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ResumoIntrodução: A Má Rotação Intestinal é uma anomalia congênita causada por incompleta ou ausência de rotação normal do intestino primitivo durante o período embrionário. Ela se manifesta de forma variável. Neste presente estudo, apresentaremos um caso que representa este diagnóstico. Relato do Caso: Paciente do sexo feminino, 51 anos, deu entrada ao pronto-socorro do Hospital Santa Isabel, com queixa de dor em epigástrio há 3 dias, contínua, com irradiação para hipogástrio e região direita do abdome associada a náuseas, vômitos biliosos e parada de eliminação de fezes. Como conduta inicial, foram solicitados exames laboratoriais e de imagem, com uma hipótese diagnóstica inicial de um abdome agudo obstrutivo a esclarecer. Na tomografia de abdome, em fase sem contraste, notou-se sinais de má--rotação intestinal. Conclusão: O caso relatado mostra uma apresentação típica de complicação secundária à má rotação intestinal em um adulto. Os exames de imagem foram importantes para o diagnóstico dessa paciente. AbstractBackground: Intestinal malrotation is a congenital ano-maly caused by an incomplete or lack of normal gut rotation during embryogenic period. It manifests in varying ways. In this study, we present a case that represents this diagnosis. Case Report: Female patient, 51 years old, arrives at the Santa Isabel's Emergency Department complaining about a continuous epigastric pain for the last 3 days, irradiating to the lower abdominal quadrant and right side of abdomen, associated with nausea, bilious vomiting, and failure to thrive. As an initial approach, image and laboratory studies were performed, with a diagnostic hypothesis of obstructive acute abdomen. In contrasted tomography, no contrast phase, signals of malrotation were seen. Conclusion: This case report provides a typical presentation of a complication from intestinal malrotation in an adult. Image studies were critical to this diagnosis.

BackgroundRheumatoid arthritis (RA) is the most common autoimmune inflammatory arthritis in adults.1 Extra-articular manifestations of RA can occur in about 40% of patients, either in the beginning or during the course of their disease.2 Recent studies have suggested that RA may have an important relation in the development of cognitive and neurological dysfunction.3 However, the bond between RA and the brain is still uncertain.ObjectivesThe purpose of this study was to assess the frequency and the clinical predictors of cognitive impairment in rheumatoid arthritis (RA) patients.MethodsA cross-sectional and case-control study was performed including consecutive RA patients seen in a rheumatology outpatient clinic of referral tertiary hospital. The control group included 100 healthy subjects. We registered clinical and demographic data including age, sex, level of education, time of disease, time of diagnosis, drugs in use, cardiovascular risk factors and other comorbidities. Functional capacity was assessed using the Health Assessment Questionnaire (HAQ). Neurological appraisal was made with standardised questionnaires: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and the Hospital Anxiety and Depression (HAD). Analysis of the data was performed using qui-square and t-tests and a multivariate analysis (SPSS 22.0). Significance level was set as <0.05.ResultsWe included 102 patients (88 were female) with a mean age of 57.4 (±10.7) years; among these patients, 92 (90.2%) used corticosteroids, 66 (64.7%) methotrexate, 5 (4.9%) sulfasalazine, 43 (42.1%) leflunomide, 18 (17.6%) chloroquine and 25 (24.5%) biologic therapy. The mean age of RA diagnosis was 42.9 (±12.7) years. In both univariate and multivariate analysis, compared to the control group, patients with RA presented significant lower MMSE (22.5±4.0) and MoCA (17.1±4.5) scores (p<0.05). Adjusting for level of education, just 31 and 25 patients presented normal MMSE and MoCA scores (p<0.01), respectively. Cognitive decline was associated with higher HAQ scores (functional outcome due to RA) and prolonged time of disease (p<0.05). No correlation was found between sex, disease-modifying antirheumatic drugs, rheumatoid factor, C-reactive protein levels and the neurological impairment. The mean HAD score was 17.2 (±8.2) and anxiety and depression were more prevalent in RA patients than in control group (p<0.01).ConclusionsPatients with rheumatoid arthritis may present with cognitive decline and dementia as extra-articular manifestations of the disease. Neurological impairment is usually disregarded and might be under-diagnosed in RA patients. Future studies are necessary in order to better understand the relationship between RA and the Brain.References[1] Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part I. Arthritis Rheum2008;58:15–25.[2] Pincus T, Callahan LF, Sale WG, Brooks AL, Payne LE, Vaughn WK. Severe function...