ABSTRACT Objective: Life expectancy is increasing worldwide and studies have been demonstrating that elevated serum thyroid stimulating hormone (TSH) concentration in elderly is associated with some better health outcomes. This elevation is somewhat physiological as aging. The aim of this study was to investigate the heart rate (HR) response during a graded exercise test and its recovery in healthy elderly, comparing subjects within serum TSH in the lower limit of reference range to those within the TSH in the upper limit. Subjects and methods: A cross-sectional study was conducted with 86 healthy elderly aged 71.5 ± 5.1 years, with serum TSH between 0.4 – 4.0 mUl/mL. The participants were divided into two groups according to TSH level: < 1.0 mUl/mL (n = 13) and ≥ 1.0 µUI/mL (n = 73). All participants performed an ergometric test on a treadmill. The HR was recorded and analyzed at rest, during exercise and during the three minutes immediately after exercise. Results: No differences were observed in relation to HR at peak of exercise (TSH < 1.0 µUI/mL: 133.9 ± 22.5 bpm vs. TSH ≥ 1.0 µUI/mL: 132.4 ± 21.3 bpm; p = 0.70) and during the first minute of recovery phase (TSH < 1.0 µUI/mL: 122.3 ± 23.1 bpm vs. TSH ≥ 1.0 µUI/mL: 115.7 ± 18.4 bpm p = 0.33). The groups also presented similar chronotropic index (TSH < 1.0 µUI/mL: 78.1 ± 30.6 vs. TSH ≥ 1.0 µUI/mL: 79.5 ± 26.4; p = 0.74). Conclusion: In this sample studied, there were no difference between lower and upper TSH level concerning HR response during rest, peak of exercise and exercise recovery.

Resumo Objetivo: Verificar a efetividade do processo de doação de órgãos para transplantes no Estado do Paraná. Métodos: Estudo transversal realizado com dados disponibilizados pelo Sistema Estadual de Transplantes do Paraná referentes ao processo de doação de órgãos, no período de 2011 a 2016. Das 3.872 notificações de potenciais doadores em morte encefálica, 2.600 foram incluídas neste estudo por se constituírem em doadores elegíveis de órgãos. Avaliou-se os desfechos dos protocolos e variáveis relacionadas aos doadores elegíveis, aos centros notificantes e às notificações. Os dados foram analisados descritivamente por frequências absolutas e relativas, e calculou-se odds ratio verificando-se a associação pelo teste de Qui-Quadrado de Wald, em que considerou-se p<0,05 como significância estatística. Resultados: Entre os 2.600 doadores elegíveis, 1.267 (48,7%) tornaram-se doadores efetivos de órgãos. Como principais obstáculos do processo destacaram-se a parada cardiorrespiratória, a sepse e a recusa familiar. As chances de efetivação da doação foram significativamente maiores nos indivíduos com menos de 60 anos (p<0,001), do sexo masculino (p=0,001) e notificados pelas Macrorregionais Leste e Oeste do Estado (p<0,001). O percentual de doações de órgãos aumentou de 38,8% para 66,5% no período estudado. Conclusão: O Paraná apresentou crescimento expressivo no número de notificações e doações de órgãos nos últimos seis anos. As fragilidades identificadas no processo se referiram às questões clínicas e culturais, que indicam a necessidade de intervenções gerenciais de capacitação dos profissionais de saúde na identificação e manutenção do potencial doador, bem como na sensibilização da sociedade quanto a importância do consentimento à doação.

Abstract Objective: to verify the effectiveness of the organ donation process in the State of Paraná. Methods: Cross-sectional study carried out with data provided by the Department of Transplantation of the State of Paraná referred to the organ donation process, from 2011 to 2016. Of the 3,872 notifications of potential donors with brain death, 2,600 were included in this study since they were eligible organ donors. The outcome of the protocols and variables related to eligible donors, notifying centers and notifications were evaluated. Data were analyzed descriptively by absolute and relative frequencies, and odds ratio was calculated through the Wald Chi-square test, with p<0.05 considered as statistically significant. Results: Out of the 2,600 eligible donors, 1,267 (48.7%) became effective organ donors. The main obstacles of the process were cardiopulmonary arrest, sepsis and family refusal. The odds of donation were significantly higher in the individuals younger than 60 years old (p<0.001), male (p=0.001) and in the East and West Macro-regions of the State (p<0.001). The percentage of organ donations increased from 38.8% to 66.5% in the period studied. Conclusion: The state of Parana presented a significant increase in the number of notifications and organ donations in the last six years. The weaknesses identified in the process refer to clinical and cultural issues, which indicate the need for interventions to train health professionals in the identification and maintenance of the potential donor, as well as in raising awareness of the importance of the consent to donation.

Abstract Objective: to verify the effectiveness of the organ donation process in the State of Paraná. Methods: Cross-sectional study carried out with data provided by the Department of Transplantation of the State of Paraná referred to the organ donation process, from 2011 to 2016. Of the 3,872 notifications of potential donors with brain death, 2,600 were included in this study since they were eligible organ donors. The outcome of the protocols and variables related to eligible donors, notifying centers and notifications were evaluated. Data were analyzed descriptively by absolute and relative frequencies, and odds ratio was calculated through the Wald Chi-square test, with p<0.05 considered as statistically significant. Results: Out of the 2,600 eligible donors, 1,267 (48.7%) became effective organ donors. The main obstacles of the process were cardiopulmonary arrest, sepsis and family refusal. The odds of donation were significantly higher in the individuals younger than 60 years old (p<0.001), male (p=0.001) and in the East and West Macro-regions of the State (p<0.001). The percentage of organ donations increased from 38.8% to 66.5% in the period studied. Conclusion: The state of Parana presented a significant increase in the number of notifications and organ donations in the last six years. The weaknesses identified in the process refer to clinical and cultural issues, which indicate the need for interventions to train health professionals in the identification and maintenance of the potential donor, as well as in raising awareness of the importance of the consent to donation.

Resumo Objetivo: Verificar a efetividade do processo de doação de órgãos para transplantes no Estado do Paraná. Métodos: Estudo transversal realizado com dados disponibilizados pelo Sistema Estadual de Transplantes do Paraná referentes ao processo de doação de órgãos, no período de 2011 a 2016. Das 3.872 notificações de potenciais doadores em morte encefálica, 2.600 foram incluídas neste estudo por se constituírem em doadores elegíveis de órgãos. Avaliou-se os desfechos dos protocolos e variáveis relacionadas aos doadores elegíveis, aos centros notificantes e às notificações. Os dados foram analisados descritivamente por frequências absolutas e relativas, e calculou-se odds ratio verificando-se a associação pelo teste de Qui-Quadrado de Wald, em que considerou-se p<0,05 como significância estatística. Resultados: Entre os 2.600 doadores elegíveis, 1.267 (48,7%) tornaram-se doadores efetivos de órgãos. Como principais obstáculos do processo destacaram-se a parada cardiorrespiratória, a sepse e a recusa familiar. As chances de efetivação da doação foram significativamente maiores nos indivíduos com menos de 60 anos (p<0,001), do sexo masculino (p=0,001) e notificados pelas Macrorregionais Leste e Oeste do Estado (p<0,001). O percentual de doações de órgãos aumentou de 38,8% para 66,5% no período estudado. Conclusão: O Paraná apresentou crescimento expressivo no número de notificações e doações de órgãos nos últimos seis anos. As fragilidades identificadas no processo se referiram às questões clínicas e culturais, que indicam a necessidade de intervenções gerenciais de capacitação dos profissionais de saúde na identificação e manutenção do potencial doador, bem como na sensibilização da sociedade quanto a importância do consentimento à doação.

Abstract We report on four patients with fatal influenza A(H1N1)pdm09 and dengue virus coinfections. Clinical, necropsy and histopathologic findings presented in all cases were characteristic of influenza-dengue coinfections, and all were laboratory-confirmed for both infections. The possibility of influenza and dengue coinfection should be considered in locations where these two viruses’ epidemic periods coincide to avoid fatal outcomes. Dengue is a mosquito-borne viral infection caused by one of the four dengue viruses (DENV-1 to 4). Each of these viruses is capable of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998). As a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with that of other common febrile illnesses in tropical regions (Chacon et al. 2015). In April 2009, a new virus, influenza A/H1N1/pandemic (FluA/H1N1/09pdm), caused a severe outbreak in Mexico. The virus quickly spread throughout the world, and in June 2009, the World Health Organization declared a pandemic (WHO 2010). In Brazil, the first laboratory confirmed case of FluA/H1N1/09pdm was in July 2009 (Pires Neto et al. 2013). The state of Ceará, in Northeast Brazil, is a dengue endemic area. In this state, the virus influenza A(H1N1)pdm09 has circulated since 2009, and through the first half of 2012, 11 deaths caused by the virus were confirmed (Pires Neto et al. 2013). The influenza and dengue seasons in Ceará overlap, which led to diagnostic difficulties. We report four cases of laboratory-confirmed coinfection of deadly influenza A(H1N1)pdm09 with DENV, which occurred during the dengue and influenza season in 2012 and 2013 in Ceará.

Objective Investigate the differences in cardiopulmonary (CP) capacity and Quality of Life (QOL) between healthy elderly (≥ 65 years) with different TSH levels (< 1.0 and ≥ 1.0 μIU/mL) both within the normal range. Also, evaluate the effects of TSH elevation on CP test and QOL, by administering methimazole to subjects with initial lower-normal TSH, in order to elevate it to superior-normal limit. Materials and methods Initially, a cross-sectional study was performed to compare CP capacity at peak exercise and QOL (using WHOQOL-OLD questionnaire) between healthy seniors (age ≥ 65 years) with TSH < 1.0 μIU/mL vs. TSH ≥1.0 μIU/mL. In the second phase, participants with TSH < 1.0 μIU/mL were included in a non-controlled-prospective-interventional study to investigate the effect of TSH elevation, using methimazole, on QOL and CP capacity at peak exercise. Results From 89 elderly evaluated, 75 had TSH ≥ 1 μIU/mL and 14 TSH < 1 μIU/mL. The two groups had similar basal clinical characteristics. No difference in WHOQOL-OLD scores was observed between groups and they did not differ in terms of CP function at peak exercise. QOL and CP variables were not correlated with TSH levels. Twelve of 14 participants with TSH < 1.0 μIU/mL entered in the prospective study. After one year, no significant differences in clinical caracteristics, QOL, and CP variables were detected in paired analysis before and after methimazole intervention. Conclusions We found no differences in CP capacity and QOL between health elderly with different TSH levels within normal range and no impact after one year of methimazole treatment. More prospective-controlled-randomized studies are necessary to confirm or not the possible harm effect in normal low TSH.

OBJECTIVE: The aim of this study was to evaluate the effect of oral tamoxifen treatment on the number of myofibroblasts present during the healing process after experimental bile duct injury. METHODS: The sample consisted of 16 pigs that were divided into two groups (the control and study groups). Incisions and suturing of the bile ducts were performed in the two groups. Tamoxifen (20 mg/day) was administered only to the study group. The animals were sacrificed after 30 days. Quantification of myofibroblasts in the biliary ducts was made through immunohistochemistry analysis using anti-alpha smooth muscle actin of the smooth muscle antibody. Immunohistochemical quantification was performed using a digital image system. RESULTS: In the animals treated with tamoxifen (20 mg/day), there was a significant reduction in immunostaining for alpha smooth muscle actin compared with the control group (0.1155 vs. 0.2021, p = 0.046). CONCLUSION: Tamoxifen reduced the expression of alpha smooth muscle actin in the healing tissue after bile duct injury, suggesting a decrease in myofibroblasts in the scarred area of the pig biliary tract. These data suggest that tamoxifen could be used in the prevention of biliary tract stenosis after bile duct surgeries.