AVALIAÇÃO DE SINTOMAS DEPRESSIVOS E DA QUALIDADE DE VIDA EM PACIENTES COM SÍNDROME FIBROMIÁLGICA

Fibromialgia é uma síndrome de etiologia desconhecida com dor difusa, generalizada e crônica. O diagnóstico da fibromialgia deve ser feito de acordo com o critério do American College of Rheumatology (ACR) 1990. O paciente deve apresentar dor difusa por mais de três meses e relatar dor à palpação em pelo menos 11 de 18 pontos sensíveis, chamados de tender points , caracaterizando assim a síndrome. A maioria dos pacientes acometidos são mulheres, e o pico de incidência etária na ocasião do diagnóstico está entre 40 e 50 anos. A dor crônica promove um impacto na qualidade de vida dessas pessoas, diminuindo sua auto-estima, isolando-as do convívio social e fazendo com que percam o controle dos seus pensamentos e sentimentos. Sintomas depressivos podem ser o resultado da disfunção orgânica, associada às condições de limitação das atividades diárias.Este estudo tem como objetivo investigar a presença dos sintomas depressivos e analisar o impacto dos mesmos sobre a qualidade de vida das pacientes com SF. Foram selecionadas 30 mulheres com diagnóstico de SF, em atendimento no período de outubro a novembro de 2005, as quais responderam a dois questionários: Inventário de Depressão de Beck, para investigar a presença de sinto- mas depressivos e o SF-36 Medical Outcome Survey Short Form -36, para avaliar a qualidade de vida. Os resultados obtidos na estatística pelo programa SPS demons- tram que os sintomas depressivos são responsáveis pelo impacto na qualidade de vida dessas pessoas, principalmente nos domínios: aspectos físicos, aspectos sociais, saú- de mental, vitalidade e saúde geral. A análise dos dados sugere que os sintomas depressivos podem influenciar negativamente a qualidade de vida das mulheres fibromiálgicas, pois aumenta a sensação de incapacidade física, diminui a qualidade das relações sociais, aumenta o pessimismo, a fadiga e o desânimo

O LÚDICO VIA FÁBULAS EM ATENDIMENTO PSICOTERAPÊUTICO: UM ESTUDO DE CASO CLÍNICO DE MOBBING

Esta pesquisa verifica a validade da utilização de fábulas em processo psicoterapêutico de paciente de Mobbing acometida de depressão e síndrome de pânico. Desenvolve-se por meio de estudo de caso avaliativo-interventivo evolutivo prolongado, com um total de 116 sessões semanais. Inicialmente realiza o diagnóstico clínico elaborado a partir do desenho da figura humana, extraído do teste projetivo House Tree and Person, de entrevista inicial semi-dirigida, e de coleta de relatos verbais e observações feitas durante os primeiros atendimentos. As sessões são realizadas com utilização ocasional de fábulas, associada ou não a técnicas de relaxamento de Schultz e Jacobson, com interpretação de sonhos e recomendação de filmes. O objetivo é verificar se as fábulas contribuem de forma positiva para o paciente compreender com mais facilidade as interpretações do psicoterapeuta, se diminui sua resistência ao falar dos seus conteúdos e se amplia à consciência simbólica. O primeiro momento interventivo tem a duração de aproximadamente 16 meses, o segundo, de 04 meses, quando é solicitado o segundo desenho e o terceiro processa-se em 09 meses, quando é solicitado o último desenho. No primeiro momento é proporcionado à paciente um ambiente facilitador com sustentação emocional (Holding), buscando resgatar sua ilusão, numa visão winnicottiana. Revela-se uma situação de Mobbing acompanhada de depressão manifesta e síndrome do pânico; com alto nível de exigência pessoal e profissional; grande passividade nos relacionamentos e na dinâmica do casal. Ao final desse momento, já consegue começar a desviar sua auto-agressividade para o meio externo de maneira mais positiva e socialmente aceita. No segundo momento predomina o encontro e aceitação de seu verdadeiro jeito de ser; enxerga o quanto estava se deixando prejudicar; mostra-se mais confiante, comunica-se e enfrenta melhor suas dificuldades afetivas. No terceiro momento demonstra estar segura e feliz. Cuida de sua aparência e sente prazer em ser notada socialmente. Demonstra ter aprendido a se defender em situações de confronto, com maior autonomia e verbaliza estar muito feliz com as mudanças, sorri com freqüência. A análise evolutiva dos desenhos confirmam esta boa evolução. A utilização de fábulas foi muito bem aceita pela paciente, que conseguiu por meio da leitura simbólica contida nas mesmas, aproximar-se de sua problemática e aprender a lidar com ela de forma mais saudável. Os resultados também indicam que a utilização de relaxamento associado à leitura das fábulas contribuiu para sua assimilação mais abrangente e profunda. O estudo ilustra a evolução do caso por meio de 24 vinhetas, devidamente analisadas em relação aos momentos descritos.(AU)

QT interval prolongation related to psychoactive drug treatment:a comparison of monotherapy versus polytherapy

Background - Several antipsychotic agents are known to prolong the QT interval in a dose dependent manner. Corrected QT interval (QTc) exceeding a threshold value of 450 ms may be associated with an increased risk of life threatening arrhythmias. Antipsychotic agents are often given in combination with other psychotropic drugs, such as antidepressants, that may also contribute to QT prolongation. This observational study compares the effects observed on QT interval between antipsychotic monotherapy and psychoactive polytherapy, which included an additional antidepressant or lithium treatment. Method - We examined two groups of hospitalized women with Schizophrenia, Bipolar Disorder and Schizoaffective Disorder in a naturalistic setting. Group 1 was composed of nineteen hospitalized women treated with antipsychotic monotherapy (either haloperidol, olanzapine, risperidone or clozapine) and Group 2 was composed of nineteen hospitalized women treated with an antipsychotic (either haloperidol, olanzapine, risperidone or quetiapine) with an additional antidepressant (citalopram, escitalopram, sertraline, paroxetine, fluvoxamine, mirtazapine, venlafaxine or clomipramine) or lithium. An Electrocardiogram (ECG) was carried out before the beginning of the treatment for both groups and at a second time after four days of therapy at full dosage, when blood was also drawn for determination of serum levels of the antipsychotic. Statistical analysis included repeated measures ANOVA, Fisher Exact Test and Indipendent T Test. Results - Mean QTc intervals significantly increased in Group 2 (24 ± 21 ms) however this was not the case in Group 1 (-1 ± 30 ms) (Repeated measures ANOVA p < 0,01). Furthermore we found a significant difference in the number of patients who exceeded the threshold of borderline QTc interval value (450 ms) between the two groups, with seven patients in Group 2 (38%) compared to one patient in Group 1 (7%) (Fisher Exact Text, p < 0,05). Conclusions - No significant prolongation of the QT interval was found following monotherapy with an antipsychotic agent, while combination of these drugs with antidepressants caused a significant QT prolongation. Careful monitoring of the QT interval is suggested in patients taking a combined treatment of antipsychotic and antidepressant agents.

Subject identification via ECG fiducial-based systems:influence of the type of QT interval correction

Electrocardiography (ECG) has been recently proposed as biometric trait for identification purposes. Intra-individual variations of ECG might affect identification performance. These variations are mainly due to Heart Rate Variability (HRV). In particular, HRV causes changes in the QT intervals along the ECG waveforms. This work is aimed at analysing the influence of seven QT interval correction methods (based on population models) on the performance of ECG-fiducial-based identification systems. In addition, we have also considered the influence of training set size, classifier, classifier ensemble as well as the number of consecutive heartbeats in a majority voting scheme. The ECG signals used in this study were collected from thirty-nine subjects within the Physionet open access database. Public domain software was used for fiducial points detection. Results suggested that QT correction is indeed required to improve the performance. However, there is no clear choice among the seven explored approaches for QT correction (identification rate between 0.97 and 0.99). MultiLayer Perceptron and Support Vector Machine seemed to have better generalization capabilities, in terms of classification performance, with respect to Decision Tree-based classifiers. No such strong influence of the training-set size and the number of consecutive heartbeats has been observed on the majority voting scheme.

Influence of QT correction on temporal and amplitude features for human identification via ECG

Identification of humans via ECG is being increasingly studied because it can have several advantages over the traditional biometric identification techniques. However, difficulties arise because of the heartrate variability. In this study we analysed the influence of QT interval correction on the performance of an identification system based on temporal and amplitude features of ECG. In particular we tested MLP, Naive Bayes and 3-NN classifiers on the Fantasia database. Results indicate that QT correction can significantly improve the overall system performance. © 2013 IEEE.

Prevalência da síndrome metabólica e seus componentes nos estágios pubertários de escolares do sexo feminino norte-rio-grandenses

The diagnosis of nutritional status is extremely re levant in clinical practice and population assessment, due to the association betwe en body fat and metabolic alterations. The aim of this study is to analyze th e prevalence of metabolic syndrome (MS) and its components in the pubertal stages of f emale students in Rio Grande do Norte state, Brazil, in accordance with Internation al Diabetes Federation criteria. This is a cross-sectional study with 449 students aged betw een 8 and 19 years, stratified into pubertal stages systematized by Marshal and Tanner (1969), as follows: 27.6% prepubertal, 44.3% pubertal and 28.1% postpubertal, with mean ages of 9.4±1.27, 12.4±2.23 and 15.1±1.88 years, respectively. Preval ences were analyzed using distribution of frequencies and their respective 95 % confidence intervals, while the chi- square test and odds ratio were applied to analyze the associations between variables. The general prevalence of MS was 3.3% (CI: 2% - 5%) , without occurrences in the prepubertal stage, observing that it emerges from t he pubertal stage onwards with a prevalence of 2.5% (CI 95% 0.1% - 5%), 1% (CI 95% 0.4% - 2.3%) of cases with overweight and 1.5% (CI 95% -0.1% - 3.2%) with obes e individuals, while in the postpubertal stage the prevalence is 7.9% (CI 95% 3 .2% - 12.6%), 0.8% (CI 95% -0.8% - 2.3%) normal weight cases, 4% (CI 95% 0.6% - 7.4% ) overweight and 3.1% (CI 0.1% - 6.2%) obese individuals. There was an association (p<0.02) between pubertal stages and MS ( x 2 =5.2), with an OR of 3.3 (CI: 1.2 - 5), showing tha t postpubertal adolescents are more prone to SM than pubertals, while the OR i n obese individuals was 2.1 (CI: 2– 2.2) compared to the overweight. Body mass index (B MI) ( x 2 = 29.4; p<0.001) and age range ( x 2 = 13.1; p<0.001) showed a significant linear assoc iation with MS. Of the adolescents with MS, those aged ten years or younge r exhibited higher %G. The most prevalent components in all the stages were altered waist circumference (27.2% [CI 23% - 31%]) and low HDL cholesterol (39.6% [CI 35% – 44%]), which, coupled with hypertension, displayed significant differences in the postpubertal stage in relation to the other stages. The results show that MS emerges from the pubertal stage onwards in proportion to excess childhood body fat, a fact tha t calls for prevention strategies using an educational approach, reducing the large demand on the National Health System. Keywords: Metabolic syndrome, pubertal stages, risk factors.

Processos de construção do sentido por portadores da Síndrome de Asperger

Para la lingüística Cognitiva, la construcción del sentido darse a través del accionamiento de procesos mentales específicos que están directamente ligados a las experiencias socioculturales, sensorio motores y perceptuales. En portadores de la Síndrome de Asperger, el comprometimiento de estos procesos, debido a características específicas dela propia síndrome, puede estar directamente relacionado a problemas de construcción de sentido por estos individuos. En este sentido, el objetivo de esta investigación es investigar los procesos cognitivos que direccionan la construcción del sentido en estos portadores de trastornos neurales. La investigación es realizada con alumnos de la APPARN (Associação de país e amigos dos autistas do Rio Grande do Norte), teniendo como grupo de control alumnos neurotípicos de otras instituciones, siendo los portadores de la síndrome practicantes de la lengua materna o grupo experimental de la búsqueda. Para elucidar el proceso de construcción del sentido por estos alumno, fueron desarrollados testes contiendo rasgos linguisticos norteadores responsables por el accionamiento de algunos procesos cognitivos como los esquemas (JOHNSON, 1987), frames (MINSKY, 1974), affordances (GIBSON, 1979) y simulación mental (BARSALOU, 1999). Los testes fueron basados en los presupuestos teóricos de la Lingüística Cognitiva, más precisamente, de la Teoria Neural del Linguaje. Los resultados apuntan para una posible justificativa para el comprometimiento de la construcción del sentido en portadores de la Síndrome de Asperger, que comprende directamente la relevancia intersubjetiva de la infersencias recibidas y construidas socialmente por los participantes específicamente de este análisis.

Parâmetros bioquímicos e níveis de IgE total e específicas para aeroalérgenos em mulheres obesas com síndrome dos ovários policísticos

Introduction: Polycystic ovary syndrome (PCOS) whose classic features (menstrual irregularity of oligo/ amenorrhea type, chronic anovulation, infertility and hyperandrogenism clinical and/ or biochemical), is associated with aspects of metabolic syndrome (MS), as obesity and insulin resistance. The level of obesity determines different levels of inflammation, increasing cytokines participants of metabolic and endocrine functions, beyond modulate the immune response. Metabolic changes, added to the imbalance of sex hormones underlying irregular menstruation observed in (PCOS) can trigger allergic processes and elevation of total and specific IgE antibodies indicate that a sensitization process was started. Objective: To evaluate the influence of PCOS on biochemical parameters and levels of total and specific IgE to aeroallergens in obese women. Methods: After approval by the Committee of Ethics in Research, were recruited 80 volunteers with BMI ≥ 30 kg/m2 and age between 18 and 45 years. Among these, 40 with PCOS according to the Rotterdam criteria and 40 women without PCOS (control group). All participants were analysed with regard to anthropometric, clinical, gynecological parameters, interviewed using a questionnaire, and underwent blood sampling for realization of laboratory tests of clinical biochemistry: Total cholesterol, LDL-cholesterol, HDL- cholesterol, Triglycerides, Fasting glucose, Urea, Creatinine, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and immunological: total and specific IgE to Dermatophagoides pteronyssinus, Blomia tropicalis, Dermatophagoides farinae and Dermatophagoides microceras.Statistical analysis was performed using SPSS 15.0 software through the chi-square tests, Fisher, Student t test and binary logistic regression, with significance level (p <0.05). Results: It was observed in the group of obese women with PCOS that 29 (72.5%) had menstrual cycle variable and 27 (67.5%) had difficulty getting pregnant. According to waist-hip ratio, higher average was also observed in obese PCOS (0.87). Blood level of HDL (36.9 mg/dL) and ALT (29.3 U/L) were above normal levels in obese women with PCOS, with statistically significant relationship. In the analysis of total and specific IgE to D. pteronyssinus high results were also prevalent in obese PCOS, with blood level (365,22 IU/mL) and (6.83 kU/L), respectively, also statistically significant. Conclusions: Observed predominance of cases with high levels of total IgE in the group of obese women with PCOS, 28 (70%) of the participants, whose mean blood concentration of the group was 365.22 IU/mL. In the analysis of Specific IgE between the groups, the allergen Dermatophagoides pteronyssinus showed greater dispersion and average the results of sensitization in the group of obese PCOS, whose mean blood concentration was 6.83 kU/l. Keywords: Obesity, Allergens and Polycystic Ovary Syndrome

Manifestações oculares em mulheres com síndrome dos ovários policísticos: prevalência e associação com fatores de risco metabólicos e inflamatórios

Objetivos: Estimar a prevalência de alterações do filme lacrimal e da doença do olho seco (DOS), comparar as mudanças na pressão intraocular (PIO) e comparar as espessuras macular e da camada de fibras nervosas da retina (CFNR), entre mulheres com síndrome dos ovários policísticos (SOP) e mulheres saudáveis, estratificando-as em condições clínicas, metabólicas e inflamatórias. Metodologia: O estudo incluiu 45 mulheres com SOP e 47 mulheres saudáveis ovulatórias submetidas a avaliações clínico-ginecológicas e oftalmológicas, incluindo propedêuticas para a avaliação do filme lacrimal e medida da PIO, e medição da espessura macular, da CFNR e parâmetros do disco óptico usando tomografia de coerência óptica. Resultados: Tempo de ruptura do filme lacrimal (TRFL; p=0.001) e impregnação por fluoresceína (p=0.006) apresentaram diferenças estatisticamente significantes entre os grupos estudados. A prevalência de DOS foi de 44,4% nas portadoras de SOP. Houve redução estatisticamente significativa do TRFL na presença de SOP (p=0.001). Além disso, houve efeito estatisticamente significativo de intolerância à glicose e síndrome metabólica/inflamação na impregnação por fluoresceina (p=0.004; p=0.015, respectivamente). A PIO encontrou-se estatisticamente mais elevada no grupo SOP que no grupo controle (p=0.011). Houve um aumento na média do IPC (índice pressão-córnea) com a associação entre SOP e da síndrome metabólica (p = 0.005); A média da espessura da CNFR superior ao redor do nervo óptico foi estatisticamente mais espessa nas voluntárias com SOP que nas voluntárias saudáveis (p=0.036); Após estratificação pela presença de resistência insulínica, as médias dos subcampos das espessuras maculares “macular interno temporal, macular interno inferior, macular interno nasal e macular externo nasal, foram mais espessas no grupo SOP que no grupo controle (p<0.05); Houve associação significativa entre obesidade e resistência insulínica (p=0.037), e intolerância à glicose (p=0.001), com aumento médio do componente principal 1 (CP1), e, na presença de síndrome metabólica (p<0.0001), com aumento médio do componente principal 2 (CP2), respectivamente, em relação à espessura macular total. Na presença de obesidade e inflamação, houve redução no escore médio da CP2 (p=0.034), em relação à espessura da CFNR na mácula. xviii Conclusões: Há uma associação da SOP, suas alterações metabólicas e inflamatórias com alterações do filme lacrimal e com mudanças na PIO. A diminuição na espessura da CFNR macular e aumento da espessura total macular estão possivelmente associadas às alterações metabólicas, e, o aumento na espessura da CFNR ao redor do nervo óptico estão provavelmente associadas às alterações hormonais, inerentes à SOP.

Síndrome de Guillain-Barré: epidemiologia, prognóstico e fatores de risco

Introduction. Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy and the principal cause of acute neuromuscular paralysis. The most prominent GBS subtypes are: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor-sensory axonal neuropathy (AMSAN) and Fisher syndrome (FS). Differences in geographical distribution of variants have been reported. In Brazil, there are few studies describing the characteristics of GBS, but none on the frequency of GBS variants and their clinical manifestations. Infection-induced aberrant immune response resulting from molecular mimicry and formation of cross-reacting antibodies, contribute to complement activation. Functional biallelic polymorphism in immunoglobulin receptors that influence the affinity of IgG subclasses and the type of immune response have been described, suggesting genetic susceptibility to developing disease. It remains unclear whether individuals carrying different FCGR alleles have differential risk for GBS and⁄or disease severity. The goals of this study were: (1) To characterize GBS and describe the clinical findings in a cohort of patients with GBS from the state of Rio Grande do Norte, Brazil; (2) to determine whether polymorphism in FCGR were associated with development of GBS, and (3) to tease out whether the global gene expression studies could be a tool to identify pathways and transcriptional networks which could be regulated and decrease the time of disease. Methods. Clinical and laboratory data for 149 cases of GBS diagnosed from 1994 to 2013 were analyzed. Genomic DNA and total RNA were extracted from whole blood. Antigangliosides antibodies were determined in the sera. In addition, we also assessed whether FCGR polymorphism are present in GBS (n=141) and blood donors (n=364), and global gene expressions were determined for 12 participants with GBS. Blood samples were collected at the diagnosis and post-recovery. Results. AIDP was the most frequent variant (81.8%) of GBS, followed by AMAN (14.7%) and AMSAN (3.3%). The incidence of GBS was 0.3 ⁄ 100,000 people for the state of Rio Grande do Norte and cases occurred at a younger age. GBS was preceded by infections, with the axonal variant associated with episodes of diarrhea (P = 0.025). Proximal weakness was more frequent in AIDP, and distal weakness predominant in the axonal variant. Compared to 42.4% of cases with AIDP (P<0.0001), 84.6% of cases with the axonal variant had nadir in <10 days. Individuals with the axonal variant took longer to recover deambulation (P<0.0001). The mortality of GBS was 5.3%. A worse outcome was related to an axonal variant (OR17.063; P=0.03) and time required to improve one point in the Hughes functional scale (OR 1.028; P=0.03). The FCGR genotypes and allele frequencies did not differ significantly between the patients with GBS and the controls (FCGR2A p=0.367 and FCGR3A p=0.2430). Global gene expression using RNAseq showed variation in transcript coding for protein isoforms during acute phase of disease. Conclusions. The annual incidence of GBS was 0.3 per 100,00 and there was no seasonal pattern. A predominance of the AIDP variant was seen, and the incidence of the disease decreased with age. The distribution of weakness is a function of the clinical variants, and individuals with the axonal variant had a poorer prognosis. Early diagnosis and variant identification leads to proper intervention decreasing in long-term morbidity. FCGR polymorphisms do not seem to influence susceptibility to GBS in this population. This study found deregulated genes and signs of transcriptional network alterations during the acute and recovery phases in GBS. Identification of pathways altered during disease might be target for immune regulation and with potential to ameliorate symptoms.

A influência da perda de peso no perfil inflamatório de mulheres com síndrome dos ovários policísticos

The polycystic ovary syndrome (PCOS) is considered the most common endocrine disorder in reproductive age women, with a prevalence ranging from 15 to 20%. In addition to hormonal and reproductive changes, it is common in PCOS the presence of risk factors for developing cardiovascular disease (CVD) and diabetes mellitus, insulin resistance (IR), visceral obesity, chronic low-grade inflammation and dyslipidemia. Due to the high frequency of obesity associated with PCOS, weight loss is considered as the first-line treatment for the syndrome by improving metabolic and normalizes serum androgens, restoring reproductive function of these patients. Objectives: To evaluate the inflammatory markers and IR in women with PCOS and healthy ovulatory with different nutritional status and how these parameters are displayed after weight loss through caloric restriction in with Down syndrome. Methods: Tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) were assessed in serum samples from 40 women of childbearing age. The volunteers were divided into four groups: Group I (not eutrophic with PCOS, n = 12); Group II (not eutrophic without PCOS, n = 10), Group III (eutrophic with PCOS, n = 08) and Group IV (eutrophic without PCOS, n = 10). The categorization of groups was performed by body mass index (BMI), according to the World Health Organization (WHO) does not eutrophic, overweight and obesity (BMI> 25 kg / m²) and normal weight (BMI <24.9 kg / m²). IR was determined by HOMA-IR index. In the second phase of the study a controlled dietary intervention was performed and inflammatory parameters were evaluated in 21 overweight and obese women with PCOS, before and after weight loss. All patients received a low-calorie diet with reduction of 500 kcal / day of regular consumption with standard concentrations of macronutrients. Results: Phase 1: PCOS patients showed increased levels of CRP (p <0.01) and HOMAIR (p <0.01). When divided by BMI, both not eutrophic group with PCOS (I) as eutrophic with PCOS (III) showed increased levels of CRP (I = 2.35 ± 0,55mg / L and 2.63 ± III = 0,65mg / L; p <0.01) and HOMA-IR (I = 2.16 ± 2.54 and III = 1.07 ± 0.55; p <0.01). There were no differences in TNF-α and IL-6 between groups. Step 2: After the weight loss of 5% of the initial weight was reduced in all of the components of serum assessed inflammatory profile, PCR (154.75 ± 19:33) vs (78.06 ± 8.9) TNF α (10.89 ± 5.09) vs (6:39 ± 1:41) and IL6 (154.75 ± 19:33) vs (78.06 ± 08.09) (p <0:00) in association with improvement some hormonal parameters evaluated. Conclusion: PCOS contributed to the development of chronic inflammation and changes in glucose metabolism by increasing CRP, insulin and HOMA-IR, independent of nutritional status. The weight loss, caloric restriction has improved the inflammatory condition and hormonal status of the evaluated patients.

Prevalência e fatores associados à síndrome da fragilidade em idosos: inquérito populacional em Campina Grande-PB

The frailty syndrome is a geriatric medical condition of vulnerability resulting in the decline of physiological reserves, characterized by high-risk consequences as falls, disability, hospitalization, institutionalization and death. Although the presence of comorbidities is not always accompanied by fragility, this presence could also indicate an increased risk of adverse health events, taking the elderly to a greater likelihood of becoming brittle due to the physical limitations that may occur with emergence of diseases, which are strongly predictive of Fragility Syndrome. This study aimed to assess the prevalence of frailty syndrome in the elderly and associated factors. The specific objectives were to identify the prevalence of frailty syndrome in the elderly and their associations with demographic, economic, health, functional and psychological; identify the reasons for the prevalence of frailty syndrome with the demographic profile, health problems, use of legal drugs and problems with sleep of older people. The study was cross-sectional and composed of 385 elderly aged 65 or more. Multivariate Poisson regression models were used to check conditions associated with fragility and determine the prevalence ratio (α = 0.05). The prevalence of fragility was 8.7% and pre-fragility of 50.4%. Fragile and pre-frail elderly presented, bigger and increasing prevalence ratio for marital status, difficulty in performing instrumental activities of daily living, old age, involuntary loss of stool, depression and negative affect. Elderly people who do not work have a higher prevalence of fragility, as well as those who reported having had a stroke / stroke / ischemia, those who suffered falls in the last 12 months and those with sleep problems. It is considered that the results, together with other available in the literature, can contribute to the understanding of the fragility epidemiology and also in the implementation of specific programs aimed at reducing the prevalence of frailty, optimizing the quality of life. It is suggested that future programs have special attention to the profiles of elderly people who have not yet developed fragility, i.e., pre-fragile. This could prevent the elderly from becoming frail.

Avaliação da genotoxicidade em mulheres com síndrome dos ovários policísticos: impacto da dieta

Introduction: Polycystic Ovary Syndrome (PCOS), present in 6-12% of women of reproductive age, the criterion of Rotterdam, is characterized by hyperandrogenism, insulin resistance (IR) and its inflammatory state, exacerbated by obesity and factors associated with the increase in damage DNA. Weight loss, combined with healthy eating, acts restoring the reproductive and metabolic functions in the SOP, though its influence in reducing DNA damage in PCOS are unknown. Aim: To investigate whether there are differences between DNA damage markers and factors of cardiometabolic risk in women with PCOS and control, and evaluate the effectiveness of nutritional intervention in DNA damage markers and cardiometabolic risk markers in overweight and obese women with PCOS. Methods: the study was conducted in two studies and the participants were aged between 18 and 35 years. In the first study, a prospective case-control, were included 27 women diagnosed with PCOS and 20 controls. In the second study, clinical trial of nutritional intervention with 12-week calorie-restricted diet 500Kcal / day. The genotoxicity, DNA damage (intensity tail, tail moment and tail length) was evaluated by the comet assay. Anthropometric data, dietary intake, hormonal, biochemical and inflammatory were evaluated in different studies. Results: there was no significant difference between the DNA damage marker tail intensity (p = 0.18), tail moment (p = 0.76) and tail length (p = 0.109) in PCOS when compared to the control group. Data after nutritional intervention in PCOS women with overweight and obesity showed a decrease in DNA damage markers: tail intensity (24.35 ± 5.86 - pre-diet vs. 17.15 ± 5.04 -Post-diet) and tail moment (20.47 ± 7.85 - pre-diet vs. 14.13 ± 6.29 -post-diet) (p <0.001). Reduction of weight (3.5%) and decreased cardiometabolic markers IR and hyperandrogenism. Conclusion: women with PCOS have a worse cardiometabolic risk profile compared to control however similar genotoxicity identified by DNA damage. Nutritional intervention reduced the genotoxicity of overweight and obese women with PCOS, and reduce the factors of cardiometabolic risk.

Intervenção mediacional e hábitos alimentares: um estudo de crianças com síndrome de Down

The inadequacy about eating habits have been established as a serious problem nowadays. It is a multifactorial and difficult to handle, given their different nuances and causes. A population particularly exposed to the bad eating habits arising harm are individuals with Down syndrome, both with regard to the aspects inherent to the individual's own condition, regarding eating misfits, making it the weight control a necessary measure for a proper development. Thus, this study aimed to develop and evaluate a proposal based nutrition education from the assumptions of mediated learning, with children three to four years with Down syndrome. The participants were five children, four girls and a boy. Also included his parents and / or guardians. The data collection procedure involved the use of eight playful workshops with children and nutritional evaluation of those five meetings with parents and three home visits with each participating family. We tried to build with these children and their families a nutritional education to contribute to their daily choices of eating. Using listening, observation and questionnaire, besides playful interventions, it was observed that the first meaning of the act of eating is built in the family and reinforced by their social life. Overall, our sample characteristics seem to agree with the literature. During the intervention, the children showed attention, but little understanding of the content. With mothers, the results were different, with reflections on the inadequate power both the type of food offered, and quantity and so this offer is performed, conducted along the interventions changes in your lifestyle, such as perception of influence they had on their children in the formation of their eating habits, as well as less frequent intake of soft drinks and sweets. Nutritional interventions and mediations conducted with the mothers is that they seem to be effective strategies to combat obesity. Face of what was discussed, we see the importance of implementing intervention measures in combating and preventing overweight or obese since childhood, particularly with children with Down syndrome. One should prevent childhood obesity with educational and informative measures from birth, with family and with each child, through the primary health care and schools.

Síndrome dos Ovários Policísticos: diagnóstico, tratamento e repercussões ao longo da vida

A síndrome dos ovários policísticos (SOP) é uma endocrinopatia comum em mulheres na idade reprodutiva. Caracteriza-se por hiperandrogenismo, disfunção ovulatória e infertilidade. Está associada a reconhecidos fatores de risco cardiovascular: obesidade, resistência à insulina, dislipidemias, hipertensão arterial, síndrome metabólica,risco aumentado para intolerância à glicose e diabetes mellitus tipo 2 em idade mais precoce que o habitual. Embora mulheres com SOP apresentem perfil de risco cardiovascular adverso, os estudos são limitados em confirmar a associação entre SOP e mortalidade por evento cardiovascular. Devido à ampla variabilidade clínica, o diagnóstico de SOP nem sempre é fácil. De acordo com o Consenso de Rotterdam, os critérios para diagnóstico de SOP incluem pelo menos dois dos seguintes critérios: amenoreia e/ou oligomenorreia, sinais clínicos e/ou bioquímicos de hiperandrogenismo e/ou ovário policístico à ultrassonografia; com exclusão de outras etiologias que apresentam manifestações clínicas semelhantes. O tratamento de SOP é sintomático e direcionado de acordo com a manifestação clínica, o desejo de contracepção ou gestação e a presença de distúrbios metabólicos associados. As pacientes com SOP devem ser informadas que esta é uma enfermidade crônica, com tratamento e seguimento por longo prazo.