Carmen Marcondes Ribas

Prognostic evaluation of severe sepsis and septic shock: Procalcitonin clearance vs Δ Sequential Organ Failure Assessment

PURPOSE The purpose of the study is to compare the clearance of procalcitonin (PCT-c) in the first 24 and 48 hours of treatment of severe sepsis and septic shock with another early prognostic marker represented by the 48-hour Δ Sequential Organ Failure Assessment (SOFA). MATERIALS AND METHODS Prospective, observational cohort study conducted in a general intensive care unit including patients with severe sepsis and septic shock. The PCT-c was determined at the diagnosis of sepsis and after 24 and 48 hours. The SOFA score was determined at the time of intensive care unit admission and after 48 hours. RESULTS One hundred thirty adult patients with severe sepsis and septic shock were studied over an 18-month period. The 24- and 48-hour PTC-c scores were significantly higher in survivors (P < .0001). In nonsurvivors, the initial SOFA was significantly higher, and the 48-hour Δ SOFA was significantly smaller (P = .01). The area under the receiver operating characteristic curve was 0.68 for Δ SOFA and 0.76 for 24- and 48-hour PCT-c. CONCLUSIONS The 48-hour Δ SOFA score and the clearance of 24- and 48-hour PCT are useful markers of prognosis in patients with severe sepsis and septic shock. A decrease in PCT-c in the first 24 hours of treatment should prompt the reassessment of the appropriateness and adequacy of treatment.

Análise da cicatrização do cólon com uso do extrato aquoso da Orbignya phalerata (Babaçu) em ratos

INTRODUCAO: A cicatrizacao e processo complexo, com diferentes fases. Embora exista grande variedade de plantas medicinais poucas tem sido investigadas com intencao de melhorar a cicatrizacao de orgaos e tecidos, dentre elas, a Orbignya phalerata (babacu). OBJETIVO: Analisar comparativamente as alteracoes tensiometricas e histologicas na cicatrizacao de anastomoses colonicas proporcionadas pelo uso do extrato aquoso do mesocarpo do babacu (Orbignya phalerata). METODOS: Utilizaram-se 40 ratos Wistar, machos, separados em dois grupos de vinte, denominados grupos controle e experimento, Os ratos de cada grupo foram divididos em dois sub-grupos de 10 animais cada e avaliados no terceiro e setimo dia de pos-operatorio. Realizaram-se colotomia e colorrafia em plano unico. Os animais do grupo controle receberam no ato operatorio dose unica de solucao salina isotonica em dose e via de administracao semelhantes ao grupo experimento e os do grupo experimento receberam extrato aquoso de babacu em dose de 50 mg/kg/peso, concentracao de 25 mg/ml por via intraperitoneal. Foram analisados os seguintes parâmetros: a) avaliacao macroscopica da parede e cavidade abdominal; b) avaliacao tensiometrica da anastomose (pressao e ruptura); c) caracteristicas histologicas da anastomose. RESULTADOS: O exame macroscopico evidenciou a presenca de aderencias em todos os animais, sendo estatisticamente maior no grupo experimento de tres dias quando comparados com o grupo controle. Nos animais do grupo de sete dias nao houve diferenca. Nao houve ocorrencia de deiscencia de anastomose, fistulas, abscessos e/ou hemorragia. Com relacao a tensiometria, constatou-se que a media de ruptura dos grupos controle e experimento tanto para os animais do grupo de tres dias (25,4 mmHg - 14,8 mmHg) quanto para os de sete dias (183 mmHg - 175 mmHg), foram iguais, nao ocorrendo diferenca estatisticamente significante. A analise histologica dos animais do grupo de tres dias mostrou... INTRODUCTION: Healing is a highly complex process with different phases. Because some medicinal plants have antiinflamatory properties, they could influence the wound healing process. There are many species of medicinal plants used for research, among them the Orbignya phalerata (Babassu). PURPOSE: To analyze, comparatively, the tensiometric and histologic alterations in the healing process of colon anastomosis with the use of aqueous extract of the babacu mesocarp. METHODS: Forty Wistar male rats were used, divided in two groups of 20 animals named control and experimental group. Each group was further divided in two sub-groups of 10 animals and evaluated on the third and seventh post-operative days. Colotomy and one suture line coloraphy was performed in all animals. The control group received an intraperitoneal single dose of isotonic saline solution at the time of the surgery. The animals from the experimental group received babassu aqueous extract dose with 50mg/kg/weight, concentration of 25 mg/ml dose, with the same administration method. The following parameters were evaluated: a) macroscopic appearance of abdominal wall and cavity; b) tensiometric evaluation of anastomosis (bursting pressure); c) histologic characteristics of anastomosis. RESULTS: The macroscopic examination showed the presence of adherences in all animals with statistical significance in the ones from the experimental group at third day when compared to the control group. No difference was observed in the seventh-day group. No fistulae, abscesses and/or hemorrhage were observed. In regard to the tensiometric variation, the bursting pressure for the control and experimental groups, both for the third day (25.4 mmHg - 14.8 mmHg) and at seventh (183 mmHg - 175 mmHg), were similar with no significant difference. Histological analysis for the third day showed significant difference in the experimental group in relation to the controls, in regard the presence ofto...INTRODUCTION Healing is a highly complex process with different phases. Because some medicinal plants have antiinflammatory properties, they could influence the wound healing process. There are many species of medicinal plants used for research, among them the Orbignya phalerata (Babassu). PURPOSE To analyze, comparatively, the tensiometric and histologic alterations in the healing process of colon anastomosis with the use of aqueous extract of the babaçu mesocarp. METHODS Forty Wistar male rats were used, divided in two groups of 20 animals named control and experimental group. Each group was further divided in two sub-groups of 10 animals and evaluated on the third and seventh post-operative days. Colotomy and one suture line coloraphy was performed in all animals. The control group received an intraperitoneal single dose of isotonic saline solution at the time of the surgery. The animals from the experimental group received babassu aqueous extract dose with 50mg/kg/weight, concentration of 25 mg/ml dose, with the same administration method. The following parameters were evaluated: a) macroscopic appearance of abdominal wall and cavity; b) tensiometric evaluation of anastomosis (bursting pressure); c) histologic characteristics of anastomosis. RESULTS The macroscopic examination showed the presence of adherences in all animals with statistical significance in the ones from the experimental group at third day when compared to the control group. No difference was observed in the seventh-day group. No fistulae, abscesses and/or hemorrhage were observed. In regard to the tensiometric variation, the bursting pressure for the control and experimental groups, both for the third day (25.4 mmHg - 14.8 mmHg) and at seventh (183 mmHg - 175 mmHg), were similar with no significant difference. Histological analysis for the third day showed significant difference in the experimental group in relation to the controls, in regard the presence ofto mononuclear ones whereas at seventh day there was significant statistical difference in all variables from the experimental group compared to the control one. CONCLUSION A favorable effect with administration of the aqueous extract of the babaçu mesocarp was seen in histological parameters of the healing process of colon anastomosis however there was no difference in the tensiometric evaluation between the control and experimental group.

Healing process in bladder suture of rats with and without the administration of intraperitoneal Jatropha gossypiifolia L. gross extract

INTRODUCTION The suture of tissues and their healing process is one of the basic fundamentals of surgery, and the research on substances which could improve the process is an ongoing challenge. The use of plants has been tested but till nowadays without scientific demonstration. PURPOSE To compare the macroscopic and histological alterations done by the use of intraperitoneal Jatropha gossypiifolia L. gross extract, in the healing process of sutures performed on the bladder of rats. METHODS Forty adult, male, Wistar rats were distributed into two animal groups. One centimeter longitudinal incision on the bladder ventral wall, and single plane synthesis with separated polyglactine 910 5-0 (Ethicon) stitches was done in all the animals. In the control group an intraperitoneal cavity instillation of distilled water at a ratio of 1 ml/kg/weight, and a 1 ml/kg/weight of Jatropha gossypiifolia L. extract for the Jatropha group was done representing 200 mg of the substance. Each group was subdivided into two with 10 animals in each, being submitted to euthanasia on 3rd and 7th post-operative days. Comparative histological, macroscopic and statistical analysis were undertaken between the subgroups. RESULTS Statistical significant difference was observed in the acute inflammation changes, vascular neoformation and bonding on day 3; the first one was greater in the control group, and the latter two greater in the Jatropha group; acute inflammation variables and fibroblastic proliferation presented to be more intense on day 7, with statistical significance favoring the control group. CONCLUSION No favorable healing effect was observed with the administration of single intraperitoneal dose of Jatropha gossypiifolia L. gross extract on the sutures of bladder in rats.

Estudo citofotométrico da expressão dos marcadores tumorais Ki-67 e CD34 no adenocarcinoma de próstata

OBJECTIVE To quantify the percentage of immunostaining through the labeling index as well as the optical density of Ki-67 and CD34 in prostate adenocarcinoma and compare the results between markers. METHODS Markers Ki-67 and CD34 were studied using immunohistochemistry in 34 cases of prostate adenocarcinoma from radical prostatectomies performed at the Hospital Regional do Gama in Brasilia, Brazil from 2000 through 2005. Those markers were quantified using the SAMBA 4000 software - Automated Scanning Microscopic Analysis System - and the IMMUNO software in the analysis of the variables labeling index and optical density. Spearmans correlation coefficient was estimated in order to evaluate the association between the expression levels of the markers. For the comparison of lesion types, Students paired t-test and the nonparametric Wilcoxon test were used. RESULTS Of the 34 blocks referred for the study of the tumor markers, 15 were positive for Ki-67, 34 showed CD34 expression, and 14 were positive for both markers. The median value for the labeling index of CD34 was 72.72%; the minimum was 5.14% and the maximum, 88.81%. The median for the Ki-67 labeling index was 73.78%, while the minimum was 16.87%, and the maximum, 87.47%. The median value for the optical density of CD34 was 48.33, the minimum was 35.65 and the maximum, 85.86. For the optical density of Ki-67, the median was 40.03, while the minimum and maximum values were 21.53 and 52.43, respectively. CONCLUSION The cytophotometric expression of Ki-67 had a mean labeling index of 64.04%, and the mean CD34 labeling index was 61.64%. The cytophotometric expression of the mean optical density of Ki-67 was 39.49, while for CD34 it was 53.69. There was a significant difference between Ki-67 and CD34 immunostaining with respect to optical density (P=0.025); no significant difference occurred regarding labeling index (P=0.470).

External validation of EORTC risk scores to predict recurrence after transurethral resection of brazilian patients with non -muscle invasive bladder cancer stages Ta and T1

ABSTRACT Validate the EORTC risk tables in Brazilian patients with NMIBC. Methods: 205 patients were analyzed. The 6 parameters analyzed were: histologic grading, pathologic stage, size and number of tumors, previous recurrence rate and concomitant CIS. The time for first recurrence (TFR), risk score and probability of recurrence were calculated and compared to the probabilities obtained from EORTC risk tables. C-index was calculated and accuracy of EORTC tables was analyzed. Results: pTa was presented in 91 (44.4%) patients and pT1 in 114 (55.6%). Ninety-seven (47.3%) patients had solitary tumor, and 108 (52.7%) multiple tumors. One hundred and three (50.2%) patients had tumors smaller than 3 cm and 102 (40.8%) had bigger than 3 cm. Concomitant CIS was observed in 21 (10.2%) patients. Low grade was presented in 95 (46.3%) patients, and high grade in 110 (53.7%). Intravesical therapy was utilized in 105 (56.1%) patients. Recurrence was observed in 117 (57.1%) patients and the mean TFR was 14,2 ± 7,3 months. C-index was 0,72 for 1 year and 0,7 for 5 years. The recurrence risk was 28,8% in 1 year and 57,1% in 5 years, independently of the scoring risk. In our population, the EORTC risk tables overestimated the risk of recurrence in 1 year and underestimated in 5 years. Conclusion: The validation of the EORTC risk tables in Brazilian patients with NMIBC was satisfactory and should be stimulated to predict recurrence, although these may overestimated the risk of recurrence in 1 year and underestimated in 5 years.

DEVELOPMENT OF METRICS FOR TECHNICAL PRODUCTION: QUALIS BOOKS AND BOOK CHAPTERS

OBJECTIVE To propose metrics to qualify the publication in books and chapters, and from there, establish guidance for the evaluation of the Medicine III programs. METHOD Analysis of some of the 2013 area documents focusing this issue. Were analyzed the following areas: Computer Science; Biotechnology; Biological Sciences I; Public Health; Medicine I. RESULTS Except for the Medicine I, which has not adopted the metric for books and chapters, all other programs established metrics within the intellectual production, although with unequal percentages. CONCLUSION It´s desirable to include metrics for books and book chapters in the intellectual production of post-graduate programs in Area Document with percentage-value of 5% in publications of Medicine III programs. OBJETIVO Propor a métrica para qualificar a produção veiculada através de livros e capítulos e, a partir daí, estabelecer orientação para a avaliação dos programas de pós-graduação da Medicina III. MÉTODO Análise dos documentos de área de 2013 dos programas de pós-graduação senso estrito das áreas: Ciência da Computação; Biotecnologia; Ciências Biológicas I; Saúde Coletiva; Medicina I. RESULTADOS Excetuando-se o programa da Medicina I, que não adotou a métrica para classificação de livros e capítulos, todos os demais estabeleceram-na dentro da sua produção intelectual, embora com percentuais desiguais. CONCLUSÃO É desejável inserir a métrica de livros e capitulos de livros na produção intelectual do Documento de Área dos programas, ortorgando a ela percentual de 5% das publicações qualificadas dos programas da Medicina III.