Rev. APS. 2018 jul/set; 21(3): 355 -364. AVANÇOS E DESAFIOS PARA A IMPLEMENTAÇÃO DAS PRÁTICAS INTEGRATIVAS E COMPLEMENTARES NO BRASIL RESUMOAnalisou-se a conjuntura da produção científica, os avanços e os desafios para a implementação das Práticas Integrativas e Complementares (PIC) no Brasil. O estudo se deu por meio de Revisão Integrativa dos artigos indexados nas bases de dados bibliográficas da Rede Biblioteca Virtual de Saúde (BVS), selecionando-se 68 artigos. Notou-se que a região Sudeste permanece como polo científico e a maior parte dos estudos não possui nível de evidência significativo. No decorrer dos anos, houve pequeno aumento no número de estudos e maior comprovação da eficácia e eficiência das PIC em diversas áreas, porém entraves relacionados a pouca formação profissional, má gestão do Sistema e concepções enraizadas na medicina alopática permanecem e dificultam a ampliação das PIC no país. PALAVRAS-CHAVE:Antroposofia; Fitoterapia; Homeopatia; Medicina Tradicional Chinesa; Terapias Complementares. INTRODUÇÃOAs PIC são sistemas médicos e recursos terapêuticos complexos empregados para promoção do amplo cuidado em saúde, valorizando a autonomia, cultura e o ambiente dos indivíduos. Dessa forma, como resultado da mudança de paradigmas relacionados à assistência em saúde, da demanda popular, de recomendações da Organização Mundial de Saúde (OMS) e de diretrizes nacionais relacionadas ao tema, foi aprovada, em 2006, ABSTRACTWe analyzed the scientific production, the advances, and the challenges for the implementation of Integrative and Complementary Practices (ICP) in Brazil. The study was done through an integrative review in the Virtual Health Library, selecting 68 articles. It was noted that the Southeast region continues as a scientific hub, and that most of the studies do not have a significant level of evidence. Over the years, there has been a small increase in the number of studies and greater evidence of the effectiveness and efficiency of ICP in several areas. However, problems related to poor professional training, bad management of the system, and concepts rooted in allopathic medicine remain, and hinder the expansion of ICP in Brazil.
Background The diagnosis of Cushing’s syndrome is challenging; however, through the clinical picture and the search for secondary causes of osteoporosis, it was possible to reach the diagnosis of the case reported. There was an independent, symptomatic ACTH hypercortisolism manifested by typical phenotypic changes, severe secondary osteoporosis and arterial hypertension in a young patient. Case presentation A 20-year-old Brazilian man with low back pain for 8 months. Radiographs showed fragility fractures in the thoracolumbar spine, and bone densitometry showed osteoporosis, especially when evaluating the Z Score (− 5.6 in the lumbar spine). On physical examination, there were wide violaceous streaks on the upper limbs and abdomen, plethora and fat increase in the temporal facial region, hump, ecchymosis on limbs, hypotrophy of arms and thighs, central obesity and kyphoscoliosis. His blood pressure was 150 × 90 mmHg. Cortisol after 1 mg of dexamethasone (24.1 µg/dL) and after Liddle 1 (28 µg/dL) were not suppressed, despite normal cortisoluria. Tomography showed bilateral adrenal nodules with more severe characteristics. Unfortunately, through the catheterization of adrenal veins, it was not possible to differentiate the nodules due to the achievement of cortisol levels that exceeded the upper limit of the dilution method. Among the hypotheses for the differential diagnosis of bilateral adrenal hyperplasia are primary bilateral macronodular adrenal hyperplasia, McCune–Albright syndrome and isolated bilateral primary pigmented nodular hyperplasia or associated with Carney’s complex. In this case, primary pigmented nodular hyperplasia or carcinoma became important etiological hypotheses when comparing the epidemiology in a young man and the clinical-laboratory-imaging findings of the differential diagnoses. After 6 months of drug inhibition of steroidogenesis, blood pressure control and anti-osteoporotic therapy, the levels and deleterious metabolic effects of hypercortisolism, which could also impair adrenalectomy in the short and long term, were reduced. Left adrenalectomy was chosen, given the possibility of malignancy in a young patient and to avoid unnecessary definitive surgical adrenal insufficiency if the adrenalectomy was bilateral. Anatomopathology of the left gland revealed expansion of the zona fasciculate with multiple nonencapsulated nodules. Conclusion The early identification of Cushing’s syndrome, with measures based on the assessment of risks and benefits, remains the best way to prevent its progression and reduce the morbidity of the condition. Despite the unavailability of genetic analysis for a precise etiological definition, it is possible to take efficient measures to avoid future damage.
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