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Challenges in Implementing DVI Best Practice Guidelines Due to the Brumadinho Disaster

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forensic Medicine and Anatomy Research 2024年第1期12卷 1-12页

作者： Reinaldo Moreira silva Bruno Diniz Sander Morais Carlos Danilo Ruas silva Elza Cristina Lopes de Oliveira fernando Pereira Macedo giovanni Vitral Pinto Guadalupe Dell’Arret Coutinho Higgor Gonçalves Dornelas João Luiz silva Moreira Laila Evangelista de Almeida fernandes Marcia Lobão Iannini Patrícia Siqueira Valéria Rosalina Dias e Santos Sordaini Maria Caligiorne Instituto de Criminalística Polícia Civil de Minas Gerais Belo Horizonte Brazil

The broke of a tailings dam from Vale S.A. destroyed a gigantic area killing 270 persons in Brumadinho/Brazil. Organizing activities after a mass disaster is a complex process that requires the involvement of many people and resources in the laboratory. To DNA identification of the victims, a daunting work had to be made by DNA laboratory staff in a collaborative effort with many partners. Efforts to implement good practice guidelines in Disaster Victim Identification (DVI) have revealed several important aspects that need to change in the forensic DNA laboratory. This article highlights the challenges of implementing DVI best practice guidelines in resource-poor settings, but with professionals from different sectors engaged in the same goal of briefly identifying victims and helping families and society.

关键词： Disaster Victim Identification DNA Brumadinho

Non-invasive tests for the prediction of primary hepatocellular carcinoma

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World Journal of Gastroenterology 2020年第24期26卷 3326-3343页

作者： giovanni Marasco Antonio Colecchia giovanni silva Benedetta Rossini Leonardo Henry Eusebi federico Ravaioli Elton Dajti Luigina Vanessa Alemanni Luigi Colecchia Matteo Renzulli Rita Golfieri Davide festi Department of Medical and Surgical Sciences(DIMEC) University of BolognaBologna 40138Italy Unit of Gastroenterology Borgo Trento University Hospital of VeronaVerona 37126Italy Radiology Unit Sant’Orsola Malpighi HospitalUniversity of BolognaBologna 40138Italy

Hepatocellular carcinoma(HCC)is one of the most common malignancies in the world and it is one of the main complications of cirrhosis and portal *** in the presence of a well-established follow-up protocol for cirrhotic patients,to date poor data are available on predictive markers for primary HCC occurrence in the setting of compensated advanced chronic liver disease patients(cACLD).The gold standard method to evaluate the prognosis of patients with cACLD,beyond liver fibrosis assessed with histology,is the measurement of the hepatic venous pressure gradient(HVPG).An HVPG≥10 mmHg has been related to an increased risk of HCC in cACLD ***,these methods are burdened by additional costs and risks for patients and are mostly available only in referral *** the last decade increasing research has focused on the evaluation of several,simple,non-invasive tests(NITs)as predictors of HCC *** reviewed the currently available literature on biochemical and ultrasound-based scores developed for the noninvasive evaluation of liver fibrosis and portal hypertension in predicting primary *** found that the most reliable methods to assess HCC risk were the liver stiffness measurement,the aspartate aminotransferase to platelet ratio index score and the fibrosis-4 *** promising NITs need further investigations and validation for different liver disease aetiologies.

关键词： Non-invasive test fibrosis-4 index Hepatocellular carcinoma Liver stiffness measurement Spleen stiffness measurement Albi

Embolization of splenorenal shunt associated to portal vein thrombosis and hepatic encephalopathy

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World Journal of Gastroenterology 2014年第42期20卷 15910-15915页

作者： Letícia de Campos franzoni fábio Cardoso de Carvalho Rafael Gomes de Almeida Garzon fábio da silva Yamashiro Laís Augusti Lívia Alves Amaral Santos Mariana de Souza Dorna Júlio Pinheiro Baima Talles Bazeia Lima Carlos Antonio Caramori giovanni faria silva fernando Gomes Romeiro Internal Medicine Department Gastroenterology Division Botucatu Medical School UNESP 18 618 970 Botucatu Sao Paulo Brazil Hospital do Cora??o do Instituto de Moléstias Cardiovasculares S?o José do Rio Preto Sao Paulo 15015-210 Brazil Department of Internal Medicine Division of Cardiology Botucatu School of Medicine UNESP Univ Estadual Paulista

Hepatic encephalopathy(HE)is a cognitive disturbance characterized by neuropsychiatric *** occurs in acute and chronic hepatic disease and also in patients with portosystemic *** presence of these portosystemic shunts allows the passage of nitrogenous substances from the intestines through systemic veins without liver ***,the embolization of these shunts has been performed tocontrol HE manifestations,but the presence of portal vein thrombosis is considered a *** this presentation we show a cirrhotic patient with severe HE and portal vein thrombosis who was submitted to embolization of a large portosystemic *** report:a 57 years-old cirrhotic patient who had been hospitalized many times for persistent HE and hepatic coma,even without precipitant *** had a wide portosystemic shunt and also portal vein *** abdominal angiography confirmed the splenorenal shunt and showed other *** larger shunt was embolized through placement of microcoils,and the patient had no recurrence of overt *** was a little increase of esophageal and gastric varices,but no endoscopic treatment was *** portosystemic shunts are frequent causes of recurrent HE in cirrhotic patients,portal vein thrombosis should be considered a relative contraindication to perform a shunt ***,in particular cases with many shunts and severe HE,we found that one of these shunts can be safely embolized and this procedure can be sufficient to obtain a good HE *** conclusion,we reported a case of persistent HE due to a wide portosystemic shunt associated with portal vein *** the patient had other shunts,she was successfully treated by embolization of the larger shunt.

关键词： Recurrent hepatic encephalopathy Liver cirrhosis Port systemic shunt Shunt embolization Portal vein thrombosis

Sorafenib after Arterial Chemoembolization in Child-Pugh A and B Cirrhotic Patients with Intermediate Hepatocellular Carcinoma: A Retrospective Analysis

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Journal of Cancer Therapy 2015年第3期6卷 286-292页

作者： fernando Gomes Romeiro Luciana Yumi Odani Sigahi Matheus Alvarez fabio da silva Yamashiro fábio Cardoso de Carvalho Leonardo Pelafsky Talles Bazeia Lima Letícia de Campos franzoni José Ricardo de Arruda Miranda giovanni faria silva Gastroenterology Division Department of Internal Medicine Faculdade de Medicina de Botucatu UNESP—Univ Estadual Paulista Sao Paulo Brazil faculdade de Medicina de Botucatu UNESP—Univ Estadual Paulista Sao Paulo Brazil Department of Physics and Biophysics Instituto de Biociências de Botucatu UNESP—Univ Estadual Paulista Sao Paulo Brazil Gastroenterology Division Department of Surgery and Orthopedics Faculdade de Medicina de Botucatu UNESP—Univ Estadual Paulista Sao Paulo Brazil

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of mortality among cirrhotic patients, and current guidelines recommend single-treatment modalities according to patient and liver disease classifications. New studies have shown promising results from combining locoregional and systemic treatments, but most of them were limited to Child-Pugh A patients due to toxicity concerns. Aim: The objective of this study was to analyze survival rates of Child-Pugh A and B patients with intermediate HCC tumors treated with transarterial chemoembolization (TACE) followed by full-dose sorafenib usage. Material and methods: a retrospective analysis of 37 cirrhotic patients (Child-Pugh A and B rates = 23/14) treated with TACE and TACE followed by sorafenib usage (17 and 20 patients, respectively). Results: The mean survival was 379 days in the combined treatment group and 151 days in the single-treatment group (p = 0.007). There were no differences in survival according to the Child-Pugh classification. Conclusions: sorafenib after TACE can be an option for selected cirrhotic patients with intermediate HCC tumors if this combined approach is cautiously performed on an individualized schedule. Our results suggest that the Child-Pugh classification should not be a limitation to this combined treatment.

关键词： Hepatocellular Carcinoma Cirrhosis Arterial Chemoembolization Sorafenib

Pancreatic paracoccidioidomycosis simulating malignant neoplasia:Case report

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World Journal of Gastroenterology 2013年第34期19卷 5750-5753页

作者： Talles Bazeia Lima Maria Aparecida Custódio Domingues Carlos Antonio Caramori giovanni faria silva Cássio Vieira de Oliveira fábio da silva Yamashiro Letícia de Campos franzoni Lígia Yukie Sassaki fernando Gomes Romeiro Division of Gastroenterology Department of Internal MedicineBotucatu School of MedicineRubio JuniorDistrict S/N18618-970 So PauloBrazil Department of Pathology Botucatu School of MedicineRubio Junior District S/N18618-970 So PauloBrazil

Paracoccidioidomycosis is a systemic granulomatous disease caused by fungus,and must be considered in the differential diagnosis of intra-abdominal tumors in endemic *** report a rare case of paracoccidioidomycosis in the pancreas.A 45-year-old man was referred to our institution with a 2-mo history of epigastric abdominal pain that was not diet-related,with night sweating,inappetence,weight loss,jaundice,pruritus,choluria,and acholic feces,without signs of sepsis or palpable *** ultrasonography(US)showed a solid mass of approximately 7 cm×5.5 cm on the pancreas *** computerized tomography showed dilation of the biliary tract,an enlarged pancreas(up to 4.5 in the head region),with dilation of the major pancreatic *** patient underwent exploratory laparotomy,and the surgical description consisted of a tumor,measuring 7 to 8 cm with a poorly-defined margin,adhering to posterior planes and mesenteric vessels,showing an enlarged bile *** drainage of the biliary tract,Rouxen-Y gastroenteroanastomosis,lymph node excision,and biopsies were performed,but malignant neoplasia was not *** analysis showed chronic pancreatitis and a granulomatous chronic inflammatory process in the choledochal lymph ***-alcohol resistant bacillus and fungus screening were ***-needle aspiration of the pancreas was performed under US *** smear was compatible with infection by Paracoccidioides *** report a rare case of paracoccidioidomycosis simulating a malignant neoplasia in the pancreas head.

关键词： Paracoccidioidomycosis Pancreas fungus infection Pancreatic tumors Differential diagnosis

Grade 4 febrile neutropenia and fournier's Syndrome associated with triple therapy for hepatitis C virus:A case report

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World Journal of Hepatology 2014年第6期6卷 448-452页

作者： Kelly Cristhian Lima Oliveira Emili de Oliveira Bortolon Cardoso Suzana Carla Pereira de Souza flávia Souza Machado Carlos Eduardo Alves Zangirolami Alecsro Moreira giovanni faria silva Cássio Vieira de Oliveira Division of Gastroenterology Department of Internal MedicineBotucatu School of Medicine18618-970 Sao PauloBrazil

The use of triple therapy for hepatitis C not only increases the rate of sustained virological responses compared with the use of only interferon and ribavirin(RBV) but also leads to an increased number of side effects. The subject of this study was a 53-year-old male who was cirrhotic with hepatitis C virus genotype 1 A and was a previous null non-responder. We initially attempted retreatment with boceprevir(BOC), Peginterferon and RBV, and a decrease in viral load was observed in the 8th week. In week 12, he presented with disorientation, flapping, fever, tachypnea, arterial hypotension and tachycardia. He also exhibitedleucopenia with neutropenia. Cefepime and filgrastim were initiated, and treatment for hepatitis C was suspended. A myelogram revealed hypoplasia, cytotoxicity and maturational retardation. After 48 h, he developed bilateral inguinal erythema that evolved throughout the perineal area to the root of the thighs, with exulcerations and an outflow of seropurulent secretions. Because we hypothesized that he was suffering from fournier's Syndrome, treatment was replaced with the antibiotics imipenem, linezolid and clindamycin. After this new treatment paradigm was initiated, his lesions regressed without requiring surgical debridement. Triple therapy requires knowledge regarding the management of adverse effects and drug interactions; it also requires an understanding of the importance of respecting the guidelines for the withdrawal of treatment. In this case report, we observed an adverse event that had not been previously reported in the literature with the use of BOC.

关键词： Hepatitis C Treatment Boceprevir Telaprevir Adverse events

Metabolomics in chronic hepatitis C:Decoding fibrosis grading and underlying pathways

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World Journal of Hepatology 2023年第11期15卷 1237-1249页

作者： Adriana Camargo ferrasi Samara Vitória Granja Lima Aline faria Galvani Jeany Delafiori flavia Luísa Dias-Audibert Rodrigo Ramos Catharino giovanni faria silva Roberta Rodrigues Praxedes Driele Bretones Santos Dayane Trevisan de Macedo Almeida Estela Oliveira Lima Department of Internal Medicine Sao Paulo State UniversityBotucatu 18618-686Brazil Innovare Biomarkers Laboratory University of CampinasCampinas 13083-877Brazil

BACKGROUND Chronic Hepatitis C(CHC)affects 71 million people globally and leads to liver issues such as fibrosis,cirrhosis,cancer,and death.A better understanding and prognosis of liver involvement are vital to reduce morbidity and *** accurate identification of the fibrosis stage is crucial for making treatment decisions and predicting *** used to grade fibrosis include histological analysis and imaging but have *** markers such as molecular biomarkers can offer valuable insights into *** To identify potential biomarkers that might stratify these lesions and add information about the molecular mechanisms involved in the *** Plasma samples were collected from 46 patients with hepatitis C and classified into fibrosis grades f1(n=13),f2(n=12),f3(n=6),and f4(n=15).To ensure that the identified biomarkers were exclusive to liver lesions(CHC fibrosis),healthy volunteer participants(n=50)were also *** untargeted metabolomic technique was used to analyze the plasma metabolites using mass spectrometry and database *** analyses were performed to identify differential biomarkers among *** Six differential metabolites were identified in each grade of *** six-metabolite profile was able to establish a clustering tendency in patients with the same grade of fibrosis;thus,they showed greater efficiency in discriminating *** This study suggests that some of the observed biomarkers,once validated,have the potential to be applied as prognostic ***,it suggests that liquid biopsy analyses of plasma metabolites are a good source of molecular biomarkers capable of stratifying patients with CHC according to fibrosis grade.

关键词： Chronic Hepatitis C fibrosis Metabolome Biomarkers Plasma Liquid biopsy

Mobile Robotic Platform for Contactless Vital Sign Monitoring

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Cyborg and Bionic Systems 2022年第1期2022卷 87-97页

作者： Hen-Wei Huang Jack Chen Peter R.Chai Claas Ehmke Philipp Rupp farah Z.Dadabhoy Annie feng Canchen Li Akhil J.Thomas Marco da silva Edward W.Boyer giovanni Traverso Department of Mechanical Engineering Massachusetts Institute of TechnologyUSA The Koch Institute of Integrated Cancer Rssearch Massachusetts Institute of TechnologyUSA Division of Gast roenterology Brigham and Women's HospitalHarvard Medical SchoolUSA Department of Engineering Science University of TorontoCanada Department of Emergency Medicine Brigham and Women's HospitalHarvard Medical SchoolUSA Department of Psychosocial Oncology and Plliative Care Dana Farber Cancer InstituteUSA The fenway Institute USA Boston Dynamics USA

The COVID-19 pandemic has accelerated methods to faciltate contactless evaluation of patients in hospital *** minimizing in-person contact with individuals who may have COVID 19,healthcare workers can prevent disease transmission and conserve personal protective *** vital signs is a ubiquitous task that is commonly done in person by healthcare *** eliminate the need for in-person contact for vital sign measurement in the hospital setting,we developed ***,a mobile quadruped robotic *** system includes IR and RGB cameras for vital sign monitoring and a tablet computer for face-to-face medical *** is teleoperated by trained clinical staff to simultaneously measure the skin temperature,respiratory rate,and heart rate while maintaining social distancing from patients and without removing their *** enable accurate,contactless measurements on a mobile system without a static black body as reference,we propose novel methods for skin temperature compensation and respiratory rate measurement at various distances between the subject and the cameras,up to 5 *** compensation,the skin temperature MAE is 13℃.Using the proposed compensation method,the skin temperature MAE is reduced to 0.3℃.The respiratory rate method can provide continuous monitoring with a MAE of 1.6 BPM in 30s or rapid screening with a MAE of 2.1 BPM in *** the heart rate estimation,our system is able to achieve a MAE less than 8 BPM in 10s measured in arbitrary indoor light conditions at any distance below 2 m.

关键词： removing protective eliminate

Late diagnosis and TCD8 immune response profile of cutaneous tuberculosis: A case report

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Open Journal of Immunology 2012年第3期2卷 125-131页

作者： Bruna Daniella de Souza silva Sueli Lemes de ávila Alves André Kipnis Ana Paula Junqueira-Kipnis Departamento de Microbiologia Imunologia Patologia e Parasitologia Instituto de Patologia Tropical e Saúde Pública Universidade Federal de Goiás Goiania/GO Brazil Laboratório Central de Saúde Pública Dr. giovanni Cysneiros LACEN/GO Goiania/GO Brazil

Introduction: Cutaneous tuberculosis (CTB) is a rare form of extra-pulmonary tuberculosis that, when associated with late diagnosis, worsen the quality of life of the sick individuals. This report presents a case of late diagnosis of CTB. Unusual clinical manifestations retarded the correct tuberculosis diagnosis for more than a year. The immune response elicited by this type of tuberculosis as well as the factors that might contribute to the delay in diagnosis was evaluated and discussed. Methodology: Clinical evaluation and flow cytometric analyses of PBMC were realized for a case of CTB and a healthy individual as a control. Results: M. tuberculosis specific TCD8+ cell response was analyzed by flow cytometry and revealed positive cells for IL-17, IL-10, TGf-β and IDO. The CTB patient presented higher percentage of those cells when compared to a healthy donor. However, TCD8 cells positive for the important protective cytokine, IfN-γ was decreased in the CTB patient. Conclusion. The assessment of the M. tuberculosis specific TCD8+ immune response showed a regulatory/modulatory phenotype with a reduced IfN-γ response when compared to the healthy control that could have contributed to the CTB infection.

关键词： Cutaneous tuberculosis Late Diagnosis CD8+ T Cells