Centro Medico

Sala, Brazil

Centro Medico

Sala, Brazil
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Petersson F.,Charles University | Petersson F.,National University of Singapore | Vanecek T.,Charles University | Michal M.,Charles University | And 13 more authors.
Human Pathology | Year: 2012

To date, only a few cases of "rosette forming t(6;11), HMB45-positive renal carcinoma" have been published. In this article, we contribute further data on 4 cases of this rare entity. Patients were 3 women and 1 man with an age range of 20 to 54 years (median, 23 years). Follow-up (range, 3-5 years; median, 4 years) did not reveal any metastatic events or recurrences. All tumors were well circumscribed and mostly encapsulated with homogeneous gray to tan cut surfaces. No necrosis was seen. All tumors displayed a solid or solid/alveolar architecture and contained occasionally long and branching tubular structures composed of discohesive neoplastic cells and pseudorosettes. The presence of pseudorosettes was a constant finding, but the number of pseudorosettes varied significantly among cases. All cases displayed focal immunoreactivity for the melanocytic marker HMB45, cathepsin K, and vimentin. Melan A, tyrosinase, cytokeratins, CD10, and microphthalmia transcription factor were each positive in 3 of 4 cases. On ultrastructural examination, numerous electron-dense secretory cytoplasmic granules with some resemblance to melanosomes were identified. The pseudorosettes were composed of reduplicated basement membrane material surrounded by small lymphocyte-like neoplastic cells. Using reverse transcription polymerase chain reaction, 2 tumors were positive for the Alpha-TFEB fusion transcript. The presence of the translocation t(6;11)(Alpha-TFEB) was confirmed in 2 analyzed cases. No von Hippel-Lindau tumor suppressor gene mutation, promotor methylation or loss of heterozygosity of 3p was found. Losses of part of chromosome 1 and chromosome 22 were found in one case. © 2012 Elsevier Inc. All rights reserved.


Brugo Olmedo S.,Centro Medico | De Vincentiis S.,Centro Medico | De Martino E.,Centro Medico | Bedecarras P.,CONICET | And 4 more authors.
PLoS ONE | Year: 2013

Background and aim of the study:Serum anti-Müllerian hormone (AMH) is a reliable marker of ovarian reserve, and it has been shown to be correlated with reproductive outcomes in grouped analyses. However, practical data is scarce for the physician and the patients to predict these outcomes in an individual couple according to serum AMH measured prior to assisted reproduction technology (ART) procedures.Study Design:To address this question, we performed an analytic observational study including 145 females undergoing intracytoplasmic sperm injection (ICSI) in a single center. Results were analyzed according to serum AMH; subgroup analyses were performed by grouping patients according to patient's age and FSH levels.Results:The risk of cycle cancelation decreased from 64% in patients with serum AMH ≤3 pmol/L (0.42 ng/mL) to 21% with AMH ≥15 pmol/L (2.10 ng/mL). Cycle cancelation occurred in approximately two-thirds of the patients with AMH ≤ 3 pmol/L irrespective of the FSH level. However, with higher AMH values the risk of cycle cancelation decreased more significantly in patients with normal FSH. The rate of good response increased from almost null in patients with AMH ≤3 pmol/L to 61% in those with AMH ≥15 pmol/L. The positive correlation between good response and AMH was also significant, but with lower absolute rates, when patients were grouped according to their age or FSH levels. Pregnancy rate increased moderately, but significantly, from 31% with AMH ≤3 pmol/L to 35% with AMH ≥15 pmol/L.Conclusions:We provide estimates of reproductive outcomes according to individualized values of serum AMH, in general and in subgroups according to patient's age or serum FSH, which are helpful for the clinician and the couple in their decision making about starting an assisted reproductive treatment. © 2013 Brugo Olmedo et al.


PubMed | Clinica de Golf, Hospital Universitario, University of La Sabana, Hospital Luis Vernaza and 16 more.
Type: Journal Article | Journal: Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis | Year: 2014

The present document has been prepared by a group of experts, members of Cardiology, Endocrinology, Internal Medicine, Nephrology and Diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high- risk population, usually underestimated and undertreated. These recommendations results from presentation and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming both physicians and patients from effectively adhering to guideline recommendations.


PubMed | Centro Medico, Cardica, Hospital Civil Of Guadalajara Dr Juan I Menchaca Guadalajara Jal, Hospital General Naval Of Alta Especialidad and 10 more.
Type: | Journal: Archivos de cardiologia de Mexico | Year: 2016

The aim of this paper is to compare the state of Cardiac Rehabilitation Programs (CRP) in 2009 with 2015. We shall focus on assistance, training of health-providers, research and the implementation barriers.All authors of RENAPREC-2009, and other cardiac rehabilitation leaders in Mexico were requested to participate. These centers were distributed in two groups: RENAPREC-2009 centers that participated in 2015 and the new CRP units.In 2009 there were 14 centers, two of them disappeared and another two did not respond. CRP-units increased 71% (n=24), and their geographic distribution shows a centripetal pattern. The coverage of CRP-units was 0.02 centers per 100,000 inhabitants. Only 4.4% of eligible patients were referred to CRP, with a rate of 10.4 patients/100,000 inhabitants in 2015. The ratio of Clinical Cardiologists to Cardiac Rehabilitation Specialists is 94:1, and the ratio of Intervention Specialists to cardiac rehabilitation experts is 16:1. Cardiac rehabilitation activities and costs varied widely. Patients dropout rate in phase II was 12%. Several barriers were identified: financial crisis (83%), lack of skilled personnel (67%), deficient equipment (46%), inadequate areas (42%) and a reduced number of operating centers (38%).CRPs in Mexico are still in the process of maturing. Mexican CRP-centers have several strengths like the quality of the education of the professionals and multidisciplinary programs. However, the lack of reference of patients and the heterogeneity of procedures are still their main weaknesses.


PubMed | World Wide Clinical Trials, Das Consulting, Medsantrud City Clinical Hospital and 23, The Good and 12 more.
Type: Clinical Trial, Phase III | Journal: The Lancet. Infectious diseases | Year: 2016

Community-acquired bacterial pneumonia (CABP) is a leading cause of morbidity and mortality, and treatment recommendations, each with specific limitations, vary globally. We aimed to compare the efficacy and safety of solithromycin, a novel macrolide, with moxifloxacin for treatment of CABP.We did this global, double-blind, double-dummy, randomised, active-controlled, non-inferiority trial at 114 centres in North America, Latin America, Europe, and South Africa. Patients (aged 18 years) with clinically and radiographically confirmed pneumonia of Pneumonia Outcomes Research Team (PORT) risk class II, III, or IV were randomly assigned (1:1), via an internet-based central block randomisation procedure (block size of four), to receive either oral solithromycin (800 mg on day 1, 400 mg on days 2-5, placebo on days 6-7) or oral moxifloxacin (400 mg on days 1-7). Randomisation was stratified by geographical region, PORT risk class (II vs III or IV), and medical history of asthma or chronic obstructive pulmonary disease. The study sponsor, investigators, staff, and patients were masked to group allocation. The primary outcome was early clinical response, defined as an improvement in at least two of four symptoms (cough, chest pain, sputum production, dyspnoea) with no worsening in any symptom at 72 h after the first dose of study drug, with a 10% non-inferiority margin. The primary analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT-01756339.Between Jan 3, 2013, and Sept 24, 2014, we randomly assigned 860 patients to receive solithromycin (n=426) or moxifloxacin (n=434). Patients were followed up to days 28-35 after first dose. Solithromycin was non-inferior to moxifloxacin in achievement of early clinical response: 333 (782%) patients had an early clinical response in the solithromycin group versus 338 (779%) patients in the moxifloxacin group (difference 029, 95% CI -55 to 61). Both drugs had a similar safety profile. 43 (10%) of 155 treatment-emergent adverse events in the solithromycin group and 54 (13%) of 154 such events in the moxifloxacin group were deemed to be related to study drug. The most common adverse events, mostly of mild severity, were gastrointestinal disorders, including diarrhoea (18 [4%] patients in the solithromycin group vs 28 [6%] patients in the moxifloxacin group), nausea (15 [4%] vs 17 [4%] patients) and vomiting (ten [2%] patients in each group); and nervous system disorders, including headache (19 [4%] vs 11 [3%] patients) and dizziness (nine [2%] vs seven [2%] patients).Oral solithromycin was non-inferior to oral moxifloxacin for treatment of patients with CABP, showing the potential to restore macrolide monotherapy for this indication.Cempra.


Lopez-Jaramillo P.,Santander University | Sanchez R.A.,Hospital Universitario | Diaz M.,Clinica Platinum | Cobos L.,Colegio Panamericano Del Endotelio | And 17 more authors.
Journal of Hypertension | Year: 2013

The present document has been prepared by a group of experts, members of cardiology, endocrinology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of 'metabolic syndrome' is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that 'metabolic syndrome' is a useful nosographic entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particularly high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations. © 2013 Wolters Kluwer Health | Lippincott Williams Wilkins.


The International Association of HealthCare Professionals is pleased to welcome Jaime R. Reyes, MD, General Practitioner, to their prestigious organization with his upcoming publication in The Leading Physicians of the World. He is a highly trained and qualified general practitioner with a vast expertise in all facets of his work. Dr. Reyes has been in practice for more than 30 years and is currently the Medical Director of Centro Medico Capilar in Cuenca, Ecuador. Furthermore, he is affiliated with San Juan De Dios Hospital. Dr. Jaime R. Reyes received his Doctor in Medicine and Surgery Degree in 1986 at Ecuador’s Cuenca State University. Following his graduation, Dr. Reyes completed residencies in Anesthesia and Surgery. He then moved to the United States to start his training in Hair Restoration Surgery, before returning to practice in Ecuador. In July 2014 He moved to Calgary, Canada to joint Dr. Louis Grondin to developed Hair Restoration Institute, a division of Sante Medical Group. In October 2016 he joint forces to Dr. Jeffrey Marvel from Nashville, Tennessee to establish “Nashville Hair Clinic”, a estate of the art hair transplant clinic located in the heart of the country music c Dr. Reyes is now the Clinical Director of Nashville Hair Clinic in Tennessee and often travels to Ecuador to continue attending his busy practice at Centro Medico Capilar. He maintains professional memberships with the International Society of Hair Restoration, the American Academy of Aesthetic Medicine, The American Academy of Anti-aging Medicine and the International Association of Healthcare Professionals. Dr. Reyes attributes his success to working with a great team, as well as always being open and honest with his patients. When he is not working, Dr. Reyes enjoys soccer, martial arts training, and spending time with his children. Learn more about Dr. Reyes by reading his upcoming publication in The Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics.  Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review.  FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise.  A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life.  Click here for more information about FindaTopDoc.


Bittencourt L.K.,Federal University of Rio de Janeiro | Matos C.,Free University of Colombia | Coutinho A.C.,Centro Medico
Magnetic Resonance Imaging Clinics of North America | Year: 2011

Recent technological achievements have enabled the transposition of diffusion-weighted imaging (DWI) with good diagnostic quality into other body regions, especially the abdomen and pelvis. Many emerging and established applications are now being evaluated on the upper abdomen, the liver being the most studied organ. This article discusses imaging strategies for DWI on the upper abdomen, describes the clinical protocol, and reviews the most common clinical applications of DWI on solid abdominal organs. © 2011 Elsevier Inc.


Andrioli M.,Centro Medico | Valcavi R.,Centro Palmer
Frontiers of Hormone Research | Year: 2016

Ultrasonography (US) represents the most sensitive and efficient method for the evaluation of the thyroid and parathyroid glands. Infectious and autoimmune thyroiditis are common diseases, usually diagnosed and followed up by clinical examination and laboratory analyses. Nevertheless, US plays an important role in confirming diagnoses, predicting outcomes and, in autoimmune hyperthyroidism, in titrating therapy. Conversely, in nodular thyroid disease US is the imaging method of choice for the characterization and surveillance of lesions. It provides consistent clues in predicting the risk of malignancy, thus directing patient referral for fine-needle aspiration (FNA) biopsy. Suspicious US features generally include marked hypoechogenicity, a shape taller than it is wide, ill-defined or irregular borders, microcalcifications and hardness at elastographic evaluation. Finally, the role of US in thyroid cancer is to evaluate extension beyond the thyroid capsule and to assess nodal metastases or tumor recurrence. The main application of US in parathyroid diseases is represented by primary hyperparathyroidism. In this condition, US plays a role after biochemical diagnosis, and it should always be strictly performed for localization purposes. In both thyroidal and parathyroid diseases, US is recommended as a guide in FNA biopsies. © 2016 S. Karger AG, Basel.

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