Cardiac transplantation: five years' activity

OBJECTIVE: To analyze the initial five years experience of the new heart transplant program of Coimbra University Hospitals. METHODS: Between November 2003 aid December 2008, 132 patients were transplanted, with a mean age of 52.0 years (range 3-71 years), of whom 98 were male (74%). Half of the patients had dilated cardiomyopathy and 33% ischemic cardiomyopathy. The mean age of donors was 31.7 years and 102 were male (77%). Donor hearts were harvested at a distance in 62% of cases. There was a gender mismatch between donor and recipient (F:M) in 19% of cases and ABO blood type disparity (not identical but compatible) in 11%. In all cases we used the technique of total transplantation with bicaval anastomosis, modified in this center. Mean ischemia time was 88.9 +/- 32.2 minutes. All patients received induction therapy with basiliximab and methylprednisolone. RESULTS: Six patients (4.5%) died within 30 days or during hospitalization, due to graft failure in four and hyperacute rejection in two. Two patients required prolonged ventilation, ten (8%) required inotropic support for more than 48 hours, and four required pacemaker implantation. Mean hospital stay was 15.6 +/- 15.2 days (median 13 days). Ninety percent of patients (116/129) were maintained on triple immunosuppressive therapy, including cyclosporine, the remainder receiving tacrolimus. In 23 patients it was necessary to change the immunosuppressive regimen due to renal and/or tumoral complications, or humoral rejection. All patients are followed regularly in the Surgical Center. Thirteen patients (10%) died late of cancer (6 patients), infection (4 patients), and pancreatitis, pulmonary hypertension and suicide (one patient each). Twenty-two patients (17%) had 25 episodes of cellular rejection (> or = 2R), with clinical consequences in only one case, and five had humoral rejection (3.9%). No patients died of late rejection, but there is evidence of mild graft vascular disease in one. Actuarial survival (Kaplan-Meier) at one and five years was 90% and 82%, respectively. CONCLUSION: In this initial series of five years we obtained results equivalent to or bette than those in centers with wider and longer experience, aided by self-correction arising from our own experience. This program has increased the rate of cardiac transplantation in Portugal to above the European average

A diabetes mellitus prévia não agrava o prognóstico no primeiro ano após a transplantação cardíaca

BACKGROUND AND AIMS: Heart transplantation remains the gold standard treatment for selected patients with end-stage heart failure. However, transplantation in diabetic patients remains controversial. The hyperglycemic effect of immunosuppressant therapy further complicates posttransplantation management of diabetes and, although this is still unproven, could be responsible for a higher incidence of post-transplantation infection, rejection and mortality. In this study, we aimed to compare one-year outcomes of survival and morbidity after cardiac transplantation among recipients with and without diabetes mellitus. METHODS: This was a prospective observational study of 114 patients who underwent first heart transplantation between November 2003 and January 2008, with 1-year follow-up. They were divided into two groups according to whether they had pre-transplantation diabetes (group 1) or not (group 2). Baseline variables and complications were recorded. Logistic regression analysis was used to identify independent predictors of 1-year mortality. RESULTS: Of the 114 patients, 33% were diabetic before transplantation. Diabetic patients were older (57.0 +/- 7.4 vs. 51.2 +/- 12.9 years, p = 0.013), and had a higher prevalence of hypertension (63.6% vs. 16.7%, p = 0.002), lower creatinine clearance (53.5 +/- 16.2 vs. 63.0 +/- 21.8 ml/min, p = 0.020) and higher C-reactive protein levels (1.8 +/- 2.4 vs. 0.9 +/- 1.3 mg/l, p = 0.029) than non-diabetics. They tended to have more peripheral arterial disease (20.8 vs. 14.8%, p = NS) and carotid disease (25.8 vs. 14.3%, p = NS). In diabetic patients fasting glucose levels were significantly lower at one year than before heart transplantation (134.2 +/- 45.3 vs. 158.4 +/- 71.2 mg/dl, p = 0.039). There were no significant differences between diabetic and non-diabetic patients in rejection (16.2 vs. 23.4%, p = 0.467), infection (27.0 vs. 33.8%, p = 0.524) or mortality (16.2 vs. 6.5%, p = 0.171) at 1-year follow-up. On logistic regression analysis, the only predictor of 1-year mortality was baseline creatinine > 1.4 mg/dl (OR: 6.36, 95% CI: 1.12-36.04). Diabetes and impaired fasting glucose before heart transplantation were not independent predictors of 1-year mortality. CONCLUSIONS: These data suggest that diabetes is not associated with worse 1-year survival or higher morbidity in heart transplant patients, as long as good blood glucose control is maintained

Complications of endomyocardial biopsy in heart transplant patients: a retrospective study of 2117 consecutive procedures

BACKGROUND: Endomyocardial biopsy (EMB) remains the gold standard for the diagnosis of graft rejection after heart transplantation (HT). Our purpose was to evaluate the rate of complications of this invasive procedure. METHODS: This was a retrospective study of 175 patients, who were transplanted between November 2003 and October 2010 and survived more than 1 month after surgery. We evaluated the number of inconclusive EMB and described the incidence, nature, and subsequent management of several complications associated with this procedure. RESULTS: Over a period of approximately 7 years, we performed 2217 EMB yielding 4972 specimens, namely, an average of 2.3 fragments per procedure. The majority of EMBs (95.3%) were performed by the femoral approach. Only 12 EMB (0.57%) were inconclusive. The overall complication rate was 0.71%. During puncture, one patient experienced a vasovagal reaction and another one, a femoral artery false aneurysm. During the biopsy, there was one case of cardiac perforation with tamponade, two cases of supraventricular tachycardia, and three atrioventricular conduction abnormalities. In 19 patients, histological analysis revealed chordal tissue, but only two patients developed mild tricuspid regurgitation. We observed five cases of coronary artery fistulae. The clinical outcomes were favorable in all cases. CONCLUSION: EMB proved to be a suitable, safe method to monitor rejection after HT

Children's health care assistance according to their families: a comparison between models of Primary Care

OBJETIVO Comparar o modelo assistencial de Unidades Básicas Tradicionais (UBS) com as unidades Estratégia Saúde da Família (ESF) quanto à presença e extensão dos atributos da Atenção Primária de Saúde (APS), no atendimento de crianças. MÉTODO Estudo transversal, com abordagem quantitativa, com familiares de crianças atendidas no Serviço Público de Saúde de Colombo, Paraná. O Primary Care Assessment Tool (PCA-Tool) foi aplicado aos responsáveis de 482 crianças, 235 de unidades ESF e 247 de UBS, abrangendo todas as unidades de atenção primária do município, entre junho e julho de 2012. Os resultados foram analisados segundo o manual do PCA-Tool. RESULTADOS As unidades com ESF alcançaram escore geral limítrofe para APS. Porém, tiveram melhores resultados nos atributos Afiliação, Coordenação da integração dos cuidados, Integralidade, Orientação Familiar e Acessibilidade quanto à utilização, enquanto os atributos Orientação Comunitária, Coordenação dos sistemas de informações, Longitudinalidade e Acesso foram classificados como insuficientes para a APS. As UBS tiveram escores baixos em todos os atributos. CONCLUSÃO As unidades com ESF estão mais próximas dos princípios da APS, mas há necessidade de rever ações de assistência à criança, visando aos atributos da APS, em ambos os modelos de atenção, corroborando com estudos semelhantes em outras regiões do Brasil.OBJETIVO Comparar el modelo asistencial de Unidades Básicas Tradicionales (UBS) con las unidades Estrategia Salud de la Familia (ESF) en cuanto a la presencia y extensión de los atributos de la Atención Primaria de Salud (APS), en la atención a los niños. MÉTODO Estudio transversal, con abordaje cuantitativo, con familiares de niños atendidos en el Servicio Público de Salud de Colombo, Paraná. El Primary Care Assessment Tool (PCA-Tool) fue aplicado a los responsables de 482 niños, 235 de unidades ESF y 247 de UBS, abarcando todas las unidades de atención primaria del municipio, entre junio y julio de 2012. Los resultados fueron analizados según el manual del PCA-Tool. RESULTADOS Las unidades con ESF alcanzaron un puntaje general limítrofe para APS. Sin embargo, tuvieron mejores resultados en los atributos Afiliación, Coordinación de la integración de los cuidados, Integralidad, Orientación Familiar y Accesibilidad en cuanto a la utilización, mientras que los atributos Orientación Comunitaria, Coordinación de los sistemas de informaciones, Longitudinalidad y Acceso fueron clasificados como insuficientes para la APS. Las UBS tuvieron puntajes bajos en todos los atributos. CONCLUSIÓN Las unidades con ESF se acercan más a los principios de la APS, pero existe la necesidad de rever acciones de asistencia al niño, con vistas a los atributos de la APS, en ambos modelos de atención, corroborando con estudios semejantes en otras regiones de Brasil.OBJECTIVE To compare the health assistance models of Basic Traditional Units (UBS) with the Family Health Strategy (ESF) units for presence and extent of attributes of Primary Health Care (APS), specifically in the care of children. METHOD A cross-sectional study of a quantitative approach with families of children attended by the Public Health Service of Colombo, Paraná. The Primary Care Assessment Tool (PCA-Tool) was applied to parents of 482 children, 235 ESF units and 247 UBS units covering all primary care units of the municipality, between June and July 2012. The results were analyzed according to the PCA-Tool manual. RESULTS ESF units reached a borderline overall score for primary health care standards. However, they fared better in their attributes of Affiliation, Integration of care coordination, Comprehensiveness, Family Centeredness and Accessibility of use, while the attributes of Community Guidance/Orientation, Coordination of Information Systems, Longitudinality and Access attributes were rated as insufficient for APS. UBS units had low scores on all attributes. CONCLUSION The ESF units are closer to the principles of APS (Primary Health Care), but there is need to review actions of child care aimed at the attributes of APS in both care models, corroborating similar studies from other regions of Brazil

Physiological responses to water stress and stress memory in Argania spinosa

Drought stress is one of the major abiotic stress factors shifting the physiology and metabolism of the plants. In semiarid areas, drought stress events are often recurrent, and plants have developed strategies to remember a first so-called priming stress to eventually respond more effectively to a second triggering stress. In this study, we tested several physiological and morphological variables in Argania spinosa (L.) Skeels plants, growing in greenhouse conditions under a drought treatment induced by water withholding. Two sequential one-month periods of water stress were imposed to understand the stress memory events in this species The plants were divided into two groups depending on the treatment applied (irrigated and stressed) which later, after one month of a recuperation phase, were divided again into two more groups (having a total of four at the end of the study). Leaf samples were periodically taken and relative water content, gas exchange, chlorophyll content and other variables were measured, analysed and compared between those groups. Plants, which have suffered the two sequential water stress periods, were more affected according to several variables than plants subjected to only one stress treatment, so we finally conclude that this species does not seem to have any drought stress memory mechanisms for the studied variables, under the conditions of this experiment

Cardiac allograft systolic function. Is the aetiology (ischaemic or idiopathic) a determinant of ventricular function in the heart transplant patient?

The natural history of the LV systolic function (LV-SF) and functional capacity of survivors of heart transplantation (Htx) has not been defined. Some investigators suggest that SF may be different in recipients with different pre-transplant aetiologies: ischaemic or dilated, idiopathic disease. Routine transthoracic echocardiograms (TTE) were performed during a 1-year follow-up in 48 Htx recipients (total 864 examinations; mean 18/patient). Patients were divided into two groups based on pre-transplant diagnosis: ischaemic (CAD-CMP: n=13, age 54+/-1.7 years, 23% females) and idiopathic dilated cardiomyopathy (ID-CMP: n=35, age 51+/-2.3 years, 26% females). Patients with valvular and toxic aetiology were excluded. All patients underwent left ventriculography (VENT) 12-15 months after Htx. The majority of 1-year survivors of Htx maintained normal LV-SF: mean LVEF 65+/-4% by echocardiography and 68+/-3% by ventriculography, but in the ID-CMP group LVEF was significantly higher: 67+/-4% vs. 62+/-4% (TTE) and 77+/-4% vs. 60+/-4% (VENT), without significant differences in functional capacity (NYHA). 82.9% of ID-CMP patients had LVEF >65% vs. 39% in CAD-CMP. The incidence of acute cellular rejection, freedom from cardiac vasculopathy, renal failure, diabetes, hypertension and pre-transplant alloantibody level was similar. Our study shows a strong correlation between pre-transplant heart disease and the systolic function of the cardiac allograft at 1-year follow-up

ONDE ESTÃO OS EGRESSOS DO CURSO DE ADMINISTRAÇÃO DA UFSC?

O Estudo de Caso aborda a atuação profissional de egressos, modalidade presencial, do Curso de Administração (2011-2014), da Universidade Federal de Santa Catarina (CAD-UFSC). Da população de 548 bacharéis da lista de Graduados deste Survey, obteve-se a Amostra de 146 investigados, num Intervalo de Confiança de 95% e Erro Amostral de 7% (RENDER, STAIR JR.; HANNA, 2010). O questionário foi estruturado com perguntas fechadas Estilo Likert (HAIR JR., ANDERSON; TATHAM; BLACK, 2005), fixado no Google Docs e enviado por e-mail a todos egressos do período. A coleta foi feita em maio e junho de 2015, o tratamento dos dados foi quantitativo e usou-se o SPSS® na sua operacionalização. A pesquisa apontou que predominam os egressos na faixa etária de 26 a 30 anos (50,7%), sendo 50,7% do sexo feminino, a maioria natural do Estado de Santa Catarina, cursaram o ensino médio em escola privada e que cerca de 30% fez intercâmbio no exterior durante a graduação. Eles trabalham em empresas de médio porte e a faixa salarial predominante oscila de 3 a 6 salários mínimos, mas a maioria deles fez ou está cursando pós-graduação. Realçam à relevância em terem se graduado na UFSC, pois lhes permitiu reconhecimento pessoal e profissional, reforçando as avaliações do CAD-UFSC como um dos cursos 5 estrelas pelo MEC-Brasil

Algorithmic statistics revisited

The mission of statistics is to provide adequate statistical hypotheses (models) for observed data. But what is an "adequate" model? To answer this question, one needs to use the notions of algorithmic information theory. It turns out that for every data string $x$ one can naturally define "stochasticity profile", a curve that represents a trade-off between complexity of a model and its adequacy. This curve has four different equivalent definitions in terms of (1)~randomness deficiency, (2)~minimal description length, (3)~position in the lists of simple strings and (4)~Kolmogorov complexity with decompression time bounded by busy beaver function. We present a survey of the corresponding definitions and results relating them to each other