RESUMO
The healthcare ethics committee of the Regional Hospital of Talca, shares with the hospital community, ethical considerations in medical-clinical decisions, in the context of the COVID 19 pandemic. Focus attention on the person, with dignified treatment, with the center in quality and proportional to the individual condition, within the framework of protected teamwork, and that everyone is responsible for mutual care. The considerations of admission to critical units of complicated patients, with principles of caring over healing, without abandoning those who require assistance. Resources are scarce and must be protected, people must not be discriminated against, age is a precedent that must be considered, given the chances of survival, without going beyond the limitations to the therapeutic effort, which must be shared with the treating medical team and of the hospital ethics committee if required. A dignified death is an element to be considered with respect for the person, their families and the community.
Assuntos
Pandemias , COVID-19 , Área Programática de Saúde , Comitês de Ética Clínica , Hospitais/normasRESUMO
Osteoporosis is a silent and frequent disease, which increases fracture risk. Approximately half of women and one of five men over 50 years old will suffer an osteoporotic fracture throughout their lives. Dual-energy x-ray absorptiometry (DXA) allows a real bone mineral density (BMD) measurement in different parts of the skeleton and is considered the "gold standard" for quantifying osteoporosis with high accuracy and precision. The Board of the Chilean Society of Endocrinology and Diabetes (SOCHED) required from the Bone Disease Study Group to develop a consensus about the "Correct use of bone densitometry in clinical practice in Chilean population". Therefore, we elaborated 25 questions which addressed key aspects about the indications for a DXA scan, and the details of how to perform and report this test. Since some of the evidence obtained was of low quality or inconclusive, we decided to create a multidisciplinary group of national experts in osteoporosis to develop a consensus in this subject. The group consisted of 22 physicians including endocrinologists, gynecologists, geriatricians, radiologists, rheumatologists and nuclear medicine specialists. Using the Delphi methodology to analyze previously agreed questions, we elaborated statements that were evaluated by the experts who expressed their degree of agreement. The final report of this consensus was approved by the SOCHED board.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Osteoporose/diagnóstico por imagem , Absorciometria de Fóton/normas , Densidade Óssea , Sociedades Médicas , Chile , Consenso , Endocrinologistas/normasRESUMO
Osteoporosis is a silent and frequent disease, which increases fracture risk. Approximately half of women and one of five men over 50 years old will suffer an osteoporotic fracture throughout their lives. Dual-energy x-ray absorptiometry (DXA) allows a real bone mineral density (BMD) measurement in different parts of the skeleton and is considered the "gold standard" for quantifying osteoporosis with high accuracy and precision. The Board of the Chilean Society of Endocrinology and Diabetes (SOCHED) required from the Bone Disease Study Group to develop a consensus about the "Correct use of bone densitometry in clinical practice in Chilean population". Therefore, we elaborated 25 questions which addressed key aspects about the indications for a DXA scan, and the details of how to perform and report this test. Since some of the evidence obtained was of low quality or inconclusive, we decided to create a multidisciplinary group of national experts in osteoporosis to develop a consensus in this subject. The group consisted of 22 physicians including endocrinologists, gynecologists, geriatricians, radiologists, rheumatologists and nuclear medicine specialists. Using the Delphi methodology to analyze previously agreed questions, we elaborated statements that were evaluated by the experts who expressed their degree of agreement. The final report of this consensus was approved by the SOCHED board.
Assuntos
Absorciometria de Fóton/normas , Densidade Óssea , Osteoporose/diagnóstico por imagem , Adulto , Idoso , Chile , Consenso , Endocrinologistas/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sociedades MédicasRESUMO
To shed light on the epidemiology of ascariasis in Ecuador and Zanzibar, 177 adult worms retrieved by chemo-expulsion from either people or pigs were collected, measured and subjected to polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis of the ribosomal internal transcribed spacer (ITS) region. Upon double digestion with RsaI and HaeIII, PCR-RFLP analysis revealed the presence of A. lumbricoides in people and A. suum in pigs in Ecuador. In contrast, while there are no pigs on Zanzibar, of the 56 worms obtained from people, one was genotyped as A. suum. No additional genetic variation was detected upon further PCR-RFLP analysis with several other restriction enzymes. Upon measurement, worm mass and length differed by location and by species, A. suum being lighter and longer. While there is no evidence to suggest zoonotic transmission in Ecuador, an enduring historical signature of previous zoonotic transmission remains on Zanzibar.
Assuntos
Ascaríase/veterinária , Ascaris/classificação , Doenças dos Suínos/parasitologia , Animais , Ascaríase/epidemiologia , Ascaríase/parasitologia , Ascaris/genética , Criança , Equador , Humanos , Suínos , Doenças dos Suínos/epidemiologia , TanzâniaRESUMO
BACKGROUND: Most childhood asthma in poor populations in Latin America is not associated with aeroallergen sensitization, an observation that could be explained by the attenuation of atopy by chronic helminth infections or effects of age. OBJECTIVE: To explore the effects of geohelminth infections and age on atopy, wheeze, and the association between atopy and wheeze. METHODS: A case-control study was done in 376 subjects (149 cases and 227 controls) aged 7-19 years living in rural communities in Ecuador. Wheeze cases, identified from a large cross-sectional survey, had recent wheeze and controls were a random sample of those without wheeze. Atopy was measured by the presence of allergen-specific IgE (asIgE) and skin prick test (SPT) responses to house dust mite and cockroach. Geohelminth infections were measured in stools and anti-Ascaris IgE in plasma. RESULTS: The fraction of recent wheeze attributable to anti-Ascaris IgE was 45.9%, while those for SPT and asIgE were 10.0% and 10.5% respectively. The association between atopy and wheeze was greater in adolescents than children. Although Anti-Ascaris IgE was strongly associated with wheeze (adj. OR 2.24 (95% CI 1.33-3.78, P = 0.003) and with asIgE (adj. OR 5.34, 95% CI 2.49-11.45, P < 0.001), the association with wheeze was independent of asIgE. There was some evidence that the association between atopy and wheeze was greater in uninfected subjects compared with those with active geohelminth infections. CONCLUSIONS AND CLINICAL RELEVANCE: Atopy to house dust mite and cockroach explained few wheeze cases in our study population, while the presence of anti-Ascaris IgE was an important risk factor. Our data provided only limited evidence that active geohelminth infections attenuated the association between atopy and wheeze in endemic areas or that age modified this association. The role of allergic sensitization to Ascaris in the development of wheeze, independent of atopy, requires further investigation.
Assuntos
Helmintíase/imunologia , Hipersensibilidade Imediata/etiologia , Hipersensibilidade Imediata/imunologia , Sons Respiratórios/etiologia , Sons Respiratórios/imunologia , Adolescente , Fatores Etários , Animais , Ascaris/imunologia , Estudos de Casos e Controles , Criança , Baratas/imunologia , Equador/epidemiologia , Feminino , Humanos , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Masculino , Pyroglyphidae/imunologia , População Rural , Testes Cutâneos , Adulto JovemRESUMO
Objetivo. Medir la eficiencia técnica relativa en las fincas asociadas a la cooperativa COOUNIÓN mediante Data Envelopment Analysis DEA (Análisis Envolvente de Datos). Materiales y métodos. Se tomaron como muestra las doce fincas asociadas a la Cooperativa Coounión en el municipio de Guasca (Cundinamarca). La información se obtuvo durante el período comprendido entre el 1º de junio del 2008 y el 31 de mayo del 2009. Los datos se estructuraron en seis variables, de las cuales se plantean dos modelos, ambos con cuatro variables y que están orientados a las entradas con rendimientos constantes a escala (CRS). El primer modelo consta de tres entradas: nutrición, mantenimiento, ordeño, y una salida: leche; mientras que el segundo modelo cuenta con dos entradas: nutrición, mantenimiento y dos salidas: carne, crías. Resultados. De las doce fincas solo una presentó, la mejor eficiencia tanto en el modelo 1 como en el modelo 2. Por esta razón, se determinaron las mejores prácticas de esta finca con el fin de replicarlas en las demás. Conclusiones. Aplicar la metodología DEA en las fincas ganaderas es viable porque permite enfocarse principalmente en aquellas variables que son controlables por el ganadero como los insumos. Por consiguiente, la evaluación de la eficiencia técnica relativa se desarrolló orientada a estos; así se demostró que las fincas pueden mantener sus niveles de producción actuales haciendo reducciones significativas en sus costos.
Assuntos
Fenômenos Fisiológicos da Nutrição Animal , BovinosRESUMO
BACKGROUND: The low prevalence of allergic disease in the rural tropics has been attributed to the protective effects of chronic helminth infections. There is concern that treatment-based control programmes for these parasites may lead to an increase in the prevalence of allergic diseases. OBJECTIVE: We measured the impact of 15-17 years of anthelmintic treatment with ivermectin on the prevalence of allergen skin test reactivity and allergic symptoms in school-age children. METHODS: The prevalence of allergen skin test reactivity, exercise-induced bronchospasm and allergic symptoms was compared between school-age children living in communities that had received community-based treatments with ivermectin (for onchocerciasis control) for a period of 15-17 years with those living in geographically adjacent communities that had received no ivermectin. RESULTS: The prevalence of allergen skin test reactivity was double in children living in treated communities compared with those in untreated communities (16.7% vs. 8.7%, adjusted OR 2.10, 95% CI 1.50-2.94, P<0.0001), and the effect was mediated partly by a reduced prevalence of Trichuris trichiura among treated children. Ivermectin treatments were associated with an increased prevalence of recent eczema symptoms (adjusted OR 2.24, 95% CI 1.05-4.78, P=0.04) but not symptoms of asthma or rhino-conjunctivitis. The effect on eczema symptoms was not associated with reductions in geohelminth infections. CONCLUSION: Long-term periodic treatments with ivermectin were associated with an increased prevalence of allergen skin test reactivity. There was some evidence that treatment was associated with an increased prevalence of recent eczema symptoms but not those of asthma or rhino-conjunctivitis.
Assuntos
Anti-Helmínticos/administração & dosagem , Eczema/epidemiologia , Hipersensibilidade/epidemiologia , Ivermectina/administração & dosagem , Oncocercose/prevenção & controle , Adolescente , Anti-Helmínticos/efeitos adversos , Asma Induzida por Exercício/epidemiologia , Criança , Conjuntivite Alérgica/epidemiologia , Esquema de Medicação , Equador/epidemiologia , Eczema/diagnóstico , Eczema/imunologia , Feminino , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Ivermectina/efeitos adversos , Modelos Logísticos , Masculino , Razão de Chances , Oncocercose/epidemiologia , Oncocercose/imunologia , Prevalência , Rinite/epidemiologia , Medição de Risco , Fatores de Risco , População Rural , Testes Cutâneos , Fatores de TempoRESUMO
UNLABELLED: Obesity has increased worldwide affecting people of all ages and accounting for a severe public health problem. There exist several treatment options for obesity: dietary, pharmacological, physical exercising, psychotherapy, and surgical. Placement of the so-called intragastric ballonn, a silicone device similar to a 600-mL sphere, has been proposed, indicated for patients with a body mass index higher than 30 kg/m(2). OBJECTIVE: To assess the effect of the intragastric balloon as an alternative method for weight loosing in obese patients. METHODOLOGY: Longitudinal, experimental, descriptive, and exploring study. The sample includes 40 obese patients. Anthropometrical measurements including weight, height, abdominal circumference, tricipital and subscapular folds were done; the body mass index (BMI), muscle surface area and fat a surface area were calculated at baseline, first, third and sixth months after balloon placement. RESULTS: The sample comprised 31 women (77.5%) y 9 men (22.5%). The mean age for women was 35.87 years, and for men 44.67 years. At the end of the study, there was a total mean weight reduction of 18.25 kg, BMI 5.95 kg/m(2), abdominal circumference 13.53 cm, and arm circumference 4.14 cm, in both genders; the decrease in anthropometrical measurements was higher in men than women. CONCLUSIONS: The intragastric balloon showed to be an effective method for weight loosing in obese patients, with better outcomes in men than women.
Assuntos
Balão Gástrico , Obesidade/cirurgia , Redução de Peso , Adulto , Feminino , Humanos , Estudos Longitudinais , MasculinoRESUMO
UNLABELLED: Generally, a student changes lifestyle when enters to the University, this can lead to different alimentary habits that could become as risk factors of nontransmissible chronic diseases (NTCD). OBJECTIVE: To evaluate the presence of risk factors of NTCD in students of medicine race in Carabobo University. METHODOLOGY: 120 people were evaluated, students of third to the sixth year of the medicine race, Carabobo University, year 2006. Family records, nutritional habits, alcohol and tobacco consumption were studied. Anthropometric measures, arterial pressure, glycemia and lipids sérics, were determined. RESULTS: Of evaluated students 68 they belonged to feminine sex and 52 masculine, age between 18 and 26 years old. The risk factor more frequent was the sedentary (72.49%), followed of alcoholic habits (68.3%) and smoking tobacco (34.16%). A 37.5% had high consumption of oils and fats, 58.3% starches and sugars. A 33.34% was overweight or obesity; 3.33% with high blood pressure and metabolic syndrome. The family antecedent predominant was high blood pressure (60%) and obesity (28.2%). CONCLUSION: In this student population risk factors for NTCD exist, which alerts on the necessity to restore plans of education and measures of primary prevention in order to diminish to future the appearance of NTCD in the students of the medicine race in Carabobo University.
Assuntos
Alcoolismo/epidemiologia , Sobrepeso/epidemiologia , Fumar/epidemiologia , Estudantes , Adolescente , Adulto , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco , Universidades , VenezuelaRESUMO
UNLABELLED: Overweight and obesity represent an important public health problem in the world, including developed and underdeveloped countries, as contributing factors for non transmissible chronic illnesses in the adult, affecting both sexes, but especially to women. OBJECTIVE: To associate excess in weight to the presence of comorbidities in adult women. METHODOLOGY: 130 women, age 25 to 70 years with body mass index (BMI) > 25 kg/m(2) were assessed. Weight, height, arm, waist and hip circumferences, tricipital and subescapular skinfolds. BMI, waist/hip ratio (W/H ratio) and fatty area were determined. Presence of diabetes mellitus (DM); high blood pressure (HBP), dyslipidemia and arthropathy were assessed. Overweight and obesity were classified according to OMS criteria. Data was analyzed by SPSS version 11.0. RESULTS: 24,6% of women (n = 32) were overweight; 38,5% (n = 50) were obese I; 23,8% (n = 31) were obese II; and 13,1% (n = 17) had obesity III. Associated pathologies were present in 80,8% of the studied women: 46,9% (n = 61) with dyslipidemia; 42,3% (n = 55) with HBP; 33,1% (n = 43) with arthropaties; and 16,2% (n = 21) with DM. Overweight and obese I women showed a higher prevalence of dyslipidemia (56%) and (52%), respectively; while in Obese II and Obese III, 38,7% and 47,1% presented HBP respectively. There was a positive correlation (Spearman) among DM, HBP and dyslipidemia (p < 0,05) with age; and significant correlation (Pearson, p < 0,05) between W/H ratio and DM. CONCLUSION: There was a high prevalence of associated pathologies in the valued women, being the most frequent dyslipidemia, HBP and arthropathy, which are directly proportional with the age and the IC/C.
Assuntos
Obesidade/complicações , Sobrepeso , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To analyze the association of obesity anthropometrics indicators in coronary ischemic disease (CID). METHODOLOGY: A sample of 120 men was studied; group A (n = 60) with CID and group B (n = 60) without CID and apparent healthy, between 35-55 years old; from Valencia, Venezuela. Age and clinical data were obtained. Weight, height, circumferences of arm, waist, hip, skinfold tricipital and subescapular, were measured; body mass index (BMI), fatty area (FA) and waist/hip index (W/H) were calculated. RESULTS: The mean age for Group A was 45,2 +/- 9,1 years old; BMI 28,5 +/- 4,1 kg/m2 and W/H index of 0,96 +/- 0,004 cm; for Group B age was 40,8 +/- 4,8 years old, BMI 26,39 +/- 4,4 kg/m2 and W/H index 0,90 +/- 0,06 cm. A significant difference for age and BMI (p < 0,05) and for the W/H index (p < 0,01) was found. For men with CID, 40% were obese, 76% had high W/H index and 30% high AG, finding a significant association (p < 0,01) for the W/H index. CONCLUSION: Results showed that there are an positive association between high anthropometrics indicators for W/H index and the BMI index with coronary ischemic disease in the people studied, so they are an important risk factor for this patology.
Assuntos
Doença das Coronárias/complicações , Obesidade/complicações , Adulto , Antropometria , Índice de Massa Corporal , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Risco , VenezuelaRESUMO
La osteoporosis es una enfermedad caracterizada por una disminución de la masa ósea, con deterioro de la microarquitectura del hueso y con aumento del riesgo de fractura. Las fracturas osteoporóticas, especialmente de la cadera, son la consecuencia más grave de la enfermedad. Su prevalencia es alta y seguirá aumentando en todo el mundo debido a su incremento de la población de edad avanzada. Los principales responsables de las pérdidas ósea son las alteraciones del metabolismo mineral: en las mujeres, aquellas secundarias a la pérdida de la función gonadal relacionadas con la menopausia y en ambos sexos, aquellas debidas al proceso del envejecimiento. Además, son importantes algunos factores genéticos y ambientales. Actualmente se conocen con claridad los factores de riesgo de presentar esta condición, así como también se dispone de métodos diagnóstico adecuados para evaluar la masa y el metabolismo óseo. Los tratamientos actualmente en uso permiten no solamente aumentar la masa ósea sino también disminuir la tasa de fracturas
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fraturas do Quadril , Osteoporose , Osteoporose Pós-Menopausa/epidemiologia , Osso e Ossos , Cálcio da Dieta , Densitometria , Lordose , Biomarcadores , Osteoporose , Osteoporose Pós-Menopausa/diagnóstico , Osteoporose Pós-Menopausa/tratamento farmacológicoRESUMO
Background: Radio-iodine is a definite therapy for Graves disease hyperthyroidism. However, the optimal dosage is still debatable. Aim: To assess the effects of different radioiodine doses on thyroid function and complications in patients with hyperthyroidism. Material and methods: A retrospective analysis of 139 patients with hyperthyroidism, treated with ratioiodine between 1988 and 1998. Radio iodine dose used was classified as low (<10 mCi), intermediate (10-14.9 mCi) or high (ü 15 mCi). Results: Thirty five patients were treated with low doses, 33 with intermediate doses and 71 with high doses. There were no differences between these patients in age, disease severity, frequency of post treatment euthyroidism or complications. Patients treated with low doses had a higher frequency of persistent hyperthyroidism than patients treated with high doses (25.7 and 4.2 percent respectively, p<0,001). Likewise, the frequency of subsequent hypothyroidism was 60 percent in patients treated with low doses and 84.5 percent of those with high doses, in whom it also appeared earlier. Associated complications were clinically irrelevant. In seven patients, Graves ophtalmopathy progressed after treatment, but this progression was not associated with the dose used. Conclusions: Radio iodine in high doses is useful, safe and effective for the treatment of Graves hyperthyroidism
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Hipertireoidismo/radioterapia , Radioisótopos do Iodo/administração & dosagem , Doença de Graves/radioterapia , Dosagem Radioterapêutica , Glândula Tireoide/efeitos da radiação , Relação Dose-Resposta à RadiaçãoRESUMO
Hungry bone syndrome is a unusual complication of the postoperative period of primary hyperparathyroidism. This syndrome is characterized by hypocalcemia, hypophosphatemia and hypomagnesemia, due to an excessive bone remineralization. We report the clinical features, laboratory and therapy in four females (aged 39 to 73 years old) with a long standing hyperparathyroidism, elevated alkaline phosphatases and decreased bone mineralization in two. The mean size of the adenoma was 2.9 ñ 1.1 cm. Hypocalcemia appeared between days 1 and 6 of the postoperative period. All were treated with calcium, calcitriol and magnesium at different timing and dosages. The mean hospitalization period was 19.8 ñ 2.1 days. As reported previously, low bone mineralization and a large adenoma are risk factors for the syndrome. Serial monitoring of serum calcium and magnesium and an early supplementation of these minerals could prevent hypocalcemia and decrease the hospitalization time
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias das Paratireoides/cirurgia , Reabsorção Óssea/fisiopatologia , Neoplasias das Paratireoides/complicações , Calcitriol/administração & dosagem , Cálcio/administração & dosagem , Hipofosfatemia/diagnóstico , Hipercalcemia/diagnóstico , Densidade ÓsseaRESUMO
Se analiza la osteopetrosis como enfermedad, su clasificación, anatomía patológica, radiología y diagnóstico. Se presentaron tres casos clínicos tratados en los últimos 15 años. Se discute sobre la dificultad en el tratamiento y los intentos que están haciendo al respecto. La mejor solución seria el trasplante de médula ósea
Assuntos
Humanos , Masculino , Adolescente , Pessoa de Meia-Idade , Osteoblastos , Osteopetrose , Transplante de Medula ÓsseaRESUMO
ACTH secreting macroadenomas and pituitary apoplexy are unusual in Cushing disease. In the few cases reported in the literature, they have been found in long term hypercortisolism. We communicate a 43 yr old woman with a 4 year evolution Cushing syndrome, who developed sudden cephalea and oftalmoplejia. A Computed Tomography of the pituitary fossa disclosed a macroadenoma with intracapsular hemorrhage and suprasellar expansion. In the functional tests, serum cortisol was suppressed with dexamethasone in a dose of 1 and 8 mg and responded to the desmopressin stimulus. Nevertheless, cortisol levels were lower than those observed in Cushing syndrome of similar magnitude. The tumor was resected by transphenoidal surgery and immunohistochemistry to ACTH was positive. In this case, the laboratory results suggest a partial remission of the hypercortisolism after pituitary apoplexy
Assuntos
Humanos , Feminino , Adulto , Neoplasias Hipofisárias/complicações , Apoplexia Hipofisária/complicações , Síndrome de Cushing/etiologia , Dexametasona , Nifedipino/uso terapêutico , Desamino Arginina Vasopressina , Hiperfunção Adrenocortical , Oftalmoplegia/etiologia , Síndrome de Cushing/diagnóstico , Testes de Função HipofisáriaRESUMO
Osteoporosis in young or middle age men is unusual and requires an extensive diagnostic work-up. To report a retrospective review of nine men with osteoporosis aged 27 to 61 years old (mean 39), that presented with primary diagnosis of osteoporosis, were reviewed. Subjects were subjected to a diagnostic work-up 5 years after the onset of symptoms. Their body mass index ranged from 21.7 to 26.3 kg-m2, all had vertebral fractures (crush fractures in 8 and a biconcave deformity in one) between T4 and L4 and all had normal serum calcium, phosphate, alkaline phosphatase and cretinine. Four patients had a history of neprholithiasis and 3 had hypercalciuria. Bone density, measured in 7 patients with a dual photon densitometer, showed a mean Z score of -2.0 in the spine and -2.2 in the femoral neck. The final diagnoses of these patients were Cushing's disease in 2, malabsorption syndrome in 1, use of phenobarbital and hydantoin in 1, over renal hypercalciuria with low calcium intake in 1 and alcoholic liver disease in 1. In 3 patients, osteoporosis was considered idiopathic. Of these, 2 had moderate absorptive hypercalciuria as a presumible risk factor. Six of the 9 studied male patients with osteoporosis had an underlying cause and in three, this condition was considered idiopathic
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Traumatismos da Coluna Vertebral/diagnóstico , Osteoporose/fisiopatologia , Traumatismos da Coluna Vertebral/etiologia , Estudos Retrospectivos , Fatores de Risco , Minerais/metabolismo , Densidade Óssea/fisiologia , Índice de Massa Corporal , Síndrome de Cushing/complicaçõesRESUMO
The effect of chronic alcoholism on bone mass and density has been a subject of considerable controversy. The goal of the present study was to evaluate bone mineral content and density in 2 groups of alcoholic men without evidence of liver damage and determine if the modality of alcohol consumption could cause an alcohol-mediated bone loss. We studied 70 alcoholic non cirrhotic men divided into intermittent (n=38) and continuos (n=32) drinkers. They were compared to 109 normal men. Dual photon densitometry technique using a Gd 153 source was utilized and bone mineral density (BMD) of lumbar spine, femoral neck, Ward's triangle, trochanter, total body bone density (TBBD) and mineral (TBBM) were measured. Hematologic, serum and urinary tests of mineral metabolism were also carried out. No significant differences were found in lumbar spine BMD between normals and alcoholics regardless of the type of alcohol consumption and duration of alcoholism. In the femoral neck, a significant decrease in BMD was found in alcoholics when plotted as regression curves (r=25;p=0,02). In this site duration of alcoholism was significantly correlated to decreased BMD in the total group of alcoholics (r=0,27;p=0,02) and also in the continuous drinker group (r=0,40;p=0,02) when considered duration of alcohol abuse. Total bone mineral was significantly lower in alcoholics (p<0.001) and the subgroups compared to normals and correlated with duration of alcohol abuse (p=0,01). Chemical values revealed normal calcium, phosphorus, alkaline phosphatases, PTH and Ca/Cr concentration. Only serum magnesium was found disminished in 16,6 percent of studied subjects. We conclude that pure alcoholism may affect femoral neck density and total body mineral content, being proportional to the duration of alcohol abuse. Spine density appears unaffected. The type of alcoholic abuse was less important than its duration to cause bone mass abnormalities
Assuntos
Humanos , Masculino , Adulto , Alcoolismo/complicações , Densidade Óssea , Doenças Ósseas/diagnóstico , Estudos de Casos e Controles , Densitometria , Consumo de Bebidas Alcoólicas/efeitos adversos , Colo do Fêmur , Colo do Fêmur/fisiopatologia , Reabsorção Óssea/fisiopatologiaRESUMO
We studied 20 female patients, aged 51 ñ 13.6 years old, with the diagnosis of Primary Biliary Cirrhosis (PBC) to assess osteopenia, main involved sites and its relation to menopause, some parameters of mineral metabolism and the degree of histological liver involvement. The diagnosis of PBC was based in histological, clinical and laboratory features. Bone densitometry was measured with dual-photon densitometer and compared with values of a normal female population from the laboratory. When compared to controls, studied patients had a significantly lower lumbar spine bonedensity and total bone mineral content and a non significantly lower density in femoral neck and total body. Serum calcium, phosphorus, magnesium, PTH and urinary calcium/creatinine ratio were within normal limits. Lumbar spine density was no significantly lower in patients with more severe liver histological involvement and in postmenopausal women. No correlation was found between the duration of postmenopausal period and the degree of osteopenia. It is concluded that patients with PBC have a clear lumbar spine osteopenia and a lower total mineral content and that these parameters worsen in a non significant fashion in subjects along with liver histological involvement and with the length of post menopausal period