Thromboembolism in Arthroplasty: Compliance to Prophylaxis.

Objective The present paper aims to identify the profile of compliance to thromboembolism drug prophylaxis in patients undergoing knee or hip arthroplasty at a public hospital. Methods This is a prospective cohort study, carried out from August 2017 to September 2018, with adult patients who were followed-up from admission until the postoperative period. The Morisky Medication Adherence Scale, consisting of eight items, was applied. Compliance was quantified according to the sum of all correct answers as high (8 points), medium (6 to < 8 points), and low compliance (< 6 points). For the present study, subjects with high compliance were referred as highly compliant, whereas those with medium to low compliance were referred as partially compliant. Results The compliance analysis showed that 73.0% of the patients were highly compliant and 27.0% were partially compliant to thromboprophylaxis. The anticoagulant prescribed at hospital discharge was rivaroxaban, a direct factor Xa inhibitor. Compliance was greater in patients who did not require reinforcement in prophylaxis guidance during follow-up; these subjects reported good and excellent acceptance of prophylaxis, although they were on multiple medications at discharge. Conclusion The data analysis allowed us to conclude that the factors that most influenced compliance were the levels of understanding and acceptance of prophylaxis by the patients, the amount of medication used per day by the subject, the cost of the anticoagulant agent, and its potential to cause adverse reactions.

Perfil das infecções fúngicas em pacientes transplantados renais / Profile of fungal infectios in renal transplantes patients

O transplante renal é uma alternativa eficaz como tratamento da Doença Renal Crônica, dado seu custo efetividade e o aumento na sobrevida dos pacientes. Os imunossupressores também garantem maior sobrevida do enxerto, porém tornam o receptor susceptível a infecções, como as fúngicas. O objetivo do estudo foi conhecer as infecções fúngicas de pacientes da enfermaria de transplante renal do Hospital de Referência do Maranhão, através de pesquisa dos prontuários destes com diagnóstico de micose entre 2014 a 2018. Foram encontrados 9 casos, 5 de criptococose, 2 de aspergilose e 2 de candidíase, sendo 6 pacientes homems e 3 mulheres; 5 receptores de doadores vivos e 4, doadores falecidos. Em 7 casos, a terapia de imunossupressão prescrita foi metilprednisolona e basiliximab, e em 2 casos, timoglobulina. O exame diagnóstico foi o micológico direto em 6 casos e endoscopia digestiva alta, biópsia de pele e exame clínico em 1 caso cada. As espécies isoladas foram Cryptococcus sp. (3), C. neoformans (2), Aspergillus sp. (2), Candida tropicalis, C. krusei (1) e C. albicans (1). Excetuando-se um caso de candidíase tratado com fluconazol e um caso com a forma desoxicolato, todos os outros foram tratados com anfotericina B lipídica e fluconazol como manutenção. Sete casos tiveram a cura como desfecho, e 2 o óbito. Percebe-se a importância do estudo dessas infecções, o olhar cuidadoso em relação as mesmas e a atuação do farmacêutico para monitorização da farmacoterapia, para maior segurança do paciente. (AU)

Renal transplantation has been an effective alternative as the treatment of Chronic Renal Disease, due to its cost effectiveness and the increase of the patients' survival. Immunosuppressants also ensure the longer survival of the graft, but make the recipient susceptible to infections, such as fungi. The objective of the study was to know as the main fungal infections of patients with transplant renal disease at the Reference Hospital of Maranhão, through the study of the medical records of patients diagnosed with fungal infection in the period from 2014 to 2018. There were 9 cases, cryptococcosis, 2 aspergillosis and 2 per candidiasis, 6 male and 3 female patients, 5 live donor recipients and 4 deceased donors. In 7 cases, a prescribed immunosuppressive therapy was methylprednisolone and basiliximab, and in 2 cases thymoglobulin. The clinical examination was done in 6 cases and upper digestive endoscopy, skin biopsy and clinical examination in 1 case each. The species were Cryptococcus sp. (3), C. neoformans (2), Aspergillus sp. (2), Candida tropicalis, C. krusei (1) and C. albicans (1). Except for one case of candidacy treated with fluconazole and one case with a deoxycholate form, all others were treated with amphotericin B lipid complex and fluconazole as maintenance. Seven cases had a cure as an outcome, and 2 a death. It was noticed the importance of the study of these infections, the careful look at them and the pharmacist's performance to monitor pharmacotherapy, for greater patient safety. (AU)

Avaliação do risco cardiovascular em pacientes renais crônicos em fase não dialítica por indicadores antropométricos / Cardiovascular risk evaluation in chronic renal patients in non-dialysis by anthropometric indicators

Introdução: Estudos que adotaram os indicadores antropométricos de risco cardiovascular na avaliação de pacientes com doença renal crônica (DRC) em fase não dialítica são escassos. Objetivo: Avaliar o risco cardiovascular por indicadores antropométricos em pacientes com DRC em fase não dialítica e fatores associados. Métodos: Estudo transversal com 106 pacientes atendidos em hospital universitário, em São Luís-MA. Aplicou-se formulário estruturado com informações sociodemográficas, estilo de vida, morbidades e estadiamento da doença renal. Para avaliação antropométrica e identificação do risco cardiovascular, adotaram-se os indicadores: índice de massa corporal, circunferência da cintura, circunferência do pescoço, diâmetro abdominal sagital, relação cintura-estatura e índice de conicidade. Os testes do Qui-quadrado de Person e Exato de Fischer avaliaram a associação entre as variáveis e adotou-se o nível de significância p<0,05. Resultados: Pela circunferência da cintura, houve risco cardiovascular muito elevado nas mulheres (75,4%), e pelo índice de conicidade, todas estavam em risco (p<0,001). Nos pacientes com ≥60 anos de idade, houve risco cardiovascular pelos indicadores diâmetro abdominal sagital (77,5%), razão cintura-estatura (92,6%) e índice de conicidade (98,2%) (p<0,005). A circunferência do pescoço apontou risco elevado nos fumantes (100,0%) e etilistas (88,9%) (p=0,001). Pela circunferência do pescoço (73,5%) e razão cintura-estatura (91,7%), os renais crônicos diabéticos apresentaram risco cardiovascular elevado (p<0,05). Conclusão: O risco cardiovascular evidenciado por diferentes indicadores antropométricos aponta que ações de promoção da saúde devem ser implementadas, de modo a melhorar o estilo de vida e contribuir para o melhor prognóstico desses pacientes.

Introduction: Studies that have adopted anthropometric indicators for the evaluation of cardiovascular risk in patients with chronic kidney disease (CKD) in the non-dialysis phase are scarce. Objective: To assess cardiovascular risk, with anthropometric indicators, in patients with CKD in the non-dialysis phase and their associated factors. Methods: Cross-sectional study with 106 patients treated at a university hospital in São Luís-MA. A structured form was applied to collect information on sociodemographics, lifestyle, morbidities, and stage of kidney disease. For anthropometric evaluation and identification of cardiovascular risk, the following indicators were adopted: body mass index, waist circumference, neck circumference, sagittal abdominal diameter, waist-to- height ratio, and conicity index. Person's chi-square test and Fischer's exact test evaluated the association between the variables and adopted the significance level p<0.05. Results: According to waist circumference, there was very high cardiovascular risk in women (75.4%); and according to the conicity index, all were at risk (p<0.001). In patients with ≥60 years of age, there was cardiovascular risk according to the indicators of sagittal abdominal diameter (77.5%), waist-to-height ratio (92.6%), and conicity index (98.2%) (p<0.005). Neck circumference showed high risk in smokers (100.0%) and alcohol users (88.9%) (p=0.001). According to neck circumference (73.5%) and waist-to-height ratio (91.7%), diabetic chronic renal patients presented high cardiovascular risk (p<0.05). Conclusion: The cardiovascular risk, evidenced by different anthropometric indicators, shows that actions promoting a healthy lifestyle should be implemented, thus contributing to the better prognosis of these patients.

Sensitivity and specificity of the body mass index in the diagnosis of obesity in patients with non-dialysis chronic kidney disease: a comparison between gold standard methods and the cut-off value purpose.

INTRODUCTION: Introduction: nutritional status is an important predictor of prognosis in chronic kidney disease (CKD), including pre-dialysis. Anthropometric measures universally used for the diagnosis of obesity in the general population may not present the same performance in individuals with CKD. Objective: to verify the sensitivity and specificity of body mass index (BMI) in relation to the percentage of body fat (%BF) obtained by dual energy X-ray absorptiometry (DEXA) and air displacement plethysmography (PDA) for patients with non-dialysis chronic kidney disease. Methods: BMI was obtained. DEXA and ADP were used to determine %BF and they were considered as gold standard methods. Results: a total of 78 patients were evaluated, with a mean age of 54.4 ± 13.9 years old. There was a higher prevalence of overweight/obesity (55.2%), according to BMI, and high %BF, according to DEXA (69.2%) and ADP (53.8%). BMI showed a statistically significant correlation with the %BF obtained by both methods and in both sexes (p < 0.05). To detect high %BF, a BMI of 25 kg/m2 had better sensitivity and specificity values for DEXA (73.3% and 66.7%, respectively) and ADP (77.3% and 52.9%, respectively) in men, and for DEXA (79.9% and 46.7%, respectively) in women. However, a BMI of 26 kg/m2 for ADP in women would be more accurate (70.0% and 73.7%, respectively). Conclusion: the prevalence of patients with excess body fat was high. The conventional cut-off points for BMI were not adequate in these patients and suggested that BMI ≥ 25 kg/m2 were more accurate for diagnosing obesity.

INTRODUCCIÓN: Introducción: el estado nutricional es un importante predictor de pronóstico en la enfermedad renal crónica (ERC), incluso en la fase de prediálisis. Las medidas antropométricas universalmente usadas para el diagnóstico de la obesidad en la población general pueden no presentar el mismo desempeño en individuos con ERC. Objetivo: verificar la sensibilidad y especificidad del índice de masa corporal (IMC) en relación con el porcentaje de grasa corporal (%GC), obtenido por la absorciometría con rayos X de doble energía (DEXA) y pletismografía de desplazamiento aéreo (PDA) de pacientes renales crónicos no dialíticos. Métodos: se obtuvo el IMC. La DEXA y la PDA se utilizaron para determinar el porcentaje de GC y se consideraron métodos patrón-oro. Resultados: se evaluaron 78 pacientes con una media de edad de 54,4 ± 13,9 años. Se observó una elevada prevalencia de sobrepeso/obesidad (55,2%), según el IMC, y de porcentaje de GC alto, de acuerdo con la DEXA (69,2%) y la PDA (53,8%). El IMC presentó una correlación estadísticamente significativa con el porcentaje de GC obtenido por los dos métodos y en ambos sexos (p < 0,05). Para detectar un %GC alto, el IMC de 25 kg/m2 presentó mayor sensibilidad y especificidad para DEXA (73,3% y 66,7%, respectivamente) y PDA (77,3% y 52,9%, respectivamente) en los hombres y para DEXA (79,9% y 46,7%, respectivamente) en mujeres, pero el IMC de 26 kg/m2 para la PDA en mujeres sería más preciso (70,0% y 73,7%, respectivamente). Conclusión: la prevalencia de pacientes con exceso de grasa corporal fue elevada. Los puntos de corte convencionales para el IMC no fueron adecuados en esos pacientes y esto sugiere que los valores de IMC ≥ 25 kg/m2 presentan mayor exactitud para el diagnóstico de obesidad.

Sensitivity and specifi city of the body mass index in the diagnosis of obesity in patients with non-dialysis chronic kidney disease: a comparison between gold standard methods and the cut-off value purpose / Sensibilidad y especificidad del índice de masa corporal en el diagnóstico de obesidad en pacientes renales crónicos no dialíticos: comparación con métodos estándar de oro y propuesta de puntos de corte

Introduction: nutritional status is an important predictor of prognosis in chronic kidney disease (CKD), including pre-dialysis. Anthropometric measures universally used for the diagnosis of obesity in the general population may not present the same performance in individuals with CKD. Objective: to verify the sensitivity and specifi city of body mass index (BMI) in relation to the percentage of body fat (%BF) obtained by dual energy X-ray absorptiometry (DEXA) and air displacement plethysmography (PDA) for patients with non-dialysis chronic kidney disease. Methods: BMI was obtained. DEXA and ADP were used to determine %BF and they were considered as gold standard methods. Results: a total of 78 patients were evaluated, with a mean age of 54.4 ± 13.9 years old. There was a higher prevalence of overweight/obesity (55.2%), according to BMI, and high %BF, according to DEXA (69.2%) and ADP (53.8%). BMI showed a statistically signifi cant correlation with the %BF obtained by both methods and in both sexes (p < 0.05). To detect high %BF, a BMI of 25 kg/m2 had better sensitivity and specifi city values for DEXA (73.3% and 66.7%, respectively) and ADP (77.3% and 52.9%, respectively) in men, and for DEXA (79.9% and 46.7%, respectively) in women. However, a BMI of 26 kg/m2 for ADP in women would be more accurate (70.0% and 73.7%, respectively). Conclusion: the prevalence of patients with excess body fat was high. The conventional cut-off points for BMI were not adequate in these patients and suggested that BMI ≥ 25 kg/m2 were more accurate for diagnosing obesity

Introducción: el estado nutricional es un importante predictor de pronóstico en la enfermedad renal crónica (ERC), incluso en la fase de prediálisis. Las medidas antropométricas universalmente usadas para el diagnóstico de la obesidad en la población general pueden no presentar el mismo desempeño en individuos con ERC. Objetivo: verificar la sensibilidad y especifi cidad del índice de masa corporal (IMC) en relación con el porcentaje de grasa corporal (%GC), obtenido por la absorciometría con rayos X de doble energía (DEXA) y pletismografía de desplazamiento aéreo (PDA) de pacientes renales crónicos no dialíticos. Métodos: se obtuvo el IMC. La DEXA y la PDA se utilizaron para determinar el porcentaje de GC y se consideraron métodos patrón-oro. Resultados: se evaluaron 78 pacientes con una media de edad de 54,4 ± 13,9 años. Se observó una elevada prevalencia de sobrepeso/obesidad (55,2%), según el IMC, y de porcentaje de GC alto, de acuerdo con la DEXA (69,2%) y la PDA (53,8%). El IMC presentó una correlación estadísticamente significativa con el porcentaje de GC obtenido por los dos métodos y en ambos sexos (p < 0,05). Para detectar un %GC alto, el IMC de 25 kg/m2 presentó mayor sensibilidad y especifi cidad para DEXA (73,3% y 66,7%, respectivamente) y PDA (77,3% y 52,9%, respectivamente) en los hombres y para DEXA (79,9% y 46,7%, respectivamente) en mujeres, pero el IMC de 26 kg/m2 para la PDA en mujeres sería más preciso (70,0% y 73,7%, respectivamente). Conclusión: la prevalencia de pacientes con exceso de grasa corporal fue elevada. Los puntos de corte convencionales para el IMC no fueron adecuados en esos pacientes y esto sugiere que los valores de IMC ≥ 25 kg/m2 presentan mayor exactitud para el diagnóstico de obesidad

Alterations in postmenopausal plasmatic lipidome.

BACKGROUND: Menopause consists of a physiological process in women between 40 and 50 years of age, and it has substantial consequences for health, ranging from disturbances in lipid and glycidic metabolism to psychological stress and sleep alterations, thereby increasing women's risk of cardiovascular diseases. Here, we attempted to identify potential lipid alterations not identified by the classic methods. METHODS AND RESULTS: We analyzed the serum lipid profile in 40 women in pre- and post-menopause using a lipidomic approach and mass spectrometry. Lipid species presented increased concentrations, with a difference of more than 25% post-menopause and with the ceramides (N.C23:0.Cer, N.C23:0(OH).Cer and N.C24:0(OH).Cer) standing out with a fold change of 1.68, 1.59, and 1.58, respectively. It was also observed that 14 metabolites presented a significant difference in the average concentrations between pre- and post-menopause, especially the ceramide species. Strong and positive correlations were identified between various metabolites and fasting glucose, glycated hemoglobin, total cholesterol, LDL, and triglycerides. Of note were the association ceramide (N.C10:0.Cer) and lysophosphatidylethanolamine (LPE.a.C18:0) between fasting glucose and glycated hemoglobin. CONCLUSION: This study detected lipid alterations, especially in ceramides, post-menopause, as well as correlations with glycidic and lipid markers, which may in the future be useful to investigate diseases associated with menopause.

Does infection by the hepatitis C virus decrease the response of immunization against the hepatitis B virus in individuals undergoing dialysis? / Infecção pelo virus da hepatite C diminui a resposta vacinal para o vírus da hepatite B em uma população em diálise?

Abstract Introduction: Vaccination is the most effective tool in preventing transmission of Hepatitis B Virus (HBV). The patient with chronic kidney disease (CKD) on dialysis appear to be at greater risk of becoming infected with this virus and does not show the same vaccine response when compared to patients without uremia. Objectives: To evaluate the results related to the HBV vaccine and identify factors associated with the response in patients with CKD on hemodialysis. Methods: Individuals with HBsAG and negative anti-HBC, under hemodialysis were assessed in two units of São Luis, Maranhão and were undergone full vaccination schedule for HBV. They were divided in groups: anti-HBs10 mUI/mL and compared as to age, gender, presence of diabetes mellitus (DM), time on dialysis and anti-HCV status. Logistic regression analysis was performed to identify factors independently associated with the vaccine response. p10mUI/Ml (or = 5.239 IC: 1.279-21.459, p = 0.021). Conclusion: The rate of vaccine response to HBV in patients with CKD on dialysis was 70% and the lack of anti-HCV infection was associated with seroconversion of anti-HBs suggesting that infection by the hepatitis C virus may be a factor that decreases the response of the HBV vaccine in dialysis CKD patients.

Resumo Introdução: A vacinação é a medida mais efetiva na prevenção da transmissão do vírus da hepatite B (HBV). O portador de doença renal crônica (DRC) em diálise apresenta maior risco de se contaminar com este vírus e não tem a mesma resposta vacinal quando comparada com indivíduos sem uremia. Objetivos: Avaliar os resultados da vacina para o HBV e identificar fatores associados à resposta, em portadores de DRC em hemodiálise. Metodologia: Foram avaliados indivíduos com HBsAg e anti-HBc negativos, que estavam sob hemodiálise em duas unidades de São Luís, Maranhão e que haviam sido submetidos ao esquema completo de vacinação para o HBV. Foram distribuídos em dois grupos: anti-HBs < 10mUI/mL e anti-HBs ≥ 10mUI/mL e comparados quanto à idade, gênero, presença de diabetes mellitus (DM), tempo em diálise e status do anti-HCV. Análise de regressão logística foi realizada para identificar fatores independentemente associados à resposta vacinal. Anti-HBs ≥ 10mUI/mL(OR = 5.239 IC:1.279-21.459, p = 0.021) Conclusões: A taxa de resposta vacinal ao HBV em portadores de DRC em diálise foi de 70% e a ausência do anti-HCV foi associada à soroconversão do anti-HBs, sugerindo que a infecção pelo vírus da hepatite C pode ser um fator que diminui a resposta da vacina para o HBV em indivíduos portadores de DRC em diálise.

Does infection by the hepatitis C virus decrease the response of immunization against the hepatitis B virus in individuals undergoing dialysis?

INTRODUCTION: Vaccination is the most effective tool in preventing transmission of Hepatitis B Virus (HBV). The patient with chronic kidney disease (CKD) on dialysis appear to be at greater risk of becoming infected with this virus and does not show the same vaccine response when compared to patients without uremia. OBJECTIVES: To evaluate the results related to the HBV vaccine and identify factors associated with the response in patients with CKD on hemodialysis. METHODS: Individuals with HBsAG and negative anti-HBC, under hemodialysis were assessed in two units of São Luis, Maranhão and were undergone full vaccination schedule for HBV. They were divided in groups: anti-HBs10 mUI/mL and compared as to age, gender, presence of diabetes mellitus (DM), time on dialysis and anti-HCV status. Logistic regression analysis was performed to identify factors independently associated with the vaccine response. p10mUI/Ml (or = 5.239 IC: 1.279-21.459, p = 0.021). CONCLUSION: The rate of vaccine response to HBV in patients with CKD on dialysis was 70% and the lack of anti-HCV infection was associated with seroconversion of anti-HBs suggesting that infection by the hepatitis C virus may be a factor that decreases the response of the HBV vaccine in dialysis CKD patients.

Quantitative methods in electroencephalography to access therapeutic response.

Pharmacometrics or Quantitative Pharmacology aims to quantitatively analyze the interaction between drugs and patients whose tripod: pharmacokinetics, pharmacodynamics and disease monitoring to identify variability in drug response. Being the subject of central interest in the training of pharmacists, this work was out with a view to promoting this idea on methods to access the therapeutic response of drugs with central action. This paper discusses quantitative methods (Fast Fourier Transform, Magnitude Square Coherence, Conditional Entropy, Generalised Linear semi-canonical Correlation Analysis, Statistical Parametric Network and Mutual Information Function) used to evaluate the EEG signals obtained after administration regimen of drugs, the main findings and their clinical relevance, pointing it as a contribution to construction of different pharmaceutical practice. Peter Anderer et. al in 2000 showed the effect of 20mg of buspirone in 20 healthy subjects after 1, 2, 4, 6 and 8h after oral ingestion of the drug. The areas of increased power of the theta frequency occurred mainly in the temporo-occipital - parietal region. It has been shown by Sampaio et al., 2007 that the use of bromazepam, which allows the release of GABA (gamma amino butyric acid), an inhibitory neurotransmitter of the central nervous system could theoretically promote dissociation of cortical functional areas, a decrease of functional connectivity, a decrease of cognitive functions by means of smaller coherence (electrophysiological magnitude measured from the EEG by software) values. Ahmad Khodayari-Rostamabad et al. in 2015 talk that such a measure could be a useful clinical tool potentially to assess adverse effects of opioids and hence give rise to treatment guidelines. There was the relation between changes in pain intensity and brain sources (at maximum activity locations) during remifentanil infusion despite its potent analgesic effect. The statement of mathematical and computational aspects in the use of clinical data is frequent and elucidation of these aspects we use PhysioNet https://www.physionet.org/, Clinical Database online supported by the National Institutes of Health (National Institutes of Health of United States of America/NIH-USA) for the acquisition of EEG data and the Matlab program to do the simulations with the methods and thus create opportunities greater understanding.

Occult hepatitis B among patients with chronic renal failure on hemodialysis from a capital city in northeast Brazil.

Occult hepatitis B (OHB) is characterized by the presence of HBV-DNA in the absence of HBsAg in the serum of patients. Hemodialysis patients are at high risk for hepatitis B virus and there are few data on the prevalence of OHB in this population, mainly in Brazil. Thus, the aim of this study was to determine the prevalence of OHB in patients undergoing hemodialysis. A cross-sectional study was performed, including 301 patients on chronic hemodialysis at two dialysis centers in São Luís (Maranhão), northeast Brazil. Serological tests were performed for HBsAg, anti-HBc, anti-HBs, and anti-HCV using enzyme immunoassays (ELISA); HBV-DNA and HCV-RNA were studied by real-time PCR. The mean age was 49 ± 15 years, and 128 (42%) were female. Serological tests confirmed that all samples were HBsAg negative. Anti-HBc was positive in 114 (38%) patients, anti-HBc and anti-HBs were simultaneously positive in 104 (35%), and anti-HBc alone was positive in 10 (3%). Tests were negative for anti-HBc and anti-HBs in 55 patients (18%). Anti-HBs was the only positive marker in 132 (44%) patients. Anti-HCV was positive in 15 (5%) patients with HCV-RNA present in 14 of them (93%). HBV-DNA was positive in seven cases (2.3%). There was no association of HBV-DNA with age, gender, time on dialysis, previous kidney transplant, or HBV serological pattern, but there was a positive correlation with the presence of anti-HCV (P < 0.001). OHB in chronic renal failure patients on hemodialysis appears to be a relevant finding, suggesting that studying HBV-DNA in this population using sensitive molecular tests should be a recommended course of action, especially in candidates for renal transplant.