TRAUMA, REABILITAÇÃO E QUALIDADE DE VIDA

This article presents a review of the literature, based on articles published from July, 2002 until May, 2007. It aims to analyze questions related to different types of traumas and their relationships with the rehabilitation programs and quality of life. This review was realized through a search into the international databases Medline,Scielo and Lilacs.The selected articleswere divided in four categories, in two different axis of analysis, based in the International Classification of Functionality: 1. structures and functions of the body (medical-surgical and functional aspects, and validation of protocols) and 2. Activities and social participation (psychosocial aspects). Finally, ahead of the changes related with trauma and based in the results and discussion that the articles presented, we emphasize the importance of the multidisciplinary work of the rehabilitation team, in particular the contribution of the occupational therapy, and the necessity of quality of life promotion of these populations in the physical aspects, as well in emotional, social and familiar.Este trabalho apresenta uma revisão da literatura, baseada em artigos publicados no período de julho de 2002 a maio de 2007. Procuramos analisar questões referentes a diversos tipos de traumas e suas relações com os programas de reabilitação e qualidade de vida. A revisão foi realizada a partir da consulta às bases de dados internacionais Medline, Scielo e Lilacs e os artigos selecionados foram divididos em quatro categorias, dentro de dois eixos de análise, baseados na Classificação Internacional de Funcionalidade . 1. estruturas e funções do corpo, (aspectos clínico-cirúrgicos e funcionais e validação de protocolos) e 2. atividades e participação social (aspectos psicossociais). Por fim, diante das mudanças decorrentes do trauma e baseados nos resultados e discussões que os artigos apresentam, enfatizamos a importância do trabalho multidisciplinar da equipe de reabilitação, em particular a contribuição da Terapia Ocupacional, e a necessidade de promoção da qualidade de vida destas populações, tanto nos aspectos físicos, como emocionais e sócio-familiar

Status of the SIRGAS reference frame: recent developments and new challenges

In accordance with recent developments of the International Association of Geodesy (IAG) and the policies promoted by the Subcommittee on Geodesy of the United Nations Committee of Experts on Global Geospatial Information Management (UN-GGIM), a main goal of the Geodetic Reference System for the Americas (SIRGAS) is the procurement of an integrated regional reference frame. This frame should support the precise determination of geocentric coordinates and also provide a unified physical reference frame for gravimetry, physical heights, and a geoid. The geometric reference frame is determined by a network of about 500 continuously operating GNSS stations, which are routinely processed by ten analysis centers. The GNSS solutions from the analysis centers are used to generate weekly station positions aligned to the International Terrestrial Reference Frame (ITRF) and multi-year (cumulative) reference frame solutions. This processing is also the basis for the generation of precise tropospheric zenith path delays with an hourly sampling rate over the Americas. The reference frame for the determination of physical heights is a regional densification of the International Height Reference Frame (IHRF). Current efforts focus on the estimation and evaluation of potential values obtained from high resolution gravity field modelling, an activity tightly coupled with geoid determination. The gravity reference frame aims to be a regional densification of the International Terrestrial Gravity Reference Frame (ITGRF). Thus, SIRGAS activities are focused on evaluating the quality of existing absolute gravity stations and to identify regional gaps where additional absolute gravity stations are needed. Another main goal of SIRGAS is to promote the use of its geodetic reference frame at the national level and to support capacity building activities in the region. This paper summarizes key milestones in the establishment and maintenance of the SIRGAS reference frame and discusses current efforts and future challenges.Fil: Alves Costa, Sonia M.. Instituto Brasileiro de Geografia E Estatística; BrasilFil: Sanchez, Laura. Technische Universität München; AlemaniaFil: Piñon, Diego. Ministerio de Defensa. Instituto Geografico Nacional; ArgentinaFil: Tarrio Mosquera, Jose A.. Universidad de Santiago de Chile; ChileFil: Guimaraes, Gabriel. Universidade Federal de Uberlandia; BrasilFil: Demian Gomez. Ohio University; Estados UnidosFil: Drewes, Hermann. Deutsches Geodätisches Forschungsinstitut; AlemaniaFil: Mackern Oberti, María Virginia. Universidad Nacional de Cuyo. Facultad de Ingeniería; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Antokoletz, Ezequiel Darío. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: de Matos, Ana C. O.C. Universidade de Sao Paulo; BrasilFil: Blitzkow, Denizar. Universidade de Sao Paulo; Brasi

The Barretos Cancer Hospital Animal Facility: implementation and results of a dedicated platform for preclinical oncology models

The Barretos Cancer Hospital Animal Facility (BCHAF) is a unique facility in Brazil exclusively dedicated to working with animal models for cancer research. In this article, we briefly present our modern facility and the main experiments performed, focusing on mutant strains of mice (PTCH-knockout and ApcMin mice), xenograft models, and patient-derived xenografts (PDXs). Our results show the progress and challenges in establishing these models and the need for having an appropriate representation of our cancer population to better understand tumor biology and to identify cancer biomarkers, which could be putatively targeted, allowing for personalized therapy.This study was funded by the Public Ministry of Labor Campinas (Research, Prevention and Education of Occupational Cancer) and by Pio XII Foundation, Barretos Cancer Hospital internal funds, Grant Number: 13/2021

Qualidade de vida de vítimas de trauma seis meses após a alta hospitalar

OBJECTIVE: Trauma is the third most important cause of death in Brazil. However, its impact on survivors' quality of life has been scarcely studied in this country. This study aimed to assess trauma victims' quality of life, cared for in an emergency hospital unit, six months after discharge. METHODS: A total of 35 patients from the emergency unit of a university hospital in the city of Ribeirão Preto, Southeastern Brazil, were included in this study, between 2005 and 2006. Patients were interviewed in their homes, six months after hospital discharge. The short version of the World Health Organization Quality of Life (WHOQOL-BREF) instrument was applied to assess the physical, psychological, social relationships, and environmental domains. Associations between domain scores and hospital stay, age, sex and Injury Severity Score variables were analyzed with linear regression models. RESULTS: Significant reduction in quality of life was found in the group studied, when compared to samples of normal people in national and international studies, especially as regards the physical, psychological, and environmental domains. The social relationships domain revealed the highest mean scores, with 69.7 points, whereas the environmental domain received the lowest score (52.4 points), both on the percentage scale. Variables associated with the physical domain were hospital stay (p=0.02), age (pOBJETIVO: El trauma ocupa el tercer lugar entre las causas de muerte en Brasil. Sin embargo, su impacto en la calidad de vida de los sobrevivientes ha sido poco estudiado en el país. El objetivo del estudio fue evaluar la calidad de vida de víctimas de trauma atendidas en unidad hospitalaria de emergencia, seis meses después del alta hospitalaria. MÉTODOS: Fueron incluidos 35 pacientes de unidad de emergencia de hospital universitario de Ribeirao Preto (Sureste de Brasil), entre 2005 y 2006. Los pacientes fueron entrevistados en sus domicilios, seis meses después de haber recibido el alta hospitalaria. Fue aplicado el instrumento "World Health Organization Quality of Life", versión corta, para evaluación de los dominios físico, psicológico, relaciones sociales y medio ambiente. Las asociaciones entre los escores de los dominios y las variables permanencia hospitalaria, edad, sexo y "Injury Severity Store" fueron exploradas por modelo de regresión lineal. RESULTADOS: Se observó disminución significativa en la calidad de vida del grupo estudiado, cuando se compara con muestras de personas normales en estudios nacionales e internacionales, en particular en los dominios físico, psicológico y de medio ambiente. El dominio relaciones sociales presentó el mayor promedio de escores, con 69,7 puntos, mientras que el dominio medio ambiente recibió la menor puntuación (52,4), ambos en la escala de porcentaje. Las variables asociadas a dominio físico fueron permanencia hospitalaria (p=0,02), edad (pOBJETIVO: O trauma ocupa o terceiro lugar dentre as causas de morte no Brasil. Contudo, seu impacto na qualidade de vida dos sobreviventes tem sido pouco estudado no País. O objetivo do estudo foi avaliar a qualidade de vida de vítimas de trauma atendidas em unidade hospitalar de emergências, seis meses após a alta hospitalar. MÉTODOS: Foram incluídos 35 pacientes de unidade de emergência de hospital universitário de Ribeirão Preto (SP), entre 2005 e 2006. Os pacientes foram entrevistados em seus domicílios, seis meses após terem tido alta hospitalar. Foi aplicado o instrumento World Health Organization Quality of Life, versão breve, para avaliação dos domínios físico, psicológico, relações sociais e meio ambiente. As associações entre os escores dos domínios e as variáveis permanência hospitalar, idade, sexo e Injury Severity Score foram exploradas por modelos de regressão linear. RESULTADOS: Observou-se diminuição significativa na qualidade de vida do grupo estudado, quando comparado a amostras de pessoas normais em estudos nacionais e internacionais, em particular nos domínios físico, psicológico e de meio ambiente. O domínio relações sociais apresentou a maior média de escores, com 69,7 pontos, enquanto o domínio meio ambiente recebeu a menor pontuação (52,4), ambos na escala percentual. As variáveis associadas a domínio físico foram permanência hospitalar (p=0,02), idade (

TLR9 activation dampens the early inflammatory response to paracoccidioides brasiliensis, Impacting host survival

Background: Paracoccidioides brasiliensis causes paracoccidioidomycosis, one of the most prevalent systemic mycosis in Latin America. Thus, understanding the characteristics of the protective immune response to P. brasiliensis is of interest, as it may reveal targets for disease control. The initiation of the immune response relies on the activation of pattern recognition receptors, among which are TLRs. Both TLR2 and TLR4 have been implicated in the recognition of P. brasiliensis and regulation of the immune response. However, the role of TLR9 during the infection by this fungus remains unclear.J.F. Menino was supported by a grant from Fundacao para a Ciencia e Tecnologia (FCT), Portugal (SFRH/BD/33446/2008). This work was supported by a grant from FCT (PTDC/BIA-MIC/108309/2008). M. Saraiva is a Ciencia 2007 fellow and M. Sturme is a Ciencia 2008 fellow. We would also like to thank FAPESP (Fundacao para Amparo a Pesquisa do Estado de Sao Paulo) and CNPq (Conselho Nacional de Desenvolvimento Cientifico e Tecnologico) for financial support. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Phenotypical, Clinical, and Molecular Aspects of Adults and Children With Homozygous Familial Hypercholesterolemia in Iberoamerica

Fil: Alves, Ana Catarina. Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa; Portugal.Fil: Alonso, Rodrigo. Center for Advanced Metabolic Medicine and Nutrition, Santiago; Chile.Fil: Diaz-Diaz, José Luís. Hospital Universitario A Coruña. Department of Internal Medicine; España.Fil: Medeiros, Ana Margarida. Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa; Portugal.Fil: Jannes, Cinthia E. University of São Paulo. Medical School. Hospital São Paulo. Heart Institute (InCor); Brasil.Fil: Merchan, Alonso. Fundación Clinica SHAIO, Cardiología, Bogotá; Colombia.Fil: Vasques-Cardenas, Norma A. Universidad Autónoma de Guadalajara. Facultad de Medicina Zapopan; México.Fil: Cuevas, Ada. Center for Advanced Metabolic Medicine and Nutrition, Santiago; Chile.Fil: Chacra, Ana Paula. University of São Paulo. Medical School. Hospital São Paulo. Heart Institute (InCor); Brasil.Fil: Krieger, Jose E. University of São Paulo. Medical School. Hospital São Paulo. Heart Institute (InCor); Brasil.Fil: Arroyo, Raquel. Fundación Hipercolesterolemia Familiar, Madrid; España.Fil: Arrieta, Francisco. Hospital Ramón y Cajal. Departamento de Endocrinología, Madrid; España.Fil: Schreier, Laura. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica, Laboratorio de Lípidos y Aterosclerosis; Argentina.Fil: Corral, Pablo. Universidad FASTA. Facultad de Medicina. Cátedra Farmacología e Investigación, Mar del Plata; Argentina.Fil: Bañares, Virginia. ANLIS Dr.C.G.Malbrán. Centro Nacional de Genética Médica. Departamento de Genética Experimental; Argentina.Fil: Araujo, Maria B. Hospital Garrahan. Servicio de Nutrición; Argentina.Fil: Bustos, Paula. Universidad de Concepción. Facultad de Farmacia; Chile.Fil: Asenjo, Sylvia. Universidad de Concepción. Facultad de Medicina; Chile.Fil: Stoll, Mario. Programa GENYCO, Laboratorio de Genética Molecular. Comisión Honoraria de Salud Cardiovascular, Montevideo; Uruguay.Fil: Dell'Oca, Nicolás. Programa GENYCO, Laboratorio de Genética Molecular. Comisión Honoraria de Salud Cardiovascular, Montevideo; Uruguay.Fil: Reyes, Maria. Fundación Cardiovascular de Colombia. Cardiología; Bogotá.Fil: Ressia, Andrés. Fundación Cardiovascular de Colombia. Cardiología; Bogotá.Fil: Campo, Rafael. Instituto Mexicano del Seguro Social. Centro de Investigación Biomédica del Occidente, Guadalajara; México.Fil: Magaña-Torres, Maria T. Instituto Nacional de Ciencias Médicas y Nutrición. Unidad de Investigación de Enfermedades Metabólicas; México.Fil: Metha, Roopa. Instituto Nacional de Ciencias Médicas y Nutrición. Unidad de Investigación de Enfermedades Metabólicas; México.Fil: Aguilar-Salinas, Carlos A. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Departamento de Endocrinología y Metabolismo. Secretaría de la Defensa Nacional. Unidad de Especialidades Médicas. Servicio de Endocrinología; México.Fil: Ceballos-Macias, José J. Pontificia Universidad Javerina. Facultad de Medicina. Departamento de Medicina Interna, Bogotá; Colombia.Fil: Ruiz Morales, Álvaro J. Pontificia Universidad Javerina. Facultad de Medicina. Departamento de Medicina Interna, Bogotá; Colombia.Fil: Mata, Pedro. Fundación Hipercolesterolemia Familiar, Madrid; España.Fil: Bourbon, Mafalda. Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa; Portugal.Fil: Santos, Raul D. University of São Paulo. Medical School. Hospital São Paulo. Heart Institute (InCor); Brasil.OBJECTIVE: Characterize homozygous familial hypercholesterolemia (HoFH) individuals from Iberoamerica. APPROACH AND RESULTS: In a cross-sectional retrospective evaluation 134 individuals with a HoFH phenotype, 71 adults (age 39.3±15.8 years, 38.0% males), and 63 children (age 8.8±4.0 years, 50.8% males) were studied. Genetic characterization was available in 129 (96%). The majority (91%) were true homozygotes (true HoFH, n=79, 43.0% children, 46.8% males) or compound heterozygotes (compound heterozygous familial hypercholesterolemia, n=39, 51.3% children, 46.2% males) with putative pathogenic variants in the LDLR. True HoFH due to LDLR variants had higher total (P=0.015) and LDL (low-density lipoprotein)-cholesterol (P=0.008) compared with compound heterozygous familial hypercholesterolemia. Children with true HoFH (n=34) tended to be diagnosed earlier (P=0.051) and had a greater frequency of xanthomas (P=0.016) than those with compound heterozygous familial hypercholesterolemia (n=20). Previous major cardiovascular events were present in 25 (48%) of 52 children (missing information in 2 cases), and in 43 (67%) of 64 adults with LDLR variants. Children who are true HoFH had higher frequency of major cardiovascular events (P=0.02), coronary heart (P=0.013), and aortic/supra-aortic valve diseases (P=0.022) than compound heterozygous familial hypercholesterolemia. In adults, no differences were observed in major cardiovascular events according to type of LDLR variant. From 118 subjects with LDLR variants, 76 (64%) had 2 likely pathogenic or pathogenic variants. In 89 subjects with 2 LDLR variants, those with at least one null allele were younger (P=0.003) and had a greater frequency of major cardiovascular events (P=0.038) occurring at an earlier age (P=0.001). CONCLUSIONS: There was a high frequency of cardiovascular disease even in children. Phenotype and cardiovascular complications were heterogeneous and associated with the type of molecular defect

Development of a World Health Organization International Reference Panel for different genotypes of hepatitis E virus for nucleic acid amplification testing.

Globally, hepatitis E virus (HEV) is a major cause of acute viral hepatitis. Epidemiology and clinical presentation of hepatitis E vary greatly by location and are affected by the HEV genotype. Nucleic acid amplification technique (NAT)-based assays are important for the detection of acute HEV infection as well for monitoring chronic cases of hepatitis E. The aim of the study was to evaluate a panel of samples containing different genotypes of HEV for use in nucleic NAT-based assays. The panel of samples comprises eleven different members including HEV genotype 1a (2 strains), 1e, 2a, 3b, 3c, 3e, 3f, 4c, 4g as well as a human isolate related to rabbit HEV. Each laboratory assayed the panel members directly against the 1 World Health Organization (WHO) International Standard (IS) for HEV RNA (6329/10) which is based upon a genotype 3 a strain. The samples for evaluation were distributed to 24 laboratories from 14 different countries and assayed on three separate days. Of these, 23 participating laboratories returned a total of 32 sets of data; 17 from quantitative assays and 15 from qualitative assays. The assays used consisted of a mixture of in-house developed and commercially available assays. The results showed that all samples were detected consistently by the majority of participants, although in some cases, some samples were detected less efficiently. Based on the results of the collaborative study the panel (code number 8578/13) was established as the "1st International Reference Panel (IRP) for all HEV genotypes for NAT-based assays" by the WHO Expert Committee on Biological Standardization. This IRP will be important for assay validation and ensuring adequate detection of different genotypes and clinically important sub-genotypes of HEV

Genomics and epidemiology for gastric adenocarcinomas (GE4GAC): a Brazilian initiative to study gastric cancer

Abstract Gastric cancer (GC) is the fifth most common type of cancer worldwide with high incidences in Asia, Central, and South American countries. This patchy distribution means that GC studies are neglected by large research centers from developed countries. The need for further understanding of this complex disease, including the local importance of epidemiological factors and the rich ancestral admixture found in Brazil, stimulated the implementation of the GE4GAC project. GE4GAC aims to embrace epidemiological, clinical, molecular and microbiological data from Brazilian controls and patients with malignant and pre-malignant gastric disease. In this letter, we summarize the main goals of the project, including subject and sample accrual and current findings

Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA

Purpose: Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown. Methods: In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis. Results: Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0–1.00) and 85.9% (75.4–92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20–2.92) or receiving a written TLD (HR 2.32, CI 1.11–4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former. Conclusion: Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life