Clinical aspects, diagnosis and management of Loxosceles spider envenomation: literature and case review.

The genus Loxosceles comprises 140 species widely distributed around the world. These spiders are nocturnal, sedentary and remarkably nonaggressive, although they cause accidents in humans with wide degrees of severity, generating signs and symptoms that define the clinical condition known as loxoscelism. Its local signs and symptoms were first reported in 1872, and over the years, a large medical literature has been accumulated; unfortunately, it is not always trustworthy. Assessing the reliability of such information, we reviewed 120 case reports of loxoscelism published in 84 articles over the past 20 years. This search allowed us to gather information on the clinical aspects, diagnosis and treatment of loxoscelism, showing that the severity of these accidents has multiple degrees and that it is influenced by many factors. Thus, coupled with epidemiological and species occurrence information, this study can be a useful tool for the clinical practice of loxoscelism. It may support and provide a multidisciplinary view that should be taken into consideration when establishing the therapeutic approach in cases of Loxosceles envenomation.

Clinical aspects, diagnosis and management of Loxosceles spider envenomation: literature and case review

The genus Loxosceles comprises 140 species widely distributed around the world. These spiders are nocturnal, sedentary and remarkably nonaggressive, although they cause accidents in humans with wide degrees of severity, generating signs and symptoms that define the clinical condition known as loxoscelism. Its local signs and symptoms were first reported in 1872, and over the years, a large medical literature has been accumulated; unfortunately, it is not always trustworthy. Assessing the reliability of such information, we reviewed 120 case reports of loxoscelism published in 84 articles over the past 20 years. This search allowed us to gather information on the clinical aspects, diagnosis and treatment of loxoscelism, showing that the severity of these accidents has multiple degrees and that it is influenced by many factors. Thus, coupled with epidemiological and species occurrence information, this study can be a useful tool for the clinical practice of loxoscelism. It may support and provide a multidisciplinary view that should be taken into consideration when establishing the therapeutic approach in cases of Loxosceles envenomation.

Clinical aspects, diagnosis and management of Loxosceles spider envenomation: literature and case review

The genus Loxosceles comprises 140 species widely distributed around the world. These spiders are nocturnal, sedentary and remarkably nonaggressive, although they cause accidents in humans with wide degrees of severity, generating signs and symptoms that define the clinical condition known as loxoscelism. Its local signs and symptoms were first reported in 1872, and over the years, a large medical literature has been accumulated; unfortunately, it is not always trustworthy. Assessing the reliability of such information, we reviewed 120 case reports of loxoscelism published in 84 articles over the past 20 years. This search allowed us to gather information on the clinical aspects, diagnosis and treatment of loxoscelism, showing that the severity of these accidents has multiple degrees and that it is influenced by many factors. Thus, coupled with epidemiological and species occurrence information, this study can be a useful tool for the clinical practice of loxoscelism. It may support and provide a multidisciplinary view that should be taken into consideration when establishing the therapeutic approach in cases of Loxosceles envenomation.

Hemorragia subaracnóidea aneurismática: análise da evolução dos pacientes internados em um hospital de Tubarão / Aneurysmal subarachnoid hemorrhage: analysis of the evolution of the patients hospitalized at a hospital of Tubarão

Introdução: Estima-se que 2 a 3% dos seres humanos sejam portadores de aneurismas intracranianos. A ruptura dessas lesões gera um quadro clínico grave, com hemorragia subaracnóidea, cuja taxa de mortalidade chega a 40%. Objetivo: Analisar a evolução dos pacientes com hemorragia subaracnóidea de origem aneurismática internados no Hospital Nossa Senhora da Conceição (HNSC). Métodos: Realizado um estudo de coorte histórica e coorte. A população foi composta por todos os pacientes portadores de hemorragia subaracnóidea aneurismática internados entre janeiro de 2005 e maio de 2007. Resultados: A população foi composta por 33 pacientes, com prevalência maior em mulheres (57.5%). Pacientes tabagistas totalizaram 63% e hipertensos 54.6%. História prévia de aneurismas foi duas vezes maior no grupo de mau prognóstico (RP=2.00; IC 95%: 1.32-2.92). Cefaléia ou meningismo foi a apresentação clínica mais comum (66.7%). Pacientes submetidos ao tratamento cirúrgico apresentaram uma prevalência quase 60% menor de vir a ter um desfecho ruim na alta hospitalar (RP=0.43; IC 95%: 0.26-0.70; pKruskal-Wallis =0.03). Após a hemorragia aguda, 42.3% dos integrantes puderam retomar suas atividades laborais. Conclusão: Os resultados encontrados foram compatíveis com os descritos na literatura, o que sustenta a manutenção da modalidade terapêutica atual do HNSC frente aos pacientes com hemorragia subaracnóidea aneurismática.

Introduction: It is estimated that 2 to 3% of humans have intracranial aneurysms. The rupture of this lesion develop a serious clinical situation, with subarachnoid hemorrhage, whose rate of mortality arrives to 40%. Objective: To analyze the evolution of the patients with subarachnoid hemorrhage originated from intracranial aneurysms hospitalized at Nossa Senhora da Conceição Hospital (HNSC). Methods: A study of historical cohort and cohort. The population was formed by aneurysmal subarachnoid hemorrhage diagnosis patients hospitalized from January 2005 though May of 2007. Results: The population was formed by 33, with a higher prevalence in women (57.5%). Patients who were smokers summed 63%, and those with hypertension 54.6%. Previous history of aneurism was two times higher in the group of bad prognosis (PR=2.00; CI 95%: 1.32-2.92). Headache or meningism was the most common clinical presentation (66.7%). Patients submitted to surgical treatment presented a prevalence almost 60% lower of coming to have a bad prognosis in the discharge (PR=0.43; CI 95%: 0.26-0.70; pKruskal-Wallis =0.03). After the sharp hemorrhage, 42.3% of the participants were able to return to their labor activities. Conclusions: The results found here were compatible with the literature, ones what sustains the maintenance of the current therapeutic modality of the HNSC front to the patients with aneurysmal subarachnoid hemorrhage.

Evaluation of late-onset hypogonadism (andropause) treatment using three different formulations of injectable testosterone / Avaliação do tratamento de pacientes hipogonádicos tardios (andropausa) usando três formulações diferentes de testosterona injetável

OBJECTIVE: To compare the modalities of treatment for male hypogonadism available in Brazil. METHODS: Thirty-two men with late-onset hypogonadism ("andropause") were followed-up in the Hospital de Guarnição de Florianópolis, in Florianópolis, south Brazil. Clinical diagnosis was established according to AMS questionnaire (positive if equal to or higher than 27 points), and laboratorial diagnosis was made through low values of total testosterone (under 300 ng/dL) and/or free calculated testosterone (under 6.5 ng/dL). Patients were randomized to three non-enteral treatment groups (Deposteron® - 11 patients; Durateston® - 11 patients; and Nebido® - 10 patients). RESULTS: Clinically, Nebido® seemed to be superior when compared to Deposteron® (mean value of improvement percentage; p = 0.03) and when compared to Durateston® (post-treatment average AMS score; p = 0.03). According to laboratorial analysis, Nebido® showed higher testosterone levels than Deposteron® and Durateston® (p < 0.001). CONCLUSIONS: All non-enteral testosterone formulas available in the Brazilian market are efficient in raising testosterone levels and in clinical improvement of hypogonadal patients. Nebido® showed both a better clinical and laboratorial effectiveness.

OBJETIVO: Comparar os tratamentos para hipogonadismo masculino disponíveis no Brasil. MÉTODOS: Foram selecionados 32 homens com hipogonadismo tardio ("andropausa") no Hospital de Guarnição de Florianópolis. O diagnóstico foi feito por meio do questionário AMS (acima de 27 pontos) e dos níveis diminuídos de testosterona total dosada (abaixo de 300 ng/dL) e/ou testosterona livre calculada (abaixo de 6,5 ng/dL). Os pacientes foram divididos em três grupos de tratamento parenteral (Deposteron® - 11 pacientes; Durateston® - 11 pacientes; Nebido® - 10 pacientes). RESULTADOS: Clinicamente, o tratamento com Nebido® mostrou-se superior ao tratamento com Deposteron® (média do percentual de melhora; p = 0,03) e ao Durateston® (média do questionário AMS pós-tratamento; p = 0,03). Laboratorialmente, o tratamento com Nebido® mostrou níveis de testosterona superiores ao Deposteron® e Durateston® (p < 0,001). CONCLUSÕES: As três formulações de testosterona parenteral existentes no mercado brasileiro são eficientes em elevar os níveis de testosterona e melhorar clinicamente pacientes hipogonádicos, sendo o Nebido® mais efetivo clínica e laboratorialmente.

Prevalência de obesidade e sobrepeso em acadêmicos do curso degraduação em Medicina da Universidade Federal de Santa Catarina / Prevalence of obesity and overweight among medical students of Federal University of Santa Catarina

Objetivo: Avaliar a prevalência de obesidade e sobrepeso dos acadêmicos de Medicina da UniversidadeFederal de Santa Catarina e crrelacionar esses dados à prática de atividade física regular, obesidade abdominal e história familiar para obesidade e sobrepeso. Métodos: Os acadêmicos voluntários a participação da pesquisa responderam o questionário auto-aplicativo e foram submetidos à avaliação antropométrica realizada por profissionais de educação física. Resultados: Encontrou-se uma prevalência de sobrepeso/ obesidade em 17% da população estudada, sendo33% entre os homens e nula entre as mulheres. Não houve uma relação positiva significativa entre históriafamiliar positiva e o IMC. Houve relação direta entre o IMC e a presença de obesidade abdominal. A relação entre o percentual de gordura e o IMC foi positiva para os homens estudados e indiferente para as mulheres. Conclusão: A prevalência de sobrepeso e obesidade foi menor na população estudada que a média nacional.A amostra apresentou valores menores também quando comparada à população universitária norte-americana. Apesar de sabidamente um fator de proteção, o exercício físico regular só é praticado por 52% dos estudantes de medicina.

Objective: To evaluate overweight and obesity prevalence among medical students from Federal Universityof Santa Catarina and correlate this data to physical activity practice, abdominal obesity and overweight andobesity familiar history. Methods: Individuals answered a self-applicablequestionnaire, and were submitted to anthropometric evaluation, conducted by physical education professionals.Results: It was found a prevalence of 17% of overweight and obesity on the studied population (33% of the men and none of the women). It was not found asignificant risk relationship between positive familiar history and obesity/overweight. Also, it was found and direct relationship between BMI and abdominal obesity. The same relationship was found for fat percentage and BMI in men, but not in women. Conclusion: The prevalence of overweight and obesity found on the study was smaller than the nationalaverage. It was also smaller when compared to American university population and American medical students. Regular exercise, although known as a protective factor, was only practiced by 52% of the medical students.

Evaluation of late-onset hypogonadism (andropause) treatment using three different formulations of injectable testosterone.

OBJECTIVE: To compare the modalities of treatment for male hypogonadism available in Brazil. METHODS: Thirty-two men with late-onset hypogonadism ('andropause') were followed-up in the Hospital de Guarnição de Florianópolis, in Florianópolis, south Brazil. Clinical diagnosis was established according to AMS questionnaire (positive if equal to or higher than 27 points), and laboratory diagnosis was made through low values of total testosterone (under 300 ng/dL) and/or free calculated testosterone (under 6.5 ng/dL). Patients were randomized to three non-enteral treatment groups (Deposteron--11 patients; Durateston--11 patients; and Nebido--10 patients). RESULTS: Clinically, Nebido seemed to be superior when compared to Deposteron (mean value of improvement percentage; p = 0.03) and when compared to Durateston (post-treatment average AMS score; p = 0.03). According to laboratory analysis, Nebido showed higher testosterone levels than Deposteron and Durateston (p < 0.001). CONCLUSIONS: All non-enteral testosterone formulas available in the Brazilian market are efficient in raising testosterone levels and in clinical improvement of hypogonadal patients. Nebido showed both a better clinical and laboratory effectiveness.