Pelotas, Brazil

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Engelman M.D.F.B.,Sapucai Valley University | Grande R.M.,Sapucai Valley University | Naves M.A.,University of Sao Paulo | De Franco M.F.,University of Sao Paulo | De Paulo Castro Teixeira V.,University of Sao Paulo
Pathology and Oncology Research | Year: 2013

Integrin-linked kinase (ILK) is an unique intracellular serine/threonine kinase and adapter protein. When dysregulated, it has been associated with increased cell proliferation, anchorage-independent cell growth, evasion of apoptosis, angiogenesis, invasion of surrounding tissues, downregulation of E-cadherin expression, nuclear translocation of β-catenin and metastasis, all features of tumoral malignancy. The objective of the present work was to evaluate the expression of ILK in clear cell renal carcinomas (CCRC) as a possible prognostic indicator. ILK immunoexpression was evaluated in a tissue microarray (TMA) with 45 human CCRCs. In addition, the apoptotic and proliferative indices and the immuno-expression of β-catenin and E-cadherin were also evaluated. E-cadherin expression was significantly decreased in tumors with positive ILK expression in relation to those with negative immunoexpression (p = 0.011). ILK immunostaining was significantly increased in high-grade in comparison to low-grade CCRCs (p = 0.0008). ILK expression was also associated with increased proliferative index (p = 0.020), tumor size >7.0 cm (p = 0.018) and with renal vein and capsule invasion (p = 0.003 and p = 0.00). Finally, tumors stage I and II (noninvasive) presented significantly reduced ILK immunoexpression when compared to stage III (locally invasive) (p = 0.0028). ILK immunoexpression in CCRC increases with loss of intercellular adhesion, nuclear grading, increased proliferative index and Robson stage. Altogether, our data suggest a possible role for ILK in the progression of CRCC. © 2012 Arányi Lajos Foundation.


Salome G.M.,Sapucai Valley University | De Almeida S.A.,University of Sao Paulo | Ferreira L.M.,Federal University of São Paulo
Advances in Skin and Wound Care | Year: 2015

Objective: The objective of the study was to evaluate the association of sociodemographic factors with hope for cure and levels of religiosity and spirituality in patients with venous leg ulcers (VLUs). Design: This was a primary, prospective, descriptive, analytical, clinical, nonrandomized study. Setting: The study was performed at a nursing care and education center of a university hospital in interior Minas Gerais, Brazil. Patients: A convenience sample of 50 adult patients with VLUs and Doppler ankle-brachial index ranging from 0.8 to 1.0 participated in the study. Patients with mixed ulcers, arterial ulcers, and diabetic foot ulcers were excluded from the study. Main Outcome Measures: A questionnaire assessing sociodemographic and clinical characteristics of patients, the Spirituality Self-rating Scale (SSRS), and the Herth Hope Index (HHI) were administered to all patients. Main Results: The mean SSRS score was 10.20, and the mean HHI was 25.5, corresponding to low levels of spirituality andmoderate hope for cure, respectively. Patients aged between 50 and 59 years, men, nonsmokers, and those who were unemployed had the lowest mean SSRS scores. The lowest mean HHI values were reported by patients whose ulcers had exudate and odor, those aged 20 to 39 years, retired, and living with the wound for 1 year or less. Patients who had no religion or were not practicing a religion and those who considered living with an ulcer as a punishment reported low SSRS scores. Conclusion: The results showed that most patients with VLUs had low levels of spirituality, did not perceive divine intervention in their daily life or practice religious activities such as prayer, and had moderate hope for cure. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Filho M.M.,Sapucai Valley University | Luz B.S.R.,Hospital Maternidade Frei Galvao | Araujo C.S.,Hospital Ermelino Matarazzo
Ciencia e Saude Coletiva | Year: 2014

The scope of this study was to evaluate the attributes of primary health care for children and establish associated factors. A cross-sectional, observational and analytical study was conducted. Data were collected from interviews with caregivers of children enrolled in primary health care services, using a sociodemographic and health protocol, an instrument of economic classification and the Brazilian version of the Project Complexity Assessment Tool questionnaire for children. Models were developed using Poisson regression to search for associations. Only the longitudinality attribute was well evaluated. All the other mean scores were considered low. More than 80% of respondents rated the special and general scores of primary health care with low values. Children who had no brothers, were of the female sex, with socioeconomic classification A or B, and who had male caregivers with no partner were significantly associated with the low scores. Primary health care was thus poorly rated.


Objective: To evaluate the clinical and sociodemographic factors and correlate them to the self-image and self-esteem. Methods: A study conducted at Ostomy Pole of PousoAlegre. The data were collected between December 2012 and May 2013. This was a non-probabilistic, by convenience, sample. For data collection, the Rosenberg Self-Esteem Scale/UNIFESP-EPM and Body Investment Scale were used. For statistical analysis, chi-squared test, Kruskal–Wallis test and Spearman correlation were used. Levels of significance of 5% (p ≤ 0.05) were considered. Results: Participants had a mean score of 10.81 in the Rosenberg Self-Esteem Scale/UNIFESP. Regarding Body Investment Scale results, the mean total score was 38.79; the mean in the domain of body image was 7.74, and for personal touch, 21.31. When comparing data related to the stoma and sociodemographic profiles with the Rosenberg Self-Esteem Scale/UNIFESP and Body Investment Scale, we realize that all patients demonstrated a decrease in self-esteem and self-image. Individuals were over 60 years old, male, retired, married and werenot participants in support group/association. With regard to the characteristics of thestoma, those permanent colostomized had as causes of stoma implementation inflammatory disease and neoplasia; stomata measured between 20 and 40 mm; these people used two-piece devices. People who have not been notified that would be subjected to the stoma and in whom no demarcation was done showed worsening in self-esteem and self-image in relation to other features related to injury and sociodemographic data. Conclusion: Patients who participated in this study had low self-image and self-esteem in all characteristics of the stoma and in sociodemographic data, meaning that these individuals had negative feelings about their own bodies. © 2014 Sociedade Brasileira de Coloproctologia. Published by Elsevier Editora Ltda. All rights reserved.


Barbosa L.C.R.,Sapucai Valley University | Da Silva I.D.C.G.,Federal University of São Paulo | Correa J.C.,Institute of Pathology Jose Carlos Correa | Ribalta J.C.L.,Federal University of São Paulo
International Journal of Gynecological Cancer | Year: 2011

Introduction: Infection by human papillomavirus is the most important risk factor in the pathogenesis of uterine cervical cancer. The aims of this study were to evaluate the expression of survivin protein and telomerase enzyme in samples of uterine cervix from women with human papillomavirusYinduced lesions and to determine the relationship between survivin and telomerase expression and the different grades of cervical squamous intraepithelial neoplasia and invasive cervical carcinoma. Methods: Biopsy samples from the uterine cervix of 105 women aged 18 to 80 years were analyzed. The patients were divided into 5 groups: WN group, 20 patients without neoplasia; CIN-1 group, 24 patients with grade 1 cervical intraepithelial neoplasia (CIN), grade 1; CIN-2 group, 20 patients with CIN grade 2; CIN-3 group, 24 patients with CIN, grade 3; and ICC group, 17 patients with invasive cervical carcinoma. Human papillomavirus detection, telomerase activity, and survivin expression were assessed using polymerase chain reaction (PCR), real-time PCR (RT-PCR), and immunochemistry, respectively. Results: There was a significant increase in the expression of telomerase and survivin associated with the severity of the lesion. Conclusions: The results suggest that mechanisms that promote both cell proliferation (telomerase activity) and cell survival (survivin expression) are active in cervical cancer and its precursor lesions. There was a negative correlation between survivin expression and the number of PCR cycles necessary to detect telomerase activity in the total sample, achieving statistical significance in patients in the CIN-3 group. Copyright © 2010 by IGCS and ESGO.


Salome G.M.,Sapucai Valley University | de Brito M.J.,Sapucai Valley University | Ferreira L.M.,Sapucai Valley University
Journal of wound care | Year: 2014

OBJECTIVE: To assess self-esteem in patients with venous leg ulcers treated with Unna's boot. •METHOD: A descriptive, analytic, clinical study was conducted from June 2010 to May 2011 in an outpatient wound care clinic in São Paulo, Brazil. Patients of both sexes, aged ≥18 years, who had had a venous leg ulcer for more than one year and a Doppler ankle brachial index ranging from 0.8-1.0 were consecutively selected for inclusion. Patients were treated with wound dressings and Unna's boot. Self-esteem was assessed using the Brazilian version of the Rosenberg Self-Esteem Scale (RSE) at inclusion (baseline) and after 4, 8, and 12 months of compression therapy using Unna's boot. The scale is reverse-scored; thus lower scores indicate higher levels of self-esteem. •RESULTS: The patients showed a slight but significant improvement in self-esteem after 4 months of treatment (mean RSE score=17.12) compared with baseline (mean RSE score=24.90). However, a marked and significant improvement in self-esteem was observed after 8 months (mean RSE score=7.40) and 12 months (mean RSE score=2.10) of compression therapy using Unna's boot. •CONCLUSION: Patients with venous leg ulcers treated with Unna's boot for 12 months showed a significant improvement in self-esteem •DECLARATION OF INTEREST: All authors declare that no competing financial interests exist. There was no external funding for this study.


Salome G.M.,Sapucai Valley University | Ferreira L.M.,Federal University of São Paulo
World Journal of Surgery | Year: 2013

Background: Disability and pain were assessed in patients with venous leg ulcers treated with split-thickness skin grafts to evaluate to what extent skin grafting improves functional status in this population. Methods: A prospective, nonrandomized, multicenter case-control study was conducted from July 2008 to December 2010 in two hospitals in Brazil. One hundred patients with venous leg ulcers were divided into two treatment groups of 50 patients each: the control group (conservative treatment) and the surgery group (skin grafting). Patients were assessed at baseline (day 0) and on days 30, 90, and 180. Disability was measured with the Disability Index of the Health Assessment Questionnaire (HAQ-DI). The visual analog scale (VAS) and McGill Pain Questionnaire (MPQ) were used to assess pain. Results: Surgery group patients reported significantly lower (p = 0.0001) overall HAQ-DI scores (lower disability levels) 180 days postoperatively (HAQ-DI = 0.18) compared with baseline (HAQ-DI = 2.65); mean overall HAQ-DI scores for control patients was 1.70 on day 180, with a significant difference between groups (p = 0.0001). The surgery group showed significant improvement on all HAQ-DI categories and reported significantly lower pain intensity (VAS pain scores) on days 30, 90, and 180 compared with controls (p = 0.0001). The MPQ was used to assess the sensory, affective, evaluative, and miscellaneous dimensions of pain in the two groups; there were significant differences between groups on days 30, 90, and 180 (p = 0.0001). Conclusions: Patients with venous leg ulcers treated with split-thickness skin grafts showed improvement in functional status compared with controls. © 2013 Société Internationale de Chirurgie.


To evaluate health-related quality of life (HRQoL) and self-esteem in patients with diabetic foot ulcers (DFUs), a cross-sectional, comparative study was conducted among 35 consecutive patients with diabetes mellitus (DM) attending outpatient clinics in Pouso Alegre, Brazil. Fifteen (15) patients with and 20 without a DFU participated in the study. Demographic variables were obtained and HRQoL and self-esteem were assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and Rosenberg Self-Esteem Scale. In both groups, 80% of patients were women. Average age did not differ significantly between the DFU and control groups (average 56 [SD 8.42] and 52 years [SD 6.68], respectively) but disease duration was significantly longer (P < 0.001) in the DFU (mean 12 years, range 3 to 24 years) than in the control group (mean 8 years, range 1 to 21 years). Mean HRQoL scores in all domains were lower in the DFU than in the control group with significant differences in the following domains: physical functioning (P = 0.043), role physical (P = 0.003), social functioning (P = 0.022), and role emotional (P = 0.001). Self-esteem scores were similar in both groups. The results of this study confirm that patient HRQoL is negatively affected by the presence of a DFU. Wound prevention programs for patients with DM may help reduce the scope of this problem while DFU treatment programs that include psychological support may improve patient QoL.


CONTEXT AND OBJECTIVE: The stress of living with a terminal disease has a negative impact on the mental health of hemodialysis (HD) patients. Spirituality is a potential coping mechanism for stressful experiences. Studies on the relationship between spirituality and mental health among HD patients are scarce. The purpose of this study was to evaluate the relationship between mental health and spiritual well-being among HD patients. DESIGN AND SETTING: Cross-sectional observational study on hemodialysis patients at a single center in Brazil, between January and December 2011. METHODS: Mental health was assessed using the General Health Questionnaire and spiritual wellbeing was assessed using the Spiritual Wellbeing Scale; 150 HD patients participated in the study. RESULTS: A significant correlation was found between mental health and spiritual wellbeing (P = 0.001). Spiritual wellbeing was the strongest predictor of mental health, psychological distress, sleep disturbance and psychosomatic complaints. CONCLUSION: Poor mental health was associated with lower spiritual wellbeing. This has important implications for delivery of palliative care to HD patients.


Salome G.M.,Sapucai Valley University | Blanes L.,Federal University of São Paulo | Ferreira L.M.,Federal University of São Paulo
World Journal of Surgery | Year: 2014

Background: The assessment of health-related quality of life in patients with venous leg ulcers provides important information for clinical decision making, evaluation of therapeutic benefits, and prediction of survival probabilities. Methods: Health-related quality of life and self-esteem were assessed using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Rosenberg self-esteem (RSE) scale, respectively, in patients with venous leg ulcers treated with split-thickness skin grafts. One hundred patients with venous leg ulcers and indication for skin grafting were divided into two groups of 50 patients each: the control group (patients who received conservative treatment) and surgery group (patients who received split-thickness skin grafts). Results: Patients in the surgery group reported significantly higher SF-36 scores (better health status) than controls one month after surgery, as well as 90 and 180 days postoperatively (p < 0.002). The mean total RSE score was significantly lower (indicating higher self-esteem) in the surgery group (mean RSE score, 17.54) than in the control group (mean RSE score, 24.22). Conclusions: Split-thickness skin grafting resulted in better health-related quality of life and self-esteem in patients with venous leg ulcers than did compression therapy with Unna's boot. © 2013 Société Internationale de Chirurgie.

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