Intraobserver and interobserver agreement of Goutallier classification applied to magnetic resonance images.

BACKGROUND: Fatty infiltration of the muscle bellies is an important prognostic factor in rotator cuff tears. It was described initially in computed tomography examinations, and there is an ongoing debate about whether magnetic resonance (MR) is a reliable method for staging fatty infiltration. This study sought to determine intraobserver and interobserver agreement for Goutallier's classification of fatty infiltration of the rotator cuff as evaluated through MR imaging. MATERIALS AND METHODS: Twenty MR examinations of the shoulder showing full-thickness tear of the supraspinatus tendon, with or without associated lesions, were evaluated by 3 radiologists with experience in musculoskeletal system imaging and 3 fellowship-trained shoulder surgeons. The evaluators classified the fatty infiltration of the supraspinatus muscle according to the guidelines proposed by Goutallier et al. After 8 weeks, they re-evaluated the examinations, without access to their previous reports. Weighted κ index values were determined for intraobserver and interobserver agreement analyses, and intraobserver agreement κ values are reported with 95% confidence intervals (CIs). RESULTS: The mean intraobserver agreement was 0.832 among the orthopedists (CI > 95%) and 0.741 among the radiologists (CI > 95%). Interobserver agreement was 0.8214 (evaluation 1) and 0.7231 (evaluation 2) among the orthopedists (P < .0001) and 0.6627 (evaluation 1) and 0.6067 (evaluation 2) among the radiologists (P < .0001). Intraobserver agreement was not associated with length of experience or frequency of routine evaluations. CONCLUSIONS: When it is applied to MR images of rotator cuff musculature, Goutallier's fatty infiltration staging rubric yielded highly significant intraobserver and interobserver agreement.

Serology with ML Flow test in health professionals from three different states of Brazil / Sorologia com o teste ML Flow em profissionais de saude em tres diferentes estados do Brasil

BACKGROUND: In highly endemic countries, transmission and sub-clinical infection of leprosy are likely and the disease manifests itself in individuals without any known close contact with a leprosy patient. Health workers are social contacts belonging to the same network (the Health System) and some of them share the same social environment (nursing assistants) as patients with known patients and / or carriers. OBJECTIVE: To identify ML Flow seropositivity among health professionals. METHODS: We conducted a cross-sectional study using a serological survey with the ML Flow test in 450 health professionals (doctors, nurses and nursing assistants), in order to detect seropositivity in areas of high and low endemicity in municipalities from three Brazilian states (RJ, MS and RS). RESULTS: The results showed general 16% seropositivity, higher in low endemic areas, regardless of whether there was direct care for leprosy patients. Paradoxically, a statistical association was observed between the area studied and seropositivity, as the place with the lowest endemicity (CA) had the highest seropositivity rate (p = 0.033). CONCLUSION: The authors suggest these results are associated with a presence of an unspecified link to bovine serum albumin (BSA), carrier of PGL-1 in the ML Flow test, and recommend expanded seroepidemiological research utilizing tests with human and bovine albumin. .

FUNDAMENTOS: Em países altamente endêmicos a transmissão e infecção sub-clínica da hanseníase provavelmente ocorrem e a doença se manifesta em indivíduos sem qualquer contato próximo conhecido com paciente com hanseníase. Os trabalhadores de saúde são contatos sociais que pertencem à mesma rede (Sistema de Saúde) e alguns deles compartilham o mesmo ambiente social (auxiliares de enfermagem) com pacientes conhecidos e/ou portadores. OBJETIVO: Conhecer a soropositividade ao ML Flow entre os profissionais de saúde. MÉTODOS: Foi realizado um estudo transversal através de inquérito sorológico com o teste ML Flow em 450 profissionais de saúde (médicos, enfermeiros e auxiliares de enfermagem) visando conhecer a soropositividade em áreas de alta e baixa endemicidade em municípios de três estados brasileiros (RS, MS e RJ). RESULTADOS: Os resultados mostraram 16% de soropositividade em geral, mais elevada na área de baixa endemicidade, independente da assistência direta a pacientes com hanseníase. Paradoxalmente foi observada associação estatística entre a área estudada e soropositividade, apontando o lugar de mais baixa endemicidade (CA) com o maior valor (p=0,033). CONCLUSÃO: os autores sugerem a presença de ligação inespecífica a soroalbumina bovina (BSA), carreadora do antígeno PGL-1 no teste ML Flow para explicar os resultados inesperados e recomendam testagem ampliada utilizando testes com albumina humana e bovina. .

Serology with ML Flow test in health professionals from three different states of Brazil.

BACKGROUND: In highly endemic countries, transmission and sub-clinical infection of leprosy are likely and the disease manifests itself in individuals without any known close contact with a leprosy patient. Health workers are social contacts belonging to the same network (the Health System) and some of them share the same social environment (nursing assistants) as patients with known patients and / or carriers. OBJECTIVE: To identify ML Flow seropositivity among health professionals. METHODS: We conducted a cross-sectional study using a serological survey with the ML Flow test in 450 health professionals (doctors, nurses and nursing assistants), in order to detect seropositivity in areas of high and low endemicity in municipalities from three Brazilian states (RJ, MS and RS). RESULTS: The results showed general 16% seropositivity, higher in low endemic areas, regardless of whether there was direct care for leprosy patients. Paradoxically, a statistical association was observed between the area studied and seropositivity, as the place with the lowest endemicity (CA) had the highest seropositivity rate (p = 0.033). CONCLUSION: The authors suggest these results are associated with a presence of an unspecified link to bovine serum albumin (BSA), carrier of PGL-1 in the ML Flow test, and recommend expanded seroepidemiological research utilizing tests with human and bovine albumin.

Informed consent for record linkage: a systematic review.

BACKGROUND: Record linkage is a useful tool for health research. Potential benefits aside, its use raises discussions on privacy issues, such as whether a written informed consent for access to health records and linkage should be obtained. The authors aim to systematically review studies that assess consent proportions to record linkage. METHODS: 8 databases were searched up to June 2011 to find articles which presented consent proportions to record linkage. The screening, eligibility and inclusion of articles were conducted by two independent reviewers. The authors carried out meta-regression, subgroup and sensitivity analyses to assess heterogeneity. RESULTS: Of the 141 studies identified, only 11 presented empirical consent proportions and were included in the systematic review. The consent proportion varied widely from 39% to 97%. Seven studies presented consent proportions of 88% or higher, one of 72%, and only three presented consented proportion equal to or lower than 53%. None of the studies' characteristics evaluated explained heterogeneity. CONCLUSION: The results of this review show that, in general, individuals tend to consent to the use of their data for record linkage, with exceptions in specific populations or minorities. The authors believe that this, as well as the cited literature, lends support to policies that, while keeping relevant ethical controls in place, do not require individual informed consent for each and every study that relies on secondary data.

Carcinoma epidermoide do pênis: estudo clínico-patológico de 34 casos / Squamous cell carcinoma of the penis: clinicopathologic study of 34 cases

FUNDAMENTOS: No Brasil, a incidência do câncer do pênis é de 8,3 casos/100.000 habitantes, contrastando com 0,7 na Europa e nos Estados Unidos. Em 95 por cento dos casos, trata-se do carcinoma epidermoide. Em geral, é diagnosticado tardiamente. OBJETIVOS: Descrever as características clínico-patológicas do carcinoma epidermoide do pênis, registradas no Hospital entre 1978 e 2004. MÉTODOS: Estudo observacional transversal. Incluíram-se os casos de carcinoma epidermoide do pênis, confirmados histologicamente. Avaliaram-se, pessoalmente, os pacientes que atenderam à convocação para o estudo, enquanto os demais tiveram seus dados pesquisados nos prontuários médicos. RESULTADOS: Registraram-se 34 pacientes com carcinoma epidermoide do pênis: 8 in situ e 26 invasivos, com idade média de 54,7 12,5 anos, respectivamente. A± 22,4 e 64,7 ±, (este trecho ficou truncado e não consegui entendê-lo. Será que o autor poderia revisá-lo?!) A glande foi acometida em 91,1 por cento dos casos e o prepúcio, em 41,1 por cento. Os carcinomas epidermoides in situ exibiam pápulas ou eritema e erosão, geralmente menores do que 2 cm. Os invasivos mostravam úlceras e/ou vegetações, geralmente únicas, e maiores do que 2 cm. Dos CE invasivos, 80,8 por cento eram bem diferenciados; metade encontrava-se no estágio I TNM e o restante, do II ao IV; 16 pacientes tiveram o pênis amputado e 3 faleceram. CONCLUSÕES: O câncer do pênis é raro, acomete adultos de todas as faixas etárias e o tratamento pode ser agressivo. O aspecto clínico inespecífico das lesões iniciais, o insuficiente treinamento médico em lesões dermatológicas e a carência de rotinas de investigação diagnóstica, tratamento e acompanhamento destes casos contribuem para o mau prognóstico desta neoplasia.

BACKGROUND: In Brazil, the incidence of penile cancer is 8.3 cases per 100,000 population, in contrast to 0.7 in Europe and the United States. 95 percent of these cases correspond to squamous cell carcinoma (SCC). It is usually diagnosed late. OBJECTIVES: To describe the clinicopathologic features of squamous cell carcinoma of the penis registered at the Hospital between 1978 and 2004. METHODS: A cross-sectional observational study. We included cases of squamous cell carcinoma of the penis that were histologically confirmed. Those patients who responded to the study call were evaluated in person, while others had their data researched in medical records. RESULTS: 34 patients with squamous cell carcinoma of the penis were registered: 8 in situ and 26 invasive, with a mean age of 54.7 ± 22.4 and 64,7 ± 12.5 years, respectively. Glans cancer was involved in 91.1 percent of the cases and the foreskin in 41.1 percent. SCC in situ exhibited papules or erythema and erosion, usually smaller than 2 cm. Invasive SCC was characterized by ulcers and/or vegetation, usually single and bigger than 2 cm. Of the invasive cases, 80.8 percent were well differentiated; half was in the TNM stage I and the remaining in stages II to IV. 16 patients had their penis amputated, and 3 died. CONCLUSIONS: Cancer of the penis is rare and affects adults of all ages and treatment can be aggressive. The nonspecific clinical appearance of early lesions, insufficient medical training in skin lesions and lack of routine diagnostic investigation, treatment and follow up of these cases contribute to the poor prognosis of this neoplasm.

Transtornos mentais maternos graves e risco de malformação congênita do bebê: uma metanálise / Severe mental illness in mothers and congenital malformations in newborns: a meta-analysis

O risco de ter malformações parece ser maior em bebês de mães com transtornos mentais em comparação com bebês de mães sem histórico de transtornos psiquiátricos. O objetivo deste artigo foi realizar uma metanálise dos estudos sobre a associação entre transtornos mentais maternos e malformações congênitas. A revisão consistiu na busca de artigos nas bases MEDLINE, ISIWEB, Scopus, LILACS e SciELO, utilizando-se os descritores: "mental disorders" OR "mental health" OR "psychotic disorders" OR "schizophrenia" AND "congenital abnormalities" OR "birth defects". Foram localizados 108 estudos, sendo selecionados cinco artigos de acordo com os critérios estabelecidos. Estes artigos foram incluídos na metanálise, envolvendo um total de 4.194 crianças de mães com transtornos mentais e 249.548 crianças de mães sem tais transtornos. A medida combinada revelou associação significativa entre exposição a transtornos mentais maternos e risco de malformações (RR = 2,06, IC95 por cento: 1,46-2,67). O presente estudo evidencia a relação entre saúde mental materna durante a gravidez e suas repercussões na saúde do bebê.

The risk of congenital malformations appears to be higher in infants of mothers with mental disorders as compared to those of mothers with no history of psychiatric illness. This article presents a meta-analysis of studies on the association between maternal mental illness and congenital malformations. The review consisted of an article search in the MEDLINE, ISIWEB, Scopus, and SciELO databases, using the following key words: "mental disorders" OR "mental health" OR "psychotic disorders" OR "schizophrenia" AND "congenital abnormalities" OR "birth defects". A total of 108 studies were identified, and five articles were selected according to the established criteria. These articles were included in a meta-analysis, involving a total of 4,194 children of mothers with mental illness and 249,548 children of mothers with no such disorders. Pooled relative risk showed a significant association between exposure to mental illness in mothers and risk of malformations in newborns (RR = 2.06, 95 percentCI: 1.46-2.67). The study highlights the relationship between maternal mental health during pregnancy and its effects on the infant's health.

Squamous cell carcinoma of the penis: clinicopathologic study of 34 cases.

BACKGROUND: In Brazil, the incidence of penile cancer is 8.3 cases per 100,000 population, in contrast to 0.7 in Europe and the United States. 95% of these cases correspond to squamous cell carcinoma (SCC). It is usually diagnosed late. OBJECTIVES: To describe the clinicopathologic features of squamous cell carcinoma of the penis registered at the Hospital between 1978 and 2004. METHODS: A cross-sectional observational study. We included cases of squamous cell carcinoma of the penis that were histologically confirmed. Those patients who responded to the study call were evaluated in person, while others had their data researched in medical records. RESULTS: 34 patients with squamous cell carcinoma of the penis were registered: 8 in situ and 26 invasive, with a mean age of 54.7 ± 22.4 and 64,7 ± 12.5 years, respectively. Glans cancer was involved in 91.1% of the cases and the foreskin in 41.1%. SCC in situ exhibited papules or erythema and erosion, usually smaller than 2 cm. Invasive SCC was characterized by ulcers and/or vegetation, usually single and bigger than 2 cm. Of the invasive cases, 80.8% were well differentiated; half was in the TNM stage I and the remaining in stages II to IV. 16 patients had their penis amputated, and 3 died. CONCLUSIONS: Cancer of the penis is rare and affects adults of all ages and treatment can be aggressive. The nonspecific clinical appearance of early lesions, insufficient medical training in skin lesions and lack of routine diagnostic investigation, treatment and follow up of these cases contribute to the poor prognosis of this neoplasm.

[Severe mental illness in mothers and congenital malformations in newborns: a meta-analysis]. / Transtornos mentais maternos graves e risco de malformação congênita do bebê: uma metanálise.

The risk of congenital malformations appears to be higher in infants of mothers with mental disorders as compared to those of mothers with no history of psychiatric illness. This article presents a meta-analysis of studies on the association between maternal mental illness and congenital malformations. The review consisted of an article search in the MEDLINE, ISIWEB, Scopus, and SciELO databases, using the following key words: "mental disorders" OR "mental health" OR "psychotic disorders" OR "schizophrenia" AND "congenital abnormalities" OR "birth defects". A total of 108 studies were identified, and five articles were selected according to the established criteria. These articles were included in a meta-analysis, involving a total of 4,194 children of mothers with mental illness and 249,548 children of mothers with no such disorders. Pooled relative risk showed a significant association between exposure to mental illness in mothers and risk of malformations in newborns (RR = 2.06, 95%CI: 1.46-2.67). The study highlights the relationship between maternal mental health during pregnancy and its effects on the infant's health.

Epidemiologic study of 107 cases of families with leprosy in Duque de Caxias, Rio de Janeiro, Brazil.

BACKGROUNDS: ultibacillary patients are the major source of infection in leprosy. Nevertheless, the risk is higher in household contacts between multibacillary patients than paucibacillary patients and in the general population. Household contacts are in close genetic relationship with the index case-patient. OBJECTIVE: To evaluate epidemiological data of the following variables: age, gender, education level, genetic proximity, and type of contact with the index case-patient (household or not) in 107 families with leprosy. METHODS: Home visits were conducted to clinically examine family members. The medical charts of index case-patients and co-prevalent cases were reviewed. RESULTS: The controlled analysis of variables such as type of contact and genetic proximity revealed that household contacts and first-degree kinship are independently associated with a higher chance of contracting the disease. CONCLUSION: Household contacts are often genetically closer to the index case-patient. To investigate the independent relevance of these risks in leprosy surveillance contact studies has been a challenge. Our results confirm literature data that show the influence of genetics in the susceptibility to leprosy per se.

STROBE initiative: guidelines on reporting observational studies.

Reporting of observational studies is often inadequate, hampering the assessment of their strengths and weaknesses and, consequently, the generalization of study results. The initiative named Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) developed a checklist of 22 items, the STROBE Statement, with recommendations about what should be included in a more accurate and complete description of observational studies. Between June and December 2008, a group of Brazilian researchers was dedicated to the translation and adaptation of the STROBE Statement into Portuguese. The present study aimed to show the translation into Portuguese, introduce the discussion on the context of use, the potential and limitations of the STROBE initiative.

Estudo epidemiológico de 107 focos familiares de hanseníase no município de Duque de Caxias - Rio de Janeiro, Brasil / Epidemiologic study of 107 cases of families with leprosy in Duque de Caxias, Rio de Janeiro, Brazil

FUNDAMENTOS - Os pacientes multibacilares (MB) são a principal fonte de infecção na hanseníase e esse risco é maior nos contatos domiciliares dos pacientes MB do que nos contatos dos paucibacilares (PB) e na população em geral. Entretanto, os contatos domiciliares são os mais próximos do caso-índice (CI), em termos genéticos. OBJETIVO: Analisar dados epidemiológicos das variáveis: sexo, idade, anos de estudo, grau de parentesco com o CI e tipo de contato residencial (intradomiciliar ou peridomiciliar) com o CI em 107 famílias de hanseníase. MÉTODOS: Foram realizadas visitas domiciliares para exame clínico dos familiares. Os prontuários dos CIs e de seus coprevalentes (contatos familiares que também tiveram hanseníase) foram revistos. RESULTADOS: A análise controlada das variáveis tipo de contato e grau de parentesco revelou que o contato domiciliar e o parentesco de primeiro grau estão independentemente associados a uma probabilidade maior de adoecer. CONCLUSÃO: Os contatos domiciliares, em geral, são os mais próximos do caso, em termos genéticos, e aferir a magnitude desses riscos separadamente tem sido um desafio nos estudos de vigilância de contatos em hanseníase. Os resultados deste estudo confirmam os dados da literatura, demonstrando a influência genética no desfecho da hanseníase per se.

BACKGROUNDS: ultibacillary patients are the major source of infection in leprosy. Nevertheless, the risk is higher in household contacts between multibacillary patients than paucibacillary patients and in the general population. Household contacts are in close genetic relationship with the index case-patient. OBJECTIVE: To evaluate epidemiological data of the following variables: age, gender, education level, genetic proximity, and type of contact with the index case-patient (household or not) in 107 families with leprosy. METHODS: Home visits were conducted to clinically examine family members. The medical charts of index case-patients and co-prevalent cases were reviewed. RESULTS: The controlled analysis of variables such as type of contact and genetic proximity revealed that household contacts and first-degree kinship are independently associated with a higher chance of contracting the disease. CONCLUSION: Household contacts are often genetically closer to the index case-patient. To investigate the independent relevance of these risks in leprosy surveillance contact studies has been a challenge. Our results confirm literature data that show the influence of genetics in the susceptibility to leprosy per se.

Iniciativa STROBE: subsídios para a comunicação de estudos observacionais / Prevalencia de extremos antropométricos en niños del estado de Alagoas, Noreste de Brasil / STROBE initiative: guidelines on reporting observational studies

Freqüentemente, a descrição de pesquisas de natureza observacional é inadequada, dificultando a avaliação de seus pontos fracos e fortes e, em conseqüência, a generalização de seus resultados. A iniciativa denominada Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), formulou uma lista de verificação que contém 22 itens, denominada STROBE Statement ("Declaração STROBE"), com recomendações sobre o que deveria ser incluído em uma descrição mais precisa e completa de estudos observacionais. Entre junho e dezembro de 2008, um grupo de pesquisadores brasileiros dedicou-se à tradução e adaptação da "Declaração STROBE" para o português. O objetivo do estudo foi apresentar a tradução para o português, bem como introduzir a discussão sobre o contexto de utilização, as potencialidades e limitações da Iniciativa STROBE.

Reporting of observational studies is often inadequate, hampering the assessment of their strengths and weaknesses and, consequently, the generalization of study results. The initiative named Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) developed a checklist of 22 items, the STROBE Statement, with recommendations about what should be included in a more accurate and complete description of observational studies. Between June and December 2008, a group of Brazilian researchers was dedicated to the translation and adaptation of the STROBE Statement into Portuguese. The present study aimed to show the translation into Portuguese, introduce the discussion on the context of use, the potential and limitations of the STROBE initiative.

El objetivo del artículo fue estimar la prevalencia de extremos antropométricos indicativos del estado nutricional de niños. Se realizó estudio transversal con muestra probabilística de 1.386 niños menores de cinco años del estado de Alagoas. Las prevalencias de déficit (z< -2; patrón de la Organización Mundial de Salud - 2006) para los índices peso-para-edad (bajo peso), peso-para-altura (flacura) y altura-para-edad (déficit estatural) fueron, respectivamente, 2,9 por ciento (n=40), 1,2 por ciento (n=17) y 10,3 por ciento (n=144). El exceso de peso-para-altura (sobrepeso) acometió 135 niños (9,7 por ciento). Se concluyó que las prevalencias de bajo peso y flacura son epidemiológicamente irrelevantes y que el déficit estatural y el sobrepeso prevalecen con idéntica magnitud.

Ambulatory blood pressure monitoring and cardiovascular risk in resistant hypertensive women.

BACKGROUND: Few studies have explored the prognostic value of ambulatory blood pressure (ABP) in resistant hypertensive patients, a high-risk group. OBJECTIVE: To investigate the prognostic value of uncontrolled daytime ABP in resistant hypertensive women. METHODS: We followed 382 resistant hypertensive women, aged 24-92 years, from a hypertension unit of a university hospital, for up to 8.9 years (mean 3.9). Patients were classified as controlled (office BP>140/90 mmHg and daytime ABP<135/85 mmHg) or uncontrolled (office BP>140/90 mmHg and daytime ABP >135/85 mmHg). We analyzed a combined endpoint, consisting of cardiovascular mortality, ischemic heart disease, stroke and nephropathy. Cox proportional hazard models were used to estimate the risk for cardiovascular events, adjusting for potential confounders. RESULTS: The total event rate was 5.0 per 100 women-years. In the controlled and uncontrolled groups, the rates were 3.7 vs. 5.8 events respectively, p=0.06. The relative risks adjusted for age and current smoking status associated with a 10 mmHg increment in systolic ABP were greater than the ones associated with a 5 mmHg increment in diastolic ABP. Non-dipper patients had a higher risk for cardiovascular events than dipper patients (RR = 1.42 (0.87-2.32)), although this association had no statistical significance. Uncontrolled daytime blood pressure (yes/no) was a stronger independent risk factor, 1.67 (1.00-2.78). CONCLUSIONS: There was a 67% increase in the risk of a cardiovascular event if daytime ambulatory blood pressure was uncontrolled in women with resistant hypertension. Therefore, it is mandatory to use ABP to evaluate control and to guide therapeutic strategies in resistant hypertensive patients.

Monitorização ambulatorial da pressão arterial e risco cardiovascular em mulheres com hipertensão resistente / Monitoreo ambulatorio de la presión Arterial y riesgo cardiovascular en mujeres con hipertensión resistente / Ambulatory blood pressure monitoring and cardiovascular risk in resistant hypertensive women

FUNDAMENTO: Poucos estudos exploraram o valor prognóstico da monitorização ambulatorial da pressão arterial (MAPA) em pacientes hipertensos resistentes, um grupo que apresenta alto risco. OBJETIVO: Investigar o valor prognóstico da pressão arterial (PA) de vigília, em mulheres hipertensas resistentes. MÉTODOS: Foram acompanhadas por até 8,9 anos (média 3,9), 382 mulheres hipertensas resistentes com idade entre 24-92 anos, atendidas em uma unidade de hipertensão de um hospital universitário. As pacientes foram classificadas como controladas (PA de consultório > 140/90 mmHg e PA de vigília<135/85 mmHg) ou não-controladas (PA de consultório > 140/90 mmHg e PA de vigília > 135/85 mmHg). Analisou-se uma combinação de mortalidade cardiovascular, cardiopatia isquêmica, acidente vascular encefálico e nefropatia. Utilizou-se o modelo proporcional de Cox para estimar o risco de eventos cardiovasculares ajustado para potenciais confundidores. RESULTADOS: A taxa total de eventos foi de 5,0 por 100 mulheres-ano. No grupo de controladas esse valor foi de 3,7 e entre as não-controladas, de 5,8, com p=0.06. Os riscos relativos associados ao aumento de 10 mmHg na PA sistólica, ajustando para idade e tabagismo atual, foram maiores que os associados a aumentos de 5 mmHg na PA diastólica. Pacientes com descenso noturno<10 por cento tiveram risco para evento cardiovascular maior que os com descenso noturno > 10 por cento, embora essa associação não tenha sido estatisticamente significante. A pressão de vigília não controlada (sim/não) foi um forte fator de risco independente, 1,67 (1,00-2,78). CONCLUSÃO: O aumento de 67 por cento no risco de evento cardiovascular quando a PA de vigília não estava controlada é indicador de que o uso da MAPA é essencial na avaliação do controle e como guia das decisões terapêuticas na hipertensão resistente.

BACKGROUND: Few studies have explored the prognostic value of ambulatory blood pressure (ABP) in resistant hypertensive patients, a high-risk group. OBJECTIVE: To investigate the prognostic value of uncontrolled daytime ABP in resistant hypertensive women. METHODS: We followed 382 resistant hypertensive women, aged 24-92 years, from a hypertension unit of a university hospital, for up to 8.9 years (mean 3.9). Patients were classified as controlled (office BP>140/90mmHg and daytime ABP <135/85 mmHg) or uncontrolled (office BP>140/90mmHg and daytime ABP >135/85 mmHg). We analyzed a combined endpoint, consisting of cardiovascular mortality, ischemic heart disease, stroke and nephropathy. Cox proportional hazard models were used to estimate the risk for cardiovascular events, adjusting for potential confounders. RESULTS: The total event rate was 5.0 per 100 women-years. In the controlled and uncontrolled groups, the rates were 3.7 vs. 5.8 events respectively, p=0.06. The relative risks adjusted for age and current smoking status associated with a 10 mmHg increment in systolic ABP were greater than the ones associated with a 5 mmHg increment in diastolic ABP. Non-dipper patients had a higher risk for cardiovascular events than dipper patients (RR = 1.42 (0.87 - 2.32)), although this association had no statistical significance. Uncontrolled daytime blood pressure (yes/no) was a stronger independent risk factor, 1.67 (1.00-2.78). CONCLUSIONS: There was a 67 percent increase in the risk of a cardiovascular event if daytime ambulatory blood pressure was uncontrolled in women with resistant hypertension. Therefore, it is mandatory to use ABP to evaluate control and to guide therapeutic strategies in resistant hypertensive patients.

FUNDAMENTO: Pocos estudios exploraron el valor pronóstico del monitoreo ambulatorio de presión arterial (MAPA) en pacientes hipertensos resistentes, un grupo que presenta alto riesgo. OBJETIVO: Investigar el valor pronóstico de la presión arterial (PA) diurna, en mujeres hipertensas resistentes. MÉTODOS: Se siguieron por hasta 8,9 años (promedio 3,9), a 382 mujeres hipertensas resistentes con edad entre 24 y 92 años, atendidas en una unidad de hipertensión de un hospital universitario. Se clasificaron a las pacientes como controladas (PA de consultorio>140/90 mmHg y PA diurna<135/85 mmHg) o no-controladas (PA de consultorio>140/90 mmHg y PA diurna>135/85 mmHg). Se analizó una combinación de mortalidad cardiovascular, cardiopatía isquémica, accidente vascular encefálico y nefropatía. Se utilizó el modelo proporcional de Cox para estimarse el riesgo de eventos cardiovasculares ajustado para potenciales confundidores. RESULTADOS: La tasa total de eventos fue de 5,0 por 100 mujeres-año. En el grupo de controladas ese valor fue de 3,7 y entre las no-controladas, de 5,8, con p=0.06. Los riesgos relativos asociados al aumento de 10 mmHg en la PA sistólica, ajustando para edad y tabaquismo actual, fueron mayores que los asociados a aumentos de 5 mmHg en la PA diastólica. Pacientes con descenso nocturno <10 por ciento tuvieron riesgo para evento cardiovascular mayor que los con descenso nocturno >10 por ciento, aunque esa asociación no haya sido estadísticamente significante. La presión diurna no controlada (sí/no) fue un fuerte factor de riesgo independiente, 1,67 (1,00-2,78). CONCLUSIÓN: El aumento del 67 por ciento en el riesgo de evento cardiovascular cuando la PA diurna no estaba controlada es un indicador de que el empleo del MAPA es esencial en la evaluación del control y como guía de las decisiones terapéuticas en la hipertensión resistente.

Heterogeneous resistance to vancomycin and teicoplanin among Staphylococcus spp. isolated from bacteremia.

This study evaluated the BHIA screening method with 4 or 6 mug/mL of vancomycin to detect glycopeptides heteroresistant staphylococci strains isolated from bacteremia. A total of 213 staphylococci strains were isolated from 106 patients between October/2001 and November/2002 in a tertiary hospital in Rio de Janeiro city. Fifty-seven (53.8%) patients presented Staphylococcus aureus, while coagulase-negative staphylococci (CNS) were isolated from 49 (46.2%). Resistance rates for oxacillin of 26.3% and 81.6% were found for the staphylococci isolates, respectively. Thirteen CNS isolated from nine (8.5%) patients grew on agar screening with 4 mug/mL of vancomycin and showed heterogeneous profiles of resistance for vancomycin and teicoplanin by the population analysis profile method. Only 30.8% of them grew at the concentration 6 mug/mL. Bacterial infection and use of antimicrobial therapy were common among these patients. Alert about the emergence of oxacillin-resistant staphylococci presenting heteroresistance to glycopeptides is important in order to achieve judicious use of antimicrobials. Vancomycin agar screening test could help to confirm the presence of these isolates in hospitals.

Heterogeneous resistance to vancomycin and teicoplanin among Staphylococcus spp. isolated from bacteremia

This study evaluated the BHIA screening method with 4 or 6 mug/mL of vancomycin to detect glycopeptides heteroresistant staphylococci strains isolated from bacteremia. A total of 213 staphylococci strains were isolated from 106 patients between October/2001 and November/2002 in a tertiary hospital in Rio de Janeiro city. Fifty-seven (53.8 percent) patients presented Staphylococcus aureus, while coagulase-negative staphylococci (CNS) were isolated from 49 (46.2 percent). Resistance rates for oxacillin of 26.3 percent and 81.6 percent were found for the staphylococci isolates, respectively. Thirteen CNS isolated from nine (8.5 percent) patients grew on agar screening with 4 mug/mL of vancomycin and showed heterogeneous profiles of resistance for vancomycin and teicoplanin by the population analysis profile method. Only 30.8 percent of them grew at the concentration 6 mug/mL. Bacterial infection and use of antimicrobial therapy were common among these patients. Alert about the emergence of oxacillin-resistant staphylococci presenting heteroresistance to glycopeptides is important in order to achieve judicious use of antimicrobials. Vancomycin agar screening test could help to confirm the presence of these isolates in hospitals.

Saúde bucal em crianças com e sem necessidades especiais: percepções e atitudes dos responsáveis / Oral health of handicapped and not handicapped children: perceptions and attitudes of parents

Este estudo avaliou percepções e atitudes em saúde bucal de 169 responsáveis por crianças portadoras ou não de necessidades especiais (31,0 meses ± 14,4) de uma instituição pública do Rio de Janeiro. Somente 17,9 por cento da amostra respondeu corretamente sobre como a saúde bucal pode interferir na saúde geral. No entanto, a higiene bucal foi apontada pela maioria como principal método de prevenção da cárie. Das crianças que já visitaram o cirugião-dentista, 94,4 por cento têm quem escove seus dentes. Este valor é de 73,4 por cento para as que nunca visitaram um dentista (p-valor=0,0002). Conclui-se que os conhecimentos e atitudes em saúde bucal não foram satisfatórios