Understanding of the role of serum creatinine in a subset of the Brazilian population / Conhecimento de uma amostragem da população brasileira sobre a função da creatinina sérica

Abstract Introduction: Chronic kidney disease is usually asymptomatic, and its diagnosis depends on laboratory tests, with emphasis on serum creatinine and proteinuria. Objective: To assess knowledge on the role of serum creatinine as a biomarker of kidney function in a sample of the Brazilian population. Method: Cross-sectional observational study conducted in São Paulo (SP, Brazil), in which a random adult population was interviewed. Results: A total of 1138 subjects were interviewed, with a median age of 36 years old (27-52); 55.1% were female. Regarding the "creatinine" biomarker, 40.6% stated they had never performed such a test. When asked about their knowledge on the usefulness of this exam, only 19.6% knew its function. The other responses were "I don't know" (71.6%), evaluating heart function (0.9%) and liver function (7.8%). Of those who reported they had already taken a creatinine test, only 29.4% correctly identified the role of creatinine. When dividing the groups into "knows" and "does not know" the function of creatinine, a statistically significant difference (p < 0.05) was observed regarding level of education, female sex, being a healthcare student/worker, having ever measured creatinine, knowing someone with kidney disease and older age. In the multivariate analysis, the main variable related to knowing the creatinine role was having previously taken the test (OR 5.16; 95% CI 3.16-8.43, p < 0.001). Conclusion: There is a significant lack of knowledge about creatinine and its use in checkups. The results indicate that greater efforts are needed from healthcare professionals to raise awareness on the role of serum creatinine.

Resumo Introdução: A doença renal crônica costuma ser assintomática e seu diagnóstico depende da realização de exames laboratoriais, com destaque para a creatinina sérica e pesquisa de proteinúria. Objetivo: Avaliar em uma amostra da população brasileira o conhecimento sobre o papel da creatinina sérica como marcador de função renal. Método: Estudo observacional transversal realizado na cidade de São Paulo (SP, Brasil), em que foi entrevistada uma população adulta aleatória. Resultados: Foram entrevistados 1138 indivíduos, com idade mediana de 36 anos (27-52); 55,1% do sexo feminino. Com relação ao marcador "creatinina", 40,6% afirmaram que nunca realizaram tal dosagem. Quando questionados quanto ao conhecimento sobre a utilidade desse exame, somente 19,6% sabiam a sua função. As outras respostas foram "não sei" (71,6%), avaliar o funcionamento do coração (0,9%) e fígado (7,8%). Dos que afirmaram já terem realizado o exame de creatinina, somente 29,4% acertaram a função da creatinina. Ao dividir os grupos em "sabe" e "não sabe" a função da creatinina, percebeu-se diferença estatisticamente significante (p < 0,05) em relação ao grau de escolaridade, sexo feminino, ser aluno/trabalhador da saúde, ter dosado creatinina alguma vez, conhecer alguém com doença renal e maior idade. Na análise multivariada, a principal variável relacionada com conhecer a função da creatinina foi ter realizado o exame anteriormente (OR 5,16; IC 95% 3,16-8,43, p < 0,001). Conclusão: Há grande desconhecimento sobre a creatinina e seu uso em check-ups. Os resultados indicam que é necessário maior esforço por parte dos profissionais de saúde para divulgar o papel da creatinina sérica.

Understanding of the role of serum creatinine in a subset of the Brazilian population.

INTRODUCTION: Chronic kidney disease is usually asymptomatic, and its diagnosis depends on laboratory tests, with emphasis on serum creatinine and proteinuria. OBJECTIVE: To assess knowledge on the role of serum creatinine as a biomarker of kidney function in a sample of the Brazilian population. METHOD: Cross-sectional observational study conducted in São Paulo (SP, Brazil), in which a random adult population was interviewed. RESULTS: A total of 1138 subjects were interviewed, with a median age of 36 years old (27-52); 55.1% were female. Regarding the "creatinine" biomarker, 40.6% stated they had never performed such a test. When asked about their knowledge on the usefulness of this exam, only 19.6% knew its function. The other responses were "I don't know" (71.6%), evaluating heart function (0.9%) and liver function (7.8%). Of those who reported they had already taken a creatinine test, only 29.4% correctly identified the role of creatinine. When dividing the groups into "knows" and "does not know" the function of creatinine, a statistically significant difference (p < 0.05) was observed regarding level of education, female sex, being a healthcare student/worker, having ever measured creatinine, knowing someone with kidney disease and older age. In the multivariate analysis, the main variable related to knowing the creatinine role was having previously taken the test (OR 5.16; 95% CI 3.16-8.43, p < 0.001). CONCLUSION: There is a significant lack of knowledge about creatinine and its use in checkups. The results indicate that greater efforts are needed from healthcare professionals to raise awareness on the role of serum creatinine.

Play into the domestic routine to promote child development: cross-sectional study.

OBJECTIVE: To analyze the association between the incorporation of play into the domestic routine of caregivers, and the child development of children under their care. METHOD: Cross-sectional study conducted with 129 caregiver-child dyads aged 12-23 months, living in the southern region of São Paulo. Child development was assessed using the Ages & Stages Questionnaire-3, and the incorporation of play into the domestic through a questionnaire and filming of the dyads in activities related to the domestic routine. RESULTS: Almost all the caregivers were the mother (98%), who, when answering the questionnaire, reported incorporating play into their domestic routine (93%), however in the video, only one third played with the child (34%). There was a positive association between playing in moments of domestic routine and domains of child development in children aged 18 months or less. CONCLUSIONS: A positive association was found between the incorporation of play into the domestic routine and child development.

Play into the domestic routine to promote child development: cross-sectional study / El juego en la rutina doméstica para la promoción del desarrollo infantil: estudio transversal / O brincar na rotina doméstica para a promoção do desenvolvimento infantil: estudo transversal

ABSTRACT Objective: To analyze the association between the incorporation of play into the domestic routine of caregivers, and the child development of children under their care. Method: Cross-sectional study conducted with 129 caregiver-child dyads aged 12-23 months, living in the southern region of São Paulo. Child development was assessed using the Ages & Stages Questionnaire-3, and the incorporation of play into the domestic through a questionnaire and filming of the dyads in activities related to the domestic routine. Results: Almost all the caregivers were the mother (98%), who, when answering the questionnaire, reported incorporating play into their domestic routine (93%), however in the video, only one third played with the child (34%). There was a positive association between playing in moments of domestic routine and domains of child development in children aged 18 months or less. Conclusions: A positive association was found between the incorporation of play into the domestic routine and child development.

RESUMEN Objetivo: Analizar la asociación entre la incorporación del juego en la rutina doméstica, por parte de cuidadoras, y el desarrollo infantil de niños bajo su cuidado. Método: Estudio transversal con 129 díadas cuidadora-niño de 12-23 meses, en la ciudad de São Paulo. El desarrollo infantil se evaluó con el Ages & Stages Questionnaire-3 y la incorporación del juego a la rutina doméstica a través de cuestionario y filmaciones de las díadas en actividades relacionadas con la rutina doméstica. Resultados: Casi todas las cuidadoras fueron la madre (98%) que, al responder al cuestionario, refirieron incorporar el juego en su rutina doméstica (93%), pero en el video, solo un tercio jugó con el niño (34%). Hubo asociación positiva entre jugar en momentos de rutina doméstica y dominios del desarrollo de niños de 18 meses o menos. Conclusiones: Se encontró una asociación positiva entre la incorporación del juego en la rutina doméstica y el desarrollo infantil.

RESUMO Objetivo: Analisar a associação entre a incorporação do brincar na rotina doméstica de cuidadoras e o desenvolvimento infantil de crianças sob seu cuidado. Método: Estudo transversal conduzido com 129 díades cuidadora-criança de 12-23 meses, na região sul de São Paulo. O desenvolvimento infantil foi avaliado com a utilização do Ages & Stages Questionnaire-3, e a incorporação do brincar na rotina doméstica, por meio de questionário e filmagem das díades em atividades relacionadas à rotina doméstica. Resultados: Quase a totalidade das cuidadoras era a mãe (98%) que, ao responder ao questionário, referiu incorporar o brincar na rotina doméstica (93%), porém, no vídeo, apenas um terço brincou com a criança (34%). Verificou-se associação positiva entre brincadeiras em momentos da rotina doméstica e domínios do desenvolvimento em crianças com idade igual ou inferior a 18 meses. Conclusões: Constatou-se associação positiva entre a incorporação do brincar na rotina doméstica e o desenvolvimento infantil.

Congenitally Corrected Transposition of the Great Arteries in the Adult

ABSTRACT Introduction: Congenitally corrected transposition of the great arteries (CCTGA) is a rare anomaly. Current data available regarding adult cases is derived from small series, information simultaneously presented in pediatric publications, and one classical multicenter study. This review, not aimed to exhaust the subject, has the purpose to examine the literature addressing presentation, diagnostic methodology, and management of afflicted adult patients. Methods: A comprehensive search was undertaken in three major databases (PubMed, Cochrane, SciELO), using the keywords "congenitally corrected transposition of the great arteries" and "adults". Relevant articles in English, Spanish, and Portuguese were extracted and critically appraised in this review. Steps for study selection were: (1) identification of titles of records through databases searching, (2) removal of duplicates, (3) screening and selection of abstracts, (4) final inclusion in the study. Results: Four hundred sixty-five publications on CCTGA in adult patients were retrieved, and 166 were excluded; 299 studies were used for this review including 76 full-text articles, 70 studies related to general aspects of the subject, and, due to the small number of publications, 153 case reports. Sixty-one articles referring to combined experiences in pediatric and adult patients and judged to be relevant, but retrieved from another sources, were also included. Conclusion: Albeit clinical presentation and diagnostic criteria have been well stablished, there seems to be room for discussion related to clinical and surgical management of CCTGA in adults. Considering the rarity of the disease, well designed multicenter studies may provide answers.

Congenitally Corrected Transposition of the Great Arteries in the Adult.

INTRODUCTION: Congenitally corrected transposition of the great arteries (CCTGA) is a rare anomaly. Current data available regarding adult cases is derived from small series, information simultaneously presented in pediatric publications, and one classical multicenter study. This review, not aimed to exhaust the subject, has the purpose to examine the literature addressing presentation, diagnostic methodology, and management of afflicted adult patients. METHODS: A comprehensive search was undertaken in three major databases (PubMed, Cochrane, SciELO), using the keywords "congenitally corrected transposition of the great arteries" and "adults". Relevant articles in English, Spanish, and Portuguese were extracted and critically appraised in this review. Steps for study selection were: (1) identification of titles of records through databases searching, (2) removal of duplicates, (3) screening and selection of abstracts, (4) final inclusion in the study. RESULTS: Four hundred sixty-five publications on CCTGA in adult patients were retrieved, and 166 were excluded; 299 studies were used for this review including 76 full-text articles, 70 studies related to general aspects of the subject, and, due to the small number of publications, 153 case reports. Sixty-one articles referring to combined experiences in pediatric and adult patients and judged to be relevant, but retrieved from another sources, were also included. CONCLUSION: Albeit clinical presentation and diagnostic criteria have been well stablished, there seems to be room for discussion related to clinical and surgical management of CCTGA in adults. Considering the rarity of the disease, well designed multicenter studies may provide answers.

The Knowledge and Prescription of Pre-Exposure Prophylaxis for HIV by Physicians in Goiás / O Conhecimento e a Prescrição da Profilaxia Pré-Exposição ao HIV por Médicos em Goiás

The acquired immunodeficiency syndrome (AIDS) is a disease which effects the immune system and, to reduce the development of this pathology, antiretrovirals was created. Evidences demonstrate the effectiveness of Pre-Exposure Prophylaxis (PrEP), however, it still has obstacles, such as the lack of knowledge, technique and training of health professionals for patient guidance and prescription. The aim of this research is to investigate the subjective and objective knowledge of PrEP, futhermore the number of prescriptions in State of Goiás. For data collection, a survey was applied to 152 physicians with active enrollment in Conselho Regional de Medicina do Estado de Goiás. As a result, 132 physicians (86,8%) reported having previous knowledge about PrEP, on average of 44,2% informed having knowledge for prescription, 129 (84,8%) never prescribed PrEP and, when objectively evaluated, on average of 83,8% have knowledge about the risk categorization for the drug use. The outcome of this research is not consonant with the hypothesis that only 20% of the physicians would have plenty knowledge, according to the literature, but it is evident the need for medical training to optimize the clinical impact on public health of this important HIV prevention strategy.

A Síndrome da Imunodeficiência Adquirida é uma infecção que acomete o sistema imunológico e, para redução da propagação dessa patologia, desenvolveu-se os antirretrovirais. Evidências demonstram a eficácia da Profilaxia Pré-Exposição (PrEP), mas ainda com obstáculos, como a falta de conhecimento, técnica e treinamento dos profissionais de saúde para a sua orientação e prescrição. O objetivo dessa pesquisa é investigar o conhecimento subjetivo, objetivo e prescrição da PrEP por médicos do Estado de Goiás. Para a coleta de dados foi aplicado um questionário à 152 médicos com inscrição ativa no Conselho Regional de Medicina do Estado de Goiás. Como resultado, 132 médicos (86,8%) afirmaram possuir conhecimento prévio sobre a PrEP, em média 44,2% informaram ter conhecimento para prescrição, 129 (84,8%) nunca prescreveram PrEP e, quando avaliado objetivamente, em média 83,8% possuem conhecimento sobre a categorização de risco para o uso do medicamento. Os resultados dessa pesquisa não estão em consonância com a hipótese de que apenas 20% dos médicos teriam conhecimento suficiente, de acordo com a literatura, mas é evidente a necessidade de capacitação médica visando otimizar o impacto clínico na saúde pública desta importante estratégia de prevenção do HIV.

Frailty in geriatric psychiatry inpatients: a retrospective cohort study.

OBJECTIVE: We aimed to evaluate the prevalence, clinical determinants, and consequences (falls and hospitalization) of frailty in older adults with mental illness. DESIGN: Retrospective clinical cohort study. SETTING: We collected the data in a specialized psychogeriatric ward, in Boston, USA, between July 2018 and June 2019. PARTICIPANTS: Two hundred and fourty-four inpatients aged 65 years old and over. MEASUREMENTS: Psychiatric diagnosis was based on a multi-professional consensus meeting according to DSM-5 criteria. Frailty was assessed according to two common instruments, that is, the FRAIL questionnaire and the deficit accumulation model (aka Frailty Index [FI]). Multiple linear regression analyses were conducted to evaluate the association between frailty and sample demographics (age, female sex, and non-Caucasian ethnicity) and clinical characteristics (dementia, number of clinical diseases, current infection, number of psychotropic, and non-psychotropic medications in use). Multiple regression between frailty assessments and either falls or number of hospital admissions in the last 6 and 12 months, respectively, were analyzed and adjusted for covariates. RESULTS: Prevalence of frailty was high, that is, 83.6% according to the FI and 55.3% according to the FRAIL questionnaire. Age, the number of clinical (somatic) diseases, and the number of non-psychotropic medications were independently associated with frailty identified by the FRAIL. Dementia, current infection, the number of clinical (somatic) diseases, and the number of non-psychotropic medications were independently associated with frailty according to the FI. Falls were significantly associated with both frailty instruments. However, we found only a significant association for the number of hospital admissions with the FI. CONCLUSION: Frailty is highly prevalent among geriatric psychiatry inpatients. The FRAIL questionnaire and the FI may capture different forms of frailty dimensions, being the former probably more associated with the phenotype model and the latter more associated with multimorbidity.

Atenção à saúde sexual e reprodutiva: levantamento estadual para a construção da Linha de Cuidado para a Saúde na Adolescência e Juventude para o Sistema Único de Saúde no Estado de São Paulo (LCA&J) / Sexual and reproductive health care: state survey for the construction of the Healthcare Service Network for Adolescents and Young People for the National Health System (SUS) in the State of São Paulo (LCA&J)

Este artigo tem como objetivos descrever os perfis e as atividades de serviços de saúde localizados nos municípios do estado de São Paulo quanto à atenção em saúde sexual e reprodutiva de adolescentes e jovens; e apresentar a orientação para este tema da Linha de Cuidado para a Saúde na Adolescência e Juventude para o Sistema Único de Saúde no Estado de São Paulo, que tem como marco o documento elaborado e apresentado à Comissão Intergestores Bipartite de SP, em 2018, e publicado em livro on-line em 2021.

p53 and p21 expression in bone marrow clots of megaloblastic anemia patients.

The pathogenesis of megaloblastic hemopathies (MH) is centered on the deficiency of vitamin B12 and folic acid with interruption of erythrocyte maturation. This study researched the participation of p53 and p21 in the pathophysiology of the disease. A retrospective study enrolled 95 patients with histopathologic diagnosis by biopsy or bone marrow clot (BMB/BMC), with clinical review and immunohistochemical study in tissue microarray (TMA) for p53 and p21, detailing their marking location. All patients had BMC and only 11 had BMB. The CMO was a differential of this study and it allowed an expanded sample. In the TMA, 63.7% (58/91) of the samples were immunopositive for p53; and 35.2% (31/88) were immunopositive for p21. Nuclear staining, divergent from the literature, was observed in 17.3% (10/58) among those p53+ and in 38.7% (12/31) among those p21+. The pattern of immunostaining showed non-significant differences (P=0.474) regarding morphologic and clinical aspects. The positivity for both may indicate an effective balance between apoptosis and anti-apoptotic action. Excessive inhibition of apoptosis would contribute to high global cellularity, but without functional maturation effectiveness. In conclusion, there is p21 and/or p53 immunoexpression in most cases of this study and there is no clear association between immunoexpression pattern and patient outcome. Unlike the literature, we also found a percentage of nuclear immunostaining, but the finding was not statistically significant. Combination of p21 and p53 results created different possibilities of pathologic interpretation for MH, reinforcing the importance of studies similar to this one.

Determination of the value of vertebral heart size regarding the weight and body area in canines / Determinação dos valores do vertebral heart size em relação ao peso e área corporal canina

The vertebral heart size is a method used to measure the cardiac dimension in order to identify the remodeling of the chambres in heart disease. This study aims to determinate the vertebral heart size values at right lateral and ventrodorsal radiographs views relating to canines weight and body area variations. For the purpose of the study 40 healthy dogs within the age of 1 to 6 years, males and females, with deep or intermediated thorax were selected, brachycephalic dogs were not included in the study; the dogs were separated in four groups: group 1(n=9) compound of dogs up to 5 kg; group 2 (n=8) with dogs from 5,1 to 10 kg; group 3 (n=12) with dogs from 10,1 to19 kg and group 4 (n=11) with dogs weighing more than 19,1 kg. The values of body score, body mass index and the thorax configuration where previously measured, as well as the VHS and the depth width ratio from the radiographs. The results demonstrated intervals of right lateral-lateral vertebral heart size 9.9 to 10.4v and ventro-dorsal vertebral heart size of 9.8-10.3v. The study results show that the vertebral heart size numbers did not correlate with weight or body area, regardless the type of radiography view. Therefore, it can be concluded that the vertebral heart size in right lateral and ventrodorsal radiography can be used to rate the cardiac area, not suffering influence by the dog's weight or body area.

O vertebral heart size é um método utilizado para mensurar a dimensão cardíaca visando identificar os remodelamentos das câmaras nas cardiopatias. O objetivo do estudo foi determinar os valores de vertebral heart size nas projeções radiográficas latero-lateral direita e ventro-dorsal conforme as variações do peso e área corporal. Para isso, foram selecionados 40 cães hígidos com idade entre 1 e 6 anos, machos e fêmeas, com padrão torácico intermediário e profundo, com exclusão dos braquicefálicos; os cães foram divididos em quatro grupos: grupo 1 (n=9) composto por cães de até 5 kg; grupo 2 (n=8) com cães de 5,1 a 10 kg; grupo 3 (n=12) com cães de 10,1 a 19 kg e grupo 4 (n=11) com cães acima de 19,1 kg. Os valores de escore corporal, índice de massa corporal e conformação torácica foram previamente mensurados, bem como os valores dos vertebral heart size a relação profundidade/largura torácica das radiografias. Os resultados demonstraram intervalos de vertebral heart size latero-lateral 9.9 a 10.4v e vertebral heart size ventro dorsal de 9.8-10.3v. Os valores não apresentaram correlação com o peso e área corporal nos grupos estudados, independente das projeções estudas. Assim, pode-se concluir que método vertebral heart size nas projeções estudadas é aplicável na avaliação da área cardíaca, não sofrendo influências do peso e área corporal canina.

Determination of the value of vertebral heart size regarding the weight and body area in canines / Determinação dos valores do vertebral heart size em relação ao peso e área corporal canina

The vertebral heart size is a method used to measure the cardiac dimension in order to identify the remodeling of the chambres in heart disease. This study aims to determinate the vertebral heart size values at right lateral and ventrodorsal radiographs views relating to canines weight and body area variations. For the purpose of the study 40 healthy dogs within the age of 1 to 6 years, males and females, with deep or intermediated thorax were selected, brachycephalic dogs were not included in the study; the dogs were separated in four groups: group 1(n=9) compound of dogs up to 5 kg; group 2 (n=8) with dogs from 5,1 to 10 kg; group 3 (n=12) with dogs from 10,1 to19 kg and group 4 (n=11) with dogs weighing more than 19,1 kg. The values of body score, body mass index and the thorax configuration where previously measured, as well as the vertebral heart size and the depth width ratio from the radiographs. The results demonstrated intervals of right lateral-lateral vertebral heart size 9.9 to 10.4v and ventro-dorsal vertebral heart size of 9.8-10.3v. The study results show that the vertebral heart size numbers did not correlate with weight or body area, regardless the type of radiography view. Therefore, it can be concluded that the vertebral heart size in right lateral and ventrodorsal radiography can be used to rate the cardiac area, not suffering influence by the dog's weight or body area.

O vertebral heart size é um método utilizado para mensurar a dimensão cardíaca visando identificar os remodelamentos das câmaras nas cardiopatias. O objetivo do estudo foi determinar os valores de vertebral heart size nas projeções radiográficas latero-lateral direita e ventro-dorsal conforme as variações do peso e área corporal. Para isso, foram selecionados 40 cães hígidos com idade entre 1 e 6 anos, machos e fêmeas, com padrão torácico intermediário e profundo, com exclusão dos braquicefálicos; os cães foram divididos em quatro grupos: grupo 1 (n=9) composto por cães de até 5 kg; grupo 2 (n=8) com cães de 5,1 a 10 kg; grupo 3 (n=12) com cães de 10,1 a 19 kg e grupo 4 (n=11) com cães acima de 19,1 kg. Os valores de escore corporal, índice de massa corporal e conformação torácica foram previamente mensurados, bem como os valores dos vertebral heart size a relação profundidade/largura torácica das radiografias. Os resultados demonstraram intervalos de vertebral heart size latero-lateral 9.9 a 10.4v e vertebral heart size ventro dorsal de 9.8-10.3v. Os valores não apresentaram correlação com o peso e área corporal nos grupos estudados, independente das projeções estudas. Assim, pode-se concluir que método vertebral heart size nas projeções estudadas é aplicável na avaliação da área cardíaca, não sofrendo influências do peso e área corporal canina.

5-Hydroxymethylfurfural formation and color change in lactose-hydrolyzed Dulce de leche.

The work described in this Research Communication concerns the production of Dulce de leche (DL), that is a traditional product from South America obtained by concentration. Maillard reaction (MR) products are mainly responsible for the formation of color and flavor in this product. Lactose-hydrolyzed products have been developed to supply consumer demand, but this hydrolysis may affect the flavor, color, taste, texture and even some nutritional aspects of the product. We studied the influence of different levels of lactose-hydrolysis, sucrose addition and initial pH on the development of MR, appraised by the determination of 5-hydroxymethylfurfural (HMF). A process simulator with multi-monitoring system was used to produce 15 DL. Box-Behnken 33 experimental design was applied for the three factors: pH, lactose-hydrolysis level and sucrose concentration. Lipids, protein, ashes, carbohydrates, water activity, dissolved solids, colorimetric analysis and HMF (free and total) are among the physicochemical attributes and MR indicators analyzed in this work. The products showed significant differences in composition but all the values were in agreement with the literature. Moreover, higher levels of lactose hydrolysis and higher pH presented a direct relation with the development of MR, observed by an increase in coloration (lower luminosity) and more formation of HMF, both free and total. The present study expands the knowledge about DL spread made of lactose-hydrolyzed milk, allowing the food industries to produce a lactose free DL with nutritional and sensory characteristics closer to the traditional product.

Advanced Thyroid Follicular Carcinoma in a Pregnant Woman.

The diagnostic and therapeutic approach for pregnant women with thyroid nodules can present a challenge, especially concerning surgical procedures. In the context of malignant diagnosis, by fine needle aspiration (FNA), during pregnancy, the uncertainty lies in performing surgery. This article reports the case of a 41-year-old pregnant woman in her first gestation, who sought medical care complaining of right shoulder pain. Imaging workup depicted the destruction of the humeral head and involvement of the surrounding soft tissue. She was 20 weeks pregnant. The histological report favored the diagnosis of malignancy and the thyroid as the primary site. At 30 weeks of gestation, the patient underwent a cesarean section, a total thyroidectomy, and total resection of the metastasis. The child was born healthy, but one year after the diagnosis, the patient died. Bone and soft tissue metastasis of thyroid neoplasms are not very common and indicate poor prognosis.

Prevalence of factor V Leiden in patients with venous thrombosis / Prevalência do fator V de Leiden em pacientes com trombose venosa

ABSTRACT INTRODUCTION: Venous thrombosis is a multifactor disease with high incidence in the population. The development of this disease is closely linked to the presence of environmental and genetic factors and may occur in combination or alone. Among the various genetic mutations that may predispose to a thrombotic event, the most frequent in the population is the G1691A mutation in clotting factor V, known as factor V Leiden (FVL). This mutation brings the phenotype known as activated protein C resistance, leading to a hypercoagulable state, which increases the risk of thrombosis. OBJECTIVE: To investigate the presence of FVL in individuals with history of venous thrombosis, and as the control group, individuals with no history of the disease. METHOD: The method used was the polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP). RESULTS: The results showed mutation prevalence of 21.5% in heterozygosity in patient group; no individuals with mutated homozygous were identified. The results also showed a high recurrence rate among the mutation carriers. CONCLUSION: In conclusion, the research of mutation on factor V has strong impact on investigation of venous thromboembolism, in order to elucidate the etiology of the event, and in treatment and in prophylaxis against the recurrence.

RESUMO INTRODUÇÃO: A trombose venosa é uma doença de caráter multifatorial e de alta incidência na população. O desenvolvimento dessa patologia está intimamente ligado à presença de fatores ambientais e genéticos, podendo ocorrer em associação ou isoladamente. Entre as diversas mutações genéticas que podem predispor a um evento trombótico, a de maior ocorrência na população é a mutação G1691A no fator V da coagulação, conhecida como fator V de Leiden (FVL). Essa mutação provoca o fenótipo conhecido como resistência à proteína C ativada, levando a um quadro de hipercoagulabilidade, que aumenta o risco de trombose. OBJETIVO: Investigar a presença do FVL em indivíduos com histórico de trombose venosa e, como grupo-controle, indivíduos sem histórico. MÉTODO: A metodologia utilizada foi a técnica de reação em cadeia da polimerase (PCR), seguida de polimorfismo no comprimento dos fragmentos de restrição (RFLP). RESULTADOS: Os resultados mostraram prevalência da mutação de 21,5% em heterozigose entre o grupo de pacientes; não foram identificados indivíduos homozigotos mutados. Os resultados também apresentaram alto índice de recorrência entre os portadores da mutação. CONCLUSÃO: Conclui-se que a pesquisa da mutação do fator V tem forte impacto na investigação do tromboembolismo venoso a fim de elucidar a etiologia do evento, além de auxiliar no tratamento e na profilaxia diante da recorrência.

Penile hair tourniquet resulting in hypospadias failure.

Penile hair tourniquet (PHT) is a painless form of penile ischemia, typically seen in toddlers with long-haired mothers, caused by entanglement of hair on the balano-prepucial sulcus, normally associated with circumcision. Its association with hypospadias has been reported only once. A school-aged boy admitted for surgery to treat hypospadias failure was incidentally detected to have PHT and severe hourglass deformity of the penis. Urethral anastomosis and glanuloplasty were done after removal of the constricting ring, without complications. Normal erections were reported during follow up. Treatment may involve urethral reconstruction and penile reimplantation in extreme cases.

Percepção da administração tópica ocular de drogas: aplicador facial x gotas / Topical drug administration perception with and without eye drop applicator

OBJETIVOS: Avaliar por meio de questionário, qual o grau de dificuldade para aplicação tópica de medicações oculares, com ou sem o auxílio do apoio facial. Observar qual método foi tecnicamente melhor utilizado para aplicação de drogas tópicas oculares. MÉTODOS: O estudo foi um ensaio clínico controlado e randomizado, realizado em 50 pacientes no decorrer de 2009 e 2010 na Unidade de Saúde da Família - Lapa. Foi utilizado um frasco de colírio Oftane® e o mesmo foi acoplado ao dispositivo de apoio facial. Cada participante aplicou em cada um dos olhos, a solução com ou sem o uso do dispositivo, sendo que a seleção foi feita através de um processo randomizado. Foi perguntado ao paciente questões pré-formuladas sobre a praticidade de ambos os métodos. RESULTADOS: Considerando o grau de dificuldade de administração tópica ocular: 12 por cento acharam difícil ou muito difícil a aplicação com o objeto de apoio facial e 22 por cento sem o apoio (p=0,0024). As dificuldades descritas pelos pacientes foram relatadas por 22 por cento dos pacientes para aplicação com o dispositivo de apoio facial e por 46 por cento para aplicação sem o mesmo. Já 34 por cento dos pacientes necessitaram de mais de uma instilação para aplicação do colírio sem o apoio, enquanto que 54 por cento dos pacientes precisaram de mais de uma aplicação para que a gota atingisse o olho com o auxílio do apoio facial (p= 0,04). Em 56 por cento dos pacientes houve toque da ponta do colírio com os tecidos oculares, quando o objeto de apoio facial não foi usado, porém quando ele foi utilizado, apenas 2 por cento dos pacientes observados tocaram os tecidos oculares (p=0,0001). CONCLUSÃO: É mais fácil a instilação de colírios com o auxílio do dispositivo de apoio facial. Este também dificulta o contato da ponta do frasco com os tecidos oculares, prevenindo a contaminação do frasco.

OBJECTIVE: Evaluate how difficult it is to apply ocular topical medications with and without an eye dropper facial applicator based on patient observation and answers to a questionnaire. METHODS: The study was a controlled and randomized clinical trial performed in 50 patients during the years of 2009 and 2010 in PSF - Lapa. Eye drops were applied with and without aid of an eye dropper facial applicator. Each individual tested applied randomly on one of their eyes an eye drop with or without the applicator. The patients had to answer questions about the practice concerning both forms of topical eye drug application. RESULTS: 12 percent informed that it was difficult or very difficult to instill eye drops and 22 percent to instill eye drops helped by an eye dropper facial applicator (0,0024). Problems described by patients were considered by 22 percent for eye drops with the applicator and by 46 percent for topical eye drop instillation without it. 34 percent of the patients needed more than one eye drop application to have eye drop contact , while 54 percent of the patients needed more than one application with the eye drop facial applicator in order to get drug eye contact (p= 0,04). In 56 percent of patients there were an eyedropper tip contact with ocular tissues, however there was only 2 percent of contact when the eye drop was instilled aided by the applicator (p=0,0001). CONCLUSION: It is easier to instill an eye drop with the help of an eye dropper applicator than without it. This dispositive also reduces the eyedropper tip contact with the ocular tissues.