Cognitive function in patients with chronic pain treated with opioids: characteristics and associated factors.

BACKGROUND: The paucity of studies regarding cognitive function in patients with chronic pain, and growing evidence regarding the cognitive effects of pain and opioids on cognitive function prompted us to assess cognition via neuropsychological measurement in patients with chronic non-cancer pain treated with opioids. METHODS: In this cross-sectional study, 49 patients were assessed by Continuous Reaction Time, Finger Tapping, Digit Span, Trail Making Test-B and Mini-mental State Examination tests. Linear regressions were applied. RESULTS: Patients scored poorly in the Trail Making Test-B (mean = 107.6 s, SD = 61.0, cut-off = 91 s); and adequately on all other tests. Several associations among independent variables and cognitive tests were observed. In the multiple regression analyses, the variables associated with statistically significant poor cognitive performance were female sex, higher age, lower annual income, lower schooling, anxiety, depression, tiredness, lower opioid dose, and more than 5 h of sleep the night before assessment (P < 0.05). CONCLUSIONS: Patients with chronic pain may have cognitive dysfunction related to some reversible factors, which can be optimized by therapeutic interventions.

Sexual abuse victimisation and perpetration in a cohort of men living with HIV/AIDS who have sex with women from São Paulo, Brazil.

Sexual abuse leads to physical harm and devastating psychosocial consequences. It increases risk of HIV transmission and is associated with risky behaviour. Little is known about sexual abuse victimisation (SAV) and perpetration (SAP) among HIV-positive men who have sex with women (MSW). We investigated self-reported SAV and SAP among 242 Brazilian MSW selected at HIV care centres. Patients were questioned about sociodemographic data, mode of HIV acquisition, sexual practices, drug use and history of SAV or SAP. Prevalence of outcomes was estimated and risk factors for SAP investigated by logistic regression. Fifty-eight (24.1%) interviewees reported SAV. Of patients abused before 15 years of age, 64.3% reported events before the age of ten. Aggressors included relatives, friends and teachers. Among those victimised after 15 years old, 57.7% described events before 17 and 38.5% had acquainted aggressors. Fourteen (5.8%) interviewees reported SAP and most knew their victims. Sexual abuse perpetration was associated with lower schooling, marital status, illicit drug use and self-reported SAV. Sexual abuse was frequently reported by MSW from this cohort. Identifying predictors of violence and addressing SAV and SAP in comprehensive HIV care may help reduce violent behaviour, psychological distress and contribute to maximise benefits of preventive and care interventions.

Sexual abuse victimisation and perpetration in a cohort of men living with HIV/AIDS who have sex with women from São Paulo, Brazil

Sexual abuse leads to physical harm and devastating psychosocial consequences. It increases risk of HIV transmission and is associated with risky behaviour Little is known about sexual abuse victimisation (SAV) and perpetration (SAP) among HIVpositive men who have sex with women (MSW). We investigated self-reported SAV and SAP among 242 Brazilian MSW selected at HIV care centres. Patients were questioned about sociodemographic data, mode of HIV acquisition, sexual practices, drug use and history of SAV or SAP. Prevalence of outcomes was estimated and risk factors for SAP investigated by logistic regression. Fifty-eight (24.1%) interviewees reported SAV. Of patients abused before 15 years of age, 64.3%reported events before the age of ten. Aggressors included relatives, friends and teachers. Among those victimised after 15 years old, 57.7 described events before 17 and 38.5 had acquainted aggressors. Fourteen (5.8%) interviewees reported SAP and most knew their victims. Sexual abuse perpetration was associated with lower schooling, marital status, illicit drug use and self-reported SAV. Sexual abuse was frequently reported by MSW from this cohort. Identifying predictors ofviolence and addressing SAVand SAP in comprehensive HIV care may help reduce violent behaviour, psychological distress and contribute to maximise benefits of preventive and care interventions

Sexual abuse victimisation and perpetration in a cohort of men living with HIV/AIDS who have sex with women from São Paulo, Brazil

Sexual abuse leads to physical harm and devastating psychosocial consequences. It increases risk of HIV transmission and is associated with risky behaviour Little is known about sexual abuse victimisation (SAV) and perpetration (SAP) among HIVpositive men who have sex with women (MSW). We investigated self-reported SAV and SAP among 242 Brazilian MSW selected at HIV care centres. Patients were questioned about sociodemographic data, mode of HIV acquisition, sexual practices, drug use and history of SAV or SAP. Prevalence of outcomes was estimated and risk factors for SAP investigated by logistic regression. Fifty-eight (24.1%) interviewees reported SAV. Of patients abused before 15 years of age, 64.3%reported events before the age of ten. Aggressors included relatives, friends and teachers. Among those victimised after 15 years old, 57.7 described events before 17 and 38.5 had acquainted aggressors. Fourteen (5.8%) interviewees reported SAP and most knew their victims. Sexual abuse perpetration was associated with lower schooling, marital status, illicit drug use and self-reported SAV. Sexual abuse was frequently reported by MSW from this cohort. Identifying predictors ofviolence and addressing SAVand SAP in comprehensive HIV care may help reduce violent behaviour, psychological distress and contribute to maximise benefits of preventive and care interventions

Course of the post-catheterization pulseless arm.

With the purpose of determining the course of the non-operated post-catheterization brachial artery thrombosis, 45 patients in this condition were followed during a one month period of survey. A gradual increase in Doppler-derived pressure index of the ischemic arm was observed. This index averaged 0.51 on the day of occlusion, increased to an average of 0.66 in the immediate following day and on the 30th day averaged 0.82. All but 10 patients were asymptomatic after 30 days, although a similar increase in pressure index was observed among these patients, being thus indistinguishable from the whole group. Since it was not possible to predict in which patients symptoms of arm ischemia would remain present, it seems advisable to consider surgical restoration of flow in all cases of brachial artery thrombosis after cardiac catheterization.

Embolectomia arterial tardia. / Delayed arterial embolization

Em raras ocasioes a isquemia determinada por fenomeno embolico arterial das extremidades e suficientemente compensado para nao levar a situacao definida de irreversibilidade com consequente perda do segmento comprometido, favorecendo a protelacao de procura de tratamento medico por parte do paciente. Quatorze pacientes foram atendidos nestas circunstancias, todos com tempo de isquemia igual ou superior a sete dias. Em todos os casos foi tentada a embolectomia convencional por meio de cateter, a qual foi conseguida em 13 casos ja que em um nao se conseguiu vencer o trombo localizado na bifurcacao da aorta.Em outro caso houve trombose subsequente a embolectomia. Dentre os demais pacientes ocorreu um obito e em um definiram-se lesoes irreversiveis do segmento isquemico.Desta forma, a emblolectomia foi efetiva em 72% dos casos, ocorrendo indice de mortalidade de 7%, e igual numero de amputacoes

Aneurisma toraco-abdominal.Consideracoes cirurgicas e anestesiologicas. / Thoraco-abdominal aneurysm: surgical and anestesiologic considerations

O aneurisma da aorta toraco-abdominal e apresentado como afeccao grave e de indicacao cirurgica. Os autores explicam sua experiencia inicial a aneurismectomia pela tecnica preconizada por Crawford, fazendo consideracoes a respeito do procedimento cirurgico e ressaltando as implicacoes anestesiologicas, bem como as dos preparo pre-operatorio