Federal University of São Paulo

About: Federal University of São Paulo is a education organization based out in São Paulo, Brazil. It is known for research contribution in the topics: Population & Medicine. The organization has 27971 authors who have published 49365 publications receiving 935536 citations. The organization is also known as: Universidade Federal de São Paulo & Universidade Federal de Sao Paulo.

Global patient outcomes after elective surgery: Prospective cohort study in 27 low-, middle- and high-income countries

Abstract: Background As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. Methods We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. Results A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2–7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. Conclusions Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care.

Contemporary Assessment of Antimicrobial Susceptibility Testing Methods for Polymyxin B and Colistin: Review of Available Interpretative Criteria and Quality Control Guidelines

Abstract: The emergence of infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter spp. has necessitated the search for alternative parenteral agents such as the polymyxins. The National Committee for Clinical Laboratory Standards (NCCLS) documents do not currently provide interpretative criteria for the testing of the polymyxins, colistin and polymyxin B. Therefore, an evaluation of the antimicrobial activity of colistin and polymyxin B was initiated using 200 bloodstream infection pathogens collected through the SENTRY Antimicrobial Surveillance Program. All susceptibility tests were performed according to the NCCLS recommendations. Polymyxin B and colistin displayed a nearly identical spectrum of activity, exhibiting excellent potency against P. aeruginosa (MIC(90), 2 microg/ml) and Acinetobacter sp. (MIC(90), 2 microg/ml). In contrast, they showed limited activity against some other nonfermentative bacilli such as Burkholderia cepacia (MIC(90), >/=128 microg/ml). Excellent correlation was achieved between broth microdilution and agar dilution tests (r = 0.96 to 0.98); 94.3% of the results were +/-1 log(2) dilution between the methods used for both compounds. At a resistance breakpoint of >/=4 microg/ml for both agents, unacceptable false-susceptible or very major errors were noted for colistin (5%) and polymyxin B (6%). Modified zone criteria for colistin ( /=14 mm) and polymyxin B ( /=14 mm) were suggested, but some degree of error persisted (>/=3.5%). It is recommended that all susceptible disk diffusion results be confirmed by MIC tests using the preferred reference NCCLS method. The quality control (QC) ranges listed in the product package insert require an adjusted range by approximately 3 mm for both NCCLS gram-negative quality control strains. This evaluation of in vitro susceptibility test methods for the polymyxin class drugs confirmed continued serious testing error with the disk diffusion method, the possible need for breakpoint adjustments, and the recalculation of disk diffusion QC ranges. Clinical laboratories should exclusively use MIC methods to assist the therapeutic application of colistin or polymyxin B until disk diffusion test modifications are sanctioned and published by the NCCLS.

Annotated checklist of the birds of Brazil by the Brazilian Ornithological Records Committee / Lista comentada das aves do Brasil pelo Comitê Brasileiro de Registros Ornitológicos

Abstract: Since 2005, the Brazilian Ornithological Records Committee (CBRO) has published updated checklists of Brazilian birds almost every year. Herein, we present a completely new and annotated version of our checklist. For the first time, we list all bird subspecies known from Brazil that are currently accepted by at least one key ornithological reference work. The inclusion of the subspecies should be seen as a synthesis, and not as a taxonomic endorsement. As such, we include in the new checklist 1919 avian species, 910 of which are treated as polytypic in reference works (2042 subspecies), totaling 3051 taxa at the species and subspecies level. We anticipate that several of the subspecies included in our list may be subject to future taxonomic upgrades to species status, while others will probably be shown to be invalid in the light of future taxonomic studies. The results highlight Brazil as a megadiverse country and reinforce the need for proper enforcement of political tools, laws and international commitments assumed by the country to preserve its biodiversity.

Metabolic control of type 1 regulatory T cell differentiation by AHR and HIF1-α

Abstract: Our understanding of the pathways that regulate lymphocyte metabolism, as well as the effects of metabolism and its products on the immune response, is still limited. We report that a metabolic program controlled by the transcription factors hypoxia inducible factor-1α (HIF1-α) and aryl hydrocarbon receptor (AHR) supports the differentiation of type 1 regulatory T cell (Tr1) cells. HIF1-α controls the early metabolic reprograming of Tr1 cells. At later time points, AHR promotes HIF1-α degradation and takes control of Tr1 cell metabolism. Extracellular ATP (eATP) and hypoxia, linked to inflammation, trigger AHR inactivation by HIF1-α and inhibit Tr1 cell differentiation. Conversely, CD39 promotes Tr1 cell differentiation by depleting eATP. CD39 also contributes to Tr1 suppressive activity by generating adenosine in cooperation with CD73 expressed by responder T cells and antigen-presenting cells. These results suggest that HIF1-α and AHR integrate immunological, metabolic and environmental signals to regulate the immune response.

mhGAP Intervention guide for mental, neurological and substance use disorders in non-specialized health settings: version 2.0

Abstract: Em todo o mundo existe uma enorme diferença entre o número de pessoas que vivem com transtornos mentais e o número de pessoas que recebem qualquer tipo de tratamento. Mais de 45% da população mundial reside em países onde existe menos de um psiquiatra para cada 100.000 pessoas, e o número de neurologistas é ainda menor. O número pequeno de profissionais especialistas em saúde mental, aliado à desigualdade na distribuição territorial desses profissionais, não permite que essa diferença seja superada apenas pelos serviços especializados. Esta é uma publicação da Organização Mundial da Saúde e se insere no mhGAP (“Mental Health Gap Action Plan”), plano para reduzir desigualdades em saúde mental global. Atualmente existe um consenso de que é necessário haver boa evidência sobre o que funciona na prática para que se possam desenvolver programas efetivos, especialmente em regiões onde os recursos sejam escassos. Pesquisas demonstram a efetividade das intervenções farmacológicas e psicossociais desenvolvidas na atenção primária. Sendo assim, um livro que aborde estratégias de cuidado em saúde mental para não especialistas é de extrema importância, especialmente nas capacitações realizadas pelos psiquiatras aos profissionais da Estratégia Saúde da Família. A primeira versão deste Manual (lançada em 2010) foi utilizada por mais de 80 países e traduzida em mais de 20 idiomas. A atual versão (lançada em 2016) traz 23 novas recomendações que constituem um conjunto de ferramentas para o generalista lidar com situações diversas. As novas recomendações são abrangentes, envolvendo desde intervenções no estado nutricional dos pacientes diagnosticados com demência, até o treinamento dos cuidadores para o manejo de crianças e adolescentes com transtornos globais do desenvolvimento. Trata-se de um guia de orientações baseadas em evidências, composto de algoritmos, diagramas e fluxogramas que permitem ao profissional não especialista o diagnóstico e tratamento dos transtornos mentais considerados prioritários (com base nos critérios de mortalidade, morbidade e incapacidade). O módulo 1 traz princípios essenciais do cuidado em saúde mental, incluindo a atenção aos familiares e cuidadores. É dividido em duas seções. A primeira abrange as bases de uma boa aliança terapêutica, reforçando a importância do cuidado ser oferecido em um ambiente sem julgamentos e não estigmatizante. A segunda apresenta elementos essenciais da prática clínica em saúde mental em contextos comunitários. Os sete módulos seguintes tratam individualmente de cada condição prioritária para WHO: depressão,