Association between dietary patterns and renal function in a cross-sectional study using baseline data from the ELSA-Brasil cohort

Previous analyses of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) identified four main dietary patterns (DP). The aim of this study was to explore the association between the previously defined DP and renal function (RF). A cross-sectional study using the ELSA-Brasil baseline data was carried out. DP ("traditional", "fruits and vegetables", "bakery", and "low sugar/low fat), metabolic syndrome (MS) using the Joint Interim Statement criteria, microalbuminuria (MA), and glomerular filtration rate (eGFR) through the CKD-EPI equation were evaluated. Abnormal RF was defined as eGFR<60 mL·min-1·(1.73 m2)-1 and MA≥3.0 mg/dL. Factors associated with RF were determined and mediation analysis was performed to investigate the association between DP, MS, and RF. A total of 15,105 participants were recruited, with a mean age of 52±9 years; 8,134 participants (54%) were females. The mediation analysis identified indirect associations between "bakery" and "fruits and vegetables", and both were associated with decreased eGFR and albuminuria in both genders, compared with "traditional" and "low sugar/low fat" patterns in the general population. There was a direct association of the "bakery" pattern with MA in men (OR: 1.17, 95%CI: 1.92-1.48). The "fruits and vegetables" pattern also showed a direct association with reduced eGFR in women (OR: 1.65, 95%CI: 1.28-2.12), although there was no significance after adjustment. The "fruits and vegetables" and "bakery" DPs were associated with renal dysfunction. The only independent, direct association was between "bakery" DP and MA in men, raising concerns about DP and renal damage in men.

Association between cognitive performance and self-reported glaucoma in middle-aged and older adults: a cross-sectional analysis of ELSA-Brasil

Recent evidence suggests that glaucoma and Alzheimer's disease are neurodegenerative diseases sharing common pathophysiological and etiological features, although findings are inconclusive. We sought to investigate whether self-reported glaucoma patients without dementia present poorer cognitive performance, an issue that has been less investigated. We employed cross-sectional data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) and included participants ≥50 years of age without a known diagnosis of dementia and a self-reported glaucoma diagnosis. We excluded those with previous stroke, other eye conditions, and using drugs that could impair cognition. We evaluated cognition using delayed word recall, phonemic verbal fluency, and trail making (version B) tests. We used multinomial linear regression models to investigate associations between self-reported glaucoma with cognition, adjusted by several sociodemographic and clinical variables. Out of 4,331 participants, 139 reported glaucoma. Fully-adjusted models showed that self-reported glaucoma patients presented poorer performance in the verbal fluency test (β=-0.39, 95%CI=-0.64 to -0.14, P=0.002), but not in the other cognitive assessments. Thus, our results support the hypothesis that self-reported glaucoma is associated with poor cognitive performance; however, longitudinal data are necessary to corroborate our findings.

Mortality rate after open Roux-in-Y gastric bypass: a 10-year follow-up

The prevalence of obesity has increased to epidemic status worldwide. Thousands of morbidly obese individuals undergo bariatric surgery for sustained weight loss; however, mid- and long-term outcomes of this surgery are still uncertain. Our objective was to estimate the 10-year mortality rate, and determine risk factors associated with death in young morbidly obese adults who underwent bariatric surgery. All patients who underwent open Roux-in-Y gastric bypass surgery between 2001 and 2010, covered by an insurance company, were analyzed to determine possible associations between risk factors present at the time of surgery and deaths related and unrelated to the surgery. Among the 4344 patients included in the study, 79% were female with a median age of 34.9 years and median body mass index (BMI) of 42 kg/m2. The 30-day and 10-year mortality rates were 0.55 and 3.34%, respectively, and 53.7% of deaths were related to early or late complications following bariatric surgery. Among these, 42.7% of the deaths were due to sepsis and 24.3% to cardiovascular complications. Male gender, age ≥50 years, BMI ≥50 kg/m2, and hypertension significantly increased the hazard for all deaths (P<0.001). Age ≥50 years, BMI ≥50 kg/m2, and surgeon inexperience elevated the hazard of death from causes related to surgery. Male gender and age ≥50 years were the factors associated with increased mortality from death not related to surgery. The overall risk of death after bariatric surgery was quite low, and half of the deaths were related to the surgery. Older patients and superobese patients were at greater risk of surgery-related deaths, as were patients operated on by less experienced surgeons.

Epidemiology of recurrent venous thrombosis

Venous thrombosis, including deep vein thrombosis and pulmonary embolism, is a common disease that frequently recurs. Recurrence can be prevented by anticoagulants, but this comes at the risk of bleeding. Therefore, assessment of the risk of recurrence is important to balance the risks and benefits of anticoagulant treatment. This review briefly outlines what is currently known about the epidemiology of recurrent venous thrombosis, and focuses in more detail on potential new risk factors for venous recurrence. The general implications of these findings in patient management are discussed.

Leveduras no rúmen de caprinos e bovinos de corte criados em pastagem tropicais / Yeasts in the rumen of beef steers and goats raised on tropical pasture

Yeasts suplemented in the rumen have been produced benefic interations in the digestion and in the health of the ruminants. This study aimed to quantify, to isolate and, to identify aerobic fungi and yeasts naturally present in the rumen of goats and cattle raised on tropical pastures of the North of Minas Gerais State, Brazil. Samples of 15mL of ruminal juice from 18 hibrid goats and 31 crossbred Nellore steers were used. The physico-chemical characteristics of the samples were evaluated and mycological culture, quantification, and identification of the aerobic fungi were performed. The results indicated the absence of yeasts in the ruminal fluid of steers. However, theses microorganisms were cultured from ruminal juice for all evaluated goats, at an average concentration of 3.2 x 10VCFU/mL. The species Pichia membranifaciens was the most frequently identified yeast, suggesting its participation in the ruminal microbiot of theses small ruminants.

Fungos anaeróbios do rúmen de bovinos e caprinos de corte criados em pastagens tropicais / Ruminal anaerobic fungi of beef cattle and beef goats raised on tropical pastures

The presence of anaerobic fungi structures was evaluated in ruminal juice of beef goats and beef cattle raised in the North of Minas Gerais, Brazil. The strains were collected from 18 Anglo-Nubian crossbred male goats and 23 Nellore crossbred steers during the dry period of the year. Physical-chemical characteristics of the juice were evaluated and direct examination with KOH digestion was performed for anaerobic fungi detection. Structures of these fungi were detected in samples of 14 (77.8 percent) goats and 17 (73.9 percent) steers. The monocentric fungi frequency (56.5 percent) was significantly higher in cattle than polycentric fungi frequency (26.1 percent). This study is the first report of anaerobic ruminal fungi in these ruminants in Brazil and showed high prevalence of theses microorganisms in the ruminal ecosystem of both animals.

Detection of renal dysfunction based on serum creatinine levels in a Brazilian community: the Bambuí Health and Ageing Study

There are few population-based studies of renal dysfunction and none conducted in developing countries. In the present study the prevalence and predictors of elevated serum creatinine levels (SCr > or = 1.3 mg/dl for men and 1.1 mg/dl for women) were determined among Brazilian adults (18-59 years) and older adults (>60 years). Participants included all older adults (N = 1742) and a probabilistic sample of adults (N = 818) from Bambuí town, MG, Southeast Brazil. Predictors were investigated using multiple logistic regression. Mean SCr levels were 0.77 ± 0.15 mg/dl for adults, 1.02 ± 0.39 mg/dl for older men, and 0.81 ± 0.17 mg/dl for older women. Because there were only 4 cases (0.48 percent) with elevated SCr levels among adults, the analysis of elevated SCr levels was restricted to older adults. The overall prevalence of elevated SCr levels among the elderly was 5.09 percent (76/1494). The prevalence of hypercreatinemia increased significantly with age (chi² = 26.17, P = 0.000), being higher for older men (8.19 percent) than for older women (5.29 percent, chi² = 5.00, P = 0.02). Elevated SCr levels were associated with age 70-79 years (odds ratio [OR] = 2.25, 95 percent confidence interval [CI]: 1.15-4.42), hypertension (OR = 3.04, 95 percent CI: 1.34-6.92), use of antihypertensive drugs (OR = 2.46, 95 percent CI: 1.26-4.82), chest pain (OR = 3.37, 95 percent CI: 1.31-8.74), and claudication (OR = 3.43, 95 percent CI: 1.30-9.09) among men, and with age >80 years (OR = 4.88, 95 percent CI: 2.24-10.65), use of antihypertensive drugs (OR = 4.06, 95 percent CI: 1.67-9.86), physical inactivity (OR = 2.11, 95 percent CI: 1.11-4.02) and myocardial infarction (OR = 3.89, 95 percent CI: 1.58-9.62) among women. The prevalence of renal dysfunction observed was much lower than that reported in other population-based studies, but predictors were similar. New investigations are needed to confirm the variability in prevalence and associated factors of renal dysfunction among populations

Consumo de álcool, cigarro e outras drogas: prevalência e fatores correlatos em jovens universitários / The alcohol, tobacco and other drugs: prevalence and correlates among undergraduate students

Este estudo objetiva determinar a prevalência do consumo de álcool e outras drogas entre estudantes universitários através de três estudos transversais (1998,1999,2000).Foi utilizado um questionário anônimo e auto-aplicado contendo dez questões do Alcohol Use Disorders Identification Test - AUDIT, questões referentes ao uso de drogas na vida e nos últimos 12 meses. Um total de 374 estudantes participaram dos três in-quéritos(1998,1999 e 2000).A adesão ao estudo variou de 67 a 83 por cento.A idade média foi de 21,9 anos, variando de 20 a 32 anos.Um total de 166 alunos eram do sexo feminino(44 por cento) e 208 do sexo masculi-no(56 por cento).O uso na vida de tabaco foi relatadopor 44 por cento;maconha por 29 por cento e cocaína por 6 por cento de todos os alunos.no último ano,o uso de maconha e cocaína foram de 9,1 por cento e 0,5 por cento,respectivamente.30,2 por cento dos entrevistados foram classificados como fazendo uso nocivo de álcool(AUDIT maior que 8 pontos):35,7 por cento no 1º estudo(1998);26,4 por cento no 2º (1999)e 28,3 por cento no 3º(2000). Estudantes do sexo masculino tinham duas vezes mais chance de usar o álcool de forma nociva do que estudantes do sexo feminino(OR=2.3,C195 por cento:1.7-4.9). Este estudo sugere que o AUDIT pode ser um instrumento útil para estudos de prevalência relacionados ao consumo de álcool entre universitários. Além disto, monitorar a prevalência destes problemas em estudos transversais sucessivos pode ajudar estimar o impacto de esforços direcionados àprevenção

Leishmaniose tegumentar na Região Metropolitana de Belo Horizonte: aspectos clínicos, laboratoriais, terapêuticos e evolutivos (1989-1995) / Cutaneous leishmaniasis in the Metropolitan Region of Belo Horizonte: clinical, laboratorial, therapeutic and prognosis features (1989-1995)

This study investigated clinical, laboratorial, therapeutic and prognostic aspects of American cutaneous leishmaniasis in Belo Horizonte in 358 patients with cutaneous leishmaniasis (CL) and 25 with mucocutaneous leishmaniasis (MCL). Compared to CL patients, the MCL patients reported longer duration of disease and higher frequency of other diseases, suggesting that debilitation caused by leishmaniasis or other conditions might contribute to activation and/or mucous dissemination of the parasite. The sensitivity of skin test, indirect immunofluorescence reactions and direct detection of parasites was 78.4, 79.3 and 68.3%, respectively. The treatment with meglumine antimoniate presented 100% efficacy, but 59% patients had side-effects. During two years of follow-up, there were 32/318 relapses after successful treatment. Most relapses (31/32) were of CL patients treated with 15 mg Sb5+/kg/day. The negative response to skin test was the only factor associated with a significant threefold increased risk of relapse. Higher dose or longer duration of treatment might improve the prognosis in these patients.

Foram investigados aspectos clínicos, laboratoriais, terapêuticos e evolutivos da leishmaniose tegumentar americana em Belo Horizonte. O estudo incluiu 358 pacientes com leishmaniose cutânea (LC) e 25 com leishmaniose mucosa (LM). Comparados aos pacientes com LC, aqueles com LM apresentaram maior tempo de doença e relato de outras doenças concomitantes, sugerindo que a debilitação pela leishmaniose e/ou outras doenças podem contribuir para a ativação e/ou disseminação mucosa do parasito. As sensibilidades das reações intradérmica, de imunofluorescência indireta e da pesquisa direta do parasito foram de 78,4, 79,3 e 68,3%, respectivamente. O tratamento com antimoniato de meglumina foi 100% eficaz, com 59% de efeitos colaterais ao longo do tratamento. A recidiva após tratamento ocorreu em 32 (10,1%) dos 318 casos seguidos por até dois anos. A maioria das recidivas (31 dos 32 casos) ocorreu em pacientes com LC tratados com 15mg Sb5+/kg/dia. Na investigação de critérios de cura, a reação intradérmica negativa foi o único fator associado a um risco três vezes maior de recidiva. Um aumento da dose ou do tempo de tratamento talvez melhore o prognóstico nestes pacientes.

O envelhecimento e a funcao pulmonar. / Aging and the lung function

O pulmao do recem-nascido e qualitativamente diferente do pulmao adulto.A relacao entre superficie alveolar e superficie corporal aumenta de 13,3 no periodo neonatal para 39,5 na idade adulta.A partir dos vinte anos de idade, em media comeca a progressiva reducao da funcao respiratoria do pulmao que, no entanto, e capaz de manter adequada cappacidade de hematose dentro da perspectiva de vida maxima de pessoas sadias. Com a idade ha uma gradual perda da elasticidade pulmonar devido a um desajuste espacial na estrutura das ligacoes cruzadas de elastina. Associa-se uma ectasia ductal e uma reducao da superficie alveolar a razao de 4% por decada apos os 30 anos de idade. A diminuicao de amplitude do movimento das articulacoes corto-vertebrais e condro-costais em conjunto com as alteracoes pulmonares leva a uma reducao da capacidade inspiratoria, do volume de reserva expiratoria, da capacidade vital e da capacidade pulmonar total, a um aumento do volume residual e da capacidade residual funcional. Ha um consistente declinio dos varios indices de velocidade de fluxo. A desuniformidade da relacao ventilacao-perfusao promove uma diminuicao da pressao parcial de oxigenio no sangre arterial, chegando a media de 75 mmHg na setima decada. Aparentemente todas essas alteracoes sao mais intensas nos homens

Niveis de proteinas totais e fracoes e imunoglobulinas G, M e A no soro do cordao umbilical de criancas normais. / Total protein and protein fractions levels and G, M and A immunoglobulins levels in serum of umbilical cord of normal infants

Foram determinados os niveis de proteinas totais e fracoes separados por eletroforese em acetato de celulose e, de IgG, IgM e IgA por imunodifusao radial simples em imunoplacas confeccionadas no proprio laboratorio, de 60 amostras de sangue do cordao umbilical de recem-nascidos normais do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto. A distribuicao dos valores de proteinas totais e fracoes foi examinada por meio de um diagrama de pontos, exceto para alfa-1-globulina, detectada somente em 36.66% dos soros.As IgG e IgM foram detectadas em 100% das amostras e a A em apenas 6,6% em baixas concentracoes. Os autores observaram diferencas de resultados do presente trabalho na literatura nacional e estrangeira.Consideram que a determinacao de faixa de normalidade para uso local constitui referencia mais apropriada

Paracoccidioidomicose genital masculina. / Male genital paracoccidioidomycosis

Sao relatados sete casos de paracoccidioidomicose com comprometimento dos orgaos genitais masculinos. Com excecao de um caso, os sintomas pulmonares precederam o envolvimento genital. O epididimo e testiculo foram os orgaos mais frequentemente atingidos. Os aspectos histopatologicos foram ressaltados

Consideracoes sobre a sindrome do lobo medio. / Middle lobe syndrome

Os autores revisaram a bibliografia sobre a chamada sindrome do lobo medio, ilustrando com o relato de cinco casos. Apresentaram como conclusoes: (a) Sindrome do lobo medio: entidade clinica e radiologica caracterizada por atelectasia cronica do lobo medio do pulmao direito com episodios de pneumonite e alteracoes supurativas e sintomas respiratorios cronicos ou recorrentes. As vezes pode ser um achado radiologico com antecedentes clinicos pouco expressivos; (b) Sintomas respiratorios:tosse produtiva, que piora com o decubito dorsal, hemoptise, dor toracica anterior direita, dispneia e sibilos. Infeccoes respiratorias baixas de repeticao (pneumonias recorrentes). (c) Os fatores patogenicos basicos seriam a hipoventilacao colateral do lobo medio e/ou a susceptibilidade de seu bronquio lobar a obstrucao; (d) Valorizam-se a broncoscopia e sobretudo a broncografia com o procedimento diagnosticos. A tomografia do lobo medio frente e perfil e de alta sensibilidade diagnostica das condicoes lobares. (e) O tratamento conservador pode ser suficiencte na maioria dos casos. Indicacoes cirurgicas: malignidade no bronquio lobar, atelectasia e/ou supuracao cronica resistente ao tratamento conservador e hemorragia com erosao de luz bronquica

Pneumonia por Mycoplasma pneumoniae: relato de um caso com insuficiencia respiratoria aguda. / Mycoplasma pneumoniae infection associated with acute pulmonary insufficiency. Report of a case

Um homem de 29 anos de idade, previamente higido, apresentou severa pneumonia com insufuciencia respiratoria aguda. Estudos sorologicos indicaram infeccao por Mycoplasma pneumoniae. O tratamento com doxiciclina foi bem sucedido