Different cut-off values of quantitative D-dimer methods to predict the risk of venous thromboembolism recurrence : a post-hoc analysis of the PROLONG study

Background: The PROLONG study showed that patients with venous thromboembolism who had qualitatively abnormal results in a D-dimer assay (Clearview Simplify D-dimer) after discontinuation of vitamin K antagonism benefit from resumption of treatment with vitamin K antagonism. The objective of this study was to evaluate the possible advantage of using quantitative D-dimer assays. Design and Methods: VIDAS D-dimer Exclusion (bioMerieux), Innovance D-DIMER (Dade Behring), HemosIL D-dimer HS (Instrumentation Laboratory) and STA Liatest D-dimer (Diagnostica Stago) assays were performed in plasma aliquots sampled 30\ub110 days after cessation of vitamin K antagonism in 321 patients enrolled in the PROLONG study. Results: During the follow-up without vitamin K antagonism, 25 patients had recurrent venous thromboembolism. The cut-off levels of the quantitative assays giving results most comparable with those of the qualitative test were: VIDAS = 800 ng/mL; Innovance = 800 ng/mL; HemosIL HS = 300 ng/mL; STA Liatest = 700 ng/mL. When the effect of the patients' age ( 6470 vs. >70 years) was analyzed, it was found that only in younger patients was the rate of recurrence of venous thromboembolism significantly higher in patients with abnormal D-dimer levels. However, using the quantitative assays and age-specific cut-off levels it was possible to determine statistically significant hazard ratios also in elderly patients (VIDAS = 600 and 1200 ng/mL, Innovance = 500 and 900 ng/mL, HemosIL HS = 250 and 450 ng/mL, STA Liatest = 700 and 1000 ng/mL, in patients aged 6470 and >70 years, respectively). Conclusions: Quantitative D-dimer assays may provide information useful for evaluating the individual risk of recurrent venous thromboembolism. They seem particularly advantageous since they allow the selection of different cut-off levels according to the age or other characteristics of the patients

OBESIDADE E SINTOMAS DE DEPRESSÃO, ANSIEDADE E DESESPERANÇA EM MULHERES SEDENTÁRIAS E NÃO SEDENTÁRIAS

O objetivo deste estudo de campo foi verificar se existe relação entre obesidade e sintomas de depressão, ansiedade e desesperança em 40 mulheres, com idade média = 30,35 anos (± 8,60), divididas em dois grupos: não sedentárias, caracterizadas por praticar atividade física pelo menos três vezes semanais e por três semanas consecutivas e sedentárias, caracterizadas por não praticar qualquer tipo de atividade física regular quando recrutadas. O método consistiu em: avaliações objetivas do humor, através dos Inventários Beck de Ansiedade (BAI), de Depressão (BDI) e de Desesperança (BHS) e Avaliação Física, incluindo massa corporal total, estatura, circunferências da cintura e do quadril e espessura de dobras cutâneas. Foram realizados cálculos do Índice de Massa Corpórea (IMC), da Razão Cintura-Quadril (RCQ) e da porcentagem de gordura corporal (%G) para avaliar presença e grau de obesidade. Resultados das análises de regressão para mínimos quadrados sustentaram as hipóteses iniciais quanto a existência da relação entre obesidade e sintomas psíquicos somente em mulheres sedentárias (BDI/RCQ, p=0,035, BDI/IMC, p=0,009, BDI/%G, p=0,019, BAI/IMC, p=0,009, BAI/%G, p=0,037, BHS/RCQ, p=0,025, BHS/IMC, p=0,041), já que a relação de dependência não pôde ser confirmada em mulheres não sedentárias (BDI/RCQ, p=0,750, BDI/IMC, p=0,141, BDI/%G, p=0,064, BAI/RCQ, p=0,729, BAI/IMC, p=0,384, BAI/%G, p=0,246, BHS/RCQ, p=0,491, BHS/IMC, p=0,986, BHS/%G, p=0,322) e que, quanto maior o nível de obesidade, maiores os níveis de sintomas psíquicos nos dois grupos. Essas observações parecem indicar que a prática de atividade física foi um fator de minimização da presença e intensidade de sintomas psíquicos em mulheres não sedentárias.The aim of this field study was to verify if there is a relation between obesity and symptoms of depression, anxiety and hopelessness in 40 women aged 30,35 on average (± 8,60), divided into two groups: non-sedentary ones, characterized for doing a physical activity at least three times a week for three weeks in a row and sedentary ones, characterized by not practicing any type of regular physical activity when recruited. The method consisted of: objective evaluations of humor, through Beck Inventories of Anxiety (BAI), Depression (BDI) and Hopelessness (BHS) and Physical Evaluation, including total body mass, height, waist and hip circumferences and skin folds thickness. Calculations of the body mass index (BMI), of the waist/hip index (WHI) and of the percentage of corporal fat (%F) were performed in order to evaluate the presence and level of obesity. Results of the analysis of regression to square minimum supported the initial hypothesis concerning the existence of a relation between obesity and psychic symptoms only in sedentary women (BDI/WHI, p=0,035, BDI/BMI, p=0,009, BDI/%G, p=0,019, BAI/BMI, p=0,009, BAI/%G, p=0,037, BHS/WHI, p=0,025, BHS/BMI, p=0,041), once the relation of dependency could not be confirmed in non-sedentary women BDI/WHI, p=0,750, BDI/BMI, p=0,141, BDI/%G, p =0,064, p=0,729,p=0,384, BAI/%G, p=0,246, BHS/WHI, p=0,491, BHS/BMI, p=0,986, p=0,322) and the greater the level of obesity, the greater the level of psychic symptoms in both groups. These observations seem to point out that the practice of physical activities was a factor of minimization of presence and intensity of psychic symptoms in non-sedentary women. 

Hydrogenation of nitrobenzene to 4-aminophenol in a fully reusable solvent system, by using Pt, Rh, Pd supported on carbon-CF3COOH catalytic system

4-Aminophenol is an important raw material for several products in the field of dyes, photographs and pharmaceutics. For instance, paracetamol (N-acetyl-4-aminophenol) a widely employed analgesic and antipyretic whose production is in continuous growth specially in the far east region. Industrial synthesis of paracetamol is based mainly on 4-aminophenol, which is obtained by three different routes: i) nucleophilic substitution of the Cl of the 4-chloronitrobenzene, ii) reduction of 4-nitro-phenol, iii) selective hydrogenation of nitrobenzene [1]. The selective hydrogenation of nitrobenzene is however, the most convenient from both economical and environmental point of view [1, 2]. The major concern of this process is, however, the presence of H2SO4, which is origin of corrosion, safety, environmental and separation problems. The reaction is typically carried out in CSTR in which the biphasic reaction medium is used to accomplish simultaneously the Pt catalyzed hydrogenation of nitrobenzene and the acid catalyzed Bamberger rearrangement of the intermediate N-phenylhydroxylamine. From environmental point of view, the major drawback of the process is the neutralization of the acidic phase, with the consequent by-production of sulfate salts, which are undesired wastes. Starting from recent results obtained in the Beckmann rearrangement of the cyclohexanone oxime in CH3CN-CF3COOH system [3], here we show some findings on the hydrogenation of nitrobenzene to 4-aminophenol in a single liquid phase CH3CN-H2O-CF3COOH and in the presence a hydrogenation catalyst. The easy of recovery of solvent and catalysts allows to develop a greener process than that based on the biphasic H2SO4-nitrobenzene syste

COMPARAÇÃO ENTRE DADOS SELECIONADOS DE DOIS SISTEMAS DE COMUNICAÇÃO DE ACIDENTE DE TRABALHO NO MUNICÍPIO DE SÃO JOSÉ DOS CAMPOS

Neste texto, o objetivo é analisar dados da  Rede Nacional de Atenção Integral à Saúde do Trabalhador (Renast) comparados com os dados de registro do Anuário Estatístico de Acidentes do Trabalho (AEAT) para o município de São José dos Campos nos anos de 2013 e 2014. Utilizando os dados do AEAT divulgada pela Previdência Social e o Ministério do Trabalho, pode-se verificar uma discrepância entre os dados relacionados a acidentes de trabalho desta pesquisa e aqueles registrados na base de dados da Renast, procedentes do Sistema Único de Saúde (SUS). A comparação mostrou que a AEAT aponta números de quase sete vezes os da Renast. Sugere-se que essa diferença se deva á subnotificação do registro de acidentes e a situação de desvalorização ao qual se encontra a Renast regional devido à falta de incentivos voltados para a área de saúde e segurança do trabalhador

Risk of recurrence after a first unprovoked venous thromboembolism : external validation of the Vienna Prediction Model with pooled individual patient data

Background: In order to stratify patients with a first unprovoked venous thromboembolism (VTE) according to their recurrence risk and to identify those who would actually benefit from indefinite anticoagulation, three prediction models have been developed so far; none of them has been yet externally validated. Objective: To externally validate the Vienna Prediction Model (VPM), a prediction guide for estimating the recurrence risk after a first unprovoked VTE developed through Cox modeling and including sex, D-dimer and index VTE site as predictors. Patients/Methods: Nine hundred and four patients pooled from five prospective studies evaluating the prognostic value of D-dimer for VTE recurrence served as the validation cohort. The validity of the VPM in stratifying patients according to their relative recurrence risk (discrimination) and in predicting the absolute recurrence risk (calibration) was tested with survival analysis methods. Results: The ability of the VPM to distinguish patients' risk for recurrent VTE in the validation cohort was at least as good as in the original cohort, with a calibration slope of 1.17 (95% confidence interval 0.71-1.64; P\ua0=\ua00.456 for the hypothesis of a significant difference from 1), and a c-statistic of 0.626 (vs. 0.651 in the original derivation cohort). The VPM absolute predictions in terms of cumulative rates tended to underestimate the observed recurrence rates at 12\ua0months. Conclusions: By using a pooled individual patient database as a validation cohort, we confirmed the ability of the VPM to stratify patients with a first unprovoked VTE according to their risk of recurrence

Phase III studies on novel oral anticoagulants for stroke prevention in atrial fibrillation -a look beyond the excellent results

In this overview we address the three phase III studies that compared new oral anticoagulants (dabigatran, rivaroxaban and apixaban) with warfarin in the setting of stroke prevention in atrial fibrillation. Strengths and weaknesses of the studies were examined in detail through indirect comparison. We analyze and comment the inclusion and exclusion criteria, the characteristics of randomized patients, the primary efficacy and safety end points and side effects. All new oral anticoagulants resulted in being non-inferior to vitamin K antagonists in reducing stroke or systemic embolism in patients with atrial fibrillation. Dabigatran 150 mg and apixaban were superior to vitamin K antagonists. Importantly, new oral anticoagulants significantly reduced hemorrhagic stroke in all three studies. Major differences among new oral anticoagulants include the way they are eliminated and side effects. Both dabigatran and apixaban were tested in low- to moderate-risk patients (mean CHADS2 [Congestive heart failure, Hypertension, Age, Diabetes, Stroke] score = 2.1-2.2) whereas rivaroxaban was tested in high-risk patients (mean CHADS2 score = 3.48) and at variance with dabigatran and apixaban was administered once daily. Apixaban significantly reduced mortality from any cause. The choice of a new oral anticoagulant should take into account these and other differences between the new drugs

The SHOX gene and the short stature. Roundtable on diagnosis and treatment of short stature due to SHOX haploinsufficiency: How genetics, radiology and anthropometry can help the pediatrician in the diagnostic process padova (April 20th, 2011)

The growth of the human body depends from a complex interaction between nutritional, environmental and hormonal factors and by a large number of different genes. One of these genes, short stature homeobox (SHOX), is believed to play a major role in growth. SHOX haploinsufficiency is associated with a wide spectrum of conditions, all characterized growth failure such as Leri-Weill dyschondrosteosis , Turner syndrome, short stature with subtle auxological and radiological findings and the so called “idiopathic short stature” (short stature with no specific findings other than growth failure). The document was prepared by a multidisciplinary team (paediatric endocrinologists, paediatrician, radiologist, geneticist and epidemiologist) to focus on the investigation of children with suspected SHOX- deficiency (SHOX-D) for an early identification and a correct diagnostic work - up of this genetic disorder. On the basis of a number of screening studies, SHOX-D appears to be a relatively frequent cause of short stature. The following recommendations were suggested by our multidisciplinary team: (i) a careful family history, measurements of body proportions and detection of any dysmorphic features are important for the suspect of a genetic disorder ,(ii)the presence of any combination of the following physical findings, such as reduced arm span/ height ratio, increased sitting height/height ratio, above average BMI, Madelung deformity, cubitus valgus, short or bowed forearm, dislocation of the ulna at the elbow, or the appearance of muscular hypertrophy, should prompt the clinician to obtain a molecular analysis of the SHOX region, (iii) it is of practical importance to recognise early or mild signs of Madelung deformity on hand and wrist radiographs, (iv) growth hormone ,after stimulation test, is usually normal . However, treatment with rhGH may improve final adult height; the efficacy of treatment is similar to that observed in those treated for Turner syndrome

Evaluation of a new turbidimetric assay for von Willebrand factor activity useful in the general screening of von Willebrand disease

We evaluated a new assay (HemosIL\u2122VWF Activity on ACL-Futura) in the screening of VWD. Samples from healthy donors and previously diagnosed VWD patients were blindly analyzed by this new activity assay and standard VWF:RCo. Results agreed and both assays showed a similar sensitivity for the screening of VWD