Frequency of skin diseases in renal transplant recipients and patients with chronic kidney disease in a tertiary center: a cross-sectional study

ABSTRACT BACKGROUND: The prevalence of chronic kidney disease (CKD) has increased in the recent decades, along with the number of patients in the terminal stages of this disease, requiring transplantation. Some skin disorders are more frequent in patients with CKD and in renal transplant recipients (RTR). OBJECTIVES: To evaluate the frequency of skin diseases in RTR and patients with CKD receiving conservative treatment. DESIGN AND SETTING: This observational cross-sectional study recruited consecutive patients with CKD and RTR from a nephrology clinic at a teaching hospital in Brazil between 2015 and 2020. METHODS: Quantitative, descriptive, and analytical approaches were used. The sample was selected based on convenience sampling. Data were collected from dermatological visits and participants' medical records. RESULTS: Overall, 308 participants were included: 206 RTR (66.9%, median age: 48 years, interquartile range [IQR] 38.0-56.0, 63.6% men) and 102 patients with CKD (33.1%, median age: 61.0 years, IQR 50.0-71.2, 48% men). The frequency of infectious skin diseases (39.3% vs. 21.6% P = 0.002) were higher in RTR than in patients with CKD. Neoplastic skin lesions were present in nine (4.4%) RTR and in only one (1.0%) patient with CKD. Among the RTR, the ratio of basal cell carcinoma to squamous cell carcinoma was 2:1. CONCLUSIONS: This study revealed that an increased frequency of infectious skin diseases may be expected in patients who have undergone kidney transplantation. Among skin cancers, BCC is more frequently observed in RTR, especially in those using azathioprine.

TDAH nas epilepsias: prevalência e fatores de risco / ADHD in epilepsy: prevalence and risk factors / TDAH en la epilepsia: prevalencia y factores de riesgo

O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) representa uma das comorbidades mais prevalentes da epilepsia, mas a associação entre ambas as condições é pouco compreendida. Esta revisão sistemática da literatura foi realizada em base de dados eletrônica (Medline/Pubmed), no recorte 2011-2016, com o objetivo de investigar os fatores associados à comorbidade. Aplicados os critérios de elegibilidade, foram selecionados 15 artigos. A prevalência de TDAH na epilepsia variou amplamente de 5,3% a 64,9%. Apesar de o TDAH estar presente nas epilepsias focais e generalizadas, alguns tipos ou síndromes epilépticas, como a epilepsia rolândica e a epilepsia frontal, foram fortemente associados aos sintomas de TDAH, especialmente naqueles indivíduos com epilepsia recém-diagnosticada, com crises pouco controladas e com eletroencefalograma anormal.

Attention Deficit / Hyperactivity Disorder (ADHD) represents one of the most prevailing comorbidities of epilepsy. However, the association between both conditions is little understood. This systematic literature review was conducted based on electronic data (Medline/Pubmed), in the 2011-2016 period, with the purpose of investigating the contributing factors for the co-occurrence. After applying the eligibility criteria, 15 articles were selected. The prevalence of ADHD in epilepsy varied widely from 5.3% to 64.9%. Although ADHD is present in focal and generalized epilepsies, some epileptic types or disorders, such as rolandic epilepsy and frontal epilepsy, were strongly associated with ADHD symptoms, especially in those individuals with newly diagnosed epilepsy, poorly controlled seizures, and abnormal electroencephalogram.

El Trastorno por Déficit de Atención e Hiperactividad (TDAH) representa una de las comorbidades más prevalecientes de la epilepsia, pero la asociación entre ambas condiciones es poco comprendida. Esta revisión sistemática de la literatura fue realizada en base de datos electrónica (Medline/Pubmed), en el recorte 2011-2016, con el objetivo de investigar los factores contribuyentes para la co-ocurrencia. Aplica dos los criterios de elegibilidad, fueron seleccionados 15 artículos. La prevalencia de TDAH en epilepsia varió ampliamente de 5,3% a 64,9%. A pesar del TDAH está presente en las epilepsias focales y generalizadas, algunas clases de síndromes epilépticas, como la epilepsia rolándica y la epilepsia frontal se asociaron fuertemente con los síntomas de TDAH, particularmente en aquellos individuos con epilepsia recién diagnosticadas, crisis poco controladas y con electroencefalograma anormal.

The history of the introduction of the giant river prawn, Macrobrachium cf. rosenbergii (Decapoda, Palaemonidae), in Brazil: new insights from molecular data

The giant river prawn, Macrobrachium cf. rosenbergii, is one of the most cultivated freshwater prawns in the world and has been introduced into more than 40 countries. In some countries, this prawn is considered an invasive species that requires close monitoring. Recent changes in the taxonomy of this species (separation of M. rosenbergii and M. dacqueti) require a re-evaluation of introduced taxa. In this work, molecular analyses were used to determine which of these two species was introduced into Brazil and to establish the geographic origin of the introduced populations that have invaded Amazonian coastal waters. The species introduced into Brazil was M. dacqueti through two introduction events involving prawns originating from Vietnam and either Bangladesh or Thailand. These origins differ from historical reports of the introductions and underline the need to confirm the origin of other exotic populations around the world. The invading populations in Amazonia require monitoring not only because the biodiversity of this region may be affected by the introduction, but also because admixture of different native haplotypes can increase the genetic variability and the likelihood of persistence of the invading species in new habitats.

Validação do Teste de Controle da Asma em português para uso no Brasil / Portuguese-language version of the Asthma Control Test: validation for use in Brazil

OBJETIVO: Desenvolver e validar uma versão do Asthma Control Test (ACT, Teste de Controle da Asma) em português para uso no Brasil. MÉTODOS: Foram estudados 290 pacientes ambulatoriais com asma maiores que 12 anos. Os pacientes responderam ao ACT e foram examinados por um pneumologista para avaliar o controle da asma em duas visitas. Na primeira visita, também realizaram prova de função pulmonar. A segunda visita foi realizada ao menos quatro semanas depois da primeira. RESULTADOS: Utilizando-se como ponto de corte um escore de 18 para diferenciar asma controlada de asma não controlada, foram encontradas sensibilidade de 93 por cento, especificidade de 74 por cento, valor preditivo negativo de 86 por cento e valor preditivo positivo de 85 por cento. As razões de verossimilhança positiva e negativa foram, respectivamente, 3,58 e 0,09. O questionário tem grande capacidade de discriminar asma controlada de asma não controlada, com uma área sob a curva ROC de 0,904. Os pacientes que mantiveram os sintomas estáveis na segunda avaliação tiveram pontuação semelhante no questionário, indicando uma boa reprodutibilidade teste-reteste, com um coeficiente de correlação intraclasse de 0,93. Os pacientes que melhoraram os sintomas na segunda avaliação tiveram pontuação do questionário significativamente melhor, indicando uma boa responsividade do questionário para identificar mudanças no controle da doença. CONCLUSÕES: A versão em português do ACT apresentou boa reprodutibilidade teste-reteste e foi capaz de discriminar o nível de controle da asma, assim como detectar mudanças no controle da asma em uma população de baixa escolaridade e renda familiar em um serviço público de saúde no Brasil.

OBJECTIVE: To develop and validate a Portuguese-language version of the Asthma Control Test (ACT) for use in Brazil. METHODS: The study comprised 290 asthma outpatients over 12 years of age. The patients completed the ACT questionnaire and had an appointment with a pulmonologist in order to assess asthma control in two visits. In the first visit, the patients also underwent spirometry. The second visit took place at least four weeks later. RESULTS: We found that a cut-off score of 18 points-to differentiate between subjects with controlled asthma and those with uncontrolled asthma-had a sensitivity of 93 percent, a specificity of 74 percent, a negative predictive value of 86 percent and a positive predictive value of 85 percent. The positive and negative likelihood ratios were 3.58 and 0.09, respectively. The questionnaire has an outstanding capacity to differentiate uncontrolled asthma from controlled asthma, with an area under the ROC curve of 0.904. The patients whose symptoms remained stable between the two visits had similar scores, demonstrating good test-retest reproducibility, with an intraclass correlation coefficient of 0.93. The patients whose symptoms improved in the second visit had significantly higher scores, demonstrating good responsiveness of the questionnaire in the identification of changes in disease control. CONCLUSIONS: The Portuguese-language version of the ACT showed good test-retest reproducibility and was capable of discriminating the levels of asthma control and detecting changes in asthma control in a population of patients with a low level of education and low family income at a public health facility in Brazil.

A percepção do controle dos sintomas em pacientes asmáticos / Perception of asthma control in asthma patients

OBJETIVO: Estimar a proporção de pacientes asmáticos com percepção inadequada do controle dos sintomas e avaliar as características deste subgrupo. MÉTODOS: Estudo transversal no qual foram selecionados pacientes ambulatoriais consecutivos com asma leve, moderada ou grave, maiores de 12 anos. Os pacientes foram submetidos a exame clínico, avaliação de depressão e da percepção do controle da asma e exame de função pulmonar. Foram realizadas avaliação da concordância quanto ao controle dos sintomas de asma entre médicos e pacientes e comparação entre as características dos pacientes com percepção adequada e inadequada do controle da asma. RESULTADOS: A concordância entre médicos e pacientes quanto ao controle da asma foi baixa (índice kappa = 0,5). Dos 289 pacientes incluídos, 66 (23 por cento) apresentaram percepção inadequada do controle da asma. A análise preliminar univariada revelou que os pacientes com percepção inadequada eram mais idosos, tinham menor renda familiar e apresentavam asma de menor gravidade. A análise multivariada não modificou os resultados. Não houve diferença entre os grupos quanto a sexo, freqüência de pacientes alfabetizados, tempo de sintomas de asma, diagnóstico de rinite, freqüência de depressão, função pulmonar ou adesão ao tratamento. CONCLUSÕES: A freqüência de percepção inadequada do controle da doença em pacientes com asma é elevada, principalmente em pacientes idosos, com baixa renda familiar e asma de menor gravidade.

OBJECTIVE: To determine the proportion of asthma patients with poor perception of asthma control and to evaluate the characteristics of this subgroup. METHODS: A cross-sectional study in which consecutive outpatients (over the age of 12) with mild, moderate, or severe asthma were selected. The patients underwent clinical examination and pulmonary function tests, as well as being assessed for depression and perception of asthma control. The degree of concordance between patients and physicians regarding the perception of asthma control was determined. Patients with good perception of asthma control were compared, in terms of characteristics, with those presenting poor perception. RESULTS: The degree of concordance between patients and physicians regarding the perception of asthma control was low (kappa index = 0.5). Of the 289 patients included, 66 (23 percent) presented poor perception of asthma control. The preliminary univariate analysis revealed that the patients with poor perception of asthma control were older, had a lower income, and presented a lower degree of asthma severity. Those factors did not change in the multivariate analysis. There were no differences between the groups in terms of gender, frequency of having literate patients, duration of asthma symptoms, having been diagnosed with rhinitis, frequency of depression, pulmonary function, or treatment compliance. CONCLUSIONS: The incidence of poor perception of asthma control in asthma patients is high, especially in elderly patients with lower income and a lower degree of asthma severity.