In the February 2007 issue of Clinics

EDITORIAL

In the February 2007 issue of Clinics

Mauricio Rocha-e-Silva, Editor

Hospital das Clínicas, São Paulo University Medical School – São Paulo/SP, Brazil. Email: [e-mail]

This issue of CLINICS opens our 3^rd year of existence. We now operate through a new Editorial Management system, with Manuscript Central, which we hope will help us to acquire increased international visibility. In this issue we wish to highlight an interesting anatomical study by Daniel et al. on pharyngeal dimensions of 10 volunteer healthy men and 10 women in a quest for possible explanations for the higher prevalence of obstructive sleep apnea in men. The interesting finding is that pharyngeal air columns exhibited similar dimensions in men and women, but that in women this column is surrounded by smaller, lighter structures. This might imply a smaller effort for women to keep airway patency. Thus, an anatomical protective factor in women against the upper airway collapse may exist. We publish 9 other original research papers.

Carvalho et al describe patterns of detection and optical correction among 578 ophthalmologists and resident physicians to determine age of first ophthalmic evaluation and optical prescription along with present optical correction among ophthalmologists of different age groups. This cross-sectional study, conducted through a self-administered questionnaire, detected average ages for (i) first ophthalmologic exam, (ii) use of first optical prescription, and (iii) the types of chosen corrective devices. Authors conclude that the first ophthalmic evaluation and corresponding optical correction occurred relatively late, and take this as a sign of general habits in the Brazilian population.

Pinho et al compared a new evaluation method (EMAPO) to the method of the American College of Physicians for determining the risk of cardiovascular complications in noncardiac surgeries searching for new influencing variables. Scores through both criteria were obtained for 700 patients. Mortality rates and the incidence of cardiovascular complications were documented. Renal failure, major surgery, and emergency surgery were independently related to the occurrence of cardiovascular complications, with similar results obtained through the two methods. EMAPO was thus as good as the American College of Physicians method in determining the risk of cardiovascular complications in non-cardiac surgeries, but identified new variables related to surgical risk.

Canzian et al assessed the predictive value and impact on survival of a semi quantitative scoring procedure performed on lung biopsies from 63 patients with diffuse pulmonary infiltrate and found that female gender, the presence of diffuse alveolar damage, acute or chronic histological changes were associated with increased death risk. All of which suggests that a detailed analysis of histological specimens can provide valuable information concerning prognosis.

Casella et al describe the late results of catheter-directed recombinant tissue plasminogen activator fibrinolytic therapy applied to 18 patients with iliofemoral deep venous thrombosis and conclude that this is a safe and effective method for the treatment of acute iliofemoral venous thrombosis. The late evolution as revealed clinically and by ultrasound was superior in patients for whom lytic therapy was effective.

Costa et al endoscopically studied the postoperative structural changes of the intranasal ostium following external dacryocystorhinostomy observed in 50 patients to evaluate the influence of saline solution and 5-fluorouracil, and found that 5-fluorouracil does not significantly influence the final size of the surgical fistula as determined 2 months post surgery.

Zilberstein et al standardized methods of sample collection of mucus from the digestive tract (mouth, esophagus, stomach, duodenum, jejunum, ileum, colon, rectum), in order to determine the microbiota in a sample (n=64) of healthy Brazilian volunteers. The collection methods developed were efficient in obtaining adequate samples from each segment of the total digestive tract to reveal the normal microbiota. These procedures are safe and easily reproducible for microbiological studies.

Maciel et al characterized the different components of metabolic acidosis in 58 patients with hyperlactatemia in order to determine the degree to which lactate is responsible for the acidosis and the relevance that this might have in their outcome. They found that hyperlactatemia is usually accompanied by metabolic acidemia, but lactate that is responsible for a lesser portion of the acidosis, whereas unmeasured anions account for most of the acidosis in these patients. They conclude that the fraction of the acidosis due to hyperlactatemia was not relevant in terms of outcome.

Lucareli et al determined the effect of clinically prescribed floor reaction ankle-foot orthosis on kinematic parameters of the hip, knee and ankle in the stance phase of the gait cycle, compared to barefoot walking on 71 children with cerebral palsy. The results obtained from this study show that maximum knee extension and ankle dorsiflexion were significantly affected in moderately limited patients while no change was observed in severely affected children. The maximum hip extension was not significantly affected in any of the three groups. Authors conclude that when indicated to improve the extension of the knees and ankle in the stance of the cerebral palsy patients floor reaction ankle-foot orthosis was effective.

Terrabuio Junior et al present the more frequent associations found in 558 autopsies of immunocompromised patients who developed secondary interstitial pneumonia as well as the risk of death (odds ratio) in having specific secondary interstitial pneumonia according to the cause of immunocompromise. The conclude that patients with secondary immunosuppression who developed secondary interstitial pneumonia during treatment in hospital should be evaluated to avoid death by diffuse alveolar damage, pulmonary edema, bronchopneumonia, lung hemorrhage, pulmonary thromboembolism, or lung metastasis. The high-risk patients are those immunosuppressed by hematologic disease; those under steroid treatment; or those with colon or hepatic carcinoma, cachexia, or arterial hypertension.

We also publish a review by Maturana et al on menopause, estrogens, and endothelial dysfunction, and 3 case reports.

Publication Dates

• Publication in this collection
  28 Feb 2007
• Date of issue
  Feb 2007