Astenopia em docentes universitários durante a pandemia da COVID-19 / Asthenopia in college lecturers during the COVID-19 pandemic

RESUMO Objetivo: Avaliar sintomas astenópicos e fatores sociodemográficos, hábitos comportamentais e clínicos nos docentes universitários durante a pandemia da COVID-19. Métodos: Trata-se de estudo transversal que avaliou a ocorrência de astenopia em 104 docentes. Questionários de sintomatologia visual validados foram adaptados para a coleta de dados. Houve comparação dos docentes quanto à ocorrência ou não de sintomas astenópicos, bem como foi aplicada regressão logística binária, para aferir a associação com variáveis independentes (p<0,05). Resultados: Houve maior aparecimento de sintomas astenópicos durante o período pandêmico, em que o tempo de exposição a telas parece ter sido o fator mais determinante. Além disso, os indivíduos com tempo de tela superior a 5 horas diárias, que faziam uso de telas para o lazer e usavam colírio/lubrificantes apresentaram significativamente maior chance de estar no grupo com sintomas astenópicos. Conclusão: Foi identificada associação significativa entre a ocorrência de sintomas astenópicos e o uso de telas durante o período pandêmico, principalmente nos grupos com maior duração do tempo de tela. O estudo chama atenção para a saúde ocular de docentes universitários em ensino remoto, além de suscitar novos estudos para investigação desse quadro em distintos ambientes escolares.

ABSTRACT Objective: To assess asthenopic symptoms and sociodemographic factors, behavioral and clinical aspects in college lecturers during the COVID-19 pandemic. Methods: This is a cross-sectional study evaluating asthenopia in 104 lecturers. Some validated visual symptom questionnaires were adapted for data collection. Lecturers were compared regarding the occurrence or not of asthenopic symptoms, and binary logistic regression was applied to measure the association with independent variables (p<0.05). Results: Asthenopic symptoms occurred more often during the pandemic, when exposure to screens was a determinant factor. The individuals with screen time longer than five hours a day, who used screens for leisure, and who used eye drops/lubricants were significantly more likely to be in the group with asthenopic symptoms. Conclusion: A significant association was identified in occurrence of asthenopic symptoms and screen use during the pandemic period, especially in groups with longer screen time. The study draws attention to the eye health of college lecturers in distance learning, and the need for further research on this situation in different school environments.

Longitudinal Changes in the European League Against Rheumatism Sjögren's Syndrome Patient Reported Index in Real-Life Practice

OBJECTIVE: To investigate longitudinal changes in the European League Against Rheumatism (EULAR) Sjögren's syndrome patient reported index (ESSPRI) and to study the clinical features associated with favorable ESSPRI changes in primary Sjögren's syndrome (pSS). METHODS: At baseline and after a median period of 6.6 years, 41 pSS patients were evaluated using the ESSPRI, EULAR Sjögren's syndrome disease activity index (ESSDAI), short-form 36, xerostomia inventory (XI), and visual analog scale (VAS) scores for symptoms. The favorable subgroup included patients who were stable or showed improved to satisfactory symptom status (ESSPRI<5) and the unfavorable subgroup included those with stable or worsening to an unsatisfactory symptom status (ESSPRI ≥5). RESULTS: Median ESSPRI increased from 4.11 to 5.33 (p<0.05), although XI scores (p=0.01) and oral dryness (p<0.05) were significantly decreased. Serum immunoglobulin G level was significantly reduced (p<0.001) but ESSDAI scores were unchanged. Six (14.6%) patients showed clinical improvement in ESSDAI, and 11 (26.8%) showed improvement in ESSPRI. On comparing the favorable (n=17) and unfavorable (n=24) subgroups, the former exhibited significantly lower VAS scores for sicca and depression and XI and ESSPRI scores at baseline (all p<0.05) and more lacrimal flow (p<0.05). The favorable subgroup received a significantly lower cumulative dose of pilocarpine and glucocorticoids (both p<0.05). CONCLUSION: About 25% of pSS patients showed clinically significant ESSPRI improvement and about 40% showed a favorable ESSPRI course. Because the favorable subgroup had more lacrimal flow and less sicca symptoms at baseline, long-term patient-derived outcomes could depend on residual exocrine function at pSS diagnosis.

The Effects of Formaldehyde Exposure on Self-reported Symptoms of Respiratory-eye Mucosa and Integumentary System during Anatomy Practices among Korean Medical Students / 체질인류학회지

This study aims to determine the effects of formaldehyde exposure on self-reported symptoms of respiratory-eye mucosa and integumentary system during anatomy practices among Korean medical students. Data were collected using the web-based survey. Study subjects in 1st and 2nd grade medical student, and having anatomy dissection in medical college and medical graduate school. A total of 463 students from the 14 medical college and medical graduate school participated in this study. The results show that 261 (56.4%) of the participants responded feeling discomfort above moderate at anatomy dissection. After anatomy dissection, 104 (43.2%) students responded aggravating the symptom allergic rhinitis, xerophthalmia and so on. 209 (95.0%) of them responded the new symptom's appearance. In the result of multiple logistic regression, women (OR: 2.000, 95% CI: 1.169~3.421) and the students with feeling discomfort (OR: 3.190, 95% CI: 1.807~5.632) were more likely to increase the risk of pre-existing respiratory · eye mucosal system symptom's aggravation than the counter parts. For pre-existing integumentary system symptom's aggravation, risk is significantly higher in elder age group (OR: 2.612, 95% CI: 1.187~5.750) and with disapproval protective equipments (OR: 2.217, 1.006~4.885). In case of new symptom's appearance, people with feeling discomfort above moderate (OR: 5.097, 95% CI: 1.075~24.160) in respiratory · eye mucosal system were more likely to increase the risk of new symptom's appearance. And for integumentary system, risk was higher in people with feeling discomfort (OR: 1.921, 95% CI: 1.218~3.031), in woman (OR: 1.711, 1.090~2.686) and without enough protective equipments preparation (OR: 1.953, 1.189~3.210). This study confirms the protective equipments for minimizing exposure from chemicals for cytological fixation (e,g formaldehyde) is not worn enough and students in anatomy dissection experience discomfort and disease after anatomy dissection. Therefore, this study indicates that the safe guideline in anatomy dissection should be enhanced and institutional strategy to protect student's right of health should be provided.

Síndromes em Odontologia - revisão de literatura / Syndromes in Dentistry - literature review

Objetivo: o presente trabalho teve por objetivos descrever as principais síndromes de acometimento bucal primário, relatando seus sinais, sintomas, métodos de diagnóstico e tratamento e ressaltar a importância do cirurgião-dentista no diagnóstico de alterações sistêmicas. Métodos: foi realizada uma pesquisa bibliográfica acerca de cinco síndromes de acometimento bucal primário, para isso, realizou-se uma busca de informações nas bases de dados eletrônicas Scielo, Bireme, Pubmed entre 2000 a 2017. Revisão de Literatura: Entende-se por "síndrome" um conjunto de sinais e sintomas que caracterizam determinada enfermidade, essas, podem ocorrer de forma isolada ou manifestar seus primeiros sintomas na cavidade oral, os quais são indícios de alterações sistêmicas que possam estar ocorrendo. Entre tantas, destacam-se a seguir cinco das principais síndromes de acometimento bucal primário: Síndrome de Behçet, Síndrome de Sjögren, Síndrome de Peutz-Jeghers, Doença de Addison, e Síndrome de Gardner. Considerações finais: a partir da revisão de literatura foi possível notar que as síndromes podem ocorrer de forma isolada ou manifestar seus primeiros sintomas na cavidade oral. Como suas primeiras manifestações são orais, é imprescindível que o cirurgião-dentista tenha conhecimento sobre elas para que seja elaborado um diagnóstico e protocolo de tratamento corretos e de rápida execução, já que sua terapia será executada com auxílio de vários profissionais da área da saúde.

Objective: the objective of this study was to describe the main syndromes of primary oral affection, reporting its signs, symptoms, methods of diagnosis and treatment, and to emphasize the importance of the dental surgeon in the diagnosis of systemic alterations. Methods: we carried out a literature search about five syndromes of primary oral affection. For this, a search of information was made in the electronic databases Scielo, Bireme, Pubmed between 2000 and 2017. Literature Review: "Syndrome" is understood as a set of signs and symptoms that characterize a particular disease; these can occur in isolation or manifest their first symptoms in the oral cavity, which are indications of systemic changes that may be occurring. Among so many, five of the main syndromes of primary buccal involvement are: Behçet's Syndrome, Sjögren's Syndrome, Peutz-Jeghers Syndrome, Addison's Disease, and Gardner's Syndrome. Final considerations: from the literature review it was possible to note that the syndromes may occur in isolation or manifest their first symptoms in the oral cavity. Since the first manifestations are oral, it is essential that the dentist know about them so that a correct diagnosis and protocol of treatment is elaborated and fast execution, since its therapy will be executed with the help of several professionals of the health area.

Evaluation of the ocular surface following bariatric surgery / Avaliação da superfície ocular após cirurgia bariátrica

ABSTRACT Purpose: To identify and evaluate changes in the ocular surface in obese patients with bariatric surgery. Methods: The study included 89 randomly selected patients; 81 (91.0%) were women, 35 were preoperative, 32 were included 0-12 months after surgery, and 22 were included >12 months after surgery. All patients completed a dry eye-specific questionnaire and were evaluated by the tear ferning test, tear-film breakup time (BUT), Schirmer's test I, examination of the ocular surface by 1% rose Bengal staining, and impression cytology. Patients were questioned about compliance with nutritional supplementation. Results: The pre- and postoperative groups did not differ significantly in age (p=0.082), but did differ in body mass index (p<0.001). All test values are within the normal range and there was no statistically significant difference in ocular surface disease index score between the preoperative and postoperative periods. The mean tear-film BUT was lower than that considered normal (10 s) at each time it was tested. No statistically significant group differences were observed in Schirmer's test, BUT, rose Bengal staining, or impression cytology. A high rate of noncompliance with nutritional supplementation was observed. Conclusions: No symptoms of xerophthalmia developed in this series of bariatric surgery patients. No changes were observed in any of the specific tests used to evaluate the ocular surface up to 5 years after surgery compared with presurgery results.

RESUMO Objetivos: Analisar os resultados dos testes de avialiação da superfície ocular em pacientes com obesidade submetidos à cirurgia bariátrica e identificar a presença e intensidades das alterações oculares após cirurgia bariátrica. Métodos: O estudo foi composto de 89 pacientes, amostra randômica, sendo 81 mulheres (91,0%). Os pacientes foram agrupados com relação à relação da cirurgia bariátrica: pré-operatório (35 pacientes), pós-operatório 0 a 12 meses (32 pacientes) e mais de 12 meses (22 pacientes). Todos os pacientes foram submetidos a seguinte sequencia de exames: questionário olho seco específico, teste de cristalização do filme lacrimal, teste da tempo de ruptura do filme lacrimal, Schirmer teste I, avaliação da superfície ocular usando rosa bengala, citologia de impressão. Os pacientes foram questionados quanto ao uso da suplementação nutricional. Resultados: Não houve diferença estatística entre os grupos quanto à idade (p=0,082). BMI foi significativamente diferente entre os grupos (p<0,001). Quanto ao OSDI, os valores foram normais, sem diferença estatística entre os períodos pré-operatório e pós-operatório. A média do tempo de ruptura do filme lacrimal foi abaixo do considerado normal (10 segundos) em todos os momentos avaliados. Não houve di ferença estatisticamente significante entre os grupos com relação aos exames: teste de Schirmer, BUT, biomicroscopia com rosa bengala 1% e citologia de impressão. Elevada taxa de uso incorreto da suplementação nutricional foi encontrada (73%). Conclusão: Não houve surgimento de sintomas de xeroftalmia nos pacientes submetidos à cirurgia bariátrica e não foram encontrados alterações em nenhum teste utilizado para avaliar a superfície ocular em cinco anos após a cirurgia em comparação com os pacientes antes da cirurgia.

Efficacy of Carboxymethylcellulose and Hyaluronate in Dry Eye Disease: A Systematic Review and Meta-Analysis / 가정의학회지

BACKGROUND: The efficacy of two artificial tears, carboxymethylcellulose (CMC) and hyaluronate (HA), was compared in the treatment of patients with dry eye disease. METHODS: We conducted a systematic review and meta-analysis on randomized controlled trials in the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. The efficacy was compared in terms of the mean change from baseline in tear break-up time. The meta-analysis was conducted using both random and fixed effect models. The quality of the selected studies was assessed for risk of bias. RESULTS: Five studies were included involving 251 participants. Random effect model meta-analysis showed no significant difference between CMC and HA in treating dry eye disease (pooled standardized mean difference [SMD]=-0.452; 95% confidence interval [CI], -0.911 to 0.007; P=0.053). In contrast, fixed effect model meta-analysis revealed significant improvements in the CMC group when compared to the HA group (pooled SMD=-0.334; 95% CI, -0.588 to -0.081; P=0.010). CONCLUSION: The efficacy of CMC appeared to be better than that of HA in treating dry eye disease, although meta-analysis results were not statistically significant. Further research is needed to better elucidate the difference in efficacy between CMC and HA in treating dry eye disease.

Aspectos relevantes da síndrome de Sjõgren para o cirurgião-dentista / Sjogren’s syndrome’s relevant aspects for the dental surgeon

A síndrome de Sjõgren (SS), conhecida como síndrome sicca, é uma doença autoimune caracterizada pela hipofunção das glândulas salivares e lacrimais, cuja prevalência na população mundial é de aproximadamente 0,5% a 1%. Por ser uma doença autoimune complexa e de difícil diagnóstico, é sub-diagnosticada e sub-tratada segundo o consenso realizado em 2012 pelo Colégio Americano de Reumatologia (ACR). O Cirurgião-Dentista pode desempenhar papel importante na detecção de possíveis alterações compatíveis com a síndrome, além de auxiliar no tratamento de diversas patologias orais decorrentes da síndrome. Este trabalho tem como objetivo explanar aspectos importantes referentes ao diagnóstico e tratamento da síndrome aqui discutida. A SS apesar de ser considerada uma doença de evolução lenta, em estágios avançados pode ser fatal, principalmente por aumentar as chances dos pacientes virem a desenvolver linfoma não Hodking. O tratamento odontológico dos pacientes com SS deve principalmente ser profilático, com a recomendação do uso de repositores de saliva e controle rígido da higiene bucal.

Sjogren’s syndrome (SS), known as the sicca syndrome, is an autoimmune disease characterized by salivary and lacrimal glands hypofunction which prevalence in the world population is approximatel y around 0,5% to 1%. For being a complex autoimmune disease and with difficult diagnosis, it is sub diagnosed and miss treated according to the consensus occurred in 2012 by the American College of Rheumatology (ACR). The surgeon-dentist (SD) may play a important role on the detection of possible changes compatible to the syndrome, besides can help in the treatment of many oral pathologies caused by the syndrome. This work has the main purpose to explain the important aspects regards to the correct diagnosis and treatment of this syndrome.The SS besides been considered a slow evolution disease, in advanced stages it can be fatal,mainly for increasing the patient’s chances of developing non-Hodking lymphoma. The dental treatment of patients with SS must be prophylactic, with the recomedations of the use of salivary replenishing and careful control of the oral hyigiene.

Two Cases of Distal Renal Tubular Acidosis accompanied by Sjogren's Syndrome / 대한내과학회지

Renal tubular acidosis (RTA) is a syndrome characterized by hyperchloremic metabolic acidosis and an inability to excrete highly acid urine, in which the impaired acid excretion is disproportional to the reduction in the glomerular filtration rate. Distal renal tubular acidosis (dRTA) is frequently associated with immune-mediated disease, including Sjogren's syndrome. Sjogren's syndrome is a systemic autoimmune disease that mainly affects exocrine glands, such as the lacrimal and salivary glands, resulting in xerophthalmia and xerostomia. Extraglandular manifestations are frequent and may include renal involvement. Recently, we experienced two cases of renal tubular acidosis in patients with Sjogren's syndrome. The first patient had lower extremity weakness and hypokalemia and the second had nephrocalcinosis. We discuss the frequency and pathogenesis of dRTA in Sjogren's syndrome.

Síndrome de Sjõgren, más que un ojo seco / Sjõgren syndrome, more than a dry eye

El síndrome de Sjõgren primario (SSp) es una exocrinopatía autoinmune de gran importancia en la actualidad, ya que afecta entre 0.2 al 3 % de la población general. Al SSp se le ha atribuido una estrecha relación con la susceptibilidad genética de cada individuo, debido a la presencia de alelos del HLA DR y HLA DQ y a la influencia ambiental que conllevan al desarrollo de dicha enfermedad.El SSp se caracteriza por pérdida de la tolerancia central, la cual origina una epitelitispor la infiltración de células linfomonocitarias, proceso que tiene como consecuencia atrofia acinar de las glándulas exocrinas. Las manifestaciones clínicas fundamentalmente se dividen en dos grupos: manifestaciones glandulares como xerostomía,xeroftalmia e hipertrofia parotídea y manifestaciones extraglandulares como artralgias,neuropatía, fatiga, entre otras.El SSp es un reto para el clínico, ya que requiere un alto índice de sospecha debido a la amplia gama de manifestaciones, pero apoyándose en una adecuada implementación e interpretación de ayudas diagnósticas y siguiendo los criterios de clasificación se puede realizar un diagnóstico oportuno. El tratamiento depende de la sintomatología y del compromiso que genere. Este se basa en tres pilares fundamentales: medidas generales para evitar la sequedad, estimulantes de secreción y la medicación cuando existe compromiso sistémico.En los últimos años se ha despertado el interés acerca del uso de anticuerpos monoclonales en el tratamiento del SSp, los cuales han llevado a resultados prometedores como el uso de anti CD20...

Síndrome de Sjögren: Caso clínico / Sjögren's syndrome: case report

Introducción: El síndrome de Sjögren (SS) es una enfermedad crónica, autoinmune, que afecta principalmente a las glándulas exocrinas lagrimales y salivales. En niños es una enfermedad rara. Objetivo: Presentar el caso de un adolescente con síntomas inespecíficos, en que la sospecha clínica hizo llegar al diagnóstico de SS. Caso Clínico: Paciente de 12 años, de sexo masculino, con historia de artralgias de 3 años de evolución y xeroftalmia dudosa. El examen físico mostró leve congestión conjuntival, boca seca e hiperlaxitud de rodillas. Pruebas de laboratorio: hemograma y VHS normales, anticuerpos antinucleares (+) > 60, Ro (+) > 60 U, factor reumatoideo (+) 160 UI/ml. Se sospechó SS y se completó el estudio: test de Shirmer, que determinó ojo seco leve; gammagrafía de las glándulas salivales, que mostró disfunción de las glándulas submaxilares y parotídeas; biopsia de glándulas salivales, que mostró focos de infiltrado linfoide acinar y periductal. Se confirmó SS y se inició tratamiento con prednisona 7,5 mg/día e hidroxicloroquina 200 mg/día y tratamientos locales, con buena respuesta. Conclusiones: Los criterios diagnósticos del SS en adultos identifican solo al 39% de los pacientes pediátricos por la baja frecuencia de síntomas de sicca. Aún no existen criterios diagnósticos validados para niños. Un buen diagnóstico permitirá aliviar los síntomas, evitar complicaciones y detectar enfermedades asociadas.

Introduction: Sjögren’s syndrome (SS) is a chronic autoimmune disease that primarily affects the lacrimal and salivary exocrine glands. In children, it is a rare condition. Objective: To present the case of an adolescent with non-specific symptoms, but with a clinical suspicion of SS. Case report: A male 12-year old patient, with history of arthralgias for 3 years and suspicion of xerophthalmia. Physical examination showed mild conjunctival congestion, dry mouth and hypermobility of the knees. Laboratory work: blood count and ESR were normal, antinuclear antibodies (+) > 60, Ro (+) > 60 U, and rheumatoid factor concentration (+) 160 IU/ml. SS was suspected, and a study was carried out: Schirmer test determined mild dry eye, salivary gland scintigraphy showed parotid and submandibular gland dysfunction, and salivary gland biopsy reported focal lymphocytic acinar and periductal infiltration. SS was confirmed and treated with prednisone 7.5 mg/day and hydroxychloroquine 200 mg/day, and local treatment, with good response. Conclusions: The diagnostic criteria for SS in adults identified only 39% of pediatric patients, due to the low frequency of sicca symptoms. Still there are no validated diagnostic criteria for children. A good diagnosis will alleviate symptoms, prevent complications and detect associated diseases.

Experimental study on efficiency of Spanishneedles Herb eye drops in treating perimenopausal xerophthalmia in rabbits / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the efficiency of Spanishneedles Herb eye drops in treating perimenopausal xerophthalmia in rabbits.</p><p><b>METHOD</b>Totally 36 rabbits (36 right eyes) were ovariectomized, and 2 months later divided into three groups: the experimental group (group A, n = 12) given Spanishneedles Herb eye drops, the control group (group B, n = 12) given PBS and the model group (group C, n = 12) given no drug. The Schirmer I test (SIT), fluorescent (FL), total tear protein, diastase activity, lactoferrin and lysozyme contents and confocal scanning microscopy were performed at before the treatment and at 1 w, 2 w, 1 mo, 2 mo after the treatment.</p><p><b>RESULT</b>Before the treatment, There was no significant difference in SIT, FL, total tear protein, lysozyme, lactoferrin and amylase activity between two groups. Two months later after the treatment, both the group B and the group A showed differences degrees of changes in SIT, FL, total tear protein, lysozyme, lactoferrin and amylase activity compared with that before the treatment, with statistical differences (P < 0.05); At each time point, both groups revealed statistical differences in SIT, FL, total tear protein, lysozyme, lactoferrin and amylase activity (1 < 0.05). Two months later alter the treatment, densities of basal epithelial cells and inflammatory cells in the group A were (4 122 ±416) cells/mm2 and (339 ± 131) cells/mm2, while that in the group B were (3 343 ± 424) cells/mm2 and (49 ± 17) cells/mm2, with statistical differences between them (P < 0.05).</p><p><b>CONCLUSION</b>Spanishneedles Herb eye drops could effectively treat perimenopausal xerophthalmia in rabbit caused by sex hormones decline.</p>

A Case of Sjogren's Syndrome Associated with Common Variable Immunodeficiency / 대한내과학회지

Common variable immunodeficiency (CVID) is a heterogeneous group of primary immune deficiencies in adults characterized by hypogammaglobulinemia, recurrent bacterial infections, and a higher incidence of autoimmune diseases. More than 25% of CVID patients also have autoimmune diseases such as autoimmune hemolytic anemia, immune thrombocytopenic purpura, rheumatoid arthritis, and systemic lupus erythematosus. However, the pathogenesis of autoimmunity in CVID remains obscure. We report a 56-year-old woman with CVID and Sjogren's syndrome. In addition to a long history of recurrent upper respiratory infections, acute gastroenteritis, and cellulitis, she has also suffered from persistent xerostomia and xerophthalmia for the past 10 years. Serologic studies revealed hypogammaglobulinemia (low levels of IgG, IgA, and IgM in serum) and the presence of anti-Ro antibodies, and salivary scintigraphy indicated salivary gland involvement. These findings led to a diagnosis of CVID and Sjogren's syndrome, which was treated by monthly intravenous immunoglobulin therapy.

Signal Detection and Safety Information Generation of Aripiprazole in Spontaneous Adverse Event Reports Database / 대한정신약물학회지

OBJECTIVE: Korea Institute of Drug Safety and Risk Management works for signal detection and safety information generation by analyzing spontaneous adverse event reports database. As the number of reports and detected signals of aripiprazole by each data mining indices were more than other drugs, aripiprazole was selected as a subject of study. METHODS: 1989-2012 spontaneous reporting database was analyzed and the model drug ingredient was aripiprazole. We estimated proportional reporting ratio, reporting odds ratio, and information component for data mining. Then we assessed the causality through review of local and foreign drug labels and literatures. RESULTS: In reconstructed 1989-2012 spontaneous reporting database, there were 2,062 reports on aripiprazole and 2,565 aripiprazole-adverse events pairs. As a result of data mining analysis and signal prioritization, 78 adverse events were detected, 20 adverse events of them were not included in drug label. After literature review, back pain, epistaxis, xerophthalmia and ejaculation disorder were generated as novel safety information on aripiprazole. CONCLUSION: Those 4 novel safety informations of Aripiprazole, back pain, epistaxis, xerophthalmia and ejaculation disorder had become listed on the local label in April 2013.

Professor ZHOU Yun-xian's experience of acupuncture combined with Chinese material medica for xerophthalmia / 中国针灸

Professor ZHOU Yun-xian's clinical experience of acupuncture combined with Chinese material medica for xerophthalmia is introduced. Her treatment for xerophthalmia is firstly focused on syndrome differentiation, indicating that different syndrome has different treatment of acupuncture and Chinese material medica. It is emphasized that by following the holistic concept of TCM, the local acupoints and whole-body acupoints cooperate closely, forming her special combination method of acupoints. In clinic, attention is focused on the application of many acupuncture techniques and extra points. With the combination of acupuncture and Chinese material medica, the treatment is flexible with superior clinical efficacy.

Perfil clínico y epidemiológico de pacientes con síndrome de Sjõgren concomitante a artritis reumatoide / Clinical and epidemiological profile of patients with Sjõgren's syndrome concomitant to rheumatoid arthritis

El síndrome de Sjõgren es una enfermedad crónica autoinmune en la cual se ven afectadas las glándulas exocrinas del organismo. El síndrome Sjõgren se caracteriza principalmente por xerostomía y xeroftalmia. Objetivo. Describir el perfil clínico y epidemiológico de los pacientes con síndrome de Sjõgren concomitante a artritis reumatoide atendidos en una clínica privada de la ciudad de Medellín-Colombia. 2005- 2010. Metodología. Estudio descriptivo del tipo de series clínicas en el que se revisaron las historias clínicas de pacientes con Sjõgren concomitante a artritis reumatoide en una clínica privada de Medellín-Colombia. Para el análisis estadístico se utilizó el programa SPSS, a las variables cuantitativas se les calculó promedio y desviación estándar, además de los valores mínimo y máximo, y a las variables cualitativas se les estimó proporciones. Resultados. Se obtuvieron 23 pacientes, los cuales tenían una mediana de la edad de 55 años y el 91.3% eran del sexo femenino. Los síntomas más frecuentemente reportados fueron xerostomía y xeroftalmia con un 69.6% y 56.5% respectivamente. Los métodos más empleados para el diagnóstico fueron el factor reumatoide (78.3%) y los anticuerpos antinucleares (69.6%); mientras que los principales medicamentos empleados fueron la cloroquina y la rednisolona (cada uno con 52.2%). Conclusión. síndrome de Sjõgren concomitante a artritis fue encontrado más comúnmente en el sexo femenino. Las manifestaciones clínicas más frecuentes fueron la xerostomía y xeroftalmia y la mediana del tiempo de diagnóstico fue de 61 meses. Es necesario seguir ahondando en el tema para caracterizar mejor aquellos pacientes con Sjõgren y otra enfermedad inmunológica de base. [Martínez-Sánchez LM, Cardona-Vélez J, Vargas-Grisales N, Rojas-Londoño J, Rodríguez-Gázquez MA. Perfil clínico y epidemiológico de pacientes con síndrome de Sjõgren concomitante a artritis reumatoide.

Sjogren's syndrome is a chronic autoimmune disease where the exocrine glands of the body. Sjogren's syndrome is characterized by xerostomia and xerophthalmia. Objective. To describe the clinical and epidemiological profile of patients with Sjogren's syndrome concomitant to rheumatoid arthritis in a private clinic from Medellin, Colombia. 2005 2010. Methodology. Descriptive study of clinical series in which we review the medical histories of patients with diagnosis of Sjogren's syndrome concomitant to rheumatoid arthritis in a private clinic from Medellin, Colombia. The SPSS program was used for statistical analysis. Quantitative variables were calculated using averages and standard deviations, as well as the minimum and maximum values, and proportions were estimated for qualitative variables. Results. We found 23 patients who had a median age of 55 years and 91.3% were female. The most frequent reported symptoms were xerostomia and xerophthalmia (69.6% and 56.5% respectively). Most methods for diagnosis were the Rheumatoid Factor (78.3%) and the antinuclear antibodies (69.6%), while the main drugs used were the chloroquine and prednisolone (each one with 52.2%). Conclusion. Sjogren's syndrome concomitant with arthritis was most commonly found in females. The most frequent clinical manifestations were xerostomia and xerophthalmia and the median time of diagnosis was 61 months. It is necessary to continue investigating the topic to further characterize those patients with Sjogren and other immunological diseases. [Martinez-Sanchez LM, Cardona-Velez J, Vargas-Grisales N, Rojas-Londoño J, Rodriguez-Gazquez MA. Clinical and epidemiological profile of patients with Sjogren's syndrome to rheumatoid arthritis concomitant.

Síndrome do olho seco em Ginecologia / Dry eye syndrome in Gynecology

Objetivo: Este trabalho teve por objetivo reunir informações relevantes para melhor compreensão das alterações oculares decorrentes da deficiência lacrimal, bem como suas possíveis causas. Metodologia: Fez-se levantamento bibliográfico para compilar informações acerca das deficiências de produção da lágrima que possam estar de alguma forma relacionadas às afecções ginecológicas ou que afetam a produção dos hormônios esteroides. Conclusão: Os mecanismos que influenciam a produção da lágrima ainda não são totalmente conhecidos, porém é notório que alterações hormonais, proteicas ou mesmo anatômicas ou de transmissão do impulso neural afetam significativamente a produção e/ou qualidade do filme lacrimal.

Anticuerpo anticitrulina y manifestaciones extra articulares en artritis reumatoidea / Anticitrulin antibody and the extra-articular manifestations in rheumatoid arthritis

Los pacientes con artritis reumatidea (AR) pueden desarrollar manifestaciones extra articulares (MExA), relacionadas a su morbi-mortalidad. Los anticuerpos anti-péptidos citrulinados cíclicos (ACCP) son específicos para la AR y estan relacionados con el daño articular; y podrían tener rol patogénico en las MExA. Nuestro objetivo fue determinar la relación entre los anticuerpos ACCP y MExA en pacientes con AR. Se incluyeron 74 pacientes con diagnóstico de AR (ACR 1987) mayores de 18 años, de más de 6 meses de evolución, con MExA, y un control apareado por sexo y edad sin MExA por cada paciente. Las variables demográficas, clínicas y de laboratorio se compararon con test t, chi cuadrado o Mann-Whitney. Se realizó análisis multivariado; p ≤ 0.05. Los pacientes con MExA presentaron mayor título de anticuerpo ACCP (116 vs. 34, p < 0.01) y de factor reumatoideo (FR) (108 vs. 34.5, p < 0.01). En el análisis multivariado hubo asociación entre la presencia de MExA y tabaquismo activo (p = 0.02, OR: 3.78, IC 95%: 1.17-12.2), FR positivo (p = 0.04, OR: 3.23, IC95%: 1.04-11.8) y anticuerpo ACCP positivo (p = 0.04, OR: 3.23, IC 95%: 1.04-10). Presentaron mayor título de anticuerpo ACCP que los controles los pacientes con xerostomía (109 vs. 34, p = 0.04), xeroftalmia (150 vs. 34, p < 0.01), nódulos sub-cutáneos (NSC) (141 vs. 34, p < 0.01) y fibrosis pulmonar (158 vs. 34, p = 0.04). En conclusión, el anticuerpo ACCP positivo, el FR positivo y el tabaquismo activo fueron factores de riesgo independientes para el desarrollo de MExA.

A large proportion of rheumatoid arthritis (RA) patients develop extra-articular manifestations (EAM), which are associated with morbidity and early mortality. Anti cyclic citrullinated peptide (ACCP) antibody has proven to be highly specific for the diagnosis of RA, associated with severe joint damage and may have some role in the pathogenesis of EAM. The aim of this study was to determine the relationship between ACCP antibody and the presence of EAM in RA patients. Seventy four RA patients (ACR 1987) with EAM, > 18 years, more than 6 months duration were included, and an EAM free control, matched by sex and age, for each patient. Demographic, clinical and laboratory variables were compared using t-test, chi-square or Mann-Whitney test. Multivariate analysis was performed: p ≤ 0.05. Patients with EAM presented a greater value of ACCP antibody (116 vs. 34, p < 0.01) and rheumatoid factor (108 vs. 34.5, p < 0.01). Independent association with current smoking habit (p = 0.02, OR = 3.78, 95%: 1.17-12.2), RF positive (p = 0.04, OR 3.23, CI 95%: 1.04 to 11.8) and ACCP antibody positive (p = 0.04, OR 3.23, 95% CI: 1.04-10) was found. The patients with xerostomia (109 vs. 34, p = 0.04), xerophthalmia (150 vs. 34, p < 0.01), subcutaneous nodules (141 vs. 34, p < 0.01) and pulmonary fibrosis (158 vs. 34, p = 0.04) had a higher degree of the ACCP antibody, than controls. In conclusion, ACCP antibody positive, RF positive and smoking were independent risk factors for the development of MEXA.

Severe Pulmonary Hypertension in Primary Sjogren's Syndrome

A 65 year-old female with a history of xerostomia and xerophthalmia was presented with dyspnea on exertion (New York Heart Association class III). Echocardiography and cardiac catheterization demonstrated severe pulmonary hypertension (PH). Laboratory examinations showed positive anti-nuclear and anti-Ro/SS-A antibodies. Schirmer's test was positive and salivary gland scintigraphy revealed severely decreased tracer uptakes in both parotid and submandibular glands. By excluding other possible causes of PH during further examinations, she was diagnosed with severe PH associated with primary Sjogren's syndrome. Her dyspnea symptom was much improved with endothelin receptor antagonist and azathioprine.

Clinical study on spanishneedles leaves in treatment of middle and severe xerophthalmia of menopausal females / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the clinical effect of spanishneedles leaves on middle and severe xerophthalmia of menopausal females.</p><p><b>METHOD</b>This study was a prospective random controlled trial. Ninty-six menopausal females diagnosed with xerophthalmnia (aged from 40 to 50) were randomly divided into in two groups: group A' the spanishneedles leaves group (n=48) and group B' the control group (n=48). Both groups were treated with Forte eye drops. All patients were detected at 3, 7, 28 h before and after treatment to evaluate subjective symptoms, OSDI and four tear film indicators. Variance analysis and differential analysis on sample average or median were made on both groups before and after treatment.</p><p><b>RESULT</b>There were no significant difference in symptom and diction indicators between both groups before treatment. For 28 d after treatment, among middle and severe xerophthalmia samples of the spanishneedles leaves group, the mean differences showed significant improvement compared with that before treatment , OSDI and four tear film indicators also showed improvement to varying degrees. For 28 d after treatment, among middle and severe xerophthalmia samples of the vitamin C group, the mean differences showed no significant improvement compared with that before treatment , OSDI and four tear film indicators also showed no remarkable improvement. There were significant differences in OSDI, BUT, SIT, height of tear meniscus and FL between both groups.</p><p><b>CONCLUSION</b>Spanishneedles leaves can effectively improve symposiums and signs of middle and severe xerophthalmia among menopausal females and thus showing clinical significance to some extent.</p>

Efficacy observation of xerophthalmia treated with acupuncture of warming-promotion needling technique / 中国针灸

<p><b>OBJECTIVE</b>To observe the differences in the efficacy on xerophthalmia treated with the needling technique for warming-promotion at Fengchi (GB 20) as the main acupoint in comparison with the conventional needling technique.</p><p><b>METHODS</b>Thirty cases were randomly divided into a warming-promotion needling group (n = 15) and a routine needling group (n = 15). In warming-promotion needling group, the needling technique for warming-promotion was applied to Fengchi (GB 20). Additionally, the local and distal acupoints [such as the point beneath Cuanzu (BL 2), Neiguan (PC 6), Guangming (GB 37), Taichong (LR 3), Fulio (KI 7) and Sanyinjiao (SP 6)], as well as the scalp acupuncture (bilateral supraoccipital lateral line and supraoccipital midline) were selected and stimulated with even-needling technique by rotating the needle. In routine needling group, the acupoints were same as warming-promotion needling group and were stimulated with even-needling technique by rotating the needle. After 2 sessions of treatment, the efficacy, tear secretion volume and the total score of symptoms were compared between two groups.</p><p><b>RESULTS</b>The total effective rate was 86.7% (13/15) in warming-promotion needling group, which was superior to 66.7% (10/15) in routine needling group (P < 0.05). After treatment, the tear secretion volume and the total score of symptoms were all apparently improved in two groups (all P < 0.05), in which, the improvement in warming-promotion needling group was much obvious (all P < 0.05).</p><p><b>CONCLUSION</b>The therapeutic effect of warming-promotion needling technique is apparently superior to that of conventional one.</p>