Traumatic brain injury (TBI) is a worldwide social, economic, and health problem related to premature death and long-term disabilities. There were no prospective and multicentric studies analyzing the predictors of TBI related mortality and estimating the burden of TBI in Brazil. To address this gap, we investigated prospectively: (1) the hospital mortality and its determinants in patients admitted with severe TBI we analyzed in three reference centers; (2) the burden of TBI estimated by the years of life lost (YLLs) due to premature death based on the hospital mortality considering the hospital mortality. Between April 2014 and January 2016 (22 months), all the 266 patients admitted with Glasgow coma scale (GCS), ≤ 8 admitted in three TBI reference centers were included in the study. These centers cover a population of 1,527,378 population of the Santa Catarina state, Southern Brazil. Most patients were male ( n = 230, 86.5%), with a mean (SD) age of 38 (17) years. Hospital mortality was 31.1% ( n = 83) and independently associated with older age, worse cranial CT injury by the Marshall classification, the presence of subarachnoid hemorrhage in the CT, lower GCS scores and abnormal pupils at admission. The final multiple logistic regression model including these variables showed an overall accuracy for hospital mortality of 77.9% (specificity 88.6%, sensitivity 53.8%, PPV 67.7%, and NPV 81.1%). The estimated annual incidence of hospitalizations and mortality due to severe TBI were 9.5 cases and 5.43 per 100,000 inhabitants, respectively. The estimated YLLs in 22 months, in the 2 metropolitan areas were 2,841, corresponding to 1,550 YLLs per year and 101.5 YLLs per 100,000 people every year. The hospital mortality did not change significantly since the end of the 1990s and was similar to other centers in Brazil and Latin America. Significant predictors of hospital mortality were the same as those of studies worldwide, but their strength of association seemed to differ according to countries income. Present study results question the extrapolation of TBI hospital mortality models for high income to lower- and middle-income countries and therefore have implications for TBI multicentric trials including countries with different income levels.

Spondyloarthritis (SpA) is a musculoskeletal inflammatory disease linked with immune responses to intestinal microbiota, and subclinical intestinal ulcerations that are closely related to inflammatory bowel diseases. Helicobacter pylori is a common cause of gastroduodenal ulceration, and anti-Saccharomyces cerevisiae antibodies (ASCA) are associated with intestinal inflammation in both Crohn disease (CD) and SpA. We investigated the relationship between H. pylori and ASCA. Ninety-one patients with axial SpA and forty with CD were included. ASCA IgG/IgA and anti-H. pylori IgG titers were assessed by ELISA. The proportion of ASCA+ patients in the positive and negative anti-H. pylori IgG groups with SpA and CD were compared using Chi-square tests, and correlations were evaluated using the Spearman's coefficient. Anti-H. pylori IgG titers were significantly negatively correlated with the ASCA IgG (r = -0.563, p < 0.001) and IgA (r = -0.342, p = 0.019) titers in the axial SpA patients. The same pattern of negative correlation was also observed in the CD patients. Anti-H. pylori+ serology was significantly more frequent in axial SpA patients than in those with CD (52.4 vs. 18.4 %, p < 0.001), while ASCA+ serology was significantly more frequent in CD patients than in SpA patients. A negative correlation between the anti-H. pylori titers and ASCA was found for axial SpA and CD. Anti-H. pylori+ serology was more frequent in SpA than in CD, while ASCA positivity was more frequent in CD patients than in those with SpA. A possible influence of H. pylori on the development of ASCA needs further investigation.

Objectives: To create a Brazilian version of the national Institutes of Health -Chronic Prostatitis Symptom Index (nIH-CPSI) using a cross-cultural adaptation process. Materials and Methods:The nine items of the nIH-CPSI were translated to Portuguese, by two independent translators, of native Portuguese language origin, and it was obtained a single version, that was retranslated to English by two English native spoken translators, in order to correct any discrepancies. Those versions were compared to the original text, the modifications were applied and it was created a final version in Portuguese. That was pre-tested and applied to 30 patients with pain or perineal or ejaculatory disorder. To each item of the pre-final version it was assigned a score according to the grade of understanding and clarity in order to implement the adequate corrections. The final version in Portuguese was submitted to evaluations including face validation and psychometric proprieties of reproducibility and internal consistency, respectively evaluated by the (p) Pearson correlation coefficient and α Cronbach coefficient. Results: All items applied to 30 patients during pre-test phase had a grade higher than 8 of understanding and clarity, and were considered clearly understandable by the patients. However, at face validation evaluation, there was an inconsistency of item three that was redone. The final produced version, called nIH-CPSI (Braz) showed good reproducibility (p = 0.89-0.99) and internal consistency (α Cronbach coefficient = 0.85-0.93). Conclusions: nIH-CPSI was adapted to Brazilian spoken Portuguese and its original proprieties were maintained, being a valid instrument for evaluations of symptoms of chronic prostatitis in Brazilian patients.

Leukoencephalopathy with intracranial calcifications and cysts (LCC) is a rare and recently described entity characterized radiologically by white matter abnormalities, calcifications, cysts and enhancing nodules 1 . LCC is a disorder of unknown etiology and its neurological manifestations include cognitive decline, seizure, obstructive hydrocephalus, progressive cerebellar, besides extrapyramidal and pyramidal signs with juvenile onset 2 . We report a case of LCC with remarkable radiological and clinical features. CASEA 30-year-old man presenting frontooccipital headache for the last 7 days, worsening in the morning, associated with progressive anorexia and vomiting.Eight years ago, he had an acute neurological event characterized by paresis and aphasia of expression.His past medical history demonstrated moderate cognitive impairment since childhood.Family history, were unremarkable and no consanguinity was known. Neurological examination revealed left paresis grade 4+ with positive Babinski sign besides ataxia. Brain MRI (1.5T) revealed an expansive solid / cystic interhemispheric lesion measuring 55×25 mm with important mass effect. T2 imaging showed remarkable hemossiderin deposition in its walls. MR perfusion demonstrated high capilar density within the walls. Multiple enhancing nodular lesions were observed envolving supra and infratentorial brain parenchyma. Some of these nodules had hemorrhagic component on T2 images. Broad and symmetric calcifications in periventricular white matter, basal ganglia, brainstem and dentate nuclei were observed.Patient underwent surgery for relieving intracranial hypertension and biopsy. Pathological examination was inconclusive due to the large amount of clotted blood within the material. No neoplastic cells were observed. Patient was discharged in good clinical condition, without signs of intracranial hypertension, remaining hemiparesis and aphasia.

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Neste artigo, professores e monitores da disciplina de Técnina Operatória do Curso de Graduação em Medicina da Universidade Federal de Santa Catarina apresentam inovações de baixo custo para o treinamento de habilidades cirúrgicas no ensino de graduação.