RESUMO

Resumen Los "bezoar" son conglomerados de materiales no comestibles ingeridos voluntaria o involuntariamente, no digeridos e incapaces de transitar por el tracto intestinal. Principalmente afectan a jóvenes mujeres o adolescentes que presentan el fenómeno llamado "pica", y a pesar de que se ha registrado una alta prevalencia de este fenómeno en pacientes con enfermedad renal crónica (ERC), ha sido poco estudiado. Caso clínico: Paciente del sexo masculino de 35 años de edad que cursa con ERC KDIGO-5 en tratamiento con diálisis peritoneal; se obtiene el hallazgo de "bezoar plástico" transoperatorio (laparotomia por oclusión intestinal) a 10 cm de la válvula ileocecal. El paciente fallece por complicaciones de la patología de origen. Se plantea la necesidad de realizar la búsqueda de comportamientos en pacientes con ERC, que indiquen al cirujano la sospecha, dado que los pacientes generalmente ocultan u omiten referir sobre la ingesta de material extraño.

Abstract The "bezoar" are conglomerates of inedible materials ingested voluntarily or involuntarily, which are not digested and are unable to pass through the intestinal tract. They mainly affect young women or adolescents who present the phenomenon called "pica", despite the fact that a high prevalence of this phenomenon of "pica" has been registered in patients with chronic kidney disease, it has been little studied. Clinical case: A 35-year-old male with CKD KDIGO-5 undergoing peritoneal dialysis treatment, which was found to have a transoperative "plastic bezoar" (laparotomy for intestinal occlusion) 10 cm from the ileocecal valve. The patient died due to complications of his pathology. Discussion: the clinical case raises the need to search for behaviors such as pica in patients with CKD, as well as to develop the suspicion to the surgeon, since patients generally hide or ignore reporting foreign material phagia.

RESUMO

Autism Spectrum Disorders (ASD) may significantly impact the well-being of patients and their families. The therapeutic use of cannabis for ASD has gained interest due to its promising results and low side effects, but a consensus on treatment guidelines is lacking. In this study, we conducted a retrospective analysis of 20 patients with autistic symptoms who were treated with full-spectrum cannabis extracts (FCEs) in a response-based, individually-tailored dosage regimen. The daily dosage and relative proportions of cannabidiol (CBD) and tetrahydrocannabinol (THC) were adjusted based on treatment results following periodic clinical evaluation. Most patients (80%) were treated for a minimum of 6 months. We have used a novel, detailed online patient- or caregiver-reported outcome survey that inquired about core and comorbid symptoms, and quality of life. We also reviewed patients' clinical files, and no individual condition within the autistic spectrum was excluded. This real-life approach enabled us to gain a clearer appraisal of the ample scope of benefits that FCEs can provide for ASD patients and their families. Eighteen patients started with a CBD-rich FCE titrating protocol, and in three of them, the CBD-rich (CBD-dominant) FCE was gradually complemented with low doses of a THC-rich (THC-dominant) FCE based on observed effects. Two other patients have used throughout treatment a blend of two FCEs, one CBD-rich and the other THC-rich. The outcomes were mainly positive for most symptoms, and only one patient from each of the two above-mentioned situations displayed important side effects one who has used only CBD-rich FCE throughout the treatment, and another who has used a blend of CBD-Rich and THC-rich FCEs. Therefore, after FCE treatment, 18 out of 20 patients showed improvement in most core and comorbid symptoms of autism, and in quality of life for patients and their families. For them, side effects were mild and infrequent. Additionally, we show, for the first time, that allotriophagy (Pica) can be treated by FCEs. Other medications were reduced or completely discontinued in most cases. Based on our findings, we propose guidelines for individually tailored dosage regimens that may be adapted to locally available qualified FCEs and guide further clinical trials.

RESUMO

This case describes the successful use of transcranial color-coded duplex sonography (TCCD) to diagnose a posterior circulation aneurysm in a patient with subarachnoid hemorrhage. A 33-year-old, was admitted to the ICU after a brain CT scan showed peritroncal subarachnoid hemorrhage. TCCD revealed a rounded image with color Doppler near the P1 portion of the right posterior cerebral artery, which was later confirmed to be a 4 mm aneurysm at the right posterior inferior cerebellar artery (PICA). The aneurysm was treated with coil exclusion and TCCD confirmed its disappearance post-treatment. While TCCD has limitations, including its inability to detect small aneurysms, it is a noninvasive diagnostic tool that provides real-time visualization of the brain and allows for follow-up evaluations. This case demonstrates the potential usefulness of TCCD in diagnosing cerebral aneurysms in patients with subarachnoid hemorrhage and for follow-up evaluations post-treatment.

Assuntos

RESUMO

PURPOSE: Synthetic cannabinoid receptor agonists (SCRAs) are a class of varied compounds that mimic the effects of natural cannabinoids found in cannabis. Because they have a wide range of diverse structures, they vary widely in their potency. The abuse of new psychoactive substances (NPS) in prisons was reported in many European countries and in the USA. In the present study, we have described the identification of SCRAs in 56 infused paper sheet samples, seized mainly in Brazilian prisons between 2016 and 2020. METHODS: The materials were seized by local or federal law enforcement and analyzed by São Paulo State Police or Brazilian Federal Police using gas chromatography-mass spectrometry, attenuated total reflection-Fourier transform infrared spectroscopy, liquid chromatography-high-resolution mass spectrometry or nuclear magnetic resonance spectrometry. RESULTS: Most of these samples (87.5%) were seized in 2019-2020; seven different SCRAs were identified in samples, and the most frequently identified substances were MDMB-4en-PINACA (23.6%) and 5F-MDMB-PICA (36.4%), the newest SCRAs emerging recently. CONCLUSIONS: As observed in Europe and the USA, Brazil also shows the prevalence of indazole-3-carboxamides and indole-3-carboxamides among SCRAs seizures in the prison system. This phenomenon is spreading all over the world at this moment. These data on the prevalence could help to alert judicial authorities to shutting down the introduction of NPS, including SCRAs, into prisons to ensure safety and security for avoiding health risks of prisoners and staff, leading to positive effects in this population. To our knowledge, this is the first demonstration of SCRAs smuggling into prisons in Latin America.

Assuntos

RESUMO

Aneurysms are the most frequent issue for the posterior inferior cerebellar artery (PICA). PICA aneurysms account for 1.4% to 4.5% of all intracranial aneurysms.1-3 Although the majority of PICA aneurysms arise from their junction with the vertebral artery, they can be found in any of 5 segments.4,5 Although PICA is more prone to form nonsaccular aneurysms than other intracranial arteries, ruptured aneurysms are usually saccular.6 Nearly all PICA aneurysms are located intracranially, above the foramen magnum. Extracranial PICA aneurysms are rare, with few reports in literature.7 Microsurgical clipping remains a good treatment alternative for these aneurysms. Higher risk of rerupture has even been reported with embolization of the distal PICA aneurysm with parent artery preservation.8 Here we present the case of a 64-year-old male patient who presented right after a thunderclap headache, followed by a temporary loss of consciousness and disorientation. He was diagnosed with a modified Fisher 4 and Hunt and Hess 2 subarachnoid hemorrhage and found to have a partially thrombosed left PICA saccular aneurysm of the caudal loop just below the foramen magnum. The lesion was approached via a midline suboccipital craniotomy with C1 laminectomy. Microsurgical clipping of the aneurysm was performed without any complications (Video 1). Postoperatively, the patient was discharged without neurologic deficits. We present the first surgical video of the necessary steps in order to perform a microsurgical clipping of an extracranially located caudal loop PICA aneurysm through a midline suboccipital craniotomy with C1 laminectomy.

Assuntos

RESUMO

Presentamos el caso clínico de un adolescente varón de 15 años derivado a Psiquiatría Infanto-Juvenil por realizar ingestas repetitivas de sustancias no nutritivas como gomas de borrar, escamas psoriásicas o incluso pintura de la pared. Entre sus antecedentes somáticos de interés, conviene destacar la Enfermedad de Kawasaki y psoriasis, además de haber sufrido un traumatismo craneoencefálico (TCE) tras lo cual presentó una exacerbación del cuadro. Tras el fracaso en el manejo conductual realizado por parte de su madre y teniendo en cuenta sus rasgos de personalidad caracterizados por una elevada suspicacia y desconfianza hacia los demás, se decide iniciar tratamiento con paliperidona oral produciéndose una rotunda mejoría clínica. Durante todo el seguimiento posterior hasta su mayoría de edad, se ha mantenido la desaparición de la pica. Presentamos el primer caso clínico publicado en la bibliografía actual de un adolescente con el diagnóstico de pica y un TCE previo y una adecuada respuesta a paliperidon

We present a case report of a 15-year-old male adolescent who was referred to our consultation of Children and Adolescent Psychiatry due to persistent eating of non-nutritive substances like rubber, psoriatic scale or wall paint. The patient had the previous diagnostic of Kawasaki Disease and psoriasis. In addition, he had suffered a traumatic brain injury, after which he presented an exacerbation of the clinic. After behaviour therapy failure realized by his mother and taking into account his personality features with high suspicion and distrust of others, he was prescribed paliperidone oral treatment and pica disappeared. During all subsequent follow-up until the age of majority, the disappearance of pica has been maintained. We describe the first case report in the current bibliography of an adolescent with the diagnosis of pica, a previous traumatic brain injury and a good response to oral paliperidone.

Assuntos

RESUMO

Abstract Pica behaviors (PB) are defined as the persistent intake of non-food substances, this behavior that has been identified in patients with Chronic Kidney Disease (CKD), mainly associated with metabolic alterations derived from the disease. The aim of this work was to perform a systematic review for the identification and description of empirical studies on PB in patients with CKD. Four studies were described based on the PRISMA recommendations, which focused on the evaluation of the prevalence of PB and their relationship with sociodemographic, nutritional, metabolic and quality of life variables, evaluating by means of self-report 668 patients, of whom 164 (24.5%) met criteria for PB. It was identified that the PB were more present in women (69%) and in Afroamericans (65-86%) and in contrast to what is reported a clinical context did not differ statistically in the biological and clinical variables. It is concluded that if PB are presented in a quarter of the population studied, is necessary to have a definition of homogeneous that were defined differently and the forms of evaluation. Finally, reference is made to the lack of inclusion of psychological variables and behavioral type analysis, since, as discussed, PB are a clearly analyzable pattern in behavioral terms.

Resumen Las conductas de pica (CP) se definen como la ingesta persistente de sustancias no alimenticias, forma de comportamiento que se ha identificado en pacientes con enfermedad renal crónica (ERC), asociadas principalmente con alteraciones metabólicas derivadas de la enfermedad. El objetivo de este trabajo fue realizar una revisión narrativa de los estudios empíricos existentes sobre CP en pacientes con ERC. Con base en las recomendaciones PRISMA se describieron cuatro estudios, centrados en evaluar la prevalencia de las CP y su relación con variables sociodemográficas, nutricionales, metabólicas y de calidad de vida, evaluando por medio de herramientas de autoreporte a un total de 668 pacientes, de los cuales 164 (24.5%) cumplieron criterios para CP. Éstas se presentaron más en mujeres (69%) y en afroamericanos (65-86%), y al contrario de lo reportado a nivel clínico, no se encontraron diferencias estadísticamente significativas en las variables biológicas y clínicas. Se concluye que, si bien las CP se presentan en una cuarta parte de la población estudiada, es necesario contar con una definición homogénea, ya que en cada estudio se definieron de manera diferente y, por ende, las formas de evaluación variaron. Finalmente, se hace referencia a la falta de inclusión de variables psicológicas y análisis de tipo conductual, pese a que las CP constituyen un patrón claramente analizable en términos conductuales.

RESUMO

Geophagy is widespread among women from Sub-Saharan Africa, South America and the Caribbean and may persist in western countries. This practice may be associated with adverse effects such as anaemia, constipation or intestinal occlusion. We aimed to determine the prevalence of geophagy and the level of knowledge about its health effects among healthy adults originating from these countries and attending a travel medicine and international vaccination consultation in France. Among 101 travellers enrolled in the study, 83 (82.1%) were born in Sub-Saharan Africa and 13 (12.8%) in South America or the Caribbean. The mean duration of residence in France was 15.6 ± 10.4 years. Previous or current geophagy was present in 42 travellers [previous geophagy in 31 (30.7%) and current consumption in 11 (10.9%)]; 38 (90.5%) were women. The rate of awareness of harmful effects of geophagy as the risk of iron-deficient anaemia (18.8%) and soil-transmitted intestinal parasitic infections (11.9%) was low overall. Women with previous or current geophagy more often had history of iron therapy compared to those who never consumed, both during pregnancy (50.0 versus 14.3%; p = 0.0009) and outside pregnancy (47.4 versus 2.8%; p < 0.0001). Despite a long period of residence in France, geophagy was still a current practice among 10.9% of Sub-Saharan, South American and Caribbean travellers, who are poorly informed of its harmful effects. Therefore, specific information tailored to Sub-Saharan, South American and Caribbean about the risks of geophagy should be implemented in western countries.Level of evidence Level V, descriptive cross-sectional survey.

Assuntos

RESUMO

ABSTRACT Objective To evaluate aspects of eating behavior, presence of non-food substance consumption and negative urgency in women from an on-line support group for eating disorders. Methods Participants (n=147) completed questionnaires for binge eating assessment, Intuitive Eating, negative urgency, cognitive restraint and a question of non-food substance consumption. Participants were separated according to criteria for bulimic symptoms and compulsive symptoms. Results The consumption of non-food substances was 4.8% (n=7). The Bulimic Group (n=61) showed higher values for binge eating (p=0.01), cognitive restraint (p=0.01) and negative urgency (p=0.01) compared with the Compulsive Group (n=86). Only the Compulsive Group showed an inverse correlation between scores for binge eating and Intuitive Eating (p=0.01). In both groups, binge eating was inversely correlated with the subscale of body-food choice congruence of Intuitive Eating scale. As expected, the Bulimic Group reached higher values for measures of disordered behaviors such as cognitive restraint and binge eating, and lower scores for Intuitive Eating. Conclusion The aspects of Intuitive Eating are inversely associated with compulsive and bulimic symptoms and the correlation analyses for binge eating and negative urgency agreed with models reported in published literature about negative urgency.

RESUMO Objetivo Avaliar aspectos do comportamento alimentar, presença do consumo de substâncias não alimentares e urgência negativa em mulheres de um grupo de apoio para transtornos alimentares. Métodos As participantes (n=147) preencheram instrumentos para avaliação de compulsão alimentar, Comer Intuitivo, urgência negativa, restrição cognitiva e uma questão para consumo de substâncias não alimentares. Elas foram divididas de acordo com critérios para sintomas bulímicos e sintomas compulsivos. Resultados O consumo de substâncias não alimentares foi de 4,8% (n=7). O Grupo Bulímico (n=61) apresentou maiores valores para compulsão alimentar (p=0,01), restrição cognitiva (p=0,01), e urgência negativa (p=0,01) em relação ao Grupo Compulsivo (n=86). Apenas o Grupo Compulsivo demonstrou correlação inversa entre escores para compulsão alimentar e Comer Intuitivo (p=0,01). Para ambos os grupos, a compulsão alimentar foi inversamente correlacionada com a subescala de escolhas alimentares realizadas em congruência com o estado do corpo do Comer Intuitivo. Como esperado, o Grupo Bulímico apresentou maiores valores para medidas de comportamentos disfuncionais como restrição e compulsão alimentar, e menores escores para Comer Intuitivo. Conclusão Os aspectos do Comer Intuitivo estiveram inversamente associados com os sintomas compulsivos e bulímicos, e os resultados das análises de correlação para Escala de Compulsão Alimentar e urgência negativa concordam com modelos da literatura sobre o envolvimento da urgência negativa.

Assuntos

RESUMO

La phasa (conocida así entre los pobladores aymaras) es un tipo de arcilla comestible que se encuentra en los suelos, empleada como medicina tradicional en la mayoría de los continentes, principalmente para aliviar o tratar patologías gastrointestinales e infecciones cutáneas. Su consumo se remonta muchos siglos atrás; existe evidencia del uso de este elemento en las Placas de arcilla de Nippur en Mesopotamia (2500 años a. C.). Develar las propiedades bio-físico-químicas de las arcillas comestibles está permitiendo a la ciencia explicar las propiedades terapéuticas que posee y así confirmar los grandes avances en la medicina alternativa que tuvieron nuestros antepasados. El uso de la phasa no se limita a la medicina, sino también a muchas otras ramas de la ciencia. En los últimos 10 años se ha experimentado en la agricultura, veterinaria, incluso en el cuidado del medio ambiente dando resultados muy gratificantes y prometedores.

Phasa, an Aymara's language word, is a type of edible clay found in soils; which is used in traditional medicine worldwide mainly to relieve or treat gastrointestinal pathologies and skin infections. Its consumption dates back many centuries, even millennia ago; there is evidence of the use of this element in the clay plates of Nippur in Mesopotamia (2500 years BC). Revealing the bio-physical-chemical properties of edible clay has allowed science to explain their healing and therapeutic properties and confirms the great advances our ancestors got. The use of phasa is not limited to medicine, it is also used in many other sciences; in the last 10 years it has been used in agriculture and veterinary medicine, getting gratifying results.

Assuntos

RESUMO

ABSTRACT: Pica is a condition associated with the chronic, compulsive consumption of a particular substance or material that is not considered food. Culturally it is not accepted by society and its nutritional value is non-existent. When this behavior is repeated consistently for more than one month, it is considered to be Pica. This eating disorder does not have a clear etiology, but is associated with; orality in children, psychotic disorders, nutritional deficiencies, psychosocial problems, autism, family problems, OCD, stress, abuse, family separations and other traumatic events. In order to detect it, it is necessary to perform a correct anamnesis, clinical examination, radiographic examination, complementary examinations such as blood count, as well as a relationship of trust between the dentist and the patient are necessary. All of them will be able to guide us and make us come out of suspicion that this harmful behavior exists, since patients often hide it.

RESUMEN: Pica es una condición asociada al consumo compulsivo y crónico de alguna sustancia o material en particular, que no es considerada alimento. Culturalmente no es aceptado por la sociedad y su valor nutricional es inexistente. Cuando esta conducta se repite consiste-ntemente durante más de un mes, se considera como Pica. Este desorden de comportamiento alimenticio no tiene una etiología clara, pero se asocia a la oralidad en niños, trastornos psicóticos, deficiencias nutricionales, problemas psicosociales, autismo, problemas familiares, TOC, estrés, abuso, separaciones familiares y otros eventos traumáticos. Para detectarla, es necesaria una correcta anamnesis, examen clínico, radiográfico, exámenes complementarios como hemograma, además de una relación de confianza rapport odontólogo- paciente. El conjunto de ellos nos podrán guiar y salir de sospecha que esta conducta dañina existe, ya que los pacientes muchas veces lo esconden.

Assuntos

RESUMO

Resumen Cittarium pica es un gasterópodo conspicuo de los litorales rocosos del Caribe. Dada su importancia en la dieta de las comunidades del Caribe, éste ha sido sobrexplotado, incluso en algunos lugares se ha extinguido, por lo cual algunos países lo han incluido dentro de la lista roja de invertebrados marinos. En la isla de San Andrés Colombia la pesca es artesanal y no tiene regulaciones, conllevando a una disminución de su población. Teniendo en cuenta la importancia socioeconómica, cultural y ecológica de C. pica, así como su grado de vulnerabilidad a la extinción, es urgente desarrollar acciones de manejo que incrementen la resiliencia de la especie y el sostenimiento del recurso. Para evaluar el estado de la población de C. pica de la isla, se estimó la estructura por talla y por sexo, talla de maduración, y los parámetros de crecimiento a partir del análisis de datos de frecuencia de tallas. De septiembre a diciembre 2013 y de enero a marzo 2014, se recolectaron al azar 458 ejemplares en ocho estaciones representativas del litoral rocoso de la isla. Se midió el diámetro de la base de la concha, se determinó el sexo y el tamaño mínimo de maduración. El 80 % de la población consistió de individuos pequeños < 25.5 mm. La proporción de sexos fue de 1:1, excepto en noviembre y el tamaño mínimo de inicio de la madurez para sexos combinados fue de 14.07 mm. Los parámetros de von Bertalanffy K (0.730 año-1), L∞ (110.78 mm) y Φ (3.95) son mayores respecto a otras poblaciones del Caribe. La mortalidad total fue de 3.39 año-1, la mortalidad natural y por pesca fue de 1.02 año-1 y 2.36 año-1, respectivamente. El máximo reclutamiento se estimó para junio y la tasa de explotación máxima entre 0.563 y 0.640, para tamaños de captura de 40 y 50 mm. La tasa de explotación se estimó en 0.70, lo que sugiere una fuerte presión sobre el recurso. Por lo anterior, se recomienda vedar por completo la captura manual de C. pica hasta que un monitoreo evidencie que la población se recupera en la isla.

Abstract Cittarium pica is a conspicuous gastropod of the rocky coastlines of the Caribbean. Given its importance in the diet of Caribbean communities, it has been over-exploited, even reaching extinction in some places, and the species has been included in the red lists of marine invertebrates in some countries. Its fishery in San Andres Island-Colombia is artisanal without any regulation, leading to a decrease in its population. Taking into account the socio-economic, cultural and ecological importance of C. pica and its vulnerability to extinction, it is urgent to develop management actions directed to increase the resilience of the species and its sustainability as a fishery resource. To assess the current population state of C. pica from San Andrés Island, we estimated size structure, sex structure, maturation size, and growth parameters, based on length-frequency data analysis. From September to December 2013, and January to March 2014, we randomly collected 458 individuals at eight representative sites of the rocky shores of the island. We measured the longest diameter of the shell base, determined the sex by the color of the gonad, and thus determined the minimum maturation size. We found, that 80 % of the population consisted of small individuals < 25.5 mm sizes. The sex ratio was 1:1 except in November, where males were more abundant. The minimum size at the beginning of maturity for both sexes was 14.07 mm. The growth parameters of von Bertalanffy: K (0.730 yr-1), L∞ (110.78 mm) and Φ (3.95) were higher when compared to other populations of the Caribbean. The total mortality was 3.39 yr-1, while natural and fishing mortalities were 1.02 yr-1 and 2.36 yr-1, respectively. The maximum annual recruitment pulse was estimated for June, and the maximum exploitation rate for a sustainable yield was between 0.563 and 0.640, when the catch size was greater than 40 mm or 50 mm, respectively. The exploitation rate was estimated in 0.70, suggesting a strong extractive resource pressure. With these results we recommend the closure of the fishery and constant monitoring to promote and the population recovery is verified. Until a monitoring shows that the population recovers on the island.

RESUMO

Com base em delineamento descritivo e exploratório, objetivou-se avaliar indicadores emocionais (sinais de estresse, ansiedade e depressão) e de enfrentamento (coping) em sete gestantes adultas com Diabetes Mellitus e relato de práticas de picamalácia. A prática de picamalácia na gestação atual foi identificada por meio de entrevista validada, antes das participantes responderem aos instrumentos para avaliação psicológica: (a) Inventário de sinais e sintomas de stress de Lipp (ISSL), para avaliar estresse; (b) Escalas BECK, Inventário BAI e BDI, para avaliar ansiedade e depressão; (c) Escalas Modos de Enfrentamento de Problemas (EMEP), para identificas estratégias de enfrentamento frente ao estresse; e (d) Roteiro de entrevista elaborado para pesquisa. As gestantes foram entrevistadas individualmente e seu relato foi analisado em macro-categorias pela metodologia de Bardin. Indicadores de estresse, ansiedade e depressão foram encontrados em todas as gestantes e as práticas de picamalácia mais referidas foram pagofagia (30,8%) e ingestão de fruta com sal (30,8%). Todas as gestantes apresentavam em comum uma sensação de satisfação após a prática da picamalácia. Tendo em vista possíveis associações entre este transtorno alimentar e desfechos desfavoráveis, considera-se importante investigar a picamalacia a fim de propor uma assistência pré-natal mais efetiva na melhora da saúde da díade mãe-filho.

Based on a descriptive and exploratory research design, this study aimed to evaluate emotional (sings of stress, anxiety and depression) and coping indicators in seven pregnant women with diabetes and pica reporting practices. The pica reporting practices in their current pregnancies were identified before they answered the following instruments for psychological evaluation: (a) Inventory of signs and symptoms of stress of Lipp (ISSL), to evaluate stress; (b) BECK Scales, BAI and BDI Inventory, to evaluate anxiety and depression; (c) Scales of Ways of Coping (EMEP), to identify coping strategies to deal with stress; (d) an Interview Guide created for this study. The pregnant women were interviewed individually and their reports were analyzed into macro-categories by the Bardin's methodology. Indicators of stress, anxiety and depression were found in all pregnant women, whose most reported practice was pagofagia (30.8%) and fruit with salt (30.8%). The verbal report revealed that all women had a feeling of satisfaction after the practice of pica. Given that the associations between this eating disorder and unfavorable outcomes, it is important to investigate the pica in order to propose a more effective prenatal care in improving the health of the mother-child dyad.

Basado en un diseño descriptivo y exploratorio, el objetivo del estudio fue evaluar los indicadores de estrés, ansiedad, depresión y afrontamiento en siete mujeres embarazadas diagnosticadas con diabetes y informes de la pica. La práctica de pica fue identificada a través de una entrevista aplicada antes de los siguientes instrumentos de evaluación psicológica: (a) Inventario de los signos y síntomas de estrés Lipp (ISSL), para evaluar el estrés; (b) Escalas de BECK de Ansiedad y Depresión (BAI y BDI), para evaluar la ansiedad y la depresión; (c) Escala Modos de Afrontamiento de Problemas (EMEP), para evaluar las estrategias de afrontamiento delante el estrés y (d) Entrevista individual preparada para la investigación. Las entrevistas fueran analizadas por la metodología de Bardin. Indicadores de estrés, ansiedad y depresión se encontraron en todas ellas, la práctica de pica más reportada fue pagofagia (30,8 %) y las frutas con sal (30,8 %). Las participantes reportaron un sentido de satisfacción después de la práctica. Teniendo en cuenta las asociaciones entre los trastornos alimentarios y desenlaces desfavorables, se considera importante investigar la Pica con el fin de proponer un cuidado prenatal más eficaz para la mejora de la salud de la díada madre-hijo.

Assuntos

RESUMO

Geophagy, or the ingestion of earth or clay, is widespread among women of Sub-Saharan African, Caribbean or French Guiana origin. Little is known about this practice among HIV patients native of these countries and who are followed-up in France. The aims of this study were to determine (i) the prevalence and factors associated with geophagy among HIV patients native of these countries, (ii) patients' knowledge about the harmful effects of geophagy, and (iii) the association of geophagy with iron deficiency, or a history of anemia or constipation. Among the 119 included patients, current geophagy and previous geophagy were present in 11/119 (9%) and 47/119 (40%) patients, respectively. Female gender was the only factor associated with consumption (OR 5.37; 95% CI 2.07-15.92 p = 0.001). Awareness about the risk of iron-deficient anemia was low (24%). Preventive education should be integrated into the care of HIV adults from countries in which geophagy is a culture and widely accepted practice.

Assuntos

RESUMO

The head impulse, nystagmus type, test of skew (HINTS) protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS). The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients with AVS. We studied a group of 114 patients who were admitted to a General Hospital due to AVS, 72 of them with vestibular neuritis (based on positive head impulse, abnormal caloric tests, and negative MRI) and the rest with stroke: 32 in the posterior inferior cerebellar artery (PICA) territory (positive HINTS findings, positive MRI) and 10 in the anterior inferior cerebellar artery (AICA) territory (variable findings and grade 3 ataxia, positive MRI). Truncal ataxia was measured by independent observers as grade 1, mild to moderate imbalance with walking independently; grade 2, severe imbalance with standing, but cannot walk without support; and grade 3, falling at upright posture. When we applied the HINTS protocol to our sample, we obtained 100% sensitivity and 94.4% specificity, similar to previously published findings. Only those patients with stroke presented with grade 3 ataxia. Of those with grade 2 ataxia (n = 38), 11 had cerebellar stroke and 28 had vestibular neuritis, not related to the patient's age. Grade 2-3 ataxia was 92.9% sensitive and 61.1% specific to detect AICA/PICA stroke in patients with AVS, with 100% sensitivity to detect AICA stroke. In turn, two signs (nystagmus of central origin and grade 2-3 Ataxia) had 100% sensitivity and 61.1% specificity. Ataxia is less sensitive than HINTS but much easier to evaluate.

RESUMO

OBJECTIVE: To describe and determine the association between the occurrence of pica and eating attitudes in women with high-risk pregnancies and to determine the prevalence of pica during pregnancy. METHODS: A cross-sectional and prospective 24-month study was conducted with 913 women with high-risk pregnancies. Structured interviews were carried out and the Eating Attitudes Test was applied. RESULTS: Pica was diagnosed in 5.7 % of the pregnant women, and its most commonly practiced type was geophagia (57.7 %). The association between pica and signs related to the eating attitudes: "to be considered too thin by others" (p < 0.02), and "to spend too much time thinking about food" (p = 0.05); and the association between pica and the risk of both anorexia nervosa and bulimia nervosa (p < 0.01) were statistically significant. CONCLUSIONS: The absence of validated instruments in the literature for assessing pica reinforces the difficulty of investigating this practice and the need for further studies. Moreover, additional efforts need to focus in the improvement of screening for other eating disorders with obstetric consequences associated with pica and be incorporated into the routine of healthcare professionals.

Assuntos

RESUMO

La Pica es un síndrome caracterizado por la ingestión persistente de más de un mes de sustancias no nutritivas, se presenta en pacientes con alteración de la salud mental de cualquier causa con padecimientos de orden metabólico, enfermedad celíaca, drepanocitosis, déficit de nutrientes y embarazadas, entre otros. Las complicaciones asociadas a la Pica varían según el tipo de sustancia consumida, manifestándose como obstrucción intestinal -siendo esta la más frecuente- infecciones y desnutrición. Asimismo, observamos que el 75% de los pacientes atendidos necesita cirugía, el 30% sufre complicaciones y hasta el 11% fallece a consecuencia de la Pica o complicaciones postoperatorias. Por ser un síndrome de etiología no bien clarificada, multifactorial y recidivante, los pacientes debe ser evaluados y tratados por un equipo de salud multidisciplinario. En el presente estudio se presentan tres casos de pacientes pediátricos autóctonos de la provincia de Corrientes y una breve revisión y actualización clínica del tema.

Assuntos

RESUMO

Resumo OBJETIVO: Avaliar fatores nutricionais e psicológicos associados com a ocorrência da prática da picamalácia em gestantes atendidas em maternidade pública do Rio de Janeiro, Brasil. MÉTODOS: Estudo descritivo, de caráter exploratório, realizado com 13 gestantes (idades entre 16 e 40 anos) com diagnóstico de picamalácia na gestação atual identificada em entrevista padronizada na consulta com nutricionista que abordava questões sobre ocorrência e frequência do transtorno, além dos tipos de substâncias ingeridas. Após assinarem o Termo de Consentimento Livre e Esclarecido (TCLE), todas as gestantes passaram por avaliação nutricional e, posteriormente, sete foram submetidas à avaliação psicológica com instrumentos padronizados para medida de ansiedade e estresse, além da avaliação de estratégias de enfrentamento (coping ) diante de estressores. RESULTADOS: As práticas de picamalácia mais referidas foram pagofagia (30,8%) e fruta com sal (30,8%). Observou-se ocorrência de algum grau de estresse e ansiedade em todas as gestantes com picamalácia, assim como alguma comorbidade (69,2%) e sintomatologia digestiva (84,6%). As estratégias decoping mais prevalentes foram "focada em práticas religiosas/pensamento fantasioso" e "busca de suporte social", ambas com 42%. CONCLUSÃO: Considerando que a picamalácia pode associar-se com maior risco perinatal, é fundamental que essa prática seja investigada durante o atendimento pré-natal e que ocorra a adoção de práticas preventivas obstétricas, psicológicas e nutricionais para reduzir complicações para a mãe e o concepto.

Abstract PURPOSE: To evaluate the nutritional and psychological factors associated with the occurrence of the practice of pica in pregnant women attending a public hospital in Rio de Janeiro, Brazil. METHODS: The study was based on a descriptive design with exploratory features, and conducted on 13 adult and adolescent pregnant women aged 16 to 40 years with a diagnosis of pica in the current pregnancy. Pica was diagnosed by a nutritionist in a standardized interview situation, when questions about the occurrence and frequency of pica, and types of substance ingestion were investigated. After signing the Informed Consent Form (ICF), all participants were evaluated by a nutritionist and seven of them were submitted to psychological assessment with standardized instruments to evaluate stress and anxiety, and to assess coping strategies. RESULTS: The type of pica most frequently reported was pagophagia (30.8%) and the consumption of fruit with salt (30.8%). The most prevalent coping strategies were "religious practice-focused" and "seeking social support", both presented by 42% of the pregnant women. We observed the occurrence of some degree of stress and anxiety in all pregnant women, as well as comorbidities (69.2%) and gastrointestinal symptoms (84.6%). CONCLUSION: Considering that pica may be associated with increased perinatal risk, it is very important to investigate this disorder during prenatal care, and to dopt obstetric, psychological and nutritional preventive practices to reduce the complications for mother and fetus.

Assuntos

RESUMO

Objetivo: descripción de la resolución quirúrgica de un aneurisma complejo, gigante de circuito posterior (arteria cerebelosa posteroinferior), embolizado previamente, y la evolución postoperatoria. Descripción: Paciente de 48 años de edad con antecedentes de hidrocefalia obstructiva, e hipertensión de fosa posterior, la cual fue tratada por vía endovascular hace 4 años, con colocación de derivación ventricular, y craniectomía descompresiva de fosa posterior, con evolución progresiva de déficit de pares craneales bajos, y síndrome de hipertensión endocraneana. Intervención: Se realizó abordaje extremo lateral con drilado parcial del cóndilo occipital, control proximal de la arteria vertebral, y reconstrucción de la pared aneurismática del sector arteria vertebral- arteria cerebelosa posteroinferior (PICA), mediante microcirugía, con posterior apertura del saco dural y remoción de coils y trombosis intraaneurismática, removiendo el efecto de masa aneurismático. Conclusión: El tratamiento microquirúrgico con la técnica de la reconstrucción parietal del aneurisma y el control proximal del mismo, en conjunto con abordajes de base de cráneo permiten el definitivo y adecuado tratamiento para los aneurismas gigantes de la pica.

Objective: to describe the surgical treatment for complex, giant, embolized, PICA aneurysm and the follow up.Description: 48 years old, female patient with clinical history of obstructive hydrocephalus and posterior fossa´s hipertension. The treatment was endovascular surgery with coils and venricular shunt with posterior fossa´s deccompresive surgery 4 years ago. The clinical evolution was poor. Due to low cranial nerves déficit and progressive posterior fossa´s hipertension, we performed microsurgical treatment Intervention: We performed extreme lateral approach with partial drilling of occipital condile, wiht proper proximal vascular vertebral control, and vascular parietal artery reconstruction in the vertebral-posterior inferior cerebellar artery (PICA) aneurysmatic segment,with microsurgery, posterior opening of the dome and coils remotion. Conclusion: Microsurgical treatment with reconstruction parietal technique, proximal vascular control and skull base approaches are the definitive and more adecuated treatment for giant PICA aneurysms.

Assuntos

RESUMO

Los pobladores del altiplano peruano-boliviano consumen una sustancia natural conocida como "chaco", muy difundida desde la época precolombina y apreciada por sus propiedades digestivas. El Chaco es una arcilla medicinal comestible que es usada en forma de suspensión con agua para cohibir molestias dispépticas o manifestaciones ácido-pépticas. En esta contribución damos a conocer aspectos físico-químicos de la composición del Chaco, estudios experimentales en animales que evalúan su efecto antiulceroso y una prueba in vitro que estudia su propiedad antiácida. El mecanismo de acción terapéutico propuesto se debe a una acción citoprotectora sobre la mucosa gástrica por mecanismos independientes de la inhibición de la secreción ácida, ya que no posee propiedad antiácida in vitro. Además tiene una capacidad de adsorción a distintas moléculas orgánicas debido a su gran superficie externa y carga tetraédrica que hace que interaccione con sustancias polares como el agua y toxinas. El otro propósito de esta contribución especial, es reconocer la coexistencia de la "Medicina Tradicional" y la "Medicina Occidental", situación que conlleva a la necesidad de la investigación preclínica de diversos recursos naturales.

The inhabitants of the peruvian-bolivian plateau consume a natural substance known as "Chaco", widespread since pre-Columbian era and appreciated for its digestive properties. The Chaco is an edible medicinal clay that is used as slurry with water to restrain dyspeptic discomfort or acid-peptic manifestations. In this contribution we present physicochemical aspects of the composition of the Chaco, experimental animal studies that evaluate its antiulcer effect and in vitro test that studies the antacid property. The proposed mechanism of therapeutic action is due to a cytoprotective effect on the gastric mucosa by independent mechanisms of acid secretion inhibition, as it has no antacid property in vitro. Also it has an adsorptivity to different organic molecules due to their large surface area and tetrahedral charge that makes it to interact with polar substances such as water and toxins. The other purpose of this special contribution is to recognize the coexistence of "Traditional Medicine" and "Western Medicine", a situation which leads to the need for preclinical research of various natural resources.

Assuntos