Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand Questionnaire

The objective of the present study was to translate, adapt and validate a Brazilian Portuguese version of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. The study was carried out in two steps. The first was to translate the DASH into Portuguese and to perform cultural adaptation and the second involved the determination of the reliability and validity of the DASH for the Brazilian population. For this purpose, 65 rheumatoid arthritis patients of either sex (according to the classification criteria of the American College of Rheumatology), ranging in age from 18 to 60 years and presenting no other diseases involving the upper limbs, were interviewed. The patients were selected consecutively at the rheumatology outpatient clinic of UNIFESP. The following results were obtained: in the first step (translation and cultural adaptation), all patients answered the questions. In the second step, Spearman's correlation coefficients for interobserver evaluation ranged from 0.762 to 0.995, values considered to be highly reliable. In addition, intraclass correlation coefficients ranged from 0.97 to 0.99, also highly reliable values. Spearman's correlation coefficients and the intraclass correlation coefficients obtained during intra-observer evaluation ranged from 0.731 to 0.937 and from 0.90 to 0.96, respectively, being highly reliable values. The Ritchie Index showed a weak correlation with Brazilian DASH scores, while the visual analog scale of pain showed a good correlation with DASH score. We conclude that the Portuguese version of the DASH is a reliable instrument.

Utilizaçäo de recursos e custos em osteoporose / Resource utilization and costs in osteoporosis

A osteoporose é uma doença caracterizada por baixa massa óssea e deterioraçäo da microarquitetura do tecido ósseo, com conseqüente aumento da fragilidade óssea e suscetibilidade a fraturas . Os recursos utilizados no tratamento de fraturas por osteoporose säo siginificativos e com custos elevados. OBJETIVO: Dimensionar a utilizaçäo de recursos e custo anual por pacientes com osteoporose pós-menopausa. MÉTODOS: Cem pacientes foram consecutivamente selecionados do ambulatório de doenças osteometabólicas da Universidade Federal de Säo Paulo-Escola Paulista de Medicina (UNIFESP-EPM), entre abril de 1997 a agosto de 1998. Os critérios de inclusäo foram: osteoporose pós-menopausa (OMS, 1994) há pelo menos um ano; mínimo de um ano em acompanhamento ambulatorial; mínimas condiçöes de entendimento e expressäo verbal para responder aos questionários. Características socio-econômicas, clínicas, utilizaçäo de recursos e custos no último ano foram levantadas através de entrevistas empregando-se dois questionários. Os custos unitários dos recursos utilizados no Serviço Público de Assistência à Saúde basearam-se na Tabela SUS de agosto de 1998. RESULTADOS: A média de idade foi 65,85 anos e a renda familiar média-mensal, R$ 534,14. Foram realizadas em média sete consultas/paciente/ano. Das pacientes, 77 por cento usaram cálcio e 38 por cento estrógenos por algum período durante o último ano. Os custos médios totais anuais para o tratamento das pacientes com osteoporose pós-menopausa, sob a perspectiva da sociedade, no Sistema Público em Säo Paulo, foram de R$ 908,18/paciente/ano. CONCLUSÄO: Os custos com o tratamento de osteoporose pagos pelas pacientes representaram 11 por cento da renda familiar mensal média (R$ 534). Em funçäo do envelhecimento da populaçäo e aumento da incidência de osteoporose, políticas de alocaçäo racional de recursos basedas em análises econômicas devem ser implementadas

Bone mineral density of the lumbar spine of Brazilian children and adolescents aged 6 to 14 years

The authors performed a study of bone mass in eutrophic Brazilian children and adolescents using dual-energy X-ray absorptiometry (DXA) in order to obtain curves for bone mineral content (BMC) and bone mineral density (BMD) by chronological age and correlate these values with weight and height. Healthy Caucasian children and adolescents, 120 boys and 135 girls, 6 to 14 years of age, residents of São Paulo, Brazil, were selected from the Pediatric Department outpatient clinic of Hospital São Paulo (Universidade Federal de São Paulo). BMC, BMD and the area of the vertebral body of the L2-L4 segment were obtained by DXA. BMC and BMD for the lumbar spine (L2-L4) presented a progressive increase between 6 and 14 years of age in both sexes, with a distribution that fitted an exponential curve. We identified an increase of mineral content in female patients older than 11 years which was maintained until 13 years of age, when a new decrease in the velocity of bone mineralization occurred. Male patients presented a period of accelerated bone mass gain after 11 years of age that was maintained until 14 years of age. At 14 years of age the mean BMD values for boys and girls were 0.984 and 1.017 g/cm², respectively. A stepwise multiple regression analysis of paired variables showed that the "vertebral area-age" pair was the most significant in the determination of BMD values and the introduction of a third variable (weight or height) did not significantly increase the correlation coefficient

Translation, adaptation and validation of the Roland-Morris questionnaire - Brazil Roland-Morris

The purpose of the present study was to translate the Roland-Morris (RM) questionnaire into Brazilian-Portuguese and adapt and validate it. First 3 English teachers independently translated the original questionnaire into Brazilian-Portuguese and a consensus version was generated. Later, 3 other translators, blind to the original questionnaire, performed a back translation. This version was then compared with the original English questionnaire. Discrepancies were discussed and solved by a panel of 3 rheumatologists and the final Brazilian version was established (Brazil-RM). This version was then pretested on 30 chronic low back pain patients consecutively selected from the spine disorders outpatient clinic. In addition to the traditional clinical outcome measures, the Brazil-RM, a 6-point pain scale (from no pain to unbearable pain), and its numerical pain rating scale (PS) (0 to 5) and a visual analog scale (VAS) (0 to 10) were administered twice by one interviewer (1 week apart) and once by one independent interviewer. Spearman's correlation coefficient (SCC) and intraclass correlation coefficient (ICC) were computed to assess test-retest and interobserver reliability. Cross-sectional construct validity was evaluated using the SCC. In the pretesting session, all questions were well understood by the patients. The mean time of questionnaire administration was 4 min and 53 s. The SCC and ICC were 0.88 (P<0.01) and 0.94, respectively, for the test-retest reliability and 0.86 (P<0.01) and 0.95, respectively, for interobserver reliability. The correlation coefficient was 0.80 (P<0.01) between the PS and Brazil-RM score and 0.79 (P<0.01) between the VAS and Brazil-RM score. We conclude that the Brazil-RM was successfully translated and adapted for application to Brazilian patients, with satisfactory reliability and cross-sectional construct validity

Reduced bone mineral density in men after heart transplantation

Heart transplantation is associated with rapid bone loss and an increased prevalence and incidence of fractures. The aim of the present study was to compare the bone mineral density (BMD) of 30 heart transplant (HT) recipients to that of 31 chronic heart failure (CHF) patients waiting for transplantation and to determine their biochemical markers of bone resorption and hormone levels. The BMD of lumbar spine and proximal femur was determined by dual-energy X-ray absorptiometry. Anteroposterior and lateral radiographs of the thoracic and lumbar spine were also obtained. The mean age of the two groups did not differ significantly. Mean time of transplantation was 25.4 + ou - 21.1 months (6 to 88 months). Except for the albumin levels, which were significantly higher, and magnesium levels, which were significantly lower in HT patients when compared to CHF patients, all other biochemical parameters and hormone levels were within the normal range and similar in the two groups. Both groups had lower BMD of the spine and proximal femur compared to young healthy adults. However, the mean BMD of HT patients was significantly lower than in CHF patients at all sites studied. Bone mass did not correlate with time after transplantation or cumulative dose of cyclosporine A. There was a negative correlation between BMD and the cumulative dose of prednisone. These data suggest that bone loss occurs in HT patients mainly due to the use of corticosteroids and that in 30 per cent of the patients it can be present before transplantation. It seems that cyclosporine A may also play a role in this loss.

Contribuição científica da reumatologia brasileira em nível internacional / International contribution of Brazilian rheumatology

A reumatologia brasileira é uma especialidade médica em expansão no Brasil. Um número crescente de profissionais reumatologistas tem sido formado, atendendo à necessidade de controle das doenças reumáticas no país. Além disso, atividades de pesquisa desenvolvidas nas escolas médicas têm contribuído para o desenvolvimento e reconhecimento da especialidade. Neste trabalho os autores avaliam a contribuição científica da reumatologia brasileira em nível internacional, analisando as publicações brasileiras nos encontros anuais do American College of Rheumatology-ACR no período de 1987 a 1997.

Estudo controlado e randomizado a curto prazo com metotrexato na artrite reumatóide / A short term randomized controlled study with methotrexate in rheumatoid arthritis

O estudo teve por finalidade avaliar a efetividade e toxicidade do metotrexato (MTX) no tratamento da artrite reumatóide. Trinta e seis pacientes foram incluídos no estudo. Vinte e oito pacientes completaram 12 semanas de tratamento, sendo 14 pertencentes ao grupo de MTX e 14 ao grupo placebo. Os pacientes tratdos com MTX apresentaram uma melhora nos parâmetros dor, força de preensäo e capacidade funcional estatsticamente superior (p < 0,05) à observada no grupo placebo. Efeitos colaterais de leve intensidade foram observados em quatro pacientes tratados com MTX e em dois pacientes tratados com placebo. Esses achados sustentam aqueles encontrados em outros estudos e conferem ao metotrexato uma posiçäo relativante no tratamento da artrite reumatóide, devido à sua cômoda posologia, favorável efetividade e tolerabilidade

Febre reumática: manifestaçöes articulares atípicas / Rheumatic fever: atypical articular manifestations

O diagnóstico de febre reumática (FR) continua sendo um dos mais difíceis em pediatria, devido ao polimorfismo do seu quadro e à falta de exames laboratoriais específicos ou patognomônicos da doença. Este trabalho aborda o critério diagnóstico mais freqüente e menos específico, a artrite. Foram estudadas 93 crianças (117 surtos) acompanhadas no setor de Reumatologia Pediátrica do Departamento de Pediatria da Escolar Paulista de Medicina, sendo critério de inclusäo a presença de artrite. O diagnóstico foi baseado na história clínica, exame físico e exames complementares, tendo sido considerados os critérios de Jones modificados. Em 45// observamos artrite e cardite, em 7// artrite e coréia e em 4// artrite, cardite e coréia. A artrite foi migratória em 75 surtos (64// e aditiva em 42 (32//), poliarticular em 64// e pauciarticular em 36//. Monoartrite foi encontrada em 3//. Em 5// foi observada artrite de coxofemoral como manifestaçäo inicial da doença. O tempo de duraçäo da artrite foi igual ou maior a seis semanas em 5// dos surtos. O diagnóstico definitivo de FR nos casos com manifestaçöes articulares atípicas só foi possível com a presença de cardite ou coréia. Os autores chamam a atençäo para o diagnóstico diferencial da FR com outras doenças, principalmente quando a artrite é o único critério maior encontrado

Estudo da reprodutibilidade e validade do índice de atividade do lúpus eritematoso sistêmico / Reproductibility and validity study of activity index of systemic lupus erythematosus

Com o objetivo de testar a reprodutibilidade e validade do índice de atividade do LES (SLEDAI), foram feitas análises de correspondência dos escores obtidos através da aplicaçäo do SLEDAI e da avaliaçäo global subjetiva em 46 pacientes com LES, encontrando-se correlaçäo de Pearson de 0,722 (p < 0,05). Em 23 dos pacientes a correspondência das avaliaçöes globais feitas por dois diferentes reumatologistas mostrou correlaçäo de 0,831 (p < 0,05), enquanto a correlaçäo entre os escores obtidos por dois outros pesquisadores, de forma independente, utilizando o SLEDAI em 20 pacientes, foi de 0,942 (p < 0,05). Conclui-se que o SLEDAI é um bom método para se avaliar a atividade do LES e apresenta boa reprodutibilidade e boa correlaçäo com avaliaçäo subjetiva

A study of the gram-negative bacterial flora in patients with ankylosing spondylitis

Twenty-eight patients with active definite primary ankylosing spondylitis and fifty-four healthy control subjects were studied. The HLA-B27 antigen was found in 75% of patients and 3.7% of control. Fecal samples from these subjects were cultured for gram-negative enteric bacteria on two occasions within one month. Positive cultures for Klebsiella sp were found in 32.1% of patients and in 22.2% of healthy controls, but this difference was not statistically significant. All obther microorganisms detected were qualitatively and quantitatively similar in both groups. Significantly increased mean values of serum IgA levels were found in the patient group when compared with the control group (P<0.01). The mean serum IgG and IgM levels did not differ statistically between the two groups. There was no correlation between any laboratory or clinical parameter and presence of Klebsiella sp carriage in ankylosing spondylitis patients. These data are consistent with the view that a long time elapses between exposure to a trigger facter and clinical manifestations of the disease

Ruptura de aneurisma intra hepatico em poliarterite nodosa. / Rupture of intrahepatic aneurysm in polyarteritis nodosa

Os autores descrevem um caso de ruptura de aneurisma intra-hepatico como complicacoes de uma poliarterite nodosa. Discutem a raridade do fato, sendo o terceiro caso descrito na literatura, bem como os meios propedeuticos clinicos e laboratoriais para o diagnostico