Accuracy of prognostic serological biomarkers in predicting liver fibrosis severity in people with metabolic dysfunction-associated steatotic liver disease: a meta-analysis of over 40,000 participants.

Introduction: A prognostic model to predict liver severity in people with metabolic dysfunction-associated steatotic liver disease (MASLD) is very important, but the accuracy of the most commonly used tools is not yet well established. Objective: The meta-analysis aimed to assess the accuracy of different prognostic serological biomarkers in predicting liver fibrosis severity in people with MASLD. Methods: Adults ≥18 years of age with MASLD were included, with the following: liver biopsy and aspartate aminotransferase-to-platelet ratio (APRI), fibrosis index-4 (FIB-4), non-alcoholic fatty liver disease fibrosis score (NFS), body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes score (BARD score), FibroMeter, FibroTest, enhanced liver fibrosis (ELF), Forns score, and Hepascore. Meta-analyses were performed using a random effects model based on the DerSimonian and Laird methods. The study's risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Results: In total, 138 articles were included, of which 86 studies with 46,514 participants met the criteria for the meta-analysis. The results for the summary area under the receiver operating characteristic (sAUROC) curve, according to the prognostic models, were as follows: APRI: advanced fibrosis (AF): 0.78, any fibrosis (AnF): 0.76, significant fibrosis (SF): 0.76, cirrhosis: 0.72; FIB-4: cirrhosis: 0.83, AF: 0.81, AnF: 0.77, SF: 0.75; NFS: SF: 0.81, AF: 0.81, AnF: 0.71, cirrhosis: 0.69; BARD score: SF: 0.77, AF: 0.73; FibroMeter: SF: 0.88, AF: 0.84; FibroTest: SF: 0.86, AF: 0.78; and ELF: AF: 0.87. Conclusion: The results of this meta-analysis suggest that, when comparing the scores of serological biomarkers with liver biopsies, the following models showed better diagnostic accuracy in predicting liver fibrosis severity in people with MASLD: FIB-4 for any fibrosis, FibroMeter for significant fibrosis, ELF for advanced fibrosis, and FIB-4 for cirrhosis.Clinical trial registration: [https://clinicaltrials.gov/], identifier [CRD 42020180525].

Reliability of telemedicine evaluation for EDSS functional systems in multiple sclerosis.

Introduction: There was an increase in telemedicine during the COVID-19 pandemic to follow patients with multiple sclerosis (MS). However, there is scarce data if online evaluations can cover important information assessed during in-clinic appointments, especially the Expanded Disability Status Score (EDSS). This study aims to develop a remote evaluation tool for EDSS functional systems and compare the performance with face-to-face evaluations. Methods: This was a single-center study that included all MS patients followed up at outpatient clinics of Hospital São Lucas Pontifícia Universidade Católica do Rio Grande do Sul, between April and August 2022. Initially, patients were routinely in-clinic evaluated by one trained neurologist for EDSS. After, patients were evaluated remotely without any information about the in-clinic EDSS results. We used a standardized interview with an interactive video platform to evaluate EDSS functional systems by telemedicine. Results: Forty-nine participants completed the two steps. Intra-class coefficient was 0.97 (95% CI: 0.95-0.98), concordance for EDSS below 4.0 was 0.87 (95% CI: 0.77-0.93) and ≥4.0 was 0.97 (95% CI: 0.89-0.99). There was perfect agreement in the final EDSS in 71.4% of the online and in-clinic evaluations. In the multivariate analysis, the visual (beta = 0.453; p = 0.003) and pyramidal (beta = 0.403; p = 0.009) systems contributed significantly to the difference in the final EDSS. Conclusion: The telemedicine tool created in this study can detect changes in functional systems with reliable results compared to in-clinic EDSS assessment. Telemedicine evaluations may reduce the number of in-clinic visits and the disease burden for patients with MS.

Correction: Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant.

[This corrects the article on p. 688 in vol. 13, PMID: 36160465.].

Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant.

BACKGROUND: Cholangiocarcinoma (CC) is a rare tumor that arises from the epithelium of the bile ducts. It is classified according to anatomic location as intrahepatic, perihilar, and distal. Intrahepatic CC (ICC) is rare in patients with cirrhosis due to causes other than primary sclerosing cholangitis. Mixed hepatocellular carcinoma-CC (HCC-CC) is a rare neoplasm that shows histologic findings of both HCC and ICC within the same tumor mass. Due to the difficulties in arriving at the correct diagnosis, patients eventually undergo liver transplantation (LT) with a presumptive diagnosis of HCC on imaging when, in fact, they have ICC or HCC-CC. AIM: To evaluate the outcomes of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma on pathological examination after liver transplant. METHODS: Propensity score matching was used to analyze tumor recurrence (TR), overall mortality (OM), and recurrence-free survival (RFS) in LT recipients with pathologically confirmed ICC or HCC-CC matched 1:8 to those with HCC. Progression-free survival and overall mortality rates were computed with the Kaplan-Meier method using Cox regression for comparison. RESULTS: Of 475 HCC LT recipients, 1.7% had the diagnosis of ICC and 1.5% of HCC-CC on pathological examination of the explant. LT recipients with ICC had higher TR (46% vs 11%; P = 0.006), higher OM (63% vs 23%; P = 0.002), and lower RFS (38% vs 89%; P = 0.002) than those with HCC when matched for pretransplant tumor characteristics, as well as higher TR (46% vs 23%; P = 0.083), higher OM (63% vs 35%; P = 0.026), and lower RFS (38% vs 59%; P = 0.037) when matched for posttransplant tumor characteristics. Two pairings were performed to compare the outcomes of LT recipients with HCC-CC vs HCC. There was no significant difference between the outcomes in either pairing. CONCLUSION: Patients with ICC had worse outcomes than patients undergoing LT for HCC. The outcomes of patients with HCC-CC did not differ significantly from those of patients with HCC.

Randomization of endovascular treatment with stent-retriever and/or thromboaspiration versus best medical therapy in acute ischemic stroke due to large vessel occlusion trial: Rationale and design.

BACKGROUND: RESILIENT is a prospective, multicenter, randomized phase III trial to test the safety, efficacy, and cost-effectiveness of mechanical thrombectomy as compared to medical treatment alone in patients treated under the less than ideal conditions typically found in the public healthcare system of a developing country. METHODS: Subjects must fulfill the following main inclusion criteria: symptom onset ≤8 h, age ≥18 years, baseline NIHSS ≥8, evidence of intracranial ICA or proximal MCA (M1 segment) occlusion, ASPECTS ≥6 on CT or >5 on DWI-MRI and be either ineligible for or unresponsive to intravenous alteplase. The primary end-point is the distribution of disability levels (on the modified Rankin Scale, mRS) at 90 days under the intention-to-treat principle. RANDOMIZATION: Randomization is performed under a minimization process using age, baseline NIHSS, intravenous alteplase use, occlusion site and center. DESIGN: The trial is designed with an expectation of a 10% difference in the proportion of favorable outcome (mRS 0-2 at 90 days) common odds ratio of 1.615. PRIMARY OUTCOME: Projected sample size is 690 subjects with pre-planned interim analyses at 174, 346, and 518 subjects. SECONDARY OUTCOMES: Secondary end-points include: 90-day functional independence (mRS ≤2), mRS shift stratified for treatment with IV rt-PA at 90 days, infarct volume on 24 h CT or MRI, early dramatic response (NIHSS 0-2 or improvement ≥8 points) at 24 h, vessel recanalization evaluated by CTA or MRA at 24 h, and the post-procedure rate of successful reperfusion (defined as a modified Treatment in Cerebral Infarction 2b or greater). Safety variables are mortality at 90 days, symptomatic intracranial hemorrhage at 24 h and procedure-related complications.

Thrombectomy for Stroke in the Public Health Care System of Brazil.

BACKGROUND: Randomized trials involving patients with stroke have established that outcomes are improved with the use of thrombectomy for large-vessel occlusion. These trials were performed in high-resource countries and have had limited effects on medical practice in low- and middle-income countries. METHODS: We studied the safety and efficacy of thrombectomy in the public health system of Brazil. In 12 public hospitals, patients with a proximal intracranial occlusion in the anterior circulation that could be treated within 8 hours after the onset of stroke symptoms were randomly assigned in a 1:1 ratio to receive standard care plus mechanical thrombectomy (thrombectomy group) or standard care alone (control group). The primary outcome was the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. RESULTS: A total of 300 patients were enrolled, including 79 who had undergone thrombectomy during an open-label roll-in period. Approximately 70% in the two groups received intravenous alteplase. The trial was stopped early because of efficacy when 221 of a planned 690 patients had undergone randomization (111 to the thrombectomy group and 110 to the control group). The common odds ratio for a better distribution of scores on the modified Rankin scale at 90 days was 2.28 (95% confidence interval [CI], 1.41 to 3.69; P = 0.001), favoring thrombectomy. The percentage of patients with a score on the modified Rankin scale of 0 to 2, signifying an absence of or minor neurologic deficit, was 35.1% in the thrombectomy group and 20.0% in the control group (difference, 15.1 percentage points; 95% CI, 2.6 to 27.6). Asymptomatic intracranial hemorrhage occurred in 51.4% of the patients in the thrombectomy group and 24.5% of those in the control group; symptomatic intracranial hemorrhage occurred in 4.5% of the patients in each group. CONCLUSIONS: In this randomized trial conducted in the public health care system of Brazil, endovascular treatment within 8 hours after the onset of stroke symptoms in conjunction with standard care resulted in better functional outcomes at 90 days than standard care alone. (Funded by the Brazilian Ministry of Health; RESILIENT ClinicalTrials.gov number, NCT02216643.).

PD-L1 and p16 Expression in Penile Squamous Cell Carcinoma From an Endemic Region.

BACKGROUND: Penile squamous cell carcinoma (PSCC) is a rare malignancy with higher incidence in developing countries. Treatment options include surgery, radiation therapy, and systemic chemotherapy. However, effective treatments for advanced disease are lacking. To understand the biology underlying PSCC may help the development of new therapeutic strategies. The objective of this study was to evaluate immunohistochemical expression of programmed death-ligand 1 (PD-L1) and p16 in PSCC and its association with clinicopathologic features and outcomes. PATIENTS AND METHODS: A cohort of 40 patients with PSCC from an academic institution in Brazil was analyzed. Clinicopathologic features and outcomes were retrospectively collected. PD-L1 and p16 immunohistochemical expression were performed in formalin-fixed paraffin-embedded specimens. PD-L1 was positive with any staining in more than 1% of tumor, and p16 was positive in more than 10%. Associations were performed using the Mann-Whitney and Fisher exact test. Kaplan-Meier curves were used to estimate survival rates with log-rank. RESULTS: Of 35 patients, 5 were excluded, 4 owing to a lack of data and 1 owing to no tumor available; 18 (51.4%) patients were PD-L1-positive (PD-L1+). PD-L1+ was associated with larger tumors (P = .027). There was an association between PD-L1+ and p16 expression (P = .002). PD-L1+ was more frequent in grade II and III disease than grade I (77.8% vs. 22.2%) and was expressed in all patients with grade III disease. Lymph node involvement was associated with PD-L1 expression (69.2% PD-L1+ vs. 30.8% PD-L1-negative). The 5-year mortality was 37.1%. CONCLUSION: PD-L1 expression appears to be associated with p16 expression, larger tumors, and worse clinical outcomes in PSCC and may provide clinical data for new studies to evaluate anti-PD-L1 immune therapies.

Design, randomization and methodology of the TriAtiva Program to reduce obesity in school children in Southern Brazil.

BACKGROUND: The prevalence of child obesity in Brazil has increased rapidly in recent decades. There is, therefore, an urgent need to develop effective strategies to prevent and control child obesity. In light of these considerations, an intervention program with a focus on nutrition education and physical activity was developed for to prevent and control obesity in schools. The intervention was called the TriAtiva Program: Education, Nutrition and Physical Activity. This article describes the design, randomization and method used to evaluate the TriAtiva program. METHODS/DESIGN: This randomized controlled cluster trial was performed in 12 municipal schools in the city of Porto Alegre/RS (six schools in the intervention group and six control schools) which offered first- through fourth grade, during one school year. The TriAtiva Program was implemented through educational activities related to healthy eating and physical activity, creating an environment which promoted student health while involving the school community and student families. The primary outcome of the present study was body mass, while its secondary outcomes were waist circumference, percent body fat, blood pressure and behavioural variables such as eating habits and physical activity levels, as well as the prevalence, incidence and remission rates of obesity. DISCUSSION: The intervention was developed based on a comprehensive review of controlled trials of similar design. The TriAtiva Program: Education, Nutrition and Physical Activity was the first study in Southern Brazil to use a randomized controlled design to evaluate an intervention involving both nutrition education and physical activity in schools. Our results will contribute to the development of future interventions aimed at preventing and controlling child obesity in schools, especially in Brazil. Brazilian Clinical Trials Registry (REBEC) number RBR2xx2z4.

Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy.

This study aimed to investigate the electromyographic activity of cervical and trunk extensors muscles in children with cerebral palsy during two handlings according to the Bobath concept. A crossover trial involving 40 spastic diplegic children was conducted. Electromyography (EMG) was used to measure muscular activity at sitting position (SP), during shoulder internal rotation (IR) and shoulder external rotation (ER) handlings, which were performed using the elbow joint as key point of control. Muscle recordings were performed at the fourth cervical (C4) and at the tenth thoracic (T10) vertebral levels. The Gross Motor Function Classification System (GMFCS) was used to assess whether muscle activity would vary according to different levels of severity. Humeral ER handling induced an increase on EMG signal of trunk extensor muscles at the C4 (P=0.007) and T10 (P<0.001) vertebral levels. No significant effects were observed between SP and humeral IR handling at C4 level; However at T10 region, humeral IR handling induced an increase of EMG signal (P=0.019). Humeral ER resulted in an increase of EMG signal at both levels, suggesting increase of extensor muscle activation. Furthermore, the humeral ER handling caused different responses on EMG signal at T10 vertebra level, according to the GMFCS classification (P=0.017). In summary, an increase of EMG signal was observed during ER handling in both evaluated levels, suggesting an increase of muscle activation. These results indicate that humeral ER handling can be used for diplegic CP children rehabilitation to facilitate cervical and trunk extensor muscles activity in a GMFCS level-dependent manner.

Role of gender in the survival of surgical patients with nonsmall cell lung cancer.

PURPOSE: There are reports of greater survival rates in nonsmall cell lung cancer (NSCLC) patients of female gender. The objective of this study was to evaluate the role of gender in survival of NSCLC patients treated surgically with curative intent (stage I/II). METHODS: In a retrospective cohort design, we screened 498 NSCLC patients submitted to thoracotomies at the hospital Sγo Lucas, in Porto Alegre, Brazil from 1990 to 2009. After exclusion of patients that did not fit to all the inclusion criteria, we analyzed survival rates of 385 subjects. Survival was analyzed using the Kaplan-Meier method. The Cox regression model was used to evaluate potential confounding factors. RESULTS: Survival rates at 5 and 10 years were 65.3% and 49.5% for women and 46.5% and 33.2% for men, respectively (P = 0.006). Considering only stage I patients, the survival rates at 5 and 10 years were 76.2% and 55.1% for women and 50.7% and 35.4% for men, respectively (P = 0.011). No significant differences in survival rates were found among stage II patients. CONCLUSIONS: Our results show female gender as a possible protective factor for better survival of stage I NSCLC patients, but not among stage II patients. This study adds data to the knowledge that combined both genders survival rates for NSCLC is not an adequate prognosis.

Translation and validation of Autism Diagnostic Interview-Revised (ADI-R) for autism diagnosis in Brazil.

OBJECTIVE: To translate into Brazilian Portuguese the Autism Diagnostic Interview-Revised (ADI-R), an extremely useful diagnostic tool in autism. METHODS: A case-control study was done to validate the ADI-R. After being translated, the interview was applied in a sample of 20 patients with autism and 20 patients with intellectual disability without autism, in order to obtain the initial psychometric properties. RESULTS: The internal consistency was high, with a of Crombach of 0.967. The validity of criterion had sensitivity and specificity of 100%, having as a gold standard the DSM-IV diagnostic criteria. The interview had high discriminant validity, with higher scores in the group of patients with autism, as well as high interobserver consistency, with median kappa of 0.824. CONCLUSION: The final version of ADI-R had satisfactory psychometric characteristics, indicating good preliminary validation properties. The instrument needs to be applied in bigger samples in other areas of the country.

Translation and validation of Autism Diagnostic Interview-Revised (ADI-R) for autism diagnosis in Brazil / Tradução e validação da ADI-R (Autism Diagnostic Interview-Revised) para diagnóstico de autismo no Brasil

OBJECTIVE: To translate into Brazilian Portuguese the Autism Diagnostic Interview-Revised (ADI-R), an extremely useful diagnostic tool in autism. METHODS: A case-control study was done to validate the ADI-R. After being translated, the interview was applied in a sample of 20 patients with autism and 20 patients with intellectual disability without autism, in order to obtain the initial psychometric properties. RESULTS: The internal consistency was high, with a of Crombach of 0.967. The validity of criterion had sensitivity and specificity of 100 percent, having as a gold standard the DSM-IV diagnostic criteria. The interview had high discriminant validity, with higher scores in the group of patients with autism, as well as high interobserver consistency, with median kappa of 0.824. CONCLUSION: The final version of ADI-R had satisfactory psychometric characteristics, indicating good preliminary validation properties. The instrument needs to be applied in bigger samples in other areas of the country.

OBJETIVO: Traduzir para o português do Brasil a ADI-R (Autism Diagnostic Interview-Revised), uma ferramenta diagnóstica extremamente útil em casos de autismo. MÉTODOS: Foi realizado um estudo caso-controle para validar a ADI-R. A fim de se obter as propriedades psicométricas iniciais da entrevista, após a tradução, a ADI-R foi aplicada em uma amostra de 20 pacientes com autismo e 20 controles com retardo mental sem autismo. RESULTADOS: A consistência interna foi alta, com um a de Crombach de 0,976. A validade de critério mostrou uma sensibilidade e uma especificidade de 100 por cento, tendo os critérios diagnósticos do DSM-IV como padrão ouro. A entrevista teve uma alta validade discriminante, com maiores escores no grupo de pacientes com autismo, bem como uma alta consistência entre observadores, com um Kappa médio de 0,824. CONCLUSÃO: A versão final da ADI-R teve características psicométricas satisfatórias, indicando boas propriedades preliminares de validação. O instrumento necessita ser aplicado em amostras maiores em outras áreas do país.

Prevalence and acquisition of MRSA amongst patients admitted to a tertiary-care hospital in Brazil.

BACKGROUND: There are few studies in Brazil that address baseline prevalence of MRSA colonization and associated risk factors at hospital admission, or the incidence of nosocomial colonization. We report a prospective study in a tertiary-care, university-affiliated hospital to implement a new MRSA control policy at the institution. METHODS: A cohort of randomly selected patients admitted to emergency and clinical wards at our hospital was followed until discharge. Nasal swabs were taken for identification of MRSA-colonized patients and detection of SCCmecA in positive cultures, at admission and weekly thereafter. Multivariate analysis using a log-binomial analysis was used to identify risk factors for colonization. RESULTS: After screening 297 adult patients and 176 pediatric patients, the prevalence of MRSA at admission was 6.1% (95%CI, 3.6% to 9.4%), in the adult population and 2.3% (95%CI, 0.6% to 5.7%), for children. From multivariate analysis, the risk factors associated with colonization in adults were: age above 60 years (P = 0.019) and hospitalization in the previous year (P = 0.022). Incidence analysis was performed in 276 MRSA-negative patients (175 adults and 101 children). Acquisition rate was 5.5/1,000 patient-days for adults (95%CI, 3.4 to 8.5/1,000 patients-days), and 1.1/1,000 patient-days for children (95%CI, 0.1 to 4.0/1,000 patients-days). CONCLUSIONS: The identification of MRSA carriers is a step towards establishing a control policy for MRSA, and helps to identify measures needed to reduce colonization pressure and to decrease the high acquisition rate in hospitalized patients.

Prevalence of acute toxoplasmosis infection among 41,112 pregnant women and the mother-to-child transmission rate in a public hospital in South Brazil.

Untreated acute toxoplasmosis among pregnant women can lead to serious sequelae among newborns, including neurological impairment and blindness. In Brazil, the risk of congenital toxoplasmosis (CTox) has not been fully evaluated. Our aim was to evaluate trends in acute toxoplasmosis prevalence from 1998-2005, the incidence of CTox and the rate of mother-to-child transmission (MTCT). A cross-sectional study was undertaken to dentify patients who fit the criteria for acute toxoplasmosis during pregnancy. Exposed newborns were included in a historical cohort, with a median follow-up time of 11 months, to establish definite diagnosis of CTox. Diagnoses for acute infection in pregnancy and CTox were based on European Research Network on Congenital Toxoplasmosis criteria. In 41,112 pregnant women, the prevalence of acute toxoplasmosis was 4.8/1,000 women. The birth prevalence of CTox was 0.6/1,000 newborns [95% confidence interval (CI): 0.4-0.9]. During the follow-up study, 12 additional cases were detected, increasing the CTox rate to 0.9/1,000 newborns (95% CI: 0.6-1.3). Among the 200 newborns exposed to Toxoplasma gondii,there were 37 babies presenting diagnostic criteria of CTox, leading to an MTCT rate of 18.5% (95% CI: 13.4-24.6%). The additional cases identified during follow-up reinforce the need for serological monitoring during the first year of life, even in the absence of evidence of congenital infection at birth.

Prevalence of acute toxoplasmosis infection among 41112 pregnant women and the mother-to-child transmission rate in a public hospital in South Brazil

Untreated acute toxoplasmosis among pregnant women can lead to serious sequelae among newborns, including neurological impairment and blindness. In Brazil, the risk of congenital toxoplasmosis (CTox) has not been fully evaluated. Our aim was to evaluate trends in acute toxoplasmosis prevalence from 1998-2005, the incidence of CTox and the rate of mother-to-child transmission (MTCT). A cross-sectional study was undertaken to dentify patients who fit the criteria for acute toxoplasmosis during pregnancy. Exposed newborns were included in a historical cohort, with a median follow-up time of 11 months, to establish definite diagnosis of CTox. Diagnoses for acute infection in pregnancy and CTox were based on European Research Network on Congenital Toxoplasmosis criteria. In 41,112 pregnant women, the prevalence of acute toxoplasmosis was 4.8/1,000 women. The birth prevalence of CTox was 0.6/1,000 newborns [95 percent confidence interval (CI): 0.4-0.9]. During the follow-up study, 12 additional cases were detected, increasing the CTox rate to 0.9/1,000 newborns (95 percent CI: 0.6-1.3). Among the 200 newborns exposed to Toxoplasma gondii,there were 37 babies presenting diagnostic criteria of CTox, leading to an MTCT rate of 18.5 percent (95 percent CI: 13.4-24.6 percent). The additional cases identified during follow-up reinforce the need for serological monitoring during the first year of life, even in the absence of evidence of congenital infection at birth.

Autismo infantil: tradução e validação da Childhood Autism Rating Scale para uso no Brasil / Childhood autism: translation and validation of the Childhood Autism Rating Scale for use in Brazil

OBJETIVO: Traduzir, adaptar e validar uma versão em português (do Brasil) da Childhood Autism Rating Scale (CARS). MÉTODOS: Após processo de tradução, a versão foi aplicada em 60 pacientes com diagnóstico de autismo infantil, de 3 a 17 anos de idade, selecionados consecutivamente de um ambulatório especializado a fim de analisar as propriedades psicométricas da nova versão (CARS-BR) (consistência interna, validade e confiabilidade). RESULTADOS: A consistência interna foi elevada, com valor de alfa de Cronbach de 0,82; a validade convergente (comparada com a Escala de Avaliação de Traços Autístícos) alcançou um coeficiente de correlação de Pearson de r = 0,89. Ao ser correlacionada à Escala de Avaliação Global de Funcionamento (para determinação da validade discriminante), a CARS-BR apresentou um coeficiente de correlação de Pearson de r = -0,75. A confiabilidade teste-reteste foi 0,90. CONCLUSÃO: A metodologia utilizada e os cuidados no processo de tradução permitem concluir que esse é um instrumento válido e confiável para avaliação da gravidade do autismo no Brasil.

OBJECTIVE: To translate the Childhood Autism Rating Scale into Brazilian Portuguese and to determine the initial psychometric properties of the resulting version (CARS-BR). METHODS: The methodology used to produce an adequate version included translation, backtranslation and evaluation of semantic equivalence. In order to determine its psychometric properties (internal consistency, validity and reliability), the CARS-BR was administered to 60 consecutive patients with autism, aged between 3 and 17 years and seen at a university hospital. RESULTS: Internal consistency was high, with a Cronbach's alpha of 0.82. Convergent validity, in comparison with the Autistic Traits Assessment Scale, exhibited a Pearson's correlation coefficient of r = 0.89. When correlated with the Global Assessment of Functioning Scale in order to evaluate discriminant validity, the CARS-BR exhibited a Pearson's coefficient of r = -0.75. Test-retest reliability exhibited a kappa coefficient of 0.90. CONCLUSION: These results suggest that the CARS-BR is a valid and reliable instrument for evaluating autism severity in Brazil.

Childhood autism: translation and validation of the Childhood Autism Rating Scale for use in Brazil.

OBJECTIVE: To translate the Childhood Autism Rating Scale into Brazilian Portuguese and to determine the initial psychometric properties of the resulting version (CARS-BR). METHODS: The methodology used to produce an adequate version included translation, backtranslation and evaluation of semantic equivalence. In order to determine its psychometric properties (internal consistency, validity and reliability), the CARS-BR was administered to 60 consecutive patients with autism, aged between 3 and 17 years and seen at a university hospital. RESULTS: Internal consistency was high, with a Cronbach's alpha of 0.82. Convergent validity, in comparison with the Autistic Traits Assessment Scale, exhibited a Pearson's correlation coefficient of r = 0.89. When correlated with the Global Assessment of Functioning Scale in order to evaluate discriminant validity, the CARS-BR exhibited a Pearson's coefficient of r = -0.75. Test-retest reliability exhibited a kappa coefficient of 0.90. CONCLUSION: These results suggest that the CARS-BR is a valid and reliable instrument for evaluating autism severity in Brazil.

Cross-validation of the Children's and Infants' Postoperative Pain Scale in Brazilian Children.

OBJECTIVE: To validate CHIPPS (Children's and Infants' Postoperative Pain Scale) in Brazilian children. BACKGROUND: Cross-validation is needed in order to apply this scale in a different language and culture. METHODS: We applied a Portuguese version of CHIPPS to 100 children aged 0 to 5 years. The scale was translated and tested for inter-rater reliability, internal consistency, and construct, content, and concurrent validity. The children's behavior was videotaped before, during and after a procedure in a primary care unit. Three observers then rated pain behavior from videotapes. RESULTS: The scale showed excellent inter-rater reliability (intraclass correlation coefficient: 0.89) and a very good internal consistency, with Cronbach's alpha of 0.86. The positive correlation between CHIPPS and Modified Behavior Pain Scale supports concurrent (criterion) validity (Spearman coefficient 0.70 before and 0.81 after vaccinations). Construct validity was determined by comparing the scores of each child before vaccination (without pain) and during the procedure (experiencing pain), and the difference in pain scores was statistically significant (Wilcoxon signed rank test; P < 0.001). Content validity (by expert review) was very good. CONCLUSIONS: Based on the results obtained, we can infer that CHIPPS is a valid and reliable tool for Brazilian children aged 0 to 5 years old.

Estudo do efeito do creme de lidocaína eprilocaína na saturação transcutânea de oxigênio como parâmetro para avaliação da dor em recém-nascidos / Study on the effect of lidocaine-prilocainecream on hemoglobin saturation as anindex of pain in newborns

Objetivo: Avaliar o efeito do EMLA sobre a saturação transcutânea da hemoglobinacomo parâmetro para avaliação indireta da dor de punções periféricas para coleta sangüíneaem recém-nascidos.Metodologia: Conduziu-se ensaio clínico randomizado com 20 recém-nascidos, a termo,entre 24 e 72 horas de vida, submetidos à primeira coleta sangüínea. Em oito utilizou-se oEMLA e em 12, um placebo. Sessenta minutos após a aplicação do anestésico, procedeu-se àcoleta sangüínea por punção venosa periférica; 120 minutos após a aplicação, foi realizadauma segunda coleta. Em cada uma verificou-se, imediatamente antes e logo após, a saturaçãoda hemoglobina, e secundariamente, outros marcadores de dor, que incluíram: freqüência cardíaca,cortisol e insulina. Na primeira coleta, dosou-se metemoglobina.Resultados: Na primeira coleta os grupos EMLA e placebo apresentaram reduçõespercentuais na saturação da hemoglobina de 1,86% (p = 0,0277) e 2,01% (p = 0,0844),respectivamente. Na segunda coleta, somente o grupo placebo apresentou uma diminuiçãoestatisticamente significativa de 3,51% (p = 0,0129). Houve, na segunda coleta, decréscimo(p = 0,0069) na freqüência cardíaca no grupo placebo. Não houve diferençassignificativas nos níveis hormonais entre as coletas. Não houve diferença nos níveis demetemoglobina.Conclusões: Conclui-se que o recém-nascido responde à dor da punção venosa comalterações na saturação da hemoglobina e na freqüência cardíaca. Essas respostas podem,em princípio, ser diminuídas com aplicação preventiva do EMLA. Os resultados destetrabalho foram derivados de um estudo com grupo pequeno, sugerindo-se, portanto, estudosmais aprofundados.

Objectives: To study the effect of EMLA on transcutaneos hemoglobin saturation usedas an indirect marker of pain secondary to venipuncture in newborns.Methodology: A randomized clinical assay was made with 20 term newborns, within24 and 72 hours of life, which were subjected to the first blood collection. In eight EMLAwas used and in 12, placebo. Sixty minutes after the anesthetic was applied, blood wascollected, and a second collection was made120 minutes after the cream application. Ineach of these moments, hemoglobin saturation was measured, before and after the puncture,as well other markers of pain: heart rate, cortisol and insulin. In the first collection,methemoglobin was analysed.Results: In the first collection, both the EMLA group and placebo group showed reductionsin hemoglobin saturation, of 1.86% (p = 0,0277) and 2.01% (p = 0,0844), respectively.In the second collection, only the placebo group showed a statiscally significantdecrease (3.51%, p = 0,0129). In the second collection, there was a decrease in heartrate (p = 0,0069) in the placebo group. No significant differences were found between thehormonal levels. And no differences in the methemoglobin levels were found.Conclusions: It was concluded that the newborn reacts to pain of venipuncutre withchanges in hemoglobin saturation and in heart rate. These responses can be alleviatedwith a preventive dosage of EMLA. Definitive conclusions are to be waited, since thestudy group is small, and additional researches are welcome.

Adesão ao tratamento de manutenção em asma (estudo ADERE) / Compliance with maintenance treatment of asthma (ADERE study)

OBJETIVO: Avaliar a adesão ao tratamento preventivo de asma persistente moderada e grave. MÉTODOS: Médicos de vários Estados do país foram contactados para selecionar asmáticos persistentes moderados ou graves, maiores de doze anos. Os pacientes receberam salmeterol/fluticasona 50/250 µg diskus durante 90 dias (sendo orientados a retornarem as embalagens ao final do estudo para conferência da dosagem total utilizada). Receberam telefonemas da equipe do estudo no início e ao final de 90 dias para que fosse avaliada a adesão. Foi considerado como aderente ao tratamento o asmático que utilizou no mínimo 85 por cento das doses prescritas. As variáveis estudadas foram sexo, idade, cor, estado civil, escolaridade, tabagismo atual, outras atopias, co-morbidades, gravidade da asma, uso de outras medicações e número de hospitalizações por asma. RESULTADOS: Foram incluídos 131 pacientes oriundos de quinze estados, com taxa geral de adesão de 51,9 por cento. Houve diferença significativa na adesão quanto à gravidade da asma (maior adesão nos casos graves; p = 0,02). Não houve diferença estatisticamente significativa nas demais variáveis. CONCLUSÃO: A taxa geral de adesão ao tratamento de manutenção da asma foi baixa.

OBJECTIVE: To determine the rate of compliance with preventive treatment of moderate and severe persistent asthma. METHODS: Physicians at various medical centers across the country were invited to nominate patients for participation in the study. Inclusion criteria were being over the age of 12 and presenting moderate or severe persistent asthma. Participating patients received salmeterol/fluticasone 50/250 µg by dry powder inhaler for 90 days and were instructed to return the empty packages at the end of the study as a means of determining the total quantity used. In order to evaluate compliance, a member of the research team contacted each patient via telephone at the study outset and again at the end of the 90-day study period. Asthma patients were considered compliant with the treatment if they used at least 85 percent of the prescribed dose. The following variables were studied: gender, age, race, marital status, years of schooling, smoking habits, other atopic conditions, comorbidities, asthma severity, use of other medication and number of hospital admissions for asthma. RESULTS: A total of 131 patients from fifteen states were included. The overall rate of compliance was found to be 51.9 percent. There was a significant difference in compliance in relation to asthma severity: compliance was greater among patients with severe persistent asthma than among those with moderate persistent asthma (p = 0.02). There were no statistically significant differences among any of the other variables. CONCLUSION: The overall rate of compliance with maintenance treatment of asthma was low.