Astronomical tuning of the Aptian stage and its implications for age recalibrations and paleoclimatic events.

The Aptian was characterized by dramatic tectonic, oceanographic, climatic and biotic changes and its record is punctuated by Oceanic Anoxic Events (OAEs). The timing and duration of these events are still contentious, particularly the age of the Barremian-Aptian boundary. This study presents a cyclostratigraphic evaluation of a high-resolution multiproxy dataset (δ13C, δ18O, MS and ARM) from the Poggio le Guaine core. The identification of Milankovitch-band imprints allowed us to construct a 405-kyr astronomically-tuned age model that provides new constraints for the Aptian climato-chronostratigraphic framework. Based on the astronomical tuning, we propose: (i) a timespan of ~7.2 Myr for the Aptian; (ii) a timespan of ~420 kyr for the magnetic polarity Chron M0r and an age of ~120.2 Ma for the Barremian-Aptian boundary; and (iii) new age constraints on the onset and duration of Aptian OAEs and the 'cold snap'. The new framework significantly impacts the Early Cretaceous geological timescale.

Using trend arrows in continuous glucose monitoring systems for insulin adjustment in clinical practice: Brazilian Diabetes Society Position Statement.

This manuscript reports the Brazilian Diabetes Society Position Statement for insulin adjustments based on trend arrows observed in continuous glucose monitoring systems. The Brazilian Diabetes Society supports the utilization of trend arrows for insulin dose adjustments in patients with diabetes on basal-bolus insulin therapy, both with multiple daily insulin doses or insulin pumps without closed-loop features. For those on insulin pumps with predictive low-glucose suspend feature, we suggest that only upward trend arrows should be used for adjustments. In this paper, tables for insulin adjustment based on sensitivity factors are provided and strategies to optimize the use of trend arrows in clinical practice are discussed.

[Importance of percutaneous venous catheterization in the identification of the origin of hyperandrogenism]. / Importância do cateterismo venoso percutâneo na identificação da origem do hiperandrogenismo.

Selective percutaneous venous catheterization (SPVC) was performed to ascertain the source of androgen excess (AE) in 3 virilized women (12, 50 and 58y) in whom hormonal and radiologic investigation (ultrasonography and computerized tomography) was inconclusive. In all cases, elevated testosterone levels remained unsuppressed with dexamethasone, but were adequately suppressed by normal basal DHEA-S and cortisol. SPVC for T and F determinations (and the T/F ratio) were performed before surgery in all cases and during surgery in case 3. A T/F ratio of 152.4 and 71.8 (with an ovary-peripheral vein gradient [OPG] of 637 and 1173 ng/dl) identified the right and left ovary as the source of androgen excess respectively in cases 1 and 2, whereas the T/F ratio (87.4 and 97.2) and OPG (749 and 1162 ng/dl) were increased in both ovaries in patient 3. Thus, lateralization was evident in cases 1 (R ovary Leydig cell tumor) and 2 (L ovary hemangioma and stromal luteinization) whereas bilateral production in case 3 was confirmed by biopsy (PCO). Pre-operative identification of the origin of AE by SPVC is essential in defining proper treatment for patients suspected of harboring a neoplasia. Because it is not widely available nor devoid of complications, SPVC should only be indicated in hirsute/virilized women whose basal plasma testosterone and DHEA-S levels are in the tumoral range, i.e. higher than 150 ng/dl and 700 micrograms/dl, respectively.

Hepatite tóxica causada por ketoconazol: relato de quatro casos / Ketoconazole causing toxic hepatitis: report of 4 cases

Säo descritos quatro casos de hepatite tóxica por ketoconazol. Todas eram mulheres e tomavam a droga de oito a 16 semanas (200mg/dia). O quadro clínico, em todas, foi superponível ao de uma hepatite viral. A normalizaçäo clínico-laboratorial ocorreu entre 60 e 90 dias após a suspensäo da droga, näo tendo havido óbito. Em uma das pacientes, o ketoconazol foi reintroduzido após normalizaçäo clínico-laboratorial, tendo ocorrido nova hepatite tóxica após 15 dias; a segunda suspensäo da droga foi seguida de cura da hepatite

[Toxic hepatitis caused by ketoconazole: a report of 4 cases]. / Hepatite tóxica causada por ketoconazol: relato de quatro casos.

The authors describe four cases of toxic hepatitis due to ketoconazole. All patients were female and were given the drug from 8 to 16 weeks (200mg/day). The clinical condition of the four patients was similar to that of viral hepatitis. Normalization of clinical and laboratory findings occurred 60 to 90 days after discontinuation of the drug and no patient died. One patient received ketoconazole again after her clinical and laboratory results were normalized, and a new toxic hepatitis appeared within 15 days; the second discontinuation of the drug lead to cure of the hepatitis.