Hypothyroidism does not lead to worse prognosis in COVID-19: findings from the Brazilian COVID-19 registry.

BACKGROUND: It is not clear whether previous thyroid diseases influence the course and outcomes of COVID-19. METHODS: The study is a part of a multicentric cohort of patients with confirmed COVID-19 diagnosis from 37 hospitals. Matching for age, sex, number of comorbidities, and hospital was performed for the paired analysis. RESULTS: Of 7,762 patients with COVID-19, 526 had previously diagnosed hypothyroidism and 526 were matched controls. The median age was 70 years, and 68.3% were females. The prevalence of comorbidities was similar, except for coronary and chronic kidney diseases that were higher in the hypothyroidism group (p=0.015 and p=0.001). D-dimer levels were lower in patients with hypothyroid (p=0.037). In-hospital management was similar, but hospital length-of-stay (p=0.029) and mechanical ventilation requirement (p=0.006) were lower for patients with hypothyroidism. There was a trend of lower in-hospital mortality in patients with hypothyroidism (22.1% vs 27.0%; p=0.062). CONCLUSION: Patients with hypothyroidism had a lower requirement of mechanical ventilation and showed a trend of lower in-hospital mortality. Therefore, hypothyroidism does not seem to be associated with a worse prognosis.

Prevalence of low bone mass and changes in vitamin D levels in human immunodeficiency virus-infected adults unexposed to antiretrovirals.

INTRODUCTION: The prevalence of low bone mass is 3 times higher in people living with human immunodeficiency virus (PLWH) and using antiretrovirals than in the HIV-unaffected population. Changes in vitamin D levels is one of the factors associated with decreased bone mass. The objective of this study is to evaluate the low bone mass and altered vitamin D levels in PLWH who have not been exposed to antiretrovirals. METHODS: A cross-sectional study was carried out with HIV-infected individuals between the ages of 18 and 55 years immediately prior to the start of antiretroviral therapy in a specialized reference center focusing on infectious and parasitic diseases. Results of clinical examination (patient's weight, height, blood pressure, and clinical history), laboratory tests, and X-ray absorptiometry, were collected. RESULTS: Sixty patients were included, with a mean age of 34 years. Nine (16.7%) patients presented with low bone mass and 4 (7.1%) patients showed low total femur BMD. Analysis revealed that 23.3% and 36.7% of the patients had deficient and insufficient levels of 25-hydroxyvitamin D3, respectively. CONCLUSIONS: Our study population presented with compromised bone health and with low bone mineral density and 25-(OH)-vitamin D levels.

Lipid accumulation product index in HIV-infected patients: a marker of cardiovascular risk.

The lipid accumulation product (LAP) index is an emerging cardiovascular risk marker. We aimed to assess the accuracy of this index as a marker of cardiovascular risk in HIV-infected patients. A cross-sectional study of 133 HIV-infected patients on antiretroviral drugs and 20 non-infected controls was conducted at the outpatient clinic of a referral center of infectious and parasitic diseases. Evaluations included LAP index, homeostasis model assessment (HOMA) index, anthropometric measurements, blood pressure, glucose tolerance test, and cholesterol and triglyceride levels. Body mass index (BMI) was similar in both groups; however, waist circumference was greater in the HIV-infected patients. Triglyceride levels were significantly higher (p<0.001) and HDL cholesterol levels were lower in HIV-infected patients (p<0.001). Plasma glucose (p=0.01) and insulin (p=0.005) levels two hours after a glucose load, HOMA-IR index (p<0.001) and LAP index (p<0.001) were higher in the HIV-infected patients. A positive and significant correlation was found between HOMA-IR index and LAP (r=0.615; p<0.01), BMI (r=0.334; p<0.01) and waist circumference (r=0.452; p<0.01) in the HIV-infected patients. In male HIV-infected patients and controls, ROC curve analyses revealed that the best cut-off value of LAP to define the presence of insulin resistance was 64.8 (sensitivity 86%, specificity 77% and area under the curve 0.824). These results confirm that insulin resistance is more common in HIV-patients on antiretroviral drugs than in HIV-negative controls. A positive and significant correlation was found between the LAP index and the HOMA index, with LAP≥64.8 constituting an additional risk factor for cardiovascular disease in male HIV patients.

Effect of photodynamic therapy as an adjuvant to non-surgical periodontal therapy: Periodontal and metabolic evaluation in patients with type 2 diabetes mellitus.

BACKGROUND: This pilot study aimed to evaluate the effect of antimicrobial photodynamic therapy (aPDT) as an adjuvant to non-surgical periodontal therapy (NSPT) on periodontal status and glycemic control in patients with type 2 diabetes mellitus and generalized chronic periodontitis. METHODS: Twelve patients were evaluated at five time points: during the preparation of the patient (T0), during the treatment phase (T1) and after 30 (T2), 90 (T3) and 180 (T4) days. The patients had a mean age of 52.2 years and a 9.58-year history of diabetes, on average, and were divided into two randomized treatment groups: 6 patients received NSPT combined with aPDT (G1) and 6 patients received only NSPT (G2). The aPDT was applied associating the photosensitizing agent methylene blue (10 mg/ ml) with a red laser (660 nm-40 mW). The total time of exposure was 2 min per tooth. RESULTS: Whitin the limitation of this study, the results showed that the plaque index reduced significantly only in the control group (p = 0.02) at T2 (30 days). For bleeding on probing, both groups showed a significant reduction between T1 and T2, with no difference between groups G1 and G2. Regarding the probing depth, there were no differences between groups, but the parameters decreased over time when compared to T1. The glycated haemoglobin and fructosamine levels did not significantly differ between or within the groups at any time point. CONCLUSION: When NSPT was combined with aPDT, no additional benefits were observed for the periodontal and metabolic clinical parameters.

Ultrasonographic measurement of intra-abdominal fat thickness in HIV-infected patients treated or not with antiretroviral drugs and its correlation to lipid and glycemic profiles.

AIMS: To compare the intra-abdominal fat thickness measured by ultrasound between HIV-infected patients treated or not with antiretroviral drugs and to correlate these visceral adiposity measurements to other parameters of cardiovascular risks. METHODS: In a transversal observational study, 160 HIV-infected patients were recruited and divided in two groups, i.e., 123 antiretroviral (ARV)-treated and 37 ARV-naïve patients. These patients were submitted to anthropometric determinations, laboratorial analysis, ultrasonographic measurements of subcutaneous and intra- abdominal fat thickness and to tetrapolar bioelectrical impedance analysis in order to measure the body composition. RESULTS: In the patients treated with highly active antiretroviral therapy (HAART) the intra-abdominal fat pad was significantly thicker than that of the untreated group (69 +/- 21 mm, n = 123 vs. 60 +/- 18 mm, n = 37; p = 0.03 Student's t test). The intra-abdominal fat thickness correlated significantly with plasma triglyceride, total cholesterol, fasting glucose, glucose measurements 2 h after dextrose load, fasting insulin, HOMA-IR index, systolic and diastolic blood pressures, weight, BMI, WHR and caliper-measured total fat percentage. CONCLUSION: The results showed that antiretroviral therapy is associated with increased ultrasonographic measurements of visceral adiposity. Our data demonstrated a strong correlation between intra-abdominal fat thickness and independent risk factors of cardiovascular disease: atherogenic lipid profile and insulin resistance.

Parathyroid ultrasonography and bone metabolic profile of patients on dialysis with hyperparathyroidism.

AIM: To evaluate the parathyroid ultrasonography and define parameters that can predict poor response to treatment in patients with secondary hyperparathyroidism due to renal failure. METHODS: This cohort study evaluated 85 patients with chronic kidney disease stage V with parathyroid hormone levels above 800 pg/mL. All patients underwent ultrasonography of the parathyroids and the following parameters were analyzed: Demographic characteristics (etiology of chronic kidney disease, gender, age, dialysis vintage, vascular access, use of vitamin D), laboratory (calcium, phosphorus, parathyroid hormone, alkaline phosphatase, bone alkaline phosphatase), and the occurrence of bone changes, cardiovascular events and death. The χ(2) test were used to compare proportions or the Fisher exact test for small sample frequencies. Student t-test was used to detect differences between the two groups regarding continuous variables. RESULTS: Fifty-three patients (66.4%) had parathyroid nodules with higher levels of parathyroid hormone, calcium and phosphorus. Sixteen patients underwent parathyroidectomy and had higher levels of phosphorus and calcium × phosphorus product (P = 0.03 and P = 0.006, respectively). They also had lower mortality (32% vs 68%, P = 0.01) and lower incidence of cardiovascular or cerebrovascular events (27% vs 73%, P = 0.02). Calcium × phosphorus product above 55 mg(2)/dL(2) [RR 1.48 (1.06, 2.08), P = 0.03], presence of vascular calcification [1.33 (1.01, 1.76), P = 0.015] and previous occurrence of vascular events [RR 2.25 (1.27, 3.98), P < 0.001] were risk factors for mortality in this population. There was no association between the occurrence of nodules and mortality. CONCLUSION: The identification of nodules at ultrasonography strengthens the indication for parathyroidectomy in patients with secondary hyperparathyroidism due to renal failure.

[Urinary excretion of calcium, uric acid and citrate in healthy children and adolescents]. / Excreção urinária de cálcio, ácido úrico e citrato em crianças e adolescentes sadios.

OBJECTIVE: To obtain regional reference values for calcium, uric acid and citrate urinary excretion and establish a correlation between those excretions in 24-hour urine sample and single urine sample for their use in clinical practice. METHODS: A hundred and twenty-five healthy children and adolescents were randomly chosen and submitted to the following protocol: clinical examination, biochemical analysis of blood, blood cell count, parathormone, 24-hour urine, fasting urine sample and stool test. RESULTS: The maximum value of calcium excretion in 24-hour urine was 3.75 mg/kg; in mg/dl of the glomerular filtration rate, it was 0.10; and for the calcium/creatinine (mg/dl) ratio in the fasting urine sample was 0.25. Positive correlation was observed between calcium excretion in the 24-hour urine and the fasting sample (mg/dl and mg/dl of glomerular filtration rate). The maximum values of uric acid excretion in 24-hour urine were 600, 450, and 320 mg and 13, 15 and 18 mg/kg for adolescents, school and preschool children, respectively; in mg/dl of glomerular filtration rate, in the fasting urine sample, it was 0.47. Positive correlation was observed for the uric acid excretion in 24-hour urine and fasting urine samples. The mean values for the citrate excretion in 24-hour urine were 1.6, 1.1 and 0.5 mmol for adolescents, school and preschool children, respectively; for citrate/creatinine ratio, in the fasting urine sample the mean value was 0.3. CONCLUSIONS: The calcium and uric acid excretion in 24-hour urine showed correlation with those in the fasting urine sample, which allows their use for metabolic diagnosis, population studies and follow-up of patients with hypercalciuria and hyperuricosuria without voiding control; the citrate/creatinine ratio in the fasting urine sample can be used for controlling patients with hypocitraturia.

American and Brazilian Children With Primary Urolithiasis: Similarities and Disparities.

Objectives. Considering the differences in location, socioeconomic background, and cultural background, the aim of this study was to try to identify possible factors associated with the increased incidence of urolithiasis by comparing American and Brazilian children with stones. Methods. Data of 222 American and 190 Brazilian children with urolithiasis were reviewed including age, gender, body mass index, imaging technique used (ultrasound and computed tomography), and 24-hour urine volume and chemistries. Results. There were no differences between age and gender at diagnosis. Brazilian children were leaner but in no population did obesity rate exceed that of the general population. Ultrasound was most commonly used to diagnose stones, even more so in Brazilians. Decreased urine flow was more common among Americans (P = .004), hypercalciuria among Brazilians (P = .001), and elevated Ca/citrate ratio among Americans (P = .009). There were no differences between the groups in the frequency of hypocitraturia, hyperuricosuria, absorptive hyperoxaluria, and cystinuria. Conclusions. Despite some differences between the populations, the leading causes of urolithiasis among both were "oliguria," hypercalciuria, and high Ca/citrate ratio. In neither country was obesity the reason for the increase in incidence of urolithiasis, nor was the use of computed tomography. The similarities between the 2 populations call for combining efforts in addressing the leading causes of pediatric urolithiasis.

Prevalence of low bone mass and changes in vitamin D levels in human immunodeficiency virus-infected adults unexposed to antiretrovirals

Abstract INTRODUCTION: The prevalence of low bone mass is 3 times higher in people living with human immunodeficiency virus (PLWH) and using antiretrovirals than in the HIV-unaffected population. Changes in vitamin D levels is one of the factors associated with decreased bone mass. The objective of this study is to evaluate the low bone mass and altered vitamin D levels in PLWH who have not been exposed to antiretrovirals. METHODS: A cross-sectional study was carried out with HIV-infected individuals between the ages of 18 and 55 years immediately prior to the start of antiretroviral therapy in a specialized reference center focusing on infectious and parasitic diseases. Results of clinical examination (patient's weight, height, blood pressure, and clinical history), laboratory tests, and X-ray absorptiometry, were collected. RESULTS: Sixty patients were included, with a mean age of 34 years. Nine (16.7%) patients presented with low bone mass and 4 (7.1%) patients showed low total femur BMD. Analysis revealed that 23.3% and 36.7% of the patients had deficient and insufficient levels of 25-hydroxyvitamin D3, respectively. CONCLUSIONS: Our study population presented with compromised bone health and with low bone mineral density and 25-(OH)-vitamin D levels.

Lipid accumulation product index in HIV-infected patients: a marker of cardiovascular risk

ABSTRACT The lipid accumulation product (LAP) index is an emerging cardiovascular risk marker. We aimed to assess the accuracy of this index as a marker of cardiovascular risk in HIV-infected patients. A cross-sectional study of 133 HIV-infected patients on antiretroviral drugs and 20 non-infected controls was conducted at the outpatient clinic of a referral center of infectious and parasitic diseases. Evaluations included LAP index, homeostasis model assessment (HOMA) index, anthropometric measurements, blood pressure, glucose tolerance test, and cholesterol and triglyceride levels. Body mass index (BMI) was similar in both groups; however, waist circumference was greater in the HIV-infected patients. Triglyceride levels were significantly higher (p < 0.001) and HDL cholesterol levels were lower in HIV-infected patients (p < 0.001). Plasma glucose (p = 0.01) and insulin (p = 0.005) levels two hours after a glucose load, HOMA-IR index (p < 0.001) and LAP index (p < 0.001) were higher in the HIV-infected patients. A positive and significant correlation was found between HOMA-IR index and LAP (r = 0.615; p < 0.01), BMI (r = 0.334; p < 0.01) and waist circumference (r = 0.452; p < 0.01) in the HIV-infected patients. In male HIV-infected patients and controls, ROC curve analyses revealed that the best cut-off value of LAP to define the presence of insulin resistance was 64.8 (sensitivity 86%, specificity 77% and area under the curve 0.824). These results confirm that insulin resistance is more common in HIV-patients on antiretroviral drugs than in HIV-negative controls. A positive and significant correlation was found between the LAP index and the HOMA index, with LAP ≥ 64.8 constituting an additional risk factor for cardiovascular disease in male HIV patients.

Quem é e o que deveria fazer um clínico no Brasil? Conceito, história e identidade / Who is and what should do a clinician in Brazil? Concep, history and identity

O ensino da clínica médica deve ser o ensino de uma atitude. O objetivo desse texto é entender a trajetória do clínico e o seu papel no sistema de saúde brasileiro. Há muita ambiguidade entre os termos clínico, clínico geral e até mesmo médico. Quando se diz que um médico é clínico pode-se referir ao seu método, ou à ideia de clínico geral, sem especialização. Ao longo da história, com avanço do conhecimento, a Medicina, a Clínica, sofre progressiva especialização. Paralelamente, o clínico perde valor. Todavia, com o avanço científico escancara-se a incerteza e complexidade do paciente real, o que, reforça a importância da formação do médico em base e atitude clínica, que trabalha os contrastes e limites, procura o todo e os detalhes, e exagera na reflexão. Ensinar clínica é ensinar essa forma de ser e de olhar. O papel do clínico na rede ambulatorial é impreciso, o que, desorganiza os cuidados, com excessivas fragmentação e simplificação. Há um discurso que o médico clínico com formação mais geral é necessário e deve ser valorizado. Mas não passa retórica, pois esses clínicos são considerados mal sucedidos. A maioria dos médicos recém-formados opta pelas áreas mais focais. Há cada vez menos clínicos e, portanto, menos professores de Clínica Médica, comprometendo o seu ensino. Por tudo isso, o clínico, especialista em Clínica Médica, atualmente com atuação mais restrita ao hospital precisa alargar seu campo de atuação e se valorizar. É necessário que se insira sistematicamente na rede ambulatorial.

Teaching clinical medicine involves a change in attitude. Our objective is to understand the course of the clinical physician and his role in brazilian health system. There is a lot of ambiguity in terms clinical physician, general practice and even physician. When someone tells that a doctor is a clinical physician means that his a method or that he is a physician without no specialization. Along history, with knowledge advance, Medicine and Clinical Medicine become progressively specialized. In parallel, the clinical physician loses value. However, the scientific advance opens wide real pacient uncertainty and complexity, which reinforce importance of medical education on grounds and attitude clinical, what means work with contrats and limits, search entire and details, and exaggerate in reflection. Teach clinical medicine is training this way of be and look. The clinical role in outpatient system is vague, what disorganize the care with excessive fragmentation and simplification. There is a speech that a clinical physician with a general formation is necessary and should be valued. But this is only a speech, because these doctors are considered unsuccessful. Most medical graduates choose more focal áreas. There are progressively less clinical physicians, and, therefore, less teachers of Clinical Medicine. For all this, the clinical physician, specialized in Clinical Medicine, currently working mainly in hospitals, needs to expand his practice and his value. It is fundamental that clinical physician enter up systematically in ambulatory net.

Prevalência e motivos para recusar participação em pesquisa clínica / Prevalence and reasons for refusal to participate in clinical research / Prevalencia y motivos de la negación a participar en investigaciones clínicas

As informações fornecidas sobre prevalência e os motivos da recusa de voluntários a participar em pesquisa científica são escassas. Este artigo objetiva descrever esses dados em coorte voltada a avaliar morbimortalidade de pessoas vivendo com HIV/aids (PVHA) a partir de estudo transversal realizado no Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias. Foram obtidas as informações: origem, data de nascimento, idade, sexo e motivo do não consentimento, quando aplicável. Falta de tempo para se dedicar a pesquisa foi o principal motivo alegado para o não consentimento (63%), seguido por medo de falta de sigilo (17%). Não houve diferença estatística entre os que aceitaram ou não participar por sexo, idade ou origem do serviço. Consideraram-se elevados os percentuais de recusa de PVHA (40,7%), bem como de falta de tempo disponível para participação (63%).

The information provided regarding the prevalence and reasons why volunteers refuse to participate in scientific research is sparse. This article aims to describe the prevalence and reasons for refusing to voluntarily participate in the cohort study whose objective is to evaluate morbidity and mortality amongst people living with HIV/AIDS (PLWHA), through a cross-sectional study conducted at the Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias (Training and Referral Center for Infectious and Parasitic Diseases). The following information was obtained: origin, date of birth, age, gender, and reason for not consenting, when applicable. The lack of time to devote to the research was the main reason given (63%), followed by fear of lack of confidentiality (17%). There was no statistical difference among those who accepted or not to participate in terms of gender, age or origin of the service. The percentage of PLWHA who refused to participate in the study (40.7%) and lack of time available for their participation (63%) were considered high.

Las informaciones disponibles respecto a la prevalencia y a los motivos de la negación de voluntarios para participar de investigaciones científicas son escasas. Este artículo tiene como objetivo describir la prevalencia y los motivos de la negación a participar voluntariamente en una cohorte dedicada a evaluar la morbilidad y la mortalidad de personas que viven con VIH/SIDA, a partir de un estudio transversal realizado en el Centro de Capacitación y Referencia en Enfermedades Infecciosas y Parasitarias. Se obtuvieron las siguientes informaciones: origen, fecha de nacimiento, edad, sexo y motivo del no consentimiento, cuando correspondiera. La falta de tiempo para dedicarse a la investigación fue el principal motivo alegado para el no consentimiento (63%), seguido por el temor a la no confidencialidad (17%). No hubo diferencias estadísticas entre los que aceptaron participar o no de acuerdo a sexo, edad u origen del servicio. Se consideraron elevados los porcentajes en la negación de las personas que viven con VIH/SIDA a participar de la investigación (40,7%), así como la falta de tiempo disponible para esta participación (63%).

Avaliação dos relatórios de referência recebidos em um serviço público universitário de Endocrinologia de Belo Horizonte / Evaluation of reference reports received in a universitypublic service in Endocrinology in Belo Horizonte

Introdução: o sistema de referência e contrarreferência (RCR) define um fluxo hierarquizado de atenção aos pacientes e/ou de comunicação entre profissionais. A referência é um documento que demanda uma consultoria e/ou encaminha pacientes a outros médicos (consultores), que elaboram um documento-resposta, a contrarreferência. No Brasil, o RCR não funciona bem e não há estudos que o avaliem sistematicamente. Objetivos: avaliar relatórios de referência provenientes de serviços de saúde da Prefeitura de Belo Horizonte (PBH), de municípios da região metropolitana de Belo Horizonte (RMBH) e do Hospital das Clínicas da UFMG (HC), elaborados por clínicos gerais (CLN) ou especialistas (ESP), recebidos no Serviço de Endocrinologia do HC, e definir informações necessárias em referência que permitam ao consultor decidir por interconsulta presencial. Foram considerados CLNs os médicos que atuam no Programa Saúdeda Família (PSF) ou clínicos da atenção secundária e terciária. Métodos: trata-se de estudo seccional e observacional. Resultados: dois pesquisadores (k=0,652) avaliaram 282 relatórios, sendo constatado que 62% poderiam ser abordados na atenção primária. A frequência de relatórios com informações suficientes para a tomada de decisãofoi maior naqueles oriundos do HC e elaborados por especialistas. Maior número de relatórios foi aceito quando apresentaram doenças próprias da Endocrinologia, dados do exame físico e dos exames complementares. Conclusões: a maioria dos pacientes referidos apresentava transtornos abordáveis na AP e um relatório de referência deve conter diagnóstico, dados dos exames complementares e do exame físico.

Introduction: the reference and counter-reference system (RCR) defines a hierarchical flow of assistance to patients and/or communication among professionals. The reference is a document that requires consulting and/or forwards patients to other doctors (consultants) who draw up a reply document, the counter-reference. In Brazil, the RCR system does not work well, and no study has systematically evaluated it. Objectives: to evaluate reference reports from health services from Belo Horizonte (PBH), municipalities in the metropolitan region of Belo Horizonte (RMBH), and the General Hospital from UFMG (HC) elaborated by general practitioners (GP) or specialists (ESP) and received in the Endocrinology Service from the GH, and define the necessary information in reference to enable the consultant to decide for a face-to-face consultation. The doctors who work in the Family Health Program (FHP) or secondary and tertiary care doctors were considered GPs. Methods: this was an observational and sectional study. Results: two researchers (k = 0.652) evaluated 282 reports and identified that 62% could have been assisted in the primary care. The frequency of reports with enough information for decision-making was greater in those from the GH and elaborated by specialists. A greater number of reports were accepted when presenting endocrinology diseases and physical and complementary examination data. Conclusions: most of the referred patients presented disorders that could have received care in the primary.care; a reference report must contain a diagnosis and datafrom additional tests and physical examination

High-sensitivity C-reactive protein levels in HIV-infected patients treated or not with antiretroviral drugs and their correlation with factors related to cardiovascular risk and HIV infection.

AIMS: To compare high-sensitivity C-reactive protein (hsCRP) in HIV-infected patients treated or not with antiretroviral (ARV) drugs and to correlate hsCRP levels with traditional cardiovascular risk factors and parameters of HIV infection. METHODS: One hundred and seventy-one HIV-infected patients were included (129 ARV-treated and 42 ARV-naïve). Evaluations included anthropometric measurements, blood pressure, laboratory tests, ultrasonographic measurement of fat thickness and impedance analysis. RESULTS: hsCRP levels were higher in ARV-treated compared to ARV-naïve patients (p<0.001). Seventy-two (56%) ARV-treated patients and 11 (26%) ARV-naïve patients had hsCRP concentrations >3 mg/dl (high risk for cardiovascular complications) (OR 3.56; 95%CI: 1.55-8.29; p=0.001, chi(2) test). hsCRP levels correlated positively with waist measurement (p=0.004), waist-to-hip ratio (p<0.001), systolic (p=0.05) and diastolic (p=0.03) blood pressure, intra-abdominal fat thickness (p=0.02), triglycerides (p=0.001), total cholesterol (p=0.01), fasting glucose (p=0.01), and glucose (p<0.001) and insulin levels (p=0.02) measured 2 h after load. No correlation was found between hsCRP levels and CD4 cell counts and HIV-viral load. Independent factors associated with hsCRP levels were therapy with current non-nucleoside reverse transcriptase inhibitors (NNRTI) (p=0.003), waist-to-hip ratio (p=0.006), fasting glucose (p=0.049) and glucose levels 2 h after load (p=0.003) in multivariate analysis model 1 and current NNRTI therapy (p<0.001), protease inhibitor therapy (p=0.016) and cardiometabolic syndrome (p=0.022) in multivariate analysis model 2. CONCLUSION: hsCRP in HIV-infected patients is associated with traditional cardiovascular risk factors, principally in ARV-treated patients. hsCRP levels are not associated with CD4 cell counts and HIV-viral load and may constitute a marker for cardiovascular risk related to HIV infection and ARV therapy.

Doença cardiovascular aterosclerótica e a infecção pelo HIV: uma atualização / Atherosclerotic cardiovascular disease and HIV infection: an update

Antes da introdução da terapia antirretroviral de alta potência, as complicações cardiovasculares na população infectada pelo HIV eram relacionadas à imunossupressão. Entretanto, após o advento do uso combinado das drogas antirretrovirais, houve considerável diminuição na morbidade e na mortalidade desses pacientes. Porém, aparentemente,complicações metabólicas como resistência insulínica e dislipidemia passaram a ser mais frequentes nesses indivíduos, sugerindo aumento do risco de doença aterosclerótica. O objetivo deste artigo é rever a literatura e descrever as complicações cardiovasculares da infecção pelo HIV, com ênfase no período pós-terapia antirretroviral combinada. A revisão foi realizada dando destaque aos fatores de risco cardiovasculares e, principalmente, à doença cardíaca aterosclerótica e suas particularidades na população infectada pelo HIV...

Before high-power antiretroviral therapy was introduced, cardiovascular complications in the HIV-infected population were mainly related to immunosuppression. However, after the advent of combined use antiretroviral drugs the morbimortality of these patients decreased considerably. It seems, however, that metabolic complications such as insulin resistance and dyslipidemia have become more frequent, suggesting an increased risk of atherosclerotic disease. The purpose of this article is to review the literature and describe the cardiovascular complications related to HIV infection, with an emphasis on the period after combined antiretroviral therapy was introduced. The review was conducted to highlight the cardiovascular risk factors, mainly of atherosclerotic heart disease and its peculiarities among the HIV-infected population...

Report on a balantidiasis case in a person living with HIV/AIDS (PLWHA)

Balantidium coli é um protozoário parasito ciliado que afeta os porcos e primatas não-humanos. Sua presença em seres humanos é rara e pode se tornar um parasito oportunista em hospedeiros imunodeprimidos. Balantidíase é uma doença causada pela ingestão de cistos de B. coli. Osindivíduos infectados podem apresentar dor abdominal, cefaléia, astenia, tenesmo, meteorismo e diarréia caracterizada por cinco ou seis evacuações por dia. Este trabalho é o primeiro no Brasil a relatar a presença de B. coli em um paciente HIV-positivo.

Excreção urinária de cálcio, ácido úrico e citrato em crianças e adolescentes sadios / Urinary excretion of calcium, uric acid and citrate in healthy children and adolescents

Objetivo: determinar valores de referência regionais para a excreçäo urinária de cálcio, ácido úrico e citrato e estabelecer correlaçäo entre essas excreçöes em urina em 24h e amostras únicas, para uso na prática clínica. Material e métodos: 125 crianças e adolescentes saudáveis, selecionados aleatoriamente, foram submetidos ao protocolo: exame clínico, bioquímica de sangue, hemograma, paratormônio, urina em 24h, urina em amostra única colhida com jejum, e exame parasitológico de fezes.Resultados: o valor máximo para a excreçäo de cálcio em urina em 24h foi 3,75mg/kg, em mg/dl do ritmo de filtraçäo glomerular - RFG foi 0,10, e, para a relaçäo cálcio/creatinina(mg/dl) na urina, em amostra única em jejum, foi de 0,25. Observou-se correlaçäo positiva entre a excreçäo de cálcio em urina em 24h, e urina em amostra única em jejum (mg/dl e mg/dl do RFG). Os valores máximos para a excreçäo de ácido úrico em urina em 24h foram 600, 450 e 320mg e 13, 15 e 18 mg/kg para adolescentes, escolares e pré-escolares, respectivamente; em mg/dl do RFG em amostra única de urina foi 0,47. Observou-se correlaçäo positiva para a excreçäo de ácido úrico em urina em 24h e urina em amostra única em jejum. Os valores médios para a excreçäo de citrato em urina em 24h foram 1,6, 1,1 e 0,5mmol para adolescentes, escolares e pré-escolares, respectivamente; para a relaçäo citrato/creatinina em urina, em amostra única, com jejum, foi 0,3. Conclusöes: as excreçöes de cálcio e ácido úrico em urina em 24h se correlacionaram com aquelas das amostras urinárias simplificadas, permitindo o uso destas para diagnósticos metabólicos, estudos populacionais e controle de pacientes hipercalciúricos e hiperuricosúricos sem controle de esfíncter vesical; o quociente citrato/creatinina em urina, em amostra única, pode ser utilizado para controle de pacientes com hipocitratúria