Diagnostic accuracy of an uncorrected native T1 mapping sequence for liver fibrosis and inflammation in autoimmune hepatitis: a prospective study using histopathology as reference standard.

PURPOSE: There is an unmet clinical need for non-invasive imaging biomarkers that could replace liver biopsy in the management of patients with autoimmune hepatitis (AIH). In this study, we sought to evaluate the diagnostic accuracy of a simple uncorrected, non-contrast T1 mapping for detecting fibrosis and inflammation in AIH patients using histopathology as a reference standard. MATERIAL AND METHODS: Over 3 years, 33 patients with AIH were prospectively studied using a multiparametric liver MRI protocol which included T1 mapping. Biopsies were performed up to 3 months before imaging, and a standardized histopathological score for fibrosis (F0-F4) and inflammatory activity (PPA0-4) was used as a reference. Statistical analysis included independent t test, Mann-Whitney U-test, and ROC (receiver operating characteristic) analysis. RESULTS: T1 mapping values were significantly higher in patients with advanced fibrosis (F0-2 vs. F3-4; p < 0.015), significant fibrosis (F0-1 vs. F2-4; p < 0.005), and significant inflammatory activity (PPA 0-1 vs. PPA 2-4 p = 0.048). Moreover, the technique demonstrated a good diagnostic performance in detecting significant (AUC 0.856) and advanced fibrosis (AUC 0.835), as well as significant inflammatory activity (AUC 0.763). CONCLUSION: A rapid, simple, uncorrected, non-contrast T1 mapping sequence showed satisfactory diagnostic performance in comparison with histopathology for detecting significant tissue inflammation and fibrosis in AIH patients, being a potential non-invasive imaging biomarker for monitoring disease activity in such individuals.

Does hepatitis B virus coinfection have any impact on treatment outcome in hepatitis C patients on hemodialysis?

BACKGROUND: HBV/HCV coinfection is a common finding among hemodialysis patients. However, there is scarce information concerning the impact of HBV coinfection on the response to treatment of HCV-infected patients on hemodialysis. AIM: We aimed to compare the rate of sustained virologic response (SVR) to treatment with interferon-alfa (IFN) between hemodialysis patients with HBV/HCV coinfection and those with HCV-monoinfection. MATERIAL AND METHODS: HCV-infected patients on hemodialysis treated with IFN were included. Patients coinfected by HBV/HCV were compared to HCV-monoinfected patients, regarding clinical and biochemical features and rates of SVR. RESULTS: One hundred and eleven patients were treated. HBV/HCV coinfection was observed in 18/111 patients (16%). Coinfected patients were younger (p = 002), had more time on dialysis (p = 0.05) and showed a tendency to present a higher prevalence of septal fibrosis (p = 0.06). The analysis by intention to treat showed SVR of 56% among coinfected patients and 18% in HCV-monoinfected patients (p = 0.004). CONCLUSION: In conclusion, end-stage renal disease patients with HBV/HCV coinfection exhibit higher rate of SVR to HCV treatment than HCV-monoinfected patients. It is possible that factors related to the host immune response and viral interaction could explain the better response observed among coinfected patients.

Phenotypes of Dialysis-Requiring Acute Kidney Injury and Associations with Mortality in a South American Population.

BACKGROUND: Acute kidney injury (AKI) is a complex syndrome typically classified into strict categories. Alternatively, it may be more accurate to consider it as an intermediate event between an initiating cause and its outcome. Therefore, we investigated the burden of clinical scenarios associated with dialysis-requiring AKI (AKI-D) using latent class analysis (LCA) and examined the etiological spectrum and clinical phenotypes across different life stages. METHODS: We analyzed 17,158 AKI-D patients from 170 medical facilities in Rio de Janeiro, Brazil (2002-2012). Utilizing survival curves and mixed-effects Cox regression for survival estimation, LCA classified patients based on clinical characteristics and outcomes, focusing on etiological variation over the human lifespan. RESULTS: The median age was 75 (IQR 59-83). Infections were the most common cause (44.2%), particularly community-acquired pneumonia (23.8%). Cardiovascular issues, especially ischemic heart disease (9.0%) and acute heart failure (8.1%), were also significant. LCA identified four distinct patient classes with varying clinical and outcome profiles. Class 1 patients were younger (median age 66), predominantly male, with lower ICU admission and higher rates of community-acquired AKI (60.8%). They had the lowest mortality (39.5%) and highest recovery rates. Class 2 had intermediate mortality (67.4%) and the highest comorbidity burden (mean Charlson score: 3.39). Classes 3 and 4 had the highest mortality (82.8% and 78.6%), requiring more mechanical ventilation and vasopressor use. Class 3 had a high prevalence of sepsis (92.7%) with lower comorbidities, while Class 4 had high chronic heart disease (76.3%) and perfusion factors (79.4%). Despite high mortality, Class 3 recovered better than Class 2 and 4. Survival analyses revealed diverse outcomes across etiological groups, with liver-related conditions being the most severe. CONCLUSIONS: This study highlights the complexity of AKI and the utility of LCA in revealing its clinical heterogeneity. It underscores distinct etiological trends across ages, suggesting future research should integrate clinical profiles with advanced diagnostics to understand AKI's clinical and molecular phenotypes throughout life.

Alkaline phosphatase and liver fibrosis at diagnosis are associated with deep response to ursodeoxycholic acid in primary biliary cholangitis.

OBJECTIVE: Primary biliary cholangitis is a chronic and progressive autoimmune liver disease, whose prognosis can be improved by normalizing alkaline phosphatase and bilirubin. While ursodeoxycholic acid (UDCA) is first line standard of care, approximately 40 % of patients exhibit incomplete response. We aimed to identify prognostic markers for deep response to UDCA therapy at presentation. PATIENT AND METHODS: Data from the Brazilian Cholestasis Study Group cohort were analyzed retrospectively. Patients were assessed for deep response, defined as normal alkaline phosphatase and bilirubin, after 1 year of UDCA treatment. Additionally, the performance of the UDCA response score in predicting deep response was evaluated. RESULTS: A total of 297 patients were analyzed, with 57.2 % achieving an adequate response according to the Toronto criteria, while 22.9 % reached deep response. Cirrhosis (OR 0.460; 95 % CI 0.225-0.942; p = 0.034) and elevated baseline alkaline phosphatase levels (OR 0.629; 95 % CI 0.513-0.770; p < 0.001) were associated with reduced odds of deep response. The UDCA response score exhibited moderate discrimination power (AUROC = 0.769) but lacked calibration. CONCLUSIONS: Baseline ALP and liver fibrosis emerge as the most important prognostic factors to predict normalization of alkaline phosphatase and bilirubin after UDCA. The UDCA response score was inadequate for predicting deep response in the Brazilian PBC population.

A new and simple score to predict adequate and deep response to ursodeoxycholic acid in patients with primary biliary cholangitis: the ALP-A score.

BACKGROUND: Ursodeoxycholic acid (UDCA) is the standard treatment for primary biliary cholangitis (PBC), but a significant proportion of patients do not respond adequately, leading to increased risk of adverse outcomes. This study aims to develop a new and straightforward predictive score to identify PBC patients likely to achieve a complete response to UDCA. METHODS: A logistic regression analysis was conducted using a derivation cohort of PBC patients to identify pre-treatment variables associated with response to UDCA. This analysis led to the development of the ALP-A score, calculated as: Age at diagnosis divided by (alkaline phosphatase at diagnosis/upper limit of normal). ALP-A score accuracy was evaluated using the area under the ROC curve, validated with a large external cohort from Brazil. Additionally, the correlation between the ALP-A score and the previously validated UDCA response score (URS) was assessed. RESULTS: ALP-A score had good predictive power for adequate (AUC 0.794; 95% CI, 0.737-0.852) and deep (0.76; 95% CI, 0.69-0.83) UDCA response at 1 year of treatment. A cutoff score of 17 and 23 points was determined to be the optimal threshold for distinguishing adequate and deep responders, respectively, from non-responders. ALP-A score demonstrated a sensitivity of 73%, specificity of 71%, positive predictive value of 65%, negative predictive value of 78%, and overall accuracy of 72% for biochemical response. The URS displayed similar discriminative ability (AUC 0.798; 95% CI, 0.741-0.855). CONCLUSION: ALP-A score performs comparably to URS but offers the great advantage of simplicity for routine clinical use. It serves as a valuable tool to identify PBC patients less likely to respond to UDCA treatment, facilitating early consideration of alternative therapeutic approaches.

Burden, Stress, and Depression in Informal Caregivers of Patients Pre and Post Liver Transplant.

BACKGROUND: Caring for a patient with chronic liver disease involves exposure to factors that increase family caregivers' vulnerability to developing mental disorders. This study reassessed the scores of burden, stress, and depression in informal (family) caregivers of patients with liver disease after liver transplant. METHODS: In this observational and descriptive study, the caregivers were reassessed for the same outcomes 4 to 10 years following the initial assessment pre-transplant. The data were obtained from the identification card, the interview script, the Brazilian version of the Caregiver Burden Scale, the Lipp Inventory of Stress Symptoms for Adults, and the Beck Depression Inventory. Descriptive statistics of pre- and post-liver transplant phases were calculated, and the Wilcoxon signed rank test was used to compare the burden scores. RESULTS: The 5 caregivers were women, with a mean age of 51.6 (SD, 8.38) years. All of the caregivers' (100%) burden score increased, 2 caregivers needed to seek some form of help, and 3 caregivers showed an indication of burden risk. Regarding stress symptoms, 3 caregivers (60%) maintained a score indicating no stress, 2 caregivers (40%) presented increased scores, and the predominant symptoms changed from psychological to physical. Regarding depression, 3 caregivers (60%) maintained the minimum level of symptoms for depression, and 2 caregivers (40%) presented increased scores. CONCLUSION: After liver transplant, caregivers' burden scores increased, and levels of stress and depression increased for caregivers who already showed symptoms in the pre-transplant phase.

Iron Overload in Renal Transplant Patients: The Role of Hepcidin and Erythropoietin.

Renal transplant patients may present important serum iron overload (IO), which can persist for long periods after transplantation, but its mechanisms are not fully understood. We raised the hypothesis that post-transplant hypererythropoietinemia might induce reduction in serum hepcidin, favoring iron absorption. The aims of this study were to determine the prevalence of IO and associated factors in transplant patients and to evaluate erythropoietin and hepcidin levels in patients with and without IO. A total of 168 patients were included, with a median time of dialysis and transplantation of 28 and 65 months, respectively. Most patients (85%) received large amounts of parenteral iron (3600 mg iron) during the dialysis period. Median ferritin was 427 ng/mL, and transferrin saturation was 33%. IO was present in 26 patients (15%). A comparison of patients with and without IO showed a predominance of male and nonwhite patients in the former group (P < .001 and .002, respectively). The total amount of iron used before transplantation and hemoglobin levels were higher in the group with IO (P = .023 and .046, respectively). Hepcidin was higher in the group with IO (P < .0001), whereas erythropoietin did not differ between groups. There was no correlation between serum levels of hepcidin and erythropoietin (r = -0.001). In conclusion, factors associated with IO were male sex, higher hemoglobin levels, and the amount of iron received before transplantation. IO was not the result of reduction in hepcidin secondary to hypererythropoietinemia. The elevated levels of serum hepcidin were possibly secondary to IO, mediated by mechanisms that are independent of the hepcidin-erythropoietin axis.

Outcomes and Risk Factors for Polymicrobial Posttraumatic Osteomyelitis.

Background: We hypothesized that polymicrobial posttraumatic osteomyelitis (PTO) may be associated with worse outcomes when compared to monomicrobial PTO. We therefore attempted to show the outcomes and predisposing factors associated with polymicrobial PTO. Methods: A single-center case-control study was carried out from 2007 to 2012. The outcome variables analyzed were: the need for additional surgical and antibiotic treatments, rates of amputation, and mortality associated with the infection. Univariate and multivariable analyses using multiple logistic regression were performed to identify risk factors associated with polymicrobial PTO, and p < 0.05 was considered significant. Results: Among the 193 patients identified, polymicrobial PTO was diagnosed in 37.8%, and was significantly associated with supplementary surgical debridement (56.1% vs. 31%; p < 0.01), a higher consumption of antibiotics, and more amputations (6.5% vs 1.3%; p < 0.01). Factors associated with polymicrobial PTO in the multivariable analysis were older age (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 1.01 to 1.03, p = 0.04), working in agriculture (OR = 2.86, 95% CI = 1.05 to 7.79, p = 0.04), open fracture Gustilo type III (OR = 2.38, 95% CI = 1.02 to 5.56, p = 0.04), need for blood transfusion (OR = 2.15, 95% CI = 1.07 to 4.32, p = 0.03), and need for supplementary debridement (OR = 2.58, 95% CI = 1.29 to 5.16, p = 0.01). Conclusions: PTO is polymicrobial in more than one-third of patients, associated with extra surgical and clinical treatment, and worse outcomes including higher rates of amputation.

Association Between Nutrition Status and Survival in Elderly Patients With Colorectal Cancer.

BACKGROUND: Aging patients with cancer have a higher risk of mortality and treatment-associated morbidity than younger patients. Nutrition status may play an important role in cancer mortality. We aimed to evaluate the survival time of elderly patients with colorectal cancer and its association with body mass index (BMI), the patient-generated subjective global assessment (PG-SGA), and phase angle (PA). MATERIALS AND METHODS: BMI, PG-SGA, and PA were determined for all patients (n = 250) at first assessment. RESULTS: Seventy-one (28.4%) patients were in active oncologic treatment (group 1) and 179 (71.6%) were in remission (group 2). At the time of the analysis, 73 (29.2%) patients had died and 177 (70.8%) were censored. The mean (standard deviation) age was 70.9 (7.49) years; 17.2% were undernourished, 56% normal weight, and 26.8% were overweight. According to the PG-SGA, 35.2% of patients needed some nutrition intervention and 4.4% needed it urgently. The mean PA was 4.94 ± 1°. PG-SGA, tumor stage, and PA differed significantly ( P < .001) between the groups; BMI did not ( P = .459). Severe malnutrition (PG-SGA C), compared with PG-SGA A, was associated with a relative hazard of death of 12.04 (95% confidence interval [CI], 3.43-42.19, P < .001). PA >5° was associated with better prognosis: a relative hazard of 0.456 (95% CI, 0.263-0.792; P < .005). CONCLUSION: Among elderly patients with colorectal cancer, PA and PG-SGA were prognosis factors. PA >5° was associated with best survival and PG-SGA C with worst survival.

Predisposing factors for recurrence of chronic posttraumatic osteomyelitis: a retrospective observational cohort study from a tertiary referral center in Brazil.

BACKGROUND: The incidence of posttraumatic osteomyelitis (PTO) is increasing despite new treatment strategies. Assessment of patients' outcomes following PTO is challenging due to multiple variables. The study goals are to determine the frequency of recurrence following PTO treatment and identify factors predisposing patients to treatment failure. METHODS: Between August 01, 2007 to August 30, 2012, a single-center retrospective cohort study was performed among 193 patients diagnosed with PTO following orthopedic surgery for fracture care. Bone and soft tissues were collected for cultures and PTO was defined according to CDC/NHSN criteria. Patient, injury, surgery-associated variables, and microbiological records were reviewed for risk factors associated to recurrence of PTO. Univariate and multivariable analyses using logistic regression were performed, with p <0.05 considered significant. RESULTS: Thirty-eight patients (20%) of 192 diagnosed and treated for PTO failed their treatment. Factors associated with recurrence were age between 61 and 80 years [hazard ratio (HR) = 6.086, 95% confidence interval (CI) = 2.459;15.061, p = <0.001], age above 80 years [HR = 9.975 (95% CI = 3.591;27.714), p = <0.001], intraoperative blood transfusion [HR = 2.239 (95% CI = 1.138;4.406), p = 0.020], and positive culture for Pseudomonas aeruginosa [HR = 2.700 (95% CI = 1.370;5.319), p = 0.004]. CONCLUSIONS: Risk factors associated with recurrence of PTO are difficult to measure. The present study revealed that elderly patients, intraoperative blood transfusions, and infection due to P. aeruginosa were independently associated with recurrence of PTO. These factors should warn clinicians of a higher failure rate following treatment of PTO. Trial registration: ISRCTN71648577. Registered 18 May 2017. Retrospectively registered.

Fluctuation of academic performance of medical students selected by affirmative action policies (PIMESP) / Flutuação do desempenho acadêmico de alunos de medicina selecionados por políticas afirmativas (PIMESP)

Abstract: Introduction: Almost 20 years since the beginning of affirmative action implementation, there is still much discussion about the real effectiveness of these measures, especially regarding academic performance, comparing "quota holders" to "non-quota holders", with doubts arising about whether the former can keep up with the latter. Objective: To establish a profile and compare the academic performance and other aspects related to the academic life of "quota holder" students (Inclusion Program with Merit in Public Higher Education in São Paulo - PIMESP) with the other students in their respective classes selected via broad competition (BC). Method: Retrospective cohort of 1st to 3rd-year medical students, divided in BC or PIMESP. The following were assessed: arithmetic mean of the final grades of the curricular subjects; final approval status (FAS) in the subjects; frequency; books borrowed from the library (BBLi) and participation in monitoring/academic center. Continuous variables were compared by Student's t-test or Mann-Whitney test and categorical by chi-square or Fisher's exact test. Values p < 0.05 were considered significant. Results: Of the 237 students included in the sample, all had completed the 1st year (2015, 2016 and 2017 entrants), 158 students (2015 and 2016 entrants) the 1st and 2nd years, and 78 (32.9%) had completed the 3rd year (2015 entrants) at the time of the survey. In the analysis of all those who had completed the 1st year, where 16% were PIMESP, there was a difference in mean final grades and FAS, higher for BC students and no difference for attendance, BBLi, participation in monitoring and academic center. In the analysis of those who had completed the 2nd year, where 15.8% were PIMESP, there was no difference between any of the studied variables. The analysis of those who had completed the 3rd year, where 15.4% were PIMESP, once again showed difference between the averages of final grades and FAS, higher for BC students, but with a less marked difference, and there were no significant differences for the other variables. Conclusion: We observed a fluctuation of academic performance among PIMESP students, towards inferior outcomes, when compared to BC students, throughout the first three years of medical school, but not for other variables. No increase in the dropout rate was observed, contrary to what is found in the literature.

Resumo: Introdução: Depois de quase 20 anos desde o início da materialização das ações afirmativas, ainda há muita discussão sobre a real efetividade dessas medidas, principalmente, no que tange ao desempenho acadêmico, quando se comparam "cotistas" e "não cotistas", surgindo dúvidas se aqueles conseguem acompanhar estes. Objetivo: Este estudo teve como objetivos traçar um perfil do desempenho acadêmico e compará-lo e os demais aspectos relacionados à vida acadêmica dos alunos "cotistas" (Programa de Inclusão com Mérito no Ensino Superior Público Paulista - Pimesp) com os demais alunos de suas respectivas turmas selecionados via ampla concorrência (AC). Método: Trata-se de coorte retrospectiva de alunos da primeira à terceira série de Medicina, divididos em AC ou Pimesp. Avaliaram-se os seguintes aspectos: média aritmética das notas finais das disciplinas curriculares, situação final de aprovação nas disciplinas (SFA), frequência, títulos emprestados na biblioteca (TEB) e participação em monitorias/centro acadêmico. As variáveis contínuas foram comparadas pelo teste t de Student ou Mann-Whitney, e as categóricas, por qui-quadrado ou exato de Fisher. Valores p < 0,05 foram considerados significantes. Resultado: Participaram do estudo 237 alunos. Todos haviam concluído a primeira série (ingressantes de 2015, 2016 e 2017); 158 alunos (ingressantes de 2015 e 2016), a primeira e segunda séries; e 78 (32,9%) haviam concluído a terceira série (ingressantes de 2015) no momento da pesquisa. Na análise de todos os que haviam concluído a primeira série, dos quais 16% faziam parte do Pimesp, houve diferença nas médias das notas finais e da SFA, maior para alunos AC, e não houve diferença para frequência, TEB, participação em monitorias e centro acadêmico. Na análise dos que haviam concluído a segunda série, dos quais 15,8% faziam parte do Pimesp, não houve diferença entre nenhuma das variáveis estudadas. A análise dos que haviam concluído a terceira série, dos quais 15,4% faziam parte do Pimesp, mostrou novamente diferença entre as médias das notas finais e da SFA, maior para alunos AC, porém com uma diferença menos acentuada, e não houve diferenças significativas para as demais variáveis. Conclusão: Observou-se flutuação do desempenho acadêmico dos estudantes Pimesp, para menor, em relação aos estudantes AC, ao longo dos três primeiros anos do curso de Medicina, mas não para outras variáveis. Não foi observado aumento do índice de evasão, contrariando a literatura.

Feeding of children with tracheostomy at hospital discharge / Forma de alimentação de crianças com traqueostomia na alta hospitalar

ABSTRACT Purpose: to describe the work of speech-language-hearing therapists and verify which was the most prevalent feeding method in the sample studied. Methods: a descriptive observational study based on data surveyed from medical records. The following variables were used: age, medical diagnosis, hospital ward, feeding method before and after the tracheostomy, time of speech-language-hearing care, and speech-language-hearing discharge. The data were submitted to descriptive statistical analysis with the appropriate tests to compare the categorical variables. All infants and children with tracheostomy performed either before or during hospital stay between July 2017 and July 2018, who received speech-language-hearing care upon request of the physician, were included. Results: a total of 51 children took part in the study, most of whom were males (56.9%), with a median age of 12 months, ranging from 1 month to 12 years old at the time of the speech-language-hearing assessment. The feeding methods at hospital discharge were described as follows: full oral feeding (37%), partial oral feeding (25.5%), nasogastric/nasoenteral tube (19.6%), and gastrostomy (17.6%). Conclusion: the full oral diet of tracheostomized children was the most prevalent feeding method at hospital speech-language-hearing discharge.

RESUMO Objetivo: descrever o trabalho fonoaudiológico e verificar qual forma de alimentação foi mais prevalente dentro da amostra estudada. Métodos: trata-se de um estudo observacional descritivo, realizado por meio de levantamento de dados nos prontuários, onde buscou-se as seguintes variáveis: idade, diagnóstico médico, setor de internação, forma de alimentação antes e após traqueostomia, período de atendimento fonoaudiológico e alta fonoaudiológica. Os dados foram submetidos à análise estatística descritiva, tendo sido utilizados testes pertinetes para a comparação de variáveis categóricas. Foram incluídos no estudo todos os lactentes e crianças traqueostomizadas com traqueostomia prévias ou realizadas durante internação, no período de julho de 2017 a julho de 2018, que receberam atendimento fonoaudiológico mediante solicitação médica. Resultados: cinquenta e uma crianças foram incluídas no estudo. A maioria das crianças era do sexo masculino (56,9%) e a idade mediana foi de 12 meses, com variação de 01 mês de vida a 12 anos de idade, no momento da avaliação fonoaudiológica. A forma de alimentação na alta fonoaudiológica hospitalar foi descrita em: via oral exclusiva (37%), via oral parcial (25,5%), sonda nasogástrica/nasoenteral (19,6%) e gastrostomia (17,6%). Conclusão: foi possível observar que a dieta por via oral de maneira exclusiva foi a forma de alimentação de maior prevalência na alta fonoaudiológica hospitalar.

VEGF Polymorphisms Related to Higher Serum Levels of Protein Identify Patients with Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the most common primary neoplasia of the liver. Major risk factors for hepatocellular carcinoma include chronic liver diseases, carcinogenic agents, and genetic alterations as well as vascular endothelial growth factor (VEGF) involved in angiogenesis process. The aim of this study was to evaluate the association of VEGF-A (C936T and A1154G) with HCC and cirrhosis, in addition to serum levels of VEGF, clinical profile, lifestyle habits, and comorbidities. A total of 346 individuals were studied: 102 with HCC (G1), 117 with cirrhosis (G2), and 127 controls (G3). Polymorphisms were analysed by PCR/RFLP and serum levels of VEGF by ELISA. Alpha error was set at 5%. The wild-type genotype of both polymorphisms prevailed (P > 0.05). In G1, 23% of the patients died, with no relation to genetic profile (P > 0.05). Increased VEGF level was observed in G1 and G3, related to the mutant allele of VEGF-C936T and VEGF-A1154G, respectively, and compared with the wild-type genotype (P = 0.0285; P = 0.0284, resp.) as well as G1 versus G2 and G3 for VEGF-C936T and G1 versus G2 for VEGF-A1154G (P < 0.05 for both). In conclusion, there is a relationship between mutant alleles of VEGF-C936T and VEGF-A1154G polymorphisms and higher VEGF level, making them potential markers for HCC.

Ações de prevenção primária e secundária relacionadas aos fatores de risco para osteoporose / Primary and secondary prevention actions related to risk factors for osteoporosis / Acciones de prevención primaria y secundaria relacionadas con los factores de riesgo para osteoporosis

Objetivo: Analisar a efetividade do teste da International Osteoporosis Foundation (IOF) para as prevenções primária e secundária relacionadas aos fatores de risco para a osteoporose. Métodos: Estudo transversal realizado no interior de São Paulo, Brasil, durante a Campanha de Prevenção à Osteoporose realizada em outubro de 2016. Participaram 400 pessoas, selecionadas aleatoriamente, entrevistadas de acordo com o teste de um minuto para risco de osteoporose da IOF. A análise estatística utilizou o teste de Kolmogorov-Smirnov, o teste qui-quadrado de Pearson, o Mann-Whitney e a análise multivariada para fatores de risco associados à osteoporose pelo modelo de regressão logística binária. Os resultados foram apresentados em odds ratio, com intervalo de confiança de 95%. Resultados: A amostra foi composta por 260 mulheres e 140 homens, com mediana de 57 anos, e 95% indicaram possuir algum fator de risco. As questões com maior índice de positividade indicaram que ambos os sexos estão expostos à baixa exposição ao sol, à baixa ingesta de alimentos ricos em vitamina D (p=0,140) e ao hábito de atividades físicas por tempo inferior a 30 min (p=0,657). O índice de massa corporal (IMC) menor que 19kg/m2 (p=0,336) indicou menor positividade. A regressão logística mostrou associação entre quatro fatores de risco (densitometria óssea, queda por fraqueza, mudança de altura após os 40 anos e sexo) e a população em estudo acima de 60 anos. Conclusão: O teste da IOF se mostrou uma ferramenta funcional na promoção da saúde e atenção primária, podendo trazer benefícios socioeconômicos.

Objective: To analyze the effectiveness of the International Osteoporosis Foundation (IOF) test for primary and secondary prevention related to risk factors for osteoporosis. Methods: This is a cross-sectional study conducted in the interior of São Paulo, Brazil, during the Osteoporosis Prevention Campaign carried out in October 2016. 400 people, selected at random, interviewed according to the IOF one-minute osteoporosis risk test, participated. Statistical analysis used the Kolmogorov-Smirnov test, Pearson's chi-square test, Mann-Whitney, and multivariate analysis for risk factors associated with osteoporosis using the binary logistic regression model. The results were presented in odds ratios, with a 95% confidence interval. Results: The sample consisted of 260 women and 140 men, with a median of 57 years, and 95% indicated having some risk factor. The questions with the highest positivity index indicated that both sexes are exposed to low exposure to the sun, low intake of foods rich in vitamin D (p=0.140), and the habit of physical activities for less than 30 min (p=0.657 ). The body mass index (BMI) less than 19 kg/m2 (p=0.336) indicated less positivity. Logistic regression showed an association between four risk factors (bone densitometry, fall due to weakness, change in height after 40 years and sex) and the study population over 60 years. Conclusion: The IOF test proved to be a functional tool in promoting health and primary care, and can bring socioeconomic benefits.

Objetivo: Analizar la efectividad de la prueba de la International Osteoporosis Foundation (IOF) para las prevenciones primaria y secundaria relacionadas con los factores de riesgo para osteoporosis. Métodos: Estudio transversal realizado en una ciudad de São Paulo, Brasil, durante la Campaña de Prevención de Osteoporosis realizada en octubre de 2016. Participaron 400 personas que han sido elegidas de modo aleatorio y entrevistadas según la prueba de un minuto para riesgo de osteoporosis de la IOF. El análisis estadístico utilizó la prueba de Kolmogorov-Smirnov, la prueba de Chi-cuadrado de Pearson, la de Mann-Whitney y el análisis multivariado para los factores de riesgo asociados con la osteoporosis por el modelo de regresión logística binaria. Se ha presentado los resultados en odds ratio con intervalo de confianza del 95%. Resultados: La muestra fue de 260 mujeres y 140 hombres con mediana de la edad de 57 años y el 95% indicaron tener algún factor de riesgo. Las preguntas con mayor índice de positividad han indicado que ambos sexos tienen baja exposición solar, baja ingesta de alimentos con vitamina D (p=0,140) y la costumbre de actividades físicas de tiempo menor que 30 min (p=0,657). El índice de masa corporal (IMC) de menos de 19kg/m2 (p=0,336) ha indicado menor positividad. La regresión logística ha mostrado asociación entre cuatro factores de riesgo (densitometría ósea, caída causada por debilidad muscular, cambio de altura después de los 40 años y sexo) y la población del estudio con más de 60 años. Conclusión: La prueba de la IOF se presentó como una herramienta funcional para la promoción de la salud y atención primaria lo que puede llevar a beneficios socioeconómicos.

Análise do padrão de consumo de álcool em usuários da Unidade Básica de Saúde Santo Antônio em São José do Rio Preto / Analysis of alcohol's consumption pattern in users of the Santo Antonio Primary Health Care Unit in São José do Rio Preto

Introdução: o uso nocivo do álcool é um dos fatores de risco de maior impacto em todo o mundo. Segundo pesquisas nacionais, 12% da população brasileira é dependente de álcool, representando uma parcela significativa da população atingida por esta problemática que é um dos mais graves problemas de saúde pública. Objetivo: identificar o padrão de consumo de álcool entre usuários de um serviço de Atenção Primária à Saúde. Metodologia: estudo descritivo com pacientes da Unidade Básica de Saúde (UBS) Santo Antônio em São José do Rio Preto, São Paulo, através de aplicação de questionário AUDIT (Alcohol Use Disorders Identification Test) que foi desenvolvido para rastrear o uso excessivo de álcool e quantificar o consumo e sintomas de dependência do alcoolismo. Foram incluídos pacientes com idade maior ou igual a 18 anos e que aceitaram participar da pesquisa, assinando o Termo de Consentimento Livre e Esclarecido. Resultados: no total, 163 participantes foram incluídos no estudo e os padrões de consumo encontrados foram: 44,4% dos pacientes em zona I (baixo risco); 25,3% em zona II, 9,3% em zona III e 21% em zona IV. Conclusão: foi encontrada uma parcela preocupante de pacientes com índice de uso nocivo e dependência de álcool entre pacientes de uma UBS no noroeste de São Paulo. Este índice foi superior à média nacional. Estes dados serão divulgados junto às autoridades competentes, visando estimular ainda mais a implantação de medidas que visem prevenção e promoção da saúde, quanto ao uso nocivo de bebidas alcoólicas junto à sociedade.

Introduction: the harmful use of alcohol is one of the most impacting risk factors in the world. According to national surveys, 12% of the Brazilian population is alcohol addicted, representing a significant portion of the population affected by one of the most serious public health problems. Objective: to identify the pattern of alcohol consumption among users of a Primary Health Care Unit in Sao Jose do Rio Preto, Sao Paulo. Methodology: a descriptive study was conducted with patients from the Santo Antônio Primary Health Care Unit in São José do Rio Preto, São Paulo, Brazil, through AUDIT (Alcohol Use Disorders Identification Test) questionnaire, an instrument developed to track alcohol abuse and to quantify consumption and symptoms of dependence. Patients older than or equal to 18 years old and who agreed to participate in the study were enrolled, after signing the Informed Consent Term. Results: a total of 163 participants were included in the study and the consumption patterns founded were: 44.4% patients in zone I (low risk); 25.3% in zone II, 9.3% in zone III and 21% in zone IV of the AUDIT. Conclusion: a worrying portion of patients with harmful use and alcohol dependence were found among patients from a Primary Health Care Unit in the northwest of Sao Paulo. This index was higher than the national average. These information will be divulged to the competent authorities, objectifying to encourage the implementation of measures aimed at prevention and health promotion, regarding the harmful use of alcoholic beverages in society

Acute pancreatitis associated with boceprevir: a case report.

Approximately 170 million people are infected with hepatitis C, and the sustained virological response rate to treatment with pegylated interferon and ribavirin is 30-50%. In an attempt to improve the chances of cure, boceprevir is being added to therapy, but it is associated with an increased incidence of adverse events. We herein report a case of acute pancreatitis developed during treatment with pegylated interferon, ribavirin and boceprevir. Boceprevir was the most likely cause of drug-associated pancreatitis after the most common causes were ruled out, since this adverse event had not occurred when the patient had previously been exposed to pegylated interferon and ribavirin and there was no recurrence of the episode of pancreatitis when these two drugs were reintroduced. Acute pancreatitis is a rare adverse event associated with boceprevir therapy, but a potentially fatal event. Sequential determination of pancreatic enzymes should be considered during hepatitis C treatment with boceprevir.

Cursos Preparatórios para os Exames de Residência e a Evasão dos Cenários de Prática: Cadê o Interno que Estava Aqui? / Preparatory Courses for Residency Examinations and the Avoidance of Practical Settings: Where Is the Clerkship Student That Was Here?

RESUMO Embora não seja obrigatória, a residência médica faz parte do processo de ensino e da formação dos médicos e é considerada padrão ouro na modalidade de ensino de pós-graduação lato sensu. Entretanto, o número de vagas para residência médica não acompanhou a expansão dos cursos de graduação em Medicina, gerando uma intensa disputa por uma vaga nos cursos de residência, o que fez proliferar os cursos preparatórios para os exames de residência (CP). A evasão do interno de Medicina de suas atividades acadêmicas para se dedicar às atividades dos cursinhos preparatórios para os exames de residência médica preocupa os docentes. Este estudo tem por objetivo traçar um perfil no internato da Faculdade de Medicina de São José do Rio Preto (Famerp) sobre a adesão dos internos aos CP. Os resultados apontam que a imensa maioria dos 297 alunos pesquisados pretende fazer residência médica e que apenas 27 alunos (84,4%) dos 32 que consideravam o curso de preparação necessário, mas não dispunham de recursos financeiros para frequentá-los. Os entrevistados afirmaram que a maior qualidade dos cursos preparatórios reside na didática das aulas e que a maior desvantagem destes é a dissociação entre conteúdo teórico e prático, também vivida no internato. Concluímos que a percepção dos internos e acadêmicos de Medicina é bem definida quanto aos cursinhos preparatórios para residência médica. Apesar de aderirem à prática destes cursinhos, sabem que há uma dicotomia entre a teoria e a prática oferecida no internato, o que prejudica a formação profissional. A grande maioria dos acadêmicos pesquisados pretende fazer a residência médica após o internato, dando continuidade aos estudos e ao aprendizado. Por outro lado, a atual conjuntura do mercado de trabalho na área da medicina, marcada por uma concorrência acirrada, e as exigências constantes de atualização e aperfeiçoamento levam os acadêmicos a verem na residência o único caminho natural após o internato e ainda uma alternativa para sanar as possíveis deficiências do internato. Mudanças na graduação sugeridas pelos pesquisados, como melhor didática em aulas da graduação e a abordagem de conteúdo teórico durante o internato, refletem a deficiência da graduação e do internato, a qual pode ser sanada com uma postura mais assertiva de professores e preceptores.

ABSTRACT Although not compulsory, medical residency is part through the physicians' teaching and training process. It is considered the gold standard in the teaching modality of Lato Sensu Graduate Programs. However, the number of residency positions available has not kept pace with the expansion of medical undergraduate courses, resulting in high levels of competition for medical residency vacancies, and a proliferation of preparatory courses (PC) offering supervised postgraduate training. The evasion of clerkship students from their academic activities to take prep courses in order to apply for a residency position is a cause for concern among teachers. This study outlines a profile in the São José do Rio Preto (Famerp) School of Medicine internship programme regarding medical interns' adherence to prep courses. The results indicate that the vast majority of the study sample (297 students) intended to apply for a medical residency program. Only 27 (84.4%) out of the 32 students, despite considering the prep course necessary, did not have the financial resources to attend these courses. The interviewees pointed out that the higher quality of prep courses is due to the didactics of the classes, but that the main disadvantage of these classes is the dissociation between the theoretical and practical content, also experienced during the internship. We conclude that the perceptions of the interns and medical students is well defined in relation to prep courses to get into a medical residency. Although they adhere to the practice of these courses, they know that there is a dichotomy between the theory and the practice that is offered in the internship, and that this hinders their professional training. The vast majority of the study sample intended to apply for the medical residency program after the internship, continuing their studies and learning. On the other hand, the current environment of the job market in the field of medicine, marked by fierce competition and constant requirements to update and improve, is leading students to view the medical residency as the only natural way to continue after the internship. They also see it as a way of making up for any shortfalls of the internship program. Changes in undergraduate courses, such as a better class didactics and the approach to theoretical content during the internship, reflect the deficiency of undergraduate courses and the internship program, but which can be remedied with a more assertive attitude on the part of teachers and preceptors.

Fibromialgia: atividade física, depressão e qualidade de vida / Fibromyalgia: physical activity, depression and quality of life

A fibromialgia (FM), doença caracterizada por dor musculoesquelética difusa acompanhada de outros sintomas não relacionados ao aparelho locomotor, apresenta prevalência no Brasil de 2,5%. Objetivo: avaliar a prática de atividade física, os sintomas de depressão e a qualidade de vida em pacientes com FM. Tipo de estudo: Estudo observacional retrospectivo. Método: Participaram do estudo 50 pacientes adultos com diagnóstico de FM de acordo com os critérios de classificação do American College of Rheumatology (ACR), sendo excluídos os que apresentaram comorbidades. Após aprovação do projeto pelo Comitê de Ética em Pesquisa, pacientes que compareceram à consulta de rotina em consultório privado de reumatologia e atenderam aos critérios de inclusão foram convidados a participar do estudo. A análise dos dados foi realizada por meio dos testes Kruskal-Wallis, Mann-Whitney e coeficiente de correlação de Pearson. Valores de P<0,05 foram considerados significantes. Resultados: Houve predominância do sexo feminino, idade média de 47 anos, etnia branca, estado civil casado e com filhos. O resultado da EVA variou entre 0 (n=9) a 8 (n=6). O FIQ variou entre 0 e 86,7 e o BDI total entre 0 e 26. A BDI-13 variou entre 0 e 22. Houve correlação positiva do escore do BDI-13 com o FIQ-total e do BDI-13 com o escore EVA. Conclusão: Os dados não sugerem impacto significativo da atividade física na melhora dos sintomas de dor, qualidade de vida e depressão em pacientes com fibromia (AU)

Fibromyalgia (FM) is a disease characterized by widespread musculoskeletal pain that can be accompanied by several other symptoms not related to the musculoskeletal system and its predominance in Brazil is of 2,5%. Objective: Evaluate the performance in physical activity, symptoms of depression and life quality in patients with FM. Type of study: Retrospective observational study. Method: fifty adult patients that were diagnosed with FM according to the American College of Rheumatology (ACR) criteria. Patients who presented comorbidities were excluded of the study. After the project being approved by the research ethics committee, patients with fibromyalgia that attended a routine doctor's visit in a private rheumatologic office and met the inclusion criteria were invited to take part in the study. The data analysis was done with the Kruskal­Wallis test, Mann-Whitney e coefficient and correlation Person test. Values of P< 0,05 were considered significant. Results: Female predominance, white ethnicity, average age of 47 (±13) years old, married, and with children. Physical activity (56% of participants), physical activity measured by IPAQ short version showed that 24% of participants presented low level, 42% moderate and 24% high. VAS varied score between 0 (n=9) and 8 (n=6). Significant statistic (p=0,44) was not observed when compared with VAS and IPAQ. The FIQ score varied between 0 and 86,7. The total BDI score varied between 0 and 26. The Affective-cognitive subscale (BDI-13) varied between 0 and 22. Statistic difference was not observed when compared with BDI total and BDI-13 with IPAQ. There was positive correlation of BDI-13 score with the total FIQ and the BDI13 with VAS score. Conclusion: Benefit of physical activity was not demonstrated in the symptoms of pain relief, neither life quality nor depression in patients with fibromyalgia. This result might be related to the inaccuracy of the IPAQ method used to quantify the intensity of physical activity self-reported by the patients. (AU)

AIDS depois dos 50 anos: incidência de 2003 a 2013 em São José do Rio Preto, SP, e a percepção dos idosos de uma Unidade Básica de Saúde sobre a doença / AIDS after the age of 50: incidence from 2003 to 2013 in the city of São José do Rio Preto, São Paulo, and the perception on the disease of the elderly of a Basic Health Care Unit

Os avanços da medicina e da tecnologia favorecem o envelhecimento, prolongando a sexualidade. Concomitantemente, crescem os casos de AIDS nesta população desassistida sobre o assunto. Objetivo: Calcular a incidência de AIDS em pessoas com 50 anos ou mais em São José do Rio Preto - SP e verificar o conhecimento dessas pessoas sobre a doença em uma Unidade Básica de Saúde. Métodos: Estudo retrospectivo da incidência de AIDS a partir dos casos notificados no sistema eletrônico da Secretaria de Saúde do Estado de São Paulo entre 2003 e 2013. A percepção dos idosos sobre a doença foi avaliada mediante a aplicação de questionários, antes e após intervenção educativa (panfleto). Os dados foram comparados utilizando-se o teste Qui-quadrado de McNemar. Resultados: De 2003 a 2013, foram notificados 224 casos novos de AIDS na população estudada, com predomínio do sexo masculino. Embora tenha ocorrido certa oscilação na incidência, ao se comparar o início e o final do período estudado observou-se decréscimo de 68% na notificação destes novos casos. Responderam aos questionários 34 homens e 66 mulheres entre 50 e 88 anos. A maioria (59%) referiu ter parceiro fixo e negou a utilização de preservativos (87%). Após a atividade educativa, apenas 5% continuaram com dúvidas e 68% demonstraram interesse em obter informações sobre DTS na UBS. Conclusão: Nota-se instabilidade na incidência de AIDS no município; contudo, no período estudado ocorreu diminuição significativa dos casos. A maioria dos entrevistados não possuía conhecimentos sobre a AIDS, mas os panfletos se mostraram uma ferramenta simples e eficaz.

The advances in medicine and technology favor aging, thus prolonging sexuality. Concomitantly, AIDS cases present growth on such an unassisted population. Objective: To estimate the incidence of AIDS in people aged 50 years of more in the city of São José do Rio Preto, São Paulo, and to verify their knowledge about the disease in a Basic Health Care Unit (Unidade Básica de Saúde). Methods: A retrospective study of AIDS incidence based on cases reported in the electronic system of the São Paulo State Health Department between 2003 and 2013. The elderly perception on the disease was evaluated through questionnaires, before and after the educational intervention (leaflets). Data were compared using the McNemar Chi-square test. Results: From 2003 to 2013, 224 new cases of AIDS were reported in the studied population, with a predominance of males. Although there was some oscillation in the incidence, a comparison between the beginning and the end of the studied period revealed a 68% decrease in new notified cases. Questionnaires were answered by 34 men and 66 women ranging 50 to 88 years of age. Most of them (59%) reported having a steady partner and denied the use of condom (87%). After the educational activity, only 5% remained in doubt and 68% showed interest in obtaining information about STDs at the Basic Health Care Unit. Conclusion: An instability in the incidence of AIDS was observed within the city; however, during the studied period there was a significant reduction in cases. Most of the interviewees did not know about AIDS, and the leaflets proved to be a simple and effective tool.