Association of hypertension and insulin resistance in individuals free of diabetes in the ELSA-Brasil cohort.

Insulin resistance (IR) is defined as the subnormal response to insulin action on its target tissues. Studies suggest that IR may increase the risk of hypertension, but the results are inconsistent and it is not known whether such an effect is independent of overweight/obesity. We aimed to evaluate the association between IR and the incidence of prehypertension and hypertension in the Brazilian population and whether this association is independent of overweight/obesity. In 4717 participants of the Brazilian Longitudinal Study of Adult's Health (ELSA-Brasil), free of diabetes and cardiovascular disease at baseline (2008-2010), we investigated the incidence of prehypertension and hypertension after a mean follow-up of 3.8 ± 0.5 years. Insulin resistance at baseline was assessed by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index, defined if above the 75th percentile. The risk of IR-associated prehypertension/hypertension was estimated by multinomial logistic regression after adjustment for confounding factors. Secondary analysis were stratified by body mass index. The mean (SD) age of participants was 48 (8) years, 67% were women. The 75th percentile of HOMA-IR at baseline was 2.85. The presence of IR increased the chance of developing prehypertension by 51% (95% CI 1.28-1.79) and hypertension by 150% (95% CI 1.48-4.23). In individuals with BMI < 25 kg/m2, the presence of IR remained associated with the incidence of prehypertension (OR 1.41; 95% CI 1.01-1.98) and hypertension (OR 3.15; 95% CI 1.27-7.81). In conclusion, our results suggest that IR is a risk factor for hypertension, regardless of the presence of overweight or obesity.

Advance care planning and goals of care discussion: the perspectives of Brazilian oncologists.

BACKGROUND: Advance care planning (ACP) and goals of care discussions are important instruments that enable respect for patient autonomy, especially in patients with a life-threatening disease, such as cancer. Despite their well-established benefits, ACP and goals of care discussions are still not frequently performed in clinical oncology practice. Understanding the barriers to this topic is the first step toward developing future interventions that are more likely to improve professional practice and patient satisfaction with care. AIM: To explore Brazilian oncologists' barriers to discuss goals of care and advance care planning. METHODS: A cross-sectional study was developed to identify Brazilian oncologists' barriers to discussing goals of care and ACP. The Decide-Oncology questionnaire was used to identify the importance of these barriers according to oncologists' perceptions. Participants were asked to rank the importance of various barriers to discussing goals of care, ranging from 1 (extremely unimportant) to 7 (extremely important). A quantitative analysis using descriptive statistics was used, including median and interquartile intervals and a qualitative analysis based on Bardin content analysis of the two open questions. RESULTS: Sixty-six oncologists participated in this study. Most of them perceived the patient and family's related barriers as the most important, such as patients' difficulty in understanding their diagnosis and accepting their prognosis. Physician and external related factors, such as lack of training and lack of time for this conversation, were also described as important barriers. Participants with formal training regarding goals of care communication and with experience in palliative care perceived the lack of patients' advanced directives as a significant barrier and manifested more willingness to participate in decision-making about goals of care. The lack of access and of support for referral to palliative care was also considered a significant barrier for ACP and goals of care discussion. CONCLUSION: The identification of barriers that limit the discussion of ACP and early palliative care referrals can certainly help to prioritise the next steps for future studies aimed at improving ACP and helping clinicians to better support patients through shared decision-making based on the patient's values and experiences.

Advance Directives: Knowledge of the Topic Among Psychiatrists.

Objective: Advance directives are becoming increasingly important as health technologies evolve. We sought to assess psychiatrists' knowledge of advance directives, as this knowledge is fundamental to the implementation and drafting of these personal documents. Methods: A previously published questionnaire that evaluated the knowledge of medical professors was used. The sample, composed of psychiatrists from Rio de Janeiro, Brazil, originated from a publicly available list. During the search process, the COVID-19 pandemic affected Brazil and the rest of the world, which influenced our methodology and results. Results: A total of 40 psychiatrists participated in the study. The results obtained, although not significant, suggested that psychiatrists with an increased time of practice had more knowledge of advance directives. Nevertheless, less than half of the participants had knowledge about this topic. Conclusion: The number of psychiatrists surveyed indicates the need for further studies on the subject. The influence of the COVID-19 pandemic on this study led to findings such as a change in sensitivity when addressing the topic and greater difficulty in contacting professionals.

Patterns of antimicrobial consumption in neonatal and pediatric intensive care units in Germany and Brazil.

Antibiotic consumption (AC) is a key component of antimicrobial stewardship programs to recognize local patterns of antibiotic use. Our aim was to measure AC in neonatal units, including neonatal (NICU)/paediatric (PICU) intensive care units in different countries. We conducted a multicenter, retrospective, cohort study in three NICUs, one neonatal ward, and three PICUs with a total of 84 beds. Global and individual AC in days of therapy (DOT) and DOT per 1000 patient-days were assessed. During the study period, 2567 patients were admitted, corresponding to 4961 patient-days in neonatal units and 9243 patient-days in PICUs. Multidrug-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus were more frequent in Brazil than in Germany. Average AC was 386.5 and 1335.5 DOT/1000PD in German and Brazilian neonatal units, respectively. Aminopenicillins plus 3rd generation cephalosporins were the most commonly prescribed antibiotics in German neonatal units, while aminopenicillins plus aminoglycosides were the class most commonly used in Brazilian NICU. Average AC was 888.1 and 1440.7 DOT/1000PD in German and Brazilian PICUs, respectively. Antipseudomonal penicillins were most commonly used in the German PICU, and glycopeptides were the most frequently prescribed in Brazilian PICUs. Carbapenems represented 2.3-14% of total DOTs in German neonatal units and 4% in the Brazilian NICU and 13.0% in the German PICU and 6-12.2% in Brazilian PICUs. We concluded that different patterns of most commonly prescribed antibiotics were observed in neonatal units and PICUs in these two countries, probably related to different local patterns of antibiotic resistance, with a higher antibiotic consumption in Brazilian study units.

Factors preventing restoration of bowel continuity in patients with rectal cancer submitted to anterior rectal resection and protective ileostomy. / Fatores associados a não reconstrução do trânsito intestinal em pacientes com câncer retal submetidos à ressecção anterior do reto e ileostomia de proteção.

OBJECTIVE: to evaluate the factors associated with non-closure of protective ileostomy after anterior resection of the rectum with total mesorectum excision for rectal cancer, the morbidity associated with the closure of ileostomies and the rate of permanent ileostomy in patients with rectal adenocarcinoma. METHODS: we conducted a retrospective study with 174 consecutive patients diagnosed with rectal tumors, of whom 92 underwent anterior resection of the rectum with coloanal or colorectal anastomosis and protective ileostomy, with curative intent. We carried out a multivariate analysis to determine the factors associated with definite permanence of the stoma, as well as studied the morbidity of patients who underwent bowel continuity restoration. RESULTS: In the 84-month follow-up period, 54 of the 92 patients evaluated (58.7%) had the ileostomy closed and 38 (41.3%) remained with the stoma. Among the 62 patients who had the ileostomy closed, 11 (17.7%) presented some type of postoperative complication: three had ileal anastomosis dehiscence, five had intestinal obstruction, two had surgical wound infection, and one, pneumonia. Eight of these patients required a new stoma. CONCLUSION: according to the multivariate analysis, the factors associated with stoma permanence were anastomotic fistula, presence of metastases and closure of the ileostomy during chemotherapy.

OBJETIVO: avaliar os fatores associados ao não fechamento de ileostomia protetora após ressecção anterior do reto com excisão total do mesorreto por câncer retal, a morbidade associada ao fechamento destas ileostomias e a taxa de estomia permanente em pacientes com adenocarcinoma retal. MÉTODOS: estudo retrospectivo de 174 pacientes consecutivos com diagnóstico de tumores retais, dos quais 92 foram submetidos à ressecção anterior do reto com intenção curativa, anastomose coloanal ou colorretal e ileostomia de proteção. Foi realizada análise multivariada visando a determinar os fatores associados à permanência definitiva da estomia, assim como o estudo da morbidade nos que se submeteram à reconstrução do trânsito. RESULTADOS: no período de seguimento de 84 meses, 54 dos 92 pacientes avaliados (58,7%) tiveram a ileostomia fechada e 38 (41,3%) permaneceram com a estomia. Entre os 62 pacientes que tiveram a ileostomia fechada, 11 (17,7%) apresentaram algum tipo de complicação pós-operatória: três com deiscência de anastomose ileal, cinco com obstrução intestinal, dois com infecção de ferida operatória e um com pneumonia. Oito destes pacientes necessitaram de um novo estoma. CONCLUSÃO: de acordo com a análise multivariada, os fatores associados à permanência da estomia foram fístula de anastomose, presença de metástases e fechamento da ileostomia durante quimioterapia.

Recognition and control of hypertension, diabetes, and dyslipidemia in patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) patients have a high risk for cardiovascular events, but few studies have evaluated the recognition and none have evaluated the control of cardiovascular risk factors (RF) in SLE patients. The study aims to describe the recognition and control frequencies of systemic arterial hypertension (SAH), dyslipidemia, and diabetes mellitus (DM) in SLE patients. Of the female patients with SLE, 137 answered a questionnaire focused on general knowledge of the RF for coronary artery disease (CAD) and on recognition of the risk factors that they possess. The patient's information collected on a structured medical record was reviewed to evaluate the RF control. The mean age was 29.1 (9.6) years. Seventy patients had SAH; 85.7% recognized their condition and 71.4% had desirable blood pressure (BP) control (< 140 × 90 mmHg). From a group of 63 patients with dyslipidemia, 68.3% recognized that they had dyslipidemia and 69.8% had desirable LDL-cholesterol (< 130 mg/dL). Sixteen patients had DM; 87.5% admitted being diabetic and 50.0% had desirable glycemic control (HbA1C < 7%). Most patients were aware of presenting SAH, DM, or dyslipidemia, and the recognition frequency was higher in comparison to general population. The SAH and dyslipidemia control frequencies were higher than that described for the general population.

Recognition and control of hypertension, diabetes, and dyslipidemia in patients with rheumatoid arthritis.

Absolute cardiovascular risk of an individual with rheumatoid arthritis (RA) is greater when compared to the general population, and several factors have proven to be important for the development of coronary artery disease (CAD) in these patients, including factors related to the underlying disease, such as the systemic inflammatory response, drugs used in its treatment, and a higher prevalence of traditional risk factors for CAD. Our aim is to describe the recognition and control frequencies of systemic arterial hypertension (SAH), dyslipidemia, and diabetes mellitus (DM) in RA patients. Patients with RA answered a questionnaire focused on their general knowledge of the risk factors for CAD, as well as on the recognition of the risk factors that they possess. The patient's information, collected from a structured medical record, was reviewed to evaluate the control of risk factors. Hundred and thirty-four patients were included in the study. One patient was excluded due to the impossibility of reviewing her medical records. Therefore, 133 patients remained in the study. Patients had a mean (SD) age of 57.3 (12.9) years. SAH was diagnosed in 88 subjects, with a recognition frequency of 89.8%, and 63.3% had desirable blood pressure control. Seventy-two patients were diagnosed with dyslipidemia; 68.1% recognized that they had dyslipidemia and 69.4% achieved desirable LDL-c control. Twenty-two patients had DM; 90.9% admitted being diabetic and 40.9% had desirable glycemic control. The frequencies of the CAD risk factor recognition and control were high in comparison to those described for the general population.

Fatores associados a não reconstrução do trânsito intestinal em pacientes com câncer retal submetidos à ressecção anterior do reto e ileostomia de proteção / Factors preventing restoration of bowel continuity in patients with rectal cancer submitted to anterior rectal resection and protective ileostomy

RESUMO Objetivo: avaliar os fatores associados ao não fechamento de ileostomia protetora após ressecção anterior do reto com excisão total do mesorreto por câncer retal, a morbidade associada ao fechamento destas ileostomias e a taxa de estomia permanente em pacientes com adenocarcinoma retal. Métodos: estudo retrospectivo de 174 pacientes consecutivos com diagnóstico de tumores retais, dos quais 92 foram submetidos à ressecção anterior do reto com intenção curativa, anastomose coloanal ou colorretal e ileostomia de proteção. Foi realizada análise multivariada visando a determinar os fatores associados à permanência definitiva da estomia, assim como o estudo da morbidade nos que se submeteram à reconstrução do trânsito. Resultados: no período de seguimento de 84 meses, 54 dos 92 pacientes avaliados (58,7%) tiveram a ileostomia fechada e 38 (41,3%) permaneceram com a estomia. Entre os 62 pacientes que tiveram a ileostomia fechada, 11 (17,7%) apresentaram algum tipo de complicação pós-operatória: três com deiscência de anastomose ileal, cinco com obstrução intestinal, dois com infecção de ferida operatória e um com pneumonia. Oito destes pacientes necessitaram de um novo estoma. Conclusão: de acordo com a análise multivariada, os fatores associados à permanência da estomia foram fístula de anastomose, presença de metástases e fechamento da ileostomia durante quimioterapia.

ABSTRACT Objective: to evaluate the factors associated with non-closure of protective ileostomy after anterior resection of the rectum with total mesorectum excision for rectal cancer, the morbidity associated with the closure of ileostomies and the rate of permanent ileostomy in patients with rectal adenocarcinoma. Methods: we conducted a retrospective study with 174 consecutive patients diagnosed with rectal tumors, of whom 92 underwent anterior resection of the rectum with coloanal or colorectal anastomosis and protective ileostomy, with curative intent. We carried out a multivariate analysis to determine the factors associated with definite permanence of the stoma, as well as studied the morbidity of patients who underwent bowel continuity restoration. Results: In the 84-month follow-up period, 54 of the 92 patients evaluated (58.7%) had the ileostomy closed and 38 (41.3%) remained with the stoma. Among the 62 patients who had the ileostomy closed, 11 (17.7%) presented some type of postoperative complication: three had ileal anastomosis dehiscence, five had intestinal obstruction, two had surgical wound infection, and one, pneumonia. Eight of these patients required a new stoma. Conclusion: according to the multivariate analysis, the factors associated with stoma permanence were anastomotic fistula, presence of metastases and closure of the ileostomy during chemotherapy.

Prevalence of fungemia in a tertiary hospital: Analysis of the last decade.

INTRODUCTION: The prevalence of nosocomial fungemia has increased worldwide, and mortality caused by this disease is high. OBJECTIVE: To assess progress in the last decade, and the prevalence and profile of fungal agents isolated in blood cultures performed in a tertiary university hospital. METHOD: All the results of blood cultures processed at Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG), in the time intervals 2001-2003 and 2011-2013 were analyzed retrospectively. For each three-year period, the number of collected blood cultures, the overall positivity rate and the percentage of fungemia were recorded. In addition, all identified fungal species were cataloged. All blood samples were incubated in the BacT/ALERT® (bioMérieux) automation system. RESULTS: In 2001-2003, 34,822 samples were evaluated, with 5,510 (15.8%) positive results. In 2011-2013, the number of blood cultures processed increased to 55,052 samples, with 4,873 (8.9%) positive results. There was an increase in the number of positive cultures for fungi in the analyzed period (2001-2003: 4.16%; 2011-2013: 5.95%; p<0.001). Among the agents, candidemias were predominant, especially those caused by non-albicans Candida species (2001-2003: 57.64%; 2011-2013: 65.17%; p<0.05). There was also an increase in fungemia caused by other genera (2001-2003: 2.62%; 2011-2013: 4.48%; p<0.01). CONCLUSION: There was an increase in the prevalence of fungemia in the last decade at HC-UFMG. Although candidemias have been responsible for most of the cases, there has been an increase in fungemias caused by other species.

Prevalence of fungemia in a tertiary hospital: Analysis of the last decade / Prevalência de fungemia em um hospital terciário: análise da última década

Summary Introduction: The prevalence of nosocomial fungemia has increased worldwide, and mortality caused by this disease is high. Objective: To assess progress in the last decade, and the prevalence and profile of fungal agents isolated in blood cultures performed in a tertiary university hospital. Method: All the results of blood cultures processed at Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG), in the time intervals 2001-2003 and 2011-2013 were analyzed retrospectively. For each three-year period, the number of collected blood cultures, the overall positivity rate and the percentage of fungemia were recorded. In addition, all identified fungal species were cataloged. All blood samples were incubated in the BacT/ALERT® (bioMérieux) automation system. Results: In 2001-2003, 34,822 samples were evaluated, with 5,510 (15.8%) positive results. In 2011-2013, the number of blood cultures processed increased to 55,052 samples, with 4,873 (8.9%) positive results. There was an increase in the number of positive cultures for fungi in the analyzed period (2001-2003: 4.16%; 2011-2013: 5.95%; p<0.001). Among the agents, candidemias were predominant, especially those caused by non-albicans Candida species (2001-2003: 57.64%; 2011-2013: 65.17%; p<0.05). There was also an increase in fungemia caused by other genera (2001-2003: 2.62%; 2011-2013: 4.48%; p<0.01). Conclusion: There was an increase in the prevalence of fungemia in the last decade at HC-UFMG. Although candidemias have been responsible for most of the cases, there has been an increase in fungemias caused by other species.

Resumo Introdução: a prevalência de fungemia hospitalar tem aumentado em todo o mundo e a mortalidade por essa afecção é elevada. Objetivo: avaliar a evolução, na última década, da prevalência e do perfil dos agentes fúngicos isolados em hemoculturas realizadas em um hospital universitário terciário. Método: foram analisados retrospectivamente todos os resultados de hemocultura processados no Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), entre os períodos de 2001-2003 e de 2011-2013. Para cada triênio foram registrados o número de hemoculturas coletadas, o percentual de positividade geral e o percentual de fungemia. Também foram catalogadas todas as espécies fúngicas identificadas. Todas as amostras sanguíneas foram incubadas no sistema de automação BacT/ALERT® (bioMérieux). Resultados: entre 2001-2003, foram avaliadas 34.822 amostras, sendo 5.510 (15,8%) positivas. Entre 2011-2013, o número de hemoculturas processadas aumentou para 55.052 amostras, sendo 4.873 (8,9%) positivas. Observou-se um aumento do número de culturas positivas para fungos no período analisado (2001-2003: 4,16%; 2011-2013: 5,95%; p<0,001). Dentre os agentes, as candidemias foram predominantes, principalmente por espécies de Candida não albicans (2001-2003: 57,64%; 2011-2013: 65,17%; p<0,05). Houve também aumento da fungemia por outros gêneros (2001-2003: 2,62%; 2011-2013: 4,48%; p<0,01). Conclusão: houve aumento da prevalência de fungemia na última década no HC-UFMG. Embora as candidemias tenham sido responsáveis pela maioria dos casos, houve aumento de fungemias causadas por outras espécies.

Fibra dietética e gordura saturada: relação entre marcadores bioquímicos da síndrome metabólica / Dietary fiber and saturated fat: relation between biochemical markers of metabolic syndrome

Aims: To relate the consumption of dietary fiber and saturated fat to biochemical markers in individuals with metabolic syndrome.Methods: The database of this cross-sectional study consisted of both male and female adults diagnosed with metabolic syndrome, according to the National Cholesterol Education Program's Adult Treatment Panel III, who participated in a study at the Pontifical Catholic University of Rio Grande do Sul. Data on all individuals registered at baseline who had complete information about their food intake were used. Consumption of dietary fiber and saturated fat was calculated based on the information provided by a 24-hour recall survey and a two-day food record. We evaluated the subjects in general and stratified by gender. The data were analyzed using descriptive statistics and the Student's t test. The correlation between fiber and saturated fat intake and biochemical markers was measured by Pearson's correlation coefficient. The significance level was set at 5%.Results: There were 79 individuals whose records contained complete information and who were eventually included in the study. A significant positive correlation was observed between saturated fat intake and serum triglyceride levels (r=0.30; p=0.008) and between saturated fat intake and insulin (r=0.26; p=0.021). Also, a significant inverse correlation was observed between fiber intake and serum levels of HDL cholesterol (r=-0.28; p=0.011). When stratified by gender, the positive correlation between consumption of saturated fat and triglycerides remained significant only among men (r=0.44; p=0.034).Conclusions: In this population diagnosed with metabolic syndrome, lower levels of HDL cholesterol were found in individuals who referred higher intake of dietary fiber, while individuals who reported elevated consumption of saturated fat had higher levels of insulin and triglycerides. In the gender-stratified analysis, positive correlation was found only between saturated fat consumption and serum triglyceride levels in men.

Objetivos: Relacionar o consumo de fibra alimentar e de gordura saturada com marcadores bioquímicos em indivíduos portadores de síndrome metabólica.Métodos: A base de dados deste estudo transversal foi formada por adultos de ambos os sexos com diagnóstico de síndrome metabólica conforme o National Cholesterol Education Program's Adult Treatment Panel III, participantes de um estudo realizado na Pontifícia Universidade Católica do Rio Grande do Sul. Foram utilizados os dados de todos os indivíduos cadastrados na linha de base que possuíam informações completas sobre o consumo alimentar. O consumo de fibra alimentar e de gordura saturada foi apurado a partir das informações obtidas de um recordatório alimentar 24 horas e de um registro alimentar de dois dias. Foram avaliados os sujeitos de forma geral e estratificados por sexo. A análise de dados foi realizada por estatística descritiva e teste t de Student. A correlação entre o consumo de fibras e de gordura saturada com marcadores bioquímicos foi obtida através do coeficiente de correlação de Pearson. Foi utilizado nível de significância de 5%.Resultados: Foram encontrados 79 indivíduos cujos registros continham as informações completas, sendo incluídos no estudo. Observou-se correlação positiva significativa do consumo de gordura saturada com níveis séricos de triglicerídeos (r=0,30; p=0,008) e com insulina (r=0,26; p=0,021). Além disso, observou-se correlação inversa significativa entre consumo de fibras e níveis séricos de HDL-colesterol (r=-0,28; p=0,011). Quando estratificados os indivíduos por sexo, observou-se que a correlação positiva entre consumo de gordura saturada e nível de triglicerídeos manteve-se significativa apenas entre os homens (r=0,44; p=0,034).Conclusões: Nessa população com diagnóstico de síndrome metabólica, foram encontrados níveis mais baixos de HDL-colesterol nos indivíduos que referiam maior consumo de fibra alimentar, enquanto os indivíduos que relataram elevado consumo de gordura saturada tiveram níveis mais altos de insulina e de triglicerídeos. Na análise estratificada por sexo, correlação positiva foi encontrada apenas entre consumo de gordura saturada e níveis séricos de triglicerídeos em homens.

Caracterización del síndrome de burnout en amas de casa residentes en el barrio rodrigo de bastidas de la ciudad de santa marta, colombia / Characterization of burnout syndrome in housewives who sit in the neighborhood rodrigo de bastidas in the city of santa marta, colombia

El síndrome de Burnout en amas de casa puede afectar la salud y la calidad de vida de esta población; lo anterior puede generar patologías y disfunción familiar. En este artículo se presentan los resultados de una investigación cuyo objetivo fue identificar y describir la presencia del síndrome de Burnout en amas de casa. Igualmente se estableció la relación existente entre el nivel sociocultural, el estado civil y la edad con la aparición del Burnout en amas de casa residentes del barrio Rodrigo de Bastidas en la ciudad de Santa Marta. Este estudio se desarrolló, a partir de la aplicación a 203 amas de casa quienes fueron seleccionadas de forma aleatoria, del Cuestionario de Burnout para Amas de Casa y una ficha sociodemográfica y se compararon los resultados. Estos mostraron que el 11,3 % estaban afectadas por el síndrome. Las edades oscilaban entre los 41 y 60 años y ellas ejercían labores domésticas desde hacía 1 a 30 años. La mayoría estaba casada o en unión libre y mostraron mayor nivel de cansancio emocional; lo que puede atribuirse al doble papel desempeñado: madres y trabajadoras. Así mismo un grupo significativo pertenecía a familias nucleares o extensas; por lo tanto, estas podían experimentar mayores estresores familiares.

Burnout Syndrome in housewives can affect the health and quality of life of this population; this can generate diseases and family dysfunction. This article presents the results of an investigation whose aim was to identify and describe the presence of the Burnout Syndrome in housewives. Also was established the relationship between the socio-cultural level, marital status and age with the appearance of the Burnout in housewives who sit in the neighborhood Rodrigo de Bastidas in the city of Santa Marta. This study developed, from the application to 203 housewives who were selected randomly, of Burnout questionnaire for housewives and one tab socio-demographic and the results were compared. These showed that 11.3% were affected by the syndrome. The ages ranged between 41 and 60 years and they exerted housework for one to thirty years. The majority was married or in common-law union and they showed a higher level of emotional exhaustion; this can be attributed to the double role: mothers and workers. Likewise a significant group belonged to nuclear or extensive families; these could therefore experience greater family stressors.

The role of immunohistochemistry in the detection of vascular invasion in specimens of endoscopic submucosal dissection / O papel da imuno-histoquímica na detecção de invasão vascular em espécimes de dissecção endoscópica da submucosa

INTRODUCTION: Endoscopic submucosal dissection (ESD) of early neoplasias of the gastrointestinal tract (GIT) has been increasingly applied as an alternative to invasive surgical procedures, with the aim to preserve the patient's organ and quality of life, although it does not allow the histopathological analysis of lymph nodes. Previous studies demonstrated that the presence of neoplastic emboli in lymphatic (lymphatic vascular invasion [LVI]) or blood vessels (blood vascular invasion [BVI]) is considered a positive predictive factor for the occurrence of lymph node metastasis. The assessment of vascular invasion carried out only by routine hematoxylin and eosin staining (HE) may yield both falsepositive and false-negative results. D2-40 is a specific monoclonal antibody to the lymphatic endothelium. Thus, it is useful for identifying LVI and distinguishing if tumor embolization is found in blood or lymphatic vessels. OBJECTIVE: To determine the role of immunohistochemistry (IHC) in the assessment of ESD specimens by comparing the detection of LVI and BVI by HE and IHC with D2-40 and CD34 immunolabeling. METHOD: We conducted the IHC study using D2-40 and CD34 markers (pan-endothelial) in 30 cases of ESD with histological diagnosis of carcinoma in order to assess the presence of LVI and BVI. RESULTS: The detection of LVI was more prevalent than BVI. Three out of six cases with LVI were false-positive by HE and six were false-negative by IHC. Regarding BVI, five cases were identified and one was false-negative by IHC. CONCLUSION: Our results indicated that the histopathological analysis of ESD specimens by exclusively routine HE staining does not allow proper evaluation of BVI or LVI.

INTRODUÇÃO: A dissecção endoscópica da submucosa (DES) de neoplasias precoces do trato gastrointestinal (TGI) tem sido cada vez mais aplicada como alternativa aos procedimentos cirúrgicos invasivos, visando a preservar o órgão e a qualidade de vida do paciente, contudo, não possibilita a avaliação histopatológica de linfonodos. Estudos anteriores demonstraram que a presença de êmbolos neoplásicos, em vasos linfáticos (invasão vascular linfática [IVL]) ou sanguíneos (invasão vascular sanguínea [IVS]), é considerada um fator preditivo positivo para ocorrência de metástase linfonodal. A avaliação da invasão vascular realizada apenas pela coloração de rotina hematoxilina e eosina (HE) pode gerar resultados falso-positivos e falso-negativos. O D2-40 é um anticorpo monoclonal específico para endotélio linfático, sendo, portanto, útil para identificar IVL e distinguir se a embolização tumoral encontra-se em vasos sanguíneos ou linfáticos. OBJETIVO: Determinar o papel do estudo imuno-histoquímico (IHQ) na avaliação de espécimes de DES, comparando a detecção de IVL e IVS, pelo HE e IHQ com marcação por D2-40 e CD34. MÉTODO: Foi realizado estudo IHQ utilizando os marcadores D2-40 e CD34 (pan-endotelial) em 30 casos de produtos de DES com diagnóstico histológico de carcinoma para avaliar a presença de IVL e IVS. RESULTADOS: A detecção de IVL foi maior que a de IVS. Dos seis casos com IVL ao HE, três eram falso-positivos e seis, falso-negativos à IHQ. Em relação à IVS, foram identificados cinco casos falsopositivos e um falso-negativo à IHQ. CONCLUSÃO: Nossos resultados indicaram que a análise histopatológica dos produtos de DES realizando apenas a coloração HE não permite a avaliação adequada da presença de IVS ou IVL.

Non-invasive endothelial function assessment in patients with neurofibromatosis type 1: a cross-sectional study.

BACKGROUND: Neurofibromatosis type 1 (NF1) is a multi-systemic disease caused by neurofibromin deficiency. The reduced life expectancy of patients with NF1 has been attributed to NF1-associated malignant neoplasms. However, an analysis of death certificates in the USA suggests that vascular disease could be an important cause of early death among these patients. Endothelial dysfunction (ED) is related to vasculopathy and is an early marker of subclinical atherosclerosis. Since neurofibromin has already been demonstrated to affect endothelial cell function, ED may be associated with NF1. The purpose of this study was to assess endothelial function in patients with NF1 using a non-invasive method. METHODS: NF1 patients and healthy control subjects, aged 18 to 35 years, were included. Subjects were excluded if they had any risk factor for vascular disease or any other condition known to affect endothelial function. Endothelial function was assessed using reactive hyperemia-peripheral arterial tone (RH-PAT) technology. ED was defined as a reactive hyperemia index (RHI) lower than 1.35. RESULTS: Four of the 29 (13.8%) NF1 patients and 1 of the 30 (3.3%) healthy volunteers had ED (p=0.153). RHI medians and interquartile intervals were 1.8 (1.58-2.43) for the NF1 group and 2.02 (1.74-2.49) for the control group (p=0.361). CONCLUSION: The prevalence of ED was similar in NF1 patients and healthy controls.

Factores motivacionales que influyen en las personas que deciden someterse a rinoplastía en el Centro de Cirugía Plástica Ciplast Estetic, 2012 / Motivational factors that influece people that decide to undergo rhinoplasty in the Center of Plastic Surgery Ciplast Estetic. 2012

Antecedentes: Históricamente los médicos han restado importancia a los factores que motivan a las personas a recurrir a una cirugía plástica. El número de cirugías plásticas realizadas continúa creciendo cada año, pero los factores motivacionales en las personas aún no han sido conceptualizados y cuantificados objetivamente. El presente estudio busca establecer los factores motivacionales de las personas que deciden someterse a rinoplastía. Metodología: Se realizó un estudio descriptivo, observacional, cuantitativo, prospectivo y transversal. Entre enero y diciembre del año 2012, se aplicó un cuestionario a las 64 pacientes que acudieron al Centro de Cirugía Plástica CIPLAST ESTETIC para una rinoplastia. Resultados: El factor psicológico que motiva a las pacientes a someterse a rinoplastía es la imagen corporal. La autoestima no resultó ser un factor motivacional. La influencia social, como por ejemplo la historia de burlas, la opinión de los compañeros, padres y familia; y la influencia cultural, como por ejemplo los medios de comunicación y la opinión pública, son factores motivacionales socioculturales de las personas que deciden someterse a rinoplastia. Conclusiones: Se encontró que la imagen corporal constituye un factor motivacional psicológico, a diferencia de la autoestima. Adicionalmente, los factores socioculturales (influencia social y cultural) quedaron demostrados como factores motivacionales en las personas que deciden someterse a rinoplastia.

Background: Historically doctors have neglected the importance of the factors that motivate people to undertake plastic surgery. The number of plastic surgery procedures grows every year, but the motivational factors in people have not yet been conceptualized and quantified objectively. This study seeks to establish the motivational factors of people who decide to undergo a rhinoplasty. Method: We performed a descriptive, observational, quantitative, prospective, cross-sectional study. During January and December 2012, a questionnaire was administered to 64 patients who went to the Plastic Surgery Center CIPLAST ESTETIC for a rhinoplasty. Results: The psychological factor that motivates people to undergo a rhinoplasty is the body image. The self-esteem proved not to be a motivational factor. The social influence, as for example the teasing story and the opinion of peers, parents and relatives; as well as the cultural influence, as for example the media and the public opinion are motivational factors in people who decide to undergo Rhinoplasty. Conclusions: We found that the body image is a psychological motivational factor, unlike the self-esteem. In addition, the sociocultural factors (social- and cultural influence) were demonstrated as motivational factors in people who decide to undergo Rhinoplasty.

Actinomycosis mimicking colonic neoplasia

Actinomycosis is a rare inflammatory disease caused by Actinomyces israelii. It can mimic many other diseases, such as malignant neoplasms or inflammatory bowel disease. We present a case in which actinomycosis simulated a colonic neoplasia. (AU)

Actinomicose é uma doença inflamatória rara, causada pelo agente Actinomyces israelii. Pode mimetizar várias outras entidades, como neoplasias malignas e doenças inflamatórias intestinais. Relatamos aqui um caso, no qual a actinomicose simulou neoplasia cólica. (AU)

Role of SOCS2 in modulating heart damage and function in a murine model of acute Chagas disease.

Infection with Trypanosoma cruzi induces inflammation, which limits parasite proliferation but may result in chagasic heart disease. Suppressor of cytokine signaling 2 (SOCS2) is a regulator of immune responses and may therefore participate in the pathogenesis of T. cruzi infection. SOCS2 is expressed during T. cruzi infection, and its expression is partially reduced in infected 5-lipoxygenase-deficient [knockout (KO)] mice. In SOCS2 KO mice, there was a reduction in both parasitemia and the expression of interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), IL-6, IL-10, SOCS1, and SOCS3 in the spleen. Expression of IFN-γ, TNF-α, SOCS1, and SOCS3 was also reduced in the hearts of infected SOCS2 KO mice. There was an increase in the generation and expansion of T regulatory (Treg) cells and a decrease in the number of memory cells in T. cruzi-infected SOCS2 KO mice. Levels of lipoxinA(4) (LXA(4)) increased in these mice. Echocardiography studies demonstrated an impairment of cardiac function in T. cruzi-infected SOCS2 KO mice. There were also changes in calcium handling and in action potential waveforms, and reduced outward potassium currents in isolated cardiac myocytes. Our data suggest that reductions of inflammation and parasitemia in infected SOCS2-deficient mice may be secondary to the increases in Treg cells and LXA(4) levels. This occurs at the cost of greater infection-associated heart dysfunction, highlighting the relevance of balanced inflammatory and immune responses in preventing severe T. cruzi-induced disease.

Satisfacción post operatoria de los pacientes sometidas a rinoplastías y blefaroplastías en relación a sus expectativas: Centro de Cirugía Plástica Ciplast Estetic, 2011 / Post-surgery satisfaction of the patients who underwent rhinoplasties and blepharoplasties in relation to their expectations in the Plastic Chirurgical Center Ciplast Estetic in the period January-August 2011

Objetivos: Determinar el nivel de satisfacción post operatoria de los pacientes sometidos a rinoplastias y blefaroplastias en relación a sus expectativas en el centro de cirugía plástica "Ciplast Estetic" en el periodo Enero a Agosto del 2011. Metodología: Se realizó un estudio observacional, descriptivo, prospectivo y transversal. Se encuestaron a 79 pacientes sometidos a blefaroplastia y rinoplastia en el periodo comprendido entre Enero y Agosto del 2011. Resultados: La mayoría de pacientes eran del sexo femenino en un 92.4 por cientode los casos, y la media de la edad fue de 36.05+/-14.4 años; siendo la mínima edad de 27 años y la máxima de 73 años. El 91.1 por ciento de los pacientes tenían nivel de estudio superior universitario. En resumen observamos que hubo una mayor frecuencia de alto nivel de satisfacción en las dimensiones infraestructura (64.6 por ciento) y capacidad de respuesta (59.5 por ciento); y de un mediano nivel de satisfacción en la dimensión fiabilidad (5l.9 por ciento) y seguridad (49.4 por ciento). Conclusiones: Existe un alto nivel de satisfacción post operatoria de los pacientes sometidos a rinoplastias y blefaroplastias en relación a sus expectativas en el centro de cirugía plástica "Ciplast Estetic" en el periodo Enero a Agosto del 2011.

Objective: To determine the level of post-surgery satisfaction of the patients who underwent rhinoplasties and blepharoplasties in relation to their expectations in the Plastic Chirurgical Center "Ciplast Estetic" in the period January-August 2011. Methodology: An observational, descriptive, prospective and transversal study was performed. We survey 79 patients who underwent blepharoplasty and rhinoplasty in the period between January and August 2011. Results: The majority of the patients were female, 92.2 per cent of the cases, and the average age was 36.05+/-14.4 years. The minimal age was 18 years and the maximum was 73 years. The 91.1 per cent of the patients had a university degree. In summary, we observed that there was a high satisfaction in the dimensions of infrastructure (64.6 per cent) and capacity response (59.5 per cent) and a medium level of satisfaction in the dimensions of reliability (5l.9 per cent) and in the dimensions of security (49.4 per cent). Conclusions: There is a high level of post operatory satisfaction on the patients undergoing rhinoplasty and blepharoplasty in relation with their expectations from January to August 2011.

Iron, folate and vitamin B12 parameters in HIV-1 infected patients with anaemia in southern Brazil.

We conducted a study to determine the role of iron, folate and vitamin B12 in HIV-infected patients with anaemia attending a tertiary-care hospital in southern Brazil. Low serum folate levels were found in 14 (41%) HIV-infected patients; parameters of iron deficiency such as low transferring saturation index and ferritin in 10 (30%); and combined folate and iron deficiency in five (14%). Vitamin B12 deficiency was found in only two (6%) patients who presented with mean corpuscular volumes within the normal range. Our study has shown that folate and iron deficiency were frequently detected in HIV-infected patients at our institution, and should be considered in the differential diagnosis of anaemia in all HIV-infected patients independent of their HIV stage of progression.