Qualidade da certificação médica da causa de morte em São Paulo, Brasil

It was made an analysis of the medical certifications of death; it was analysed the fulfilling of the items of the certifications and the declaration of the underlying cause of death. A study had been made on a sample of the deaths occurred in hospitals in the period from March 1971 to February 1972. Additional information about each case was obtained through medical records; so, it was possible to know the real underlying cause of death and compare this one with that stated in the original certification. It was observed that, due to the lack of fulfilment of the corresponding items, only 4.0 per cent of the certifications brought together information about the time break between the onset of the disease and death and information about the laboratory data that confirmed the diagnosis. It was also observed that 65.5 per cent didn't show any information about the referred items. The most neglected item was that related to the time interval: 93.5 per cent of the certifications didn't carry it; 68.0 per cent didn't show informations about the laboratory data that confirmed the diagnosis; 31.4 per cent of the certifications didn't carry any statement about the real underlying cause of death; 6.5 per cent, though carrying it, were fulfilled in such an inadequate way that it became impossible to select the underlying cause of death for statistical purposes. It was concluded that the quality of the medical certifications of death of the city of S. Paulo is not satisfactory; comparing the results of this research with those of a similar one made in 1962/1963 it was verified that no improvement was observed in the last 10 years.Foi feita análise dos atestados de óbito, do preenchimento dos seus itens e da declaração da causa básica da morte. Foi estudada uma amostra de óbitos ocorridos em hospitais e pronto socorros no período de 1.º de março de 1971 a 29 de fevereiro de 1972. Foram colhidas informações adicionais, para cada caso, a partir dos prontuários médicos, o que permitiu conhecer a verdadeira causa básica da morte e comparar com o que foi declarado no atestado. Verificou-se que somente 4,0% dos atestados apresentaram informações sobre o intervalo de tempo entre o início da doença e a morte e sobre o exame complementar que confirmou o diagnóstico, sendo que 65,5% não apresentaram ambas as informações. O item mais negligenciado foi o referente ao intervalo de tempo, pois em 93,5% dos atestados este item não se encontrava preenchido; 68,0% dos atestados não tinha preenchido o item sobre exame complementar que confirmou o diagnóstico. Quanto a declaração da verdadeira causa básica foi verificado que 31,4% dos atestados não a apresentavam registrada e 6,5%, ainda que a tivessem registrada, não era selecionada como a causa primária da morte para finalidades de estatística de mortalidade. Conclui-se que não é boa a qualidade dos atestados de óbitos na cidade de São Paulo, e comparando os resultados com os de estudo semelhante feito em 1962/1963, verifica-se que não houve melhora na certificação médica da causa de morte nos últimos 10 anos

Mortalidade por diabetes mellitus no município de São Paulo (Brasil): evolução em um período de 79 anos (1900-1978) e análise de alguns aspectos sobre associação de causas

The trend of the mortality from diabetes mellitus in the city of S. Paulo, Brazil, is presented through a historical series of 79 years (1900 to 1978). A progressive increase in mortality rates was noted until 1960, when they showed a tendency to become stable around 20 per 100.000 inhabitants. The proportional mortality ratio from diabetes mellitus increased more than the rates. For a given point in the period studied (1974/75), mortality from diabetes mellitus was analysed according to the methodology of the multiple causes of death, which made possible the study of the more frequent underlying causes in diabetics and also of the more important associations of causes. In both cases cardiovascular diseases proved to be the most frequent, especially ischemic heart and cerebrovascular diseases, while arterial hypertension was very important as an associated cause.A evolução da mortalidade por diabetes mellitus no município de São Paulo, Brasil, é apresentada através de uma série histórica de 79 anos (1900-1978). Dentro desse período, verificou-se uma ascensão progressiva dos coeficientes até por volta de 1960, quando tenderam a estabilizar-se em valores próximos a 20 por 100 mil habitantes. Também é analisada a mortalidade proporcional pela doença, verificando-se que ela aumentou mais que o próprio risco de morrer, medido pelo coeficiente de mortalidade. Para um ponto do período estudado (1974/75), a mortalidade por diabetes mellitus foi analisada segundo a metodologia das causas múltiplas de morte, o que permitiu verificar quais as causas básicas de morte mais freqüentes nos diabéticos e quais as associações de causas mais freqüentes. Nos dois casos, destacaram-se as doenças do aparelho circulatório, notadamente a doença isquêmica do coração, as doenças cerebrovasculares, enquanto a hipertensão arterial se destaca como causa associada bastante freqüente

Increase of 10% in the Rate of Adverse Drug Reactions for Each Drug Administered in Hospitalized Patients

OBJECTIVE: To assess the risk factors, incidence and severity of adverse drug reactions in in-patients. METHODS: This prospective study evaluated 472 patients treated at a teaching hospital in Brazil between 2010 and 2013 by five medical specialties: Internal Medicine, General Surgery, Geriatrics, Neurology, and Clinical Immunology and Allergy. The following variables were assessed: patient age, gender, comorbidities, family history of hypersensitivity, personal and family history of atopy, number of prescribed drugs before and during hospitalization, hospital diagnoses, days of hospitalization. The patients were visited every other day, and medical records were reviewed by the investigators to detect adverse drug reactions. RESULTS: There were a total of 94 adverse drug reactions in 75 patients. Most reactions were predictable and of moderate severity. The incidence of adverse drug reactions was 16.2%, and the incidence varied, according to the medical specialty; it was higher in Internal Medicine (30%). Antibiotics were the most commonly involved medication. Chronic renal failure, longer hospital stay, greater number of diagnoses and greater number of medications upon admission were risk factors. For each medication introduced during hospitalization, there was a 10% increase in the rate of adverse drug reaction. In the present study, the probability of observing an adverse drug reaction was 1 in 104 patients per day. CONCLUSIONS: Adverse drug reactions are frequent and potentially serious and should be better monitored in patients with chronic renal failure or prolonged hospitalization and especially in those on ‘polypharmacy’ regimens. The rational use of medications plays an important role in preventing adverse drug reactions

Imunoterapia específica com venenos de Hymenoptera: revisão sistemática

CONTEXT AND OBJECTIVE: The only effective treatment for patients who have severe reactions after Hymenoptera stings is venom immunotherapy. The aim of this study was to review the literature to assess the effects of venom immunotherapy among patients presenting severe reactions after Hymenoptera stings. DESIGN AND SETTING: Randomized controlled trials in the worldwide literature were reviewed. The manuscript was produced in the Discipline of Allergy and Clinical Immunology, Universidade de São Paulo (USP). METHODS: Randomized controlled trials involving venom immunotherapy versus placebo or only patient follow-up were evaluated. The risk of systemic reactions after specific immunotherapy was evaluated by calculating odds ratios (OR) and their 95% confidence intervals. RESULTS: 2,273 abstracts were identified by the keywords search. Only four studies were included in this review. The chi-square test for heterogeneity showed that two studies were homogeneous and could be included in a meta-analysis. By combining the two studies, the odds ratio became significant: 0.29 (0.10-0.87). However, analysis on the severity of the reactions after immunotherapy showed that the benefits may not be so significant because the reactions were mostly similar to or milder than the original reaction. CONCLUSIONS: Specific immunotherapy should be recommended for adults and children with moderate to severe reactions, but there is no need to prescribe it for children with skin reactions alone, especially if the exposure is very sporadic. On the other hand, the risk-benefit relation should always be assessed in each case.CONTEXTO E OBJETIVO: O único tratamento eficaz para pacientes que têm reações graves após ferroada de Hymenoptera é a imunoterapia com veneno. O objetivo deste estudo foi rever a literatura para avaliar os efeitos da imunoterapia com veneno em pacientes com reações graves após ferroada de Hymenoptera. TIPO DE ESTUDO E LOCAL: Foram revisados na literatura mundial ensaios clínicos controlados e aleatórios. O manuscrito foi realizado na Disciplina de Alergia e Imunologia Clínica, Universidade de São Paulo (USP). MÉTODOS: Ensaios clínicos controlados e aleatórios envolvendo imunoterapia com veneno de Hymenoptera versus placebo ou apenas acompanhamento dos pacientes foram avaliados. Realizada imunoterapia específica, o risco de reações sistêmicas foi avaliado através de cálculo do "odds ratio" e intervalo de confiança de 95%. RESULTADOS: 2.273 resumos foram identificados na busca pelas palavras chave. Apenas quatro estudos foram incluídos nesta revisão. O teste qui-quadrado de heterogeneidade mostrou que dois estudos foram homogêneos e puderam ser incluídos na metanálise. Ao combinar os dois estudos, o "odds ratio" passou a ser significativo: 0.29 (0.10-0.87). Entretanto, ao analisar a gravidade das reações ocorridas após a imunoterapia, observou-se que os benefícios podem não ser tão relevantes, pois as reações foram, na grande maioria, ou mais leves ou semelhantes à reação original. CONCLUSÕES: A imunoterapia específica deve ser recomendada para adultos e crianças com reações moderadas a graves, porém não há necessidade de prescrevê-la para as crianças apenas com reações cutâneas, especialmente se a exposição é muito esporádica. No outro lado, a relação risco-benefício deve ser sempre avaliada em cada caso

The role of IFN-γ production during retroviral infections: an important cytokine involved in chronic inflammation and pathogenesis

Interferon-gamma (IFN-γ) plays a crucial role in viral infections by preventing viral replication and in the promotion of innate and adaptive immune responses. However, IFN-gamma can exert distinct effects in different persistent viral infections. The long-term overproduction of IFN-γ in retroviral infections, such as the human immunodeficiency virus (HIV), human T-lymphotropic virus type 1 (HTLV-1), and human endogenous retroviruses (HERVs), resulting in inflammation, may cause neuronal damage. This review is provocative about the role of IFN-γ during persistent retroviral infections and its relationship with the causation of some neurological disorders that are important for public health

Is the telomere length associated with neurocognitive disabilities in HIV-1-infected subjects?

Objective: We evaluated the association between cognitive deficits and leukocyte telomere length (LTL) in HIV-1-infected individuals. Design: 73 HIV-1-infected patients undergoing neuropsychological evaluation and 91 healthy controls were included in this study. Fifteen HIV-1 positive patients did not have cognitive disorders whereas 26 had asymptomatic neurocognitive disorder (ANI), 13 presented mild to moderate neurocognitive disorder (MND), and 10 had HIV-associated dementia (HAD). Methods: DNA from the peripheral blood of HIV-1-infected patients was used for measurement of telomere length by real-time PCR. HIV-1 viral load was determined in blood. Results: LTL decreased with age in healthy controls (p=0.0001). Regardless of the HIV status, age-matched LTL from HIV patients, including those with ANI and MND, were shortened in comparison to the healthy control group (p=0.0073); however, no association was found among the HIV-1-infected individuals with cognitive deficits (p=0.01). In addition, no gender-related association with LTL was observed (p=0.80), smoking, physical exercise, and plasma viral load were not correlated to telomere length (p=0.66). Conclusions: We concluded that leukocyte telomere length may not be a marker of cellular senescence in individuals with HIV infection and neurocognitive disorders

Uncovered stent does not provoke reactions in renal arteries and renal parenchyma in swines

OBJECTIVE: To assess the histological changes of the aorta, the renal arteries and the renal parenchyma in swine, induced by a metalic uncovered stent implanted in transrenal position in the abdominal aorta. METHODS: Ten pigs with a mean weight of 86.6 kg and mean age of 6 months underwent implantation of metal stent graft placed in the aorta at the level of the renal arteries after 100 days of implantation. The self-expanding stents were released by laparotomy. Anatomic and histological analyses of the abdominal aorta, the renal arteries and the renal parenchyma were performed. Histological slices were performed in the following sites: 1) transitional zone between the aorta with and without stent graft; 2) portion of the renal arteries ostia; 3) renal parenchyma. The slices were stained through the hematoxylin and eosin stain technique and analyzed according the protocol of histological analyses applied in the clinical practice of pathology labs. RESULTS: The macroscopic findings showed thickening of the aortic wall; patent renal arteries; and normal anatomic renal structures. Microscopic analyses, close to the stents, showed thickening of the vascular wall, renal arteries without changes, and preserved renal parenchyma. CONCLUSION: The uncovered stainless steel stent caused a significant inflammatory reaction with thickening of the aortic wall. However, the renal arteries remained patent and the renal parenchyma did not present embolic or ischemic changes.OBJETIVO: Avaliar as alterações histológicas da aorta, artéria renal e parênquima renal, em suínos, induzidos pelo stent metálico descoberto implantado em localização transrenal na aorta abdominal. MÉTODOS: Foram utilizados 10 suínos com peso médio de 86,6 quilos e idade média de 6 meses, submetidos a implante de stent metálico posicionado na aorta, no nível das artérias renais, após 100 dias do implante. Os stents foram liberados por auto-expansão com laparotomia. Foram realizadas análises anatômicas e histológicas da aorta abdominal, artérias renais e parênquima renal. Os cortes histológicos foram realizados nos seguintes locais: 1) transição entre a aorta normal e aorta contendo stent; 2) porção contendo os óstios das artérias renais, 3) parênquima renal. As lâminas foram coradas pela técnica da hematoxilina e eosina e analisadas conforme protocolo de análise histológica aplicada na prática clínica dos laboratórios de patologia. RESULTADOS: Os achados macroscópicos revelaram espessamento da parede aórtica; artérias renais pérvias; estrutura anatômica renal normal. Análises microscópicas, próximas aos stents, evidenciaram espessamento da parede vascular, artérias renais sem alterações e parênquima renal preservado. CONCLUSÃO: O stent de aço inoxidável descoberto produziu importante reação inflamatória com espessamento da parede da aorta. No entanto, as artérias renais permaneceram pérvias e o parênquima renal sem alterações isquêmicas ou embólicas.INCOR Hospital Maternidade Marieta Konder BonhausemUNIFESPUNIFESP - Escola Paulista de Medicina São PauloUniversidade do Estado de Santa Catarina Hospital VeterinárioLaboratório RochaHospital São JoséSanta CasaUNIFESP, EPMSciEL

Immunothrombosis and COVID-19 ‒ a nested post-hoc analysis from a 3186 patient cohort in a Latin American public reference hospital

Objective: COVID-19 is associated with an elevated risk of thromboembolism and excess mortality. Difficulties with best anticoagulation practices and their implementation motivated the current analysis of COVID-19 patients who developed Venous Thromboembolism (VTE). Method: This is a post-hoc analysis of a COVID-19 cohort, described in an economic study already published. The authors analyzed a subset of patients with confirmed VTE. We described the characteristics of the cohort, such as demographics, clinical status, and laboratory results. We tested differences amid two subgroups of patients, those with VTE or not, with the competitive risk Fine and Gray model. Results: Out of 3186 adult patients with COVID-19, 245 (7.7%) were diagnosed with VTE, 174 (5.4%) of them during admission to the hospital. Four (2.3% of these 174) did not receive prophylactic anticoagulation and 19 (11%) discontinued anticoagulation for at least 3 days, resulting in 170 analyzed. During the first week of hospitalization, the laboratory most altered results were C-reactive protein and D-dimer. Patients with VTE were more critical, had a higher mortality rate, worse SOFA score, and, on average, 50% longer hospital stay. Conclusion: Proven VTE incidence in this severe COVID-19 cohort was 7.7%, despite 87% of them complying completely with VTE prophylaxis. The clinician must be aware of the diagnosis of VTE in COVID-19, even in patients receiving proper prophylaxis