Congenital Adrenal Hyperplasia-When Clinical Symptoms Are Missing.

BACKGROUND: Congenital adrenal hyperplasia is an autossomic recessive condition. The most common mutation is in the CYP21A2 gene situated in chromosome 6, leading to a 21-hydroxylase deficiency. Clinical presentation ranges from light hyperandrogenism to potentially fatal adrenal salt-losing crisis. In this study, we describe a case of congenital adrenal hyperplasia in a male newborn. CASE: A male newborn was brought to the emergency department owing to an episode of regurgitation after feeding, followed by pallor of the skin and decreased activity. In physical examination, he was hypotonic with irregular respiratory pattern. Heart rate was 180 beats per minute, blood pressure levels were 93/63 mm Hg, and peripheral oxygen saturation was 80% to 84% associated with a sine wave pattern in the electrocardiogram. No scrotal hyperpigmentation was present. The venous blood gas analysis showed a metabolic acidosis (pH, 7.28; pCO2, 41 mmHg; sodium bicarbonate, 18.2 mmol/L; and base excess of -7), hyperkalemia (9.3 mmol/L), and hyponatremia (112 mmol/L). Based on these findings, the most probable diagnosis was a salt wasting form of congenital adrenal hyperplasia. Treatment of hyperkalemia and sodium deficit correction were initiated, as well as glycorticoid therapy. The concentration of 17-hydroxyprogesterone in dried blood spot confirmed the diagnosis. CONCLUSIONS: Because of the severity of this disease and the risk for rapid hemodynamical collapse, clinicians should be aware of this condition. In this specific case, we highlight the absence of testicular hyperpigmentation, which is a hallmark of this condition.

Characterization of students with high intellectual capacity: the approach in the Portuguese school context and importance of teacher training for their educational inclusion.

This paper takes a terminological approach to the concept of high intellectual abilities, highlighting the distinctive aspects of the way it is addressed in the Portuguese educational context. It outlines the existing conceptual differentiation in the field of higher abilities, emphasizing how the main characteristics are described and including the strengths and weaknesses of current teaching and learning processes in Portugal. As we will show, educational work with these students in Portuguese schools is characterized by unequal regulation compared to other educational needs, by an imbalance of educational processes aimed at these gifted students, and by clear underdiagnosis that sometimes leads to them being ignored in the classroom, with the consequent harm that this can cause to their overall development and to their academic and professional careers. The paper emphasizes the importance of teacher training in Portugal as an aspect that could be key to reversing, as far as possible, this gap in educational processes-which currently include educational inclusion for all their students as part of the key action principles in the Portuguese educational system.

Validation of a questionnaire for assessing fecal impaction in the elderly: impact of cognitive impairment, and using a proxy.

BACKGROUND: Studies on the epidemiology of fecal impaction are limited by the absence of a valid and reliable instrument to identify the condition in the elderly. Our aim is to validate a questionnaire for identifying fecal impaction in the elderly and to assess the impact of cognitive impairment and the aid of a proxy on its reliability. METHODS: We developed a 5 questions' questionnaire. The questionnaire was presented to twenty doctors to test its face validity. Feasibility was pre-tested with ten non institutionalized subjects who completed the questionnaire twice, once alone or with the help of a proxy, and another along with the researcher.For the validation of the questionnaire all residents in a single nursing-home were invited to participate, allowing the self-decision of using a proxy. Medical records of all subjects were abstracted without knowledge of subjects' answers and agreement between fecal impaction according to self-reported and medical records analyzed. Physical impairment was measured with the Barthel's test and cognitive impairment with the mini-mental test. RESULTS: In the face validity only minor changes in wording were suggested. In the feasibility pre-test all subjects were able to understand and complete the questionnaire and all questions were considered appropriate and easily understandable.One-hundred and ninety-nine of the 244 residents participated in the study (mean age 86,1 ± 6,6). One hundred and forty two subjects understood all questions; not understanding them was inversely associated with cognitive impairment score (aOR: 0.86; 95% CI: 0.82-0.91). One hundred and sixty decided to use a proxy; the use of a proxy was inversely associated with educative level (0.13 (0.02-0.72), minimental's score (0.85; 0.76-0.95) and Barthel's score (0.96; 0.94-0.99). Agreement between medical records and self-completed questionnaire was 85.9% (kappa 0.72 (0,62- 0,82). Disagreement was unrelated to education and cognitive impairment. CONCLUSIONS: Our simple questionnaire is reliable for identifying fecal impaction in the elderly by self-report. Limitation imposed by cognitive impairment is minimized with the aid of a proxy.

Prevalence of childhood obesity in northeastern Ontario: a cross-sectional study.

PURPOSE: In Canada, the incidence of childhood obesity has tripled within the past 20 years. The prevalence of obesity in the Timmins, Ontario, student population was studied to gain knowledge for program planning and resource allocation, and to compare Centers for Disease Control and Prevention (CDC) criteria with Cole's international criteria for childhood obesity. METHODS: Anthropometric measurements of 801 students were taken. Students were chosen from randomly selected schools for each grade. Data were analyzed according to age, gender, and ethnicity. Data were also compared with other studies. Intragroup comparisons were performed using hypothesis testing for significance with the z table and chi-square test. RESULTS: Overweight and obesity prevalence was 28% according to CDC criteria. No statistical difference was found between genders or among ethnic groups, or between this study and other Canadian studies. In comparison with the CDC criteria, Cole's international criteria indicated less obesity and increased overweight prevalence. These differences were not statistically significant. CONCLUSIONS: The findings suggest that in the northern Ontario community of Timmins, the prevalence of childhood obesity is of epidemic proportions. When the findings are shared with different agencies, this study will help the health unit to take necessary public health measures to curb the epidemic.

Antioxidant activity of a botanical extract preparation of Ilex paraguariensis: prevention of DNA double-strand breaks in Saccharomyces cerevisiae and human low-density lipoprotein oxidation.

We analyzed the antioxidant properties of Ilex paraguariensis infusion (Ip) popularly known as mate (mä'ta), by using two experimental models: the induction of DNA double-strand breaks (DSB) by hydrogen peroxide (H(2)O(2)) and lethality in Saccharomyces cerevisiae, as well as peroxide and lipoxygenase-induced human low-density lipoprotein (LDL) oxidation. Diploid yeast cells were exposed to different concentrations of H(2)O(2) (5-10 mmol/L) in the absence or presence of Ip infusion (10(-1) v/v) or alpha-tocopherol (10(-2) mol/L). Both mate infusion and alpha-tocopherol significantly decreased the dose dependent DSB number, and the lethality induced by H(2)O(2). Peroxynitrite and lipoxygenase-induced human LDL oxidation are inhibited by Ip extracts in a potent, dose-dependent fashion. Dilutions of 5 x 10(-3) v/v provide 50% +/- 10% inhibition. Finally, Ip extracts are potent direct quenchers of the free radical 1,1-diphenyl-2-picrylhydrazyl. Dilutions of 2 x 10(-2) v/v produced quenching of more than 30%, which was comparable to that obtained with 0.5-1 mmol/L alpha-tocopherol or the quercetin aglycone, respectively. For comparison, total polyphenol content of Ip, green, and black tea (Camelia sinensis) were 6.5 +/- 0.8; 1.8 +/- 0.5; and 1.13 +/- 0.3 mmol of quercetin equivalents per liter, respectively. Their respective free radical quenching activities at dilutions of 1 x 10(-1) v/v were 75% +/- 5%; 35% +/- 5%; and 2% +/- 5%. Ip is thus a rich source of polyphenols and has antioxidant properties comparable to those of green tea which merit further in vivo intervention and cross-sectional studies.

A nation-wide study of prevalence and risk factors for fecal impaction in nursing homes.

BACKGROUND: There are no existing studies that provide data regarding the epidemiology of, and risk factors for, fecal impaction, either in the general population or in any sub-group of people. OBJECTIVE: Estimate the prevalence of and factors associated with fecal impaction on a representative sample of the institutionalized elderly population. DESIGN: Two-phase study. Phase 1: pilot study validating the methodology in which all residents of a single nursing home participated. Phase 2: national multi-center cross-sectional study. SETTING: 34 randomly selected nursing homes. MEASUREMENTS: The presence of fecal impaction and associated factors were evaluated using three different tools: data collected from medical records; a self-completion questionnaire filled out by the subjects or a proxy; and a rectal examination. SUBJECTS: Older subjects living in nursing homes. RESULTS: The prevalence of chronic constipation was 70.7% (95%CI: 67.3-74.1%), of which 95.9% of patients were properly diagnosed and 43.1% were properly controlled. The prevalence of FI according to patient history was 47.3% (43.6-51.0%) and 6.6% (4.7-8.5%) according to rectal examination. Controlled constipation (OR: 9.8 [5.2-18.4]) and uncontrolled constipation (OR: 37.21 [19.7-70.1]), the number of medications (OR: 1.2 [1.1-1.3]), reduced functional capacity (OR: 0.98 [0.97-0.99]) and the occasional use of NSAIDs were independent risk factors for fecal impaction. CONCLUSIONS: Constipation affects more than 70% of people living in nursing homes. Although it is properly diagnosed in more than 95% of cases, the disease is only controlled in less than 50%. Constipation, especially when not controlled, is the most significant risk factor leading to fecal impaction, which is prevalent in almost 50% of this population.

La vigilancia activa en pacientes con cáncer de próstata localizado. Análisis de adherencia y salida del protocolo / Active surveillance in patients with localized prostate cancer. Analysis of adherence and exit from the protocol

Objetive: VA is currently considered the treatment of choice for patients with low and very low risk prostate cancer. We analyzed the evolution of this treatment strategy in our series and adherence to the protocol. Material and methods: Ambispective study of patients in VA in our center between 2014- 2019. 237 meet inclusion criteria, of which 142 (60%) have a minimum of 12 months of follow- up. Mean age: 68.5 (46-78), median PSA 6.37 ng / ml (1-33). 229 (96.6%) are ISUP 1 and 8 (3.4%) ISUP 2. Objectives are pro- posed to assess our adherence to the protocol. Descriptive statistics are used to communicate the results. Results: According to the classification by risk groups of the NCCN, 145 (61.2%), 49 (20.7%) and 42 (17.7%) were very low risk, low risk and favorable intermedi- ate risk patients, respectively. The median of follow-up is 14 months (0-66). Of the patients with a minimum follow-up of 12 months, 107 (75.4%) were re-biopsied. 80 (33.8%) leave the protocol in these 5 years, 31.3% (25) by their own decision, 55% (44) due to medical criteria, and 11.3% (9) go to WW. After 5 years of follow-up, 99.2% of patients are still alive, 0.8% died of specific non-cancer causes. Of the objectives to assess adherence, 8 are achieved, 1 partially and 1 is not evaluable. Conclusions: VA in our center is already the treatment of choice for very low-risk patients, with a constant increase from year to year. Adherence to the protocol has been favorable during the period of time studied.(AU)

El agua como medida terapéutica / Water is a therapy

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Diagnóstico precoce do câncer do colo: experiência de 12 casos / Early diagnosis of cervical cancer: experience of 12 cases

É apresentada uma estatística de 12 anos de um ambulatório modelar em prevençäo do câncer do colo do útero. Relatam-se experiência no diagnóstico e tratamento dos casos e comenta-se

Observaçäo sobre 21 casos de microcarcinoma / Observation on 21 cases of microcarcinomas

Apresentam-se 21 casos de microcarcinomas e fazem-se observaçöes sobre o diagnóstico citológico, colposcópico, histológico e tratamento, além de correlacionarem-se os métodos diagnósticos e comentarem-se certas particularidades quanto à idade das pacientes, paridade e cor

Citologia endometrial de esfregaços de DIU: estudo da reaçäo endometrial / Endometrial cytology of IUD smears: study of endometrial reaction

Objetivou-se verificar a presença de possíveis reaçöes anormais do endométrio, em conseqüência da presença do corpo estranho representado pelo Dispositivo Intra-Uterino (DIU). Foram feitos esfregaços com o material contido nos DIUS, imediatamente após sua retirada, de 110 pacientes, dos quais foram computados 102 casos, quase todos provenientes do Serviço de Planejamento Familiar e Reproduçäo Humana, do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina da UFMG, no período de julho de 1981 a dezembro de 1982. Utilizou-se vários parâmetros, representados pelas células endometriais e "elementos associados", computados como modelo do DIU, idade da usuária e dia do ciclo em que foi retirado o DIU

Antioxidant activity of a botanical extract preparation of Ilex paraguariensis : prevention of DNA double-strand breaks in saccharomyces cerevisiae and human low-density lipoprotein oxidation

We analyzed the antioxidant properties of Ilex paraguariensis infusion (Ip) popularly known as mate (ma ta), by using two experimental models : the induction of DNA double-strand breaks (DSB) by hydrogen peroxide (H2O2) and lethality in Saccharomyces cerevisiae, as well as peroxide and lipoxygenase-induced human low-density lipoprotein (LDL) oxidation. Diploid yeast cells were exposed to different concentrations of H2O2 (5-10mmol/L) in the absence or presence of Ip infusion (10 -1 v/v) or a-tocopherol (10 -2 mol/L). Both mate infusion and a-tocopherol significantly decreased the dose dependent DSB number, and the lethality induced by H2O2. Peroxynitrite and lipoxygenase-induced human LDL oxidation are inhibited by Ip extract in a potent, dose-dependent fashion. Dilutions of 5 x 10-3 v/v provide 50 percent+- 10 percent inhibition. Finally, Ip extracts are potent direct quenchers of the free radical 1,1-diphenyl-2-picrylhydrazyl. Dilutions of 2 x 10 -2 v/v produced quenching of more than 30 percent, which was comparable to that obtained with 0.5-1mmol/La-tocopherol or the quercetin aglycone, respectively. For comparison, total polyphenol content of Ip, green, and black tea (Camelia sinensis) were 6.5 +- 0.8;1.8+-0.5; and 1.13+-0.3 mmol of quecetin equivalents per liter, respectively. Their respective free radical quenching activities at dilutions of 1 x 10 -1 v/v were 75 percent+-5 percent; 53 percent+- 5 percent; and 2 percent +- 5 percent. Ip is thus a rich source of polyphenols and has antioxidant properties comparable to those of green tea which merit further in vivo intervention and cross-sectional studies

Cateterismo cardíaco ambulatorio en un hospital de la ciudad de México / Ambulatory cardiac catheterization in a hospital of Mexico city

En este reporte se demuestra la utilidad clínica, a costo moderado, del cateterismo cardíaco y cineangiografía coronaria, efectuados como procedimiento de la consulta externa en un grupo de pacientes. Treinta y cuatro pacientes (91.2%) fueron estudiados debido a datos sugestivos de enfermedad isquémica coronaria, y tres pacientes (8.8%), por enfermedad valvular cardíaca grave. En treinta y dos pacientes (94%) se utilizó el método de Seldinger/Judkins y en dos individuos, el método de Sones. No hubo complicaciones cardíacas, secundarias al estudio. El período de observación, después del estudio, fue de 6 a 8 horas, excepto en una paciente con disfunción de prótesis valvular aórtica que fue hospitalizada para ser sometida a cirugía de urgencia. El costo promedio del procedimiento ambulatorio fue comparado con el costo promedio del cateterismo cardíaco tradicional, con un día mínimo de hospitalización. La diferencia de ambos promedios fue sujeta a estudio estadístico con prueba no pareada de "t", encontrándose una diferencia significativa (p = <0.05). Aún cuando la experiencia aquí informada es limitada, los resultados y la ausencia de complicaciones demuestran que el cateterismo cardíaco ambulatorio es una opción de procedimiento invasivo confiable y de costo moderado