Awareness of stroke among patients with chronic kidney disease on hemodialysis: a cross-sectional study

ABSTRACT BACKGROUND: Stroke is a major cause of mortality worldwide. Renal dysfunction is an important risk factor for stroke. Brazilian studies on stroke knowledge are generally population based. Studies stratifying stroke knowledge according to comorbidities are rare. Scientific data are essential to guide the awareness of stroke. OBJECTIVE: To assess stroke knowledge in patients with chronic kidney disease (CKD) on hemodialysis. DESIGN AND SETTING: Cross-sectional analytical study of patients with CKD on hemodialysis in north-eastern Brazil. METHODS: A self-administered questionnaire survey on stroke awareness was administered to patients with CKD on hemodialysis between April and November 2022. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression. RESULTS: A total of 197 patients were included in the analysis. The Brazilian acronym for stroke was used by 53.5% of the participants. Less than 10.0% of the sample showed optimal decision-making ability regarding stroke. Of the participants, 29.9% knew at least one risk factor and one symptom; however, this was considered as having below the minimum capacity because they did not know the emergency service call number. In the analysis adjusted for income and education, females (odds ratio [OR], 0.40%; 95% confidence interval [CI], 0.20-0.82), older patients (OR, 0.24%; 95% CI, 0.09-0.63) and having at most one comorbidity (OR, 0.48%; 95% CI, 0.23-0.98) were factors for lower levels of knowledge or ideal decision-making capacity against stroke. CONCLUSIONS: Patients on hemodialysis, especially women and older people, have little knowledge about stroke.

Urbanization and kidney dysfunction in Brazilian indigenous people: a burden for the youth

SUMMARY OBJECTIVE: The aim of this study was to investigate whether the degree of urbanization influences the prevalence of chronic kidney disease in Brazilian indigenous people. METHODS: This is a cross-sectional study conducted between 2016 and 2017 in northeastern Brazil and includes individuals aged between 30 and 70 years from two specific indigenous groups who volunteered to participate in the study: the Fulni-ô people (lowest degree of urbanization) and the Truká group (greater degree of urbanization). Cultural and geographical parameters were used to characterize and measure the magnitude of urbanization. We excluded individuals with known cardiovascular disease or renal failure who required hemodialysis. Chronic kidney disease was defined as a single measurement of an estimated glomerular filtration rate <60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. RESULTS: A total of 184 indigenous people from the Fulni-ô group and 96 from the Truká group with a median age of 46 years (interquartile range: 15.2) were included. We found a chronic kidney disease rate of 4.3% in the total indigenous population, generally affecting an older population: 41.7% over 60 years old (p<0.001). The Truká people had a chronic kidney disease prevalence of 6.2%, with no differences in kidney dysfunction across age groups. The Fulni-ô participants had a chronic kidney disease prevalence of 3.3%, with a higher proportion of kidney dysfunction in older participants (of the six Fulni-ô indigenous people with chronic kidney disease, five were older). CONCLUSION: Our results suggest that a higher degree of urbanization seems to negatively influence the prevalence of chronic kidney disease in Brazilian indigenous people.

Smartphone and application use in self-management of chronic kidney disease: a cross-sectional feasibility study

ABSTRACT INTRODUCTION: Smartphone and application use can improve communication and monitoring of chronic diseases, including chronic kidney disease, through self-management and increased adherence to treatment. OBJECTIVE: To assess smartphone use in patients with chronic kidney disease on dialysis and their willingness to use mobile applications as a disease self-management strategy. DESIGN AND SETTING: This was a cross-sectional study of chronic kidney disease patients on hemodialysis in the São Francisco Valley in the Northeast Region, Brazil. METHODS: The questionnaire developed by the authors was administered between April and June 2021. Cronbach's alpha coefficient for the construct was 0.69. Associations between the dependent and independent variables were determined using univariate analysis. Multivariate analysis with logistic regression analysis was also performed. RESULTS: A total of 381 patients were included, of whom 64% had a smartphone, although only 3.1% knew of a kidney disease-related application. However, 59.3% believed that using an application could help them manage their disease. Having a smartphone was associated with treatment adherence, higher educational attainment, and higher per capita income. Educational attainment remained an independent factor in multivariate analysis. CONCLUSION: More than 64% of patients had a smartphone, although few knew of applications developed for kidney disease. More than half of the population believed that technology use could benefit chronic kidney disease treatment. Smartphone ownership was more common among the younger population, with higher educational attainment and income, and was associated with greater adherence to hemodialysis sessions.

Tecnologia digital como instrumento de saúde em uma comunidade indígena no Vale de São Francisco / Digital technology as a tool for health promotion in an indigenous community in the Vale de São Francisco

Resumo: Introdução: As comunidades tradicionais são grupos de indivíduos socialmente organizados que partilham comportamentos econômicos, socioambientais e culturais comuns. Entre elas, destacam-se as comunidades indígenas no Brasil, que vêm sofrendo o impacto da urbanização, do crescimento de doenças crônicas e epidemias e do aumento da insegurança alimentar. Relato de experiência: Este estudo teve como objetivo descrever as experiências da equipe de saúde, quanto ao uso de uma ferramenta de gestão de dados na assistência, em uma comunidade indígena no Nordeste brasileiro. Trata-se de um relato de experiência do uso de uma ferramenta digital nas ações assistenciais em uma comunidade tradicional. A equipe de saúde foi dividida em dois grupos: agentes comunitários de saúde e estudantes de Medicina. Discussão: A descrição das experiências e a análise das narrativas resultaram na identificação de 258 citações, que foram classificadas em 12 categorias, relacionadas ao objeto de estudo. Dentre estas, as questões ligadas aos benefícios da ferramenta foram as mais mencionadas (43,41%), em que os subgrupos abordaram diferentes reflexões. A segunda categoria mais citada se referia às limitações da ferramenta (15,11%), sendo a necessidade do sinal de internet o ponto crítico. Ou seja, esta pesquisa mostra vantagens da ferramenta na atenção à saúde, mas também explicita fragilidades inerentes ao seu uso, de modo a trazer questões importantes dessa vivência e estimular práticas semelhantes. Conclusão: Esse relato de experiência, como método científico, traz importantes questões vivenciadas, relacionadas à aplicabilidade prática de uma ferramenta digital em uma comunidade indígena. Apesar de ser inegável que há pontos de fragilidade evidentes, eles não comprometeram o resultado afirmativo da vivência, melhorando a assistência.

Abstract: Introduction: Traditional communities are groups of socially organized individuals with common economic, socio-environmental, and cultural behaviors. Brazil's indigenous communities are a prime example of these groups, suffering the impact of urbanization, the growth of chronic diseases, epidemics, and increased food insecurity. Experience report: To describe the health team's experiences in the use of a data management tool for care in an indigenous community in northeastern Brazil. Methodology: This is an experience report on the use of a digital tool to assist actions in a traditional community. The health team was divided into community health agents and medical students. Discussion: The description of the experiences and analysis of the narratives resulted in identifying 258 citations, classified into 12 categories related to the study scope. Of these, issues related to benefits of the tool were the most commonly mentioned (43.41%), where the subgroups addressed different reflections. The second most cited category referred to the tool's limitations (15.11%), with the need for an internet connection being the critical point. This research, therefore, shows the tool's advantages in health care but also explains weaknesses inherent to its use, raising important issues of this experience and stimulating similar practices. Conclusion: This experience report, as a scientific method, addresses essential experienced issues related to the practical applicability of a digital tool in an indigenous community. Although it is undeniable that there are obvious points of weakness, these did not compromise the positive result of the experience, and care was improved.

Awareness towards stroke among high school students in Brazil: a cross-sectional study

ABSTRACT BACKGROUND: Stroke is one of the main causes of death worldwide. Educational interventions on stroke are potentially effective in reducing the period between the onset of symptoms and the initial emergency medical assistance. OBJECTIVES: To assess high school students' knowledge of stroke. DESIGN AND SETTING: Cross-sectional study conducted in high schools in northeastern Brazil. METHODS: A self-structured questionnaire survey regarding stroke awareness was applied among high school students in northeastern Brazil. Data were collected between 2018 and 2019. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression. RESULTS: A total of 1,788 students were analyzed. Eighty percent (n = 1430) of them did not have the minimum knowledge on how to act in a stroke situation. Only 10% (n = 179) presented the ideal knowledge on how to act. Males presented lower levels of knowledge on risk factors (odds ratio, OR: 0.62%; 95% confidence interval, CI: 0.49-0.79) and signs and symptoms of stroke (OR: 0.63%; 95% CI: 0.52-0.77). Students with ≥ 10 years of schooling (OR: 1.64%; 95% CI: 1.30-2.07) demonstrated greater knowledge of signs and symptoms of stroke. Students aged 18 years (OR: 1.70%; 95% CI: 1.14-2.52) demonstrated greater knowledge than other ages regarding the telephone number of the emergency medical services. CONCLUSIONS: There was a knowledge deficit with regard to recognizing stroke and activating the emergency medical services. The findings apply to the sample investigated and suggest that there is a need for stroke educational interventions, starting in high school.

Modeling of covariates predicting renal allograft failure within six months after transplantation / Modelagem das covariáveis preditivas para falência do enxerto renal até seis meses do transplante

INTRODUCTION: Kidney transplantation (KT) is the renal replacement therapy (RRT) of choice for patients with chronic kidney disease (CKD). However, not every KT is successful and some patients persist on RRT. OBJECTIVE: To model a logistic regression with pre- and post-KT risk covariates capable of predicting secondary allograft dysfunction in need of RRT or reaching stage V of CKD until the first six months post-KT. METHODS: Cohort with KT recipients from Northeastern Brazil. Medical records of KT performed between 2011-2018 were analyzed. KT-recipients with insufficient data or who abandoned follow-up were excluded. The covariables analyzed were: demographic; infectious; pre- and post-KT comorbidities; panel reactive-antibodies; number of HLA mismatches; acute rejection episodes mediated by T-cell (ACR) or antibodies (AAR) six months after KT; and laboratory tests six months after KT. RESULTS: Covariates with higher risk for the analyzed outcomes six months after KT were: elderly KT recipients (OR:1.41; CI95%:1.01-1.99), time between onset of RRT and KT (ΔT-RRT&KT)>10years (OR:3.54; CI95%:1.27-9.87), diabetes mellitus (DM) pre-KT (OR:3.35; CI95%:1.51-7.46), pyelonephritis (OR:2.45; CI95%:1.24-4.84), polyomavirus nephropathy (OR:4.99; CI95%:1.87-13.3), AAS (OR:4.82; CI95%:1.35-17.2), 24h-proteinuria ≥300mg/24h (OR:5.05; CI95%:2.00-12.7) and serum calcium (Ca) <8.5mg/dL (OR:4.72; CI95%:2.00-11.1). The multivariate model presented an accuracy of 88.1% and the mean variance inflation factor is 1.81. CONCLUSION: Elderly-recipients, ΔT-RRT&KT>10 years, pre-KT DM, and post-KT aggressions until six months (pyelonephritis, polyomavirus nephropathy, ABMR, 24h-proteinuria≥300mg/24h, and Ca<8.5mg/dL) are associated with high predictive power for secondary allograft dysfunction in need of RRT or reaching CKD stage V until the first six months post-KT.

INTRODUÇÃO: Transplante renal (TR) é a terapia renal substitutiva (TRS) de escolha para pacientes com doença renal crônica (DRC). Entretanto, nem todo TR é bem-sucedido e alguns pacientes persistem em TRS. OBJETIVO: Modelar uma regressão logística com covariáveis de risco pré e pós-TR preditora da disfunção secundária do aloenxerto com necessidade de TRS ou alcance ao estágio V da DRC até os primeiros seis meses pós-TR. MÉTODOS: Coorte com receptores transplantados realizado em hospital no Nordeste brasileiro. Analisou-se registros médicos dos TR realizados entre 2011-2018. Receptores com dados insuficientes ou que abandonaram seguimento foram excluídos. Foram analisadas covariáveis: demográficas; infecciosas; comorbidades pré e pós-TR; painel de reatividade; incompatibilidades de HLA; episódios de rejeições agudas mediadas por células-T ou por anticorpos; exames laboratoriais seis meses pós-TR. RESULTADOS: Receptores idosos (OR:1,41; IC95%:1,01-1,99), tempo entre início da TRS e TR (∆T-TRS&TR)>10 anos (OR:3,54; IC95%:1,27-9,87), diabetes mellitus (DM) pré-TR (OR:3,35; IC95%:1,51-7,46), pielonefrite (OR:2,45; IC95%:1,24-4,84), nefropatia por poliomavírus (OR:4,99; IC95%:1,87-13,3), RAMA (OR:4,82; IC95%:1,35-17,2), proteinúria de 24h (Pt24h) ≥300mg/24h (OR:5,05; IC95%:2,00-12,7) e cálcio sérico (Ca)<8,5mg/dL (OR:4,72; IC95%:2,00-11,1) foram identificadas como covariáveis de maior risco para os desfechos analisados até seis meses pós-TR. O modelo multivariado apresentou acurácia de 88,1% e fator de inflação da variância médio de 1,81. CONCLUSÃO: Receptores idosos, ∆T-TRS&TR>10anos, DM pré-TR e agressões até seis meses pós-TR (pielonefrite, nefropatia por poliomavírus, RAMA, Pt24h≥300mg/24h e Ca<8,5mg/dL), apresentam alto poder preditivo para disfunção secundária do aloenxerto com necessidade de TRS ou alcance ao estágio V da DRC até os primeiros seis meses pós-TR.

Ultrasound-guided percutaneous renal biopsy at a university hospital: retrospective analysis of success and complication rates / Biópsia renal percutânea guiada por ultrassonografia: análise retrospectiva de sucesso e complicações em um hospital universitário

Abstract Objective: To evaluate the success and complication rates of ultrasound-guided renal biopsy at a tertiary care hospital. Materials and Methods: This was a retrospective analysis of 97 ultrasound-guided renal biopsies, all performed by the same radiologist, between 1 March, 2017 and 31 October, 2019. Results: Of the 97 biopsies evaluated, 87 had a definitive pathological diagnosis. In five cases (5.4%), the biopsy results were inconclusive and a second procedure was required. In seven procedures (7.6%), there were complications, all of which were properly resolved. Conclusion: Ultrasound-guided renal biopsy has proven to be a safe, effective method for the diagnosis of nephropathies, with high success rates.

Resumo Objetivo: Avaliar taxas de sucesso e de complicações de biópsias renais guiadas por ultrassonografia em um hospital terciário. Materiais e Métodos: Análise retrospectiva de 97 biópsias renais realizadas entre 1º de março de 2017 e 31 de outubro de 2019, guiadas por ultrassonografia e executadas por um único médico radiologista. Resultados: Oitenta e sete biópsias apresentaram diagnóstico anatomopatológico definitivo. Cinco biópsias foram inconclusivas (5,4%) e precisaram de um segundo procedimento. Houve complicações em sete procedimentos (7,6%), todas devidamente solucionadas. Conclusão: A biópsia renal guiada por ultrassonografia demonstrou ser um método efetivo e seguro para o diagnóstico de nefropatias, com elevada taxa de sucesso em sua execução.

Dados alarmantes sobre a notificação de sífilis congênita em uma capital do Norte brasileiro: um estudo transversal / Alarming data on the notification of congenital syphilis in a capital of the North of Brazil: a cross-sectional study

RESUMO: Modelo do estudo: Estudo de prevalência. Objetivo do estudo: Descrever o perfil clínico e epidemiológico dos portadores de Sífilis Congênita entre Janeiro de 2010 a Junho de 2016 em uma capital do Norte brasileiro. Metodologia: Foi realizado um levantamento das fichas de notificação para infecção por sífilis congênita da Vigilância Epidemiológica em Rio Branco-Acre no período de Janeiro 2010 a Junho de 2016. Os dados foram analisados por meio do Statistical Package for Social Sciences (SPSS). Resultados: Foram notificados 189 casos de sífilis congênita precoce. Apenas 36,51% (n=69) receberam diagnóstico de sífilis gestacional antes do parto. Os casos evoluíram com 74,6% de nascidos vivos, 15,3% de natimortos, 6,3% de abortos e 2,1% de óbitos por sífilis congênita. A relação entre o Venereal Disease Research Laboratory (VDRL) materno e o desfecho dos casos sugere que filhos provenientes de mães com títulos ≥1:16 representam 82,2% das evoluções deletérias associadas (p=0,045). Conclusão: A sífilis na gestação é uma patologia ainda subdiagnosticada durante a gravidez e, nesse estudo, foi mais frequente em filhos de mães no auge da menacme, de baixa escolaridade e moradoras da zona urbana. Apesar das medidas preventivas já implantadas, a sífilis congênita continua sendo um problema de saúde pública nesta capital do Norte brasileiro e deve continuar como alvo de estudos que gerem novas estratégias de prevenção. (AU)

ABSTRACT: Study model: A Prevalence study. Objective: Describing the clinical and epidemiological profile of patients with Congenital Syphilis between January 2010 and June 2016 in a capital city in the North of Brazil. Methodology: A survey was carried based on the reports of infection for congenital syphilis of the Epidemiological Surveillance in Rio Branco-Acre from January 2010 to June 2016. The data were analyzed through the SPSS Program. Results: 189 cases of early congenital syphilis were reported. Only 36.51% (n = 69) were diagnosed with gestational syphilis before delivery. The cases evolved with 74.6% of live births, 15.3% of stillborn infants, 6.3% of abortions, and 2.1% of congenital syphilis deaths. The relationship between the maternal VDRL and the outcome of the cases suggests that children from mothers with titles ≥1:16 represent 82.2% of the associated deleterious evolutions (p = 0.045). Conclusion: Congenital syphilis is a pathology still underdiagnosed during pregnancy and, in this study, was more frequent in children of mothers at the height of menacme, low schooling, and urban dwellers. Despite preventive measures already in place, congenital syphilis continues to be a public health problem in this capital of the Brazilian North and should continue to be the target of studies that generate new prevention strategies. (AU)

Acidente vascular encefálico isquêmico devido à síndrome do anticorpo antifosfolípide em paciente lúpica - um relato de caso / schemic stroke due to antiphospholipid syndrome in a lupus patient - a case report

RESUMO: Lúpus eritematoso sistêmico é uma doença de origem autoimune que apresenta um amplo espectro de manifestações clínicas causadas pelo estado inflamatório crônico. A associação com a síndrome do anticorpo antifosfolípide ocorre em aproximadamente 36% dos pacientes lúpicos. Nesses pacientes, a doença de base e o uso crônico de corticosteroides contribuem para aterosclerose acelerada, uma complicação que agrega risco cardiovascular. Relatamos um caso de acidente vascular encefálico em paciente de 25 anos portadora de lúpus eritematoso sistêmico e síndrome do anticorpo antifosfolípide. (AU)

ABSTRACT: Systemic lupus erythematosus is an autoimmune disease that presents a wide spectrum of clinical manifestations caused by the chronic inflammatory state. Association with antiphospholipid antibody syndrome occurs in approximately 36% of lupus patients. In these patients, the underlying disease and the chronic use of corticosteroids contribute to accelerated atherosclerosis, a complication that adds increased cardiovascular risk. We report a case of stroke in a 25-year-old patient with systemic lupus erythematosus and antiphospholipid antibody syndrome. (AU)

Hematúria levando ao diagnóstico de duas condições singulares na prática clínica - síndrome de quebra-nozes e traço falcêmico: um relato de caso / Hematuria leading to the diagnosis of two singular conditions in clinical practice - renal nutcracker syndrome and sickle cell trait: a case report

RESUMO: A hematúria é definida como o achado de mais que duas hemácias por campo de aumento na análise microscópica de urina coletada por jato médio. Na sua forma macroscópica, caracteriza-se por sua coloração típica (avermelhada ou marrom), acompanhada pela presença de mais de 106 hemácias/ml na sedimentoscopia. É uma condição que necessita de investigação da causa e apresenta-se com prevalência incerta e definição às vezes imprecisa, mas com vasto diagnóstico diferencial. Dentre as possíveis causas, encontramos a presença do traço falciforme, aparentemente subdiagnosticado, e a síndrome de quebra-nozes, possibilidade mais rara. No caso relatado a seguir, foram diagnosticadas simultaneamente as duas causas acima citadas, descobertas após a investigação do primeiro episódio de hematúria macroscópica em uma mulher jovem previamente hígida. Com o objetivo de chamar a atenção para a concomitância de duas possíveis e incomuns causas de hematúria numa mesma paciente, relatamos o caso a seguir. (AU)

ABSTRACT: Hematuria is defined as the finding more than two red blood cells per field of analysis in the microscopic analysis of the urine collected by the medium jet. In its macroscopic form, it is characterized by its typical coloration (reddish or brown), accompanied by the presence of more than 106 red cells/ml in urinary sediment. It is a condition that needs investigation and it presents itself sometimes with imprecise definition, but with vast differential diagnosis. Among the possible etiologies, there is the presence of the sickle cell trait, apparently underdiagnosed, and the renal nutcracker syndrome, a rarer possibility. In the case reported below, these two findings were diagnosed simultaneously, following an investigation of the first episode of macroscopic hematuria in a young and previously healthy woman. In order to draw attention to the simultaneous presence of two unusual causes of hematuria in the same patient, we report the following case. (AU)

Pneumonia risk factors in stroke patients / Fatores de risco para pneumonia em pacientes com acidente vascular encefálico

ABSTRACT Purpose: to assess the demographic and clinical characteristics associated with the development of pneumonia in post-stroke patients hospitalized in a tertiary hospital, located in the Vale do São Francisco, that covers the states of Pernambuco and Bahia, Brazil. Methods: a unicentric, observational, analytical, cross-sectional study, based on the medical records of patients diagnosed with stroke and included in the Stroke Registry (RAVESS study). The statistical analysis was made with the chi-square test, Fisher's exact test, and the analysis of variance, with the Bonferroni's post-test, and P≤0.05. Results: data from 69 patients presented with acute stroke were collected, aged 63.2±16.8 years; 37 (53.6%) were females; the prevalence of pneumonia during hospital stay was estimated at 31.9% (95% confidence interval: 21.2-44.2%). In the univariate analysis of predictors for post-stroke pneumonia, the following were identified: older age (72.6±17.9 vs. 58.8±14.5; P = 0.001), lower response signal to the Glasgow Coma Scale at admission (11.3±1.8 vs. 13.3±2.1; P = 0.001), and higher frequency of dysarthria at admission (61.9% vs. 27.9%; P = 0.009). Conclusion: pneumonia was a prevalent complication in post-stroke patients at a Brazilian tertiary hospital. It was related to the patient's older age and the severity of the cerebral event.

RESUMO Objetivo: avaliar as características demográficas e clínicas associadas ao desenvolvimento de pneumonia em pacientes após acidente vascular encefálico internados em um hospital terciário do Vale do São Francisco que atende os estados de Pernambuco e Bahia, Brasil. Métodos: trata-se de estudo unicêntrico, observacional, analítico e transversal realizado a partir dos prontuários de pacientes com diagnóstico de acidente vascular encefálico incluídos no Registro de Acidente Vascular Encefálico (Estudo RAVESS). A análise estatística foi composta pelos testes qui-quadrado, exato de Fisher e a análise de variância com pós-teste de Bonferroni com nível de P≤0,05. Resultados: foram coletados dados de 69 pacientes com AVE agudo com média±desvio padrão de idade de 63,2±16,8 anos, sendo 37 (53,6%) do sexo feminino, com prevalência de pneumonia durante o internamento estimada em 31,9% (Intervalo de Confiança de 95%: 21,2-44,2%). Na análise univariada para preditores de pneumonia após acidente vascular encefálico foram identificados: idade mais avançada (72,6±17,9 vs. 58,8±14,5; P=0,001), menor sinal de resposta a escala de coma de Glasgow durante a admissão (11,3±1,8 vs. 13,3±2,1; P=0,001) e maior frequência de disartria na admissão (61,9% vs. 27,9%; P=0,009). Conclusão: a pneumonia foi uma complicação prevalente em pacientes após acidente vascular encefálico de um hospital terciário brasileiro, tendo sido relacionada com idade avançada do paciente e a severidade do evento encefálico.

Fever of unknown origin in special groups

SUMMARY Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.

RESUMO Febre de origem indeterminada (FOI) é uma entidade desafiadora com presença marcante nos hospitais de todo o mundo. É definida como temperatura ≥37,8 ° C em várias ocasiões, com duração ≥3 semanas, na ausência de diagnóstico após três dias de investigação hospitalar ou três consultas ambulatoriais. As principais etiologias são de ordem infecciosa, neoplásica e doenças inflamatórias não infecciosas. O diagnóstico é baseado na história clínica e no exame físico minuciosos desses pacientes, com a finalidade de direcionar os exames complementares específicos a serem realizados em cada caso. A abordagem diagnóstica inicial do paciente com FOI deve incluir exames complementares inespecíficos. A terapia empírica não é recomendada (com poucas exceções) em pacientes com febre prolongada, uma vez que ela pode camuflar e retardar o diagnóstico e a conduta para tratar a etiologia específica. O prognóstico engloba uma mortalidade de 12-35%, variando de acordo com a etiologia de base.

Fever of unknown origin - a literature review

SUMMARY Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world and can be associated with a myriad of differential diagnoses. It is defined as axillary temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or three outpatient visits. The main etiologies are: infectious, neoplastic, and rheumatic. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12% - 35%, varying according to the underlying etiology. In this sense, the objective of this study is to review the main topics about fever of undetermined origin, bringing historical and scientific aspects, national and international.

RESUMO Febre de origem indeterminada (FOI) é uma entidade desafiadora com presença marcante nos hospitais de todo o mundo, à qual uma miríade de diagnósticos diferenciais podem estar associados. É definida como temperatura axilar ≥37,8 0 C em várias ocasiões, com duração ≥ três semanas, na ausência de diagnóstico após três dias de investigação hospitalar ou três consultas ambulatoriais. As principais etiologias são de ordem infecciosa, neoplásica e reumatológica. O diagnóstico é baseado na história clínica e no exame físico minuciosos desses pacientes, com a finalidade de direcionar os exames complementares específicos a serem realizados em cada caso. A terapia empírica não é recomendada (com poucas exceções) em pacientes com febre prolongada, uma vez que ela pode camuflar e retardar o diagnóstico e a conduta para tratar a etiologia específica. O prognóstico engloba uma mortalidade de 12-35%, variando de acordo com a etiologia de base. O objetivo deste estudo é revisar os principais tópicos acerca da febre de origem indeterminada, trazendo aspectos históricos e científicos, nacionais e internacionais.

Validade e Confiabilidade do Maastricht Clinical Teaching Questionnaire para Língua Portuguesa / Validity and Reliability of the Portuguese-Language Version of the Maastricht Clinical Teaching Questionnaire

RESUMO Introdução Num cenário de aprendizagem clínica, preceptores devem se comportar como mediadores entre os saberes que o estudante já tem e os que necessita adquirir, integrando a teoria e a prática no contexto da assistência ao paciente. Para isso, é necessário capacitar preceptores e desenvolver instrumentos capazes de aferir o desempenho de tais docentes. Em 2008, foi desenvolvido na Holanda o Maastricht Clinical Teaching Questionnaire (MCTQ), destinado à avaliação de preceptores pelos estudantes com o objetivo de proporcionar feedback a esses sobre suas habilidades de ensino em relação à supervisão realizada durante o estágio. A validação de um instrumento para outro idioma é de grande valia, uma vez que permite avaliar e investigar determinado fenômeno em diferentes países. Objetivo Realizar a validação do MCTQ para a língua portuguesa. Metodologia Trata-se de um estudo de validação de instrumento de pesquisa realizado em quatro hospitais do Nordeste brasileiro com a aplicação da versão adaptada para a língua portuguesa do MCTQ em uma amostra não probabilística composta por 246 estudantes de Medicina do quinto e sexto anos de quatro diferentes instituições de ensino do Estado de Pernambuco. Para avaliar a validade do construto, foi utilizado o índice Kappa. A confiabilidade foi medida por meio do Coeficiente Alfa de Cronbach padronizado. O nível de reprodutibilidade do MCTQ foi calculado pelo teste t de Student para medidas repetidas, comparando valores do teste e do reteste. A pesquisa foi aprovada no Comitê de Ética e Pesquisa da Faculdade Pernambucana de Saúde. Resultados O índice Kappa variou entre 0,527 e 0,710, e o Coeficiente Alfa de Cronbach de 0,77 a 0,954, comprovando bom grau de concordância e de consistência interna do instrumento, respectivamente. Em relação à reprodutibilidade, todos os valores de coeficiente de correlação encontrados foram significativos e de boa magnitude (≥ 0,72). Conclusão A versão em português do MCTQ mostrou-se confiável e válida para uso na língua portuguesa e pode ser útil como instrumento a promover melhorias pedagógicas nos cursos de graduação e pós-graduação, especialmente aqueles relacionados às ciências da saúde.

ABSTRACT Introduction In clinical learning scenarios, preceptors should mediate between the knowledge students already possess and the knowledge they need to acquire, integrating theory and practice into the patient care context. In order to make this possible, we must train preceptors and develop instruments for evaluating their performance as educators. In 2008, the Maastricht Clinical Teaching Questionnaire (MCTQ) was developed in the Netherlands with the purpose of enabling students to evaluate their preceptors, in order to provide preceptors with feedback regarding their teaching skills and the supervision provided by them during the internship period. Validating an instrument that has been translated is important and valuable, because it enables certain phenomena to be evaluated and investigated in different countries. Objective To validate the Portuguese-language version of the MCTQ. Methodology This is an instrument validation study, with research carried out in four different hospitals in the Northeast Region of Brazil. It applied the Portuguese-language version of the MCTQ to a non-probability sample composed of 246 fifth- and sixth-year students of Medicine from four different institutions in the state of Pernambuco. Kappa values were used to evaluate the validity of the construct, and reliability was measured using standardized Cronbach's alpha coefficient. The reproducibility level of the MCTQ was calculated using the Student's t-test for repeated measures, comparing test and re-test values. This study was approved by the Human Research Ethics Committee of the Faculdade Pernambucana de Saúde. Results The kappa index was between 0.527 and 0.71, and Cronbach's alpha coefficient was between 0.77 and 0.954, demonstrating that the instrument has good levels of agreement and internal consistency, respectively. With respect to reproducibility, all coefficient correlation values found were significant and showed good magnitude (≥0.72). Conclusion The Portuguese-language version of the MCTQ proved to be reliable and valid for use in Portuguese-language settings, and can be useful as an instrument for promoting pedagogical improvements in undergraduate and graduate courses, especially in health sciences.

Granulomatose com poliangiite: atualização do diagnóstico ao tratamento / Granulomatosis with polyangiitis: updates from diagnosis to treatment

Introdução: Granulomatose com poliangiite (GPA) é uma vasculite granulomatosa necrosante pauci-imune que afeta predominantemente pequenos vasos. É uma doença rara, de etiologia multifatorial, e constitui importante diagnóstico diferencial das síndromes pulmão-rim. Objetivo: atualizar os principais tópicos acerca da granulomatose com poliangiite, além de trazer perspectivas futuras e avanços no manejo clínico dessa vasculite. Metodologia: revisão de literatura realizada em 2018 a partir das publicações dos últimos 5 anos nas base de dados do PubMed Central® e da SciELO®. Resultados: 29 referências bibliográficas selecionadas, das quais: 16 revisões de leteratura; 2 revisões sistemáticas; 1 estudo transversal; 2 estudos caso-controle; 6 coortes; 2 consensos atualizados (1 brasileiro de 2017 e 1 internacional de 2017). Conclusão: a granulomatose com poliangiite é uma entidade de elevada morbimortalidade, e teve seu algoritmo de tratamento recentemente atualizado, conforme abordado nesta revisão. Novos estudos ainda em estão em andamento para avaliar a eficácia e segurança de novas abordagens terapêuticas.

Introduction: Granulomatosis with polyangiitis (GPA) is a pauci-immune necrotizing granulomatous vasculitis that affects predominantly small vessels. It is a rare disease with a multifactorial etiology and an important differential diagnosis of Pulmonary-renal syndromes. Objective: to update the main topics about granulomatosis with polyangiitis, in addition to bringing future perspectives and advances in the clinical management of this vasculitis. Methodology: literature review conducted in 2018 from the publications of the last 5 years in PubMed Central® and SciELO® databases. Results: 29 selected bibliographical references, of which: 16 literature reviews; 2 systematic reviews; 1 cross-sectional study; 2 case-control studies; 6 cohorts; 2 updated consensuses (1 Brazilian, 2017 and 1 international, 2017). Conclusion: granulomatosis with polyangiitis is an entity with high morbidity and mortality, and its treatment algorithm has recently been updated, as discussed in this review. Further studies are underway to evaluate the efficacy and safety of novel therapeutic approaches.

Epidemiologia de traumatismo craniencefálico em um hospital / Epidemiology of cranioencephalic trauma in a hospital

OBJETIVO: Analisar o perfil epidemiológico de vítimas de traumatismo craniencefálico. MÉTODOS: Estratificação de uma amostra de 4.466 pacientes com traumatismo craniencefálico de um hospital de Uberlândia (MG), entre 2010 e 2015, acordo com a ocorrência anual. Os pacientes foram divididos em grupos de idade e sexo, utilizando o Excel. RESULTADOS: Os homens foram as principais vítimas dos traumatismos craniencefálicos em todas as faixas etárias e em todos os anos analisados neste estudo, principalmente em idades inferiores a 40 anos. CONCLUSÃO: O sexo masculino e a idade até 40 anos tendem a ser fatores risco para o traumatismo craniencefálico. Os resultados desta análise podem justificar medidas de prevenção direcionadas para este grupo de risco, no sentido de reduzir a morbimortalidade.(AU)

OBJECTIVE: To analyze the epidemiological profile of cranioencephalic trauma (CET) patients. METHODS: Stratification of a sample of 4,466 patients with cranioencephalic trauma of a hospital in the city of Uberlândia, state of Minas Gerais, between 2010 and 2015, according to an yearly occurrence. The patients were divided in in age and gender groups, with the use of Excel. RESULTS: Men were the main victims of cranioencephalic trauma in all age groups and in all the years analyzed in this study, especially in the ages below 40 years. CONCLUSION: Males and ages up to 40 years tend to be at risk for cranioencephalic trauma. The results of this analysis may warrant prevention measures directed to this risk group to reduce morbidity and mortality.(AU)