Caring for a patient with chronic liver disease involves exposure to factors that increase family caregivers’ vulnerability to developing mental disorders. This study reassessed the scores of burden, ...stress, and depression in informal (family) caregivers of patients with liver disease after liver transplant.
In this observational and descriptive study, the caregivers were reassessed for the same outcomes 4 to 10 years following the initial assessment pre-transplant. The data were obtained from the identification card, the interview script, the Brazilian version of the Caregiver Burden Scale, the Lipp Inventory of Stress Symptoms for Adults, and the Beck Depression Inventory. Descriptive statistics of pre- and post-liver transplant phases were calculated, and the Wilcoxon signed rank test was used to compare the burden scores.
The 5 caregivers were women, with a mean age of 51.6 (SD, 8.38) years. All of the caregivers’ (100%) burden score increased, 2 caregivers needed to seek some form of help, and 3 caregivers showed an indication of burden risk. Regarding stress symptoms, 3 caregivers (60%) maintained a score indicating no stress, 2 caregivers (40%) presented increased scores, and the predominant symptoms changed from psychological to physical. Regarding depression, 3 caregivers (60%) maintained the minimum level of symptoms for depression, and 2 caregivers (40%) presented increased scores.
After liver transplant, caregivers’ burden scores increased, and levels of stress and depression increased for caregivers who already showed symptoms in the pre-transplant phase.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Hepatocellular carcinoma (HCC) is the most common primary neoplasia of the liver. Major risk factors for hepatocellular carcinoma include chronic liver diseases, carcinogenic agents, and genetic ...alterations as well as vascular endothelial growth factor (VEGF) involved in angiogenesis process. The aim of this study was to evaluate the association of VEGF-A (C936T and A1154G) with HCC and cirrhosis, in addition to serum levels of VEGF, clinical profile, lifestyle habits, and comorbidities. A total of 346 individuals were studied: 102 with HCC (G1), 117 with cirrhosis (G2), and 127 controls (G3). Polymorphisms were analysed by PCR/RFLP and serum levels of VEGF by ELISA. Alpha error was set at 5%. The wild-type genotype of both polymorphisms prevailed ( P > 0.05 ). In G1, 23% of the patients died, with no relation to genetic profile ( P > 0.05 ). Increased VEGF level was observed in G1 and G3, related to the mutant allele of VEGF-C936T and VEGF-A1154G, respectively, and compared with the wild-type genotype ( P = 0.0285 ; P = 0.0284 , resp.) as well as G1 versus G2 and G3 for VEGF-C936T and G1 versus G2 for VEGF-A1154G ( P < 0.05 for both). In conclusion, there is a relationship between mutant alleles of VEGF-C936T and VEGF-A1154G polymorphisms and higher VEGF level, making them potential markers for HCC.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Objetivos: Existem poucos dados sobre as alterações orgânicas após uma ingestão aguda de álcool por estudantes, de modo que o objetivo do presente estudo foi verificar se há alterações nas enzimas ...hepáticas e nos marcadores renais, assim como avaliar o estresse oxidativo após a ingestão aguda de álcool em estudantes de medicina após festas. Métodos: Duas amostras de sangue foram coletadas antes e após o consumo de álcool em 74 estudantes do 1º ao 8º semestre do curso de medicina. Marcadores de estresse oxidativo TBARS (substâncias reativas ao ácido tiobarbitúrico) e TEAC (capacidade antioxidante), hepáticos (AST, ALT e GGT) e renais (creatinina e ureia) foram dosados por espectrofotometria. A ingestão média de álcool nas festas foi de 102,4 ± 70,0 g. Resultados: Não houve diferença significante nas concentrações sorológicas nos estudantes após a ingestão de álcool, quanto ao ALT, AST, GGT, creatinina e ureia. Porém, a ingestão de álcool reduziu a capacidade antioxidante no soro (p=0,042), mas não houve diferença na concentração de TBARS. Conclusões: O consumo agudo de álcool em festas não modifica parâmetros de função hepática e renal em estudantes de medicina. Entretanto, uma diminuída capacidade antioxidante é observada, o que sugere que o consumo agudo de álcool leva ao estresse oxidativo nesta população, com potencial dano hepático. Dessa forma, a longo prazo, é necessário avaliar os danos orgânicos e no desempenho acadêmico dos alunos em função desse consumo intermitente de álcool.
Objetivo: Analisar a efetividade do teste da International Osteoporosis Foundation (IOF) para as prevenções primária e secundária relacionadas aos fatores de risco para a osteoporose. Métodos: Estudo ...transversal realizado no interior de São Paulo, Brasil, durante a Campanha de Prevenção à Osteoporose realizada em outubro de 2016. Participaram 400 pessoas, selecionadas aleatoriamente, entrevistadas de acordo com o teste de um minuto para risco de osteoporose da IOF. A análise estatística utilizou o teste de Kolmogorov-Smirnov, o teste qui-quadrado de Pearson, o Mann-Whitney e a análise multivariada para fatores de risco associados à osteoporose pelo modelo de regressão logística binária. Os resultados foram apresentados em odds ratio, com intervalo de confiança de 95%. Resultados: A amostra foi composta por 260 mulheres e 140 homens, com mediana de 57 anos, e 95% indicaram possuir algum fator de risco. As questões com maior índice de positividade indicaram que ambos os sexos estão expostos à baixa exposição ao sol, à baixa ingesta de alimentos ricos em vitamina D (p=0,140) e ao hábito de atividades físicas por tempo inferior a 30 min (p=0,657). O índice de massa corporal (IMC) menor que 19kg/m2 (p=0,336) indicou menor positividade. A regressão logística mostrou associação entre quatro fatores de risco (densitometria óssea, queda por fraqueza, mudança de altura após os 40 anos e sexo) e a população em estudo acima de 60 anos. Conclusão: O teste da IOF se mostrou uma ferramenta funcional na promoção da saúde e atenção primária, podendo trazer benefícios socioeconômicos.
ABSTRACT Purpose: to describe the work of speech-language-hearing therapists and verify which was the most prevalent feeding method in the sample studied. Methods: a descriptive observational study ...based on data surveyed from medical records. The following variables were used: age, medical diagnosis, hospital ward, feeding method before and after the tracheostomy, time of speech-language-hearing care, and speech-language-hearing discharge. The data were submitted to descriptive statistical analysis with the appropriate tests to compare the categorical variables. All infants and children with tracheostomy performed either before or during hospital stay between July 2017 and July 2018, who received speech-language-hearing care upon request of the physician, were included. Results: a total of 51 children took part in the study, most of whom were males (56.9%), with a median age of 12 months, ranging from 1 month to 12 years old at the time of the speech-language-hearing assessment. The feeding methods at hospital discharge were described as follows: full oral feeding (37%), partial oral feeding (25.5%), nasogastric/nasoenteral tube (19.6%), and gastrostomy (17.6%). Conclusion: the full oral diet of tracheostomized children was the most prevalent feeding method at hospital speech-language-hearing discharge.
RESUMO Objetivo: descrever o trabalho fonoaudiológico e verificar qual forma de alimentação foi mais prevalente dentro da amostra estudada. Métodos: trata-se de um estudo observacional descritivo, realizado por meio de levantamento de dados nos prontuários, onde buscou-se as seguintes variáveis: idade, diagnóstico médico, setor de internação, forma de alimentação antes e após traqueostomia, período de atendimento fonoaudiológico e alta fonoaudiológica. Os dados foram submetidos à análise estatística descritiva, tendo sido utilizados testes pertinetes para a comparação de variáveis categóricas. Foram incluídos no estudo todos os lactentes e crianças traqueostomizadas com traqueostomia prévias ou realizadas durante internação, no período de julho de 2017 a julho de 2018, que receberam atendimento fonoaudiológico mediante solicitação médica. Resultados: cinquenta e uma crianças foram incluídas no estudo. A maioria das crianças era do sexo masculino (56,9%) e a idade mediana foi de 12 meses, com variação de 01 mês de vida a 12 anos de idade, no momento da avaliação fonoaudiológica. A forma de alimentação na alta fonoaudiológica hospitalar foi descrita em: via oral exclusiva (37%), via oral parcial (25,5%), sonda nasogástrica/nasoenteral (19,6%) e gastrostomia (17,6%). Conclusão: foi possível observar que a dieta por via oral de maneira exclusiva foi a forma de alimentação de maior prevalência na alta fonoaudiológica hospitalar.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background
information regarding histological progression of hepatitis C after renal transplant (RTx) is scarce.
Aims
To analyze clinical and laboratory evolution and histological progression of ...hepatitis C in patients evaluated before and after RTx.
Methods
Twenty‐two HCV‐infected patients submitted to liver biopsy pre‐ and post‐RTx were included. A semiquantitative analysis of necroinflammatory activity and fibrosis staging was performed and the two biopsies were compared.
Results
Patients were mostly men (73%) with mean age of 36 ± 9 yr. Time post‐transplant was 4 ± 2 yr and time between biopsies was 5 ± 2 yr. An elevation of alanine aminotransferase (p = 0.041) and aspartate aminotransferase (p = 0.004) levels was observed in the post‐transplant period. Fibrosis progression after renal transplantation was observed in 11 (50%) of the patients, and necroinflammatory activity worsening was observed in 7 (32%) of the patients. The histological progression occurred even among those without significant histological lesions in pre‐transplant biopsy.
Conclusion
The findings of this study suggest that the practice of indicating treatment in the pre‐transplant phase based mainly on histological disease should be revised, because a high proportion of patients present disease progression. Because interferon cannot be used safely after RTx, treatment should be indicated for all ESRD patients with hepatitis C.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
RESUMO Embora não seja obrigatória, a residência médica faz parte do processo de ensino e da formação dos médicos e é considerada padrão ouro na modalidade de ensino de pós-graduação lato sensu. ...Entretanto, o número de vagas para residência médica não acompanhou a expansão dos cursos de graduação em Medicina, gerando uma intensa disputa por uma vaga nos cursos de residência, o que fez proliferar os cursos preparatórios para os exames de residência (CP). A evasão do interno de Medicina de suas atividades acadêmicas para se dedicar às atividades dos cursinhos preparatórios para os exames de residência médica preocupa os docentes. Este estudo tem por objetivo traçar um perfil no internato da Faculdade de Medicina de São José do Rio Preto (Famerp) sobre a adesão dos internos aos CP. Os resultados apontam que a imensa maioria dos 297 alunos pesquisados pretende fazer residência médica e que apenas 27 alunos (84,4%) dos 32 que consideravam o curso de preparação necessário, mas não dispunham de recursos financeiros para frequentá-los. Os entrevistados afirmaram que a maior qualidade dos cursos preparatórios reside na didática das aulas e que a maior desvantagem destes é a dissociação entre conteúdo teórico e prático, também vivida no internato. Concluímos que a percepção dos internos e acadêmicos de Medicina é bem definida quanto aos cursinhos preparatórios para residência médica. Apesar de aderirem à prática destes cursinhos, sabem que há uma dicotomia entre a teoria e a prática oferecida no internato, o que prejudica a formação profissional. A grande maioria dos acadêmicos pesquisados pretende fazer a residência médica após o internato, dando continuidade aos estudos e ao aprendizado. Por outro lado, a atual conjuntura do mercado de trabalho na área da medicina, marcada por uma concorrência acirrada, e as exigências constantes de atualização e aperfeiçoamento levam os acadêmicos a verem na residência o único caminho natural após o internato e ainda uma alternativa para sanar as possíveis deficiências do internato. Mudanças na graduação sugeridas pelos pesquisados, como melhor didática em aulas da graduação e a abordagem de conteúdo teórico durante o internato, refletem a deficiência da graduação e do internato, a qual pode ser sanada com uma postura mais assertiva de professores e preceptores.
ABSTRACT Although not compulsory, medical residency is part through the physicians’ teaching and training process. It is considered the gold standard in the teaching modality of Lato Sensu Graduate Programs. However, the number of residency positions available has not kept pace with the expansion of medical undergraduate courses, resulting in high levels of competition for medical residency vacancies, and a proliferation of preparatory courses (PC) offering supervised postgraduate training. The evasion of clerkship students from their academic activities to take prep courses in order to apply for a residency position is a cause for concern among teachers. This study outlines a profile in the São José do Rio Preto (Famerp) School of Medicine internship programme regarding medical interns’ adherence to prep courses. The results indicate that the vast majority of the study sample (297 students) intended to apply for a medical residency program. Only 27 (84.4%) out of the 32 students, despite considering the prep course necessary, did not have the financial resources to attend these courses. The interviewees pointed out that the higher quality of prep courses is due to the didactics of the classes, but that the main disadvantage of these classes is the dissociation between the theoretical and practical content, also experienced during the internship. We conclude that the perceptions of the interns and medical students is well defined in relation to prep courses to get into a medical residency. Although they adhere to the practice of these courses, they know that there is a dichotomy between the theory and the practice that is offered in the internship, and that this hinders their professional training. The vast majority of the study sample intended to apply for the medical residency program after the internship, continuing their studies and learning. On the other hand, the current environment of the job market in the field of medicine, marked by fierce competition and constant requirements to update and improve, is leading students to view the medical residency as the only natural way to continue after the internship. They also see it as a way of making up for any shortfalls of the internship program. Changes in undergraduate courses, such as a better class didactics and the approach to theoretical content during the internship, reflect the deficiency of undergraduate courses and the internship program, but which can be remedied with a more assertive attitude on the part of teachers and preceptors.
AbstractBackground. HBV/HCV coinfection is a common finding among hemodialysis patients. However, there is scarce information concerning the impact of HBV coinfection on the response to treatment of ...HCV-infected patients on hemodialysis. Aim. We aimed to compare the rate of sustained virologic response (SVR) to treatment with interferon-alfa (IFN) between hemodialysis patients with HBV/HCV coinfection and those with HCV-monoinfection. Material and methods. HCV-infected patients on hemodialysis treated with IFN were included. Patients coinfected by HBV/HCV were compared to HCV-monoinfected patients, regarding clinical and biochemical features and rates of SVR. Results. One hundred and eleven patients were treated. HBV/HCV coinfection was observed in 18/111 patients (16%). Coinfected patients were younger (p = 002), had more time on dialysis (p = 0.05) and showed a tendency to present a higher prevalence of septal fibrosis (p = 0.06). The analysis by intention to treat showed SVR of 56% among coinfected patients and 18% in HCV-monoinfected patients (p = 0.004). Conclusion. In conclusion, end-stage renal disease patients with HBV/HCV coinfection exhibit higher rate of SVR to HCV treatment than HCV-monoinfected patients. It is possible that factors related to the host immune response and viral interaction could explain the better response observed among coinfected patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A fibromialgia (FM), doença caracterizada por dor musculoesquelética difusa acompanhada de outros sintomas não relacionados ao aparelho locomotor, apresenta prevalência no Brasil de 2,5%. Objetivo: ...avaliar a prática de atividade física, os sintomas de depressão e a qualidade de vida em pacientes com FM. Tipo de estudo: Estudo observacional retrospectivo. Método: Participaram do estudo 50 pacientes adultos com diagnóstico de FM de acordo com os critérios de classificação do American College of Rheumatology (ACR), sendo excluídos os que apresentaram comorbidades. Após aprovação do projeto pelo Comitê de Ética em Pesquisa, pacientes que compareceram à consulta de rotina em consultório privado de reumatologia e atenderam aos critérios de inclusão foram convidados a participar do estudo. A análise dos dados foi realizada por meio dos testes Kruskal-Wallis, Mann-Whitney e coeficiente de correlação de Pearson. Valores de P<0,05 foram considerados significantes. Resultados: Houve predominância do sexo feminino, idade média de 47 anos, etnia branca, estado civil casado e com filhos. O resultado da EVA variou entre 0 (n=9) a 8 (n=6). O FIQ variou entre 0 e 86,7 e o BDI total entre 0 e 26. A BDI-13 variou entre 0 e 22. Houve correlação positiva do escore do BDI-13 com o FIQ-total e do BDI-13 com o escore EVA. Conclusão: Os dados não sugerem impacto significativo da atividade física na melhora dos sintomas de dor, qualidade de vida e depressão em pacientes com fibromia
There is scarce information regarding clinical evolution of HBV infection in renal transplant patients.
To evaluate the prevalence of acute exacerbation in HBV-infected renal transplant patients and ...its association with the time after transplantation, presence of viral replication, clinical evolution, and use of antiviral prophylaxis.
HBV infected renal transplant patients who underwent regular follow-up visits at 6-month intervals were included in the study. The criteria adopted to characterize exacerbation were: ALT >5× ULN and/or >3× baseline level. Predictive factors of exacerbation evaluated were age, gender, time on dialysis, type of donor, post-transplant time, ALT, HBeAg, HBV-DNA, HCV-RNA, immunosuppressive therapy, and use of antiviral prophylaxis.
140 HBV-infected renal transplant patients were included (71% males; age 46±10 years; post-renal transplant time 8±5 years). During follow-up, 25% (35/140) of the patients presented exacerbation within 3.4±3 years after renal transplant. Viral replication was observed in all patients with exacerbation. Clinical and/or laboratory signs of hepatic insufficiency were present in 17% (6/35) of the patients. Three patients died as a consequence of liver failure. In univariate analysis variables associated with exacerbation were less frequent use of prophylactic/preemptive lamivudine and of mycophenolate mofetil. Lamivudine use was the only variable independently associated with exacerbation, with a protective effect.
Acute exacerbation was a frequent and severe event in HBV-infected renal transplant patients. Prophylactic/preemptive therapy with antiviral drugs should be indicated for all HBsAg-positive renal transplant patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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