Metabolic syndrome in HIV-infected patients receiving antiretroviral therapy in Latin America

OBJECTIVE: To evaluate the prevalence of and the associated factors for metabolic syndrome (MS) among Latin American HIV-infected patients receiving antiretroviral therapy (ART) using baseline data from the RAPID II study. METHODS: A longitudinal study to evaluate the metabolic profile, cardiovascular disease (CVD) risk and associated treatment practices to reduce this risk has been conducted in seven Latin American countries (the RAPID II study). Adult HIV patients with at least six months of RT were enrolled. MS was defined following ATP-III criteria. Demographic and anthropometric data, serum biochemical and clinical parameters were compared in patients with and without MS using bivariate and multivariate analysis. RESULTS: A total of 4,010 patients were enrolled, 2,963 (74 percent) were males. Mean age (SD) was 41.9 (10.0) years. The prevalence of MS was 20.2 percent. Females had higher prevalence of MS than males (22.7 percent vs. 19.4 percent, p = 0.02). MS was driven by high triglycerides, low HDL-cholesterol and high blood pressure (HBP). Patients with MS had higher 10year CVD risk: 22.2 percent vs. 7.4 percent, p < 0.001. Age (OR: 1.05 per year), female gender (OR: 1.29), family history of CVD (OR: 1.28), CD4 cell count (OR: 1.09 per 100 cell increase), and protease inhibitor based-ART (OR: 1.33) correlated with MS in the multivariate analysis. CONCLUSIONS: Prevalence of MS in this setting was similar to that reported from developed countries. MS was driven by high triglycerides, low-HDL and HBP, and it was associated with higher risk of CVD. Traditional risk factors, female gender, immune reconstitution, and protease inhibitor based-ART correlated with MS.

Perfuracoes do globo ocular e ferimentos da face. Necessidade de diagnostico precoce. / Perforations of the eyeball and wounds of the face. Need of precocious diagnosis

Os autores apresentam 5 casos pacientes politraumatizados, com ferimentos de face, palpebra e globo ocular, que tiveram pronto atendimento, em hospitais gerais, com cuidados para as lesoes faciais e com um retardo de 2 a 7 dias no diagnostico e tratamento do ferimento perfurante do globo ocular. Ressaltam os danos que tal retardo pode acarretar e computam o fato a desinformacao, do medico plantonista. Enfatizam a necessidade do ensaio de oftalmologia preventiva e conduta frente o provavel ferimento ocular aos graduandos, assim como o desenvolvimento de programas de educacao sanitaria em oftalmologia

Complicacoes tardias pos betaterapia em tratamento de pterigio. / Late complications after beta-therapy in the treatment of pterygium

Os autores apresentam 7 casos de complicacao de beta-terapia que se manifestaram de 2 a 15 anos apos cirurgia de pterigio. Ressaltam a necessidade de se controlar a dosagem e indicacoes do uso de beta-terapia assim como das proprias indicacoes de cirurgia de pterigio

Alteracoes endomiocardicas com insuficiencia cardiaca na tetrade de Fallot. / Endomyocardial changes with cardiac insufficiency in tetralogy of Fallot

Os autores examinaram seis pacientes que apresentavam quadro clinico e hemodinamico de tetrade de Fallot associada a processo miocardico. A insuficiencia cardiaca consequente ao aumento da pressao venocapilar, presente em todos os casos, contraindicou a correcao cirurgica. Os exames mais expressivos foram a radiografia do torax, que revelava acentuado aumento do ventriculo esquerdo com estase pulmonar, e os aspectos eletrocardiograficos que mostravam potencial evidente de ventriculo esquerdo e sobrecarga isolada deste ventriculo. Foram estudados os aspectos clinicos e propedeuticos invasivos ou nao, no sentido de conhecer as resultantes da interacao hemodinamica das duas patologias