Effects of paternal diet and antioxidant addition to the semen extender on bovine semen characteristics and on the phenotype of the resulting embryo.

The aim of this study was to examine the effects of long-term dietary supplementation of young Nellore bulls with rumen-protected polyunsaturated fatty acids (PUFAs) and of the inclusion of catalase in the semen extender on semen quality, in vitro sperm fertilizing ability, and intracytoplasmic lipid content in the resulting embryos. Twelve Nellore bulls were supplemented with rumen-protected PUFAs or with a basal diet from 14 to 24 months of age. The semen was collected at the end of supplementation. For cryopreservation, the ejaculate was divided into two equal volumes and catalase was added to the extender in one of the fractions. Thus, the experimental design consisted of a 2 × 2 factorial scheme with two diets (control and PUFA) and two extenders (Cat+ and Cat-). Total motility and the percentage of rapid cells in fresh semen were negatively affected by dietary supplementation with PUFAs (P < 0.05), but these effects did not persist after freezing. The frozen/thawed semen of animals fed PUFAs exhibited an increase in the percentages of damaged plasma and acrosomal membranes, as well as an increase in the proportion of lipids ions at m/z 578 and m/z 757 detected by MALDI-MS. Nevertheless, there was no effect of the treatments on in vitro embryo development. However, embryos derived from bulls supplemented with PUFAs exhibited higher lipid accumulation compared to control (P < 0.05). In conclusion, PUFA supplementation promoted worsening of semen quality without affecting the in vitro sperm fertilizing ability; however, the paternal diet affected the intracytoplasmic lipid content in the resulting embryos.

Mapeamento dos domínios da ANVISA para o padrão ISO IDMP / Mapping of ANVISA domains to the ISO IDMP standard / Mapeo de dominios de ANVISA al estándar ISO IDMP

Objetivo: Apresentar o mapeamento entre vocabulários controlados da Agência Nacional de Vigilância Sanitária (ANVISA) para listas do European Directorate for the Quality of Medicines and Healthcare (EDQM). Método: O mapeamento obedeceu aos princípios da ABNT NBR ISO 12300. Resultados: Foram mapeadas as listas: Via de Administração, Forma Farmacêutica e Embalagem. 47% dos mapeamentos foram classificados com grau de equivalência 4, onde o conceito fonte foi mais restrito com mais significado específico que o conceito/termo alvo. Conclusão: Entende-se que este estudo fornece subsídios para a ANVISA prosseguir no trabalho de harmonização das listas locais com o padrão IDMP.

Objective: To present the mapping between controlled Brazilian Health Regulatory Agency (ANVISA) vocabularies for European Directorate for the Quality of Medicines and Healthcare (EDQM) lists. Method: The mapping followed the principles described in the ABNT NBR ISO 12300. Results: Terms of three lists were mapped: Routes of Administration, Pharmaceutical Dose Forms and Packaging. Almost half of the mappings were classified with equivalence grade 4 meaning that the source concept was more restricted with more specific meaning than the target concept / term. Conclusion: This work provides the necessary subsidies for ANVISA to proceed with the work of harmonizing local lists with the IDMP standard.

Objetivo: Presentar el mapeo entre vocabularios controlados de Agencia Nacional de Vigilancia Sanitaria (ANVISA) para listas European Directorate for the Quality of Medicines and Healthcare (EDQM). Método: El mapeo siguió los principios descritos en lo estándar ABNT NBR ISO 12300. Resultados: Se mapearon los términos de las listas: Vía de administración, Forma farmacéutica y Embalajes. La mayoría se clasificaron como grado de equivalencia 4, donde el concepto fuente era más restringido con un significado más específico que el concepto/término objetivo. Conclusión: Se entiende que este estudio proporciona subsidios para ANVISA continúe el trabajo de armonizar las listas locales con el estándar IDMP.

Expression of Thomsen-Friedenreich Antigen in Colorectal Cancer and Association with Microsatellite Instability.

Microsatellite instability (MSI) is a molecular phenotype due to a deficient DNA mismatch repair (dMMR). In colorectal cancer (CRC), dMMR/MSI is associated with several clinical and histopathological features, influences prognosis, and is a predictive factor of response to therapy. In daily practice, dMMR/MSI profiles are identified by immunohistochemistry and/or multiplex PCR. The Thomsen-Friedenreich (TF) antigen was previously found to be a potential single marker to identify MSI-high gastric cancers. Therefore, in this study, we aimed to disclose a possible association between TF expression and MSI status in CRC. Furthermore, we evaluated the relationship between TF expression and other clinicopathological features, including patient survival. We evaluated the expression of the TF antigen in a cohort of 25 MSI-high and 71 microsatellite stable (MSS) CRCs. No association was observed between the expression of the TF antigen and MSI-high status in CRC. The survival analysis revealed that patients with MSI-high CRC showed improved survival when the TF antigen was expressed. This finding holds promise as it indicates the potential use of the TF antigen as a biomarker of better prognosis in MSI-high CRCs that should be validated in an independent and larger CRC cohort.

Pulmonary mucormycosis: A case report.

Mucormycosis is a rare fungal infection caused by Mucorales order fungi. The rhino-cerebral form of mucormycosis is most commonly seen in patients with diabetes mellitus, whereas, pulmonary mucormycosis is a rare manifestation in patients with haematological malignancy and transplant recipients. We report a case of pulmonary mucormycosis presenting with a late acute onset diabetes on a patient immunosuppressed with a low dose of steroids. We aim to illustrate the need for a high clinical suspicion for the diagnosis of mucormycosis and to report the importance of early and aggressive inhiation of antifungal therapy.

Azole-resistant Candida albicans Spondylodiscitis After Bariatric Surgery: A Case Report.

CASE: We present a case of azole and partial caspofungin-resistant Candida albicans spondylodiscitis, after bariatric surgery with bowel perforation. Treatment included debridement and several months of anidulafungin, complemented with antibacterial therapy because of relapse for bacterial superinfection. After treatment, the infection did not recur clinically or radiologically during one and half years follow-up. CONCLUSION: Although C. albicans spondylodiscitis is rare, fungi should be suspected as a causative agent. Adequate history, imaging and laboratory testing, and medical and surgical treatment should be performed to successfully eradicate the infection and resolve potential neurological deficits.

Prospective study of blood viral load of Epstein-Barr virus, herpes virus type 6 and human parvovirus B19 in Crohn's disease: Does therapy matter?

BACKGROUND: The interplay between inflammatory bowel disease (IBD) and DNA viruses, such as Epstein-Barr (EBV), human parvovirus B19 (HPVB19) and human herpes type 6 (HHV6) is scarcely studied. The main aim of this prospective study is to screen for EBV, HSV6, and HPVB19 DNA viremia in adult patients with stable Crohn's disease (CD), correlating the results with IBD treatment. METHODS: From July 2015 - March 2017, 100 patients were enrolled and divided in four groups of 25 participants each, according to in course treatment. Blood collections were performed every 5 months in all patients. Antibodies for EBV and HPVB19 were screened and repeated if negative. Blood EBV DNA, HPVB19 DNA, and HHV6 DNA were quantified by quantitative real-time Polymerase Chain Reaction. RESULTS: Patients had evidence of EBV (100 %) and HPVB19 (70 %) past infection. Across the study timeline, EBV-DNA, HPVB19-DNA, and HHV6-DNA were detected in the blood of 25, 11, and 7 patients, respectively. Viremia was detected only once in 72 %, 73 %, and 86 % of the patients in the studied period, for EBV, HPVB19, and HHV6, respectively. We did not find significant differences between treatment groups, independently of the viral cut-off for the three viruses. CONCLUSIONS: The detection of EBV, HPVB19, and HHV6 viremia, in stable CD patients, was not impacted by biological/immunosuppressant therapy. Although attractive as a non-invasive technique, this approach did not prove to be useful in stable patients. More and larger studies are needed to address the relevance of these viruses on IBD course, in stable patients and during exacerbations.

Asymptomatic reactivation of hepatitis B virus after prolonged treatment with etanercept.

Etanercept is an anti-tumor necrosis factor ɑ (anti-TNFɑ) drug used for treating immunomediated inflammatory diseases. It is least associated with hepatitis B virus (HBV) reactivation. We present a 71-year-old man with psoriasis refractory to phototherapy and acitretin, which led to etanercept monotherapy. Before anti-TNFɑ treatment, past contact with HBV was elicited; antibodies to HBc and HBs were positive whereas HBsAg was negative. Seven years after treatment initiation, while the patient was completely asymptomatic, a transaminase elevation was found and a reactivation of HBV was documented, with a high viral load of the virus. He started entecavir therapy and, after a 14-month follow-up, the viral load is still detectable at a low level, as well as HBsAg. We emphasize the late and asymptomatic reactivation of HBV associated with soluble anti-TNFɑ monotherapy. This case reinforces the importance of current recommendations for periodic monitoring of viral load and HBV markers in all patients that have had prior contact with HBV (positive anti-HBc), with or without indication for treatment of HBV (HBsAg and HBV-DNA negative).

Lipid content and cryotolerance of in vitro-produced bovine embryos treated with forskolin before vitrification / Acúmulo de lipídios intracitoplasmáticos, desenvolvimento e criotolerância de embriões bovinos produzidos in vitro e tratados com diferentes concentrações de forskolin antes da vitrificação

The aim of the present study was to evaluate the intracytoplasmic lipid content, development and cryotolerance of in vitro-produced bovine embryos treated with different concentrations of forskolin before vitrification. Embryos were produced from abattoir-derived ovaries and allocated into four groups. In the treatment groups, forskolin was added to the in vitro culture medium on Day 6 and incubated for 24 hours in one of the following concentrations: 2.5µM (Forsk 2.5 group), 5.0µM (Forsk 5.0 group) or 10.0µM (Forsk 10.0 group). Embryos from the control group were cultured without forskolin. On Day 7 of culture, the expanded blastocysts were stained with the lipophilic dye Sudan Black B for determination of the intracytoplasmic lipid content or were cryopreserved via the Vitri-Ingá® procedure. Although there were no significant differences (P>0.05) in the blastocyst rates between the Control group (44.9%) and the other treatments, the embryo production was lower (P<0.05) in Forsk 10.0 group (38.8%) compared to Forsk 2.5 (50.5%) and Forsk 5.0 (54.7%) groups. The intracytoplasmic lipid content (expressed in arbitrary units of pixels) in blastocysts from the Control group (1.00±0.03) was similar (P>0.05) to that found in Forsk 2.5 (0.92±0.03) and Forsk 10.0 groups (1.06±0.03) groups; however the lipid accumulation in blastocysts from Forsk 5.0 group (0.82±0.04) was lower than in the Control group (P<0.05). Based on these results, Forsk 5.0 treatment was tested for cryotolerance and it was observed that the blastocoel re-expansion rate evaluated 24 hours after warming was greater (P<0.05) in Forsk 5.0 group (72.2%) compared to the Control group (46.2%). In conclusion, pre-treatment with forskolin at a concentration of 5.0 µM for 24 hours before vitrification is effective in reducing the intracytoplasmic lipid content and, consequently, improves cryotolerance of IVP bovine embryos.(AU)

Os embriões foram produzidos a partir de ovários obtidos em abatedouro e foram alocados em quatro grupos experimentais. Nos grupos tratados, o forskolin foi adicionado ao meio de cultivo in vitro no dia 6 do cultivo e os embriões foram incubados durante 24 horas com uma das seguintes concentrações: 2,5µM (grupo Forsk 2,5), 5,0µM (grupo Forsk 5,0) ou 10,0µM (grupo Forsk 10,0). Os embriões do grupo controle foram cultivados na ausência de forskolin. No dia 7 do cultivo, os blastocistos expandidos foram corados com o corante lipofílico Sudan Black B para a determinação do teor de lípidos intracitoplasmáticos ou foram criopreservados através do protocolo Vitri-Ingá®. Não foi observada diferença significativa (P>0,05) na taxa de produção de blastocistos entre o grupo Controle (44,9%) e os demais tratamentos, todavia observou-se menor produção de embriões (P<0,05) no grupo Forsk 10,0 (38,8%) em comparação com os grupos Forsk 2,5 (50,5%) e Forsk 5,0 (54,7%). A quantidade de lipídeos intracitoplasmáticos do grupo Controle (1,00±0,03) foi semelhante (P>0,05) a dos grupos Forsk 2,5 (0,92±0,03) e Forsk 10,0 (1,06±0,03); no entanto, o acúmulo de lípidos nos blastocistos do grupo Forsk 5.0 (0,82 ± 0,04) foi menor do que no grupo controle (P<0,05). A partir destes resultados, o grupo Forsk 5,0 foi testado quanto à criotolerância e foi observado que a taxa de re-expansão da blastocele 24 horas após o aquecimento foi maior (P<0,05) no grupo Forsk 5,0 (72,2%) quando comparado ao grupo Controle (46,2%). Em conclusão, o pré-tratamento com forskolin na concentração de 5,0 µM durante 24 horas antes da vitrificação foi eficiente para promover a redução da quantidade de lipídeos intracitoplasmáticos e, consequentemente, melhorou a criotolerância de embriões bovinos produzidos in vitro.(AU)

Improving the cytoplasmic maturation of bovine oocytes matured in vitro with intracellular and/or extracellular antioxidants is not associated with increased rates of embryo development.

The production of reactive oxygen species (ROS) is a normal process that occurs in the cellular mitochondrial respiratory chain. However, an increase in ROS levels during in vitro production of bovine embryos induces oxidative stress, leading to failed embryonic development. Therefore, we investigated whether supplementation of IVM medium with intracellular (cysteine and cysteamine; C + C) and/or extracellular (catalase; CAT) antioxidants improves the culture system, affects the mitochondrial membrane potential, affects the intracellular levels of ROS and glutathione (GSH) in the bovine oocytes at the end of maturation, and thereby affects the subsequent embryonic development. At the end of IVM, the metaphase II rates were unaffected by the treatments (76.7 ± 1.7% to 80.6 ± 5.2%; P > 0.05). The intracellular ROS levels, expressed in arbitrary fluorescence units, found in the oocytes treated with intracellular antioxidants (C + C and C + C + CAT groups; 1.06, averaged) were as low as those observed in immature oocytes (0 hour: 1.00 ± 0.12). Among mature oocytes, higher (P < 0.05) ROS levels were found in the control group (1.91 ± 0.10) when compared to the ROS levels found in oocytes treated with antioxidants. Intracellular GSH levels in all groups were lower (0.17 ± 0.09 to 0.51 ± 0.05; P < 0.05) than those in immature oocytes (1.00 ± 0.08), although GSH levels in the C + C group (0.51 ± 0.05) were greater (P < 0.05) than in the control, CAT, and C + C + CAT groups (0.23; averaged). The mitochondrial membrane potential in all groups was improved (1.6; averaged; P < 0.05) compared to the membrane potential observed in the immature oocytes (1.00 ± 0.05), with the exception of the C + C group (0.94 ± 0.03). There was no effect (P > 0.05) of antioxidant supplementation on embryonic development to the blastocyst stage (36.1%; averaged); however, there was an increased tendency (P = 0.0689) to obtain a higher blastocyst rate for the C + C + CAT group (47.5 ± 5.6%) compared to the control group (29.9 ± 4.8%). In conclusion, despite improvements in specific parameters of cytoplasmic maturation, the addition of intracellular and/or extracellular antioxidants during IVM did not affect embryo development.

Implantação de sistema de suporte a decisão clínica e análise de dados em pacientes com hipoglicemia / Clinical decision-support system implementation and data analysis in patients with hypoglycemia / Implantación del sistema de apoyo a la toma de decisiones y análisis de los datos en pacientes con hipoglucemia

Foi desenvolvido no Hospital Sírio Libanês um sistema de apoio à decisão de condutas nas linguagens de programação JAVA e Delphi. Foi implantado no sistema um protocolo para tratamento de hipoglicemia que após o diagnóstico através da glicemia capilar e inserção do dado no sistema, inicia-se um processo que finaliza em uma conduta. O objetivo deste estudo foi descrever o processo de implantação deste sistema, além de analisar os dados demográficos das hipoglicemias. É um estudo observacional, transversal, retrospectivo. Os dados foram coletados de 01/2014 a 12/2015.635 episódios de hipoglicemia foram avaliados. 87,1% das 635 hipoglicemias foram leves (50 a 60mg/dL). A unidade de internação oncológica mostrou a menor prevalência de hipoglicemias (17,8%), enquanto internações prolongadas entre16 e 30 dias mostraram maior prevalência (21,6%). As hipoglicemias também foram mais comuns em homens acima de45 anos e em mulheres entre 15 e 44 anos.

A decision support system was developed at Sírio Libanês Hospital using the programming languages JAVA and Delphi. A hypoglycemic protocol was inserted in the system to test the support to clinical decision. After a hypoglycemia diagnosis using the capillary glucose test, the data was inserted in the system and a process was generated with some steps that finished with an intervention procedure. The objective of this study was to describe the system implementationprocess and to analyze demographic characteristics of hypoglycemic episodes. This is an observational,cross-sectional, retrospective study. The data was from January 2014 to December 2015. 635 hypoglycemic episodeswere included in this analysis. 87.1% hypoglycemic episodes were mild. Oncology unit was the one with lower prevalence(17.8%), while a longer stay at the hospital (16 to 30 days) had a high prevalence (21.6%). Hypoglicemic episodes were more common in men over 45 years old and among women between 15 and 44 years old.

Effects of gaseous atmosphere and antioxidants on the development and cryotolerance of bovine embryos at different periods of in vitro culture.

This study examined the effects of antioxidant supplementation and O2 tension on embryo development, cryotolerance and intracellular reactive oxygen species (ROS) levels. The antioxidant supplementation consisted of 0.6 mM cysteine (CYST); 0.6 mM cysteine + 100 µM cysteamine (C+C); 100 IU catalase (CAT) or 100 µM ß-mercaptoethanol (ß-ME) for 3 or 7 days of in vitro culture (IVC). Two O2 tensions (20% O2 [5% CO2 in air] or 7% O2, 5% CO2 and 88% N2 [gaseous mixture]) were examined. After 7 days of antioxidant supplementation, the blastocyst frequencies were adversely affected (P < 0.05) by CYST (11.2%) and C+C (1.44%), as well as by low O2 tension (17.2% and 11.11% for 20% and 7% O2, respectively) compared with the control (26.6%). The blastocyst re-expansion rates were not affected (P > 0.05) by the treatments (range, 66-100%). After 3 days of antioxidant supplementation, the blastocyst frequencies were not affected (P > 0.05) by any of the antioxidants (range, 43.6-48.5%), but they were reduced by low O2 tension (P < 0.05) (52.1% and 38.4% for 20% and 7% O2, respectively). The intracellular ROS levels, demonstrated as arbitrary fluorescence units, were not affected (P > 0.05) by antioxidant treatment (range, 0.78 to 0.95) or by O2 tension (0.86 and 0.88 for 20% and 7% O2, respectively). The re-expansion rates were not affected (P > 0.05) by any of the treatments (range, 63.6-93.3%). In conclusion, intracellular antioxidant supplementation and low O2 tension throughout the entire IVC period were deleterious to embryo development. However, antioxidant supplementation up to day 3 of IVC did not affect the blastocyst frequencies or intracellular ROS levels.

Reduced levels of intracellular reactive oxygen species and apoptotic status are not correlated with increases in cryotolerance of bovine embryos produced in vitro in the presence of antioxidants.

The effects of intracellular (cysteine and ß-mercaptoethanol) and extracellular (catalase) antioxidant supplementation at different times during in vitro production (IVM and/or in vitro culture (IVC)) on bovine embryo development, intracellular reactive oxygen species (ROS) levels, apoptosis and re-expansion rates after a vitrification-thawing process were examined. Blastocyst frequencies were not affected by either antioxidant supplementation (40.5%-56.4%) or the timing of supplementation (41.7%-55.4%) compared with control (48.7%; P>0.05). Similarly, antioxidants and the moment of supplementation did not affect (P>0.05) the total number of blastomeres (86.2-90.5 and 84.4-90.5, respectively) compared with control (85.7). However, the percentage of apoptotic cells was reduced (P<0.05) in groups supplemented during IVM (1.7%), IVC (2.0%) or both (1.8%) compared with control (4.3%). Intracellular ROS levels measured in Day 7 blastocysts were reduced (P<0.05) in all groups (0.60-0.78), with the exception of the group supplemented with ß-mercaptoethanol during IVC (0.88), which did not differ (P>0.05) from that in the control group (1.00). Re-expansion rates were not affected (P>0.05) by the treatments (50.0%-93.0%). In conclusion, antioxidant supplementation during IVM and/or IVC reduces intracellular ROS and the rate of apoptosis; however, supplementation does not increase embryonic development and survival after vitrification.

São Paulo city health information system--a case report.

São Paulo is the largest city in Brazil and one of the largest in the world. In 2004, São Paulo City Department of Health decided to implement a Healthcare Information System that would support managing healthcare services and provide an ambulatory health record. The system was designed to build on from national standards that identify healthcare workers, organizations and the relationships among them and reuse as much as possible existing concepts and software. At the same time, the system should reduce fragmentation, not only by integrating existing redundant or competing systems but also by providing a framework in which new modules would be naturally integrated to each other. Today, the web-based system, known as SIGA Saúde, runs in more than 370 healthcare units, processes some 8 thousand appointment scheduling daily and more than 10 thousand high-cost procedure authorizations monthly. This paper profiles the São Paulo City and its needs and describes the project, obstacles and results so far.

Documentação médica: guarda e manuseio dos prontuários médicos / Medical documentation: keeping and handling medical files

Atualmente, realizam-se, no Brasil, mais de 360 milhões de consultas médicas por ano, que geram quantidade imensa de prontuários médicos. Pela legislação brasileira, médicos, clínicas e hospitais são obrigados a manter esses prontuários arquivados por pelo menosdez anos, podendo, a partir desse prazo, ser microfilmados e destruídos. A quantidade de espaço que esses arquivos em papel exigem está tornando os custos cada vez mais elevados. Alguns estabelecimentos tiveram que ampliar ou alugar dependências próprias para arquivo, ocasionando considerável aumento de custos com uma atividade que extrapola os objetivos de um hospital.A partir de agora, os prontuários médicos podem ser elaborados e arquivados com computador. E a guarda dos mesmos poderá ser permanente , sem ocupação de espaço físico. Para garantir a confidencialidade(segredo médico) e a integridade dos dados dos pacientes(uma vez inseridos um dado no sistema, ele não poderá ser alterado), o Conselho Federal de Medicina aprovou normas rígidas para a guarda e o manuseio desses documentos. O sistema de informação utilizado deverá garantir, entre outros requisitos, um rígido controle de acesso aos dados e plena capacidade de recuperação dos registros originais. Cuidados maiores são exigidos nos casos de transmissão de dados do prontuário via internet. Para que possam viabilizar tais transferências, os sistemas deverão incorporar a criptografia assimétrica por chaves(pública e privada), nos termos definidos pela ICP-Brasil(Infra-estrutura de Chaves Públicas Brasileira).A criptografia por chaves garante a autenticidade e a confidencialidade dos documentos eletrônicos, permitindo a transmissão segura pela rede. Certificado fornecido pelo Conselho Federal de Medicina garantirá o valor legal e probante dos prontuários eletrônicos. Os prontuários em suporte de papel que assim permanecem deverão ser armazenados por um período mínimo de vinte anos, contando a partir do último registro...

Tendências atuais para implementaçäo do prontuário médico eletrônico e sistemas de informaçäo em saúde / Actual trends for implememtation electronic medical records and information systems in health

Neste artigo nós descrevemos e discutimos alguns dos tópicos principais e avanços apresentados no XII Simpósio Internacional para a Criação de Sistemas Eletrônicos de Prontuários em Saúde, realizado em maio de 1996 nos Estados Unidos.

CorbaMed: objetos distribuídos para a área da saúde / CorbaMed: distributed objects to by health area

Este artigo visa apresentar o modelo de objetos distribuidos proposto pelo grupo OMG (Object Management Group), padronizado através da arquitetura CORBA (Common Object Request Borker) com seus serviços, operações, interfaces de domínio, e objetos da aplicação. Apresenta-se um breve histórico do grupo OMG, discutindo-se brevemente os componentes da arquitetura CORBA, apresentando-se as propostas do sub-comitê CORBAmed que visa a criação de objetos CORBA para o domínio da Saúde. No final discute-se a integração deste paradigma com a proposta do HL-7 orientado a objetos.

Estaçäo de trabalho para ecocardiografia: banco de dados e imagens / Workstation to echocardiography: data base and images

Este artigo visa apresentar um modelo de estação de trabalho para ecocardiografia que pretende oferecer ao médico um ambiente integrado para manipulação da informação sobre o paciente, incluindo as imagens dos exames ecocardiográficos. Para a construção deste protótipo está sendo utilizada a metodologia de orientação a objetos, tanto para a modelagem quanto para a implementação do sistema. Padrões para representar a informação médica, sempre que existentes, estão sendo utilizados, tais como CID para a descrição dos diagnósticos e DICOM (Digital Imaging and Communications in Medicine) para o armazenamento das imagens. O trabalho apresenta o estado atual do projeto e perspectivas futuras.