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Introduction: The T315I mutation in patients with chronic myeloid leukemia (CML) has been associated with therapeutic resistance and an unfavourable prognosis. Aim: To study the frequency of T315I mutation in patients with CML, BCR-ABL(+), their clinical characteristics, disease evolution, and median survival. Patients and methods: We studied 75 patients with CML and BCR-ABL1(+). T315I mutation was detected by digital droplet PCR and BCR-ABL1 was analyzed by RT-PCR. A comparative analysis was performed by sex, age, disease phase, risk group, treatment, molecular response (MR), and median survival in T315I(+) and T315I(−) patients. Results: T315I mutation was detected in 11 patients (14.7%). No significant difference was found in the phase, risk group, and first-line therapy. A significantly higher proportion of T315I(+) did not achieve MR>3.5 log: 8 (72.7%) vs. 22 (34.4%) (p=0.023). The lowest mean BCR-ABL1 levels were significantly higher in the CML T315I(+) group compared to the CML T315I(−) group: 12.1±6.0 vs. 3.77±1.28 (p=0.009). The median survival of T315I(+) patients was significantly shorter: 73 months vs. 175 months (p Conclusions: Our data confirm the world experience on the frequency of T315I mutation, including the unfavourable evolution, resistance to TKI treatment and short survival. ddPCR is a highly sensitive method for early detection of genetic mutations which gives the chance for effective treatment.

Introducao Dentre as fistulas coronario cavitarias, as mais encontradas correspondem as que envolvem a coronaria direita e as cavidades cardiacas direitas com sobrecarga de volume correspondente pelo desvio arteriovenoso. As manifestacoes clinicas correspondem a insuficiencia cardiaca, angina com infarto do miocardio e arritmias. Sopro continuo orienta facilmente ao diagnostico do defeito congenito, que se torna consolidado pelas imagens. Outras fistulas sempre devem ser lembradas na suspeita diagnostica diferencial, como o canal arterial persistente, janela aortopulmonar, colaterais sistemico-pulmonares e fistulas do [...]

The objective of this research was to learn about the effects of music as a non-pharmacological therapeutic intervention applied to Alzheimer’s disease. To this aim, we evaluated its results regarding symptomatology and caregiver burden. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. We searched Pubmed/Medline (NLM), Web of Science, Scopus, Cochrane and Google Scholar, including articles from 1 January 2011–20 July 2021, using the keywords “Alzheimer’s disease”, “Music therapy”, “Caregivers overload”, “Amnesia retrograde” and “Clinical evolution”. To select the articles our criteria included complete text availability, quantitative research of an experimental nature and studies which, at least, figured in SJR or in JCR. Results: We found a relationship between the application of music therapy in patients with Alzheimer’s disease and an improvement regarding symptomatology, as it smoothed down the progress of the disease. Using music therapy in Alzheimer’s patients also led to a decrease in caregivers’ burden and an increase in their well-being. Conclusions: Our results showed the benefits of music therapy, as it improved both patients’ symptomatology and caregivers’ burden.

Nutcracker syndrome, whose prevalence and natural history are still poorly known, is a clinical syndrome caused by left renal vein compression between the superior mesenteric artery and the aorta. Long-term results and treatment outcomes are not well known. Our group aimed to characterize 7 patients diagnosed with nutcracker syndrome in childhood and to describe their clinical manifestations, diagnostic approaches, and mostly their clinical evolution, rate of complications, and treatment outcomes.

Objective: Evaluate risk factors related to clinical evolution and dedifferentiation of parosteal (juxtacortical) osteosarcoma to high-grade osteosarcoma. Methods: Retrospective cohort study performed over a period of 25 years, using data from medical records of patients diagnosed with parosteal osteosarcoma. The data were submitted to statistical analysis by Fisher’s exact test and Student’s t-test. Results: Of the 326 patients treated for osteosarcoma, we identified 17 patients diagnosed with parosteal osteosarcoma. Of these, 4 (23.5%) were not actually diagnosed with parosteal osteosarcoma and 4 did not have the minimum data required for analysis, being excluded from the study. Of the 9 patients studied, we observed that 3 (33.3%) evolved with tumor dedifferentiation to high-grade osteosarcoma. Moreover, 2 (66.7%) had local recurrence and 2 (66.7%) metastases. Conclusion: Age, sex, and the tumor size were not directly related to the dedifferentiation from parosteal osteosarcoma to high-grade osteosarcoma. The most aggressive clinical evolution - presence of local recurrences and metastasis - in parosteal osteosarcoma occurred in tumors with dedifferentiation, however, we cannot associate each other as cause and effect, but as related factors. Level of Evidence IV, Case Series. RESUMO Objetivo: Avaliar fatores de risco relacionados à evolução clínica e à desdiferenciação do osteossarcoma justacortical (parosteal, paraosteal) em osteossarcoma de alto grau. Métodos: Estudo de coorte retrospectiva realizado num período de 25 anos. Foram utilizados dados de prontuários de pacientes com diagnóstico de osteossarcoma parosteal que, em seguida, foram submetidos à análise estatística pelo Teste Exato de Fisher e pelo Teste t de Student. Resultados: Foram tratados 326 pacientes com diagnóstico de osteossarcoma, dos quais 17 (5,21%) receberam diagnóstico de osteossarcoma parosteal, 4 (1,22%) foram diagnosticados com osteossarcoma convencional e 4 (1,22%) não tinham dados mínimos necessários para análise, sendo excluídos do estudo. Dos 9 (2,76%) pacientes estudados, 3 (0,92%) evoluíram com desdiferenciação do tumor para osteossarcoma de alto grau. Dois (0,84%) pacientes apresentaram recidiva local e 2 (0,84%%) apresentaram metástases. Conclusão: Os fatores idade, sexo e volume do tumor não estão diretamente relacionados com a desdiferenciação do osteossarcoma parosteal para osteossarcoma de alto grau. Apesar de a evolução clínica mais agressiva - presença de recidivas locais e metástase - no osteossarcoma parosteal ter ocorrido nos tumores com desdiferenciação, não é possível estabelecer uma relação de causa e efeito, apenas considerá-las como fatores relacionados. Nível de Evidência IV, Série de Casos.

Aim To translate and validate the Post-COVID-19 Functional Status Scale into Mexican-Spanish. Materials and methods A cross-sectional study was performed for transcultural validation of the Post-COVID-19 Functional Status Scale in people over 18 years of age, using the international guidelines for validation published by Beaton and Guillemin. Diagnostic and clinimetric validity tests were applied to the scale. Statistical analysis was performed with the statistical program R. Results The scale was applied to 249 patients, obtaining a Cronbach’s alpha of 0.84 for the structured interview, and 0.67 for the self-reported questionnaire. When comparing both tests, and considering the structured interview as the reference test, the self-reported questionnaire had a sensitivity of 86.2%, a specificity of 96.3%, and a negative predictive value of 95.8%. Conclusion A practical and valid scale was obtained, in concordance with that published in the original version, which can be used in daily clinical practice and rehabilitation. The scale can be used to rapidly and adequately identify post-COVID-19 patients with alterations in functionality who could benefit from rehabilitation therapy. LAY ABSTRACT After having COVID-19, many people live with limitations in their daily life. Doctors therefore need a tool to assess these limitations properly, and to be able to identify them at an early stage, in order to offer adequate rehabilitation.

Objetivo: identificar os fatores associados ao óbito porCOVID-19 entre puérperas brasileiras, nos primeiros cincomeses da pandemia e nos cinco meses posteriores e descreveras características sociodemográficas e clínicas de puérperas quedesenvolveram a doença. Método: estudo transversal, de basepopulacional, com dados secundários do Sistema de Informaçãode Vigilância Epidemiológica da Gripe, disponibilizados peloMinistério da Saúde do Brasil. Foram incluídas 869 puérperase a análise considerou os primeiros cinco meses da pandemia eos cinco meses posteriores. A associação entre as variáveis deinteresse e o desfecho (óbito/cura por COVID-19) foi investigadapor regressão logística. Resultados: a maioria das puérperastinha entre 20 e 34 anos, cor da pele parda/branca e residia emzona urbana/periurbana. A proporção de óbitos foi de 20,2% noprimeiro período e 11,2% no segundo. Em ambos os períodos,aumentou a chance de evolução para óbito a presença de sinaise sintomas respiratórios: dispneia, desconforto respiratório esaturação de oxigênio inferior a 95%, assim como necessitar desuporte ventilatório e terapia intensiva. Conclusão: a proporçãode óbitos entre puérperas foi elevada, com redução no segundoperíodo estudado. Associaram-se ao óbito sinais e sintomasrespiratórios, necessidade de ventilação mecânica e de terapiaintensiva, em ambos os períodos analisados. Objetivo: identificar los factores asociados a muerte porCOVID-19 durante el puerperio en brasileñas, en los primeroscinco meses de la pandemia y en los cinco meses posterioresy, describir las características sociodemográficas y clínicas depuérperas que desarrollaron la enfermedad. Método: estudiotransversal, de base poblacional, con datos secundariosdel Sistema de Informação de Vigilância Epidemiológica daGripe - SIVEP-Gripe (Sistema de Información de VigilanciaEpidemiológica de la Gripe), del Ministerio de la Salud deBrasil. Fueron incluidas 869 puérperas y el análisis considerólos primeros cinco meses de la pandemia y los cinco mesesposteriores. La asociación entre las variables de interés y elresultado (muerte/cura por COVID-19) fue investigada porregresión logística. Resultados: la mayoría de las puérperastenía entre 20 y 34 años, color de piel parda/blanca y residíaen zona urbana/periurbana. La proporción de muertes fuede 20,2% en el primer período y 11,2% en el segundo. Enlos dos períodos - aumento más las probabilidades de morir- la presencia de señales y síntomas respiratorios (disnea,incomodidad respiratoria y saturación de oxígeno inferior a95%), así como necesitar de soporte ventilatorio y terapiaintensiva. Conclusión: la proporción de muertes entrepuérperas fue elevada, con reducción en el segundo períodoestudiado. Se asociaron a la muerte señales y síntomasrespiratorios, la necesidad de ventilación mecánica y de terapiaintensiva, en los dos períodos analizados. Objective: to identify the factors associated with death dueto COVID-19 among Brazilian postpartum women in the firstfive months of the pandemic and five subsequent months, anddescribe the sociodemographic and clinical characteristics ofpostpartum women who developed the disease. Method: crosssectionalpopulation-based study using a secondary databaseavailable in the Sistema de Informação de VigilânciaEpidemiológica da Gripe -SIVEP-Gripe (Influenza EpidemiologicalSurveillance Information System), Brazilian Ministry of Health. Atotal of 869 postpartum women were included, and the analysisconsidered the first five months of the pandemic and subsequentfive months. Association between the variables of interestand outcome (death due to COVID-19/cure) was investigatedusing logistic regression. Results: most participants were agedbetween 20 and 34, of mixed race or Caucasian, and lived in theurban/peri-urban area. The proportion of deaths was 20.2% inthe first period and 11.2% in the second. The likelihood of deathincreased in both periods due to the presence of respiratorysigns and symptoms: dyspnea, respiratory distress, and oxygensaturation below 95%, in addition to the need for ventilatorysupport and intensive care. Conclusion: the proportion ofdeaths among postpartum women was high and decreased inthe second period under study. Respiratory signs and symptoms,mechanical ventilation, and intensive care were associated withdeath in both periods.

Resumen Introducción: La infección del sitio operatorio (ISO) es la causa más común de infección en pacientes quirúrgicos. La curación en el periodo posquirúrgico parece tener gran impacto en este resultado. Objetivo: Evaluar la disminución de infección posoperatoria superficial o profunda en pacientes con heridas abdominales sucias, al realizar curaciones con apósitos de hidrofibra con plata o apósitos de gasa. Asimismo, evaluar la satisfacción y la presencia de dolor durante las curaciones, identificar eventos adversos y cambios en la estancia hospitalaria. Métodos: Es un ensayo clínico aleatorizado abierto, realizado en pacientes mayores de 18 años operados por alguna urgencia quirúrgica abdominal y con herida clasificada como sucia en el Hospital Universitario San Vicente Fundación o la IPS Universitaria entre diciembre de 2016 y enero de 2018. Durante el seguimiento se tomaron datos de consultas al servicio de urgencias y consulta externa, y así, se evaluaron los reingresos, la ISO y la mortalidad. Resultados: De 78 pacientes elegibles, se incluyeron 69 en el análisis final: a 34 se les hizo curación con gasa y, a 35, curación con apósitos de hidrofibra. No se encontraron diferencias estadísticamente significativas para el desarrollo de ISO, entre la curación con gasa y aquella con hidrofibra, tampoco en cuanto a la presencia de dolor o la duración de la estancia hospitalaria. Conclusión: El uso de apósitos de hidrofibra con plata en las curaciones de heridas sucias abdominales, puede tener beneficios. Sin embargo, en este estudio no se encontró ninguna diferencia al compararla con la gasa. Abstract Introduction: Surgical site infection (SSI) is the most common cause of infection in surgical patients. Post-surgical wound care treatment seems to have a great impact on this outcome. Objective: To evaluate the decrease of superficial or deep SSI in patients with an abdominal surgical wound managing wound care with silver hydrofiber or gauze. Likewise, to evaluate the satisfaction and presence of pain during care of the wound, and to identify adverse events and changes during the hospital stay. Methods: Open-label randomized clinical trial carried out in patients older than 18 years with an abdominal surgical emergency at Hospital San Vicente Fundación and IPS Universitaria, Medellín, Colombia, and wound classified as dirty between December 2016 and January 2018. Follow-up of the data of the consultations to the emergency service and external consultations, evaluate readmissions, SSI and mortality associated. Results: 78 eligible patients, 69 in the final analysis, 34 had wound care treatment with gauze and 35 with hydrofiber dressing. We did not find statistically significant differences for the development of SSI between the wound care treatment with gauze and with hydrofiber, neither in terms of the presence of pain or in the hospital length of stay. Conclusion: The use of iconic silver hydrofiber in the healing of the dirty abdominal surgical wounds may have benefits, however in this study no difference was found when compared with gauze.

Introducción. La aplicación de programas de tipo vía rápida (fast track) en cirugía abdominal mayor fue inicialmente implementada en cirugía abierta de colon con resultados comparables a los del abordaje laparoscópico. La disminución de la estancia hospitalaria y de los costos hospitalarios fueron las principales ventajas. Recientemente, se trasladó la aplicación de protocolos de recuperación posquirúrgica rápida (Enhanced Recovery After Surgery, ERAS) a la cirugía hepática con resultados aparentemente alentadores. El objetivo de este trabajo fue valorar los resultados iniciales obtenidos en un grupo de pacientes sometidos a hepatectomías menores por metástasis hepáticas, con resección simultánea de colon o sin ella. Métodos. Se evaluaron los datos de 13 resecciones hepáticas menores por metástasis hepáticas de origen colorrectal con resección simultánea del tumor primario o sin ella, las cuales se incorporaron a un protocolo ERAS. Se evaluaron los datos demográficos, de las hepatectomías, de la observancia del protocolo y de algunos factores que pueden afectar los resultados de una recuperación rápida, así como también lo que se considera recuperación total al momento del egreso. Resultados. En las 13 resecciones se pudo llevar adelante la aplicación del protocolo. Como resultado principal, se logró una corta estancia hospitalaria (3,69 días), el cumplimiento del protocolo fue alto y la recuperación total al egreso fue de 46,2 %. Conclusión. La aplicación de este protocolo ha sido exitosa en cuanto a una franca disminución de la estancia hospitalaria. El número de pacientes es pequeño, pero los resultados son esperanzadores.

Dados clinicos Paciente evoluiu sem sintomas desde o nascimento ate a juventude, ocasiao do advento de hipoxia mais acentuada, que requereu a feitura de anastomose tipo Blalock-Taussig a direita. Ha 5 anos, notou-se novamente agravamento da hipoxia, com hemofereses a cada 6 meses, alem de cansaco de pequenos a medios esforcos e ainda com disfuncao ventricular associada. Em uso de warfarina, carvedilol e enalapril, alem de oxigenio nasal a noite. […] Caso 4/2019 – Atresia Pulmonar, Comunicacao Interventricular e Circulacao [...]

Dados clinicos Paciente evoluiu sem sintomas desde o nascimento, ocasiao do diagnostico da cardiopatia, exteriorizada por sopro cardiaco. Ha 2 anos, extrassistoles supraventriculares motivaram uso de atenolol, propafenona, e magnesio, sem melhora. Endocardite infecciosa foi tratada efetivamente ha 10 anos. Em uso de levotiroxina 50 mcg por hipotireoidismo. Exame fisico: bom estado geral, eupneica, acianotica, pulsos normais nos 4 membros. Peso: 60 Kg, Altura 160 cm, PAMSD: 120 x 70 mmHg, FC: 60 bpm. […] Caso 1 / 2019 – [...]

OBJECTIVE: To describe the clinical impact of the first year treatment with dornase alfa, according to age groups, in a cohort of Brazilian Cystic Fibrosis (CF) patients. METHODS: The data on 152 eligible patients, from 16 CF reference centers, that answered the medical questionnaires and performed laboratory tests at baseline (T0), and at six (T2) and 12 (T4) months after dornase alfa initiation, were analyzed. Three age groups were assessed: six to 11, 12 to 13, and >14 years. Pulmonary tests, airway microbiology, emergency room visits, hospitalizations, emergency and routine treatments were evaluated. Student's t-test, chi-square test and analysis of variance were used when appropriated. RESULTS: Routine treatments were based on respiratory physical therapy, regular exercises, pancreatic enzymes, vitamins, bronchodilators, corticosteroids, and antibiotics. In the six months prior the study (T0 phase), hospitalizations for pulmonary exacerbations occurred in 38.0, 10.0 and 61.4% in the three age groups, respectively. After one year of intervention, there was a significant reduction in the number of emergency room visits in the six to 11 years group. There were no significant changes in forced expiratory volume in one second (VEF1), in forced vital capacity (FVC), in oxygen saturation (SpO2), and in Tiffenau index for all age groups. A significant improvement in Shwachman-Kulczychi score was observed in the older group. In the last six months of therapy, chronic or intermittent colonization by P. aeruginosa was detected in 75.0, 71.4 and 62.5% of the studied groups, respectively, while S. aureus colonization was identified in 68.6, 66.6 and 41.9% of the cases. CONCLUSIONS: The treatment with dornase alfa promoted the maintenance of pulmonary function parameters and was associated with a significant reduction of emergency room visits due to pulmonary exacerbations in the six to 11 years age group, with better clinical scores in the >14 age group, one year after the intervention. OBJETIVO: Relatar el impacto clínico del primer año de tratamiento con dornasa alfa conforme a la franja de edad, en una cohorte de pacientes brasileños con fibrosis quística (FC). MÉTODOS: El presente estudio analizó datos de 152 pacientes elegibles, de 16 centros de referencia para FC, los que contestaron a los cuestionarios clínicos y realizaron pruebas laboratoriales, al inicio del tratamiento con la dornasa alfa (T0) y después de 6 (T2) y 12 (T4) meses de la intervención. Se analizaron 3 grupos etarios: 6-11, 12-13 e >14 años de edad. Se evaluaron las pruebas pulmonares, la microbiología de vías aéreas, las atenciones de emergencia, hospitalizaciones y tratamientos emergenciales y de rutina. Las estadísticas descriptivas, pruebas t y chi-cuadrado y ANOVA fueron usadas cuando pertinentes. RESULTADOS: El tratamiento regular se basó en la fisioterapia respiratoria, ejercicios regulares, encimas pancreáticas, vitaminas, broncodilatadores, corticosteroides y antibióticos. En los 6 meses anteriores al estudio (fase T0), las hospitalizaciones por exacerbación pulmonar ocurrieron en 38, 10 y 61,4%, respectivamente, para las tres franjas de edad analizadas. En el grupo 6-11 años, hubo reducción significativa de atenciones de emergencia después de 1 año de tratamiento. No hubo modificaciones significativas de volumen espiratorio forzado en el 1er segundo (VEF1), capacidad vital forzada (CVF), saturación de oxígeno (SpO)2 e índice de Tiffeneau, en todos grupos. El escore de Schwachman-Kulczychi mejoró significativamente en el grupo de más edad. Los últimos 6 meses de tratamiento, la colonización crónica o intermitente por P. aeruginosa fue detectada en el 75, 71,4 y 62,5%, respectivamente, mientras que por S. aureus ocurrió en 68,6, 66,6 y 41,9% de los casos en cada grupo de edad. CONCLUSIONES: La intervención con dornasa alfa resultó en mantenimiento de los parámetros pulmonares y fue asociada a la reducción significativa de visitas a la emergencia por exacerbación pulmonar en el grupo de 6 a 11 años de edad, con mejora del escore clínico en el grupo >14 años de edad, al final de un año de estudio. OBJETIVO: Relatar o impacto clínico do primeiro ano de tratamento com dornase alfa de acordo com a faixa etária, numa coorte de pacientes brasileiros com fibrose cística (FC). MÉTODOS: O presente estudo analisou dados de 152 pacientes elegíveis, de 16 centros de referência para FC, os quais responderam aos questionários clínicos e realizaram testes laboratoriais, ao início do tratamento com dornase alfa (T0) e após seis (T2) e 12 (T4) meses da intervenção. Analisaram-se três grupos etários: seis a 11, 12 a 13 e >14 anos de idade. Avaliaram-se os testes pulmonares, a microbiologia de vias aéreas, os atendimentos de emergência, as hospitalizações e os tratamentos emergenciais e rotineiros. O teste t de Student, o qui-quadrado e a análise de variância foram usados quando pertinentes. RESULTADOS: O tratamento baseou-se em fisioterapia respiratória, exercícios regulares, enzimas pancreáticas, vitaminas, broncodilatadores, corticosteroides e antibióticos. Nos seis meses anteriores ao estudo (fase T0), as hospitalizações por exacerbação pulmonar ocorreram em 38,0, 10,0 e 61,4%, respectivamente para as três faixas etárias analisadas. No grupo de seis a 11 anos, houve redução significativa de atendimentos de emergência após um ano de tratamento. Não houve modificações significativas de volume expiratório forçado no primeiro segundo (VEF1), capacidade vital forçada (CVF), saturação de oxigênio (SpO)2 e índice de Tiffeneau em todos os grupos. O escore de Shwachman-Kulczychi melhorou significativamente no grupo de mais idade. Nos últimos seis meses de tratamento, a colonização crônica ou intermitente por P.aeruginosa foi detectada em 75,0, 71,4 e 62,5%, respectivamente, enquanto a colonização por S.aureus ocorreu em 68,6, 66,6 e 41,9% dos casos em cada grupo etário. CONCLUSÕES: A intervenção com dornase alfa resultou em manutenção dos parâmetros pulmonares e associou-se à redução significativa de visitas à emergência por exacerbação pulmonar no grupo de seis a 11 anos de idade, com melhora do escore clínico no grupo >14 anos de idade ao final de um ano de estudo.

BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin that affects patients of all ages andboth genders. The impact of the disease on quality of life is greater among patients with moderate to severe psoriasis. OBJECTIVE: to establish a correlation between the psoriasis area and severity index (PASI) and theDermatology Life Quality Index (DLQI) based on a quality of life questionnaire adapted to the Brazilian contextfor patients with plaque psoriasis before and after systemic treatment. METHODS: This was a cross-sectional, descriptive study of psoriasis patients who did not undergo treatment or who manifested clinical activity of the disease. Patients were evaluated according to the PASI and the quality of life questionnaire adapted to theBrazilian context before and 60 days after systemic treatment. RESULTS: Thirty-five patients participated in thestudy. Twenty-six were men, with a mean age of 46 years. There was no correlation between the PASI and thequality of life questionnaire adapted to the Brazilian context, but there was a correlation between the PASI andsome items of the quality of life questionnaire adapted to the Brazilian context, such as jobs involving public contact. CONCLUSION: The non-correlation between the PASI and the quality of life questionnaire adapted to the Brazilian context in this work may be associated with a history of chronic disease, which implies greater acceptance of the illness, or may be related to the low income and social status of the patients studied. The correlationobserved among patients with careers involving public contact suggests that some professions are more impacted by the disease. It may be necessary to adapt the quality of life questionnaire to patients with a low income andcultural and social limitations. The small sample size (n=35 patients) and the short follow-up period of 60 dayswere some of the limitations of this work. FUNDAMENTOS: Psoríase é doença inflamatória crônica da pele que afeta pacientes de todas as idades eambos os gêneros. O impacto negativo na qualidade de vida é mais importante naqueles pacientes com psoríasemoderada a grave. OBJETIVO: Correlacionar o índice de gravidade e extensão da psoríase e o índice de qualidadede vida, segundo questionário de qualidade de vida adaptado ao Brasil, em pacientes de psoríase em placas antes e depois de tratamento sistêmico. MÉTODO: Estudo transversal, descritivo, de pacientes de psoríase, virgens detratamento ou em atividade clinica, submetidos a avaliação do índice de gravidade e extensão da psoríase e aoquestionário de qualidade de vida adaptado ao Brasil antes e após 60 dias de tratamento com medicação sistêmica. RESULTADOS: Trinta e cinco pacientes foram estudados, 26 homens, com idade média de 46 anos. Não houvecorrelação entre índice de gravidade e extensão da psoríase e questionário de qualidade de vida adaptado aoBrasil. Mas, houve correlação entre índice de gravidade e extensão da psoríase e itens do questionário de qualidade de vida adaptado ao Brasil, tal como "atividade profissional com público". CONCLUSÃO: A não correlação entre índice de gravidade e extensão da psoríase e questionário de qualidade de vida adaptado ao Brasil nessainvestigação pode estar relacionada com história crônica de psoríase, o que implicaria em melhor aceitação dadoença ao longo do tempo ou às condições sociais e de baixa renda dos pacientes estudados. A correlação observada entre aqueles com atividade pública sugere que algumas profissões podem sofrer maior impacto da enfermidade. É possível que o questionário de qualidade de vida adaptado ao Brasil deva ser adaptado a pacientes de baixa renda e com dificuldades de acesso cultural e social. Como limitação do trabalho há que citar o pequenonúmero de pacientes (n=35) e o tempo de acompanhamento (60 dias).

Background: Bioresorbable vascular scaffolds (BVS) were developed to improve the long-term results of percutaneous coronary intervention, restoring vasomotion. Objectives: To report very late follow-up of everolimus-eluting Absorb BVS (Abbott Vascular, Santa Clara, USA) in our center. Methods: Observational retrospective study, in a single Brazilian center, from August 2011 to October 2013, including 49 patients submitted to Absorb BVS implantation. Safety and efficacy outcomes were analyzed in the in-hospital and very late follow-up phases (> 2 years). Results: All 49 patients underwent a minimum follow-up of 2.5 years and a maximum of 4.6 years. Mean age was 56.8 ± 7.6 years, 71.4% of the patients were men, and 26.5% were diabetic. Regarding clinical presentation, the majority (94%) had stable angina or silent ischemia. Device success was achieved in 100% of cases with 96% overall procedure success rate. Major adverse cardiovascular events rate was 4% at 30 days, 8.2% at 1 year, and 12.2% at 2 years, and there were no more events until 4.6 years. There were 2 cases of thrombosis (1 subacute and 1 late). Conclusions: In this preliminary analysis, Absorb BVS showed to be a safe and effective device in the very late follow-up. Establishing the efficacy and safety profiles of these devices in more complex scenarios is necessary. Resumo Fundamento: Os suportes vasculares bioabsorvíveis (SVB) foram desenvolvidos com o intuito de melhorar os resultados da intervenção coronária percutânea a longo prazo, restabelecendo-se a vasomotricidade. Objetivos: Reportar o seguimento muito tardio do implante do SVB eluidor de everolimus Absorb® (Abbot Vascular, Santa Clara, EUA) em nosso centro. Métodos: Estudo observacional, retrospectivo, em um único centro brasileiro, que incluiu 49 pacientes submetidos ao implante do SVB Absorb® entre agosto/2011 e outubro/2013. Foram analisados os desfechos de segurança e eficácia na fase hospitalar e bastante tardia (> 2 anos). Resultados: Todos os 49 pacientes completaram um seguimento mínimo de 2,5 anos, sendo o máximo de 4,6 anos. A média de idade foi 56,8 ± 7,6 anos, sendo 71,4% da população estudada do sexo masculino e 26,5% composta por diabéticos. Considerando a apresentação clínica, a grande maioria (94%) tinha angina estável ou isquemia silenciosa. Obteve-se sucesso do dispositivo em 100% dos casos e do procedimento, em 96%. A taxa de eventos cardiovasculares maiores foi de 4% aos 30 dias, de 8,2% em 1 ano, e de 12,2% em 2 anos, sem mais eventos até 4,6 anos. Houve 2 casos de trombose (1 subaguda e 1 tardia) até o último seguimento. Conclusões: Nesta análise preliminar, o uso do SVB Absorb® mostrou-se seguro e eficaz no seguimento bastante tardio. Faz-se necessário estabelecer o perfil de eficácia e segurança destes dispositivos em cenários de maior complexidade.

OBJECTIVE: to assess the predictive validity of the Manchester Triage System implemented in a municipal hospital in Belo Horizonte, MG, Brazil. METHOD: cohort prospective and analytical study. The sample of 300 patients was stratified by color groups. The outcome measured was the scores, obtained by patients in each classification group in the Therapeutic Intervention Scoring System - 28, 24 hours after admission to the emergency department. RESULTS: A total of 172 (57%) patients were men and the average age of all patients was 57.3 years old. The median score concerning the severity of their conditions was 6.5 points in the yellow group, 11.5 in the orange group, and 22 points in the red group. Statistically significant differences were found among the three groups (p

INTRODUCTION: Cancer is a disease that affects a large population, being the colorectal cancer one of the most prevalent. The early diagnosis of these neoplasms represents a better life expectancy. The high cost of diagnostic tests and the low socioeconomic status are considered factors leading to delayed diagnosis. OBJECTIVES: Assess the difference between colorectal cancer staging in patients of private clinics and patients of the Brazilian National Health Service (SUS) and assess the changes in cancer staging in the past five years. METHODS: This retrospective study was conducted with 53 patients divided in two groups (SUS and private clinic) diagnosed with colorectal cancer and treated in 2009. Staging of patients diagnosed in 2009 was compared with data from patients diagnosed in 2004, already published in 2005. RESULTS: Both groups were similar in gender and age. Regarding the staging of patients, no statistical difference was observed between the two groups (p=0.147). When comparing the staging of patients diagnosed in 2009 with that of patients studied in 2004, patients diagnosed in 2009 presented early stages (II and III) in relation to patients analyzed in 2004 (III and IV), pINTRODUÇÃO: O câncer é uma doença que afeta grande parte da população, sendo o câncer colorretal um dos mais prevalentes. O diagnóstico precoce dessas neoplasias resulta em uma melhor expectativa de vida. O alto custo dos exames diagnósticos e o baixo nível socioeconômico são apontados como fatores que levam ao atraso no diagnóstico. OBJETIVOS: Avaliar a diferença no estadiamento de câncer colorretal no momento do diagnóstico de pacientes oriundos da clínica privada e pacientes do Sistema Único de Saúde (SUS), assim como, avaliar as mudanças no estadiamento nos últimos cinco anos. MÉTODOS: Estudo retrospectivo envolvendo 54 pacientes divididos em dois grupos (SUS e clínica privada) diagnosticados no ano de 2009. Os estadiamentos dos pacientes diagnosticados em 2009 foram comparados com os dados de pacientes diagnosticados em 2004, já publicados em 2005. RESULTADOS: Ambos os grupos eram similares em gênero e idade. Em relação ao estadiamento dos pacientes não houve diferença estatística entre os dois grupos (p=0,147). Na comparação entre os pacientes de 2009 e os pacientes estudados em 2004 se evidencia que os pacientes de 2009 apresentaram-se com estádios mais precoces (II e III) em relação aos pacientes de 2004 (III e IV), p

OBJETIVO: Descrever as características demográficas e clínicas de crianças submetidas à cirurgia de correção de cardiopatia congênita (CC) em um hospital universitário, comparando pacientes com e sem complicações respiratórias no pós-operatório. MÉTODOS: Estudo retrospectivo, realizado por meio de consulta de prontuários de crianças submetidas à cirurgia corretiva de CC em hospital universitário brasileiro no período de novembro de 2006 a setembro de 2007. Foram analisados dados relativos a idade, sexo, peso, comorbidades e tipo de CC das crianças incluídas no estudo, comparando pacientes com e sem complicações respiratórias no pós-operatório. Foram utilizados o teste de Mann-Whitney e exato de Fisher, considerando-se significante p

Fundamento: Inúmeros fatores vêm contribuindo para a mudança do perfil do paciente com cardiopatia congênita (CC), incluindo o diagnóstico pré-natal e a disponibilidade de novos procedimentos terapêuticos. O conhecimento dessas mudanças é fundamental para um melhor atendimento. Objetivos: Descrever o perfil dos pacientes com CC de um serviço de referência no Estado do Rio Grande do Sul, Brasil. Métodos: Trata-se de um estudo transversal, com 684 pacientes portadores de CC, em um serviço de cardiologia pediátrica, de janeiro de 2007 a maio de 2008. Esses pacientes foram entrevistados (e/ou seus pais) e examinados (malformações congênitas, medidas antropométricas), além de terem seus prontuários revisados para mais detalhes sobre as cardiopatias, procedimentos e ecocardiografia. Resultados: A idade dos pacientes variou de 16 dias a 66 anos, sendo 51,8% do sexo feminino, com 93,7% de brancos. A idade média determinada pelo diagnóstico foi de 15,8 ± 46,8 meses. As CC mais prevalentes foram a comunicação interventricular, a persistência do canal arterial e a Tetralogia de Fallot. Dos pacientes analisados, 59,1%, com idade média de 44,3 ± 71,2 meses, realizaram algum procedimento terapêutico; 30,4% tinham malformações congênitas extracardíacas; e 12 pacientes tinham síndrome genética comprovada. Quanto ao desenvolvimento, 46,6% tiveram atraso ponderoestatural e 13,7% atraso neuropsicomotor. Além disso, 18,4% apresentaram história familiar de cardiopatia congênita. Conclusões: O atraso neuropsicomotor e o baixo ganho ponderoestatural podem estar associados às CC. Estabelecer um perfil dos pacientes com CC atendidos em uma instituição de referência pode servir como base para o planejamento adequado do atendimento desta população. (Arq Bras Cardiol 2010; 94(3):333-338) Background: Several factors, which include prenatal diagnosis and availability of new therapeutic procedures, have contributed to change the profile of patients with congenital heart disease (CHD). Knowing these changes is important to a better health care. Objectives: Description of profile of patients with CHD in a reference service in the State of Rio Grande do Sul, Brazil. Methods: It is a cross-sectional study including 684 patients with CHD in a service of pediatric cardiology from January 2007 to May 2008. We interviewed the patients (and/or their parents) and examined these patients (congenital malformations, anthropometric measures). Moreover, their charts were reviewed in order to detail heart diseases, procedures and echocardiography. Results: Patients were from 16 days to 66 years old, 51.8% were female, and 93.7% were Caucasian. The mean age at diagnosis was 15.8 ± 46.8 months. Ventricular septal defect, patent ductus arteriosus and Tetralogy of Fallot were the most prevalent CHD. 59.1% of examined patients, whose average age was 44.3 ± 71.2 months, have been undergoing therapeutic procedures; 30.4% had congenital extracardiac malformations; and 12 patients had genetic syndrome. Regarding development, 46.6% had low weight and height gain, and 13.7% had neuropsychomotor delay. Furthermore, 18.4% had family history of congenital heart disease. Conclusions: Neuropsychomotor delay and low weight and height gain may be related to CHD. Establishing a profile of patients with CHD, who were treated at an institution of reference, may function as a basis in which health care of this population can be planed appropriately. (Arq Bras Cardiol 2010; 94(3):313-318)

Orientador: Jazon Romilson de Souza Almeida Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: Introdução. A hepatite B crônica é uma importante causa de cirrose hepática e a história natural da doença tem várias fases clínicas que devem ser bem entendidas para se realizar o tratamento adequado. Objetivos. Descrever o comportamento clínico, a resposta ao tratamento e os fatores de pior prognóstico em 247 pacientes com infecção crônica pelo vírus da hepatite B. Métodos. Estudo retrospectivo observacional, realizado através da análise dos prontuários dos pacientes entre janeiro de 2000 e janeiro de 2015. Resultados. A maioria dos pacientes eram do gênero masculino (67,2%) e 74,1% eram HBeAg negativo. Cerca de 41% tinham cirrose hepática e 8,5% eram coinfectados pelo vírus da hepatite C. A negativação da carga viral em um ano com lamivudina, entecavir e tenofovir foi respectivamente de 56%, 75% e 75%; efeitos adversos foram mais comuns com tenofovir. A resistência virológica em cinco anos a lamivudina, adefovir e entecavir foi respectivamente de 57,5%, 51,8% e 1,9%. A taxa geral de soroconversão do HBeAg foi de 31,2% e do HBsAg foi de 9,7%. Carcinoma hepatocelular foi diagnosticado em 9,7%, transplante hepático foi realizado em 9,7% e a mortalidade geral foi de 10,5%. Elevações de alanina aminotransferase (p=0,0194) e carga viral (p

OBJETIVOS: Verificar o perfil de alterações clínicas e, principalmente, laboratoriais hepáticas observadas em pacientes de cada uma das classes de insuficiência cardíaca. MÉTODOS: Por meio de um estudo seccional, foram pesquisados os dados clínicos e laboratoriais (alanina aminotransferase [ALT], aspartato aminotransferase [AST], fosfatase alcalina [FA], gama-glutamil transpeptidase [gama-GT], bilirrubinas e coagulograma) de 50 pacientes internados em 2002 em um hospital terciário com diagnóstico de insuficiência cardíaca. Os doentes foram separados de acordo com sua classe de insuficiência cardíaca e seus dados, comparados estatisticamente. Foram excluídos pacientes com hepatopatia de qualquer etiologia. RESULTADOS: A análise das médias de transaminases revelou aumento significativo apenas nos pacientes da classe IV. Por outro lado, a FA e a gama-GT apresentaram aumento progressivo de acordo com a classe de insuficiência cardíaca. CONCLUSÃO: A insuficiência cardíaca é caracterizada por perfil colestático progressivo de alterações laboratoriais, enquanto as transaminases se elevam apenas na insuficiência cardíaca mais avançada. O entendimento dessas alterações é fundamental para que se evite investigação hepática desnecessária em indivíduos com insuficiência cardíaca. OBJECTIVES: To verify the clinical alterations and, in particular, hepatic laboratory alterations in patients in each of the heart failure (HF) functional classes. METHODS: The clinical and laboratory data - alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), bilirubin and coagulogram - of 50 patients admitted in 2002 to a tertiary hospital with the diagnosis of heart failure were researched by means of a cross sectional study. The patients were separated in accordance with their HF class and their data were compared statistically. Patients with hepatopathy of any etiology were excluded. RESULTS: Analysis of the mean transaminase values revealed a significant increase only for the Class IV patients. On the other hand, alkaline phosphatase and GGT presented a progressive increase in accordance with the HF class. CONCLUSION: HF is characterized by a progressive cholestatic profile of laboratory alterations, while transaminase values are only elevated in advanced HF. It is of utmost importance to understand these alterations in order to avoid unnecessary hepatic investigations in individuals with heart failure.

Introduction: A recently published study raised doubts about the need for percutaneous treatment of nonculprit lesions in patients with acute coronary syndromes (ACS). Methods: Retrospective, unicentric, observational study. Objective: To analyze the long-term outcomes in patients undergoing treatment of the culprit artery, comparing those who remained with significant residual lesions in nonculprit arteries (group I) versus those without residual lesions in other coronary artery beds (group II). The study included 580 patients (284 in group I and 296 in group II) between May 2010 and May 2013. We obtained demographic and clinical data, as well as information regarding the coronary treatment administered to the patients. In the statistical analysis, the primary outcome included combined events (reinfarction/angina, death, heart failure, and need for reintervention). The comparison between groups was performed using the chi-square test and ANOVA. The long-term analysis was conducted with the Kaplan-Meier method, with a mean follow-up of 9.86 months. Results: The mean ages were 63 years in group I and 62 years in group II. On long-term follow-up, there was no significant difference in combined events in groups I and II (31.9% versus 35.6%, respectively, p = 0.76). Conclusion: The strategy of treating the culprit artery alone seems safe. In this study, no long-term differences in combined endpoints were observed between patients who remained with significant lesions compared with those without other obstructions. Resumo Fundamento: Um estudo publicado recentemente levantou dúvidas sobre a necessidade de abordagem percutânea de lesões não culpadas em pacientes com síndromes coronarianas agudas (SCA). Métodos: Estudo retrospectivo, unicêntrico e observacional. Objetivo: Comparar desfechos a longo prazo entre pacientes submetidos à abordagem da artéria culpada, comparando os que permaneceram com lesões residuais significativas em artérias não culpadas (grupo I) versus aqueles sem lesões residuais em outros leitos coronarianos (grupo II). Foram incluídos 580 pacientes (284 no grupo I e 296 no grupo II) entre maio de 2010 e maio de 2013. Foram obtidos dados demográficos e clínicos, além de informações sobre o tratamento coronariano administrado aos pacientes. Na análise estatística, o desfecho primário incluiu eventos combinados (reinfarto/angina, morte, insuficiência cardíaca e necessidade de reintervenção). A comparação entre grupos foi realizada através do teste do qui-quadrado e ANOVA. A análise a longo prazo foi realizada pelo método de Kaplan-Meier, com seguimento médio de 9,86 meses. Resultados: As médias das idades foram de 63 anos no grupo I e 62 anos no grupo II. O seguimento a longo prazo não mostrou diferença significativa em eventos combinados nos grupos I e II (31,9% versus 35,6%, respectivamente, p = 0,76). Conclusão: A estratégia de tratar somente a artéria considerada culpada parece segura. Neste estudo, não houve diferenças a longo prazo em desfechos combinados entre pacientes que permaneceram com lesões significativas comparativamente àqueles sem outras obstruções.

Ghrelin system comprises a complex family of peptides, receptors (GHSRs), and modifying enzymes [e.g. ghrelin-O-acyl-transferase (GOAT)] that control multiple pathophysiological processes. Aberrant alternative splicing is an emerging cancer hallmark that generates altered proteins with tumorigenic capacity. Indeed, In1-ghrelin and truncated-GHSR1b splicing variants can promote development/ progression of certain endocrine-related cancers. Here, we determined the expression levels of key ghrelin system components in neuroendocrine tumor (NETs) and explored their potential functional role. Twenty-six patients with NETs were prospectively/retrospectively studied [72 samples from primary and metastatic tissues (30 normal/42 tumors)] and clinical data were obtained. The role of In1-ghrelin in aggressiveness was studied in vitro using NET cell lines (BON-1/QGP-1). In1-ghrelin, GOAT and GHSR1a/1b expression levels were elevated in tumoral compared to normal/adjacent tissues. Moreover, In1-ghrelin, GOAT, and GHSR1b expression levels were positively correlated within tumoral, but not within normal/adjacent samples, and were higher in patients with progressive vs. with stable/cured disease. Finally, In1-ghrelin increased aggressiveness (e.g. proliferation/migration) of NET cells. Altogether, our data strongly suggests a potential implication of ghrelin system in the pathogenesis and/or clinical outcome of NETs, and warrant further studies on their possible value for the future development of molecular biomarkers with diagnostic/prognostic/therapeutic value, This work has received the following grants: Proyectos de Investigación en Salud (FIS) PI13–01414, and PIE-0041 (funded by Instituto de Salud Carlos III) and S2011/BMD-2328 TIRONET (funded by Comunidad de Madrid) (to MM). BIO-0139, CTS-1406, PI-0639–2012 (funded by Junta de Andalucía), Proyectos de Investigación en Salud (FIS) PI13–00651 (funded by Instituto de Salud Carlos III), BFU2013–43282-R (funded by Ministerio de Economía y Competitividad), CIBERobn and Ayuda Merck Serono 2013 (to RML and JPC). Fellowship CTS-5051 (to AIC). “Sara Borrell” program CD11/00276 (to MDG)

Made available in DSpace on 2014-12-03T13:10:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-09-01Bitstream added on 2014-12-03T13:23:10Z : No. of bitstreams: 1 S0365-05962013000500799.pdf: 360224 bytes, checksum: 4b0caf2f4c9c8e3a011f4bc797f4e2c3 (MD5) Graft-versus-host disease is observed mainly in recipients of hematopoietic cell transplantation and is expressed by cutaneous or systemic signals and symptoms. Graft-versus-host disease is clinically classified as acute or chronic. Chronic Graft-versus-host disease occurs in up to 70% of hematopoietic cell transplanted patients and its clinical manifestations have important impact on morbidity and quality of life. The authors report an expressive cutaneous, oral and adnexal involvement in a patient with chronic Graft-versus-host disease with multiple lesions of lichenoid and atrophic pattern. Sao Paulo State Univ Julio de Mesquita Filho FMB, Botucatu Med Sch, Dept Dermatol & Radiotherapy, Botucatu, SP, Brazil Sao Paulo State Univ Julio de Mesquita Filho FMB, Botucatu Med Sch, Dept Dermatol & Radiotherapy, Botucatu, SP, Brazil

BACKGROUND Psoriasis is a chronic inflammatory disease of the skin that affects patients of all ages andboth genders. The impact of the disease on quality of life is greater among patients with moderate to severe psoriasis. OBJECTIVE to establish a correlation between the psoriasis area and severity index (PASI) and theDermatology Life Quality Index (DLQI) based on a quality of life questionnaire adapted to the Brazilian contextfor patients with plaque psoriasis before and after systemic treatment. METHODS This was a cross-sectional, descriptive study of psoriasis patients who did not undergo treatment or who manifested clinical activity of the disease. Patients were evaluated according to the PASI and the quality of life questionnaire adapted to theBrazilian context before and 60 days after systemic treatment. RESULTS Thirty-five patients participated in thestudy. Twenty-six were men, with a mean age of 46 years. There was no correlation between the PASI and thequality of life questionnaire adapted to the Brazilian context, but there was a correlation between the PASI andsome items of the quality of life questionnaire adapted to the Brazilian context, such as jobs involving public contact. CONCLUSION The non-correlation between the PASI and the quality of life questionnaire adapted to the Brazilian context in this work may be associated with a history of chronic disease, which implies greater acceptance of the illness, or may be related to the low income and social status of the patients studied. The correlationobserved among patients with careers involving public contact suggests that some professions are more impacted by the disease. It may be necessary to adapt the quality of life questionnaire to patients with a low income andcultural and social limitations. The small sample size (n=35 patients) and the short follow-up period of 60 dayswere some of the limitations of this work.

OBJECTIVE: to study the changes in health-related quality of life from beginning of anticoagulation therapy to six-month follow-up, and to study associations of sociodemographic and clinical characteristics with measures of quality of life and general health status at six-month follow-up, in individuals using oral anticoagulation due to various medical indications for the therapy. METHOD: prospective study performed at a city in the state of Paraná, Brazil, composed of 78 patients. Measures included the Duke Anticoagulation Satisfaction Scale and the Medical Outcomes Survey Short Form SF-36. RESULTS: mean age was 57 years (S.D.= 16) and 54% were women. Compared to the beginning of therapy, there was a statistically significant improvement in health-related quality of life at six-month follow-up. Linear regression analyses explained 32% and 30%, respectively, of the variance of the Duke Anticoagulation Satisfaction Scale and of the general health status. There was improvement in all components of the SF-36, except Mental Health. CONCLUSION: The use of oral anticoagulation therapy was associated with improvement in health-related quality of life in the first six months of therapy. This study is longitudinal and therefore, has fewer limitations than cross-sectional studies published to date in the Nursing literature in Brazil. OBJETIVO: Estudiar los cambios en la calidad de vida relacionada con la salud desde el inicio de la anticoagulación oral y al final de seis meses de tratamiento, y estudiar las asociaciones de las características sociodemográficas y clínicas con las medidas de calidad de vida y salud general seis meses después de iniciar la terapia, en pacientes con diversas indicaciones clínicas de anticoagulación oral. MÉTODO: Se realizó un estudio prospectivo en una ciudad de Paraná, Brasil, evaluando 78 pacientes. Las herramientas aplicadas fueron la Duke Anticoagulation Satisfaction Scale y el Medical Outcomes Survey Short Form SF-36. RESULTADOS: La edad promedia fue de 57 años (D.E.=16) y el 54% era mujer. En comparación con el inicio de la terapia, se observó una mejoría estadísticamente significativa en la calidad de vida relacionada con la salud tras seis meses de seguimiento. El análisis de regresión representó el 32% y 30%, respectivamente, de la varianza de la Duke Anticoagulation Satisfaction Scale y la salud general. Hubo una mejora en todos los componentes del SF-36, excepto la Salud Mental. CONCLUSIÓN: El uso de anticoagulantes orales se asocia con una mejoría en la calidad de vida relacionada con la salud tras seis meses de seguimiento. Debido a su diseño longitudinal, este estudio trae menos limitaciones que los estudios transversales publicados en la Enfermería brasileña hasta ahora. OBJETIVO: estudar as mudanças na qualidade de vida relacionada à saúde do início da anticoagulação oral ao final de seis meses dessa terapia, e estudar as associações das características sociodemográficas e clínicas com as medidas de qualidade de vida e estado de saúde geral seis meses após o início do tratamento, em indivíduos com diversas indicações clínicas para anticoagulação oral. MÉTODO: estudo prospectivo realizado em um município do Paraná, Brasil, avaliando 78 pacientes. Foram utilizados os instrumentos Duke Anticoagulation Satisfaction Scale e Medical Outcomes Survey Short Form SF-36. RESULTADOS: a idade média foi 57 anos (D.P.= 16) e 54% eram mulheres. Comparado com o início da terapia, houve melhora estatisticamente significante na qualidade de vida relacionada à saúde aos seis meses de seguimento. Os modelos de regressão linear explicaram 32% e 30%, respectivamente, da variância do Duke Anticoagulation Satisfaction Scale e do estado geral de saúde. Houve melhora em todos os componentes do SF-36, exceto Saúde Mental. CONCLUSÃO: O uso do anticoagulante oral foi associado à melhora da qualidade de vida relacionada à saúde nos seis meses de acompanhamento. Por ser longitudinal, esse estudo tem menos limitações que os estudos transversais publicados na área da Enfermagem brasileira até o momento.

AIM: to assess the clinical evolution of patients hospitalized due to the first episode of Acute Coronary Syndrome (ACS) according to its clinical manifestation. METHODS: data were collected from 234 patients, hospitalized between May 2006 and July 2009 due to the first episode of an ACS, by consulting their medical records. RESULTS: 234 patients were hospitalized, 140 (59.8%) due to Acute Myocardial Infarction (AMI). In the group with AMI, 19.3% presented complications, against 12.8% in the group with Unstable Angina (UA) (p=0.19). Angioplasty levels were higher among patients with AMI than with UA (p=0.02) and coronary artery bypass graft surgery was more frequent among UA patients (p=0.03). The majority (227; 97%) survived after the coronary event. Among the seven patients who died during the hospitalization, four had AMI (2.9%) and three UA (3.2%). CONCLUSIONS: A larger number of complications were found among infarction victims and the accomplishment of coronary artery bypass graft surgery differed between the groups. OBJETIVO: evaluar la evolución clínica de pacientes internados por el primer episodio del Síndrome Aguda de Coronarias según su manifestación clínica. MÉTODOS: Fueron colectados datos de 234 pacientes internados entre mayo de 2006 y julio de 2009 debido el primer episodio de una ACA mediante consultas a los prontuarios. RESULTADOS: La mayoría (59,8%) internó debido al Infarto Agudo del Miocardio (IAM). En el grupo con IAM, 19,3% presentaron complicaciones y 12,8% en el grupo con Angina Inestable (AI)(p=0,19). La realización de angioplastia fue mayor entre los pacientes con IAM de lo que con AI (p=0,02) y la cirugía de revascularización fue más realizada entre los pacientes con AI (p=0,03). La mayoría (227; 97%) sobrevivió al evento de las coronarias. Entre los siete pacientes que murieron en la internación, cuatro tenían IAM (2,9%) y tres AI (3,2%). CONCLUSIONES: Hubo mayor número de complicaciones entre los infartados y la realización de revascularización del miocardio fue diferente en los dos grupos. OBJETIVO: avaliar a evolução clínica de pacientes internados pelo primeiro episódio da síndrome coronariana aguda (SCA), segundo sua manifestação clínica. MÉTODOS: foram coletados dados de 234 pacientes internados entre maio de 2006 e julho de 2009, em decorrência do primeiro episódio de uma SCA, mediante consultas aos prontuários. RESULTADOS: a maioria (59,8%) foi internada devido ao infarto agudo do miocárdio (IAM). No grupo com IAM, 19,3% apresentaram complicações e 12,8% no grupo com angina instável (AI) (p=0,19). A realização de angioplastia foi maior entre os pacientes com IAM do que com AI (p=0,02) e a cirurgia de revascularização foi mais realizada entre os pacientes com AI (p=0,03). A maioria (227 - 97%) sobreviveu ao evento coronariano. Entre os sete pacientes que morreram na internação, quatro tinham IAM (2,9%) e três AI (3,2%). CONCLUSÕES: houve maior número de complicações entre os infartados e a realização de revascularização do miocárdio foi diferente nos dois grupos.

OBJECTIVE: To describe clinical events of sickle cell disease and the correlation with β-globin haplotypes and α-thalassemia in under 6-year-old children. METHODS: A retrospective study was conducted of under 6-year-old children from the neonatal screening program in Rio de Janeiro. Forty-eight male and 48 female children were enrolled in this study, 79 with sickle cell anemia and 17 with hemoglobin SC. The mean age was 29.9 (standard deviation = 20.9) months, 62 (16.2 ± 8.6) were aged between 0-3 years old and 34 (54.9 ± 11.3) were from 3-6 years old. Painful events, acute splenic sequestration, hemolytic crises, hand-foot and acute chest syndromes and infections were evaluated. RESULTS: The events were more frequent in under 3-year-old children, 94% of children had at least one episode. Infection was the most common event affecting 88.5% of children. Acute splenic sequestration took place earlier, while painful crises and acute chest syndromes in under 6-year-old children. Thal-α 3.7 was observed in 20.9% of cases. Bantu was the most frequent haplotype found, followed by Benin. No correlation was observed between clinical events and β-globin haplotypes. Children with sickle cell anemia and α-thalassemia have less infectious events. No correlation was found among these polymorphisms and clinical events, however, the majority of children with Bantu/Bantu and without α-thalassemia had more clinical events.

The authors describe the evolution of schistosomiasis mansoni in inhabitants of Capitão Andrade, Minas Gerais, Brazil, from 1973 to 1994. The prevalence of infection was 60.8% in 1973, 36.2% in 1984, and 27.3% in 1994. The evolution of the clinical forms of the disease in this group was as follows: unchanged in 76.7%, clinical progression in 8.4% and clinical regression in 14.9%. The reduction of the prevalence and severity of Schistosoma mansoni infection over the 21 years period, can be attributed to treatment of infected subjects performed in the area and to the installation of piped water in their dwellings.

Objetivo: Evaluar la evolución y letalidad de los pacientes portadores de endocarditis infecciosa, así como la presencia de complicaciones y la influencia de estas sobre la mortalidad. Diseño: Estudio longitudinal no concurrente. Lugar: Servicio de cardiología del Hospital 2 de Mayo, hospital universitario. Pacientes: Pacientes con diagnóstico de endocarditis infecciosa. Intervenciones: Se revisó las historias clínicas de los pacientes con diagnóstico de endocarditis infecciosa atendidos entre junio de 1999 y junio de 2005. Se evaluó los criterios clínicos, de laboratorio y ecocardiográficos (criterios de Duke) empleados en el diagnóstico. Para el análisis estadístico, se realizó el análisis descriptivo y comparativo con el empleo de las pruebas de Fisher y t de Student y la comparación de las curvas de Kaplan Meier, para evaluar la supervivencia a través de la prueba de rango logarítmico. Principales medidas de resultados: Evaluación de supervivencia: Complicaciones y mortalidad en pacientes en endocarditis infecciosa. Resultados: Se estudió 75 pacientes, la edad promedio fue 42,1±20,4 años, 66,7% del sexo masculino. El 93,3% tenía cardiopatía de base. La presentación clínica incluyó insuficiencia cardiaca congestiva (73,3%), encefalopatía (17,3%) y fenómenos embólicos (50,6%). Se evaluó la evolución de los parámetros de laboratorio, evidenciándose deterioro de la función renal. El ecocardiograma evidenció presencia de vegetaciones en 97,3% y complicaciones, como rotura valvar (8%), abscesos valvares (4%). Durante la evolución, se sometió a cirugía a 14,7%. La letalidad general fue 14,7%, la cual estuvo influenciada por el número de complicaciones, en particular las complicaciones sépticas y renales, que impactaron de igual manera en la probabilidad de supervivencia de estos pacientes. Conclusiones: Se registró una letalidad general de 14,7%. La probabilidad de supervivencia se vio afectada significativamente por el número de complicaciones presentes, entre ellas significativamente las complicaciones sépticas y renales., Objective: To evaluate infectious endocarditis evolution and lethality as well as complications and their influence on mortality. Design: Non-concurrent longitudinal study. Setting: Dos de Mayo Hospital Cardiology service, a teaching hospital. Patients: Patients with infectious endocarditis. Interventions: Clinical charts, laboratory and echocardiographic (Dukes criteria) studies of patients with infectious endocarditis attended between June 1999 and June 2005 were reviewed. Fisher and Sudent t tests were used for statistical analysis and Kaplan Meier curves comparison and logarithmic range test to evaluate survival. Main outcome measures: Infectious endocarditis complications and mortality. Results: Seventy-five patients were studied, mean age 42,1±20,4 years, 66,7% males; 93,3% presented cardiopathy. Clinical presentation included heart failure (73,3%), encephalopathy (17,3%), and embolic phenomena (50,6%). Laboratory evolution showed worsening renal function. Echocardiography demonstrated presence of vegetations in 97,3% and complications like valve breakage (8%), valve abscesses (4%); 14,7% of patients had surgery. Mortality was 14,7%, caused by renal and septic complications affecting patients' survival. Conclusions: Mortality in this group was 14,7%. Survival was affected by the number of complications, mainly renal and septic complications

Introduction. Patients suffering clinical dementia caused by Alzheimer's disease have a high risk of developing malnutrition caused by all the physiological, socio-economic and psychological changes related to the disease, together with the ageing process.Objective. To describe the nutritional condition of a group of patients with Alzheimer's dementia according to the degree of disease severity. Patients were selected from the University of Antioquia Neurosciences Group.Materials And Methods. Descriptive cross sectional study. Patients were assessed and information was collected about their body composition, food consumption behaviour, clinical, and psychosocial variables.Results. 77 patients were studied; their mean age was 65, 5 +/- 12.8 years. 48 had a family history of Alzheimer's disease; 39 were diagnosed more than 60 months before the study started; the most frequently found degree of severity was moderate, the most common type of dementia was the early family form. 26 began the disease process before they were 50 years old. Significant differences for Body Mass Index, brachial adipose area and brachial lean area were found (p = 0.001, p = 0.000, p = 0.000, respectively) between patients with the different degrees of disease severity. These parameters measures were lowest in patients with severe disease. The intake of calcium and folate was the lowest amongst the nutrients studied.Conclusion. The nutritional state is impaired in patients suffering Alzheimer's dementia from the early stages of the disease. The most important nutritional and clinical abnormalities found were depletion of the lean and fat stores, low intake of calcium and folate and clinical signs of the disease. Changes in these parameters worsen as the disease progresses.