Pilot Study on Newborn Screening for Spinal Muscular Atrophy.

INTRODUCTION: Newborn screening (NBS) in Portugal is a significant public health measure to provide early detection for specific disorders so that early treatment is possible. Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder that causes degeneration of anterior horn cells in the human spinal cord and subsequent loss of motor neurons. Its incidence is estimated in 1.6000-11.800 live births. A pilot study on 100.000 newborns is being carried out at the neonatal screening laboratory with the aim of determining the specificity, sensitivity, and feasibility of the SMA screening at the NBS laboratory in Portugal. METHODS: The study presented here was based on data obtained from neonatal screening, involving the analysis of 25.000 newborns. SMA screening is performed by a qualitative detection of exon 7 of the SMN1 gene. The assay was performed using a commercially available real-time PCR, the Eonis SMN1, TREC, and KREC kit. RESULTS/CASE REPORT: The dried blood spots of a total of 25.000 newborns were tested; among these newborns, two were diagnosed as having SMA with survival motor neuron 1 (SMN1) deletion. These two SMA-positive samples were sent to a specialized clinical centre and a peripheral blood sample was sent to the reference laboratory for confirmation of the exon 7 deletion and determination of the SMN2 copy number. CONCLUSION: Early diagnosis and intervention are important for SMA treatment to be effective; the treatment should be started at the pre-symptomatic stage of SMA. Thus, newborn screening for SMA is strongly recommended. Currently, targeted therapies for SMA are available, and attempts are being made worldwide to include SMA screening in newborns.

Digital rectal examination impact on PSA derivatives and prostate biopsy triggers: a contemporary study.

OBJECTIVE: To evaluate the impact of the digital rectal exam (DRE) on PSA measurements and clinical decision-making. METHODS: Healthy male volunteers between 50 and 70 years old were recruited during a 30-day public screening program. PSA levels were measured using two different methods (standard enhanced chemiluminescence immunoassay-ECLIA, and novel immunochromatography assay-ICA/rapid PSA) in the same blood sample. Two blood samples were drawn; first before DRE and the second 30-40 min after DRE. The effect of DRE on PSA levels and its impact on clinical decision-making for individual patients were evaluated based on different biopsy trigger cutoffs. RESULTS: ECLIA-PSA was measured in 74 participants both pre- and 37 ± 5 min post-DRE, mean age 57.2 ± 8.3 years, and mean prostate volume 33.6 (20-80) cm3. Both total and free ECLIA-PSA increased significantly after DRE (mean increase of 0.47 and 0.26 ng/ml, respectively, both p < 0.001). Different internationally accepted biopsy triggers were reached after DRE only: 5 total PSA > 3 ng/ml, 13 increase > 0.75 ng/ml, 3 PSA density > 0.15, and 1 free/total PSA < 0.18. On two occasions, patients were pushed away from biopsy trigger after DRE due to free/total PSA > 0.18. ICA-PSA was detectable (> 2.0 ng/ml) in 5 of 45 measured samples (11%) before DRE and 13/45 (29%) after DRE, p = 0.0316. Four among five detectable ICA-PSA tests increased after DRE. CONCLUSION: Performing DRE immediately before PSA measurement might change the clinical decision-making on a significant number of occasions (roughly 1 in 3); even though the mean increase (0.47 ng/ml) looks deceivingly small. Further studies are required that include gold standard tests (biopsy, or imaging).

Urinary tubular biomarkers as predictors of death in critically ill patients with COVID-19.

Aim: To evaluate the prediction capacity of urinary biomarkers for death in critically ill patients with COVID-19. Methods: This is a prospective study with critically ill patients due to COVID-19 infection. The urinary biomarkers NGAL, KIM-1, MCP-1 and nephrin were quantified on ICU admission. Results: There was 40% of death. Urinary nephrin and MCP-1 had no association with death. Tubular biomarkers (proteinuria, NGAL and KIM-1) were predictors of death and cut-off values of them for death were useful in stratify patients with worse prognosis. In a multivariate cox regression analysis, only NGAL remains associated with a two-mount survival chance. Conclusion: Kidney tubular biomarkers, mostly urinary NGAL, had useful capacity to predict death in critically ill COVID-19 patients.

Pediatric Patients With Steroid-Sensitive Nephrotic Syndrome Have Higher Expression of T Regulatory Lymphocytes in Comparison to Steroid-Resistant Disease.

Background and Aim: Idiopathic nephrotic syndrome (INS) is classified according to the response to drug therapy in steroid-sensitive (SS), steroid-dependent (SD), and steroid-resistant (SR) categories. Previous studies showed changes in inflammatory activity of subpopulations of lymphocytes in INS. This study aimed to compare SS and SR patients in regard to subpopulations of leukocytes, profile of regulatory lymphocytes, and migratory activity of lymphocyte subpopulations. Results obtained in INS patients were also compared to age and sex-matched healthy controls. Methods: This is a cross-sectional study including SS patients (n = 30), SR patients (n = 14), and controls (n = 10). Peripheral blood samples were withdrawn for ex-vivo leukocyte flow cytometry analysis. Results: Percentage of B-lymphocytes and natural killer (NK) cells were significantly reduced in SR patients when compared to controls, while the percentage of NKT cells were decreased in SS patients in comparison to controls. Percentages of CD4+ expressing FoxP3 and CTLA4 were significantly higher in SS patients in comparison to SR patients and controls. The expression of integrin CD18 on the surface of T lymphocytes (CD3+) was reduced in SS patients if compared to controls. Conclusion: This study found that SS INS patients have higher levels of regulatory T-lymphocytes and lower expression of adhesion molecules than SR patients.

Decreased percentage of CD4+ lymphocytes expressing chemokine receptors in bipolar disorder.

OBJECTIVE: Although accumulating evidence supports the hypothesis that immune/inflammatory mechanisms are associated with the pathophysiology of bipolar disorder (BD), data about the profile of chemokines (chemotactic cytokines) and chemokine receptors are still scarce. The current study was designed to evaluate the expression of chemokine receptors on lymphocytes of patients with BD in comparison with controls. METHODS: Thirty-three patients with type I BD (N = 21 in euthymia; N = 6 in mania/hypomania; N = 6 in depression) and 22 age- and sex-matched controls were subjected to clinical evaluation and peripheral blood draw. The expression of chemokine receptors CCR3, CCR5, CXCR4, and CXCR3 on CD4+ and CD8+ lymphocytes was assessed by flow cytometry. RESULTS: Patients with BD had decreased percentage of CD4+CXCR3+ (p = 0.024), CD4+CCR3+ (p = 0.042), and CD4+CCR5+ (0.013) lymphocytes in comparison with controls. The percentage of both CD4+ and CD8+ lymphocytes expressing the chemokine receptor CXCR4 was similar in patients with BD and controls. Likewise, the percentages of CD8+CXCR3+, CD8+CCR3+, and CD8+CCR5+ lymphocytes were similar in patients with BD and controls. CONCLUSION: Our findings reinforce the hypothesis that immune pathways, especially involving CD4+ lymphocytes, are involved in the physiopathology of BD.

T-lymphocyte-expressing inflammatory cytokines underlie persistence of proteinuria in children with idiopathic nephrotic syndrome / Os linfócitos T que expressam citocinas inflamatórias são subjacentes à persistência de proteinúria em crianças com síndrome nefrótica idiopática

Abstract Objective: There is evidence of an important role of immune system changes in the triggering and maintenance of idiopathic nephrotic syndrome (INS). The aim of this study was to investigate the expression of cytokines in lymphocyte populations of patients with INS in comparison to healthy individuals, according to proteinuria. Methods: This cross-sectional study included 44 patients with INS and eight healthy children, matched for age and sex (controls). Patients were subdivided according to proteinuria: persistent proteinuria or partial remission (PP ≥ 300 mg/24 h, n = 17) and low proteinuria or complete remission (LP < 300 mg/24 h, n = 27). Ex vivo analysis of peripheral blood leukocytes by flow cytometry was performed using surface markers for T-lymphocytes, TCD4, TCD8, natural killer (NK) cells, NKT, and B-lymphocytes. Frequencies of intracellular cytokines were analyzed in these cells. Results: The frequencies of B-lymphocytes, NK cells, and NKT cells were lower in INS than in controls, whereas INS patients had a higher frequency of CD4+tumor necrosis factor (TNF)-α+ cells than controls. Cytotoxic-T-lymphocytes expressing IFN-γ were lower in INS than in controls. Patients with PP showed higher frequencies of CD4-T-lymphocytes expressing IFN-γ and TNF-α than controls. CD8-lymphocytes expressing TNF-α were increased in PP group when compared with LP and controls, while CD8+interferon (IFN)-γ+ cells were lower than in LP and in controls. Conclusion: Regardless the level of proteinuria, INS patients had increased expression of TNF-α in CD4-lymphocytes and reduced expression of IFN-γ in CD8-lymphocytes. Persistence of proteinuria was associated with higher levels of inflammatory markers.

Resumo Objetivo Há comprovação do importante papel das alterações no sistema imunológico no desencadeamento e manutenção da síndrome nefrótica idiopática (SNI). O objetivo deste estudo foi investigar a expressão das citocinas em populações de linfócitos de pacientes com SNI em comparação a indivíduos saudáveis e de acordo com a proteinúria. Métodos Este estudo transversal incluiu 44 pacientes com SNI e oito crianças saudáveis, pareados por idade e sexo (controles). Os pacientes foram subdivididos de acordo com a proteinúria: proteinúria persistente ou remissão parcial (PP ≥ 300 mg/24 h, n = 17) e proteinúria baixa ou remissão completa (PB < 300 mg/24 h, n = 27). A análise ex vivo de leucócitos no sangue periférico por citometria de fluxo foi feita utilizando marcadores de superfície para linfócitos T, TCD4, TCD8, células natural killer (NK), linfócitos NKT e B. As frequências das citocinas intracelulares foram analisadas nessas células. Resultados A frequência dos linfócitos B, células NK e células NKT foi menor em pacientes com SNI do que nos controles, ao passo que os pacientes com SNI apresentaram maior frequência de células CD4+fator de necrose tumoral (TNF)-α+ do que nos controles. Os linfócitos T citotóxicos que expressam interferon (IFN)-γ foram menores nos pacientes com SNI do que nos controles. Os pacientes com PP mostraram maiores frequências de linfócitos T CD4 que expressam IFN-γ e TNF-α que os controles. Os linfócitos CD8 que expressam TNF-α apresentaram aumento no grupo com PP, em comparação aos com PB e os controles, apesar de as células CD8+IFN-γ+ serem mais baixas nos pacientes com PB e nos controles. Conclusão Com relação ao nível de proteinúria, os pacientes com SNI apresentaram aumento na expressão de TNF-α nos linfócitos CD4 e expressão reduzida de IFN-γ nos linfócitos CD8. A persistência da proteinúria foi associada a maiores níveis de marcadores inflamatórios.

T-lymphocyte-expressing inflammatory cytokines underlie persistence of proteinuria in children with idiopathic nephrotic syndrome.

OBJECTIVE: There is evidence of an important role of immune system changes in the triggering and maintenance of idiopathic nephrotic syndrome (INS). The aim of this study was to investigate the expression of cytokines in lymphocyte populations of patients with INS in comparison to healthy individuals, according to proteinuria. METHODS: This cross-sectional study included 44 patients with INS and eight healthy children, matched for age and sex (controls). Patients were subdivided according to proteinuria: persistent proteinuria or partial remission (PP≥300mg/24h, n=17) and low proteinuria or complete remission (LP<300mg/24h, n=27). Ex vivo analysis of peripheral blood leukocytes by flow cytometry was performed using surface markers for T-lymphocytes, TCD4, TCD8, natural killer (NK) cells, NKT, and B-lymphocytes. Frequencies of intracellular cytokines were analyzed in these cells. RESULTS: The frequencies of B-lymphocytes, NK cells, and NKT cells were lower in INS than in controls, whereas INS patients had a higher frequency of CD4+tumor necrosis factor (TNF)-α+ cells than controls. Cytotoxic-T-lymphocytes expressing IFN-γ were lower in INS than in controls. Patients with PP showed higher frequencies of CD4-T-lymphocytes expressing IFN-γ and TNF-α than controls. CD8-lymphocytes expressing TNF-α were increased in PP group when compared with LP and controls, while CD8+interferon (IFN)-γ+ cells were lower than in LP and in controls. CONCLUSION: Regardless the level of proteinuria, INS patients had increased expression of TNF-α in CD4-lymphocytes and reduced expression of IFN-γ in CD8-lymphocytes. Persistence of proteinuria was associated with higher levels of inflammatory markers.

Increased Migratory and Activation Cell Markers of Peripheral Blood Lymphocytes in an Experimental Model of Nephrotic Syndrome.

The present study aimed to evaluate the expression of CD80 and CD18 in subpopulations of peripheral blood leukocytes and oxidative kidney damage in rats with nephrotic syndrome (NS) induced by doxorubicin (Dox) in comparison to control animals at different time points. Male adult Wistar rats were submitted to 24-hour urine and blood collection for biochemical and immunological analysis at 7, 14, 21, and 28 days after Dox injection. After euthanasia, the kidneys were removed for histological analysis and the evaluation of oxidative stress. The phenotypic characterization of leukocytes was performed using flow cytometry. Dox-injected animals exhibited increased CD18 expression in cytotoxic T lymphocytes, NK cells, and monocytes and high CD80 expression in monocytes. Kidney oxidative damage was positively correlated with CD80 expression in monocytes and serum levels of creatinine. These results suggest that phagocytic and cytotoxic cells are preferentially recruited to the tissue injury site, which may contribute to kidney dysfunction in this animal model of NS. The blockade of integrin and costimulatory molecules may provide new therapeutic opportunities for NS.

The role of the immune system in idiopathic nephrotic syndrome: a review of clinical and experimental studies.

Idiopathic nephrotic syndrome (INS) is a multifactorial disease, characterized by proteinuria, hypoalbuminemia, edema and hyperlipidemia. Studies in humans and animal models have associated INS with changes in the immune response. The purpose of this article is to review clinical and experimental findings showing the involvement of the immune response in the pathogenesis of INS. The role of the immune system in INS has been shown by clinical and experimental studies. However, the pattern of immune response in patients with INS is still not clearly defined. Many studies show changes in the dynamics of T lymphocytes, especially the regulatory T cells. Alternatively, there are other reports regarding the involvement of the complement system and B lymphocytes in the pathophysiology of INS. Indeed, none of the immunological biomarkers evaluated were undeniably linked to changes in glomerular permeability and proteinuria. On the other hand, some studies suggest a link between urinary chemokines, such as IL-8/CXCL8 and MCP-1/CCL2, and changes in glomerular permeability and/or the deterioration of glomerulopathies. To understand the pathophysiology of INS, longitudinal studies are clearly needed. The characterization of the profile of the immune response might help the development of specific and individualized therapies, leading to clinical improvement and better prognosis.

Impact of autologous hematopoetic stem cell transplantation on the quality of life of patients with multiple sclerosis.

OBJECTIVE: To evaluate the impact of autologous hematopoetic stem cell transplantation (autoHSCT) in the health related quality of life (HRQL) in patients with multiple sclerosis. METHOD: The sample consisted of 34 patients, over 18 years old, treated at a University Hospital in the state of São Paulo, Brazil. For data collection MOS SF-36 and EDSS scales were applied at three time points: admission of the patient, hospital discharge and 1 year posttransplantation. RESULTS: 27 patients (79%) showed stabilization or neurological improvement 1 year posttransplantation. At this time point, there was statistically significant improvement in all domains of the HRQoL. When EDSS scores were correlated with the domains of the MOS SF-36 scale, statistically significant correlations were found with physical functioning at the three time points analysed. CONCLUSION: In spite of the high risk of complications of the procedure, the HSCT had positive impact in the health related quality of life.

Impact of autologous hematopoetic stem cell transplantation on the quality of life of patients with multiple sclerosis / Impacto do transplante autólogo de células-tronco hematopoéticas na qualidade de vida de pacientes com esclerose múltipla

OBJECTIVE: To evaluate the impact of autologous hematopoetic stem cell transplantation (autoHSCT) in the health related quality of life (HRQL) in patients with multiple sclerosis. METHOD: The sample consisted of 34 patients, over 18 years old, treated at a University Hospital in the state of São Paulo, Brazil. For data collection MOS SF-36 and EDSS scales were applied at three time points: admission of the patient, hospital discharge and 1 year posttransplantation. RESULTS: 27 patients (79 percent) showed stabilization or neurological improvement 1 year posttransplantation. At this time point, there was statistically significant improvement in all domains of the HRQoL. When EDSS scores were correlated with the domains of the MOS SF-36 scale, statistically significant correlations were found with physical functioning at the three time points analysed. CONCLUSION: In spite of the high risk of complications of the procedure, the HSCT had positive impact in the health related quality of life.

OBJETIVO: Avaliar o impacto do transplante de células-tronco hematopoéticas (TCTH) na qualidade de vida relacionada à saúde (QVRS) de pacientes com esclerose múltipla (EM). MÉTODO: A amostra foi composta por 34 sujeitos, maiores de 18 anos, atendidos em um hospital-escola do interior do Estado de São Paulo, Brasil. Para coleta de dados foram aplicados os instrumentos MOS SF-36 e EDSS. RESULTADOS: 27 (79 por cento) sujeitos apresentaram estabilização ou melhora neurológica um ano após o TCTH. Decorrido um ano do procedimento, houve melhora estatisticamente significativa em todos os domínios da QVRS. Ao relacionar os escores da EDSS com os domínios do MOS SF-36, foram encontradas diferenças estatisticamente significantes na Funcionalidade nos três momentos do TCTH. CONCLUSÃO: Apesar do elevado risco de complicações, pode-se afirmar que o TCTH repercutiu positivamente na apreciação que o paciente faz de sua QVRS.

Esclerose múltipla: qualidade de vida relacionada à saúde no pré e pós transplante de células-tronco hematopoiéticas.

Pacientes com Esclerose Múltipla (EM), em decorrência da enfermidade ou dos tratamentos realizados, em geral, enfrentam uma depreciação na qualidade e na expectativa de suas vidas. Nesse contexto, a qualidade de vida relacionada à saúde (QVRS) é um importante indicador do impacto causado pela doença, bem como pelos tratamentos realizados. O objetivo principal deste trabalho foi avaliar a QVRS de pacientes com esclerose múltipla submetidos ao transplante autólogo de células-tronco hematopoiéticas (TCTH). Trata-se de um estudo caracterizado como uma pesquisa clínica, descritiva e exploratória, com recorte longitudinal e enfoque metodológico quanti-qualitativo. A amostra foi composta por 34 pacientes da Unidade de Transplante de Medula Óssea do HCFMRP-USP, dos quais 18 (52,9%) eram do sexo feminino, 21 (61,8%) conviviam com companheiro(a) e 14 (41%) dos participantes possuíam 12 ou mais anos de estudo. Em média, os participantes tinham 40,59±9,01 anos, com amplitude de variação de 19 a 55 anos e o tempo médio de doença de 7,38±2,39, com variação de 4 a 13 anos. Dos participantes, 38,2% possuíam renda familiar acima de cinco salários mínimos e 82,3% deles se diziam inativos no momento da avaliação pré-TMO. Para a coleta de dados, utilizaram-se um roteiro de entrevista semiestruturado e o Questionário Genérico de Avaliação de Qualidade de Vida Relacionada à Saúde (SF -36). A coleta foi realizada em três momentos distintos do tratamento: antes do transplante (pré- TCTH), cerca de 30 dias após a realização do procedimento (pós- TCTH imediato) e um ano após o procedimento (pós- TCTH tardio). As entrevistas foram gravadas e, posteriormente, transcritas na íntegra. O método de análise temática de conteúdo foi utilizado com o objetivo de identificar as concepções, crenças, valores, motivações e atitudes dos participantes...(AU)

Patients with Multiple Sclerosis (MS), due to illness or treatments, in general, face depreciation in the quality and expectation of their lives. In this context, health related quality of life (HRQoL) is an important indicator of the impact of the disease as well as the treatments performed. The objective of this study was to evaluate the HRQoL of MS patients undergoing autologous hematopoietic stem cell transplantation (HSCT). This is a descriptive, exploratory and clinical study, with longitudinal cross-section and a quanti-qualitative methodological approach. The sample consisted of 34 patients of the Bone Marrow Transplant Unit HCFMRP-USP, of which 18 (52.9%) were female, 21 (61.8%) lived with a partner and 41 % had 12 or more years of study. On average, participants were 40.59 ± 9.01 years old, ranging from 19 to 55 years and with mean disease duration of 7.38 ± 2.39 years, ranging from 4 to 13 years. Of the participants, 38.2% had a family income above five minimum wages and 82.3% of them said they were inactive at the time of the pre-HSCT. To collect data, we used a semi-structured interview and the Medical Outcomes Study 36 Item Short-Form Health Survey (SF- 36). Data were collected at three separate stages of treatment: before transplantation (pre-HSCT), about 30 days after the procedure (immediate post-HSCT) and one year after transplantation (late post-HSCT). The interviews were recorded and later transcribed in full. The method of thematic content analysis was used in order to identify the concepts, beliefs, values, motivations and attitudes of the participants. The SF-36 was applied individually and face-to-face, classified and analyzed according to the specific recommendations of this technique. Initially, descriptive statistical analysis was performed and then, to compare the results of the three moments, the nonparametric Friedman test was used...(AU)

Quality of life of patients with autoimmune diseases submitted to bone marrow transplantation: a longitudinal study.

This study aimed to assess the quality of life of patients with autoimmune diseases (AID) submitted to Bone Marrow Transplantation (BMT) at two different moments: when the patient is admitted at the hospital and at the moment of hospital discharge (30 days after the transplantation). Patients who attended the BMT unit, were older than 18 years, with conditions and availability to voluntarily collaborate to the study were selected. Data were collected through a semi-structured interview and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The sample consisted of 19 patients attended at a university hospital in the interior of São Paulo State, Brazil. The collected data suggest these patients' quality of life is reduced before the realization of the transplantation, followed by a progression in their diseases. Immediately after the transplantation, an improved capacity to perform daily activities is observed, as well as a renewed possibility of making future plans.

Quality of life of patients with autoimmune diseases submitted to bone marrow transplantation: a longitudinal study / Calidad de vida de pacientes con enfermedades autoinmunes sometidos a transplante de médula ósea: un estudio longitudinal / Qualidade de vida de pacientes com doenças auto-imunes submetidos ao transplante de medula óssea: um estudo longitudinal

This study aimed to assess the quality of life of patients with autoimmune diseases (AID) submitted to Bone Marrow Transplantation (BMT) at two different moments: when the patient is admitted at the hospital and at the moment of hospital discharge (30 days after the transplantation). Patients who attended the BMT unit, were older than 18 years, with conditions and availability to voluntarily collaborate to the study were selected. Data were collected through a semi-structured interview and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The sample consisted of 19 patients attended at a university hospital in the interior of São Paulo State, Brazil. The collected data suggest these patients' quality of life is reduced before the realization of the transplantation, followed by a progression in their diseases. Immediately after the transplantation, an improved capacity to perform daily activities is observed, as well as a renewed possibility of making future plans.

El objetivo de este estudio fue evaluar la calidad de vida de pacientes con enfermedades auto-inmunes (EAI), sometidos al Transplante de Médula Ósea (TMO), en dos momentos distintos: en la admisión del paciente y durante la ocasión del alta hospitalaria (30 días después del transplante). Fueron seleccionados pacientes atendidos en la unidad de TMO, mayores de 18 años, que presentaron condiciones y disponibilidad para colaborar voluntariamente. Para recolectar los datos se utilizó un cuestionario de entrevista semi-estructurado y el Cuestionario de Evaluación de Calidad de Vida - SF-36. La muestra fue compuesta por 19 pacientes atendidos en un hospital-escuela del interior del Estado de San Pablo, Brasil. Los datos obtenidos sugieren depreciación en la calidad de vida de esos pacientes antes de la realización del transplante, acompañada de la progresión de sus enfermedades. Inmediatamente después del transplante ya se observa una percepción de mejoría en la capacidad de realizar actividades del cotidiano y la posibilidad renovada de trazar planos futuros.

O objetivo deste estudo foi avaliar a qualidade de vida de pacientes com doenças auto-imunes (DAI), submetidos ao Transplante de Medula Óssea (TMO), em dois momentos distintos: na admissão do paciente e por ocasião da alta hospitalar (30 dias após o transplante). Foram selecionados pacientes atendidos na unidade de TMO, maiores de 18 anos, que apresentaram condições e disponibilidade para colaborar voluntariamente. Para a coleta de dados utilizou-se roteiro de entrevista semi-estruturada e o Questionário de Avaliação de Qualidade de Vida - SF-36. A amostra foi composta por 19 pacientes atendidos em um hospital-escola do interior do Estado de São Paulo, Brasil. Os dados obtidos sugerem depreciação da qualidade de vida desses pacientes antes da realização do transplante, acompanhada da progressão de suas enfermidades. Imediatamente após o transplante já se percebe melhora da capacidade para realizar atividades do cotidiano e a possibilidade renovada de traçar planos futuros.

Oficinas rap para adolescentes: proposta metodológica de intervenção psicossocial em contexto de privação de liberdade

Pautado no pensamento complexo e na abordagem psicossocial de fenômenos como exclusão social, este estudo propõe o atendimento a adolescentes autores de ato infracional por meio de técnicas derivadas do psicodrama e utilizando a música rap como ferramenta projetiva, com o intuito de verificar a utilidade deste estilo musical enquanto instrumento de expressão acerca da realidade psicossocial vivida por adolescentes em conflito com a lei. Para a realização do estudo foi utilizada a metodologia qualitativa, sendo os dados coletados através de oficinas de rap nas quais os participantes construíam suas histórias de vida na forma de letra de música, que foram analisadas através do método construtivo-interpretativo. Participaram do estudo três adolescentes que cumpriam medida socioeducativa de internação em uma instituição do Distrito Federal . Os resultados possibilitaram o levantamento de questões clínicas acerca de cada participante e a construção de zonas de sentido no discurso dos jovens, que apontam a complexidade das relações entre pobreza e baixa auto-estima, habituação ao ilícito, precocidade no envolvimento infracional, valorização do status social em detrimento da ética, transgeracionalidade e inexorabilidade do crime, banalização da violência, sentimento de impotência, subversão dos valores morais, habituação às armas-de-fogo, a figura da mãe como único referencial positivo de afeto e a necessidade de transformação, revelando o valor das oficinas rap enquanto ferramenta clínica alternativa no atendimento a adolescentes em conflito com a lei (AU)

Impacto das clínicas de insuficiência cardíaca congestiva na abordagem terapêutica dos pacientes / Impact of a congestive heart failure clinics on medical management for patients

Embora, nas últimas duas décadas, significantes avanços tenham ocorrido no entendimento da fisiopatologia e na terapêutica da insuficiência cardíaca, surpreendentemente ocorreram apenas pequenas alterações nas taxas de mortalidade. Tal fato tem sido creditado a vários fatores: pacientes mais idosos, maior freqüência de comorbidades e, principalmente, a não-utilização ou a subutilização das drogas que mostraram significante e favorável impacto na morbidade e na sobrevida (inibidores da enzima de conversão da angiotensina, betabloqueadores e espironolactona). A criação das clínicas especializadas em insuficiência cardíaca congestiva, atuando por meio de equipes multidisciplinares, e o seguimento ambulatorial mais intensivo têm permitido melhor otimização da terapêutica, com incontestes benefícios, incluindo evolução mais favorável, menores admissões hospitalares, melhor qua.lidade de vida e redução dos custos...

Prioridade axiológicas, tempo de serviço e cidadania organizacional / Value priorities, tenure and organizational citizenship

Foi objetivo desta pesquisa estudar a relaçäo entre as prioridades axiológicas, o tempo de serviço e a cidadania organizacional. Os autores näo tem conhecimento de que prioridades axiológicas do indivíduo tenham sido estudadas como antecedentes da cidadania organizacional. A amostra foi composta por 300 empregados, homens e mulheres, com idade média de 38,07 anos. Dois instrumentos de medida foram utilizados: o Inventário de Valores de Schwartz e Escala de Cidadania Organizacional. Os sujeitos foram divididos em dois grupos de acordo com as suas prioridades axiológicas (escore alto, e baixo). Os quatro fatores axiológicos de ordem superior e os cinco fatores de cidadania organizacional foram considerados para a análise estatística (Anova 2X3). As prioridades ao nível dos valores de autotranscendência, autopromoçäo, individualismo e coletivismo tiveram influência significativa sobre vários fatores de cidadania organizacional. O impacto do tempo de serviço foi limitado a dois fatores: clima organizacional externo e proteçäo ao patrimônio organizacional

Prioridades axiologicas, tempo de servico e cidadania organizacional

Foi objetivo desta pesquisa estudar a relacao entre as prioridades axiologicas, o tempo de servico e a cidadania organizacional. Os autores nao tem conhecimento de que as prioridades axiologicas do individuo tenham sido estudadas como antecedentes da cidadania organizacional. A amostra foi composta por 300 empregados, homens e mulheres, com idade media de 38,07 anos. Dois instrumentos de medida foram utilizados: o Inventario de Valores de Schwartz e a Escala de Cidadania Organizacional. Os sujeitos foram divididos em dois grupos de acordo com as suas prioridades axiologicas (escore alto e baixo). Os quatro fatores axiologicos de ordem superior e os cinco fatores de cidadania organizacional foram considerados para a analise estatistica (Anova 2 x 3). As prioridades ao nivel dos valores de autotranscendencia, autopromocao, individualismo e coletivismo tiveram influencia significativa sobre varios fatores de cidadania organizacional. O impacto do tempo de servico foi limitado a dois fatores: clima organizacional externo e protecao ao patrimonio organizacional.

Tratamento mecânico da superfície radicular: comparação do desgaste radicular "in vitro", obtido com várias técnicas. I - Análise micrométrica / Mechanical treatment of root surfaces: comparison of root wear \"in vitro\" obtained through various technics. I - Mycrometrical analysis

Como terapia periodontal básica é a eliminação de contaminantes radiculares através de procedimentos mecânicos e também como existe indicação para que grupos de pacientes de maior risco recebem terapia de manutenção periódica a longo prazo, o objetivo deste trabalho foi comparar a efetiva capacidade de desgaste radicular "in vitro" dos seguintes procedimentos de desgaste: raspagem, polimento, ultrassom e jato de bicarbonato. Após períodos simulados de tempo de 5, 10 e 15 anos, conclui-se, pela análise do desgaste em microscópio de comparação, que a raspagem provoca o maior desgaste em todos os períodos, mas que a cada 10 segundos de aplicação a quantidade de desgaste provocada pela raspagem é menor (0.0065mm) do que os outros procedimentos, sendo que o maior desgaste é do polimento (0.0160mm)