In this closing issue of volume 61/2006, CLINICS completes its second year of existence, and some points should be stressed: (i) estimated article submission figures indicate a 30% increase over 2005 (with 91% over 2004); (ii) substantial increases have occurred in contributions from outside São Paulo University Medical School and from contributors outside of Brazil; (iii) the total number of articles published has remained fairly stable, meaning that an already existing priority scale has been more rigidly applied, which led to an increase in our rejection rate to slightly over 60%; and (iv) in January 2007, we hope to implement Manuscript Central®, a powerful online editorial software that we recently acquired from ScholarOne, which should increase our user friendliness and make CLINICS more readily recognizable abroad. Regarding impact, all we can do is offer a preliminary estimate, because CLINICS will only complete its first database by May, 2008. So far, we can say that we are doing better than our predecessor, Revista do Hospital das Clínicas. In its last (and highest!) calculated impact, CLINICS scored 0.395, which was attained in 2005.
In this issue, we publish 12 original research papers, 1 review article, and 2 case reports.
Serra et al determined the nature of hyaline membranes in pulmonary specimens from 26 patients with (i) pulmonary, (ii) extrapulmonary, and (iii) idiopathic diffuse alveolar damage. Hyaline membranes were examined using various kinds of antibodies; they were most frequent in pulmonary and least frequent in idiopathic diffuse alveolar damage. The study showed that only the epithelial/endothelial components (surfactant apoprotein-A, cytokeratin AE1/AE3, and factor VIII-related antigen) were present in hyaline membrane formation in the 3 groups of patients, suggesting local and specific lesions with different pathways (direct, indirect, or idiopathic), depending on the type of diffuse alveolar damage.
Andrusaitis et al investigated the prevalence and possible risk factors for low back pain in truck drivers through a questionnaire that included personal factors such as age, practice of physical and sports activities, general health habits, and occupation-related factors. This questionnaire was applied to 410 truck drivers in the state of São Paulo, Brazil. Low back pain occurred in 241 drivers (59%), and the number of working hours was the only variable significantly associated with its occurrence: drivers with low back pain drove an average 1 hour longer/day as compared to those without pain.
Barreto Jr. et al compared intraocular pressure measurements by dynamic contour tonometry with Goldman applanation tonometry in 12 patients with normal corneas versus 10 patients with advanced keratoconus and found that intraocular pressure readings with dynamic contour tonometry in the keratoconus group were significantly higher than the Goldman measurements, but lower when compared to the control group. As there are no published manometric studies in eyes with keratoconus, the authors claim that these lower intraocular readings with the dynamic contour tonometry could be related to the discrepancy between the radius of corneal curvature and the tonometer tip, to the significant thinning of the cornea, or to other corneal biomechanical abnormalities related to advanced keratoconus.
Souza & Thomson describe an epidemiologic study of drug interactions in a Brazilian teaching hospital using a sample of 1,785 drug prescriptions drawn from a total of 11,250. The median number of drugs in each prescription was 7, and at least 1 drug-drug interaction was present in 887 prescriptions. Interactions were classified as minor (20 cases), moderate (184 cases), major (30 cases), and undetermined because of an incidence of more than 1 interaction in a single prescription (653 cases). Out of the 30 major interaction cases, 17 presented adverse drug reactions. Physicians may be unaware of drug-drug interactions. Education, computerized prescribing systems and drug information, collaborative drug selection, and pharmaceutical care are strongly encouraged for physicians and pharmacists.
Brench & Guarniero evaluated the effects of physiotherapy in the treatment of Legg-Calvé-Perthes disease using muscle strengthening and stretching exercises in a prospective follow-up study conducted in 17 patients. Treated patients exhibited significant improvements in articular range of motion, muscular strength, and articular dysfunction, but these improvements were not evident on radiographs.
Lucon et al describe the results of surgical correction of huge polycystic kidneys associated with rectus abdominis diastasis and umbilical hernia in 4 patients and conclude that a midline supraumbilical incision is an excellent approach for this operation, resulting in an esthetically pleasing belly, no rectus abdominis diastasis, and no umbilical hernia. One to two months after bilateral nephrectomy, the patients received a live donor kidney with an uneventful outcome.
Rosoky et al retrospectively investigated the clinical outcome of 326 patients with arterial obstructive pathologies, aiming to determine whether physical training was an effective treatment for situations in which the arterial disease was stable or progressive. Follow-up was 276 days for stable, and 277 days for progression groups, respectively. All patients underwent an unsupervised program of submaximal walking 4 days a week. Changes in maximal walking distance at a progressive treadmill test were appraised during the follow-up, but performance was not significantly different between groups over the entire follow-up period.
Leme et al examined the evolution of 56 elderly patients aged 60 years and over with hip fracture secondary to falls, finding that fractures were more common among Caucasian widowed women and most falls occurred at home. General mortality within 1 year after the occurrence of fracture was 30% and was associated with sex and age. There was an increase in the inability to walk and in the use of a supporting device. A significant reduction in the functional ability to perform basic and instrumental daily life activities was also detected.
Antunes et al retrospectively analyzed risk factors for incidental carcinoma of the prostate in 218 patients with benign prostatic hyperplasia, finding that advanced age and the presence of a suspect digital rectal examination represent the most important risk factors for the diagnosis of an incidental carcinoma of the prostate. However, they point out that the low positive predictive values reflect the weak correlations among these variables.
Ortale et al analyzed anatomical variations of sinuatrial nodal branches of the coronary artery of 50 human hearts, mainly focusing on their number, with the following findings: a single branch was observed in 47 cases, 2 branches in 2 cases, and 3 branches in 1 case. The differential anatomical details were described for each variant. The lower frequency of occurrence of the 2-branch variant found in Brazilians was compared to the higher frequency found among the Japanese, with the difference being ascribed to a possible ethnic group origin variation.
Teixeira et al tested macrolides and quinolones as potential therapeutic tools for the treatment of recurrent pleural effusions. The two classes of antibiotics were injected intrapleurally into rabbits, but none of the 4 tested drugs (azithromycin, clarithromycin, levofloxacin, or gatifloxacin) showed any potential for generating significant pleurodesis, leading to the conclusion that the quest for an ideal sclerosant agent in clinical practice must still continue.
Giovani et al compared bone graft cryopreservation method at -80°C with a new preservation method using a 98% glycerol solution at room temperature (10°C-35°C) and 30 samples of trabecular bone tissue from 10 patients undergoing total hip arthroplasty. Antibacterial and antifungal effects and the observed histological alterations caused by 98% glycerol and cryopreservation were comparatively analyzed. The new 98% glycerol solution method was reported to be similar to cryopreservation in terms of bone matrix preservation, and no bacteria or fungi were found in any of the samples
This issue also publishes a review on complex wounds and 2 case reports.