Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update.

BACKGROUND: Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007. METHODS: SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey. RESULTS: The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

Estudo do coeficiente de asfericidade e aberração esférica longitudinal da superfície corneana / Study of asphericity coefficient and longitudinal spherical aberration surface corneal

Resumo Objetivo: Correlacionar o coeficiente de asfericidade com a aberração esférica longitudinal na superfície corneana, correlacionando também cada uma dessas variáveis com a ceratometria média Métodos: Realizou-se um estudo observacional através da coleta de dados pré-operatórios nos prontuários de indivíduos candidatos a facectomia. Os dados coletados se referiam ao sexo e idade, além do Q, LSA da superfície corneana e ceratometria média (Km). Foram excluídos do estudo os pacientes que realizaram qualquer procedimento cirúrgico corneano, por alterar as medidas da Q, LSA e Km. O topógrafo selecionou, de maneira fixa, uma área 4,5mm da superfície anterior da córnea para medida do Q e da LSA, tendo como ponto central o eixo pupilar. A ocorrência da LSA é relevante em ambientes de penumbra, em indivíduos com pupila maior que 3mm. Resultados: A amostra foi composta por 70 olhos de 35 indivíduos: 24 (68,6%) mulheres e 11 (31,4%) homens. A idade variou de 48 a 89 anos (média de 69,97 ± 8,29). A Km variou de 41,00D a 46,50D com média de 43,94 ± 1,48D. Na avaliação do Q da superfície corneana se observou uma média de -0,15 ± 0,15. Seis (8,57%) córneas apresentaram desenho esférico com Q= 0 e apenas uma córnea apresentou desenho asférico com Q= -0,50, gerando LSA= 0,0µm. Em relação a LSA da superfície corneana se observou média de +0,33 ± 0,14 µm. Quarenta e dois olhos (60,0%) apresentaram LSA entre +0,31 a +0,64µm e 19 (27,15%) entre +0,16 a +0,30µm. Não houve correção entre a Km e o Q (r= -0,005 / p= 0,965), assim como entre Km e a LSA (r= 0,167 / p= 0,170). Observou-se correlação (r= 0,962 / p= 0,000) entre as variáveis Q x LSA. Conclusão: Foi observada correlação entre o Q e a LSA da superfície corneana. Não foi observado correlações entre o coeficiente de asfericidade ou aberração esférica longitudinal com a ceratometria média.

Abstract Objective: To correlate the asphericity coefficient (Q) with longitudinal spherical aberration (LSA) of the corneal surface, also correlating each of these variables with the average keratometry Methods: An observational study was conducted by collecting preoperative data from the medical records of individuals candidate cataract surgery, i.e., patient sex and age, as well as Q, LSA of the corneal surface and mean keratometry (Km). Patients who had been subjected to any corneal surgical procedure who would alter Q, LSA and Km measuements were excluded. The corneanl topograph selected, fixedly, a 4.5 mm area of the anterior surface of the cornea for the measurement of Q and LSA, having the pupillary axis as the central point, since the occurrence of LSA is relevant in dim environments in individuals with a pupil wider than 3 mm Results: The sample consisted of 70 eyes of 35 individuals, 24 of them women (68.6%) and 11 men (31.4%) ranging in age from 48 to 89 years (mean: 69.97 ± 8.29). Km ranged from 41.00 to 46.50 D, with a mean of 43.94 ± 1.48D, and mean Q of the corneal surface was -0.15 ± 0.15. Six corneas showed a spherical design (Q= 0.0) and only one showed an aspheric design with Q = -0.50, generating an LSA of 0.0. Mean LSA of the corneal surface was +0.33 ± 0.14 µm. Only one eye showed an LSA equal to 0.0µm, and five showed an LSA of +0.10 to +0.30µm. No eye showed a negative LSA of the corneal surface. There was no correlation between Km and Q (r = -0.005 / p = 0.965) or between Km and LSA (r = 0.167 / p = 0.170). A correlation (r = 0.962 / p = 0.000) was observed between Q and LSA Conclusion: There was a correlation between Q and LSA of the corneal surface. There was no correlation between the sphericity coefficient or longitudinal spherical aberration with the average keratometry.

Translation, validation, and construct reliability of a Portuguese version of the Xerostomia Inventory.

OBJECTIVES: To generate and validate at pretest level a cross-culturally adapted Portuguese version of Xerostomia Inventory (XI), a 11-item questionnaire designed to measure specific xerostomia rating of patients complaints. METHODS: The original English version of the XI was translated into Portuguese following the guidelines for cross-cultural adaptation of health-related quality of life measures. Thirty patients with primary Sjögren syndrome were recruited for this study. The questionnaires were administered by trained and calibrated dental doctors to each patient. XI properties were examined including reliability, internal consistency, and test-retest reliability, using Cronbach's alpha, total and inter-item correlation, and intra-class correlation coefficients (ICC), respectively. Construct validity supported by objective measurements of xerostomia intra-oral signs and salivary secretion was investigated. Alpha was set at 0.05. Informed consents and local ethical committee clearance were obtained. RESULTS: Internal consistency and test-retest reliability were excellent (Cronbach's α=0.9; ICC range=0.79-0.94). Scatterplot interpolation and Pearson correlation coefficient suggested the presence of a strong, negative, and significant correlation between salivation and the XI scores indicating construct validity. CONCLUSION: The Portuguese version of the XI can be considered a reliable and valid instrument to measure patients' xerostomia symptoms.

Estudo químico e da atividade biológica cardiovascular do óleo essencial de folhas de Alpinia zerumbet (Pers.) B.L.Burtt & R.M.Sm. em ratos / Phytochemistry and cardiovascular biological activity of the essential oil from leaves of Alpinia zerumbet (Pers.) B.L. Burtt & R.M.Sm. in rats

A espécie vegetal Alpinia zerumbet (Pers.) B.L.Burtt & R.M. Sm. é popularmente empregada para o tratamento de diversas enfermidades, entre elas a hipertensão. Avaliar a composição química, a atividade antihipertensiva e ação na hipertrofia cardíaca do óleo essencial das folhas de Alpinia zerumbet (OEAZ) em ratos foram os objetivos deste estudo. O OEAZ, obtido por hidrodestilação em aparelho Clevenger, teve sua composição química analisada em cromatografia gasosa acoplada à espectrometria de massas (CG-EM). Foram identificados 14 constituintes, sendo terpinen-4-ol (37,45 por cento) o majoritário, seguido pelos óxido de cariofileno (7,56 por cento), trans-hidrato de sabineno (6,61 por cento) e 1,8-cineol (4,02 por cento). A avaliação cardiovascular foi feita após o tratamento crônico de ratos espontaneamente hipertensos (SHR) e seus respectivos controles, ratos Wistar-Kyoto (WKY). Os dados hemodinâmicos revelaram redução da pressão arterial média (PAM) no grupo tratado (SHRP: 160 ± 7 mm Hg; p<0,01) em relação ao não tratado (SHR: 180 ± 5 mm Hg). A relação entre peso do ventrículo esquerdo e peso corporal (VE/PC) do SHRP (2,50 ± 0,03 mg g-1; p<0,01) mostrou-se inferior ao SHR (2,61 ± 0,01 mg g-1), confirmando a redução da hipertrofia cardíaca (HC). Os dados de PAM e VE/PC dos animais SHRP foram estatisticamente diferentes quando comparados com os ratos controle (WKY: 116 ± 2 mm Hg e WKYP: 119 ± 4 mm Hg; p<0,05; WKY: 2,15 ± 0,04 mg g-1 e WKYP: 2,17 ± 0,04 mg g-1 ; p<0,01), indicando não ter havido normalização dos mesmos. Conclui-se que o tratamento crônico com OEAZ foi capaz de determinar redução, mas não a normalização, da PAM e da HC de ratos SHR, provavelmente pela presença dos componentes terpinen-4-ol e 1,8-cineol. Estudos com doses maiores ou período de tratamento superior são necessários para avaliar a possibilidade de o OEAZ normalizar os parâmetros analisados (PAM e HC).

Alpinia zerumbet (Pers.) B.L. Burtt & R.M.Sm. is traditionally employed to treat several diseases such as hypertension. The aim of this study was to evaluate the chemical composition, the anti-hypertensive activity and the capacity to reduce cardiac hypertrophy of the essential oil of A. zerumbet leaves (EOAZ) in rats. EOAZ was obtained through hydrodistillation in Clevenger apparatus and its chemical composition was analyzed by gas chromatography-mass spectrometry (GC-MS). Several constituents (14) were identified, terpen-4-ol (37.45 percent) being the major component, followed by caryophyllene oxide (7.56 percent), trans-sabinene hydrate (6.61 percent) and 1,8-cineol (4.02 percent). The cardiovascular effect was investigated after chronic treatment with spontaneously hypertensive rats (SHR) and their respective controls, Wistar-Kyoto rats (WKY). The treated group showed a lower mean arterial pressure (MAP) (SHRP: 160 ± 7 mm Hg; p<0.01) than the untreated group (SHR: 180 ± 5 mm Hg). The ratio of left ventricle-to-body weight (LV/BW) for SHRP was lower (2.504 ± 0.03 mg g-1; p<0.01) than that for SHR (2.162 ± 0.01 mg g-1), confirming the cardiac hypertrophy (CH) reduction. There were significant differences in MAP and CH between SHRP animals and control rats (WKY: 116 ± 2 mm Hg and WKYP: 119 ± 4 mm Hg; p<0.05. WKY: 2.152 ± 0.04 mg g-1 and WKYP: 2.168 ± 0.04 mg g-1; p<0.01), indicating that these values were not normalized. Those data showed that the chronic treatment with EOAZ reduces MAP and CH in SHR probably due to the presence of the compounds terpinen-4-ol and 1,8-cineol. Studies with higher doses or longer treatment periods are necessary to evaluate whether EOAZ can reduce the analyzed parameters (MAP and CH) to normal values.

[Perceived pain and weather changes in rheumatic patients]. / A percepçao da dor e alteracoes climatéricas em doentes reumáticos.

INTRODUCTION: Rheumatic patients with chronic pain describe in a vivid way the influence of climate on pain and disease activity. Several studies seem to confirm this association. OBJECTIVES: To evaluate and compare in a population of rheumatic patients the perceived influence of weather changes on pain and disease activity METHODS: This is a retrospective cross-sectional study. For three weeks an assisted self-reported questionnaire with nine dimensions and a VAS pain scale was performed on consecutive out-patients in our clinic. RESULTS: 955 patients 787 female 168 male mean age 57.9 years with several rheumatologic diagnosis were evaluated. Overall 70 of the patients believed that the weather influenced their disease and 40 believed that the influence was high. Morning stiffness was influenced in 54 high influenced in 34 . Autumn and Winter were the most influential periods as well as humidity 67 and low temperatures 59 . CONCLUSION: In our study as well as in literature we found that a high percentage of patients 70 perceived that weather conditions influenced their pain and disease. Fibromyalgia patients seemed to be strongly influenced by weather changes. Our study confirms that patients perception on the influence of climate on pain and therefore their disease is an important clinical factor and it should be considered when evaluating rheumatic patients.