Sex and body mass index impact on digit circumference for Leeds Dactylitis Index calculation.

OBJECTIVES: To estimate digit circumference and the impact of sex and body mass index (BMI) for the calculation of the Leeds Dactylitis Index (LDI) in psoriatic arthritis (PsA) patients with bilateral dactylitis. METHODS: Digit circumference of the hands and the foot were measured with a dactylometer and were studied according to sex and BMI (divided in 4 weight categories) in healthy Portuguese subjects, using Student's t-test and One-way ANOVA, respectively. The effect size of sex and BMI were calculated using Cohen's d test and Eta squared, respectively. Multiple linear regression was used to calculate the effect of sex and BMI, as well as their interaction, to create a formula to predict digit circumference. RESULTS: Fifty-nine participants (33 women, 26 men) with a mean BMI of 24.8 were included. Men's mean digit circumferences were statistically higher than those of women (p<0.001), with a large sex effect size in most of the digits. Differences in the mean circumference between the four BMI categories were statistically significant (p<0.05) for all digits, with a large BMI effect size. Sex and BMI were independent variables to predict mean digit circumference (p<0.001). A new tool (based on regression analysis) allowing to estimate the circumference of digits for males and females of different BMIs is presented. CONCLUSIONS: Our data allows the calculation of digit circumference for males and females of different BMIs in the Portuguese population; and shows that BMI influences digital circumference supporting BMI inclusion in LDI references tables.

A rare case of cerebellar degeneration due to primary Sjogren's syndrome.

Sjogren's syndrome (SS) is an autoimmune pathology which mainly affects salivary and lacrimal glands. Cerebellar degeneration association with SS is very rare, with only a few cases described. The treatment of SS with central nervous system involvement is not consensual. We present a 48-year-old woman with dysarthria, diplopia and ataxia associated with xerostomia. The brain magnetic imaging revealed bilateral cerebellar atrophy. She had antibody positivity for anti-SSA and anti-SSB and minor salivary glands biopsy revealed lymphocytic infiltration. Methylprednisolone, cyclophosphamide and intravenous immunoglobulin yielded no results. Rituximab was initiated with improvement in dysarthria and coordination.

Tentativa de suicídio: prevalência e fatores associados entre usuários da Atenção Primária à Saúde / Suicide attempt: prevalence and associated factors among users of Primary Health Care

OBJETIVO: Estimar a prevalência de tentativa de suicídio entre usuários da Atenção Primária à Saúde (APS) e verificar fatores associados. MÉTODOS: Estudo transversal realizado com indivíduos de 18 anos ou mais, atendidos na rede urbana da APS de Passo Fundo, Rio Grande do Sul. Foi calculada a prevalência do desfecho, com intervalo de confiança de 95% (IC95), além das Razões de Prevalência (RPs) brutas e ajustadas para verificação dos fatores associados. RESULTADOS: Amostra de 1.443 indivíduos, prevalência da tentativa de suicídio de 9% (IC95 8%-11%), com maior probabilidade em mulheres (RP = 3,01; IC95 1,54-5,86), 18-59 anos (RP = 2,15; IC95 1,38-3,34), sem cônjuge (RP = 1,82; IC95 1,09-3,03), com duas ou mais doenças crônicas não transmissíveis (RP = 1,54; IC95 1,08-2,18), diagnóstico de HIV/AIDS (RP = 3,02; IC95 1,30-7,02), de depressão (RP = 2,69; IC95 1,83-3,96), história familiar de tentativa de suicídio (RP = 1,99; IC95 1,50-2,63) e insônia (RP = 1,46; IC95 1,05-2,02). Observou-se tendência linear inversamente proporcional em relação à escolaridade, com redução de 42% na probabilidade do desfecho entre os participantes com ensino superior (RP = 0,58; IC95 0,39-0,86). CONCLUSÕES: Constataram-se alta prevalência de tentativa de suicídio, em comparação à média nacional, e associação com idade adulta, sexo feminino, menor escolaridade, ausência de cônjuge, diagnóstico de doenças crônicas, insônia e história familiar de suicídio.

OBJECTIVE: To estimate the prevalence of attempted suicide among Primary Health Care (PHC) users and to verify the associated factors. METHODS: Cross-sectional study, performed with individuals aged ≥ 18 years, assisted in the urban PHC services in Passo Fundo, Rio Grande do Sul, Brazil. The prevalence of the outcome was calculated, with a confidence interval of 95% (95% CI), in addition to the crude and adjusted Prevalence Ratios (PR) to verify the associated factors. RESULTS: Sample of 1,443 individuals, 9% prevalence of attempted suicide (95% CI 8%-11%), most likely in women (PR = 3.01; 95% CI 1.54-5.86), 18-59 years (PR = 2.15; 95% CI 1.38-3.34), individuals without a spouse (PR = 1.82; 95% CI 1.09-3.03), with two or more chronic non-communicable diseases (PR = 1.54; 95% CI 1.08-2.18), diagnosis of HIV/AIDS (PR = 3.02; 95% CI 1.30-7.02) and of depression (PR = 2.69; 95% CI 1.83-3.96), family history of attempted suicide (PR = 1.99; 95% CI 1.50-2.63) and insomnia (PR = 1.46; 95% CI 1.05-2.02). An inversely proportional linear trend was observed in relation to education, with a 42% reduction in the probability of the outcome among participants with higher education (PR = 0.58; 95% CI 0.39-0.86). CONCLUSIONS: There was a high prevalence of attempted suicide compared to the national average and association with adult age, female gender, lower education level, absence of a partner, diagnosis of chronic diseases, insomnia and family history of suicide.

Myopathy associated with anti-signal recognition particle antibodies with pulmonary involvement and response to rituximab.

The authors present the case of a 76-year-old female patient with progressive decrease in proximal muscle strength, fatigue, dyspnea, diffuse hand edema and painful triphasic Raynaud's phenomenon. Anti-SRP and anti-SSA antibodies were detected, muscle biopsy revealed changes consistent with necrotizing myopathy and capillaroscopy had findings compatible with systemic sclerosis. High-resolution chest computed tomography revealed interstitial lung disease with a non-specific interstitial pneumonia pattern. Lung function tests demonstrated a forced vital capacity 93% and a diffusing capacity for carbon monoxide of 65% predicted. After multidisciplinary discussion, she was diagnosed with immune-mediated necrotizing myopathy/systemic sclerosis overlap syndrome with pulmonary involvement. Initially, dual immunomodulation therapy with high-dose steroids and intravenous immunoglobulin was started, but after 4 weeks, the patient had clinical and analytical deterioration. At this time, she was started on rituximab, with an excellent and sustained response at both muscle and lung, sustained after 12 months.

Abdominal pain in Systemic Lupus Erythematosus: About a rare cause.

Systemic lupus erythematosus (SLE) is an autoimmune disease with potential multisystemic involvement. Mesenteric panniculitis (MP) has been described as a rare feature in patients with SLE. The authors present a case of a 26 years old patient with previous diagnosis of SLE presenting with abdominal pain and distension and a peri-umbilical mass. Imagological findings were compatible with MP and ganglion biopsy revealed inflammatory pattern. Corticosteroid therapy was initiated with a resolution of pain after 6 months of treatment, with image reevaluation showing improvement of previous findings.

The European Portuguese version of the ASAS Health Index for Patients with Spondyloarthritis: Measurement properties.

OBJECTIVE: The Assessments of SpondyloArthritis international Society Health Index (ASAS HI), estimates the impact of Spondyloarthritis (SpA) on global functioning and health. This article assesses the construct validity, reliability and responsiveness of the Portuguese version of the ASAS HI. PATIENTS AND METHODS: Patients fulfilling ASAS classification criteria for axial (axSpA) or peripheral SpA (pSpA) were included. Construct validity was assessed through Spearman's correlation analysis with other health outcomes. Discriminant validity was tested comparing the ASAS HI across disease activity and functional states using the Kruskal-Wallis test. Internal consistency was assessed by Cronbach's α, and test-retest reliability by intraclass correlation coefficients (ICC). Responsiveness was evaluated by the standardized response mean (SRM) in patients with active disease who required therapy escalation. RESULTS: Among the 91 patients included, 67% were male, mean (SD) age 47.2 (12.9) years, 63 patients with axSpA and 28 patients with pSpA. The hypothesis defined a priori to test construct validity were confirmed. The ASAS HI showed ability to discriminate between patients with different disease activity and functional states (p<0.001). Internal consistency (Cronbach's α: 0.88) and test-retest reliability [ICC=0.76 (95%CI 0.09-0.91)] were good. Responsiveness was moderate (SRM=-0.53). The smallest detectable change was 3.0. CONCLUSIONS: The Portuguese version of the ASAS HI is a comprehensible questionnaire that is valid, reliable and responsive. It can be used to assess the impact of SpA and its treatment on functioning and health, in clinical practice and for research purposes.

GO-DACT: a phase 3b randomised, double-blind, placebo-controlled trial of GOlimumab plus methotrexate (MTX) versus placebo plus MTX in improving DACTylitis in MTX-naive patients with psoriatic arthritis.

OBJECTIVES: To assess the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy in psoriatic arthritis (PsA) dactylitis. METHODS: Multicentre, investigator-initiated, randomised, double-blind, placebo-controlled, parallel-design phase 3b trial in 11 Portuguese rheumatology centres. Patients with PsA along with active dactylitis and naive to MTX and biologic disease-modifying antirheumatic drugs (bDMARDs) were randomly assigned to golimumab or placebo, both in combination with MTX. The primary endpoint was Dactylitis Severity Score (DSS) change from baseline to week 24. Key secondary endpoints included DSS and Leeds Dactylitis Index (LDI) response, and changes from baseline in the LDI and MRI dactylitis score. Analysis was by intention-to-treat for the primary endpoint. RESULTS: Twenty-one patients received golimumab plus MTX and 23 MTX monotherapy for 24 weeks. One patient from each arm discontinued. Patient inclusion was halted at 50% planned recruitment due to a favourable interim analysis. Median baseline DSS was 6 in both arms. By week 24, patients treated with golimumab plus MTX exhibited significantly greater improvements in DSS relative to MTX monotherapy (median change of 5 vs 2 points, respectively; p=0.026). In the golimumab plus MTX arm, significantly higher proportions of patients achieved at least 50% or 70% improvement in DSS and 20%, 50% or 70% improvement in LDI in comparison to MTX monotherapy. CONCLUSIONS: The combination of golimumab and MTX as first-line bDMARD therapy is superior to MTX monotherapy for the treatment of PsA dactylitis. TRIAL REGISTRATION NUMBER: NCT02065713.

Dificuldades alimentares em pré-escolares, práticas alimentares pregressas e estado nutricional / Feeding difficulties in preschool children, previous feeding practices, and nutritional status

RESUMO Objetivo: Identificar a prevalência de dificuldade alimentar (DA) em pré-escolares, sua associação com fatores epidemiológicos e práticas alimentares pregressas, bem como sua repercussão sobre o estado nutricional. Métodos: Estudo transversal com aplicação de questionário às mães de 301 crianças de dois a seis anos de creches públicas e privadas em Natal, Rio Grande do Norte, em 2014 e 2015. Identificou-se DA segundo critérios de Kerzner, incluindo os perfis de "ingestão altamente seletiva", "criança agitada com baixo apetite", "fobia alimentar" e "criança com distúrbio psicológico ou negligenciada". As variáveis de associação analisadas por regressão logística foram: tempo de aleitamento materno, idade de introdução de leite de vaca e da alimentação complementar, faixa etária, renda familiar, tipo de escola, perfil das mães (responsivas ou não responsivas) e índice de massa corpórea (IMC). Resultados: DA foi encontrada em 37,2% dos casos analisados, com predomínio de "ingestão altamente seletiva" (25,4%). Não houve associação entre DA e práticas alimentares na fase de lactente, renda familiar e tipo de escola. Não houve diferença entre as médias de escore Z IMC para os grupos com e sem DA (1,0±1,5DP e 1,1±1,4DP, respectivamente). A faixa etária de cinco a seis anos apresentou maior ocorrência de DA (OR 1,8; IC95% 1,1-2,9) e filhos de mães com perfil responsivo tiveram menores chances de apresentar DAs (OR 0,4; IC95% 0,2-0,8). Conclusões: DA foi de alta prevalência. Não houve repercussão sobre o estado nutricional nem associação às práticas alimentares pregressas. O perfil responsivo das mães é fator protetor para as DAs e reforça a importância da natureza comportamental e da interação mãe-filho.

ABSTRACT Objective: To identify the prevalence of feeding difficulties in preschoolers, its association with epidemiological factors and previous eating habits, and repercussion on nutritional status. Methods: Cross-sectional study with a questionnaire given to the mothers of 301 children aged 2-6 years enrolled in public and private kindergartens in Natal, Northeast Brazil, conducted in 2014-2015. Feeding difficulty was assessed according to Kerzner's criteria, resulting in the profiles "highly selective intake", "active child with small appetite", "fear of feeding", and "child with psychological disorder or neglected". Association with the following independent variables was analyzed by logistic regression: breastfeeding time, age of cows' milk and complementary feeding introduction, age range, family income, type of school, mothers' profile (responsive or nonresponsive), and body mass index (BMI). Results: Feeding difficulty was found in 37.2% of cases, with predominance of "highly selective intake" (25.4%). It was not associated with infancy feeding practices, family income or type of school. There were no differences between the BMI Z score means for the groups with and without feeding difficulty (1.0±1.5 SD and 1.1±1.4 SD, respectively). The five-to-six age range had more occurrences (OR 1.8; 95%CI 1.1-2.9). Children of responsive mothers were less likely to have feeding difficulties (OR 0.4; 95%CI 0.2-0.8). Conclusions: Feeding difficulties were very frequent. Nutritional status was not impacted by it, and infancy eating habits were not associated with it. Responsive mothers' profile is a protective factor against eating difficulties and reinforces the importance of behavioral factors and mother-child interaction.

Importância da prática de atividade física para as pessoas com autismo / Importance of physical activity practice for people with autism

Introdução: O termo "autismo" foi utilizado para caracterizar a perda de contato com a realidade, gerando dificuldade ou impossibilidade de comunicação. Hoje, o autismo faz parte dos transtornos globais do desenvolvimento, chamados de Transtornos do Espectro Autista (TEA). Os autistas necessitam de cuidados multidisciplinares; o tratamento envolve técnicas de mudança de comportamento, programas educacionais ou de trabalho, além de terapias de linguagem/comunicação. Objetivo: O objetivo deste estudo foi realizar uma revisão literária de trabalhos que apontassem a importância da prática de atividades físicas para o desenvolvimento de pessoas com TEA, apresentando exemplos de atividades já executadas com essa finalidade, e quais os resultados obtidos. Métodos: O presente estudo trata-se de uma revisão de literatura narrativa sobre a importância da prática de atividades físicas por parte de pessoas com autismo, e como esta variável pode auxiliar seu desenvolvimento. Resultados: Estudos demonstram que, por meio da prática de exercícios como caminhada, equinoterapia, e atividades aquáticas as pessoas com autismo conseguem desenvolver melhor sua capacidade comunicativa, reduzir o comportamento antissocial, diminuir comportamentos que demonstram inadaptação, estereotipias e agressividade. Conclusão: Apesar de ser um tema extremamente importante, não se encontram muitos estudos que abordam essa temática; por esse motivo, o presente trabalho adquire relevância e abre espaço para que outras pesquisas sobre o assunto sejam realizadas, levando a um maior conhecimento sobre o tema. Dessa forma, as pessoas com autismo poderão ser mais bem atendidas em todas as suas necessidades biopsicossociais. (AU)

Introduction: The term "autism" was used to characterize the loss of contact with reality, generating difficulty or impossibility of communication. Today, autism is part of the global developmental disorders, called Autism Spectrum Disorders (ASD). Autistics need multidisciplinary care; Treatment involves behavior change techniques, educational or work programs, as well as language / communication therapies. Objective: The objective of this study was to carry out a literary review of papers that pointed out the importance of the practice of physical activities for the development of people with ASD, presenting examples of activities already performed for this purpose, and the results obtained. Methods: The present study is a review of narrative literature about the importance of physical activity practice by people with autism, and how this variable can help their development. Results: Studies show that, through the practice of exercises such as walking, equine, and aquatic activities, people with autism can better develop their communicative capacity, reduce antisocial behavior, reduce behaviors that show maladaptation, stereotypy and aggressiveness. Conclusion: Although it is an extremely important topic, there are not many studies that address this theme; For this reason, the present work acquires relevance and opens space for other researches on the subject to be carried out, leading to a greater knowledge on the subject. In this way, people with autism can be better served in all their biopsychosocial needs. (AU)

Primary Breast Lymphoma with cutaneous involvement in a patient with Rheumatoid Arthritis - a complication of infliximab therapy?

It is well established that rheumatoid arthritis is associated with an increased risk of lymphoma. The use of tumor-necrosis factor-α inhibitors as a therapy in rheumatoid arthritis has been related to higher incidence of lymphoma arising at atypical and/or unusual locations; however, recent data shows their safety. We report the case of a 79 year-old woman with rheumatoid arthritis treated with infliximab, who presented a primary breast lymphoma with cutaneous involvement.

PORTUGUESE RECOMMENDATIONS FOR THE USE OF BIOLOGICAL THERAPIES IN PATIENTS WITH PSORIATIC ARTHRITIS--2015 UPDATE.

OBJECTIVE: To update recommendations for the treatment of psoriatic arthritis with biological therapies, endorsed by the Portuguese Society of Rheumatology (SPR). METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. At a national meeting the 16 recommendations included in this document were discussed and updated. The level of agreement among Portuguese Rheumatologists was assessed using an online survey. A draft of the full text of the recommendations was then circulated and suggestions were incorporated. A final version was again circulated before publication. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with psoriatic arthritis (PsA). Specific recommendations were developed for several disease domains: peripheral arthritis, axial disease, enthesitis and dactylitis. CONCLUSION: These recommendations may be used for guidance in deciding which patients with PsA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.

Efeitos do treinamento concorrente sobre aspectos bioquímicos, antropométricos, funcionais e hemodinâmicos de mulheres diabéticas do tipo 2 / Effects of concurrent training on biochemical, anthropometric, hemodynamic and functional parameters of type 2 diabetic women

Objetivo: O estudo teve o objetivo de investigar os efeitos do treinamento físico concorrente sobre parâmetros bioquímicos, antropométricos, funcionais e hemodinâmicos em mulheres diabéticas. Métodos: A amostra foi composta por 16 mulheres diabéticas tipo 2, com média de idade de 62,8±9,5 anos. Os exercícios físicos foram realizados três vezes por semana, com duração de 60 minutos por sessão. As sessões de treinamento foram compostas por exercícios aeróbios seguidos de exercícios resistidos. A coleta de dados foi baseada nos parâmetros funcionais (testes de aptidão funcional), bioquímicos (glicemia, colesterol e triglicérides), antropométricos (estatura, massa corporal, índice de massa corporal e circunferência abdominal) e hemodinâmicos (pressão arterial). Resultados: Os dados demonstraram que houve melhora significativa na resistência de força, coordenação, no índice de aptidão física geral, glicemia de jejum e pressão arterial sistólica e diastólica de repouso. Os demais parâmetros avaliados não apresentaram diferença estatisticamente significativa. Conclusão: O treinamento concorrente foi eficiente em promover alterações importantes em parâmetros relacionados à saúde de mulheres diabéticas tipo 2.

Existe a constipação após histerectomia? Avaliação clínica e manométrica / Is there constipation after hysterectomy? Clinical and manometric evaluation

A histerectomia é procedimento cirúrgico ginecológico de grande porte mais comum, sendo a maioria das indicações por doença benigna. Dentre as complicações desse procedimento cirúrgico estão a constipação, dispareunia, incontinência para gases e fezes, urgência evacuatória, escapes fecais e distensão abdominal. A constipação tem sido encontrada freqüentemente após a histerectomia principalmente em trabalhos retrospectivos. Objetivo: estudar a incidência de constipação após a histerectomia e as alterações manométricas a ela relacionadas. Métodos: Estudo prospectivo em nove pacientes submetidas à histerectomia total abdominal por mioma. Foi realizado estudo manométrico e aplicação do escore de constipação adotado pela sociedade brasileira de motilidade digestiva no pré e sessenta dias de pós-operatório. Resultados: Os autores encontraram a presença de evacuação incompleta que não ocorria no pós-operatório. Não foram encontradas alterações manométricas e duas pacientes apresentaram dor abdominal à distensão da ampola retal na aferição do volume máximo tolerável. Conclusões: Os achados deste estudo sugerem que alterações intestinais ocorrem após a histerectomia e são principalmente relacionadas ao reto.

Hysterectomy is the most common gynecologic surgical procedure of great bearing being the majority of the indications due to being disease. Among the complications of this surgical procedure are constipation, dyspareunia, gas and feces incontinence, evacuatory urgency, fecal escapes and abdominal distension. Constipation has been frequently found after a hysterectomy, especially in retrospective studies. Objective: Study the incidence of constipation after hysterectomy and the manometrical alterations related to them. Methods: Prospective study in nine patients subjected to total abdominal hysterectomy due to myoma. A manometrical study and application of the constipation score adopted by "Sociedade Brasileira de Motilidade Digestiva" was performed in the pre and sixty days of post-operative. Results: The autors found presence of incomplete evacuation that did not occur in the pre-operative. Manometrical alterations were found and two of the patients presented abdominal pain to the rectal ampule distension in the tolerable maximum volume checking. Conclusions: The findings of this study suggest that intestinal alterations occur after hysterectomy and are specially related to the rectum.

Diagnóstico situacional da assistência pré-natal pelo Programa Saúde da Família no município de Corinto, Minas Gerais / Diagnosis of the prenatal care provided by the Family Health Program (FHP) in the city of Corinto, Minas Gerais

Na história da saúde pública, a atenção materno-infantil é reconhecida como prioritária. A assistência pré-natal influencia diretamente os coeficientes de morbimortalidade materna e infantil e possui um alto potencial indicativo da qualidade dos serviços de saúde. O objetivo do presente estudo é formular o diagnóstico da assistência pré-natal no município de Corinto/MG, a partir da cobertura da população pelas equipes do Programa de Saúde da Família (PSF), e das informações dos sistemas de informação SIAB e SINASC, no período de maio/2003 a maio/2004. Os resultados mostram uma cobertura populacional pelas equipes do PSF de 57%, um percentual de 24,1% de gestantes adolescentes, 96,5% de gestantes acompanhadas pelos agentes de saúde, 91,7% com consulta médica, 86,9% com pré-natal iniciado no primeiro trimestre e uma cobertura de vacinação contra tétano de 95,2%. A maioria das gestantes realizou o número ideal de consultas para garantia de uma boa atenção pré-natal (4 a 6 e/ou 7 ou mais consultas). A avaliação do processo de um programa de saúde analisa seu funcionamento, contempla os cuidados fornecidos e recebidos na assistência. Assim, são importantes tanto as atividades dos profissionais envolvidos quanto dos pacientes na procura e na utilização dos serviços disponibilizados, a fim de estimular uma melhor adequação do serviço. Os coeficientes de morbimortalidade materna e infantil podem ser reduzidos com determinação política na garantia de aprimoramentos mos serviços básicos de saúde à população, incluindo, especialmente, melhorias na assistência pré-natal.

Throughout the history of Public Health, mother and child care is recognized as a priority. Prenatal care has direct influence upon the mother and child morbidity and mortality coefficients and is a strong indicator of the quality of health care services. The present study aims at formulating a diagnosis of the prenatal care in the city of Corinto/MG, based on the coverage of the population by the teams of the Family Health Program (FHP) and on the data available at the information systems SIAB and SINASC over the period May 2003 to May 2004. The results show a coverage of the population by the FHP teams of 57%, which is below the rate recommended by the Ministry of Health. With regard to prenatal care, there is a percentage of 24,1% of pregnant adolescents - 96,5% of pregnant women were followed up by the health agents, 91,7% received medical care and 86,9% started the prenatal care in the first trimester of the pregnancy. As refers to antitetanic vaccination, the coverage of pregnant women was of 95,2%. The greater part of pregnant women had the ideal number of medical appointments for ensuring good prenatal care (4 to 6 or 7 or more). The assessment of the process of a health program implies in analyzing its functioning and the provided and received care. Thus, for allowing a better adjustment of the care services, not only the activities of the involved professionals must be contemplated but also the activities of the patients searching for and utilizing the offered services. The mother and child morbidity and mortality coefficients can be reduced through policies capable of improving the basic care provided to the population, including especially improvements in prenatal care.

Diabetes mellitus in patients with cystic fibrosis.

Cystic fibrosis-related diabetes (CFRD) is the principal extra-pulmonary complication of cystic fibrosis, occurring in 15-30% of adult cystic fibrosis patients. The number of cystic fibrosis patients who develop diabetes is increasing in parallel with increases in life expectancy. The aim of this study was to review the physiopathology, clinical presentation, diagnosis and treatment of CFRD. A bibliographic search of the Medline and Latin American and Caribbean Health Sciences Literature databases was made. Articles were selected from among those published in the last twenty years. Insulin deficiency, caused by reduced beta-cell mass, is the main etiologic mechanism, although insulin resistance also plays a role. Presenting features of type 1 and type 2 diabetes, CFRD typically affects individuals of approximately 20 years of age. It can also be accompanied by fasting, non-fasting or intermittent hyperglycemia. Glucose intolerance is associated with worsening of nutritional status, increased morbidity, decreased survival and reduced pulmonary function. Microvascular complications are always present, although macrovascular complications are rarely seen. An oral glucose tolerance test is recommended annually for patients > or = 10 years of age and for any patients presenting unexplained weight loss or symptoms of diabetes. Patients hospitalized with severe diseases should also be screened. If fasting hyperglycemia persists for more than 48 h, insulin therapy is recommended. Insulin administration remains the treatment of choice for diabetes and fasting hyperglycemia. Calories should not be restricted, and patients with CFRD should be managed by a multidisciplinary team.

Diabetes melito: uma importante co-morbidade da fibrose cística / Diabetes mellitus in patients with cystic fibrosis

Diabetes melito relacionado à fibrose cística (DMFC) é a principal complicação extrapulmonar da fibrose cística. Atualmente, ele afeta 15-30 por cento dos adultos com fibrose cística e sua prevalência tende a aumentar com o aumento da expectativa de vida desses pacientes. Esse trabalho tem por objetivo rever a fisiopatologia, morbidade, manifestações clínicas, diagnóstico e tratamento do DMFC. Uma pesquisa bibliográfica utilizou os bancos de dados Medline e Literatura Latino-Americana e do Caribe em Ciências da Saúde, selecionando artigos publicados nos últimos vinte anos. A insulinopenia secundária à destruição de células beta pancreáticas é o principal mecanismo causal, embora a resistência insulínica também possa estar presente. O DMFC apresenta características do diabetes melito tipo 1 e tipo 2 e tem início, em média, aos 20 anos de idade. Ele pode cursar com hiperglicemia em jejum, pós-prandial ou intermitente. As alterações do metabolismo glicêmico agravam o estado nutricional, aumentam a morbidade, diminuem a sobrevida e pioram a função pulmonar. As complicações microvasculares estão presentes, porém raramente observam-se as macrovasculares. A triagem para o DMFC deve ser anual, a partir dos 10 anos de idade, através do teste de tolerância oral à glicose e, em qualquer faixa etária, se houver perda ponderal inexplicada ou sintomatologia de diabetes. Pacientes hospitalizados também devem ser investigados e receber terapia insulínica se a hiperglicemia em jejum persistir além de 48 h. A insulina é o tratamento de escolha para o diabetes com hiperglicemia em jejum. Não existe consenso quanto ao tratamento do diabetes intermitente ou sem hiperglicemia de jejum. Não há orientações de restrições alimentares. O acompanhamento deve ser multidisciplinar.

Cystic fibrosis-related diabetes (CFRD) is the principal extra-pulmonary complication of cystic fibrosis, occurring in 15-30 percent of adult cystic fibrosis patients. The number of cystic fibrosis patients who develop diabetes is increasing in parallel with increases in life expectancy. The aim of this study was to review the physiopathology, clinical presentation, diagnosis and treatment of CFRD. A bibliographic search of the Medline and Latin American and Caribbean Health Sciences Literature databases was made. Articles were selected from among those published in the last twenty years. Insulin deficiency, caused by reduced beta-cell mass, is the main etiologic mechanism, although insulin resistance also plays a role. Presenting features of type 1 and type 2 diabetes, CFRD typically affects individuals of approximately 20 years of age. It can also be accompanied by fasting, non-fasting or intermittent hyperglycemia. Glucose intolerance is associated with worsening of nutritional status, increased morbidity, decreased survival and reduced pulmonary function. Microvascular complications are always present, although macrovascular complications are rarely seen. An oral glucose tolerance test is recommended annually for patients e" 10 years of age and for any patients presenting unexplained weight loss or symptoms of diabetes. Patients hospitalized with severe diseases should also be screened. If fasting hyperglycemia persists for more than 48 h, insulin therapy is recommended. Insulin administration remains the treatment of choice for diabetes and fasting hyperglycemia. Calories should not be restricted, and patients with CFRD should be managed by a multidisciplinary team.

A construção de um estágio em psicoterapia de grupo: uma perspectiva construcionista social / Constructing an internship in group therapy: a constructionist perspective / La construcción de una práctica en psicoterapia de grupo: una perspectiva construccionista social

Esse artigo consiste de um relato de experiência cujo objetivo é descrever a estrutura e o funcionamento do atendimento em psicoterapia de grupo, orientado por uma perspectiva construcionista social, tal como realizado em um estágio curricular do curso de Psicologia da Universidade Federal de Uberlândia. A perspectiva teórica utilizada enfatiza a análise do processo social de construção dos sentidos; uma postura de co-construção entre terapeuta e cliente; o olhar sobre os relacionamentos nos quais o cliente está envolvido; a multiplicidade de formas de descrever um problema; e um discurso de potencialidades positivas e de construção de realidades futuras. Os grupos, realizados sob supervisão de um docente, são coordenados por quatro estagiárias divididas em duplas de campo e equipe reflexiva. Os grupos fechados têm 12 sessões semanais de 1h30 de duração e têm como clientela a população adulta. Os principais desafios enfrentados pelas estagiárias se referem à aprendizagem da postura de não-saber e à utilização de perguntas conversacionais. Por meio deste estágio, tem sido possível reconhecer a produtividade, bem como os desafios, da construção desta nova perspectiva em terapia de grupo.

This article describes the structure and the functioning of a social constructionist group therapy program, as carried out in the Psychology internship at the Universidade Federal de Uberlândia. This theoretical perspective emphasizes the analysis of the social process of making sense; a stance of co-construction between therapist and client; a focus on the relationships in which the client is involved; the multiplicity of forms to describe a problem; and a discourse of positive potentials and the construction of future realities. The groups are coordinated by four trainees divided in pairs of field therapists and reflecting team members. The closed groups have 12 weekly sessions of 1h30 of duration and are attended by adult people. The main challenges faced by the trainees are related to the learning of the not-knowing position and the use of conversational questions. Through this experience, it has been possible to recognize the productivity, as well as the challenges, of the construction of this new perspective in group therapy.

Este artículo consiste de un relato de experiencia cuyo objetivo es describir la estructura y el funcionamiento del atendimiento en psicoterapia de grupo, orientado por una perspectiva construccionista social, tal como realizado en una práctica curricular del curso de Psicología de la Universidade Federal de Uberlândia. La perspectiva teórica utilizada enfatiza el análisis del proceso social de construcción de los sentidos; una postura de co-construcción entre terapeuta y cliente; la mirada sobre los relacionamientos en los cuales el cliente está envuelto; la multiplicidad de formas de describir un problema; y un discurso de potencialidades positivas y de construcción de realidades futuras. Los grupos, realizados con supervisión de un docente, son coordinados por cuatro practicantes dividas en duplas de campo y equipo reflexivo. Los grupos cerrados tienen 12 sesiones semanales de 1h30 de duración y tienen como clientela la población adulta. Los principales desafíos enfrentados por las practicantes se refieren al aprendizaje de la postura de no-saber y a la utilización de preguntas conversacionales. Por medio de esta práctica, ha sido posible reconocer la productividad, bien como los desafíos de la construcción de esta nueva perspectiva en terapia de grupo.

Tratamento do hipertireoidismo com iodo radioativo: experiência do HUCFF-UFRJ - 1978-1996 / Treatment of hyperthyroidism with radioactive iodine

Os autores apresentam o resultado do tratamento do hipotireoidismo com 131 I em 128 pacientes: 50 por cento estavam em hipotireoidismo após períodos de observaçäo de 1 a 14 anos. A necessidade de retratamento se situou em torno de 20 por cento. Näo houve complicaçöes, sendo muito bem tolerado.