RESUMO
La evidencia reciente muestra que los patrones de sueño nocturno pueden ser un factor que contribuye a la epidemia de obesidad, sin embargo no se ha explorado esta asociación en adultos mayores (AM). El objetivo del presente estudio es determinar la asociación entre cantidad de sueño nocturno y obesidad en AM autónomos chilenos. Se evaluaron 1.706 AM autónomos de ambos sexos, de la ciudad de Santiago de Chile, 59,9% mujeres. Se les aplicó a cada uno la encuesta de sueño de Pittsburg y una evaluación antropométrica. El 84,0% de los AM duerme menos que lo recomendado. Dormir menos horas de las recomendadas se asocia con obesidad, (OR=1,49 (IC95% 1,04- 2,13)). Sin embargo al ajustar por tabaco y medicamentos esta asociación pierde significancia ((OR=1,50 (IC95% 0,95-2,38)). Se observa una asociación entre menos horas de sueño nocturno y obesidad en AM autónomos(AU)
Nocturnal sleep patterns maybe a contributing factor for the epidemic of obesity. Epidemiologic and experimental studies have reported that sleep restriction is an independent risk factor for weight gain and obesity, but has not been explored this association in elderly. The objetive is to determine the association between the sleep durationand obesity in elderly Chilean autonomous.1,706 AM autonomous 59.9% women, of the city of Santiago, of Chile, was applied to each survey dream of Pittsburg and anthropometric evaluation.84.0% of the elderly population sleeps less than recommended. Sleeping less hours than recommended is associated with an increased risk of obesity. (OR=1,49 (IC95% 1.04 - 2.13)) However, without adjusting for tobacco and medicine consumption, this association loses its significance ((OR=1,50 (IC95% 0,95-2,38)). An association between less sleep hours and an increased risk of obesity in the autonomous elderly is observed(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso , Estado Nutricional/fisiologia , Distúrbios do Início e da Manutenção do Sono , Obesidade/etiologia , Seguridade Social , Atividade MotoraRESUMO
Nocturnal sleep patterns maybe a contributing factor for the epidemic of obesity. Epidemiologic and experimental studies have reported that sleep restriction is an independent risk factor for weight gain and obesity, but has not been explored this association in elderly. The objetive is to determine the association between the sleep durationand obesity in elderly Chilean autonomous.1,706 AM autonomous 59.9% women, of the city of Santiago, of Chile, was applied to each survey dream of Pittsburg and anthropometric evaluation.84.0% of the elderly population sleeps less than recommended. Sleeping less hours than recommended is associated with an increased risk of obesity. (OR=1,49 (IC95% 1.04 - 2.13)) However, without adjusting for tobacco and medicine consumption, this association loses, its significance ((OR=1,50 (IC95% 0,95-2,38)). An association between less sleep hours and an increased risk of obesity in the autonomous elderly is observed.
Assuntos
Obesidade/etiologia , Privação do Sono/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antropometria , Chile/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Obesidade/epidemiologia , Obesidade/fisiopatologia , Valores de Referência , Fatores de Risco , Sono/fisiologia , Privação do Sono/epidemiologia , Privação do Sono/fisiopatologia , Estatísticas não Paramétricas , Fatores de TempoRESUMO
AIM: To determine the prevalence of mild and excessive somnolence and the associated factors with the presence of daytime sleepiness in the elderly. METHODS: A total of 1780 independent individuals 60 years and older of both sexes (70.9±7.9 years old; females 62%), were included, of which 1704 of them completed all the information. All of them were assessed using an Epworth sleepiness scale (ESE), an Pittsburgh sleep quality index, plus information of cigarettes smoking, dinner time, and an anthropometric evaluation. An ESE score>10 was considered drowsiness and scores>15 excessive or severe drowsiness. RESULTS: Among the population under 80 years, 5.3% showed ESE score>15 and 26.2% an ESE score>10. For over 80 years, the prevalence of sleepiness was 6.3% for an ESE score>15 and 32.5% for an ESE score>10. In the adjusted model, the factors associated with increased risk of sleepiness (ESE>10) were age older than 80 years (OR=1.58; 95% CI=1.14 to 2.19) and dinner after 21 hours (OR=1.3; 95% CI=1.01 to 1.68). By contrast, only age older than 80 years was independently associated with severe sleepiness (OR=1.81; 95% CI=1.01 to 3.29). CONCLUSIONS: Meals after 21 hours and age above 80 years are associated with increased likelihood of daytime sleepiness. Instead, only older than 80 years is associated with severe daytime sleepiness.
Assuntos
Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Chile , Dieta , Feminino , Humanos , Masculino , Prevalência , Fatores de RiscoRESUMO
BACKGROUND & AIMS: Celiac disease (CD) patients often complain of symptoms consistent with gastroesophageal reflux disease (GERD). We aimed to assess the prevalence of GERD symptoms at diagnosis and to determine the impact of the gluten-free diet (GFD). METHODS: We evaluated 133 adult CD patients at diagnosis and 70 healthy controls. Fifty-three patients completed questionnaires every 3 months during the first year and more than 4 years after diagnosis. GERD symptoms were evaluated using a subdimension of the Gastrointestinal Symptoms Rating Scale for heartburn and regurgitation domains. RESULTS: At diagnosis, celiac patients had a significantly higher reflux symptom mean score than healthy controls (P < .001). At baseline, 30.1% of CD patients had moderate to severe GERD (score >3) compared with 5.7% of controls (P < .01). Moderate to severe symptoms were significantly associated with the classical clinical presentation of CD (35.0%) compared with atypical/silent cases (15.2%; P < .03). A rapid improvement was evidenced at 3 months after initial treatment with a GFD (P < .0001) with reflux scores comparable to healthy controls from this time point onward. CONCLUSIONS: GERD symptoms are common in classically symptomatic untreated CD patients. The GFD is associated with a rapid and persistent improvement in reflux symptoms that resembles the healthy population.
Assuntos
Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Dieta Livre de Glúten , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Adolescente , Adulto , Idoso , Doença Celíaca/patologia , Doença Celíaca/terapia , Feminino , Seguimentos , Refluxo Gastroesofágico/patologia , Refluxo Gastroesofágico/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND/OBJECTIVES: the usefulness of duodenoscopic markers for predicting celiac disease (CD) has been questioned. We assessed the diagnostic efficacy of endoscopic markers of mucosal atrophy in individuals with different pretest probability of CD. METHODS: we prospectively performed endoscopic intestinal biopsies and CD-related serology tests in 661 individuals, including 143 consecutive patients attending a malabsorption clinic (high pretest probability) and 518 subjects randomly selected fom those undergoing routine endoscopy because of upper GI symptoms (low pretest probability). Duodenoscopic markers reported were: mosaic pattern, scalloped folds, and reduction in number or loss of Kerkring's folds. RESULTS: sixty-three (44.1%) and 18 (3.5%) patients were diagnosed with CD in the high and low risk groups, respectively Among high pretest subjects, the presence of any marker had very high sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the identification of CD (92.1%, 93.8%, 92.1%, 93.8% and 93.0%, respectively). The performance of these parameters for the presence of any marker in the low pretest population were 61.1%, 96.8%, 40.7%, 98.6% and 95.6%, respectively. Sensitivity (p < 0.004) and positive predictive value (p < 0.0001) of markers were significantly higher for the high risk patients. The identification of a reduction in number or loss of Kerkring'sfolds was not a reliable finding unless other signs were also present. CONCLUSIONS: we confirm that endoscopic markers are useful in predicting CD in different clinical scenarios. The high negative predictive value in the low probability group suggests that intestinal biopsy is not required if endoscopic markers are absent.
Assuntos
Doença Celíaca/diagnóstico , Duodenoscopia , Mucosa Intestinal/patologia , Adulto , Idoso , Atrofia , Biópsia , Doença Celíaca/patologia , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
Este artículo parte de la presentación de un caso clínico, que ilustra las dificultades a las que se enfrentan los psiquiatras en el ejercicio de la profesión, ante situaciones como el consentimiento informado, la libre elección del tratamiento por parte de los pacientes y la capacidad de intervención a través de la relación médico-paciente. A lo largo de esta exposición se tocan situaciones asociadas con las posibilidades terapéuticas dentro del marco de la Ley 100 de 1993, y se concluye haciendo hincapié en la necesidad de tener como marco de referencia, en nuestro quehacer como psiquiatras, los derechos de los pacientes, el establecimiento de una buena relación médico-paciente y la urgente necesidad de replantear las posibilidades de comprensión de la realidad de los individuos, más desde su capacidad funcional, y no desde la perspectiva estrictamente médica.
The article presents a clinical case in order to illustrate the difficulties that psychiatrists face in their professional practice, such as informed consent, free election of treatment by the patients, and the capacity of intervention through the establishment of a doctor-patient relationship. Along the presentation, other situations are explored in relation to the therapeutic possibilities framed in the Law 100. The need for a reference point of our work as psychiatrists is proposed as a conclusion, especially with regard to our patient's rights, the establishment of a good doctor-patient relationship, and an urgent need to discuss the possibilities of comprehension of the patients' reality from a functional point of view rather than a strictly medical perspective.
RESUMO
OBJECTIVE: Refractory sprue is a rare and severe malabsorptive disorder that mimics celiac disease but is refractory to a gluten-free diet and is without initial evidence of overt lymphoma. Treatment is largely empiric and often ineffective, with steroids and immunosuppression being the mainstream therapeutic options. The aim of this study was to evaluate prospectively the effect of azathioprine on a group of patients diagnosed with refractory sprue. METHODS: We studied seven consecutive patients (five women and two men) with a well-defined diagnosis of refractory sprue and a lack of response to oral or parenteral steroids. At diagnosis, five patients had endoscopic evidence of ulcerative jejunitis, and five underwent exploratory laparotomy for exclusion of malignancies. The characteristic monoclonal TCRgamma gene rearrangement was shown in five of six patients studied. Patients were treated for a mean of 11 months (range 8-12 months), and clinical, biochemical, molecular, and histological parameters were reassessed at the end of the trial. The study was a prospective, open-label, non-placebo-controlled study using azathioprine (2 mg/kg/ day) plus oral prednisone (1 mg/kg/day). A gluten-free diet (n = 7) as well as enteral (n = 6) and parenteral nutrition (n = 5) were administered during the trial. RESULTS: After treatment, five patients had a complete clinical remission, and biochemical and nutritional parameters were significantly improved. Steroids were tapered after the onset of azathioprine, and no patient was on steroids at the end of the trial. Intestinal histology improved significantly in all cases (normal histology in three cases and minor infiltration in the lamina propria in two). Two patients did not respond to treatment at any time and died in months 10 and 9, of an irreversible ventricular fibrillation and sepsis, respectively. No overt lymphoma was demonstrated during the follow-up. CONCLUSIONS: The present study confirms earlier anecdotal reports on the efficacy of azathioprine in refractory sprue, with clear clinical and histological improvement shown in most patients. However, monoclonality persisted after treatment. We consider that a larger number of patients should be evaluated before a definitive recommendation is adopted for use of this drug in refractory sprue.