ImportanceThe vascular risk attributable to HIV infection is rising. The heterogeneity of the samples studied is an obstacle to understanding whether HIV is a vascular risk across geographic regions.ObjectiveTo test the hypothesis that HIV infection is a vascular risk factor, and that the risk conferred by HIV varies by geographical region.Data sourcesA systematic search of publications was carried out in seven electronic databases: PubMed, The Cochrane Library, EMBASE, Web of Science, LILACS, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform from inception to July 2015.Study selectionWe included longitudinal studies of HIV+ individuals and their risk of vascular outcomes of ≥ 50 HIV+ cases and excluded studies on biomarkers of vascular disease as well as clinical trials.Data extraction and synthesisData was extracted by one of the authors and independently confirmed by the other two authors. We used incidence rate (IR), incidence risk ratio (IRR) and hazard ratio (HR) with their 95% confidence intervals as measures of risk.Main outcomeAll-death, myocardial infarction (MI), coronary heart disease (CHD), any stroke, ischemic stroke (IS) or intracranial hemorrhage (ICH).ResultsWe screened 11,482 references for eligibility, and selected 117 for analysis. Forty-four cohorts represented 334,417 HIV+ individuals, 49% from the United States. Compared with their European counterparts, HIV+ individuals in the United States had higher IR of death (IRR 1.78, 1.69–1.88), MI (IRR 1.61, 1.29–2.01), CHD (IRR 2.27, 1.92–2.68), any stroke (IRR 1.94, 1.59–2.38), IS (IRR 1.56, 1.23–1.98), and ICH (IRR 4.03, 2.72–6.14). Compared with HIV- controls and independent of geographical region, HIV was a risk for death (HR 4.77, 4.55–5.00), MI (HR 1.60, 1.49–1.72), any CHD (HR 1.20, 1.15–1.25), any stroke (HR 1.82, 1.53–2.16), IS (HR 1.27, 1.15–1.39) and ICH (HR 2.20, 1.61–3.02). Use of antiretroviral therapy was a consistent risk for cardiac outcomes, while immunosuppression and unsuppressed viral load were consistent risks for cerebral outcomes.ConclusionsHIV should be considered a vascular risk, with varying magnitudes across geographical and anatomical regions. We think that strategies to reduce the HIV-related vascular burden are urgent, and should incorporate the disparities noted here.

Chronic kidney disease is associated with a high prevalence of depression, which increases inversely with the glomerular filtration rate. This paper aims to evaluate the factors associated with a low quality of life and depression in patients on haemodialysis. Two hundred patients undergoing haemodialysis answered the Medical Outcomes Study 36 - Item Short - Form Health Survey (SF-36) and Beck Depression Inventory (BDI). Clinical and laboratory variables were analysed and correlated with these two tools. The prevalence of depression was 29%. Anaemia and hypoalbuminemia were independent risk factors for depression. All SF-36 domains showed worse results in patients with depression, and the pain domain presented the highest correlation. Our findings provide evidence that patients on haemodialysis have a low quality of life and a high prevalence of depression. A greater number of comorbidities, an excessive number of medications, diabetes mellitus, anaemia and hypoalbuminemia were associated with a reduced quality of life.

Kidney donation is unquestionably a safe procedure. However, a better understanding of the long-term consequences of living donor kidney transplantation is still needed. This knowledge may have important implications for the follow-up of these patients. Our study has demonstrated a non-negligible presence of an early marker of glomerular injury and a decrease in the GFR of some patients, thereby reinforcing the proposal for long-term follow-up of living kidney donors.

INTRODUÇÃO: Diretivas Antecipadas de Vontade (DAV) é um tema que se torna cada vez mais presente devido à transição epidemiológica que vive o Brasil e seu conseqüente aumento da prevalência dos cuidados paliativos. OBJETIVO: Este trabalho tem como objetivo conscientizar docentes e discentes sobre a importância do conhecimento das DAV devido sua extrema relevância ao bem estar do paciente, cuidados paliativos e terminalidade, e também como meio de defesa jurídica para os profissionais. MÉTODOS: Trata-se de uma revisão sistemática de literatura, sem meta-análise, que utilizou as seguintes bases de dados: Bireme, Medline, SciELO e Medscape, no recorte temporal de 2001 a 2016, com artigos que relacionam as diretivas antecipadas, educação médica e relação médico-paciente. RESULTADOS: Diversos trabalhos revelam significativo desconhecimento dos profissionais de saúde sobre este tema e sobre a Resolução do CFM 1995/2012. Observou-se também que grande parte das matrizes curriculares das universidades não apresenta as DAV no plano das disciplinas e que médicos com mais conhecimento sobre cuidados paliativos e terminalidade são os mais seguros a tomarem decisões benéficas aos pacientes. CONCLUSÃO: É fato a necessidade da introdução das DAV nos programas de graduação, visto que é mínimo o conhecimento sobre este tema, o que prejudica a relação médico-paciente, autonomia e o exercício da profissão com segurança e autonomia.