Navegando por Orientadores "LIBONATI, Rosana Maria Feio"

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Alterações endócrinas e metabólicas em pacientes HIV positivos com lipodistrofia
(Universidade Federal do Pará, 2007-11-30) YAMANO, Ernesto Yoshihiro Seki; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
Lipodystrophy is one of the complications of highly active antiretroviral therapies (HAART). This study evaluates the metabolic and endocrine changing in patients with lipodystrophy. Forty patients were evaluated and classified as lipoatrophy, lipohypertrophy and mixed syndrome. We analyzed insulin resistance for HOMA-IR (Homeostasis Model Assesment Insulin Resistance), fasten glucose and OGTT, urea, creatinine, TSH, Free T4, cortisol, DHEA, ratio cortisol/DHEA, prolactin, testosterone (in male), FSH, LH and estradiol (in female), total cholesterol, LDL-c, HDL-c, uric acid. Anthropometrics measures (Weight, height, body mass index, waist, hip and skin folds thickness), ultrasonographic exams for evaluate hepatic steatosis and measure of bone density. The isolated lipohipertrophy occurred only in female (p<0,05). The mean of age was similar in the groups, without changing in the distribution by age group. Dyslipidemia occurred in all groups after HAART (lipodystrophy mixed, 100%, lipohypertrophy, 80% and lipoatrophy, 70%). Antropometric data showed waist increased in the female with lipohypertrophy (98+ 13,4) and decreased in female with lipoatrophy (76,8 + 6,1). Patients with lipoatrophy have been eutrophic (82,4%) and patients with lipohypertrophy have overweight or obesity (60%). Male was associated with osteoporosis (p < 0,05). We found elevated prevalence of the dyslipidemia (85%) and metabolic syndrome (37,5%) in all groups. The metabolic syndrome was associated with lipohypertrophy. No significant changes were found in the thyroid, cortisol, cortisol/DHEA ratio, testosterone, FSH, LH and prolactina. Conclusions: Female is associated with isolated lipohypertrophy, metabolic syndrome and insulin resistance. Male is related with Osteopenia and osteoporosis. Hepatic steatosis were common, but is not influenced for a type of lipodystrophy. Hormonal changing were unusual events in lipodystrophy.
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Avaliação da efetividade da farinha da casca do maracujá sobre as alterações metabólicas secundárias à terapia antirretroviral em pacientes portadores de síndrome Lipodistrófica
(Universidade Federal do Pará, 2010-09-01) MARQUES, Simone do Socorro Fernandes; SABAA-SRUR, Armando Ubirajara Oliveira; http://lattes.cnpq.br/9777905758332275; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
Anatomical and metabolic changes are common in individuals with HIV who use high-Retroviral Therapy (HAART). We conducted a clinical trial to evaluate the effectiveness of using flour of passion fruit peel (FCM) associated with the Dietary Guideline on the metabolic changes secondary to HAART in patients with lipodystrophy in lipodystrophy clinic of the Hospital Universitário João de Barros Barreto. We evaluated 36 adult patients of both sexes, people with HIV with lipodystrophy syndrome in use of HAART. These individuals were divided into two groups (n = 18 each), group 1 received 30 grams daily FCM for 90 days associated with dietotherapeutic counseling, group 2 received only dietotherapeutic counseling. The metabolic changes were analyzed before and after intervention. The results were analyzed by BioEstat 5.0 and Diet Pro and significance level p <0.05. There was greater prevalence of males, age 40-49 years, singles and family income 1-3 times the minimum wage. The majority had 10-15 years time of HIV diagnosis and the same time the use of HAART. The scheme was first prescribed HAART 1 or 2 NRTIs + 2 IP. Lipoatrophy syndrome was more prevalent and the metabolic syndrome was detected in 19.4% of the sample. Most patients presented diagnostic nutritional Eutrophic. There was no significant difference between the two groups mentioned in any of these variables, demonstrating the homogeneity of the groups. The use of FCM was effective in reducing plasma levels of total cholesterol after 30 days of use, without, however, changing its classification, there was improvement in the plasma levels of LDL - c after the use of FCM for 90 days and improvement category (increased LDL - c rating - great) there was an increase in HDL - c after 90 days of consumption of FCM without improvement in the classification of lipoproteins, there was a decrease of plasma levels of triglycerides after 30 days of FCM and improvement category. There were no changes in blood glucose after the use of FCM. Individuals who used the FCM showed a lower risk of developing coronary artery disease after 90 days of use. There was no difference between the two groups regarding the consumption of the main components of food. The use of 30 grams of FCM for 90 days associated with the Dietary Guideline is effective in improving plasma levels of total cholesterol, LDL - c, HDL – c, Triglycerides without interfering with blood glucose values.
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Avaliação das anormalidades do metabolismo mineral ósseo em pacientes portadores de lipodistrofia e HIV positivos
(Universidade Federal do Pará, 2012-03-21) OLIVEIRA, Danielle Lima de; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
The advances in antirretroviral therapy (HAART) markedly suppressed viral activity and increased longevity of those living with HIV / AIDS, however, a variety of metabolic abnormalities related to treatment was reported after the introduction of HAART combined among these complications, changes in bone mineral density arouse special attention, not only for its long-term implications, but also by the conflicting data available in the literature. OBJECTIVES: to evaluate changes in bone mineral density, and correlate them with sex, age, body mass index body, types of lipodystrophy, laboratory levels of serum calcium, parathyroid hormone and vitamin D and hormonal profile. METHODS: in this cross-sectional study 77 HIV patients with lipodystrophy syndrome treated with highly active antirretroviral therapy (HAART), and enrolled in the clinic lipodystrophy of the João de Barros Barreto University Hospital. The clinical examination of patients involved the measurement of weight, height and waist circumference. Laboratory tests performed included measurement of serum calcium, vitamin D, parathyroid hormone, estradiol, testosterone.Patients were divided into three groups according to the form of lipodystrophy: mixed, atrophic and hypertrophic. RESULTS: most patients were male, and the predominant form of lipodystrophy was mixed form. The mean time of infection after HIV diagnosis was 10.98 ± 6.03 years. The prevalence of osteopenia was 61.03% and osteoporosis was 25.97%. The male patients presented more frequently osteoporosis in femoral neck and the female patients in the lumbar spine. Osteoporosis in the lumbar spine was more prevalent in the mixed form of lipodystrophy and the femoral neck and shown to be similar between the atrophic and mixed forms of lipodystrophy. And the frequency of osteoporosis was present in all sequences of age in males and in females only after 50 years. CONCLUSIONS: the prevalence of osteoporosis increases with age in females. There was no association between BMD and the form of lipodystrophy.
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Avaliação do polimorfismo genético das apolipoproteínas A1 e A5 em pacientes HIV positivos com síndrome lipodistrófica no estado do Pará
(Universidade Federal do Pará, 2012-06-13) DUTRA, Claudia Daniele Tavares; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
Introducion: Dyslipidemia is one of the metabolic changes caused by using antiretroviral therapy (ART) in HIV patients with lipodystrophy syndrome. Objective: To evaluate the genetic polymorphisms of apolipoproteins A1 and A5 in HIV patients with lipodystrophy in use of antiretroviral therapy and its association with dyslipidemia. Methods: It´s a cross-sectional and analytical study. We used a research protocol which studied conditions sociodemographic, clinical risk factors (physical activity, smoking, drinking, food frequency) for dyslipidemia, and biochemical assessment of the apolipoproteins A1 and A5 polymorphisms. Results: Of the 105 HIV-positive patients studied, 63.8% were men, mean age of 44.5 (± 9.4) years, 70.5% reported being single and having a family income of up to three minimum wages (77,1%). The risk factors were: smoking (21%), alcohol use (43.8%), physical inactivity (69.5%), diabetes mellitus (16.2%), overweight (22.9%) and cardiovascular risk (39.1%). The most prevalent form of lipodystrophy syndrome was mixed (51.4%). Food frequency intake observed of fruits (60.8%) and vegetables (36.3%), milk and dairy products (75%) were daily. While candy and sweets (31.4%), sausages (11.7%) and fatty snacks (26.4%) were more than twice a week. And the habit of eating meat with fat apparent was common (56.9%). The observed dyslipidemia classification revealed most patients with isolated hypertriglyceridemia (30.5%) and mixed hyperlipidemia (32.4%). It was observed that the isolated hypertriglyceridemia associated with the apolipoprotein A5 gene (rs3135506, rs619054 and rs662799), and not being influenced by clinical forms of lipoatrophy. There was no presence of the apolipoprotein A1 polymorphism (Lys107-0must2) in the patients studied. Conclusion: The main factors for hypertriglyceridemia were being man and had apolipoprotein A5 gene polymorphisms (rs3135506, rs619054 and rs662799).
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Avaliação do risco cardiovascular em pacientes com lipodistrofia secundária a terapia antirretroviral: critérios de framingham, índice tornozelo-braço e medida da espessura da camada medio-intimal da carótida
(Universidade Federal do Pará, 2011-12-16) KOURY JUNIOR, Adib; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
The use of combination antiretroviral therapy has significantly reduced mortality and morbidity in patients infected by HIV virus. However, this treatment may cause metabolic alterations such as dyslipidemia, glucose intolerance, insulin resistance and lipodystrophy. The clinical and laboratorial consequences that follow these alterations may raise the risk for cardiovascular diseases. This research aimed to investigate the epidemiological, clinical and laboratorial aspects of patients with lipodystrophy associated to raise cardiovascular risk, ankle-brachial index (ABI) and measurement of the carotid intima-media thickness (cIMT). For so, it was performed a Transversal analytical study with 62 patients with lipodystrophy using highly active antiretroviral therapy (HAART) with ages varying from 29 to 68, followed up in the outpatient unit of lipodystrophy of João de Barros Barreto University Hospital. The patients were submitted to anamnesis with clinical examination, blood collection for laboratorial tests with glycemia dosage, total cholesterol and its fractions, triglycerides and ultrasensitive PCR, measurement of the ankle-brachial index and measurement of the carotid intima-media thickness through mode B ultrasonography. The patients were classified according to their cardiovascular risks through the criteria of the Framingham Score. The variables were analyzed by the study of the measurements of central trend and the hypotheses were analyzed by the chi-square Test and/or the Fisher exact Test. The prevalence of alteration of the ABI in the studied sample was 21% and of the patients with a increase of the cIMT was 48.4%. According to the Framingham score, 53.2% of the patients presented low risk to a cardiovascular event in a 10 year range, 16.1% of moderate risk and 30.7% of high risk. A patient with a increase of the cIMT presented a larger cardiovascular risk through the Framingham score. Male, age, increase of the abdominal circumference have presented a significant association with the carotid intima-media thickness cIMT.
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Comprometimento pulmonar na malária: associação com fatores epidemiológicos, imunológicos e variantes do Plasmodium vivax
(Universidade Federal do Pará, 2014-11-20) OHNISHI, Maria Deise de Oliveira; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
Malaria is a disease caused by protozoan parasites of the genus Plasmodium and transmitted to humans by mosquitoes of the genus Anophelis. In 2011, the Brazilian Amazon reported 266.348 cases. In Brazil, the most prevalent species is Plasmodium vivax (80%). It´s considered responsible for benign forms of malaria, reports have shown severe forms of pulmonary malaria and deaths. The pathophysiological mechanisms are not well understood.Thus, we analyzed 247 patients with vivax malaria recruited from the Clinical Trials Program in Malaria Institute Evandro Chagas (IEC) Belém / PA) and malaria diagnosis service of the Secretariat of Health of the city of Goianésia / Pará between April / 2011 to October / 2013 to evaluate clinical, epidemiological, parasitological, radiological, genetic and immune (variants of P. vivax) parameters, associating them to the pulmonary involvement in vivax malaria. The project was approved by the Research Ethics Committee of the Instituto Evandro Chagas.Hematological parameters (blood count, transaminases, bilirubin), parasite density were analyzed as were measured at D0 and D14 serum levels of cytokines (TNF-, IL-10 and INFγ), relating to the pulmonary manifestations. D0 was determined prevalence of P. vivax variants (VK210 and VK247 and P. vivax-like) and established association of these variants with patients who had an abnormal chest X-ray and / or spirometry. The study was longitudinal, prospective analytical type involving clinical, immunological, hematological, and radiological aspects of respiratory function. Patients with pulmonary involvement confirmed by clinical and / or radiological and / or functional findings constituted the study group, and patients without such findings, the control group. Participants: those with vivax malaria diagnosed by thick blood, confirmed by PCR, 15-60 years old, both genders, with no chronic diseases, no use of corticosteroids at diagnosis and who signed the consent form. Project approved by the CEP of the IEC. Observed: 69.2% were males; mean age 35 years old; 64.4% lived in Belém; 79.8% contracted malaria in the state of Pará; First infection 42.5%; mean duration of disease 7.5 ± 5.9 days; average of 6979.25 ± 8692.22 parasitaemia parasites / mm3; 46.8% were overweight or obese I; smoking and previous lung disease were not risk factors for worsening of the disease in this sample; 92.3% had headache from malaria triad; among respiratory symptoms, cough was the most frequent (53.4%); hepatomegaly and splenomegaly was more frequent among naïve malaria; Thrombocytopenia was significant in D0; radiological abnormalities in 9.7% of cases; changes in X-ray were related to malaria shortness of breath and cough had statistical significance in those with changes in the X-ray and / or spirometry; IL-10 INFγ and cytokines were significantly higher compared D0 to D14, unlike that serum TNF levels were low in D0. VK210 P. vivax variant was more frequent (69.1%); there was no significant correlation in the appearance of changes in RX in this sample and / or spirometry related to any of the P. vivax subspecies. Among the cytokines, INFγ was significantly elevated in D0 associated to variants in the following situations: (VK210, VK247, VK210 / 247). IL-10 also significantly increased in D0 only when the subspecies was VK210. Lung malaria is a reality still underestimated, especially less prominent pulmonary manifestations, being necessary to investigate potential mechanisms involved linked to the host and the parasite, emphasizing the importance of early diagnosis, avoiding unfavorable outcome.
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Estado nutricional na malária: influência nos aspectos clínicos e laboratoriais de pacientes naturalmente infectados por Plasmodium vivax
(Universidade Federal do Pará, 2015-11-10) MONTE, Carlos Rodrigo Souza do; VENTURA, Ana Maria Revorêdo da Silva; http://lattes.cnpq.br/0682511755329264; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
Malaria is considered by the World Health Organization a global public health problem. In Brazil, most cases occur by P. vivax. This study aimed to evaluate the influence of obesity on inflammatory markers, biochemical, hematological, parasitological profiles and clinical manifestations in vivax malaria patients at Pará State. Seventy-eight (37 eutrophic, 25 overweight and 14 obese) patients positive to P. vivax were included. Chills, headache, malaria triad (fever, chills and headache), myalgia, cough and diarrhea were more frequent, whereas the clinical score were higher in obese compared to normal weight patients. Obese patients had a higher level of count of total leukocytes, neutrophils, monocytes, triglycerides, total cholesterol, VLDL, AST, ALT compared to lean patients. Parasitaemia was similar among nutritional status, although was observed trend to higher parasitaemia (> 5.000 parasites/μL) in obese patients. Serum levels of TNF-α and IL-10 did not differ among nutritional groups, though there was a negative correlation between TNF-α and waist circumference. Among overweight and obese was observed a positive correlation between IL-10 and parasitemia, neutrophils, urea and a negative correlation with red blood cells, lymphocytes, platelets. Throughout, TNF-α was correlated negativity with the clinical score. Nutritional status influences immune response against the infection and it has been an important risk factor in this findings. However, further studies are required to understand the malaria in this context.
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Níveis de TNF-α e seu polimorfismo genético em pacientes HIV positivos, portadores de lipodistrofia e em uso de terapia anti-retroviral
(Universidade Federal do Pará, 2008) PINHEIRO, Miguel Corrêa; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
This work presents the results of the research entitled Levels of TNF-α and its Genetic Polimorfism in Patient Positive HIV, Bearers of Lipodistrophy and in Use of Anti-retroviral Therapy. It was aimed at, through the research for now presented, to study the levels serics of TNF-α and its Genetic Polymorphism in Patient Positive HIV, Bearers of lipodistrophy and in Use of Anti-retroviral Therapy. The need of know better the factors involved in the development of a syndrome clinic known as lipodistrophy justifies that aims, considered an adverse effect of the anti-retroviral therapy, so that that knowledge oportunize the reliable of a safe therapeutic regime, propitiating, in that way, a possible improvement in the quality of the patients' life. The methodology undertaken for the quantitative determination of the serics levels of TNF-α it was used of the ELISA method, while, tends in view the research of the occurrence of the polymorphism, it was used of the reaction of PCR for the extraction of DNA, followed by the digestion for the restriction enzyme Ncol. Forty patients participated of the present researches, which 26 were male and 14 were female. In this patient, the dosing of the TNF-α levels was proceeded, as well as it researches of the presence or absence of the genetic polymorphism (-308A).
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Perfil epidemiológico de mulheres vivendo com o hiv/aids a partir da perimenopausa no estado do Pará: um estudo através dos instrumentos de monitoramento da epidemia
(Universidade Federal do Pará, 2018-09-20) SANTOS, Eliane Regine Fonseca; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
The great progress in controlling HIV infection through combined antiretroviral therapy (HAART) has transformed AIDS from a fatal into a chronic disease. Women living with HIV/AIDS will experience the climacteric and its events more often, what justifies the necessity to know the female population in order to design an action plan for this phase. This transversal, descriptive study was based on an exploratory documentary analysis of HIV/AIDS registries among women in the 40-64 age group, from 2014 to 2017, in the state of Pará. The Brazilian Notifiable Diseases Surveillance System (SINAN), Mortality Surveillance System (SIM), Logistic and Supply Management System of Drugs (SICLOM), Medical Laboratory Examination Management System (SISCEL), and Hospital Surveillance System of the National Health System (SIHSUS) provided data studied herein. This research aimed at describing the epidemiological profile of women living with HIV/AIDS in the state of Pará to identify the rate of hospital stays for AIDS and its related diseases, the AIDS mortality rates in the state, the number of women in virological failure, and their whereabouts. A total sum of 1.237 cases were reported in the period, with the highest amount in 2017 (37.1%), mainly in the 40-44 age group (30.3%), brown (82.1%), low schooling (41.2%), and urban dwellers (85.2%). The highest hospital mortality rate was in the metropolitan region I (73.9%). The viral load was detectable in 383 women, being the 40-44 age group the one with the highest detectability rate. UREDIPE and CASA DIA are the services where most women were observed in virological failure. It is concluded that brown female urban dwellers, with low schooling, in the 40-44 age group were the ones with the highest number of notification at SINAN. The metropolitan region I had the highest mortality rate.
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Perfil lipidico de uma população residente em área de alta endemicidade para malária
(Universidade Federal do Pará, 2012) NEVES, Frederico Augusto Rocha; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
Malaria is an infectious disease caused by a protozoan of the genus Plasmodium. In the Brazilian Amazon malaria is endemic, where more than 99% of the notifications of the disease. The municipality of Anajás, located in Pará State, was found an Annual Parasite Incidence (API = 57.7). The study was a cross-sectional controlled, having as main objective to evaluate the impact of malaria on lipid parameters of a population living in a highly endemic area. To this end, we considered three groups of patients: Group I: patients with malaria (n = 64), Group II: patients without malaria (n = 46), both groups consist of people living in the city of Anajás - Pará, and another Group III: patients with no history of malaria (n = 46) and residing in Belém – Pará. Was analyzed the levels of total cholesterol and triglyceride fractions and of all individuals included in the study. The analyzes showed that females were more affected and the species P. falciparum was more frequent. Mean total HDL cholesterol, LDL cholesterol, VLDL cholesterol and triglycerides were statistically significant only for patients with malaria (Group I) and mean LDL cholesterol was statistically significant in all groups evaluated. To investigate the past malarial population three subgroups were created from the group of patients without malaria Anajás, Groups Iia, IIb and IIc. For this evaluation used the average total cholesterol and triglyceride fractions and was observed that the greater the number of episodes of malaria, higher HDL cholesterol levels and lower LDL cholesterol levels in patients in this subgroup.
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Perfil metabólico e nutricional de pacientes HIV positivos com lipodistrofia submetidos à terapia anti-retroviral: orientação nutricional
(Universidade Federal do Pará, 2008-04-24) DUTRA, Cláudia Daniele Tavares; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
Adverse effects of the lipodystrophyca syndrome is common in patients submitted to the use of highly active anti-retroviral therapy (HAART). This study evaluates the effectiveness of nutritional guidance on the metabolic changes in patients with lipodystrophy secondary to TARV, in the city of Belém - PA, in the period October 2006 to December 2007. We evaluated 29 patients, aged from 20 to 60 years, of both sexes, HIV positive, with lipodystrophyca syndrome, use of HAART and analyzed the metabolic and nutritional alterations before and after the intervention clinical-nutrition. The results were analyzed through programmes BioEstat 4.0 with p<0.05 and Virtual Nutri 1.0. We analyzed total cholesterol and fractions (LDL and HDL), triglycerides, insulin resistance, anthropometric measurements, measure of bone density, assessment of hepatic steatosis and cardiovascular risk. There was greater prevalence of patients retirees, male, aged 41 to 50 years and income from zero to three minimum wages. There were no significant differences between the sexes as to alcoholism and smoking, while 72% of patients not practiced physical activity. The association between lipoatrophy and lipohypertrophy and time of use of HAART, was significant, regardless of sex. There is total cholesterol and high triglycerides, low HDL and LDL normal. The analysis of the metabolism of carbohydrates, 48% of patients had changes glicêmicas and 34% resistance to insulin. It was observed that 52% of patients had hepatic steatosis and 79% change in bone mineral density, with greater prevalence for men. The syndrome presented lipoatrófica global measures smaller than the syndrome and mixed lipohipertrófica. After intervention clinical and nutritional changes significant decrease in levels of triglycerides and glucose and increase of HDL. As for cardiovascular changes, 31% of patients reduced the absolute risk of heart attack and death in 10 years, with reduction of total cholesterol and HDL. The nutritional intervention had a significant decrease in food intake of calories, proteins and lipids. Nutrition treatment minimized the metabolic changes of HAART, providing a better prognosis and quality of life of these patients.
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A qualidade de vida de pacientes com Síndrome lipodistrófica associada ao HIV
(Universidade Federal do Pará, 2016) GUIMARÃES, Débora Suellen de Oliveira; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
The HIV lipodystrophy syndrome is characterized by changes in body fat distribution, or anatomical changes, such as lipoatrophy in the face region; loss of limb fat, apparently leaving the venous network of members; the loss of fat from the buttocks with or without the accumulation of fat in the abdomen and can occur in both sexes; and metabolic changes characterized by increased serum lipids; by peripheral insulin resistance, which results in diabetes mellitus. These changes are related to ART - antiretroviral therapy, chronic infection caused by HIV, genetic factors and the wearer's lifestyle (ABBATE, 2006). The purpose of this research is to investigate the quality of life of patients with lipodystrophy syndrome associated with HIV. Data collection was conducted through interviews with patients with lipodystrophy syndrome associated with HIV / AIDS in the age groups above 18 years, who agree to participate. The questionnaire was: A characterization questionnaire of adults with HIV / AIDS and for evaluating the quality of life questionnaire will be used the World Health Organization Quality of Life in HIV Infection, abbreviated version (WHOQOL-HIV-Bref). For statistical analysis we used the electronic program Statistical Package for Social Sciences (SPSS) version 22.0, and the chi-square test of Pearson (X2), assuming level α = 0.05 (5%) and value p≤0,05. Most respondents were male (66%), with age range between 29 and 73 years, as the level of education, 44% had completed high school. Were predominantly of low socioeconomic status, and family income around 1 to 3 minimum wages (88%). Regarding marital status, only 14% were married. Among the respondents, 28 (56%) had a final score for quality of life, so that 22 (44%) had a score to bad quality life. research The conclusion has implications for professional practice, with the realization of the importance of observing, improve and step in to the demands of the users of the services can be met, with a view to further actions directed to their resolution and strengthening the patient's bond with the health team, watching the patient holistically in their various fields of this study, because in general, the majority of patients were dissatisfied with other external services to outpatient endocrinology, showing that this link needs to be strengthened in services of health.