São Paulo medical journal = Revista paulista de medicina
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Animal models for essential hypertension have been used for understanding the human pathological conditions observed in pregnant hypertensive women. ⋯ The SHR strain may be considered as a model for chronic hypovolemic maternal hypertension, with the fetal growth retardation being determined by this hypovolemic state.
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The loss of body weight and fat late in life is associated with premature death and increased risk of disability, even after excluding elderly subjects who have a preexisting disease. Although it is important to recognize that periods of substantially positive or negative energy balance and body weight fluctuation occur as a normal part of life, weight losses greater than 5% over 6 months should be investigated. We can divide the major causes of weight loss in the elderly into 4 categories: social, psychiatric, due to medical conditions, and age-related. The clinical evaluation should include a careful history and physical examination. If these fail to provide clues to the weight loss, simple diagnostic tests are indicated. A period of watchful waiting is preferable to blind pursuit of additional diagnostic testing that may yield few useful data, if the results of these initial tests are normal. The first step in managing patients with weight loss is to identify and treat any specific causative or contributing conditions and to provide nutritional support when indicated. Non-orexigenic drugs have found an established place in the management of protein-energy malnutrition. Early attention to nutrition and prevention of weight loss during periods of acute stress, particularly during hospitalization, may be extremely important, as efforts directed at re-feeding are often unsuccessful. ⋯ Narrative review.
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Several investigations have postulated that the perimenopause may represent a period of increased psychiatric vulnerability, particularly for mood disorders. This review characterizes the perimenopause, including biological changes, the influence of psychosocial factors and the most common clinical manifestations. Clinic-based studies and community-based surveys addressing the prevalence of depressive symptoms in perimenopausal women are critically reviewed. We also discuss the potential greater vulnerability to mood disturbance during the perimenopause in response to hormonal variability. A therapeutic algorithm for management of depressive symptoms in middle-aged perimenopausal women is also presented. The role of estrogen in the treatment of perimenopausal depressive symptoms is particularly discussed. In addition, we review the existing data regarding the potential efficacy of estrogen as an antidepressant agent (monotherapy, augmentation strategy or prophylaxis). ⋯ Narrative review.
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Multiple diagnostic methods are available for the detection of Helicobacter pylori infection, but at present no single one can be used as the gold standard. ⋯ Our results suggest that among invasive methods, an association between the rapid urease test and histology constituted the best choice for the detection of Helicobacter pylori infection. If results of histology and the rapid urease test are different, serology may be recommended.
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Many patients with intermittent claudication continue to be forwarded to the vascular surgeon for initial evaluation after arteriography has already been accomplished. ⋯ There are no indications for arteriography in the early evaluation of patients with intermittent claudication, because it does not modify the initial therapy, independent of its result. In cases where surgical treatment is indicated, this procedure should only be performed prior to surgery.