De Clinicas Research Articles

Hypovitaminosis D and secondary hyperparathyroidism in resident physicians of a general hospital in southern Brazil

To evaluate the prevalence of hypovitaminosis D and secondary hyperparathyroidism in resident physicians of a general hospital in southern Brazil and identify associated factors. Cross-sectional study. Resident physicians of Hospital de Clinicas de Porto Alegre, Porto Alegre, southern Brazil. Seventythree subjects age 26.4+/-1.9. Serum PTH, 25- hydroxyvitamin D [25(OH)D], total calcium, phosphorus, magnesium, creatinine, and alkaline phosphatase were measured. In addition calcium, creatinine, and magnesium were measured in urine. Fractional excretion of calcium and magnesium were calculated. Calcium intake was estimated by a food intake questionnaire. Mean serum levels of 25(OH)D were 17.9+/-8.0 ng/ml and 57.4% presented 25(OH)D below 20 ng/ml. Secondary hyperparathyroidism, defined as serum PTH > or =48 pg/ml and normal or low serum calcium, was identified in 39.7% of the individuals. Mean serum levels of magnesium were higher (p=0.02) and the fractional excretion of calcium was lower (p<0.001) in individuals with secondary hyperparathyroidism. Serum PTH levels were positively correlated with body mass index (r=0.33 and p=0.006) and serum magnesium levels (r=0.33 and p=0.02) and negatively correlated with serum 25(OH)D levels (r=-0.33 and p=0.008), estimated calcium intake (r=-0.25 and p=0.04), and fractional excretion of calcium (r=-0.34 and p=0.009). Vitamin D deficiency and secondary hyperparathyroidism was very common in resident physicians. Therefore, measures to prevent this situation should be recommended.

Perfil clinicopatológico dos pacientes com pioderma gangrenoso do Hospital das Clínicas de Porto Alegre (RS) - Brasil (2000-2006)

FUNDAMENTOS: O pioderma gangrenoso é doença neutrofílica pouco freqüente. Caracteriza-se por lesões cutâneas ulceradas, dolorosas, com bordas subminadas e violáceas. Os membros inferiores configuram o local mais acometido. Sua etiologia é incerta, mas em 50% dos casos encontra-se associação com outras doenças. A histopatologia é inespecífica, e o diagnóstico, essencialmente clínico. OBJETIVO: Avaliar o perfil clinicopatológico de pacientes com pioderma gangrenoso. MÉTODO: Estudo retrospectivo dos pacientes diagnosticados no período de 2000 a 2006 no Serviço de Dermatologia do Hospital de Clínicas de Porto Alegre. RESULTADOS: Foram observados 16 pacientes cuja idade média foi 49 anos, com predomínio do sexo feminino (62,5%). O período médio entre início da doença e diagnóstico foi de 1,6 ano. A forma clínica predominante foi a ulcerativa (81,25%), e 87,5% das lesões localizavam-se nos membros inferiores. O sintoma mais freqüentemente associado foi dor local (37,5%). Doze pacientes (66%) apresentaram doenças sistêmicas concomitantes. Doença de Crohn, diabetes e colagenoses foram as principais comorbidades encontradas. O tratamento mais utilizado foi a corticoterapia sistêmica, associada ou não a outros medicamentos (50%), tendo 43,75% dos pacientes apresentado recidiva do quadro. CONCLUSÕES: Os dados avaliados condizem com os encontrados na literatura. As doenças associadas mais prevalentes foram ileíte regional, diabetes melitus e afecções do tecido conectivo. O tratamento mais utilizado incluiu corticoterapia sistêmica. A maioria dos pacientes apresentou cicatrização completa , porém o número de recidivas foi elevado.

Temporal Distribution of Trauma Deaths: Quality of Trauma Care in a Developing Country

Examination of the epidemiology and timing of trauma deaths has been deemed a useful method to evaluate the quality of trauma care. The purpose of this study was to evaluate the quality of trauma care in a regional trauma system and in a university hospital in Brazil by comparing the timing of deaths in the studied prehospital and in-hospital settings to those published for trauma systems in other areas. We analyzed the National Health Minister's System of Deaths Information for the prehospital mortality and we retrospectively collected the demographics, timelines, and trauma severity scores of all in-hospital patients who died after admission through the Emergency Unit of Hospital das Clinicas de Ribeirao Preto between 2000 and 2001. During the study period, there were 787 trauma fatalities in the city: 448 (56.9%) died in the prehospital setting and 339 (43.1%) died after being admitted to a medical facility. In 2 years, 238 trauma deaths occurred in the studied hospital, and we found a complete clinical set of data for 224 of these patients. The majority of deaths in the prehospital setting were caused by penetrating injuries (66.7%), whereas in-hospital mortality was mainly because of blunt traumas (59.1%). The largest number of in-hospital deaths occurred beyond 72 hours of stay (107 patients-47%). The region studied showed some deficiencies in prehospital and in-hospitals settings, in particular in the critical care and short-term follow-up of trauma patients when compared with the literature. Particularly, the late mortality may be related to training and human resources deficiency. Based on the timeline of trauma deaths, we can suggest that the studied region needs improvements in the prehospital trauma system and in hospital critical care.

General psychiatric or depressive symptoms were not predictive for mortality in a healthy elderly cohort in Southern Brazil.

General psychiatric symptoms may interfere with the ability of individuals to take care of their health, to get involved with activities and develop social abilities, thereby increasing risk of death.ObjectiveTo evaluate general psychiatric symptoms as predictive factors for mortality in a community elderly cohort in Southern Brazil.Methods345 healthy elderly, aged .60 years, from the catchment area of Hospital de Clinicas de Porto Alegre were followed from 1996. Data for the present study were drawn from the period 1996-2004. General psychiatric symptoms (Self-Reporting Questionnaire . SRQ), depressive symptoms (Montgomery-Asberg depressive rating scale), and Mini Mental State Examination scores at baseline were included in the study. Socio-demographic, medical conditions, and functional capacity were also analyzed. The outcome was vital status at follow-up obtained from family members, hospital records and checked against official death registers.ResultsOf the 345 baseline individuals, 246 were followed-up. The global mortality rate over the study period was 36.9% (N=90). Those who deceased during the period were older (73.5±7.5), more dependent overall, and more cognitively impaired than the living elderly (univariate analyses). In the logistic regression, only age (OR=0.93; p=0.003) and functional capacity (OR=0.22; p=0.007) remained significant in the final equation.ConclusionPsychiatric symptoms presented no association with mortality in the present sample. Older age and functional incapacity were risk factors for mortality.

A influência do turno de trabalho em pacientes com diabetes mellitus tipo 2

This study aimed to investigate the relationship between the work shift and diabetic patients. A cross-section study was performed in a cohort of 95 type 2 diabetic patients that work in the Hospital de Clinicas de Porto Alegre. Patients were divided into 2 groups according to the shift, day or night work. Patients underwent clinical and laboratory evaluations. There were no significant differences in age, gender, diabetes duration, body mass index, blood pressure, fasting glucose, A1c (1%), triglycerides, total cholesterol, LDL cholesterol, HDL cholesterol, serum creatinine and uric acid. A higher average of waist circumference was found in the group of night workers. Waist circumference was greater in the group of night workers; which may be indicative of insulin resistance in this group of patients. Our research indicates that the shift is not associated with a worsening of metabolic control in subjects or presence of diabetic nephropathy.

Sexual Function in Women from Infertile Couples and in Women Seeking Surgical Sterilization

The purpose of this study was to compare sexual function between women of infertile couples (AR) and women seeking tubal ligation (TL). Women who attended Setor de Infertilidade do Serviço de Ginecologia e Obstetrícia do Hospital de Clinicas de Porto Alegre (HCPA) or the Serviço de Orientação e Planejamento Familiar (SERPLAN) completed the Female Sexual Function Index, a questionnaire about sexual activity in the last 4 weeks. Scored data were collected on six different domains: desire, arousal, lubrication, orgasm, satisfaction, and discomfort/pain. The greatest positive correlation in the TL group was between orgasm and sexual satisfaction (0.798), and in group AR between desire and arousal (0.627). Infertile women and fertile women who want to undergo surgical sterilization have similar sexual satisfaction scores.

Trombólise pré-hospitalar no infarto agudo do miocárdio: uma alternativa factível para o Brasil?

Mailing address: Carisi A. Polanczyk • Hospital de Clinicas de Porto Alegre Rua Ramiro Barcelos 2350, sala 2060 90035-903 Porto Alegre, RS Brazil E-mail: cpolanczyk@hcpa.ufrgs.br Coronary artery disease (CAD) remains the main cause of mortality, with Acute Myocardial Infarction (AMI) contributing with approximately one-third of the death cases. In this context, the therapeutic resources used to reduce the unfavorable outcomes related to this disease, mainly in its acute form, have significantly increased. The advent of the thrombolytic therapy, for instance, represented a considerable advance in the treatment of AMI. Large randomized clinical trials published in the 80s such as GISSI and ISIS 2 have consistently demonstrated the decrease in mortality associated to these drugs when used timely after the onset of AMI symptoms, with its effectiveness being time-dependent and exponential, i.e., earlier the start of drug infusion, greater the clinical benefit.

Nursing diagnosis of patients with colorectal neoplasia undergoing chemotherapy treatment - a qualitative research

Based on a qualitative research of the case study type, this article aims at establishing Nursing Diagnosis (ND`s) of patients with colorectal neoplasia undergoing chemotherapy treatment considering their altered basic human needs. The project was approved by the Research and Post-Graduation Group of Hospital de Clinicas de Porto Alegre (HCPA) (project number 07-001). The study analyzed 11 subjects starting ambulatory chemotherapy treatment in the Ambulatory Chemotherapy Unit of HCPA. Out of 23 established ND`s, 15 were related to physiological needs, 6 to alterations in protection and safety needs and 2, related to alterations in esteem needs. The collected data led to the conclusion that the most prevalent ND`s are connected with physiological needs, namely: Infection Risk; Sleep Disturbance Pattern; Unbalanced Nutrition: below the body needs; Damaged Tissue Integrity; and, High Risk for Damaged Tissue Integrity. Regarding alterations in protection and safety needs, Anxiety ND was the most prevalent one. At last, the ND`s established from esteem needs were: Disturbed Body Image and Impotence. According to the obtained results, it is possible to reaffirm the importance of the ND as a tool in the nursing care because it can interfere in an efficient, individual and proper way for each kind of problem experience by the patient.

Leucemia mielóide aguda: o olhar dos anos 2000 no Serviço de Hematologia do Hospital de Clínicas de Porto Alegre-RS

A leucemia mielóide aguda (LMA) representa uma preocupação para os especialistas, porque perfaz um percentual alto das leucemias no adulto e o sucesso terapêutico ainda é insatisfatório. A partir do ano 2000, o Serviço de Hematologia do Hospital de Clínicas de Porto Alegre definiu estratégias para diagnóstico, tratamento e seguimento das LMAs, de acordo com o subtipo FAB, idade, citogenética e performance status (ECOG). Todos os casos de LMA "de novo"não promielocítica, em adultos (15 a 65 anos) foram acompanhados prospectivamente, desde outubro de 2001, data da implantação do protocolo c,ompreendendo três fases de tratamento: indução com o tradicional "7+3", citarabina 100 mg/m²/dia em infusão contínua em 7d, e daunorrubicina 60 mg/m²/dia em 3d e citarabina intratecal no D1 nas LMA M4 e M5. Após a recuperação medular, segue a consolidação idêntica à indução e posteriormente a intensificação com dois ou três ciclos de altas doses de citarabina 6 g/m²/dia por três dias. Foram diagnosticados, entre outubro/01 e dezembro/05, 69 pacientes portadores de LMA e destes, 39 com LMA "de novo"e idade entre 15 e 65 anos. Neste grupo foram analisadas a taxa de remissão, a taxa de recaída, a refratariedade e o tempo de sobrevida global. No final da observação foram encontrados: a taxa de indução de remissão 75%; aconteceram 12 (40%) recaídas, 7 (19%) foram refratários ao tratamento. A sobrevida global foi 37% em 56 meses, representando um incremento aos resultados obtidos no Serviço na década passada.

Chapitre 12. Clinical Bioethics Committees: A Brazilian Experience

Since its beginning, Bioethics has been related to medical decision making. In health settings, difficult dilemmas, critical situations, controversial decisions are problems that clinical Bioethics reflects on. Institutional Ethics Committees is a general and ambiguous denomination to many different activities. In Brazilian hospitals, we have three different kinds of ethics and bioethics committees: Medical Ethics Committees, Research Ethics Committees and Clinical Bioethics Committees. The first implemented committees were the Medical Ethics Committees, whose objective is to evaluate professional ethics conflicts. These committees were proposed by the Conselho Federal de Medicina (Brazilian Medicine Council). In 1988, the Brazilian government, through the Conselho Nacional de Saude (Brazilian National Health Council) proposed the first research guidelines: Resolucao 01/88, updated in 1996 by Resolucao 196/96. One of these guidelines created the Research Ethics Committees. The first one was created in the Hospital Sao Lucas and the second in the Hospital de Clinicas de Porto Alegre, both in Porto Alegre, Rio Grande do Sul. In 1993, the Hospital de Clinicas de Porto Alegre created the first Brazilian Clinical Bioethics Committee. A Clinical Bioethics Committee can be defined as an interdisciplinary group of health professionals and other persons, whose objective is to provide consultancy on ethical questions and suggest institutional ethical guidelines, in a transdisciplinary perspective. In healthcare institutions, especially in hospitals, Clinical Bioethics Committees can help different segments in critical decision-making that involves ethical, moral, legal or social issues. The activities of a Clinical Bioethics Committee can be reactive or proactive. Consultancy is the typical reactive activity. Clinical Bioethics rounds are the example of proactive activity. In this study, we will present two different Brazilian experiences in Clinical Bioethics Committees: Hospital Sao Lucas and Hospital de Clinicas de Porto Alegre.

Impacto da internação em unidade de terapia intensiva pediátrica: avaliação por meio de escalas de desempenho cognitivo e global

OBJETIVO: Avaliar o impacto da internação sobre os desempenhos cognitivo e global em crianças admitidas na unidade de tratamento intensivo (UTI) pediátrica do Hospital de Clínicas de Porto Alegre. MÉTODOS: Estudo longitudinal, observacional de amostra seqüencial de crianças gravemente doentes. Foram utilizados os indicadores Pediatric Index of Mortality (PIM), para gravidade e risco de morte na admissão, Pediatric Cerebral Performance Category (PCPC), para morbidade cognitiva, e Pediatric Overall Performance Category (POPC), para morbidade global, na admissão e na alta. Para morbidade relacionada à UTI, foi utilizada a diferença entre as classificações de alta e de admissão (escores delta). Foi empregado o teste de Kruskal-Wallis. RESULTADOS: Foram avaliados 443 pacientes, sendo 54% do sexo masculino, com mediana de idade de 12 meses (IQ 4-45), e mediana de permanência na UTI de 4,24 dias (IQ 2,4-8). A taxa de mortalidade foi de 6,3%. A mediana do PIM foi de 2,36% (IQ 1-7). Na admissão, 46% dos pacientes tinham algum grau de morbidade cognitiva e 66% de morbidade global. Na alta, 60% de morbidade cognitiva e 86% de morbidade global. Na avaliação de morbidade relacionada à UTI, 25% dos pacientes mostraram variação na área cognitiva, enquanto que 41% mostraram variação global na alta em comparação à admissão. CONCLUSÕES: Ainda que influenciado por elevado grau de morbidade na admissão, o impacto da internação na UTI foi mais importante no domínio global do que no cognitivo. Da mesma forma, tanto o risco de morte na admissão quanto o tempo de permanência tiveram efeito significativo na morbidade dos pacientes gravemente doentes.

Opinião da equipe de enfermagem sobre o processo de avalição de desempenho

OBJETIVO: O estudo teve o propósito de analisar o processo de avaliação de desempenho segundo a opinião da equipe de enfermagem. MÉTODOS: Trata-se de um estudo survey de caráter quantitativo. Participaram 119 auxiliares de enfermagem e 45 enfermeiros de unidades de internação clínica e cirúrgica do Hospital de Clínicas de Porto Alegre, totalizando 164 profissionais. Utilizou-se um instrumento não identificado contendo questões fechadas, que foram analisadas com base estatística descritiva, freqüências absolutas e relativas e teste quiquadrado para estabelecer significância. RESULTADOS: Os dados apontam, de forma geral, predomínio de satisfação e aspectos positivos, porém essa satisfação não abrange toda equipe, indicando falhas e necessidades de melhorias em algumas etapas do processo. CONCLUSÃO: A insatisfação com o processo é maior entre os funcionários mais antigos. O instrumento avaliativo, a periodicidade das avaliações e a possibilidade de avaliações mais participativas necessitam ser discutidos visando a construção de novas alternativas para o processo avaliativo.

Latin American Science Moves into the Spotlight

With new incentives, some governments in Latin America are starting to increase investment in basic and applied research. Although the news is encouraging, scientists in this region still face many challenges ahead.

Incidence of retinopathy and neonatal nurse practioner’s role in prevention of blindness due to retinopathy of prematurity at Hospital de Clínicas de Porto Alegre, Brazil – prospective observational descriptive study

Introduction: Retinopathy of prematurity is a leading cause of blindness in children in middle-income countries. Recent improvements in the intensive neonatal cares allied with better personal qualification for assistance to the pre-term neonate increased survival rates among very low birth weight infants. This study aims to evaluate the incidence of the disease in premature children born at Hospital de Clinicas de Porto Alegre - Brazil, and also to describe the neonatal nurse practioner’s in prevention of blindness at this institution. Methods: A prospective observational descriptive study was conducted on 329 premature children born with birth weight ≤ 1.500 grams and/or ≤ 32 weeks of gestational age between October of 2002 and October of 2006. All of the children were examined by indirect binocular ophthalmoscopy after pupil dilation with association of Tropicamide 0.5% and Phenylephrine 2.5%, eye drops. The ophthalmological examination was first conducted between the 4th and the 6th weeks of life and repeated according the findings based in the international classification. Results: Retinopathy was diagnosed in 84 of the neonates with an incidence rate of 25.5% (84/329). Eighteen of the 329 screened children (5.5%) reached threshold disease and 17 of them needed diode laser treatment to prevent the disease progression. One patient missed the treatment. Conclusions: The incidence of retinopathy was similar to other international results as well as the occurrence of 5.2% of treatable disease. Only one of the infants developed the disease up to the most serious stage (ROP 5), resulting in a 0.3% of blindness due to the retinopathy at the institution since 2002.

Úlceras cutâneas na hanseníase: perfil clínico-epidemiológico dos pacientes

FUNDAMENTOS: A hanseníase é uma doença de evolução crônica cuja lesão nervosa determina alterações sensitivas e motoras, levando à instalação de deformidades assim como as úlceras cutâneas. OBJETIVO: Traçar perfil epidemiológico dos hansenianos ulcerados e não ulcerados atendidos no Hospital das Clínicas de Ribeirão Preto 2003/2004. MÉTODOS: Estudo transversal de 79 hansenianos atendidos em 2003 e 2004 junto ao Arquivo Médico, separando-os em Grupo 1 RESULTADOS: Nesta amostra, 69,6% eram do sexo masculino, 91,1% brancos e baciloscopia positiva em 62%. Destes, 25 (32%) pacientes apresentaram ulcerações (Grupo 1) localizadas nos membros inferiores em 68% dos casos, classificados como grau II de incapacidade (72%), diferente em relação ao grupo 2 (p&lt;0,01). Na classificação espectral da hanseníase, comparando os pares de grupos observaram-se diferenças entre tuberculóide e virchowiano (p&lt;0,01), dimorfo e dimorfo-virchowiano (p&lt;0,05), e este com virchowiano (p&lt;0,01). Na operacional, 80% dos ulcerados eram multibacilares enquanto 12% paucibacilares (p&lt;0,05). CONCLUSÕES: Os Grupos 1 e 2 foram epidemiologicamente semelhantes. As ulcerações dos hansenianos parecem estar relacionadas ao grau II de incapacidade e à positividade da baciloscopia, características detectadas por ambas as classificações (espectral e operacional).

Disartria e doença de Machado-Joseph: relato de caso

O objetivo deste estudo foi descrever os principais aspectos fonoaudiológicos relacionados à fala na doença de Machado-Joseph, em um indivíduo do sexo masculino, selecionado entre outros pacientes portadores desta doença com limitações significativas de fala. O paciente foi atendido no Setor de Fonoaudiologia do Serviço de Fisiatria do Hospital de Clínicas de Porto Alegre. Especificamente quanto à fala e seus processos, observou-se quadro disártrico predominantemente atáxico, que piorou com a evolução da doença, passando de leve para severo. Estes resultados permitiram a conclusão de que as alterações tornam-se significativas na fala do portador de doença de Machado-Joseph, associadas ao comprometimento da respiração, articulação, fonação e ressonância. Concluiu-se também quanto à importância do tratamento fonoaudiológico na doença de Machado-Joseph, sugerindo-se novos estudos, com número maior de indivíduos, sejam realizados, a fim de melhor caracterizar as alterações de fala observadas neste estudo.

Contratransferência no atendimento inicial de vítimas de violência sexual e urbana: uma pesquisa qualitativa/quantitativa

OBJETIVO: Avaliar a contratransferência dos terapeutas durante o atendimento inicial de pacientes mulheres vítimas de violência sexual e urbana, investigando a influência do gênero do terapeuta e da natureza e momento do trauma. MÉTODO: A amostra foi composta por 36 relatos redigidos por médicos residentes de psiquiatria do Hospital de Clínicas de Porto Alegre, oriundos do atendimento de 36 pacientes. Este estudo utilizou métodos qualitativos e quantitativos para a análise dos seus dados. Os relatos foram classificados em seis grupos, conforme o gênero do terapeuta e a natureza do trauma. Foi realizada a análise de conteúdo dos relatos. Associou-se uma análise estatística dos dados. RESULTADOS: Houve predomínio de sentimentos de aproximação nos terapeutas de ambos os sexos no atendimento de vítimas de violência sexual. Entre terapeutas mulheres, a natureza do trauma (sexual ou urbano) não influenciou os padrões contratransferenciais (p = 0,7). Entre os terapeutas homens, ao contrário, a natureza do trauma influenciou de forma significativa (p = 0,044) o padrão contratransferencial, havendo um número elevado de sentimentos de distanciamento nos relatos de atendimentos de vítimas de violência urbana. CONCLUSÕES: Houve um predomínio de sentimentos de aproximação dos terapeutas de ambos os sexos no atendimento inicial de pacientes vítimas de violência sexual. Foi observado um predomínio de sentimentos de distanciamento nos terapeutas homens que atenderam vítimas de violência urbana. Mais estudos são necessários para uma melhor compreensão das relações terapêuticas nos atendimentos de vítimas de trauma psíquico.

Incidence and risk factors for retinopathy of prematurity in very low and in extremely low birth weight infants in a unit-based approach in southern Brazil

To analyse the incidence and risk factors for retinopathy of prematurity (ROP) and survival rates among extremely low birth weight (ELBW) and very low birth weight (VLBW) preterm infants. A prospective cohort study of 352 infants admitted at a teaching hospital, Hospital de Clinicas de Porto Alegre, Brazil, between October 2002 and December 2006, was screened for ROP. The ELBW group comprised infants whose birth weight (BW) was < or = 1000 g and the VLBW group comprised those infants whose BW were > 1000 g and < or = 1500 g. Perinatal risk factors for ROP were assessed using univariate and multivariate analysis. Of the 352 neonates screened, 88 were ELBW babies. Survival rates among ELBW and VLBW were 47.8 and 88.7%, respectively. ROP affected 48.9% of ELBW infants and 18.2% of VLBW babies. Threshold disease occurred in 21 patients, 15 of whom were born weighing < 1000 g. Only 2.3% of the neonates born with more than 1000 g developed treatable disease. Univariate analysis showed that gestational age (GA), BW, use of indomethacin and erythropoietin, blood transfusions, and intraventricular haemorrhage were associated with ROP. After logistic regression, the most important adjusted risk factors were BW (OR: 1.002;95% CI: 1.001-1.003; P=0.003), GA (OR: 1.254;95% CI: 1.082-1.455; P=0.003), and use of erythropoietin (OR: 2.486;95% CI: 1.182-5.231; P=0.016). This study showed reduced survival rates, high incidence of ROP, and a greater need of treatment among ELBW infants as compared to VLBW babies admitted in this institution.

Freqüência das dermatofitoses em exames micológicos em Hospital Geral de Porto Alegre, Brasil

FUNDAMENTOS- As espécies de dermatófitos podem variar de uma região para outra, tendo esse fato importância epidemiológica e terapêutica. OBJETIVO- Descrever a freqüência dos dermatófitos nos exames micológicos em pacientes ambulatoriais do Hospital de Clínicas de Porto Alegre (HCPA). MÉTODOS - Foi realizada análise retrospectiva dos exames micológicos realizados em pacientes ambulatoriais do Serviço de Dermatologia do Hospital de Clínicas de Porto Alegre (HCPA) durante o período de agosto de 1998 a fevereiro de 2006. Os dados foram comparados com os de trabalhos anteriores locais e de outras cidades do Brasil utilizando o teste do qui-quadrado. RESULTADOS - Das 5.077 amostras coletadas, 2.033 (40,0%) foram positivas para dermatófitos, sendo entre os dermatófitos o Trichophyton rubrum a espécie mais isolada (62,4%), seguido de T. mentagrophytes (18,2%), Microsporum canis (5,7%), Epidermophyton floccosum (2,0%), M. gypseum (1,4%) e T.tonsurans (0,3%). CONCLUSÕES - Não houve variação significativa na epidemiologia dos dermatófitos nos últimos sete anos na cidade de Porto Alegre (p&gt;0,05). Entretanto, o estudo evidencia diferenças na microbiota de Porto Alegre, comparada à de alguns outros centros urbanos do país (p&lt;0,001). Foi observada menor ocorrência de T. tonsurans e M. canis em relação a São Paulo; ao contrário do T. mentagrophytes, que é quase três vezes mais freqüente em Porto Alegre.

Clinical and Laboratory Profile of Patients With Type 2 Diabetes With Low Glomerular Filtration Rate and Normoalbuminuria

The initial evidence of diabetic nephropathy in type 2 diabetic patients is the development of microalbuminuria (1). However, the UK Prospective Diabetes Study demonstrated that 51% of patients who progress to chronic renal failure had no preceding albuminuria (1). Patients with low estimated glomerular filtration rate (eGFR) (<60 ml/min per 1.73 m2) and normoalbuminuria presented an increased rate of cardiovascular disease (2–4) due to unknown reasons. Aggregation of conventional cardiovascular risk factors might play a role. Therefore, the aim of this study was to analyze the clinical and laboratory features of type 2 diabetic patients with low eGFR and normoalbuminuria. A cross-sectional study was performed in all consecutive normoalbuminuric type 2 diabetic patients attending the outpatient clinic at Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil, between 1999 and 2006 with eGFR >15 ml/min per 1.73 m2. Normoalbuminuria was defined by urinary albumin excretion (UAE) values <20 μg/min, <17 mg/l (random sample), or <30 mg in 24 h (5) on at least two occasions over the preceding 6 months while on their usual antihypertensive medication. eGFR was calculated using the Modification of Diet in Renal Disease formula: 186 × [plasma creatinine (mg/dl)−1.154 × age (years)−0.203 × (1.212 if black) × (0.742 if female)] (6). All patients answered a standard questionnaire and underwent physical examination and laboratory tests. Metabolic syndrome was defined according to …