Generalized Lymphadenopathy as the First Manifestation of Systemic Lupus Erythematosus.

Lymphadenopathy (LAP) is a common but nonspecific feature of many diseases, representing a vast spectrum of etiologies such as infectious or inflammatory diseases, malignancies, and drugs. In systemic lupus erythematosus (SLE), it can be the first manifestation. We present the case of a 20-year-old female with a history of fever, night sweats, anorexia, and asthenia for five months. She also had diffuse generalized LAP. Although malignant etiologies were our major concern, an extensive workup for malignancy and infections was unrevealing. However, an autoimmune workup led to the diagnosis of SLE. This case shows that SLE can present as generalized LAP with constitutional symptoms, and hence it should be considered in the differential diagnosis.

Endoscopic and Histopathological Findings of the Esophagus, Stomach, and Duodenum in Patients with Crohn's Disease from a Reference Center in Bahia, Brazil.

(1) The aim of the present study was to describe the endoscopic and histopathological findings in the esophagus, stomach, and duodenum in patients with Crohn's disease. (2) Methods: This was a cross-sectional study that included patients receiving treatment from the inflammatory bowel disease outpatient clinic. Esophagogastroduodenoscopies with biopsies of the stomach and proximal duodenum were performed. Presence of Helicobacter pylori bacteria was assessed by Giemsa staining. (3) Results: We included 58 patients. Erosive esophagitis was identified in 25 patients (43.1%), gastritis was diagnosed in 32 patients (55.2%) and erosive duodenitis was found in eight (13.8%). The most frequent histopathological finding in the H. pylori-positive group was increased inflammatory activity in the gastric body and antrum, with a predominance of mononuclear and polymorphonuclear cells. In turn, the most frequent finding in the H. pylori-negative group was chronic inflammation with predominance of mononuclear cells. Focally enhanced gastritis was identified in four patients (6.9%), all of whom were negative for H. pylori. Granulomas were not observed. H. pylori infection was present in 19 patients (32.8%). (4) Conclusions: Nonspecific endoscopic and histological findings were frequent in patients with Crohn's disease. Focally enhanced gastritis was uncommon and observed only in H. pylori-negative patients. The time from the diagnosis, patient age, and therapy in use may have influenced the nondetection of epithelioid granuloma.

Body Composition Influences Post-Operative Complications and 90-Day and Overall Survival in Pancreatic Surgery Patients.

INTRODUCTION: Pancreatic surgery still carries a high morbidity and mortality even in specialized centers. The aim of this study was to evaluate the influence of patients' body composition on postoperative complications and survival after pancreatic surgery. METHODS: This was a retrospective study on patients undergoing pancreatic surgery between March 2012 and December 2017. Demographics, clinical data, and postoperative complications classified according to Clavien-Dindo were recorded. Body composition was assessed using routine diagnostic or staging computed tomography (CT). Multiple Cox proportional hazards models were adjusted. RESULTS: Ninety patients were included, 55% were male, and the mean age was 68 ± 10.9 years. Of these 90, 92% had a total pancreatectomy or pancreaticoduodenectomy, 7% a distal pancreatectomy, and 1% a pancreaticoduodenectomy with multi-visceral resection; 84% had malignant disease. The incidence of major complications was 27.8% and the 90-day mortality was 8.8%. The ratio of visceral fat area/skeletal muscle area (VFA:SMA) was associated with an increased risk of complications (OR 2.24, 95% CI 1.14-4.87, p = 0.03) and 90-day survival (HR 2.13, 95% CI 1.13-4.01, p = 0.019). On simple analysis, shorter overall survival (OS) was observed in patients aged ≥70 years (p = 0.0009), with postoperative complications ≥IIIb (p = 0.01), an increased VFA:SMA (p = 0.007), and decreased muscle radiation attenuation (p = 1.6 × 10-5). In an OS model adjusted for age, disease malignancy, postoperative complications, and body composition parameters, muscle radiation attenuation remained significantly associated with survival (HR 0.94, 95% CI 0.90-0.98, p = 0.0016). A model which included only body composition variables had a discrimination ability (C-statistic 0.76) superior to a model which comprised conventional clinical variables (C-statistic 0.68). CONCLUSION: Body composition is a major determinant of postoperative complications and survival in pancreatic surgery patients.

INTRODUÇÃO: A cirurgia pancreática continua associada a uma elevada morbimortalidade mesmo em centros de referência. O objetivo do presente estudo foi avaliar a influência da composição corporal nas complicações e sobrevivência após cirurgia pancreática. MÉTODOS: Estudo retrospetivo em doentes submetidos a cirurgia pancreática entre Março 2012 e Dezembro 2017. Foram registadas variáveis demográficas, clínicas, complicações pós-cirúrgicas classificadas de acordo com a classificação de a classificação de Clavien Dindo. A composição corporal foi avaliada utilizando imagens de Tomografia Axial Computorizada (TAC) realizada no diagnóstico. Modelos de riscos porporcionais de Cox foram ajustados. RESULTADOS: Incluídos 90 doentes, 55% homens e média de idade de 68 ± 10.9 anos; 92% submetidos a pancreatectomia/pancreatoduodenectomia, 7% pancreatectomia distai e 1% pancreatoduodenectomia com ressecção multivisceral; 84% tinham doença maligna. A incidência de complicações major foi de 27.8% e a mortalidade aos 90 dias de 8.8%. O rácio da Área de Gordura Visceral (AGV) / Área de Tecido Muscular Esquelético (ATME) associou-se a um risco acrescido de complicações (OR 2.24, 95% Cl 1.14­4.87, p = 0.03) e de morte aos 90 dias (HR 2.13, 95% Cl 1.13­4.01, p = 0.019). Observámos uma sobrevivência global mais baixa em doentes com idade ≥70 anos (p = 0.0009), com complicações ≥IIIb (p = 0.01), com AGV/ ATME aumentada e atenuação muscular diminuída (p = 1.6 × 10−5). A atenuação muscular ajustada para a idade, malignidade, complicações, manteve-se associada à sobrevivência global (HR 0.94, IC 95% 0.90­0.98, p = 0.0016). Um modelo que inclua apenas variáveis de composição corporal mostrou uma capacidade discriminatória (C-statistic 0.76) superior a um modelo convencional com variáveis clínicas (C-statistic 0.68). CONCLUSÃO: A composição corporal é um determinante major de complicações pós-cirúrgicas e de sobrevivência de doentes submetidos a cirurgia pancreática.

N-Acetyl-D-Glucosamine-Loaded Chitosan Filaments Biodegradable and Biocompatible for Use as Absorbable Surgical Suture Materials.

The aim of this study was to prepare chitosan (CS) filaments incorporated with N-acetyl-D-Glucosamine (GlcNAc), using the wet spinning method, in order to combine the GlcNAc pharmacological properties with the CS biological properties for use as absorbable suture materials. The filaments were characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), uniaxial tensile testing, in vitro biodegradation, and through in vitro drug release and cytotoxicity studies. It was observed that the addition of GlcNAc did not alter the morphology of the filaments. The CS and CS/GlcNAc filaments presented diameters 145 µm and 148 µm, respectively, and the surfaces were homogeneous. Although the mechanical resistance of the chitosan filaments decreased with the incorporation of the GlcNAc drug, this property was greater than the mean values indicated in the U.S. Pharmacopeia (1.7 N) for suture number 6-0 (filament diameter of 100-149 µm). The biodegradation of the CS filaments was accelerated by the addition of GlcNAc. After 35 days, the CS/GlcNAc filaments degradability was at its total, and for the CS filaments it was acquired in 49 days. The in vitro kinetic of the release process was of the zero-order and Hopfenberg models, controlled by both diffusion and erosion process. The in vitro cytotoxicity data of the CS and CS/GlcNAc filaments toward L929 cells showed that these filaments are nontoxic to these cells. Thus, the GlcNAc-loaded CS filaments might be promising as absorbable suture materials. In addition, this medical device may be able to enhance healing processes, relieve pain, and minimize infection at the surgery site due the prolonged release of GlcNAc.

Dietary patterns and their relationships to sarcopenia in Portuguese patients with gastrointestinal cancer: An exploratory study.

OBJECTIVES: The purpose of this exploratory study was to identify the main dietary patterns of a Portuguese population of patients with gastrointestinal cancer and to analyze their association with sarcopenia. METHODS: This was a prospective study with a consecutive sample of 100 patients with gastrointestinal cancer enrolled at diagnosis. Dietary intake was assessed with a semiquantitative Food Frequency Questionnaire, and dietary patterns were obtained with principal component analysis. Nutritional assessment was done using the Patient-Generated Subjective Global Assessment, and body composition was evaluated with anthropometric measures and computed tomography image processing obtained at the third lumbar vertebrae. Sex and body mass index specific cutoffs were used to define sarcopenia. RESULTS: Four major patterns were identified: high-fat dairy products, fried snacks, and processed meat diet; legumes, vegetables, and fruit diet; fat and fish diet; and alcohol, cereal, and animal protein diet. On simple logistic regression, the occurrence of sarcopenia in participants in the second tertile (odds ratio [OR] 0.30; 95% confidence interval [CI] 0.10-0.83; P = 0.02) and third tertile (OR 0.24; 95% CI 0.08-0.69; P = 0.01) of adherence to the high-fat and fish diet was reduced compared with the first tertile. On multiple logistic regression, the second tertile (OR 0.38, 95% CI 0.11-1.19; P = 0.10) of the fat and fish dietary pattern maintained a trend toward a reduction of the odds of sarcopenia compared with the first tertile, independently of calorie intake, age, disease location, and stage. CONCLUSIONS: The fat and fish dietary pattern was associated with lower odds of sarcopenia in this population of patients with gastrointestinal cancer.

Post-traumatic cyst-like lesion of cortical bone in children.

Post-traumatic cyst-like lesions are an infrequent complication of fractures in children. To our knowledge, no more than 30 cases have been reported in the English-language literature. They most commonly affect the distal radius following a greenstick or torus fracture. These cortical defects are often asymptomatic, non-expansile, and typically resolve spontaneously in 1-3 years. They appear proximal to the compression site and are usually identified 2-4 months after a minor fracture. These lesions have a distinct appearance on magnetic resonance imaging (MRI), with intralesional fatty marrow, which may help to differentiate it from other bone lesions. We review the literature and present 3 more cases studied with plain radiographs, computed tomography (CT), and MRI. Post-traumatic cyst-like lesions require no treatment, and therefore recognition of its typical features is crucial to prevent unnecessary invasive procedures.

Cardiac computed tomography previous to atrial fibrillation ablation - effects of technological improvements and protocol optimization. / Tomografia computorizada cardíaca prévia a ablação de fibrilhação auricular ­ efeitos da evolução tecnológica e otimização de protocolos.

BACKGROUND: Cardiac computed tomography (CT) can provide a precise tridimentional anatomic map and exclude intra-cardiac thrombus. We aimed to access the impact of CT protocol optimization and technological evolution on the contrast and radiation dose as well as on image quality previous to atrial fibrillation (AF) ablation. METHODS: From a prospective registry of consecutive patients who underwent cardiac CT in a single center, we selected 270 patients in whom the CT was done for evaluation prior to AF ablation and they were distributed in 3 groups: Group1: the first 150 patients included; Group2: the last 60 patients performed with the same CT scanner; Group3: the first 60 exams performed with the new CT scanner. Quality of the protocol was access based on radiation dose, contrast volume used, the use of a second (delayed) acquisition, and on quantitative image quality analisis (signal to noise and contrast to noise ratios; density homogeneity racio between LA and LAA). RESULTS: We found a significant radiation dose as well as contrast dose reduction between the first and last subgroups (G1: 5,6mSv and 100ml; G2: 1,3mSv and 90ml; G3: 0,6mSv and 65ml). Even though group 3 had less radiation and contrast used it still had better quantitative image quality (signal/noise of 13,5; contrast/noise 14,8; density homogeneity racio of 0,92). CONCLUSION: Protocol optimization and technology both contributed to significant lower radiation dose and contrast volume used on cardiac CTs prior to AF ablation, without compromising image quality.

MRI for adenomyosis: a pictorial review.

Adenomyosis is defined as the presence of ectopic endometrial glands and stroma within the myometrium. It is a disease of the inner myometrium and results from infiltration of the basal endometrium into the underlying myometrium. Transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) are the main radiologic tools for this condition. A thickness of the junctional zone of at least 12 mm is the most frequent MRI criterion in establishing the presence of adenomyosis. Adenomyosis can appear as a diffuse or focal form. Adenomyosis is often associated with hormone-dependent lesions such as leiomyoma, deep pelvic endometriosis and endometrial hyperplasia/polyps. Herein, we illustrate the MRI findings of adenomyosis and associated conditions, focusing on their imaging pitfalls. TEACHING POINTS: • Adenomyosis is defined as the presence of ectopic endometrium within the myometrium. • MRI is an accurate tool for the diagnosis of adenomyosis and associated conditions. • Adenomyosis can be diffuse or focal. • The most established MRI finding is thickening of junctional zone exceeding 12 mm. • High-signal intensity myometrial foci on T2- or T1-weighted images are also characteristic.

Lower skeletal muscle attenuation and high visceral fat index are associated with complicated disease in patients with Crohn's disease: An exploratory study.

BACKGROUND AND AIMS: The prognostic value of body composition analysis in patients with Crohn's disease (CD) is poorly explored. The aims of the present study were to assess fat and skeletal muscle compartments including muscle radiation attenuation (MA) in patients with CD, and to analyze its predictive value to identify complicated phenotypes. METHODS: Seventy one patients with CD who have had an abdominal CT within one month of clinical, laboratory, and endoscopic evaluation were included. Skeletal muscle area (SMA) and index (SMI), visceral fat area (VFA) and index (VFI), subcutaneous fat area (SFA), and mean MA were measured using appropriate software. Sarcopenia, as defined by Martin's criteria was assessed. Montreal classification was used to characterize disease phenotype. RESULTS: Mean MA was lower in patients >40 years (p = 0.001), L2 (p = 0.09) and stricturing/penetrating disease (p = 0.03) whereas SMA and SMI were significantly lower in patients with positive C-reactive protein and previous hospital admissions (p < 0.01). On multivariate analysis, higher MA was protective against the complicated disease phenotype (stricturing/penetrating disease and/or previous surgeries) (OR 0.81; p = 0.002) whereas a high visceral fat index increased such risk (OR 26.1; p = 0.02). A ROC curve showed a 82.4% sensibility, 90.3% specificity, 17.6% positive predictive value, 9.7% negative predictive value and an area under the curve (AUC) of 0.91 for body composition analysis to predict complicated disease. CONCLUSIONS: A lower muscle attenuation and a high visceral fat index seem to be associated with more severe phenotypes in patients with CD.

Enhancing glioblastoma cell sensitivity to chemotherapeutics: A strategy involving survivin gene silencing mediated by gemini surfactant-based complexes.

Glioblastoma (GBM), the highest grade astrocytoma, is one of the most aggressive and challenging cancers to treat. The standard treatment is usually limited due to the intrinsic resistance of GBM to chemotherapy and drug non-specific effects. Therefore, new therapeutic strategies need to be developed to target tumor cells, sparing healthy tissues. In this context, the inhibitor-of-apoptosis protein (IAP) survivin emerges as an ideal target for a gene silencing approach, since it is sharply differentially expressed in cancer tissues. In this work, two different families of cationic gemini surfactants (bis-quat conventional and serine-derived) were tested regarding their efficiency to deliver small interfering RNAs (siRNAs) in a human GBM cell line (U87), in order to select an effective siRNA anti-survivin carrier. Importantly, survivin downregulation combined with administration of the chemotherapeutic agents temozolomide or etoposide resulted in a synergistic cytotoxic effect, thus revealing to be a promising strategy to reduce the chemotherapeutic doses for GBM treatment.

Application of thermoresponsive PNIPAAM-b-PAMPTMA diblock copolymers in siRNA delivery.

Gene knockdown has emerged as an important tool for cancer gene therapy as well as for viral infections and dominantly inherited genetic disorders. The generation of suitable siRNA delivery systems poses some challenges, namely, to avoid nuclease degradation, to surpass the cytoplasmic membrane, and to release the nucleic acids into the cytosol. Aiming at evaluating the ability of thermoresponsive block copolymers formed by units of N-isopropylacrylamide and of (3-acrylamidopropyl)trimethylammonium chloride to efficiently deliver siRNAs, an extensive study was performed with four different copolymers using a human fibrosarcoma cell line as cell model. The silencing ability and cytotoxicity of the generated copolymer-based siRNA delivery systems were found to be dependent on the cloud point of the polymer, which corresponds to the transition temperature at which the aggregation or precipitation of the polymer molecules becomes thermodynamically more favorable than their solubilization. In the present study, a system capable of delivering siRNAs efficiently, specifically and without presenting relevant cytotoxicity, even in the presence of serum, was developed. Confocal fluorescence experiments showed that the ability of the generated systems to silence the target gene is related to some extent to nucleic acid internalization, being also dependent on polymer/siRNA dissociation at 37 °C. Thus, a delicate balance between nucleic acid internalization and intracellular release must be met in order to reach an ideal knockdown efficiency. The special features and potential for manipulation of the N-isopropylacrylamide-based copolymers make them suitable materials for the design and synthesis of new and promising siRNA delivery systems.

Activation of ERK1/2 by protein kinase C-alpha in response to hydrogen peroxide-induced cell death in human gingival fibroblasts.

Hydrogen peroxide (H(2)O(2)) increases protein tyrosine phosphorylation of numerous proteins in human gingival fibroblasts (HGFs). Two main proteins, with an apparent molecular weight of 44 and 42kDa, were phosphorylated after hydrogen peroxide stimulation of the human gingival fibroblasts. Further analysis identified these two proteins as ERK1/2. Maximum phosphorylation was detected at 10min post-H(2)O(2) treatment. Pretreatment with an MEK inhibitor, PD98059, inhibited H(2)O(2)-stimulated ERK1/2 phosphorylation in a dose-dependent manner. Treatment with H(2)O(2) also induced phosphorylation of protein kinase C-alpha (PKCalpha). Staurosporine, a PKC inhibitor, blocked ERK1/2 phosphorylation induced by H(2)O(2). In addition, H(2)O(2)-induced cell death was prevented by PD98059, SB203580, and calphostin C, which are MEK, p38 and PKC inhibitors, respectively. These results suggest that H(2)O(2) leads to the phosphorylation and activation of ERK1/2 in a PKC-dependent manner. These findings demonstrate that the MAPK signaling pathway plays an active role in mediating the H(2)O(2)-induced decrease in HGF cell viability and ATP depletion.

[Pulmonary tuberculosis: association between extent of the residual pulmonary lesion and alteration in the lung function]. / Tuberculose pulmonar: associação entre extensão de lesão pulmonar residual e alteração da função pulmonar.

OBJECTIVE: To describe alterations in spirometric variables and its disturbances and to study the existence of a relationship between extent of the residual lung lesion at the end of treatment for tuberculosis and alteration of the lung function measured by spirometry. METHODS: Analyzed were 96 patients with diagnosis of pulmonary tuberculosis, treated in three health centers in the metropolitan area of Recife, from January, 2003 to November, 2005. Patients of both genders, 15 years of age or older were included, whose chest x-rays at end of the treatment were classified according to criteria of the National Tuberculosis Association (NTA) for extent of lung lesion. Patients replied to a questionnaire at the beginning of the survey, and were submitted to spirometry after conclusion of treatment. RESULTS: Of the 96 patients, 89.6% presented with radiographic sequels. About 54% had moderate to severe sequels. These radiographic alterations correspond to 24.6% and 73.8% respectively of alterations in the pulmonary function. CONCLUSION: The large number of residual radiographic lesionss (89.6%) and breathing dysfunction (66,7%) identified in this survey call attention to the fact that treatment of a patient with pulmonary tuberculosis must not be restricted to bacteriological healing of the disease. Identification of the residual lung lesions and of the breathing dysfunction in patients who conclude treatment will promote early actions to treat these sequels, improving the quality of life of these patients.

Tuberculose pulmonar: associação entre extensão de lesão pulmonar residual e alteração da função pulmonar / Pulmonary tuberculosis: association between extent of the residual pulmonary lesion and alteration in the lung function

OBJETIVO: Descrever as alterações nas variáveis da espirometria e seus distúrbios; estudar a existência de associação entre a extensão da lesão pulmonar residual ao final do tratamento da tuberculose e a alteração da função pulmonar aferida pela espirometria. MÉTODOS: Estudou-se uma série de 96 pacientes com diagnóstico de tuberculose pulmonar, atendidos em três unidades de saúde de Região Metropolitana do Recife, durante o período de janeiro de 2003 a novembro de 2005. Foram analisados pacientes de ambos os sexos, com idade a partir de 15 anos, cujas radiografias do tórax do final do tratamento foram classificadas pelo critério da National Tuberculosis Association (NTA). Os pacientes responderam questionário, no início da pesquisa, e foram submetidos à prova de função pulmonar, após o término do tratamento. RESULTADOS: Dos 96 pacientes estudados, concluímos que 89,6 por cento apresentavam seqüelas radiográficas; 54 por cento apresentavam seqüelas moderadas a graves. Estas alterações radiográficas correspondiam a 24,6 por cento e 73,8 por cento, respectivamente, de alterações na função pulmonar. CONCLUSÃO: Foram identificadas 89,6 por cento de lesões residuais radiográficas, enquanto 66,7 por cento das disfunções respiratórias alertam para o fato de que a assistência ao paciente com tuberculose pulmonar não deve se restringir apenas à cura baciloscópica da doença. A identificação de lesões pulmonares residuais e disfunções respiratórias em pacientes que concluem o tratamento da tuberculose permitirão instituir medidas precoces de tratamento dessas seqüelas para uma melhor qualidade de vida.

OBJECTIVE: To describe alterations in spirometric variables and its disturbances and to study the existence of a relationship between extent of the residual lung lesion at the end of treatment for tuberculosis and alteration of the lung function measured by spirometry. METHODS: Analyzed were 96 patients with diagnosis of pulmonary tuberculosis, treated in three health centers in the metropolitan area of Recife, from January, 2003 to November, 2005. Patients of both genders, 15 years of age or older were included, whose chest x-rays at end of the treatment were classified according to criteria of the National Tuberculosis Association (NTA) for extent of lung lesion. Patients replied to a questionnaire at the beginning of the survey, and were submitted to spirometry after conclusion of treatment. RESULTS: Of the 96 patients, 89.6 percent presented with radiographic sequels. About 54 percent had moderate to severe sequels. These radiographic alterations correspond to 24.6 percent and 73.8 percent respectively of alterations in the pulmonary function. CONCLUSION: The large number of residual radiographic lesionss (89.6 percent) and breathing dysfunction (66,7 percent) identified in this survey call attention to the fact that treatment of a patient with pulmonary tuberculosis must not be restricted to bacteriological healing of the disease. Identification of the residual lung lesions and of the breathing dysfunction in patients who conclude treatment will promote early actions to treat these sequels, improving the quality of life of these patients.

Tuberculose pulmonar: associação entre extensão da imagem da lesão radiográfica e alteração da função pulmonar / Pulmonary tuberculosis: association between radiographic extent of the lesion and the alterations in lung function

A tuberculose continua sendo um problema de saúde pública dos mais alarmantes. Seu diagnóstico, ainda, é feito de forma tardia, apesar de todo o aparato tecnológico, por vários fatores: como os decorrentes dos serviços de saúde e aqueles inerentes ao próprio paciente. Em relação à tuberculose pulmonar, muito se tem escrito sobre os desfechos desfavoráveis do seu tratamento, salientando-se, sempre, o óbito, a falência e o abandono do tratamento. Existem, relativamente, poucos estudos na literatura abordando as seqüelas da tuberculose pulmonar, mesmo após a cura bacteriológica alcançada com seu tratamento. O grau de extensão da lesão parece depender, diretamente, do tempo oportuno para o diagnóstico e a instituição da terapêutica. As várias lesões residuais pleuro-pulmonares são apresentadas desde o início da sua formação até as suas conseqüências prejudiciais à qualidade de vida dos pacientes. Às vezes, a incapacidade laborativa resultante e o tratamento dispensado às intercorrências correspondem a um grande ônus para a Sociedade e o Estado. Mais ainda, as conseqüências pessoais que essas seqüelas acarretam: a baixa auto-estima, as limitações na vida profissional, e, até, as dificuldades de convivência com outras pessoas. O objetivo desta revisão é descrever os padrões radiográficos na tuberculose pulmonar e suas seqüelas.

Urinary tract infection in non-hospitalized patients with cirrhosis and no symptoms of urinary tract infection: a case series study

Bacterial infections are important factors in decompensation, and they increase the mortality rate of patients with liver cirrhosis. The most common infections among these patients are spontaneous bacterial peritonitis, pneumonia, skin infections and urinary tract infections (UTI). This transversal study evaluated the frequency of UTI in non-hospitalized patients with cirrhosis followed in a hepatology outpatient unit. Patients with clinical, laboratorial, echographic and/or histological diagnosis of cirrhosis were evaluated from April 2002 to August 2004. Patients who accepted participating in this study were submitted to clinical evaluation and the following laboratorial examinations: urine analysis, urine culture, blood culture and hepatic function tests. Patients with symptoms of UTI, diabetis, prostatic disease were excluded. Eighty-two patients with cirrhosis were studied. Their mean age was 51 years (SD = 11); 73 percent were male. Hepatitis C virus was the main etiology in 45 percent of the cases. The Child-Pugh B functional class was observed in 52 percent of the cases. Urine cultures were positive in 4.9 percent of these patients. In this study of non-hospitalized cirrhotic patients, with no symptoms of UTI, the frequency of urinary tract infection was approximately 5 percent. The bacteria found were E. coli and Klebsiella pneumonia. We conclude that it is necessary to screen for UTI in such patients.

Infecção do trato urinário em pacientes cirróticos: revisão sistemática da literatura / Urinary tract infection in cirrhotic patients: systematic review

Introdução: A infecção do trato urinário é uma complicação em pacientes com cirrose. Objetivo: Avaliar a freqüencia de infecção urinária em pacientes cirroticos. Metodologia: Revisão sistemática da literatura utilizando as bases de dados eletronicas (Medline, Embase, Lilacs e Cochrane), abrangendo o período de 1993 a 2004, incluíndo os estudos escritos em inglês, espanhol e português. Resultados: Foram recuperados 135 trabalhos, dos quais 11 estavam de acordo com a metodologia a que se propõe este estudo. A maioria dos casos descritos era de adultos com idade entre 45 e 61 anos, do gênero masculino, tendo o álcool implicado como acusador da cirrose na maioria dos artigos. As classificações de cirrose mais prevalentes segundoo critério Child foram de B e C, e a bactéria mais comum, a Escherichia coli. Conclusão: A maioria dos artigos recebeu classificações baixas quanto à avaliação, sendo demonstrado que não satisfizeram os critérios de sistematização das variáveis

Hemostasia com injeção da solução de cianoacrilato em pacientes com ruptura de varizes gástricas: estudo de série de casos / Hemostasis with cyanoacrylate solution injection in patients with gastric varices bleeding: study of a series

A hemorragia digestiva alta (HDA) é uma patologia freqüente nas emergências hospitalares, responsável por cerca de 300.000 internamentos por ano e com a mortalidade global de 1 3,2%. As causas mais freqüentes de HDA são úlcera péptica e ruptura de varizes esofagogástricas (RVEG), variando de 9 a 46%. A mortalidade na HDA por RVEG é maior que a global, entre 30 e 50%. No caso da ruptura por varizes gástricas, a hemostasia com a injeção da solução de cianoacrilato mais lipiodol (SCl) é importante para reduzir a morbimortalidade aguda, o número de unidades de hemoderivados transfundidas e tempo de internação. Este estudo tem como objetivo verificar a eficácia da hemostasia com injeção da SCl na RVEG, nas primeiras 72 horas após o procedimento. Métodos: Estudo observacional, prospectivo, tipo série de casos, incluindo 30 pacientes com hipertensão portal, submetidos a obliteração com a injeção da SCl, no período de fevereiro de 2004 a março de 2005/ no SED-CHD-HGRS. Resultados: Obteve-se a hemostasia em 100% (30/30) dos pacientes nas primeiras 72 horas. A idade média foi de 50,07 anos, sexo masculino em 66,7% (20/30) e feminino em 33/9% (10/30). Dentre as causas da hemorragia, varizes gástricas tipo I corresponderam a 10% (3/30)/ tipo 11 a 46% (14 / 30)/ tipo 111 a 10% (3/30), tipo I e 11 a 13/3% (4/30)/ úlcera pós-esclerose a 3,3% (1/30) e variz subcárdica a 16/7% (5/30). A etiologia da hipertensão portal foi de 43,3% (13/30) para doença crônica parenquimatosa do fígado de etiologia não definida (DCPFND), de 23,3% (7/30) DPCF por doença alcoólica do fígado (DAF), de 20% (6/30) por esquistossomose e de 13/3% (4/30) DCPF por vírus C. A quantidade média injetada da SCl foi de 2/63ml. Não houve dano ao endoscópio; entretanto, houve dano em 53,4% dos cateteres injetores da SCl. Conclusão: A hemostasia com injeção da SCl para obliteração na ruptura de varizes gástricas na HDA é eficaz, tecnicamente segura e diminui o ressangramento nas primeiras horas do quadro agudo

Por que está tão difícil controlar a tubeculose? / Why is so difficult controlling tuberculosis?

A tuberculose no mundo continua sendo um grave problema de saúde pública, conside- rada pela OMS, desde abril de 1993, como em estado de urgência, com uma estimativa nesta década de 90 milhões de casos novos e 30 milhões de mortes em todo o planeta. No Brasil, as precárias condições de vida de grande parte da população, a co-infecção pelo HI V e a desestruturação da maioria dos serviços de saúde fazem manter o alto número de casos novos anuais. Estes estão estimados em tomo de 90 mil, a maioria de formas pulmonares bacilíferas, notando-se em vários municípios de alguns Estados brasileiros elevação quase que exponencial do problema. O controle da endemia passa pela distribuição de renda da população, combate sistemático da miséria, melhores condições de moradia e educação, que são cruciais na manutenção da grave situação epidemiológica atual Dotar o sistema de saúde de condições ideais para o combate efetivo, valorizar o profissional de saúde, utilizar de todos os recursos tecnológicos disponíveis, novos e antigos, assim como envolver todos os demais segmentos da sociedade são fatores imprescindíveis para essa árdua tarefa de livrar o mundo dessa gigantesca ameaça.

Tabagismo: é possível controlar? / Tabagism

O tabagismo é a maior causa de mortes evitáveis em todo o mundo. Nas duas próximas décadas, nos países em desenvolvimento, a tendência de mortalidade por tabagismo aumentará de um mulhäo para sete milhöes. As doenças tabaco-relacionadas que têm alta morbidez afetamnäo apenas os fumantes ativos, mas também os passivos, entre esses, principalmente, as crianças. O tabagismo necessita ser combatido em várias frentes, na legislaçäo, na censura à propaganda e no exemplo dos paisfrente as crianças e adolescentes, que säo altamente influenciáveis. O tratamento da dependência nicotínica é abordado em todos os seus aspectos: psicológico, medicamentoso, grupos de auto-ajuda