Isabel Gomes Quirino

Clinical course of 822 children with prenatally detected nephrouropathies.

BACKGROUND AND OBJECTIVES With the advent of fetal screening ultrasonography, the detection of congenital anomalies of the kidney and urinary tract (CAKUT) in utero has permitted early management of these conditions. This study aims to describe the clinical course of a large cohort of patients with prenatally detected nephrouropathies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this retrospective cohort study, 822 patients were prenatally diagnosed with CAKUT and systematically followed up at a tertiary Renal Unit for a median time of 43 months. Variables included in the analysis were sex, laterality, fetal ultrasonography (isolated versus associated hydronephrosis), and presence/absence of nephrouropathies. The events of interest were urinary tract infection, surgical interventions, hypertension, CKD, and death. Survival analyses were performed to evaluate time until occurrence of the events of interest. RESULTS Urinary tract infection occurred in 245 (29.8%) children, with higher risk in females (hazard ratio=1.30, 95% confidence interval=1.02-1.70, P=0.05); 22 patients (2.7%) had hypertension, and 49 (6%) patients developed CKD. The risk of CKD was greater in patients with associated hydronephrosis (hazard ratio=5.20, 95% confidence interval=2.90-9.30, P<0.001). Twelve patients (1.5%) died during follow-up. Death was significantly associated with being born during the first period of the study (hazard ratio=6.00, 95% confidence interval=1.60-22.50, P<0.001), associated hydronephrosis (hazard ratio=9.30, 95% confidence interval=2.90-29.30, P<0.001), and CKD (hazard ratio=170.00, 95% confidence interval=41.00-228.00, P<0.001). CONCLUSIONS In our series, the clinical course of prenatally detected CAKUT was heterogeneous, and those infants with associated hydronephrosis at baseline were identified as a high-risk subgroup.

Pesquisadores do CNPq na área de medicina: comparação das áreas de atuação

OBJECTIVE To assess the profile and scientific output of medical researchers supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) grants. METHODS Data were extracted from the Lattes curricula of 411 medical researchers with active grants for the 2006–2008 period. The variables of interest were gender, institutional affiliation, scientific output, and advisership of undergraduate research fellows and master’s and doctoral candidates. RESULTS Researchers were predominantly male (68%) and recipients of category 2 grants (55.7%). Four Brazilian states (São Paulo, Rio de Janeiro, Rio Grande do Sul, and Minas Gerais) accounted for 90% of all researchers. Eight institutions accounted for roughly 80% of researchers in the sample, particularly USP (30.7%) and UNIFESP (17%). The study identified 30 areas of expertise for researchers. Median scientific output was 4.13 published articles per year (interquartile range, IQ, 2.9–5.8), or 2.23 per year (IQ, 1.4–3.2) after adjusting for articles published in Web of Science-indexed journals. The most productive areas in terms of indexed articles were Neuroscience (3.16 articles/year; IQ, 1.8–4.7) and Psychiatry (2.92; IQ, 1.73–4.5). CONCLUSION Medical researchers are concentrated in the Southeast region of Brazil. The scientific output of most Brazilian researchers has increased over the past five years. An understanding of the profile of medical researchers in the country may aid development of effective strategies for qualitative improvement of scientific output.

Diagnostic Accuracy of Renal Pelvic Dilatation for Detecting Surgically Managed Ureteropelvic Junction Obstruction

PURPOSE In this study we evaluate the diagnostic accuracy of renal pelvic dilatation for detecting infants with prenatal hydronephrosis who will need surgical intervention for ureteropelvic junction obstruction during followup. MATERIALS AND METHODS Between 1999 and 2010, 371 newborns diagnosed with isolated prenatal hydronephrosis were prospectively followed. The main event of interest was the need for pyeloplasty. Diagnostic odds ratio, sensitivity, specificity and diagnostic accuracy (assessed by AUC) of fetal renal pelvic dilatation and postnatal renal pelvic dilatation were evaluated. RESULTS A total of 312 patients were included in the analysis and 25 (7.5%) infants underwent pyeloplasty. The diagnostic performance for detecting the need for pyeloplasty was excellent for all ultrasonography measurements. The AUC was 0.96 (95% CI 0.92-0.98) for fetal renal pelvic dilatation, 0.97 (95% CI 0.95-0.98) for postnatal renal pelvic dilatation and 0.95 (95% CI 0.92-0.97) for the Society for Fetal Urology grading system. A cutoff of 18 mm for fetal renal pelvic dilatation and a cutoff of 16 mm for postnatal renal pelvic dilatation had the best diagnostic odds ratio to identify infants who needed pyeloplasty. Considering a diagnosis to be positive only if fetal renal pelvic dilatation was greater than 18 mm and postnatal dilatation was greater than 16 mm, sensitivity was 100% and specificity was 86% (95% CI 80.7-89.9). CONCLUSIONS Our findings suggest that the combination of fetal and postnatal renal pelvic dilatation is able to increase the diagnostic accuracy for detecting infants who need a more comprehensive postnatal investigation for upper urinary tract obstruction.

Combined Use of Late Phase Dimercapto-Succinic Acid Renal Scintigraphy and Ultrasound as First Line Screening After Urinary Tract Infection in Children

PURPOSE The aim of this study was to evaluate the diagnostic accuracy of dimercapto-succinic acid renal scintigraphy and renal ultrasound in identifying high grade vesicoureteral reflux in children after a first episode of urinary tract infection. MATERIALS AND METHODS A total of 533 children following a first urinary tract infection were included in the analysis. Patients were assessed by 3 diagnostic imaging studies, renal ultrasound, dimercapto-succinic acid scan and voiding cystourethrography. The main event of interest was the presence of high grade (III to V) vesicoureteral reflux. The combined and separate diagnostic accuracy of screening methods was assessed by calculation of diagnostic OR, sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio. RESULTS A total of 246 patients had reflux, of whom 144 (27%) had high grade (III to V) disease. Sensitivity, negative predictive value and diagnostic OR of ultrasound for high grade reflux were 83.3%, 90.8% and 7.9, respectively. Dimercapto-succinic acid scan had the same sensitivity as ultrasound but a higher negative predictive value (91.7%) and diagnostic OR (10.9). If both tests were analyzed in parallel by using the OR rule, ie a negative diagnosis was established only when both test results were normal, sensitivity increased to 97%, negative predictive value to 97% and diagnostic OR to 25.3. Only 9 children (6.3%) with dilating reflux had an absence of alterations in both tests. CONCLUSIONS Our findings support the idea that ultrasound and dimercapto-succinic acid scan used in combination are reliable predictors of dilating vesicoureteral reflux.

Primary versus secondary hypertension in children followed up at an outpatient tertiary unit

Childhood hypertension has classically been recognized as a secondary disease. However, primary hypertension also occurs in children. The aim of this study was to compare clinical features of pediatric patients with elevated blood pressure, which were referred to an outpatient tertiary unit, and to detect variables associated with the identification of primary hypertension. The records of 220 patients with hypertension followed between 1996 and 2006 were analyzed. The variable of interest was primary hypertension. Logistic regression analysis was applied to identify clinical variables that were independently associated with primary hypertension. Of 220 patients, 33 (15%) had primary hypertension, and 187 (85%) exhibited secondary hypertension. No statistically significant differences were detected in gender, race, age at diagnosis, and systolic/diastolic blood pressure levels between both groups. After adjustment, four variables at baseline remained independently associated with primary hypertension: absence of signs/symptoms (OR 18.87, 95% CI 6.32–56.29), normal serum creatinine (OR 0.02, 95% CI 0.00–0.27), family history of hypertension (OR 3.03, 95% CI 1.04–8.79), and elevated body weight (OR 1.06, 95% CI 1.02–1.10). The absence of signs/symptoms, normal serum creatinine, family history of hypertension, and overweight/obesity at admission are clues to diagnose primary hypertension in childhood.

Perfil e produção científica dos pesquisadores do CNPq nas áreas de Nefrologia e Urologia

OBJECTIVE This study aimed at evaluating the profile and scientific production of researchers in Nephrology and Urology, receiving grants in the area of Clinical Medicine from the Brazilian National Research Council. METHODS The standardized online curriculum vitae (Curriculum Lattes) of 39 researchers in Medicine receiving grants in the 2006-2008 triennium were included in the analysis. The variables analyzed were: gender, affiliation, time from completion of the PhD program, scientific production, and supervision of undergraduate students, and masters and PhD programs. RESULTS Males (74.4%) and category 2 grants (56.4%) predominated. The following three Brazilian states are responsible for 90% of the researchers: São Paulo (28; 71.8%); Rio Grande do Sul (4; 10.3%); and Minas Gerais (3; 7.7%). Four institutions are responsible for 70% of the researchers: UNIFESP (14; 36%); USP (8; 20.5%); UFMG (3, 7.7%); and UNICAMP (3; 7.7%). Considering the academic career, the assessed researchers published 3,195 articles in medical journals, with a median of 75 articles per researcher (QI = 52-100). The researchers received a total of 25,923 citations at the database Web of Science®, with a median of 452 citations per researcher (QI = 161-927). The average number of citations per article was 13.8 citations (SD = 11.6). CONCLUSIONS The Southeastern region of Brazil concentrates researchers in Nephrology and Urology. Our study has shown an increase in the scientific production of most researchers in the last five years. By knowing the profile of researchers in Nephrology and Urology, more effective strategies to encourage the scientific production and the demand for resources to finance research projects can be defined.

Pesquisadores do Conselho Nacional de Desenvolvimento Científico e Tecnológico na área de Cardiologia

BACKGROUND Systematic assessments of the scientific production can optimize resource allocation and increase research productivity in Brazil. OBJECTIVE The aim of this study was to evaluate the profile and scientific production of researchers in the field of Cardiology who have fellowship in Medicine provided by the Conselho Nacional de Desenvolvimento Científico e Tecnológico. METHODS The curriculum Lattes of 33 researchers with active fellowships from 2006 to 2008 were included in the analysis. The variables of interest were: gender, affiliation, tutoring of undergraduate, masters and PhD students, and scientific production and its impact. RESULTS : There was predominance of males (72.7%) and of fellowship level 2 (56.4%). Three states of the Federation were responsible for 94% of the researchers: SP (28; 71.8%), RS (4; 10.3%), e RJ (3; 9.1%). Four institutions are responsible for about 82% of researchers: USP (13; 39.4%), UNESP (5; 15.2%), UFRGS (4; 12.1%) e UNIFESP (3; 9.1%). During all academic careers, the researchers published 2.958 journal articles, with a mean of 89 articles per researcher. Of total, 55% and 75% were indexed at Web of Science and Scopus databases, respectively. The researchers received a total of 19648 citations at the database Web of Science, with a median of 330 citations per researcher (IQ = 198-706). The average number of citations per article was 13.5 citations (SD = 11.6). CONCLUSION Our study has shown that researchers in the field of cardiology have a relevant scientific production. The knowledge of the profile of researchers in the field of Cardiology will probably enable effective strategies to qualitatively improve the scientific output of Brazilian researchers.

Perfil e análise da produção científica dos pesquisadores brasileiros em Neurociência Clínica

Background: Several studies have examined the scientific production of National Counsel of Technological and Scientific Development (CNPq) researchers in various areas of knowledge. However, specific data about the main Brazilian researchers in Neurosciences are scarce. Objective: Evaluate the scientific production of researchers in the field of Neurosciences who receives productivity grant from the CNPq. Methods: The Lattes Curriculum of 58 researchers with active grants in the years from 2006 to 2008 were included in the analysis. The variables of interest were: gender, affiliation, human resources training, and scientific produc tion. Grants categories/levels were classified according to CNPq database. Results: There was predominance of grants level 1 (55.2%). Researchers published 6,526 articles (median of 90). Of these, 61% were indexed in the ISI database. There was no significant difference between the categories regarding the number of articles (P = 0.12). The median h-index was 10.5 and the median m-index was 0.77. There was no significant difference in m-index between the categories (P = 0.28). Discussion: Strategies to qualitatively improve the scientific output possibly can be enhanced by the knowledge of the profile of researchers in the field of Neurosciences.