Brazilian evidence-based guideline for screening, diagnosis, treatment, and follow-up of metabolic dysfunction-associated steatotic liver disease (MASLD) in adult individuals with overweight or obesity: A joint position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM), Brazilian Society of Hepatology (SBH), and Brazilian Association for the Study of Obesity and Metabolic Syndrome (Abeso)

ABSTRACT Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as Nonalcoholic fatty liver disease (NAFLD), is one of the most common hepatic diseases in individuals with overweight or obesity. In this context, a panel of experts from three medical societies was organized to develop an evidence-based guideline on the screening, diagnosis, treatment, and follow-up of MASLD. Material and methods: A MEDLINE search was performed to identify randomized clinical trials, meta-analyses, cohort studies, observational studies, and other relevant studies on NAFLD. In the absence of studies on a certain topic or when the quality of the study was not adequate, the opinion of experts was adopted. Classes of Recommendation and Levels of Evidence were determined using prespecified criteria. Results: Based on the literature review, 48 specific recommendations were elaborated, including 11 on screening and diagnosis, 9 on follow-up, 14 on nonpharmacologic treatment, and 14 on pharmacologic and surgical treatment. Conclusions: A literature search allowed the development of evidence-based guidelines on the screening, diagnosis, treatment, and follow-up of MASLD in individuals with overweight or obesity.

"Anti-obesity medications" or "medications to treat obesity" instead of "weight loss drugs" - why language matters - an official statement of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) and the Brazilian Society of Endocrinology and Metabolism (SBEM)

ABSTRACT Obesity is largely undertreated, in part because of the stigma surrounding the disease and its treatment. The use of the term "weight loss drugs" to refer to medications for the treatment of obesity may contribute to this stigma, leading to the idea that anyone who wants to lose weight could use them and that short-term use, only in the active weight loss phase would be enough. On the contrary, the use of terms such as "medications to treat obesity" or "anti-obesity medications" conveys the idea that the treatment is directed at the disease rather than the symptom. This joint statement by the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) and the Brazilian Society of Endocrinology and Metabolism (SBEM) intends to alert the press, healthcare professionals and scientific community about the importance of the appropriate use of language, with the aim of improving obesity care.

Fibrohistiocitoma maligno de face: uma apresentação rara / Malignant fibrohistiocytoma of face: a rare presentation

Contexto: O fibrohistiocitoma maligno é um sarcoma de tecidos moles muito agressivo, com rara apresentação limitada à pele e tecido subcutâneo em face. O diagnóstico é anatomopatológico com auxílio da imuno-histoquímica. Descrição do caso: Este artigo relata o caso de um paciente com diagnóstico de fibrohistiocitoma maligno restrito à face com boa resposta terapêutica após exérese cirúrgica. Discussão: Tendo em vista a raridade dessa afecção, dificuldade diagnóstica devido ao quadro inespecífico e com rápida evolução, é importante lembrar desse possível diagnóstico e atuar precocemente. Conclusões: O diagnóstico precoce interfere de forma significativa na evolução do quadro, sendo necessária a manutenção do acompanhamento oncológico e dermatológico com o intuito de detectar precocemente recidivas locais e metástases a distância.

Processos grupais com adolescentes em situação de vulnerabilidade social / Group processes with social vulnerability teenagers / Procesos grupales con adolescentes en situación de vulnerabilidad social

O presente relato de experiência visa problematizar a prática com grupos de adolescentes em situação de vulnerabilidade social. Realizou-se cinco grupos entre agosto e dezembro de 2019. Os grupos eram fechados e com duração de 1 hora e 40 minutos cada. Como método e forma de manejo grupal utilizou-se a estratégia de coordenação cartográfica. Os resultados e discussão apontam rizomaticamente para diferentes direções: a alta disponibilidade dos adolescentes em participar dos grupos; a importância do delineamento e da sensibilização ao setting grupal; o modo como os vetores macropolíticos e institucionais incidem nos processos grupais; os efeitos da sub-apropriação da língua formal na dinâmica dos grupos e na circulação social; a importância de dar lugar ao que não tem lugar; e, o mapeamento de expressões com camadas de sentido. Por fim, aponta-se o grupo como dispositivo potente para a instauração de novas formas de vida.(AU)

The present experience report aims to problematize the practice with groups of adolescents in situations of social vulnerability. Five groups were held between August and December 2019. The groups were closed and lasting 1 hour and 40 minutes each. As a method and as a form of group management was used the strategy of cartographic coordination. The results and discussion indicate rhizomatically to different directions: the high availability of adolescents to participate in groups; the importance of design and sensation by the participants of the group setting; the macro-political and institutional vectors converging on group processes; the effects of the sub-appropriation of formal language in the groups dynamics and social mobilities; the importance of step up a place for what has no place; and, the mapping of expressions with layers of meaning. Finally, the group is pointed out as a powerful device for the creation of new forms of life.(AU)

El presente informe de experiencia tiene como objetivo problematizar la práctica con grupos de adolescentes en situaciones de vulnerabilidad social. Se realizaron cinco grupos entre agosto y diciembre de 2019. Los grupos fueron cerrados y ocurrieron durante 1 hora y 40 minutos cada uno. Como método y forma de seguimiento grupal se utilizó la estrategia de coordinación cartográfica. Los resultados y la discusión apuntan rizomaticamente a diferentes direcciones: la alta disponibilidad de adolescentes para participar de los grupos; la importancia del diseño y de la sensibilización del espacio grupal; los vectores macropolíticos y institucionales en los procesos grupales; los efectos de la sub-apropiación de la lengua formal sobre la dinámica grupal y la circulación social; la importancia de producir lugar para lo que no tiene lugar; y, el mapeo de expresiones con capas de sentido. Finalmente, se señala el grupo como un fuerte dispositivo para la producción de nuevas formas de vida.(AU)

Management of hypopituitarism: a perspective from the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Hypopituitarism is a disorder characterized by insufficient secretion of one or more pituitary hormones. New etiologies of hypopituitarism have been recently described, including head trauma, cerebral hemorrhage, and drug-induced hypophysitis. The investigation of patients with these new disorders, in addition to advances in diagnosis and treatment of hypopituitarism, has increased the prevalence of this condition. Pituitary hormone deficiencies can induce significant clinical changes with consequent increased morbidity and mortality rates, while hormone replacement based on current guidelines protects these patients. In this review, we will first discuss the different etiologies of hypopituitarism and then address one by one the clinical aspects, diagnostic evaluation, and therapeutic options for deficiencies of TSH, ACTH, gonadotropin, and GH. Finally, we will detail the hormonal interactions that occur during replacement of pituitary hormones.

Perfil clínico, histopatológico e tricoscópico da alopecia frontal fibrosante: estudo retrospectivo de casos de um serviço de referência de dermatologia / Clinical, histopathological and trichoscopic of frontal alopecia fibrosing: retrospective study of cases of a service of dermatology reference

Contexto: Alopecia frontal fibrosante (AFF) é uma alopecia cicatricial que acomete a região frontotemporal, e predomina em mulheres pós-menopausadas. Objetivo: Descrever o perfil clínico, histopatológico e tricoscópico de pacientes com diagnóstico de AFF. Desenho e local: Estudo de coorte retrospectivo observacional que foi desenvolvido no ambulatório de tricologia do departamento de dermatologia do Hospital Santa Casa de Misericórdia de Vitória, Vitória (ES), Brasil. Métodos: O estudo foi realizado por meio da análise de prontuários e de revisão histopatológica de pacientes com diagnóstico de AFF atendidos entre 1 de março de 2019 a 29 de fevereiro de 2020. Resultados: No período, 17 pacientes do sexo feminino foram diagnosticadas com AFF, 76,5% delas na pós-menopausa. Todas apresentavam alopecia frontotemporal e madarose. À tricoscopia, ausência de pelos velus, aberturas foliculares reduzidas, hiperceratose folicular e eritema perifolicular foram encontrados na maioria dos casos. Todas as biópsias mostraram aspectos microscópicos compatíveis com AFF. O tratamento mais utilizado foi tacrolimo 0,1%. Discussão: A patogênese da AFF ainda não é compreendida. A associação com doenças autoimunes sugere a influência da imunidade no quadro. A tricoscopia é uma ferramenta de fácil acesso e não invasiva que pode auxiliar no diagnóstico. Histopatologicamente a AFF é indistinguível do líquen plano pilar. O tratamento objetiva reduzir a inflamação e retardar a progressão da doença. Conclusões: Embora apresentações clínicas e tricoscópicas tenham sido descritas ao longo dos anos, a patogênese, a histologia e os tratamentos eficazes para AFF ainda são debatidos. O reconhecimento e o tratamento precoce da doença permitiriam a redução da progressão da doença.

Psicologia nos cras: uma análise do dissenso e dos processos de coletivização / Psicología en los cras: un análisis de los procesos de disensión y colectivización / Psychology in brazil's social assistence reference centers (cras): an analisis of dissense and collectivization processes

Resumo O presente trabalho busca analisar os modos como se organizam os Centros de Referência em Assistência Social (CRAS), a partir de experiências coletivas e práticas comunitárias realizadas pelas equipes-território, destacando os processos de dissensos e consensos nas relações de trabalho. Metodologicamente, com base na análise de discurso, foram realizadas coletivamente 14 entrevistas semiestruturadas com cada equipe dos CRAS de dois estados da macrorregião sul do Brasil. Os resultados apontam que trabalhar as divergências internas sem tentar homogeneizá-las, compondo práticas transdisciplinares e horizontalizantes, se mostrou um modo potente de organização das equipes de trabalho. Ademais, foi relatado também a potência na produção dos fazeres de territorialização, com e a partir do território, por meio de seus significantes e possibilidades singulares. Finalmente, apontam-se as práticas comunitárias com grupos e coletivos nos CRAS como um dos vetores potentes no enfrentamento ao sofrimento ético-político produzido pelas desigualdades sociais.

Resumen El presente trabajo busca analizar las formas en que se organizan los Centros de Referencia de Asistencia Social (CRAS), a partir de experiencias colectivas y prácticas comunitarias realizadas por los equipos del territorio, destacando los procesos de desacuerdos y consensos en las relaciones laborales. Metodológicamente, con base en el análisis del discurso, se realizaron colectivamente 14 entrevistas semiestructuradas con cada equipo de los CRAS de dos estados del macrorregión sur del Brasil. Los resultados muestran que trabajar las diferencias internas sin tratar de homogeneizarlas, componiendo prácticas transdisciplinarias y horizontales, resultó ser una forma poderosa de organizar equipos de trabajo. Además, también se informó del poder en la producción de actividades de territorialización, con y desde el territorio, a través de sus significantes y posibilidades singulares. Finalmente, las prácticas comunitarias con grupos y colectivos en los CRAS se señalan como uno de los vectores poderosos para enfrentar el sufrimiento ético-político que producen las desigualdades sociales.

Abstract This paper analyzes the ways through which the Social Assistance Reference Centers (CRAS) is organized, based on collective experiences and community practices carried out by the territory-teams, highlighting the processes of dissent and consensus in working relations. Methodologically, based on discourse analysis, 14 semi-structured interviews were conducted collectively with each CRAS team from two states of the Brazilian southern region. The results indicate that working internal differences without trying to homogenize them, composing transdisciplinary and horizontal practices, proved to be a powerful way of organizing the work teams. Besides, the power in the production of territorialization actions, with and from the territory, was also reported through its significant and singular possibilities. Finally, the community practices with groups and collectives in CRAS are pointed as one of the potent vectors in facing the ethical-political suffering produced by social inequalities.

Percepção de pessoas com hipertensão arterial sobre aspectos que influenciam a adesão ao tratamento' / Percepción de las personas con hipertensión arterial sobre aspectos que influyen en la adherencia al tratamento / Perception of people with arterial hypertension about aspects that influence treatment adherence

Objetivo: descrever a percepção de pessoas com hipertensão arterial sobre aspectos que facilitam e dificultam a adesão ao tratamento. Método: estudo qualitativo descritivo desenvolvido com 16 pessoas atendidas em consultas de enfermagem. Realizaram-se entrevistas com roteiro semiestruturado e utilizou-se a técnica de análise de conteúdo. Os dados foram coletados entre os meses de janeiro e agosto de 2017. Resultados: observou-se que ter força de vontade, apoio familiar e multiprofissional, conhecimento sobre a patologia e formas de prevenção e medo da morte facilitou a adesão; por outro lado, pouco conhecimento, preguiça, falta de infraestrutura urbana e condições climáticas, hábito de consumir alimentos não saudáveis, bebidas alcoólicas e tabaco, custo do tratamento e esquecimento de tomar a medicação dificultaram a adesão. Conclusão: o tratamento da hipertensão acarreta mudanças na dinâmica da vida para as quais é fundamental ter força de vontade, apoio familiar e profissional, além de superar hábitos não saudáveis.

Objective: to describe the perception of people with arterial hypertension of the aspects that facilitate and hinder treatment adherence. Method: descriptive qualitative study developed with 16 people met in Nursing consultations. Interviews were conducted with a semi-structured guide and the content analysis technique was used. Data were collected between January and August 2017. Results: having willpower, family and multidisciplinary support, knowledge about the pathology and forms of prevention and fear of death facilitated adherence; on the other hand, little knowledge, laziness, lack of urban infrastructure and climatic conditions, habit of consuming unhealthy foods, alcoholic beverages and tobacco, cost of treatment and forgetfulness of taking the medication hindered adherence. Conclusion: the treatment of hypertension causes changes in the dynamics of life, being essential to have willpower, family and professional support, in addition to overcoming unhealthy habits.

Objetivo: describir la percepción de las personas con hipertensión arterial sobre los aspectos que facilitan y dificultan la adherencia al tratamiento. Método: estudio cualitativo descriptivo desarrollado con 16 personas atendidas en consultas de enfermería. Se realizaron entrevistas con un guion semiestructurado y se utilizó la técnica de análisis de contenido. Los datos se recopilaron entre enero y agosto de 2017. Resultados: se observó que tener fuerza de voluntad, apoyo familiar y multidisciplinario, conocimiento sobre la patología y las formas de prevención y miedo a la muerte facilitaba la adherencia; por otro lado, poco conocimiento, pereza, falta de infraestructura urbana y condiciones climáticas, hábito de consumir alimentos no saludables, bebidas alcohólicas y tabaco, costo de tratamiento y olvido de tomar el medicamento obstaculizaba la adherencia. Conclusión: el tratamiento de la hipertensión provoca cambios en la dinámica de la vida para los que es esencial contar con fuerza de voluntad, apoyo familiar y profesional, además de superar hábitos poco saludables.

Bioavailability of heavy metals in mangrove soil in Alagoas, Brazil / Biodisponibilidade de metais pesados em solo de mangue em Alagoas, Brasil

The mangrove forest is an important transitional ecosystem consisted of terrestrial and marine environment located in tropical and subtropical regions with average temperatures above 20 °C. In Alagoas, the mangrove forests are found on the entire coastline from Maragogi to Piaçabuçu. In the last 20 years, due to the pollution of water resources, studies of coastal aquatic ecosystems have been developed. The objective of this study was to analyze the physicochemical properties and determine the levels of heavy metals in mangrove sediments of the Mundaú-Manguaba estuary lagoon complex (MMELC) and Meirim River in Alagoas. Zinc, copper, lead, cadmium and chromium were chosen due to their relationship with sewer, agricultural, and industrial wastes. 22 soil samples were collected in the MMELC and in the Meirim River. The samples were submitted to soil routine analyses of Embrapa. The heavy metals were extracted by the Mehlich-1 method and analyzed by atomic absorption spectrometry. The mean concentrations of these metals in thesediment samples followed the order Mn > Zn >Pb > Cr> Cu >Cd in MMELC and Zn > Mn >Pb > Cr> Cu >Cd in Meirim River. All proposed heavy metals were found in sediments, however, the cadmium levels were above the normal levels proposed by Environment National Council (CONAMA) and Canadian Council of Ministers of the Environment. The study shows that the analysis of sediment can contribute to environmental monitoring actions and development of public policies aimed to controlling the sustainable use of natural resources of the studied areas.

O manguezal é um importante ecossistema de transição entre o ambiente marinho e terrestre, localizado em regiões tropicais e subtropicais com temperaturas médias acima de 20°C. Em Alagoas podemos encontrar florestas de mangue em praticamente todo o litoral desde Maragogi até Piaçabuçu. Nosúltimos 20 anos, a poluição dos recursos hídricos tem levado ao estudo dos ecossistemas aquáticos costeiros, que são importantes para preservação e equilíbrio da vida. O objetivo deste trabalho foi analisar as propriedades físico-químicas e determinar os teores ambientalmente disponíveis de metais nos sedimentos do mangue existente na foz CELMM (e do rio Meirim em Alagoas. Foram escolhidos os metais zinco, cobre, chumbo, cádmio e crômio por estarem ligados aos despejos de esgotos, projetos agropecuários, e fontes industriais. Foram coletadas 22 amostras de solo nos estuários do CELMM e do rio Meirim. As amostras foram submetidas as análises de rotina para solos da Embrapa. As concentrações médias desses metais nas amostras de sedimento seguiram a ordem Mn > Zn >Pb > Cr> Cu >Cd in CELMM e Zn > Mn >Pb > Cr> Cu >Cd no Rio Meirim. Os metais foram extraídos pelo método Mehlich-1 e analisados por meio de espectrometria de absorção atômica. Foram encontrados nos sedimentos todos os metais propostos na pesquisa com destaque para os teores de cádmio detectados em valores absolutos acima de valores considerados normais pelo Conselho Nacional doMeio Ambiente e pelo Canadian Council of Ministers of the Environment em alguns pontos do estuário do rio Meirim. O estudo mostra que a análise dos sedimentos pode, portanto, contribuir para ações de monitoramento ambiental, subsidiando a implantação e desenvolvimento de políticas públicas que visem controlar o usoracional e sustentável dos recursos naturais das áreas do estudas.

Biomonitoring of Heavy Metals (Fe, Zn, Cu, Mn, Cd and Cr) in Oysters: Crassostrea rhizophorae of Mangrove Areas of Alagoas (Brazil)

Abstract Mangroves are tropical and subtropical flooded forests that generally develop in estuarine areas over unstable sediments protected from the action of waves in the intertidal zone with an environment characterized by a great diversity of fauna and flora. Thus, the present study aimed to evaluate the levels of heavy metals that are absorbed by mangrove oysters, in estuarine systems in the Alagoas coast by determining the concentrations of Fe, Cu, Mn, Zn, Cd and Cr. Two areas, which consisted of both a collection during the rainy season and the dry season, were selected for sampling of mangrove oysters. In each collection, seven samples were collected, at seven different points, where each sample contained four oysters. In the laboratory the oysters were dried at 105°C for 72 hours and then macerated. It was then digested with 10 ml of a solution comprising a combination of 4:1 nitric acid and hydrochloric acid, initially in 1h at 40°C, followed by 3 hours at 140°C. In General, the medians followed the order Zn > Fe > Mn > Cu > Cr > Cd in MMELC and Zn > Cu > Fe > Mn > Cr > Cd in Meirim River. It is concluded that the Crassostrea rhizophorae oysters from the studied environments presented concentrations of all the metals proposed in the research and demonstrates its accumulating and bioindicator character.

Thalidomide in plasma cell balanitis refractory to conventional topical treatment

Abstract: Zoon's plasma cell balanitis is a chronic genital inflammatory dermatosis that affects uncircumcised men, especially the elderly. It's characterized by painless erythematous plaques of orange hue, located on the glans penis and foreskin. Circumcision is the most effective treatment; however, it can be hard for patients to accept. As an alternative, topical calcineurin inhibitors are used, with good response. This article reports the case of a 32-year-old patient, HIV carrier, diagnosed with Zoon's plasma cell balanitis. Treatment with topical tacrolimus was administered, without improvement. A 6-week course of thalidomide resulted in complete remission of the lesions, without recurrence after eight months of follow-up.

Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.

A review of Cushing's disease treatment by the Department of Neuroendocrinology of the Brazilian Society of Endocrinology and Metabolism

ABSTRACT The treatment objectives for a patient with Cushing's disease (CD) are remission of hypercortisolism, adequate management of co-morbidities, restoration of the hypothalamic-pituitary-adrenal axis, preservation of fertility and pituitary function, and improvement of visual defects in cases of macroadenomas with suprasellar extension. Transsphenoidal pituitary surgery is the main treatment option for the majority of cases, even in macroadenomas with low probability of remission. In cases of surgical failure, another subsequent pituitary surgery might be indicated in cases with persistent tumor imaging at post surgical magnetic resonance imaging (MRI) and/or pathology analysis of adrenocorticotropic hormone-positive (ACTH+) positive pituitary adenoma in the first procedure. Medical treatment, radiotherapy and adrenalectomy are the other options when transsphenoidal pituitary surgery fails. There are several options of medical treatment, although cabergoline and ketoconazole are the most commonly used alone or in combination. Novel treatments are also addressed in this review. Different therapeutic approaches are frequently needed on an individual basis, both before and, particularly, after surgery, and they should be individualized. The objective of the present review is to provide the necessary information to achieve a more effective treatment for CD. It is recommended that patients with CD be followed at tertiary care centers with experience in treating this condition.

Bicytopenia and leukoerythroblastosis: a rare initial presentation of signet ring cell gastric adenocarcinoma

Gastric adenocarcinoma is a common neoplasia and is responsible for up to 30% of the overall deaths due to cancer. Advanced disease is mostly characterized by peritoneum, liver, and lung involvement. The spread of the disease to the bone is rare, and bone marrow dissemination is even rarer. In this setting, leukoerythroblastosis may be the initial manifestation of the disease. The authors report the case of a 64-year-old Caucasian man who sought medical care complaining of back pain, weakness, and weight loss. The physical examination revealed pallor, and the laboratory work-up depicted severe anemia and thrombocytopenia; the peripheral blood smear was consistent with leukoerythroblastosis. The ongoing investigation through a bone marrow biopsy showed massive involvement of the bone marrow by a signet ring cell adenocarcinoma. During hospitalization, the patient presented melena, and an upper digestive endoscopy depicted an ulcerated and infiltrative lesion in the cardia, upon which the histological examination revealed a signet ring cell adenocarcinoma. This case highlights the bone marrow invasion represented by bicytopenia and leukoerythroblastosis as the initial manifestation of this histological type of gastric cancer. Although treatment attempts were made with chemotherapy and radiotherapy, the patient died early on, showing the aggressive behavior of this form of tumoral presentation.

Histiocitose de células de Langerhans: relato de um caso / Langerhans cell histiocytosis: case report

A histiocitose de células de Langerhans corresponde a um grupo heterogêneo de desordens caracterizadas pela proliferação monoclonal de células dendríticas. Predomina na infância e pode afetar qualquer órgão. Relata-se caso de paciente, sexo feminino, 44 anos, apresentando placas espessas, exsudativas, com escamas aderentes aos pelos, localizadas no couro cabeludo, semelhantes a dermatite seborreica, além de fístulas nas axilas, regiões inframamárias e inguinais de evolução há 16 anos. Realizou-se biópsia da lesão cutânea seguida de imunohistoquímica que concluiu diagnóstico de Histiocitose de células de Langerhans. Investigação sistêmica evidenciou acometimento pulmonar concomitante. Até o presente momento existem poucas publicações sobre envolvimento cutâneo em adultos, assim como não há protocolos de tratamento para os mesmos, necessitando maiores estudos para melhor manejo desses pacientes.

Langerhans cell histiocytosis corresponds a heterogeneous group of disorders characterized by monoclonal dendritic cells proliferation, it predominates in childhood which may affect any organ of the body. The case reports of a female patient, aged 44, presenting thick plates with scales adhering to the hairs, scalp located, similar to seborrheic dermatitis, besides fistulas in axillas, inguinal and infra mammary regions. The hypothesis of Langerhans cell histiocytosis was confirmed by cutaneous biopsy and immunohistochemistry. Systemical investigation accused pulmonary involvement. Until now are few publications about adult cutaneous cases, so none treatment protocols are avaible for them. More specific studies are demanded for better management of these patients.

A review on the diagnosis and treatment of patients with clinically nonfunctioning pituitary adenoma by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Clinically nonfunctioning pituitary adenomas (NFPA) are the most common pituitary tumors after prolactinomas. The absence of clinical symptoms of hormonal hypersecretion can contribute to the late diagnosis of the disease. Thus, the majority of patients seek medical attention for signs and symptoms resulting from mass effect, such as neuro-ophthalmologic symptoms and hypopituitarism. Other presentations include pituitary apoplexy or an incidental finding on imaging studies. Mass effect and hypopituitarism impose high morbidity and mortality. However, early diagnosis and effective treatment minimizes morbidity and mortality. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism is to provide a review of the diagnosis and treatment of patients with NFPA, emphasizing that the treatment should be performed in reference centers. This review is based on data published in the literature and the authors’ experience. Arch Endocrinol Metab. 2016;60(4):374-90.

O profissional de educação física e a promoção da saúde em núcleos de apoio à saúde da família / The physical education professional and the promotion of health at family health support centers / El profesional de educación física y la promoción de salud en núcleos de apoyo a la salud de la familia

Resumo Os núcleos de apoio à saúde da família configuram-se hoje como um lócus de inserção do profissional de educação física na atenção primária à saúde. Esse fato trouxe novos desafios à atuação desse profissional, como a realização de ações de promoção da saúde nos âmbitos individual e coletivo. O objetivo deste artigo foi analisar as ações realizadas por tal profissional nesses núcleos no estado de Minas Gerais, em 2015. Tratou-se de pesquisa qualitativa e exploratória, que utilizou a pesquisa documental e grupos focais com 15 participantes como instrumentos de coleta de dados. Os resultados demonstraram diferentes e complementares concepções acerca do conceito de promoção da saúde e a realização de ações de promoção abrangentes, diversificadas e em conjunto com a equipe e a comunidade. Fatores como a reorientação do modelo de saúde, a participação da comunidade, a valorização do trabalho multiprofissional e intersetorial e o incentivo governamental para as práticas de atividades físicas foram apontados como facilitadores para a realização dessas ações. Entre as dificuldades, destacaram-se a falta de infraestrutura e de capacitação e a concepção dos demais profissionais, ainda voltada para as ações clínicas individuais, em detrimento de ações coletivas de promoção da saúde.

Abstract Today, the family health support centers are a locus for the insertion of the physical education professional in primary health care. This fact has introduced new challenges to the work of this professional, such as the undertaking of health promotion activities at the individual and collective levels. This study aimed to analyze the actions taken by such a professional at these centers in the state of Minas Gerais, Brazil, in 2015 with 15 participants. This was a qualitative, exploratory study, which used the documentary research and focus groups as data collection instruments. The results showed different and complementary conceptions about the health promotion concept and the undertaking of comprehensive and diversified promotion actions together with the team and the community. Factors such as the reorientation of the model of health, community participation, the appreciation of multidisciplinary and intersectoral work, and government incentives for physical activity practices were identified as facilitators to carry out these actions. The greatest perceived difficulties included the lack of infrastructure and training and the conception of other professionals, still focused on individual clinical actions to the detriment of collective actions to promote health.

Resumen Los núcleos de apoyo a la salud de la familia se configuran hoy como un locus de inserción del profesional de educación física en la atención primaria a la salud. Este hecho trajo nuevos desafíos a la actuación de este profesional, como la realización de acciones de promoción de salud en ámbitos individuales y colectivos. El objetivo del artículo es analizar las acciones realizadas por dicho profesional, en esos núcleos, en el estado de Minas Gerais, Brasil, en 2015. Se trata de una investigación cualitativa y exploratoria, que utilizó la búsqueda documental y grupos focales con 15 participantes como instrumentos de recolección de datos. Los resultados demostraron concepciones distintas y complementarias acerca del concepto de promoción de la salud y la realización de acciones de promoción abarcativas, diversificadas y en conjunto con el equipo y la comunidad. La reorientación del modelo de salud, la participación de la comunidad, la valoración del trabajo multiprofesional e intersectorial y el incentivo gubernamental para la práctica de actividades físicas fueron señalados como elementos que facilitan la realización de estas acciones. Entre las dificultades, se destacaron la falta de infraestructura y de capacitación, así como la concepción de los demás profesionales, aún dirigidas hacia acciones clínicas individuales, en detrimento de acciones colectivas de promociones de salud.

Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing's disease in Brazil

ABSTRACT Although it is a rare condition, the accurate diagnosis and treatment of Cushing’s disease is important due to its higher morbidity and mortality compared to the general population, which is attributed to cardiovascular diseases, diabetes mellitus and infections. Screening for hypercortisolism is recommended for patients who present multiple and progressive clinical signs and symptoms, especially those who are considered to be more specific to Cushing’s syndrome, abnormal findings relative to age (e.g., spinal osteoporosis and high blood pressure in young patients), weight gain associated with reduced growth rate in the pediatric population and for those with adrenal incidentalomas. Routine screening is not recommended for other groups of patients, such as those with obesity or diabetes mellitus. Magnetic resonance imaging (MRI) of the pituitary, the corticotropin-releasing hormone (CRH) test and the high-dose dexamethasone suppression test are the main tests for the differential diagnosis of ACTH-dependent Cushing’s syndrome. Bilateral and simultaneous petrosal sinus sampling is the gold standard method and is performed when the triad of initial tests is inconclusive, doubtful or conflicting. The aim of this article is to provide information on the early detection and establishment of a proper diagnosis of Cushing’s disease, recommending follow-up of these patients at experienced referral centers. Arch Endocrinol Metab. 2016;60(3):267-86.

Acute Coronary Syndrome Treatment Costs from the Perspective of the Supplementary Health System / Custos de Tratamento da Síndrome Coronariana Aguda sob a Perspectiva do Sistema de Saúde Suplementar

AbstractBackground:Acute coronary syndrome (ACS) is defined as a “group of clinical symptoms compatible with acute myocardial ischemia”, representing the leading cause of death worldwide, with a high clinical and financial impact. In this sense, the development of economic studies assessing the costs related to the treatment of ACS should be considered.Objective:To evaluate costs and length of hospital stay between groups of patients treated for ACS undergoing angioplasty with or without stent implantation (stent+ / stent-), coronary artery bypass surgery (CABG) and treated only clinically (Clinical) from the perspective of the Brazilian Supplementary Health System (SHS).Methods:A retrospective analysis of medical claims of beneficiaries of health plans was performed considering hospitalization costs and length of hospital stay for management of patients undergoing different types of treatment for ACS, between Jan/2010 and Jun/2012.Results:The average costs per patient were R$ 18,261.77, R$ 30,611.07, R$ 37,454.94 and R$ 40,883.37 in the following groups: Clinical, stent-, stent+ and CABG, respectively. The average costs per day of hospitalization were R$ 1,987.03, R$ 4,024.72, R$ 6,033.40 and R$ 2,663.82, respectively. The average results for length of stay were 9.19 days, 7.61 days, 6.19 days and 15.20 days in these same groups. The differences were significant between all groups except Clinical and stent- and between stent + and CABG groups for cost analysis.Conclusion:Hospitalization costs of SCA are high in the Brazilian SHS, being significantly higher when interventional procedures are required.

Fundamento:Síndrome coronariana aguda (SCA) é definida como um “grupo de sintomas clínicos compatíveis com isquemia miocárdica aguda”, representando a principal causa de óbito no mundo, com elevado impacto clínico e financeiro. Nesse sentido, o desenvolvimento de estudos econômicos que avaliem os custos despendidos no tratamento da SCA deve ser considerado.Objetivo:Avaliar custos e tempo de internação hospitalar entre grupos de pacientes que trataram SCA, submetidos a procedimentos de angioplastia com ou sem implante de stent (stent+ / stent-), revascularização (Revasc) e tratados apenas clinicamente (Clínico), sob a perspectiva do sistema de saúde suplementar (SSS) brasileiro.Métodos:Realizou-se uma análise retrospectiva de contas médicas de beneficiários de planos de saúde considerando dados de custos de internação e tempo de permanência hospitalar para o manejo de pacientes submetidos a diferentes tipos de tratamento para SCA, no período entre 1/2010 e 6/2012.Resultados:Os custos médios por paciente foram de R$ 18.261,77, R$ 30.611,07, R$ 37.454,94 e R$ 40.883,37 nos grupos Clínico, stent-, stent+ e Revasc, respectivamente. Os custos médios por dia de internação foram de R$ 1.987,03, R$ 4.024,72, R$ 6.033,40 e R$ 2.663,82, respectivamente. Os tempos médios de internação foram de 9,19 dias, 7,61 dias, 6,19 dias e 15,20 dias nesses mesmos grupos. As diferenças foram estatisticamente significativas entre todos os grupos, exceto Clínico e stent- e entre os grupos stent + e Revasc, para a análise de custos.Conclusão:O custo hospitalar da SCA é elevado no SSS brasileiro e significativamente mais alto quando há a necessidade da realização de procedimentos intervencionistas.

Pituitary deficiency after aneurysmal subarachnoid hemorrhage

OBJECTIVE: Aneurysmal subarachnoid hemorrhage puts patients at high risk for the development of pituitary insufficiency. We evaluated the incidence of pituitary dysfunction in these patients and its correlation with clinical outcome. METHODS: Pituitary function was tested in 66 consecutive patients in the first 15 days after aneurysmal subarachnoid hemorrhage. The following were measured in all patients: thyroid-stimulating hormone, free thyroxine, triiodothyronine, luteinizing hormone, follicle-stimulating hormone, total testosterone (in males), estradiol (in females), prolactin, serum cortisol, plasma adrenocorticotropic hormone, growth hormone and insulin growth factor. RESULTS: The endocrine assessment was made at a mean of 7.4 days (standard deviation ±6.6) after subarachnoid hemorrhage. Forty-four (66.7%) female and 22 (33.3%) male patients were evaluated. Thirty-nine patients (59.1%) had some type of pituitary dysfunction. Follicle-stimulating hormone/luteinizing hormone deficiency was the most frequent disorder (34.8%), followed by growth hormone/insulin growth factor (28.7%), adrenocorticotropic hormone (18.1%) and thyroid-stimulating hormone (9%). Seventeen (25.7%) patients showed deficiencies in more than one axis. A greater incidence of hormone deficiency was observed in patients with a Glasgow Coma Scale score ≤13 (t test, p = 0.008), Hunt-Hess grade ≥4 (t test, p<0.001), or Fisher grade 4 (t test, p = 0.039). Hormone deficiency was not significantly associated (p>0.05) with increased hospitalization or clinical outcome. CONCLUSION: Pituitary dysfunction was identified in a substantial portion of patients with previous aneurysmal subarachnoid hemorrhage, but no association was found between this dysfunction and poor clinical outcome. .