ABSTRACT Background: The increase in life expectancy for patients living with human immunodeficiency virus (HIV) infection has resulted in health complications related to a chronic disease. Objectives: To evaluate the prevalence of bone mineral density (BMD) alterations and vitamin D concentrations in HIV-infected children and adolescents and to verify the variations in those parameters during a 12-month interval. Methods: A prospective cohort study with a dual period of evaluation was conducted in 57 patients perinatally HIV-infected and one patient with sexual abuse in early infancy. Demographic, anthropometric, pubertal stage, viral load, T CD4+ cell count and antiretroviral therapy were evaluated. Biochemical tests and total body (TB) and lumbar spine (L1-L4) bone density evaluations by dual X-ray absorptiometry (DXA) were performed. Calcium or vitamin D supplements were prescribed if reduction in BMD or deficiency for vitamin D was detected. Results: 58 patients (ages 5.4-18.3 years; 60.3% girls) were included (T0); 55 patients were reevaluated after 12 (±3) months (T1). Low bone mass for chronological age was found in 6/58 (10.4%) and 6/55(10.9%) patients at T0 and at T1, respectively. There was no statistical relationship between z-scores for BMD (BMD z-score) and the variables sex, fracture history, family history of osteoporosis, physical activity and pubertal stage. There was a relation between BMD z-score alterations for TB and HIV viral load at T1 (p = 0.016). There was no association between duration or classes of antiretroviral therapy and bone density. The mean value of vitamin D in T0 was 23.43 ng/mL ± 2.015 and in T1 22.1 ng/mL ± 0.707 and considered insufficient levels for this population. Conclusion: Patients infected with HIV are at risk for BMD alterations and lower vitamin D serum concentrations; both of these variables should be evaluated at routine examinations in order to improve both prevention and therapeutic planning.

CONTEXTO: Pouco relatado na literatura, o ato de chorar parece ser um importante fator precipitante de enxaqueca e cefaléia do tipo tensional na prática clínica diária. OBJETIVO: Avaliar o papel do choro como fator precipitante de enxaqueca e cefaléia do tipo tensional. TIPO DE ESTUDO: Avaliação prospectiva. PARTICIPANTES: 163 funcionários ou estudantes da Universidade Metropolitana de Santos que apresentavam cefaléia pelo menos uma vez por mês, por pelo menos um ano, sendo o diagnóstico enxaqueca ou cefaléia do tipo tensional. PROCEDIMENTOS: Entrevista usando questionário e avaliação individual. Detalhes dos fatores precipitantes das crises foram avaliados. RESULTADOS: Do grupo de 163 funcionários ou estudantes, 90 (55.2%) consideravam o choro como um potencial desencadeante de crises de cefaléia. Deste grupo de 90 pessoas, 62 apresentavam enxaqueca (6 homens e 56 mulheres) e 28 apresentavam cefaléia do tipo tensional (5 homens e 23 mulheres). Apenas estresse, ansiedade e período menstrual foram tão ou mais importantes que o choro como desencadeantes dos dois tipos de cefaléia. CONCLUSÕES: A fisiologia do choro não é bem documentada ou compreendida. O ato de chorar parece ser um importante fator desencadeante de cefaléias primárias e deveria ser estudado em maior detalhe. Os autores gostariam de comentários neste tema e gostariam também de trabalhar em colaboração com outros grupos interessados no tema.

CONTEXT: Scarcely reported in the literature, crying seems to be an important precipitating factor for both migraine and tension-type headache in daily practice. OBJECTIVE: To evaluate the role of crying as a precipitating factor for migraine and tension-type headache. TYPE OF STUDY: Prospective evaluation. PARTICIPANTS: 163 workers or students from the Universidade Metropolitana de Santos, who presented at least one attack a month, for at least one year, of either migraine or tension-type headache. PROCEDURES: Interview by means of questionnaires and personal evaluations. Details of precipitating factors for the attacks were assessed. RESULTS: From the total group of 163 individuals, 90 (55.2%) considered crying to be a potential factor for triggering headache attacks. Of this group of 90 persons, 62 presented migraine (6 males, 56 females) and 28 presented tension-type headache (5 males, 23 females). Only stress, anxiety and menstrual periods rated higher or equal to crying as triggering factors for both types of headache. CONCLUSIONS: The physiology of crying is not well documented or understood. The act of crying seems to be an important precipitating factor for primary headaches and it should be studied further. The authors welcome comments on the matter and would like to work in collaboration with other groups interested in this subject.