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Background Hypertensive disorders are important causes of maternal and perinatal morbidity and death. Considering the role of both physical and psychological factors in pregnancies complicated by hypertension, the aim of this study is to examine psychological factors and coping strategies in pregnancies complicated by hypertension. Methods Cross-sectional study. A sample of 552 pregnant women, 343 with pregnancies complicated by hypertension, were assessed in terms of depression, anxiety, stress and coping. Results The hypertensive group had higher scores of depression, stress and anxiety than the control one. Coping strategies were different between hypertensive and control groups (except for confrontive and self-reliant coping styles). When splitting up the hypertensive group into gestational hypertension, chronic hypertension and preeclampsia syndrome, differences between this new classification reached the statistical level. Our data suggests that women with preeclampsia have more symptoms of depression and worse coping strategies – they are less optimistic and more fatalistic. However, after a cluster analysis, two different subgroups of hypertensive women were found: one with worst coping strategies and more vulnerability to negative affective states and another with better coping and more resilient to mental health problems. Limitations Data were cross-sectional. We excluded women with some comorbidities, such as a diagnosis of kidney disease, diabetes or fetal malformation. Conclusions It is important to consider distinct profiles of pregnant women, in order to be able to better understand the peculiarities of mental health and coping during the gestation, especially in pregnancies complicated by hypertension.

Introduction: Academic leagues are Brazilian student-led initiatives aimed at doing multiple extracurricular activities in a medical school. The leagues exist in almost all the universities of the country. Purpose: To characterize the activity profile of the academic leagues of a medical school. Method: Quali-quantitative cross-sectional descriptive study that collected data on academic leagues such as: year of foundation, number of members, number of teachers, types of selection and admission and activities performed. Results: Of the 52 active leagues, 27 provided data. The average number of students was 21.6 ± 10.4, ranging from 07 to a maximum of 48. Most respondents (77.8%) had only one teacher. The performed activities were mainly theoretical classes, discussion of clinical cases, practical activities, production of scientific articles, publications in social networks, solidarity activities and organization of their own events. Conclusions: Academic leagues are student-led initiatives with great potential to expand medical school actions using the existing structure. With their activities mapped and guided by management, academic leagues can be great catalysts for complementary activities and can contribute greatly to the training of new doctors. Resumo: Introdução: Ligas acadêmicas são iniciativas de estudantes brasileiros criadas para realizar múltiplas atividades extracurriculares em uma escola médica. As ligas existem em quase todas as universidades do país. Objetivo: Caracterizar o perfil de atividades das ligas acadêmicas de uma escola médica. Método: Estudo descritivo transversal qualiquantitativo que coletou dados das ligas acadêmicas, como: ano de fundação, número de membros, número de professores, formas de seleção e ingresso e atividades realizadas. Resultados: Das 52 ligas ativas, 27 forneceram dados. O número médio de estudantes foi de 21,6 ± 10,4, variando entre 07 e 48. A maior parte das respondentes (77,8%) possui apenas um professor. As atividades realizadas são, majoritariamente, aulas teóricas, discussão de casos clínicos, atividades práticas, produção de artigos científicos, publicação em redes sociais, atividades de voluntariado e organização de eventos próprios. Conclusões: Ligas acadêmicas são iniciativas lideradas por estudantes com grande potencial de amplificar as ações da escola médica usando a estrutura já existente. Com suas atividades mapeadas e orientadas pela gestão da escola, as ligas acadêmicas podem ser grandes catalisadoras das atividades complementares e contribuir para a formação de novos médicos.

BACKGROUND: The academic leagues are collectives of students, under teacher supervision, formatted as a regular longitudinal program of university extension. They are very common on Brazilian medical schools and are gaining even more ground among the extracurricular activities. PURPOSE: To evaluate the activities of medical students who participate in academic leagues and their influence on professional training. METHOD: Exploratory, quantitative, and descriptive cross-sectional study using an online questionnaire for students in the last two years of graduation at a medical school in Rio Grande do Sul/Brazil, in January and February 2022. RESULTS: Sample of 71 students (36.4% of the total population). On average, each student participated in 3.56 (± 1.55) leagues. Students who were already in their sixth year, who had published a paper, or who had average grades above 8.6 reported participation in a significantly higher average number of leagues. The more leagues the student participated and the more satisfied he was with them, the more he recommended participation to other students. In addition to the leagues, the average participation in different complementary activities by students was 3.00 (± 1.01) activities, especially internships, tutoring, volunteering, and scientific initiation. The average number of papers published was 1.12 (±1.35), with 31 students (43.66%) without any publications. The correlation between the number of leagues per student and papers published was positive, with a Pearson correlation coefficient of 0.89. CONCLUSIONS: Students usually enter academic leagues early, participating in many of them, in addition to participating in other complementary activities. Participation in leagues is associated with complementary activities and the publication of scientific papers. Satisfied academics refer league participation to their peers, creating a cycle of increased participation among students. Academic leagues are complementary activities that have a positive impact on the training of medical students.

Objective The objective of this work is to investigate the role of personality in pregnancies complicated by hypertension, thru analysis of structure and associations between negative affect and coping strategies, and their role towards psychological distress. Method A cross-sectional study with 343 women, where 192 pregnancies complicated by hypertension, was carried out by employing the following tools: the five-factor model (Big Five), Depression, Anxiety and Stress Scale (DASS-21), and Jalowiec's Coping Inventory. Two complementary strategies were carried out: an exploratory approach on the interactions between latent variables and a confirmatory technique. Results Coping strategies seem to be dissociated in the hypertensive group, and these participants tend to use strategies according to their personality, mostly emotion focused, extraversion, and neuroticism. The extraversion model exclusively shows an acceptable goodness-of-fit after a structural equation modelling. A multigroup analysis reached a full metric invariance level for extraversion. Conclusions These results are of interest for both clinical and research settings. Prenatal screening and associated interventions may reduce perinatal negative affective states and related pregnancy complications.

O artigo comenta a narrativa do sujeito no cotidiano do fazer médico a escuta que se torna essência para o cuidado colaborativo e base para promoção da saúde do indivíduo. A escuta é a ferramenta proposta pela Medicina Narrativa para permear o encontro clínico e facilitar a compreensão de que a atenção é um atributo da presença e do interesse pelo outro. São trazidas duas situações em que histórias de vida acontecem no cenário de saúde em que pessoas – médicos, pacientes e seus familiares – são protagonistas do cuidado. Conclui-se que a evidência científica não basta, quando não ancorada no indivíduo e seu contexto. E que profissionais de saúde ao utilizarem a escuta atenta da narrativa pessoal compreendem melhor o adoecimento e permitem que o sujeito que sofre tenha condições de viver para além de sua doença.

Objective To analyze the prescription of antimicrobial agents for pregnant women admitted into the obstetrics service who presented with acute pyelonephritis. Methods Three cross-sectional studies were performed comparing the prescription of antimicrobials for pyelonephritis in pregnant women in the time periods evaluated (2010-2011: 99 patients evaluated; 2013: 116 patients evaluated; 2015: 107 patients evaluated), at the Hospital Fêmina, Porto Alegre, in the state of Rio Grande do Sul, Brazil. The analysis was performed before and after the promotion of an institutional protocol for the treatment of pyelonephritis during pregnancy, and on a third occasion after the introduction of a smartphone-based mobile educational tool. Results The evaluation of the prescribing physicians and the adequacy of the prescriptions between the different periods studied revealed a significant increase in appropriate conduct for the choice of antimicrobial (2010: 83.8%; 2013: 95.7%; and 2015: 100%), route of administration (2010: 97%; 2013: 100%; and 2015: 100%), and interval (2010: 91.9%; 2013: 95.7%; and 2015: 100%), following the introduction of the protocol, and again after the implementation of the softwareapplicationwithorientationsontheantimicrobial treatment. Conclusion The use of specific mobile applications should be encouraged to attain a better quality and accuracy in prescriptions and to include strategies that not only reduce the risk of negative outcomes, but also improve the quality of care and treatment for maintaining the health both of the mother and of the baby. Resumo Objetivo Analisar a prescrição de antimicrobianos para gestantes admitidas no serviço de obstetrícia que apresentaram pielonefrite aguda. Métodos Foram realizados três estudos transversais comparando a prescrição de antimicrobianos para pielonefrite em gestantes nos períodos avaliados (2010-2011: 99 indivíduos avaliados; 2013: 116 indivíduos avaliados; 2015: 107 indivíduos avaliados), no Hospital Fêmina, Porto Alegre, RS, Brasil. A análise foi realizada antes e após a promoção de um protocolo institucional para o tratamento da pielonefrite durante a gravidez e, em uma terceira ocasião, após a introdução de uma ferramenta educacional móvel para uso por smartphone. Resultados A avaliação das prescrições médicas e a adequação das prescrições entre os diferentes períodos estudados revelaram um aumento significativo na conduta adequada para a escolha do antimicrobiano (2010: 83,8%; 2013: 95,7%; e 2015: 100%), via de administração (2010: 97%; 2013: 100%; e 2015: 100%) e intervalo (2010: 91,9%; 2013: 95,7%; e 2015: 100%), após a introdução do protocolo, e novamente após a implementação do aplicativo com orientações sobre tratamento antimicrobiano. Conclusão O uso de aplicativos móveis específicos deve ser incentivado para obter melhor qualidade e precisão nas prescrições e incluir estratégias que não apenas reduzam o risco de resultados negativos, mas que também melhorem a qualidade dos cuidados e do tratamento para manter a saúde conjunta da mãe e do bebê.

Background: Hypertension is a disorder that affects many people and its complications can cause serious damage to health. In pregnancy, it is even more serious with risks both to pregnant women and their fetuses. This study investigated the role played by personality and coping strategies in blood pressure levels during pregnancy. Its specific goal was to study whether coping strategies can mediate the effect of personality in pregnancy complicated by hypertension. Methods: Assessment of a sample of 351 pregnant women, encompassing 192 pregnancies complicated by hypertension. This is a cross-sectional study where personality traits were measured by the Five-Factor Model and coping was evaluated by the Jalowiec´s Coping Inventory. Results: Personality can partially predict systolic and diastolic blood pressure. Openness to experience trait and emotion focused coping correlated with systolic and diastolic blood pressure. Diastolic blood pressure was predicted by openness to experience (β=-.15; pConclusions: It is suggested to reinforce the development of coping strategies that are more focused on the problem than on emotion, in order to avoid negative effects of emotional coping in blood pressure in pregnancy.

Objective: To evaluate the overall health-related quality of life in patients with bronchiolitis obliterans. Methods: Participants with a diagnosis of post-infectious bronchiolitis obliterans, who were being followed-up at two specialized outpatient clinics of Pediatric Pulmonology in Porto Alegre, Brazil, and controls aged between 8 and 17 years, of both genders, were included in the study. Controls were paired by gender, age, and socioeconomic level in relation to the group of participants with post-infectious bronchiolitis obliterans. The version of the Pediatric Quality of Life Inventory (PedsQ) tool validated for Brazil was applied for the assessment of Health-related Quality of Life, through an interview. The comparison of the Health-related Quality of Life means between the groups was performed using Student's t-test for independent samples and the chi-squared test, for categorical variables. Results: 34 patients diagnosed with post-infectious bronchiolitis obliterans and 34 controls participated in the study. The mean age of the children included in the study was 11.2 ± 2.5 years, and 49 (72%) of them were males. The groups showed no significant differences in relation to these variables. The quality of life score was significantly and clinically lower in the post-infectious bronchiolitis obliterans group when compared with controls in the health (72.36 ± 15.6, 81.06 ± 16.4, p = 0.031) and school domains (62.34 ± 20.7, 72.94 ± 21.3, p = 0.043), as well as in the total score (69.53 ± 14.9, 78.02 ± 14.8, p = 0.024), respectively. Conclusion: Patients with post-infectious bronchiolitis obliterans presented lower health-related quality of life scores when compared with healthy individuals in the total score and in the health and school domains. Resumo: Objetivo: Avaliar a qualidade de vida relacionada à saúde geral em participantes com bronquiolite obliterante. Métodos: Foram incluídos no estudo participantes com diagnóstico de bronquiolite obliterante pós-infecciosa que estavam em acompanhamento em dois ambulatórios especializados de pneumologia pediátrica em Porto Alegre, Brasil e controles, com idades entre 8 e 17 anos, de ambos os sexos. Os controles foram pareados por sexo, idade e nível socioeconômico em relação ao grupo de participantes com bronquiolite obliterante pós-infecciosa. Para avaliação da Qualidade de Vida Relacionada à Saúde geral foi aplicado a versão validada para o Brasil do instrumento PedsQL (Pediatric Quality of Life Inventory), por meio de entrevista. A comparação entre as médias da Qualidade de Vida Relacionada à Saúde entre os grupos foi realizada mediante o teste t para amostras independentes e para as variáveis categóricas por teste Qui-quadrado. Resultados: Participaram do estudo 34 pacientes com diagnóstico de bronquiolite obliterante pós-infecciosa e 34 controles. A média da idade das crianças incluídas foi 11,2 ± 2,5 anos e 49 (72%) deles eram do sexo masculino. Os grupos não apresentaram diferenças significativas em relação a essas variáveis. O escore de qualidade de vida foi significativamente e clinicamente menor no grupo bronquiolite obliterante pós-infecciosa em comparação com o controle nos domínios saúde: (72,36 ± 15,6; 81,06 ± 16,4; p = 0,031); escolar: (62,34 ± 20,7; 72,94 ± 21,3; p = 0,043) e no escore total (69,53 ± 14,9; 78,02 ± 14,8, p = 0,024), respectivamente. Conclusão: Concluímos que os pacientes com bronquiolite obliterante pós-infecciosa apresentam escores de qualidade de vida relacionados à saúde menor que indivíduos saudáveis no escore total e nos domínios saúde e escolares. Keywords: Health-related quality of life, Bronchiolitis obliterans, Children, Palavras-chave: Qualidade de vida relacionada à saúde, Bronquiolite Obliterante, Crianças

Objectives: To compare nitric oxide (NO) serum levels in women with and without preeclampsia. Methods: 106 women were classified into preeclampsia group (n = 40) and normotensive group (n = 66). NO content was measured in the serum. Clinical and laboratorial data were recorded for comparison. Results: Preeclampsia presented a significant increase in nitrate and NOx levels compared to the control group. Uric acid, gestational age, systolic and diastolic blood pressure, and creatinine showed correlation with nitrates and NOx. Conclusion: Increase of NO was observed in preeclampsia women. Failure in the mechanism of action, dependent on cyclic GMP, may justify this finding.

Patients with HIV may have an increased risk of hypertension and cardiovascular disease (CVD). The objective of this study was to determine the prevalence and risk factors for hypertension in a population of HIV-infected patients at an HIV/AIDS clinic in southern Brazil. We reviewed medical records of 1009 HIV-infected patients aged 18 years or more in an urban HIV/AIDS clinic based in Porto Alegre, southern Brazil. Hypertension was defined according to the Eighth Joint National Committee criteria. The prevalence of hypertension in this study cohort was 22.5% (95% confidence interval, 20%-25.2%). Individuals were significantly older in the hypertensive group (P.001). After adjustment using a Poisson regression model of all variables that presented P.2 in the univariate analysis, the variables that were significantly associated with hypertension were only age ≥40 years and obesity. Also in this setting, dyslipidemia (P = .068) showed a tendency of association with hypertension. Compared with HIV-infected persons aged 18-39 years, those aged 40-59 years presented a 2-fold higher prevalence of hypertension (95% confidence interval, 1.2-3.3).The present study showed a high prevalence of hypertension among HIV-infected persons, similar to other studies, ranging from 13% to 45%, and also similar to the HIV-negative general population. Age and obesity were the factors associated with hypertension. Finally, the present study indicates a similar pattern of behavior and comorbidities for HIV-positive and -negative patients in relation to hypertension.

Objectives Eclampsia results in high morbidity and mortality, so it is important to identify clinical and laboratorial aspects that may be useful as potential markers to differentiate women at higher risk. Thus, we aim to identify, among women with preeclampsia, aspects that may increase the risk to develop eclampsia. Study design Retrospective cohort study. The records of patients delivered at Hospital Sao Lucas/PUCRS were reviewed retrospectively; 733 pregnant women with hypertension were analyzed; 329 had preeclampsia, and 45 eclampsia. Main outcome measures Serum uric acid levels and protein excretion in women that develop eclampsia. Results Patients with eclampsia had higher serum uric acid levels and protein excretion, systolic and diastolic blood pressure; were more likely to have cesarean section and had worst perinatal outcomes. The combination of uric acid above 5.9 mg/dL and protein/creatinine ratio over 4.9 had a striking association with eclampsia (p ≤ 0.001). The occurrence of HELLP syndrome was significantly different between groups, with a higher incidence among women who developed eclampsia (OR 6.5; 95%CI, 3.2–13.2; p Conclusion Our data suggest that the combination of high levels of maternal serum uric acid and proteinuria are strongly associated with the development of eclamptic crises.

AIMS: To validate the Brazilian version of the Fresno test of competence in Evidence-Based Medicine.METHODS: This is a cross-sectional, validation study. Phase 1: translation of the Fresno instrument. Phase 2: validation of the translated version, which was tested in 70 undergraduate medical students. The psychometric properties evaluated were validity, internal consistency, and sensitivity to change.RESULTS: Overall, validity was adequate; most items showed a moderate to strong and significant correlation with the total score; there was an important and significant difference between both groups, with and without previous contact with Evidence-Based Medicine (median, 55 [IQ25-75, 45.2-61.7] vs. median, 18.5 [IQ25-75, 6.0-29.7]) (p

The National Examination of Student Performance (ENADE) integrates the National System of Higher Education Assessment (SINAES) as a mandatory curriculum component in Brazilian undergraduate courses. The objective of this work was to analyze, in a critical-reflexive way, the questions of the ENADE, applied to Pharmacy academics in 2010, in order to understand if the profile of the test and the evaluative intention are consistent with the recommendations by the National Curriculum Guidelines for pharmacy courses (DCNF). Through Qualtrics Survey Software were prepared four questionnaires sent by digital means teachers allocated to 18 Pharmacy courses, public and private institutions, from the Rio Grande do Sul State (RS). A total of 131 teachers evaluatedof the ENADE 2010 test. Teachers’ opinion for suitability of the Specific issues reached an average score 7.78 ± 2.22, most assessed exercise capacity in drugs and medicines (63%) they demanded critical-reflective ability (45.5%) and interdisciplinary approach (45.3%). The General Training questions, average score was 5.16 ± 2.87 seconds teachers, helped in understanding the social, cultural and economic environment in which health professionals be inserted (42.8%) and, to a lesser acuity assessed the critical-reflective character (32.2%), humanist (12.2%) and ethical (10.6%). It was through the opinion of teachers, that Pharmacy ENADE 2010 test contemplates the principles defined by NDCF, however presented an asymmetric distribution of the training aspects required to the formation of the general pharmacist.

The relationship between personality and health is frequently studied in scientific research. This study investigated the clinical/biochemical course of kidney transplant patients based on personality traits.A longitudinal study assessed 114 kidney transplant patients (men = 68 and women = 46) with an average age of 47.72 years (SD = 11.4). Personality was evaluated using the Brazilian Factorial Personality Inventory (BFP/Big Five Model). Clinical variables were analyzed based on patient charts (estimated glomerular filtration rate (eGFR), hypertension, acute rejection, infection, graft loss, and death). Personality types were assessed by hierarchical cluster analysis.Two groups with personality types were differentiated by psychological characteristics: Cluster 1 - average neuroticism, high surgency, agreeableness and conscientiousness, and low openness; Cluster 2 - high neuroticism, average surgency and agreeableness, average conscientiousness, and low openness. There was no statistically significant difference between the clusters in terms of hypertension, acute infection, graft loss, death, and Human Leukocyte Antigen (HLA) I and II panel reactive antibodies. eGFR was associated with the personality types. Cluster 2 was associated with a better renal function in the 9-month follow-up period after kidney transplantation.In this study, patients from Cluster 2 exhibited higher eGFR 9 months after the transplant procedure compared to those from Cluster 1. Monitoring these patients over a longer period may provide a better understanding of the relationship between personality traits and clinical course during the post-transplant period.

Hemodialysis therapy significantly impacts on patients' physical, psychological, and social performances. Such reduced quality of life depends on several factors, such as malnutrition, depression, and metabolic derangements. This study aims to evaluate the current nutritional status, quality of life and depressive symptoms, and determine the possible relationships with other risk factors for poor outcomes, in stable hemodialysis patients. This was a single-center, cross-sectional study that enrolled 59 adult patients undergoing hemodialysis. Laboratory tests that included high-sensitivity c-reactive protein (CRP), and quality of life and depressive symptom evaluation, as well as malnutrition-inflammation score, nutritional status and body composition (by direct segmental multi-frequency bioimpedance analysis) determinations were performed. Patients were classified as "underfat", "standard", "overfat", or "obese" by multi-frequency bioimpedance analysis. Seven patients were underfat, 19 standard, 19 overfat, and 14 obese. Triglyceride levels significantly differed between the underfat, standard, overfat, and obese groups (1.06 [0.98-1.98]; 1.47 [1.16-1.67]; 2.53 [1.17-3.13]; 2.12 [1.41-2.95] mmol/L, respectively; P=0.026), as did Kt/V between the underfat, overfat, and obese groups (1.49 ± 0.14; 1.23 ± 0.19; 1.19 ± 0.22; P=0.015 and P=0.006, respectively). Depressive symptoms, quality of life, and CRP and phosphate levels did not diverge among nutritional groups. Creatinine, albumin, and phosphate strongly correlated, as well as percent body fat, body mass index, and waist circumference (r=0.859 [P

INTRODUÇÃO: A nutrição desempenha papel fundamental nas doenças renais. A recomendação nutricional deve ofertar uma dieta hiperproteica, adequada em energia e fósforo segundo o Kidney Disease Outcomes Quality Initiative (K/DOQI). É necessário controlar e/ou prevenir as complicações da Doença Renal Crônica (DRC), pois ela impõe desafios clínicos diretamente ligados ao estado nutricional. OBJETIVO: Investigar as associações entre a ingestão energética, proteica e de fósforo em pacientes em hemodiálise (HD). PACIENTES E MÉTODOS: Estudo observacional envolvendo 72 pacientes em HD, em dois hospitais de Porto Alegre/RS/Brasil. Foram coletados dados referentes ao perfil antropométrico (peso, altura e índice de massa corporal - IMC) e do registro alimentar de três dias (ingestão de energia, proteína e fósforo). O teste de correlação de Spearman foi utilizado para avaliar as associações entre as variáveis do registro alimentar (p < 0,05). RESULTADOS: A ingestão energética, proteica e de fósforo foi, respectivamente, de: 28 ± 10,0 kcal/kg, 1,1 ± 0,4 g ptn/kg, 958 ± 374 mg/dia, estando os níveis de energia e proteína abaixo das recomendações do K/DOQI. Observou-se correlação positiva forte entre as variáveis. DISCUSSÃO: O perfil no tratamento nutricional é fundamental, pois houve correlações entre os nutrientes. É importante salientar que as recomendações do K/DOQI não conseguem ser atingidas pelos pacientes. CONCLUSÃO: Há associação positiva entre a ingestão de energia, proteína e fósforo na alimentação de pacientes em HD. O controle desses nutrientes na dieta é essencial, pois auxilia no controle das complicações relacionadas com a DRC. Assim, a avaliação nutricional é importante nas unidades de diálise para definir o perfil dietético dos pacientes e que seja feito o ajuste de suas prescrições.

Salt taste sensitivity is the capacity to identify the flavour of salt. It is possible that salt taste sensitivity threshold (STST) can influence salt appetite, and sodium ingestion is associated with hypertension. The present study evaluates the relationship between salt taste sensitivity threshold (STST) and blood pressure (BP) response to exercise during a treadmill stress test. Two hundred and three normotensive individuals undergoing evaluation before starting an exercise training program were tested for STST, using concentrated saline solutions from 0.22 to 58.4g/L. Patients were divided into two groups according to the STST: normal (n-STST) and increased (i-STST); and into two groups according to their BP response to exercise: exercise-induced hypertension (EIH) or physiological blood pressure response (n-EIH). EIH was detected in 49 (24.1%) individuals. Initial systolic and diastolic BP and their areas under the curves during the test were higher in the EIH group. Initial systolic and diastolic BP areas under the curves were significantly higher in i-STST than n-STST. There was an association between STST of at least 1.8g/L (increased STST) and EIH (OR=6.71, 95% CI 1.5-29.99) independent of gender, body mass index and age. Occurrence of EIH was associated to i-STST, suggesting that a relationship between high STST and increased BP response to exercise is possible.

OBJETIVO: O estudo avalia sensibilidade gustativa ao sal, excreção urinária de sódio e pressão arterial (PA) em normotensos. A hipótese foi de que limiar de sensibilidade gustativa ao sal (LSGS) aumentado se associasse a maior natriúria em 24 horas e níveis aumentados de PA. MÉTODOS: Foram avaliados 24 voluntários sem diagnóstico de HA. Para avaliar LSGS, usou-se soluções de cloreto de sódio (NaCl) em diferentes concentrações. Os voluntários foram submetidos à monitorização ambulatorial da pressão arterial (MAPA) de 24 horas e coleta de urina de 24 horas para dosagem de sódio (NaU). Para análise, foram agrupados de acordo com o LSGS, aumentado ou normal. RESULTADOS: Os grupos não diferiram para idade, índice de massa corporal (IMC), variáveis demográficas, uso de álcool, fumo e PA. NaU foi significativamente maior no grupo com LSGS aumentado. Utilizando-se o coeficiente de correlação de Pearson, com significância determinada pelo teste t, houve correlação de forte intensidade entre médias de PA sistólica e diastólica com IMC, de regular intensidade entre LSGS e NaU, assim como para PA sistólica e NaU. CONCLUSÃO: Natriúria de 24 horas foi maior em indivíduos com LSGS aumentado, sugerindo que esta maior avidez ao sal determine maior ingestão de sódio. Houve forte associação entre PA e IMC. Não foi evidenciada associação entre LSGS e PA, diferente do já documentado em pacientes com PA aumentada. Aumentando-se o número de pessoas, faixa etária e pacientes com níveis pressóricos aumentados, talvez se respondam outras perguntas a respeito da relação entre LSGS, natriúria e PA.OBJECTIVE: The study evaluates salt taste sensibility, urinary sodium excretion and blood pressure (BP) in normotensive persons. The hypothesis was that a higher salt taste threshold (STT) can be associated to a higher 24 hour natriuresis and increased BP levels. METHODS: Twenty four not hypertensive volunteers were selected. To evaluate STT, different concentrations of sodium chloride were used. Individuals were submitted to 24 hour ambulatory blood pressure monitoring (ABPM) and the 24 hour urine was collected for sodium dosage. Patients were divided in two groups related to higher or normal STT. RESULTS: Both groups did not differ regarding age or body mass index (BMI). There was no difference between the groups regarding demographic variables, alcohol or tobacco use, and ABPM. Twenty-four hour natriuresis was significantly higher in the group with increased STT. Using Pearson´s correlation coefficient, with the significance determined by Student-t test, there was a strong correlation between 24 hour Systolic BP and BMI, Diastolic BP and BMI, and a regular correlation between STT with 24 hour natriuresis and Systolic BP with 24 hour natriuresis. CONCLUSION: Twenty four hour natriuresis was significantly higher in individuals with higher STT, suggesting that this avidity for salt is followed by higher ingestion of sodium. There was strong association between BP and BMI. The association between STT and BP levels was not confirmed. Increasing the number of persons, the age bracket, and of hypertensive patients may lead to a better understanding of the relations between STT, natriuresis and BP variation.

Imbalance in hemostatic mechanisms can occur during pregnancy with a tendency for hypercoagulability and increased thrombosis risk. Pregnant women with hypertensive disorder, especially preeclampsia, show alterations in platelet indexes. Immature platelet fraction (IPF) has been suggested as a sensitive index for monitoring changes in platelet production and destruction.To evaluate the IPF in patients diagnosed with a gestational hypertensive disorder (GHD).A cross-sectional study was conducted at an University Hospital to estimate maternal blood IPF index in 99 pregnant women, divided into three groups: normotensive pregnancy (NP), preeclampsia syndrome (PES), and non-proteinuric hypertensive pregnancy (nPHP). Following ethical approval and written informed consent, samples were collected from 33 NP, 34 PES, and 32 nPHP women. Platelet indexes were measured by fluorescent flow cytometry.IPF and mean platelet volume (MPV) counts in GHD were significantly higher than in NP (IPF: 3.8, 2.4-5.1%; 8.6, 5.8-10.6%; 7.3, 4.2-10.2%; p0.001 and MPV: 10.6 ± 0.9 fL; 12.1 ± 1.0 fL; 11.6 ± 1.0 fL; p0.001 for NP, PES, and nPHP, respectively). No difference was detected between PES and nPHP groups. The distribution of patients with an IPF above 6.1%for NP, PES, and nPHP was 9%, 65%, and 43.8%, respectively (p0.001). IPF as a test to differentiate GHD from the controls achieved an area under the curve of 0.83 on a receiver operating characteristics curve.A distinct profile in platelet indexes was detected in hypertensive pregnancies. It suggests that these markers could be used in daily routine as an additional tool in the management of pregnant women.

To determine the correlation between protein-to-creatinine ratio and 24-h urinary protein, proteinuria was measured in 45 patients attending a public HIV clinic in Porto Alegre, Brazil, using 24-h urinary protein excretion (24hUP) and urinary protein-to-creatinine ratio. Spearman’s correlation test was done to evaluate the association between spot protein-to-creatinine ratio and 24hUP. The limits of agreement between the two methods were analysed by the Bland–Altman method. For protein excretion

Objectives: The purpose of the present study was to evaluate the association between pre-eclampsia and blood groups in a group of pregnant women hospitalized in a University Hospital in Porto Alegre, Brazil -Hospital São Lucas (HSL)/PUCRS. \ud Study design: Our sample consisted of 10.040 pregnant women admitted to the maternity department of HSL between 2005 and 2010. The patients were reviewed retrospectively for inclusion. Medical records of 414 women were diagnosed as preeclampsia/eclampsia and were identified 9611 women to the control group. The patients were divided into two groups: the group with preeclampsia/eclampsia and the control group, and their blood groups were considered. Data were analyzed using SPSS for Windows version 17.0. Categorical data were summarized by counts and percentages, with the statistical significance evaluated by the Chi-square test. The null hypothesis was rejected when p0.05). \ud Conclusions: When we adopted stricter criteria for pre-eclampsia and a large sample from the same region we noted that the results did not show any association between blood groups and the development of pre-eclampsia.

Ramsay Hunt Syndrome (RHS) is the result of herpes zoster virus reactivation producing hearing loss, pain and vesicles in the ear or mouth, along with ipsilateral facial palsy due to the 7th cranial nerve geniculate ganglion infectious involvement. This condition has not been previously described, particularly in transplant patients. A 38-year old man underwent kidney transplantation and two years later experienced an ache on the left side of the face and hearing loss in the ear, also exhibiting vesicular lesions and concomitant facial peripheral palsy. Acyclovir IV was initiated, and the prednisone dose was increased. The patient was discharged 15 days later, feeling better but still exhibiting dark spots on his face. At three months follow-up he was asymptomatic, showing notable palsy improvement. Until this case, herpes zoster facial lesions causing typical RHS have never been reported in literature, particularly in kidney transplant patients.

The contemplation of volunteerism as activity in medical school, put forward by Sapiro and Mattiello in the present issue of Scientia Medica, brings to light the idea that those who provide benefits have to understand why they do so, as occurs among adults. And to understand selflessness, a topic that has been recurrent in medicine over time, reading about what has already been produced is not enough, since exposure to the practice of concern for the welfare of others is essential.Observational evidence suggests that volunteerism may be beneficial to the mental health and survival of exposed individuals, even though the causal mechanisms remain unknown. Consequently, further studies are needed to shed more light upon the topic, but while that does not occur, the following quotation gives us some food for thought: “If you would like to be selfish, you should do it in a very intelligent way. The stupid way to be selfish is … seeking happiness for ourselves alone. … the intelligent way to be selfish is to work for the welfare of others”. The Dalai Lama.

The performance of creatinine-based equations to obtain the estimated GFR in adolescents and young adults is poorly understood. We assessed creatinine-based GFR estimating equations in a cross-section of 751 adolescents and young adults (1054 measurements), using inulin clearance (measured GFR [mGFR]) as the reference method. We evaluated the following: Cockcroft-Gault, four-variable Modified Diet in Renal Disease, and the Chronic Kidney Disease Epidemiology Collaboration equations for adult participants, as well as the Schwartz 2009 and Schwartz-Lyon equations for pediatric age groups. Participants ranged in age from 10 to 26 years (mean 16.8 years); we divided the population into four groups according to age (10-12 years, 13-17 years, 18-21 years, and 21-25 years). Evaluation of the agreement between these formulas and mGFR (e.g., correlation, Bland-Altman plots, bias, and accuracy) showed that there was a good correlation between mGFR and both pediatric formulas in all age groups, whereas the adult formulas substantially overestimated mGFR. In conclusion, we recommend the use of pediatric equations to estimate GFR from childhood to early adulthood.

Erythrocytes l-arginine uptake is conveyed by y+ and y+L membrane transport systems. Pre-incubation with N-ethylmaleimide for 10 min at 37°C inhibits the y+ system. The aim of this study was to determine the ideal pre-incubation temperature in evaluating y+ and y+L systems. Cells were pre-incubated with or without N-ethylmaleimide for 10 min at 4°C and 37°C. l-Arginine uptake was quantified by radioisotope and standard erythrocytes membrane flux methodology. Results demonstrate that erythrocytes l-arginine content is depleted by pre-incubation at 37°C for 10 min, thus changing the V max measurement. The inhibitory effect of N-ethylmaleimide pre-incubation was temperature independent and already complete after 1 min of incubation. No significant difference in kinetic parameters was detected between cells pre-incubated at 37°C or 4°C, under zero-trans conditions. In conclusion, we suggest that measurement of erythrocytes l-arginine uptake by y+ and y+L systems could be carried out without N-ethylmaleimide pre-incubation at 37°C.

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FUNDAMENTO: A síndrome de pré-eclâmpsia se associa com a disfunção endotelial e o diagnóstico diferencial entre pré-eclâmpsia pura (PE) e sobreposta (PES) só pode ser feito após 12 semanas do parto. OBJETIVO: Comparar a avaliação da função endotelial através de dilatação mediada por fluxo de gestantes com pré-eclâmpsia pura e sobreposta. MÉTODOS: A dilatação mediada por fluxo da artéria braquial foi realizada utilizando as recomendações da International Brachial Artery Reactivity Task Force em gestantes com a Síndrome de Pré-eclâmpsia. Pré-eclâmpsia (n = 14) e pré-eclâmpsia sobreposta (n = 13) foram diagnosticadas no pós-parto segundo as definições do National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. RESULTADOS: A mediana da dilatação mediada por fluxo (DMF) na PES (6,0%; 1,9-10,3) foi reduzida em comparação com PE (13,6%; 4,4-17,1), uma disparidade aparentemente relevante, mas sem diferença estatisticamente significativa (p = 0,08). A DMF inferior a 10% foi detectada em 30,8% das PE e em 69,2% das PES (p = 0,057). Diferenças significativas não ocorreram na comparação entre a morfologia das artérias uterinas de PE e PES através do espectro do Doppler. CONCLUSÃO: A DMF da artéria braquial de pacientes com Síndrome de Pré-eclâmpsia não se mostrou ser um método capaz de diferenciar PE de PES. Entretanto, os dados sugerem que PES se associa com pior função endotelial em comparação a PE. BACKGROUND: The preeclampsia syndrome is associated with endothelial dysfunction and the differential diagnosis between pure preeclampsia (PE) and superimposed preeclampsia (SPE) can be only be attained 12 weeks after delivery. OBJECTIVE: To compare the assessment of endothelial function through flow-mediated dilatation in pregnant women with pure preeclampsia and superimposed preeclampsia. METHODS: The flow-mediated dilatation of the brachial artery was carried out according to the recommendations of the International Brachial Artery Reactivity Task Force in pregnant women with preeclampsia syndrome. PE (n=14) and SPE (n=13) were diagnosed in the postpartum period according to the definitions of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. RESULTS: The median of the flow-mediated dilatation (FMD) in SPE (6.0%; 1.9-10.3) was decreased in comparison with the PE (13.6%;4.4-17.1), an apparently relevant difference , but not statistically significant (p = 0.08). The FMD < 10% was detected in 30.8% of the PE cases and in 69.2% of the SPE cases (p = 0.057). Significant differences could not be detected in the morphology of the uterine arteries between the PE and SPE cases through the Doppler spectrum. CONCLUSION: The FMD of the brachial artery of patients with preeclampsia syndrome was not capable of differentiating between PE and SPE. However, the data suggest that SPE is associated with worse endothelial function I comparison to PE. FUNDAMENTO: El síndrome de preeclampsia se asocia con la disfunción endotelial y el diagnóstico diferencial entre preeclampsia pura (PE) y sobreagregada (PES) sólo puede realizarse 12 semanas después del parto. OBJETIVO: Comparar la evaluación de la función endotelial a través de dilatación mediada por flujo en gestantes con preeclampsia pura y sobreagregada. MÉTODOS: La dilatación mediada por flujo de la arteria braquial se realizó utilizando las recomendaciones de la International Brachial Artery Reactivity Task Force en gestantes con Síndrome de Preeclampsia. La Preeclampsia (n = 14) y preeclampsia sobreagregada (n = 13) fueron diagnosticadas en el posparto según las definiciones del National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. RESULTADOS: El promedio de la dilatación mediada por flujo (DMF) en la PES (6,0%; 1,9-10,3) fue reducido en comparación con la PE (13,6%; 4,4-17,1), una disparidad aparentemente relevante, pero sin diferencia estadísticamente significativa (p = 0,08). Una DMF inferior al 10% se detectó en el 30,8% de las PE y en el 69,2% de las PES (p = 0,057). No aparecieron diferencias significativas en la comparación entre la morfología de las arterias uterinas de PE y PES a través del espectro del Doppler. CONCLUSIÓN: La DMF de la arteria braquial de pacientes con Síndrome de Preeclampsia no demostró ser un método capaz de diferenciar PE de PES. No obstante, los datos sugieren que la PES se asocia a una peor función endotelial en comparación con la PE.

The preeclampsia syndrome is associated with endothelial dysfunction and the differential diagnosis between pure preeclampsia (PE) and superimposed preeclampsia (SPE) can be only be attained 12 weeks after delivery.To compare the assessment of endothelial function through flow-mediated dilatation in pregnant women with pure preeclampsia and superimposed preeclampsia.The flow-mediated dilatation of the brachial artery was carried out according to the recommendations of the International Brachial Artery Reactivity Task Force in pregnant women with preeclampsia syndrome. PE (n=14) and SPE (n=13) were diagnosed in the postpartum period according to the definitions of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy.The median of the flow-mediated dilatation (FMD) in SPE (6.0%; 1.9-10.3) was decreased in comparison with the PE (13.6%;4.4-17.1), an apparently relevant difference , but not statistically significant (p = 0.08). The FMD10% was detected in 30.8% of the PE cases and in 69.2% of the SPE cases (p = 0.057). Significant differences could not be detected in the morphology of the uterine arteries between the PE and SPE cases through the Doppler spectrum.The FMD of the brachial artery of patients with preeclampsia syndrome was not capable of differentiating between PE and SPE. However, the data suggest that SPE is associated with worse endothelial function I comparison to PE.

In July 2004, an anemia outbreak was identified in our hemodialysis (HD) unit. The dialysate chloramine levels had risen from

Objective: To evaluate associations between maternal serum uric acid (UA) levels, maternal status, and fetal outcome. Methods: Maternal UA, urinary protein-creatinine ratio (P/C), blood pressure (BP), gestational age at delivery, and birth weight were evaluated in hypertensive pregnant women (n = 58). These were divided into two groups: high UA (≥357 μmol/L) or normal UA (

OBJETIVO: O estudo avalia sensibilidade gustativa ao sal, excreção urinária de sódio e pressão arterial (PA) em normotensos. A hipótese foi de que limiar de sensibilidade gustativa ao sal (LSGS) aumentado se associasse a maior natriúria em 24 horas e níveis aumentados de PA. MÉTODOS: Foram avaliados 24 voluntários sem diagnóstico de HA. Para avaliar LSGS, usou-se soluções de cloreto de sódio (NaCl) em diferentes concentrações. Os voluntários foram submetidos à monitorização ambulatorial da pressão arterial (MAPA) de 24 horas e coleta de urina de 24 horas para dosagem de sódio (NaU). Para análise, foram agrupados de acordo com o LSGS, aumentado ou normal. RESULTADOS: Os grupos não diferiram para idade, índice de massa corporal (IMC), variáveis demográficas, uso de álcool, fumo e PA. NaU foi significativamente maior no grupo com LSGS aumentado. Utilizando-se o coeficiente de correlação de Pearson, com significância determinada pelo teste t, houve correlação de forte intensidade entre médias de PA sistólica e diastólica com IMC, de regular intensidade entre LSGS e NaU, assim como para PA sistólica e NaU. CONCLUSÃO: Natriúria de 24 horas foi maior em indivíduos com LSGS aumentado, sugerindo que esta maior avidez ao sal determine maior ingestão de sódio. Houve forte associação entre PA e IMC. Não foi evidenciada associação entre LSGS e PA, diferente do já documentado em pacientes com PA aumentada. Aumentando-se o número de pessoas, faixa etária e pacientes com níveis pressóricos aumentados, talvez se respondam outras perguntas a respeito da relação entre LSGS, natriúria e PA. OBJECTIVE: The study evaluates salt taste sensibility, urinary sodium excretion and blood pressure (BP) in normotensive persons. The hypothesis was that a higher salt taste threshold (STT) can be associated to a higher 24 hour natriuresis and increased BP levels. METHODS: Twenty four not hypertensive volunteers were selected. To evaluate STT, different concentrations of sodium chloride were used. Individuals were submitted to 24 hour ambulatory blood pressure monitoring (ABPM) and the 24 hour urine was collected for sodium dosage. Patients were divided in two groups related to higher or normal STT. RESULTS: Both groups did not differ regarding age or body mass index (BMI). There was no difference between the groups regarding demographic variables, alcohol or tobacco use, and ABPM. Twenty-four hour natriuresis was significantly higher in the group with increased STT. Using Pearson´s correlation coefficient, with the significance determined by Student-t test, there was a strong correlation between 24 hour Systolic BP and BMI, Diastolic BP and BMI, and a regular correlation between STT with 24 hour natriuresis and Systolic BP with 24 hour natriuresis. CONCLUSION: Twenty four hour natriuresis was significantly higher in individuals with higher STT, suggesting that this avidity for salt is followed by higher ingestion of sodium. There was strong association between BP and BMI. The association between STT and BP levels was not confirmed. Increasing the number of persons, the age bracket, and of hypertensive patients may lead to a better understanding of the relations between STT, natriuresis and BP variation.

We describe a case of an adult organ recipient patient with a pulmonary cavitary lesion due to Neisseria lactamica , a harmless commensal organism that rarely causes human infection. To our knowledge, this is the first report of pulmonary disease caused by this organism and the second case of N. lactamica infection in an adult patient.

The study evaluates salt taste sensibility, urinary sodium excretion and blood pressure (BP) in normotensive persons. The hypothesis was that a higher salt taste threshold (STT) can be associated to a higher 24 hour natriuresis and increased BP levels.Twenty four not hypertensive volunteers were selected. To evaluate STT, different concentrations of sodium chloride were used. Individuals were submitted to 24 hour ambulatory blood pressure monitoring (ABPM) and the 24 hour urine was collected for sodium dosage. Patients were divided in two groups related to higher or normal STT.Both groups did not differ regarding age or body mass index (BMI). There was no difference between the groups regarding demographic variables, alcohol or tobacco use, and ABPM. Twenty-four hour natriuresis was significantly higher in the group with increased STT. Using Pearson's correlation coefficient, with the significance determined by Student-t test, there was a strong correlation between 24 hour Systolic BP and BMI, Diastolic BP and BMI, and a regular correlation between STT with 24 hour natriuresis and Systolic BP with 24 hour natriuresis.Twenty four hour natriuresis was significantly higher in individuals with higher STT, suggesting that this avidity for salt is followed by higher ingestion of sodium. There was strong association between BP and BMI. The association between STT and BP levels was not confirmed. Increasing the number of persons, the age bracket, and of hypertensive patients may lead to a better understanding of the relations between STT, natriuresis and BP variation.

Introduction The ABO-system of antigens and the Rh-system (D-antigen) is genetically determined and remains the most important blood group systems clinically. Several studies have examined the association between ABO and Rhesus blood group systems and pre-eclampsia. At present there is no consensus to define this association, especially not in a Brazilian population. Objectives The purpose of the present study was to evaluate the association between pre-eclampsia versus ABO and Rhesus blood group systems in pregnant women hospitalized in a University Hospital in Porto Alegre, Brazil – Hospital S a o Lucas (HSL). Methods Pre-eclampsia/eclampsia (PE/E) was diagnosed by the National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy guidelines. This study consisted of 14,894 pregnant women admitted to the Maternity Department between 2005 and 2010. The patients were reviewed retrospectively for inclusion. Complications in pregnancy not related to pre-eclampsia/eclampsia (PE/E) and those with uncompleted data were excluded. Medical records of 410 women were used to diagnose PE/E. The control group consisted of 8781 women. Each group was subdivided according to their blood groups. Results In comparison to the PE/E women and controls, no specific relation in blood groups was observed. With respect to ABO and Rh groups, no differences between PE/E and controls were observed ( P =0.479 and P =0.169 respectively). When analyzed with both Rh and ABO Pearson Chi-Square also showed no differences ( P =0.569). ABO/RhNormal (%)PE/E (%)TotalO−401 (4,56)16 (3,90)417O+4014 (45,71)205 (50)4219A−335 (3,81)13 (3,17)348A+2833 (32,2)120 (29,2)2953B−83 (0,94)2 (0,48)85B+867 (9,87)42 (10,24)909AB−24 (0,27)0 (0)24AB+224 (2,55)12 (2,92)236Total8781 (100)410 (100)9191 Conclusion This study aimed to demonstrate some association between blood groups and PE/E using a large sample from the south of Brazil, a population not investigated before. In our study, no specific differences were observed between PE/E and controls in the distribution of the blood groups. In conclusion, the results of this study suggest no association between ABO and Rhesus blood group systems and PE/E in our population. Funding CAPES Foundation-Ministry of Education of Brazil

Hypokalemic periodic paralysis is a rare life-threatening syndrome, potentially reversible when detected at an early stage. Hypokalemia may also occur in other conditions characterized by muscle weakness. Acute myopathy associated with thyrotoxicosis has been described in Asian populations, although it seldom affects Caucasians or African-Americans. It can be difficult to recognize in western populations. Acute recurrent episodes of flaccid paralysis, symmetrically affecting the proximal muscles of the lower limbs, either following strenuous physical activity or carbohydrate overindulgence, is the usual presentation. Hypokalemia seems to result from transcellular shifts of potassium rather than losses. A case of thyrotoxic hypokalemic periodic paralysis occurring in a young Caucasian male diagnosed with Graves' disease is reported.

OBJECTIVES: HIV-related renal diseases are the leading causes of chronic kidney diseases worldwide. The present study aimed to investigate the prevalence of pathological proteinuria and its risk factors among HIV patients. METHODS: A review of the medical records of 666 HIV-infected individuals aged 18 years or older in an urban HIV/AIDS clinic based in Porto Alegre in southern Brazil. Overt proteinuria was defined as a protein-to-creatinine ratio greater than 150 mg/g according to Kidney Disease: Improving Global Outcomes. RESULTS: The prevalence of pathological proteinuria in the present study cohort was 20%. Characteristics associated with pathological proteinuria after univariate analysis included alcohol abuse, hepatitis C virus coinfection, the occurrence of diabetes and therapy including tenofovir. Adjusted residuals analysis indicated an association between pathological proteinuria and both a CD4 lymphocyte count below 200 cells/mm3 and a viral load higher than 1000 copies/mL. Additionally, an absence of pathological proteinuria was associated with a CD4 lymphocyte count higher than 500 cells/mm3. After adjustment for variables with p