Effect of hyperbaric oxygen therapy: case report of patient with hepato-pulmonary syndrome on waiting list for liver transplantation

INTRODUÇÃO: As doenças hepáticas apresentam índices de morbidade e mortalidade elevados e quando em estágio avançado têm o transplante do fígado como forma de tratamento potencialmente curativo e eficaz, embora este não possa ser oferecido a todos os pacientes. Isso faz com que essas doenças sejam consideradas problema de saúde pública em todo o mundo. Os cuidados clínicos para manter o paciente com condições de esperar e suportar o transplante continua um desafio. RELATO DO CASO: Mulher com 65 anos de idade, procedente do Recife, com diagnóstico de cirrose hepática secundária a vírus C apresentava dispnéia importante aos mínimos esforços tendo PaO2 de repouso de 60 mmHg e O2 de 90%, com espirometria normal. Realizou eco-Doppler que evidenciou shunt pulmonar importante. Durante a triagem em lista de transplante (MELD de 16 em agosto de 2006) foi optado pelo início de sessões de oxigenioterapia em câmara hiperbárica a fim de melhorar a sintomatologia respiratória da síndrome hepato-pulmonar. Apresentava melhora substancial da tolerância ao exercício após a terapia hiperbárica, assim como os valores do PaO2 à gasometria. Realizou 10 sessões de oxigenioterapia em câmara hiperbárica. Realizou transplante hepático em outubro de 2007 e vem em acompanhamento ambulatorial com boa evolução e melhora substancial da dispnéia. CONCLUSÃO: Constatou-se melhora da condição hepato-pulmonar após oxigenoterapia hiperbárica. Desta forma, ela surge como mais uma ferramenta para o tratamento das doenças hepáticas, devendo ser realizados outros estudos que avaliem sua utilização clínica.INTRODUCTION: Progressive impairment of liver function in hepatic cirrhosis is a major medical problem with limited therapeutic approaches, and liver transplantation is the only effective therapy. Reports of alternatives for liver function improvement on patients awaiting liver transplantation may include hyperbaric oxygen therapy. CASE REPORT: A 65-year old woman had diagnosis of hepatitis C and liver cirrhosis during treatment for breast cancer. In addition to liver failure and a MELD of 16, the patient presented hypoxemia with a PaO2 of 60 mmHg, and further evaluation with eco-Doppler revealed a hepatopulmonary syndrome. Clinical improvement was attempted with hyperbaric oxygeniotherapy, and substantial clinical and laboratorial improvement was acheived after 10 sessions, with significant improvement on cyanosis and arterial gas values. CONCLUSION: Oxygen therapy was effective in the improvement of dyspnea and hypoxemia secondary to hepatopulmonary syndrome in a patient with liver cirrhosis indicated for liver transplantation. The positive results of this treatment suggest that hyperbaric oxygen therapy may help on improvement of symptoms of hepatopulmonary syndrome

Structural and paragenetic analysis of swarms of bubble like pegmatites in a miarolitic granite from Assunção South – Viseu – Central Portugal

Publicado em "PEG 2013 : Contributions to The 6th International Symposium on Granitic Pegmatites

Antiproliferative effects of lectins from Canavalia ensiformis and Canavalia brasiliensis in human leukemia cell lines

AbstractThe antiproliferative activity of lectins Canavalia ensiformis (ConA) and Canavalia brasiliensis (ConBr) were studied using human leukemia MOLT-4 and HL-60 cell lines. It was revealed that both ConA and ConBr were markedly cytotoxic to cells using MTT and NAC assays. The IC50 values were approximately 3 and 20μg/mL for ConA and ConBr, respectively, for both MOLT-4 and HL-60 cells. However, in normal human peripheral blood lymphocytes, the lectins were not cytotoxic, even when tested at concentrations as high as 200μg/ml. Using comet assay, the lectins produced a rate of DNA damage exceeding 80% in MOLT-4 and HL-60 cells. Fluorescence analysis revealed the morphology characteristic of apoptosis, with low concentrations of apoptotic bodies and fragmented DNA (5μg/ml). Flow cytometric analysis demonstrated an accumulation of cells in the sub-G1 cell cycle that is characteristic of DNA fragmentation, and a decrease in membrane integrity at high concentrations. Lastly, we evaluated the alterations in mitochondrial potential that reduced after treatment with lectins. Our results indicate that ConA and ConBr inhibited cell proliferation selectively in tumor cells and that apoptosis was the main death mechanism. Therefore, lectins can be considered a class of molecules with a high antitumor activity potential

A new methodology for assessment of pectus excavatum correction after bar removal in Nuss procedure: preliminary study

Purpose: The objective is to present a new methodology to assess quantitatively the impact of bar removal on the anterior chest wall, among patients with pectus excavatum who have undergone the Nuss procedure, and present a preliminary study using this methodology. Methods: We propose to acquire, for each patient, the surface of the anterior chest wall using a three-dimensional laser scanner at subsequent time points (short term: before and after surgery; long term: follow-up visit, 6 months, and 12 months after surgery). After surfaces postprocessing, the changes are assessed by overlapping and measuring the distances between surfaces. In this preliminary study, three time points were acquired and two assessments were performed: before vs after bar removal (early) and before vs 2-8 weeks after bar removal (interim). In 21 patients, the signed distances and volumes between surfaces were computed and the data analysis was performed. Results: This methodology revealed useful for monitoring changes in the anterior chest wall. On average, the mean, maximum, and volume variations, in the early assessment, were -0.1 +/- 0.1 cm, -0.6 +/- 0.2 cm, and 47.8 +/- 22.2 cm(3), respectively; and, in the interim assessment, were -0.5 +/- 0.2 cm, -1.3 +/- 0.4 cm, and 122.1 +/- 47.3 cm3, respectively (p < 0.05). Data analysis revealed that the time the bar was in situ was inversely and significantly correlated with postretraction and was a relevant predictor of its decrease following surgery (p < 0.05). Additionally, gender and age suggested influencing the outcome. Conclusions: This methodology is novel, objective and safe, helping on follow-up of pectus excavatum patients. Moreover, the preliminary study suggests that the time the bar was in situ may be the main determinant of the anterior chest wall retraction following bar removal. Further studies should continue to corroborate and reinforce the preliminary findings, by increasing the sample size and performing long-term assessments.FEDER funds, through the Competitiveness Factors Operational Programme (COMPETE), and by National funds, through the Foundation for Science and Technology (FCT), under the scope of the projects PTDC/SAU-BEB/103368/2008 and POCI-01-0145-FEDER-007038; and by the projects NORTE-07-0124-FEDER-000017 and NORTE-01-0145-FEDER-000013, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER)info:eu-repo/semantics/publishedVersio

Phred-Phrap package to analyses tools: a pipeline to facilitate population genetics re-sequencing studies

BACKGROUND: Targeted re-sequencing is one of the most powerful and widely used strategies for population genetics studies because it allows an unbiased screening for variation that is suitable for a wide variety of organisms. Examples of studies that require re-sequencing data are evolutionary inferences, epidemiological studies designed to capture rare polymorphisms responsible for complex traits and screenings for mutations in families and small populations with high incidences of specific genetic diseases. Despite the advent of next-generation sequencing technologies, Sanger sequencing is still the most popular approach in population genetics studies because of the widespread availability of automatic sequencers based on capillary electrophoresis and because it is still less prone to sequencing errors, which is critical in population genetics studies. Two popular software applications for re-sequencing studies are Phred-Phrap-Consed-Polyphred, which performs base calling, alignment, graphical edition and genotype calling and DNAsp, which performs a set of population genetics analyses. These independent tools are the start and end points of basic analyses. In between the use of these tools, there is a set of basic but error-prone tasks to be performed with re-sequencing data. RESULTS: In order to assist with these intermediate tasks, we developed a pipeline that facilitates data handling typical of re-sequencing studies. Our pipeline: (1) consolidates different outputs produced by distinct Phred-Phrap-Consed contigs sharing a reference sequence; (2) checks for genotyping inconsistencies; (3) reformats genotyping data produced by Polyphred into a matrix of genotypes with individuals as rows and segregating sites as columns; (4) prepares input files for haplotype inferences using the popular software PHASE; and (5) handles PHASE output files that contain only polymorphic sites to reconstruct the inferred haplotypes including polymorphic and monomorphic sites as required by population genetics software for re-sequencing data such as DNAsp. CONCLUSION: We tested the pipeline in re-sequencing studies of haploid and diploid data in humans, plants, animals and microorganisms and observed that it allowed a substantial decrease in the time required for sequencing analyses, as well as being a more controlled process that eliminates several classes of error that may occur when handling datasets. The pipeline is also useful for investigators using other tools for sequencing and population genetics analyses

Assessment of the risk of burnout and its associated factors in healthcare professionals during the COVID-19 pandemic: A prospective cohort study

IntroductionThe COVID-19 pandemic resulted in tremendous physical and psychological pressure on healthcare professionals, especially on those working in intensive care units (ICUs) and Emergency Departments (EDs). The present study intended to characterize the profile of these professionals which is associated with burnout and determine the potential predictors of such condition.MethodsA Prospective cohort study was carried out in a tertiary hospital between March 2020 and March 2021, in Salvador, Brazil. A standardized and validated version of the Oldenburg Burnout inventory (OLBI) was applied to assess risk of burnout together with data forms designed to collect information on sociodemographic characteristics and religious beliefs. ICU and ED healthcare professionals were evaluated during off-hours at two distinct periods of the COVID-19 pandemic, in 2020 and in 2021. Differences in the results obtained from each study participant between the timepoints were compared. A binary logistic regression analysis was performed to identify the predictors of burnout development independent of other confounding factors.ResultsSeventy-seven healthcare professionals with a median age of 33 (interquartile range [IQR]: 31–37.5) years and predominantly female (72.7%; n = 56) were enrolled. There were 62 professionals at risk of developing burnout through the OLBI. Those had a median age of 33 (IQR: 31–37) and female predominance (71%, n = 44). Disengagement and burnout were the only features which frequencies significantly changed over time, with increasing detection at the latest timepoint. Alcohol consumption was found to be an important risk factor for burnout development [adjusted odds ratio (aOR): 10.8 (95% CI: 1.8–64.2)]. Importantly, working in the ICU [aOR: 0.04 (95%CI: 0.01–0.32)] and the habit of praying daily [aOR: 0.07 (95%CI: 0.01–0.41)] were characteristics linked to reduced odds of burnout.DiscussionDisengagement substantially increased during the COVID-19 pandemic in healthcare professionals. Alcohol consumption favors the onset of burnout whereas habit of praying daily and working in the ICU are protective against such outcome. Institutional policies aimed at minimizing etilism may positively impact mental health of these professionals

Contamination of Mesenchymal Stem-Cells with Fibroblasts Accelerates Neurodegeneration in an Experimental Model of Parkinson’s Disease

Pre-clinical studies have supported the use of mesenchymal stem cells (MSC) to treat highly prevalent neurodegenerative diseases such as Parkinson’s disease (PD) but preliminary trials have reported controversial results. In a rat model of PD induced by MPTP neurotoxin, we first observed a significant bilateral preservation of dopaminergic neurons in the substantia nigra and prevention of motor deficits typically observed in PD such as hypokinesia, catalepsy, and bradykinesia, following intracerebral administration of human umbilical cord-derived MSC (UC-MSC) early after MPTP injury. However, surprisingly, administration of fibroblasts, mesenchymal cells without stem cell properties, as a xenotransplantation control was highly detrimental, causing significant neurodegeneration and motor dysfunction independently of MPTP. This observation prompted us to further investigate the consequences of transplanting a MSC preparation contaminated with fibroblasts, a plausible circumstance in cell therapy since both cell types display similar immunophenotype and can be manipulated in vitro under the same conditions. Here we show for the first time, using the same experimental model and protocol, that transplantation of UC-MSC induced potent neuroprotection in the brain resulting in clinical benefit. However, co-transplantation of UC-MSC with fibroblasts reverted therapeutic efficacy and caused opposite damaging effects, significantly exacerbating neurodegeneration and motor deficits in MPTP-exposed rats. Besides providing a rationale for testing UC-MSC transplantation in early phases of PD aiming at delaying disease progression, our pre-clinical study suggests that fibroblasts may be common cell contaminants affecting purity of MSC preparations and clinical outcome in stem cell therapy protocols, which might also explain discrepant clinical results

DADOS MÉDICO-LEGAIS SOBRE AFOGAMENTOS NA REGIÃO DE RIBEIRÃO PRETO (SP, BRASIL): UM PASSO PARA A PREVENÇÃO

This is a prevalence study with the first specific description of drowning cases in a non-coastal area of Brazil, in the locality of Ribeirão Preto, State of São Paulo—a region with standards of living comparable to those in developed countries—regarding the establishment of preventative measures for this specific kind of injury. Methodology: An analysis of the forensic documentation of 89 drowning cases occurred between 2001 and 2004. The pattern of drowning fatalities was studied in relation to parameters like age, sex, socio-economic background and evaluation of alcohol consumption.Results : rate of 2.69 cases per 100,000 habitants per year was observed. The predominant profile among drowning victims was that of the Caucasian male of economically productive age (15 to 59 years), accidentally drowned in rivers and dams in rural areas during the summer and autumn, being impossible the evaluation of alcohol consumption. Conclusion and Relevance : the observation of the victim profile through the analysis of forensic reports allowed the development of a successful pilot program of drowning prevention that can be expanded to other non-coastal areas in Brazil, regarding the reduction of the number of victims by prevention. The difficulties in alcohol consumption analysis are discussed.Este é um estudo de prevalência com a primeira descrição específica de casos de afogamento em uma área não-costeira do Brasil, em Ribeirão Preto, estado de São Paulo, uma região com padrão de vida comparável ao de países desenvolvidos, com o objetivo de estabelecer medidas preventivas para este tipo específico de trauma. Metodologia : Uma análise da documentação médico-legal de 89 casos de afogamento ocorridos entre 2001 e 2004. O padrão de mortes por afogamento foi estudado através de parâmetros como idade, sexo, características sócio-econômicas e avaliação do consumo de álcool. Resultados: um índice de 2,69 casos por 100.000 habitantes foi observado. O perfil predominante entre as vítimas de afogamento foi o do homem caucasiano em idade economicamente produtiva (15-59 anos), afogados acidentalmente em rios e represas na área rural durante o verão e o outono, sendo inviável a avaliação do consumo de álcool. Conclusão e Relevância : a observação do perfil da vítima de afogamento através dos relatórios médico-legais permitiu o desenvolvimento de um projeto piloto de sucesso na prevenção de afogamentos que pode ser expandido para outras áreas não-costeiras do Brasil, visando à redução do número de vítimas através da prevenção. As dificuldades de investigar a influência do consumo de álcool são discutidas. 

A system for the generation of in-car human body pose datasets

Published online: 8 October 2020With the advent of autonomous vehicles, detection of the occupants’ posture is crucial to tackle the needs of infotainment interaction or passive safety systems. Generative approaches have been recently proposed for human body pose in-car detection, but this type of approaches requires a large training dataset for a feasible accuracy. This requirement poses a difficulty, given the substantial time required to annotate such large amount of data. In the in-car scenario, this requirement risk increases even further, since a robust human body pose ground-truth system capable of working in it is needed but inexistent. Currently, the gold standard for human body pose capture is based on optical systems, requiring up to 39 visible markers for a plug-in gait model, which in this case are not feasible given the occlusions inside the car. Other solutions, such as inertial suits, also have limitations linked to magnetic sensitivity and global positioning drift. In this paper, a system for the generation of images for human body pose detection in an in-car environment is proposed. To this end, we propose to smartly combine inertial and optical systems to suppress their individual limitations: By combining the global positioning of 3 visible head markers provided by the optical system with the inertial suit’s relative human body pose, we obtain an occlusion-ready, drift-free full-body global positioning system. This system is then spatially and temporally calibrated with a time-of-flight sensor, automatically obtaining in-car image data with (multi-person) pose annotations. Besides quantifying the inertial suit inherent sensitivity and accuracy, the feasibility of the overall system for human body pose capture in the in-car scenario was demonstrated. Our results quantify the errors associated with the inertial suit, pinpoint some sources of the system’s uncertainty and propose how to minimize some of them. Finally, we demonstrate the feasibility of using system generated data (which was made publicly available), independently or mixed with two publicly available generic datasets (not in-car), to train 2 machine learning algorithms, demonstrating the improvement in their algorithmic accuracy for the in-car scenario.This work is supported by: European Structural and Investment Funds in the FEDER component, through the Operational Competitiveness and Internationalization Programme (COMPETE 2020) [Project n.º 002797; Funding Reference: POCI-01-0247-FEDER-002797]