Low glomerular filtration rate values are associated with higher TSH in an elderly population at high cardiovascular disease risk.

Background: Hypothyroidism is associated with impaired glomerular filtration rate (GFR), a recognized cardiovascular disease (CVD), and mortality risk factor. In older adults, this association remains unexplored. We aimed to determine the relationship of elevated TSH with GFR in an elderly population at high CVD risk. Methods: Older adults (age>65ys) with high CVD risk defined by two or more CVD risk factors: smoking (S), high blood pressure (HBP), high total cholesterol, low HDL cholesterol, diabetes (DM), metabolic syndrome or previous cardiovascular event, were prospectively included at our ambulatory Endocrine Clinic. Patients under levothyroxine or thyroid disease were excluded. TSH> 6mU/l defined subclinical hypothyroidism (ScH) with normal free T4 levels. Estimated GFR was calculated by the Berlin-Initiative Study (BIS)-1 formula for elderly population. Urinary albumin to creatinine ratio (uACR), IL-6 and TNF-α, and Carotid intima-media thickness (CIMT) were also determined. The U Mann-Whitney test, the Spearman test, and multiple linear regression were used as statistical tests. Results: Finally 246 patients (68% females) were included and 20 (8%) had ScH. This group, was older (median, Q1-Q3: 77,72-78; 72,68-77 years, p=0.01) and DM was less frequent than in the euthyroid group (35 vs 58%, p=0.039). Lower fasting glucose (-20%,p=0.01), GFR (-14%,p=0.01) and freeT4 (-10%,p<0.001) were found compared to euthyroid patients. A higher prevalence of Kidney failure was found in ScH (80 vs. 46%, p=0.003) vs. euthyroid individuals. Significant correlations with GFR were detected: age (r-0.482,p<0.001), TSH (r-0.172,p=0.004), IL-6 (r-0.150,p=0.047), TNF-α (r-0.274,p<0.001), uACR (r-0.170,p=0.009) and CIMT(r-0.189,p=0.004). By multiple linear regression, in a model adjusted by age, sex, BMI, uACR, S, DM, TNF-α and HBP, TSH (Bst -0.14, p=0.023, R2 = 0.25) was found an independent predictor of GFR. Conclusion: In older adults with high CVD risk, ScH is associated with lower renal function, and this relationship is present regardless of other cardiometabolic risk factors. These results suggest that ScH could contribute to low GFR and excess CVD risk, although this hypothesis should be addressed in longitudinal studies.

Intervenção educativa em saúde para idosas à cerca do exame Papanicolau / Educational intervention in health for the elderly about the Pap smear

A educação em saúde é uma estratégia de empoderamento das pessoas para o cuidado com a saúde e que deve continuar sendo praticada por todos os trabalhadores nos vários espaços de relação interpessoal. Tal prática deve permear as ações de prevenção e detecção precoce do câncer de colo uterino em todas as mulheres. Especialmente, como intervenção educacional para idosas na perspectiva de adesão e realização do exame de Papanicolaou acima de 60 anos, que muitas vezes não possuem acesso a informações sobre o exame e sua relevância ou até pela falta de interesse quando não se tem mais um companheiro e pelo entendimento de que viúvas ou que não tem mais vida sexual não estão susceptíveis ao câncer de colo de útero. Afirma-se a positividade da intervenção educativa com atendimento ao objetivo proposto, tornando essencial a manutenção dessa prática, para que as mulheres possam entender cada vez mais que o exame tem aspecto preventivo. A partir desse entendimento, possam multiplicar as informações e outras mulheres aderirem a realização do exame por meio da educação em saúde realizada por todos os profissionais da saúde

Particle-size distribution (PSD) of pulverized hair: A quantitative approach of milling efficiency and its correlation with drug extraction efficiency.

Different types of hair were submitted to different milling procedures and their resulting powders were analyzed by scanning electron microscopy (SEM) and laser diffraction (LD). SEM results were qualitative whereas LD results were quantitative and accurately characterized the hair powders through their particle size distribution (PSD). Different types of hair were submitted to an optimized milling conditions and their PSD was quite similar. A good correlation was obtained between PSD results and ketamine concentration in a hair sample analyzed by LC-MS/MS. Hair samples were frozen in liquid nitrogen for 5min and pulverized at 25Hz for 10min, resulting in 61% of particles <104µm and 39% from 104 to 1000µm. Doing so, a 359% increment on ketamine concentration was obtained for an authentic sample extracted after pulverization comparing with the same sample cut in 1mm fragments. When milling time was extended to 25min, >90% of particles were <60µm and an additional increment of 52.4% in ketamine content was obtained. PSD is a key feature on analysis of pulverized hair as it can affect the method recovery and reproducibility. In addition, PSD is an important issue on sample retesting and quality control procedures.

Validation of a SPE-LC-MS/MS method for the determination of ketamine and norketamine in micropulverized hair after a single IV dose.

A SPE-LC-MS/MS method for the determination of ketamine (KET) and norketamine (NKET) was developed and validated. Extensive pulverization (25min at 25Hz) of previously cooled samples (5min in liquid nitrogen) allowed for extraction in a phosphate buffer (pH 6) solution after 10min vortex agitation at room temperature, simplifying the coupling of the extraction to an effective mixed-mode SPE (solid phase extraction) clean-up procedure. The extraction optimization was performed with samples fortified by drug incorporation according to a published procedure involving incubation of blank matrices for 16days. The method was validated for selectivity, matrix effect, linearity, LLQ (lower limit of quantification), precision, accuracy, recovery, carryover and stability after preparation and has proven to be accurate and reliable within a range of 0.02-10ng/mg for KET and 0.04-4ng/mg for NKET, meeting proposed KET cutoffs for discrimination from chronic use. In addition, the method was sensitive enough to detect the drugs after unique small (1mg/kg) intravenous doses received by patients submitted to general anesthesia before surgical procedures. Ketamine levels varied from 0.060 to 0.111ng/mg and norketamine was positive (

Association between worse metabolic control and increased thyroid volume and nodular disease in elderly adults with metabolic syndrome.

BACKGROUND: Metabolic syndrome has been associated with nodular goiter. Our aim was to evaluate which metabolic parameters in elderly patients with metabolic syndrome are associated with thyroid enlargement or increased prevalence of thyroid nodules. METHODS: In this cross-sectional study, 77 patients >65 years of age with metabolic syndrome were included. We evaluated the presence of thyroid nodules and thyroid volume by ultrasonography and several biochemical, metabolic and anthropometric parameters. Only patients with thyrotropin (thyroid-stimulating hormone, TSH) levels between 0.3 and 6 mU/L were included. We further divided subjects into two groups-type 2 diabetes mellitus (T2DM) and non-T2DM and established comparisons between them. RESULTS: Among all parameters analyzed we found a significant correlation between glycated hemoglobin (HbA1c) and volume (r=0.261, P=0.027) or number of nodules (r=0.266, P=0.023). Neither sex, age, body mass index (BMI), metformin, nor levothyroxine use were associated with thyroid volume or nodularity. Within the whole cohort, those patients with T2DM had larger thyroid volumes compared to non-T2DM [median (confidence interval, CI) 6.976 (5.220-10.789) vs. 5.034 (3.796-6.034) mL, P<0.008). Furthermore, a larger proportion of T2DM patients presented thyroid volumes >5.8 mL [69 vs. 23%, P<0.001; odds ratio=7.25 (CI 2.04-25.56)]. CONCLUSIONS: In elderly patients with metabolic syndrome, worse metabolic control, represented by higher HbA1c levels, was found associated to increased prevalence of thyroid nodules and larger thyroid volume. Moreover, within the whole metabolic syndrome group, patients with T2DM had the largest thyroid volumes.

Treatment of endometriosis with local acetylsalicylic acid injection: experimental study in rabbits.

The objective of the present study was to estimate the effects of introduction of acetylsalicylic acid solution into peritoneal implants in autologous endometrium as a method for treating endometriosis. Forty adult female rabbits were subdivided into 4 groups of 10 rabbits each, and endometriosis was induced via autotransplantation of endometrial fragments into the peritoneal cavity. At 30 days after induction of endometriosis, all animals were randomly assigned to 1 of 2 protocols. In protocol 1, animals were evaluated at 24 hours after treatment; group 1 (control) received physiologic solution, and group 2 received acetylsalicylic acid. In protocol 2, animals were evaluated at 10 days after treatment, group 3 (control) and group 4 received acetylsalicylic acid. After measuring the lesion, the endometriotic focus was removed and prepared for mounting on slides for histologic analysis. Imaging software was used for analysis of the total remaining area of endometrial tissue. The affected area in acetylsalicylic acid-treated animals was smaller than that in control animals at 24 hours and 10 days after treatment; a significant difference was found between control and treated groups (p < .001). Statistical analysis comparing protocols 1 and 2 demonstrated no differences between controls groups or acetylsalicylic acid groups (p = .30), and no differences between times (p = .75). Acetylsalicylic acid solution led to less growth (or higher involution) of endometrial implants. Acetylsalicylic acid injected directly into endometriotic foci was effective in their destruction. This presents new perspectives for treatment of endometriosis and for clinical applications based on further clinical studies.

Estado nutricional de adolescentes atendidos em uma unidade de referência para adolescentes no município de Cascavel, estado do Paraná, Brasil / The nutritional status of adolescents assisted by an adolescent health center in the Municipality of Cascavel, State of Parana, Brazil

Objetivo: verificar a prevalência de sobrepeso e obesidade em adolescentes atendidos em unidade de saúde de referência para adolescentes, bem como sua associação com idade e sexo. Metodologia: estudo transversal com 383 adolescentes de dez a 19 anos de idade atendidos em unidade de referência no atendimento médico de adolescentes no Município de Cascavel, Estado do Paraná, Brasil. Utilizou-se o índice de massa corporal (IMC) de acordo com a idade e sexo, com os seguintes pontos de corte: IMC < percentil 5 (baixo peso); ≥ percentil 5 e < percentil 85 (adequado); ≥ percentil 85 e < percentil 95 (sobrepeso); e ≥ percentil 95 (obesidade). Utilizou-se o teste de qui-quadrado para verificar associação entre as variáveis. Resultados: dos adolescentes entrevistados, 15,4 por cento apresentaram sobrepeso e 7,6 por cento obesidade, totalizando excesso de peso em 23,0 por cento; encontrou-se significância estatística entre o estado nutricional e a faixa etária dos adolescentes, identificando maior proporção de sobrepeso/obesidade entre os mais jovens. Conclusão: a prevalência de sobrepeso e obesidade encontrada foi elevada, confirmando a magnitude do problema e a necessidade de ações preventivas.

Objective: this study aims to verify the prevalence of overweight and obesity in adolescents assisted by an adolescent health center, and its association with age and gender. Methodology: this cross-sectional study was carried out with 383 adolescents (aged 10 to 19 years) assisted by a referral unit for adolescent medical care in the Municipality of Cascavel, State of Paraná, Brazil; age- and gender- adjusted body mass index (BMI) was calculated with the following cut-off points: BMI < 5th percentile (underweight); ≥ 5th percentile and < 85th percentile (adequate); ≥85th percentile and < 95th percentile (overweight); and ≥95th percentile (obese); the chi-square test was used to verify the association between variables. Results: among the adolescents interviewed, 15.4 per cent were overweight and 7.6 per cent were obese, totaling 23.0 percent with excess weight; a statistically significant association between nutritional status and age was found, with a higher proportion of overweight/obesity among younger adolescents. Conclusion: the observed prevalence of overweight and obesity were high, confirming both the magnitude of the problem and the need for preventive action.

Low-level laser therapy in the prevention and treatment of chemotherapy-induced oral mucositis in young patients.

OBJECTIVE: A pilot clinical study was conducted to evaluate the efficacy and feasibility of low-level laser therapy (LLLT) in the prevention and treatment of chemotherapy (CT)-induced oral mucositis (OM) in young patients. BACKGROUND DATA: Besides compromising the patient's nutrition and well-being, oral mucositis represents a portal of entry into the body for microorganisms present in the mouth, which may lead to sepsis if there is hematological involvement. Oncologic treatment tolerance decreases and systemic complications may arise that interfere with the success of cancer treatment. LLLT appears to be an interesting alternative to other approaches to treating OM, due to its trophic, anti-inflammatory, and analgesic properties. MATERIALS AND METHODS: Patients undergoing chemotherapy (22 cycles) without mucositis were randomized into a group receiving prophylactic laser-irradiation (group 1), and a group receiving placebo light treatment (group 2). Patients who had already presented with mucositis were placed in a group receiving irradiation for therapeutic purposes (group 3, with 10 cycles of CT). Serum granulocyte levels were taken and compared to the progression of mucositis. RESULTS: In group 1, most patients (73%) presented with mucositis of grade 0 (p = 0.03 when compared with the placebo group), and 18% presented with grade 1. In group 2, 27% had no OM and did not require therapy. In group 3, the patients had marked pain relief (as assessed by a visual analogue scale), and a decrease in the severity of OM, even when they had severe granulocytopenia. CONCLUSION: The ease of use of LLLT, high patient acceptance, and the positive results achieved, make this therapy feasible for the prevention and treatment of OM in young patients.

Rhabdomyosarcoma of the oral tissues--two new cases and literature review.

Rhabdomyosarcoma (RMS) is a malignant soft tissue neoplasm consisting of cells derived from the primitive mesenchyme that exhibit a profound tendency to myogenesis. About 35% of RMS arises in the head and neck, being classified as parameningeal and non-orbital non-parameningeal forms. Parameningeal tumors carry the worst prognosis. The use of contemporary, multi-agent chemotherapy, radiotherapy, and surgery has made treatment of the disseminated disease possible, and has significantly improved overall survival from 25% in 1970 to 70% in 1991. Here, we present the management of two cases of orofacial RMS in adolescents: an 18-year-old, white female that had a 9-month history of a nodule in the left buccal mucosa, and a 19-year-old, white male who had been aware of a nodule in the left, posterior maxillary ridge with progressive growth for 4 months. Before final diagnosis, both cases were previously treated as inflammatory lesions. Their clinicopathological aspects, treatment, and poor survival as a consequence of delays in diagnosis are discussed.