Mário Bernardes Wagner

Is depression a risk factor for mortality in chronic hemodialysis patients

OBJECTIVEnThe present study was conducted to assess the association between depressive symptomatology and mortality in chronic hemodialysis.nnnMETHODnA cohort of 40 patients was followed for a median period of 10.5 months. The Beck Depression Inventory was used to classify patients as exposed to depression (Beck Depression Inventory score > 14) or not (Beck Depression Inventory < or = 14). Kaplan-Meier survival curves were used to compare the mortality rate between the two groups. The effects of potential confounding factors were adjusted using Cox proportional hazards model.nnnRESULTSnAfter 24 months of follow-up, survival rates were 39% for exposed and 95% for non-exposed patients (p = 0.029). The Cox proportional hazards model showed results similar to those of the bivariate analysis, indicating that depressive symptomatology tended to be associated with mortality (HR = 6.5, 95%CI: 0.8-55.6; p = 0.085). Other study variables, including age, concurrent systemic diseases, and biochemical markers, were not significantly associated with mortality. Exposed patients remained on dialysis longer and received kidney transplants less frequently (9% vs. 50% for non-exposed patients). When kidney transplantation was included in the Cox regression model, the hazard ratio of mortality for exposed as compared to non-exposed patients lost statistical significance (HR = 4.5; 95%CI: 0.5-40.0; p = 0.17).nnnCONCLUSIONSnOur study suggests that the presence of depressive symptoms may act as an independent risk factor for mortality in chronic hemodialysis patients. However, this finding needs further investigations.

Quality of life and sexuality in chronic dialysis female patients.

Patients in end-stage renal disease (ESRD) present reduced quality of life (QOL) and impaired sexual function. Previous studies have mostly addressed male sexual dysfunction. This was a cross-sectional controlled study that applied a general and the World Health Organization Quality of Life-bref© questionnaires to assess demographic, marital, and sexual conditions, and QOL in 86 healthy women aged 18 or more years (Group 1), and 38 female ESRD patients on dialysis for at least 2 months (Group 2). The effect of several explanatory variables upon QOL components was estimated. Quality of life was lower in Group 2 – overall, and on physical and environment domains. To undergo dialysis and to be poorly educated negatively affected the QOL. Yet age, a stable marital relationship or being sexually active had no effect. Female patients undergoing chronic dialysis had lower QOL and were significantly more sexually dysfunctional than comparable healthy women. Decline in sexual function had no effect on the QOL.

Impact of a Low-Cost and Simple Intervention in Enhancing Treatment Adherence in a Brazilian Asthma Sample

The aim of this study was to evaluate adherence to treatment in persistent asthma in Brazil to determine the factors associated with non-adherence and to measure the efficacy of telephone calls in enhancing adherence. In a prospective, multicenter, interventional clinical trial with parallel groups, asthmatics were randomized into an intervention group or a control group. Asthmatics included in the intervention group received an initial telephone call to record demographic information and asthma characterization. After that, biweekly telephone calls were made to promote treatment adherence. Asthmatics included in the control group received only the initial and final telephone calls. Both groups received three packages of salmeterol/fluticasone for 3 months. The main outcome measure was the percentage of participants who took the prescribed doses of the drug. A total of 271 patients were included. The overall adherence rate was 51.9% for the control group and 74.3% for the intervention group. This meant a reduction of relative risk (RRR) of 47% (p < 0.001). The number needed to treat (NNT) was 4.5. The only variable associated with better adherence was severe persistent asthma. A low-cost easily implemented intervention, tailored to each individual, enhanced the adherence rate among Brazilian asthmatic patients.

Is there a gender difference in non-small cell lung cancer survival?

BACKGROUNDnA possible association had previously been noted between gender and prognosis in non-small cell lung cancer (NSCLC), with a better survival rate for women.nnnOBJECTIVEnThe purpose of the current study was to further clarify the role of gender as a possible prognostic factor in NSCLC.nnnMETHODSnThis retrospective cohort study examined the survival of NSCLC patients who underwent surgical curative treatment at the Hospital Sao Lucas da PUCRS, Porto Alegre, Brazil, between January 1, 1990, and December 31, 2000. Data were analyzed using Kaplan-Meier survival curves. In addition, a Cox proportional hazards regression model was used to adjust for potential confounding factors.nnnRESULTSnIn the period studied, lung resections were performed in 253 patients with NSCLC, of whom 114 had stage I tumors. Four patients were excluded because of death in the immediate postoperative period, and 1 committed suicide. The 5-year survival rate was 85.5% for women and 46.4% for men (P<0.0001). The median overall survival time was 44.7 months (interquartile range [IQR(25%-75%)], 17.4-72.3 months) and was longer in women than in men: 63.9 months (IQR(25%5%), 35.2-98.7 months) versus 32.3 months (IQR(25%-75%), 11.8-61.5 months), respectively (P<0.0001). Gender effect was still present after adjustment by Cox regression for several factors (age, smoking habits, hemoglobin, forced expiratory volume in 1 second, tumor size, tumor-node-metastasis stage, histology, postoperative complications, and surgery type). The adjusted hazard ratio in women was 0.23 (95% CI, 0.09-0.59; (P<0.0001) when compared with men.nnnCONCLUSIONnThis study confirms previous findings that women live longer than men after surgery for stage I NSCLC. This effect persisted after adjusting for several factors. These results highlight the fact that analyses of long-term survival of NSCLC patients, usually generalized to men and women as a whole, may be an inadequate extrapolation. These results question whether analyses of long-term survival, which commonly group men and women together, provide an adequate prognosis of survival rates in women with NSCLC.

Sobrevida de longo prazo em carcinoma brônquico após tratamento cirúrgico: sexo é fator prognóstico?

INTRODUCAO: A semelhanca de resultados relatados por outros autores, anteriormente haviamos encontrado possivel associacao entre sexo e prognostico em carcinoma bronquico nao-pequenas celulas (CBNPC) em estagio I, com melhores taxas de sobrevida em mulheres. OBJETIVO: O objetivo do presente trabalho foi o de ampliar o estudo dos possiveis fatores prognosticos em CBNPC. METODO: Em estudo de coorte retrospectivo, foi avaliada a sobrevida de 163 pacientes com CBNPC tratados cirurgicamente, com intencao curativa, no Hospital Sao Lucas da Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), entre 1990 e 1997, ate o obito ou o seguimento por cinco anos. Os dados foram analisados atraves de curvas de Kaplan-Meier e pelo teste de Mann-Whitney para comparar os tempos de sobrevida e pelo modelo de regressao de Cox para avaliar possiveis fatores de confusao. RESULTADOS: Foram incluidos 124 (76,07%) homens e 39 (23,93%) mulheres. A sobrevida mediana foi 32,3 e 60,6 meses e a sobrevida em cinco anos de 38,0% e 55,4%, para homens e mulheres, respectivamente (p=0,030). Considerando apenas pacientes em Estagio I, as taxas de sobrevida foram 44,4% e 81,8% para homens e mulheres, respectivamente (p=0,009). O efeito do sexo persistiu apos ajuste para varios fatores (idade, hemoglobina, histologia, tamanho do tumor, extensao da cirurgia e complicacoes pos-operatorias), realizado atraves da regressao de Cox. O risco relativo em mulheres foi 0,09 (IC90%:0,03-0,25, p<0,001) quando comparado com o de homens. CONCLUSAO: Este estudo confirmou achados previos de que as mulheres vivem por mais tempo apos cirurgia para tratamento de CBNPC, quando comparadas aos homens. Esse efeito e observado apenas em estagio precoce e persiste apos ajuste de varios fatores.

The relationship between omega-3 and smoking habit: a cross-sectional study

BackgroundOmega3 polyunsaturated fatty acids (PUFAs) are related to several diseases, including smoking. The aim of this study was to evaluate the relationship between omega-3 intake and tobacco smoking, taking into account the qualitative differences in dietary intake between smokers and non-smokers, the amount of the ingested PUFA and their red blood (RBC) contents. We also looked for an association between omega-3 RBC content and smoking, and also between omega3 intake and the level of nicotine dependence.MethodsUsing a cross-sectional study, we included 50 current smokers (group I) and 50 lifetime non-smokers (group II), aged 18–75 years. We screened them at the Toronto Western Hospital and the Centre for Addiction and Mental Health (Toronto, Canada). The subjects completed a questionnaire with demographic data, lifestyle habits and details of food intake. The PUFAs measured in the RBC membranes were alphalinolenic acid, eicosapentaenoic acid (EPA), docosapentaenoic acid and docosahexaenoic acid (DHA). In order to perform an adjusted comparison between smokers and non-smokers we used the ANCOVA model.ResultsAfter adjusting for confounding factors, non-smokers showed higher consumption of PUFAs, especially salmon: 800xa0g (0–7.740) than smokers 430xa0g (0–2.150) Pu2009<u20090.001. They also had higher DHA levels compared to smokers: 4.81xa0% (2.79–10.21) and 4.13xa0% (2.33–7.73), respectively, pu2009<u20090.05. The other PUFAs showed no significant differences between the two groups.ConclusionsSmokers ate less fish rich in omega3 fatty acids than non-smokers, showing and inverse and significant relationship between omega3 intake and smoking. Smokers had lower levels of DHA and EPA, a not previously reported finding. Considering that PUFAs probably interfere in smoking habit, the increase in omega-3 consumption may become a perspective in prevention or treatment of smoking. However, this inference must be evaluated through specific studies.

Role of gender in the survival of surgical patients with nonsmall cell lung cancer

PURPOSE: There are reports of greater survival rates in nonsmall cell lung cancer (NSCLC) patients of female gender. The objective of this study was to evaluate the role of gender in survival of NSCLC patients treated surgically with curative intent (stage I/II). METHODS: In a retrospective cohort design, we screened 498 NSCLC patients submitted to thoracotomies at the hospital Sγo Lucas, in Porto Alegre, Brazil from 1990 to 2009. After exclusion of patients that did not fit to all the inclusion criteria, we analyzed survival rates of 385 subjects. Survival was analyzed using the Kaplan-Meier method. The Cox regression model was used to evaluate potential confounding factors. RESULTS: Survival rates at 5 and 10 years were 65.3% and 49.5% for women and 46.5% and 33.2% for men, respectively (P = 0.006). Considering only stage I patients, the survival rates at 5 and 10 years were 76.2% and 55.1% for women and 50.7% and 35.4% for men, respectively (P = 0.011). No significant differences in survival rates were found among stage II patients. CONCLUSIONS: Our results show female gender as a possible protective factor for better survival of stage I NSCLC patients, but not among stage II patients. This study adds data to the knowledge that combined both genders survival rates for NSCLC is not an adequate prognosis.

Network meta-analysis of probiotics to prevent respiratory infections in children and adolescents.

Probiotics have emerged as a promising intervention for the prevention of respiratory tract infections (RTIs) in children. Assess the effect of probiotics on prevention of RTIs in children and adolescents. MEDLINE, EMBASE, LILACS, SCIELO, CINAHL, SCOPUS, and Web of Science. Key words: “respiratory tract infections” AND probiotics. Randomized controlled trials RCT assessing the effect of probiotics on RTIs in children and adolescents were included. Two reviewers, working independently, to identify studies that met the eligibility criteria. Main and secondary outcomes were RTIs and adverse effects, respectively. Twenty‐one trials with 6.603 participants were included. Pairwise meta‐analysis suggested that Lactobacillus casei rhamnosus (LCA) was the only effective probiotic to the rate of RTIs compared to placebo (RR0.38; Crl 0.19–0.45). Network analysis showed that the LCA exhibited 54.7% probability of being classified in first, while the probability of Lactobacillus fermentum CECT5716 (LFC) being last in the ranking was 15.3%. LCA showed no better effect compared to other probiotic strains by indirect analysis. This systematic review found a lack of evidence to support the effect of probiotic on the incidence rate of respiratory infections in children and adolescents. Pediatr Pulmonol. 2017;52:833–843.

Effect of Radiocontrasts on Selected Membrane Transport Systems

Background. This study was aimed at examining the effects of radiocontrast agents on selected membrane transport functions. Methods. The effect of diatrizoate sodium (DS), diatrizoate meglumine (DM), and diatrizoate compound (DC) on Na+/K+ pump activity and number, L-arginine, and choline transports were evaluated in erythrocytes of normal individuals and patients undergoing cardiac catheterization. Results. Normal individuals erythrocytes potassium influxes were 1.50 ± 0.35, 1.32 ± 0.37, 1.28 ± 0.30, and 1.01 ± 0.25 mmol/L cell/h in control, DS, DM, and DC groups, respectively (P = 0.004; DC vs. control). Patients exposure to Hypaque M-76® significantly diminished Na+/K+ pump activity (1.40 ± 0.36 before, vs. 1.27 ± 0.40 mmol/L cell/h after; P = 0.039). The number of Na+/K+ pumps was reduced (156 ± 36 vs. 143 ± 34 pumps/erythrocyte; P = 0.015) in presence of DS. L-arginine and choline transports changed only at high radiocontrast concentrations. Conclusion. Selective changes in erythrocytes membrane transport function take place on exposure to radiocontrasts.