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Publications in this journal

• Great expectations.

  Authors: Paulo Manuel Pêgo-Fernandes, Benoit Jacques Bibas

  São Paulo medical journal = Revista paulista de medicina. 130(1):3-4.

• Infection profile of patients undergoing autologous bone marrow transplantation in a Brazilian institution.

  Authors: Kelli Borges Santos, Abrahão Elias Hallack Neto, Girlene Alves Silva, Angelo Atalla, Marcus Matta Abreu, Luiz Cláudio Ribeiro

  São Paulo medical journal = Revista paulista de medicina. 130(1):10-6.

  Hematopoietic stem cell transplantation (HSCT) has been widely used for treating oncological and hematological diseases. Although HSCT has helped to improve patient survival, the risk of developingHematopoietic stem cell transplantation (HSCT) has been widely used for treating oncological and hematological diseases. Although HSCT has helped to improve patient survival, the risk of developing infection during hospitalization is an important cause of morbidity and mortality. This study aimed to analyze the infection profile during hospitalization and the associated risk factors among patients undergoing autologous HSCT at the University Hospital, Universidade Federal de Juiz de Fora. This was a cross-sectional study on patients undergoing autologous HSCT at a public university hospital. Patients with febrile neutropenia between 2004 and 2009 were retrospectively evaluated regarding their infection profile and associated risk factors. Infection occurred in 57.2% of 112 patients with febrile neutropenia. The main source of infection was the central venous catheter (25.9%). Infection was chiefly due to Gram-positive bacteria, although Gram-negative-related infections were more severe and caused a higher death rate. Sex, age, skin color, nutritional status and underlying disease were not associated with the development of infection. Patients with severe mucositis (Grades III and IV) had a higher infection rate (P < 0.001). Patients who developed pulmonary complications during hospitalization had higher infection rates (P = 0.002). Infection was the main cause of death (57.1%) in the study sample. Strategies aimed at reducing infection-related mortality rates among patients undergoing autologous HSCT are necessary.

• Epidemiological and clinical characteristics of injuries among adolescents attended at an emergency service in the city of Ribeirão Preto, São Paulo.

  Authors: Luiz Antonio Del Ciampo, Ivan Savioli Ferraz, Maria Tazima, Letícia Graziela Bachette, Karla Ishikawa, Rodrigo Paixão

  São Paulo medical journal = Revista paulista de medicina. 130(1):27-31.

  Injuries are an important cause of morbidity during adolescence, but can be avoided through learning about some of their characteristics. This study aimed to identify the most frequent injuries amongInjuries are an important cause of morbidity during adolescence, but can be avoided through learning about some of their characteristics. This study aimed to identify the most frequent injuries among adolescents attended at an emergency service. Retrospective descriptive study on adolescents attended at the emergency service of the Teaching Health Center, Faculdade de Medicina de Ribeirão Preto (FMRP), between January 1, 2009, and September 30, 2009. Age, sex, type of injury, site, day and time of occurrence, part of body involved, care received, whether the adolescent was accompanied at the time of injury and whether any type of counseling regarding injury prevention had been given were analyzed. Among 180 adolescents attended, 106 (58.8%) were boys and 74 (41.1%) were girls. Their ages were: 10 to 12 (66/36.6%), 12 to 14 (60/33.3%) and 14 to 16 years (54/30%). The injuries had occurred in public places (47.7%) and at home (21.1%). The main types were bruises (45.1%) and falls (39.2%), involving upper limbs (46.1%), lower limbs (31%) and head/neck (13.1%). The injuries occurred in the afternoon (44.4%) and morning (30%), on Mondays (17.7%) and Thursdays (16.6%). Radiological examinations were performed on 53.8%. At the time of injury, 76.1% of the adolescents were accompanied. Some type of counseling about injury prevention had been received by 39.4%. Although the injuries were of low severity, preventive attitudes need to be incorporated in order to reduce the risks and provide greater safety for adolescents.

• Incidence of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in patients with urinary tract infection.

  Authors: Sobhan Ghafourian, Zamberi Sekawi, Vasanthakumari Neela, Afra Khosravi, Mohammad Rahbar, Nourkhoda Sadeghifard

  São Paulo medical journal = Revista paulista de medicina. 130(1):37-43.

  Resistant bacteria are emerging worldwide as a threat to favorable outcomes from treating common infections in community and hospital settings. The present investigation was carried out to study theResistant bacteria are emerging worldwide as a threat to favorable outcomes from treating common infections in community and hospital settings. The present investigation was carried out to study the incidence of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae in patients with urinary tract infection in different seasons of the year, in order to determine the prevalence of the genes blaTEM, blaSHV and blaCTX-M, which are responsible for ESBL production among ESBL-producing K. pneumoniae, in three cities in Iran, and to investigate the antimicrobial susceptibility pattern of K. pneumoniae in different seasons. Retrospective study carried out among patients with urinary tract infections in five hospitals in Iran. Two hundred and eighty-eight clinical isolates of K. pneumoniae were collected between March 2007 and April 2008 from five hospitals in three cities in Iran. ESBLs were identified by phenotypic and genotypic methods. ESBL-producing Klebsiella pneumoniae were evaluated against non-beta-lactam antibiotics. Genes coding for ESBLs (blaSHV, TEM and CTX-M) were screened. Among the 288 clinical isolates of K. pneumoniae, 37.7%, 46.7% and 15.6% were obtained from hospitals in Ilam, Tehran and Tabriz, respectively, of which 39.4%, 50.7% and 45.8% were ESBL-producing K. pneumoniae in Ilam, Milad and Emam Reza hospitals, respectively. According to the results from this study, resistance to third-generation cephalosporins is higher during the cold months than during the warm months.

• Type 1 diabetes in a patient with Ellis-van Creveld syndrome.

  Authors: Carla Graziadio, Pricila Bernardi, Rafael Fabiano Machado Rosa, Paulo Ricardo Gazzola Zen, Giorgio Adriano Paskulin

  São Paulo medical journal = Revista paulista de medicina. 130(1):53-6.

  CONTEXT: Ellis-van Creveld (EVC) syndrome is a rare autosomal recessive disease characterized by disproportionate short stature, narrow thorax, postaxial polydactyly, nail and tooth abnormalities andCONTEXT: Ellis-van Creveld (EVC) syndrome is a rare autosomal recessive disease characterized by disproportionate short stature, narrow thorax, postaxial polydactyly, nail and tooth abnormalities and congenital heart disease. CASE REPORT: The patient was a 22-year-old Caucasian man, the third child of consanguineous parents. He received the diagnosis of insulin-dependent diabetes mellitus (DM) at 16 years of age, and around one year later, he underwent surgery to correct a partial atrioventricular septal defect. Upon physical examination, at 22 years of age, he presented stature of 145.5 cm (P3), weight of 49 kg (P3), head circumference of 54 cm (P2-50), high palate, absence of one of the lower lateral incisor teeth, narrow shoulders, narrowing of the upper thorax, scoliosis, rhizomelic shortening of the upper limbs, brachydactyly, postaxial polydactyly and clinodactyly of the second and third fingers. The lower limbs showed rhizomelic shortening with significant genu valgum (knock-knee deformity), small feet with postaxial polydactyly, syndactyly between the second and third toes and hallux valgus. Multiple melanocytic nevi were evident on the face, thorax and limbs. At that time, he was using neutral protamine Hagedorn (NPH) insulin, with poorly controlled DM. The clinical findings presented led to the diagnosis of EVC syndrome. Only one case of this syndrome has been described with DM so far. Attention is drawn to the fact that the genes associated with this syndrome are located close to those of the Wolfram syndrome, a condition that leads to early-onset diabetes.

• Stridor and respiratory failure due to tracheobronchomalacia: case report and review of the literature.

  Authors: Ramon Andrade de Mello, Adriana Magalhães, Abílio José Vilas-Boas

  São Paulo medical journal = Revista paulista de medicina. 130(1):61-4.

  Tracheobronchomalacia (TBM) results from structural and functional abnormalities of the respiratory system. It is characterized by excessive collapse: at least 50% of the cross-sectional area of theTracheobronchomalacia (TBM) results from structural and functional abnormalities of the respiratory system. It is characterized by excessive collapse: at least 50% of the cross-sectional area of the trachea and main bronchi. In this paper, we present a rare case of a patient with TBM who first presented with stridor and respiratory failure due to exacerbation of chronic bronchitis. An 81-year-old Caucasian man was admitted presenting coughing, purulent sputum, stridor and respiratory failure. He had a medical history of chronic obstructive pulmonary disease (COPD) and silicosis and was a former smoker. Axial computed tomography on the chest revealed marked collapse of the trachea in its middle third. Bronchoscopy showed characteristics compatible with TBM. He was treated with noninvasive ventilation, without any good response. Subsequently, a Dumon Y stent was placed by means of rigid bronchoscopy. After the procedure, he was discharged with a clinical improvement. TBM is fatal and often underdiagnosed. In COPD patients, stridor and respiratory failure may be helpful signs that should alert physicians to consider TBM as an early diagnosis. Thus, these signs may be important for optimizing the treatment and evolution of such patients.

• Twenty-first century: the beginning of the replacement parts era?

  Authors: Alessandro Wasum Mariani, Paulo Manuel Pêgo-Fernandes

  São Paulo medical journal = Revista paulista de medicina. 130(2):75-6.

• Prevalence of common mental disorders in mothers in the semiarid region of Alagoas and its relationship with nutritional status.

  Authors: Adriana Toledo de Paffer, Haroldo da Silva Ferreira, Cyro Rego Cabral Júnior, Claudio Torres de Miranda

  São Paulo medical journal = Revista paulista de medicina. 130(2):84-91.

  Compromised maternal mental health (MMH) is considered to be a risk factor for child malnutrition in low income areas. Psychosocial variables associated with MMH are potentially different betweenCompromised maternal mental health (MMH) is considered to be a risk factor for child malnutrition in low income areas. Psychosocial variables associated with MMH are potentially different between urban and rural environments. The aim here was to investigate whether associations existed between MMH and selected sociodemographic risk factors and whether specific to urban or rural settings. Cross-sectional study on a representative population sample of mothers from the semiarid region of Alagoas. Multistage sampling was used. The subjects were mothers of children aged up to 60 months. MMH was evaluated through the Self-Reporting Questionnaire-20. Mothers' nutritional status was assessed using the body mass index and waist circumference. Univariate analysis used odds ratios (OR) and chi-square. Logistic regression was performed separately for urban and rural subsamples using MMH as the dependent variable. The sample comprised 288 mothers. The prevalences of common mental disorders (CMD) in rural and urban areas were 56.2% and 43.8%, respectively (OR = 1.03; 95% CI: 0.64-1.63). In univariate analysis and logistic regression, the variable of education remained associated with MMH (OR = 2.2; 95% CI: 1.03-4.6) in urban areas. In rural areas, the variable of lack of partner remained associated (OR = 2.6; 95% CI: 1.01-6.7). The prevalence of CMD is high among mothers of children aged up to two years in the semiarid region of Alagoas. This seems to be associated with lower educational level in urban settings and lack of partner in rural settings.

• Correlation between balance and the level of functional independence among elderly people.

  Authors: Melina Galetti Prata, Marcos Eduardo Scheicher

  São Paulo medical journal = Revista paulista de medicina. 130(2):97-101.

  As the overall number of elderly people increases there is a corresponding rise in the number of older persons with disabilities. In order to examine whether there is any relationship between balanceAs the overall number of elderly people increases there is a corresponding rise in the number of older persons with disabilities. In order to examine whether there is any relationship between balance and activities of daily living, we evaluated balance and daily activities among elderly people living in the community. Cross-sectional study at Universidade Estadual Paulista (Unesp), Marília, São Paulo, Brazil. The study included 70 community-dwelling elderly people aged 65 and over. Balance was evaluated using the Berg Balance Scale (BBS) and physical independence in daily activities was evaluated using the Barthel Index (BI). The Spearman correlation coefficient was used to examine the relationship between the parameters evaluated. Significance was set at the level of 5% (P < 0.05). The population's mean age was 70.5 ± 5 years. The mean BBS score was 50.9 ± 4.1, whereas the mean BI score was 98.1 ± 2.8. Statistically significant relationships were found between the BBS and BI (r = 0.41; P = 0.0004); between age and BI (r = -0.24; P = 0.04); and between age and BBS (r = -0.57; P = 0.0001). The results showed that among elderly people, there are correlations between age, balance and independence level.

• Use of epidemiological data as the basis for developing a medical curriculum.

  Authors: José Lúcio Martins Machado, Sonia Regina Pereira de Souza, Sylvia Michelina Fernandes Brenna, Regina Albanese Pose, Valdes Roberto Bollela, Joaquim Edson Vieira

  São Paulo medical journal = Revista paulista de medicina. 130(2):109-14.

  Epidemiology may help educators to face the challenge of establishing content guidelines for the curricula in medical schools. The aim was to develop learning objectives for a medical curriculum fromEpidemiology may help educators to face the challenge of establishing content guidelines for the curricula in medical schools. The aim was to develop learning objectives for a medical curriculum from an epidemiology database. Descriptive study assessing morbidity and mortality data, conducted in a private university in São Paulo. An epidemiology database was used, with mortality and morbidity recorded as summaries of deaths and the World Health Organization's Disability-Adjusted Life Year (DALY). The scoring took into consideration probabilities for mortality and morbidity. The scoring presented a classification of health conditions to be used by a curriculum design committee, taking into consideration its highest and lowest quartiles, which corresponded respectively to the highest and lowest impact on morbidity and mortality. Data from three countries were used for international comparison and showed distinct results. The resulting scores indicated topics to be developed through educational taxonomy. The frequencies of the health conditions and their statistical treatment made it possible to identify topics that should be fully developed within medical education. The classification also suggested limits between topics that should be developed in depth, including knowledge and development of skills and attitudes, regarding topics that can be concisely presented at the level of knowledge.

• Risk of persistent high-grade squamous intraepithelial lesion after electrosurgical excisional treatment with positive margins: a meta-analysis.

  Authors: Caroline Alves de Oliveira, Fábio Bastos Russomano, Saint Clair Dos Santos Gomes Júnior, Flávia de Miranda Corrêa

  São Paulo medical journal = Revista paulista de medicina. 130(2):119-25.

  Even if precursor lesions of cervical cancer are properly treated, there is a risk of persistence or recurrence. The aim here was to quantify the risks of persistence of high-grade intraepithelialEven if precursor lesions of cervical cancer are properly treated, there is a risk of persistence or recurrence. The aim here was to quantify the risks of persistence of high-grade intraepithelial squamous lesions, one and two years after cervical electrosurgical excisional treatment with positive margins. Systematic review of the literature and meta-analysis at Instituto Fernandes Figueira. This meta-analysis was on studies published between January 1989 and July 2009 that were identified in Medline, Scopus, Embase, Cochrane, SciELO, Lilacs, Adolec, Medcarib, Paho, Wholis, Popline, ISI Web of Science and Sigle. Articles were selected if they were cohort studies on electrosurgical excisional treatment of high-grade squamous intraepithelial lesions with a minimum follow-up of one year, a histopathological outcome of persistence of these lesions and a small risk of bias. The search identified 7,066 articles and another 21 in the reference lists of these papers. After applying the selection and exclusion criteria, only four articles were found to have extractable data. The risk of persistence of high-grade intraepithelial lesions after one year was 11.36 times greater (95% confidence interval, CI: 5.529-23.379, P < 0.0001) in patients with positive margins and after two years, was four times greater (95% CI: 0.996-16.164), although without statistical significance. This meta-analysis confirms the importance of positive margins as an indicator of incomplete treatment after the first year of follow-up and highlights the need for appropriately chosen electrosurgical techniques based on disease location and extent, with close surveillance of these patients.

• Determination of lactate value.

  Authors: Viroj Wiwanitkit

  São Paulo medical journal = Revista paulista de medicina. 130(2):130.

• Psychosocial interventions for premature ejaculation.

  Authors: Tamara Melnik, Stanley Althof, Alvaro Nagib Atallah, Maria Eduarda Dos Santos Puga, Sidney Glina, Rachel Riera

  São Paulo medical journal = Revista paulista de medicina. 130(2):132.

  Premature ejaculation (PE) is a very common sexual dysfunction among patients, and with varying prevalence estimates ranging from 3% to 20%. Although psychological issues are present in most patientsPremature ejaculation (PE) is a very common sexual dysfunction among patients, and with varying prevalence estimates ranging from 3% to 20%. Although psychological issues are present in most patients with premature PE, as a cause or as a consequence, research on the effects of psychological approaches for PE has in general not been controlled or randomised and is lacking in long-term follow up. To assess the efficacy of psychosocial interventions for PE. CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW: Trials were searched in computerized general and specialized databases, such as: MEDLINE by PubMed (1966 to 2010); PsycINFO (1974 to 2010); EMBASE (1980 to 2010); LILACS (1982 to 2010); the Cochrane Central Register of Controlled Trials (Cochrane Library, 2010); and by checking bibliographies, and contacting manufacturers and researchers. Randomised or quasi-randomised controlled trials evaluating psychosocial interventions compared with different psychosocial interventions, pharmacological interventions, waiting list, or no treatment for PE. Information on patients, interventions, and outcomes was extracted by at least two independent reviewers using a standard form. The primary outcome measure for comparing the effects of psychosocial interventions to waiting list and standard medications was improvement in IELT (i.e., time from vaginal penetration to ejaculation). The secondary outcome was change in validated PE questionnaires. In one study behavioral therapy (BT) was significantly better than waiting list for duration of intercourse (MD (mean difference) 407.90 seconds, 95% CI 302.42 to 513.38), and couples' sexual satisfaction (MD -26.10, CI -50.48 to -1.72). BT was also significantly better for a new functional-sexological treatment (FS) (MD 412.00 seconds, 95% CI 305.88 to 518.12), change over time in subjective perception of duration of intercourse (Women: MD 2.88, 95% CI 2.06 to 3.70; Men: MD 2.52, CI 1.65 to 3.39) and couples' sexual satisfaction (MD -25.10, 95% CI -47.95 to -2.25), versus waiting list. Overall, there is weak and inconsistent evidence regarding the effectiveness of psychological interventions for the treatment of premature ejaculation. Three of the four included randomised controlled studies of psychotherapy for PE reported our primary outcome (Improvement in IELT), and the majority have a small sample size. The early success reports (97.8%) of Masters and Johnson could not be replicated. One study found a significant improvement from baseline in the duration of intercourse, sexual satisfaction and sexual function with a new functional-sexological treatment and behavior therapy compared to waiting list. One study showed that the combination of chlorpromazine and BT was superior to chlorpromazine alone. Randomised trials with larger group samples are still needed to further confirm or deny the current available evidence for psychological interventions for treating PE.

• Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial.

  Authors: Bruno Teixeira Bernardes, Ana Paula Magalhães Resende, Liliana Stüpp, Emerson Oliveira, Rodrigo Aquino Castro, Zsuzsanna Ilona Katalin Jármy di Bella, Manoel João Batista Castello Girão, Marair Gracio Ferreira Sartori

  São Paulo medical journal = Revista paulista de medicina. 130(1):5-9.

  Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is toPrevious studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse. Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo. Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI); a hypopressive exercise group (GII); and a control group (GIII). The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment. The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001), but not in relation to GIII (P = 0.816). The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle.

• Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil.

  Authors: Ana Claudia Molina Cavassini, Silvana Andréa Molina Lima, Iracema Mattos Paranhos Calderon, Marilza Vieira Cunha Rudge

  São Paulo medical journal = Revista paulista de medicina. 130(1):17-26.

  Pregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications. Hospital costs increase according to the type of care provided. This study aimed toPregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications. Hospital costs increase according to the type of care provided. This study aimed to estimate the cost-benefit relationship and social profitability ratio of hospitalization, compared with outpatient care, for pregnant women with diabetes or mild hyperglycemia. This was a prospective observational quantitative study conducted at a university hospital. It included all pregnant women with pregestational or gestational diabetes, or mild hyperglycemia, who did not develop clinical intercurrences during pregnancy and who delivered at the Botucatu Medical School Hospital (Hospital das Clínicas, Faculdade de Medicina de Botucatu, HC-FMB) of Universidade Estadual de São Paulo (Unesp). Thirty pregnant women treated with diet were followed as outpatients, and twenty treated with diet plus insulin were managed through frequent short hospitalizations. Direct costs (personnel, materials and tests) and indirect costs (general expenses) were ascertained from data in the patients' records and the hospital's absorption costing system. The cost-benefit was then calculated. Successful treatment of pregnant women with diabetes avoided expenditure of US$ 1,517.97 and US$ 1,127.43 for patients treated with inpatient and outpatient care, respectively. The cost-benefit of inpatient care was US$ 143,719.16, and outpatient care, US$ 253,267.22, with social profitability of 1.87 and 5.35, respectively. Decision-tree analysis confirmed that successful treatment avoided costs at the hospital. Cost-benefit analysis showed that outpatient management was economically more advantageous than hospitalization. The social profitability of both treatments was greater than one, thus demonstrating that both types of care for diabetic pregnant women had positive benefits.

• Initial experience at a university teaching hospital from using telemedicine to promote education through video conferencing.

  Authors: Bruno Monteiro Tavares Pereira, Thiago Rodrigues Araújo Calderan, Marcos Tadeu Nolasco da Silva, Antonio Carlos da Silva, Antonio Carlos Marttos, Gustavo Pereira Fraga

  São Paulo medical journal = Revista paulista de medicina. 130(1):32-6.

  Telehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and toTelehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and to medical education. The aim here was to report our institution's experience from 100 videoconferencing meetings between five different countries in the Americas over a one-year period. Retrospective study at Universidade Estadual de Campinas. Through a Microsoft Excel database, all conferences in all specialties held at our institution from September 2009 to August 2010 were analyzed retrospectively. A total of 647 students, physicians and professors participated in telemedicine meetings. A monthly mean of 8.3 (± 4.3) teleconferences were held over the analysis period. Excluding holidays and the month of inaugurating the telemedicine theatre, our teleconference rate reached a mean of 10.3 (± 2.7), or two teleconferences a week, on average. Trauma surgery and meetings on patient safety were by far the most common subjects discussed in our teleconference meetings, accounting for 22% and 21% of the total calls. Our experience with telemedicine meetings has increased students' interest; helped our institution to follow and discuss protocols that are already accepted worldwide; and stimulated professors to promote telemedicine-related research in their own specialties and keep up-to-date. These high-technology meetings have shortened distances in our vast country, and to other reference centers abroad. This virtual proximity has enabled discussion of international training with students and residents, to increase their overall knowledge and improve their education within this institution.

• Colposcopic triage methods for detecting cervical intraepithelial neoplasia grade 3 after cytopathological diagnosis of low-grade squamous intraepithelial lesion: a systematic review on diagnostic tests.

  Authors: Flávia de Miranda Corrêa, Fábio Bastos Russomano, Caroline Alves de Oliveira

  São Paulo medical journal = Revista paulista de medicina. 130(1):44-52.

  The age-stratified performance of the oncogenic HPV-DNA (human papillomavirus deoxyribonucleic acid) test for triage of low-grade squamous intraepithelial lesions (LSIL) requires investigation. TheThe age-stratified performance of the oncogenic HPV-DNA (human papillomavirus deoxyribonucleic acid) test for triage of low-grade squamous intraepithelial lesions (LSIL) requires investigation. The objective of this study was to evaluate and compare the age-stratified performance (cutoff point: 35 years) of oncogenic HPV-DNA testing and repeated cytological tests, for detecting cervical intraepithelial neoplasia grade 3 (CIN3), in order to triage for LSIL. Systematic review. Studies were identified in nine electronic databases and in the reference lists of the articles retrieved. The eligibility criteria consisted of initial cytological findings of LSIL; subsequent oncogenic HPV-DNA testing and repeated cytological tests; and CIN3 detection. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) guidelines were used for quality assessment. Qualitative information synthesis was performed. Out of 7,776 studies, 284 were identified as pertinent and three fulfilled the eligibility criteria. The CIN3 prevalence ranged from 6% to 12%. The HPV-DNA positivity rate ranged from 64% to 83%; sensitivity for CIN3 detection ranged from 95.2% to 100%; and specificity was available in two studies (27% and 52%). The sensitivity of repeated cytological tests, in relation to the threshold for atypical squamous cells of undetermined significance (ASCUS), was available in two studies (33% and 90.8%); and specificity was available in one study (53%). Currently, there is no scientific evidence available that would prove that colposcopic triage using oncogenic HPV-DNA testing to detect CIN3 performs better than repeated cytological tests, among women with LSIL aged 35 years and over.

• Paraganglioma of seminal vesicle and chromophobe renal cell carcinoma: a case report and literature review.

  Authors: César Augusto Alvarenga, José Manuel Lopes, João Vinagre, Paula Itagyba Paravidino, Marcelo Alvarenga, Adilson Prando, Lísias Nogueira Castilho, Paula Soares, Athanase Billis

  São Paulo medical journal = Revista paulista de medicina. 130(1):57-60.

  Extra-adrenal paragangliomas are rare tumors that have been reported in many locations, including the kidney, urethra, urinary bladder, prostate, spermatic cord, gallbladder, uterus and vagina. ThisExtra-adrenal paragangliomas are rare tumors that have been reported in many locations, including the kidney, urethra, urinary bladder, prostate, spermatic cord, gallbladder, uterus and vagina. This report describes, for the first time to the best of our knowledge, a primary paraganglioma of the seminal vesicle occurring in a 61-year-old male. The patient presented persistent arterial hypertension and a previous diagnosis of chromophobe renal cell carcinoma. It was hypothesized that the seminal vesicle tumor could be a metastasis from the chromophobe renal cell carcinoma. Immunohistochemical characterization revealed expression of synaptophysin and chromogranin in tumor cell nests and peripheral S100 protein expression in sustentacular cells. Succinate dehydrogenase A and B-related (SDHA and SDHB) expression was present in both tumors. No genetic alterations to the VHL and SDHB genes were detected in either the tumor tissue or tissues adjacent to the tumor, which led us to rule out a hereditary syndrome that could explain the association between paraganglioma and chromophobe renal cell carcinoma in a patient with arterial hypertension.

• Some aspects of medical education in the former Soviet Union.

  Authors: Sergei Jargin

  São Paulo medical journal = Revista paulista de medicina. 130(1):65-6.

• Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia.

  Authors: Dulcimary Dias Bittencourt, Rita Maira Zanine, Ana Martins Sebastião, Nabiha Saadi Taha, Neila Góis Speck, Julisa Chamorro Lascasas Ribalta

  São Paulo medical journal = Revista paulista de medicina. 130(2):92-6.

  Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was toLarge loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). Cross-sectional study at Universidade Federal de São Paulo (Unifesp). The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. The patients' mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.

• Red blood cell transfusions worsen the outcomes even in critically ill patients undergoing a restrictive transfusion strategy.

  Authors: João Manoel da Silva Junior, Ederlon Rezende, Cristina Prada Amendola, Rafael Tomita, Daniele Torres, Maria Tereza Ferrari, Diogo Oliveira Toledo, Amanda Maria Ribas Rosa Oliveira, Juliana Andreia Marques

  São Paulo medical journal = Revista paulista de medicina. 130(2):77-83.

  Anemia and blood transfusions are common in intensive care. This study aimed to evaluate epidemiology and outcomes among critically ill patients under a restrictive transfusion strategy. ProspectiveAnemia and blood transfusions are common in intensive care. This study aimed to evaluate epidemiology and outcomes among critically ill patients under a restrictive transfusion strategy. Prospective observational cohort study in an intensive care unit (ICU) at a tertiary hospital. All adults admitted to the ICU over a one-year period who remained there for more than 72 hours were included, except those with acute coronary syndrome, ischemic stroke, acute hemorrhage, prior transfusion, pregnant women and Jehovah's Witnesses. The restrictive strategy consisted of transfusion indicated when hemoglobin levels were less than or equal to 7.0 g/dl. The study enrolled 167 patients; the acute physiology and chronic health evaluation II (APACHE II) score was 28.9 ± 6.5. The baseline hemoglobin level was 10.6 ± 2.2 g/dl and on day 28, it was 8.2 ± 1.3 g/dl (P < 0.001). Transfusions were administered to 35% of the patients. In the transfusion group, 61.1% did not survive, versus 48.6% in the non-transfusion group (P = 0.03). Transfusion was an independent risk factor for mortality (P = 0.011; odds ratio, OR = 2.67; 95% confidence interval, CI = 1.25 to 5.69). ICU stay and hospital stay were longer in the transfusion group: 20.0 (3.0-83.0) versus 8.0 (3.0-63.0) days (P < 0,001); and 24.0 (3.0-140.0) versus 14.0 (3.0-80.0) days (P = 0.002), respectively. In critically ill patients, there was a reduction in hemoglobin with increasing length of ICU stay. Moreover, transfusion was associated with worse prognoses.

• Relationship between lower-limb muscle strength and frailty among elderly people.

  Authors: Fernanda Sotello Batista, Grace Angelica de Oliveira Gomes, Anita Liberalesso Neri, Maria Elena Guariento, Fernanda Aparecida Cintra, Maria da Luz Rosario de Sousa, Maria José D'Elboux

  São Paulo medical journal = Revista paulista de medicina. 130(2):102-8.

  Sarcopenia is the main factor involved in the development of frailty syndrome. The aims here were to investigate relationships between lower-limb muscle strength and the variables of sex, age andSarcopenia is the main factor involved in the development of frailty syndrome. The aims here were to investigate relationships between lower-limb muscle strength and the variables of sex, age and frailty criteria; compare lower-limb muscle strength with each frailty criterion; and assess the power of each criterion for estimating the risk of frailty among elderly outpatients. Cross-sectional study at the Geriatrics Outpatient Clinic of a university hospital in Campinas. A non-probabilistic convenience sample of 150 elderly people of both sexes who were followed up as outpatients was assessed. Sociodemographic data (sex and age) and physical health data (frailty criteria and the five-times sit-to-stand test) were gathered. Descriptive, comparative and multivariate logistic regression analyses were performed. The majority of the elderly people (77.3%) were 70 years of age or over, with predominance of females (64.2%) and had a low score for the five-times sit-to-stand test (81.4% scored 0 or 1); 55.3% of the elderly people presented three or more frailty criteria. A significant association was found between lower-limb muscle strength and the variables of age and number of frailty criteria. Lower levels of lower-limb muscle strength were associated with advanced age and greater presence of signs of frailty. Moreover, lower-limb muscle strength was also associated with the criteria of reduced walking speed criteria and hand-grip strength.

• Description of color/race in Brazilian biomedical research.

  Authors: Teresa Veronica Catonho Ribeiro, Luzitano Brandão Ferreira

  São Paulo medical journal = Revista paulista de medicina. 130(2):115-8.

  Over recent years, the terms race and ethnicity have been used to ascertain inequities in public health. However, this use depends on the quality of the data available. This study aimed toOver recent years, the terms race and ethnicity have been used to ascertain inequities in public health. However, this use depends on the quality of the data available. This study aimed to investigate the description of color/race in Brazilian scientific journals within the field of biomedicine. Descriptive study with systematic search for scientific articles in the SciELO Brazil database. A wide-ranging systematic search for original articles involving humans, published in 32 Brazilian biomedical scientific journals in the SciELO Brazil database between January and December 2008, was performed. Articles in which the race/ethnicity of the participants was identified were analyzed. In total, 1,180 articles were analyzed. The terms for describing race or ethnicity were often ambiguous and vague. Descriptions of race or ethnicity occurred in 159 articles (13.4%), but only in 42 (26.4%) was there a description of how individuals were identified. In these, race and ethnicity were used almost interchangeably and definition was according to skin color (71.4%), ancestry (19.0%) and self-definition (9.6%). Twenty-two races or ethnicities were cited, and the most common were white (37.3%), black (19.7%), mixed (12.9%), nonwhite (8.1%) and yellow (8.1%). The absence of descriptions of parameters for defining race, as well as the use of vague and ambiguous terms, may hamper and even prevent comparisons between human groups and the use of these data to ascertain inequities in healthcare.

• Mucosa-associated lymphoid tissue lymphoma of the trachea: case report.

  Authors: Maria Elisa Ruffolo Magliari, Renata Telles Rudge de Aquino, Anna Luiza Lobão Gonçalves, Fábio Marioni, Fabíola Del Carlo Bernardi, Sérgio Brasil, Joaquim Antonio da Fonseca Almeida, Benedito Juarez Andrade, Carlos Sérgio Chiattone, Carlos Alberto da Conceição Lima

  São Paulo medical journal = Revista paulista de medicina. 130(2):126-9.

  Mucosa-associated lymphoid tissue (MALT) lymphomas are most commonly found in the stomach, lungs, orbital soft tissue, salivary glands and thyroid. Involvement of the trachea is extremely rare. ThisMucosa-associated lymphoid tissue (MALT) lymphomas are most commonly found in the stomach, lungs, orbital soft tissue, salivary glands and thyroid. Involvement of the trachea is extremely rare. This report describes a rare case of MALT lymphoma of the trachea in a 71-year-old woman who presented with a one-year history of coughing, dyspnea, hoarseness and weight loss. There was an infiltrative lesion in the mid-trachea. The anatomopathological diagnosis was only made from the fifth endoscopic biopsy attempt. Immunochemotherapy consisting of rituximab, cyclophosphamide, vincristine and prednisone (R-COP) induced complete remission of the symptoms and endoscopic lesion. MALT lymphoma of the trachea is extremely rare and indolent disease. It has to be considered in the differential diagnosis of airway lesions. It is crucial to obtain an anatomopathological diagnosis from a specialized pathologist. Immunochemotherapy with R-COP induced complete remission of the disease.

• Response to letter to the editor.

  Authors: Ana Paula Metran Nascente, Murillo Assunção, Carla Janaina Guedes, Flávio Geraldo Rezende Freitas, Bruno Franco Mazza, Miriam Jackiu, Flávia Ribeiro Machado

  São Paulo medical journal = Revista paulista de medicina. 130(2):130-1.

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