Clinical and epidemiological aspects of Candida yeast infections and rational use of antifungals.

Aim: The objective of this study was to evaluate the clinical and epidemiological aspects of Candida infections. Methods: The study relied on the analysis of electronic medical records. Results: Among 183 patients with positive fungal infections, 57 were from the community and 126 from hospitals. Females predominated in both groups (82.4% in the community, 54.7% in hospitals). Non-albicans Candida spp. accounted for 62.8% of cases. Antifungal therapy was prescribed for 67 patients, with a 55.6% mortality rate. Conclusion: The increasing prevalence of non-albicans Candida species highlights the need for better candidiasis monitoring and control, especially concerning antifungal use amidst rising antimicrobial resistance, particularly in empirical therapy scenarios.

Fungal infections, particularly those caused by a group of yeasts called Candida, are a major concern. This study looks at clinical laboratory and medical records. We found that certain species of Candida not previously associated with human disease are common. We also noted the inappropriate use of antifungal medication, highlighting the need for healthcare workers to carefully diagnose patients and make appropriate decisions when treating fungal infections.

Return to play after anterior cruciate ligament reconstruction / Retorno ao esporte após a reconstrução do ligamento cruzado anterior / Retorno al deporte después de reconstrucción del ligamento cruzado anterior

ABSTRACT The anterior cruciate ligament (ACL) tear represents more than half of all knee injuries in sports that involve body rotations and sudden changes of direction. Discharging the athlete for return to play (RTP) post-ACL reconstruction (ACLR) is a difficult task with multidisciplinary responsibility. For many years, a six-month period post-ACLR was adopted as the only criterion for RTP. However, it is now suggested that RTP should not be exclusively time-based, but to clinical data and systematic assessments. Despite the importance of post-ACLR factors for RTP, pre- and peri-ACLR factors must also be considered. Historically, ACLR is performed with the hamstring or autologous patellar tendons, although the choice of graft is still an open and constantly evolving theme. Anterolateral ligament reconstruction and repair of meniscal ramp tear associated with ACLR have recently been suggested as strategies for improving knee joint stability. Subjective questionnaires are easy to apply, and help identify physical or psychological factors that can hamper RTP. Functional tests, such as hop tests and strength assessment by means of isokinetic dynamometers, are fundamental tools for decision making when associated with clinical evaluation and magnetic resonance imaging. Recently, the capacity to generate force explosively has been incorporated into the muscle strength assessment. This is quantified through the rate of torque development (RTD). Due to characteristics inherent to the practice of sport, there is an extremely short time available for produce strength. Thus, RTD seems to better represent athletic demands than the maximum strength assessment alone. This review investigates the pre-, peri- and post-ACLR factors established in the literature, and shares our clinical practice, which we consider to be best practice for RTP. Level of evidence V; Specialist opinion.

RESUMO A ruptura do ligamento cruzado anterior (LCA) representa mais da metade das lesões do joelho em esportes que envolvem rotações e mudanças repentinas de direção. A liberação do atleta para o retorno ao esporte (RAE) depois da reconstrução do LCA (RLCA) é uma tarefa difícil, de responsabilidade multidisciplinar. Por muitos anos, o período de seis meses pós-RLCA foi utilizado como único critério para RAE. Contudo, atualmente, sugere-se que o RAE não deve estar atrelado exclusivamente ao tempo, mas a dados clínicos e avaliações sistemáticas. Apesar da importância dos fatores pós-RLCA para o RAE, os fatores pré- e peri-RLCA também devem ser contemplados. Historicamente, a RLCA é realizada com tendões isquiotibiais ou patelares autólogos, apesar da escolha do enxerto ainda ser um tema em aberto e em constante evolução. Recentemente, a reconstrução do ligamento anterolateral e o reparo da lesão na rampa meniscal associadas à RLCA têm sido sugeridas como estratégias para melhorar a estabilidade articular do joelho. Questionários subjetivos são de fácil aplicação e ajudam a identificar fatores físicos ou psicológicos que possam dificultar o RAE. Testes funcionais como os hop tests e a avaliação de força com dinamômetros isocinéticos são ferramentas fundamentais na decisão quando aliadas à avaliação clínica e de ressonância magnética. Recentemente, tem-se incorporado ao escopo de avaliação da força muscular a capacidade de gerar força de maneira explosiva, mensurada através da taxa de desenvolvimento de torque (TDT). Devido a características inerentes a prática esportiva os tempos disponíveis para produção de força são demasiadamente pequenos e, sendo assim, a TDT parece representar melhor as demandas esportivas do que a avaliação isolada de força máxima. Nesta revisão, foram reunidos fatores pré, peri e pós-RLCA estabelecidos na literatura, assim como foi compartilhada nossa prática clínica, que consideramos ser a melhor para o RAE. Nível de evidência V; Opinião do especialista.

RESUMEN La ruptura del ligamento cruzado anterior (LCA) representa más de la mitad de las lesiones de rodilla en deportes que involucran rotaciones y cambios repentinos de dirección. La liberación del atleta para el retorno al deporte (RAD) después de la reconstrucción del LCA (RLCA) es una tarea difícil, de responsabilidad multidisciplinaria. Durante muchos años, el período de seis meses post-RLCA fue usado como único criterio para RAD. Sin embargo, actualmente, se sugiere que el RAD no debe estar vinculado exclusivamente al tiempo, sino a datos clínicos y evaluaciones sistemáticas. A pesar de la importancia de los factores post-RLCA para el RAD, también deben ser contemplados los factores pre y peri-RLCA. Históricamente, la RLCA es realizada con tendones isquiotibiales o patelares autólogos, a pesar de que la elección del injerto aún sea un tema abierto y en constante evolución. Recientemente, la reconstrucción del ligamento anterolateral y la reparación de la lesión en la rampa meniscal asociadas a la RLCA han sido sugeridas como estrategias para mejorar la estabilidad articular de la rodilla. Los cuestionarios subjetivos son de fácil aplicación y ayudan a identificar los factores físicos o psicológicos que pueden dificultar el RAD. Los tests funcionales como los hop tests y la evaluación de fuerza con dinamómetros isocinéticos son herramientas fundamentales en la decisión cuando se combinan a la evaluación clínica y de resonancia magnética. Recientemente, se ha incorporado al alcance de evaluación de la fuerza muscular, la capacidad de generar fuerza de manera explosiva, medida a través de la tasa de desarrollo de torque (TDT). Debido a características inherentes a la práctica deportiva, los tiempos disponibles para producción de fuerza son demasiado pequeños y, siendo así, la TDT parece representar mejor las demandas deportivas que la evaluación aislada de fuerza máxima. En esta revisión fueron reunidos factores pre, peri y post-RLCA establecidos en la literatura, así como fue compartida nuestra práctica clínica, que consideramos la mejor para el RAD. Nivel de evidencia V; Opinión del especialista.

Musculoskeletal injuries in athletes from five modalities: a cross-sectional study.

BACKGROUND: Musculoskeletal injuries (MSK-I) are a serious problem in sports medicine. Modifiable and non-modifiable factors are associated with susceptibility to these injuries. Thus, the aim of this study was to describe the prevalence of and identify the factors associated with MSK-I, including tendinopathy and joint and muscle injuries, in athletes. METHODS: In this cross-sectional observational study, 627 athletes from rugby (n = 225), soccer (n = 172), combat sports (n = 86), handball (n = 82) and water polo (n = 62) were recruited at different sports training centres and competitions. Athlete profiles and the prevalence of MSK-I were assessed using a self-reported questionnaire. Only previous MSK-I with imaging confirmation and/or a positive physical exam by a specialized orthopaedist were considered. The association of the epidemiological, clinical and sports profiles of athletes with MSK-I was evaluated by a logistic regression model. RESULTS: The mean age was 25 ± 6 years, and 60% of the athletes were male. The epidemiological, clinical and sports profiles of the athletes were different for the five sport groups. The MSK-I prevalence among all athletes was 76%, with 55% of MSK-I occurring in a joint, 48% occurring in a muscle and 30% being tendinopathy, and 19% of athletes had three investigated injuries. The MSK-I prevalence and injury locations were significantly different among sport groups. There was a predominance of joint injury in combat sports athletes (77%), muscle injury in handball athletes (67%) and tendinopathy in water polo athletes (52%). Age (≥30 years) was positively associated with joint (OR = 5.2 and 95% CI = 2.6-10.7) and muscle (OR = 4.9 and 95% CI = 2.4-10.1) injuries and tendinopathy (OR = 4.1 and 95% CI = 1.9-9.3). CONCLUSION: There is a high prevalence of tendinopathy and joint and muscle injuries among rugby, soccer, combat sports, handball and water polo athletes. The analysis of associated factors (epidemiological, clinical and sports profiles) and the presence of MSK-I in athletes suggests an approximately 4-5-fold increased risk for athletes ≥30 years of age. The identification of modifiable and non-modifiable factors can contribute to implementing surveillance programmes for MSK-I prevention.

Prevalência e resistência a antibióticos de Stenotrophomonas maltophilia em amostras clínicas: estudo epidemiológico de 10 anos / Epidemiological and physiological characteristics of clinical isolates of Stenotrophomonas maltophilia: 10 years study

Introdução:Stenotrophomonas maltophilia é um patógeno oportunista emergente, associado, principalmente, a infecções nosocomiais. As opções terapêuticas para o tratamento de infecções por S. maltophilia são limitadas, devido a sua resistência a uma grande variedade de antibióticos. Objetivo: Investigar a prevalência e a resistência aos antibióticos de isolados identificados como S. maltophilia, a partir de pacientes hospitalizados, recuperados em um laboratório clínico, localizado em Juiz de Fora ­ Minas Gerais, bem como analisar dados epidemiológicos destes pacientes. Materiais e Métodos: Isolados consecutivos, não duplicados de S. maltophilia (n=58), referentes ao período de 10 anos foram analisados. Todas as amostras foram identificadas utilizando o sistema automatizado Vitek 2® Compact (BioMérieux/França). Os padrões de resistência aos antibióticos foram realizados utilizando o método de disco difusão. Os prontuários dos pacientes foram avaliados e dados como idade, sexo, espécime clínico, bem como índice de óbito intra-hospitalar atribuído à infecção por S. maltophilia foi igualmente analisado. Resultados: De um total de 39.547 (100%) espécimes clínicos analisados, 58 (0,14%) isolados não replicados foram identificados como S. maltophilia. 70,6% dos isolados de S. maltophilia foram isolados de secreção traqueal e 15,5% de sangue.Todas as amostras foram sensíveis, in vitro, aos antibióticos testados. Frequência de óbito intra-hospitalar associado à infecção por S. maltophilia foi de 44,7%. Indivíduos de ampla faixa etária (0-100 anos) foram acometidos por infecção por S. maltophilia, sendo o sexo feminino o mais prevalente (56,9%). Conclusão: Pneumonia e bacteremia foram as síndromes clínicas mais frequentes causadas por S. maltophila. Constatou-se moderada taxa de mortalidade associada a infecções por S. maltophilia, apesar da alta sensibilidade in vitro aos antibióticos testados. Novos trabalhos se fazem necessários, a fim de gerar dados e informações que possam ser úteis no diagnóstico precoce, manejo e tratamento correto de infecções associadas a S. maltophilia, em especial aquelas com perfil de resistência aos antibóticos.

Introduction:Stenotrophomonas maltophilia is an emerging opportunistic pathogen, mainly associated with nosocomial infections. Therapeutic options for the treatment of S. maltophilia infections are limited because of their resistance to a wide variety of antibiotics. Objective: To investigate the prevalence and antibiotic resistance of isolates identified as S. maltophilia from hospitalized patients recovered from a clinical laboratory located in Juiz de Fora - Minas Gerais, as well as to analyze epidemiological data of these patients. Materials and Methods: Consecutive, non duplicate isolates of S. maltophilia (n=58) for the 10-year period were analyzed. All samples were identified using the automated Vitek 2® Compact system (BioMérieux/France). Antibiotic resistance standards were performed using the disk diffusion method. Patient records were evaluated and data such as age, gender, clinical specimen, and in-hospital death rate attributed to S. maltophilia infection were also analyzed. Results: From a total of 39,547 (100%) clinical specimens analyzed, 58 (0,14%) unreplicated isolates were identified as S. maltophilia. 70,6% of S. maltophilia isolates were isolated from tracheal secretion and 15,5% from blood. All samples were sensitive in vitro to the antibiotics tested. In-hospital death frequency associated with S. maltophilia infection was 44,7%. Individuals from a wide age range (0-100 years) were affected by S. maltophilia infection, with females being the most prevalent (56,9%). Conclusion: Pneumonia and bacteremia were the most frequent clinical syndromes caused by S. maltophila. A moderate mortality rate associated with S. maltophila infections was observed, despite the high sensitivity in vitro to the antibiotics tested. New studies are necessary in order to generate data and information that may be useful in early diagnosis, management and correct treatment of infections associated with S. maltophila, especially those with a profile of antibiotic resistance.

Epidemiological, Physiological, and Molecular Characteristics of a Brazilian Collection of Carbapenem-Resistant Acinetobacter baumannii and Pseudomonas aeruginosa.

Nonfermenting Gram-negative bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii are widespread in the environment and are increasingly associated with nosocomial infections, often associated with multidrug-resistance phenotypes. This study aimed to evaluate epidemiological, physiological, and molecular characteristics of carbapenem resistance in P. aeruginosa and A. baumannii. In total, 63 nonreplicated strains (44 A. baumannii and 19 P. aeruginosa) were isolated from hospitalized patients. Antimicrobial resistance patterns, biocide tolerance, oxidative stress, hemolytic activity, and biofilm formation were assessed. Genetic markers related to ß-lactamase synthesis, efflux systems, and porin loss were screened by PCR. Epidemiological data of patients were analyzed. Advanced age, intensive care unit admission, invasive medical devices, treatment with fluoroquinolones or ß-lactams/ß-lactamase inhibitor combinations, and prolonged hospital stay were predisposing factors for infection. Colistin showed to be active in vitro against these bacteria. Carbapenem-resistant P. aeruginosa strains did not show hemolytic activity and were less tolerant to oxidative stress and biocides. However, increased ability of biofilm formation was observed, comparing to the carbapenem-susceptible isolates. Genetic markers related to oxacillinases synthesis (OXA-23 and OXA-143), oprD absence, and efflux pump (adeB) were detected in carbapenem-resistant A. baumannii. Screening for OXA-51-like gene was performed as confirmatory test for A. baumannii identification. In P. aeruginosa genes encoding efflux pumps (MexAB-OprM, MexCD-OprJ, MexEF-OprN, and MexXY-OprM) and SPM-1 were found; besides, oprD absence was also observed. Our results suggest that these organisms are well adapted to different environments and confirm the difficulty of therapeutic management of patients with infections associated with multidrug-resistant microorganisms, with direct impact on mortality and epidemiological control of these strains in health centers.

Physiological and molecular characteristics of carbapenem resistance in Klebsiella pneumoniae and Enterobacter aerogenes.

INTRODUCTION: Bacterial resistance is a growing concern in the nosocomial environment in which Klebsiella pneumoniae and Enterobacter aerogenes play an important role due to their opportunism and carbapenemase-production. This work aimed to evaluate physiological and molecular characteristics of carbapenem-resistant K. pneumoniae and E. aerogenes isolated in a Brazilian tertiary hospital. METHODOLOGY: In total, 42 carbapenem-resistant bacteria isolated from clinical specimens were included (21 K. pneumoniae and 21 E. aerogenes). Drug-sensitive K. pneumoniae (n = 27) were also included. Antimicrobial susceptibility and biocide tolerance patterns, hemolytic activity, tolerance to oxidative stress, and aggregative ability were assessed. Genetic markers related to carbapenem resistance, or ESBL-production were screened by PCR. RESULTS: Compared to drug-sensitive strains, carbapenem-resistant K. pneumoniae were more tolerant to biocides and to oxidative stress, and they displayed an increase in biofilm formation. The genetic markers blaKPC (95.2%) and blaTEM (90.5%) were the most frequent. Among the carbapenem-resistant E. aerogenes strains, blaKPC, and blaTEM were detected in all bacteria. Drug-sensitive E. aerogenes were not isolated in the same period. blaSHV, blaVIM, and blaCTX markers were also observed among carbapenem-resistant bacteria. CONCLUSIONS: Results suggest that carbapenemase-producing enterobacteria might show peculiar characteristics regarding their physiology associated with their environmental persistency, virulence, and multidrug resistance. The observed phenomenon may have implications not only for antimicrobial chemotherapy, but also for the prognosis of infectious diseases and infection control.

Approach to dizziness in internal medicine: a systematic review / Revisão sistemática da abordagem da tontura em clínica médica

BACKGROUND AND OBJECTIVES: One of the most common complaints physicians face is dizziness. Patients with dizziness may have an array of conditions, from benign vertigo to potentially fatal cardiac arrhythmias, and including diverse conditions such as Parkinson`s disease and hyponatremia. This is a systematic review of the classification of dizziness, aiming at a more efficient and comprehensive clinical management of the condition, prompted from the presentation of an actual clinical case. METHODS: A 63-year-old man, with a 1-year history of dizziness predominantly on walking, was presented. The complaint prompted a search of the Pubmed and Scielo databases, for flow-charts and systematizations of the approach to the condition. RESULTS: Some approaches were identified that were useful in primary care, chiefly Drachman`s 4-type classification, which minimizes diagnostic biases. The clinical case was then discussed according to the information found, and a sequence of physical examination maneuvers, to beimplemented whenever a patient with dizziness is seen, waspresented. CONCLUSION: Approaching a patient complaining of dizziness and making its differential diagnosis is a huge intellectual challenge to any physician. There are tools that allow for correct classification of the patients, reduce diagnostic biases, discourage incorrect treatments and reduce expenses...

JUSTIFICATIVA E OBJETIVOS: Uma das queixas mais prevalentes e que mais confunde médicos é a tontura. Esses pacientes podem ter desde vertigens benignas até arritmias cardíacas potencialmente fatais, passando ainda por condições tão diversas quanto a doença de Parkinson e a hiponatremia. Este estudo tem por objetivo apresentar uma revisão sistemática sobre as classificações das tonturas, de forma a permitir uma abordagem clínica mais eficiente e abrangente, a partir da apresentação de um caso clínico real. MÉTODOS: é apresentado um paciente de 63 anos com queixa de tontura há cerca de 1 ano, principalmente para caminhar. A partir do quadro, foi feita revisão sistemática da literatura no Pubmed e Scielo, buscando os fluxogramas e sistematizações disponíveis para a abordagem da tontura. RESULTADOS: foram encontradas algumas formas de abordagem da tontura, muito úteis em atenção primária e clínica médica, especialmente a classificação nas 4 categorias de Drachman, a qual minimiza os vieses diagnósticos. Por fim, foi exposto o desfecho e a discussão do caso, juntamente com uma sugestão de sequência de exame físico a ser realizada em todo paciente com tontura. CONCLUSÃO: Saber abordar essa queixa e realizar seu diagnóstico diferencial é um grande desafio intelectual ao médico de qualquer especialidade. Há ferramentas disponíveis que permitem enquadrar o paciente em categorias, evitando vieses diagnósticos, tratamentos incorretos e gastos desnecessários...

A Brazilian original pedagogical approach to the teaching of neurology.

UNLABELLED: The two-arm Clinical Decisions/Diagnostic Workshop (CD/DW) approach to undergraduate medical education has been successfully used in Brazil. OBJECTIVE: Present the CD/DW approach to the teaching of stroke, with the results of its pre-experimental application and of a comparative study with the traditional lecture-case discussion approach. METHOD: Application of two questionnaires (opinion and Knowledge-Attitudes-Perceptions-KAP) to investigate the non-inferiority of the CD/DW approach. RESULTS: The method was well accepted by teachers and students alike, the main drawback being the necessarily long time for its completion by the students, a feature that may better cater for different educational needs. The comparative test showed the CD/DW approach to lead to slightly higher cognitive acquisition as opposed to the traditional method, clearly showing its non-inferiority status. CONCLUSION: The CD/DW approach seems to be another option for teaching neurology in undergraduate medical education, with the bonus of respecting each learner`s time.

A Brazilian original pedagogical approach to the teaching of neurology / Uma abordagem pedagógica original brasileira para o ensino da neurologia

The two-arm Clinical Decisions/Diagnostic Workshop (CD/DW) approach to undergraduate medical education has been successfully used in Brazil. Objective Present the CD/DW approach to the teaching of stroke, with the results of its pre-experimental application and of a comparative study with the traditional lecture-case discussion approach. Method Application of two questionnaires (opinion and Knowledge-Attitudes-Perceptions-KAP) to investigate the non-inferiority of the CD/DW approach. Results The method was well accepted by teachers and students alike, the main drawback being the necessarily long time for its completion by the students, a feature that may better cater for different educational needs. The comparative test showed the CD/DW approach to lead to slightly higher cognitive acquisition as opposed to the traditional method, clearly showing its non-inferiority status. Conclusion The CD/DW approach seems to be another option for teaching neurology in undergraduate medical education, with the bonus of respecting each learner`s time. .

O método Decisões Clínicas/Oficinas Diagnósticas (DC/OD) é usado com sucesso na graduação médica no Brasil. Objetivo Apresentar o método DC/OD usando o exemplo do Acidente Vascular Encefálico, assim como os resultados de sua aplicação pré-experimental e de um estudo comparativo com o método tradicional (aula mais discussão de casos). Método Aplicação de questionários de opiniões e de questionários de conhecimentos, atitudes e percepções para investigar a não inferioridade do método DC/OD. Resultados DC/OD foi bem aceito por professores e estudantes. A principal crítica foi o tempo necessariamente longo para os estudantes completá-lo, característica que pode atender às diferentes necessidades educacionais. O estudo comparativo demonstrou que o método DC/OD levou a uma aquisição cognitiva maior que o tradicional, demonstrando sua não inferioridade. Conclusão O método DC/OD parece ser uma alternativa para o ensino da neurologia na graduação médica, com a vantagem de respeitar o diferente tempo de aprendizado dos estudantes. .

Abdome agudo: diagnóstico sindrômico / Acute abdome: syndromic diagnosis

O objetivo do capítulo é facilitar o diagnostico etiológico do quadro de abdome agudo na sala de emergência. Será apresentado um algoritmo para melhor sistematização do diagnóstico, uma vez que abdome agudo é um dos motivos mais comuns que levam um paciente ao atendimento de emergência.

The purpose of this work is to facilitate etiologic diagnosis of acute abdomen in the emergency room. Showing an algorithm to better systematize of the diagnosis, since acute abdomen is one of the most common reasons that lead a patient to emergency care.

Fraturas expostas: classificação e manejo / Exposed fractures: classification and management

Apesar de bastante comuns no dia-a-dia de profissionais que lidam com o atendimento de trauma, as fraturas expostas despertam muitas dúvidas, principalmente aos olhos de profissionais não especialistas que se deparam diariamente com estes casos nas emergências. Este artigo traz uma revisão e um guia para o diagnóstico e o manejo dessas lesões.

Although very common between professionals that deal with trauma care on a daily basis, open fractures bring up several questions, mainly when seen through the eyes of non-specialists who face these cases on emergencies every day. This paper brings a review and a guide for diagnosis and management of these injuries.

Streptococcus agalactiae em gestantes: incidência em laboratório clínico de Juiz de Fora (MG) - 2007 a 2009 / Streptococcus agalactiae in pregnant women: incidence in the clinical laboratory of Juiz de Fora (MG) - 2007 to 2009

Streptococcus agalactiae ou estreptococos do grupo B de Lancefield (EGB) foi descrito inicialmente como um importante agente da mastite bovina. Esta bactéria pode ser encontrada no trato gastrintestinal, pele, vias respiratórias superiores e aparelho urogenital de seres humanos. Sua relevância clínica está associada à possibilidade de transmissão para recém-nascidos, durante o parto, ocasionando diversas doenças, como sepse, meningite, pneumonia e osteomielite. A prevalência da colonização materna pelo EGB no Brasil varia de 14,9 a 21,6%, sendo que a mundial varia de 10 a 30 %. O objetivo do trabalho é traçar a evolução da frequência de colonização pelo EGB em parturientes atendidas em um serviço de microbiologia clínica de Juiz de Fora (MG), no período de 2007 a 2009. Os espécimes clínicos (material vaginal e ou anal) foram recuperados de 911 gestantes e processados utilizando-se técnicas de cultura microbiológica clássica. As colônias sugestivas de EGB foram submetidas à identificação bioquímica através do sistema automatizado ATB Expression (bioMerieux, França). Das 911 gestantes avaliadas, 16,6% exibiram cultura positiva para EGB. O ano de 2009 apresentou o maior índice de solicitações médicas (39,9% ; 363 solicitações) e mais alta taxa de incidência de colonização materna (27,5%). Concluiu-se que o EGB é um micro-organismo prevalente entre as parturientes atendidas em um serviço de microbiologia clínica de Juiz de Fora. Entretanto, face ao crescimento do número de detecções do EGB, torna-se fundamental o reconhecimento, por parte do Ministério da Saúde, da importância de se incluir no programa de pré-natal a estratégia de detecção laboratorial de colonização das gestantes por EGB.

Emergency EEG: study of survival.

OBJECTIVE: To determine the survival rate according to the main findings of emergency electroencephalography (EEGs) of patients treated in a tertiary hospital. METHOD: In this prospective study, the findings of consecutive emergency EEGs performed on inpatients in Hospital de Base in São José do Rio Preto, Brazil were correlated with survival utilizing Kaplan-Meyer survival curves. RESULTS: A total of 681 patients with an average age of 42 years old (1 day to 96 years) were evaluated, of which 406 were male. The main reasons for EEGs were epileptic seizures (221 cases), hepatic encephalopathy [116 cases of which 85 (73.3%) were men, p-value=0.001], status epilepticus (104 cases) and impaired consciousness (78 cases). The underlying disease was confirmed in 578 (84.3%) cases with 119 (17.5%) having liver disease [91 (76.0%) were men, p-value=0.001], 105 (15.4%) suffering strokes, 67 (9.9%) having metabolic disorders, 51 (7.5%) central nervous system infections and 49 (7.2%) epilepsy. In the three months following EEG, a survival rate of 75% was found in patients with normal, discreet slow activity or intermittent rhythmic delta activity EEGs, of 50% for those with continuous delta activity and generalized epileptiform discharges, and of 25% for those with burst-suppression, diffuse depression, and in alpha/theta-pattern coma. Death was pronounced immediately in patients with isoelectric EEGs. CONCLUSION: The main findings of EEGs, differentiated different survival rates and are thus a good prognostic tool for patients examined in emergencies.

Emergency EEG: study of survival / EEG de urgência: taxa de sobrevivência

OBJECTIVE: To determine the survival rate according to the main findings of emergency electroencephalography (EEGs) of patients treated in a tertiary hospital. METHOD: In this prospective study, the findings of consecutive emergency EEGs performed on inpatients in Hospital de Base in São José do Rio Preto, Brazil were correlated with survival utilizing Kaplan-Meyer survival curves. RESULTS: A total of 681 patients with an average age of 42 years old (1 day to 96 years) were evaluated, of which 406 were male. The main reasons for EEGs were epileptic seizures (221 cases), hepatic encephalopathy [116 cases of which 85 (73.3 percent) were men, p-value=0.001], status epilepticus (104 cases) and impaired consciousness (78 cases). The underlying disease was confirmed in 578 (84.3 percent) cases with 119 (17.5 percent) having liver disease [91 (76.0 percent) were men, p-value=0.001], 105 (15.4 percent) suffering strokes, 67 (9.9 percent) having metabolic disorders, 51 (7.5 percent) central nervous system infections and 49 (7.2 percent) epilepsy. In the three months following EEG, a survival rate of 75 percent was found in patients with normal, discreet slow activity or intermittent rhythmic delta activity EEGs, of 50 percent for those with continuous delta activity and generalized epileptiform discharges, and of 25 percent for those with burst-suppression, diffuse depression, and in alpha/theta-pattern coma. Death was pronounced immediately in patients with isoelectric EEGs. CONCLUSION: The main findings of EEGs, differentiated different survival rates and are thus a good prognostic tool for patients examined in emergencies.

OBJETIVO: Determinar a taxa de sobrevivência (TS), segundo os principais achados de eletrencefalograma de urgência (E-EEG), dos pacientes atendidos nas emergências de hospital de alta complexidade. MÉTODO: Estudo prospectivo, por ordem de chegada, da correlação entre os achados de E-EEG, feitos nos pacientes à beira do leito, com TS, utilizando-se as curvas de sobrevidas de Kaplan Meyer no Hospital de Base de São José do Rio Preto, São Paulo/Brasil. RESULTADOS: Foram estudados 681 pacientes, dos quais 406 (59,6 por cento) masculinos, com idade média de 42 anos (1 dia a 96 anos). As principais motivações para o E-EEG foram crises epilépticas (221 casos), encefalopatia hepática [(116 casos, dos quais 85 masculinos (73,3 por cento), p= 0,001]; estado de mal epiléptico 104 e rebaixamento de consciência 78. O diagnóstico da doença de base foi confirmado em 578 (84,3 por cento), sendo 119 (17,5 por cento) hepatopatia, dos quais 91 (76, por cento) masculinos, p= 0,001; 105 (15,4 por cento) acidente vascular encefálico; 67 (9,9 por cento) distúrbio metabólico; 51 (7,5 por cento) infecção do sistema nervoso central e 49 (7,2 por cento) epilepsia. TS de 75 por cento nos três primeiros meses foi encontrada nos pacientes com E-EEG com alentecimento discreto ou com atividade delta rítmica intermitente. TS por volta de 50 por cento nos três meses foi encontrado nos pacientes com E-EEG com delta contínuo, crítico e com descargas periódicas. A TS foi menor que 25 por cento nos dois primeiros meses após E-EEG, nos pacientes com E-EEG com surto/supressão, com depressão difusa e com comas alfa/teta e 0 por cento nos E-EEG iselétricos. CONCLUSÃO: O E-EEG, com seus principais achados, foi capaz de diferenciar as diversas taxas de sobrevivências na amostra estudada, constituindo-se, portanto, bom instrumento de prognóstico para pacientes atendidos nas unidades de emergência hospitalar.

[Prevalence of chronic kidney disease, stages 3, 4 and 5 in adults]. / Prevalência da doença renal crônica nos estágios 3, 4 e 5 em adultos.

INTRODUCTION: Strategies that optimize early diagnosis of chronic kidney disease (CKD) are paramount to decrease progression of the disease and the burden of patients needing renal replacement therapy. OBJECTIVE: The aim of this study was to determine the prevalence of CKD stage 3, 4 and 5 in people submitted to dosage of serum creatinine due to different causes, employing a dataset from a private laboratory of the city of Juiz de Fora comprising the years 2004 and 2005. METHODS: Diagnosis and staging of CKD were based upon glomerular filtration rate (GFR) estimated from serum creatinine as recommended by the KDOQI of the National Kidney Foundation and the Brazilian Society of Nephrology. RESULTS: Prevalence of CKD stage 3, 4 and 5 was of 9.6%, with 12.2%, 5.8%, 25.2% and 3.7% among women, men, people >60 and < 60 years of age, respectively. CONCLUSION: Prevalence of CKD found in our study may not only be interpreted as an epidemiologic indicator, but also discloses an alternative operational strategy to identify the disease. Furthermore it supports a proposal to include the estimation of GFR from serum creatinine in the laboratory report as an important and simple tool for early diagnosis of CKD.

Hiperuricemia: um marcador para doença renal crônica pré-clínica? / Hyperuricemia: a marker for chronic kidney disease pre-clinical?

Introdução: Os níveis séricos de ácido úrico aumentam na doença renal crônica (DRC), contudo o impacto desta observação clínica na história natural da doença ainda não está elucidado. Objetivo: Testar a hipóteses de que níveis elevados de ácido úrico em indivíduos com função renal preservada se associam com maior prevalência de DRC. Material e métodos: O estudo foi realizado a partir dos dados clínicos (sexo e idade) e laboratoriais (creatinina e ácido úrico) obtidos em um laboratório de análises clínicas em dois períodos distintos: basal (2000-2003) e de avaliação (2004-2005). A filtração glomerular estimada (FGe) foi calculada pela fórmula do estudo <60mL/min/1,73m², num período aproximado de 3 meses. O ácido úrico expresso em mg/dL foi analisado pela separação dos indivíduos em normouricêmicos e hiperuricêmicos e pela divisão da distribuição da amostra em quartis. Resultados: Do total de 4.991 indivíduos avaliados no período basal, 4.041 (90,0%) apresentavam FG>60mL/min/1,73m². Os indivíduos hiperuricêmicos (homens, mulheres, com menos de 60 anos e idosos) apresentaram maior risco relativo para DRC do que os normuricêmicos. Também foi observado que os grupos de indivíduos com ácido úrico mais elevado apresentaram maior prevalência de DRC no período basal (ácido úrico/FGe:<4,0/16,3%; 4,1-5,1/21,2%;5,2-6,7/28,6%;>6,7/34,0%;p<0,001). A prevalência de DRC no período de avaliação também foi maior nos grupos de indivíduos com níveis mais elevados de ácido úrico (ácido úrico/FG:<4,0/22,3%;4-5,1/26,9%; 5,2-6,7/28,5%;>6,7/22,3%;p<0,05). Conclusão: Em indivíduos não portadores de DRC níveis elevados de ácido úrico sérico se associam com maior prevalência da doença e parecem identificar um estado "pré-clínico" de disfunção renal.

Introduction: The serum uric acid increase in chronic kidney disease (CKD), however the impact of this clinical observation in the natural history of disease has not yet been elucidated. Objective: To test the hypothesis that high levels of uric acid in subjects with normal renal function are associated with higher prevalence of CKD. Methods: The study was conducted based on clinical data (age and sex) and laboratory (creatinine and uric acid) obtained in a clinical laboratory in two distinct periods: baseline (2000-2003) and evaluation (2004 - 2005). The estimated glomerular filtration (FGE) was calculated using the study <60mL/min/1, 73m ², within approximately three months. Uric acid in mg / dL was analyzed by the separation of individuals in normouricêmicos hyperuricemic and division and distribution of the sample into quartiles. Results: Of 4,991 subjects evaluated at baseline, 4,041 (90.0%) had FG> 60mL/min/1, 73m ². Hyperuricemic individuals (men, women, younger than 60 years and older) had higher relative risk for CKD than normuricêmicos. It was also observed that groups of individuals with higher uric acid had a higher prevalence of CKD at baseline (uric acid / FGE: <4.0 / 16.3%, from 4.1 to 5.1 / 21.2%; 5.2 to 6.7 / 28.6%> 6.7 / 34.0%, p <0.001). The prevalence of CKD in the evaluation period was also greater in individuals with higher levels of uric acid (uric acid / FG: <4.0 / 22.3%, from 4 to 5.1 / 26.9% 5 0.2 to 6, 7 / 28, 5%,> 6.7 / 22.3%, p <0.05). Conclusion: In non-CKD high levels of serum uric acid are associated with higher prevalence of the disease state and appear to identify a "preclinical" renal dysfunction.

Prevalência da doença renal crônica nos estágios 3, 4 e 5 em adultos / Prevalence of chronic kidney disease, stages 3, 4 and 5 in adults

INTRODUÇÃO: Medidas que otimizem a detecção precoce da doença renal crônica (DRC) são fundamentais para o retardo na evolução da doença e diminuição do aporte de indivíduos às terapias renais de substituição. OBJETIVOS: Estimar a prevalência da DRC em seus estágios 3, 4 e 5, utilizando registros laboratoriais de indivíduos submetidos a dosagem de creatinina sérica por causas diversas em laboratório da rede particular do município de Juiz de Fora, no período de 2004 e 2005. MÉTODOS: O estudo foi consubstanciado pelo cálculo estimado da filtração glomerular, utilizando a equação do estudo MDRD (Modification of diet in renal disease), e seguiu os critérios propostos pelo K/DOQI (Kidney Disease Outcomes Quality Initiative) para o diagnóstico e classificação da DRC. RESULTADOS: A prevalência encontrada foi de 9,6 por cento, sendo 12,2 por cento no sexo feminino, 5,8 por cento no sexo masculino, 3,7 por cento em indivíduos abaixo de 60 anos e 25,2 por cento acima de 60 anos. CONCLUSÃO: Os resultados evidenciam a prevalência da DRC não apenas como um indicador epidemiológico, mas demonstram um aspecto operacional alternativo para otimizar a capacidade de detecção dos casos e permitem sugerir a inclusão do cálculo da filtração glomerular como um dado complementar aos resultados das dosagens de creatinina sérica fornecidos pelos laboratórios.

INTRODUCTION: Strategies that optimize early diagnosis of chronic kidney disease (CKD) are paramount to decrease progression of the disease and the burden of patients needing renal replacement therapy. OBJECTIVE: The aim of this study was to determine the prevalence of CKD stage 3, 4 and 5 in people submitted to dosage of serum creatinine due to different causes, employing a dataset from a private laboratory of the city of Juiz de Fora comprising the years 2004 and 2005. METHODS: Diagnosis and staging of CKD were based upon glomerular filtration rate (GFR) estimated from serum creatinine as recommended by the KDOQI of the National Kidney Foundation and the Brazilian Society of Nephrology. RESULTS: Prevalence of CKD stage 3, 4 and 5 was of 9.6 percent, with 12.2 percent, 5.8 percent, 25.2 percent and 3.7 percent among women, men, people >60 and < 60 years of age, respectively. CONCLUSION: Prevalence of CKD found in our study may not only be interpreted as an epidemiologic indicator, but also discloses an alternative operational strategy to identify the disease. Furthermore it supports a proposal to include the estimation of GFR from serum creatinine in the laboratory report as an important and simple tool for early diagnosis of CKD.

Avaliação comparativa da sedimentoscopia urinária realizada pelo nefrologista e pelo profissional de análises clínicas em pacientes com glomerulopatias / Comparative assessment of urinary sediment done by the nephrologist and by the clinical analyst professional in patients with glomerulonephritis

Introdução: A sedimentoscopia urinária com microscópio munido com contraste de fase (MCF) deveria ser a primeira etapa na determinação da origemdas hematúrias. Objetivo: Avaliar discrepâncias nas descrições dos parâmetros urinários relacionados à origem das hematúrias, comparando as descrições do nefrologista (Nef) e do profissional de análises clínicas (PAC). Métodos: Urinas de pacientes com glomerulopatias (GP) confirmadas por biópsia renal foram analisadas sob MCF, por um Nef e um PAC, ambos sem conhecimento prévio da origem das amostras. Cilindros hemáticos, acantocitúria ou células G1 >5% e dismorfismo eritrocitário foram utilizados na localização glomerular das hematúrias. Resultados: Dos 28 pacientes, 13 pacientes (46,4%) apresentavam glomerulonefrites não proliferativas e 15 (53,6%) glomerulonefrites proliferativas. Comparativamente ao PAC, o Nef identificou maior número de hemácias (mediana/mL de urina, 80.000 vs 4.800, p=0,001), maior número de cilindros hemáticos (39,3% vs 0%, p=0,001), maior freqüência de acantocitúria ou células G1 >5% (35,7% vs. 7,14%, p=0,021) e de dismorfismo eritrocitário (96,2% vs 7,14%, p<0,001). As discrepâncias dos resultados permaneceram após a separação das glomerulopatias em proliferativas e não proliferativas. Conclusão: Os parâmetros urinários que caracterizam a origem da hematúria foram mais freqüentemente identificados pelo nefrologista e sugerem que a urinálise, pela sua simplicidade e grande valor informativo, deveria ser incluída obrigatoriamente nos programas de treinamento em nefrologia.

Introduction: In the assessment of hematuria, the first step should be the identification of the origin of the bleeding, which can be done easily by analyzing the urine under phase-contrast microscopy. Obective: To assess the discrepancy of reports of the urinary parameters utilized in the localization of the glomerular origin of hematuria, comparing reports by the nephrologists and by the clinical laboratory technologist. Methods: Urines of patients with biopsy proven glomerulonephritis were assessed under phase-contrast microscopy by a nephrologist and a clinical laboratory technologist, both without previous knowledge of the origin of the samples. Red blood cell (RBC) casts, urinary acanthocytes or G1 cells >5%, and erithrocyte dysmorphism were used tolocalize the glomerular bleeding. Results: Among 28 patients, 13 (46.4%) had non proliferative glomerulonephritis and 15 (53.6%) had proliferative glomerulonephritis. Relatively to the clinical laboratory technologist, the nephrologist identified more RBC (median of 80.000 vs 4.800, p= 0.001), more RBC casts (39.3% vs 0%, p=0.001), more urinary acanthocytes or G1 cells >5% (35.7% vs 7.14%, p=0.021) and more dysmorphic RBC (96.2% vs 7.14%,p<0.001). The discrepancies of the reports were maintained after the separation of the glomerulonephritis in proliferative and non proliferative. Conclusion: The urinary parameters used in characterization of the origin of the hematuria were more frequently identified by the nephrologist, and suggest that the urinalysis, a simple and very informative test, should be mandatory in programs of training in nephrology.