Durometry as an alternative tool to the modified Rodnans skin score in the assessment of diffuse systemic sclerosis patients: a cross-sectional study

Abstract Background The reproducibility and reliability of the modified Rodnan's Skin Score (mRSS) are debated due to investigator-related subjectivity. Here, we evaluate if durometry correlates with mRSS in patients with diffuse systemic sclerosis (SSc). Methods This cross-sectional study was conducted from December 2018 to June 2019, including 58 diffuse SSc patients. Two certified researchers, blind to each other's scores, performed the mRSS, followed by durometry at 17 predefined skin sites. For durometry and mRSS, individual scores per skin site were registered. Durometry and mRSS results measured by each researcher, as well as scores from different researchers, were compared. Skin thickness measurements from forearm skin biopsies were available in a subset of the patients, for comparisons. Statistical analyses included Cohen's Kappa Coefficient, Intraclass Correlation Coefficient, Kendall's Coefficient and Spearman's test. Results Mean (standard deviation, SD) patient age was 44.8 (12.9) years, and 88% were female. Inter-rater agreement varied from 0.88 to 0.99 (Intraclass correlation coefficient) for durometry, and 0.54 to 0.79 (Cohen's Kappa coefficient) for mRSS, according to the specific evaluated sites. When data were compared with skin thickness assessed in forearm biopsies, durometry correlated better with skin thickness than mRSS. Conclusion Durometry may be considered as an alternative method to quantify skin involvement in patients with diffuse SSc. The strong inter-rater agreement suggests that the method may be useful for the assessment of patients by multiple researchers, as in clinical trials.(AU)

Polipose gástrica / Gastric polyposis

Paciente do sexo feminino, com 54 anos, branca, com obesidade grau I, portadora de dispepsia crônica, dependente do uso de Omeprazol para o satisfatório controle do quadro dispéptico. Submetida à endoscopia digestiva alta que evidenciou um pregueado mucoso bem distribuído, incisura gástrica integra, hiperemia leve difusa da mucosa gástrica, com vários pólipos sésseis medindo aproximadamente entre 0,5 e 2,5 cm, difusos em corpo e fundo gástrico, com o piloro pérvio e duodeno sem alterações. O exame anatomopatológico de uma amostra dos pólipos evidenciou a presença de pólipo gástrico de glândulas fúndicas, com pesquisa do Helicobacter pylori negativo.

Complicações cardíacas em cirurgia vascular / Cardiac complications in vascular surgery

CONTEXTO: Aproximadamente 60% dos pacientes portadores de doença arterial oclusiva crônica periférica têm doença coronariana grave, sendo que a principal causa de morte no pós-operatório de cirurgia vascular de grande porte é o infarto agudo do miocárdio. OBJETIVOS: Determinar a prevalência da doença coronariana em pacientes submetidos a cirurgia vascular eletiva de grande porte e sua relação com as complicações cardiológicas pós-operatórias. MÉTODOS: Foram analisados 200 pacientes submetidos a cirurgia vascular arterial eletiva: doença obstrutiva carotídea, aortoilíaca e femoropoplítea distal e doença aneurismática de aorta abdominal e de artérias ilíacas. Os pacientes constituíram três grupos: grupo I, sem doença coronariana; grupo II, com doença coronariana assintomática; e grupo III, com doença coronariana sintomática. As complicações cardiológicas consideradas foram infarto agudo do miocárdio fatal e não fatal, insuficiência cardíaca congestiva, choque cardiogênico, fibrilação atrial aguda e outras arritmias. RESULTADOS: Complicações cardíacas ocorreram em 11 pacientes (5,5%): três infartos agudos do miocárdio não fatais (1,5%) sempre em pacientes do grupo III. A complicação cardíaca mais frequente foi arritmia (exceto fibrilação atrial) ocorrida em cinco (2,5%) pacientes, sendo três do grupo II. A mortalidade precoce foi de nove pacientes (4,5%). Apenas uma morte foi decorrente de problema cardíaco: choque cardiogênico em paciente do grupo III. CONCLUSÕES: A doença coronariana não foi preditora de óbito nos pacientes submetidos a cirurgia vascular periférica de grande porte. A sobrevida dos pacientes com ou sem doença coronariana não mostrou diferenças estatísticas.

BACKGROUND: Approximately 60% of patients with chronic occlusive peripheral arterial disease have severe coronary disease and the principal cause of death during the postoperative period after major vascular surgery is acute myocardial infarction. OBJECTIVES: To determine the prevalence of coronary disease among patients scheduled for elective major vascular surgery and its relationship with postoperative cardiological complications. METHODS: A total of 200 patients who underwent elective vascular arterial surgery for obstructive carotid disease, aortoiliac and distal femoropopliteal disease and aneurysmal disease of the abdominal aorta and iliac arteries were analyzed. These patients were allocated to three groups: group I, free from coronary disease; group II, asymptomatic coronary disease; and group III, symptomatic coronary disease. The cardiological complications analyzed were fatal and nonfatal acute myocardial infarction, congestive heart failure, cardiogenic shock, acute atrial fibrillation and other arrhythmias. RESULTS: Cardiac complications occurred in 11 patients (5.5%): three nonfatal acute myocardial infarctions (1.5%), all in patients from group III. The most common cardiac complication was arrhythmia (excluding atrial fibrillation) in five (2.5%) patients, three from group II. Early mortality was nine patients (4.5%). Just one death was caused by a cardiac problem: cardiogenic shock in a patient from group III. CONCLUSIONS: Coronary disease was not predictive of death among patients who underwent major peripheral vascular surgery. There were no statistical differences in survival between patients with or without coronary disease.

PEGYLATED INTERFERON AND RIBAVIRIN FOR TREATMENT OF RECURRENT HEPATITIS C AFTER LIVER TRANSPLANTATION: a single-liver transplant center experience in Brazil / Interferon peguilado e ribavirina no tratamento da recorrência da hepatite C após transplante hepático: experiência de um centro de transplante hepático no Brasil

BackgroundTreatment of hepatitis C virus infection in post-transplantation patients is a challenge due to poor tolerance and low success rates.ObjectiveTo determine the response rate to pegylated interferon and ribavirin in post-liver transplant patients with hepatitis C recurrence.MethodsBetween 18 May 2002 and 18 December 2011, 601 patients underwent liver transplantation at our service (Hospital Universitário Walter Cantídio, University of Ceará), 176 (29.2%) of whom were hepatitis C virus positive. Forty received antiviral therapy and were included in this cohort study. Twenty-eight (70%) completed the treatment protocol, which consisted of pegylated interferon and ribavirin for 48 weeks.ResultsThe sustained virological response rate was 55% according to intention-to-treat analysis. Recipient age and exposure to antiviral drugs prior to liver transplantation were associated with sustained virological response in the multivariate analysis. Patients were followed for 57 months on the average. Survival at 1 and 5 years was 100% in responders, versus 100% and 78%, respectively, in non-responders.ConclusionSustained virological response rates were satisfactory in our series of liver transplantation patients, and decreased with increasing recipient age. Non-exposure to antiviral drugs prior to liver transplantation was positively associated with sustained virological response. The overall survival of responders and non-responders was similar.

ContextoO tratamento da infecção do vírus da hepatite C pós-transplante é um desafio devido à baixa tolerância dos pacientes e às baixas taxas de resposta.ObjetivoDeterminar a taxa de resposta ao interferon peguilado e ribavirina no tratamento da recorrência da hepatite C após transplante de fígado.MétodosEntre 18 de maio de 2002 e 18 de dezembro de 2011, 601 pacientes realizaram transplante hepático no Hospital Universitário Walter Cantídio, 176 (29,2%) desses eram infectados pelo vírus da hepatite C. Quarenta pacientes receberam terapia antiviral e foram incluídos nesse estudo. Vinte e sete (70%) completaram o protocolo de tratamento, que consistia de interferon peguilado e ribavirina por 48 semanas.ResultadosA taxa de resposta virológica sustentada foi de 55% de acordo com a análise por intenção de tratar. A idade dos receptores e a exposição prévia ao transplante de antivirais foram fatores associados com a resposta virológica sustentada na análise multivariada. Pacientes foram acompanhados por 57 meses em média. A sobrevida em 1 e 5 anos foi de 100% em respondedores, enquanto que em não respondedores foi de 100% e 78% respectivamente.ConclusãoA resposta virológica sustentada foi satisfatória na série de pacientes transplantados e diminuiu com o aumento da idade. A não exposição prévia ao transplante a drogas antivirais teve impacto positivo na chance de resposta virológica sustentada. A sobrevida global foi similar em respondedores e não respondedores.

Descripción de los hallazgos en el perfil lipídico y proteico de pacientes dependientes a cocaína, en abstinencia reciente / Serum lipid levels in a group of cocaine dependent subjects in recent abstinence

Background: Chronic cocaine users develop multiple potentially lethal ischemic vascular complications associated with accelerated atherosclerosis. Aim: To assess biochemical and lipid profiles among cocaine dependent subjects in recent abstinence. Material and Methods: A blood sample to measure blood count, biochemical and lipid profiles was obtained from 78 patients aged 19 to 53 years (78% males) who complied with DSM-IV criteria for cocaine dependency. Laboratory results were compared with a group of normal subjects. Results: All cases had positive urinary cocaine, with a mean consumption lapse of 7.6 years. The frequency of smoking was higher in cases. Dependent males had higher body mass index than controls. Compared to controls, dependent females had significantly higher triglyceride (TG) levels and lower HDL cholesterol. Therefore the relation total/HDL cholesterol was higher (p = 0.0365). Dependent males had higher TG levels than their normal counterparts. Dependent subjects consuming cocaine base-paste had higher TG levels. Total proteins, albumin, urea and blood urea nitrogen were lower in dependent subjects. Among males, serum creatinine was lower and blood urea was positively correlated with the daily amount of cocaine use (p = 0.03). After a month of strict abstinence, lipid profile was repeated in 27 patients and remained unchanged. Conclusions: Chronic cocaine use was associated with higher TG in both genders and lower HDL cholesterol in women when compared with a group of healthy counterparts.

Leprosy reactions: coinfections as a possible risk factor

OBJECTIVE: This study aimed to determine the frequency of coinfections in leprosy patients and whether there is a relationship between the presence of coinfections and the development of leprosy reactional episodes. METHOD: A cross-sectional study based on an analysis of the medical records of the patients who were treated at the Leprosy Clinics of the Ribeirão Preto Medical School, University of São Paulo, was conducted from 2000 to 2010. Information was recorded regarding the age, sex, clinical status, WHO classification, treatment, presence of reactions and coinfections. Focal and systemic infections were diagnosed based on the history, physical examination, and laboratory tests. Multinomial logistic regression was used to evaluate the associations between the leprosy reactions and the patients' gender, age, WHO classification and coinfections. RESULTS: Two hundred twenty-five patients were studied. Most of these patients were males (155/225 = 68.8%) of an average age of 49.31±15.92 years, and the most prevalent clinical manifestation was the multibacillary (MB) form (n = 146), followed by the paucibacillary (PB) form (n = 79). Erythema nodosum leprosum (ENL) was more prevalent (78/122 = 63.9%) than the reversal reaction (RR) (44/122 = 36.1%), especially in the MB patients (OR 5.07; CI 2.86-8.99; p<0.0001) who exhibited coinfections (OR 2.26; CI 1.56-3.27; p,<0.0001). Eighty-eight (88/225 = 39.1%) patients exhibited coinfections. Oral coinfections were the most prevalent (40/88 = 45.5%), followed by urinary tract infections (17/88 = 19.3%), sinusopathy (6/88 = 6.8%), hepatitis C (6/88 = 6.8%), and hepatitis B (6/88 = 6.8%). CONCLUSIONS: Coinfections may be involved in the development and maintenance of leprosy reactions.

Avaliação da capacidade funcional e do risco de hospitalização de idosos / Evaluation of functional capacity and risk of hospital admission of elderly

Objetivo: avaliar a capacidade funcional e o risco de hospitalização estimado para idosos em Samambaia. Método: utilizou-se um questionário validado, Avaliação Funcional Breve, para avaliação do risco de hospitalização e um questionário para avaliação da capacidade funcional de 101 idosos. Resultado: houve predominância do sexo feminino (64,4%) e idade entre 65-74 anos (68,3%). Observou-se que 75,2% dos entrevistados não foram internados no último ano e maior incidência de internação e consultas no sexo feminino. Com relação ao risco, 21% apresentaram risco baixo, 28% médio, 22% médio-alto e 30% alto. A prevalência de diabetes foi 30,7% e doenças cardiovasculares 18,8%. O déficit visual foi o mais frequente (73%). Conclusão: apopulação estudada apresentou grande proporção de idosos com alto risco de hospitalização, por isso, um atendimento diferenciado deve ser adotado para este grupo. Entretanto, observou-se a preservação da capacidade funcional da maioria dos idosos entrevistados.

Purpose: to evaluate functional capacity and risk of hospital admission of elderly in Samambaia – Federal District.Methods: we used a validated questionnaire to identify risk of hospitaladmission and a questionnaire to evaluate functional capacity of 101elders. Results: patients were predominantly female (64.4%), aged 65-74 years (68.3%). It was observed that 75.2% of respondents had no hospital admission in past year. Higher incidence of hospital admission and doctor visit was presented in females. In risk assessment, it was shown that 21% had low risk, 28% medium, 22% medium-high and 30% high. Prevalence of diabetes and cardiovascular diseases was, respectively, 30.7% and 18.8%. Among the sensory deficits, most common was visual impairment (73%).Conclusions: our study showed a high proportion of elders at high risk of hospital admission, therefore, a differentiated service should be adopted for this group. However, we observed preservation of functional capacity of majority of them.

Adesão ao tratamento com anti-retrovirais entre pacientes com AIDS / Compliance with antiretroviral treatment among patients with AIDS: a descriptive study

Objective: To assess compliance with antiretroviral therapy (ARVT) among HIV/aids patients and to propose strategies that would facilitate it. Methods: A study of the descriptive and exploratory type was conducted at a specialized outpatient clinic in Fortaleza-CE between May and June 2004, with Thirty-eight patients with aids taking ARVT of a structured interview. Compliance was calculated on the basis of the sum of the total quantities of ARVT pills taken during the three days preceding the interview. A patient who used at least 95% of the amount of ARVT prescribed was considered to be compliant. Results: There was a predominance of males aged 30 years or more, with elementary schooling, married, Catholic, unemployed and with a family income of up to one minimum wage. The rate of compliance was 71%. Correlation of the different variables showed that non-compliance was related to male sex, age range between 20 and 29 years, low educational level, being single, being unemployed, and having low financial resources. Conclusions: Among the different socioeconomic variables, age showed statistical significance, i.e., the older individuals tended to show more compliance. It is assumed that the intervention of health professionals directly aimed at improving the use of specific medications may act as a facilitating factor in the process and maintenance of the expected pattern of compliance. In this respect, we suggest that adequate organization of the service and of a multi-professional team, the creation of ties and the formation of adhesion groups, in addition to individual care, may respond to the expectations and the doubts due to the continuous use of ARVT.

O uso da terapia anti-retroviral combinada colabora para a regressão de manifestações clínicas da infecção pelo HIV e para a melhoria na qualidade de vida dos pacientes, no entanto, apesar da adesão à terapêutica constituir importante ação para a resolutividade do tratamento, permanece como sério problema, tendo em vista as inúmeras dificuldades para alcançar a adesão. Objetivo: Avaliar a adesão dos portadores de HIV/aids em face do uso de terapia anti-retroviral (TARV) e propor estratégias que facilitem a adesão. Métodos: Desenvolveu-se estudo do tipo descritivo e exploratório em ambulatório especializado em Fortaleza-CE entre maio e junho de 2004, com 38 pacientes com aids em uso da TARV, por meio de entrevista semi-estruturada. A adesão foi baseada na soma das quantidades totais de comprimidos da TARV tomados nos três dias que antecederam a entrevista. Como aderente considerou-se o paciente que utilizou pelo menos 95% da quantidade de TARV prescrita. Resultados: Houve predomínio do sexo masculino, com trinta anos ou mais, com ensino fundamental, casados, católicos, desempregados e renda familiar de até um salário mínimo. A taxa de adesão foi de 71%. Ao correlacionar as diferentes variáveis, a não-adesão esteve relacionada ao sexo masculino, faixa etária entre 20 e 29 anos, pouca escolaridade, solteiros, desempregados e entre aqueles com escassos recursos financeiros. Conclusão: Nas diferentes variáveis socioeconômicas obteve-se significância estatística para a idade: os mais velhos tendem a maior adesão. Supõe-se que a atuação de profissional de saúde diretamente voltada a melhorar o uso de medicamentos específicos poderá agir como um facilitador no processo e manutenção de um padrão esperado de adesão...

Patogenicidade de Metarhizium anisopliae var. anisopliae e Metarhizium anisopliae var. acridum sobre Nasutitermes coxipoensis (Holmgren) (Isoptera: Termitidae) / Pathogenicity of Metarhizium anisopliae var. anisopliae and Metarhizium anisopliae var. acridum on Nasustitermes coxipoensis (Holmgren) (Isoptera: Termitidae)

A ação de Metarhizium anisopliae var. anisopliae e Metarhizium anisopliae var. acridum sobre o cupim de montículo Nasutitermes coxipoensis (Holmgren) e a produção de conídios sobre os insetos mortos foram estudadas em laboratório. Doses infectivas foram determinadas através do contato direto dos insetos com a cultura fúngica após 12 dias de crescimento e quantificação dos conídios em câmara de Neübauer. Foram utilizadas as doses 0,5 x 10(6) e 1,6 x 10(7) conídos/ml, para M. anisopliae var. anisopliae, e 1,4 x 10(5) e 1,8 x 10(6) conídios/ml para M. anisopliae var. acridum, nominadas dose A e dose B, respectivamente. As doses corresponderam a 3 min. e 15 min. de contato direto de 20 cupins com a cultura fúngica. A produção de conídios foi avaliada utilizando-se insetos inoculados com o fungo, 10 dias após a morte. Os bioensaios foram realizados em triplicata. Os percentuais de mortalidade acumulada de N. coxipoensis tratados com M. anisopliae, no terceiro dia após a inoculação, foram: controle, 15,7 por cento; dose A 95,7 por cento e dose B 100 por cento; para M. anisopliae var. acridum foram: controle, 13,3 por cento; dose A 66,4 e dose B 88,8 por cento. A média da produção de conídios foi mais elevada para M. anisopliae var. anisopliae do que para M. anisopliae var. acridum. Os resultados mostraram que M. anisopliae var. anisopliae apresentou maior potencial para o controle biológico de N. coxipoensis.

The action of Metarhizium anisopliae var. anisopliae and Metarhizium anisopliae var. acridum on the mound termite Nasutitermes coxipoensis (Holmgren) and the conidia production on dead insects were studied in laboratory. Infective doses were determined through direct contact of the insects with the fungi cultures with 12 days of growth followed by conidia quantification in Neübauer camera. The doses of 0.5 x 10(6) and 1.6 x 10(7) conidia/ml of M. anisopliae var. anisopliae, and 1.4 x 10(5) e 1.8 x 10(6) conidia/ml of M. anisopliae var. acridum were named dose A and dose B, for each fungus, respectively. These doses corresponded to 3-min and 15-min direct contact of 20 insects with the fungi cultures. Conidia production was evaluated using the insects inoculated with fungi. The bioassays were carried out in triplicate. The percentage of accumulated mortality of N. coxipoensis treated with M. anisopliae var. anisopliae on the third day after inoculation were: control, 15.7 percent; dose A 95.7 percent and dose B 100 percent; for M. anisopliae var. acridum: control, 13.3 percent; dose A 66.4 percent and dose B 88,8 percent. The average of conidia production was higher for M. anisopliae var. anisopliae than M.anisopliae var. acridum. The results showed that M. anisopliae var. anisopliae presented better potential for the biological control of N. coxipoensis.

Teste de esforço em hipertensos em uso de diferentes inibidores da enzima conversora da angiotensina / Exercise testing in hypertensive patients taking different angiotensin-converting enzyme inhibitors

OBJECTIVE: To compare blood pressure response to dynamic exercise in hypertensive patients taking trandolapril or captopril. METHODS: We carried out a prospective, randomized, blinded study with 40 patients with primary hypertension and no other associated disease. The patients were divided into 2 groups (n=20), paired by age, sex, race, and body mass index, and underwent 2 symptom-limited exercise tests on a treadmill before and after 30 days of treatment with captopril (75 to 150 mg/day) or trandolapril (2 to 4 mg/day). RESULTS: The groups were similar prior to treatment (p<0.05), and both drugs reduced blood pressure at rest (p<0.001). During treatment, trandolapril caused a greater increase in functional capacity (+31 percent) than captopril (+17 percent; p=0.01) did, and provided better blood pressure control during exercise, observed as a reduction in the variation of systolic blood pressure/MET (trandolapril: 10.7±1.9 mmHg/U vs 7.4±1.2 mmHg/U, p=0.02; captopril: 9.1±1.4 mmHg/U vs 11.4±2.5 mmHg/U, p=0.35), a reduction in peak diastolic blood pressure (trandolapril: 116.8±3.1 mmHg vs 108.1±2.5 mmHg, p=0.003; captopril: 118.2±3.1 mmHg vs 115.8±3.3 mmHg, p=0.35), and a reduction in the interruption of the tests due to excessive elevation in blood pressure (trandolapril: 50 percent vs 15 percent, p=0.009; captopril: 50 percent vs 45 percent, p=0.32). CONCLUSION: Monotherapy with trandolapril is more effective than that with captopril to control blood pressure during exercise in hypertensive patients

Marcha fitoquímica y actividad citotóxica con artemia salina de la corteza del árbol tetragastritis panamensis (kerosin) / Phytochemical march and cytotoxic activity with brine shrimp from the tree bark tetragastritis panamensis (kerosin)

En el presente trabajo de investigación se realiza un estudio fitoquímico de tipo preliminar en la corteza del árbol Tetragastris panamensis. Se realiza una marcha fitoquímica en la corteza del árbol Tetragaslris panamensis, utilizando reactivos de coloración y precipitación, así como cromatografía de capa delgada, con el fin de detectar metabolitos secundarios, así mismo, se obtiene fracciones eluidas con solventes a diferentes polaridades del material vegetal haciendo uso de la cromatografía de columna a baja presión, se determina también la actividad citotóxica a través del bioensayo con Artemia salina en la corteza de la especie Tetragastris panamensis, para el extracto vegetal crudo etanólico obtenido por soxhlet y las fracciones de hexano, acetato de etilo, alcohol etnico y agua obtenidas por cromatografía líquida de columna de presión media. Finalmente, se hace uso del Método Gráfico Reed - Muench para encontrar la dosis letal media (DL50)