Update on the Genetics of and Systemic Therapy Options for Combined Hepatocellular Cholangiocarcinoma

Combined hepatocellular-cholangiocarcinoma (cHCC-ICC) is an uncommon and aggressive form of primary liver cancer. Currently, there are no international guidelines for optimal management. For localized tumors, radical resection represents the preferred treatment option, whereas for advanced tumors, systemic therapies recommended for intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) are often selected. Emerging information from comparative cohort studies, genomic and transcriptomic data sets are starting to build a case for rationalized approaches to systemic treatment in the advanced setting specific to cHCC-ICC

Integration of all support systems in the clinical environment.

Evidence based medicine (EBM) is an approach to patient care which ensures that potential advances in health care must be tested and proven to do more good than harm before they are incorporated into medical practice. It promotes the collection, interpretation and integration of patient reported, clinician observed and research-derived evidence. For this information to be used as an integral part of medical practice, regularly updated systematic reviews such as those organised through the Cochrane Collaboration are essential. It has been argued that electronic access to information sources from the health care professional's normal work place is the only feasible way to bring EBM into routine clinical practice where it is used as a framework for determining the care of individual patients.Within the context of clinical decision-making using EBM, two sources of information are necessary. Firstly patient information, which includes treatment regimes, clinical assessments and the results of laboratory tests on a particular patient. Secondly reference information, which is the evidence base on which to justify the care delivered to that patient. It is believed that bringing patient and reference data together so that they can be accessed through a single workstation within the hospital workplace could provide an effective tool to support healthcare delivery using EBM. The concept of the clinical workstation is one that has been used to describe a single workstation which gives access to all clinical information. If this concept is applied to a workstation to support EBM, then both patient specific and reference information must be available through the workstation. This study describes work at the Royal Hallamshire Hospital (RHH) in Sheffield, an acute 850-bedded teaching hospital located in an industrial city. The work aims at integrating access to reference and patient data through a single user interface - a Web browser - as a method of providing direct support for the delivery of EBM. A user-centred iterative approach to the research has been employed and in this study the user requirements and a prototype workstation to support evidence based medicine are described and evaluated

Sodium and potassium urinary excretion and dietary intake: a cross-sectional analysis in adolescents

Background: Hypertension is the leading cause for heart disease and stroke, for mortality and morbidity worldwide, and a high sodium-to-potassium intake ratio is considered a stronger risk factor for hypertension than sodium alone. Objective: This study aims to evaluate sodium and potassium urinary excretion, and assess the food sources of these nutrients in a sample of Portuguese adolescents. Design: A cross-sectional study with a sample of 250 Portuguese adolescents. Sodium and potassium excretion were measured by one 24-h urinary collection, and the coefficient of creatinine was used to validate completeness of urine collections. Dietary sources of sodium and potassium were assessed using a 24-h dietary recall. Results: Valid urine collections were provided by 200 adolescents (118 girls) with a median age of 14.0 in both sexes (p 0.295). Regarding sodium, the mean urinary excretion was 3,725 mg/day in boys and 3,062 mg/day in girls (pB0.01), and 9.8% of boys and 22% of girls met the World Health Organization (WHO) recommendations for sodium intake. Concerning potassium, the mean urinary excretion was 2,237 mg/day in boys and 1,904 mg/day in girls (pB0.01), and 6.1% of boys and 1.7% of girls met theWHOrecommendations for potassium intake. Major dietary sources for sodium intake were cereal and cereal products (41%), meat products (16%), and milk and milk products (11%); and for potassium intake, main sources were milk and milk products (21%), meat products (17%), and vegetables (15%). Conclusions: Adolescents had a high-sodium and low-potassium diet, well above the WHO recommendations. Health promotion interventions are needed in order to decrease sodium and increase potassium intake

Auditory evoked potentials and multiple sclerosis

Multiple sclerosis (MS) is an inflammatory, demyelinating disease that can affect several areas of the central nervous system. Damage along the auditory pathway can alter its integrity significantly. Therefore, it is important to investigate the auditory pathway, from the brainstem to the cortex, in individuals with MS. Objective: the aim of this study was to characterize auditory evoked potentials in adults with MS of the remittent-recurrent type. Method: the study comprised 25 individuals with MS, between 25 and 55 years, and 25 age- and gender-matched healthy controls (research and control groups). Subjects underwent audiological and electrophysiological evaluations. Results: Statistically significant differences were observed between the groups regarding the results of the auditory brainstem response and the latency of the Na and P300 waves. Conclusion: Individuals with MS present abnormalities in auditory evoked potentials indicating dysfunction of different regions of the central auditory nervous system.Univ São Paulo FMUSP, Auditory Evoked Potentials Lab, Sch Med, Speech Pathol & Audiol Course, São Paulo, BrazilUniv São Paulo FMUSP, Speech Pathol & Audiol Course, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo Hosp, São Paulo, BrazilFMUSP, Rehabil Sci Program, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo Hosp, São Paulo, BrazilWeb of Scienc

Auditory evoked potentials: predicting speech therapy outcomes in children with phonological disorders

OBJECTIVES: This study investigated whether neurophysiologic responses (auditory evoked potentials) differ between typically developed children and children with phonological disorders and whether these responses are modified in children with phonological disorders after speech therapy. METHODS: The participants included 24 typically developing children (Control Group, mean age: eight years and ten months) and 23 children clinically diagnosed with phonological disorders (Study Group, mean age: eight years and eleven months). Additionally, 12 study group children were enrolled in speech therapy (Study Group 1), and 11 were not enrolled in speech therapy (Study Group 2). The subjects were submitted to the following procedures: conventional audiological, auditory brainstem response, auditory middle-latency response, and P300 assessments. All participants presented with normal hearing thresholds. The study group 1 subjects were reassessed after 12 speech therapy sessions, and the study group 2 subjects were reassessed 3 months after the initial assessment. Electrophysiological results were compared between the groups. RESULTS: Latency differences were observed between the groups (the control and study groups) regarding the auditory brainstem response and the P300 tests. Additionally, the P300 responses improved in the study group 1 children after speech therapy. CONCLUSION: The findings suggest that children with phonological disorders have impaired auditory brainstem and cortical region pathways that may benefit from speech therapy

ANÁLISE ECONÔMICA DA APLICAÇÃO DO FINALISMO MITIGADO PARA AFERIÇÃO DO CONCEITO DE EMPRESÁRIO

O artigo trata da aplicação da teoria da finalista mitigada aos empresários para considera-los como consumidores em contratos empresariais. Procura-se demonstrar que as noções de consumidor e empresário são inconfundíveis e se subordinam a regimes jurídicos específicos, de modo que a noção de vulnerabilidade seria restrita ao âmbito consumeirista e incapaz de considerar os custos de transação e a barganha envolvida nos contratos empresariais. O método utilizado foi o dedutivo e a pesquisa bibliográfica se apoia na doutrina empresarial, consumeirista e econômica

Processo de supervisão: Perceções de professores cooperantes do 2.º ciclo do Ensino Básico

Em Portugal, a formação inicial dos educadores de infância e professores do ensino básico, enquadrada pelo Decreto-lei n.º 79/2014, inclui a componente de Iniciação à Prática Profissional, quer na Licenciatura em Educação Básica, quer nos mestrados, em que os alunos desenvolvem a Prática de Ensino Supervisionada. Neste âmbito, é fundamental falar no processo de supervisão. Inscrevendo-o numa perspetiva de cariz sócio-construtivista, possibilita aos alunos envolver-se em experiências formativas diversificadas e a integração e sistematização de saberes que emergem na interdependência entre a ação e a reflexão. Cabe aos supervisores a função de incentivá-los a observar, analisar e interpretar as práticas educativas e a implicar-se na procura de respostas para as dificuldades com que se defrontam. Esta comunicação resulta de um estudo de natureza interpretativa mais abrangente que incluiu educadores e professores cooperantes da Escola Superior de Educação de Bragança (da Licenciatura em Educação Básica e dos Mestrados em Educação Pré-escolar, em Educação Pré-Escolar e Ensino do 1.º Ciclo, e em Ensino do 1.º e do 2.º Ciclo do Ensino Básico) e teve como principal objetivo compreender as suas perceções/vivências acerca do processo de supervisão, com o objetivo de recolher informações que nos ajudem a refletir sobre o processo de supervisão/formação desenvolvido na nossa instituição. O processo de recolha de dados recorreu a um questionário com perguntas abertas que inclui as seguintes categorias: papéis desempenhados no processo de supervisão, interações/relações estabelecidas entre a instituição de formação e contexto escolar, reflexão e avaliação no âmbito da supervisão. O questionário foi aplicado no final do ano letivo 2013/2014. Esta comunicação refere-se às perceções dos professores do 2.º ciclo do Ensino Básico (crianças dos 10-12 anos). Responderam 17 professores, de um total de 28 envolvidos nas unidades de IPP (Licenciatura) e de PES (Mestrado). As respostas foram sujeitas a análise de conteúdo, tendo sido criadas categorias, a posteriori. Relativamente aos papéis desempenhados no processo de supervisão, os dados mostram, sobretudo, que as opiniões são variadas. Por exemplo, há professores que consideram que os papéis são adequados, outros assinalam que deveria existir mais supervisão em sala de aula por parte do supervisor e alguns apontam para a necessidade de uma definição diferenciada de papéis. As interações/relações estabelecidas entre instituição de formação e contexto escolar, onde foi realizado o estágio, são percebidas, pela maioria dos professores, como positivas. É, contudo, apontada a necessidade de mais momentos de interacção entre o aluno (estagiário), o professor cooperante e os professores supervisores, no sentido de promover uma melhor organização do processo de supervisão. Ao nível da reflexão, componente essencial da prática letiva, os professores cooperantes, mais uma vez, revelam opiniões diversificadas, sendo apontada a adequação da reflexão realizada, mas propõe-se o aumento da periodicidade dos momentos de reflexão com os supervisores da instituição de formação. Sobre a avaliação do processo, é visível a centralização das respostas na avaliação dos alunos esquecendo o papel dos demais intervenientes no processo supervisivo

Prevalencia do herpes virus tipo 2 e fatores de risco associados a sua infeccao em mulheres do sul do Brasil

SUMMARY The herpes simplex virus type 2 (HVS-2) is the most prevalent infection worldwide. It is a cofactor in the acquisition of human immunodeficiency virus (HIV) and the persistence of human papillomavirus (HPV). This study evaluated the prevalence of HSV-2, using the polymerase chain reaction (PCR), and associated factors in patients treated at the Federal University of Rio Grande (FURG) and Basic Health Units (BHU) in Rio Grande, Brazil. The observed prevalence of HSV-2 was 15.6%. Among the 302 women studied, 158 had received assistance in BHU and 144 were treated at FURG. The prevalence of HSV-2 in these groups was 10.8% and 20.8%, respectively, RR 1.9 and p = 0.012. Knowledge about the Pap smear, and the presence of lesions showed no association with HSV-2 infection. Multivariate analysis showed that the variable that most influenced the risk of HSV-2 infection was the presence of HIV infection, with a relative risk of 1.9 and p = 0.04. Discussion: Genital ulcers are an important entry point for HIV, and condom use is an important strategy to reduce transmission of HIV and HSV-2.RESUMO O vírus herpes simplex tipo 2 (HVS-2) é uma das infecções mais prevalentes em todo o mundo. Considera-se um co-factor na aquisição do vírus da imunodeficiência humana (HIV) e na persistência do papilomavirus humano (HPV). Este estudo tem como objetivo avaliar a prevalência de HSV-2 usando a reação em cadeia da polimerase (PCR) e fatores associados em pacientes atendidos na Universidade Federal do Rio Grande e em Unidades Básicas de Saúde (UBS) do Rio Grande, Brasil. A prevalência de HSV-2 encontrada neste estudo foi de 15,6%. Entre as 302 mulheres estudadas, 158 haviam recebido assistência na UBS e 144 foram atendidos na FURG. A prevalência de HSV-2 nestes grupos foi de 10,8 e 20,8%, respectivamente, com RR: 1,9 e p = 0,012. Conhecer o exame de Papanicolaou, e presença de lesão não teve associação com infecção HSV-2. A análise multivariada mostrou que a variável que influencia no risco de infecção HSV-2 foi o paciente ter HIV, com risco relativo 1,9 e p = 0,04. Discussão: As úlceras genitais são importante porta de entrada para o vírus HIV e o uso do preservativo é estratégia importante para reduzir a transmissão do HIV e do HSV-2

Fatores de risco para a transmissao vertical do HIV-1 e a influencia da terapia antirretroviral (ARV) no desfecho gestacional

In the absence of intervention, the rate of vertical transmission of HIV can range from 15-45%. With the inclusion of antiretroviral drugs during pregnancy and the choice of delivery route this amounts to less than 2%. However ARV use during pregnancy has generated several questions regarding the adverse effects of the gestational and neonatal outcome. This study aims to analyze the risk factors for vertical transmission of HIV-1 seropositive pregnant women living in Rio Grande and the influence of the use of ARVs in pregnancy outcome. Among the 262 pregnant women studied the rate of vertical transmission of HIV was found to be 3.8%. Regarding the VT, there was a lower risk of transmission when antiretroviral drugs were used and prenatal care was conducted at the referral service. However, the use of ART did not influence the outcome of pregnancy. However, initiation of prenatal care after the first trimester had an influence on low birth weight, as well as performance of less than six visits increased the risk of prematurity. Therefore, the risk factors analyzed in this study appear to be related to the realization of inadequate pre-natal and maternal behavior.Na ausência de intervenção, as taxas de transmissão vertical do HIV podem variar de 15-45%. Com a inserção dos antirretrovirais durante a gestação e a escolha da via de parto estas taxas chegam a menos de 2%. No entanto o uso de ARV na gestação tem gerado várias duvidas quanto aos efeitos adversos causados ao desfecho gestacional e ao neonato. Este estudo objetiva analisar os fatores de risco da transmissão vertical do HIV-1 em gestantes soropositivas atendidas na cidade do Rio Grande e a influência do uso do ARV no desfecho gestacional. Entre as 262 gestantes estudadas a taxa de transmissão vertical do HIV encontrada foi de 3,8%. Em relação à TV, foi observado menor risco de transmissão quando esta havia feito uso de antirretrovirais e o pré-natal era realizado no serviço de referência. Entretanto, o uso de ARV não influenciou negativamente o desfecho gestacional. No entanto, o inicio do pré-natal após o primeiro trimestre teve influencia sobre o baixo peso ao nascer, assim como a realização de menos de seis consultas aumentou o risco de prematuridade. Portanto, os fatores de risco analisados neste estudo parecem estar relacionados à realização não adequada do pré-natal e ao comportamento materno

Etiology of liver cirrhosis in Brazil: chronic alcoholism and hepatitis viruses in liver cirrhosis diagnosed in the state of Espfrito Santo

OBJECTIVES: To report the etiology of liver cirrhosis cases diagnosed at the University Hospital in Vitoria, Espirito Santo, Brazil. METHODS: The medical charts of patients with liver cirrhosis who presented to the University Hospital in Vitoria were reviewed. Chronic alcoholism and the presence of hepatitis B or C infections (HBV and HCV, respectively) were pursued in all cases. RESULTS: The sample consisted of 1,516 cases (male:female ratio 3.5:1, aged 53.2±12.6 years). The following main etiological factors were observed: chronic alcoholism alone (39.7%), chronic alcoholism in association with HBV or HCV (16.1 %), HCV alone (14.5%) and in association with alcoholism (8.6%) (total, 23.1 %), and HBV alone (13.1%) and in association with alcoholism (7.5%, total 20.6%). The remaining etiologies included cryptogenic cases (9.8%) and other causes (6.0%). The mean patient age was lower and the male-to-female ratio was higher in the cirrhosis cases that were associated with alcoholism or HBV compared with other causes. Intravenous drug abuse and a history of surgery or blood transfusion were significantly associated with HCV infection. Hepatocellular carcinoma was present at the time of diagnosis in 15.4% of cases. Chronic alcoholism associated with HCV infection was significantly associated (