Acidic food choice among adolescents with bulimic symptomatology: a major risk factor for erosive tooth wear?

PURPOSE: Evaluate dietary habits and the presence of erosive tooth wear (ETW) among female adolescents with varying severity of bulimic symptomatology. METHODS: An explanatory study was conducted with 72 female school adolescents with bulimic symptomatology, aged 15-18 years in Southeastern Brazil. Dietary habits were evaluated through a food frequency questionnaire. Bulimic symptomatology was evaluated and classified (mild, moderate and severe) according to the Bulimic Investigatory Test of Edinburgh. ETW examinations were performed. Data analysis involved descriptive statistics, bivariate analysis, Kruskal-Wallis/Mann-Whitney tests and Poisson regression. Ethical approval and informed consents were obtained. RESULTS: The final population consisted of 62 participants. The prevalence of ETW differed among adolescents with mild, moderate and severe bulimic symptomatology (p = 0.001), corresponding to 5.9%, 8.0% and 45.0%, respectively. Adolescents with severe bulimic symptomatology presented higher daily consumption of acidic food: citric fruits (p < 0.005), diet soda (p < 0.009) and ketchup (p = 0.004). No difference related to vomiting practices was observed between groups (p = 0.060). The adjusted regression model showed that a higher prevalence of ETW was associated with self-induced vomit at least once a week (PR = 2.42, 95% CI = 1.00-5.86, p = 0.05) and higher frequencies of consumption of citric fruits (PR = 7.96, 95% CI = 1.50-42.11, p = 0.015) and diet soda (PR = 2.32, 95% CI = 1.09-4.91, p = 0.029). CONCLUSION: It was the food choices (acidic food) and not purging practices that differed among adolescents with varying severity of bulimic symptomology. Likewise, higher consumption of citric fruits was the main factor associated with higher prevalence of ETW. LEVEL OF EVIDENCE: III case-control analytic study.

Una mirada al estilo de personalidad tendiente a los desórdenes alimentarios desde el constructivismo hermenéutico / A look at the personality style tending to food disorders from the hermeneutical constructivism

El estilo de personalidad tendiente a los trastornos alimentarios se refiere a una lucha de sentido con el propio cuerpo, que regula la dialéctica entre la co-percepción del otro y el sentido de sí mismo, el problema alimentario va comprendido como un problema con la dialéctica del cuerpo, no con la imagen del cuerpo. El punto fundamental para comprender el trastorno alimentario es en relación a la imagen corporal, la mujer y los medios de información. Adicionalmente, se ha encontrado que la tecnología juega un papel importante al afectar no sólo la experiencia de la percepción, a través de acelerar el cambio en contextos específicos, sino la introducción de nuevos recursos de signi- ficado; nuevos puntos de referencia que proporcionan el anclaje para crear y mantener la identidad propia. Esto sitúa al hombre en una nueva forma de orientarse emocional- mente en relación a su contexto.

The eating disorder-prone style of personality refers to a feeling struggle with the same body, which regulates the dialectic between the other co-perception and the sense of self, the eating disorder is understood as a problem related to the dialectic of the body itself but not to the image of the body. The main point in order to understand the eating disorder is associated with the body image, the female gender and media. On the other hand, it has been found that technology plays a vital role not only by afecting the experience perception by accelerating the change in specific contexts but also by introducing new resources of meaning; new points of reference which provide the basis to create and keep the own identity. Thus, it sets the human in a new way of emotional orientation in relationship with his context.

Características sociodemográficas, alterações orais e prevalência da Candida spp em pacientes com transtornos alimentares / Sociodemographic characteristics, oral status and prevalence of Candida spp in patients of eating disorders

As alterações orais nos pacientes com transtornos alimentares (TAs) são estudadas na literatura, porém poucos artigos abrangem a relação entre as alterações orais, candidose bucal e avaliação sociodemográfica. O presente estudo avaliou as características sociodemográficas, orais e a prevalência de Candida spp em pacientes com TAs. Foram avaliados 14 pacientes, destes 6 possuíam o diagnóstico estabelecido de Anorexia purgativa, 7 de Bulimia Nervosa e 1 TANE (transtorno alimentar não especificado). A idade média dos pacientes do estudo foi de 30,7 anos e todos eram do sexo feminino. Os pacientes responderam a um questionário elaborado pela pesquisadora e em seguida foram submetidos ao exame clínico inicial, para avaliação geral da saúde bucal, com enfoque na presença de lesões de mucosa, cáries, erosões e candidose. Também foi coletado saliva para a avaliação do fluxo salivar. As seguintes características sociodemográficas foram encontradas: 28,4% exerciam atividade remunerada; 42,8% possuíam terceiro grau completo e 78,6% eram solteiras; o tempo médio do transtorno alimentar foi de 14,8 anos e o tempo de diagnóstico médico foi de 8,07 anos. Na avaliação odontológica foram encontrados: CPO-d (dentes-cariados, perdidos e obturados) médio de 10,57; IHOS (índice de higiene oral) médio de 1,3; 71,4% das pacientes possuíam perda de brilho na face palatina dos dentes e 14,2% apresentaram perimólise. As pacientes purgativas apresentaram um índice CPO-d maior que as pacientes restritivas, a classe social mais prevalente foi a classe média. A Candida spp foi mais isolada em pacientes do serviço público e a xerostomia não foi um fator predisponente à colonização de Candida spp. A perimólise teve relação com o tempo de TAs das pacientes. Os resultados obtidos demonstram a necessidade de acompanhamento odontológico regular em pacientes com TAs.

The oral changes in patients with eating disorders (ED) are studied in literature, but few articles disclose the connection between oral changes, oral candidiasis and sociodemographic characteristics. This study evaluated the sociodemographic characteristics, oral changes and the prevalence of Candida spp. Fourteen patients were evaluated. Six subjects were diagnosed with Anorexia (purging subtype), seven with Bulimia and one with EDNOS (eating disorders no specified). Every subject included was female with a mean age of 30,7 years. All of them answered a questionnaire and passed through a clinical exam to evaluate the oral health focusing on oral lesions, erosion, decayed and candidiasis. Saliva was collected for analysis. The social demographics characteristics were observed 28.4% of subjects exercise a paid activity, 42.8% had college degree and 78.5% were single. The mean time of ED was 14.8 years and mean time of medical diagnosis was 8.07 years. The clinical exam revealed the following data: DMFT mean of 10.57; Plaque index (oral hygiene) mean of 1.3; 71.4% of subjects showed tooth wear in enamel on palatine surface and 14,2%, perimolysis. This results suggest that patients with purging habits had higher DMFT than restrictive patients, the social class can be a predisposing factor for ED, the local where treatment was done influenced in isolation of Candida spp; and xerostomia did not influence in colonization of the fungus. The perimolysis presented relation with time of manifestation ED. This results showed the importance of concomitant treatment with dentistry.

Recurrent aborted sudden cardiac death with seizures and rhabdomyolysis due to bulimia-induced hypokalemia: report of one case.

Recurrent vomiting due to bulimia associated with abuse of furosemide and laxatives causing severe hypokalemia may result in recurrent aborted sudden cardiac death (SCD) and seizures. We report a 25-year-old female with a history of bulimia associated with abuse of furosemide and laxatives since the age of 15 years, migraine since puberty, renal abscesses at age 20 y, and rhabdomyolysis of unknown cause at age 24 y. She experienced aborted SCD due to severe hypokalemia with symptomatic seizures at 21 and 25 years of age. Bulimia patients additionally taking laxatives or furosemide are at particular risk of SCD and rhabdomyolysis and require periodic determination of electrolytes, potassium substitution, and adequate psychiatric therapy and surveillance.

Impact of bariatric surgery on depression and anxiety symptons, bulimic behaviors and quality of life.

OBJECTIVE: To assess psychiatric symptoms, substance use, quality of life and eating behavior of patients undergoing bariatric surgery before and after the procedure. METHODS: We conducted a prospective longitudinal study of 32 women undergoing bariatric surgery. To obtain data, the patients answered specific, self-administered questionnaires. RESULTS: We observed a reduction in depressive and anxious symptoms and also in bulimic behavior, as well as an improved quality of life in the physical, psychological and environmental domains. There was also a decrease in use of antidepressants and appetite suppressants, but the surgery was not a cessation factor in smoking and / or alcoholism. CONCLUSION: a decrease in psychiatric symptoms was observed after bariatric surgery, as well as the reduction in the use of psychoactive substances. In addition, there was an improvement in quality of life after surgical treatment of obesity.

Menstruation disorders in adolescents with eating disorders-target body mass index percentiles for their resolution.

OBJECTIVE: To analyse the progression of body mass index in eating disorders and to determine the percentile for establishment and resolution of the disease. METHODS: A retrospective descriptive cross-sectional study. Review of clinical files of adolescents with eating disorders. RESULTS: Of the 62 female adolescents studied with eating disorders, 51 presented with eating disorder not otherwise specified, 10 anorexia nervosa, and 1 bulimia nervosa. Twenty-one of these adolescents had menstrual disorders; in that, 14 secondary amenorrhea and 7 menstrual irregularities (6 eating disorder not otherwise specified, and 1 bulimia nervosa). In average, in anorectic adolescents, the initial body mass index was in 75th percentile; secondary amenorrhea was established 1 month after onset of the disease; minimum weight was 76.6% of ideal body mass index (at 4th percentile) at 10.2 months of disease; and resolution of amenorrhea occurred at 24 months, with average weight recovery of 93.4% of the ideal. In eating disorder not otherwise specified with menstrual disorder (n=10), the mean initial body mass index was at 85th percentile; minimal weight was in average 97.7% of the ideal value (minimum body mass index was in 52nd percentile) at 14.9 months of disease; body mass index stabilization occurred at 1.6 year of disease; and mean body mass index was in 73rd percentile. Considering eating disorder not otherwise specified with secondary amenorrhea (n=4); secondary amenorrhea occurred at 4 months, with resolution at 12 months of disease (mean 65th percentile body mass index). CONCLUSION: One-third of the eating disorder group had menstrual disorder - two-thirds presented with amenorrhea. This study indicated that for the resolution of their menstrual disturbance the body mass index percentiles to be achieved by female adolescents with eating disorders was 25-50 in anorexia nervosa, and 50-75, in eating disorder not otherwise specified.

Impact of bariatric surgery on depression and anxiety symptons, bulimic behaviors and quality of life / O impacto da cirurgia bariátrica nos sintomas depressivos e ansiosos, comportamento bulímico e na qualidade de vida

OBJECTIVE: To assess psychiatric symptoms, substance use, quality of life and eating behavior of patients undergoing bariatric surgery before and after the procedure. METHODS: We conducted a prospective longitudinal study of 32 women undergoing bariatric surgery. To obtain data, the patients answered specific, self-administered questionnaires. RESULTS: We observed a reduction in depressive and anxious symptoms and also in bulimic behavior, as well as an improved quality of life in the physical, psychological and environmental domains. There was also a decrease in use of antidepressants and appetite suppressants, but the surgery was not a cessation factor in smoking and / or alcoholism. CONCLUSION: a decrease in psychiatric symptoms was observed after bariatric surgery, as well as the reduction in the use of psychoactive substances. In addition, there was an improvement in quality of life after surgical treatment of obesity. .

OBJETIVO: avaliar a sintomatologia psiquiátrica, o uso de substâncias, a qualidade de vida e o comportamento alimentar de pacientes submetidos a cirurgia bariátrica antes e após o procedimento. MÉTODOS: estudo longitudinal prospectivo com 32 mulheres submetidas à cirurgia báriatrica. Para a obtenção de dados, as pacientes responderam a questionários específicos, autoaplicados. RESULTADOS: foi identificada uma redução na sintomatologia depressiva e ansiosa e também no comportamento bulímico, bem como uma melhora na qualidade de vida nos domínios físico, psíquico e ambiental. Houve diminuição do uso de antidepressivos e de moderadores de apetite, porém a cirurgia não foi um fator determinante na cessação do tabagismo e/ou etilismo. . CONCLUSÃO: foi observada uma diminuição da sintomatologia psiquiátrica após a cirurgia bariátrica, bem como redução do uso de substâncias psicoativas. Além disso, houve melhora na qualidade de vida após o tratamento cirúrgico da obesidade. .

Recurrent aborted sudden cardiac death with seizures and rhabdomyolysis due to bulimia-induced hypokalemia: Report of one case / Muerte súbita abortada recurrente con convulsiones y rabdomiolisis causada por hipokalemia: Informe de una paciente con bulimia

Recurrent vomiting due to bulimia associated with abuse of furosemide and laxatives causing severe hypokalemia may result in recurrent aborted sudden cardiac death (SCD) and seizures. We report a 25-year-old female with a history of bulimia associated with abuse of furosemide and laxatives since the age of 15 years, migraine since puberty, renal abscesses at age 20 y, and rhabdomyolysis of unknown cause at age 24 y. She experienced aborted SCD due to severe hypokalemia with symptomatic seizures at 21 and 25 years of age. Bulimia patients additionally taking laxatives or furosemide are at particular risk of SCD and rhabdomyolysis and require periodic determination of electrolytes, potassium substitution, and adequate psychiatric therapy and surveillance.

Los vómitos recurrentes debidos a bulimia, asociados a abuso de furosemida y laxantes que causan hipokalemia severa, pueden llevar a muerte súbita abortada y convulsiones. Informamos una mujer de 25 años con una historia de bulimia asociada a abuso de furosemida y laxantes desde los 15 años, migrañas desde la pubertad, abscesos renales a los 20 años y rabdomiolisis de causa desconocida a los 24 años. La paciente tuvo dos episodios de muerte súbita abortada con convulsiones a los 21 y 25 años, debido a hipokalemia severa. Los pacientes con bulimia y abuso de furosemida y laxantes tienen un riesgo mayor de tener muerte súbita y rabdomiolisis, requieren de controles periódicos de electrolitos y tratamiento psiquiátrico.

Menstruation disorders in adolescents with eating disorders ? target body mass index percentiles for their resolution / Distúrbios menstruais em adolescentes com transtornos alimentares ? meta de percentil de índice de massa corporal para resolução dos distúrbios menstruais

Objective To analyse the progression of body mass index in eating disorders and to determine the percentile for establishment and resolution of the disease. Methods A retrospective descriptive cross-sectional study. Review of clinical files of adolescents with eating disorders. Results Of the 62 female adolescents studied with eating disorders, 51 presented with eating disorder not otherwise specified, 10 anorexia nervosa, and 1 bulimia nervosa. Twenty-one of these adolescents had menstrual disorders; in that, 14 secondary amenorrhea and 7 menstrual irregularities (6 eating disorder not otherwise specified, and 1 bulimia nervosa). In average, in anorectic adolescents, the initial body mass index was in 75th percentile; secondary amenorrhea was established 1 month after onset of the disease; minimum weight was 76.6% of ideal body mass index (at 4th percentile) at 10.2 months of disease; and resolution of amenorrhea occurred at 24 months, with average weight recovery of 93.4% of the ideal. In eating disorder not otherwise specified with menstrual disorder (n=10), the mean initial body mass index was at 85th percentile; minimal weight was in average 97.7% of the ideal value (minimum body mass index was in 52nd percentile) at 14.9 months of disease; body mass index stabilization occured at 1.6 year of disease; and mean body mass index was in 73rd percentile. Considering eating disorder not otherwise specified with secondary amenorrhea (n=4); secondary amenorrhea occurred at 4 months, with resolution at 12 months of disease (mean 65th percentile body mass index). Conclusion One-third of the eating disorder group had menstrual disorder − two-thirds presented with amenorrhea. This study indicated that for the resolution of their menstrual disturbance the body mass index percentiles to be achieved by female adolescents with eating disorders was 25-50 in anorexia nervosa, and 50-75, in eating disorder not otherwise specified. .

Objetivo Analisar a progressão do índice de massa corporal nos transtornos alimentares e determinar o percentil para estabelecimento e resolução da doença. Métodos Estudo retrospectivo descritivo, com análise dos processos de adolescentes com transtorno alimentar. Resultados Das 62 adolescentes com distúrbio alimentar, 51 apresentavam distúrbio sem outra especificação, 10 anorexia nervosa, e uma bulimia. Vinte e uma adolescentes apresentavam distúrbios menstruais, sendo 14 amenorreia secundária, 7 irregularidades menstruais (6 distúrbio alimentar sem outra especificação e 1 bulimia). Em média, nas anoréticas: índice de massa corporal inicial - percentil 75, instalação da amenorreia secundária com um mês de doença, peso mínimo 76,6% do índice de massa corporal ideal, no percentil 4), com 10,2 meses de doença, resolução da amenorreia aos 24 meses com recuperação ponderal média de 93,4% do peso ideal. No distúrbio alimentar sem outra especificação com distúrbio menstrual (n=10), o índice de massa corporal inicial médio no percentil 85, peso mínimo, em média, 97,7% do valor de peso ideal (média no percentil 52 de índice de massa corporal), aos 14,9 meses, estabilização ponderal aos 1,6 anos, percentil médio de índice de massa corporal de 73. Na perturbação do comportamento alimentar sem outra especificação com amenorreia secundária (n=4): amenorreia secundária aos 4 meses, resolução aos 12 meses (média no percentil 65 do índice de massa corporal). Conclusão Um terço do grupo com transtornos alimentares teve distúrbios menstruais − sendo dois terços com amenorreia secundária. Este estudo indicou que, para resolução ...

Trastornos estomatológicos desencadenados por la bulimia nerviosa: trabajo de investigación UNLP / Stomatological disorders produced by bulimia nervosa: UNLP investigation paper

La investigación se llevó a cabo en ALUBA (Asociación de Lucha contra la Bulimia y la Anorexia), una institución creada por padres de pacientes con trastornos de la conducta alimentaria , El estudio de campo se efectuó sobre 29 pacientes que padecían bulimia, subtipo purgativa. El objetivo planteado fue describir cómo se alteran las estructuras estomatológicas y cómo influe sobre el patrón deglutorio. Se pretende ampliar el campo de acción de la fonoaudiología e incluir a la patología alimentaria dentro del protocolo de anamnesis y valoración de nuestra área de incumbencia, así como también poder brindar una respuesta terapéutica a este tipo de trastorno . Este trabajo es una investigación de tipo transversal, descriptiva. Los resultados más relevantes fueron el hallazgo de patrones deglutorios alterados en el 79,31 por ciento de los pacientes, ausencia del reflejo nauseoso en el 93,10 por ciento y marcadas disfonías en el 68,96 por ciento. En cuanto al sistema dentario, la característica más importante fue el desgaste de piezas dentarias en el 51.72 por ciento, y la presencia de caries en el 53,33 por ciento. Se reconoce que todas estas alteraciones son factores comunes hallados en pacientes seculares de bulimia subtipo purgativa. Podemos afirmar que fueron producidas por los ácidos digestivos y contracciones constantes de los músculos de todo el organismo producidos por el vómito autoprovocado, que llegaron a lesionar las estructuras blandas del sistema fonoestomatológico y a modificar su funcionalidad.(AU)

Trastornos estomatológicos desencadenados por la bulimia nerviosa: trabajo de investigación UNLP / Stomatological disorders produced by bulimia nervosa: UNLP investigation paper

La investigación se llevó a cabo en ALUBA (Asociación de Lucha contra la Bulimia y la Anorexia), una institución creada por padres de pacientes con trastornos de la conducta alimentaria , El estudio de campo se efectuó sobre 29 pacientes que padecían bulimia, subtipo purgativa. El objetivo planteado fue describir cómo se alteran las estructuras estomatológicas y cómo influe sobre el patrón deglutorio. Se pretende ampliar el campo de acción de la fonoaudiología e incluir a la patología alimentaria dentro del protocolo de anamnesis y valoración de nuestra área de incumbencia, así como también poder brindar una respuesta terapéutica a este tipo de trastorno . Este trabajo es una investigación de tipo transversal, descriptiva. Los resultados más relevantes fueron el hallazgo de patrones deglutorios alterados en el 79,31 por ciento de los pacientes, ausencia del reflejo nauseoso en el 93,10 por ciento y marcadas disfonías en el 68,96 por ciento. En cuanto al sistema dentario, la característica más importante fue el desgaste de piezas dentarias en el 51.72 por ciento, y la presencia de caries en el 53,33 por ciento. Se reconoce que todas estas alteraciones son factores comunes hallados en pacientes seculares de bulimia subtipo purgativa. Podemos afirmar que fueron producidas por los ácidos digestivos y contracciones constantes de los músculos de todo el organismo producidos por el vómito autoprovocado, que llegaron a lesionar las estructuras blandas del sistema fonoestomatológico y a modificar su funcionalidad.

[Acute abdomen by gastric perforation due to foreign body from long stay: a case report]. / Abdomen agudo debido a perforación gástrica por cuerpo extraño de larga permanencia: reporte de caso.

The intake of foreign bodies is a common clinical entity in Gastroenterology, most of them are expelled spontaneously, but those that are long and sharp may cause complications in 1 to 5%, therefore requiring endoscopic extraction or surgical treatment sometimes. We report the case of a patient with a history of bulimia that came to the Guillermo Almenara Hospital for symptoms of acute abdominal pain due to gastric perforation by foreign body after many years there has been the intake and whose resolution was surgery.

Trastornos de la conducta alimentaria y situaciones de riesgo, en adolescentes de tercero de secundaria, Cochabamba julio a agosto 2009 / Eating disorders and risk, adolescents in ninth grade, Cochabamba July-August 2009

La anorexia y la bulimia son consideradas enfermedades modernas. El presente trabajo consiste en establecer los trastornos de la conducta alimentaria (anorexia y bulimia) y situaciones de riesgo en adolescentes del sexo femenino de 14 a 19 años de tercero de secundaria de dos establecimientos educativos, con escenarios distintos, colegio fiscal "Elena Arze de Arze" y el colegio particular "Instituto Americano".Es una investigación con enfoque cuantitativo; se aplicó un cuestionario que evaluó dos áreas importantes: criterios diagnósticos y situaciones de riesgo de adolescentes.Los resultados muestran que las estudiantes del "Instituto Americano" tienen más criterios de bulimia y las estudiantes del Colegio "Elena Arze de Arze" tienen más criterios de anorexia nerviosa. Entre los factores predisponentes a los trastornos de la alimentación, la insatisfacción con la imagen corporal de la madre del adolescente es la más frecuente en ambos colegios. Entre los factores precipitantes sólo las estudiantes del Colegio "Elena Arze de Arze" indican como factor la opinión de sus compañeros sobre ellas.

Erosión o corrosión dental: factores etiológicos y diagnóstico / Dental erosion or corrosion: etiology and diagnosis

La Erosión dental o Corrosión dental constituye una de las afecciones dentales más comunes de la vida moderna, fundamentalmentedebido la proliferación de alimentos, medicamentos y bebidas ácidas en la dieta diaria. Otros aspectos de la etiología de estaafección también se discuten con la intención de permitir la identificación de los factores etiológicos para lograr un buen diagnóstico así como prevenir la corrosión dental.

Dental Erosion or dental corrosion is one of the most common dental diseases of modern life, due to wide presence of acidic food,drugs and beverages on everyday diet. Other details of the etiology of this disease are also discussed intending to allow theidentification of etiologic factors in order to achieve a good diagnosis as well to prevent dental corrosion.

Laryngeal and vocal analysis in bulimic patients.

UNLABELLED: Bulimia is an eating disorder classified as a mental disorder according to DSM-IV. AIMS: The aim of the study was to evaluate vocal and laryngeal abnormalities in patients with bulimia compared to a control group. MATERIALS & METHODS: Study control group. Twenty-two women were evaluated, with an age range of 18 to 34 years old. Eleven diagnosed with purging bulimia and 11 in the control group. Both groups underwent an otolaryngological, perception and acoustic evaluation. The statistic analysis was done through a chi-square test and a Kruskall-Wallis non-parametric test, considering 5% as significance level. RESULTS: The bulimic group presented a higher prevalence of laryngeal abnormalities compared to the control group (p=0.000). The group with bulimia had higher GRBSI values (p=0.000) and A (p=0.022) of the GRBASI scale. The results of vocal acoustics analysis of the jitter, shimmer, PPQ and APQ were higher in the bulimic group (p=0.033). No statistical significance difference in the fundamental frequency and NHR were found between both groups. CONCLUSION: the bulimic patients in this study presented more laryngeal, acoustics and perception evaluation disorders when compared to a control group.

Avaliação laríngea e vocal de pacientes com bulimia / Laryngeal and vocal analysis in bulimic patients

A Bulimia Nervosa é um transtorno mental, de acordo com o sistema de classificação DSM-IV. OBJETIVO: Descrever os sinais vocais e laríngeos de pacientes com diagnóstico de bulimia e em indivíduos sem a doença. MATERIAIS E MÉTODOS: Estudo caso-controle. Vinte e duas mulheres foram avaliadas com idade entre 18 a 34 anos, sendo 11 mulheres com diagnóstico de bulimia, com o subtipo purgativo, e 11 mulheres do grupo controle. Ambos os grupos foram submetidos à avaliação otorrinolaringológica e fonoaudiológica. Na análise estatística foram realizados os testes qui-quadrado e Kruskall-Wallis considerando o valor de significância de 5 por cento. RESULTADOS: Na avaliação otorrinolaringológica, os pacientes com bulimia apresentaram uma maior prevalência de alterações laríngeas quando comparado com o grupo controle (p=0,000). Na avaliação perceptivo-auditiva da voz, o grupo com bulimia apresentou maiores alterações nos parâmetros GRBSI (p=0,000) e A (p=0,022) da escala GRBASI, quando comparados ao grupo controle. Os valores de jitter, shimmer, QPF e QPA foram maiores no grupo com bulimia com diferença estatística (p=0,033). Os valores de frequência fundamental e PHR não se diferiram entre os grupos. CONCLUSÃO: Os pacientes com bulimia apresentaram maiores alterações laríngeas, perceptivo-auditivas e acústicas da voz quando comparados ao grupo controle.

Bulimia is an eating disorder classified as a mental disorder according to DSM-IV. AIMS: The aim of the study was to evaluate vocal and laryngeal abnormalities in patients with bulimia compared to a control group. MATERIALS & METHODS: Study control group. Twenty-two women were evaluated, with an age range of 18 to 34 years old. Eleven diagnosed with purging bulimia and 11 in the control group. Both groups underwent an otolaryngological, perception and acoustic evaluation. The statistic analysis was done through a chi-square test and a Kruskall-Wallis non-parametric test, considering 5 percent as significance level. RESULTS: The bulimic group presented a higher prevalence of laryngeal abnormalities compared to the control group (p=0.000). The group with bulimia had higher GRBSI values (p=0.000) and A (p=0.022) of the GRBASI scale. The results of vocal acoustics analysis of the jitter, shimmer, PPQ and APQ were higher in the bulimic group (p=0.033). No statistical significance difference in the fundamental frequency and NHR were found between both groups. CONCLUSION: the bulimic patients in this study presented more laryngeal, acoustics and perception evaluation disorders when compared to a control group.

Comer, demandar e desejar: considerações psicanalíticas sobre o corpo e o objeto na obesidade / Eating, demanding and desiring: psychoanalytical considerations about the body and the object in obesity

O presente estudo discute o tratamento psicanalítico da obesidade, tendo em vista os impasses no manejo dessa problemática. Para tanto, parte-se da análise da patologização do corpo gordo, sua medicalização e os dispositivos biopolíticos de regulação dos corpos que aí figuram para propor uma diferenciação entre o sintoma médico e seu aspecto subjetivo. Contextualizando a cultura na atualidade, que coloca em evidência o corpo, desenvolve-se a disjunção entre necessidade e demanda proposta por Lacan para pensar uma diferença ética que a abordagem psicanalítica da obesidade oferece em relação ao dispositivo médico, na medida em que não se propõe a normalizar os corpos segundo o peso adequado. Essa proposta coloca em pauta a questão do circuito pulsional que, em sua matriz alteritária, estabelece o objeto pulsional vinculado a uma perda originária que, ao mesmo tempo, constitui o desejo como insatisfeito. Considerando que o dispositivo psicanalítico proposto por Freud se estrutura em torno da falta que advém ao final do complexo de Édipo, e que a angústia de castração ocupa lugar prioritário de motor do tratamento, a obesidade se coloca como um problema à medida que a comida comparece revestindo o objeto perdido e fornecendo a consistência à qual o obeso permanece atado. Para pensar de que maneira a psicanálise pode acolher a demanda feita por pacientes obesos e que recursos teórico-clínicos pode-se lançar mão nesses tratamentos, é estabelecido um paralelo com outras problemáticas, tais como: as toxicomanias e a bulimia. Propomos, por fim, que o tratamento psicanalítico visa oferecer um campo de subjetivação que permita a emergência da angústia não somente referida ao corpo e seus excessos, possibilitando a construção de recursos simbólicos necessários à elaboração do real pulsional...

Etiopatogenia de la amenorrea hipotalámica funcional: Interacción de las respuestas hormonales del sistema nervioso central y neuropéptidos periféricos / Ethiopatogeniae of functional hypothalamic amenorrhea: Interactions of central nervous system and peripherical neuropeptides responses

La amenorrea hipotalámica funcional (AHF) es una patología compleja provocada generalmente por el estrés psicológico, o por alteraciones psicógenas como la depresión en otras entidades como la amenorrea nerviosa y bulimia o en la excesiva actividad física (atletas competitivas, bailarinas clásicas) entre las causas más frecuentes. Habitualmente, estos factores se presentan asociados a dietas cuali y cuantitativamente inadecuadas, originando alteraciones en el balance energético (consumo /gasto calórico) y modificaciones en la composición corporal. En general, estas alteraciones se presentan combinadas e inducen reacciones hormonales tendientes a defender la homeostasis metabólica general. Los protagonistas de estos procesos adaptativos son un "circuito" constituido en el sistema nervioso central que se interrelaciona con otro "circuito periférico hormonal". Las manifestaciones del primero incluyen principalmente una atenuación funcional de los ejes hipotalamo-hipófiso-somatotrófico, prolactínico y tiroideo, amplificación de la secreción nocturna de la melatonina e hiperactividad adrenal. A su vez, las interrelaciones, a nivel hipotalámico, del eje CRH-ACTH-sistemas-opiodeo-dopaminérgico y la consiguiente inhibición de la secreción de Gn RH, constituye un mecanismo fisiopatológico crucial para el desarrollo de la disfunción gonadal. Por otro lado, el grado de alteración de la actividad pusátil del Gn RH está condicionado por la etiopatogenia, intensidad nosológica y el tiempo de evolución. La variabilidad y el tipo de irregularidades del ciclo menstrual, que frecuentemente son observados en las atletas competitivas, constituyen un reflejo representativo de ello. Por otro lado, el hipoestrogenismo e hipoandrogenismo de estas mujeres repercuten negativamente en el metabolismo general y osteocálcico, en particular. La osteopenia con su riesgo de fracturas, está omnipresente en este síndrome. No menos importante, el hipoestrogenismo es también uno de los factores de riesgo cardiovascular. No obstante, la administración de anticonceptivos que combinan estrógenos más progesterona, pueden aumentar significativamente los niveles de la proteína C reactiva, un reconocido y seguro marcador de riesgo cardiovascular. Ello induce a tomar precauciones en su utilización en estas amenorricas desnutridas. Asimismo, la administración de anticonceptivos no ha demostrado brindar un beneficio sustancial en el tratamiento de la osteosporosis de estas pacientes. El "circuito periférico", funcionalmente interrelacionado con el central, está principalmente compuesto por la leptina, adiponectina, ghrelin, insulina e IGF-1, péptidos provenientes del compartimiento graso ("adipocitokinas") tracto gastrointestinal superior, páncreas e hígado, respectivamente. Estos péptidos no sólo están involucrados en los mecanismos centrales del apetito y saciedad, sino que también participan en las respuestas de adaptación homeostática, tendientes a revertir los desvíos del metabolismo intermedio y fosfocálcico, que en grado variable afectan a estas pacientes. Conclusiones: la AHF relacionada en general con el estrés psicofísico prolongado y la mala nutrición, es un síndrome complejo, cuyas respuestas hormonales centrales y periféricas de adaptación, resultan primordiales en estas mujeres que padecen un cierto grado de compromiso nutritivometabólico general. Enfocando globalmente este abigarrado síndrome, estimamos que la AHF es, obviamente, un epifenómeno menos vital.

Functional Hypothalamic Amenorrhea (FHA) is a complex pathology produced by psicological stress, as observed in amenorrhea nervosa and bulimia or in intensive physical activity (athletas, competitions, classic dancing). Frequently, these factors are associated to quali-quantitative inadequated diets and therefore they induce alterations in the energetic balance (caloric intake, caloric expend and modification in body composition). These factors are usually combinated and they induce hormonal reactions trend to sustain the general metabolic homeostasis. The protagonists of this adaptative process are a "central nervous system circuit" interrelated with "periferical hormonal circuit". The responses to the first, mainly includes functional atenuation of Hypothalamic- Hipophyseal Somatotropic, Prolactin and Thyroid axes, amplification of nocturnal melatonine secretion and hyper adrenal activity. The relationships, to hypothalamic level, of CRH-ACTH, opioid, and dopaminergic systems, and the subsequent inhibition of Gn-RH secretion, constitute a physiopathological mechanism for the development of gonadal disfunction. On the other hand, the degree of alteration in the Gn-RH pulsatility is conditioned by the ethipahogenic, nosologic intensity and time of evolution. Variability and type of irregularity of menstrual cycle observed in competitive athletes, is a demonstrative example. On the other hand, hypoestrogenism and hypoandrogenism in these women affect negatively the general metabolism and, particularly, the osteocalcic system. Osteopenia with its fracture risk is omnipresence in this syndrome. As important as that hypoestrogenism is also one of cardiovascular factor risk. However the administration of contraceptives which combines estrogens plus progesterone, may significantly increase the C-reactive protein level, a known and safety marker of cardiovascular risk. Therefore it induces to take precautions in its administration in these unnourished amenorrheic women. Also, the administration of contraceptives has not showed a substantial benefit in osteoporosis treatment of this patients. A "periferic circuit", functionally interrelated with the "central circuit", is mainly composed by leptin, adiponectine, ghrelin, insulin and IGF1 peptides, coming from fat compartiment (adipokines), gastro-intestinal tract, pancreas and liver, respectively. These peptides, are not only involved in the central mechanisms of appetite and saciety, but they also participate in homeostatic adaptative responses, with the aim of to balance the alteration of middle and phosphocalcic metabolism which affect these patients in a variable form. CONCLUSIONS: FHA, generally related with psychic/physic stress and malnutrition, is a complex syndrome in which the central and peripheral adaptative hormonal responses are mainly important in these women which are affected of a kind of nutritive and general metabolic compromise. Analazing this complex process we considerate that the hypothalamic amenorrhea is obviously a less vital phenomenon.