Sociedade Brasileira De Research Articles

Validation protocol for multiple blood gas analyzers in accordance with laboratory accreditation programs

Introduction:The results of blood gas analysis using different instrumentation can vary widely due to the methodological differences, the calibration procedures and the use of different configurations for each type of instrument.Objective:The objective of this study was to evaluate multiple analytical systems for measurement of blood gases, electrolytes and metabolites in accordance with the accreditation program (PALC) of Sociedade Brasileira de Patologia Clinica/Medicina Laboratorial (SBPC/ML).Materials and methods:20 samples were evaluated in three ABL800 Flex (Radiometer Medical ApS, Denmark) blood gas analyzers, and the results were compared with those of the device in use, which was considered the reference. The analysis of variance (Anova) was applied for statistical purposes, as well as the calculation of mean, standard deviation and coefficient of variation.Results:The p values obtained in the statistical analysis were: pH = 0.983, pO2 = 0.991, pCO2 = 0.353, lactate = 0.584, glucose = 0.995, ionized calcium = 0.983, sodium = 0.991, potassium = 0.926, chlorine = 0.029.Conclusion:The evaluation of multiple analytical systems is an essential procedure in the clinical laboratory for quality assurance and accuracy of the results.

Safe use of biological therapies for the treatment of rheumatoid arthritis and spondyloarthritides

The treatment of autoimmune rheumatic diseases has gradually improved over the last half century, which has been expanded with the contribution of biological therapies or immunobiopharmaceuticals. However, we must be alert to the possibilities of undesirable effects from the use of this class of medications. The Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia) produced a document based on a comprehensive literature review on the safety aspects of this class of drugs, specifically with regard to the treatment of rheumatoid arthritis and spondyloarthritides. The themes selected by the participating experts, on which considerations have been established as the safe use of biological drugs, were: occurrence of infections (bacterial, viral, tuberculosis), infusion reactions, hematological, neurological, gastrointestinal and cardiovascular reactions, neoplastic events (solid tumors and hematologic neoplasms), immunogenicity, other occurrences and vaccine response. For didactic reasons, we opted by elaborating a summary of safety assessment in accordance with the previous themes, by drug class/mechanism of action (tumor necrosis factor antagonists, T-cell co-stimulation blockers, B-cell depletors and interleukin-6 receptor blockers). Separately, general considerations on safety in the use of biologicals in pregnancy and lactation were proposed. This review seeks to provide a broad and balanced update of that clinical and experimental experience pooled over the last two decades of use of immunobiological drugs for RA and spondyloarthritides treatment.

Segurança do uso de terapias biológicas para o tratamento de artrite reumatoide e espondiloartrites

The treatment of autoimmune rheumatic diseases has gradually improved over the last half century, which has been expanded with the contribution of biological therapies or immunobiopharmaceuticals. However, we must be alert to the possibilities of undesirable effects from the use of this class of medications. The Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia/SBR) produced a document based on a comprehensive literature review on the safety aspects of this class of drugs, specifically with regard to the treatment of rheumatoid arthritis (RA) and spondyloarthritides. The themes selected by the participating experts, on which considerations have been established as the safe use of biological drugs, were: occurrence of infections (bacterial, viral, tuberculosis), infusion reactions, hematological, neurological, gastrointestinal and cardiovascular reactions, neoplastic events (solid tumors and hematologic neoplasms), immunogenicity, other occurrences and vaccine response. For didactic reasons, we opted by elaborating a summary of safety assessment in accordance with the previous themes, by drug class/mechanism of action (tumor necrosis factor antagonists, T‐cell co‐stimulation blockers, B‐cell depletors and interleukin‐6 receptor blockers). Separately, general considerations on safety in the use of biologicals in pregnancy and lactation were proposed. This review seeks to provide a broad and balanced update of that clinical and experimental experience pooled over the last two decades of use of immunobiological drugs for RA and spondyloarthritides treatment.

Brazilian recommendations of mechanical ventilation 2013. Part 2.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Brazilian recommendations of mechanical ventilation 2013. Part I.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Remarkable facts about the history of the Brazilian Society of Tropical Medicine

The Brazilian Society of Tropical Medicine (BSTM) was established in the 1960s in an effort to bring together numerous academic members, professors and researchers from different universities and faculties throughout the country as a counterpoint to the Brazilian Society of Hygiene (Sociedade Brasileira de Higiene SBH). In those days, the SBH experienced a marked reduction in activity that continued until it ceased to exist. It must be remembered that the SBH, which was established in the 1920s, was very important and was the leader in the control of parasitic endemic diseases through its various programs and projects. In the beginning, the members of the SBH were mostly health workers but also included researchers and professors. Carlos Chagas was one of the many active and important presidents that belonged to this society. Over the decades, there was a separation in Brazil between the activities and claims of the so-called sanitarians, who participated in control services, and the activities of researchers and university professors. The BSTM was very important in re-founding the Brazilian Society of Parasitology (Sociedade Brasileira de Parasitologia SBP), which was originally founded in 1965. Dr. Wladimir Lobato Paraense was its fi rst president and was followed by Professor Amilcar Vianna Martins. With Martins’ forfeiture and mandatory retirement in 1969 due to the infamous Institutional Act no 5, produced by the military dictatorship that assumed control of the country in 1964, the Society ceased to function. However, it was re-established in 1975 under the leadership of Professor Rubens Campos from the State of Sao Paulo. For 10 years, the Society held combined annual meetings with the BSTM, from which it received all of its necessary support and funding. It is valuable to note that expert groups were created in the BSTM, sometimes formally or informally. These groups were extremely important because they could ensure that ineffective drugs and vaccines for the treatment of Chagas disease were not offered for sale. Similarly, glucosamine

Evaluation of scientific production in the field of Dentistry in Public Health from 1999 to 2009

Introduction: Studies that analyze scientific production are essential to guide researchers. Aim: The purpose of this study was to analyze the profile of scientific production in the field of Dentistry in Public Health, by means of the abstracts published in the Annals of Sociedade Brasileira de Pesquisa Odontológica in the period from 1999 to 2009. Material and method: First, the reading of all the 22388 abstracts published in the annals of the Sociedade Brasileira de Pesquisa Odontológica from 1999 to 2009 was undertaken. The sample was 3061 abstract belonging to Public Health area. Result: There was growing participation of studies on Dentistry in Public Health with 113 studies having been inscribed in 1999 and 441 in 2009. There was a predominance of scientific studies in comparison with systematic reviews, meta-analyses, or case reports. In the classification of general nature of the research, 71.28% concerned studies with human beings. The greatest weight in the total number of researches with humans was in 2002, contributing with 79.79% of the total. With regard to the area of thematic domain, it was verified that studies involving Epidemiology were more frequent in all the years. When analyzing the institutional origin of studies, it was verified that in all the studied years, the public universities were responsible for the majority of scientific publications, 75.6% (n=2315). Conclusion: The studies on Dentistry in Public Health have grown significantly in the studied period of ten years. There was predominance of Epidemiological studies, and those of the in vivo and scientific research type.

Goals, globalization and the impact factor of the journal.

Over the years, as editors of Revista Brasileira de Hematologia e Hemoterapia (RBHH), we have faced different issues. The irst of these, an observation that sometimes became a question, is about the purpose of the journal. To answer this question it is necessary to return to the journal’s origins in the 1980s. In those dificult times of discretion, Brazil was different and the Sociedade Brasileira de Hematologia e Hematologia (SBHH) was going through a period of restructuring and controversy about the role of hemotherapy in the country. In a irm and decisive action, remunerated blood donation was banned in Brazil. The SBHH had published a monthly newsletter since 1973 which aimed to promote the activities of the Executive Board of the society and informing everyone about what was going on in hematology and transfusion medicine across the country. At a time when there was little information, when for most it was dificult to access scientiic journals, it was said that for some corners of the country, this was the only accessible communication about hematology and transfusion medicine. An international congress of hematology was hosted by the city of Buenos Aires, Argentina, in 1984 when the Board of the SBHH, in a daring act involving four or ive people, modiied the format of the newsletter and launched instead a prototype of the scientiic journal that circulated during the event. At that point the primary objective and heresy of the creators was to move forward and to mark a scientiic position, a criticism that the SBHH received, in addition to attracting young people

Brazilian recommendations of mechanical ventilation 2013. Part I.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

The Guidelines Project: Brazilian guidelines for acute promyelocytic leukemia

The Guidelines Project of the Associacao Medica Brasileira (AMB) and of the Conselho Federal de Medicina (CFM) began in 2000 with specialist societies participating in the preparation of the texts. The guidelines are based on research and contain solid advice on the diagnosis, therapy, and prevention of diseases. Grounded in evidence-based medicine, they seek to answer specific or crucial questions regarding the disease. A review of the literature is performed and, using pre-established criteria, studies on the disease are selected and graded according to their characteristics and type. Randomized clinical trials and meta-analyses have the highest value (A). Second in importance are observational and clinical studies (B), then case reports and case series (C), and finally, publications of consensuses and opinions (D). Due to the methodology employed, current systematic reviews are clearly more relevant when compared to those written in the past. Historically, reviews were much more based on personal opinions and subject to the author's interest, that is, more concerned with the individual point of view and based on personal experience.1 The Associacao Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) began to participate effectively in the development of the guidelines of the AMB in 2009, with contributions by several experts as shown in Table 1; previously, the collection was limited, with fewer themes. After 2012, guidelines on several diseases were completed and published in the Revista Brasileira de Hematologia e Hemoterapia (RBHH); chronic myelogenous leukemia,2 multiple myeloma,3 and diagnosis4 and treatment of immune thrombocytopenic purpura.5 It is also important to quote other systematic reviews published in the RBHH, such as preventive practices in longterm hematopoietic stem cell transplantation survivors, with the participation of experts from several different countries.6 The consensus of the Sociedade Brasileira de Transplante de Medula Ossea (SBTMO) produced the famous 'Pink Book'; this was rounded out with two publications on transplantation in acute myeloid leukemia7 and autoimmune diseases.8 Table 1 Guidelines published on hematological diseases. Acute promyelocytic leukemia (APL) has well-defined clinical, cytogenetic, and morphological characteristics; it encompasses 10% to 15% of all myeloid-type leukemias. Its molecular bases are well defined, with different variations influencing the treatment of patients.9 The results, as reported by the International Consortium on APL, established the treatment strategies and the conduct for the disease in developing countries.10,11 The guidelines for the diagnosis and treatment of APL12 are published in this issue of the RBHH, the first in 2014, thereby adding to those already published. Hopefully, this will stimulate other experts to continue this hard work, aiming to contribute to medical practice and to solidify the knowledge on the diagnoses and treatment of hematologic diseases.

Brazilian recommendations of mechanical ventilation 2013. Part 2.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Construindo saberes em psicologia: o desafio de articular diferentes teorias e práticas

In this article – presented during the Opening Conference of the 44 th Brazilian Psychological Society (SBP) Annual Meeting, held in Ribeirao Preto, in 10/21/14 – the author discusses the articulations between different theoretical and technical approaches built by her from professional experiences within the academy and clinical practice. The story of a 42-year-journey – both as a professor/researcher and as a clinical psychologist – is narrated, highlighting the inseparable conception of such roles. The author presents results from surveys regarding family assessment, marriage, divorce, remarriage, and family and couple’s psychotherapy, as well as contemporary conjugality and parenthood. The article features the possibilities in which different theoretical approaches can complement themselves during research and clinical practice with families and couples. Traditional purism in data analysis is waived during the “Parent Conjugality Questionnaire” (QCP, in Portuguese) validation studies, favoring a closer dialogue between two seemingly incompatible areas – Psychometrics and Psychoanalysis – reaffi rming the 1 Conferencia de Abertura da 44a Reuniao Anual da Sociedade Brasileira de Psicologia (SBP), proferida pela

Ossification of vascular pedicle in fibula free flap: a case report

Introduction: The use of fibula flaps for the reconstruction of craniomaxillofacial defects has many advantages, including the low morbidity of the donor area, good bone quality for use of osseointegrated implants, and the possibility to include a skin island, when indicated. During the dissection of the flap, a muscle “cuff” and a periosteal strip are usually included near the region of the vascular pedicle. The Brazilian Society of PlaStic Surgery SOCIEDADE BrASIlEIrA DE CIrurgIA plaStICA Relato de Caso Rev. Bras. Cir. Plast. 2014;29(2):198-200 DOI: 10.5935/2177-1235.2014RBCP0037

Referências de periódicos médicos brasileiros em publicações nacionais

ObjectiveTo assess whether there is a preference for international journal citation to the detriment of national ones in ten Brazilian medical journals, in two different periods. MethodsAll references in the articles published in Arquivos Brasileiros de Oftalmologia, Revista Brasileira de Cirurgia Cardiovascular, Revista da Associação Médica Brasileira, São Paulo Medical Journal, Arquivos Brasileiros de Endocrinologia e Metabologia, Clinics, Jornal Brasileiro de Pneumologia, Revista da Sociedade Brasileira de Medicina Tropical, Revista Brasileira de Psiquiatria e Acta Ortopédica Brasileira in the years 2011 and 2007 were analyzed, assessing the number of articles published in national and international journals. ResultsA total of 36,125 references from 1,462 articles published in the 10 aforementioned journals were analyzed. Of the total number, 4.242 (11.74%) were from Brazilian journals. There was no significant difference between the two analyzed periods. A total of 453 (30,98%) of the articles studied non-cited brazilian papers,and 81 (5.54%) articles had more Brazilian than international references. ConclusionOf total references analyzed, 11.74% were related to articles published in Brazilian journals. This number, when compared to the percentage of Brazilian articles published in the medical area, demonstrates a good number of citations of national articles.

Ajit Kumar Padhy

© 2013. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

History of Nuclear Medicine in the Philippines

© 2013. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Laboratory errors, adverse events and research methodologies: a systematic review

First submission on 01/04/13; last submission on 01/04/13; accepted for publication on 05/04/13; published on 20/10/13 1. Pathologist; master’s degree in Collective Health from Escola Nacional de Saude Publica Sergio Arouca da Fundacao Oswaldo Cruz (ENSP-Fiocruz); director of accreditation and quality at Sociedade Brasileira de Patologia Clinica (2012-2013); institutional relationship manager of Grupo Fleury. 2. Researcher at ENSP-Fiocruz. ABStrACt

Honour the scientist.

© 2013. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Recommendations for the management and treatment of psoriatic arthritis

The members of the Comissão de Espondiloartrites da Sociedade Brasileira de Reumatologia (Commission on Spondyloarthritis of the Brazilian Society of Rheumatology, SBR) 2010-2012 took part in the Evidence Preparation Course given by the Associação Médica Brasileira (Brazilian Medical Association, AMB) in São Paulo in the first semester of 2011. The questions were finally concluded at a meeting of the Commission on Spondyloarthritis held on 15 October 2011 in Florianópolis (SC, Brazil), during the 18th Southern Cone Rheumatology Meeting and were later approved by all the coordinators of the Brazilian Spondyloarthritis Registry. The 15 clinical questions considered to be relevant were structured using the P.I.C.O. method (patient; intervention or indicator; comparison; outcome). The literature search was conducted by searching the databases MEDLINE, EMBASE, SciElo/Lilacs, and the Cochrane Library through February, 2012 (Appendix). Critical assessment of the evidence in the selected articles was performed using the Jadad score. Next, the answers to the questions included in the Recommendations were elaborated, and all the selected references exhibit the corresponding grade of recommendation and strength of scientific evidence. The references were updated through August, 2012, entered into a single file by the coordinator, and sent to the co-authors in two successive rounds for preparation of the final version. A. Most consistent experimental and observational studies. B. Less consistent experimental and observational studies. C. Case reports (uncontrolled studies). D. Opinion that is not substantiated by critical evaluation, based on consensus, physiological studies or animal models. To establish recommendations for the management (criteria for classification and clinical assessment) and treatment of psoriatic arthritis.

Recommendations for the management and treatment of systemic sclerosis

Description of the method to elaborate the evidence The members of the Comissao de Esclerose Sistemica da Sociedade Brasileira de Reumatologia (Systemic Sclerosis Commission of the Brazilian Society of Rheumatology, SBR) 2010- 2012 took part in the Evidence Preparation Course given by the Associacao Medica Brasileira (Brazilian Medical Association, AMB) in Sao Paulo in the first semester of 2011. The questions were formulated and discussed via internet in the second semester of 2011. The 15 clinical questions considered to be relevant were structured using the P.I.C.O. method (patient; intervention or indicator; comparison; outcome). The literature search was conducted by searching the databases MEDLINE, EMBASE, SciElo/Lilacs, and the Cochrane Library through February, 2012 (Appendix). Critical assessment of the evidence in the selected articles was performed using the Jadad score. The observational studies and case series were considered for analysis when randomised clinical trials could not be located. A manual search located the relevant studies that were included in the analysis. The answers to the questions included in the Recommendations were refined and elaborated, and all of the selected references exhibited the corresponding grade of recommendation and the strength of scientific evidence. The references were updated through December, 2012, entered into a single file by the coordinator, and sent to the co-authors in four successive rounds for preparation of the final version. Grades of recommendation and strength of evidence A. Most consistent experimental and observational studies. B. Less consistent experimental and observational studies. C. Case reports (uncontrolled studies). D. Opinion that is not substantiated by critical evaluation, based on consensus, physiological studies or animal models. Objective To establish recommendations for the management and treatment of systemic sclerosis.