Nadja Maria Jorge Asano

Bisfosfonatos podem minimizar a fome óssea após paratireoidectomia em pacientes com hiperparatireoidismo primário e osteíte fibrosa cística

OBJECTIVE To assess the effect of bisphosphonates on post-parathyroidectomy hypocalcemia in patients with osteitis fibrosa cystica. METHODS Review of the medical records of six patients using bisphosphonates preoperatively. RESULTS Mean age was 35.6 ± 10.5 years; serum calcium = 13.51 + 0.87 mg/dL; iPTH = 1,389 + 609 pg/mL. The mean value of urine deoxypyridinoline (UDPD) of three patients was 131 ± 183 nmol/mmol Cr, and of C-telopeptide (CTX), 2,253 ± 1,587 pg/mL. The mean values of bone densitometry (T score) were as follows: 0.673 ± 0.150 g/cm(2) (-4.42 ± 1.23) in lumbar spine (L2-L4); 0.456 ± 0.149 g/cm(2) (-5.58 ± 1.79) in the femoral neck; and 0.316 ± 0.055 g/cm(2) (-5.85 ± 0.53) in radius 33. Patient 1 received oral alendronate, 30 mg/day for four weeks; his calcium decreased from 14 to 11.6 mg/dL, and his UDPD from 342 to 160 nmol/mmol Cr. Patient 2 received oral alendronate, 20 mg/day for six weeks; his calcium decreased from 14 to 11.0 mg/dL and his UDPD from 28.8 to 14 nmol/mmol Cr. Patient 3 received intravenous pamidronate, 90 mg prior to surgery. Patient 4 received oral alendronate, 140 mg/week for six weeks; her calcium decreased from 13.7 to 12.3 mg/dL and her CTX from 2,160 to 1,340 pg/mL. Patient 5 received oral alendronate, 140 mg/ week for six weeks; her calcium levels dropped from 14.3 to 14.1 mg/dL; her CTX did not change. Patient 6 received ibandronate, 150 mg, ten days prior to surgery; his CTX reduced by 62%. No patient developed severe hypocalcemia in the first postoperative week. One year after surgery, the mean gain in bone mineral density was 40% ± 29% in L2-L4, 86 ± 39% in the femoral neck, and 22% ± 11% in radius 33. CONCLUSION The preoperative use of bisphosphonates seems to attenuate bone hunger without preventing a significant increase in bone mass in the follow-up of parathyroidectomy.

Tumor necrosis factor alpha promoter polymorphism -308 G/A in Brazilian patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of antibodies to components of the cell nucleus in association with a diverse array of clinical manifestations. Polymorphisms in cytokines genes may play an important role in the development and clinical manifestation. Due to this, there is a great interest in the identification of biomarkers that which could quantify the susceptibility and disease activity. A case-control study of 98 lupus cases and 76 lupus-free adults controls, was performed to analyze whether or not the polymorphism of the TNF-α gene promoter at positions -308 G/A would alter the risk for SLE and clinical manifestations. Genotyping was carried out by polymerase chain reaction, PCR products were digested by NcoI restriction enzyme and fractionated after on 2% Agarose gel and visualized posteriorly staining by ethidium bromide. There were significant differences in the distribution of the TNF-α gene polymorphism between the SLE and control groups. Individual carriers of the variant allele A had a 3.29 (95% CI: 1.7738-6.1325)-fold increased risk for SLE. Moreover, association was observed between SLE patients and serositis (P=0.0228). This study presents a preliminary evidence of association between TNF-α polymorphism and SLE susceptibility in the Northeast population from Brazil.

Psychiatric comorbidities in patients with systemic lupus erythematosus: a systematic review of the last 10 years

OBJECTIVE To analyze the frequency of psychiatric comorbidities in patients with systemic lupus erythematosus (SLE) using the systematic review method. METHODS A systematic literature search was performed between April and July 2011 in the following databases: BIREME, PubMed and CAPES thesis database. This search prioritized studies published over the last ten years (2001-2011), involving the presence of psychiatric comorbidities in patients with SLE. RESULTS Out of 314 articles published in scientific journals (PubMed) and 29 (BIREME), previously identified ones, 13 articles on psychiatric disorders and SLE were selected so they could be submitted to the systematic review methodological approach. The articles indicated high frequency of psychiatric comorbidities, especially mood and anxiety disorders. There is no consensus between the disease activity and psychiatric disorders. Patients with active SLE showed a higher risk of developing mood disorders than patients with inactive SLE. CONCLUSION Patients with SLE had a higher suicide risk than the general population. More thorough studies to evaluate the psychological and genetic role, specific and non-specific autoimmune inflammatory mechanisms in mood and anxiety disorders are needed.

Comorbidades psiquiátricas em pacientes com lúpus eritematoso sistêmico: uma revisão sistemática dos últimos 10 anos

OBJECTIVE: To analyze the frequency of psychiatric comorbidities in patients with systemic lupus erythematosus (SLE) using the systematic review method. METHODS: A systematic literature search was performed between April and July 2011 in the following databases: BIREME, PubMed and CAPES thesis database. This search prioritized studies published over the last ten years (2001-2011), involving the presence of psychiatric comorbidities in patients with SLE. RESULTS: Out of 314 articles published in scientific journals (PubMed) and 29 (BIREME), previously identified ones, 13 articles on psychiatric disorders and SLE were selected so they could be submitted to the systematic review methodological approach. The articles indicated high frequency of psychiatric comorbidities, especially mood and anxiety disorders. There is no consensus between the disease activity and psychiatric disorders. Patients with active SLE showed a higher risk of developing mood disorders than patients with inactive SLE. CONCLUSION: Patients with SLE had a higher suicide risk than the general population. More thorough studies to evaluate the psychological and genetic role, specific and non-specific autoimmune inflammatory mechanisms in mood and anxiety disorders are needed.

Interleukin-6 promoter polymorphisms -174 G/C in Brazilian patients with systemic lupus erythematosus.

To investigate the association of the IL-6 gene promoter polymorphism (-174 G/C) with SLE susceptibility and disease features in Brazilian patients, a case-control study of 80 lupus cases and 60 volunteer healthy women was performed. Genotyping was carried out by polymerase chain reaction and PCR product was digested by HSP92II restriction enzyme, being after visualized in polyacrylamide gel. There were significant differences in the distribution of the IL-6 gene C/C polymorphism between the SLE and control groups (χ(2) = 8.668; P = 0.0032). Individual carriers of the variant allele G had a 1.98 (95% CI: 1.0844-3.6353)-fold increased risk for SLE. Besides, association was observed in frequency of C allele (P = 0.0247; OR = 0.5036) between SLE patients and control groups. This study presents preliminary evidence for association between IL-6 polymorphism and SLE susceptibility in a Northeast population from Brazil.

Acupuncture as Adjuvant Therapy for Sleep Disorders in Parkinson's Disease.

There are few studies which attest the efficacy of acupuncture on treatment of sleep disturbs in Parkinson disease. The aimed of this randomized clinical trial was to evaluate the effects of acupuncture on sleep disturbs of 22 patients with diagnosis of idiopathic Parkinson disease (Hoehn-Yahr 1 to 3) who have assistance on the Pro-Parkinson Program of Clinical Hospital at Federal University of Pernambuco in Brazil. All participants were evaluated by Parkinson Disease Sleep Scale (PDSS) before and after 8 weeks. The experimental group was submitted to 8 sections (once a week) which had duration of 30 minutes. The control group had no intervention. The intervention was executed using the acupuncture points LR3 (Taichong), SP6 (Sanyinjiao), LI4 (Hegu), TE5 (Wai-Guan), HT7 (Shenmen), PC6 (Neiguan), LI11 (Quchi), GB20 (Fengchi). Paired analyses were obtained by Wilcoxon test and independent analyses were made according to Mann-Whitney test. This study presented a potential therapeutic benefit of acupuncture on sleep disturbs of Parkinsons disease patients. This study showed a possible therapeutic benefit through acupuncture in sleep disorders in patients with PD. However, we propose new studies related to the effects of acupuncture on the clinical symptoms and evolution of the disease.

Transtornos psiquiátricos em pacientes com lúpus eritematoso sistêmico

Background The frequency of psychiatric disorders associated with systemic lupus erythematosus (SLE) is variable. Objective To identify the psychiatric disorders of patients with SLE. Methods The Mini International Neuropsychiatric Interview Plus was used in 131 women for the diagnosis of psychiatric disorders related with age, time and activity of the disease (SLEDAI-2K). Eighty women with SLE and 60 healthy women were genotyped by polymerase chain reaction. In 113 patients, the SF-36 was evaluated. Results Major depressive episode (37.4%), Agorafobia (45.0%) and generalized anxiety disorder (34.4%) were the most common findings. Activity of the SLE was significantly associated with the presence of humor disorders, disorders of anxiety and suicide risk (p<0.05). Humor disorders, anxiety disorders and suicide risk presented greater tendency to the G/G genotype. The domains of SF-36 for physical function, vitality and mental health had significant results for all the disorders (p<0.05). Conclusions The activity of the SLE represented risk for the presence of humor and anxiety disorders. This study has presented evidences of the association between polymorphism in the promoter – 174 G/C of the gene IL-6. All SF-36 domains were shown to be related with psychiatric disorders.

MAO‐B and COMT Genetic Variations Associated With Levodopa Treatment Response in Patients With Parkinson's Disease

The most commonly used Parkinsons disease (PD) treatment is the replacement of dopamine by its levodopa precursor (l‐dopa). Monoamine oxidase‐B (MAO‐B) and catechol‐o‐methyl transferase (COMT) are enzymes involved in the metabolism and regulation of dopamine availability. In our study we investigated the possible relation among selected single‐nucleotide polymorphisms (SNPs) in the MAO‐B (rs1799836) and COMT (rs4680) genes and the therapeutic response to levodopa (l‐dopa). A total of 162 Brazilian patients from the Pro‐Parkinson service of Clinics Hospital of Pernambuco diagnosed with sporadic PD and treated with levodopa were enrolled. PD patients were stratified into 2 groups according to the daily levodopa dose. MAO‐B and COMT SNP genotyping was conducted by polymerase chain reaction–restriction fragment length polymorphism. After multivariate analysis, we observed a significant difference between PD groups for the following variables: sex (P = .02), longer duration of disease (P = .02), longer levodopa therapy duration (P = .01), younger onset of PD (P = .01), and use of COMT inhibitor (P = .02). We observed that patients carrying MAO‐B (rs1799836) A and AA genotypes and COMT (rs4680) LL genotype suffered more frequently from levodopa‐induced‐dyskinesia. In addition, we found an increased risk of 2.84‐fold for male individuals carrying the MAO‐B G allele to be treated with higher doses of levodopa (P = .04). We concluded that before beginning PD pharmacological treatment, it is important to consider the genetic variants of the MAO‐B and COMT genes and the sex, reinforcing the evidence that sexual dimorphism in the genes related to dopamine metabolism might affect PD treatment.

The influence of SLC6A3 and DRD2 polymorphisms on levodopa-therapy in patients with sporadic Parkinson's disease

The aim of this study was to evaluate a possible relationship between DRD2/ANKK1 (rs1800497) and SLC6A3/DAT1 (rs28363170) gene polymorphisms with the response to levodopa (L‐DOPA)‐therapy in patients with Parkinsons disease (PD).

Contribuições da eletromiografia de agulha para o estudo da deglutição em seres humanos

Intramuscular EMG is performed by the doctor, from the fixing needle electrodes or thin wire for the study of isolated muscles or deep muscles. This study aims to identify and describe the contributions of intramuscular electromyography, for the evaluation of swallowing in humans. The search, carried out between April and March 2015, in the databases PubMed, BIREME, AND BANK OF THESES OF CAPES, resulted in 21 references, of which only seven met our inclusion criteria. Selected articles make important contributions to the understanding of the electrophysiological behavior and electrophysiological during swallowing and it is believed that the lack of studies using this tool in humans should be the annoyance and risks caused by the introduction of the needle into the belly muscle and maybe the introduction of a thin wire (fine wire or wire cooper) is more interesting for the aid diagnosis of neuromuscular disorders and nerve that compromise swallowing, the ability to dramatically reduce the annoyance caused by the needle.