Objective: To determine if paternal preconception exposure to ionizing radiation through uranium mining increases the risk of congenital anomaly (CA) in offspring. Methods: A population-based matched case-control study was conducted. Cases were infants with CAs recorded in the Canadian Congenital Anomalies Surveillance System and born alive in Ontario 1979-86 (ICD-9 codes 740-759); controls were liveborn infants without CAs identified from Ontario birth certificates and individually matched to cases (case-control file {CCF}). Exposed fathers were identified through the linkage of the CCF to the Mining Master File or the National Dose Registry file, which include those who worked in Ontario uranium mines 1952-1986. For men who linked with a case or control child, radon, gamma and total gonadal doses were estimated for three preconception periods: entire, 3-months and 6-months. Odds ratios were estimated using conditional logistic regression. Results: Linkage of 28,991 uranium miners and 40,482 case-control pairs of fathers and offspring in the CCF identified 431 discordant pairs. There was no evidence of increased risk of a child having a CA if the father was ever a uranium miner before conception of the child (OR=0.89, 95% CI=0.74–1.08). Since gamma radiation (especially during the 6-month preconception period) is more biologically relevant to gonads than radon, further analyses were performed on 117 discordant pairs where data on gamma exposures were available. When ever/never miner, exposed to gamma (yes/no), and gamma dose-response variables were all in the model, there was no ever/never miner effect (OR=1.20, 95% CI=0.85–1.69, p-value=0.30), an inverse association for exposure to gamma (OR=0.42, 95% CI=0.25–0.71, p-value=0.001), but most importantly, there was no statistically significant dose-response relationship between gamma dose during the 6-month preconception period and all CAs (OR=1.15 per loge {mSv+0.01}, 95% CI=0.83–1.59, p-value=0.40). Similarly, no dose-response relationship was observed for exposure to gamma radiation in the 3-month preconception period, or for radon or total gonadal radiation in the 3- or 6-month preconception periods. Conclusion: There was no increased risk of a CA among liveborn children of Ontario uranium miners who were exposed to radon, gamma or total radiation during the 3- or 6-month periods before conception.

Objective: To determine if paternal preconception exposure to ionizing radiation through uranium mining increases the risk of congenital anomaly (CA) in offspring. Methods: A population-based matched case-control study was conducted. Cases were infants with CAs recorded in the Canadian Congenital Anomalies Surveillance System and born alive in Ontario 1979-86 (ICD-9 codes 740-759); controls were liveborn infants without CAs identified from Ontario birth certificates and individually matched to cases (case-control file {CCF}). Exposed fathers were identified through the linkage of the CCF to the Mining Master File or the National Dose Registry file, which include those who worked in Ontario uranium mines 1952-1986. For men who linked with a case or control child, radon, gamma and total gonadal doses were estimated for three preconception periods: entire, 3-months and 6-months. Odds ratios were estimated using conditional logistic regression. Results: Linkage of 28,991 uranium miners and 40,482 case-control pairs of fathers and offspring in the CCF identified 431 discordant pairs. There was no evidence of increased risk of a child having a CA if the father was ever a uranium miner before conception of the child (OR=0.89, 95% CI=0.74–1.08). Since gamma radiation (especially during the 6-month preconception period) is more biologically relevant to gonads than radon, further analyses were performed on 117 discordant pairs where data on gamma exposures were available. When ever/never miner, exposed to gamma (yes/no), and gamma dose-response variables were all in the model, there was no ever/never miner effect (OR=1.20, 95% CI=0.85–1.69, p-value=0.30), an inverse association for exposure to gamma (OR=0.42, 95% CI=0.25–0.71, p-value=0.001), but most importantly, there was no statistically significant dose-response relationship between gamma dose during the 6-month preconception period and all CAs (OR=1.15 per loge {mSv+0.01}, 95% CI=0.83–1.59, p-value=0.40). Similarly, no dose-response relationship was observed for exposure to gamma radiation in the 3-month preconception period, or for radon or total gonadal radiation in the 3- or 6-month preconception periods. Conclusion: There was no increased risk of a CA among liveborn children of Ontario uranium miners who were exposed to radon, gamma or total radiation during the 3- or 6-month periods before conception.

This study estimates the association between dietary factors and spontaneous pancreatitis in dogs. A case-control study was conducted using 198 dogs with a clinical diagnosis of pancreatitis and 187 control dogs with a diagnosis of renal failure without clinical evidence of pancreatitis. Information on signalment, weight, body condition, dietary intake, medical history, diagnostic tests performed, concurrent diseases, treatment, length of hospital stay, and discharge status was extracted from medical records for dogs admitted to the Texas A&M University Small Animal Clinic (TAMU SAC) during January 2000 to December 2005. Information on dietary intake, signalment, weight, medical, surgical and environmental history was collected for the same dogs through a telephone questionnaire conducted from November 2006 through January 2007. Descriptive statistics were calculated, tabular analyses performed, and logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Based on information extracted from the medical records, ingesting unusual food (OR=4.3; CI=1.7 to 10.7), ingesting table food (OR=1.5; CI=1.0 to 2.2), or exposure to both of these dietary factors (OR=2.1; CI=1.3 to 3.2) increased the odds of pancreatitis. Collected through the telephone questionnaire, ingesting unusual food (OR=6.1; CI=2.2 to 16.5), ingesting table scraps the week before diagnosis (OR=2.2; CI=1.2 to 3.8) or regularly throughout life (OR=2.2; CI=1.2 to 4.0), and getting into the trash (OR=13.2; CI=2.1 to undefined) increased the odds of pancreatitis. Multivariable modeling estimated the associations of exposure to one or more dietary factors reported through the telephone questionnaire (OR=2.6; CI=1.4 to 5.0), overweight (OR=1.3; CI=0.7 to 2.5), year of diagnosis (OR=3.5; CI=1.9 to 6.5), neuter status (OR=3.6; CI=1.4 to 9.5), non-neuter surgery (OR=21.1; CI=3.3 to 133.9) and an interaction term between neuter status and non-neuter surgery (OR=0.1; CI=0.01 to 0.4). Dietary factors increase the odds of spontaneous pancreatitis in dogs.

Contexte. Les études cas-témoins sont très fréquemment utilisées par les épidémiologistes pour évaluer l’impact de certaines expositions sur une maladie particulière. Ces expositions peuvent être représentées par plusieurs variables dépendant du temps, et de nouvelles méthodes sont nécessaires pour estimer de manière précise leurs effets. En effet, la régression logistique qui est la méthode conventionnelle pour analyser les données cas-témoins ne tient pas directement compte des changements de valeurs des covariables au cours du temps. Par opposition, les méthodes d’analyse des données de survie telles que le modèle de Cox à risques instantanés proportionnels peuvent directement incorporer des covariables dépendant du temps représentant les histoires individuelles d’exposition. Cependant, cela nécessite de manipuler les ensembles de sujets à risque avec précaution à cause du sur-échantillonnage des cas, en comparaison avec les témoins, dans les études cas-témoins. Comme montré dans une étude de simulation précédente, la définition optimale des ensembles de sujets à risque pour l’analyse des données cas-témoins reste encore à être élucidée, et à être étudiée dans le cas des variables dépendant du temps. Objectif: L’objectif général est de proposer et d’étudier de nouvelles versions du modèle de Cox pour estimer l’impact d’expositions variant dans le temps dans les études cas-témoins, et de les appliquer à des données réelles cas-témoins sur le cancer du poumon et le tabac. Méthodes. J’ai identifié de nouvelles définitions d’ensemble de sujets à risque, potentiellement optimales (le Weighted Cox model and le Simple weighted Cox model), dans lesquelles différentes pondérations ont été affectées aux cas et aux témoins, afin de refléter les proportions de cas et de non cas dans la population source. Les propriétés des estimateurs des effets d’exposition ont été étudiées par simulation. Différents aspects d’exposition ont été générés (intensité, durée, valeur cumulée d’exposition). Les données cas-témoins générées ont été ensuite analysées avec différentes versions du modèle de Cox, incluant les définitions anciennes et nouvelles des ensembles de sujets à risque, ainsi qu’avec la régression logistique conventionnelle, à des fins de comparaison. Les différents modèles de régression ont ensuite été appliqués sur des données réelles cas-témoins sur le cancer du poumon. Les estimations des effets de différentes variables de tabac, obtenues avec les différentes méthodes, ont été comparées entre elles, et comparées aux résultats des simulations. Résultats. Les résultats des simulations montrent que les estimations des nouveaux modèles de Cox pondérés proposés, surtout celles du Weighted Cox model, sont bien moins biaisées que les estimations des modèles de Cox existants qui incluent ou excluent simplement les futurs cas de chaque ensemble de sujets à risque. De plus, les estimations du Weighted Cox model étaient légèrement, mais systématiquement, moins biaisées que celles de la régression logistique. L’application aux données réelles montre de plus grandes différences entre les estimations de la régression logistique et des modèles de Cox pondérés, pour quelques variables de tabac dépendant du temps. Conclusions. Les résultats suggèrent que le nouveau modèle de Cox pondéré propose pourrait être une alternative intéressante au modèle de régression logistique, pour estimer les effets d’expositions dépendant du temps dans les études cas-témoins / Background: Case-control studies are very often used by epidemiologists to assess the impact of specific exposure(s) on a particular disease. These exposures may be represented by several time-dependent covariates and new methods are needed to accurately estimate their effects. Indeed, conventional logistic regression, which is the standard method to analyze case-control data, does not directly account for changes in covariate values over time. By contrast, survival analytic methods such as the Cox proportional hazards model can directly incorporate time-dependent covariates representing the individual entire exposure histories. However, it requires some careful manipulation of risk sets because of the over-sampling of cases, compared to controls, in case-control studies. As shown in a preliminary simulation study, the optimal definition of risk sets for the analysis of case-control data remains unclear and has to be investigated in the case of time-dependent variables. Objective: The overall objective is to propose and to investigate new versions of the Cox model for assessing the impact of time-dependent exposures in case-control studies, and to apply them to a real case-control dataset on lung cancer and smoking. Methods: I identified some potential new risk sets definitions (the weighted Cox model and the simple weighted Cox model), in which different weights were given to cases and controls, in order to reflect the proportions of cases and non cases in the source population. The properties of the estimates of the exposure effects that result from these new risk sets definitions were investigated through a simulation study. Various aspects of exposure were generated (intensity, duration, cumulative exposure value). The simulated case-control data were then analysed using different versions of Cox’s models corresponding to existing and new definitions of risk sets, as well as with standard logistic regression, for comparison purpose. The different regression models were then applied to real case-control data on lung cancer. The estimates of the effects of different smoking variables, obtained with the different methods, were compared to each other, as well as to simulation results. Results: The simulation results show that the estimates from the new proposed weighted Cox models, especially those from the weighted Cox model, are much less biased than the estimates from the existing Cox models that simply include or exclude future cases. In addition, the weighted Cox model was slightly, but systematically, less biased than logistic regression. The real life application shows some greater discrepancies between the estimates of the proposed Cox models and logistic regression, for some smoking time-dependent covariates. Conclusions: The results suggest that the new proposed weighted Cox models could be an interesting alternative to logistic regression for estimating the effects of time-dependent exposures in case-control studies.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Made available in DSpace on 2011-05-04T12:36:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / O aumento das taxas de incidência e mortalidade dos tumores do sistema nervoso central no Brasil e no mundo tem impulsionado a investigação de seus fatores etiológicos. As exposições ambientais, principalmente as ocupacionais, têm sido foco crescente destes trabalhos. Este estudo caso-controle de base hospitalar realizado na região metropolitana do Rio de Janeiro, entre 1999-2002, teve como objetivo identificar as associações entre ramos de atividade econômica e ocupações referidas com as neoplasias intracranianas em adultos, segundo subtipos histológicos gliomas emeningiomas. Foi analisada a história ocupacional de 239 casos e 267 controles, pareados por freqüência de sexo e idade, utilizando as classificações por ramos de atividades econômicas e por grupos ocupacionais. Os riscos foram estimados por regressão logística. Na análise por ramo de atividade, a Agricultura apresentou OR: 2,52(IC 95 por cento: 1,15 5,53) para o conjunto das neoplasias cerebrais. Além disso, Saúde e Social, Administração Pública e Educação apresentaram associação positiva sem significância estatística. Quanto aos meningiomas, observou-se risco em trabalhadores das áreas de Transporte (OR: 3,14, IC 95 por cento: 1,08 9,19) e Bens Imóveis (OR: 2,45, IC 95 por cento: 1,17 5,15). Em relação aos grupos ocupacionais, os agricultores apresentaram risco significativo: OR: 2,44 (IC 95 por cento: 1,14 5,18). Associação direta foi evidenciada nos grupos de Transporte / Produção de Equipamentos e Forças Armadas enquanto que Profissionais Técnicos e Trabalhadores com Vendas apresentaram associação inversa. A análise para gliomas mostrou risco para Empregados de Escritório: OR: 2,33 (IC 95 por cento: 1,02 5,29). Os achados sugerem que trabalhadores da agricultura, militares e profissionais de saúde apresentam risco para neoplasias intracranianas, demandando novas pesquisas para identificação de exposições específicas. / The increase of incidence and mortality taxes of brain tumors in Brazil and the world has stimulated the inquiry of its etiological factors. Environmental exposure, mainly the occupational ones, have been extensively focused in the studies. This case-control study of hospital base carried through in the metropolitan region of Rio de Janeiro, between 1999-2002, had as objective to identify associations between branches of economic activity and occupations related with brain tumors in adults, according to histological subtypes gliomas and meningiomas. It was analyzed the occupational history of 239 cases and 267 controls, matched by frequency of sex and age, using the classifications for branches of economic activities and occupational groups. The risks had been esteem by logistic regression. In the analysis for activity branch, Agriculture presented OR: 2,52 (CI 95%: 1,15 - 5,53) for brain tumors with no histological stratification. Moreover, Social and Health, Public Administration and Education had presented positive association without significance statistics. To meningiomas, it´s observed elevated risk in workers of the areas of Transport (OR: 3,14 CI 95%: 1,08 - 9,19) and Real Estate Activities (OR: 2,45, CI 95%: 1,17 - 5,15). In relation to the occupational groups, the agriculturists had presented significant risk: OR: 2,44 (CI 95%: 1,14 - 5,18). Direct association was evidenced in the groups of Transport/Production of Equipaments and Professional Armed Forces, whereas Technical Workers and Sell Workers had presented inverse association. The analysis for gliomas showed risk for Office Employees: OR: 2,33 (IC 95%: 1,02 - 5,29). The findings suggest that agriculture workers, military and health professionals present risk for brain tumors, demanding new researches for identification of specific expositions.

Introdução: A psoríase é uma doença sistêmica crônica, inflamatória e imuno- mediada, que afeta a pele, vasos e sistema osteomuscular. A inflamação é um fator de risco importante para a aterosclerose, e a psoríase está associada com risco aumentado de dislipidemia, diabetes, hipertensão, obesidade e esteato-hepatite não alcoólica. No entanto, o impacto da inflamação crônica sistêmica sobre a saúde vascular e aterosclerose permanece mal compreendido. Objetivos: Analisar a associação entre psoríase e aterosclerose subclínica com uma medição não invasiva, avaliada no ramo das artérias carótidas, usando a espessura médio-intimal (IMTc). O objetivo secundário foi comparar a IMTc entre os subgrupos psoríase: leve, moderada à psoríase/grave e artropática, com o grupo controle. Métodos: Neste estudo caso-controle transversal, 221 pacientes com psoríase (31,2% psoríase leve, 41,6% psoríase moderada/grave e 31,2% psoríase artropática) foram comparados com um grupo de 5.061 controles existentes recrutados a partir de um inquérito anterior (ELSA-Brasil HU-USP). Os critérios de inclusão compreendem os seguintes fatores: acima de 40 anos de idade para mulheres e 35 anos para homens; psoríase diagnosticada e clinicamente ativa, pelo menos há dois anos. Os critérios de exclusão foram: gravidez, presença de neoplasia, gota, artrite reumatóide e lúpus eritematoso sistêmico. Todos os participantes foram submetidos a exame médico, exame clínico e dados antropométricos recolhidos, bem como amostras de sangue para análise laboratorial. Em seguida, foram realizados exame de ultrassonografia das artérias carótidas direita e esquerda a fim de determinar IMTc. Ambos os lados analisados com média dos valores; quando aumentados foram utilizadas como um indicador da aterosclerose subclínica. Resultados: No grupo psoríase, o tempo médio de doença foi de 16 (± 13) anos. Em relação ao IMT da carótida (média dos lados direito e esquerdo), não observamos valores aumentados no grupo de psoríase, em comparação com o grupo controle, com os dados crus (P = 0,24 e P = 0,83, IMT esquerda e IMT direita, respectivamente). No entanto, quando o ajuste por sexo e idade (P = 0,038 e P < 0,0001, IMT para a esquerda e direita, respectivamente) e um ajuste multivariado para o risco cardiovascular, uma diferença significativa é encontrada (P = 0,028 e P < 0,0001, IMT esquerda e IMT direita, respectivamente) com valores mais elevados da carótida IMT no grupo de psoríase do que no grupo controle. Em consonância com isso, não foram observadas diferenças na IMT entre ameno, sub-grupos artrite psoriática moderado-grave e grupo controle (P = 0,50 e P = 0,52, respectivamente). Hipertensão, Hs CRP, IMC, HDL e LDL foram maiores nos pacientes com psoríase, em comparação com os controles (ambos p < 0,001). Conclusões: Na coorte brasileira, pacientes com psoríase apresentaram um perfil mais grave de fatores de risco cardiovascular do que os controles, em função do aumento da espessura da parede da artéria carótida encontrada nesses pacientes. O papel preciso da inflamação sistêmica crônica e outros fatores sobre a progressão da doença e comorbidades devem ainda ser elucidados . / Introduction: Psoriasis is a chronic systemic immune-mediated inflammatory disease affecting skin, vessels and osteomuscular system. Inflammation is an important risk-factor for atherosclerosis and psoriasis is associated with increased risk for dislipidemia, diabetes, hypertension, obesity and non-alcoholic steatohepatitis. However, the impact of chronic systemic inflammation on vascular health and atherosclerosis remains poorly understood. Objectives: To examine the association between psoriasis and subclinical atherosclerosis assessed at the carotid artery branch using a non-invasive measurement of the intima-media thickness (IMTc). The secondary objective was to compare the IMTc between psoriasis subgroups: mild, moderate / severe psoriasis and arthropathica with control group. Methods: In this cross-sectional case-control study, 221 psoriasis patients (31.2% mild psoriasis, 41.6% moderate-severe psoriasis and 31.2% arthritic psoriasis) were compared with a group of 5,061 existing controls recruited from a previous investigation (ELSA-Brasil HU-USP). Inclusion criteria were: 40 y of age for women and 35 y of age for men; psoriasis diagnosed and clinically active for at least 2 years. Exclusion criteria were: pregnancy, neoplasia, gout, rheumatic arthritis and systemic lupus erythematosus. All participants were submitted to medical screening, clinical examination and had anthropometric data collected as well as blood samples for laboratorial analysis. Then, they undertook an ultrasound scan of the right and left carotid arteries in order to determine IMTc. Both sides were averaged and increased values were used as an indicator of subclinical atherosclerosis. Results: The psoriasis group the mean disease time was 16±13 years. In relation to the carotid IMT (right and left sides averaged), we did not observe increased values in the psoriasis group as compared to the control group, with crude data (P = 0,24 and P = 0,83, IMT left and IMT right respectively). However, when adjusting by sex, age (P = 0,038 and P < 0,0001, IMT left and IMT right respectively) and a multivariate adjustment for cardiovascular risk, a significant difference is found (P = 0,028 and P < 0.0001, IMT left and IMT right respectively) with higher carotid IMT values in the psoriasis group than in the control group. In line with this, no differences were observed in the IMT between mild, moderate-severe, psoriatic arthritis sub-groups and control group (P = 0.50 e P = 0.52, respectively). Hypertension, Hs CRP, BMI, HDL and LDL were higher in psoriasis patients as compared to controls (both p < 0.001). Conclusions: In the Brazilian cohort, psoriasis patients presented a more severe profile of cardiovascular risk factors than controls, with increased carotid arterial wall thickness being found in these patients. The precise role of chronic systemic inflammation and other factors on disease progression and comorbidities are yet to be elucidated

Eventos adversos (EAs), definidos como complicações não intencionais decorrentes do cuidado prestado, são reconhecidos como um dos maiores problemas na área da saúde. Embora a maior parte dos eventos acarrete incapacitações leves, uma proporção considerável está relacionada à morte de pacientes. O atendimento de urgência é considerado importante fator de risco para o desencadeamento destas complicações. No Brasil, estudos relacionados a este tema não foram publicados até o momento. O presente estudo objetivou identificar a ocorrência de EAs em pacientes admitidos por acidente vascular cerebral (AVC) ao Pronto-Socorro de Clínica Médica (PSM) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) e determinar as categorias de EAs associadas a óbito. Este estudo caso-controle pareado envolveu 468 pacientes admitidos por AVC ao PSM-HCFMUSP no período de março de 1996 a setembro de 1999. O grupo-caso compreendeu 234 óbitos hospitalares consecutivos e o grupo-controle 234 pacientes que receberam alta, pareados pelo diagnóstico provisório e pela época de internação. Eventos adversos, detectados por revisão de prontuários, foram classificados segundo sua gravidade, causas imediatas, sistemas acometidos e categorias profissionais envolvidas no cuidado aos pacientes. A associação com óbito foi analisada por regressão logística multivariada condicional, incluindo variáveis relacionadas a aspectos demográficos, gravidade do quadro inicial e características da assistência. Nos 468 pacientes foram identificados 1.218 EAs: 932 EAs (76,5%) em 170 casos e 286 EAs (23,5%) em 125 controles. Eventos adversos major corresponderam a 54,1% do total de eventos, com 659 episódios: 538 eventos em 143 casos e 121 em 65 controles. Os procedimentos diagnósticos e terapêuticos e os cuidados de enfermagem foram responsáveis em conjunto por 55,2% do total de eventos. Em relação ao tipo de sistema afetado, 46,0% dos EAs identificados ocasionaram manifestações gerais. Eventos adversos relacionados à enfermagem e EAs médicos representaram as categorias profissionais de EAs mais freqüentes (38,4% e 31,0% do total de eventos). Uma associação significante com óbito foi encontrada em relação a EAs major, EAs médicos e infecções hospitalares, com valores de OR ajustado estimados em 3,72 (IC 95% = 1,63-8,48), 3,69 (IC 95% = 1,60-8,50) e 3,20 (IC 95% = 1,20-8,51), respectivamente. Em resumo, eventos adversos, na sua maioria graves, foram freqüentes em casos e controles, determinando predominantemente manifestações gerais. Os procedimentos diagnósticos e terapêuticos e os cuidados de enfermagem corresponderam às principais causas imediatas de EAs. Em relação à categoria profissional envolvida, os EAs relacionados à enfermagem e os eventos médicos predominaram. Eventos adversos major, EAs médicos e as infecções hospitalares associaram-se de maneira significante com óbito em pacientes com AVC admitidos ao Pronto-Socorro de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo / Adverse events (AEs), defined as unintended injuries caused by medical care, are recognized as a major health problem. Although most of them lead to minimal impairments, a considerable proportion is related to patients’ death. Urgent care is considered an important AE risk factor. No related Brazilian studies were published so far. The present study aimed to identify the occurrence of AEs in patients admitted for stroke to the medical emergency department of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) and to determine the AEs’ categories associated to death. This paired case-control study enrolled 468 patients admitted for stroke to the HCFMUSP medical emergency department from March 1996 to September 1999. The cases comprised 234 consecutive deaths and the controls 234 discharged patients, matched for primary diagnosis and admission period. AEs, detected by retrospective chart review, were classified with regard to their severity, immediate causes, affected systems and professional involved in patient care. The association with death was analyzed by multivariate conditional regression including variables related to demographic aspects, clinical severity on admission and care characteristics. A total of 1,218 AEs were identified in 468 patients: 932 AEs (76.5%) in 170 cases and 286 AEs (23.5%) in 125 controls. Major AEs corresponded to 54.1% of all AEs, with 659 episodes: 538 events in 143 cases and 121 in 65 controls. Diagnostic and therapeutic procedures and nursing activities accounted together for 55.2% of all events. Concerning the affected system, 46.0% of the identified AEs lead to general manifestations. Nursing and medical AEs represented the most frequent professional categories involved (38.4% and 31.0% of all events). A significant association with death was found regarding major AEs, medical AEs and nosocomial infections, with adjusted OR estimates of 3.72 (95% IC = 1.63-8.48), 3.69 (95% IC = 1.60-8.50) and 3.20 (95% IC = 1.20-8.51), respectively. In summary, adverse events, most of them severe, were frequent in cases and controls, leading mainly to general manifestations. Diagnostic and therapeutic procedures and nursing activities corresponded to the main AEs’ immediate causes. Regarding the professional involved, AEs related to nurses and physicians predominated. Major AEs, medical AEs and nosocomial infectious were significantly associated to death in stroke patients admitted to the medical emergency department of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

O processo de reparação tecidual evolui tardiamente com alteração das propriedades físicas da pele, cuja gravidade varia, entre outros fatores, em função da profundidade original da lesão. Clinicamente a pele é seca, descamativa, discrômica e com diminuição da elasticidade, especialmente em cicatrizes hipertróficas. As características do tegumento pós-queimadura podem ser melhoradas com agentes de uso tópico normalmente utilizados em patologias como acne e fotoenvelhecimento. Foram avaliados 77 pacientes portadores de seqüela de queimadura peri-oral, entre seis e 46 anos de idade. O tipo de tegumento foi classificado como restaurado, quando epitelizado espontaneamente, ou enxertado. O tratamento tópico consistiu de tretinoína (0,01-0,05%) e ácido glicólico (5-7%) durante três meses. Duas distâncias foram medidas com paquímetro digital em abertura bucal máxima, a inter-dentária (D) e a inter-labial (L). Houve aumento significativo (p£0,01) de D e L nos grupos tratados quando comparados aos respectivos controles, tanto nos pacientes com tegumento restaurado como nos enxertados. O aumento de L foi significativamente maior que D. Sugerimos a utilização da medida inter-labial como parâmetro complementar à medida inter-incisal como método de avaliação indireta da elasticidade cutânea no tegumento pós-queimadura. / Tissue repair processes evolve with alterations of the cutaneous physical properties, which are proportional, among other factors, to the original depth of the lesion. At examination, the skin is dry, dyschromic and less elastic, specially in hypertrophic scars. Post-burn skin characteristics can be improved by topical agents regularly used in pathologies like acne or photodamage. We evaluated 77 patients who had peri-oral burn sequela. The ages ranged from six to 46 years old. The tegument was classified as restored, when spontaneously healed, or skin grafted. The topical treatment consisted of tretinoin (0,01-0,05%) and glycolic acid (5-7%) for three months. Inter-incisal (D) and inter-labial (L) distances were measured at maximal mouth opening with a digital pachymeter. Both inter-incisal and inter-labial distances increased significantly in the groups treated when compared to respective controls (p£0,01). This fact was similar in both types of tegument. Inter-labial distance (L) increased significantly more than D. We suggest its use as a complementary measure to inter-incisal distance for indirect evaluation of skin elasticity in the post-burn tegument.