Calcium supplementation and cardiovascular disease in postmenopausal women: a study in South Brazil / Suplementação de cálcio e doença cardiovascular em mulheres na pós-menopausa: um estudo no Sul do Brasil

Objective: To evaluate the link between calcium supplementa- tion and cardiovascular disease in postmenopausal women (aged 55 years or older). Methods: A standardized questionnaire was employed to collect data about calcium supplements, eart di- sease, and demographic of women attended at Primary Care in the South Region of Brazil. Generalized linear regression models were performed to evaluate the association and adjust for poten- tial confounders. Results: Overall, 1,057 women completed the questionnaire. Information about calcium supplementation was present in 1,035 questionnaires. The mean ± standard deviation of the age of participants was 67.2±7.6 years. The frequency of calcium supplementation was 18.6%. There was no association between heart failure, stroke, and ischemic heart disease and cal- cium supplementation (prevalence ratio; 95% confidence interval of 0.3; -0.9-0.4, -0.2; -0.8-0.4 and -0.5; -1.0-0.02, respectively. Con- clusions: Our study did not find an association of higher risk of cardiovascular disease in women using calcium supplementation at Primary Care in South Brazil.

Objetivo: Avaliar a ligação entre a suplementação de cálcio e doença cardiovascular em mulheres na pós-menopausa (com 55 anos ou mais). Métodos: Um questionário padronizado foi em- pregado para coletar dados sobre suplementos de cálcio, doenças cardíacas e demográficos de mulheres que frequentavam a Aten- ção Primária na Região Sul do Brasil. Modelos de regressão linear generalizada foram realizados para avaliar a associação e ajustar os potenciais fatores de confusão. Resultados: No total, 1.057 mulheres responderam ao questionário. As informações sobre su- plementação de cálcio estavam presentes em 1.035 questionários. A média ± desvio-padrão da idade dos participantes foi de 67,2 ± 7,6 anos. A frequência de suplementação de cálcio foi de 18,6%. Não houve associação entre insuficiência cardíaca, acidente vas- cular cerebral e doença cardíaca isquêmica e suplementação de cálcio (razão de prevalência; intervalo de confiança de 95% de -0,3; -0,9-0,4, -0,2; -0,8-0,4 e -0,5; -1,0-0,02, respectivamente). Con- clusão: Nosso estudo não encontrou associação de maior risco de doença cardiovascular em mulheres em uso de suplementação de cálcio na Atenção Primária no Sul do Brasil.

Translation and validation of the Indian Takayasu clinical activity score (ITAS2010) for the Brazilian Portuguese language

Abstract Background: The Indian Takayasu Clinical Activity Score (ITAS2010) was developed in 2010 as an assessment tool for disease activity in patients with Takayasu arteritis (TA). It has since been widely used in different studies and in clinical practice for the management of patients with TA. The present study aims to translate the ITAS2010 into Brazilian Portuguese language and to validate it for use in clinical practice in Brazil. Methods: For this cross-sectional study, the ITAS2010 was translated in accordance with the guidelines described by Beaton et al. and then applied with 27 patients with TA on three assessments by two rheumatologists working independently. To measure interrater agreement, the assessments were performed on the same day within approximately 1 hour. One of the rheumatologists performed a second evaluation of patients with TA within 7 to 14 days to measure intrarater agreement. Results: The correlation coefficient for the ITAS2010 score between the two raters was high (r =0.916; p < 0.0001), as well as the intraclass correlation coefficient (ICC) [0.918 with a 95% confidence interval (95CI): 0.828-0.962]. The correlation coefficient and the ICC for intrarater agreement were moderate for ITAS2010 (r =0.633; p < 0.0001 and ICC = 0.594; 95CI: 0.292-0.790). The ITAS2010 at baseline was compared with the physician's global assessment (PGA) and with Kerr's criteria for detecting disease activity in TA. Higher ITAS2010 scores were observed in patients with active and grumbling/persistent disease than in those presenting inactive disease according to the PGA [1.5 (0.0-3.0) vs. 0.0 (0.0-0.0); p = 0.0025]. Patients with active disease according to the Kerr's criteria had also higher ITAS2010 scores than those considered in remission [3.0 (3.0-7.0) vs. 0.0 (0.0-0.0); p = 0.0068]. Conclusions: The Brazilian Portuguese version of the ITAS2010 is a valid and reproducible tool for the assessment of disease activity in TA and it is an additional tool for the routine evaluation of Brazilian patients with TA.

Hipercalcemia: avaliação e princípios do tratamento / Hypercalcemia: evaluation and principles of treatment

A hipercalcemia é um problema clínico relativamente comum na prática clínica; todavia, o seu diagnóstico e manejo são pouco discutidos em nível ambulatorial. Esta revisão visa discutir o diagnóstico de hipercalcemia, suas manifestações clínicas, principais causas e princípios de tratamento em nível de atenção primária em saúde. Considera-se hipercalcemia quando o cálcio total ou ionizado encontra-se no limite superior da normalidade, com níveis superiores a 10,5 mg/dl para o cálcio total. Em indivíduos em que não haja alteração do pH e das proteínas, a aferição do cálcio total é extremamente confiável e não existe motivo para a solicitação de cálcio ionizado. A principal causa de hipercalcemia em pacientes ambulatoriais é o hiperparatireoidismo primário; entretanto, valores de cálcio total superiores a 13 mg/dl não são usuais nestes pacientes, e a presença de neoplasia deve ser investigada. O tratamento da hipercalcemia objetiva reduzir os níveis séricos de cálcio e, se possível, tratar a doença de base. A terapia inicial da hipercalcemia inclui simultaneamente a hidratação com solução salina e o uso de calcitonina e bisfosfonatos. Indivíduos com níveis séricos superiores a 13,5 mg/dl devem ser encaminhados a um serviço de emergência (AU)

Hypercalcemia is a relatively common clinical problem in clinical practice; however, its diagnosis and management are hardly discussed at an outpatient level. This review discusses the diagnosis of hypercalcemia, its clinical manifestations, main causes and principles of treatment at the level of primary health care. A diagnosis of hypercalcemia is made when the total or ionized calcium is in the upper limit of normality, with total calcium levels above 10.5 mg/dL. In subjects where there is no change in pH and proteins, measurement of total calcium is extremely reliable and there is no reason for requesting ionized calcium. The main cause of hypercalcemia in outpatients is primary hyperparathyroidism; however, total calcium values greater than 13 mg/dl are unusual in these patients and the presence of neoplasm should be investigated. Treatment aims to reduce serum calcium levels and if possible treat the underlying disease. Initial therapy of hypercalcemia includes simultaneous hydration with saline and the use of calcitonin and bisphosphonates. Individuals with serum levels higher than 13.5 mg/dL should be referred to an emergency department (AU)