Spontaneous dissection of the right coronary artery in a patient with acute coronary syndrome

We present a case of acute coronary syndrome with ST-segment elevation (ACS-STEMI) and spontaneous dissection of the right coronary artery, as evidenced by coronary angiography in a male patient, previously submitted to primary angioplasty with a stent implantation 3 years ago

Efeito da mudança do estilo de vida em paciente com hipertrigliceridemia grave

Relatamos um caso de hipertrigliceridemia grave em uma mulher de 61 anos, durante uma consulta de rotina no ambulatório de cardiologia, que foi diagnosticada com hipertrigliceridemia grave e resistente ao tratamento medicamentoso prescrito. Ela é aposentada, sedentária, não apresentava hábitos de vida saudáveis e mora sozinha em seu domicílio. Foi encaminhada ao ambulatório de nutrição, e sugerimos um plano terapêutico para mudanças no estilo de vida. A combinação de terapias de estilo de vida foram: atividade física, modificação dietética e inserção na vida social. As recomendações dietéticas seguiram as propostas pela atualização da diretriz brasileira de dislipidemia, com adição do convívio social. Neste caso, foi demonstrado a redução drástica dos níveis séricos de triglicerídeos, com a combinação de terapia de estilo de vida, aliado à melhora de imagem corporal e retorno ao convívio social. Assim, acreditamos que estes adicionais foram cruciais para motivar o seguimento do plano dietético proposto e evitar risco de pancreatite

Risk of SARS-CoV-2 infection among front-line healthcare workers in Northeast Brazil : a respondent-driven sampling approach

Objectives We assessed the prevalence of SARS-CoV-2 infection, personal protective equipment (PPE) shortages and occurrence of biological accidents among front-line healthcare workers (HCW). Design, setting and participants Using respondent-driven sampling, the study recruited distinct categories of HCW attending suspected or confirmed patients with COVID-19 from May 2020 to February 2021, in the Recife metropolitan area, Northeast Brazil. Outcome measures The criterion to assess SARS-CoV-2 infection among HCW was a positive self-reported PCR test. Results We analysed 1525 HCW: 527 physicians, 471 registered nurses, 263 nursing assistants and 264 physical therapists. Women predominated in all categories (81.1%; 95% CI: 77.8% to 84.1%). Nurses were older with more comorbidities (hypertension and overweight/obesity) than the other staff. The overall prevalence of SARS-CoV-2 infection was 61.8% (95% CI: 55.7% to 67.5%) after adjustment for the cluster random effect, weighted by network, and the reference population size. Risk factors for a positive RT-PCR test were being a nursing assistant (OR adjusted: 2.56; 95% CI: 1.42 to 4.61), not always using all recommended PPE while assisting patients with COVID-19 (OR adj: 2.15; 95% CI: 1.02 to 4.53) and reporting a splash of biological fluid/respiratory secretion in the eyes (OR adj: 3.37; 95% CI: 1.10 to 10.34). Conclusions This study shows the high frequency of SARS-CoV2 infection among HCW presumably due to workplace exposures. In our setting, nursing assistant comprised the most vulnerable category. Our findings highlight the need for improving healthcare facility environments, specific training and supervision to cope with public health emergencies

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Índice de massa corporal em indivíduos com infecção pelo HIV

O uso dos antirretrovirais combinados para o tratamento de pacientes com HIV/aids inaugurou a chamada era HAART (Highly Active Antiretroviral Therapy), que proporcionou a diminuição na ocorrência de doenças oportunistas, a redução da taxa de mortalidade e o aumento significativo da expectativa de vida, além de importantes alterações no perfil nutricional desses pacientes. Em um primeiro artigo, realizou-se uma revisão da literatura publicada sobre o perfil do Índice de Massa Corporal (IMC) em pacientes com HIV/aids com o objetivo de identificar o registro de sua mudança ao longo do tempo. Evidenciou-se que a perda de peso e a desnutrição, frequentes antes do uso disseminado da HAART, apresentaram diminuição de sua prevalência após o seu uso, muito embora, em condições de baixa situação econômica, a desnutrição ainda aparece em proporções consideráveis. O uso da HAART, no entanto, provocou efeitos adversos indesejáveis, que ocasionaram o surgimento de novas características, como a lipodistrofia, dislipidemia, resistência à insulina, osteopenia, alterações glicêmicas e cardíacas e obesidade, as quais têm desafiado os profissionais de saúde envolvidos no atendimento a essa população. O segundo artigo, original, objetivou estimar a prevalência de magreza e sobrepeso/obesidade, através da aferição do IMC e fatores associados ao seu desenvolvimento em indivíduos com HIV/aids. Realizou-se, para isso, um estudo de corte seccional com caso-controle aninhado a partir de dados de 2.018 pacientes atendidos em dois hospitais de referência para doenças infecciosas em Recife-PE, no período de junho de 2007 a outubro de 2009. Todos os pacientes do estudo foram classificados como magros (IMC < 18,5 Kg/m²), sobrepesados/obesos (IMC &#8805;25 Kg/m²) e eutróficos (IMC &#8805; 18,5 24,9 Kg/m²). Realizou-se análise multinomial univariada e multivariada, considerando-se os desfechos magreza e sobrepeso/obesidade, tendo como referência os eutróficos. A prevalência de magreza foi 8,8%, e a de sobrepeso/obesidade, 32,1%. A análise multinomial multivariada revelou associação estatisticamente significante entre magreza e anemia (OR=1,78; IC (95%): 1,17 2,74; p= 0,008) e contagem de células T CD4 < 200mm³ ( OR=2,13; IC(95%): 1,41-3,24; p= 0,000). Os fatores associados ao aumento do risco de sobrepeso/obesidade foram idade &#8805; 40 anos (OR=1,30; IC (95%): 1,03-1,63; p= 0,025) e a presença de diabetes (OR=2,41; IC(95%): 1,41-4,14; p=0,001). As variáveis associadas à diminuição do risco de sobrepeso/obesidade foram: ter companheiro fixo (OR= 0,82; IC (95%): 0,73-0,92; p= 0,001), tabagismo (OR=0,58; IC(95%): 0,44-0,75; p=0,000), apresentar doença oportunista (OR= 0,67; IC(95%):0,53-0,84; p=0,001), anemia (OR=0,59; IC(95%): 0,46-0,76; p=0,000) e níveis de albumina < 3,5mg/dL (OR=0,27; IC(95%): 0,12-0,61; p=0,002). Constatou-se que, na população estudada, o principal desvio nutricional observado, avaliado pelo IMC foi, o sobrepeso/obesidade, superando a magreza. Os indivíduos mais velhos e que apresentam diabetes devem ser alvos prioritários de uma intervenção para mudanças nutricionais e de estilo de vid

Hepatotoxicity during Treatment for Tuberculosis in People Living with HIV/AIDS

Submitted by Adagilson Silva ([email protected]) on 2017-06-07T18:36:27Z No. of bitstreams: 1 27332812 2016 ara-hep.oa.PDF: 721009 bytes, checksum: 325c6d1b4407580d9ce662bb8f85efd4 (MD5)Approved for entry into archive by Adagilson Silva ([email protected]) on 2017-06-07T18:36:43Z (GMT) No. of bitstreams: 1 27332812 2016 ara-hep.oa.PDF: 721009 bytes, checksum: 325c6d1b4407580d9ce662bb8f85efd4 (MD5)Made available in DSpace on 2017-06-07T18:36:43Z (GMT). No. of bitstreams: 1 27332812 2016 ara-hep.oa.PDF: 721009 bytes, checksum: 325c6d1b4407580d9ce662bb8f85efd4 (MD5) Previous issue date: 2016Universidade Federal de Pernambuco. Departamento de Medicina Tropical. Recife, PE, Brasil.Universidade Federal de Pernambuco. Departamento de Medicina Tropical. Recife, PE, Brasil.Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Laboratório de Virologia. Recife, PE, Brasil.Secretaria de Saúde de Pernambuco. Hospital Correia Picanço. Recife, PE, Brasil.Universidade de Pernambuco. Instituto de Ciências Biológicas. Recife, PE, Brasil.Universidade Federal de Pernambuco. Departamento de Medicina Tropical. Recife, PE, Brasil / Universidade de Pernambuco. Faculdade de Ciências Médicas. Recife, PE, Brasil.Universidade Federal de Pernambuco. Departamento de Medicina Tropical. Recife, PE, Brasil.Universidade de Pernambuco. Faculdade de Ciências Médicas. Recife, PE, Brasil.Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Departamento de Saúde Coletiva. Recife, PE, Brasil.Hepatotoxicity is frequently reported as an adverse reaction during the treatment of tuberculosis. The aim of this study was to determine the incidence of hepatotoxicity and to identify predictive factors for developing hepatotoxicity after people living with HIV/AIDS (PLWHA) start treatment for tuberculosis. This was a prospective cohort study with PLWHA who were monitored during the first 60 days of tuberculosis treatment in Pernambuco, Brazil. Hepatotoxicity was considered increased levels of aminotransferase, namely those that rose to three times higher than the level before initiating tuberculosis treatment, these levels being associated with symptoms of hepatitis. We conducted a multivariate logistic regression analysis and the magnitude of the associations was expressed by the odds ratio with a confidence interval of 95%. Hepatotoxicity was observed in 53 (30.6%) of the 173 patients who started tuberculosis treatment. The final multivariate logistic regression model demonstrated that the use of fluconazole, malnutrition and the subject being classified as a phenotypically slow acetylator increased the risk of hepatotoxicity significantly. The incidence of hepatotoxicity during treatment for tuberculosis in PLWHA was high. Those classified as phenotypically slow acetylators and as malnourished should be targeted for specific care to reduce the risk of hepatotoxicity during treatment for tuberculosis. The use of fluconazole should be avoided during tuberculosis treatment in PLWHA

Body mass index in individuals with HIV infection and factors associated with thinness and overweight/obesity

A cross-sectional study was conducted using body mass index (BMI) to estimate the prevalence of thinness and overweight/obesity and associated factors in 2,018 individuals with HIV/AIDS attending health services referral centers. The dependent variable was classified as thinness, overweight/obesity and eutrophy. Multinomial logistic regression analyses were performed considering eutrophy as the reference level. The prevalence of thinness was 8.8% and of overweight/obesity, 32.1%. The variables associated with thinness were anemia and CD4 cell count < 200mm³. The variables associated with risk of overweight/obesity were age &gt; 40 years and diabetes, and the variables identified as decreasing likelihood of overweight/obesity were having no long-term partner, smoking, presence of an opportunistic disease, anemia, and albumin levels < 3.5mg/dL. The main nutritional problem observed in this population was overweight and obesity, which were much more prevalent than thinness. Older individuals with diabetes should be targeted for nutritional interventions and lifestyle changes

Índice de massa corporal em indivíduos com infecção pelo HIV e fatores associados com magreza e sobrepeso/obesidade

Submitted by Kamylla Nascimento ([email protected]) on 2018-09-13T11:20:11Z No. of bitstreams: 1 Body mass index in individuals with HIV infection.pdf: 114186 bytes, checksum: 76ce15e73a18b7d77575377d4461f7b8 (MD5)Approved for entry into archive by Kamylla Nascimento ([email protected]) on 2018-09-13T11:34:28Z (GMT) No. of bitstreams: 1 Body mass index in individuals with HIV infection.pdf: 114186 bytes, checksum: 76ce15e73a18b7d77575377d4461f7b8 (MD5)Made available in DSpace on 2018-09-13T11:34:29Z (GMT). No. of bitstreams: 1 Body mass index in individuals with HIV infection.pdf: 114186 bytes, checksum: 76ce15e73a18b7d77575377d4461f7b8 (MD5) Previous issue date: 2011Ministry of Health Program DST/AIDS/UNESCO (CSV 182/06 - Projeto Estudo Clínico-Epidemiológico da Co-Infecção HIV/Tuberculose em Recife).Universidade Federal de Pernambuco. Recife, PE, Brasil.Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil.Universidade Federal de Pernambuco. Recife, PE, Brasil.Universidade Federal de Pernambuco. Recife, PE, Brasil.Universidade Federal de Pernambuco. Recife, PE, Brasil.Instituto de Medicina Integral Prof. Fernando Figueira. Recife, PE, Brasil.Instituto de Medicina Integral Prof. Fernando Figueira. Recife, PE, Brasil.Hospital Correia Picanço. Recife, PE, Brasil.Universidade Federal de Pernambuco. Recife, PE, Brasil.Estudo seccional para estimar a prevalência de magreza e sobrepeso/obesidade e fatores associados em 2.018 indivíduos com HIV/AIDS, atendidos em serviços de referência em Recife, Pernambuco, Brasil, utilizando o índice de massa corporal. A variável dependente foi classificada como magreza, sobrepeso/obesidade e eutrofia. Realizou-se análise de regressão logística multinomial considerando-se como referência os eutróficos. A prevalência de magreza foi de 8,8% e a de sobrepeso/obesidade de 32,1%. Permaneceram associados à magreza ter anemia e contagem de células TCD4 40 anos e presença de diabetes, e aqueles inversamente associados com sobrepeso/obesidade: não ter companheiro fixo, tabagismo, história recente de doença oportunista, anemia e níveis de albumina 40 years and diabetes, and the variables identified as decreasing likelihood of overweight/obesity were having no long-term partner, smoking, presence of an opportunistic disease, anemia, and albumin levels < 3.5mg/dL. The main nutritional problem observed in this population was overweight and obesity, which were much more prevalent than thinness. Older individuals with diabetes should be targeted for nutritional interventions and lifestyle changes