Syndrome In Brazil Research Articles

Altered intrauterine ultrasound, fetal head circumference growth and neonatal outcomes among suspected cases of congenital Zika syndrome in Brazil

Abstract Objectives: to describe altered intrauterine ultrasound, analyze fetal head circumference (HC) growth and neonates' outcomes among presumed cases of congenital Zika syndrome in Brazil. Methods: 30 women were included in the study with suspected history of Zika virus (ZIKV) infection during pregnancy and fetal's brain altered on ultrasound diagnosis. Sociodemographic and obstetric characteristics, prenatal altered ultrasounds, HC and other perinatal outcomes have been described. The relation between HC and gestational age was analyzed by using random regression effects based on polynomials fractions. The Z test was calculated to determine an instant variant mean rate of the HC for each gestational age. Results: the mean gestational age of the ultrasound diagnosis was 33.3 + 4.7 weeks and HC at birth was 28.9 + 1.6 cm. The main altered brain ultrasound was microcephaly (96.7%). The analysis of the fetal head circumference showed an estimated increase of the average HC, as to gestational age, it did not occur in a linear form. The instant HC variation rate increased according to gestational age (p<0,001). Conclusions: Fetal's main morphological alteration was microcephaly, observing an increase in the head circumference according to gestational age in a non-linear form and the variation decreased with gestational age.

Brazilian borreliosis with special emphasis on humans and horses.

Borreliosis caused by Borrelia burgdorferi sensu lato is a cosmopolitan zoonosis studied worldwide; it is called Lyme disease in many countries of the Northern Hemisphere and Lyme-like or Baggio-Yoshinari Syndrome in Brazil. However, despite the increasing number of suspect cases, this disease is still neglected in Brazil by the medical and veterinary communities. Brazilian Lyme-like borreliosis likely involves capybaras as reservoirs and Amblyomma and Rhipicephalus ticks as vectors. Thus, domestic animals can serve as key carriers in pathogen dissemination. This zoonosis has been little studied in horses in Brazil. The first survey was performed in the state of Rio de Janeiro, and this Brazilian Borreliosis exhibits many differences from the disease widely described in the Northern Hemisphere. The etiological agent shows different morphological and genetic characteristics, the disease has a higher recurrence rate after treatment with antibiotics, and the pathogen stimulates intense symptoms such as a broader immune response in humans. Additionally, the Brazilian zoonosis is not transmitted by the Ixodes ricinus complex. With respect to clinical manifestations, Baggio-Yoshinari Syndrome has been reported to cause neurological, cardiac, ophthalmic, muscle, and joint alterations in humans. These symptoms can possibly occur in horses. Here, we present a current panel of studies involving the disease in humans and equines, particularly in Brazil.

News from the battlefront: Zika virus-associated Guillain-Barré syndrome in Brazil.

In the wake of the Zika virus (ZIKV) epidemic, international resources have been dedicated to combating the increasing rates of ZIKV-associated microcephaly. However, other severe neurologic complications, such as Guillain-Barre syndrome (GBS), have received less attention and funding. In July 2015, 76 patients with recent symptoms suggestive of ZIKV infection with neurologic syndromes were identified in the state of Bahia, northeast Brazil, of which 42 (55%) were confirmed GBS.1 In November 2015, the Aggeu Magalhaes Research Center of the Oswaldo Cruz Foundation reported that ZIKV infection was found in 10 out of 224 suspected dengue cases.1 Seven of the 10 positive samples belonged to patients with a neurologic syndrome.

94 Analysis of obstetric care during delivery in hypertensive women in Brazil

Objectives The aim of this paper is to describe the mode of delivery in women with hypertensive syndrome in Brazil and to evaluate if they are receiving the safest treatment. Introduction The excessive cesarean sections in low risk women in Brazil is well known and probably one of the reasons why there is still a long way to reach the Fifth Millennium Development Goal. A recent study in Brazil shows that the excess of cesarean rates is responsible for almost threefold higher maternal mortality when compared to vaginal delivery. Although it’s known to be safer to end a pregnancy complicated by hypertension through vaginal delivery (induction or spontaneous labour) this is not observed in Brazil. The mode of birth of 2999 women with diagnosis of hypertensive syndrome was evaluated from the birth in Brazil database. Methods This is a cross-sectional study of the database from birth in Brazil survey, a national hospital-based study of 23,894 postpartum women conducted between 2011 and 2012. The information was obtained from a sample of 266 hospitals with 500 or more deliveries per year. This sample was stratified by Brazil’s five macro-regions and type of hospital (private, public or mixed). Results The preliminary results from this study shows a prevalence of 12.5% of the hypertensive syndrome during pregnancy. The hospitals from the unified health system (SUS) were responsible for 80.0% (n = 2400) of women and the private hospitals for 20.0%, this difference was similar to that found for the whole. The mean age of the women with hypertensive syndrome was 20–34 years (68.8%), 13.2% had 12–19 years and 17.9% above 35 years. The sample assisted by SUS had a greater number of younger women ( 11 years versus 42.9%). The women with hypertension syndrome had 72.9% of cesarean, only 35.0% went on spontaneous labour and 11.7% got labour induction. This evaluation is even more distressing if considered the private facilities alone, were 93.7% had cesarean section, 91.6% didn’t went on labor and induction rate was less than 3%. When compared the whole population and those with hypertensive syndromes, there are statistical difference in both public and private sectors for the delivery route and for labor (p The distribution of prematurity was similar in both sectors. There was 20.9% premature births, analyzing separately the total prematurity in the private facilities was 23.0% and 20.3% in the hospitals led by SUS (p = 0,151), which was more than double found in whole population (p Conclusion The cesarean rates for women with hypertensive syndromes during pregnancy is abusive, especially in the private facility were better resources are usually available. Another intriguing data is similar rates of induction of labour between low risk and hypertensive women when higher rates is expected. Brazilian women aren’t receiving an adequate treatment towards termination of pregnancy and this could be contributing to unaccepted morbimortality rate.

Pathology of congenital Zika syndrome in Brazil: a case series

Zika virus is an arthropod-borne virus that is a member of the family Flaviviridae transmitted mainly by mosquitoes of the genus Aedes. Although usually asymptomatic, infection can result in a mild and self-limiting illness characterised by fever, rash, arthralgia, and conjunctivitis. An increase in the number of children born with microcephaly was noted in 2015 in regions of Brazil with high transmission of Zika virus. More recently, evidence has been accumulating supporting a link between Zika virus and microcephaly. Here, we describe findings from three fatal cases and two spontaneous abortions associated with Zika virus infection. In this case series, formalin-fixed paraffin-embedded tissue samples from five cases, including two newborn babies with microcephaly and severe arthrogryposis who died shortly after birth, one 2-month-old baby, and two placentas from spontaneous abortions, from Brazil were submitted to the Infectious Diseases Pathology Branch at the US Centers for Disease Control and Prevention (Atlanta, GA, USA) between December, 2015, and March, 2016. Specimens were assessed by histopathological examination, immunohistochemical assays using a mouse anti-Zika virus antibody, and RT-PCR assays targeting the NS5 and envelope genes. Amplicons of RT-PCR positive cases were sequenced for characterisation of strains. Viral antigens were localised to glial cells and neurons and associated with microcalcifications in all three fatal cases with microcephaly. Antigens were also seen in chorionic villi of one of the first trimester placentas. Tissues from all five cases were positive for Zika virus RNA by RT-PCR, and sequence analyses showed highest identities with Zika virus strains isolated from Brazil during 2015. These findings provide strong evidence of a link between Zika virus infection and different congenital central nervous system malformations, including microcephaly as well as arthrogryposis and spontaneous abortions. None.

Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation

In November, 2015, an epidemic of microcephaly was reported in Brazil, which was later attributed to congenital Zika virus infection. 7830 suspected cases had been reported to the Brazilian Ministry of Health by June 4, 2016, but little is known about their characteristics. We aimed to describe these newborn babies in terms of clinical findings, anthropometry, and survival. We reviewed all 1501 liveborn infants for whom investigation by medical teams at State level had been completed as of Feb 27, 2016, and classified suspected cases into five categories based on neuroimaging and laboratory results for Zika virus and other relevant infections. Definite cases had laboratory evidence of Zika virus infection; highly probable cases presented specific neuroimaging findings, and negative laboratory results for other congenital infections; moderately probable cases had specific imaging findings but other infections could not be ruled out; somewhat probable cases had imaging findings, but these were not reported in detail by the local teams; all other newborn babies were classified as discarded cases. Head circumference by gestational age was assessed with InterGrowth standards. First week mortality and history of rash were provided by the State medical teams. Between Nov 19, 2015, and Feb 27, 2015, investigations were completed for 1501 suspected cases reported to the Brazilian Ministry of Health, of whom 899 were discarded. Of the remainder 602 cases, 76 were definite, 54 highly probable, 181 moderately probable, and 291 somewhat probable of congenital Zika virus syndrome. Clinical, anthropometric, and survival differences were small among the four groups. Compared with these four groups, the 899 discarded cases had larger head circumferences (mean Z scores -1·54 vs -3·13, difference 1·58 [95% CI 1·45-1·72]); lower first-week mortality (14 per 1000 vs 51 per 1000; rate ratio 0·28 [95% CI 0·14-0·56]); and were less likely to have a history of rash during pregnancy (20·7% vs 61·4%, ratio 0·34 [95% CI 0·27-0·42]). Rashes in the third trimester of pregnancy were associated with brain abnormalities despite normal sized heads. One in five definite or probable cases presented head circumferences in the normal range (above -2 SD below the median of the InterGrowth standard) and for one third of definite and probable cases there was no history of a rash during pregnancy. The peak of the epidemic occurred in late November, 2015. Zika virus congenital syndrome is a new teratogenic disease. Because many definite or probable cases present normal head circumference values and their mothers do not report having a rash, screening criteria must be revised in order to detect all affected newborn babies. Brazilian Ministry of Health, Pan American Health Organization, and Wellcome Trust.

Microtia e atresia congênita do canal auditivo em cão: relato de caso

RESUMO Descreve-se o caso de um cão, Pinscher, fêmea de 11 meses de idade, com alteração anatômica da orelha do lado direito. Após avaliação, foi realizado o diagnóstico clínico e o radiográfico de microtia com atresia do canal auditivo do lado direito. Como o animal não apresentava sinais de alterações no sistema vestibular ou otite, optou-se pelo acompanhamento clínico do caso. A microtia, caracterizada pela hipoplasia parcial ou completa da pina, assim como outras anomalias do conduto auditivo, é raramente descrita em medicina veterinária. De acordo com a revisão de literatura realizada, este é o primeiro relato ocorrido no Brasil de um cão com microtia e atresia congênita do canal auditivo sem a associação de síndrome vestibular.

Primary or rescue percutaneous coronary intervention in smokers

ABSTRACT Background Despite the close association between smoking and atherosclerotic disease development, little is known about the clinical characteristics and outcomes related to percutaneous coronary intervention (PCI) in smokers with acute coronary syndrome in Brazil. This study aimed to analyze the clinical, angiographic, and procedural profile, in addition to in-hospital outcomes, in smokers and non-smokers with acute myocardial infarction with ST-segment elevation (STEMI) submitted to primary or rescue PCI. Methods Cross-sectional study of the Central Nacional de Intervencoes Cardiovasculares (CENIC) registry between 2006 and 2016. The study population included patients aged ≥ 18 years who presented with STEMI and were submitted to primary or rescue PCI. Results A total of 20,319 patients were included, of whom 6,880 (34.4%) were smokers. The group of smokers was significantly younger, male, and with a lower prevalence of comorbidities. At angiography, smokers showed greater complexity, with a higher prevalence of thrombi, long lesions or TIMI flow 0/1. During the procedure, smokers received a lower proportion of drug-eluting stents and thrombus aspiration was more frequent, as well as procedural success (94.2% vs. 92.1%; p Conclusions Although the clinical outcomes associated with the PCI were favorable to smokers, the multivariate analysis did not show a protective effect of smoking. Such results are due to differences in clinical and angiographic characteristics between smokers and non-smokers.

Clinical characteristics and long-term progression of young patients with acute coronary syndrome in Brazil

Objective In Brazil, there are few descriptions in the literature on the angiographic pattern and clinical characteristics of young patients with acute coronary syndrome, despite the evident number of cases in the population. The objective of this study was to evaluate which clinical characteristics are most closely related to the acute coronary syndrome in young patients, and what long-term outcomes are in this population.Methods This is a prospective observational study with 268 patients aged under 55 years with acute coronary syndrome, carried out between May 2010 and May 2013. Data were obtained on demographics, laboratory test and angiography results, and the coronary treatment adopted. Statistical analysis was presented as percentages and absolute values.Results Approximately 57% were men and the median age was 50 years (30 to 55). The main risk factors were arterial hypertension (68%), smoking (67%), and dyslipidemia (43%). Typical pain was present in 90% of patients. In young individuals, 25.7% showed ST segment elevation. Approximately 56.5% of patients presented with a single-vessel angiographic pattern. About 7.1% were submitted to coronary bypass surgery, and 42.1% to percutaneous coronary angioplasty. Intrahospital mortality was 1.5%, and the combined event rate (cerebrovascular accident/stroke, cardiogenic shock, reinfarction, and arrhythmias) was 13.8%. After a mean follow-up of 10 months, mortality was 9.8%, while 25.4% of the patients had new ischemic events, and 37.3% required readmission to hospital.Conclusion In the short-term, young patients presented with mortality rates below what was expected when compared to the rates noted in other studies. However, there was a significant increase in the number of events in the 10-month follow-up.

Surveillance of congenital rubella syndrome in Brazil, 1995–2005

In Brazil, routine childhood rubella vaccination was introduced during 1992-2000 and a campaign targeted to women of childbearing age was conducted during 2001-2002 to accelerate control of congenital rubella syndrome (CRS). Surveillance of CRS was implemented in 2000, to detect CRS cases and evaluate impact of rubella vaccination strategies and an elimination goal was established in 2003. National CRS surveillance data were analyzed to describe CRS incidence and positive predictive value (PPV). International standard CRS case definitions were used. Completeness of coverage was estimated by a capture-recapture method using surveillance data and a retrospective study in maternity hospitals. Case detection strategies were evaluated using data from three CRS clusters investigated in Brazil during 1999-2002. In 2001, CRS incidence was 2.3 per 100,000 children <1 year of age and PPV was 18%, decreasing to 0.1 and 4%, respectively, in 2004. No new confirmed or compatible cases of CRS were identified in 2005. Of 2,443 suspected CRS cases reported during 1995-2005, 1,889 (77%) were born during 2000-2005. Of these, 1,486 (79%) had one blood sample for IgM testing; 93% (n =1 ,024) within six months of age. A total of 280 (12%) infants had confirmed or compatible CRS, of which 51% (93/184) had fatal outcome. Completeness of coverage was estimated at 7%. PPV of active case finding (63%) was 4.3-fold greater than follow-up of pregnant women with confirmed rubella (15%). Rubella and CRS incidence have declined dramatically in Brazil demonstrating the impact of national rubella control strategies, and representing surveillance challenges in the end-stage of elimination. High routine rubella vaccination coverage and a high-quality surveillance system will be critical to achieve the elimination goal. Active CRS surveillance at maternity and referral tertiary hospitals is recommended.

Characteristics relating to the interiorization of acquired immunodeficiency syndrome in Brazil: a cross-sectional study.

BackgroundIn recent years there has been changes in the social and geographic profile of acquired immunodeficiency syndrome (AIDS). The aim of this study was to evaluate the internalization of AIDS in the state of Rondônia, Brazil.FindingsIn Rondônia, 1473 AIDS cases were reported, with an average annual incidence of 15.8/100,000 persons (42.7 % women). The most common mode of viral transmission was sexual (96.5 %), and the majority of the individuals had not completed their primary education (64.8 %). There was heterogeneity in relation to case distribution, involving almost all of the municipalities in the state. The average annual mortality rate was 2.5/100,000 persons.ConclusionRondônia has a higher incidence of AIDS than the national average and the northern region. Efforts to provide access to treatment and follow-up of these individuals should be implemented, prioritizing areas where the incidence is higher and decentralizing the treatment of patients with AIDS in the state.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-015-0060-2) contains supplementary material, which is available to authorized users.

Risk Factors for Development of Children with Down Syndrome in Brazil

The study of risk factors that affect the development of children with Down syndrome (DS) has been the main subject of several studies. In the Brazilian context, the development of instruments to identify such risks is still a challenge. The current study had the objective of examining the characteristics of a diagnostic organizer instrument which detects risk factors for development. The study was conducted in a clinic that offers services to children with DS in a Public Hospital in Curitiba, Brazil—and 15 parents of children from 0 - 8 years with DS that use the ambulatory service were interviewed, while the children’s medical records were also consulted. With the use of the Organization Diagnostic for Early Intervention (ODAP (GAT, 2008)), current and past conditions of child development as well as risk factors were evaluated. The research provided an organization of diagnostic, identifying cumulative risks factors for child development with emphasis on biological and environmental factors, and revealed vulnerabilities. The study provided a comprehensive understanding about the influence of the risk factors to development, as well as informing the development of strategies for intervention to enhance protective factors and promote positive child development and higher quality in family and social relationships.

Enhancing the cross-cultural adaptation and validation process: linguistic and psychometric testing of the Brazilian–Portuguese version of a self-report measure for dry eye

ObjectivesTo provide a reliable, validated, and culturally adapted instrument that may be used in monitoring dry eye in Brazilian patients and to discuss the strategies for the enhancement of the cross-cultural adaptation and validation process of a self-report measure for dry eye. MethodsThe cross-cultural adaptation process (CCAP) of the original Ocular Surface Disease Index (OSDI) into Brazilian–Portuguese was conducted using a 9-step guideline. The synthesis of translations was tested twice, for face and content validity, by different subjects (focus groups and cognitive interviews). The expert committee contributed on several steps, and back translations were based on the final rather than the prefinal version. For validation, the adapted version was applied in a prospective longitudinal study to 101 patients from the Dry Eye Clinic at the General Hospital of the University of São Paulo, Brazil. Simultaneously to the OSDI, patients answered the short form-36 health survey (SF-36) and the 25-item visual function questionnaire (VFQ-25) and underwent clinical evaluation. Internal consistency, test–retest reliability, and measure validity were assessed. ResultsCronbach's alpha value of the cross-culturally adapted Brazilian–Portuguese version of the OSDI was 0.905, and the intraclass correlation coefficient was 0.801. There was a statistically significant difference between OSDI scores in patients with dry eye (41.15 ± 27.40) and without dry eye (17.88 ± 17.09). There was a negative association between OSDI and VFQ-25 total score (P < 0.01) and between the OSDI and five SF-36 domains. OSDI scores correlated positively with lissamine green and fluorescein staining scores (P < 0.001) and negatively with Schirmer test I and tear break-up time values (P < 0.001). ConclusionAlthough most of the reviewed guidelines on CCAP involve well-defined steps (translation, synthesis/reconciliation, back translation, expert committee review, pretesting), the proposed methodological steps have not been applied in a uniform way. The translation and adaptation process requires skill, knowledge, experience, and a considerable investment of time to maximize the attainment of semantic, idiomatic, experiential, and conceptual equivalence between the source and target questionnaires. A well-established guideline resulted in a culturally adapted Brazilian–Portuguese version of the OSDI, tested and validated on a sample of Brazilian population, and proved to be a valid and reliable instrument for assessing patients with dry eye syndrome in Brazil.

Prevalence of metabolic syndrome among workers from the Company of Generation and Distribution of Energy in Rio de Janeiro, Brazil

Little is known about the prevalence of metabolic syndrome in the World’s working force. We examined the prevalence of such disease in the Company of Generation and Distribution of Energy in Rio de Janeiro city, Brazil.METHODS: A cross-sectional study was designed to analyze data from employees submitted to the annual company medical check-up in 2008. Medical charts were reviewed for collection of clinical and laboratorial information.RESULTS: The total prevalence of metabolic syndrome was 48.6% (95%CI 46.0-51.2). It increased with age and reached 58.7% (95%CI 56.1-61.3) in employees older than 60 years. The age- adjusted prevalence was 38.2% (95%CI 35.7-40.7). Increased waist circumference was the most prevalent component of the syndrome (94.2%; 95%CI 92.1-95.7), followed by high blood pressure (69.3%; 95%CI 65.7-72.7). In a multivariate analysis age, sedentary lifestyle and level of uric acid were significantly associated with the metabolic syndrome.CONCLUSION: Metabolic syndrome is highly prevalent in the studied working population in Rio de Janeiro. Our study will help delineating key risk factors for the development of metabolic syndrome in Brazil and may help the creation of new preventive public health policies.

Key-Gaskell syndrome in Brazil: first case report

Feline dysautonomia is a devastating disease characterized by neuronal degeneration in autonomic ganglia that results in clinical signs related to dysfunction of the sympathetic and parasympathetic nervous systems. The cause is unknown and this disease has a poor prognosis and no definitive treatment. Most reports have been described in few countries around the world, but the prevalence may be underestimated in countries like Brazil. This study describes the progression and clinicopathological changes of dysautonomia in a 17-month-old female Brazilian shorthair cat.

AB0580 Clinical and Epidemiological Features and Management of BehÇEt Disease in A Brazilian Tertiary Hospital

BackgroundBehçet disease (BD) is prevalent in Central and East Asia and in the Eastern Mediterranean area where most studies have been performed. Although BD is one of the most common...

Twenty years of hantavirus pulmonary syndrome in Brazil: a review of epidemiological and clinical aspects

Hantavirus infection is transmitted to humans by wild rodents and the most common clinical form in Brazil is the Hantavirus Pulmonary Syndrome (HPS). The first serological evidence of the disease was identified in 1990, in Recife, Pernambuco State, and later in 1993 in Juquitiba, State of São Paulo. Since then there has been a progressive increase in case notification in all regions of the country. The clinical aspects of the disease in Brazil are characterized by a prodromal phase, with nonspecific signs and symptoms of an acute febrile illness. After about three days, respiratory distress develops, accompanied by dry cough that turns progressively productive, evolving to dyspnea and respiratory failure with cardiogenic shock. Although the majority of patients receive hospital care in intensive care therapy units, case-fatality rate in Brazil ranges from 33% to 100% depending on the region. Besides it has to be added the problem of differential diagnosis with other prevalent diseases in the country, like dengue and leptospirosis. Questions about the impact of uncontrolled urbanization and other environmental changes caused by human action have been raised. Due to increasing incidence and high case-fatality, there is an urge to respond to such questions to recommend preventative measures. This article aims to review the main acquisitions in clinical and epidemiological knowledge about HPS in Brazil in the last twenty years.

Regional variations and time trends of hantavirus pulmonary syndrome in Brazil

Hantavirus pulmonary syndrome (HPS) is a zoonosis and a public health concern in the Americas due to its high fatality rate. Since the first cases were identified in USA in 1993, HPS has been observed over a wide area of the American continents. Over 1600 HPS cases have been confirmed in Brazil since 1993, and different genotypes of hantavirus have been identified in several biomes in this country of continental dimensions. We performed a retrospective study of data from 2001 to 2011 that encompassed all notified cases of HPS in the National Disease Notification System (SINAN) of Brazil to determine the regional differences and temporal trends of the disease. During the study period, 1486 cases were reported, and analyses of the temporal trends of the disease revealed that the number of cases in Brazil increased over this period (P < 0·01). The frequency distributions of the cases stratified by region revealed different patterns of seasonality; however, these patterns were not statistically significant with the exception of the South region (P < 0·05). We found regional differences in the occurrence of the disease throughout the year and a trend towards an increasing number of cases. These findings reinforce the necessity of adjusting surveillance tools and control policies to respond effectively to this public health problem.

The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis.

Objective To analyze the cost-utility of using extracorporeal oxygenation for patients with severe acute respiratory distress syndrome in Brazil.Methods A decision tree was constructed using databases from previously published studies. Costs were taken from the average price paid by the Brazilian Unified Health System (Sistema Único de Saúde; SUS) over three months in 2011. Using the data of 10,000,000 simulated patients with predetermined outcomes and costs, an analysis was performed of the ratio between cost increase and years of life gained, adjusted for quality (cost-utility), with survival rates of 40 and 60% for patients using extracorporeal membrane oxygenation.Results The decision tree resulted in 16 outcomes with different life support techniques. With survival rates of 40 and 60%, respectively, the increased costs were R$=-301.00/-14.00, with a cost of R$=-30,913.00/-1,752.00 paid per six-month quality-adjusted life-year gained and R$=-2,386.00/-90.00 per quality-adjusted life-year gained until the end of life, when all patients with severe ARDS were analyzed. Analyzing only patients with severe hypoxemia (i.e., a ratio of partial oxygen pressure in the blood to the fraction of inspired oxygen <100mmHg), the increased cost was R$=-5,714.00/272.00, with a cost per six-month quality-adjusted life-year gained of R$=-9,521.00/293.00 and a cost of R$=-280.00/7.00 per quality-adjusted life-year gained.Conclusion The cost-utility ratio associated with the use of extracorporeal membrane oxygenation in Brazil is potentially acceptable according to this hypothetical study.

Cognitive assessment in an elderly population with metabolic syndrome in Brazil.

Chronic degenerative conditions are very common in the elderly. According to medical literature, there is a correlation between cognitive impairment among elders and arterial hypertension/hyperglycemia which in turn are common diseases among the elderly population worldwide. Nonetheless, data on the association between cognitive impairment and Metabolic Syndrome (MetS) remains controversial.OBJECTIVETo compare the cognitive status of Brazilian elderly outpatients with and without MetS.METHODSA cross-sectional case-control study with 49 subjects (25 MetS and 24 controls) who underwent a global geriatric and neuropsychological assessment was carried out. The scores for cognitive abilities (sustained attention, alternating attention, immediate memory, working memory, memory - immediate recall, memory - delayed recall, memory - recognition, executive function, ideomotor praxis, constructive praxis, naming ability, verbal fluency) were compared with the data for the normal population and differences between case and control groups were analyzed using Student's t-test or the Mann-Whitney test.RESULTSForty-five patients (91.8%) were female, with a mean age of 73.9±5.9 years, and 3.0±1.0 years of schooling. A significant difference (p<0.01) was found between case and control groups regarding the MetS components. For cognitive abilities, no statistically significant difference was detected between the groups and all subjects presented low cognitive scores.CONCLUSIONThe results obtained in the present study showed that MetS was not associated with cognitive impairment in this population. Further prospective studies are necessary to investigate the influence of well-controlled MetS on cognitive performance among elders.