Projeto doenças orificiais experiência do HCFMUSP em hospital-dia e doenças anorretais

The treatment of malignant or benign colorectal pathologies that require more complex management are priorities in tertiary hospitals such as "Hospital das Clínicas" University of São Paulo Medical Center (HCFMUSP). Therefore, benign, uncomplicated orifice conditions are relegated to second place. The number of patients with hemorrhoids, perianal fistulas, fissures, condylomas and pilonidal cysts who seek treatment at the HFMUSP is very great, resulting in over-crowding in the outpatient clinics and a long waiting list for recommended surgical treatment (at times over 18 months). The authors describe the experience of the HCFMUSP over an eight-day period with day-hospital surgery in which 140 patients underwent surgery. Data was prospectively taken on the patients undergoing surgery for benign orifice pathologies including age, sex, diagnosis, surgery performed, immediate and late postoperative complications, and follow-up. 140 patients operated on over eight days were studied. 68 were males (48.75%) with ages ranging from 25 to 62 (mean 35.2 yrs.). Hemorrhoids was the most frequent condition encountered (82 hemorrhoidectomies, 58.6%), followed by perineal fistula (28 fistula repairs, 20.0%). The most common complication was headache secondary to rachianesthesia occurring in 9 patients (6.4%). One patient (0.7%) developed bleeding immediately PO that required reoperation. Mean follow-up was 104 days. Day-surgery characterized by quality care and low morbidity is feasible in tertiary public hospitals, permitting surgery for benign orifice pathologies on many patients within a short period of time.O tratamento das patologias colorretais malignas ou benignas, que necessitam tratamento com maior grau de complexidade são prioridades em hospitais terciários, como é o Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), permanecendo assim as patologias orificiais benignas em um segundo plano. Todavia devido à sua característica assistencial, o número de pacientes que procuram o HCFMUSP por doença hemorroidária, fístulas perianais, fissuras, condilomas e cistos pilonidais é muito grande, resultando na hipertrofia dos ambulatórios e lentidão para o tratamento cirúrgico preconizado (às vezes um ano e meio). Os autores descrevem a experiência do HCFMUSP durante oito dias com o atendimento tipo hospital-dia em que 140 pacientes foram atendidos e submetidos a intervenções cirúrgicas. Foram anotados prospectivamente os dados de paciente submetidos a tratamento cirúrgico para patologias orificiais benignas quanto a idade, sexo, diagnóstico, tratamento cirúrgico realizado, e complicações pós operatórias imediatas e tardias e tempo de seguimento ambulatorial. Foram estudados 140 pacientes, operados em oito dias, sendo 68(48,75%) homens e a idade variando entre 25 e 62 anos (média de 35,2 anos). A doença hemorroidária foi a patologia mais freqüente, com 82 doentes operados (58,57%), seguido pela fístula perineal com 20,0% dos casos operados. A complicação mais freqüente foram as anestésicas com a cefaléia pós raquianestesia ocorrendo em nove pacientes (6,42%). Um paciente (0,71%) apresentou hemorragia no PO necessitando reoperação para hemostasia. O tempo médio de seguimento foi de 104 dias. O uso do conceito hospital-dia em serviços públicos terciários é factível, com a possibilidade de atendimento de grande quantidade de pacientes com patologias orificiais benignas, em curto espaço de tempo, com qualidade e baixas taxas de complicações

Toxoplasmose experimental em éguas gestantes: estudo dos fetos e placentas

Nine pregnant mares were orally infected with sporulated T. gondii oocysts. Three additional, pregnant, uninfected mares were used as control. T. gondii were found in the placenta, retina, esophagus, liver, diaphragm, brain, spinal cord, skeletal muscles, heart, lung and tongue of newborn foals from experimentally infected mares. The finding of T. gondii in the foals reinforced the hupothesis of transplacentary transmission of this protozoa in equines.Nove éguas prenhes foram inoculadas, via oral, com oocistos esporulados de T. gondii. Três éguas prenhes, não infectadas, foram mantidas como testemunhas. O T. gondii foi encontrado na placenta, retina, esôfago, fígado, diafragma, cérebro, medula espinhal, músculo esquelético, coração, pulmão e língua de potros nascidos de éguas inoculadas. A obtenção e T. gondii em diferentes tecidos, desses potros reforça a hipótese da transmissão transplacentária deste protozoário cm eqüinos

Sistema radicular de cultivares de feijão em resposta à calagem

Root growth is genetically controlled and the variability among cultivars and soil factors, such as Al toxicity and low Ca and Mg contents, can damage it. The objective of this study was to evaluate root growth and shoot growth of bean cultivars in response to liming. The experiment was carried out in pots with 13 dm3 of soil, in greenhouse until 43 days after the emergence of the plants. The experimental design was a completely randomized block, in a factorial scheme 4x4, with four doses of line (0, 1.59, 3.18 and 4.48 t ha-1), four bean cultivars (Campeão 1, Carioca, FT-Bonito and Pérola), and four replications. Pérola cultivar presents a root system more tolerant to low base saturation in comparison to the others. The maximum root growth occurred in base saturation values around 43% for Campeão 1, Carioca and Pérola cultivars. Under high acidity conditions, bean cultivars reduce root diameter and increase root length. Liming improves the root system growth and the aerial parts growth of the cultivars.O crescimento radicular apresenta variabilidade genética, e é afetado pelo Al tóxico e baixos teores de Ca e Mg do solo, que podem comprometer o seu desenvolvimento. O objetivo deste trabalho foi avaliar o sistema radicular de cultivares de feijão em resposta à calagem. O experimento foi realizado em vasos de 13 dm3 de solo, em casa de vegetação, até 43 dias após a emergência das plantas. O delineamento experimental utilizado foi o inteiramente casualizado, em arranjo fatorial 4x4, composto por quatro doses de calcário (0, 1,59, 3,18 e 4,48 t ha-1) e quatro cultivares de feijão (Campeão 1, Carioca, FT-Bonito e Pérola), com quatro repetições. O sistema radicular da cultivar Pérola foi mais tolerante à baixa saturação por bases do que o das demais cultivares. O máximo crescimento radicular das cultivares Campeão 1, Carioca e Pérola ocorreu em saturação por bases ao redor de 43%. Em condições de elevada acidez, o diâmetro radicular das cultivares é reduzido e há um incremento em comprimento. A calagem promove aumento do sistema radicular e da parte aérea das cultivares

Association between functional EGF+61polymorphism and glioma risk

Epidermal growthf actor (EGF) plays a critical role in cancer. A polymorphism in the EGF gene (EGF+61) may influence its expression and contribute to cancer predisposition and aggressiveness. In the present study, we aimed to elucidate the role of EGF+61in glioma susceptibility and prognosis. Experimental Design:A case-control study involving197 glioma patients and 570 controlswas done. Univariate and multivariate logistic regression analyses were used to calculate odds ratio (OR) and 95% confidence intervals (95% CI). False-positive report probability was also assessed.The luciferase reporter gene assay was used to ascertain the functional consequences of this polymorphism. Results: Corroborating the univariate analysis, the multivariate model showed that the G allele conferred higher risks for gliomas (OR,1.32; 95% CI,1.04-1.67), glioblastomas (OR,1.47; 95% CI, 1.02-2.10), and oligodendrogliomas (OR,1.55; 95% CI,1.07-2.23).TheGG genotypeswere associatedwithincreased risk for gliomas (OR,1.71; 95%CI,1.07-2.73), glioblastomas (OR, 2.03; 95% CI, 1.02-4.05), and oligodendrogliomas (OR, 2.72; 95% CI, 1.18-6.28). In addition, the AG+GG genotypes were associated withhigher risk for gliomas (OR,1.52; 95% CI,1.03-2.23) and oligodendrogliomas (OR, 2.80; 95% CI,1.35-5.79). No significant associationwas observed between the EGF+61polymorphism and glioblastoma or oligodendroglioma patients’overall survival. The luciferase reporter gene assay exhibited a significant increased promoter activity for the G variant compared withthe referenceA allele. Conclusions: These findings support the role of the EGF+61polymorphism as a susceptibility factor for development of gliomas and show its implication on EGF promoter activity.Sixth Research Framework Programme of the European Union, Project INCA (LSHC-CT-2005-018704

Modulation of Vasomotive Activity in Rabbit External Ophthalmic Artery by Neuropeptides

Purpose. To investigate the vasomotive activity upon the external ophthalmic artery of vasointestinal peptide (VIP) and neuropeptide Y (NPY) using a previously developed model. Methods. Isolated rabbit eyes (n = 12) were perfused in situ with tyrode through the external ophthalmic artery. Effects of intra-arterial injections of NPY 200 μg/ml (Group A; n = 6) and VIP 200 μg/ml (Group B; n = 6) on the recorded pressure were obtained. For statistical analysis, Student's paired t-test and Fast Fourier Transform were used. Results. Spontaneous oscillations were observed before any drug administration in the 12 rabbit models. NPY produced an increase in total vascular resistance and a higher frequency and amplitude of oscillations, while VIP evoked the opposite effects. Conclusions. This study provides evidence of vasomotion in basal conditions in rabbit external ophthalmic artery. Concerning drug effects, NPY increased arterial resistance and enhanced vasomotion while VIP produced opposite effects which demonstrates their profound influence in arterial vasomotion

Changes in bone Pb accumulation: Cause and effect of altered bone turnover

Notice: this is the author’s version of a work that was accepted for publication in Bone. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Bone, [Vol 64 (2014 Jul)] DOI 10.1016/j.bone.2014.04.021"This paper assesses the magnitude of Pb uptake in cortical and trabecular bones in healthy animals and animals with altered balance in bone turnover, and the impact of exposure to Pb on serum markers of bone formation and resorption. The results reported herein provide physiological evidence that Pb distributes differently in central compartments in Pb metabolism, such as cortical and trabecular bone, in healthy animals and animals with altered balance in bone turnover, and that exposure to Pb does have an impact on bone resorption resulting in OC-dependent osteopenia. These findings show that Pb may play a role in the etiology of osteoporosis and that its concentration in bones varies as a result of altered bone turnover characteristic of this disease, a long standing question in the field. In addition, data collected in this study are consistent with previous observations of increased half-life of Pb in bone at higher exposures. This evidence is relevant for the necessary revision of current physiologically based kinetic models for Pb in humans.

Quality evaluation of simvastatin compounded capsules

Simvastatin is commercially available as tablets and compounded capsules in Brazil. Very few reports regarding these capsules' quality, and consequently their efficacy, are available. The pharmaceutical quality of 30 batches of 20 mg simvastatin capsules from the market was evaluated by weight determination, content uniformity, disintegration (Brazilian Pharmacopeia), assay and dissolution test (USP32 tablet monograph). A HPLC method was developed for assay, content uniformity and dissolution test, and specifications were also established. Out of the 30 batches evaluated, 29 showed capsule disintegration within 45 min and individual weight variation was within ±10% or ±7.5% relative to average weight, for < or &gt; 300 mg, respectively. Only 27 batches met dissolution test criteria with values &gt;80% of the labeled amount in 45 min; 21 batches showed simvastatin content between 90.0-110.0% of the labeled amount and 19 batches had at least 9 out of 10 capsules with content uniformity values between 85.0-115.0% of the labeled amount with RSDNo Brasil, a sinvastatina está comercialmente disponível na forma de comprimidos e cápsulas manipuladas. Poucos relatos estão disponíveis sobre a qualidade e, consequentemente, a eficácia dessas cápsulas. A qualidade de 30 lotes de sinvastatina 20 mg cápsulas do mercado foi avaliada através da determinação de peso, uniformidade de conteúdo, desintegração (Farmacopéia Brasileira), doseamento e teste de dissolução (monografia comprimidos USP32). Método por CLAE foi desenvolvido para o doseamento, uniformidade de conteúdo e teste de dissolução; além disso, especificações foram estabelecidas. Dos 30 lotes avaliados, 29 apresentaram desintegração da cápsula até 45 min e a variação do peso individual foi ± 10% ou ± 7,5% em relação ao peso médio, se < ou &gt; 300 mg, respectivamente. Apenas 27 lotes preencheram os critérios do teste de dissolução com valores &gt; 80% da quantidade rotulada, em 45 min, 21 lotes apresentaram conteúdo de sinvastatina entre 90,0-110,0% do valor rotulado e 19 lotes apresentaram pelo menos 9 em 10 cápsulas, com valores de uniformidade de conteúdo entre 85,0 -115,0% da quantidade rotulada com RSD < 6,0%. Apenas 14 de todos os lotes (30) atenderam completamente os padrões de qualidade farmacopéicos. O estabelecimento das condições para os testes e de especificações para os parâmetros das cápsulas de sinvastatina mostrou que houve diferenças relevantes na qualidade farmacopeica entre os lotes das cápsulas manipuladas por distintas farmácias. A eficácia do tratamento hipercolesterolêmico poderia estar comprometida para 53,33% dos produtos testados

innovation through design

Background: Asthma affects the lives of hundred million people around the World. Despite notable progresses in disease management, asthma control remains largely insufficient worldwide, influencing patients' wellbeing and quality of life. Poor patient handling of inhaling devices has been identified as a major persistent problem that significantly reduces inhaled drugs' efficacy and is associated with poor adherence to treatment, impairing clinical results such as asthma control and increasing disease-related costs. We herein review key research and development (R&D) innovation in inhaler devices, highlighting major real-world critical errors in the handling and inhalation technique with current devices and considering potential solutions. Furthermore, we discuss current evidence regarding breath-triggered inhalers (BTI). Main body: The two most common significant problems with inhalers are coordinating actuation and inhalation with pressurized metered-dose inhalers (pMDIs), and the need to inhale forcibly with a dry powder inhaler. BTI R&D plans were designed to overcome these problems. Its newest device k-haler® has several other important features, generating a less forceful aerosol plume than previous pMDIs, with efficient drug delivery and lung deposition, even in patients with low inspiratory flow. The local and systemic bioavailability of fluticasone propionate and formoterol (FP/FORM) administered via k-haler® has been shown to be therapeutically equivalent when administered via the previous FP/FORM pMDI. This device requires very few steps and has been considered easy to use (even at first attempt) and preferred by the patients in a randomized crossover study. In our country, FP/FORM k-haler is available without additional costs compared to FP/FORM pMDI. All devices continue to require education and regular checking of the correct inhalation technique. Conclusion: BTI R&D can bring advantage over current available inhalers, avoiding the two most common identified critical errors in inhalation technique. K-haler® BTI is currently available, without an increased cost, and approved for adolescents and adults with asthma in whom treatment with inhaled combined therapy with long-acting beta2-agonists and corticosteroids is indicated. Its attractive and practical design to facilitate its use has been awarded. K-haler® represents added value through innovation to fulfill actual asthma patient needs, thus with potential relevant impact in asthma management and effective control.publishersversionpublishe

Iron status is associated with mood, cognition, and functional ability in older adults: a cross-sectional study

Several conditions are risk factors for iron deficiency (ID), some of which are highly prevalent in older individuals. Despite the amount of evidence pointing for a role of ID in cognition, mood and physical functional ability, the research addressing these associations in older individuals is still scarce. In the present study, 162 older community-dwelling individuals (29.53% classified as ID) were enrolled in a cross-sectional analysis and characterized regarding cognition, mood, functional ability, general nutritional intake and iron status. Assessment of iron status was performed using several blood biomarkers. Storage and erythropoiesis dimensions were positively associated with memory, along with an interaction (moderator effect) between iron storage and nutritional status. A more depressed mood was negatively associated with (iron) transport, transport saturation and erythropoiesis dimensions, and functional tiredness was positively associated with the erythropoiesis dimension. These observations indicate that lower iron status is associated with depressive mood, functional tiredness and poorer memory ability, with the latter moderated by nutritional status. These findings suggest that using iron as a continuous variable may be useful in finding associations with iron homeostasis, eventually missed when iron levels are considered within the usual classification groups.This work has been funded by National funds, through the Foundation for Science and Technology (FCT)-project UIDB/50026/2020 and UIDP/50026/2020; and by the projects NORTE-01-0145-FEDER-000013 and NORTE-01-0145-FEDER-000023, supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), by the Fundacao Calouste Gulbenkian (Portugal) (contract grant number: P-139977; project "Better Mental Health during Ageing based on Temporal Prediction of Individual Brain Ageing Trajectories (TEMPO)") and by the European Commission (FP7): "SwitchBox" (Contract HEALTH-F2-2010-259772). C.P.-N was supported by the Portuguese Science Foundation (FCT) doctoral scholarship PD/BD/106050/2015 via the Inter-University PhD Programme in Ageing and Chronic Diseases, T.C.C. was a recipient of a doctoral fellowship from the Portuguese Foundation for Science and Technology (FCT; SFRH/BD/90078/2012), L.A. was a recipient of a doctoral fellowship from the Portuguese Foundation for Science and Technology (FCT; SFRH/BD/101398/2014), P.S.M. was supported by the FCT fellowship grant with the reference PDE/BDE/113601/2015 from the PhDiHES program, N.C.S. was a recipient of a research assistantship by the through the FCT Investigator Programme 200 infinity Ciencia

SIMULAÇÃO VAZÃOEROSÃO USANDO O MODELO SWAT PARA UMA GRANDE BACIA DA REGIÃO SEMIÁRIDA DA PARAÍBA

Modelos matemáticos apresentam grande potencial para serem utilizados como instrumento de apoio ao planejamento de uso da terra, com o propósito de melhorar a qualidade do solo e da água. Este trabalho tem como objetivo estimar a produção de sedimentos na bacia do Rio Taperoá, localizada na região semiárida do Estado da Paraíba, utilizando o modelo Soil and Water Assessment Tool (SWAT). Neste trabalho foram utilizados dados de precipitação, temperatura e umidade para o período de 1970 a 1993, além de mapas dos tipos de solos, uso e ocupação do solo e modelo de elevação digital. Valores simulados pelo modelo SWAT foram comparados com dados de vazão medidos e de produção de sedimentos estimados. O modelo foi calibrado e validado usando dados mensais de vazão para o posto fluviométrico Poço de Pedras. Os resultados mostram um bom ajuste, com vazão média observada de 6,86 m³/s e vazão média simulada de 7,73 m³/s, enquanto a produção de sedimentos para todo o período de 2,5 t/ha/ano