Valve reconstruction in the Heart Institute of São Paulo,Brazil

In the Heart Institute of University of S?o Paulo Medical School, between 1980 and 2000, were performed 712 mitral valve repair procedures, 39 aortic valve repairs and 469 tricuspid valve repairs. In our experience with mitral valve repair, the most performed techniques were quadrangular resection of the posterior leaflet, posterior annuloplasty with bovine pericardial sling and Carpentier ring annuloplasty. Quadrangular resection of the posterior leaflet is the technique of choice in mitral regurgitation due to degenerative disease, and repair is possible in 90% of the cases. Since 1994, we perform the quadrangular resection without ring annuloplasty, a modification in the technique called "Double Teflon" technique, with good results. Aortic valve repair is performed in specific situations. In congenital aortic insufficiency, we perform the suspention of the prolapsed leaflets in the comissures. In rheumatic aortic insufficiency, when we found leaflet retraction, we elongate the leaflets with bovine pericardial patchs. Our experience of aortic valve repair, between 1980 and 2000, consists of a small group of 39 patients. The results are satisfactory, but these techniques are feasible only in selected cases. Tricuspid insufficiency is generally a consequence of annular enlargement in patients with mitral valve disease and we prefer the De Vega annuloplasty in these cases. In cases with large annulus dilatation, we prefer to use the "Revuelta" or the "bicuspidization" techniques. In patients with previous tricuspid repair and annulus distortion, we prefer to use bovine pericardial sling or Carpentier ring annuloplasty.     

Results of urgent liver retransplantation in the state of São Paulo, Brazil

The treatment of end-stage liver disease includes transplantation as a life-saving procedure although it has serious complications of hepatic artery thrombosis, liver dysfunction, or primary nonfunction, which frequently lead to the need for retransplantation. According to various reports, the incidence of retransplantation is around 10%. Given the critical organ shortage, the chance for a second transplant remains a controversial discussion in medical, ethical, and economic grounds because patient and graft survival rates after retransplantation are lower than those for primary transplantations. We retrospectively reviewed all of the urgent liver retransplants from October 2001 to February 2005 (52 months) by analyzing the number of retransplants, blood group, time between first and second liver transplantation, age, sex, and mortality. Data were obtained from the Transplantation System, State of Sao Paulo Health Secretariat. Among 1252 liver transplants performed during this period, 98 (7.82%) were urgent retransplantations. The primary procedure employed 955 (76.28%) deceased donors and 297 (23.72%) living donors. All 98 retransplants were performed using an organ from the pool of deceased donors. The retransplant rate was acceptable according to the literature, although we observed high rates of early mortality (<60 days), leading to a discussion of which patients had a better chance of survival and the best time to perform the second transplantation to use this scarce and precious resource in the best possible way.     

Liver transplantation: waiting list dynamics in the state of São Paulo, Brazil

S?o Paulo is the first Brazilian state to perform liver transplantation in 1968. Since then the recipient waiting list has increased; now approximately 150 new cases per month are referred to the single list at the central organ procurement organization. Official data have shown 37.3 monthly deaths on the waiting list in the state of S?o Paulo. The number of liver transplants has increased after the creation of S?o Paulo transplant notification centers but are insufficient to deal with the increasing waiting list. The aim of this study was to demonstrate the performance of our state liver transplantation program and analyze when the number of liver transplantations will meet our waiting list demand.     

The structural molecular biology network of the State of São Paulo, Brazil

This article describes the achievements of the Structural Molecular Biology Network (SMolBNet), a collaborative program of structural molecular biology, centered in the State of S?o Paulo, Brazil, and supported by S?o Paulo State Funding Agency (FAPESP). It gathers twenty scientific groups and is coordinated by the scientific staff of the Center of Structural Molecular Biology, at the National Laboratory of Synchrotron Light (LNLS), in Campinas. The SMolBNet program has been aimed at 1) solving the structure of proteins of interest related to the research projects of the groups. In some cases, the choice has been to select proteins of unknown function or of possible novel structure obtained from the sequenced genomes of the FAPESP genomic program; 2) providing the groups with training in all the steps of the protein structure determination: gene cloning, protein expression, protein purification, protein crystallization and structure determination. Having begun in 2001, the program has been successful in both aims. Here, four groups reveal their participation in the program and describe the structural aspects of the proteins they have selected to study.     

Groundwater resources in the State of São Paulo (Brazil): the application of indicators

Indicators, for groundwater resources, have mostly been employed to define the present status and the degradation tendency, regarding both quantity (under- or overexploitation) and quality (natural and anthropic contamination). This work presents the application of indicators in order to draw a picture of the groundwater resources situation in the 22 Water Resource Management Units (WRMU) of the State of S?o Paulo. The seven Indicators (I1 to I7) applied provide a general overview of groundwater dependence (I1, I2), availability (I3, I4), and quality (I5, I6, I7). Considering public supply (Indicator 1), one observes that 9 WRMUs show high (>50% of the population supplied by groundwater), 6, intermediate (49-25%), and 7, low (<24%) dependence on groundwater. Indicators 3 and 4 show that the resource still presents a great potential for further abstractions in most of the WRMUs, although there is evidence of overexploitation in the Upper Tietê, Turvo/Grande, and Pardo basins, and low availability in the Upper Tietê, Piracicaba/Capivari/Jundiai, and Turvo/Grande. Indicator 5 (aquifer natural vulnerability) denotes that the WRMUs 2, 4, 8, 13, 14 and 18-22 (part of the recharge area of Guarani Aquifer System) need more attention mainly where large contaminant loads are present. Indicator 6 shows the general excellent natural quality of groundwater, although it also denotes that 3 WRMUs need special consideration due to chromium and fluoride contamination. Indicator 7 demonstrates a close relationship between groundwater contamination occurrence and density/type of land occupation.     

Effect of the COVID-19 Pandemic on Organ Donation and Transplantation in São Paulo,Brazil

The COVID-19 pandemic has affected donation and transplantation activities in São Paulo, Brazil, as well as the patients receiving these organs. In this study, information from the database of the São Paulo Organ Allocation System was analyzed and compared 2 periods—before the pandemic and during the pandemic—to identify this effect. The COVID-19 pandemic interfered in the mortality rate and the time on the waiting list for heart, liver, pancreas, lung, and kidney transplants; the number of effective donors; and the use or disposal of available organs from deceased donors. It also reduced the transplant activity with living donors. Regarding the activity of eye tissue transplantation, the time on the waiting list increased and the number of transplant procedures decreased. The kidney transplant program was the most affected in our study. There was an increase in waiting time and mortality in the waiting list for this organ and also a decrease in kidney utilization rates.     

Vitamin D deficiency and seasonal variation over the years in São Paulo,Brazil

Summary

Brazil is a tropical/subtropical geographic area with elevated ultraviolet (UV) radiation. We report very high prevalence of vitamin D deficiency in a large database of Brazilian subjects and show seasonal and reciprocal relationship between vitamin D and parathyroid hormone (PTH) over the years in this tropical area.

Introduction

We aim to examine the prevalence of vitamin D deficiency, characterize the temporal relationship between 25-hydroxyvitamin D levels (25(OH)D) and intact PTH (iPTH) according to seasons, and investigate potential associations between 25(OH)D levels and extra-skeletal outcomes in a Brazilian population.

Methods

We retrospectively determined population weekly mean concentrations of unpaired 25(OH)D and iPTH using 39,004 laboratory results of Brazilian individuals of both genders aged 2 to 95 years. The 25(OH)D and iPTH distributions were normalized, and the means fit with a sinusoidal function. Potential associations between 25(OH)D serum levels and inflammatory markers, fasting glucose, HbA1c and Homeostasis Model Assessment index (HOMA) were examined.

Results

Of the samples, 33.9 % had 25(OH)D serum concentrations lower than 20 ng/mL, while the vast majority (70.7 %) were found to be vitamin D deficient or insufficient (<30 ng/mL). Vitamin D deficiency was significantly higher during the winter as compared to the summer (38.4 % <20 ng/mL and 75.5 % <30 ng/mL versus 23.3 % <20 ng/mL and 62.5 % <30 ng/mL, respectively; p?<?0.001). Seasonal variation was observed for both 25(OH)D and iPTH. 25(OH)D peaks occurred in March and troughs in September. iPTH levels showed an inverted pattern of peaks and troughs with a delay of 1?±?5 week. 25(OH)D was significantly associated with inflammatory markers but not with glucose homeostasis.

Conclusions

A sinusoidal interrelationship has been detected between vitamin D and PTH in this tropical population. A large percentage of the individuals showed vitamin D deficiency. Public health strategies are needed to better understand and manage this very high and apparently contradictory prevalence of vitamin D deficiency.

     

Pediatric liver transplantation: fourteen years of experience at the children institute in São Paulo, Brazil

This study reports the 14-year experience of a single center on 206 liver transplantations from living and cadaveric donors performed in 179 pediatric patients. Biliary atresia (57.2%) and fulminant hepatitis (9.8%) were the most frequent indications. The mean age of the recipients was 3 years, 7 months (9 months to 18 years) and mean weight was 14 kg (7 to 57 kg). The allografts were distributed as 82 (39.8%) whole cadaveric, 76 (36.9%) reduced-size cadaveric, 46 (22.3%) living donor liver transplants, and 2 (0.9%) ex situ split livers. The waiting periods were 25 days for living donors and 2.5 years for cadaveric donors (P <.001). Twenty-seven children were retransplanted with hepatic artery thrombosis the most frequent indication. The postoperative complications were: primary nonfunction (12.2%), biliary stenosis (28.8%), hepatic artery thrombosis (12.2%), portal vein stenosis (4.9%), hepatic vein stenosis (6.9%), and lymphoproliferative disorder (5.9%). The diagnosis of biliary stenosis was obtained by liver biopsy and transhepatic cholangiography and treated by balloon dilatation, although four children (3.9%) required a redo hepaticojejunostomy. The venous stenoses were percutaneously dilated with five-children (4.9%) requiring venous stents. The incidence of hepatic vein stenosis was 15.6% among living donor and 2.5% in cadaveric liver transplantation (P <.05). The overall 5-year patient and graft survivals were 70.2% and 65.1%. Liver transplantation provides excellent long-term survival. The use of grafts from living donors decreases the waiting periods but increases the incidence of hepatic vein stenosis.     

Knowledge, attitude and practice of breast self-examination in a female population of metropolitan São Paulo

OBJECTIVE: Evaluation of the knowledge, attitude and practice of breast self-examination in different groups of women in S?o Paulo. METHODS: Application of a questionnaire to 392 women divided in four groups. Group one: 101 patients of the National Health Service, Group two: 95 female physicians; Group three: 95 female medical students; and Group four: 101 wives of gynecologists. RESULTS: Self-examination was performed by 90.3% of women, Group 1 having the lowest rate, 69.3%. However, proper self-examination (performed monthly or once per cycle, after menstrual period, with at least one stage in standing or sitting up position) was performed by only 30.4%, the poorest performance being found in Group 1 (15.7%) and the best one in Group 2 (43.6%). For women in Group 1, "mass media" was the most important source of information on breast self-examination, whereas for the other groups, it was "medical sources". CONCLUSION: The majority of women are knowledgeable about breast self-examination but perform it improperly, this finding being more common among women who depend on the National Health Service, who represent a section of the general population. As breast self-examination remains an important tool in countries with limited resources, this study confirms the importance of disseminating proper information, and that more investment should be made in awareness campaigns.     

Radiocarbon geochronology of the sediments of the São Paulo Bight (southern Brazilian upper margin)

The aim of this work was to generate an inventory of the data on radiocarbon datings obtained from sediments of the S?o Paulo Bight (southern Brazilian upper margin) and to analyze the data in terms of Late Quaternary sedimentary processes and sedimentation rates. A total of 238 radiocarbon datings from materials collected using differents ampling procedures was considered for this work. The sedimentation rates varied from less than 2 to 68 cm.kyr(-1). The highest sedimentation rate values were found in a low-energy (ría type) coastal system as well as in the upwelling zones of Santa Catarina and Cabo Frio. The lowest rates were found on the outer shelf and upper slopes. Our results confirm the strong dependency of the shelf currents, with an emphasis to the terrigenous input from the Río de La Plata outflow which is transported via the Brazilian Coastal Current, as well as of the coupled Brazil Current - Intermediate Western Boundary Current (BC-IWBC) dynamics on the sedimentary processes. At least three indicators of the paleo sea level were found at 12200 yr BP (conventional radiocarbon age) (103 meters below sea level - mbsl), 8300-8800 cal yr BP (13 mbsl) and 7700-8100 cal yr BP (6 mbsl).     

Over 500 pancreas transplants by a single team in São Paulo, Brazil

Pancreas transplantation (PT) remains a developing practice in Latin America. From 1996 to 2009, 506 PTs were performed by our team in the following categories: simultaneous pancreas-kidney (SPK), simultaneous deceased donor pancreas and living-donor kidney (SPLK), pancreas after kidney (PAK), and pancreas transplant alone (PTA). Enteric drainage was preferred for SPK and bladder drainage for solitary PT or SPLK. Immunosuppression was with tacrolimus, mycophenolate mofetil, and steroids, and anti-lymphocytic drugs were used to induce solitary PT and SPLK. The series includes 254 SPK, 60 SPLK, 94 PAK, and 98 PTA. The one-yr patient survivals were 82% for SPK, 90% for SPLK, 95% for PTA, and 93% for PAK. The one-yr pancreas graft survivals were 70% for SPK, 86% for SPLK, 86% for PAK, and 77% for PTA. The one-yr kidney graft survivals were 77.5% for SPK and 89% for SPLK. This represents the largest reported PT series in Latin America. Results comparable to those of developed countries were achieved, with the exception of the SPK category. This has led our program to prioritize solitary PT and SPLK.     

A survey of diseases in Passeriform birds obtained from illegal wildlife trade in São Paulo City, Brazil

The order Passeriformes comprises the largest number of families and species of birds of any avian order. Brazil is rich in passerine birds, which are a common victim of wildlife trafficking in Brazil. Annually, many birds die as a consequence of illegal trade. To investigate the occurrence of the principle diseases and to identify the main causes of death in smuggled passerine birds, the cause of death was evaluated in 360 passerine birds confiscated within the city of S?o Paulo, Brazil. Causes of death were determined by anatomopathologic and microbiologic studies. Infectious diseases were the cause of death of most birds, which corresponded to 78.6% of cases. The most common infectious diseases were poxvirus infection, aspergillosis, and coccidiosis. Although the etiologic agents of these diseases can coexist asymptomatically within hosts, once the host's immunity is compromised, the pathogen multiplies quickly and causes disease. The results of this study may help to improve the care of passerine birds in captivity and increase the survival rate of confiscated birds. Results may also be useful for in situ conservation programs that investigate the reintroduction of confiscated species or captive birds.     

Severe facial trauma: control of the upper airway?

This is the case report of a 16-year-old male who suffered major facial trauma in a road traffic accident (unhelmeted scooter rider against signpost). During prehospital care, he was stable and awake. He was admitted to the emergency room of our university hospital and rapidly transferred, in a sitting position and breathing spontaneously, to the operating room for emergent surgical tracheostomy under local anaesthesia and sedation. This procedure turned out to be difficult (sitting position, patient uncooperative) and ventilatory compromise led us to intubate the patient without difficulties: indeed, supraphysiological mouth aperture (due to multifocal mandible fractures) and presence of supraglottic bubbling under spontaneous ventilation facilitated intubation in spite of major oropharyngeal bleeding. This allowed rapid restoration of adequate ventilation and tracheostomy was performed under standard conditions without further problems. This case report confirms the superiority of orotracheal intubation under light sedation over emergent tracheostomy in this type of situation, as stated under the SFAR guidelines.     

Nocturia is not associated with falls among the elderly: a population study in the city of São Paulo

Introductionthe present study aims to evaluate the association between nocturia and falls in a group of community-living elderly men in the city of São Paulo (Brazil).Material and methodsunder the coordination of the Pan American Health Organization and World Health Organization, a multicenter study named Health, Welfare and Aging (SABE Study) is being conducted to evaluate the living and health conditions of older people in Latin America and Caribbean. In Brazil, this study is evaluating the elderly population (60 years or more) in São Paulo since 2000. The presence of nocturia was taken as the response “yes” to the question “Do you need to void three times or more at night?” .The presence of falls was also taken as the response “yes” to the question “Did you have any fall during the last 12 months?” The intergroup analysis used was the logistic regression.Resultstotal of 865 men was interviewed, mean age 68 years. It was observed high prevalence of nocturia and falls in all groups, with higher prevalence of both in the eldest group (p < 0.001), however, the association of nocturia and falls was not statistically significant in any of the groups (p = 0.45).Conclusionthis is one of the pioneering studies that assess only the male population, showing that nocturia was not significantly associated with falls. Nocturia and falls are highly prevalent conditions in the elderly, but no association was found between both, so that these variables may be correlated to age and other clinical conditions.     

Human herpesvirus-8 infection in hemodialysis patients from São Paulo, Brazil: preliminary results

Epidemiological studies conducted in endemic areas of human herpesvirus 8 (HHV-8) infection have shown iatrogenic Kaposi's sarcoma in renal transplant recipients. Hemodialysis has not yet been demonstrated to be a route of virus transmission/acquisition, although recently blood transfusion has been suggested as a vehicle of HHV-8 transmission. The present study searching HHV-8 antibodies among serum samples from 70 hemodialysis patients disclosed a high prevalence of infection (22.9%). There was an association between HHV-8 seroreactivity and previous transfusions and transplantation, as well as with a black/pardum ethnic background of patients. These results emphasized that chronic renal patients are at risk of developing HHV-8-related diseases.