Resumo Em revisão feita em protocolos de 757 casos de paracoccidioidomicose foram encontrados 11 (1,5%) pacientes que previamente haviam sido submetidos à gastrectomia. É sugerido que à semelhança do que ocorre na tuberculose, os indivíduos submetidos à gastrectomia apresentam maior risco para o desenvolvimento dessas infecções. Palavras-chaves: Tuberculose. Paracoccidioidomicose. Gastrectomia. Doença granulomatosa infecciosa.Abstract In a review of the clinical records of 757 cases of paracoccidioidomycosis 11 (1.5%) of the patients had been previously submitted to gastrectomy. It is suggested that after gastrectomy individuals present a higher risk for the development of such infections, similar to that which occurs in tuberculosis.
AimS: Vitamin D is known to be vital in sustaining musculoskeletal functions, with its deficiency may cause muscle weakness and decreased bone mineral density. Vitamin D inadequacy is highly prevalent and its deficiency or insufficiency estimated to affect one billion people worldwide. It causes secondary hyperparathyroidism, bone loss, fractures and it has been associated with a number of other conditions, such as impaired muscle function (1), we decided to verify if there is an association between 25(OH)D status and handgrip strength and with lean muscle mass after cholecalciferol supplementation in elderly women.Methods : We studied fifty-four postmenopausal women with serum 25(OH)D below 30 ng/mL during three months. Cholecalciferol supplementation was divided into two levels according to classification: deficient (10000 units/day) and insufficient (2000 units/day). Changes in biochemical response and in body composition were assessed using dual-x-ray energy absormetry, handgrip strength and blood tests before and after supplementation.Results: The majority of the sample were vitamin D deficient. There was no difference in the deficient group for handgrip strength after the supplementation (p=0,489), but PTH had a statistically significant reduction (p=0.001). Besides, the deficient group had a decrease in lean mass even after the intervention (p=0.006). The results were similar when comparing within results of the insufficient group, however lean mass remained stable (p=0.423).Conclusion: Three-month cholecalciferol supplementation alone in elderly women with doses according to 25(OH)D serum was insufficient to change handgrip strength and total lean muscle mass, however secondary hyperparathyroidism was corrected.
The physiatrists specialized in treating spasticity were brought together for a panel discussion about the use of botulinum toxin (BT) in the public system in different states of Brazil. The data analyzed during the discussion of Datasus demonstrate a low-demand profile of the product dispensed by the Unified Health System (SUS), with heterogeneity in the distribution of TB in the Brazilian states. This scenario seems to be set up mainly for lack of a properly planned public policy, such as lack of unification and standardization of distribution centers, the lack or inadequacy of TB compensation proceeding to treatment centers, in a standardized manner by SUS and shortage of trained doctors to do it together with the lack of qualified multidisciplinary rehabilitation centers. The use of botulinum toxin for therapeutic purposes in Brazil began in the 90s, to treat dystonia and spasticity. It is currently employed in different clinical conditions; however, despite growing demand and indications over the years, there are few reports or publications on its use and benefit to patients served by the Unified Health System (SUS). To address this issue, in May 2015, in São Paulo, physiatrists from different states of Brazil met and discussed the relevance of botulinum toxin in treating spasticity.
Vitamin D deficiency is a common condition among the elderly and it is associated with an increased risk of fractures. The condition is common among elderly at higher latitude locations and very common among the institutionalized. Currently there is also evidence that low levels of vitamin D are associated with multiple disorders such as cardiovascular diseases, inflammation, and infectious diseases, among other things. In addition, clinical studies on the elderly have shown that the low vitamin D levels correlate with reduced muscle strength in the lower limbs and poor physical performance. However, suitable levels for maintaining proper muscle function and strength have not yet been established. Objective: To verify recent evidence of the effects of vitamin D on muscle strength in the elderly. Method: A survey of studies published between 2010 and 2014 in Pubmed, Medline, and Scopus using the terms “cholecalciferol”, “muscle strength,” and “elderly.” Results: Seven studies were selected. The results suggest a positive influence of vitamin D on muscle strength in the elderly. Conclusion: This review showed that despite the action of vitamin D on the musculoskeletal system, there is still uncertainty; there tended to be a greater benefit with vitamin D supplementation at higher doses. However, additional studies are needed to define the best therapeutic profile
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