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Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq Acute lymphocytic leukemia (ALL) is characterized as a hematological disease that originates during the development of young white blood cells, called lymphocytes. Although it is the type of cancer with the highest number of cases in children, however adults can also be diagnosed with the disease. In 2016, according to the National Cancer Institute (INCA), 10,070 new cases (5,540 men and 4,530 women) were diagnosed in Brazil. The risk of developing the disease for children has a higher incidence rate at the age of five and nine years. To treat the disease, chemotherapy is used, where several drugs are administered with the intention to destroy the tumor cells, usually by the venous route. Unfortunately, these drugs are not selective and can cause damage to healthy cells in the body. This work aims to determine the concentration levels of some elements present in whole blood of patients and to correlate it with possible collateral damages throughout the treatment, since the change in its concentrations of the same can influence directly in the performance of some organs, as well as in the homeostasis of the organism as a whole. Blood samples from patients with ALL were collected at Santa Maria University Hospital with the consent of the responsible person, reaching all different stages of the disease. In order to obtain reliable results, possible metal contaminants in the collection vials and anticoagulants were evaluated. The determinations of element concentration were performed by inductively coupled plasma mass spectrometry. In addition to determining the levels of elements present in the whole blood of patients, enzymatic activity tests for catalase were also performed in order to correlate the effect of a possible reduction in metal levels with the efficiency of the enzymes in reducing the production of reactive oxygen species (ROS). Due to the big amount of samples and reduced volume, a sample decomposition procedure was developed using only 250 mg in open system and single disposable vial. A mixture of 1: 1 HNO3 and H2O2 was used and the samples were submitted to micro-wave irradiation for a period of 20 minutes. The development of this method proved to be crucial for the decomposition of a large number of samples, fast and has a good efficiency. The determined elements were Arsenic, Cu, Mn, Rb, Sb, Sr, V and Zn were quantified. Rare earth elements were monitored, but their concentration were below the limit of quantification or contamination, while high contamination of Ca, Mg, Na and Al was observed from the collection and sample handling. Elements were performed by inductively coupled plasma mass spectrometry. In addition, enzymatic activity assays for catalase were also performed in order to correlate the effect of a possible reduction in metal levels with the efficiency of the enzymes in reducing the production of radical oxygen. It was observed that patients with ALL have very low concentrations of the metals before starting the treatment of the disease. However at the end of the treatment, the concentration of the elements is mostly very close to the concentration of the control group. The catalase enzymatic assays showed a high activity for the beginning of the treatment and reduction towards the stages near the end of the treatment, indicating a possible reduction in the generation of ROS generated before and during the treatment. A leucemia linfocítica aguda (LLA) se caracteriza como uma doença hematológica que se origina durante o desenvolvimento de glóbulos brancos jovens, denominados linfócitos. Embora seja o tipo de câncer com o maior número de casos em crianças, adultos também podem ser diagnosticados com a doença. Em 2016, segundo o Instituto Nacional de Câncer (INCA), 10.070 novos casos (5.540 homens e 4.530 mulheres) foram diagnosticados no Brasil. O risco de desenvolvimento da doença para crianças apresenta um índice maior de incidência na idade de 2 a 5 anos. Para o combate da doença, recorre-se ao tratamento quimioterápico, onde diversos medicamentos são administrados com o intuito de destruir as células tumorais, geralmente por via venosa. Infelizmente, esses medicamentos não são seletivos e acabam causando danos a células sadias presentes no organismo. Desta maneira, o presente trabalho tem como objetivo determinar a concentração de alguns elementos presentes no sangue dos pacientes e correlacioná-los com possíveis danos colaterais ao longo do tratamento, uma vez que o decaimento ou aumento nas concentrações dos mesmos pode influenciar diretamente no desempenho de alguns órgãos, bem como, na homeostase do organismo como um todo. As amostras de sangue dos pacientes com LLA foram coletadas no Hospital Universitário de Santa Maria mediante consentimento do responsável, em diferentes estágios da doença. Devido a grande quantidade de amostras e volume reduzido, desenvolveu-se um método analítico para a decomposição de sangue utilizando um volume de apenas 250 μL em sistema aberto e frasco único descartável, utilizando uma mistura de HNO3 e H2O2 1:1 e irradiação micro-ondas por um período total de 20 minutos. O desenvolvimento deste método se mostrou crucial para a decomposição do grande volume de amostra pela sua boa eficiência e rapidez. Para que se tenham resultados confiáveis, possíveis contaminantes metálicos nos frascos de coleta e anticoagulantes foram avaliados. Os elementos determinados foram As, Cu, Mn, Rb, Sb, Sr, V e Zn. Embora outros metais, como os elementos terras raras, tenham sido monitorados, sua quantificação não foi possível por estarem abaixo do limite de quantificação ou pela contaminação proveniente dos frascos de coleta e manuseio, como é o caso de Ca, Mg, Na e Al. As determinações da concentração dos elementos foram realizadas por espectrometria de massa com plasma indutivamente acoplado (ICP-MS). Além da determinação dos níveis de elementos presentes no sangue total de pacientes, testes de atividade enzimática para catalase também foram realizados com o intuito de correlacionar o efeito de uma possível redução nos níveis de metais com a eficiência das enzimas na redução da produção de espécies de oxigênio radicalar. Foi possível observar que pacientes com LLA possuem concentrações muito baixas de alguns elementos antes de iniciarem o tratamento da doença e que a concentração, ao chegarem à última etapa do tratamento, se aproxima muito da concentração do grupo controle. Os testes enzimáticos para catalase mostraram uma alta atividade para o início do tratamento e redução para etapas próximas ao final do tratamento, indicando uma possível redução na geração de espécies de oxigênio reativas geradas antes e durante o tratamento.

BACKGROUNDStudies on the cost-effectiveness ratio of drug-eluting stents (DES) are rare. Our objective was to evaluate the results and compare costs (incremental cost-effectiveness ratio – ICER) per restenosis avoided between DES and bare metal stents (BMS) using the propensity score.METHODSTwo hundred and twenty consecutive patients were included in the study, of which 111 were treated with DES and 109 with BMS. The propensity score was used to adjust the effect of the intervention, by means of matching, stratification and weighing.RESULTSMost patients were male (67.7% vs. 66.9%; P = 0.53), with a mean age of 65.9 years. Patients treated with the DES had a higher rate of diabetes (54% vs. 17.4%; P < 0.001), three-vessel disease (18.9% vs. 10.1%; P = 0.029) and poor ventricular function (54.1% vs. 22%; P < 0.0001). The diameter of stents was 2.76 ± 0.35mm vs. 2.91 ± 0.47mm (P = 0.006) and the sum of the lengths of stents was 37.6 ± 23mm vs. 24.8 ± 15.8mm (P < 0.0001). Restenosis was observed on 6.3% vs. 12.8% of the patients (P = 0.099) and in 4.1% vs. 9.8% of the lesions (P = 0.048). There was an incremental cost of R$ 9,500.00 and the ICER was R$ 147,538.00 per restenosis avoided (above the World Health Organization threshold). However, when the propensity score was used, the variables that best classified patients for DES and had a maximum ICER of R$ 4,776.96 were age > 72 years, diabetes and lesions with diameter < 3.2mm and length > 18mm.CONCLUSIONSAlthough DES were not cost-effective in the overall population, the propensity score showed that in elderly patients, diabetics and patients with long lesions or small vessels, the use of DES was cost-effective.

Paciente com angina pos-infarto, associada a lesoes graves, em arterias circunflexa e marginal esquerda. Foi submetida a angioplastia com implante de stents, mas apresentou grave disseccao do tronco de coronaria esquerda (TCE), que se estendeu para o segmento ascendente da aorta, evoluindo com hipotensao, parada cardiorrespiratoria e posterior instabilidade hemodinâmica. Houve resolucao imediata do quadro clinico com implante de stent no TCE.

Male patient with unstable angina and critical calcified lesion in the left main coronary artery (LMCA). Background: coronary artery bypass grafting and anemia. The intention to treat was angioplasty with drugeluting stents (DES) in the LMCA. The patient presented gastrointestinal bleeding and worsening of anemia, which were treated. Angina was refractory to medical therapy. Because of antiplatelet therapy limitation, bioresorbable vascular support (BVS) was implanted in the LMCA. This case report discusses the use of BVS in complex lesion, enabling absorption of the device and better management of antiplatelet therapy and future follow-up of the obstruction treated using by non-invasive imaging methods.

The objective of this study was to translate, to adapt culturally and to verify the semantic equivalence from english to portuguese of the Co­caine Selective Severity Assessment (CSSA), which evaluates the wi­thdrawal for cocaine. The CSSA was translated from English to Portu­guese, administered to 10 persons, and then submitted to brainstorming in a group of 3 psychiatrics for individual and verbal reproduction, item by item. Backtranslation was executed based on first translation and from brainstorming to the origin language. Then, it was translated again into Portuguese. The entire process was analyzed by a committee of psychiatrists with expertise in addiction, which emitted opinions and the pertinent comments. The scale in its general scope was well understood by both patients and professionals. Few changes were done from the first translation to final version in items 3, 4, 5, 10, 11 e 12. To the others items, the original translation was kept. Statements were added to the end of all items. Considering the opinions of the experts and a final pilot study, was constructed the final Brazilian version of the CSSA. Results indicated a satisfactory semantic equivalence between the two versions and so the CSSA may be helpful instrument in treating withdrawal of cocaine / crack. O objetivo deste estudo foi traduzir, adaptar culturalmente e verificar a equivalência semântica do inglês para o português da escala Cocaine Selective Severity Assessment (CSSA), a qual avalia a abstinência de co­caína. A CSSA foi traduzida do inglês para o português, aplicada em 10 pacientes e submetida ao brainstorming em um grupo de 3 psiquiatras para reprodução individual e verbal, item a item. Foi realizada a retrotradução (backtrans­lation) da primeira tradução e do brainstorming, sendo realizada nova tradução para o português. Todo o processo foi analisado por um comitê de psiquiatras com experiência em toxicomania, os quais emitiram pareceres com as observações pertinentes. A escala, em seu âmbito geral, foi bem compreendida pelos pacientes e profissionais. Pou­cas mudanças foram feitas da primeira tradução até a versão final nos itens 3, 4, 5, 10, 11 e 12. Para os demais itens, a tradução original foi mantida. Sentenças foram adicionadas ao final de todos os itens. Considerando os pareceres dos especialistas e um último estudo piloto, construiu-se a versão final brasileira da CSSA. Os resultados indicaram uma equivalência semântica satisfatória entre as versões, podendo a CSSA ser um instrumento útil no tratamento de abstinência de cocaína/crack.

INTRODUÇÃO: Os estudos sobre a razão de custo-efetividade dos stents farmacológicos (SFs) são escassos. Nosso objetivo foi avaliar os resultados e comparar os custos (razão custo-efetividade incremental - RCEI) por reestenose evitada entre SFs e stents não-farmacológicos (SNFs) utilizando o escore de propensão. MÉTODOS: Incluímos na análise 220 pacientes tratados consecutivamente, dos quais 111 com SFs e 109 com SNFs. O escore de propensão foi usado para ajustar o efeito da intervenção por meio de pareamento, estratificação e ponderação. RESULTADOS: Predominaram pacientes do sexo masculino (67,7% vs. 66,9%; P = 0,53), com média de idade de 65,9 anos. Pacientes tratados com SFs apresentaram maior frequência de diabetes (54% vs. 17,4%; P < 0,001) e doença triarterial (18,9% vs. 10,1%; P = 0,029) e pior função ventricular (54,1% vs. 22%; P < 0,0001). O diâmetro dos stents foi de 2,76 ± 0,35 mm vs. 2,91 ± 0,47 mm (P = 0,006) e a soma do comprimento dos stents foi de 37,6 ± 23 mm vs. 24,8 ± 15,8 mm (P < 0,0001). Reestenose ocorreu em 6,3% vs. 12,8% dos pacientes (P = 0,099) e em 4,1% vs. 9,8% das lesões (P = 0,048). Houve incremento de custo de R$ 9.590,00 e a RCEI foi de R$ 147.538,00 por reestenose evitada (acima do limiar da Organização Mundial da Saúde). Entretanto, utilizando o escore de propensão, as variáveis que melhor classificaram os pacientes para SFs e apresentam RCEI máxima de R$ 4.776,96 foram idade > 72 anos, diabetes e lesões com diâmetro < 3,2 mm e comprimento > 18 mm. CONCLUSÕES: Apesar de os SFs não terem sido custo-efetivos na população em geral, o escore de propensão demonstrou que em idosos, diabéticos e pacientes com lesões longas ou vasos de fino calibre o uso de SFs foi custo-efetivo. BACKGROUND: Studies on the cost-effectiveness ratio of drug-eluting stents (DES) are rare. Our objective was to evaluate the results and compare costs (incremental cost-effectiveness ratio - ICER) per restenosis avoided between DES and bare metal stents (BMS) using the propensity score. METHODS: Two hundred and twenty consecutive patients were included in the study, of which 111 were treated with DES and 109 with BMS. The propensity score was used to adjust the effect of the intervention, by means of matching, stratification and weighing. RESULTS: Most patients were male (67.7% vs. 66.9%; P = 0.53), with a mean age of 65.9 years. Patients treated with the DES had a higher rate of diabetes (54% vs. 17.4%; P < 0.001), three-vessel disease (18.9% vs. 10.1%; P = 0.029) and poor ventricular function (54.1% vs. 22%; P < 0.0001). The diameter of stents was 2.76 ± 0.35 mm vs. 2.91 ± 0.47 mm (P = 0.006) and the sum of the lengths of stents was 37.6 ± 23 mm vs. 24.8 ± 15.8 mm (P < 0.0001). Restenosis was observed on 6.3% vs. 12.8% of the patients (P = 0.099) and in 4.1% vs. 9.8% of the lesions (P = 0.048). There was an incremental cost of R$ 9,500.00 and the ICER was R$ 147,538.00 per restenosis avoided (above the World Health Organization threshold). However, when the propensity score was used, the variables that best classified patients for DES and had a maximum ICER of R$ 4,776.96 were age > 72 years, diabetes and lesions with diameter < 3.2 mm and length > 18 mm. CONCLUSIONS: Although DES were not cost-effective in the overall population, the propensity score showed that in elderly patients, diabetics and patients with long lesions or small vessels, the use of DES was cost-effective.

Levels above 75% of striatal dopamine 2 receptor occupancy (D2RO) have been associated with extrapyramidal symptoms (EPS). The aim of the present study is to investigate the relationship between D2RO and EPS in a sample of psychotic patients in current treatment with both typical and atypical antipsychotics. Brain iodine-123-iodobenzamide single photon emission computed tomography (I-123-IBZM SPECT) was performed in 81 patients taking stable doses of haloperidol, risperidone, olanzapine, quetiapine, clozapine or ziprasidone. First, the degree of D2RO and Positive and Negative Syndrome Scale (PANSS) scores was compared between the group of patients who presented EPS and the group free of EPS. Afterwards, these variables were compared among the different antipsychotic medications. The group with EPS presented means of D2RO significantly higher than the group free of EPS. Significant differences in D2RO were found in clozapine, quetiapine and ziprasidone groups compared with the haloperidol group. No differences were observed between either olanzapine or risperidone and haloperidol. No quetiapine- or clozapine-treated patients developed EPS. Haloperidol and risperidone demonstrated a relationship between striatal D2RO and EPS. The findings suggest that higher D2RO is related to appearance of EPS. Occupancy in the group with EPS was in agreement with previous studies that suggested a high degree of D2RO is necessary for the occurrence of EPS. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

FUNDAMENTO: Na literatura nacional há escassez de análises de custo-efetividade, comparando stents farmacológicos (SF) versus não farmacológicos (SNF), no seguimento tardio. OBJETIVO: Estimar a Razão de Custo-Efetividade Incremental (RCEI) entre SF e SNF na coronariopatia uniarterial. MÉTODOS: 217 pacientes (130 SF e 87 SNF), com 48 meses de seguimento (média=26). Desfecho primário: custo por re-estenose evitada, sendo efetividade definida como redução de eventos maiores. O modelo analítico de decisão foi baseado no estudo de Polanczyk et al. Os custos diretos foram aqueles utilizados diretamente nas intervenções. RESULTADOS: A amostra foi homogênea para idade e sexo. O SF foi mais utilizado em diabéticos: 59 (45,4%) vs 16 (18,4%)(p

There is a scarcity of cost-effectiveness analyses in the national literature comparing drug-eluting stents (DES) with bare-metal stents (BMS), at late follow-up.To estimate the Incremental Cost-Effectiveness Ratio (ICER) between DES and BMS in uniarterial coronariopathy.217 patients (130 DES and 87 BMS), with 48 months of follow-up (mean = 26 months) were assessed.cost per prevented restenosis, with effectiveness being defined as the decrease in major events. The analytical model of decision was based on the study by Polanczyk et al. The direct costs were those used directly in the interventions.The sample was homogenous for age and sex. The DES was more used in diabetic patients: 59 (45.4%) vs 16 (18.4%)(p0.0001) and with a history of coronary artery disease (CAD): 53 (40.7%) vs 13 (14.9%)(p0.0001). The BMS was more used in simple lesions, but with worse ventricular function. The DES were implanted preferentially in proximal lesions: (p=0.0428) and the BMS in the mid-third (p=0.0001). Event-free survival: DES = 118 (90.8%) vs BMS=74 (85.0%) (p=0.19); Angina: DES=9 (6.9%) vs BMS=9 (10.3%) (NS): Clinical restenosis: DES=3 (2.3%) vs BMS=10 (10.3%) (p=0.0253). Cardiac deaths: 2 (1.5%) in DES and 3 (3.5%) in BMS (NS).the tree of decision was modeled based on restenosis. The net benefit for the DES needed an increment of R$7,238.16. The ICER was R$131,647.84 per prevented restenosis (above the WHO threshold).The DES was used in more complex lesions. The clinical results were similar. The restenosis rate was higher in the BMS group. The DES was a non-cost-effective strategy.

Submitted by Johnny Rodrigues (johnnyrodrigues@ufcg.edu.br) on 2018-11-01T20:18:23Z No. of bitstreams: 1 ALCIDES FERREIRA MACHADO FILHO - DISSERTAÇÃO PPGECA 1999..pdf: 13028445 bytes, checksum: 5842e4d302e6524cef39c0bc93988f70 (MD5) Made available in DSpace on 2018-11-01T20:18:23Z (GMT). No. of bitstreams: 1 ALCIDES FERREIRA MACHADO FILHO - DISSERTAÇÃO PPGECA 1999..pdf: 13028445 bytes, checksum: 5842e4d302e6524cef39c0bc93988f70 (MD5) Previous issue date: 1999-06-22 elatam-se resultados obtidos em uma pesquisa visando mostrar que o estudo de misturas entre solos arenosos e argila montmorilonítica (bentonita) pode identificar informações e processos que contribuam para orientar a escolha de materiais para construção de núcleos em barragens de terra. Foram analisados dois tipos de solos provenientes de região do Nordeste do Brasil conhecida como o Planalto da Borborema. Solos e misturas entre solo e bentonitas foram submetidos a ensaios em laboratório. Os dados obtidos permitiram classificar os solos e misturas usando a Classificação Unificada de Solos (Unified Soils Classification System) e identificar propriedades de misturas entre solo e bentonita que contribuiriam para a previsão de comportamento como material de construção em núcleos de barragens de terra. It was reported some results obtained from a research to show that mixing soil with montmorilonitic clays (bentonita) should contribute to identify information and process to choose materiais of construction to earthfill core dams. It was analyzed two types of soils from a northeast region of Brazil called the "Planalto da Borborema". Plain soil and their mixes with bentonita were tested in laboratory. The obtained data were useful to classify soil and their mixes using the Unified Soil Classification System and to identify properties from those material and mixes that should contribute to foresight their behavior as materiais of construction to earthfill core dams.

Orientadores : Christel Lingnau, Alzir Fellipe Buffara Antunes Dissertação (mestrado) - Universidade Federal do Paraná Resumo: O uso combinado de imagens de satélites de diferentes sensores tem proporcionado diversas pesquisas e soluções para o mapeamento de muitas áreas. Esse trabalho mostra a aplicabilidade da combinação de imagens ópticas e de radar para fins de mapeamento geo-ambiental. Para tal, utilizou-se imagens dos satélites Landsat-5 TM (bandas 3, 4 e 5) e RADARSAT (banda C). Como estudo de caso, tomou-se uma área pertencente ao município de Dourados-MS, onde pode-se distinguir tipos bem distintos de classes, tais como: solo exposto, áreas de cultivo agrícola, pastagem, área urbana, vegetação remanescente, várzea, corpos d'água etc. Verificou-se que o uso combinado dessas imagens apresentou melhorias na interpretação dos dados, no processamento digital e na acurácia temática da imagem classificada. As classes mais beneficiadas foram: pastagem, área de plantio direto, reflorestamento e várzea; as áreas de solo exposto e corpos d'água mostraramse bem classificadas sem o auxílio da banda radar; verificou-se também que a imagem RADARSAT isoladamente mostrou-se eficiente na diferenciação entre áreas urbanas e corpos d'água. Abstract: The combination of different satellite sensors imagery provides solution for mapping in many areas. This work presents an aplication of the combination of optic and radar imagery for geo-environmental mapping. For such purpose Landsat TM5 and RADARSAT imagery were used. This project was developed in the city of Dourados, in the Pantanal area (Central Brazil), where there could be distinguished different types of classes such as: bare soil, agricultural area, pasture, urban area, natural vegetation, floodplain, water etc. The combined use of Landsat and RADARSAT imagery has improved the accuracy of the processed data mainly in the land use thematic map. An improvement was noticed in the following classes: pasture, soil preparation, reforestation and wetlands. In addition, bare soil and water bodies have been properly classified using only Landsat imagery. The use of RADARSAT imagery by itself has proved to be efficient in the selection of urban areas and water bodies.