bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of medicines information for patient safety
Authors: Pappa Dimitra , Telonis Panagiotis , Stergioulas Lampros K
Published: August 2006

Ensuring patient safety in the management of medicines requires the efficient collection, administration, analysis and distribution of huge amounts of data from different sources. This requires the development of generic methods and tools for tasks such as: (1) data mining and semantics-based inference; (2) integration of heterogeneous scientific information databases relating to drugs and diseases; (3) terminology and coding issues; (4) adverse drug events and signal detection; and (5) networking and security. Collaborative research and development will be required to develop coordinated health care information services. Easy access to high-quality information will provide better health care and increased cost efficiency.
Pharmacotherapy Interventions Undertaken by Pharmacists in the Fleetwood Phase III Study: the Role of Process Control
Authors: Lapane Kate L , Hughes Carmel M
Published: August 2006

Background:

The Fleetwood Model incorporates prospective review, direct communication with the prescriber, and formalized pharmacotherapy planning in patients at highest risk for medication-related problems.

Objectives:

To describe the intervention activities performed by consultant pharmacists and dispensing pharmacists in the context of the Fleetwood Phase III Study.

Methods:

We report on a total of 4272 residents living in 12 nursing homes included in the intervention arm of the demonstration project. The intervention period was January through December 2004. Using pharmacotherapy planning software with a Web-based interface, daily interchange of information from the commercial pharmacy software, as well as laptop-based software for use in the nursing homes, pharmacists documented the reason for the intervention, the level of service, and the extent to which the recommendations were accepted.

Results:

There were 2118 Fleetwood interventions performed on 4272 residents (intervention rate: 9.48/100 resident months), with 81% of interventions performed by consultant pharmacists. The top 5 reasons for Fleetwood interventions by dispensing pharmacists were: missing information/clarification needed (19.8%), drug–age precautions (14.4%), excessive duration alert (9.5%), suboptimal regimen (8.7%), and laboratory test needed (7.3%). The top 5 reasons for involvement of the consultant pharmacists were: laboratory test needed (13.1%), missing information/clarification needed (13%), unnecessary drug (10.3%), product selection opportunity (10.3%), and excessive duration alert (9.1%).

Conclusions:

Extending the federally mandated medication review process in nursing homes to incorporate elements of the Fleetwood Model is possible. The recommendation acceptance rates for pharmacist interventions are high.
Prolactin Modulates TRPV1 in Female Rat Trigeminal Sensory Neurons
Authors: Diogenes Anibal , Patwardhan Amol M. , Jeske Nathaniel A. , Ruparel Nikita B. , Goffin Vincent , Akopian Armen N. , Hargreaves Kenneth M.
Published: August 2006

Sex dependency in pain perception is well documented and is thought to be attributable to the effect of reproductive hormones on nociceptive processing. In the present study, we evaluated whether estradiol alters gene transcription in the trigeminal ganglia (TG) of ovariectomized rats (OVX). These experiments demonstrated a dramatic (40-fold) upregulation of prolactin (PRL) expression in TG by 17-β-estradiol (E2). PRL expression was restricted to TG neurons and was highly overlapped with transient potential receptor vanilloid type 1 (TRPV1) (∼90%) in TG. Additionally, PRL is released from neurons during stimulation. Both forms of PRL receptors (PRLRs), short and long, were also present in TG neurons. Moreover, expression of the long PRLRs was under control of estradiol. We next evaluated the novel hypothesis that PRL acts as a neuromodulator of sensory neurons. PRL pretreatment significantly enhanced capsaicin-evoked inward currents, calcium influx, and immunoreactive calcitonin gene-related peptide release from cultured TG neurons. This PRL modulation of capsaicin responses was abolished by withdrawal of E2 from TG cultures. Biochemical analysis demonstrated that PRL increased (>50%) phosphorylation levels of TRPV1 in TG. In a behavioral test, PRL pretreatment significantly potentiated capsaicin-evoked nocifensive behavior in female rats at proestrous and in OVX rats after E2 treatment. Thein vivopotentiating effect of PRL on capsaicin responses was also dependent on E2. Collectively, these data demonstrate that PRL is a novel modulator of sensory neurons tightly regulated by E2. These findings are consistent with the hypothesis that PRL could contribute to the development of certain pain disorders, possibly including those modulated by estrogen.
Restoring Cerebral Blood Flow Reveals Neural Regions Critical for Naming
Authors: Hillis Argye E. , Kleinman Jonathan T. , Newhart Melissa , Heidler-Gary Jennifer , Gottesman Rebecca , Barker Peter B. , Aldrich Eric , Llinas Rafael , Wityk Robert , Chaudhry Priyanka
Published: August 2006

We identified areas of the brain that are critical for naming pictures of objects, using a new methodology for testing which components of a network of brain regions are essential for that task. We identified areas of hypoperfusion and structural damage with magnetic resonance perfusion- and diffusion-weighted imaging immediately after stroke in 87 individuals with impaired picture naming. These individuals were reimaged after 3–5 d, after a subset of patients underwent intervention to restore normal blood flow, to determine areas of the brain that had reperfused. We identified brain regions in which reperfusion was associated with improvement in picture naming. Restored blood flow to left posterior middle temporal/fusiform gyrus, Broca's area, and/or Wernicke's area accounted for most acute improvement after stroke. Results show that identifying areas of reperfusion that are associated with acute improvement of a function can reveal the brain regions essential for that function.
Who do Taxi Drivers Trust?
Authors: Hamill Heather , Gambetta Diego
Published: August 2006

Driving a taxi is dangerous, and picking up the wrong fare can be devastating. Yet drivers only have a moment to make a choice.
Brazilian synchrocyclotron light
Authors: BURGOS MARCELO BAUMANN
Published: August 2006

The National Synchrotron Light Laboratory (LNLS) is one of the ten institutes linked to the National Council for Scientific and Technological Development (CNPq) and one of the most important investments made in the last two decades by the Brazilian federal government in civil Science and Technology (S&T). The issue I address involves the understanding of how the Synchrotron Project materializes. Such objective implies revisiting the long negotiation process, which lasts through two political regimes and five different governments; and which faced resistance even from scientists and researchers

My hypothesis is that the institutionalization of the Synchrotron Project becomes viable thanks to a process that goes from the permeability of the LNLS negotiation process to the imposed transformations by the transition to the democratic regime.
Political storms, financial uncertainties, and dreams of “big science:” The construction of a heavy ion accelerator in Argentina
Authors: DE MENDOZA DIEGO HURTADO , VARA ANA MARIA
Published: August 2006

Experimental nuclear physics in Argentina entered the era of so-called “big science” with a project to build a 20 MeV tandem-type accelerator for heavy ions. Promoted by the group of nuclear physicists of Argentina's National Atomic Energy Commission (CNEA), the TANDAR (TANDem ARgentino) project was presented to CNEA's Navy authorities during a democratic period of complete turmoil and a deep economic crisis. Most of its construction took place during eight years of brutal military dictatorship (1976–1983), leading to its inauguration in the first years of a new democratic government (1986). This article narrates how the project was envisioned, planned, and executed, and discusses the distortion of the usual meaning of “big science” when applied to a “peripheral” context.
Adverse Drug Reactions Among Children Over a 10-Year Period
Authors: Le Jennifer , Nguyen Thuy , Law Anandi V. , Hodding Jane
Published: August 2006

OBJECTIVES. This study was designed to evaluate (1) the incidence and common types of adverse drug reactions among hospitalized children, (2) the frequency of adverse drug reaction reporting by health care providers, and (3) the follow-up processes resulting from adverse drug reactions.

METHODS. A retrospective cohort study of pediatric patients who experienced an adverse drug reaction between January 1, 1995, and December 31, 2004, was conducted at a community-based, tertiary care, children's teaching hospital.

RESULTS. A total of 1087 adverse drug reactions were reported; the overall incidence was 1.6%. The severity of most adverse drug reactions was low (levels 1–3: 89%; high levels 4–6: 11%). Adverse drug reactions with low severity were significantly more common in both the general pediatric unit and the NICU. Adverse reactions resulting from use of antibiotics (particularly penicillins, cephalosporins, and vancomycin) were usually mild. In contrast, adverse drug reactions rated high in severity were significantly more common among reactions that led to hospital admission or occurred during surgery and among certain drug classes, including anticonvulsants and antineoplastic agents. Adverse drug reactions were reported by pharmacists (89%), nurses (10%), and physicians (<1%). Although documentation of physician notification occurred for 93% of adverse drug reactions, only 29% of cases were documented in the patient's medical chart, 13% included follow-up education for individuals involved, and 10% were updated in the allergy profile of the hospital computer system.

CONCLUSION. Measures to improve detection and reporting of adverse drug reactions by all health care professionals should be undertaken, to enhance our understanding of the nature and impact of these reactions in children.
Comparison of Respiratory Physiologic Features When Infants Are Placed in Car Safety Seats or Car Beds
Authors: Kinane T. Bernard , Murphy Joan , Bass Joel L. , Corwin Michael J.
Published: August 2006

OBJECTIVE. The objective of this study was to compare the respiratory physiologic features of healthy term infants placed in either a car bed or a car safety seat.

METHODS. Within the first 1 week of life, 67 healthy term infants were recruited and assigned randomly to be monitored in either a car bed (33 infants) or a car safety seat (34 infants). Physiologic data, including oxygen saturation and frequency and type of apnea, were obtained and analyzed in a blinded manner.

RESULTS. The groups spent similar amounts of time in the devices (car bed: 71.6 minutes; car seat: 74.2 minutes). The mean oxygen saturation values were not different between the groups (car bed: 97.1%; car seat: 97.3%). The percentages of time with oxygen saturation of <95% were also similar for the 2 groups (car bed: 18.3%; car seat: 11.8%). In both groups, a number of infants spent high percentages of study time with oxygen saturation of <95%. The 6 infants with the most time at this level were all in the car safety seat group (54%–63% of study time). Values for the 6 infants in the car bed group with the most time at this level were lower (20%–42%). This difference in the duration of oxygen saturation of <95% was not statistically significant. The mean end-tidal carbon dioxide levels and the numbers of episodes of apnea were similar for the 2 groups.

CONCLUSIONS. The respiratory physiologic features of infants in the 2 car safety devices were observed to be similar. Of note, substantial periods of time with oxygen saturation of <95% were surprisingly common in both groups.
Preoperative Anxiety, Postoperative Pain, and Behavioral Recovery in Young Children Undergoing Surgery
Authors: Kain Zeev N. , Mayes Linda C. , Caldwell-Andrews Alison A. , Karas David E. , McClain Brenda C.
Published: August 2006

OBJECTIVE. Findings from published studies suggest that the postoperative recovery process is more painful, slower, and more complicated in adult patients who had high levels of preoperative anxiety. To date, no similar investigation has ever been conducted in young children.

METHODS. We recruited 241 children aged 5 to 12 years scheduled to undergo elective outpatient tonsillectomy and adenoidectomy. Before surgery, we assessed child and parental situational anxiety and temperament. After surgery, all subjects were admitted to a research unit in which postoperative pain and analgesic consumption were assessed every 3 hours. After 24 hours in the hospital, children were discharged and followed up at home for the next 14 days. Pain management at home was standardized.

RESULTS. Parental assessment of pain in their child showed that anxious children experienced significantly more pain both during the hospital stay and over the first 3 days at home. During home recovery, anxious children also consumed, on average, significantly more codeine and acetaminophen compared with the children who were not anxious. Anxious children also had a higher incidence of emergence delirium compared with the children who were not anxious (9.7% vs 1.5%) and had a higher incidence of postoperative anxiety and sleep problems.

CONCLUSIONS. Preoperative anxiety in young children undergoing surgery is associated with a more painful postoperative recovery and a higher incidence of sleep and other problems.
Concepts of the Advantages and Disadvantages of Teenage Childbearing Among Pregnant Adolescents: A Qualitative Analysis
Authors: Rosengard Cynthia , Pollock Lealah , Weitzen Sherry , Meers Ann , Phipps Maureen G.
Published: August 2006

OBJECTIVE. We sought to enhance our understanding of pregnant adolescents’ concepts of the advantages and disadvantages of teen pregnancy and childbearing.

METHODOLOGY. This is a qualitative study of 247 pregnant adolescents recruited during their first prenatal health care visit to a women's primary care clinic in Providence, Rhode Island. Participants responded in writing to open-ended questions assessing their ideas about what was advantageous and disadvantageous about having an infant during their teen years rather than waiting until they were older. Themes and patterns in responding were coded, and subgroup differences based on age, ethnicity, intendedness of current pregnancy, and pregnancy/parenting history were assessed.

RESULTS. Themes related to advantages of teen pregnancy included enhancing connections, positive changes/benefits, and practical considerations. Themes related to disadvantages included lack of preparedness, changes/interference, and others’ perceptions. Differences among groups based on age, ethnicity, intendedness of the current pregnancy, and pregnancy/parenting history were examined and noted.

CONCLUSIONS. Pregnant adolescents do not represent a homogeneous group. Considering differences in how pregnancy and childbearing are conceptualized along developmental, cultural, attitudinal, and experiential lines will strengthen our ability to tailor pregnancy-prevention messages.
Risk Factors for Invasive, Early-Onset Escherichia coli Infections in the Era of Widespread Intrapartum Antibiotic Use
Authors: Schrag Stephanie J. , Hadler James L. , Arnold Kathryn E. , Martell-Cleary Patricia , Reingold Arthur , Schuchat Anne
Published: August 2006

OBJECTIVE. The goal was to evaluate risk factors for invasive Escherichia coli infections in the first week of life (early onset), focusing on the role of intrapartum antibiotic use.

METHODS. We conducted a retrospective case-control study. Between 1997 and 2001, case infants, defined as infants <7 days of age with E coli isolated from blood or cerebrospinal fluid, were identified in selected counties of California, Georgia, and Connecticut by the Active Bacterial Core Surveillance/Emerging Infections Program Network. Control infants (N = 1212) were identified from a labor and delivery record review of a stratified random sample of live births at the same hospitals in 1998 and 1999.

RESULTS. Surveillance identified 132 E coli cases, including 68 ampicillin-resistant cases. The case fatality rate was 16% (21 of 132 cases). Two thirds of case infants were preterm, and 49% (64 of 132 infants) were born at ≤33 weeks of gestation. Fifty-three percent of case mothers (70 of 132 mothers) received intrapartum antibiotic therapy; 70% of those received ampicillin or penicillin. Low gestational age (≤33 weeks), intrapartum fever, and membrane rupture of ≥18 hours were associated with increased odds of early-onset E coli infection. Results were similar when case subjects were limited to those infected with ampicillin-resistant strains. Exposure to any intrapartum antibiotic treatment, β-lactam antibiotic treatment, or ≥4 hours of intrapartum antibiotic therapy was associated with increased odds of E coli infection and ampicillin-resistant infection in univariate analyses. Among preterm infants, intrapartum antibiotic exposure did not remain associated with either outcome in multivariable models. Among term infants, exposure to ≥4 hours of intrapartum antibiotic therapy was associated with decreased odds of early-onset E coli infection.

CONCLUSIONS. Exposure to intrapartum antibiotic therapy did not increase the odds of invasive, early-onset E coli infection. Intrapartum antibiotic therapy was effective in preventing E coli infection only among term infants.
Use of Wireless Capsule Endoscopy in the Management of Severe Henoch-Schonlein Purpura
Authors: Preud'Homme Daniel L. , Michail Sonia , Hodges Cathy , Milliken Tonya , Mezoff Adam G.
Published: August 2006

Henoch-Schonlein purpura is a multisystem vasculitis that primarily affects children. Characteristic symptoms include purpura of the lower extremities and buttocks, abdominal pain, arthralgias, and hematuria. Gastrointestinal bleeding occurs in ∼50% of children and, although often self-limiting, can be significant. Wireless capsule endoscopy has been found to be safe and effective for children over 10 years of age. It is now the preferred imaging modality for evaluating gastrointestinal bleeding from the small intestine. Here we report an unusual case of chronic Henoch-Schonlein purpura vasculitis, primarily affecting the gastrointestinal tract, in which wireless capsule endoscopy was helpful in evaluating and directing treatment options.
Vitamin D Deficiency in Breastfed Infants in Iowa
Authors: Ziegler Ekhard E. , Hollis Bruce W. , Nelson Steven E. , Jeter Janice M.
Published: August 2006

OBJECTIVE. The purpose of this work was to assess the vitamin D status of breastfed infants living in Iowa (latitude: 41°N).

METHODS. Blood samples and dietary records from 84 breastfed infants participating in another study were used for a survey of vitamin D status at 280 days of age. The vitamin D status of those (35 infants) who did not receive preformed vitamin D at 280 days of age (unsupplemented infants) was assessed longitudinally between 112 days and 15 months of age. Plasma 25-hydroxyvitamin D and, in most cases, parathyroid hormone and alkaline phosphatase were determined.

RESULTS. At 280 days of age, 10% of breastfed infants were vitamin D deficient (25-hydroxyvitamin D <11 ng/mL). Deficiency was significantly more prevalent among dark-skinned infants and during winter and occurred exclusively in unsupplemented infants. During winter, 78% of unsupplemented infants were vitamin D deficient. During summer, only 1 infant who had dark skin pigmentation was vitamin D deficient. Longitudinal assessment of unsupplemented infants similarly showed that the majority of breastfed infants were vitamin D deficient during winter. Severe deficiency (25-hydroxyvitamin D <5 ng/mL) was common and was accompanied by elevation of parathyroid hormone and alkaline phosphatase. The prevalence of vitamin D deficiency decreased with age but was still 12% at 15 months of age if no preformed vitamin D was received.

CONCLUSIONS.Vitamin D deficiency, including severe deficiency, was common among breastfed infants in Iowa who did not receive preformed vitamin D. Deficiency occurred mostly during winter but was not completely absent during summer. It affected infants with light as well as dark skin pigmentation. Consumption of preformed vitamin D from vitamin supplements or formula is effective in preventing vitamin D deficiency. Vitamin D supplementation should be provided to all breastfed infants.
Multiple Cutaneous Infantile Hemangiomas Associated With Hepatic Angiosarcoma: Case Report and Review of the Literature
Authors: Nord Kristin M. , Kandel Jessica , Lefkowitch Jay H. , Lobritto Steven J. , Morel Kimberly D. , North Paula E. , Garzon Maria C.
Published: August 2006

Multiple cutaneous hemangiomas can be associated with internal hemangiomas, with the liver being the most common site. Here we report a case of a premature female neonate who presented with cardiac failure at birth and had typical-appearing infantile hemangiomas on the skin in association with vascular lesions in the liver. Her clinical presentation was felt to be consistent with cutaneous and hepatic infantile hemangiomas. After failure to respond to systemic steroids and chemotherapy, she underwent liver transplantation. Histopathologic evaluation of the liver revealed a diagnosis of type 2 infantile hepatic hemangioendothelioma (regarded as synonymous with angiosarcoma) rather than benign infantile hemangioma of the liver. Subsequent skin biopsies confirmed that her multiple cutaneous lesions were infantile hemangiomas and not metastatic angiosarcoma. We report this case and a review of the literature on pediatric angiosarcoma of the liver associated with cutaneous infantile hemangiomas.
Socioeconomic Impact of Modern Multidisciplinary Management of Retinoblastoma
Authors: Wilson Matthew W. , Haik Barrett G. , Rodriguez-Galindo Carlos
Published: August 2006

OBJECTIVE. Our objective for this study was to examine the impact of the modern management of intraocular retinoblastoma on the patient and the family.

METHODS. This study comprises a retrospective, noncomparative case series of 25 consecutive patients with multifocal, intraocular retinoblastoma that was treated with primary systemic chemotherapy. Medical charts were reviewed, and the following data were extracted: patients’ age and gender, laterality of disease, and Reese-Ellsworth classification of each eye as well as the number of central venous lines placed, cycles of chemotherapy received, outpatient appointments, examinations under anesthesia, focal therapies administered, computed tomography/MRI, radiation treatments, anesthetic procedures administered, and miles traveled.

RESULTS. Twenty patients with bilateral and 5 with unilateral intraocular retinoblastoma (median age: 9.3 months) had 895 outpatient appointments and underwent 698 examinations under anesthesia with 230 focal therapies, 347 days of radiotherapy, 226 computed tomography scans/MRIs, and 38 central venous line placements. A total of 1272 anesthetic procedures (median: 50) were performed with no major complication. In all, patients traveled 822312 miles (median: 22214 miles) to receive their care. The median follow-up was 82 months.

CONCLUSIONS. Successful retinoblastoma management requires close surveillance, aggressive consolidation, and numerous anesthetic procedures, all of which the patients and the families must endure. There is a significant impact on the patient, the family, and hospital resources.
Shopping Cart–Related Injuries to Children
Authors:   Committee on Injury, Violence, and Poison Prevention
Published: August 2006

Shopping cart–related injuries to children are common and can result in severe injury or even death. Most injuries result from falls from carts or cart tip-overs, and injuries to the head and neck represent three fourths of cases. The current US standard for shopping carts should be revised to include clear and effective performance criteria to prevent falls from carts and cart tip-overs. Pediatricians have an important role as educators, researchers, and advocates to promote the prevention of these injuries.
Shopping Cart–Related Injuries to Children
Authors: Smith Gary A. ,   for the Committee on Injury, Violence, and Poison Prevention
Published: August 2006

An estimated 24200 children younger than 15 years, 20700 (85%) of whom were younger than 5 years, were treated in US hospital emergency departments in 2005 for shopping cart–related injuries. Approximately 4% of shopping cart–related injuries to children younger than 15 years require admission to the hospital. Injuries to the head and neck represent three fourths of all injuries. Fractures account for 45% of all hospitalizations. Deaths have occurred from falls from shopping carts and cart tip-overs. Falls are the most common mechanism of injury and account for more than half of injuries associated with shopping carts. Cart tip-overs are the second most common mechanism, responsible for up to one fourth of injuries and almost 40% of shopping cart–related injuries among children younger than 2 years. Public-awareness initiatives, education programs, and parental supervision, although important, are not enough to prevent these injuries effectively. European Standard EN 1929-1:1998 and joint Australian/New Zealand Standard AS/NZS 3847.1:1999 specify requirements for the construction, performance, testing, and safety of shopping carts and have been implemented as national standards in 21 countries. A US performance standard for shopping carts (ASTM [American Society for Testing and Materials] F2372-04) was established in July 2004; however, it does not adequately address falls and cart tip-overs, which are the leading mechanisms of shopping cart–related injuries to children. The current US standard for shopping carts should be revised to include clear and effective performance criteria for shopping cart child-restraint systems and cart stability to prevent falls from carts and cart tip-overs. This is imperative to decrease the number and severity of shopping cart–related injuries to children. Recommendations from the American Academy of Pediatrics regarding prevention of shopping cart–related injuries are included in the accompanying policy statement.
Specific language impairment: linguistic and neurobiological aspects
Authors: Hage Simone Rocha de Vasconcelos , Cendes Fernando , Montenegro Maria Augusta , Abramides Dagma V. , Guimarães Catarina A. , Guerreiro Marilisa Mantovani
Published: August 2006

Specific language impairment (SLI) occurs when children present language maturation, at least 12 months behind their chronological age in the absence of sensory or intellectual deficits, pervasive developmental disorders, evident cerebral damage, and adequate social and emotional conditions. The aim of this study was to classify a group of children according to the subtypes of SLI and to correlate clinical manifestations with cortical abnormalities. Seventeen children with SLI were evaluated. Language assessment was based on standardized test (Peabody) and a non-standardized protocol, which included phonological, syntactical, semantical, pragmatical and lexical aspects of language. All children, except one, had abnormal MRI. Thirteen children presented perisylvian polymicrogyria. The MRI findings in the remaining three patients were: right frontal polymicrogyria, bilateral fronto-parietal atrophy, and hypogenesis of corpus callosum with Chiari I. The data show that patients with posterior cortical involvement tended to present milder form of SLI (no sign of articulatory or bucofacial praxis disturbance), while diffuse polymicrogyric perisylvian cortex usually was seen in patients who presented severe clinical manifestation, mainly phonological-syntactic deficit. In conclusion, SLI may be associated with perisylvian polymicrogyria and clinical manifestation may vary according to the extent of cortical anomaly.
Cognitive dysfunction in congestive heart failure: transcranial Doppler evidence of microembolic etiology
Authors: Jesus Pedro A.P. , Vieira-de-Melo Rodrigo M. , Reis Francisco J.F.B. , Viana Leila C. , Lacerda Amanda , Dias Jesangeli S. , Oliveira-Filho Jamary
Published: August 2006

Cognitive symptoms are common in patients with congestive heart failure (CHF) and are usually attributed to low cerebral blood flow. In the present study, we aimed to evaluate global cognitive function (Mini Mental State Exam MMSE) in relation to both cardiac function (evaluated by echocardiogram) and cerebrovascular hemodynamics (evaluated by transcranial Doppler TCD) in CHF patients. In 83 patients studied, no correlation was found between echocardiographic parameters and MMSE scores. In contrast, a significant correlation was found between right middle cerebral artery (RMCA) mean flow velocity and MMSE score (r=0.231 p=0.039), as well as between RMCA pulsatility index and MMSE score (r s= -0.292 p=0.015). After excluding patients with a previous history of stroke, only RMCA pulsatility index correlated with MMSE score (r s=-0,314 p=0,007). The relationship between high cerebrovascular resistance and worse cognitive scores suggest that microembolism may be responsible for a significant proportion of cognitive symptoms in CHF patients.
OSP-Immunofluorescent remyelinating oligodendrocytes in the brainstem of toxically-demyelinated Wistar rats
Authors: Sallis Eliza Simone Viégas , Mazzanti Cinthia Melazzo , Mazzanti Alexandre , Pereira Luis Antonio Violin , Arroteia Kélen Fabíola , Fustigatto Rafael , Pelizzari Charles , Rodrigues Aline , Graça Dominguita Lühers
Published: August 2006

Central nervous system (CNS) remyelination following toxically-induced demyelination is a well known process. Oligodendrocytes constitute the bulk of the myelinating cells in the brain whereas Schwann cells overwhelm oligodendrocytes numbers in spinal cord remyelination. Despite the common knowledge of these facts, we still do not know completely the origin of both remyelinating cells. The present study investigated the participation of mature oligodendrocytes in remyelination after ethidium-bromide (EB) induced demyelination in the brainstem of normal and cyclosporin A-immunosuppressed Wistar rats. Thirty adult female rats were divided into three experimental groups. In group 1 the rats received a single intracisternal injection of 10 muL of 0.1% ethidium bromide (EB) in 0.9% saline (n=10); in group 2 the rats received the EB injection while immunosuppressed with cyclosporin A (n=10); in group 3 the rats received a single 10 muL injection of 0.9% saline while treated with cyclosporin A. The rats were killed at 15, 21 and 31 days after injection. Within the EB lesions, from 15 days onward many cells within the periphery of the lesions stained positive for OSP (oligodendrocyte specific protein) a marker for mature oligodendrocytes and myelin. This cell marking signals that, at least, part of the process of repairing the myelin sheaths is carried out by mature cells of the oligodendrocyte lineage.
Anatomia microcirúgica da substâcia perfurada anterior basal humana
Authors: D’Ávila Arlindo Alfredo Silveira , Schneider Felipe Luís
Published: August 2006

A substância perfurada anterior constitui referencial na base do encéfalo. Localizada acima da bifurcação subaracnóidea da artéria carótida interna em sua porção basal e junto à artéria comunicante anterior na face inter-hemisférica, é transfixada por ramos perfurantes dirigidos aos núcleos telencefálicos corticais, cápsula interna e parte do tálamo. Por injeção intravascular de gelatina carminada, resina de Batson e látex, analisamos 50 hemisférios cerebrais humanos adultos de ambos os sexos, sob o microscópio cirúrgico. Objetivamos contribuir para a determinação da origem, número e topografia dos ramos destinados a essa região, seu curso, anastomoses e territórios de penetração. Propusemo-nos também a analisar a contribuição da artéria comunicante anterior à substância perfurada anterior. Foram encontradas variações anatômicas, incluindo anastomoses, envolvendo principalmente a artéria cerebral média e a artéria coróidea anterior. Estes conhecimentos são de interesse clínico-cirúrgico em razão da freqüência de patologias vasculares e tumorais a ela relacionadas.
Relação entre tensão neural adversa e estudos de condução nervosa em pacientes com sintomas da sídrome do túnel do carpo
Authors: Mahmud Mahmud Ahmad Ismail , Merlo Álvaro Roberto Crespo , Gomes Irênio , Becker Jefferson , Nora Daniel Bocchese
Published: August 2006

O propósito deste estudo foi avaliar, através de uma série de casos, a relação entre tensão neural adversa do nervo mediano (TNAm) e o parâmetro eletrofisiológico em 38 pacientes com sintomas da síndrome do túnel do carpo (STC), submetidos a estudos de condução nervosa (ECN). As principais medidas foram a TNAm obtida no teste de provocação de tensão neural (TPTN) e parâmetros dos ECN, dividindo-se os braços avaliados em três grupos: normal, com alteração eletrofisiológica sem gravidade e com alteração eletrofisiológica grave. Correlação significante entre TNAm e parâmetros dos ECN foram encontrados (p<0,05), bem como entre a TNAm e os três grupos definidos pela alteração eletrofisiológica (r s=+0.437, p=0,002). Valores de TNAm foram significantemente maiores nos braços com diagnóstico eletrofisiológico (p=0,007). Sugere-se que a TNAm tem participação na fisiopatologia da STC, indicando o uso de procedimentos terapêuticos que diminuam ou previnam a tensão neural.
Cerebral metastasis of cervical uterine cancer: report of three cases
Authors: Cordeiro Joacir Graciolli , Prevedello Daniel Monte-Serrat , Ditzel Léo Fernando da Silva , Pereira Carlos Umberto , Araújo João Cândido
Published: August 2006

Cervical uterine cancer (CUC) spreads locally (pelvis and paraortic lymphnodes) or distantly (lungs, liver and bones). Metastasis to central nervous system (CNS) are rare. There are about 80 cases reported in the literature. Outcome is poor and survival varies from 3 to 6 months. Three cases of CNS metastasis from CUC are reported, one infratentorial and two supratentorials in location. In one patient, the initial manifestation was due to the cerebral lesion, a feature reported for the first time. All cases were treated by surgery, radiotherapy and/or chemotherapy. Clinical findings and treatment options of these rare lesions are reviewed.
Spontaneous artery dissection in a patient with Human Immunodeficiency Virus (HIV) infection
Authors: Felício André Carvalho , Silva Gisele Sampaio , Santos William Adolfo Celso dos , Pieri Alexandre , Gabbai Alberto Alain , Massaro Ayrton Roberto
Published: August 2006

BACKGROUND: The relationship between human immunodeficiency virus infection and stroke may be attributed in some cases to an underlying vasculopathy such as in spontaneous cervical arteries dissections. CASE REPORT: We report the case of an HIV-infected patient who developed a Wallemberg's syndrome due to a vertebral artery dissection. Screening laboratory exams showed hyperhomocysteinemia and also high C-reactive protein plasma levels. CONCLUSIONS: This is the first case describing the association between arterial dissection (AD) and HIV-infection. We suggest that AD should also be remembered as a possible mechanism of ischemic stroke in HIV-infected patients.
Estudo neurofisiológico na síndrome miastênica congênita do canal lento: relato de caso
Authors: Lorenzoni Paulo José , Kay Cláudia Suely Kamoi , Arruda Walter Oleschko , Scola Rosana Herminia , Werneck Lineu César
Published: August 2006

A síndrome do canal lento é uma das síndromes miastênicas congênitas atribuída a desordem dinâmica do canal iônico do receptor de acetilcolina da junção neuromuscular. Descrevemos o caso de um homem de 25 anos com progressiva ptose palpebral e limitação da movimentação ocular desde infância, que evoluiu há 6 anos com piora da oftalmoparesia externa e diminuição da força muscular em ombros e mãos. O estudo da condução nervosa motora após estímulo único demonstrou duplo potencial de ação muscular composto (PAMC) com desaparecimento do segundo após esforço de 30 segundos. Ao estímulo repetitivo dos nervos facial e acessório observou-se um decremento da amplitude do PAMC maior que 10% com desaparecimento do segundo potencial. O paciente fez uso de fluoxetina mostrando discreta melhora da força muscular, porém persiste com: ptose palpebral, limitação dos movimentos oculares e PAMC repetitivo ao estudo da condução nervosa motora. As características da doença são discutidas.
Displasia fibrosa do clivus: relato de caso
Authors: Falavigna Asdrubal , Borba Luis Alencar B. , Teles Alisson Roberto
Published: August 2006

Relatamos o caso de uma paciente de 43 anos com história de cefaléia crônica e diplopia. O exame neurorradiológico demonstrou aumento de volume e alteração na densidade óssea do clivus. Foi submetida a cirurgia e o exame anatomopatológico evidenciou displasia fibrosa. Foram relatados na literatura outros 14 casos de displasia fibrosa envolvendo o clivus. Discutimos essa rara apresentação da doença segundo o quadro clínico, exames de imagem, histologia e tratamento.
Metástase intramedular de carcinoma da tireóide: relato de caso
Authors: Holanda Maurus Marques de Almeida , Andrade Emerson Magno Fernandes de , Silva José Alberto Gonçalves da
Published: August 2006

Relata-se um caso de metástase intramedular de neoplasia da glândula tireóide em uma mulher de 70 anos queixando-se há três meses de dor cervical intensa, sem déficit motor focal nem alterações de sensibilidade. Seis meses antes do início dos sintomas, a paciente foi submetida a tireoidectomia total para ressecção de adenocarcinoma tireoideano. Ressonância magnética com contraste gadolíneo mostrou lesão intramedular. Foi realizada ressecção parcial do tumor medular que revelou ao exame anatomopatológico adenocarcinoma metastático. No pós-operatório a paciente desenvolveu monoplegia crural à esquerda.
Revascularização clínica e intervencionista no acidente vascular cerebral isquêmico agudo: opinião nacional
Authors: Raffin Cesar N. , Fernandes Jefferson Gomes , Evaristo Eli Faria , Siqueira Neto José Ibiapina , Friedrich Maurício , Puglia Paulo , Darwich Rogério
Published: August 2006

Este artigo apresenta as conclusões sobre revascularização clínica e intervencionista no acidente vascular cerebral isquêmico agudo, um dos temas discutidos na reunião "Opinião Nacional sobre o Tratamento do AVC". Tratou-se de reunião promovida e coordenada pela Sociedade Brasileira de Doenças Cerebrovasculares, com neurologistas especializados em doenças cerebrovasculares, que analisaram e discutiram as evidências e experiências atuais sobre o uso de trombólise e técnicas intervencionistas em pacientes com acidente vascular cerebral isquêmico agudo.
Estudo crítico da avaliação da maturidade fetal pela citologia do líquido âmnico: comparação com outros métodos
Authors: Almeida Pedro Augusto Marcondes de , Oliveira Ana Maria Bertini de , Porto Antonio Guilherme Moreira , Delascio Domingos , Vigorito Neusa Maria , Chow Prescilla , Amed Abes Mohamed , Dalla Ari , Boyacyan Krikor , Baugartner Adelheid
Published: August 2006

Através da amniocentese em 90 gestações de alto risco, foi feito estudo crítico da citologia do líquido amniótico pelo Sulfato de Azul do Nilo em comparação com a creatinina e o Rx simples de abdomen e sua relação com a idade do RN (calculados pelas tabelas de Lubchenco e Capurro). Concluiu-se que a técnica do Sulfato de Azul do Nilo apresenta real valor, nas nossas condições econômicas, com menor percentagem de falhas com os demais métodos, sendo melhor para a avaliação de maturidade fetal o emprego simultâneo de todos os métodos, aliados à clínica.
Importância dos animais sinantrópicos no controle da endemia chagásica
Authors: Rocha e Silva Eduardo Olavo da , Andrade José Carlos Rehder de , Lima Anísio Ribeiro de
Published: August 2006

Foi salientado que, em certas áreas, os métodos de rotina no controle dos vetores da doença de Chagas necessitam ser complementados por atividades de captura de resrevatórios do T. cruzi, especialmente no caso, marsupiais (Didelphis) e roedores (Rattus). Foram citados trabalhos realizados em alguns municípios da Região Administrativa 5 - Campinas, Estado de São Paulo, Brasil, onde a presença de reservatórios e triatomíneos semi-domiciliários (Panstrongylus megistus), nas moradias, propiciam condições à reintrodução do ciclo domiciliar do parasita. São comentados os resultados da pesquisa do Trypanosoma tipo cruzi, nesses triatomíneos e nos citados vertebrados, relacionando ainda os resultados com as reações de precipitina realizadas no sentido de detectar o tipo de sangue ingerido pelos P. megistus capturados.
Manual de normas e procedimentos do serviço de enfermagem de saúde pública
Authors: Andrade Odete Barros de
Published: August 2006

São apresentadas sugestões para elaboração de um manual de normas e procedimentos para serviços de enfermagem de saúde pública a nível local. A metodologia proposta descreve os procedimentos para cada fase, incluindo: análise da situação através da coleta, análise e interpretação de informações para determinar o conteúdo do manual; determinação das categorias de informações incluindo detalhamento e correção; organização com detalhes quanto à estruturação do conteúdo informativo e ordenação, seleção dos recursos materiais requeridos e montagem; considerações sobre utilização, avaliação e atualização do manual.
Utilização de leitos hospitalares gerais em Ribeirão Preto, São Paulo (Brasil)
Authors: Rocha Juan Stuardo Yazlle
Published: August 2006

Foi estudada a demanda de leitos hospitalares gerais do município de Ribeirão Preto, São Paulo (Brasil), no ano de 1972, pela população do município, a partir da utilização destes leitos. Valeu-se, para tanto, de um centro de informática de dados hospitalares. As características da demanda encontrada foram: elevado coeficiente de internação, baixo índice de hospitalização, curta duração média das internações (determinada por fatores demográficos e do sistema previdenciário de internações); utilização do índice de 2,43 leitos gerais/1.000 hab., naquele ano.
Atividades dos setores de epidemiologia e estatística no Centro de Saúde
Authors: Souza José Maria Pacheco de , Barbosa Victório , Laurenti Ruy , Gotlieb Sabina Lea , Silveira Maria Helena
Published: August 2006

São analisadas as atividades dos setores de epidemiologia e estatística no centro de saúde. As atividades de epidemiologia têm como objetivo geral caracterizar as doenças e problemas de saúde da região. As de estatística fornecem os dados necessários aos diversos setores do centro de saúde, incluindo-se os de epidemiologia e administração. São feitas sugestões para correção quantitativa e qualitativa dos dados obtidos. Algumas considerações são feitas sobre a possibilidade de aproveitamento dos setores de epidemiologia e estatística para ensino e treinamento.
Programa de saúde mental
Authors: Guimarães Cid , Silva Eunice P. Castro , Trancredi Francisco Bernardini , Souza José Maria Pacheco de , Silveira Maria Helena , Laurenti Ruy , Gotlieb Sabina Lea
Published: August 2006

É apresentado o programa de Saúde Mental decorrente de convênio estabelecido pela Secretaria da Saúde do Estado de São Paulo com a Universidade de São Paulo, através da Faculdade de Saúde Pública. Este convênio tem por finalidade a realização de estudos na área de Saúde Mental, tais como assistência psiquiátrica preventiva e pesquisas visando a medir transtornos mentais através de casos de óbito e na população da cidade e de cursos e atividades curriculares e extra-curriculares.
Indicador de quantidade e qualidade de vida e do nível de saúde
Authors: Tinôco Aldo da Fonseca
Published: August 2006

Estudos estão sendo desenvolvidos a partir da estrutura etária da população, no sentido de estabelecer um indicador do nível de saúde de coletividades e também da quantidade e da qualidade de vida. O nível de saúde de comunidade vem sendo fixado atualmente por inferência de dados de morbidade e mortalidade. Pressupõe-se que a estrutura etária da população seja o reflexo de um grande número de variáveis que condicionam o nível de saúde, a quantidade e a qualidade da vida, o que possibilitaria a determinação de um indicador positivo e direto. Propõe-se inicialmente um esquema, que decompõe a população em dois grupos de idade: 0 - 19 e 20 e mais anos de idade. A contribuição percentual do grupo de 0 - 19 para o total da população estabeleceria os níveis de saúde, bem como a quantidade e a qualidade de vida. São evidenciados os seguintes aspectos: a) populações com crescimento anual, superior a 4%, ocorrência possível de ser verificada nos chamados "polos" de desenvolvimento econômico intenso que funcionam como atração de imigrantes; b) populações onde se desenvolvem campanhas ou programas de vacinação em massa; c) populações onde se desenvolvem programas de controle de natalidade em massa.
Os laboratórios de saúde pública nos programas de saúde
Authors: Carvalho João Pessoa de Paula
Published: August 2006

Os laboratórios de saúde pública estão integrados a todo programa moderno de assistência médica e saúde pública. Em conseqüência, surgem problemas concernentes à demanda de serviços e recursos para satisfazê-la. Neste trabalho é apresentada e discutida a necessidade de maior reconhecimento da importância dos serviços e alguns fatores básicos a serem considerados no planejamento e organização de um sistema nacional unificado de serviços de laboratório de saúde pública.
Paracoccidioides brasiliensis, nova amostra isolada de fezes de um pinguim (Pygoscelis adeliae)
Authors: Garcia Nilma Maciel , Del Negro Gilda Maria Barbaro , Heins-Vaccari Elisabeth Maria , Melo Natalina Takahashi de , Assis Cezar Mendes de , Lacaz Carlos da Silva
Published: August 2006

Os Autores apresentam os resultados obtidos com a amostra "pinguim" de Paracoccidioides, isolada por GEZUELE et al. (1989) na Antártica uruguaia. Das fezes de um desses animais, foi isolado um fungo considerado, recentemente, como nova espécie de Paracoccididoides - P. antarclicus. Os exames micológico e imunoquímico demonstraram tratar-se de Paracoccidioides brasiliensis, inclusive com a verificação da presença da glicoproteína 43 kDa pelos métodos de imunodifusão dupla, SDS-PAGE e imunoeletroforese. A possibilidade de se tratar de uma variedade do Paracoccididoides brasiliensis somente poderá ser confirmada através de outros estudos baseados na chamada taxonomía molecular, incluindo cariotipagem. Os Autores registram o significado epidemiológico deste achado, sugerindo uma revisão nos conhecimentos do nicho ecológico do P. brasiliensis.
Effect of oxamniquine on cell adhesion to Schistosoma mansoni larvae in the peritoneal cavity of naive mice
Authors: Melo Alan Lane de , Pereira Leógenes Horácio
Published: August 2006

The treatment of naive mice with high closes of oxamniquine, 1 hour before the intraperitoneal inoculation of Schistosoma mansoni cercariae, induces a delay in the transformation process resulting in a longer host cell adhesion.
Schistosomiasis mansoni in an area of low transmission: II. Risk factors for infection
Authors: Marçal Júnior Oswaldo , Hotta Luiz Koodi , Patucci Rosa Maria de Jesus , Glasser Carmen Moreno , Dias Luiz Candido de Souza
Published: August 2006

Risk factors for Schistosoma mansoni infection were identified using a 1:1 matched case-control design. The work was conducted in the municipality of Pedro de Toledo, São Paulo State, Brazil, an area where the snail host is Biomphalaria tenagophila. Information on water contact patterns, knowledge, attitudes and pratices (kap), socioeconomic and sanitary conditions were obtained by mean of questionnaires. The crude odds ratio estimates and the adjusted odds ratio estimates using the logistic regression model are presented. Most of the examined individuals admitted recent water contacts (90.6% of the cases). The most frequent reason for contact was swimming, playing and fishing and the preferential site of contact was the river. According to the logistic regression technique, the main risk factors for infection were: a) water contact through swimming, playing and fishing; b) fording; c) bad hygiene. We concluded that recreational activities are the main reasons for schistosomiasis transmission in Pedro de Toledo and leisure alternatives should be offered to the local population.