Abstract In Malignant Hilar Biliary Stricture (MHBS) palliative biliary drainage is a frequent strategy, improving the quality of life, reducing pruritus, loss of appetite and relieving cholangitis. The endoscopic approach is an effective, although challenging procedure. This study aimed to evaluate technical and clinical success rates of biliary drainage by ERCP. This is a retrospective study including all patients with MHBS referred to Instituto do Cancer do Hospital de São Paulo (ICESP) submitted to biliary drainage by ERCP, between January 2010 and December 2017. Multivariable logistic regression was performed to evaluate predictors of clinical failure, as total bilirubin levels, Bismuth classification, number of hepatic sectors drained and presence of cholangitis. In total, 82 patients presenting unresectable MHBS were included in this study. 58.5% female and 41.5% male, with a mean age of 60±13 years. Bismuth classification grades II, IIIA, IIIB and IV were noted in 23.2%, 15.9%, 14.6% and 46.3%, respectively. Technical and clinical success was achieved in 92.7% and 53.7% respectively. At multivariable logistic-regression analyses, Bismuth IV strictures were related to higher clinical failure rates when compared to other strictures levels, with an Odds Ratio of 5.8 (95% CI 1.28‒20.88). In conclusion, endoscopic biliary drainage for malignant hilar biliary stricture had a high technical success but suboptimal clinical success rate. Proximal strictures (Bismuth IV) were associated with poor drainage outcomes.

Abstract Introduction Seasonal influenza A (H3N2) virus is an important cause of morbidity and mortality in the last 50 years in population that is greater than the impact of H1N1. Data assessing immunogenicity and safety of this virus component in juvenile systemic lupus erythematosus (JSLE) is lacking in the literature. Objective To evaluate short-term immunogenicity and safety of influenza A/Singapore (H3N2) vaccine in JSLE. Methods 24 consecutive JSLE patients and 29 healthy controls (HC) were vaccinated with influenza A/Singapore/ INFIMH-16-0019/2016(H3N2)-like virus. Influenza A (H3N2) seroprotection (SP), seroconversion (SC), geometric mean titers (GMT), factor increase in GMT (FI-GMT) titers were assessed before and 4 weeks post-vaccination. Disease activity, therapies and adverse events (AE) were also evaluated. Results JSLE patients and controls were comparable in current age [14.5 (10.1–18.3) vs. 14 (9–18.4) years, p = 0.448] and female sex [21 (87.5%) vs. 19 (65.5%), p = 0.108]. Before vaccination, JSLE and HC had comparable SP rates [22 (91.7%) vs. 25 (86.2%), p = 0.678] and GMT titers [102.3 (95% CI 75.0–139.4) vs. 109.6 (95% CI 68.2–176.2), p = 0.231]. At D30, JSLE and HC had similar immune response, since no differences were observed in SP [24 (100%) vs. 28 (96.6%), p = 1.000)], SC [4 (16.7%) vs. 9 (31.0%), p = 0.338), GMT [162.3 (132.9–198.3) vs. 208.1 (150.5–287.8), p = 0.143] and factor increase in GMT [1.6 (1.2–2.1) vs. 1.9 (1.4–2.5), p = 0.574]. SLEDAI-2K scores [2 (0–17) vs. 2 (0–17), p = 0.765] and therapies remained stable throughout the study. Further analysis of possible factors influencing vaccine immune response among JSLE patients demonstrated similar GMT between patients with SLEDAI < 4 compared to SLEDAI ≥ 4 ( p = 0.713), as well as between patients with and without current use of prednisone ( p = 0.420), azathioprine ( p = 1.0), mycophenolate mofetil ( p = 0.185), and methotrexate ( p = 0.095). No serious AE were reported in both groups and most of them were asymptomatic (58.3% vs. 44.8%, p = 0.958). Local and systemic AE were alike in both groups ( p > 0.05). Conclusion This is the first study that identified adequate immune protection against H3N2-influenza strain with additional vaccine-induced increment of immune response and an adequate safety profile in JSLE. ( www.clinicaltrials.gov , NCT03540823).

RESUMO: Introdução: O Escore Finlandês de Risco de Diabetes (FINDRISC) é um instrumento que inicialmente foi desenvolvido para predizer o risco de desenvolver diabetes mellitus tipo 2 em adultos. Esse instrumento é simples, rápido de aplicar, não invasivo e de baixo custo. Os objetivos deste estudo foram descrever o processo de tradução e adaptação transcultural do FINDRISC para o português do Brasil e avaliar a sua confiabilidade teste-reteste. Metodologia: O projeto foi conduzido de acordo com as recomendações dos Princípios de Boas Práticas para o Processo de Tradução e Adaptação Transcultural de Medidas de Resultados Relatados pelo Paciente desenvolvidas pela ISPOR. Uma vez desenvolvida a versão final em português brasileiro (FINDRISC-Br), realizou-se a avaliação da confiabilidade usando uma amostra não aleatória de 83 indivíduos atendidos em uma unidade de atenção básica. Cada participante foi entrevistado por nutricionistas registradas treinadas em duas ocasiões com intervalo médio de 14 dias. A avaliação da confiabilidade foi realizada por meio da análise do nível de concordância entre as respostas do teste-reteste, utilizando-se o coeficiente kappa de Cohen e o coeficiente de correlação intraclasse (CCI). Resultados: As etapas das diretrizes da ISPOR foram seguidas consecutivamente sem maiores problemas. Em relação à avaliação da confiabilidade do teste-reteste, o questionário como um todo apresentou confiabilidade adequada (kappa de Cohen = 0,82; IC95% 0,72 - 0,92 e CCI = 0,94; IC95% 0,91 - 0,96). Conclusão: O FINDRISC foi traduzido e adaptado transculturalmente para o português do Brasil seguindo procedimentos padronizados. O FINDRISC-Br já está disponível para uso e tem potencial para ser usado como ferramenta de rastreamento em diferentes cenários brasileiros.

ABSTRACT: Introduction: The Finnish Diabetes Risk Score (FINDRISC) is a tool that was initially developed to predict the risk of developing type 2 diabetes mellitus in adults. This tool is simple, quick to apply, non-invasive, and low-cost. The aims of this study were to perform a translation and cultural adaptation of the original version of FINDRISC into Brazilian Portuguese and to assess test-retest reliability. Methodology: This work was done following the ISPOR Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes Measures. Once the final Brazilian Portuguese version (FINDRISC-Br) was developed, the reliability assessment was performed using a non-random sample of 83 individuals attending a primary care health center. Each participant was interviewed by trained registered dieticians on two occasions with a mean interval of 14 days. The reliability assessment was performed by analyzing the level of agreement between the test-retest responses of FINDRISC-Br using Cohen’s kappa coefficient and the intraclass correlation coefficient (ICC). Results: The steps of ISPOR guidelines were consecutively followed without major problems. Regarding the reliability assessment, the questionnaire as a whole presented adequate reliability (Cohen’s kappa = 0.82, 95%CI 0.72 - 0.92 and ICC = 0.94, 95%CI 0.91 - 0.96). Conclusion: FINDRISC was translated into Brazilian Portuguese and culturally adapted following standard procedures. FINDRISC-Br has thus become available for use and has potential as a screening tool in different Brazilian settings and applications.

RESUMO: Introdução: O Escore Finlandês de Risco de Diabetes (FINDRISC) é um instrumento que inicialmente foi desenvolvido para predizer o risco de desenvolver diabetes mellitus tipo 2 em adultos. Esse instrumento é simples, rápido de aplicar, não invasivo e de baixo custo. Os objetivos deste estudo foram descrever o processo de tradução e adaptação transcultural do FINDRISC para o português do Brasil e avaliar a sua confiabilidade teste-reteste. Metodologia: O projeto foi conduzido de acordo com as recomendações dos Princípios de Boas Práticas para o Processo de Tradução e Adaptação Transcultural de Medidas de Resultados Relatados pelo Paciente desenvolvidas pela ISPOR. Uma vez desenvolvida a versão final em português brasileiro (FINDRISC-Br), realizou-se a avaliação da confiabilidade usando uma amostra não aleatória de 83 indivíduos atendidos em uma unidade de atenção básica. Cada participante foi entrevistado por nutricionistas registradas treinadas em duas ocasiões com intervalo médio de 14 dias. A avaliação da confiabilidade foi realizada por meio da análise do nível de concordância entre as respostas do teste-reteste, utilizando-se o coeficiente kappa de Cohen e o coeficiente de correlação intraclasse (CCI). Resultados: As etapas das diretrizes da ISPOR foram seguidas consecutivamente sem maiores problemas. Em relação à avaliação da confiabilidade do teste-reteste, o questionário como um todo apresentou confiabilidade adequada (kappa de Cohen = 0,82; IC95% 0,72 - 0,92 e CCI = 0,94; IC95% 0,91 - 0,96). Conclusão: O FINDRISC foi traduzido e adaptado transculturalmente para o português do Brasil seguindo procedimentos padronizados. O FINDRISC-Br já está disponível para uso e tem potencial para ser usado como ferramenta de rastreamento em diferentes cenários brasileiros.

ABSTRACT: Introduction: The Finnish Diabetes Risk Score (FINDRISC) is a tool that was initially developed to predict the risk of developing type 2 diabetes mellitus in adults. This tool is simple, quick to apply, non-invasive, and low-cost. The aims of this study were to perform a translation and cultural adaptation of the original version of FINDRISC into Brazilian Portuguese and to assess test-retest reliability. Methodology: This work was done following the ISPOR Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes Measures. Once the final Brazilian Portuguese version (FINDRISC-Br) was developed, the reliability assessment was performed using a non-random sample of 83 individuals attending a primary care health center. Each participant was interviewed by trained registered dieticians on two occasions with a mean interval of 14 days. The reliability assessment was performed by analyzing the level of agreement between the test-retest responses of FINDRISC-Br using Cohen’s kappa coefficient and the intraclass correlation coefficient (ICC). Results: The steps of ISPOR guidelines were consecutively followed without major problems. Regarding the reliability assessment, the questionnaire as a whole presented adequate reliability (Cohen’s kappa = 0.82, 95%CI 0.72 - 0.92 and ICC = 0.94, 95%CI 0.91 - 0.96). Conclusion: FINDRISC was translated into Brazilian Portuguese and culturally adapted following standard procedures. FINDRISC-Br has thus become available for use and has potential as a screening tool in different Brazilian settings and applications.

Abstract This study aimed to evaluate the physical properties and antifungal activities of polymethyl methacrylate (PMMA) acrylic resins after the incorporation of chlorhexidine diacetate salt (CDA). Methodology: First, acrylic resin specimens were fabricated with Vipi Cor® and DuraLay® resins with and without the incorporation of 0.5%, 1.0% or 2.0% CDA. The residual monomer and CDA release were measured at intervals ranging from 2 hours to 28 days using ultraviolet spectrometry combined with high-performance liquid chromatography. The antifungal activity against C. albicans was evaluated with the agar diffusion method. Fourier transform infrared spectroscopy was used to analyze the degree of resin conversion. Finally, the water sorption values of the resins were also measured. Results: The incorporated CDA concentration significantly changed the rate of CDA release (p<0.0001); however, the brand of the material appeared to have no significant influence on drug release. Subsequently, the inhibition zones were compared between the tested groups and within the same brand, and only the comparisons between the CDA 2% and CDA 1% groups and between the CDA 1% and CDA 0.5% groups failed to yield significant differences. Regarding the degrees of conversion, the differences were not significant and were lower only in the CDA 2% groups. Water sorption was significantly increased at the 1.0% and 2.0% concentrations. Conclusions: We concluded that the incorporation of CDA into PMMA-based resins enabled the inhibition of C. albicans growth rate, did not alter the degrees of conversion of the tested resins and did not change the release of residual monomers.

The present work was designed to select for sweet potatoes clones (Ipomoea batatas) resistant to Meloidogyne enterolobii (Syn. M. mayaguensis) as well as evaluate the efficiency of the selection methods used by estimating their genetic (VCg) and environmental (VCe) variation coefficients as well as broad sense heritability. A total of 142 sweet potato genotypes were tested, including four commercial varieties (Brazlândia Rosada, Brazlândia Roxa, Brazlândia Branca, and Palmas) as well as the Santa Clara tomato cultivar (utilized as a susceptibility standard). The experimental design was completely randomized blocks, in two repetitions of six plants each. Resistance levels were classified according to the numbers of eggs per gram of roots, the reproduction factor (RF), and the reproduction index (RI) relative to the Santa Clara tomato cultivar. The b= VCg/VCe ratio and broad sense heritability were high in terms of the numbers of eggs per gram of roots, as well as in terms of the reproduction factor and reproduction index, demonstrating the efficiency of the methodology used in the selection of resistant genotypes. Thirty-one sweet potato genotypes resistant to M. enterolobii were identified as having significant potential for continuing the breeding program.

Este trabajo fue realizado con el objetivo de seleccionar clones de batata (Ipomoea batatas) resistentes a Meloidogyne enterolobii (Syn. M. mayaguensis) y evaluar la eficiencia del método de selección empleado, por la estimación de los coeficientes de variación genética (CVg) y el medio ambiente (CVe), y de las estimaciones de las herencias en el sentido amplio. Se utilizaron 142 genotipos de batata, entre ellos cuatro cultivares comerciales: Brazlândia Rosada, Brazlândia Roxa, Brazlândia Branca y Palmas, y el tomate cv. Santa Clara (utilizado como patrón de susceptibilidad). El diseño experimental utilizado fue de bloques aleatorizados completos con dos repeticiones de seis plantas cada uno. La clasificación de los niveles de resistencia fue realizada de acuerdo con el número de huevos por gramo de raíz, factor de reproducción (FR) e índice de reproducción (IR) relativo a lo observado en el tomate Santa Clara. La relación b = CVg / CVe y la heredabilidad en sentido amplio fueron altas tanto para el número de huevos por gramo de raíz como para el factor de reproducción e índice de reproducción, demostrando la eficiencia del método empleado para la selección de genotipos resistentes. Se identificaron, como prometedores para dar continuidad al programa de mejoramiento genético, 31 genotipos de batata resistentes a M. enterolobii.

ABSTRACT Prostate cancer is the second most common cancer and the fifth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers. The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The first Brazilian Consensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer. This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.

Abstract Low number of fetal cells in maternal blood limited the use of fetal materials in diagnostic and clinical applications. This research developed a technology which allowed the extraction of fetal DNA by a non-invasive method that offers no risk to the mother or fetus. A total of 132 pregnant women participated in this inquiry. The DNA extraction was performed employing an in-house method based on guanidine thiocyanate and magnetic bead. For the amplification it was used the Quantifier Y Kit™. The fetal sexing analysis of the 132 pregnant women were 100% in agreement with the ultrasound. Sensitivity and specificity for detection of Y chromosome sequences was possible using Real-Time Polymerase Chain Reaction since the 4th week of gestation. This non-invasive early determination could be employed in fetal gender and also to be extended to detection of genetic diseases in the shortest possible time avoiding invasive methods that puts the fetus at risk.

Abstract Aims: The present study aimed to assess the effect of a 24-week intervention on the physical activity level among adults at risk of developing type 2 diabetes mellitus (DM2). Methods: It was included 129 individuals of both sexes who underwent the Preventive Health Check-up at the Albert Einstein Israelita Hospital between January and August 2010 and who were at high and very high risk of developing DM2. The risk of developing DM2 was assessed according to the FINDRISC criteria. All participants were evaluated by the International Physical Activity Questioner (IPAQ). Subjects were followed-up for 24 weeks by a physical education professional through emails during a 6 month period. The IPAQ was sent by email after 3 and 6 months of follow-up. Statistical analysis was performed using the chi-square test with p<0.05 and the Yule Coefficient test. Results: At baseline of the follow-up period, 80.3% of individuals failed to comply with the recommended weekly physical activity. In the end, motivational intervention by e-mail encouraged 74.2% of individuals to comply with the weekly-recommended physical activity and only 1.5% were classified as sedentary. Conclusion: Therefore, the follow-up protocol conducted by periodic and personalized e-mails proved to be effective in promoting physical activity among people at risk of developing metabolic diseases.

Human immunodeficiency virus (HIV) infection was considered a contraindication for solid organ transplantation (SOT) in the past. However, HIV management has improved since highly active antiretroviral therapy (HAART) became available in 1996, and the long-term survival of patients living with HIV has led many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection. Based on the available data in the medical literature and the cumulative experience of transplantation in HIV-positive patients at our hospital, the aim of the present article is to outline the criteria for transplantation in HIV-positive patients as recommended by the Immunocompromised Host Committee of the Hospital das Clínicas of the University of São Paulo.

RESUMO O fósforo (P) extraído do solo depende do extrator empregado, reatividade do fertilizante fosfatado e interação do P adicionado com os constituintes do solo, dentre esses a matéria orgânica. Objetivou-se avaliar o P extraível em amostras de Latossolo Vermelho (LVd) e de Neossolo Quartzarênico (RQ), incubadas com 0; 5; 10; 50 ou 100 mg kg-1 de C-ácido húmico (C-AH) e 400 mg kg-1 de P, disponibilizadas pelas fontes fosfato natural de Araxá (FA), fosfato natural reativo de Bayóvar (FB) ou superfosfato simples (SS). Desse modo, os tratamentos foram constituídos por esquema fatorial cinco (concentrações de C-AH) x três (fontes de P), utilizando o delineamento em blocos casualizados, com três repetições. As misturas entre solo, C-AH e fonte de P foram incubadas por 60 dias e, posteriormente, o P do solo foi extraído pelas soluções de Bray-1, Mehlich-1 e Mehlich-3 e pelo extrator resina mista de troca iônica. No LVd e RQ, a adição de C-AH reduziu os teores extraíveis de P quando a fonte foi o FA e FB. Os teores extraíveis de P aumentaram com a aplicação de C-AH no RQ com o uso do SS, de modo que a concentração média de 50 mg kg-1 de C-AH foi a que propiciou o maior teor de P extraído por Bray-1, Mehlich-3 e resina mista. O pH é o atributo químico que mais influencia o teor de P extraível do solo.

ABSTRACT Extractable phosphorus (P) in soil depends on soil test employed, reactivity of fertilizer and interaction of P added to the soil properties, including organic matter. The aim of this paper was to assess the contents of P extracted from Red Latosol (LVd) and Quartzarenic Neosol (RQ) samples, incubated with 0; 5; 10; 50 or 100 mg kg-1 C-humic acid (C-HA) and 400 mg kg-1 of P, via Araxá phosphate rock (AP), Bayóvar reactive phosphate rock (BP) or single superphosphate (SS). Thus, it was adopted a five (C-HA concentrations) x three (P sources) factorial arrangement, using a randomized block design with three replications. The mixtures of soil, C-HA concentrations and P sources were incubated for 60 days; in sequence, the soil P was extracted by solutions of Bray-1, Mehlich-1 and Mehlich-3 and mixed ion exchange resin. In the LVd and RQ samples, the addition of C-HA reduced extractable phosphorus when the source was AP and BP. The levels of extractable P increased with the application of C-HA in RQ when the source was SS; the average concentration of 50 mg kg-1 C-AH provided the maximum extractable P by Bray-1, Mehlich-3 and mixed resin. The pH is the chemical attribute that most influence the extractable P content of the soil.

RESUMO O ácido húmico (AH) pode reduzir a adsorção e aumentar a disponibilidade de P nos solos, entretanto, a magnitude desse efeito é diferente quando o Ca2+ prevalece sobre Mg2+ em solos com acidez corrigida. Objetivou-se avaliar os efeitos de doses de AH e fontes de carbonato na adsorção, fator capacidade de P máximo (FCPm) e disponibilidade de P em solos contrastantes. Amostras de Latossolo e Gleissolo foram primeiramente incubadas com as seguintes doses de AH: 0, 20, 50, 100, 200 e 400 mg kg-1, combinadas com CaCO3 ou MgCO3, para avaliar a adsorção de P. Em sequência, as amostras de solo foram novamente incubadas com P (400 mg kg-1), para determinar a disponibilidade de P. A aplicação de doses de AH reduziu a capacidade máxima de adsorção, aumentou a energia de ligação do P e não alterou a FCPm do Gleissolo. O teor de P disponível aumentou com o acréscimo das doses de AH no Latossolo, contudo, não foram alterados no Gleissolo. A escolha correta da dose de AH reduziu a FCPm em até 40% e aumentou a disponibilidade de P no Latossolo em 17%. A aplicação de MgCO3 em vez do CaCO3 reduziu a adsorção de P em ambos os solos. Assim, houve correlação positiva entre o teor de Ca2+ e a FCPm. A dose ótima de AH e a predominância de Mg2+ sobre Ca2+ no volume de solo adubado com P são práticas efetivas para reduzir a adsorção e aumentar a disponibilidade de P, especialmente, no Latossolo argiloso.

ABSTRACT Humic acid (HA) may reduce adsorption and increase soil P availability, however, the magnitude of this effect is different when Ca2+ prevails over Mg2+ in limed soils. The objective of this study was to evaluate the effects of HA rates and carbonate sources on the adsorption, phosphate maximum buffering capacity (PMBC), and P availability in two contrasting soils. Oxisol and Entisol samples were firstly incubated with the following HA rates: 0, 20, 50, 100, 200 and 400 mg kg-1, combined with CaCO3 or MgCO3, to evaluate P adsorption. In sequence, soil samples were newly incubated with P (400 mg kg-1) to evaluate P availability. The least P adsorption was found when 296 mg kg-1 of HA was added to Oxisol. Applying HA rates decreased maximum adsorption capacity, increased P binding energy to soil colloids and did not alter PMBC of Entisol. Available P contents in Oxisol increased with HA rates, but it did not change in Entisol. Choosing the right HA rate can decrease PMBC up to 40% and increase the Oxisol P availability by 17%. Application of MgCO3 instead of CaCO3 decreased P adsorption in both soils. Thus, a positive correlation between Ca2+ content and PMBC was verified. Optimum rate of HA and the preponderance of Mg2+ instead of Ca2+ in soil volume fertilized with P are effective practices to reduce adsorption and increase P availability, especially in clayey Oxisol.

ABSTRACT: In alkalinized and Ca-rich composts, solubilization of apatite from phosphate rocks (PRs) is not guaranteed; however, chelating agents and humified substances produced during composting may alter the soluble contents and P forms of monoammonium phosphate (MAP)-based composts. These effects may depend on the proportions of organic wastes and P source used in the compost piles. The aim of this study was to evaluate the effect of composting chicken manure, coffee husk, and Araxá PR, Bayóvar PR, or MAP in different proportions on the organic matter decomposition, total N, Ca contents, and soluble P fractions in the composts. The treatments consisted of a 3 × 4 × 2 factorial, through the combination of three P sources [Araxá PR, Bayóvar PR, and MAP], with four mixtures in the respective proportions: 25, 40, 50, and 75 % of P source with 37.5, 40, 25, and 12.5 % of chicken manure, and 37.5, 20, 25, and 12.5 % of coffee husk, composted or not for 150 days. The composts with PRs showed greater reductions in total C and water-soluble C and lower dry mass yields than MAP-based composts. The use of MAP in mixtures ensured lower N losses compared to composts formulated with PRs. Regardless of the mixture among chicken manure, coffee husk, and PRs, composting increased the pH and total Ca contents and did not alter the fractions of soluble P in water, in citric acid, and in neutral ammonium citrate plus water in the final PR-based composts. Composting of these mixtures was not an efficient route to solubilize P from Araxá and Bayóvar PRs. Values of pH above 8 and high Ca contents were the main factors explaining the stability and non-solubilization of the apatite of PRs in the composts. Composting with MAP, mixed in different proportions with chicken manure and coffee husk, reduced water-soluble P, maintained the pH of the mixtures in the range of 5 to 7, and enriched the composts with N and P.

Resumo Fundamento: Sintomas depressivos estão associados de forma independente ao risco aumentado de doença cardiovascular (DCV) em indivíduos com DCV não diagnosticada. Os mecanismos subjacentes a essa associação, entretanto, não estão claros. Inflamação tem sido indicada como um possível elo mecanicista entre depressão e DCV. Objetivos: Este estudo avaliou a associação entre sintomas depressivos persistentes e o início de inflamação de baixo grau. Métodos: De um banco de dados de 1.508 indivíduos jovens (idade média: 41 anos) sem diagnóstico de DCV submetidos a pelo menos duas avaliações de saúde de rotina, 134 tinham sintomas depressivos persistentes (Inventário de Depressão de Beck - BDI ≥10, BDI+) e 1.374 não apresentavam sintomas em nenhuma das ocasiões (BDI-). Todos os participantes foram submetidos a repetidas avaliações clínicas e laboratoriais em seguimento regular, cuja média foi de 26 meses desde a condição basal. Definiu-se inflamação de baixo grau como concentração plasmática de proteína C reativa (PCR) ultrassensível > 3 mg/L. O desfecho foi a incidência de inflamação de baixo grau por ocasião da segunda avaliação clínica. Resultados: A incidência de inflamação de baixo grau foi maior no grupo BDI+ em comparação ao grupo BDI- (20,9% vs. 11,4%; p = 0,001). Após ajuste para sexo, idade, circunferência abdominal, índice de massa corporal, níveis de atividade física, tabagismo e prevalência de síndrome metabólica, os sintomas depressivos persistentes continuaram sendo um preditor independente de início de inflamação de baixo grau (OR = 1,76; IC 95%: 1,03-3,02; p = 0,04). Conclusões: Sintomas depressivos persistentes foram independentemente associados com início de inflamação de baixo grau em indivíduos saudáveis.

Abstract Background: Depressive symptoms are independently associated with an increased risk of cardiovascular disease (CVD) among individuals with non-diagnosed CVD. The mechanisms underlying this association, however, remain unclear. Inflammation has been indicated as a possible mechanistic link between depression and CVD. Objectives: This study evaluated the association between persistent depressive symptoms and the onset of low-grade inflammation. Methods: From a database of 1,508 young (mean age: 41 years) individuals with no CVD diagnosis who underwent at least two routine health evaluations, 134 had persistent depressive symptoms (Beck Depression Inventory - BDI ≥ 10, BDI+) and 1,374 had negative symptoms at both time points (BDI-). All participants had been submitted to repeated clinical and laboratory evaluations at a regular follow-up with an average of 26 months from baseline. Low-grade inflammation was defined as plasma high-sensitivity C-Reactive Protein (CRP) concentrations > 3 mg/L. The outcome was the incidence of low-grade inflammation evaluated by the time of the second clinical evaluation. Results: The incidence of low-grade inflammation was more frequently observed in the BDI+ group compared to the BDI- group (20.9% vs. 11.4%; p = 0.001). After adjusting for sex, age, waist circumference, body mass index, levels of physical activity, smoking, and prevalence of metabolic syndrome, persistent depressive symptoms remained an independent predictor of low-grade inflammation onset (OR = 1.76; 95% CI: 1.03-3.02; p = 0.04). Conclusions: Persistent depressive symptoms were independently associated with low-grade inflammation onset among healthy individuals.