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Poulose B.K.,Vanderbilt University | Roll S.,Santa Casa of Sao Paulo Medical School | Murphy J.W.,William Beaumont Hospital Troy | Matthews B.D.,Carolinas Medical Center | And 6 more authors.
Hernia | Year: 2016

Purpose: Wide variation in care and costs exists regarding the management of abdominal wall hernias, with unproven benefit for many therapies. This work establishes a specialty society-based solution to improve the quality and value of care delivered to hernia patients during routine clinical management on a national scale. Methods: The Americas Hernia Society Quality Task Force was charged by the Americas Hernia Society leadership to develop an initiative that utilizes the concepts of continuous quality improvement (CQI). A disease-based registry was created to collect information for CQI incorporating real-time outcome reporting, patient reported outcomes, stakeholder engagement, and collaborative learning methods to form a comprehensive quality improvement effort. Results: The Americas Hernia Society Quality Collaborative (AHSQC) was formed with the mission to provide health care professionals real-time information for maximizing value in hernia care. The initial disease areas selected for CQI were incisional and parastomal hernias with ten priorities encompassing the spectrum of care. A prospective registry was created with real-time analytic feedback to surgeons. A data assurance process was implemented to ensure maximal data quality and completeness. Four collaborative meetings per year were established to meet the goals of the AHSQC. As of the fourth quarter 2014, the AHSQC includes nearly 2377 patients at 38 institutions with 82 participating surgeons. Conclusions: The AHSQC has been established as a quality improvement initiative utilizing concepts of CQI. This ongoing effort will continually refine its scope and goals based on stakeholder input to improve care delivered to hernia patients. © 2016, Springer-Verlag France. Source


de Carvalho Aguiar I.,Nove de Julho University | Peixoto R.A.O.,Nove de Julho University | dos Santos I.R.,Nove de Julho University | Nacif S.R.,Nove de Julho University | And 6 more authors.
Clinical and Experimental Medical Letters | Year: 2012

Obesity is a major public health problem in both developed and developing countries alike and leads to a series of changes in cardiorespiratory physiology. There is a strong correlation between obesity and sleep disorders. Weight loss among such patients leads to a reduction in these pathological alterations, but clinical treatment is not effective over the long-term. Thus, bariatric surgery is a viable option. Morbid obesity is also associated with cardiomyopathy, increased left ventricular wall stress, left ventricular hypertrophy, and diastolic dysfunction. This process stimulates the autonomic nervous system (ANS), leading to systemic vasoconstriction and arterial hypertension. The heart rate variability (HRV) has been incorporated as an important method of assessment of ANS. The objective of this study was to analyze HRV in morbidly obese patients undergoing bariatric surgery before and 60 days after surgery. Material/Methods: The study included 14 patients (11 females), and data collection included BMI classification, abdominal and neck circumferences, Epworth sleepiness scale, a sleep study, and HRV analysis. Results: The mean age was 36.07±10.97. The mean BMI before surgery was 48.68±5.64 and after surgery it was 41.92±5.72 Kg/m2. Our findings demonstrate gains in HRV in all patients after surgery. Conclusions: We conclude that obese patients have a high prevalence of obstructive sleep apnea syndrome and unstable HRV during sleep, with a predominance of sympathetic activity. However, with weight reduction, after 60 days of bariatric surgery there is significant improvement in anthropometric, and sleep variables, and HRV. © Clin Exp Med Lett. Source


Rolim Rosa Lima S.M.,Santa Casa of Sao Paulo Medical School | Yamada S.S.,Santa Casa of Sao Paulo Medical School | Reis B.F.,Santa Casa of Sao Paulo Medical School | Reis B.F.,Sapucai Valley University | And 3 more authors.
Maturitas | Year: 2013

Objetive: To assess efficacy and tolerability of a isoflavone (Glycine max L. Merr.) vaginal gel to the treatment of vaginal atrophy in postmenopausal women. Methods: The double-blind, randomized, placebo-controlled, clinical trial. Ninety women were treated for 12 weeks with isoflavone vaginal gel 4% (1 g/day) and a placebo gel and conjugated equine estrogen cream (0.3 mg/day). After 4 and 12 weeks, the vaginal atrophy symptoms were classified at none, mild, moderate and severe and the vaginal cytology were taken to determine the maturation value. The endometrial safety (by transvaginal ultrasonography) was evaluated through at screening and the end of the trial. Results: Isoflavone vaginal gel appears to be effective for relief of vaginal dryness and dyspareunia symptons and an increase in the intermediate and superficial cells was noted. These results were similar to the effects with use of conjugated equine estrogens and superior to placebo gel. No changes in endometrial thickness, sera FSH and estradiol levels were observed at study endpoint. Conclusion: Glycine max (L.) Merr. at 4% vaginal gel on a daily basis in postmenopausal women led to improvements in vaginal atrophy symptoms and a significant increase in cell maturation values. Isoflavones proved good treatment options for relief of vulvovaginal symptoms especially in women who do not wish to use hormonal therapy or have contra-indications for this treatment. © 2012 Elsevier Ireland Ltd. Source


Lyra A.,Santa Casa of Sao Paulo Medical School | Bonfitto A.J.,Santa Casa of Sao Paulo Medical School | Barbosa V.L.P.,Santa Casa of Sao Paulo Medical School | Barbosa V.L.P.,Movere Institute | And 4 more authors.
Annals of Nutrition and Metabolism | Year: 2015

Aim: To compare the body composition of overweight children and adolescents by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) before and after physical activity program. Methods: One hundred and eleven patients with mean age (SD) of 12 (1.9) participated in the study. We assessed the weight, height, waist circumference (WC), and body composition by DXA and BIA. Patients underwent a program of diet and physical activity (1 h 30 min/day, 3 times a week for 3 months) and were evaluated before and after this period. Results: Mean initial zBMI were 2.3 (0.5) and waist SDS 5.9 (1.8). Significant differences were observed when we compared the measurements taken by DXA and BIA, respectively: total body fat percentage (40 and 31.5) and fat-free mass (43.1 and 50.6 kg). Regarding the trunk fat by DXA, there was a positive correlation with the WC/height ratio (r = 0.65; p < 0.01). After the intervention period, we observed a reduction in the zBMI, waist SDS, and total body fat and increase of fat-free mass by DXA. BIA only detected reduction in fat. Conclusion: BIA underestimates the percentage of fat and overestimates fat-free mass in relation to DXA. There is positive correlation between trunk fat and the ratio WC/height. In addition, DXA detected changes in body composition induced by a short period of physical training, unlike BIA. © 2014 S. Karger AG, Basel. Source


Reis B.F.,Santa Casa of Sao Paulo Medical School | Reis B.F.,Sapucai Valley University | Lima S.M.R.R.,Santa Casa of Sao Paulo Medical School | Silva G.M.D.,Santa Casa of Sao Paulo Medical School | And 4 more authors.
Histology and Histopathology | Year: 2016

Objective: A prospective randomized controlled trial was conducted to evaluate the effect of low dose of tibolone on the histology, expression of estrogen (ER) and progesterone receptors (PR) and Bcl- 2 protein, in endometrium of postmenopausal women. Method: Forty postmenopausal women consented to treatment and were allocated into two groups of 20 women: Group 1 (Control) without hormone replacement therapy (HRT); Group 2 (Tibolone) treatment at the dose of 1.25 mg/day of oral tibolone administered for a 24-week period. The effect on the endometrium was assessed by histology and the apoptosis marker Bcl-2. The immunoexpression of ER and PR were also measured. Results: Tibolone group showed higher expression of ER, PR and Bcl-2 protein in glandular epithelium and stroma compared to control group. Conclusion: Tibolone in a daily dose of 1.25 mg during 24 weeks demonstrated endometrial action that resulted in low proliferation and was shown to lead to atrophic endometrium. It had favorable effects on the postmenopausal endometrium due to its higher immunoexpression of PR and Bcl-2 protein in endometrial glandular epithelium, thereby creating a balance between pro-apoptotic and anti-apoptotic actions. © 2016, Histology and Histopathology. All right reserved. Source

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