BACKGROUND:Available measures of patient-reported outcomes for complementary and alternative medicine (CAM) inadequately capture the range of patient-reported treatment effects. The Self-Assessment of Change questionnaire was developed to measure multi-dimensional shifts in well-being for CAM users. With content derived from patient narratives, items were subsequently focused through interviews on a new cohort of participants. Here we present the development of the final version in which the content and format is refined through cognitive interviews.METHODS:We conducted cognitive interviews across five iterations of questionnaire refinement with a culturally diverse sample of 28 CAM users. In each iteration, participant critiques were used to revise the questionnaire, which was then re-tested in subsequent rounds of cognitive interviews. Following all five iterations, transcripts of cognitive interviews were systematically coded and analyzed to examine participants' understanding of the format and content of the final questionnaire. Based on this data, we established summary descriptions and selected exemplar quotations for each word pair on the final questionnaire.RESULTS:The final version of the Self-Assessment of Change questionnaire (SAC) includes 16 word pairs, nine of which remained unchanged from the original draft. Participants consistently said that these stable word pairs represented opposite ends of the same domain of experience and the meanings of these terms were stable across the participant pool. Five pairs underwent revision and two word pairs were added. Four word pairs were eliminated for redundancy or because participants did not agree on the meaning of the terms. Cognitive interviews indicate that participants understood the format of the questionnaire and considered each word pair to represent opposite poles of a shared domain of experience.CONCLUSIONS:We have placed lay language and direct experience at the center of questionnaire revision and refinement. In so doing, we provide an innovative model for the development of truly patient-centered outcome measures. Although this instrument was designed and tested in a CAM-specific population, it may be useful in assessing multi-dimensional shifts in well-being across a broader patient population.

本研究分析在2005年台北縣長選舉中，民眾是否以回顧性評價或是展望性評估來決定其投票對象。運用2006年「台灣選舉與民主化調查」的研究資料，分析民眾對於過去的家庭經濟情況、社會整體經濟狀況評價及施政表現；以及民眾對於未來家庭經濟、總體經濟狀況評估及主要政黨候選人展望性預期，是否影響其投票行為。 本研究發現：控制民眾的人口學背景以及其他政治態度之後，民眾認為過去整體經濟情況變差者，愈不傾向投給民進黨候選人。認為民進黨候選人愈具備執政能力者則愈傾向投給他。除此之外，民眾的政黨認同也具有重要的影響力。 從本研究的結果可以得知，民眾會運用理性的標準，判斷過過去總體經濟表現與未來哪位候選人較具執政能力而決定其投票對象。顯示執政者應該以總體經濟表現以及優秀的人才，才可以吸引選民持續的支持。 / In this Study, we employ individual-level survey data collected by ‘Taiwan’s Election and Democratization Study” in the 2005 Taipei Magistrate election to examine whether voters apply retrospective voting or prospective voting. We include variables such as personal well-being and national economics performance in the past ,candidate evaluation and expectations on future economic performance to see how these variables might affect their voting behavior. We demonstrate that, after controlling demographic variables and other political attitudes, when voters consider national economy is worse off, he/she voted against the incumbent party. However, voters give greater support to candidates of the incumbent party if he/she believes this candidate is competent to govern Taipei county. Additionally, party identification still exerts a powerful influence upon the individual vote decision. In the study, it is found that people decide their voting behavior is employ their rational calculations to examine sociotropic economic performance and candidate quality. Therefore, citizens are not fools, and the incumbent party has to realize the importance of governance and nominate qualified candidates to govern.

The 2006 Swedish parliamentary election was a historic election with the largest bloc transfer of voters in Swedish history. The 2002-2006 incumbent Social Democratic Party (S) received its lowest voter support since 1914 as roughly 150,000, or 8%, of the 2002 S voters went to the main opposition, the conservative Moderate Party (M). This became the most decisive factor in ousting S from power after 12 years of rule. As a result, the M-led Alliance (A) with the People's Party (FP), the Center Party (C), and the Christian Democrats (KD) won the election. Natural Disasters and National Election makes the novel contribution of proposing two natural disasters, the Indian Ocean’s 2004 Boxing Day Tsunami and 2005 Storm Gudrun (Erwin), which struck only two weeks following the tsunami, as major events that impacted government popularity in the 2006 election and contributed to the redistribution of voter support, within and across party-blocs. The core findings from this thesis show that the S government’s poor crisis response to Gudrun, which is the hitherto most costly natural disaster in Swedish history, alone has an estimated effect of a magnitude that likely contributed to the 2006 historic regime shift, while the tsunami also seems to have mattered. The tsunami is particularly interesting, as S’s poor international crisis response to the event constitutes the first natural disaster situation to knowingly have affected an election on the other side of the planet. Moreover, to some degree voters recognized the active opposition by C as effective representation and rewarded the party for its strong stance on the poor handling of both events by S. In fact, the active voice of C concerning these disasters likely helped move the party from the periphery of party politics to becoming the third-largest party in Swedish politics. In sum, this research investigates accountability and effective party representation via retrospective voting, which is an essential mechanism for the legitimacy of democracy. Findings suggest that the average Swedish voter indeed may be voting retrospectively to hold publically elected officials accountable, which suggest a healthy status of the retrospective voting mechanism and Swedish democracy.

In der Literatur finden sich viele Angaben zur Wirkung des Testosterons, zur Symptomatik eines Testosteron-Defizits, zu den Auswirkungen eines zu hohen Spiegels durch Doping und auch internationale Guidelines zur Diagnose und Therapie des Testosteron-Defizits. Zu dessen Ursachen ist vieles bekannt, vor allem zum angeborenen Mangel, weniger zum erworbenen Mangel. Es besteht eine Liste von Ätiologien, aber ohne Angaben zu deren Häufigkeit. Dies ist der Ausgangspunkt der Arbeit. In einer allgemein-internistischen Praxis werden Daten von einer Patientenpopulation von 108 Männern mit Testosteron-Defizit erhoben. Neben den Laborwerten und der Symptomatik werden Untersuchungsbefunde vor Therapiebeginn erfasst. Diese Angaben werden systematisch ergänzt durch eine Anamnese von Krankheiten, die in den Guidelines als Ätiologien des erworbenen Testosteron-Defizits stehen. Daraus können Prävalenzen dieser Krankheiten in der Patientenpopulation errechnet werden. Prävalenzen für die Gesamtbevölkerung sind in der Literatur zu finden. Diese werden statistisch miteinander verglichen. Für die Befunde Hodenvolumen kleiner als15 ml, Hodenhochstand, Infertilität und verminderte Zeugungsfähigkeit und St n. Vasektomie kann in der Patientenpopulation eine höhere Prävalenz nachgewiesen werden. Zwischen Hodenvolumen (gemessen mit Orchidometern nach Prader) und Testosteron-Spiegel besteht eine Korrelation, die mit einer linearen Regression dargestellt werden kann. Eine entsprechende Korrelation zwischen dem Intervall zwischen Vasektomie und Diagnose des Testosteron-Defizits und dem Testosteron-Spiegel ist nicht signifikant. Diese Daten werden anhand der Literatur diskutiert, speziell auch im Hinblick auf Inflammation in den Testes als mögliche gemeinsame Pathogenese. Als Schlussfolgerungen werden Empfehlungen für die Präventivuntersuchung des Mannes bei Hausärzten und Urologen, für Abklärungen beim Fertilitätsspezialisten und die Forschung dargelegt. / There are many indications in the literature about the effects of testosterone, on the symptoms of a testosterone deficit, on the effects of excessive levels of doping, and also international guidelines for the diagnosis and treatment of the testosterone deficit. There are many known causes of this, especially the congenital deficiency, less of the acquired deficiency. There is a list of etiologies, but no information about their frequency. This is the starting point of the work. In a general-internal practice, data are collected from a patient population of 108 men with testosterone deficit. In addition to the laboratory values ​​ and the symptoms, examination findings are recorded before the start of therapy. These data are systematically supplemented by an anamnesis of diseases that are included in the guidelines as etiologies of the acquired testosterone deficit. Prevalence of these diseases in the patient population can be calculated from this. Prevalence for the whole population can be found in the literature. These are compared statistically with each other. A higher prevalence can be detected in the patient population for the findings of testicular volume of less than 15 ml, meldescensus testis, infertility and reduced fertility and status after vasectomy. There is a correlation between testicular volume (as measured by Orchidometers according to Prader) and testosterone level, which can be represented by a linear regression. A corresponding correlation between the interval between vasectomy and diagnosis of the testosterone deficiency and the testosterone level is not significant. These data are discussed with reference to the literature, especially with regard to inflammation in the testes as possible common pathogenesis. Conclusions include recommendations for preventive examinations of the man in general practitioners and urologists, for examinations in fertility specialists and research.

PURPOSE: To demonstrate the feasibility of using a knowledge base of prior treatment plans to generate new prostate intensity modulated radiation therapy (IMRT) plans. Each new case would be matched against others in the knowledge base. Once the best match is identified, that clinically approved plan is used to generate the new plan. METHODS: A database of 100 prostate IMRT treatment plans was assembled into an information-theoretic system. An algorithm based on mutual information was implemented to identify similar patient cases by matching 2D beam's eye view projections of contours. Ten randomly selected query cases were each matched with the most similar case from the database of prior clinically approved plans. Treatment parameters from the matched case were used to develop new treatment plans. A comparison of the differences in the dose-volume histograms between the new and the original treatment plans were analyzed. RESULTS: On average, the new knowledge-based plan is capable of achieving very comparable planning target volume coverage as the original plan, to within 2% as evaluated for D98, D95, and D1. Similarly, the dose to the rectum and dose to the bladder are also comparable to the original plan. For the rectum, the mean and standard deviation of the dose percentage differences for D20, D30, and D50 are 1.8% +/- 8.5%, -2.5% +/- 13.9%, and -13.9% +/- 23.6%, respectively. For the bladder, the mean and standard deviation of the dose percentage differences for D20, D30, and D50 are -5.9% +/- 10.8%, -12.2% +/- 14.6%, and -24.9% +/- 21.2%, respectively. A negative percentage difference indicates that the new plan has greater dose sparing as compared to the original plan. CONCLUSIONS: The authors demonstrate a knowledge-based approach of using prior clinically approved treatment plans to generate clinically acceptable treatment plans of high quality. This semiautomated approach has the potential to improve the efficiency of the treatment planning process while ensuring that high quality plans are developed. / Dissertation

O método mais eficaz para detecção de carcinoma mamário ductal in situ é a mamografia, que apesar de apresentar alta sensibilidade, possui baixa especificidade e não demonstra todos os casos deste tipo de lesão. Assim sendo, pesquisadores têm desenvolvido modalidades por imagem adjuntas à mamografia, das quais a mais promissora talvez seja a ressonância magnética mamária de alta resolução. Neste estudo investigou-se a capacidade da ressonância magnética, realizada em aparelho de 1,5 Tesla, com gradientes de alto desempenho, uso de bobina de superfície dedicada para mama e agente paramagnético por via endovenosa, em demonstrar focos de carcinoma ductal in situ em sua forma pura. Realizou-se análise retrospectiva em 24 pacientes que apresentaram este diagnóstico histológico e haviam sido submetidas à mamografia e à ressonância magnética. Evidenciou-se baixa reprodutibilidade entre os achados mamográficos e os da ressonância magnética mamaria, com discordância em 13 dos 24 casos (54%). Mesmo assim, concluiu-se que a ressonância magnética mamária foi valiosa, pois apesar de ter sido negativa em 5 dos 16 casos mamograficamente detectados (20,83%) revelou 8 focos de carcinoma ductal in situ não vistos à mamografia (33,33%), contribuindo de modo decisivo para o planejamento terapêutico destas pacientes. / Mammography is the most effective method to detect ductal carcinoma in situ of the breast. However, despite its high sensitivity, its specificity is low and some foci of ductal carcinoma in situ may not be detected by it. This fact has encouraged researchers to develop imaging methods adjunctive to mammography of which high resolution magnetic resonance imaging is perhaps the most promising. The purpose of this study is to investigate the ability of magnetic resonance imaging, performed in a 1.5 Tesla system with high performance gradients, the use of breast dedicated surface coil and intravenous paramagnetic agent to demonstrate foci of pure ductal carcinoma in situ. Retrospective analysis was performed to the examinations of 24 patients with this pathologic diagnosis that have been subjected to both mammography and breast magnetic resonance imaging. This study revealed that the concordance rates between mammography and magnetic resonance imaging provided low reprodutibility, being discordant in 13 of the 24 cases (54%). However, we concluded that breast magnetic resonance imaging was valuable because, despite of not depicting 5 of 16 mammographically detected cases (20,83%), it was able to detect 8 foci of ductal carcinoma in situ exclusively (33,33%), contributing to the therapeutic planning for these patients.

Para avaliar as características clínico-laboratoriais dos pacientes co-infectados com HIV e VHC, foram revisados os prontuários de pacientes atendidos no Núcleo de Extensão para Atendimento de Pacientes com HIV/AIDS (Casa da AIDS) da Divisão de Clínica de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, de acordo com o esquema antirretroviral que receberam pelo menos com seis meses de antecedência da primeira biopsia hepática realizada. Foram pesquisados os 3.512 prontuários de pacientes em acompanhamento na Casa da AIDS à procura de casos de conversão sorológica para o VHC. Desses pacientes, 435 não tinham feito nenhuma avaliação, sendo possível discriminar a presença de sorologia só em 3.077 pacientes, dos quais 468 (15,20%) apresentaram positividade para o VHC. Fizeram parte da amostra 111 pacientes, dos quais 74 foram tratados com medicamentos inibidores de protease (grupo CIP) e 37 tratados sem medicamentos inibidores de protease (grupo SIP) dentro do seu esquema antirretroviral altamente ativo (HAART). Dados epidemiológicos, clínicos e laboratoriais foram pesquisados com referência a seu comportamento separados de acordo com o tipo de terapia antirretroviral recebida (com ou sem inibidor da protease). Foi observada uma população jovem (média de 41 anos em ambos os grupos) de predominância masculina (74,3% no grupo CIP e 51,4% no grupo SIP) de raça branca (CIP 80,6% e SIP 94,4%) de grau educacional não profissional (CIP 92,9% e SIP 100%). Tinham antecedentes de risco para ambas as infecções em 93,2% dos pacientes CIP e 89,2% dos SIP. E com um consumo considerado habitual no grupo CIP em 40% dos casos e nenhum em 42,3% dos casos no grupo SIP. Presença de alguma doença definidora de AIDS durante o curso da doença foi identificado unicamente no 18,9% dos casos CIP e no 13,5% dos casos SIP. Consumo de drogas hepatotóxicas foi observado (8,1% no grupo CIP e 13,5% no SIP). Houve elevação média das enzimas hepáticas em ambos os grupos (TGO 52,1 no grupo CIP e 53,2 no SIP) em ausência de sintomas relacionáveis com doença hepática (16,2% em ambos os grupos). A média de CD4 em ambos os grupos foi maior de 350 cel/ml (CIP 362,2 e SIP 378,1). O grau de fibrose foi predominantemente baixo em ambas as populações (0-2 em 63,6% dos pacientes CIP e 80% dos casos SIP) com atividade necro-inflamatória somada de entre 5-7 no 51,3% dos pacientes CIP e 42,9% do grupo SIP. Sugere-se realização de biopsia seqüencial para melhor avaliar a evolução da doença hepática de acordo com o esquema HAART recebido / In order to evaluate the clinical and laboratorial characteristics of the co-infected HIV-HCV patients, medical charts were reviewed from the AIDS outpatient clinic, of the department of Infectious Diseases, São Paulo University School of Medicine, according to the antiretroviral treatment taken at least six months prior to the first liver biopsy performed. A total of 3.512 medical charts were reviewed from patients followed by the AIDS outpatient clinic, in search of patients of serological conversion for HCV. Of these patients 435 were never tested for HCV. From the 3.077 patients who had performed HCV serology, 468 of them (15,20%) were positive for the virus. The sample consisted of 111 patients. Were treated with protease inhibitor drugs (w/ PID group) 74, and 37 without protease inhibitor drugs (w/o PID group), according to their Highly Active Anti-Retroviral Therapy (HAART). Epidemiological, clinical and laboratorial data were analyzed according to the antiretroviral therapy received (with or without protease inhibitors). It was observed a young population (mean age of 41 years old in both groups), predominantly male (74,3% w/ PID, and 51,4% w/o PID), white (80,6% w/ PID, and 94,4% w/o PID), non-professional educational degree (92,9% w/ PID, and 100% w/o PID). The 93,2% w/ PID were, and 89,2% w/o PID of the patients had risk factors for both HIV and HCV. A usual alcoholic intake was observed in 40% of the w/ PID group, and no alcohol use was observed in 42,3% of the w/o PID group. The presence of AIDS defining diseases during the time of disease were observed only on 18,9% of the w/ PID group, and on 13,5% of the w/o PID group. Hepatotoxic drugs intake was observed in 8,1% of the w/ PID group, and in 13,5% of the w/o PID group. An average elevation of liver enzymes was observed in both groups (TGO 52,1 w/ PID, and 53,2 w/o PID), in absence of liver disease-related symptoms (16,2% in both groups). The CD4 mean in both groups was above 350 cel/ml (362,2 w/ PID and 378,1 w/o PID). Fibrosis degree was predominantly low on both populations (0-2 in 63,6% of patients w/ PID and 80% of patients w/o PID), with cumulative necro-inflamatory activity between 5-7 in 51,3% of patients w/ PID and 42,9% of patients w/o PID. We suggest that a new liver biopsy should be performed in order to better evaluate the development of the hepatic disease according to the HAART received

O ensino de Interpretação em universidades brasileiras tem crescido a cada ano. No entanto, pouco se sabe a respeito dos métodos utilizados por professores de interpretação, que normalmente reproduzem a maneira como aprenderam ou utilizam exemplos de sua prática na profissão. Este trabalho pretende dar um passo em direção à pesquisa em formação de intérpretes, apresentando a discussão sobre o ensino de interpretação ser precedido pela interpretação consecutiva. Utilizando as metodologias de Linguística de Corpus, que investiga o produto de interpretações de alunos, em interação com as Entrevistas Retrospectivas, que investiga o processo de interpretar desses mesmos alunos, todos de um curso de Graduação em Tradução e Interpretação da cidade de São Paulo, demonstraremos as diferenças e semelhanças entre alunos iniciantes e concluintes, em relação aos padrões linguísticos produzidos e parâmetros que nos ajudam a avaliar a qualidade de sua produção, encontrados no CEIS Corpus de Ensino de Interpretação Simultânea. Os resultados demonstram que a interpretação consecutiva não é pré-requisito para a interpretação simultânea. Na triangulação entre produto e processo, observamos que os processos cognitivos envolvidos em cada modalidade da interpretação são os fatores que influenciam sua produção enquanto aprendizes, e não a desverbalização ou análise do texto de partida. É necessário, portanto, pensarmos no desenvolvimento de um currículo que promova a formação do intérprete nos modos de simultânea e consecutiva paralelamente. Ao final, sugerimos aplicações da Linguística de Corpus para pesquisas com o CEIS e sua utilização para melhores práticas educacionais na formação de intérpretes. / Interpreting education has widened its scope in Brazilian universities year after year. However, the methods for teaching used by interpreting teachers are not very known, leading them to reproduce the way they have been taught or examples of their professional practice. This work aims at opening up the research path to interpreting education, discussing if consecutive should be a pre-requisite to simultaneous. Corpus Linguistics is one of the methodologies for this study, to investigate the production of interpreting students, in an interaction with another methodology, the Retrospective Interviews, which investigates interpreting processes. The subjects of this study are interpreting students from an undergraduate Translation & Interpretation program from São Paulo, Brazil. In this study, we show the similarities and differences of linguistic patterns produced by beginners and veteran students. In addition, we provide the corpus analysis of previously established parameters to quality assessment of students production at CEIS Simultaneous Interpreting Learners Corpora (Corpora de Ensino de Interpretação Simultânea). Results show consecutive interpreting teaching is not a pre-requisite to simultaneous interpreting. In the triangulation across product and process, we find out that the cognitive processes evolved in interpreting modes are the factors that influence learners production, covering the effects of deverbalization or source text analysis. It is demanding, though, to develop the interpreting curriculum to promote simultaneous and consecutive teaching in parallel. Last, but not least, we suggest Corpus Linguistics use and application to CEIS expansion and optimal educational practices for interpreting teaching.

INTRODUÇÃO: As infecções osteoarticulares permanecem como um grande desafio para os profissionais de saúde envolvidos no seu manejo, a despeito do sucesso obtido com a introdução dos antimicrobianos para o tratamento das doenças infectocontagiosas no final da década de 1930. O Staphylococcus aureus (S. aureus) é o agente mais frequentemente encontrado nestas infecções e também é o agente mais estudado, porém possuímos poucas informações disponíveis na literatura médica a respeito das osteomielites por bacilos Gram-negativos (BGN). OBJETIVOS: A caracterização clínica e microbiológica dos episódios de osteomielite causadas por bacilos Gram-negativos. A determinação das diferenças evolutivas e dos fatores de risco para a ocorrência de osteomielite por bacilos Gram-negativos, quando comparadas à osteomielite causada por S. aureus. MÉTODOS: Análise retrospectiva dos casos de osteomielite causadas por bacilos Gram-negativos atendidos no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no período de janeiro de 2007 a janeiro de 2009. Apenas amostras de osso ou aspirado de canal medular foram consideradas válidas. RESULTADOS: Foram incluídos 89 pacientes no grupo S. aureus e 101 pacientes no grupo BGN. Os pacientes do grupo BGN eram predominantemente do sexo masculino (63%), com mediana de 42 anos de idade. Apresentaram-se com osteomielite crônica (43%) e osteomielite aguda associada à fratura exposta (32%), nos membros inferiores (71%), cuja principal sintomatologia inicial foi a fistulização (69%). Quando comparado ao grupo S. aureus, o grupo BGN estava estatisticamente associado com o antecedente de fratura exposta (35% vs. 18%; p=0,0064), apresentando ainda um maior tempo de internação hospitalar (mediana 41 vs. 24 dias; p=0,0114), maior tempo para a obtenção da primeira cultura positiva (mediana 10 vs. 6,5 dias; p=0,0042), antibioticoterapia mais prolongada (mediana 40 vs. 24 dias; p=0,0329), maior número de procedimentos cirúrgicos (média 3,41 vs. 2,47; p=0,0173) e maior uso de reparo do revestimento cutâneo (31% vs. 9%; p=0,0005). O grupo S. aureus estava estatisticamente associado com as osteomielites da coluna vertebral (23,6% vs. 6,9%; p=0,0008). Foram isolados 121 agentes Gram-negativos de 101 amostras clínicas e os agentes mais frequentes foram Enterobacter spp. (24,7%), Acinetobacter baumannii (21,4%), Pseudomonas aeruginosa (19,8%) e Klebsiella pneumoniae (8,2%). CONCLUSÕES: Os 101 pacientes portadores de osteomielite por BGN eram na sua maioria jovens, do sexo masculino, vítimas de traumas nos membros inferiores e que desenvolveram osteomielite aguda e crônica associadas a fraturas expostas. Os pacientes do grupo BGN necessitaram de um número maior de procedimentos cirúrgicos, maior uso de reparo do revestimento cutâneo, permaneceram internados por mais tempo, necessitaram de um número de dias maior para o isolamento do agente infeccioso e utilizaram antibioticoterapia mais prolongada, quando comparados aos pacientes do grupo S. aureus. O antecedente de fratura exposta foi o principal fator de risco para o desenvolvimento de osteomielite por um BGN, quando comparado ao grupo S. aureus / INTRODUCTION: Bone and joint infection remains a serious therapeutic challenge, despite the high success rate observed with antibiotic therapy in most bacterial disease since the end of 1930 decade. Staphylococcus aureus (S. aureus) is the most studied and the most frequently isolated pathogen, but there is insufficient information in medical literature regarding Gram- negative bacilli (GNB) osteomyelitis. OBJECTIVES: Describe clinical and microbiological characteristics of Gram-negative bacilli osteomyelitis. Establish evolving differences and risk factors for the occurrence of GNB osteomyelitis, compared to S. aureus osteomyelitis. METHODS: Retrospective analysis of all patients with GNB osteomyelitis treated at Institute of Orthopedics and Traumatology, Hospital das Clínicas - School of Medicine, Universidade de São Paulo from january 2007 to january 2009. Only bone or bone marrow aspirate samples were included. RESULTS: 89 patients were included in S. aureus group and 101 patients were included in GNB group. Patients in GNB group were mostly male (63%), with median age of 42 years. At presentation, they had chronic osteomyelitis (43%) and acute open-fracture associated osteomyelitis (32%), in the lower limbs (71%), with a discharging sinus as the main clinical sign (69%). When compared to S. aureus group, GNB group was statistically associated with a previous history of open-fracture (35% vs. 18%; p=0.0064), showed a longer length of hospital stay (median 41 vs. 24 days; p=0.0114), a higher number of days to isolate the infective bacteria (median 10 vs. 6,5 days; p=0.0042), a longer use of antibiotics (median 40 vs. 24 days; p=0.0329), a higher number of surgical procedures (mean 3,41 vs. 2,47; p=0.0173) and a higher rate of soft- tissue reconstruction (31% vs. 9%; p=0.0005). S. aureus group was statistically associated with spine osteomyelitis (23,6% vs. 6.9%; p=0.0008). 121 Gram-negative pathogens were isolated from 101 clinical samples and the most frequent agents were Enterobacter spp. (24.7%), Acinetobacter baumannii (21.4%), Pseudomonas aeruginosa (19.8%) and Klebsiella pneumoniae (8.2%). CONCLUSIONS: Patients with GNB osteomyelitis were mainly young, male, with lower limb trauma and developed chronic and open- fracture associated osteomyelitis. Patients in GNB group had a higher number of surgical procedures, a higher rate of soft-tissue reconstruction, a longer length of hospitalization, a longer time to isolate the infective bacteria and a prolonged use of antibiotics, when compared to patients in S. aureus group. A previous history of open-fracture was the main risk factor to development of GNB osteomyelitis, compared to S. aureus group

Introdução: A Síndrome HELLP é uma complicação das formas graves de préeclampsia caracterizada por hemólise, elevação das enzimas hepáticas e plaquetopenia. O tratamento gera discussão principalmente nos casos abaixo de 34 semanas. Objetivos: Caracterizar a população internada com diagnóstico de Síndrome HELLP no HCFMUSP entre 2001 a 2011. Associar os parâmetros clínicos e laboratoriais maternos como preditores de complicações maternas e perinatais. Caracterizar os resultados perinatais e complicações maternas na conduta conservadora. Método: Estudo retrospectivo observacional e analítico. Resultados: Foram internadas 51 pacientes. A idade média foi de 27,48 anos, a maioria foi da cor branca (47%) e com pelo menos mais de 1 gestação (62,75%). Apenas 15,69% apresentavam hipertensão arterial crônica. A idade Gestacional média foi 30,94 semanas. Os sintomas clínicos e exames laboratoriais maternos não apresentaram relação com as complicações maternas e resultados perinatais. As complicações maternas não apresentaram relação com resultados perinatais, exceto a Idade gestacional. A conduta conservadora foi possível em 16 pacientes com ganho médio de 12,94 dias na gestação. As complicações maternas foram insuficiência renal aguda em 3 casos, descolamento de placenta em 2 casos e iminência de eclampsia em 1 caso. As complicações perinatais foram sepse em 10 casos, angústia respiratória em 10 casos, hemorragia intracraniana em 2 casos, enterocolite necrosante em 2 casos, Apgar < 7 no 5° min. em 2 casos e óbito neonatal tardio em 2 casos, permanência no berçário em média de 41,47 ± 21,75 dias. A idade gestacional média no parto foi de 30,56 ± 3,41 semanas. O peso médio dos recém-nascidos foi 1.116,64 ± 393,52 g. A conduta resolutiva foi necessária em 19 pacientes e as complicações maternas observadas foram insuficiência renal aguda em 5 casos, descolamento de placenta em 1 caso, iminência de eclampsia em 4 casos e eclampsia em 4 casos. As complicações perinatais foram sepse em 12 casos, angústia respiratória em 10 casos, hemorragia intracraniana em 4 casos, Apgar < 7 no 5° min. em 3 casos e óbito neonatal tardio em 2 casos, permanência no berçário em média de 58 ± 23 dias. A idade gestacional média no parto foi de 28,93 ± 2,11 semanas. O peso médio dos recém-nascidos foi 1.090 ± 307,49 g. Conclusão: Não há relação direta entre a gravidade da doença materna e resultados perinatais adversos. A Idade gestacional foi a única variável determinante para os resultados perinatais. Na conduta conservadora houve ganho de 2 semanas na gestação e 17 dias a menos de permanência no berçário / Introduction: The HELLP syndrome is a complication of severe forms of preeclampsia characterized by hemolysis, elevated liver enzymes and thrombocytopenia. The treatment is questioned especially in cases before 34 weeks. Objectives: This study aims to characterize the population of hospitalized patients with HELLP Syndrome at HCFMUSP 2001-2011. To associate maternal clinical and laboratory parameters as predictives for maternal complications and adverse perinatal outcomes. Other aim is to charaterize maternal and perinatal outcomes in the expectant management. Methods: This is a retrospective observational and analytical study. Results: There were 51 patients hospitalized. The mean age was 27.48 years, most were white (47%) and had at least one pregnancy (62.75%). Only 15.69% had chronic arterial hypertension. The average gestational age was 30.94 weeks. The maternal clinical symptoms and laboratory tests did not correlate with maternal complications and perinatal outcomes. Maternal complications were not associated with perinatal outcomes except gestational age. Expectant management was possible in 16 patients with in average gain of 12.94 days of pregnancy. Maternal complications were acute renal failure in 3 cases, placental abruption in 2 cases and imminent eclampsia in 1 case. Perinatal complications were neonatal sepsis in 9 cases, respiratory distress syndrome in 10 cases, intracranial hemorrhage in 1 case, Apgar score less than 7 at 5° minute in 2 cases and neonatal late death in 2 cases, period of hospitalization in average of 41.47 ± 21.75 days. The gestational age at delivery was in average 30.8 ± 3.41 weeks. The weight of the newborns was in average 1116.64 ± 393.52 in average. Immediate interruption was need in 19 patients and the maternal complications were acute renal failure in 5 cases, placental abruption in 1 case and imminent eclampsia in 3 cases, eclampsia in 4 cases; Perinatal complications were: neonatal sepsis in 12 cases, respiratory distress syndrome in 14 cases, intracranial hemorrhage in 4 cases, necrotizing enterocolitis in 1 case, Apgar score less than 7 at 5° minute in 3 cases and neonatal late death in 1 case, period of hospitalization in average of 58 ± 23 days. The gestational age at delivery was in average 29.4 ± 2.4 weeks. The weight of the newborns was in average 1090 ± 307.49 in average. Conclusion: There is no direct relationship between the severity of maternal disease and adverse perinatal outcomes. The gestational age of delivery was crucial to perinatal outcomes. There were gain of 2 weeks of gestational age between hospitalization and delivery and 17 days less of hospitalization for newborns in the expectant management