Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus.

The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

Italian association of clinical endocrinologists (AME) position statement: drug therapy of osteoporosis.

Treatment of osteoporosis is aimed to prevent fragility fractures and to stabilize or increase bone mineral density. Several drugs with different efficacy and safety profiles are available. The long-term therapeutic strategy should be planned, and the initial treatment should be selected according to the individual site-specific fracture risk and the need to give the maximal protection when the fracture risk is highest (i.e. in the late life). The present consensus focused on the strategies for the treatment of postmenopausal osteoporosis taking into consideration all the drugs available for this purpose. A short revision of the literature about treatment of secondary osteoporosis due both to androgen deprivation therapy for prostate cancer and to aromatase inhibitors for breast cancer was also performed. Also premenopausal females and males with osteoporosis are frequently seen in endocrine settings. Finally particular attention was paid to the tailoring of treatment as well as to its duration.

Frequência de staphylococcus aureus em casos de mastite bovina subclínica, na região sul do Rio Grande do Sul / Staphylococcus aureus frequency of subclinical bovine mastitis in southern Rio Grande do Sul

A mastite bovina é uma doença importante na exploração leiteira, não apenas pelas perdas econômicas diretas que promove, mas também pelas perdas indiretas e o potencial risco à saúde pública. Dentre as principais causas de infecções intramamárias, destacam-se as bactérias do gênero Staphylococcus spp., sendo que Staphylococcus aureus é o agente etiológico predominante em mastite subclínica. O objetivo desse trabalho foi verificar a frequência de mastite subclínica em oito rebanhos localizados na região Sul do Rio Grande do Sul (Brasil) e a relação da enfermidade com a presença de S. aureus. Adicionalmente, pesquisou-se a presença de S. intermedius e S. hyicus nas amostras de leite obtidas. Para identificação da doença, utilizou-se o California Mastitis Test (CMT). A identificação da espécie de Staphylococcus spp. foi feita em meio de cultura ágar Baird-Parker, com posterior confirmação das colônias suspeitas em coloração de gram, prova de catalase, pesquisa de coagulase livre e pesquisa de termonuclease. A mastite subclínica foi constatada em 53,6% dos animais testados. A presença de Staphylococcus coagulase positiva foi identificada em 12,6% dos animais com mastite subclínica. Nesses mesmos animais, a bactéria identificada como S. aureus foi o agente etiológico presente em 17,6% dos casos. Adicionalmente, pode-se perceber que, dentre o grupo identificado como coagulase positiva, 85,7% corresponderam a S. aureus, enquanto8,5% mostraram características bioquímicas compatíveis com S. intermedius e 5,8% foram consideradas S. hyicus...

Bovine mastitis is an important disease in dairy farming, not only by promoting direct economic losses, but also for indirect losses and the potential risk to public health. The main causes of intramammary infections include the bacteria of the genus Staphylococcus spp., Staphylococcus aureus being the predominant etiologic agent in subclinical mastitis. The aim of this study was to determine the frequency of subclinical mastitis in eight herds from southern Rio Grande do Sul (Brazil) and the relationship of the disease with the presence of S. aureus. In addition, we checked for the presence of S. intermedius and S. hyicus in the milk samples obtained. For identification of the disease, we used the California Mastitis Test (CMT). Identification of Staphylococcus spp. species was made in Barid-Parker agar culture medium, with subsequent confirmation of suspected colonies by way of Gram stain and catalase test along with free-coagulase and thermonuclease research. Subclinical mastitis was identified in 53.6% of animals tested. The presence of coagulase-positive Staphylococcus was identified in 12.6% of animals with subclinical mastitis. In these same animals, bacteria identified as S. aureus were the etiologic agent present in 17.6% of cases. Additionally, it was revealed that among the group identified as coagulase positive, 85.7% corresponded to S. aureus, while 8.5% had biochemical characteristics consistent with S. intermedius and 5.8% were considered S. hyicus...

Is arterial stiffness in HIV-infected individuals associated with HIV-related factors?

We investigated the association between pulse wave velocity (PWV) and HIV infection, antiretroviral treatment-related characteristics, viral load, immune status, and metabolic changes in a cross-sectional study nested in a cohort of HIV/AIDS patients who have been followed for metabolic and cardiovascular changes since 2007. The study included patients recruited from the cohort (N = 261) and a comparison group (N = 82) of uninfected individuals, all enrolled from April to November 2009. Aortic stiffness was estimated using the carotid-femoral PWV (Complior-Artech, Paris, France). The groups were similar with respect to age, metabolic syndrome, diabetes mellitus, Framingham score, and use of antihypertensive and hypolipidemic medications. Hypertension was more frequent among the controls. Individuals with HIV had higher triglyceride, glucose and HDL cholesterol levels. Among individuals with HIV/AIDS, those with a nadir CD4+ T-cell count <200 cells/mm³ had a higher PWV (P = 0.01). There was no statistically significant difference when subjects were stratified by gender. Heart rate, age, male gender, and blood pressure were independently correlated with PWV. Nadir CD4+ T-cell count did not remain in the final model. There was no significance difference in PWV between HIV-infected individuals and uninfected controls. PWV was correlated with age, gender, and blood pressure across the entire population and among those infected with HIV. We recommend cohort studies to further explore the association between inflammation related to HIV infection and/or immune reconstitution and antiretroviral use and PWV.

Cardiac tamponade: an unusual complication of pericardial cyst.

Pericardial cysts are not common and rarely cause symptoms. We report a unique case of a 15-year-old male patient with cardiac tamponade clinically diagnosed who was referred for echocardiography. Transthoracic echocardiography revealed, in addition to a large pericardial effusion associated with echocardiographic signs of cardiac tamponade, an 8 x 5 cm echofree image suggesting a pericardial cyst adjacent to the right atrium. Immediately after pericardiocentesis, yielding a serosanguinous liquid, the patient showed striking clinical improvement and echocardiography demonstrated minimal pericardial effusion with persistence of the cystic image. At surgery a pericardial cyst containing a sanguinous fluid was found and the pathologic findings were consistent with hematic pericardial cyst. Thus echocardiography played a fundamental role for the diagnosis and treatment of the rare complication of a pericardial cyst documented in this patient.