Osteoporosis in primary care: an opportunity to approach risk factors / Osteoporose na atenção primária: uma oportunidade para abordar os fatores de risco

ABSTRACT Introduction: Climacteric women are susceptible to a number of changes, among them osteoporosis. Osteoporosis is a disease characterized by low bone mass and susceptibility to fracture. Currently, this disease is a public health issue, being necessary to recognize its risk factors. Objectives: Identify risk factors related to osteoporosis in women attending Propis/Proex/UFMA, tracing a socio-demographic characterization and considering community lifestyles. Material and methods: This is a transversal retrospective clinical with a quantitative approach study conducted between March and June 2013 in São Luís (MA) with 107 women treated at the Programa de Práticas de Integralidade em Saúde (Propis - Integrality Health Practice Program). The study was approved by the University Hospital Ethics Committee of UFMA under opinion no. 362/07. Data were tabulated and analyzed in the epidemiological Epi-Info® software, version 3.4.1. Results: The brown color was predominant, consensual relationships proved to be a protective factor and low education was a risk factor. The average age of the group with menopause was 54.1 years and without menopause was 31.3 years (p < 0.0001). The average age of menopause was 43.7 years. The irregular menstrual cycle was a protective factor. The average number of pregnancies was 4.56 for the group with menopause and 2.45 for the group without menopause, with most births occurring normally (p < 0.0001). Smoking, physical inactivity and caffeine intake were risk factors, while the absence of alcoholism and of soda intake were protective factors for the disease. Conclusion: The patients followed the socioeconomic and demographic profile of Maranhão. Most had menarche and menopause in appropriate periods, showed no positive family history of osteoporosis, did not usually drink alcohol, were sedentary and the caffeine intake was high.

RESUMO Introdução: As mulheres no climatério estão suscetíveis a uma série de mudanças, entre elas a osteoporose. A osteoporose é uma doença caracterizada por uma baixa massa óssea e susceptibilidade à fratura. Atualmente, essa doença é um problema de saúde pública e é necessário reconhecer seus fatores de risco. Objetivos: Identificar os fatores de risco relacionados com a osteoporose em mulheres atendidas pelo Programa de Práticas de Integralidade em Saúde (Propis)/Proex/UFMA, traçar uma caracterização sociodemográfica e considerar o estilo de vida da comunidade. Material e métodos: Trata-se de um estudo transversal retrospectivo clínico com uma abordagem quantitativa, feito entre março e junho de 2013, em São Luís (MA), com 107 mulheres atendidas pelo Programa de Práticas de Integralidade em Saúde (Propis). O estudo foi aprovado pelo Comitê de Ética do Hospital Universitário da UFMA, sob parecer nº 362/07. Os dados foram tabulados e analisados com o software epidemiológico Epi-Info®, versão 3.4.1. Resultados: A etnia parda foi predominante, a união estável mostrou ser um fator protetor e a baixa escolaridade foi um fator de risco. A idade média do grupo com menopausa foi de 54,1 anos e a do sem menopausa de 31,3 anos (p < 0,0001). A idade média da menopausa foi de 43,7 anos. O ciclo menstrual irregular foi um fator protetor. O número médio de gestações foi de 4,56 para o grupo com menopausa e 2,45 para o grupo sem menopausa, com a maior parte dos partos normal (p < 0,0001). O tabagismo, a inatividade física e o consumo de cafeína foram fatores de risco, enquanto a ausência de alcoolismo e de ingestão de refrigerante foram fatores de proteção para a doença. Conclusão: Os pacientes seguiram o perfil socioeconômico e demográfico do Maranhão. A maior parte teve a menarca e a menopausa em períodos apropriados, não apresentava antecedentes familiares de osteoporose, não costumava ingerir bebida alcoólica, era sedentária e consumia uma elevada quantidade de cafeína.

Avaliação da resposta IgE para o entendimento do papel de fungos do ar na alergia respiratória em crianças / Evaluation of IgE responses for a better understanding of the role of airborne fungi in respiratory allergy in children

Este estudo realizou-se na cidade de São Luis, Maranhão, com a finalidade de investigar possível relação entre alergia respiratória e elevação sérica de IgE total e IgE específica para fungos isolados de ambientes externos. Métodos: Fizeram parte deste estudo 98 crianças com diagnóstico clínico de asma e/ou rinite alérgica, com idades entre 4 e 12 anos, sendo 65(66,3%) do sexo masculino e 33 (33,7%) do sexo feminino. Quantificaram-se no soro dessas crianças os níveis de IgE total e IgE específica para Aspergillus spp e Penicillium spp, pelo método de ELISA. Resultados: IgE total foi detectada em 95 crianças (96,9%); 73 (74,5%) apresentaram níveis detectáveis de IgE anti-Aspergillus spp e 85 (86,7%) de IgE anti-Penicillium spp. Não houve significância estatística quando foram correlacionados níveis de IgE total, sexo e área de residência das crianças estudadas (p = 0,88). Na correlação entre IgE total e faixa etária verificou-se distribuição não normal dos dados, com destaque à faixa etária de 11 anos, onde os níveis deIgE total foram mais elevados (Teste de Shapiro p < 0,05). Não houve correlação entre IgE anti-Aspergilluse IgE anti-Penicillium com idade, sexo e área de residência. Conclusão: Anticorpos IgE contra os fungos estudados possivelmente fazem parte de uma polissensibilização, já que os fungos estão presentes em todas as áreas e durante todo o ano na cidade de São Luis, Maranhão, Brasil. Serão necessários mais estudos para o entendimento da alergia respiratória por fungos do ar em São Luis, Maranhão...

The present study was carried out in the city of São Luís, capital of the state of Maranhão, northeastern Brazil, with the aim of investigating a possible relationship between respiratory allergies and high serum levels of total IgE and specific IgE for fungi isolated in outdoor environments. Methods: The study included 98 children with a clinical diagnosis of asthma and/or allergic rhinitis, aged 4 to 12 years. Sixty-five (66.3%) were male and 33 (33.7%) female. Total IgE, Aspergillus spp-specific IgE, and Penicillium spp-specific IgE were quantified in the serum of the children using the ELISA method. Results: Total IgE was detected in 95 children (96.9%). Seventy-three (74.5%) showed detectable levels of Aspergillus spp-specific IgE, and 85 (86.7%), of Penicillium spp-specific IgE. There was no significant correlation between total IgE levels, sex, and area of residence among the children assessed (p = 0.88). When assessing the correlation between total IgE levels and age, data were found to have a non-normal distribution, especially in the 11-year old age group, where total IgE levels were higher than in the other ages (Shapiro test, p < 0.05). There was no significant correlation of Aspergillus spp- and Penicillium spp-specific IgE with age, gender, and area of residence. Conclusion: IgE antibodies against the fungi investigated are possibly a part of polysensitization, as these fungi are present in all areas and throughout the year in the city investigated. Further studies are necessary for a better understanding of the role played by fungal sensitization in respiratory allergy in São Luís, Maranhão...

Diversity and dynamics of airborne fungi in Sao Luis, State of Maranhao, Brazil

Introduction: This study aimed to identify airborne fungi in São Luis, Maranhão, Brazil, to determine the prevalent genera and to correlate these genera with the area and season. Methods: In total, 1,510 colony-forming units (CFUs) of airborne fungi were isolated from the north, south, east and west sides and from the center of the city from January to December 2007. The samples were collected on Petri dishes that were exposed to the fungi by the gravitational method. Results: Twenty genera of fungi were isolated; the most common were Aspergillus (33.5%), Penicillium (18.8%), Cladosporium (14.2%), Curvularia (10.6%) and Fusarium (7.6%). The CFUs of the fungi were statistically significant (p < 0.0001). Fungal biological diversity was present all year, without any large seasonal variations but with slight increases in May, August and September. Conclusions: The fungal genera identified in this study were correlated with natural systems and could be useful when evaluating the impact of environmental changes on the region. .

Eco-epidemiologic study of emerging fungi related to the work of babacu coconut breakers in the State of Maranhao, Brazil

Introduction: There are more than 300,000 extractors using the babaçu coconut as a source of income in the States of Maranhão, Pará, Tocantins and Piauí, and this activity is associated with fungal infections. The objective of this study was to examine the occurrence of emergent fungi in the conjunctiva, nails and surface and subcutaneous injuries of female coconut breakers in Esperantinópolis, Maranhão. Additionally, soil samples and palm structures were collected. Methods: The obtained samples were cultured in Petri dishes containing potato-dextrose-agar and chloramphenicol. The etiological agent was confirmed by a direct mycological exam and growth in culture. Results: In total, 150 domiciles were visited, and samples were collected from 80 patients. From the ground, the most frequently isolated fungus was Aspergillus niger (53. 8%). the most frequently detected fungus in babaçu coconut was Aspergillus niger (66.7%). Conjunctival fungal growth occurred in 76.3% of the women. The ocular fungal microbiota consisted of filamentous fungi (80.6%), and yeasts were present in 19.4% of cases. Onychomycosis was diagnosed in 44% (11/25) of the women. Conclusions: The identification of the genera Neosartorya, Rhizopus and Curvularia in onychomycoses shows that emergent filamentous fungi can be isolated. Aspergillus sp., Penicillium sp. and Scedosporium sp. were the predominant genera found in the babaçu coconut. From ocular conjunctiva, Candida spp. were the most prevalent species isolated, and Fusarium sp. was present only in one woman. The nearly permanent exposure of coconut breakers to the external environment and to the soil is most likely the reason for the existence of a mycotic flora and fungal infections, varying according to the individual's practices and occupation. .

Tumor filoide em adolescente: relato de caso em jovem de 13 anos / Phyllodes tumor in adolescent: a case report of a 13-year-old girl

Os tumores filoides são neoplasias fibroepiteliais raras de mama. Em sua forma menos agressiva, comportam-se semelhantemente ao fibroadenoma, diferenciando-se apenas pelo tamanho do tumor e/ou velocidade do crescimento. Relatou-se um caso de uma menor de idade, apresentando ginecomastia bilateral, submetida à mastectomia esquerda e quadrantectomia na mama direita. O diagnóstico anatomopatológico demonstrou proliferação estromal, compatível com tumor filoide, o que comprometeu toda a extensão das peças cirúrgicas, inclusive a pele da região areolar. O diagnóstico de tumor filoide é raro nas mamas de adolescentes. O caso relatado adquire grande importância em função da idade da paciente, da localização e da extensão da lesão.

Phyllodes tumors are rare fibroepithelial breast neoplasms. In a less aggressive form, they behave in a similar fashion to the fibroadenoma, and the only differences can be seen in the tumor size and/or speed of growth. We reported the case of an underage girl, with bilateral gynecomastia, who underwent left mastectomy and right breast quadrantectomy. The histopathological diagnosis showed stromal proliferation, consistent with phyllodes tumor that compromised the entire length of the surgical specimens, including the skin areolar region. Diagnosis of phyllodes tumor is rare in breasts of adolescents. The reported case is of great importance due to the patient?s age, and location and extent of the injury