Autogerindo o tratamento da osteoporose no regaste do bem-estar, mediado pela (in)visibilidade de indicadores da doença

The present study aimed to understand patients experience with osteoporosis treatment. The methodological and theoretical frameworks were, respectively, the Grounded Theory and Symbolic Interactionism. The research subjects were 12 patients monitored in a specialized outpatient unit. The obtained statements were transcribed and analyzed, leading to a synthesis of the described themes. From the analysis process, two phenomena emerged: self-evaluating health conditions according to the disease signs and making a decision about the treatment targeting at well-being. The realignment and the inter-relationship of the components belonging to these phenomena (themes, categories, and subcategories) allowed to identify the core category: self-managing osteoporosis treatment for well-being recovery mediated by the (in)visibility of the disease signs. Furthermore, it allowed for the design of a theoretical model concerning the process used by the player in his cyclic movement of the experience, between adherence to and relaxation from the osteoporosis treatment.Este estudio tuvo como objetivo comprender la experiencia de los pacientes con el tratamiento de la osteoporosis. Los marcos teórico y metodológico fueron, respectivamente, la Grounded Theory y el Interaccionismo Simbólico. Los sujetos fueron 12 pacientes en una clínica especializada. Las declaraciones fueron transcritas y analizadas, habiendo sido obtenida una síntesis de los temas descritos. En el proceso de análisis surgieron dos fenómenos: auto-evaluando el estado de salud de acuerdo a los indicadores de la enfermedad y, tomando una decisión sobre el tratamiento teniendo como meta el bienestar. La reestructuración y la interrelación de los componentes que pertenecen a estos fenómenos (temas, categorías y subcategorías) permitieron identificar la categoría central, llamada auto-administrando el tratamiento de la osteoporosis en el rescate del bienestar, por medio de la (in)visibilidad de los indicadores de la enfermedad. Además, permitió elaborar un modelo teórico referente al proceso emprendido por el actor en su movimiento cíclico da experiencia, entre la adhesión y el relajamiento en lo que se refiere al tratamiento de la osteoporosis.O presente estudo teve como objetivo compreender a experiência dos pacientes com o tratamento da osteoporose. Os referenciais metodológico e teórico foram, respectivamente, a Grounded Theory e o Interacionismo Simbólico. A amostra desta pesquisa foi composta por 12 pacientes, acompanhados em um ambulatório especializado. Dos depoimentos obtidos, após transcritos e analisados, obteve-se uma síntese dos temas descritos. Do processo de análise, emergiram dois fenômenos: autoavaliando o estado de saúde, segundo os indicadores da doença e tomando a decisão quanto ao tratamento, tendo como meta o bem-estar. O realinhamento e a inter-relação de componentes, pertencentes a esses fenômenos (temas, categorias e subcategorias), possibilitaram identificar a categoria central, denominada autogerindo o tratamento da osteoporose no regaste do bem-estar, mediado pela (in)visibilidade de indicadores da doença. Ademais, permitiu elaborar um modelo teórico referente ao processo empreendido pelo ator no seu movimento cíclico da experiência, entre a adesão e o relaxamento quanto ao tratamento da osteoporose

Comparative Evaluation of Oculometric Variables in Graves’ Ophthalmopathy

OBJECTIVES: To estimate oculometric parameters of Graves' ophthalmopathy in comparison to healthy eyes using digital photography and digital image analysis. INTRODUCTION: Graves' ophthalmopathy is the main cause of eye proptosis. Because these protrusions cause clinically perceived distortions in orbital architecture, digital photographs can be used to detect and quantify these changes. METHODS: We carried out a cross-sectional study comprising 12 healthy volunteers and 15 Graves' ophthalmopathy patients with the purpose of evaluating the use of simple, non-invasive digital photography to estimate oculometric parameters of Graves' ophthalmopathy and compare them with the parameters of unaffected eyes. Facial photographs of cases and controls were taken in a standardized manner. Oculometric parameters were compared between the groups and then correlated to proptometer measures. RESULTS: All estimated oculometric variables showed significant differences between the groups, in particular with regard to mediopupilar aperture, lateral height, distance from the iris edge to the lateral boundary of the palpebral fissure, and distance from the higher point of the iris to the lateral limit of the palpebral fissure. The product of medial aperture and horizontal palpebral fissure also revealed greater discrepancy between the groups. Proptometer measures showed significant linear correlation between the distance from the iris edge to the lateral boundary of the palpebral fissure and between the distance from the higher point of the iris to the lateral limit of palpebral fissure (p<0.05). CONCLUSIONS: Comparative analysis of oculometric parameters in Graves' ophthalmopathy suggests that eye proptosis is related to an asymmetric increase in lateral oculometric measures. Standardized digital photographs can be used in clinical practice to objectively estimate oculometric parameters of Graves' ophthalmopathy patients

Perfil de la ingestión nutricional de los pacientes con masa ósea disminuida

A osteoporose é uma desordem sistêmica na qual é observada a fragilidade óssea e o aumento da susceptibilidade às fraturas. Uma alimentação balanceada que forneça quantidades suficientes de proteínas, vitaminas e minerais, influencia positivamente a saúde dos ossos. Desse modo, este estudo objetivou traçar o perfil do consumo dos principais nutrientes envolvidos com a saúde óssea, procurando otimizar esta ingestão, nos pacientes portadores de baixa massa óssea, acompanhados no Ambulatório de Distúrbios do Cálcio (ADC) do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP. Foram convidados a participar do estudo 45 pacientes com baixa massa óssea, acompanhados no ADC. Destes, 15 pacientes do sexo feminino, com idade média de 60,7 anos, aceitaram e concluíram o projeto. Foram realizados recordatórios de 24 horas e desenvolvidas Atividades de Educação Nutricional (AEN), baseadas em um livreto informativo, objetivando a otimização do consumo de cálcio (Ca), vitamina D, fósforo (P), magnésio (Mg) e demais nutrientes envolvidos na saúde óssea. Foram ainda realizadas degustações de preparações dietéticas, ricas em Ca. O consumo médio dos nutrientes, foi avaliado antes e após o final das atividades, por meio do Programa.DietPro 5i®. A ingestão mediana de energia (1096,8 Kcal) e macronutrientes (carboidratos: 127,2g; proteínas: 40,4g; lipídeos: 20,4g) esteve abaixo do recomendado pelas Dietary References Intakes-DRI. O consumo desses nutrientes não apresentou alterações significativas após as AEN (energia: 1120,8 Kcal; carboidratos: 164,8; proteínas: 60,5 g; lipídeos: 29,9 g/ p> 0,05). A ingestão mediana de micronutrientes esteve abaixo do recomendado pelas DRI/Institute of Medicine-IOM (Ca: 661,57 mg; vitamina D: 0,64 µg; Mg: 292,71 mg; P: 1214,00 mg). O consumo desses nutrientes não apresentou alterações significativas após as AEN (Ca: 619,57 mg; vitamina D: 0,73 µg; Mg: 212,15 mg; P: 821,24 mg; p> 0,05). Os percentuais de inadequação para cálcio, vitamina D e magnésio foram elevados (81,7%, 99,8% e 100%, respectivamente). O percentual de inadequação para o fósforo foi de 36%. Neste grupo de pacientes portadoras de baixa massa óssea, observou-se um perfil de ingestão inadequado em relação aos principais nutrientes relacionados a saúde óssea. A orientação nutricional durante o período de oito meses não se mostrou eficiente na otimização desta ingestão. Este achado ressalta a importância do estabelecimento de novas estratégias que otimizem o consumo destes nutrientes.Osteoporosis is a systemic disorder in which there is bone fragility and an increase in susceptibility to fractures. A balanced diet that provides sufficient quantities of proteins, vitamins, and minerals has a positive influence on bone health. The aim of this study was to determine the profile of consumption of the main nutrients involved in bone health, in order to optimize their ingestion, in patients with low bone mass. The progress of the patients was followed at the calcium disorders outpatients unit of the Clinical Hospital of Botucatu Medical School (UNESP). Forty-five patients with low bone mass were invited to participate in this study. Of these, 15 women, with an average age of 60.7 years, accepted and concluded the project. 24-h food recollections were performed and nutritional education activities (NEA) were organized based on an information leaflet, with the aim of optimizing the consumption of calcium (Ca), vitamin D, phosphorus (P), magnesium (Mg), and other nutrients involved in bone health. There was also tasting of dietary preparations rich in Ca. The average consumption of the nutrients was evaluated before and after the end of the activities, using the program DietPro 5i®. The median ingestion of energy (1096.8 Kcal) and macronutrients (carbohydrates: 127.2 g; proteins: 40.4 g; lipids: 20.4 g) was below the levels recommended according to the Dietary Reference Intakes (DRI). The consumption of energy and the nutrients showed no significant changes after the NEA (energy: 1120.8 Kcal; carbohydrates: 164.8 g; proteins: 60.5 g; lipids: 29.9 g; p>0.05). The median ingestion of micronutrients was also below the levels recommended by DRI/Institute of Medicine (IOM) (Ca: 661.57 mg; vitamin D: 0.64 µg; Mg: 292.71 mg; P: 1214.00 mg). The consumption of such nutrients did not present significant changes after the NEA (Ca: 619.57 mg; vitamin D: 0.73 µg; Mg: 212.15 mg; P: 821.24 mg; p>0.05). The percentage deficiencies for Ca, vitamin D and Mg were elevated (81.7%, 99.8%, and 100%, respectively). The percentage deficiency for P was 36%. In this group of female patients with low bone mass, there was an unsatisfactory ingestion profile for the main nutrients related to bone health. The nutritional guidance provided during the 8-month period was not effective in optimizing such ingestion. This finding highlights the importance of establishing new strategies in order to optimize the consumption of these nutrients.La osteoporosis es una enfermedad sistémica en la cual se observa fragilidad ósea y aumento de la susceptibilidad a las fracturas. Una alimentación equilibrada, que proporcione cantidades suficientes de proteínas, vitaminas y minerales, influye positivamente en la salud de los huesos. Así, el objetivo del estudio fue delinear el perfil de consumo de los principales nutrientes implicados en la salud ósea, con la finalidad de mejorar esta ingestión en pacientes con baja masa ósea, fueron acompañados en la enfermería de Trastornos de calcio del Hospital de las Clínicas de la Facultad de Medicina de Botucatu – UNESP. Fueron llamados a participar del estudio 45 pacientes con baja masa ósea, seguidos en el ADC. De éstos, 15 pacientes del sexo femenino, con edad media de 60,7 años, aceptaron y concluyeron el proyecto. Se registraron históricos alimenticios de 24 horas y se  desarollaron actividades de educación nutricional (AEN), basadas en un folleto informativo, apuntando la optimización del consumo de calcio (Ca), vitamina D, fósforo (P), magnesio (Mg) y otros nutrientes implicados en la salud ósea. Fueron también realizadas degustaciones de preparaciones alimenticias, ricas en Ca. El consumo medio de los nutrientes fue evaluado antes y después de las actividades, a través del programa DietPro 5i®. La ingesta mediana de energía (1096,8 Kcal) y de macronutrientes (hidratos de carbono: 127,2g; proteínas: 40,4g; lípidos: 20,4g) estaba debajo de lo recomendado por las Dietary References Intakes-DRI.. El consumo de éstos nutrientes no presentó cambios significativos después de las AEN (energía: 1120,8 Kcal; hidratos de carbono: 164,8; proteínas: 60,5 g; lípidos: 29,9 g/ p> 0,05). La ingestión mediana de micronutrientes también estaba debajo de lo recomendado por DRI/Institute of Medicine-IOM (Ca: 661,57 mg; vitamina D: 0,64 µg; Mg: 292,71 mg; P: 1214,00 mg). El consumo de éstos nutrientes no ha presentado cambios significativos después de las AEN (Ca: 619,57 mg; vitamina D: 0,73 µg; Mg: 212,15 mg; P: 821,24 mg; p> 0,05). Los porcentajes de inadecuación para el Ca, vitamina D y Mg fueron elevados (81,7%, 99,8% y 100%, respectivamente). El porcentaje de inadecuación para el P fue de 36%. En este grupo de pacientes femeninos con baja masa ósea, se observó un perfil de ingestión inadecuada en relación a los principales nutrientes implicados en la salud ósea. La orientación nutricional no se mostró eficiente en la optimización de esta ingestión. Esta constatación destaca la importancia de establecer nuevas estrategias que optimicen el consumo de estos nutrientes

Profile of the nutritional intake of patients with decreased bone mass

Osteoporosis is a systemic disorder in which there is bone fragility and an increase in susceptibility to fractures. A balanced diet that provides sufficient quantities of proteins, vitamins, and minerals has a positive influence on bone health. The aim of this study was to determine the profile of consumption of the main nutrients involved in bone health, in order to optimize their ingestion, in patients with low bone mass. The progress of the patients was followed at the calcium disorders outpatients unit of the Clinical Hospital of Botucatu Medical School (UNESP). Forty-five patients with low bone mass were invited to participate in this study. Of these, 15 women, with an average age of 60.7 years, accepted and concluded the project. 24-h food recollections were performed and nutritional education activities (NEA) were organized based on an information leaflet, with the aim of optimizing the consumption of calcium (Ca), vitamin D, phosphorus (P), magnesium (Mg), and other nutrients involved in bone health. There was also tasting of dietary preparations rich in Ca. The average consumption of the nutrients was evaluated before and after the end of the activities, using the program DietPro 5i®. The median ingestion of energy (1096.8 Kcal) and macronutrients (carbohydrates: 127.2 g; proteins: 40.4 g; lipids: 20.4 g) was below the levels recommended according to the Dietary Reference Intakes (DRI). The consumption of energy and the nutrients showed no significant changes after the NEA (energy: 1120.8 Kcal; carbohydrates: 164.8 g; proteins: 60.5 g; lipids: 29.9 g; p&gt;0.05). The median ingestion of micronutrients was also below the levels recommended by DRI/Institute of Medicine (IOM) (Ca: 661.57 mg; vitamin D: 0.64 µg; Mg: 292.71 mg; P: 1214.00 mg). The consumption of such nutrients did not present significant changes after the NEA (Ca: 619.57 mg; vitamin D: 0.73 µg; Mg: 212.15 mg; P: 821.24 mg; p&gt;0.05). The percentage deficiencies for Ca, vitamin D and Mg were elevated (81.7%, 99.8%, and 100%, respectively). The percentage deficiency for P was 36%. In this group of female patients with low bone mass, there was an unsatisfactory ingestion profile for the main nutrients related to bone health. The nutritional guidance provided during the 8-month period was not effective in optimizing such ingestion. This finding highlights the importance of establishing new strategies in order to optimize the consumption of these nutrients.</p

Perfil de la ingestión nutricional de los pacientes con masa ósea disminuida

A osteoporose é uma desordem sistêmica na qual é observada a fragilidade óssea e o aumento da susceptibilidade às fraturas. Uma alimentação balanceada que forneça quantidades suficientes de proteínas, vitaminas e minerais, influencia positivamente a saúde dos ossos. Desse modo, este estudo objetivou traçar o perfil do consumo dos principais nutrientes envolvidos com a saúde óssea, procurando otimizar esta ingestão, nos pacientes portadores de baixa massa óssea, acompanhados no Ambulatório de Distúrbios do Cálcio (ADC) do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP. Foram convidados a participar do estudo 45 pacientes com baixa massa óssea, acompanhados no ADC. Destes, 15 pacientes do sexo feminino, com idade média de 60,7 anos, aceitaram e concluíram o projeto. Foram realizados recordatórios de 24 horas e desenvolvidas Atividades de Educação Nutricional (AEN), baseadas em um livreto informativo, objetivando a otimização do consumo de cálcio (Ca), vitamina D, fósforo (P), magnésio (Mg) e demais nutrientes envolvidos na saúde óssea. Foram ainda realizadas degustações de preparações dietéticas, ricas em Ca. O consumo médio dos nutrientes, foi avaliado antes e após o final das atividades, por meio do Programa.DietPro 5i®. A ingestão mediana de energia (1096,8 Kcal) e macronutrientes (carboidratos: 127,2g; proteínas: 40,4g; lipídeos: 20,4g) esteve abaixo do recomendado pelas Dietary References Intakes-DRI. O consumo desses nutrientes não apresentou alterações significativas após as AEN (energia: 1120,8 Kcal; carboidratos: 164,8; proteínas: 60,5 g; lipídeos: 29,9 g/ p> 0,05). A ingestão mediana de micronutrientes esteve abaixo do recomendado pelas DRI/Institute of Medicine-IOM (Ca: 661,57 mg; vitamina D: 0,64 µg; Mg: 292,71 mg; P: 1214,00 mg). O consumo desses nutrientes não apresentou alterações significativas após as AEN (Ca: 619,57 mg; vitamina D: 0,73 µg; Mg: 212,15 mg; P: 821,24 mg; p> 0,05). Os percentuais de inadequação para cálcio, vitamina D e magnésio foram elevados (81,7%, 99,8% e 100%, respectivamente). O percentual de inadequação para o fósforo foi de 36%. Neste grupo de pacientes portadoras de baixa massa óssea, observou-se um perfil de ingestão inadequado em relação aos principais nutrientes relacionados a saúde óssea. A orientação nutricional durante o período de oito meses não se mostrou eficiente na otimização desta ingestão. Este achado ressalta a importância do estabelecimento de novas estratégias que otimizem o consumo destes nutrientes.Osteoporosis is a systemic disorder in which there is bone fragility and an increase in susceptibility to fractures. A balanced diet that provides sufficient quantities of proteins, vitamins, and minerals has a positive influence on bone health. The aim of this study was to determine the profile of consumption of the main nutrients involved in bone health, in order to optimize their ingestion, in patients with low bone mass. The progress of the patients was followed at the calcium disorders outpatients unit of the Clinical Hospital of Botucatu Medical School (UNESP). Forty-five patients with low bone mass were invited to participate in this study. Of these, 15 women, with an average age of 60.7 years, accepted and concluded the project. 24-h food recollections were performed and nutritional education activities (NEA) were organized based on an information leaflet, with the aim of optimizing the consumption of calcium (Ca), vitamin D, phosphorus (P), magnesium (Mg), and other nutrients involved in bone health. There was also tasting of dietary preparations rich in Ca. The average consumption of the nutrients was evaluated before and after the end of the activities, using the program DietPro 5i®. The median ingestion of energy (1096.8 Kcal) and macronutrients (carbohydrates: 127.2 g; proteins: 40.4 g; lipids: 20.4 g) was below the levels recommended according to the Dietary Reference Intakes (DRI). The consumption of energy and the nutrients showed no significant changes after the NEA (energy: 1120.8 Kcal; carbohydrates: 164.8 g; proteins: 60.5 g; lipids: 29.9 g; p>0.05). The median ingestion of micronutrients was also below the levels recommended by DRI/Institute of Medicine (IOM) (Ca: 661.57 mg; vitamin D: 0.64 µg; Mg: 292.71 mg; P: 1214.00 mg). The consumption of such nutrients did not present significant changes after the NEA (Ca: 619.57 mg; vitamin D: 0.73 µg; Mg: 212.15 mg; P: 821.24 mg; p>0.05). The percentage deficiencies for Ca, vitamin D and Mg were elevated (81.7%, 99.8%, and 100%, respectively). The percentage deficiency for P was 36%. In this group of female patients with low bone mass, there was an unsatisfactory ingestion profile for the main nutrients related to bone health. The nutritional guidance provided during the 8-month period was not effective in optimizing such ingestion. This finding highlights the importance of establishing new strategies in order to optimize the consumption of these nutrients.La osteoporosis es una enfermedad sistémica en la cual se observa fragilidad ósea y aumento de la susceptibilidad a las fracturas. Una alimentación equilibrada, que proporcione cantidades suficientes de proteínas, vitaminas y minerales, influye positivamente en la salud de los huesos. Así, el objetivo del estudio fue delinear el perfil de consumo de los principales nutrientes implicados en la salud ósea, con la finalidad de mejorar esta ingestión en pacientes con baja masa ósea, fueron acompañados en la enfermería de Trastornos de calcio del Hospital de las Clínicas de la Facultad de Medicina de Botucatu – UNESP. Fueron llamados a participar del estudio 45 pacientes con baja masa ósea, seguidos en el ADC. De éstos, 15 pacientes del sexo femenino, con edad media de 60,7 años, aceptaron y concluyeron el proyecto. Se registraron históricos alimenticios de 24 horas y se  desarollaron actividades de educación nutricional (AEN), basadas en un folleto informativo, apuntando la optimización del consumo de calcio (Ca), vitamina D, fósforo (P), magnesio (Mg) y otros nutrientes implicados en la salud ósea. Fueron también realizadas degustaciones de preparaciones alimenticias, ricas en Ca. El consumo medio de los nutrientes fue evaluado antes y después de las actividades, a través del programa DietPro 5i®. La ingesta mediana de energía (1096,8 Kcal) y de macronutrientes (hidratos de carbono: 127,2g; proteínas: 40,4g; lípidos: 20,4g) estaba debajo de lo recomendado por las Dietary References Intakes-DRI.. El consumo de éstos nutrientes no presentó cambios significativos después de las AEN (energía: 1120,8 Kcal; hidratos de carbono: 164,8; proteínas: 60,5 g; lípidos: 29,9 g/ p> 0,05). La ingestión mediana de micronutrientes también estaba debajo de lo recomendado por DRI/Institute of Medicine-IOM (Ca: 661,57 mg; vitamina D: 0,64 µg; Mg: 292,71 mg; P: 1214,00 mg). El consumo de éstos nutrientes no ha presentado cambios significativos después de las AEN (Ca: 619,57 mg; vitamina D: 0,73 µg; Mg: 212,15 mg; P: 821,24 mg; p> 0,05). Los porcentajes de inadecuación para el Ca, vitamina D y Mg fueron elevados (81,7%, 99,8% y 100%, respectivamente). El porcentaje de inadecuación para el P fue de 36%. En este grupo de pacientes femeninos con baja masa ósea, se observó un perfil de ingestión inadecuada en relación a los principales nutrientes implicados en la salud ósea. La orientación nutricional no se mostró eficiente en la optimización de esta ingestión. Esta constatación destaca la importancia de establecer nuevas estrategias que optimicen el consumo de estos nutrientes

Genotype and phenotype landscape of MEN2 in 554 medullary thyroid cancer patients: the BrasMEN study

Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant genetic disease caused by RET gene germline mutations that is characterized by medullary thyroid carcinoma (MTC) associated with other endocrine tumors. Several reports have demonstrated that the RET mutation profile may vary according to the geographical area. In this study, we collected clinical and molecular data from 554 patients with surgically confirmed MTC from 176 families with MEN2 in 18 different Brazilian centers to compare the type and prevalence of RET mutations with those from other countries. The most frequent mutations, classified by the number of families affected, occur in codon 634, exon 11 (76 families), followed by codon 918, exon 16 (34 families: 26 with M918T and 8 with M918V) and codon 804, exon 14 (22 families: 15 with V804M and 7 with V804L). When compared with other major published series from Europe, there are several similarities and some differences. While the mutations in codons C618, C620, C630, E768 and S891 present a similar prevalence, some mutations have a lower prevalence in Brazil, and others are found mainly in Brazil (G533C and M918V). These results reflect the singular proportion of European, Amerindian and African ancestries in the Brazilian mosaic genome

TSH and TPOAB as predictors of thyroid disease in diabetic patients

We tested the values of antithyroid peroxidase antibody and thyrotropin levels for the development of thyroid dysfunction in 109 diabetic patients. Baseline thyrotropin level was a predictor of thyroid dysfunction in diabetic patients, excluding nodular disease. The antithyroid peroxidase antibody had no predictive value for thyroid dysfunction