desenlaces de morbilidad asociada al procedimiento fueron caracterizados, indicando que las principales causas de morbilidad son los eventos tromboticos y las infecciones. Se caracterizaron como estadísticamente significativos para estancia hospitalaria el requerimiento transfusional (r=0,451, p=0,001), colecistectomía (p=0,016), el riesgo anestésico ASA≥3 (p=0,03), entre otros. El perfil de infección mostró relación estadísticamente significativa con resecciones de órganos específicas (p<0,05 para colectomía derecha [OR=5,3], colecistectomía [OR=21,8] y esplenectomía [OR=4,2]), el riesgo anestésico ASA≥3 (OR=1,2, p=0,036), anemia (OR=7,1, p=0,004), fístula (OR=5,2, p=0,036), entre otros. Conclusiones: El procedimiento de Sugarbaker es eficaz y seguro en nuestra institución. Se requiere de más estudios en poblaciones diversas que permitan comprender el comportamiento de las infecciones en la población sometida al procedimiento.

Dos direitos da personalidade e a lei de doação de órgãos: o que há para cartografar?

This study aimed at examining the representation and the level of knowledge as well as getting acquainted whether there had been significant divergence among three social groups of 3rd year Law students, 7th period Medical students at UFPB and a group of people from the Catholic Church in vila dos pescadores in João Pessoa - about organ donation, transplant law and ethical issues that raise questions. In order to accomplish the qualitative analysis, Bardin´s content analysis technique was applied in conjunction with the Chisquare test which was applied with significance level of 5% to quantitative data. The data revealed that most informants agree with organ donation, Although they are not acquainted with the law of transplants, and with the lack of confidence in the single list of recipients. The problem is that there is an encouragement to trades with organs and the possibility of any person legally authorized to donate organs in life. The statistically significant difference was observed in only two questions, ie, in response to the confidence in the diagnosis of brain death: 64% of 7th period Medical students at UFPB trust this diagnosis versus 12% of the evangelizing group of vila dos pescadores. The other difference refers to the answer about the confidence in the single list of recipients: 36% of the 7th period Medical students of UFPB said to trust the list versus 12% of the 3rd law students of UFPB. This is was a multidisciplinary study with Involvement of lawyers and doctors

Habilidades expressivas de um grupo de alunos com paralisia cerebral na atividade de jogo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Paracoccidioides brasiliensis isolated from armadillos is virulent to Syrian hamsters

Isolates of Paracoccidioides brasiliensis may vary in virulence according to time of in vitro subcultivation. The present study compared the morphology and pathogenicity to hamsters of two P. brasiliensis isolates: one obtained from human lesions and maintained in the laboratory for several years (Pb-18) and the other isolate recovered from hamsters inoculated with organ homogenates from armadillos (Pb-T). The microscopic morphology of Pb-18 and Pb-T showed yeast cells with similar diameter. However, Pb-T produced a significantly higher number of buds per mother cell than Pb-18. Besides, the mycelial form of Pb-T developed abundant sporulation during 8 weeks of culture which was absent in the Pb-18 isolate. Virulence studies demonstrated that mortality rates, antibody levels, fungal load and extent of lesions in the organs were significantly higher in animals infected with Pb-T. The results demonstrated that Pb-T recently isolated from an animal was more virulent than Pb-18. These differences between the two P. brasillensis isolates may be indicators of virulence attenuation in this fungal species.

Description of a new species of Pseudopaludicola Miranda-Ribeiro, 1926 from the state of São Paulo, Southeastern Brazil (Anura, Leiuperidae)

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

Isolamento e caracterização de promotores órgão-específicos a partir de informações do Banco FORESTs (Eucalyptus Genome Sequencing Project Consortium)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Associação de emissões vocais de macacos-prego (Cebus apella, Primate, Cebidae) a contextos comportamentais em cativeiro

A vocalização é uma importante forma de comunicação em primatas, pois a maioria das espécies vive em florestas densas, o que dificulta a comunicação visual à distância. A espécie Cebus apella apresenta um rico repertório de sinais vocais contextualizados a diversos comportamentos, como o forrageio alimentar, alerta a predadores, chamados de contato, chamados de corte, entre outros. Com o objetivo de elaborar um banco de dados (biblioteca sonora) de vocalizações de dezesseis indivíduos cativos da espécie Cebus apella, nós coletamos no biotério da Escola Experimental de Primatas, na Universidade Federal do Pará, vocalizações emitidas em ocorrências naturais (agonismo, contato) e em experimentos planejados (alimentação individual e alarme), editamos o material coletado e produzimos os sonogramas. Registramos e analisamos, pelo menos, dez emissões sonoras distintas agrupadas em diferentes contextos (alimentação, alarme, agonismo, contato) e mapeamos os comportamentos que não foram acompanhados de vocalizações. Foram feitas análises estatísticas das diferenças entre os chamados de machos e fêmeas na situação de alimentação individual. Nossos dados confirmaram que a espécie Cebus apella, possui um repertório vocal extenso, com chamados diferentes relacionados a comportamentos particulares, diferenças sexuais nos chamados e combinação de unidades sonoras, o que está de acordo com as indicações de plasticidade cerebral e complexidade social da espécie.

A new species of Pseudopaludicola Miranda-Ribeiro, 1926 (Anura: Leptodactylidae: Leiuperinae) from northwestern state of Sao Paulo, Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Entre santos e demônios: a percepção do mal na teologia e hagiografias do Reino Visigodo de Toledo (séculos VI-VII)

Pós-graduação em História - FCLAS

Pulsar da Medusa: um experimento de criação cênica e estudo da expressividade do corpo-voz a partir dos fatores do movimento de Rudolf Laban

Pós-graduação em Artes - IA

Pulsar da Medusa: um experimento de criação cênica e estudo da expressividade do corpo-voz a partir dos fatores do movimento de Rudolf Laban

Pós-graduação em Artes - IA

The effect of noise on the voice of preschool institution educators

OBJECTIVE: To analyze the association between noise levels present in preschool institutions and vocal disorders among educators. METHODS: Cross-sectional study conducted in 2009 with 28 teachers from three preschool institutions located in the city of Sao Paulo (Southeastern Brazil). Sound pressure levels were measured according to Brazilian Technical Standards Association, with the use of a sound level meter. The averages were classified according to the levels of comfort, discomfort, and auditory damage proposed by the Pan American Health Organization. The educators underwent voice evaluation: self-assessment with visual analogue scale, auditory perceptual evaluation using the GRBAS scale, and acoustic analysis utilizing the Praat program. To analyze the association between noise and voice evaluation, descriptive statistics and the chi-square test were employed, with significance of 10% due to sample size. RESULTS: The teachers' age ranged between 21 and 56 years. The noise average was 72.7 dB, considered as damage 2. The professionals' vocal self-assessment ranked an average of 5.1 on the scale, being considered as moderate alteration. In the auditory-perceptual assessment, 74% presented vocal alteration, especially hoarseness; of these, 52% were considered mild alterations. In the acoustic assessment the majority presented fundamental frequency below the expected level. Averages for jitter, shimmer and harmonic-noise ratio showed alterations. An association between the presence of noise between the harmonics and vocal disorders was observed. CONCLUSIONS: There is an association between presence of noise between the harmonics and vocal alteration, with high noise levels. Although most teachers presented mild voice alteration, the self-evaluation showed moderate alteration, probably due to the difficulty in projection.

Mining tissue microarray data to uncover combinations of biomarker expression patterns that improve intermediate staging and grading of clear cell renal cell cancer

PURPOSE: Tumor stage and nuclear grade are the most important prognostic parameters of clear cell renal cell carcinoma (ccRCC). The progression risk of ccRCC remains difficult to predict particularly for tumors with organ-confined stage and intermediate differentiation grade. Elucidating molecular pathways deregulated in ccRCC may point to novel prognostic parameters that facilitate planning of therapeutic approaches. EXPERIMENTAL DESIGN: Using tissue microarrays, expression patterns of 15 different proteins were evaluated in over 800 ccRCC patients to analyze pathways reported to be physiologically controlled by the tumor suppressors von Hippel-Lindau protein and phosphatase and tensin homologue (PTEN). Tumor staging and grading were improved by performing variable selection using Cox regression and a recursive bootstrap elimination scheme. RESULTS: Patients with pT2 and pT3 tumors that were p27 and CAIX positive had a better outcome than those with all remaining marker combinations. A prolonged survival among patients with intermediate grade (grade 2) correlated with both nuclear p27 and cytoplasmic PTEN expression, as well as with inactive, nonphosphorylated ribosomal protein S6. By applying graphical log-linear modeling for over 700 ccRCC for which the molecular parameters were available, only a weak conditional dependence existed between the expression of p27, PTEN, CAIX, and p-S6, suggesting that the dysregulation of several independent pathways are crucial for tumor progression. CONCLUSIONS: The use of recursive bootstrap elimination, as well as graphical log-linear modeling for comprehensive tissue microarray (TMA) data analysis allows the unraveling of complex molecular contexts and may improve predictive evaluations for patients with advanced renal cancer.

The role of lymphadenectomy in high risk prostate cancer

Historically, patients with high risk prostate cancer were considered poor candidates for radical prostatectomy (RP) due to the likelihood of positive pelvic lymph nodes and decreased long term survival. Although there is still no consensus on the optimal therapy for this group of patients, there is increasing evidence that surgery could play a role. Cancer specific survival (CSS) rates after RP for locally advanced disease at 10 year follow up range from 29 to 72%, depending on tumor differentiation. The role of pelvic lymph node dissection (PLND) in prostate cancer remains a controversial topic. Nonetheless, in conjunction with RRP extended PLND (ePLND) should be performed as extended lymph node dissection in lieu of standard PLND may increase staging accuracy, influence decision making with respect to adjuvant therapy and possibly impact outcome. High risk patients with organ confined prostate cancer and low volume (micro)metastatic disease may be the ones to profit most from this approach.