Risk factors for the development of endometrial lesions in breast cancer patients using tamoxyphen: a retrospective cohort study.

INTRODUCTION: breast cancer is the cancer with the highest incidence in women in Brazil, representing 29.7% of all cancers. More than two thirds of women with breast cancer show expression for hormone receptors, and in these cases, hormone therapy with tamoxifen is indicated, which may represent a risk factor for the development of endometrial cancer (four-fold greater relative risk). OBJECTIVE: this study aimed to evaluate the association of tamoxifen and the development of endometrial disturbances and to assess possible other associated risk factors. PATIENTS AND METHOD: a total of 364 breast cancer patients were evaluated, 286 who used tamoxifen and 78 who did not use this hormone therapy. Results: patients who used tamoxifen had a mean follow-up time of 51.42 months similar to those without hormone therapy (p=0.081). A total of 21 (7.3%) women who used tamofixen and no cases among women without hormone therapy presented endometrial changes during follow-up (p=0.01). Despite information regarding obesity was available for only 270 women, obesity was also significantly associated with the development of endometrial changes (p=0.008). CONCLUSION: furthermore, the association between tamofixen and endometrial changes remained significant (p=0.039) after adjusting for obesity.

Action of enfuvirtide on the pregnancy of albino rats ( Rattus norvegicus albinus, Rodentia, Mammalia ): biological assay and functional and histological analyses of exposed maternal-fetal organs.

OBJECTIVE: • No drug related fetal malformations. • No adverse effects on vital organ functions. To assess the effects of enfuvirtide on pregnancy in albino rats and their fetuses. METHODS: Forty pregnant EPM 1 Wistar rats were randomly allocated into four groups: control (E) (distilled water twice/day), G1 (4mg/kg/day enfuvirtide), G2 (12mg/kg/day enfuvirtide), and G3 (36mg/kg/day enfuvirtide) groups. On the 20th day of gestation, the rats were anesthetized and subjected to cesarean section. Their blood was collected for laboratory analysis, and they were sacrificed. The offspring's fragments of their kidneys, liver, and placentas and the maternal rats' fragments of their lungs, kidneys, and liver were separated in the immediate postpartum period for light microscopy analysis. RESULTS: No maternal deaths occurred. In the second week at the end of pregnancy, the mean weight of the G3 Group was significantly lower than that of the G2 Group (p=0.029 and p=0.028, respectively). Analyzing blood laboratory parameters, the G1 Group had the lowest mean amylase level, and the G2 Group had the lowest mean hemoglobin level and the highest mean platelet count. In the morphological analysis, there were no changes in organs, such as the kidneys and liver, in both the maternal rats and offspring. Three maternal rats in the G3 Group had pulmonary inflammation in the lungs. CONCLUSION: Enfuvirtide has no significant adverse effects on pregnancy, conceptual products, or functional alterations in maternal rats.

Risk factors for the development of endometrial lesions in breast cancer patients using tamoxyphen: a retrospective cohort study / Estudo de coorte retrospectivo para avaliação de fatores de risco para desenvolvimento de lesão endometrial em pacientes com câncer da mama em uso de tamoxifeno

ABSTRACT Introduction: breast cancer is the cancer with the highest incidence in women in Brazil, representing 29.7% of all cancers. More than two thirds of women with breast cancer show expression for hormone receptors, and in these cases, hormone therapy with tamoxifen is indicated, which may represent a risk factor for the development of endometrial cancer (four-fold greater relative risk). Objective: this study aimed to evaluate the association of tamoxifen and the development of endometrial disturbances and to assess possible other associated risk factors. Patients and method: a total of 364 breast cancer patients were evaluated, 286 who used tamoxifen and 78 who did not use this hormone therapy. Results: patients who used tamoxifen had a mean follow-up time of 51.42 months similar to those without hormone therapy (p=0.081). A total of 21 (7.3%) women who used tamofixen and no cases among women without hormone therapy presented endometrial changes during follow-up (p=0.01). Despite information regarding obesity was available for only 270 women, obesity was also significantly associated with the development of endometrial changes (p=0.008). Conclusion: furthermore, the association between tamofixen and endometrial changes remained significant (p=0.039) after adjusting for obesity.

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.

Action of enfuvirtide on the pregnancy of albino rats ( Rattus norvegicus albinus, Rodentia, Mammalia ): biological assay and functional and histological analyses of exposed maternal-fetal organs

ABSTRACT Objective To assess the effects of enfuvirtide on pregnancy in albino rats and their fetuses. Methods Forty pregnant EPM 1 Wistar rats were randomly allocated into four groups: control (E) (distilled water twice/day), G1 (4mg/kg/day enfuvirtide), G2 (12mg/kg/day enfuvirtide), and G3 (36mg/kg/day enfuvirtide) groups. On the 20th day of gestation, the rats were anesthetized and subjected to cesarean section. Their blood was collected for laboratory analysis, and they were sacrificed. The offspring's fragments of their kidneys, liver, and placentas and the maternal rats' fragments of their lungs, kidneys, and liver were separated in the immediate postpartum period for light microscopy analysis. Results No maternal deaths occurred. In the second week at the end of pregnancy, the mean weight of the G3 Group was significantly lower than that of the G2 Group (p=0.029 and p=0.028, respectively). Analyzing blood laboratory parameters, the G1 Group had the lowest mean amylase level, and the G2 Group had the lowest mean hemoglobin level and the highest mean platelet count. In the morphological analysis, there were no changes in organs, such as the kidneys and liver, in both the maternal rats and offspring. Three maternal rats in the G3 Group had pulmonary inflammation in the lungs. Conclusion Enfuvirtide has no significant adverse effects on pregnancy, conceptual products, or functional alterations in maternal rats.

Liver retransplantation: a model for determining long-term survival.

BACKGROUND: 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. METHODS: 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. RESULTS: 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, score <24; 33rd to 66th percentile, 24 < or = score < or = 32; above the 66th percentile, score > 32). One-year, 3-year, and 5-year patient survival rates following retransplantation were respectively 85%, 82%, and 77% for scores <24; 69%, 66%, and 61% for scores between 24 and 32; and 21%, 19%, and 16% for scores >32 (P < 0.0001). CONCLUSION: 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.

[Paresthesia and/or pain affecting the hand and/or wrist as a referral for electrodiagnostic studies]. / Parestesia e/ou dor nas mãos e/ou punhos como motivo de encaminhamento para estudo eletroneuromiográfico.

To study the reasons for referral to electrodiagnostic evaluation, 490 patients referred for electrodiagnostic evaluation to two laboratories (UNIFESP and UNEF) answered the following question: "What was the reason that brought you to look for a physician and that led him to ask this examination?" Paresthesia and/or pain were answered as the main reason by 175 of them (26% UNIFESP and 40% UNEF). The electromyographical examinations were normal in 30.8% and 35.3% and involvement of the median nerve at the wrist was detected in 5 9% and 51.5% of them. Nocturnal symptoms and paresthesia were commonly noted in both groups of patients; they, however, were not able to separate the patients with and without median nerve compression at the wrist. The question asked seems to be a useful selection instrument, to select two similar symptomatic samples of patients from two laboratories serving with very different target populations.

[Translation and validation of an instrument for evaluation of severity of symptoms and the functional status in carpal tunnel syndrome]. / Tradução e validação do questionário de avaliação de gravidade dos sintomas e do estado funcional na síndrome do tú nel do carpo.

The objective of the present study was to translate, to do cultural equivalence and validation of the Levine et al. (1993) or Boston Carpal Tunnel Questionnaire (BCTQ) to Portuguese. The BCTQ application to patients, selected by the question "What was the reason that brought you to look for a physician and that led him to ask this examination?" showed very good reproducibility. The validity was measured through the comparison of the severity symptoms scores (SSS) and the functional status scores (FSS) with the results of grip forces, Minnesota, two point discrimination, Semmes-Weinstein filaments perception and sensory conduction at the median nerve. The internal consistency was evaluated through Chronbach's alpha coefficient comparing the SSS and the FSS. The measuring properties were evaluated through paired t-test between pre and pos-surgical scores. Reproducibility, internal consistency, validation and measuring properties of the translated BCTQ were similar to those found by Levine et al. with the original version.

[Quality of life of pregnant women infected with the human immunodeficiency virus (HIV) in the city of São Paulo]. / Qualidade de vida de gestantes infectadas pelo vírus da imunodeficiência humana (HIV) na cidade de São Paulo.

PURPOSE: It was to assess the quality of life (QOL) of HIV-infected pregnant women using the HIV/AIDS - Targeted Quality of Life (HAT-QoL) questionnaire. METHODS: A descriptive study of 60 pregnant women attended at the Multidisciplinary Nucleus of Infectious Diseases During Pregnancy (NUPAIG) - UNIFESP/EPM and in the referral network of the Municipal Office of São Paulo, conducted from February 2011 to October 2012. Sociodemographic and clinical variables were collected from 60 HIV-infected pregnant women who answered the HAT-QoL questionnaire, which included 34 questions about quality of life. RESULTS: The average age was 30 years and the average period of HIV infection was 5.7 years. Only 8.3% of patients had a CD4 cell score of ≤200 cells/mm³ and 45% showed undetectable viral load. The average domain scores ranged from 47.5 to 83.7. The domains with the lowest scores were financial concerns and concerns about secrecy. The domains with the highest scores and lower impact on quality of life were concerns about medication and confidence in the professional. CONCLUSION: In this initial study with 60 pregnant women, we concluded that the HAT-QOL can contribute to the assessment of quality of life in the population of HIV-infected pregnant women in Brazil.

The Influence of HIV-1 Subtype in the Response to Therapeutic Dendritic Cell Vaccine.

In the present study, we investigated the influence of HIV-1 subtype in the response to the dendritic cell (DC) therapeutic vaccine for HIV. HIV-1 viral load and TCD8+/TCD4+ cell counts for up to 48 weeks after vaccination. Out of 19 immunized subjects, 13 were infected by subtype B, 5 by subtype F, and 1 by subtype D. Overall, 42.1% (8/19) achieved a viral load decline of ≥ 1 log(10) sustained up to 48 weeks after immunization. Such magnitude of viral load drop was seen in 80% (4/5) of subtype F infected patients, and in 23.0% (3/13) of the subtype B infected ones (p=0.08). Moreover, mean viral load decline was 1.32 log(10), for subtype F infected individuals compared to 0.5 log(10) among subtype B infected patients (p=0.01). The variation in TCD4+ cell count was not related to HIV-1 subtype. Larger studies are necessary to confirm the efficacy of this immunotherapy and the differential response according to the background genetic diversity of HIV-1.

Randomized trial - oxybutynin for treatment of persistent plantar hyperhidrosis in women after sympathectomy

OBJECTIVE: Hyperhidrosis is a common disease, and thoracoscopic sympathectomy improves its symptoms in up to 95% of cases. Unfortunately, after surgery, plantar hyperhidrosis may remain in 50% of patients, and compensatory sweating may be observed in 70%. This clinical scenario remains a challenge. Our objective was to evaluate the effectiveness of oxybutynin in the treatment of persistent plantar hyperhidrosis and compensatory sweating and its effects on quality of life in women after thoracoscopic sympathectomy. METHOD: We conducted a prospective, randomized study to compare the effects of oxybutynin at 10 mg daily and placebo in women with persistent plantar hyperhidrosis. The assessment was performed using a quality-of-life questionnaire for hyperhidrosis and sweating measurement with a device for quantifying transepidermal water loss. Clinicaltrials.gov: NCT01328015. RESULTS: Sixteen patients were included in each group (placebo and oxybutynin). There were no significant differences between the groups prior to treatment. After oxybutynin treatment, there was a decrease in symptoms and clinical improvement based on the quality-of-life questionnaire (before treatment, 40.4 vs. after treatment, 17.5; p = 0.001). The placebo group showed modest improvement (p = 0.09). The outcomes of the transepidermal water loss measurements in the placebo group showed no differences (p = 0.95), whereas the oxybutynin group revealed a significant decrease (p = 0.001). The most common side effect was dry mouth (100% in the oxybutynin group vs. 43.8% in the placebo group; p = 0.001). CONCLUSION: Oxybutynin was effective in the treatment of persistent plantar hyperhidrosis, resulting in a better quality of life in women who had undergone thoracoscopic sympathectomy. .

Qualidade de vida de gestantes infectadas pelo vírus da imunodeficiência humana (HIV) na cidade de São Paulo / Quality of life of pregnant women infected with the human immunodeficiency virus (HIV) in the city of São Paulo

OBJETIVO: Avaliar a qualidade de vida (QV) de gestantes infectadas pelo HIV, utilizando o questionário HIV/AIDS - Targeted Quality of Life (HAT-QoL). MÉTODOS: Estudo descritivo que incluiu 60 gestantes atendidas no Núcleo Multidisciplinar de Patologias Infecciosas na Gestação (NUPAIG) - UNIFESP/EPM e na rede de referência da Secretaria Municipal de São Paulo. Foi realizado no período de fevereiro de 2011 a outubro de 2012. Foram coletadas variáveis sociodemográficas e clínicas de 60 gestantes infectadas pelo HIV, que responderam o questionário HAT-QoL, o qual incluiu 34 questões sobre qualidade de vida. RESULTADOS: A média de idade foi 30 anos e o tempo médio de infecção pelo HIV foi de 5,7 anos. Somente 8,3% das pacientes tinham contagem de células CD4 ≤200 células mm³ e 45% apresentavam carga viral indetectável. Os escores médios dos domínios variaram entre 47,5 e 83,7. Os domínios com escores mais baixos foram preocupações financeiras e preocupações com o sigilo. Os domínios com escores mais altos e menor impacto na qualidade de vida foram preocupações com a medicação e confiança no profissional. CONCLUSÃO: Neste estudo inicial, com 60 grávidas, concluímos que o HAT-QOL poderá contribuir para a avaliação da qualidade de vida na população de gestantes infectadas pelo HIV no Brasil. .

PURPOSE: It was to assess the quality of life (QOL) of HIV-infected pregnant women using the HIV/AIDS - Targeted Quality of Life (HAT-QoL) questionnaire. METHODS: A descriptive study of 60 pregnant women attended at the Multidisciplinary Nucleus of Infectious Diseases During Pregnancy (NUPAIG) - UNIFESP/EPM and in the referral network of the Municipal Office of São Paulo, conducted from February 2011 to October 2012. Sociodemographic and clinical variables were collected from 60 HIV-infected pregnant women who answered the HAT-QoL questionnaire, which included 34 questions about quality of life. RESULTS: The average age was 30 years and the average period of HIV infection was 5.7 years. Only 8.3% of patients had a CD4 cell score of ≤200 cells/mm³ and 45% showed undetectable viral load. The average domain scores ranged from 47.5 to 83.7. The domains with the lowest scores were financial concerns and concerns about secrecy. The domains with the highest scores and lower impact on quality of life were concerns about medication and confidence in the professional. CONCLUSION: In this initial study with 60 pregnant women, we concluded that the HAT-QOL can contribute to the assessment of quality of life in the population of HIV-infected pregnant women in Brazil. .

Avaliação de métodos diagnósticos, morfológicos e biomoleculares em mulheres encaminhadas com citologia alterada / The diagnostic efficacy of morphologic and molecular methods in women with abnormal citology

Introdução: o câncer do colo uterino é a neoplasia mais frequente em mulheres de países em desenvolvimento. Doença causada pela infecção persistente com diferentes tipos de papilomavírus humano (HPV) classificados em baixo e alto risco, de acordo com o potencial oncogênico. Objetivo: em mulheres com diagnóstico citopatológico anormal por ocasião de exame de rastreamento do câncer cervical, encaminhadas por diferentes postos de atendimento do Sistema Único de Saúde para serviço universitário de referência e com diagnóstico definitivo de lesão intraepitelial de alto grau ou câncer cervical, avaliara eficácia diagnóstica de métodos morfológicos e biomoleculares utilizados de maneira isolada ou em associação; e a prevalência, estratificada em duasfaixas etárias, abaixo de 30 e igual ou superior a 30 anos, do HPV tipos 16, 18 e 45. Métodos: estudaram-se 167 mulheres encaminhadas ao Ambulatório de Patologia Cervical e Colposcopia do Hospital Universitário da Universidade Federal de Juiz de Fora, no período de novembro de 2002 e dezembro de 2003,com colo uterino íntegro, não grávidas e sem história de câncer no trato genital inferior. Coletaram-se, de todas as mulheres, amostras para estudo citológico,convencional e em meio líquido, e para os testes de DNA-HPV. Considerou-se como diagnóstico histopatológico final a avaliação mais grave dentre ospossíveis espécimes, biópsia, conização ou peça cirúrgica, que a paciente pudesse ter. Resultados: não há qualquer diferença no tocante à sensibilidade,ao valor preditivo positivo e negativo e à acurácia dentre os métodos diagnósticos estudados, porém a associação da citologia com o teste DNA-HPV tem menor especificidade que o exame citológico isolado, quer convencional ou em meio líquido. A prevalência do HPV 16, 18 e 45 cai de 88,9% para 50,0%nas mulheres com 30 anos ou mais (p = 0,02). Conclusão: nas mulheres encaminhadas ao ambulatório de PTGIC do HU-UFJF com colpocitologia alteradanão se justifica a realização de qualquer exame confirmatório, devendo realizar-se imediatamente a colposcopia para se ter o desfecho diagnóstico.

Introduction: cervical cancer is the most frequent neoplasia among the women of countries in development. Great part of these cases is caused by persistent infection with different types of human papilomavirus (HPV) classified as low and high risk, according to the risk of cervical cancer development. Objectives:based on women with abnormal cytology when screening for cervical cancer who were led from different units of the Public Health System to the reference university service and with a definite diagnosis of high cervical intraepithelial neoplasia or cancer, was to evaluate the diagnostic efficacy of morphologicand molecular methods used alone or together and the prevalence of HPV types 16, 18, 45, stratified into two age brackets. Methods: 167 women went to the Cervical Pathology and colposcopy clinic of the University Hospital of the Universidade Federal de Juiz de Fora, during the period from November 2002 to December 2003, with intact uterine cervix, not pregnant and without previous chemical and/or radiotherapy treatment for the inferior genital tract.Samples for cytology study were collected from all women, with conventional and liquid-based preparations, for CH2 for high risk virus, for DNA PAP andfor Probe Pack test. The worst histologic diagnosis among the possible histologic studies through biopsy, conization or cirurgic pieces was considered as "gold standard". Results: there is no difference regarding sensibility, positive predict value and negative predict value for all methods studied, However, the DNA PAP method has less specificities than the citology exam, either with conventional or based-liquid preparation. The prevalence of HPV 16, 18, 45 decreases from 88,9% to 50% in women of 30 years old or more, being this decrease statistically significant. Conclusion: in those women led to the PTGIC of the HUUFJF with abnormal cytology it is not necessary to repeat any tests, just colposcopy in order to reach the final diagnosis.

Estimating the length of the first antiretroviral therapy regiment durability in Säo Paulo, Brazil

Brazil was the first country to provide unrestricted, cost-free access to antiretroviral (ARV) medicine for AIDS treatment. However, there is little data about the benefits of such a policy for these patients. We evaluated the duration of benefit obtained with the introduction of ARVs, defined as the durability of the first ARV regiment. We reviewed the medical charts of patients attended from 1996-2000, at the outpatient clinics of the Federal University of Säo Paulo, Brazil. A total of 120 drug-naive HIV-1 infected patients were eligible to participate in the study. About half of the individuals (53 percent) presented with disease symptoms; 59 percent of them had CD4 count below 200 cells/mm³. Mean estimated duration of the benefit of therapy was 14.1 months. The most used regimen in this cohort was Zidovudine/3TC/Indinavir (26 percent), followed by Zidovudine/DDI (17 percent), and Zidovudine/3TC/Nelfinavir (13 percent). The most frequent cause of interruption of therapy was gastrointestinal intolerance. Use of treatment regimens with three drugs was more effective than with two drugs, but only for patients with CD4<200 cells/mm³ or CV>100,000 copies RNA/mL. However, the use of triple therapy was associated with a significantly higher probability of reaching maximum viral suppression, during a longer period (p<0.05).The patients enrolled in the study benefitted from therapy for a limited time, after the introduction of double or triple antiretroviral therapy. The incidence of adverse events was significantly associated with loss of the benefits provided by the initial therapeutic regimen.

Plasma levels of tumor necrosis factor-alfa in patients with visceral leishmaniasis (Kala-azar): association with activity of the disease and clinical remission following antimonial therapy

Avaliacao de TNF-alfa em pacientes com calazar tem despertado grande interesse devido ao seu papel no sistema imunologico e a sua atividade caquetizante. O objetivo deste estudo foi examinar a associacao entre os niveis plasmaticos de TNF-alfa, medidos atraves de sua imunorreatividade (ELISA) e bioatividade (ensaio citotoxico sobre as celulas L-929), e as manifestacoes clinicas da leishmaniose visceral. Amostras de 19 pacientes foram obtidas para determinacao do TNF-alfa antes, durante e apos a terapia antimonial, utilizando o ensaio de citotoxidade (todos os pacientes) e o ELISA (14 pacientes). Resultados discrepantes entre os ensaios de citotoxidade e o ELISA foram observados...

Morbidade febril puerperal em pacientes infectadas pelo HIV / Puerperal morbidity in HIV-positive women

OBJETIVO: avaliar as taxas de morbidade febril puerperal em pacientes infectadas pelo HIV e sua correlaçäo com a via de parto, duraçäo do trabalho de parto, tempo de rotura de membranas, número de células CD4+ e carga viral do HIV periparto. MÉTODOS: foram incluídas 207 gestantes infectadas pelo HIV, com seguimento pré-natal e parto entre maio de 1997 e dezembro de 2001, sendo 32 submetidas a parto vaginal e 175 a cesárea. Do total de pacientes, 62,8 por cento foram submetidas a cesárea eletiva. A idade média no grupo analisado foi de 27,4 anos, 25,6 por cento eram nulíparas e 26 por cento primíparas, com idade gestacional média de 37,8 semanas no momento do parto. A contagem média de células CD4+ foi de 481 células /mm3 e da carga viral do HIV de 49.100 cópias/mL, ambas no final da gestaçäo. RESULTADOS: a morbidade febril puerperal ocorreu em 34 pacientes, sendo 33 pós-cesárea e 1 pós-parto vaginal. O tipo mais comum de intercorrência infecciosa pós-cesárea foi infecçäo de cicatriz cirúrgica (13 por cento dos casos de infecçäo). Os fatores analisados, como duraçäo do trabalho de parto, tempo de rotura de membranas, contagem de células CD4+ ou carga viral do HIV periparto, näo interferiram na taxa de morbidade febril puerperal. CONCLUSÕES: A incidência de morbidade febril puerperal foi de 16,8 por cento, sendo mais freqüente pós-cesárea (18,9 por cento) que pós-parto vaginal (3,1 por cento). Os demais fatores näo mostraram relaçäo significativa com a taxa de morbidade febril puerperal

Parestesia e/ou dor nas mäos e/ou punhos como motivo de encaminhamento para estudo eletroneuromiográfico / Paresthesia and/or pain affecting the hand and/or wrist as a referral for electrodiagnostic studies

Com o objetivo de conhecermos os motivos de encaminhamento para estudo eletrofisiológico, perguntamos a 490 pacientes, encaminhados a dois laboratórios de neurofisiologia (UNIFESP e UNEF): "Qual o motivo que a(o) levou a procurar o médico e que fez com que ele solicitasse este exame"? Parestesia e/ou dor nas mäos e/ou punhos foram espontaneamente referidas como motivo principal por 175 deles (26 por cento UNIFESP e 40 por cento UNEF). O exame eletroneuromiográfico foi normal em, respectivamente, 30,8 por cento e 35,3 por cento e revelou compressäo do nervo mediano no carpo em 59 por cento e 51,5 por cento destes pacientes. Sintomas noturnos e parestesia foram comuns nos dois grupos de pacientes, mas näo foram capazes de discriminar aqueles com e sem compressäo do nervo mediano no carpo. O sintoma dor predominou nos pacientes com exame normal. A pergunta formulada pareceu ser bom instrumento de seleçäo. Conseguiu selecionar duas amostras de pacientes sintomáticos semelhantes, em laboratórios com populaçäo alvo muito diferente

Infecçäo por Trypanosoma cruzi em candidatos a doador de sangue / Trypanosoma cruzi infection in blood donors

A transmissäo transfusional da tripanossomíase americana tem-se reduzido no Brasil, com a progressiva ampliaçäo do controle de qualidade do sangue. Nesse sentido, realizou-se pesquisa para avaliar a atual soro-prevalência da infecçäo por Trypanosoma cruzi em candidatos a doador de sangue em Londrina, PR (Brasil, e comparar essa taxa com a encontrada em candidatos a doador estudados em 1958 e 1975, na mesma cidade. Estudo transversal para determinaçäo da soroprevalência. O imuno-diagnóstico de infecçäo por Trypanosoma cruzi foi realizado através das técnicas imunoenzimática (ELISA) e imunofluorescência indireta. A taxa de soroprevalência encontrada foi de 1,3 por cento. Foi detectada tendência de queda temporal da taxa de positividade dos testes sorológicos para o diagnóstico de infecçäo por Trypanosoma cruzi nos bancos de sangue do município estudado nos anos de 1958, 1975 e 1995

Traduçäo e validaçäo do questionário de avaliaçäo de gravidade dos sintomas e do estado funcional na síndrome do túnel do carpo / Translation and validation of an instrument for evaluation of severity of symptoms and the functional status in carpal tunnel syndrome

Este estudo tem por objetivo traduzir, fazer a equivalência cultural e validar o questionário de Levine et al. (1993) ou Boston Carpal Tunnel Questionnaire (BCTQ), para o português. O BCTQ aplicado a pacientes selecionados pela pergunta "Qual o motivo que a(o) levou a procurar o médico e que fez com que ele solicitasse este exame?" mostrou boa reprodutibilidade. A validade foi medida comparando o escore de gravidade dos sintomas (EGS) e o escore do estado funcional (EEF) aos resultados dos testes de força de preensäo e pinça, Minnesota, discriminaçäo entre dois pontos, Semmes-Weinstein e velocidade de conduçäo sensitiva no nervo mediano. A consistência interna foi avaliada pelo coeficiente a de Chronbach, comparando o EGS ao EEF. A propriedade de medida foi avaliada pelo teste t pareado, comparando escores pré-cirúrgicos aos pós-cirúrgicos. Reprodutibilidade, consistência interna, validade e propriedades de medida do BCTQ traduzido foram semelhantes às encontradas por Levine et al. na versäo original

Prevalência da infecçao pelo citomegalovírus em uma unidade de oncologia pediátrica / Prevalence of cytomegalovirus infection in a pediatric oncology unit

O objetivo deste estudo foi avaliar a prevalência da infecção pelo citomegalovírus (CMV) em crianças e adolescentes com câncer. Os portadores de neoplasias malignas constituem um grupo de alto risco, predisposto a infecções graves pelo CMV. Os marcadores séricos do CMV (IgG) foram avaliados em 267 pacientes com câncer. A idade destes pacientes variou de 1 mês a 25 anos e as neoplasias foram divididas em leucemias e linfomas, tumores ósseos e outros. Cerca de 193 (72,3 por cento) pacientes dos 267 pesquisados apresentaram anticorpos anti-CMV e a imunoglobulina IgM anti-CMV foi positiva em 37 (19,1 por cento) dos 193 pacientes com marcadores sorológicos para o CMV. E, este anticorpo foi encontrado em 59,4 por cento (22/37) das crianças com idade inferior a dez anos. Na população estudada a infecção pelo CMV ocorreu precocemente, atingindo crianças de baixa idade. A alta prevalência dos marcadores para o CMV constituti um alerta para o perigo de suas complicações nas fases mais acentuadas de imunodepressão, mesmo em crianças com idade inferior a dez anos.