Brazil

Country: Brazil
City: Campinas, SP

IHTC:
Hemocentro – UNICAMP, Unit of Hemophilia “Cláudio Luis Pizzigatti Correa”

Rua Carlos Chagas 480 – Cidade Universitária Zeferino Vaz
PO Box 6198 - Campinas, SP, Brazil – 13.081-878

Tel.: 55 19 3521 8256 / 55 19 3521 8756
Fax: 55 19 3521 8000
E-mail: margaret@unicamp.br; erich@unicamp.br
Website: www.hemocentro.unicamp.br

Director:  Margareth Castro Ozelo, M.D., Ph.D.
Health professional responsible for training of candidates: Margareth Castro Ozelo, M.D., Ph.D. and Erich V de Paula, M.D., Ph.D.
Fellowship logistics coordinator: Márcia A. Piccoloto Matta, PT, MSc

Year of IHTC designation: 2008

Areas of specialty: General hemophilia care; physiotherapy; dental; laboratory diagnosis; genetic diagnosis; nursing.

DESCRIPTION OF TRAINING PROGRAM

Clinical activities: The Hemophilia Treatment Unit (HTU) is part of the Hematology and Hemotherapy Center of State University of Campinas (Hemocentro UNICAMP), an institution that provides general hematological care and blood banking services. Our centre has 584 patients with diagnosis of inherited bleeding disorders, including 240 hemophilia A patients, 67 hemophilia B patients, 200 with von Willebrand disease, and 77 patients with other rare bleeding disorders. To provide assistance for these patients we have a multi-disciplinary team of 16 professionals who have dedicate their career to hemophilia care.

Laboratory activities/research: There are purpose-built designated laboratories which manage the tests required for the treatment of haemophilia, the diangosis of new bleeding disorders and the molecular basis of bleeding disorders with provision for ante-natal diagnosis. The laboratory also provides a routine haemostasis service for the Royal Free Hospital.

Laboratory result meetings are held regularly to discuss the ongoing work up of the complex cases that are sent to this tertiary referral centre. Several research areas are always active. Currently gene therapy, global hemostasis assays, and aspects of inhibitor development are being investigated by full-time research staff. This work is presented and discussed in seminars that the trainee will be encouraged to attend.

Multidisciplinary activities/research:The hemostasis laboratory performs screening and specialized functional and immunologic coagulation tests.  The Laboratory Diagnosis of Hemophilia Training Program is organized so as to offer a more precise understanding of the specificities of the laboratory diagnosis of hemophilia. The trainee will have a short, basic laboratory training that will include general aspects such as pre-analytical variables, reference ranges, etc, as well as more specific issues such as screening coagulation tests, factor VIII, IX and inhibitor testing.

The Molecular Biology and Genetic Training Program provides an opportunity to learn basic principles and practical methods and techniques for the molecular diagnosis and genetic counseling of hemophilia. This program is directed towards laboratory technicians, biologists or persons with science-related degrees. The trainees will be introduced to molecular principles, both standard and alternative techniques used in the molecular investigations for hemophilia, including analysis and interpretation of the results, and genetic counseling.

Multidisciplinary Activities / Research: Our multi-disciplinary team includes professionals who have dedicate their career to hemophilia care and are aware that treatment of hemophilia requires the cooperation of different professionals.

• Odontology: The goal of the Dental Care Training Program is to offer the trainee the opportunity to learn about the most important aspects of the dental management of people with hemophilia and other bleeding disorders such as Von Willebrand disease, hereditary platelet disorders and other rarer coagulopathies. The trainee will have the opportunity to be in contact with the most relevant aspects involved in the dental management of these patients from a practical point of view and to discuss them with professionals with experience in the management of these patients. The clinical problems that the trainees will have contact with will focus on prevention, oral manifestations of bleeding disorders and planning and treatment.
• Nursing: As a key member of the staff, the nurse must be trained on specific skills that involve education and coordination of almost all of the Hemophilia Treatment Center (HTC) routines.  Therefore, the goal of this training program is to offer nurses with little knowledge about hemophilia an opportunity to develop those skills, by sharing the routine work of our HTC’s nurse and the whole staff. Besides assisting with the outpatient clinic for regular scheduled visits and emergency treatment for bleeding episodes, the trainee will also be involved in educational programs, assisting the medical staff by teaching patient and family about basic aspects of pathogenesis of hemophilia, complications, prevention and treatment of bleeding episodes, as well as self-infusion training sessions. The trainee will have specific training regarding the control of the patients’ records and the management of the HTC database.
• Physiotherapy: This training program offers theoretical and practical contents for comprehensive care in the treatment of hemophilia and others inherited haemostasis disorders, with the main objectives: to disseminate the knowledge related to physiotherapy techniques and protocols appropriated to hemophilia treatment; to permit the professional living experiences in routines of a multidisciplinary service for chronic patients; to stimulate the development of research in this field, with focus on the prophylaxis and alternatives for treatment of musculoskeletal complications in bleeding disorders. The trainee will also participate in our radiosynovectomy protocol, which involves our orthopedic and other physicians from the Nuclear Medicine Department.

Additional information: The physiotherapists also participate on international multicenter studies like “Musculoskeletal Function in Haemophilia in Developing Countries: an international multicenter study”, organized by Dr. Alok Srivastava, from Christian Medical College, Vellore, India. We are also participating in the “Musculoskeletal Assessment in Patients with Severe Hemophilia A in Latin America,” developed by the Committee of Latin America on the Therapeutics of Inhibitor Groups (CLOTTING).

DESCRIPTION OF IHTC FACILITIES

Location: Campinas has a population of approximately 1 million inhabitants and is situated 97 km from Sao Paulo (southeast area). It has played a strategic role in the development of its region by industry, services and technology generation.  It accounts for 10% of the national scientific production and is the third largest research and development center in Brazil. Campinas has a diversified commercial center.

Climate: Campinas has an excellent climate characterized by mostly sunny and hot days. The average temperature is 22.3° C and the rainy season is from November to March.

Accommodation (residence, meals, etc…): Close to our center, inside the campus of the university there is a hotel with reasonable rates. Private and shared residences are also available in the neighbourhood. Meals are available from cafeteria and restaurants in the neighbourhood as well.

Transportation: There is free shuttle in the campus and easy access to public transportation. Malls are easily accessible by car or by bus and a small district called Barao Geraldo, with many facilities, is about 10 minutes by bus from our Center.

Languages: English, Spanish, and Portuguese
Financial assistance: Dependent on WFH funds.

Cost of living (USD $  per week) 600-700 USD (accommodation, food, and local transportation)

Communications tools for trainees: Computer, free internet access, telephone, medical library.

Other local support provided for trainees: The trainee will have access to a library with scientific literature relevant to the field, including the most important journals related to hemophilia and hemostasis.

RELEVANT PUBLICATIONS BY IHTC STAFF

Santos A, Annichino-Bizzacchi JM, Ozelo MC. Inhibitors of factor VIII in hemophilia. N Engl J Med. 2009 Jul 16;361(3):309-10.

Ozelo MC, Villaça PR, De Almeida JO, Bueno TM, De Miranda PA, Hart WM, Karamalis M. A cost evaluation of treatment alternatives for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil. Haemophilia. 2007 Sep;13(5):462-9.

Jiang H, Pierce GF, Ozelo MC, de Paula EV, Vargas JA, Smith P, Sommer J, Luk A, Manno CS, High KA, Arruda VR. Evidence of multiyear factor IX expression by AAV-mediated gene transfer to skeletal muscle in an individual with severe hemophilia B. Mol Ther. 2006 Sep;14(3):452-5

Updated March 2011