Purpose A growing body of evidence suggests that low testosterone can be an independent predictor of adverse clinicopathological features and worse prognosis in prostate cancer (PCa) patients. However, this association is still incompletely understood and the results are divisive. The aim of this study was to analyze testosterone as a predictor of aggressive disease in subjects with clinically localized PCa. Materials and Methods A cohort was conducted including the patients submitted to radical prostatectomy in our institution during a period of four years. The patients had clinically localized disease and their total testosterone (TT) was routinely measured preoperatively in the morning before surgery. They were stratified in groups with low (< 300 ng/dL) and normal TT (≥ 300 ng/dL). Tumor aggressiveness was inferred based on preoperative PSA levels, pathological Gleason score (lower, equal or greater than 7), TNM stage and surgical margins status. Results After analyzing 164 patients we found a significant association between mean preoperative TT and extraprostatic disease (379 for pT3 vs. 421 ng/for pT2 - p < 0.001, AUC > 0.99). Conversely, men with high Gleason score had similar mean TT compared to those with lower scores. Preoperative low TT (defined as TT < 300 ng/dL) could not be statistically correlated with either preoperative PSA levels, pathological Gleason score, extraprostatic extension, positive surgical margins or seminal vesicles involvement. Conclusions This study indicates that testosterone may be a useful predictive tool once pathological extraprostatic extension was somewhat signaled by lower TT levels preoperatively. However, it does not consolidate a clear association between aggressive tumor biology and hypogonadism.

Este trabalho busca auxiliar na solução de um problema de seleção de uma aeronave enfrentado por uma empresa aérea que estuda o investimento na atividade de voo charter regional. A empresa em análise, pertencente a um grupo econômico cujo negócio principal é a logística, dispõe de oito alternativas a serem avaliadas sob onze diferentes critérios. A metodologia utilizada para a solução do problema é um novo método de apoio à decisão multicritério derivado do método de Borda, denominado Método de Borda com Utilização das Medianas. A utilização do método se justifica por sua característica de ser menos influenciado que o método original pelas alternativas irrelevantes e por sua facilidade de entendimento e baixa complexidade computacional. O método forneceu resultados consistentes, dando suporte confiável à decisão.

This article tries to solve a problem of selecting an airship for an airline company whose core business is regional charter flights. The company belongs to an economic group whose main activity is logistics. The decision problem that the company faces has eight alternatives to be accessed according to eleven criteria. For approaching the problem a novel multicriteria decision aiding method is used. This new method is one variant of the classical Borda method denoted by Modified or Median-based Borda Method. Using this new method is justified by the fact that it is less influenced by the irrelevant alternatives as well as by its easy of understanding and its low computational complexity. The thus Modified Borda Method provided for consistent results and thus led to a reliable decision support.

PURPOSE: To analyze the influence of urethral mobility and Valsalva leak point pressure on postoperative outcomes of transobturator sling (TOT) for female stress urinary incontinence. MATERIALS AND METHODS: A prospective cohort was conducted including 66 patients submitted to TOT from March 2006 to May 2009. Urethral hypermobility was defined as mobility ≥ 30º on Q-tip test, and Valsalva leak point pressure (VLPP) was classified as greater than 60 cmH2O or 60 and less on preoperative urodynamics. These parameters were compared through well defined postoperative objective and subjective success criteria. Intensity of urinary leakage and quality of life was analysed by ICIQ-SF. Statistical analysis was accomplished and the results rendered significant if p < 0.05. RESULTS: Mean follow up was 10 months (3 to 28). Mean age was 55 years (33 to 80), 70% were white and 30% African descendent, mean body mass index was 27 (21 to 38), average vaginal and abdominal deliveries were 2.8 and 0.5 respectively. A quarter had prior stress incontinence surgery. Patients with urethral hypermobility had higher objective success rates (98% versus 81.25%, p = 0.04). The subjective success rate was also greater in the hypermobility group (84% versus 62.5%), but statistical significance was not reached (p = 0.07). VLPP had no influence on either objective or subjective postoperative success rates (p = 0.17 and 0.34, respectively). In the subgroup analysis, those with low mobility and high VLPP had worse objective success rates in comparison to the group with hypermobility and low VLPP (p = 0.04) and also in relation to the remaining of the studied population. Other possible prognostic factors (previous surgery, mixed incontinence, gestational status) had no influence on success rates. CONCLUSIONS: High urethral mobility, regardless of the sphincteric status indicated by VLPP, is a favorable prognostic factor for tension-free transobturator tape procedure. No relationship was demonstrated between postoperative success rates and VLPP.

Rangelia vitalii é um protozoário que infecta cães e foi descrito nas regiões Sul e Sudeste do Brasil. R. vitalii é filogeneticamente próxima à Babesia spp., mas dados deste misterioso parasito ainda são escassos. O objetivo deste trabalho foi detectar a presença de piroplasmas em cães naturalmente infectados no estado do Rio de Janeiro, através da amplificação do gene 18S rRNA pela PCR, clivagem com enzimas de restrição (RFLP) e caracterização genética através do sequenciamento. De 103 cães, sete (6,8%) foram positivos para Babesia spp. pela PCR. Os produtos amplificados foram digeridos por enzimas de restrição para a diferenciação das espécies de Babesia e uma amostra foi identificada como Babesia vogeli. O padrão de amplificação observado nas outras seis amostras não correspondeu ao padrão descrito para babesias que infectam cães. O sequenciamento das seis amostras confirmou ser uma espécie geneticamente idêntica a R. vitalii apresentando grande homologia (99-100%) com a sequência do sul do Brasil. Este estudo confirma a presença de Babesia vogeli e Rangelia vitalii infectando cães em Teresópolis, Rio de Janeiro, Brasil.

Rangelia vitalii is a protozoon described from dogs in the south and southeast regions of Brazil. It is phylogenetically related to Babesia spp. that infects dogs, but data on this enigmatic parasite is still limited. The aim of this work was to detect piroplasm species in dogs in the state of Rio de Janeiro, Brazil, by 18S rRNA gene-based PCR assay, restriction fragment length polymorphism (RFLP) and sequence analyses. Of 103 dogs examined, seven (6.8%) were positive for Babesia spp. by PCR. The amplified products were digested by restriction enzymes to differentiate the Babesia species, and one sample was identified as Babesia vogeli. The pattern observed for the other six amplification products did not match with pattern described for large Babesia infecting dogs. Sequencing analysis confirmed these six samples as R. vitalii, with high homologies (99-100%) with a sequence from south Brazil. This study confirms the presence of Babesia vogeli and Rangelia vitalii circulate in domestic dogs in Teresópolis, Rio de Janeiro, Brazil.

É bem conhecida a relação entre tumor vesical e Schistosoma haematobium, porém somente casos esporádicos de infecção vesical por Schistosoma mansoni foram relatados. Neste caso, uma mulher de 48 anos com hematúria macroscópica, disúria e massa abdominal palpável foi investigada, ultra-sonografia mostrou uma grande massa exofítica na bexiga. A ressecção transuretral de bexiga evidenciou ovos viáveis de Schistosoma mansoni. A paciente foi tratada clinicamente com oxaminiquine e uma cirurgia foi realizada para ressecar a grande massa. Este caso mostra que a esquistossomose mansônica vesical pode simular um câncer vesical.

The relationship between bladder tumors and Schistosoma haematobium is well known, but only sporadic cases of bladder infection due to Schistosoma mansoni have been reported. In this case, a 48-year-old woman with macroscopic hematuria, dysuria and a palpable abdominal mass was investigated. Ultrasound showed a large exophytic mass in the bladder. Transurethral resection of the bladder revealed viable eggs of Schistosoma mansoni. The patient was treated clinically with oxamniquine and surgery was performed to resect the large mass. This case shows that schistosomiasis Mansoni in the bladder can simulate bladder cancer.

OBJECTIVE: To map and measure the flows of financial resources for health research and development in Brazil for the years 2000-2002. METHODS: After adapting the methodology developed for the Center for Economic Policy Research, data were collected on the sources and uses of resources for health research and development. RESULTS: The annual average value of resources apportioned to health research and development was approximately US$ 573 million. The public sector as a whole invested US$ 417.3 million and the health department US$ 51.1 million. Expressed in percentages, the public sector invested 4.15% of the health department's budget although the Ministry of Health assigned only 0.3% of its budget to health research in the country. The universities and the research institutes are the main users of the resources allocated to health research and development, receiving 91.6% of the total public spending, while the private sector receives a small share of around 0.69% of the total. The private sector invested US$ 135.6 million per year, and the international organizations US$ 20.1 million per year. CONCLUSION: Besides measuring the financial resources made available for health research and development, the results allowed the filling of gaps in national information; the identification of the flows of applied financial resources; and the testing and adaptation of the proposed methodology, generating information suitable for international comparisons.

OBJETIVO: Mapear y medir las corrientes de recursos financieros para la investigación y el desarrollo en salud en el Brasil durante los años 2000-2002. MÉTODOS: Tras adaptar la metodología desarrollada para el Centro de Investigación de Políticas Económicas, se reunieron datos sobre las fuentes y los usos de los recursos destinados a la investigación y el desarrollo sanitarios. RESULTADOS: El valor medio anual de los recursos asignados a la investigación y el desarrollo sanitarios fue de aproximadamente US$ 573 millones. El sector público invirtió en conjunto US$ 417,3 millones, y el departamento de salud US$ 51,1 millones. Expresando las cantidades en porcentajes, el sector público invirtió un 4,15% del presupuesto del departamento de salud, pero el Ministerio de Salud asignó sólo un 0,3% de su presupuesto a la investigación sanitaria en el país. Las universidades y los institutos de investigación son los usuarios principales de los recursos asignados a la investigación y el desarrollo sanitarios, recibiendo un 91,6% del gasto público total, mientras que el sector privado recibe un pequeño porcentaje, de alrededor del 0,69% del total. El sector privado invirtió US$ 135,6 millones al año, y las organizaciones internacionales, US$ 20,1 millones anuales. CONCLUSIÓN: Además de medir los recursos financieros aportados para la investigación y el desarrollo sanitarios, los resultados permitieron colmar diversas lagunas en la información nacional; identificar las corrientes de los recursos financieros empleados; y ensayar y adaptar la metodología propuesta, obteniéndose información idónea para realizar comparaciones internacionales.

OBJECTIF: Cartographier et mesurer les flux financiers pour la recherche et le développement en santé au Brésil sur la période 2000-2002. MÉTHODES: Après adaptation de la méthodologie développée par le Center for Economic Policy Research, des données ont été recueillies sur les sources de financement et les utilisations de ces ressources en faveur de la recherche et du développement en santé. RÉSULTATS: Le montant annuel moyen des ressources affectéesà la recherche et au développement en santé était de US$ 573 millions environ. Le secteur public dans son ensemble avait investi US$ 417,3 millions et le Département de la santé US$ 51,1 millions. En pourcentage, l'investissement du secteur public représentait 4,15 % du budget du Département de la santé, bien que le Ministère de la santé ait affecté 0,3 % seulement de son budget à la recherche en santé dans le pays. Les universités et les instituts de recherche ont été les principaux utilisateurs des ressources allouées à la recherche et au développement en santé, recevant 91,6 % des dépenses publiques totales, tandis que le secteur privé ne bénéficiait que d'une part réduite, soit environ 0,69 % de ce total. Le secteur privé a investi US$ 135,6 millions par an et les organisations internationales US$ 20,1 millions par an. CONCLUSION: Outre la mesure des ressources financières mises à la disposition de la recherche et du développement en santé, les résultats de cette étude ont permis de combler des lacunes en matière de données nationales, d'identifier les flux de ressources financières utilisées, ainsi que de tester et d'adapter la méthodologie proposée, ce qui a permis d'obtenir des informations se prêtant à des comparaisons internationales.

Este trabalho teve como objetivo determinar a prevalência de Escherichia coli Shigatoxigênicas dos sorogrupos O157, O111 e O113 em bovinos leiteiros, água e leite de propriedades rurais do Município de Jaboticabal/SP. Para isso, foram colhidas 454 amostras de fezes, 54 amostras de água e 30 amostras de leite e pesquisada a presença de seqüências stx1, stx2 e eae pela reação em cadeia da polimerase (PCR). Todas as amostras stx e/ eae positivas foram submetidas a uma nova reação de PCR para detecção das seqüências rfb O157, rfb O111 e rfb O113. Uma alta ocorrência (59,9%) de stx foi detectada nas fezes dos bovinos. Os coeficientes de prevalência das seqüências rfb O157, O111 e O113 nas fezes dos bovinos foram, respectivamente, 18,9%, 3,3% e 30,4%. Todas as seqüências foram encontradas com maior freqüência em bezerros e novilhas. As seqüências eae e stx2 foram as mais detectadas entre as amostras de fezes. Foram detectados 1,9% e 3,3% de seqüências stx na água e no leite, respectivamente. Nas amostras de água observou-se uma baixa prevalência de O113 e não foram detectadas O157 e O111. Nenhum dos sorogrupos pesquisados foi encontrado nas amostras de leite. STEC foram identificadas em todos os rebanhos (100%) e os sorogrupos O157, O111 e O113 foram observados em 40,0%, 50,0% e 90,0% dos rebanhos. Conclui-se que a prevalência de STEC em fezes de bovino, no Município de Jaboticabal/SP é alta, caracterizando-a como importante via de contaminação ambiental para esses microrganismos.

The objective of this study was to determine the prevalence of Shigatoxigenic Escherichia coli (STEC) and STEC serogroups O157, O111 and O113 in feces, water and milk sampled in dairy farms in Jaboticabal, SP, Brazil. Feces (n=454), water (n=54) and milk samples (n=30) were collected from 10 herds and assessed for the presence of the virulence genes stx1, stx2 and eae by polymerase chain reaction (PCR). All stx and eae positive samples were submitted to a second PCR reaction targeting the sequences rfb O157, rfb O111 and rfb O113. High prevalence of stx was detected (59.9%) in fecal samples, whereas the prevalence of sequences rfb O157, rfb O111 and rfb O113 was 18.9%, 3.3% and 30.4%, respectively. All sequences were detected more frequently in calves and heifers. Sequences stx2 and eae were prevalent in the fecal samples. stx sequences were detected in 1.9% and 3.3% of water and milk samples, respectively. Low prevalence of E. coli O113 was observed in water samples, whereas no E. coli O157 or E. coli O111 was detected. Furthermore, none of the serogroups were identified in milk samples. STEC was identified in all herds (100%), and serogroups O157, O111 and O113 were observed in 40%, 50% and 90% of the herds, respectively. In conclusion, the high STEC prevalence detected in dairy herds evidences that bovine feces might play an important role as a contamination source in the region of Jaboticabal, Brazil.

Apresentamos uma série consecutiva de 110 pacientes com hematoma subdural agudo traumático (HSDA) admitidos no serviço de emergência do HBDF no período de 1°-janeiro a 1°-dezembro-1994. Todos os pacientes foram atendidos de acordo com o mesmo protocolo. Houve predominância do sexo masculino (79%), com idade variando entre 14 e 70 anos, sendo os atropelamentos (34%) e os acidentes automobilísticos (20%) as causas mais comuns. A maioria dos pacientes (85,7%) foi admitida muito grave, com 8 pontos ou menos na Escala de Coma Glasgow (ECG), o que influenciou diretamente na mortalidade. A tomografia computadorizada de crânio foi o exame diagnóstico de escolha que mostrou serem as contusões e o inchaço cerebral ("swelling") as lesões intracranianas associadas mais freqüentes. A cirurgia foi realizada em 45,1% dos pacientes, e, em sua maioria, através de craniotomia fronto-têmporo-parietal ampla, com drenagem do hematoma, seguida de plástica da dura-mater. Em 54,9% as condições clínicas não permitiram a realização da cirurgia; neste grupo, cerca de 69,6% estavam em coma profundo à admissão, com 3 pontos na ECG. A letalidade cirúrgica foi de 61,2% e esteve diretamente relacionada à condição clínica inicial e à idade do paciente. A letalidade, incluindo todos os pacientes cirúrgicos e não cirúrgicos com HSDA, mesmo aqueles admitidos já com sinais de falência de tronco cerebral, foi de 79,5%. Além destes pacientes que faleceram, cerca de 7% evoluíram sem seqüelas ou com seqüelas mínimas; outros 11,4% com seqüelas de moderadas a paves e 2,1 % permaneceram em estado vegetativo persistente. Nossos dados estão de acordo com os da literatura no que se refere a elevada taxa de morbidade e mortalidade dos pacientes com HSDA.

We report a series of 110 patients with acute traumatic subdural hematoma (ASDH) admitted at HBDF emergency within 1994 (January Is1 to December PJ.All patients were treated according to the same protocol. There was a predominance of males (79%), with ages ranging from 14 to 70, being car accidents (20%) and car-pedestrian accidents (34%) the most frequent causes The majority of patients (85.7%) was admitted in very serious condition, with a score of 8 points on the Glasgow Coma Scale (GCS) or lesser, which directly influenced the mortality rates. CT scan was the diagnostic procedure of choice, and it showed contusion and brain swelling to be the most frequent associated intracranial lesions. Surgery was carried out in 45.1% of cases and, in most instances, through an ample fronto-temporo-parietal craniotomy, with hematoma drainage and dural reconstitution. In 54.9% of cases, clinical conditions did not allow surgery and in this group, 69.6%