BACKGROUND Background: Spondyloarthritis (SpA) patients, mainly those with advanced disease, may have postural difficulties. In these patients the spine may became stiff due to the chronic inflammatory process of fibroconnective tissues and bones, leading to hip flexion, increase in dorsal kyphosis and loss of lumbar and cervical lordosis. Knee flexion occurs as a compensatory mechanism promoting the appearance of the classic skier posture. Such malalignment causes dislocation of the center of mass of the trunk, disturbing static and dynamic balance. It also causes difficulties in looking up and creating visual inputs that are important to compensate the negative effects of postural instability. Aim: To study balance impairment and falls in SpA patients and its association with clinical and epidemiological variables, disease activity, functional and metrology indexes. MATERIALS AND METHODS Materials and methods: Cross sectional study of 55 SpA patients with axial disease. Clinical and epidemiological were collected from the charts. Balance was accessed by Berg Balance Scale (BBS). The following instruments were applied: ASDAS (Ankylosing Spondylitis Disease Activity Score)-ESR, ASDAS-CRP, BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), BASFI (Bath Ankylosing Spondylitis Functional Index), BASMI (Bath Ankylosing Spondylitis Metrology Index) and ASQoL (Ankylosing spondylitis quality of life questionnaire). The number of falls in the last year was collected. RESULTS Results: In this sample, 30.9% had high risk of falls by the BBS and 25.4% recalled having at least one fall in the last years. The BBS values were lower in those with white ethnic background (p=0.01); smokers (p=0.03) and with HLA-B27 (p=0.03) and correlated inversely with BASDAI (rho=-0.28), ASDAS-ESR (rho=-0.32) and ASDAS-CRP (rho=-0.33), BASFI (rho=-0.71,p<0.0001), BASMI (rho=-0.80; p<0.0001), and age (rho=-0.50;p<0.001). Multivariated analysis showed that BASFI and BASMI were independently associated with BBS (p=0.02 and 0.0001 respectively). Patients with falls had lower BBS (p=0.03) and loss of balance correlated with impairment of the quality of life (rho=-0.56;p<0.001). CONCLUSION Conclusions: Conclusions: Balance is impaired in almost 1/3 of SpA patients and the BBS is associated mainly with functional and metrology indexes, showing that patients with severe cumulative damage are more affected.

Both inotropic drugs were similarly effective in restoring tissue blood flow and oxygen supply to adequate levels in patients with low cardiac output undergoing cardiac surgery.

Objective To investigate the prevalence of electrocardiographic changes in patients with spondyloarthritis and to correlate these changes with use of anti-tumor necrosis factor-alpha (TNF-α) drugs and HLA-B27 positivity. Methods Retrospective study including 100 patients diagnosed with spondyloarthritis according to Assessment of SpondyloArthritis International Society (ASAS) criteria and 50 controls. Epidemiological and clinical features, results of inflammatory activity tests, HLA-B27 positivity, and medication use data were extracted from medical records. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All participants were submitted to electrocardiogram performed using a 12-lead device; rhythm, heart rate, conduction disorders and QT interval corrected using the Bazett formula were analyzed. Results Of 100 patients with spondyloarthritis, 51 were on anti-TNF-α drugs and 49 were not. HLA-B27 was detected in 53.1% of patients in the sample. Patients with spondyloarthritis had lower heart rate (p=0.06), longer QT interval (p<0.0001) and higher prevalence of right bundle branch block (p=0.014) compared to controls. Duration of disease was weakly correlated with heart rate (Rho=0.26; 95%CI: 0.06-0.44; p=0.008). The prevalence of right bundle branch block was positively correlated with HLA-B27 positivity. Use of Anti-TNF-α drugs did not interfere with electrocardiographic parameters. Conclusion Patients with spondyloarthritis had lower heart rate, longer QT interval and a higher prevalence of right bundle branch block compared to controls. HLA-B27 positivity was associated with the prevalence of right bundle branch block. Anti-TNF-α drugs had no impact on electrocardiographic findings.

No abstract

RESUMOIntrodução: A toxicidade da vitamina D é rara e potencialmente grave. As características clínicas da hipervitaminose D são decorrentes, principalmente, da hipercalcemia. Relato de caso: Feminina, 50 anos, em acompanhamento no serviço de endocrinologia e metabologia do HC-UFPR devido bócio multinodular (BMN) tóxico, sendo iniciado tratamento com tapazol. Encaminhada para tireoidectomia total pelo serviço de cirurgia de cabeça e pescoço do HC-UFPR. Evoluiu, no pós operatório, com hipoparatireoidismo e hipocalcemia grave sintomática, necessitando reposição de gluconato de cálcio endovenoso. Recebeu alta hospitalar com cálcio total de 8,2mg/dl e prescrição de calcitriol 0,25mcg 6 comprimidos (cp) ao dia, carbonato de cálcio (CaCO3) 500mg 8 cp ao dia e vitamina D3 15.000U/semana e retorno ambulatorial em 2 semanas. No retorno, três meses após, queixa de náuseas, vômitos, hiporexia e perda de 5,8kg em dois meses, apresentando sinais de desidratação ao exame físico. Cálcio total no retorno de 11,4mg/dl, PTH < 5,00pg/ml, fósforo (Pi) 3,5mg/dl, albumina (alb) 3,9g/dl, creatinina (Cr) 1,5mg/dl. Suspenso CaCO3 e vitamina D, reduzida dose de calcitriol para 2 cp ao dia e orientada hidratação via oral. Após 1 semana, melhora dos sintomas, com cálcio total de 8,1mg/dl, Pi 3,9mg/dl, alb 3,8g/dl, PTH 10,70pg/ml, 25-OH-vitamina D 43ng/ml, Cr 1,1mg/dl. Mantida dose de calcitriol e reiniciado CaCO3 na dose de 1g/dia. Novo retorno em um mês, assintomática, com cálcio total de 8,3mg/dl, PTH 20pg/ml e 25-OH-vitamina D 41ng/ml, Cr 0,8mg/dl, compatível com hipoparatireoidismo transitório e intoxicação por calcitriol resolvida. Conclusão: Diante de um quadro de vômitos persistentes e hipercalcemia, na presença de hormônio da paratireódide normal ou baixo, o diagnóstico de intoxicação por vitamina D deve ser suspeitado e, a normalização de seus níveis alivia os sintomas e pode prevenir lesão renal aguda.Descritores: intoxicação, calcitriol, hipercalcemia ABSTRACT Introduction: Vitamin D toxicity is rare and potentially serious. The clinical features of hypervitaminosis D are due mainly to the hypercalcemia. Case report: Female, 50, followed at endocrinology and metabology HC-UFPR due multinodular goiter toxic, and treatment with tapazol. Forwarded to total thyroidectomy by the head and neck surgery department of the HC-UFPR. It evolved in the postoperative with hypoparathyroidism and symptomatic severe hypocalcemia, requiring calcium gluconate intravenous replacement. He was discharged with total calcium of 8,2mg/dl and calcitriol prescription 0,25mcg 6 tablets per day, calcium carbonate (CaCO3) 500mg 8 tablets per day and vitamin D3 15.000U/week and outpatient in two weeks. Three months later, complaining of nausea, vomiting, appetite loss and loss of 5.8 kg in two months, showing signs of dehydration on physical examination. Total calcium in the return 11,4mg/dl, PTH <5,00pg/ml, phosphorus (P) 3.5 mg/dL albumin (alb) 3.9g/dL creatinine (Cr) 1.5 mg/dl. Suspended CaCO3 and vitamin D, reduced dose of calcitriol for 2 tablets daily a...