Estudo de 434 casos de corpos estranhos corneias no Hospital Universitário da Universidade Federal de Santa Catarina

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Dapartamento de Clínica Cirúrgica

Relação entre anticorpos anti-Saccharomyces cerevisiae (ASCA) e anti-Helicobacter pylori em pacientes com espondiloartrite axial: um estudo comparativo com doença de Crohn

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, 2013.Introdução: Espondiloartrites (SpA) são doenças musculoesqueléticasinflamatórias crônicas, possivelmente associadas à resposta do sistemaimune à microbiota intestinal, bem como a ulcerações intestinaissubclínicas. Helicobacter pylori (H. pylori) é uma causa comum deulcerações gastroduodenais. Anticorpos anti-Saccharomyces cerevisiae(ASCA) estão associados à inflamação intestinal em pacientes comdoença de Crohn (DC) e em SpA. Pesquisou-se a relação entre anti-H.pylori e ASCA (frequência de sorologia positiva e titulação) empacientes com SpA axial, comparando-a em DC. Materiais e Métodos:Estudo observacional transversal de 91 pacientes com SpA axial, emacompanhamento no HU-UFSC, no período de janeiro a novembro de2012. Quarenta pacientes com DC foram incluídos como grupo controle.Títulos de ASCA IgG/IgA e anti-Helicobacter pylori IgG foramavaliados utilizando-se ensaio imunoenzimático (ELISA). O teste doQui-quadrado foi empregado para comparar a proporção de casos ASCApositivo entre subgrupos anti-H. pylori positivo e anti-H. pylorinegativo. Para correlacionar os títulos de anti-H. pylori e ASCA foirealizado o coeficiente de Spearman. Resultados: Ocorreu umacorrelação negativa significativa entre os títulos de ASCA IgG e anti-H.pylori IgG (? = -0,563, p Abstract : Background: Spondyloarthritis (SpA) are musculoskeletalinflammatory diseases possibly linked to immune responses to intestinalmicrobiota and subclinical intestinal ulcerations. Helicobacter pylori (H.pylori) is a common cause of gastroduodenal ulcerations. Anti-Saccharomyces cerevisiae antibodies (ASCA) are associated withintestinal inflammation in Crohn?s disease (CD) and SpA. We researchthe relationship between anti-H. pylori and ASCA to determine theirfrequencies and titers in axial SpA and compare them with CD patients.Material and Methods: Cross-sectional study of 91patients with axialSpA at a University Hospital in Florianópolis, Brazil, from January toNovember 2012. 40 patients with CD were included for comparativepurposes. ASCA IgG and IgA and anti-H. pylori IgG titers wereassessed by ELISA. Chi-square test was used to compare the proportionof positive ASCA patients between the positive anti-H. pylori IgG andnegative anti-H. pylori IgG groups. Anti-H.pylori IgG and ASCA titerswere correlated using the Spearman coefficient. Results: We noticed asignificant negative correlation between ASCA IgG and anti-H. pyloriIgG titers (? = -0.563, p < 0.001) and between ASCA IgA and anti-H.pylori IgG titers (? = -0.342, p = 0.019) in axial SpA patients. The samepattern of negative correlation was observed in CD patients. Anti-H.pylori positive serology was significantly more frequent in axial SpAthan in CD patients (52.4% versus 18.4%, p < 0.001), while ASCA wasless frequent in axial SpA than in CD group (ASCA IgG: 26.8% versus59.5%, p = 0.001; ASCA IgA: 4.9% versus 43.2%, p < 0.001).Conclusions: A negative correlation between anti-H. pylori and ASCAwas observed in axial SpA and CD. Anti-H. pylori positive serology wasmore frequent in axial SpA than in CD patients. ASCA positiveserologies were more frequent in CD than in axial SpA patients. Wepropose that H. pylori negatively modulate the severity of intestinalinflammation in SpA. This hypothesis requires further investigation

Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil

Traumatic brain injury (TBI) is a worldwide social, economic, and health problem related to premature death and long-term disabilities. There were no prospective and multicentric studies analyzing the predictors of TBI related mortality and estimating the burden of TBI in Brazil. To address this gap, we investigated prospectively: (1) the hospital mortality and its determinants in patients admitted with severe TBI we analyzed in three reference centers; (2) the burden of TBI estimated by the years of life lost (YLLs) due to premature death based on the hospital mortality considering the hospital mortality. Between April 2014 and January 2016 (22 months), all the 266 patients admitted with Glasgow coma scale (GCS), ≤ 8 admitted in three TBI reference centers were included in the study. These centers cover a population of 1,527,378 population of the Santa Catarina state, Southern Brazil. Most patients were male (n = 230, 86.5%), with a mean (SD) age of 38 (17) years. Hospital mortality was 31.1% (n = 83) and independently associated with older age, worse cranial CT injury by the Marshall classification, the presence of subarachnoid hemorrhage in the CT, lower GCS scores and abnormal pupils at admission. The final multiple logistic regression model including these variables showed an overall accuracy for hospital mortality of 77.9% (specificity 88.6%, sensitivity 53.8%, PPV 67.7%, and NPV 81.1%). The estimated annual incidence of hospitalizations and mortality due to severe TBI were 9.5 cases and 5.43 per 100,000 inhabitants, respectively. The estimated YLLs in 22 months, in the 2 metropolitan areas were 2,841, corresponding to 1,550 YLLs per year and 101.5 YLLs per 100,000 people every year. The hospital mortality did not change significantly since the end of the 1990s and was similar to other centers in Brazil and Latin America. Significant predictors of hospital mortality were the same as those of studies worldwide, but their strength of association seemed to differ according to countries income. Present study results question the extrapolation of TBI hospital mortality models for high income to lower- and middle-income countries and therefore have implications for TBI multicentric trials including countries with different income levels

O ensino teórico-prático durante a graduação em medicina: superando limitações

Neste artigo, professores e monitores da disciplina de Técnina Operatória do Curso de Graduação em Medicina da Universidade Federal de Santa Catarina apresentam inovações de baixo custo para o treinamento de habilidades cirúrgicas no ensino de graduação

Efeito do anti-VEGF na regeneração do nervo mediano de ratos wistar em modelo de lesão por esmagamento

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, 2018.Introdução: Lesões por quedas são frequentes em pacientes oncológicos. As neuropatias secundárias ao trauma apresentam crescente aumento nessa população. O fator de crescimento endotelial vascular (VEGF) desempenha reconhecido efeito no desenvolvimento e proteção neurais, enquanto os seus inibidores estão se destacando como agentes antineoplásicos.Objetivo: Avaliar o efeito do bevacizumab (BEV), um inibidor de VEGF, na regeneração do nervo mediano de ratos Wistar submetidos à lesão por esmagamento. Métodos: Estudo experimental, randomizado, duplo-cego que utilizou 132 ratos machos, da linhagem Wistar, com peso médio de 250-300g e idade entre 12 e 14 semanas, provenientes do Biotério Central da Universidade Federal de Santa Catarina (UFSC), Brasil. Empregou-se o modelo experimental de lesão por esmagamento do nervo mediano. A aplicação de BEV em 2 doses (10 e 20 mg/kg) neste modelo foi comparada com controle operado (NaCl 0,9%) e shams (NaCl 0,9% e BEV 20 mg/kg). Realizou-se avaliação da regeneração nervosa por teste de preensão; parâmetros histológicos e análise das concentrações do VEGF no tecido nervoso. Procedeu-se análise estatística por ANOVA de 1 e 2 vias, com pós-teste de Dunnett ou Tukey, respectivamente, utilizando-se o programa Prism 6.07® (La Jolla, CA, EUA).Resultados: Não ocorreu diferença na significância estatística entre os grupos NaCl 0,9% e bevacizumab submetidos a lesão do nervo mediano por esmagamento nos teste de preensão; diâmetros do nervo e fibras axonais mielinizadas; concentrações de VEGF.Conclusão: Bevacizumab não implica em piora da função neurológica em animais submetidos à lesão tipo esmagamento de nervo.Abstract : Background: Falls injuries are common in oncological patients. Neuropathies secondary to trauma show a growing increase in this population. Vascular Endothelial Growth Factor (VEGF) has been recognized to play a role in neural development and protection, while its inhibitors have been stood out as antineoplastic agents.Objective: This work aims to evaluate the effect of bevacizumab (BEV), a VEGF inhibitor, in the median nerve regeneration of Wistar rats submitted to crush injury. Methods: A randomized, double blind study using 132 Wistar male rats, with a mean weight of 250-300g and age between 12 and 14 weeks, from the Federal University of Santa Catarina (UFSC), Brazil. It was used the experimental model of lesion by median nerve crush. BEV application in 2 doses (10 and 20 mg / kg) in this model were compared with operated control (NaCl 0.9%) and shams (NaCl 0.9% and BEV 20 mg / kg) groups. Nerve regeneration was evaluated by: grasping test; histological parameters and analysis of VEGF concentrations in nerve tissue. Statistical evaluation among the groups was obtained by 1-way and 2-way ANOVA, with either Dunnett or Tukey post-test, respectively, using the Prism 6.07® software (La Jolla, CA, USA).Results: There were not statistically significant differences in the grasping test; nerve diameters and myelinated axonal fibers; concentrations of VEGF among NaCl 0.9% and bevacizumab groups submitted to median nerve crush injury.Conclusion: Bevacizumab does not lead to worsening of neurological function in animals submitted to nerve crush injury

Relação entre anticorpos anti-Saccharomyces cerevisiae (ASCA) e anti-Helicobacter pylori em pacientes com espondiloartrite axial

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, 2013.Introdução: Espondiloartrites (SpA) são doenças musculoesqueléticasinflamatórias crônicas, possivelmente associadas à resposta do sistemaimune à microbiota intestinal, bem como a ulcerações intestinaissubclínicas. Helicobacter pylori (H. pylori) é uma causa comum deulcerações gastroduodenais. Anticorpos anti-Saccharomyces cerevisiae(ASCA) estão associados à inflamação intestinal em pacientes comdoença de Crohn (DC) e em SpA. Pesquisou-se a relação entre anti-H.pylori e ASCA (frequência de sorologia positiva e titulação) empacientes com SpA axial, comparando-a em DC. Materiais e Métodos:Estudo observacional transversal de 91 pacientes com SpA axial, emacompanhamento no HU-UFSC, no período de janeiro a novembro de2012. Quarenta pacientes com DC foram incluídos como grupo controle.Títulos de ASCA IgG/IgA e anti-Helicobacter pylori IgG foramavaliados utilizando-se ensaio imunoenzimático (ELISA). O teste doQui-quadrado foi empregado para comparar a proporção de casos ASCApositivo entre subgrupos anti-H. pylori positivo e anti-H. pylorinegativo. Para correlacionar os títulos de anti-H. pylori e ASCA foirealizado o coeficiente de Spearman. Resultados: Ocorreu umacorrelação negativa significativa entre os títulos de ASCA IgG e anti-H.pylori IgG (? = -0,563, p < 0,001) e entre ASCA IgA e anti-H. pyloriIgG (? = -0,342, p = 0,019) nos pacientes com SpA axial. O mesmopadrão de correlação negativa foi observado nos pacientes com DC.Sorologia anti-H. pylori positiva foi significativamente mais frequenteem SpA axial que em pacientes com DC (52,4% versus 18,4%, p <0,001), enquanto ASCA foi menos frequente em SpA axial que DC(26,8% contra 59,5%, p = 0,001, para ASCA IgG e 4,9% versus 43,2%,p < 0,001 para ASCA IgA). Conclusão: Observou-se uma correlaçãonegativa entre anti-H. pylori e ASCA nos pacientes com SpA axial eDC. Sorologia anti-H. pylori positiva foi mais frequente em SpA axialque em DC. Já as sorologias ASCA foram mais frequentes em DC queem SpA axial. Propõe-se que H. pylori possa ser um agente ambientalcapaz de reduzir a gravidade da inflamação intestinal em pacientes comSpA, porém esta hipótese requer investigação adicional. <br>Abstract : Background: Spondyloarthritis (SpA) are musculoskeletalinflammatory diseases possibly linked to immune responses to intestinalmicrobiota and subclinical intestinal ulcerations. Helicobacter pylori (H.pylori) is a common cause of gastroduodenal ulcerations. Anti-Saccharomyces cerevisiae antibodies (ASCA) are associated withintestinal inflammation in Crohn?s disease (CD) and SpA. We researchthe relationship between anti-H. pylori and ASCA to determine theirfrequencies and titers in axial SpA and compare them with CD patients.Material and Methods: Cross-sectional study of 91patients with axialSpA at a University Hospital in Florianópolis, Brazil, from January toNovember 2012. 40 patients with CD were included for comparativepurposes. ASCA IgG and IgA and anti-H. pylori IgG titers wereassessed by ELISA. Chi-square test was used to compare the proportionof positive ASCA patients between the positive anti-H. pylori IgG andnegative anti-H. pylori IgG groups. Anti-H.pylori IgG and ASCA titerswere correlated using the Spearman coefficient. Results: We noticed asignificant negative correlation between ASCA IgG and anti-H. pyloriIgG titers (? = -0.563, p < 0.001) and between ASCA IgA and anti-H.pylori IgG titers (? = -0.342, p = 0.019) in axial SpA patients. The samepattern of negative correlation was observed in CD patients. Anti-H.pylori positive serology was significantly more frequent in axial SpAthan in CD patients (52.4% versus 18.4%, p < 0.001), while ASCA wasless frequent in axial SpA than in CD group (ASCA IgG: 26.8% versus59.5%, p = 0.001; ASCA IgA: 4.9% versus 43.2%, p < 0.001).Conclusions: A negative correlation between anti-H. pylori and ASCAwas observed in axial SpA and CD. Anti-H. pylori positive serology wasmore frequent in axial SpA than in CD patients. ASCA positiveserologies were more frequent in CD than in axial SpA patients. Wepropose that H. pylori negatively modulate the severity of intestinalinflammation in SpA. This hypothesis requires further investigation

Cultural Adaptation of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) - to Brazilian Spoken Portuguese: NIH-CPSI (Braz)

Objectives To create a Brazilian version of the National Institutes of Health – Chronic Prostatitis Symptom Index (NIH-CPSI) using a cross-cultural adaptation process. Materials and Methods The nine items of the NIH-CPSI were translated to Portuguese, by two independent translators, of native Portuguese language origin, and it was obtained a single version, that was retranslated to English by two English native spoken translators, in order to correct any discrepancies. Those versions were compared to the original text, the modifications were applied and it was created a final version in Portuguese. That was pre-tested and applied to 30 patients with pain or perineal or ejaculatory disorder. To each item of the pre-final version it was assigned a score according to the grade of understanding and clarity in order to implement the adequate corrections. The final version in Portuguese was submitted to evaluations including face validation and psychometric proprieties of reproducibility and internal consistency, respectively evaluated by the (p) Pearson correlation coefficient and α Cronbach coefficient. Results All items applied to 30 patients during pre-test phase had a grade higher than 8 of understanding and clarity, and were considered clearly understandable by the patients. However, at face validation evaluation, there was an inconsistency of item three that was redone. The final produced version, called NIH-CPSI (Braz) showed good reproducibility (p = 0.89-0.99) and internal consistency (α Cronbach coefficient = 0.85-0.93). Conclusions NIH-CPSI was adapted to Brazilian spoken Portuguese and its original proprieties were maintained, being a valid instrument for evaluations of symptoms of chronic prostatitis in Brazilian patients