WRONGFUL BIRTH: A POSSIBILIDADE DE REPARAÇÃO CIVIL NOS CASOS DE TRISSOMIA DO CROMOSSOMO 21 NÃO DETECTADOS DURANTE A GESTAÇÃO

O presente trabalho discute a possibilidade de reparação civil nos casos de Síndrome de Down não detectados durante a gestação pelo profissional médico responsável pela assistência pré-natal, à luz do ordenamento jurídico brasileiro. Atualmente, com o avanço da tecnologia, tornou-se possível um diagnóstico pré-natal cada vez mais preciso. A detecção precoce de uma disfunção genética como a Síndrome de Down, permite aos futuros pais se prepararem emocional e financeiramente para a chegada do bebê e a buscarem informações sobre as peculiaridades advindas da aneuploidia. Em países onde o abordo é permitido, o wrongful birth versa sobre a perda da chance do exercício do direito de aborto. No Brasil, embora não exista no ordenamento jurídico a possibilidade de se interromper uma gravidez senão pelas exceções previstas em lei, é possível afirmar que essas ações ganham relevância na esfera cível. Com a constitucionalização do Direito, o avanço da ciência jurídica aliado à evolução da ciência médica e do desenvolvimento tecnológico surgiram novas modalidades de danos reparáveis, fato que obrigou o Poder Judiciário a alterar a sua estrutura jurisprudencial, refletindo na valorização da função compensatória e na necessidade de oferecer assistência à vítima do dano. Por essa razão, buscou-se por meio de pesquisa bibliografia, sustentar o cabimento da indenização pelo wrongful birth pelo erro de diagnóstico pré-natal, pois interfere diretamente no planejamento familiar dos futuros pais

A Network-Based Algorithm for Clustering Multivariate Repeated Measures Data

The National Aeronautics and Space Administration (NASA) Astronaut Corps is a unique occupational cohort for which vast amounts of measures data have been collected repeatedly in research or operational studies pre-, in-, and post-flight, as well as during multiple clinical care visits. In exploratory analyses aimed at generating hypotheses regarding physiological changes associated with spaceflight exposure, such as impaired vision, it is of interest to identify anomalies and trends across these expansive datasets. Multivariate clustering algorithms for repeated measures data may help parse the data to identify homogeneous groups of astronauts that have higher risks for a particular physiological change. However, available clustering methods may not be able to accommodate the complex data structures found in NASA data, since the methods often rely on strict model assumptions, require equally-spaced and balanced assessment times, cannot accommodate missing data or differing time scales across variables, and cannot process continuous and discrete data simultaneously. To fill this gap, we propose a network-based, multivariate clustering algorithm for repeated measures data that can be tailored to fit various research settings. Using simulated data, we demonstrate how our method can be used to identify patterns in complex data structures found in practice

The comparative burden of mild, moderate and severe Fibromyalgia: results from a cross-sectional survey in the United States

<p>Abstract</p> <p>Background</p> <p>Fibromyalgia (FM) is characterized by chronic, widespread pain, fatigue, and other symptoms; yet few studies have comprehensively assessed its humanistic burden. This observational study evaluates the impact of FM severity on patients' symptoms, health-related quality of life (HRQoL), and productivity in the United States.</p> <p>Methods</p> <p>203 FM subjects were recruited from 20 physician offices. Subjects completed a questionnaire including the EuroQol 5D (EQ-5D), Fibromyalgia Impact Questionnaire (FIQ), Multidimensional Assessment of Fatigue (MAF), Medical Outcomes Study Sleep Scale (MOS-SS), and Hospital Anxiety and Depression Scale (HADS) and questions about demographics, pain and other symptoms, HRQoL and productivity. FIQ total scores were used to define FM severity, with 0- < 39, 39- < 59, and 59-100, representing mild, moderate, and severe FM, respectively. Sites recorded subjects' clinical characteristics and FM treatment on case report forms using medical records. Summary statistics were calculated for continuous variables and frequency distributions for categorical variables. Differences across FM severity groups were evaluated using the Kruskal-Wallis or Chi-square tests. Statistical significance was evaluated at the 0.05 level.</p> <p>Results</p> <p>Mean (SD) age was 47.9 (10.9); 95% were female. Most (92%) were prescribed medication for FM; 24% and 66% reported moderate and severe FM, respectively. Mean (SD) scores were: 6.3 (2.1) for pain intensity; 0.35 (0.35) for EQ-5D; 30.7 (14.2) for MAF; 57.5 (18.4) for MOS-SS Sleep Problems Index; 10.2 (4.8) for HADS anxiety and 9.4 (4.4) for HADS depression. Subjects with worse FM severity reported significantly increased pain severity, HRQoL, fatigue, sleep disturbance, anxiety and depression (p < 0.001). Overall, 50% of subjects reported some disruption in their employment due to FM; this differed across severity levels (p < 0.001). Employed subjects missed a mean (SD) of 1.8 (3.9) workdays during the past 4 weeks; this also differed across severity levels (p = 0.03).</p> <p>Conclusions</p> <p>FM imposes a substantial humanistic burden on patients in the United States, and leads to substantial productivity loss, despite treatment. This burden is higher among subjects with worse FM severity.</p

Detection efficacy of [89Zr]Zr-PSMA-617 PET/CT in [68Ga]Ga-PSMA-11 PET/CT-negative biochemical recurrence of prostate cancer

Rationale In patients with biochemical recurrence of prostate cancer (BCR), preliminary data suggest that prostate-specifc membrane antigen (PSMA) ligand radiotracers labeled with zirconium-89 (89Zr; half-life ~ 78.41 h), which allow imaging≥24 h post-injection, detect suspicious lesions that are missed when using tracers incorporating short-lived radionuclides. Materials and methods To confrm [ 89Zr]Zr-PSMA-617 positron emission tomography/computed tomography (PET/CT) detection efcacy regarding such lesions, and compare quality of 1-h, 24-h, and 48-h [ 89Zr]Zr-PSMA-617 scans, we retrospectively analyzed visual fndings and PET variables refecting lesional [ 89Zr]Zr-PSMA-617 uptake and lesion-to-background ratio. The cohort comprised 23 men with BCR post-prostatectomy, median (minimum–maximum) prostate-specifc antigen (PSA) 0.54 (0.11–2.50) ng/mL, and negative [ 68Ga]Ga-PSMA-11 scans 40±28 d earlier. Primary endpoints were percentages of patients with, and classifcations of, suspicious lesions. Results Altogether, 18/23 patients (78%) had 36 suspicious lesions (minimum–maximum per patient: 1–4) on both 24-h and 48-h scans (n=33 lesions) or only 48-h scans (n=3 lesions). Only one lesion appeared on a 1-h scan. Lesions putatively represented local recurrence in 11 cases, and nodal or bone metastasis in 21 or 4 cases, respectively; 1/1 lesion was histologically confrmed as a nodal metastasis. In all 15 patients given radiotherapy based on [ 89Zr]Zr-PSMA-617 PET/CT, PSA values decreased after this treatment. Comparison of PET variables in 24-h vs 48-h scans suggested no clear superiority of either regarding radiotracer uptake, but improved lesion-to-background ratio at 48 h. Conclusions In men with BCR and low PSA, [ 89Zr]Zr-PSMA-617 PET/CT seems efective in fnding prostate malignancy not seen on [ 68Ga]Ga-PSMA-11 PET/CT. The higher detection rates and lesion-to-background ratios of 48-h scans versus 24-h scans suggest that imaging at the later time may be preferable. Prospective study of [ 89Zr]Zr-PSMA-617 PET/CT is warranted

Burden of Illness Associated with Peripheral and Central Neuropathic Pain among Adults Seeking Treatment in the U nited S tates: A Patient‐Centered Evaluation

Objective The aim of this study was to evaluate patient‐reported burden associated with peripheral and central neuropathic pain ( NeP ) by pain severity and NeP condition. Design Six hundred twenty‐four subjects with one of six NeP conditions were recruited during routine office visits. Subjects consented to retrospective chart review and completed a one‐time questionnaire (including E uro Q ol‐5 dimensions, 12‐item S hort‐ F orm H ealth S urvey, B rief P ain I nventory‐ S hort F orm, M edical O utcomes S tudy S leep S cale, H ospital A nxiety and D epression S cale, and demographic and clinical characteristics). Pain severity scores were used to stratify subjects by mild, moderate, and severe pain. Summary statistics and frequency distributions were calculated. Differences by severity level were compared using K ruskal– W allis (continuous variables) and chi‐square or F isher's exact test (categorical variables). Effect size was computed with C ohen's d (mild vs severe). Results Subjects' mean age was 55.5. The majority (80.8%) had moderate or severe pain. Patient‐reported outcomes (health status, physical and mental health, pain interference with function, sleep, anxiety, and depression) were significantly worse among subjects with greater pain severity (all P  0.95) for all others. The observed burden was most substantial among chronic low back pain‐ NeP , although the pattern of disease burden was similar across the six NeP conditions. Conclusions Subjects across NeP conditions exhibited high pain levels, which were significantly associated with poor function, compromised health status and sleep, and increased anxiety and depression. Results indicate substantial patient burden across broad NeP , particularly among subjects with severe pain.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109996/1/pme12502.pd

A look at the anatomy educator job market: anatomists remain in short supply

In 2002, a widely publicized report projected an anatomy educator shortage based on department chairpersons' perceptions. Now, 17 years later, the question lingers: “Does an anatomy educator shortage persist and, if so, how severe is the shortage?” Trends in the number, type, and fill rate of anatomy educator job openings were explored by analyzing job posting in the United States over the past two years. A survey was distributed to leaders of anatomy‐related departments in the United States, Canada, and European Union. Most departmental leaders who responded (65% or more) from the United States/Canada (n = 81) and the European Union (n = 52) anticipate they will have “moderate” to “great” difficulty hiring anatomy educators in gross anatomy, histology, and embryology over the next five years. Within the United States, the number of anatomy educator job postings at medical schools more than doubled from at least 21 postings in 2017 to 52 postings in 2018. Twenty‐one percent of postings between 2017 and 2018 were never filled. While the number of anatomy educator openings within the United States/Canada is perceived to remain in a steady state for the next five years, the European Union estimates a five‐fold increase in the number of openings. Departmental leaders prioritize anatomy educator applicants who have teaching experience (mean ± SD = 4.64 ± 0.84 on five‐point Likert scale), versatility in teaching multiple anatomy disciplines (3.93 ± 1.07), and flexibility in implementing various teaching pedagogies (3.69 ± 1.17). Collectively, these data suggest the shortage of anatomy educators continues in the United States/Canada and the European Union

Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A CENTER-TBI Analysis.

BACKGROUND: Trauma-induced coagulopathy in patients with traumatic brain injury (TBI) is associated with high rates of complications, unfavourable outcomes and mortality. The mechanism of the development of TBI-associated coagulopathy is poorly understood. METHODS: This analysis, embedded in the prospective, multi-centred, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, aimed to characterise the coagulopathy of TBI. Emphasis was placed on the acute phase following TBI, primary on subgroups of patients with abnormal coagulation profile within 4 h of admission, and the impact of pre-injury anticoagulant and/or antiplatelet therapy. In order to minimise confounding factors, patients with isolated TBI (iTBI) (n = 598) were selected for this analysis. RESULTS: Haemostatic disorders were observed in approximately 20% of iTBI patients. In a subgroup analysis, patients with pre-injury anticoagulant and/or antiplatelet therapy had a twice exacerbated coagulation profile as likely as those without premedication. This was in turn associated with increased rates of mortality and unfavourable outcome post-injury. A multivariate analysis of iTBI patients without pre-injury anticoagulant therapy identified several independent risk factors for coagulopathy which were present at hospital admission. Glasgow Coma Scale (GCS) less than or equal to 8, base excess (BE) less than or equal to - 6, hypothermia and hypotension increased risk significantly. CONCLUSION: Consideration of these factors enables early prediction and risk stratification of acute coagulopathy after TBI, thus guiding clinical management

[89Zr]Zr-PSMA-617 PET/CT in biochemical recurrence of prostate cancer : first clinical experience from a pilot study including biodistribution and dose estimates

Purpose Prostate-specific membrane antigen (PSMA)-targeted PET/CT has become increasingly important in the management of prostate cancer, especially in localization of biochemical recurrence (BCR). PSMA-targeted PET/CT imaging with long-lived radionuclides as 89Zr (T1/2=78.4 h) may improve diagnostics by allowing data acquisition on later time points. In this study, we present our frst clinical experience including preliminary biodistribution and dosimetry data of [ 89Zr]Zr-PSMA-617 PET/CT in patients with BCR of prostate cancer. Methods Seven patients with BCR of prostate cancer who revealed no (n =4) or undetermined (n =3) findings on [ 68Ga]Ga-PSMA-11 PET/CT imaging were referred to [ 89Zr]Zr-PSMA-617 PET/CT. PET/CT imaging was performed 1 h, 24 h, 48 h, and 72 h post injection (p.i.) of 111±11 MBq [ 89Zr]Zr-PSMA-617 (mean±standard deviation). Normal organ distribution and dosimetry were determined. Lesions visually considered as suggestive of prostate cancer were quantitatively analyzed. Results Intense physiological uptake was observed in the salivary and lacrimal glands, liver, spleen, kidneys, intestine and urinary tract. The parotid gland received the highest absorbed dose (0.601±0.185 mGy/MBq), followed by the kidneys (0.517±0.125 mGy/MBq). The estimated overall efective dose for the administration of 111 MBq was 10.1 mSv (0.0913±0.0118 mSv/MBq). In 6 patients, and in particular in 3 of 4 patients with negative [ 68Ga]Ga-PSMA-11 PET/CT, at least one prostate cancer lesion was detected in [ 89Zr]Zr-PSMA-617 PET/CT imaging at later time points. The majority of tumor lesions were frst visible at 24 h p.i. with continuously increasing tumor-to-background ratio over time. All tumor lesions were detectable at 48 h and 72 h p.i. Conclusion [ 89Zr]Zr-PSMA-617 PET/CT imaging is a promising new diagnostic tool with acceptable radiation exposure for patients with prostate cancer especially when [ 68Ga]Ga-PSMA-11 PET/CT imaging fails detecting recurrent disease. The long half-life of 89Zr enables late time point imaging (up to 72 h in our study) with increased tracer uptake in tumor lesions and higher tumor-to-background ratios allowing identifcation of lesions non-visible on [ 68Ga]Ga-PSMA-11 PET/CT imaging