Carlos Maurício Cardeal Mendes

Factors Associated with Insulin Resistance in Patients with Chronic HCV Genotype 1 Infection without Obesity or Type 2 Diabetes.

Objective: To investigate the prevalence of insulin resistance (IR) and its association with clinical parameters in patients with hepatitis C virus (HCV) genotype 1 without obesity or type 2 diabetes. Methods: One hundred and twenty-seven HCV-infected patients admitted to the Nutrition and Hepatology Clinic were included. Statistical analysis was performed using the Mann-Whitney test, Fishers exact test, and Poisson regression analysis. Results: The prevalence of IR (homeostasis model assessment [HOMA]-IR ≥ 3.0) was 37.0%. The independent predictors for IR included the following: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) 1.5 times the upper normal limit (odds ratio [PR] = 2.06, 95% CI, 1.16–3.66; PR = 2.32, 95% CI, 1.26–4.49, respectively); gamma glutamyl transferase (γGT) ≥ 85 U/L (PR = 2.09, 95% CI, 1.12–4.12); increased waist circumference (PR = 2.24, 95% CI, 1.25–4.17); increased waist : hip ratio (PR = 2.24, 95% CI, 1.11–5.17); increased body fat percentage (PR = 2.21, 95% CI, 1.01–5.79); overweight (PR = 2.54, 95% CI, 1.40–4.82); and metabolic syndrome (PR = 3.05, 95% CI, 1.69–5.44). High ALT levels and anthropometric parameters remained in the model of multivariate regression analysis. Conclusions: Our findings showed a significantly high prevalence of insulin resistance in nondiabetic, nonobese patients with hepatitis C genotype 1. High ALT levels and anthropometric parameters were significantly associated with IR after multivariate regression analysis. Our data show the importance of monitoring IR, weight, and body composition in patients with chronic hepatitis C. Nutritional management seems to be important in the control of comorbidities related to excess weight and the enhancement of therapeutic responses.

Mortality for Critical Congenital Heart Diseases and Associated Risk Factors in Newborns. A Cohort Study

Background Congenital heart diseases are the most common type of congenital defects, and account for more deaths in the first year of life than any other condition, when infectious etiologies are ruled out. Objectives To evaluate survival, and to identify risk factors in deaths in newborns with critical and/or complex congenital heart disease in the neonatal period. Methods A cohort study, nested to a randomized case-control, was performed, considering the Confidence Interval of 95% (95% CI) and significance level of 5%, paired by gender of the newborn and maternal age. Case-finding, interviews, medical record analysis, clinical evaluation of pulse oximetry (heart test) and Doppler echocardiogram were performed, as well as survival analysis, and identification of death-related risk factors. Results The risk factors found were newborns younger than 37 weeks (Relative Risk - RR: 2.89; 95% CI [1.49-5.56]; p = 0.0015), weight of less than 2,500 grams (RR: 2.33 [; 95% CI 1.26-4.29]; p = 0.0068), occurrence of twinning (RR: 11.96 [95% CI 1.43-99.85]; p = 0.022) and presence of comorbidity (RR: 2.27 [95% CI 1.58-3.26]; p < 0.0001). The incidence rate of mortality from congenital heart disease was 81 cases per 100,000 live births. The lethality attributed to critical congenital heart diseases was 64.7%, with proportional mortality of 12.0%. The survival rate at 28 days of life decreased by almost 70% in newborns with congenital heart disease. The main cause of death was cardiogenic shock. Conclusion Preterm infants with low birth weight and comorbidities presented a higher risk of mortality related to congenital heart diseases. This cohort was extinguished very quickly, signaling the need for greater investment in assistance technology in populations with this profile.

Avaliação quantitativa da produção ambulatorial em saúde auditiva no município de Salvador-Bahia no período de 2004 a 2016

Introducao : a saude auditiva no Brasil ganhou impulso com a implantacao da Politica Nacional de Atencao a Saude Auditiva (PNASA), em 2004, gerando melhorias para a assistencia ao deficiente auditivo. Essa politica ficou vigente ate o ano de 2011, quando foi instituido o Plano Nacional dos Direitos da Pessoa com Deficiencia – Plano Viver sem Limite (PVSL), mudando o cenario brasileiro no cuidado a pessoa com deficiencia, no qual a assistencia ao deficiente auditivo havia sido incluida. Objetivos : avaliar a producao ambulatorial em saude auditiva e os recursos financeiros investidos nessa producao nos anos de 2004 a 2016, no municipio de Salvador-Bahia e verificar o impacto da revogacao da PNASA e implantacao do PVSL no tempo sobre a producao ambulatorial em saude auditiva e recursos financeiros investidos nessa producao no municipio de Salvador. Metodologia : estudo ecologico realizado atraves de dados secundarios de dominio publico provenientes do Sistema de Informacoes Ambulatoriais do SUS (SIA/SUS). Foi realizada analise descritiva dos dados por meio do tamanho do efeito, media, desvio padrao, valor minimo e maximo, frequencia relativa e frequencia absoluta. Resultados : verificou-se crescimento da producao ambulatorial e dos recursos financeiros investidos no ano de 2004 a 2016. Observou-se, tambem, que a revogacao da PNASA e instituicao do PVSL ocasionou grande efeito na producao ambulatorial e nos recursos financeiros. Conclusao : foi possivel constatar que as mudancas no cenario da saude auditiva no Brasil geraram evolucao dos servicos, podendo ser constatado pela crescente producao ambulatorial e aumento dos investimentos financeiros ao longo dos anos

Exatidão e precisão das réguas milimetradas utilizadas durante procedimentos endodônticos

Introduction : The use of millimeter rules is of fundamental importance for the proper conduct in the various stages of endodontic treatment. The professional should be concerned by the accuracy and precision of these instruments in order to avoid possible measurement errors and interpretation able to frustrate the endodontic therapy. Objective: This study was aimed to evaluate the accuracy and precision of millimeter rulers sold in Brazil used during endodontic procedures and evaluate the use and preference of this instrument by professionals working in this area. Methodology: Preliminarily, experts and graduate students in endodontics were consulted regarding the use and the brand preference for millimeter rules. In parallel, a hundred rulers have been selected divided into ten groups of ten units each, according to the manufacturer and the type of material used. Each ruler was measured in 30 mm by means of an electronic digital caliper, and the accuracy assessed by comparing the rulers with a gold-standard ruler credited by the Laboratory of Metrology – MEC-Q/BA. As for the accuracy the results were compared between the units of each group. Results: The questionnaire applied revealed that 19.23% of respondents did not know how to refer to the rulers’ brands used and 23.07% reported using more than one millimeter ruler to perform endodontic procedures. A millimeter ruler produced by Maillefer was the most cited by respondents, followed by Intermedium and Microdont. Evaluation of rulers produced by Maillefer revealed greater accuracy, while the greatest accuracy was accredited to rulers produced by JON. The ruler made of polymer by Maquira was considered the least accurate and precise. Conclusion: As the millimeter endodontic rulers analyzed were neither precise nor accurate, the Professional should use the same ruler throughout treatment.

Misofonia: Quando o som não embala mas abala

Introducao : a misofonia e uma condicao cronica caracterizada por experiencias emocionais desagradaveis em resposta a sons especificos. Existem poucos estudos que podem contribuir para o desenvolvimento de um modelo teorico para entender a misofonia e os fenomenos relativos a ela, bem como o seu tratamento. Objetivo: revisar a literatura sobre a misofonia e suas implicacoes, diagnostico e possiveis tratamentos, numa perspectiva atual. Metodologia: foi realizada uma busca na literatura nas principais bases de dados online, utilizando o termo misofonia. Apos analise dos resumos, 13 artigos foram selecionados para analise detalhada. Resultados: pouco ainda se sabe sobre os aspectos fisiopatologicos da misofonia e acredita-se que ha um envolvimento dos sistemas limbico e autonomico na severidade das respostas aos chamados sons gatilhos. Os principais sons que desencadeiam respostas de aversao no individuo misofonico envolvem mastigacao, respiracao e outros sons de padrao repetitivo. Nao ha um consenso no melhor metodo diagnostico desta condicao e o tratamento tambem nao segue uma padronizacao, podendo envolver terapia de habituacao ao som, terapia cognitivo comportamental e utilizacao de medicamentos. Conclusao: a misofonia e uma condicao que se mostra cada vez mais comum e que pode afetar muito a vida do individuo que a possui, no entanto, o entendimento sobre o mecanismo neurobiologico, os aspectos fisiopatologicos, a caracterizacao clinica, o diagnostico e tratamento desse fenomeno ainda e evasivo.

The Demographic and Clinical Characteristics of Ulcerative Colitis in a Northeast Brazilian Population.

Introduction. The purpose of this study was to describe the clinical and demographic characteristics of UC in Bahia, a Brazilian state, and to identify the variables associated with extensive colitis, steroid therapy, immunosuppression, and colectomy. Methods. In this cross-sectional study UC patients were interviewed, and additional information was collected from the medical records. Descriptive statistics and multivariate Poisson regression analysis were used. Results. This study included 267 individuals, the mean age of whom was 39.4 years at diagnosis. There was a predominance of females and left-side colitis. Extensive colitis was positively associated with male gender, diarrhea, weight loss, and a younger age at diagnosis. In contrast, active smoking and a family history of IBD were negatively associated with extensive colitis. Positive associations were observed between steroid therapy and diarrhea, weight loss, urban patients, extraintestinal manifestations (EIMs), and hospitalization. Younger age and weight loss at diagnosis, a family history of IBD, extensive colitis, EIMs, hospitalization, and steroid therapy were all positively associated with immunosuppression. In contrast, Caucasian individuals, smokers, patients with rectal bleeding, and rural patients areas were all observed to have a decreased likelihood of immunosuppression. Conclusions. Our results corroborate the association between higher prevalence of extensive colitis and younger age at diagnosis. An association between steroid therapy and clinical presentation at diagnosis was observed. The observation that white individuals and rural patients use less immunosuppressive drugs highlights the need to study the influence of environmental and genetic factors on the behavior of UC in this population.

Qualidade de vida e capacidade funcional na Mucopolissacaridose tipo II – Relato de Caso

Introducao: As mucopolissacaridoses (MPS) sao causadas pelo acumulo intralisossomico de glicosaminoglicano, secundario a deficiencia enzimatica, sendo a MPS II (Sindrome de Hunter ) uma sindrome genetica de heranca recessiva ligada ao cromossomo X, caracterizada pela deficiencia de iduronato-2-sulfatase, causando diversas manifestacoes em orgaos e sistemas que podem levar a de clinio funcional e prejuizos na qualidade de vida (QV). Ha poucos dados na literatura sobre a QV e capacidade funcional. Objetivo: Relatar o caso de um paciente com MPS II sobre a qualidade de vida e capacidade funcional. Metodologia: Estudo realizado no HUPES/UFBA, Salvador/BA. A avaliacao da QV foi realizada pelo questionario SF-36 e a capacidade funcional pelo teste de caminhada de seis minutos (TC6M). Resultados : O paciente apresentou pontuacao baixa nas areas relacionadas ao estado de saude geral (32), aspectos sociais (62,5) e saude mental (68) na avaliacao da QV pelo SF-36 e a distância percorrida no TC6M (DTC6M) foi 420m. Conclusao: Houve baixa pontuacao em alguns dominios da QV, sendo o estado de saude geral o mais prejudicado, e diminuicao da distância percorrida no teste de caminhada de seis minutos, caracterizando baixa tolerância ao esforco.

Perfil audiológico e utilização e benefício de dispositivo de amplificação sonora na síndrome de Goldenhar: um relato de caso

Background: The Goldenhar Syndrome may cause hearing damages as a result of improper development of the outer, middle and inner ear. A hearing loss can be categorized in three different ways: conductive, mixed or sensorineural, depending on the location of the malformation. In patients with conductive or mixed hearing loss, the BAHA® (Bone-anchored hearing aid) is a good hearing aid option. In order to evaluate the satisfaction provided by this hearing aid, functional gain testing is not enough. The level of satisfaction with a hearing aid used on a daily basis can be studied through the questionnaire Satisfaction with Amplification in Daily Life – SADL. Objective: To outline the audiologic profile, through the analysis of audiometric results of a patient with Goldenhar Syndorme, as well as to evaluate the benefit of the hearing aid used by her as treatment, through the result of the functional gain test and also the satisfaction provided by it, according to the Brazilian SADL questionnaire. Methodology: The audiometric and functional gain exam certificates were analyzed and the Brazilian SADL questionnaire was applied. Results: The air-conduction thresholds did not change much as the bone-conduction thresholds presented larger changes, with a 30 dB average bilaterally. The functional gain showed a 25 dB average with the BAHA in the left ear, another 30 dB average with the BAHA in the right ear and a 25 dB average with the BAHA being used bilaterally. With the SADL questionnaire, the global score average was 6,06. Conclusion: This study showed that the bone-conduction hearing aids were beneficial for this patient, for offering an audibility improvement and a high level of satisfaction with their use.