Sao Paulo Medical Journalhttps://www.scielo.br/feed/spmj/2008.v126n1/2024-02-20T19:57:28.506000ZVol. 126 No. 1 - 2008WerkzeugEvidence-based healthcare for all: a new era?10.1590/S1516-318020080001000012024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZAtallah, Álvaro Nagib
<em>Atallah, Álvaro Nagib</em>;
<br/><br/>
Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic10.1590/S1516-318020080001000022024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZResegue, RosaPuccini, Rosana FioriniSilva, Edina Mariko Koga da
<em>Resegue, Rosa</em>;
<em>Puccini, Rosana Fiorini</em>;
<em>Silva, Edina Mariko Koga Da</em>;
<br/><br/>
CONTEXT AND OBJECTIVE: Knowledge of risk factors associated with child development disorders is essential for delivering high-quality childcare. The objective here was to evaluate the relationships between risk factors and occurrences of developmental abnormalities among children attended at a reference clinic for children at risk of developmental abnormalities. DESIGN AND SETTING: Retrospective study at a multidisciplinary reference center, Embu, São Paulo. METHODS: All cases followed up for more than three months between 1995 and 2003 were reviewed. The risk factors assessed were low birth weight, gestational age, length of stay in neonatal ward, perinatal asphyxia, mother’s age < 18 years, congenital infections, malformations and low mother’s education level. Developmental abnormalities were defined according to developmental tests and assessments by the clinic’s professionals. The statistical analysis consisted of the chi-squared test for comparing categorical variables and a logistic regression model for multivariate analysis. RESULTS: 211 children were followed up for more than three months. Developmental abnormalities occurred in 111 (52.6%). Univariate analysis showed significant relationships between developmental abnormality and low birth weight, perinatal asphyxia, length of stay > 5 days, prematurity and mother’s age 18 years and older. Low birth weight, history of perinatal asphyxia and mother’s age continued to be significant in multivariate analysis. CONCLUSIONS: Special attention must be paid to the development of low birth weight infants and/or infants with histories of neonatal complications. Low birth weight is easily assessed and should be considered to be an important marker when defining guidelines for following up child development.Postoperative study of vital capacity and ventilation measurements following elective craniotomy10.1590/S1516-318020080001000032024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZSogame, Luciana Carrupt MachadoFaresin, Sonia MariaVidotto, Milena CarlosJardim, José Roberto
<em>Sogame, Luciana Carrupt Machado</em>;
<em>Faresin, Sonia Maria</em>;
<em>Vidotto, Milena Carlos</em>;
<em>Jardim, José Roberto</em>;
<br/><br/>
CONTEXT AND OBJECTIVE: Changes in pulmonary function commonly occur after general surgery. The aims were to evaluate vital capacity, tidal volume and respiratory frequency among patients undergoing elective craniotomy and to determine possible correlations of these parameters with surgery duration and etiology for neurosurgery. DESIGN AND SETTING: Prospective, open study at a tertiary university hospital. METHODS: Twenty-six patients underwent elective craniotomy for aneurysm clipping (11) or tumor resection (15). Vital capacity (VC), tidal volume (TV), minute volume (VE) and respiratory rate were determined before the operation and on the first to fourth postoperative days. RESULTS: There were significant decreases of 25% in VC, 22% in TV and 12% in VE (p < 0.05) and no significant increase in respiratory frequency (5%) on the first postoperative day. VE returned to baseline on the second postoperative day and TV on the third postoperative day, while VC was 8% lower on the fourth postoperative day, compared with before the operation (p < 0.05). VC reduction was significantly greater in patients undergoing aneurysm clipping (43%) than in patients undergoing tumor resection (14%) when surgery duration was more than four hours (p < 0.05), with no significant change when surgery duration was less than four hours. CONCLUSION: Reductions in VC, TV and VE were observed during the postoperative period in patients undergoing aneurysm clipping or tumor resection. The reductions in VC and TV were greater in patients undergoing craniotomy due to aneurysm and with longer surgery duration.Recurrence of cervical intraepithelial neoplasia grades 2 or 3 in HIV-infected women treated by large loop excision of the transformation zone (LLETZ)10.1590/S1516-318020080001000042024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZRussomano, FábioReis, AldoCamargo, Maria JoséGrinsztejn, BeatrizTristão, Maria Aparecida
<em>Russomano, Fábio</em>;
<em>Reis, Aldo</em>;
<em>Camargo, Maria José</em>;
<em>Grinsztejn, Beatriz</em>;
<em>Tristão, Maria Aparecida</em>;
<br/><br/>
CONTEXT AND OBJECTIVE: Women infected by HIV are more likely to have cervical cancer and its precursors. Treatment of the precursor lesions can prevent this neoplasia. The aim of this study was to assess the likelihood of recurrent cervical intraepithelial neoplasia grades 2 or 3 (CIN 2-3) in HIV-infected women, compared with HIV-negative women, all treated by large loop excision of the transformation zone (LLETZ). DESIGN AND SETTING: A cohort study in Instituto Fernandes Figueira, Fundação Oswaldo Cruz (IFF-Fiocruz), Rio de Janeiro. METHOD: 55 HIV-positive and 212 HIV-negative women were followed up after LLETZ for CIN 2-3 (range: 6-133 months). RESULTS: The incidence of recurrent CIN 2-3 was 30.06/10,000 woman-months in the HIV-positive group and 4.88/10,000 woman-months in the HIV-negative group (relative risk, RR = 6.16; 95% confidence interval, CI: 2.07-18.34). The likelihood of recurrence reached 26% at the 62nd month of follow-up among the HIV-positive women, and remained stable at almost 0.6% at the 93rd month of follow-up among the HIV-negative women. We were unable to demonstrate other prognostic factors relating to CIN recurrence, but the use of highly active antiretroviral therapy (HAART) may decrease the risk of this occurrence among HIV patients. CONCLUSION: After LLETZ there is a higher risk of recurrence of CIN 2-3 among HIV-positive women than among HIV-negative women. This higher risk was not influenced by margin status or grade of cervical disease treated. The use of HAART may decrease the risk of this occurrence in HIV patients.Accuracy study on "Osteorisk": a new osteoporosis screening clinical tool for women over 50 years old10.1590/S1516-318020080001000052024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZSteiner, Marcelo LuisFernandes, César EduardoStrufaldi, RodolfoAzevedo, Lucia Helena deStephan, CristinaPompei, Luciano MeloPeixoto, Sérgio
<em>Steiner, Marcelo Luis</em>;
<em>Fernandes, César Eduardo</em>;
<em>Strufaldi, Rodolfo</em>;
<em>Azevedo, Lucia Helena De</em>;
<em>Stephan, Cristina</em>;
<em>Pompei, Luciano Melo</em>;
<em>Peixoto, Sérgio</em>;
<br/><br/>
CONTEXT AND OBJECTIVE: Osteoporosis is the greatest cause of quality-of-life reductions, morbidity and mortality among postmenopausal women, with growing incidence as populations age. Clinical tools like Osteorisk provide an easy-access and low-cost alternative method that helps physicians to reduce the need for dual-energy X-ray absorptiometry (DXA), the expensive gold standard examination for diagnosing osteoporosis. The aim here was to study the accuracy of Osteorisk using heel ultrasonography for bone mineral density (BMD). DESIGN AND SETTING: Cross-sectional study, at Faculdade de Medicina do ABC. METHODS: A structured questionnaire was applied to 615 postmenopausal women, with anthropometric measurements, Osteorisk calculations and quantitative ultrasound on the heel using Sonost 2000 equipment. RESULTS: 461 women were included, with mean age 60 ± 9 years, weight 67.6 ± 12.9 kg and body mass index (BMI) 28.8 ± 5.0 kg/m². Their Osteorisk classifications were: 61.0% low-risk, 28.4% medium-risk and 10.6% high-risk. Quantitative ultrasound showed 81.3% low-risk, 10.0% medium-risk and 8.7% high-risk regarding osteoporosis. Statistically significant results were observed (p < 0.001) when Osteorisk was correlated with age, years since menopause and BMI. Correlating these same variables with quantitative ultrasound, statistically significant results were observed for age (p < 0.001), years since menopause (p < 0.001) and BMI (p < 0.006). The sensitivity, specificity, negative predictive value and positive predictive value for Osteorisk were 64%, 6.7%, 89% and 30.6%, respectively. CONCLUSION: Osteorisk is a valid tool for screening for women at low risk of osteoporosis, making it possible for these women not to have to undergo densitometry.Relationship between stuttering severity in children and their mothers’ speaking rate10.1590/S1516-318020080001000062024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZDehqan, AliBakhtiar, MehdiPanahi, Sadegh SeifAshayeri, Hassan
<em>Dehqan, Ali</em>;
<em>Bakhtiar, Mehdi</em>;
<em>Panahi, Sadegh Seif</em>;
<em>Ashayeri, Hassan</em>;
<br/><br/>
CONTEXT AND OBJECTIVE: Stuttering is a complex disease that influences occupational, social, academic and emotional achievements. The aim of this study was to correlate the stuttering severity index with speaking rates of mothers and children. DESIGN AND SETTING: Cross-sectional study, at the child rehabilitation clinics of Tehran city. METHODS: 35 pairs of mothers and their children who stuttered were studied. There were 29 boys and six girls, of mean age 8.5 years (range: 5.1-12.0). Speech samples from the mother-child pairs were audiotaped for approximately 15 minutes, until a reciprocal verbal interaction had been obtained. This sample was then analyzed in accordance with a stuttering severity index test and speaking rate parameters. RESULTS: The research results outlined a significant relationship between the mothers’ speaking rate and their children’s stuttering severity. CONCLUSION: The results suggest that the mothers’ speaking rate should be incorporated in the assessment and treatment of stuttering.Divergences in antihypertensive therapy in special situations in nephrology10.1590/S1516-318020080001000072024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZLemos, Marcelo MontebelloPedrosa, Alessandra CoelhoTavares, Alze PereiraGóes, Miguel ÂngeloDraibe, Sérgio AntônioSesso, Ricardo
<em>Lemos, Marcelo Montebello</em>;
<em>Pedrosa, Alessandra Coelho</em>;
<em>Tavares, Alze Pereira</em>;
<em>Góes, Miguel Ângelo</em>;
<em>Draibe, Sérgio Antônio</em>;
<em>Sesso, Ricardo</em>;
<br/><br/>
CONTEXT AND OBJECTIVE: The choice of an antihypertensive drug is based on several criteria and specific situations give rise to doubt and controversy. The aim here was to evaluate physicians’ approaches towards treatment with antihypertensive agents in specific situations. DESIGN AND SETTING: Cross-sectional study, at Universidade Federal de São Paulo, São Paulo. METHODS: A questionnaire was applied during a nephrology meeting to evaluate individual approaches towards each hypothetical clinical situation. The questionnaire consisted of five multiple-choice questions (clinical cases) concerning controversial aspects of antihypertensive therapy. RESULTS: A total of 165 questionnaires were analyzed. Most participants were nephrologists (93.2%). There was a preference for angiotensin-converting enzyme (ACE) inhibitors in at least two of the cases. Only 57.2% of the physicians were correct in choosing beta-blockers as the first-line drugs for patients with ischemic coronary disease. Moreover, 66.2% chose ACE inhibitors as the first-line drugs for patients with chronic kidney disease and proteinuria. About 5% of the physicians did not follow the current recommendations for the use of ACE inhibitors in diabetic patients with microalbuminuria. The most controversial question concerned the first-line drug for advanced chronic kidney disease. Most physicians were correct in choosing calcium channel blockers and avoiding ACE inhibitors in renovascular hypertension in the case of a patient with a single functioning kidney. CONCLUSIONS: Most physicians adopted the correct approach, but some had an alternative strategy for the same situations that was not based on evidence.Cutaneous melanoma: descriptive epidemiological study10.1590/S1516-318020080001000082024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZFerrari Júnior, Nelson MarcosMuller, HelenaRibeiro, ManoelMaia, MarcusSanches Júnior, José Antonio
<em>Ferrari Júnior, Nelson Marcos</em>;
<em>Muller, Helena</em>;
<em>Ribeiro, Manoel</em>;
<em>Maia, Marcus</em>;
<em>Sanches Júnior, José Antonio</em>;
<br/><br/>
CONTEXT AND OBJECTIVE: Cutaneous melanoma represents around 3% of all skin tumors. About 20% of such patients will have advanced disease and will die before reaching five years of survival. The aim of this paper was to describe the clinical and histopathological variables and their correlations. DESIGN AND SETTING: Retrospective, descriptive, epidemiological study at the Melanoma Unit, Dermatological Clinic, Irmandade da Santa Casa de Misericórdia, São Paulo. METHODS: Records from 364 cases between May 1993 and January 2006 were analyzed. The frequencies of all study variables and their 95% confidence intervals were determined. The chi-squared test was used to evaluate associations among the variables, adopting a significant level of 0.05. RESULTS: Females predominated, with 1.4 women for each man. The patients’ mean age was 58.9 years. Nonwhite patients represented 13.7% of the sample. The prevalent anatomical sites for cutaneous melanoma were the trunk and feet, for both men and women. Acral lentiginous melanoma represented 22.3% of the cohort. In situ primary lesions were observed in few cases and a high percentage of thick cutaneous melanoma was detected. Ulceration was found in 13.4% of the thin tumors (< 1.0 mm). Thicker and ulcerated lesions predominated in male patients (p = 0.011 and p < 0.001 respectively) and in elderly patients (p = 0.021 and p = 0.015). CONCLUSIONS: The cohort mostly presented thick and ulcerated tumors, denoting late diagnosis and bad prognosis. Also, the sample was characterized by considerable prevalence of female patients, nonwhite patients, limb lesions and acral lentiginous melanoma.Sudden infant death syndrome in Brazil: fact or fancy?10.1590/S1516-318020080001000092024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZWoida, Francesca MaiaSaggioro, Fabiano PintoFerro, Maria Alice RossatoPeres, Luiz Cesar
<em>Woida, Francesca Maia</em>;
<em>Saggioro, Fabiano Pinto</em>;
<em>Ferro, Maria Alice Rossato</em>;
<em>Peres, Luiz Cesar</em>;
<br/><br/>
CONTEXT AND OBJECTIVE: The true incidence of sudden infant death syndrome (SIDS) in Brazil is unknown. The aim here was to identify SIDS cases in the city of Ribeirão Preto, State of São Paulo, between 2000 and 2005, in order to estimate its incidence. DESIGN AND SETTING: Retrospective analysis of data on live births and infant deaths in Ribeirão Preto and from autopsies of infants performed at the Death Verification Service of the Interior (SVOI) between 2000 and 2005. RESULTS: There were 47,356 live births and 537 deaths, with infant mortality rates ranging from 12.9‰ to 10.9‰ of live births. Among the 24 infants who died possibly due to SIDS and who were autopsied at the SVOI, six were from families living in the municipality (0.13‰ of live births): three (50%) were diagnosed as SIDS, and one each (16.66%) as indeterminate cause, bronchoaspiration and cerebral edema. Two deaths occurred in the first month of life (33.33%) and one each (16.66%) at two, four, six and eight months. Two deaths each (33.33%) occurred in the months of February and December, one each in August and October (16.66%). Four cases (66.7%) occurred in the summer and one each (16.66%) in winter and spring. There was 5:1 predominance of males over females. CONCLUSIONS: The frequency of SIDS was lower than what has been reported worldwide and in the Brazilian literature, thus suggesting underdiagnosis, indicating the lack of any specific postmortem protocol for SIDS identification and showing the need to implement this.Diagnosis and treatment of polycythemia vera: Brazilian experience from a single institution10.1590/S1516-318020080001000102024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZLinardi, Camila da Cruz GouveiaPracchia, Luís FernandoBuccheri, Valeria
<em>Linardi, Camila Da Cruz Gouveia</em>;
<em>Pracchia, Luís Fernando</em>;
<em>Buccheri, Valeria</em>;
<br/><br/>
CONTEXT AND OBJECTIVE: Polycythemia vera (PV) is a chronic myeloproliferative disorder characterized by predominant proliferation of erythroid precursors. Few data are available concerning Brazilian patients with this condition. The aim of this study was to describe clinical and demographic characteristics of PV patients at diagnosis and analyze their long-term outcomes. DESIGN AND SETTING: Retrospective study at the Division of Hematology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo. METHODS: All consecutive patients with PV diagnosed according to World Health Organization criteria were eligible for this study. Clinical and demographic characteristics, thrombotic events, transformation to acute leukemia, myelofibrosis and survival were evaluated. RESULTS: Sixty-six patients were evaluated. Thirty-six (54.5%) were females, with a median age at diagnosis of 61 years. At diagnosis, the median hemoglobin concentration was 18.8 mg/dl and the median platelet count was 593,000/mm³. Fifty-eight patients (88.0%) were treated with hydroxyurea with or without phlebotomy. During a median follow-up of 77 months, 22 patients (33.3%) had new thrombotic events, mainly of arterial type. The overall incidence of leukemia and myelofibrosis was 0.42% per patient-year and 1.06% per patient-year, respectively. Median overall survival was not reached and the seven-year survival rate was 77.8%. CONCLUSION: The PV patients described here had long survival and arterial thrombotic events were the most important and common complication among this population.Demographics and complaints of university students who sought help at a campus mental health service between 1987 and 200410.1590/S1516-318020080001000112024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZOliveira, Maria Lilian Coelho deDantas, Clarissa de RosalmeidaAzevedo, Renata Cruz Soares deBanzato, Cláudio Eduardo Muller
<em>Oliveira, Maria Lilian Coelho De</em>;
<em>Dantas, Clarissa De Rosalmeida</em>;
<em>Azevedo, Renata Cruz Soares De</em>;
<em>Banzato, Cláudio Eduardo Muller</em>;
<br/><br/>
CONTEXT AND OBJECTIVE: Client characterization is an important step in evaluating the services offered by campus counseling and mental health centers and in their further planning and development. The objectives here were to describe reported complaints and demographics among students who sought counseling/mental healthcare at a Brazilian campus mental health service over a 17-year period and to compare these characteristics with those of the general university student body. DESIGN AND SETTING: Retrospective study at the Psychological and Psychiatric Service for Students (SAPPE), Universidade Estadual de Campinas (Unicamp). METHODS: The participants were all of the 2,194 students who sought counseling/mental health care at SAPPE from 1987 to 2004. Information was obtained from clients’ clinical charts. Unicamp’s database was consulted for general information on its students. RESULTS: The findings indicated overrepresentation, among the clients, of undergraduates, female students, students from Brazilian states other than São Paulo, students living in the campus residence hall and those whose main source of income was a scholarship grant. We also found overrepresentation of Humanities and Arts students among the clients. The most frequently reported complaints were difficulties in interpersonal relationships, family conflicts and poor academic performance. CONCLUSION: Course level (undergraduate or postgraduate), study field, living in a university residential facility and reliance on a scholarship grant were found to influence the behavior of seeking mental health counseling among Brazilian university students in this study. Course level was found to influence the pattern of complaints reported at first contact with the mental health service.Low-cost outpatient chemotherapy regimen of cisplatin, 5-fluorouracil and leucovorin for advanced head and neck and esophageal carcinomas10.1590/S1516-318020080001000122024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZFabrício, Vanessa de CarvalhoAmado, FernandaDel Giglio, Auro
<em>Fabrício, Vanessa De Carvalho</em>;
<em>Amado, Fernanda</em>;
<em>Del Giglio, Auro</em>;
<br/><br/>
CONTEXT AND OBJECTIVE: Patients with advanced head and neck (H/N) and esophageal squamous cell carcinoma (SCC) often have a poor performance status and a dire prognosis. Our aim was to evaluate the feasibility, activity and quality of life (QOL) of an outpatient chemotherapy regimen consisting of cisplatin, 5-fluorouracil and leucovorin (CFL). DESIGN AND SETTING: Prospective phase II study conducted at a Brazilian public institution. METHODS: Fifteen patients with residual, recurrent or metastatic SCC of the H/N or esophagus received bolus infusions of leucovorin 20 mg/m²/day and 5-fluorouracil 370 mg/m²/day on days 1-4, and 90 minutes of infusion of cisplatin 25 mg/m²/day on days 1-3, every 21 to 28 days, depending on hematological recovery. We also evaluated QOL by applying the European Organization for Research and Treatment of Cancer Quality of Life-C30 questionnaire (EORTC QLQ-C30) before each cycle. RESULTS: The overall response rate was 36%, and the mean overall survival and progression-free survival were six and three months, respectively. We observed grade 3 or higher hematological toxicity in seven patients and one patient had grade 3 nausea and vomiting. One patient died because of neutropenic fever. Seven out of the 12 patients who could be evaluated regarding QOL presented an improvement in their overall health status and functional QOL scores over the course of the treatment. CONCLUSIONS: CFL is an active outpatient protocol with tolerable toxicity and a favorable QOL impact. Larger studies are warranted, in order to confirm these results.Comments on the manuscript "Hepatorenal syndrome: an update"10.1590/S1516-318020080001000132024-02-20T19:57:28.506000Z2020-08-09T06:49:21.481000ZSoper, Charles
<em>Soper, Charles</em>;
<br/><br/>