Diagnosis of metabolic syndrome in nursing professionals: An accuracy study.

Metabolic Syndrome (MetS) represents a group of cardiovascular risk factors. This article aims to evaluate the accuracy of the tools of MetS diagnosis in Nursing professionals from Primary Health Care (PHC) in Bahia, Brazil. A cross-sectional study with a random sample selected according to essential health information for the diagnostic of MetS. For MetS diagnostic, we used EGIR, NCEP-ATPIII, AACE, IDF, Barbosa et al. (2006), and IDF/AHA/NHLBI (defined as gold standard) definition. Sensitivity, specificity, predictive values, and likelihood ratio were estimated for each diagnostic tool and compared with the gold standard. Kappa statistic was used to determine the agreement between the diagnostic methods. One thousand one hundred and eleven nursing professionals were included in this study. Sensitivity varied from 15% to 95.1%, and specificity varied between 99.5% and 100%. IDF and Barbosa et al. (2006) definitions were more sensitive (95.1% and 92.8%, respectively), and EGIR, NCEP, ATP III, and IDF showed 100% specificity. IDF and Barbosa et al. (2006) use suitable metabolic syndrome identification and confirmation criteria. The highest agreement was found in the definition of the IDF, Barbosa et al. (2006) and the NCEP ATP III. Defining metabolic syndrome with a higher diagnostic accuracy could contribute to the screening and the early identification of nursing professionals with cardiovascular disease risk factors, which provide opportunities for appropriate prevention and treatment.

A meta-analysis of patients with chronic hepatitis C treated with interferon-alpha to determine the risk of autoimmune thyroiditis.

OBJECTIVE: In order to analyze the effect on autoimmune thyroiditis (AT) of current anti-hepatitis C virus (HCV) treatment in HCV-infected patients, we performed a systematic review with meta-analysis of the available literature. The present meta-analysis was conducted to evaluate the strength and the consistency of the association between treatments with interferon-alpha (IFN-alpha) for HCV infection and AT. MATERIAL AND METHODS: A search in Medline, PubMed, and EMBASE was conducted with a systematic review of clinical studies in English and other languages. Only studies in HCV subjects compared to a control group with hepatitis B (positive HBsAg) were considered. The relative risk (RR) of AT was regarded as the most reliable outcome end-point. The pooled odds ratio (OR) and 95% confidence intervals (95% CI) were calculated from the raw study data using the Mantel-Haenszel methods. We used a statistical evaluation of heterogeneity by the chi2-test to assess whether the variation in treatment effect within trials of the same group was greater than it might be expected. RESULTS: We identified 35 clinical trials with a total of 6.403 patients. Five trials were selected for analysis involving a total of 625 patients with hepatitis C treatment with IFN-alpha and 456 HBsAg-positive controls. These studies yielded a combined adjusted OR of 4.98 (95% IC 1.56-15.91). The test for heterogeneity was significant (P = 0.0008), and the test for overall effect was Z statistic 2.71 (P = 0.007). CONCLUSION: Our meta-analysis indicates that treatment with IFN-alpha for HCV infection has an increased risk of AT.

Association between metabolic syndrome and work: an integrative review of the literature.

The aim of this study was to highlight the association between occupational aspects and the occurrence of metabolic syndrome among various occupational groups. This is an integrative review of the literature that included articles indexed in the following databases: LILACS, SciELO, PubMed, and CINAHL. We evaluated 32 articles, most of which were published in Englishlanguage medical journals and with level 4 scientific evidence. The occupational aspects most commonly reported as associated with metabolic syndrome were occupation, work shift, and occupational stress. Our results indicated that occupational aspects could negatively interfere with workers' health; more robust longitudinal studies should contribute to further uncovering the reported associations.

Cutaneous leishmaniasis during pregnancy: exuberant lesions and potential fetal complications.

Cutaneous leishmaniasis affects millions of people worldwide. After observations of atypical lesions in pregnant women at the health centers of Corte de Pedra, Brazil, 9 years of records were reviewed, and 26 pregnant patients were identified. A retrospective case-control study revealed that lesions in pregnant women were much larger than those in nonpregnant patients in an age- and sex-matched group (mean area, 6.08 cm2 vs. 1.46 cm2; P=.008), and many lesions had an exophytic nature. Despite foregoing treatment until after delivery, response to pentavalent antimony therapy was favorable (rate of cure with 1 course of treatment, 85%). High rates of preterm births (10.5%) and stillbirths (10.5%) were reported. Cutaneous leishmaniasis during pregnancy produces distinct lesions and may have adverse fetal effects.

Congenital growth hormone (GH) deficiency and atherosclerosis: effects of GH replacement in GH-naive adults.

BACKGROUND: GH deficiency (GHD) in adults is associated with increased abdominal adiposity and systolic blood pressure, total and low-density lipoprotein cholesterol, and C-reactive protein. METHODS: We have studied the effects of 6-month GH replacement therapy in 20 adult members of a large Brazilian kindred with lifelong severe and isolated GHD due to a homozygous mutation in GHRH receptor gene (46 +/- 14.5 yr; 122 +/- 7.7 cm; 36.7 +/- 5.4 kg; 10 men). Subjects were studied at baseline, after 6-month bimonthly depot GH injections (Nutropin Depot; Genentech, Inc., South San Francisco, CA) [post GH (pGH)], and after 6- and 12-month washout. RESULTS: Despite modest trough serum IGF-I increase, GH replacement therapy caused a decrease in skinfolds and in waist-hip ratio, with a rebound increase at 12 months. Total and low-density lipoprotein cholesterol were reduced pGH and returned to baseline at 6 months. High-density lipoprotein cholesterol increased pGH, but at 12 months was lower than baseline. A progressive increase in left ventricular mass index, posterior wall, and septum thickness occurred from pGH to 12 months, and of carotid intima-media thickness, from 6 to 12 months. Individuals were 6, 16, and 52 times more likely to have an atherosclerotic carotid plaque at pGH, 6 and 12 months, respectively, when compared with baseline. CONCLUSION: In patients with lifetime isolated GHD, 6-month treatment with GH has reversible beneficial effects on body composition and metabolic profile, but it causes a progressive increase in intima-media thickness and in the number of atherosclerotic carotid plaques.

Chronotropic incompetence and a higher frequency of myocardial ischemia in exercise echocardiography.

BACKGROUND: Exercise echocardiography (EE) is an established method to diagnose coronary artery disease (CAD). Chronotropic incompetence (CI) during the EE may be a marker of myocardial ischemia. The purpose of this investigation was to evaluate the additive value of CI during EE in CAD diagnosis. METHODS: Between 2000 and 2006, 4042 patients (1900 men with a mean age of 56 +/- 11 years) were evaluated by EE. Based on the heart rate (HR) reached during the exercise test, the subjects were divided into two groups: G1 group - 490 patients who failed to achieve 85% of the maximal age-predicted HR, and G2 group - 3552 patients who were able to achieve 85% of the maximal age-predicted HR. Clinical characteristics, left ventricular wall motion abnormalities - wall motion score index (WMSI) - and coronary angiography (CA) were the parameters compared between the two groups. RESULTS: The left ventricular wall motion abnormalities were more frequent in G1 group than in G2 group (54% versus 26%; P < 0.00001). WMSI was higher in G1 group than in G2 group, both at rest (1.06 +/- 0.17 versus 1.02 +/- 0.09; P < 0.0001) and after exercise (1.12 +/- 0.23 versus 1.04 +/- 0.21; P < 0.0001). In G1 group, 82% of the patients with positive EE for myocardial ischemia presented obstructive coronary, compared to 71% (P = 0.03) in G2 group. CONCLUSION: CI is associated with a higher frequency of myocardial ischemia during EE, reinforcing the concept that CI is a marker of the severity of myocardial ischemia.

[Liver injury in visceral leishmaniasis in children: systematic review]. / Alteraciones hepáticas en la Leishmaniasis Visceral (Kalazar) en niños: revisión sistemática de la literatura.

UNLABELLED: Visceral Leisshimaniosis or Kalazar is a parasitic infection caused by Leishimania Donovani subspecies. It is transmitted by phlebotomineos and may lead to liver and spleen enlargements as well as immunological impairment. Sometimes it is described liver injury simulating acute or chronic viral hepatitis and even portal hypertension. The liver injury makes difficult the diffencial diagnosis of Kalazar and other liver diseases in endemic regions. OBJECTIVE: To define and clarify the liver injury spectrum described in published cases reports. METHODS: Systematic revision of published data on Kalazar and liver injury using the following databank: LILACS, MEDLINE and EMBASE. Only paper published in French, English, Portuguese and Spanish were taken into consideration. The procedures for systematic review recommended by the NHS Centre for Reviews and Dissemination, University of Cork, were adopted. The paper quality classification was based on the number of reported variables previously defined in our study RESULTS: Only 11/28 (55%) publications were included in our analysis because they filled the minimal required data. Acute and chronic liver disease were well documented in these articles. Serum albumin and prothombine time were associated with severity of liver disease (P < .05). CONCLUSION: "Liver involvement, even when it is severe, may occur at tha begining of the disease. Kalazar should be considered as a differential diagnosis of cholestasis, acute and chronic liver injury as well as portal hypertension in children.

HDV genotypes in the Western Brazilian Amazon region: A preliminary report.

In Brazil, hepatitis delta virus (HDV) is only reported in Western Amazonia, where severe cases of acute and chronic HDV hepatitis have been described. The study area was chosen in the States of Acre and Rondonia where most cases of hepatitis B virus (HBV)/HDV are reported. From December 2003 to October 2004, 40 HBsAg carriers with anti-HDV IgM were selected. An epidemiologic questionnaire, including demographic and clinical/epidemiologic variables was filled out. HDV amplification and genotyping were performed. Genotype I was detected in 22 patients (55.0%), whereas genotype III was identified in 18 (45.0%). Patients who were infected with genotype I were older (45.1 +/- 17.8 years) than patients infected with genotype III (32.8 +/- 10.9 years; P = 0.01). No symptoms were reported by 21 (52.5%) patients. Otherwise, 19 (47.5%) had symptoms (fatigue, abdominal pain, weight loss, and decompensated liver disease) that motivated them to seek medical care. Genotype III carriers were more symptomatic, but no statistical significance was achieved. Our preliminary results show that HDV genotypes I and III are present in Brazilian Amazonia and that HDV genotype III is not limited to the Amerindian population.

Association between severe asthma and changes in the stomatognathic system.

OBJECTIVE:: To describe orofacial muscle function in patients with severe asthma. METHODS:: This was a descriptive study comparing patients with severe controlled asthma (SCA) and severe uncontrolled asthma (SUA). We selected 160 patients, who completed a sociodemographic questionnaire and the 6-item Asthma Control Questionnaire (ACQ-6), as well as undergoing evaluation of orofacial muscle function. RESULTS:: Of the 160 patients evaluated, 126 (78.8%) and 34 (21.2%) presented with SCA and SUA, respectively, as defined by the Global Initiative for Asthma criteria. Regardless of the level of asthma control, the most frequent changes found after evaluation of muscle function were difficulty in chewing, oronasal breathing pattern, below-average or poor dental arch condition, and difficulty in swallowing. When the sample was stratified by FEV1 (% of predicted), was significantly higher proportions of SUA group patients, compared with SCA group patients, showed habitual open-mouth chewing (24.8% vs. 7.7%; p < 0.02), difficulty in swallowing water (33.7% vs. 17.3%; p < 0.04), and voice problems (81.2% vs. 51.9%; p < 0.01). When the sample was stratified by ACQ-6 score, the proportion of patients showing difficulty in swallowing bread was significantly higher in the SUA group than in the SCA group (66.6% vs. 26.6%; p < 0.01). CONCLUSIONS:: The prevalence of changes in the stomatognathic system appears to be high among adults with severe asthma, regardless of the level of asthma control. We found that some such changes were significantly more common in patients with SUA than in those with SCA. OBJETIVO:: Descrever os achados da avaliação miofuncional orofacial em pacientes com asma grave. MÉTODOS:: Estudo descritivo comparando pacientes com asma grave controlada (AGC) e asma grave não controlada (AGNC). Foram selecionados 160 participantes, que responderam a um questionário sociodemográfico e o Asthma Control Questionnaire com seis questões (ACQ-6) e realizaram avaliação miofuncional orofacial. RESULTADOS:: Na amostra estudada, 126 (78,8%) e 34 (21,2%) pacientes, respectivamente, apresentavam AGC e AGNC segundo os critérios da Global Initiative for Asthma. Independentemente do nível de controle da asma grave, as alterações mais frequentes observadas na avaliação miofuncional foram problemas de mastigação, padrão de respiração oronasal, estado de conservação da arcada dentária médio ou ruim e problemas na deglutição. Quando a amostra foi estratificada pelo VEF1 (% do previsto), os resultados foram significativamente maiores no grupo AGNC que no grupo AGC quanto a mastigação habitual com boca aberta (24,8% vs. 7,7%; p < 0,02), deglutição de água com dificuldade (33,7% vs. 17,3%; p < 0,04) e problemas de voz (81,2% vs. 51,9%; p < 0,01). Quando estratificada pelo ACQ-6, os resultados do grupo AGNC foram significativamente maiores que no grupo AGC quanto à deglutição de pão com dificuldade (66,6% vs. 26,6%; p < 0,01). CONCLUSÕES:: A prevalência de alterações do sistema estomatognático parece ser alta em adultos com asma grave independentemente do nível de controle da doença. No grupo AGNC, algumas dessas alterações foram significativamente mais frequentes que no grupo AGC.

Decrease of plasma triglycerides during the acute phase of unstable angina or non-ST elevation myocardial infarction is a marker of recurrent ischemia.

Both increase and decrease of plasma triglycerides during acute coronary syndromes (ACS) are reported, however, a clinical relevance for these distinct metabolic responses is unclear. To test the association between distinct responses of lipid metabolism and cardiovascular risk, 39 subjects admitted with non-ST elevation ACS within 48 h of presentation had plasma lipids measured on the first and sixth days of hospitalization, and continuous electrocardiogram was performed during the first 2 days to quantify recurrent ischemia and heart rate variability. No lipid-lowering therapy was offered to the patients. During the first 5 days, half of them experimented a decrease in triglycerides (n=19, median: -18 mg/dl) and the other half presented triglyceride increase (n=20, median: +44 mg/dl). A higher incidence of recurrent ischemia (35% versus 5%, P=0.02) and greater ischemic burden/patient (123 +/- 286 mm min versus 47 +/- 212 mm min, P=0.02) were observed in subjects with triglyceride reduction, when compared with those with triglyceride increase. Individuals with heart rate variability below the median presented a median decrease in triglycerides during the 5-day period, as opposed to the counterparts (P=0.05). In conclusion, triglyceride reduction during ACS is associated with a greater incidence of recurrent ischemia and may constitute a sign of higher sympathetic activity.

Anti-inflammatory effect of atorvastatin (80 mg) in unstable angina pectoris and non-Q-wave acute myocardial infarction.

In this randomized trial, C-reactive protein increased during the first 5 days of an acute coronary syndrome in patients treated with placebo, but this phenomenon was not observed in those randomized to atorvastatin 80 mg/day. This suggests that short-term statin therapy inhibits inflammation in patients with non-ST-elevation acute coronary syndromes.

Zinc/copper imbalance reflects immune dysfunction in human leishmaniasis: an ex vivo and in vitro study.

BACKGROUND: The process of elimination of intracellular pathogens, such as Leishmania, requires a Th1 type immune response, whereas a dominant Th2 response leads to exacerbated disease. Experimental human zinc deficiency decreases Th1 but not Th2 immune response. We investigated if zinc and copper levels differ in different clinical forms of leishmaniasis, and if these trace metals might be involved in the immune response towards the parasite. METHODS: Blood was collected from 31 patients with either localized cutaneous (LCL), mucosal (ML) or visceral (VL) leishmaniasis, as well as from 25 controls from endemic and non-endemic areas. Anti-Leishmania humoral and cellular immune response were evaluated by quantifying specific plasma IgG, lymphoproliferation and cytokine production, respectively. Plasma levels of Cu and Zn were quantified by atomic absorption spectrophotometry. RESULTS: A significant decrease in plasma Zn was observed in all three patient groups (p < 0.01 for LCL and ML, p < 0.001 for VL), as compared to controls, but only VL (7/10) and ML (1/7) patients displayed overt Zn deficiency. Plasma Cu was increased in LCL and VL (p < 0.001) but not in ML, and was strongly correlated to anti-Leishmania IgG (Spearman r = 0.65, p = 0.0028). Cu/Zn ratios were highest in patients with deficient cellular (VL<LCL>ML) immune response. Ex vivo production of parasite-induced IFN-gamma was negatively correlated to plasma Cu levels in LCL (r = -0.57, p = 0.01). In vitro, increased Cu levels inhibited IFN-gamma production. CONCLUSIONS: 1. Zn deficiency in VL and ML indicate possible therapeutic administration of Zn in these severe forms of leishmaniasis. 2. Plasma Cu positively correlates to humoral immune response across patient groups. 3. Environmentally or genetically determined increases in Cu levels might augment susceptibility to infection with intracellular pathogens, by causing a decrease in IFN-gamma production.

Evaluation of IFN-gamma and TNF-alpha as immunological markers of clinical outcome in cutaneous leishmaniasis.

To evaluate if IFN-gamma and TNF-alpha levels could be used as markers of therapeutic response in cutaneous leishmaniasis, 54 patients with history of one ulcerated cutaneous lesion, with up to 30 days onset, were enrolled in the study. IFN-gamma and TNF-alpha were measured by ELISA in lymphocyte cultures supernatant before and 60 days after initiating therapy. Cure was considered to be a complete healing of lesion 60 days after treatment. IFN-gamma and TNF-alpha levels were similar in both groups of patients before therapy. There was a tendency to increase IFN-gamma levels in patients that were cured in 60 days, however the values did not reach statistical significance. In both groups of patients, TNF-alpha levels were similar before therapy and fell significantly after treatment, irrespective of cure or maintenance of active lesion.

The Prevalence of Metabolic Syndrome Among Soldiers of the Military Police of Bahia State, Brazil.

The mortality rate of men is generally higher than that of women, irrespective of the age group. Currently, a key concern for health care professionals is the prevalence of risk factors associated with cardiovascular disease and metabolic syndrome. This study aimed at assessing the prevalence of individual risk factors for cardiovascular disease as well as the prevalence of metabolic syndrome among men serving in the Military Police Corps of the state of Bahia, Brazil. This service employs mostly men, and they are known to experience high levels of occupational stress and professional victimization. We conducted a cross-sectional study among military police soldiers (n = 452) who were candidates for a military police training course in Bahia, Brazil. All candidates who attended the selection process were evaluated according to the criteria of the National Cholesterol Education Program's Adult Panel III in order to assess the presence of medical disorders that could contribute to cardiovascular disease and metabolic syndrome. The authors identified a high prevalence of hypertension (55.76%), hypertriglyceridemia (50.85%), waist circumference of >102 cm (31.76%), low high-density lipoprotein cholesterol levels (30.46%), and impaired fasting glucose (28.15%) in our subjects. The overall prevalence of metabolic syndrome was 38.54%. The authors suggest that measures should be taken to ensure that military policemen receive continued medical care, both in their professional capacity and in their personal circumstances, and that attention be focused on intervention programs.

Association between hepatitis C and hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the fifth most common cancer, the third most common cause for cancer death in the world, a major cause of death in patients with chronic hepatitis C virus infection, and responsible for approximately one million deaths each year. Overwhelming lines of epidemiological evidence have indicated that persistent infection with hepatitis C virus (HCV) is a major risk for the development of HCC. The incidence of HCC is expected to increase in the next two decades, largely due to hepatitis C infection and secondary cirrhosis, and detection of HCC at an early stage is critical for a favorable clinical outcome. Potential preventive strategies in the development of HCC are being recognized. The natural history of HCC is highly variable and the clinical management choices for HCC can be complex, hence patient assessment and treatment planning have to take the severity of the nonmalignant liver disease into account. This review summarizes the inter-relationship between HCV and liver carcinogenesis.

Predictors of adherence to treatment in patients with severe asthma treated at a referral center in Bahia, Brazil.

OBJECTIVE: To determine the rate of adherence to treatment with inhaled corticosteroids in patients with severe asthma, to identify predictive factors for adherence and to evaluate the relationship between adherence to treatment and parameters of clinical and functional response. METHODS: Prospective cohort study of patients enrolled in the Program for the Control of Asthma and Allergic Rhinitis in the state of Bahia, Brazil. The study comprised 160 patients with severe asthma, monitored for 180 days in order to evaluate adherence (dependent variable) to the prescribed inhaled corticosteroid. Independent variables were assessed at baseline and for a six-month follow-up period by means of interviews and the completion of a standardized questionnaire.Patients recorded the missed doses in a diary. RESULTS: Of the 160 patients. 158 completed the study. Adherence rate was 83.8%. Of the 158 patients, 112 (70.9%) were considered adherent (cut-off point: 80% of prescribed doses administered). There was a significant association between asthma control and adherence to treatment.Predictors of poor adherence were adverse effects, living far from the referral center, limited resources to pay for transportation and dose schedule. Other factors, such as depressive symptoms, religion and economic status, were not associated with poor adherence. CONCLUSIONS: Adherence to asthma treatment was high and was associated with the clinical response to treatment, in a sample of patients with severe asthma enrolled in a public program that provides free medication and the assistance of a multiprofessional specialized team in a referral center.

Exercise stress echocardiography in the identification of coronary artery disease in the elderly with chronotropic incompetence.

BACKGROUND: Chronotropic incompetence (CTI) is frequent in elderly patients and may limit the role of the exercise test in the identification of coronary artery disease (CAD) in this population. OBJECTIVE: To assess the value of CTI in an elderly population in the diagnosis of CAD. METHODS: A total of 3,308 patients were studied, 804 were elderly individuals (age > 65 years) who underwent exercise stress echocardiography (ESE). Based on the heart rate (HR) reached during the exercise test, were divided into two groups: G1 150 patients who did not reach 85% of the age-predicted HR, and G2 654 patients who did. The groups were compared to clinical characteristics, segmental left ventricular contractility rate (WMSI) and coronary angiography (CAG). RESULTS: Clinical characteristics were similar between the groups. WMSI was higher in G1 than in G2, both at rest (1.09 +/- 0.21 versus 1.04 +/- 0.15) and after exercise (1.15 +/- 0.29 versus 1.08 +/- 0.2) (p < 0.001). Abnormalities in wall contractility were more frequent in G1 than in G2 (55% versus 37%; p < 0.05), thus suggesting that elderly with CTI have a higher frequency of CAD. CAG was performed in 69% ESE positive for myocardial ischemia. In the G1 group, 91% of the ESE were true positive versus 84.5% in G2, that is, presence of obstructive coronary artery disease (> 50%). CONCLUSION: CTI is associated with a higher frequency of contractile alterations in the elderly population and adds a positive predictive value to ESE in the identification of patients with obstructive CAD.

Intrafamilial prevalence of hepatitis B virus in Western Brazilian Amazon region: epidemiologic and biomolecular study.

BACKGROUND: Hepatitis B is endemic in the Amazon region. METHODS: Serological markers for hepatitis B virus (HBV) were determined in 266 household members for hepatitis B surface antigen (HBsAg)-positive women (G1) and 395 household members for HBsAg-negative women (G2), randomly selected in Acre State Women's Medical Care Program, in order to evaluate the prevalence of HBV in this population. Before blood sample collection an epidemiological questionnaire was applied. RESULTS: The overall prevalence of HBV carriers (HBsAg) and exposed individuals (anti-HBc, IgG) was, respectively, 21.1% and 60.5% in G1 and 2.8% and 27.4% in G2 (P < 0.0000001). The frequency of HBsAg was higher among siblings from group G1 (75%) compared to the absence of any HBsAg-positive sibling in G2 (P < 0.00006). The HBV markers in other family members was as follows: G1 parents, 27.3% vs 4.5% (P < 0.03), sexual partners, 21.1% vs 2.5% (P < 0.04), and offspring, 10.4% vs 1.5% (P < 0.04). A low prevalence of HBsAg and anti-HBc (IgG) was observed for the last offspring of G2 mothers compared to the high prevalence among children of G1 mothers (0% vs 18.2%, P < 0.01 and 2.3% vs 59.1%, P < 0.0000005, respectively), with children younger than 1 year being the most affected. The frequency of the habit of sharing toothbrushes and the presence of at least one HBsAg carrier were higher in G1 than in G2 (P < 0.0001 and P < 0.000002), respectively. Genotypes A, D and G were found to be predominant by Innolipa test. There were cases that reacted to more than one genotype. CONCLUSION: Intrafamilial transmission of HBV is evident in the present study and is possibly associated with the presence of more than one HBV carrier in the family and the shared use of toothbrushes among household contacts. Genotype analysis confirms intrafamilial transmission.