MDD seems to be associated with global HcV atrophy. Larger longitudinal follow-up studies designed to analyze the influence of sociodemographic variables on this relationship are required to yield better evidence about this topic.

Introduction Although it is the most common agent among the fungal causes of endocarditis, Candida albicans endocarditis is rare. Objective To evaluate the efficacy of amphotericin B in the treatment of C. albicans endocarditis beyond a systematic review. Data search Articles in English, Spanish and Portuguese, conducted in the following databases: MEDLINE, LILACS, IBECS and SciELO, in humans and published in the last 25 years. Study selection Observational studies, clinical trials, and case series providing data on the amphotericin B use in patients with a C. albicans endocarditis diagnosis without age limitations. Data synthesis From the initial search (n=79), 25 articles were fully evaluated, of which 19 were excluded for meeting one or more exclusion criteria, remaining five articles (two observational studies and three case series). Patients using amphotericin B demonstrated improvement in survival rates, and its main use was in association with the surgical method as well as with caspofungin association. Conclusion Literature lacks evidence to conclude about efficacy and safety of amphotericin B in the treatment of fungal endocarditis. Randomized clinical trials are necessary to provide better evidence on the subject.

Tamoxifen (TMX) is the main drug used both in pre and postmenopausal women as adjuvant treatment for hormone receptor-positive breast cancer. An important barrier to the use of TMX is the development of drug resistance caused by molecular processes related to genetic and epigenetic mechanisms, such as the actions of cytochrome P450 2D6 (CYP2D6) polymorphisms and of its metabolites. The present study aimed to review recent findings related to the impact of CYP2D6 polymorphisms and how they can affect the results of TMX in breast cancer treatment. The keywords CYP2D6, tamoxifen, and breast cancer were searched in the PubMed, Scopus, The Cochrane Library, Scielo, and Bireme databases. Studies related to other types of neoplasms or based on other isoenzymes from cytochrome P450, but not on CYP2D6, were excluded. The impact of CYP2D6 polymorphisms in the TMX resistance mechanism remains unclear. The CYP2D6 gene seems to contribute to decreasing the efficacy of TMX, while the main mechanism responsible for therapy failure, morbidity, and mortality is the progression of the disease.

Dementia is a general term for a heterogeneous group of organic neurodegenerative diseases. Cerebrovascular causes account for 20% of cases.Objective: To describe the clinical and epidemiological features of individuals aged >60 years diagnosed with vascular dementia (VD) or mixed dementia (MxD) in a referral hospital for dementia.Methods: A descriptive, retrospective study was carried out from 2014 to 2017 involving elderly individuals (≥60 years) with VA or MxD. Patients presenting other forms of dementia or in use of medication that mimics cognitive disorders were excluded. The 12-item Neuropsychiatric Inventory was used to assess neuropsychiatric symptoms (NPS).Results: 81.1% of the patients presented NPS and only 15% had two or more symptoms. Apathy was the most frequent NPS (56.6%). There was an association between CDR score 1 or 2 and NPS (OR = 6.16, 95% CI: 1.36-27.9, p = 0.02).Conclusion: Most patients had a single symptom, predominantly apathy. There was an association between mild-to-moderate dementia and NPS.

SUMMARY BACKGROUND: Depression and anxiety disorders (DAD) are the most prevalent mental health conditions worldwide. Among the adult population served in basic care, it is estimated that depression affects about 14.3% of these individuals worldwide, and between 21.4% and 31% in Brasil. Anxiety affects up to 33.7% of the population during their lifetimes. OBJECTIVES: estimate the prevalence proportions of DAD among patients in a municipality in Northeast Brasil and study the association between DAD and cardiovascular risk factors. METHODS: a cross-sectional study with the medical records of patients from primary care centers in Jaboatão dos Guararapes, Pernambuco. Patients aged ≥ 18 years and regularly followed-up were included. Exclusion criteria: a history of traumatic brain injury, alcohol or drug abuse, previous stroke, medical conditions or medications that mimic DAD symptoms. Subjects were divided into two groups depending on the presence or absence of DAD, and cardiovascular risk factors were compared between groups. RESULTS: A total of 1030 subjects were initially included, of whom 215 (20%) were excluded. No-DAD subjects had more history of myocardial infarction and alcoholism. The prevalence of depression was 10.3%, anxiety disorder was 27.1%, and mixed DAD represented 4.5%. There was a significant association between DAD and hypertension (OR = 2.11; 95%CI: 1.16 –3.84; p=0.01), obesity (OR = 4.47; 95%CI: 1.74 –11.46; p=0.002), and hyperlipidemia (OR = 3.88; 95%CI: 1.81-8.3; p<0.001). CONCLUSION: DAD were associated with an increased risk for arterial hypertension, obesity, and hyperlipidemia.

Santos MAO, Bezerra LS. Trombocitopenia induzida por heparina: do diagnóstico ao tratamento / Heparin induced thrombocytopenia: diagnosis and treatment. Rev Med (São Paulo). 2018 mar.-abr.;97(2):160-4. Diretor Científico do Grupo de RESUMO:A heparina é largamente utilizada na prática clínica como droga anticoagulante. Trombocitopenia induzida por heparina (TIH) é uma síndrome imune-hematológica que resulta na ativação plaquetária decorrente do uso de heparina, com uma incidência em torno de 1 a 6%. Pode ser classificada em tipo I e II, sendo esta mais grave e potencialmente letal. O somatório de achados clínicos e laboratoriais compatíveis com HIT e positividade para anticorpo HIT é necessário para confirmação diagnóstica. A escala de probabilidade de Warkentin auxilia no diagnóstico de TIH, com alto valor preditivo negativo. Uma abordagem adequada incluindo a suspensão precoce da heparina é mandatória. O esquema de anticoagulação alternativa se faz necessário, com preferência pelo uso dos inibidores diretos da trombina. O uso de fondaparinux nesse contexto mostrou benefícios, embora sejam necessários ensaios clínicos randomizados para melhor nível de evidência.Descritores: Trombocitopenia; Trombocitopenia/diagnóstico; Trombocitopenia/terapia; Heparina; Anticogulantes. ABSTRACT:Heparin is the most common anticoagulant drug used in the clinical practice. Heparin-induced thrombocytopenia (HIT) is an immuno-hematologic syndrome that results from platelets activation in patients under heparin therapy. The incidence of HIT is about 1 to 6%. It might be classified in type I and II, this last is potentially lethal. Clinical and laboratorial findings are both mandatory to diagnostic confirmation, as well as positivity for HIT antibody. The Warkentin probability scale helps on HIT diagnosis and has a high negative predictive value. A clinical approach that includes heparin discontinuation is mandatory. An alternative anticoagulation therapy must be initiated and the direct inhibitors of thrombin are the preferred drugs. Foundaparinux has showed benefits in this context, although randomized clinical trials are needed for better evidence.

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BACKGROUND AND OBJECTIVES: Peripheral neuropathy and carpal tunnel syndrome are debilitating diseases associated to diabetes mellitus in 12 to 21% of cases. There are no significant evidences of the clinical differentiation between such painful syndromes and their specific management. This study aimed at reporting the clinical presentation of a patient with peripheral polyneuropathy associated to carpal tunnel syndrome, focusing on therapeuthic approaches and discussing clinical differentiation between both diseases. CASE REPORT: Male patient, 68 years old, married, retired, who looked for medical assistance complaining of burning pain, especially in left upper limb. He also referred pain in lower limbs with night exacerbation, in addition to numbness in extremities and pain intensity of 6 in the visual analog scale. Presence of trigger-points in trapezius and levator scapulae muscles. Patient was submitted to decompression surgery due to carpal tunnel syndrome diagnosis two years ago, however without postoperative improvement. Patient refers pain in upper and lower limbs, with nocturnal exacerbation, numbness and pain in extremities. He has history of hypertension, diabetes mellitus type 2 and leprosy. At physical evaluation: painful boot and glove hypoesthesia and possible motor deficit in C6 and C7. Electromyography showed mixed peripheral polyneuropathy of lower limbs and median carpal syndrome to the left. There has been movement amplitude improvement in myotomes C6 and C7. Pain decreased to 3 in the visual analog scale after two weeks under gabapentin and duloxetine. CONCLUSION: It is difficult to clinically differentiate between neuropathy of different etiology and peripheral polyneuropathy. The proposed treatment has provided 50% improvement in the Pharmacological approach for the management of patient with carpal tunnel syndrome associated to diabetic polyneuropathy. Case report Conduta farmacológica no tratamento de paciente com síndrome do túnel do carpo associada à polineuropatia diabética. Relato do caso visual analog scale two weeks later. Lidocaine infusion at 5% has provided acute improvement of patient's pain.