Variant genotypes associated with reduced expression of RhCE antigens among Brazilian blood donors.

BACKGROUND: The genetic diversity of the RHCE gene locus has been explored in diverse populations of different racial backgrounds. Data referring to the diversity of RHCE encoding weakened expression of C, c, E, and e in multiethnic populations is still incomplete. METHODS: Samples from Brazilian blood donors presenting reduced expression of C, c, E, or e on gel method were selected for the study. All exons and flanking introns of RHCE were genotyped though direct Sanger sequencing for the included donors. RESULTS: Sixty-six donors were included: 23 with weak C, 22 with weak c, 6 with weak E, 14 with weak e, and 1 with weak c and E. Among the samples with weak C, the following altered RH*C were encountered: RHCE*CeMA (n = 3), RHCE*Ce941C (n = 1), and RHCE*CeVA (n = 1). RHD*D-CE(4-7)-D was detected in six cases, RHCE*CE was presumably present in five cases, and seven cases were unexplained. Two altered alleles underlay the weak c phenotype: RHCE*ceJAL (n = 20) and RHCE*ce340T (n = 2), and two altered RHCE justified weak e: RHCE*ceMO (n = 6) and RHCE*ceJAL (n = 8). Three variant RHCE were associated with weak E: RHCE*cEJU (n = 4), RHCE*cE382C (n = 1), and RHCE*cEIV (n = 1). The RHCE*cE905A justified one case of weak c and E. CONCLUSION: We describe the distribution of RHCE variants found in association with weak expression of C, c, E, and e in blood donors of multiethnic origin, which differs in comparison to that previously reported for people of African or Caucasian descent.

Weak D types 38 and 11: determination of frequencies in a Brazilian population and validation of an easy molecular assay for detection.

CONCLUSIONS: Recent evidence shows that, among Brazilians, the distribution of weak D types significantly differs from that represented in people of European descent, with a high percentage of weak D types 38 and 11. Our goal was to determine the population frequencies of weak D types 38 and 11 in a Brazilian population and to validate a molecular approach to identify these two variants. Blood donors were sequentially enrolled in the study in a 5-year period. Donors with serologic weak D phenotype had the RHD coding region sequenced. The frequencies of weak D type 38 and weak D type 11 (CDe-associated) were calculated. Two allele-specific-polymerase chain reaction (AS-PCR) assays were designed to detect RHD*weak D type 38 and RHD*weak partial 11 and were validated with samples positive and negative for these two variants, respectively. A total of 618,542 donors were enrolled, of which 265 presented with a serologic weak D phenotype. When considering all donors evaluated, the frequencies of weak D types 38 and 11 were 0.013 and 0.002 percent, respectively. In the subgroup of donors with a serologic weak D phenotype, the frequencies of weak D types 38 and 11 were 30.2 and 4.9 percent, respectively. The two proposed AS-PCR assays for detection of RHD*weak D type 38 and RHD*weak partial 11 showed 100 percent accuracy. The frequencies of weak D types 38 and 11 among Brazilians are high compared to that previously described for other populations. The AS-PCR assays to detect RHD*weak D type 38 and RHD*weak partial 11 represent potentially helpful tools for investigating Brazilian individuals with these weak D phenotypes.

Effectiveness of strategies to screen for blood donors with RH variants in a mixed population.

INTRODUCTION: Patients with RH variants presenting antibodies directed to RH high frequency antigens or multiple RH antibodies might, in some occasions, be better served with RH genotype-matched units, requiring screening for RH variants among blood donors. To date, strategies to identify donors with RH variants were restricted to selecting individuals of African descent based on self-reported race, what can be inaccurate in racially mixed population. Our goal was to: 1) Screen for donors with RH variants in a mixed population using self-declared race and Rh phenotype as selection criteria; and 2) Verify if including the Duffy null genotype in the screening algorithm increases its effectiveness. METHODS: Brazilian donors were included if self-declared as black and phenotyped as R0r or R1r. All individuals were genotyped for RHCE exons 1, 5, 6 and 7 and for the FY*B c.-67 T > C polymorphism in order to determine the Duffy null genotype. RHD variants were searched for in cases of altered RHCE. RESULTS: Among 2500 blood donors, 217 fulfilled the inclusion criteria and were enrolled. Fifty-three (24.4 %) had a predicted clinically relevant Rh phenotype (partial antigens or lack of high frequency antigens). Twelve donors (5.5 %) had a predicted RhCE phenotype lacking either hrB or hrS. Most cases with predicted lack of high frequency antigens (66.7 %) occurred in donors with the Duffy null genotype. CONCLUSION: Selecting donors based on self-declared race, Rh phenotype and Duffy null genotype is feasible and effective in identifying RH variants lacking Rh high frequency antigens among racially mixed donors.

High frequency of variant RHD genotypes among donors and patients of mixed origin with serologic weak-D phenotype.

BACKGROUND: The current transfusion policy recommended for individuals with serologic weak-D phenotype is based on data derived from European-descent populations. Data referring to the distribution of RH alleles underlying weak-D phenotype among people of mixed origin are yet incomplete, and the applicability of European-based transfusion guidelines to this specific population is questionable. GOAL: To evaluate the distribution of RHD variant genotype among individuals with serologic weak-D phenotype of both African and European descent. METHODS: Donors and patients of mixed origin and with serologic weak-D phenotype were selected for the study. They were investigated using conventional RHD-PCR assays and RHD whole-coding region direct sequencing. RESULTS: One hundred and six donors and 58 patients were included. There were 47 donors and 29 patients with partial-D genotype (47/106, 44.3%, and 29/58, 50%, respectively). RHD*DAR and RHD*weak D type 38 represented the most common altered RHD alleles among donors (joint frequency of 39.6%), while weak D types 1-3 accounted for 10.4% of the total D variant samples. RHD*DAR was the most common allele identified in the patient group (frequency of 31%), and weak D types 1-3 represented 29.3% of the total. CONCLUSION: The frequency of partial D among mixed individuals with serologic weak-D phenotype is high. They should be managed as D-negative patients until molecular tests are complete.

Evaluation of the applicability and effectiveness of a molecular strategy for identifying weak D and DEL phenotype among D- blood donors of mixed origin exhibiting high frequency of RHD*Ψ.

BACKGROUND: Molecular tests designed to detect the presence of active RHD gene among D- donors have been successfully applied in people of European ancestry, but not in admixed populations with a considerable frequency of RHD*Ψ. Our goal was to evaluate the performance of a molecular screening tool for identifying active RHD alleles among Brazilian blood donors classified as D- C+ and/or E+. STUDY DESIGN AND METHODS: Pools of five DNA samples of serologically D- C+ and/or E+ donors were checked by a RHD polymerase chain reaction (PCR) assay specific for RHD Intron 4 and Exon 7. When a pool result was positive, samples were genotyped individually for RHD Intron 4 and Exon 7, RHD*Ψ, RHCE*Cc, and RHD zygosity. Donors suspected of active RHD gene were further evaluated by whole-coding region and flanking intron direct sequencing. RESULTS: A total of 405 donors were included. Two percent exhibited active RHD gene, codifying D-weak (38 and 45) or DEL phenotype. The most prevalent DEL allele was RHD*DEL1 (c.1227G>A), which is proven to be immunogenic. A high frequency of RHD*Ψ was detected in the donors with nondeleted RHD alleles (31%), far superior to the frequency of RHD variant alleles (15.5%). The proposed approach presented sensitivity of 100% and specificity of 85.7% for identifying active RHD gene. CONCLUSION: The strategy of checking D- donors with RHD PCR followed by exclusion of RHD*Ψ allele has proved efficient in identifying weak-D and DEL phenotype in the Brazilian population.

Intensity modulated radiotherapy for localized prostate cancer: rigid compliance to dose-volume constraints as a warranty of acceptable toxicity?

BACKGROUND: To report the toxicity after intensity modulated radiotherapy (IMRT) for patients with localized prostate cancer, as a sole treatment or after radical prostatectomy. METHODS: Between August 2001 and December 2003, 132 patients with prostate cancer were treated with IMRT and 125 were evaluable to acute and late toxicity analysis, after a minimum follow-up time of one year. Clinical and treatment data, including normal tissue dose-volume histogram (DVH) constraints, were reviewed. Gastro-intestinal (GI) and genito-urinary (GU) signs and symptoms were evaluated according to the Radiation Therapy Oncology Group (RTOG) toxicity scales. Median prescribed dose was 76 Gy. Median follow-up time was of 26.1 months. RESULTS: From the 125 patients, 73 (58.4%) presented acute Grade 1 or Grade 2 GI and 97 (77.2%) presented acute Grade 1 or Grade 2 GU toxicity. Grade 3 GI acute toxicity occurred in only 2 patients (1.6%) and Grade 3 GU acute toxicity in only 3 patients (2.4%). Regarding Grade 1 and 2 late toxicity, 26 patients (20.8%) and 21 patients (16.8%) presented GI and GU toxicity, respectively. Grade 2 GI late toxicity occurred in 6 patients (4.8%) and Grade 2 GU late toxicity in 4 patients (3.2%). None patient presented any Grade 3 or higher late toxicity. Non-conformity to DVH constraints occurred in only 11.2% of treatment plans. On univariate analysis, no significant risk factor was identified for Grade 2 GI late toxicity, but mean dose delivered to the PTV was associated to higher Grade 2 GU late toxicity (p = 0.042). CONCLUSION: IMRT is a well tolerable technique for routine treatment of localized prostate cancer, with short and medium-term acceptable toxicity profiles. According to the data presented here, rigid compliance to DHV constraints might prevent higher incidences of normal tissue complication.

Validando o SIR: um melhor índice prognóstico para pacientes com metástases cerebraistratados com cirurgia estereotática / Validating the SIR: a better prognostic score index for patients with brain metastases treated with stereotactic radiosurgery

Objetivo: Validar o SIR (score index for survival in patients with brain metastasis treated with stereotatic radiosurgery) [índice de escore paraavaliar a sobrevida de pacientes com metástases cerebrais tratadoscom radiocirurgia estereotática], uma classificação elaborada paramelhor prever o prognóstico de pacientes com metástases cerebraistratados com radiocirurgia, reavaliar a sobrevida dos pacientes e revisara literatura médica. Métodos: Foram analisados dados de 100 pacientes com metástases cerebrais tratados com radiocirurgia estereotática um uma única instituição, entre julho de 1993 e fevereiro de 2002. Os fatores prognósticos e índices estudados foram: idade, índice de desempenho de Karnofsky, estado da doença extracraniana, número de lesões cerebrais, volume da maior lesão, tipode tumor primário, tratado ou não tratado com radioterapia cerebral total,SIR e RPA (Recursive Partitioning Analysis – classificação por análiserecursiva fragmentada). As curvas atuariais de sobrevida de Kaplan-Meier foram calculadas e comparadas. Os modelos Cox – completo e de eliminação retrógrada – foram utilizados para identificar os fatores prognósticos e índices, associados à sobrevida. Resultados: Ao analisar as curvas de sobrevida de Kaplan-Meier, o índice de desempenho de Karnofsky, o estado da doença extracraniana, o volume da maior lesão cerebral, a RPA e o SIR mostraram correlação significativa com o prognóstico. Aplicando os modelos de Cox, observou-se significância para índice de desempenho de Karnofsky (p < 0,0001) e volume da maior lesão (p = 0,0182), assim como para o SIR e paraa RPA, quando testados individualmente (p < 0,0001 e p = 0,0002). Contudo, testando SIR e RPA conjuntamente, só o SIR alcançou significância estatística independente (p < 0,0001). Conclusão: Ao reavaliar nossa casuística, a classificação SIR mostrou maior precisão do que a RPA para prever o tempo de sobrevida de pacientes com metástases cerebrais tratados com radiocirurgia.

Objective: The aim of this paper is to validate the score index forsurvival in patients treated with stereotactic radiosurgery, using aclassification prepared to better evaluate the prognosis of patientswith brain metastasis submitted to stereotactic surgery, re-evaluatingsurvival of patients and reviewing the medical literature. Methods:Data from 100 patients with brain metastases treated with stereotacticradiosurgery at a single institution, between July 1993 and February2000, were retrospectively analyzed. The prognostic factors andscores studied were age, Karnofsky performance status, extracranialdisease status, number of brain lesions, volume of the largest lesion,primary tumor type, treated or not with whole brain radiation therapy,SIR, and RPA. Kaplan-Meier actuarial survival curves for subsets werecalculated and compared by log-rank test. Complete and backwardelimination Cox models were utilized to identify the prognostic factorsand scores independently associated with survival. Results: Karnofskyperformance status, extracranial disease status, volume of the largestbrain lesion, RPA, and SIR were significantly correlated with prognosisin Kaplan-Meier survival analysis. Applying Cox models, significancewas observed for KPS and volume of the largest lesion (p < 0.0001and p = 0.0182, respectively), as well as for SIR and RPA when testedindividually (p < 0.0001 and p = 0.0002, respectively). However, whentesting SIR and RPA together, only SIR reached independent statisticalsignificance (p < 0.0001). Conclusion: SIR classification demonstrateda better accuracy in predicting survival time than RPA. SIR was testedin other centers, showing superior accuracy and applicability than theRPA, thus validating this score.

Isolation and identification of fungi from vaginal flora in three species of captive Leontopithecus.

The ability to reproduce in captivity is an essential component of lion tamarin (Leontopithecus) conservation programs. However, infections such as vaginitis, cervicitis, and endometritis are important diseases that may influence the reproduction of these animals. Therefore, it is important to detect continuous or occasional vaginal microbial populations, and to understand their potential role as an endogenous source of infection [Collins, 1964; Blue, 1983; Pugh et al., 1986]. Vaginal swabs were collected from 25 female tamarins of the three currently available species (L. rosalia, L. chrysopygus, and L. chrysomelas) at the Center of Primatology in Rio de Janeiro, Brazil. The swabs were processed according to standard mycological protocols, and isolates were biochemically characterized. Fungal isolates were recovered from 16 animals (64.0%). The results showed that 70.6% of the isolated microorganisms consisted of yeast, including three species of Candida (mainly C. glabrata). We suggest that this species is a resident member of the normal vaginal flora in Leontopithecus. Filamentous fungi (mainly from Trichosporon, Aspergillus, and Penicilliumgenera) constituted 29.4% of the isolates, and were considered to be transitory contaminants of the genital area. We suggest that colonization of the vaginal environment is related to the endocrine pattern associated with the reproductive status of these animals, but not to parity.

Psicoterapia analítica de grupo hoje

A Psicoterapia Analítica de Grupo tem uma origem que já se divisa longe, e sua prática foi sendo sedimentada em um contexto próprio à época do desenvolvimento da teoria mais conhecida. Questiona-se a validade de uma praxe que não está inserida no novo mundo vivente de terapeutas e analisandos. As adaptações passam não só pela teoria, que sempre busca se adaptar à realidade e não o inverso, como também a necessidade de ter suas sociedades fomentadoras em sintonia com um moderno modo de se inserir no mercado de escolas de técnicas. Exemplifica algumas práticas atávicas e que estão em desacordo com a ética atual da profissão médica e do código de defesa do consumidor brasileiro. (AU)

Mudancas de setting, setting dinamico

Discute-se um conceito mais abrangente para o setting, chamando-o de 'dinamico' ao incorporar as mudancas que possam ocorrer no dia-a-dia sem com isto interferir negativamente no processo terapeutico. Coloca-o como um fator mais virtual do que concreto, diminuindo a importancia do aspecto fisico do local das sessoes.

Uso do grupo de reflexao em instituicao hospitalar: uma experiencia pessoal

O autor apresenta uma experiencia pessoal com grupo de reflexao em hospital psiquiatrico. Descreve sua constituicao e discute as dificuldades no funcionamento, as solucoes encontradas, e o resultado obtido.

O grupo da instituicao

Apresenta-se as possiveis inter-relacoes entre os grupos existentes em uma instituicao de assistencia psiquiatrica, examinando-se as origens das acoes e reacoes e a capacidade terapeutica decorrente destas relacoes.

Bloqueio do gânglio estrelado em dor crônica de origem näo cancerosa / Stellate ganglion block in non cancerous chronic pain

O presente trabalho teve a finalidade de avaliar a eficácia do bloqueio do gânglio estrelado em dezeseis pacientes do ambulatório de dor, portadores de dor crônica nos membros superiores e regiöes supridas pelo simpático cervical. Os pacientes foram divididos em três grupos de acordo com a etiologia da dor: Grupo I - seis pacientes portadores de neuralgia pós-herpética; Grupo II - seis pacientes submetidos a múltipla cirurgias em plexos nervosos superiores; Grupo III - quatro pacientes com etiologias diversas da dor. A avaliaçäo da intensidade da dor foi feita pelo análogo visual. A avaliaçäo do comportamento emocional, assim como a terapia de grupo, foram feitas pelo psiquiatra do ambulatório de dor. Os resultados demostraram que em 56 por cento dos pacientes houve melhora da dor. Verificou-se que no grupo I, constituído de pacientes com lesäo de nervos e sem comprometimento emocional, o resultado foi melhor. No grupo II verificou-se alta incidência de quadros psiquiátricos associados. Nestes pacientes a eficácia do bloqueio näo pode ser avaliada claramente devido às alteraçöes comportamentais. No grupo III os resultados demonstraram melhora em duas pacientes, piora em uma e nenhuma alteraçäo do quadro doloroso da última. Concluímos que o procedimento é mais eficaz em pacientes com lesäo de nervos, sem alteraçöes emocionais associadas

Anatomia coronaria e funçäo ventricular esquerda em pacientes sobreviventes de infarto aguda do miocárdio / Coronary anatomy and left ventricular function in patients surviving acute myocardial infarction

Cento e trinta e oito pacientes consecutivos e não selecionados, com menos de 70 anos de idade, sobreviventes da fase aguda de infarto do miocárdio (IM) entraram no estudo. Quarenta e dois (30%) desses recusaram estudos invasivos, restando 96 pacientes que se submeteram à cinecoronariografia na 4.ª semana de evolução. IM de parede inferior ocorreu em 44/96 (46%) pacientes, IM de parede anterior em 42/96 (44%), IM não-transmural em 9/90 (9%) e IM de localização indeterminada em 1 (1%). A idade dos pacientes variou de 30 a 69 (53,9 ± 9,6) anos e 82/96 (85%) eram do sexo masculino. Doença coronária de um vaso foi encontrada em 24/96 (25%) pacientes (12 tinham IM anterior, 10 tinham IM inferior, 1 tinha IM não-transmural). Doença coronária de 2 e 3 vasos foi encontrada em 31/96 (32%) e 41/96 (43%) pacientes, respectivamente. Lesão do tronco da artéria coronária esquerda foi vista em 11/96 (11%) pacientes (6 tinham IM inferior, 4 tinham IM anterior e 1 tinha IM não-transmural). A freqüência de lesão de 1, 2 ou 3 vasos ou de tronco nos IM anterior, inferior e subendocárdico não foi significativamente diferente. Pacientes com idade de 50 anos ou menos tinham menor freqüência de doença coronária multivascular que os mais idosos (67% vs. 81%, N.S.), o mesmo observandose em relação à lesão de tronco (0% vs. 19%, p < 0,01). A maioria dos pacientes tinha oclusão ou suboclusão de pelo menos um vaso e cerca de um quarto tinha oclusão de 2 vasos. Nenhum paciente tinha artérias coronárias normais. O volume diastólico final do ventrículo esquerdo variou de 24 a 171 ml/m2 (75,7 ± 23,8). O volume sistólico final variou de 8 a 134 ml/m2 (40,1 ± 21,2) e era significativamente maior nos pacientes com IM de parede anterior. A fração de ejeção ventricular esquerda variou de 16% a 86% (48,4 ± 15,6) e era significativamente menor nos pacientes com IM anterior; 14% dos pacientes tinham valor igual ou menor que 30%. A pressão diastólica final do ventrículo esquerdo variou de 3 a 37 mmHg (16,4 ± 7,6), e 30% dos pacientes tinham valores iguais ou maiores que 20 mmHg. Conclui-se que os pacientes que sobrevivem à fase aguda do IM têm alta prevalência de doença coronária multivascular, a qual é ainda maior nos indivíduos com mais de 50 anos de idade. Pacientes com IM de parede anterior têm função ventricular esquerda significativamente pior do que aqueles com IM inferior. A maioria dos pacientes com IM não-transmural tem função ventricular esquerda normal