Quality Of Life And Epilepsy Surgery In Childhood And Adolescence.

Epilepsy can affect the quality of life (QOL) of patients. The temporal lobe epilepsy (TLE) is often refractory to medication, which has an adverse impact on QOL. The surgery can be a form to control the seizures and to improve the QOL of the patients. The aim of this study was to verify the QOL of children and adolescents with TLE who underwent surgery for epilepsy, comparing QOL before and after surgery and investigating which parameters showed improvement. We used semi-structured questionnaire in the pre-and post-surgery in 13 patients. The data were analyzed using the Wilcoxon test. The analysis showed that there was general improvement in the QOL postoperatively. There was improvement in general health issues, adverse effects of antiepileptic drugs and the relationship with parents. When properly indicated, epilepsy surgery improves quality of life of patients with TLE.6923-

The ATP-sensitive potassium channel blocker glibenclamide prevents renal ischemia/reperfusion injury in rats

The ATP-sensitive potassium channel blocker glibenclamide prevents renal ischemia/reperfusion injury in rats.BackgroundRenal ischemia/reperfusion (I/R) is a complex neutrophil-mediated syndrome. Adenosine-triphosphate (ATP)-sensitive potassium (KATP) channels are involved in neutrophil migration in vivo. In the present study, we have investigated the effects of glibenclamide, a KATP channel blocker, in renal I/R injury in rats.MethodsThe left kidney of the rats was excised through a flank incision and ischemia was performed in the contralateral kidney by total interruption of renal artery flow for 45 minutes. Renal perfusion was reestablished, and the kidney and lungs were removed for analysis of vascular permeability, neutrophil accumulation, and content of cytokines [tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-10] 4 and 24 hours later. Renal function was assessed by measuring creatinine, Na+, and K+ levels in the plasma and by determination of creatinine clearance. Drugs were administered subcutaneously after the onset of ischemia.ResultsReperfusion of the ischemic kidney induced local (kidney) and remote (lung) inflammatory injury and marked renal dysfunction. Glibenclamide (20 mg/kg) significantly inhibited the reperfusion-associated increase in vascular permeability, neutrophil accumulation, increase in TNF-α levels and nuclear factor-κB (NF-κB) translocation. These inhibitory effects were noticed in the kidney and lungs. Moreover, glibenclamide markedly ameliorated the renal dysfunction at 4 and 24 hours.ConclusionTreatment with glibenclamide is associated with inhibition of neutrophil recruitment and amelioration of renal dysfunction following renal I/R. Glibenclamide may have a therapeutic role in the treatment of renal I/R injury, such as after renal transplantation

Alpinia

Species of the genus Alpinia are widely used by the population and have many described biological activities, including activity against insects. In this paper, we describe the bioactivity of the essential oil of two species of Alpinia genus, A. zerumbet and A. vittata, against Rhodnius nasutus, a vector of Chagas disease. The essential oils of these two species were obtained by hydrodistillation and analyzed by GC-MS. The main constituent of A. zerumbet essential oil (OLALPZER) was terpinen-4-ol, which represented 19.7% of the total components identified. In the essential oil of A. vittata (OLALPVIT) the monoterpene β-pinene (35.3%) was the main constituent. The essential oils and their main constituents were topically applied on R. nasutus fifth-instar nymphs. In the first 10 min of application, OLALPVIT and OLALPZER at 125 μg/mL provoked 73.3% and 83.3% of mortality, respectively. Terpinen-4-ol at 25 μg/mL and β-pinene at 44 μg/mL provoked 100% of mortality. The monitoring of resistant insects showed that both essential oils exhibited antifeedant activity. These results suggest the potential use of A. zerumbet and A. vittata essential oils and their major constituents to control R. nasutus population

Comfort from the perspective of families of people hospitalized in the intensive care unit

This study aimed at understanding the meaning of comfort to the families of people in intensive care units. It consists of a qualitative study carried out in the intensive care unit of a hospital in Salvador-Bahia. Fourteen family members were interviewed. The authors utilized the theoretical principles of symbolic interactionism and the technique of qualitative data analysis. Results indicated that the categories Safety, Receptiveness, Information, Proximity, Social and Spiritual Support, Convenience and Integration expressed the meaning of comfort, which was comprised of reliability in terms of technical-scientific competence and a supportive and sensitive attitude of the team, chance of recovery, access to information and the opportunity to be close to the patient, support of people in their social life, spiritual sources and the environmental structure of the hospital, preservation of self-care and routine activities. It was concluded that the family is important as objects and subjects of the actions in healthcare and must be the focus in public health policies and programs in Brazil

A vivência da amamentação em “mães de primeira viagem”

L'allaitement dépasse la limite du biologique, en nous insérant aussi de contextes social et psychologique. Cette étude, réalisée à la Clinique Obstétrique de ICHC-FMUSP, a utilisé la méthodologie qualitative pour interviewer en profondeur dix « mères de premier voyage », afin de comprendre des aspects psychologiques impliqués dans l'allaitement, dans la première semaine de vie du bébé, et comme ces mères traitent avec les orientations des arrivées de l'équipe de santé. Des entrevues individuelles et de l'analyse qualitative des données ont été réalisées. L'allaitement est apparu comme une expérience ambivalente, avec des sentiments de pouvoir et complétude, de féminité, mais aussi une expérience pénible. La moitié des interviewées a reçu des orientations de l'équipe de santé, senties comme une aide et une sécurité émotionnelle. Ainsi, l'allaitement, quand il n'est pas imposé, peut favoriser la rencontre de la mère avec son bébé et le contact avec elle-même. L'équipe de santé peut agir comme une facilitation, en utilisant des connaissances techniques mais en se maintenant ouverte à l'écoute de ces femmes.A amamentação ultrapassa o limite do biológico, inserindo-se também nos âmbitos social e psicológico. Esse estudo, realizado na Clínica Obstétrica do ICHC-FMUSP, utilizou a metodologia qualitativa para entrevistar em profundidade dez "mães de primeira viagem", a fim de compreender aspectos psicológicos envolvidos na amamentação, na primeira semana de vida do bebê, e como essas mães lidam com as orientações vindas da equipe de saúde. Foram realizadas entrevistas individuais e análise qualitativa dos dados. A amamentação apareceu como uma vivência ambivalente, com sentimentos de poder e completude, feminilidade, mas também uma experiência dolorosa. Metade das entrevistadas recebeu orientações da equipe de saúde, sentidas como um apoio e segurança emocional. Assim, a amamentação, quando não é imposta, pode favorecer o encontro da mãe com seu bebê e o contato com ela mesma. A equipe de saúde pode atuar como facilitadora, utilizando conhecimentos técnicos, mas mantendo-se aberta à escuta dessas mulheres.El amamantamiento sobrepasa el límite biológico, haciendo parte también de los ámbitos social y psicológico. Este estudio, realizado en la Clínica Obstétrica del ICHC-FMUSP, utilizó la metodología cualitativa para entrevistar con detenimiento a diez "madres de primer viaje", con la finalidad de comprender aspectos psicológicos vinculados al amamantamiento en la primera semana de vida del bebé, y cómo esas madres manejan las orientaciones recibidas del equipo de salud. Fueron realizadas entrevistas individuales y análisis cualitativo de los datos. El amamantamiento apareció como una experiencia ambivalente, con sentimientos de poder y sensación de plenitud, femineidad, pero también una experiencia dolorosa. La mitad de las entrevistadas recibió orientaciones del equipo de salud, las cuales fueron evaluadas como un apoyo y seguridad emocional. Así, el amamantamiento, cuando no es impuesto, puede favorecer el encuentro de la madre con su bebé y el contacto con ella misma. El equipo de salud puede actuar como facilitador, utilizando conocimientos técnicos pero manteniéndose de oídos abiertos hacia esas mujeres.Breast-feeding exceeds the boundaries of biology, inserting itself also in the social and psychological scopes. This study, taken place in the Obstetric Clinic of the ICHC-FMUSP, used the qualitative methodology to interview in depth ten "first-time mothers", in order to understand the psychological aspects involved in breast-feeding, during the baby’s first week of life, and how these mothers dealt with the guidance given by the health team. Individual interviews and qualitative analysis of the data has been carried through. Breast-feeding appeared as an ambivalent experience, with feelings of power and completeness, femininity, but also appeared as a painful experience. Half of the interviewed mothers received guidance from the health team, and felt it as an emotional support and security. Thus, breast-feeding, when it is not imposed, may favor the meeting of mother and child, as well as the contact of the mother with herself. The health team can act as a facilitator, using technical knowledge, but always keeping themselves opened to listening to these women

A Model of DENV-3 Infection That Recapitulates Severe Disease and Highlights the Importance of IFN-γ in Host Resistance to Infection

There are few animal models of dengue infection, especially in immunocompetent mice. Here, we describe alterations found in adult immunocompetent mice inoculated with an adapted Dengue virus (DENV-3) strain. Infection of mice with the adapted DENV-3 caused inoculum-dependent lethality that was preceded by several hematological and biochemical changes and increased virus dissemination, features consistent with severe disease manifestation in humans. IFN-γ expression increased after DENV-3 infection of WT mice and this was preceded by increase in expression of IL-12 and IL-18. In DENV-3-inoculated IFN-γ−/− mice, there was enhanced lethality, which was preceded by severe disease manifestation and virus replication. Lack of IFN-γ production was associated with diminished NO-synthase 2 (NOS2) expression and higher susceptibility of NOS2−/− mice to DENV-3 infection. Therefore, mechanisms of protection to DENV-3 infection rely on IFN-γ-NOS2-NO-dependent control of viral replication and of disease severity, a pathway showed to be relevant for resistance to DENV infection in other experimental and clinical settings. Thus, the model of DENV-3 infection in immunocompetent mice described here represents a significant advance in animal models of severe dengue disease and may provide an important tool to the elucidation of immunopathogenesis of disease and of protective mechanisms associated with infection

Experiência brasileira utilizando terapia sequencial de alta dose seguido de transplante autólogo de célula-tronco hematopoética para linfomas malignos

Using the overall survival (OS), disease free survival (DFS) and progression free survival (PFS), as well as associated toxicity, the purpose of this work was to evaluate the effectiveness of HDS followed by ASCT as salvage therapy. A retrospective analysis was performed of 106 patients with high grade non-Hodgkin lymphoma receiving HDS followed by ASCT, between 1998 and 2006. Median age was 45 years (Range: 8-65), with 66 (62%) men. Histopathological classification was: 78% DLBCL patients, 12% T and anaplastic and 9% Mantle cell lymphomas; 87% had B cell and 12% T cell lymphomas; 83% were stage III-IV (Ann Arbor Staging), 63% had B symptoms, 32% had bone marrow involvement, 62% bulky disease and 42% high-intermediate or high risk IPI. After HDCY, 9 patients died, 7 from toxicity and 2 from sepsis. Eighty patients underwent ASCT, 47% were in complete remission (CR) and 15% died, all from toxicity. Their OS was 45% over 8 years. During the follow-up, another 35 patients died [4 CR, 1 partial response (PR), 2 relapsed disease (RD) and 28 disease progression (DP)], 11 (31%) had not performed ASCT. OS was 37%; DFS was 49% and PFS 28%. OS by diagnosis was 42% for DLBCL, 40% for T-cell (8 y) and 20% for Mantle Cell (6 y) (P=NS). OS by B symptom patients was 22% vs. 58% (P=0.002) and PFS was 23% vs. 37% (P=0.03). Patients who achieved CR after HDCY (38) had significantly better OS and PFS (38% and 17%) than patients who remained in DP (P<0.0001). Cox Regression demonstrated therapeutic lines before HDCY (Relative risk - RR = 1.41; CI 95%: 1.04-1.90; P= 0.02) and PD both before (RR = 2.70; CI 95%: 1.49-4.91, P<0.001) and after HDCY (RR = 5.38; 95% CI: 2.93-9.87; P<0.0001). Conclusions: Our study suggests HDS is an efficient treatment to improve status and to reduce tumoral burden. Regardless of toxicity-related mortality it is feasible, especially considering the poor prognosis of patients.A proposta deste trabalho foi avaliar a eficácia da HDS seguida do transplante autólogo como terapia de salvamento através da sobrevida global, livre de doença e livre de progressão bem como sua toxicidade. Realizou-se estudo retrospectivo com 106 pacientes com LNH de alto grau de malignidade entre 1998 e 2006. A mediana de idade foi 45 anos (8-65); 62% homens; DLBCL, 78%; 12%, T e anaplásico e 9%, linfoma da zona do manto; 87%, células B; 83% estádios III-IV; 63% com sintomas B; 32% com infiltração da medula óssea ao diagnóstico; 62% com grande massa e 42% com IPI de alto risco ou intermediário. Após alta dose de ciclofosfamida (HDCY), nove pacientes faleceram. Oitenta pacientes realizaram o transplante, sendo que 47% estavam em RC e 15% faleceram devido à toxicidade. A sobrevida global foi de 45% em oito anos para estes pacientes. Trinta e cinco pacientes não realizaram o transplante por causas diversas. Sobrevida global para todos os pacientes foi de 42%, DLBCL, 40%; T-cell, 40% e zona do manto, 20% (P=NS). Pacientes que obtiveram RC após HDCY tiveram melhor sobrevida global e livre de progressão (38% e 17%, respectivamente) do que os que permaneceram em PD (P<0.0001). O modelo de Cox resultou que o número de linhas terapêuticas antes da HDCY (RR 1.41 IC 95%: 1.04-1.90, P=0.02) e PD antes da HDCY (RR 2.70, IC 95%: 1.49-4.91, P<0.001) e após HDCY (RR 5.38, IC 95%: 2.93-9.87, P<0.0001). Nosso estudo sugere que HDS é um método eficiente de tratamento para melhorar o status e reduzir a massa tumoral. Em relação à toxicidade, é factível, especialmente em pacientes de prognóstico ruim91