Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil: data from the Brazilian Type 1 Diabetes Study Group.

BACKGROUND: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. METHODS: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. RESULTS: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North-Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. CONCLUSIONS: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities.

Plasmocitoma extramedular / Extramedulary plasmocytoma

Plasmocitoma extramedular é uma doença rara, caracterizada histopatologicamente por infiltrado de células plasmáticas de maturidades diversas e produtoras de imunoglobulina monoclonal fora da medula óssea. Sua incidência aumenta com a idade, sendo mais comum no homem e acometendo com maior freqüência o trato aerodigestivo superior. Apresenta-se clinicamente com epistaxe, rinorréia e obstrução nasal. O diagnóstico baseia-se no encontro de tumor monoclonal de plasmócitos extramedular excluindo-se mieloma múltiplo. Devido à radiosensibilidade do tumor, a radioterapia é peça central na terapêutica, porém, ainda se discute dose e necessidade de irradiação de linfonodos regionais. Cirurgia é tratamento de primeira escolha e quimioterapia continua sendo controversa. Os autores relatam um caso de plasmocitoma extramedular com manifestação intestinal em homem jovem submetido a duas cirurgias por complicações obstrutivas, recebendo quimioterapia como tratamento específico por recidiva tumoral.