Hospital Universitário Walter Cantídio

Resumo A doença de Madelung (DM) é uma afecção rara do tecido adiposo que causa múltiplos acúmulos lipomatosos simétricos nas regiões maxilofacial e cervical, no tronco e nos membros. Acomete indivíduos de forma esporádica, e tem relação com o histórico de etilismo. O prejuízo estético e funcional da DM representa diversas facetas que justificam a necessidade de abordagem por cirurgia plástica. O presente trabalho relata o caso de um paciente do sexo masculino diagnosticado com DM e submetido a intervenções com finalidade de reabilitação. Optou-se pela ressecção seriada das lesões cervicais, com a realização de dermolipectomias e uso de retalhos locais para a reconstrução, com ressecção das glândulas submandibulares e preservação da inervação adjacente. No futuro, o paciente será submetido a novas intervenções para abordagens das demais lesões. A etiologia da DM não foi esclarecida, mas alguns fatores foram associados ao seu desenvolvimento, como etilismo, infecção pelo HIV e distúrbios metabólicos, entre os quais se destacam a secreção excessiva de insulina, hiperuricemia, acidose tubular renal, dislipidemia, hipertrigliceridemia e alterações na função tireoidiana, adrenal, hipofisária e testicular. Apesar de ter curso benigno, a DM tem enormes consequências psicossociais, e a abordagem cirúrgica busca mitigar os efeitos das deformidades para o restabelecimento da saúde do paciente acometido.

Parkinson's disease (PD) presents motor and non-motor symptoms that impair function and quality of life. Identifying clinical factors linked to physical performance is key for patient care and management.To examine associations between sarcopenia-related measures and physical performance in mild-to-moderate PD (Hoehn & Yahr [HY] I-III).This was a cross-sectional study including patients with idiopathic Parkinson's disease at mild to moderate stages (Hoehn & Yahr I-III), evaluated in the ON medication state. Physical performance was assessed using the Short Physical Performance Battery (SPPB). Sarcopenia was evaluated according to the revised European Working Group on Sarcopenia in Older People (EWGSOP2) consensus, including screening with the SARC-F questionnaire and the Ishii score, assessment of muscle strength by handgrip dynamometry, and evaluation of body composition and appendicular lean mass by whole-body dual-energy X-ray absorptiometry (DXA). Analyses included bivariate comparisons, correlation analyses, and logistic regression models (Enter and Best Subsets).A total of 127 patients were evaluated (mean age 66 years; 41.7% females). Low physical performance was observed in 39% (n = 50) of patients and was strongly associated with positive screening of sarcopenia (SARC-F score ≥ 4; odds ratio [OR]: 1.67; 95%CI: 1.30-2.15; p < 0.001). Ishii score (p = 0.009), reduced mean handgrip strength (26 ± 10 kgf versus 30 ± 10 kgf; p = 0.02), and postural instability and gait difficulty (PIGD) (p < 0.001) were also significantly associated with low SPPB performance in bivariate analyses. In the multivariable models, SARC-F and PIGD emerged as independent predictors of poor physical performance. The best subset model, combining SARC-F and PIGD, showed good discriminative accuracy (area under the curve [AUC] = 0.82).Higher PIGD scores and SARC-F ≥ 4 correlated with poor physical performance in PD. Low performance was linked to both SARC-F and Ishii scores, which help identify risk of functional decline. Longitudinal studies are needed to clarify causality and treatment implications.

Objetivo: propor ao Hospital Universitário Walter Cantídio a sistematização do atendimento de anafilaxia por meio de um protocolo de manejo clínico desta condição. Método: foi realizada busca de estudos identificados como diretrizes de anafilaxia utilizando os termos “anaphylaxis” e “guideline”. Os artigos selecionados deveriam conter recomendações no manejo clínico da anafilaxia na fase aguda em adultos, sendo excluídas diretrizes de hipersensibilidade e alergia em geral. Resultados: foram elaboradas perguntas norteadoras com base nas principais recomendações contidas nas diretrizes selecionadas. Depois disso, organizou-se um quadro-sumário com as respostas e suas respectivas fontes bibliográficas. A partir deste quadro, foi criado um fluxograma de manejo da anafilaxia com as recomendações mais frequentemente encontradas nas diretrizes avaliadas. Conclusão: este protocolo, elaborado com base nas recomendações mais recentes sobre anafilaxia de diversas sociedades mundiais, pode auxiliar a abordagem clínica desta condição que demanda assistência rápida e assertiva.

BackgroundLipodystrophy syndromes (LS) are characterized by reduced body fat and associated metabolic complications, such as insulin resistance and diabetes. The diagnosis of LS can be challenging in clinical settings. Skinfold measurement and body composition assessment using DEXA are commonly used for screening and diagnosis. This study aimed to identify alternative easy-to-use body composition parameters for diagnosing LS in clinical settings.MethodsThis cross-sectional study included patients with genetically confirmed congenital generalized lipodystrophy (CGL) and familial partial lipodystrophy (FPL), with 62 matched healthy controls. Comprehensive data, including medical history, body composition, laboratory measurements, and imaging parameters, were collected. The receiver operating characteristic (ROC) curve was constructed using genetic test results, the gold standard for diagnosing genetic lipodystrophy, as the reference, and the sensitivity and specificity of calf skinfold measurements were measured with those of the genetic tests.ResultsWe included 62 patients with a mean age of 32 ± 18 (2–68) years, of whom 69.3% were women. The prevalence of diabetes mellitus (70%) and hypertriglyceridemia (83%) were also high. All body composition parameters significantly differed, except for calf skinfold measurements, which were similar between the CGL and FPL patients (p = 0.270). The ROC curve analysis identified a new cutoff point for calf skinfold measurement of <8 mm, with high diagnostic accuracy.ConclusionsThis study identified calf skinfold measurements <8 mm as an accurate diagnostic tool for CGL and FPL. Notably, clinical accessibility to calf skinfold will favor its widespread use, standardization, and inclusion in physical examination protocols, improving lipodystrophy detection and diagnosis.

Background: Effective pharmacotherapy for Cocaine Use Disorder is needed. The Cocacrack-2 study showed that homeopathic fifty-millesimal potencies of Opium and Erythroxylum coca were more effective than a placebo in reducing cocaine/crack use. However, the study experienced high dropout rates, which are common in the study population but could introduce bias. Therefore, further research is needed, focusing on strategies to ensure trial patient retention. The Cocacrack-3 study protocol initially aimed to improve retention through home visits from Primary Care. However, due to the COVID-19 pandemic, we revised the protocol to utilize specialized facilities with network support and telemedicine follow-up to enhance retention. Objectives: 1) Assess the effectiveness and safety of sequential administration of homeopathic potencies (LM2, LM4, LM6) of Opium and Erythroxylum coca in reducing cocaine use. 2) Evaluate the effectiveness of telemedicine and support networks in enhancing treatment retention. Setting: Psychosocial Attention Centers for Alcohol and other Drugs (CAPS-AD) in Florianópolis, São José, and Palhoça, Brazil. Study center: Research Laboratory for the History of Nursing and Health Knowledge at the Federal University of Santa Catarina. Methods: Randomized, placebo-controlled, double-blind, crossover clinical trial (six weeks per participant). Hypothesis: H0: No significant difference between homeopathic potencies and placebo. H1: Significant difference between homeopathic potencies and placebo. Inclusion criteria: Men and women aged 18-70, patients at CAPS-AD, with a support network. Exclusion criteria: Remission of cocaine use &gt; two weeks, inability to participate virtually. Sample size: 120 participants, randomized 1:1 to verum or placebo sequences. Interventions: LM2, LM4, LM6 potencies of Opium and Erythroxylum coca, or placebo. Primary measure: Percentage of cocaine use days at week 3. Secondary measures: Cocaine use days, craving, progression, concomitant medications, adverse events, treatment adherence, and participant retention.

Introdução: A NEM-1 é uma síndrome genética rara associada a mutações no gene supressor tumoral MEN-1. O gigantismo como primeira manifestação da NEM-1 é incomum. Relato do caso: D.B.R., 33 anos, masculino, diagnosticado com gigantismo aos 20 anos, em consulta ambulatorial onde foi identificado macroadenoma hipofisário, hiperprolactinemia e hipercalcemia. Um mês após o atendimento inicial, foi internado com indícios de apoplexia hipofisária, sendo submetido a cirurgia transesfenoidal. Na época, o rastreio para NEM-1 evidenciou hiperparatireoidismo primário e tumor pancreático, sendo posteriormente submetido a paratireoidectomia total com implante e duodenopancreatectomia. Perdeu seguimento clínico por 10 anos. Em 2022, apresentou pneumotórax espontâneo, sendo novamente internado, quando referiu diarreia crônica. Nova investigação clínica evidenciou macroadenoma hipofisário com hiperprolactinemia, hiperparatireoidismo primário por paratireoide extranumerária e novo tumor pancreático associado a nódulo hepático (síndrome carcinoide) com 5-HIAA normal. Desde então, segue em uso de cabergolina e octreotide com normalização dos níveis de prolactina e remissão da diarreia. Discussão: O adenoma hipofisário foi a primeira manifestação clínica da NEM-1, o que ocorre em apenas 13-17% dos casos, sendo rara a presença de tumores secretores de GH. Conclusão: A presença de neoplasias endocrinológicas em jovens, principalmente em crianças e adolescentes, deve motivar a pesquisa de síndromes genéticas.

Objective To analyze the reliability, construct and content validity, ceiling and floor effects, acceptability, and feasibility of the Patient-Specific Functional Scale (PSFS) in individuals with asthma. Methods This methodological study included individuals with asthma. Sociodemographic and clinical characteristics, lung function (forced expiratory volume in one second – FEV1), asthma control, and quality of life (Asthma Quality of Life Questionnaire – AQLQ) were assessed, in addition to the administration of the PSFS. Reliability, construct, and content validity, as well as ceiling/floor effects, were analyzed. Results One hundred participants were evaluated (88% women, mean age 56 ± 14 years), the mean PSFS score was 4.1 ± 2.3. Regarding reliability, the intraclass correlation coefficient was 0.95 (95% confidence interval (CI): 0.88–0.97, p < .0001). The PSFS showed a fair correlation with the AQLQ activity limitation domain (r = 0.34, p = .001) and a weak correlation with FEV1 (r = 0.16, p = .19). Lower scores were observed in participants with poorer asthma control (p = .03). Ninety-seven percent of the activities reported in the PSFS were classified under the Activity and Participation domain of the International Classification of Functioning, Disability, and Health (ICF). No ceiling or floor effects were detected. Conclusions The PSFS demonstrated strong reliability, adequate validity, and no ceiling or floor effects, supporting its potential as a useful tool for assessing activity limitations in asthma.