Marilia Medical School Famema

Marília, Brazil

Marilia Medical School Famema

Marília, Brazil
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PubMed | Marilia Medical School FAMEMA, São Paulo State University, University of Campinas and University of Sao Paulo
Type: Journal Article | Journal: JMIR research protocols | Year: 2016

Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. CEA has been considered the first-line treatment for carotid stenosis worldwide, and the safety and efficacy of CAS compared to CEA remains in question.The purpose of this study is to compare the practice and outcomes of CAS and CEA in a real-world setting within public university hospitals in Brazil.This study will be a prospective 5-year analysis of treatment for atherosclerotic carotid stenosis with CEA and CAS performed at 5 centers affiliated with the Vascular Study Group at public university hospitals in Brazil. The indications for the procedures will be determined by each surgeons individual discretion, in accordance with preoperative risk evaluation. The primary outcome measures will be (1) any in-hospital stroke or death, and (2) any per-procedural stroke, death, or myocardial infarction (MI). Patients undergoing CEA in conjunction with cardiac surgery will be excluded from the study. Multivariate logistic regression will be performed to identify predictors of stroke or death in patients undergoing CEA and CAS. All tests of significance will be performed at the .05 level. This study was approved by the Committee of Ethics in Research at the University Hospital of Ribeirao Preto Medical School, and in all other participating institutions linked to National Research System and National Board of Health in Brazil (Process 15695/2011).This study is currently in the recruitment phase, and the final patient is expected to be enrolled by the end of 2018. We hope to recruit approximately 800 patients to the study. Analyses will focus on primary end points for patients that are allocated to each treatment group. During the per-procedural period, the occurrence of the primary end point components (stroke, MI, or death) for CAS and CEA will be analyzed for symptomatic or asymptomatic subjects.The analyses of the primary endpoints (and all others variables of the study) are expected to be published in 2019 in a peer reviewed journal, and results will be presented at scientific meetings, with summary results published online. This study will obtain new data related to the quality of treatment for carotid disease in Brazil at the primary training centers of future vascular surgeons, but the initial data that will be obtained and published (with the outcomes and complications) are restricted to the first 30 days postprocedure. This time restriction limits the comparison of the results that relate to the main goal of treatment, which is to decrease the risk of stroke over 5 years. The purpose of the study group is to continue the monitoring of patient records, and evaluate the follow-up data in the 5 years following the initial evaluation. This study protocol will contribute very significantly to improving the care of patients with carotid disease, in addition to qualifying the level of assistance provided in public university hospitals in the state of So Paulo, Brazil.Clinicaltrials.gov NCT02538276; https://www.clinicaltrials.gov/ct2/show/NCT02538276 (Archived by WebCite at http://www.webcitation.org/6m7APnFLD).


Marim R.G.,Marilia Medical School FAMEMA | de Gusmao A.S.,Marilia Medical School FAMEMA | Castanho R.E.P.,Marilia Medical School FAMEMA | Deminice R.,University of Sao Paulo | And 3 more authors.
Revista do Instituto de Medicina Tropical de Sao Paulo | Year: 2012

The tissue changes that occur in Chagas disease are related to the degree of oxidative stress and antioxidant capacity of affected tissue. Studies with vitamin C supplementation did not develop oxidative damage caused by Chagas disease in the host, but other studies cite the use of peroxiredoxins ascorbate - dependent on T. cruzi to offer protection against immune reaction. Based on these propositions, thirty "Swiss" mice were infected with T. cruzi QM1 strain and treated with two different vitamin C doses in order to study the parasitemia evolution, histopathological changes and lipid peroxidation biomarkers during the acute phase of Chagas disease. The results showed that the parasite clearance was greater in animals fed with vitamin C overdose. There were no significant differences regarding the biomarkers of lipid peroxidation and inflammatory process or the increase of myocardium in animals treated with the recommended dosage. The largest amount of parasite growth towards the end of the acute phase suggests the benefit of high doses of vitamin C for trypomastigotes. The supplementation doesn't influence the production of free radicals or the number of amastigote nests in the acute phase of Chagas disease.


PubMed | Marilia Medical School FAMEMA, University of Sao Paulo and University of North Carolina at Chapel Hill
Type: | Journal: Nursing & health sciences | Year: 2016

Recent advances in genomics and related technologies have the potential to improve health care throughout the world. In this cross-sectional study, we examine genetics education, knowledge, and genetics-related experiences among the nurses and physicians who provide primary care in a Brazilian city. Fifty-four healthcare professionals from family health units participated in the study (response rate: 90%). Data were collected using a structured 36-item questionnaire divided into five axes: sociodemographic data and academic background; genetics education; genetics knowledge; genetics-related experiences in family practice; and knowledge regarding the National Policy for Comprehensive Care in Clinical Genetics in the Unified Health System. Although most participants (85.2%) acknowledged receiving some genetic content during their undergraduate education, the majority (77.8%) advised that they did not feel prepared to deliver genomics-based health care in primary care. The results suggest that nurses and physicians often lack the knowledge to provide genomics-based health care in primary care. Therefore, continuing education in genetics/genomics should be provided to primary healthcare professionals in order to enhance family practice and compliance with national policies.


Caleman Neto A.,Blood Center | Rasmussen L.T.,Sacred Heart University of Brazil | de Labio R.W.,Blood Center | de Queiroz V.F.,Marilia Medical School FAMEMA | And 5 more authors.
Journal of Venomous Animals and Toxins Including Tropical Diseases | Year: 2014

Background: Epidemiological investigations have indicated thatHelicobacter pyloriinduces inflammation in the gastric mucosa regulated by several interleukins. The genesIL1BandIL8are suggested as key factors in determining the risk of gastritis. The aim of this paper was to evaluate the association of gene polymorphism of interleukin-1 and interleukin-8 with chronic gastrits inH. pyloriinfected patients. A total of 60 patients underwent endoscopic procedure. Biopsy samples were collected for urease test, histopathological and molecular exams. The DNA of theses samples was extracted for detection ofH. pyloriand analysis of the genes mentioned above. Patients with gastritis had a higher frequency ofH. pylori-positive samples.Results: H. pyloriwas detected in 30/60 patients (50%) by PCR. As for polymorphism of interleukin 8 (-251) gene we observed a statistical difference when analyzed TA (p = 0.039) and TT (p = 0.047) genotypes. In theIL1B31 there was a statistical difference in TT (p = 0.01) genotype and in theIL1B-511there wasn't any statistical difference.Conclusion: Our results suggest a strong correlation between the presence of chronic gastritis and infection byH. pyloriand thatIL1B-31TTandIL8-251TTgenotypes appear to act as protective factors againstH. pyloriinfection whileIL8-251TAgenotype may comprise a risk factor for infection with this bacterium. © 2014 Caleman Neto et al.


Rasmussen L.T.,Sacred Heart University of Brazil | de Labio R.W.,Blood Center | Neto A.C.,Blood Center | Silva L.C.,Marilia Medical School FAMEMA | And 4 more authors.
Journal of Venomous Animals and Toxins Including Tropical Diseases | Year: 2012

Helicobacter pylori, a gram-negative bacterium, possesses two important virulence factors: the vacuolating toxin (vacA), and the cytotoxin-associated gene product (cagA). The aim of the present study was to evaluate the presence of H. pylori in the stomach and oral cavity of humans and compare the cagA and vacA genotypes of H. pylori found in different samples (stomach, saliva and dental plaque) from the same patient. Gastric biopsies, saliva and dental plaques were obtained from 62 dyspeptic adults. DNA was extracted and evaluated for the presence of H. pylori and the alleles cagA and vacA. Persons with gastritis had a higher frequency of H. pylori-positive samples in the stomach while positive samples from gastric biopsies were significantly correlated with those from the oral cavity. There was a high H. pylori frequency in patients while the cagA gene was associated with vacA s1 alleles in gastric biopsies. Our results suggest a reservoir of the species in the oral cavity and that, in one patient, more than one H. pylori strain may exist in the saliva, dental plaque and stomach. We found a relationship between gastric infection and the bacterium in the oral cavity, with the cytotoxin genotype varying between saliva and dental plaque. © CEVAP 2012.


Braga J.C.M.S.,Dante Pazzanese Institute of Cardiology | Assef J.E.,Dante Pazzanese Institute of Cardiology | Waib P.H.,Marilia Medical School Famema | De Sousa A.G.D.M.R.,Dante Pazzanese Institute of Cardiology | And 7 more authors.
Journal of the American Society of Echocardiography | Year: 2015

Background Sickle cell anemia (SCA) is associated with cardiac abnormalities and premature death. The aims of this study were to identify early markers of cardiac dysfunction through ventricular strain and ventricular twist and determine the relationships between these measures and other markers of cardiovascular risk. Methods Forty patients with SCA (mean age, 23.5 ± 9.3 years; 24 male patients) and 40 age- and sex-matched healthy individuals were compared. All subjects participated in structured interviews, and blood samples were collected. Standard echocardiography with subsequent offline evaluations using left ventricular (LV) and right ventricular systolic strain and rotational analyses of the left ventricle using two-dimensional speckle-tracking echocardiography were performed. Results There were no differences in LV ejection fraction, global LV strain (longitudinal, circumferential, and radial), and global right ventricular longitudinal strain between patients and controls; however, LV twist was significantly lower in the patient group (mean, 7.4 ± 1.2° vs 10.7 ± 1.8°; P <.0001). Several variables were strongly related to LV twist, including the clinical severity index (ρ = -0.97, Z score = -6.05, P <.0001), E/e′ ratio (r = 0.78, P <.0001), LV end-diastolic volume index (r = 0.81, P <.0001), and pulmonary artery systolic pressure (r = 0.72, P <.0001). Conclusions LV twist is altered in patients with SCA. There were strong correlations between left ventricular twist and clinical severity index, E/e′ ratio, LV end-diastolic volume index, and pulmonary artery systolic pressure. These data suggest that decreased LV twist may indicate a subgroup of patients with SCA at greater cardiac risk. © 2015 American Society of Echocardiography.


Calamita Z.,Marilia Medical School FAMEMA | Alonso A.C.R.,Marilia Medical School FAMEMA | da Costa L.C.O.,Marilia Medical School FAMEMA | Calamita A.B.P.,Marilia Medical School FAMEMA
Open Medicinal Chemistry Journal | Year: 2015

Background: The skin contact test or patch test is considered to be a fundamental tool for investigating allergic contact dermatitis (ACD). Better knowledge on the prevalence of allergens in the environment is a good strategy for enabling a better approach towards contact dermatitis (CD) cases. Objective: The objective of the present study was to evaluate the prevalence of the main allergens of ACD in a population group in the interior of the state of São Paulo, Brazil. Methods: The results from 368 patch tests on adult patients with CD were evaluated through a retrospective study under the supervision of the Discipline of Allergy and Clinical Immunopathology and the Discipline of Dermatology at the Marília Medical School. Results: Mean age was 41.2 (± 17.2) years, with predomination of women (71.5%). The majority of the patients (91.3%) presented reactivity to at least one substance. Nickel sulfate and the perfume mix stood out as the most allergenic substances. Conclusion: Among the variety of substances to be tested in an etiological investigation for CD, perfumes and nickel are especially likely to be allergens in this population group. © Calamita et al.; Licensee Bentham Open.


De Padua V.B.C.,University of Marília | Maldonado H.,Marilia Medical School FAMEMA | Vilela J.C.R.,University of Marília | Provenza A.R.,Orthopedics Service | And 2 more authors.
Revista Brasileira de Ortopedia | Year: 2012

Objective: To compare ACL reconstruction with anatomical positioning of the tunnels using the hamstring or patellar tendons. Methods: We prospectively evaluated 52 patients who underwent ACL reconstruction using the Chambat's technique, with anatomical positioning of the tunnels drilled outside in. They were divided into group A, with 27 patients, using the patellar tendon as a graft, and group B, with 25 patients, using the hamstring. Results: In group A 26 patients were very satisfied or satisfied and 1 unhappy, in group B. 25 patients were very satisfied or satisfied with the procedure (p = 0.990). According to the Lysholm scale, group A had a mean score of 96.11 and group B, 95.32 (p = 0.594). In relation to preoperative IKDC, 100% of the patients in group A and 92% of those in group B were IKDC C or D (p = 0.221); in the assessment with a minimum of two-year follow-up, 96% of group A and 92% of group B were IKDC A or B (p = 0.256). The Lachman test, pivot shift, return to sports activities, and the comparative difference in anterior translation (Rolimeter™) also showed no statistically significant difference. In group A, 5 patients (18.5%) were unable to kneel on a hard surface, whereas no patient in group B had this complaint. Conclusion: The anterior cruciate ligament reconstruction presents similar results using the hamstring or patellar tendon with anatomical positioning of the tunnels. Drilling the femoral tunnel outside in is a reproducible and accurate option in the correct placement the femoral tunnel.


PubMed | Marilia Medical School Famema and Dante Pazzanese Institute of Cardiology
Type: Journal Article | Journal: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography | Year: 2015

Sickle cell anemia (SCA) is associated with cardiac abnormalities and premature death. The aims of this study were to identify early markers of cardiac dysfunction through ventricular strain and ventricular twist and determine the relationships between these measures and other markers of cardiovascular risk.Forty patients with SCA (mean age, 23.59.3years; 24 male patients) and 40 age- and sex-matched healthy individuals were compared. All subjects participated in structured interviews, and blood samples were collected. Standard echocardiography with subsequent offline evaluations using left ventricular (LV) and right ventricular systolic strain and rotational analyses of the left ventricle using two-dimensional speckle-tracking echocardiography were performed.There were no differences in LV ejection fraction, global LV strain (longitudinal, circumferential, and radial), and global right ventricular longitudinal strain between patients and controls; however, LV twist was significantly lower in the patient group (mean, 7.41.2 vs 10.71.8; P<.0001). Several variables were strongly related to LV twist, including the clinical severity index (=-0.97, Z score=-6.05, P<.0001), E/e ratio (r=0.78, P<.0001), LV end-diastolic volume index (r=0.81, P<.0001), and pulmonary artery systolic pressure (r=0.72, P<.0001).LV twist is altered in patients with SCA. There were strong correlations between left ventricular twist and clinical severity index, E/e ratio, LV end-diastolic volume index, and pulmonary artery systolic pressure. These data suggest that decreased LV twist may indicate a subgroup of patients with SCA at greater cardiac risk.


Study Design:Retrospective cohort.Objectives:The aim of this study was to evaluate the correlation between the level and completeness of the injury with Functional Independence Measure (FIM) score and the validity and responsiveness of the FIM in Brazilian individuals with spinal cord injury admitted to rehabilitation.Setting:SARAH Network of Rehabilitation Hospitals, Brasília, Brazil.Methods:A total of 218 patients with spinal cord injury admitted for rehabilitation in 2006 was included in this study. The validity was assessed as the ability of the FIM to discriminate different levels of disability (cervical, thoracic and lumbar) at admission and the responsiveness was obtained by analyzing admission and discharge data for each of the three injury groups.Results:Total FIM score, motor FIM score and each of the 13 items were valid when comparing three groups and comparing groups two by two, except the items 'eating' and 'grooming' among paraplegics, and 'stairs' at cervical and thoracic levels. The scale was not responsive to the five cognitive items, 'stairs' and 'eating', among paraplegics, or 'grooming', 'bathing' and 'dressing upper body' in lumbar level patients. The patient difficulty in performing tasks can vary among populations. Therefore, the continuous evaluation process of psychometric characteristics is important to validate the use of the instrument in different contexts. © 2014 International Spinal Cord Society.

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