Clinical Hospital of Porto Alegre

Porto Alegre, Brazil

Clinical Hospital of Porto Alegre

Porto Alegre, Brazil

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Kuchenbecker R.S.,Federal University of Rio Grande do Sul | Pilger K.O.,Clinical Hospital of Porto Alegre | Pagano M.,Federal University of Rio Grande do Sul | Barth A.L.,Federal University of Rio Grande do Sul | Barth A.L.,Clinical Hospital of Porto Alegre
American Journal of Infection Control | Year: 2012

Background: Most published data on multidrug-resistant Acinetobacter baumanii (MDR Ab) are derived from outbreaks. We report incidence trends on health care-acquired infections due to MDR Ab over a 12-month period in the city of Porto Alegre in southern Brazil. Methods: Clinical and epidemiologic data were obtained from the local health care information system of the municipal health department. Polymerase chain reaction was used to detect the presence of the genes blaOXA-23-like, blaOXA-24-like, bla OXA-51, and blaOXA-58, and repetitive sequence-based polymerase chain reaction and pulsed-field gel electrophoresis were performed for molecular typing. Results: The highest rate of infection (9.0/1,000 inpatient-days) was identified in a trauma hospital. The gene bla OXA-23-like was identified in 99.0% of MDR Ab isolates. Eight main clonal groups were identified by molecular typing, and 3 of these were found in all hospitals. Conclusion: The presence of 3 clones in all hospitals demonstrates the ability of MDR Ab to spread among hospitals. Moreover, the occurrence of one particular clone (clone 4) throughout the study period suggests its increased ability to cause outbreaks and to remain in the environment. The monitoring of epidemic strains by molecular methods is of paramount importance to prevent or reduce the spread of MDR Ab. © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.


PubMed | Federal University of Campina Grande, Federal University of Sergipe, Santa Casa Hospital, State University Londrina and 21 more.
Type: | Journal: Diabetology & metabolic syndrome | Year: 2015

In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities.This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected.We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.630 and 70.419, respectively; p<0.05). In addition, North-Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.530.6; Southeast: 1.650.7; South: 1.720.7; Midwest: 1.670.7; p<0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined.Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities.


PubMed | Federal University of Campina Grande, Childrens Hospital Albert Sabin, Childrens Hospital Juvencio Mattos, Federal University of São Carlos and 5 more.
Type: Journal Article | Journal: European journal of medical research | Year: 2016

Pycnodysostosis is an autosomal recessive skeletal dysplasia, the prevalence of which is estimated to be low (1 per million). Nevertheless, in recent years we have found 27 affected individuals from 22 families in Cear State, a region of the Brazilian Northeast, giving a local prevalence of 3 per million. This local prevalence associated with a high parental consanguinity, suggesting a possible founder effect, prompted us to perform a molecular investigation of these families to test this hypothesis.The CTSK gene was sequenced by the Sanger method in the patients and their parents. In addition to 18 families from Cear, this study also included 15 families from other Brazilian regions. We also investigated the origin of each family from the birthplace of the parents and/or grandparents.We have studied 39 patients, including 33 probands and 6 sibs, from 33 families with pycnodysostosis and identified six mutations, five previously described (c.436G>C, c.580G>A, c.721C>T, c.830C>T and c.953G>A) and one novel frameshift (c.83dupT). This frameshift variant seems to have a single origin in Cear State, since the haplotype study using the polymorphic markers D1S2344, D1S442, D1S498 and D1S2715 suggested a common origin. Most of the mutations were found in homozygosity in the patients from Cear (83.3%) while in other states the mutations were found in homozygosity in half of patients. We have also shown that most of the families currently living outside of Cear have northeastern ancestors, suggesting a dispersion of these mutations from the Brazilian Northeast.The high frequency of pycnodysostosis in Cear State is the consequence of the high inbreeding in that region. Several mutations, probably introduced a long time ago in Cear, must have spread due to consanguineous marriages and internal population migration. However, the novel mutation seems to have a single origin in Cear, suggestive of a founder effect.


Vidor L.P.,Federal University of Rio Grande do Sul | Torres I.L.S.,Institute of Basic Health science | Torres I.L.S.,Federal University of Rio Grande do Sul | De Souza I.C.C.,Clinical Hospital of Porto Alegre | And 5 more authors.
Journal of Pain and Symptom Management | Year: 2013

Context. The association between myofascial temporomandibular disorder (TMD) and nonrestorative sleep supports the investigation of therapies that can modulate the sleep/wake cycle. In this context, melatonin becomes an attractive treatment option for myofascial TMD pain. Objectives. To investigate the effects of melatonin on pain (primary aim) and sleep (secondary aim) as compared with placebo in a double-blind, randomized, parallel-group trial. Methods. Thirty-two females, aged 20e40 years, with myofascial TMD pain were randomized into placebo or melatonin (5 mg) treatment groups for a period of four weeks. Results. There was a significant interaction (time vs. group) for the main outcomes of pain scores as indexed by the visual analogue scale and pressure pain threshold (analysis of variance; P < 0.05 for these analyses). Post hoc analysis showed that the treatment reduced pain scores by ©44% (95% CI ©57%, ©26%) compared with placebo, and it also increased the pressure pain threshold by 39% (95% CI 14%, 54%). The use of analgesic doses significantly decreased with time (P < 0.01). The daily analgesic doses decreased by ©66% (95% CI ©94%, ©41%) when comparing the two groups. Additionally, melatonin improved sleep quality, but its effect on pain was independent of the effect on sleep quality. Conclusion. This study provides additional evidence supporting the analgesic effects of melatonin on pain scores and analgesic consumption in patients with mild-to-moderate chronic myofascial TMD pain. Furthermore, melatonin improves sleep quality but its effect on pain appears to be independent of changes in sleep quality. J Pain Symptom Manage 2013;46:422e432. © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.


Mainieri V.C.,Pontifical Catholic University of Rio Grande do Sul | Saueressig A.C.,Pontifical Catholic University of Rio Grande do Sul | Marcos Pascoal Pattussi,University of the Rio dos Sinos Valley | Fagondes S.C.,Clinical Hospital of Porto Alegre | Grossi M.L.,Pontifical Catholic University of Rio Grande do Sul
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology | Year: 2012

Objective. This validation study compared an electromyography (EMG) device, Bitestrip, versus polysomnography in the diagnosis of sleep bruxism (SB). Study design. Forty-nine consecutive patients (32 women and 17 men, 41.2 ± 12.9 years old) with a clinical history of SB were included in the study from the Orofacial Pain Clinic, Faculty of Dentistry, Pontifical Catholic University of Rio Grande do Sul in Brazil. Results. Initially, we compared an SB positive/negative test result for both systems (agreement 87.8%, sensitivity 84.2%, positive predictive value 100%, and crude kappa 0.71). We then compared a 4-scale test (no, light, moderate, or severe bruxism) between the 2 methods (agreement 80.27%, weighted kappa 0.51, and Kendall W coefficient 0.575). Conclusions. The Bitestrip can be considered as a moderate screening method for the diagnosis of SB, because it is more precise in detecting the presence or absence of SB but less precise in detecting its intensity. © 2012 Elsevier Inc. All rights reserved.


Rodrigues T.C.,University of Colorado at Denver | Rodrigues T.C.,Clinical Hospital of Porto Alegre | Ehrlich J.,University of Colorado at Denver | Hunter C.M.,University of Colorado at Denver | And 3 more authors.
Diabetes Technology and Therapeutics | Year: 2010

Aim: Reduced heart rate variability (HRV) is a manifestation of cardiac autonomic neuropathy, a known complication of type 1 diabetes (T1D). We evaluated whether HRV predicted coronary artery calcium (CAC) progression. Methods: Subjects between 19 and 56 years of age with T1D or those without diabetes from the Coronary Artery Calcification in Type 1 Diabetes study underwent supine deep breathing 12-lead electrocardiograms. The SD of consecutive RR intervals was used as a measure of HRV. CAC was measured at two visits 6.0 ± 0.5 years apart. Progression of CAC was defined as an increase in square root transformed CAC volume of ≥2.5 mm 3, excluding patients who had cardiovascular events during follow-up. Results: Reduced HRV was associated with older age, higher hemoglobin A1c, elevated albuminuria, CAC volume at baseline, and increased fibrinogen. Higher HRV at baseline was associated with lower likelihood CAC progression (odds ratio = 0.71, 95% confidence interval 0.56-0.90, P = 0.005), and the adjustment for known cardiovascular risk factors did not change this strong association, including adjustment for inflammatory markers. Conclusions: Reduced HRV predicted progression of CAC in adults with and without T1D. This association further supports the participation of autonomic neuropathy in the atherosclerosis process. Copyright 2010, Mary Ann Liebert, Inc.


Becker G.F.,Federal University of Rio Grande do Sul | Passos E.P.,Federal University of Rio Grande do Sul | Passos E.P.,Clinical Hospital of Porto Alegre | Moulin C.C.,Federal University of Rio Grande do Sul | Moulin C.C.,Food and Nutrition Research Center
American Journal of Clinical Nutrition | Year: 2015

Background: Obesity is related to hormonal disorders that affect the reproductive system. Low-glycemic index (LGI) diets seem to exert a positive effect on weight loss and on metabolic changes that result from obesity. Objective: We investigated the effects of a hypocaloric diet with an LGI and low glycemic load on anthropometric and metabolic variables, ghrelin and leptin concentrations, and the pregnancy rate in overweight and obese infertile women who were undergoing in vitro fertilization (IVF). Design: The study was a randomized block-design controlled trial in which we analyzed 26 overweight or obese infertile women. Patients were assigned to a hypocaloric LGI-diet group or a control group and followed the protocol for 12 wk. Body weight, body mass index (BMI), percentage of body fat, glucose, insulin, homeostasis model assessment of insulin resistance, serum lipids, reproductive hormones, leptin, acylated ghrelin, number of oocytes retrieved in the IVF cycle, and pregnancy rate were determined. Results: There were greater reductions in body mass, BMI, percentage of body fat, waist:hip ratio, and leptin in the LGI-diet group than in the control group (P , 0.05). Despite a change of 18% in mean values, there was no significant increase in acylated ghrelin concentrations in the LGI group compared with the control group (P = 0.215). The LGIdiet group had 85.4% more oocytes retrieved than did the control group (7.75 6 1.44 and 4.18 6 0.87, respectively; P = 0.039) in the IVF cycle. Three patients (21.4%) in the LGI group experienced a spontaneous pregnancy during the follow-up, which generated 3 live births. Conclusions: The hypocaloric LGI diet promoted a decrease in BMI, percentage of body fat, and leptin concentrations, which improved oocyte development and pregnancy rate. These results support the clinical recommendation to advise overweight and obese women to lose weight through a balanced diet before being submitted for treatment with assisted reproduction technologies. A hypocaloric diet combined with LGI foods seems to be beneficial for these patients, but additional studies are required before this treatment is recommended. This trial was registered at clinicaltrials.gov as NCT02416960. © 2015 American Society for Nutrition.


Da Motta G.D.C.P.,Clinical Hospital of Porto Alegre | Schardosim J.M.,University of Brasilia | Da Cunha M.L.C.,Federal University of Rio Grande do Sul
Journal of Pain and Symptom Management | Year: 2015

Context The Neonatal Infant Pain Scale (NIPS), initially developed in Canada, has been previously used but not adequately adapted and validated for use in Brazil. Objectives The goal of the present study was to perform a cross-cultural adaptation and clinical validation of the NIPS for use in the Brazilian population. Methods The instrument was adapted based on the method outlined by Beaton et al., including the production and combination of translated versions, back-translation, committee review, and pilot testing. The psychometric properties of the adapted instrument, including its validity, reliability, and internal consistency, were tested in a clinical validation study. The sample comprised 60 at-term newborns who were evaluated by six nurses as they experienced vaccination. Psychometric properties were evaluated using Student's t-tests, prevalence-adjusted and bias-adjusted kappa scores, the Bland-Altman method, and Cronbach's alpha coefficients. Results The Brazilian version of the NIPS (Escala de Dor no Recém-Nascido [NIPS-Brazil]) demonstrated excellent interobserver and intraobserver reliability. Total NIPS-Brazil scores yielded prevalence-adjusted and bias-adjusted kappa scores of 0.93, whereas the Bland-Altman method revealed interobserver and intraobserver reliability values of 95% and 90%, respectively. The NIPS-Brazil had adequate internal consistency, as evidenced by a Cronbach's alpha of 0.762. Conclusion The NIPS was successfully adapted for use in Brazil and is now available for use in the assessment of acute pain in at-term newborns in Brazil. © 2015 American Academy of Hospice and Palliative Medicine.


Magalhaes O.A.,Federal University of Rio Grande do Sul | Marinho D.R.,Clinical Hospital of Porto Alegre | Kwitko S.,Clinical Hospital of Porto Alegre
British Journal of Ophthalmology | Year: 2013

Background/aims: The present study aims to identify the rate of rejection and safety of 0.03% tacrolimus eye drops associated with 1% prednisolone in a topical formulation, comparing them with the use of 1% prednisolone eye drops alone in patients with high-risk corneal transplantation. Methods: Retrospective cohort study with 72 patients (72 eyes) who underwent more than one penetrating keratoplasty (PK) in the same eye or had severe chemical burn between 2004 and 2011 in the department of cornea and external disease of the Clinical Hospital of Porto Alegre, Brazil. We compared the records of 36 patients that performed unilateral PK and received only 1% prednisolone eye drops between May 2004 and July 2008, with 36 patients that received 0.03% tacrolimus eye drops in addition to 1% prednisolone between August 2008 and August 2011. Results: The mean follow-up of the group exposed to tacrolimus was 23.1 months and 24.0 in the prednisolone alone group. The demographics, intraoperative and initial indications for first PK were similar between groups, as well as the number of regrafts performed. Intraocular pressure (IOP) was not statistically different among groups. Regarding irreversible rejections, topical tacrolimus showed greater protection: only seven grafts (19.4%) lost transparency against 16 (44.4%) in the 1% prednisolone alone group (p <0.05). Conclusions: Topical 0.03% tacrolimus was effective in preventing irreversible rejection in patients with high-risk corneal transplantation without increasing IOP.

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