Correlation between levels of perceived stress and depressive symptoms in the functional disability of patients with fibromyalgia

SUMMARY OBJECTIVE: The aim of this study was to evaluate the factors that are most correlated with the levels of functional disability in patients with fibromyalgia. METHODS: This is a cross-sectional descriptive study in which 42 patients diagnosed with fibromyalgia according to the criteria of the American College of Rheumatology reported their status using the following questionnaires: the Beck Depression Inventory, the Perceived Stress Scale 14, the Revised Fibromyalgia Impact Questionnaire, the Visual Analog Pain Scale, and the Health Assessment Questionnaire. RESULTS: Moderate to severe levels of depression (Beck Depression Inventory: 22.35±10.39), moderate to severe functional disability (Health Assessment Questionnaire: 1.28±0.58), and high levels of stress (Perceived Stress Scale 14: 31.59±10.02) were found. The correlation adjusted by multiple regression as a function of the Health Assessment Questionnaire indicated a negligible to weak positive correlation with perceived stress (r=0.11), while a moderately strong positive correlation was observed with the Visual Analog Pain Scale (r=0.55). Regarding physical exercise, one of the pillars of the treatment, a moderate negative correlation was found with the Health Assessment Questionnaire (r=-0.4). CONCLUSION: The pain levels were moderately influenced by depression severity. The factors most linked to functional disability are due to the pain levels but not to the perception of stress.

Adaptation to Brazilian Portuguese and Latin-American Spanish and psychometric properties of the Mental Illness Clinicians' Attitudes Scale (MICA v4)

Abstract Objective To describe translation to Spanish and Portuguese and adaptation of the Mental Illness Clinicians' Attitudes Scale version 4 (MICA v4). Methods The questionnaire was administered to primary care physicians (PCPs) from four Latin-American countries, Brazil, Bolivia, Chile, and Cuba. The validation process included four phases: 1) translation of the questionnaire to Spanish and Portuguese; 2) assessment of face validity; 3) assessment of reliability; and 4) evaluation of construct validity with confirmatory factor analysis (CFA). Results The study sample comprised 427 PCPs. The mean age of the Spanish-speaking sample (n = 252) was 40.1 (S.D = 9.7) years and the mean age of the Portuguese-speaking sample (n = 150) was 40.2 (S.D = 10.9) years. Both models demonstrated "appropriate" internal reliability. Total omega was 0.91 for the Spanish-speaking sample and 0.89 for the Portuguese-speaking sample. The CFA of both questionnaires showed an appropriate fit for a three-factor model (Portuguese: CFI = 0.927; TLI = 0.913; RMSEA = 0.066; Spanish: CFI = 0.945; TLI = 0.935; RMSEA = 0.068). Conclusion The Latin-American versions of the MICA v4 in Spanish and Brazilian Portuguese have appropriate psychometric properties, good internal consistency, and are applicable to and acceptable in the Latin-American context. The instrument proved its validity for collecting data on stigmatizing attitudes among health professionals in different contexts and cultures.

Skin manifestations of tick bites in humans

Abstract: Ticks are blood-sucking arthropods that attach to human skin through oral devices causing diverse initial cutaneous manifestations, and may also transmit serious infectious diseases. In certain situations, the Health Teams (and especially dermatologists) may face difficulties in identifying the lesions and associating them to the parasites. To assist them in clinical diagnosis, we suggest a classification of the skin manifestations in primary lesions, which occur by the attachment the tick to the host (for toxicity and the anticoagulant substances in the saliva and/or marked inflammation by the penetration and permanence of the mouthparts) and secondary lesions that are manifestations of infections caused by rickettsia, bacteria, protozoa and fungi inoculated by the ticks.

Manifestação rara de edema agudo de pulmão associado à miocardite lúpica aguda - relato de caso / Unusual clinical manifestation of acute pulmonary edema associated to acute lupic myocarditis - case report

O lupus eritematoso sistêmico (LES) é a mais comum das doenças auto-imunes sistêmicas. Embora os rins classicamente sejam os órgãos mais acometidos no LES, o coração também pode ser afetado de forma significativa. Entretanto, a ocorrência de edema agudo de pulmão associado à miocardite lúpica é rara e de tratamento imunossupressor específico ainda incerto. O presente relato de caso revisa a literatura quanto a manifestações lúpicas do sistema cardiopulmonar, seu diagnóstico e tratamento, e descreve uma paciente lúpica jovem que evoluiu com edema agudo de pulmão decorrente de uma miopericardite lúpica aguda. O rápido diagnóstico pôde permitir o emprego da terapêutica imunossupressora adequada com reversão completa da disfunção miocárdica. Em pacientes jovens com quadro sugestivo de edema agudo de pulmão, o diagnóstico de LES deve ser considerado. O uso de pulsoterapia com corticóide endovenoso mostrou-se eficaz e seguro para o tratamento da manifestação cardíaca extrema.

Systemic lupus erythematosus is the most common systemic autoimmune disease. Although kidneys are the mainorgans affected, heart may suffer injury too. However, acute pulmonary edema associated to lupic myocarditis is rare and its specific immunosuppressive treatment is still undefined. The present case report reviews literature about lupic manifestations in heart and lungs, their diagnosis and treatment, and describes an young lupic patient that had pulmonary edema due toacute lupic myopericarditis. Prompt diagnosis enabled correct immunosuppressive therapy that resulted in a complete reversion of myocardial disfunction. Lupus is a possible diagnosis in young patients with pulmonary edema. The use of intravenous pulse therapy with corticosteroids was safe and efficient to healing of this severe myocardial manifestation.

Artrite reumatóide e doença cardiovascular na atualidade: o que sabemos sobre essa associação e o que podemos fazer pelo paciente? / Rheumatoid arthritis and cardiovascular disease: what do we know about this relationship and how can we treat affected patients nowadays?

O interesse em doenças auto-imunes vem crescendo a cada ano, principalmente sobre sua relação com doenças cardiovasculares. Especificamente a artrite reumatóide vem sendo considerada um fator de risco independente para doença arterial coronária nos últimos anos. Diversos estudos foram realizados recentemente com o objetivo de esclarecer pontos cruciais na estratificação de risco desses pacientes e no seu respectivo tratamento medicamentoso adequado. Novas terapias específicas da doença reumatóide ainda estão em estudo, e prometem reduzir o risco cardiovascular a longo prazo. Desse modo, realizamos uma revisão bibliográfica ampla, utilizando as principais bases de dados nacionais e internacionais, com o objetivo de salientar a importância de mecanismos ateroscleróticos e inflamatórios sobre a doença arterial coronária. Além disso, frente às atuais evidências, sugerimos estratégias de estratificação de risco e tratamento da doença arterial coronária em pacientes com artrite reumatóide.

The interest in auto-immune diseases has been grown, mainly about cardiovascular illnesses. Rheumatoid arthritis has been considered an independent risk factor for coronary arterial disease in last years. Recently, different studies have been performed in order to better clarify crucial points in risk stratification and correct treatment for patients with rheumatoid arthritis. New specific therapies have been studying and promising reduction of cardiovascular risk. Thereby, we made a bibliographic revision to show the importance of atherosclerotic and inflammatory mechanisms in coronary artery disease. Furthermore, wesuggested different strategies to establish risk stratification andtreatment of cardiovascular diseases in patients with rheumatoid arthritis.

Resultados em longo prazo de um programa de qualidade para melhorar a adequação na hemodiálise / long-term results of a qualíty program designed to improve tbe adequacy ín hemodíalysis

Objetivo: Avaliar os resultados em longo prazo de um Programa de Qualidade implantado em onze unidades de hemodiálise simultaneamente, que objetivou reduzir a prevalência de pacientes com Kt/V de uréia inadequado. Métodos: As prescrições de diálise passaram a ser revistas e corrigidas seguindo um algoritmo que incluía modificações no fluxo de sangue (FS), na duração da sessão e no coeficiente de transferência de massa (KoA) dos filtros. Todos os dados foram coletados de forma padronizada em todas as 11 unidades. Neste estudo são apresentados os resultados de três avali- ações transversais, feitas imediatamente antes do início, após dois anos e quatro anos depois da implantação deste pro- grama. Resultados: Na primeira avaliação, nos 1315 pacientes considerados, o Kt/V equilibrado (eKt/V) era 1,26 ± 0,23, sendo que 55 deles tinham eKt/V > 1,2. Após dois anos, nos 1538 pacientes em hemodiálise, o FS, a duração da sessão e o KoA dos filtros eram significativamente mais altos. O eKt/V era maior (1,52 + 0,27; P< 0,001 vs. inicial) sendo > 1,2 em 83 dos pacientes. Com quatro anos de seguimento, 91 de 1560 pacientes avaliados tinham eKt/V > 1,2. Nesta última avaliação, havia uma correlação inversa entre peso seco e eKt/V (r= -0,44; P< 0,001). No último quartil de peso, o percentual de pacientes com Kt/V < 1,2 era mais elevado entre aqueles dialisando com FS < 400milrnin do que entre aque- les com FS > 400m11min (30 vs. 16; P< 0,001). Conclusões: Após a implementação do Programa de Qualidade, a prevalência de pacientes com eKt/V inadequado foi significativamente reduzida.

Intoxicaçäo por chumbo / Lead poisoning

O autor faz uma revisäo bibliográfica sobre a intoxicaçäo pelo chumbo, seus efeitos no organismo humano, incluindo fisiopatologia e tratamento