Sarcopenia em pacientes de 40 a 64 anos hospitalizados por insuficiência cardíaca / Sarcopenia in patients aged 40­64 years hospitalized for heart failure

Introdução: a insuficiência cardíaca (IC) e a sarcopenia são condições prevalentes e inter-relacionadas, figurando como importantes causas de limitações funcionais. Objetivo: avaliar critérios de sarcopenia, e suas relações com parâmetros cardiometabólicos, em pacientes de 40 a 64 anos hospitalizados por IC. Metodologia: estudo de corte transversal com caráter analítico envolvendo indivíduos com IC confirmada. A massa muscular apendicular (MMA) foi avaliada através da absorciometria por raios-X de dupla energia (DXA), considerando-se baixa MMA mulheres com MMA/altura² <5,5 kg/m² ou MMA/índice de massa corporal (IMC) <0,512 e homens com MMA/altura² <7,0 kg/m² ou MMA/IMC <0,789. Baixa força de preensão manual (FPM) foi considerada quando <16 kg em mulheres e <27 kg em homens. Resultados: avaliou-se 109 pacientes (50,5% mulheres), com mediana de idade de 58 anos. Constatou-se baixa MMA em 41,3% e baixa FPM em 64,2%, não havendo correlação significativa entre FPM e MMA em nenhum dos gêneros. Baixa MMA se associou ao gênero masculino (68,9% versus 35,9%; p=0,001), a maiores idades (60,0 [53,0-63,0] versus 57,0 [51,3-60,0] anos; p=0,039) e maiores níveis séricos de paratormônio (48,0 [30,5-94,4] versus 29,9 [23,0-54,1] pg/mL; p=0,009). Baixa FPM se associou a maior sintomatologia cardíaca (75,7% com baixa FPM tinham classificação funcional da New York Heart Association III-IV, versus 51,3% daqueles com FPM normal; p=0,009). Conclusões: há uma relevante prevalência de sarcopenia em pacientes de 40 a 64 anos hospitalizados por IC, observando-se maior frequência de baixa MMA nos homens, associação entre baixa FPM e sintomatologia cardíaca, e maiores níveis de paratormônio naqueles com perda muscular.

Introduction: heart failure (HF) and sarcopenia are prevalent and interrelated conditions, being important causes of functional limitations. Objective: to evaluate sarcopenia criteria, and their relationship with cardiometabolic parameters, in patients aged 40­64 years hospitalized for HF. Methodology: Cross-sectional study including patients with established HF. Appendicular skeletal muscle mass (ASMM) was assessed using dual-energy X-ray absorptiometry (DXA), considering low ASMM women with ASMM/height² <5.5 kg/m² or ASMM/body mass index (BMI) <0.512 and men with ASMM/height² <7.0 kg/m² or ASMM/BMI <0.789. Low handgrip strength (HGS) was considered when <16 kg in women and <27 kg in men. Results: we evaluated 109 patients (50.5% women), with a median age of 58 years. Low ASMM was found in 41.3% and low HGS in 64.2%, with no significant correlation between HGS and ASMM in either gender. Low ASMM was associated with male gender (68.9% versus 35.9%; p=0.001), older age (60.0 [53.0-63.0] versus 57.0 [51.3-60, 0] years; p=0.039) and higher serum parathyroid hormone (48.0 [30.5-94.4] versus 29.9 [23.0-54.1] pg/mL; p=0.009). Low HGS was associated with greater cardiac symptoms (75.7% with low HGS had a New York Heart Association III-IV functional classification, versus 51.3% of those with normal HGS; p=0.009). Conclusions: there is a relevant prevalence of sarcopenia in patients aged 40­64 years hospitalized for HF, observing a higher frequency of low ASMM in men, an association between low HGS and cardiac symptoms, and higher levels of parathyroid hormone in those with muscle wasting.

Inteligência emocional entre estudantes de enfermagem na pandemia de COVID-19 / Inteligencia emocional en estudiantes de enfermería durante la pandemia de COVID-19 / Emotional intelligence among nursing students in the COVID-19 pandemic

Resumo Objetivo Analisar a inteligência emocional entre estudantes de enfermagem na pandemia de COVID-19 e descrever os escores de atenção emocional, clareza e reparação na gestão das emoções. Métodos Trata-se de um estudo quantitativo, observacional de delineamento transversal, composto por 121 estudantes do Curso de Enfermagem da Universidade Federal do Vale do São Francisco. A coleta de dados foi realizada por meio de um formulário autoaplicável contendo Termo de Consentimento Livre e Esclarecido, questionário sociodemográfico e a escala Trait Meta-Mood Scale-24, validado para o uso em língua portuguesa. Os dados foram submetidos a tratamento estatístico utilizando-se o programa Statistical Package for the Social Sciences, versão 20.0. Resultados Não houve diferenças significativas entre sexo, dados sociodemográficos e período da graduação com a pontuação do Trait Meta-Mood Scale-24. Entretanto, os alunos do quarto e do oitavo semestre apresentaram significativamente menores médias desta escala (p=0,015). Conclusão Evidenciou-se a necessidade de abordar a inteligência emocional ao longo da graduação em enfermagem, além de reforçar o amparo psicológico dos estudantes, a partir de serviços já disponibilizados pela universidade.

Resumen Objetivo Analizar la inteligencia emocional de estudiantes de enfermería durante la pandemia de COVID-19 y describir los puntajes de atención emocional, claridad y reparación en la gestión de las emociones. Métodos Se trata de un estudio cuantitativo, observacional de diseño transversal, compuesto por 121 estudiantes de la carrera de Enfermería de la Universidad Federal do Vale do São Francisco. La recopilación de datos se realizó a través de un formulario autoaplicado que contenía el Consentimiento Informado, un cuestionario sociodemográfico y la escala Trait Meta-Mood Scale-24, validada para uso en idioma portugués. Los datos pasaron por tratamiento estadístico utilizando el programa Statistical Package for the Social Sciences, versión 20.0. Resultados No hubo diferencias significativas entre sexo, datos sociodemográficos y semestre de la carrera con el puntaje de la Trait Meta-Mood Scale-24. Sin embargo, los alumnos del cuarto y del octavo semestre presentaron promedios considerablemente inferiores en esta escala (p=0,015). Conclusión Se evidenció la necesidad de tratar la inteligencia emocional a lo largo de la carrera de enfermería, además de reforzar la contención psicológica de los estudiantes, a partir de servicios que la universidad ya ofrece.

Abstract Objective To analyze emotional intelligence among nursing students during the COVID-19 pandemic and describe emotional attention, clarity and repair scores in managing emotions. Methods This is a quantitative, observational cross-sectional study, comprising 121 nursing students at the Universidade Federal do Vale do São Francisco. Data collection was performed using a self-administered form containing the Informed Consent Form, a sociodemographic questionnaire and the Trait Meta-Mood Scale-24, validated for use in Portuguese. Data were submitted to statistical treatment using the Statistical Package for the Social Sciences, version 20.0. Results There were no significant differences between gender, sociodemographic data, and graduation period with Trait Meta-Mood Scale-24 scores. However, fourth and eighth semester students had significantly lower averages on this scale (p=0.015). Conclusion The need to address emotional intelligence throughout the nursing graduation was evidenced, in addition to reinforcing the psychological support of students, based on services already provided by the university.

Medical management of primary hyperparathyroidism

ABSTRACT Primary hyperparathyroidism (PHPT) is an endocrine disorder resulting from the hyperfunction of one or more parathyroid glands, with hypersecretion of parathyroid hormone (PTH). It can be managed by parathyroidectomy (PTX) or non-surgically. Medical therapy with pharmacological agents is an alternative for those patients with asymptomatic PHPT who meet guidelines for surgery but are unable or unwilling to undergo PTX. In this review, we focus upon these non-surgical aspects of PHPT management. We emphasize the most studied and widely used pharmacological alternatives: bisphosphonates, denosumab, cinacalcet and hormone therapy, in addition to combined therapy. We also address the relevant aspects of perioperative management.

Musculoskeletal effects of obesity and bariatric surgery - a narrative review

Abstract Obesity affects several areas of the human body, leading to increased morbidity and mortality and the likelihood of other diseases, such as type 2 diabetes mellitus, cardiovascular diseases and musculoskeletal disorders. These conditions predispose to bone fractures and sarcopenic obesity, defined by the presence of an obesity-associated decrease in muscle mass and strength. Both bone fragility and sarcopenic obesity disease are consequences of several factors, such as a low degree of chronic inflammation, insulin resistance, hormonal changes, nutritional deficiencies, ectopic fat deposits and sedentary lifestyle. The diagnosis of obesity-related musculoskeletal disorders is limited by the lack of sarcopenia criteria and lower accuracy of bone mineral density measurement by dual-energy X-ray absorptiometry in overweight people. Reducing body weight provides undeniable benefits to this population, however treating cases of severe obesity with bariatric surgery can cause even greater damage to bone and muscle health, especially in the long term. The mechanisms involved in this process are not yet fully understood, but factors related to nutrient malabsorption and mechanical discharge as well as changes in gut hormones, adipokines and bone marrow adiposity should be taken into account. Depending on the surgical technique performed, greater musculoskeletal damage may occur, especially in cases of malabsorptive surgeries such as Roux-en-Y gastric bypass, when compared to restrictive techniques such as sleeve gastrectomy. This difference is probably due to greater weight loss, nutrient malabsorption and important hormonal changes that occur as a consequence of the diversion of intestinal transit and loss of greater absorptive surface. Thus, people undergoing bariatric procedures, especially malabsorptive ones, should have their musculoskeletal health supervised to allow early diagnosis and appropriate therapeutic interventions to prevent osteoporotic fractures and preserve the functionality of the skeletal muscles. Arch Endocrinol Metab. 2022;66(5):621-32

Long-term consequences of osteoporosis therapy with denosumab

ABSTRACT Denosumab (DMAb) is a human monoclonal antibody used as an antiresorptive drug in the treatment of osteoporosis. Approval at a dosage of 60 mg every 6 months was based on the results of the randomized, placebo-controlled trial (FREEDOM). The design of this 3-year study included an extension for up to 10 years. Those who were randomized to DMAb continued on drug, while those who were randomized to placebo transitioned to DMAb. The 10-year experience with DMAb provides data on efficacy of drug in terms of reduced fractures and continued increases in bone mineral density (BMD). The 10-year experience with denosumab also provides information about rare complications associated with the use of DMAb, such as osteonecrosis of the jaw (ONJ), and atypical femoral fractures (AFF). This experience provided new insights into the reversibility of effects upon discontinuation without follow-on therapy with another agent. This review focuses upon prolonged treatment with DMAb, with regard to beneficial effects on fracture reduction and safety. Additionally, its use in patients with impaired renal function, compare its results with those of bisphosphonates (BPs), the occurrence/frequency of complications, in addition to the use of different tools, from imaging techniques to histological findings, to evaluate its effects on bone tissue.

Definition and management of very high fracture risk in women with postmenopausal osteoporosis: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Association of Bone Assessment and Metabolism (ABRASSO)

ABSTRACT Several drugs are available for the treatment of osteoporosis in postmenopausal women. Over the last decades, most patients requiring pharmacological intervention were offered antiresorptive drugs as first-line therapy, while anabolic agents were considered a last resource for those with therapeutic failure. However, recent randomized trials in patients with severe osteoporosis have shown that anabolic agents reduce fractures to a greater extent than antiresorptive medications. Additionally, evidence indicates that increases in bone mineral density (BMD) are maximized when patients are treated with anabolic agents first, followed by antiresorptive therapy. This evidence is key, considering that greater increases in BMD during osteoporosis treatment are associated with a more pronounced reduction in fracture risk. Thus, international guidelines have recently proposed an individualized approach to osteoporosis treatment based on fracture risk stratification, in which the stratification risk has been refined to include a category of patients at very high risk of fracture who should be managed with anabolic agents as first-line therapy. In this document, the Brazilian Society of Endocrinology and Metabolism and the Brazilian Association of Bone Assessment and Metabolism propose the definition of very high risk of osteoporotic fracture in postmenopausal women, for whom anabolic agents should be considered as first-line therapy. This document also reviews the factors associated with increased fracture risk, trials comparing anabolic versus antiresorptive agents, efficacy of anabolic agents in patients who are treatment naïve versus those previously treated with antiresorptive agents, and safety of anabolic agents.

Avaliação dos processos organizacionais da atenção primária à saúde / Evaluation of organizational processes of primary health care / Evaluación de procesos organizativos de la atención primaria de salud

Objetivo: Avaliar os processos organizacionais das equipes de Atenção Básica do estado do Pará, segundo seus componentes referentes à organização de prontuários, organização da agenda e acolhimento à demanda espontânea. Métodos: Pesquisa de natureza avaliativa, por meio de um estudo transversal com abordagem quantitativa, utilizando dados do terceiro ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Resultados: A organização de prontuários possui 82,4% de adesão eficiente do modelo por núcleos familiares, com baixo percentual de uso de prontuários eletrônicos (11,1%). A organização da agenda é realizada em sua totalidade na modalidade presencial (100%), com garantia da consulta de retorno ao usuário (90,1%). O acolhimento à demanda espontânea é realizado (99%), com o acesso aos serviços de saúde pelo usuário apenas para renovação de receitas de medicamentos (97,3%). Conclusão: Os dados revelaram fragilidades pertinentes em relação à organização dos prontuários, devido questões materiais e estruturais. Encontram-se potencialidades na organização da agenda e acolhimento à demanda espontânea, garantindo a integralidade do acesso e longitudinalidade do cuidado. (AU)

Objective: Evaluate the organizational processes of Primary Care teams in the state of Pará, according to their components regarding the organization of medical records, organization of the agenda and acceptance of spontaneous demand. Methods: Research of an evaluative nature, through a cross-sectional study with a quantitative approach, using data from the third cycle of the Program National for Improving Access and Quality in Primary Care. Results: The organization of medical records has 82.4% efficient adherence of the model by family nuclei (82.4%), with a low percentage of use of electronic medical records (11.1%). The organization of the agenda is carried out in its entirety in the face-to-face modality (100%), with guaranteed return consultation to the user (90.1%). Welcoming spontaneous demand is performed (99%), with access to health services by the user only for renewing medication prescriptions (97.3%). Conclusion: The data revealed pertinent weaknesses in relation to the organization of medical records, due to material and structural issues. There are potentialities in organizing the agenda and welcoming spontaneous demand, guaranteeing the integrality of access and longitudinality of care. (AU)

Objetivo: Evaluar los procesos organizativos de los equipos de Atención Primaria en el estado de Pará, según sus componentes en cuanto a la organización de la historia clínica, organización de la agenda y aceptación de la demanda espontánea. Métodos: Investigación de carácter evaluativo, mediante un estudio transversal con enfoque cuantitativo, utilizando datos del tercer ciclo del Programa Nacional de Mejoramiento del Acceso y la Calidad en Atención Primaria. Resultados: La organización de historias clínicas tiene 82,4% de adherencia eficiente del modelo por núcleos familiares, con un bajo porcentaje de uso de historias clínicas electrónicas (11,1%). La organización de la agenda se realiza en su totalidad en la modalidad presencial (100%), con consulta de retorno garantizada al usuario (90,1%). Se realiza la acogida de la demanda espontánea (99%), con acceso a los servicios de salud por parte del usuario solo para la renovación de prescripción de medicamentos (97,3%). Conclusión: Los datos revelaron debilidades pertinentes en relación con la organización de las historias clínicas, debido a cuestiones materiales y estructurales. Se pueden encontrar potencialidades en la organización de la agenda y la acogida de la demanda espontánea, garantizando la integralidad del acceso y la longitudinalidad de la atención. (AU)

The impact of visceral fat and levels of vitamin D on coronary artery calcification

SUMMARY OBJECTIVE: To evaluated calcification of the coronary arteries and its association with visceral fat and 25-hydroxyvitamin D (25(OH)D) serum levels. METHODS: A cross sectional study involving 140 individuals without any previous diagnosis of cardiovascular disease. A biochemical analysis of vitamin D serum levels was carried out, as well as computed tomography to measure coronary artery calcium score and visceral adipose tissue. RESULTS: The mean age of the individuals was 55.9 (±12.4). Coronary artery calcium was observed in 40.7% of the population. Vitamin D presented median serum levels of 30.4 ng/ml (IQ24.5-39.1), with 14,1 and 33.7% of the individuals presenting deficiency and insufficiency, respectively. In the univariate analysis, the calcium score was more prevalent in aged patients (p<0.01), in hypertensive individuals (p<0.01), in diabetics (p=0.02), and in those with a higher concentration of VAT (p=0.02). In the adjusted analysis, it was found that the highest concentration of VAT (OR: 4.0; 95%CI 1.4-11.7), hypertension (OR: 4.8; 95%CI 1.5-15.3), and age (OR: 10.4; 95%CI 3.9-27.6) were predictors of subclinical atherosclerosis, regardless of body mass index, diabetes, and 25OHD. CONCLUSIONS: Excess visceral fat was associated with subclinical atherosclerosis, regardless of other risk factors for cardiovascular disease. Serum levels of 25OHD were not associated with CAD in its early stages.

Reference values of 25-hydroxyvitamin D revisited: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society of Clinical Pathology/Laboratory Medicine (SBPC)

ABSTRACT Hypovitaminosis D is a common condition with a negative impact on health. This statement, prepared by experts from the Brazilian Society of Endocrinology and Metabolism and the Brazilian Society of Clinical Pathology/Laboratory Medicine, includes methodological aspects and limitations of the measurement of 25-hydroxyvitamin D [25(OH)D] for identification of vitamin D status, and identifies individuals at increased risk for deficiency of this vitamin in whom 25(OH)D measurement is recommended. For the general population, 25(OH)D levels between 20 and 60 ng/mL are considered normal, while individuals with levels below 20 ng/mL are considered to be vitamin D deficient. This statement identifies potential benefits of maintaining 25(OH)D levels > 30 ng/mL in specific conditions, including patients aged > 65 years or pregnant, those with recurrent falls, fragility fractures, osteoporosis, secondary hyperparathyroidism, chronic kidney disease, or cancer, and individuals using drugs with the potential to affect the vitamin D metabolism. This statement also calls attention to the risk of vitamin D intoxication, a life-threatening condition that occurs at 25(OH)D levels above 100 ng/mL

Rede de atenção: fragilidades no processo de implementação na perspectiva de especialistas em gestão da atenção primária / Care network: the implementation process from professionals' perspective specialized in primary health care management

Objetivo: Conhecer, da perspectiva de profissionais capacitados em gestão de Atenção Primária em Saúde, fragilidades relacionadas aos atributos e elementos necessários à implementação de uma Rede de Atenção às Condições Crônicas na Região Metropolitana III, no Pará. Metodologia: Pesquisa exploratório-descritiva, qualitativa, cujos dados foram colhidos por entrevista semiestruturada com 23 profissionais. A análise de conteúdo dos dados foi fundamentada nos preceitos organizativos da Rede de Atenção à Saúde. Resultados: Os profissionais alegaram fragilidades quanto aos atributos e elementos estruturais de atenção básica: falta de mecanismos de coordenação de cuidados, sistema de governança inoperante, estrutura operacional sem fluxos, déficit de insumos e de material, acesso precário no território, característica marcante na Região Norte. Conclusão: Constatam-se fragilidades na atenção básica e no sistema de governança, a falta de planejamento e pactuações. Urge estabelecer estratégias, planejamento e diálogo entre gestores de saúde da região, incluindo responsabilização dos serviços da rede e profissionais. (AU)

Objective: To know, from the perspective of professionals trained in Primary Health Care management, weaknesses related to the attributes and elements necessary for the implementation of a Network of Attention to Chronic Conditions in the Metropolitan Region III, Pará. Methodology: Exploratory-Descriptive, Qualitative Research , the data collected by semi-structured interview of 23 professionals. The analysis of the content of the data was based on the organizational precepts of the Health Care Network. Results: The professionals claimed fragilities regarding attributes and structural elements of basic care: lack of coordination mechanisms for care, inoperative governance system, operational structure without flows, input and material deficits, precarious access in the territory, a striking feature in the Northern Region. Conclusion: We note weaknesses in basic care and in the governance system, the lack of planning and pacts. It is imperative to establish strategies, planning and dialogue among health managers in the region, including the accountability of network services and professionals. (AU)

Objetivo: Conocer, desde la perspectiva de profesionales capacitados en gestión de Atención Primaria en Salud, fragilidades relacionadas a los atributos y elementos necesarios para la implementación de una Red de Atención a las Condiciones Crónicas en la Región Metropolitana III, en Pará. Metodología: Investigación exploratoria-descriptiva, cualitativa , los datos recogidos por entrevista semiestructurada, de 23 profesionales. El análisis del contenido de los datos fue fundamentado en los preceptos organizativos de la Red de Atención a la Salud. Resultados: Los profesionales alegaron fragilidades en cuanto a los atributos y elementos estructurales de atención básica: falta de mecanismos de coordinación de cuidados, sistema de gobernanza inoperante, estructura operativa sin flujos, déficit de insumos y de material, acceso precario en el territorio, característica marcante en la Región Norte. Conclusión: Se constata a las fragilidades en la atención básica y en el sistema de gobernanza, la falta de planificación y pactos. Es urgente establecer estrategias, planificación y diálogo entre gestores de salud de la región, incluyendo responsabilización de los servicios de la red y profesionales. (AU)

Competências do enfermeiro no rastreio precoce de demência em idosos na atenção primária à saúde / Nursing competencies at the early screening of dementia in elderly persons on primary health care

Objetivos: identificar os conhecimentos, habilidades e atitudes do enfermeiro no rastreio precoce de demência em idosos na atenção primária à saúde e os instrumentos utilizados neste rastreio. Metodologia: pesquisa descritiva, exploratória, com abordagem qualitativa, realizada com 15 enfermeiros das unidades municipais de saúde de Belém-PA, de outubro de 2018 a janeiro de 2019. Coletou-se os dados por meio de entrevista semiestruturada, cujo material gerado foi submetido à Análise de Conteúdo de Bardin. Resultados: emergiram quatro categorias: Conhecimentos do enfermeiro sobre o rastreio precoce de demência; Percepção do enfermeiro sobre suas habilidades no rastreio; Atitudes do enfermeiro ante à identificação de idosos com risco de desenvolver demência; Uso de instrumentos pelo enfermeiro para o rastreio precoce de demência. Conclusão: constatou-se que o enfermeiro necessita voltar-se para o estudo da demência, pois seu conhecimento é escasso; poucos possuem habilidades no rastreio e não conhecem os instrumentos necessários. (AU)

Objectives: to identify nurses' knowledge, skills and attitudes in the early screening of dementia in the elderly in primary health care and the instruments used in this screening. Methodology: a descriptive, exploratory, qualitative study with 15 nurses from the municipal health units of Belém-PA, from October 2018 to January 2019. The data were collected through a semi- structured interview, the material of which was submitted to the Analysis of Bardin's Content. Results: four categories emerged: Nurses' knowledge about early dementia screening; Nurses' perceptions of their screening skills; Nurses' attitudes towards the identification of elderly individuals at risk of developing dementia; Nurses' use of instruments for the early screening of dementia. Conclusion: it was found that nurses need to go back to the study of dementia, because their knowledge is scarce; few have screening skills and do not know the necessary tools. (AU)

Objetivos: identificar los conocimientos, habilidades y actitudes del enfermero en el seguimiento precoz de demencia en ancianos en la atención primaria a la salud y los instrumentos utilizados en este rastreo. Metodología: investigación descriptiva, exploratória, com enfoque qualitativo, realizada com 15 enfermeros de las unidades municipales de salud de Belém-PA de octubre de 2018 a enero de 2019.Se recopiló los datos por medio de una entrevista semiestructurada cuyo material generado fue sometido al Análisis de Contenido de Bardin. Resultados: surgieron cuatro categorías: Conocimientos del enfermero sobre el seguimiento precoz de demencia; Percepción del enfermero sobre sus habilidades en el rastreo; Actitudes del enfermero ante la identificación de ancianos con riesgo de desarrollar demencia; Uso de instrumentos por el enfermero para el seguimiento precoz de demencia. Conclusión: se constató que el enfermero necesita volverse hacia el estudio de la demencia, pues su conocimiento es escaso; pocos tienen habilidades en el rastreo y no conocen los instrumentos necesarios. (AU)

Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Objective To present an update on the diagnosis and treatment of hypoparathyroidism based on the most recent scientific evidence. Materials and methods The Department of Bone and Mineral Metabolism of the Sociedade Brasileira de Endocrinologia e Metabologia (SBEM; Brazilian Society of Endocrinology and Metabolism) was invited to prepare a document following the rules set by the Guidelines Program of the Associação Médica Brasileira (AMB; Brazilian Medical Association). Relevant papers were retrieved from the databases MEDLINE/PubMed, LILACS, and SciELO, and the evidence derived from each article was classified into recommendation levels according to scientific strength and study type. Conclusion An update on the recent scientific literature addressing hypoparathyroidism is presented to serve as a basis for the diagnosis and treatment of this condition in Brazil.

Tratamento endovascular versus tratamento aberto de aneurisma de artéria poplítea: artigo de revisão / Endovascular vs. open repair of popliteal artery aneurysm: review article

O tratamento convencional do aneurisma da artéria poplítea é a cirurgia aberta de exclusão do aneurisma e revascularização do membro acometido. Nos últimos anos, o tratamento endovascular vem ganhando popularidade e interesse. O tratamento endovascular é menos invasivo e de menor morbidade; porém, é de alto custo e sua perviedade é incerta. O objetivo desta revisão é comparar os dois tratamentos através da análise de desfechos abordados em estudos primários e secundários. Realizou-se uma revisão narrativa da literatura publicada nos últimos 5 anos. Foram selecionados seis estudos retrospectivos, duas metanálises, um ensaio clínico e uma revisão sistemática Cochrane. Número limitado de pacientes e curto período de seguimento não nos permitem extrair conclusões consistentes. Não há evidência clara que sugere melhores resultados entre um ou outro tratamento eletivo. Novos ensaios randomizados devem ser realizados para determinar o papel do tratamento endovascular desse aneurisma

he conventional treatment for a popliteal artery aneurysm is open surgery to exclude the aneurysm and revascularization of the affected limb. Over recent years, endovascular treatment has grown in popularity and has been attracting increased interest. Endovascular treatment is less invasive and associated with lower rates of morbidity, but it is expensive and patency is uncertain. The aim of this review is to compare these two treatments by analyzing the outcomes reported in primary and secondary studies. A narrative review is conducted of the literature published over the last 5 years. Six retrospective studies, two meta-analyses, one clinical trial and one Cochrane systematic review were selected. We were unable to draw firm conclusions because of small patient samples and short follow-up periods. There is no clear evidence to indicate that the outcomes of one or another elective treatment are superior. New randomized trials should be conducted to determine the role endovascular treatment has to play in management of this type of aneurysm

Práticas e saberes do cuidador familiar de portadores de Alzheimer à luz de stratuss / Practices and knowledge of the family caregiver of carriers of Alzheimer's disease in the light of stratuss

Objetivo: Analisar práticas e saberes do cuidador familiar de portadores de Alzheimer à luz da teoria de Strauss”. Método: Estudo do tipo descritivo com abordagem qualitativa e análise a luz da Teoria Fundamentada nos Dados desenvolvida por Anselm Strauss. Resultados: Emergiram três categorias analíticas com as respectivas subcategorias. “A dimensão do cuidar” e subcategorias: I Rotina Geral;II Rotina/ Relação do Grau de dependência; III Interferência do uso de medicação na rotina. “Enfrentamento das dificuldades no cuidado ao paciente” e subcategorias: IV Enfrentamento das Dificuldades; V Alimentação higiene corporal e medicação; VI Comportamento do paciente humor e agressividade; VII Impactos na descoberta da doença. “Possibilidades de aquisição do conhecimento” e subcategoria.VIII Busca pelo conhecimento através da mídia, equipes de saúde e Associação Brasileira de Alzheimer. Conclusão: As várias fases da doença influenciam no processo de cuidar havendo a necessidade de entender a doença em todos os aspectos.

Allium sativum compared to cilostazol as an inhibitor of myointimal hyperplasia

Abstract Objective: Intimal hyperplasia is associated with graft failure and vascular sutures in the first year after surgery and in postangioplasty restenosis. Allium sativum (common garlic) lowers cholesterol and has antioxidant effects; it also has antiplatelet and antitumor properties and, therefore, has great potential to reduce or inhibit intimal hyperplasia of the arteries. Our objective is to determine if the garlic has an efficacy to inhibit myointimal hyperplasia compared to cilostazol. Methods: Female New Zealand rabbits were divided into the following groups (n=10 each) according to treatment: group A, garlic, 800 µg×kg-1×day-1, orally; group C, cilostazol, 50 mg.day-1, orally; group PS, 10 ml of 0.9% physiological saline solution, orally. Our primary is the difference of the mean of myointimal hyperplasia. Statistical analysis was performed by using ANOVA and Tukey tests, as well as the Chi-square test. We calculated the 95% confidence interval for each point estimate, and the P value was set as < 0.05. Results: Group PS had a mean hyperplasia rate of 35.74% (95% CI, 31.76–39.71%); group C, 16.21% (95% CI, 13.36–19.05%); and group A, 21.12% (95% CI, 17.26–25.01%); P<0.0001. Conclusion: We conclude that Allium sativum had the same efficacy in inhibiting myointimal hyperplasia when compared to the positive control, cilostazol.

Herpes zoster ophthalmicus and varicella zoster virus vasculopathy / Herpes zoster ophthalmicus e vasculopatia por vírus varicella zoster

ABSTRACT Herpes zoster (HZ) corresponds to the reactivation of varicella zoster virus (VZV). Among adults, the ophthalmic division of the trigeminal nerve is one of the most common sites of involvement. Vasculopathy caused by HZ is associated with significant morbidity and mortality, affecting structures such as the brain, which can lead to stroke. In this review, we analyzed the epidemiological and clinical aspects of the vascular involvement of VZV, focusing on the peculiarities of its association with ocular HZ. A review of the available literature indicated that ocular involvement of HZ was a risk factor for vasculopathy after adjusting for age, sex, body mass index, smoking, indicators of metabolic syndrome, and vascular and heart diseases. Considering the severity of this complication, vascular disease mediated by VZV requires early diagnosis and aggressive treatment. Finally, the anti-HZ vaccine has been recommended as a prophylactic measure in the elderly, but it should be used with caution in immunocompromised individuals.

RESUMO Herpes zoster (HZ) corresponde à reativação do vírus varicela zoster (VVZ) e, entre os adultos, o envolvimento da divisão oftálmica do nervo trigêmeo é um dos locais mais comuns A vasculopatia associada ao HZ é uma complicação dotada de grande morbimortalidade e afeta diferentes estruturas, favorecendo, inclusive o acidente vascular cerebral. Nesta revisão analisamos aspectos epidemiológicos e clínicos da vasculopatia mediada pelo VZV, bem como as peculiaridades relacionadas com o HZ ocular. De acordo com dados disponíveis na literatura, o acometimento ocular pelo HZ mostrou ser um fator de risco para vasculopatia após se ajustar para idade, sexo, índice de massa corporal, tabagismo, indicadores da síndrome metabólica, doença vascular e cardiopatias. Em face da gravidade dessa complicação, a doença vascular mediada pelo VZV requer diagnóstico precoce e tratamento agressivo. A vacina anti-HZ tem sido recomendada profilaticamente em idosos, mas deve ser usada com cautela em indivíduos imunocomprometidos.

Iliac artery myointimal hyperplasia in rabbits submitted to angioplasty and treated with Moringa oleifera / Hiperplasia miointimal na artéria ilíaca em coelhos submetidos à angioplastia e tratados com Moringa oleifera

Objective: to assess post-angioplasty myointimal hyperplasia in iliac artery of rabbits treated with extract of Moringa oleifera leaves. Methods : we conducted a randomized trial in laboratory animals for five weeks of follow-up, developed in the Vivarium of Pharmaceutical Technology Laboratory of the Universidade Federal da Paraíba. We used rabbits from the New Zealand breed, subjected to a hypercholesterolemic diet and angioplasty of the external iliac artery, randomized into two groups: M200 Group (n=10) - rabbits treated with 200mg/kg/day of Moringa oleifera leaves extract orally; SF group (n=10) - rabbits treated with 0.9% saline orally. After five weeks, the animals were euthanized and the iliac arteries prepared for histology. Histological sections were analyzed by digital morphometry. Statistical analysis was performed using the Student's t test. The significance level was 0.05. Results : there was no significant difference in myointimal hyperplasia between M200 and SF groups when comparing the iliac arteries submitted to angioplasty. Conclusion : there was no difference of myointimal hyperplasia between groups treated with saline and Moringa oleifera after angioplasty.

Objetivo: determinar a diferença da média de hiperplasia miointimal pós-angioplastia na artéria ilíaca de coelhos tratados e não tratados com extrato das folhas de Moringa oleifera. Métodos: ensaio aleatório em animais de laboratório por cinco semanas de seguimento, desenvolvido no Biotério do Laboratório de Tecnologia Farmacêutica da Universidade Federal da Paraíba. Foram utilizadas coelhas da raça Nova Zelândia, submetidas à dieta hipercolesterolêmica e angioplastia da artéria ilíaca externa, randomizadas em dois grupos: Grupo M200 (n=10), coelhas tratadas com 200mg/kg/dia de extrato de folhas de Moringa oleifera, por via oral; Grupo SF (n=10), coelhas tratadas com soro fisiológico 0,9%, por via oral. Após cinco semanas, os animais foram eutanaziados e as artérias ilíacas preparadas para histologia. Os cortes histológicos foram analisados por morfometria digital. A análise estatística foi realizada com o teste t de Student. O nível de significância foi 0,05. Resultados: comparando as artérias ilíacas submetidas à angioplastia do grupo M200 com as do grupo SF, não houve diferença significativa da hiperplasia miointimal Conclusão: não houve diferença da hiperplasia miointimal nos grupos tratados com soro fisiológico e Moringa oleifera após angioplastia.

Diagnosis and management of Paget?s disease of bone / Diagnóstico e tratamento da doença de Paget óssea

Objective: To conduct a literature review on the diagnosis and management of Paget’s disease of bone. Materials and methods: This scientific statement was generated by a request from the Brazilian Medical Association (AMB) to the Brazilian Society of Endocrinology and Metabolism (SBEM) as part of its Clinical Practice Guidelines program. Articles were identified by searching in PubMed and Cochrane databases as well as abstracts presented at the Endocrine Society, Brazilian Society for Endocrinology Annual Meetings and the American Society for Bone and Mineral Research Annual Meeting during the last 5 years. Grading quality of evidence and strength of recommendation were adapted from the first report of the Oxford Centre for Evidence-based Medicine. All grades of recommendation, including “D”, are based on scientific evidence. The differences between A, B, C and D, are due exclusively to the methods employed in generating evidence. Conclusion: We present a scientific statement on Paget’s disease of bone providing the level of evidence and the degree of recommendation regarding causes, clinical presentation as well as surgical and medical treatment. Arq Bras Endocrinol Metab. 2014;58(6):587-99 .

Objetivo: Conduzir uma atualização das últimas evidências científicas a respeito da apresentação, diagnóstico e manejo clínico da doença de Paget óssea. Materiais e métodos: Este documento foi concebido pelo Departamento de Metabolismo Ósseo da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) a partir daquele oriundo do Programa de Diretrizes da Associação Médica Brasileira (AMB). Realizamos uma revisão dos artigos mais relevantes obtidos nos bancos de dados PubMed e Cochrane, além de abstracts apresentados nos encontros anuais da Endocrine Society, Sociedade Brasileira de Endocrinologia e da American Society for Bone and Mineral Research dos últimos cinco anos e classificamos as evidências em níveis de recomendações de acordo com a força científica por tipo de estudo, adaptando o primeiro relato do “Oxford Centre for Evidence-based Medicine”. Todos os graus de recomendação, incluindo-se o “D”, foram baseados em evidência científica, sendo as diferenças entre o A, B, C e D devidas exclusivamente ao desenho empregado na geração da evidência. Conclusão: Apresentamos uma atualização científica a respeito da doença de Paget óssea, classificando e graduando em níveis de recomendações as principais evidências científicas sobre as suas causas, as variadas formas de apresentação, seu diagnóstico e tratamento. .