Long-term outcomes of endoscopic sinus surgery for chronic rhinosinusitis with and without nasal polyps.

UNLABELLED: Chronic rhinosinusitis (CRS) significantly affects patient quality of life. Medical and surgical treatments aim to clinically manage the condition. OBJECTIVE: To assess the long-term quality of life and clinical management of CRS in patients submitted to endoscopic sinus surgery. METHOD: This prospective cross-sectional cohort study enrolled 38 patients and looked into the follow-up data of subjects diagnosed with CRS before surgery, three months after surgery, and at least two years after surgery. The Sinonasal Outcome Test 22 (SNOT-22) was used to assess response to treatment and long-term clinical management of the disease. RESULTS: Significant improvements in the SNOT-22 scores were seen between the preoperative (61.3) and postoperative assessments with three (16.9) and 24 (32.3) months. No statistically significant differences were seen when patients with polyps were compared to polyp-free subjects. Few patients were controlled in both groups, and 7.89% of the subjects had revision surgery during the study. CONCLUSION: Endoscopic sinus surgery significantly improved the quality of life of patients with chronic rhinosinusitis. Clinical control of the condition was acceptable, with few patients requiring re-operation within two years of the first surgery.

Resultados em longo prazo da cirurgia endoscópica nasossinusal no tratamento da rinossinusite crônica com e sem pólipos nasais / Long-term outcomes of endoscopic sinus surgery for chronic rhinosinusitis with and without nasal polyps

Rinossinusite crônica (RSC) afeta significativamente a qualidade de vida e o tratamento clínico e cirúrgico visa apenas seu controle clínico. OBJETIVO: Avaliar a qualidade de vida e o controle clínico da RSC em longo prazo em pacientes submetidos à cirurgia endoscópica nasossinusal. MÉTODO: Estudo observacional longitudinal prospectivo que seguiu pacientes com diagnóstico clínico de RSC no pré-operatório, pós-operatório de 3 meses e depois por no mínimo 2 anos após cirurgia nasossinusal endoscópica com a utilização do questionário Sinonasal Outcome Test 22 (SNOT-22) como principal medida de resposta ao tratamento, além da avaliação do controle clínico a longo prazo. RESULTADOS: Trinta e oito pacientes foram avaliados em todos os intervalos. Houve uma grande melhora dos valores do SNOT-22 entre o pré-operatório (61,3) e o pós-operatório de 3 (16,9) e 24 meses (32,3). Não houve diferença estatisticamente significante entre os pacientes com e sem pólipos nasais. Nota-se pouca proporção de pacientes controlados em ambos os grupos, e 7,89% foram submetidos à cirurgia revisional no período estudado. CONCLUSÃO: A cirurgia endoscópica nasossinusal promoveu importante melhora da qualidade de vida nos pacientes com rinossinusite crônica, atingindo controle clínico aceitável com baixa necessidade de reintervenção cirúrgica, mesmo após dois anos de seguimento pós-operatório.

Chronic rhinosinusitis (CRS) significantly affects patient quality of life. Medical and surgical treatments aim to clinically manage the condition. OBJECTIVE: To assess the long-term quality of life and clinical management of CRS in patients submitted to endoscopic sinus surgery. METHOD: This prospective cross-sectional cohort study enrolled 38 patients and looked into the follow-up data of subjects diagnosed with CRS before surgery, three months after surgery, and at least two years after surgery. The Sinonasal Outcome Test 22 (SNOT-22) was used to assess response to treatment and long-term clinical management of the disease. RESULTS: Significant improvements in the SNOT-22 scores were seen between the preoperative (61.3) and postoperative assessments with three (16.9) and 24 (32.3) months. No statistically significant differences were seen when patients with polyps were compared to polyp-free subjects. Few patients were controlled in both groups, and 7.89% of the subjects had revision surgery during the study. CONCLUSION: Endoscopic sinus surgery significantly improved the quality of life of patients with chronic rhinosinusitis. Clinical control of the condition was acceptable, with few patients requiring re-operation within two years of the first surgery.

Evaluation of calcium and folic acid supplementation in prenatal care in São Paulo / Avaliação da suplementação pré-natal de cálcio e ácido fólico na gravidez em São Paulo

CONTEXT AND OBJECTIVE: Preeclampsia and neural tube defects can be prevented during pregnancy. Today, there is level I evidence showing that calcium supplementation during pregnancy may prevent preeclampsia and that use of folic acid may prevent neural tube defects. The aim here was to evaluate the proportion of patients undergoing prenatal follow-up who had received a prescription for calcium and/or folic acid supplementation, and their adherence to the use of these two substances. DESIGN AND SETTING: Cross-sectional study at two hospitals in the Greater São Paulo region, Brazil (Faculdade de Medicina da Fundação ABC, Santo André, and "Dr. Mário de Moraes Altenfelder Silva" Municipal Teaching and Maternity Hospital, Vila Nova Cachoeirinha). METHODS: Early primigravidae, late primigravidae and pregnant women with chronic hypertension, diabetes mellitus or kidney disease who had already had their first prenatal consultation were included. RESULTS: Out of 250 pregnant women interviewed, 10.40 percent had received a prescription for calcium supplementation and 80.76 percent of them reported taking it in tablet form. Regarding folic acid, 48 percent of the women said that they had received a prescription for this and 64.16 percent reported that they had started to use it during the periconceptional period. CONCLUSIONS: Calcium supplementation and periconceptional use of folic acid seem not to be prescribed routinely by physicians. This should motivate the implementation of educational programs for obstetricians on the use of interventions based on the best available evidence.

CONTEXTO E OBJETIVO: Pré-eclâmpsia e defeitos no tubo neural podem ser prevenidas na gravidez. Atualmente há evidência de nível I de que a suplementação de cálcio durante a gestação pode prevenir pré-eclâmpsia, e que o uso de ácido fólico pode prevenir defeitos no tubo neural. O objetivo foi avaliar a proporção de pacientes em acompanhamento de pré-natal que recebem prescrição de suplementação de cálcio e/ou ácido fólico, bem como a proporção das pacientes prescritas que aderem ao uso das duas substâncias. TIPO DE ESTUDO E LOCAL: Estudo transversal em dois hospitais da grande São Paulo (Faculdade de Medicina da Fundação ABC, Santo André, e Hospital Municipal Maternidade Escola "Dr. Mário de Moraes Altenfelder Silva", Vila Nova Cachoeirinha). MÉTODOS: Foram incluídas primigestas precoces e tardias e gestantes hipertensas crônicas, e/ou com diabetes mellitus e nefropatas com a primeira consulta de pré-natal já realizada. RESULTADOS: Das 250 gestantes entrevistadas, 10,4 por cento receberam prescrição de suplementação de cálcio, sendo que 80,76 por cento responderam fazer uso de cálcio na forma de comprimidos. Em relação ao ácido fólico, 48 por cento responderam ter recebido prescrição de suplementos contendo a substância, sendo que 64.16 por cento começaram o uso dentro do período periconcepcional. CONCLUSÕES: A suplementação de cálcio e o uso periconcepcional de ácido fólico parecem não ser prescritos de forma rotineira pelos médicos, o que deve motivar a adoção de programas educacionais para obstetras sobre a utilização de intervenções baseadas na melhor evidência disponível.

Evaluation of calcium and folic acid supplementation in prenatal care in São Paulo.

CONTEXT AND OBJECTIVE: Preeclampsia and neural tube defects can be prevented during pregnancy. Today, there is level I evidence showing that calcium supplementation during pregnancy may prevent preeclampsia and that use of folic acid may prevent neural tube defects. The aim here was to evaluate the proportion of patients undergoing prenatal follow-up who had received a prescription for calcium and/or folic acid supplementation, and their adherence to the use of these two substances. DESIGN AND SETTING: Cross-sectional study at two hospitals in the Greater São Paulo region, Brazil (Faculdade de Medicina da Fundação ABC, Santo André, and "Dr. Mário de Moraes Altenfelder Silva" Municipal Teaching and Maternity Hospital, Vila Nova Cachoeirinha). METHODS: Early primigravidae, late primigravidae and pregnant women with chronic hypertension, diabetes mellitus or kidney disease who had already had their first prenatal consultation were included. RESULTS: Out of 250 pregnant women interviewed, 10.40% had received a prescription for calcium supplementation and 80.76% of them reported taking it in tablet form. Regarding folic acid, 48% of the women said that they had received a prescription for this and 64.16% reported that they had started to use it during the periconceptional period. CONCLUSIONS: Calcium supplementation and periconceptional use of folic acid seem not to be prescribed routinely by physicians. This should motivate the implementation of educational programs for obstetricians on the use of interventions based on the best available evidence.

Hipertensão arterial sistêmica: atualidades sobre sua epidemiologia, diagnóstico e tratamento / Systemic hypertension: latest information on its epidemiology, diagnosis and treatment

A hipertensão arterial sistêmica é uma doença crônica com alta prevalência na população brasileira e mundial, com elevado custo econômico-social, principalmente em decorrência das suas complicações. Estima-se que exista cerca de 1 bilhão de indivíduos hipertensos no mundo, sendo a hipertensão arterial responsável por aproximadamente 7,1 milhões de óbitos por ano. Dando ênfase ao seu controle e tratamento precoces, a classificação da hipertensão arterial foi recentemente modificada pelo Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. A adoção de hábitos de vida saudáveis por todas as pessoas é essencial para a prevenção da hipertensão arterial, sendo indispensável como parte do tratamento para indivíduos hipertensos. A droga de escolha para a maioria dos pacientes portadores de hipertensão arterial primária é um diurético tiazídico. Foi realizado levantamento bibliográfico em bases de dados eletrônicos sobre o tema estudado em março de 2005. Das publicações encontradas, foram utilizadas as que apresentavam os maiores níveis de evidência. Devido a notável prevalência da hipertensão arterial em nosso meio e da necessidade de uma abordagem correta desses pacientes pelos profissionais de saúde, tivemos como objetivo sistematizar o conhecimento atual sobre aspectos epidemiológicos, diagnósticos e terapêuticos da hipertensão arterial.

Systemic hypertension is a chronic disease with a high prevalence among the Brazilians as well as world populations with a high social and economic cost due to its complications.It is estimated that 1 billion individuals all over the world suffer from hypertension, and this disease is responsible for approximately 7,1 million deaths per year. With an emphasis on control and easy treatment, the classification of hypertensionhas been recently modified in the Seventh Report of the Joint National Committee on Prevention, Detection,Evaluation, and Treatment of High Blood Pressure. The adoption of a healthy lifestyle is essential for the preventionof hypertension in all people but it is indispensable as part of the treatment for hypertensive individuals. The choice of drug for most sufferers of basic hypertension is a tiazidic diuretic. Bibliographical survey in electronic databases on the subject studied in March of 2005 was carried through. Offound publications, the ones had been used that presented the biggest levels of evidence. Due to the high prevalenceof hypertension among people and the need for the right approach to these patients by health professionals, ourobjective has been to carry out a review of the literature on the epidemiological, diagnostic and therapeutic aspects ofthis disease and how they are approached in this hospital.

Hipoglicemia reacional: do diagnóstico ao tratamento / Hypoglycemia reactive: from diagnosis to treatment

A hipoglicemia reacional (HR) caracteriza-se por níveis de glicose menores que 60mgdl (3,3mmol/ml) e sintomas simpaticomiméticos observados poucas horas após a ingestão de alimentos. Sua fisiopatologia ainda não está completamente elucidade, porém muitos de seus mecanismos já são conhecidos. Com a revisão da literatura pôde-se comparar a eficiência dos diversos métodos diagnósticos e estabelecer tratamentos mais adequados. A HR deve ser diagnosticada pela observação dos sintomas juntamente à hipoglicemia química, evitando erros diagnósticos. O melhor teste diagnóstico é a dieta hiperglicídica e o tratamento se faz com dieta adequada. Quando esta não é suficiente, a droga de escolha é a acorbose.

Reactive hypoglycemia is due to a biochemical blood glucose less then 3.3mmol/l (60mg/dl) and sympathetic symptoms occurring a few hours after food intake. Although it's pathophysiology is not completely elucidated, many of it's mechanisms are already known. After a literature review, is was possible to compare different diagnose tests in order to propose the most accurate treatment. In order to avoid misdiagnosis, the disease should be diagnosed through the observation of symptoms and chemical hypoglycemia. The best diagnose test is hyperglucidic test, and the main treatment should be diet. If diet itself is not enough, the drug of choise is acarbose.