Treating the face of women with botulinum toxin type A: 7-year review / Tratamento da face de mulheres com toxina botulínica do tipo A: revisão de 7 anos

Introduction: Botulinum toxin type A (BTX-A) is the number one aesthetic procedure worldwide, and the difficulty in standardizing the aesthetic treatment of the face results in a broad range of treatment possibilities. The objective this study aimed to describe the author's experience treating facial wrinkles of women with BTX-A and suggest a standardized initial treatment method. Methods: A documentary retrospective review of all medical records from the main author's clinic from 2010 to 2017 in São Paulo, Brazil, was performed, searching for female patients who required the BTX-A aesthetic treatment to reduce facial wrinkles. The main author obtained, reviewed, and classified photographic data ("Carruthers Grading Scale for Forehead Lines"). Results: The BTX-A used in all patients was Botox® (Allergan Inc., Irvine, CA, USA). A total of 156 female treatments with BTX-A were identified. The average total units of BTX-A used for the referred treatment was 32.43U. The average period between treatments in the same patient was 8.73 months. All patients showed an improved "Grading Scale for Forehead Lines" post-treatment Conclusion: The review suggests a safe and effective technique is possible with even lower complication rates than found in the literature using fewer units, resulting in lower product costs. One should always try to minimize risks in aesthetic treatments.

Introdução: A aplicação de toxina botulínica do tipo A (BTX-A) é o procedimento estético mais realizado no mundo. Não há consenso sobre a forma ideal de realizar essa aplicação, que defina os locais de aplicação e a quantidade ideal necessária para o referido tratamento. O objetivo do estudo tem como objetivos descrever a experiência do autor no tratamento das rugas faciais em mulheres com BTX-A e sugerir uma padronização para o tratamento inicial. Método: Foi realizado um estudo documental retrospectivo de todos os prontuários médicos da clínica do autor principal, em São Paulo - SP, Brasil, desde 2010 até 2017, em busca dos dados de pacientes do sexo feminino que foram submetidas ao tratamento das rugas faciais com BTX-A, por razões estéticas. Os arquivos fotográficos foram obtidos, revisados e classificados pelo autor principal de acordo com a "Carruthers Grading Scale for Forehead Lines". Resultados: A BTX-A utilizada em todas as pacientes foi: Botox® (Allergan Inc., Irvine, CA, USA). Um total de 156 tratamentos com BTX-A foi encontrado. A média de unidade de toxina utilizada para o tratamento foi de 32,43U. O período médio de retorno para nova aplicação, na mesma paciente, foi de 8,73 meses. Todas as pacientes apresentaram melhora da classificação obtida através da "Grading Scale for Forehead Lines" após o tratamento. Conclusão: A revisão sugere que uma técnica efetiva e segura para o tratamento é possível, com menos unidades e menor taxa de complicações, quando comparada à literatura. Devemos sempre minimizar os riscos em tratamentos estéticos.

HIV and neoplasms: What do we know so far?

ABSTRACT Introduction The human immunodeficiency virus (HIV) pandemic remains an important issue. In 2020, approximately 37.7 million people were living with the disease and there were more than 680 thousand deaths due to complications linked to the disease. Despite these exorbitant numbers, the introduction of highly active antiretroviral therapy has marked a new era, changing the epidemiological profile of the infection and related pathologies, including neoplasms. Objective We performed a literature review to assess the role of neoplasms in patients with HIV after the introduction of antiretroviral therapy. Methods A literature review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, searching the MEDLINE, LILACS, and COCHRANE databases for articles published from 2010 onwards. Results Using specific key terms, 1,341 articles were identified; two were duplicates, 107 were selected for full-text evaluation, and 20 were included in the meta-analysis. The selected studies included 2,605,869 patients. Fifteen of the 20 articles indicated a reduction in the global incidence of AIDS-defining neoplasms and 12 indicated an overall increase in non-AIDS-defining cancers after the introduction of antiretrovirals. This growth trend could be explained by a range of factors including the aging population with HIV, risky behaviors, and coinfection with oncogenic viruses. Conclusions There was a decreasing trend in the incidence of AIDS-defining neoplasms and increasing trend in non-AIDS-defining neoplasms. However, the carcinogenic effect of antiretrovirals could not be confirmed. In addition, studies focusing on the oncogenic role of HIV and screening for neoplasms in individuals with HIV are required.

O papel da endoscopia na síndrome dispéptica de crianças e adolescentes / The role of endoscopy in dyspeptic syndrome in children and adolescentes

ABSTRACT Background Dyspepsia is pain or discomfort in the epigastric region, and can be subdivided into organic and functional. The diagnosis of functional dyspepsia is based on the criteria defined by the Rome committee. In the pediatric population, functional dyspepsia is more common than organic dyspepsia, in addition to being part of a set of diseases called defined gastrointestinal disorders, defined by the Rome IV criteria. The most efficient diagnostic method of functional dyspepsia in the pediatric population is still uncertain since endoscopy is an important test to rule out organic changes, but it is invasive to be performed on a large scale. Objective To evaluate the role of endoscopy in the diagnosis of functional dyspepsia in pediatric patients, aiming at preventing invasive procedures and reaching high specificity in the result, which is important to determine the best diagnostic guideline for these patients. Methods: Narrative literature review study performed by searching for articles in the PubMed/Medline and LILACS database using the PRISMA method. Results A total of 102 articles were found in PubMed, 15 of which were selected for the study. In the LILACS database, nine articles were found and one was selected. Thus, 16 articles were selected for the study. The most appropriate indications for endoscopy, how to differentiate organic from functional dyspepsia without endoscopy, the main endoscopic findings of the studies, the differences between Rome III and Rome IV criteria, and the prevalence and factors possibly associated with functional dyspepsia were approached through the selected articles. Conclusion The main indication for endoscopy is the presence of alarm symptoms in pediatric patients with dyspepsia and the Rome clinical criteria are efficient for the diagnosis of functional dyspepsia. However, there is still no standardized diagnostic guideline to be followed in this age group.

RESUMO Contexto: A dispepsia é a dor ou desconforto na região epigástrica, e pode ser subdividida em orgânica e funcional. O diagnóstico de dispepsia funcional é realizado com base nos critérios definidos pelo comitê de Roma. Na população pediátrica a dispepsia funcional é mais comum que a orgânica, além de que está dentro de um conjunto de doenças denominado distúrbios gastrointestinais funcionais, definidos pelos critérios de Roma IV. O método diagnóstico de dispepsia funcional mais eficiente na população pediátrica, ainda é incerto uma vez que a endoscopia é um exame importante para descartar alterações orgânicas, porém invasivo para ser realizado em alta escala, por isso a importância desse estudo, que visa definir a melhor conduta. Objetivo: Avaliar o papel da endoscopia no diagnóstico da dispepsia funcional em pacientes pediátricos, visando prevenir procedimentos invasivos e atingir alta especificidade no resultado, o que é importante para determinar a melhor diretriz diagnóstica para esses pacientes. Métodos: Estudo de revisão narrativa da literatura, realizada por meio de buscas de artigos na base de dados PubMed/Medline e LILACS, utilizando o método PRISMA. Resultados: No PubMed foram encontrados 102 artigos, sendo 15 selecionados para o estudo. Na base de dados LILACS foram encontrados nove artigos e selecionado um. Dessa forma, 16 artigos foram selecionados ao estudo, sendo abordado por meio deles quais são as indicações mais adequadas para a endoscopia, como diferenciar dispepsia orgânica de funcional sem endoscopia, quais os principais achados endoscópicos dos estudos, quais as diferenças entre os critérios de Roma III e Roma IV, qual a prevalência e os fatores possivelmente associados à dispepsia funcional. Conclusão A principal indicação para endoscopia foi a presença de fatores de alarme nos pacientes pediátricos com dispepsia e os critérios clínicos de Roma mostraram-se eficientes para o diagnóstico de dispepsia funcional. Porém, ainda não existe uma diretriz diagnóstica padronizada a ser seguida nessa faixa etária.

Acute pancreatitis and COVID-19: a new target for infection?

ABSTRACT This review aimed to investigate whether SARS-CoV-2 is capable of infecting the gland and causing acute pancreatitis, and the peculiarities in the management of these cases. The research was conducted through PubMed® database, and 62 articles were systematically selected for analysis. Differences were found in the literature; however, there are important warnings, such as the presence of hyperlipasemia, clinical and imaging findings suggestive of acute pancreatitis in the presence and even in the absence of respiratory symptoms. Attention should be paid to clinical and imaging findings during this virus infection, since it is possible to identify these two diseases early. Therefore, it is possible to detect and isolate these patients more quickly, providing the correct care and decreasing the morbidity and mortality of two potentially severe diseases.

COVID-19 and the gastrointestinal tract: what do we already know? / COVID-19 e o trato gastrintestinal: o que já sabemos?

ABSTRACT The new coronavirus disease pandemic is defining 2020, with almost 17.5 million infected individuals and 700 thousand deaths up to beginning of August. It is caused by SARS-CoV-2 and the transmission is through the respiratory tract. Those infected may be asymptomatic, present typical symptoms (fever, dry cough and dyspnea), gastrointestinal symptoms (diarrhea, nausea, vomiting and abdominal pain) and viral RNA in stools. The objective of this work was to review the literature related to the prevalence of gastrointestinal symptoms, and to check the possibility of fecal-oral transmission. We searched PubMed® database on COVID-19 and gastrointestinal tract and selected articles using the PRISMA method. We eliminated articles based on titles and abstracts, small number of patients and the mechanism of infection, leaving 14 studies. Comorbidities and laboratory alterations (elevation of hepatic aminotransferases and bilirubin) were related to worsening of the disease. The prevalence of gastrointestinal symptoms ranged from 6.8% to 61.3%, including diarrhea (8.14% to 33.7%), nausea/vomiting (1.53% to 26.4%), anorexia (12.1% to 40.0%) and abdominal pain (0% to 14.5%). The presence of viral RNA in stools was rarely tested, but positive in 0% to 48.1%. The gastrointestinal tract is affected by COVID-19, causing specific symptoms, laboratory alterations and viral presence in the feces. However, the results of prevalence and possibility of fecal-oral transmission were varied, requiring further studies for more assertive conclusions. It is important that healthcare professionals draw attention to this fact, since these changes can help make diagnosis and initiate early treatment.

RESUMO Com quase 17,5 milhões de infectados e 700 mil mortos até o início de agosto no mundo, a pandemia do novo coronavírus está marcando o ano de 2020. O agente causador da doença é o vírus SARS-CoV-2, e a transmissão é por via respiratória. Os infectados podem ser assintomáticos, apresentar sintomas típicos (febre, tosse seca e dispneia), sintomas gastrintestinais (diarreia, náusea, vômito e dor abdominal) e RNA viral nas fezes. O objetivo deste trabalho foi revisar a literatura relacionada com a prevalência dos sintomas gastrintestinais, e verificar se é possível a transmissão fecal-oral da doença. Fizemos uma pesquisa na base de dados PubMed® sobre a COVID-19 e o trato gastrintestinal, selecionando artigos pelo método PRISMA. Eliminamos artigos com base em títulos e resumos, quantidade pequena de pacientes e sobre mecanismo de infecção, restando 14 estudos. Comorbidades e alterações laboratoriais (elevação de aminotransferases hepáticas e bilirrubina) foram relacionadas com piora da doença. A prevalência de sintomas gastrintestinais variou entre 6,8% e 61,3%, sendo eles diarreia (8,14% a 33,7%), náusea/vômito (1,53% a 26,4%), anorexia (12,1% a 40,0%) e dor abdominal (0% a 14,5%). A presença do RNA viral foi pouco testada, mas foi positiva entre 0% a 48,1%. O trato gastrintestinal é muito acometido pela COVID-19, provocando sintomas específicos, alterações laboratoriais e presença viral nas fezes. Contudo, os resultados de prevalência e a possibilidade de transmissão fecal-oral foram variados, necessitando de estudos maiores para conclusões mais assertivas. É importante a atenção de profissionais da saúde a isso, visto que essas alterações podem ajudar no diagnóstico e a iniciar tratamento precoce.

Urinary beta-trace protein gene expression analysis in type 2 diabetes mellitus patients / Análise da expressão do gene da proteína beta-traço na urina de pacientes com diabetes mellitus tipo 2

ABSTRACT Objective: To evaluate the gene expression of beta-trace protein in urine of diabetic patients, with no reduction in glomerular filtration rate, which was defined as below 60mL/min/1.73m2. Methods: Type 2 diabetes mellitus patients were recruited, and a group of non-diabetic individuals served as control. Beta-trace protein gene expression was analyzed by quantitative PCR. Blood samples were collected to establish glucose levels and baseline kidney function. Accuracy was analyzed using ROC curves. Results: Ninety type 2 diabetes mellitus patients and 20 non-diabetic individuals were recruited. The area under the curve was 0.601, sensitivity of 20% and specificity of 89.47%. Among diabetic participants, 18% showed an expression above the cutoff point. Conclusion: These results of accuracy of beta-trace protein gene expression in urine of diabetic patients are promising, although they did not achieve a higher area under the curve level.

RESUMO Objetivo: Avaliar a expressão do gene da proteína beta-traço na urina de pacientes diabéticos, sem redução na taxa de filtração glomerular, definida como abaixo de 60mL/min/1,73m2. Métodos: Foram recrutados pacientes com diabetes mellitus tipo 2, e um grupo de indivíduos não diabéticos serviu como controle. A expressão do gene da proteína beta-traço foi analisada por PCR quantitativa. Amostras de sangue foram coletadas para estabelecer níveis de glicemia e função renal inicial. A acurácia foi analisada utilizando curvas ROC. Resultados: Foram recrutados 90 pacientes com diabetes mellitus tipo 2 e 20 não diabéticos. A área sob a curva foi de 0,601, com sensibilidade de 20% e especificidade de 89,47%. Entre os diabéticos, 18% apresentaram expressão acima do ponto de corte. Conclusão: Estes resultados de acurácia da expressão do gene da proteína beta-traço na urina de pacientes diabéticos são promissores, apesar de não terem atingido um nível alto na área sob a curva.

Antiretroviral drugs and acute pancreatitis in HIV/AIDS patients: is there any association? A literature review / Drogas antirretrovirais e pancreatite aguda em pacientes com HIV/AIDS: existe alguma associação? Revisão da literatura

In HIV-seropositive individuals, the incidence of acute pancreatitis may achieve 40% per year, higher than the 2% found in the general population. Since 1996, when combined antiretroviral therapy, known as HAART (highly active antiretroviral therapy), was introduced, a broad spectrum of harmful factors to the pancreas, such as opportunistic infections and drugs used for chemoprophylaxis, dropped considerably. Nucleotide analogues and metabolic abnormalities, hepatic steatosis and lactic acidosis have emerged as new conditions that can affect the pancreas. To evaluate the role of antiretroviral drugs to treat HIV/AIDS in a scenario of high incidence of acute pancreatitis in this population, a systematic review was performed, including original articles, case reports and case series studies, whose targets were HIV-seropositive patients that developed acute pancreatitis after exposure to any antiretroviral drugs. This association was confirmed after exclusion of other possible etiologies and/or a recurrent episode of acute pancreatitis after re-exposure to the suspected drug. Zidovudine, efavirenz, and protease inhibitors are thought to lead to acute pancreatitis secondary to hyperlipidemia. Nucleotide reverse transcriptase inhibitors, despite being powerful inhibitors of viral replication, induce a wide spectrum of side effects, including myelotoxicity and acute pancreatitis. Didanosine, zalcitabine and stavudine have been reported as causes of acute and chronic pancreatitis. They pose a high risk with cumulative doses. Didanosine with hydroxyurea, alcohol or pentamidine are additional risk factors, leading to lethal pancreatitis, which is not a frequent event. In addition, other drugs used for prophylaxis of AIDS-related opportunistic diseases, such as sulfamethoxazole-trimethoprim and pentamidine, can produce necrotizing pancreatitis. Despite comorbidities that can lead to pancreatic involvement in the HIV/AIDS population, antiretroviral drug-induced pancreatitis should always be considered in the diagnosis of patients with abdominal pain and elevated pancreatic enzymes.

Em HIV-soropositivos, a incidência de pancreatite aguda pode chegar até 40% ao ano, o que é consideravelmente maior que na população geral, cuja incidência é de 2%. A partir de 1996, com a introdução da terapia antirretroviral combinada, conhecida pela sigla HAART (highly active antiretroviral therapy), o espectro de fatores nocivos ao pâncreas, como infecções oportunistas e uso de drogas para sua quimioprofilaxia, diminuiu consideravelmente. Análogos nucleotídeos e anormalidades metabólicas, esteatose hepática e acidose láctica despontaram como novas condições que podem acometer o pâncreas. A fim de avaliar o papel das drogas antirretrovirais para tratamento do HIV/AIDS na incidência elevada de pancreatite aguda nessa população, foi realizada revisão sistemática, com inclusão de artigos originais, relatos e séries de caso, cujos alvos de estudo eram pacientes HIV-soropositivos que evoluíram com pancreatite aguda após exposição a alguma das drogas que compõem o esquema antirretroviral. Essa associação foi confirmada após exclusão de outras possíveis etiologias e/ou recorrência do episódio de pancreatite aguda após reexposição ao fármaco suspeito. Zidovudina, efavirenz e os inibidores de protease são suspeitos de levar a uma pancreatite secundária à hiperlipidemia. Já os análogos nucleotídeos da transcriptase reversa, apesar de serem potentes inibidores da replicação viral, possuem grande espectro de efeitos colaterais, entre eles a mielotoxicidade e a pancreatite aguda. Didanosina, zalcitabina e estavudina já foram reportados como produtores de pancreatite crônica e aguda, tendo risco elevado com dose cumulativa. Didanosina com hidroxiureia, álcool ou pentamidina são fatores de risco adicionais, podendo induzir a uma pancreatite fatal, embora pouco frequente. Além disso, outras drogas usadas para profilaxia de doenças oportunistas relacionadas à AIDS, como sulfametoxazol-trimetoprima e pentamidina, podem produzir pancreatite necrotizante. Apesar das comorbidades que podem levar ao acometimento pancreático na população com HIV/AIDS, pancreatite medicamentosa desencadeada por drogas antirretrovirais sempre deve ser considerada no diagnóstico diferencial desses pacientes que se apresentam com dor abdominal e elevação das enzimas pancreáticas.

Perfil mastigatório de obesos mórbidos submetidos à gastroplastia / Masticatory profile of morbidly obese patients undergoing gastroplasty

OBJETIVO: traçar o perfil mastigatório do obeso mórbido. MÉTODO: estudo pareado por idade e sexo avaliou motricidade orofacial e mastigação de 40 obesos mórbidos submetidos à gastroplastia e 40 eutróficos sem queixas de mastigação e/ou deglutição. RESULTADOS: obesos mórbidos apresentaram: alteração de práxis e variáveis de lábios, língua, além de alteração no tamanho de mandíbula; na avaliação de mastigação habitual - ritmo rápido, movimentação vertical de mandíbula, tamanho grande do bolo, escassez de mastigação e necessidade de líquido durante a mastigação; nas avaliações de mastigações lateralizadas - ausência de corte do alimento, ritmo rápido, movimentação vertical de mandíbula, tamanho grande do bolo e escassez de mastigação. CONCLUSÃO: pacientes obesos mórbidos apresentam alterações de mastigação.

PURPOSE: to trace a profile of morbidly obese patient chewing. METHOD: study matched for age and sex evaluated oral motor and chew of 40 morbidly obese patients undergoing bariatric surgery and 40 eutrophic with no complaints of chewing and/or swallowing. RESULTS: morbidly obese showed: change in praxis and variables of lips and tongue and change in mandible size upon evaluating the mastication process - fast pace, vertical movement of the jaw, large size of the pie, chewing scarcity and need for fluid during chewing; in evaluations of lateralized chewing - no food cut, fast pace, the vertical movement of the jaw, large size of the cake and a shortage of mastication. CONCLUSION: morbidly obese patients show chewing alterations.

Impulsividade na obesidade: questões conceituais e metodológicas / Impulsivity in obesity: conceptual and methodological issues / Impulsividad en la obesidad: aspectos conceptuales y metodológicos

Na abordagem clínica da obesidade, aspectos psicológicos e fatores ambientais são alvo de manejo que melhor podem contribuir para a perda de peso. Dentre os aspectos psicológicos, a impulsividade destaca-se como componente importante da compulsão alimentar que pode levar à obesidade. Objetivo: Descrever os estudos que investigaram a relação impulsividade e obesidade. Método: Pesquisa na base de dados Bireme com os descritores impulsivity and obesity em títulos ou resumos no período de 2002 a 2009. Resultados: A pesquisa retornou 44 artigos, dos quais foram selecionados 22 com foco no estudo da impulsividade associada à obesidade, hiperfagia e/ou compulsão alimentar. Conclusão: Estudos voltados à investigação da associação obesidade, transtorno de hiperatividade e déficit de atenção e transtorno da compulsão alimentar periódica prometem avanços na identificação de um denominador comum, mas demandam instrumentos mais específicos que possam ser usados em amostras expressivas.

The clinical management of obesity, psychological and environmental factors are the targets of management that can best contribute to weight loss. Among the psychological aspects, impulsivity stands out as an important component of binge eating that can lead to obesity. Objective: To describe the studies that investigated the relationship between impulsivity and obesity. Method: Search Bireme database with descriptors impulsivity and obesity in titles or abstracts between 2002 and 2009. Results: The search returned 44 items of which 22 were selected according the focus on impulsivity related to obesity, overeating and binge eating. Conclusion: Studies aimed on investigating the association between obesity, attention-deficit hyperactivity disorder and binge eating promising advances towards identifying a common denominator, but require more specific instruments that can be used on samples more expressive.

El manejo clínico de la obesidad, psicológicos y los factores ambientales son los objetivos de gestión que mejor pueden contribuir a la pérdida de peso. Entre los aspectos psicológicos, la impulsividad se destaca como un componente importante de los atracones que pueden conducir a la obesidad. Objetivo: Describir los estudios que investigaron la relación entre la impulsividad y la obesidad. Método: base de datos de búsqueda con descriptores impulsividad Bireme y la obesidad en los títulos o resúmenes de 2002 a 2009. Resultados: La búsqueda ha dado 44 artículos de los cuales 22 fueron seleccionados con un enfoque en el estudio de la impulsividad asociados a la obesidad, hiperfagia y / o trastorno por atracón. Conclusión: Los estudios destinados a investigar la asociación de la obesidad, el trastorno de hiperactividad y déficit de atención y trastorno del atracón avances prometedores en la identificación de un denominador común, pero requieren instrumentos más específicos que se pueden utilizar en las muestras de expresión.

Associações entre impulsividade, compulsão alimentar e obesidade em adolescentes / Associations between impulsivity, binge eating and obesity in adolescent / Las asociaciones entre atracones, impulsividad, y la obesidad en adolescentes

A impulsividade pode ser importante componente no âmbito da compulsão alimentar e obesidade. OBJETIVO: Apresentação de um protocolo com a utilização do Teste Palográfico para medida da impulsividade. MÉTODOS: 60 adolescentes (10-20 anos; Md: 13,97 anos; DP 2,17) de ambos os sexos foram avaliados quanto ao IMC, compulsão alimentar e impulsividade. RESULTADOS: A compulsão alimentar foi prevalente em meninas e a impulsividade em meninos; 38 por cento da amostra estava acima do peso saudável, dos quais 13 por cento simultaneamente com obesidade/obesidade grave, compulsão alimentar e altos escores para impulsividade. A associação entre IMC e impulsividade pontuou valores próximos do nível de significância estabelecido no estudo (chi square = 14.85, DF = 8, p = . 062). CONCLUSÃO: O Teste Palográfico mostrou boa sensibilidade e especificidade justificando a aplicação do presente protocolo em desenhos de estudos que comportem amostras maiores e que preconizem as diferenças sexuais.

Impulsivity may be an important component on context of binge eating and obesity. OBJECTIVE: Presentation of a protocol with the use of Palográfico test to measure impulsivity. METHODS: 60 adolescents (10 - 20 years; Md: 13.97 years, SD 2.17) of both sexes were assessed for BMI, binge eating and impulsivity. RESULTS: Binge eating was prevalent in girls and impulsivity in boys. 38 percent of the sample was above the healthy weight and of these, 13 percent simultaneously with obesity / morbid obesity, binge eating and higher scores for impulsiveness. The association between BMI and impulsivity scored values near the significance level of the study (chi square = 14.85, DF = 8, p =. 062). CONCLUSION: The Palográfico test showed good sensitivity and specificity justifying the application this protocol in study designs involving larger samples and focused that focus on sexual differences.

La impulsividad puede ser un componente importante en el contexto de atracones y la obesidad. OBJETIVO: Presentación de un protocolo con el uso de prueba Palográfico para medir la impulsividad. MÉTODOS: 60 adolescentes (10 - 20 años, Md: 13,97 años, SD 2.17) de ambos sexos se evaluaron el IMC, los atracones y la impulsividad. RESULTADOS: Los atracones eran frecuentes en las niñas y la impulsividad en los niños. 38 por ciento de la muestra estaban por encima del peso saludable y de estos, el 13 por ciento de forma simultánea con la obesidad la obesidad / mórbida, los atracones y las puntuaciones más altas de la impulsividad. La asociación entre el IMC y la impulsividad anotó valores próximos al nivel de significación en el estudio (chi cuadrado = 14,85, gl = 8, p =. 062). CONCLUSIÓN: La prueba Palográfico mostró buena sensibilidad y especificidad justifica la aplicación de este protocolo en los diseños de estudio con muestras más grandes y centrados in las diferencias sexuales.

Doença do refluxo gastroesofágico: uma afecção crônica / Gastroesophageal reflux disease (GERD): a chronical disorder

A doença do refluxo gastroesofágico (DRGE) pode ser definida como “uma afecção crônica decorrente do refluxo retrógrado de parte do conteúdo gastroduodenal para esôfago ou órgãos adjacentes a ele, acarretando um espectro variável de sintomas e/ou sinais esofagianos e/ou extraesofagianos, associados ou não a lesões teciduais”. É uma afecção prevalente, porém subestimada, no entanto pode comprometer sobremaneira a qualidade de vida do paciente. Sua etiologia e patogenia são multifatoriais, porém depende essencialmente da integridade da barreira anti-refluxo, com seus componentes anatômicos e funcionais. Um dos fatores que mais se destaca nesta doença é o distúrbio do esfíncter inferior do esôfago (EIE). O diagnóstico de certeza é feito através da pHmetria de 24 horas, sendo a endoscopia digestiva alta muito utilizada na avaliação da gravidade da doença, assim como no diagnóstico de erosões, úlceras, sangramentos e complicações (esôfago de Barrett), com a realização de biópsia (histologia), além de permitir, em alguns casos a terapêutica. O tratamento visa o alívio dos sintomas, cicatrização das lesões e a prevenção de recidivas e complicações. Para isso é utilizado o tratamento clínico, com as medidas comportamentais e o farmacológico, e em algumas situações bem definidas é realizado tratamento cirúrgico e, num futuro próximo, o tratamento endoscópico.

Gastroesophageal reflux disease (GERD) can be defined as “a chronic disorder related to the retrograde flow of the gastroduodenal contents into the esophagus and/or adjacent organs, resulting in a variable spectrum of symptoms, with or without tissue damage”. Its pathophysiology and etiology are multiple but the integrity of the antireflux barrier is a very important issue and also the disorders of the lower esophageal sphincter (LES). The gold-standard test for GERD is the 24-hour pHmetry and the upper endoscopy is also useful on the diagnosis of erosions, ulcers, upper bleedings and Barrett’sesophagus, allowing the tissue analysis and in some circunstances the treatment. The objectives are alleviation of symptoms, the healing of mucosal lesions, and prevention of recurrence and complication. The therapeutic approach can be divided into behavioral a pharmacological measures thatshould be implemented, but in some special cases, the surgical treatment is needed, and in the near future, the endoscopic treatment should be available..

Efficacy of a triple therapy for Helicobacter pylori eradication in a well-developed urban area in Brazil

CONTEXTO: A erradicação do Helicobacter pylori tem sido o principal tratamento para a doença ulcerosa péptica. Consiste em uma terapia tripla com omeprazol juntamente com dois antibióticos. Devido à inexistência de uma medicação ideal, assim como a um alto índice de resistência primária aos nitroimidazólicos em nosso meio, tem-se adotado o uso da claritromicina. OBJETIVOS: Determinar o índice de erradicação do Helicobacter pylori em pacientes com doença ulcerosa péptica mediante a terapia com lanzoprazol, amoxicilina e claritromicina, por sete dias. MÉTODOS: Num estudo retrospectivo, aberto e realizado na Faculdade de Medicina do ABC, foram incluídos 130 pacientes portadores de doença ulcerosa péptica (endoscopia digestiva alta) e com infecção por Helicobacter pylori diagnosticada pelos testes da urease, respiratório e histológico; todos sem tratamento prévio. Os pacientes foram tratados com lanzoprazol (30 mg), amoxicilina (1.000 mg) e claritromicina (500 mg) duas vezes ao dia por sete dias. Os índices de erradicação foram avaliados noventa dias após o tratamento. RESULTADOS: 94 pacientes completaram o estudo, sendo a média de idade 52,23 anos, 51,54% mulheres, 84,31% brancos, 37,69% tabagistas, 20,77% usuários de antiinflamatórios não-hormonais e 8,46% de etilistas. A endoscopia digestiva alta revelou: 78,46% de úlcera duodenal (UD) e 21,53% de úlcera gástrica (UG) (4UD:1UG). O índice de erradicação por protocolo foi de 85,11% e por intenção de tratamento foi de 97%. Foram observados poucos efeitos colaterais. CONCLUSAO: A terapia tríplice com lanzoprazol, amoxicilina e claritromicina mostrou-se bem tolerável, com altos índices de erradicação, sendo uma boa alternativa para países em desenvolvimento.

Therapeutic efficacy of ranitidine bismuth citrate with clarithromycin for seven days in the eradication of Helicobacter pylori in Brazilian peptic ulcer patients

CONTEXT: The curative treatment of peptic ulcer is made available nowadays through the eradication of the bacterium Helicobacter pylori, which is associated with it, but the best therapeutic regimen is yet to be determined. OBJECTIVE: To assess the efficacy of a therapeutic regimen with 400 mg ranitidine bismuth citrate associated with 500 mg clarithromycin given twice a day for seven days in a cohort of Brazilian patients with peptic ulcer. TYPE OF STUDY: Cross-sectional study. SETTING: Tertiary-care hospital. PATIENTS: One hundred and twenty nine outpatients, with active or healed peptic ulcers infected by Helicobacter pylori, diagnosed via endoscopy with confirmation via the urease test and histological examination, who had never undergone a regimen for the eradication of the bacterium. PROCEDURE: Administration of 400 mg ranitidine-bismuth and 500 mg clarithromycin twice a day, for seven days. MAIN MEASUREMENTS: Efficacy of the treatment, with a check on the cure done via another endoscopy eight weeks after drug administration. The eradication of the bacterium was determined via the urease test and histological examination. Patients who were negative for both were considered to be cured. RESULTS: Eight patients failed to complete the study. The eradication rate according to intention to treat was 81 percent (104/129) and per protocol was 86 percent (104/121). CONCLUSION: The bismuth ranitidine compound associated with clarithromycin used for one week was shown to be a simple, effective and well-tolerated therapeutic regimen for the eradication of Helicobacter pylori

Omeprazole, Furazolidone, and Tetracycline: an eradication treatment for resistant H. pylori in Brazilian patients with peptic ulcer disease

OBJECTIVES: To determine the efficacy of a simple, short-term and low-cost eradication treatment for Helicobacter pylori (H. pylori) using omeprazole, tetracycline, and furazolidone in a Brazilian peptic ulcer population, divided into 2 subgroups: untreated and previously treated for the infection. PATIENTS AND METHODS: Patients with peptic ulcer disease diagnosed by endoscopic examination and infected by H. pylori diagnosed by the rapid urease test (RUT) and histological examination, untreated and previously unsuccessfully treated by macrolides and nitroimidazole, were medicated with omeprazole 20 mg daily dose and tetracycline 500 mg and furazolidone 200 mg given 3 times a day for 7 days. Another endoscopy or a breath test was performed 12 weeks after the end of treatment. Patients were considered cured of the infection if a RUT and histologic examination proved negative or a breath test was negative for the bacterium. RESULTS: Sixty-four patients were included in the study. The women were the predominant sex (58 percent); the mean age was 46 years. Thirty-three percent of the patients were tobacco users, and duodenal ulcer was identified in 80 percent of patients. For the 59 patients that underwent follow-up examinations, eradication was verified in 44 (75 percent). The eradication rate for the intention-to-treat group was 69 percent. The incidence of severe adverse effects was 15 percent. CONCLUSION: The treatment provides good efficacy for H. pylori eradication in patients who were previously treated without success, but it causes severe adverse effects that prevented adequate use of the medications in 15 percent of the patients

Low efficacy of an ultra-short term, once-daily dose triple therapy with omeprazole, azithromycin, and secnidazole for Helicobacter pylori eradication in peptic ulcer

PURPOSE: To determine the eradication rate of an ultra-short treatment schedule for Helicobacter pylori infection in a population with peptic ulcers, using omeprazole, secnidazole, and azithromycin in a once-daily dose for 3 days. METHODS: Thirty patients with peptic ulcer diagnosed by upper endoscopy and for Helicobacter pylori infection by rapid urease test and histologic examination received omeprazole 40 mg, secnidazole 1000 mg, and azithromycin 500 mg, administered once daily for 3 days. A follow-up exam was performed 12 weeks after the end of the treatment. Patients who were negative for Helicobacter pylori infection by rapid urease test and histologic examination were considered cured. RESULTS: Patients were predominantly female, and the mean age was 50 years. Duodenal peptic ulcer was found in 73 percent of the patients. Eradication was achieved in 9 of the 28 (32 percent) patients as determined from the follow-up endoscopic exam. The eradication rate by intention to treat was 30 percent. Side effects were present in 3 percent of the patients, and compliance to treatment was total. CONCLUSIONS: In spite of the low rate of side effects and good compliance, the eradication index was low. A possible drawback of this therapy is that it reduces the efficacy of macrolide and nitroimidazole compounds in subsequent treatments

Pancreatic involvement in co-infection visceral leishmaniasis and HIV: histological and ultrastructural aspects

The involvement of the gastrointestinal tract in the co-infection of HIV and Leishmania is rarely reported. We report the case of an HIV-infected adult man co-infected with a disseminated form of leishmaniasis involving the liver, lymph nodes, spleen and, as a feature reported for the first time in the English literature, the pancreas. Light microscopy showed amastigote forms of Leishmania in pancreatic macrophages and immunohistochemical staining revealed antigens for Leishmania and also for HIV p24. Microscopic and ultrastructural analysis revealed severe acinar atrophy, decreased zymogen granules in the acinar cytoplasm and also nuclear abnormalities such as pyknosis, hyperchromatism and thickened chromatin. These findings might correspond to the histologic pattern of protein-energy malnutrition in the pancreas as shown in our previous study in pancreas with AIDS and no Leishmania. In this particular case, the protein-energy malnutrition may be due to cirrhosis, or, Leishmania or HIV infection or all mixed. We believe that this case represents the morphologic substratum of the protein energy malnutrition in pancreas induced by the HIV infection. Further studies are needed to elucidate these issues

Factors affecting Helicobacter pylori eradication using a seven-day triple therapy with a proton pump inhibitor, tinidazole and clarithromycin, in brazilian patients with peptic ulcer

Triple therapy is accepted as the treatment of choice for H. pylori eradication. In industrialized countries, a proton pump inhibitor plus clarithromycin and amoxicillin or nitroimidazole have shown the best results. Our aims were: 1. To study the eradication rate of the association of a proton pump inhibitor plus tinidazole and clarithromycin on H. pylori infection in our population. 2. To determine if previous treatments, gender, age, tobacco, alcohol use, and non-steroidal anti-inflammatory drugs (NSAIDs) change the response to therapy. METHODS: Two hundred patients with peptic ulcer (upper endoscopy) and H. pylori infection (histology and rapid urease test - RUT) were included. A proton pump inhibitor (lansoprazole 30 mg or omeprazole 20 mg), tinidazole 500 mg, and clarithromycin 250 mg were dispensed twice a day for a seven-day period. Eradication was assessed after 10 to 12 weeks of treatment through histology and RUT. RESULTS: The eradication rate of H. pylori per protocol was 65 percent (128/196 patients). This rate was 53 percent for previously treated patients, rising to 76 percent for not previously treated patients, with a statistical difference p<0.01. No significant difference was observed regarding sex, tobacco use, alcohol consumption, and NSAID use, but for elderly patients the difference was p = 0.05. Adherence to treatment was good, and side effects were mild. CONCLUSIONS: A proton pump inhibitor, tinidazole, and clarithromycin bid for seven days resulted in H. pylori eradication in 65 percent of the patients. Previous treatments were the main cause of treatment failure