Italian guidelines for primary headaches: 2012 revised version

The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105–190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version

Evaluation of lipid profile in adolescents during long-term use of combined oral hormonal contraceptives

The study evaluated the effects of the long-term use of a combined oral hormonal contraceptive containing 30 mug ethinyl estradiol and 75 mug gestodene in adolescents. Thirty-three volunteers, aged from 14 to 19 years, who used the oral contraceptive for three consecutive years, were studied. Evaluation of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides was made before use and after 1, 2 and 3 years. During the 3-year study period, total cholesterol, HDL-C, LDL-C and triglyceride levels were significantly higher than previous measurements, but average values did not exceed the normal range. Compared to the first year, the second- and third-year cholesterol, HDL-C, LDL-C and triglyceride levels were not significantly different. (C) 2005 Elsevier Inc. All rights reserved.71211812

Prevalência e fatores associados ao tabagismo em estudantes de medicina de uma universidade em Passo Fundo (RS) Prevalence of and variables related to smoking among medical students at a university in the city of Passo Fundo, Brazil

OBJETIVO: Verificar a prevalência e fatores associados ao tabagismo entre os acadêmicos de medicina e avaliar o perfil desse grupo. MÉTODOS: Responderam a um questionário autoaplicável, contendo perguntas sobre consumo e atitudes relacionadas ao tabagismo, 316 acadêmicos de medicina (98,7% do total) da Universidade de Passo Fundo. Segundo recomendações da Organização Mundial da Saúde, os estudantes foram classificados em fumantes diários, fumantes ocasionais, ex-fumantes ou não-fumantes, sendo considerados fumantes ativos os nas duas primeiras categorias. RESULTADOS: Observou-se que 16,5% dos acadêmicos eram fumantes ativos (5,4% diários e 11,1% ocasionais) e 3,5% eram ex-fumantes. A média de idade foi 22,2 ± 2,4 anos. Os fatores significativamente associados ao tabagismo (p < 0,05) foram sexo masculino, pai fumante, uso regular de bebidas alcoólicas e uso de antidepressivos ou ansiolíticos. Verificou-se que 69,2% dos fumantes iniciaram o tabagismo entre 15 e 19 anos, tendo como principais motivações a vontade própria e/ou a influência de amigos. A conceituação do tabagismo como doença foi significativamente maior entre os não-fumantes. Quanto à carga tabágica, 70,6% dos fumantes consumiam 1-10 cigarros por dia. Entre os fumantes, 67,3% já tentaram parar de fumar, 96,0% acreditam serem capazes de fazê-lo e 87,2% pretendem deixar de fumar, ao passo que 92,3% admitiram que o cigarro faz mal à saúde. CONCLUSÕES: A prevalência do tabagismo ainda é significativa entre os acadêmicos de medicina, sendo fundamental estabelecer estratégias preventivas e de cessação mais efetivas a fim de se tentar reduzir o número de fumantes entre os futuros médicos.<br>OBJECTIVE:To determine the prevalence of and factors associated with smoking among medical students, as well as to evaluate the profile of this group. METHODS: A total of 316 medical students (98.7% of the total) at the University of Passo Fundo, in the city of Passo Fundo, Brazil, completed a self-report questionnaire with questions on tobacco intake and on attitudes related to smoking. In accordance with the World Health Organization guidelines, the students were classified as daily smokers, occasional smokers, former smokers or nonsmokers, those in the two first categories being considered active smokers. RESULTS: We found that 16.5% of the students were active smokers (daily smokers, 5.4%; occasional smokers, 11.1%) and that 3.5% were former smokers. The mean age was 22.2 ± 2.4 years. Factors significantly associated with the smoking habit (p < 0.05) were male gender, paternal smoking, regular alcohol consumption and use of antidepressants or anxiolytics. For the majority (69.2%) of the smokers, the age at smoking onset was 15-19 years of age, and the main motivations to start smoking were selfinitiative and influence of friends. The conceptualization of smoking as an illness was significantly higher among the nonsmokers. In 70.6% of the smokers, tobacco intake was 1-10 cigarettes a day. Among the smokers, 92.3% agreed that smoking is harmful to health, 67.3% had tried to quit smoking, 96.0% believed themselves able to do so, and 87.2% intended to quit smoking. CONCLUSIONS: The prevalence of smoking remains significant among medical students. Therefore, it is fundamental that we develop more effective strategies for smoking prevention and cessation in order to reduce the number of smokers among future doctors

Capítulo 7 - Zigomicose Chapter 7 - Zygomycosis

A zigomicose (mucormicose) é uma infecção rara, mas altamente invasiva, causada por fungos da ordem Mucorales (gêneros Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces e Syncephalastrum). Esse tipo de infecção é usualmente associado a doenças hematológicas, cetoacidose diabética e transplante de órgãos. A apresentação clínica mais frequente é a mucormicose rinocerebral, com ou sem envolvimento pulmonar. A zigomicose pulmonar ocorre mais frequentemente em pacientes com neutropenia profunda e prolongada e pode se apresentar como infiltrado lobar ou segmentar, nódulos isolados, lesões cavitárias, hemorragia ou infarto. As manifestações clínicas e radiológicas são na maioria dos casos indistinguíveis daquelas associadas com aspergilose invasiva. Este artigo descreve as características gerais da zigomicose pulmonar, com ênfase no diagnóstico laboratorial, e ilustra a morfologia de algumas lesões.<br>Zygomycosis (mucormycosis) is a rare but highly invasive infection caused by fungi belonging to the order Mucorales, which includes the genera Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces and Syncephalastrum. This type of infection is usually associated with hematologic diseases, diabetic ketoacidosis and organ transplantation. The most common form of presentation is rhinocerebral mucormycosis, with or without pulmonary involvement. Pulmonary zygomycosis is more common in patients with profound, prolonged neutropenia and can present as segmental or lobar infiltrates, isolated nodules, cavitary lesions, hemorrhage or infarction. The clinical and radiological manifestations are often indistinguishable from those associated with invasive aspergillosis. This article describes the general characteristics of pulmonary zygomycosis, emphasizing laboratory diagnosis, and illustrates the morphology of some lesions