RESUMO
Resumen: Se trata de dar a conocer las vicisitudes de la Psiquiatría y de algunos Psiquiatras en la V Región de Valparaíso, Chile, abarcando un período de 50 años, desde 1940 hasta 1990. Se quiere resaltar las características del ejercicio médico-psiquiátrico y del equipo de salud mental, en una época de cambios político-sociales que impactaban en el ejercicio médico y en especial en la psiquiatría, tomando en cuenta el origen y evolución del Hospital del Salvador de Valparaíso.
The aim is to share the struggles of Psychiatry and of some Psychiatrists in the V Region of Valparaíso, Chile, covering a period of 50 years, from 1940 to 1990. It is intended to highlight the characteristics of the medical-psychiatric practice and the influence of the mental health team, at a time of political-social changes that had an impact on medical practice and especially on psychiatry, taking into account the origin and evolution of the Hospital del Salvador de Valparaíso.
Assuntos
História do Século XX , Psiquiatria , Saúde Mental , História , ChileRESUMO
KEY MESSAGE: An efficient and improved transformation method for functional genetics studies in S. italica, being a boon for the Setaria scientific community and for crop improvement. Foxtail millet (Setaria italica) is a short life cycle C4 plant, with sequenced genome, and a potential model plant for C4 species. S. italica is also important on a global food security and healthiness context due to its importance in arid and semi-arid areas. However, despite its importance, there are just few transformation protocols directed to this species. The current protocols reached about 5.5-9% of efficiency, which do not make it a valuable model organism. Different types of explants were used in the above mentioned methods, such as immature and mature inflorescence and shoot apex. However, these techniques have many limitations, such as unavailability of explants throughout the year and a crucial, laborious and considerable time-consuming selection. Aiming a simplified and efficient methodology, we adopted dry mature seeds as explants, which are available in abundance, are constant along the year and well responsive to tissue culture, in addition to a differentiated approach that reaches on an average 19.2% transformation efficiency of S. italica. Thus, we propose a protocol that optimizes the transformation efficiency of this cereal crop allowing a high increase on transformation and regeneration rates. Our transformation protocol provides an interesting tool for Setaria community research as well as enables new strategies for breeding enhanced productivity in the species.
Assuntos
Regeneração/genética , Setaria (Planta)/genética , Transformação Genética , Agrobacterium tumefaciens/genética , Técnicas de Cultura de Células/métodos , Células Cultivadas , Grão Comestível/genética , Grão Comestível/metabolismo , Técnicas Genéticas , Vetores Genéticos , Fenótipo , Melhoramento Vegetal , Folhas de Planta/genética , Folhas de Planta/crescimento & desenvolvimento , Folhas de Planta/metabolismo , Plantas Geneticamente Modificadas , Interferência de RNA , Regeneração/fisiologia , Sementes/efeitos dos fármacos , Sementes/genética , Setaria (Planta)/metabolismo , Setaria (Planta)/microbiologia , Setaria (Planta)/fisiologiaRESUMO
PURPOSE: hENT1 is a transmembrane protein which acts as a nucleoside transporter and is the main mediator of Gemcitabine (GEM) uptake into human cells. In this retrospective study we compared GEM versus FOLFIRINOX in patients with metastatic pancreatic cancer in which hENT1 evaluation was available. METHODS: 149 patients affected by unresectable metastatic pancreatic cancer, treated in our institution from 2009 to 2013, have been screened for inclusion in this retrospective study. Seventy patients, treated with GEM or FOLFIRINOX in first-line therapy, fulfilled clinical inclusion criteria for survival analysis. Thirty-one patients were available and contained sufficient quality/quantity RNA for evaluation of hENT1 expression by RT-PCR. The primary endpoint was OS and the secondary endpoint was PFS. RESULTS: The survival analysis, carried out on 70 patients regardless of hENT1 expression, showed a statistically longer OS and PFS in the group treated with FOLFIRINOX compared to GEM. Within the exploratory analysis, which included 31 patients, no differences were found in hENT1 positive patients treated with FOLFIRINOX compared to GEM in terms of OS (8.5 vs 7 months, HR: 0.89; 95 % CI 0.3-2.5; p = 0.8) and PFS (5.5 vs 5 months, HR: 0.8, 95 % CI 0.2-2.2; p = 0.61). GEM-treated hENT1 positive patients showed a statistically significant improvement both of OS (8 vs 2 months; p = 0.0012) and PFS (5 vs 1 months; p = 0.0004) in comparison to GEM-treated hENT1 negative patients. CONCLUSIONS: In our exploratory analysis GEM seems as effective as FOLFIRINOX in terms of survival with a better safety profile in hENT1 positive metastatic pancreatic cancer.
Assuntos
Adenocarcinoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Pancreáticas/tratamento farmacológico , Adenocarcinoma/metabolismo , Adenocarcinoma/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Capecitabina/administração & dosagem , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Transportador Equilibrativo 1 de Nucleosídeo , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Humanos , Irinotecano , Leucovorina/administração & dosagem , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/patologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Gencitabina , Neoplasias PancreáticasRESUMO
OBJECTIVE: To describe incidence rates and risk factors associated with external ventricular drain (EVD)-related infections at a tertiary Brazilian teaching hospital. METHODS: The patient cohort consisted of all patients at a major teaching hospital in Brazil with an EVD during the period 1 April 2007 to 30 June 2008 (15 months). Patients were followed up for 30 days after catheter removal. According to the Center for Diseases Control and Prevention criteria for meningitis/ventriculitis, all of the central nervous system (CNS) infections that occurred during this period could be considered to be meningitis or ventriculitis related to EVD placement. Infection rates were calculated using different denominators, such as (1) per patient (incidence), (2) per procedure, and (3) per 1,000 catheter-days (drain-associated infection rate). Patient demographic data, medical history of underlying diseases, antibiotic prophylaxis usage, American Society of Anesthesiologists Score classification, duration of surgery and hospitalization, length of time the EVD was in place, and overall mortality were evaluated during the study period. A logistic regression model was developed to identify factors associated with infection. RESULTS: A total of 119 patients, 130 EVD procedures, and 839 catheter-days were evaluated. The incidence of infection was 18.3%, the infection rate was 16.9% per procedure, and the drain-associated infection rate was 22.4 per 1,000 catheter-days; 77% of the infections were caused by Gram-negative micro-organisms. Only 75% of patients received antibiotic prophylaxis. The infection rate increased with length of the hospital stay. The length of time the catheter was in place was the only independent risk factor associated with infection (p = 0.0369). CONCLUSION: The incidence of EVD-related infections is high in our hospital, Gram-negative micro-organisms were the most frequent causal agents identified and length of time that the catheter was in place contributed to the infection rate.
Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Infecções Bacterianas do Sistema Nervoso Central/epidemiologia , Ventrículos Cerebrais/cirurgia , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Derivações do Líquido Cefalorraquidiano/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Infecções por Bactérias Gram-Negativas/epidemiologia , Hospitais de Ensino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemAssuntos
Infecção Hospitalar/epidemiologia , Neoplasias Hematológicas/complicações , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/classificação , Pseudomonas aeruginosa/enzimologia , Transplante , beta-Lactamases/biossíntese , Antibacterianos/farmacologia , Brasil , Carbapenêmicos/farmacologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , DNA Bacteriano/genética , Genótipo , Desinfecção das Mãos/métodos , Humanos , Hospedeiro Imunocomprometido , Controle de Infecções/métodos , Testes de Sensibilidade Microbiana , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/mortalidade , Pseudomonas aeruginosa/isolamento & purificação , Transplante de Células-Tronco/efeitos adversos , Resistência beta-LactâmicaRESUMO
Enterobacter cloacae has emerged as an important pathogen in neonatal units, with several outbreaks of infection being reported. The aim of this study was to investigate an outbreak of sepsis due to E. cloacae in a neonatal unit and to review the literature. A retrospective cohort study was conducted in which cases were compared with all newborns hospitalised for more than 48h in the neonatal intensive care unit (NICU). Cohorting of infected patients and work reorganisation were implemented. Pulsed-field gel electrophoresis was performed. The retrospective cohort included the six cases and 13 control patients that had been in the NICU during April 2006. Univariate analysis showed that the use of dobutamine was significantly associated with infection (P=0.036) and that enteral feeding was a protective factor (P=0.02). Multivariate analysis did not find any independent risk factor. Bed occupancy rate in March 2006 was 109.6%, indicating overcrowding. PFGE identified indistinguishable patterns among isolates from all six newborns. PubMed and OVID was search from 1 January 1983 to 15 January 2008 for papers including the terms 'E. cloacae', 'outbreaks', 'clusters' in combination with 'neonate', 'newborn', and 'infant'. We found 26 reports of outbreaks due to E. cloacae in neonate patients: sixteen (52%) were bloodstream infection outbreaks, of which two (12.5%) were related to multiple-dose medications. The source for our outbreak was not identified. Reinforcement of hygiene practices, restrictions on new admissions and the establishment of single-dose medications helped to control the outbreak.
Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Surtos de Doenças , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Técnicas de Tipagem Bacteriana , Impressões Digitais de DNA , Eletroforese em Gel de Campo Pulsado , Enterobacter cloacae/classificação , Genótipo , Humanos , Lactente , Recém-Nascido , Terapia Intensiva NeonatalAssuntos
Bacteriemia/epidemiologia , Infecção Hospitalar/epidemiologia , Fungemia/epidemiologia , Hospitais Universitários/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Brasil/epidemiologia , Candida/classificação , Candida/isolamento & purificação , Candida albicans/isolamento & purificação , Candidíase/epidemiologia , Candidíase/microbiologia , Candidíase/mortalidade , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Fungemia/microbiologia , Fungemia/mortalidade , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/isolamento & purificação , Cocos Gram-Positivos/classificação , Cocos Gram-Positivos/isolamento & purificação , IncidênciaRESUMO
Candidemia is associated with high morbidity and mortality resulting in significant increases in the length of patients' hospitalization and in healthcare costs. Critically ill patients are at particular risk for candidemia because of their debilitated condition and frequent need for invasive procedures. The aim of this study was to characterize the incidence and epidemiology of candidemia over a seven-year period in intensive care units (ICUs) and the use of fluconazole and caspofungin in a large university-affiliated hospital. All cases of candidemia were identified by surveillance, using the Centers for Diseases Control and Prevention criteria. Demographic variables, use of antifungal (fluconazole and caspofungin) and patient outcomes were evaluated. The chi2 test for linear trend was employed to evaluate the distribution of Candida spp. and the use of fluconazole and caspofungin by defined daily dose (DDD) per 1,000 patients-days during the study period. One hundred and eight episodes of candidemia were identified. The overall incidence of candidemia (P=0.20) and incidence of non-Candida albicans Candida infections (P=0.32) remained stable over the study period and ranged from 0.3-0.9 episodes per 1,000 catheter-days and 0.39-0.83 episodes per 1,000 patients-days. However, the use of fluconazole and caspofungin increased significantly (P<0.001). While there were no reports of the use of fluconazole for prophylaxis in 1999, its use for this purpose increased from 3% in 2000 to 7.0% (P=0.07) in 2006. C. albicans was the most frequent specie isolated and burns and cancer were the most frequent underlying conditions. The overall mortality was 76%. There was no difference between C. albicans and non-C. albicans Candida infections when the crude and 14-day mortality rates were compared. Our data demonstrated that C. albicans is still the most frequent species causing candidemia in our intensive care units. Our rates of candidemia are lower than those reported from the region and similar to American and European hospitals. Although the incidence of blood stream infections (BSI) and candidemia remained stable, the use of fluconazole and caspofungin increased significantly over the years included in this study but had no impact on the incidence of infections caused by non-C. albicans Candida species.
Assuntos
Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Equinocandinas/uso terapêutico , Fluconazol/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Candidíase/microbiologia , Caspofungina , Criança , Infecção Hospitalar/microbiologia , Feminino , Hospitais Universitários , Humanos , Incidência , Unidades de Terapia Intensiva , Lipopeptídeos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
The purpose of this work was to analyze the effect of diets that contain several oils whose composition in fatty acids were different, on the kinetic parameters of the gamma-glutamyltranspeptidase (GGTP) and the lipoperoxidation of the epididymis because GGTP controls the level of the glutathione that is an molecule that regulates the level of oxidation protecting the maturation and survival of sperm in the lumen of the epididymis. The caput portion of the epididymis was chosen because the epithelium of this segment synthesizes GGTP. Weaned BALB-c mice were fed a commercial or semi-synthetic diet that contained 5% added olein. The mice were maintained on corn oil or fish oil diet for the first 4-8 months of age. The kinetic variables of the GGTP enzyme, analyzed by means of multiple regression analysis using dummy variables, showed that values were similar in olein and corn oil samples, whereas in samples from the fish oil fed group the enzyme behaved as that in animals maintained on commercial diets. Although there were no variations in maximum velocity (Vm) of the enzyme, the Km value, was greater (P < 0.0001) for the mice fed the olein and corn diets. These groups contained greater percentages of the monounsaturated fatty acids, palmitoleic (16:1 n-7) and oleic acid, 18:1 n-9. Similarly, the amount of lipid peroxidation was also greater in the olein and corn oil groups with respect to commercial and fish groups. The significant increment in Km of GGTP in the olein and corn groups was correlated with greater amount of monounsaturated fatty acids and lipid peroxidation in the epididymis. In conclusion, modifications of dietary lipid sources differentially modulated the epididymis tissue fatty acid profile, lipid peroxidation amounts, and the Km of GGTP. These effects may alter the metabolism of the natural substrate of GGTP, glutathione, a tripeptide with a powerful antioxidant activity, which is necessary in maintaining the oxidative state of the sperm microenvironment, thereby favoring maturation of the male gametes.
Assuntos
Gorduras na Dieta/farmacologia , Epididimo/enzimologia , Ácidos Graxos/análise , Peroxidação de Lipídeos/efeitos dos fármacos , Maturação do Esperma/efeitos dos fármacos , gama-Glutamiltransferase/farmacocinética , Animais , Óleo de Milho/química , Gorduras na Dieta/administração & dosagem , Epididimo/metabolismo , Óleos de Peixe/química , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Maturação do Esperma/fisiologia , gama-Glutamiltransferase/efeitos dos fármacosRESUMO
Como o diagnóstico da hipertensão arterial é feito por métodos diversos, sendo o mais tradicional o auscultatório e, o mais recente, o oscilométrico (digital), a proposta do presente trabalho foi comparar esses dois métodos.Para isso, tomou-se uma amostra de 40 pacientes em tratamento dontológico, para os quais foram obtidas as medidas de pressão arterial, segundo esses dois métodos.Para os valores de pressão arterial obtidos, aplicou-se o coeficiente de correlação intra- classe (r).Os métodos mostraram excelente concordância para pressão arterial sistólica (r=0,93) e boa concordância para a pressão arterial diastólica (r=0,75).Concluiu-se, pelo excelente nível de concordância para pressão arterial sistólica, que o uso do aparelho digital pode ser recomendado para o acompanhamento das variações dessa pressão em um mesmo indivíduo.Já a concordância boa, obtida na determinação da pressão arterial diastólica, permite concluir que o aparelho digital é confiável, porém novos estudos precisariam ser realizados para uma melhor compreensão das discordâncias que ocorrerem na aferição dessa pressão.