Ricardo Fakhouri

Aspartate aminotransferase-to-platelet ratio index for fibrosis and cirrhosis prediction in chronic hepatitis C patients

In chronic hepatitis C (CHC), liver biopsy is the gold standard method for assessing liver histology, however it is invasive and can have complications. Non-invasive markers have been proposed and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) has been shown as an easy and inexpensive marker of liver fibrosis. This study evaluated the diagnostic performance of APRI for significant fibrosis and cirrhosis prediction in CHC patients. This study included treatment-naive CHC patients who had undergone liver biopsy from January 2000 to August 2006. All histological slides were reviewed according to the METAVIR system. APRI was calculated based on laboratory results performed within four months from the biopsy. Twenty-eight (56%) patients had significant fibrosis (F2-F4) and 13 (26%) had cirrhosis (F4). The area under ROC curves of APRI for predicting significant fibrosis and cirrhosis were 0.92 (0.83-1.00) and 0.92 (0.85-1.00), respectively. Using cut-off values recommended by prior studies, significant fibrosis could be identified, in accordance with liver biopsy, in 44% and cirrhosis in 66% of patients. APRI could identify significant fibrosis and cirrhosis at a high degree of accuracy in studied patients.

Evaluation of agreement between clinical and histopathological data for classifying leprosy

BACKGROUND The diversity of clinical manifestations of leprosy has given rise to different classification systems. However, there are important differences in the sensitivity and specificity of these classifications. The objective of this study was to evaluate the agreement between clinical and histopathological data for classifying leprosy. METHODS A total of 1265 patient reports containing clinical and histopathological data relating to the diagnosis and classification of leprosy were included in this study. The diagnostic concordance between the clinical form (Madrid classification) and the histopathological type, as well as the initial and final classifications, was calculated by dividing the number of concordant cases by the total number of patients. RESULTS The overall agreement between the World Health Organization operational classification and the results of direct smear examination of the lesion for acid-fast bacilli was 84.8% (1073/1265). The clinical-histopathological agreement was 58.1% (735/1265). The indeterminate and lepromatous forms were those that showed the highest percentages of agreement: 72.1% (186/258) and 71.0% (142/200), respectively. CONCLUSION Although classifications based on clinical characteristics have an important role in the control of leprosy, they present flaws that can influence the adequacy of treatment. Therefore, a histopathological examination is important for appropriate treatment.

Toxicidade aguda do extrato aquoso de folhas de Erythrina velutina em animais experimentais

The aim of this work was to evaluate the acute toxicity of the aqueous extract of Erythrina velutina leaves, which is frequently used in folk medicine as a tranquilizer. The experimental design followed the Guide for Preclinical Toxicity Studies of Herbal Medicines from the Agencia Nacional de Vigilância Sanitaria (Anvisa, 2004). Adult Wistar rats were treated per os with the limit dose of 5g/kg of the extract and then observed for 14 consecutive days. No animals died and no signs of toxicity were detected either during the behavioral observations or at the autopsies, what indicates a reasonable lack of toxicity for the extract.

The Accessory Soleus Muscle: Case Report and a Review of the Literature

Durante una diseccion de rutina, se encontro un musculo soleo accesorio, en la pierna izquierda de un cadaver masculino. El musculo se localizaba posteromedialmente en la pierna, entre los musculos flexor largo de los dedos y largo del halux. Su origen estaba en el tercio superior de la fascia anterior del musculo soleo y su insercion se realizaba, a traves de un tendon en la superficie anteromedial del hueso calcaneo

Epidemiological aspects of dengue in Aracaju, State of Sergipe, Brazil

INTRODUCTION The dengue fever remains to be a disease of serious public health concern, and its incidence has increased in the past decades. This study aimed to characterize the epidemiological incidence of dengue in the period 2001-2010. METHODS This is an epidemiological study of dengue in the municipality of Aracaju, state of Sergipe, in the period between 2001 and 2010, whose data were obtained from the Information System of Diseases Notifications. A descriptive analysis of the number of confirmed cases of dengue, according to year, semester, sanitary district, age, and sex, was performed. RESULTS There were 16,462 confirmed cases, especially in 2008, which obtained the highest incidence of the disease, with 10,485 confirmed cases. The first semester obtained the highest registration of cases during the years of research; this was predominated by females between 15 and 49 years old. With regard to the territorial distribution, the second district of the municipality obtained the highest number of cases. CONCLUSIONS In 2008, in the City of Aracaju, SE, a significant increase in the proportion of dengue cases compared with other years was verified. However, a fast decline in the other years was observed, possibly because of the intensification of preventive actions to combat the mosquito that transmits the dengue virus.

Cisto mesentérico: aspectos clínicos e anátomopatológicos

OBJECTIVE To evaluate epidemiologic, clinical, pathologic and therapeutic characteristics of the mesenteric cysts in hospitals of Sergipe, Brazil. METHODS Mesenteric cysts were assessed by a non-interventional cross-sectional study from the archives of the Pathology Laboratory of Federal University of Sergipe between 1995 and 2007. The charts of the patients were reviewed in order to find out: gender, age, clinical findings, complementary exams and therapeutic approach. RESULTS Eighteen cases of mesenteric cysts were found. Females were more affected (72.2%). Mean of age of the patients was 30.46. More frequent symptoms were pain and abdominal mass. Ultrasonography of abdomen, performed in all patients, was not conclusive in half of the cases. CTscan of abdomen with contrast was performed in six cases, being cystic tumor well identified in all of them. Regarding histopathology, 6 lymphangiomas, 8 mesotheliomas, 1 hemorrhagic cyst in organization and 1 mucinous cyst were found. Surgical treatment was performed in all cases. Intracystic bleeding was the main complication in 3 cases. CONCLUSION The mesenteric cysts presented clinically with unspecific symptoms. CTscan was more effective than ultrasonography for the diagnosis. Lymphangiomas and mesothelioma had been found in equal ratios. The complete resection of the cyst was the treatment of election. There were no deaths in postoperative period.

Efeito do omeprazol e do pantoprazol sobre a regeneração hepática após hepatectomia parcial em ratos

PURPOSE: To assess the effects of omeprazole and pantoprazole on liver regeneration after partial hepatectomy. METHODS: Fifty eight male Wistar rats were divided into 4 groups: SHAM, HP, PANTO and OMEP Groups. They were submitted to 67% partial hepatectomy (HP, PANTO and OMEP Groups) or laparotomy (SHAM Group). Their livers were removed 32 and 56 hours after the operation. Then, the animals were sacrificed. In all groups, the substances (saline solution, omeprazole and pantoprazole) were injected once daily from the moment they were operated on until the time of sacrifice. RESULTS: In SHAM Group the mitotic index was not significant. Thirty two hours after hepatectomy, the mitosis index was 1.2 ± 1.09 in HP Group, 1.2 ± 1.6 in OMEP Group and 2.6 ± 3.2 in PANTO Group. Concerning the 56-hour analysis, the values were 1.6 ± 0.89 in HP Group, 2 ± 1.8 in OMEP Group and 2.6 ± 0.54 in PANTO Group. These results were not statistically significant. CONCLUSION: Omeprazole and pantoprazole, proton pump inhibitors (H+, K+-ATPase), do not cause any change on liver regeneration 32 and 56 hours after 67% partial hepatectomy in rats.

Fall-related traumas in urgent care centers

OBJECTIVE: To identify the scope and the characteristics of fall-related traumas in urgent care centers in Sergipe, Brazil and to verify potential associations among the following variables: gender, age, and where the event occurred. METHOD: This descriptive, cross-sectional study with a quantitative approach was conducted in the urgent care centers of two public referral hospitals in the state of Sergipe, Brazil. The data collection was conducted in November 2010, after approval was obtained from the Human Research Ethics Committee, through a structured interview with a sample of 509 fall victims. RESULTS: Most of the participants were male, between 0 and 19 years old, single, with no impairments or preexisting diseases, nor regular use of medication or alcohol. The victims were brought to the hospital by ambulance and were accompanied. Most events occurred at home, were same-level falls, and most frequently resulted from slipping and tripping during recreational activities with a subsequent fracture, contusion or sprain. Most victims were discharged from the hospital after care delivery. Statistically significant associations were found between place of fall and age and gender. CONCLUSION: There is a high incidence of seeking out care in urgent care centers due to falls, which constitutes a severe public health problem that affects both genders in different age groups. The adoption of preventive measures aimed to reduce such events is urgently required.

Câncer de mama feminino: aspectos clínicos e patológicos dos casos cadastrados de 2005 a 2008 num serviço público de oncologia de Sergipe

OBJECTIVES: to discover the clinical and pathologic aspects of cases of female breast cancer registered at a public oncology service in Sergipe. METHODS: an attempt was made to associate the stage with the characteristics of the tumors. Data was gathered from 165 medical records taken between 2005 and 2008 at the oncology outpatients clinic of the Hospital Cirurgia, in the city of Aracaju, Sergipe, using a data collection form in 2009. RESULTS: ductal invasive carcinoma was identified as the most frequent kind of neoplasia, accounting for 80.8% of cases. Seventy-six (46.1%) of neoplasias were identified at an advanced stage (IIB, III and IV) and mastectomy was the main kind of surgery used, irrespective of the stage of the cancer. All the hormone receptors were associated with the stage and it was noted that positive estrogen and progesterone levels were associated with a more positive prognosis. CONCLUSIONS: it is worth noting that the cases of breast cancer studied were those that are more biologically aggressive with a less promising prognosis in terms of clinical stage. Action to ensure early detection of breast cancer needs to be taken in the course of basic care in Sergipe in order to reduce morbidity and mortality and to improve the survival rates and quality of life of women afflicted with this kind of neoplasia.

Characterization of victims of trauma treated in an emergency hospital

Objective: to describe the socio-demographic profile of victims of trauma treated in an emergency hospital in Sergipe, Brazil. Method: this is an ecological, retrospective, and quantitative study. The sample consisted of 301 medical records of patients treated between January 2006 and July 2008 at Hospital de Urgencia in Sergipe. The collection was carried out within the period from September to December 2008, after the approval by the Research Ethics Committee of Universidade Federal de Sergipe under the Protocol 2448.0.000.107-08. The variables under study were age, gender, external cause, the most severely affected body region, length of hospital stay, Glasgow Coma Scale, and outcome. The data were analyzed through the software Statistical Package for the Social Sciences (SPSS) version 16.0. Results: the average age was 27.8 years, with a prevalence of males (85.7%), individuals from Sergipe state towns, apart from the capital (56.2%), victims of traffic accidents (47.2%) and aggression (27.6%), predominance of cranioencephalic trauma (61.5%), between Friday and Monday (71.5%), average length of hospitalization of 10 days and hospital discharge (74.1%). Conclusion: the higher frequency of cranioencephalic trauma in male young adults, victims of weekend accidents, suggests the need for intensifying the traffic accident prevention strategies to minimize the occurrence and possible consequences related to trauma. Descriptors: wounds and injuries; mortality; accidents, traffic; external causes.