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Made available in DSpace on 2021-06-25T15:20:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-04-26 Associacao Brasileira de Transplantes de Orgaos, ABTO This retrospective multicenter (n = 18) cohort study evaluated the incidence, risk factors, and the impact of delayed graft function (DGF) on 1-year kidney transplant (KT) outcomes. Of 3992 deceased donor KT performed in 2014-2015, the incidence of DGF was 54%, ranging from 29.9% to 87.7% among centers. Risk factors ((lower-bound-95%CI) OR (upper-bound-95%CI)) were male gender ((1.066)1.249(1.463)), diabetic kidney disease ((1.053)1.296(1.595)), time on dialysis ((1.005)1.007(1.009)), retransplantation ((1.035)1.397(1.885)), preformed anti-HLA antibodies ((1.011)1.383(1.892)), HLA mismatches ((1.006)1.066(1.130)), donor age ((1.011)1.017(1.023)), donor final serum creatinine (sCr) ((1.239)1.317(1.399)), cold ischemia time (CIT) ((1.031)1.043(1.056)), machine perfusion ((0.401)0.542(0.733)), and induction therapy with rabbit antithymocyte globulin (rATG) ((0.658)0.800(0.973)). Duration of DGF > 4 days was associated with inferior renal function and DGF > 14 days with the higher incidences of acute rejection, graft loss, and death. In conclusion, the incidence and duration of DGF were high and associated with inferior graft outcomes. While late referral and poor donor maintenance account for the high overall incidence of DGF, variability in donor and recipient selection, organ preservation method, and type of induction agent may account for the wide variation observed among transplant centers. Univ Fed Cear, Dept Med Clin, Fortaleza, CE, Brazil Hosp Geral Fortaleza, Fortaleza, CE, Brazil Hosp Clin Univ Campinas, Campinas, SP, Brazil Hosp Clin Porto Alegre, Porto Alegre, RS, Brazil Univ Estadual Paulista, Dept Med Interna, Botucatu, SP, Brazil Fundacao Oswaldo Ramos, Hosp Rim, Sao Paulo, SP, Brazil Univ Fed Sao Paulo, Escola Paulista Med, Sao Paulo, SP, Brazil Santa Casa Miserordia Porto Alegre, Porto Alegre, RS, Brazil Hosp Sao Francisco Providencia Deus, Rio De Janeiro, RJ, Brazil Hosp Univ Walter Cantidio, Fortaleza, CE, Brazil Hosp Santa Isabel, Blumenau, SC, Brazil Fundacao Prorim, Hosp Municipal Sao Jos Joinville, Joinville, SC, Brazil Univ Sao Paulo, Hosp Clin, Sao Paulo, SP, Brazil Real Hosp Portugues Benefencia Pernambuco, Recife, PE, Brazil Hosp Israelita Albert Einstein, Sao Paulo, SP, Brazil Santa Casa Miserordia Juiz De Fora, Juiz De Fora, MG, Brazil Hosp Felicio Rocho, Belo Horizonte, MG, Brazil Hosp Univ Cajuru, Curitiba, PR, Brazil Santa Casa Montes Claros, Montes Claros, MG, Brazil Hosp Univ Ciencias Med, Belo Horizonte, MG, Brazil Univ Fed Ciencias Saude Porto Alegre, Porto Alegre, RS, Brazil Univ Estadual Paulista, Dept Med Interna, Botucatu, SP, Brazil

Objective The present study aims to obtain basic demographic information, the level of interest and of training in gynecology oncology among Brazilian obstetricians and gynecologists (OB-GYNs) to create a professional profile. Methods An online questionnaire was sent to 16,008 gynecologists affiliated to the Brazilian Federation of Associations of Gynecology and Obstetrics (FEBRASGO, in the Portuguese acronym). We considered gynecologists dedicated to gynecologic oncology (OB-GYNs ONCO) those who self-reported that > 50% of their daily practice consists in working with women’s cancer care. Results A total of 1,608 (10%) of 16,008 FEBRASGO members responded. The OBGYNs are concentrated in the southern and southeastern states of Brazil. Gynecologic oncology was considered the 8th greatest area of interest in gynecology among the OBGYNs. A total of 95 (5.9%) of the OB-GYNs were considered OB-GYNs ONCO. Obstetricians and gynecologists are actively engaged in cancer care: > 60% of them dedicate up to 25% of their daily practice to oncology. The role of the physicians in screening and prevention, diagnosis, in the treatment of precancerous lesions, and in low complexity surgical procedures is notably high. Gynecologists dedicated to gynecologic oncology in Brazil have a heterogeneous, nonstandardized and short training period in gynecologic oncology. These professionals had a more significantly role in performing medium- and high-complexity operations compared with OB-GYNs (65.2% versus 34%, and 47.3% versus 8.4%, respectively). Conclusion The role of OB-GYNs and of OB-GYNs ONCO appears to be complementary. Obstetricians and gynecologists actmore often in screening and prevention and in low-complexity surgical procedures, whereas OB-GYNs ONCO are more involved in highly complex cases. Strategies to raise standards in cancer training and to encourage the recognition of gynecologic oncology as a subspecialty should be adopted in Brazil. Resumo Objetivo Opresente estudotemcomo objetivo obter informações demográficas básicas, o nível de interesse e de treinamento em ginecologia oncológica entre obstetras e ginecologistas (OB-GYNs) brasileiros para criar um perfil destes profissionais. Métodos Umquestionário online foi enviado a 16.008 ginecologistas filiados à Federação Brasileira de Associações de Ginecologia e Obstetrícia (FEBRASGO). Nós consideramos ginecologistas dedicados à oncologia ginecológica (OB-GYNsONCO) aqueles que referiram atuar em > 50% de sua prática diária com o tratamento do câncer feminino. Resultados Um total de 1.608 (10%) dos 16.008 membros da FEBRASGO responderam ao questionário. Os OB-GYNs estão concentrados nos estados do sul e sudeste do Brasil. A oncologia ginecológica foi considerada a 8ª área de maior interesse em ginecologia entre os OB-GYNs. Um total de 95 (5,9%) dos OB-GYNs foram considerados ginecologistas dedicados à oncologia ginecológica (OB-GYNs ONCO). Obstetras e ginecologistas estão ativamente envolvidos no tratamento do câncer: > 60% deles dedicam até 25% de sua prática diária à oncologia. O papel dosmédicos na triageme na prevenção, no diagnóstico, no tratamento de lesões pré-cancerosas e em procedimentos cirúrgicos de baixa complexidade é notavelmente alto. Ginecologistas dedicados à oncologia ginecológica no Brasil têm umperíodo de treinamento emoncologia ginecológica heterogêneo, não padronizado e curto. Estes profissionais tiveram um papel mais significativo na realização de operações de média e alta complexidade em comparação com OB-GYNs (65,2% versus 34%, e 47,3% versus 8,4%, respectivamente). Conclusão Os papéis dos OB-GYN e dos OB-GYNs ONCO parecem ser complementares. Os OB-GYNs frequentemente atuam emtriageme prevenção e em procedimentos cirúrgicos de baixa complexidade, enquanto os OB-GYNs ONCO estão mais envolvidos em casos demais alta complexidade. Estratégias para elevar os padrões de treinamento em oncoginecologia e incentivar o reconhecimento da oncologia ginecológica como uma subespecialidade devem ser adotadas no Brasil.

Made available in DSpace on 2018-11-26T22:40:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-08-01. Added 1 bitstream(s) on 2019-10-09T18:27:56Z : No. of bitstreams: 1 S0004-282X2018000800539.pdf: 336862 bytes, checksum: 861f2018734ed5dc938f69878cf50b6e (MD5) Biogen Idec Genzyme Merck Novartis Rocha Teva Roche Sanofi-Genzyme World Federation of Neurology European Committee on Treatment and Research in Multiple Sclerosis Biogen Schering Biogen Indec Merck-Serono Teva (EMOCEMP Study-NCT) Euroimmun AG Shire Quest/Athena Diagnostics Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Bayer Partners MS Center, Harvard Medical School Distrito Federal Research Foundation (FAP-DF) Libbs Sanofi Serono Teva Pharmaceuticals Sonofi-Genzyme Novartis-PPD Merck Serono Bayer Health Care Ipsen Sanofi Genzyme The expanding therapeutic arsenal in multiple sclerosis (MS) has allowed for more effective and personalized treatment, but the choice and management of disease-modifying therapies (DMTs) is becoming increasingly complex. In this context, experts from the Brazilian Committee on Treatment and Research in Multiple Sclerosis and the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology have convened to establish this Brazilian Consensus for the Treatment of MS, based on their understanding that neurologists should be able to prescribe MS DMTs according to what is better for each patient, based on up-to-date evidence and practice. We herein propose practical recommendations for the treatment of MS, with the main focus on the choice and management of DMTs, as well as present a review of the scientific rationale supporting therapeutic strategies in MS. Univ Sao Paulo, Fac Med Ribeirao Preto, Hosp Clin Ribeirao Preto, Ribeirao Preto, SP, Brazil Pontificia Univ Catolica Rio Grande do Sul, Porto Alegre, RS, Brazil Univ Sao Paulo, Fac Med, Hosp Clin, Sao Paulo, SP, Brazil Univ Fed Minas Gerais, Ctr Invest Esclerose Multipla Minas Gerais, Belo Horizonte, MG, Brazil Univ Jose Rosario Vellano, Belo Horizonte, MG, Brazil Univ Fed Estado Rio de Janeiro, Rio De Janeiro, RJ, Brazil Hosp Restauracao, Recife, PE, Brazil Clin Goncalves Dias, Curitiba, Parana, Brazil Univ Estadual Campinas, Campinas, SP, Brazil Clin Privada, Cuiaba, MT, Brazil Hosp Sao Rafael, Salvador, BA, Brazil Univ Fed Fluminense, Niteroi, RJ, Brazil Fundacac Ctr Integrado Apoio Portador Deficiencia, Joao Pessoa, Paraiba, Brazil Univ Brasilia, Brasilia, DF, Brazil Univ Catolica Brasilia, Brasilia, DF, Brazil Santa Casa Misericordia Londrina, Londrina, PR, Brazil Univ Fed Goias, Fac Med, Goiania, Go, Brazil Clin Neurol & Endocrinol, Brasilia, DF, Brazil Univ Estadual Paulista, Sao Paulo, SP, Brazil Inst Neurol Curitiba, Curitiba, Parana, Brazil Univ Regiao Joinville, Joinville, SC, Brazil Univ Fed Amazonas, Hosp Univ Getulio Vargas, Manaus, Amazonas, Brazil Pontificia Univ Catolica Sao Paulo, Sorocaba, SP, Brazil Senne Liquor Diagnost, Sao Paulo, SP, Brazil Hosp Cruz Azul, Sao Paulo, SP, Brazil Fac Sao Leopoldo Mandic, Campinas, SP, Brazil Hosp Israelita Albert Einstein, Sao Paulo, SP, Brazil Univ Fed Uberlandia, Uberlandia, MG, Brazil Hosp Base Dist Fed, Brasilia, DF, Brazil Imperial Hosp Caridade, Florianopolis, SC, Brazil Escola Bahiana Med & Saude Publ, Salvador, BA, Brazil Univ Estadual Paulista, Sao Paulo, SP, Brazil Teva (EMOCEMP Study-NCT): 61080516.4.1001.5336

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: Although the decrease in striatal dopamine transporter (DAT) density has been described in North American, European, and Asian Parkinson's disease (PD) patients, studies on this issue are required in the rest of the world. This study examined the diagnostic utility of DAT imaging in Brazilian PD patients.Material/Methods: Twenty PD patients (13 males, 7 females, median age: 62 years, median age at disease onset: 56 years, median disease duration: 5 years, and median UPDRS-III score: 29) and 9 age-and sex-matched healthy subjects underwent single-photon emission computerized tomography (SPECT) using Tc-99m-TRODAT-1.Results: PD patients showed a significant decrease in the striatum, caudate nucleus, and putamen DAT densities compared with data from healthy subjects. Striatal Tc-99m-TRODAT-1 bindings had the highest diagnostic accuracy compared to those estimates from caudate nucleus and putamen. For the diagnosis of PD, a striatal Tc-99m-TRODAT-1 binding cut-off value of 0.90 was associated with a sensitivity of 100% and a specificity of 89%. There was no significant difference between striatal Tc-99m-TRODAT-1 binding values provided by different readers, contrary to Tc-99m-TRODAT-1 binding estimates in the caudate nucleus.Conclusions: Striatal DAT imaging using Tc-99m-TRODAT-1 can be considered a marker for differentiating PD patients from healthy individuals, with a good interobserver reproducibility. Univ Sao Paulo, Sch Med, Hosp Clin, Dept Neurol Surg, Sao Paulo, Brazil Univ Fed Sao Paulo, Dept Neurol & Neurosurg, Sao Paulo, Brazil Univ Fed Sao Paulo, Dept Psychiat, Sao Paulo, Brazil Hosp Israelita Albert Einstein, Dept Neurol, Sao Paulo, Brazil Univ Fed Sao Paulo, Dept Neurol & Neurosurg, Sao Paulo, Brazil Univ Fed Sao Paulo, Dept Psychiat, Sao Paulo, Brazil Web of Science

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Genetic variations in TGF-beta and IFN-gamma may interfere with proinflammatory cytokine production and, consequently, may be involved with inflammatory diseases, as acute kidney injury (AKI). We considered that genetic polymorphisms of these cytokines may have a crucial role in the outcome of critically ill patients. To investigate whether the genetic polymorphisms of rs1800470 (codon 10 T/C), rs1800471 (codon 25 C/G) from the TGF-beta, and rs2430561 (+874 T/A) from IFN-gamma may be a risk factor for ICU patients to the development of AKI and/or death. in a prospective nested case-control study, were included 139 ICU patients who developed AKI, 164 ICU patients without AKI, and 244 healthy individuals. We observed a higher frequency to T/A genotype for IFN-gamma (intermediate producer phenotype) and higher frequency of TT GG and TC GG genotype (high producer) for TGF-beta polymorphism in overall population. However, these polymorphisms have not been shown as a predictor of risk for AKI and death. We found an increased prevalence of high and intermediate producer phenotypes from TGF-beta and IFN-gamma, respectively, in patients in ICU setting. However, the studied genetic polymorphism of the TGF-beta and IFN-gamma was not associated as a risk factor for AKI or death in our population. Universidade Federal de São Paulo, UNIFESP, Div Nephrol, São Paulo, Brazil Hosp Israelita Albert Einstein, São Paulo, Brazil Tufts Univ New England Med Ctr, Boston, MA USA Univ Nove Julho, UNINOVE, São Paulo, Brazil Universidade Federal de São Paulo, UNIFESP, Div Nephrol, São Paulo, Brazil FAPESP: 07/58363-0 Web of Science

Objective: To compare the changes in cardiorespiratory fitness in evaluations performed every ten years since 1978/1980, according to the nutritional status and gender of students in the city of Ilhabela, Brazil. Methods: The study is part of the Mixed Longitudinal Project on Growth, Development and Physical Fitness of Ilhabela. The study included 1,291 students of both genders, aged 10 to 11 years old. The study periods were: 1978/1980, 1988/1990, 1998/2000, and 2008/2010. The variables analyzed were: body weight, height, and cardiorespiratory fitness (VO2max - L.min-1 and mL.kg-1.min-1) performed using a submaximal progressive protocol on a cycle ergometer. Individuals were classified as normal weight and overweight according to curves proposed by the World Health Organization of body mass index for age and gender. Analysis of variance (ANOVA) with three factors followed by the Bonferroni method were used to compare the periods. Results: The number of normal weight individuals (61%) was higher than that of overweight. There was a significant decrease in cardiorespiratory fitness in both genders. Among the schoolchildren with normal weight, there was a decrease of 22% in males and 26% in females. In overweight schoolchildren, males showed a decrease of 12.7% and females, of 18%. Conclusion: During a 30-year analysis with reviews every ten years from 1978/1980, there was a significant decrease in cardiorespiratory fitness in schoolchildren of both genders, which cannot be explained by the nutritional status. The decline in cardiorespiratory fitness was greater in individuals with normal weight than in overweight individuals. Resumo: Objetivo: Comparar as mudanças da aptidão cardiorrespiratória em avaliações a cada 10 anos a partir de 1978/1980, de acordo com o estado nutricional e o sexo de escolares do município de Ilhabela, Brasil. Métodos: O estudo faz parte do Projeto Misto-Longitudinal de Crescimento, Desenvolvimento e Aptidão Física de Ilhabela. Participaram do estudo 1.291 escolares de ambos os sexos, de 10 e 11 anos de idade. Os períodos analisados foram 1978/1980, 1988/1990, 1998/2000 e 2008/2010. As variáveis analisadas foram peso corporal, estatura e aptidão cardiorrespiratória (VO2máx - L.min−1 e mL.kg−1.min−1) realizada por um protocolo progressivo submáximo em um ciclo ergômetro. Os indivíduos foram classificados em eutróficos e excesso de peso mediante as curvas propostas pela Organização Mundial da Saúde de índice de massa corporal para idade e sexo. Para comparar os períodos, foi utilizado a ANOVA com três fatores, seguida pelo método Bonferroni. Resultados: A quantidade de eutróficos (61%) foi maior do que a de excesso de peso. Houve diminuição significativa da aptidão cardiorrespiratória em ambos os sexos. Entre os escolares meninos e as meninas eutróficas houve diminuição de 22% e 26%, respectivamente. Nos escolares com excesso de peso, os meninos diminuíram em 12,7%, e as meninas, em 18%. Conclusão: Em uma análise de 30 anos, com avaliações a cada 10 anos a partir de 1978/1980, houve uma diminuição significante da aptidão cardiorrespiratória em escolares de ambos os sexos, que não pode ser explicada pelo estado nutricional. A queda da aptidão cardiorrespiratória foi maior nos escolares eutróficos do que nos obesos. Keywords: Nutritional status, Physical fitness, Physical activity, Aerobic exercise, Palavras-chave: Estado nutricional, Aptidão física, Atividade física, Exercício aeróbico

OBJECTIVES: To correlate the importance of the ankle-brachial index in terms of cardiovascular morbimortality and the extent of coronary arterial disease amongst elderly patients without clinical manifestations of lower limb peripheral arterial disease.METHODS: We analyzed prospective data from 100 patients over 65 years of age with coronary arterial disease, as confirmed by coronary angiography, and with over 70% stenosis of at least one sub-epicardial coronary artery. We measured the ankle-brachial index immediately after coronary angiography, and a value of

Made available in DSpace on 2018-11-26T17:41:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-11-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Ministry of Health which, via Technical Area of Health of Aged (PROADI) Hospital Israelita Albert Einstein under Support Program for Institutional Development of Brazilian Unified National Health System (SUS) Objectives: We assessed whether potential changes in brain activation patterns of elderly individuals with metabolic syndrome (MetS) who were cognitively healthy (without mild cognitive impairment or dementia) were associated with cognitive decline in executive function in the short-term. Method: We analyzed 43 individuals (23 MetS, 20 controls) using a global geriatric evaluation, a neuropsychological battery, and task-related (attention) fMRI exam. Correlation analysis between the fMRI signal at baseline and cognitive impairment after 1 year was based on the voxel-based Pearson coefficient, corrected for multiple comparisons. Results: At baseline, MetS patients showed reduced brain response in frontal and parietal regions compared to controls. After one year, the MetS group also showed a decline in verbal fluency performance. fMRI response in the right dorsolateral prefrontal cortex and bilateral parietal lobes was negatively correlated with verbal fluency decline in the MetS group. Discussion: Our results provide an early biomarker of the possible development of cognitive impairment, particularly in the executive function, of elderly individuals suffering from MetS. These findings also point to an up or down regulation which could be interpreted as compensatory mechanism for possible brain tissue burden caused by MetS. Univ Fed Sao Paulo, Escola Paulista Med, Dept Psychiat, Rua Borges Lagoa 570, BR-04038030 Sao Paulo, SP, Brazil Hosp Israelita Albert Einstein, Rua Borges Lagoa 570, BR-04038030 Sao Paulo, SP, Brazil Hosp Israelita Albert Einstein, Ave Albert Einstein, Sao Paulo, Brazil Hosp Israelita Albert Einstein, Rua Madre Cabrini 462, BR-04020001 Sao Paulo, SP, Brazil Univ Estadual Sao Paulo Julio de Mesquita Filho, Fac Med Botucatu, Dept Internal Med, Rua Borges Lagoa 570, BR-04038030 Sao Paulo, SP, Brazil Univ Fed Sao Paulo, Escola Paulista Med, Dept Internal Med, Div Geriatr, Rua Francisco de Castro 105, BR-04020050 Sao Paulo, SP, Brazil Univ Estadual Sao Paulo Julio de Mesquita Filho, Fac Med Botucatu, Dept Internal Med, Rua Borges Lagoa 570, BR-04038030 Sao Paulo, SP, Brazil CAPES: 2009/12271-3

Made available in DSpace on 2018-11-28T03:37:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-01-01. Added 1 bitstream(s) on 2019-10-09T18:27:35Z : No. of bitstreams: 1 S0004-282X2017000100050.pdf: 155772 bytes, checksum: c55550248854584f7b2472bcb06a538a (MD5) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Brazilian Ministry of Health (Decit/SCTIE/MS) These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus. This guidelines focuses on the implications of the recent clinical trials on endovascular therapy for acute ischemic stroke due to proximal arterial occlusions, and the final text aims to guide health care providers, health care managers and public health authorities in managing patients with this condition in Brazil. Univ Sao Paulo, Fac Med Ribeirao Preto, Ribeirao Preto, SP, Brazil Hosp Clin Porto Alegre, Porto Alegre, RS, Brazil Emory Univ, Sch Med, Grady Mem Hosp, Marcus Stroke & Neurosci Ctr, Atlanta, GA USA Univ Fed Sao Paulo, Sao Paulo, SP, Brazil Hosp Base Brasilia, Brasilia, DF, Brazil Univ Sao Paulo, Fac Med, Sao Paulo, SP, Brazil Univ Estadual Paulista, Fac Med Botucatu, Botucatu, SP, Brazil Hosp Pro Cardiaco, Rio De Janeiro, RJ, Brazil Univ Fed Minas Gerais, Belo Horizonte, MG, Brazil Univ Fed Fluminense, Niteroi, RJ, Brazil Inst Dor Pesquisa & Ensino, Rio De Janeiro, RJ, Brazil Hosp Municipal Sao Jose, Div Neurol, Joinville, SC, Brazil Hosp Geral Fortaleza, Fortaleza, Ceara, Brazil Hosp Restauracao, Recife, PE, Brazil Hosp Sirio Libanes, Sao Paulo, SP, Brazil Univ Fed Bahia, Salvador, BA, Brazil Santa Casa Sao Paulo, Fac Ciencias Med, Sao Paulo, SP, Brazil Hosp Israelita Albert Einstein, Sao Paulo, SP, Brazil Univ Estadual Paulista, Fac Med Botucatu, Botucatu, SP, Brazil CNPq: 402388/2013-5 CNPq: 467322/2014-7

Sociedade Beneficiente Israelita Brasileira Hospital Israelita Albert Einstein OBJECTIVES: To determine the viruses and risk factors associated with hospital and intensive care unit (ICU) admissions in infants with acute bronchiolitis.INTRODUCTION: Bronchiolitis is a major cause of morbidity in infants. Widespread use of molecular-based methods has yielded new insights about its etiology, but the impact of viral etiologies on early outcomes is still unclear.METHODS: Seventy-seven infants with bronchiolitis who were under two years of age and visited an emergency unit were included. Using molecular-based methods, samples were tested for 12 different respiratory viruses. Logistic regression models were used to identify clinical and virological variables associated with the main endpoints: hospital admission and ICU admission.RESULTS: We identified at least one virus in 93.5% of patients, and coinfections were found in nearly 40% of patients. RSV was the most common pathogen (63.6%), followed by rhinovirus (39%). Identification of RSV was only associated with an increased risk of hospital admission in the univariate model. Younger age and enterovirus infection were associated with an increased risk of hospital admission, while atopy of a first-degree relative showed a protective effect. Prematurity was associated with an increased risk of admission to the ICU. Coinfections were not associated with worse outcomes.CONCLUSIONS: Molecular-based methods resulted in high rates of viral identification but did not change the significant role of RSV in acute bronchiolitis. Younger age and enterovirus infection were risk factors for hospital admission, while prematurity appeared to be a significant risk factor for admission to the ICU in acute viral bronchiolitis. Hosp Israelita Albert Einstein, Dept Saude Materno Infantil, São Paulo, Brazil Hosp Israelita Albert Einstein, Ctr Pesquisa Expt, Inst Ensino & Pesquisa, São Paulo, Brazil Hosp Israelita Albert Einstein, UPA, São Paulo, Brazil Univ São Paulo, Virol Lab, Inst Trop Med, São Paulo, Brazil Universidade Federal de São Paulo, Fac Med, Hosp Clin, Inst Crianca, São Paulo, Brazil Universidade Federal de São Paulo, Fac Med, Hosp Clin, Inst Crianca, São Paulo, Brazil Web of Science

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Substantial evidence points to melatonin as playing a role in the regulation of circadian rhythms, sleep, and headache disorders. the objective of the study was to assess 6-sulphatoxymelatonin (aMT6s) levels in a large consecutive series of patients with migraine, comparing with controls. A total of 220 subjects were evaluated-146 had migraine and 74 were control subjects. Urinary samples were collected into the same plastic container since 8:00 p.m. to 8:00 a.m. of the next day (12-h period) and aMT6s was measured with quantitative ELISA technique. Among patients with migraine, 53% presented pain on the day of the urine samples collection. Their urinary aMT6s concentration was significantly lower than in the urine of patients without pain [14.0 +/- 7.3 vs. 49.4 +/- 19.0; t(143) = -15.1; 95% CI = -40.0 to -30.8; P

Made available in DSpace on 2018-11-26T17:34:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-06-01 Background. This study compared the use of static cold storage versus continuous hypothermic machine perfusion in a cohort of kidney transplant recipients at high risk for delayed graft function (DGF). Methods. In this national, multicenter, and controlled trial, 80 pairs of kidneys recovered from brain-dead deceased donors were randomized to cold storage or machine perfusion, transplanted, and followed up for 12 months. The primary endpoint was the incidence of DGF. Secondary endpoints included the duration of DGF, hospital stay, primary nonfunction, estimated glomerular filtration rate, acute rejection, and allograft and patient survivals. Results. Mean cold ischemia time was high but not different between the 2 groups (25.6 +/- 6.6 hours vs 25.05 +/- 6.3 hours, 0.937). The incidence of DGF was lower in the machine perfusion compared with cold storage group (61% vs. 45%, P = 0.031). Machine perfusion was independently associated with a reduced risk of DGF (odds ratio, 0.49; 95% confidence interval, 0.26-0.95). Mean estimated glomerular filtration rate tended to be higher at day 28 (40.6 +/- 19.9 mL/min per 1.73 m(2) vs 49.0 +/- 26.9 mL/min per 1.73 m(2); P = 0.262) and 1 year (48.3 +/- 19.8 mL/min per 1.73 m(2) vs 54.4 +/- 28.6 mL/min per 1.73 m(2); P = 0.201) in the machine perfusion group. No differences in the incidence of acute rejection, primary nonfunction (0% vs 2.5%), graft loss (7.5% vs 10%), or death (8.8% vs 6.3%) were observed. Conclusions. In this cohort of recipients of deceased donor kidneys with high mean cold ischemia time and high incidence of DGF, the use of continuous machine perfusion was associated with a reduced risk of DGF compared with the traditional cold storage preservation method. Univ Fed Sao Paulo, Hosp Rim, Sao Paulo, SP, Brazil Escola Paulista Med, Org Procura Orgaos, Sao Paulo, SP, Brazil Univ Sao Paulo, Fac Med, Hosp Clin, Sao Paulo, SP, Brazil Hosp Israelita Albert Einstein, Kidney Transplant Unit, Sao Paulo, SP, Brazil Hosp Samaritano, Sao Paulo, SP, Brazil Santa Casa Sao Paulo, Sao Paulo, SP, Brazil Hosp Bandeirantes, Sao Paulo, SP, Brazil Hosp Servidor Publ Estadual, Sao Paulo, SP, Brazil Hosp Beneficencia Portuguesa, Sao Paulo, SP, Brazil Hosp Dante Pazzanese, Sao Paulo, SP, Brazil Hosp Base Sao Jose do Rio Preto, Sao Jose Do Rio Preto, SP, Brazil Univ Estadual Paulista, UNESP, Dept Internal Med, Rubiao Jr S-N, Sao Paulo, Brazil Santa Casa Ribeirao Preto, Ribeirao Preto, SP, Brazil Hosp Alemao Oswaldo Cruz, Sao Paulo, SP, Brazil Hosp Santa Marcelina, Sao Paulo, SP, Brazil Univ Estadual Paulista, UNESP, Dept Internal Med, Rubiao Jr S-N, Sao Paulo, Brazil

Hospital das Forc, as Armadas e Instituto de Cardiologia de Brasilia Background: N-acetylcysteine (NAC) or sodium bicarbonate (NaHCO3), singly or combined, inconsistently prevent patients exposed to radiographic contrast media from developing contrast-induced acute kidney injury (CI-AKI).Objective: We asked whether intravenous isotonic saline and either NaHCO3 in 5% dextrose or else a high dose of NAC in 5% dextrose prevent CI-AKI in outpatients exposed to high-osmolal iodinated contrast medium more than does saline alone.Methods: This completed prospective, parallel, superiority, open-label, controlled, computer-randomized, single-center, Brazilian trial (NCT01612013) hydrated 500 adult outpatients (214 at high risk of developing CI-AKI) exposed to ioxitalamate during elective coronary angiography and ventriculography. From 1 hour before through 6 hours after exposure, 126 patients (group 1) received a high dose of NAC and saline, 125 (group 2) received NaHCO3 and saline, 124 (group 3) received both treatments, and 125 (group 4) received only saline.Results: Groups were similar with respect to age, gender, weight, pre-existing renal dysfunction, hypertension, medication, and baseline serum creatinine and serum cystatin C, but diabetes mellitus was significantly less prevalent in group 1. CI-AKI incidence 72 hours after exposure to contrast medium was 51.4% (257/500), measured as serum creatinine > (baseline+0.3 mg/dL) and/or serum cystatin C > (1.1 center dot baseline), and 7.6% (38/500), measured as both serum creatinine and serum cystatin C > (baseline+0.3 mg/dL) or > (1.25 center dot baseline). CI-AKI incidence measured less sensitively was similar among groups. Measured more sensitively, incidence in group 1 was significantly (p

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Abdominal aortic aneurysms are among the main causes of death. the high morbidity and mortality associated with aneurysm rupture and repair represents a challenge for surgeons and high risk for patients. Although experimental models are useful to understand, train, and develop new treatment and diagnostic methods for this pathology, animal models developed to date are far from ideal. Animals are either too small and do not represent the pathology of humans, or the procedures employ laparotomy, or the aortic behavior does not resemble that of a true aneurysm. We developed a novel, less invasive and effective method to induce true aortic aneurysms in Large White pigs. Animals were submitted to an endovascular chemical induction using either calcium chloride (25%) or swine pancreatic elastase. Controls were exposed to saline solution. All animals were operated on using the same surgical technique under general anesthesia. They were followed weekly with ultrasound examinations and at 4 weeks the aorta was harvested. Although elastase induced only arterial dilation, imaging, histological, and biomechanical studies of the aorta revealed the formation of true aneurysms in animals exposed to calcium chloride. Aneurysms in the latter group had biomechanical failure properties similar to those of human aneurysms. These findings indicate that the endovascular approach is viable and does not cause retroperitoneal fibrosis. Univ São Paulo, Univ Hosp, São Paulo, Brazil Hosp Israelita Albert Einstein, São Paulo, Brazil Universidade Federal de São Paulo, Escola Paulista Med, São Paulo, Brazil Univ São Paulo, Fac Med, São Paulo, Brazil Universidade Federal de São Paulo, Escola Paulista Med, São Paulo, Brazil FAPESP: 2010/07307-6 Web of Science

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Tinnitus is characterized by the perception of sound in the absence of an external auditory stimulus. the network connectivity of auditory and non-auditory brain structures associated with emotion, memory and attention are functionally altered in debilitating tinnitus. Current studies suggest that tinnitus results from neuroplastic changes in the frontal and limbic temporal regions. the objective of this study was to use Single-Photon Emission Computed Tomography (SPECT) to evaluate changes in the cerebral blood flow in tinnitus patients with normal hearing compared with healthy controls. Methods: Twenty tinnitus patients with normal hearing and 17 healthy controls, matched for sex, age and years of education, were subjected to Single Photon Emission Computed Tomography using the radiotracer ethylenedicysteine diethyl ester, labeled with Technetium 99 m (99 mTc-ECD SPECT). the severity of tinnitus was assessed using the Tinnitus Handicap Inventory (THI). the images were processed and analyzed using Statistical Parametric Mapping (SPM8). Results: A significant increase in cerebral perfusion in the left parahippocampal gyrus (pFWE

Background Few studies have assessed the time to blood culture positivity as a predictor of clinical outcome in fungal bloodstream infections (BSIs). The purpose of this study was to evaluate the time to positivity (TTP) of blood cultures in patients with Candida albicans BSIs and to assess its impact on clinical outcome. Methods A historical cohort study with 89 adults patients with C. albicans BSIs. TTP was defined as the time between the start of incubation and the time that the automated alert signal indicating growth in the culture bottle sounded. Results Patients with BSIs and TTPs of culture of ≤36 h (n=39) and >36 h (n=50) were compared. Septic shock occurred in 46.2% of patients with TTPs of ≤36 h and in 40.0% of patients with TTP of >36 h (p=0.56). A central venous catheter source was more common with a BSI TTP of ≤36 h (p=0.04). Univariate analyis revealed that APACHE II score≥20 at BSI onset, the development of at least one organ system failure (respiratory, cardiovascular, renal, hematologic, or hepatic), SOFA at BSI onset, SAPS II at BSI onset, and time to positivity were associated with death. By using logistic regression analysis, the only independent predictor of death was time to positivity (1.04; 95% CI, 1.0-1.1, p=0.035), with the chance of the patient with C. albicans BSI dying increasing 4.0% every hour prior to culture positivity. Conclusion A longer time to positivity was associated with a higher mortality for Candida albicans BSIs; therefore, initiating empiric treatment with antifungals may improve outcomes.

Sepsis is the main cause of acute kidney injury (AKI) among individuals hospitalized in intensive care units. Acute kidney injury is an independent risk factor for mortality, and its occurrence increases the complexity and cost of treatment. However, the pathophysiological mechanisms of AKI remain unclear. Hemodynamic, vascular, tubular, cellular, inflammatory, and oxidative processes are involved. Individuals with AKI generally have various comorbidities and are elderly and hypercatabolic and on vasopressors and mechanical ventilation. Dialysis is the main treatment for AKI. Although there is no clear benefit of any specific dialysis modality, these patients are initially instructed to use continuous dialysis methods, especially for the most severe cases with multiple organ system dysfunctions and for those who display signs of hemodynamic instability. Recent studies demonstrate that patients should receive a dialysis dose of at least 25 mL.kg(-1).h(-1). Universidade Federal de São Paulo UNIFESP, Div Nephrol, São Paulo, Brazil Hosp Israelita Albert Einstein, Renal Transplant Unit, São Paulo, Brazil Universidade Federal de São Paulo UNIFESP, Div Nephrol, São Paulo, Brazil Web of Science

Centers for Disease Control and Prevention's Prevention Research Centers Program Background: the aim of this study was to determine the prevalence and correlates of physical activity counseling among physicians and nurses working in primary health care in Brazil.Methods: A phone survey was carried out in 2011 with professionals working in primary health care in Brazil. the target sample consisted of 1,600 randomly selected primary care units covering all regions of the country. We successfully interviewed 529 professionals within the sampled units; 182 physicians and 347 nurses. the overall response rate was 49.6%. Multivariable logistic regression was used to estimate correlates of counseling in the whole sample and separately for physicians and nurses.Results: the prevalence of regular physical activity counseling for at least six months was 68.9% (95% CI 64.9; 72.8) and was significantly higher among physicians compared to nurses (p < 0.05). Most professionals (93.2%) interviewed were unfamiliar with current physical activity recommendations for health. in the adjusted analysis, physical activity counseling was more frequent among those who report assessing patient's physical activity (OR = 2.16; 95% CI 1.41; 3.29), those reporting that lack of time was not a barrier for counseling (OR = 0.62 95% CI 0.42-0.93), those who felt prepared to provide physical activity counseling (OR = 2.34; 95% CI 1.50-3.66), and those working at primary care units offering physical activity programs for patients (OR = 2.06; 95% CI 1.33-3.20). in the stratified analysis, only assessing patient's physical activity was a significant correlate among physicians whereas assessing patient's physical activity, feeling prepared to provide counseling and working in units with physical activity interventions were significant correlates among nurses.Conclusions: Physicians and nurses deemed physical activity counseling of great importance in primary health care in Brazil. However, in order to increase the quality of counseling and the number of professionals engaging in this activity, these health teams require greater knowledge about physical activity (global recommendations for health) as well as training on the application of instruments for assessing physical activity. Moreover, sufficient time must be allowed during consultations for the counseling process, and physical activity promotion programs should be implemented within the primary health care units. Univ São Paulo, Sch Arts Sci & Humanities, São Paulo, Brazil Univ Fed Pelotas, Postgrad Program Epidemiol, Pelotas, RS, Brazil Univ Fed Sao Carlos, Gerontol Dept, BR-13560 Sao Carlos, SP, Brazil Universidade Federal de São Paulo, Dept Prevent Med, São Paulo, Brazil Hosp Israelita Albert Einstein, São Paulo, Brazil Washington Univ, George Warren Brown Sch Social Work, Prevent Res Ctr St Louis, St Louis, MO 63130 USA Univ Missouri, Sch Med, Dept Hlth Management & Informat, Columbia, MO USA Ctr Dis Control & Prevent, Div Diabet Translat, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA USA Univ Fed Pelotas, Sch Phys Educ, Pelotas, RS, Brazil Universidade Federal de São Paulo, Dept Prevent Med, São Paulo, Brazil Centers for Disease Control and Prevention's Prevention Research Centers Program: U48/DP001903 Web of Science

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Purpose: To compare the effect on intraocular pressure (IOP) of the silicone Ahmed glaucoma valve with and without an intravitreal injection of triamcinolone acetonide.Patients and Methods: Forty-nine patients with clinically uncontrolled neovascular glaucoma were included in the study; 22 were randomly assigned to the study group (silicone Ahmed glaucoma valve implant with intravitreal triamcinolone acetonide) and 27 to the control group (silicone Ahmed glaucoma valve). IOP was the primary outcome measure in this study. the secondary outcome measure was success, defined by IOP lower than 22 mm Hg and higher than 5 mm Hg, and no serious complications. Success rates in both the groups were compared using Kaplan-Meier survival curves and the log-rank test. IOP levels were compared using mixed linear model analysis to correct for repeated measures correlation.Results: Forty-three patients, 18 in the study group and 25 in the control group, completed the study (follow-up of 12 mo). the mean IOP was significantly lower after 1 year in both the groups (P < 0.001). the mean IOP in the first month of follow-up was lower in the study group (control; 20.4 +/- 9.7, study; 13.6 +/- 6.5, P < 0.01). the success rate at 1 year was 78% for the study group and 76% for the control group (P = 0.82). Complication rates were not different between the groups.Conclusions: Intravitreal injection of triamcinolone acetonide in neovascular glaucoma did not affect the intermediate-term success of the silicone Ahmed valve nor reduce the incidence of complications. the mean IOP spike in the first month was lower in the triamcinolone group. Universidade Federal de São Paulo, Dept Ophthalmol, São Paulo, Brazil Hosp Israelita Albert Einstein, São Paulo, Brazil HORP, Sao Jose Do Rio Preto, SP, Brazil Univ Fed Triangulo Mineiro, Uberaba, MG, Brazil Universidade Federal de São Paulo, Dept Ophthalmol, São Paulo, Brazil Web of Science

Staphylococcus aureus is a frequent agent of serious intensive care unit infections with high associated mortality rates. Resistance to methicillin is frequent, exceeding 50% in many countries, and for these strains, vancomycin is the agent of choice. Resistance to this drug is now frequent for Enterococcus, but low rates are reported for S. aureus. Nonetheless, treatment failures with vancomycin for infections caused by strains considered susceptible have been reported during recent years. This article aims to review the possible explanations for this phenomenon, which is challenging the old paradigm of S. aureus infections and vancomycin use. Universidade Federal de São Paulo, Dept Infect Dis, BR-05685090 São Paulo, Brazil Hosp Israelita Albert Einstein, São Paulo, Brazil Universidade Federal de São Paulo, Dept Infect Dis, BR-05685090 São Paulo, Brazil Web of Science

Background The frequency of ESBL producing Klebsiella pneumoniae bloodstream infections (BSI) is high in Brazilian hospitals, however little is known regarding what role, if any, resistance plays in the expected outcome in hospitals with a high prevalence of these pathogens. Methods From 1996 to 2001, hospital acquired K. pneumoniae BSI were evaluated retrospectively. Each patient was included only once at the time of BSI. ESBL producing strains were identified using the E-test method. The association of variables with the mortality related to bacteremia was included in a stepwise logistic regression model. Results One hundred and eight hospital acquired K. pneumoniae BSI met criteria for inclusion. Fifty two percent were due to ESBL producing strains. The overall in-hospital mortality was 40.8%. Variables independently predicting death by multivariate analysis were the following: mechanical ventilation (p = 0.001), number of comorbidities (p = 0.003), antimicrobials prescribed before bacteremia (p = 0.01) and fatal underlying disease (p = 0.025). Conclusion Bacteremia due to ESBL producing K. pneumoniae strains was not an independent predictor for death in patients with BSI. An increased mortality in hospital-acquired BSI by K. pneumoniae was related to the requirement for mechanical ventilation, more than two comorbidities, the previous use of two or more antibiotics, and the presence of a rapidly fatal disease.

Wellcome Trust/MRC Joint Call in Neurodegeneration award United Kingdom Medical Research Council Wellcome Trust Parkinson's Disease UK Kattan Trust Objectives: To compare the dopaminergic neuronal imaging features of different subtypes of genetic Parkinson's Disease.Methods: A retrospective study of genetic Parkinson's diseases cases in which DaTSCAN (123I-FP-CIT) had been performed. Specific non-displaceable binding was calculated for bilateral caudate and putamen for each case. the right: left asymmetry index and striatal asymmetry index was calculated.Results: Scans were available from 37 cases of monogenetic Parkinson's disease (7 glucocerebrosidase (GBA) mutations, 8 alpha-synuclein, 3 LRRK2, 7 PINK1, 12 Parkin). the asymmetry of radioligand uptake for Parkinson's disease with GBA or LRRK2 mutations was greater than that for Parkinson's disease with alpha synuclein, PINK1 or Parkin mutations.Conclusions: the asymmetry of radioligand uptake in Parkinsons disease associated with GBA or LRRK2 mutations suggests that interactions with additional genetic or environmental factors may be associated with dopaminergic neuronal loss. UCL, Dept Clin Neurosci, Inst Neurol, London, England Birmingham Womens Hosp, Reg Genet Unit, Dept Clin Genet, Birmingham, W Midlands, England Natl Taiwan Univ Hosp, Coll Med, Dept Neurol, Taipei, Taiwan Natl Taiwan Univ Hosp, Coll Med, Dept Nucl Med, Taipei, Taiwan Hosp Israelita Albert Einstein, Inst Israelita Ensino & Pesquisa Albert Einstein, São Paulo, Brazil Hosp Univ Insular Gran Canaria, Dept Neurol, Parkinsons & Movement Disorders Unit, Las Palmas Gran Canaria, Spain Univ Salerno, Ctr Neurodegenerat Dis, Salerno, Fisciano Provin, Italy UCL, Inst Neurol, Sobell Dept Motor Sci, London, England Universidade Federal de São Paulo, Dept Neurol, São Paulo, Brazil Erasmus MC, Dept Clin Genet, Rotterdam, Netherlands Aristotle Univ Thessaloniki, G Papanikolaou Hosp, Dept Neurol 3, GR-54006 Thessaloniki, Greece Gen Hosp S Michele AOB G Brotzu, Neurol Serv, Cagliari, Italy Gen Hosp S Michele AOB G Brotzu, Stroke Unit, Cagliari, Italy Univ Bologna, Dept Biomed & Neuromotor Sci, Bologna, Italy Universidade Federal de São Paulo UNIFESP, EPM, Div Movement Disorders, São Paulo, Brazil UCL Inst Neurol, Dept Mol Neurosci, London, England Univ Navarra, Div Neurosci, Ctr Appl Med Res, Neurogenet Lab, E-31080 Pamplona, Spain CNR, Inst Biostruct & Bioimaging, I-80125 Naples, Italy Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden Universidade Federal de São Paulo, Dept Neurol, São Paulo, Brazil Universidade Federal de São Paulo UNIFESP, EPM, Div Movement Disorders, São Paulo, Brazil Wellcome Trust/MRC Joint Call in Neurodegeneration award: WT089698 United Kingdom Medical Research Council: G1001983 Web of Science