Interações físicas e psicossociais em mulheres com fibromialgia

Fibromyalgia (FM) is a non-inflammatory rheumatic syndrome of unknown etiology, with symptoms of diffuse musculoskeletal pain and presence of specific anatomic sites called tender points. The symptoms are often associated with fatigue, sleep disturbances, morning stiffness, alterations in pain perception, anxiety and depression. Fibromyalgia exhibits a correlation between physical and behavioral symptoms, which have a negative influence on the quality of life of patients. Emotional skills are important factors since they are related to subjective well-being, personal productivity, social interaction and interpersonal relationships. We aim to describe the physical and psychosocial interactions in women with FM, showing the association between perceived social support and affect with symptoms of pain, functionality and mood. We will also describe a body representation of pain in women with FM. Data were collected over 3 years and the sample size ranged between studies. This is an exploratory cross-sectional study conducted with a convenience sample of 63 women with FM and 42 healthy women as a control group (CT), aged 20-76 years, recruited through spontaneous demand at Onofre Lopes University Hospital (HUOL) and the Clinical School of Physiotherapy of Universidade Potiguar (UNP). The Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), Social Support Scale (MOS), Hamilton Anxiety Scale and Scale of Positive and Negative Affect Schedule (PANAS), in addition to pressure algometry were used. For data analysis, we used parametric and non-parametric tests and a general linear model with adjustment variables and analysis of variance. A significant difference was found between pain threshold and tolerance, functionality, depression, anxiety, social support, and positive and negative affect between the groups. Affective states and social support were associated with anxiety, depression and functionality. A body was drawn representing pain with higher incidences in trapeze, supraspinatus and second ribs. The reason for studying sensory aspects, affective behavior and social support in FM patients opens perspectives for scientific and clinical research of this syndrome. Women with chronic pain such as FM appear to have altered mood states, less social support and affective dysfunctions, influencing the other symptoms of the syndrome

Boto cinza (Sotalia guianensis, Van Benédén, 1864) (Cetacea, Delphinidae): Atividade aérea, forrageio e interações inter-específicas, na Praia de Pipa (Tibau do Sul RN) e estudo comparativo entre duas populações do Nordeste do Brasil

Sotalia guianensis is a small cetacean of the Delphinidae family, with coastal habits and whose area of distribution ranges from Florianópolis (27º35'S, 48º34'W), in Brazil, to Honduras (15º58'N, 85º42'W). At Pipa beach, on the south coast of RN state, in Brazil, the species occur throughout the year. The present study was carried out in two bays, which are bordered by cliffs. The animals were monitored from vantage points, using the "Ad libitum" and "all the occurrences" methods; during the years of 1999 and 2004. The study was divided in 4 chapters: Behavioral standards of two populations of gray dolphin, (Sotalia guianensis, Van Benédén, 1864) in the northeast of Brazil; Aerial activity of the gray dolphin: its possible function and the influence of environmental and behavioral factors; The influence of daily and monthly variation of the tides, of the period of the day and group size on the gray dolphin forage activity; kleptoparasitism interactions of frigatebird (Fregata magnificens, Mattheus, 1914) during the gray dolphin forage activity. The results have shown that the gray dolphin has a varied and complex behavioral repertoire. The leap is the most frequent behavior; the aerial activity is diffuse during daylight and is influenced by some factors, such as the level of the tide and social factors. The gray dolphin, when in the bay, most frequently feeds isolate or in small groups. The forage is diffuse during daylight; however, being more frequent in the morning and is influenced by the daily and monthly variation of the tide. At Pipa beach, kleptoparasitarian interactions were registered between the gray dolphin and the frigatebird (Fregata magnificens). The frigatebird forage strategy consists basically of two ways: to fly over great extensions searching for dead fish and to steal food (kleptoparasitism). These interactions were predominantly carried out between immature and female adult birds and adult and immature dolphins, and occurred during daylight. The present study can be considered an initial landmark to a better knowledge on the gray dolphin surface behavior, especially regarding the aerial behavioral repertoire and forage strategy of this species. However, it is necessary to continue these studies, so that we can understand better the complex social life of these animals and thus create effective measures for its conservation

Avaliação do cortisol, dehidroepiandrosterona sulfato e dos perfis lipídico e imunológico e suas correlações com a sensibilidade dolorosa, depressão e funcionalidade em mulheres com fibromialgia na pós-menopausa

Fibromyalgia (FM) is a non-inflammatory rheumatic syndrome characterized by widespread musculoskeletal pain with palpable tender points, muscle stiffness, fatigue, and sleep disturbances. Patients with FM have hormonal changes that are directly correlated with symptoms of the syndrome. The neuroendocrine regulation may be impaired, with abnormalities in the hypothalamus-pituitary-adrenal (HPA) axis with various hormones showing changes in their levels. In women in fertile period, various gonadal hormones are associated with symptoms of the syndrome, but studies focusing only a population of women in post-menopausal period who do not use hormone replacement are rare. We developed an analytical cross sectional study to assess the plasma levels of cortisol and dehidroepiandrosterona sulfate (DHEA-S) with quimioluminescence method in a group of 17 women with FM and 19 healthy women in post-menopause who do not use hormone replacement and observe the correlation with the symptoms of pain through algometry, depression and physical functional capacity measured from the Beck Depression Index (BDI) and the Fibromyalgia Impact Questionnaire (FIQ). Three blood samples were collected in the morning (between 8:00 9:30) with an interval of 24 hours for the measurements of hormonal levels and biochemical profile. There were no immunological or lipid changes in patients with FM. Comparing the two groups, there is no difference in levels of cortisol and a tangential effect for DHEA-S (p=0,094) with the lowest levels in the FM. DHEA-S also correlated with pain threshold (r=0,7) and tolerance (r=0,65) in group FM. We found the presence of depressive state and low physical functional capacity in FM. It was also evident that women in post-menopausal period, DHEA-S should influence the symptoms of increased sensitivity to pain, but not the presence of depressive status and low physical functional

Medida da preditividade de instrumentos psicológicos nas avaliações psicológicas de condutores

The object of this study was to identify the possibility of predicting the involvement in traffic infractions from the results of the psychological tests carried out by psychologists specialized in the process of driver licensing in the state of Rio Grande do Norte (RN). The proposal consisted in identifying the penalty points recorded in national driving licenses (CNH) and identifying the corresponding tests and scores obtained, verifying if the average scores in the tests of drivers with and without an infraction record were significantly different and if there is any relation between the test scores and the frequency of the infractions. The results of the psychological instruments were collected in two moments the first being in the act of acquisition of the CNH and the second being during license renewal at the only certified clinic and at the DETRAN-RN. A population of 839 drivers of 14 municipalities were identified. 127 protocols of psychological tests were identified in the records of the DETRAN-RN (2002) and 76 at the clinic (2007), pointing out failures in the process of safekeeping of the psychological material, as well as in its retrieval from the record files. The sample was thus reduced to 68 drivers, all male, with age range between 18 and 41 years old, mean of 21,72 years old (DP = 5,24). 54 drivers were identified without a record of infraction, and 14 with a record. The latter committed 29 infractions. The penalty points recorded in their CNH ranged from 0 to 35 and the typical value of points (median) was zero. In the group with a record of infractions the number of points ranged between 3 and 35, mean of 10,79 (DP = 7,73). Differences were observed in the composition of the battery of tests in the two moments with the same subjects. The use of different tests to assess the same construct of the subject, first and second moment of assessment, did not allow for some analyzes with more efficient statistical proof. It was pointed out that five tests were not carried out and 118 were not corrected/analyzed. Significant differences between the groups were not identified with the psychological instruments used. In another attempt to establish differences between the means, the application of the independent t-Test evidenced a significant difference in the scores of the instruments of concentrated attention in 2002 (t = 2,21, gl = 25, p = 0.037) and of diffuse attention in 2002 (t = 2,37, gl = 24, p = 0.026). The results also did not evidence significant correlation between the scores of the tests and the penalty points of the infractions. Based on this study, it cannot be concluded with precision that the high or low scores are good criteria to determine that a driver will commit more or less traffic infractions, nor that the drivers with higher scores in the tests commit less infractions and vice-versa. Furthermore, the problems to find the instruments and the most basic data require a stronger monitoring on the part of the certified clinic and of the DETRAN-RN.

Ferramentas quimiométricas aplicadas a classificação de amostras de leite em pó e quantificação de proteínas

In this work we used chemometric tools to classify and quantify the protein content in samples of milk powder. We applied the NIR diffuse reflectance spectroscopy combined with multivariate techniques. First, we carried out an exploratory method of samples by principal component analysis (PCA), then the classification of independent modeling of class analogy (SIMCA). Thus it became possible to classify the samples that were grouped by similarities in their composition. Finally, the techniques of partial least squares regression (PLS) and principal components regression (PCR) allowed the quantification of protein content in samples of milk powder, compared with the Kjeldahl reference method. A total of 53 samples of milk powder sold in the metropolitan areas of Natal, Salvador and Rio de Janeiro were acquired for analysis, in which after pre-treatment data, there were four models, which were employed for classification and quantification of samples. The methods employed after being assessed and validated showed good performance, good accuracy and reliability of the results, showing that the NIR technique can be a non invasive technique, since it produces no waste and saves time in analyzing the samples

Construção de modelos multivariados para determinação de lipídios totais e unidade em leite em pó comercial utilizando espectroscopia no infravermelho próximo

In this work calibration models were constructed to determine the content of total lipids and moisture in powdered milk samples. For this, used the near-infrared spectroscopy by diffuse reflectance, combined with multivariate calibration. Initially, the spectral data were submitted to correction of multiplicative light scattering (MSC) and Savitzsky-Golay smoothing. Then, the samples were divided into subgroups by application of hierarchical clustering analysis of the classes (HCA) and Ward Linkage criterion. Thus, it became possible to build regression models by partial least squares (PLS) that allowed the calibration and prediction of the content total lipid and moisture, based on the values obtained by the reference methods of Soxhlet and 105 ° C, respectively . Therefore, conclude that the NIR had a good performance for the quantification of samples of powdered milk, mainly by minimizing the analysis time, not destruction of the samples and not waste. Prediction models for determination of total lipids correlated (R) of 0.9955, RMSEP of 0.8952, therefore the average error between the Soxhlet and NIR was ± 0.70%, while the model prediction to content moisture correlated (R) of 0.9184, RMSEP, 0.3778 and error of ± 0.76%

Estudo de titanatos nanoestruturados obtidos por tratamento hidrotérmico de óxido de titânio em meio alcalino

TiTanate NanoTubes (TTNT) were synthesized by hydrothermal alkali treatment of TiO2 anatase followed by repeated washings with distinct degrees of proton exchange. TTNT samples with different sodium contents were characterized, as synthesized and after heattreatment (200-800ºC), by X-ray diffraction, scanning and transmission electron microscopy, electron diffraction, thermal analysis, nitrogen adsorption and spectroscopic techniques like FTIR and UV-Vis diffuse reflectance. It was demonstrated that TTNTs consist of trititanate structure with general formula NaxH2−xTi3O7·nH2O, retaining interlayer water in its multiwalled structure. The removal of sodium reduces the amount of water and contracts the interlayer space leading, combined with other factors, to increased specific surface area and mesopore volume. TTNTs are mesoporous materials with two main contributions: pores smaller than 10 nm due to the inner volume of nanotubes and larger pores within 5-60 nm attributed to the interparticles space. Chemical composition and crystal structure of TTNTs do not depend on the average crystal size of the precursor TiO2-anatase, but this parameter affects significantly the morphology and textural properties of the nanostructured product. Such dependence has been rationalized using a dissolution-recrystallization mechanism, which takes into account the dissolution rate of the starting anatase and its influence on the relative rates of growth and curving of intermediate nanosheets. The thermal stability of TTNT is defined by the sodium content and in a lower extent by the crystallinity of the starting anatase. It has been demonstrated that after losing interlayer water within the range 100-200ºC, TTNT transforms, at least partially, into an intermediate hexatitanate NaxH2−xTi6O13 still retaining the nanotubular morphology. Further thermal transformation of the nanostructured tri- and hexatitanates occurs at higher or lower temperature and follows different routes depending on the sodium content in the structure. At high sodium load (water washed samples) they sinter and grow towards bigger crystals of Na2Ti3O7 and Na2Ti6O13 in the form of rods and ribbons. In contrast, protonated TTNTs evolve to nanotubes of TiO2(B), which easily convert to anatase nanorods above 400ºC. Besides hydroxyls and Lewis acidity typical of titanium oxides, TTNTs show a small contribution of protonic acidity capable of coordinating with pyridine at 150ºC, which is lost after calcination and conversion into anatase. The isoeletric point of TTNTs was measured within the range 2.5-4.0, indicating behavior of a weak acid. Despite displaying semiconductor characteristics exhibiting typical absorption in the UV-Vis spectrum with estimated bandgap energy slightly higher than that of its TiO2 precursor, TTNTs showed very low performance in the photocatalytic degradation of cationic and anionic dyes. It was concluded that the basic reason resides in its layered titanate structure, which in comparison with the TiO2 form would be more prone to the so undesired electron-hole pair recombination, thus inhibiting the photooxidation reactions. After calcination of the protonated TTNT into anatase nanorods, the photocatalytic activity improved but not to the same level as that exhibited by its precursor anatase

The effects of intrathecal administration of betamethasone over the dogs' spinal cord and meninges

OBJETIVO: Determinar possíveis alterações clínicas e histológicas determinadas pela administração da betametasona no espaço subaracnóideo de cães. MÉTODOS: Vinte e um cães foram incluídos no estudo de forma aleatória e encoberta. Depois de anestesiados, os cães foram submetidos a punção subaracóidea com injeção de 1 ml da solução sorteada. Os animais receberam solução salina 0,9% em G1, betametasona na dose de 1,75 mg em G2 e betametasona na dose de 3,5 mg em G3. Todos os animais foram mantidos em observação clínica por 21 dias, sendo posteriormente sacrificados. Porções da medula espinhal e sacral foram removidas para análise histológica por microscopia óptica. RESULTADOS: Não foram detectadas alterações clínicas em quaisquer dos animais incluídos no estudo. da mesma forma, nenhum animal do G1 apresentou alterações histológicas. Infiltração inflamatória foi observada em dois cães, um do G2 e outro e G3. No cão do G2 onde a infiltração inflamatória foi observada ocorreu, conjuntamente, hemorragia e necrose. em dois cães, um de G2 e outro de G3, observou-se discreta fibrose e espessamento da aracnóide, sendo focal em um e difusa no outro. CONCLUSÃO: A administração subaracnóidea de betametasona determinou alterações histológicas em medula e meninges de alguns dos cães envolvidos no estudo.

Segmentação Fuzzy de Texturas e Vídeos

The segmentation of an image aims to subdivide it into constituent regions or objects that have some relevant semantic content. This subdivision can also be applied to videos. However, in these cases, the objects appear in various frames that compose the videos. The task of segmenting an image becomes more complex when they are composed of objects that are defined by textural features, where the color information alone is not a good descriptor of the image. Fuzzy Segmentation is a region-growing segmentation algorithm that uses affinity functions in order to assign to each element in an image a grade of membership for each object (between 0 and 1). This work presents a modification of the Fuzzy Segmentation algorithm, for the purpose of improving the temporal and spatial complexity. The algorithm was adapted to segmenting color videos, treating them as 3D volume. In order to perform segmentation in videos, conventional color model or a hybrid model obtained by a method for choosing the best channels were used. The Fuzzy Segmentation algorithm was also applied to texture segmentation by using adaptive affinity functions defined for each object texture. Two types of affinity functions were used, one defined using the normal (or Gaussian) probability distribution and the other using the Skew Divergence. This latter, a Kullback-Leibler Divergence variation, is a measure of the difference between two probability distributions. Finally, the algorithm was tested in somes videos and also in texture mosaic images composed by images of the Brodatz album

Intoxicação aguda por metano arsonato ácido monossódico em bovinos

O presente trabalho estudou a intoxicação acidental por arsênico em um lote de 24 vacas Girolando, as quais tiveram acesso a pasto pulverizado com herbicida à base de metano arsonato ácido monossódico (MSMA). Os bovinos apresentaram apatia, anorexia e diarreia profusa. Foram necropsiados na fazenda dois animais de 14 que morreram. Os principais achados macroscópicos foram úlceras abomasais e congestão renal. No exame microscópico, as principais lesões observadas foram abomasite e omasite necro-hemorrágica multifocal acentuada e, nos rins, necrose tubular difusa. As concentrações médias de arsênico em vacas com sinais clínicos foram 1,19±0,40, 10,52±2,16 e 76,06±48,37ppm no sangue, leite e fezes, respectivamente. Os níveis de arsênico encontrados em dois animais necropsiados foram 25,58 e 23,85ppm em fígado, e 28,71 e 35,94ppm em rins, respectivamente. No feto de uma vaca necropsiada, os níveis de arsênico mensurados no fígado e rim foram 9,0 e 8,92ppm, respectivamente. A concentração de arsênico no capim do piquete pulverizado foi 111,58ppm. No Brasil, o uso MSMA na composição de pesticidas e herbicidas é permitido somente para uso agrícola, mas não pecuário. A utilização desse ou de outros produtos à base de arsênico na pecuária pode causar altos índices de mortalidade no rebanho, além de diminuição da produção e contaminação de produtos de origem animal.

What is a Fuzzy Bi-implication?

In order to make this document self-contained, we first present all the necessary theory as a background. Then we study several definitions that extended the classic bi-implication in to the domain of well stablished fuzzy logics, namely, into the [0; 1] interval. Those approaches of the fuzzy bi-implication can be summarized as follows: two axiomatized definitions, which we proved that represent the same class of functions, four defining standard (two of them proposed by us), which varied by the number of different compound operators and what restrictions they had to satisfy. We proved that those defining standard represent only two classes of functions, having one as a proper subclass of the other, yet being both a subclass of the class represented by the axiomatized definitions. Since those three clases satisfy some contraints that we judge unnecessary, we proposed a new defining standard free of those restrictions and that represents a class of functions that intersects with the class represented by the axiomatized definitions. By this dissertation we are aiming to settle the groundwork for future research on this operator.

On rich modal logics

I thank to my advisor, João Marcos, for the intellectual support and patience that devoted me along graduate years. With his friendship, his ability to see problems of the better point of view and his love in to make Logic, he became a great inspiration for me. I thank to my committee members: Claudia Nalon, Elaine Pimentel and Benjamin Bedregal. These make a rigorous lecture of my work and give me valuable suggestions to make it better. I am grateful to the Post-Graduate Program in Systems and Computation that accepted me as student and provided to me the propitious environment to develop my research. I thank also to the CAPES for a 21 months fellowship. Thanks to my research group, LoLITA (Logic, Language, Information, Theory and Applications). In this group I have the opportunity to make some friends. Someone of them I knew in my early classes, they are: Sanderson, Haniel and Carol Blasio. Others I knew during the course, among them I’d like to cite: Patrick, Claudio, Flaulles and Ronildo. I thank to Severino Linhares and Maria Linhares who gently hosted me at your home in my first months in Natal. This couple jointly with my colleagues of student flat Fernado, Donátila and Aline are my nuclear family in Natal. I thank my fiancée Luclécia for her precious a ective support and to understand my absence at home during my master. I thank also my parents Manoel and Zenilda, my siblings Alexandre, Paulo and Paula.Without their confidence and encouragement I wouldn’t achieve success in this journey. If you want the hits, be prepared for the misses Carl Yastrzemski

Tratamento Clínico e Seguimento das Hiperplasias de Endométrio

Objetivos: avaliar a eficácia do acetato de medroxiprogesterona e do acetato de megestrol nas hiperplasias de endométrio. Métodos: foram incluídas, retrospectivamente 47 pacientes com sangramento uterino anormal, submetidas a curetagem uterina diagnóstica e/ou biópsia de endométrio, cujo achado histopatológico foi de hiperplasia de endométrio. Nas pacientes com hiperplasia sem atipia foi iniciado a terapêutica com acetato de medroxiprogesterona por via oral, na dose de 10 mg/dia durante 10-12 dias por mês. Nas com atipia, era utilizado o acetato de megestrol por via oral, dose de 160 mg/dia, uso contínuo. O período de tratamento variou de 3 a 18 meses. Biópsia de endométrio e/ou curetagem uterina de controle foram realizadas entre três e seis meses do início do tratamento e periodicamente para avaliar a resposta terapêutica. Resultados: foram analisadas 42 pacientes com hiperplasia endometrial sem atipia e cinco com atipia. A média de idade das pacientes foi de 49,5 ± 10,6 anos, sendo 70,2% com idade superior a 45 anos. O acetato de medroxiprogesterona foi eficaz em fazer regredir as hiperplasias sem atipias em 83,2% (35/42) e o acetato de megestrol em 80% (4/5) das hiperplasias com atipia. em 16,8% (7 casos) das hiperplasias sem atipia e em 20% (1 caso) das com atipia, ocorreu persistência das lesões, apesar do tratamento. em nenhum caso ocorreu progressão para câncer de endométrio, durante o período de seguimento que foi de 3 meses a 9 anos. No acompanhamento dessas pacientes, verificamos que 18 (38,3%) apresentaram amenorréia, em 12 (25,5%) ocorreu regularização do ciclo menstrual e 17 (36,2%) permaneceram com sangramento uterino anormal, sendo submetidas a histerectomia total abdominal. O exame anatomopatológico mostrou a persistência da lesão hiperplásica em oito casos, leiomioma em quatro, adenomiose em três, mio-hipertrofia uterina difusa em um caso e útero normal em outro, tendo havido regressão das lesões hiperplásicas nesses últimos nove casos. Conclusões: o tratamento das hiperplasias de endométrio com acetato de medroxiprogesterona e/ou acetato de megestrol, representa uma alternativa satisfatória para mulheres que desejam preservar o útero ou que tenham risco cirúrgico elevado. Entretanto, é necessário monitorização cuidadosa do endométrio, o que deve ser realizado pela avaliação dos sintomas, ultra-sonografia transvaginal e biópsia periódica.

Tuberculose em necropsias realizadas no Serviço de Anatomia Patológica da Faculdade de Medicina de Botucatu

Entre 6.316 necropsias realizadas, no período de 1969 a 2000, no Departamento de Patologia da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista (FMB/UNESP), foram encontradas 240 necropsias com diagnóstico de tuberculose, sendo 117 registradas como doença principal (grupo tuberculose/doença principal) e 123, como doença associada (grupo tuberculose/doença associada). No grupo tuberculose/doença principal, 100% apresentavam tuberculose ativa, com 80 ocorrências em homens e 37 em mulheres e média de idade de 47,7 anos. Caquexia (37,2%) e cor pulmonale (23,7%) foram as co-morbidades mais prevalentes nesse grupo. Os pulmões estavam comprometidos em 95,7% dos casos, seguido pelos linfonodos (38,9%) e pleuras (27,1%). Os padrões morfológicos das lesões pulmonares foram: 1. miliar, 58,4%; 2. cavernas, 56,6%; 3. fibrose, 41,5%; 4. bronquiectasias, 26,5%; 5. enfisema, 19,4%; e 6. cistos, 1,7%. Cavernas foram observadas em diferentes áreas, com discreto predomínio no pulmão direito, sendo a localização apical preferencial (100%) e quase sempre bilaterais (94%). Lesões miliares, bronquiectasias e fibrose estavam distribuídas, de forma difusa e aleatória, nos pulmões. No grupo tuberculose/doença associada também houve predomínio de homens (70,8%). Nesses casos, a AIDS e o alcoolismo crônico foram as doenças principais mais freqüentes, representando 22% e 16,3%, respectivamente. Os pulmões estavam acometidos em 85,2% dessas necropsias (100% nos casos de AIDS), seguidos pelos linfonodos (31,9%) e baço (28,6%). Nossos dados corroboram a importância da necropsia no estudo e no conhecimento da tuberculose, fornecendo subsídios para uma melhor abordagem clínica e epidemiológica dessa doença em nossa região.

Síndrome nefrótica primária grave em crianças: descrição clínica e dos padrões histológicos renais de seis casos

Os autores relatam os casos de seis crianças com síndrome nefrótica primária grave de padrão histológico renal incomum na rotina cotidiana dos nefrologistas e patologistas. O diagnóstico da doença foi realizado nas faixas etárias de 3 a 9 meses de idade (n = 4), aos 2 anos e 4 meses (n = 1) e aos 11 anos (n = 1). Um paciente foi prematuro, duas pacientes eram irmãs e seus pais eram primos de primeiro grau. Todos apresentavam edema generalizado; dois pacientes apresentavam desnutrição e hipotireoidismo e dois apresentavam hipertensão arterial e insuficiência renal. A histologia renal mostrou esclerose mesangial difusa (n = 3), proliferação mesangial (n = 2) e síndrome nefrótica do tipo finlandês (n = 1). Quatro pacientes faleceram, as causas de óbito foram infecção (n = 2), insuficiência renal (n = 1) e acidose metabólica (n = 1). Entre os sobreviventes, um paciente foi tratado com vitaminas, tiroxina, captopril e indometacina, apresentando aumento da albumina sérica e melhora do crescimento. O outro paciente apresentava insuficiência renal terminal, sendo tratado com diálise e transplante renal.