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Introduction: In many countries, the prevalence of obesity and chronic diseases has been increased, which are normally associated with changes in lifestyle, that are especially characterized by high consumption of diets rich in carbohydrates of rapid absorption. Such diets classified as high glycemic index and high glycemic load can lead to hyperglycemia. Objectives: Discuss the role of the diets of high glycemic index and/or high glycemic load on the oxidative stress and inflammatory process, in order to verify their influence on those diseases. Results and discussion: Studies demonstrate direct relationship between hyperglycemia, inflammatory process and oxidative stress that contribute to the development of chronic diseases. [ABSTRACT FROM AUTHOR]

Este artigo realiza uma revisão abrangente dos principais estudos publicados no Brasil e no mundo abordando os indicadores financeiros, amostra, métodos e eficiência preditiva dos modelos de previsão de falências a partir de 1930 até 2015. O levantamento selecionou, no total, 227 artigos sobre a temática, sendo 48 artigos nacionais e 179 internacionais. Após a seleção, esses trabalhos foram agrupados em cinco fases de acordo com suas características metodológicas e de escolha de indicadores financeiros. Dessa forma, este trabalho contribui com a organização dos principais modelos e indicadores de previsão de falências utilizados na literatura desde 1930. Sugere-se, para pesquisas futuras, que os autores foquem na utilização de modelos já existentes, e não no desenvolvimento de novos modelos, bem como na utilização de mais indicadores não contábeis aos seus modelos.

Las instituciones públicas del siglo XXI están inmersas en entornos complejos, en dicho contexto el capital humano requiere estímulos que influyan en su conducta para que su comportamiento esté orientado al logro de objetivos organizacionales, generando ventajas competitivas, que les permitan dar respuestas a las comunidades con las cuales interactúan y cumplir su misión social. El artículo tiene como propósito hacer un abordaje teórico de la motivación y su influencia en la gestión del capital humano en los gobiernos locales venezolanos. La investigación fue documental haciendo un arqueo en fuentes bibliográficas y electrónicas de la perspectiva de autores sobre el tema, tales como: Alles (2005/2008) Chiavenato (2008), Cuenca (2010), De Luna (2008), Drucker (1999), Etkin (2005), Guerrero (2010), Rosales (2006), Varona (2002), y soportado en las teorías de la motivación, tales como: ley del efecto, expectativas, equidad, necesidades, teoría de los factores y teoría Z entre otras. Los hallazgos se presentan en dos secciones: la primera aborda aspectos teóricos de la motivación y el capital humano en el contexto organizacional, la segunda explica su prospectiva en gobiernos locales venezolanos. Las conclusiones evidencian las contradicciones entre la teoría y la praxis organizacional, destacando la importancia de la asertiva gestión del capital humano lo cual lleva implícito la motivación para influir en su conducta orientada a la eficiencia y mejoramiento de los procesos internos, en un entorno complejo.

A história da humanidade tem demonstrado que a inovação é uma das forças motrizes e um dos meios para sustentar a evolução e criação de vantagem competitiva em um cenário de mudanças. Dada a importância da inovação no contexto empresarial e organizacional, o presente trabalho realizou um estudo bibliométrico estruturado nos artigos compreendidos entre 1990 a 2007 das duas revistas mais importantes na área de Estudos Organizacionais: Administrative Science Quarterly e Organization Science. O objetivo foi a compreensão da evolução dos estudos relacionados à inovação sob ótica dos elementos da organização. O resultado demonstrou uma tendência crescente em estudar a inovação com base em redes de conhecimento e alianças, assim como a manutenção da importância, ao longo do tempo, daqueles que abordaram a inovação e a organização como instrumento social. Outra contribuição deste trabalho é o agrupamento dos artigos estudados mediante a técnica de cluster, com isso foi possível traçar um mapa sobre a situação da produção acadêmica da área envolvendo a inovação relacionada aos elementos organizacionais e sugestões para pesquisas futuras.

Este ensayo teórico se centra en las teorías que explican cómo las organizaciones a obtener y mantener una ventaja competitiva. Tres Paradigmas se resumen, el paradigma y el paradigma de conflicto estratégico de Porter, y las conversaciones para poner fin al paradigma de recursos basado en recursos. "Capacidad dinámica" se derivan de la fuerte relación entre las nociones generalizadas de eficacia con respecto a los cambios y las fórmulas genéricas e la ventaja competitiva sustentable.

Este artículo tiene como objetivo identificar y analizar el mix de marketing de Submarino.com y las ventajas competitivas conferidas por ésta. Se realizó un estudio de caso de Submarino.com, una compañía líder en ventas en Internet de Brasil, dentro de un enfoque cualitativo. Se observó que la forma en que el Submarino utiliza el mix de marketing está en línea con su visión estratégica declarada. Así que la empresa puede diferenciarse de la competencia y establecer barreras a la entrada de nuevos competidores, obteniendo una ventaja competitiva como: el pionero, una red de relaciones con proveedores y clientes, el surtido de productos, entre otros.

O Custeio Baseado em Atividades tem se mostrado como uma alternativa promissora para fazer frente à complexidade que caracteriza os custos hospitalares. Nos últimos dez anos, somente na Plataforma Lattes, foram encontrados mais de uma centena de estudos dessa natureza. Este trabalho tem como objetivo, conhecer, empiricamente, a utilização do Custeio ABC nos hospitais universitários e de ensino brasileiros e comparar os resultados, conforme as possibilidades, com as pesquisas realizadas nas maiores empresas brasileiras pelos autores: Khoury (1999), Beuren e Roedel (2002) e Azevedo, Santos e Pamplona (2004). Dos 115 questionários enviados aos hospitais universitários, 34 foram respondidos. O estudo levou a conclusões importantes, como: Os sistemas de custos atuais dos hospitais têm poucas condições de fornecer informações úteis à gestão; o Custeio ABC é bastante conhecido no ambiente, mas o número de usuários ainda é relativamente pequeno: apenas 15% da amostra; mas existe expectativa por parte de 44% dos hospitais com relação ao uso futuro da abordagem. As principais causas apresentadas para a não-utilização do Sistema ABC foram: (a) o sistema utilizado atende às necessidades da organização e (b) o Custeio Baseado em Atividades é muito complexo.The Cost Based Activity has been a promising alternative to deal with the complexity that characterizes hospital costs. In the last ten years, only in the Plataforma Lattes, more than a hundred studies of this nature had been found. This work aims to find out, empirically, the use of ABC Costing in Brazilian university hospitals and to compare the results, according to the possibilities, with the researches that have been made in the biggest Brazilian companies by the authors: Khoury (1999), Beuren and Roedel (2002) and Azevedo, Santos and Pamplona (2004). A hundred and fifteen questionnaires were sent to the university hospitals, 34 had been answered. The study relates important conclusions: The current cost systems of the hospitals have few conditions to supply useful information to the management; the ABC Costing is enough known in the hospital area, but the number of users is still relatively small: only 15% of the sample; but there is a expectation on the part of 44% of the hospitals regarding the future use of the boarding. The main causes presented for not-using the ABC Costing had been: (a) the system in use serves the necessities of the organization and (b) the Activity Based Costing is very complex.

The effect of harvest period on the quality of storage roots and leaves of cassava cultivars was determined in an experiment carried out in a randomized complete block design with four replications in a split plot scheme, with five cultivars in the plots and ten harvest times in the subplots. The IAC 13 cultivar had the highest rate of dry matter accumulation in the storage roots and the Mico cultivar the lowest. The period of least dry matter content in the storage roots occurred later for the Fécula Branca, Mico and IAC 14 cultivars, and the minimum starch content in the storage roots occurred later for the Fécula Branca and Mico cultivars. In general, the IAC 13, IAC 14 and Fécula Branca cultivars had higher dry matter content in the storage roots, while higher starch content in the dry and fresh matter were obtained in the Fécula Branca cultivar. The crude protein content in the leaves decreased as the plant aged.

Objective: Bone mineral density changes during the life span, rising rapidly during adolescence, plateauing around 30 years of age and decreasing in later years. Life events such as pregnancy and lactation temporarily reduce bone density, and their long-term effects on osteoporosis development are still unclear. This study aimed to analyse the association between pregnancy in adolescence and osteoporosis in aged women., Methods: This was a cross-sectional study conducted with data from the ELSI-Brazil baseline (2015-2016). The sample consisted of 2634 women aged 60 years old or over with complete information for the variables of interest. Data collection was conducted through individual home interviews and physical assessments. The dependent variable was osteoporosis and the independent variable of interest was pregnancy in adolescents under 20 years of age. The association between the variables was tested using multiple logistic regression., Results: The prevalence of osteoporosis was 32%, and the percentage of women who reported pregnancy in adolescence was 38%. After adjusting for socio-economic and health variables, an association was observed between pregnancy in adolescence and osteoporosis (OR = 1.38; 95% CI = 1.09-1.73), which indicates that specific bone health interventions for teenage mothers could help prevent osteoporosis later in life., Conclusion: Women who reported pregnancy before age 20 were more likely to report osteoporosis in old age, indicating that pregnancy in adolescence can be a criterion for directing actions to prevent osteoporosis in aged women., (© 2025 AJA Inc’.)

Background: Resilience is a crucial factor in students' mental health, playing an important role in their successful adaptation to the academic environment. However, there is a lack of understanding about resilience and its associated factors in students from different undergraduate courses. This study aimed to describe the resilience profile of undergraduate students from various courses in Brazil and identify sociodemographic, economic, and academic factors associated with resilience., Methods: This study has data from a cross-sectional multicenter study involving undergraduate students from eight Federal Institutions of Higher Education in Minas Gerais, Brazil. The dependent variable was resilience, measured using the Connor-Davidson Resilience Scale (CD-RISC) 10-item version, with sociodemographic, economic, and academic factors considered independent variables. Data was collected virtually via a self-administered questionnaire between October 2021 and February 2022 (during the covid-19 pandemic). Independent samples t-tests and ANOVAs were conducted to compare resilience scores between independent variables, and Tukey's post-hoc test was performed when necessary. Multiple linear regression was performed to create three models., Results: 8,650 undergraduate students were included in this study. The average score on the resilience scale was 19.86 ± 8.15, with a normal distribution. The respondents ranged from 18 to 71 years old, averaging 23.9 ± 6.33. Being female, not having a religious belief, having low per capita family income, having had a decrease in the family income, not being heterosexual, or having the head of the family with a low education level were the main factors associated, individually, with low resilience scores in the sociodemographic and economic multiple linear regression model constructed. Being from linguistics, letters and arts courses, being enrolled in fewer subjects, or being from UFMG were the main factors associated, individually, with low resilience scores in the academic multiple linear regression model constructed., Conclusions: The study's findings revealed that sociodemographic, economic, and academic variables were significantly associated with resilience scores in undergraduates from Minas Gerais during the covid-19 pandemic. These findings can help universities develop target strategies to promote students' resilience and reduce the risk of poor mental health among this population., (© 2024. The Author(s).)

Objective: To evaluate the effects of replacing time spent in sedentary behavior (SB) with moderate to vigorous physical activity on sleep quality in young adults., Methods: Multicenter cross-sectional study, carried out with students enrolled in undergraduate courses at universities in Brazil. Sleep quality was assessed using a question of the World Health Organization Quality of Life (WHOQOL-brief) and classified as good or poor sleep quality. SB was evaluated by self-reported total sitting time, and the level of leisure-time PA was classified according to the intensity of moderate-intensity physical activity (MPA) and vigorous-intensity physical activity (VPA), which were assessed using a self-reported questionnaire. An isotemporal replacement logistic model was used to evaluate the effects of different SB, MPA, and VPA sessions on sleep quality., Results: A total of 8,059 study participants were evaluated, the majority had poor sleep quality (64.79%), were physically inactive (48.28%, defined as practicing < 150 min of MPA or < 75 min of VPA per week), and spent ≥ 9 h/day in SB (55.08%). The multivariate model showed an association between non-adherence to wake-based movement guidelines and poor sleep quality, where those with one altered behavior were 43% more likely to have poor sleep quality (OR:1.43;95%CI:1.27 to 1.60), while individuals with two altered behaviors were 97% more likely (OR:1.97;95%CI:1.73 to 2.24). In the isotemporal analysis, replacing MPA and VPA with equivalent time in SB increased the odds of poor sleep at all times assessed, with peaks of 56% for MPA and 68% for VPA., Conclusion: The results of the present study indicate that replacing SB with the same amount of MPA or VPA may reduce poor sleep quality., (© 2024. The Author(s).)

Background: Movement behaviours, such as sedentary behavior (SB) and physical inactivity, have become a public health issue due to their implications for physical and mental health. The literature indicates that the university environment influences the movement behaviors of university students, and the strategies adopted during the pandemic may have favored a decrease in the practice of physical activity and an increase in the time dedicated to SB in this population. We aimed to evaluate the association of SB and moderate to vigorous leisure-time physical activity (MVPA) with presence of symptoms of mental disorders during the COVID-19 pandemic., Methods: This is a multicenter survey conducted with undergraduate students from eight Brazilian universities between October 2021 and February 2022 using an online questionnaire. The outcome variable was symptoms of anxiety and depression, assessed by the Depression, Anxiety, and Stress Scale-21. SB was assessed by total sitting time, being that individuals with ≥ 9 h/day were classified with high SB. The practice of MVPA was evaluated based on weekly frequency, duration, and type of exercise. Subsequently, the ratio between the time spent in MVPA (minutes/day) and the time spent in SB (hours/day) was calculated, being considered as cutoff point was the practice of 2.5 min of MVPA for each sedentary hour. To assess the association between the outcome and explanatory variables, multivariable logistic regression was performed., Results: A total of 8,650 students participated in the study, with an average age of 23.9 years (SD: ± 6.34). In the multivariate analysis, the odds of anxiety symptoms [OR: 1.37 (95% CI: 1.24-1.50)] and depression [OR: 1.61 (95% CI: 1.47-1.77)] were higher in individuals with ≥ 9 h of SB per day. In the analysis of the relationship between MVPA and SB, not engaging in 2.5 min of MVPA per hour of SB increases the odds of anxiety symptoms [OR: 1.44 (95% CI: 1.31-1.58)] and depression [OR: 1.74 (95% CI: 1.59-1.92)]., Conclusion: The results suggest that SB is a risk factor associated with symptoms of anxiety and depression and that not engaging in MVPA exacerbates the negative effects of SB., (© 2024. The Author(s).)

Purpose: Renal cell carcinoma is an aggressive disease with a high mortality rate. Management has drastically changed with the new era of immunotherapy, and novel strategies are being developed; however, identifying systemic treatments is still challenging. This paper presents an update of the expert panel consensus from the Latin American Cooperative Oncology Group and the Latin American Renal Cancer Group on advanced renal cell carcinoma management in Brazil., Methods: A panel of 34 oncologists and experts in renal cell carcinoma discussed and voted on the best options for managing advanced disease in Brazil, including systemic treatment of early and metastatic renal cell carcinoma as well as nonclear cell tumours. The results were compared with the literature and graded according to the level of evidence., Results: Adjuvant treatments benefit patients with a high risk of recurrence after surgery, and the agents used are pembrolizumab and sunitinib, with a preference for pembrolizumab. Neoadjuvant treatment is exceptional, even in initially unresectable cases. First-line treatment is mainly based on tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs); the choice of treatment is based on the International Metastatic Database Consortium (IMCD) risk score. Patients at favourable risk receive ICIs in combination with TKIs. Patients classified as intermediate or poor risk receive ICIs, without preference for ICI + ICIs or ICI + TKIs. Data on nonclear cell renal cancer treatment are limited. Active surveillance has a place in treating favourable-risk patients. Either denosumab or zoledronic acid can be used for treating metastatic bone disease., Conclusion: Immunotherapy and targeted therapy are the standards of care for advanced disease. The utilization and sequencing of these therapeutic agents hinge upon individual risk scores and responses to previous treatments. This consensus reflects a commitment to informed decision-making, drawn from professional expertise and evidence in the medical literature., (© 2024. The Author(s).)

Objective: We aimed to evaluate the association between the triglyceride glucose index (TyG index) and sleep quality and to establish a cut-off value for the TyG index based on the prevalence of subjects with insulin resistance (IR)., Methods: This cross-sectional study involved Brazilian health professionals (20-59 years). A total of 138 subjects answered the Pittsburgh Sleep Quality questionnaire to evaluate sleep quality. They were categorized into two groups: good sleep quality (global score ≤ 5 points) and poor sleep quality (global score ≥ 6 points). Also, we classified the subjects as having a high (>8.08 or >4.38) or low TyG index (≤ 8.08 or ≤4.38)., Results: The majority of the subjects (70%) with high TyG index values (>8.08 or >4.38) reported poor sleep quality (p ≤ 0.001). Those with poor sleep quality had a 1.44-fold higher prevalence of IR (TyG index >8.08 or >4.38) compared to those with good sleep quality, regardless of sex, total cholesterol, LDL/HDL ratio, insulin, complement C3, CRP, and adiponectin (p ≤ 0.001)., Conclusion: Our data showed a positive and significant association between the TyG index and poor sleep quality. Thus, these findings support the association between poor sleep quality and IR.

Background: Haemophagocytic syndrome (HPS) is a severe immunological disorder characterised by uncontrolled inflammation and multiple organ failure. HPS can be triggered by viral, bacterial, fungal and parasitical infections. We report our experience with infection-related HPS and estimate its local incidence., Material and Method: We conducted an observational retrospective study of infection-associated HPS in patients treated in the Department of Infectious Diseases of a university hospital within a 5-year period, as well as a review of the published series in Europe., Results: HPS was associated with infection by cytomegalovirus in 2 women with Crohn's disease and was associated with visceral leishmaniosis in 4 patients (3 men, 1 woman; 1 case of multiple myeloma; 2 cases of solid tumours; 1 case of no apparent disease). Two patients died, and the estimated incidence rate was 0.58/100,000 inhabitants/year. The published series are mixed., Conclusions: Infection-related HPS must be more common than reported. The geographical environment can influence the triggering infections (in our environment, Leishmania should be considered)., (Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Background: Metabolic syndrome (MS) and its components increase the risk of a number of chronic diseases. Evidence regarding its prevalence among health professionals, particularly in Latin America, is limited. The purpose of this study was to assess the overall prevalence of MS and its components among health professionals and students from five Latin American countries. Methods: A cross-sectional multicenter study entitled LATIN America METabolic Syndrome (LATINMETS) was conducted on five groups of apparently healthy volunteer subjects. Sociodemographic factors, lifestyle variables (smoking and physical activity), anthropometric measurements (weight, height, and waist circumference), standard biochemical analyses [triglycerides, glucose, and high-density lipoprotein cholesterol (HDL-C)], and blood pressure measurements were assessed. MS was diagnosed based on internationally harmonized criteria. Associations between MS components and sociodemographic, lifestyle, and anthropometric variables were analyzed using multivariate logistic regression. Results: A total of 1,032 volunteers ( n  = 316-Mexico, n  = 285-Colombia, n  = 223-Brazil, n  = 132-Paraguay, and n  = 76-Argentina) were recruited. The majority of them were women (71.9%), students (55.4%), and younger than 28 years (67.2%). The overall prevalence of age-standardized MS was 15.5% (23.1% men and 12.2% women). The majority (59.3%) presented at least one MS component, mainly abdominal obesity (29.7%) and low HDL-C levels (27.5%). After adjusting for age and sex, MS and its components were positively associated with being overweight or obese. Conclusions: MS prevalence in this study was similar to that generally found among young populations in Latin-American countries. More than half of the sample had at least one MS component, suggesting that preventive measures and treatments aimed at achieving low-risk health status are essential in this population.

Cytoreductive nephrectomy (CN) followed by systemic therapy had been considered the standard of care for metastatic renal cell carcinoma (mRCC) patients since two clinical trials established its role during the cytokines era. With introduction of new and effective drugs, such as vascular endothelial growth factor-targeted therapies, the role of CN started to be challenged. Retrospective studies conducted during the targeted therapy era pointed to better outcomes when CN was associated with systemic treatment, although certain patients with poor risk features did not seem to benefit. Therefore, prospective clinical trials supporting CN were needed. Recently, with the publication of two randomized trials evaluating CN in the targeted therapy era, it has been made clear that patient selection and multidisciplinary discussion are of paramount importance in order to achieve the best outcomes. We reviewed the available literature on the role of CN among mRCC patients, commenting on how to apply the new evidence into clinical practice and providing future perspectives., (© 2019 S. Karger AG, Basel.)

Background and Objective: Asthma is the most common chronic disease in children. Cases of severe asthma (SA) are underdiagnosed. Periostin is a biomarker for SA in adults, but its role in children is poorly understood. Objectives: The aims of the study were to estimate the percentage of cases of uncontrolled severe asthma (UcSA) in children with poorly controlled asthma and to evaluate the role of periostin as a biomarker., Material and Methods: We performed an observational study in children aged 5 to 14 years with poorly controlled asthma. Demographic and clinical data were collected in addition to the results of the lung function test, the fraction of exhaled nitric oxide, the skin prick test, total IgE, specific IgE, blood eosinophil count, serum periostin, treatment, asthma control, and quality of life. Variables were compared between the group with UcSA and the other children., Results: Fifty children with poorly controlled asthma (72% male) were included. Nineteen children (38%) had UcSA. Most children had limitations in their activities of daily living and had visited the emergency department. In addition, 38% were hospitalized. Quality of life was poor. Only 42% of the children received appropriate treatment. The UcSA group was more likely to have a total IgE >500 kUA/mL (52.6% vs 19%, P=.02) and less likely to have serum periostin >1000 ng/mL (31.2% vs 63%, P=.04)., Conclusions: In our setting, 38% of children with poorly controlled asthma have UcSA, which is associated with higher levels of total serum IgE and lower levels of serum periostin.

Introduction: Visceral fat accumulation is associated with several changes, such as, increased production of inflammatory biomarkers, especially, C-reactive protein (CRP) and fibrinogen. Anthropometric measurements for central adiposity evaluation, such as, waist circumference (WC) and sagittal abdominal diameter (SAD) have been highlighted. However, there is no consensus on the best anatomical site for measurement., Objective: To evaluate the reliability of different measurements of WC and SAD and verify their capacity to discriminate changes in inflammatory biomarkers., Method: 130 men (20-59 years) were assessed, having measurements of weight, height, WC and SAD. It was considered as the cutoff point for high-sensitivity CRP (hs-CRP) values ≥ 0.12 mg/dL and for fibrinogen the 50th percentile of the evaluated sample., Results: All measurements presented an intraclass correlation coefficient between 0.998 and 0.999. WC measured at the umbilical level (AUC=0.693 ± 0.049) and the smallest circumference between the thorax and the hips (AUC=0.607 ± 0.050) had greater ability to discriminate changes in concentrations of hs-CRP and fibrinogen, respectively. SAD (umbilical level) showed the better ability to detect changes in concentrations of hs-CRP (AUC=0.698 ± 0.049) and fibrinogen (AUC=0.625 ± 0.049), according to the ROC analysis (p<0.05)., Conclusion: WC (smallest circumference between the thorax and the hips) and SAD (umbilical level) are the anatomic sites of measurement for use in predicting the inflammatory risk in apparently health men., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: Leptospirosis is a zoonosis of worldwide distribution and tropical predominance. Its incidence could be underestimated in template regions. We describe the manifestations of leptospirosis in an area of Southwestern Spain., Patients and Methods: Eighty-six cases of leptospirosis (April 1997-April 2013) were retrospectively analyzed. The diagnosis was based in clinical and serological (Leptospira IgM ELISA) judgement. Epidemiological, clinical, laboratory, and prognostic dates were recorded., Results: The mean age was 43.1 ± 13.8 years (84.9% males). The mean annual incidence was 1.99/100.000. There were activities of risk in 94%: 82.5% contact with animals (57.4% pigs, 38.1% dogs, 31.7% cows, 22.2% sheeps), and 31.7% contact with pooled water. The most frequent symptoms were fever (94.1%), arthromyalgias (60.7%), and cephalalgia (53.3%). The main laboratory alterations were hypertransaminemia (48%), renal insufficiency (26.3%), and thrombocytopenia (16.9%). A lymphocytic meningitis was associated in 11 cases (12.5%) and a picture of Weil's disease was observed in 13 patients (15.1%). The patients with meningitis were younger (31.2 ± 9.2 versus 44.8 ± 15.2, p=0.004). The patients with Weil's disease were older (53.5 ± 15.8 versus 41.2 ± 14.5, p=0.007). Fifty seven patients were hospitalized (66.3%) and 6 patients died (7.0%). Factors independently associated with mortality were age >60 years (odds ratio [OR] 45.0, confidence interval 95% [CI95%] 4.7-434.6) and diagnosis of Weil's disease (OR 15.8, CI95% 2.5-98.7)., Conclusions: In our experience, leptospirosis have a not despicable incidence and tends to show fever and arthromyalgias in men with risk activities. Leptospirosis should be included in the differential diagnosis of lymphocytic meningitis. Mortality is associated with older age., (Copyright © 2013 Elsevier España, S.L. All rights reserved.)

Introduction: Epidemiological studies have shown an association between coronary heart disease and emerging cardiovascular risk factors, such as, levels of fibrinogen and high-sensitivity C-reactive protein (hs-CRP)., Objectives: To verify the ability of biochemical indicators in discriminating changes in the levels of hs-CRP and fibrinogen, in apparently healthy adult men., Methods: Were evaluated 130 apparently healthy men (20-59 years), having measurement of weight and height. Biochemical measurements (lipid profile, fasting glucose, uric acid, hs-CRP and fibrinogen) were performed. Body mass index, total cholesterol/HDL-c and LDL-c/HDL-c ratios were calculated. It was considered as the cutoff point for hs-CRP values ≥ 0.12 mg/dL and for fibrinogen the 50th percentile of the evaluated sample., Results: The uric acid showed the best correlation (r = 0.325) and the higher area under the ROC curve (0.704 ± 0.054), showing greater ability to discriminate higher levels of hs-CRP (p < 0.01). The total cholesterol/HDL-c ratio (r = 0.222) and the LDL-c/HDL-c ratio (r = 0.235) showed the best correlations and the higher areas under the ROC curves (0.624 ± 0.049 and 0.624 ± 0.049) in identify higher levels of fibrinogen (p < 0.05)., Conclusion: The uric acid and the total cholesterol/HDL-c and the LDL-c/HDL-c ratios showed greater ability to identify changes in the levels of hs-CRP and fibrinogen, respectively. It was suggested the use of biochemical markers in the clinical practice, in order to establish preventive action for cardiovascular disease in apparently healthy adult men., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Background: The metabolic syndrome (MS) is a complex of risk factors for cardiovascular disease. This syndrome increases the risk of diabetes, cardiovascular disease and all-cause mortality. It has been demonstrated that the prevalence of MS is increasing worldwide. Despite the importance of MS in the context of metabolic and cardiovascular disease, few studies have described the prevalence of MS and its determinants in Latin America. The present study aims to assess studies describing the prevalence of MS in Brazil in order to determine the global prevalence of the syndrome and its components., Methods: Systematic review. Searches were carried out in PubMed and Scielo from the earliest available online indexing year through May 2013. There were no restrictions on language. The search terms used to describe MS were taken from the PubMed (MeSH) dictionary: "metabolic syndrome x", "prevalence" and "Brazil". Studies were included if they were cross-sectional, described the prevalence of MS and were conducted in apparently healthy subjects, from the general population, 19-64 years old (adult and middle aged) of both genders. The titles and abstracts of all the articles identified were screened for eligibility., Results: Ten cross-sectional studies were selected. The weighted mean for general prevalence of MS in Brazil was 29.6% (range: 14.9%-65.3%). Half of the studies used the criteria for clinical diagnosis of MS proposed by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) (2001). The highest prevalence of MS (65.3%) was found in a study conducted in an indigenous population, whereas the lowest prevalence of MS (14.9%) was reported in a rural area. The most frequent MS components were low HDL-cholesterol (59.3%) and hypertension (52.5%)., Conclusions: Despite methodological differences among the studies selected, our findings suggested a high prevalence of MS in the Brazilian adult population.

Introduction: Obesity has been considered a chronic subclinical inflammation. High sensitivity C-reactive protein (hs-CRP) and fibrinogen are increasingly associated with cardiovascular risk., Objectives: To evaluate the ability of anthropometric and body composition indicators in discriminating higher levels of hs-CRP and fibrinogen., Methods: 130 men (20-59 years) were assessed, having measurement of weight, height, waist circumference (WC), hip and thigh circumferences, sagittal abdominal diameter (SAD), coronal diameter (CD) and body composition. Conicity index, waist/height ratio, body mass index, waist/hip ratio, waist/thigh ratio and sagittal index were calculated. It was considered as the cutoff point for hs-CRP values ≥ 0.12 mg/dL and for fibrinogen the 50th percentile of the evaluated sample., Results: Sagittal index (r = 0.280), waist/thigh ratio (r = 0.233) and waist/height ratio (r = 0.233) showed the best correlation with hs-CRP (p < 0.01). Conicity index (r = 0.305) and waist/height ratio (r = 0.279) showed the best correlation with fibrinogen (p < 0.01). In ROC analysis, the SAD (0.698 ± 0.049) and the conicity index (0.658 ± 0.048) had greater ability to discriminate cardiovascular risk through higher levels of hs-CRP and fibrinogen, respectively (p < 0.01). The cutoff points of 30 cm, 89.9 cm and 20.5 cm were the ones that reached largest sum between sensitivity and specificity values for the CD, WC and SAD, respectively., Conclusions: The SAD and the conicity index demonstrated a greater ability to detect higher levels of hs-CRP and fibrinogen, respectively, in apparently healthy adult men., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

A 53-year old male admitted for episodes of sustained ventricular tachycardia subjected to electrical cardioversion, carrier of a right femoral central venous catheter, began with febrile peaks, and Staphylococcus epidermidis was isolated in the blood cultures. What is the value of isolation in the blood cultures of S. epidermidis, a microorganism that forms a part of the usual flora of the skin and mucous of the patient? How should this situation be managed? Should an antimicrobial agent be administered? Which one? For how long?, (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Background and Objective: Hospital mortality is a indicator of quality of care, and their study may improve assistance of hospitalized patients. Our objective was to know the most frequent death causes of hospitalized patients, to identify clinical and analytical variables associated with each cause, and to determine gender differences., Material and Methods: A systematic and retrospective revision of 113 medical reports of death patients was carried out; it corresponded 26% of all deaths occurred between March 2002 to November 2004. At each case, epidemiological variables, previous clinical reports, biochemical and haematological parameters, death cause and in-hospital complications were registered., Results: Mean age was 79 +/- 10 years and 58.4% of cases were males. Thirty eight percent had previous admission, and 45% had functional class III-IV. Men died with less age that women (76.6 +/- 10.3 versus 82.3 +/- 8.0 p < 0.002) and they had more frequent antecedents of chronic bronchopulmonary disease (43% versus 19%, p <0.04); however, women had worse ventilatory situation at admission. The main death causes were cardiopulmonary (56% whole, 34% because of respiratory insufficience, 14% because of pneumonia, and 8% because of acute lung oedema), followed by neurological causes (25% whole, 23% because of stroke) and 19% because another reason (neoplasia, multiorganic failure, hepatic insufficience and renal failure). Patients died from cardiopulmonary cause had a more frequent previous hospitalization (p < 0.04). Patients died from neurological cause had higher systolic and diastolic blood pressure at admission (p < 0.0001), higher rate of hypertension (p < 0.0001) and more frequent nosocomial fever (p = 0.0001)., Conclusions: In our Service, male patients died with less age that women, the main death causes were cardiorespiratory diseases and subsequently neurologic diseases. Hypertension at admission was most frequent in patients died from neurologic cause.

Background: Chronic hepatitis C and B are the main causes of hepatocellular carcinoma (HCC) worldwide. It is not clear whether chronic hepatitis C or B virus (HCV or HBV) infection is a prognostic factor for HCC. This study aimed to asses epidemiology of HCC in a rural area and to determine if chronic HCV or HBV infection had any impact on survival after the diagnosis of HCC., Material and Methods: Fifty-one consecutive patients were retrospectively studied. All of them were diagnosed of HCC between january 1994 and december 2002 in a First Level Hospital. The following variables were analysed: age, sex, HCV and HBV infection, chronic alcohol abuse (daily intake upper 80 g), clinical presentation, Child stage, number ol liver nodules, therapeutic options and survival., Results: The mean age at diagnosis of HCC was 68,5 years old (age range 45-90) and 45 patients (88,6%) were male. Heavy alcohol intake (66%) and chronic HCV infection (42,8%) were the most prevalent etiologic factors. Chronic HBV was found in 11,9%. Chronic HCV or HBV infection was present in 48,9%. Twenty-five percent were asymptomatic and 66% were in Child stage A. The rate single lesion / multilobular HCC was 52/48. Only 6% of all patients could be treated with a curative intention. The mean survival was 10,9 +/- 9,1 months, and there were no differences in age, sex, Child stage and number of nodules. There was a significantly higher survival in patients with chronic HCV or HBV infection (16,7 +/- 13,1 months versus 4,75 +/- 5,3 months in seronegative patients; p=0.02). On multivariate analysis, only chronic HCV or HBV infection was associated with survival longer than 10 months (OR 22,3; CI 95% 1,8-277,9)., Conclusions: In our area, heavy alcohol abuse and HCV infection were the most prevalent etiologic factors of HCC. Chronic HCV or HBV infection was associated with longer survival in patients with HCC.

Background: Mumps is a viral infection which is particularly found in children and adolescents and one of its manifestations is as lymphocytary meningitis. The aim of this study was to analyze the clinical, epidemiologic and serologic characteristics of the cases of meningitis by the mumps virus (MMV) observed during an epidemic of mumps., Subjects and Methods: Twenty-eight cases of MMV diagnosed from December 1, 1994 to August 31, 1995 during an epidemic of mumps in the south of the province of Badajoz (Spain) were analyzed. Demographic, clinical, analytical and evolutive data were obtained., Results: Cases predominated in the winter and summer in adolescents and youths (mean age 16.9 years) with a male:female relationship of 3:1. On admission most patients presented fever, headache, and parotid hypertrophy. Orchitis was observed in half of the males. No case of encephalitis was seen. Hyperproteinorrhachia was observed in the cephalorrhachidian fluid of 79% of the cases and hypoglucorrhachia was found in only two patients (7%). The course was benign, except in four patients (14%) who had sequelae (headache, unilateral hyperacusia and testicular discomfort)., Conclusions: The epidemiologic and liquoral data of MMV in adolescents agree with those described in series of children. Nonetheless, the absence of encephalic involvement and the high proportion of orchitis is of note.

Alveolar hemorrhage in mixed cryoglobulinemia associated with hepatitis C virus infection. A 61 year-old woman with type II mixed cryoglobulinemia associated to hepatitis C virus infection has suffered alveolar hemorrhage with multiple pulmonary infiltrates, purpura, glomerulonephritis and polyneuropathy. The respiratory and kidney findings resolved with prednisone, but glomerulonephritis reappeared when interferon-alpha treatment was started and prednisone was reduced. This is the third case of alveolar hemorrhage and glomerulonephritis associated with mixed cryoglobulinemia reported in the literature. The lung involvement in mixed cryoglobulinemia is reviewed. The clinic manifestations (asthma, pleural effusion, hemoptysis or pulmonary fibrosis) are uncommon, but the lung involvement is very frequent if roentgenographic signs and necropsy findings are assessed.

Gastric tuberculosis is a rare entity that often coincides with pulmonary involvement at the time of diagnosis. Many cases reported in developed countries are in immunodepressed patients, particularly those with HIV infection. We report the case of a 43-year-old man who presented with weight loss of 14 kg, persistent vomiting and bilateral pulmonary nodes measuring 1.5 to 3 cm in diameter. An ulcerous, hypertrophic gastric lesion was observed by oral digestive endoscopy, such that the clinical, radiologic and endoscopic profile initially suggested gastric neoplasia with bilateral pulmonary metastasis. Examination of the gastric biopsy and of the bronchial aspirate revealed the presence of acid-alcohol resistant bacilli; a culture in Löwenstein-Jenssen medium was positive for Mycobacterium tuberculosis. The patient responded satisfactorily to short-term specific treatment with three drugs.