Universidade Federal De São Paulo Research Articles

What do Cochrane systematic reviews say about the use of cannabinoids in clinical practice?

The therapeutic effects of cannabinoid compounds have been the center of many investigations. This study provides a synthesis on all Cochrane systematic reviews (SRs) that assessed the use of cannabinoids as a therapeutic approach. Review of SRs, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). A broad search was conducted in the Cochrane Database of Systematic Reviews to retrieve any Cochrane SRs that assessed the efficacy and safety of cannabinoids as a therapeutic approach. The results and key characteristics of all reviews included were summarized and discussed. Eight SRs were included. They assessed the use of cannabinoids for the following types of conditions: neurological (two SRs), psychiatric (two SRs), rheumatological (one SR), infectious (one SR) and oncological (two SRs). There was moderate-quality evidence showing that the use of cannabinoids reduced nausea and vomiting among adults, compared with placebo. Additionally, there was moderate-quality evidence showing that there was no difference between cannabinoids and prochlorperazine regarding the number of participants who reported vomiting, in this same population. This review identified eight Cochrane systematic reviews that provided evidence of unknown to moderate quality regarding the use of cannabinoids as a therapeutic intervention. Further studies are still imperative for solid conclusions to be reached regarding practical recommendations.

Pediatric-onset multiple sclerosis in Brazilian patients: Clinical features, treatment response and comparison to pediatric neuromyelitis optica spectrum disorders

BackgroundMultiple Sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are acquired demyelinating syndromes of the central nervous system more frequently in young adults and their beginning before 18 years of age is rare. They are autoimmune diseases with distinct pathophysiology, clinical presentation, treatment and prognoses. During childhood these conditions often present similar clinical features and differential diagnosis among pNMOSD, pMS and acute disseminated encephalomyelitis (ADEM) is still difficult at disease onset. The aim of this article is to describe the epidemiologic and clinical features, to evaluate the response to treatment and to compare the mains characteristics between the patients with MS and NMOSD who had the first event prior to 18 years of age followed at the Universidade Federal de São Paulo (UNIFESP). MethodsRetrospective analysis of patients with MS and NMOSD who started the disease before 18 years of age followed for at UNIFESP. All patients fulfilled the McDonald 2010 criteria for MS and the IPND 2015 criteria or 2006 diagnostic criteria for NMOSD. For treatment analysis, we select patients with a follow-up of more than 6 months. ResultsSixty-eight patients fulfilled the inclusion criteria for MS and were selected for analysis. Mean age of onset was 15 years, 73.5% were female and the mean follow-up was 6.7 years. Mean annualized relapse rate (aRR) observed was 0,82 relapse/year and mean progression index (PI) was 0.31 EDSS points/year. The multivariate analysis showed a significant association between the EDSS on first appointment and total number of relapses with neurological disabilities in long term in patients with MS. The treatment with interferon-beta (IFN-β) and glatiramer acetate (GA) was safe and patients treated with high dose IFN-β and GA had a statistically significant reduction in disability progression. Eleven patients fulfilled the inclusion criteria for NMOSD: mean age of onset was 14 years, 72.7% were female and the mean follow-up was 6.3 years. Mean aRR observed was 1.5 relapse/year and mean PI was 2.2 EDSS points/year. The treatment with azathioprine was safe and significant halts disability progression. Patients with NMOSD reached EDSS 6 prior than those with MS. ConclusionsPediatric demyelinating diseases in Brazil are similar to the diseases described abroad. In patients with pMS, the EDSS score at the first appointment and the total number of relapses were associated with poor prognosis. NMOSD is more severe than MS in pediatric patients. Treatment with DMD and azathioprine was well tolerated and effective in reducing relapse rate and disability.

Evidence for varicose vein treatment: an overview of systematic reviews.

Varicose veins affect nearly 30% of the world's population. This condition is a social problem and needs interventions to improve quality of life and reduce risks. Recently, new and less invasive methods for varicose vein treatment have emerged. There is a need to define the best treatment options and to reduce the risks and costs. Since there are cosmetic implications, treatments for which effectiveness remains unproven present risks to consumers and higher costs for stakeholders. These risks and costs justify conducting an overview of systematic reviews to summarize the evidence. Overview of systematic reviews within the Discipline of Evidence-Based Health, at Universidade Federal de São Paulo (UNIFESP). Systematic reviews on clinical or surgical treatments for varicose veins were included, with no restrictions on language or publication date. 51 reviews fulfilled the inclusion criteria. Outcomes and comparators were described, and a narrative review was conducted. Overall, there was no evidence that compression stockings should be recommended for patients as the initial treatment or after surgical interventions. There was low to moderate evidence that minimally invasive therapies (endovenous laser therapy, radiofrequency ablation or foam sclerotherapy) are as safe and effective as conventional surgery (ligation and stripping). Among these systematic reviews, only 18 were judged to present high quality. There was evidence of low to moderate quality that minimally invasive treatments, including foam sclerotherapy, laser and radiofrequency therapy are comparable to conventional surgery, regarding effectiveness and safety for treatment of varicose veins.

Fluorescence of Chlorophyll <i>a</i> for Discovering Inhibitors of Photosynthesis in Plant Extracts

Aims: Twelve crude extracts were prepared from different parts of Pluchea sagittalis, Cecropia palmata and Brachiaria brizantha, and their effect on the light reaction of photosynthesis. Study Design: Use of fluorescence of ChL a (Chlorophyll a) to detect inhibitors of photosynthesis in plant extracts. Place and Duration of Study: Instituto de Ciencias Ambientais, Quimicas e Farmaceuticas, Departamento de Ciencias Exatas e da Terra, Universidade Federal de Sao Paulo (UNIFESP), between July 2015 and January 2016. Methodology: The samples had their effect on the light reaction of photosynthesis studied by Chlorophyll a (Chl a) fluorescence transient by the use of chloroplasts isolated from spinach leaves. As negative controls we used the same amounts of DMSO that have been employed to solubilize the samples, and as positive control we have used 10 μM of the commercial herbicide DCMU (Diuron). Results: The extracts inhibited the photosynthesis, and their inhibition sites were located in the range of electron flow from OEC complex and between P680 to QA of PS II, and inhibited the photosystem II (PS II) by inducing the appearance of the transient bands K and J. Conclusion: Our results suggest an indicative that the photochemical apparatus probably is failing at the donor and acceptor sides of PSII, causing damage to electron transport during the photosynthesis phenomenon.

Validation of the Brazilian version of the Burn Specific Health Scale-Brief (BSHS-B-Br)

IntroductionProgressive increases in survival rates from burn trauma have shifted attention to patient rehabilitation and posttraumatic quality of life. The assessment of quality of life is strongly dependent on reliable instruments for its measurement. A literature review has revealed that the Burn Specific Health Scale-Brief (BSHS-B) questionnaire is the most commonly used instrument worldwide. ObjectivesThe aim of this study was to translate the BSHS-B into the Portuguese language, adapt it culturally to the Brazilian population, and test its psychometric properties. MethodsThe questionnaire was translated into Portuguese; culturally adapted; and tested for reproducibility, face validity, content validity, and construct validity. The translated version was tested on 92 patients with burns. Internal consistency was tested by means of Cronbach's alpha. Construct validity was performed by correlating the BSHS-B questionnaire with the Burn Specific Health Scale-Revised (BSHS-R), BurnSexQ-Escola Paulista de Medicina (EPM)/Universidade Federal De São Paulo (UNIFESP), the Rosenberg Self-Esteem Scale (RSES), and the Beck Depression Inventory (BDI). ResultsCronbach's alpha was 0.85. The Pearson correlation coefficients were significant at three time points of the reliability analysis. A significant correlation was observed between BSHS-B domains and BSHS-R, and between RSES and BDI domains. A significant correlation was also observed between BSHS-B and the BurnSexQ-EPM/UNIFESP social comfort and body image domains. ConclusionThe BSHS-B questionnaire was translated into Portuguese. It is a reliable tool in this language, showing face, content, and construct validity. The modified instrument has been named BSHS-B-Br.

The profile of patients followed at the Neuroimmunology Clinic at UNIFESP: 20 years analysis.

To describe the clinical activities at the Neuroimmunology Clinic of the Universidade Federal de São Paulo (UNIFESP) from 1994 to 2013. The final diagnosis of all patients that attended the center was reviewed and established upon specific guidelines for each disease. The number of total appointments and extra clinical activities (reports and prescriptions) were also analyzed, as are part of routine activities. 1,599 patients attended the Clinic from 1994 to 2013: 816 with multiple sclerosis (MS), 172 with clinical isolated syndromes, 178 with neuromyelitis optica (NMO), 216 with other demyelinating disease, 20 with metabolic disorder, 42 with a vascular disease and 155 with other or undetermined diagnosis. A mean 219 outpatient visits and 65 extra clinical activities were performed monthly. We identified that 15% of patients seen have NMO. As patients with NMO have a more severe disease than MS, this data may be important for planning local health care policies.

Efetividade da infiltração intra-articular guiada por imagem: comparação entre fluoroscopia e ultrassom

ObjectiveCompare the effectiveness of ultrasound and fluoroscopy to guide intra-articular injections (IAI) in selected cases. Material and methodsA prospective study in our outpatient clinics at the Rheumatology Division at Universidade Federal de São Paulo (UNIFESP), Brazil, was conducted to compare the short-term (4 weeks) effectiveness of ultrasound and fluoroscopy-guided IAI in patients with rheumatic diseases. Inclusion criteria were: adults with refractory synovitis undergo- ing IAI with glucocorticoid. All patients had IAI performed with triamcinolone hexaceton- ide (20mg/ml) with varying doses according to the joint injected. ResultsA total of 71 rheumatic patients were evaluated (52 women, 44 whites). Mean age was 51.9 ± 13 years and 47 of them (66.2%) were on regular DMARD use. Analysis of the whole sample (71 patients) and hip sub-analysis (23 patients) showed that significant im- provement was observed for both groups in terms of pain (P < 0.001). Global analysis also demonstrated better outcomes for patients in the FCG in terms of joint flexion (P < 0.001) and percentage change in joint flexion as compared to the USG. Likert scale score analyses demonstrated better results for the patients in the USG as compared to the FCG at the end of the study (P < 0.05). No statistically significant difference between groups was observed for any other study variable. Discussion and conclusionImaging-guided IAI improves regional pain in patients with vari- ous types of synovitis in the short term. For the vast majority of variables, no significant difference in terms of effectiveness was observed between fluoroscopy and ultrasound- guided IAI.

Effectiveness of imaging-guided intra-articular injection: a comparison study between fluoroscopy and ultrasound

ObjectiveCompare the effectiveness of ultrasound and fluoroscopy to guide intra-articular injections (IAI) in selected cases. Material and methodsA prospective study in our outpatient clinics at the Rheumatology Division at Universidade Federal de São Paulo (UNIFESP), Brazil, was conducted to compare the short-term (4 weeks) effectiveness of ultrasound and fluoroscopy-guided IAI in patients with rheumatic diseases. Inclusion criteria were: adults with refractory synovitis undergo- ing IAI with glucocorticoid. All patients had IAI performed with triamcinolone hexaceton- ide (20mg/ml) with varying doses according to the joint injected. ResultsA total of 71 rheumatic patients were evaluated (52 women, 44 whites). Mean age was 51.9 ± 13 years and 47 of them (66.2%) were on regular DMARD use. Analysis of the whole sample (71 patients) and hip sub-analysis (23 patients) showed that significant im- provement was observed for both groups in terms of pain (P < 0.001). Global analysis also demonstrated better outcomes for patients in the FCG in terms of joint flexion (P < 0.001) and percentage change in joint flexion as compared to the USG. Likert scale score analyses demonstrated better results for the patients in the USG as compared to the FCG at the end of the study (P < 0.05). No statistically significant difference between groups was observed for any other study variable. Discussion and conclusionImaging-guided IAI improves regional pain in patients with vari- ous types of synovitis in the short term. For the vast majority of variables, no significant difference in terms of effectiveness was observed between fluoroscopy and ultrasound- guided IAI.

AB1426-HPR Evaluation of socio-demographic variables, psychiatric comorbidity, and pain in fibromyalgia patients

BackgroundFibromyalgia isa chronic pain syndrome of unknown etiology associated to emotional disorders and low levels in health related quality of life.ObjectivesTo compare socio-demographic variables, psychiatric comorbidity, and pain among fibromyalgia...

The results of the International Consortium on Acute Promyelocytic Leukemia: a 'proof of concept' of networking as a strategy to improve the outcome of treatment of hematological malignancies in developing countries.

The results of the International Consortium on Acute Promyelocytic Leukemia: a 'proof of concept' of networking as a strategy to improve the outcome of treatment of hematological malignancies in developing countries.

Cerebellar ataxia associated to anti-glutamic acid decarboxylase autoantibody (anti-GAD): partial improvement with intravenous immunoglobulin therapy

Universidade Federal de Sao Paulo (UNIFESP) Division of General Neurology and Ataxias Department of Neurology and Neurosurgery

Desenvolvimento de um radioimunoensaio de dexametasona no soro como subsídio para o diagnóstico da síndrome de Cushing

INTRODUÇÃO: O teste de supressão com 1 mg de dexametasona (TSDx) é amplamente empregado no rastreamento da síndrome de Cushing (SC) dada sua elevada acurácia diagnóstica. A SC é um distúrbio endocrinometabólico resultante do hipercortisolismo crônico com característica de ausência de supressão do cortisol no TSDx. OBJETIVO: Desenvolver um radioimunoensaio (RIE) para a dosagem de dexametasona (Dx) no soro para complementar o TSDx. MÉTODOS: Foram imunizados três coelhos com o conjugado dexametasona-21-hemissuccinato-BSA para escolha do melhor anticorpo e o RIE foi desenvolvido de acordo com as recomendações da RE 899/2003 da Agência Nacional de Vigilância Sanitária (ANVISA). Analisamos 96 voluntários, sendo 67 submetidos ao TSDx e 29 não, e 12 pacientes com SC, estudados na Universidade Federal de São Paulo (UNIFESP) e na Santa Casa de Misericórdia de São Paulo. RESULTADOS: O anticorpo contra Dx selecionado mostrou boa especificidade, coeficiente de variação (CV%) intra e interensaio < 20%, exatidão de 93,8% e dose mínima detectada de 19,5 ng/dl. A concentração de Dx no soro foi semelhante nos voluntários e pacientes com SC (ausência/supressão do cortisol): 205 a 703 ng/dl e 174 a 661 ng/dl (intervalo de confiança [IC] 95%), respectivamente; os valores foram indetectáveis naqueles que não se submeteram ao teste. DISCUSSÃO: O anticorpo empregado apresenta boa afinidade e especificidade para quantificar a Dx no soro. O RIE mostrou reprodutibilidade e eficiência na determinação dos níveis séricos de Dx durante o TSDx. CONCLUSÃO: O presente RIE para a dosagem de Dx no soro é acurado e confiável, permitindo estabelecer uma faixa de referência de valores para subsidiar a interpretação do TSDx.

Evaluation of Quality of Life and Sexual Satisfaction in Women Suffering from Chronic Pelvic Pain With or Without Endometriosis

Chronic pelvic pain (CPP) is one of the most frequent symptoms in women of reproductive age. This is an enigmatic clinical condition that results from the complex interactions of physiological and psychological factors with direct impact on the social, marital, and professional lives of women. To evaluate the quality of life and sexual satisfaction of women who suffer from CPP with or without endometriosis. Forty-nine patients who had been diagnosed with endometriosis and 35 patients with CPP diagnosed with another gynecological condition, all 84 of whom were treated at the Chronic Pelvic Pain and Endometriosis Clinic at Universidade Federal de São Paulo (UNIFESP) from January to July of 2008. The controls were 50 healthy women from the Family Planning Clinic at UNIFESP. World Health Organization Quality of Life Assessment-Bref (WHOQOL-BREF) quality of life questionnaire and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). No statistically significant differences were observed between the groups with CPP symptoms, in either the results from the WHOQOL-BREF or in the GRISS questionnaire. In both questionnaires, differences were observed when the two groups of symptomatic women were compared with the group of healthy women. CPP caused by endometriosis or other gynecological conditions leads to a significant reduction of quality of life and sexual satisfaction.

Cytogenetics, JAK2 and MPL mutations in polycythemia vera, primary myelofibrosis and essential thrombocythemia

BackgroundThe detection of molecular and cytogenetic alterations is important for the diagnosis, prognosis and classification of myeloproliferative neoplasms.ObjectivesThe aim of this study was to detect the following mutations: JAK2 V617F, JAK2 exon 12 and MPL W515K/L, besides chromosomal abnormalities. Furthermore, molecular and cytogenetic alterations were correlated with the leukocyte and platelet counts, hemoglobin levels and age in all patients and with the degree of fibrosis in primary myelofibrosis cases.MethodsTwenty cases of polycythemia vera, 17 of essential thrombocythemia and 21 of primary myelofibrosis were selected in the Hematology Department of the Universidade Federal de São Paulo (UNIFESP) between February 2008 and December 2009. The JAK2 V617F, JAK2 exon 12 mutations, MPL W515K and MPL W515L mutations were investigated by real-time PCR and direct sequencing. G-band karyotyping and fluorescence in situ hybridization were used to detect chromosomal abnormalities.ResultsChromosomal abnormalities were observed only in polycythemia vera (11.8%) and primary myelofibrosis cases (17.6%), without correlation to clinical data. Chromosomal abnormalities were not detected by fluorescence in situ hybridization. The JAK2 V617F mutation was observed in polycythemia vera (90%), primary myelofibrosis (42.8%) and essential thrombocythemia (47%). Patients with JAK2 V617F-negative polycythemia vera had lower platelet and leukocyte counts compared to V617F-positive polycythemia vera (p-value = 0.0001 and p-value = 0.023, respectively). JAK2 V617F-positive and MPL W515L-positive primary myelofibrosis cases had a higher degree of fibrosis than V617F-negative cases (p-value = 0.022). JAK2 exon 12 mutations were not detected in polycythemia vera patients. The MPL W515L mutation was observed in one case of primary myelofibrosis and in one of essential thrombocythemia. The MPL W515K mutation was not found in patients with essential thrombocythemia or primary myelofibrosis. The MPL W515L-positive patient with primary myelofibrosis had more severe anemia than other patients with primary myelofibrosis.ConclusionsThis study demonstrates that karyotyping for JAK2 and MPL mutations is useful in the diagnosis of myeloproliferative neoplasms. The precise pathogenetic contribution of these alterations is still unclear. However, this study adds more information about the pathophysiology of polycythemia vera, essential thrombocythemia and primary myelofibrosis.

Influência da hipertensão na sobrevida do enxerto renal em pacientes pediátricos

To evaluate the effect of 1 year systemic arterial hypertension on 3-year allograft survival in children with kidney transplantation. A retrospective study was carried out of pediatric patients submitted to kidney transplantation at the Universidade Federal de São Paulo (UNIFESP) between January, 1998 and January, 2003. Patients were classified as normotensive or hypertensive according to presence of hypertension within the first year after transplantation. Survival analyses were performed with the Kaplan-Meier survival method, and survival curves were compared with the log-rank test. A p value of < 0.05 was considered statistically significant. Prior to transplantation there were 86 patients (64%) and after 1 year, 70 children (52%) were classified as hypertensive, respectively. Overall, the 3-year graft survival was of 92.5%. Survival of the normotensive group was 95.3% and 90.0% for the hypertensive group; the difference was not statistically significant. Although the difference between the two groups was not statistically significant the higher survival of the normotensive group seems to be clinically significant and allows hypothesizing that arterial hypertension could be a risk factor for pediatric graft survival. However, due to limitations of the study it is impossible to affirm that hypertension is an independent risk factor for lower graft survival.

Desafios do ensino de psicologia clínica em cursos de psicologia

Este artigo analisa os desafios e as dificuldades do ensino de Psicologia clínica em cursos de graduação em Psicologia a partir de dados coletados em pesquisa realizada na Universidade Federal de São Paulo (Unifesp). Nota-se que a preparação para o exercício profissional deve ser desenvolvida pela maior articulação entre o arcabouço teórico para esse fazer profissional e a realidade em que o aluno irá atuar. Tomar a prática como eixo estruturante possibilita ao aluno aprender numa situação real com o cliente. Os sujeitos percebem a necessidade de mudanças na formação do psicólogo clínico. Os dados apontam a necessidade de reformulações curriculares que vão ao encontro do movimento que ocorre no ensino de Psicologia clínica, em que a práxis deve voltar-se para a articulação entre a clínica e o social. O novo profissional necessita compreender a clínica a partir de referenciais teóricos que contemplem a noção de subjetividade como resultante de uma construção social e histórica.

Fatores associados ao risco de consumo insuficiente de fibra alimentar entre adolescentes

OBJETIVO: Avaliar o consumo de fibra alimentar entre adolescentes e analisar os fatores associados ao risco de consumo insuficiente desse nutriente. MÉTODOS: Estudo transversal com 722 adolescentes da cidade de São Leopoldo. O processo amostral deu-se por conglomerados por meio de sorteio sistemático de 40 setores censitários e domicílios, incluindo todos os indivíduos entre 10 e 19 anos. Foram obtidos peso e estatura dos adolescentes e dados sociodemográficos da família. Os métodos utilizados para avaliar o consumo alimentar foram o inquérito recordatório de 24 horas e o inquérito de freqüência. Para o cálculo da quantidade de fibra alimentar da dieta, foi utilizado o Programa de Apoio à Nutrição (Nutwin) do Departamento de Informática da Universidade Federal de São Paulo (UNIFESP). A análise estatística foi realizada por meio de regressão logística, utilizando modelo hierárquico. RESULTADOS: A prevalência de consumo insuficiente de fibras foi de 69% nas meninas e 49,7% nos meninos (p < 0,001). Entre os meninos, os fatores que determinaram essa condição foram: consumo não habitual de feijão (OR 2,65; IC95% 1,05-6,68) e excessivo de lipídeo (OR 2,67; IC95% 11,23-5,83). Para as meninas, maior faixa etária (OR 5,33; IC95% 2,33-12,2), consumo não habitual de feijão (OR 3,01; IC95% 1,44-6,53), consumo excessivo de lipídeo (OR 1,85; IC95% 1,01-3,37), fazer dieta para perder peso (OR 2,50; IC95% 1,10-5,70) e presença de excesso de peso (OR 2,06; IC95% 1,04-4,07). CONCLUSÕES: Os resultados permitem concluir que a ingestão excessiva de gordura e o consumo não habitual de feijão estão fortemente associados ao risco de consumo insuficiente de fibra alimentar em ambos os sexos e que o sexo feminino apresenta mais fatores de risco para esse desfecho.

Factors associated with risk of low dietary fiber intake in adolescents

To evaluate dietary fiber intake among adolescents and to analyze factors associated with the risk of insufficient consumption of this nutrient. Cross-sectional study of 722 adolescents from the town of São Leopoldo, RS, Brazil. Sampling was by clusters, with a systematic randomization of 40 census sectors and residences, including all individuals aged 10 to 19 years. The adolescents' weight and height were measured and sociodemographic data on their families recorded. A 24-hour dietary recall and a frequency survey were used to assess dietary intakes. The quantity of dietary fiber in diets was calculated using Nutwin nutrition support software (Programa de Apoio à Nutrição), developed by the IT Department at Universidade Federal de São Paulo (UNIFESP). Statistical analysis was by means of logistic regression, employing a hierarchical model. The prevalence of insufficient dietary fiber intake was 69% among girls and 49.7% for boys (p < 0.001). The determinant factors of this condition among boys were non-habitual consumption of beans (OR 2.65; 95%CI 1.05-6.68) and excessive fat intake (OR 2.67; 95%CI 11.23-5.83). For girls factors were increased age (OR 5.33; 95%CI 2.33-12.2), non-habitual consumption of beans (OR 3.01; 95%CI 1.44-6.53), excessive fat intake (OR 1.85; 95%CI 1.01-3.37), dieting for weight loss (OR 2.50; 95%CI 1.10-5.70) and presence of overweight (OR 2.06; 95%CI 1.04-4.07). These results admit of the conclusion that excessive fat consumption and non-habitual consumption of beans are strongly linked with the risk of insufficient dietary fiber intake in both sexes and that females exhibit a greater number of risk factors for this outcome.

The Portuguese version of the Epilepsy Surgery Inventory (ESI-55): Cross-cultural adaptation and evaluation of psychometric properties

The purpose of this study was to develop a Portuguese version of the Epilepsy Surgery Inventory (ESI-55) and to assess its psychometric properties. Sixty patients with temporal lobe epilepsy related to unilateral mesial temporal sclerosis who underwent presurgical evaluation at the Universidade Federal de São Paulo (UNIFESP) formed the sample for this study. The psychometric properties of the ESI-55 included: reliability, validity, and responsiveness. Internal consistency was high in all domains (Cronbach’s α ranging from 0.76 for Social Function to 0.88 for Physical Function) except Overall Quality of Life ( α = 0.45). Test–retest reliability after 1 week was good, with the intraclass correlation coefficient ranging from 0.79 (Energy/Fatigue) to 0.92 (Role Limitations due to Emotional Problems). Interrater reliability ranged from 0.84 (Cognitive Function) to 0.94 (Role Limitations due to Physical Problems). For construct validity, we verified a high correlation between the ESI-55 and Health Assessment Questionnaire-8 for the Physical Function domain (Pearson linear correlation = −0.84), and a moderate correlation for the Pain domain ( P = −0.58), but for the other subscales no correlation was detected. Beck Depression Inventory and ESI-55 domains were highly statistically correlated (ANOVA: P < 0.005), but there was no association of the Cognitive Function and Role Limitations due to Memory Problems subscales with neuropsychological evaluation (Pearson coefficient: P > 0.05). With respect to demographic characteristics, a statistically significant correlation was observed for the variable educational level (Student t, P < 0.005) and ESI-55 scores. There was a high correlation between seizure frequency and ESI-55 domains for clinical variables (ANOVA, P < 0.005). Surgical treatment in this series improved health-related quality of life in the seizure-free group in three domains—Health Perception (1.24), Emotional Well-Being (1.32), and Energy/Fatigue (1.48)—as reflected by the standard response mean and the effect size of the sample. Our results support the psychometric properties of the Portuguese version of the ESI-55 as a measure of health-related quality of life.

Insuficiência adrenal primária no adulto: 150 anos depois de Addison

Thomas Addison first described, 150 years ago, a clinical syndrome characterized by salt-wasting and skin hyperpigmentation, associated with a destruction of the adrenal gland. Even today, over a century after Addison's report, primary adrenal insufficiency can present as a life-threatening condition, since it frequently goes unrecognized in its early stages. In the 1850s, tuberculous adrenalitis was present in the majority of patients, but nowadays, autoimmune Addison's disease is the most common cause of primary adrenal insufficiency. In the present report, we show the prevalence of different etiologies, clinical manifestations and laboratorial findings, including the adrenal cortex autoantibody, and 21-hydroxylase antibody in a Brazilian series of patients with primary adrenal insufficiency followed at Divisão de Endocrinologia da Universidade Federal de São Paulo (UNIFESP) and at Faculdade de Medicina de Ribeirão Preto-USP (FMRP-USP).