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Introdução: A peritonite bacteriana espontânea (PBE) é uma das infecções mais frequentes nos pacientes cirróticos, acarretando uma alta morbimortalidade. Métodos: Estudo transversal, retrospectivo, descritivo. Feita revisão dos prontuários de líquidos de ascite com cultura positiva para PBE. Resultados: Os bacilos gram-negativos constituíram 57,1% das culturas positivas, sendo que E. coli foi responsável por 28,5%, seguida por Klebsiella sp. (14,2%). Cocos gram positivos corresponderam a 38% e, destes, os mais incidentes foram Enterococcus sp. (23,8%) e Streptococcus sp. (9,5%). Conclusão: A amostra analisada apresentou maior prevalência de enterococcus em comparação com o descrito na literatura mundial. Devido à mudança do perfil microbiológico, percebe-se a necessidade de uma instituição analisar o seu perfil microbiológico, para melhor assistência aos seus usuários (AU)

Introduction: Spontaneous bacterial peritonitis (SBP) is one of the most common infections in cirrhotic patients, leading to high morbidity and mortality. Methods: Cross-sectional, retrospective, descriptive study. A review of records of ascites fluid with positive culture for SBP was carried out. Results: Gram-negative bacilli constituted 57.1% positive cultures, and E. coli accounted for 28.5%, followed by Klebsiella sp (14.2%). Gram positive cocci accounted for 38%, and of these the most frequent ones were Enterococcus sp. (23.8%) and Streptococcus sp. (9.5%). Conclusion: The sample showed a higher prevalence of enterococci as compared with what is described in world literature. Due to the change in the microbiological profile, we highlight the need for an institution to analyze its microbiological profile, for better assistance to its members (AU)

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Introdução: A hepatite crônica pelo vírus da Hepatite C (VHC) é um importante problema de saúde pública mundial, acometendo cerca de 3% da população mundial, e que somente 22% destas saibam de seu diagnóstico. Métodos: Coorte histórica, analisando 28 pacientes submetidos à terapia do VHC atendidos no Ambulatório Central da Universidade de Caxias do Sul no período de 01 de Janeiro de 2007 a 31 de Dezembro de 2009. Resultados: Obteve-se resposta viral sustentada (RVS) em 57,1% (n = 16) e 52,9% sem RVS (n = 12). O genótipo viral, o grau de fibrose hepática pelo escorre de Metavir, carga viral ao início do tratamento foram comparados e não interferiram na taxa de RVS na análise univariada. Conclusão: A taxa de RVS assemelha-se à descrita na literatura para coortes nacionais e internacionais .

Introduction: Chronic hepatitis due to hepatitis virus C (HCV) is an important global public health problem, with a prevalence of about 3% of worldwide population, and only 22% percent of infected individuals are aware of the diagnosis. Métodos: Historical coort, analysing 28 patientes who underwent HCV therapy followed-up in the Central Ambulatory of Universidade de Caxias do Sul, throughout January 01 of 2007 to December 31 of 2009. Results: Sustained viral response (SVR) was obtained in 57.1% (n = 16) and 52.9% had no-SVR (n = 12). Viral genotype, hepatic fibrosis through Metavir score, viral load at the beginning of therapy were compared and did not interfere with SVR rates in the univariated analysis. Conclusion: SVR frequency is similar to that already describe in the literature to national and international coorts.

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JUSTIFICATIVA E OBJETIVO: No Brasil, desde a criaçãodo Sistema Único de Saúde, o acesso aos cuidados de saúde éum direito do cidadão e um dever do Estado. Atualmente, 70%da população são assistidas exclusivamente pelo Sistema Únicode Saúde, o que ocasiona a necessidade de racionalização dosrecursos. Assim, esforços para a melhoria da eficácia, garantiada segurança e qualificação da atenção dispensada aos pacientessão necessários em todos os níveis. O estudo descreveu oimpacto de uma equipe de Medicina Hospitalar no contextodo Sistema Único de Saúde no Brasil. MÉTODOS: Trata-se deestudo observacional descritivo. Em julho de 2011, uma equipede Medicina Hospitalar passou a assistir os pacientes clínicos doSistema Único de Saúde, sendo abolidos os cuidados pelo métodotradicional. Neste estudo, os autores compararam índices demorbidade hospitalar utilizados no monitoramento do desempenhodos serviços médicos obtidos pelas duas equipes médicasdiferentes, em dois períodos consecutivos de 6 meses. Os dadosdos pacientes foram coletados a partir do sistema informatizadodo hospital. RESULTADOS: Comparando os dois períodos,houve significativo aumento do escore de Charlson (2,5±2,0versus 3,3±2,1) com diminuição do tempo médio de internaçãoem dias (8,5±1,8 versus 6,0±1,1) assim como da ocorrênciade infecção hospitalar em percentual de pacientes (5,2±0,9 versus2,8±1,8). Ao se comparar a mortalidade nos dois períodos, observou-se diferença significativa ao se controlar a análise peloíndice de comorbidades de Charlson. Quando se comparou amortalidade nos dois períodos, diferença significativa pôde ser vista, controlando-se a análise pelo escore de gravidade (5/261versus 8/321; p=0,033). Ao que se referem às reinternações,não houve diferença na comparação dos períodos em 30 dias(61/261 versus 55/321; p=0,508). CONCLUSÃO: Considerandoa realidade de falta de leitos hospitalares, as iniciativas quediminuem o tempo de internação, sem prejudicar a assistência,devem ser alvo de avaliação e incentivo financeiro por parte dosgestores públicos.

BACKGROUND AND OBJECTIVE: Since the creation ofthe Unified Health System, the access to health care in Brazilhas been citizen?s right and government?s duty. Nowadays,more than 70% of the population is assisted exclusively by theUnified Health System and this leads to a need to streamline theresources. Thus, an attempt to improve efficiency, to guaranteesafety and qualified attention to patients at all levels is necessary.This study described the impact of a Hospital Medicine teamin the context of the Public Health Care System in Brazil.METHODS: This was a descriptive observational study. InJuly 2011, a Hospital Medicine team started attending theUnified Health System patients and the traditional method wasabolished. The study compared hospital morbidity rates used formonitoring the performance of the two different medical teamsin two consecutive 6-month periods. The data from all patientswere collected from the hospital computer system. RESULTS:Comparing the two periods, there was a significant increasein Charlson?s score (2.5±2.0 versus 3.3±2.1), a decrease in theaverage hospital stay in days (8.5±1.8 versus 6.0± 1.1) as well as inthe percentage of patients presenting hospital infection (5.2±0.9versus 2.8±1.8). When comparing the mortality between thetwo systems, significant statistical difference was seen usingCharlson?s score to control the analysis (5/261 versus 8/321;p=0.033). There was no difference between the two systems interms of readmissions within a thirty-day period (61/261 versus55/321; p=0.508). CONCLUSION: Considering the reality oflack of hospital beds, initiatives that allow a decrease in hospital stay must be observed and be target of financial incentives bythe public managers

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BACKGROUND: Eradication of Helicobacter pylori in patients with functional dyspepsia continues to be a matter of debate. We studied eradication effects on symptoms and quality of life of primary care patients. METHODS: Helicobacter pylori -positive adult patients with functional dyspepsia meeting the Rome III International Consensus criteria were randomly assigned to receive omeprazole, amoxicillin trihydrate, and clarithromycin, or omeprazole plus placebo for 10 days. Endoscopy and H pylori tests were performed at screening and at 12 months. Outcome measures were at least 50% symptomatic improvement at 12 months using a validated disease-specific questionnaire (primary end point), patient global assessment of symptoms, and quality of life. RESULTS: We randomly assigned 404 patients (78.7% were women; mean age, 46.1 years); 201 were assigned to be treated with antibiotics (antibiotics group) and 203 to a control group. A total of 389 patients (96.3%) completed the study. The proportion of patients who achieved the primary outcome was 49.0% (94 of 192) in the antibiotics group and 36.5% (72 of 197) in the control group (P = .01; number needed to treat, 8). In the patient global assessment of symptoms, 78.1% in the antibiotics group (157 of 201) answered that they were better symptomatically, and 67.5% in the control group (137 of 203) said that they were better (P = .02). The antibiotics group had a significantly larger increase in their mean (SD) Medical Outcomes Study 36-Item Short Form Health Survey physical component summary scores than the control group did (4.15 [8.5] vs 2.2 [8.1]; P = .02). CONCLUSION: Helicobacter pylori eradication provided significant benefits to primary care patients with functional dyspepsia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00404534.

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CONTEXT AND OBJECTIVE: Quality of life (QoL) is considered important as an outcome measurement, especially for long-term diseases such as chronic renal failure. The present study searched for predictors of QoL in a sample of patients undergoing dialysis in southern Brazil. DESIGN AND SETTING: This was a cross-sectional study developed in three southern Brazilian dialysis facilities. METHODS: Health-related QoL of patients on hemodialysis or peritoneal dialysis was measured using the generic Short Form-36 (SF-36) health survey questionnaire. The results were correlated with sociodemographic, clinical and laboratory variables. The analysis was adjusted through multiple linear regression. RESULTS: A total of 140 patients were assessed: 94 on hemodialysis and 46 on peritoneal dialysis. The mean age was 54.2 +/- 15.4 years, 48% were men and 76% were white. The predictors of higher (better) physical component summary in SF-36 were: younger age (beta-0.16; 95% confidence interval, CI: -0.27 to -0.05), shorter time on dialysis (beta-0.06; 95% CI: -0.09 to -0.02) and lower Khan comorbidity-age index (beta 5.16; 95% CI: 1.7-8.6). The predictors of higher mental component summary were: being employed (beta 8.4; 95% CI: 1.7-15.1), being married or having a marriage-like relationship (beta 4.56; 95% CI: 0.9-8.2), being on peritoneal dialysis (beta 4.9; 95% CI: 0.9-8.8) and not having high blood pressure (beta 3.9; 95% CI: 0.3-7.6). CONCLUSIONS: Age, comorbidity and length of time on dialysis were the main predictors of physical QoL, whereas socioeconomic issues especially determined mental QoL.

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CONTEXT AND OBJECTIVE: Quality of life (QoL) is considered important as an outcome measurement, especially for long-term diseases such as chronic renal failure. The present study searched for predictors of QoL in a sample of patients undergoing dialysis in southern Brazil. DESIGN AND SETTING: This was a cross-sectional study developed in three southern Brazilian dialysis facilities. METHODS: Health-related QoL of patients on hemodialysis or peritoneal dialysis was measured using the generic Short Form-36 (SF-36) health survey questionnaire. The results were correlated with sociodemographic, clinical and laboratory variables. The analysis was adjusted through multiple linear regression. RESULTS: A total of 140 patients were assessed: 94 on hemodialysis and 46 on peritoneal dialysis. The mean age was 54.2 ± 15.4 years, 48 percent were men and 76 percent were white. The predictors of higher (better) physical component summary in SF-36 were: younger age (β-0.16; 95 percent confidence interval, CI: -0.27 to -0.05), shorter time on dialysis (β-0.06; 95 percent CI: -0.09 to -0.02) and lower Khan comorbidity-age index (β 5.16; 95 percent CI: 1.7-8.6). The predictors of higher mental component summary were: being employed (β 8.4; 95 percent CI: 1.7-15.1), being married or having a marriage-like relationship (β 4.56; 95 percent CI: 0.9-8.2), being on peritoneal dialysis (β 4.9; 95 percent CI: 0.9-8.8) and not having high blood pressure (β 3.9; 95 percent CI: 0.3-7.6). CONCLUSIONS: Age, comorbidity and length of time on dialysis were the main predictors of physical QoL, whereas socioeconomic issues especially determined mental QoL.

CONTEXTO E OBJETIVO: A qualidade de vida (QoL) é considerada uma importante medida de desfecho, especialmente no manejo de doenças de longa evolução, como a doença renal crônica. O presente estudo avaliou os preditores de QoL em uma amostra de pacientes tratados por diálise. TIPO DE ESTUDO E LOCAL: Estudo transversal com coleta de dados em três centros de diálise do sul do Brasil. MÉTODOS: Avaliação de pacientes tratados por diálise, com aplicação do questionário genérico SF-36 (Short Form-36) e correlação com variáveis demográficas, socioeconômicas, clínicas e laboratoriais. A análise foi ajustada por regressão linear múltipla. RESULTADOS: Foram avaliados 140 pacientes, 94 tratados por hemodiálise e 46 por diálise peritoneal, com idade 54.2 ± 15,4 anos, 48 por cento homens e 76 por cento brancos. A dimensão física do SF-36 esteve associada à idade (β -0,17 intervalo de confiança, IC 95 por cento -0,27-0,58), ao tempo em diálise (β-0,05 IC 95 por cento -0,08-0,01) e ao índice de idade-comorbidade de Khan mais elevado (β 5,52 IC 95 por cento 2,1-8,9). A dimensão mental esteve associada a ocupação remunerada (β 8,4 IC 95 por cento 1,7-15,1), união estável (β 4,56 IC 95 por cento 0,9-8,2), tratamento por diálise peritoneal (β 4,9 IC 95 por cento 0,9-8,8) e ao fato de não ser hipertenso (β 3,9 IC 95 por cento 0,3-7,6). CONCLUSÕES: Os pacientes mais jovens, tratados por diálise há menos tempo e com um menor número de comorbidades apresentaram melhor QoL do ponto de vista físico. A QoL mental foi melhor em pacientes que desempenham atividade remunerada, são casados, tratados por diálise peritoneal e não-hipertensos.

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INTRODUCTION: Kidney transplantation is currently the treatment of choice for end-stage renal disease. As the successful transplantation improves the physical and mental quality of life, it is expected that the transplant recipient should play a productive role in the society. The present study evaluates the occurrence and predictors of employment after kidney transplantation. METHODS: Population-based cross-sectional study in which 272 adult kidney recipients assisted in a Brazilian Southern state were evaluated. RESULTS: At the moment of the interview, 29% of the patients were employed. After analysis with logistic regression, the predictors of employment were male sex (OR 4.04; 95% CI 1.99-8.23), pre-transplant employment for non-diabetic (OR 4.35; 95% CI 3.79-4.99), diabetes for individuals who worked while on dialysis (OR 0.06; 95% CI 0.008-0.5), high educational level for individuals with mental quality of life scores above the 25th percentile (OR 3.06; 95% CI 2.98-3.14 for 50th percentile of mental quality of life). The Hosmer-Lemeshow test was of 3.33 (p = 0.91). CONCLUSION: The participation of the kidney transplant recipients with functioning graft into the work force in the Brazilian state of Rio Grande do Sul is low, being predicted mainly by sociodemographic factors. It was not detected any influence of patient perception of his/her physical conditions or other clinical variables, except for the presence of diabetes.

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INTRODUÇÃO: No século XX, as mulheres vivenciaram inúmeras transformações e alcançaram uma participação mais ativa na sociedade.O estudo visa descrever o perfil da clientela feminina, admitida em um serviço de internação psiquiátrica com as transformações históricas, sociais e demográficas.Oferece um retrato comparativo das condições epidemológicas existentes no decorrer da série histórica e os aspectos do meio da condição sociocultural das mulheres do estado. MATERIAIS E MÉTODOS: Estudo epidemiológico descritivo, longitudinal, tipo série histórica de dados, baseado na coleta de dados efetuada no serviço de arquivo médico e de estatísticas de um hospital. Foram analisadas as seguintes variáveis: idade, estado civil, cor, setor profissional, ocupação, classe social e diagnóstico psiquiátrico, todos padronizados conforme os critérios da Classificação Internacional de Doenças, edições 9 e 10. Para identificação dos casos, utilizaram-se todas as primeiras internações de mulheres. RESULTADOS: No decorrer de 70 anos, obteve-se um total de 9.629 indivíduos/casos. Observou-se o predomínio de mulheres na faixa etária de 26 a 45 anos (47,9 por cento), brancas (91,3 por cento), pertencentes ao subproletariado (86,8 por cento), fora da população economicamente ativa (96,7 por cento) e com diagnóstico de transtornos afetivos (28,6 por cento) e psicoses esquizofrênicas (25,2 por cento). Quanto ao estado civil, verificou-se maior presença de mulheres casadas (44,9 por cento). Todavia, na década de 90, as mulheres solteiras representaram 54,4 por cento, enquanto que as casadas perfizeram 39,7 por cento das pacientes. CONCLUSÃO: Foram detectadas mudanças significativas nos motivos para admissão de mulheres nos últimos anos. Sugere-se que as variações tenham sido influenciadas pelos determinantes biológicos das doenças mentais graves e, também de maneira significativa, pelas pressões sociais advindas do novo papel da mulher na sociedade.

INTRODUCTION: Along the 20th century, women underwent numerous changes and reached a more active participation in society. This study aims at describing the profile of the female patients admitted to a service of psychiatric hospitalization from May 1931 to December 2000. In addition, it relates the profile of psychiatric morbidity with the historical, social and demographic changes. It also offers a comparison between the epidemiological conditions throughout the historical series and the aspects regarding the environment and the sociocultural status of women from a Southern Brazilian state. MATERIALS AND METHODS: Descriptive, longitudinal, epidemiological study including historical data and based on data collected from the medical files and statistics of a hospital. The following variables were assessed: age, marital status, race, professional area, occupation, social class and psychiatric diagnosis, all standardized according to the International Classification of Diseases (ICD-9 and ICD-10) criteria. To identify the cases, all first hospitalizations of women were used. RESULTS: Along 70 years, a total of 9,629 individuals/cases was obtained. There was a predominance of women in the age group between 26-45 years (47.9 percent), white (91.3 percent), belonging to the subproletariat (86.8 percent), not belonging to the economically active part of the population (96.7 percent) and with diagnosis of affective disorders (28.6 percent) and schizophrenic psychoses (25.2 percent). With regard to marital status, married women were prevalent (44.9 percent). However, in the 1990's, single women represented 54.4 percent, whereas married women accounted for 39.7 percent of the patients. CONCLUSION: Significant changes were detected in the reasons for admitting women to psychiatric services over the past years. It is suggested that the variations might have been influenced by biological determinants of severe mental diseases, and especially by the ...

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Kidney transplantation is currently the treatment of choice for end-stage renal disease. Although new immunosuppressive drugs have been introduced into clinical practice, the effect of such medication on quality of life (QoL) in transplant recipients is still unclear. The present study analyzes the impact of tacrolimus-based immunosuppression on QoL in a representative sample of adult kidney transplant recipients from Rio Grande do Sul, a Brazilian southern state. This was a cross-sectional multicenter study which used the SF-36 Health Survey for measuring QoL. The effect of tacrolimus on QoL was adjusted for possible confounders using multiple linear regression. A total of 272 patients (from 11 different centers) were evaluated, 48 of them were treated with tacrolimus. Transplant patients in use of tacrolimus presented significant higher scores in the physical component summary of SF-36 than non-users (49.1+/-8.3 vs. 46.1+/-8.7; p=0.03), and such difference was noted in the physical functioning and general health subscales (81.5+/-17.1 and 74.7+/-21.8; 74.6+/-22.3 and 67.1+/-22.3 for users and non-users of tacrolimus, respectively, p<0.05). The effect of tacrolimus remained significant after adjustment for age, gender, skin color and time since transplantation (coeff.: 2.83; 95% CI: 0.05-5.6, p=0.045). The association between tacrolimus-based immunosuppression and better perception of physical functioning and general health for renal transplant patients represents a significant finding as it may influence therapeutical decisions and contribute to maximize kidney transplantation benefits.

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