The effects of cabergoline in the presurgical and recurrence periods of Cushing's disease patients.

BACKGROUND: The dopaminergic agonist cabergoline (CAB) has been used in the pharmacological treatment of Cushing's disease (CD). The effect is attributed to the frequent expression of the dopamine receptor subtype 2 in corticotroph tumors. However, in vivo studies have demonstrated the normalization of 24-h urinary cortisol (24-h UC) in approximately 30-40% of patients over the long term, mainly after surgical failure. OBJECTIVE: To evaluate the effect of CAB as monotherapy in the early preoperative period and on the recurrence of CD. METHODS: A single-center retrospective study was conducted in a tertiary referral center. Twenty-one patients with confirmed CD were included. The median age was 32 years (13-70), 86% were female, 10 had microadenomas, and 11 had macroadenomas. They were diagnosed from 1986 to 2016 and used CAB as monotherapy either in the preoperative period (n=7, CABi) or upon recurrence before any other treatment (n=14, CABr). A 'complete response' was considered 24-h UC normalization and a 'partial response' was considered a 24-h UC reduction of >50%. UC was obtained at the last follow-up evaluation. The normalization of late-night salivary cortisol (LNSC) after CAB use was evaluated in most patients, as well as the tumor diameter by pituitary MRI, before and after CAB treatment. RESULTS: Complete response was achieved in 29% (6/21) of subjects after 14.9±16.4 months of treatment, with an average dose of 2.2±1.0 mg/week. Partial response occurred in 9.5% (2/21). LNSC normalized in 35% (6/17) of patients, and no variation in tumor diameter before and after CAB use was observed (n=13): 6.8±6.8 vs. 7.2±7.1 mm. There was no normalization of 24-h-UC in the CABi subgroup at the end of the treatment, whereas 43% (6/14) of patients in the CABr subgroup reached complete response. The CABi subgroup was treated for 4.7±1.9 months, and the CABr subgroup was treated for 20.1±18.1 months. Both groups were administered similar doses of CAB (CABi 2.1±0.9 and CABr 2.3±1.1 mg/week). Interestingly, the difference between the subgroups' complete response was evident early on in the three months of treatment: no patients in the CABi subgroup vs. 6/10 (60%) in the CABr subgroup (p=0.035), despite a lower dose in the CABr subgroup (1.1 vs. 1.6; p=0.008). The normalization of LNSC occurred in 20% of the CABi subgroup and in 42% of the CABr subgroup. CONCLUSIONS: The normalization of 24-h UC and LNSC occurred in approximately 30% of all patients, mainly in those who used CAB for the recurrence of CD. Despite the small number of subjects in the CABi subgroup, the absence of hormone control in this subgroup discourages the use of this medication as primary therapy or as a preoperative treatment option.

A Community of Practice of primary health care occupational therapists: Advancing practice-based knowledge.

INTRODUCTION: New contexts of practice demand that professionals engage in critical reflection to handle new situations and to create new knowledge that is responsive to professional practices situated in unique historical and social contexts. Community of Practice offers a framework for professions to reflect together on practice dilemmas and to generate practical solutions. METHODS: This paper presents a participatory action research project that traces the trajectory of a Community of Practice made up of seven occupational therapists working in primary health care and a researcher team, in Brazil. This study mapped the Community of Practice's trajectory between 2013 and 2017 through a group timeline analysis, which occurred gradually, in a collaborative mode. RESULTS: Three distinct phases in the trajectory of the development of the Community of Practice were identified: narrative perspectives were utilised as a means to identify dilemmas and difficulties in practice; the investigation of clients' needs and identification of issues was an ongoing process; and the generation of practice-based knowledge through the development of instruments to sustain clinical reasoning was a creative solution to practical dilemmas. CONCLUSION: Three main aspects were highlighted: the partnership between researchers and practitioners as a potential avenue for the production of knowledge relevant to professional practice; the negotiation of the dilemma of "putting practice into words" in the context of constantly changing local and global perspectives; and the investigation of situated practice as an important element that can strengthen, strain, resist or even modify hegemonic perspectives of knowledge production in our field.

Dispersal behavior of yellowjacket (Vespula germanica) queens.

Understanding the factors that affect animal dispersal behavior is important from both fundamental and applied perspectives. Dispersal can have clear evolutionary and ecological consequences, but for nonnative insect pests, dispersal capacity can also help to explain invasion success. Vespula germanica is a social wasp that, in the last century, has successfully invaded several regions of the world, showing one of the highest spread rates reported for a nonnative insect. In contrast with nonsocial wasps, in social species, queens are responsible for population redistribution and spread, as workers are sterile. For V. germanica, it has been observed that queen flight is limited to 2 distinct periods: early autumn, when new queens leave the nest to mate and find sheltered places in which to hibernate, and spring when new colonies are founded. Our aim was to study the flight behavior of V. germanica queens by focusing on the different periods in which dispersal occurs, characterizing as well the potential contribution of queen flight (i.e., distance) to the observed geographical spread. Our results suggest that the distances flown by nonoverwintered queens is greater than that flown by overwintered individuals, suggesting that the main queen dispersal events would occur before queens enter hibernation. This could relate to a behavioral trait of the queens to avoid the inbreeding with related drones. Additionally, given the short distances flown and remarkable geographical spread observed, we provide evidence showing that queen dispersal by flight is likely to contribute proportionately less to population spread than human-aided factors.

Cross-cultural Adaptation, Reliability, and Validity of the BICAMS in Brazil.

OBJECTIVE: To investigate the reliability and validity of a Brazilian-Portuguese adaptation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). METHOD: A Brazilian sample of 58 multiple sclerosis (MS) patients and 58 healthy controls (HC) were administered the Brazilian-Portuguese BICAMS test battery, comprising the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test Second Edition (CVLT2), and the Brief Visuospatial Memory Test Revised (BVMTR). Mean differences between groups on BICAMS tests were assessed using analysis of covariance (ANCOVA), controlling for age, gender, education, anxiety, and depression. Test-retest data were obtained from 49 of the MS patients, two weeks after the initial assessment. RESULTS: The MS patient group scored significantly lower on all BICAMS tests (CVLT2 F1,110 = 28.99, p < .001; BVMTR F1,110 = 7.77, p < .01; SDMT F1,110 = 21.09, p < .001). Mixed-factor ANCOVAs tested differences in learning curves across trials for CVLT2 and BVMTR. HCs had significantly steeper learning curves on both CVLT2 (F1,111 = 10.82, p < .01) and BVMTR (F1,110 = 7.816, p < .01). These findings support diagnostic validity of the Brazilian-Portuguese adaptation. Test-retest reliability was satisfactory for SDMT, CVLT2, and BVMTR (.86, .84, and .77, respectively). CONCLUSION: The results suggest that this Brazilian version of the BICAMS will be a valid and reliable measure once complete normative data become available.

Cryptococcus neoformans isolados de pacientes com AIDS / Cryptocococcus neoformans in patients with AIDS

Criptococose é considerada a infecçäo fúngica sistêmica oportunista mais comum em pacientes com AIDS. Nestes pacientes tem predominado como agente etiológico Cryptococcus neoformans var. neoformans, e muito raramente relata-se C. neoformans var. gattiii, mesmo nas regiöes onde se verifica a sua prevalência. Foram estudados 50 pacientes com lesöes de criptococose meningoencefálica associada com AIDS. Os isolados foram identificados através de características microscópicas e macroscópicas exibidas em meios de ágar Sabouraud, ágar niger e Christensen. As variedades de C. neoformans foram determinadas pela reaçäo de coloraçäo obtida em meio de L-canavanina glicina-azul de bromotimol (CGB). Em todos os pacientes examinados foram isolados C. neoformans, sendo identificados C. neoformans var. neoformans em 47 isolados e C. neoformans var. gattii em 3. Os resultados encontrados mostram que a criptococose em pacientes com AIDS pode também ser causada por C. neoformans var. gatti, apesar de haver predominância de C. neoformans var neoformans nesta populaçäo