Mestrado em Medicina
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- ItemAlterações dermatológicas em pacientes coinfectados cronicamente pelos vírus da Hepatite C e HIV em comparação com pacientes infectados apenas pelo vírus da hepatite C ou HIV atendidos no Hospital Universitário Cassiano Antônio Moraes - Vitória (Espírito Santo) – Brasil(Universidade Federal do Espírito Santo, 2018-08-07) Medeiros, Karina Bittencourt; Diniz, Lucia Martins; Gomes, Maria da Penha Zago; Gonçalves, Luciana Lofego; Cerutti Junior, CrispimBackground: The skin is affected in more than 90% of human immunodeficiency virus patients throughout the disease. And those infected by hepatitis C virus, between 40 and 74% present at least one extrahepatic manifestation in the course of the disease. In studies of cutaneous conditions, there are few data in the literature about incidence, prevalence and clinical specificities in those coinfected with human immunodeficiency virus and hepatitis C virus. Objective: To determine the dermatoses in patients coinfected by hepatitis C virus and human immunodeficiency virus and to compare them with the monoinfected by hepatitis C virus or human immunodeficiency virus. Patients and methods: A cross-sectional, descritive study was performed at the Cassiano Antônio Moraes University Hospital in Vitória (ES) in patients coinfected with hepatitis C virus and human immunodeficiency virus and in the groups infected by human immunodeficiency virus or hepatitis C virus. Skin, oral mucosa and nails were examined in the search for dermatoses and the presence of pruritus was recorded. Results: A total of 134 patients were examined, 31 human immunodeficiency virus/hepatitis C virus coinfected, 62 human immunodeficiency virus infected and 41 hepatitis C virus infected. Compared to human immunodeficiency virus monoinfected individuals, the coinfected group had more cases of dermatoses suggestive of hepatic alterations (OR:3.040, p=0.001) and more cases of dyschromias (OR:2.315, p=0.005). The group infected by HCV infected had more skin infections (OR:2.272, p=0.002) and more cases of dermatoses suggestive of hepatic alterations (OR:2.536, p=0.002) when compared to those coinfected. When evaluating pruritus, the coinfected group showed no difference in compared to the human immunodeficiency virus infected group, but was more present in the hepatitis C virus infected individuals than in those coinfected (OR:1.963, p=0.001). Discussion and conclusion: The coinfected patients were more likely to present dermatoses suggestive of liver disease than those infected with hepatitis C virus or human immunodeficiency virus. Such differance occurs due to hepatic disease itself, aggravated by human immunodeficiency virus coinfection. The coinfected patients had a higher frequency of 14 dyschromia than the human immunodeficiency virus monoinfected group. Pruritus was not significantly different in its frequency in the human immunodeficiency virus monoinfected group compared to coinfected but was more present in the hepatitis C virus monoinfected group, possibly due to human immunodeficiency virus interference in the mechanisms of hepatitis C virus pruritus. Human immunodeficiency virus / hepatitis C virus coinfection predisposed to the increased frequency of infectious dermatoses, dyschromia and cutaneous alterations of liver diseases and contributed to the reduction of cutaneous pruritus. Patients with cutaneous stigmata of hepatic abnormalities, but without pruritus can direct the suspicion towards the double human immunodeficiency virus / hepatitis C virus infection.
- ItemVolumes cortical e subcortical como preditores do desempenho cognitivo em alcoolistas : um estudo de seguimento de 6 anos(Universidade Federal do Espírito Santo, 2017-11-24) Morgado, Adriano Daniel Peres; Nakamura-Palacios, Ester Miyuki; Rosa Júnior Marcos; Pacheco, Felipe TorresAlcohol use has been long proven to result in brain atrophy and cognitive deficiencies, but how changes of specific brain structures would be related to these cognitive changes remains unclear. This study explored changes of gray matter cortical and subcortical volumes of alcoholics after 6-years interval and their relation to changes of frontal executive and global cognitive mental status. Cortical and subcortical segmentation and corrections of magnetic resonance (1.5 T) images acquired in 2010 (T1) and 2016 (T2) from 16 alcoholics (14 males, mean age 49.8 years ± 8.5 SD in T1 and 55.7 years ± 8.4 SD in T2) with long-term use of alcohol (mean of 29.8 to 34.7 years) were performed using FreeSurfer. Results showed global reduction of gray matter volumes and more specifically in brain regions, mostly from prefrontal areas, subcortical structures and cerebellum cortex, highly related to the executive function and drug dependence condition. More importantly, reduction over the 6-year interval of gray matter volumes of right frontal pole (p < .01) and left cerebellar cortex (p < .05) were predictive of changes of frontal executive performance, and reduction of right putamen gray matter volume was predictive (p < .05) of changes of global cognitive mental status in alcoholics. We suggest that combination of volumetric analysis of gray matter from specific brain areas with brief examination of frontal executive and global cognitive mental status over the course of alcohol use may be clinically relevant to determine the degree of executive and cognitive commitment in alcoholism.
- ItemTratamento da toxoplasmose ocular adquirida : revisão sistemática(Universidade Federal do Espírito Santo, 2017-08-19) Lima, Guilherme Sturzeneker Cerqueira; Saraiva, Fábio Petersen; Carvalho, André Correa Maia de; Sarti, Thiago DiasOcular toxoplasmosis, a disease caused by the parasite Toxoplasma gondii, is the most common form of posterior infectious uveitis. Despite the fact that combined anti-parasitic therapy is still the usual practice regarding the treatment of ocular toxoplasmosis, there is no definitive evidence towards its routine necessity. The existence of multiple therapeutic schemes available nowadays has motivated the realization of this study, with the objective of trying to identify elements capable of guiding the physician to perform the best treatment in a case of ocular toxoplasmosis. It was concluded that there is no forceful scientific evidence that proves there is an ideal treatment and that there are no statistically significant differences between the functional outcomes obtained with the different therapeutic schemes employed in the present time.
- ItemEstratégias de troca para segundo imunobiológico na artrite reumatoide : resultados do registro brasileiro de agentes imunobiológicos em doenças reumáticas-BIOBADABRASIL(Universidade Federal do Espírito Santo, 2017-08-21) Falcão, Jansen Giesen; Cristo, Valéria Valim; Zandonade, Eliana; Gavi, Maria Bernadete Renoldi de O.; Hadad, David JamilOBJECTIVE: To compare different strategies of switching to a second biological therapy in Rheumatoid Arthritis (RA) in patients from BIOBADABRASIL register. METHODS: Data from a population-based cohort including 1,109 patients with RA according to American College Rheumatology / European League Against Rheumatism (ACR/EULAR) 2010. Patients were followed from beginning of the first biologic therapy up to 7 years (2009-2015). Sex, age, disease duration, DAS 28 and concomitant treatments at baseline were considered. Kaplan-Meier estimates, Chisquare, Kruskal-Wallis and Wilcoxon-Mann-Whitney tests, Cox regression analysis were applied when appropriate. Results were expressed as mean ± SD and %(n). Small sample size precluded the inclusion of Golimumab (GOLI) and Certolizumab (CERTO) in the survival analysis. RESULTS: From all, 85% were women, mean age of 50 years and disease duration of 11 years. Rheumatoid Factor (RF) was positive in 87%, DAS 28 5.36 ±1.35, 76% using corticoid and 71% taking Methotrexate (MTX). Ninety one percent started AntiTumor Necrosis Factor (Anti-TNF), as followed: Adalimumab (ADA) 33% (370), Infliximab (INF) 32 % (356), Etanercept (ETA) 23% (258), Tocilizumab (TOCI) 3% (35), Golimumab (GOLI) 2% (19), Certolizumabe (CERTO) 1% (9), Abatacept (ABA), 1% (14) e Rituximab (RTX) 4% (48). Considering first treatment, survival of non anti-TNF (58.50 ± 3.46; 95%CI 51.71 – 65.28) was higher than anti-TNF (53.43 ± 1.21; 95%CI 51.05 – 55.77), p=0.042. Tocilimumab (TOCI) showed higher survival (57.22 ± 4.57; 95%CI 48.27 – 66.17) when compared to anti –TNF (53.41±1.21; 95%CI 51.05 – 55.77); p=0.023. Only 32.28% (358) switched to a second biological therapy. 65.92% (236) switched from anti-TNF to anti-TNF (ETA=105, ADA=83, INF=33, others anti-TNF=15); 27,93% (100) switched from anti-TNF to non anti-TNF (RTX=38, TOCI=32, ABA=30) and few 6,13% (22), from non anti-TNF to any class. 336 patients who started using anti-TNF (INF= 140, ADA=120, ETA=69) and switched to a second biological therapy were included for survival analysis. The best switching strategy was from anti-TNF to non anti-TNF: 50.72 ± 3 months (CI95% 44.84-56.60) versus 44.67±2.46 months (CI95% 39.85-49.49), p=0.010. Even using less corticoid and showing higher DAS 28 in the beginning of treatment, patients who changed from anti –TNF to TOCI achieved better survival (55.80 ± 4.74; CI95% 46.51-65.09 months, p=0.029) compared to ETA (50.06 ±3.61; IC 95% 42.99-57.14), RTX (47.75 ± 4.93; CI95% 38.10-57.40), ABA (44.89±5.94; CI95% 33.25-56.53), ADA (39.45±3.89; CI95% 31.83-47.08) and INF (34.43±4.65; CI95% 25.31-43.55). The reasons for switching were inefficacy or loss of efficacy (64%, n = 216), adverse effects (26%, n=87), and others (10%, n = 33). When the reason for switching was adverse effects, the best option was a non antiTNF with 50.29 ± 4.93 months (95%IC=40.62 – 59.95) versus 43.23 ± 4.22 months (95%IC= 34.96 – 51.51), p=0.038. CONCLUSION: The anti-TNF is the most prescribed drugs at BIOBADABRASIL register as first and second biological therapy. The option for a non anti –TNF as first biological therapy showed better survival. Switching from anti-TNF to non anti-TNF was better too. TOCI was the drug with better survival as second biological therapy. The main reason for switching was inefficacy or loss of efficacy. When the reason was adverse effect the best option was switching to non anti –TNF.
- ItemRessonância magnética na avaliação das articulações do pé de pacientes com artrite reumatoide(Universidade Federal do Espírito Santo, 2016-06-24) Rondina, Ronaldo Garcia; Mello, Ricardo Andrade Fernandes de; Rosa Júnior, Marcos; Nacif, Marcelo Souto; Volpato, RichardPurpose: Study the joints of the clinically dominant foot of patients with rheumatoid arthritis by MRI using RAMRIS score and correlate with clinical data regarding disease activity and functional capacity, measured respectively by DAS28 and HAQ scores. Methods: Cross-sectional descriptive study of fifty-five patients diagnosed with RA followed by the rheumatology division of the Hospital Cassiano Antonio Moraes of the Federal University of Espírito Santo between February and December 2014. The patients' clinically dominant foot was assessed by MRI and clinical and laboratory data were collected to measure the DAS28. Results: Our study demonstrated a linear relationship between the degree of joint involvement, measured by the RAMRIS, with the loss of functional capacity, assessed by HAQ questionnaire. There was also a linear relationship between the score that measures disease activity (DAS28) and HAQ. There was no statistical relationship between the degree of joint involvement, measured by RAMRIS, and DAS28. Conclusion: We conclude that the assessment by MRI can document a state of persistently active disease despite clinical remission assessed by DAS28 score.