Creatinine level variation in patients subjected to contrast-enhanced tomography: a meta-analysis.

Variation in the creatinine levels of patients who have undergone contrast-enhanced computed tomography (CT) has been adopted as a practical method for assessment of possible kidney damage caused by the contrast. Criteria employed include an absolute increase in serum creatinine ≥ 0.5 mg/dL or a relative increase ≥ 25% as indicative of possible renal disorders, such as contrast-induced nephropathy (CIN). Our objective was to analyze the incidence of CIN by means of a meta-analysis of nine articles related to incidence of kidney damage caused by contrast, calculating odds ratios (OR) and confidence intervals (95%CI) using RStudio. The overall incidence of CIN in patients who had CT scans was 11.29%, with an OR of 1.38 (95%CI 0.88-2.16). Non-ionic contrasts are safer than other types of contrast, and volumes exceeding 115 mL may be associated with CIN. Preexisting kidney disease had a statistically significant relationship with worse CIN rates.

Assessment of medical knowledge toward genetic testing for individuals with hereditary breast and ovarian cancer syndrome in Brazil.

Genetic testing has become increasingly used in medical practice to enable genetic cancer risk assessment. In Hereditary Breast and Ovarian Cancer syndrome (HBOC), it can be used to screen pathogenic germline variants. The access to early diagnosis, from the request until the proper interpretation of genetic tests depends on medical knowledge. The aim of this study was to evaluate the knowledge of family physicians, oncologists, geneticists and gynecologists regarding genetic testing for patients with suspected HBOC in Brazil. A cross-sectional survey of physicians was performed using a self-administered questionnaire. One hundred and ninety-two physicians answered the questionnaire (23 were geneticists, 38 gynecologists, 39 family physicians, and 92 oncologists). Only 15.4% of family physicians and 26% of gynecologists feel prepared to order genetic testing for patients with personal and/or family history of breast and/or ovarian cancer. Even though 87% of the oncologists have genetic testing available in their clinical practice, only 51.1% consider they have sufficient knowledge to manage patients after detecting a pathogenic germline variant and 17.4% do not feel comfortable interpreting them. Most oncologists and geneticists are very knowledgeable about recommendations for genetic testing order and management of HBOC patients. On the other hand, gynecologists and family physicians order genetic testing less frequently (28.9% and 7.7%, respectively) and have difficulties interpreting (26.3% and 2.3%, respectively) and managing these patients. These observations raise important issues regarding the implementation of genetic testing in Brazil, including the development of training programs for physicians from different specialties.

Circunferência do pescoço como marcador preditivo para síndrome metabólica e risco cardiovascular / Neck circumference as a predictive marker for metabolic syndrome and cardiovascular risk

A circunferência de cintura é há muito tempo o índice padrão para avaliar a gordura abdominal na identificação de pacientes com síndrome metabólica. No entanto, observa-se que uma proporção de doentes com doenças cardiovasculares exibe essa circunferência normal. Assim, o objetivo deste estudo foi avaliar se a circunferência de pescoço pode ser utilizada como marcador preditivo para Síndrome Metabólica e risco cardiovascular. Participaram deste estudo transversal, 42 indivíduos submetidos à avaliação socioeconômica e antropométrica. A circunferência do pescoço correlacionou-se positivamente com a circunferência de cintura, glicemia de jejum, pressão arterial sistólica e diastólica e triglicerídeos. A curva Receiver Operating Characteristic exibiu ponto de corte de 40 cm com alto risco cardiovascular acima deste valor. Os resultados demonstram que a circunferência de pescoço além de rápida e não invasiva pode ser útil na previsão de Síndrome Metabólica e risco cardiovascular. (AU)

Waist circumference has long been the standard index to assess abdominal fat in the identification of patients with Metabolic Syndrome. However, it is observed that a proportion of patients with cardiovascular diseases present abnormal values in this circumference. Thus, the objective of this study was to evaluate whether neck circumference can be used as a predictive marker for Metabolic Syndrome and cardiovascular risk. Forty-two individuals who underwent a socioeconomic and anthropometric evaluation participated in this cross-sectional study. Neck circumference correlated positively with waist circumference, fasting glucose, systolic and diastolic blood pressure, and triglycerides. The ROC curve had a cutoff point of 40 cm, with high cardiovascular risk above this value. The results show that, in addition to being fast and non-invasive, neck circumference can be useful in predicting Metabolic Syndrome and cardiovascular risk. (AU)

Avaliação dos níveis de creatinina em pacientes submetidos à tomografia contrastada: uma metanálise / Creatinine level variation in patients subjected to contrast-enhanced tomography: a meta-analysis

Resumo A variação do valor encontrado nos exames de creatinina em pacientes submetidos à tomografia computadorizada (TC) contrastada tem sido utilizada como método prático para a avaliação de possíveis lesões renais causadas pelo uso do contraste. Entre os critérios, considera-se o aumento absoluto de creatinina sérica ≥ 0,5 mg/dL ou relativo em ≥ 25% para possíveis distúrbios renais, como a nefropatia induzida por contraste (NIC). Nosso objetivo foi analisar a incidência de NIC através de uma metanálise envolvendo nove artigos relacionados à incidência de lesão renal por contraste, sendo calculado o odds ratio (OR) e o intervalo de confiança (IC95%) por meio do programa RStudio. A incidência de NIC em pacientes submetidos a TC foi de 11,29%, sendo o OR de 1,38 (IC95% 0,88-2,16). Contrastes não iônicos apresentam maior segurança em seu uso que outros tipos de contraste, e o volume maior que 115 mL pode estar relacionado a NIC. A doença renal prévia apresentou significado estatístico em agravar a NIC.

Abstract Variation in the creatinine levels of patients who have undergone contrast-enhanced computed tomography (CT) has been adopted as a practical method for assessment of possible kidney damage caused by the contrast. Criteria employed include an absolute increase in serum creatinine ≥ 0.5 mg/dL or a relative increase ≥ 25% as indicative of possible renal disorders, such as contrast-induced nephropathy (CIN). Our objective was to analyze the incidence of CIN by means of a meta-analysis of nine articles related to incidence of kidney damage caused by contrast, calculating odds ratios (OR) and confidence intervals (95%CI) using RStudio. The overall incidence of CIN in patients who had CT scans was 11.29%, with an OR of 1.38 (95%CI 0.88-2.16). Non-ionic contrasts are safer than other types of contrast, and volumes exceeding 115 mL may be associated with CIN. Preexisting kidney disease had a statistically significant relationship with worse CIN rates.