People with severe mental illness experience medical comorbidities to a greater extent than the general population. When hospitalized in general hospital settings, they experience poorer outcomes and are experienced as difficult by nurses. An understanding of the experience of hospitalization from the patient's perspective is important to improving care and outcomes for this population. The purpose of this study was to explore the lived experience of nonpsychiatric hospitalization for persons with severe mental illness. Heideggarian phenomenology provided the philosophical underpinning and informed the methodology employed. Participants were recruited through mental health providers. Ten individuals with severe mental illness participated in minimally structured interviews and described their experience of hospitalization on a medical-surgical unit. Data, including transcribed interviews and field notes, were analyzed within the hermeneutic tradition as described by Cohen et al. (2000). The lived experience of nonpsychiatric hospitalization was expressed in four themes: taking care of me (subthemes: being cared for, not being cared for), it's my life, on my toes (subthemes: needing an advocate, managing my mental health), and being a good patient. Care providers' comportment, perception of the patient's illness, attentiveness, responsiveness, and personalized caring behaviors characterized the participant experience of being cared for or not being cared for. It's my life reflected participants' desire to be informed and involved so they could contribute to their recovery. Participants felt the need to be on my toes in order to look out for and advocate for themselves. The need to be on my toes extended to the management of a chronic illness while hospitalized for an unrelated acute condition. The final theme reflected the perceived patient role obligation to be a "good patient". Findings were consistent with the literature regarding experiences of hospitalization from the perspective of persons without mental illness. Identified themes emphasize the critical importance of the nurse-patient relationship to the patient experience. There are significant implications for how nurses come to know their patients in medical-surgical settings so that they can effectively personalize care. Reflective practices may empower nurses to solicit assistance and support to improve caring practices / text

Background: Lung cancer causes more deaths than any other cancer. Smoking causes roughly 90% of lung cancer cases. Concurrent chemoradiation therapy is the standard of care for stage IIIb patients with performance status (PS) 0-1. A less toxic approach is warranted for less fit patients. To optimize care, the understanding of common clinical variables such as haematological responses to inflammation could be much improved. Adherence to guidelines for proper clinical work-up is vital to ensure patients’ optimal care, especially for predictive assays. Screening of high-risk patients is now being implemented internationally. Chronic pulmonary obstructive disease (COPD) patients, a group at high risk to develop lung cancer, could be of interest for screening. Methods: Patient cohorts collected nationally and regionally by manual search in patient records or automated search in electronic patient records and national registries were analysed in relation to overall survival, comorbidities, medication, treatment, smoking status, biomarkers and adherence to guidelines. Standard statistics were applied to adjust for confounding factors. Results: Induction chemotherapy results in longer overall survival than radiotherapy alone (15.6 and 11.6 months respectively). The overall survival for patients with combined anaemia, leucocytosis and thrombocytosis at diagnosis is half of what could be anticipated if blood samples are normal (8.0 and 16.0 months respectively). Fifty percent of patients were overlooked in the routine work-up with EGFR analysis. Less than 40% of the patients received EGFR-tyrosine kinase inhibitors in first-line therapy. The frequency of EGFR mutation was 9.9%. COPD patients with asthma and medicating with inhaled corticosteroids, specific serotonin reuptake inhibitors (SSRI) or beta-blockers have a significantly decreased risk of lung cancer. Conclusions: Patients unfit to receive chemoradiation therapy should be considered for induction chemotherapy sequentially to radiotherapy. A patient that presents with pathological blood samples is likely to have poor prognosis and diagnostic work-up should be thorough to optimize outcome. Inadequate adherence to the national guidelines regarding treatment and EGFR analysis was shown. COPD patients medicating with ICS, beta-blockers or SSRI and with a concurrent asthma diagnosis have a decreased risk of lung cancer.

The objective of this thesis is to formalize, model, align and operationalize the evidence-based clinical algorithms of co-morbid chronic heart failure (CHF) and atrial fibrillation (AF) in order to provide clinical recommendations, care coordination and decision support to general practitioners (GPs). This thesis addresses following healthcare knowledge modeling issues: (a) modeling of healthcare knowledge, especially in terms of clinical guidelines and clinical pathways, to develop an ontology-based knowledge model for handling co-morbid diseases; (b) computerization of clinical pathways to offer point-of-care decision support; (c) alignment of ontologically-modeled disease-specific clinical pathways to handle co-morbid diseases; and (d) the provision of computerized decision support to GPs, based on modeled clinical guidelines and pathways, to assist them in handling co-morbid diseases. An elaborate OWL CP ontology for co-morbid CHF and AF was developed that can be executed to support the diagnosis and management of co-morbid CHF and AF in a general practice setting. / In this thesis we present an ontology based decision-support framework for handling co-morbidities by the alignment of ontologically modeled clinical practice guidelines (CPGs). The objective of this thesis is to formalize, model, align and operationalize the evidence-based clinical algorithms of co-morbid chronic heart failure (CHF) and atrial fibrillation (AF) in order to provide evidence-based clinical recommendations, care coordination and decision support to general practitioners (GPs) for effective management of CHF and AF. In this regard, the thesis addresses the following healthcare knowledge modeling issues: (a) modeling of healthcare knowledge, especially in terms of clinical guidelines and clinical pathways, to develop an ontology-based healthcare knowledge model for handling co-morbid diseases; (b) computerization of clinical pathways to offer point-of-care decision support; (c) alignment of ontologically-modeled disease-specific clinical pathways to handle co-morbid diseases; and (d) the provision of computerized decision support to general practitioners, based on modeled clinical guidelines and pathways, to assist them in handling chronic and co-morbid diseases. An elaborate OWL CP ontology for co-morbid CHF and AF—the CP ontology was developed that can be executed to support the diagnosis and management of co-morbid CHF and AF in a general practice setting. We have developed a decision support framework termed COMET (Co-morbidity Ontological Modeling & ExecuTion) that can handle three patient care scenarios, (i) patient has CHF; (ii) patient has AF; and (iii) patient develops a co-morbidity of both AF and CHF. COMET is accessible by web and is designed for GPs. COMET has been evaluated, both by simulated cases and by health professionals (GP and specialist), for its ability to handle single disease and comorbid care scenarios based on patient data and related constraints. The output at every phase is compared with the expected output as per single disease or comorbid management. Our results show that the resultant sequence of plans and their outcomes are comparable to the CP knowledge. Also, our ontology was able to handle any updates in the CP knowledge as advised by the domain experts

ABSTRACT IMPORTANCE: Age-related macular degeneration (AMD) is a leading cause of low vision in elderly population. The association of vascular and renal conditions has been reported inconsistently. Unfolding the association may provide the insight to eye care providers to take account general health management into eye care. OBJECTIVES: To investigate the prevalence of the vascular and renal comorbidities with AMD, examine the association of a single or combination of these comorbidities with AMD. DSIGN AND PARTICIPANTS: Population-base cross-sectional study involved the adults aged 40 years or older (N=4596) who participated in the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES), a national representative population-based survey of non-institutionalized US residents. MAIN OUTCOMES AND MEASURES: AMD was defined by the presence of drusen and presence of pigmental abnormality. Angina pectoris (AP), coronary heart disease (CHD), congestive heart failure (CHF) and myocardial infarction (MI), and stroke, assessed by self-report by the questionnaire of medical conditions, Chronic kidney disease (CKD), assessed by self-report and estimation of glomerular filtration rate (GFR) and the level of urine albumin. Heart disease (HD) was defined as having AP or CHF or CHD or MI. RESULTS: Among individuals with AMD, 6% had AP, 10% had CHD, 7% had CHF, 10% had MI, 13% had stroke, and 29% had CKD. The weighted prevalence of these conditions were significantly higher than those without AMD (All P-values CONCLUSION AND RELEVANCE: These findings from the nationally-representative sample of the US population highlight the prevalence of vascular and renal comorbidities associated with AMD, the modest evidence of relationship of each single comorbidity, and strong association of combination of stroke and CKD to AMD independent of age, gender, and other factors. Because of the cross-sectional design, the results of this study can not address a causal relationship between AMD and the examined comorbidities. It is unclear whether AMD and comorbidities arise from individual predisposition to vascular and renal diseases or whether complications from these morbidities increase the risk of AMD. However, the important caveat is that preventive and care management for the examined comorbidities may lessen the severity of symptoms or prevent AMD.

Submitted by JOSÉ WILLIAM ZUCCHI null (jwzucchi@hotmail.com) on 2018-04-02T23:13:39Z No. of bitstreams: 1 Dissertação Mestrado José W. Zucchi.pdf: 2342865 bytes, checksum: 860bbd3c7b2672c61b7ca6b121b0e8f9 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-04-03T12:55:11Z (GMT) No. of bitstreams: 1 zucchi_jw_me_bot.pdf: 2342865 bytes, checksum: 860bbd3c7b2672c61b7ca6b121b0e8f9 (MD5) / Made available in DSpace on 2018-04-03T12:55:11Z (GMT). No. of bitstreams: 1 zucchi_jw_me_bot.pdf: 2342865 bytes, checksum: 860bbd3c7b2672c61b7ca6b121b0e8f9 (MD5) Previous issue date: 2018-02-28 / Introdução: Os pacientes com doença pulmonar obstrutiva crônica (DPOC) exibem características clínicas heterogêneas que estão associados a diferentes respostas a tratamentos e prognósticos. A complexidade da doença faz com que sejam buscadas ferramentas alternativas como o agrupamento de cluster para a identificação de características específicas e que possam tratadas diferentemente dentro da mesma doença. Entretanto, ainda são escassos dados da América Latina em relação aos possíveis clusters da DPOC. Objetivo: Avaliar os possíveis clusters na DPOC em dois centros de estudo no Brasil. Métodos: Os pacientes foram submetidos à avaliação composta por doenças associadas, Índice de Charlson, composição corporal, fármacos atuais, história de tabagismo (anos/maço), monóxido de carbono exalado, histórico de exacerbações/ hospitalizações no último ano, espirometria, teste de caminhada de seis minutos, questionários de qualidade de vida, dispneia e escala hospitalar de ansiedade e depressão. Também foram coletadas amostras de sangue para dosagens de proteína C reativa (PCR), gases sanguíneos, análise laboratorial e hemograma. Resultados: Foram avaliados 334 pacientes portadores de sintomas respiratórios e fator de risco para DPOC. Desse total, 13 pacientes foram excluídos do estudo por não terminarem o protocolo, 20 pacientes sem diagnóstico de DPOC e 10 por não terem sido classificados em nenhum cluster. Assim, foram incluídos 291 pacientes [53,6% homem, 67,5 ± 9,6 anos e volume expiratório forçado no primeiro segundo (VEF1) = 45,5 ± 17,9]. Para a construção dos clusters foram selecionadas 13 variáveis continuas e realizado análise com o método de Ward e método K means que determinaram quatro clusters. O primeiro cluster foi caracterizado por menor gravidade sintomática e funcional da doença, o segundo grupo por maior valor de eosinófilos periféricos, o terceiro grupo por serem mais inflamados sistemicamente e o quarto grupo por serem com maior gravidade obstrutiva e pior troca gasosa. O cluster 2 apresentou média de 959± 3 eosinófilos periféricos, cluster 3 apresentou maior prevalência de depleção nutricional (46,1%) e o cluster 4 apresentou maior índice BODE. Em relação as comorbidades associadas identificamos que apenas a síndrome de apneia obstrutiva do sono e o tromboembolismo pulmonar foram mais prevalentes no cluster 4. Conclusão: As manifestações clínicas e comorbidades associadas da DPOC identificadas nos quatros diferentes clusters deste estudo mostram as características heterogêneas da doença e isso pode estar relacionado à desfechos prognósticos diferentes em cada cluster podem diferenciar o tratamento em cada agrupamento com maior efetividade. / Introduction: Patients with chronic obstructive pulmonary disease (COPD) exhibit heterogeneous clinical features that are associated with different responses to treatments and prognoses. The complexity of the disease causes alternative tools such as clustering to identify specific characteristics and that can be treated differently within the same disease. However, there are still little data from Latin America regarding possible clusters in COPD. Objective: To evaluate possible clusters in COPD in two Brazilian centers. Methods: We assesses the comorbidities, Charlson's index, body composition, pharmacological treatment, smoking history (pack-years), exhaled carbon monoxide, exacerbations/hospitalizations rate in the last year, spirometry, six-minute walk test, quality of life questionnaires, dyspnea and hospital anxiety and depression scale. We also collected blood gases, laboratory and blood counts. Results: A total of 334 patients with respiratory symptoms and a risk factor for COPD were evaluated. From the total, 13 patients were excluded from the study because they didn’t complete the protocol, 20 patients without a diagnosis of COPD and 10 because they were not classified in any cluster. Thus, 291 patients were included [53.6% male, 67.5 ± 9.6 years and forced expiratory volume in the first second (FEV1) = 45.5 ± 17.9]. For the construction of the clusters, 13 continuous variables were selected and an analysis was performed with the Ward method and K method, which determined four clusters. The first cluster was characterized by lower symptomatic and mild COPD. The second cluster was characterized by higher value of peripheral eosinophils, the third cluster with systemic inflammation and the fourth cluster had severe COPD and worst gas exchange. Cluster 2 presented a mean of 959 ± 3 peripheral eosinophils, cluster 3 presented a higher prevalence of nutritional depletion (46.1%) and cluster 4 presented higher BODE index. In relation to the associated comorbidities, we identified that only obstructive sleep apnea syndrome and pulmonary thromboembolism were more prevalent in cluster 4. Conclusion: The clinical manifestations and associated comorbidities of COPD identified in the four different clusters of this study show the heterogeneous characteristics of the disease and this may be related to different outcomes and treatment.

Foram estudados 125 pacientes em idade escolar que procuraram o Posto de Atendimento Médico Especializado (PAME) da cidade de São Leopoldo, Rio Grande do Sul, Brasil, nos anos de 2003 e 2004, encaminhados pela escola, pelo pediatra ou Conselho Tutelar, por estarem apresentando dificuldades na escolarização. Realizaram-se entrevistas com os pais ou responsáveis, exame neurológico tradicional, exame neurológico evolutivo, eletroencefalograma em sono e vigília em todas as crianças e tomografia cerebral e ressonância magnética, quando necessário. Foram estudados aspectos neuropsicossociais dos indivíduos e de suas respectivas famílias. Encontraram-se famílias comprometidas em sua história prévia e atual: 29,30% com dificuldades escolares, 27,20% com doenças psiquiátricas, 26,10% com epilepsia, 21,70% com alcoolismo e 10,90% com deficiência mental. As comorbidades tiveram um papel relevante no desempenho escolar: 50,50% com hiperatividade, 17,20% com distúrbio de conduta e 17,20% com problemas emocionais (listados como queixa principal por ocasião do encaminhamento para a triagem). / A hundred and twenty five patients at school age referred to the Ambulatory of Specialized Diseases in the town of São Leopoldo, Rio Grande do Sul, Brazil, by the school, by the pediatricians or by Tutor Counsellor, due to learning disability, were followed during the years 2003 and 2004. Parents were interviewed; neurological examination was performed as well as electroencephalographic exams. In some cases, brain computadorized tomography and brain magnetic resonance was also done, when necessary. Neurological, psychological and social aspects of the patient and his family were investigated. Both past and current conditions were found in these families: 29.30% with learning disabilities, 27.20% with mental illness, 26.10% with epilepsy, 21.70% with alcoholism, 10.90% with mental handicap. Comorbidities also played an important role in school performance: 50.50% hyperactivity, 17.20% conduct problems, 17. 20% emotional problems all listed as complaints by the school, pediatricians, parents or Tutor Counsellor.

Base teórica: A infecção pelo HIV tornou-se uma doença crônica com o uso de terapia antiretroviral combinada, e a expectativa de vida de pessoas vivendo com HIV aproxima-se da população geral. Entretanto, à medida que a população com HIV envelhece, um número elevado de comorbidades crônicas é descrito. Objetivo: comparar a prevalência de multimorbidade entre indivíduos HIV-positivos e controles HIV-negativos. Métodos: Em um estudo transversal, pacientes HIV-positivos com idade superior a 50 anos foram selecionados no Hospital de Clínicas de Porto Alegre (HCPA) e pareados a controles da Unidade Básica de Saúde do HCPA. A prevalência de multimorbidade e o número de comorbidades crônicas foi comparada entre os grupos. Um modelo de regressão foi utilizado para analisar fatores associados a ocorrência de multimorbidade na amostra de pacientes com HIV Resultados: Foram incluídos 416 pacientes no estudo. A prevalência de multimorbidade foi maior em pacientes com HIV (63% vs 43%, p<0.001). O número médio de comorbidades nos pacientes HIV-positivos e HIV-negativos foi de 2 e 1.4, respectivamente (p<0.001). A quantidade de comorbidades crônicas em pacientes com HIV foi comparável a controles 10 anos mais velhos. Duração de infecção pelo HIV (p=0.02) e de terapia antiretroviral (p=0.015) foram associadas a maior prevalência de multimorbidade, após ajuste para idade. Conclusão: Demonstramos maior prevalência de multimorbidade em pacientes com HIV. Além disso, as comorbidades estão presentes em pacientes com HIV em idades inferiores em comparação aos controles. Duração da terapia antiretroviral e de infecção pelo HIV estão associadas à ocorrência de multimorbidade. Uma rede de cuidado necessitará ser construída para manejo adequado da população que envelhece com HIV. / Background: HIV became a chronic disease with the use of combined antiretroviral therapy (cART), with life expectancy approaching that of general population. However, as HIV individuals are ageing, a large number of chronic comorbidities are being reported. Objective: The aim of this study was to compare disease burden between HIV-positive individuals with non-HIV matched controls in Brazil. Methods: In a cross-sectional study, 1:1 ratio, HIV-positive patients older than 50 years of age were enrolled at Hospital de Clínicas de Porto Alegre. HIV negative controls were from the Health Basic Unit. Prevalence of multimorbidity and number of non-AIDS related comorbidities were compared between groups. A regression model was used to analyze multimorbidity risk factors in HIV individuals Results: A total of 416 individuals were recruited. Multimorbidity prevalence was higher in HIV-positive patients (63% vs 43%, p<0.001). The mean number of comorbidities in HIV population and in HIV-negative controls was 2 and 1.4, respectively (p<0.001). Disease burden in HIV patients was comparable to that of patients 10 years older in the control group. After adjusting for age, duration of HIV infection (p=0.02) and time on ART (p=0.015) were associated with greater prevalence of multimorbidity in HIV-positive individuals. Conclusion: We demonstrate a high multimorbidity prevalence in HIV-positive patients. Furthermore, these comorbidities were present at younger age compared to non-HIV controls. Length of cART exposure and duration of HIV infection were associated with multimorbidity in HIV individuals. The world will need to construct a network to deal with the ageing of HIV population.

Submitted by CAMILA DEBASTIANI (came.db@hotmail.com) on 2018-06-29T04:57:20Z No. of bitstreams: 1 Dissertação - Camila Debastiani.pdf: 2369114 bytes, checksum: 6a444ec6d5c74327764a5ed2c35581ef (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-07-04T14:46:06Z (GMT) No. of bitstreams: 1 debastiani_c_me_bot.pdf: 2369114 bytes, checksum: 6a444ec6d5c74327764a5ed2c35581ef (MD5) / Made available in DSpace on 2018-07-04T14:46:06Z (GMT). No. of bitstreams: 1 debastiani_c_me_bot.pdf: 2369114 bytes, checksum: 6a444ec6d5c74327764a5ed2c35581ef (MD5) Previous issue date: 2018-05-10 / A obesidade é a doença nutricional mais frequente em animais de companhia que pode ser causada ou influenciada por fatores de risco, ambientais ou genéticos. O tecido adiposo é um órgão endócrino que secreta substâncias que podem apresentar-se em desequilíbrio no organismo obeso. Isso gera um prejuízo a saúde animal e pode desencadear várias comorbidades. Com a finalidade de identificar fatores de risco e principais complicações associadas a obesidade canina foram aplicados questionários on-line e físicos a tutores de cães, totalizando 1303 participações. Dos tutores entrevistados 25% consideraram que seus cães apresentavam sobrepeso ou obesidade. Os fatores de risco identificados para a obesidade relacionados ao animal foram: idade do animal (7-8 anos), raça (Labrador, Poodle, etc), sexo (fêmeas), esterilização, pouca disposição, pouca prática de atividade física, baixa duração da atividade, apetite voraz, dor e dificuldade de locomoção e uso de medicações (corticoide, fenobarbital e anticoncepcionais). Quanto aos tutores: idade (>60 anos), estado civil (divorciado), morar sozinho. As complicações que apresentaram correlação com obesidade foram: dermatopatias em geral, pele oleosa, descamação da pele, alergopatia, otopatia, claudicação, doença articular, tumor, tártaro, tosse, ronco, cansaço fácil e poliúria. / Obesity is the most frequent nutritional disease in companion animals that can be caused or influenced by environmental or genetic risk factors. The adipose tissue is an endocrine organ that secretes substances that may be in imbalance in the obese animal. This causes animal health impairment and can trigger several comorbidities. In order to identify risk factors and major complications associated with canine obesity, online and presential questionnaires were applied to dog owners, totaling 1303 participations. Of the owners interviewed, 25% considered that their dogs were overweight or obese. The risk factors identified for obesity related to the animal were: age of the animal (7-8 years), breed (Labrador, Poodle, etc), sex (females), sterilization status, little disposition and little practice of physical activity, low duration of activity, voracious appetite, pain and difficulty to locomote and use of medications (corticoid, phenobarbital and contraceptives). The risks related to owners were: age (> 60 years), marital status (divorced), live alone. The complications that presented correlation with obesity were: dermatopathies in general, oily skin, skin peeling, allergy, otopathy, lameness, joint disease, tumor, tartar, cough, snoring, easy fatigue and polyuria.

Objetivo: Analisar o impacto das co-morbidades no desempenho pós-operatório de lobectomia por carcinoma brônquico. Pacientes e Métodos: Entre Janeiro de 1998 e Dezembro de 2004, foram estudados retrospectivamente 493 pacientes submetidos à lobectomia por carcinoma brônquico, dentre os quais 305 preencheram os critérios de inclusão. Todos os pacientes foram submetidos à lobectomias com técnica cirúrgica semelhante. Foi realizada análise das co-morbidades de forma a categorizar os pacientes nas escalas de Torrington-Henderson (PORT) e de Charlson, estabelecendo-se assim grupos de risco para complicações e óbito. Resultados: a mortalidade operatória foi 2,9% e o índice de complicações de 44%. O escape aéreo prolongado foi a complicação mais freqüente (20.6%). A análise univariada mostrou que sexo, idade, tabagismo, terapia neoadjuvante e diabetes apresentaram impacto significativo na incidência de complicações. O índice de massa corporal (23,8 ± 4,4), o VEF1 (74,1±24%), bem como a relação VEF1/CVF (0,65 ± 0,1) foram fatores preditivos da ocorrência de complicações. Ambas as escalas de Charlson e PORT foram eficazes na identificação de grupos de risco e na relação com a morbi-mortalidade (p=0,001 e p<0,001). A análise multivariada identificou que o IMC e o índice de Charlson foram os principais determinantes de complicações, enquanto que o escape aéreo prolongado foi o principal fator envolvido na mortalidade (p=0,01). Conclusão: Valores reduzidos de VEF1, VEF1/CVF e IMC baixo, assim como graus 3-4 de Charlson, e 3 de PORT estão associados a maior número de complicações após lobectomias por carcinoma brônquico. Nesta amostra, o escape aéreo persistente esteve fortemente associado à mortalidade. / Objetive: To analyze the impact of comorbidities on the postoperative outcome of patients who underwent lobectomy for lung cancer. Patients and Methods: From January 1998 to December 2004, records of 493 lobectomies for lung cancer were reviewed and 305 met the inclusion criteria. All resections were carried out by the same team using the same surgical technique. The co-morbidity analysis was done in a way that all the patients could be categorized both on the Torrington-Henderson scale (PORT) and the Charlson comorbidity index to identify the highest risk patients as well as the factors involved in morbidity and mortality. Univariate and multivariate analyses were performed to define the impact of comorbidities on the postoperative outcome. Results: the operative mortality was 2.9% and complication rate was 44 %. The univariate analysis showed that gender, age, diabetes, smoking and neoadjuvant chemotherapy had no impact on morbidity. Conversely, BMI (23.8 ± 4), FEV1 (74.1±24%) and FEV1/CVF (0.65 ± 0,1) were predictors of complications (p<0.05). The PORT scale and the Charlson index were both useful to identify the patients at risk and their relationship with morbidity and mortality. The logistic regression showed that BMI (p=0.03) and the Charlson index (p=0.01) were the only significant variables involved in postoperative complications. In this study, prolonged air leak was a factor associated in mortality (p=0.01). Conclusions: low preoperative FEV1, FEV1/FVC, BMI and grades 3-4 on the Charlson and grade 3 on PORT scale were associated to higher postoperative complications. Persistent air leak was a strong predictor of postoperative mortality.

Introdução: A psoríase é uma doença inflamatória crônica, que afeta a pele, couro cabeludo, unhas e ocasionalmente as articulações. A prevalência da psoríase varia de 0,6 a 4,8% na população mundial, afetando homens mulheres igualmente. A doença tem sido associada a um maior risco de desenvolvimento de várias comorbidades. O objetivo desse estudo é avaliar a associação entre psoríase e a presença de comorbidades como hipertensão, diabetes, dislipidemia, obesidade, depressão e os hábitos de fumar e ingerir bebidas alcoólicas. Métodos: Estudo caso-controle (psoríase x não psoriásicos) realizado no ambulatório de Dermatologia do Hospital de Clínicas de Porto Alegre. Foram avaliados os parâmetros de: peso, altura, pressão arterial, circunferência abdominal e diagnóstico de comorbidades. Nos pacientes com psoríase avaliou-se também a estimativa da área corporal acometida. Resultados: O estudo incluiu 350 casos (55,1% mulheres) e 346 controles (63,6% mulheres). A média de idade dos casos em anos foi 49,81 e nos controles 48,5. Os fatores de riscos que apresentaram diferença significativa entre casos e controles estudados foram: cintura abdominal aumentada com p<0,01 e OR=2,1 (IC 95%1,3-3,3); o Índice de Massa Corporal p=0,01 e OR= 1,8 (IC 95%1,1-2,9), tabagismo com p<0,01, OR=2,1 (IC 95%1,4-2,9) e depressão com p < 0,01 e OR=2,1 (IC 95%1,4-3,2). As variáveis triglicerídeos e o consumo habitual de álcool perderam a significância após ajuste para e idade, assim como a hipertensão. Colesterol HDL, diabetes, cardiopatia e comorbidades não listadas não mostraram diferença significativa na amostra. Ao compararmos os pacientes com estimativa de acometimento da área corporal menor e maior que 20%, as comorbidades hipertensão (p=0,03 e OR=1,69 (IC 95% 1,1 - 2,6) e diabetes (p<0,01 e OR= 2,9 (IC 95%1,6-5,4) mostraram diferença significativa. O tabagismo foi mais significativo entre os pacientes com estimativa de acometimento da área corporal menor que 20% (p<0,01 e OR 0,5 (IC 95% 0,3-0,8). As demais variáveis (cardiopatia, síndrome metabólica, depressão, comorbidades não listadas, uso de álcool, cintura abdominal alterada, Índice de Massa Corporal > 25kg/m2, triglicerídeos e colesterol HDL) não mostraram diferença entre os pacientes com maior e menor acometimento da área corporal. Conclusão: Nossos resultados confirmam a prevalência de significantes comorbidades em pacientes com psoríase quando comparado com os controles. Estes achados reforçam a necessidade da implementação de uma rotina de rastreamento para riscos metabólicos e cardiovasculares, assim como orientações sobre o estilo de vida e hábitos saudáveis. / Introduction: Psoriasis is a chronic inflammatory disease that affects the skin, scalp, nails and occasionally the joints. The prevalence of psoriasis varies from 0.6 to 4.8% of the world population and affects men and women alike. The disease has been associated with an increased risk of several comorbidities. The aim of this study is to evaluate the association between psoriasis and comorbidities such as hypertension, diabetes, metabolic syndrome, dyslipidemia, obesity, depression, smoking and alcohol use. Methods: A case-control study (psoriasis vs. no psoriasis) conducted in the Dermatology Outpatient Service of the Hospital de Clinicas de Porto Alegre. The evaluated parameters were: weight, height, blood pressure, waist circumference and diagnosis of comorbidity. In the patients with psoriasis the affected body surface area was also evaluated. Results: The study included 350 cases (55.1% women) and 346 controls (63.6% women). The average age was 49.81 years in the cases and 48.5 in the controls The risk factors that showed significant differences between the studied cases and controls were: increased waist circumference with p <0.01 and OR = 2.1 (95% CI 1.3 to 3.3), Body Mass Index p = 0.01 and OR = 1.8 (95% CI 1.1 to 2.9), smoking with p <0.01, OR = 2.1 (95% CI 1.4 to 2.9) and depression with p <0. 01, and OR = 2.1 (95% CI 1.4 to 3.2). The variables, triglycerides and habitual consumption of alcohol lost significance after adjustment for age and gender, as did hypertension. HDL cholesterol, diabetes, heart disease and non-listed comorbidities showed no significant difference in the sample. When comparing patients with an estimated involved body surface area smaller and larger than 20%, the comorbidities, hypertension (p = 0.03 and OR = 1.69 (95% CI 1.1 - 2.6) and diabetes (p <0.01 and OR = 2.9 (95% CI 1.6 to 5.4) showed a significant difference. Smoking was more significant among patients with an estimated involved body surface area of less than 20% (p <0.01 and OR 0.5 (95% CI 0.3-0.8). With the other variables (heart disease, metabolic syndrome, depression, non-listed comorbidities, alcohol use, altered waist circumference, Body Mass Index > 25kg/m2, triglycerides and HDL cholesterol) there was no apparent difference between patients with smaller or larger affected body surface areas. Conclusion: Our results confirm the significant prevalence of comorbidities in psoriasis patients compared with controls. The patients with more than 20% of the BSA affected are 1.69 times more likely to have hypertension and 2.9 times more likely to have diabetes. These findings reinforce the need to implement routine screening for metabolic and cardiovascular risks, as well as guidance on lifestyle and healthy habits.