Estudo de fase II de pregabalina para prevenção de náuseas e vômitos induzidos por quimioterapia / Phase II study of pregabalin for the prevention of chemotherapy induced nausea and vomiting

Para avaliar o papel da pregabalina na proteção das náuseas e vômitos induzidos pela quimioterapia, foi realizado um ensaio clínico de fase II, aleatorizado, duplamente cego, controlado por placebo, para investigar se a pregabalina poderia melhorar o controle completo das náuseas e vômitos (desfecho primário). Inscrevemos 82 pacientes virgens de quimioterapia, programados para receber quimioterapia moderadamente e altamente emetogênica. Todos os doentes receberam ondansetron 8mg por via intravenosa, dexametasona 10mg antes da quimioterapia no primeiro dia e, dexametasona 4 mg por via oral, b.d., nos dias dois e três. Os doentes foram distribuídos aleatoriamente para tomar pregabalina 75 mg ou placebo, bd, desde a noite anterior à quimioterapia até ao quinto dia. A resposta completa global não foi estatisticamente significativa entre os grupos (53,7 versus 48,8%, respetivamente, no grupo da pregabalina e no grupo de controlo (P=0,65)). Também não houve diferença estatística significativa durante a fase aguda (primeiras 24 horas) e a fase tardia (24-120h): 80,5% versus 82,9% (P=0,77), 53,7 versus 51,2% (P=0,82), respectivamente. Neste estudo não foi identificada ação da pregabalina na prevenção de náuseas e vômitos induzidos por quimioterapia. Número de registo no Clinicaltrial.gov: NCT04181346.

To evaluate the role of pregabalin in the protection of chemotherapy-induced nausea and vomiting, we performed a phase II randomized, double-blind, placebo-controlled trial to investigate whether pregabalin could improve the complete control of nausea and vomiting (primary end point). We enrolled 82 chemotherapy-naive patients, scheduled to receive moderately and highly emetogenic chemotherapy. All patients received IV ondansetron 8mg, dexamethasone 10mg before chemotherapy on day one and oral dexamethasone 4mg, b.d., on days two and three. Patients were randomly assigned to take pregabalin 75mg or placebo, bd, from the night before chemotherapy to day five. The overall complete response was not statistically significant between the groups (53.7 versus 48.8%, respectively, in the pregabalin group and the control group (P=0.65)). There was also no significant difference during the acute phase (first 24 hours) and delayed phase (24-120h): 80.5% versus 82.9% (P=0.77), 53.7 versus 51.2% (P=0.82), respectively. There is no role for pregabalin preventing chemotherapy-induced nausea and vomiting. Clinicaltrial.gov registration number: NCT04181346.

Febrile neutropenia incidence and the variable toxicity profile between brand and generic docetaxel in the adjuvant treatment of breast cancer with docetaxel and cyclophosphamide regimen

ABSTRACT Objective To assess the incidence of febrile neutropenia without primary granulocyte colony-stimulating factor prophylaxis in patients undergoing chemotherapy with adjuvant docetaxel and cyclophosphamide, and to evaluate the toxicity profile of brand-name docetaxel (Taxotere ® ) and the generic formulation. Methods This retrospective study was conducted using data obtained from electronic medical records of patients treated at a Brazilian cancer center. Patients with breast cancer who underwent adjuvant treatment between January 2016 and June 2019 were selected. Data were analyzed using chi-square and Fisher correlation of variables, and multivariate analyses were adjusted for propensity score. Results A total of 231 patients with a mean age of 55.9 years at the time of treatment were included in the study. The majority (93.9%) had luminal histology, 84.8% were at clinical stage I, and 98.2% had a good performance status. The overall incidence of febrile neutropenia in the study population was 13.4% (31 cases). The use of brand-name docetaxel (Taxotere ® ) was the only factor associated with febrile neutropenia occurrence (OR= 3.55, 95%CI= 1.58-7.94, p=0.002). Conclusion In patients with breast cancer who require treatment with adjuvant docetaxel and cyclophosphamide regimen, the toxicity profile differs between brand-name and generic docetaxel. Regardless of the formulation used, the incidence of febrile neutropenia was less than 20%, which may allow for the omission of primary prophylactic granulocyte colony-stimulating factor use in this setting.

Role of intrathecal chemotherapy in the management of meningeal carcinomatosis in patients with breast cancer

ABSTRACT Objective To evaluate whether intrathecal chemotherapy improves clinical outcomes in patients with meningeal carcinomatosis. Methods This retrospective cohort study included consecutive patients with breast cancer diagnosed with meningeal carcinomatosis. Clinical and treatment data were collected from the patients' medical charts. The primary outcome was overall survival, and the secondary outcomes were time to neurological deterioration and reporting of clinical benefit. Logistic regression and Cox proportional hazard models adjusted for potential confounders were used to evaluate the clinical response and overall survival, respectively. Results Overall, 109 female patients were included, 50 (45.9%) of whom received intrathecal chemotherapy with methotrexate and dexamethasone. The median treatment duration was 3 weeks (range, 1-13 weeks). Patients treated with intrathecal chemotherapy were more likely to report clinical benefit (74% versus 57.7%, adjusted odds ratio [OR] = 9.0, 95%CI=2.6-30.9, p<0.001). However, there was no difference in the time to neurologic deterioration (hazard ratio [HR] = 0.96, 95%CI= 0.57-1.59, p=0.86). Patients who received intrathecal chemotherapy did not show an increase in overall survival compared with that of patients who did not receive intrathecal chemotherapy (median overall survival = 1.8 months, 95%CI= 1.27-3.0 versus 2.5, 95%CI= 1.9-3.9, adjusted HR = 0.71, 95%CI= 0.41-1.22, p=0.21). There was a significant interaction between intrathecal chemotherapy and systemic treatment, and patients who received systemic therapy without intrathecal chemotherapy had better overall survival than that of the no-treatment group (adjusted HR = 0.38, 95%CI= 0.20-0.70, p=0.002). Conclusion Intrathecal chemotherapy did not increase overall survival or time to neurological deterioration and should not preclude or postpone systemic treatments.

Incidentes críticos na convivência familiar e social de idosos com hiv/aids / Critical incidents in family and social life of elderly people with hiv/aids / Incidentes críticos en la interacción familiar y social de personas mayores con vih/sida

O aumento das Infecções Sexualmente Transmissíveis e dos casos de contágio pelo HIV/AIDS na população idosa reflete aspectos da prática sexual e vulnerabilidades que podem estar sendo enfrentadas por essas pessoas em seu convívio social e familiar. Objetivo: descrever, por meio de incidentes críticos, as situações, comportamentos e consequências relacionadas à descoberta do HIV/AIDS por pessoas idosas soropositivas. Método: estudo descritivo, com abordagem qualitativa, realizado no Centro de Infectologia de um município da região sul do estado do Ceará, utilizando a Técnica de Incidente Crítico (TIC), nos meses de fevereiro a setembro de 2020. Participaram 25 idosos cadastrados no serviço, com idades entre 55 e 77 anos. Os dados foram coletados por meio de entrevista semiestruturada e o conteúdo analisado com auxílio do software IRaMuTeQ por meio de categorias temáticas. Resultados: os dados empíricos contendo as situações, comportamentos e consequências (incidentes críticos) elucidaram quatro categorias empíricas: descoberta do diagnóstico de HIV/AIDS; sentimentos, estigmas e preconceitos vivenciados; soropositividade e reflexos no convívio familiar e social; e mudanças no comportamento sexual após diagnóstico de HIV/AIDS. Conclusão: as relações familiares e sociais vivenciadas e os desafios enfrentados pelas pessoas idosas com HIV/AIDS constituíram incidentes críticos complexos, afetando-as desde o momento do diagnóstico, com impactos negativos sobre seus modos de vida familiar e social, que dificultam a convivência inclusiva e não estigmatizante dentro e fora de casa.

The increase of Sexually Transmitted Infections and cases of HIV/AIDS in the elderly population reflects aspects of sexual practice and vulnerabilities that may be faced by these people in their social and family life. Objective: to describe, through critical incidents, the situations, behaviors and consequences related to the discovery of HIV/AIDS by seropositive elderly people. Method: a descriptive study with a qualitative approach, conducted at the Infectious Diseases Center of a city in the southern region of the state of Ceará, using the Critical Incident Technique (CIT), from February to September 2020. Twenty-five elderly people enrolled in the service, aged 55 to 77 years, participated. The data were collected through semi-structured interviews and the content analyzed with the help of IRaMuTeQ software through thematic categories. Results: The empirical data containing situations, behaviors and consequences (critical incidents) elucidated four empirical categories: discovery of the HIV/AIDS diagnosis; feelings, stigmas and prejudices experienced; seropositivity and reflections on family and social life; and changes in sexual behavior after the diagnosis of HIV/AIDS. Conclusion: the family and social relationships experienced and the challenges faced by elderly people with HIV/AIDS constituted complex critical incidents, affecting them from the moment of diagnosis, with negative impacts on their family and social lifestyles, which hinder inclusive and non-stigmatizing coexistence inside and outside the home.

El aumento de las Infecciones de Transmisión Sexual y de los casos de VIH/Sida en la población anciana refleja aspectos de la práctica sexual y vulnerabilidades que pueden enfrentar estas personas en su vida social y familiar. Objetivo: describir, a través de incidentes críticos, las situaciones, comportamientos y consecuencias relacionadas con el descubrimiento del VIH/SIDA por personas mayores seropositivas. Método: estudo descritivo, com abordagem qualitativa, realizado no Centro de Infectologia de um município da região sul do estado do Ceará, utilizando a Técnica de Incidente Crítico (TIC), nos meses de fevereiro a setembro de 2020. Participaron 25 ancianos registrados en el servicio, con edades comprendidas entre 55 y 77 años. Os dados foram recolhidos através de entrevistas semiestructuradas e o conteúdo foi analisado com a ajuda do software IRaMuTeQ através de categorias temáticas. Resultados: los datos empíricos que contienen las situaciones, comportamientos y consecuencias (incidentes críticos) elucidaron cuatro categorías empíricas: descripción del diagnóstico de VIH/SIDA; sentimientos, estigmas y preconceptos vividos; seropositividad y reflejos en la convivencia familiar y social; y cambios en el comportamiento sexual tras el diagnóstico de VIH/SIDA. Conclusão: as relações familiares e sociais vividas e os desafios enfrentados pelos idosos com HIV/AIDS constituem incidentes críticos complexos, afetando-as desde o momento do diagnóstico, com impactos negativos sobre seus modos de vida familiar e social, que dificultam a convivência inclusiva e não estigmatizante dentro e fora de casa.

Prevalence and predisposing factors for fatigue in patients with chronic renal disease undergoing hemodialysis: a cross-sectional study

ABSTRACT BACKGROUND: Patients with chronic renal disease and undergoing hemodialysis are at a high risk for developing several complications. Fatigue is a common, troubling symptom that affects such patients and can contribute to unfavorable outcomes and high mortality. OBJECTIVE: This cross-sectional study aimed to evaluate the prevalence of fatigue in Brazilian patients with chronic kidney disease undergoing hemodialysis and determine the predisposing factors for fatigue. DESIGN AND SETTING: An observational, cross-sectional, descriptive study was conducted in two renal replacement therapy centers in the Greater ABC region of São Paulo. METHODS: This study included 95 patients undergoing dialysis who were consecutively treated at two Brazilian renal replacement therapy centers between September 2019 and February 2020. The Chalder questionnaire was used to evaluate fatigue. Clinical, sociodemographic, and laboratory data of the patients were recorded, and the Short Form 36 Health Survey, Pittsburgh Sleep Quality Index, and Beck Depression Inventory were administered. RESULTS: The prevalence of fatigue in patients undergoing hemodialysis was 51.6%. Fatigue was independently associated with lower quality of life in terms of physical and general health. Patients with fatigue had a higher incidence of depression (65.9% vs. 34.1%, P = 0.001) and worse sleep quality (59.1% vs. 49.9%; P = 0.027) than those without fatigue. CONCLUSION: Prevalence of fatigue is high in patients undergoing hemodialysis and is directly related to physical and general health.

COVID-19 in the perioperative period of cardiovascular surgery: the brazilian experience

Abstract Introduction: We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods: A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results: The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. Conclusion: COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.

High mortality among patients with cancer and COVID-19 infection: the experience of a Brazilian cancer center / Alta mortalidade entre pacientes com câncer e infecção por COVID-19: a experiência de um centro oncológico brasileiro

ABSTRACT Objective To evaluate the severity of COVID-19 in cancer patients to describe clinical and epidemiological factors associated with poor outcomes (mortality and need of intensive care unit admission or mechanical ventilation). Methods Retrospective data from patients with cancer and laboratory diagnosis of COVID-19, obtained between March 16 and May 29, 2020, were retrieved out of a cancer center database. Data analyzed included patient history, age, sex, comorbidities, types of cancer and anticancer therapy. Results This sample comprised 105 patients aged 18-92 years, 80.9% of whom were females. Dyspnea was the most prevalent initial symptom (30.4%) among patients who died (p<0.0001). Overall, 57.1% of patients had metastatic disease and 60% had poor performance status (Eastern Cooperative Oncologic Group ≥2) at the time of COVID-19 diagnosis. The overall mortality rate was 40.95%. Mortality rates were higher in male patients and those with poor performance status (p<0.0001). Conclusion This cohort is one of the largest Brazilian studies describing clinical and epidemiological features of patients with cancer and concurrent COVID-19. Findings of this study emphasize the vulnerability of cancer patients in the current pandemic, and indicate high mortality from COVID-19 among male cancer patients and cancer patients with poor performance status. This analysis may assist the selection of patients who may benefit from strict isolation and eventual discontinuation of anticancer therapy to reduce exposure to infection.

RESUMO Objetivo Avaliar a gravidade da infecção por COVID-19 em pacientes oncológicos, determinando os aspectos clínicos e epidemiológicos associados ao pior desfecho, seja em termos de mortalidade, necessidade de internação em unidade de terapia intensiva ou ventilação mecânica. Métodos Pacientes com câncer e diagnóstico confirmado por laboratório de COVID-19 foram identificados nos bancos de dados de um hospital oncológico entre 16 de março e 29 de maio de 2020. Os dados coletados incluíram história, idade, sexo e comorbidades dos pacientes, além dos tipos de câncer e do tratamento anticâncer. Resultados Dentre os 105 pacientes analisados, a idade variou de 18 a 92 anos, e 80,9% eram do sexo feminino. Dispneia foi o sintoma inicial mais prevalente entre os que morreram (30,4%). No momento do diagnóstico da infecção, 57,1% apresentavam doença metastática e 60% performance status ruim (Eastern Cooperative Oncologic Group ≥2). A taxa de mortalidade geral foi 40,95% e superior entre os homens e pacientes com baixo nível de performance status (p<0,0001). Conclusão Este coorte é um dos estudos mais robustos do Brasil, descrevendo características clínicas e epidemiológicas de pacientes com câncer e COVID-19. Os achados do estudo alertam para a vulnerabilidade dos pacientes oncológicos na pandemia atual e demonstram alta mortalidade por COVID-19 em pacientes do sexo masculino e com pior performance status. Essa análise pode ajudar a selecionar os pacientes que podem se beneficiar de isolamento rigoroso e até mesmo da interrupção do tratamento, reduzindo a exposição à infecção.

La cirugía en el tratamiento de la crisis tirotóxica / Surgery for the Treatment of Thyrotoxic Crisis

RESUMEN La crisis tirotóxica es una complicación de la tirotoxicosis mal tratada y se asocia con una elevada mortalidad. Requiere tratamiento médico urgente en unidades de cuidados intensivos. Mujer de 42 años, con antecedentes personales de hipertensión arterial y nódulo tiroideo hiperfuncionante desde hace 18 años, con abandono del tratamiento médico hace dos años, que acude a urgencias con disnea paroxística nocturna, taquicardia, hipertensión arterial, gran bocio y anasarca. Ingresa en la unidad de cuidados intensivos con diagnóstico de crisis tirotóxica e inicia el tratamiento médico con medidas de soporte precisas, la que incluye intubación orotraqueal. Debido a la dificultad de manejo clínico y respiratorio de la paciente, se decide realizar tratamiento quirúrgico urgente. Se practica una tiroidectomía total de bocio multinodular parcialmente intratorácico y una traqueostomía preventiva. El resultado de anatomía patológica fue: bocio multinodular tóxico. La paciente fue dada de alta con función tiroidea normal, cierre de traqueostomía y buena fonación, tras mes y medio de hospitalización. A pesar de que un tratamiento médico conservador es el adecuado de la tirotoxicosis, los síntomas y signos sistémicos de la crisis tirotóxica y sus manifestaciones órgano-específicas, asociados a una persistente dificultad respiratoria por síntomas compresivos derivados del gran bocio, se consideró que la tiroidectomía urgente en este caso estaba indicada, dato que se corroboró ante la buena evolución posoperatoria. El tratamiento de la tirotoxicosis es fundamentalmente clínico, sin embargo, la cirugía puede ser útil ante la dificultad en el manejo clínico(AU)

Abstract The thyrotoxic crisis is a complication of poorly treated thyrotoxicosis and is associated with high mortality. This condition requires urgent medical treatment in intensive care units. A 42-year-old woman, with a personal history of high blood pressure, hyperfunctioning thyroid nodule for 18 years, and abandonment of medical treatment since two years ago, presented to the emergency department with paroxysmal nocturnal dyspnea, tachycardia, high blood pressure, large goiter, and anasarca. She was admitted into the intensive care unit with a diagnosis of thyrotoxic crisis and started to receive medical treatment under precise support measures, including orotracheal intubation. Due to the patient's difficult clinical and respiratory management, it was decided to perform urgent surgical treatment. She was performed a total thyroidectomy of partial intrathoracic multinodular goiter and a preventive tracheostomy. The result of pathological anatomy was toxic multinodular goiter. The patient was discharged with normal thyroid function, tracheostomy closure, and good phonation, after a month and a half of hospitalization. Despite the fact that conservative medical treatment is the adequate one for thyrotoxicosis, the systemic symptoms and signs of the thyrotoxic crisis, and its organ-specific manifestations, associated with persistent respiratory distress due to compression symptoms derived from large goiter, urgent thyroidectomy needed to be indicated in this case, a fact corroborated after good postoperative evolution. The treatment of thyrotoxicosis is fundamentally clinical; however, surgery can be useful given the difficulty in clinical management(AU)

Benefits of fasting abbreviation with carbohydrates and omega-3 infusion during cabg: a double-blind controlled randomized trial

Abstract Objective: To assess postoperative clinical data considering the association of preoperative fasting with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). Methods: 57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control. Results: There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive drugs during surgery and ICU stay (P<0.05); and had better blood glucose levels in the first six hours of recovery (P=0.015), requiring less exogenous insulin (P=0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups (P=0.009). Subjects who receive ω-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively (P=0.008). Interleukin-10 levels varied among groups (P=0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ω-3 PUFA (P=0.049). Conclusion: Fasting abbreviation with carbohydrate loading and intraoperative infusion of ω-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG.

Hormone receptor-negative as a predictive factor for pathologic complete response to neoadjuvant therapy in breast cancer / Receptor hormonal negativo como fator preditivo para resposta patológica completa ao tratamento neoadjuvante de câncer de mama

ABSTRACT Objective To define a predictive factor for pathologic complete response, compare the oncologic outcomes associated with the degree of pathologic response after neoadjuvant chemotherapy, and to analyze pathologic complete response as a prognostic factor for overall survival and progression-free survival. Methods A retrospective study of patients admitted to Hospital Estadual Mário Covas and Hospital Anchieta from 2008 to 2012, with locally advanced breast cancer. Hormone receptor status, HER2 status, histologic and nuclear grade, age upon diagnosis and histological type of the tumor were analyzed. Pathologic evaluation of the tumor was subdivided into pathologic complete response, defined by the absence of tumor; intermediate response, considered as a favorable stage; and poor response, considering low-responder patients. Data obtained were submitted to statistical analysis. Results The study included 243 patients. There was an association of pathologic complete response with HER-2 negative, histological grade 3, stage III, hormone receptor negative, positive lymph node, older age and more advanced tumors. However, after multivariate analysis the only predictor of pathologic complete response was the presence of negative hormone receptor. By analyzing the prognostic factors, hormone receptor negative was considered as an independent risk factor, and pathologic complete response was considered as an independent protective factor. Conclusion Hormone receptor negative is predictive of pathologic complete response and is an isolated risk factor for lower progression-free survival and overall survival. Pathologic complete response is a protective factor for these same survival analyses.

RESUMO Objetivo Definir um fator preditivo para resposta patológica completa, comparar os resultados oncológicos associados com o grau de resposta patológica, após quimioterapia neoadjuvante, e analisar a resposta patológica completa como fator prognóstico para sobrevivência global e livre de progressão de doença. Métodos Estudo retrospectivo de pacientes admitidas no Hospital Estadual Mário Covas e Hospital Anchieta, no período de 2008 a 2012, com câncer de mama localmente avançado. Foram utilizados status dos receptores hormonais, proteína HER2, grau histológico e nuclear, idade do paciente ao diagnóstico e tipo histológico do tumor. A avaliação patológica do tumor foi subdividida em resposta patológica completa, definida com ausência de tumor; resposta intermediária, considerada como um estádio favorável; e resposta ruim, considerando os pacientes pouco respondedores. As informações obtidas foram submetidas à análise estatística. Resultados Foram incluídas 243 pacientes. Verificou-se associação de resposta patológica completa entre HER-2 negativo, grau histológico 3, estadiamento III, receptor hormonal negativo, linfonodo positivo, maior idade e tumores mais avançados. Porém, após análise multivariada, o único fator preditivo de resposta patológica completa foi presença de receptor hormonal negativo. Ao analisar fatores prognósticos, receptor hormonal negativo permaneceu como variável independente de risco, e resposta patológica completa, como variável independente de proteção. Conclusão O receptor hormonal negativo é fator preditivo isolado de resposta patológica completa e fator de risco para menor sobrevida livre de doença e sobrevida global. Já a resposta patológica completa é fator protetor para estas mesmas análises de sobrevivência.

Fatores associados a quedas recorrentes em uma coorte de idosos / Factors associated with recurrent falls in a cohort of elderly people

Resumo Introdução Quedas de idosos configuram-se como importante causa de morbimortalidade. Objetivo Verificar a reincidência de quedas e identificar fatores associados a quedas e a quedas recorrentes. Metodologia Estudo de seguimento de 4 anos, por meio de duas ondas de inquérito (2010 e 2014/2015), com uma coorte de 218 idosos, de ambos os sexos e não institucionalizados em Juiz de Fora, MG. Utilizou-se regressão logística multinomial para estimar a associação de cada variável independente com os desfechos analisados. No modelo final foram mantidas as variáveis com p ≤ 0,05. Para cálculo de odds ratio (OR), foi considerado intervalo de confiança de 95%. Resultados 33,5% das pessoas relataram ter caído no ano anterior ao primeiro inquérito. No segundo inquérito, essa frequência foi de 38,5%. Durante o seguimento, 44,5% não relataram quedas, 39% sofreram queda em pelo menos um dos inquéritos e 16,5% manifestaram ter sofrido queda nas duas ondas. Não foram encontradas associações para queda recorrente. Queda no seguimento associou-se a sexo feminino e idade (71 a 80 anos). Conclusão Os resultados evidenciam e ratificam a magnitude com que quedas e quedas recorrentes atingem a população idosa e apontam para a necessidade de estratégias preventivas a partir da identificação de grupos de riscos.

Abstract Introduction For the elderly, falling constitute an important cause of morbidity and mortality. Objective Verify the recurrence of falls and identify factors associated with falls and recurrent falls. Methodology A 4-year follow-up study using two survey waves (2010 and 2014/2015), with a cohort of 218 elderly people, both genders and non-institutionalized, in Juiz de Fora-MG. Multinomial logistic regression was used to estimate the association of each independent variable with the outcomes analyzed. In the final model, variables with p ≤ 0.05 were maintained. Odds Ratio (OR) was calculated with a 95% confidence interval. Results 33.5% of the participants reported falling in the prior year of the first inquiry. In the second inquiry, the frequency was 38.5%. During the follow-up study, 44.5% did not report falls, 39% suffered a fall in at least one of the surveys, and 16.5% reported falling in both waves. No associations for recurrent falls were found. In the follow-up, falls were associated with female gender and age (71 to 80 years old). Conclusion The results demonstrate and confirm the magnitude with which falls and recurrent falls affect the elderly population, and indicate the need for preventive strategies based on the identification of groups at risk.

Avaliação de peptídeo natriurético em cães doentes renais crônicos / Natriuretic peptide assessment in dogs with chronic kidney disease

Na doença renal crônica (DRC), a hipertensão arterial é uma das complicações mais comuns, que pode estar associada a liberação dos peptídeos natriuréticos e a hipertrofia ventricular no homem. Em cães os peptídeos natriuréticos são estudados como biomarcadores cardíacos, mas ainda se desconhece sua função em cães com DRC. Desta forma, este estudo teve como objetivo relacionar a concentração sérica de peptídeo natriurético B aos achados de pressão arterial, eletrocardiográficos, eletrolíticos, hematológicos e bioquímicos séricos e urinários em cães nos distintos estágios da DRC. Foram constatadas diferenças significativas na relação de proteína creatinina urinária (UPC, p=0,006), anemia, creatinina e uréia sérica (p<0,001) nos grupos de doentes renais comparado com saudáveis. Apesar das variações de pressão arterial, amplitude e intervalo QRS e fósforo não serem significativas, foi observada tendência de alteração desses valores com o avanço da doença. Não foi observado correlação entre BNP (peptídeo natriurético cerebral) e DRC.(AU)

In chronic kidney disease (CKD) hypertension is one of the most common complications that may be associated with the release of natriuretic peptides and ventricular hypertrophy in humans. In dogs the natriuretic peptides are studied as cardiac biomarkers, but still unaware their function in dogs with CKD. Thus, this study aimed to relate the serum natriuretic peptide B with blood pressure findings, electrocardiographic, electrolyte, blood and serum and urinary biochemistry in dogs in different stages of CKD. Significant differences were found in urinary protein to creatinine ratio (UPC, p=0.006), anemia, serum creatinine and urea (p<0.001) in the group of patients with renal disease compared with the healthy group. Despite the variation in blood pressure, amplitude and QRS interval and phosphorus are not significant, a tendency for alterations of these values was observed with the advance of the disease. There was no correlation between BNP and CKD.(AU)

Relation between anaemia and bone marrow features and serum erythropoietin in dogs with chronic kidney disease / Relação entre anemia e achados de medula óssea e eritropoetina sérica em cães com doença renal crônica

Chronic anaemia is one of the most severe complications of chronic kidney disease, contributing to morbidity and mortality caused by the disease; therefore, bone marrow cytological evaluation is needed to monitor the progression of anaemia. This study aimed to correlate the anaemia in dogs at different stages of chronic kidney disease with their serum biochemistry, myelogram results and serum erythropoietin findings. Sixty-three dogs were grouped according to International Renal Interest Society (IRIS) classification in stages 1, 2, 3 and 4. Haematologic, serum and urinary biochemistry and serum erythropoietin were performed for comparison with the findings of bone marrow cytology obtained by aspiration of the manubrium. Cytological findings for erythroid hypoplasia were described in 93.65% of dogs, and the anaemia was observed in 84.1% of them. The haematological findings were correlated with azotaemia (p<0.05). It was concluded that the erythroid hypoplasia has correlation with persistent anaemia in dogs at all stages of chronic kidney disease, with iron deficiency in dogs in the early stages and with peripheral destruction of erythrocytes caused by azotaemia.(AU)

A anemia crônica é umas das complicações mais graves da doença renal crônica, contribuindo para a morbidade e mortalidade causada pela doença; Portanto, a avaliação citológica da medula óssea é necessária para monitorar a progressão da anemia. Assim, esse estudo objetivou correlacionar a anemia em cães em diferentes estágios da doença renal crônica aos achados de bioquímica sérica, mielograma e concentração sérica de eritropoietina. Sessenta e três cães foram agrupados de acordo com a classificação da International Renal Interest Society (IRIS) em estágios 1, 2, 3 e 4. Foram realizadas análises hematológicas, bioquímicas séricas e urinárias, e dosagem sérica de eritropoetina para comparação com os achados medulares obtidos por citologia aspirativa do manúbrio. Os achados citológicos de hipoplasia eritróide foram descritos em 93,65% dos cães, e a anemia foi observada em 84,1% dos cães. Os resultados hematológicos foram correlacionados com azotemia (p<0,05). Concluiu-se que a hipoplasia eritróide teve associação com a anemia persistente em cães em todas as fases de doença renal crônica, com deficiência de ferro em cães em fases iniciais e com a destruição periférica dos eritrócitos causada pela azotemia.(AU)

Seroprevalence of Toxoplasma gondii in dogs of riverside communities of Mato Grosso Pantanal, Brazil / Soroprevalência de Toxoplasma gondii em cães de comunidades ribeirinhas do Pantanal de Mato Grosso, Brasil

Abstract Toxoplasma gondii is an intracellular protozoan with worldwide distribution and dogs act as sentinels of human infection. This search aimed to determine the occurrence of antibodies against T. gondii in dogs of the communities on the Cuiabá River, Mato Grosso and variables associated with infection. The dogs of the riverside communities in Cuiabá River, which includes Barranco Alto, Praia do Poço, Engenho Velho, Varginha, Bom Sucesso, Passagem da Conceição and São Gonçalo Beira Rio, were evaluated for the presence of T. gondii antibodies by indirect immunofluorescence antibody test (IFAT). The prevalence and factors associated with infection were calculated by chi-squared test (χ2) or Fisher’s exact test, and univariate and multiple analysis. Of the 248 dogs surveyed, 107 (43.1%) were seropositive for T. gondii. The seroprevalence ranged from 25.6% to 64.3%. There was no statistically significant difference between the communities studied (p > 0.05). As for the associated factors, the only statistically significant factor was that of dogs living with cats (p = 0.02), with approximately twice the risk of acquiring infection. In conclusion, the seroprevalence in dogs of riverside communities in the Baixada Cuiabana demonstrated that high rates of infection, being the factor associated with infection, contact with domestic cats.

Resumo Toxoplasma gondii é um protozoário intracelular com distribuição mundial e o cão atua como sentinela para infecção humana. Esta pesquisa teve por objetivo determinar a ocorrência de anticorpos contra T. gondii em cães de comunidades ribeirinhas ao Rio Cuiabá, Mato Grosso e as variáveis associadas à infecção. Os cães das comunidades ribeirinhas do Rio Cuiabá, que inclui Barranco Alto, Praia do Poço, Engenho Velho, Varginha, Bom Sucesso, Passagem da Conceição e São Gonçalo Beira Rio, foram avaliados para a presença de anticorpos para T. gondii pela reação de imunofluorescência indireta (IFI). A prevalência e fatores associados com a infecção foram calculados pelo teste de qui-quadrado (χ2) ou exato de Fisher, e análise univariada e multivariada. Dos 248 cães estudados, 107 (43,1%) foram soropositivos para T. gondii. A prevalência variou de 25,6% a 64,3%. Não houve diferença estatisticamente significativa entre as comunidades estudadas (p > 0,05). Quanto aos fatores associados, o único fator estatisticamente significante o convívio com gatos (p = 0,02), com cerca de duas vezes mais risco de adquirir a infecção. Em conclusão, a soroprevalência em cães de comunidades ribeirinhas da Baixada Cuiabana demonstram altas taxas de infecção, sendo o fator associado à infecção, o contato com gatos domésticos.

Uso de packing preperitoneal en paciente politraumatizado / Use of preperitoneal packing in politraumatized patient

Objetivo Reportar un caso de grave fractura pélvica y sangrado masivo tratado inicialmente con packing pélvico. Caso clínico Paciente precipitado hemodinámicamente debido a varias fracturas abiertas, entre las que se incluye fractura pélvica con importante diástasis púbica. Se decide intervención quirúrgica procediendo a fijación externa de la pelvis, y posteriormente se realiza un packing extraperitoneal dado el gran hematoma extraperitoneal con sangrado en sábana. Finalmente, se practica arteriografía donde se ve sangrado arterial activo dependiente del tronco pudendo obturador y de la arteria glútea superior izquierda que se embolizan, con posterior estabilización hemodinámica. Conclusión La arteriografía puede mejorar el control de la hemorragia en los pacientes con sangrado arterial y hemodinámicamente estables, pero el packing tiene prioridad en los pacientes con fracturas de pelvis e inestabilidad hemodinámica.

Aim To report a case of severe pelvic fracture and massive bleeding initially treated with pelvic packing. Clinical case Patient who falls off a high place, hemodynamically unstable due to several open fractures including a pelvic fracture with significant pubic diastasis. It is decided to operate on the patient, proceeding to external fixation of the pelvis and performing, afterwards, an extraperitoneal packing due to the large extraperitoneal hematoma with oozing hemorrhage. Lastly an arteriography is done, where active arterial bleeding is observed localized at the obturator pudendal trunk and the left superior gluteal artery, which are embolized with hemodynamic stabilization. Conclusion Arteriography can improve hemorrhage control in hemodynamically stable patients with arterial bleeding, but packing has the priority on patients with pelvic fractures and hemodynamic instability.

Associação entre capacidade cognitiva e ocorrência de quedas em idosos / Association between cognitive ability and the occurrence of falls in elderly

Resumo Introdução As alterações cognitivas advindas com o envelhecimento humano representam condições importantes, pois afetam diretamente a funcionalidade dos indivíduos e os predispõe a quedas. Objetivo Verificar a associação entre capacidade cognitiva e quedas em uma população de idosos e caracterizar o perfil dessa amostra. Metodologia Estudo transversal oriundo do projeto Inquérito de Saúde no Município de Juiz de Fora, MG. A amostra foi composta por 462 idosos (60 anos ou mais), de ambos os sexos e não institucionalizados. As variáveis analisadas foram resultantes da aplicação do Mini-Exame do Estado Mental (MEEM) e de um questionário semiestruturado contendo questões sociodemográficas e ocorrência de quedas. Foram estimadas as frequências absolutas e relativas e utilizado o teste Qui-quadrado (χ2) para averiguar a associação entre capacidade cognitiva apontada pelo MEEM e quedas (nível de significância = 5%). Resultados A média de idade foi 71,03 (dp = 7,79) e de anos de escolaridade, 3,64 (dp = 3,26), 64,8% eram do sexo feminino e 28,14% apresentaram declínio cognitivo. A frequência de quedas encontrada no grupo com comprometimento cognitivo foi de 42%. Verificou-se associação entre comprometimento cognitivo e queda (p = 0,043). Conclusão Idosos com comprometimento cognitivo apresentaram maior frequência de quedas comparados com a população idosa em geral. Esse achado, aliado à associação entre comprometimento cognitivo e queda, reforça a necessidade de ações preventivas e novas práticas de saúde com ênfase no envelhecimento saudável.

Abstract Introduction Cognitive changes due to human aging process represent important conditions as they directly affect functionality and predispose subjects to falls. Objective To investigate the association between cognitive ability and falls in an elderly population and to characterize their profile. Methodology Cross-sectional study from the Health Survey project at Juiz de Fora, MG. The analyzed variables were calculated by applying the Mini-Mental State Examination (MMSE) and a semi-structured questionnaire containing questions on sociodemographic and falls occurence. We estimated the absolute and relative frequencies and used the chi-square (c2) to investigate the association between cognitive ability indicated by MMSE and falls, the significance level was 5%. Results 462 elderly, mean age 71.03 (SD = 7.79) and 3.64 years of schooling (SD = 3.26), 64.8% female and 28.14% showed cognitive decline; frequency of falls in the group with cognitive impairment was 42% and there was an association between cognitive ability and falls (p = 0.043). Conclusion Elderly patients with cognitive impairment had a higher frequency of falls compared with general elderly population. This finding together with the association between cognitive impairment and falls, reinforce the need for preventive measures and new health practices with an emphasis on healthy aging.

Análise da terapia antimicrobiana empírica em infecção de correntesanguínea por Pseudomonas aeruginosa em um hospital universitário / Analysis of empirical antimicrobial therapy in Pseudomonas aeruginosabloodstream infections in a university hospital

Justificativa e Objetivo: Infecções de corrente sanguínea causadas por Pseudomonas aeruginosa apresentam significantes taxas de morbidade, mortalidade e custos hospitalares. A terapia empírica adequada impacta significativamente na mortalidade, porém, a escolha do antibiótico empírico apropriado contra uma infecção causada por P. aeruginosa é um desafio para os clínicos devido a resistência à diversos antimicrobianos. O presente estudo teve como objetivo analisar a adequação da terapia antimicrobiana empírica e correlacioná-la com a mortalidade em 30 dias. Métodos: Foi realizado um estudo coorte retrospectivo com pacientes que apresentaram infecção de corrente sanguínea por P. aeruginosa no período de Janeiro a Dezembro de 2011. Foram analisadas variáveis epidemiológicas e clínicas destes pacientes correlacionando-as com a mortalidade em 30 dias. Resultados: Vinte e nove pacientes foram incluídos no estudo. A média de idade dos pacientes que tiveram óbito foi de 66 anos e dos sobreviventes foi de 72 anos (p=0,37). Foi detectada uma elevada mortalidade hospitalar (21 de 29 pacientes, 72,4%) entre os pacientes com infecção de corrente sanguínea por P. aeruginosa. Meropenem isoladamente foi o antimicrobiano mais utilizado (34,5%). Houve inadequação na terapia empírica em oito pacientes (27,5%). Em relação às variáveis analisadas, nenhuma teve correlação estatisticamente significante com a mortalidade em 30 dias. Conclusão Nosso estudo encontrou uma elevada taxa de mortalidade entre paciente com bacteremia por P. aeruginosa. Nenhuma variável foi preditora de mortalidade em 30 dias. Estudos com uma maior casuística são necessários para um melhor entendimento das variáveis relacionadas à mortalidade entre estes pacientes

Background and Purpose: Bloodstream infections caused by Pseudomonas aeruginosa presents significant morbidity, mortality and hospital costs. Appropriate empirical antimicrobial therapy significantly impacts on mortality however the choice of adequate antibiotic therapy is a challenge for clinicians due to bacterial resistance. This study aimed to analyze the adequacy of empirical antimicrobial therapy among patients with BSI caused by Pseudomonas aeruginosa and to correlate it with the 30-day mortality. Methods: We performed a retrospective cohort study of patients with bloodstream infections caused by P. aeruginosa from January 1st, 2011 to December 31, 2011. We analyzed demographic and clinical variables of those patients correlating them with the 30-day mortality. Results: Twenty-nine patients were included in the study. The average age of patients who died and survived was 66 years and 72 years, respectively (p=0.37). A high hospital mortality rate (21 of 29 patients, 72.4%) was detected. Meropenem was the most used antibiotic during the study period (34.5%). There was inadequate empirical antimicrobial therapy in eight patients (27.5%). No statistically significant difference was observed with regard to 30-day mortality among the variables analyzed. Conclusion: Our study found a high mortality rate among patients with BSI caused by Pseudomonas aeruginosa. No variable was found to be predictor of 30-day mortality in this cohort of patients. Further studies with larger samples are needed for a better understanding of variables related to mortality among these patients.

Avaliação dos métodos de otoscopia e exame do swab parasitológico no diagnóstico da otocariose canina: uma abordagem bayesiana / Evaluation of methods of the otoscopy and parasitological swab in diagnosis of canine otocariose: a bayes analysis

Ácaros do gênero Otodectes são parasitos encontrados frequentemente no ouvido de cães e gatos, sendo reconhecidos como os principais causadores de otite externa nesses animais. Trezentos e vinte cães, oriundos do município de Cuiabá, Mato Grosso, foram examinados através da otoscopia e do exame do swab parasitológico, com o objetivo de avaliar, através da análise bayesiana para a estimativa da prevalência, sensibilidade e especificidade destes métodos no diagnóstico da infestação causada pelo ácaro utilizando-se de dados a priori informativos e não informativos. Cada animal foi considerado uma unidade experimental. Do total de cães examinados, 142 (44,37%) apresentaram-se positivos para otocariose. Em 100 animais (31,25%) a infestação foi diagnosticada pelos dois métodos, em 31 (9,69%) apenas pelo exame do swab parasitológico, em 11 (3,44%) apenas pela otoscopia e em 178 (55,62%) animais o resultado foi negativo por ambos os métodos. A sensibilidade da otoscopia, quando comparada ao exame do swab parasitológico, foi considerada menor, a especificidade dos testes, porém, não difere estatisticamente. O modelo, a priori informativo, demonstrou ser o mais plausível e reduziu consideravelmente o intervalo de credibilidade das estimativas dos parâmetros. Conclui-se que a análise bayesiana é efetiva na estimativa da prevalência e características dos testes diagnósticos...

Mites of the genus Otodectes are parasites found frequently in the ear of dogs and cats, being recognized as the main causers of external otitis in these animals. Three hundred and twenty dogs, deriving of the city of Cuiabá, Mato Grosso, had been examined through the otoscopy and of the examination of parasitological swab, with the objective to evaluate through the bayes'analysis for the estimate of the prevalence, sensitivity and especificity of these methods in the diagnosis of the infestation caused for the mite, using dates informative and not informative a priori. Each animal was considered an experimental unit. Of the total of examined dogs, 142 (44.37%) had been presented positive for otocariosis. In 100 animals (31.25%) the infestation was diagnosed by the two methods, in 31 (9.69%) only for the examination of parasitological swab, in 11 (3.44%) only for the otoscopy and in 178 (55.62%) animal the result was negative for both the methods. The sensitivity of the otoscopy, when compared with the examination of parasitological swab, was considered lesser, however the especificity of tests they do not differ. The informative model with priori it demonstrated to be most reasonable and considerably reduced the interval of credibility of the estimates of the parameters. It can be concluded that Bayes'analysis is effective in the estimation of prevalence and characteristics of the diagnostic tests...

El papel del cuerpo calloso en el procesamiento visoespacial / The role of the corpus callosum in the visuospatial processing

El procesamiento visoespacial es una función adaptativa del organismo que permite su interacción con los elementos que se encuentran en su medio ambiente. Se considera una función superior, ya que involucra sistemas de reconocimiento y de memoria, entre otros. Hasta el momento se ha descrito la participación de diversas estructuras cerebrales en el procesamiento de información visoespacial, por ejemplo, tradicionalmente se considera una especialización funcional por parte del hemisferio derecho; sin embargo aún existen muchas controversias con respecto a la participación de diversas áreas cerebrales tanto ipsilaterales como contralaterales en estás funciones visoespaciales. En el presente trabajo se discute el papel de la comunicación interhemisferica, y específicamente del papel que juega el cuerpo calloso en el procesamiento visoespacial. Se inicia con una descripción de las vías de procesamiento visoespacial desde el ojo hasta la corteza V1 y las conexiones anatómicas funcionales que se establecen a partir de ésta. Posteriormente se resume la estructura-función del cuerpo calloso y se revisan los trabajos que han reportado relaciones entre éste y la función visoespacial. Por último, se revisan algunas de las patologías neurológicas que cursan con afectación del cuerpo calloso y que se ha reportado en la literatura que afectan a la función visoespacial...

The visuospatial processing is an adaptive function of the organism that allows it to interact with the elements that are in their environment. It is considered a high-order function as it involves recognition systems, memory, among others. So far described the participation of various brain structures in processing visuospatial information, for example, is traditionally considered a functional specialization by the right hemisphere, but there are still many controversies regarding the participation of various brain areas, both ipsilateral and contralateral in the visuospatial functions. In this paper we discuss the role of interhemispheric communication, and specifically the role of the corpus callosum in visuospatial processing. It begins with a description of visuospatial processing pathways from the eye to the cortex V1 and the anatomical-functional connections are established from this. Later summarizes the structure-function of the corpus callosum and reviews the studies that have reported relationships between this and visuospatial function. Finally we review some of the neurological disorders that present with involvement of the corpus callosum and it has been reported in the literature that affect visuospatial function...