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RESUMO Introdução: o câncer da mama é o câncer de maior incidência no sexo feminino no Brasil, representando 29,7% de todos os cânceres. Mais de dois terços das mulheres com câncer da mama apresentam expressão para receptores hormonais, estando, nestes casos, indicada a terapia hormonal com tamoxifeno, que pode representar fator de risco para o desenvolvimento do câncer do endométrio (risco relativo quatro vezes maior). Objetivo: este trabalho teve como objetivo avaliar a associação entre o uso de tamoxifeno e o desenvolvimento de distúrbios endometriais bem como eventuais outros fatores associados. Pacientes e método: Estudo de coorte retrospectivo de 364 pacientes com câncer da mama, das quais 286 utilizaram tamoxifeno e 78 não utilizaram esta hormonioterapia. Resultados: pacientes que usaram tamoxifeno tiveram um seguimento médio de 51,42 meses, semelhante àquelas sem terapia hormonal (p=0,081). Um total de 21 (7,3%) mulheres que usaram tamofixeno e nenhuma mulher sem terapia hormonal apresentaram alterações endometriais durante o seguimento (p=0,01). Nas 270 mulheres que tinham informação sobre obesidade, esta se associou significantemente com o desenvolvimento de alterações endometriais (p=0,008). A associação entre tamofixeno e alterações endometriais permaneceu significante (p=0,039) após ajustar para interação com obesidade. Conclusão: o uso de tamoxifeno no tratamento do câncer da mama esteve associado ao maior risco para desenvolvimento de alterações endometriais especialmente quando associado à obesidade.

Dismenorreia consiste em dor na regiao hipogastrica caracterizada como em colica intensa que ocorre durante o periodo menstrual. Esse trabalho tem como objetivo descrever a influencia da pratica de atividade fisica na dismenorreia. Trata-se de um estudo transversal e descritivo que resultou em uma amostra de 59 mulheres, no qual foram investigadas caracteristicas sociais, presenca de comorbidades, caracterizacao de padrao menstrual e pratica de atividade fisica. A amostra e constituida por mulheres de cerca de 25 anos, preferencialmente estudantes, com poucas comorbidades e que tinham vida esportiva extremamente ativa com pratica de multiplas modalidades. A maioria das entrevistadas relatou relacao positiva entre pratica de atividade fisica e controle da dismenorreia, sendo essa percepcao mais prevalente entre mulheres com dismenorreia moderada do que entre mulheres com dismenorreia grave. Assim, conclui-se a eficacia da pratica de atividade fisica em atenuar os sintomas da dismenorreia.

Introduction Postoperative delirium (POD) is a common disorder and its frequency varies from 15% to 25% after major elective surgery. There are few data on the incidence of POD in Brazil. Here, we sought to assess the incidence of POD following transurethral resection of the prostate (TURP) and to examine precipitating and predisposing factors associated. Method We performed a prospective observational study of elderly male patients undergoing TURP (N=55) in Northeast Brazil. Information on demographic, medical, cognitive and functional characteristics were collected. The participants were followed until hospital discharge. POD was diagnosed by the Confusion Assessment Method. Results A total of three participants (5.45%) were identified with POD. Episodes of delirium lasted 3±1 days. The study sample consisted of a healthy population. Patients with POD had longer hospital stay and more precipitating factors. The POD group showed statistically significant lower Barthel index score (p

Ianna Lacerda Sampaio Braga,1–3 João Castelo-Filho,2 Rafael de Sousa Bezerra Pinheiro,3 Rodrigo Barbosa de Azevedo,3 Antônio Talys Ponte,4 Romulo Augusto da Silveira,4 Pedro Braga-Neto,5,6 Adriana Rolim Campos1,21Northeast Biotechnology Network, Universidade de Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil; 2Medical School Graduate Program, Health Sciences Center, Universidade de Fortaleza, Fortaleza, Ceará, Brazil; 3Internal Medicine Service, Hospital Geral Dr. César Carls, Fortaleza, Ceará, Brazil; 4Urology Service, Hospital Geral Dr. César Cals, Fortaleza, Ceará, Brazil; 5Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil; 6Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, BrazilCorrespondence: Ianna Lacerda Sampaio BragaMedical School Graduate Program, Health Sciences Center, Universidade de Fortaleza (UNIFOR), Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza, Ceará, BrazilEmail iannalacerda@unifor.brPedro Braga-NetoDepartment of Clinical Medicine, Universidade Federal do Ceará, Rua Prof. Costa Mendes, 1608 - 4 andar - Rodolfo Teófilo, Fortaleza, Ceará, BrazilTel +55 859 998 5616Email pbraganeto@ufc.brIntroduction: Postoperative delirium (POD) is a common disorder and its frequency varies from 15% to 25% after major elective surgery. There are few data on the incidence of POD in Brazil. Here, we sought to assess the incidence of POD following transurethral resection of the prostate (TURP) and to examine precipitating and predisposing factors associated.Method: We performed a prospective observational study of elderly male patients undergoing TURP (N=55) in Northeast Brazil. Information on demographic, medical, cognitive and functional characteristics were collected. The participants were followed until hospital discharge. POD was diagnosed by the Confusion Assessment Method.Results: A total of three participants (5.45%) were identified with POD. Episodes of delirium lasted 3±1 days. The study sample consisted of a healthy population. Patients with POD had longer hospital stay and more precipitating factors. The POD group showed statistically significant lower Barthel index score (p

Objective To investigate the efficacy and safety of sofosbuvir (SOF) plus daclatasvir (DCV) or simeprevir (SMV) in a randomized, open-label, noninferiority trial of patients infected with hepatitis C virus genotype 1, who were previously unresponsive to pegylated interferon and ribavirin or were treatment naive. Methods Patients were randomly assigned to receive SOF (400 mg once daily) plus DCV (60 mg once daily) or SMV (150 mg once daily) for 12 weeks. The analysis included all participants who received at least one dose of the study drugs. The primary endpoint was sustained virologic response 12 weeks after ending treatment (SVR12; hepatitis C virus RNA measured using COBAS TaqMan RT-PCR (lower limit of detection and quantification of 12 UI/mL)). This study was registered at ClinicalTrials.gov (NCT02624063). Results A total of 125 of 127 enrolled and randomized patients started treatment (n = 65 SOF + DCV; n = 60 SOF + SMV). SVR12 was attained in 121 patients (96.8%): 65 (100%) receiving SOF + DCV (95% confidence interval (CI), 94.5 to 100) and 56 (93.3%) receiving SOF + SMV (95% CI, 83.8 to 98.2; absolute difference, 6.6%; 95% CI, −15.0 to 0). The most common adverse events were fatigue (n = 32, 25.6%), headache (n = 27, 21.6%), and mood swings (n = 24, 19.2%). No patients discontinued therapy. Conclusions The overall SVR rate was 96.9%; SOF + DCV (100%) was higher than that of SOF + SMV (93.3%). Despite no statistically significant intergroup difference in SVR12 rates, the noninferiority of SOF + SMV to SOF + DCV could not be established because the difference in efficacy was clinically relevant.

Esse trabalho apresenta um metodo numerico para resolver as equacoes governantes para escoamentos viscoelasticos modelados pela equacao constitutiva integral KBKZ-PSM em malhas hierarquicas. A metodologia proposta e verificada num escoamento entre placas paralelas. Os resultados numericos nas malhas avaliadas mostraram-se em concordância com a solucao semi-analitica.

Introduction Postoperative delirium (POD) is a common disorder and its frequency varies from 15% to 25% after major elective surgery. There are few data on the incidence of POD in Brazil. Here, we sought to assess the incidence of POD following transurethral resection of the prostate (TURP) and to examine precipitating and predisposing factors associated. Method We performed a prospective observational study of elderly male patients undergoing TURP (N=55) in Northeast Brazil. Information on demographic, medical, cognitive and functional characteristics were collected. The participants were followed until hospital discharge. POD was diagnosed by the Confusion Assessment Method. Results A total of three participants (5.45%) were identified with POD. Episodes of delirium lasted 3±1 days. The study sample consisted of a healthy population. Patients with POD had longer hospital stay and more precipitating factors. The POD group showed statistically significant lower Barthel index score (p

Introduction: Postoperative delirium (POD) is a common disorder and its frequency varies from 15% to 25% after major elective surgery. There are few data on the incidence of POD in Brazil. Here, we sought to assess the incidence of POD following transurethral resection of the prostate (TURP) and to examine precipitating and predisposing factors associated. Method: We performed a prospective observational study of elderly male patients undergoing TURP (N=55) in Northeast Brazil. Information on demographic, medical, cognitive and functional characteristics were collected. The participants were followed until hospital discharge. POD was diagnosed by the Confusion Assessment Method. Results: A total of three participants (5.45%) were identified with POD. Episodes of delirium lasted 3±1 days. The study sample consisted of a healthy population. Patients with POD had longer hospital stay and more precipitating factors. The POD group showed statistically significant lower Barthel index score (p

To assess whether a warning system based on mobile SMS messages increases the adherence of HIV-infected Brazilian women to antiretroviral drug-based treatment regimens and their impressions and satisfaction with respect to incoming messages.A randomized controlled trial was conducted from May 2009 to April 2010 with HIV-infected Brazilian women. All participants (n=21) had a monthly multidisciplinary attendance; each participant was followed over a 4-month period, when adherence measures were obtained. Participants in the intervention group (n=8) received SMS messages 30 min before their last scheduled time for a dose of medicine during the day. The messages were sent every Saturday and Sunday and on alternate days during the working week. Participants in the control group (n=13) did not receive messages.Self-reported adherence, pill counting, microelectronic monitors (MEMS) and an interview about the impressions and satisfaction with respect to incoming messages.The HIV Alert System (HIVAS) was developed over 7 months during 2008 and 2009. After the study period, self-reported adherence indicated that 11 participants (84.62%) remained compliant in the control group (adherence exceeding 95%), whereas all 8 participants in the intervention group (100.00%) remained compliant. In contrast, the counting pills method indicated that the number of compliant participants was 5 (38.46%) for the control group and 4 (50.00%) for the intervention group. Microelectronic monitoring indicated that 6 participants in the control group (46.15%) were adherent during the entire 4-month period compared to 6 participants in the intervention group (75.00%). According to the feedback of the 8 participants who completed the research in the intervention group, along with the feedback of 3 patients who received SMS for less than 4 months, that is, did not complete the study, 9 (81.81%) believed that the SMS messages aided them in treatment adherence, and 10 (90.90%) responded that they would like to continue receiving SMS messages.SMS messaging can help Brazilian women living with HIV/AIDS to adhere to antiretroviral therapy for a period of at least 4 months. In general, the results are encouraging because the SMS messages stimulated more participants in the intervention group to be adherent to their treatment, and the patients were satisfied with the messages received, which were seen as reminders, incentives and signs of affection by the health clinic for a marginalized population.

PURPOSE: We sought to assess the effect of naproxen versus placebo on prevention of atrial fibrillation after coronary artery bypass graft (CABG) surgery.METHODS: in this randomized, double-blind, placebo-controlled, single-center trial of 161 consecutive patients undergoing CABG surgery, patients received naproxen 275 mg every 12 hours or placebo at the same dosage and interval over 120 hours immediately after CABG surgery. the primary outcome was the occurrence of atrial fibrillation in the first 5 postoperative days.RESULTS: the incidence of postoperative atrial fibrillation was 15.2% (12/79) in the placebo versus 7.3% (6/82) in the naproxen group (P = .11). the duration of atrial fibrillation episodes was significantly lower in the naproxen (0.35 hours) versus placebo group (3.74 hours; P = .04). There was no difference in the overall days of hospitalization between placebo (17.23 +/- 7.39) and naproxen (18.33 +/- 9.59) groups (P = .44). Intensive care unit length of stay was 4.0 +/- 4.57 days in the placebo and 3.23 +/- 1.25 days in the naproxen group (P = .16). the trial was stopped by the data monitoring committee before reaching the initial target number of 200 patients because of an increase in renal failure in the naproxen group (7.3% vs 1.3%; P = .06).CONCLUSIONS: Postoperative use of naproxen did not reduce the incidence of atrial fibrillation but decreased its duration, in a limited sample of patients after CABG surgery. There was a significant increase in acute renal failure in patients receiving naproxen 275 mg twice daily. Our study does not support the routine use of naproxen after CABG surgery for the prevention of atrial fibrillation. (C) 2011 Elsevier Inc. All rights reserved. . the American Journal of Medicine (2011) 124, 1036-1042 Duke Univ, Duke Clin Res Inst, Med Ctr, Durham, NC 27705 USA Universidade Federal de São Paulo, Div Invas Clin Electrophysiol, Dept Cardiol, São Paulo, Brazil Pontificia Univ Catolica Rio Grande do Sul, Div Cardiol, Porto Alegre, RS, Brazil Brazilian Clin Res Inst, São Paulo, Brazil Universidade Federal de São Paulo, Div Invas Clin Electrophysiol, Dept Cardiol, São Paulo, Brazil Web of Science

Most algorithms for surface reconstruction from sample points rely on computationally demanding operations to derive the reconstruction. In this paper we introduce an innovative approach for generating 3D piecewise linear approximations from sample points that relies strongly on topological information, thus reducing the computational cost and numerical instabilities typically associated with geometric computations. Discrete Morse theory provides the basis for a topological framework that supports a robust reconstruction algorithm capable of handling multiple components and has low computational cost. We describe the proposed approach and introduce the reconstruction algorithm, called TSR – topological surface reconstructor. Some reconstruction results are presented and the performance of TSR is compared with that of other reconstruction approaches for some standard point sets.

Because of the worse results from retransplantation in relation to the initial liver transplantation, there is a need to refine the indication for retransplantation, such that fair distribution of this benefit is obtained.This was a study of 139 patients who underwent liver retransplantation. Thirty variables were studied: 18 relating to the recipient and 12 to the donor. All the independent variables were initially compared with the length of survival using univariate analyses. Variables presenting significance were compared with the dependent variable of length of survival, to determine which factors were related to longer survival among patients, when evaluated together.A multivariate model for determining long-term survival among patients with retransplants was built up using the following variables: recipient's age, creatinine, urgency of retransplantation and early failure of the first graft. Through this multivariate model it was possible to determine a score that was categorized according to tertile distributions (below the 33rd percentile, score24; 33rd to 66th percentile, 24or = scoreor = 32; above the 66th percentile, score32). One-year, 3-year, and 5-year patient survival rates following retransplantation were respectively 85%, 82%, and 77% for scores24; 69%, 66%, and 61% for scores between 24 and 32; and 21%, 19%, and 16% for scores32 (P0.0001).The variables of recipient's age, creatinine, urgency of retransplantation, and early failure of the initial transplantation were factors that were independently related to the long-term survival of patients with liver retransplants.

Background: Transcranial Doppler (TCD) is the key test in determining the need for prophylactic blood transfusion to prevent stroke in children with sickle cell disease (SCD). The role of TCD in assessing stroke risk in adults with SCD as well as the pattern of TCD velocities in these patients are still undetermined. Methods: The authors compared TCD velocities in SCD adults (n = 56) with those of healthy controls (n = 56). Results: Velocities in SCD adults were lower than those found in children and higher than in controls and negatively correlated to hematocrit in both groups. Conclusion: The pattern of TCD velocities in adults with SCD is different from that described in children. Age-specific TCD criteria may assist the detection of stroke risk in these patients.