Comorbidity adjustment index for the international classification of diseases, 10

OBJECTIVE: To develop a Charlson-like comorbidity index based on clinical conditions and weights of the original Charlson comorbidity index. METHODS: Clinical conditions and weights were adapted from the International Classification of Diseases, 10th revision and applied to a single hospital admission diagnosis. The study included 3,733 patients over 18 years of age who were admitted to a public general hospital in the city of Rio de Janeiro, southeast Brazil, between Jan 2001 and Jan 2003. The index distribution was analyzed by gender, type of admission, blood transfusion, intensive care unit admission, age and length of hospital stay. Two logistic regression models were developed to predict in-hospital mortality including: a) the aforementioned variables and the risk-adjustment index (full model); and b) the risk-adjustment index and patient's age (reduced model). RESULTS: Of all patients analyzed, 22.3% had risk scores >1, and their mortality rate was 4.5% (66.0% of them had scores >1). Except for gender and type of admission, all variables were retained in the logistic regression. The models including the developed risk index had an area under the receiver operating characteristic curve of 0.86 (full model), and 0.76 (reduced model). Each unit increase in the risk score was associated with nearly 50% increase in the odds of in-hospital death. CONCLUSIONS: The risk index developed was able to effectively discriminate the odds of in-hospital death which can be useful when limited information is available from hospital databases.

Clinical and epidemiological features of AIDS/tuberculosis comorbidity

Considering the relevance of AIDS/tuberculosis comorbidity worldwide, especially in Brazil, this study was developed to describe the clinical and epidemiological features of the comorbid cases identified from 1989 to 1997 by the epidemiology service of the Hospital das Clínicas of the Universidade de São Paulo. METHODS: Databases containing information on all identified AIDS/tuberculosis cases cared for at the hospital were used to gather information on comorbid cases. RESULTS: During the period, 559 patients were identified as presenting with AIDS/tuberculosis comorbidity. Risk behavior for AIDS was primarily heterosexual contact (38.9%), followed by intravenous drug use (29.3%) and homosexual/bisexual contact (23.2%). Regarding clinical features, there were higher rates of extrapulmonary tuberculosis when compared to tuberculosis without comorbidity. There was an increase in reporting of AIDS by ambulatory units during the period. Epidemiologically, there was a decrease in the male/female ratio, a predominance in the 20 to 39 year-old age group, and a majority of individuals who had less than 8 years of schooling and had low professional qualifications. CONCLUSIONS: High rates of AIDS/tuberculosis cases at our hospital indicate the need for better attention towards early detection of tuberculosis, especially in its extrapulmonary form. Since the population that attends this hospital tends to be of a lower socioeconomic status, better management of AIDS and tuberculosis is required to increase the rates of treatment adherence and thus lower the social costs.

Genetic gains in physic nut using selection indexes

The objective of this work was to estimate genetic gains in physic nut (Jatropha curcas) using selection indexes and to establish the best selection strategy for the species. Direct and indirect selection was carried out using different selection indexes, totalizing 14 strategies. One hundred and seventy five families from the active germplasm bank of Embrapa Agroenergy, Brasília, Brazil, were analyzed in a randomized complete block design with two replicates. The evaluated traits were: grain yield; seeds per fruit; endosperm/seed ratio; seed weight, length, width, and thickness; branches per plant at 0.5, 1.0, and 1.5 m; plant height; stem diameter; canopy projection on rows and between lines; canopy volume; juvenility (days to the first flowering); and height of the first inflorescence. Evaluations were done during the second year of cultivation. The use of selection indexes is relevant to maximize the genetic gains in physic nut, favoring a better distribution of desirable traits. The multiplicative and restrictive indexes are considered the most promising for selection.

Differential responses of nematode communities to soybean genotypes resistant and susceptible to Heterodera glycines race 3

Heterodera glycines and Helicotylenchus dihystera were the two most abundant plant-parasitic nematodes found in two H. glycines race 3-infested fields, Chapadão do Céu, MS and Campo Alegre, MG. These fields had been planted with resistant (R) and susceptible (S) plants to cyst nematodes. In the first field, soybean (Glycine max) FT-Cristalina (S) was susceptible to H. glycines but resistant to H. dihystera, while GOBR93 122243 (R) was just the opposite. In the second field, M-Soy 8400 (R) was more resistant to the spiral nematode than M-Soy8411 (S), but the resistance to the cyst nematode was not different between the two genotypes. The total abundance of nematodes was not different between the susceptible and resistant plants in the two fields, suggesting that H. dihystera and/or bacterial feeders and other trophic groups replaced the reduced abundance of the cyst nematodes in resistant plants. Bacterial feeders acted as a compensatory factor to plant-parasitic nematodes in ecological function. The populations of fungal feeders were higher in GOBR93 122243 (R) than in susceptible FT-Cristalina (S) in Chapadão do Céu, but lower in M-Soy 8400 (R) than in M-Soy 8411 (S) in Campo Alegre. This is being attributed to the different periods of soil samplings that were made at the florescent period in the first field, and at the final growing cycle in the second field. Only four nematodes, H. glycines, H. dihystera, Acrobeles sp. and Panagrolaimus sp. dominated the nematode resistant community GOBR93 122243 (R) in Chapadão do Céu, but dominance was shared by ten genera in Campo Alegre, which explains why the five diversity indexes (S, d, Ds, H' and T) were higher in resistant plants than in susceptible plants in field two.

Chemical indexes calculated for 8,11,13-trien-abietane diterpenoids isolated from Swartzia species

The disparity found in the molecular structures of compounds isolated from nine plants of the Swartzia genus indicates that the Swartzia species that furnished cassane diterpenoids and triterpenoidal saponins are more recent, since these metabolites have adopted the mevalonic acid route of formation, abandoning the shikimic acid/acetate route that produces the isoflavonoids found in the remaining species. Chemical indexes calculated from the molecular structure diversities of sixteen 8,11,13-trien-abietane diterpenoids isolated from Swartzia langsdorffii and S. arborescens indicate that S. arborescens is more recent than S. langsdorffii. The results suggest a more evolved position in Swartzia species of the section Possira.

The relationship between anxiety and depression in animal models: a study using the forced swimming test and elevated plus-maze

The present study evaluated the correlation between the behavior of mice in the forced swimming test (FST) and in the elevated plus-maze (PM). The effect of the order of the experiments, i.e., the influence of the first test (FST or PM) on mouse behavior in the second test (PM or FST, respectively) was compared to handled animals (HAND). The execution of FST one week before the plus-maze (FST-PM, N = 10), in comparison to mice that were only handled (HAND-PM, N = 10) in week 1, decreased % open entries (HAND-PM: 33.6 ± 2.9; FST-PM: 20.0 ± 3.9; mean ± SEM; P<0.02) and % open time (HAND-PM: 18.9 ± 3.3; FST-PM: 9.0 ± 1.9; P<0.03), suggesting an anxiogenic effect. No significant effect was seen in the number of closed arm entries (FST-PM: 9.5 (7.0-11.0); HAND-PM: 10.0 (4.0-14.5), median (interquartile range); U = 46.5; P>0.10). A prior test in the plus-maze (PM-FST) did not change % immobility time in the FST when compared to the HAND-FST group (HAND-FST: 57.7 ± 3.9; PM-FST: 65.7 ± 3.2; mean ± SEM; P>0.10). Since these data suggest that there is an order effect, the correlation was evaluated separately with each test sequence: FST-PM (N = 20) and PM-FST (N = 18). There was no significant correlation between % immobility time in the FST and plus-maze indexes (% time and entries in open arms) in any test sequence (r: -0.07 to 0.18). These data suggest that mouse behavior in the elevated plus-maze is not related to behavior in the forced swimming test and that a forced swimming test before the plus-maze has an anxiogenic effect even after a one-week interval.

Smoking and psychiatric disorders: a comorbidity survey

Epidemiological and clinical studies have shown a positive correlation between smoking and psychiatric disorders. To investigate the prevalence of cigarette smoking, 277 psychiatric outpatients with anxiety or depressive disorders (DSM-IV) answered a self-evaluation questionnaire about smoking behavior and were compared with a group of 68 control subjects. The diagnoses (N = 262) were: 30.2% (N = 79) major depressive disorder, 23.3% (N = 61) panic disorder, 15.6% (N = 41) social anxiety disorder, 7.3% (N = 19) other anxiety disorders, and 23.7% (N = 62) comorbidity disorders. Among them, 26.3% (N = 69) were smokers, 23.7% (N = 62) were former smokers and 50.0% (N = 131) were nonsmokers. The prevalence of nicotine dependence among the smokers was 59.0% (DSM-IV). The frequency of cigarette smoking did not show any significant difference among the five classes of diagnosis. The social anxiety disorder patients were the heaviest smokers (75.0%), with more unsuccessful attempts to stop smoking (89.0%). The frequency of former smokers was significantly higher among older subjects and nonsmokers were significantly younger (c² = 9.13, d.f. = 2, P = 0.01). Our data present some clinical implications suggesting that in our psychiatric outpatient sample with anxiety disorder, major depression and comorbidity (anxiety disorder and major depression), the frequency of cigarette smoking did not differ from the frequency found in the control group or in general population studies. Some specific features of our population (outpatients, anxiety and depressive disorders) might be responsible for these results.

Headache complaints associated with psychiatric comorbidity in a population-based sample

The objective of the present study was to determine the frequency at which people complain of any type of headache, and its relationship with sociodemographic characteristics and psychiatric comorbidity in São Paulo, Brazil. A three-step cluster sampling method was used to select 1,464 subjects aged 18 years or older. They were mainly from families of middle and upper socioeconomic levels living in the catchment area of Instituto de Psiquiatria. However, this area also contains some slums and shantytowns. The subjects were interviewed using the Brazilian version of the Composite International Diagnostic Interview version 1.1. (CIDI 1.1) by a lay trained interviewer. Answers to CIDI 1.1 questions allowed us to classify people according to their psychiatric condition and their headaches based on their own ideas about the nature of their illness. The lifetime prevalence of "a lot of problems with" headache was 37.4% (76.2% of which were attributed to use of medicines, drugs/alcohol, physical illness or trauma, and 23.8% attributed to nervousness, tension or mental illness). The odds ratio (OR) for headache among participants with "nervousness, tension or mental illness" was elevated for depressive episodes (OR, 2.1; 95%CI, 1.4-3.4), dysthymia (OR, 3.4; 95%CI, 1.6-7.4) and generalized anxiety disorder (OR, 4.3; 95%CI, 2.1-8.6), when compared with patients without headache. For "a lot of problems with" headaches attributed to medicines, drugs/alcohol, physical illness or trauma, the risk was also increased for dysthymia but not for generalized anxiety disorder. These data show a high association between headache and chronic psychiatric disorders in this Brazilian population sample.

Evaluation of chromosomal abnormalities by cIg-FISH and association with proliferative and apoptotic indexes in multiple myeloma

Eighty-six newly diagnosed multiple myeloma (MM) patients from a public hospital of São Paulo (Brazil) were evaluated by cIg-FISH for the presence of del(13)(q14), t(4;14)(p16.3;q32) and del(17)(p13). These abnormalities were observed in 46.5, 9.3, and 7.0% of the patients, respectively. In order to identify the possible role of del(13)(q14) in the physiopathology of MM, we investigated the association between this abnormality and the proliferative and apoptotic indexes of plasma cells. When cases demonstrating t(4;14)(p16.3;q32) and del(17)(p13) were excluded from the analysis, we observed a trend towards a positive correlation between the proportion of cells carrying del(13)(q14) and plasma cell proliferation, determined by Ki-67 expression (r = 0.23, P = 0.06). On the other hand, no correlation between the proportion of cells carrying del(13)(q14) and apoptosis, determined by annexin-V staining, was detected (r = 0.05, P = 0.69). In general, patients carrying del(13)(q14) did not have lower survival than patients without del(13)(q14) (P = 0.15), but patients with more than 80% of cells carrying del(13)(q14) showed a lower overall survival (P = 0.033). These results suggest that, when del(13)(q14) is observed in a high proportion of malignant cells, it may have a role in determining MM prognosis. Another finding was a statistically significant lower overall survival of patients with t(4;14)(p16.3;q32) (P = 0.026). In the present study, almost half the patients with t(4;14)(p16.3;q32) died just after diagnosis, before starting treatment. This fact suggests that, in São Paulo, there may be even more patients with this chromosomal abnormality, but they probably die before being diagnosed due to unfavorable socioeconomic conditions. This could explain the low prevalence of this chromosomal abnormality observed in the present study.

Linfoma não-Hodgkin envolvendo tonsila palatina: relato de 3 casos

O objetivo deste trabalho consiste em relatar três casos de linfoma não-Hodgkin (LNH) com acometimento de tonsilas palatinas acompanhados no Hospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ), com pequena revisão de literatura. Os LNH acometem sítios extra-nodais em 25-30% dos casos. Dos casos extra-nodais, 10-30% acometem cabeça e pescoço. Destes casos de LNH em cabeça e pescoço, 60-70% estão presentes no anel de Waldeyer, e deste grupo, algumas séries relatam que 80% encontram-se na tonsila palatina. Concluímos, portanto, que o acometimento das tonsilas pelo LNH constitui uma apresentação incomum desta malignidade hematológica, que merece atenção e destaque para que seja feito diagnóstico precoce, seguido de tratamento e acompanhamento corretos.

Síndrome do aqueduto vestibular alargado: relato de 3 casos e revisão bibliográfica

A Síndrome do Aqueduto Vestibular Alargado (SAVA) é caracterizada por um alargamento do aqueduto vestibular associado a uma perda auditiva neurossensorial, algumas vezes mista, que pode ser congênita ou adquirida na infância. A disacusia pode ser dividida em leve, moderada ou profunda, associada com períodos de melhora ou de piora súbita. O alargamento do aqueduto vestibular é a anomalia da orelha interna mais comum. A SAVA é admitida como resultado de uma anormalidade genética no desenvolvimento do aqueduto vestibular anterior à quinta semana de gestação. A incidência de SAVA está entre 1% e 1,3%, podendo chegar a 7% dependendo da população examinada. O objetivo deste estudo é relatar 3 casos de SAVA atendidos no Núcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de São Paulo e no serviço de Radiologia do Hospital São Camilo - São Paulo, sendo que dois pacientes são irmãos somente por parte materna. Dois pacientes eram do sexo feminino, um do sexo masculino e a idade variou de 9 a 30 anos. O método diagnóstico de eleição é a TC de osso temporais. A conduta para os casos foi o tratamento conservador com ressalva a cuidados como traumatismos cranianos, barotraumas e, quando necessário, uso de próteses auditivas.

Enraizamento adventício de estacas do maracujazeiro silvestre Passiflora mucronata Lam.: forma de veiculação e concentrações do ácido indol-3-butírico

Passiflora mucronata Lam. apresenta como características ser ornamental, medicinal e resistente à bacteriose nas folhas, além de ser altamente resistente à antracnose nos frutos e ramos. Objetivou-se, com este trabalho, avaliar a forma de veiculação, líquida ou sólida, e as concentrações do ácido indol-3-butírico (AIB) no enraizamento adventício de estacas de P. mucronata. O experimento foi conduzido no delineamento de blocos ao acaso, em esquema fatorial 2x5 (formas de veiculação do AIB: líquida e sólida x concentrações de AIB: 0; 250; 500; 750 e 1000 mg L-1, se líquido, ou mg Kg-1, se sólido), com quatro repetições, de 16 estacas cada. As características avaliadas foram enraizamento (%), número de raiz, comprimento da maior raiz (cm), volume de raiz (cm³) e massa de matéria seca de raiz (g). Verificou-se que o enraizamento de estacas de P. mucronata Lam. independe da forma como é veiculado o AIB, se sólida ou líquida, porém a qualidade do sistema radicular, avaliada por meio do número, volume e massa de matéria seca de raízes, foi superior à obtida ao se empregar o AIB sólido. O comportamento do enraizamento, do número e do comprimento de raízes foi linear crescente, até a máxima concentração de AIB (1000 mg L-1 ou mg Kg-1).