Osteomielite: perfil epidemiológico e desfechos verificados em pacientes internados em um hospital público de Curitiba / Osteomyelitis: epidemiologic profile and outcomes of inpatients of a public hospital in Curitiba

Introdução: Osteomielite é inflamação aguda ou crônica de ossos trabeculares ou corticais, periósteo, medula óssea e tecidos moles próximos. É classificada pela localização dentro do osso, extensão da dispersão e fonte de infecção. Objetivo: Avaliar os aspectos epidemiológicos dos pacientes internados com osteomielite e analisar relação entre o tempo de internamento e fatores correlatos.Métodos: Estudados dados de 33 pacientes de uma seleção inicial de 42 prontuários. Resultados: O grupo de 0 a 20 anos com 8 (24,4%) pacientes ficou 18 ± 24 dias, 13 (39,4%) adultos jovens (21 a 40 anos): 12,3 ± 12,4 d; 6 (18,1%) adultos (41 a 60 anos) e 6 (18,1%) >60 anos receberam cuidados hospitalares por 31,8 ± 36 e 19,6 ± 15,8 dias respectivamente. O periodo maior de permanência foi de 91 dias. O etilismo (6%), o tabagismo (6%) e o diabetes (6%) foram as comorbidades mais encontradas. A mortalidade foi de 15%, sendo que 60% eram usuários de álcool. O perfil epidemiológico também mostrou o predomínio do sexo masculino na faixa de 21 a 40 anos e o principal agente infeccioso encontrado foi S. aureus. Conclusão: A alta taxa de mortalidade em indivíduos maiores de 50 anos, com maior permanência hospitalar e presença de comorbidades como o etilismo e diabetes mellitus alerta para a necessidade de planejamento estratégico visando intervenções que diminuam prejuízos tanto para o paciente quanto para o sistema de saúde.

Introduction: Osteomyelitis is an acute or chronic inflammation of trabecular or cortical bones, periosteum, bone marrow, and nearby soft tissue. It is classified by location within the bone, extent and source of infection. Objective: Assess the epidemiological aspects of hospitalized patients with osteomyelitis and analyze the relationship between length of stay and correlated factors. Methods: Data were collected from 33 patients from an initial selection of 42. Results: The groups were arranged as follows: 8 (24.4%) individuals from 0-20 yo and with a hospital stay of 18 ± 24 d; 13 (39.4%) young adults (21-40 yo) and 12.3 ± 12.4 d; 6 (18.1%) adults (41-60 yo) and 31.8 ± 36 d; and 6 (18.1%) over 60 yo who were under hospital care for 19.6 ± 15.8 d. The longest period of hospital stay was 91 days. Alcoholism (6%), smoking habits (6%) and diabetes (6%) were the most common comorbidities. Mortality rate was 15%, among which 60% were alcohol users. The epidemiologic profile also showed that the majority of the hospitalized were males between the ages 21-40 yo and the most common infective agent was S. aureus. Conclusion: the high mortality rate in individuals over 50, with comorbidities and longer hospital stays highlights the need for strategic planning yielding interventions that diminish harm to the patients and the health system.

Tumores neuroendócrinos pancreáticos: revisão histopatológica / Pancreatic neuroendocrine tumors: histopathological review

Introdução: Os tumores neuroendócrinos pancreáticos são considerados raros. Eles são classificados em funcionantes e não funcionantes. Objetivo: Definir e classificar tumores neuroendócrinos pancreáticos de acordo com sua avaliação histopatológica e imunoistoquímica, associado aos critérios diagnósticos. Método: Trata-se de revisão narrativa sobre publicações encontradas no PubMed, SciELO e Google Acadêmico. Resultados: Esses tumores podem ser bem ou pouco diferenciados e apresentam características microscópicas distintas. As células bem diferenciadas têm formato pequeno, núcleos uniformes redondos ou ovais, citoplasma finamente granular indicando forte capacidade secretória e mantêm a estrutura organoide. A presença de necrose tumoral, atividade mitótica aumentada e índice de Ki-67 elevado indicam alta probabilidade de neoplasia neuroendócrina. Cromogranina A e sinaptofisina favorecem o diagnóstico do bem diferenciado. Já a marcação positiva do BCL 10 em conjunto com a ausência de expressão da cromogranina A e da sinaptofisina mostram a precária diferenciação tumoral. A presença de marcação positiva para as expressões hormonais não define o tumor como funcionante. Conclusão: Houve aumento do diagnóstico de tumores neuroendócrinos pancreáticos com o uso de técnicas de imagem e a conscientização sobre a doença. A análise histopatológica com imunoistoquímica, especialmente quando há sintomas consumptivos, podem indicar o tipo do carcinoma e induzir ao mais adequado tratamento.

Introduction: Pancreatic neuroendocrine tumors are considered rare. They are classified into functioning and non-functioning. Objective: To define and classify pancreatic neuroendocrine tumors according to their histopathological and immunohistochemical evaluation, associated with diagnostic criteria. Method: This is a narrative review of publications found in PubMed, SciELO and Google Scholar. \Results: These tumors can be well or poorly differentiated and have distinct microscopic characteristics. Well-differentiated cells are small in shape, have uniform round or oval nuclei, finely granular cytoplasm indicating strong secretory capacity, and maintain the organoid structure. Presence of tumor necrosis, increased mitotic activity and high Ki-67 index indicate a high probability of neuroendocrine neoplasia. Chromogranin A and synaptophysin favor the diagnosis of well-differentiated. The positive staining of BCL 10 together with the absence of expression of chromogranin A and synaptophysin show poor tumor differentiation. The presence of positive staining for hormone expressions does not define the tumor as functioning. Conclusion: There was an increase in the diagnosis of pancreatic neuroendocrine tumors with the use of imaging techniques and awareness of the disease. Histopathological analysis with immunohistochemistry, especially when there are consuming symptoms, can indicate the type of carcinoma and lead to the most appropriate treatment.

Wnt3a but not CDX-2 expression is associated with differentiated thyroid cancer.

OBJECTIVE: Thyroid neoplasm incidence has increased worldwide, mostly due to the advancements in medical imaging and screening rates. The aberrant Wnt/ß-catenin pathway has been identified as a key mechanism, and it has also been related to the metastatic activity of differentiated thyroid cancer. We aimed to verify the difference in the expression of Wnt3a, a canonical activator of the ß-catenin signaling, and CDX-2, a transcription factor upregulated by Wnt/ß-catenin pathway, in multinodular goiter and differentiated thyroid cancer and to determine their prognostic value. METHODS: We included 194 thyroid tissue surgical specimen and their clinicopathological data: study group (differentiated thyroid cancer, n=154) and control group (multinodular goiter, n=40). Immunohistochemistry (IHC) was performed on formalin-fixed, paraffin-embedded tissue by the primary antibodies Wnt3a and CDX-2. RESULTS: High Wnt3a expression was significantly associated with differentiated thyroid cancer (p=0.031). CDX-2 was negative in all differentiated thyroid cancer cases (100%) and also in multinodular goiter. Wnt3a expression was significantly associated with tumors ≤20 mm (p=0.044) and with the absence of capsule invasion (p=0.031). The multivariate analyses suggested that older age (≥55), independent of capsular invasion and tumor size, was an independent prognostic factor for Wnt3a expression (p=0.058). CONCLUSIONS: Wnt3a expression but not CDX-2 is correlated with differentiated thyroid cancer samples in comparison to multinodular goiter. Although its prognostic value was limited to tumor size and capsule invasion, a combined model in a panel of immune markers can add accuracy in the classification of challenging thyroid follicular-derived lesions.

Wnt3a but not CDX-2 expression is associated with differentiated thyroid cancer

SUMMARY OBJECTIVE: Thyroid neoplasm incidence has increased worldwide, mostly due to the advancements in medical imaging and screening rates. The aberrant Wnt/β-catenin pathway has been identified as a key mechanism, and it has also been related to the metastatic activity of differentiated thyroid cancer. We aimed to verify the difference in the expression of Wnt3a, a canonical activator of the β-catenin signaling, and CDX-2, a transcription factor upregulated by Wnt/β-catenin pathway, in multinodular goiter and differentiated thyroid cancer and to determine their prognostic value. METHODS: We included 194 thyroid tissue surgical specimen and their clinicopathological data: study group (differentiated thyroid cancer, n=154) and control group (multinodular goiter, n=40). Immunohistochemistry (IHC) was performed on formalin-fixed, paraffin-embedded tissue by the primary antibodies Wnt3a and CDX-2. RESULTS: High Wnt3a expression was significantly associated with differentiated thyroid cancer (p=0.031). CDX-2 was negative in all differentiated thyroid cancer cases (100%) and also in multinodular goiter. Wnt3a expression was significantly associated with tumors ≤20 mm (p=0.044) and with the absence of capsule invasion (p=0.031). The multivariate analyses suggested that older age (≥55), independent of capsular invasion and tumor size, was an independent prognostic factor for Wnt3a expression (p=0.058). CONCLUSIONS: Wnt3a expression but not CDX-2 is correlated with differentiated thyroid cancer samples in comparison to multinodular goiter. Although its prognostic value was limited to tumor size and capsule invasion, a combined model in a panel of immune markers can add accuracy in the classification of challenging thyroid follicular-derived lesions.

Impacto da cirurgia bariátrica no perfil lipídico e glicêmico em pacientes obesos / Impact of bariatric surgery on lipid and glycemic profile in obese patients

A obesidade é atualmente problema de saúde pública e tem como seu principal marcador o IMC. Existem evidências consistentes de que o tratamento cirúrgico possui resultados mais favoráveis em relação a perda de peso e redução de comorbidades em comparação com intervenções comportamentais. Os objetivos deste estudo foram avaliar os impactos da cirurgia bariátrica nos parâmetros antropométricos, metabólicos e bioquímicos na obesidade. É estudo coorte retrospectivo com amostragem não probabilística por conveniência dos submetidos à cirurgia bariátrica a partir de dados de prontuários pré- e pós-operatórios. Foram analisados 75 pacientes no pré, pós-operatório de 3 meses e pós- operatório de 6 meses. Em conclusão, o colesterol total LDL e triglicerídeos tiveram decréscimo significativo no pós-operatório; o mesmo ocorreu com a glicemia em jejum, hemoglobina glicada e insulina. Assim, a cirurgia bariátrica mostrou-se eficaz na redução dos parâmetros antropométricos e metabólicos dos obesos operados.

Obesity is currently a public health problem and its main marker is BMI. There is consistent evidence that surgical treatment has more favorable results in terms of weight loss and reduction of comorbidities compared to behavioral interventions. The objectives of this study were to evaluate the impacts of bariatric surgery on anthropometric, metabolic and biochemical parameters in obesity. This is a retrospective cohort study with non-probabilistic convenience sampling of those undergoing bariatric surgery based on data from pre- and postoperative medical records. A total of 75 patients were analyzed preoperatively, in 3 and 6 months postoperatively. In conclusion, total LDL cholesterol and triglycerides had a significant decrease postoperatively; the same occurred with fasting glucose, glycated hemoglobin and insulin. Thus, bariatric surgery proved to be effective in reducing the anthropometric and metabolic parameters of obese patients undergoing surgery.

Análise dos fatores de risco para déficit neurológico em fraturas da coluna vertebral torácica e lombar / Analysis of risk factors for neurological deficit in fractures of the thoracic and lumbar vertebral spine

Responsáveis por 89% de lesões neurológicas, as fraturas de coluna vertebral torácica e lombar, quando analisadas perante os fatores de risco para déficit neurológico, apresentam associação controversa. Apesar da relação contestável, estudos apontam que as características morfológicas dessas lesões estão associadas ao grau de déficit neurológico e funcionam como guia para a estratégia terapêutica. O objetivo deste estudo foi identificar quais os fatores de risco para déficit neurológico nas fraturas da coluna vertebral torácica e lombar. É estudo transversal, observacional e individuado, no qual foram analisados 150 pacientes. Em conclusão, demonstrou-se que os subtipos de fratura A são fatores de risco para déficit neurológico e determinantes da conduta terapêutica aplicada. Além disso, indicou relação entre a classificação do déficit neurológico e energia do trauma com a necessidade de tratamento invasivo.

Responsible for 89% of neurological injuries, fractures of the thoracic and lumbar spine, when analyzed in terms of risk factors for neurological deficit, present a controversial association. Despite the debatable relationship, studies indicate that the morphological characteristics of these lesions are associated with the degree of neurological deficit and function as a guide for the therapeutic strategy. The aim of this study was to identify the risk factors for neurological deficit in thoracic and lumbar spine fractures. It is a cross-sectional, observational and individualized study, in which 150 patients were analyzed. In conclusion, it was demonstrated that fracture subtypes A are risk factors for neurological deficit and determinants of the therapeutic approach applied. In addition, it indicated a relationship between the classification of neurological deficit and trauma energy with the need for invasive treatment.

A combinação das alterações anatômicas cardíacas na tetralogia de Fallot / The combination of cardiac anatomical changes in Fallot Tetralogy

A tetralogia de Fallot é a cardiopatia congênita cianótica mais comum. Caracteriza-se por tétrade de malformações anatômicas que incluem estenose pulmonar, defeito do septo ventricular, hipertrofia do ventrículo direito e dextroposição da aorta (cavalgamento da aorta). O objetivo deste estudo foi analisar e descrever as alterações anatômicas cardíacas, tratamento e prognóstico de pacientes com a doença. É revisão narrativa de artigos indexados na base de dados PubMed, Google Acadêmico e LILACS utilizando os descritores "tetralogy of Fallot", "congenital heart disease", "cyanotic disease". Em conclusão, a tetralogia de Fallot é cardiopatia congênita comum e com prognóstico ruim caso não seja realizado diagnóstico e tratamento precoces. O seguimento médico contínuo e próximo ao paciente é importante para acompanhar a evolução e programar novas intervenções caso necessárias.

Tetralogy of Fallot is the most common cyanotic congenital heart disease. It is characterized by tetrads of anatomical malformations that include pulmonary stenosis, ventricular septal defect, right ventricular hypertrophy, and aortic dextroposition (aortic cavalcade). The objectives of this study were to analyze and describe cardiac anatomical changes, treatment and prognosis of patients with the disease. It was a narrative review of articles indexed in PubMed, Academic Google and LILACS databases using the descriptors "Tetralogy of Fallot", "congenital heart disease", "cyanotic disease". In conclusion, tetralogy of Fallot is a common congenital heart disease with poor prognosis if early diagnosis and treatment are not performed. Continuous medical follow-up and to be close to the patient are important to monitor the evolution and schedule new interventions if necessary.

Intoxicações por inibidores das colinesterases em mulheres / Poisonings by cholinesterases inhibitors in women

Organofosforados e carbamatos são produtos muito utilizados na agropecuária, que têm, em comum, a inibição da enzima acetilcolinesterase, causando impactos na saúde humana. O objetivo deste estudo foi avaliar aspectos epidemiológicos e clínicos das intoxicações agudas por organofosforados e carbamatos em mulheres. Tratase de estudo retrospectivo, transversal e descritivo, no qual foram analisados 218 casos de intoxicações agudas. Foram avaliadas variáveis clínicas, sociodemográficas e ocupacionais. Em conclusão, os dados demostraram intoxicações de gravidade leve a moderada por pesticidas nas mulheres, com registro de dois casos fatais. Efeitos crônicos podem aparecer em pessoas expostas a esses compostos. Medidas educativas e preventivas no manejo e comércio dessas substâncias devem diminuir o número de intoxicações e agravos à saúde da população.

Organophosphates and carbamates are products widely used in agriculture, both of this two substances work in the same way, through the inhibition of the enzyme acetylcholinesterase, and both also cause impacts on human health. The goal of this study was to evaluate the epidemiological and clinical aspects of acute poisoning by organophosphates and carbamates in women. This is a descriptive, cross-sectional, retrospective study in which 218 cases of acute poisoning were analyzed. Clinical, sociodemographic and occupational variables were included. In conclusion, the data demonstrated mild to moderate severity of pesticide poisoning in women, with two deaths reported. Chronic effects can appear in people exposed to these substances. Educational and preventive measures on the handling and sale of these substances can contribute to reducing the number of poisonings and health problems in the population.

Avaliação da função cardíaca por métodos ecocardiográficos em pacientes assintomáticos com lúpus eritematoso sistêmico / Assessment of cardiac function by echocardiographic methods in asymptomatic patients with systemic lupus erythematosus

O lúpus eritematoso sistêmico (LES) é doença autoimune crônica. Uma das suas importantes complicações é o dano cardiovascular. O objetivo deste trabalho foi estudar a prevalência de disfunção cardíaca em uma população local com LES e verificar se o grau de disfunção está associado com o a atividade da doença medida pelo SLEDAI (Systemic Lupus erythematosus activity index). Foram selecionados 19 pacientes assintomáticos do ponto de vista cardiovascular com diagnóstico de LES e que preenchiam os critérios classificatórios. A atividade de doença foi medida pelo SLEDAI e a função cardíaca por ecocardiografia transtorácica. Em conclusão, não foi possível identificar disfunção cardíaca na amostra estudada. Pontuações mais altas no índice de atividade do lúpus demonstraram correlação com aumento de massa de ventrículo esquerdo e fração de ejeção.

Systemic lupus erythesis (SLE) is a chronic autoimmune disease. One of the important complications of this disease is the cardiovascular damage The objective of this work was to study the prevalence of cardiac dysfunction in a local population with SLE and to verify whether the degree of dysfunction is associated with the disease activity measured by SLEDAI (Systemic Lupus erythematosus activity index). Were selected 19 patients asymptomatic from cardiovascular point of view diagnosed with SLE and who met the classification criteria for SLE. Disease activity was measured by SLEDAI and cardiac function was evaluated by transthoracic echocardiography. In conclusion, cardiac dysfunction could not be identified in the sample studied. Higher scores in the lupus activity index showed a correlation with increased left ventricle mass and ejection fraction.

Anticorpos anti topoisomerase 1 no lúpus eritematoso sistêmico / Anti-topoisomerase 1 antibodies in systemic lupus erythematosus

Antitopoisomerase-1 (ou Scl-70) é um autoanticorpo considerado como biomarcador da forma difusa de esclerodermia. Alguns autores o têm encontrado em pacientes com lúpus. O objetivo deste estudo foi estudar a presença do anticorpo Scl-70 em lúpus eritematoso sistêmico (SLE). É pesquisa com 94 pacientes com LES para anticorpo anti Scl-70 usando o kit comercial de ELISA Virgo™, Columbia, USA. Dados clínicos, epidemiológicos e sorológicos foram obtidos dos prontuários. Como resultado, somente 2 pacientes (2.1%) tinham anticorpos anti Scl-70 em baixos títulos. Nenhum deles tinha características de esclerodermia. Em conclusão, não se confirmam achados anteriores acerca da presença de anti Scl-70 em lúpus. Este anticorpo parece ser específico para esclerodermia.

Antitopoisomerase-1 (or Scl-70) is an autoantibody considered as a biomarker of the diffuse form of scleroderma. Some authors have found it in lupus patients. The aim of this study was to study the presence of the Scl-70 antibody in systemic lupus erythematosus (SLE). It is screened with 94 SLE patients for anti Scl-70 antibody using the commercial Virgo™ ELISA kit, Columbia, USA. Clinical, epidemiological and serological data were obtained from medical records. As a result, only 2 patients (2.1%) had anti-Scl-70 antibodies at low titers. None of them had features of scleroderma. In conclusion, previous findings regarding the presence of anti Scl-70 in lupus are not confirmed. This antibody appears to be specific for scleroderma.

D-Meld como preditor de sobrevida após transplante hepático é alternativa superior? / D-Meld as a predictor of survival after hepatic transplantation is a superior alternative?

Novos preditores de sobrevida são desenvolvidos com a finalidade de auxiliar o processo de decisão do transplante hepático. Apesar disso, até o momento utilizam-se apenas o Model for End-Stage Liver Disease (MELD) como clinicamente útil. O objetivo deste estudo foi verificar a epidemiologia dos pacientes submetidos ao transplante hepático, verificar o melhor ponto de corte dos escores prognósticos BAR, SOFT, e D-MELD e avaliar se o escore D-MELD é melhor preditor de mortalidade em 1 ano comparativamente com os escores BAR e SOFT. É estudo retrospectivo transversal com base na análise dos prontuários médicos. Como conclusão, todos os escores avaliados apresentaram capacidade abaixo do ideal em predizer mortalidade em 1 ano após transplante hepático.

New survival predictors are developed in order to help the liver transplant decision process. Despite this, to date, only the Model for End-Stage Liver Disease (MELD) has been used as clinically useful. The aim of this study was to verify the epidemiology of patients undergoing liver transplantation, verify the best cutoff point for BAR, SOFT, and D-MELD prognostic scores, and assess whether the D-MELD score is a better predictor of 1-year mortality compared with the BAR and SOFT scores. It is a cross-sectional retrospective study based on the analysis of medical records. In conclusion, all scores evaluated had a suboptimal ability to predict 1-year mortality after liver transplantation.

Tratamento da dor em pacientes vítimas de queimaduras agudas / Pain treatment in patients victims of acute burns

A dor nos pacientes vítimas de queimaduras agudas pode variar e as técnicas descritas podem se chegar ao manejo ideal, melhorando os resultados da recuperação e evitando sequelas psicológicas em longo prazo. O presente estudo teve por objetivo trata de estabelecer na atualidade os melhores métodos de tratamento para dor da vítima de queimadura aguda. É revisão sistemática realizada através de busca nas bases de dados PubMed, Scopus e Scielo, utilizando os descritores como strings de busca. Em conclusão, o tratamento da dor em queimados é um desafio para a equipe. Assim, o conhecimento sobre avaliação da dor e as terapias utilizadas trazem benefícios tanto na recuperação como evitar as sequelas neurológicas e dor crônica.

Pain in patients suffering from acute burns can vary and the techniques described can achieve optimal management, improving recovery results and avoiding long-term psychological sequelae. The present study aimed to establish currently the best methods of treatment for pain in acute burn victims. It is a systematic review carried out by searching PubMed, Scopus and Scielo databases, using descriptors as search strings. In conclusion, pain management in burn patients is a challenge for the team. Thus, knowledge about pain assessment and the therapies used bring benefits both in recovery and in avoiding neurological sequelae and chronic pain.

Vitamin D deficiency in children and adolescents submitted to hematopoietic stem cell transplantation.

BACKGROUND: Sub-optimal levels of vitamin D have been found to be highly prevalent in all age groups, with epidemiologic studies demonstrating a link between vitamin D deficiency and disease susceptibility, such as infection and cancer, and mortality rates. In adult transplant patients, it has been suggested that the immunomodulatory properties of vitamin D may have an important role in the prevention and treatment of graft-versus-host disease. OBJECTIVE: The objective of this study was to assess serum 25-hydroxyvitamin D levels of children and adolescents submitted to allogeneic hematopoietic stem cell transplantation. METHODS: Serum 25-hydroxyvitamin D levels of 66 patients, aged 4-20 years, were assessed at three stages: before hospitalization for hematopoietic stem cell transplantation and at 30 and 180 days after hematopoietic stem cell transplantation. The control group consisted of 25 healthy children. RESULTS: At the pre-hematopoietic stem cell transplantation stage, patients had lower levels of 25-hydroxyvitamin D compared to controls (25.7 ± 12.3 ng/mL vs. 31.9 ± 9.9 ng/mL; p-value = 0.01), and a higher prevalence of 25-hydroxyvitamin D deficiency (32% vs. 8%; p-value = 0.01). Prevalence increased significantly after hematopoietic stem cell transplantation (p-value = 0.01) with half of the patients having vitamin D deficiency at 180 days after transplantation. At this stage, mean serum 25-hydroxyvitamin D levels were 20.9 ± 10.9 ng/mL, a significant decline in relation to baseline (p-value = 0.01). No correlation was found between 25-hydroxyvitamin D levels and vitamin D intake, graft-versus-host disease, corticoid use or survival rates. CONCLUSION: Low levels of 25-hydroxyvitamin D were detected even before hematopoietic stem cell transplantation and were significantly lower at 180 days after hematopoietic stem cell transplantation, thus recommending vitamin D supplementation for children and adolescents submitted to hematopoietic stem cell transplantation.

Vitamin D deficiency in children and adolescents submitted to hematopoietic stem cell transplantation

Background: Sub-optimal levels of vitamin D have been found to be highly prevalent in all age groups, with epidemiologic studies demonstrating a link between vitamin D deficiency and disease susceptibility, such as infection and cancer, and mortality rates. In adult transplant patients, it has been suggested that the immunomodulatory properties of vitamin D may have an important role in the prevention and treatment of graft-versus-host disease. Objective: The objective of this study was to assess serum 25-hydroxyvitamin D levels of children and adolescents submitted to allogeneic hematopoietic stem cell transplantation. Methods: Serum 25-hydroxyvitamin D levels of 66 patients, aged 4-20 years, were assessed at three stages: before hospitalization for hematopoietic stem cell transplantation and at 30 and 180 days after hematopoietic stem cell transplantation. The control group consisted of 25 healthy children. Results: At the pre-hematopoietic stem cell transplantation stage, patients had lower levels of 25-hydroxyvitamin D compared to controls (25.7 ± 12.3 ng/mL vs. 31.9 ± 9.9 ng/mL; p-value = 0.01), and a higher prevalence of 25-hydroxyvitamin D deficiency (32% vs. 8%; p-value = 0.01). Prevalence increased significantly after hematopoietic stem cell transplantation (p-value = 0.01) with half of the patients having vitamin D deficiency at 180 days after transplantation. At this stage, mean serum 25-hydroxyvitamin D levels were 20.9 ± 10.9 ng/mL, a significant decline in relation to baseline (p-value = 0.01). No correlation was found between 25-hydroxyvitamin D levels and vitamin D intake, graft-versus-host disease, corticoid use or survival rates...

Osteomalácia oncogênica: cintilografia com sestamibi-99mTc na localização do tumor / Oncogenic osteomalacia: localization of underlying peripheral tumor with99mTc-sestamibi scintigraphy

A osteomalácia oncogênica hipofosfatêmica (OOH) é uma síndrome paraneoplásica induzida por tumor, de tecidos mole ou ósseo. Apresenta-se com dor e fraturas, acompanhada de hipofosfatemia, hiperfosfatúria e concentrações plasmáticas de 1,25(OH)2D3 inapropriadamente normais/diminuídas. Após a remoção do tumor, a completa resolução das anormalidades clínicas e bioquímicas é sua maior característica. Uma mulher de 44 anos de idade é descrita no caso com dificuldade para caminhar por causa de dores nos membros inferiores, fraqueza muscular generalizada e hipofosfatemia com relativa hiperfosfatúria. A cintilografia de corpo total com sestamibi-99mTc mostrou acúmulo do radiofármaco no terço superior de coxa esquerda onde pequeno tumor foi detectado no exame pelo ultra-som. Com a retirada do tumor, um lipoma, os sintomas melhoraram após um mês, com recuperação completa ao redor do quarto mês. Neste caso, a cintilografia de corpo inteiro com sestamibi-99mTc foi decisiva na localização do tumor causador da osteomalácia oncogênica.

Oncogenic osteomalacia is a paraneoplastic syndrome usually induced by bone or soft tissue tumors. It is presented by the development of pain and fractures with hypophosphatemia, hyperphosphaturia, and inappropriate normal/low plasma 1,25(OH)2D3 concentration. After the removal of the tumor the complete resolution of all biochemical and clinical abnormalities is the main characteristic. A case of a 44-year-old female with difficulty in walking due to leg pain and generalized muscle weakness and hypophosphatemia, with relative hyperphosphaturia, is described. A whole-body 99mTc-sestamibi scintigraphy showed accumulation in the left thigh region, and a small tumor was detected by ultrasound examination. By removal of the tumor, a lipoma, the symptoms improved significantly after a month, with complete recovery by the fourth month. In this case, 99mTc-sestamibi scintigraphy was useful in identifying the location of the tumor, which caused oncogenic osteomalacia.

[Oncogenic osteomalacia: localization of underlying peripheral tumor with 99mTc-sestamibi scintigraphy]. / Osteomalácia oncogênica: cintilografia com sestamibi-99mTc na localização do tumor.

Oncogenic osteomalacia is a paraneoplastic syndrome usually induced by bone or soft tissue tumors. It is presented by the development of pain and fractures with hypophosphatemia, hyperphosphaturia, and inappropriate normal/low plasma 1,25(OH)2D3 concentration. After the removal of the tumor the complete resolution of all biochemical and clinical abnormalities is the main characteristic. A case of a 44-year-old female with difficulty in walking due to leg pain and generalized muscle weakness and hypophosphatemia, with relative hyperphosphaturia, is described. A whole-body 99mTc-sestamibi scintigraphy showed accumulation in the left thigh region, and a small tumor was detected by ultrasound examination. By removal of the tumor, a lipoma, the symptoms improved significantly after a month, with complete recovery by the fourth month. In this case, 99mTc-sestamibi scintigraphy was useful in identifying the location of the tumor, which caused oncogenic osteomalacia.

[High doses statins administration causing rhabdomyolysis: case report]. / Rabdomiólise devido ao uso de estatina em altas doses: relato de caso.

Rhabdomyolysis has been the theme in medical literature for the last fifty years. In these last decades, with statins being used in primary and secondary cardiovascular prevention events, this theme returns and statins are now pointed as the trigger to this almost always fatal complication. Rhabdomyolysis due to statins administration occurs mainly in association with other drugs. Our case reports on a patient with fatal statin-induced rhabdomyolysis whose medical history included diffuse atherosclerotic disease.

Rabdomiólise devido ao uso de estatina em altas doses: relato de caso / High doses statins administration causing rhabdomyolysis: case report

A rabdomiólise tem sido motivo de publicação na literatura médica há mais de 50 anos. Nas últimas décadas, com o advento das estatinas, usadas na prevenção primária e secundária da doença cardiovascular, este assunto volta como importante complicação, muitas vezes fatal, do uso desta classe de drogas. A rabdomiólise associada ao uso das estatinas ocorre principalmente devido a associações medicamentosas. A seguir, descreveremos um caso de uma paciente em uso de altas doses de Sinvastatina, devido à doença aterosclerótica difusa, que desenvolveu quadro compatível com rabdomiólise resultando em óbito.