Gender Dysphoria: Concepts, Diagnosis and Clinical Management.

Gender dysphoria is defined as a condition characterized by mental suffering associated with the incongruence between one's experienced gender and their birth-assigned sex. Gender as a construct and gender dysphoria as a condition in need of multidisciplinary intervention have developed as swiftly as their visibility in society, making it mandatory to promote the literacy and education of all healthcare professionals in this area. This article aims to review information based on scientific evidence on people with gender dysphoria and its clinical approach, while contributing to a safe, inclusive, and non-discriminatory practice of healthcare.

Female sexual dysfunction in an outpatient andrology clinic-A therapeutic opportunity?

INTRODUCTION: The sexual life of a couple is a dynamic entity, in which the two influence each other mutually, thus the existence of female sexual dysfunction (FSD) can influence the treatment of the man who seeks clinical help. Identify sexual dysfunction in female partners of patients attending an andrology clinic may provide a therapeutic opportunity. The authors aim to assess proportion of FSD in this population by comparison with a control group. MATERIAL AND METHODS: A longitudinal study over 12 months timespan. The female partners of patients attending the andrology clinic participating in the study (study group - SG) completed the Female Sexual Function Index (FSFI), as did the women serving as controls (control group - CG). Further data such as age, duration and quality of the relationship and previous relationships was also collected. RESULTS: Of the 30 women included in the SG, 14 (46.6%) considered that their current sex life was worse than in previous relationships. Of the 20 women in the CG, 60% considered that their current sex life was better. In the SG, 22 (73.3%) had FSD, with a mean score in the FSFI of 20.5, whereas only 3 women in the CG (15%) had FSD, with a mean score of 30.7 (p<0.01). CONCLUSIONS: Our study demonstrated that the proportion of FSD in female partners of patients attending an andrology clinic is significantly higher than control group. FSD treatment should be considered as a therapeutic opportunity for the couple in this setting.

Construção e validação de uma Escala de Avaliação de Informação Pré-Operatória / Development and validation of a Preoperative Information Assessment Scale / Construcción y validación de una Escala de Evaluación de la Información Preoperatoria

Enquadramento: A transmissão de informações no pré-operatório é uma estratégia adotada pelos enfermeiros para controlar os níveis de ansiedade da pessoa que será submetida a cirurgia programada. Uma ferramenta que avalie essa informação contribui para a melhoria da qualidade dos cuidados de enfermagem. Objetivos: Construir e validar uma escala para avaliação da informação pré-operatória. Metodologia: Estudo psicométrico. Foi desenvolvida uma lista de 15 itens com base na revisão da literatura e experiência dos investigadores, na forma de escala tipo likert, aplicada a 200 pessoas no pré-operatório de cirurgia programada. A validade de construto foi estudada pela análise fatorial exploratória, método dos componentes principais, rotação varimax, tipo ortogonal. Resultados: O valor dos testes de Kaiser-Meyer-Olkin e de esfericidade de Bartlett confirmam a adequabilidade do modelo e a prossecução com a análise fatorial exploratória, extraindo-se dois fatores que explicam 53,48% da variância total. O alfa de Cronbach global foi de 0,903. Conclusão: A versão final da escala apresenta boas propriedades psicométricas, permitindo avaliar a perceção da pessoa acerca da informação que possui.

Background: Preoperative information provision is a strategy used by nurses to control elective surgical patients' anxiety levels. A tool for assessing this information will improve the quality of nursing care. Objective: To develop and validate a preoperative information assessment scale. Methodology: Psychometric study. A Likert-type 15-item scale was developed based on a literature review and the researchers' experience. The scale was applied to 200 patients undergoing elective surgery in the preoperative period. Construct validity was assessed through exploratory factor analysis, principal components method, Varimax orthogonal rotation. Results: The KMO measure (0.92) and Bartlett's test of sphericity confirm the model's suitability. Two factors were extracted with the exploratory factor analysis, explaining 53.48% of the total variance. Cronbach's alpha for the total scale was 0.903. Conclusion: The final version of the scale has good psychometric properties and allows assessing the patient's perception of the information received.

Marco contextual: La transmisión de información en el preoperatorio es una estrategia adoptada por los enfermeros para controlar los niveles de ansiedad de la persona que se someterá a una cirugía programada. Una herramienta que evalúa esta información contribuye a mejorar la calidad de la atención de enfermería. Objetivos: Construir y validar una escala para evaluar la información preoperatoria. Metodología: Estudio psicométrico. Se elaboró una lista de 15 ítems, basada en la revisión de la literatura y la experiencia de los investigadores, como una escala de tipo Likert, y se aplicó a 200 personas en el período preoperatorio de una cirugía programada. La validez de constructo se estudió mediante el análisis factorial exploratorio, el método de componentes principales, la rotación varimax, el tipo ortogonal. Resultados: El valor de la prueba de Kaiser-Meyer-Olkin y de esfericidad de Bartlett confirman la adecuación del modelo y la continuación con el análisis factorial exploratorio, extrayendo dos factores que explican el 53,48% de la varianza total. El alfa de Cronbach global fue de 0,903. Conclusión: La versión final de la escala tiene buenas propiedades psicométricas, lo que permite evaluar la percepción de la información que tiene la persona.

Development of an autonomous biosampler to capture in situ aquatic microbiomes.

The importance of planktonic microbial communities is well acknowledged, since they are fundamental for several natural processes of aquatic ecosystems. Microorganisms naturally control the flux of nutrients, and also degrade and recycle anthropogenic organic and inorganic contaminants. Nevertheless, climate change effects and/or the runoff of nutrients/pollutants can affect the equilibrium of natural microbial communities influencing the occurrence of microbial pathogens and/or microbial toxin producers, which can compromise ecosystem environmental status. Therefore, improved microbial plankton monitoring is essential to better understand how these communities respond to environmental shifts. The study of marine microbial communities typically involves highly cost and time-consuming sampling procedures, which can limit the frequency of sampling and data availability. In this context, we developed and validated an in situ autonomous biosampler (IS-ABS) able to collect/concentrate in situ planktonic communities of different size fractions (targeting prokaryotes and unicellular eukaryotes) for posterior genomic, metagenomic, and/or transcriptomic analysis at a home laboratory. The IS-ABS field prototype is a small size and compact system able to operate up to 150 m depth. Water is pumped by a micropump (TCS MG2000) through a hydraulic circuit that allows in situ filtration of environmental water in one or more Sterivex filters placed in a filter cartridge. The IS-ABS also includes an application to program sampling definitions, allowing pre-setting configuration of the sampling. The efficiency of the IS-ABS was tested against traditional laboratory filtration standardized protocols. Results showed a good performance in terms of DNA recovery, as well as prokaryotic (16S rDNA) and eukaryotic (18S rDNA) community diversity analysis, using either methodologies. The IS-ABS automates the process of collecting environmental DNA, and is suitable for integration in water observation systems, what will contribute to substantially increase biological surveillances. Also, the use of highly sensitive genomic approaches allows a further study of the diversity and functions of whole or specific microbial communities.

Strategies for serum chemokine/cytokine assessment as biomarkers of therapeutic response in HCV patients as a prototype to monitor immunotherapy of infectious diseases.

In this study, strategies for serum biomarker assessment were developed for therapeutic monitoring of HCV patients. For this purpose, serum chemokine/cytokine levels were measured by cytometric-bead-array in HCV patients, categorized according to immunotherapy response as: non-responder/NR, relapser/REL and sustained-virologic-responder/SVR. The results demonstrated an overall increase of serum chemokine/cytokine levels in HCV patients. In general, therapeutic failure was associated with presence of a predominant baseline proinflammatory pattern with enhanced CCL5/RANTES, IFN-α, IFN-γ along with decreased IL-10 levels in NR and increased IL-6 and TNF in REL. SVR displayed lower baseline proinflammatory status with decreased CXCL8/IL-8, IL-12 and IL-17 levels. The inability to uphold IFN-α levels during immunotherapy was characteristic of NR. Serum chemokine/cytokine signatures further support the deleterious effect of proinflammatory baseline status and the critical role of increased/persistent IFN-α levels to guarantee the sustained virologic response. The prominent baseline proinflammatory milieu observed in NR and REL yielded a restricted biomarker network with small number of neighborhood connections, whereas SVR displayed a network with integrated cytokine connectivity. Noteworthy was that SVR presented a shift towards a proinflammatory pattern upon immunotherapy, assuming a pattern similar to that observed in NR and REL at baseline. Moreover, the immunotherapy guided REL towards a profile similar to SVR at baseline. Analysis of baseline-fold changes during treatment pointed out IFN-α and TNF as high-performance biomarkers to monitor immunotherapy outcome. This knowledge may contribute for novel insights into the treatment and control of the continuous public health threat posed by HCV infection worldwide.

Influência da informação de enfermagem na ansiedade pré-operatória / Influence of nursing information on preoperative anxiety

Uma grande parte dos doentes manifesta diversos níveis de ansiedade quando são submetidos a uma intervenção cirúrgica, um acontecimento crítico na vida da pessoa doente. Torna-se fundamental, desenvolver conhecimento nesta área que é caracterizada por uma elevada subjetividade, de modo a auxiliar os enfermeiros a definir modos de atuação baseados na evidência científica. Este estudo visa avaliar a ansiedade pré-operatória de doentes propostos para cirurgia programada e a informação que têm acerca do ato anestésico-cirúrgico; analisar a relação entre a informação que possuem e a ansiedade, e se algumas variáveis sociodemográficas influenciam essa ansiedade. Desenvolveu-se um estudo quantitativo, descritivo-correlacional, em 200 doentes submetidos a cirurgia eletiva. Foi aplicado um questionário de caracterização sociodemográfica, uma Escala de Informação e o IDATE-Y1. Os resultados revelam que os doentes percecionam estar melhor informados acerca dos aspetos organizacionais e logísticos, comparativamente ao que toca aos cuidados de enfermagem. Quanto ao nível de ansiedade pré-operatória, os doentes apresentaram baixos níveis de ansiedade, encontrando-se diferenças estatisticamente significativas em função do sexo, o que vai de encontro aos resultados de outros estudos. Por outro lado, a informação pré-operatória demonstrou estar relacionada de forma significativa com o número de elementos do agregado familiar e o tempo em lista de espera. Relativamente à informação pré-operatória, conclui-se que os enfermeiros devem investir no fortalecimento da informação acerca dos cuidados de enfermagem que prestam ao longo do período perioperatório. Tratando-se de uma área autónoma da profissão, enfatiza-se a relevância da informação/educação na prestação de cuidados de qualidade e ganhos em saúde.

Identification of immunodominant antigens for the laboratory diagnosis of toxocariasis.

OBJECTIVES: To identify immunodominant antigens of Toxocara canis recognised by Toxocara-infected sera as recombinant reagents for immunodiagnosis of toxocariasis. METHODS: Pooled sera from human cases of toxocariasis were used to identify immunodominant antigens by immunoscreening a T. canis larval expression cDNA library. The positive clones were sequenced to reveal the identity of the antigens. The recombinant proteins were expressed in E. coli and then used to confirm their immunoreaction with sera of humans with toxocariasis. Two chosen antigens were also used to differentiate Toxocara infection from other helminth infections in mice. RESULTS: Eleven antigens with immunodiagnostic potential were identified, including two C-type lectins (CTLs) that reacted strongly with the Toxocara-positive serum pool. The first CTL (Tc-CTL-1) is the same as TES-32, previously identified as a major immunodominant component of TES; the second CTL (Tc-CTL-2) is a novel C-type lectin sharing 83% amino acid sequence identity within the functional domain of Tc-CTL-1. The E. coli-expressed recombinant Tc-CTL-1 was strongly recognised by the Toxocara-positive serum pool or sera from animals experimentally infected with T. canis. Reactivity with recombinant Tc-CTL-1 was higher when the unreduced protein was used in an enzyme-linked immunosorbent assay (ELISA), dot-blot assay or Western blot test compared to the protein under reduced condition. Both recombinant Tc-CTL-1- and Tc-CTL-2-based ELISAs were able to differentiate T. canis infection from other helminth infections in experimentally infected mice. CONCLUSIONS: Both Tc-CTL-1 and Tc-CTL-2 were able to differentiate Toxocara infection from other helminth infections and could potentially be used as sensitive and specific immunodiagnostic antigens.

New insights into the immunopathology of early Toxocara canis infection in mice.

BACKGROUND: Nematodes of the genus Toxocara are cosmopolitan roundworms frequently found in dogs and cats. Toxocara spp. can accidentally infect humans and cause a zoonosis called human toxocariasis, which is characterized by visceral, ocular or cerebral migration of larval stages of the parasite, without completing its life cycle. In general, chronic nematode infections induce a polarized TH2 immune response. However, during the initial phase of infection, a strong pro-inflammatory response is part of the immunological profile and might determine the outcome and/or pathology of the infection. METHODS: Parasitological aspects and histopathology during larval migration were evaluated after early T. canis experimental infection of BALB/c mice, which were inoculated via the intra-gastric route with a single dose of 1000 fully embryonated eggs. Innate immune responses and systemic cytokine patterns (TH1, TH2, TH17 and regulatory cytokines) were determined at different times after experimental challenge by sandwich ELISA. RESULTS: We found that experimental infection with T. canis induced a mix of innate inflammatory/TH17/TH2 responses during early infection, with a predominance of the latter. The TH2 response was evidenced by significant increases in cytokines such as IL-4, IL-5, IL-13 and IL-33, in addition to increasing levels of IL-6 and IL-17. No significant increases were observed for IL-10, TNF-α or IFN-γ levels. In parallel, parasitological analysis clearly revealed the pattern of larval migration through the mouse organs, starting from the liver in the first 24 h of infection, reaching the peak in the lungs on the 3rd day of infection and finally being found numerously in the brain after 5 days of infection. Peripheral leukocytosis, characterized by early neutrophilia and subsequent eosinophilia, was remarkable during early infection. The tissue damage induced by larvae was evidenced by histopathological analysis of the organs at different time points of infection. In all of the affected organs, larval migration induced intense inflammatory infiltrate and hemorrhage. CONCLUSION: In conclusion, these new insights into early T. canis infection in mice presented here enabled a better understanding of the immunopathological events that might also occur during human toxocariasis, thus contributing to future strategies of diagnosis and control.

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic and morphological evaluation.

PURPOSE: To evaluate the effect of short and long term alloxan-induced diabetes on bladder and urethral function of female rats, and also describing its correlated morphological alterations. METHODS: Thirty five female rats were divided into three groups: G1 (n=9), control group; G2 (n=17), six weeks alloxan-induced diabetic rats; G3 (n=9), 20 weeks alloxan-induced diabetic rats. Functional evaluation was performed by cystometry and simultaneous measurements of the urethral pressure during bladder filling and voiding. Morphological evaluation was also performed with measurement of bladder and urethral fibrosis and collagen content and thickness of lamina propria and smooth muscle layers. RESULTS: The peak bladder pressures and contraction amplitudes were decreased in 100% and 47% of the G3 and G2 groups respectively, when compared to control. Bladder overactivity was observed in 53% of the G2 group. CONCLUSION: Alloxan-induced diabetes urethropathty in female rat was associated to bladder morphological alterations as higher thicknesses of it lamina propria, detrusor and adventicea.

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic and morphological evaluation

PURPOSE: To evaluate the effect of short and long term alloxan-induced diabetes on bladder and urethral function of female rats, and also describing its correlated morphological alterations. METHODS: Thirty five female rats were divided into three groups: G1 (n=9), control group; G2 (n=17), six weeks alloxan-induced diabetic rats; G3 (n=9), 20 weeks alloxan-induced diabetic rats. Functional evaluation was performed by cystometry and simultaneous measurements of the urethral pressure during bladder filling and voiding. Morphological evaluation was also performed with measurement of bladder and urethral fibrosis and collagen content and thickness of lamina propria and smooth muscle layers. RESULTS: The peak bladder pressures and contraction amplitudes were decreased in 100% and 47% of the G3 and G2 groups respectively, when compared to control. Bladder overactivity was observed in 53% of the G2 group. CONCLUSION: Alloxan-induced diabetes urethropathty in female rat was associated to bladder morphological alterations as higher thicknesses of it lamina propria, detrusor and adventicea. .

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic evaluation and action of sildenafil citrate.

PURPOSE: To evaluate the effect of diabetes mellitus and of sildenafil citrate on female urethral function. METHODS: Twenty nine female rats were divided into four groups: G1 - (n=9), normal rats; G2 - (n=6), normal rats treated with sildenafil citrate; G3 - (n=9) rats with alloxan-induced diabetes; G4 - (n=5) rats with alloxan-induced diabetes treated with sildenafil citrate. Under anesthesia, urodynamic evaluation was performed by cystometry and urethral pressure simultaneously. RESULTS: A significant increase in urethral pressure was observed during micturition. CONCLUSION: Sildenafil citrate can partially reduced urethral pressure in diabetic female rats.

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic evaluation and action of sildenafil citrate

To evaluate the effect of diabetes mellitus and of sildenafil citrate on female urethral function. Twenty nine female rats were divided into four groups: G1 - (n=9), normal rats; G2 - (n=6), normal rats treated with sildenafil citrate; G3 - (n=9) rats with alloxan-induced diabetes; G4 - (n=5) rats with alloxan-induced diabetes treated with sildenafil citrate. Under anesthesia, urodynamic evaluation was performed by cystometry and urethral pressure simultaneously. A significant increase in urethral pressure was observed during micturition. Sildenafil citrate can partially reduced urethral pressure in diabetic female rats.

Expression of FAS ligand in the ipsilateral and contralateral testicles of rats subjected to the torsion of the unilateral testicular cord.

PURPOSE: To investigate the expression of FAS ligand (FASL) in ipsilateral and contralateral testicles of rats submitted to ischemia/reperfusion. METHODS: Wistar rats (n=21) distributed into groups control (GC), n=5, testicular exposure; ischemia (GI), (n=8), Torsion in the left testicular Cord (TCT) for three hours followed by orchiectomy without distortion and orchietomy of the contralateral testicle after 24 hours; and reperfusion (GR), (n=8), left TCT for 3 hours and distortion and repositioning on the scrotum and bilateral orchiectomy after 24 hours. Quantification of the FASL expression by immune-histochemistry. RESULTS: Statistical analysis showed similarity between GC and GI (p>0.05), differences detected are concentrated on the GR (p<0.05), increase in immunoexpression of FASL in the subgroups Right GR (406.8+-61.5) and Left GR (135.3 +-28.9) with significant predominance in the GR subgroup. CONCLUSION: Ischemia/reperfusion increased the FASL expression significantly in contralateral testicles in GR, in rats.

Expression of FAS ligand in the ipsilateral and contralateral testicles of rats subjected to the torsion of the unilateral testicular cord

PURPOSE: To investigate the expression of FAS ligand (FASL) in ipsilateral and contralateral testicles of rats submitted to ischemia/reperfusion. METHODS: Wistar rats (n=21) distributed into groups control (GC), n=5, testicular exposure; ischemia (GI), (n=8), Torsion in the left testicular Cord (TCT) for three hours followed by orchiectomy without distortion and orchietomy of the contralateral testicle after 24 hours; and reperfusion (GR), (n=8), left TCT for 3 hours and distortion and repositioning on the scrotum and bilateral orchiectomy after 24 hours. Quantification of the FASL expression by immune-histochemistry. RESULTS: Statistical analysis showed similarity between GC and GI (p>0.05), differences detected are concentrated on the GR (p<0.05), increase in immunoexpression of FASL in the subgroups Right GR (406.8+-61.5) and Left GR (135.3 +-28.9) with significant predominance in the GR subgroup. CONCLUSION: Ischemia/reperfusion increased the FASL expression significantly in contralateral testicles in GR, in rats.

[Forensic psychiatry and psychology in the evaluation for forensic sexology]. / A psiquiatria e a psicología na avaliação pericial em sexologia forense.

The authors intended to reflect about the contribution of Forensic Psychiatry and Psychology in the evaluation of sexual offences, according to the Portuguese legislation and medical legal issues.

Traduzir o outro: etnografia e semelhança / Translate the other: ethnography and likeness

Traduzir o outro se divide em duas partes: a primeira, analogia e escrita etnográfica, aborda as conceituações construídas pelas teorias antropológicas sobre as possibilidades de se estabelecer a semelhança e a correspondência entre nós e os outros. A segunda parte, analogia e pensamento ameríndio, segue o pensamento nativo a partir das formas como este estabelece a semelhança e as possibilidades de tradução ao explorar os conceitos de semelhança, pessoalidade e zonas de contato.

Estimated costs of treatment of benign prostate hyperplasia in Brazil

INTRODUCTION: The treatment of benign prostate hyperplasia (BPH) presents 2 options: medical or surgical, and there are doubts about what is the best treatment since 80 percent of patients who undergo surgery become asymptomatic and 10 to 40 percent of those under medical regimen undergo surgery within a 5 years period. It is difficult to assess the actual costs of treating BPH in Brazil due to several factors, among them regional particularities and the scarcity of current statistical data. PATIENTS AND METHODS: Recently, in the Ribeirão Preto area, São Paulo, Brazil, the IPSS (International Prostatic Symptoms Score) and quality of life were verified in 934 volunteers. It was determined the percentage of individuals with ages ranging from 40 to 79 years with moderate symptoms (score 8-19) and with severe symptoms (score 20-35), values for which are indicated medical and surgical treatment, respectively, according to the Brazilian Society of Urology consensus on BPH. Data on Brazilian population in that age range were obtained from the Brazilian Institute of Geography and Statistics referent to the year of 2000. It was determined the number of patients, according to the criteria above, subjected to either one of the treatments mentioned. Surgical costs of prostate transurethral resection were researched according to Unified Health System - SUS tables (US$ 173) and of Brazilian Medical Society - AMB with a mean cost in 3 hospitals of US$ 933. Drug costs were calculated by the annual mean price (US$ 355) of 4 alpha-blockers (tamsulosin, alfuzosin, doxazosin and terazosin). RESULTS: The estimated population for medical treatment was 5,397,321 individuals, with a cost corresponding to US$ 1,916,489,055.00. The estimated population for surgical treatment was 2,040,299 men, what would represent a cost of US$ 353,291,204.00 based on the SUS table and of US$ 1,904,279,066.00 based on AMB with hospital expenses included. CONCLUSION: All theses facts induce us to predict that the treatment of BPH in a not-so-far future can become a public health problem for Brazilian society, since the current estimate would be, approximately, costs around 2.26 - 3.83 billion dollars, added by the yearly increase in the risk population (24.99 percent) for the group under medical treatment and over the non-operated amount of the surgical group.