Risk adjustment measures for mortality after hip fracture

OBJECTIVE: To assess factors associated to mortality in patients with hip fracture and to describe different risk adjustment measures. METHODS: Non-concurrent cohort study comprising 390 patients aged 50 years and more. Patients were identified from the Brazilian Unified Health System Hospital Information System, admitted for hip fracture surgery in a teaching hospital in Rio de Janeiro, southeastern Brazil, between 1995 and 2000. Data from medical records were collected and analyzed by logistic regression models to study 90-day mortality odds after admission according to patient and treatment profiles. Severity of illness classification indexes were estimated. RESULTS: Mortality rate was 7.4% and factors affecting mortality were age (OR=1.06; 95% CI: 1.02;1.11), number of co-morbidities (OR=1.44; 95% CI: 1.12;1.69), Charlson co-morbidity index (OR=6.67; 95% CI: 2.98;22.16) and time to surgery (OR=1.04; 95% CI: 1.02;1.07). CONCLUSIONS: Number of co-morbidities and Charlson co-morbidity index helped predicting the mortality rate.     

Distribution of HLA-A, -B and -DRB1 antigenic groups and haplotypes from the Brazilian bone marrow donor registry (REDOME)

To improve assistance for patients awaiting a bone marrow transplant from an unrelated donor, it is important to genetically characterize the Brazilian volunteer bone marrow donors registry (REDOME). Our objective was to describe the antigenic groups and haplotype frequencies of HLA-A, HLA-B and HLA-DRB1 in the five regions of Brazil and by self-reported ethnicity groups using the REDOME data. Our study included 3,038,286 individuals. HLA antigenic groups and haplotype frequencies were estimated using an Expectation-Maximization (EM) algorithm. All described HLA-A*, HLA-B* and HLA-DRB1* groups were identified in this study. A*02 (25.9%), B*35 (11.8%) and DRB1*13 (13.4%) are the most frequent antigenic groups in REDOME, and the A*01-B*08-DRB1*03 haplotype is the most frequent in the registry. The antigenic group and haplotype frequency data obtained in this study could be helpful for national donor recruitment strategies across the country.     

Leishmaniasis in Portugal: enzyme polymorphism of Leishmania infantum based on the identification of 213 strains

This study reports isoenzyme polymorphism of Leishmania strains isolated in different regions of Portugal between 1982 and 2005. A total of 213 strains were obtained from cases of visceral and cutaneous leishmaniasis isolated from immunocompetent patients (adults and children) and immunocompromised adults, as well as from dogs and sandflies. Four zymodemes were identified: MON-1, MON-24, MON-29 and MON-80. Zymodeme MON-1 was identified in 96.7% of the strains, predominating in both immunocompetent and immunocompromised human patients, and it was the only zymodeme isolated from dogs. Isoenzyme diversity in HIV-infected patients was higher than in the immunocompetent group, in which all the strains from visceral leishmaniasis were MON-1. The domestic dog was confirmed as the reservoir host of zoonotic leishmaniasis in Portugal and Phlebotomus perniciosus and Phlebotomus ariasi as vectors. The overall low enzyme polymorphism observed in the Portuguese foci contrasts with the neighbouring foci in Spain.     

Astrocyte-derived GDNF is a potent inhibitor of microglial activation

Neuroinflammation is recognized as a major factor in Parkinson's disease (PD) pathogenesis and increasing evidence propose that microglia is the main source of inflammation contributing to the dopaminergic degeneration observed in PD. Several studies suggest that astrocytes could act as physiological regulators preventing excessive microglia responses. However, little is known regarding how astrocytes modulate microglial activation. In the present study, using Zymosan A-stimulated midbrain microglia cultures, we showed that astrocytes secrete factors capable of modulating microglial activation, namely its phagocytic activity and the production of reactive oxygen species since both parameters were highly diminished in cells incubated with astrocytes conditioned media (ACM). Glial cell line-derived neurotrophic factor (GDNF), cerebral dopamine neurotrophic factor (CDNF) and brain-derived neurotrophic factor (BDNF), known to have a neuroprotective role in the nigrostriatal system, are among the candidates to be astrocyte-secreted molecules involved in the modulation of microglial activation. The effect of ACM on Zymosan A-induced microglial activation was abolished when the GDNF present in the ACM was abrogated using a specific antibody, but not when ACM was neutralized with anti-CDNF, anti-BDNF or with a heat-inactivated GDNF antibody. In addition, media conditioned by astrocytes silenced for GDNF were not able to prevent microglial activation, whereas supplementation of non-conditioned media with GDNF prevented the activation of microglia evoked by Zymosan A. Taken together, these results indicate that astrocyte-derived GDNF plays a major contribution to the control of midbrain microglial activation, suggesting that GDNF can protect from neurodegeneration through the inhibition of neuroinflammation.     

Nurse, haemodialysis, patient: is our caring based within a helping relationship?

Due to our experience in haemodialysis (HD) we became interested in evaluating the quality of care given during HD treatment. In May 1994, we conducted a cross sectional survey comparing the assessment of the total interaction between nurses and haemodialysis patients in a Lisbon dialysis facility. Our purpose was to identify nurses' and patients' opinion on the total interaction established during the dialysis treatment among both groups.     

Age-related changes in natural killer cell receptors from childhood through old age

Most studies on natural killer (NK) cells and aging have focused on overall cell numbers and global cytotoxic activity. NK cell functions are controlled by surface receptors belonging to three major families: killer cell immunoglobulin-like receptors (KIRs), natural cytotoxicity receptors (NCRs), and C-type lectins. The expression of these receptors was investigated from childhood through old age in T, NKT- and NK cells and also in the CD56(dim) (cytotoxic) and CD56(bright) (responsible for cytokine production) NK cell subsets. A decrease in the expression of activating receptors (NKp30 and NKp46) was observed in NK cells in elderly individuals. KIR expression was increased only in the CD56(bright) subset. Children presented similar results regarding expression of NKp30 and KIR, but not NKp46. NKG2D expression was decreased in T cells of elderly subjects. Analysis of KIR genotype revealed that KIR2DL5 and KIR2DS3 were significantly associated with old age. Cytotoxic activity was preserved from childhood through old age, suggesting that the increase of the absolute number of CD56(dim), observed in elderly, may represent a compensatory mechanism for the receptor expression alterations. This initial study provides the framework for more focused studies of this subject, which are necessary to determine whether the changing balance of NK receptor expression may influence susceptibility to infectious, inflammatory, and neoplastic diseases.     

Evaluation of lesion clustering in irradiated plasmid DNA

PURPOSE: To measure the yield of DNA strand breaks and clustered lesions in plasmid DNA irradiated with protons, helium nuclei, and y-rays. MATERIALS AND METHODS: Plasmid DNA was irradiated with 1.03, 19.3 and 249 MeV protons (linear energy transfer = 25.5, 2.7, and 0.39 keV microm(-1) respectively), 26 MeV helium nuclei (25.5 keV microm) and gamma-rays (137Cs or 60Co) in phosphate buffer containing 2 mM or 200 mM glycerol. Single-and double-strand breaks (SSB and DSB) were measured by gel electrophoresis, and clustered lesions containing base lesions were quantified by converting them into irreparable DSB in transformed bacteria. RESULTS: For protons, SSB yield decreased with increasing LET (linear energy transfer). The yield of DSB and all clustered lesions seemed to reach a minimum around 3 keV microm(-1). There was a higher yield of SSB, DSB and total clustered lesions for protons compared to helium nuclei at 25.5 keV microm(-1). A difference in the yields between 137Cs and 60Co gamma-rays was also observed, especially for SSB. CONCLUSION: In this work we have demonstrated the complex LET dependence of clustered-lesion yields, governed by interplay of the radical recombination and change in track structure. As expected, there was also a significant difference in clustered lesion yields between various radiation fields, having the same or similar LET values, but differing in nanometric track structure.     

Routine CD4 monitoring in HIV patients with viral suppression: Is it really necessary? A Portuguese cohort

Purpose

CD4 cell-count has been regarded as the key surrogate marker for prognostic staging and therapeutic monitoring of HIV-infected individuals. Our purpose was to assess the probability of maintaining a CD4 count >200 cells/μL in patients with continuous viral suppression and CD4 cell counts >200 cells/μL.

Percutaneous mitral valvuloplastry in a pregnant woman guided only by the transesophageal echocardiography

Mitral valve stenosis is the most common valve lesion in pregnancy. In spite of an optimized clinical treatment and a favorable valve anatomy according to Wilkins and Block score, in symptomatic patients, percutaneous intervention is shown to be of great importance. In these patients, avoiding x-ray exposure as much as possible is recommended so as to protect the fetus from the deleterious effects of ionizing radiation. In this case report, a 24-year old pregnant patient with severe mitral stenosis (valve area of 0.9 cm(2)) was successfully submitted to a TEE-guided percutaneous treatment, without the use of x-ray.