RESUMO

Abstract A previously healthy 24 yo male presented with a two-month history of epigastric pain, nausea, vomiting, fatigue and malaise. He reported abuse of different substances, including an injectable veterinary vitamin compound, which contains high doses of vitamin A, D and E, and an oily vehicle that induces local edema and enhances muscle volume. Serum creatinine was 3.1 mg/dL, alanine transaminase 160 mg/dL, aspartate transaminase 11 mg/dL, total testosterone 23 ng/dL, 25-OH-vitamin D >150 ng/mL (toxicity >100), 1,25-OH-vitamin D 80 pg/mL, vitamin A 0.7 mg/dL, parathormone <3 pg/mL, total calcium 13.6 mg/dL, 24-hour urinary calcium 635 mg/24h (RV 42-353). A urinary tract ultrasound demonstrated signs of parenchymal nephropathy. The diagnosis was hypercalcemia and acute renal failure secondary to vitamin D intoxication. He was initially treated with intravenous hydration, furosemide and prednisone. On the fifth day of hospitalization a dose of pamidronate disodium was added. The patient evolved with serum calcium and renal function normalization. Thirty days later he presented normal clinical and laboratory tests, except 25-OH-vitamin D that was persistently increased (107 ng/mL), as it may take several months to normalize. This case report is a warning of the risks related to the use of veterinary substances for aesthetics purposes.

Resumo Um paciente de 24 anos do sexo masculino, previamente hígido, apresentou-se com uma história de dois meses de dor epigástrica, náuseas, vômitos, fadiga e mal-estar. Ele relatava abuso de diferentes substâncias, incluindo um composto vitamínico veterinário injetável contendo altas doses de vitamina A, D e E, e um veículo oleoso que induz edema local com aumento de volume muscular. A creatinina sérica estava 3,1 mg/dL, alanina transaminase 160 mg/dL, aspartato transaminase 11 mg/dL, testosterona total 23 ng/dL, 25-OH-vitamina D > 150 ng/mL (toxicidade > 100), 1,25-OH-vitamina D 80 pg/mL, vitamina A 0,7 mg/dL, paratormônio < 3 pg/mL, cálcio total 13,6 mg/dL, cálcio urinário de 24h 635 mg/24h (VR 42-353). Uma ultrassonografia do trato urinário demonstrou sinais de nefropatia parenquimatosa. O diagnóstico foi hipercalcemia e insuficiência renal aguda secundária a intoxicação por vitamina D. Ele foi tratado inicialmente com hidratação intravenosa, furosemida e prednisona. No quinto dia de hospitalização uma dose de pamidronato dissódico foi adicionada. O paciente evoluiu com normalização do cálcio sérico e da função renal. Trinta dias depois ele apresentou testes clínicos e laboratoriais normais, exceto a 25-OH-vitamina D que estava persistentemente elevada (107 ng/mL), já que ela pode demorar vários meses para normalizar. Este relato de caso é um alerta aos riscos relacionados ao uso de substâncias veterinárias para fins estéticos.

Assuntos

RESUMO

Objetivo: Avaliar a prevalência de compulsão alimentar periódica. Métodos: Estudo descritivo transversal, com 49 pacientes candidatos à cirurgia bariátrica, em acompanhamento pré-cirúrgico, submetidos à anamnese direcionada e aos quais foi aplicada a Escala de Compulsão Alimentar Periódica. Resultados: A média de idade foi de 39,18±10,38 anos, sendo a maioria do sexo feminino (79,59%). O peso e o índice de massa corporal médios da amostra foram respectivamente 131,89±25,78kg e 49,72±6,79kg/m². As comorbidades mais prevalentes foram hipertensão arterial sistêmica (55,10%) e diabetes mellitus (30,61%). Dos 49 entrevistados, 10 (20,40%) apresentaram pontuação compatível com compulsão alimentar periódica, sendo moderada em 8 (16,32%) e grave em 2 pacientes (4,08%). Houve relação entre a presença de compulsão alimentar periódica e menor tempo de obesidade. Conclusão: A prevalência de compulsão alimentar periódica nos pacientes candidatos à cirurgia bariátrica analisados foi semelhante ao descrito na literatura e parece haver relação inversa entre compulsão alimentar e velocidade de ganho de peso. São necessários estudos maiores para confirmar nossos achados.

Objective: To evaluate the prevalence of binge eating disorder. Methods: Cross-sectional descriptive study with 49 patients that are candidates for bariatric surgery in the presurgical monitoring, who underwent directed anamnesis and then had the Binge Eating Scale (BES) applied. Results: The average age was 39.18±10.38 years, with most of them being female (79.59%). Average weight and body mass index (BMI) were respectively 131.89±25.78kg, and 49.72±6.79kg/m². The most prevalent comorbidities were hypertension (55.10%) and Diabetes Mellitus (30.61%). Of the 49 patients interviewed, 10 (20.40%) had a score that was consistent with binge eating disorder, moderate in 8 (16.32%), and severe in 2 patients (4.08%). There was a relation between the presence of binge eating disorder and shorter time of obesity. Conclusion: The prevalence of binge eating disorder in patients eligible for bariatric surgery in this study was similar to that described in the literature, and there seems to be an inverse relation between binge eating and weight gain velocity. Further, larger studies are necessary to confirm these findings.

Assuntos

RESUMO

A previously healthy 24 yo male presented with a two-month history of epigastric pain, nausea, vomiting, fatigue and malaise. He reported abuse of different substances, including an injectable veterinary vitamin compound, which contains high doses of vitamin A, D and E, and an oily vehicle that induces local edema and enhances muscle volume. Serum creatinine was 3.1 mg/dL, alanine transaminase 160 mg/dL, aspartate transaminase 11 mg/dL, total testosterone 23 ng/dL, 25-OH-vitamin D >150 ng/mL (toxicity >100), 1,25-OH-vitamin D 80 pg/mL, vitamin A 0.7 mg/dL, parathormone <3 pg/mL, total calcium 13.6 mg/dL, 24-hour urinary calcium 635 mg/24h (RV 42-353). A urinary tract ultrasound demonstrated signs of parenchymal nephropathy. The diagnosis was hypercalcemia and acute renal failure secondary to vitamin D intoxication. He was initially treated with intravenous hydration, furosemide and prednisone. On the fifth day of hospitalization a dose of pamidronate disodium was added. The patient evolved with serum calcium and renal function normalization. Thirty days later he presented normal clinical and laboratory tests, except 25-OH-vitamin D that was persistently increased (107 ng/mL), as it may take several months to normalize. This case report is a warning of the risks related to the use of veterinary substances for aesthetics purposes.

Assuntos

RESUMO

Introdução: Deficiência de vitamina D é reconhecida hoje como pandemia e fator de impacto no desenvolvimento de várias doenças, sendo recentemente relacionada à fisiopatologia da obesidade e da síndrome metabólica. Objetivos: Analisar os níveis séricos de vitamina D em pacientes obesos em avaliação pré-operatória para cirurgia bariátrica correlacionando-os com variáveis clínicas, laboratoriais e epidemiológicas. Métodos: Estudo observacional transversal, com 170 pacientes obesos grau 2 e 3 avaliados no ambulatório de cirurgia bariátrica do HU-UFSC em 2013. Foram coletados dados clínicos, epidemiológicos, antropométricos e laboratoriais. Resultados: A média de idade foi de 40 ± 10 anos, sendo a maioria do sexo feminino, caucasiana e habitante do litoral. O peso e o IMC médios foram 126,0 ± 24,2 kg e 48,0 ± 7,1 kg/m² respectivamente. As comorbidades mais prevalentes foram diabetes mellitus tipo 2 (24,7%) e hipertensão arterial sistêmica (55,3%). A média dos níveis de 25(OH)-vitamina D foi de 26,3 ± 8,4 ng/mL. Deficiência e insuficiência de vitamina D foram encontrados em 23,5 e 45,3% dos pacientes, respectivamente. Não houve correlação significativa entre os níveis de vitamina D e as demais variáveis estudadas, exceto o cálcio corrigido para a albumina. Conclusão: Os pacientes obesos em avaliação para cirurgia bariátrica neste serviço apresentam alta prevalência de deficiência/insuficiência de vitamina D. Estes níveis apresentaram correlação negativa estatisticamente significativa com o cálcio sérico corrigido, mas não com as demais variáveis estudadas.

Background: Vitamin D deficiency nowadays is recognized as a pandemic and important factor for development of a variety of diseases. It has been recently related to the physiopathology of obesity and metabolic syndrome. Objectives: To analyze serum levels of vitamin D in obese patients on preoperative evaluation for bariatric surgery and correlate them to clinical, laboratory and epidemiological variables. Methods: Cross-sectional observational study, including 170 patients with grade 2 and 3 obesity evaluated at the obesity outpatient clinic of the University Hospital (HU-UFSC) in 2013. Clinical, epidemiological, anthropometric and laboratory data were collected. Results: Mean age was 40 ± 10 years, the majority was females, Caucasian and living on the coast. Average weight and BMI were 126.0 ± 24.2 kg e 48.0 ± 7.1 kg/m² respectively. The most prevalent comorbidities were type 2 diabetes mellitus (24.7%) and hypertension (55.3%). Mean serum level of 25(OH)-vitamin D was 26.3 ± 8.4 ng/mL. Vitamin D deficiency and insufficiency were found in 23.5 and 45.3% of patients, respectively. There was no significant correlation between serum vitamin D levels and variables analyzed in this study, except albumin-corrected serum calcium. Conclusion: Obese patients evaluated for bariatric surgery in this service present a high prevalence of vitamin D deficiency/insufficiency. These levels were significantly negatively correlated with albumin-corrected serum calcium, but not with the other studied variables.

RESUMO

OBJETIVO: Diabetes mellitus é uma doença crônica prevalente, associada a inúmeras complicações. A neuropatia periférica diabética é a mais comum, acometendo 50% dos diabéticos, mas muitas vezes não é diagnosticada. Por cursar com insensibilidade distal e alterações arquiteturais dos pés, predispõe a úlceras, podendo culminar no pé diabético com risco de amputação. O diabetes mellitus é responsável por 70% das amputações de membros, que poderiam ser prevenidas com o diagnóstico precoce da neuropatia periférica diabética. Sugere-se avaliar o grau de neuropatia em diabéticos por meio de escores, visando homogeneizar o diagnóstico, quantificar a prevalência e promover medidas preventivas. MÉTODOS: Realizou-se entrevista, exame físico e coleta de dados de diabéticos atendidos ambulatorialmente, para pontuação e qualificação no Escore de Sintomas Neuropáticos e no Escore de Comprometimento Neuropático, validados na língua portuguesa para avaliar neuropatia periférica diabética, além de análise das características clínicas e epidemiológicas associadas. RESULTADOS: Foram incluídos 116 pacientes, constatando-se neuropatia periférica diabética em 31,9%. Houve correlação significativa de neuropatia periférica diabética coma idade dos pacientes, mas não com as demais variáveis clínicas e laboratoriais. Os pacientes avaliados apresentaram médias de idade de 55±15 anos e tempo de diabetes de 14,8±10,9 anos, sendo predominantemente caucasianos, mulheres e portadores de diabetes mellitus tipo 2. Eram hipertensos 67,2% e 42,2%, obesos. CONCLUSÃO: A prevalência encontrada corrobora a literatura, embora poucos estudos tenham utilizado critérios similares para diagnosticar neuropatia periférica diabética. Empregando os escores padronizados, de baixo custo e fácil aplicação possibilitamos o diagnóstico precoce e embasado dessa entidade, sendo possível, com isso, reduzir a prevalência de graves complicações do pé diabético e disseminar informações a respeito.

OBJECTIVE: Diabetes mellitus is a prevalent chronic disease, associated with numerous complications. Diabetic peripheral neuropathy is the most common, affecting 50% of diabetics, although is often not diagnosed. Presenting with distal numbness and architectural alterations of the feet, it predisposes ulcers and may culminate in diabetic foot at risk for amputation. Diabetes mellitus is responsible for 70% of limb amputations, which could be prevented with early diagnosis of diabetic peripheral neuropathy. This study aims to evaluate the degree of neuropathy in diabetics through validated scores, in order to standardize the diagnosis, quantify the prevalence and promote preventive actions. METHODS: We performed an interview, physical examination and data collection of diabetic outpatients, for rating in the Neuropathy Symptom Score and the Neuropathy Disability Score, validated in Portuguese, to assess diabetic peripheral neuropathy, in addition to analysis of clinical and epidemiological associated characteristics. RESULTS: We included 116 patients and diabetic peripheral neuropathy was found in 31.9%. There was significant correlation diabetic peripheral neuropathy with age, but not with other clinical and laboratory variables. The mean age was 55±15 years, diabetes duration was 14.8±10.9 years and patients were predominantly Caucasian, women and had type 2 diabetes mellitus. Of the patients, 67.2 % were hypertensive and 42.2% obese. CONCLUSION: The prevalence found is supported by previous data, although few studies have used similar criteria to diagnose diabetic peripheral neuropathy. Employing the standard scores, of low cost and easy implementation, we enable early and accurate diagnosis of this condition, allowing to reduce the prevalence of severe diabetic foot complications and spread information about it.

Assuntos

RESUMO

BACKGROUND: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D). METHODS: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups. RESULTS: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). The majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001). CONCLUSIONS: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.

RESUMO

BACKGROUND: To determine the relationship between adherence to the diet reported by patients with type 1 diabetes under routine clinical care in Brazil, and demographic, socioeconomic status, glycemic control and cardiovascular risk factors. METHODS: This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data was obtained from 3,180 patients, aged 22 ± 11.8 years (56.3% females, 57.4% Caucasians and 43.6% non-Caucasians). The mean time since diabetes diagnosis was 11.7 ± 8.1 years. RESULTS: Overall, 1,722 (54.2%) of the patients reported to be adherent to the diet without difference in gender, duration of diabetes and socioeconomic status. Patients who reported adherence to the diet had lower BMI, HbA1c, triglycerides, LDL-cholesterol, non HDL-cholesterol and diastolic blood pressure and had more HbA1c at goal, performed more frequently self-monitoring of blood glucose (p < 0.001), and reported less difficulties to follow specific schedules of diet plans (p < 0.001). Less patients who reported to be adherent were obese or overweight (p = 0.005). The quantity of food and time schedule of the meals were the most frequent complaints. Logistic regression analysis showed that ethnicity, (Caucasians, (OR 1.26 [1.09-1.47]), number of medical clinical visits in the last year (OR 1.10 [1.06-1.15]), carbohydrate counting, (OR 2.22 [1.49-3.30]) and diets recommended by diabetes societies', (OR 1.57 [1.02-2.41]) were related to greater patients' adherence (p < 0.05) and age, [adolescents (OR 0.60 [0.50-0.72]), high BMI (OR 0.58 [0.94-0.98]) and smoking (OR 0.58 [0.41-0.84]) with poor patients' adherence (p < 0.01). CONCLUSIONS: Our results suggest that it is necessary to rethink medical nutrition therapy in order to help patients to overcome barriers that impair an optimized adherence to the diet.

Assuntos

RESUMO

JUSTIFICATIVA E OBJETIVO: A síndrome do ovário policístico é uma desordem metabólica complexa que afeta cerca de 10% das mulheres em idade reprodutiva, sendo uma das alterações endocrinológicas mais comuns. Para a avaliação e o acompanhamento clínico das pacientes, dispõem-se de alguns exames laboratoriais e de ferramentas como o índice de massa corporal, o Homeostasis Model Assessment e, o mais recente deles, o Lipid Accumulation Product. O objetivo deste estudo foi analisar o perfil clínico-epidemiológico das pacientes do Ambulatório de Endocrinologia e Metabologia do Hospital Universitário da Universidade de Santa Catarina e avaliar a utilização do índice Lipid Accumulation Product. MÉTODOS: Foram coletados dados clínicos e laboratoriais de 28 pacientes com síndrome do ovário policístico atendidas nos anos de 2010 e 2011. Foram aplicados os cálculos de índice de massa corporal, Homeostasis Model Assessment e Lipid Accumulation Product e foi realizada análise estatística das variáveis. RESULTADOS: As pacientes apresentaram média de idade de 29 anos e menarca, em média, aos 12 anos de idade. A pesquisa mostrou perfil metabólico anormal da população analisada, com alteração de quase todos os parâmetros metabólicos, como hemoglobina glicada média de 6,7±1,4%, colesterol total de 202,4±27,5mg/dL, triglicerídeos de 151,1±160,5mg/dL, o que implica maior risco de doença cardiovascular. O Lipid Accumulation Product apresentou maior número de associações significativas com as variáveis estudadas, estando relacionado a colesterol total, LDL-colesterol, triglicerídeos e glicemia de jejum, o que mostra que pode se tratar de um bom método de avaliação metabólica das pacientes. CONCLUSÃO: É necessária uma abordagem multidisciplinar e direcionada aos fatores de risco cardiovasculares em pacientes com síndrome do ovário policístico a fim de minimizar as complicações em longo prazo...

BACKGROUND AND OBJECTIVE: The polycystic ovary syndrome is a complex metabolic disorder that affects about 10% of women at reproductive age, thus being one of the most common endocrine abnormalities. For medical evaluation and monitoring of the patients we have some laboratory tests and tools such as body mass index, Homeostasis Model Assessment and, most recently, Lipid Accumulation Product. The objective of this study was to analyze the clinical and epidemiological profile of the patients from the Endocrinology and Metabolism Clinic from Hospital Universitário of Universidade de Santa Catarina, and to evaluate the use of Lipid Accumulation Product index. METHODS: Clinic and laboratory data were collected from 28 patients with polycystic ovary syndrome in the years 2010 and 2011. Body mass index, Homeostasis Model Assessment and Lipid Accumulation Product were calculated and the variables were analyzed statistically. RESULTS: Patients presented mean age of 29 years and menarche on average when they were 12 years old. The research showed abnormal metabolic profile of the surveyed population, with almost all the metabolic parameters altered, such as mean glycosylated hemoglobin of 6.7±1.4%, total cholesterol of 202.4±27.5mg/dL, and triglycerides of 151.1±160.5mg/dL, which implies a higher risk for cardiovascular disease. Lipid Accumulation Product had the greatest number of significant correlations with the variables studied, being related to total cholesterol, LDL cholesterol, triglycerides and fasting glucose, what shows that it can be a good method for evaluating patients metabolically. CONCLUSION: A multidisciplinary approach is necessary, directed to cardiovascular risk factors in patients with polycystic ovary syndrome in order to minimize long-term complications...

Assuntos

RESUMO

BACKGROUND: To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated. METHODS: This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years). RESULTS: Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001). CONCLUSIONS: A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.

RESUMO

OBJECTIVE: To determine the prevalence of patients with type 1 diabetes mellitus who meet the glycemic and cardiovascular (CV) risk factors goals and the frequency of screening for diabetic complications in Brazil according to the American Diabetes Association guidelines. RESEARCH DESIGN AND METHODS: This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 1774 adult patients (56.8% females, 57.2% Caucasians) aged 30.3 ± 9.8 years with diabetes duration of 14.3 ± 8.8 years. RESULTS: Systolic blood pressure was at goal in 40.3% and diastolic blood pressure was at goal in 26.6% of hypertensive patients. LDL cholesterol and HbA1c were at the goal in 45.2% and 13.2% of the patients, respectively. Overweight was presented in 25.6% and obesity in 6.9%. Among those with more than 5 years of disease, screening for retinopathy was performed in the preceding year in 70.1%. Nephropathy and feet complications were screened in 63.1% and 65.1%, respectively. CONCLUSIONS: The majority of patients did not meet metabolic control goals and a substantial proportion was not screened for diabetic complications. These issues may increase the risk of chronic complications and negatively impact public health.

Assuntos

RESUMO

Introdução: O eixo hipotálamo-hipófise pode sofrer alterações no traumatismo crânio-encefálico (TCE), com consequente hipopituitarismo. A deficiência hormonal mais comum nesses casos é do hormônio de crescimento (GH). O presente estudo pretende avaliar o eixo somatotrófico em pacientes vítimas de TCE grave, ocorridos entre os anos de 2000 a 2004, na região da grande Florianópolis (SC). Métodos: Após avaliação clínica dos pacientes (n=30) com história prévia de TCE grave(Escala de Coma de Glasgow igual ou inferior a 8), foi realizada dosagem de GH basal e IGF-I (Insulin-like growth factor-I). Resultados: Dos 30 pacientes avaliados, 73,3% eram homens e 26,7% mulheres. As principaiscausas de TCE foram acidentes automobilísticos (63,3%) e quedas (23,3%). Onze pacientes (36,7%) apresentaram GH baixo e todos eram do sexo masculino. A média de idade dos pacientes com GH baixo foi 31,6anos. Seis pacientes (20%) apresentaram IGF-I baixo, sendo 04 homens e 02 mulheres. A média de idade foi de 46,5 anos. O tempo médio entre o TCE e a avaliação clínica e laboratorial para o GH e IGF-I foi de aproximadamente 5 anos. Conclusão: Dos pacientes estudados, 1 em cada 5 apresentou IGF-I diminuído, o que pode representar um indício de Deficiência de Hormônio de Crescimento (DGH). Neste grupo de pacientes, é necessário um teste de estímulo com baixo risco de convulsão, como o GHRH-arginina, que não é disponível no nossomeio, para confirmar o diagnóstico de DGH e justificar a reposição de somatotropina humana.

Background: The axis hypothalamo-pituitary can be affected in traumatic brain injuries (TBI), with hypopituitarism as a consequence. The most common hormonal deficiency in these cases is growth hormone deficiency(GHD). This study intends to evaluate the GHD in patients who suffered severe TBI that occurred between 2000 and 2004, in Florianópolis and surrounding area (SC). Methods: After a clinical evaluation of the patients(n=30) with previous history of severe TBI (Glasgow Scale or 8), it was carried out an evaluation of the somatotrophic axis by dosing GH and IGF-I. Results: Of the 30 patients, 73,3% (n=22) were men and 26,7% (n=08) were women. The most prevalent causes of TBI were car and motorcycle accidents (63,3%) and falls (23,3%). According to the laboratorial evaluation, 11 (36,7%) patients presented low GH and all of them were men. The mean age of the patients with low GH was 31,6 years and the majority had between 14 and 30 years. Six (20%) patients had low IGF-I and 4 were men and 2 were women. The mean age was 46,5 years and 66,7% (n=04) had between 31 and 45 years. The time between TBI and clinical and laboratorial evaluation for GH and IGF-Iwas approximately 5 years. Conclusions: In this study, one in every 5 patients presented a low value of IGF- 1, which may represent Growth Hormone Deficiency (GHD). Therefore, it is necessary to perform a test with low risk of developing convulsion to confirm the diagnosis of GHD (like GHRH-Arginine) in these subjects, that is not available in our health system. The recognization and proper treatment of GHD may positively influence directly the improvement of TBI and offer a better quality of life for these patients.

RESUMO

OBJECTIVES: To translate into Portuguese, perform cross-cultural adaptation and to evaluate the psychometric properties of the Summary of Diabetes Self-Care Activities Questionnaire - SDSCA. MATERIALS AND METHODS: The process followed the international guidelines for the adaptation and evaluation of psychometric properties. The Cronbach's alpha (α) was determined to evaluate the internal consistency (inter-itens correlation) and the reliability (test-retest and inter-evaluator correlation). RESULTS: The inter-itens correlation showed values of α = 0.09 to α = 0.86. In the test-retest evaluation, the lowest correlation was obtained for the item "eat sweets" (α = 0.15) and the highest correlation was obtained for the items concerning smoking (α = 1.00). The inter-evaluator correlations varied from α = 0.29 to α = 1.00. CONCLUSIONS: The adapted questionnaire showed psychometric properties similar to those of the SDSCA. Its Brazilian version provides a reliable and valid questionnaire to evaluate diabetic patient adherence to self-care in our community.

Assuntos

RESUMO

OBJETIVOS: Traduzir para o português, adaptar culturalmente e avaliar as propriedades psicométricas do Summary of Diabetes Self-Care Activities Questionnaire - SDSCA. MATERIAIS E MÉTODOS: O processo seguiu as normas internacionais para adaptação e avaliação das propriedades psicométricas. O alfa de Cronbach (α) foi utilizado para avaliar a consistência interna (correlação interitens) e a confiabilidade (teste-reteste e correlação interavaliador). RESULTADOS: A correlação interitens variou de α = 0,09 a α = 0,86. Na avaliação teste-reteste, a menor correlação foi para o item "ingerir doces" (α = 0,15) e a maior, para os itens sobre o uso do cigarro (α = 1,00). As correlações interavaliador variaram de α = 0,29 a α = 1,00. CONCLUSÕES: O questionário adaptado apresentou propriedades psicométricas semelhantes às do SDSCA. Sua versão para o Brasil fornece um questionário confiável e válido para avaliar a aderência ao autocuidado nos diabéticos em nosso meio.

OBJECTIVES: To translate into Portuguese, perform cross-cultural adaptation and to evaluate the psychometric properties of the Summary of Diabetes Self-Care Activities Questionnaire - SDSCA. MATERIALS AND METHODS: The process followed the international guidelines for the adaptation and evaluation of psychometric properties. The Cronbach's alpha (α) was determined to evaluate the internal consistency (inter-itens correlation) and the reliability (test-retest and inter-evaluator correlation). RESULTS: The inter-itens correlation showed values of α = 0.09 to α = 0.86. In the test-retest evaluation, the lowest correlation was obtained for the item "eat sweets" (α = 0.15) and the highest correlation was obtained for the items concerning smoking (α = 1.00). The inter-evaluator correlations varied from α = 0.29 to α = 1.00. CONCLUSIONS: The adapted questionnaire showed psychometric properties similar to those of the SDSCA. Its Brazilian version provides a reliable and valid questionnaire to evaluate diabetic patient adherence to self-care in our community.

Assuntos

RESUMO

Objetivo: O objetivo da pesquisa foi determinar o perfil clínico epidemiológico dos pacientes com câncer diferenciado de tireoide atendidos no Hospital Universitário de Florianópolis (HU-UFSC). Métodos: Tratou-se de estudo descritivo, realizado através da análise de prontuários. Incluídos pacientes com diagnóstico de câncer diferenciado de tireoide, em acompanhamento no Serviço de Endocrinologia de Hospital Universitário em consulta de setembro de 2009 a fevereiro de 2010. Considerou-se: idade ao diagnóstico, sexo, história familiar de câncer de tireoide, citologia pré-operatória (PAAF), histologia, tamanho tumoral,tipo de tireoidectomia; dose de I131, PCI (pesquisa de corpo inteiro), diagnóstico de hipoparatireoidismo póscirúrgico, níveis de tireoglobulina, anticorpo anti-tireoglobulina e TSH. Resultados: Foram avaliados 50 pacientes, sendo 92% mulheres. A média de idade foi de 48,5 anos. A prevalência de carcinoma papilífero e folicular foi de 92% e 8%, respectivamente. Hipoparatireoidismo ocorreu em 20% dos pacientes, sendo 8% permanente. Detectou-se evidência de doença ativa em 24% dos pacientes. Conclusões: Em nosso meio, o câncer de tireoide diferenciado é mais frequente em mulheres, sendo o papilífero o mais comum. O hipoparatireoidismo pós-cirúrgico definitivo é uma complicação importante encontrada em 8% dos casos.

Objective: The research aimed to determine the clinical and epidemiological profile in patients with differentiated thyroid cancer assisted at the University Hospital (HU-UFSC). Methods: The study was descriptive study by analysis of medical records. Included patients with differentiated thyroid cancer and followed at the Endocrinology Service of University Hospital from September 2009 to February 2010. Was considered: age at diagnosis, sex, family history of thyroid cancer, preoperative thyroid aspiration cytology, histology, tumor size, type of thyroidectomy, the dose of I131, whole body scan, post-surgical hypoparathyroidism, thyroglobulin, antithyroglobulin antibodies and TSH level. Results: We evaluated 50 patients, 92% women. The mean age was 48.5 years. The prevalence of papillary and follicular carcinoma was 92% and 8% respectively. Hypoparathyroidism occurred in 20% of patients, 8%permanent. Was detected evidence of active disease in 24% of patients. Conclusions: In our research, differentiated thyroid cancer is more common in women, with the papillary the most common. The post-surgical hypoparathyroidism is an important complication found in 8% of cases.

RESUMO

Objetivo: Avaliar a prevalência de adesãomedicamentosa aos antidiabéticos orais (ADO) emindivíduos com diabetes mellitus tipo 2 (DM2), suarelação com variáveis sociodemográficas, clínicas,laboratoriais e com outros métodos indiretos utilizadospara inferir adesão.Método: Estudo observacional, descritivo,apresentando dois cortes transversais com 25 a 50 diasde intervalo, em 36 pacientes em tratamento com ADOhá mais de 2 meses nos ambulatórios do HU-UFSC.Entre as entrevistas, realizou-se a contagem doscomprimidos ADO utilizados. Os pacientes foramconsiderados aderentes quando houve o uso de 80% a110% dos comprimidos prescritos. Foram avaliados dadossociodemográficos, clínicos e antropométricos, exameslaboratoriais, relato de adesão (auto-afirmação e testede Morisky), controle glicêmico e conhecimento sobreADO em uso.Resultados: Metade dos pacientes aderiu aotratamento. A adesão não apresentou relação com fatoressociodemográficos ou com relato dos pacientes. A máadesão foi associada com história de uso de álcool(p=0,045), tratamento há menos de 2 anos (p=0,0029) edesconhecimento dos ADO em uso (p=0,04). Adequadaadesão medicamentosa foi associada com média depressão arterial (PA) até 130/80 mmHg (p=0,044),glicemia capilar casual com valor máximo até 140 mg/dL (p=0,018), valor de hemoglobina glicada (HbA1c) até7% (p=0,044) e até 8% (p=0,0008).Conclusão: O tratamento medicamentoso apresentaalta taxa de má-adesão. Tempo de tratamento, históriade etilismo e controle da PA influenciam a adesãomedicamentosa. Ao contrário do relato de adesão,conhecimento sobre medicação em uso, valores deHbA1c e glicemias capilares são métodos indiretos quese associam com adesão medicamentosa.

Objective: To identify, in patients with diabetesmellitus type 2, the prevalence of adherence to oralantidiabetic drugs (OAD) therapy and relate it with socialdemographic,clinical and laboratorial aspects, as wellas with other indirect methods of adherence measure.Method: Observational, descriptive and crosssectionalstudy with 36 patients who were undergoingtreatment for at least 2 months, at clinics from HU-UFSC.The method used was pill counts between two interviewsdistanced 25 to 50 days. Patients with use of 80% to110% of prescribed pills were classified as adherents.The study analyzed social-demographic, clinical,anthropometric and laboratorial variables, adherencereport (self-report and Morisky et al. test), glicemiccontrol and OAD knowledge.Results: Half of the patients were adherent totreatment. There were no significant differences betweenadherence and social-demographic variables. History ofalcohol consumption was related with poor adherence(p=0,045), as well as use of OAD for less than 2 years(p=0,0029) and ignoring OAD names (p=0,04). Greateradherence was identified in patients with mean of bloodpressure (BP) until 130/80 mmHg (p=0,044), maximumcasual capillary glucose until 140 mg/dL and glycatedhemoglobin values less than 7% (p=0,044) and less than8% (p=0,0008).Conclusions: There is a high rate of non-adherenceto OAD therapy. Years of treatment, history of alcoholconsumption and BP control interfere in adherence.Knowledge of OAD?s names, values of glycatedhemoglobin and casual capillary glucose are indirectmethods associated with adherence.

RESUMO

Introdução: O infarto muscular do diabético ocorre,frequentemente, associado à nefropatia, neuropatia eretinopatia. Apresenta-se com dor e edema súbito, emgeral na coxa. O diagnóstico é feito pela associação doquadro clínico à ressonância magnética (RNM). Apesarde complicação rara associada ao diabetes mellitus(DM), possui importância clínica, ao fazer diagnósticodiferencial com várias doenças como: piomiosite,trombose venosa profunda, fasceíte necrotizante,tumores, hematoma e distensão muscular.Caso Clínico: J.O, masculino, negro, 52 anos,sabidamente diabético e hipertenso, chega ao Serviçode Emergência do HU-UFSC queixando-se de dorprogressiva e edema de coxa direita há 10 dias. Ecografiade coxa evidenciou aumento da ecogenicidade muscularanterior e medial, com disposição linear de líquido entreos músculos e com associação de derrame articular emjoelho direito. A ressonância magnética mostrou aumentodo sinal global em ambas as coxas, principalmente emquadríceps direito. Havia presença de líquido subfacialenvolvendo os músculos dos quadríceps femoral esartórios. Essas alterações sugeriam isquemia musculardifusa de coxas, notando-se área de necrose, por infartomuscular no vasto medial direito. Foi feito um curso desete dias de antibioticoterapia empírica associada àanalgesia e repouso, resultando na melhora da dor.Conclusão: Apesar do acometimento atípico musculardifuso, bilateral e derrame articular associado, o diagnósticode infarto muscular foi confirmado pelo quadro clínico eimagem. O tratamento baseado em repouso, analgesia econtrole do DM, indicado pela literatura, foi eficaz.

Introduction: Diabetic muscular infarction occurs,usually, in conjunction with nephropathy, neuropathy andretinopathy. It presents with acute pain and edema, mostlyin the thigh. Diagnosis is made by clinical findingsassociated to magnetic resonance imaging patterns.Although it is a rare complication associated with diabetesmellitus (DM), it carries a high clinical relevance, beinga differential diagnosis with pyomyositis, deep venousthrombosis, necrotizing fasciitis, tumors, hematoma andmuscular distensions.Clinical Case: J.O., male, african-descendant, 52years old, previously known to be diabetic and havinghypertension, came to the emergency department of HUUFSC within 10 days of the start of progressive painand edema in the right thigh. The leg ultrasonographyhighlighted increased anterior and medial muscularechogenicity, with linear disposition of liquid betweenmuscles and articular effusion in the right knee. Amagnetic resonance showed increased signal in boththighs, mainly in the right quadriceps, with subfascialeffusion involving quadriceps femoris and sartoriusmuscles. These findings suggested diffuse muscularischemia in both thighs, with a necrosis area due tomuscular infarction in the right vastus medialis. A 7 daycourse of antibiotic was given, empirically, along withanalgesia a muscular resting, resulting in the offset ofpain. Conclusion: Despite the atypical diffuse and bilateralmuscular involvement, together with articular effusion,the diagnosis could be confirmed by clinical and imagefindings. The treatment, based in muscular resting,analgesia and glycemic control proved to be effective,according to the literature.

RESUMO

Traumatic brain injury (TBI) is the most common cause of death and disability in young adults. Post-TBI neuroendocrine disorders have been increasingly acknowledged in recent years due to their potential contribution to morbidity and, probably, to mortality after trauma. Marked alterations of the hypothalamic-pituitary axis during the post-TBI acute and chronic phases have been reported. Prospective and longitudinal studies have shown that some abnormalities are transitory. On the other hand, there is a high frequency (15 percent to 68 percent) of pituitary hormone deficiency among TBI survivors in a long term setting. Post-TBI hypogonadism is a common finding after cranial trauma, and it is predicted to develop in 16 percent of the survivors in the long term. Post-TBI hypogonadism has been associated with adverse results in the acute and chronic phases after injury. These data reinforce the need for identification of hormonal deficiencies and their proper treatment, in order to optimize patient recovery, improve their life quality, and avoid the negative consequences of non-treated hypogonadism in the long term.

O traumatismo cranioencefálico (TCE) é a causa mais comum de morte e incapacidade em adultos jovens. Desordens neuroendócrinas pós-TCE vêm sendo reconhecidas cada vez mais nos últimos anos devido à sua potencial contribuição para a morbidade e, possivelmente, mortalidade após trauma. Alterações acentuadas do eixo hipotálamo-hipófise foram documentadas nas fases aguda e crônica pós-TCE. Estudos prospectivos e longitudinais têm mostrado que algumas anormalidades são transitórias. Por outro lado, existe uma elevada frequência de deficiências hormonais hipofisárias a longo prazo entre os sobreviventes de TCE, que varia de 15 por cento a 68 por cento. Hipogonadismo pós-TCE é um achado comum a longo prazo e estima-se que, em média, 16 por cento dos sobreviventes sejam afetados. Hipogonadismo pós-TCE tem sido associado a resultados adversos tanto na fase aguda quanto na fase crônica após a lesão. Esses dados reforçam a necessidade da identificação e adequado tratamento das deficiências hormonais, para otimizar a recuperação do paciente, melhorar a qualidade de vida e evitar as consequências negativas a longo prazo do hipogonadismo não tratado.

Assuntos

RESUMO

OBJECTIVE: To compare the modalities of treatment for male hypogonadism available in Brazil. METHODS: Thirty-two men with late-onset hypogonadism ("andropause") were followed-up in the Hospital de Guarnição de Florianópolis, in Florianópolis, south Brazil. Clinical diagnosis was established according to AMS questionnaire (positive if equal to or higher than 27 points), and laboratorial diagnosis was made through low values of total testosterone (under 300 ng/dL) and/or free calculated testosterone (under 6.5 ng/dL). Patients were randomized to three non-enteral treatment groups (Deposteron® - 11 patients; Durateston® - 11 patients; and Nebido® - 10 patients). RESULTS: Clinically, Nebido® seemed to be superior when compared to Deposteron® (mean value of improvement percentage; p = 0.03) and when compared to Durateston® (post-treatment average AMS score; p = 0.03). According to laboratorial analysis, Nebido® showed higher testosterone levels than Deposteron® and Durateston® (p < 0.001). CONCLUSIONS: All non-enteral testosterone formulas available in the Brazilian market are efficient in raising testosterone levels and in clinical improvement of hypogonadal patients. Nebido® showed both a better clinical and laboratorial effectiveness.

OBJETIVO: Comparar os tratamentos para hipogonadismo masculino disponíveis no Brasil. MÉTODOS: Foram selecionados 32 homens com hipogonadismo tardio ("andropausa") no Hospital de Guarnição de Florianópolis. O diagnóstico foi feito por meio do questionário AMS (acima de 27 pontos) e dos níveis diminuídos de testosterona total dosada (abaixo de 300 ng/dL) e/ou testosterona livre calculada (abaixo de 6,5 ng/dL). Os pacientes foram divididos em três grupos de tratamento parenteral (Deposteron® - 11 pacientes; Durateston® - 11 pacientes; Nebido® - 10 pacientes). RESULTADOS: Clinicamente, o tratamento com Nebido® mostrou-se superior ao tratamento com Deposteron® (média do percentual de melhora; p = 0,03) e ao Durateston® (média do questionário AMS pós-tratamento; p = 0,03). Laboratorialmente, o tratamento com Nebido® mostrou níveis de testosterona superiores ao Deposteron® e Durateston® (p < 0,001). CONCLUSÕES: As três formulações de testosterona parenteral existentes no mercado brasileiro são eficientes em elevar os níveis de testosterona e melhorar clinicamente pacientes hipogonádicos, sendo o Nebido® mais efetivo clínica e laboratorialmente.

Assuntos

RESUMO

OBJETIVO: Avaliar a função hipofisária-gonadal nos pacientes vítimas de TCE graves ocorridos na Grande Florianópolis, entre 2000 e 2004. MÉTODOS: Foram estudados 30 pacientes, sendo 22 homens e 8 mulheres, submetidos à avaliação clínica e laboratorial em seguimento médio de 4 anos após a data do traumatismo. RESULTADOS: Os homens possuíam em média 38 anos no ano da avaliação, enquanto as mulheres, 42 anos. A maioria dos traumatismos está relacionada aos acidentes de trânsito (63,3 por cento). Três pacientes (10 por cento) estavam com valores de FSH abaixo do normal e apenas 1 paciente (3,3 por cento) apresentou LH alterado. Nas mulheres avaliadas, os níveis de estradiol foram normais. Na população masculina, foi evidenciado nível de testosterona baixo em 2 pacientes (9,1 por cento). Todos os pacientes apresentavam normoprolactinemia. CONCLUSÃO: Dois casos de hipogonadismo masculino (9,1 por cento) foram diagnosticados neste estudo. Isso indica a necessidade de atenção aos pacientes sobreviventes de TCE grave para realizar diagnóstico precoce de hipogonadismo.

OBJECTIVE: The purpose of this study is to evaluate pituitary function impairment in order to verify the prevalence of sex hormone deficiency and to analyze the profile of TBI population. METHODS: Thirty patients were studied, 22 were male and 8 were female. All patients had their gonadal function assessed and they were evaluated at a median of 4 years post-trauma. RESULTS: The average age of the men was 38 years at the time of the evaluation, while the mean age of women was 42 years. The majority of TBI was related to traffic accidents (63.3 percent). Three patients (10 percent) had low FSH and only 1 patient (3.3 percent) had low LH. There was no biochemical evidence of hypogonadism in women. Two male patients presented low testosterone (9.1 percent) and were diagnosed with hypogonadism. Prolactin levels were normal in all patients. CONCLUSION: Two cases of hypogonadism (9.1 percent) were diagnosed among men in this study. It is therefore necessary that medical professionals involved in the management of TBI patients are aware of hypogonadism as a complication of TBI, in order to diagnose it early.

Assuntos

RESUMO

OBJECTIVE: To provide epidemiological information about thyroid cancer (TC) in the Metropolitan area of Florianopolis and investigate some factors that could be associated with this type of cancer. METHOD: This study analyzed data of patients who had TC diagnosed and underwent surgical treatment in 2000 and 2005. Epidemiological factors about patients, tumors and surgical procedures were evaluated. RESULTS: In 2000 and 2005, an increasing incidence of TC at a rate of 132.33% was detected. The increased rate was mainly observed for tumors measuring less than 1 cm (p = 0.004). Results also showed an increase in the number of multifocal tumors (p = 0.02) and in the rate of total thyroidectomy (p = 0.002). CONCLUSIONS: The increasing incidence of TC in the Metropolitan area of Florianopolis is probably due to more invasive thyroid nodule management. Future studies are necessary to establish potential predicting factors for papillary thyroid microcarcinoma aggressiveness, as well as predictors of follicular lesion malignancy to identifying more accurately the appropriate therapy approach.

Assuntos