Avaliação do paciente com artrite / Assessment of patients with arthritis

Artrites são manifestações clínicas de uma série de doenças. Sua classificação etiológica é muitas vezes difícil e depende de história clínica e exame físico cuidadosos. Artrite séptica e gota se apresentam mais comumente como monoartrite aguda e quadros reacionais são geralmente poliarticulares. A internação hospitalar é fator de risco para o desenvolvimento tanto de artrites reacionais quanto para crises de gota e artrite séptica. O diagnóstico precoce é muito importante a fim de iniciar o tratamento precocemente, alívio dos sintomas e preservação da funcionalidade articular. A punção do líquido sinoviale sua análise são de fundamental importância diagnóstica nos quadros de monoartrite aguda.

Arthritis are clinical manifestations of plenty of diseases. Its etiological classification is many timesdifficult and depends on careful clinical history and physical examination. Gout and skeptical arthritispresents commonly as acute monoarthritis and reactional arthritis are often polyarticular. Hospitalaradmission is a risk factor to the development of reactional arthritis, crisis of gout and septical arthritis.Early diagnosis is imperative to start early treatment, symptom relief and articular function preservation.Synovial fluid aspiration and its analysis are of critical diagnostic importance in cases of acute monoarthritis.

Insuficiência renal aguda / Acute renal failure

A Insuficiência Renal Aguda (IRA) pode estar associada a várias etiologias no organismo humano,sendo este um dos motivos da importância dispensada àa esta doença. A prevenção é a principal ferramenta do médico e quando esta não foi possível, o tratamento visa afastar as principais causas,com investigação das demais e medidas de suporte para manter a viabilidade renal, muitas das vezes com êxito. A taxa de mortalidade em pacientes com IRA não se alterou muito nos últimos 30 anos. Os óbitos podem ocorrer em consequência da doença de base e não da própria IRA, pois o rim é um dos poucos órgãos cuja função pode ser substituída em parte por longos períodos (ex. diálise).

The Acute Renal Failure (ARF) can be related to several etiologies in the human organism, being one ofthe reasons of the importance given to this disease. The prevention is the doctor's main tool and, whenit is not possible, the treatment looks forward repelling the main causes, also investigating the othersand keeping supportive care to maintain the renal viability, most of the times, successfully. The mortalityrate in patients with ARF did not change much in the last 30 years. The deaths can occur as a result of theunderlying disease and not of ARF, because the kidney is one of the few organs which function can besubstituted, in part, for long periods (ex. dialysis).

Manejo das complicações agudas da doença falciforme / Management of acute complications of sickle cell disease

Anemia falciforme (HbSS) é uma doença autossômica recessiva caracterizada pela herança homozigotada hemoglobina S (HbS). Clinicamente apresenta-se com anemia hemolítica e vaso-oclusão. O termo doença falciforme engloba a anemia falciforme e heterozigozes compostas com hemoglobina S,como S? talassemia e hemoglobinopatia SC, além de outras associações menos comuns. São várias as complicações agudas na doença falciforme: crises vaso-oclusivas, infecções por microorganismos encapsulados, principalmente do trato respiratório e septicemia, síndrome torácica aguda, sequestro esplênico, priapismo, Acidente Vascular Cerebral (AVC) e crise aplástica. O conhecimento das intercorrências na Doença Falciforme é de extrema importância para todos os níveis de atendimento destes pacientes. A detecção precoce das complicações possibilita tratamento adequado e diminuição da morbimortalidade relacionada a elas.

Sickle cell anemia (SCA) is an autosomal recessive disease characterized by the presence of hemoglobinS. It presents with hemolytic anemia e vaso-occlusives phenomena. The term sickle cell disease (SCD)includes the SCA and a group of compound heterozygous states in which the person has only one copy of the mutation that causes HbS and one copy of another abnormal haemoglobin allele, like sickle hemoglobinC disease (HbSC), sickle beta-thalassaemia and other rarer combinations. There are many acute complications of SCD: vaso-occlusives crisis, encapsulated organisms infections, mainly of the airways and sepsis, acute chest syndrome, splenic sequestration, priapism, stroke and aplastic crisis.The knowledge of these complications is very important for all grades of medical assistence. The early detection allows appropriate treatment and reduction of the morbidity and mortality associated with the disease.

Álcool e sistema nervoso central / Alcohol and central nervous system

Os efeitos patológicos do uso do álcool sobre o Sistema Nervoso Central (SNC) são bem conhecidos, embora nem todos tenham explicação satisfatória. Os sintomas podem advir de qualquer nível do neuroeixo incluindo o encéfalo, nervos periféricos e músculos. Traumatismos cranioencefálicos devido aos graves acidentes automobilísticos causados por motoristas embriagados também devem ser mencionados como consequência do álcool sobre o SNC. O fator genético é outro determinante importante do risco para a patogênese do grupo de sintomas que juntos são característicos ou indicativos da condição específica (alcoolismo), incluindo a predisposição individual para o alcoolismo.O objetivo deste texto é listar as complicações mais importantes do álcool sobre o SNC, importantes para o conhecimento do clínico. Enquanto a confirmação diagnóstica, o tratamento e o seguimento de várias das complicações mencionadas neste capítulo são normalmente de responsabilidade do neurologista, o clínico é frequentemente o primeiro a avaliar o paciente e deve estar suficientemente familiarizado com afecções do cérebro e da coluna espinhal para formular o diagnóstico e o tratamento inicial visando o controle ou a cura do problema; estas duas vertentes de abordagens têm provado alterar o provável curso de inúmeras afecções sobre o SNC, causados pelo abuso do álcool, especialmente a possibilidade de poder revertê-las.

The effects of pathologic patterns of alcohol use on the Central Nervous System (CNS) are a wellestablished fact, although not all have received a satisfactory explanation. The symptoms can be felt atany level of the neural axis, including the brain, peripheral nerves and muscles. Cranio-encephalic traumatism (CET) from severe car accidents caused by drunk drivers should also be mentioned as an unfortunate after-effect of alcohol abuse on the CNS. Genetic factors are another important determinant of the risk for the pathogenesis of the group of symptoms that together are characteristic or indicative of this specific condition (alcoholism), including aperson's inward disposition toward alcoholism. Our aim in this chapter is to list the most important complications of alcohol intake on the CNS, considered to be indispensable knowledge for all clinicians. Although diagnostic confirmation, treatment and follow-up of several of the complications mentioned in this chapter are usually within the province of the neurologist, the internist or general physician is oftenthe first to evaluate the patient and should be familiar enough with head and spine injury to formulate the initial diagnosis and treatment of the disorder by some remedial or curative process; this two-pronged approach has proved to involve a change in the forecast of the probable course of several affections of the CNS by alcohol abuse, especially of the possibility for recovery.

Dengue: transmissão, aspectos clínicos, diagnóstico e tratamento / Dengue: transmission, clinical features, diagnosis and treatment

A dengue é uma arbovirose transmitida principalmente pela picada do mosquito Aedes aegypti. Pode ser assintomática ou apresentar amplo espectro clínico, variando de doença febril autolimitada até formas graves, que podem evoluir com choque circulatório e óbito. Para evitar esse desfecho, a precocidade no diagnóstico da doença e na detecção de sinais de alarme, que indicam evolução desfavorável; assim como a instituição de tratamento adequado, são fundamentais. Não há tratamento específico, ele é apenas sintomático e de suporte. Até o momento, não existe vacina disponível para prevenção da doença, sendo o controle do vetor a medida mais efetiva.

Dengue is an arbovirus transmitted mainly by the bite of the mosquito Aedes aegypti. It can be asymptomaticor present a wide clinical spectrum, ranging from self-limited febrile illness to severe forms that could evolve with circulatory shock and death. In order to avoid this outcome, early diagnosis of disease and the detection of warning signs that indicate unfavorable, as well as adequate treatment are essential,There is no specific treatment, it is only symptomatic and supportive. Up to now, there is no vaccine available for prevention of disease, vector control the most effective measure.

Infecção do trato urinário / Urinary tract infection

A infecção do trato urinário (ITU) é uma das causas mais comuns de infecção na população geral. É mais prevalente no sexo feminino, mas também acomete pacientes do sexo masculino principalmente quando associada à manipulação do trato urinário e à doença prostática. A ITU pode ser classificada quanto à localização em ITU baixa (cistite) e ITU alta (pielonefrite) e quanto à presença de fatores complicadores em ITU não complicada e ITU complicada. A ITU é complicada quando estão presentes alterações estruturais ou funcionais do trato urinário ou quando se desenvolve em ambiente hospitalar. Na ITU não complicada a Escherichia coli é a bactéria responsável pela maioria das infecções enquanto nas ITUs complicadas o espectro de bactérias envolvido é bem mais amplo incluindo bactérias Grampositivas e Gram negativas e com elevada frequência organismos multirresistentes. ITU é definida pela presença de 100.000 ufc/mL. Os sinais e sintomas associados à ITU incluem polaciúria, urgência miccional, disúria, hematúria e piúria. A escolha da terapia antimicrobiana para a ITU varia de acordo com a apresentação da infecção, hospedeiro e agente. Estratégias envolvendo diferentes esquemas terapêuticos de acordo com grupos específicos de pacientes maximizam os benefícios terapêuticos, além de reduzir os custos, as incidências de efeitos adversos e o surgimento de microrganismos resistentes.

Urinary Tract Infection (UTI) is one of the most common causes of infection in the general population. Itis more prevalent in females, but also affects male patients especially when associated with manipulation of the urinary tract and prostate disease. The UTI can be classified according to location in lower UTI (cystitis) and high UTI (pyelonephritis) and according the presence of complicating factors in uncomplicated UTI and complicated UTI. The ITU is complicated when structural or functional abnormalities of the urinary tract are present or when it develops in the hospital. In uncomplicated UTI, Escherichia coli is the bacteria responsible for most infections while in complicated UTIs the bacterial spectrum involved is much broader including Gram positive and Gram-negative and high-frequency multi-resistant organisms. UTI is defined by the presence of 100000 cfu/mL. Signs and symptoms associated with UTI include urinary frequency, urinary urgency, dysuria, hematuria and pyuria. The choice of antimicrobial therapy for UTI varies with the presentation of the infection, host and agent. Strategies involving different treatment regimens according to specific patient groups maximize the therapeutic benefits and reduce costs, the incidences of adverse effects and the emergency of resistant organisms.

Pulmonary artery sarcoma and chronic thromboembolism.

Pulmonary artery sarcoma is a rare and highly lethal disease whose clinical findings are often indistinguishable from those of chronic thromboembolic pulmonary hypertension. Partial improvement after thrombolytic therapy has suggested that thromboembolic phenomena may be superimposed on the tumor, but, to date, a well-documented statement of these events has not been provided.

Stroke-independent association between metabolic syndrome and functional dependence, depression, and low quality of life in elderly community-dwelling Brazilian people.

OBJECTIVES: Metabolic syndrome (Met.S) is a risk factor for stroke, dementia, and ischemic heart disease (IHD). It is unclear whether Met.S is an independent risk factor for functional dependence, depression, cognitive impairment, and low health-related quality of life (HRQoL) in a population free of clinical stroke. DESIGN: Cross-sectional. SETTING: Two communities in southern Brazil. PARTICIPANTS: Four hundred twenty people aged 60 and older. MEASUREMENTS: An adapted (body mass index > or =30 kg/m(2) and blood pressure > or =140/90) Adult Treatment Panel III definition was used in diagnosing Met.S. Depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised) and Mini-Mental State Examination were evaluated along with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). HRQoL was measured using a visual analogue scale (0-10). All values were adjusted for age, sex, and presence of IHD. RESULTS: Forty (9.5%) subjects had a stroke and were excluded from the final analysis. Met.S was present in 37.4% of the stroke-free population. Met.S was significantly and independently associated with 2.24 times as much ADL dependence, 2.39 times as much IADL dependence, a 2.12 times higher risk of depression, a 2.27 times higher likelihood of cognitive impairment, and a 1.62 times higher chance of low self-perceived HRQoL (all P<0.05). Adjustment for its own components reduced the strength of the above associations but did not eliminate their statistical significance. If Met.S were removed from this population, dependence, depression, cognitive impairment, and low QoL would be reduced 15.0% to 21.4%. CONCLUSION: Met.S was significantly associated with functional dependence, depression, cognitive impairment, and low HRQoL, and its effects were independent of clinical stroke, IHD, and its own individual components.

Terpinen-4-ol: mechanisms of relaxation on rabbit duodenum.

The effect of terpinen-4-ol was studied on rabbit duodenum in-vitro. Terpinen-4-ol induced relaxation of the basal tonus (IC50 170.2 (95% confidence interval, 175-204) microM) with a maximal relaxant response of 180.4+/-3.9% (n=6) of the contraction induced by 60 mM [K(+)]. The maximal relaxation induced in control conditions was not affected (P>0.05) by pretreatment of the tissues with phentolamine (50 microM) or propranolol (10 microM), N(G) nitro-L-arginine methyl ester (L-NAME; 1 mM), 1H-(1,2,4)oxadiazolo[4,3-a]quinoxalin-1-one (ODQ; 100 microM), hexamethonium (1 mM), tetrodotoxin (1 microM), the mixture charybdotoxin-apamin (1 microM), glibenclamide (10 microM), 4-aminopyridine (10 microM) or tetraethyl-ammonium (100 microM). In addition, terpinen-4-ol completely relaxed tissues precontracted with 60 mM [K(+)] solutions (IC50 325.9 (245.1-433.1) microM) and also blocked (IC50 154.7 (117.7-191.7) microM) the phasic component of this contraction. At a concentration of 195 and 650 muM it reduced by 41.3+/-3.4% and 75.4+/-3.1%, respectively the maximal contractile response to Ca(2+) in depolarized duodenum. Terpinen-4-ol completely blocked the component of carbachol-induced contraction, which was resistant to nifedipine (100 microM) pretreatment or to a Ca(2+)-free solution. These data show that terpinen-4-ol relaxes intestinal smooth muscle and suggest that this effect is myogenic in nature and depends on calcium antagonism.