Resumo em Português:

CONTEXTO E OBJETIVO: O tumor de corpo carotídeo, ou quimiodectoma, é o paraganglioma mais comum em cabeça e pescoço, com aproximadamente 80% dos casos. Pode apresentar poucos sintomas; no entanto, necessita atenção especial para o diagnóstico e tratamento adequado. Os objetivos deste estudo são mostrar a abordagem do quimiodectoma e avaliar as complicações nos pacientes tratados cirurgicamente sem embolização prévia. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo de quimiodectomas acompanhados pelo Serviço de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia, Unicamp. MÉTODOS: Vinte e dois pacientes foram avaliados entre 1983 e 2009. O diagnóstico foi baseado em achados clínicos e métodos de imagens. Foram analisados aspectos epidemiológicos, características das lesões, métodos diagnósticos, tratamento e complicações. RESULTADOS: Os paragangliomas foram classificados em Shamblin I (9%), II (68,1%) e III (22,7%). Angiografia, ressonância nuclear magnética e tomografia computadorizada confirmaram o diagnóstico em 20 pacientes (90,9%). Cinco (22,7%) tiveram sangramento significativo durante a cirurgia, enquanto quatro (18,1%) tiveram sangramento mínimo. Quatro pacientes (18,1%) tiveram sequelas neurológicas. Sete (31,8%) necessitaram de ligadura da artéria carótida externa. Três (13,6%) foram submetidos a ressecção do bulbo carotídeo. O acompanhamento variou de 3 meses a 14 anos, sem recorrências ou óbitos. CONCLUSÕES: Em nossa experiência e de acordo com a literatura, sangramentos significativos e sequelas neurológicas podem ocorrer nos quimiodectomas principalmente em pacientes Shamblin III. As complicações do tratamento sem embolização prévia foram similares aos relatos observados na literatura nos quais se aplicou tal procedimento antes da cirurgia.

Resumo em Inglês:

CONTEXT AND OBJECTIVE: Carotid body tumors, or chemodectomas, are the most common head and neck paragangliomas, accounting for 80% of the cases. They may present minor symptoms; however, they deserve special attention in order to achieve accurate diagnosis and adequate treatment. The objectives of this study were to show the approach towards chemodectomas and evaluate the complications of the patients treated surgically without previous embolization. DESIGN AND SETTING: Retrospective study on chemodectomas followed up at the Head and Neck Surgery Service, Department of Surgery, Unicamp. METHODS: Twenty-two patients were evaluated between 1983 and 2009. The diagnosis was based on clinical findings and imaging methods. The epidemiological characteristics, lesion characteristics, diagnostic methods, treatment and complications were analyzed. RESULTS: The paragangliomas were classified as Shamblin I (9%), II (68.1%) and III (22.7%). Angiography, magnetic resonance imaging and computed tomography confirmed the diagnosis in 20 patients (90.9%). Five (22.7%) had significant bleeding during the surgery, while four (18.1%) had minor bleeding. Four patients (18.1%) developed neurological sequelae. Seven (31.8%) needed ligatures of the external carotid artery. Three patients (13.6%) underwent carotid bulb resection. The postoperative follow-up ranged from 3 months to 14 years without recurrences or mortality. CONCLUSIONS: In our experience and in accordance with the literature, significant bleeding and neurological sequelae may occur in chemodectoma cases, particularly in Shamblin III patients. The complications from treatment without previous embolization were similar to data in the literature data, from cases in which this procedure was applied prior to surgery.

Resumo em Português:

CONTEXTO E OBJETIVOS: Anemia é a mais frequente complicação extraintestinal na doença inflamatória intestinal. Este estudo objetivou: 1) determinar a prevalência de anemia em portadores de doença inflamatória intestinal; 2) investigar se os marcadores laboratoriais de uso rotineiro são úteis para o diagnóstico da anemia; 3) avaliar se existe associação entre anemia e variáveis clínico-laboratoriais. TIPO DE ESTUDO E LOCAL: Estudo transversal em uma universidade federal. MÉTODOS: Foram avaliados 44 pacientes ambulatoriais com doença de Crohn e 55 com retocolite ulcerativa. Foram investigados aspectos clínicos (índice de atividade da doença, localização da doença e tratamento farmacológico) e laboratoriais (hemograma, ferrocinética, vitamina B12 e ácido fólico). RESULTADOS: Anemia e/ou anormalidades na ferrocinética estavam presentes em 75% dos pacientes com doença de Crohn e em 78,2% dos pacientes com retocolite. Anemia foi observada em 20,5% do grupo com doença de Crohn e em 23,6% do grupo com retocolite. Anemia por deficiência de ferro predominou entre os pacientes com doença de Crohn (69,6%) e com retocolite (76,7%). Anemia de doença crônica associada à anemia ferropriva estava presente em 3% dos pacientes com doença de Crohn e em 7% daqueles com retocolite. Na retocolite, a anemia estava associada com o índice de atividade da doença. CONCLUSÕES: A maioria dos pacientes apresentava alterações na ferrocinética com ou sem anemia, principalmente decorrente da ferropenia. O diagnóstico diferencial entre os dois tipos mais prevalentes de anemia foi baseado nos dados clínicos e nos testes laboratoriais de rotina. Anemia estava associada com o índice de atividade na retocolite.

Resumo em Inglês:

CONTEXT AND OBJECTIVES: Anemia is the most frequent extraintestinal complication of inflammatory bowel disease. This study aimed to: 1) determine the prevalence of anemia among patients with inflammatory bowel disease; 2) investigate whether routine laboratory markers are useful for diagnosing anemia; and 3) evaluate whether any association exists between anemia and clinical/laboratory variables. DESIGN AND SETTING: Cross-sectional at a federal university. METHODS: 44 outpatients with Crohn's disease and 55 with ulcerative colitis were evaluated. Clinical variables (disease activity index, location of disease and pharmacological treatment) and laboratory variables (blood count, iron laboratory, vitamin B12 and folic acid) were investigated. RESULTS: Anemia and/or iron laboratory disorders were present in 75% of the patients with Crohn's disease and in 78.2% with ulcerative colitis. Anemia was observed in 20.5% of the patients with Crohn's disease and in 23.6% with ulcerative colitis. Iron-deficiency anemia was highly prevalent in patients with Crohn's disease (69.6%) and ulcerative colitis (76.7%). Anemia of chronic disease in combination with iron deficiency anemia was present in 3% of the patients with Crohn's disease and in 7% of the patients with ulcerative colitis. There was no association between anemia and disease location. In ulcerative colitis, anemia was associated with the disease activity index. CONCLUSIONS: Most patients present iron laboratory disorders, with or without anemia, mainly due to iron deficiency. The differential diagnosis between the two most prevalent types of anemia was made based on clinical data and routine laboratory tests. In ulcerative colitis, anemia was associated with the disease activity index.

Resumo em Português:

CONTEXTO E OBJETIVO: Náusea e vômito são inconvenientes importantes para pacientes submetidos a quimioterapia. A despeito do tratamento preventivo padrão, náuseas e vômitos induzidos por quimioterapia (NVIQ) ocorrem em aproximadamente 50% dos pacientes. Na tentativa de otimizar este tratamento, avaliamos os possíveis efeitos da carbamazepina na prevenção de náuseas e vômitos induzidos por quimioterapia. TIPO DE ESTUDO E LOCAL: Estudo fase II, prospectivo, não randomizado, aberto, realizado em um serviço público brasileiro de oncologia. MÉTODOS: Recrutaram-se continuamente pacientes alocados para o primeiro ciclo de quimioterapia altamente emetogênica. Além do protocolo anti-emético padrão disponibilizado, os pacientes receberam carbamazepina, por via oral, em doses escalonadas, a partir do terceiro dia anterior até o quinto dia após a quimioterapia. Dada a escassa evidência de eficácia dos anticonvulsivantes na prevenção de NVIQ, adotamos o desenho de Simon em duas fases, que deveria incluir 43 pacientes a não ser que prevenção completa global não fosse alcançada em 9 dos primeiros 15 participantes. O questionário "Functional Living Index-Emesis" foi usado para avaliar o impacto na qualidade da vida. RESULTADOS: Nenhum dos 10 pacientes (0%) apresentou prevenção completa global. Três tiveram a carbamazepina suspensa por sonolência e vômito antes da quimioterapia. Sete foram capazes de tomar a medicação por todo o período proposto e nenhum obteve resposta, sendo então interrompido o estudo. Não houve impacto na qualidade da vida. CONCLUSÃO: Carbamazepina não foi efetiva para prevenção de NVIQ e apresentou perfil deletério de efeitos adversos nesta população.

Resumo em Inglês:

CONTEXT AND OBJECTIVE: Nausea and vomiting are major inconveniences for patients undergoing chemotherapy. Despite standard preventive treatment, chemotherapy-induced nausea and vomiting (CINV) still occurs in approximately 50% of these patients. In an attempt to optimize this treatment, we evaluated the possible effects of carbamazepine for prevention of CINV. DESIGN AND LOCATION: Prospective nonrandomized open-label phase II study carried out at a Brazilian public oncology service. METHODS: Patients allocated for their first cycle of highly emetogenic chemotherapy were continuously recruited. In addition to standard antiemetic protocol that was made available, they received carbamazepine orally, with staggered doses, from the third day before until the fifth day after chemotherapy. Considering the sparseness of evidence about the efficacy of anticonvulsants for CINV prevention, we used Simon's two-stage design, in which 43 patients should be included unless overall complete prevention was not achieved in 9 out of the first 15 entries. The Functional Living Index-Emesis questionnaire was used to measure the impact on quality of life. RESULTS: None of the ten patients (0%) presented overall complete prevention. In three cases, carbamazepine therapy was withdrawn because of somnolence and vomiting before chemotherapy. Seven were able to take the medication for the entire period and none were responsive, so the study was closed. There was no impact on the patients' quality of life. CONCLUSION: Carbamazepine was not effective for prevention of CINV and also had a deleterious side-effect profile in this population.

Resumo em Português:

CONTEXTO E OBJETIVO: Há poucos estudos sobre os fatores de risco para os subgrupos de gagueira. O objetivo deste estudo foi caracterizar os fatores de risco para a gagueira desenvolvimental familial em meninos que gaguejam e que não gaguejam como tipologia das disfluências, fatores qualitativos e comunicativos associados, estresse físico e emocional, atitude familiar e reação pessoal. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico com um grupo controle, realizado no Laboratório de Estudo da Fluência, que faz parte do Departamento de Fonoaudiologia de uma universidade pública. MÉTODOS: Pais de 40 meninos com e sem gagueira pareados por idade fizeram parte do estudo. Os participantes foram divididos em dois grupos: crianças com gagueira e crianças sem gagueira, com idades entre 6 anos 0 meses e 11 anos 11 meses Inicialmente todos os participantes foram submetidos a uma avaliação de fluência e depois os dados foram coletados por meio do Protocolo de Risco para a Gagueira do Desenvolvimento. RESULTADOS: Não foi observada diferença nos fatores de estresse físicos e reações pessoais entre os grupos. As atitudes inadequadas familiares foram apresentadas por 95% das crianças com gagueira e 30% das crianças sem gagueira. Quatro fatores de risco analisados não ocorreram nas crianças sem gagueira, a saber, disfluências gagas, fatores qualitativos, estresse físico e emocional. CONCLUSÕES: Os achados sugerem que a presença de disfluências gagas, fatores qualitativos e comunicativos associados, estresse emocional e atitude familiar inadequada são fatores de risco importantes para a gagueira desenvolvimental familial em meninos.

Resumo em Inglês:

CONTEXT AND OBJECTIVE: There have been few studies on the risk factors for subgroups of stuttering. The aim of this study was to characterize the risk factors for developmental familial stuttering among boys who stutter and who do not stutter, such as disfluency types, associated quality and communication factors, emotional and physical stress, familial attitudes and personal reactions. DESIGN AND SETTING: Analytical cross-sectional study with a control group, performed at the Fluency Studies Laboratory of the Department of Speech and Hearing Disorders of a public university. METHODS: The parents of 40 age-matched stuttering and non-stuttering boys took part in this study. The participants were divided into two groups: stuttering children (SC) and non-stuttering children (NSC), with ages between 6 years 0 months and 11 years 11 months. Initially, all of the participants underwent a fluency assessment and then data were gathered using the Protocol for the Risk of Developmental Stuttering. RESULTS: There were no differences in the physical stress distribution factors and personal reactions between the groups. Inappropriate familial attitudes were presented by 95% of the SC and 30% of the NSC. Four risk factors analyzed were not shown by the NSC, namely stuttering-like disfluency, quality factors, physical stress and emotional stresses. CONCLUSIONS: The findings suggest that the presence of stuttering-like disfluency, associated quality and communication factors, emotional stress and inappropriate family attitudes are important risk factors for familial developmental stuttering among boys.

Resumo em Português:

CONTEXTO E OBJETIVO: Para a realização de transplantes de medula óssea com material alogênico, é necessária a verificação de histocompatibilidade das moléculas do sistema HLA (human leukocyte antigen), fundamental para o sucesso desses transplantes. O objetivo desta pesquisa foi caracterizar os doadores de medula óssea segundo gênero, idade, etnia e grupos HLA de um centro regional de hemoterapia brasileiro. TIPO DE ESTUDO E LOCAL: Estudo descritivo dos doadores cadastrados em um centro regional de hemoterapia de um hospital público universitário da região Sudeste do Brasil. MÉTODOS: Foram consultadas as fichas dos 66.780 doadores cadastrados entre 2005 e junho de 2011 e tabuladas as variáveis estudadas. RESULTADOS: Encontrou-se distribuição equilibrada entre os gêneros, e 82,8% dos doadores tinham até 45 anos de idade. Quanto à etnia auto-referida, 77,3% se apresentaram como brancos, 15,0% como pardos, 5,7% como negros, os 2% restantes dividindo-se em outras etnias. Quanto à caracterização imunogenética, no grupo alélico HLA-A, o mais frequente foi o HLA-A*02, com 39,20%; no grupo alélico HLA-B, o mais comum foi o HLA-B*35, com 14,18%; no grupo alélico HLA-DRB1, o mais frequente foi o HLA-DRB1*03, com 17,03% do total de doadores. Quando esses resultados são comparados com os dados do cadastro nacional de doadores (REDOME), observam-se diferenças demográficas e imunogenéticas, que se explicam pelo histórico de imigração da região de Ribeirão Preto, no Sudeste brasileiro. CONCLUSÕES: Os resultados encontrados reforçam a importância de conhecer o perfil demográfico e imunogenético das regiões do Brasil, para reduzir o tempo de espera por um doador histocompatível.

Resumo em Inglês:

CONTEXT AND OBJECTIVE: Checking the histocompatibility of the molecules of the human leukocyte antigen (HLA) system is vital for performing bone marrow transplantation with allogeneic material. The objective of this study was to characterize bone marrow donors according to gender, age, ethnicity and HLA groups at a regional hemotherapy center in Brazil. DESIGN AND SETTING: Descriptive study on registered donors at a regional hemotherapy center in a public university hospital in the southeastern region of Brazil. METHODS: The records of 66,780 donors who were registered between 2005 and June 2011 were consulted, and the variables studied were tabulated. RESULTS: There were equal numbers of male and female donors and 82.8% of them were under 45 years of age. In terms of ethnicity, 77.3% declared themselves to be white, 15.0% mixed race, 5.7% black and 2% others. In terms of immunogenetic characterization, the most frequent HLA-A allelic group was HLA-A*02, with 39.20% of the donors; in the HLA-B allelic group, the most common was HLA-B*35, with 14.18%; while in the HLA-DRB1 allelic group, the most frequent was HLA-DRB1*03, with 17.03%. Comparison between these results and data from the Brazilian Bone Marrow Donor Registry (REDOME) showed that there were demographic and immunogenetic differences due to the history of immigration in the region of Ribeirão Preto, in southeastern Brazil. CONCLUSIONS: The results reinforce the importance of understanding the demographic and immunogenic profile of regions of Brazil, in order to reduce the waiting time for a histocompatible donor.

Resumo em Português:

CONTEXTO E OBJETIVO: A esclerose sistêmica (ES) é uma doença autoimune caracterizada por anormalidades da vascularização, que podem gerar fibrose da pele e outros órgãos, podendo levar a disfunção. Assim, torna-se imprescindível a elaboração de instrumentos capazes de avaliar a função de indivíduos com ES. O objetivo deste estudo foi traduzir para o português, adaptar à cultura brasileira e testar a validade e confiabilidade do Scleroderma Health Assessment Questionnaire (SHAQ). TIPO DE ESTUDO E LOCAL: A validação do SHAQ seguiu uma metodologia aceita internacionalmente, e foi realizada nos ambulatórios da universidade. MÉTODOS: Foi realizada tradução e contra-tradução do instrumento. Na fase de adaptação cultural, o SHAQ foi aplicado a 20 pacientes. As questões que apresentaram mais de 20% de incompreensão foram modificadas e aplicadas em outros 20 pacientes. Para validade e confiabilidade, 20 pacientes foram entrevistados em dois momentos: no primeiro, por dois entrevistadores e após 14 dias por um deles. Foram aplicados o Health Assessment Questionnaire (HAQ), o Disabilities of the Arm, Shoulder and Hand (DASH) e o short form-36 (SF-36), para a validade externa. RESULTADOS: Na avaliação interobservador, o coeficiente de correlação de Pearson e o coeficiente de correlação intraclasse foram ambos de 0,967. Na avaliação intraobservador o coeficiente de correlação de Pearson foi de 0,735, e o coeficiente de correlação intraclasse foi de 0,687. Na validade externa, os escores do SHAQ foram associados estatisticamente com todos os instrumentos, exceto com o domínio estado geral de saúde do SF-36 e o escore relacionado ao trabalho (Q2) do DASH. CONCLUSÃO: A versão brasileira do SHAQ mostrou ser válida e confiável para a avaliação de função em pacientes com esclerose sistêmica difusa.

Resumo em Inglês:

CONTEXT AND OBJECTIVE: Systemic sclerosis is an autoimmune disease characterized by abnormalities of vascularization that may cause fibrosis of the skin and other organs and lead to dysfunction. It is therefore essential to have tools capable of evaluating function in individuals with this condition. The aim of this study was to translate the Scleroderma Health Assessment Questionnaire (SHAQ) into Portuguese, adapt it to Brazilian culture and test its validity and reliability. DESIGN AND SETTING: The validation of SHAQ followed internationally accepted methodology, and was performed in university outpatient clinics. METHODS: SHAQ was translated into Portuguese and back-translated. In the cultural adaptation phase, it was applied to 20 outpatients. Items not understood by 20% of the patients were modified and applied to another 20 outpatients. Twenty patients were interviewed on two different occasions to determine the validity and reliability of the questionnaire: two interviewers on the first occasion and one interviewer 14 days later. To determine the external validity, comparisons were made with Health Assessment Questionnaire (HAQ), Disabilities of the Arm, Shoulder and Hand (DASH) and short form-36 (SF-36). RESULTS: In the interobserver evaluation, Pearson's correlation coefficient and the intraclass correlation coefficient were both 0.967. In the intraobserver evaluation, Pearson's correlation coefficient was 0.735 and the intraclass correlation coefficient was 0.687. Regarding external validity, SHAQ scores were statistically correlated with all measurements, except the general health domain of SF-36 and the work-related score (Q2) of DASH. CONCLUSION: The Brazilian version of SHAQ proved to be valid and reliable for assessing function in patients with diffuse systemic sclerosis.

Resumo em Português:

CONTEXTO E OBJETIVO: Ainda persistem muitas incertezas relativas a fatores de risco e evolução das desordens cognitivas. Descrevemos métodos e resultados preliminares da investigação da cognição no ELSA-Brasil, Estudo Longitudinal de Saúde do Adulto. TIPO DE ESTUDO E LOCAL: Estudo de coorte, multicêntrico, com servidores públicos de seis instituições públicas de ensino e pesquisa. MfÉTODOS: Participantes foram entrevistados e examinados, para obtenção de amplo espectro de variáveis sociais, clínicas e ambientais. Foram utilizados instrumentos padronizados de avaliação da memória, linguagem e funções executiva e visual espacial: teste de memória de palavras ou de figuras, de fluência verbal semântica (animais) e fonêmica (letra F) e teste de trilhas B. RESULTADOS: 15,101 de 15,105 participantes fizeram os testes cognitivos; 54% eram mulheres, a média da idade foi de 51 anos e 52% tinham grau universitário. 14.965 participantes (99%) fizeram o teste de palavras e 136 (1%) o teste de figuras, dado o menor grau de instrução. Os escores dos testes de fluência verbal semântica (média = 18.42 ± 5.29, mediana = 18 palavras) foram maiores que os escores dos testes de fluência verbal fonêmica (média = 12.46 ± 4.5, mediana = 12 palavras). O tempo mediano para execução do teste de trilhas foi de 1,6 minutos. CONCLUSÃO: O grande tamanho da coorte, de idade jovem, e a extensa quantidade de dados clínicos e epidemiológicos disponíveis permitirão a investigação do prognóstico de variáveis de natureza biológica, comportamental, ambiental, ocupacional e psicossociais, em curto e médio prazo, sobre o declínio cognitivo em adultos e idosos.

Resumo em Inglês:

CONTEXT AND OBJECTIVE: Many uncertainties concerning risk factors and evolution of cognitive disorders remain. We describe the methods and preliminary results from the investigation of the cognitive function in the Longitudinal Study on Adult Health (ELSA-Brasil). DESIGN AND SETTING: Multicenter cohort study on public employees at six public teaching and research institutions. METHODS: The participants were interviewed and examined to obtain a broad range of social, clinical and environmental characteristics. The following standardized tools were used to assess memory, language and visuospatial and executive functions: words or figure memory test; semantic (animals) and phonemic (letter F) verbal fluency tests; and trail test B. RESULTS: 15,101 out of 15,105 participants took the cognitive tests: 54% were women; the mean age was 51 years; and 52% had a university degree. 14,965 participants (99%) did the word test and 136 (1%) did the figure test due to low schooling level. The scores from the semantic verbal fluency tests (mean = 18.42 ± 5.29; median = 18 words) were greater than the scores from the phonemic verbal fluency tests (mean = 12.46 ± 4.5; median = 12 words). The median time taken to perform the trail test was 1.6 minutes. CONCLUSION: The large cohort size, of young age, and the extensive amount of clinical and epidemiological data available will make it possible to investigate the prognostic value of biological, behavioral, environmental, occupational and psychosocial variables over the short and medium terms in relation to cognitive decline, among adults and elderly people.

Resumo em Português:

CONTEXTO E OBJETIVO: Estudos de caso-controle são importantes no desenvolvimento do conhecimento clínico e de saúde pública. O STROBE statement (STrengthening the Reporting of OBservational Studies in Epidemiology) foi criado para estabelecer uma lista de itens que devem estar presentes na descrição de estudos observacionais. Nosso objetivo é analisar a adequação de artigos caso-controle psiquiátricos publicados em periódicos brasileiros Qualis B1/B2 CAPES em 2009 utilizando o STROBE statement. TIPO DE ESTUDO E LOCAL: Estudo descritivo de artigos em psiquiatria publicados por periódicos brasileiros, realizado no Programa de Pós-Graduação em Medicina: Psiquiatria, na Universidade Federal do Rio Grande do Sul. MÉTODOS: Todos os estudos de caso-controle psiquiátricos em revistas brasileiras Qualis B1/B2 de psiquiatria, neurologia e saúde pública em 2009 foram analisados. Os quatro itens mais específicos do STROBE statement foram utilizados para avaliar se os estudos se ajustavam aos parâmetros de caso-controle: 1) seleção de casos e controles, 2) controle de vieses, 3) análise estatística e 4) apresentação dos resultados. RESULTADOS: Dezesseis estudos de caso-controle foram identificados, 68,75% (11) deles de periódicos de psiquiatria. Após a análise com base no STROBE statement, todos os artigos adequavam-se ao item 1; 12,5% (2) adequavam-se completamente ao item 2; nenhum ajustava-se completamente ao item 3; e somente 18,8% (3) estavam adequados em relação ao item 4. CONCLUSÃO: Os estudos de caso-controle avaliados aqui não se adequaram completamente aos quatro itens do STROBE statement para o desenho de caso-controle. Tendo em vista a inadequada metodologia dos estudos publicados, os achados justificam direcionar-se o foco para a pesquisa e metodologia, aumentando a investigação da adesão dos estudos aos seus desenhos.

Resumo em Inglês:

CONTEXT AND OBJECTIVE: Case-control studies are important in developing clinical and public health knowledge. The STROBE statement (STrengthening the Reporting of OBservational Studies in Epidemiology) was developed to establish a checklist of items that should be included in articles reporting observational studies. Our aim was to analyze whether the psychiatric case-control articles published in Brazilian journals with CAPES Qualis rating B1/B2 in 2009 conformed with the STROBE statement. DESIGN AND SETTING: Descriptive study on psychiatric papers published in Brazilian journals, within the Postgraduate Medical Program on Psychiatry, at Universidade Federal do Rio Grande do Sul. METHODS: All psychiatric case-control studies from Brazilian Qualis B1/B2 journals of psychiatry, neurology and public health in 2009 were analyzed. The four most specific items of the STROBE statement were used to evaluate whether these studies fitted within the case-control parameters: 1) selection of cases and controls; 2) controlling for bias; 3) statistical analysis; and 4) presentation of results. RESULTS: Sixteen case-control studies were identified, of which eleven (68.75%) were in psychiatry-focused journals. From analysis using the STROBE statement, all of the articles conformed with item 1; two (12.5%) completely conformed with item 2; none completely conformed with item 3; and only three (18.8%) conformed with item 4. CONCLUSION: The case-control studies analyzed here did not completely conform with the four STROBE statement items for case-control design. In view of the inadequate methodology of the published studies, these findings justify focusing on research and methodology and expanding the investigations on adherence of studies to their designs.

Resumo em Português:

CONTEXTO: A ingestão de bateria em disco é queixa frequente em pediatria. As complicações graves decorrentes de ingestão acidental têm aumentado significativamente nas últimas duas décadas, devido ao fácil acesso aos aparelhos e brinquedos eletrônicos. Nos últimos anos, o aumento do uso de baterias de lítio com diâmetro de 20 mm trouxe novos desafios, por serem mais prejudiciais para a mucosa em comparação com outros tipos, com elevada morbidade e mortalidade. As queixas clínicas, muitas vezes inespecíficas, podem levar ao atraso no diagnóstico, aumentando o risco de complicação grave. RELATO DE CASO: Menino de cinco anos, com queixa de dor abdominal há 10 dias, é trazido ao serviço de emergência com quadro clínico de hematêmese há duas horas. Na admissão, apresentava palidez, taquicardia e hipotensão. Imagem sugestiva de bateria em disco foi visualizada na radiografia simples de abdome. A endoscopia digestiva demonstrou lesão ulcerada profunda no esôfago sem sangramento ativo. Após o procedimento, o paciente apresentou hematêmese profusa e hipotensão grave, seguidos de parada cardiorrespiratória (PCR), revertida. Submetido a laparotomia exploradora de urgência, apresentou novo episódio de PCR, sem reversão. A bateria foi removida por exploração retal. CONCLUSÃO: Este caso descreve a evolução fatal de ingestão da bateria em disco com diagnóstico tardio e associação com lesão grave de mucosa digestiva. Alto nível de suspeita clínica é obrigatório para evitar tal evolução. As estratégias de prevenção são necessárias, bem como a educação em saúde, com alerta aos pais, cuidadores e profissionais de saúde.

Resumo em Inglês:

CONTEXT: Button battery ingestion is a frequent pediatric complaint. The serious complications resulting from accidental ingestion have increased significantly over the last two decades due to easy access to gadgets and electronic toys. Over recent years, the increasing use of lithium batteries of diameter 20 mm has brought new challenges, because these are more detrimental to the mucosa, compared with other types, with high morbidity and mortality. The clinical complaints, which are often nonspecific, may lead to delayed diagnosis, thereby increasing the risk of severe complications. CASE REPORT: A five-year-old boy who had been complaining of abdominal pain for ten days, was brought to the emergency service with a clinical condition of hematemesis that started two hours earlier. On admission, he presented pallor, tachycardia and hypotension. A plain abdominal x-ray produced an image suggestive of a button battery. Digestive endoscopy showed a deep ulcerated lesion in the esophagus without active bleeding. After this procedure, the patient presented profuse hematemesis and severe hypotension, followed by cardiorespiratory arrest, which was reversed. He then underwent emergency exploratory laparotomy and presented a new episode of cardiorespiratory arrest, which he did not survive. The battery was removed through rectal exploration. CONCLUSION: This case describes a fatal evolution of button battery ingestion with late diagnosis and severe associated injury of the digestive mucosa. A high level of clinical suspicion is essential for preventing this evolution. Preventive strategies are required, as well as health education, with warnings to parents, caregivers and healthcare professionals.

Resumo em Inglês:

BACKGROUND: People with asthma may show less tolerance to exercise due to worsening asthma symptoms during exercise or other reasons such as deconditioning as a consequence of inactivity. Some may restrict activities as per medical advice or family influence and this might result in reduced physical fitness. Physical training programs aim to improve physical fitness, neuromuscular coordination and self confidence. Subjectively, many people with asthma report that they are symptomatically better when fit, but results from trials have varied and have been difficult to compare because of different designs and training protocols. Also, as exercise can induce asthma, the safety of exercise programmes needs to be considered. OBJECTIVE: To gain a better understanding of the effect of physical training on the respiratory and general health of people with asthma, from randomised trials. METHODS: Search methods: We searched the Cochrane Airways Group Specialised Register of trials up to January 2013. Selection criteria: We included randomised trials of people over eight years of age with asthma who were randomised to undertake physical training or not. Physical training had to be undertaken for at least 20 minutes, two times a week, over a minimum period of four weeks. Data collection and analysis: Two review authors independently assessed eligibility for inclusion and undertook risk of bias assessment for the included studies. MAIN RESULTS: Twenty-one studies (772 participants) were included in this review with two additional 2012 studies identified as 'awaiting classification'. Physical training was well tolerated with no adverse effects reported. None of the studies mentioned worsening of asthma symptoms following physical training. Physical training showed marked improvement in cardiopulmonary fitness as measured by a statistically and clinically significant increase in maximum oxygen uptake (mean difference (MD) 4.92 mL/kg/min; 95% confidence interval (CI) 3.98 to 5.87; P < 0.00001; 8 studies on 267 participants); however, no statistically significant effects were observed for forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), minute ventilation at maximal exercise (VEmax) or peak expiratory flow rate (PEFR). Meta-analysis of four studies detected a statistically significant increase in maximum heart rate, and following a sensitivity analysis and removal of two studies significance was maintained (MD 3.67 bpm; 95% CI 0.90 to 3.44; P = 0.01). Although there were insufficient data to pool results due to diverse reporting tools, there was some evidence to suggest that physical training may have positive effects on health-related quality of life, with four of five studies producing a statistically and clinically significant benefit. AUTHORS' CONCLUSIONS: This review demonstrated that physical training showed significant improvement in maximum oxygen uptake, though no effects were observed in other measures of pulmonary function. Physical training was well tolerated among people with asthma in the included studies and, as such, people with stable asthma should be encouraged to participate in regular exercise training, without fear of symptom exacerbation. More research is needed to understand the mechanisms by which physical activity impacts asthma management.

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BACKGROUND: This is an update of our previous 2008 review. Several recent trials and systematic reviews of the impact of exercise on people with dementia are reporting promising findings. OBJECTIVE: Primary: Do exercise programs for older people with dementia improve cognition, activities of daily living (ADLs), challenging behaviour, depression, and mortality in older people with dementia? Secondary: Do exercise programs for older people with dementia have an indirect impact on family caregivers' burden, quality of life, and mortality? Do exercise programs for older people with dementia reduce the use of healthcare services (e.g. visits to the emergency department) by participants and their family caregivers? METHODS: Search methods: We identified trials for inclusion in the review by searching ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group's Specialised Register, on 4 September 2011, and again on 13 August 2012. The search terms used were: 'physical activity' OR exercise OR cycling OR swim* OR gym* OR walk* OR danc* OR yoga OR 'tai chi'. Selection criteria: In this review, we included randomized controlled trials in which older people, diagnosed with dementia, were allocated either to exercise programs or to control groups (usual care or social contact/activities) with the aim of improving cognition, ADLs, behaviour, depression, and mortality. Secondary outcomes related to the family caregiver(s) and included caregiver burden, quality of life, mortality, and use of healthcare services. Data collection and analysis: Independently, at least two authors assessed the retrieved articles for inclusion, assessed methodological quality, and extracted data. Data were analysed for summary effects using RevMan 5.1 software. We calculated mean differences or standardized mean difference (SMD) for continuous data, and synthesized data for each outcome using a fixed-effect model, unless there was substantial heterogeneity between studies, when we used a random-effects model. We planned to explore heterogeneity in relation to severity and type of dementia, and type, frequency, and duration of exercise program. We also evaluated adverse events. MAIN RESULTS: Sixteen trials with 937 participants met the inclusion criteria. However, the required data from three trials and some of the data from a fourth trial were not published and not made available. The included trials were highly heterogeneous in terms of subtype and severity of participants' dementia, and type, duration and frequency of exercise. Only two trials included participants living at home. Our meta-analysis suggested that exercise programs might have a significant impact on improving cognitive functioning (eight trials, 329 participants; SMD 0.55, 95% confidence interval (CI) 0.02 to 1.09). However, there was substantial heterogeneity between trials (I 2 value 80%), most of which we were unable to explain. We repeated the analysis omitting one trial, an outlier, that included only participants with moderate or severe dementia. This reduced the heterogeneity somewhat (I2 value 68%), and produced a result that was no longer significant (seven trials, 308 participants; SMD 0.31, 95% CI -0.11 to 0.74). We found a significant effect of exercise programs on the ability of people with dementia to perform ADLs (six studies, 289 participants; SMD 0.68, 95% CI 0.08 to 1.27). However, again we observed considerable unexplained statistical heterogeneity (I2 value 77%) in this meta-analysis. This means that there is a need for caution in interpreting these findings. In further analyses, we found that the burden experienced by informal caregivers providing care in the home may be reduced when they supervise the participation of the family member with dementia in an exercise program (one study, 40 participants; MD -15.30, 95% CI -24.73 to -5.87), but we found no significant effect of exercise on challenging behaviours (one study, 110 participants; MD -0.60, 95% CI -4.22 to 3.02), or depression (six studies, 341 participants; MD -0.14, 95% CI -0.36 to 0.07). We could not examine the remaining outcomes, quality of life, mortality, and healthcare costs, as either the appropriate data were not reported, or we did not retrieve trials that examined these outcomes. AUTHORS' CONCLUSIONS: There is promising evidence that exercise programs can have a significant impact in improving ability to perform ADLs and possibly in improving cognition in people with dementia, although some caution is advised in interpreting these findings. The programs revealed no significant effect on challenging behaviours or depression. There was little or no evidence regarding the remaining outcomes of interest.