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.

Complex auditory musical hallucinations with ambivalent feelings.

A 78-year-old woman with hypertension, diabetes mellitus type 2 and bilateral sensorineural hearing loss was referenced to geriatric psychiatry consultation. She presented cognitive dysfunction, erotomanic delusion and complex musical hallucinations (MH), described as hearing her neighbour singing a familiar church song along with bells in the background, making comments and talking to her. A computed tomography (CT) of the brain detected small right nucleocapsular and bilateral external capsules hypodensities of presumed vascular aetiology during hospitalisation. MH are a rare phenomenon with heterogeneous aetiology. Most frequently, the cause is hearing impairment; other causes include social isolation, cognitive dysfunction, vascular risk factors and medication. Studies suggest that some brain areas related to musical memory circuitry might be related and not fully mapped. Auditory verbal hallucinations with a voice that either comments, talks or sings to the patient have never been described in the literature, making this clinical case attractive.

Combined approaches to obtain cellulose nanocrystals, nanofibrils and fermentable sugars from elephant grass.

This work is focused in methodologies to obtain cellulose nanocrystals, cellulose nanofibrils, soluble lignin and fermentable sugars from elephant grass, aiming a more integral use of this biomass. To improve hydrolysis, three different pretreatments for biomass delignification and bleaching were compared: 1. Concentrated alkaline peroxide (CP); 2. Diluted alkaline peroxide (DP); and 3. Acid-alkali (AA) pretreatment. Cellulose nanocrystals were obtained from elephant grass leaves by acid hydrolysis, with a 12-16% w/w yield considering the initial biomass weight, and presented high crystallinity index (CI=72-77%) and aspect ratios (30-44), depending on the pretreatment approach. Together with the cellulose nanocrystals, other useful by-products were obtained, such as cellulose nanofibrils (3.8%-9.7% w/w yield), extractives (12.3%), liquors rich in hydrolysed lignin (16.0-21.1%) and sugars (22.1-25.2%). The results presented herewith should contribute to the economic viability and the sustainability of this biomass fractionation process.

Availability and toxicity of cadmium to forage grasses grown in contaminated soil.

It is important to know the mechanisms for forage development, especially those related to the tolerance of potentially toxic elements, when considering their use in phytoremediation in heavy metal contaminated areas. In this study, we evaluated plant growth, concentration, and the availability of cadmium (Cd) for forage grasses (Panicum maximum Jacq. cv. Aruana and cv. Tanzânia; Brachiaria decumbens cv. Basilisk; Brachiaria brizantha cv. Xaraés and cv. Marandu) cultivated in Cd contaminated soils. The experiments were performed under greenhouse conditions over a 90-day evaluation period, and the Cd rates were 2, 4, and 12 mg/kg of soil. The relative growth rate of the forage grasses decreased as Cd rates increased, and the following descending order of susceptibility was observed: Marandu > Xaraés > Aruana > Tanzânia > Basilisk, with regard to phytotoxicity in these plants. The forage Cd concentration increased in line with increases in the Cd rates. Cd contents extracted by Mehlich-1 and by diethylenetriaminepentaacetic acid presented high positive correlation with forage relative growth. The forage plants did not block Cd entry into the food chain because they were not capable of limiting Cd absorption.

Prevalência de excesso de peso entre estudantes de ensino fundamental de escola pública e privada em Sorocaba, São Paulo, Brasil / Prevalence of overweight among students of public and private elementary and middle schools in Sorocaba, São Paulo, Brazil / Prevalencia de sobrepeso entre los estudiantes de primaria en escuelas públicas y privadas en Sorocaba, São Paulo, Brasil

Objetivo: Este estudo teve como objetivo avaliar a prevalência de sobrepeso e obesidade em um grupo de estudantes e investigar se há correlacão entre IMC (índice de massa corporal) e renda familiar. Métodos: Estudo tipo transversal, realizado com 213 estudantes do ensino fundamental de escola pública (EPU) e privada (EPR), com idade entre 10 e 14 anos, aprovado pelo comitê de ética local e mediante assinatura do termo de consentimento livre e esclarecido pelos estudantes e os responsáveis por eles. Os estudantes foram pesados e medidos e o IMC foi calculado; os dados foram avaliados com base nos gráficos da OMS para IMC conforme o sexo. Os estudantes responderam ao questionário socioeconômico segundo o critério da ABEP. A análise dos dados foi realizada usando o programa SPSS. Foi adotado nível de significância de 5%. Resultados: Prevalência global de excesso de peso (sobrepeso) na amostra estudada foi de 41,3%. Na comparação dos resultados isolados, a frequência de excesso de peso foi maior em alunos da escola particular (47,3%) do que nos da escola pública (32,1%), com significância estatística (p=0,03). A frequência de excesso de peso nos meninos da EPR foi maior do que nos da EPU (23,3% versus 14,3%; p=0,05). Nas meninas, verificou-se a mesma tendência, sem, todavia, significância estatística (24,0% versus 17,9%; p=0,18). Houve correlação positiva entre IMC e renda familiar (r=0,14, p=0,04). Conclusão: Cerca de 40% dos estudantes entrevistados apresentaram excesso de peso, com prevalência maior entre os meninos da escola particular. É relevante o desenvolvimento de estratégias de prevenção da obesidade em todos os níveis da sociedade, pois há potenciais riscos à saúde na vida adulta.

Objective: The objectives of this study were to evaluate the prevalence of overweight and obesity in a sample of students and investigate the correlation between BMI (body mass index) and family income. Methods: A cross-sectional study conducted with 213 primary school students of public (PUS) and private (PRS) schools, aged between 10 and 14 years. This study was approved by the local Ethics Committee, and students and parents who were willing to participate could only do it by signing a consent form. Students were weighed and measured, and the BMI was calculated, the resulting data were evaluated according to the WHO BMI charts related to sex. The students answered a questionnaire on socioeconomic status according to the 'ABEP' charts. Data analysis was performed using SPSS, with 5% significance level. Results: The total prevalence of overweight in the sample studied was of 41.3%. Comparing the individual results, the frequency of overweight was higher for private school (47.3%) than for public school (32.1%) children, with statistical significance (p=0.03). The frequency of overweight among PRS boys was higher than among the PUS boys (23.3% versus 14.3%, p=0.05). In girls, the same trend was observed, but with no statistical significance (24.0% versus 17.9%, p=0.18). There was a positive correlation between BMI and family income (r=0.14, p=0.04). Conclusion: About 40% of the students who participated in the study were overweight, with higher prevalence among private school boys. It is important to establish strategies to prevent obesity at all levels of society, considering the potential health risks for those overweight children when they reach adulthood.

Objetivo: Los objetivos de esto estudio fueron evaluar la prevalencia del sobrepeso y obesidad en una muestra de estudiantes e investigar si hay correlación entre el IMC (índice de masa corporal) y el ingreso familiar. Métodos: Estudio transversal realizado en 213 estudiantes del primaria de escuela pública (EPU) y privada (EPR), con edades comprendidas entre 10 y 14 años. Este estudio fue aprobado por el Comité de Ética local, mediante la firma de un consentimiento informado, libre y claro, por los estudiantes y sus padres. Los estudiantes fueron pesados y medidos y se calculó el IMC; los datos resultantes fueron evaluados de acuerdo con los gráficos de la OMS para IMC para hombres y mujeres. Los estudiantes respondieron a un cuestionario sobre la situación socioeconómica a discreción de ABEP. El análisis de los datos se realizó mediante el programa SPSS, con el nivel de significancia de 5%. Resultados y discusión: La prevalencia global de sobrepeso en la muestra estudiada fue de 41,3%. Comparando los resultados de forma aislada, la frecuencia de sobrepeso fue significativamente mayor (p=0,03) para los alumnos de las escuelas privadas (47,3%) que para los de escuela pública (32,1%). La frecuencia de sobrepeso entre los varones de EPR fue mayor que entre los de la EPU (23,3% versus 14,3%, p=0,05). Se observó la misma tendencia para las niñas pero sin significación estadística (24,0% versus 17,9%; p=0,18). Se observó una correlación positiva entre el IMC y el ingreso familiar (r=0,14, p=0,04). Conclusión: Alrededor del 40% de los estudiantes encuestados tenían sobrepeso, con mayor frecuencia entre los niños de la escuela privada. Es relevante el desarrollo de estrategias para prevenir la obesidad en todos los niveles de la sociedad, teniendo en cuenta los riesgos potenciales para la salud en la edad adulta.

Q289P mutation in FGFR2 gene causes Saethre-Chotzen syndrome: some considerations about familial heterogeneity.

OBJECTIVE: To describe the first report on a three-generation family presenting typical features of Saethre-Chotzen syndrome, in which the Q289P mutation in the FGFR2 gene was detected. DESIGN: Dysmorphological evaluation was performed by a clinical geneticist. Direct sequencing of the polymerase chain reaction-amplified coding region of TWIST and screening for the P250R mutation in the FGFR3 gene were performed. Exons IIIa and IIIc of FGFR2 were sequenced also. The mutation was confirmed by both restriction-enzyme digestion and allelic-specific polymerase chain reaction. RESULTS: Neither TWIST gene analysis nor analysis of the P250R mutation on gene FGFR3 showed mutation within the coding sequence. A nucleotide change from CAG to CCG in exon IIIa of the FGFR2 gene that caused a Q289P mutation was detected, although exon IIIc in the propositus was normal. These same results were detected in his mother, but no other members of the kindred presented clinical features consistent with Saethre-Chotzen syndrome. CONCLUSIONS: This mutation was previously reported in individuals with Crouzon and Jackson-Weiss syndromes. The FGFR2 mutation in the family with Saethre-Chotzen syndrome herein reported reinforces the idea of an interaction among TWIST and FGFR genes during development. Absence of the Q289P mutation in some affected individuals in this family is discussed.

Prevençåo de hipertensåo arterial em crianças de 3 a 12 anos na comunidade de Joåo Paulo II / Arterial hypertension prevention in children between 3 to 12 years of age in the community of Joåo Paulo II

A Hipertensåo Arterial Sistêmica (HAS) em crianças era, até pouco tempo atrás, considerada rara. Hoje, sabe-se que é subdiagnosticada, seja por falta de alerta do profissional de saúde, seja por grande demanda no ambulatório, o que impossibilita um exame físico mais completo. O presente trabalho tem como objetivo identificar o risco de HAS futura em crianças de 3 a 12 anos, filhos de pais hipertensos, na comunidade de Joåo Paulo II, no município de Camaragibe. Haja vista a incidência dessa patologia e o fato de já existirem, na área de abrangência do Programa Saúde da Família (PSF), três crianças hipertensas nesta faixa etária. A importância da experiência está em identificar precocemente os pacientes de risco e traçar uma estratégia de prevençåo da HAS futura. Foram aferidas as pressões arteriais de 77 crianças, e, dentre elas, 22 foram identificadas como fora dos padrões de normalidade. A escolha do tema pela equipe foi determinada pela necessidade imediata da promoçåo da saúde na futura populaçåo adulta, partindo da história familiar e pessoal de crianças de 3 a 12 anos de idade. Verificou-se a necessidade de intensificar cada vez mais precocemente a educaçåo em relaçåo à saúde das famílias, orientando-as, por exemplo, a evitarem o uso de alimentos industrializados; mais atençåo dos profissionais de saúde que trabalham com crianças, e os benefícios de uma infância saudável influenciando de forma direta na qualidade de vida do futuro adulto.

Agressão por arma branca e arma de fogo interligada ao consumo de drogas / Agressuib by furearns abd deadly weapon allied to drug consumption

O objetivo deste estudo foi identificar o perfil de 80 clientes submetidos à intervenção cirúrgica, vítimas de agressão por arma branca ou de fogo, que estavam sob efeito de substância psicoativa. Os dados foram coletados através de entrevista e complementado com os registros do prontuário. Constatou-se que a maioria dos entrevistados eram usuários de substâncias psicoativas: jovens, solteiros, sexo masculino, tendo como cenário a rua, predominantemente, nos finais de semana. Em face dos resultados, sugere-se a implementação de estratégias educativas, articulando escolas e comunidade, com o objetivo de combater a violência, a drogadição e o alcoolismo entre crianças e adolescentes...

The objective of this study was to identify the profile of 80 clients submitted to surgical intervention, victims of aggression by firearms and deadly weapon that were affected by psychoactive substances. The data was collected through an interview and completed with register notes. It was noticed that the majority of the interviewed were drug users, young people, single, men that have a street environment, predominantly, on weekends. In lien of the results, it suggests the implementation of educational strategies, articulating school and community, with the objective to combat violence, drug addiction and alcoholism in children and adolescents...

El objetivo de este estudio fue identificar y analizar el perfil de 80 clientes sometidos a intervención quirúrgica, víctimas de agresión por arma blanca o de fuego, que estaban sobre el efecto de sustancia psicoactiva. los datos fueron obtenidos através de la entrevista y complementados con los registros de las historias clínicas. Se constatá que la violencia fue mediada por la agresión de arma blanca o de fuego y la mayoría de los entrevistados eran usuarios de sustancias psicoactivas, jóvenes, solteros, sexo masculino, teniendo como escenario las calles, predominantemente en los finales de semana. Frente a los resultados, se sugiere la implementación de estrategias educativas, articulando las escuelas y la comunidad, con el objetivo de combatir la violencia, la drogadicción y el alcoholismo entre los ninos y adolescentes...

Clinical findings in four Brazilian families affected by Saethre-Chotzen syndrome without TWIST mutations.

OBJECTIVE: To analyze the dysmorphological variability and to investigate the presence of mutations in the exon 1 of TWIST gene using direct sequencing in Brazilian families presenting with Saethre-Chotzen Syndrome (SCS). METHODS: Four families with 24 patients diagnosed as having features of SCS were studied. Phenotypic characteristics of all patients were inventoried. The investigation protocol included anamnesis, dysmorphological examination, abdominal ultrasound, spine and cranium x-ray, chromosomal analysis on GTG banding, and screening for mutations in the exon 1 of TWIST gene. RESULTS: Frequent facial features included brachycephaly (24 of 24), facial asymmetry (20 of 24), prominent ears crus (15 of 24), low-set ears (14 of 24), maxillary hypoplasia (13 of 24), prominent nasal bridge (13 of 24), ptosis of the eyelids (12 of 24), and low-set frontal hairline (12 of 24). Limb abnormalities such as partial hand cutaneous syndactyly (18 of 24), clinodactyly (13 of 24), and broad great toes (13 of 24), and partial cutaneous syndactyly of the feet (9 of 24) were also detected. Among radiological findings were relevant bicoronal (eight of nine) and unicoronal (one of nine) craniosynostosis, digital impressions (eight of nine), bilateral parietal foramina (two of nine), partial fusion 1 and 2 degrees costal arches (two of nine) and bifid spine on lumbar vertebra (two of nine). GTG-banding chromosomal analyses were normal. No TWIST gene mutations were found. CONCLUSIONS: Affected individuals in these four SCS families may carry mutations in other genes of the same developmental pathway. Considering the complexity of the genes involved in skull-limbs development, an accurate dysmorphological evaluation in patients with SCS and their families is especially important for genetic counseling.