Assessment of quality of life in patients with inflammatory bowel disease / Avaliação da qualidade de vida em pacientes com doença inflamatória intestinal

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract, occurring main-ly in the young, socioeconomically active age group. Both the recurrent-remitting course of symptoms and the chronicity of the disease impact patients' quality of life (QoL). Objective: determine the contributing factors asso-ciated with QoL in IBD patients in a tertiary service. Methods: a cross-sectional study of patients seen at the IBD outpatient clinic of the Federal University of Pelotas from January to November 2020, with clinical and laboratory data collection. Disease assessment was performed using Crohn's Disease Activity Index for Crohn's disease and Mayo score for ulcerative colitis and quality of life through the Inflammatory Bowel Disease Questionnaire (IBDQ). Results: the presence of a history of depression resulted in a significant impact on the overall QoL (p = 0.005) and mainly in the systemic symptoms (p = 0.04), social (p <0.001), and emotional (p = 0.008) domains. Regarding disease activity, statistical significance was evidenced in the intestinal symptoms domain (p <0.001) and overall QoL (p <0.001). Conclusion: a history of psychiatric illness and IBD disease activity were predictors of poorer QoL assessed by the IBDQ (AU)

A doença inflamatória intestinal (DII) é um distúrbio inflamatório crônico do trato gastrointestinal ocorrendo prin-cipalmente na faixa etária jovem socioeconomicamente ativa. Tanto o curso recorrente-remitente dos sintomas quanto a cronicidade da doença impactam a qualidade de vida (QoL) dos pacientes. Objetivo: avaliar a qualidade de vida de pacientes com DII em um serviço terciário. Métodos: estudo transversal de pacientes atendidos no ambulatório de DII da Universidade Federal de Pelotas no período de janeiro a novembro de 2020, com coleta de dados clínicos e laboratoriais. A atividade de doença foi avaliada pelo Crohn's Disease Activity Index para os casos de Doença de Crohn e escore de Mayo para os casos de retocolite ulcerativa e QoL por meio do Inflammatory Bowel Disease Questionnaire (IBDQ). Resultados: a presença de história de depressão resultou em impacto significativo na QoL (p = 0,005) e principalmente nos domínios sintomas sistêmicos (p = 0,04), social (p < 0,001) e emocional (p = 0,008). Em relação à atividade da doença, evidenciado significância estatística nos domínios sintomas intes-tinais (p < 0,001) e qualidade global (p < 0,001). Conclusão: há evidências de que os pacientes com história de depressão e não remissão da DII apresentam maior impacto na qualidade de vida avaliados pelo IBDQ (AU)

Spatial analysis of pneumococcal meningitis in São Paulo in the pre- and post-immunization era

ABSTRACT OBJECTIVE To analyze the pneumococcal meningitis incidence rates in the State of São Paulo, Brazil, by age group, municipalities and micro-regions, as well as the spatial distribution of pneumococcal meningitis incidence rates among children under 5 years old in the pre- (2005-2009) and post-vaccination (2011-2013) periods and its associations with socioeconomic variables and vaccination coverage. METHODS The data source was the Brazilian Notifiable Diseases Information System. For the pre- and post-vaccination periods, thematic maps were built for pneumococcal meningitis incidence in under-5 children, by São Paulo state micro-regions, vaccination coverage and socioeconomic variables, using QGIS 2.6.1 software. Scan statistics performed by the SatScan 9.2 software were used to analyze spatial and spatiotemporal clusters in São Paulo municipalities and micro-regions. A Bayesian inference for latent Gaussian model with zero-inflated Poisson model through the integrated nested Laplace approximation was used in the spatial analysis to evaluate associations between pneumococcal meningitis incidence rates and socioeconomic variables of interest in São Paulo micro-regions. RESULTS From 2005 to 2013, 3,963 pneumococcal meningitis cases were reported in São Paulo. Under-5 children were the most affected in the whole period. In the post-vaccination period, pneumococcal meningitis incidence rates decreased among this population, particularly among infants (from 4.17/100,000 in 2005 to 2.54/100,000 in 2013). Two clusters were found in pre-vaccination - one of low risk for pneumococcal meningitis, in the northwest of the state (OR = 0.45, p = 0.0003); and another of high risk in the southeast (OR = 1.62, p = 0.0000). In the post-vaccination period, only a high-risk cluster remained, in the southeast (RR = 1.97, p = 0.0570). In Bayesian analysis, wealth was the only variable positively associated to pneumococcal meningitis (RR = 1.026, 95%CI 1.002-1.052). CONCLUSIONS Pneumococcal meningitis is probably underdiagnosed and underreported in São Paulo. Differentiated rates of pneumococcal meningitis diagnosis and reporting in each microregion, according to the São Paulo Index of Social Responsibility, might explain our results.

The Brazilian Society of Rheumatology recommendations on investigation and diagnosis of systemic autoimmune myopathies

Abstract Background: This research is recommended by the Myopathy Committee of the Brazilian Society of Rheumatology for the investigation and diagnosis of systemic autoimmune myopathies. Body: A systematic literature review was performed in the Embase, Medline (PubMed) and Cochrane databases, including studies published until October 2018. PRISMA was used for the review, and the articles were evaluated, based on the Oxford levels of evidence. Ten recommendations were developed addressing different aspects of systemic autoimmune myopathy investigation and diagnosis. Conclusions: The European League Against Rheumatism/ American College of Rheumatology (EULAR/ACR) classification stands out for the diagnosis of systemic autoimmune myopathies. Muscular biopsy is essential, aided by muscular magnetic resonance images and electroneuromyography in complementary research. Analysis of the factors related to prognosis with the evaluation of extramuscular manifestations, and comorbidities and intense investigation regarding differential diagnoses are mandatory.

Guidelines of the Brazilian Society of Rheumatology for the treatment of systemic autoimmune myopathies

Abstract Background: Recommendations of the Myopathy Committee of the Brazilian Society of Rheumatology for the management and therapy of systemic autoimmune myopathies (SAM). Main body: The review of the literature was done in the search for the Medline (PubMed), Embase and Cochrane databases including studies published until June 2018. The Prisma was used for the systematic review and the articles were evaluated according to the levels of Oxford evidence. Ten recommendations were developed addressing the management and therapy of systemic autoimmune myopathies. Conclusions: Robust data to guide the therapeutic process are scarce. Although not proven effective in controlled clinical trials, glucocorticoid represents first-line drugs in the treatment of SAM. Intravenous immunoglobulin is considered in induction for refractory cases of SAM or when immunosuppressive drugs are contra-indicated. Consideration should be given to the early introduction of immunosuppressive drugs. There is no specific period determined for the suspension of glucocorticoid and immunosuppressive drugs when individually evaluating patients with SAM. A key component for treatment in an early rehabilitation program is the inclusion of strengthbuilding and aerobic exercises, in addition to a rigorous evaluation of these activities for remission of disease and the education of the patient and his/her caregivers.

Analysis of sexual function of patients with dermatomyositis and polymyositis through self-administered questionnaires: a cross-sectional study / Análise da função sexual de pacientes com dermatomiosite e polimiosite através de questionários autoaplicados: um estudo transversal

Abstract Introduction: To date, there are no descriptions in the literature on gynecologic and sexual function evaluation in female patients with dermatomyositis (DM) and polymyositis (PM). Objective: To assess sexual function in female patients with DM/PM. Patients and methods: This is a monocentric, cross-sectional study in which 23 patients (16 DM and 7 PM), with ages between 18 and 40 years, were compared to 23 healthy women of the same age group. Characteristics on sexual function were obtained by applying the questionnaires Female Sexual Quotient (FSQ) and Female Sexual Function Index (FSFI) validated for the Brazilian Portuguese language. Results: The mean age of patients was comparable to controls (32.7 ± 5.3 vs. 31.7 ± 6.7 years), as well as the distribution of ethnicity and socioeconomic class. As for gynecological characteristics, patients and healthy controls did not differ with respect to age at menarche and percentages of dysmenorrhea, menorrhagia, premenstrual syndrome, pain at mid-cycle, mucocervical secretion, and vaginal discharge. The FSQ score, as well as all domains of the FSFI questionnaire (desire, arousal, lubrication, orgasm and satisfaction), were significantly decreased in patients vs. controls, with 60.9% of patients showing some degree of sexual dysfunction. Conclusions: This was the first study to identify sexual dysfunction in patients with DM/PM. Therefore, a multidisciplinary approach is essential for patients with idiopathic inflammatory myopathies, in order to provide prevention and care for their sexual life, providing a better quality of life, both for patients and their partners.

Resumo Introdução: Até o presente momento, não há descrições na literatura da avaliação ginecológica e da função sexual em pacientes do sexo feminino com dermatomiosite (DM) e polimiosite (PM). Objetivos: Avaliar a função sexual em pacientes do sexo feminino com DM/PM. Casuística e métodos: Estudo transversal unicêntrico em que 23 pacientes (16 DM e sete PM), entre 18 e 40 anos, foram comparadas com 23 mulheres saudáveis, com a mesma faixa etária. As características sobre a função sexual foram obtidas por meio da aplicação dos questionários Female Sexual Quotient (FSQ) e Female Sexual Function Index (FSFI) validados para a língua portuguesa do Brasil. Resultados: A média de idade das pacientes foi comparável à dos controles (32,7 ± 5,3 vs. 31,7 ± 6,7 anos), assim como a distribuição de etnia e da classe socioeconômica. Quanto às características ginecológicas, pacientes e controles saudáveis não apresentaram diferenças em relação à idade na menarca e às porcentagens de dismenorreia, menorragia, síndrome pré-menstrual, dor no meio do ciclo, secreção mucocervical e corrimento vaginal. O escore de pontuação do FSQ, assim como todos os domínios do questionário do FSFI (desejo, excitação, lubrificação, orgasmo e satisfação), estavam significantemente diminuídos nas pacientes comparativamente com os controles, 60,9% das pacientes apresentavam algum grau de disfunção sexual. Conclusões: Este foi o primeiro estudo que identificou disfunção sexual nas pacientes com DM/PM. Assim, uma abordagem multidisciplinar é essencial para pacientes com miopatias inflamatórias idiopáticas para fornecer medidas de prevenção e cuidados para sua vida sexual e propiciar uma melhor qualidade de vida das pacientes e de seus parceiros.

Níveis elevados de transaminases em um caso de coledocolitíase: a importância do reconhecimento deste padrão / High levels of transaminases in a choledocholithiasis case: the importance of knowing this pattern

Case report of a 34-year-old healthy woman diagnosed with symptomatic choledocholithiasis associated with elevated results of transaminases without hepatic disease. High levels of these enzymes can occur in choledocholithiasis cases without further causes of liver injury. Clinicians must be aware of this phenomenon, avoiding unnecessary investigation and its consequences.

Relato de caso de uma mulher hígida de 34 anos de idade diagnosticada com coledocolitíase sintomática associada a elevados níveis de transaminases, sem doença hepática. Altos valores destas enzimas podem ocorrer na coledocolitíase sem outra causa de lesão hepática concomitante. Os médicos devem estar atentos a este fenômeno, a fim de se evitar investigação desnecessária e suas consequências.

Síndrome de Lõfgren / Lõfgren’s Syndrome

A sarcoidose é uma doença crônica granulomatosa, de origem desconhecida, que pode envolver praticamente qualquer órgão, mas na qual a presença de artrite é incomum. Apresentamos um caso no qual a artrite foi o achado inicial, associada ao eritema nodoso, levando à investigação e ao diagnóstico da síndrome de Lõfgren. Nessa forma de apresentação da sarcoidose, além da artrite ou artralgias e do eritema nodoso, também deve estar presente a linfadenopatia hilar bilateral como critério diagnóstico. A síndrome de Lõfgren é chamada algumas vezes de sarcoidose aguda, estando geralmente associada com um bom prognóstico e resolução espontânea.

Sarcoidosis is a chronic granulomatous disease, of unknown origin, that may involve virtually any organ, but in which the presence of arthritis is uncommon. Here we present a case in which arthritis was the first finding, associated with erythema nodosun, leading to the investigation and diagnosis of Lõfgren Syndrome. In this form of sarcoidosis presentation, in addition to arthritis or arthralgia and erythema nodosun there must be bilateral hilar lymphadenopathy as a diagnostic criterion. Lõfgren’s syndrome is sometimes called acute sarcoidosis, usually being associated with good prognosis and spontaneous resolution.

Diagnóstico da monoartrite aguda na emergência / Diagnosis of acute monoarthritis in emergency

JUSTIFICATIVA E OBJETIVOS: A apresentação clínica B de artrite aguda na emergência é frequente e seu diagnóstico, etiológico é desafiador, tendo uma gama de possíveis diagnósticos. A correta avaliação da causa precipitante do sintoma é de extrema importância para orientar o tratamento adequado, minimizando as complicações. O objetivo deste estudo foi auxiliar o médico emergencista, no atendimento de pacientes adultos com quadro clínico de artrite aguda, em articulação nativa. CONTEÚDO: Artigos publicados entre 1970 e 2009, foram selecionados no banco de dados do MedLine através a das palavras-chave: monoartrite e emergência, assim como diretrizes internacionais foram buscadas no link http: sumsearch.uthsca.edu. Adicionalmente, referências destes a artigos, capítulos de livros e artigos históricos foram avaliados CONCLUSÃO: A artrite aguda é uma situação de emergência clínica, associada à fatores precipitantes e etiologias diversas. O correto atendimento, assim como o diagnóstico etiológico, assegura a recuperação e melhoria dos pacientes. Entre as etiologias de artrite aguda, deve-se salientar a importância da artrite infecciosa, devido suas complicações e sequelas, caso não seja instituído tratamento adequado.

Metástases pulmonares em homem: localização incomum do tumor primário / Pulmonary metastases in men: primary tumor in an unusual location

Os autores relatam caso de câncer de mama em um homem de 72 anos achado acidentalmente durante a pesquisa do tumor primário para investigação de metástases pulmonares. São abordados aspectos epidemiológicos, diagnóstico, tratamento e prognóstico desta patologia no sexo masculino.

We report a case of breast cancer identified in a 72-year-old male as an accidental finding during the course of the investigation of a primary tumor and the search for pulmonary metastases. We address aspects related to the epidemiology, diagnosis, treatment and prognosis of this condition in males.

Comparação entre tomografia computadorizada e mediastinoscopia na avaliação do envolvimento ganglionar mediastínico no carcinoma brônquico não de pequenas células / Comparison between computed tomography and mediastinoscopy in the assessment of mediastinal nodal involvement in non-small cell bronchial carcinoma

OBJETIVO: Avaliar o rendimento da tomografia computadorizada torácica, em relação à mediastinoscopia, na detecção de metástases ganglionares mediastinais em pacientes portadores de carcinoma brônquico analisando o rendimento dessa e identificando as regiões mais problemáticas. MATERIAIS E MÉTODOS: Analisamos 195 pacientes portadores de carcinoma brônquico, buscando-se comparar os achados entre tomografia computadorizada torácica e mediastinoscopia com biópsia. RESULTADOS: Em relação às metástases nodais mediastinais, 33,9 por cento tinham doença metastática ganglionar peribrônquica e/ou hilar ipsilateral, 46,1 por cento possuíam metástases mediastinais ipsilaterais e/ou subcarinais e 20 por cento apresentavam doença metastática mediastinal e/ou hilar contralateral, escalênica ou supraclavicular. As regiões com melhores valores de sensibilidade foram traqueobrônquica direita, paratraqueal direita alta e paratraqueal esquerda alta. As regiões nodais com melhores resultados de especificidade foram paratraqueal esquerda alta, paratraqueal direita alta e regiões traqueobrônquicas. CONCLUSÃO: A tomografia computadorizada torácica mostrou-se importante ferramenta diagnóstica na detecção de anormalidades em gânglios mediastinais; entretanto, a natureza neoplásica desses gânglios deve ser conferida por mediastinoscopia, ou até mesmo por toracotomia, a fim de que a correta decisão quanto ao tratamento possa ser tomada.

OBJECTIVE: To evaluate the yielding of chest computed tomography in comparison with mediastinoscopy for detection of mediastinal nodal metastases in patients with bronchial carcinoma, and identifying the most problematic regions. MATERIALS AND METHODS: We have analyzed 195 patients with bronchial carcinoma, comparing the findings of chest computed tomography and mediastinoscopy with biopsy. RESULTS: As regards mediastinal nodal metastasis, 33.9 percent of patients presented peribronchial and/or ipsilateral hilar nodal metastases, 46.1 percent ipsilateral and/or subcarinal mediastinal metastases, and 20 percent contralateral mediastinal and/or hilar, scalenic or supraclavicular metastatic disease. Higher sensitivity values were found in the following regions: right tracheobronchial, right upper paratracheal, and left upper paratracheal. Higher specificity values were found in the following nodal regions: left upper paratracheal, right upper paratracheal and tracheobronchial. CONCLUSION: Chest computed tomography has shown to be an important diagnostic tool for detection of mediastinal lymph nodes abnormalities. However, the neoplastic nature of such mediastinal nodes should be confirmed by means of mediastinoscopy or even thoracotomy, aiming at making the correct decision regarding the treatment of patients with non-small cell lung cancer.