Resumo em Português:

Resumo Atualmente, a América Latina está passando por uma grande epidemia de Zika vírus, transmitido por mosquitos Aedes. A preocupação pela infecção pelo Zika vírus vem aumentando, uma vez que é suspeita de causar defeitos cerebrais em recém-nascidos, como a microcefalia e, mais recentemente, potenciais complicações neurológicas e autoimunes, como síndrome de Guillian-Barré e encefalomielite disseminada aguda. Descrevemos um caso de infecção pelo vírus em uma mulher de 25 anos durante o primeiro trimestre de gestação, confirmado dentre os exames laboratoriais apenas pela detecção de partículas virais na urina materna, com estudos de imagens demonstrando a evolução das alterações cranianas e encefálicas no feto e no recém-nascido, como redução do perímetro cefálico, calcificações cerebrais e ventriculomegalia.

Resumo em Inglês:

Summary Currently Latin America is undergoing a major epidemic of Zika virus, which is transmitted by Aedes mosquitoes. Concern for Zika virus infection has been increasing as it is suspected of causing brain defects in newborns such as microcephaly and, more recently, potential neurological and autoimmune complications including Guillian-Barré syndrome and acute disseminated encephalomyelitis. We describe a case of virus infection in a 25-year-old woman during the first trimester of her pregnancy, confirmed by laboratory tests only for the detection of viral particles in maternal urine, with imaging studies demonstrating the progression of cranial and encephalic changes in the fetus and later in the newborn, such as head circumference reduction, cerebral calcifications and ventriculomegaly.

Resumo em Português:

Resumo Descrevemos um caso de paciente do gênero feminino, 21 anos, apresentando crises de dispneia e sibilância há 2 anos. Radiografia torácica evidenciou perda volumétrica do lobo inferior esquerdo e opacidade triangular basal retrocardíaca ipsilateral. Tomografia computadorizada mostrou formação expansiva sólida com ápice protruindo para o interior dos brônquios principal e lobar inferior esquerdos, promovendo atelectasia distal. Estudos anatomopatológico e imuno-histoquímico após biópsia transbrônquica da lesão diagnosticaram um tumor carcinoide típico, confirmado após ressecção tumoral com pneumectomia total esquerda.

Resumo em Inglês:

Summary We describe the case of a female patient, 21 years old, complaining of dyspnea attacks and wheezing 2 years ago. Chest radiography showed volume loss in the left lower lobe and ipsilateral retrocardiac triangular basal opacity. CT scan showed an extensive solid mass with apex protruding into the left main and lower lobar bronchi, causing distal atelectasis. Histopathological and immunohistochemical study of transbronchial biopsy of the lesion revealed a typical carcinoid tumor, confirmed after tumor resection with total left pneumectomy.

Resumo em Português:

Resumo Peliose hepática é uma patologia benigna rara caracterizada pela presença de múltiplas cavidades preenchidas por sangue sem localização preferencial no parênquima do fígado. Pode estar relacionada a uma série de condições etiológicas, dentre elas doenças infecciosas e toxicidade por drogas imunossupressoras. Para nosso conhecimento, existem apenas três artigos que abordam a associação entre peliose hepática e lúpus eritematoso sistêmico. Neste relato, descrevemos um caso desta rara condição, destacando a importância da ressonância magnética. Uma breve revisão sobre o tema é apresentada.

Resumo em Inglês:

Summary Peliosis hepatis is a rare benign disorder characterized by the presence of multiple cavities filled with blood with no preferential localization in the liver parenchyma. It may be related to several etiologic conditions, especially infections and toxicity of immunosuppressive drugs. To our knowledge, there are only three articles reporting the association between peliosis hepatis and systemic lupus erythematosus. In this report, we describe a case of this rare condition, highlighting the importance of magnetic resonance imaging. A short review of this subject is also presented.

Resumo em Inglês:

Summary Objective: Ovarian torsion must be diagnosed and treated as early as possible. The aim of the present study was to investigate the effects of intraperitoneal administration of nanocurcumin on ischemia-reperfusion injury in ovaries. Method: Thirty-five (35) healthy female Wistar rats weighing approximately 250 g were randomized into seven experimental groups (n=5): Group SSG – The rats underwent only laparotomy. Group I: A 3-hour ischemia only. Group I/R: A 3-hour ischemia and 3-hour reperfusion. Group I/C: A 3-hour ischemia only, and 1 mg/kg intraperitoneal administration of curcumin 2.5 hours after induction of ischemia. Group I/R/C: A 3-hour ischemia, 3-hour reperfusion, and 1 mg/kg intraperitoneal administration of curcumin 2.5 hours after induction of ischemia. Group I/NC: A 3-hour ischemia only and 1 mg/kg intraperitoneal administration of nanocurcumin 2.5 hours after induction of ischemia. Group I/R/C: A 3-hour ischemia, 3-hour reperfusion and 1 mg/kg intraperitoneal administration of nanocurcumin 2.5 hours after induction of ischemia. Results: Nanocurcumin-treated animals showed significantly improved development of ischemia and reperfusion tissue injury compared to those in the other groups (p<0.05). Significant higher values of SOD, tGSH, GPO, GSHRd and GST were observed in I/R/NC animals compared to those in the other groups (p<0.05). The damage indicators (NOS, MDA, MPO and DNA damage level) were significantly lower in I/R/NC animal compared to those of other groups (p<0.05). Conclusion: Intraperitoneal administration of nanocurcumin can be helpful in minimizing ischemia-reperfusion injury in ovarian tissue exposed to ischemia.

Resumo em Inglês:

Summary Objective: The most important determinant of suicide ideation, tendency and initiative is the presence of mental disorders. Since the number of those who lost their lives due to suicide in the world rose rapidly among the young population, the World Health Organization emphasizes the importance of assessing young people in the high-risk age group to prevent suicidal behavior. This study aimed to determine psychological symptom levels and suicide probability in young people. Method: The cross-sectional research consisted of 15-24 year-old individuals (N=348), who have sought a psychiatric clinic between February and June, 2015. The Research Data was collected by applying Data Collection Form, Suicide Probability Scale (SPS) and Brief Symptom Inventory (BSI). SPSS 22.0 statistical package program was used for data analysis. Results: There was a statistically significant difference (p<0.05) between the mean SPS scores according to education, psychiatric treatment, self-harm, smoking and drinking status of the participants in the study. Apart from this, there was also a statistically significant correlation between anxiety, depression, negative self and hostility according to the SPS and BSI subscales (p<0.001, r=0.739; p<0.001, r=0.729; p<0.001, r=0.747; p<0.001, r=0.715; respectively). Conclusion: The results of our study show that suicide risk is significantly higher in young people with depression, anxiety, negative self-perception and hostility symptoms. In this regard, we suggest the relevance of assessing the suicide risk of young people seeking a psychiatric clinic, with thorough attention to those who have high potential for suicide.

Resumo em Inglês:

Summary Objective: To investigate the neuropsychological characteristics and changes in CRP, S100B, MBP, HSP-7, and NSE in serum. Method: Sixty-six (66) patients treated in our hospital as CCCI group were chosen for our study, and 90 patients with depression were selected as the depression group. The patients in both groups were examined with CT perfusion, depression, anxiety and cognition evaluation. Their serum CRP, S100B, MBP, HSP-70 and NSE levels were detected. Neuropsychological and serum markers characteristics were compared. Results: The CBF and CBV in bilateral basal ganglia, frontal lobes, greater oval center, brain stem, and left and right regions of occipital lobes of the patients in CCCI group were significantly lower than in the depression group. The HAMD and HAMA scores of CCCI group patients were significantly lower than in the depression group; CCCI group performed better regarding attention, memory, abstract terms and delayed recall. CCCI also had significantly higher total scores than the depression group. Serum CRP, S100B, MBP, HSP-70 and NSE levels in CCCI group were significantly higher than in the depression group. The differences reach statistical significance (p<0.05). Conclusion: CCCI patients who are accompanied by minor depressive disorder have different degrees of cognitive impairment and experience a significant rise in serum CRP, S100B, MBP, HSP-70 and NSE.

Resumo em Português:

Resumo Objetivo: Avaliar o impacto da necessidade de ventilação mecânica (VM) e sua duração na qualidade de vida (QV) e no estado funcional físico (EFF) dos pacientes após a alta imediata da UTI. Método: Estudo transversal incluindo todos os pacientes que, consecutivamente, tiveram alta da UTI durante um período de um ano. Durante a primeira semana após a alta da UTI, a QV foi avaliada através do questionário WHOQoL-Bref e o EFF através do índice de Karnofsky e do índice de Barthel modificado, comparados retrospectivamente com o estado pré-admissão (variação [Δ] dos índices). Resultados: Durante o estudo, 160 indivíduos preencheram os critérios de inclusão. Os indivíduos submetidos a VM apresentaram maior prejuízo no EFF (Δ Karnofsky [-19,7 ± 20,0 vs. -14,9 ± 18,2; p=0,04] e Δ Barthel modificado [-17,4 ± 12,8 vs. -13,2 ± 12,9; p=0,05]) quando comparados aos pacientes sem VM. A duração da VM foi um bom preditor de redução do EFF (Δ Karnofsky [-14,6-1,12 * dias totais de VM; p=0,01] e Δ Barthel modificado [-14,2-0,74 * dias totais de VM; p=0,01]). A QV, avaliada pelo WHOQoL-Bref, não mostrou diferença entre os grupos (14,0 ± 1,8 vs. 14,5 ± 1,9; p=0,14) e a duração da VM não influenciou a QV (WHOQoL-Bref [14,2-0,05 * dias totais de VM; p=0,43]). Conclusão: A necessidade e a duração do VM reduzem a performance física dos pacientes após a alta da UTI.

Resumo em Inglês:

Summary Objective: To evaluate the impact of the need for mechanical ventilation (MV) and its duration throughout ICU stay on the quality of life (QoL) and physical functional status (PFS) after the immediate ICU discharge. Method: This was a cross-sectional study including all subjects consecutively discharged from the ICU during 1-year period. During the first week after ICU discharge, QoL was assessed through WHOQoL-Bref questionnaire and PFS through the Karnofsky Performance Status and modified-Barthel index, and retrospectively compared with the pre-admission status (variation [Δ] of indexes). Results: During the study, 160 subjects met the inclusion criteria. Subjects receiving MV presented PFS impairment (Δ Karnofsky Performance Status [-19.7 ± 20.0 vs. -14.9 ± 18.2; p=0.04] and Δ modified-Barthel index [-17.4 ± 12.8 vs. -13.2 ± 12.9; p=0.05]) compared with those who did not receive MV. Duration of MV was a good predictor of PFS (Δ Karnofsky Performance Status [-14.6-1.12 * total days of MV; p=0.01] and Δ modified-Barthel index [-14.2-0.74 * total days of MV; p=0.01]). QoL, assessed by WHOQoL-Bref, showed no difference between groups (14.0 ± 1.8 vs. 14.5 ± 1.9; p=0.14), and the duration of MV did not influence QoL (WHOQoL-Bref scale [14.2-0.05* total days of MV; p=0.43]). Conclusion: Need for MV and duration of MV decrease patient PFS after ICU discharge.

Resumo em Português:

Resumo Objetivo: Analisar criticamente artigos referentes à relação entre a circunferência do pescoço (CP) de adolescentes e: índice de massa corporal, distribuição de gordura, síndrome metabólica e seus componentes individuais e risco cardiovascular. Método: Revisão sistemática realizada por dois pesquisadores independentes nas bases de dados Pubmed/Medline, Lilacs/Medline, Scielo e Cochrane nos idiomas inglês, espanhol e português nos últimos 5 anos. Resultados: Foram selecionados 18 artigos. Os artigos demonstram a associação entre CP de adolescentes e gordura corporal (IMC), distribuição central gordura (CC), síndrome metabólica e vários de seus componentes individuais, e risco cardiovascular. Existem propostas de pontos de corte da CP para o diagnóstico do estado nutricional, hipertensão e pré-hipertensão, risco cardiovascular, resistência insulínica e síndrome metabólica. Foi identificada ainda uma curva de percentis construída para adolescentes brasileiros. Conclusão: Há escassez de estudos com amostras representativas, variedade nos locais de medição da CP e na idade dos participantes, o que dificulta estabelecimento de referências definitivas.

Resumo em Inglês:

Summary Objective: To critically analyze articles on the relation between neck circumference (NC) in adolescents and: body mass index, fat distribution, metabolic syndrome and its individual components, and cardiovascular risk. Method: Systematic review undertaken by two independent researchers using the Pubmed/Medline, Lilacs/Medline, Scielo and Cochrane databases in English, Spanish and Portuguese in the period comprising the past 5 years. Results: Eighteen (18) articles were selected. The articles show an association between NC in adolescents and body fat (BMI), central fat distribution (WC), metabolic syndrome and several of its individual components, and cardiovascular risk. Some values are proposed for NC cutoff points as a diagnostic tool for nutritional status, high blood pressure and pre-hypertension, cardiovascular risk, insulin resistance and metabolic syndrome. We identified a percentile curve constructed for Brazilian adolescents. Conclusion: There is a shortage of studies with representative samples, variety at the NC measurement sites, and the age of the participants, which makes it difficult to establish definitive landmarks.

Resumo em Português:

Resumo Introdução: A chikungunya é uma arbovirose tropical, transmitida pela fêmea dos mosquitos Aedes aegypti e Aedes albopictus. No Brasil, existem casos relatados desde 2014. As manifestações iniciais dessa virose são: febre alta de início súbito, cefaleia, calafrios, erupções cutâneas, mialgia e dor articular intensa. Normalmente, a chikungunya apresenta as fases aguda e crônica, sendo a última caracterizada pela poliartralgia bilateral, que pode durar meses e até anos. Durante esse período, doenças autoimunes podem ser desencadeadas, tornando o quadro ainda mais complicado. Método: Foi realizada uma revisão sistemática nos bancos de dados PubMed e Scielo em janeiro de 2017. Ensaios clínicos, coortes, casos-controle e relatos de caso foram incluídos na pesquisa. Opiniões de especialista, consensos de sociedades e revisões literárias foram critérios de exclusão. Foram avaliados estudos nas línguas inglesa, espanhola e portuguesa. Os estudos foram analisados descritivamente, e os dados agrupados, conforme semelhança metodológica. Resultados: Foram selecionados 24 artigos; em obediência aos critérios de inclusão e exclusão, 18 foram eliminados, restando seis estudos na presente revisão: cinco ensaios clínicos e um relato de caso. Conclusão: Quando as manifestações da chikungunya se tornam crônicas, quanto mais tempo duram, mais complicações surgem. A poliartralgia pode ser incapacitante, afastando os indivíduos das suas atividades de vida diária. Anti-inflamatórios (esteroides ou não), somados a imunossupressores, homeopatia e fisioterapia são medidas de tratamento que, conforme a literatura, têm alcançado êxito no alívio ou na extinção dos sintomas. Todavia, é fundamental que os estudos do tratamento da chikungunya sejam mais aprofundados.

Resumo em Inglês:

Summary Introduction: Chikungunya (CHIK) is a tropical arbovirus, transmitted by the female mosquito Aedes aegypti and Aedes albopictus. In Brazil, there have been cases reported since 2014. The initial manifestations of this virus are sudden onset high fever, headache, chills, rashes, myalgia and intense joint pain. Usually, CHIK presents the acute and chronic phases, the latter characterized by bilateral polyarthralgia, which can last for months or even years. During this period, autoimmune diseases can be triggered, making the picture even more complicated. Method: A systematic review was performed on the PubMed and Scielo databases in January 2017. Clinical trials, cohorts, case-control and case reports were included in the study. Expert opinions, societal consensuses and literary reviews were exclusion criteria. Studies were conducted in English, Spanish and Portuguese. The studies were descriptively analyzed and the data was grouped according to methodological similarity. Results: Twenty-four (24) articles were selected and, in compliance with the inclusion and exclusion criteria, 18 were eliminated, with six studies remaining in the present review: five clinical trials and one case report. Conclusion: When the manifestations of CHIK become chronic and, the longer they last, more complications arise. Polyarthralgia can be immaterial, distancing individuals from their daily-life activities. Anti-inflammatory drugs (either steroid or not), in addition to immunosuppressants, homeopathy and physiotherapy are measures of treatment that, according to the literature, have been successful in relieving or extinguishing symptoms. However, it is fundamental that studies of CHIK treatment be further developed.

Resumo em Português:

Resumo A nova tecnologia PET/RM é o protótipo de diagnóstico por imagem híbrido e permite combinar dados moleculares obtidos da tomografia PET e informações morfofuncionais derivadas da ressonância magnética. Avanços recentes relativos a aspectos técnicos desse dispositivo, principalmente após o desenvolvimento de fotomultiplicadores de silício compatíveis com RM, permitiram uma melhora do desempenho diagnóstico da PET/RM traduzida em redução da dose e qualidade superior das imagens. Entre diversas aplicações clínicas, a PET/RM ganha espaço inicialmente no campo da oncologia, onde a RM tem papel essencial na avaliação de tumores primários (limitado no caso da PET/TC), incluindo tumores de próstata, reto e ginecológicos. Por outro lado, a avaliação dos pulmões ainda é um enigma, a despeito de novas sequências de RM que estão sendo criadas para tentar resolver essa questão. Outras indicações clínicas da PET/RM são encontradas no âmbito da neurologia, cardiologia e de processos inflamatórios, nos quais a técnica também abre perspectivas para pacientes pediátricos, já que envolve uma exposição baixíssima à radiação. Nossa revisão teve como objetivo destacar as indicações atuais da PET/RM e discutir os desafios e perspectivas da aplicação dessa técnica no Hospital das Clínicas da FMUSP.

Resumo em Inglês:

Summary The new technology of PET/MRI is a prototype of hybrid imaging, allowing for the combination of molecular data from PET scanning and morphofunctional information derived from MRI scanning. Recent advances regarding the technical aspects of this device, especially after the development of MRI-compatible silicon photomultipliers of PET, permitted an increase in the diagnostic performance of PET/MRI translated into dose reduction and higher imaging quality. Among several clinical applications, PET/MRI gains ground initially in oncology, where MRI per se plays an essential role in the assessment of primary tumors (which is limited in the case of PET/CT), including prostate, rectal and gynecological tumors. On the other hand, the evaluation of the lungs remains an enigma although new MRI sequences are being designed to overcome this. More clinical indications of PET/MRI are seen in the fields of neurology, cardiology and inflammatory processes, and the use of PET/MRI also opens perspectives for pediatric populations as it involves very low radiation exposure. Our review aimed to highlight the current indications of PET/MRI and discuss the challenges and perspectives of PET/MRI at HC-FMUSP.

Resumo em Inglês:

Summary Diabetic nephropathy is the main cause of chronic kidney disease, and represents the most common and serious complication of diabetes. The exact pathogenesis is complex and not elucidated. Several factors and mechanisms contribute to the development and outcome of diabetic nephropathy. An early diagnosis and intervention may slow down disease progression. A variety of biological markers associated with diabetic nephropathy were found in recent years, which was important for predicting the occurrence and development of the disease. Therefore, this article provides an overview of early biomarkers that are associated with diabetic nephropathy.