Adrenocortical function in hypotensive patients with end stage renal disease.

BACKGROUND: Sustained hypotension among patients with end stage renal disease on dialysis (ESRDh) varies from 5.0% to 12.0%. Despite their role in the regulation of blood pressure (BP) corticoadrenal hormones have been poorly investigated. OBJECTIVES: This study aims to detect adrenal insufficiency in ESRDh and follow their clinical outcome. METHODS: Fifty ESRDh and 30 healthy volunteers were studied. In all cases basal blood and saliva were obtained. Synthetic ACTH (25µg) was injected intramuscularly and at 30min saliva was collected. Circulating ACTH, renin, cortisol and aldosterone were measured and steroids were also assessed in saliva by immunoassay. RESULTS: Fifteen ESRDh achieved steroid responses not different than healthy volunteers; four had primary adrenal insufficiency; six had secondary adrenal insufficiency; nine had selective hypoaldosteronism and sixteen secondary hyperaldosteronism. The years on dialysis did not differ among subgroups. ROC analysis defined the following cut-offs for basal cortisol to predict adrenal insufficiency: in serum ⩽232.0nM (sensitivity (S) 100.0% and specificity (E) 90.0%); in saliva ⩽4.4nM (100.0% S and E). Basal aldosterone cut-off values to predict hyperaldosteronism were: in serum >500.0pM and saliva >60.0pM (100.0% S and E, for both). For the prediction of hypoaldosteronism the basal serum aldosterone was ⩽260.0pM (100% S; 53% E) and in saliva it was ⩽20.1pM (100% S; 58.5% E). Three patients with primary adrenal insufficiency and six with secondary adrenal insufficiency improved general clinical condition and normalized BP on steroids. One patient died before initiation of steroid therapy. CONCLUSION: Adrenal function should be assessed in ESRDh in order to unmask adrenal insufficient states.

Esperanza y Vida: a culturally and linguistically customized breast and cervical education program for diverse Latinas at three different United States sites.

Breast cancer is the most common cause of cancer and the leading cause of cancer death among Latinas in the United States. In addition, Latinas experience a disproportionate burden of cervical cancer incidence, morbidity, and mortality compared with non-Hispanic White women. Lower use of breast and cervical cancer screening services may contribute to these disparities. To address the underutilization of breast and cervical cancer screening among diverse subgroups of Latinas, a peer-led education program called Esperanza y Vida ("Hope and Life") was developed and administered at 3 sites (2 in New York and 1 in Arkansas). Immigrant Latina women and their partners were educated about the importance of breast and cervical cancer screening, with the goals of increasing their knowledge about these cancers and their screening behavior. An analysis of the intervention's findings at baseline among female participants demonstrated significant sociodemographic, interpersonal, cultural, health care system, and program variability in 3 distinct geographic regions in the United States. These data indicate the need for and feasibility of customizing cancer outreach and educational programs for diverse Latina subgroups living in various U.S. regions, with implications for informing the expansion and replication of the program in other regions of the country.

Salivary testosterone for the diagnosis of androgen deficiency in end-stage renal disease.

BACKGROUND: Hypogonadism is frequent in patients with end-stage renal disease (ESRD). Salivary testosterone (Sal-T) is a non-invasive tool to screen androgen deficiency in adult male with normal renal function. However, available data on its utility in ESRD are not conclusive. OBJECTIVES: The objectives of the study were: (i) to compare free testosterone fractions in saliva (SAL-T) and serum (Free-T); (ii) to establish the correlation of Sal-T with circulating total (TT) and bioavailable testosterone (Bio-T); (iii) to detect androgen deficiency through Sal-T; (iv) to determine the correlation of Sal-T with clinical parameters. METHODS: The study included: 60 adult ESRD men on haemodialysis (20-60 years old) with decreased libido referred from two dialysis centres; 112 eugonadic and 40 hypogonadic adult men with normal renal function as controls. Simultaneous morning saliva and serum samples were obtained for testosterone measurements by liquid RIA (SAL-T; TT). Free-T and Bio-T were calculated by the Vermeulen equation. RESULTS: Sal-T (0.338±0.177 nM) and Free-T (0.338±0.165 nM) did not differ (P>0.900) in ESRD as well as in control (0.337±0.182 and 0.337±0.172 nM, respectively; P>0.900). Sal-T levels correlated positively (P<0.0001) with Free-T (r=0.95), TT (r=0.80) and Bio-T (r=0.76) in ESRD. Sal-T negatively correlated with age and years on dialytic therapy. Sal-T showed 100% sensitivity and specificity to differentiate patients with androgen deficiency (22%) from those with normal androgen levels (78%). Hypogonadism was hypergonadotrophic in 69% cases and hypogonadotrophic in 31%. CONCLUSIONS: These data demonstrate the value of morning Sal-T testing as a non-invasive approach to screen androgen status in ESRD patients.

Poroleprieuria, a new xylariaceous genus from Mexico.

Poroleprieuria gen. nov. is described and illustrated to accommodate P. rogersii in the Xylariaceae, Xylariales. This ascomycete, known only from the type collection, is characterized by reniform, light brown, smooth ascospores with a germ pore; cylindrical, persistent asci lacking an apical apparatus, septate persistent paraphyses, and erumpent, erect, dark brown, fragile, subcylindrical stromata. The characteristics of this xylariaceous fungus were compared with those of some other ascomycetes having superficially similar cylindrical stromata or ascospores with germ pores.

Desarrollo de una metodología para la enseñanza de educación alimentaria-nutricional en el sistema formal de educación de adultos / Development of a methodology for teaching nutrition-feeding education in the formal system of adult education

El presente estudio fue realizado con el propósito principal de diseñar, desarrollar y evaluar una metodología de Educación Alimentaría-Nutricional aplicada al sistema formal de enseñanza de adultos; para el cual se seleccionaron dos escuelas nocturnas de la capital, con características semejantes en cuanto a magnitud de población escolar, índice de deserción y otros factores socioeconómicos. El estudio se realizó con 111 alumnos asistentes de la 111 etapa de la Escuela Nacional Nocturna J. Simeón Cañas y Villacocta y H. Abraham Cabrera; durante los meses de mayo a junio de 1982. El estudio comprendió un análisis comparativo de una metodología experimental consistente en la combinación de técnicas modernas de enseñanza y una metodología control, caracterizada esta última por el uso de técnicas de enseñanza de tipo tradicional en las escuelas. Para la recolección de los datos se elaboraron siete instrumentos de registro con los cuales se logró establecer el perfil del educando, el nivel de conocimientos sobre Nutrición-Alimentación de maestros y alumnos, el modelo metodológico, la evaluación de las actividades educativas y el costo de la actividad. En el análisis estadístico de los resultados se aplicaron las pruebas de "Ji cuadrado y Probabilidad Exacta de Fisher", para determinar la existencia de diferencia estadísticamente significativa entre las variables de los sujetos de estudio. Se aplicó la prueba de análisis de varianza, para determinar la existencia de interacción entre los factores de variación y el Método de Compraciones Múltiples de Scheffé para determinar la diferencia significativa entre las variables que presentaron interacciones