Prothrombin G20210A gene mutation, factor V Leiden and anticardiolipin antibodies do not influence renal graft survival after transplantation

INTRODUCTION: Thromboembolic complications are important risk factors for graft failure and worse renal transplantation outcome. Patients with thrombophilic disorders have a higher risk of thromboembolic complications. The prevalence of thrombophilic disorders and the associated risk for graft failure and for intravascular thrombosis were analyzed in renal transplant recipients. METHODS: This is a cohort study of 388 adult recipients investigated regarding the presence of thrombophilia, through the search for anticardiolipin antibodies (aCL) via ELISA and FV G1691A and PT G20210A gene mutations by multiplex PCR. RESULTS: Thrombophilic disorders were identified in 25.8% of the patients. The 2-year graft survival was similar among patients with and without thrombophilic disorder (94% versus 94%, p = 0.53), and so was the survival free of intravascular thrombosis (97% versus 97%, p = 0.83). The prevalence of intravascular thrombosis was similar in both groups (3% versus 3.5%, p = 0.82). Patients with previous kidney transplantation had a higher risk of graft failure (OR 20.8, p < 0.001) and of intravascular thrombosis (OR 6.8, p = 0.008). CONCLUSIONS: The prevalences of FV G1691A and PT G20210A gene mutations in this cohort of patients were similar to those of the general non-transplanted population. The prevalence of aCL antibodies was higher in this cohort than that observed in healthy individuals. The thrombophilic markers studied did not predict the medium-term survival of renal transplant.INTRODUÇÃO: Complicações tromboembólicas são importantes fatores de risco para perda do enxerto e pior evolução após o transplante renal. Pacientes com defeito trombofílico apresentam maior risco de complicações tromboembólicas. Foram analisados, entre receptores de transplante renal, a prevalência de defeito trombofílico e o risco atribuído a esta condição para a perda do enxerto e para o desenvolvimento de tromboses intravasculares. MÉTODOS: Estudo do tipo coorte incluindo 388 receptores adultos analisados quanto à presença de trombofilia de acordo com a pesquisa de anticorpos anticardiolipina (aCL) por ELISA e das mutações G1691A no gene do fator V (FV) e G20210A no gene da protrombina (PT) por PCR multiplex. RESULTADOS: Defeito trombofílico foi identificado em 25,8% dos pacientes. As taxas de sobrevida de 2 anos do enxerto foram semelhantes entre os pacientes com e sem defeito trombofílico (94% versus 94%, p = 0,53), bem como a sobrevida dos enxertos livres de tromboses intravasculares (97% versus 97%, p = 0,83). Pacientes com defeito trombofílico apresentaram prevalência de tromboses intravasculares semelhante à do grupo-controle (3% versus 3,5%, p = 0,82). O transplante renal anterior foi associado a maior risco de perda de enxerto (OR 20,8, p < 0,001) e de ocorrência de tromboses intravasculares (OR 6,8, p = 0,008). CONCLUSÕES: As prevalências das mutações FV G1691A e PT G20210A na população estudada foram semelhantes às da população geral não transplantada, e a prevalência de anticorpos aCL superou a observada entre os indivíduos sadios. Não houve associação entre os marcadores de trombofilia estudados e a sobrevida em médio prazo do transplante renal.UNIFESP Departamento de Medicina, Disciplina de HematologiaUNIFESP Departamento de Medicina, Disciplina de NefrologiaUNIFESP Departameto de Medicina, Disciplina de ReumatologiaUNIFESP Departamento de Medicina Preventiva, Disciplina de BioestatísticaUniversidad de Antofagasta Departamento de Tecnologia MedicaUNIFESP, Depto. de Medicina, Disciplina de HematologiaUNIFESP, Depto. de Medicina, Disciplina de NefrologiaUNIFESP, Departameto de Medicina, Disciplina de ReumatologiaUNIFESP, Depto. de Medicina Preventiva, Disciplina de BioestatísticaSciEL

Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function?

<p>Abstract</p> <p>Background</p> <p>Left ventricular ejection fraction (LVEF) has been considered a major determinant of early outcome in acute myocardial infarction (AMI). Myocardial performance index (MPI) has been associated to early evolution in AMI in a heterogeneous population, including non ST-elevation or previous AMI. Left atrial volume has been related with late evolution after AMI. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF) specifically in patients with a first isolated ST-elevation AMI.</p> <p>Methods</p> <p>Echocardiography was performed within 30 hours of chest pain in 95 patients with a first ST-elevation AMI followed during the first week of hospitalization. Several clinical and echocardiographic variables were analyzed. CHF was defined as Killip class ≥ II. Multivariate regression analysis was used to select independent predictor of in-hospital CHF.</p> <p>Results</p> <p>Early in-hospital CHF occurred in 29 (31%) of patients. LVEF ≤ 0.45 was the single independent and highly significant predictor of early CHF among other clinical and echocardiographic variables (odds ratio 17.0; [95% CI 4.1 - 70.8]; p < 0.0001). MPI alone could not predict CHF in first ST-elevation AMI patients. Left atrial volume was not associated with early CHF in such patients.</p> <p>Conclusion</p> <p>For patients with first, isolated ST-elevation AMI, LVEF assessed by echocardiography still constitutes a strong and accurate independent predictor of early in-hospital CHF, superior to isolated MPI and left atrial volume in this particular subset of patients.</p

Mental Disorders in Megacities: Findings from the São Paulo Megacity Mental Health Survey, Brazil

Background: World population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. São Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders. Methods and Results: A representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year. Discussion: Adults living in São Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries

A note on the Hardy-Weinberg model in generalized ABO systems

An alternative formulation for the Hardy-Weinberg model in generalized ABO-like systems is introduced. It is indicated how such an approach may be employed to construct explicit Wald's statistics for goodness-of-fit tests.ABO blood group Hardy-Weinberg model Wald's test statistics

Severe physical punishment: risk of mental health problems for poor urban children in Brazil

Objective To examine the relationship between specific types of child mental health problems and severe physical punishment, in combination with other important known risk factors.Methods We conducted a cross-sectional study in Embu, São Paulo, Brazil, as the Brazilian component of a multicountry survey on abuse in the family environment. From a probabilistic sample of clusters that included all eligible households (women aged 15-49 years with a son or daughter 7). Backward logistic regression analysis identified independent correlates and significant interactions.Findings Multivariate modelling showed that severe punishment wash an independent correlate of comorbid internalizing and externalizing problems but was not associated with internalizing problems only. It increased the risk of externalizing problems alone only for children and adolescents not exposed to maternal anxiety or depression. Maternal anxiety or depression increased the risk only for children or adolescents not exposed to severe punishment.Conclusion Severe punishment may be related to child mental health problems, with the mechanism depending on the type of problem. Its influence persists in the presence of family stressors such as the father's absence and maternal anxiety or depression.Universidade Federal de São Paulo, Escola Paulista Med, BR-04023061 São Paulo, BrazilColumbia Univ, New York State Psychiat Inst, New York, NY USAUniv Presbiteriana Mackenzie, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, BR-04023061 São Paulo, BrazilWeb of Scienc

Risk factors for surgical site infection in kidney transplant recipients

We analyzed the epidemiologic characteristics and risk factors for surgical site infection (SSI) in kidney transplant recipients. From among 1,939 kidney transplant recipients, 120 with corresponding control subjects were evaluated in this study (1: 1 ratio). Reoperation, chronic glomerulonephritis, acute graft rejection, delayed graft function, diabetes, and high body mass index were identified in the analysis as risk factors for SSI.Hosp Rim & Hipertensao, Dept Internal Med, Div Infect Dis, São Paulo, BrazilHosp Rim & Hipertensao, Div Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Div Stat, Dept Prevent Med, São Paulo, BrazilUniversidade Federal de São Paulo, Div Stat, Dept Prevent Med, São Paulo, BrazilWeb of Scienc