Background: Fibromyalgia (FM) is a clinical syndrome mainly characterized by generalized chronic pain, fatigue, sleep and cognition disorders. The role played by vitamin D in the pathophysiology of painful syndromes is poorly known. Studies assessing the association between vitamin D and FM have presented conflicting results. The aims of the current study were to assess vitamin D levels in FM patients, by comparing them to healthy controls, as well as to analyze their impact on this disease.Methods: This was a cross-sectional study comprising 43 FM patients (ACR 2010 criteria) and 40 healthy individuals. All participants had their vitamin D levels measured, and FM patients also had their total calcium, albumin, phosphorus and parathyroid hormone (PTH) measured. Clinical variables capable of affecting the results were evaluated and the fibromyalgia impact questionnaire (FIQ) was applied.Results: There was not statistically significant difference in global mean values of vitamin D between groups. In the total sample, only 4.8% of the individuals had vitamin D deficiency, which corresponded to the deficiency found in the group of patients; in the control, no one had vitamin deficiency; 39.8% had insufficient levels and 55.4% with sufficient levels. The mean serum vitamin D values were similar between the FM and control groups (34.8 ± 12 and 34.7 ± 12.3 ng/ mL, respectively; P = 0.806). However, a significant negative correlation was found between vitamin D concentration and FIQ values, that is, patients with the greatest impact of the disease had lower concentrations of vitamin D (P = 0.018). Conclusion: FM patients did not present higher prevalence of vitamin D deficiency or insufficiency than healthy individuals, although low vitamin D concentrations could indicate more severe disease impacts.

Objective: To assess the effect of bisphosphonates on post-parathyroidectomy hypocalcemia in patients with osteitis fibrosa cystica. Methods: Review of the medical records of six patients using bisphosphonates preoperatively. Results: Mean age was 35.6 ± 10.5 years; serum calcium = 13.51 + 0.87 mg/dL; iPTH = 1,389 + 609 pg/mL. The mean value of urine deoxypyridinoline (UDPD) of three patients was 131 ± 183 nmol/mmol Cr, and of C-telopeptide (CTX), 2,253 ± 1,587 pg/mL. The mean values of bone densitometry (T score) were as follows: 0.673 ± 0.150 g/cm 2 (-4.42 ± 1.23) in lumbar spine (L2-L4); 0.456 ± 0.149 g/cm 2 (-5.58 ± 1.79) in the femoral neck; and 0.316 ± 0.055 g/cm 2 (-5.85 ± 0.53) in radius 33. Patient 1 received oral alendronate, 30 mg/day for four weeks; his calcium decreased from 14 to 11.6 mg/dL, and his UDPD from 342 to 160 nmol/mmol Cr. Patient 2 received oral alendronate, 20 mg/day for six weeks; his calcium decreased from 14 to 11.0 mg/dL and his UDPD from 28.8 to 14 nmol/mmol Cr. Patient 3 received intravenous pamidronate, 90 mg prior to surgery. Patient 4 received oral alendronate, 140 mg/week for six weeks; her calcium decreased from 13.7 to 12.3 mg/dL and her CTX from 2,160 to 1,340 pg/mL. Patient 5 received oral alendronate, 140 mg/ week for six weeks; her calcium levels dropped from 14.3 to 14.1 mg/dL; her CTX did not change. Patient 6 received ibandronate, 150 mg, ten days prior to surgery; his CTX reduced by 62%. No patient developed severe hypocalcemia in the first postoperative week. One year after surgery, the mean gain in bone mineral density was 40% ± 29% in L2-L4, 86 ± 39% in the femoral neck, and 22% ± 11% in radius 33. Conclusion: The preoperative use of bisphosphonates seems to attenuate bone hunger without preventing a significant increase in bone mass in the follow-up of parathyroidectomy.

Introduction: Pulmonary artery aneurysm (PAA) is a rare condition and associated with multiple pathologies. In most cases there are reports of dyspnea and palpitation, however, some patients are completely asymptomatic. Its natural history is uncertain and there are no clear guidelines about its treatment and monitoring.Method: This is one case report, obtained through data from medical records of a reference hospital, located in the city of Juazeiro do Norte, Ceará, Brazil.Case Report: Patient, female, 64 years old, healthy, sought medical assistance after a clinical picture of drug allergy. The physical examination performed at admission revealed hyperdynamic precordium associated with systolic thrills and murmur. Her chest radiography (X-ray) revealed a mediastinal widening, which after CT evaluation, it was found that it was a large aneurysm of trunk of the pulmonary artery. As it remained asymptomatic throughout the investigation and she refused to undergo surgical treatment, there was the adoption of a conservative conduct only with an outpatient treatment.