RESUMO Objetivo: avaliar o impacto financeiro das complicações pós-operatórias no transplante simultâneo pâncreas-rim durante a internação hospitalar. Métodos: estudo retrospectivo dos dados da internação hospitalar dos pacientes submetidos consecutivamente ao transplante simultâneo pâncreas-rim no período de janeiro de 2008 a dezembro de 2014 no Hospital do Rim/Fundação Oswaldo Ramos. As principais variáveis estudadas foram a reoperação, pancreatectomia do enxerto, óbito, complicações pós-operatórias (cirúrgicas, infecciosas, clínicas e imunológicas) e os dados financeiros da internação para o transplante. Resultados: a amostra foi composta de 179 pacientes transplantados. As características dos doadores e receptores foram semelhantes nos pacientes com e sem complicações. Na análise dos dados, 58,7% dos pacientes apresentaram alguma complicação pós-operatória, 21,8% necessitaram de reoperação, 12,3%, de pancreatectomia do enxerto e 8,4% evoluíram para o óbito. A necessidade de reoperação ou pancreatectomia do enxerto aumentou o custo da internação em 53,3% e 78,57%, respectivamente. A presença de complicação pós-operatória aumentou significativamente o custo. Entretanto, a presença de óbito, hérnia interna, infarto agudo do miocárdio, acidente vascular cerebral e disfunção do enxerto pancreático não apresentaram significância estatística no custo, cuja média foi de US$ 18,516.02. Conclusão: complicações pós-operatórias, reoperação e pancreatectomia do enxerto aumentaram significativamente o custo médio da internação hospitalar do SPK, assim como as complicações cirúrgicas, infecciosas, clínicas e imunológicas. No entanto, o óbito durante a internação, a hérnia interna, o infarto agudo do miocárdio, o acidente vascular cerebral e a disfunção do enxerto pancreático não interferiram estatisticamente neste custo.

ABSTRACT Objective: considering simultaneous pancreas-kidney transplantation cases, to evaluate the financial impact of postoperative complications on hospitalization cost. Methods: a retrospective study of hospitalization data from patients consecutively submitted to simultaneous pancreas-kidney transplantation (SPKT), from January 2008 to December 2014, at Kidney Hospital/Oswaldo Ramos Foundation (Sao Paulo, Brazil). The main studied variables were reoperation, graft pancreatectomy, death, postoperative complications (surgical, infectious, clinical, and immunological ones), and hospitalization financial data for transplantation. Results: the sample was composed of 179 transplanted patients. The characteristics of donors and recipients were similar in patients with and without complications. In data analysis, 58.7% of the patients presented some postoperative complication, 21.8% required reoperation, 12.3% demanded graft pancreatectomy, and 8.4% died. The need for reoperation or graft pancreatectomy increased hospitalization cost by 53.3% and 78.57%, respectively. The presence of postoperative complications significantly increased hospitalization cost. However, the presence of death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction did not present statistical significance in hospitalization cost (in average US$ 18,516.02). Conclusion: considering patients who underwent SPKT, postoperative complications, reoperation, and graft pancreatectomy, as well as surgical, infectious, clinical, and immunological complications, significantly increased the mean cost of hospitalization. However, death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction did not statistically interfere in hospitalization cost.

RESUMO Objetivo: Avaliar o impacto do modelo tradicional de check-up na progressão do risco cardiovascular ao longo do tempo. Métodos: Estudo coorte-retrospectivo com análise de 11.126 prontuários de executivos assintomáticos, atendidos entre janeiro de 2005 e outubro de 2008. Foram observados dados demográficos, tabagismo, doenças cardiovasculares, diabetes, dislipidemia prévios, valores de colesterol total e frações, triglicérides, glicemia, proteína C-reativa, circunferência de cintura, esteatose hepática, escore de Framingham, síndrome metabólica, nível de atividade física, estresse, consumo de álcool e índice de massa corporal. Resultados: Foram incluídos 3.150 pacientes. Houve piora de todos fatores de risco, com exceção do tabagismo, do aumento na incidência de doenças cardiovasculares e da população com risco médio ou alto para eventos cardiovasculares. Houve ainda redução na prevalência de pouco ativos, estresse e consumo de álcool. Conclusão: É prioritária a adoção de políticas de saúde por parte das empresas, para a melhora da condição de saúde e a redução dos custos advindos das doenças, além do absenteísmo a eles associados.

ABSTRACT Objective: To evaluate the impact of traditional check-up appointment on the progression of the cardiovascular risk throughout time. Methods: This retrospective cohort study included 11,126 medical records of asymptomatic executives who were evaluated between January, 2005 and October, 2008. Variables included participants’ demographics characteristics, smoking habit, history of cardiovascular diseases, diabetes, dyslipidemia, total cholesterol, HDL, triglycerides, glucose, c-reactive protein, waist circumference, hepatic steatosis, Framingham score, metabolic syndrome, level of physical activity, stress, alcohol consumption, and body mass index. Results: A total of 3,150 patients was included in the final analysis. A worsening was observed in all risk factors, excepting in smoking habit, incidence of myocardial infarction or stroke and in the number of individuals classified as medium or high risk for cardiovascular events. In addition, a decrease in stress level and alcohol consumption was also seen. Conclusion: The adoption of consistent health policies by companies is imperative in order to reduce the risk factors and the future costs associated with illness and absenteeism.

PURPOSE:To perform a cost analysis of simultaneous pancreas-kidney transplantation (SPKT) in a Brazilian hospital.METHODS: Between January 2008 and December 2011, 105 consecutive SPKTs at the Hospital of Kidney and Hypertension in Sao Paulo were evaluated. We evaluated the patient demographics, payment source (public health system or supplementary system), and the impact of each hospital cost component. The evaluated costs were corrected to December 2011 values and converted to US dollars.RESULTS: Of the 105 SPKT patients, 61.9% were men, and 38.1% were women. Eight patients died, and 97 were discharged (92.4%). Eighty-nine procedures were funded by the public health system. The cost for the patients who were discharged was $18.352.27; the cost for the deceased patients was $18.449.96 (p = 0.79). The FOR for SPKT during this period was positive at $5,620.65. The costs were distributed as follows: supplies, 36%; administrative costs, 20%; physician fees, 15%; intensive care unit, 10%; surgical center, 10%; ward, 9%.CONCLUSION: Mortality did not affect costs, and supplies were the largest cost component.

Background: Hodgkin lymphoma is a highly curable disease. Aim: To evaluate the clinical characteristics and the treatment results of Hodgkin lymphoma patients of the National Cancer Program in Chile. Patients and methods: Prospective assessment of 682 patients treated in 18 adult cancer centers. Progression free survival (PFS) and overall survival (OS) were calculated. Median follow up was 127, 95, 87, 72 and 50 months for C-MOPP, radiotherapy (RT), C-MOPP/ABV, NOVP and ABVD, respectively. Results: Median age was 37 years (15-84). Nodular sclerosis and mixed cellularity were equally expressed. Advanced stages (III & IV) were present at diagnosis in 61% of cases. Age over 40 was an adverse prognostic factor (p <0.001). The rate of PFS at 5 and 10 years for early stages was 73% and 66% with RT, 80% and 74% with C-MOPP+RT, 73% and 71% with C-MOPP/ABV, 59% and 59% with NOVP+RT, and 81% with ABVD+RT, at 5 years, being significantly lower for NOVP (p =0.02). The rate of OS at 5 and 10 years for advanced stages was 82% and 70% with RT, 82% and 76% with C-MOPP+RT, 82% and 80% with C-MOPP/ABV, 68% and 60% with NOVP, and 85% with ABVD at 5 years, also significantly lower for NOVP (p =0.04). For advanced stages, the rate of PFS at 5 and 10 years was 49% and 43% with C-MOPP, 69% and 62% with C-MOPP/ABVD or C-MOPP/ABV, and 71% at 5 years with ABVD, significantly lower for C-MOPP (p =0.01). The rate of OS at 5 and 10 years was 52% and 46% with C-MOPP, 70% and 63% with C-MOPP/ABVD or C-MOPP/ABV and 76% with ABVD at 5 years, significantly lower for C-MOPP (p =0.0002). Conclusions: Age over 40 years was an adverse prognostic factor. C-MOPP/ABVD, C-MOPP/ABV and ABVD had comparable results and reached a high tumor control and overall survival in both early and advanced stages

OBJETIVOS: Avaliar o estado nutricional e a composição corporal de crianças índias das populações alto-xinguana e Ikpeng, comparando as populações. MÉTODOS: Avaliamos 95 crianças do Alto Xingu e 69 Ikpeng com idades entre 24 e 117 meses. Obtivemos dados sobre idade, peso, estatura, pregas cutâneas, circunferência do braço e impedância bioelétrica. Calculamos escores z para peso, estatura e estimativas da composição corporal. Tendo como referência o NCHS 2000, determinamos diagnóstico de baixo peso e baixa estatura como sendo inferior a -2 escores z para os indicadores peso/idade ou índice de massa corporal/idade e estatura/idade, respectivamente. Para obesidade, o ponto de corte foi 2 escores do indicador índice de massa corporal/idade. As massas corporais magra e gordurosa foram calculadas a partir de duas equações validadas na literatura. RESULTADOS: Diagnosticamos baixa estatura em 8,4% das crianças do Alto Xingu e em 37,7% das Ikpeng (p < 0,001). Baixo peso foi verificado apenas entre as crianças Ikpeng (12,5%). Para os dados relativos à composição corporal, verificamos que as crianças do Alto Xingu apresentaram valores estimados de massa corporal magra superiores aos das crianças Ikpeng (p < 0,05). Na amostra estudada, nenhuma criança apresentou obesidade. CONCLUSÕES: Crianças Ikpeng apresentaram incidências de baixo peso e baixa estatura maiores do que a população do Alto Xingu. Quando a comparação ocorreu para valores relativos à composição corporal, crianças alto-xinguanas apresentaram valores maiores. Portanto, o estado nutricional observado entre as crianças alto-xinguanas foi melhor do que o das crianças Ikpeng, independentemente do critério utilizado, dentre os disponíveis neste estudo.

OBJECTIVES: To assess the nutritional and body composition of two Brazilian indigenous populations by comparing their nutritional status. METHODS: 95 children from Alto Xingu and 69 from Ikpeng were evaluated, ages ranged from 24 to 117 months. The study was performed in the Xingu Indigenous Park. Data collected were: age, weight, height, skin folds, arm circumference, resistance and reactance. The z-scores were calculated and classified according to the parameters defined by the National Center for Health Statistics (NCHS 2000). Shortness was defined as length or stature below -2, underweight as body mass index below -2, and overweight as body mass index above 2. RESULTS: Among children from Alto Xingu, the prevalence of shortness was 8.4%, while among Ikpengs the prevalence was 37.7% (p < 0.001). Underweight was diagnosed in 12.5% of Ikpeng's children. Values of fat-free mass were greater for children from Alto Xingu and no case of obesity was found. CONCLUSION: In this study, Ikpeng's children showed higher incidences of short stature and low weight than the Altoxingu's children. Data regarding body composition have greater values among children from Alto Xingu, thus we conclude that nutritional status among children from Alto Xingu is better than the one found among the Ikpeng's children.

Objetivo: determinar o estado nutricional e estimar a composição corporal de crianças índias do Parque Nacional do Xingu, associando antropometria e impedância bioelétrica. Casuística e Métodos: foram avaliadas 164 crianças índias (89 meninas e 75 meninos), com idade desconhecida, por meio da antropometria e da mensuração da impedância bioelétrica. A partir das medidas de peso e estatura, chegou-se ao escore z do indicador de peso/estatura. Para as estimativas da composição corporal, foram utilizadas duas equações baseadas nos valores da resistência obtidos pela impedância bioelétrica. Os dados obtidos foram comparados com valores de referência internacionalmente aceitos. Resultados: a mediana do escore z do indicador peso/estatura foi 0,59 (meninos) e 0,46 (meninas) (p=0,27), respectivamente. No grupo estudado, apenas 1,8% apresentou escore z menor que -2 desvios-padrão, e 3% apresentou escore z maior que 2 desvios-padrão. A média dos valores da resistência bioelétrica encontrados foram: 625,4±79,2 Ohms (meninas), e 588,8±68,9 Ohms (meninos) (p<0,01). Os valores percentuais da composição corporal calculados para meninas foram: 14,2% massa corporal gordurosa (MCG) e 85,8% massa magra (MM) e 11,7% MCG e 88,3% MM. Para os meninos, obtiveram-se os seguintes valores: 14,9% MCG e 85,1% MM, e 10,3% MCG e 89,7% MM. Conclusões: os resultados mostram baixas taxas de desnutrição atual e obesidade, além de valores de composição corporal próximos do esperado. Os dados obtidos pela impedância bioelétrica para composição corporal realçam a boa condição nutricional das crianças estudadas, o que nos leva a crer que, ainda que sob influência da cultura ocidental, as crianças do Parque Nacional do Xingu vêm preservando seu estado nutricional ao longo das últimas três décadas.

Objective: to evaluate the nutritional status and estimate body composition of Indian children from Xingu National Park (XNP), rain forest Amazon region, by using anthropometry and bioelectrical impedance (BI) tests. Methods: one hundred and sixty-four Indian children (89 girls and 75 boys) of unknown age were evaluated by means of anthropometry and bioelectrical impedance. Weight and height were used to calculate z-score for weight-for-height (W/H) index. Two equations based on the resistance values obtained from the bioelectrical impedance were used to determine body composition. The values obtained were compared to standard reference. Results: z-score median for weigh-for-height index was 0.59 (boys) and 0.46 (girls) (P=0.27), respectively. Among the children studied only 1.8% showed z-score W/H <-2 standard deviations (SD), and 3% showed z-score W/H >2 SD. Mean resistance values were 625.4+/-79.2 Ohms (girls) and 588.8+/-68.9 Ohms (boys) (P<0.01). The percentage of body composition values obtained for girls were 14.2% fat mass (FM) and 85.8% fat-free mass (FFM), and 11.7% (FM) and 88.3% (FFM). The values for the boys were 14.9% (FM) and 85.1% (FFM), and 10.3% (FM) and 89.7% (FFM). Conclusions: there were low rates of obesity and malnutrition, what leads us to believe that the nutritional status among the Indian children from XNP has been kept in good standard along the last three decades, even under some degree of the Western culture influence. The Indians' body composition enhanced the good nutritional status among the studied population. BI played an important role in the estimation of body composition in this field study.