Pigment deposits in the retrolental space of Berger: a rare feature of pigment dispersion syndrome? / Depósitos de pigmento no espaço de Berger: uma característica rara de síndrome de dispersão pigmentar?

ABSTRACT Pigment dispersion syndrome is associated with clinical features such as Krukenberg's spindles, trabecular pigmentation, Scheie's stripe and Zentmayer's ring. Another less common feature of this syndrome is retrolental pigment deposits due to anterior hyaloid detachment or a defect in the Wieger's ligament. We present two cases of pigment deposits on the posterior lens capsule. In both cases, there is bilateral dispersion of pigment throughout the anterior segment. The retrolental deposits are unilateral in the first case and bilateral in the second. Both patients report a history of ocular trauma. This is a possible important clinical sign of pigment dispersion syndrome, rarely described.

RESUMO A síndrome de dispersão pigmentar associa-se a sinais clínicos característicos como fuso de Krukenberg, hiperpigmentação da malha trabecular, linha de Scheie e anel de Zentmeyer. Um sinal menos comum dessa síndrome é o depósito de pigmento posterior ao cristalino, que ocorre por um descolamento da hialoide anterior ou um defeito no ligamento de Wieger. Apresentamos dois casos de depósitos de pigmento posterior à cápsula posterior do cristalino. Em ambos os casos, existia dispersão bilateral de pigmento por todo o segmento anterior. No primeiro caso, os depósitos eram unilaterais e, no segundo, estavam presentes em ambos os olhos. Este pode corresponder a um sinal potencialmente importante da síndrome de dispersão pigmentar, raramente descrito.

Espondilodiscitis multifocal y meningoencefalitis por Staphylococcus aureus en un paciente inmunocomprometido / Multifocal spondylodiscitis and meningoencephalitis due to Staphylococcus aureus in an immunocompromised patient

Spondylodiscitis is a rare diagnosis, but its incidence has increased in recent years. It represents 3-5% of osteomyelitis, and the multifocal affliction is rare as it occurs in 4-8% of all spondylodiscitis. The occurrence of meningoencephalitis associated with spondylodiscitis is also a rare association. We present the case of a 54-year-old woman diagnosed with multifocal spondylodiscitis complicated with meningoencephalitis and intracanal and paravertebral abscess with identification in blood cultures of Staphylococcus aureus. Immunosuppression with infliximab was identified as a risk factor. The patient underwent targeted antibiotic therapy, opting for the conservative strategy due to the surgical risk. There was a positive evolution with imaging resolution of the intracanal abscess. This case is of particular importance due to its rarity of frequency and considering the etiological agent and the low frequency of this infection in patients under anti-TNF-alpha therapy. (AU)

La espondilodiscitis es un diagnóstico poco frecuente, pero su incidencia ha aumentado en los últimos años. Representa el 3-5% de las osteomielitis, y la afección multifocal es rara, ya que se da en el 4-8% de todas las espondilodiscitis. La aparición de meningoencefalitis asociada a espondilodiscitis también es una asociación poco frecuente. Presentamos el caso de una mujer de 54 años diagnosticada de espondilodiscitis multifocal complicada con meningoencefalitis y absceso intracanal y paravertebral con identificación en hemocultivos de Staphylococcus aureus. Se identificó como factor de riesgo la inmunosupresión con infliximab. La paciente fue sometida a antibioterapia dirigida, optándose por la estrategia conservadora debido al riesgo quirúrgico. Hubo una evolución positiva con resolución imagenológica del absceso intracanal. Este caso es de especial importancia por su escasa frecuencia y teniendo en cuenta el agente etiológico y la baja frecuencia de esta infección en pacientes bajo terapia anti-TNF-alfa. (AU)

Incidence of the first diabetic foot ulcer: A systematic review and meta-analysis.

AIM: Investigate the incidence of the first diabetic foot ulcer. METHOD: This is a systematic review with meta-analysis of cohort studies following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using RevMan software. A systematic search of Medline databases via PubMed, Embase, Lilacs, Scopus databases, and Web of Science was performed until July 2021. In addition to investigating the incidence of the first diabetic foot ulcer, the influence of the variables of the Human Development Index (HDI), glycated hemoglobin, and follow-up time of the participants on the incidence of the first diabetic foot ulcer (DFU) was analyzed through meta-regression. For the meta-analysis of cumulative incidence and possible variable associations, RevMan software was used in the Metaprop data package with 95% confidence interval (CI). RESULTS: A total of 9,772 articles were identified out of which 87 were selected and 12 studies ultimately included in the systematic review and meta-analysis. The meta-analysis of cumulative incidence was 5.65% (95% CI: 4.20; 7.57). By meta-regression, a significant inverse association was identified between DFU incidence and HDI (estimate - 2.38; 95% CI - 4.10--0.67; p = 0.01). CONCLUSION: The study presents the cumulative incidence for the first DFU, an inexistent datum in the national and international literature, and the HDI was inversely associated with the incidence of DFU.

Maculopatia solar após o uso de LSD: relato de caso / Solar maculopathy after LSD use: a case report

Introdução: A maculopatia ou retinopatia solar é uma lesão foto-traumática da mácula causada pela observação direta ou indireta de fontes luminosas intensas, que ocorre comumente na presença de distúrbios psíquicos ou após o uso de drogas recreativas. O prognóstico visual varia e a conduta é expectante. Descrição do caso: Paciente V.V.A.M., sexo masculino, 20 anos, estudante, com queixa de escotoma central em ambos os olhos. Nega antecedentes patológicos e oculares. Solicitaram-se tomografia de coerência óptica (OCT) e retinografia, que revelaram uma lesão central, bilateral e simétrica na retina externa. Paciente relatou ter feito uso de Dietilamida de ácido lisérgico (LSD) e, sob influência da droga, ter olhado de forma direta para o sol por aproximadamente 40 minutos. Discussão: O prognóstico da retinopatia solar é variável e relaciona-se com o tempo de exposição e com o comprimento da onda da fonte de luz. A etiopatogênese é explicada pelo dano causado ao epitélio pigmentar da retina (EPR) pela radiação. Conclusões: Deve haver maior orientação ao público sobre os possíveis efeitos danosos de exposição a fontes de luz de origens diversas. Além disso, destaca-se a importância do OCT para a identificação da maculopatia solar. (AU)

Introduction: Solar maculopathy or retinopathy is photo-traumatic damage created on the macula, caused by direct or indirect observation of intense light sources, commonly occurring in the presence of psychic disorders or after the use of recreational drugs. The visual prognosis varies. There is currently no known treatment. Case report: A 20-year-old male with no previous complaints reported central scotoma in both eyes despite 20/20 uncorrected vision. Bilateral, symmetric, central changes could be seen in the macula in fundoscopy. Optical coherence tomography (OCT) confirmed loss of the external retina suggestive of Solar Maculopathy. The patient later claimed to have spent 40 minutes looking directly into the sun after use of Lysergic Acid Diethylamide (LSD). Discussion: The prognosis of solar retinopathy is related to the exposure time and to the wavelength of the light source, with those between 300-350 nm being the most harmful. Its etiopathogenesis is explained by damage caused to the retinal pigment epithelium (EPR) caused by radiation, interrupting the interdigitations between this layer and the external segment of the photoreceptors. Ophthalmoscopically, solar maculopathy is characterized by a small foveolar lesion that might become yellowish in the days following exposure, in the form of exudate or edema, followed by loss of foveal reflex and thinning of the fovea. The initial yellowed lesions are subsequently replaced by a spotted EPR or even by a lamellar orifice. Conclusions: There should be public guidance on the possible harmful effects of exposure to sources of light from diverse origins, as it usually occurs during solar eclipses, after exposure to certain types of lasers or observation of fires since this habit can cause severe and sometimes irreversible visual loss. (AU)

Enzymatic vitreolysis for the treatment of tractional diabetic macular edema.

BACKGROUND: A new approach to address focal vitreomacular adhesion in patients with diabetic macular edema may control and stabilize diabetic macular edema with fewer anti-vascular endothelial growth factor injections. OBJECTIVES: The aim of this study was to demonstrate that diabetic macular edema can be improved by inducing the release of a vitreomacular adhesion, with less than 2500 µm, with enzymatic vitreolysis. METHODS: From a retrospective analysis of clinical records from patients with diabetic retinopathy, patients with diabetic macular edema and vitreomacular adhesion <2500 µm were selected for a single-arm prospective study. The primary endpoint was to control diabetic macular edema with fewer anti-vascular endothelial growth factor injections after an observed vitreomacular adhesion release. A statistical subanalysis was performed for the following two groups: the group with vitreomacular adhesion release (group 1) and the group without vitreomacular adhesion release (group 2). RESULTS: A total of 23 eyes from 19 patients were included. A reduction of the median number of injections was achieved in group 1 (p = 0.006). Adverse events were mild and transitory. CONCLUSION: Release of vitreomacular adhesion <2500 µm through enzymatic vitreolysis contributed to the control and stabilization of diabetic macular edema with fewer anti-vascular endothelial growth factor injections, reducing the burden and the risks related to these invasive and frequently chronic treatments.

Potential effect of Zika virus infection on human male fertility?

BACKGROUND: Zika virus (ZIKV) sexual transmission and prolonged viral shedding in semen have been previously reported, suggesting a strong viral affinity for genital tissues. A transient impact of ZIKV on male fertility was shown in animal and human studies. METHODS: Adult male patients with confirmed ZIKV infection diagnosed in the city of Araraquara, Brazil during the epidemic season of 2016 were invited one year after the acute infection to respond to a questionnaire of genital symptoms and to provide a semen sample for molecular ZIKV testing and spermogram analysis, as well as a serum sample for hormonal testing. RESULTS: 101 of 187 tested patients had positive ZIKV RT-PCR in plasma and/or urine samples (54%, 72 women and 29 men). Of 15 adult male participants for whom telephone contact was successful, 14 responded to the questionnaire of genital symptoms and six consented to provide a semen sample at a median of 12 months after the acute infection. We report abnormal spermogram results from patients one year after confirmed ZIKV infection. CONCLUSIONS: Our findings suggest a possible long-term detrimental effect of ZIKV infection on human male fertility that has to be further explored in well-characterized samples from cohort studies conducted in ZIKV-endemic areas.

Blood in a Haab Stria.

We describe a case of an asymptomatic and spontaneous intracorneal hemorrhage in an adult with congenital glaucoma and blood collected in a Haab stria.

Students' Characteristics and Teachers' Estimates about Their Academic Achievement / Características dos Estudantes e Estimativas dos Professores acerca do seu Desempenho Acadêmico / Características de los Estudiantes y la Estimación de sus Logros Académicos por los Profesores

Abstract The relation between teachers' expectations and students' academic achievement has received considerable interest in the education and psychology domains. In this study, we analyze the extent to which the information about students influences the formulation of teachers' estimates about their achievement. The sample consisted of 491 Portuguese teachers, aged between 26 and 82 years old (M age = 43 years). To assess the teachers' estimates, we created excerpts containing information about hypothetical students, in relation to whom an estimate of academic success was required. Each excerpt had two versions (A and B), according to the more or less favorable information regarding students' intellectual, family, self-regulation, and previous performance variables. The results show moderate differences between the estimates of the participants that received version A and those that received version B. The results are discussed considering the importance of a set of student characteristics for the way teachers develop estimates about student performance.

Resumo A relação entre as expectativas dos professores e o desempenho acadêmico dos estudantes tem recebido muito interesse da investigação. Neste estudo, analisamos a extensão em que a informação sobre os estudantes influencia as estimativas docentes acerca do seu potencial desempenho acadêmico. A amostra consistiu em 491 professores, com idades entre 26 e 82 anos (M idade = 43). Para avaliar as estimativas, foram criados diferentes excertos contendo informação sobre estudantes hipotéticos, acerca dos quais era solicitada estimativa de sucesso escolar. Cada excerto tinha duas versões (A e B), conforme a informação sobre o estudante fosse mais ou menos favorável, relativamente a variáveis intelectuais, sociodemográficas, autorregulação e desempenho anterior. Os resultados mostram diferenças moderadas entre as estimativas dos participantes que receberam a versão A, comparativamente aos que receberam a versão B, permitindo concluir que aquelas características são relevantes na forma como os docentes desenvolvem estimativas acerca do desempenho acadêmico dos estudantes.

Resumen La relación entre las expectativas de los profesores y el rendimiento académico de los estudiantes ha sido investigada con gran interés. En este estudio se analiza la influencia de la información sobre los estudiantes, en la formulación de estimaciones docentes acerca de sus rendimientos académicos. La muestra estuvo compuesta por 491 profesores, comprendidos entre los 26 y 82 años de edad (M edad = 43). Para evaluar las estimaciones, fueron creados diferentes extractos con información sobre estudiantes hipotéticos, acerca de los cuales era solicitada una estimación de éxito académico. Cada extracto poseía dos versiones (A y B), sobre la información del estudiante, más o menos favorable sobre variables intelectuales, sociodemográficas, familiares, autorregulación y rendimiento académico anterior. Los resultados muestran diferencias moderadas entre las estimaciones de los participantes que recibieron la versión A y las efectuadas por los que recibieron la versión B. Lo anterior, permite arribar a la conclusión de que aquellas características son relevantes para los profesores para realizar sus estimaciones, relativas al desempeño académico de los estudiantes.

TO Clicando - inclusão social e digital de idosos / OT Clicking - digital and social inclusion of the elderly

Introdução: A implementação de estratégias de inclusão digital e de atividades sociais, físicas, cognitivas e de lazer repercutem positivamente na preservação das capacidades físico-cognitivas e na qualidade de vida dos idosos. Objetivo: Relatar a experiência de implantação e desenvolvimento do projeto de extensão universitária "TO Clicando", descrevendo suas características, seus objetivos e suas contribuições acadêmicas e comunitárias. Método: O "TO Clicando" foi criado em 2011, visando a promover a inclusão social e digital de idosos, por meio de oficinas de informática, estimulação cognitiva, atividades manuais e atividades de socialização. As atividades foram desenvolvidas em uma instituição de longa permanência. Os idosos foram avaliados semestralmente. As oficinas e avaliações foram realizadas por alunos do curso de terapia ocupacional da Universidade de Brasília, orientados por professores dos cursos de fisioterapia e de terapia ocupacional. Resultados: Um total de 254 idosos participou das 11 turmas de oficinas de informática, oito turmas de estimulação cognitiva e cinco turmas de atividades manuais, e de duas confraternizações. O projeto contou com a participação de professores, alunos bolsistas e voluntários, e possibilitou o desenvolvimento de projeto de pesquisa e apresentações em congressos. A adesão e as produções sugerem que as atividades atendem ao interesse dos idosos, trazem novas perspectivas de participação social e abrem campo para práticas e pesquisas. Conclusão: O "TO Clicando" é um exemplo viável de projeto de extensão que envolve a participação de docentes, discentes e da comunidade, configurando espaço de aprendizagem, socialização, inclusão social e digital do idoso, permitindo a articulação entre ensino, pesquisa e extensão universitária.

Introduction: The implementation of strategies of digital inclusion and physical, cognitive and social activities has a positive effect on the preservation of the physical and cognitive abilities and quality of life of the elderly. Objective: To report the experience of establishing and developing a university extension project called "OT Clicking", describing its characteristics, goals, and academic and community contributions. Method: The "OT Clicking" project was created in 2011 to promote social and digital inclusion of the elderly by means of computer workshops, cognitive stimulation workshops, hands-on activities, and socialization activities. The activities were developed in a long-term care facility. The elderly were evaluated every six months. Workshops and assessments were performed by students of the occupational therapy course at the University of Brasilia under the guidance of teachers of the physiotherapy and occupational therapy departments. Results: Two hundred and fifty four senior citizens actively attended 11 computer workshops, eight cognitive stimulation workshops, five hands-on activities, and two socialization activities. Teachers, fellow students, and volunteers participated, enabling the development of a research project and conference presentations. The project's attendance and production suggest that the activities serve the interests of the elderly, bring new perspectives of social participation, and open a field for practice and research. Conclusion: "OT Clicking" is a viable example of extension project which includes teachers, students and the community, configuring a space for learning, socialization, and social and digital inclusion of the elderly, allowing connection between university teaching, research and extension.

Peri-implantite: tratamento regenerativo com Bio-oss: resultados clínicos e radiográficos / Periimplantitis: regenerative treatment with Bio-oss: clinical and radiographic results

Neste trabalho foi feita revisão de literatura sobre peri-implatite, abragendo sua etiologia, patogenia, epidemiologia, formas de prevenção e tratamento. Alem de revisão de literatura foi relatado caso clínico. O objetivo desta monografia foi avaliar o tratamento regenerativo com Bio-oss. A revisão de literatura foi feita por meio de pesquisa de artigos no Portal Capes com a palavra chave "perimplantitis" e no site do Pubmed com as seguintes palavras chave: "perimplantitis and treatment Bio-oo"...

Las cuestiones éticas relacionadas con las preferencias del paciente en los cuidados paliativos / Questões éticas referentes às preferências do paciente em cuidados paliativos / Ethical issues related to patient preferences in palliative care

O respeito à autonomia do paciente é um princípio ético reconhecido em diversas áreas da assistência à saúde, incluindo os cuidados paliativos, porém nem sempre as preferências do paciente são respeitadas. Uma melhor compreensão das questões éticas relacionadas ao exercício da autonomia do paciente em cuidados paliativos é importante passo para embasar juízos éticos ponderados no cotidiano da assistência. Tendo isso em vista, este trabalho objetivou identificar e analisar questões éticas relacionadas às preferências do paciente e reconhecidas por profissionais no cotidiano de uma equipe de cuidados paliativos à luz do referencial bioético da casuística. Foram entrevistados onze profissionais de nível superior. As principais questões éticas identificadas foram: respeito à autonomia do paciente; veracidade e direito à informação; habilidades de comunicação; cerco do silêncio; participação no processo de deliberação; escolha do local de tratamento e morte...

El respeto a la autonomía del paciente es un principio ético reconocido en muchas áreas de la salud, incluyendo los Cuidados Paliativos, pero no siempre se respetan las preferencias del paciente. Una mejor comprensión de las cuestiones éticas relacionadas con el ejercicio de la autonomía del paciente en los Cuidados Paliativos es un paso importante para apoyar los juicios éticos ponderados en la práctica diaria de la asistencia. Teniendo esto en cuenta, este estudio tuvo como objetivo identificar y analizar las cuestiones éticas relacionadas con las preferencias del paciente y reconocidas por los profesionales en el día a día de un equipo de cuidados paliativos en el marco bioético de la casuística. Se entrevistó a once profesionales de nivel superior. Se identificaron las principales cuestiones éticas: el respeto a la autonomía del paciente, veracidad y el derecho a la información, habilidades de comunicación, asedio del silencio, participación en el proceso de deliberación, elección del lugar de tratamiento y muerte...

The respect for patient's autonomy is an ethical principle recognized in many areas of health care including palliative care, but not always the patient's preferences are respected. A better understanding of ethical issues related to the exercise of patient's autonomy in Palliative Care is an important step to support ethical judgments in daily practice. Therefore, this study aimed to identify and analyze ethical issues related to patient preferences recognized by professionals in the daily life of a Palliative Care team under the framework of Casuistry. Eleven practitioners were interviewed. The main ethical issues identified are: respect for patient autonomy, veracity and right to information, communication skills, conspiracy of silence, participation in the deliberation process, choice of place of treatment and death...

Oficinas educativas na atenção primária de saúde para promoção do autocuidado em diabetes mellitus / Educational workshops in primary health care for promoting self-care in diabetes mellitus

Este estudo objetiva descrever as oficinas educativas em diabetes mellitus como estratégia para a promoção do autocuidado na atenção primária em saúde. As oficinas foram implementadas, utilizando metodologia participativa e técnicas lúdicas, envolvendo a participação de 63 usuários com diabetes nas Unidades Básicas de Saúde de Belo Horizonte/MG. A metodologia participativa valorizou o conhecimento prévio dos participantes em relação à fisiopatologia, dieta e atividade física e responsabilidade frente ao autocuidado. A oficina mostrou-se como espaço de reflexão e debate sobre a adoção de hábitos saudáveis, sendo considerada uma modalidade educativa adequada para os programas de educação em diabetes.

This study aims to describe educational workshops on diabetes mellitus, as a strategy for promoting self-care in primary health care. The workshops were implemented using a participatory methodology and ludic techniques, and involved the participation of 63 patients with diabetes, at primary healthcare units in Belo Horizonte/MG.. The participatory methodology considered the background of the participants in relation to pathophysiology, diet, and physical activity, and commitment to self-care. The workshop proved to be a space for reflection and discussion on the adoption of healthy habits, and is considered a suitable educational format for diabetes education programs.

Questões éticas reconhecidas por profissionais de uma equipe de Cuidados Paliativos / Ethical issues in Palliative Care

INTRODUÇÃO: A terminalidade da vida humana e a assistência ao paciente com doença que ameaça a vida envolvem questões éticas que devem ser enfrentadas por profissionais de saúde e outros envolvidos no cuidado. Conhecer os problemas éticos vivenciados na prática dos cuidados paliativos e discuti-los à luz de um referencial bioético favorece a deliberação para tomada de decisão e contribui à adequada assistência. OBJETIVOS: Identificar e analisar questões éticas reconhecidas por profissionais de uma equipe de Cuidados Paliativos, sob o referencial Bioético da Casuística; identificar quais os recursos e apoio para tomada de decisão. MÉTODOS: Pesquisa exploratória, qualitativa, com análise de conteúdo, em que profissionais atuantes em Cuidados Paliativos há pelo menos um ano responderam a entrevista semiestruturada. Realizada análise temática, adotando a Casuística como referencial teórico. RESULTADOS E DISCUSSÃO: Foram entrevistados onze profissionais de nível superior. A média de idade foi 41,3 anos. A média de exercício profissional foi de 14,5 anos, sendo em média 5,6 anos em Cuidados Paliativos. As principais questões éticas identificadas foram: Relativas às indicações terapêuticas: erros na compreensão sobre Cuidados Paliativos, que levam a falhas em encaminhamentos, pouca eficácia de interconsultas e desprestígio à equipe; divergências entre a conduta acordada entre equipe e paciente/família e a seguida no pronto socorro; futilidade terapêutica; encenação de reanimação do paciente; autoquestionamento sobre efetividade de intervenções cuja utilidade é provada em outros contextos de assistência; uso de determinados medicamentos, ventilação não invasiva e alimentação/hidratação artificial...

INTRODUCTION: Terminality of human life and the support to patients with diseases that threatens life involve ethical questions that must be faced by health professionals and other people involved in patients care. Awareness of the ethical problems faced in palliative care practice and its discussion through the prism of bioethical references favors decision-making deliberations and contributes to adequate care. OBJECTIVES: Identification and analysis of ethical questions recognized by professionals of a palliative care team, under the bioethical reference of Casuistry; identification of resources and support for the decision-making. METHODS: Exploratory research, qualitative, with content analysis, in which Palliative Care practitioners who have worked for at least one year participated in a semi-structured interview. Thematic analysis was undertaken, adopting Casuistry as theoretical reference. RESULTS AND DISCUSSION: Eleven professionals, with at least a Bachelor of Science degree, were interviewed. The mean age was 41.3 years. The average time in the profession was 14.5 years, of which 5.6 years were spent on the practice of Palliative Care. The main ethical questions identified were: Relative to the therapeutic indications: errors in the comprehension of Palliative Care, which lead to failures in referrals, low efficacy of internal consultations and lack of prestige of the team, divergence between the conduct agreed upon by the team and the patient/family and the follow-up to the emergency room; medical futility; the role play of patient resuscitation; self-questioning about the effectiveness of interventions that have been proved in other contexts of support; use of certain medication, noninvasive ventilation and artificial feeding/hydration...

Exhaled carbon monoxide as a marker for evaluating smoking abstinence in a Brazilian population sample.

BACKGROUND: Exhaled carbon monoxide (CO(Exh)) measurement is used to confirm smoking status in smoking cessation programs, but the cut-off level is still a matter for discussion. The objective of this study was to compare CO(Exh) levels in smokers and non-smokers to validate the method in a Brazilian population and to estimate the probability of the patient still smoking according to different cut-off points. METHODS: In this cross-sectional study we studied non-atopic Caucasian volunteers with no respiratory infection or steroid therapy in the preceding four weeks. Exclusion criteria were: pregnancy; breast feeding; age<18 and >65 years old; and subjects not signing informed consent. Participants filled out a questionnaire and had their CO(Exh) levels measured. Bayes' theorem was used to calculate the posttest probabilities. RESULTS: We included 393 subjects of whom 239 (61%) were smokers. The mean CO(Exh) was 14.7 +/- 9.4 ppm and 4.3 +/- 2.5 ppm (p<0.001) in smokers and nonsmokers, respectively. Patients with CO(Exh) below 8 ppm had a likelihood ratio below 1 of still smoking. The levels 9 ppm and 10 ppm provided likelihood ratios of 1.50 and 1.93, respectively. Better discriminant power was obtained at >11 ppm, when the likelihood ratio became 63.80 (95%CI 16.1-253.1). CONCLUSIONS: In smoking cessation practice, a likelihood ratio approach may be useful to determine the probability that an individual is still smoking according to various CO(Exh) cut-off points instead of using a fixed value for all patients.

Validação do método para determinação de cotinina em urina por cromatografia líquida de alta eficiência / Validation of a high-performance liquid chromatography method for the determination of cotinine in urine

Tobacco dependence reaches nearly one third of the world population, and is the second leading cause of deth around the world. Cotinine, a major metabolite of nicotine, is conssidered the most appropriate parameter to evaluate tobacco exposure HLPC (High Performance Liquid Chromatography) was choses to analyze cotinine concentrations in urine. Aiming at validating this method of analysis, urine samples with added cotinine were submitted to liquid-liquid extractions using2-phenylimidazole as the internal standard. After evaporation, residue was injected in HLPC with ultraviolet detection and C8 column. The following parameters were stabilishe: linearity, precision, detection and qualification limit, accuracy, ans stability. The calibration curve, determined ian a interval of 10ng/mL and 1000ng/mL, presented linearity (R2 = 0,09979). The method limit of detection was of 5ng/mL, and the limit of quantification was of 10ng/mL. In 50, 500, and 1000ng/mL concentrations, the precision was of 11.2; 12.3, and 8.1 per cent, accuracy found was of 107.0; 101.7, and 97.0 per cent, and loss during the stability test was of 8.1...

Abstinence rates and predictors of outcome for smoking cessation: do Brazilian smokers need special strategies?

AIMS: To study tobacco abstinence and risk factors for failure in smoking cessation program and to evaluate the need for special strategies in a Brazilian cohort of smokers. DESIGN: A non-randomized, prospective, open clinical trial. PATIENTS AND METHODS: We studied smokers who attended the Smoking Cessation Clinics of Hospital Sao Lucas da PUCRS, in Porto Alegre, Brazil between July, 1999 and June, 2003. All participated in the same behavioral therapy program and, according to the Fagerstrom test, also received nicotine patches and/or bupropion. Sustained abstinence was confirmed by exhaled CO measurements

Sobrevida de longo prazo em carcinoma brônquico após tratamento cirúrgico: sexo é fator prognóstico? / Long time survival rate in lung carcinoma after surgical treatment: is gender a prognostic factor?

INTRODUÇAO: A semelhança de resultados relatados por outros autores, anteriormente havíamos encontrado possível associação entre sexo e prognóstico em carcinoma brônquico não-pequenas células (CBNPC) em estágio I, com melhores taxas de sobrevida em mulheres. OBJETIVO: O objetivo do presente trabalho foi o de ampliar o estudo dos possíveis fatores prognósticos em CBNPC. MÉTODO: Em estudo de coorte retrospectivo, foi avaliada a sobrevida de 163 pacientes com CBNPC tratados cirurgicamente, com intenção curativa, no Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), entre 1990 e 1997, até o óbito ou o seguimento por cinco anos. Os dados foram analisados através de curvas de Kaplan-Meier e pelo teste de Mann-Whitney para comparar os tempos de sobrevida e pelo modelo de regressão de Cox para avaliar possíveis fatores de confusão. RESULTADOS: Foram incluídos 124 (76,07 por cento) homens e 39 (23,93 por cento) mulheres. A sobrevida mediana foi 32,3 e 60,6 meses e a sobrevida em cinco anos de 38,0 por cento e 55,4 por cento, para homens e mulheres, respectivamente (p=0,030). Considerando apenas pacientes em Estágio I, as taxas de sobrevida foram 44,4 por cento e 81,8 por cento para homens e mulheres, respectivamente (p=0,009). O efeito do sexo persistiu após ajuste para vários fatores (idade, hemoglobina, histologia, tamanho do tumor, extensão da cirurgia e complicações pós-operatórias), realizado através da regressão de Cox. O risco relativo em mulheres foi 0,09 (IC90 por cento:0,03-0,25, p<0,001) quando comparado com o de homens. CONCLUSAO: Este estudo confirmou achados prévios de que as mulheres vivem por mais tempo após cirurgia para tratamento de CBNPC, quando comparadas aos homens. Esse efeito é observado apenas em estágio precoce e persiste após ajuste de vários fatores.

Is there a gender difference in non-small cell lung cancer survival?

BACKGROUND: A possible association had previously been noted between gender and prognosis in non-small cell lung cancer (NSCLC), with a better survival rate for women. OBJECTIVE: The purpose of the current study was to further clarify the role of gender as a possible prognostic factor in NSCLC. METHODS: This retrospective cohort study examined the survival of NSCLC patients who underwent surgical curative treatment at the Hospital Sao Lucas da PUCRS, Porto Alegre, Brazil, between January 1, 1990, and December 31, 2000. Data were analyzed using Kaplan-Meier survival curves. In addition, a Cox proportional hazards regression model was used to adjust for potential confounding factors. RESULTS: In the period studied, lung resections were performed in 253 patients with NSCLC, of whom 114 had stage I tumors. Four patients were excluded because of death in the immediate postoperative period, and 1 committed suicide. The 5-year survival rate was 85.5% for women and 46.4% for men (P<0.0001). The median overall survival time was 44.7 months (interquartile range [IQR(25%-75%)], 17.4-72.3 months) and was longer in women than in men: 63.9 months (IQR(25%5%), 35.2-98.7 months) versus 32.3 months (IQR(25%-75%), 11.8-61.5 months), respectively (P<0.0001). Gender effect was still present after adjustment by Cox regression for several factors (age, smoking habits, hemoglobin, forced expiratory volume in 1 second, tumor size, tumor-node-metastasis stage, histology, postoperative complications, and surgery type). The adjusted hazard ratio in women was 0.23 (95% CI, 0.09-0.59; (P<0.0001) when compared with men. CONCLUSION: This study confirms previous findings that women live longer than men after surgery for stage I NSCLC. This effect persisted after adjusting for several factors. These results highlight the fact that analyses of long-term survival of NSCLC patients, usually generalized to men and women as a whole, may be an inadequate extrapolation. These results question whether analyses of long-term survival, which commonly group men and women together, provide an adequate prognosis of survival rates in women with NSCLC.