Exposure to environment chemicals and its possible role in endocrine disruption of children from a rural area.

Endocrine disrupting chemicals (EDCs), including pesticides and metals, are present in rural areas, endangering the health of exposed populations. This work aimed to investigate the possible association between the exposure to these xenobiotics and thyroid dysfunction in children living in a rural community of Southern Brazil. Fifty-four children aged 5-16 years participated in this study. Peripheral biomarker evaluations were performed in periods of low and high exposure to pesticides. Thyroid ultrasonography was evaluated in the high exposure period. Blood levels of chromium (Cr), manganese (Mn), mercury (Hg), and lead (Pb), as well as hair Pb levels were positively correlated with thyroid stimulating hormone (TSH) concentrations and negatively associated with free thyroxine (fT4) levels in the low exposure period. Prolactin was positively associated with hair Mn in both periods. In the ultrasound tests, the majority of children presented a normal echogenicity of thyroid. Glucose was inversely associated with the biomarker of exposure to cholinesterase inhibitor insecticides, butyrylcholinesterase (BuChE). Lipid profile was above the recommended levels in both periods. In summary, our results show that children environmentally exposed to a mixture of xenobiotics in an agricultural community may have health impairments, especially on thyroid function, dyslipidemia, and glucose homeostasis disruption.

Reliable Quantification of the Potential for Equations Based on Spot Urine Samples to Estimate Population Salt Intake: Protocol for a Systematic Review and Meta-Analysis.

BACKGROUND: Methods based on spot urine samples (a single sample at one time-point) have been identified as a possible alternative approach to 24-hour urine samples for determining mean population salt intake. OBJECTIVE: The aim of this study is to identify a reliable method for estimating mean population salt intake from spot urine samples. This will be done by comparing the performance of existing equations against one other and against estimates derived from 24-hour urine samples. The effects of factors such as ethnicity, sex, age, body mass index, antihypertensive drug use, health status, and timing of spot urine collection will be explored. The capacity of spot urine samples to measure change in salt intake over time will also be determined. Finally, we aim to develop a novel equation (or equations) that performs better than existing equations to estimate mean population salt intake. METHODS: A systematic review and meta-analysis of individual participant data will be conducted. A search has been conducted to identify human studies that report salt (or sodium) excretion based upon 24-hour urine samples and spot urine samples. There were no restrictions on language, study sample size, or characteristics of the study population. MEDLINE via OvidSP (1946-present), Premedline via OvidSP, EMBASE, Global Health via OvidSP (1910-present), and the Cochrane Library were searched, and two reviewers identified eligible studies. The authors of these studies will be invited to contribute data according to a standard format. Individual participant records will be compiled and a series of analyses will be completed to: (1) compare existing equations for estimating 24-hour salt intake from spot urine samples with 24-hour urine samples, and assess the degree of bias according to key demographic and clinical characteristics; (2) assess the reliability of using spot urine samples to measure population changes in salt intake overtime; and (3) develop a novel equation that performs better than existing equations to estimate mean population salt intake. RESULTS: The search strategy identified 538 records; 100 records were obtained for review in full text and 73 have been confirmed as eligible. In addition, 68 abstracts were identified, some of which may contain data eligible for inclusion. Individual participant data will be requested from the authors of eligible studies. CONCLUSIONS: Many equations for estimating salt intake from spot urine samples have been developed and validated, although most have been studied in very specific settings. This meta-analysis of individual participant data will enable a much broader understanding of the capacity for spot urine samples to estimate population salt intake.

Prevalence of low bone mineral density in adolescents and adults with cystic fibrosis.

OBJECTIVE: The aim of this cross-sectional study was to evaluate the prevalence of low bone mass density in cystic fibrosis patients as well as to evaluate the factors associated with bone mass in such patients. METHODS: Bone mass density was measured by dual-photon X-ray absorptiometry of lumbar spine (L1-L4), in patients ≤19 years old, or lumbar spine and femur (total and neck) in patients ≥20 years old. Evaluations of nutritional status, biochemical parameters, and lung function were performed. Medication data were obtained from medical records. RESULTS: Fifty-eight patients were included in the study (25 males/ 33 females), mean age 23.9 years (16-53 years). The prevalence of bone mass below the expected range for age at any site was 20.7%. None of the subjects had history of fracture. Lumbar spine Z-score in cystic fibrosis patients correlated positively with body mass index (r= 0.3, p=0.001), and forced expiratory volume in the first second (% predicted) (r=0.415, p=0.022). Mean lumbar spine Z-score was higher in women (p=0.001), in patients with no pancreatic insufficiency (p=0.032), and in patients with no hospitalization in the last 3 months (p=0.02). After multivariate analysis, body mass index (p= 0.001) and sex (p=0.001) were independently associated with Z-score in lumbar spine. CONCLUSION: Low bone mass is a frequent problem in patients with CF, being independently associated with body mass index, and male sex.

Prevalence of low bone mineral density in adolescents and adults with cystic fibrosis / Prevalência de densidade mineral óssea baixa em adolescentes e adultos com fibrose cística

Objective The aim of this cross-sectional study was to evaluate the prevalence of low bone mass density in cystic fibrosis patients as well as to evaluate the factors associated with bone mass in such patients. Methods Bone mass density was measured by dual-photon X-ray absorptiometry of lumbar spine (L1-L4), in patients ≤19 years old, or lumbar spine and femur (total and neck) in patients ≥20 years old. Evaluations of nutritional status, biochemical parameters, and lung function were performed. Medication data were obtained from medical records. Results Fifty-eight patients were included in the study (25 males/ 33 females), mean age 23.9 years (16-53years). The prevalence of bone mass below the expected range for age at any site was 20.7%. None of the subjects had history of fracture. Lumbar spine Z-score in cystic fibrosis patients correlated positively with body mass index (r= 0.3, p=0.001), and forced expiratory volume in the first second (% predicted) (r=0.415, p=0.022). Mean lumbar spine Z-score was higher in women (p=0.001), in patients with no pancreatic insufficiency (p=0.032), and in patients with no hospitalization in the last 3 months (p=0.02). After multivariate analysis, body mass index (p= 0.001) and sex (p=0.001) were independently associated with Z-score in lumbar spine. Conclusion Low bone mass is a frequent problem in patients with CF, being independently associated with body mass index, and male sex. .

Objetivo Determinar a prevalência de massa óssea baixa em pacientes adolescentes e adultos com fibrose cística e estudar os fatores potencialmente associados. Métodos Densidade mineral óssea foi determinada por absorciometria por dupla emissão de raios X na coluna lombar em pacientes ≤ 19 anos e na coluna e no fêmur em pacientes ≥ 20 anos. Avaliações nutricionais, bioquímicas e pulmonares foram realizadas. Dados referentes ao tratamento farmacológico foram coletados. Resultados 58 pacientes foram incluídos no estudo (25 homens/33 mulheres), média de idade de 23,9 anos (16-53). Massa óssea abaixo da esperada foi verificada em 20,7% dos pacientes. Não houve histórico de fratura. Z-score da coluna lombar associou-se positivamente com índice de massa corporal (r=0,3; p=0,022), volume expiratório forçado (% previsto) (r=0,415; p=0,001). A média do Z-score da coluna foi mais alta nas mulheres que nos homens (p=0,001), em pacientes que não possuíam insuficiência pancreática (p=0,02) e em pacientes que não haviam sido hospitalizados nos últimos três meses (p=0,032). Os fatores encontrados como preditores independentes de Z-score da coluna lombar foram sexo masculino (p=0,001) e índice de massa corporal (p=0,001). Conclusão Massa óssea baixa é frequente em pacientes com FC, estando associada independentemente com índice de massa corporal e sexo masculino. .

Association of busulfan and cyclophosphamide conditioning with sleep disorders after hematopoietic stem cell transplantation.

New indications and conditioning regimens for hematopoietic stem cell transplantation (HSCT) have emerged in the last 10 years. Previous studies have shown the association of HSCT with late effects such as sleep disorders. The aim of this study was to determine the prevalence and factors associated with sleep disorders following HSCT in a population considering these new trends. Sixty-one individuals 1-10 years after allogeneic HSCT were surveyed using the DSM-IV-TR criteria for sleep disorders. Factors related to conditioning and graft-versus-host disease were collected from medical records. A prevalence of sleep disorders of 26.2% was found. Busulfan-cyclophosphamide conditioning was an independent risk factor in a multivariate analysis (relative risk, RR: 3.74, 95% CI: 1.1-12.6; p = 0.03), which also included sex (RR: 2.37, 95% CI: 1.0-5.7; p = 0.05) and age (RR: 1.03, 95% CI: 0.99-1.07; p = 0.11). Sleep disorders were frequent following HSCT. Patients who were treated with busulfan-cyclophosphamide had a higher risk of developing this complication. Female sex was also possibly a risk factor.

The effect of a single dose versus a daily dose of cholecalciferol on the serum 25-hydroxycholecalciferol and parathyroid hormone levels in the elderly with secondary hyperparathyroidism living in a low-income housing unit.

We designed a randomized, double-blind, controlled clinical trial to compare the effect of two regimens for administering cholecalciferol on the serum 25-hydroxycholecalciferol [25(OH)D] levels and in the reversion of secondary hyperparathyroidism in the elderly living in a low-income housing unit in the city of Porto Alegre, southern Brazil. We studied 28 individuals ranging in age from 65 to 102 years with serum parathyroid hormone (PTH) levels greater than 48 pg/ml and normal or reduced serum calcium levels. Subjects were randomized to receive oral cholecalciferol, as a single dose of 300 000 IU (group 1) or 800 IU (group 2) daily for 9 months. Both groups received 1250 mg calcium carbonate per day. Serum 25(OH)D and PTH levels were measured at baseline and after 1, 2, 3, 6, and 9 months. Serum 25(OH)D levels in group 1 were significantly higher than in group 2 during the study (P < 0.001). After 1 (P < 0.001) and 2 (P < 0.04) months of treatment, mean serum 25(OH)D levels were higher in group 1. The number of subjects who reached serum 25(OH)D levels >/=20 ng/dl was higher in group 1, after the first (P < 0.001) and third (P = 0.008) months. In the short term, a single 300 000 IU oral dose of vitamin D(3) was more effective than 800 IU per day to increase serum 25(OH)D levels in elderly persons, living in a low-income housing unit, who were taking 500 mg elementary calcium supplement per day.

Urinary iodine in 24 h is associated with natriuresis and is better reflected by an afternoon sample.

AIMS: We aimed to assess the extent of variability in urinary iodine (UI) within a day, to determine the period of the day when UI was better associated with the UI in 24 h, and to study the relationship between UI and urinary sodium. METHODS: This cross-sectional study included 60 volunteers. Four urine samples were collected from each participant (A: from breakfast to lunch; B: from lunch to dinner; C: from dinner to bedtime, and D: from bedtime to breakfast) and were compared with the 24-hour sample (calculated from samples A-D ). UI, creatinine and Na(+) levels were measured in the partial samples and in the 24-hour sample. RESULTS: The content of iodine and sodium in urine varied during the day (p < 0.001). The UI concentration from lunch to dinner was closest to the 24-hour UI concentration using the method of Bland and Altman. There were correlations between the UI content in the different periods of the day and in 24 h: A (r = 0.54; p < 0.000), B (r = 0.78; p < 0.000), C (r = 0.37; p = 0.004) and D (r = 0.77; p < 0.000). UI and urinary sodium content were strongly correlated in all periods of the day (samples A and B: r = 0.69, p < 0.000; sample C: r = 0.85, p < 0.000, and sample D: r = 0.78, p < 0.000). CONCLUSIONS: There was a within-day variation in UI content, which was strongly associated with urinary sodium content. Iodine concentration in the afternoon urine sample better reflected the 24-hour UI concentration. Therefore, urine collected in the afternoon is probably the best to evaluate iodine sufficiency in subjects with similar dietary habits.

High prevalence of hypovitaminosis D and secondary hyperparathyroidism in elders living in nonprofit homes in South Brazil.

OBJECTIVES: Hypovitaminosis D (HD) and secondary hyperparathyroidism (SHP) are common in elders, and many factors could contribute to them. The objectives of this study were to estimate the prevalence of HD, SHP, and its associated factors, in individuals living in nonprofit homes for elders in south Brazil. Design Cross-sectional study. METHODS: Serum 25-hydroxyvitamin D 25(OH)D, intact parathyroid hormone (PTH), total calcium, phosphorus, alkaline phosphatase, magnesium, creatinine, and albumin levels were measured in late spring, November, 2005. The presence of factors potentially related with HD and SHP-age, sex, weight, height, skin phototype, sun exposure, exercise, smoking, use of < or = 5 medications or diuretics or alcohol, and daily calcium ingestion. RESULTS: 102 subjects age 77.8 +/- 9.0 were included in the study. HD was found in 85.7% and SHP in 53% of the subjects. The estimated daily calcium ingestion was 720 mg. There was no association between serum 25(OH)D levels and any of the risk factors evaluated. Serum 25(OH)D levels were correlated with serum PTH (r = -0.358, P = 0.000), calcium (r = 0.306, P = 0.002), and albumin (r = 0.253, P = 0.011) levels. In univariate analysis, SHP was positively associated with age (P = 0.006), and female sex (0.007); and negatively associated with sunlight exposure (P = 0.020), GFR (P = 0.000), Ln25(OH)D (P = 0.002), and total serum calcium (P = 0.024). After multivariate model adjustment, age [OR 1.09 (CI 1.01-1.18); P = 0.024], Ln25(OH)D [OR 0.92 (CI 0.08-0.74); P = 0.013], GFR [OR 0.96 (CI 0.92-0.99); P = 0.013], and hydrochlorothiazide treatment [OR 7.63 (CI 1.67-34.9); P = 0.008] were independently associated with SHP. CONCLUSIONS: HD and SHP are highly prevalent in elders living in old-age homes. No associations were established between common risk factors and low serum levels of 25(OH)D levels; however, SHP was independently related with age, 25(OH)D, GFR, and hydrochlorothiazide use.

Mulher branca, 45 anos, consulta por diarréia crônica, emagrecimento e anemia ferropênica / 45-year-old, white woman presents with chronic diarrhea, weight loss and iron deficiency anemia

Em novembro de 1996, uma mulher branca de 45 anos veio à consulta por diarréia aquosa e emagrecimento acentuado. Negava tabagismo e alcoolismo. Ao exame físico, apresentava mucosas hipocoradas e emagrecimento. Trazia consigo o laudo de uma endoscopia digestiva alta considerada normal e de uma colonoscopia com descrição de cólon espástico. Os exames mostraram, no soro: glicose, 74 mg/dL; uréia, 13 mg/dL; creatinina, 0,4 mg/dL; sódio, 137 mEq/L; e potássio, 4,3 mEq/L. A pesquisa de leucócitos fecais e o parasitológico de fezes foram negativos (três amostras). Foi iniciado sulfato ferroso via oral. A reavaliação, em fevereiro de 1997, mostrou os exames contidos na tabela 1, além de: alanina aminotransferase (ALT), 57 UI/L (3-17); aspartato aminotransferase (AST), 62 UI/L (9-36); bilirrubinas e provas de coagulação normais. Foi iniciada a suplementação de ácido fólico. Como havia queixa de menorragia, a paciente foi avaliada por ginecologista, que indicou reposição hormonal. Em abril de 1998, a paciente persistia com queixa de menorragia e emagrecimento. Foi submetida a nova endoscopia digestiva alta, que evidenciou algumas erosões com fibrina, no antro, e mucosa de bulbo duodenal com aspecto ladrilhado

Low-dose adrenocorticotropin test in patients with the Acquired Immunodeficiency Syndrome

Adrenocortical insufficiency is a serious complication of AIDS. Usually, integrity of the hypothalamo-pituitary-adrenal (HPA) axis in AIDS patients is assessed by measuring basal cortisol levels and cortisol response to 250 µg of ACTH. Recent studies suggest that a lower ACTH dose increases the sensitivity of the procedure. In the present study, we investigated the prevalence of adrenal hypofunction in AIDS patients using a low-dose ACTH test (1 µg), evaluated the clinical characteristics that might suggeest this diagnosis, and the diseases and/or drugs that could be associated with it. We prospectively evaluated 63 very ill AIDS patients and 16 normal controls. A standard examination assessed the presence of signs and symptoms of adrenal insufficiency. Blood samples were colleted before and 30 and 40 minutes after an injection of 1 µg 1-24 ACTH. No opportunistic disease, signs, symptoms or drugs were associated with an abnormal cortisol response to ACTH. The lowest stimulated cortisol level in the contol group was 18.5 µg/dL; cortisol level (greather or equal) 18 µg/dL were taken to indicate a normal HPA axis. Test results revealed that 12/63 AIDS patients (19 percent) had an abnormal HPA axis. With these data in mind, we suggest a prospective adrenal function evaluation of all severely ill AIDS patients.

Síndrome hiperosmolar hiperglicêmica näo-cetótica: experiência clínica, laboratorial e terapêutica / Non ketotic hyperglicemic hyperosmolar syndrome: clinical, laboratorial and therapeutics experience

Os autores analisam os aspectos clínicos e laboratoriais de 15 pacientes portadores de Síndrome Hiperosmolar Hiperglicêmica Näo-Cetótica e os resultados de um protocolo de tratamento que consistia basicamente na infusäo de endovenosa de insulina e na reposiçäo hidrossalina, inicialmente com soluçäo de NaCl a 0,9% e posteriormente de soluçäo de glicose a 5%. Observaram que esta entidade ocorreu mais freqüentemente nas mulheres (4:1) e em pacientes com diabete melito näo-dependente de insulina (tipo II). Apenas 27% dos pacientes se encontravam em coma e näo apresentavam características clínicas e laboratoriais que os distinguissem daqueles com graus menos severos de comprometimento da consciência. Näo foram relatadas complicaçöes comumente associadas aos estados hiperosmolares, e a mortalidade foi relativamente baixa (20%). Concluem que o esquema terapêutico é eficaz e seguro