Background: No studies have investigated the association between self-rated health (SRH) and high-sensitivity C-reactive protein (hs-CRP) levels in South Koreans. We explored this association and analyzed differences between sexes. Methods: Using cross-sectional data from the 2015-2017 Korea National Health and Nutrition Examination Survey, we analyzed the association between SRH and high hs-CRP levels (>1.0 mg/L) in 14,544 Koreans aged ≥19 years who responded to the SRH survey and had hs-CRP test results. Differences in sociodemographic factors were analyzed using Pearson's chi-square test for categorical variables or the Mann-Whitney U test for continuous variables. Multiple logistic regression analysis was used to measure the association between hs-CRP levels and SRH according to sex while adjusting for other possible confounders. Results: The percentage of having a very poor to poor SRH was higher in the high hs-CRP level group (22.4%) than in the low hs-CRP level group (17.66%). Among men, the risk of a high hs-CRP level increased with worse SRH (adjusted for confounders; P for trend <0.001). After adjusting for all confounders, including chronic diseases, men with a very poor SRH showed a higher odds ratio (OR) for high hs-CRP levels than those with a very good SRH (fully adjusted OR, 1.74; 95% con dence interval, 1.04-2.90). Signi cant correlations were absent among women. Conclusions: A poor SRH was correlated with low-grade in ammation (high hs-CRP level) among male Korean adults. The ndings could be useful for developing health improvement programs and in goal setting at a national scale. Background Self-rated health (SRH) is an index utilized worldwide to summarize how patients perceive their overall health status [1]. SRH is an independent predictor of mortality and disease morbidity, even after adjusting for demographic, sociological, and medical risk factors [2]. Despite criticisms that SRH is assessed based on a single question, it is known to be a strong predictor in both healthy and unhealthy individuals. SRH is not only a predictor of previously diagnosed disease but also a predictor of reactions associated with the progression of disease in the premorbid stage; it encapsulates recent or sporadic health issues that may be missed by one-time objective testing, and it also re ects behavioral and emotional factors [2, 3]. C-reactive protein (CRP) is produced by hepatocytes following acute tissue injury or infection. Though CRP levels are generally elevated in cases of severe in ammation, high-sensitivity CRP (hs-CRP) levels increase nonspeci cally in the event of in ammation in the body. In particular, hs-CRP is used as an indicator to assess the risk of cardiovascular disease (CVD), and several studies have suggested hs-CRP as a predictor of mortality. In assessing CVD risk, the American Heart Association (AHA) and Centers for Disease Control and Prevention (CDC) de ned hs-CRP levels of >3.0 mg/L as indicating high risk, 1.0-3.0 mg/L as indicating average risk, and <1.0 mg/L as indicating low risk...

Background: Huntington's disease (HD) is a progressive disorder characterized by motor, cognitive and psychiatric features. Cerebellar ataxia is classically considered as uncommon in HD clinical spectrum. Objective: To determine the prevalence of cerebellar ataxia in patients with HD, both in the early and in the late stages of HD. Methods: Seventy-two individuals considered eligible were assessed by two trained doctors, applying the Scale for Assessment and Rating of Ataxia (SARA) and Brief Ataxia Rating Scale (BARS) for ataxia, the Unified Huntington's Disease Rating Scale (UHDRS) and also, Barthel Index (BI), in order to evaluate functional capacity. Results: Fifty-one patients (70.8%) presented with clinical ataxia at the time of examination (mean time of disease was 9.1 years). Six (8.33%) patients presented with cerebellar ataxia as first symptom. When stratified according to time of disease, a decline in the presence of chorea ( p = 0.032) and an increase in cognitive deficit ( p = 0.023) were observed in the patients as the disease progressed. The presence of ataxia was associated with longer duration of illness and severity of illness (UHDRS) ( p < 0.0001), and shorter Barthel (less functionality) ( p = 0.001). Conclusions: Cerebellar involvement may play an important role in natural history of brain degeneration in HD. The presence of cerebellar ataxia in HD is relevant and it may occur even in early stages, and should be included as part of the motor features of the disease.

MYH9-related disease is an autosomal dominant disorder caused by mutations of the MYH9 gene, which encodes the non-muscle myosin heavy chain IIA on chromosome 22q12. It is characterized by congenital macrothrombocytopenia, bleeding tendency, hearing loss, and cataracts. Nephropathy occurs in approximately 30% of MYH9-related disease in a male patient carrier of a de novo missense mutation in exon 1 of the MYH9 gene [c.287C > T; p.Ser(TCG)96(TTG)Leu]. He presented all phenotypic manifestations of the disease, but cataracts. Renal alterations were microhematuria, nephrotic-range proteinuria (up to 7.5 g/24h), and rapid loss of renal function. The decline per year of the glomerular filtration rate was 20 mL/min/1.73m2 for five years. Blockade of the renin-angiotensin system, the only recommended therapy for slowing the progression of this nephropathy, was prescribed. Although MYH9-related disease is a rare cause of glomerulopathy and end-stage renal disease, awareness of rare genetic kidney disorders is essential to ensure accurate diagnosis and proper management of orphan disease patients.

Introduction: Pseudoporphyria is a rare photodermatosis with characteristics similar to those of porphyria cutanea tarda, without, however, presenting abnormalities in porphyrin metabolism. Its etiology is related to chronic kidney disease, ultraviolet radiation and certain medications. The aim of the present study is to describe a case of furosemide-related pseudoporphyria in a patient with chronic kidney disease. Case description: A 76-year-old male patient with stage 4 chronic kidney disease and in continuous use of furosemide presented ulcerated lesions with peripheral erythema and central hematic crust in the legs. On a skin infection suspicion, treatment with quinolone and neomycin sulfate was initiated, without improvement. A biopsy of the lesion was performed, with histopathological examination demonstrating findings compatible with porphyria, although the patient did not present high porphyrin levels. The diagnosis of furosemide-induced pseudoporphyria was then established, with medication suspension, and there was a significant improvement of the lesions. Discussion: There are few cases of pseudoporphyria described, but it is believed that this condition is underdiagnosed, especially in patients with chronic kidney disease. Both clinical and histopathological findings closely resemble porphyria, differentiating it from normal levels of porphyrin in plasma, urine, or feces. Conclusions: Although the lesions are mostly benign, they may increase the morbidity and mortality of these patients, so a proper diagnosis and early treatment are extremely important.

Resumo Objetivo Avaliar o potencial melhor resultado funcional e controle álgico no tratamento de fraturas patológicas e fixações profiláticas tratadas com haste intramedular associada ao polimetilmetacrilato (PMMA) em comparação com o uso de haste intramedular em lesões tumorais em ossos longos. Métodos De janeiro de 2012 a setembro de 2017, 38 pacientes com 42 lesões patológicas (fraturas ou iminência segundo os critérios de Mirels) foram tratados cirurgicamente. Dezesseis pacientes submetidos a fixação com haste intramedular bloqueada foram alocados ao grupo controle e 22 pacientes com lesões patológicas foram alocados para tratamento com haste intramedular associada ao PMMA. No pós-operatório, foi realizada a submissão dos pacientes ao escore da Musculoskeletal Tumor Society (MSTS, na sigla em inglês) e à avaliação radiográfica do tratamento realizado, assim como à avaliação de intercorrências e complicações relacionadas ao tratamento. Resultados A avaliação através do questionário MSTS demonstrou melhor resultado funcional do grupo associado com PMMA quando comparado com o grupo controle, o qual obteve uma pontuação média de 16,375 em um máximo de 30 pontos (54,6%), enquanto o grupo em estudo com associação do PMMA obteve uma média de 22,36 pontos (74,5%). O procedimento mostrou-se seguro, taxas de complicações e gravidade semelhantes e sem diferença estatística quando comparado com o tratamento padrão. Conclusão A estabilização de lesões tumorais com fixação associada ao PMMA demonstrou reabilitação precoce e melhora na qualidade de vida, permitindo rápida recuperação funcional. A utilização do PMMA apresenta vantagens como diminuição do sangramento e da necrose tumoral e maior estabilidade mecânica.

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Design of the Study: Historical Cohort. Objectives: This study aimed to verify which risk factors contribute to increase hs-cTnI in patients with Myocardial Infarcion with ST segment elevation, to ana-lyze which prognostic impacts it may have and to evaluate troponin levels in pa-tients that had previous acute myocardial infarction and assess how this com-pared to patients without previous history of an acute event. Methodology: It was assessed medical records of patients admitted in the Cor-onary Unit of the Hospital de Clínicas (HC-UFPR) in Curitiba, South of Brazil, diagnosed with ST segment elevation Myocardial Infarction and whose serum levels of high sensitivity troponin I (hs-cTnI) were collected at admission moment. The select data were: gender, age, high blood pressure, smoking, diabetes, previous myocardial infarction, dyslipidemia and serum levels of high sensitivity troponin I. For prognostic proposes, it was analysed intra-hospital death and ventricular function, based on left ventricular ejection fraction. Findings: Patients admitted with previous myocardial infarction had lower levels of hs-TnI. Gender, age, presence of high blood pressure, tabagism, diabetes and dyslipidemia didn’t reveal correlation with troponin values, allowing the in-ference that high sensitivity troponin values at first presentation of these patients have no direct relation to these variables. Regarding prognosis, levels of high sensitivity troponin could not be associated to mortality or ventricular malfunction. Conclusions: At admission, high-sensitivity troponin I levels were lower in pa-tients with prior myocardial infarction. Relevance: This work correlates the values of the high-sensitivity troponin of    patients with ST segment Elevation Myocardial Infarction to cardiovascular risks factors and to the prognosis of these patients. This approach is not found in cur-rent medical literature, whose works mainly relates to acute events.

Background The intense use of antiretroviral therapy (ART) has reduced morbidity and mortality of HIV infection. In Brazil, the specific contribution of diseases related to HIV infection leading to hospital admission and readmission is not well known. Aims The study aimed to determine the clinico-epidemiological profile, 30-day readmission rate, and factors associated with this outcome in a cohort of adults with HIV infection in southern Brazil. Methods Unicentric retrospective cohort, with data collection through the review of medical records and databases. Results We analyzed 574 index hospitalizations and 451 individuals. Of these, 57.6% were men and the mean (±SD) age was 42.2 ± 12.3 years. Only 43.4% used ART regularly and low CD4 count and high frequency of detectable viral load were observed. HIV/AIDS-related diseases were identified in 55.2%, and tuberculosis was the most frequent etiology leading to index hospitalization. We found a 30-day readmission rate of 11.5% and hospitalization for HIV/AIDS-related illness was associated with a higher risk for the outcome. Conclusions These findings highlight the need to expand resources for prevention, early diagnosis, retention, and treatment of people living with HIV in the region to reduce HIV/AIDS-associated diseases and possibly minimize consequent hospital readmission of these individuals.