Factores biológicos relacionados con la masa ósea en hombres de edad mediana / Biological Factors Associated to Bone Mass in Middle-Aged Men

RESUMEN Introducción: La osteoporosis masculina es una enfermedad clínica heterogénea y subdiagnosticada, con múltiples factores de riesgo. Requiere un proceso de diagnóstico en ocasiones más complejo que en las mujeres. Objetivo: Identificar factores biológicos relacionados con la masa ósea en hombres de edad mediana. Métodos: Se realizó estudio descriptivo, transversal, en 43 hombres de edad mediana (40-59 años) entre abril de 2017 y mayo de 2018, que fueron atendidos en el Policlínico Universitario Vedado. Se estudiaron los antecedentes patológicos familiares (APF) de osteoporosis masculina o fracturas por fragilidad, índice de masa corporal (IMC), circunferencia de la cintura (CC), presión arterial (PA), glucemia, colesterol, triglicéridos, creatinina, hormona luteinizante, folículo estimulante, estradiol, testosterona (T), prolactina y paratohormona (PTH) y densitometría dual de Rx (DXA). Según edad y resultado de la DXA, se crearon 4 grupos (de 40-49 y de 50-59 años, en L1-L4 y fémur). Se identificaron hombres con hueso normal y mala masa ósea (MMO). Se determinaron distribuciones de frecuencia (variables cualitativas), y mediana y rango (cuantitativas). Se empleó chi cuadrado para determinar relación entre variables cualitativas y Mann-Whitney para cuantitativas. Para establecer correlación entre variables cuantitativas, se calculó el test de Pearson. Resultados: En hombres de 50-59 años, con antecedentes patológicos familiares de fracturas por fragilidad, predominó la mala masa ósea (75 por ciento). La mediana del índice de masa corporal en hombres de 40-49 años fue mayor (26,7 Kg/m2sc) en los que tenían hueso normal en L1-L4; en los de 50-59 años con aumento de la circunferencia de la cintura predominó la mala masa ósea (3; 75 por ciento). La presión arterial sistólica y diastólica se correlacionaron positivamente con la densidad mineral ósea en L1-L4 ([r = 0,225; p = 0,009], [r = 0,263; p = 0,002]). Hubo correlación positiva entre colesterol y contenido mineral óseo en fémur (r = 0,164; p = 0,002). La testosterona resultó más baja en hombres con hueso normal (40-49 años: 15,3 nmol/L; 50-59 años: 12,5 nmol/L). Se observó correlación negativa entre paratohormona y contenido mineral óseo en fémur (r = -0,324; p = 0,000). Conclusiones: Se puede concluir que, de los factores biológicos estudiados en los hombres de edad mediana del Policlínico Universitario Vedado, los niveles más elevados de presión arterial y colesterol, y más bajos de paratohormona, se asociaron con mejor masa ósea(AU)

ABSTRACT Introduction: Male osteoporosis is a heterogeneous and underdiagnosed clinical condition and with multiple risk factors, which requires a diagnostic process that is sometimes more complex than for women. Objective: To identify biological factors related to bone mass in middle-aged men from "Vedado" University Polyclinic. Methods: A cross-sectional and descriptive study was carried out with 43 middle-aged (40-59 years old) men, between April 2017 and May 2018. The variables were family pathological history of osteoporosis or fragility fractures, body mass index, waist circumference, blood pressure, glycemia, cholesterol, triglycerides, creatinine, luteinizing hormone, stimulating follicle, estradiol, testosterone, prolactin and parathyroid hormone, and dual x-ray densitometry. According to age and results of the dual x-ray densitometry, four groups were created (40-49 and 50-59 years old, in L1-L4 and femur). The men with normal bone and poor bone mass were identified. Frequency distributions (qualitative variables), as well as median and range (quantitative variables) were determined. The chi-square test was used to determine the relationship between qualitative variables, and the Mann-Whitney test was used for quantitative variables. To establish correlation between quantitative variables, the Pearson test was used. Results: Among men aged 50-59 years and with a family pathological history of fragility fractures, poor bone mass prevailed (75 percent). The median body mass index among men aged 40-49 years was higher (26.7 kg/m2sc) in those with normal bone in L1-L4; among those aged 50-59 years and with increased waist circumference, poor bone mass predominated (3; 75 percent). Systolic and diastolic blood pressure were correlated positively with bone mineral density in L1-L4 [(r = 0.225, p = 0.009), (r = 0.263, p = 0.002)]. There was a positive correlation between cholesterol and bone mineral content in the femur (r = 0.164, p = 0.002). T was lower among men with normal bone (15.3 nmol/L for the group 40-49 years old, and 12.5 nmol/L for the group 50-59 years old). A negative correlation was observed between the parathyroid hormone and bone mineral content values in the femur (r = -0.324, p = 0.000). Conclusions: Among the biological factors studied in middle-aged men from "Vedado" University Polyclinic, higher levels of blood pressure and cholesterol, as well as lower levels of the parathyroid hormone were concluded to be associated with better bone mass(AU)

Câncer de mama e seus efeitos sobre a sexualidade: uma revisão sistemática sobre abordagem e tratamento / Breast cancer and its effects on sexuality: a sistematic review on the evaluation and treatment

O câncer de mama e seu tratamento afetam amplamente a sexualidade das mulheres acometidas. O impacto pode durar vários anos, mesmo após um tratamento bem-sucedido para a doença, decorrente dos diversos efeitos colaterais da terapêutica e dos eventos psíquicos resultantes do processo. Estudos mostram alterações físicas decorrentes da quimioterapia, hormonioterapia e tratamento cirúrgico que interferem na sexualidade, promovendo distúrbios no funcionamento sexual em suas diferentes fases, como desejo, excitação, lubrificação e orgasmo. Experiências psíquicas incluem medo da perda da fertilidade, imagem corporal negativa, sentimento de não ser sexualmente atraente, depressão e ansiedade, enquanto fatores sociais e relacionais exercem influência sobre o ajuste ao tratamento e à doença. A qualidade prévia do relacionamento com o parceiro é considerada o mais importante fator preditivo da qualidade do relacionamento sexual após o término do tratamento. Conclui-se que o estudo da sexualidade no contexto do câncer de mama não pode considerar separadamente os aspectos físicos dos psicossociais, e que a identificação das causas dos diferentes tipos de disfunção sexual neste subgrupo possibilita o desenvolvimento de intervenções fisiológicas e psicossociais que contribuam para a manutenção da qualidade da atividade sexual.(AU)

Breast cancer and its treatment widely affect the sexuality of female patients. The impact may last for several years, even after successful treatment of the disease, due to the many side effects of the treatment and psychical events that emerge from the process. Studies refer to physical changes derived from chemotherapy, hormone therapy and surgical treatment, that intervenes in the sexuality, promoting disturbances regarding sexuality in different phases, such as desire, arousal, lubrication and orgasm. Psychical experiences include fear of losing fertility, negative body image, feeling of not being sexually attractive, depression and anxiety, while social and relational factors affect the adjustment to the treatment and the disease. The previous quality of the relationship with the partner is considered the most important predictive factor of the quality of sexual relationship after the treatment. We conclude that the study of sexuality in the context of breast cancer must consider both physical and psychosocial aspects, and that identifying the causes of different types of sexual dysfunction in this subgroup will enable the development of physiological and psychosocial interventions that may contribute to maintaining the quality of sexual activity of the patients.(AU)

Biological agents: investigation into leprosy and other infectious diseases before indication / Agentes biologicos: pesquisa de hanseniase e outras doencas infecciosas antes da indicacao

Biological agents are widely used for various immune-mediated diseases, with remarkable effectiveness in the treatment of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease. However, attention needs to be drawn to the adverse effects of these therapies and the risk of reactivating underlying granulomatous infectious diseases such as tuberculosis, leprosy, syphilis, leishmaniasis, among others. The objective of this paper is to describe a case of leprosy in a patient with RA using anti-TNF alfa, demonstrating the need for systematic investigation of skin lesions suggestive of leprosy in patients who require rheumatoid arthritis therapeutic treatment, especially in endemic regions like Brazil.

Os agentes biológicos são amplamente utilizados em diversas doenças imuno-mediadas, com marcante eficácia no tratamento da Artrite Reumatóide (AR), Psoríase, Artrite Psoriática, Espondilite Anquilosante e Doença de Crohn. No entanto, deve-se atentar quanto aos efeitos adversos de tais terapêuticas, como o risco de reativar doenças infecciosas granulomatosas latentes, como a tuberculose, hanseníase, sífilis, leishmaniose, entre outras. O objetivo deste artigo é descrever um caso de hanseníase em paciente portador de AR em uso de terapia anti-TNF alfa, mostrando, assim, a necessidade de investigação sistematizada de lesões cutâneas sugestivas de hanseníase em pacientes com indicação de terapia anti-TNF alfa, especialmente, em regiões endêmicas como o Brasil.

Eficacia de tres tipos de surfactante exógeno en prematuros con enfermedad de membrana hialina / Effectiveness of three types of exogenous surfactant in preterm infants with hyaline membrane disease

Introducción: La enfermedad de membrana hialina es causa importante de mortalidad neonatal. El objetivo de esta investigación fue evaluar la eficacia de tres tipos de surfactante exógeno en prematuros. Pacientes y Método: Estudio de cohorte retrospectiva, en 93 neonatos prematuros, > 24 semanas y > 500 g de peso al nacer, 31 para cada surfactante. La exposición fue la administración de 1ª dosis bovactant (Alveofact®) 50 mg/kg, beractant (Survanta®) 100 mg/kg inicial, y poractant alfa (Curosurf®) 200 mg/kg. Las variables en estudio incluyeron tiempo de ventilación mecánica, tiempo de oxigenoterapia, estancia hospitalaria, necesidad de segunda dosis de surfactante, eventos adversos por la administración del surfactante y complicaciones por prematuridad. Además, se evaluó mortalidad, displasia broncopulmonar (DBP) y mortalidad o DBP. Análisis estadístico mediante Stata® 11.0, empleando X² o Prueba Exacta de Fisher para variables cualitativas y Pruebas ANOVA o Kruskal-Wallis para cuantitativas y riesgo relativo para las asociaciones, todas con su intervalo de confianza de 95%. Resultados: No hubo diferencias para sexo, peso y edad gestacional al nacer entre los 3 grupos. No se hallaron diferencias estadísticamente significativas para tiempo de ventilación mecánica, tiempo de oxigenoterapia, administración de una segunda dosis de surfactante, estancia hospitalaria y complicaciones entre los 3 grupos. Los eventos adversos por administración de surfactante se presentaron para beractant y poractant alfa. Ocurrieron 30 (32,3 por ciento) muertes, 8 (25,8 por ciento) para bovactant, 10 (32,3 por ciento) beractant y 12 (38,7 por ciento) poractant alfa (p > 0,05). La mortalidad y/o DBP ocurrió en 10 (32,2 por ciento) neonatos con bovactant, 10 (32,2 por ciento) con beractant y 14 (45,2 por ciento) con poractant alfa (p > 0,05). Conclusiones: Los resultados primarios y secundarios entre los tres surfactantes evaluados fueron muy similares...

Introduction: Hyaline membrane disease is an important cause of neonatal mortality. The objective of this research is to evaluate the efficacy of three different exogenous surfactants in premature infants. Patients and Method: A retrospective cohort analysis in 93 preterm infants > 24 weeks and birth weight > 500 g was performed, 31 infants for each surfactant. Exposure consisted of the 1st dose of bovactant (Alveofact®) 50 mg/kg, beractant (Survanta®) 100 mg/kg initially, and poractant alfa (Curosurf®) 200 mg/kg. The variables included duration of mechanical ventilation, duration of oxygen therapy, hospital stay, need for second dose of surfactant, adverse events surfactant administration and prematurity complications. Mortality and bronchopulmonary dysplasia (BPD) were evaluated. Statistical analysis was performed using Stata® 11.0, X² or Fisher exact test for qualitative variables and ALNOVA or Kruskal-Wallis tests for quantitative and association relative risk, all with 95 percent confidence level. Results: There were no gender, weight and gestational age differences at birth among the three groups. No statistically significant differences were found regarding duration of mechanical ventilation, duration of oxygen therapy, administration of a second dose of surfactant, hospital stay and complications among the three groups. Adverse events related to surfactant administration occurred for beractant and poractant alpha. There were 30 (32.3 percent) deaths, 8 (25.8 percent) associated to bovactant, 10 (32.3%) to beractant and 12 (38.7 percent) to poractant alpha (p > 0.05). Mortality and/or BDP occurred in 10 (32.2 percent) infants who received bovactant, 10 (32.2 percent) beractant and 14 (45.2 percent) with poractant alpha (p > 0.05). Conclusions: The primary and secondary outcomes among the three surfactants tested were similar, taking into account the limitations of the work.

Queixas de insônia e menopausa entre funcionárias de uma universidade no Rio de Janeiro: estudo pró–saúde / Insomnia complaints and menopause among female employees at a university in Rio de Janeiro: the pró-saúde study

Estudos demonstram que mulheres na perimenopausa e pós-menopausa apresentam maior latência para o sono, dificuldade de manutenção e estão menos satisfeitas com a qualidade do sono quando comparadas àquelas que não estão na menopausa. Apesar da vasta literatura sobre a insônia na menopausa, diversos aspectos ainda são controversos ou não foram suficientemente estudados. Objetivos: Artigo I: Estimar a prevalência de insônia e avaliar sua associação com o status menopausal em uma população de mulheres. Artigo II: Entre mulheres na menopausa, investigar a associação entre fatores psicossociais, morbidade física e mental, características da menopausa e queixas de insônia. Métodos: Artigo I: Foi realizado um estudo seccional entre funcionárias de uma universidade no Rio de Janeiro participantes de um estudo longitudinal (Estudo Pró-Saúde)(n=2.189), onde foi utilizado um questionário autopreenchível para avaliação de insônia, status menopausal e demais variáveis de estudo. Foram consideradas como “em menopausa”as mulheres não-grávidas que responderam que não ficavam mais menstruadas (peri e pósmenopausa). A insônia foi analisada como dificuldade em iniciar o sono, dificuldade em manter o sono e queixa geral de insônia (combinação das anteriores). Os Odds Ratios (OR) brutos e ajustados foram calculados através de regressão logística multivariada.

Da herança à localização cerebral: sobre o determinismo biológico de condutas indesejadas / From heritage to cerebral localization: on the biological determinism of undesired conducts

Analisamos os argumentos utilizados, em dois momentos diferentes do século XX, para justificar o recurso a explicações biológicas de condutas consideradas como socialmente indesejadas. Referimo-nos, inicialmente, aos estudos realizados pelos higienistas de início do século, cujas explicações estavam centradas no caráter orgânico e inato dos desvios, para continuar logo com os recentes estudos da neurociência que se propõem a localizar as condutas nas sinapses inadequadas e nas explicações referidas a deficiências químicas do cérebro.

The article analyzes the arguments used in two distinct moments of the 20th century, to justify the use of biological explanations for conducts considered as socially undesirable. Firstly we refer to studies of hygienists in the early century, whose explanation were centered on the organic and innate character of deviations, then we analyze the recent studies in the neurosciences which try to locate these conducts in inadequate synapses and in explanations related to chemical cerebral deficiencies.

Aspectos toxológicos do preservativo de madeira CCA (areniato de cobre cromatado): revisão / Toxicological aspects of chromated copper arsenate (CCA) wood preservative: a review

Chromated copper arsenate (CCA) is a chemical mixture consisting of three pesticide compounds (chromium, copper and arsenic) registered as wood preervatives to prevent fungal or microbial decay. CCA is injected into wood by a process that uses high pressure to saturate wood products with the chemical. CCA-treated wood is commonly used for telephone poles, fence posts, playground equipment, decks, walkways, boat docks and home constructions like fences or pool foors. In this study, a review of the literature was performed, involving articles relating to the toxicology of CCA, a preservative wich is responsible for the largest volume of treated wood in the world. This included relevant information concerning occupationa aspects and public health, particularly its use in homes, parks and playgrounds and aquatic environments to which the public has acess. More attention was given to arsenic, as compared to chromium and copper, because it is the most toxic component in the formula, since it has greater leachinh properties, from wood treated with CCA, as compared to chromium, the second most toxic component. For Brazil BIREME-Latin American and Caribbean Center for Information in Health Sciences was consulted. This gathers 114 Brazilian scientific publications. International literature was researched using Pub Med, a service of the American National Library, wich includes MEDLINE. The periodicals Portal of CAPES was also acessed for international publications, as well as the National system of Toxic-Pharmacological Information - SINITOX...

Riesgo biológico ocupacional en la medicina veterinaria, área de intervención prioritaria / Occupational biological hazard in veterinary medicine: an area for priority interventions

La medicina veterinaria constituye una actividad asociada a riesgos para la salud; durante los últimos años, se han realizado estudios sobre el riesgo biológico de origen animal; desde la óptica de las enfermedades zoonóticas y las reacciones alérgicas en los trabajadores expuestos. A pesar de su importancia, en Colombia, el conocimiento frente al tema es escaso, se ha subestimado su magnitud y existe además una actitud pasiva por parte de los profesionales del sector respecto a dicha problemática. Los pocos espacios para la investigación en el área y las acciones dispersas de divulgación sobre su prevención, repercuten directamente sobre la salud de los trabajadores, la calidad de los servicios ofrecidos y sobre la calidad de vida de la sociedad. El presente artículo discute las causas y repercusiones del riesgo biológico en medicina veterinaria, ofrece un panorama frente a la problemática del medio nacional y contribuye con alternativas de solución.

Evaluación del desarrollo psicomotor en lactantes y preescolares: Los Andes, Chile 1999 / Psychomotor development evaluation in infants and preschool children: Los Andes-Chile, 1999

Con el fin de evaluar el desarrollo psicomotor en lactantes y preescolares de un Consultorio de Atención Primaria en la ciudad de Los Andes y establecer la relación de éste con otros estudios similares realizados a nivel nacional y con algunos factores de riesgo ambiental como: estado nutricional, edad y escolaridad materna, se realizó un estudio con 487 niños sanos entre 0 y 4 años de ambos sexos que asistieron a control sano durante el año 1999. A ésta muestra se le realizó evaluación del desarrollo psicomotor con los test de Soledad Rodríguez y TEPSI de acuerdo a la edad del niño. En los lactantes estudiados un 2,5 por ciento presentó déficit del desarrollo psicomotor valor inferior a lo encontrado en bibliografía y los preescolares presentaron un 30,5 por ciento de desarrollo subnormal valor semejante a la encontrada en Chile. En ambos grupos no se encontró relación con los factores de riesgo considerados; por lo que probablemente existen otras variables más importantes que influyen en el desarrollo psicomotor del niño y que no fueron consideradas en este estudio

Biological and cognitive aspects of somatoform disorders

A practical clinical subdivision of Psychosomatic Syndromes is proposed. Physiological and clinical features of both of them are discussed. The real and serious clinical problem that this entities represents is stated. Actual concepts about functional disorders of the Gl are being analyzed. Special focus is placed in the relation between the anatomical and physiological arrangement of the visceral afferent pathways, and the clinical presentations of these entities. The terms and concepts: hypersensitivity, hyperalgesia, pain thresholds, somatic reference of visceral pain, pain memory, receptive fields are studied.The mechanisms that allows and conduces to the hole expression of the syndrome are thought to have the special characters of the visceral sensorial modalities.It is proposed that many functional psychosomatic patients (Somatoform patients) have alterations in sensorial process at a peripheral level, with alterations in the pain and noxious memory of the Sensitive neurons of the dorsal horn. Cognitive process is being discussed, and an integrative point of view is proposed.It is concluded that the unique clinical, anatomical and physiological feature of visceral sensitive process: Ambiguity, and lack of accuracy, makes it more biased to distortions in the information process

Adolescent pregnancy: are there biological barriers for pregnancy outcomes?

The present prospective study comprised 111 adolescent [< 20 years] and 637 non- adolescent [20+ years] pregnant women, at the main maternity hospital and 79 primary health care centers in Taif area. Their demographic, behavioral, nutritional and socio economic data were analyzed with birth outcomes to compare the latter in the two study groups. The pregnancy outcomes considered were fetal growth retardation [small-for-date], low birth weight, and preterm delivery. Adolescent mothers were found to be more likely to deliver low birth weight infants even after controlling for major risk factors. The possibility of biological barriers to favorable outcome of pregnancy in adolescent mothers could not be overruled. However, more studies are needed to look at biological age rather than chronological age and to determine outcomes of pregnancy such as intra-uterine growth retardation and preterm delivery more accurately before drawing any conclusion

Estudio retrospectivo multicentrico del asma bronquial en la infancia / Multicentric retrospective study of bronquial asthma in infants

Trabajo Retropectivos multicentrico. Fueron estudiados un total de 2.544 pacientes atendidos en los 4 hospitales mas grandes de Santa cruz de la Sierra en 1992. Encontrandose 1.267 pacientes en consulta externa y 1.140 en emergencia. La proporcion de consultas por asma Bronquial en estos Hospitales fue de 2.34 por ciento con un indice de internacion de 5.77 por ciento (147 pacientes internados). Se encontro una leve predominancia del sexo masculino 58.8por ciento sobre el femenino (41.2 por ciento). El grupo etereo mas acometido fueron los mayores de 5 anos. En mas de 60 por ciento de los pacientes internados los principales sintomas fueron Disnea. Sibilancia, Tos y Tiraje. La droga mas utilizada fue la Aminofilina en 93.2 por ciento, seguida de los B2 adrenergicos en 76.9 y los corticoides en 59.2. La mortlidad fue del 1.2 por ciento. La gran mayoria de los pacientes recibio alta con un tiempo medio de internacion de 2,86 dias. Conclusiones que el Asma Bronquial prevalente en Santa Cruz de la Sierra con indice de Internacion y de mortalidad bajos indicando que la mayoria de los ninos responden adecuadamente al tratamiento de la crisis asmatica.