Transition from antigenemia to quantitative nucleic acid amplification testing in cytomegalovirus-seropositive kidney transplant recipients receiving preemptive therapy for cytomegalovirus infection.

Due to the high costs, the strategy to reduce the impact of cytomegalovirus (CMV) after kidney transplant (KT) involves preemptive treatment in low and middle-income countries. Thus, this retrospective cohort study compared the performance of antigenemia transitioned to quantitative nucleic acid amplification testing, RT-PCR, in CMV-seropositive KT recipients receiving preemptive treatment as a strategy to prevent CMV infection. Between 2016 and 2018, 363 patients were enrolled and received preemptive treatment based on antigenemia (n = 177) or RT-PCR (n = 186). The primary outcome was CMV disease. Secondarily, the CMV-related events were composed of CMV-infection and disease, which occurred first. There were no differences in 1-year cumulative incidence of CMV-disease (23.7% vs. 19.1%, p = 0.41), CMV-related events (50.8% vs. 44.1%, p = 0.20), neither in time to diagnosis (47.0 vs. 47.0 days) among patients conducted by antigenemia vs. RT-PCR, respectively. The length of CMV first treatment was longer with RT-PCR (20.0 vs. 27.5 days, p < 0.001), while the rate of retreatment was not different (14.7% vs. 11.8%, p = 0.48). In the Cox regression, acute rejection within 30 days was associated with an increased the risk (HR = 2.34; 95% CI = 1.12-4.89; p = 0.024), while each increase of 1 mL/min/1.73 m2 of 30-day eGFR was associated with a 2% reduction risk of CMV-disease (HR = 0.98; 95% CI = 0.97-0.99; p = 0.001). In conclusion, acute rejection and glomerular filtration rate are risk factors for CMV disease, showing comparable performance in the impact of CMV-related events between antigenemia and RT-PCR for preemptive treatment.

Molecular Survey of Bartonella Species in Shelter Cats in Rio De Janeiro: Clinical, Hematological, and Risk Factors.

The present study aimed to detect Bartonella DNA in cats belonging to shelters, and to evaluate risk factors, clinical signs, and hematological abnormalities associated with infection. Complete blood counts and screening for the presence of Bartonella DNA were performed on cats' ethylenediamine tetraacetic acid anticoagulant-blood samples. Eighty-three cats (39.9%) were positive for Bartonella species. Bartonella DNA was also detected in fleas and in the blood of cats infested by positive flea. Cats that had not been sterilized, had outdoor access, had histories of fights, and had concurrent flea infestation were more likely to be infected by Bartonella species (P < 0.05). Age and sex were not associated with infection. Fifty-one (38.6%) symptomatic cats were positive to Bartonella species (P > 0.05). Clinical conditions most commonly observed were signs of respiratory abnormality and Sporothrix species coinfection (P > 0.05). Regarding hematological changes, eosinophilia was associated with infection (P < 0.05). A high frequency of Bartonella species infection was found in shelter cats and highlights the importance of adequate flea-control programs to prevent infection in cats and consequently in adopters and other animals.

Echocardiographic Assessment of Ventricular Function in Young Patients with Asthma.

BACKGROUND: Despite significant advances in understanding the pathophysiology and management of asthma, some of systemic effects of asthma are still not well defined. OBJECTIVES: To compare heart function, baseline physical activity level, and functional exercise capacity in young patients with mild-to-moderate asthma and healthy controls. METHODS: Eighteen healthy (12.67 ± 0.39 years) and 20 asthmatics (12.0 ± 0.38 years) patients were enrolled in the study. Echocardiography parameters were evaluated using conventional and tissue Doppler imaging (TDI). RESULTS: Although pulmonary acceleration time (PAT) and pulmonary artery systolic pressure (PASP) were within normal limits, these parameters differed significantly between the control and asthmatic groups. PAT was lower (p < 0.0001) and PASP (p < 0.0002) was higher in the asthma group (114.3 ± 3.70 ms and 25.40 ± 0.54 mmHg) than the control group (135.30 ± 2.28 ms and 22.22 ± 0.40 mmHg). The asthmatic group had significantly lower early diastolic myocardial velocity (E', p = 0.0047) and lower E' to late (E'/A', p = 0.0017) (13.75 ± 0.53 cm/s and 1.70 ± 0.09, respectively) compared with control group (15.71 ± 0.34 cm/s and 2.12 ± 0.08, respectively) at tricuspid valve. In the lateral mitral valve tissue Doppler, the asthmatic group had lower E' compared with control group (p = 0.0466; 13.27 ± 0.43 cm/s and 14.32 ± 0.25 cm/s, respectively), but there was no statistic difference in the E'/A' ratio (p = 0.1161). Right isovolumetric relaxation time was higher (p = 0.0007) in asthmatic (57.15 ± 0.97 ms) than the control group (52.28 ± 0.87 ms), reflecting global myocardial dysfunction. The right and left myocardial performance indexes were significantly higher in the asthmatic (0.43 ± 0.01 and 0.37 ± 0.01, respectively) compared with control group (0.40 ± 0.01 and 0.34 ± 0.01, respectively) (p = 0.0383 and p = 0.0059, respectively). Physical activity level, and distance travelled on the six-minute walk test were similar in both groups. CONCLUSION: Changes in echocardiographic parameters, evaluated by conventional and TDI, were observed in mild-to-moderate asthma patients even with normal functional exercise capacity and baseline physical activity level. Our results suggest that the echocardiogram may be useful for the early detection and evoluation of asthma-induced cardiac changes.

Echocardiographic Assessment of Ventricular Function in Young Patients with Asthma / Avaliação Ecocardiográfica da Função Ventricular em Pacientes Jovens com Asma

Abstract Background: Despite significant advances in understanding the pathophysiology and management of asthma, some of systemic effects of asthma are still not well defined. Objectives: To compare heart function, baseline physical activity level, and functional exercise capacity in young patients with mild-to-moderate asthma and healthy controls. Methods: Eighteen healthy (12.67 ± 0.39 years) and 20 asthmatics (12.0 ± 0.38 years) patients were enrolled in the study. Echocardiography parameters were evaluated using conventional and tissue Doppler imaging (TDI). Results: Although pulmonary acceleration time (PAT) and pulmonary artery systolic pressure (PASP) were within normal limits, these parameters differed significantly between the control and asthmatic groups. PAT was lower (p < 0.0001) and PASP (p < 0.0002) was higher in the asthma group (114.3 ± 3.70 ms and 25.40 ± 0.54 mmHg) than the control group (135.30 ± 2.28 ms and 22.22 ± 0.40 mmHg). The asthmatic group had significantly lower early diastolic myocardial velocity (E', p = 0.0047) and lower E' to late (E'/A', p = 0.0017) (13.75 ± 0.53 cm/s and 1.70 ± 0.09, respectively) compared with control group (15.71 ± 0.34 cm/s and 2.12 ± 0.08, respectively) at tricuspid valve. In the lateral mitral valve tissue Doppler, the asthmatic group had lower E' compared with control group (p = 0.0466; 13.27 ± 0.43 cm/s and 14.32 ± 0.25 cm/s, respectively), but there was no statistic difference in the E'/A' ratio (p = 0.1161). Right isovolumetric relaxation time was higher (p = 0.0007) in asthmatic (57.15 ± 0.97 ms) than the control group (52.28 ± 0.87 ms), reflecting global myocardial dysfunction. The right and left myocardial performance indexes were significantly higher in the asthmatic (0.43 ± 0.01 and 0.37 ± 0.01, respectively) compared with control group (0.40 ± 0.01 and 0.34 ± 0.01, respectively) (p = 0.0383 and p = 0.0059, respectively). Physical activity level, and distance travelled on the six-minute walk test were similar in both groups. Conclusion: Changes in echocardiographic parameters, evaluated by conventional and TDI, were observed in mild-to-moderate asthma patients even with normal functional exercise capacity and baseline physical activity level. Our results suggest that the echocardiogram may be useful for the early detection and evoluation of asthma-induced cardiac changes.

Resumo Fundamento: Apesar de avanços significativos no entendimento da fisiopatologia e manejo da asma, alguns efeitos sistêmicos da asma ainda não são bem definidos. Objetivos: Comparar a função cardíaca, o nível de atividade física basal, e a capacidade funcional de pacientes jovens com asma leve a moderada com controles saudáveis. Métodos: Dezoito voluntários saudáveis (12,67 ± 0,39 anos) e 20 pacientes asmáticos (12,0 ± 0,38 anos) foram incluídos no estudo. Os parâmetros de ecocardiografia foram avaliados pelo exame de ecocardiogragia com Doppler convencional e tecidual (EDT). Resultados: Apesar de o tempo de aceleração pulmonar (TAP) e da pressão arterial sistólica pulmonar (PASP) encontrarem-se dentro da faixa de normalidade, esses parâmetros foram significativamente diferentes entre o grupo controle e o grupo asmático. O TAP foi menor (p < 0,0001) e a PASP maior (p < 0,0002) no grupo de indivíduos asmáticos (114,3 ± 3,70 ms e 25,40 ± 0,54 mmHg) que o grupo controle (135,30 ± 2,28 ms e 22,22 ± 0,40 mmHg). O grupo asmático apresentou velocidade diastólica inicial do miocárdio (E', p = 0,0047) e relação entre E' e velocidade tardia mais baixas (E'/A', p = 0,0017) (13,75 ± 0,53 cm/s e 1,70 ± 0,09, respectivamente) em comparação ao grupo controle (15,71 ± 0,34 cm/s e 2,12 ± 0,08, respectivamente) na valva tricúspide. No exame Doppler tecidual do anel mitral lateral, o grupo asmático apresentou menor E' em comparação ao grupo controle (p = 0,0466; 13,27 ± 0,43 cm/s e 14,32 ± 0,25 cm/s, respectivamente), mas não houve diferença estatística na razão E'/A' (p = 0,1161). O tempo de relaxamento isovolumétrico foi maior no grupo de pacientes asmáticos (57,15 ± 0,97 ms) que no grupo controle (52,28 ± 0,87 ms) (p = 0,0007), refletindo uma disfunção global do miocárdio. O índice de performance miocárdica direito e esquerdo foi significativamente maior no grupo asmático (0,43 ± 0,01 e 0,37 ± 0,01, respectivamente) que no grupo controle (0,40 ± 0,01 e 0,34 ± 0,01, respectivamente) (p = 0,0383 e p = 0,0059 respectivamente). O nível de atividade física e a distância percorrida no teste de caminhada de seis minutos foram similares entre os grupos. Conclusão: Mudanças nos parâmetros ecocardiográficos, avaliados pela ecocardiografia convencional e pela EDT foram observadas em pacientes com asma moderada a grave com capacidade funcional e nível de atividade física basal normais. Nossos resultados sugerem que o ecocardiograma pode ser útil para a detecção precoce e a evolução de alterações cardíacas induzidas pela asma. (Arq Bras Cardiol. 2018; 110(3):231-239)

Breaking bad news: doctors' skills in communicating with patients / Dando más notícias: a habilidade dos médicos em se comunicar com os pacientes

ABSTRACT CONTEXT AND OBJECTIVE: Breaking bad news is one of doctors' duties and it requires them to have some skills, given that this situation is difficult and distressful for patients and their families. Moreover, it is also an uncomfortable condition for doctors. The aim of this study was to evaluate doctors' capacity to break bad news, ascertain which specialties are best prepared for doing this and assess the importance of including this topic within undergraduate courses. DESIGN AND SETTING: Observational cross-sectional quantitative study conducted at a university hospital in Belo Horizonte (MG), Brazil. METHODS: This study used a questionnaire based on the SPIKES protocol, which was answered by 121 doctors at this university hospital. This questionnaire investigated their attitudes, posture, behavior and fears relating to breaking bad news. RESULTS: The majority of the doctors did not have problems regarding the concept of bad news. Nevertheless, their abilities diverged depending on the stage of the protocol and on their specialty and length of time since graduation. Generally, doctors who had graduated more than ten years before this survey felt more comfortable and confident, and thus transmitted the bad news in a better conducted manner. CONCLUSION: Much needs to be improved regarding this technique. Therefore, inclusion of this topic in undergraduate courses is necessary and proposals should be put forward and verified.

RESUMO CONTEXTO E OBJETIVO: Dar más notícias, além de dever do médico, requer certas habilidades de sua parte, por se tratar de situação difícil e angustiante para o paciente e seus familiares, assim como desconfortável para os profissionais da saúde. O objetivo deste estudo é avaliar a capacidade dos médicos em dar más notícias, assim como as especialidades mais preparadas e a importância da inclusão do tema para a graduação. TIPO DE ESTUDO E LOCAL: Estudo observacional, transversal, quantitativo, realizado em hospital universitário de Belo Horizonte, Minas Gerais, Brasil. MÉTODOS: Este estudo utilizou de questionário baseado no protocolo SPIKES que foi respondido por 121 médicos deste hospital universitário. O questionário investigou suas atitudes, posturas, modos e medos em relação a dar más notícias. RESULTADOS: A maioria dos médicos não teve problemas quanto ao conceito de más notícias, contudo, as habilidades divergiram dependendo da etapa do protocolo, assim como quanto a especialidade e tempo de formado. De modo geral, os médicos formados há mais de 10 anos se sentem mais confortáveis e confiantes, e transmitem tal informação de maneira mais bem conduzida. CONCLUSÃO: Muito se tem a aprimorar em relação a essa técnica. Desse modo, a inclusão do tema durante a graduação é necessária e propostas devem ser sugeridas e averiguadas.

Breaking bad news: doctors' skills in communicating with patients.

CONTEXT AND OBJECTIVE:: Breaking bad news is one of doctors' duties and it requires them to have some skills, given that this situation is difficult and distressful for patients and their families. Moreover, it is also an uncomfortable condition for doctors. The aim of this study was to evaluate doctors' capacity to break bad news, ascertain which specialties are best prepared for doing this and assess the importance of including this topic within undergraduate courses. DESIGN AND SETTING:: Observational cross-sectional quantitative study conducted at a university hospital in Belo Horizonte (MG), Brazil. METHODS:: This study used a questionnaire based on the SPIKES protocol, which was answered by 121 doctors at this university hospital. This questionnaire investigated their attitudes, posture, behavior and fears relating to breaking bad news. RESULTS:: The majority of the doctors did not have problems regarding the concept of bad news. Nevertheless, their abilities diverged depending on the stage of the protocol and on their specialty and length of time since graduation. Generally, doctors who had graduated more than ten years before this survey felt more comfortable and confident, and thus transmitted the bad news in a better conducted manner. CONCLUSION:: Much needs to be improved regarding this technique. Therefore, inclusion of this topic in undergraduate courses is necessary and proposals should be put forward and verified.

Intestinal Lesion in a Dog Due to Cryptococcus gattii Type VGII and Review of Published Cases of Canine Gastrointestinal Cryptococcosis.

Cryptococcosis is a mycosis caused by yeasts of genus Cryptococcus, mainly the species C. neoformans and C. gattii that can affect humans and animals. These yeasts are widely distributed in the environment and are typically associated with avian droppings and decaying wood. Most infections are related to the respiratory tract, but the central nervous system and cutaneous lesions are also reported in the literature. The present report is a case of cryptococcosis in an 18-month-old unspayed female English Bulldog with the main complaint of weight loss and diarrhea. The presence of two large masses observed in an ultrasound examination leads us to perform an exploratory laparotomy. Considering the size of the lesion and the impossibility of owner to provide intensive care, the consent for euthanasia was requested. The postmortem diagnosis of cryptococcosis was revealed by cytological evaluation, and the involvement of C. gattii VGII was confirmed by isolation and identification tests as well as by the detection of the URA5 gene restriction fragment length polymorphism PCR analysis. Reports in the literature of the involvement of Cryptococcus in gastrointestinal lesions are rare in both human and veterinary medicine. Data about different forms of cryptococcosis are important to provide more knowledge of uncommon clinical presentations of this yeast and therefore improve the diagnoses and decisions for the best therapy.

Hematological changes associated with hemoplasma infection in cats in Rio de Janeiro, Brazil.

This study aimed to detect Mycoplasma spp. in naturally infected cats from Rio de Janeiro and to evaluate hematological abnormalities and factors associated with this infection. Out of the 197 cats sampled, 11.2% presented structures compatible with hemoplasma organisms on blood smears. In contrast, 22.8% were positive for Mycoplasma spp. by means of 16S rRNA gene real-time polymerase chain reaction, which reflects the weak concordance between techniques. The infection rates, by means of 16S rRNA gene conventional polymerase chain reaction, was 4.6%, 4.6% and 11.7% for Mycoplasma haemofelis (Mhf), 'Candidatus Mycoplasma turicensis' (CMt) and 'Candidatus Mycoplasma haemominutum' (CMhm), respectively. Mhf and CMhm infections are more frequent in the summer (p>0.05). Presence of anemia (p < 0.02), lymphocytosis (p < 0.03), thrombocytopenia (p < 0.04) and activated monocytes (p < 0.04) was associated with Mhf infection. No hematological abnormality was associated with CMt or CMhm infection. Male cats were more prone to be infected by Mhf or CMhm (p < 0.01). Adult cats had more chance to be infected by CMhm. Three hemoplasma species occur in the metropolitan region of Rio de Janeiro and Mhf seems to be the most pathogenic of them. Anemia is the most important hematological abnormality.

Hematological changes associated with hemoplasma infection in cats in Rio de Janeiro, Brazil / Alterações hematológicas associadas à infecção por hemoplasmas em gatos do Rio de Janeiro, Brasil

Abstract This study aimed to detect Mycoplasma spp. in naturally infected cats from Rio de Janeiro and to evaluate hematological abnormalities and factors associated with this infection. Out of the 197 cats sampled, 11.2% presented structures compatible with hemoplasma organisms on blood smears. In contrast, 22.8% were positive for Mycoplasma spp. by means of 16S rRNA gene real-time polymerase chain reaction, which reflects the weak concordance between techniques. The infection rates, by means of 16S rRNA gene conventional polymerase chain reaction, was 4.6%, 4.6% and 11.7% for Mycoplasma haemofelis (Mhf), ‘Candidatus Mycoplasma turicensis’ (CMt) and ‘Candidatus Mycoplasma haemominutum’ (CMhm), respectively. Mhf and CMhm infections are more frequent in the summer (p>0.05). Presence of anemia (p < 0.02), lymphocytosis (p < 0.03), thrombocytopenia (p < 0.04) and activated monocytes (p < 0.04) was associated with Mhf infection. No hematological abnormality was associated with CMt or CMhm infection. Male cats were more prone to be infected by Mhf or CMhm (p < 0.01). Adult cats had more chance to be infected by CMhm. Three hemoplasma species occur in the metropolitan region of Rio de Janeiro and Mhf seems to be the most pathogenic of them. Anemia is the most important hematological abnormality.

Resumo Este estudo teve por objetivo detectar Mycoplasma spp. em gatos naturalmente infectados do Rio de Janeiro e avaliar as alterações hematológicas e fatores associados à infecção. Dos 197 gatos amostrados, 11,2% apresentaram estruturas compatíveis com hemoplasmas em esfregaços de sangue. Em contraste, 22,8% foram positivas para Mycoplasma spp. por meio da reação em cadeia da polimerase em tempo real (qPCR), baseado no gene 16S rRNA, o que reflete a fraca concordância entre as técnicas. As taxas de infecção, por meio da reação em cadeia da polimerase convencional baseada no gene 16S rRNA, foi de 4,6%, 4,6% e 11,7% para Mycoplasma haemofelis (Mhf), 'Candidatus Mycoplasma turicensis' (CMt) e 'Candidatus Mycoplasma haemominutum' (CMhm), respectivamente. Infecção por Mhf e CMhm foram mais frequentes no verão (p> 0,05). Anemia (p<0,02), linfocitose (p<0,03), trombocitopenia (p<0,04), e presença de monócitos ativados (p<0,04) foram associados à infecção por Mhf. Nenhuma alteração hematológica foi associada à infecção por CMt ou CMhm. Gatos machos estão mais propensos à infecção por Mhf ou CMhm (p<0,01). Gatos adultos têm maiores chances de se infectarem por CMhm. Há ocorrência de três espécies de hemoplasmas na Região Metropolitana do Rio de Janeiro e Mhf parece ser o mais patogênico, tendo a anemia como principal alteração hematológica.

Perfil epidemiológico dos pacientes atendidos em um Centro de Atenção Psicossocial / Epidemiological profile of patients treated in a Center for Psychosocial Care

Estudo transversal com o objetivo de delinear o perfil dos pacientes atendidos no Centro de Atenção Psicossocial de Barbacena. Foram avaliados 583 prontuários de um total de 4.000 usuários atendidos no período de 2003 a 2008. A idade média dos participantes foi de 38,7±3,6 anos; a maioria dos pacientes era do sexo masculino (56,6%), casados ou em união estável (48,8%), com baixa escolaridade (60%), com passado de tratamento psiquiátrico (64,7%); 28,8% eram portadores de quadros psicóticos, 22% de transtornos afetivos e 20% de transtornos decorrentes do uso de substâncias. Mais da metade dos pacientes não estava em crise quando procurou o atendimento indicando a necessidade de maior investimento e capacitação nos níveis primário e secundário de atenção à saúde.

Cross-sectional study aimed to delineate the profile of patients treated at the Center for Psychosocial Care of Barbacena. There were assessed 583 medical records of a total of four thousand users attended from 2003 to 2008. The average age of participants was 38.7±3.6 years and the majority of patients were male (56.6%), married or in stable (48.8%), low education (60%) and with past psychiatric treatment (64.7%); 28.8% suffered from a psychotic condition, 22% of affective disorders and 20% of problems caused by substance use. More than half of the patients was not in crisis when he sought care indicates a need for increased investment and capacity at primary and secondary health care.