Utilización de imágenes de pacientes para marketing médico

El uso de estrategias de imagen en las redes sociales médicas está cada vez más extendido, cumpliendo el límite ético establecido por el CEM. Sabiendo esto, el presente estudio buscó comprender el problema de la exposición de los pacientes en las redes sociales médicas. Para ello, se realizó una revisión bibliográfica a partir de las bases Scientific Electronic Library Online (Scielo), PubMED, UpToDate, LILACS, incluyendo artículos en inglés, español y portugués publicados a partir de 2018. Así, se percibió en algunas ciudades la tendencia a crear leyes para regular esta exposición, dado que el uso de imágenes se ha vuelto rutinario en la publicidad médica, como una forma de demostrar resultados. Sin embargo, esta práctica está muy acompañada de faltas éticas como recomienda el CFM.

The use of imagem strategies in medical socieal networks is increasingly widespread, meeting the ethical limit established by the CEM. Knowing this, the present study sought to understand the problem of patient exposure in medical social networks. For this, a literature review was carried out from the Scientific Electronic Library Online (Scielo), Pubmed, UpToDate, LILACS databases, articles in English, Spanish and Portuguese published from 2018 onwards were included. Thus, a tendency was noticed in some cities to create laws to regulate this exposure, given that the use of images has become routine in medical advertising, as a way to demonstrate results. However, this practice is greatly accompanied by ethical failures as recommended by the CFM.

A utilização das estratégias de imagem nas redes sociais médicas está cada vez mais disseminada, encontrando-se no limite ético estabelecido pelo CEM. Sabendo disso, o presente estudo buscou entender a problemática da exposição do paciente nas redes sociais médicas. Para isso, foi feita uma revisão da literatura a partir das bases Scientific Eletronic Library Online (Scielo), PubMED, UpToDate, LILACS, foram incluídos artigos em inglês, espanhol e português publicados a partir de 2018. Assim, percebeu-se em algumas cidades a tendência de criar leis para regular essa exposição, haja vista que a utilização de imagens tornou-se rotineira na propaganda médica, como forma demonstrar resultados. Todavia, tal prática vem acompanhada grandemente de falhas éticas segundo o preconizado pelo CFM.

Impacto social del síndrome antifosfolípido: su incidencia en la calidad de vida de los pacientes / Social impact of antiphospholipid syndrome: its impact on the quality of life of patients

RESUMEN Introducción: el síndrome antifosfolípido es una enfermedad trombofílica, autoinmune, rara, todavía poco conocida por todos los profesionales de la salud, lo cual implica demora en el diagnóstico y en el tratamiento oportuno. Objetivo: exponer los factores de impacto social del síndrome antifosfolípido por su incidencia en la calidad de vida de los pacientes. Métodos: se realizó la revisión de la bibliografía a través del motor de búsqueda Google Académico con los descriptores: síndrome antifosfolípido, morbimortalidad, daño, impacto social, calidad de vida, en las bases de datos SciELO, Medline-Pubmed, Hinari. Resultados: la revisión se centra en cuatro subtemas: Ocurrencia del síndrome antifosfolípido en la morbimortalidad trombótica y obstétrica, La recurrencia de los eventos trombóticos y el daño crónico acumulado, El deterioro de la calidad de vida de los pacientes con síndrome antifosfolípido, e Importancia de la labor educativa en el impacto social del síndrome antifosfolípido. Los cambios en los estilos de vida para la corrección de los factores de riesgo que deben enfrentar estos pacientes, añaden restricciones a su vida diaria y el temor a las recurrencias y a la muerte, provocan alteraciones psicológicas adicionales que motivan atención especializada. Conclusiones: se hace necesario diseñar estrategias de salud a gran escala para la atención integral y multidisciplinaria de los pacientes con síndrome antifosfolípido, que incluyan capacitar a los profesionales de la salud y aplicar acciones educativas que involucren a las familias.

ABSTRACT Introduction: antiphospholipid syndrome is a rare, autoimmune, thrombophilic disease, still little known to all health professionals, which implies delay in diagnosis and timely treatment. Objective: to expose the factors of social impact of the antiphospholipid syndrome due to its incidence in the quality of life of the patients. Methods: the review of the bibliography was carried out through the Google Scholar search engine with the descriptors: antiphospholipid syndrome, morbidity and mortality, damage, social impact, quality of life, in the SciELO, Medline-Pubmed, and Hinari databases. Results: the review focuses on four subtopics: Occurrence of antiphospholipid syndrome in thrombotic and obstetric morbidity and mortality, Recurrence of thrombotic events and accumulated chronic damage, Impairment of quality of life in patients with antiphospholipid syndrome, and Importance of Educational work on the social impact of antiphospholipid syndrome. Changes in lifestyles to correct the risk factors that these patients must face, add restrictions to their daily life and the fear of recurrences and death, cause additional psychological alterations that motivate specialized care. Conclusions: it is necessary to design large-scale health strategies for the comprehensive and multidisciplinary care of patients with antiphospholipid syndrome, which include training health professionals and applying educational actions that involve families.

Latin American and Spanish-speaking perspectives on the challenges of global psychiatry

The multi-faceted phenomenon known as globalization has a particular impact on the conceptual and practical development of mental health disciplines in general, and psychiatry in particular, across different world regions. To be theoretically and functionally effective, global psychiatry requires an integration of its different components. To such objective, and after a brief review of continental European and Anglo-Saxon contributions, this article examines the history, characteristics, and contributions of Latin/Iberian American and Spanish-speaking psychiatry, in order to substantiate its role in world psychiatry. The Latin American proper (including Portuguese-speaking Brazil), Spain, and U.S.-based Hispanic components are described, revealing an identity that is based on a humanistic tradition, a value-based, culturally-determined clinical approach to patient care, and a pragmatic adaptation of different treatment resources and techniques. These may constitute supportive elements of an instrumental inter-regional bond in the present and future of our discipline.

A Novel Technique to Minimize Contamination for Cervical Cancer Surgery Patients.

The Laparoscopic Approach to Cervical Cancer (LACC) trial changed the surgical management of cervical cancer worldwide. It was a multinational phase III clinical trial that reported lower survival and higher rate of abdominopelvic recurrences in minimally invasive surgery (MIS) than those of open surgery after hysterectomy. It is possible that tumor exposure to the peritoneal cavity in the MIS arm may account for these differences. We propose a novel technique to minimize peritoneal contamination of malignant cells present at the cervical os by placing a vaginal cerclage abdominally to create a seal at the apex of the vagina during MIS radical hysterectomy. The 2 patients in this work remain healthy and disease-free more than 18 months after surgery using this novel technique. We intend this work to serve as a platform both for offering a safe alternative to the open approach supported by the LACC trial and, most importantly, for promoting discussion of the results of the LACC trial and further research on surgical techniques in the treatment of cervical cancer. MIS has repeatedly been shown to have lower rates of infection, fewer complications, and shorter hospital stays while providing oncologic care that is noninferior to open approach.

Retrospective Study of Cystic Echinococcosis in a Recent Cohort of a Referral Center for Liver Surgery.

BACKGROUND: Cystic echinococcosis (CE) is a zoonosis endemic in Spain caused by the larval stage of the cestode Echinococcus granulosus and is one of the 18 neglected tropical diseases recognized by the WHO. The aim of this study was to describe the epidemiological and clinical data of CE in a surgical referral hospital. METHODS: A retrospective descriptive study of all adults' patients diagnosed with CE and followed at Vall d'Hebron University Hospital in Barcelona, Spain, between 2000 and 2015. RESULTS: We found 151 cases, 78 (51.7%) women, and median age at diagnosis was 68 (range, 15-92) years. Diagnosis was a radiological finding in 97 (64.2%) and the most frequent location was the liver [135 (89.4%) patients]. Nearly 80% of the cysts were calcified and serology was positive in 48 (51.6%). The WHO-IWGE classification was only available in 70 of the 104 (67.3%) cases of liver cysts that had an ultrasound. First therapeutic plan was "watch and wait" followed by surgery. International recommendations were not always followed, particularly in CE4 and CE5 stages, and 20% needed a change of treatment because of progression or recurrence. Patients treated surgically were younger, more symptomatic, and had larger and less calcified cysts in multiple sites. Serology was not useful for CE diagnosis and neither serology nor calcification of the cyst helped to predict viability. CONCLUSIONS: The formation of multidisciplinary teams in reference hospitals could help to improve CE diagnosis, its management, and follow-up, since international recommendations are not usually followed.

Multiple indications for everolimus after liver transplantation in current clinical practice.

AIM: To assess our experience with the use and management of everolimus-based regimens post-liver transplantation and to redefine the potential role of this drug in current clinical practice. METHODS: From October 1988 to December 2012, 1023 liver transplantations were performed in 955 patients in our Unit. Seventy-four patients (7.74%) received immunosuppression with everolimus at some time post-transplantation. Demographic characteristics, everolimus indication, time elapsed from transplantation to the introduction of everolimus, doses and levels administered, efficacy, side effects, discontinuation and post-conversion survival were analyzed. RESULTS: Mean age at the time of conversion to everolimus was 57.7 ± 10 years. Indications for conversion were: refractory rejection 31.1%, extended hepatocellular carcinoma in explanted liver 19%, post-transplant hepatocellular carcinoma recurrence 8.1%, de novo tumour 17.6%, renal insufficiency 8.1%, severe neurotoxicity 10.8%, and others 5.4%. Median time from transplantation to introduction of everolimus was 6 mo (range: 0.10-192). Mean follow-up post-conversion was 22 ± 19 mo (range: 0.50-74). The event for which the drug was indicated was resolved in 60.8% of patients, with the best results in cases of refractory rejection, renal insufficiency and neurotoxicity. Results in patients with cancer were similar to those of a historical cohort treated with other immunosuppressants. The main side effects were dyslipidemia and infections. Post-conversion acute rejection occurred in 14.9% of cases. The drug was discontinued in 28.4% of patients. CONCLUSION: Everolimus at low doses in combination with tacrolimus is a safe immunosuppressant with multiple early and late indications post-liver transplantation.

Caracterização física e físico-química de frutos de araticum (Annona crassiflora Mart. ) / Physical and physical and chemical characterization of araticum fruits (Annona crassiflora Mart. )

Este trabalho objetivou caracterizar física e quimicamente frutos de araticum coletados de populações naturais de plantas localizadas em cinco áreas de Cerrado do estado de Goiás. O trabalho foi realizado na Escola de Agronomia e Engenharia de Alimentos da Universidade Federal de Goiás. Os frutos maduros foram avaliados individualmente, por área e por planta. Determinaram-se: massas do fruto, da polpa e da casca, diâmetro e altura do fruto, número total de sementes e de sementes defeituosas por fruto, massa das sementes, cores do fruto, da casca e da polpa, textura da casca e teor de sólidos solúveis totais. As características físicas mostraram variação significativa entre frutos de plantas das diferentes áreas. A massa média do fruto foi de 872,06 g. A polpa, parte de importância econômica, representou cerca de 47% dessa massa, cuja variação por região foi de 44% a 49%. O número de sementes foi elevado, em média 108, representando 15,8% da massa do fruto. Há tendência para a cor marrom da casca, assim como para a cor amarelada ou creme da polpa. Observou-se uma variação de textura da casca, desde lisa até rugosa. Do total de 219 frutos avaliados, 15,5% apresentaram o orifício de saída de Bephratelloides pomorum. Houve diferenças significativas entre áreas e entre plantas dentro de áreas para todas as variáveis físicas. A massa média dos frutos de araticum foi de 872,06 g com rendimento médio de polpa, casca e sementes de: 46,8%, 37,4% e 15,8%, respectivamente.

This work objectified to characterize physics chemically and collected fruits of araticum of natural populations of plants located in five areas of Cerrado of the state of Goiás. The work was carried through in the "Escola de Agronomia e Engenharia de Alimentos, Universidade Federal de Goiás". The mature fruits had been evaluated individually, for area and plant. They had been determined: masses of the fruit, the pulp and the rind, diameter and height of the fruit, total number of seeds and defective seeds for fruit, mass of the seeds, colors of the fruit, the rind and the pulp, texture of the rind and total soluble solids. The physical characteristics had shown significant variation between fruits of plants of the different areas. The average mass of the fruit was of 872,06 g. The pulp, part of economic importance, represented about 47% of this mass, whose variation for region was of 44% 49%. The number of seeds was raised, on average 108, representing 15.8% of the mass of the fruit. It has trend for the brown color of the rind, as well as for the yellowish color or cream of the pulp. A variation of texture of the rind was observed, since smooth until rough. Of the total 219 of evaluated fruits, 15.5% had presented the orifice of exit of Bephratelloides pomorum. It inside had significant differences between areas and plants of areas for all the variable physicist. The mass average of the 872,06 fruits of araticum was of g with average income of pulp, rind and seeds of: 46.8%, 37.4% and 15.8%, respectively.

Germinação de sementes e emergência de plântulas de araticum oriundos do cerrado de Goiás / Seed germination and seedling emergence of araticum from cerrado of Goiás state

O araticum (Annona crassiflora M.) é uma espécie frutífera da família Annonaceae, nativa da região dos cerrados, com ocorrência em todo o Estado de Goiás. O objetivo deste trabalho foi estudar a germinação de sementes de frutos de araticum coletados de populações naturais de plantas localizadas em cinco áreas de Cerrado do Estado de Goiás, tratadas com ácido giberélico (GA3). Determinou-se a velocidade de emergência a cada três dias e o percentual de germinação de sementes, de frutos de 75 plantas. O delineamento utilizado foi o de blocos casualizados, com quatro blocos e 75 tratamentos. Cada parcela foi composta por 50 sementes de uma mesma planta, totalizando 15.000 sementes. Os dados foram submetidos à análise de variância e aplicando-se o teste F. Houve germinação da maioria das sementes das plantas de cada área, mostrando que, independentemente do vigor, a dosagem utilizada de ácido giberélico foi adequada. Em média a percentagem de germinação variou de 12,81% em Vila Propicio a 28,81% em Campos Belos. Na planta 10 de Campos Belos observou-se a maior média para germinação (66%) e a menor média de dias necessários para a emergência (49 dias). As sementes provenientes de frutos de araticum das cinco áreas de Cerrado em estudo, apresentam diferenças na percentagem de germinação e na velocidade de emergêngia. As diferenças de germinação ocorrem entre plantas na área e entre áreas.

Araticum (Annona crassiflora M.) is a species of native fruit of the Annonaceas family which grows in the whole State of Goiás, Brazil. The objective of this work was to evaluate the germination of araticum fruits seeds collected of natural populations of plants located in five areas of Cerrado of the State of Goiás, treated with gibberellic acid (GA3). It was determined speed of emergency to each three days and the germination percentage of seeds, fruits of 75 plants. The used delineation was of randomized blocks, with four blocks and 75 treatments. Each parcel was composed for 50 seeds of one same plant, totalizing 15.000 seeds. The data had been submitted to the variance analysis and applying test F. It had germination of the majority of the seeds of the plants of each area, showing that, independently of the vigor, the used dosage of gibberellic acid was adjusted. On average the germination percentage varied of 12.81% in Vila Propicio 28.81% in Campos Belos. In plant 10 of Campos Belos observed it bigger average for germination (66%) and the average minor of necessary days for the emergency (49 days). The seeds proceeding from of araticum fruits of the five areas of Cerrado in study, present differences in the germination percentage and the speed of emergency. The germination differences occur between plants in the area and areas.

Dilemas contempor neos de la nosología psiquiátrica: El caso de las neurosis / Contemporary dilemmas in psychiatric nosology: The case of neurosis

Se plantean diversas reflexiones en torno a la presencia y significado actual del término y concepto de neurosis en la medicina y psiquiatría contemporáneas, tomando como punto de partida su “desaparición” de los sistemas nosológicos y diagnósticos actuales. La historia del concepto se esboza a partir de la contribución seminal de William Cullen en el Siglo XVIII y se ilustra desde diferentes perspectivas por Charcot, Freud y, en España, por Mira y López, Llopis, López Ibor y Castilla del Pino. Concluye esta sección con la descripción de las radicales modificaciones y la total eliminación del término “neurosis” en las diversas ediciones del Manual Diagnóstico y Estadístico de la Asociación Psiquiátrica Americana (DSM) a partir de 1980, así como las objeciones de Tyrer. La neurosis en la actualidad puede ser reconsiderada a partir de dos tesis contrapuestas: 1) la identificación de un conjunto de síntomas diferenciales e identificables a partir de pruebas de investigación, predominantemente neurobiológica, y 2) su consideración como expresión inmanente del sufrimiento humano (profundamente subjetivo y biográfico) que lleva a la búsqueda de ayuda profesional.

A series of reflections are presented about the presence and meaning of the concept of neurosis in contemporary medicine and psychiatry, taking as a point of departure its “disappearance” from current nosological and diagnostic systems. The concept’s history is traced back beginning with the seminal contribution by William Cullen in the 18th Century and continued from different perspectives by Charcot, Freud and, in Spain, by Mira y L¢pez, Llopis, L¢pez Ibor and Castilla del Pino. This section ends with the description of the elimination of the term “neurosis” from the several editions of APA’s DSM since 1980, and the objections by Tyrer. Neurosis as a current disorder deserves more studies on the basis of two opposite theses: 1) as a set of analyzable and interpretable symptoms to be studied by evidence-oriented research, particularly of neurobiological nature, and 2) as an immanent expression of profoundly subjective (personal and biographic) human suffering that leads to searching of professional help.

Single HCC in cirrhotic patients: liver resection or liver transplantation? Long-term outcome according to an intention-to-treat basis.

BACKGROUND: Compensated cirrhotic patients with single hepatocellular carcinoma (HCC) ≤5 cm may benefit from both liver resection (LR) and liver transplantation (LT); however, the better 10-year actuarial survival of the two treatments remains unclear. We aimed to assess the long-term outcome of cirrhotic patients with single HCC ≤5 cm treated either with LR or LT on an intention-to-treat basis. METHODS: A total of 217 cirrhotic patients with single HCC ≤5 cm were evaluated at our department: 95 were treated with LR (LR group), and 122 were included on the waiting list for LT (LT group). Patients in the LR group were divided into very early HCC (tumor size ≤2 cm) and early HCC (tumor size >2 cm). Median follow-up was 5.3 (range 0.1-18) years. RESULTS: Tumor recurrence was 72 % in the LR group versus 16 % in the LT group (p < 0.001). 1-, 5-, and 10-year cumulative risk of recurrence was 18, 69, and 83 % in the LR group versus 4, 18, and 20 % in the LT group (p < 0.001). Ten-year actuarial survival was 33 % in the LR group versus 49 % in the LT group (p = 0.002). At HCC recurrence, 27.3 % were included on the waiting list for salvage transplantation (very early HCC group) versus 15.1 % (early HCC group) (p = 0.2). After salvage transplantation, HCC recurrence was 0 % (very early HCC group) versus 40 % (early HCC group) (p = 0.2). No significant differences were observed in 1-, 5-, and 10-year actuarial survival between the very early HCC group and the LT group (95, 55, and 50 % vs. 82, 62, and 50 %). CONCLUSIONS: LR should be the treatment of choice for cirrhotic patients with very early HCC.

Cilastatin protects against cisplatin-induced nephrotoxicity without compromising its anticancer efficiency in rats.

Cisplatin is an anticancer agent marred by nephrotoxicity; however, limiting this adverse effect may allow the use of higher doses to improve its efficacy. Cilastatin, a small molecule inhibitor of renal dehydropeptidase I, prevents proximal tubular cells from undergoing cisplatin-induced apoptosis in vitro. Here, we explored the in vivo relevance of these findings and the specificity of protection for kidney cells in cisplatin-treated rats. Cisplatin increased serum blood urea nitrogen and creatinine levels, and the fractional excretion of sodium. Cisplatin decreased the glomerular filtration rate, promoted histological renal injury and the expression of many pro-apoptotic proteins in the renal cortex, increased the Bax/Bcl2 ratio, and oxidative stress in kidney tissue and urine. All these features were decreased by cilastatin, which preserved renal function but did not modify the pharmacokinetics of cisplatin area under the curve. The cisplatin-induced death of cervical, colon, breast, and bladder-derived cancer cell lines was not prevented by cilastatin. Thus, cilastatin has the potential to prevent cisplatin nephrotoxicity without compromising its anticancer efficacy.

mRNA in situ hybridization (HistoSonda): a new diagnostic tool for HER2-status in breast cancer-a multicentric Spanish study.

Monoclonal therapies could represent baseline-personalized medicine for patients with neoplasia. One of the most successful examples is Trastuzumab, a humanized antibody against epidermal growth factor receptor 2. Human epidermal growth factor receptor 2 (HER2) is a trans-membrane tyrosine kinase coded by the gene HER2/neu and overexpressed in approximately 12% to 20% of infiltrating breast carcinomas. The overexpression of HER2 is an independent adverse prognostic factor in relation to survival and is also predictive of response to treatment. Therefore, the correct evaluation of HER2 status is essential for the management of infiltrating breast carcinoma to determine the response to Trastuzumab. The most common evaluation technique is immunohistochemistry, which is confirmed by fluorescent or chromogenic monochrome or dual-gene in situ hybridization in ambiguous cases (immunohistochemical 2+). Our objective was to evaluate the diagnostic value of a new technique on the basis of HER2 mRNA in situ hybridization (HistoSonda) and study its correlation with immunohistochemistry and dual-chromogenic in situ hybridization (DUO-CISH) in 403 cases of infiltrating breast carcinoma. The percentage of DUO-CISH amplification was 25.8%, HistoSonda positivity was 31.2%, and positivity for Hercep-Test was 48.1%, including (+2) and (+3). Comparisons were made of each of the techniques, HistoSonda to IHQ and HistoSonda to DUO-CISH. The overall concordance between DUO-CISH and HistoSonda was 89%. Our data support the consistency of HistoSonda as a useful tool to determine HER2 status in breast cancer.

Novel dimeric structure of phage φ29-encoded protein p56: insights into uracil-DNA glycosylase inhibition.

Protein p56 encoded by the Bacillus subtilis phage φ29 inhibits the host uracil-DNA glycosylase (UDG) activity. To get insights into the structural basis for this inhibition, the NMR solution structure of p56 has been determined. The inhibitor defines a novel dimeric fold, stabilized by a combination of polar and extensive hydrophobic interactions. Each polypeptide chain contains three stretches of anti-parallel ß-sheets and a helical region linked by three short loops. In addition, microcalorimetry titration experiments showed that it forms a tight 2:1 complex with UDG, strongly suggesting that the dimer represents the functional form of the inhibitor. This was further confirmed by the functional analysis of p56 mutants unable to assemble into dimers. We have also shown that the highly anionic region of the inhibitor plays a significant role in the inhibition of UDG. Thus, based on these findings and taking into account previous results that revealed similarities between the association mode of p56 and the phage PBS-1/PBS-2-encoded inhibitor Ugi with UDG, we propose that protein p56 might inhibit the enzyme by mimicking its DNA substrate.

Genetic structure of mangaba (Hancornia speciosa Gomes) populations in the cerrado region of central Brazil / Estrutura genética de subpopulações de mangabeira (Hancornia speciosa Gomes) no cerrado do Brasil central

Mangaba tree (Hancornia speciosa Gomes) is a fruit species with great potential for commercial exploitation, found in most regions of Brazil and highly frequent in the Cerrado biome. Information on the genetic variability in this biome is scarce. This study aimed at characterizing the genetic structure of eight populations found in the states of Goiás, Bahia and Minas Gerais by using RAPD markers. Genetic variability was assessed by the analysis of variance on molecular data. A significant proportion of genetic variance was found among populations, corresponding to 19.6 % of the total variation. The correlation between the matrices of geographic and genetic distances was not significant, indicating that there is no spatial structure of the genetic variability among the populations, for the RAPD marker loci used here. The high variability suggests that a strategy for in situ, as well as ex situ conservation, must be based on sampling a large number of local populations.

A mangabeira (Hancornia speciosa Gomes) é uma espécie frutífera com grande potencial para exploração econômica, encontrada em várias regiões do Brasil, sendo freqüente no bioma Cerrado. Informações sobre a variabilidade genética das populações existentes neste bioma são escassas. Este estudo teve como objetivo caracterizar a estrutura genética de oito populações situadas nos Estados de Goiás, Bahia e Minas Gerais por meio de marcadores RAPD. A estrutura da variabilidade genética foi avaliada utilizando-se a análise de variância de dados moleculares. Uma proporção significativa da variância genética foi encontrada entre populações, correspondendo a 19,6 % da variação total. A correlação entre as matrizes de distâncias geográficas e genéticas não foi significativa, indicando que não existe estruturação espacial da variabilidade genética entre populações, para os locos marcadores RAPD utilizados. A alta variabilidade sugere que estratégias para conservação in situ, bem como ex situ, devem ser baseadas em amostragem de um grande número de populações locais.

Evolution and management of de novo neoplasm post-liver transplantation: a 20-year experience from a single European centre.

PURPOSE: Survival post-liver transplantation (LT) has improved; however, patients are considered at the, risk of malignancy due to prolonged immunosuppression. The long-term outcome of patients developing de novo neoplasm (DN) at our centre was evaluated. METHODS: Between October 1988 and December 2007, 800 LT were performed in 742 patients. Patients were divided into two study periods according to the time of LT; first: October 1988-December 1995; second: January 1996-December 2007. RESULTS: After a mean follow-up of 5 ± 4.6 years, 71 DN (9.5%) were detected in 742 patients. The cumulative risk of DN development increased with the time from LT although no differences at 3, 5, and 10 years were found when first and second periods were compared (3, 7, 16% vs. 2, 4, 11%, respectively; p = 0.4). DN incidence was higher in the first compared with the second period (10.7 vs. 7.8%; p < 0.04); no significant differences were observed in mortality rate (50 vs. 27%; p = 0.052). Actuarial patient survival post-DN at 1, 3, and 5 years: 67, 48, 45% versus 82, 71, 65%, in the first versus second period, respectively, p < 0.04. CONCLUSIONS: DN incidence has decreased in recent years; however, as survival post-LT increases, so does the incidence of DN. Surveillance programmes are necessary to diagnose DN at early stages.

O agente comunitário de saúde: violência e sofrimento no trabalho a céu aberto / Community health agent: violence and suffering at open work / El agente comunitario de salud: la violencia y sufrimiento en el trabajo al aire libre

Este estudo parte do pressuposto de que as violências percebidas pelos Agentes Comunitários de Saúde (ACS) em seu ambiente laboral têm comprometido a organização de seu trabalho e dificultado as ações de prevenção e promoção da saúde da população assistida pelo Sistema Único de Saúde (SUS). Para tanto, objetiva analisar significados atribuídos pelos ACS aos tipos, formas de referência e nomeação da violência vivenciada no cotidiano de trabalho no bairro do Candeal, Distrito Sanitário de Brotas na cidade do Salvador. Trata-se de um estudo de natureza qualitativa, realizado por meio de entrevistas semiestruturadas e observação participante com trabalhadores da Unidade de Saúde da Família do referido bairro. Os resultados revelam a complexidade das relações laborais vivenciadas pelos ACS no Candeal de Brotas em Salvador, Bahia, desvelando as situações de violência no cotidiano de trabalho. A pesquisa aponta para a necessidade de preparação dos ACS para as suas ações de uma forma geral e da violência em particular, estabelecendo o desafio que a Secretaria Municipal de Saúde de Salvador tem, em ampliar o conceito e as práticas de saúde, inserindo, concretamente, a violência como um problema que afeta trabalhadores e usuários dos serviços prestados pela Unidade de Saúde Familiar USF.

This study assumes that the violence perceived by the ACS in their work environment has compromised the organization of their work and hampered the prevention and health promotion actions among people assisted by SUS. Attempts were made to understand the meanings assigned by ACS to the types, forms of reference and denomination of the violence experienced in daily work in Candeal. This is a qualitative study, conducted through semi-structured interviews and participant observation with employees of the Family Health Unit in Salvador, Sanitary District of Brotas in Salvador, Bahia. We interviewed eight ACS from a care unit that volunteered to participate. The results reveal the complexity of industrial relations experienced by the ACS in Candeal, revealing the violent situations in daily work. The research points to the need for preparation of the ACS for their actions in general and violence in particular, establish the challenge that the Salvador City Department of Health has, to expand the concept and practice, placing health and specifically violence as an issue that affects workers and users of services provided by USF.

Este estudio parte del supuesto que las violencias percibidas por los Agentes Comunitarios de Salud (ACS) en su entorno laboral han comprometido la organización de su trabajo y obstaculizado las acciones de prevención y promoción de la salud de la población asistida por el Sistema Único de Salud (SUS). Para tanto, tiene por objetivo analizar significados atribuídos por los ACS a los tipos, formas de referencia y nombramiento de la violencia experimentada en el trabajo diario en el Barrio Candeal. Distrito Sanitario de Brotas en la ciudad de Salvador. Se trata de un estudio de naturaleza cualitativa, realizado a través de entrevistas semiestructuradas y observación participante con trabajadores de la Unidad de Salud de la Familia en el referido barrio. Entrevistamos a ocho trabajadores de la unidad de atención del ACS que se ofrecieron a participar. Los resultados revelan la complejidad de las relaciones laborales vividas por los ACS en Candeal de Brotas, Salvador, desvelando las situaciones de violencia en el trabajo cotidiano. La investigación apunta a la necesidad de preparación de los ACS, para sus acciones en general y de la violencia, en particular, estableciendo el reto que el Departamento de Salud de la ciudad de Salvador tiene, de ampliar el concepto y las prácticas, de salud, insiriendo concretamente la violencia, como um problema que afecta a los trabajadores y a los usuarios de los servicios prestados por la Unidad de Salud Familiar USF.

Correlação entre floração, frutificação e variáveis ambientais em Solanum lycocarpum. A. St. Hil, Solanaceae / Correlation between flowering, fructification and environmental variables in Solanum lycocarpum A. St.-Hil, Solanaceae

A lobeira (S. lycocarpum) é uma espécie típica e abundante do Cerrado, que ocupa principalmente ambientes antropizados. Possui características interessantes do ponto de vista da biologia reprodutiva, que provavelmente estão favorecendo a ampla ocupação pela espécie. Tendo em vista que a planta floresce e frutifica durante todo o ano, o presente estudo teve por objetivo verificar se existe correlação entre floração, frutificação e variáveis ambientais (temperatura, umidade e precipitação), como suporte para estudos futuros referentes à biologia reprodutiva e ecologia de espécies de plantas do Cerrado. Foi escolhida uma população de lobeira situada no município de Morrinhos, Sul do estado de Goiás, composta de 34 plantas em fase reprodutiva. Todas as plantas foram georreferenciados com um aparelho GPS. Foram feitas observações mensais durante 13 meses (junho de 2005 a julho de 2006) e quantificados flores abertas e frutos produzidos nos intervalos entre observações. Pode-se inferir alta conversão de flores hermafroditas em frutos. Por meio da correlação de Spearman, pode-se constatar correlação positiva entre floração e precipitação e umidade, o mesmo, aparentemente, não ocorre para frutificação.

Solanum lycocarpum (lobeira) is a typical and abundant species of brazilian Cerrado, which occupies mainly surrounding disturbed areas. It has interesting characteristics from the point of view of reproductive biology, that probably are favoring the large occupation of habitats by the species. Based on the fact that the species produces flowers and fruit during all the year, the present study had the purpose to verify the association between flower and fruit production with environmental variables (temperature, relative humidity and precipitation), aiming to support future studies referring to reproductive biology and ecology of plant species from Cerrado biome. A population of S. lycocarpum composed of 34 plants in reproductive phase, situated in Morrinhos, south of the State of Goiás, Brazil, , was evaluated. All the plants were geographically referenced with a GPS receptor. Observations were made monthly during 13 months (June, 2005 to July, 2006) quantifying open flowers and fruits produced in the intervals between the observations. It was possible suggest high conversion of flowers in fruits. The Spearman rank correlation showed positive correlation of flower number with precipitation and relative humidity. Fruit number was not correlated with the environmental variables.

Cilastatin attenuates cisplatin-induced proximal tubular cell damage.

A major area in cancer therapy is the search for protective strategies against cisplatin-induced nephrotoxicity. We investigated the protective effect of cilastatin on cisplatin-induced injury to renal proximal tubular cells. Cilastatin is a specific inhibitor of renal dehydrodipeptidase I (DHP-I), which prevents hydrolysis of imipenem and its accumulation in the proximal tubule. Primary cultures of proximal cells were treated with cisplatin (1-30 microM) in the presence or absence of cilastatin (200 microg/ml). Apoptosis and mitochondrial injury were assessed by different techniques. Cisplatin uptake and DNA binding were measured by inductively coupled plasma spectrometry. HeLa cells were used to control the effect of cilastatin on the tumoricidal activity of cisplatin. Cisplatin increased cell death, apoptotic-like morphology, caspase activation, and mitochondrial injury in proximal tubular cells in a dose- and time-dependent way. Concomitant treatment with cilastatin reduced cisplatin-induced changes. Cilastatin also reduced the DNA-bound platinum but did not modify cisplatin-dependent up-regulation of death receptors (Fas) or ligands (tumor necrosis factor alpha, Fas ligand). In contrast, cilastatin did not show any effects on cisplatin-treated HeLa cells. Renal DHP-I was virtually absent in HeLa cells. Cilastatin attenuates cisplatin-induced cell death in proximal tubular cells without reducing the cytotoxic activity of cisplatin in tumor cells. Our findings suggest that the affinity of cilastatin for renal dipeptidase makes this effect specific for proximal tubular cells and may be related to a reduction in intracellular drug accumulation. Therefore, cilastatin administration might represent a novel strategy in the prevention of cisplatin-induced acute renal injury.

Optimization of liver transplantation as a treatment of intrahepatic hepatocellular carcinoma recurrence after partial liver resection: experience of a single European series.

BACKGROUND: The aim of this study was to ascertain the outcome of liver transplantation (LT) due to hepatocellular carcinoma (HCC) in patients who had undergone previous liver resection (LR) for HCC. METHODS: A case-control study (1:2) was designed to compare patients who underwent LT due to HCC recurrence with a previous LR for HCC (study group) with those who underwent LT for primary HCC but without previous LR (control group). RESULTS: From January 1990 to December 2007, a total of 303 cirrhotic patients with primary HCC were evaluated for surgery. Primary LT was performed in 191 and LR in 100. When HCC recurrence was diagnosed after LR (69/100), 17 of the 69 (25%) patients underwent LT (study group). The median follow-up was 70 months (12.7-203.0 months). Disease-free survivals at 1, 3, and 5 years in the study group versus the control group were 86%, 68%, 58% vs. 97%, 93%, 89%, respectively (p < 0.04). The 1-, 3-, and 5-year actuarial patient survivals in the study group versus the control group were 59%, 52%, 52% vs. 85%, 76%, 65%, respectively (p = NS). Patients of the study group were divided into two groups according to the time to recurrence after LR: group 1 was <1 year, and group 2 was >1 year. Recurrence after LT was 75% in group 1 vs. 15.4% in group 2 (p < 0.03). The 1-, 3-, and 5-year actuarial patient survivals were 25%, 0%, 0% in group 1 and 69%, 69%, 69% in group 2, p < 0.02). CONCLUSIONS: Liver transplantation can be safely performed after a previous LR for HCC. Patients with recurrence during the first year after hepatectomy have a poor prognosis after LT.