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JUSTIFICATIVA E OBJETIVOS: O edema pulmonar por pressão negativa após obstrução de via aérea é atualmente uma entidade bem descrita, porém pouco diagnosticada e com poucos casos relatados. O objetivo deste artigo foi relatar um caso de edema pulmonar por pressão negativa (EPPN) após extubação traqueal com sucesso terapêutico, após uso de ventilação mecânica não-invasiva com pressão positiva. RELATO DO CASO: Paciente do sexo feminino, 22 anos, foi submetida à colecistectomia aberta. Os exames pré-operatórios encontravam-se sem alterações. Imediatamente após extubação a paciente apresentou dispnéia súbita e crepitações pulmonares. Foi iniciado tratamento para edema agudo de pulmão com oxigenoterapia sob máscara de Venturi, elevação do tórax e diurético. A paciente foi encaminhada a UTI devido a

Summary Introduction: Diabetes mellitus is one of the most common chronic diseases in the world, with high morbidity and mortality rates, resulting in a greatly negative socioeconomic impact. Although there are several classes of oral antidiabetic agents, most of the patients are outside the therapeutic goal range. Objective: To review the use of SGLT-2 inhibitors in the treatment of type 2 diabetes mellitus, focusing on their favorable and unfavorable effects, as well as on cardiovascular profile. Method: A literature search on Pubmed database was performed using the following keywords: "SGLT-2 inhibitors," "dapagliflozin," "empagliflozin," "canagliflozin." Results: SGLT-2 inhibitors are a class of oral antidiabetic drugs directed to the kidney. Their mechanism of action is to reduce blood glucose by inducing glycosuria. Extra-glycemic benefits have been described, such as weight loss, decline in blood pressure and levels of triglycerides and uric acid, and they can slow the progression of kidney disease. Genitourinary infections are the main side effects. There is a low risk of hypotension and hypoglycemia. Diabetic ketoacidosis is a serious adverse effect, although rare. Empagliflozin has already had its cardiovascular benefit demonstrated and studies with other drugs are currently being performed. Conclusion: SGLT-2 inhibitors are a new treatment option for type 2 diabetes mellitus, acting independently of insulin. They have potential benefits other than the reduction of blood glucose, but also carry a risk for adverse effects.

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Efetividade dos análogos da insulina comparados às insulinas humanas em gestantes com diabetes mellitus: Revisão sistemática com metanálise Abstract Diabetes during pregnancy has been linked to unfavorable maternal-fetal outcomes. Human insulins are the first drug of choice because of the proven safety in their use. However, there are still questions about the use of insulin analogs during pregnancy. The objective of the present study was to determine the effectiveness of insulin analogs compared with human insulin in the treatment of pregnant women with diabetes through a systematic review with meta-analysis. The search comprised the period since the inception of each database until July 2017, and the following databases were used: MEDLINE, CINAHL, EMBASE, ISI Web of Science, LILACS, Scopus, SIGLE and Google Scholar. We have selected 29 original articles: 11 were randomized clinical trials and 18 were observational studies. We have explored data from 6,382 participants. All of the articles were classified as having an intermediate to high risk of bias. The variable that showed favorable results for the use of insulin analogs was gestational age, with a mean difference of -0.26 (95 % confidence interval [CI]: 0.03-0.49; p ¼ 0.02), but with significant heterogeneity (Higgins test [I 2 ] ¼ 38%; chi-squared test [χ 2 ] ¼ 16.24; degree of freedom [DF] ¼ 10; p ¼ 0.09). This result, in the clinical practice, does not compromise the fetal well-being, since all babies were born at term. There was publication bias in the gestational age and neonatal weight variables. To date, the evidence analyzed has a moderate-to-high risk of bias and does not allow the conclusion that insulin analogs are more effective when compared with human insulin to treat diabetic pregnant women.Leyna Leite Santos's ORCID is https://orcid.org/0000-0002-7319-4585. Palavras-chave► diabetes mellitus ► diabetes gestacional ► insulina humana ► análogos da insulina ► gestação Rev Bras Ginecol

Objective: To report a case of hyperparathyroidism secondary to a parathyroid adenoma, presenting a high level of hypercalcemia associated with spontaneous fractures in young pregnant woman. Case report: The patient underwent an emergency cesarean after presenting premature amniorrhexis and tolerated the procedure without complications. The newborn evolved satisfactorily, without symptoms of hypocalcemia. The postpartum woman was then submitted to left lower parathyroidectomy and, in the postoperative period, she developed bone hunger syndrome, despite previous administration of bisphosphonate. There was a progressive resolution of PTH and serum calcium levels, with a consequent improvement in the clinical condition. Conclusion: This report highlights the need and the difficulty regarding the early diagnosis of primary hyperparathyroidism, which is a potentially fatal pathology for the maternal-fetal binomial. Therefore, it is essential to institute proper treatment early, with individualization according to the patient's clinical condition, to minimize the risks of complications and mortality.

RESUMOO conjunto de alterações fisiopatológicas presentes no indivíduo com obesidade mórbida pode levar ao desenvolvimento da síndrome metabólica, consequentemente gera uma alta morbimortalidade. Nesse contexto, pacientes obesos que não tiveram resposta com tratamento clínico-medicamentoso, composto por dieta de baixo teor calórico, prática de exercício físico e medicamentos, a cirurgia bariátrica se torna uma opção para o tratamento dessa enfermidade e das manifestações da síndrome metabólica. Diante disso, faz-se necessário o acompanhamento dos pacientes para avaliar se há, de fato, uma melhora dos índices relacionados à e qual o seu impacto na qualidade de vida do paciente após o procedimento cirúrgico. Logo, esta pesquisa objetiva determinar a prevalência de síndrome metabólica mediante a análise de prontuários de pacientes submetidos à cirurgia bariátrica, antes e após o procedimento, que fazem seguimento no ambulatório de cirurgia do Hospital Universitário Professor Alberto Antunes. Através dos dados obtidos, foi observado que a prevalência da cirurgia bariátrica ocorreu em maior quantidade no sexo feminino. Notou-se que a faixa etária mais frequente foi entre 31 e a 40 anos. No que se refere a comorbidades, verificou-se que mais de 50% dos pacientes apresentaram mais de uma comorbidade. A respeito da pressão arterial, exames laboratoriais e